HomeMy WebLinkAboutContract 34488-FP2 CITY SECRETAW
Department TP&W Const. Services
ft CONTRACT NO.
D D A
Project Manager t A
Risk Management J.Pa e RT ,
D.O.E. Brotherton
ICFA Westerman/Scanned
vi
The Proceeding people have been ConfiaZied concemlngthe request for final
payment&have released this project for such payment rATION AND PUBLIC WORKS 16 5 -0-2 35 0
Clearance Conducted By Shameka Kennedy )F PROJECT COMPLETION
D.O.E.N2: 7288
CJ
Regarding contract 117288 for THE RANCHES EAST ADDN PH 2-STORM DRAIN 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 reconu-nendation of the Assistant Director of the
Transportation&Public Works Department bas accepted the project as corapIete.
Original Contract Prices- $817,828.05 r,
Amount of Approved Change Orders: $34,846.10 X21,2,3
Revised Contract Amount: 5852,674.15
Total Cost Work Completed: $852,674.15
Less Deductions:
Liquidated Damages: as $210.00/Day
Pavement Deficiencies:
Total Deduction Amount:
Total Cost Work Completed: $852,674.15
Less Previous Payments: $0.00
Final Payment Due $852,674.15
.... ............. .... . .........
Recommended for Acceptance Date
Asst. TPW Infrastructure Design and Construction
c"o P
IJ
Accepted Date
41& Director, TRANSPORTN'rION & UBLIC WORKS
.......... .............
st &�; a�ager Date
Comments, ('-205 541.200--20"7"760235083
100
................... w.
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OFFUNA 1, RE-C 011t
.
CITYS IF
..............
jq.,WonITH,TX
VI 11
FORTWORTH
CITY OF FORT WORTH
FINAL PAYMENT REQUEST
Contract Name THE RANCHES FAST ADDITION PHASE 11
Contract Limits
Project Type STORM DRAIN&PAVING
City Project Numbers 02350
DOE Number 7288
Estimate Number I Payment Number I For Period Ending 9/2/2015
CD
City Secretary Contract Number 117288 Contract Time I NED
Contract Date Days Charged to Date 218
Project Manager Ehia Contract is 100.00 Complete
Contractor BURNSCO CONSTRUCTION,INC.
6331 SOUTHWEST BLVD
FORT WORTI I, TX 76132
Inspectors LAYER I TAFZAZ
I
Monday,September 14,2015 Pagel of 5
City Project Numbers 02350 DOE Number 7288
Contract Name THE RANCHES EAST ADDITION PHASE 11 Estimate Number I
Contract Limits Payment Number I
Project Type STORM DRAIN&PAVING For Period Ending 9/2/2015
Project Funding
DRAINAGE
Item Description of Items Estimated Unit Unit Cost Estimated Completed Completed
No. Quanity Total Quanity Total
1 21"RCP 81 LF $40.00 $3,240.00 81 $3,240.00
2 24"RCP 1110 LF $44.50 $49,395.00 1110 $49,395.00
3 30"RCP 169 LF $56.50 $9,548.50 169 $9,548.50
4 24"RCP 318 LF $50.00 $15,900.00 318 $15,900.00
5 10'CURB INLET 6 EA $3,100,00 $18,600.00 6 $18,600.00
6 201 CURB INLET I EA $6,200.00 $6,200.00 1 $6,200.00
7 4'DROP INLET 3 EA $3,300.00 $9,900.00 3 $9,900.00
8 4'STORM JUNCTION BOX 10 EA $3,000.00 $30,000.00 10 $30,000.00
9 2411 FLARED HEADWALL I EA $2,400.00 $2,400.00 1 $2,400.00
10 CONCRETE RIPRAP co#3 62 SY $47.00 $2,914.00 62 $2,914.00
11 LARGE STONE RIPRAP 250 SY $60.00 $15,000.00 250 $15,000.00
12 24"SET 4 EA $2,000.00 $8,000.00 4 $8,000.00
13 21"SLOPING HEADWALL I EA $1,700.00 $1,700.00 1 $1,700.00
14 24"SLOPING HEADWALL 2 EA $1,800.00 $3,600.00 2 $3,600.00
15 30"SLOPING HEADWALL I EA $2,000.00 $2,000.00 1 $2,000.00
16 ENERGY DISSIPATORS 17 EA $90.00 $1,530.00 17 $1,530.00
17 ETTP-10 TRM CON3 873 SY $4.00 $3,492.00 873 $3,492.00
Sub-Total of Previous Unit $183,419.50 $183,419.50
PAVING
Item Description of Items Estimated Unit Unit Cost Estimated Completed Completed
No. Quanity Total Quanity Total
I REMOVE GUARDRAIL 28 LF $10.00 $280.00 28 $280.00
2 REMOVE ASPHALT PVMT 485 SY $10.00 $4,850.00 485 $4,850.00
3 TEMPORARY ASPHALT PAVING REPAIR 10 SY $250.00 $2,500.00 10 $2,500.00
4 HYDRATED LRvffi CO#1 224 TN $155.00 $34,720.00 224 $34,720.00
5 6"LIME"TREAT CO#I 14949 SY $2.75 $41,109.75 14949 $41,109.75
6 6"CONC PVMT CONI 11862 SY $3290 $390,259.80 11862 $390,259.80
7 4"CONC SIDEWALK CO#1 2920 SF $4.30 $12,556.00 2920 $12,556.00
8 BARRIER FREIE RAMI1 6 EA $1,750.00 $10,500.00 6 $10,500.00
10 8"CONC PAVEMENT 2126 SY $39.85 $84,721.10 2126 $84,721.10
Monday,September 14,2015 Page 2 of 5
City Project Numbers 02350 DOE Number 7288
Contract Name THE RANCHES EAST ADDITION PHASE 11 Estimate Number I
Contract Limits Payment Number I
Project Type STORM DRAIN&PAVING For Period Ending 9/22015
Project Funding
I I SIDEWALK 5660 SF $4.30 $24,338.00 5660 $24,339.00
12 PERMANENT ASPHALT PAVEMENT REPAIR 729 LF $80.00 $58,320.00 729 $58,320.00
CO#2
13 TRAFFIC CONTROL CO#2 I LF $1,500.00 $1,500.00 1 $1,500.00
14 REMOVE CONCRETE PAVEMENT C09 1 180 SY $20.00 $3,600.00 180 $3,600.00
Sub-Total of Previous Unit $669,254.65 $669,254.65
Monday,September 14,2015 Page 3 of 5
City Project Numbers 02350 DOE Number 7288
Contract Name THE RANCHES EAST ADDITION PHASE 11 Estimate Number 1
Contract Limits Payment Number 1
Project Type STORM DRAIN&PAVING For Period Ending 9/2/2015
Project Funding
Contract Information Summary
Original Contract Amount $817,828.05
Change Orders
Change Order Number 1 $12,565.10
Change Order Number 2 $59,820.00
Change Order Number 3 ($37,539.00)
Total Contract Price $852,674.15
Date Total Cost of Work Completed
$852,674.15
Con r Less %Retained $0.00
1 1 Net Earned $852,674.15
Date / S
Inspection Sup rv' r Earned This Period $852,674.15
Retainage This Period $0.00
L G , Date Less Liquidated Damages
Project Mana
Days @ /Day $0.00
Dat /s LessPavement Deficiency $0.00
t. irector/PPW/-Infrastructure Design and Construction Less Penalty $0.00
. to � Less Previous Payment $0.00
Director/ tracting Department Plus Material on Hand Less 15% $0.00
Balance Due This Payment $852,674.15
Monday,September 14,2015 Page 4 of 5
City Project Numbers 02350 DOE Number 7288
Contract Name THE RANCHES FAST ADDITION PHASE If Estimate Number l
Contract Limits Payment Number 1
Project Type STORM DRAIN&PAVING For Period Ending 9/mo15
Project Funding
Project Manager Ehia City Secretary Contract Number 117288
Inspectors LAYER / TAEZAZ Contract Date
Contractor BURNSCO CONSTRUCTION,INC. Contract Time 150 CD
6331 SOUTHWEST BLVD Days Charged to Date 218 CD
FORT WORTH, Tx 76132 Contract is .000000 Complete
CITY OF PORT WORTH
SUMMARY OF CHARGES
Line Fund Account Center Amount Gross Retainage Net
Funded
Total Cost of Work Completed $852,674.15
Less %Retained $0.00
Net Earned $852,674.15
Earned This Period $852,674.15
Retainage This Period $0.00
Less Liquidated Damages
0 Days @ $0.00 i 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 $852,674.15
Monday,September 14,2015 Page 5 of 5
F ORT WORTH rev 013/05/0'7
TRANSPORTATION& PUBLIC WORKS
FINAL STATEMENT OF CONTRACT TIME
FINAL STATEMENT NO.:I
NAME OF PROJECT: The FAncbes East Addition Pb—ase2—
PROJECT NO.: 23 5........................__C0N'I'RA"_CT0RBurns_'c'o Construction
DOE 7299
PERIOD FROM:0 1.0-0/15 TO: 08/31/�T_FIN' lEC"TION DATE: 13-Augg-15
W 0 RK 0 RD F R f FTF E C—TI V 1,:1/2 6/2,6, CONTRACT TIME. ..............
DAY OF DAYS REASON FOR DAYS DAY OF DAYS REASON FOR DAYS
MONTH CHARGED CREDITED MONTH CHARGED CREDITED
DURING DURING
L 16.
2. 17.
3. 18.
4. 19.
5. 20.
6. 21.
9. 24.
10. 25.
.............
if. 26.
12. 27.
13. 2&
14. 29.
15. 30.
............
31.
SAT,SUN, RAIN,TOO WET, U111KIES ERS DAYS TOTAL
&HOLIDAY'S &TOO COLD RELOCATIONS OTH CHARGED DAYS
THIS 0 0 0 0 218
PERIOD
PREVIOUS 0 0 0 0 0 IT 0
PERIOD
TOTALS 0 0 0 218
TO DATE
*REMARKS;_..
..................
CONTRACPR DATE INSPEC'm DATE
nic City of F'ortWord,- T—hrockin—aa"o"n Street-Fort Wordi,"ll',X76012-631 I
(813)392 �"7941 -IFT=(817)392.. 7845
MV�L R-AVPj, iZ-RR9
WZ6 TF6T-NA-M-E—� '—,Th"e —Phaie .........
CON
ORDER No.,
CFA 9
............ ............... pm
........... ...........
DOE# 1288:
.................
WATER PROJECT X P261�6071502350
FF E
WV R P K5ECT# P275 40T13023,50
;
............ .................. .. ..............
WSPE.CTOR: Iabte A.7aar.az Phone Nm 214-325.1666
PRa9EG'r MANAGER: Fmd ENz phanp my (8.17)392-8424
............................... .......
.......... GOMRAC U[M.T............
�
AM R SEWER "--- ORMAGE STREFT UGMS C® CT
77�-lll -T D v
A S
airs a tA4Z C-t
...........
v
UTWINO.50
S TO DATE MOO
To som �35 cs
Sg Do is
.......... ..............
............ $0.00 so D
CON TT0QA7F !a 0 $177X0,114 Z $S96,86935 jf�,� s 0, .50 M.. MAI;", MOO ISO
.......... ITTM
MIT" C
........... .�Rqt-�11A.GEORrICR jS_ i, sla'sam! 00
m
PA-NMELD TI NY oa.rw LA,
�0 as
TOTAL REYISED CONTRACT AMOUNT
17 94 W-� 2�
.......... .......... 6 $ ,
C7,77,�� -7,
Revism cosr wwc Dee,comr, ,7� 7,
...........
TOTAL RhAE;ED OUNTRAM
......................... ....... ................................
Revised:10-12-2611
Ybo are directed to make I he(oPlovAn chap es Fn the contract documents:
CITY 910 ITEM
PAY ITEM 4 11 QUANTITY UNIT ITEM DESCRIPTION UNIT'PRICE TOTAL
—02sv.100 /T80\ SY Remove Cone Pvmt ,,,-_520.00—_-§_360000--
—T. S-155,67- $05,00
-Lime Treatment 3owsy
47 SY b 52.76 _ 5550.90
6 iy 6°G<mo Nmi �3230
u 46 321 v.U4g0—48 --i-2-130701 tk _$5.854.60-
-49 3213.0301 404 �430 520
��F 4"ConcSidewalk -ii
TOTAL
REASONS FOR CHANGE ORDER
c-m-fo to o,v f;(r�;a pc(;(,,j1'roo,41,Cafnm,
CITY FUNDS INVOLVED IN THIS CONTRACT,CEVCLOPER IS RESPONSIBLE FOR IODI/,OF THE CHANGE ORDER COST AND NO
vr,.k—;�lh'a q C tv NO
REIMBURSEMENT FROM THE CITY INILL BE SOUGHT BY THC DEVELOPER.
EECOMMENDEO-' APPROVED: APPROVED:
.vj I t1cm .wj D,;jju ;-p—L— ew.,-Q 6,�l-,-'kewn Fret
B
Name: .me: lq-11—k�4�1 Name: J.h.BUMS
�—idh—aetk Thomas P
Title:Principal Till -------Emmgeol-
Taw
Revised:10.12-2011 Page
2MffiLQP-L-R-A-WABQEQ-PR-QjgjZl-��Gf.QBQ�R
................. ......
PROJECTNAME The Ranchas East Addition Phase 11
Th R, ..........--.-..................... CHANGE
"has C",
T-0—NTRW—,T (A)Water,(B)Sanitary Sewpir, Q M&ORma,(D)&met Light Improvements
7a ORI)ER No!
CFA 0
CITY PROJECT Of 23 9t
50E—#
WATER PROJECT# P2W5--6Ol—1=350 2
................
'SE—WIR PRdTE—(,T# P27,5407113023-50
.............
FLF—0 X"
INSPECTOR: Hable A.Taezaz Phane Nw 214.326-1866
PROJECT MANAGEK reed FhTz Phmic No: 017)392-8424
............
CONTPACT UNIT
R sewaece-- — —,—PAVING nPBABaAlaE 6TidE&TLt6&9T8 CONTRACT
,V 777 '7—, DAYS
uw-'F"w*—
COAL ma clomst
........... tilmaosm "Its"k gumiscut i 160
Ex.TRAS 10 DATE um
slia i
..........
comm AcrIOUNTE ussm"a 494,1), $649434.04 'il 150
L
2tftOP OIAMOE OR--T% 01n.0n9aa 10i, $0,00 sow
REVISED CONTRACT AMOUNT $240,3118.10 "30100`
TOTAL RffMEb CONTRACT AMOUNT
PER
yin 0.56
77"
REVMEO COST SHARE now.cmt
TOTAL REVISED CONIRACT
........... .............
Yal atefiwleU(a ffilke the followinj changes;n inn conleact doctimnis
PAY i MA 9 F OLIANTITY UNIT IfEm DESCRUITtr(I UNIT rin-ct TOTAL
3 1—— 6 ----—S 1-50-0 6T—To—.owdo
3 12,210,1 6 —EA—iiL-r-11—flo—lion
3209.69—12 120 --LF— —9,—550——ri—Am oo
---i F i'errnannnleiall P.yerrNtni Reparc 500.00 $58.32000
3471,001 1 —1.7—TodrcConool —31.5-0000
TOTAL
REMNS FOR CHANGE ORDER
RECOMMENDED: APPROVED: APPROVED:
BY BY:
N—m F#7:
Wq��.�P)E' Hawn Nance-
7111L< rdncgal rme: Me
R0,451c:10.12-2011 Page
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FORIWORTH REV�02/22/07
,rRANSPORTxf ION AND PI)BLI C WORKS
CONTRACTOR'S EVALUATION OF CITY
1)PROJECT INFORMATION Date: 8/31/2015
Nance of Contractor, Project Name
Burnsco Construction Inc. The Ranches East Addition Phase 2
DOFInspector Project Manager
7288 Fred
....................
T)(--ENuTn—ber '— Project Difjiculty type qj'Confracl
2350 10 simple /Routine 0 Coniplex 0� ater ante Water Q Storm Drainage 0 Pavement
Initial Contract Amount al Contract Amount
$817,828.05 $852,631.1.5
11)PERFORMANCE EVALUATION
0-Inadequate I -Deficient 2-Standard 3-Good 4-Excellent
..........
-FLEMENT 'TING, EL E
EMNT RATING
r
(0-4) (0-4)
INSPECTION EVALUATION PLANS&SPECIFICATIONS
I Availability of Inspector 1 Accuracy of Plans to Existing Conditions
Knowledge of Inspector 2 Clarity&Sufficiency of Details
3 Accuracy of Measured Quantities,......... � 3 Applicability of Specifications
4 Display Of Professionalism q 4 Accuracy of Plan Quantities
Citizen Complaint Resolution -PROJECT MANAGER EVAL(JATION
6 Performance-Setting tip Valve Crews,Labs I Knowledge And/Or Problem Resolution
ADMINISTRATION 2 Availability of Project Manager
—1 ............. 4---.-4------4
1 Change Order Processing Time 3 Communication 4 I U I
2 Timliness of Contractor Payments (-1 4 Resolution of Utility Conflicts
3 Bid Opening to Pre-Con Meeting'rimeframe
111)COMMENTS&SIGNATURES
COMMENTS
............
...................
................ ...... .............................................................................................
.............
.............
................. ..........................
— .......... ..........
Signature Contractor
Signature DOE Inspector 1-1 4j �' Ate_� -
Signature DOE Inspector's Supervisor
INSPECTOR'S COMMENTS___._
.........................
.......... ..........
..............................................
TRANSPOIR1.I ATIONAND PUBLIC WORICS
Ee '.Me City of Fort Worth•100011tockmorton Street•Fort Worth,TX 7601.2-6311
(8117)392..7941 ®Fax (81° 392 - '7845
FORTOR i H REV:02/20/07
TRANSPORTATION AND PUBLIC WORKS
PERFORMANCE EVALUATION OF CONTRACTOR
1) CON'TRAC'TOR&PROJECT DATA
Name of Contractor Project Name
Burnsco Construction Inc. The Ranches East Addition Phase 2
DOE Inspector DOI,"Number
Habte Tae7az 7288
DOE Inspector Project Manager
2 Water El Waste Water [3-,Storm Drainage n-Pavement Fred
Initial Contract Amount Project Difficulty
$817,828.05 0 Simple @ Routine 0 Complex
Final Contract Amount Date
$852,631.15 8/31/2015
M PERFORMANCE EVALUATION
0-Inadequate I•-Deficient 2-Standard 3-Good 4 Excellent
ELEMENT W[UGHT(x) APPLICABLE(YIN) RATING(0 4) MAX SCORE SCORE
I Submission of Documents 2 Y 3 8 6
T Public Notifications 55 N
3 Plans on Site 5 Y 3 20 15
T Field Supervision 15 Y 3 60 45
5 Work Performed IT Y 3 60 45
6 Finished Product 15 Y 3 60 45
7 Job Site Safety 15 Y 4 60 60
8 Traffic Control Maintenance 15 7 4 60 60
97 Daily Clean Up 5 Y 3 20 15
10 Citizen's Complaint Resolution 5 Y 4 20 1 20
11 Property Restoration 5 Y 3 20 15
12 After Hours Response 5 N
13 Project Completion 5 Y 3 20 15
TOTAL ELEMENT SCORE(A) 341
BONUS POINTS(25 Maximum)(B)—
TOTAL SCORE(TS) 341
111)CONTRACTOR'S RATING
Maximum Score(MS):=448 or sum of applicable element score maximums which 408
Rating(ITS I MS1*100%) 341 408 84%
Performance Category Excellent
<20%=Inadequate 20%to<40%—Dqftcient 40%to<60%----Standard 60%to 80%--::::Good 80%=Eaceflent
Inspector's Comments(INCLUDING EXPLANATION OF BONUS POINTS AWARDED)
Signature DOE liaspector
Signature Contractor
Signature DOE Inspector's Supervisor
CONTRACTOR'S COMMENT'S
I I R.ANS]P0Rr,F,A'110N.AND PUBLIC WORKS
The City of Fort Worth• 100011roclailorton Street•Fort Worth,T.X.76012-6311
(817)392 7941 •F=(81'0 392 .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 Ab Grantges,
Contract Mgr, Of Burnsco 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;
The Ranches East Phase 2 - Water, Sanitary Sewer, Storm Drain and
h
BY
Ab Grantge ; Contract Manager
Subscribed and sworn before me on this date 14th of August, 2015.
Notary Public �`"°"� LEIA MC®WEN
Tarrant County,Texas My Comm+ssbn
dune 26.2018
„4
'-11 IF �f
CONSENT OF OWNER ❑
SURETY COMPANY ARCHITECT ❑
CONTRACTOR ❑
TO FINAL PAYMENT SURETY ❑
Conforms with the American Institute of OTHER
Architects,AIA Document G707
Bond No 022048407
PROJECT:
(name, address)The Ranches East Addition Phase II
TO (Owner)
ID.R.HORTON-TEXAS,LTD AND CITY OF FORT ARCHITECT'S PROJECT NO:
WORTH CONTRACT FOR:
6751 North Freeway The Ranches East Addition Phase II
Fort Worth TX 76131 CONTRACT RACT DATE:
CONTRACTOR:BURNSCO 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)
LIBERTY MUTUAL INSURANCE COMPANY
175 Berkeley Street
Boston MA 02116 , SURETY COMPANY
on bond of (here insert name and address of Contractor)
BURNSCO CONSTRUCTION, INC.
6331 Southwest Boulevard
Benbrook TX 76132 , CONTRACTOR,
hereby approves of the final payment to the Contractor, and agrees that final payment to the Contractor shall not relieve
the Surety Company of any of its obligations to (here insert name and address of Owner)
D.R. HORTON-TEXAS, LTD AND CITY OF FORT WORTH
6751 North Freeway
Fort Worth TX 76131 , OWNER,
as set forth in the said Surety Company's bond,
IN WITNESS,WHEREOF,
the Surety Company has hereunto set its hand this 12th day of August,2015
LIBERTY MUTUAL INSURANCE COMPANY
Sur ty Company
Attest:Robbi Morales
(Seal): Signafure of Authorized Representative
SoDhinie Hunter Attorney-in-Fact
Title
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
ONE PAGE
...................................................................
THIS P`OWER OF ATTORNEY IS NOT VALID UNLESS IT IS PRINTED ON RED BACKGROUND.
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.
Certificate No.jE1!19R
American Fire and Casualty Company Liberty Mutual Insurance Company
The Ohio Casualty Insurance Cornpany West American Insurance Ccoilcany
POWER OF ATTORNEY
KNOWN ALL PERSONS BY THESE PRESENTS: 'That American Fire&Casualty Comparly and The Ohio Casualty irisuralim Company are cv,poratiors duly organized under the laws of
the State of New Hampshire,that Liberty Mutual insurance Company is a corporation duty organized under the laws of the State of Massachusetts,and West American Insurance Company
is a corporation duty organized under the laws of the State of Indiana(herehi collectively called tlbe'Ccrnpav�ies"),pursuant to and by authority herein set forth,does i reby name,canifihite
and appoint, Don E,Cornell, �4l2r209kJ:-!§_a_M,—BODD91ti Del-ene—marstiall
..... .........................
............ ......... ..............I——.............. ........................................................................._1._____1... ..................
.......... ......................................... .........................
...............................
all of the city of j�gI�jrj__state of each individually if there be more than one named,its true and lawful attorney-h4act to rrlak®,execute,seal,acknowledge
and deliver,for and on its behalf as surety and as its act and dead,any and all undertakings,bonds,recognizances and other surety obligations,in pursuance of these presents and shall
be as binding upon the Companies as if they have been(Uysigned by the president and attested by the secretary of the Companies in their own proper persons.
IN WITNESS WHEREOF.,this Power of Attorney has been subscribed by an authorized offi cer or official of the Companies and the corporate seals of the Companies have been affixed
thereto lhhL.±9th day of Mardi 2015
D C LNsv '01,15 UR4 INSUP" American Fire and Casualty Company
The Ohio Casualty Insurance Company to
Llbefty Mutual Insurance Company
1906 0 0 191 n 1912 1991
0
W mencan insurance Company
(n 'es,
STATE OF PENNSYLVANIA as David M.Cars Zsfarit Secretary
COUNTY OF MONTGOMERY
0
0 On this before me personally appeared David M.Carey,who acknowledged himself to be the Assistant Secretary of American Fire and
_lD_th day of parrs I....................................... ........
as Casualty Company,Libedy Mutual Insurance Company,The Onto Casualty Insurance Company,and West American Insurance Company,and that he,as such,being authorized so to do, >M
46.2 execute the foregoing instrument for the purposes thereto contained by signing on behalf of the corporations by himself as a duly authorized officer. 0)W
L. M Lr.- E
(D > IN WITNESS WHEREOF,I have hereunto subscribed in name and affixed my notarial seal at Plymouth Meeting,Pennsylvania,on the day and year first above written. 0 CL
r COMMONWEALTH OF PENNSYLVANIA Vol
<n
N Pei COMMONWEALTH....................
Notarial Seal
It
71 Teresa Pastelle,Notary Publ[c By: 0
OF Plymouth Twp,,Montgomery 0wrty 'Thresa f2astalls,Ncrtaq Public 0 C
0 My Commission Exprres March 28,201
---.......................
0 Member,Pennsylvania Anaclalion of Notaries 0 r=
Ry
0�4)
r- This Power of Attorney Is made and executed purs sot to and by authority of the following By-laws and Authorizations of American Fire and Casualty Company,The Ohio Casualty InsAnance u)
Company,Liberty Mutual Insurance Company,arid West American insurance Compny which resolutions are now In full force and effect reading as follows:
IM U)
m ARTICLE IV-OFFICERS Section 12.Flowe!olAftorney.Any officer or other official of the Corporation authorized for that purpose In writing by the Chairman or the President and subject 0 r-
0 to such limitation as the Chairman or the President may prescribe,shall appoint such attorneys-in-fact,as may be necessary to act in behalf of the Corporaton to make,execute,seal, W>4
O.S arknowledge and deliver as surely any and all undertakings,bonds,reongnizances mid other surety obligations.Sucti aftorneys-in-t3d,subject to the limitations set forth in their respective
E 6 powers of attorney,shall have VI power to bind the Corporation by their signature and execution of any such instruments and to attach thereto the seal of the Corporation. When'so G
-its shall be as binding as if signed by 4�e President and attested to by the Secretary.Any power or authority granted to any representative or u nder >,Q
executed,such instrurnst
the provisions of this article may be revoked at any time by the Board,the Chairman,the President or by the officer or officers granting Such power or authority.
C141
ARTICLE X111 Execution of Conbsicts-SECTION 5.,Surety Bonds and Undertakings.Any officer of the Company authorized for that purpose in writing by the chairman or the presiden
t' E
> and subilect to such limitations as the chairman or the president may prescribe,shall appoint such aftorneys-in-fact,as may be necessary to act.In behalf of the Company 6 make execute
O sea(acknowledge and deliver as surely any and ail undertakings,bands,reGogrilzances and other surety obligations. Such aflarneys-in-fact subject to me limitations set lbrift in their
Z v respectlye powers of attorney,shall have full power to bind the Company by their signature and execution of any such instruments and to attach thereto the seal of the Company. When so 0 o
executed such instruments shall be as binding as if signed by the president and arrested by the secretary.
o cD
Certificate of Designation--The President of the Company,acting pursuant to the News of the Company,authorizes David M.Carey,Assistant Secretary to appoint such attar reys-In-
fact as may b e n ecessary to act on behalf of N Company to make,execute,seat,acknowledge and deliver as surety any arid all undertakings,bonds,recogirilzances and other surety
obligations.
Authorization-By unanimous consent of the Company's Board of Directors,the Company consents that facsimile or mechanically reproduced signature of arty assistants etary of the
Company,wherever appearing upon a cerdfied copy of any power of attorney Issued by the Company In connection with surely bonds,shall be valid and binding upon the Company with
the same force and effect as though manually affixed, t
1,Gregory W.Davenport,the undersigned,Assistant Secretary,of American Fire and Casualty Company,The Ohio Casualty Insurance Company,Llborty Mutual Insurance Company,and
West American Insurance Company do hereby certffy that the original power of attorney of which the foregoing is a full,true and correct copy of the Power of Attorney executed by said
Compariles,Is in full force and effect and has not been revoked.
IN TESTIMONY-WHEREOF,I have hereunto set my hand and affixed the seals of said Companies this day of ........................... 20
D CA's, INS& 104 Msuy
044,
1906 By:
0 1919 Q >- 1 12 ° 1991 Gregory W.Davcvnpovt Assistant Secretary
A
4,
246 of 500
LMS 12873 122019 --------------
Liberty
Mutual,
SURETY
Important tic
TO OBTAIN INFORMATION OR TO MAKE A COMPLAINT:
You may write to Liberty Mutual Surety at:
Liberty Mutual Surety
Interchange Corporate Center
450 Plymouth Road, Suite 400
Plymouth Meeting, PA 19462-8284
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:
P, 0, Box 149104
Austin, TX 78714-9104
Fax: (512) 475-1771
Web: ht_tp://www.tdi.state,tx.us
E-mail: Cons umerProtection -tdi.state.tx.us
Premium or Claim Disputes i
Should you have a dispute concerning a premium, you should contact the agent first. If you
have a dispute concerning a claim, you should contact the company 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 or condition of the
attached document.
LMIC-3500