Loading...
HomeMy WebLinkAboutContract 54044-FP2FORT WORTH. -FP2 City Secretary Contract No. 54044 Date Received 03/01/2024 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: Crystal Springs City Project No.: 100252 Improvement Type(s) Contractor Vice President Water ❑x Sewer ❑x Original Contract Price: $281,361.00 Amount of Approved Change Order(s) $34,766.00 Revised Contract Amount Total Cost of Work Complete Title Rumsey Construction, LLC Company Name ffershel Stanley suttee field Hershel Stan lev Sutterfield (Feb 27, 202415:39 CST) Project Inspector khat , -,I laaferi P.E. (Feb 19. 202422:02 CST) Project Manager FA Rehecca Owen (Mar 1. 202409:37 CST) CFA Manager u ren P ri eu r (Mar 1, 2024 08:55 CST) TPW Director I -- Asst. City Manager $316,127.00 $316,127.00 Feb 27, 2024 Date Feb 27, 2024 Date Feb 29, 2024 Date Marl, 2024 Date Marl, 2024 Date Mar 4, 2024 Date OFFICIAL RECORD CITY SECRETARY Page 1 of 2 FT. WORTH, TX Notice of Project Completion Project Name: Crystal Springs City Project No.: 100252 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: 100 WD Work Start Date: 8/3/2020 Completed number of Soil Lab Test: 188 Completed number of Water Test: 34 Days Charged: 657 Work Complete Date: 10/26/2023 Page 2of2 FoRTWORTH CITY OF FORT WORTH FINAL PAYMENT REQUEST Contract Name WATER, SANITARY SEWER, DRAINAGE, PAVING AND DRAINAGE IMP Contract Limits Project Type WATER & SEWER City Project Numbers 100252 DOE Number 1252 Estimate Number 1 Payment Number 1 For Period Ending 10/26/2023 WD City Secretary Contract Number Contract Time 10WD Contract Date 6/10/2020 Days Charged to Date 657 Project Manager NA Contract is 100.00 Complete Contractor RUMSEY CONSTRUCTION, LLC 6617 VILLAGE SPRINGS DRIVE PLANO, TX 75024 Inspectors MILLER, W / SUTTERFIELD Friday, January 26, 2024 Page 1 of 5 City Project Numbers 100252 DOE Number 1252 Contract Name WATER, SANITARY SEWER, DRAINAGE, PAVING AND DRAINAGE I Estimate Number 1 Contract Limits Payment Number 1 Project Type WATER & SEWER For Period Ending 10/26/2023 Project Funding UNIT I: WATER IMPROVEMENTS Item Description of Items Estimated Unit Unit Cost Estimated Completed Completed No. Quanity Total Quanity Total 1 ASHPALT PVMT REPAIR, ARTERIAL (WATER) 85 SY $225.00 $19,125.00 85 $19,125.00 (CO #1) 2 DUCTILE IRON WATER FITTINGS 2 TN $8,000.00 $16,000.00 2 $16,000.00 W/RESTRAINT 3 6" PVC WATER PIPE 158 LF $26.00 $4,108.00 158 $4,108.00 4 10" PVC WATER PIPE (CO #1) 2379 ;F $35.00 $83,265.00 2379 $83,265.00 5 12" PVC WATER PIPE (CO #1) 65 LF $40.00 $2,600.00 65 $2,600.00 6 FIRE HYDRANT 6 EA $3,100.00 $18,600.00 6 $18,600.00 7 6" GATE VALVE 3 EA $1,000.00 $3,000.00 3 $3,000.00 8 10" GATE VALVE 11 EA $1,920.00 $21,120.00 11 $21,120.00 9 12" GATE VALVE 2 EA $2,200.00 $4,400.00 2 $4,400.00 10 12" X 10" TAPOING SLEEVE & VALVE 1 EA $5,800.00 $5,800.00 1 $5,800.00 11 1 1/2" WATER SERVICE 3 EA $1,400.00 $4,200.00 3 $4,200.00 12 2" WATER SERVICE 2 EA $1,400.00 $2,800.00 2 $2,800.00 13 4" WATER METER AND VAULT 1 EA $13,500.00 $13,500.00 1 $13,500.00 14 6" WATER METER AND VAULT 1 EA $14,500.00 $14,500.00 1 $14,500.00 16 TRENCH SAFETY (CO #1) 2602 LF $1.00 $2,602.00 2602 $2,602.00 17 CONNECTION TO EXISTING 4" - 12" WATER MAIN 4 EA $4,135.75 $16,543.00 4 $16,543.00 ------------- Sub -Total of Previous Unit $232,163.00 $232,163.00 UNIT H. SANITARY SEWER IMPROVEMENTS Item Description of Items Estimated Unit Unit Cost Estimated Completed Completed No. Quanity Total Quanity Total 1 6" SEWER PIPE 35 LF $25.00 $875.00 35 $875.00 2 8" SEWER PIPE 562 LF $28.00 $15,736.00 562 $15,736.00 3 10" SEWER PIPE 216 LF $45.00 $9,720.00 216 $9,720.00 4 10" SEWER SERVICE CSS BACKFILL 20 LF $40.00 $800.00 20 $800.00 5 4' MANHOLE (CO #1) 10 EA $4,300.00 $43,000.00 10 $43,000.00 6 EPDXY MANHOLE LINER 44 VF $220.00 $9,680.00 44 $9,680.00 7 4' EXTRA DEPTH MANHOLE 5 VF $400.00 $2,000.00 5 $2,000.00 8 MANHOLE VACUUM TESTING (CO 41) 9 EA $150.00 $1,350.00 9 $1,350.00 Friday, January 26, 2024 Page 2 of 5 City Project Numbers 100252 DOE Number 1252 Contract Name WATER, SANITARY SEWER, DRAINAGE, PAVING AND DRAINAGE I Estimate Number 1 Contract Limits Payment Number 1 Project Type WATER & SEWER For Period Ending 10/26/2023 Project Funding 9 TRENCH SAFETY (SEWER) 803 LF $1.00 $803.00 803 $803.00 Sub -Total of Previous Unit $83,964.00 $83,964.00 Friday, January 26, 2024 Page 3 of 5 City Project Numbers 100252 DOE Number 1252 Contract Name WATER, SANITARY SEWER, DRAINAGE, PAVING AND DRAINAGE I Estimate Number 1 Contract Limits Payment Number 1 Project Type WATER & SEWER For Period Ending 10/26/2023 Project Funding Contract Information Summary Original Contract Amount $281,361.00 Chancre Orders Change Order Number 1 $30,316.00 Change Order Number 1 $4,450.00 Total Contract Price $316,127.00 Total Cost of Work Completed $316,127.00 Less % Retained $0.00 Net Earned $316,127.00 Earned This Period $316,127.00 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 $316,127.00 Friday, January 26, 2024 Page 4 of 5 City Project Numbers 100252 DOE Number 1252 Contract Name WATER, SANITARY SEWER, DRAINAGE, PAVING AND DRAINAGE I Estimate Number 1 Contract Limits Payment Number 1 Project Type WATER & SEWER For Period Ending 10/26/2023 Project Funding Project Manager NA Inspectors MILLER, W / SUTTERFIELD Contractor RUMSEY CONSTRUCTION, LLC 6617 VILLAGE SPRINGS DRIVE PLANO, TX 75024 City Secretary Contract Number Contract Date 6/10/2020 Contract Time 100 WD Days Charged to Date 657 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 $316,127.00 Less % Retained $0.00 Net Earned $316,127.00 Earned This Period $316,127.00 Retainage This Period $0.00 Less Liquidated Damages 0 Days @ $0.00 / Day $0.00 LessPavement Deficiency $0.00 Less Penalty $0.00 Less Previous Payment $0.00 Plus Material on Hand Less 15% $0.00 Balance Due This Payment $316,127.00 Friday, January 26, 2024 Page 5 of 5 PROJECT NAME: CONTRACT: CFA # CITY PROJECT # DOE # WATER PROJECT # SEWER PROJECT # FILE # INSPECTOR: PROJECT MANAGER: ORIGINAL CONTRACT EXTRAS TO DATE CREDITS TO DATE CONTRACT TO DATE AMOUNT OF PROP. CHANGE ORDER REVISED CONTRACT AMOUNT TOTAL REVISED CONTRACT AMOUNT PER UNIT REVISED COST SHARE TOTAL REVISED CONTRACT DEVELOPER -AWARDED -PROJECT CHANGE ORDER Water, Sanitary Sewer, Drainage, and Paving Improvements to serve Crystal Springs CHANGE 54044 ORDER No: CFA20-0024 CITY PARTICIPATION: NO 100252 NA 59601-5310350-0600413-100252-001580 59607-5310350-0700430-100252-001380 W-2393 Stanley Sutterfield Phone No: 817.240.4037 RECEIVED Khal Jaafari, PE Phone No: 817.392.7872 By Khal Jaafari of 6:53 pm, May 23, 2023 WATER SEWER CONTRACT UNIT PAVING Developer Developer I Developer Cost City Cost Cost City Cost Cost City Cost $201,847.00 $0.00 I $79,514.00 I $0.00 I $165,295.00 $0.00 $0.00 $0.00 I $0.00 I $0.00 I $0.00 $0.00 $0.00 $0.00 I $0.00 I $0.00 I $0.00 $0.00 $201,847.00 $0.00 I $79,514.00 I $0.00 I $165,295.00 $0.00 $ 30,316.00 $0.00 I $ 4,450.001 $0.00 I $0.00 $0.00 $232,163.00 $0.00 I $83,964.00 I $0.00 I $166,296.00 $0.00 $232,163.00 $83,964.00 $165,295.00 Dev. Cost: $759,613.32 City Cost: $759,613.32 DRAINAGE STREET LIGHTS ieveloper Developer I :ost City Cost Cost City Cost $203,408.00 $0.00 I $9,000.00 I $0.00 $0.00 $0.00 I $0.00 I $0.00 $0.00 $0.00 I $0.00 I $0.00 $203,408.00 $0.00 I $9,000.00 I $0.00 $0.00 $0.00 I $ 65,783.32I $0.00 $203,408.00 $0.00 I $74,783.32 I $0.00 $203,408.00 $74,783.32 $0.00 WORKING DAYS 100 0 0 100 0 100 Revised: 10-12-2011 Page 1 io You are directed to make the following changes in the contract documents: CITY BID ITEM PAY ITEM # I # QUANTITY 1 9999.0004 29 4 3311.0361 133 5 3311.0461 60 16 3305.0109 193 NEW ITEM 3312.0117 4 5 3339.1001 1 8 3301.0101 1 NEW ITEM 2605.0111 1 NEW ITEM 2605.3011 405 NEW ITEM 2605.3012 75 NEW ITEM 2605.3013 30 NEW ITEM 3441.1409 1910 NEW ITEM 3441.1414 535 NEW ITEM 3441.1502 5 NEW ITEM 3441.3035 7 RECEIVED By Khal Jaafari at 6:53 pm, May 23, 2023 )NIT I ITEM DESCRIPTION Unit I: Water Improvements SY ASPHALT PVMT REPAIR, ARTERIAL (WATER) LF 10" PVC WATER PIPE LF 12" PVC WATER PIPE LF TRENCH SAFETY EA CONNECTION TO EXISTING 4" - 12" WATER MAIN Unit II: Sanitary Sewer Improvements EA 4' MANHOLE EA MANHOLE VACUUM TESTING Unit V: Street Light Improvements EA FURNISH/INSTALL ELEC SERV PEDESTAL LF 2" CONDT PVC SCH 80 (T) LF 2" CONDT PVC SCH 80 (T) LF 2" CONDT RM (T) LF NO 8 INSULATED ELEC CONDR LF NO 8 BARE ELEC CONDR EA GROUND BOX TYPE B, W/ APRON EA FURNISH/INSTALL UTILITY WASHINGTON POSTLITE SERIES LED AND POLE GRAND TOTAL UNIT PRICE I TOTAL $ 225.00 $ 6,525.00 $ 35.00 $ 4,655.00 $ 40.00 $ 2,400.00 $ 1.00 $ 193.00 $ 4,135.75 $ 16,543.00 $ 4,300.00 $ 4,300.00 $ 150.00 $ 150.00 $ 6,004.10 $ 6,004.10 $ 19.75 $ 7,998.75 $ 106.67 $ 8,000.25 $ 33.33 $ 999.90 $ 4.71 $ 8,996.10 $ 3.74 $ 2,000.90 $ 400.00 $ 2,000.00 $ 4,254.76 $ 29,783.32 $100,549.32 REASONS FOR CHANGE ORDER (1) Water Line B needed to be lowered at easternmost connection to public system due to existing condition depth. (2) Pedestrian lighting along White Settlement to meet zoning landscape point system requirements. (3) Water Line A connection to existing 12-inch system needed adjusted due to field conditions. (4) An existing brick SSMH needed to be entirely replaced due to sidewalk grades. RECOMMENDED: Kimley-Horn and Associates, Inc. By: ' " 5*1C /�4/� Name: Brandon Middleton Title: Civil Enqineer APPROVED: SW Crystal Springs, LLC By. G� Name: Aaron Sherman Title: Manager APPROVED: Rurrtsey Construction, LLC By: Name. ff-aZughron Title: Vice President Revised: 10-12-2011 Page 2 FORTWORTH TRANSPORTATION AND PUBLIC WORKS PIPE REPORT FOR: PROJECT NAME: Crystal Springs CITY PROJECT NUMBER: 100252 1 WATER PIPE LAID SIZE TYPE OF PIPE Eagle 6" pvc slip Eagle 10" pvc slip eEagle 12" pvc pvc slip FIRE HYDRANTS: 6 ea PIPE ABANDONED DENSITIES: NEW SERVICES: I PIPE LAID PIPE ABANDONED DENSITIES: NEW SERVICES: VALVES (16" OR LARGER) SIZE TYPE OF PIPE yes 1 1/2 WS copper 2" WS copper SEWER SIZE TYPE OF PIPE 6" pvc slip 8" pvc slip 10" pvc slip SIZE TYPE OF PIPE yes 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 158 2379 65 LF LF LF 3 ea 2 ea 35 562 20 FORTWORTH. M, TRANSPORTATION AND PUBLIC WORKS January 25, 2024 Rumsey Construction LLC 4329 Reeder Carrollton, Texas 75010 RE: Acceptance Letter Project Name: Crystal Springs Project Type: Developer, water,sewer,drainage,pav,street lights City Project No.: 100252 To Whom It May Concern: On November 17, 2023 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 January 5, 2024. 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 January 5, 2024, 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- 392-7872. Sincerely, k& ,7aa�aki T >C KhaI Jaafari P.E. (Feb K, 2024 22:02 CST) Khal Jaafari , Project Manager Cc: Hershel Stanley Sutterfield, Inspector Wade Miller, Inspection Supervisor Emanuel Nieto, Senior Inspector Andrew Goodman, Program Manager Kimley Horn , Consultant Rumsey Construction, LLC, Contractor SW Crystal Springs, LLC, Developer File E-Mail: TPW_Acceptance@fortworthtexas.gov Rev. 8/20/19 AFFIDAVIT STATE OF Texas COUNTY OF Tarrant Before me, the undersigned authority, a notary public in the state and county aforesaid, on this day personally appeared Corey Caughron, VP 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; Water, Sanitary Sewer, Drainage and Paving Improvements to Serve Crystal Springs City Project No. 100252 C Caughron, VP Subscribed and sworn before me on tAs date24 day of February, 2024. Notary Public Denton, TX w SARAN PEREZ ;�•�` MP tVotaty PuC�l�cState of Texas Comm. Y P� '11.21�2024 L N®ter x �d6: CONSENT OF SURETY COMPANY TO FINAL PAYMENT AIA DOCUMENT G707 OWNER ❑x ARCHITECT ❑ CONTRACTOR ❑ SURETY ❑ OTHER PROJECT: Water, Sanitary Sewer, Drainage & Paving to serve Crystal Springs (name, address) Fort Worth, TX TO (Owner) CITY PROJECT NO: Stillwater Capital and The City of Fort Worth CONTRACT FOR: Public Water & Paving Fort Worth, TX CONTRACT DATE: June, 2020 BOND NO: 1077898 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 on bond of (here insert name and address of Contractor as it appears in the bond), Rumsey Construction, LLC , SURETY COMPANY, ,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) Stillwater Capital and the City of Fort Worth as set forth in the said Surety's bond. IN WITNESS WHEREOF, the Surety has hereunto set its hand this 21st day of February The Hanover Insurance Company Surety , A , OWNER, Signature of A7,Att0rized Representative Attest: Allyson W. Dearney-in-Fact (Seal)- Title AIA DOCUMENT G707 • CONS NT OF SURETY TO FINAL PAYMENT • APRIL 1970 EDITION • AIA 0 • © 1970 • THE AMERICAN INSTITUTE OF ARCHITECTS, 1735 NEW YORK AVE., NW, WASHINGTON, D.C. 20006 ,2024 ONE PAGE 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: ThatTHE 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 under the 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 by the 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 No/100 ($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 power to 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 respect thereto, granted and executed by the President or Vice President in conjunction with any Vice President of the Company, shall be binding on 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 4th day of April, 2018. The Hanover Insurance Company The lia naves insurance Caman. Massachusetts Bay lns4ance company P y Citizens Insurance Company of America too M ssachu.setts Bay Insurance Company mnyfCitizens Insurance Company of America �,.,, Z John C. Roche; E�,T and President: JamesH. Xaviecki, Vice President THE COMMONWEALTH OF MASSACHUSETTS ) COUNTY OF WORCESTER ) ss. 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 of America, 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 that the said corporate seals and their signatures as officers were duly affixed and subscribed to said instrument by the authoritv and direction of said Corporations. WANE J. MARINO NolwCOMM k Pud OF 11gi�ClRiRr7� iamrN 4. SA4Y ESN Deane 1. , a f so, Naan Puhiic �• My Conune,A— Erpi—u ,%-tan;h 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 215' day of February 2024 CERTIFIED COPY I'licodore G. Martinez, Vice President s' Hanover Insurance Group - IMPORTANT NOTICE To obtain information or make a complaint: You may call The Hanover Insurance Company/ Citizens Insurance Company of America's toll -free telephone number for information or to make a complaint at: 1-800-608-8141 You may also write to The Hanover Insurance Company/ Citizens insurance Company of America at: 440 Lincoln Street Worcester, MA 01615 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: P. O. Box 149104 Austin, TX 78714-9104 Fax: (512) 475-1771 Web: http://www.tdi.texas.gov E-mail: ConsumerProtection@tdi.texas.gov PREMIUM OR CLAIM DISPUTES: Should you have a dispute concerning your premium or about a claim you should contact the agent or the company first. 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. Texas Complaint Notice Commercial Lines AViSO IMPORTANTE Para obtener informacion o para someter una queja: Usted puede Ilamar al numero de telefono gratis de The Hanover Insurance Company/Citizens Insurance Company of America's para informacion o para someter una queja al: 1-800-608-8141 Usted tambien puede escribir a The Hanover Insurance Company/Citizens Insurance Company of America al: 440 Lincoln Street Worcester, MA 01615 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: P. O. Box 149104 Austin, TX 78714-9104 Fax: (512) 475-1771 Web: http://www.tdi.texas.gov E-mail: ConsumerProtection@tdi.texas.gov DISPUTAS SOBRE PRIMAS O RECLAMOS: Si tiene una disputa concerniente a su prima o a un reclamo, debe comunicarse con el agente o la com- pania 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. The Hanover Insurance Company 1440 Lincoln Street, Worcester, MA 01653 181-1457 nv" Pagel of i Citizens Insurance Company of America 1808 North Highlander Way, Howell, MI 48843 hanover.com