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HomeMy WebLinkAboutContract 43501-FP1 o )DC� � � yj -_ JAN 16 2015 i TRANSPORTATION AND PUBLIC WORKS 8y NOTICE OF PROJECT COMPLETION CS /4 -3 S i D.O.E. Ns: 6786 Regarding contract 43501 for MEDICAL DISTRICT WATER DISTRIBUTION SYS IMP PT8 as required by the WATER DEPARTMENT as approved by City Council on 07/10/2012 through M&C C-25716 the director of the WATER DEPARTMENT upon the recommendation of the Assistant Director of the Transportation&Public Works Department has accepted the project as complete. Original Contract Prices: $1,441,842.00 J Amount of Approved Change Orders: $70,716.00 Ns 1,2,3 Revised Contract Amount: $1,512,558.00 Total Cost Work Completed: $1,491,916.00 Less Deductions: Liquidated Damages: Days @$210.00/Day Pavement Deficiencies: i Total Deduction Amount: $0.00 Total Cost Work Completed: $1,491,916.00 Less Previous Payments: $1,476,996.84 Final Payment Due $14,919.16 Recommende for Acceptance Date Asst. Director, TPW - Infrastructure Design and Construction I I � ; Accepted Date Director, WATER DEPARTMENT City Manager Dat Comments: FUND ACCT:P265-609170168787 1 � 1\ JAN 1 2015 �g�II City Project Numbers 01687 / -� y�'�"'� DOE Number 6786 Contract Name MEDICAL DISTRICT WATER DISTRIBUTION SYS IMP PT 8 Estimate Number 21 Contract Limits JPS AND DANNON AREA Payment Number 21 Project Type WATER For Period Ending 12/15/2014 Project Funding P265 609170168787 I Project Manager Kasavicb City Secretary Contract Number 43501 Inspectors DICKINSON / WATSON Contract Date 7/10/2012 Contractor CIRCLE C CONSTRUCTION COMPANY Contract Time 200 CD PO BOY 40328 Days Charged to Date 239 CD FORT WORTH, TX 76I40 Contract is .000000 Complete � :zt CITY OF FORT WORT: a; _�, �� SUMMARY OF CHAR ��S� I � Line Fund Account Center Amount Gross Retainage Net _ Funded ---- ——,� --ui "J" r ;" i Total Cost of Work Completed $1,491,916.00 Less %Retained $0.00 Net Earned $1,491,916.00 EfT Earned Th is Period $14,919.16 ``� '�'1SRV Retainage This Period $0.00 Ccnt a crs,- w 1jii' Less Liquidated Damages t �. si S%tia cr 0 Days @ $0.00 /Day $0.00 LessPavement Deficiency $0.00 DEPARTMENT CHECK PIC 1!P E� Less Penalty $0.00 Less Previous Payment $1,476,996.84 Plus Material on Hand Less 15% $0.00 : Balance Due This Payment $14,919.16 Thursday,December 18,2014 Page 6 of 6 I FORTWORTH CITY OF FORT WORTH FINAL PAYMENT REQUEST Contract Name MEDICAL DISTRICT WATER DISTRIBUTION SYS IMP PT 8 Contract Limits JPS AND DANNON AREA Project Type WATER I City Project Numbers 01687 DOE Number 6786 Estimate Number 21 Payment Number 21 For Period Ending 12/15/2014 CD i City Secretary Contract Number 43501 Contract Time 201ED Contract Date 7/10/2012 Days Charged to Date 239 j I Project Manager Kasavich Contract is 99.000 %Complete i Contractor CIRCLE C CONSTRUCTION COMPANY PO BOX 40328 FORT WORTH, TX 76140 i Inspectors DICKINSON / WATSON i i J Thursday,December 18,2014 Page I of 6 City Project Numbers 01687 DOE Number 6786 Contract Name MEDICAL DISTRICT WATER DISTRIBUTION SYS IMP PT 8 Estimate Number 21 Contract Limits JPS AND DANNON AREA Payment Number 21 Project Type WATER For Period Ending 12115/2014 Project Funding P265 609170168787 UNIT I.WATER P265 609170168787 Item Description of Items Estimated Unit Unit Cost Estimated Completed Completed No. Quanity Total Quanity Total 1 4"PVC WATER PIPE,CSS BACKFILL 35 LF $140.00 $4,900.00 35 $4,900.00 2 6"PVC WATER PIPE,CSS BACKFILL 420 LF $145.00 $60,900.00 372 $53,940.00 3 8"PVC WATER PIPE,CSS BACKFILL CO 42 422 LF $150.00 $63,300.00 422 $63,300.00 CO#3 4 10"PVC WATER PIPE,CCS BACKFILL 40 LF $155.00 $6,200.00 32 $4,960.00 5 12"PVC WATER PIPE,CCS BACKFILL 2960 LF $160.00 £473,600.00 2998 $479,680.00 6 12"DIP WATER,CSS BACKFILL 260 LF $175.00 $45,500.00 261 $45,675.00 7 16'DIP WATER,CSS BACKFILL(RESTRAINED 900 LF $182.00 $163,800.00 876 $159,432.00 JOINTS) 9 6"WATER CARRIER PIPE 80 LF $55.00 $4,400.00 80 $4,400.00 10 6"SEER PIPE,CCS BACKFILL 60 LF $155.00 $9,300.00 20 $3,100.00 11 8"SEWER PIPE,CSS BACKFILL 60 LF $165.00 $9,900.00 60 $9,900.00 12 10"SEWER PIPE,CSS BACKFILL 40 LF $175.00 $7,000.00 20 $3,500.00 13 CONCRETE ENCASE SEWER PIPE 5 CY $125.00 $625.00 14 6"GATE VALVE 18 EA $700.00 $12,600.00 17 $11,900.00 15 8"GATE VALVE 4 EA $950.00 $3,800.00 9 $8,550.00 16 10"GATE VALVE 3 EA $1,500.00 $4,500.00 3 $4,500.00 17 12"GATE VALVE 17 EA $1,950.00 $33,150.00 17 $33,150.00 18 16"GATE VALVE W!VAULT 5 EA $8,500.00 $42,500.00 5 $42,500.00 19 12"x 6"TAPPING SLEEVE&VALVE 1 EA $1,800.00 $1,800.00 1 $1,800.00 20 FIRE HYDRANT 12 EA $2,200.00 $26,400.00 14 $30,800.00 21 DUCTILE IRON WATER FITTINGS 16 TN $5,000.00 $80,000.00 17.375 $86,875.00 22 1"WATER SERVICE METER RELOCATIONS 19 EA $350.00 $6,650.00 19 $6,650.00 CO#3 23 1"WATER SERVICE CO#3 21 EA $550.00 $11,550.00 21 $11,550.00 24 1"PRIVATE SERVICE 60 LF $85.00 $5,100.00 60 $5,100.00 25 1 1/2"WATER SERVICE,METER RELOCATION 5 EA $400.00 $2,000.00 5 $2,000.00 26 1 I/2"BORED SERVICE 1 EA $500.00 $500.00 1 $500.00 27 1 1/2"WATER SERVICE 4 EA $650.00 $2,600.00 4 $2,600.00 28 1 1/2"PRIVATE SERVICE 68 LF $75.00 $5,100.00 68 $5,100.00 29 2"WATER SERVICE,METER RELOCATION 5 EA $2,000.00 $10,000.00 5 $10,000.00 30 2"WATER SERVICE 5 EA $1,200.00 $6,000.00 5 $6,000.00 Thursday,December 18,2014 Page 2 of 6 i City Project Numbers 01687 DOE Number 6786 Contract Name MEDICAL DISTRICT WATER DISTRIBUTION SYS IMP PT 8 Estimate Number 21 Contract Limits JPS AND DANNON AREA Payment Number 21 Project Type WATER For Period Ending 12/15/2014 Project Funding P265 609170168787 31 3"WATER METER AND VAULT 1 EA $9,500.00 $9,500.00 1 $9,500.00 32 4"WATER METER AND VAULT 1 EA $11,000.00 $11,000.00 1 $11,000.00 33 6"WATER METER AND VAULT 1 EA $13,000.00 $13,000.00 1 $13,000.00 34 WATER LINE GROUTING 55 CY $125.00 $6,875.00 48 $6,000.00 35 SALVAGE FIRE HYDRANT 6 EA $800.00 $4,800.00 6 $4,800.00 36 REMOVE 4"WATER VALVE 1 EA $200.00 $200.00 1 $200.00 37 REMOVE 6"WATER VALVE 8 EA $200.00 $1,600.00 8 $1,600.00 38 REMOVE 8"WATER VALVE 5 EA $200.00 $1,000.00 5 $1,000.00 39 REMOVE 12"WATER VALVE 7 EA $250.00 $1,750.00 7 $1,750.00 40 SALVAGE 3"WATER METER 1 EA $250.00 $250.00 1 $250.00 41 SALVAGE 4"WATER METER 1 EA $250.00 $250.00 1 $250.00 42 SALVAGE 6"WATER METER 1 EA $250.00 $250.00 1 $250.00 43 REMOVE CONCRETE WATER VAULT 3 EA $1,500.00 $4,500.00 3 $4,500.00 44 TRENCH SAFETY 4875 LF $1.00 $4,875.00 4866 $4,866.00 45 UTILITY MARKERS 1 LS $1,500.00 $1,500.00 1 $1,500.00 46 6'WIDE ASPHALT PVMT REPAIR, 426 LF $40.00 $17,040.00 426 $17,040.00 RESIDENTIAL. 47 6'WIDE ASPHALT PVMT REPAIR,ARTERIAL 3608 LF $45.00 5162,360.00 3504 $157,680.00 48 ASPHALT PVMT REPAIR BYEOND DEFINED 20 SY $14.00 $280.00 WIDTH,RESIDENTIAL 49 ASPHALT PVMT REPAIR BEYOND DEFINED 270 SY $14.00 $3,780.00 208 $2,912.00 WIDTH ARTERIAL i 50 6"CONC CURB AND GUTTER 220 LF $25.00 $5,500.00 25 $625.00 i 51 SEEDING,HYDROMULCH 209 SY $5.00 $1,045.00 52 4"CONC SIDEWALK 916 SF $7.00 $6,412.00 2145 $15,015.00 53 EXPLORATORY EXCAVATION OF EXISTING 4 EA $1,500.00 $6,000.00 4 $6,000.00 j UTILITIES 54 TRAFFIC CONTROL 6 MO $4,500.00 $27,000.00 6.222 $27,999.00 55 4"SLD PVMT MARKING HAS(V) 260 LF $3.00 $780.00 1 $3.00 56 4"SLD PVMT MARKING HAS(Y) 840 LF $3.00 $2,520.00 1014 $3,042.00 57 4"BRK PVMT MARKING HAS(W) 150 LF $3.00 $450.00 253 $759.00 58 4"BRK PVMT MARKING HAS(Y) 210 LF $3.00 $630.00 253 $759.00 59 8"SLD PVMT MARKING HAS(W) 200 LF $5.00 $1,000.00 60 8"SLD PVMT MARKING HAS(Y) 100 LF $5.00 $500.00 61 12"SLD PVMT MARKING HAS(W) 120 LF $7.50 $900.00 104 $780.00 62 18"SLD PVMT MARKING HAS(W)CO#3 45 LF $10.00 $450.00 45 $450.00 I Thursday,December 18,2014 Page 3 of 6 i 1 City Project Numbers 01687 DOE Number 6786 Contract Name MEDICAL DISTRICT WATER DISTRIBUTION SYS IMP PT 8 Estimate Number 21 Contract Limits JPS AND DANNON AREA Payment Number 21 Project Type WATER For Period Ending 12/1512014 Project Funding P265 609170168787 63 LANE LEGEND ARROW 5 EA $500.00 $2,500.00 I $500.00 64 LANE LEGEND BIKE 1 EA $500.00 $500.00 1 $500.00 65 REFL RAISED MARKER TY H-A-A 30 EA $2.00 $60.00 14 $28.00 66 TAB MARKER TY W 42 EA $5.00 $210.00 6 $30.00 67 TAB MARKER TY Y 80 EA $5.00 $400.00 50 $250.00 68 TEMORY WATER SERVICES 1 LS $25,000.00 $25,000.00 1.12 $28,000.00 69 CONSTRUCTION SURVEY I LS $20,000.00 $20,000.00 70 CONNECTION TO EXISTING WATER MAINS 7 EA $1,500.00 $10,500.00 10 $15,000.00 16"AND SMALLER 71 12"AND SMALLER PRESSURE PLUG 5 EA $500.00 $2,500.00 5 $2,500.00 72 12"AND SMALLER ABANDOMENT PLUG 13 EA $300.00 $3,900.00 13 $3,900.00 73 48"WOOD BOX TUNNEL CO#1 80 LF $450.00 $36,000.00 80 $36,000.00 74 18"RCP W/CSS BACKFILL-REMOVE& 16 LF $160.00 $2,560.00 16 $2,560.00 REPLACE CO#1 75 REMOVAL TROLLEY TIES&CONCRETE BASE 1 LS $2,850.00 $2,850.00 1 $2,850.00 CO#1 76 TEMPORARY ASPHALT MAY STREET CO#2 434 LF $9.00 $3,906.00 434 $3,906.00 Sub-Total of Previous Unit $1,512,558.00 $1,491,916.00 f Thursday,December 18,2014 Page 4 of 6 City Project Numbers 01687 DOE Number 6786 Contract Name MEDICAL DISTRICT WATER DISTRIBUTION SYS IMP PT 8 Estimate Number 21 Contract Limits JPS AND DANNON AREA Payment Number 21 Project Type WATER For Period Ending 12/15/2014 Project Funding P265 609170168787 Contract Information Summary Original Contract Amount $1,441,842.00 Change Orders Change Order Number 1 $13,410.00 Change Order Number 2 $36,756.00 Change Order Number 3 $20,550.00 Total Contract Price $1,512,558.00 Date I S /.S, Total Cost of Work Completed $1,491,916.00 M r Less %Retained $0.00 Date Net Earned $1,491,916.00 lifspEctio-n Supisor Earned This Period $14,919.16 Retainage This Period $0.00 Less Liquidated Damages ject Man Days @ /Day $0.00 i Date% S LessPavement Deficiency $0.00 Asst. toYrP -Infirastructypppesign and Construction Less Penalty $0.00 ate / /4 Less Previous Payment $1,476,996.84 Director/Contracting DepaA4t Plus Material on Hand Less 15% $0.00 Balance Due This Payment $14,919.16 Thursday,December 18,2014 Page 5 of 6 FORTWORTH rev 03/05/07 TRANSPORTATION&PUBLIC WORKS FINAL STATEMENT OF CONTRACT TIME FINAL STATEMENT NO.:21 NAME OF PROJECT: Medical District Part 8 PROJECT NO.: P265-609170168787 CONTRACTOR: Circle C DOE NO.: 6786 PERIOD FROM:11/14/12 TO: 12/15/14 FINAL INSPECTION DATE: 25-Mar ' WORK ORDER EFFECTIVE:11/14/2012 CONTRACT TIME: 245 Wl() CD DAY OF DAYS REASON FOR DAYS DAY OF DAYS REASON FOR DAYS MONTH CHARGED CREDITED MONTH CHARGED CREDITED DURING DURING 1. 16. 2. 17. 3. 18. 4. 19. 5. 20. 6. 21. 7. 22. 8. 23. 9. 24. 10. 25. 11. 26. 12. 27. 13. 28. 14. 29. 15. 30. 31. SAT,SUN, RAIN' OTHERS* TOO WET UTILITIES DAYS TOTAL &HOLIDAYS &TOO COLD RELOCATIONS CHARGED DAYS THIS 0 0 0 66 0 66 PERIOD PREVIOUS 0 0 0 328 239 567 PERIOD TOTALS 0 0 0 394 239 633 TO DATE *REMARKS: CONTRACTOR DATE INSPECTOR DATE ENGINEERING DEPARTMENT ! The City of Fort Worth•1000 Throckmorton Street•Fort Worth,TX 76012-6311 (817)392-7941 •Fax:(817)392-7845 FORTWORTHREV:02/20/07 TRANSPORTATION AND PUBLIC WORKS PERFORMANCE EVALUATION OF CONTRACTOR CONTRACTOR&PROJECT DATA Name of Contractor Project Name Circle C Construction Medical District Water Distribution Part 8 DOE Inspector DOE Number Donald Watson 6786 DOE Inspector Project Manager 0 Water❑ Waste water[:] Storm DrainageE-] Pavement John Kasavich Initial Contract Amount Project Difficulty $1,441,842.00 0 Simple OQ Routine 0 Complex Final Contract Amount Date $1,491,916.00 1/5/2015 I1)PERFORMANCE EVALUATION 0-Inadequate I-Deficient 2-Standard 3-Good 4-Excellent ELEMENT WEIGHT(X) APPLICABLE(Y/N) RATING(0-4) MAX SCORE SCORE 1 Submission of Documents 2 Y 4 8 8 2 Public Notifications 5 Y 4 20 20 3 Plans on Site 5 Y 4 20 20 4 Field Supervision 15 Y 4 60 60 5 Work Performed 15 Y 4 60 60 6 Finished Product 15 Y 4 60 60 7 Job Site Safety 15 Y 4 60 60 8 Traffic Control Maintenance 15 Y 4 60 60 9 Daily Clean Up 5 Y 4 20 20 10 Citizen's Complaint Resolution 5 Y 4 20 20 11 Property Restoration 5 Y 4 20 20 12 After Hours Response 5 Y 4 20 20 13 Project Completion 5 Y 4 20 20 TOTAL ELEMENT SCORE(A) 448 BONUS POINTS(25 Maximum)(B) TOTAL SCORE(TS) 448 III)CONTRACTOR'S RATING Maximum Score(MS)=448 or sum of applicable element score maximums which= 448 Rating([TS/MS]"100%) 448 1 448 = 100% Performance Category Excellent <20%=Inadequate 20%to<40%=Deficient 40%to<60%=Standard 60%to<80%=Good >80%=Excellent Inspector's Comments(INCLUDING EXPLANATION OF BONUS POINTS AWARDED) Signature DOE Inspector S"-- Signature Contractor Signature DOE Inspector's Supervisor CONTRACTOR'S COMMENTS i TRANSPORTATION AND PUBLIC WORKS The City of Fort Worth•1000 Throckmorton Street•Fort Worth,TX 76012-6311 (817)392-7941 •Fax:(817)392-7845 FoRTWORTHREV:02/22/07 TRANSPORTATION AND PUBLIC WORKS CONTRACTOR'S EVALUATION OF CITY 1)PROJECT INFORMATION Date: 1/5/2015 Name of Contractor Project Name Circle C Construction Medical District Water Distribution Part 8 DOE Inspector Project Manager Donald Watson John Kasavich DOE Number Project D(fculty Tvpe of Contract 6786 0 Simple OQ Routine 0 Complex ❑✓ water[I waste Water❑ storm Drainage❑ Pavement Initial Contract Amount Final Contract Amount $1,441,842.00 $1,491,916.00 11)PERFORMANCE EVALUATION 0-Inadequate 1 -Deficient 2-Standard 3-Good 4-Excellent ELEMENT RATING ELEMENT RATING (0-4) (0-4) INSPECTION EVALUATION PLANS&SPECIFICATIONS I Availability of Inspector 1 Accuracy of Plans to Existing Conditions 2 Knowledge of Inspector y 12 Clarity&Sufficiency of Details 3 Accuracy of Measured Quantities 1- 3 Lplicability of Specifications 4 Display Of Professionalism 4 Accuracy of Plan Quantities 5 Citizen Complaint Resolution PROJECT MANAGER EVALUATION 6 Performance-Setting up Valve Crews,Labs 1 1 Knowledge And/Or Problem Resolution ADMINISTRATION 2 Availability of Project Manager V 1 Change Order Processing Time y 13 Communication 2 Timliness of Contractor Pa ents 14 Resolution of Utility Conflicts 3 Bid 02ening to Pre-Con Meeting Timeframe III)COMMENTS&SIGNATURES COMMENTS Signature Contractor JJW Signature DOE Inspector Signature DOE Inspector's Supervisor INSPECTOR'S COMMENTS TRANSPORTATION AND PUBLIC WORKS 10 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 PIPE REPORT FOR: PROJECT NAME: Medical District Water Distribution SYS Part 8 PROJECT NUMBER: 43501 DOE NUMBER: 6786 WATER PIPE LAID SIZE TYPE OF PIPE LF Water Pipe 4" PVC 35 Water Pipe 6" PVC 372 Water Pipe 8" PVC 422 Water Pipe 10" PVC 32 Water Pipe 12" DIP 2998 FIRE HYDRANTS: 14 VALVES(16"OR LARGER) 5 PIPE ABANDONED SIZE TYPE OF PIPE LF DENSITIES: NEW SERVICES: SEWER PIPE LAID SIZE TYPE OF PIPE LF Sewer Pipe 6" 20.00 Sewer Pipe 8" 60 Sewer Pipe 10 20 PIPE ABANDONED SIZE TYPE OF PIPE LF DENSITIES: NEW SERVICES: TRANSPORTATION AND PUBLIC WORKS s` The City of Fort Worth•1000 Throckmorton Street•Fort Worth,TX 76012-6311 (817)392-7941 •Fax:(817)392-7845 CONSENT OF SURETY OWNER TO FWAL PAYMENT ARCHITECT ❑ AIA Document G707 CONTRACTOR ❑ SURETY ❑ OTHER ❑ Bond No.TXC98217 TO OWNER: ARCHITECT'S PROJECT NO.:DOE 6786 City Project No.01687 City of Fort Worth 1000 Throckmorton Street CONTRACT FOR: Water Distribution System Fort Worth,TX 76102 Improvements CONTRACT DATED: PROJECT: (name, address) Medical District Part 8 Brader Street,Broadway Street,Henderson Street,Magnolia Avenue,St.Louis Avenue and South Main Street In accordance with the provisions of the Contract between the Owner and the Contractor as indicated above,the (Insert name and address of Surety) Merchants Bonding Company(Mutual) 2100 Fleur Drive Des Moines,IA 50321-1158 ,SURETY on bond of (Insert name and address of Contractor) William J.Schultz,Inc.,dba Circle C Construction Company P.O.Box 40328 Fort Worth,TX 76140 ,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 (Insert name and address of Owner) City of Fort Worth 1000 Throckmorton Street Fort Worth,TX 76102 ,OWNER, as set forth in the said Surety's bond. IN WITNESS WHEREOF,the Surety has hereunto set its hand this date: March 24,2014 (Insert in writing the month followed by the numeric date and year.) Merchants ing Company(Mutual) (Surety) (Signature of authorized r resentative) , Attest: tness as to Surety: Sheryl A.Klutts,Attorney-in-Fact (Seal): (Printed name and title) John Miller Note: This form is to be used as a companion document to AIA DOCUMENT G706,CONTRACTOR'S AFFIDAVIT OF PAYMENT OF DEBTS AND CLAIMS, Current Edition AIA DOCUMENT G707•CONSENT OF SURETY COMPANY TO FINAL PAYMENT•April 1970 Edition•AIA© One Page 01970•THE AMERICAN INSTITUTE OF ARCHITECTS,1735 New York Ave.,NW,Washington,D.C.20006 MERCHANTS BONDING COMPANY. POWER OF ATTORNEY Know All Persons By These Presents,that MERCHANTS BONDING COMPANY(MUTUAL)and MERCHANTS NATIONAL BONDING, INC.,both being corporations duly organized under the laws of the State of Iowa(herein collectively called the"Companies"), and that the Companies do hereby make,constitute and appoint,individually, John A Miller; John R Stockton; K R Harvey; Sheryl A Klutts of Fort Worth and State of TX their true and lawful Attorney-in-Fact,with full power and authority hereby conferred in their name,place and stead,to sign,execute,acknowledge and deliver in their behalf as surety any and all bonds,undertakings, recognizances or other written obligations in the nature thereof,subject to the limitation that any such instrument shall not exceed the amount of: TEN MILLION($10,000,000.00)DOLLARS and to bind the Companies thereby as fully and to the same extent as if such bond or undertaking was signed by the duly authorized officers of the Companies,and all the acts of said Attorney-in-Fact, pursuant to the authority herein given,are hereby ratified and confirmed. This Power-of-Attomey is made and executed pursuant to and by authority of the following By-Laws adopted by the Board of Directors of the Merchants Bonding Company(Mutual)on April 23,2011 and adopted by the Board of Directors of Merchants National Bonding,Inc.,on October 24,2011. "The President,Secretary,Treasurer,or any Assistant Treasurer or any Assistant Secretary or any Vice President shall have power and authority to appoint Attomeys-in-Fact,and to authorize them to execute on behalf of the Company,and attach the seal of the Company thereto,bonds and undertakings,recognizances,contracts of indemnity and other writings obligatory in the nature thereof. The signature of any authorized officer and the seal of the Company may be affixed by facsimile or electronic transmission to any Power of Attorney or Certification thereof authorizing the execution and delivery of any bond,undertaking,recognizance, or other suretyship obligations of the Company,and such signature and seal when so used shall have the same force and effect as though manually fixed." In Witness Whereof,the Companies have caused this instrument to be signed and sealed this 1st day of January 2012. *�(104,44", ••�p�NG Ca*.o•. MERCHANTS BONDING COMPANY(MUTUAL) P�h'q' �y: MERCHANTS NATIONAL BONDING,INC. 1933 :c: .� By STATE OF IOWA •l[ ,p,'� ••. f .`•• COUNTY OF POLK ss. rrrrrr+a�� ••'••• President On this 1st day of January 2012,before me appeared Larry Taylor,to me personally known,who being by me duly sworn did say that he is President of the MERCHANTS BONDING COMPANY(MUTUAL)and MERCHANTS NATIONAL BONDING,INC.;and that the seals affixed to the foregoing instrument is the Corporate Seals of the Companies;and that the said instrument was signed and sealed in behalf of the Companies by authority of their respective Boards of Directors. In Testimony Whereof,I have hereunto set my hand and affixed my Official Seal at the City of Des Moines,Iowa,the day and year first above written. MARANDA GREENWALT : Commission Number 770312 My Commission Expires OWN October28,2014 Notary Public,Polk County,Iowa STATE OF IOWA COUNTY OF POLK ss. I, William Warner,Jr.,Secretary of the MERCHANTS BONDING COMPANY(MUTUAL)and MERCHANTS NATIONAL BONDING,INC., do hereby certify that the above and foregoing is a true and correct copy of the POWER-OF-ATTORNEY executed by said Companies, which(ppissfftill in full force and effect and has not been amended or revoked. Z4thness Wh of,I have hereuntogtlmy hand and affixed the seal of the Companies on this day of IViarctl U 4 •6'� 1933 3• Secretary ?�POA 0014(11/11) _ �%'. ..;E `+.`c ••��� \,�c. ""grrrnr.rrN��+ MERCHANTS BONDING COMPANY, MERCHANTS BONDING COMPANY(MUTUAL) • MERCHANTS NATIONAL BONDING, INC. 2100 FLEUR DRIVE • DES MOINES, IOWA 50321-1158 - (800)678-8171 , (515)243-3854 FAX IMPORTANT NOTICE i To obtain information or make a complaint: You may contact your insurance agent at the telephone number provided by your insurance agent. You may call Merchants Bonding Company(Mutual) toll-free telephone number for information or to make a complaint at: 1-800-678-8171 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 at: P. O. Box 149104 Austin, TX 78714-9104 Fax: (512)475-1771 Web: http://www.tdi.state.tx.us E-mail: ConsumerProtection@tdi.texas.gov PREMIUM AND CLAIM DISPUTES: Should you have a dispute concerning your premium or about a claim you should contact the agent first. 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 j or condition of the attached document. 1 SUP 0032 TX(12/13) 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 Teresa S Skelly, Vice President Of Circle C Construction,known to me to be a credible person,who being by me duly sworn,upon his oath deposed and said; That all persons, firms, associations, corporations, or other organizations furnishing labor and/or materials have been paid in full; That the wage scale established by the City Council in the City of Fort Worth has been paid in full; That there are no claims pending for personal injury and/or property damages; On Contract described as; BY Vice Presidient Subscribed and sworn before me on this date 24 of March, 2014. M {WCIiELE S.LANKFORD Notary Public E Notary public Tarrant,Texas "'rFof ��cs` STATE OF TEXAS kfy Comm.Exp.A—L—7,201S I