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Contract 48939-FP1
City Secretary Contract No. 48939 -FPI FORTWORTH. Date Received Sep 27,2018 10633 9' 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:TRAMMELL CROW BUILDING "H" City Project No.: 100839 Improvement Type(s): N Paving N Drainage ❑ Street Lights ❑ Traffic Signals Original Contract Price: $853,236.35 Amount of Approved Change Order(s): -$175,716.40 Revised Contract Amount: $677,519.95 Total Cost of Work Complete: $677,519.95 Sep 24, 2018 Contractor Date Senior Project Manager Title The Conlan Company Company Name r&r�K %%% Sep 26, 2018 James T McKinnon ill(Sep 26.2018) Project Inspector Date Sep 26, 2018 Project Manager Date �7M4i ,2V-1ecttip'naj 9r Sep 26, 2018 Janie Scarlett Morales(Sep 26,2018) CFA Manager Date Swm`L> Sep 27, 2018 Suzan Alanis(Sep 27,2018) Asst. City Manager Date wed OFFICIAL RECORD RACE CITY SECRETARY Page 1 of 2 OCT -�X18 oF�oRTwoRtK FT.WORTH,TX CIN cCCPETARY c�rtt i Notice of Project Completion Project Name:TRAMMELL CROW BUILDING "H" City Project No.: 100839 City's Attachments Final Pay Estimate Change Order(s): 0 Yes ❑ N/A Contractor's Attachments Affidavit of Bills Paid Consent of Surety N �4 Statement of Contract Time Contract Time: 495 CD Days Charged: 495 0 Work Start Date: 4/24/2017 Work Complete Date: 8/31/2018 i 1 'I i i i G' i I i i (I Page 2 of 2 16 00,13 City Project Numbers 100839 DOE Number 0839 i• Contract Name TRAMMELL CROW 352 BLDG H Estimate Number I Contract Limits Payment Number 1 Project Type PAVING&DRAINAGE For Period Ending 9/30/2018 Project Funding t< Project Manager NA City Secretary Contract Number 110839 F t, Inspectors RODGERS / MOORE,R Contract Date 3/31/2017 Contractor THE CONLAN COMPANY Contract Time 365 CD 1501 LBJ FREEWAY STE 550 Days Charged to Date 495 CD FARMERS BRANCH, TX 75234 Contract is .000000 Complete CITY OF FORT WORTH SUMMARY OF CHARGES Line Fund Account Center Amount FunGross Retainage Net Funded------ ------------ F n --------- ----._ .. --........ ---- Total Cost of Work CompletedI� $677,519.95 l� Less %Retained $0.00 1 Net Earned $677,519.95 i Earned This Period $677,519.95 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 $677,519.95 Friday,September 21,2018 Page 4 of 4 d FORT WORTH CITY OF FORT WORTH FINAL PAYMENT REQUEST Contract Name TRAMMELL CROW 352 BLDG H Conti-act Limits Project Type PAVING&DRAINAGE City Project Numbers 100839 DOE Number 0839 Estimate Number I Payment Number I For Period Ending 9/30/2018 CD City Secretary Contract Number 110839 Contract Time 36CD Contract Date 3/31/2017 Days Charged to Date 495 Contract is 100.00 Complete ProjectManager NA Contractor THE CONLAN COMPANY 1501 LBJ FREEWAY STE 550 FARMERS BRANCH, TY 75234 Inspectors RODGERS / MOORE,R Friday,September 21,2018 Pagel of4 City Project Numbers 100839 DOE Number 0839 Contract Name TRAMMELL CROW 352 BLDG H Estimate Number I Contract Limits Payment Number I Project Type PAVING&DRAINAGE For Period Ending 9/30/2018 Project Funding PAVING Item Description of Items Estimated Unit Unit Cost Estimated Completed Completed No. Quanity Total Quanity Total ------------------------------------ — -- 1 EMBANKMENT BY PLAN 2500 CY $15.00 $37,500.00 2500 $37,500.00 2 SWPPP I ACRE 1 LS $7,500.00 $7,500.00 1 $7,500.00 3 8"CONCRETE PAVEMENT(CO#1 Unit Price 7777 SY $29.85 $232,143.45 7777 $232,143.45 Chante) 4 12"CONCRETE CURB AND GUTTER 3910 LF $12.65 $49,461.50 3910 $49,461.50 5 4"SLD PVIAT MARKING HAS(Y) 4066 LF $1.60 $6,505.60 4066 $6,505.60 6 HYDRO MULCH 3796 SY $3.40 $12,906.40 3796 $12,906.40 7 TRAFFIC CONTROL 3 MO $10,000.00 $30,000.00 3 $30,000.00 Sub-Total of Previous Unit $376,016.95 $376,016.95 DRAINAGE Item Description of Items Estimated Unit Unit Cost Estimated Completed Completed No. Quanity Total Quanity Total 1 REMVOE RIP RAP 4389 SF $1.00 $4,389.00 4389 $4,389.00 2 12"STORM SEWER PLUG 1 EA $350.00 $350.00 1 $350.00 3 18"STORM SEWER PLUG 4 EA $500.00 $2,000.00 4 $2,000.00 4 REMOVE HEADWALUSET 1 EA $750.00 $750.00 1 $750.00 5 TRENCH SAFETY(CO#1) 324 LF $1.00 $324.00 324 $324.00 6 CONCRETE COLLAR 2 EA $500.00 $1,000.00 2 $1,000.00 7 12"PVC STORM PIPE 5 LF $35.00 $175.00 5 $175.00 8 18"REINFORCED CONCRETE PIPE 84 LF $45.00 $3,780.00 84 $3,780.00 9 24"RCP CLASS Ill 155 LF $50.00 $7,750.00 155 $7,750.00 10 48"RCP CLASS UI 45 LF $75.00 $3,375.00 45 $3,375.00 11 6'X5'REINFORCED CONCRETE BOX CULVERT 1619 LF $165.00 $267,135.00 1619 $267,135.00 12 10'CURB INLET(CO 91) 3 EA $2,500.00 $7,500.00 3 $7,500.00 13 5'DROP INLET 1 EA $2,000.00 $2,000.00 1 $2,000.00 14 21"RCP,Class III(CO#1) 20 LF $48.75 $975.00 20 $975.00 Sub-Total of Previous Unit $301,503.00 $301,503.00 Friday,September 21,2018 Page 2 of 4 City Project Numbers 100839 DOE Number 0839 Contract Name TRAMMELL CROW 352 BLDG H Estimate Number 1 Contract Limits Payment Number I Project Type PAVING&DRAINAGE For Period Ending 9/30/2018 Project Funding Contract Information Summary Original Contract Amount $853,236.35 Change Orders Change Order Number 1 ($175,716.40) Total Contract Price $677,519.95 Total Cost of Work Completed $677,519.95 Less %Retained $0.00 Net Earned $677,519.95 Earned This Period $677,519.95 Retainage This Period $0.00 Less Liquidated Damages Days rr /Day $0.00 LessPavement Deficiency $0.00 Less Penalty $0.00 Less Previous Payment $0.00 Phis Material on Hand Less 15% $0.00 Balance Due This Payment $677,519.95 Friday,September 21,2018 Page 3 of 4 � � DEVELOPER-AWARDED-PROJECT CHAN E ORDER(REVICFDI 1 PROJECT NAME: Trammoll Crow 352 BldgH CHANGE CONTRACT: Water.Sewer Pawn Storm Drain.Sheet lights ORDER No: CFA X 2017.036 CITY PARTICIPATION: No CITY PROJECT It 100839 DOE 9 NIA 1 { WATER PROJECT# 56008.0600430-110839-001480 SEWER PROJECT9 560080600430-110839.001480 FILE 8 W-2465 INSPECTOR: Tommy McKinnon Phone No: 817.392.8306 PROJECT MANAGER: Fred Ehia Phone No: 817.392.8424 CONTRACT UNIT WATER SEWER PAVING DRAINAGE STREETLIGHTS SURVEY PPM BONDS CONTRACT DAYS D¢v¢f. rC.sl CWCmI D¢val. rL¢sl CN fest D¢v4r b Cast CftCM Oevel¢ rC.st Cost DOvel.er C¢sl Cost D4rN¢ rC.xl ml CDevcl. rt¢et CeN L ORIGINAL CONTRACT 5351]9].00 1600 5121.579.00 1000 5155]42]5 am $290,000.00 som 599606.00 9000 sew 91100 50.00 It600 EXTRAS TO DATE 50.00 5000 50.00 16o0 Moll 10.00 $o.00 5600 50.00 IbLO 50.00 {000 50.00 1000 CREDITS TO DATE 50.00 SOLO 50.00 50.00 50.00 5600 wow 1600 50.00 wM $0.00 5600 50.00 50.00 CONTRACT TO DATE 5354793.00 5600 5121579.00 SOAR 5555342.35 1600 5290,00600 Sew 599606.00 1000 $0.00 SOAO 50.00 sm 0 AMOUNT OF PROP.CHANGE ORDER t12.300.W 50.00 IS1.64000 1000 -TM.32 . 1600 53495.00 -5600 •u1.6M.[6 $50 SOHO 5600 SOHO 5000 REVISED ITRACT W.,UNT5342.493.00 f6W 5119.719.00 1600 5]76016.95 00 5301.50].00 50.00 50,00 f000 50.00 50,00 50.6 mm e TOTALREVISED CONTRACT- PERU1 4R 531 493.00 3119739.0 5]16016.95 5301,500.00 59.00 $0.00 50.00 REVISED COST SHARE O.V-Cost: $1,139,751.95 CIIy CCM: SOHO TOTAL REVISED CONTRACT $1,139,751.95 V.0 arc dralcd to moFe the loltowin rh4n ex In the mnlract documents: i ic m elD nT:L1 PAYTELI. ? QUANTITY UNIT MA DESCRIPTION UNITPRICE TOTAL WATER 3311.0604 •164 LF24'C-t1AWW C11 WRIef Pia Ra30alned Jl. 725 -5118900.00 3311.0655 1G4 LF 24•Dip W.I.,CS58addal tRnstrain4d J.inl¢I 650 510Q600.00 TOTAL LYATER 412 00.00 SEVIER 3331AIGII -28 LF 16-SEWER SERVICE 530.00 1 -$840.00 3339.0003 I STEWATER ACCESS CHAMBER 51,000.00 -SI.000.00 I TOTAL SEWER -51.840.00_ PAVING 3213.0107 -77]7 SF e•C.ncrel¢Pavement 540.05 5311.468.85 1 ]213.010] ]7T! SF 8-COncral.Pav¢m.m 529.65 5232.143.45 7 -S79.325.40 - _ - STORM - - 3305.0109 20LF I-,.-Sale 1 $20.00 1i 3341.0201 20 1 LF 21-RCP.Cl-111 540.75 $975.00 3349.5001 1 1 1 EA 10'CWbinl.t 52.500.00 52.500.00 TOTAL STORM 5]495.00 STREETLIGHTS --- 2605.3118 -2498 LF FUMISnAnsiall Conduil•Schctlut.80 PVC 2 inch 0 nCul I 510.00 -524.980.00 3441.1501 -6 EAG..od Box T o 8 $757.00 -54 54200. 3441.3051 •14 EA FUm15n4n51911LED hli Fixture 137 wall A782 Cobra) 5559.00 -57,826.00 3441.3302 •14 EA RQ Ilium F9undellon TY35.6..M8 SI575.00 •522.050.00 3441.3357 -fY FJL Fuml5Mnstall Rdvy Illum TY D-40-9 Pale 52892.00 •540A88.00 j TOTAL ELECTRIC -599686.00 REASONS FOR CHANGE ORDER 5,bsk-OIPil NMl1 o403D]Pg. u 4,500I#IOMiM(7rA pk-:mw as42 brm) d.b,V soM V= { NO CITY FUNDS INVOLVED W THIS CONTRACT,DEVELOPER W RESPONSIBLE FOR 100%OF THE CNANGE ORDER COST AND NO REIMBURSEMENT FROM THE CRY MALL BESOUGHT BY THE DEYROPER. RECOMMENDED: APPRO APPROVED: {� 1 _ r , Nam.:DennisJChovan Nemo:Robert 8randl Nam.: en m<or �! Tills:Vico Pre9ldent Two:Prl w.1 Tid.:Sani.r P,.i.cl I.Iana¢cr dl tj Revis¢d:10-12.2011 Page I Contractor Final Payment Affidavit Building A, H J 3( 5 Eagle Trammell Crow Addition Texas_ Tarrant Project State - County --The Conlan Company —� Trammell Crow Comp-gin _— Contractor Owner -— Sub1ect _ Contract entered into the _ 31 st day of March 2017 --- Day -- ------ Month --------- Year ------ Between the above mentioned parties for the construction of Buildinq A,H,J(35 Eagle Trammell Crow Addition-Cit Pro'ect#100839 --�-.1___—_ _— (Building) at ^ Fort Worth _ Texas Address City State — Know all men by these presents: 1. The undersigned hereby certify(ies)that all work employees,subcontractors,or the public at large arising required under the above contract has been performed in out of the performance of the Contract,or any suits or accordance with the terms hereof,that all materialmen, claims for any other damage of any kind,nature,or subcontractors,mechanics,and laborers have been paid description which might constitute'a lien upon the property and satisfied in full except for retention as withheld by of the Owner. Owner,and that there are not outstanding claims of any character arising out of the performance of the contract 3. The undersigned make(s)this affidavit for the purpose which have not been paid and satisfied in full. of receiving final payments in full settlement of all claims arising under or by virtue of the Contract,and acceptance 2. The undersigned further certify(ies)that to the best of of such payment is acknowledged as a release of the their(his)knowledge and belief,there are no unsatisfied Owner from any and all claims arising under or by virtue of claims for damages arising from injury or death to any the Contract. Si natures I In witness whereof,the undersigned has signed and seated this instrument this day of — Day - ---� Month Year Signed Date Notary Public .........._. Personally appeared before the undersigned, Who,after being fully sworn,depose and state that the facts stated in the above affidavit are true. Notary Public By: _ Residence My commission expires: — Consent of Surety The undersigned hereby consents to the final release of all contract funds pertaining to the above contract. Bonding Company C ti ental Casualty CyompaIMM—A s� CxiL,N� � l7` _ Attorney-In-Fact Deborah B. Sasser,Attorney-in-Fact Address McGriff Insurance services 3100 Royal Blvd.South, Alpharetta,GA 30022 Date _ --._.. __--- August 1, 2018 POWER OF ATTORNEY APPOINTING INDIVIDUAL ATTORNEY-IN-FACT Know All Men By These Presents,That Continental Casualty Company,an Illinois insurance company,National Fire Insurance Company of Hartford,an Illinois insurance company,and American Casualty Company of Reading,Pennsylvania,a Pennsylvania insurance company(herein called "the CNA Companies"),are duly organized and existing insurance companies having their principal offices in the City of Chicago,and State of Illinois, and that they do by virtue of the signatures and seals herein affixed hereby make,constitute and appoint Travis G Huffines,Brian E Madden,Deborah B Sasser,Holli Orr,Brittany L Triplett,Individually of Alpharetta,GA,their true and lawful Attorneys)-in-Fact with full power and authority hereby conferred to sign,seal and execute for and on their behalf bonds,undertakings and other obligatory instruments of similar nature -In Unlimited Amounts- i i and to bind them thereby as fully and to the same extent as if such instruments were signed by a duly authorized officer of their insurance companies and all the acts of said Attorney,pursuant to the authority hereby given is hereby ratified and confirmed. j This Power of Attorney is made and executed pursuant to and by authority of the By-Law and Resolutions,printed on the reverse hereof,duly adopted,as indicated,by the Boards of Directors of the insurance companies. In Witness Whereof,the CNA Companies have caused these presents to be signed by their Vice President and their corporate seals to be hereto affixed on this 24th day of August,2017. i �cnsuq�r tNSURgN �sANroa Continental Casualty Company l Al , National Fire Insurance Company of Hartford ,,WORAr o aaroRgT Pennsylvania lvania A American Cas ally Company of Reading, y 0o SEAL �y 10isoz r, a 1897 � HARZFO� • � � . Paul T.Bruflat Vice President State of South Dakota,County of Minnehaha,ss: On this 24th day of August,2017,before me personally came Paul T.Bruflat to me known,who,being by me duly sworn,did depose and say: that he resides in the City of Sioux Falls,State of South Dakota;that he is a Vice President of Continental Casualty Company,an Illinois insurance company, National Fire Insurance Company of Hartford,an Illinois insurance company,and American Casualty Company of Reading,Pennsylvania,a Pennsylvania insurance company described in and which executed the above instrument;that he knows the seals of said insurance companies;that the seals affixed to the said instrument are such corporate seals;that they were so affixed pursuant to authority given by the Boards of Directors of said insurance companies and that he signed his name thereto pursuant to like authority,and acknowledges same to be the act and deed of said insurance companies. frrrsrsrf, J.MOHR soumnwwr�t womak'4 uc� 69P i My Commission Expires June 23,2021 J,Mohr Notary Public i CERTIFICATE i 1,D.Johnson,Assistant Secretary of Continental Casualty Company,an Illinois insurance company,National Fire Insurance Company of Hartford, an Illinois insurance company,and American Casualty Company of Reading,Pennsylvania,a Pennsylvania insurance company do hereby certify that the Power of Attorney herein above set forth is still in force,and further certify that the By-Law and Resolution of the Board of Directors of the insurance companies printed on the reverse hereof is still in force. In testimony whereof I have hereunto subscribed my name and affixed the seal of the said insurance companies this 1St day of August 2018 I �GASUq(� tNSURgy �(SA►riOF Continental Casualty Company National Fire Insurance Company of Hartford coAPoRAte Fya`�N(ORPO&qT�O F� American Casualty Company of Reading,Pennsylvania JULY 31. >n v SEAL �c `may isot T a � 1897 � HAt1�0� � � • i D.Johnson Assistant Secretary Form F6853-412012 I t Figure: 28 TAC§1.601(x)(3) 1 IMPORTANT NOTICE AVISO IMPORTANTE To obtain information or make a complaint: Para obtener informacion o para someter una queja: 2 You may contact Continental Casualty Company, Puede comunicarse con Continental Casualty National Fire Insurance Company of Hartford, Company,National Fire Insurance Company de American Casualty Company of Reading,PA and Hartford,American Casualty Company de Reading, PA Continental Insurance Company at 312-822-5000. y Continental Insurance Company al 312-822-5000. 3 You may call Continental Casualty Company, Usted puede Ilamar al numero de telefono gratis de National Fire Insurance Company of Hartford, Continental Casualty Company, National Fire American Casualty Company of Reading, PA and Insurance Company de Hartford,American Casualty Continental Insurance Company's toll-free telephone Company de Reading, PA y Continental Insurance number for information or to make a complaint at: Company's para informacion o para someter una queja at: 1-877-672-6115 1-877-672-6115 4 You may also write to Continental Casualty Usted tambien puede escribir a Continental Casualty l Company, National Fire Insurance Company of Company, National Fire Insurance Company de Hartford,American Casualty Company of Reading, Hartford,American Casualty Company de Reading, PA and Continental Insurance Company at: PA y Continental Insurance Company: CNA Surety CNA Surety 333 South Wabash 333 South Wabash I Chicago, IL 60604 Chicago,IL 60604 I i 5 You may contact the Texas Department of Puede comunicarse con el Departamento de Seguros Insurance to obtain information on companies, de Texas para obtener informacion acerca de coverages,rights or complaints at: companias,coberturas, derechos o quejas al: l 1-800-252-3439 1-800-252-3439 I 6 You may write the Texas Department of Puede escribir at Departamento de Seguros de Insurance: Texas: P.O.Box 149104 P.O. Box 149104 Austin,TX 78714-9104 Austin,TX 78714-9104 Fax: (512)490-1007 Fax:(512)490-1007 Web: www,tdi.texas.gov Web: www.tdi.texas.gov E-Mail: ConsumerProtection@tdi.texas.gov E-Mail: ConsumerProtection@tdi.texas.gov ' 7 PREMIUM OR CLAIM DISPUTES: DISPUTAS SOBRE PRIMAS O RECLAMOS: Should you have a dispute concerning your Si tiene una disputa concerniente a su prima o a premium or about a claim you should contact un reclamo,debe comunicarse con el Continental Continental Casualty Company, National Fire Casualty Company, National Fire Insurance Insurance Company of Hartford,American Casualty Company de Hartford,American Casualty Company Company of Reading, PA and Continental Insurance de Reading, PA y Continental Insurance Company Company first. If the dispute is not resolved,you primero. Si no se resuelve la disputa, puede may contact the Texas Department of Insurance. entonces comunicarse con el departamento(TDI). 8 ATTACH THIS NOTICE TO YOUR POLICY: UNA ESTE"ISO A SU POLIZA: Este aviso es This notice is for information only and does not solo para proposito de informacion y no se become a part or condition of the attached convierte en parte o condicion del documento document. adjunto. I Form F8277-8-2015 POWER OF ATTORNEY APPOINTING INDIVIDUAL ATTORNEY-IN-FACT Know All Men By These Presents,That Continental Casualty Company,an Illinois insurance company,National Fire Insurance Company of Hartford,an Illinois insurance company,and American Casualty Company of Reading,Pennsylvania,a Pennsylvania insurance company(herein called "the CNA Companies"),are duly organized and existing insurance companies having their principal offices in the City of Chicago,and State of Illinois, and that they do by virtue of the signatures and seals herein affixed hereby make,constitute and appoint Travis G Huffines,Brian E Madden,Deborah B Sasser,Holli Orr,Brittany L Triplett,Individually of Alpharetta,GA,their true and lawful Attorneys)-in-Fact with full power and authority hereby conferred to sign,seal and execute for and on their behalf bonds,undertakings and other obligatory instruments of similar nature -In Unlimited Amounts- I and to bind them thereby as fully and to the same extent as if such instruments were signed by a duly authorized officer of their insurance companies and all the acts of said Attorney,pursuant to the authority hereby given is hereby ratified and confirmed. This Power of Attorney is made and executed pursuant to and by authority of the By-Law and Resolutions,printed on the reverse hereof,duly adopted,as indicated,by the Boards of Directors of the insurance companies. In Witness Whereof,the CNA Companies have caused these presents to be signed by their Vice President and their corporate seals to be hereto I affixed on this 24th day of August,2017. GASUq1tigU8q Continental Casualty Company �cF �° o,� National Fire Insurance Company of Hartford 00MORg7F , c $'�NCaaegaAr�o A American Cas alty Company of Reading,Pennsylvania Z + 1U�Z 1, °v SEALy Trf� a 1897 � HAptf�� i Paul T.Bruflat Vice President i State of South Dakota,County of Minnehaha,ss: j On this 24th day of August,2017,before me personally came Paul T.Bruflat to me known,who,being by me duly sworn,did depose and say: that j he resides in the City of Sioux Falls,State of South Dakota;that he is a Vice President of Continental Casualty Company,an Illinois insurance company, National Fire Insurance Company of Hartford,an Illinois insurance company,and American Casualty Company of Reading,Pennsylvania,a Pennsylvania insurance company described in and which executed the above instrument;that he knows the seals of said insurance companies;that the seals affixed to the said instrument are such corporate seals;that they were so affixed pursuant to authority given by the Boards of Directors of said insurance companies and that he signed his name thereto pursuant to like authority,and acknowledges same to be the act and deed of said insurance companies. I J.MOHR �ewtuArvuauc� ""'"�' eEA1�soun+on,wr� My Commission Expires June 23,2021 J.Mohr Notary Public CERTII+ICATE i I,D.Johnson,Assistant Secretary of Continental Casualty Company,an Illinois insurance company,National Fire Insurance Company of Hartford, an Illinois insurance company,and American Casualty Company of Reading,Pennsylvania,a Pennsylvania insurance company do hereby certify that the Power of Attorney herein above set forth is still in force,and further certify that the By-Law and Resolution of the Board of Directors of the insurance companies printed on the reverse hereof is still in force. In testimony whereof I have hereunto subscribed my name and affixed the seal of the said insurance companies this 1Stday of August 2018 I �GAStlq<) iNSURq� q�yptrrpp Continental Casualty Company X. �F tial Po� National Fire Insurance Company of Hartford 2� coavvRarE c `Q ��y0aeat;,;r�o American Casualty Company of Reading,Pennsylvania Get SEAL �e ' I ern luLSu21' y � � a 1a97 D.Johnson Assistant Secretary Foran F6853-412012 I Figure: 28 TAC§1.601(a)(3) 1 IMPORTANT NOTICE AVISO IMPORTANTE To obtain information or make a complaint: Para obtener informacion o para someter una queja: 2 You may contact Continental Casualty Company, Puede comunicarse con Continental Casualty National Fire Insurance Company of Hartford, Company, National Fire Insurance Company de American Casualty Company of Reading,PA and Hartford,American Casualty Company de Reading, PA Continental Insurance Company at 312-822-5000. y Continental Insurance Company al 312-822-5000. 3 You may call Continental Casualty Company, Usted puede Ilamar al numero de telefono gratis de National Fire Insurance Company of Hartford, Continental Casualty Company, National Fire American Casualty Company of Reading, PA and Insurance Company de Hartford,American Casualty Continental Insurance Company's toll-free telephone Company de Reading,PA y Continental Insurance number for information or to make a complaint at: Company's para informacion o para someter una queja al: 1-877-672-6115 1-877-672-6115 4 You may also write to Continental Casualty Usted tambien puede escribir a Continental Casualty Company, National Fire Insurance Company of Company, National Fire Insurance Company de Hartford,American Casualty Company of Reading, Hartford,American Casualty Company de Reading, PA and Continental Insurance Company at: PA y Continental Insurance Company: CNA Surety CNA Surety 333 South Wabash 333 South Wabash Chicago, IL 60604 Chicago,IL 60604 5 You may contact the Texas Department of Puede comunicarse con el Departamento de Seguros Insurance to obtain information on companies, de Texas para obtener informacion acerca de coverages,rights or complaints at: companias,coberturas, derechos o quejas al: 1 1-800-252-3439 1-800-252-3439 I 6 You may write the Texas Department of Puede escribir at Departamento de Seguros de Insurance: Texas: P.O. Box 149104 P.O. Box 149104 Austin,TX 78714-9104 Austin,TX 78714-9104 Fax: (512)490-1007 Fax:(512)490-1007 Web: www.idi.texas.gov Web: www.tdi.texas.gov E-Mail: ConsumerProtection@tdi.texas.gov E-Mail: ConsumerProtection@tdi.texas.gov 7 PREMIUM OR CLAIM DISPUTES: DISPUTAS SOBRE PRIMAS O RECLAMOS: Should you have a dispute concerning your Si tiene una disputa concerniente a su prima o a premium or about a claim you should contact un reclamo,debe comunicarse con el Continental Continental Casualty Company, National Fire Casualty Company, National Fire Insurance Insurance Company of Hartford,American Casualty Company de Hartford,American Casualty Company Company of Reading,PA and Continental Insurance de Reading, PA y Continental Insurance Company Company first. If the dispute is not resolved,you primero. Si no se resuelve la disputa,puede may contact the Texas Department of Insurance. entonces comunicarse con el departamento(TDI). 8 ATTACH THIS NOTICE TO YOUR POLICY: UNA ESTE"ISO A SU POLIZA: Este aviso es This notice is for information only and does not solo para proposito de informacion y no se become a part or condition of the attached convierte en parte o condicion del documento document. adjunto. I Form F8277-6-2015 =--- Green Sheet Trammell Crow . �. Building H CPN 100839 P&D Adobe Sign Document History 10/08/2018 Created: 09/21/2018 By: Etta Bacy(etta.bacy@fortworthtexas.gov) Status: Signed v Transaction ID: CBJCHBCAABAAYDVkIJ498-ns5lbOM24_PBOwIFC_g2oh "Green Sheet Trammell Crow Building H CPN 100839 P&D" Hist o ry Document created by Etta Bacy(etta.bacy@fortworthtexas.gov) 09/21/2018-2:15:51 PM CDT-IP address:209.194.29.100 C4 Document emailed to Ben Bratcher(bbratcher@conlancompany.com)for signature 09/21/2018-2:20:58 PM CDT D Document viewed by Ben Bratcher(bbratcher@coniancompany.com) 09/21/2018-4:33:04 PM CDT-IP address: 107.77.201.157 i Ben Bratcher(bbratcher@conlancompany.com) uploaded the following supporting documents: File Attachment 1 (� File Attachment 2 09/24/2018-2:04:28 PM CDT da Document e-signed by Ben Bratcher(bbratcher@conlancompany.com) Signature Date:09/24/2018-2:04:28 PM CDT-Time Source:server-IP address: 12.186.63.226 124 Document emailed to James T McKinnon III (tommy.mckinnon@fortworthtexas.gov)for signature 09/24/2018-2:04:30 PM CDT Document viewed by James T McKinnon III (tommy.mckinnon@fortworthtexas.gov) 09/26/2018-10:15:09 AM CDT-IP address: 107.77.196.135 46, Document e-signed by James T McKinnon III (tommy.mckinnon@fortworthtexas.gov) Signature Date:09/26/2018-10:19:03 AM CDT-Time Source:server-IP address:107.77.196.172 C; Document emailed to Edward D'avila (edward.davila@fortworthtexas.gov)for approval 09/26/2018-10:19:04 AM CDT FORT WORTH. _, v Adobe sign Document viewed by Edward Davila (edward.davila@fortworthtexas.gov) 09/26/2018-2:38:00 PM CDT-IP address:209.194.29.100 bo Document approved by Edward Davila (edward.davila@fortworthtexas.gov) Approval Date:09/26/2018-2:44:42 PM CDT-Time Source:server-IP address:209.194.29.100 Cy, Document emailed to Fred Ehia (freidoon.ehia@fortworthtexas.gov)for signature 09/26/2018-2:44:44 PM CDT Document viewed by Fred Ehia (freidoon.ehia@fortworthtexas.gov) 09/26/2018-2:45:57 PM CDT-IP address:209.194.29.100 Document e-signed by Fred Ehia (freidoon.ehia@fortworthtexas.gov) E-signature hosted by Etta Bacy (etta.bacy@fortworthtexas.gov) Signature Date:09/26/2018-2:49:05 PM CDT-Time Source:server-IP address:209.194.29.100 C� Document emailed to Janie Scarlett Morales (Janie.morales@fortworthtexas.gov)for signature 09/26/2018-2:49:08 PM CDT ` Document viewed by Janie Scarlett Morales Qanie.morales@fortworthtexas.gov) 09/26/2018-4:19:59 PM CDT-IP address:209.194.29.100 LYa Document e-signed by Janie Scarlett Morales (Janie.morales@fortworthtexas.gov) Signature Date:09/26/2018-4:22:12 PM CDT-Time Source:server-IP address:209.194.29.100 D-► Document emailed to Susan Alanis (susan.alanis@fortworthtexas.gov)for signature 09/26/2018-4:22:15 PM CDT �) Document viewed by Susan Alanis (susan.alanis@fortworthtexas.gov) 09/27/2018-11:37:53 AM CDT-IP address:209.194.29.100 60 Document e-signed by Susan Alanis (susan.alanis@fortworthtexas.gov) Signature Date:09/27/2018-11:38:12 AM CDT-Time Source:server-IP address:209.194.29.100 Document emailed to Allison Tidwell (cso_finalpay@fortworthtexas.gov)for filling 09/27/2018-11:38:14 AM CDT 5 Document viewed by Allison Tidwell (cso_finalpay@fortworthtexas.gov) 09/27/2018-12:53:19 PM CDT-IP address:209.194.29.100 6© Form filled by Allison Tidwell (cso_finalpay@fortworthtexas.gov) Form filling Date:09/27/2018-12:54:24 PM CDT-Time Source:server-IP address:209.194.29.100 C'' Document emailed to Trudy Brotherton (therese.brotherton@fortworthtexas.gov)for delivery 09/27/2018-12:54:26 PM CDT 5 Document viewed by Trudy Brotherton (therese.brotherton@fortworthtexas.gov) 09/27/2018-12:54:58 PM CDT-IP address:209.194.29.100 FORT WORTH, Adobe Sig G`o. Document receipt acknowledged by Trudy Brotherton (therese.brotherton@fortworthtexas.gov) Receipt Acknowledgement Date:09/27/2018-12:55:18 PM CDT-Time Source:server-IP address:209.194.29.100 E-4 Document emailed to Julie A Geho Qulie.geho@fortworthtexas.gov)for delivery 09/27/2018-12:55:20 PM CDT L-3 Document viewed by Julie A Geho oulie.geho@fortworthtexas.gov) 09/27/2018-1:25:34 PM CDT-IP address:209.194.29.100 Uo Document receipt acknowledged by Julie A Geho Qulie.geho@fortworthtexas.gov) Receipt Acknowledgement Date:09/27/2018-1:26:49 PM CDT-Time Source:server-IP address:209.194.29.100 C Document emailed to Monica De Anda (monica.deanda@fortworthtexas.gov)for delivery 09/27/2018-1:26:51 PM CDT Q Document viewed by Monica De Anda (monica.deanda@fortworthtexas.gov) 10/03/2018-10:17:15 AM CDT-IP address:209.194.29.100 4g, Document receipt acknowledged by Monica De Anda (monica.deanda@fortworthtexas.gov) Receipt Acknowledgement Date:10/03/2018-10:17:27 AM CDT-Time Source:server-IP address:209.194.29.100 24 Document emailed to Sylvia Kelley (tpwcfafiscal@fortworthtexas.gov)for delivery 10/03/2018-10:17:48 AM CDT Document viewed by Sylvia Kelley(tpwcfafiscal@fortworthtexas.gov) 10/08/2018-2:25:06 PM CDT-IP address:209.194.29.100 e Document receipt acknowledged by Sylvia Kelley(tpwcfafiscal@fortworthtexas.gov) Receipt Acknowledgement Date:10/08/2018-2:25:22 PM CDT-Time Source:server-IP address:209.194.29.100 Signed document emailed to Etta Bacy(etta.bacy@fortworthtexas.gov), Susan Alanis (susan.alanis@fortworthtexas.gov), Ben Bratcher(bbratcher@conlancompany.com), James T McKinnon III (tommy.mckinnon@fortworthtexas.gov), and 8 more 10/08/2018-2:25:22 PM CDT Foxe Adobe sign