HomeMy WebLinkAboutContract 46521-FP2 D epartmen o T &W Const.Services MY SECRUM
DOES Gate
Project onager
Risk Management ,Pag TWORTH.
D.O.E. Brotherton ~°
CFA Westerman/Scanned'
The Proceeding people have teen C acted concerning the request for Final
payment&have released this projeot for such payment 'I"I ON AND PUBLIC WORKS
Clearance Conducted By Shameka Kennedy PROJECT COMPLETION 1
" D.O.E.Ns: 7322
1
ke 'edin contract 117322 For LAKE RANCHas required by the
TRANSPORTATION&PUBLIC WORKS as apptoved 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,
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Original Contract Prices: $1,228,164.87
Amount of Approved Change Orders: Ns
Revised Contract Amount:
Total Cost Work Completed: $1,228,164.87
Less Deductions:
Liquidated Damages: Days(a $210,00/Day
Pavement Deficiencies:
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Total Deduction Amount:'
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Total Cast Work Completed: $1,228,164.87
Less Previous Payments: $0.00
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Final Payment Due $1,228,164.87 f
Recommended or Acceptance Date
Asst. Director, TPW - Infrastructure Design and Construction
9 15
Accepted Date
Director, TRANSPORTATION &PUBLIC WORKS , a
Asst. ity Manager Date
Comments: 0205-541200-207760239383
O�FFICIAL RECORD
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CITY SECRINTARY
1 TX
�SMIJ,Mf;LUY
FORT WORTH
CITY OF FORT WORTH
FINAL PAYMENT REQUEST
Conti-act Name LAKE VISTA RANCH
Contract Limits
Project Type STORM DRAIN,PAVING&ST LIGHT
City Project Numbers 02393
DOE Number 7322
Estimate Number I Payment Number I For Period Ending 10/15/2015
CD
City Secretary Contract Number 117322 Contract Time 18ED
Contract Date Days Charged to Date 191
Project Manager Long Contract is 100.00 Complete
Contractor GILCO CONTRACTING,INC.
6331 SOUTHWEST BLVD.
BENBROOK, TX 76132-1063
Inspectors LAYER / TAEZAZ
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Thursday,October 15,2015 Page 1 of
City Project Numbers 02393 DOE Number 7322
Contract Name LAKE VISTA RANCH Estimate Number I
Contract Limits Payment Number I
Project Type STORM DRAIN,PAVING&ST LIGHT For Period Ending 10/15/2015
Project Funding
STORM DRAIN
Item Description of Items Estimated Unit Unit Cost Estimated Completed Completed
No. Quanity Total
Quanity Total
— - ———————— ——— —— ———-
1 18"RCP 90 LF $37.00 $3,330.00 90 $3,330.00
2 21"RCP 192 LF $42.00 $8,064.00 192 $8,064.00
3 24"RCP 1100 LF $46.00 $50,600.00 1100 $50,600.00
4 30"RCP 394 LF $59.00 $23,246.00 394 $23,246.00
5 36"RCP 83 LF $80.00 $6,640.00 83 $6,640.00
6 42"RCP 227 LF $104.00 $23,608.00 227 $23,608.00
7 48"RCP 343 LF $140.00 $48,020.00 343 $48,020.00
8 7X3 BOX CULVERT 261 LF $316.67 $82,650.87 261 $82,650.87
9 4'STORM JUNCTION BOX 2 EA $3,300.00 $6,600.00 2 $6,600.00
10 T STORM JUNCTION BOX 3 EA $3,600.00 $10,800.00 3 $10,800.00
11 10'CURB INLET 4 EA $3,200.00 $12,800.00 4 $12,800.00
12 15'CURB INLET 10 EA $4,000.00 $40,000.00 10 $40,000.00
13 TRENCH SAFETY 2429 LF $0.50 $1,214.50 2429 $1,214.50
14 TRAFFIC CONTROL 1 MO $2,500.00 $2,500.00 1 $2,500.00
15 REMOVE RIP RAP 402 SF $2.00 $804.00 402 $804.00
16 REMOVE MISC COINC STRUCTURE 112 LS $28.00 $3,136.00 112 $3,136.00
17 24'WIDE ASPHALT PAVEMENT 28 LF $420.00 $11,760.00 28 $11,760.00
18 18"TXDOT 2 EA $1,200.00 $2,400.00 2 $2,400.00
19 24"TXDOT 3 EA $1,800.00 $5,400.00 3 $5,400.00
20 42"TXDOT 1 EA $4,500.00 $4,500.00 1 $4,500.00
21 36"TXDOT I EA $4,200.00 $4,200.00 1 $4,200.00 I
22 TXDOT SKEWED BOX CULVERT HEADWALL 1 EA $13,100.00 $13,100.00 1 $13,100.00
23 TXDOT SKEWED BOX CULVERT HEADWALL I EA $29,100.00 $29,100.00 1 $29,100.00
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24 PYRAMAT WITH SOD OVERLAY 2414 SY $23.50 $56,729.00 2414 $56,729.00
25 5"CONCRETE CHANNEL LINING 205 SY $60.00 $12,300.00 205 $12,300.00
26 TWISTED GABIONS 30 CY $400.00 $12,000.00 30 $12,000.00
27 TWISTED GABION MATTRESSES 54 CY $500.00 $27,000.00 54 $27,000.00
28 10'WIDE 8"CONC SLAB 47 LF $95.00 $4,465.00 47 $4,465.00
29 STORM LINE GROUTING 22 CY $200.00 $4,400.00 22 $4,400.00
Sub-Total of Previous Unit $511,367.37 $511,367.37
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City Project Numbers 02393 DOE Number 7322
Contract Name LAKE VISTA RANCH Estimate Number I
Contract Limits Payment Number I
Project Type STORM DRAIN,PAVING&ST LIGHT For Period Ending 10/15/2015
Project Funding
PAVING
Item Description of Items Estimated Unit Unit Cost Estimated Completed Completed
No. Quanity Total Quanity Total
1 HYDRATED LIME 263 TN $150.00 $39,450.00 263 $39,450.00
2 6"LIME TREATMENT 17513 SY $2.30 $40,279.90 17513 $40,279.90
3 6"CONC PVMT 16447 SY $30.55 002,455.85 16447 $502,455.85
4 4"CONC SIDEWALK 1735 SF $4.15 $7,200.25 1735 $7,200.25
5 BARRIER FREE RAMP 15 EA $1,750.00 $26,250.00 15 $26,250.00
6 VALVE BOX ADJUS TMENT 15 EA $100.00 $1,500.00 15 $1,500.00
7 TRAFFIC CONTROL 1 MO $1,000.00 $1,000.00 I $1,000.00
8 MANHOLE ADJUSTMENT 22 EA $200.00 $4,400.00 22 $4,400.00
9 DEAD END BARRICADE 3 EA $1,500.00 $4,500.00 3 $4,500.00
Sub-Total of Previous Unit $627,036.00 $627,036.00
ST LIGHT
Item Description of Items Estimated Unit Unit Cost Estimated Completed Completed
No. Quanity Total
Quanity Total
t 2"CONDT PVC SCH 80 2765 LF $7.00 $19,355.00 2765 $19,355.00
2 INSTALL LIGHTING FIXTURE 20 EA $100.00 $2,000.00 20 $2,000.00
3 LED LIGHTING FIXTURE 20 EA $450.00 $9,000.00 20 $9,000.00
9
4 RDWY ILLUM FOUNDATION 20 EA $1,080.00 $21,600.00 20 $21,600.00
5 RDWY ILLUM FOUNDATION 20 EA $1,600.00 $32,000.00 20 $32,000.00 j
6 NO 10 INSULATED ELEC CONDR 8295 LF $0.70 $5,806.50 8295 $5,806.50 j
Sub-Total of Previous Unit $89,761.50 $89,761.50
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City Project Numbers 02393 DOE Number 7322
Contract Name LAKE VISTA RANCH Estimate Number 1
Contract Limits Payment Number 1
Project Type STORM DRAIN,PAVING&ST LIGHT For Period Ending 10/15/2015
Project Funding
Contract Information Summary
Original Contract Amount $1,228,164.87
Change Orders
Total Contract Price $1,228,164.87
Date " Total Cost of Work Completed $1,228,164.87
Contr 1 Less %Retained $0.00
Net Earned $1,228,164.87
Date
Inspection perv'
Earned This Period $1,228,164.87
Retainage This Period $0.00
3,u Date
Less Liquidated Damages
Project Mana
Days a /Day $0.00
Date � LessPavement Deficiency $0.00
Ass. rrec r/TPW-Infrastructure Design and Construction Less Penalty $0.00
w ` Date 1�115 Less Previous Payment $0.00
Direct Contracting Departn t Plus Material on Hand Less 15% $0.00
Balance Due This Payment $1,228,164.87
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Thursday,October 15,2015 Page 4 of 5
City Project Numbers 02393 DOE Number 7322
Contract Name LAKE VISTA RANCH Estimate Number 1
Contract Limits Payment Number I
Project Type STORM DRAIN,PAVING&ST LIGHT For Period Ending 10/15/2015
Project Funding
Project Manager Long City Secretary Contract Number 117322
Inspectors LAYER / TAEZAZ Contract Date
Contractor GILCO CONTRACTING,INC. Contract Time 180 CD
6331 SOUTHWEST BLVD, Days Charged to Date 191 CD
BENBROOK, TX 76132-1063 Contract is .000000 Complete
CITY OF FORT WORTH
SUMMARY OF CHARGES
Line Fund Account Center Amount Gross Retainage Net
Funded
------------—--------------------------
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Total Cost of Work Completed $1,228,164.87
Less %Retained $0.00
Net Earned $1,228,164.87
Earned This Period $1,228,164.87 E
Retainage This Period $0.00
fi
Less Liquidated Damages
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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 g
Balance Due This Payment $1,228,164.87
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FORTWORTH rev 03/05/07
TRANSPORTATION &PUBLIC WORKS
FINAL STATEMENT OF CONTRACT TIME
FINAL STATEMENT NO. I
NAME OF PROJECT: Lake Vista Ranch Phase I
PROJECT NO.: 2393 CONTRACTOR: Gilco Contracting,Inc.
DOE NO. 7322
PERIOD FROM 03/31/15 TO: 10/715 FINAL INSPECTION DATE: 7-Oct-15
WORK ORDER TF-FFCTIVE,3/31/201-5 CONTRACT TIME 180 0 WD *ED
DAY OF DAS 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.
23.
9. 24.
10. 25.
11. 26.
12. 27.
13. 28.
14. 29.
15. 30.
31.
SAT,SUN, RAIN,TOO WET, UTILITIES RS DAYS TOTAL
OT14E ——
&HOLIDAYS &TOO COLD RELOCATIONS CHARGED DAYS
THIS
PERIOD 191
PREVIOUS
PERIOD
TOTALS 191
TO DATE
*R ARKS'�
RTRA TOR DATE; INSPVCTOX� DATE
ENGrINEERING DEPARTMENT
The(try f 0 )Xl - 1000 Throckmorton Street-Fort Wortli,TX 7601 -6311
(817)392-7941 -17%ix:(817)392-7845 OFF lCli"M R150MORD
CITY ISECREm Ry
X4`0 VVIDRTII,„ "rx,
FORTWORTHREV:02/22/07
TRANSPORTATION AND PUBLIC WORKS
CONTRACTOR'S EVALUATION OF CITY
1)PROJECT EWORMATION Date:
...............
Name of Contractor Project Name
Gilco Contracting,Inc. Lake Vista Ranch Phase I
P---rq-je--c1-M a-n-q-ge-r------
Rudy Medellin Aaron Long
DOE Nrunber Pr o�ect iffic"Ity Type of Conti act
7322 0 Simple *Routine 0 Complex P Water R1 Waste Water R]Storm Drainage R1 Pavement
Contract Amount
$1,751,328.23 $1,751,328.23
11)PERFORMANCE EVALUATION
0-Inadequate I-Deficient 2-Standard 3-Good 4-Excellent
ELEMENT (0-4)67 ELEMENT (0-4)
INSPECTION EVALUATION PLANS&SPE CMCATIONS
Availability of Inspector 1 Accuracy of Plans to Existing Conditions
Knowledge 2 Clarity&Sufficiency of Details
Accuracy of Measured Quantities 3 Applicability of Specifications
4 Display Of Professionalism m 4 Accuracy of Plan Quantities
Citizen Complaint Resolution PROJECT MANAGER EVALUATION Ty
Performance--,Setting,up Valve-C_r ews,Labs
I Knowledge And/Or Problem Resolution
ADMINISTRATION o"f"Project Manager
1 Change Order Processing Trine 3 Communication
2 Tunliness of Contractor Payments 4 Resolution of Utility Conflicts
Bid Opening to Pre Con Meetin e-J6r-ame-----
III)COMMENTS&SIGNATURES
COMMENTS
Signature Contractor
Signature DOE Inspector
Signature DOE Inspector's Supervisor
INSPECTOR'S COMMENTS
-------------
TRANSPORTATION AND PUBLIC WORKS
Y1.--e1ii-.-f)�.;t-Worth--1 0-00----T1-i-ro—ck mio -Sireeit----F--or--t-W---o—rth,-T--X--7
(817)392-7941 •Fax:(817)392-7845
FORTWORTHREV:02/20107
TRANSPORTATION AND PUBLIC WORKS
PERFORMANCE EVALUATION OF CONTRACTOR
1) CONTRACTOR&PROJECT DATA
Name of Contractor Project Name
Gilco Construction,Inc. Lake Vista Ranch Phase 1
DOEInspector DOENumber
Rudy Medellin 7322
DOE Inspector Project Manager
R1 Water R1 Waste Water B Storm Drainage F/I Pavement Aaron Long
Initial ContractAnnount Project Difficulty
$1,751,328.23 O Simple ®Routine O Complex
Final Contract Amount Date
$1,751,328.23 10/6/2015
11)PERFORMANCE EVALUATION
0-Inadequate 1-Deficient 2-Standard 3-Good 4-Excellent
ELEMENT WEIGHT(x) APPLICABLE /N) RATING 0-4 MAX SCORE SCORE
1 Submission of Documents 2 Y 3 8 6
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 4 60 60
7 Job Site Safety 15 Y 3 60 45
8 Traffic Control Maintenance 15 Y 4 60 60
9 Daily Clean Up 5 Y 3 20 15
10 Citizen's Complaint Resolution 5 Y 4 1 20 20
Ti Property Restoration 5 Y 3 20 15
12 After Hours Response 5 Y 4 20 20
13 Project Completion 5 Y 1 4 1 20 20
TOTAL ELEMENT SCORE(A) 406 j
BONUS POINTS(25 Maximum)(B)
TOTAL SCORE(TS) 406
III)CONTRACTOR'S RATING
Maximum Score(MS)=448 or sum of applicable element score maximums which= 448
Rating([TS/MS]*100%) 406 / 448 = 91%
Performance Category Excellent
<20%=Inadequate 20%to<40%=Deficient 40%to<60%=Standard 60%to<80%=Goo >_80%=F.acellent /
Inspector's Comments(INCLUDING EXPLANATION OF BONUS POINTS AWARDED)
Signature DOE Inspector —� Signature Contractor w
i
Signature DOE Inspector's Supervisor "
CONTRACTOR'S COMMENTS {
TRANSPORTATION AND PUBLIC WORKS
y The City of Fort Worth•1000 Throckmorton Street•Fort Worth,TX 76012-6311
(817)392-7941 •Fax:(817)392-7845
BNM Lake Vista Development, L. P.
901 Airport Freeway,Suite 400
North Richland Hills,Texas 76180
(817)849-5100 Fax(817)849-5101
October 2,2015
Mr, Dale Gilreath
Gilco Contracting, Inc,
6331 Southwest Blvd.
Benbrook,Texas 76132
Re: Lake Vista Ranch,Ph. I
Water, Sewer,Paving,Drainage, and Street Light Improvements
CoFW ProjectNo. 02393
CoFW File No. W-2350
CoFW DOE No. 7322
Dear Mr. Gilreath,
This letter will document that BNM Lake Vista Development,L.P,.confirms that Gilco
Contracting,Inc.has completed the work associated with the above referenced contract in an
appropriate time frame,subject to completion of any warranty or maintenance work as identified
and required by the C ity of Fort Worth, and that no liquidated damages will be assessed by BNM
Lake Vista Development,L.P. in connection with the work.
Sincerely,
f
Bruce French
BNM Lake Vista Development,L.P,
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File,Lake Vista(Development)
H.ILEMERHEADIBNAI Lake Vista Development LP.docx
rvNV Yi� r 0
IOIOIf
October 2, 2015
City of Fort Worth
CFA Administration
1000 Throckmorton St.
Fort Worth,TX 76102
RE: Final Waiver of Lien; Paving and Street Light Improvements to serve West Fork
Ranch Phase 813: DOE#7322 City Project#02393
The purpose of this letter is to acknowledge that we have been paid in full by Jabez
Development,L.P. for the public improvements constructed to serve Lake Vista Ranch,
Ph. 1, in Fort Worth, Texas. As a result,we hereby waive,release and relinquish all
rights to assert any claim or demand for lien in connection with this project.
Please feel free to contact me with any questions you may have.
Sincerely,
eia Hubbard
Operations Director
i
6331 Southwest Blvd.
3enbrook, Texas 76132
Office: 317.735.1600
Fax 31 7.735.1613
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 Leia Hubbard,
Operations Director Of Gilco Contracting, Inc.,known to me to be a
credible person,who being by me duly sworn,upon her 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 fiill;
That there are no claims pending for personal injury and/or
property damages;
On Contract described as;
Paving and Street Light Improvements to serve: Lake Vista Ranch,Ph. 1
BY Leia Hubbard
Subscribed and sworn before me on this 2nd of October ,2015.
AR
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AWE; spa, Notar ublic
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f�, Tarrant County,TX
oa w wuuwaunuiwiNU unuu�;��Rrwswonarurirmuiuru��tia.�vnv�mo�ummoriupWwuemuu�umurr�iY%�it�m�zna"d;;,�iee.P
CONSENT OF OWNER
ARCHITECT LJ
SKD����y K�����������
—''— COMPANY CONTRACTOR
TO FINAL PAYMENT SURETY F�
Conforms with the American Institute of OTHER
An,bamctp'4)A ovuvmvnt G707
Bond NoU22V50V3B
PROJECT/ Lake Vista Ranch'Water,Sewer, Paving, Drainage&Street Lights
(name, address)
Fort Worth TX
TO (Owner)
[BNM LAKE VISTA DEVELOPMENT,Lp&o|TvoF 7 ARCHITECT'S PROJECT NO:
FORT WORTH
CONTRACT FOR:
unn1 Airport Freeway,Suite*nu Lake Vista Ranch-Water,Sewer,Paving,Drainage&Street Lights
Fort Worth Tx ro�oo |
�� __J CONTRACT DATE:
CONTRACTOR:G|LCO CONTRACTING, INC.
In accordance with the provisions of the Contract between the Owner and the Conti-actor uo indicated above,the
(here Insert name and address u/Surety Company)
LIBERTY MUTUAL INSURANCE COMPANY
175 Berkeley Street
Boston MA 02116 , SURETY COK8PAP6ly
ou bond o/ (here insert name and address mContractor)
G|LCO CONTRACTING,INC.
O331 Southwest Boulevard
Bmnbmok TX 76132 , CONTRACTOR" |
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hereby approves of the fiuo1payment to the Contractor, and agrees that final payment to the Contractor shall not relieve |
the Surety Company oy any of its obligations tn (here Insert name and address vrOwner)
BNM LAKE VISTA DEVELOPMENT, LIP&CITY OF FORT WORTH
9001 Airport Freeway,Suite 4U0
Fort Worth TX 78180 , OWNER,
ua set forth iu the said Surety Company's bond,
IN WITNESS,WHEREOF,
the Surety Company has hereunto set its hand this 2nd day of October,2015
Surety Company
A.Westbrook
(Seat): SiAnatfimof Authorized Representative
Soohinie Hunter Attorney-in-Fact
Td|u
NOTE: This form is to be used as a companion document to AIA DOCUMENT 0706, CONTRACTOR's AFFIDAVIT OF PAYMENT OF DEBTS AND CLAIMS,
Current Edition
ONE PAGE
THIS POWER 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.7111256
American Fire and Casualty Company Liberty Mutual Insurance Company
The Ohio Casualty Insurance Company West American Insurance Company
POWER OF ATTORNEY
KNOWN ALL PERSONS BY THESE PRESENTS: That American Fire&Casualty Company and The Ohio Casualty Insurance Company are corporations duly organized under the laws of
the State of New Hampshire,that Liberty Mutual Insurance Company is a corporation duly organized under the laws of the State of Massachusetts,and WestAmerican Insurance Company
is a corporation duly organized under the laws of the State of Indiana(herein collectively called the'Companies"),pursuant to and by authority herein set forth,does hereby name,constitute
and appoint, Don E.Cornell;Kelly A.Westbrook;Ricardo J.Revna;Robb!Morales;Sophinle Hunter;V.DeLene Marshall
all of the city of Dallas 'state of TX each individually if there be more(han one named,its true and lawful afforney-lit-fact to make,execute,seal,acknowledge
and deliver,for and on Its behalf as surely and as its act and deed,any and all undertakings,bonds,recognizances and other surety obligations,In pursuance ofthese presents and shall
be as binding upon the Companies as if they have been duly signed 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 officer or official of the Companies and the corporate seals of the Companies have been affixed
theretothis 11th dayof September 2015
American Fire and Casualty Company
0 C4 X(INS So,?,
The Ohio Casualty Insurance Company 0)
1906 o 1919 Liberty Mutual Insurance Company
1912 1991
West merican Insurance Company
C
By:
4D
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W
STATE OF PENNSYLVANIA ss David M.Carey�-Asslstant Secretary C
M
COUNTY OF MONTGOMERY
0
Onthis 1111h dayof September 2015 before me personally appeared David M.Carey.who acknowledged himself to be the Assistant Secretary of American Fire and
16- lim I I
U w Casualty Company,Liberty Mutual Insurance Company,The Ohio Casualty Insurance Company,and West American Insurance Company,and that he,as such,being authorized so to do,
4- = 0 LU
0.@ execute the foregoing instrument for the purposes Ihereln contained by signing on behalf of the corporations by himself as a duly authorized officer. E E
IN WITNESS WHEREOF,I have hereunto subscribed my name and affixed my notarial seal at Plymouth Meeting,Pennsylvania,on the day and year first above written. 0 CL
Sp, F`Asj� COMMONWEALTH OF PENNSYLVANIA
10<
(- Notarial Seal 4-4
1- 0 Teresa Pastella,Notary Public By: 0
or Plymouth Twp.,Montgomery County Teresa Pastella,Notary Public 16.
0 My Commission Expires Match 28.2017
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60 Member,Pennsylvania Association of Notaries
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0 W WP CL
4� M
c M This Power of Attorney is made and executed pursuant to an by authority of the following By-laws and Authorizations of American Fire and Casualty Company,The Ohio Casualty Insurance
6 L_ 20
Company,Liberty Mutual Insurance Company,and WestAmerican Insurance Companywhich resolutions are now In full force and effect reading as follows:
ARTICLE IV-OFFICERS-Section 12.Power of Attorney.Any officer or other official of the Corporation authorized for that purpose in writing by(he Chairman or the President,and subject 105
to such limitation as the Chairman or the President may prescribe,shall appoint such altomeys-In-fact,as may be necessary to act in behalf of(fie Corporation to make,execute,seal,
I
0 E acknowledge and deliver as surely any and all undertakings,bonds,recognizances and other surety obligations,Such attomeys-in-fact,subject to[he limitations set forth In heir respective
E powers of attorney,shall have full power to bind the Corporation by[heir signature and execution of any such instruments and to attach thereto the seal of the Corporation. When so 0)
"4�
0 M executed,such instruments shall be as binding as if signed by[he President and attested to by the Secretary.Any power or authority granted to any representative or attorney-in-fact under
4- L- the provisions of this article may be revoked at any lime by the Board,the Chairman,the President or by the officer or officers granting such power or authority.
ARTICLE Xill-Execution of Contracts-SECTION 5.Surety Bonds and Undertakings.Any officer of the Company authorized for that purpose In writing by the chairman or the president, E
> E! and subject to such limitations as the chairman or the president may prescribe,shall appoint such attomeys-in-fact,as may be necessary to act in behalfof the Company to make execute I-"
t; .
= seal,acknowledge and deliver as surety any and all undertakings,bonds,recognizances and other surety obligations. Such attorneys-in-fact subject to the limitations set fcf�h in thel;
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respective powers of attorney,shall have full power to bind the Company by their signature and execution of any such instruments and to attach thereto[he seal ofthe Company. When so 00
executed such instruments shall be as binding as if signed by the president and attested by the secratary� 0 V-
0 T
Certificate of Designation-The President of the Company,acting pursuant to the Bylaws of the Company,authorizes David M.Carey,Assistant Secretary to appoint such attomeys.in-
fact as May be necessary to act on behalf of the Company to make,execute,seal,acknowledge and deliver as surety any and all undertakings,bonds,rerognizances and other surely
obligations,
Authorization-By unanimous consent of the Company's Board of Directors,the Company consents that facsimile or mechanically reproduced signature ofany assistant secretary of the
Companywhereve,appearing upon a certified copy of any power of attorney issued by[he Company in connection with surety bonds,shall be valid and binding upon the Company with
the same force and effect as though manually affixed.
1,Gregory W.Davenport,the undersigned,Assistant Secretary,of American Fire and Casualty Company,The Ohio Casualty Insurance Company,Liberty Mutual Insurance Company,and
West American Insurance Company do hereby certify that the original power of attorney of which the foregoing is a full,true and correct copy of the Power ofAttorney executed by said
Companies,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 1 ID
CA INS,, oINSU
y
< 1906 'a' 0 19 9 r) 1 12 1991 B
A Gregory W.Davenport,Assistant Secretary
28of5OO
ILMS 12873 122013
J
Liberty
mutual.
SURETY
Important Notice
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
i
You may write the Texas Department of Insurance:
I
P. O. Box 149104
Austin, TX 78714-9104
Fax: (512) 475-1771
Web: http://www.tdi.state.tx.us
E-mail: Cons umerProtection(cbtdi.state.tx.us
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Premium or Claim Disputes
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.
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Attach This Notice To Your Policy: f
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This notice is for information only and does not become a part or condition of the
attached document.
LMIC-3500
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