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Contract 52786-FP1
Citysecretary 52786 -FP1 Contract No. FORTWORTH., Date Received Aug 24,2020 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: SUNSET POINTE PHASE 2 City Project No.: 102110 Improvement Type(s): Water ® Sewer Original Contract Price: $496,701.10 Amount of Approved Change Order(s): $32,632.10 Revised Contract Amount: $529,333.20 Total Cost of Work Complete: $529,333.20 Kevin GersfenKarn Aug1 2020 .evin Gersten korn(Aug 21,202016:48CDT) g f Contractor Date Executive VP of Operations Title PCI Construction Inc. Company Name Kevin Barnes(Aug 24,202008:02CDT) Aug 24,2020 Pr 'e �ector Date Patrick adey(Au 4,202008:11CDT) Aug 24,2020 Project Manager Date zxfk6 Z914* Aug4 2020 Laurie Lewis(Aug 24,2020 08:26 CDT) g f CFA Manager Date 75aru��cu�t6u7o�f Dana Burghdoff( g24.2o 09:13CDT1 Aug24,2020 Asst. City Manager Date OFFICIAL RECORD CITY SECRETARY Page 1 of 2 FT. WORTH, TX Notice of Project Completion Project Name: SUNSET POINTE PHASE 2 City Project No.: 102110 City's Attachments Final Pay Estimate Change Order(s): ® Yes ❑ N/A Pipe Report: ® Yes ❑ N/A Contractor's Attachments Affidavit of Bills Paid Consent of Surety Statement of Contract Time Contract Time: 365 CD Days Charged: 291 Work Start Date: 10/21/2019 Work Complete Date: 8/5/2020 Page 2of2 FORT WORTH CITY OF FORT WORTH FINAL PAYMENT REQUEST Contract Name SUNSET POINTE PHASE 2 Contract Limits Project Type WATER&SEWER City Project Numbers 102110 DOE Number 2110 Estimate Number 1 Payment Number 1 For Period Ending 8/19/2020 CD City Secretary Contract Number Contract Time 366D Contract Date Days Charged to Date 291 Project Manager NA Contract is 100.00 Complete Contractor PCI CONSTRUCTION,INC. P.O.BOX 2967 McKINNEY, TX 75070 Inspectors DICKINSON/ BARNES Wednesday,August 19,2020 Page 1 of 5 City Project Numbers 102110 DOE Number 2110 Contract Name SUNSET POINTE PHASE 2 Estimate Number 1 Contract Limits Payment Number 1 Project Type WATER&SEWER For Period Ending 8/19/2020 Project Funding WATER Item Description of Items Estimated Unit Unit Cost Estimated Completed Completed No. Quanity Total Quanity Total --------------------------------------- 1 8"WATER PIPE 3108 LF $20.90 $64,957.20 3108 $64,957.20 2 8"DIP WATER 56 LF $35.70 $1,999.20 56 $1,999.20 3 16"CASING BY OTHER THAN OPEN CUT 56 LF $286.20 $16,027.20 56 $16,027.20 4 16"X8"TAPPING SLEEVE&VALVE 1 EA $4,150.00 $4,150.00 1 $4,150.00 5 1"WATER SERVICE 90 EA $752.00 $67,680.00 90 $67,680.00 6 8"GATE VALVE co#2 15 EA $1,238.00 $18,570.00 15 $18,570.00 7 FIRE HYDRANT 6 EA $4,722.00 $28,332.00 6 $28,332.00 8 DUCTILE IRON WATER FrrTINGS 2 TN $2,408.00 $4,816.00 2 $4,816.00 W/RESTRAINT 9 TRENCH SAFETY 3164 LF $0.10 $316.40 3164 $316.40 10 CONNECTION TO EXISTING 4"-12"WATER 3 EA $1,450.00 $4,350.00 3 $4,350.00 MAIN 11 1"PRIVATE IRRIGATION WATER SERVICE 1 EA $1,193.00 $1,193.00 1 $1,193.00 CO#3 Sub-Total of Previous Unit $212,391.00 $212,391.00 SEWER Item Description of Items Estimated Unit Unit Cost Estimated Completed Completed No. Quanity Total Quanity Total 1 8"SEWER PIPE 2632 LF $23.50 $61,852.00 2632 $61,852.00 2 4'MANHOLE 12 EA $3,433.00 $41,196.00 12 $41,196.00 3 4'DROP MANHOLE CO#2 2 EA $5,289.00 $10,578.00 2 $10,578.00 4 ADD EXTERNAL DROP TO EXISTING 2 EA $6,580.00 $13,160.00 2 $13,160.00 MANHOLE 5 MANHOLE ADJUSTMENT FOR UTILITY PIPES 5 EA $1,414.00 $7,070.00 5 $7,070.00 6 CSS ENCASEMENT FOR UTILITY PIPES 220 LF $34.00 $7,480.00 220 $7,480.00 7 EPDXY MANHOLE LINER CO#1 CO#3 188.024 VF $319.59 $60,090.59 188.024 $60,090.59 8 TRENCH WATER STOPS 14 EA $2,030.00 $28,420.00 14 $28,420.00 9 4"SEWER SERVICE 90 EA $711.00 $63,990.00 90 $63,990.00 10 CONNECT TO EXISTING 8"SS 1 EA $1,372.00 $1,372.00 1 $1,372.00 11 MANHOLE VACUUM TESTING CO#2 21 EA $204.00 $4,284.00 21 $4,284.00 12 TRENCH SAFETY 2632 LF $0.60 $1,579.20 2632 $1,579.20 13 POST CCTV INSPECTION 2632 LF $2.20 $5,790.40 2632 $5,790.40 Wednesday,August 19,2020 Page 2 of 5 City Project Numbers 102110 DOE Number 2110 Contract Name SUNSET POINTE PHASE 2 Estimate Number 1 Contract Limits Payment Number 1 Project Type WATER&SEWER For Period Ending 8/19/2020 Project Funding 14 REMOVE EXISTING MANHOLE COATING CO#3 2 EA $5,040.00 $10,080.00 2 $10,080.00 Sub-Total of Previous Unit $316,942.19 $316,942.19 -------------------------------------- Wednesday,August 19,2020 Page 3 of 5 City Project Numbers 102110 DOE Number 2110 Contract Name SUNSET POINTE PHASE 2 Estimate Number 1 Contract Limits Payment Number 1 Project Type WATER&SEWER For Period Ending 8/19/2020 Project Funding Contract Information Summary Original Contract Amount $496,701.10 Change Orders Change Order Number 1 $8,377.00 Change Order Number 2 $3,714.00 Change Order Number 3 $20,541.10 Total Contract Price $529,333.19 Total Cost of Work Completed $529,333.19 Less %Retained $0.00 Net Earned $529,333.20 Earned This Period $529,333.20 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 $529,333.20 Wednesday,August 19,2020 Page 4 of 5 City Project Numbers 102110 DOE Number 2110 Contract Name SUNSET POINTE PHASE 2 Estimate Number 1 Contract Limits Payment Number 1 Project Type WATER&SEWER For Period Ending 8/19/2020 Project Funding Project Manager NA City Secretary Contract Number Inspectors DICKINSON/ BARNES Contract Date Contractor PCI CONSTRUCTION,INC. Contract Time 365 CD P.O.BOX 2967 Days Charged to Date 291 CD McKINNEY, TX 75070 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 $529,333.19 Less %Retained $0.00 Net Earned $529,333.20 Earned This Period $529,333.20 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 $529,333.20 Wednesday,August 19,2020 Page 5 of 5 o Woo TRANSPORTATION AND PUBLIC WORKS PIPE REPORT FOR: PROJECT NAME: Sunset Pointe Phase 2 PROJECT NUMBER: 102110 DOE NUMBER: WATER PIPE LAID SIZE TYPE OF PIPE LF C900 8" PVC 3108 8" DIP 56 FIRE HYDRANTS: 6 VALVES(16" OR LARGER) PIPE ABANDONED SIZE TYPE OF PIPE LF DENSITIES: NEW SERVICES: 1" 90EA SEWER PIPE LAID SIZE TYPE OF PIPE LF SDR-26 8" PVC 2632 PIPE ABANDONED SIZE TYPE OF PIPE LF DENSITIES: NEW SERVICES: 4" 90EA TRANSPORTATION AND PUBLIC WORKS , s The City of Fort Worth• 1000 Throckmorton Street•Fort Worth,TX 76012-6311 a� (817)392-7941 •Fax: (817)392-7845 ~ § ! 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TRANSPORTATION AND PUBLIC WORKS August 6, 2020 PCI Construction P.O.Box 2967 McKinney,Texas 75070 RE: Acceptance Letter Project Name: Sunset Point Phase 2 Project Type: Sanitary Sewer, Water City Project No.: 102110 To Whom It May Concern: On August 4, 2020 a final inspection was made on the subject project. There were punch list items identified at that time. The punch list items were completed on August 5, 2020. The final inspection and the corrected punch list items indicate that the work meets the City of Fort Worth specifications and is therefore accepted by the City. The warranty period will start on August 5, 2020, which is the date of the punch list completion and will extend of two (2)years in accordance with the Contract Documents. If you have any questions concerning this letter of acceptance, please feel free to contact me at 817- 392-7830. Sincerely, Patrick a ley(Au 4,2020 08:11 CDT) Patrick Buckley, Project Manager Cc: Kevin Barnes, Inspector Doug Dickinson, Inspection Supervisor j Randy Horton, Senior Inspector Victor Tornero, Program Manager Peloton Land Solutions, Consultant PCI Construction, Contractor Pulte Group, Developer File E-Mail: TPW_Acceptance@fortworthtexas.gov Rev.8/20/19 AFFIDAVIT STATE OF TEXAS COUNTY OF COLLIN Before me,the undersigned authority, a notary public in the state and county aforesaid, on this day personally appeared Eric M. Lindberg, VP of Finance Of PCI 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; Sunset Pointe Phase 2 - City Project#102110 BY Eric M. Lindberg- VP of Finance Subscribed and sworn before me on this date 20th of August, 2020. BREE MITCHELL Notary ID#123944875 Notary Public s My Commission Expires Collin County _� September 26,20Z3 State of Texas CONStNT OF CONTRACTOR SURETY COMPANY ARCHITECT TO FINAL PAYMENT SUBCONTRACTOR SURETY AM DOCUMENT G707(Modifted) OTHER Bond No.2293450 PROJECT: Sunset Pointe Phase 2-Utility,Paving and Street Light 27 Improvements-Fort Worth,TX (name,address) TO(Contractor)Pulte Group,Inc. and City of Fort Worth ARCHITECT'S PROJECT NO: 4800 Regent Blvd #100 Irving,TX 75063 CONTRACT FOR: Utility,Paving and Street Light 27 Improvements CONTRACT DATE: 6/17/2019 SUBCONTRACTOR: PCI Construction,Inc. P.O.Box 2967 McKinney,TX 75070 In accordance with the provisions of the Contract between the Contractor and the Subcontractor as indicated above,the (here insert name and address of Surety Company) North American Specialty Insurance Company 1200 Main Street,Suite 800 Kansas City,MO 64105 , SURETY COMPANY, on bond of(here insert name and address of Subcontractor) PCI Construction,Inc. P.O.Box 2967 McKinney,TX 75070 , SUBCONTRACTOR, hereby approves of the final payment to the Subcontractor,and agrees that final payment to the Subcontractor shall not relieve the Surety Company of any of its obligations to(here insert name and address of Contractor) Pulte Group,Inc.and City of Fort Worth 4800 Regent Blvd#100 , CONTRACTOR, Irving,TX 75063 as set forth in the said Surety Company's bond. IN WITNESS WHEREOF, the Surety Company has hereunto set its hand this 22nd day of July,2020. North American Specialty Insurance Company Sure Company Signature of Authorized Representative Witness: (Seal): Debra Lee Moon,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 AIA DOCUMENT G707 CONSENT OF SURETY COMPANY TO FINAL PAYMENT APRIL 1970 EDITION AIA ONE PAGE 1970 THE AMERICAN INSTITUTE OF ARCHITECTS,1735 New York Ave.,NW,WASHINGTON,D.C. 20006 SWISS RE CORPORATE SOLUTIONS NORTH AMERICAN SPECIALTY INSURANCE COMPANY WASHINGTON INTERNATIONAL INSURANCE COMPANY WESTPORT INSURANCE CORPORATION GENERAL POWER OF ATTORNEY KNOW ALL MEN BY THESE PRESENTS,THAT North American Specialty Insurance Company,a corporatiop duly orgagized and existing under laws of the State of New Hampshire,and having its principal office in the City of Kansas City,Missouri and Washington International Insurance Company a corporation organized and existing under the laws of the State of New Hampshire and having its principal office in the City of Kansas City,Missouri and Westport Insurance Corporation,or anized under the laws of the State of Missouri,and having its principal offipe in the City of Kansas City,Missouri,each does hereby make constitute and appoint: JOHN WILLIAM NEWBY,TROY RUSSELL KEY,DEBRA LEE MOON,ANDREA ROSE CRAWFORD,SANDRA LEE RONEY,LINDA MICHELLE STALDER SUZANNE ELIZABETH NIEDZWIEDZ,SHERIE MICHELLE GREENOUGH,CHERI LYNN IRBY,AND JOSHUA D.TRITT,JOINTLY OR SEVERALLY Its true and lawful Attorney(s)-in-Fact,to make,execute,seal and deliver,for and on its behalf and as its act and deed,bonds or other writings obligatory in the nature of a bond on behalf of each of said Companies,as surety,on contracts of suretyship as are or may be required or permitted by law,regulation,contract or otherwise,provided that no bond or undertaking or contract or suretyship executed under this authority shall exceed the amount of. TWO HUNDRED MILLION($200,000,000.00)DOLLARS This Power of Attorney is granted and is signed by facsimile under and by the authority of the following Resolutions adopted by the Boards of Directors of North American Specialty Insurance Company and Washington International Insurance Company at meetings duly called and held on March 24,2000 and Westport Insurance Corporation by written consent of its Executive Committee dated July 18,2011. "RESOLVED,that any two of the President,any Senior Vice President,any Vice President,any Assistant Vice President, the Secretary or any Assistant Secretary be,and each or any of them hereby is authorized to execute a Power of Attomey qualifying the attorney named in the given Power of Attorney to execute on behalf of the Company bonds,undertakings and all contracts of surety,and that each or any of them hereby is authorized to attest to the execution of any such Power of Attorney and to attach therein the seal of the Company; and it is FURTHER RESOLVED,that the signature of such officers and the seal of the Company may be affixed to any such Power of Attorney or to any certificate relating thereto by facsimile,and any such Power of Attorney or certificate bearing such facsimile signatures or facsimile seal shall be binding upon the Company when so affixed and in the future with regard to any bond,undertaking or contract of surety to which it is attached." r`'Q�CIAL7Y/N,� �s pJ%ONAt�°" MNCF ci �oR��T SG do°RPeR9ysG By ~� e A�� c, 2' SI_AL� ;Z' Steven Anderson,Senior icePresidenIo Washington International Insurance �; �+s�p�r�s��1�(r � s tu: ;C)a _O. ,p &Senior Vice President of North American Specialty Insurance Company VG/•sL • ,. n a a t—,�;. _ &Senior Vice President of Westport Insurance Corporation •® sd�ti 1973 r� j`JAMPSr:;xiD- o �,�l) By ••'••..... Michael A.Ito,Senior Vice President at Washington International Insurance # "•qty,*urt!"+• pt0auttnaatPs� Company &Senior Vice President of North American SPecialty Insurance Company &Senior Vice President or Westport Insurance Corporation IN WITNESS WHEREOF,North American Specialty Insurance Company,Washington International Insurance Company and Westport Insurance Corporation have caused their official seals to be hereunto affixed,and these presents to be signed by their authorized officers this this 12th day of FEBRUARY ,20 20 , North American Specialty Insurance Company Washington International Insurance Company State of Illinois Westport Insurance Corporation County of Cook SS: On this 12th day of FEBRUARY,20 20,before me,a Notary Public personally appeared Steven P.Anderson ,Senior Vice President of Washington International Insurance Company and Senior Vice President of North American Specialty Insurance Company and Senior Vice President of Westport Insurance Corporation and Michael A.Ito Senior Vice President of Washington International Insurance Company and Senior Vice President of North American Specialty Insurance Company and Senior Vice President of Westport Insurance Corporation,personally known to me,who being by me duly sworn,acknowledged that they signed the above Power of Attorney as officers of and acknowledged said instrument to be the voluntary act and deed of their respective companies. OFFICIAL SEAL r M.KENNY ��•� Notary Public-State of Illinois _ My Commission bpitkY M.Kenn Notary Public �yoasost Yt �' 1 I, Jeffrey Goldberg , the duly elected Vice President and Assistant Secretary of North American Specialty Insurance Company,Washington International Insurance Company and Westport Insurance Corporation do hereby certify that the above and foregoing is a true and correct copy of a Power of Attorney given by said North American Specialty Insurance Company,Washington International Insurance Company and Westport Insurance Corporation which is still in full force and effect. IN WITNESS WHEREOF,I have set my hand and affixed the seals of the Companies this 22nd day of July 20 20 Jeffrey Goldberg,Vice President&Assistant Secretary of Washington International Insurance Company& North American Specialty Insurance Company&Vice President&Assistant Secretary of Westport Inyprance Corporation North American Specialty Insurance Company Washington International Insurance Company Westport Insurance Corporation TEXAS CLAIMS INFORMATION IMPORTANT NOTICE ADVISO IMPORTANTE In order to obtain information or make a complaint: Para obtener informacion o para someter un queja: You may contact Jeffrey Goldberg,Vice President Puede comunicarse con Jeffrey Goldberg,Vice — Claims at 1-800-338-0753 President— Claims,al 1-800-338-0753 You may call Washington International Insurance Usted puede Ilamr al numero de telefono gratis de Company and/or North American Specialty Insurance Washington International Insurance Company and/or Company's and/or Westport Insurance Corporation North American Specialty Insurance Company's and/or toll-free number for information or to make a Westport Insurance Corporation para informacion o complaint at: para someter una queja al: 1-800-338-0753 1-800-338-0753 You may also write to Washington International Usted tambien puede escribir a Washington Insurance Company and/or North American Specialty International Insurance Company and/or North Insurance Company and/or Westport Insurance American Specialty Insurance Company and/or Corporation at the following address: Westport Insurance Corporation al: 1200 Main Street 1200 Main Street Suite 800 Suite 800 Kansas City,MO 64105 Kansas City,MO 64105 You may contact the Texas Department of Insurance Puede escribir al Departmento de Seguros de Texas to obtain information on companies, coverages, para obtener informacion acerca de companias, rights or complaints at: coberturas,derechos o quejas al: 1-800-252-3439 1-800-252-3439 You may write the Texas Department of Insurance: Puede escribir al Departmento 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)475-1 771 Web: htto://www.td4.state.tx.us Web: htto://www.tdi.state.tx.us Email:ConsumerProtection@tdi.state.tx.us Email:ConsumerProtection�.latdi.state,tx.us 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 first contact the reclamo, debe comunicarse con el Washington Washington International Insurance Company and/or International Insurance Company and/or North North American Specialty Insurance Company and/or American Specialty Insurance Company and/or Westport Insurance Corporation. If the dispute is not Westport Insurance Corporation primero. Si no se resolved,you may contact the Texas Department of resuelve la disputa, puede entonces comunicarse Insurance. con el Departmento de Seguros de Texas. ATTACH THIS NOTICE TO YOUR POLICY: UNA ESTE AVISO A SU POLIZA This notice is for information only and does not Este aviso es solo para proposito de infromacion y no become a part or condition of the attached se converte en parte o condicion del documento document. adjunto. North American Specialty Insurance Company 1200 Main Street, Suite 800 Kansas City, MO 64105 CHANGE RIDER To be attached to and form a part of. Type of Bond: Two Year Maintenance Bond Bond No: 2293455 Principal: PCI Construction,Inc. Surety: North American Specialty Insurance Company In favor of Obligee:Pulte Group, Inc. and City of Fort Worth Dated: August 19, 2019 In consideration of the premium charged for the attached bond,it is hereby agreed to change the following: Description:The bond amount is amended From: Eight Hundred Eighteen Thousand Nine Hundred Sixty and 70/100 ($818,960.70) To:Nine Hundred Fourteen Thousand Four Hundred Fifty-Four and 01/100 ($914,454.01) The attached bond shall be subject to all its agreements,limitations and conditions except as herein expresslymodified. The rider is effective: 07/22/2020 ByS._ Name: Debra Lee Moon Title: Attorney-in-Fact SWISS RE CORPORATE SOLUTIONS NORTH AMERICAN SPECIALTY INSURANCE COMPANY WASHINGTON INTERNATIONAL INSURANCE COMPANY WESTPORT INSURANCE CORPORATION GENERAL POWER OF ATTORNEY KNOW ALL MEN BY THESE PRESENTS,THAT North American Specialty Insurance Company,a corporation duly organized and existing under laws of the State of New Hampshire,and having its principal office in the City of Kansas City,Missouri and Washington International Insurance Company a corporation organized and existing under the laws of the State of New Hampshire and having its principal office in the City of Kansas City,Missouri and Westport Insurance Corporation,or anized under the laws of the State of Missouri,and having its principal offipe in the City of Kansas City,Nssourf,each does hereby make constitute and appoint: JOHN WILLIAM NEWBY,TROY RUSSELL KEY,DEBRA LEE MOON,ANDREA ROSE CRAWFORD,SANDRA LEE RONEY,LINDA MICHELLE STALDER SUZANNE ELIZABETH NMDZWIEDZ,SHERIE MICHELLE GREENOUGH,CHERI LYNN MBY,AND JOSHUA D.-IRITT,JOINTLY OR SEVERALLY Its true and lawful Attorney(s)-in-Fact,to make,execute,seal and deliver,for and on its behalf and as its act and deed,bonds or other writings obligatory in the nature of a bond on behalf of each of said Companies,as surety,on contracts of suretyship as are or may be required or permitted by law,regulation,contract or otherwise,provided that no bond or undertaking or contract or suretyship executed under this authority shall exceed the amount of: TWO HUNDRED MILLION($200,000,000.00)DOLLARS This Power of Attorney is granted and is signed by facsimile under and by the authority of the following Resolutions adopted by the Boards of Directors of North American Specialty Insurance Company and Washington International Insurance Company at meetings duly called and held on March 24,2000 and Westport Insurance Corporation by written consent of its Executive Committee dated July 18,2011. "RESOLVED,that any two of the President,any Senior Vice President,any Vice President,any Assistant Vice President, the Secretary or any Assistant Secretary be,and each or any of them hereby is authorized to execute a Power of Attorney qualifying the attorney named in the given Power of Attorney to execute on behalf of the Company bonds,undertakings and all contracts of surety,and that each or any of them hereby is authorized to attest to the execution of any such Power of Attorney and to attach therein the seal of the Company; and it is FURTHER RESOLVED,that the signature of such officers and the seal of the Company may be affixed to any such Power of Attorney or to any certificate relating thereto by facsimile,and any such Power of Attorney or certificate bearing such facsimile signatures or facsimile seal shall be binding upon the Company when so affixed and in the future with regard to any bond,undertaking or contract of surety to which it is attached." ,,,„rpr rNNry,A \`UptOrUUINNarUir� •ps�tpa {t'fi+, off, aRPoaaJ..�'ys�, B �' �.. SEAL Steven Anderson, error icePresidento a, mgton nternation Insurance Company ~; _— ��iti`� •7�L &Senior Vim President of North America°Specialty Insurance Company &Senior Vice President of Westport Insurance Corporation %0 1973 a • �srr .............. •. ••* I!%ael A.Ito,Senior Vice President of Washington International Insurance ••* ,fi r*n nOtN110a000 &Senior Vice President of Nm1hpAmerican Specialty Insurance Company l &Senior Vice President of Westport Insurance Corporation IN WITNESS WHEREOF,North American Specialty Insurance Company,Washington International Insurance Company and Westport Insurance Corporation have caused their official seals to be hereunto affixed,and these presents to be signed by their authorized officers this this 12th day of FEBRUARY ,20 20 North American Specialty Insurance Company Washington International Insurance Company State of Illinois Westport Insurance Corporation County of Cook ss: On this 12th day of FEBRUARY,20 20,before me,a Notary Public personally appeared Steven P.Anderson ,Senior Vice President of Washington International Insurance Company and Senior Vice President of North American Specialty Insurance Company and Senior Vice President of Westport Insurance Corporation and Michael A.Ito Senior Vice President of Washington International Insurance Company and Senior Vice President of North American Specialty Insurance Company and Senior Vice President of Westport Insurance Corporation,personally known to me,who being by me duly sworn,acknowledged that they signed the above Power of Attorney as officers of and acknowledged said instrument to be the voluntary act and deed of their respective companies. OFFICIALKENNYAL M. ENNY (\; Notary Public-State of Illinois Myc°iziousosi 1"t`Y M.Kenny,Notary Public I, Jeffrey Goldberg , the duly elected Vice President and Assistant Secretary of North American Specialty Insurance Company,Washington International Insurance Company and Westport Insurance Corporation do hereby certify that the above and foregoing is a true and correct copy of a Power of Attorney given by said North American Specialty Insurance Company,Washington International Insurance Company and Westport Insurance Corporation which is still in full force and effect. IN WITNESS WHEREOF,I have set my hand and affixed the seals of the Companies this 22nd day of July 20 20 Jeffrey Goldberg,Vice President&Assistant Secretary of Washington International Insurance Company& North American Specialty Insurance Company&Vice President&Assistant Secretary of Westport insurance Corporation North American Specialty Insurance Company Washington International Insurance Company Westport Insurance Corporation TEXAS CLAIMS INFORMATION IMPORTANT NOTICE ADVISO IMPORTANTE In order to obtain information or make a complaint: Para obtener informacion o para someter un queja: You may contact Jeffrey Goldberg,Vice President Puede comunicarse con Jeffrey Goldberg,Vice - Claims at 1-800-338-0753 President- Claims,al 1-800-338-0753 You may call Washington International Insurance Usted puede Ilamr al numero de telefono gratis de Company and/or North American Specialty Insurance Washington International Insurance Company and/or Company's and/or Westport Insurance Corporation North American Specialty Insurance Company's and/or toll-free number for information or to make a Westport Insurance Corporation para informacion o complaint at: para someter una queja al: 1-800-338-0753 1-800-338-0753 You may also write to Washington International Usted tambien puede escribir a Washington Insurance Company and/or North American Specialty International Insurance Company and/or North Insurance Company and/or Westport Insurance American Specialty Insurance Company and/or Corporation at the following address: Westport Insurance Corporation al: 1200 Main Street 1200 Main Street Suite 800 Suite 800 Kansas City,MO 64105 Kansas City,MO 64105 You may contact the Texas Department of Insurance Puede escribir al Departmento de Seguros de Texas to obtain information on companies, coverages, para obtener informacion acerca de companias, rights or complaints at: coberturas,derechos o quejas al: 1-800-252-3439 1-800-252-3439 You may write the Texas Department of Insurance: Puede escribir al Departmento 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: htto://www.tdi.state.tx.us Web: httn:/Zvvv4w.tdm.state.tx.us Email:ConsumerProtection@tdi.state.tx.us Email:ConsumerProtection@tdi.state.tx.us 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 first contact the reclamo, debe comunicarse con el Washington Washington International Insurance Company and/or International Insurance Company and/or North North American Specialty Insurance Company and/or American Specialty Insurance Company and/or Westport Insurance Corporation. If the dispute is not Westport Insurance Corporation primero. Si no se resolved,you may contact the Texas Department of resuelve la disputa, puede entonces comunicarse Insurance. con el Departmento de Seguros de Texas. ATTACH THIS NOTICE TO YOUR POLICY: UNA ESTE AVISO A SU POLIZA This notice is for information only and does not Este aviso es solo para proposito de infromacion y no become a part or condition of the attached se convene en parte o condicion del documento document. adjunto.