HomeMy WebLinkAboutContract 48056-FP3 :paMnt of TP&W Const.services
►N# Date
skM Manager IT WORTH,
sk Management Cana '
O.E. Brotherton CITY SECRETARY
=A Morales/scanned CONTRACT NO. Q5�
itzler/Scanned � i
ie Proceeding people have been Contacted
►nceming the request for final payment&have ;ATION AND PUBLIC WORKS
leased this project for such payment. V PROJECT COMPLETION
Developer Projects)
iearance Conducted By oasna6 . �� City Project Ns: 100373
C# ' - .�c r�eo� ids z#1080-66
Regarding contract 100373 for 7-ELEVEN SOUTHWEST BASSWOQD ADDITION as required by the
TRANSPORTATION& PUBLIC WORKS as approved by City Council on N/A through M&C N/A the director
of the TRANSPORTATION&PUBLIC WORKS upon the recommendation of the Assistant Director of the
Transportation&Public Works Department has accepted the project as complete
Original Contract Price: $30,447.58 ,
Amount of Approved Change Orders: NO sus
Revised Contract Amount:
Total Cost Work Completed: $30,447.58
Recommended �A ptance Date
Asst. Director, - Development Services
C�J 1� r 2 rY
Accepted 0 Date
Director, TRANSPORTATION &PUBLIC WORKS
Asst. City)manager Date
Comments:
OFFICIAI. RECORD
'9 CITY SECRETARY
G` f FT WORTH TX `
0
Rev.9/2?/lib'- y v-
FORT WORTH
CITY OF FORT WORTH
FINAL PAYMEN REQUEST
Contract Name 7-ELEVEN SOUTHWEST BAS WOOD ADDITION
Contract Limits
Project Type PAVING&ST LIGHT
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 1I0;D
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, TXI 76092
Inspectors LAYER / ODE
Wednesday,February 21,2018 Page 1 of 5
1 ,
City Project Numbers 100373 DOE Number 0373
Contract Name 7-ELEVEN SOUTHWEST BASSWOOD ADDITION Estimate Number 1
Contract Limits Payment Number 1
Project Type PAVING&ST LIGHT For Period Ending 2/19/2018
Project Funding
PAVING
Item Description of Items Estimated Unit Unit Cost Estimated Completed Completed
No. Quanity Total Quanity Total
-------- ---- ---- - --- ----- --
1 FULL DEPTH SAWCUT PAVEMENT 79 LF $8.00 $632.00 79 $632.00
2 REMOVE CONC CURB&GUTTER 75 LF $4.28 $321.00 75 $321.00
3 HYDRATED LIME 2 TN $175.00 $350.00 2 $350.00
4 6"LIME TREATMENT 144 SY $3.33 $479.52 144 $479.52
5 7"CONCRETE DRIVEWAY 1158 SF $3.44 $3,983.52 1158 $3,983.52
6 4"CONC SIDEWALK 1066 SF $3.94 $4,200.04 1066 $4,200.04
7 6"CONC CURB&GUTTER 70 LF $20.20 $1,414.00 70 $1,414.00
-------------- ----- - -------------------
Sub-Total of Previous Unit $11,380.08 $11,380.08
STREET LIGHT
Item Description of Items Estimated Unit Unit Cost Estimated Completed Completed
No. Quanity Total Quanity Total
---------------------------------------
I CONDUIT BOX 1 EA $783.00 $783.00 1 $783.00
2 2"CONDT PVC SCH 80 400 LF $22.42 $8,968.00 400 $8,968.00
3 2"CONDT RM I LF $22.42 $22.42 1 $22.42
4 8/C 14 AWG MULTI CONDUCTOR CABLE 400 LF $1.17 $468.00 400 $468.00
5 LED LIGHTING FIXTURE I EA $633.00 $633.00 1 $633.00
6 RDWY ILLUM ASSEMBLY I EA $905.89 $905.89 1 $905.89
7 RDWY ILLUM FOUNDATION ------- 1 EA $984.84 $984.84 - 1 - $984.84
-------- -- -----
Sub-Total of Previous Unit $12,765.15 $12,765.15
MISC IMPROVEMENTS
Item Description of Items Estimated Unit Unit Cost Estimated Completed Completed
No. Quanity Total Quanity Total
- ---- ---- ---- --------- ----------
I SITE CLEARING 1 LS $2,000.00 $2,000.00 1 $2,000.00
2 UNCLASSIFIED EXCAVATION BY PLAN 33 CY $8.35 $275.55 33 $275.55
3 BORROW BY PLAN 28 CY $6.90 $193.20 28 $193.20
4 SWPPP>1 ACRE 1 LS $1,000.00 $1,000.00 1 $1,000.00
5 4"SLD PVMT MARKING TAPE 45 LF $2.58 $116.10 45 $116.10
6 24"SLD PVMT MARKING HAE 20 LF $8.84 $176.80 20 $176.80
7 REMOVE AND REINSTALL SIGN PANEL AND 2 EA $100.00 $200.00 2 $200.00
POST
Wednesday,February 21,2018 Page 2 of 5
City Project Numbers 100373 DOE Number 0373
Contract Name 7-ELEVEN SOUTHWEST BASSWOOD ADDI110N Estimate Number I
Contract Limits Payment Number I
Project Type PAVING&ST LIGHT For Period Ending 2/19/2018
Project Funding
8 FURNISH/INSTALL ALUM SIGN GROUND Z EA $300.00 $600.00 2 $600.00
MOUNT CITY STD
9 SEEDING,HYDROMULCH 67 SY $1.57 $1,051.90 670 $1,051.90
10 TOPSOIL 16 3 CY $4.10 $688.80 168 $688.80
-------------------- ------------------
Sub-Total of Previous Unit $6,302.35 $6,302.35
I
Wednesday,February 21,2018 Page 3 of 5
City Project Numbers 100373 DOE Number 0373
Contract Name 7-ELEVEN SOUTHWEST BASSWOOD ADDITION Estimate Number 1
Contract Limits Payment Number 1
Project Type PAVING&ST LIGHT For Period Ending 2/19/2018
Project Funding
Contract Information Summary
Original Contract Amount $30,447.58
Change Orders
Total Contract Price $30,447.58
U`—' Date /7i! Total Cost of Work Completed $30,447.58
Contractor Less %Retained $0.00
Date
3"l Y-Al' Net Earned $30,447.58
Inspe 'on Supervisor Earned This Period $30,447.58
Retainage This Period $0.00
—z4
Date Less Liquidated Damages
roject M er
Days @ /Day $0.00
Date t LessPavement Deficiency $0.00
Ass. irec Less Penalty $0.00
. �✓ Date Less Previous Payment $0.00
Directod Contracting Depart nt Plus Material on Hand Less 15% $0.00
Balance Due This Payment $30,447.58
Wednesday,February 21,2018 Page 4 of 5
City Project Numbers 100373 DOE Number 0373
Contract Name 7-ELEVEN SOUTHWEST BASSWOOD ADD TION Estimate Number 1
Contract Limits Payment Number 1
Project Type PAVING&ST LIGHT 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 $30,447.58
Less %Retained $0.00
Net Earned $30,447.58
Earned This Period $30,447.58
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 $30,447.58
Wednesday,February 21,2018 Page 5 of 5
FORT'WORTH 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
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 WR 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.
8. 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 0 0 0 0 470 470
PERIOD
PREVIOUS 0 0 0 0 0
PERIOD
TOTALS 0 0 0 0 [470 470
TO DATE
*REMARKS:
CONTRACTOR DATE INSPECTOR DATE
_ ENGINEERING DEPARTMENT
The City of Fort Worth• 1000 Throckmorton Street•Fort Worth,TX 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
We an Oden Go al Sahu
DOE Number Project D cu4 T)pe of Contract
CPN#100373 Q Simple Q Routine Q Complex Water Waste Water Storm Drainage0 Pavement
Initial Contract Amount Final Contract Amount
$30,447.58 $30,447.58
In PERFORMANCE EVALUATION
0-Inadequate I -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 .( 3 Applicability of Specifications
4 Display Of Professionalism 4 Accuracy of Plan Quantities kf
5 Citizen Complaint Resolution 44 PROJECT MANAGER EVALUATION
6 Performance-Setting up Valve Crews, Labs 1 Knowledge And/Or Problem Resolution K
ADMINISTRATION 2 Availability of Project Manager
1 Change Order Processing Time pf 3 Communication +�
2 Timliness of Contractor Payments 4 Resolution of Utility Conflicts
3 Bid Opening to Pre-Con Meeting Timeframe
III)COMMENTS&SIGNATURES
COMMENTS
Signature Contractor
Signature DOE Inspector �rc�
Signature DOE Inspector's Supervisor
INSPECTOR'S COMMENTS
TRANSPORTATION AND PUBLIC WORKS
ID The City of Fort Worth• 1000 Throckmorton Street•Fort Worth,TX 76012-6311
(817)392-7941 •Fax: (817)392-7845
i
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
We an Oden CPN# 100373
DOE Inspector Project Manager
❑ water❑ waste Water[] Storm Drainage Pavement Gopal Sahu
Initial Contract Amount Project Difficulty
$30,447.58 e Simple Routine O Complex
Final Contract Amount Date
$30,447.58 2/20/2018
II)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 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)
TOTAL SCORE(TS) 331
III)CONTRACTOR'S RATING
Maximum Score(MS)=448 or sum of applicable element score maximums which= 448
Rating(ITS/MS] * 100%) 331 / 448 = 74%
Performance Category Good
<20%=Inadequate 20%to<40%=Deficient 40%to<60%=Standard 60%to<80%=Good 2:80%=Excellent
Inspector's Comments(INCLUDING EXPLANATION OF BONUS POINTS AWARDED)
Signature DOE Inspector �w Signature Contractor
Signature DOE Inspector's Supervisor
CONTRACTOR'S COMMENTS
TRANSPORTATION AND PUBLIC WORKS
The City of Fort Worth• 1000 Throckmorton 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
B
Clint Clements
Subscribed and sworn before me on this date 19 of February, 2019.
TAMMI EYN DAVIS
Altotary
Notary ID # 129124687
My Commission Expires Public September 23. 2020
G1.YYZ4'1,�� I�}Ca�
County, State
1
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 001100 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 12/31/2016 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
Attomey-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'T'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.
, ,mow SURETEC INSURANCE COMPANY
OOORAN 0* By:
w F Sohn ivox 7resident
� y1
State of Texas ss:
County of Harris --'
On this 21 st 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.
is
JACQUELYN MALDONADONotary Public
state of Texas
My Gomm.Exp.5I18/2017 Jacq eiyn 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 26th day of September 2016 f A.D.
A - r
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.
AL y
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.)
SureT'c In ce Co
(Sur )
(Signature of authorized represe e)
Teri Holley
Attest: ,Attorney-in-Fact
(Seal): (Printed name and title)
SURETEC CONSENT TO FINAL PAYMENT REV. 1.1.2004
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,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 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
Attomey-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,7! ts corporate seal
to be hereto affixed this 15th day of May ,A.D. 2017 . SURETEC
TT7�
,y\diullluililllNlR(Z S URETE . SURAN C
SURAN6F"w�w
?: •,
X 9 By: —
w i w a= John Knox , resid t
State of Texas ss: o'�•,
County of Harris •..._.....'
On this 15th day of May ,A.D. 2017 before me personally came John Knox Jr.,to me known,who,being by me y 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.
`ari"�i� JACQUELYN GREENLEAF
?a°?P
_Notary Public,State of Texas
Comm.Expires 05-18-2021
Notary ID 126903029 Jacq lyn Greenleaf,Notary Public
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 2Is 1- day of "'`arc `'01 o A.D.
M.Brent Beaty,Assistant Sec etary
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