HomeMy WebLinkAboutContract 45327-FP1 CITY SECRETA 1'
Departme f P&W Const.Services CONTRACT NO. 4532 7 -FP�
DOE# ��'' Date
L�Al
Project anger�'-
Risk Management I Pape - ZT WORTH,
D.O.E. Brotherton I: 000000b
CFA Knight/Scanned Ik iZ�--l/7' (
The Proceeding people have beintonlacted concerning the request for final
payment&have released this project for such payment. ATION AND PUBLIC WORKS
Clearance Conducted By Shameka Kennedy E PROJECT COMPLETION
D.O.E.Ns: 7138
Regarding contract 317138 for EMERALD PARK PHASE 5 as required by the
TRANSPORTATION AND PUBLIC WORKS DEPARTMENT as approved by City Council on N/A through
M&C N/A the director of the TRANSPORTATION AND PUBLIC WORKS DEPARTMENT upon the
recommendation of the Assistant Director of the Transportation&Public Works Department has accepted the project
as complete.
Original Contract Prices: $48,755.50
Amount of Approved Change Orders: Ns 1
Revised Contract Amount: $48,755.50
Total Cost Work Completed: $48,755.50
Less Deductions:
Liquidated Damages: Days®$210.00/Day
Pavement Deficiencies:
Total Deduction Amount: $0.00
Total Cost Work Completed: $48,755.50
Less Previous Payments:
Final Payment Due $48,755.50
Recommended for Acceptance Date
Asst. Director, TPW - Infrastructure Design and Construction
Li, LJ C--N - //&Z S—
Accepted Date
Director, TRANSPORTATION AND P1l LIC WORKS DEPART ENT
Il I W
City Manager Date
Comments: FUND:C205-207760219583
FoRTWORTH
CITY OF FORT WORTH
FINAL PAYMENT REQUEST
Contract Name EMERALD PARK PHASE 5
Contract Limits
Project Type STREET LIGHT
City Project Numbers 02195
DOE Number 7138
Estimate Number I Payment Number 1 For Period Ending 9/15/2014
CD
City Secretary Contract Number 317138 Contract Time 2CD
Contract Date Days Charged to Date 21
Project Manager Ehia Contract is .000000 Complete
Contractor INDEPENDENT UTILITY CONSTRUCTION
5109 SUN VALLEY DRIVE
FORT WORTH, TX 76119
Inspectors LAYER / DOVERS
Monday,October 13,2014 Page 1 of 4
i
City Project Numbers 02195 DOE Number 7138
Contract Name EMERALD PARK PHASE 5 Estimate Number 1
Contract Limits Payment Number I
Project Type STREET LIGHT For Period Ending 9/15/2014
Project Funding
STREET LIGHT
Item Description of Items Estimated Unit Unit Cost Estimated Completed Completed
No. Quanity Total Quanity Total
-——————————————————————— --———- - —-
1 IOOW HPS PCS LIGHTING FIXTURE 18 EA $222.00 $3,996.00 18 $3,996.00
2 RDWYIL.LUMFOUNDATION 18 EA $904.56 $16,282.08 18 $16,282.08
3 2"SCH 80 PVC CONDUIT 850 LF $6.01 $5,108.50 850 $5,108.50
4 910XHHW CONDUCTOR 2550 LF $0.62 $1,581.00 2550 $1,581.00
5 FURNISH/INSTALL D-25 STREET LIGHT POLE 18 EA $1,210.44 $21,787.92 18 $21,787.92
--------------- - -----------------------
Sub-Total of Previous Unit $48,755.50 $48,755.50
Monday,October 13,2014 Page 2 of 4
City Project Numbers 02195 DOE Number 7138
Contract Name EMERALD PARK PHASE 5 Estimate Number 1
Contract Limits Payment Number 1
Project Type STREET LIGHT For Period Ending 9/15/2014
Project Funding
Contract Information Summary
Original Contract Amount $48,755.50
Change Orders
Total Contract Price $48,755.50
Total Cost of Work Completed $48,755.50
ontr o I Less %Retained $0.00
DateJ//p/x.
Net Earned $48,755.50
Inspection S pe icor Earned This Period $48,755.50
Retainage This Period $0.00
Date z Less Liquidated Damages
Project Manag
p� Days @ /Day $0.00
Date O �� LessPavement Deficiency $0.00
Asst.Dir c r Less Penalty $0.00
t
C)• L--)` Date )Mo o Less Previous Payment $0.00
Director/CoAracting Departmenk Plus Material on Hand Less 15% $0.00
;� Balance Due This Payment $48,755.50
Monday,October 13,2014 Page 3 of 4
City Project Numbers 02195 DOE Number 7138
Contract Name EMERALD PARK PHASE 5 Estimate Number 1
Contract Limits Payment Number I
Project Type STREET LIGHT For Period Ending 9/15/2014
Project Funding
Project Manager Ehia City Secretary Contract Number 317138
Inspectors LAYER / DOVERS Contract Date
Contractor INDEPENDENT UTILITY CONSTRUCTION Contract Time 21 CD
5109 SUN VALLEY DRIVE Days Charged to Date 21 CD
FORT WORTH, TX 76119 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 $48,755.50
Less %Retained $0.00
Net Earned $48,755.50
Earned This Period $48,755.50
Retainage This Period $0.00
Less Liquidated Damages
0 Days Q $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 $48,755.50
Monday,October 13,2014 Page 4 of 4
FoRTWORTH rev 03/05/07
TRANSPORTATION& PUBLIC WORKS
FINAL STATEMENT OF CONTRACT TIME
FINAL STATEMENT NO.:1
NAME OF PROJECT: Emerald Park PH5
PROJECT NO.: C205-2077602195-83 CONTRACTOR: Independent!Utility
DOE NO.: 7138
PERIOD FROM 08/21/14 TO: 09/15/14 FINAL INSPECTION DATE: 15-Oct
WORK ORDER EFFECTIVE-2/10/2014 CONTRACT TIME: 21 @) Wo 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,TOO WET, UTILITIES OTHERS* DAYS TOTAL
&HOLIDAYS &TOO COLD RELOCATIONS CHARGED DAYS
THIS
PERIOD 21 21
PREVIOUS 0 0
PERIOD
TOTALS
TO DATE 121 121
*REMARKS:
CONTRACTOR DATE INSPECTOR AT
ENGINEERING DEP.3RTMI-AT
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
I PROJECT INFORMATION Date: 10/16/2014
Name of Contractor Project Name
Independent Utility Construction Emerald Park PH5
DOE Inspector Project Manager
Keith Dovers Fred Ehia
DOE Number Project Dtffizculty Tvpe of Contract
7138 0 Simple QQ Routine Q Complex ❑ water[] wastewater[] Storm Drainage[] Pavement
Initial Contract Amount Final Contract Amount
$48,755.50 $48,755.50
II)PERFORMANCE EVALUATION
0-Inadequate 1 -Deficient 2-Standard 3 -Good 4-Excellent
ELEMENT RATING ELEMENT RATING
(0-4) 1 1 (0-4)
INSPECTION EVALUATION IPLANS&SPECIFICATIONS
1 Availability of Inspector 1 Accuracy of Plans to Existing Conditions
2 Knowledge of Inspector 2 Clarity&Sufficiency of Details
3 Accuracy of Measured Quantities 3 Applicability of Specifications
4 Display Of Professionalism C1 4 Accuracy of Plan Quantities
5 Citizen Complaint Resolution PROJECT MANAGER EVALUATION
6 Performance-Setting up Valve Crews,Labs 1 Knowledge And/Or Problem Resolution
ADMINISTRATION 2 Availability of Project Manager
1 Change Order Processing Time 3 Communication
2 Timliness of Contractor Payments 61 4 Resolution of Utility Conflicts
3 Bid Opening to Pre-Con Meeting Timeframe
III)COMMENTS&SIGNATURES
COMMENTS
Signature Contractor
IL
Signature DOE Inspector
Signature DOE DOE Inspector's Supervisors —
INSPECTOR'S COMMENTS
TRANSPORTATION AND PUBLIC WORKS
ID
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
Marne of Contractor Project Marne
Independent Utility Construction Emerald Park PH5
DOE Inspector DOE Number
Keith Dovers 7138
DOE Inspector Project Manager
❑ Water❑ Waste Water[] Storm Drainageo Pavement Fred Ehia
Initial Contract Amount Project Difficulty
$48,755.50 0 Simple Q Routine 0 Complex
Final Contract Amount Date
$48,755.50 10/16/2014
111)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 N
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 N
9 Daily Clean Up 5 Y 4 20 20
10 Citizen's Complaint Resolution 5 N
11 Property Restoration 5 N
12 After Hours Response 5 N
13 Project Completion 5 Y 4 20 20
TOTAL ELEMENT SCORE(A) 308
BONUS POINTS(25 Maximum)(B)
TOTAL SCORE(TS) 308
III)CONTRACTOR'S RATING
Maximum Score(MS)=448 or sum of applicable element score maximums which= 308
Rating(ITS/MSl * 100%) 308 / 308 = 100%
Performance Category Excellent
<20%=Inadequale 20%to<40%—Deficient 40%to<60%=Standard 60%to<80%=Good >80%=Ezcellenl
Inspector's Comments(INCLUDING EXPLANATION OF BONUS POINTS AWARDED)
Signature DOE Inspector �j,f� 1� �'•�. Signature Contractor
Signature DOE Inspector's Supervisor _;; f��`
CONTRACTOR'S COMMENTS
TRANSPORTATION.AND PUBLIC WORKS
(D The City of Fort Worth•1000 Throckmorton Street•Fort Worth,TX 76012-6311
(817)392-7941 •Fax:(817)392-7845
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 Richard Wolfe, VP
Of Independent Utility Construction Inc.,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;
Emerald Park Phase 5
BY
Richar Wolfe 7-Vice President
Subscribed and sworn before me on this date 5th of November, 2014.
o X Delvoua Atteberry*� �* Notary Public
STATE OF TEXAS
(moi�My Comm.expires May 11,2017
Notary Public
Tarrant County, Texas
CONSENT OF OWNER ❑
SURETY COMPANY CONTRACTOR ❑❑
TO FINAL PAYMENT SURETY ❑
OTHER
(SIMILAR TO AIA DOCUMENT G707)
Bond No. 6067221
PROJECT: Emerald Park Phase 5, City Project No. 02195
(name,address) Fort Worth,Texas
TO (Owner)
ARCHITECTS PROJECT NO:
F—City of Fort Worth CONTRACT FOR: Above Project
1000 Throckmorton Street
Fort Worth,Texas 76102
CONTRACT DATE:
CONTRACTOR: Independent Utility Construction, Inc.
In accordance with the provisions of the Contract between the Owner and the Contractor as indicated above,the(hero insert name and
address of Surety Company) Ohio Farmers Insurance Company
555 Republic Drive, Suite 450
Plano,Texas 75074 SURETY COMPANY,
on bond of(here insert name and address of Contractor)
Independent Utility Construction, Inc.
5109 Sun Valley Drive ,CONTRACTOR,
Fort Worth,Texas 76119
hereby approves of the final payment to the Contractor, and agrees that the final payment to the Contractor shall not relieve the
Surety Company of any of its obligations to(here insert name and address of Owner)
City of Fort Worth
1000 Throckmorton Street ,OWNER,
Fort Worth, Texas 76102
as set forth in the said Surety Company's bond.
IN WITNESS WHEREOF,
The Surety Company has hereunto set its hand this 4th day of November 2014
OHIO FARMERS INSURANCE COMPANY
Surety Co p
By
'VX4
Signac re,0'Ararizjd Repres tative
Attest:
(Seal): Kyle W. Sweeney Attorney—in—Fact
Title
Note:This form is intended to be used as a companion document to the Contractors Affidavit of Payment of Debts and Claims,Current Edition
THIS POWER OF ATTORNEY SUPERCEDES ANY PREVIOUS POWER BEARING THIS SAME
POWER i AND ISSUED PRIOR TO 04/29/11, FOR ANY PERSON OR PERSONS NAMED BELOW.
General POWER NO. 422005206
Power Westfield Insurance Co.
of Attorney Westfield National Insurance Co.
CERTIFIED COPY Ohio Farmers Insurance Co.
Westfield Center, Ohio
Know All Men by These Presents, That WESTFIELD INSURANCE COMPANY, WESTFIELD NATIONAL INSURANCE COMPANY and OHIO
FARMERS INSURANCE COMPANY, corporations, hereinafter referred to individually as a 'Company" and collectively as 'Companies,- duly
organized and existing under the laws of the State of Ohio, and having Its principal office in Westfield Center, Medina County,Ohio, do by these
presents make,constitute and appoint
CHARLES D.SWEENEY, MICHAEL A.SWEENEY, KYLE W. SWEENEY,ELIZABETH GRAY,JOINTLY OR SEVERALLY
of FORT WORTH and State of TX its true and lawful Attorneys)-in-Fact,with full power and authority hereby conferred in Its name,
place and stead, to execute, acknowledge and deliver any and all bonds, recognizances, undertakings, or other instruments or contracts of
suretyship- - - - - - - - -- - - - - - - - - - - - - - - - - - - - - - - -- - - - - - - - - - - - - - - - - - - - - - - -- - - - --
LIMITATION: THIS POWER OF ATTORNEY CANNOT BE USED TO EXECUTE NOTE GUARANTEE, MORTGAGE DEFICIENCY, MORTGAGE
GUARANTEE, OR BANK DEPOSITORY BONDS.
and to bind any of the Companies thereby as fully and to the same extent as if such bonds were signed by the President,sealed with the corporate
seal of the applicable Company and duly attested by its Secretary, hereby ratifying and confirming all that the said Attorney(s)-in-Fact may do In
the premises. Said appointment Is made under and by authority of the following resolution adopted by the Board of Directors of each of the
WESTFIELD INSURANCE COMPANY,WESTFIELD NATIONAL INSURANCE COMPANY and OHIO FARMERS INSURANCE COMPANY:
'Be It Resolved,that the President,any Senior Executive,any Secretary or any Fidelity&Surety Operations Executive or other Executive shall
be and is hereby vested with full power and authority to appoint any one or more suitable persons as Attorneys)-in-Fact to represent and act for
and on behalf of the Company subject to the following provisions:
The Attorney-in-Fact. may be given full power and authority for and in the name of and on behalf of the Company,to execute,acknowledge and
deliver,any and all bonds, recognizances, contracts, agreements of Indemnity and other conditional or obligatory undertakings and any and all
notices and documents canceling or terminaling the Company's liability thereunder, and any such Instruments so executed by any such
Attorney-in-Fact shall be as binding upon the Company as If signed by the President and sealed and attested by the Corporate Secretary.'
'Be/t Further Resolved,that the signature of any such designated person and the seal of the Company heretofore or hereafter affixed to any
power of attorney or any certificate relating thereto by facsimile,and any power of attorney or certificate bearing facsimile signatures or facsimile
seal shall be valid and binding upon the Company with respect to any bond or undertaking to which It Is attached' (Each adopted at a meeting
held on February e,2000).
In Witness Whereof, WESTFIELD INSURANCE COMPANY, WESTFIELD NATIONAL INSURANCE COMPANY and OHIO FARMERS INSURANCE
COMPANY have caused these presents to be signed by their Senior Executive and their corporate seals to be hereto affixed this 20th day of
APRIL A.D.,2011
Corporate asUR(�,,� +ONAL�'• ""��"""• WESTFIELD INSURANCE COMPANY
Seals �O f~f~ »tiF�` iaP NSG a= :eS�M$Upp���
Affixed v .w } ;p; WESTFIELD NATIONAL INSURANCE COMPANY
OHIO FARMERS INSURANCE COMPANY
SEAL
:o, %". 1848;*7 / /1
n«n.wN"
......... By.
State of Ohio "."• ",�•`, Richard L. Kinnaird,Jr., Natrona/Surety Leader and
County of Medina ss.: Senior Executive
On this 20th day of APRIL A.D.,2011 , before me personally came Richard L. Kinnalyd, Jr. to me known, who, being by me duly
sworn, did depose and say,that he resldes'In Medina, Ohio;that he is Senior Executive of WESTFIELD INSURANCE COMPANY,WESTFIELD
NATIONAL INSURANCE COMPANY and OHIO FARMERS INSURANCE COMPANY, the companies described in and which executed the above
Instrument;that he knows the seals of said Companies,-that the seals affixed to said Instrument are such corporate seals;that they were so affixed
by order of the Boards of Directors of said Companies;and that he signed his name thereto by like order.
Notarial
ti
Seal
Affixed AAQ\\\11��
0.\ :
Ir
William J. Kahelin,A rney at Law, Notary Public
State of Ohio e:0 0 My Commission Does Not Expire(Sec. 147.03 Ohio Revised Code)
County of Medina ss.:
I,Frank A. Carrino,Secretary of WESTFIELD INSURANCE COMPANY,WESTFIELD NATIONAL INSURANCE COMPANY and OHIO FARMERS
INSURANCE COMPANY, do hereby certify that the above and foregoing Is a true and correct copy of a Power of Attorney, executed by said
Companies,which Is still In full force and effect;and furthermore,the resolutions of the Boards of Directors, set out In the Power of Attorney are
In full force and effect.
In Witness Whereof, I have hereunto set my hand and affixed the seals of said Companies at Westfield Center, Ohio, this 4th day of
2,014
5N SEA . :m_ =oma :b_ t SacretQty
;o_ ;?x:••1848 Frank A. Carrino, Secretary
BPOAC2(combined) (06-02)
CONSENT OF OWNER ❑
SURETY COMPANY CONTRACTOR ❑❑
TO FINAL PAYMENT SURETY ❑
OTHER
(SIMILAR TO AIA DOCUMENT G707)
Bond No. 6067221
PROJECT: Emerald Park Phase 5, City Project No. 02195
(name,address) Fort Worth,Texas
TO (Owner)
ARCHITECTS PROJECT NO:
City of Fort Worth CONTRACT FOR: Above Project
1000 Throckmorton Street
Fort Worth,Texas 76102
CONTRACT DATE:
CONTRACTOR: Independent Utility Construction,Inc.
In accordance with the provisions of the Contract between the Owner and the Contractor as indicated above,the(here insert name and
address of Surety Company) Ohio Farmers Insurance Company
555 Republic Drive, Suite 450
Plano,Texas 75074 ,SURETY COMPANY,
on bond Of(here insert name and address of Contractor)
Independent Utility Construction,Inc.
5109 Sun Valley Drive ,CONTRACTOR,
Fort Worth,Texas 76119
hereby approves of the final payment to the Contractor, and agrees that the final payment to the Contractor shall not relieve the
Surety Company of any of its obligations to(here insert name and address of Owner)
City of Fort Worth
1000 Throckmorton Street
Fort Worth, Texas 76102 'OWNER,
as set forth in the said Surety Company's bond.
IN WITNESS WHEREOF,
The Surety Company has hereunto set its hand this 4th day of November 2014
OHIO FARMERS INSURANCE COMPANY
Surety Comp y
By
Signatureuth presentati
Attest: 7
(Seal): Kyle W. Sweeney Attorney—in—Fact
Title
Note:This form is intended to be used as a companion document to the Contractor's Affidavit of Payment of Debts and Claims,Current Edition
THIS POWER OF ATTORNEY SUPERCEDES ANY PREVIOUS POWER BEARING THIS SAME
POWER#AND ISSUED PRIOR TO 04/20111, FOR ANY PERSON OR PERSONS NAMED BELOW.
General
POWER NO. 4220052 06
Power Westfield Insurance Co.
of Attorney Westfield National Insurance Co.
Ohio Farmers Insurance Co.
CERTIFIED COPY Westfield Center, Ohio
Know All Men by These Presents, That WESTFIELD INSURANCE COMPANY, WESTFIELD NATIONAL INSURANCE COMPANY and OHIO
FARMERS INSURANCE COMPANY, corporations, hereinafter referred to individually as a "Company' and collectively as 'Companies,- duly
organized and existing under the laws of the State of Ohio, and having its principal office in Westfield Center, Medina County,Ohio,do by these
presents make, constitute and appoint
CHARLES D. SWEENEY, MICHAEL A. SWEENEY,KYLE W. SWEENEY, ELIZABETH GRAY, JOINTLY OR SEVERALLY
of FORT WORTH and State of TX its true and lawful Attorney(s)-in-Fact,with full power and authority hereby conferred in its name,
place and stead, to execute, acknowledge and deliver any and all bonds, recognizances, undertakings, or other instruments or contracts of
suretyship- - - - - - - - -- - - - - - - - - - - - - - - - - - - - - - - -- - - - - - - - - - - - - - - - - - - - - - - -- - - - --
LIMITATION: THIS POWER OF ATTORNEY CANNOT BE USED TO EXECUTE NOTE GUARANTEE, MORTGAGE DEFICIENCY, MORTGAGE
GUARANTEE, OR BANK DEPOSITORY BONDS.
and to bind any of the Companies thereby as fully and to the same extent as if such bonds were signed by the President, sealed with the corporate
seal of the applicable Company and duly attested by its Secretary, hereby ratifying and confirming all that the said Attorney(s)-in-Fact may do in
the premises. Said appointment is made under and by authority of the following resolution adopted by the Board of Directors of each of the
WESTFIELD INSURANCE COMPANY,WESTFIELD NATIONAL INSURANCE COMPANY and OHIO FARMERS INSURANCE COMPANY:
'Be It Resolved,that the President,any Senior Executive, any Secretary or any Fidelity&Surety Operations Executive or other Executive shall
be and is hereby vested with full power and authority to appoint any one or more suitable persons as Attorney(s)-in-Fact to represent and act for
and on behalf of the Company subject to the following provisions:
The Attorney-In-Fact may be given full power and authority for and in the name of and on behalf of the Company,to execute,acknowledge and
deliver, any and all bonds, recognizances, contracts, agreements of indemnity and other conditional or obligatory undertakings and any and all
notices and documents canceling or terminating the Company's liability thereunder, and any such Instruments so executed by any such
Attorney-in-Fact shall be as binding upon the Company as If signed by the President and sealed and attested by the Corporate Secretary.'
'Be It Further Resolved,that the signature of any such designated person and the seal of the Company heretofore or hereafter affixed to any
power of attorney or any certificate relating thereto by facsimile, and any power of attorney or certificate bearing facsimile signatures or facsimile
seal shall be valid and binding upon the Company with respect to any bond or undertaking to which it is attached." (Each adopted at a meeting
held on February 8,2000).
In Witness Whereof,WESTFIELD INSURANCE COMPANY, WESTFIELD NATIONAL INSURANCE COMPANY and OHIO FARMERS INSURANCE
COMPANY have caused these presents to be signed by their Senior Executive and their corporate seals to be hereto affixed this 20th day of
APRIL A.D.,2011 .
Corporate `'�•jYR,(�N" %nNn�" "" WESTFIELD INSURANCE COMPANY
Seals
�► �a.«•••.�!c�% �..• !V�S'�,. "aS1NSUl�,(� ,� yyESTFIELD NATIONAL INSURANCE COMPANY
Affixed
.ate 1�poa ;r`o: p ye + c^ OHIO FARMERS INSURANCE COMPANY
'z .t ARTEkfj'-. 3
f N LL.t b =t-: STAT, :m=
i�'�•,•'�` Y, :'p' . 1848
By:
State of OhioRichard L. Kinnaird,Jr., National Surety Leader and
County of Medina ss.: Senior Executive
On this 20th day of APRIL A.D.,2011 , before me personally came Richard L. Kinnaird, Jr. to me known,who, being by me duly
sworn, did depose and say,that he resides"In Medina, Ohio;that he is Senior Executive of WESTFIELD INSURANCE COMPANY,WESTFIELD
NATIONAL INSURANCE COMPANY and OHIO FARMERS INSURANCE COMPANY, the companies described in and which executed the above
Instrument;that he knows the seals of said Companies;that the seals affixed to said instrument are such corporate seals;that they were so affixed
by order of the Boards of Directors of said Companies;and that he signed his name thereto by like order.
Notariala,^ \A "w% r L.Seal a .%
Affixed
0.
William J. Kahelin,A rney at Law, Notary Public
State of Ohio ::N� jo My Commission Does Not Expire(Sec. 147.03 Ohio Revised Code)
County of Medina ss.:
•:9TH. bF 0
1, Frank A.-Carrino,Secretary of WESTFIELD INSURANCE COMPANY,WESTFIELD NATIONAL INSURANCE COMPANY and OHIO FARMERS
INSURANCE COMPANY, do hereby certify that the above and foregoing is a true and correct copy of a Power of Attorney, executed by said
Companies,which is still In full force and effect;and furthermore,the resolutions of the Boards of Directors, set out in the Power of Attorney are
in full force and effect.
In Witness Whereof, I have hereunto set my hand and affixed the seals of said Companies at Westfield Center, Ohio, this th day of
Nove ,.D. ...........r„ 4
m` uR.(,�� 2Q14PK,oNA.. ,ti
Nl �7Li " SEAL am' •�'NARTERE1j:33
�i •� 5 m; Secretary
?o; _:,•1848 r�; Frank A. Carrino, Secretary
BPOAC2(combined) (06-02)