HomeMy WebLinkAboutContract 48056-FP1 Departm t of TP&W Const.Services
CPN# D to
Project Manage •'V �T WO RT Ho
Risk Management Cana �b /
D.O.E. Brotherton — C (v' (rr
CFA Morales/Scanned — COMACTNO•
Gutzler/Scanned
The Proceeding people h ve been Contacted
concerning the request for final payment&have ANION AND PUBLIC WORKS
released this project for such payment. F PROJECT COMPLETION 5-9(0 173
r/s developer Projects)
Clearance Conducted By 0",&9r..4! City Project 0373
S 24 8 Q
Regarding contract 100373 for 7-ELEVEN SOUTHWEST BASSWOOD ADDITION as required by the
WATER DEPARTMENT as approved by City Council on N/A through M&C N/A the director of the
WATER DEPARTMENT upon the recommendation of the Assistant Director of the Transportation&Public Works
Department has accepted the project as
FL-t,-
E(NE0V�
Original Contract Price: MAY U 1 2018 $136,073.43
Amount of Approved Change Orders: 13y Ns
Revised Contract Amount: 11�
Total Cost Work Completed: $136,073.43
Recommen r Acce ance Date
Asst. Direct - evelopment Services
Accepted Date
Asst. DirectTER DEPARTMENT
Asst. City Manager Date
4
01 OFFICIAL RECORD
CITY SECRETARY
101 -22018 FT.WORTH,TX
tmr of FaaT Waal k
Cl1v
MAY 0 1 218
5% 01 - 1003 -73
City Project Numbers 100373 Jay DOE Number 0373
Contract Name 7-ELEVEN SOUTHWEST BASSWOOD ADDITION Estimate Number I
Contract Limits Payment Number 1
Project Type WATER&SEWER For Period Ending 2/19/2018
Project Funding
Project Manager NA City Secretary Contract Number
Inspectors LAYER / ODEN Contract Date
Contractor VERTICAL,CONSTRUCTION MANAGEMENT LL Contract Time 110 CD
1209 SOUTH WHITE CHAPEL BLVD#180 Days Charged to Date 470 CD
SOUTHLAKE, TX 76092 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 $136,073.43
Less %Retained $0.00
Net Earned $136,073.43
Earned This Period $136,073.43
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 $136,073.43
Wednesday,February 21,2018 Page 4 of 4
FORT WORTH
CITY OF FORT WORTH
FINAL PAYMENT REQUEST
Contract Name 7-ELEVEN SOUTHWEST BASSWOOD ADDITION
Contract Limits
Project Type WATER&SEWER
City Project Numbers 100373
DOE Number 0373
Estimate Number 1 Payment Number 1 For Period Ending 2/19/2018
CD
City Secretary Contract Number Contract Time 11(ED
Contract Date Days Charged to Date 470
Project Manager NA Contract is 100.00 Complete
Contractor VERTICAL CONSTRUCTION MANAGEMENT LL
1209 SOUTH WHITE CHAPEL BLVD#180
SOUTHLAKE e TX 76092
Inspectors LAYER / ODEN
Wednesday,February 21,2018 Page 1 of 4
City Project Numbers 100373 DOE Number 0373
Contract Name 7-ELEVEN SOUTHWEST BASSWOOD ADDITION Estimate Number I
Contract Limits Payment Number I
Project Type WATER&SEWER For Period Ending 2/19/2018
Project Funding
WATER
Item Description of Items Estimated Unit Unit Cost Estimated Completed Completed
No. Quanity Total Quanity Total
--------------------------------------- -----
1 8"WATER PIPE 993 LF $40.00 $39,720.00 993 $39,720.00
2 FIRE HYDRANT 2 EA $2,700.00 $5,400.00 2 $5,400.00
3 1"WATER SERVICE 2 EA $602.44 $1,204.88 2 $1,204.88
4 12"GATE VALVE 1 EA $5,600.00 $5,600.00 1 $5,600.00
5 8"GATE VALVE 6 EA $1,600.00 $9,600.00 6 $9,600.00
6 12"X8"TAPPING SLEEVE&VALVE 2 EA $4,312.50 $8,625.00 2 $8,625.00
7 DUCTILE IRON WATER FITTINGS 0.2 TN $16,500.00 $3,300.00 0.2 $3,300.00
W/RESTRAINT
8 TRENCH SAFETY 999 LF $7.85 $7,842.15 999 $7,842.15
-----------------------------------------
Sub-Total of Previous Unit $81,292.03 $81,292.03
SEWER
Item Description of Items Estimated Unit Unit Cost Estimated Completed Completed
No. Quanity Total Quanity Total
1 8"SEWER PIPE 676 LF $54.00 $36,504.00 676 $36,504.00
2 4"SEWER SERVICE 1 EA $313.60 $313.60 1 $313.60
3 4'MANHOLE 3 EA $3,200.00 $9,600.00 3 $9,600.00
4 CONCRETE COLLAR 2 EA $424.28 $848.56 2 $848.56
5 4'EXTRA DEPTH MANHOLE 11 VF $54.55 $600.05 11 $600.05
6 TRENCH SAFETY 684 LF $7.85 $5,369.40 684 $5,369.40
7 MANHOLE VACUUM TESTING 3 EA $107.16 $321.48 3 $321.48
8 POST CCTV INSPECTION 676 LF $1.60 $1,081.60 676 $1,081.60
9 CONCRETE ENCASE SEWER PIPE 1 CY $142.71 $142.71 I $142.71
Sub-Total of Previous Unit $54,781.40 $54,781.40
Wednesday,February 21,2018 Page 2 of 4
City Project Numbers 100373 DOE Number 0373
Contract Name 7-ELEVEN SOUTHWEST BASSWOOD ADDITION Estimate Number I
Contract Limits Payment Number I
Project Type WATER&SEWER For Period Ending 2/19/2018
Project Funding
Contract Information Summary
Original Contract Amount $136,073.43
Chance Orders
Total Contract Price $136,073.43
z4L to 3 Total Cost of Work Completed $136,073.43
Contractor li Less %Retained $0.00
Date 3-2 3�S Net Earned $136,073.43
Ins ion Supervisor Earned This Period $136,073.43
Retainage This Period $0.00
ate "� rt� Less Liquidated Damages
Je anager
I / Days @ /Day $0.00
Date-504?r VY LessPavement Deficiency $0.00
Asst. /TP Less Penalty $0.00
C J � Date SlILess Previous Payment $0.00
Director/Contracting Department Plus Material on Hand Less 15% $0.00
Balance Due This Payment $136,073.43
Wednesday,February 21,2018 Page 3 of 4
FORTWORTH rev 03/05/07
TRANSPORTATION & PUBLIC WORKS
FINAL STATEMENT OF CONTRACT TIME
FINAL STATEMENT NO.:1
NAME OF PROJECT: 7-Eleven Southwest Basswood Addition
PROJECT NO.: 100373 CONTRACTOR: Vertical Construction
100373 DOE NO.: N/A
PERIOD FROM:11/16/16 TO: 02/19/18 FINAL INSPECTION DATE: 19-Feb-18
WORK ORDER EFFECTIVE:11/16/2016 CONTRACT TIME: 470 Q WE CD
DAY OF DAYS REASON FOR DAYS DAY OF DAYS REASON FOR DAYS
MONTH CHARGED CREDITED MONTH CHARGED CREDITED
DURING DURING
1. 16.
2. 17.
3. 18.
4. 19.
5. 20.
6. 21.
7. 22.
S. 23.
9. 24.
10. 25.
11. 26.
12. 27.
13. 28.
14. 29.
15. 30.
31.
SAT,SUN, RAIN,TOO WET, UTILITIES DAYS TOTAL
&HOLIDAYS &TOO COLD RELOCATIONS OTHERS* CHARGED DAYS
THIS
PERIOD 0 0 0 0 470 470
PREVIOUS 0 0 0
PERIOD 0 0
TOTALS0 0 0
TO DATE 0 470 470
*REMARKS:
CONTRACTOR DATE INSPECTOR DATE
ENGINEERING DEPARTXIENT
The City of Fort Worth• 1000 Throckmorton Street•Fort Worth,TN 76012-6311
(817)392-7941 •Fax: (817)392-7845
FORTWORTHREV:02'22/07
TRANSPORTATION AND PUBLIC WORKS
CONTRACTOR'S EVALUATION OF CITY
I)PROJECT INFORMATION Date: 2/20/2018
Name of Contractor Project Name
Vertical Construction 7-Eleven Basswood Addition
DOE Inspector Project Manager
Weyman Oden Gopal Sahu
DOE Number Project Difficuhv Tvpe of Contract
CPN#100373 Q Simple Q Routine Q Complex Q water0 Waste water0 Storm Drainage0 Pavement
Initial Contract Amount Final Contract Amount
$136,073.43 $136,073.43
II)PERFORMANCE EVALUATION
0-Inadequate 1 -Deficient 2-Standard 3 -Good 4-Excellent
ELEMENT RATING ELEMENT RATING
(0-4) (0-4)
INSPECTION EVALUATION PLANS&SPECIFICATIONS
1 Availability of Inspector 1 Accuracy of Plans to Existing Conditions
2 Knowledge of Inspector 2 Clarity& Sufficiency of Details
3 Accuracy of Measured Quantities t4 3 Applicability of Specifications �{
4 Display Of Professionalism 4 Accuracy of Plan Quantities L{
5 Citizen Complaint Resolution PROJECT MANAGER EVALUATION
6 Performance-Setting up Valve Crews,Labs t( 1 Knowledge And/Or Problem Resolution
ADMINISTRATION 2 Availability of Project Manager
1 Change Order Processing Time t( 13 Communication 'f
2 Timliness of Contractor Payments N 4 Resolution of Utility Conflicts
3 Bid Opening to Pre-Con Meeting Timeframe �I
III)COMMENTS& SIGNATURES
COMMENTS
Signature Contractor
Signature DOE Inspector
Signature DOE Inspector's Supervisor
INSPECTOR'S COMMENTS
TRANSPORTATION AND PUBLIC WORKS
s The City of Fort Worth• 1000 Throckmorton Street•Fort Worth,TX 76012-6311
(817) 392-7941 •Fax: (817) 392-7845
FORTWORTHREV:02/20/07
TRANSPORTATION AND PUBLIC WORKS
PERFORMANCE EVALUATION OF CONTRACTOR
I) CONTRACTOR&PROJECT DATA
Name of Contractor Project Name
Vertical Construction 7-Eleven Basswood Addition
DOE Inspector DOE Number
Weyman Oden CPN# 100373
JOE Inspector Project Manager
E] Water[2] Waste Water Storm Drainage Pavement Gopal Sahu
Initial Contract Amount Project Difficulty
$136,073.43 O Simple Routine Q Complex
Final Contract Amount Date
$136,073.43 2/20/2018
11)PERFORMANCE EVALUATION
0-Inadequate 1-Deficient 2-Standard 3-Good 4-Excellent
ELEMENT WEIGHT(x) APPLICABLE(Y/N) RATING(0-4) MAX SCORE SCORE
1 Submission of Documents 2 Y 3 8 6
2 Public Notifications 5 Y 3 20 15
3 Plans on Site 5 Y 3 20 15
4 Field Supervision 15 Y 3 60 45
5 Work Performed 15 Y 3 60 45
6 Finished Product 15 Y 3 60 45
7 Job Site Safety 15 Y 3 60 45
8 Traffic Control Maintenance 15 Y 3 60 45
9 Daily Clean Up 5 Y 3 20 15
10 Citizen's Complaint Resolution 5 Y 1 3 20 15
11 Property Restoration 5 Y 3 20 15
12 After Hours Response 5 Y 3 20 15
13 Project Completion 5 Y 2 20 10
TOTAL ELEMENT SCORE(A) 331
BONUS POINTS(25 Maximum)(B)
III)CONTRACTOR'S RATING TOTAL SCORE(TS) 331
Maximum Score(MS)=448 or sum of applicable element score maximums which= 448
Rating([TS/MS] * 100%) 331 / 448 = 74%
Performance Category Good
<20%=Inadequate 20%to<40%=Deficient 40%to<60%=Standard 60%to<80%=Good >80%=Excellent
Inspector's Comments(INCLUDING EXPLANATION OF BONUS POINTS AWARDED)
Signature DOE Inspector L�Z"„r,;, -)�� Signature Contractor
Signature DOE Inspector's Supervisor
CONTRACTOR'S COMMENTS
TRANSPORTATION AND PUBLIC WORKS
S The City of Fort Worth• 1000 Throckmorton Street•Fort Worth,TX 76012-6311
(817) 392-7941 •Fax: (817) 392-7845
FORTWORTH
TRANSPORTATION AND PUBLIC WORKS
PIPE REPORT FOR:
PROJECT NAME: 7-Eleven Southwest Basswood Addition
PROJECT NUMBER: 100373
DOE NUMBER: N/A
WATER
PIPE LAID SIZE TYPE OF PIPE LF
Water 8in PVC-SDR-14 993
FIRE HYDRANTS: 2 VALVES(16" OR LARGER)
PIPE ABANDONED SIZE TYPE OF PIPE LF
DENSITIES: yes
NEW SERVICES: 1" Copper 420
SEWER
PIPE LAID SIZE TYPE OF PIPE LF
Sewer 8" PVC SDR-26 676
PIPE ABANDONED SIZE TYPE OF PIPE LF
DENSITIES: yes
NEW SERVICES: 4" PVC SDR-26 100
TRANSPORTATION AND PUBLIC WORKS
. = The City of Fort Worth• 1000 Throchxnorton Street•Fort Worth,TX 76012-6311
(817) 392-7941 •Fax: (817) 392-7845
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 Clint Clements , VP
Operations and Construction Of VCM, LLC, 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;
Public Works
Clint Clements
Subscribed and sworn before me on this date 19 of February, 2019.
/' TAMMI LYN DAVIS
_���'�V Notary ID # 129124687
�� � My Commission Expires
Notary Public sr.,Fo ,E,�- September 23, 2020
j C�U�rGtk t-�7 1-�i�.Gf
County, State
POA#: 4221098
SureTec Insurance Company
LIMITED POWER OF ATTORNEY
Know All Men by These Presents, That SURETEC INSURANCE COMPANY (the "Company"), a corporation duly organized and
existing under the laws of the State of Texas, and having its principal office in Houston, Harris County, Texas, does by these presents
make,constitute and appoint
Diane M.Thompson, Farrah Carlton, Gregory Hotchkiss,Jennifer Malone,
Michael J. Hotchkiss,Kenneth G.Hotchkiss,Tye H.Justice,Wesley L.Weatherred,Teri Holley, Kari Fumerola
its true and lawful Attorney-in-fact,with full power and authority hereby conferred in its name,place and stead,to execute,acknowledge
and deliver any and all bonds,recognizances, undertakings or other instruments or contracts of suretyship to include waivers to the
conditions of contracts and consents of surety for:
Five Million and 00/100 Dollars($5,000,000.00)
and to bind the Company thereby as fully and to the same extent as if such bond were signed by the President, sealed with the corporate
seal of the Company and duly attested by its Secretary, hereby ratifying and confirming all that the said Attomey-in-Fact may do in the
premises. Said appointment shall continue in force until 12/31/2016 and is made under and by authority of the following
resolutions of the Board of Directors of the SureTec Insurance Company:
Be it Resolved that the President, any Vice-President, any Assistant Vice-President, any Secretary or any Assistant Secretary shall be and is
hereby vested with full power and authority to appoint any one or more suitable persons as Attomey(s)-in-Fact to represent and act for and on
behalf of the Company subject to the following provisions:
Attorney-in-Fact may be given full power and authority for and in the name of and of behalf of the Company,to execute,acknowledge and
deliver,any and all bonds,recognizances,contracts,agreements or indemnity and other conditional or obligatory undertakings and any and all
notices and documents canceling or terminating the Company's liability thereunder, and any such instruments so executed by any such
Attorney-in-Fact shall be binding upon the Company as if signed by the President and sealed and effected by the Corporate Secretary.
Be it Resolved that the signature of any authorized officer and seal of the Company heretofore or hereafter affixed to any power of attorney or
any certificate relating thereto by facsimile,and any power of attorney or certificate bearing facsimile signature or facsimile seal shall be valid
and binding upon the Company with respect to any bond or undertaking to which it is attached. (Adopted at a meeting held on 20`h of April,
1999.)
In Witness Whereof, SURETEC INSURANCE COMPANY has caused these presents to be signed by its President,and its corporate seal
to be hereto affixed this 21 st day of March,A.D.2013.
SURETEC INSURANCE COMPANY
By:
John kZox Jr: resident
State of Texas ss: 7tP
d
County of Hams �••. -''p'� "
••MMu1�"
On this 21st day of March,A.D.2013 before me personally came John Knox Jr.,to me known,who,being by me duly sworn,did depose and say,that he
resides in Houston, Texas, that he is President of SURETEC INSURANCE COMPANY, the company described in and which executed the above
instrument;that he knows the seal of said Company;that the seal affixed to said instrument is such corporate seal;that it was so affixed by order of the
Board of Directors of said Company;and that he signed his name thereto by like order.
JACQUELYN MALDONADO
Notary Public A f wl �r
State of Texas
My Comm.Exp.5/18/2017 Jacq elyn Maldonado,Notary Public
My commission expires May 18,2017
I,M.Brent Beaty,Assistant Secretary of SURETEC INSURANCE COMPANY,do hereby certify that the above and foregoing is a true and correct copy
of a Power of Attorney,executed by said Company,which is still in full force and effect;and furthermore,the resolutions of the Board of Directors,set
out in the Power of Attorney are in full force and effect.
Given under my hand and the seal of said Company at Houston, Texas this day of September 2016 A.D.
zv{=rte
Bre t Beaty,Assistant ecretary
Any instrument issued in excess of the penalty stated above is totally void and without any validity.
For verification of the authority of this power you may call(713)812-0800 any business day between 8:00 am and 5:00 pm CST.
SURETEC INSURANCE COMPANY
9737 Great Hills Trail, Suite 320, Austin, Tx 78759
OWNER ❑
ARCHITECT ❑
CONSENT OF SURETY CONTRACTOR ❑
TO FINAL PAYMENT SURETY ❑
OTHER ❑
BOND NO.: 4409801
TO OBLIGEE:
(Name and Address) CONTRACT FOR:
City of Ft.Worth Water; Sanitary&Sewer and Paving
200 Texas St. Improvements
Fort Worth,TX 76102
PROJECT: CONTRACT DATED:
(Name and Address) August 11, 20169
7-Eleven-Basswood
4325 N Frwy SE SB; Ft.Worth,TX 76137
PRINCIPAL. Vertical Construction Management, LLC
At the request of the Obligee and the Principal indicated above,(Insert name and address of Surety)
SureTec Insurance Company, 9737 Great Hills Trail, Suite 320,Austin, Tx 78759
SURETY,
on bond of
(Insert name and address of Contractor) Vertical Construction Management, LLC
1209 S White Chapel Blvd., Suite 180; Southlake,TX 76092
,CONTRACTOR,
and conditioned on the representation by Obligee that all Contract provisions relating to the payment of final
payment under the Contract have been satisfied by Principal as of the date of final payment,and that no claims
by Obligee or any third party are known or believed by Obligee or its representatives to exist as of the date of
final payment,representations as to the truth and accuracy of the foregoing conditions being deemed to have
been made by Obligee in connection with this request for Consent of Surety,hereby approves of the final
payment to the Principal,and agrees that final payment in accordance with the terms hereof shall not relieve the
Surety of its obligations to
(Insert name and address of Obligee) City of Ft.Worth
200 Texas St. Fort Worth,TX 76102
OBLIGEE,
as set forth in said Surety's bond.
IN WITNESS WHEREOF,the Surety has hereunto set its hand on this date: March 21, 2018
(Insert in writing the month followed by the numeric date and year.)
SureTTeo Insu ce Co,
(Sureay)
t
(Signature of authorized represen t' e)
Teri Holley
Attest: ,Attorney-in-Fact
(Seal): (Printed name and title)
SURETEC CONSENT TO FINAL PAYMENT REV. 1.1.2004
POA 9. 4221098
SureTec Insurance Coma
LLMTED POWER OF ATTORNEY
.Know All Men by These Presents, That SURETEC INSURANCE COMPANY (the "Company"), a corporation duly organized and
existing under the laws of the State of Texas, and having its principal office in Houston, Harris County, Texas, does by these presents
make,constitute and appoint
Diane M.Thompson, Farrah Carlton, Gregory Hotchkiss,Jennifer Malone,
Michael J. Hotchkiss, Kenneth G. Hotchkiss,Tye H.Justice,Wesley L.Weatherred,Teri Holley, Kari Fumerola
its true and lawful Attorney-in-fact,with full power and authority hereby conferred in its name,place and stead,to execute, acknowledge
and deliver any and all bonds, recognizances, undertakings or other instruments,or contracts of suretyship to include waivers to the
conditions of contracts and consents of surety for,providing the bond penalty does not exceed
Five Million and 00/100 Dollars($5,000,000.00)
and to bind the Company thereby as fully and to the same extent as if such bond were signed by the President, sealed with the corporate
seal of the Company and duly attested by its Secretary,hereby ratifying and confirming all that the said Attorney-in-Fact may do in the
premises. Said appointment shall continue in force until 12/31/2019 and is made under and by authority of the following
resolutions of the Board of Directors of the SureTec Insurance Company:
Be it Resolved, that the President, any Vice-President, any Assistant Vice-President, any Secretary or any Assistant Secretary shall be and is
hereby vested with full power and authority to appoint any one or more suitable persons as Attorneys)-in-Fact to represent and act for and on
behalf of the Company subject to the following provisions:
Attorney-in-Fact may be given full power and authority for and in the name of and of behalf of the Company, to execute, acknowledge and
deliver,any and all bonds,recogaizances,contracts,agreements or indemnity and other conditional or obligatory undertakings and any and all
notices and documents canceling or terminating the Company's liability thereunder, and any such instruments so executed by any such
Attorney-in-Fact shall be binding upon the Company as if signed by the President and sealed and effected by the Corporate Secretary.
Be it Resolved that the signature of any authorized officer and seal of the Company heretofore or hereafter affixed to any power of attorney or
any certificate relating thereto by facsimile,and any power of attorney or certificate bearing facsimile signature or facsimile seal shall be valid
and binding upon the Company with respect to any bond or undertaking to which it is attached. (Adopted at a meeting held on 20"i of April,
1999)
In Witness Whereof,SURETEC INSURANCE COMPANY has caused these presents to be signed by its President, is corporate seal
to be hereto affixed this 15th day of May ,A.D. 2017 .
SURETEC SURAN C
\�SVFtANC�"�4w
By:
UJ i w a John Knox".17idt
State of Texas ss: ``. `' '2=
7 + Y
County of Harris s' `.•....... ' �s
On this 15th day of May ,A.D. 2017 before me personally came John Knox Jr.,to me known,who,being by me , did depose and say,that he
resides in Houston, Texas, that he is President of SURETEC INSURANCE COMPANY, the company described in and which executed the above
instrument;that he knows the seal of said Company;that the seal affixed to said instrument is such corporate seal;that it was so affixed by order of the
Board of Directors of said Company;and that he signed his name thereto by like order.
uuiri
JACQUELYN GREENLEAF
.Notary Public,State of Texas
Comm.Expires 05-16-2021
01 1 Jac 1 Greenleaf Nota Public
°;,,,` Notary ID 126903029 �l yn Notary
My commission expires May 18,2021
I,M.Brent Beaty,Assistant Secretary of SURETEC INSURANCE COMPANY,do hereby certify that the above and foregoing is a true and correct copy
of a Power of Attorney,executed by said Company,which is still in full force and effect;and furthermore,the resolutions of the Board of Directors,set
out in the Power of Attorney are in full force and effect.
Given under my hand and the seal of said Company at Houston, Texas this 21st day of '�,Tarc ^018 A.D.
M.Brent Beaty,Assistant Secretary
Any instrument issued in excess of the penalty stated above is totally void and without any validity.
For verification of the authority of this power you may call(713)812-0800 any business day between 8:00 am and 5:00 pm CST.
SureTec Insurance Company
THIS BOND RIDER CONTAINS IMPORTANT COVERAGE INFORMATION
Statutory Complaint Notice
To obtain information or make a complaint: You may call the Surety's toll free telephone
number for information or to make a complaint at: 1-866-732-0099. You may also write to the
Surety at:
SureTec Insurance Company
9737 Great Hills Trail, Suite 320
Austin, TX 78759
You may contact the Texas Department of Insurance to obtain information on companies,
coverage, rights or complaints at 1-800-252-3439. You may write the Texas Department of
Insurance at
PO Box 149104
Austin, TX 78714-9104
Fax#: 512-475-1771
PREMIUM OR CLAIM DISPUTES: Should you have a dispute concerning your premium or
about a claim, you should contact the Surety first. If the dispute is not resolved, you may
contact the Texas Department of Insurance.
----------------------------------------------------------------------------------------------------------------------------
Terrorism Risks Exclusion
The Bond to which this Rider is attached does not provide coverage for, and the surety shall
not be liable for, losses caused by acts of terrorism, riot, civil insurrection, or acts of war.
------------------------------------------------------------------------------------------------------------------
Exclusion of Liability for
Mold, Mycotoxins, Fungi & Environmental Hazards
The Bond to which this Rider is attached does not provide coverage for, and the surety
thereon shall not be liable for, molds, living or dead fungi, bacteria, allergens, histamines,
spores, hyphae, or mycotoxins, or their related products or parts, nor for any environmental
hazards, bio-hazards, hazardous materials, environmental spills, contamination, or cleanup,
nor the remediation thereof, nor the consequences to persons, property, or the performance
of the bonded obligations, of the occurrence, existence, or appearance thereof.
Texas Rider 010106 1