Loading...
HomeMy WebLinkAboutContract 56385-FP1 City Secretary 56385 -FP1 Contract No. FORT WORTH., Date Received Au gust 25,2022 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: Lovett Alliance City Project No.: 103472 Improvement Type(s): Water ❑x Sewer ❑x Original Contract Price: $438,824.60 Amount of Approved Change Order(s): Revised Contract Amount: Total Cost of Work Complete: $438,824.60 Tus-1-in Murchison Aug 24, 2022 Justin Murchison(Aug 24,202210:10 CDT) Contractor Date Rumsey Construction, LLC Title Project Manager Company Name Fabian Diaz(Au�2210:11CDT) Aug 24, 2022 Project Inspector Date ,2!U L,4hlkan,' �Iz5 Aug 24, 2022 Sandip Ad Kikarl,P.E.(Aug 24,202222:35 CDT) Project Manager Date wue-sc��� Aug 24, 2022 �i�����r-lpt+��������ig?4�n����7 C r)T) CFA Manager Date /--/0— Aug 25,2022 Interim TPW Director Date Wj(Aug 25,2022167 Twj(Aug 25, T CDT) Aug 25, 2022 Asst. City Manager Date OFFICIAL RECORD CITY SECRETARY FT.WORTH, TX Page 1 of 2 Notice of Project Completion Project Name: Lovett Alliance City Project No.: 103472 City's Attachments Final Pay Estimate ❑x Change Order(s): ❑x Yes ❑ N/A Pipe Report: ❑x Yes ❑ N/A Contractor's Attachments Affidavit of Bills Paid Consent of Surety Statement of Contract Time Contract Time: 120 WD Days Charged: 158 Work Start Date 12/6/2021 Work Complete Date: 8/9/2022 Soil Lab Number of Tests 203 Water Number of Tests: 18 Page 2 of 2 FORT WORTH CITY OF FORT WORTH FINAL PAYMENT REQUEST Contract Name LOVETTALLIANCE Contract Limits Project Type WATER&SEWER City Project Numbers 103472 DOE Number 3472 Estimate Number 1 Payment Number l Foi-Period Ending 8/16/2022 WD City Secretary Contract Number Contract Time 12WD Contract Date 10/7/2021 Days Charged to Date 158 Project Manager NA Contract is 100.00 Complete I Contractor RUMSEY CONSTRUCTION,LLC 6617 VILLAGE SPRINGS DRIVE PLANO, TX 75024 Inspectors MILLER,W / DIAZ,P Wednesday,Augusl 17,2022 Page I of 5 City Project Numbers 103,172 DOE Number 3472 Contract Name LOVETf ALLIANCE Estimate Number I Contract Limits Payment Number I Project Type WATER&SEWER For Period Ending 8/16/2022 Project Funding UNIT I:WATER IMPROVEMENT'S Item Description of Items Estimated Unit Unit Cost Estimated Completed Completed No. Quanity Total Quanity Total I BLOCK SOD PLACEMENT 1121 LF $3.60 $4,035.60 1121 $4,035.60 2 TRENCH SAFETY 3490 TN $1.00 $3,490.00 3490 $3,490.00 3 DUCTILE IRON WATER FITTINGS 6.38 LF $2,500.00 $15,950.00 6.38 $15,950.00 W/RESTRAINT 4 8"PVC WATER PIPE 34 LF $38.00 $1,292.00 34 $1,292.00 5 10"PVC WATER PIPE 79 LF $49.00 $3,871.00 79 $3,871.00 6 12"WATER PIPE,CSS BACKFILL 80 LF $83.00 $6,640.00 80 $6,640.00 7 12"WATER PIPE,CLSM BACKFILL 7 LF $100.00 $700.00 7 $700.00 8 12"PVC WATER PIPE 3290 EA $62.00 $203,980.00 3290 $203,980.00 9 FIRE HYDRANT 5 EA $5,274.00 $26,370.00 5 $26,370.00 10 CONNECTION TO EXISTING 4"-12"WATER 1 EA $1,362.00 $1,362.00 1 $1,362.00 MAIN I 1 1/2"WATER SERVICE 0 EA $1,346.00 $0.00 0 $0.00 12 2"WATER SERVICE 2 EA $2,656.00 $5,312,00 2 $5,312.00 13 8"GATE VALVE I EA $1,336.00 $1,336.00 1 $1,336.00 14 10"GATE VALVE 2 EA $1,974.00 $3,948.00 2 $3,948.00 15 12"GATE VALVE 10 EA $2,465.00 $24,650.00 10 $24,650.00 16 2"WATER SERVICE(IRRIGATION) 2 EA $1,346.00 $2,692.00 2 $2,692.00 Sub-Total of Previous Unit $305,628.60 $305,628.60 UNIT II:SANITARY SEWER IMPROVEMENTS Item Estimated Estimated Completed Completed Description of Items Unit Unit Cost No. Quanity Total Quanity Total - --- ----- --- --------------------------- REMOVE 8"SEWER LINE 764 LF $13.00 $9,932.00 764 $9,932.00 2 REMOVE 4'SEWER MANHOLE 2 EA $1,500.00 $3,000.00 2 $3,000.00 3 POST-CCTV INSPECTION 940 LF $2.00 $1,880.00 940 $1,880.00 4 MANHOLE VACUUM TESTING 3 EA $150.00 $450.00 3 $450.00 5 BYPASS PUMPING 1 LS $30,000.00 $30,000.00 1 $30,000.00 6 6"SEWER SERVICE I EA $2,000.00 $2,000.00 1 $2,000.00 7 8"SEWER SERVICE I EA $2,500.00 $2,500.00 1 $2,500.00 8 8"SEWER PIPE 940 LF $37.00 $34,780.00 940 $34,780.00 9 EPDXY MANHOLE LINER 19 VF $450.00 $8,550.00 19 $8,550.00 Wednesday,August 17,2022 Page 2 of 5 City Project Numbers 103472 DOE Number 3472 Contract Name LOVETT ALLIANCE Estimate Number I Contract Limits Payment Number Project Type WATER&SEWER For Period Ending 8/16/2022 Project Funding 10 4'MANHOLE I EA $7,095.00 $7,095.00 1 $7,095.00 It 4'DROP MANHOLE 1 EA $13,069.00 $13,069.00 1 $13,069.00 12 4'EXTRA DEPTH MANHOLE 19 VF $1,000.00 $19,000.00 19 $19,000.00 13 TRENCH SAFETY 940 LF $1.00 $940.00 940 $940.00 -------------------------------------- Sub-Total of Previous Unit $133,196.00 $133,196.00 -------------------------------------- Wednesday,August 17,2022 Page 3 of 5 City Project Numbers 103472 DOE Nunnber 3,172 Contract Name LOVE'rT ALLIANCE Estimate Number 1 Contract Limits Payment Number I Project Type WATER&SEWER For Period Ending 8/16/2022 Project Funding Contract Information Siunmar Original Contract Amount $438,824.60 Chanl4e Orders Total Contract Price $438,824.60 Total Cost of Work Completed $438,824.60 Less %Retained $0.00 Net Earned $438,824.60 Earned This Period $438,824.60 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 $438,824.60 Wednesday,August 17,2022 Page 4 of 5 i City Project Numbers 103472 DOE Number 3472 Contract Name LOVETT ALLIANCE Estimate Number I Contract Limits Payment Number I Project Type WATER&SEWER For Period Ending 8/16/2022 Project Funding Project Manager NA City Secretary Contract Number Inspectors MILLER,W / DIAZ,F Contact Date 10/7/2021 Contactor RUMSEY CONSTRUCTION,LLC Contract Time 120 WD 6617 VILLAGE SPRINGS DRIVE Days Charged to Date 158 WD PLANO, TX 75024 Contact is .000000 Complete CITY OF FORT WORTH SUMMARY OF CHARGES Line Fund Account Center Amount Gross Retainage Net Funded Total Cost of Work Completed $438,824.60 Less %Retained $0.00 Net Earned $438,824.60 Earned This Period $438,824.60 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 1Vlaterial on Hand Less 15% $0.00 Balance Due This Payment $438,824.60 Wednesday,August 17,2022 Page 5 of 5 FORTWORTH TRANSPORTATION AND PUBLIC WORKS PIPE REPORT FOR: PROJECT NAME: Lovett Alliance CITY PROJECT NUMBER: 103472 WATER PIPE LAID SIZE TYPE OF PIPE LF 8"PVC water pipe 8" PVC 34LF 10"PVC water pipe 10" PVC 79LF 12"PVC water pipe 12" PVC 3377LF FIRE HYDRANTS: 5 VALVES(16" OR LARGER) PIPE ABANDONED SIZE TYPE OF PIPE LF DENSITIES: All passed NEW SERVICES: 2"irrigation copper 8 2"domestic copper 8 SEWER PIPE LAID SIZE TYPE OF PIPE LF 8"sewer pipe 8" PVC 940LF PIPE ABANDONED SIZE TYPE OF PIPE LF DENSITIES: All services passed NEW SERVICES: 6"Sewer Service PVC 80 8"Sewer Service PVC 100 TRANSPORTATION AND PUBLIC WORKS The City of Fort Wortli• 1000 Throckmorton Street•Fort Worth,T176012-6311 (817)392-7941 •Fax:(817)392-7845 o C Ozo m m a � cc Z+ o O rn �� D p p o o - m cn y m m *k t -� m o a < < o o 9 0 o c, n -nj 0 O a O -4 O n -I Zi � D O `_' -1 z o o ma O o ai m D n D D -1 y o CO Z Z D m CO = m > m Z T Q m D Z m m D 00 c m m O 0 p X W -' j G r C w w w IOn N o p�9 < O o w o o ^" m N to m o m m f° O N 0 Wo al m of CD a D W o 0 0 0 P n :q �- CY N Z O o c 0 v E o n < a w m m 0 O v f N O " m m \� O m W W W N 00 j W W T O (J7 C>C VIA m m T T n o n A =F = 0 0 rn 0 0 0 0 < (D (D p z z D Q 4; o o C- oo n J to 6n d o 0 0 n D C7 ty o o 0 _ i o D a n Z z 07 0 ^ o A n o Z Go 00 (�J n o n o o � w n) mp z N m o o n 0 vA co N m N N N Z ;o O 00 -P, a0 O N 0 < v v (A Tm 0 0 0 0 0 � � A o a o D n O ZOj C) 0 0 m O = mz 0 o p z G) en o m a c a o a N In O O O (n O O A m o o r O O 2 o a O 0 o O 0 n O Iwo 0 ID I f \ 3 U) § - 2 ) \ ;u 0) > z \mm K $ z = � ID \ \ e ( cu S 2 m m0 t ° � k A § ) e \ ) / { � \ C e ® \ 3 \ 0 k § \ � \ • g z ± o & ziQ \ m § P Q � m ) w § \ 5 a m % -J mmy \ % ¥ § > > Ez > m § 14, m m ` K o ) � ~ 4 7 2 » \ \ ? m ~ 4 o ) / • , ) ®o $ � / § CD % mm ° & 5 % ® mz } - g k � � / �\ j m \ co � ( 0 CD & az q e z / z > ) n\ # o = J o � § / S g m CL E § / y j emc/ _ = o Leo S 0) § Gm � (j ) FORT WORTH. TRANSPORTATION AND PUBLIC WORKS August 16, 2022 Rumsey Construction 4329 Reeder Dr Carrollton,TX,75010 RE: Acceptance Letter Project Name: Lovett Alliance Project Type:Water And Sewer City Project No.: 103472 To Whom It May Concern: On August 16,2022 a final inspection was made on the subject project. There were no punch list items identified at that time. The final inspection indicates that the work meets the City of Fort Worth specifications and is therefore accepted by the City. The warranty period will start on August 16, 2022, which is the date of the final inspection 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- 392-8424. Sincerely, Sandip Ad Kikari,P.E.(Aug 24,202222:35 CDT) Sandip Adhikari, Project Manager Cc: Fabian Diaz, Inspector Donald Watson, Inspection Supervisor Joseph Rogers,Senior Inspector Victory.Tornero Jr, Program Manager Kimley Horn and Associates, Consultant Rusey Construction, Contractor Magnolia Pads LTD, Developer File E-Mail: TPW_Acceptance@fortworthtexas.gov Rev.08/20/19 I AFFIDAVIT STATE OF TEXAS COUNTY OF DENTON Before me,the undersigned authority, a notary public in the state and county aforesaid, on this day personally appeared Gary Wells, COO Of Rumsey 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; 103472 Lovett Alliance BY Z11,5 Gary Wells, COO Subscribed and sworn before me on this date 23 of August, 2022. �``OV111''� Notary Public RHONDA ESCOBAR cr; ,c_Notary Public,State of Texas Denton,TX "4 Comm. Expires 05-14-2024 Notary ID 132478255 0062 19-1 MAINTENANCE BOND Page I of 3 Bond No. 54-240159 1 SECTION 00 62 19 2 MAINTENANCE BOND 3 4 THE STATE OF TEXAS § KNOW ALL BY THESE PRESENTS: 5 6 COUNTY OF TARRANT § known as 7 That we Rumsey Construction,Inc. 8 "Principal"herein and United Fire&Casualty Company ,a corporate surety 9 (sureties, if more than one)duly authorized to do business in the State of Texas,known as 10 "Surety"herein(whether one or more),are held and firmly bound unto the Developer,Magnolia 11 Pads LTD,authorized to do business in Texas("Developer")and the City of Fort Worth,a Texas 12 municipal corporation("City"),in the sum of FOUR HUNDRED THIRTY EIGHT 13 THOUSAND EIGHT HUNDRED TWENTY FOUR DOLLARS AND 60/100 DOLLARS 14 ($438,824.60),lawful money of the United States,to be paid in Fort Worth,Tarrant County, 15 Texas,for payment of which sum well and truly be made jointly unto the Developer and the City 16 as dual obligees and their successors,we bind ourselves,our heirs,executors,administrators, 17 successors and assigns,jointly and severally,firmly by these presents. 18 19 WHEREAS, Developer and City have entered into an Agreement for the construction of 20 community facilities in the City of Fort Worth by and through a Community Facilities 21 Agreement,CFA Number 21-0100 ;and 22 WHEREAS,the Principal has entered into a certain written contract with the Developer 23 awarded the 7tl, day of October ,20 21 ,which Contract is 24 hereby referred to and a made part hereof for all purposes as if frilly set forth herein,to furnish all 25 materials,equipment labor and other accessories as defined by law, in the prosecution of the 26 Work,including any Work resulting from a duly authorized Change Order(collectively herein, 27 the"Work")as provided for in said Contract and designated as Lovett Alliance;and 28 29 WHEREAS,Principal binds itself to use such materials and to so construct the Work in 30 accordance with the plans,specifications and Contract Documents that the Work is and will 31 remain free from defects in materials or workmanship for and during the period of two(2)years 32 after the date of Final Acceptance of the Work by the City("Maintenance Period");and 33 CITY OF FORT WORTH IVA TER AND SEWER IMPROVENIEWN7S TO SERVE LOVETTALLIANCF. STANDARD CITY CONDITIONS—DEVELOPER AWARDED PROJECTS City Project No. 103472 Revised January 31,2012 006219-2 MAINTENANCE BOND Page 2 of 3 1 WHEREAS,Principal binds itself to repair or reconstruct the Work in whole or in part 2 upon receiving notice from the Developer and/or City of the need thereof at any time within the 3 Maintenance Period. 4 5 NOW THEREFORE, the condition of this obligation is such that if Principal shall 6 remedy any defective Work,for which timely notice was provided by Developer or City,to a 7 completion satisfactory to the City,then this obligation shall become mill and void;otherwise to 8 remain in Rill force and effect. 9 10 PROVIDED,HOWEVER, if Principal shall fail so to repair or reconstruct any timely 11 noticed defective Work,it is agreed that the Developer or City may cause any and all such 12 defective Work to be repaired and/or reconstructed with all associated costs thereof being borne 13 by the Principal and the Surety under this Maintenance Bond; and 14 15 PROVIDED FURTHER,that if any legal action be filed on this Bond,venue shall lie in 16 Tarrant County,Texas or the United States District Court for the Northern District of Texas,Fort 17 Worth Division; and 18 19 PROVIDED FURTHER,that this obligation shall be continuous in nature and 20 successive recoveries may be had hereon for successive breaches. 21 22 23 CITY OF FORT WORTH WATER AND SEWER IMPROVEMEWNTS TO SERVE LOVETT ALLIANCE STANDARD CiTY CONDITIONS—DEVELOPER AWARDED PROJECTS City Project No. 103472 Revised January 31,2012 006219-3 MAINTENANCE BOND Page 3 of 3 I IN WITNESS WHEREOF,the Principal and the Surety have each SIGNED and SEALED this 2 instrument by duly authorized agents and officers on this the 12th day of 3 October ,2021 4 PRINCIPAL: 5 Rumsey Construction,Inc. 6 7 8 BY: 9 Si atur 10 11 ATTEST: 12 lvoe 13 Name and Title 14 (Principal)Secretary 15 4329 Reeder Drive 16 Address: Carrollton,TX 75010 17 18 19 20 Witness as to Principal 21 SURETY: United Fire&Casualty Company 22 23 24 2 BY: 5 ignature 26 2 27 Allyson Dean-West, ttorney-in-fact 28 Name and Title 29 ATTEST: 30 118 Second Ave.,SE 31 Address: Cedar Rapids,IA 52401 32 )Secreta 33 34 800 332 7977 35 Witness as to trety Telephone Number: 36 37 *Note: If signed by an officer of the Surety Company,there must be on file a certified extract 38 from the by-laws showing that this person has authority to sign such obligation. If 39 Surety's physical address is different from its mailing address,both must be provided. 40 41 The date of the bond shall not be prior to the date the Contract is awarded. 42 CITY OF FORT W ORTH WATER AND SEWER IMPROVEMEIVArTS TD SERVE LOVETT ALLIANCE STANDARD CITY CONDITIONS—DEVELOPER AWARDED PROJECTS City Project No. 103472 Revised January 31,2012 UNITED FIRE&CASUALTY COMPANY,CEDAR RAPIDS,IA Inquiries: Surety Department UNITED FIRE&INDEMNTIY COMPANY,WEBSTER,TX 118 Second Ave SE FINANCIAL PACIFIC INSURANCE COMPANY,ROCKLiN,CA Cedar Rapids,IA 52401 CERTIFIED COPY OF POWER OF A-ITORNEY INSURANCE (original on file at Home Office of Company-See Certification) KNOW ALL PERSONS BY THESE PRESENTS,That United Fire&Casualty Company,a corporation duly organized and existing under the laws of die State of Iowa; United Fire& Indemnity Company, a corporation duly organized and existing tinder the laws of the State of Texas; and Financial Pack Insurance Company,it corporation duly organized and existuig tinder the laws of the State of California(herein collectively called the Companies),and having their corporate headquarters in Cedar Rapids,State of Iowa,does make,constitute and appoint ALLYSON DEAN-WEST, EVA 0. LIMMER, EMILY MIKESKA, JOHN R. WARD, THOMAS DOUGLAS MOORE, MONICA VEAZEY, EACH INDIVIDUALLY dueil-true and lawful Altotney(s)-hi-Fact with power and authority hereby conferred to sign, seal and execute in its behalf ail lawful bonds, undertakings mid other obligatory instruments of similar nature provided that no single obligation shall exceed $100,000,000.00 and to bind the Companies thereby as filly and to the smite extent as if such instruments were signed by the duly authorized officers of the Companies and all of the acts of said Attorney,pursuant to the authority hereby given and hereby ratified and confirmed. Tine Authority hereby granted is continuous and shall remain in full force and effect until revoked by United Fire&Casualty Company,United Fire& indemnity Company,and Financial Pacific Imurance Company. This Power of Attorney is made and executed pursuant to and by authority of the following bylaw duly adopted on May 15,2013,by the Boards of Directors of United Fire&Casualty Company,United Fire&indemnity Company,and Financial Pacific insurance Company. "Article VI—Surety Bonds and ltndertakings" Section 2,Appointment of Attomcy-in-Fact. "The President or any Vice President,or may other officer of the Companies may,from time to time,appoint by written certificates attomeys-in-fact to act in behalf of the Companies in the execution of policies of insurance,bonds,undertakings and other obligatory instruments of like nature. The signature of arty officer authorized hereby,and the Corporate seal,may be affixed by facsimile to jury paver of atiomcy or special power of attorney or certification of either authorized hereby; such signature and seal,when so used,being adopted by the Companies ac the original signature of such officer and the original seal of tbv Companies,to be valid and binding upon the Companies with the same force and effect as though inantwlly aftixvd. Such attorneys-in-fact,subject to the limitations set of forth in their respective certificate:of authority shall have full power to hind the Companies by their signature and execution of any such instruments and to attach the seal the Companies thereto. The President or any Vice president,the Board of Directors or any other officer of the Companies may ut any time revoke all power turd authority proviowly given to any attorney-in-fact. IN WITNESS WHEREOF.die COMPANIES have each caused these presents to be signed by its p��caiirti�ry� �poyii;oie"i', �,, � IN �nn ' corporate ." , su vice president aril its co orate seal to be hereto affixed this22nd day of July, 2021 a• Pt' n+s ?k coaroxnrc�' s e�coaroxnrc°$% UNITED FIRE&CA SUAL TY COMPANY E UNITED FIRE&NDEMNITY COMPANY SEAL .<� SFAL � yy-•,(> P.•'2i s c• �. e "-y'••<. c '`.: FINANCIAL PACIFIC INSURANCE COMPANY 'rrr'ipnUurrvrnm,�\``• Q� BY: State of Iowa,County of Linn,s: Vice President On 22nd day of July, 2021, before me personally came Dennis J. Richmann to me known,who being by the duly sworn,did depose and say;that he resides in Cedar Rapids,Slate of Iowa;lint lie is a Vice President of United Fire & Casualty Company, a Vice President of United Fire & Indemnity Company, mid a Vice President of Financial Pacific Insurance Company the corporations described in acid which executed the above instrument; that lie knows the seal of said corporations-, that the seal affixed to the said instrument is such corporate seal;that it was so affixed pursuant to authority given by the Board of Directors of said cor ixirations mud that be signed his name thereto pursuant to like authority,and acknowledges same to be the act and deed of said corporations. r r Patti Waddell Iowa Notarial Seal • Commission number 713274 Notary Public Orr. *Commission Expires 10/26/2022 My commission expires: I0/2G/2022 I,Mary A.Bertsch,Assistant Secretary of United Fire&Casualty Company and Assistant Secretory of United Fire&Indemnity Company,and Assistant Secretary of Financial Pacific Insurance Company,do hereby certify that I have compared the foregoing copy of the Power of Attorney and affidavit,mud the copy of the Section of the bylaws and resolutions of said Corporations as set forth in said Power of Attorney,with the ORIGINALS ON FILE IN THE HOME OFFICE OF SAID CORPORATIONS,and that the same are correct transcripts thereof,and of the whole of the said originals,and that the said Power of Attorney has not been revoked aid is now in frill force aid effect. In testimony whereof I have ereunto subscribed my name and affixed die corporate seal of the said Corporations this_I 2 day of fy" , 2 cl: u'a ^`:•�`nULY 2����0`- _. -.- - By: A comiom-m oapbam ter— g im =7' lgno Tor SPAT. �``� r'•�(lFOPN+ <.= Assistant Secretary, nrr�� �� ��"'iigliul�ia ''rrrrumnnoa"r OF&C&CIF&r&FDIC �1111.m BPOA0049 1217 e United Fire&Casualty Company United Fire&Indemnity Company Financial Pacific Insurance CompanySURE IMPORTANT NOTICE TO OBTAIN INFORMATION OR MAKE A COMPLAINT: You may call United Fire Group's toll free telephone number for information or to make a complaint at: 800-343-9130 You may also write to United Fire Group at: United Fire Group Attn: Surety Department P.O.Box 73909 Cedar Rapids,IA 52407-3909 -or street address- United Fire Group Attn: Surety Department 118 Second Avenue SE Cedar Rapids,IA 52401 You may contact the Texas Department of Insurance to obtain information on companies,coverages, rights or complaints at: 800-252-3439 You may write the Texas Department of Insurance at: Consumer Protection(I I I-IA) P.O. Box 149091 Austin,TX 78714-99091 Fax: (512)490-1007 Web:www.tdi.texas.gov Email: ConsumerProtection@tdi.texas.aov Premium or Claim Disputes: Should you have a dispute concerning your premium or about a claim,you should contact United Fire Group first. If the dispute is not resolved,you may contact the Texas Department of Insurance. ATTACH THIS NOTICE TO YOUR BOND. This notice is for information only and does not become a part or a condition of the attached document and is given to comply with Section 2253.021, Governmental Code,and Section 53-202,Property Code. HOME OFFICE:118 Second Avenue SE I PO Box 73909 I Cedar Rapids,Iowa 52407-3909 1 P:800-332-7977 I F:319-286-2520 I www.ufgins.com