HomeMy WebLinkAboutContract 57676-FP1FORT WORTH.
City Secretary
-FP1
Contract No. 57676
Date Received 05/18/2023
AT
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: Liberty Trails Phase 5
City Project No: 103678
Improvement Type(s): Water x❑
Original Contract Price:
Amount of Approved Change Order(s):
Revised Contract Amount:
Total Cost of Work Complete:
kbekt 6;-vU
tees Albert GranWav 18. 2 3 09:38 CDT)
Contractor
Vice President
Title
Burnsco Construction Inc
Company Name
Fabian Diaz ",lay 18, 2023 10:49 CDT)
Project Inspector
C
Project Manager
��.
Rvharr,i nI :111 P Owen fM,iv l R. 2073 15 _34 MITI
CFA Manager
TPW Director
Asst. City Manager
Sewer x❑
May 18, 2023
Date
May 18, 2023
Date
May 18, 2023
Date
May 18, 2023
Date
May 18, 2023
Date
May 19, 2023
Date
$1,253,766.70
$5,880.00
$1,259,646.70
$1,259,646.70
OFFICIAL RECORD
CITY SECRETARY
FT. WORTH, TX
Page 1 of 2
Notice of Project Completion
Project Name: Liberty Trails Phase 5
City Project No.: 103678
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 H
Statement of Contract Time
Contract Time 80 WD
Days Charged: 142
Work Start Date: 9/6/2022 Work Complete Date: 5/8/2023
Soil Lab Number of Tests: 269
Water Number of Tests: 12
Page 2of2
FoRTWORTH
CITY OF FORT WORTH
FINAL PAYMENT REQUEST
Contract Name LIBERTY TRAILS PHASE 5
Contract Limits
Project Type WATER & SEWER IMRPOVEMENTS
City Project Numbers 103678
DOE Number 6780
Estimate Number 1 Payment Number 1 For Period Ending 5/16/2023
WD
City Secretary Contract Number Contract Time 8WD
Contract Date 5/12/2022 Days Charged to Date 142
Project Manager NA Contract is 100.00 Complete
Contractor BURNSCO CONSTRUCTION, INC.
6331 SOUTHWEST BLVD
FORT WORTH, TX 76132
Inspectors WATSON / DIAZ-AGUINAG
Tuesday, May 16, 2023 Page 1 of 5
City Project Numbers 103678
Contract Name LIBERTY TRAILS PHASE 5
Contract Limits
Project Type WATER & SEWER IMRPOVEMENTS
Project Funding
UNIT I WATER IMPROVEMENTS
DOE Number 6780
Estimate Number 1
Payment Number 1
For Period Ending 5/16/2023
Item
Description of Items
Estimated Unit
Unit Cost
Estimated
Completed
Completed
No.
Quanity
Total
Quanity
Total
1
TRENCH SAFETY
5546 LF
$0.10
$554.60
5546
$554.60
2
DUCTILE IRON WATER FITTING W/ RESTRAINT
5.53 TN
$5,600.00
$30,968.00
5.53
$30,968.00
3
8" PVC WATER PIPE
4574 LF
$58.00
$265,292.00
4574
$265,292.00
4
12" WATER PIPE
925 LF
$108.00
$99,900.00
925
$99,900.00
5
12" DIP WATER
47 LF
$131.00
$6,157.00
47
$6,157.00
6
24" CASING BY OPEN CUT
35 LF
$230.00
$8,050.00
35
$8,050.00
7
FIRE HYDRANT
6 EA
$5,800.00
$34,800.00
6
$34,800.00
8
1" WATER SERVICE
144 EA
$1,250.00
$180,000.00
144
$180,000.00
9
8" GATE VALVE
15 EA
$1,820.00
$27,300.00
15
$27,300.00
10
12" GATE VALVE
2 EA
$3,150.00
$6,300.00
2
$6,300.00
11
CONNCECTION TO EXISTING 4"-12" WATER
4 EA
$900.00
$3,600.00
4
$3,600.00
MAIN
12
AUTOMATIC FLUSHING DEVICE
4 EA
$8,100.00
$32,400.00
4
$32,400.00
13
1 1/2" WATER SERVICE (CO #1)
3 EA
$1,960.00
$5,880.00
3
$5,880.00
Sub -Total of Previous Unit
$701,201.60
$701,201.60
--------------------------
UNIT R SEWER IMPROVEMENTS
Item
Description of Items
Estimated Unit
Unit Cost
Estimated
Completed
Completed
No.
Quanity
Total
Quanity
Total
1
POST -CCTV INSPECTION
4637 LF
$3.50
$16,229.50
4637
$16,229.50
2
MANHOLE VACUUM TESTING
21 EA
$125.00
$2,625.00
21
$2,625.00
3
TRENCH SAFETY
4637 EA
$1.00
$4,637.00
4637
$4,637.00
4
TRENCH WATER STOPS
12 EA
$425.00
$5,100.00
12
$5,100.00
5
4" SEWER SERVICE
144 EA
$1,040.00
$149,760.00
144
$149,760.00
6
8" SEWER PIPE
3887 LF
$56.60
$220,004.20
3887
$220,004.20
7
8" SEWER PIPE,CSS BACKFILL
220 LF
$93.00
$20,460.00
220
$20,460.00
8
10" SEWER PIPE
450 LF
$68.00
$30,600.00
450
$30,600.00
9
10"SEWER PIPE, CSS BACKFILL
80 LF
$107.00
$8,560.00
80
$8,560.00
10
4' MANHOLE
21 EA
$3,830.00
$80,430.00
21
$80,430.00
11
4'EXTRA DEPTH MANHOLE
56.33 VF
$180.00
$10,139.40
56.33
$10,139.40
12
20" CASING BY OPEN CUT
45 LF
$220.00
$9,900.00
45
$9,900.00
Tuesday, May 16, 2023
Page 2 of 5
City Project Numbers 103678 DOE Number 6780
Contract Name LIBERTY TRAILS PHASE 5 Estimate Number 1
Contract Limits Payment Number 1
Project Type WATER & SEWER IMPROVMENTS For Period Ending 5/16/2023
Project Funding
Sub -Total of Previous Unit $558,445.10 $558,445.10
Tuesday, May 16, 2023 Page 3 of 5
City Project Numbers 103678
Contract Name LIBERTY TRAILS PHASE 5
Contract Limits
Project Type WATER & SEWER IMPROVMENTS
Project Funding
Contract Information Summary
Original Contract Amount
Chanhe Orders
Change Order Number 1
DOE Number 6780
Estimate Number 1
Payment Number 1
For Period Ending 5/16/2023
$1,253,766.70
$5,880.00
Total Contract Price $1,259,646.70
Total Cost of Work Completed $1,259,646.70
Less % Retained $0.00
Net Earned $1,259,646.70
Earned This Period $1,259,646.70
Retainage This Period $0.00
Less Liquidated Damages
Days @ / Day
LessPavement Deficiency
Less Penalty
Less Previous Payment
Plus Material on Hand Less 15%
Balance Due This Payment
$0.00
$0.00
$0.00
$0.00
$0.00
$1,259,646.70
Tuesday, May 16, 2023 Page 4 of 5
City Project Numbers 103678
Contract Name LIBERTY TRAILS PHASE 5
Contract Limits
Project Type WATER & SEWER IMPROVMENTS
Project Funding
Project Manager NA
Inspectors WATSON / DIAZ-AGUINAG
Contractor BURNSCO CONSTRUCTION, INC.
6331 SOUTHWEST BLVD
FORT WORTH, TX 76132
DOE Number 6780
Estimate Number 1
Payment Number 1
For Period Ending 5/16/2023
City Secretary Contract Number
Contract Date
5/12/2022
Contract Time
80 WD
Days Charged to Date
142 WD
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 $1,259,646.70
Less % Retained $0.00
Net Earned $1,259,646.70
Earned This Period $1,259,646.70
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
$1,259,646.70
Tuesday, May 16, 2023 Page 5 of 5
PROJECT NAME:
(CONTRACT:
ICFA #
ICITY PROJECT #
IIPRC #
IFID #
IX FILE #
IFILE #
INSPECTOR:
PROJECT MANAGER:
IORIGINAL CONTRACT
IEXTRAS TO DATE
ICREDITS TO DATE
ICONTRACTTO DATE
(AMOUNT OF PROP. CHANGE ORDER
IREVISED CONTRACT AMOUNT
TOTAL REVISED CONTRACT AMOUNT
PER UNIT
REVISED COST SHARE
TOTAL REVISED CONTRACT
REVIEWED
By Kiran Konduru at 12:03 pm, Aug 19, 2022
DEVELOPER -AWARDED -PROJECT CHANGE ORDER
Liberty Trails, Phase 5
Water, Sewer, & Drainage Improvements
CFA22-0029 CITY PARTICIPATION
103678
IPRC22-0029
30114-0200431-103678-EO7685
x-27246
w-2818
Fabian Diaz Phone No
Kiran Konduru Phone No
WATER SEWER
Developer Developer
Cost City Cost Cost City Cost
$695,321.60 $558,445.10
$695,321.60 $0.00 $558,445.10 $0.00
$ 5,880.00
$701,201.60 $0.00 $558,445.10 $0.00
$701,201.60 $558,445.10
Dev. Cost: $1,679,232.70
NO
817-223-2248
817-392-2237
CHANGE
ORDER No:
1
CONTRACT UNIT
PAVING DRAINAGE STREET LIGHTS
Developer
Developer Cost City Cost Developer Cost City Cost Cost City Cost
$419,586.00
$0.00 $0.00 $419,586.00 $0.00 $0.00 $0.00
$0.00 $0.00 $419,586.00 $0.00 $0.00 $0.00
$0.00 $419,586.00 $0.00
City Cost: $0.00
$1,679,232.70
CONTRACT
DAYS
100
100
100
Revised: 10-12-2011 Page 1
You are directed to make the following changes in the contract documents:
CITY BID ITEM
PAY ITEM # # QUANTITY UNIT
13' 3312.2103 3 EA
TOTAL
REASONS FOR CHANGE ORDER Future development requires three 1.5" irrigation meters to be placed.
REVIEWED
By Kiran Konduru at 12:03 pm, Aug 19, 2022
ITEM DESCRIPTION
1 1/2" Water Service
UNIT PRICE TOTAL
$ 1,960.00 $ 5,880.00
$ 5,880.00
NO CITY FUNDS INVOLVED IN THIS CONTRACT, DEVELOPER IS RESPONSIBLE FOR 1001 OF THE CHANGE ORDER COST AND NO
REIMBURSEMENT FROM THE CITY WILL BE SOUGHT BY THE DEVELOPER.
RECOMMENDED_
By: �a�De-Daw5onEqcoilneers.lil
Name:
Idle Se for Project Manage
APPROVED:
By: ORH-HWY 114. LLC i
Title: i�L'i1Lj7 vim' 1
APPROVED:
By: Sure Cbt st�ypUon. Irtc.
Name:
Tale: Vice President
Revised: 10-12-2011 Page 2
FORT WORTH,
TRANSPORTATION AND PUBLIC WORKS
PIPE REPORT FOR:
PROJECT NAME: Libert Trails Phase 5
CITY PROJECT NUMBER: 103678
WATER
PIPE LAID SIZE TYPE OF PIPE
8" PVC Water Pipe 8" PVC
12" Water pipe 12" PVC
12" DIP Pipe 12" DIP
FIRE HYDRANTS: 6
PIPE ABANDONED
DENSITIES:
NEW SERVICES:
I
PIPE LAID
8" Sewer Pipe
10" Sewer Pipe
PIPE ABANDONED
DENSITIES:
NEW SERVICES:
VALVES (16" OR LARGER)
SIZE TYPE OF PIPE
All densities Passed
1" Water Service
1.5" IRR
SEWER
SIZE TYPE OF PIPE
8" PVC
10" PVC
SIZE TYPE OF PIPE
All Densities Passed
4" Sewer Service
TRANSPORTATION AND PUBLIC WORKS
The City of Fort Worth • 1000 Throckmorton Street • Fort Worth, TX 76012-6311
(817) 392 - 7941 • Fax: (817) 392 - 7845
LF
4574
925
47
LF
144 EA
3 EA
LF
4107
530
LF
144 EA
FORTWORTH.
M,
TRANSPORTATION AND PUBLIC WORKS
May 16, 2023
Burnsco Construction Inc
6331 Southwest Blvd
Benbrook, Texas 76132
RE: Acceptance Letter
Project Name: Liberty Trails Phase 5
Project Type: Water And Sewer
City Project No.: 103678
To Whom It May Concern:
On May 16, 2023 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 May 16, 2023,
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-
727-5702.
Sincerely,
GJ,
Andrew Goodman, Project Manager
Cc: Fabian Diaz, Inspector
Donald Watson, Inspection Supervisor
Oscar Aguillon, Senior Inspector
Victor V Tornoro Jr, Program Manager
Pepe -Dawson Engineers, Consultant
Burnsco Construction Inc, Contractor
DRH-HWY114, LLC, Developer
File
E-Mail: TPW_Acceptance@fortworthtexas.gov
Rev. 08/20/19
AFFIDAVIT
STATE OF TEXAS
COUNTY OFTARRANT
Before me, the undersigned authority, a notary public in the state
and county aforesaid, on this day personally appeared Ab Grantges,
Contract Mgr, Of Burnsco Construction, 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;
Liberty Trails Ph. 5 - Water, Sanitary Sewer and Storm Drain
BY c
Ab GrantgeeO�tract Manager
Subscribed and sworn before me on this date 18th of May, 2023.
V
Notary, �ublic
Tarrant County, Texas
2iP(`Y pVB^ CESILIA CANALES {
Notary ID #131652996 i
My Commission Expires
July 24, 2026
CONSENT OF
SURETY COMPANY
TO FINAL PAYMENT
Conforms with the American Institute of
Architects, AIA Document G707
OWNER
❑
ARCHITECT
❑
CONTRACTOR
❑
SURETY
❑
OTHER
PROJECT:
(name, addres8)Liberty Trails Phase 5 - Water, Sewer and Drainage
TO (Owner)
DRH - HWY 114, LLC AND THE CITY OF FORT
WORTH
6751 North Freeway
Fort Woth TX 76131
CONTRACTOR: BURNSCO CONSTRUCTION, INC.
Bond No 022233332
Fort Worth TX
ARCHITECT'S PROJECT NO:
CONTRACT FOR:
Liberty Trails Phase 5 - Water, Sewer and Drainage Improvements
Fort Worth, TX
CONTRACT DATE:
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 Company)
LIBERTY MUTUAL INSURANCE COMPANY
175 Berkeley Street
Boston MA 02116 , SURETY COMPANY
on bond of (here insert name and address of Contractor)
BURNSCO CONSTRUCTION, INC.
6331 Southwest Boulevard
Benbrook TX 76132
,CONTRACTOR,
hereby approves of the final payment to the Contractor, and agrees that final payment to the Contractor shall not relieve
the Surety Company of any of its obligations to (here insert name and address of Owner)
DRH - HWY 114, LLC AND THE CITY OF FORT WORTH
6751 North Freeway
Fort Woth TX 76131 , OWNER,
as set forth in the said Surety Company's bond.
IN WITNESS, WHEREOF,
the Surety Company has hereunto set its hand this
Attest:'ur. nicG�,,,eN�
(Seal):
17th day of May, 2023
LIBERTY MUTUAL INSURANCE COMPANY
Surety Company
Y
Signature of Authorized Representative
SoDhinie Hunter
Title
Attorney -in -Fact
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
ONE PAGE
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.
Liberty Liberty Mutual Insurance Company
Mutual. The Ohio Casualty Insurance Company Certificate No: 8205467-022020
West American Insurance Company
SURETY
POWER OF ATTORNEY
KNOWN ALL PERSONS BY THESE PRESENTS: That The Ohio Casualty Insurance Company is a corporation duly organized under the laws of the State of New Hampshire, that
Liberty Mutual Insurance Company is a corporation duly organized under the laws of the State of Massachusetts, and West American Insurance Company is a corporation duly organized
under the laws of the State of Indiana (herein collectively called the "Companies"), pursuant to and by authority herein set forth, does hereby name, constitute and appoint, Don E.
Cornell; Joshua Saunders; Kelly A. Westbrook; Mikaela Peppers; Ricardo J. Reyna; Robbi Morales; Sophinie Hunter; Tina McEwan; Tonie Petranek
all of the city of Dallas state of TX each individually if there be more than one named, its true and lawful attorney -in -fact to make,
execute, seal, acknowledge and deliver, for and on its behalf as surety and as its act and deed, any and all undertakings, bonds, recognizances and other surety obligations, in pursuance
of these presents and shall be as binding upon the Companies as if they have been duly signed by the president and attested by the secretary of the Companies in their own proper
persons.
IN WITNESS WHEREOF, this Power of Attorney has been subscribed by an authorized officer or official of the Companies and the corporate seals of the Companies have been affixed
thereto this 23rd day of April , 2021 .
Liberty Mutual Insurance Company
Irts�R -1Y INSU Ias(JR The Ohio Casualty Insurance Company
�JP`c�aPosyT 9Ln yJP`oPror:gT Pyy `vP 4oaroR,�g4.0 West American Insurance Company
,i r mo F �� 3 Fo m W 3 Fo rn
1912 0 0 1919 s 1991
�,))9SSACHUSF'fida y02HAMP`+�`��D�O `( �Nb1ANP a Gr �GZ�1 r L. U
By: / Rr
David M. Carey, Assistant Secretary
State of PENNSYLVANIA —
County of MONTGOMERY ss 0 E
0
On this 23rd day of April 2021 before me personally appeared David M. Carey, who acknowledged himself to be the Assistant Secretary of Liberty Mutual Insurance cmi
Company, The Ohio Casualty Company, and West American Insurance Company, and that he, as such, being authorized so to do, execute the foregoing instrument for the purposes
therein contained by signing on behalf of the corporations by himself as a duly authorized officer. > Cr
IN WITNESS WHEREOF, I have hereunto subscribed my name and affixed my notarial seal at King of Prussia, Pennsylvania, on the day and year first above written.
SN PAS,.. d O
_ Commonwealth of Pennsylvania - Notary seal
A G�v>• y l Teresa Pastella, Notary Public
P Montgomery County /,// i �yA. ' E E
OF My commission expires March 28, 2025 By:
Commission ���/�
Si'4`3F `�GJ mber 1126044
Member, Pennsylvan Pennsylvania on of Notaries Teresa Pastella, Notary Public 4 Lo
°FRr r titer o �
This Power of Attorney is made and executed pursuant to and by authority of the following By-laws and Authorizations of The Ohio Casualty Insurance Company, Liberty Mutual 3�
Insurance Company, and West American Insurance Company which resolutions are now in full force and effect reading as follows: a M
ARTICLE IV — OFFICERS: Section 12. Power of Attorney. .6
`oo
Any officer or other official of the Corporation authorized for that purpose in writing by the Chairman or the President, and subject to such limitation as the Chairman or the :a m
President may prescribe, shall appoint such attorneys -in -fact, as may be necessary to act in behalf of the Corporation to make, execute, seal, acknowledge and deliver as surety co =
any and all undertakings, bonds, recognizances and other surety obligations. Such attorneys -in -fact, subject to the limitations set forth in their respective powers of attorney, shall a (CU)
have full power to bind the Corporation by their signature and execution of any such instruments and to attach thereto the seal of the Corporation. When so executed, such o a)
instruments shall be as binding as if signed by the President and attested to by the Secretary. Any power or authority granted to any representative or attorney -in -fact under the .00mi
provisions of this article may be revoked at any time by the Board, the Chairman, the President or by the officer or officers granting such power or authority. LL aa
ARTICLE XIII — Execution of Contracts: Section 5. Surety Bonds and Undertakings.
Any officer of the Company authorized for that purpose in writing by the chairman or the president, and subject to such limitations as the chairman or the president may prescribe,
shall appoint such attorneys -in -fact, as may be necessary to act in behalf of the Company to make, execute, seal, acknowledge and deliver as surety any and all undertakings, —
bonds, recognizances and other surety obligations. Such attorneys -in -fact subject to the limitations set forth in their respective powers of attorney, shall have full power to bind the
Company by their signature and execution of any such instruments and to attach thereto the seal of the Company. When so executed such instruments shall be as binding as if
signed by the president and attested by the secretary.
Certificate of Designation —The President of the Company, acting pursuant to the Bylaws of the Company, authorizes David M. Carey, Assistant Secretary to appoint such attorneys -in -
fact as may be necessary to act on behalf of the Company to make, execute, seal, acknowledge and deliver as surety any and all undertakings, bonds, recognizances and other surety
obligations.
Authorization — By unanimous consent of the Company's Board of Directors, the Company consents that facsimile or mechanically reproduced signature of any assistant secretary of the
Company, wherever appearing upon a certified copy of any power of attorney issued by the Company in connection with surety bonds, shall be valid and binding upon the Company with
the same force and effect as though manually affixed.
I, Renee C. Llewellyn, the undersigned, Assistant Secretary, The Ohio Casualty Insurance Company, Liberty Mutual Insurance Company, and West American Insurance Company do
hereby certify that the original power of attorney of which the foregoing is a full, true and correct copy of the Powerof Attorney executed by said Companies, is in full force and effect and
has not been revoked.
IN TESTIMONY WHEREOF, I have hereunto set my hand and affixed the seals of said Companies this 17th day of May , 2023 .
INSUR
jpGQRP0RgrAyn
` Fo to
1912 C,
0
~d�9ssACN���fiab
LMS-12873 LMIC OCIC WAIC Multi Co 02121
�-i INS&,Q1NSURq
yJP4�NPbRgT 'yy `VP Gb(tP01QgT y�
vQ' 3 Fo m a: 2 Fo m
9 1919 w a s 1991 0
yO '&aa�,da� `ry, "VOIANP ,db
By:
Renee C. Llewellyn, Assistant Secretary
Liberty
mutual.
SURETY
TEXAS
IMPORTANT NOTICE
To obtain information or make a complaint:
You may call toll -free for information or to
make a complaint at
1-877-751-2640
You may also write to:
2200 Renaissance Blvd., Ste. 400
King of Prussia, PA 19406-2755
You may contact the Texas Department of
Insurance to obtain information on companies,
coverages, rights or complaints at
1-800-252-3439
You may write the Texas Department of Insurance
Consumer Protection (I I I A A)
P. 0. Box 149091
Austin, TX 78714-9091
FAX: (512) 490-1007
Web: htta://www.tdi.texas.izov
E-mail: ConsumerProtection4..tdi.texas4ov
PREMIUM OR CLAIM DISPUTES:
Should you have a dispute concerning your
premium or about a claim you should first
contact the agent or call 1-800-843-6446.
If the dispute is not resolved, you may contact the
Texas Department of Insurance.
ATTACH THIS NOTICE TO YOUR
POLICY:
This notice is for information only and does not
become a part or condition of the attached
document.
NP70680901
LMS-15292 10/15
TEXAS
AVISO IMPORTANTE
Para obtener informacion o para someter una
queja:
Usted puede Ilamar al numero de telefono gratis
para informacion o para someter una queja al
1-877-751-2640
Usted tambien puede escribir a:
2200 Renaissance Blvd., Ste. 400
King of Prussia, PA 19406-2755
Puede comunicarse con el Departamento de
Seguros de Texas para obtener informacion
acerca de companias, coberturas, derechos o
quejas al
1-800-252-3439
Puede escribir al Departamento de Seguros
de Texas Consumer Protection (I I I -IA)
P. 0. Box 149091
Austin, TX 78714-9091
FAX # (512) 490-1007
Web: httn://www.tdi.texas.Lov.
E-mail: ConsumerProtection4a.tdi.texas.aov
DISPUTAS SOBRE PRIMAS 0 RECLAMOS:
Si tiena una disputa concerniente a su prima o a
un reclamo, debe comunicarse con el agente o
primero. Si no se resuelve la disputa, puede
entonces comunicarse con el departamento (TDI)
UNA ESTE AVISO A SU POLIZA:
Este aviso es solo para proposito de informacion
y no se convierte en parte o condicion del
documento adjunto.