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Home My WebLink AboutContract 48939-FP2 City Secretary 48939 -FP2 Contract No. FORT WORTH.) Date Received Nov 5,2018 �•,� dv NOTICE OF PROJECT COMPLETION (Developer Projects) The Transportation and Public Works Department upon the recommendation of the Project Manager has accepted the following project as complete: Project Name: TRAMMELL CROW BUILDING °H" City Project No.: 100839 Improvement Type(s): Water ® Sewer Original Contract Price: $476,372.00 Amount of Approved Change Order(s): -$14,140.00 Revised Contract Amount: Total Cost of Work Complete: $462,232.00 Ben Bratcher(Oct 1,2018) Oct 1,2018 Contractor Date Senior Project Manager Title The Conlan Company Company Name 9"W&k 7'"441C,/C4rWK'/// Oct 2 2018 James T McKinnon III(Oct 2,2018) Project Date Fred Ehia(Oct 31,—/2018) Oct 31,2018 Project Manager Date ,7,kzi Jit �ettR02-91ef Janie Scarlett Morales(Nov 1,2018) - Nov 1,2018 CFA Manager Date sccswg,A4m.. 4m. k O Susan Ai-i,f Hov 1,20181 Nov 1,2018 Asst. City Manager Date -- OPtRIC-11AL RECORD CITY SECRETARY FT®WORTH,TX Page 1 of 2 Notice of Project Completion Project Name:TRAMMELL CROW BUILDING "H" City Project No.: 100839 City's Attachments Final Pay Estimate 0 Change Order(s): 0 Yes ❑ N/A Pipe Report: 0 Yes ❑ N/A Contractor's Attachments Affidavit of Bills Paid Consent of Surety Statement of Contract Time Contract Time: 495 CD Days Charged: 495 Work Start Date: 4/24/2017 Work Complete Date: 8/31/2018 Page 2 of 2 FORT WORTH CITY OF FORT WORTH FINAL PAYMENT REQUEST Contract Name TRAMMELL CROW 352 BLDG H Contract Limits Project Type WATER&SEWER City Project Numbers 100839 DOE Number 0839 Estimate Number 1 Payment Number 1 For Period Ending 9/30/2018 CD City Secretary Contract Number 110839 Contract Time 36ED Contract Date 3/31/2017 Days Charged to Date 495 Project Manager NA Contract is 100.00 Complete Contractor THE CONLAN COMPANY 1501 LBJ FREEWAY STE 550 FARMERS BRANCH, TX 75234 Inspectors RODGERS / MOORE,R Friday,September 21,2018 Page 1 of 5 City Project Numbers 100839 DOE Number 0839 Contract Name TRAMMELL CROW 352 BLDG H Estimate Number I Contract Limits Payment Number I Project Type WATER&SEWER For Period Ending 9/30/2018 Project Funding WATER Item Description of Items Estimated Unit Unit Cost Estimated Completed Completed No. Quanity Total Quanity Total 1 TRENCH SAFETY 43 LF $1.00 $43.00 43 $43.00 2 DUCTILE IRON WATER FITTINGS 3.79 TN $3,500.00 $13,265.00 3.79 $13,265.00 W/RESTRAINT 3 6"PVC WATER PIPE 166 LF $32.00 $5,312.00 166 $5,312.00 4 8"PVC WATER PIPE 15 LF $35.00 $525.00 15 $525.00 5 10"PVC WATER PIPE 15 LF $38.00 $570.00 15 $570.00 6 12"PVC WATER PIPE 2716 LF $40.00 $108,640.00 2716 $108,640.00 7 REMOVE 24"WATER LINE 164 LF $42.00 $6,888.00 164 $6,888.00 9 FIRE HYDRANT 5 EA $3,300.00 $16,500.00 5 $16,500.00 10 2"WATER SERVICE 2 EA $1,500.00 $3,000.00 2 $3,000.00 11 3"WATER METER AND VAULT 1 EA $7,500.00 $7,500.00 1 $7,500.00 12 4"WATER METER AND VAULT 3 EA $8,500.00 $25,500.00 3 $25,500.00 13 6"GATE VALVE 3 EA $800.00 $2,400.00 3 $2,400.00 14 8"GATE VALVE 5 EA $1,000.00 $5,000.00 5 $5,000.00 15 10"GATE VALVE 3 EA $1,200.00 $3,600.00 3 $3,600.00 16 12"GATE VALVE 16 EA $1,400.00 $22,400.00 16 $22,400.00 17 16"X 6"TAPPING SLEEVE&VALVE 1 EA $2,500.00 $2,500.00 1 $2,500.00 18 16"X8"TAPPING SLEEVE&VALVE 1 EA $2,750.00 $2,750.00 1 $2,750.00 19 16"X 12"TAPPING SLEEVE&VALVE 2 EA $3,000.00 $6,000.00 2 $6,000.00 20 24"X 12"TAPPING SLEEVE&VALVE 1 EA $3,500.00 $3,500.00 1 $3,500.00 21 24"DIP WATER CSS BACKFILL RESTRAINED 164 LF $650.00 $106,600.00 164 $106,600.00 JOINTS(CO#1) -------------------------------------- Sub-Total of Previous Unit $342,493.00 $342,493.00 SEWER Item Description of Items Estimated Unit Unit Cost Estimated Completed Completed No. Quanity Total Quanity Total - -------------------------------------- 1 REMOVE 24"SEWER LINE 379 LF $36.00 $13,644.00 379 $13,644.00 2 24"SEWER PIPE CLSM BACKFILL 295 LF $275.00 $81,125.00 295 $81,125.00 3 MANHOLE ADJUSTMENT MAJOR W/COVER 3 EA $750.00 $2,250.00 3 $2,250.00 5 8"SEWER PIPE 360 LF $32.00 $11,520.00 360 $11,520.00 6 WASTEWATER ACCESS CHAMBER(CO#1) 2 EA $1,000.00 $2,000.00 2 $2,000.00 Friday,September 21,2018 Page 2 of 5 City Project Numbers 100839 DOE Number 0839 Contract Name TRAMMELL CROW 352 BLDG H Estimate Number 1 Contract Limits Payment Number 1 Project Type WATER&SEWER For Period Ending 9/30/2018 Project Funding 7 4'MANHOLE 6 FOOT DEPTH 2 EA $2,500.00 $5,000.00 2 $5,000.00 8 4'EXTRA DEPTH MANHOLE 21 VF $200.00 $4,200.00 21 $4,200.00 -------------------------------------- Sub-Total of Previous Unit $119,739.00 $119,739.00 -------------------------------------- Friday,September 21,2018 Page 3 of 5 City Project Numbers 100839 DOE Number 0839 Contract Name TRAMMELL CROW 352 BLDG H Estimate Number 1 Contract Limits .Payment Number 1 Project Type WATER&SEWER For Period Ending 9/30/2018 Project Funding Contract Information Summary Original Contract Amount $476,372.00 Change Orders Change Order Number 1 ($14,140.00) Total Contract Price $462,232.00 Total Cost of Work Completed $462,232.00 Less %Retained $0.00 Net Earned $462,232.00 Earned This Period $462,232.00 Retainage This Period $0.00 Less Liquidated Damages Days @ /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 $462,232.00 Friday,September 21,2018 Page 4 of 5 City Project Numbers 100839 DOE Number 0839 Contract Name TRAMMELL CROW 352 BLDG H Estimate Number 1 Contract Limits Payment Number 1 Project Type WATER&SEWER For Period Ending 9/30/2018 Project Funding Project Manager NA City Secretary Contract Number 110839 Inspectors RODGERS / MOORE,R Contract Date 3/31/2017 Contractor THE CONLAN COMPANY Contract Time 365 CD 1501 LBJ FREEWAY STE 550 Days Charged to Date 495 CD FARMERS BRANCH, TX 75234 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 $462,232.00 Less %Retained $0.00 Net Earned $462,232.00 Earned This Period $462,232.00 Retainage This Period $0.00 Less Liquidated Damages 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 Balance Due This Payment $462,232.00 Friday,September 21,2018 Page 5 of 5 DEVELOPER-AWARDED-PROJECT CHANGE ORDER(REVISED) PROJECT NAME: Trammell CroW 352 Bldg H CHANGE CONTRACT: Water.Sewer,Paving,Storm Drain,Street lights ORDER No: CFA# 2017-036 CITY PARTICIPATION:1 NO CITY PROJECT# 100839 DOE# WA 1 WATER PROJECT# 56008-0600430-110839-001480 SEWER PROJECT# 56008-0600430-110839001480 FILE# W-2465 INSPECTOR: Tommy McKinnon Phone No: 817-392-8306 PROJECT MANAGER: Fred Ehia Phone No: 817-392-8424 CONTRACT UNIT WATER SEWER PAVING DRAINAGE STREETLIGHTS SURVEY PPM BONDS CONTRACT DAYS Da,eloperCost City Coal Developer Cos l CRY Cost Devebpe,Cost C4 Cost DeveloperCost CRyCost Dev Cost CityCo,l DevOioperCosl CRyCost Dewl.WCOSII C' Cost ORIGINAL CONTRACT $354,79300 $0.00 $121,579.00 $0.00 $455,342.35 $0.00 5298.008.00 sees $994866.00 $0.00 $0.00 SOHO $0.00 $&Do EXTRAS TO DATE $0.00 $0.00 $0.00 $0.00 $0.00 $0-00 $0.00 50-00 $0.00 50.00 $0.00 $moo $0.00 $0.00 CREDITS TO DATE $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 Well $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 CONTRACT TO DATE $354,793.00 50.00 $121.579.00 50.00 2455.342.35 $0.00 S298,009.00 $moo $99.BWDD $0-00 $0.00 Seoo $0.00 SO-00 0 AMOUNT OF PROP.CHANGE ORDER $12,300.001 50.00 IS1.840.00 $0.00 419.325.40 $0.00 $3,495.00 $0.00 (599.886.00) So 00 $0.00 SOHO $0-00 SOHO REVISED CONTRACT AMOUNT $342,493.00 W.- 3119.]39.00 $0.00 $376,015.95 50.00 SO01.503.00 50.W 50.00 $0.00 $0.00 $0.00 $0.00 $0.00 0 TOTAL REVISED CONTRACT AMOUNT PER UNIT $342.493.00 $119.739.00 5376,016.95 S301,503.00 $0.00 $0.00 $0.00 j REVISED COST SHARE Dev.Cost: $1,139,751.95 City Cost: $0.00 TOTAL REVISED CONTRACT $1,139,751.95 Yw are Wrecled to make the lollowi Nla es in the contract documents: CITY 810 REM PAY ITEM P s OUAMITY UNIT ITEM DESCRIPTION UNR PgICE TOTAL WATER 3311.06841 -164 LF 24'Concrete AwW 0303 Water Pi Restrained Jls 725 -$118.900.00 3311.06551 164 LF 24'DIPWater,CSSBack6ll Restrained Joints 850 $106,600.00 TOTAL WATER -$12,300.00 SEWER 3331.4108 -28 LF 6-SEWER SERVICE $30.00 -5840.00 3339.0003 1 -1 1 EA IwAsyEwATEN ACCESS CHAMBER 1 $1,000.00 1 -$1,000.00 TOTAL SEWER 41,640.00 PAVING 3213.0103 -7777 SF e'Concrete Pavement $40.05 311,468.85 3213.0103 7777 SF 8'Coru:rete Pavement $29.85 $232,143.45 79 325.40 STORM 3305.0109 20 LF ITrench Sal 1 $20.00 3341.0201 20 LF 21•RCP,Class III 348.75 5975.00 34 39.5001 1 EA 119 Curb Inlet 52.500.00 1 52,500.00 TOTALSTORM 495.00 STREET LIGHTS 2605.3118 -2498 LF FurnislVlnstall Conduit-Schedule 80 PVC 2 inch Cul S10.00 -$24,980.00 3441.1501 .6 EA Ground Box T B $757.00 -$4,542.00- 3441.3051 -14 EA FurnishnmtalI LED t Fixture 137 watt ATB2 Cobra $559.00 -$7,826.00 3441.3302 -14 EA Illum Foundation TY 3,5,6,and 8 $1,575.00 -$22,050.00 3441.3357 -14 EA FumisNlnstali Illum TY D-40-9 Pole 52,892.00 -$40,488.00 TOTAL ELECTRIC 886.00 REASONS FOR CHANGE ORDER S.Wtfua DIP n stead o1 B303 Ppe use 4.500 P.co-efs(hand place ruled of sip form,i add i*f rebranon an Nw4age Parkway dalafe sfreef Tghts NO CIN FUNDS INVOLVED IN THIS CONTRACT.DEVELOPER IS RESPONSIBLE FOR 100'.OF THE CHANGE ORDER COST AND NO REIMBURSEMENT FROM THE CITY WILL BE SOUGHT BY THE DEVELOPER. RECOMMENDED: ///1�/5 APPRO APPROVED: By: 00 4 8y By: Name:Dennis J Cho-t Name:Robert Brandt Name: ra a Title:Vice President Tde:Prinwipal Tille:Senior Project Manawe Revised:10-12-2011 Pagel FORTWORTH TRANSPORTATION AND PUBLIC WORKS PIPE REPORT FOR: PROJECT NAME: Trammell Crow Building H PROJECT NUMBER: CPN# 100839 DOE NUMBER: N/A WATER PIPE LAID SIZE TYPE OF PIPE LF Domestic Water 6" PVC 166 Domestic Water 8" PVC 15 Domestic Water 10" PVC 15 Domestic Water 12" PVC 2716 Domestic Water 24" DIP 164 FIRE HYDRANTS: 5 VALVES(16" OR LARGER) PIPE ABANDONED SIZE TYPE OF PIPE LF DENSITIES: NEW SERVICES: 2" IEA Water service 3" IEA Meter&Vault 4" IEA Meter&Vault SEWER PIPE LAUD SIZE TYPE OF PIPE LF Sanitary Sewer 8" PVC 360 PIPE ABANDONED SIZE TYPE OF PIPE LF DENSITIES: NEW SERVICES: TRANSPORTATION AND PUBLIC WORKS The City of Fort Worth•1000 Throckmorton Street•Fort Worth,TX 76012-6311 (817)392-7941 •Fax: (817)392-7845 Contractor Final Payment Affidavit Build_ in�A,H J 3�_5 Eagle Trammell Crow Addition TexasTarrant Project - - State__ - County The Conlan Company Trammell Crow Compal Contractor Owner —_— Subiect Contract entered into the — 31 st day of March 2017 «-Y'l Clay -- —--�� Mnnfh ---- ------ Year — Between the above mentioned parties for the construction of Building A, H,J(35 Eagle Trammell Crow Addition-City #100839 - (Building) �— W at — m — Fort Worth Texas Address City, ------ State Know all men by these presents: 1. The undersigned hereby certify(ies)that all work employees,subcontractors, or the public at large arising required under the above contract has been performed in out of the performance of the Contract,or any suits or accordance with the terms hereof,that all materialmen, claims for any other damage of any kind,nature, or subcontractors, mechanics,and laborers have been paid description which might constitute a lien upon the property and satisfied in full except for retention as withheld by of the Owner_ Owner,and that there are not outstanding claims of any character arising out of the performance of the contract 3. The undersigned make(s)this affidavit for the purpose which have not been paid and satisfied in full. of receiving final payments in full settlement of all claims arising under or by virtue of the Contract,and acceptance 2. The undersigned further certify(les)that to the best of of such payment is acknowledged as a release of tho their(his)knowledge and belief, there are no unsatisfied Owner from any and all claims arising under or by virtue of claims for damages arising from injury or death to any the Contract. Si natures In witness whereof,the undersigned has signed and sealed this instrument this day of — Day - — Month Year 5..!9ned Date Notary Public_ Personally appeared before the undersigned, Who,after being fully sworn, depose and state that the facts stated in the above affidavit are true. - Notary Public � By: Residence My commission expires:---.— Consent of Sure ........ .ty__ The undersigned hereby consents to the final release of all contract funds pertaining to the above contract. Bonding Company -- Cit�e tat Casualty omp,ryy . 1 Attorney-ln-Fant Deborah B. Sasser,Attorney-in-Fact Address McGriff Insurance Services 3100 Royal Blvd.South, Alpharetta,GA 30022 ❑ate - ----- August 1, 2018 POWER OF ATTORNEY APPOINTING INDIVIDUAL ATTORNEY-IN-FACT Know All Men By These Presents,That Continental Casualty Company,an Illinois insurance company,National Fire Insurance Company of Hartford,an Illinois insurance company,and American Casualty Company of Reading,Pennsylvania,a Pennsylvania insurance company(herein called "the CNA Companies"),are duly organized and existing insurance companies having their principal offices in the City of Chicago,and State of Illinois, and that they do by virtue of the signatures and seals herein affixed hereby make,constitute and appoint Travis G Hufflnes,Brian E Madden,Deborah B Sasser,Holli Orr,Brittany L Triplett,Individually of Alpharetta,GA,their true and lawful Attorney(s)-in-Fact with full power and authority hereby conferred to sign,sea]and execute for and on their behalf bonds,undertakings and other obligatory instruments of similar nature -In Unlimited Amounts- and to bind them thereby as fully and to the same extent as if such instruments were signed by a duly authorized officer of their insurance companies and all the acts of said Attorney,pursuant to the authority hereby given is hereby ratified and confirmed. This Power of Attorney is made and exceuted pursuant to and by authority of the By-Law and Resolutions,printed on the reverse hereof,duly adopted,as indicated,by the Boards of Directors of the insurance companies. In Witness Whereof,the CNA Companies have caused these presents to be signed by their Vice President and their corporate sea]s to be hereto affixed on this 24th day of August,2017. \ GASUgCr 1N5UBq MsRHVOF Continental Casualty Company National Fire Insurance Company of Hartford coRPoaar� O� Q ho �NG�pPpAAT�� American Cas ally Company of Reading,Pennsylvania �u SEAL < JUisoz t' 4 � yr 1897 HARt4�� y • Paul T.Bruflat Ar Vice President State of South Dakota,County of Minnehaha,ss: On this 24th clay of August,2017,before me personally came Paul T.Bruflat to me known,who,being by me duly sworn,did depose and say: that he resides in the City of Sioux Falls,State of South Dakota;that he is a Vice President of Continental Casualty Company,an Illinois insurance company, National Fire Insurance Company of Hartford,an Illinois insurance company,and American Casualty Company of Reading,Pennsylvania,a Pennsylvania insurance company described in and which executed the above instrument;that he knows the seals of said insurance companies;that the seals affixed to the said instrument are such corporate seals;that they were so affixed pursuant to authority given by the Boards of Directors of said insurance companies and that he signed his name thereto pursuant to like authority,and acknowledges same to be the act and deed of said insurance companies. ------------- I MOHR NOTARYPUBLIC SE6t SOUTH DAKOTA SEAL My Commission Expires June 23,2021 J, Mohr Notary Public CERTIFICATE 1,D.Johnson,Assistant Secretary of Continental Casualty Company,an Illinois insurance company,National Fire Insurance Company of Hartford, an Illinois insurance company,and American Casualty Company of Reading,Pennsylvania,a Pennsylvania insurance company do hereby certify that the Power of Attorney herein above set forth is still in force,and further certify that the By-Law and Resolution of the Board of Directors of the insurance companies printed on the reverse hereof is still in force. In testimony whereof I have hereunto subscribed my name and affixed the seal of the said insurance companies this Ist day of August 2018 LAsuq �. CT 1ti5URgH MQRNvpp Continental Casualty Company y National Fire Insurance Company of Hartford �w naRP.RArfi o �a �HLasvakAr�o American Casualty Company of Reading,Pennsylvania �u SEA[ t �soz 1' 11397 HARtF� � D.Johnson Assistant Secretary Form F6853-412012 Figure: 28 TAC §1.601(a)(3) 1 IMPORTANT NOTICE AVISO IMPORTANTE To obtain information or make a complaint: Para obtener informacion o para someter una queja: 2 You may contact Continental Casualty Company, Puede comunicarse con Continental Casualty National Fire Insurance Company of Hartford, Company, National Fire Insurance Company de American Casualty Company of Reading, PA and Hartford, American Casualty Company de Reading, PA Continental Insurance Company at 312-822-5000. y Continental Insurance Company al 312-822-5000. 3 You may call Continental Casualty Company, Usted puede llamar al numero de telefeno gratis de National Fire Insurance Company of Hartford, Continental Casualty Company, National Fire American Casualty Company of Reading, PA and Insurance Company de Hartford, American Casualty Continental Insurance Company's toll-free telephone Company de Reading, PA y Continental Insurance number for information or to make a complaint at: Company's para informacion o para someter una queja al: 1-877-672-6115 1-877-672-6115 4 You may also write to Continental Casualty Usted tambien puede escribir a Continental Casualty Company, National Fire Insurance Company of Company, National Fire Insurance Company de Hartford,American Casualty Company of Reading, Hartford,American Casualty Company de Reading, PA and Continental Insurance Company at: PA y Continental Insurance Company: CNA Surety CNA Surety 333 South Wabash 333 South Wabash Chicago, IL 60604 Chicago, IL 60604 5 You may contact the Texas Department of Puede comunicarse con el Departamento de Seguros Insurance to obtain information on companies, de Texas para obtener informacion acerca de coverages, rights or complaints at: companias, coberturas, derechos o quejas al: 1-800-252-3439 1-800-252-3439 6 You may write the Texas Department of Puede escribir al Departamento de Seguros de Insurance: Texas: P.O. Box 149104 P.O. Box 149104 Austin, TX 78714-9104 Austin, TX 78714-9104 Fax: (512)490-1007 Fax: (512)490-1007 Web: www.tdi.texas.gov Web: www.tdi.texas.gov E-Mail: ConsumerProtection@tdi.texas.gov E-Mail: ConsumerProtection@tdi.texas.gov 7 PREMIUM OR CLAIM DISPUTES: DISPUTAS SOBRE PRIMAS 0 RECLAMOS: Should you have a dispute concerning your Si tiene una disputa concerniente a su prima o a premium or about a claim you should contact un reclamo, debe comunicarse con el Continental Continental Casualty Company, National Fire Casualty Company, National Fire Insurance Insurance Company of Hartford, American Casualty Company de Hartford, American Casualty Company Company of Reading, PA and Continental Insurance de Reading, PA y Continental Insurance Company Company first. If the dispute is not resolved, you primero. Si no se resuelve la disputa, puede may contact the Texas Department of Insurance. entonces comunicarse con el departamento (TDI). 8 ATTACH THIS NOTICE TO YOUR POLICY: UNA ESTE"ISO A SU POLIZA: Este aviso es This notice is for information only and does not solo para proposito de informacion y no se become a part or condition of the attached convierte en parte o condicion dei documento document. adjunto. Form F8277-6-2015 POWER OF ATTORNEY APPOINTING INDIVIDUAL ATTORNEY-IN-FACT Know All Men By These Presents,That Continental Casualty Company,an Illinois insurance company,National Fire Insurance Company of Hartford,an Illinois insurance company,and American Casualty Company of Reading,Pennsylvania,a Pennsylvania insurance company(herein called "the CNA Companies"),are duly organized and existing insurance companies having their principal offices in the City of Chicago,and State of Illinois, and that they do by virtue of the signatures and seals herein affixed hereby make,constitute and appoint Travis G Hufflnes,Brian E Madden,Deborah B Sasser,Holli Orr,Brittany L Triplett,Individually of Alpharetta,GA,their true and lawful Attorney(s)-in-Fact with full power and authority hereby conferred to sign,sea]and execute for and on their behalf bonds,undertakings and other obligatory instruments of similar nature -In Unlimited Amounts- and to bind them thereby as fully and to the same extent as if such instruments were signed by a duly authorized officer of their insurance companies and all the acts of said Attorney,pursuant to the authority hereby given is hereby ratified and confirmed. This Power of Attorney is made and exceuted pursuant to and by authority of the By-Law and Resolutions,printed on the reverse hereof,duly adopted,as indicated,by the Boards of Directors of the insurance companies. In Witness Whereof,the CNA Companies have caused these presents to be signed by their Vice President and their corporate sea]s to be hereto affixed on this 24th day of August,2017. \ GASUgCr 1N5UBq MsRHVOF Continental Casualty Company National Fire Insurance Company of Hartford coRPoaar� O� Q ho �NG�pPpAAT�� American Cas ally Company of Reading,Pennsylvania �u SEAL < JUisoz t' 4 � yr 1897 HARt4�� y • Paul T.Bruflat Ar Vice President State of South Dakota,County of Minnehaha,ss: On this 24th clay of August,2017,before me personally came Paul T.Bruflat to me known,who,being by me duly sworn,did depose and say: that he resides in the City of Sioux Falls,State of South Dakota;that he is a Vice President of Continental Casualty Company,an Illinois insurance company, National Fire Insurance Company of Hartford,an Illinois insurance company,and American Casualty Company of Reading,Pennsylvania,a Pennsylvania insurance company described in and which executed the above instrument;that he knows the seals of said insurance companies;that the seals affixed to the said instrument are such corporate seals;that they were so affixed pursuant to authority given by the Boards of Directors of said insurance companies and that he signed his name thereto pursuant to like authority,and acknowledges same to be the act and deed of said insurance companies. ------------- I MOHR NOTARYPUBLIC SE6t SOUTH DAKOTA SEAL My Commission Expires June 23,2021 J, Mohr Notary Public CERTIFICATE 1,D.Johnson,Assistant Secretary of Continental Casualty Company,an Illinois insurance company,National Fire Insurance Company of Hartford, an Illinois insurance company,and American Casualty Company of Reading,Pennsylvania,a Pennsylvania insurance company do hereby certify that the Power of Attorney herein above set forth is still in force,and further certify that the By-Law and Resolution of the Board of Directors of the insurance companies printed on the reverse hereof is still in force. In testimony whereof I have hereunto subscribed my name and affixed the seal of the said insurance companies this Ist day of August 2018 LAsuq �. CT 1ti5URgH MQRNvpp Continental Casualty Company y National Fire Insurance Company of Hartford �w naRP.RArfi o �a �HLasvakAr�o American Casualty Company of Reading,Pennsylvania �u SEA[ t �soz 1' 11397 HARtF� � D.Johnson Assistant Secretary Form F6853-412012 Figure: 28 TAC §1.601(a)(3) 1 IMPORTANT NOTICE AVISO IMPORTANTE To obtain information or make a complaint: Para obtener informacion o para someter una queja: 2 You may contact Continental Casualty Company, Puede comunicarse con Continental Casualty National Fire Insurance Company of Hartford, Company, National Fire Insurance Company de American Casualty Company of Reading, PA and Hartford, American Casualty Company de Reading, PA Continental Insurance Company at 312-822-5000. y Continental Insurance Company al 312-822-5000. 3 You may call Continental Casualty Company, Usted puede llamar al numero de telefeno gratis de National Fire Insurance Company of Hartford, Continental Casualty Company, National Fire American Casualty Company of Reading, PA and Insurance Company de Hartford, American Casualty Continental Insurance Company's toll-free telephone Company de Reading, PA y Continental Insurance number for information or to make a complaint at: Company's para informacion o para someter una queja al: 1-877-672-6115 1-877-672-6115 4 You may also write to Continental Casualty Usted tambien puede escribir a Continental Casualty Company, National Fire Insurance Company of Company, National Fire Insurance Company de Hartford,American Casualty Company of Reading, Hartford,American Casualty Company de Reading, PA and Continental Insurance Company at: PA y Continental Insurance Company: CNA Surety CNA Surety 333 South Wabash 333 South Wabash Chicago, IL 60604 Chicago, IL 60604 5 You may contact the Texas Department of Puede comunicarse con el Departamento de Seguros Insurance to obtain information on companies, de Texas para obtener informacion acerca de coverages, rights or complaints at: companias, coberturas, derechos o quejas al: 1-800-252-3439 1-800-252-3439 6 You may write the Texas Department of Puede escribir al Departamento de Seguros de Insurance: Texas: P.O. Box 149104 P.O. Box 149104 Austin, TX 78714-9104 Austin, TX 78714-9104 Fax: (512)490-1007 Fax: (512)490-1007 Web: www.tdi.texas.gov Web: www.tdi.texas.gov E-Mail: ConsumerProtection@tdi.texas.gov E-Mail: ConsumerProtection@tdi.texas.gov 7 PREMIUM OR CLAIM DISPUTES: DISPUTAS SOBRE PRIMAS 0 RECLAMOS: Should you have a dispute concerning your Si tiene una disputa concerniente a su prima o a premium or about a claim you should contact un reclamo, debe comunicarse con el Continental Continental Casualty Company, National Fire Casualty Company, National Fire Insurance Insurance Company of Hartford, American Casualty Company de Hartford, American Casualty Company Company of Reading, PA and Continental Insurance de Reading, PA y Continental Insurance Company Company first. If the dispute is not resolved, you primero. Si no se resuelve la disputa, puede may contact the Texas Department of Insurance. entonces comunicarse con el departamento (TDI). 8 ATTACH THIS NOTICE TO YOUR POLICY: UNA ESTE"ISO A SU POLIZA: Este aviso es This notice is for information only and does not solo para proposito de informacion y no se become a part or condition of the attached convierte en parte o condicion dei documento document. adjunto. Form F8277-6-2015