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Home My WebLink AboutContract 49071-FP1 City Secretary 49071 -FP1 Contract No. FORTWORTH.. Date Received Dec 16,2019 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: Campus Apartments City Project No.: 100937 Improvement Type(s): ❑x Paving ❑x Drainage ❑ Street Lights ❑ Traffic Signals Original Contract Price: $275,361.28 Amount of Approved Change Order(s): Revised Contract Amount: $275,361.28 Total Cost of Work Complete: $275,361.28 MaL ry-Ma'FgaretL�o (Sep23, 9lrr0&L Sep 23, 2019 Contractor Date Sec./Tres. Title Wind Terrace, Inc. Company Name Dec 11, 2019 Oscar Aguillon(Dec 11, 19) Project Inspector Date Fred Ehia(Dec 13,2019) Dec 13, 2019 Project Manager Date Tanie So,140&Marales_ Dec 16 2 019 Janie Scarlett Morales(Dec 16,2019) CFA ManMo" Date Dana Burghdoff(Dec 16,20 Dec 16, 2019 Asst. City Manager Date OFFICIAL RECORD CITY SECRETARY FT. WORTH, TX Page 1 of 2 Notice of Project Completion Project Name: Campus Apartments City Project No.: 100937 City's Attachments Final Pay Estimate ❑x Change Order(s): ❑ Yes 0 N/A Contractor's Attachments Affidavit of Bills Paid Consent of Surety Statement of Contract Time Contract Time: 487 CD Days Charged: 506 Work Start Date: 2/27/2018 Work Complete Date: 7/19/2019 Page 2of2 FORTWORTH CITY OF FORT WORTH FINAL PAYMENT REQUEST Contract Name CAMPUS APARTMENTS Contract Limits Project Type DRAINAGE&PAVING City Project Numbers 100937 DOE Number 9370 Estimate Number 1 Payment Number I For Period Ending 7/19/2019 CD City Secretary Contract Number Contract Time 250;D Contract Date 5/l/2017 Days Charged to Date 506 Project Manager NA Contract is 100.00 Complete Contractor RUMSEY CONSTRUCTION,LLC 6617 VILLAGE SPRINGS DRIVE PLANO, TX 75024 Inspectors MILLER,W / AGUILLON,O i I' I Wednesday,August 21,2019 Page 1 of City Project Numbers 100937 DOE Number 9370 Contract Name CAMPUS APARTMENTS Estimate Number 1 Contract Limits Payment Number I Project Type DRAINAGE&PAVING For Period Ending 7/19/2019 Project Funding UNIT III:DRAINAGE IMPROVEMENTS Item Description of Items Estimated Unit Unit Cost Estimated Completed Completed No. Quanity Total Quanity Total ---------------------------------------- I TRENCH SAFETY 524 LF $4.00 $2,096.00 524 $2,096.00 2 18"RCP CLASS III 10 LF $100.00 $1,000.00 10 $1,000.00 3 48"RCP CLASS lII 398 LF $189.00 $75,222.00 398 $75,222.00 4 6'X4'BOX CULVERT 116 LF $352.00 $40,832.00 116 $40,832.00 5 Y STORM JUNCTION BOX 1 EA $6,500.00 $6,500.00 1 $6,500.00 6 STORM JUNCTION STRUCTURE(8'X6') I LS $7,800.00 $7,800.00 1 $7,800.00 7 20'CURB INLET I EA $8,000.00 $8,000.00 1 $8,000.00 8 INLET ADJUSTMENT 2 EA $1,500.00 $3,000.00 2 $3,000.00 -------------------------------------- Sub-Total of Previous Unit $144,450.00 $144,450.00 UNIT IV:PAVING IMPROVEMENTS Item Description of Items Estimated Unit Unit Cost Estimated Completed Completed No. Quanity Total Quanity Total --------------------------------------- 1 REMOVE ASPHALT PVM'1' 835 SY $9.00 $7,515.00 835 $7,515.00 2 REMOVE CONC CURB&GUTTER 544 LF $2.00 $1,088.00 544 $1,088.00 3 ASPHALT PVMT REPAIR BEYOND DEFINED 623 SY $30.00 $18,690.00 623 $18,690.00 WIDTH RESIDENTIAL 4 HYDRATED LIME 35 TN $94.60 $3,311.00 35 $3,311.00 5 6"LIME TREATMENT 2135 SY $5.62 $11,998.70 2135 $11,998.70 6 HMAC TRANSITION 42 TN $104.76 $4,399.92 42 $4,399.92 7 6"CONC PVMT 1971 SY $29.50 $58,144.50 1971 $58,144.50 8 4"CONC SIDEWALK 3602 SF $4.04 $14,552.08 3602 $14,552.08 9 BARRIER FREE RAMP TYPE R-1 3 EA $400.00 $1,200.00 3 $1,200.00 10 BARRIER FREE RAMP TYPE M-2 1 EA $449.92 $449.92 1 $449.92 11 BARRIER FREE RAMP TYPE P-1 3 EA $387.00 $1,161.00 3 $1,161.00 12 6"CONC CURB AND GUTTER 73 LF $15.01 $1,095.73 73 $1,095.73 13 9"CONC VALLEY GUTTER RESIDENTIAL 45 SY $18.01 $810.45 45 $810.45 14 24"SLD PVMT MARKING HAE(W) 14 LF $196.07 $2,744.98 14 $2,744.98 15 MANHOLE ADJUSTMENT MINOR 2 EA $1,500.00 $3,000.00 2 $3,000.00 16 TRAFFIC SIGNS W/STREET NAME BLADES 3 EA $250.00 $750.00 3 $750.00 -------------------------------------- Sub-Total of Previous Unit $130,911.28 $130,911.28 -------------------------------------- Wednesday,August 21,2019 Page 2 of City Project Numbers 100937 DOE Number 9370 Contract Name CAMPUS APARTMENTS Estimate Number 1 Contract Limits Payment Number 1 Project Type DRAINAGE&PAVING For Period Ending 7/19/2019 Project Funding Contract Information Summary Original Contract Amount $275,361.28 Change Orders Total Contract Price $275,361.28 Total Cost of Work Completed $275,361.28 Less %Retained $0.00 Net Earned $275,361.28 Earned This Period $275,361.28 ; Retainage This Period $0.00 Less Liquidated Damages Days @ /Day $0.00 LessPavement Deficiency $0.00 Less Penalty $0.00 i Less Previous Payment $0.00 Plus Material on Hand Less 15% $0.00 Balance Due This Payment $275,361.28 I I Wednesday,August 21,2019 Page 3 of 4 V City Project Numbers 100937 DOE Number 9370 Contract Name CAMPUS APARTMENTS Estimate Number I Contract Limits Payment Number I Project Type DRAINAGE&PAVING For Period Ending 7/19/2019 Project Funding Project Manager NA City Secretary Contract Number Inspectors MILLER,W / AGUILLON,O Contract Date 5/l/2017 Contractor RUMSEY CONSTRUCTION,LLC Contract Time 250 CD 6617 VILLAGE SPRINGS DRIVE Days Charged to Date 506 CD PLANO, TX 75024 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 $275,361.28 Less %Retained $0.00 Net Earned $275,361.28 Earned This Period $275,361.28 Retainage This Period $0.00 Less Liquidated Damages I 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 $275,361.28 Wednesday,August 21,2019 Page 4 of 4 V.-AIADocument G704T" - 2017 Certificate of Substantial Completion PROJECT:;name and address) CONTRACT INFORMATION: CERTIFICATE INFORMATION: Campus Drive Apartments Contract For:General Construction Certificate Number:001 BGO Job Number#16I47 Date:07-25-2016 Date-09-16-2019 OWNER:(name and addressi ARCHITECT:(name and address) CONTRACTOR:(name and address) Ah4TF,X Multi-Iioustng,Inc. BGO Architects Wind Terrace,Inc 30141 Agoura Hillas Road 4202 Beltway Drive 1201 E 13th Street The Work identified below has been reviewed and found,to the Architect's best knowledge,information,and belief,to be substantially complete.Substantial Completion is the stage in the progress of the Work when the Work or designated portion is sufficiently complete in accordance with the Contract Documents so that the Owner can occupy or utilize the Work for its intended use.The date of Substantial Completion of the Project or portion designated below is the date established by this Certificate. (Identify the Work,orportion thereof,that is substamlally complete.) The above-mentioned project consists of 224 for rent dwelling units including 03 different unit types and 02 different building types. The buildings are 03 story wood-framed. A Club leasing building consisting of 4,000+/-square feet as required by owner. It also includes a pool,a playground,and a pavillion. The project is known as Campus Drive Apartments,and is located in I;t Worth,Texas. BGO Architects ice- Jaron Daih,C.O.O. 09-30-2019 ARCHITECT(Firm Nanre) 4)GNATURE PRINTED NAME AND TITLE DATE OF SUBSTANTIAL COMPLETION WARRANTIES The date of Substantial Completion of the Project or portion designated above is also the date of commencement of applicable warranties required by the Contract Documents,except as stated below: (Identffi.•warranties that do not commence on the date of Substantial Completion,tf ar)Y,and indicate their date of commencement) WORK TO BE COMPLETED OR CORRECTED A list of items to be completed or corrected is attached hereto,or transmitted as agreed upon by the parties,and identified as follows: !Identify the list of Work to be completed or corrected.) The failure to include any items on such list does not alter the responsibility of the Contractor to complete all Work in accordance with the Contract Documents.Unless otherwise agreed to in writing,the date of commencement of warranties for items on the attached list will be the date of issuance of the final Certificate of Payment or the date of final payment,whichever occurs first.The Contractor will complete or correct the Work on the list of items attached hereto within ( )days from the above date of Substantial Completion. Cost estimate of Work to be completed or corrected: $ The responsibilities of the Owner and Contractor for security,maintenance,heat,utilities,damage to the Work,insurance,and other items identified below shall be as follows: (?rote:(homers and Contractor's legal and hunrance counsel should review insurance requirements and coverage) The Owner and Contractor hereby accept the responsibili' s assigned to them in this Certificate of Substantial Completion: Wind Terrace,Inc., Mary-Margaret Lemons A Texas nonprofit corporation Secretary 09-20-2019 CONTRACTOR(Firm IG U PRINTED NAME AND TITLE DATE Name) Mary-Margaret Lemons FW Campus Apartments,LP Secretary/Treasurer 09-20-2019 OWNER!firm.V'ame) 1 N T R PRINTED NAME AND TITLE DATE *'By:FW Campus Apartments GP,LLC,a Texas mil liability company,its General Partner **By:Fort Worth Affordability Inc.,a Texas non-profit corporation,its Sole Member AIA Document G704TM—2017.Copyright O 1963,1978,1992,2000 and 2017 oy The American Institute of Architects.All rights reserved.WARNING:This ALA®Document is protected by U.S.Copyright law and International Treaties.Unauthorized reproduction or distribution of this AIA99 Document,or any portion of it,may result in severe civil and criminal penalties,and will be prosecuted to the maximum extent possible under the law.This document was produced by AIA software at 13:00:01 CT on 09/i6/2019 under Order No.6121122116 wN&.expires on 01/09,2020,and is not far resale. User Notes: (3B9AOA38) AFFIDAVIT OF COMPLETION Date: September 16, 2019 Owner: FW Campus Apartments, LP Owner's Mailing Address: 1201 East 13th Street, Fort Worth, TX 76102 (Tarrant County) Original Contractor: Wind Terrace, Inc. Original Contractor's Mailing Address: 1201 East 13th Street, Fort Worth, TX 76102 (Tarrant County) Property: Being all of Lot 1, Block 1, CAMPUS APARTMENTS an addition to the City of Fort Worth, Tarrant County, Texas, as recorded in Instrument Number D217113437 of the Official Public Records, Tarrant County, Texas. Improvements: All buildings, structures and other improvements, existing and to be developed, built and constructed by FW Campus Apartments, LP on the Property, which shall consist of a 224-unit apartment complex. Affiants, FW Campus Apartments, LP and Wind Terrace, Inc., on oath swear that the following statements are true and within the personal knowledge of Affiants: 1. Ownership Representation. "Owner" is the owner of the Property herein described. 2. Construction Contract. The Improvements were constructed on the Property pursuant to an agreement dated May 1, 2017 by and between the Owner and Original Contractor. 3. Date of Completion. The Improvements to the Property were completed on August 27, 2019, said date being the Completion Date. For purposes of this affidavit, "completion" means within the meaning of §53.106 of the Texas Property Code, being the actual completion of the work, including any extras or change orders reasonably required or contemplated under the original contract, other than warranty or repair work. 4. Claim Against Retained Funds. A CLAIMANT MAY NOT HAVE A LIEN ON RETAINED FUNDS UNLESS THE CLAIMANT FILES AN AFFIDAVIT CLAIMING A LIEN NO LATER THAN THE THIRTIETH DAY AFTER THE DATE OF COMPLETION INDICATED IN THIS AFFIDAVIT OF COMPLETION. %4UA"YAW lkw)l I-ALOYVtM L F Campu Apart nts, V�Wind� e ll c. By: FW C pus Ap rt e s P, LLC, its general partner Mary- argaret Won By: Fort Worth Affor abi ty nc., its sole member Secretary/Treasurer By: Mary-Margaret Lemons, Secretary/Treasurer SUBSCRIBED AND SWORN TO before me on by Mary-Margaret Lemons (Secretary/Treasurer of Fort Worth Affordability, Inc— t rhember of FW Campus Apartments GP, LLC, the general partner of FW Campu pa ents, L ) .. : ,...y.�:- EVAC.KEY My Notary!D#10943269 Notary Public, S of Texas Expires August 15,2021 •��ii eeeee SUBSCRIBED AND SWORN TO before me on bcr 8 by Mary-Margaret Lemons (Secretary/Treasurer of Wind Terrace, Inc.) EVAC.KEY Notary Public, S Texas My Notary ID#10943269 .y Expires August 15,2021 em 9-VAIA Document G706' — 1994 Contractor's Affidavit of Payment of Debts and Claims PROJECT:(Nante and address) ARCHITECT'S PROJECT NUMBER: OWNER:❑ Campus Apartments 16147 ARCHITECT:❑ 4633 Campus Drive CONTRACT FOR: General Construction CONTRACTOR:❑ Fort Worth,TX 76119 SURETY:❑ TO OWNER:(Name and address) CONTRACT DATED:July 25,2016 OTHER:❑ FW Campus Apartments,LP, a Texas limited partnership 30141 Agoura Road, Suite 100 Agoura Hills,CA 9I301 STATE OF: Texas COUNTY OF: Tarrant The undersigned hereby certifies that,except as listed below,payment has been made in full and all obligations have otherwise been satisfied for all materials and equipment furnished,for all work,labor,and services performed,and for all known indebtedness and claims against the Contractor for damages arising in any manner in connec ion with the performance of the Contract referenced above for which the Owner or Owner's property might in any way be held responsible or encumbered. EXCEPTIONS: See attached list of outstanding balances. SUPPORTING DOCUMENTS ATTACHED HERETO: CONTRACTOR: (Name and address) 1. Consent of Surety to Final Payment. Whenever Wind Terrace,Inc. Surety is involved,Consent of Surety is 1201 E. 11311'Street required. AIA Document G707,Consent of Fort Worth,TX 76102 Surety,may be used for this purpose Indicate Attachment ❑ Yes Z No BY: The following supporting documents should be attached (Signatu e of autho t ed rep sentative) hereto if required by the Owner. Mary-Margaret Lem s,Secretary 1. Contractor's Release or Waiver of Liens, (Printed name and title) conditional upon receipt of final payment. 2, Separate Releases or Waivers of Liens from Subscribed and sworn to before me on this date: Subcontractors and material and equipment suppliers,to the extent required by the Owner, accompanied by a list thereof. Notary Public: _ 3. Contractor's Affidavit of Release of Liens(AIA My Commission Expires: 08 -L5.ZC' Document G706A). ...........�; EVA C.KEY *: .*`- My Notary ID#10913269 F:or S� Expires August 15,2021 AIA Document G70611"—1994.Copyright®1970 and 1994 by The American Institute of Architects.All rights reserved.WARNING:This AIA°Document is protected by U.S.Copyright Law and International Treaties.Unauthorized reproduction or distribution of this AIAe Document,or any portion of it, may result in severe civil and criminal penalties,and will be prosecuted to the maximum extent possible under the law.This document was produced by AIA software at 12:16:40 ET on 0 912 6/2 0 1 9 under Order No.7079790137 which expires on 01/11/2020,and is not for resale. User Notes: (3B9ADA70) WAMTEX 30141 AGOURA RD, STE 100 AGOURA HILLS,CA 91301 Phone 818-706-0694 Fax NOTICE: THIS DOCUMENT WAIVES RIGHTS UNCONDITIONALLY AND STATES THAT YOU HAVE BEEN PAID FOR GIVING UP THOSE RIGHTS.IT IS PROHIBITED FOR A PERSON TO REQUIRE YOU TO SIGN THIS DOCUMENT IF YOU HAVE NOT BEEN PAID THE PAYMENT AMOUNT SET FORTH BELOW. IF YOU HAVE NOT BEEN PAID,USE A CONDITIONAL RELEASE FORM. UNCONDITIONAL WAIVER AND RELEASE ON FINAL PAYMENT Project FW CAMPUS LP Job No CACN The signer of this document has been paid in full for all for all labor, services,equipment,or materials furnished to the property or to AMTEX Construction LLC(person with whom signer contracted)on the property of FW CAMPUS L.P. (owner) located at 4633 CAMPUS DR.,.FORT WORTH,Texas 76119(location)to the following extent: (job description). The signer therefore waives and releases any mechanic's lien right,any right arising from a payment bond that complies with a state or federal statute,any common law payment bond right, any claim for payment,and any rights under any similar ordinance, rule,or statute related to claim or payment rights for persons in the signer's position. The signer warrants that the signer has already paid or will use the funds received from this final payment to promptly pay in full all of the signer's laborers,subcontractors, materialmen,and suppliers for all work,materials,equipment, or services provided for or to the above referenced project up to the date of this waiver and release. Company Name:Rumsev Construction Date 06/25/2019 By: Joe Geer Title: CFO Signature: Joe Geer STATE OF: Texas § COUNTY OF: Dallas § This instrument was acknowledged before me on the 25th day of June,2019, by Sarah Perez-Lara of Rumsev Construction,for the consideration herein expressed,on behalf of same. Sarah Perez-Lara f'`+ SaLID!# �32667�3086!7 PerezLara Notary Public in and for the ry STATE OF Texas �.!� myCopires Nov20 f AFFIDAVIT OF BILLS PAID STATE OF TEXAS § § KNOW ALL MEN BY THESE PRESENTS: COUNTY OF DENTON § Personally, before me the undersigned authority, on this day appeared Gary Wells, who being duly sworn on oath, says that he is a legal representative of Rumsey Construction, LLC and that the contract for the construction of the project, designated as- 1753 Campus Apartments, has been satisfactorily completed and that all bills for materials, apparatus, fixtures, machinery, labor, and equipment used in connection with the cons u tion of this project have been fully paid. 4-� IJ)6111r Signature Title Sworn to and subscribed before me this, the 12/10/2019 Y ., SARAH PEREZ J` PrJ � �ENotary Pubi�c,State of'rexus Co rn.Expisas 11-21-2020 Notary ID 126730867 Notary Public in and for --- Denton County, Texas CONSENT OF OWNER SURETY COMPANY ARCHITECT TO FINAL PAYMENT CONTRACTOR ❑ SURETY ❑ AIA DOCUMENT G707 OTHER PROJECT: Water, Sewer, Paving, Drainage & Street Lights to serve Campus Apartments (name, address) Fort Worth, TX TO (Owner) F_ CITY PROJECT NO: The City of Fort Worth & AMTEX CONTRACT FOR: $394,670.24 Fort Worth, TX CONTRACT DATE: November 30, 2017 BOND NO: 1067498 CONTRACTOR: Rumsey Construction, LLC 4329 Reeder Drive Carrollton, TX 75010 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 as it appears in the bond). The Hanover Insurance Company SURETY COMPANY, on bond of(here insert name and address of Contractor as it appears in the bond), Rumsey Construction, LLC , CONTRACTOR, hereby approves of the final payment to the Contractor, and agrees that final payment to the Contractor shall not relieve the Surety of any of its obligations to(here insert name and address of Owner) The City of Fort Worth & AMTEX OWNER, as set forth in the said Surety's bond. IN WITNESS WHEREOF , the Surety has hereunto set its hand this 3rd day of December 12019 The Hanover Insuranc Cam an Surety Signature of Aut rized Representative Attest: Allyson Dean, A orney-in-Fact (Seal):( _ j � j �❑ , Title AIA DOC T 707-CONSENT OMURETY FINAL AY ENT-APRIL 1970 ONE PAGE EDITION-AIA 0-O 1970-THE AMERICAN INSTITUTE OF A CHITECTS, 1735 NEW YORK AVE., NW,WASHINGTON,D.C.20006 THE HANOVER INSURANCE COMPANY MASSACHUSETTS BAY INSURANCE COMPANY CITIZENS INSURANCE COMPANY OF AMERICA POWER OF ATTORNEY 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. KNOW ALL PERSONS BY THESE PRESENTS: That THE HANOVER INSURANCE COMPANY and MASSACHUSETTS BAY INSURANCE COMPANY,both being corporations organized and existing under the laws of the State of New Hampshire,and CITIZENS INSURANCE COMPANY OF AMERICA,a corporation organized and existing underthe laws of the State of Michigan,(hereinafter individually and collectively the"Company")does hereby constitute and appoint John R.Ward,Douglas Moore,Emily Mikeska,Eva O.Limmer and/or Allyson Dean Of Ward&Moore Insurance Services LP of Dallas,TX,Gatesville,TX and Temple,TX each individually,if there be more than one named,as its true and lawful attorney(s)-in-fact to sign,execute,seal,acknowledge and deliver for,and on its behalf,and as its act and deed any place within the United States, any and all surety bonds, recognizances, undertakings, or other surety obligations. The execution of such surety bonds, recognizances, undertakings or surety obligations,in pursuance of these presents,shall be as binding upon the Company as if they had been duly signed bythe president and attested by the secretary of the Company, in their own proper persons.Provided however,that this power of attorney limits the acts of those named herein;and they have no authority to bind the Company except in the manner stated and to the extent of any limitation stated below: Any such obligations in the United States,not to exceed Thirty Five Million and No1100($35,000,000)in any single instance That this power is made and executed pursuant to the authority of the following Resolutions passed by the Board of Directors of said Company,and said Resolutions remain in full force and effect: RESOLVED: That the President or any Vice President, in conjunction with any Vice President, be and they hereby are authorized and empowered to appoint Attorneys-in-fact of the Company,in its name and as it acts,to execute and acknowledge for and on its behalf as surety, any and all bonds,recognizances,contracts of indemnity,waivers of citation and all other writings obligatory in the nature thereof,with powerto attach thereto the seal of the Company.Any such writings so executed by such Attorneys-in-fact shall be binding upon the Company as if they had been duly executed and acknowledged by the regularly elected officers of the Company in their own proper persons. RESOLVED:That any and all Powers of Attorney and Certified Copies of such Powers of Attorney and certification in respectthereto,granted and executed by the President or Vice President in conjunction with any Vice President of the Company,shall be binding an the Companyto the same extent as if all signatures therein were manually affixed,even though one or more of any such signatures thereon may be facsimile. (Adopted October 7, 1981 —The Hanover Insurance Company;Adopted April 14, 1982—Massachusetts Bay Insurance Company:Adopted September 7,2001 —Citizens Insurance Company of America) IN WITNESS WHEREOF,THE HANOVER INSURANCE COMPANY,MASSACHUSETTS BAY INSURANCE COMPANY and CITIZENS INSURANCE COMPANY OF AMERICA have caused these presents to be sealed with their respective corporate seals,duly attested by two Vice Presidents,this 4' day of April,2018. The Hanover Insurance Company Massachusetts Ray Insu�ance Company Th.Ffannver Insurance Cann ny �,,,,n:.,„r Massachusetts Bay Ins-— ce C®mpae�y Citizens Insurance Company cif America ! Citizens In—ranee Company of America John C.Roche,E,-T and President JamesH.Xwwiecla,Nvice Presit ew THE COMMONWEALTH OF MASSACHUSETTS ) COUNTY OF WORCESTER On this 41h day of April,2018 before me came the above named Vice Presidents of The Hanover Insurance Company, Massachusetts Bay Insurance Company and Citizens Insurance Company ofAmerica,to me personally known to be the individuals and officers described herein,and acknowledged that the seals affixed to the preceding instrument are the corporate seals of The Hanover Insurance Company,Massachusetts Bay Insurance Company and Citizens Insurance Company of America,respectively,and thatthe said corporate seals and their signatures as officers were duly affixed and subscribed to said instrument by the authority and direction of said Corporations. JOL INANE J. MMINQ oawufww' 4 or UWD W CmniuYan m l7i�n�r., a i Pshlic Ii1te0/.7q; MyCammcss:on Espir�.',Ll arch 4.2022 I,the undersigned Vice President of The Hanover Insurance Company, Massachusetts Bay Insurance Company and Citizens Insurance Company of America, hereby certify that the above and foregoing is a full,true and correct copy of the Original Power of Attorney issued by said Companies,and do hereby further certify that the said Powers of Attorney are still in force and effect.GIVEN under my hand and the seals of said Companies,at Worcester,Massachusetts,this 3 day of bt(14 -LtA 2019 CERTIFIED COPY / .:.. .. . ...._. 't'tKpdpreG.:vtBctis ,vit;LPmsidenr ., Ha nover Insurance Group' Texas Complaint Notice Commercial Lines IMPORTANT NOTICE AVISO IMPORTANTE To obtain information or make a complaint: Para obtener informacion o para someter una queja: You may call The Hanover Insurance Company/ Usted puede Ilamar al numero de telefono gratis de Citizens Insurance Company of America's toll-free The Hanover Insurance Company/Citizens Insurance telephone number for information or to make a Company of America's para informacion o para complaint at: someter una queja al: 1-800-608-8141 1-800-608-8141 You may also write to The Hanover Insurance Company/ Usted tambien puede escribir a The Hanover Insurance Citizens Insurance Company of America at: Company/Citizens Insurance Company of America al: 440 Lincoln Street 440 Lincoln Street Worcester, MA 01615 Worcester, MA 01615 You may contact the Texas Department of Insurance Puede comunicarse con el Departamento de Seguros to obtain information on companies, coverages, de Texas para obtener informacion acerca de rights or complaints at: companias, coberturas, derechos o quejas al: 1-800-252-3439 1-800-252-3439 You may write the Texas Department of Insurance: Puede escribir al Departamento de Seguros de Texas: P. O. Box 149104 P. O. Box 149104 Austin, TX 78714-9104 Austin, TX 78714-9104 Fax: (512) 475-1771 Fax. (512) 475-1771 Web: http://www.tdi.texas.gov Web: http://www.tdi.texas.gov E-mail: ConsumerProtection@tdi.texas.gov E-mail: ConsumerProtection@tdi.texas.gov PREMIUM OR CLAIM DISPUTES: DISPUTAS SOBRE PRIMAS O RECLAMOS: Should you have a dispute concerning your premium Si tiene una disputa concerniente a su prima o a un or about a claim you should contact the agent or the reclamo, debe comunicarse con el agente o la corn- company first. If the dispute is not resolved, you may pania primero. Si no se resuelve la disputa, puede contact the Texas Department of insurance. entonces comunicarse con el departamento (TDI). ATTACH THIS NOTICE TO YOUR POLICY:This UNA ESTE AVISO A SU POI_IZA: Este aviso es solo notice is for information only and does not become para proposito de informacion y no se convierte en a part or condition of the attached document. parte o condition del documento adjunto. The Hanover Insurance Company 1440 Lincoln Street,Worcester,MA 01653 181.1457(12113)Nqy 1&1 Citizens Insurance Company of America 1808 North Highlander Way,Howell,MI 48843 hanover.com