HomeMy WebLinkAbout059982-FP1 - Construction-Related - Contract - Jackson Construction Ltd.-FP1
City Secretary 59982
Contract No.
FORT WORTH,.,
Date Received 3/12/2026
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: Tobias Place
City Project No.: 104117
Improvement Type(s): Water ❑x Sewer Fx
Original Contract Price:
$1,412,317.00
Amount of Approved Change Order(s):
$38,003.80
Revised Contract Amount:
$1,450,320.80
Total Cost of Work Complete:
$1,450,320.80
Ca'VWe4 EJte�
carmen Esleo (Feb 2, L 0 1989 CST)
Contractor
Office Manager
Title
Jackson Construction Ltd.
Company Name
-'�X5
Project Inspector
Project Manager
J��
CFA Manager
Lauren Prleur (Mar 12. 2026 12:46:35 CDT)
TPW Director
02/27/2026
Date
02/27/2026
Date
03/12/2026
Date
03/12/2026
Date
03/12/2026
Date
OFFICIAL RECORD
CITY SECRETARY
FT. WORTH, TX
Page 1 of 2
Notice of Project Completion
Project Name: Tobias Place
City Project No.: 104117
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 L
Statement of Contract Time
Contract Time: 427 WD Days Charged: 429 WD
Work Start Date: 11/16/2023 Work Complete Date: 11/24/2025
Completed number of Soil Lab Test: 541
Completed number of Water Test: 0
Page 2 of 2
FORT WORTH
CITY OF FORT WORTH
FINAL PAYMENT REQUEST
Contract Name TOBIAS PLACE
Contract Limits
Project Type WATER & SEWER
City Project Numbers 104117
DOE Number 4117
Estimate Number 1 Payment Number I
City Secretary Contract Number
Contract Date
For Period Ending 11/24/2025
WD
Project Manager NA
Contractor JACKSON CONSTRUCTION LTD
5112 SUN VALLEY DRIVE
FORT WORTH, TX 76119
Inspectors AGUIL,LON / WATSON
Contract Time 427 WD
Days Charged to Date 429
Contract is 100.00 Complete
Wednesday, February 18, 2026 Page I of 5
City Project Numbers 104117
Contract Name TOBIAS PLACE
Contract Limits
Project Type WATER & SEWER
Project Funding
UNIT L• WATER IMPROVEMENTS
Item Description of Items
No.
-----------------
1 10' WIDE ASPHALT PVMT REPAIR, ARTERIAL
2 CONC PVMT REPAIR, ARTERIAL/INUSTRIAL
3 6" CONC CURB ABD GUTTER
4 101" WATERLINR LOWERING
5 TRENCH SAFTEY
6 24" CASING BY OPEN CUT
7 TRAFFIC CONTROL
8 REMOVE WATER SERVICE (CO#2)
9 SALVAGE 1" WATER METER (CO#2)
10 CONC PVMT REPAIR, RESIDENTIAL (CO#2)
11 REMOVE EX FH AND INSTALL HEW SUPPLIED
FH
DOE Number 4117
Estimate Number 1
Payment Number I
For Period Ending 11/24/2025
Estimated
Unit
Unit Cost
Estimated
Completed
Completed
Quanity
Total
Quanity
Total
----------------------
140
LF
$225.00
$31,500.00
140
$31,500.00
10
SY
$220.00
$2,200.00
10
$2,200.00
10
LF
$130.00
$1,300.00
10
$1,300.00
5
EA
$17,265.00
$86,325.00
5
$86,325.00
I
LS
$250.00
$250.00
1
$250.00
45
LF
$415.00
$18,675.00
45
$18,675.00
1
MO
$4,000.00
$4,000.00
1
$4,000.00
1
EA
$2,600.00
$2,600.00
1
$2,600.00
1
EA
$100.00
$100.00
1
$100.00
140
SY
$220.00
$30,800.00
140
$30,800.00
1
LS
$3,000.00
$3,000.00
1
$3,000.00
--------------------------------------
Sub-Total of Previous Unit $180,750.00 $180,750.00
UNIT If: SANITARY IMPROVEMENTS
Item Description of Items
No.
----------------
1 SANITARY LINE GROUTING
1 REMOVE 8" SEWER LINE (CO#2)
2 REMOVE 12" SEWER LINE
3 12" SEWER ABANDOMENT PLUG
4 REMOVE 4' SEWER MANHOLE
5 10' WIDE ASPHALT PVMT REPAIR, ARTERIAL
(JENNINGS AVE)
6 ASPHALT PVMT REPAIR BEYOND DEFINED
WIDTH, ARTERIAL (JENNINGS AVE)
7 TEMPORARY ASPHALT PAVING REPAIR
(BUTLER ST & ALLIES)
8 CONC PVMT REPAIR, HES
ARTERIAANDUSTRIAL
9 TOPSOIL
10 UTILITY SERVICE SURFACE RESTORATION
SEDDING
Estimated Unit Unit Cost Estimated Completed Completed
Quanity Total Quanity Total
----------------------
20 CY $500.00 $10,000.00 20 $10,000.00
33.5 LF $10.00 $335.00 33.5 $335.00
45 LF $10.00 $450.00 45 $450.00
4 EA $100.00 $400.00 4 $400.00
2 EA $3,500.00 $7,000.00 2 $7,000.00
250 LF $215.00 $53,750.00 250 $53,750.00
170 SY $115.00 $19,550.00 170 $19,550.00
85 LF $38.00 $3,230.00 85 $3,230.00
100 SY $215.00 $21,500.00 100 $21,500.00
34 CY $65.00 $2,210.00 34 $2,210.00
405 SY $9.00 $3,645.00 405 $3,645.00
Wednesday, February 18, 2026 Page 2 of 5
City Project Numbers 104117 DOE Number 4117
Contract Name TOBIAS PLACE Estimate Number 1
Contract Limits Payment Number 1
Project Type SANITARY For Period Ending 11/24/2025
Project Funding
I I PRE -CCTV INSPECTION
700 LF
$6.00
$4,200.00
700
$4,200.00
12 PRE -CCTV INSPECTION
813 LF
$10.00
$8,130.00
813
$8,130.00
13 MANHOLE VACUUM TESTING
10 EA
$200.00
$2,000.00
10
$2,000.00
14 BYPASS PUMPING
I LS
5125,000.00
$125,000.00
1
$125,000.00
15 TRENCH SAFETY
686 LF
$2.00
$1,372.00
686
$1,372.00
16 CONCRETE COLLAR FOR MANHOLE
4 EA
$1,125.00
$4,500.00
4
$4,500.00
17 TRENCH WATER STOPS
7 EA
$900.00
$6,300.00
7
$6,300.00
18 CONCRETE ENCASEMENT FOR UTILITY PIPES
0 CY
$250.00
$0.00
0
$0.00
(CO#1)
19 IMPORTED EMBEDMENT/BACKFILL, CSS
10 CY
$200.00
$2,000.00
10
$2,000.00
20 IMPORTED EMBEDMENT/BACKFILL, SELECT
125 CY
$50.00
$6,250.00
125
$6,250.00
FILL
21 20" CASING BY OPEN CUT
185 LF
$395.00
$73,075.00
185
$73,075.00
22 8" SEWER CARRIER PIPE (DIP)
50 LF
$290.00
$14,500.00
50
$14,500.00
23 12" SEWER CARRIER PIPE (DIP)
135 LF
$545.00
$73,575.00
135
$73,575.00
24 8" SEWER PIPE (CO#2)
59.5 LF
$420.00
$24,990.00
59.5
$24,990.00
25 8" DIP SEWER PIPE
20 LF
$296.00
$5,920.00
20
$5,920.00
26 12" DIP SEWER, SELECT BACKFILL
65 LF
$548.00
$35,620.00
65
$35,620.00
27 EPDXY MANHOLE LINER
195 VF
$450.00
$87,750.00
195
$87,750.00
28 4' MANHOLE
7 EA
$31,000.00
$217,000.00
7
$217,000.00
29 4' DROP MANHOLE
3 EA
$29,500.00
$88,500.00
3
$88,500.00
30 4' EXTRA DEPTH MANHOLE
110 VF
$200.00
$22,000.00
110
$22,000.00
31 TRAFFIC CONTROL
1 MO
$4,000.00
$4,000.00
I
$4,000.00
32 15" HDPE SEWER PIPE (CO#1)
0 LF
$575.00
$0.00
0
$0.00
33 15" HDPE SEWER PIPE, SELECT BACKFILL
0 LF
$575.00
$0.00
0
$0.00
(CO#1)
34 15" PVC SEWER PIPE, SELECT BACKFILL
206 LF
$595.00
$122,570.00
206
$122,570.00
35 16" SEWER CARRIER PIPE (DIP) (CO#1)
280 LF
$209.46
$58,648.80
280
$58,648.80
36 30" CASING B OPEN CUT (CO#1)
280 LF
$400.00
$112,000.00
280
$112,000.00
37 15" PVC SEWER PIP, SELECT BACKFILL (CO#1)
--------------------------------------
80 LF
$595.00
$47,600.00
80
$47,600.00
Sub-Total of Previous Unit
$1,269,570.80
$1,269,570.80
--------------------------------------
Wednesday, February 18, 2026
Page 3 of 5
City Project Numbers 104117
Contract Name TOBIAS PLACE
Contract Limits
Project Type SANITARY
Project Funding
Contract Information Summary
Original Contract Amount
Change Orders
Change Order Number 1
Change Order Number 2
Change Order Number 2
Change Order Number 3
DOE Number 4117
Estimate Number 1
Payment Number 1
For Period Ending 11/24/2025
$1,412,317.00
($1.20)
$33,500.00
$1,505.00
$3,000.00
Total Contract Price $1,450,320.80
Total Cost of Work Completed $1,450,320.80
Less % Retained $0.00
Net Earned $1,450,320.80
Earned This Period $1,450,320.80
Retainage This Period $0.00
Less Liquidated Damages
Days @ / 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
$1,450,320.80
Wednesday, February 18, 2026 Page 4 of 5
City Project Numbers 104117
Contract Name TOBIAS PLACE
Contract Limits
Project Type SANITARY
Project Funding
Project Manager NA
Inspectors AGUILLON / WATSON
Contractor JACKSON CONSTRUCTION LTD
5112 SUN VALLEY DRIVE
FORT WORTH, TX 76119
DOE Number 4117
Estimate Number 1
Payment Number 1
For Period Ending 11/24/2025
City Secretary Contract Number
Contract Date
Contract Time 427 WD
Days Charged to Date 429 WD
Contract is .000000 Complete
CITY OF FORT WORTH
SUMMARY OF CHARGES
Line Fund Account Center Amount Gross Retainage
Funded
Net
Total Cost of Work Completed $1,450,320.80
Less % Retained
$0.00
Net Earned
$1,450,320.80
Earned This Period $1,450,320.80
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
$1,450,320.80
Wednesday, February 18, 2026 Page 5 of 5
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10
a
FORT WORTH
TRANSPORTATION AND PUBLIC WORKS
PIPE REPORT FOR:
PROJECT NAME:
Tobias Place
CITY PROJECT NUMBER: 104117
WATER
PIPE LAID
SIZE TYPE OF PIPE
LF
FIRE HYDRANTS:
VALVES (16" OR LARGER)
PIPE ABANDONED
SIZE TYPE OF PIPE
LF
DENSITIES:
NEW SERVICES:
SEWER
PIPE LAID
SIZE TYPE OF PIPE
LF
Sewer Pipe
8" PVC
56LF
Sewer Pipe
8" DIP
20LF
Sewer Pipe
12" DIP
65LF
Sewer Pipe
15" HDPE
28OLF
PIPE ABANDONED
SIZE TYPE OF PIPE
LF
DENSITIES:
NEW SERVICES:
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.
TRANSPORTATION AND PUBLIC WORKS
November 26, 2025
Jackson Construction, Ltd.
5112 Sun Valley Dr
Fort Worth, TX 76119
RE: Acceptance Letter
Project Name: Tobias Place
Project Type: Water, Sewer
City Project No.: 104117
To Whom It May Concern:
On November 25, 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 November 26, 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 November 26,
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-
392-8424.
Sincerely,
Sandip Adhikari, P.E., Project Manager
Cc: Sergio Garcia, Inspector
Don Watson, Inspection Supervisor
Oscar Aguillon, Senior Inspector
Andrew Goodman, P.E., Program Manager
Spiars Engineering, Consultant
Jackson Construction, Ltd., Contractor
Tobias Place, LP., Developer
File
E-Mail: TPW_Acceptance@fortworthtexas.gov
Rev. 8/20/19
JACK260
CONSTRUCTION LTD.
51 1 Z SUN VALLEY DRIVE
FORT WORTH, TX 76 19
TEL: 817-572-3303
FAX: 817-478-0443
AFFIDAVIT
STATE OF TEXAS
COUNTY OF TARRANT
Before me, the undersigned authority, a notary public in the state
and county aforesaid, on this day personally appeared Troy L. Jackson,
President Of Jackson Construction, Ltd, 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;
Sanitary Sewer, Drainage, Paving, and Street Light Improvements to serve
Tobias Place
Troy . Jackson, President
Subscribed and sworn before me on this date 18th of November, 2025.
CARMEN L. ESTEP
Notary Public, State of Texas
Comm. Expires 04-06-2028
Notary ID 2910611
Notary Public
Tarrant, Texas
CONSTRUCT10N LTD
51 12 SUN VALLEY DRIVE
FORT WORTH, TX 76119
TEL: 817-572-3303
FAX: 817-478-0443
AFFIDAVIT
STATE OF TEXAS
Before me, the undersigned authority, a notary public in the state
and county aforesaid, on this day personally appeared Troy L. Jackson,
President Of Jackson Construction, Ltd, 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;
Water Improvements to serve Tobias Place
BY Ll�%l/r�l
Troy . Jackson, President
Subscribed and sworn before me on this date 15th of April, 2024.
Tarrant, Texas
I
''�� CARMEN L. ESTEP
4�Y PLB'i
Notary Public, State of Texas
Comm. Expires 04-06-2028
Notary ID 29 O6611
CONSENT OF SURETY
OWNFR
❑
TO FINAL PAYMENT
ARCHITECT
❑
CONTRACTOR
❑
ALA Document G707
SURETY
g}
Rnnt1 Nn 11 n3A77
OTHF,R
❑
TO OWNER
ARCHITECT'S PROJECT NO.:
(Name arrd addrer)
Tobias Place, LP and City of Fort Worth CONTRACT' FOR: CFA23-0067 - Tobias Place -
TX Drainage, Sanitary & Storm Sewer
PROJECT: CONTRACT DATED:
(Name and addrrr.,j
CFA23-0067 - Tobias Place - Drainage, Sanitary & Storm Sewer
In accordance with the provisions of the Contract between the Owner and the Contractor as indicated above, the
(him" rrarneand addAngf$UMA9
The Hanover Insurance Company
440 Lincoln Street
Worcester, MA 01653
, SURETY,
on bond of
(lncen name and addrec of Cut(ratlu )
Jackson Construction, Ltd.
5112 Sun Valley Drive
Fort Worth, TX 76119
CONTRACTOR,
hereby approves of the final payment to the Contractor, and agrees that final payment to the Contractor shall not relieve the Surety of
any of its obligations to
(G>wr7 name and addrev ofOu er)
Tobias Place, LP and City of Fort Worth
TX
as set forth in said Surety's bond.
IN WITNESS WHEREOF, the Surety has hereunto set its hand on this date: November 18, 2025
(lilsarY! do ugdtbrj( tl7e rnontb follou�rf fiY the rrroner(c drrrrarrd icwr )
Attest:
(Sea)):
Clay Aikman, Surety Witness
The Hanover Insurance Company
(SrrrtH,Y)
(StgrratxrrofatNbo zr%trrprssrnratdr)
Misty Witt, Attorney -in -Fact
(Pointed name and iftle)
, OWNER,
G707--1994
THE HANOVER INSURANCE COMPANY
MASSACHUSETTS BAY INSURANCE COMPANY
CITIZENS INSURANCE COMPANY OF AMERICA
POWER OF ATTORNEY
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.
KNOW ALL PERSONS BY THESE PRESENTS:
That THE HANOVER INSURANCE COMPANY and MASSACHUSETTS BAY INSURANCE COMPANY, both being corporations organized and existing under the
laws of the State of New Hampshire, and CITIZENS INSURANCE COMPANY OF AMERICA, a corporation organized and existing under the laws of the State of
Michigan, (hereinafter individually and collectively the "Company") does hereby constitute and appoint,
Misty Witt
Of Dallas, TX individually, if there be more than one named, as its true and lawful attorney(s)-in-fact to sign, execute, seal, acknowledge and
deliver for, and on its behalf. and as its act and deed any place within the United States, any and all surety bonds, recognizances, undertakings, or other surety
obligations. The execution of such surety bonds, recognizances, undertakings or surety obligations, in pursuance of these presents, shall be as binding upon the
Company as if they had been duly signed by the president and attested by the secretary of the Company, in their own proper persons. Provided however, that this
power of attorney limits the acts of those named herein, and they have no authority to bind the Company except in the manner stated and to the extent of any
limitation stated below:
Any such obligations in the United States, not to exceed Fifty Million and Noll00 ($50,000,000) in any single instance
That this power is made and executed pursuant to the authority of the following Resolutions passed by the Board of Directors of said Company, and said Resolutions
remain in full force and effect:
SuMty Bond Number: 1103977
Principal: Jackson Construction, Ltd.
OWlgee: Tobias Place, LP and City of Fort Worth
RESOLVED: That the President or any Vice President, in conjunction with any Vice President, be and they hereby are authorized and empowered to
appoint Attorneys -in -fact of the Company, in its name and as it acts, to execute and acknowledge for and on its behalf as surety, any and all bonds,
recognizances, contracts of indemnity, waivers of citation and all other writings obligatory in the nature thereof, with power to attach thereto the seal of the
Company Any such writings so executed by such Attorneys -in -fact shall be binding upon the Company as if they had been duly executed and
acknowledged by the regularly elected officers of the Company in their own proper persons.
RESOLVED: That any and all Powers of Attorney and Certified Copies of such Powers of Attorney and certification in respect thereto, granted and
executed by the President or Vice President in conjunction with any Vice President of the Company, shall be binding on the Company to the same extent
as if all signatures therein were manually affixed, even though one or more of any such signatures thereon maybe facsimile (Adopted October 7, 1981 —
The Hanover Insurance Company, Adopted April 14, 1982 — Massachusetts Bay Insurance Company, Adopted September 7, 2001 — Citizens Insurance
Company of America and affirmed by each Company on March 24, 2014)
IN WITNESS WHEREOF, THE HANOVER INSURANCE COMPANY, MASSACHUSETTS BAY INSURANCE COMPANY and CITIZENS INSURANCE COMPANY
OF AMERICA have caused these presents to be sealed with their respective corporate seals, duly attested by two Vice Presidents, this 22nd day of April 2025
Y
1 be Ilanuscr lusurauce Cumpany
Nlamchusetb Bay Insurance Company
Citizens Insurance Company of America
J17s H. Kawieckl, Vice President
STATE OF CONNECTICUT )
COUNTY OF HARTFORD ) ss.
the liAnuscr laauraocc (Cwnyan)
1 huxetls Bay Insurance Company y(fE/Aa
nsurance ( ompam of America
Ilan M. Mendoza, Vice Prosident
On this 22"d day of April, 2025 before me came the above named Executive Vice President and Vice President of The Hanover Insurance Company,
Massachusetts Bay Insurance Company and Citizens Insurance Company of America, to me personally known to be the individuals and officers described herein,
and acknowledged that the seals affixed to the preceding instrument are the corporate seals of The Hanover Insurance Company, Massachusetts Bay Insurance
Company and Citizens Insurance Company of America, respectively, and that the said corporate seals and their signatures as officers were duly affixed and
subscribed to said instrument by the authority and direction of said Corporations.
AL KATHLEEN M. SIRARD
WNotary Public
Commonweahh of mussochusetts
My Commission Ejires
Sootember 2, 2027
Kat een M.Sirard, Notary.,Public
My C7mission expires, September 2, 2027
I, the undersigned Vice President of The Hanover Insurance Company, Massachusetts Bay Insurance Company and Citizens Insurance Company of America,
hereby certify that the above and foregoing is a full, true and correct copy of the Original Power of Attorney issued by said Companies, and do hereby further certify
that the said Powers of Attorney are still in force and effect.
GIVEN under my hand and the seals of said Companies, at Worcester, Massachusetts, this 18th day of November 2025
CERTIFIED COPY
The an ?ra
e ompa
M.9
c aany
Ci oha RewPresident
CONSENT OF SURETY
TO FINAL PAYMENT
ALA Document G707
Bond No. 1103976
TO OWNER:
(Name and adi ivz)
Tobias Place, LP & City of Fort Worth, TX
TX
IRON!
ttl[tme orrdacLtir��}
Tobias Place Water Improvements / CPN103820
ARCH1T r,,C`1'
CO vMCTOR
SURM,
O"rd
ARCMTECT'S PROJECT NO.
CONTRACT FOR: Construction
CONTRACT DATED: October 27, 2023
In accordance with the provisions ofthe Contract between the Owner and the Contractor as indimtcd above, the
(inset nanw and addkvngrW m-0)
The Hanover Insurance Company
440 Lincoln Street
Worcester, MA 01653
oat bond of
,(In$e71 reame ay id addn%q efConinn w)
lj
SURETY,
Jackson Construction, Ltd.
5112 Sun Valley Drive
Fort Worth, TX 76119
CONTRACTOR,
Ixereby approves of the final payment to the Contmaor, and agrees drat final payment to The Contractor shall not relieve the Surety of
any of its abiigations to
!!rt+� t7 nwruc and acttltx.m of OrrncT}
Tobias Place, LP & City of Fort Worth, TX
TX
as set forth in said Surety's bond.
, OWNER,
IN WIN M- WHEF,EOF, the Surety has bereunto set its band on this date: April 15, 2024
(I)Es w (tz m0thig flee wonir5,jrr ibwed hr dx wonerk date and Ivar,)
ME
Attest: 9Q o
Laurie Pflug Attorney -in -Fact
t
,Panted aame arx(f€to
0707---1994
THE HANOVER INSURANCE COMPANY
MASSACHUSETTS BAY INSURANCE COMPANY
CITIZENS INSURANCE COMPANY OF AMERICA
POWER OF ATTORNEY
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.
KNOW ALL PERSONS BY THESE PRESENTS:
ThatTHE HANOVER INSURANCE COMPANY and MASSACHUSETTS BAY INSURANCE COMPANY, both being corporations organized and existing underthe
laws of the State of New Hampshire, and CITIZENS INSURANCE COMPANY OF AMERICA, a corporation organized and existing underthe laws of the State of
Michigan, (hereinafter individually and collectively the "Company") does hereby constitute and appoint,
Jack M. Crowley, Laurie Pflug, and/or Holly Clevenger
Of Willis Towers Watson Insurance Services West, Inc of Dallas, TX each individually, if there be more than one named, as its true and lawful attomey(s)-in-fact
to sign, execute, seal, acknowledge and deliver for, and on its behalf, and as its act and deed any place within the United States, any and all surety bonds,
recognizances, undertakings, or other surety obligations. The execution of such surety bonds, recognizances, undertakings or surety obligations, in pursuance of
these presents, shall be as binding upon the Company as if they had been duly signed by the president and attested by the secretary of the Company, in their own
proper persons. Provided however, that this power of attorney limits the acts of those named herein; and they have no authority to bind the Company except in the
manner stated and to the extent of any limitation stated below:
Any such obligations in the United States, not to exceed Fifty Million and Noll 00 ($60,000,000) in any single instance
That this power is made and executed pursuant to the authority of the following Resolutions passed by the Board of Directors of said Company, and said Resolutions
remain in full force and effect:
RESOLVED: That the President or any Vice President, in conjunction with any Vice President, be and they hereby are authorized and empowered to
appoint Attorneys -in -fact of the Company, in its name and as it acts, to execute and acknowledge for and on its behalf as surety, any and all bonds,
recognizances, contracts of indemnity, waivers of citation and all otherwritings obligatory in the nature thereof, with powerto attach thereto the seal ofthe
Company. Any such writings so executed by such Attorneys -in -fact shall be binding upon the Company as if they had been duly executed and
acknowledged by the regularly elected officers of the Company in their own proper persons.
RESOLVED: That any and all Powers of Attorney and Certified Copies of such Powers of Attorney and certification in respect thereto, granted and
executed by the President or Vice President in conjunction with any Vice President of the Company, shall be binding on the Company to the same extent
as if all signatures therein were manually affixed, even though one or more of any such signatures thereon may be facsimile. (Adopted October 7,1981—
The Hanover Insurance Company; Adopted April 14,1982 — Massachusetts Bay Insurance Company; Adopted September 7, 2001—Citizens Insurance
Company of America and affirmed by each Company on March 24, 2014)
IN WITNESS WHEREOF, THE HANOVER INSURANCE COMPANY, MASSACHUSETTS BAY INSURANCE COMPANY and CITIZENS INSURANCE COMPANY
OF AMERICA have caused these presents to be sealed with their respective corporate seals, duly attested by two Vice Presidents, this 121h day of September,
2023
The Ilauowr insurance Cumpauy
M*suchwwtts Bay tnssrance Company
Citizens insurance Company_ofAmerka
—avq4 4T
J s H• Kawiecki, Vies President
STATE OF CONNECTICUT
COUNTY OF HARTFORD
) ss.
"rlic Ilanover Insurance Company
b achusetts Day Insurance Company
as Insurance Company of America
(ten M. Mendoza, Vice President
On this 12th day of September, 2023 before me came the above named Executive Vice President and Vice President of The Hanover Insurance Company,
Massachusetts Bay Insurance Company and Citizens Insurance Company of America, to me personally known to be the individuals and officers described herein,
and acknowledged that the seals affixed to the preceding instrument are the corporate seals of The Hanover Insurance Company, Massachusetts Bay Insurance
Company and Citizens Insurance Company of America, respectively, and that the said corporate seals and their signatures as officers were duly affixed and
subscribed to said instrument by the authority and direction of said Corporations.
Wendy Latoumes
Notary Public, State of Connecticut
[�=&* Commission Expires July 31, 2025
Mridy Latoai est , b ry . u tic
My cort tfe4ton expires July 31, 2C25
k..
I, the undersigned Vice President of The Hanover Insurance Company, Massachusetts Bay Insurance Company and Citizens Insurance Company of America,
hereby certify that the above and foregoing is a full, true and correct copy of the Original Power of Attorney issued by said Companies, and do hereby further certify
that the said Powers of Attorney are still in force and effect
GIVEN under my hand and the seals of said Companies, at Worcester, Massachusetts, this 15th day of April 2024.
CERTIFIED COPY
The Le
urance .ompa
M ay Ins punyCie n Ain ' a---
obn Roweddcr, Vice President