HomeMy WebLinkAboutContract 45611-FP1 DepaPanagger
TP&W Const.Services CONTRACT NO. p
DOE# Dat
ProjeG � I + WORTM,
Risk Management J. Page , 1
D.O.E. Brotherton
CFA Westerman/Scanne
The Proceeding people have been Ca ed conceming t e request for final
payment&have released this project for such payment TION AND PUBLIC WORKS
Clearance Conducted By Shameka Kennedy PROJECT COMPLETION
D.O.E. Ns: 6888
Regarding contract 116888 for ST PATRICK CATHEDRAL PARISH HALL CENTER PH 2 as required by the
TRANSPORTATION&PUBLIC WORKS as approved by City Council on N/A through M&C N/A the director
of the TRANSPORTATION&PUBLIC WORKS upon the recommendation of the Assistant Director of the
Transportation&Public Works Department has accepted the project as complete.
Original Contract Prices: $402,941.71
Amount of Approved Change Orders: Ns
Revised Contract Amount:
Total Cost Work Completed: $402,941.71
Less Deductions:
Liquidated Damages: Days @$210.00/Day
Pavement Deficiencies:
Total Deduction Amount:
Total Cost Work Completed: $402,941.71
Less Previous Payments: $0.00
Final Payment Due $402,941.71
Recommended for Acceptance Date
Asst. Director, TPW - I astructure Design and Construction
0
4
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Accepted / Date
,��Director, TRANSPORTATION & PUBLIC WORKS
M
LU
[�+ G/Z LLl
City Manager Date w
Comments: C205-541200-209760196283
OFFICIAL RECORD
CITY SECRETARY
FT.WORTH,TX
FORTNORTH
CITY OF FORT WORTH
FINAL PAYMENT REQUEST
Contract Name SAINT PATRICK CATHEDRAL PARISH HALL CENTER PH 2
Contract Limits
Project Type PAVING
City Project Numbers 01962
DOE Number 6888
Estimate Number I Payment Number 1 For Period Ending 2/19/2015
CD
City Secretary Contract Number 116888 Contract Time 9ED
Contract Date Days Charged to Date 90
Project Manager Ehia Contract is 100.00 Complete
Contractor SCOTT DENNETT CONSTRUCTION,INC.
2808 W.7TH ST.,N13
FORT WORTH, TX 76107
Inspectors LAYER / MILLER,W
Thursday,February 19,2015 Page I of 6
City Project Numbers 01962 DOE Number 6888
Contract Name SAINT PATRICK CATHEDRAL PARISH HALL CENTER PH 2 Estimate Number I
Contract Limits Payment Number I
Project Type PAVING For Period Ending 2/19/201 5
Project Funding
PAVING
Item Description of items Estimated Unit Unit Cost Estimated Completed Completed
No. Quanity Total Quanity Total
1 WORK ORDER MOBILIZATION I EA $9,480.35 $9,480.35 1 $9,480.35
2 REMOVE SIDEWALK 2422 SF $1.15 $2,785.30 2422 $2,785.30
3 REMOVE CONCRETE DRIVE 275 SF $1.15 $316.25 275 $316.25
4 REMOVE CONIC PVMT 1350 SY $10.33 $13,945.50 1350 $13,945.50
5 REMOVE ASPHALT PVMT 1350 SY $9.63 $13,000.50 1350 $13,000.50
6 REMOVE CONC CURB&GUTTER 795 LF $2.77 $2,202.15 795 $2,202.15
7 4"CONDT PVC SHH 40 190 LF $48.40 $9,196.00 190 $9,196.00
8 SITE CLEARING 1 LS $9,024.18 $9,024.18 1 $9,024.18
9 UNCLASSIFIED EXCAVATION 500 CY $31.46 $15,730.00 500 $15,730.00
10 SWPPP I LS $3,932,50 $3,932.50 1 $3,932.50
11 6 WIDE ASPHALT PVMT REPAIR 50 LF $36.30 $1,815.00 50 $1,815.00
12 2"ASPHALT PVMT TYPE D 355 SY $12.10 $4,295.50 355 $4,295.50
13 4"ASPHALT PVMT BASE B 355 SY $32.17 $11,420.35 355 $11,420.35
14 4"CONC SIDEWALK 2920 SF $5.57 $16,264.40 2920 $16,264.40
15 6"CONCRETE DRIVEWAY 275 SF $7.26 $1,996.50 275 $1,996.50
16 BARRIER FREE RAMP TYPE A 3 FA $1,269.29 $3,807.87 3 $3,807.87
17 BRICK PVMT 221 SY $69.78 $15,421.38 221 $15,421.38
18 7"CONC CURB&GUTTER 545 LF $34.57 $18,840.65 545 $18,840.65
19 4"SLD PVMT MARKING TAPE 24 LF $3-63 $87.12 24 $87.12
20 4"BRK PVMT MARKING PAINT 855 LF $3.63 $3,103.65 855 $3,103.65
21 12"SLD PVMT MARKING PAINT 105 LF $12.10 $1,270.50 105 $1,270.50
22 24"SLD PVMT MARKING PAINT 24 LF $18.15 $435.60 24 $435.60
23 LANE LEGEND ARROW 3 EA $363.00 $1,089.00 3 $1,089.00
24 LANE LEGEND DBL ARROW I EA $415.03 $415.03 l $415.03
25 LANE LEGEND ONLY 3 EA $363.00 $1,089.00 3 $1,089.00
26 REMOVE 4"PVMT MARKINGS 15 LF $1.03 $15.45 15 $15.45
27 REMOVE 12"PVMT MARKINGS 15 LF $1.03 $15.45 15 $15.45
28 TOPSOIL 20 CY $60.50 $1,210.00 20 $1,210.00
29 MANHOLE ADJUSTMENT 2 EA $423.50 $847.00 2 $847-00
30 MISC STRUCTURE ADJUSTMENT 6 EA $605.00 $3,630.00 6 $3,630.00
31 TRAFFIC CONTROL 6 MO $5,687.00 $34,122,00 6 $34,122.00 1
Thursday,February 19,2015 Page 2 of 6
City Project Numbers 01962 DOE Number 6888
Contract Name SAINT PATRICK CATHEDRAL PARISH HALL CENTER PH 2 Estimate Number 1
Contract Limits Payment Number 1
Project Type PAVING For Period Ending 2/19/2015
Project Funding
32 SAWCUT 600 LF $1.21 $726.00 600 $726.00
33 44"X 44"TREE GRATE 5 EA $4,055.92 $20,279.60 5 $20,279.60
34 STRUCTURAL SOIL 48 SY $10.89 $522.72 48 $522.72
Sub-Total of Previous Unit $222,332.50 $222,332.50
STORM DRAIN
Item Description of Items Estimated Unit Unit Cost Estimated Completed Completed
No. - Quanity--i - Total Quanity Total
I REMOVE 6"TRENCH DRAIN - 12 LF $100.00 $1,200.00 12 $1,200.00
2 REMOVE 18"STORM LINE 75 LF $7.51 $563.25 75 $563.25
3 REMOVE 10'CURB INLET l EA $442.18 $442.18 1 $442.18
4 TRENCH SAFETY 75 LF $1.21 $90.75 75 $90.75
5 UTILITY MARKERS I LS $1,210.00 $1,210.00 1 $1,210.00
6 21"RCP CLASS W 75 LF $104.06 $7,804.50 75 $7,804.50
7 4"PIPE UNDERDRAIN 115 LF $19.36 $2,226.40 115 $2,226.40
8 4'STORM JUNCTION BOX 1 EA $4,310.02 $4,310.02 1 $4,310.02
9 10'CURB INLET 2 EA $4,265.25 $8,530.50 2 $8,530.50
Sub-Total of Previous Unit $26,377.60 $26,377.60
STREET LIGHT
Item Description of Items Estimated Unit Unit Cost Estimated Completed Completed
No. Quanity Total Quanity Total
------- -- ----- - ---------- ---- ----- ---
I ELECTRICAL FACILITIES 1 LS $3,630.00 $3,630.00 1 $3,630.00
2 SALVAGE ELECTRICAL EQUIP 1 LS $695.06 $695.06 1 $695.06
3 2"CONDT PVC SCH 40 920 LF $9.68 $8,905.60 920 $8,905.60
4 2"CONDT PVC SCH 40 55 LF $12.10 $665.50 55 $665.50
5 NO 6 INSULATED ELEC CONDR 3218 LF $1.82 $5,856.76 3218 $5,856.76
6 NO INSULATED ELEC CONDR 1073 LF $1.21 $1,298.33 1073 $1,298.33
7 GROUND BOX l EA $786.50 $786.50 l $786.50
8 ORNAMENTAL ASSMBLY 1 1 EA $5,841.01 $64,251.1 I I I $64,251.11
9 RDWY ILLUM FOUNDATION I I EA $1,584.00 $17,424.00 11 $17,424.00
10 SALVAGE STREET LIGHT POLE I EA $423.50 $423.50 1 $423.50
Sub-Total of Previous Unit $103,936.36 $103,936.36
f
Thursday,February 19,2015 Page 3 of 6
City Project Numbers 01962 DOE Number 6888
Contract Name SAINT PATRICK CATHEDRAL PARISH HALL CENTER PH 2 Estimate Number 1
Contract Limits Payment Number I
Project Type PAVING For Period Ending 211912015
Project Funding
TRAFFIC CONTROL
Item Description of Items Estimated Unit Unit Cost Estimated Completed Completed
No. Quanity Total Quanity Total
1 3"CONDT PVC SCH 40 190 LF $42.35 $8,046.50 190 $8,046.50
2 3-SECT SIGNAL HEAD ASSMBLY I EA $907.50 $907.50 1 $907.50
3 4-SECT SIGNAL HEAD ASSMBLY 2 EA $1,149.50 $2,299.00 2 $2,299.00
4 PED SIGNAL HEAD ASSMBLY I EA $665.50 $665.50 1 $665.50
5 10/C 14 AWG MULTI CONDUCTOR CABLE 130 LF $4.54 $590.20 130 $590.20
6 20/C 14 AWG MULTI CONDUCTOR CABLE 325 LF $6.66 $2,164.50 325 $2,164.50
7 OPTICOM 240 LF $2.66 $638.40 240 $638.40
8 NO 8 BARE ELEC CONDR 190 LF $1.51 $286.90 190 $286.90
9 GROUND BOX LARGE WILD)APRON i EA $907.50 $907.50 1 $907.50
10 FURNISH/INSTALL 10'-14'PED POLE ASSMBLY 2 EA $1,815.00 $3,630-00 2 $3,630.00
ll FURNISH/INSTALL TYPE 41 SIGNAL POLE 1 EA $11,979.00 $11,979.00 1 $11,979.00
12 FURNISH/INSTALL MAST ARM 16'-36' 1 E4 $6,534.00 $6,534.00 1 $6,534.00
13 TY I SIGNAL FOUNDATION 2 EA $1,452.00 $2,904.00 2 $2,904.00
14 TY 3 SIGNAL FOUNDATION I E4 $3,025.00 $3,025.00 1 $3,025.00
15 SALVAGE TRAFFIC SIGNAL I E4 $3,025.00 $3,025.00 1 $3,025.00
16 RECONNECT CONDUCTOR 125 LF $8.47 $1,058.75 125 $1,058.75
17 INSTALL ALUM SIGN MAST ARM MOUNT 3 EA $544.50 $1,633.50 3 $1,633.50
Sub-Total of Previous Unit $50,295.25 $50,295.25
Thursday,February 19,2015 Page 4 of 6
City Project Numbers 01962 DOE Number 6888
Contract Name SAINT PATRICK CATHEDRAL PARISH HALL CENTER PH 2 Estimate Number 1
Contract Limits Payment Number I
Project Type PAVING For Period Ending 2/19/2015
Project Funding
Contract Information Summary
Original Contract Amount $402,941.71
Change Orders
Total Contract Price $402,941.71 ZA.
4.'tor Date r S Total Cost of Work Completed $402,941.71
Contr Less %Retained $0.00
Net Earned $402,941.71
Date
Inspection S s Earned This Period $402,941.71
Retainage This Period $0.00
Date /� Less Liquidated Damages
/ Project Man
/ Days @ /Day $0.00
Datel/Ti �� LessPavement Deficiency $0.00
Asst.Di to uc re Design and Construction Less Penalty $0.00
Date `�S �� Less Previous Payment $0.00
Director/Contracting Department �a Plus Material on Hand Less 15% $0.00
Balance Due This Payment $402,941.71
Thursday,February 19,2015 Page 5 of 6
City Project Numbers 01962 DOE Number 6888
Contract Name SAINT PATRICK CATHEDRAL PARISH HALL CENTER PH 2 Estimate Number I
Contract Limits Payment Number I
Project Type PAVING For Period Ending 2/19/2015
Project Funding
Project Manager Ehia City Secretary Contract Number 116888
Inspectors LAYER / MILLER,W Contract Date
Contractor SCOTT DENNETT CONSTRUCTION,INC. Contract Time 90 CD
2808 W.7TH ST.,NB Days Charged to Date 90 CD
FORT WORTH, TX 76107 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 $402,941.71
Less %Retained $0.00
Net Earned $402,941.71
Earned This Period $402,941.71
Retainage This Period $0.00
Less Liquidated Damages
0 Days @ $0.00 /Day $0.00
Less Pavement Deficiency $0.00
Less Penalty $0.00
Less Previous Payment $0.00
Plus Material on Hand Less 15% $0.00
Balance Due This Payment $402,941.71
I
i
Thursday,February 19,2015 Page 6 of 6
FORTWORTH rev 0310 '0'
TRANSPORTATION & PUBLIC WORKS
FINAL STATEMENT OF CONTRACT TIME
FINAL.STATEMENT NO.:1
NAME OF PROJECT: Saint Patrick Cathedral Parish Hall Center
PROJECT NO.: 01962 CONTRACTOR: Dennett Construction LC.
DOE NO.: 6888
PERIOD FROM 02/01/15 TO: 0215!15 FINAL INSPECTION DATE: I 1-Feb
WORK ORDER EFFECTIVE:51912014 CONTRACT TIME: 90 Wil CD
DAY OF DAYS REASON FOR DAYS DAY OF DAYS REASON FOR DAYS
MONTH CHARGED CREDITED MONTH CHARGED CREDITED
DURING DURING
1. sun 0 16.
2. mon 0 17.
3. tue 0 18.
4. well 0 19.
5. thu 0 20.
6. Irl 0 21.
7. sat 0 22.
8. sun 0 23.
9. mon 0 24.
10. tue 0 25.
11. wed 0 26.
12. thu 0 27.
13. fri 0 28.
14. sat 0 29.
15. sun 0 30.
31.
SAT,SUN, RAIN,TOO WET, UTILITIES OTHERS* DAYS TOTAL
&HOLIDAYS &TOO COLD RELOCATIONS CHARGED DAYS
THIS 0 0 0 0 0 0
PERIOD
PREVIOUS 0 0 0 0 90 90
PERIOD
TOTALS 0 0 0 0 90 90
TO DATE.
*REMARKS:
.S Zo S -
CONT CTOR DATE 1 SPECTOR DATE
ENGINEERING DEPART;NIENT
' The City of Fort Wordi•1000 Throckmorton Street•f otr Worth,'IX 76012-6311 OFFICIAL RECORD
(817)392-7941 •Fax:(817)392-7845 CITY SECRE ARY
FT.WORTH
FORTWORTHREV:02/22107
TRANSPORTATION AND PUBLIC WORKS
CONTRACTOR'S EVALUATION OF CITY
PROJECT INFORMATION _ Date: 2/23/2015
Name of Contractor Project Name
Dennett Construction Lc. Saint Patrick Cathedral Parish Hall
DOE Inspector _ Project Manager R
Wade Miller Fred Ehia _
DOE Number Project Dculty Type of Contract
'6888 O Simple QQ Routine Q Complex El Water❑ Waste WaterO Storm DrainagC Pavement
Initial Contract Amormf Final Contract Amount
$402,941.71 $402,941.71
H)PERFORMANCE EVALUATION
0-Inadequate 1 -Deficient 2-Standard 3-Good 4-Excellent
ELEMENT RATING ELEMENT RATING
(0-4) (0-4)
INSPECTION EVALUATION PLANS&SPECIFICATIONS
1 Availability of Inspector 1 Accuracy of Plans to Existing Conditions
2 Knowledge of Inspector 2 Clari &Sufficienc of Details
3 Accuracy of Measured Quantities _ 3 Applicability of Specifications
4 Dis la Of Professionalism 4 Accuracy of Plan Quantities
5 Citizen Com laint Resolution PROJECT MANAGER EVALUATION
6 Performance-Setting up Valve Crews,Labs 1 Knowledge And/Or Problem Resolution
ADMINISTRATION 2 Availability of Project Manager �f
I Change Order Processing Time 13 Communication
2 Tim liness of Contractor Payments 14 Resolution of Utility Conflicts
3 Bid Opening to Pre-Con Meeting Timeframe
HI)COMMENTS&SIGNATURES
COMMENTS
Signature Contractor
Signature DOE Inspector
Signature DOE Inspector's Supervisor
INSPECTOR'S COMMENTS
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 REV:02/20/07
;�,o
TRANSPORTATION AND PUBLIC WORKS
PERFORMANCE EVALUATION OF CONTRACTOR
CONTRACTOR&PROJECT DATA
Name of Contractor Project Name
Dennett Construction Lc. Saint Patrick Cathedral Parish Nall
DOE Lrspector DOE Number
Wade Miller 6888
DOE Inspector Projecl Manager
❑ Water❑ Waste Water❑ Storm DrainageE Pavement Fred Ehia
Initial Contract Amount Project Difcrdty
$402,941.71 0 Simple Routine 0 Complex
Final Contract Amount Dale
$402,941.71 2/23/2015
U)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 3 60 45
6 Finished Product 15 Y 3 60 45
7 Job Site Safety 15 Y 4 60 60
8 Tragic Control Maintenance 15 Y 4 60 60
9 Daily Clean Up 5 Y 4 20 20
10 Citizen's Complaint Resolution 5 Y 1 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) 418
BONUS POINTS(25 Maximum)(B)
TOTAL SCORE(TS) 4I8
111)CONTRACTOR'S RATING
Maximum Score(MS)=448 or sum of applicable element score maximums which= 448
Rating([TS/MS] * 100%) 418 / 448 = 93%
Performance Category Excellent
<20%=1nadequale 20%to<40%=Deficient 40%to<60%=Standard 60%!o<80%=Good _>80%=Excellenl
Inspector's Comments(LNCLUDPJG EXPLANATION OF BONUS POINTS AWARDED)
Signature DOE Inspector Signature Contractor
Signature DOE Inspector's Supervisor a zi-0
CONTRACTOR'S COMMENTS
TRANSPORTATION AND PUBLIC WORKS
= f� The City of Fort Worth• 1000 Throckmorton Street•Fort Worth,TX 76012-6311
(817)392-7941 •Fax (817)392-7845
AIA
Document G747"' - 1994
Consent Of Surety to Final Payment Bond No: PB11509800427
PROJECT:!:\'ante and rrddrevs) ARCHITECT'S PROJECT NUMBER: OWNER.TT
St.Patrick's Sidewalk
Phase It CONTRACT FOR:General Cunslnlmiun ARCHITECT:❑
CONTRACTOR:❑
TO OWNER:(Aantecirladdi-essy CONTRACT DATED:April 10.2U 14
Catholic I)itncse ur hurt worth SURETY:❑
300 \\cst Loup 320 South
OTHER:
Fort \\onii.'rX 76103 ❑
In accordance pith the prat inion,of the Conlrta between the Owncrand the('01niactur as indicated allots.till
thrb.rt nrirz andadih-st r?,"Surrn•i
Philndclphia Indemnity Insurance Company
3939 Beltline Road,Suite 650
Addison.•r\ 75001
' .sulte•rv.
on bond of
(lnsen inme aid address nf'Cwuracan•)
Scott Dutnelt Construction.I.C.
2313 Ci0lcn Street.Fort Worth,'I X 76107
CONTRACTOR.
hereby approves of'the final paynew to t1w Cumraetor,and agrces that final payinem to the C ontrocior shall not relieve the Sunt%
orant-of its obligations to
IUrsert nearer and adch,ss of Uwncr)
Culholic Diocese of Fart\\'orth
300\\'est I A)0p 820 SOUth.Fort Worth. I'X 76108 OWNIM
as set ltlrth in said Suret'b bund.
IN,\\I'1 VIiSS\VI IFRI70r.the Suri-has hcrcnmo sct its hand on this date February 10, 2015
1 bts,r!it 111-hint,[lie nrml.,h.jb11au•rd 111.1)1r inaarrit date did rear.)
Philadelphia Indemnity Insurance Company
tS'urrr w
rSi�r nu•rr�(,rurlari.r. r.�rresnianrrj
\ttc t: Fred A.Thetford Jr. Attorney-in-Fact
(S«)r: (Priitell rewire Duel IWO
AtA Document G707--1994.Copyri9hl^1982 and 03:oy The Arrencan Ins:ituleclArchdecls.All rights reserved.:"•'� •1 ' �� •%•i. '.,.,....,_n: :
,I 1,,.This docurlenl was produced by AIA
sonwj10 of 11 C0 un
21 on 03/OS%2015 due Order No SUS a2 aJi L'7_1 v.,hch e1.{.,res on C9e2VZJ 15,and i;not lcr resale
User Ndtas:
(1278237036)
2552
PHA,ADJ:LPE A INDEMIYI'I'Y INSURANCE COMPANY Bond No: P81 1509800427
One Bala Plaza,Suite 100
Bala Cynwyd,PA 19004
Power of Attorney
KNOW ALL PERSONS BY THESE PRESENTS: that PHILADELPHIA INDEMNITY INSURANCE COMPA,YY(the Company),a corporation organized and
existing under the laws of the Commonwealth of Pennsylvania,does hereby constitute and appoint: Jared Young,Fred A.Thetford,Jr.,Tobin Tucker,Tom Young
And Fred A.Thetford,In of Contract Bond Agency,LLC.
Its tnie and lawful Attorney(s)in fact with full authority to execute on its behalf bonds,undertakings,recognizances and other contracts of indemnity and writings
obligatory in the nature thereof,issued in the course of its business and to bind the Company thereby,in an amount not to exceed 525,000,000
This Power of Attorney is granted and is signed and sealed by facsimile under and by the authority of the following Resolution adopted by the Board of Directors of
PHILADELPHIA INDEMNITY INSURANCE COMPANY at a meeting duly called the 14 day oflaly,2011.
RESOLVED: That the Board of Directors hereby authorizes the President or any Vice President of Ore
Company to:(1)Appoint Attorncy(s)in Fact and authorize The Attorneys) in [act to
execute on behalf of the Company bonds and undertakings,contracts of indemnity and
other writings obligatory in the nature thereof and to attach the seal of the Company
thereto; and (2) to remove, at any time, any such Atioraey-in-Fact and revoke the
authority given. And,be it
FURTHER
RESOLVED: That the sienatures of such officers and the seal of the Company may be affixed to any
such Power of Attorney or cartificale relating thereto by facsimile,and any such Power of
Attorney so executed and certified by facsimile signatures and facsimile seal shall be
valid and biding upon the Company in the future with the respect to any bond or
undertaking to which it Is attached.
IN TESTIMONY WHEREOF,PHILADELPHIA INDEMNITY INSURANCE COMPANY HAS CAUSED THIS INSTRUMENT TO BE SIGNED AND
ITS CORPORATE SEALTO BE AFFIXED BY ITS AUTHORIZED OFFICE THIS 7T"DAY OF FEBRUARY 2013.
,J
(Seal) -
Robert D.O'Leary Jr.,President&CEO
Philadelphia Indemnity Insurance Company
On this Tr'day of February 2013,before me came the individual who executed the preceding instrument,to me personally known,and being by me.duly sworn said that
he is the therein described and authorized officer of the PHU ADELPHIA INDEMNITY INSURANCE CONJI'ANW,that the seal affixed to said insnumem is the
Corporate seal of said Company;that the said Corporate Seal and his signature were duly affixed.
Opp
1`10TANALSEA'
DAMELLE PMTK NotatyPM '
LaweT itiatlen T .,
t�tmUeslws MwT 201
Notary Public:
residing at: Bala Qyny7d PA
(Notary Seal)
My commission expires: March 22 2016
I,Craig P.Keller,Executive Vice President,Chief Financial OfEcer and Secretary of PHILADELPHIA INDEMNITY INSURANCE COMPANY,do herby certify that
the foregoing resolution ofthe Board of Directors and this Power of Attorney issued pursuant Thereto are true and correct and are still in full force and effect.I do
farther certify that Robert D.O'Leary Jr„who executed the Power of Attorney as President,was on the date of execution of the attached Power of Attorney the duly
elected President ofPHIL.ADELPHIA INDEMNITY INSURANCE COMPANY,
In Testimony Whereof]have subscribed my name raid nftixed the facsimile seal of each Company this 10th day of February ,20 15
Craig P-Keller,Executive Vice President,Chief Financial Officer&Secretary
PHJLADELPHIA INDEMNITY INSURANCE COMPANY
o �
AFFIDAVIT
s,rA7'E OF TI?XAS
COUNTY OF TARRANT
Before me, the undersigned authority, a notary public in the state and county aforesaid.
on this day personally appeared Shawn Moore, Project Manager of Scott Dennett Construction.
LC, known to me to be a credibleperson, .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;
]'hat there are no chums pending. for personal injury and/or property d ages;
On Contract described as: Remodel i
BY
9S�avvnMKeore, Project Manager
Subscribed and sa.wji before me on this date I"of May, 2015
`
N04 Public
larrunt County. Texas