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HomeMy WebLinkAboutContract 51458-FP2 City Secretary 51458 -FP2 Contract No. FORTWORTH., Date Received Jun 16,2020 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: WESTERN RIDGE City Project No.: 101181 Improvement Type(s): Water ® Sewer Original Contract Price: $940,947.68 Amount of Approved Change Order(s): $35,031.50 Revised Contract Amount: $975,979.18 Total Cost of Work Complete: $975,979.18 ur,15,202011:56CDT) Jun 15,2020 Contractor Date Executive VP of Operations Title PCI Construction Inc. Company Name /Kei/Al chgwl1e1-f Jun 15 2020 Kevin Chambers(Jun 15,202012:22 CDT) Project Inspector Date Viohor V. Tornero Tr. P.E. ictor .v.Tornero J r.P.E.(Jun 15,202013:00 CDT) Jun 15,2020 P o�an g� Date Laurie Lewis(Jun 16,202007:51 CDT) Jun 16,2020 CFA Manag r Date Jun 16 2020 Dana Burghdoff(J 16.202 :40 CDT) f Asst. City Manager Date OFFICIAL RECORD CITY SECRETARY Page 1 of 2 FT. WORTH, TX Notice of Project Completion Project Name:WESTERN RIDGE City Project No.: 101181 City's Attachments Final Pay Estimate Change Order(s): ® Yes ❑ N/A Pipe Report: ® Yes ❑ N/A Contractor's Attachments Affidavit of Bills Paid Consent of Surety Statement of Contract Time Contract Time: 363 CD Days Charged: 548 Work Start Date: 12/3/2018 Work Complete Date: 5/21/2020 Page 2of2 FORT WORTH CITY OF FORT WORTH FINAL PAYMENT REQUEST Contract Name WESTERN RIDGE Contract Limits Project Type WATER&SEWER City Project Numbers 101181 DOE Number 1181 Estimate Number 1 Payment Number 1 For Period Ending 6/15/2020 CD City Secretary Contract Number Contract Time 369D Contract Date Days Charged to Date 548 Project Manager NA Contract is 100.00 Complete Contractor PCI CONSTRUCTION,INC. P.O.BOX 2967 McKINNEY, TX 75070 Inspectors DICKINSON/ CHAMBERS Monday,June 15,2020 Page 1 of 4 City Project Numbers 101181 DOE Number 1181 Contract Name WESTERN RIDGE Estimate Number 1 Contract Limits Payment Number 1 Project Type WATER&SEWER For Period Ending 6/15/2020 Project Funding WATER Item Description of Items Estimated Unit Unit Cost Estimated Completed Completed No. Quanity Total Quanity Total --------------------------------------- 1 8"PVC WATER PIPE CO#1 5567 LF $21.30 $118,577.10 5567 $118,577.10 2 8"GATE VALVE CO#1 26 EA $1,304.00 $33,904.00 26 $33,904.00 3 24"CONCRETE AWWA C303 WATER PIPE 108 LF $591.11 $63,839.88 108 $63,839.88 4 16"X 8"TAPPING SLEEVE&VALVE 1 EA $7,348.00 $7,348.00 1 $7,348.00 5 24"X 8"TAPPING SLEEVE&VALVE 1 EA $7,620.00 $7,620.00 1 $7,620.00 6 FIRE HYDRANT 14 EA $5,243.00 $73,402.00 14 $73,402.00 7 DUCTILE IRON WATER FITTINGS 1.45 TN $12,045.52 $17,466.00 1.45 $17,466.00 W/RESTRAINT 8 1"WATER SERVICE 139 EA $712.00 $98,968.00 139 $98,968.00 9 SALVAGE FIRE HYDRANT 1 EA $5,850.00 $5,850.00 1 $5,850.00 10 FLOWABLEFILL. 150 CY $125.00 $18,750.00 150 $18,750.00 11 TRENCH SAFETY CO#1 5567 LF $0.10 $556.70 5567 $556.70 12 DIP WATER PIPE CO#1 60 LF $102.50 $6,150.00 60 $6,150.00 13 STEEL FITTINGS CO#1 1 LS $10,872.00 $10,872.00 1 $10,872.00 -------------------------------------- Sub-Total of Previous Unit $463,303.68 $463,303.68 -------------------------------------- SEWER Item Description of Items Estimated Unit Unit Cost Estimated Completed Completed No. Quanity Total Quanity Total 1 8"SEWER PIPE CO#1 5174 LF $38.70 $200,233.80 5174 $200,233.80 3 4'MANHOLE CO#1 25 EA $3,583.00 $89,575.00 25 $89,575.00 4 4'DROP MANHOLE CO#1 3 EA $6,259.00 $18,777.00 3 $18,777.00 5 EPDXY MANHOLE LINER 50 VF $215.00 $10,750.00 50 $10,750.00 6 4'EXTRA DEPTH MANHOLE 100 VF $250.00 $25,000.00 100 $25,000.00 8 4"SEWER SERVICE 139 EA $744.00 $103,416.00 139 $103,416.00 9 IMPORTED EMBEDMENTBACKFILL,CSS 200 CY $80.00 $16,000.00 200 $16,000.00 10 MANHOLE VACUUM TESTING 28 EA $175.00 $4,900.00 28 $4,900.00 11 POST CCTV INSPECTION CO#1 5465 LF $2.20 $12,023.00 5465 $12,023.00 12 TRENCH SAFETY CO#1 5465 LF $0.60 $3,279.00 5465 $3,279.00 13 8"DIP SEWER PIPE CO#1 291 LF $98.70 $28,721.70 291 $28,721.70 -------------------------------------- Sub-Total of Previous Unit $512,675.50 $512,675.50 Monday,June 15,2020 Page 2 of 4 City Project Numbers 101181 DOE Number 1181 Contract Name WESTERN RIDGE Estimate Number 1 Contract Limits Payment Number 1 Project Type WATER&SEWER For Period Ending 6/15/2020 Project Funding Contract Information Summary Original Contract Amount $940,947.68 Change Orders Change Order Number 1 $35,031.10 Total Contract Price $975,979.18 Total Cost of Work Completed $975,979.18 Less %Retained $0.00 Net Earned $975,979.18 Earned This Period $975,979.18 Retainage This Period $0.00 Less Liquidated Damages Days @ /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 $975,979.18 Monday,June 15,2020 Page 3 of 4 City Project Numbers 101181 DOE Number 1181 Contract Name WESTERN RIDGE Estimate Number 1 Contract Limits Payment Number 1 Project Type WATER&SEWER For Period Ending 6/15/2020 Project Funding Project Manager NA City Secretary Contract Number Inspectors DICKINSON/ CHAMBERS Contract Date Contractor PCI CONSTRUCTION,INC. Contract Time 363 CD P.O.BOX 2967 Days Charged to Date 548 CD McKINNEY, TX 75070 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 $975,979.18 Less %Retained $0.00 Net Earned $975,979.18 Earned This Period $975,979.18 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 $975,979.18 Monday,June 15,2020 Page 4 of 4 DEVELOPER-AWARDED-PROJECT CHANGE ORDER PROJECT NAME: Western Ride CHANGE CONTRACT: A Water,Sewer,and Drainage Improvements ORDER No: CFA# 2018-002 CITY PARTICIPATION: NO CITY PROJECT# 101181 DOE# N/A Al WATER PROJECT# 56008-0600430-101181-001480 SEWER PROJECT# 5 60 08-070 04 3 0-1 011 81-001 3 8 0 FILE# W-2528;X-24709 INSPECTOR: Kevin Chambers Phone No: 214.200.1064 PROJECT MANAGER: Victor V.Tornero Jr. Phone No: 682.201.8448 CONTRACT UNIT WATER SEWER PAVING DRAINAGE STREETLIGHTS CONTRACT Developer Developer Developer Developer DAYS Co., City Cost Cost City Cost Cost City Cost Developer Cost City Cost Cost City Cost ORIGINAL CONTRACT $442,284.08 $0.00 $498,663.60 $0.00 $0.00 $0.00 $820,779.00 $0.00 $0.00 $0.00 360 E>(TRAS TO DATE CREDITS TO DATE CONTRACT TO DATE $442,284.08 $0.00 $498,663.60 $0.00 $0.00 $0.00 $820,779.00 $0.00 $0.00 $0.00 360 AMOUNT OF PROP.CHANGE ORDER $21,019.60 $14,011.90 $15,417.40 3 REVISED CONTRACT AMOUNT $463,303.68 $0.00 $512,675.50 $0.00 $0.00 $0.00 $B36,196.40 $0.00 $0.00 $0.00 363 TOTAL REVISED CONTRACT AMOUNT PER UNIT $463,303.68 $512,675.50 $0.00 $036,196.40 $0.00 REVISED COST SHARE Dev.Cost: $1,812,175.58 City Cost: $0.00 TOTAL REVISED CONTRACT $1,812,175.58 Revised:10-12-2011 Page 1 You are directed to make the following changes in the contract documents CITY BID ITEM PAY ITEM 4 If QUANTITY UNIT ITEM DESCRIPTION UNIT PRICE I TOTAL UNIT I:Water 1 4 LF 3311.02618"PVC Water Pipe $21.30 $85.20 2 3 FA 3312.30038'Gate Valve $1,304.00 $3.912.00 11 4 LF 3305.0109 Trench Safety $0.10 $0.40 12' 60 LF 3311.0251 DIP Water Pie $102.50 $6,150.00 13' 1 LS 3311.0011 Steel Fillings $10,872.00 $10.872.00 Total: $21,019.60 UNIT It:Sewer 1 314 LF 3331AI 158'Sewer Pie $38.70 $12,151.80 2 -622 LF 9999.0000 8'SDR-26 Pressure Rated Pipe $45.00 $27,990.00 3 -1 EA 3339.10014'Manhole $3.583.00 $3,583.00 4 1 FA 3339.1002 4'Drop Manhole $6.259.00 $6,259.00 7 -2 EA 3305.0112 Concrete Collar $750.00 $1,500.00 11 -17 LF 3301.002 Post-CCTV Inpection $2.20 $37.40 12 -17 LF 3305.0109 Trench Safety $0.60 $10.20 13' 291 LF 3331.4119 a*DIP Sewer Pie $98.70 $28,721.70 Total: $14,011.90 UNIT III:Drainage 1 1 LF 3341.1201 5x3 Box Culvert $235,60 $235.60 3 -1 LF 3341.0409 48'RCP.Class III $170.10 $170.10 4 236 LF 3341,0309 36'RCP,Gass III $102.80 $24,260.80 5 -1 LF 3341.0205 24'RCP,Class III $59.30 ($59.30 6 -154 LF 330-0201 21'RCP,Class III $50.90 ($7,838.60 17 -5 FA 3137.0102 Large Slone Ri ap,d $65.00 $325.00 18 -49 SY 0241.3013 Remove 18'Storm Line $14.00 $686.00 Total: $15,417.40 GRAND TOTAL: $50,448.90 Asterisk(')indicates New Pay Item REASONS FOR CHANGE ORDER Reconciliation of Contracted quantities to Bid Forth Quantifies based on approved plans. Lowering of water line at storm crossings to maintain required separation based on field review. Installation ofifrigalion crossing sleeves. Temporary paving associated with Bowman Roberts Rd Headwall redesign,demo and replacement on Cromwell Marine Creek Rd RECOMMENDED: APPROVED: APPROVED: Consultant Developer Contractor T,yw,,Twr � ._, Krrvo errtaxk r, By. r, - By_r By:-,­ Name: _.., Trevor Truss Name: Name:David Aughinbaugh Kevin Gerstenkorn Tme: Project Engineer T;de: Vice President,Land Title: Executive VP of Operations Revised:10-12-2011 Page 2 APPROVAL RECOMMENDED: APPROVED: APPROVED AS TO FORM AND LEGALITY: (CFW-Sponsoring Department) (CFW-Assistant City Manager) (CFW-Assistant City Attorney) By: WA By:WA By:NIA Name: Name: Name: Title: Title: Title: RECOMMENDED: (CFW-'Contract Compliance Manager) `Contract Compliance Manager(Project Manager): &—for V.Tamer,Sr:.P.E. By signing I acknowledge that I am the person responsible By: �- - - for the monitoring and administration of this contract,include Name: Vlcto`r V.Tornero Jr.,P.E. ensuring all performance and reporting requirements. Title: Project Manager Q+There are NO City Funds associated with this Contract ❑There are City Funds associated with this Contract M&C Number. NIA M&C Date Approved: NIA Revised:10-12-2011 - Page 3 FORTWORTH, TRANSPORTATION AND PUBLIC WORKS June 4, 2020 PC[ Construction, Inc. P.O. Box 2967 McKinney,TX 75070 RE: Acceptance Letter Project Name:Western Ridge Project Type: Water and Sewer City Project No.: 101181 To Whom It May Concern: On May 21, 2020 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 June 3, 2020. 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 June 3, 2020, 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- 392-7830. Sincerely, Viol-or V. Tornero Tr. P.E. Victor V.Tornero Jr.P.E.(Jun 15,202013:00 CDT) Victor Tornero, Project Manager Cc: Kevin Chambers, Inspector Doug Dickinson, Inspection Supervisor Mike Glover,Senior Inspector Victor Tornero, Program Manager Hamilton Duffy, Consultant PCI Construction, Contractor Meritage Homes, Developer File E-Mail: TPW_Acceptance@fortworthtexas.gov Rev.8/20/19 FORTWORTH TRANSPORTATION AND PUBLIC WORKS PIPE REPORT FOR: PROJECT NAME: Western Ridge PROJECT NUMBER: 101181 DOE NUMBER: NA WATER PIPE LAID SIZE TYPE OF PIPE LF 8"PVC 8" PVC 5567 FIRE HYDRANTS: 14 VALVES(16" OR LARGER) NA PIPE ABANDONED SIZE TYPE OF PIPE LF DENSITIES: Yes NEW SERVICES: 139 1" copper 3475' SEWER PIPE LAID SIZE TYPE OF PIPE LF 8"PVC 8" PVC 5174 PIPE ABANDONED SIZE TYPE OF PIPE LF DENSITIES: Yes NEW SERVICES: 139 4"PVC 3336' 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 Collin Before me, the undersigned authority, a notary public in the state and county aforesaid, on this day personally appeared Eric M Lindberg, VP of Finance Of PCI 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; Western Ridge Project No. 101181 BY ERic M Lindberg -VP of Finance Subscribed and sworn before me on this date of J�tNG , 702D. n•n� �> p BREE MITCHELL Notary Public 2 Notary fD#123944875 State of Texas My Commission Expires "r< , September 26, 2023 County of Collin ' CONSENT OF OWNER SURETY COMPANY ARCHITECT TO FINAL PAYMENT CONTRACTOR SURETY AIA DOCUMENT G707 OTHER Bond No. 2276400 PROJECT: Western Ridge-Project 101181 -Water, Sanitary Sewer and Storm Drain Improvements, (name,address) Ft.Worth TX TO(Owner) [ City of Fort Worth ] ARCHITECT'S PROJECT NO: 1000 Throckmorton Street Fort Worth,TX 76102-6312 CONTRACT FOR: [ ] CONTRACT DATE: 8/16/2018 CONTRACTOR: PCI Construction,Inc. P.O.Box 2967 McKinney,TX 75070 In accordance with the provisions of the Contract between the Owner and the Contractor as indicated above,the (here insert name and address of Surety Company) North American Specialty Insurance Company 1200 Main Street,Suite 800 Kansas City,MO 64105 , SURETY COMPANY, on bond of(here insert name and address of Contractor) PCI Construction,Inc. P.O.Box 2967 McKinney,TX 75070 , CONTRACTOR, hereby approves of the final payment to the Contractors,and agrees that final payment to the Contractor shall not relieve the Surety Company of any of its obligations to(here insert name and address of Owner) City of Fort Worth 1000 Throckmorton Street Fort Worth,TX 76102-6312 ,OWNER, as set forth in the said Surety Company's bond. IN WITNESS WHEREOF, the Surety Company has hereunto set its hand this 2nd day of June 2A20 North American Specialty Insurance Company Surety Company of Authorized Representative Attest: Signature_ (Seal): Debra Lee Moon Attorney-In-Fact Title NOTE: This form is to be used as a companion document to AIA DOCUMENT G706,CONTRACTOR'S AFFIDAVIT OF PAYMENT OF DEBTS AND CLAIMS, Current Edition AIA DOCUMENT G707 CONSENT OF SURETY COMPANY TO FINAL PAYMENT APRIL 1970 EDITION AIA ONE PAGE 1970 THE AMERICAN INSTITUTE OF ARCHITECTS,1735 New York Ave.,NW,WASHINGTON,D.C. 20006 SWISS RE CORPORATE SOLUTIONS NORTH AMERICAN SPECIALTY INSURANCE COMPANY WASHINGTON INTERNATIONAL INSURANCE COMPANY WESTPORT INSURANCE CORPORATION GENERAL POWER OF ATTORNEY KNOW ALL MEN BY THESE PRESENTS,THAT North American Specialty Insurance Company,a corporation duly organized and existing under laws of the State of New Hampshire,and having its principal office in the City of Kansas City,Missouri and Washington International Insurance Company a corporation organized and existing under the laws of the State of New Hampshire and having its principal office in the City of Kansas City,Missouri and Wpstport Insurance Corporation,prganized under the laws of the State of Missouri,and having Its principal office in the City of Kansas City, issouri,eachh does hereby make constitute and appoint: JOHN WILLIAM NEWBY,TROY RUSSELL KEY,DEBRA LEE MOON,ANDREA ROSE CRAWFORD,SANDRA LEE RONEY,LINDA MICHELLE STALDER SUZANNE ELIZABETH NIEDZWIEDZ,SHERIE MICHELLE GREENOUGH,CHERI LYNN IRBY,AND JOSHUA D.TRrTT,JOINTLY OR SEVERALLY Its true and lawful Attorney(s)-in-Fact,to make,execute,seal and deliver,for and on its behalf and as its act and deed,bonds or other writings obligatory in the nature of a bond on behalf of each of said Companies,as surety,on contracts of suretyship as are or may be required or permitted by law,regulation,contract or otherwise,provided that no bond or undertaking or contract or suretyship executed under this authority shall exceed the amount of: TWO HUNDRED MILLION($200,000,000.00)DOLLARS This Power of Attorney is granted and is signed by facsimile under and by the authority of the following Resolutions adopted by the Boards of Directors of North American Specialty Insurance Company and Washington International Insurance Company at meetings duly called and held on March 24,2000 and Westport Insurance Corporation by written consent of its Executive Committee dated July 18,2011. "RESOLVED,that any two of the President,any Senior Vice President,any Vice President,any Assistant Vice President, the Secretary or any Assistant Secretary be,and each or any of them hereby is authorized to execute a Power of Attorney qualifying the attorney named in the given Power of Attorney to execute on behalf of the Company bonds,undertakings and all contracts of surety,and that each or any of them hereby is authorized to attest to the execution of any such Power of Attorney and to attach therein the seal of the Company; and it is FURTHER RESOLVED,that the signature of such officers and the seal of the Company may be affixed to any such Power of Attorney or to any certificate relating thereto by facsimile,and any such Power of Attorney or certificate bearing such facsimile signatures or facsimile seal shall be binding upon the Company when so affixed and in the future with regard to any bond,undertaking or contract of surety to which it is attached." .,.,.,,..% oauututONsuiaq, + G1AL7Y ^y a a ... A(1, VORpCCCpRij G ;�F?oaro ;SG�pp4m By �� .. Fa; SCr1�� y �:' SEAI.'F•.q Steven Antler error Vice resr ento as mgton InternationalInsurance Company mC) ert ':•ZZ�__ &Senior Vice President of North American Specialty Insurance Company a7E — s �n &Senior Vim President or Westport Insurance Corporation 2 1973 �: gy` o f� }w y` By .?aeO!.. •w,,, *,.*nr!'.`��s � nwu nnntN aaa� Michael A.Ito,Senior Vice President of yashington Internationals f &Senior Vice President of North American Specialty Insurance Company 1 &Senior Vice President or Westport Insurance Corporation IN WITNESS WHEREOF,North American Specialty Insurance Company,Washington International Insurance Company and Westport Insurance Corporation have caused their official seals to be hereunto affixed,and these presents to be signed by their authorized officers this this 12th day of FEBRUARY ,20 20 North American Specialty Insurance Company Washington International Insurance Company State of Illinois Westport Insurance Corporation County of Cook Ss: On this 12th day of FEBRUARY,20 20,before me,a Notary Public personally appeared Steven P.Anderson ,Senior Vice President of Washington International Insurance Company and Senior Vice President of North American Specialty Insurance Company and Senior Vice President of Westport Insurance Corporation and Michael A.Ito Senior Vice President of Washington International Insurance Company and Senior Vice President of North American Specialty Insurance Company and Senior Vice President of Westport Insurance Corporation,personally known to me,who being by me duly sworn,acknowledged that they signed the above Power of Attorney as officers of and acknowledged said instrument to be the voluntary act and deed of their respective companies. OFFICIAL SEAL M.KENNY Notary public-Slate of Olinnis Myc 17JO412021pi"Y 11 M.Kenny,Notary Public I, Jeffrey Goldberg , the duly elected Vice President and Assistant Secretary of North American Specialty Insurance Company,Washington International Insurance Company and Westport Insurance Corporation do hereby certify that the above and foregoing is a true and correct copy of a Power of Attorney given by said North American Specialty Insurance Company,Washington International Insurance Company and Westport Insurance Corporation which is still in full force and effect. IN WITNESS WHEREOF,I have set my hand and affixed the seals of the Companies this 2nd day of June ,20 20 Jeffrey Goldberg,Vice President&Assistant Secretary of Washington International Insurance Company& North American Specialty Insurance Company&Vice President&Assistant Secretary of Westport Insurance Corporation t North American Specialty Insurance Company Washington International Insurance Company Westport Insurance Corporation TEXAS CLAIMS INFORMATION IMPORTANT NOTICE ADVISO IMPORTANTE In order to obtain information or make a complaint: Para obtener informacion o para someter un queja: You may contact Jeffrey Goldberg,Vice President Puede comunicarse con Jeffrey Goldberg,Vice — Claims at 1-800-338-0753 President— Claims,al 1-800-338-0753 You may call Washington International Insurance Usted puede Ilamr al numero de telefono gratis de Company and/or North American Specialty Insurance Washington International Insurance Company and/or Company's and/or Westport Insurance Corporation North American Specialty Insurance Company's and/or toll-free number for information or to make a Westport Insurance Corporation para informacion o complaint at: para someter una queja al: 1-800-338-0753 1-800-338-0753 You may also write to Washington International Usted tambien puede escribir a Washington Insurance Company and/or North American Specialty International Insurance Company and/or North Insurance Company and/or Westport Insurance American Specialty Insurance Company and/or Corporation at the following address: Westport Insurance Corporation ai: 1200 Main Street 1200 Main Street Suite 800 Suite 800 Kansas City,MO 64105 Kansas City, MO 64105 You may contact the Texas Department of Insurance Puede escribir al Departmento de Seguros de Texas to obtain information on companies, coverages, para obtener informacion acerca de companias, rights or complaints at: coberturas,derechos o quejas al: 1-800-252-3439 1-800-252-3439 You may write the Texas Department of Insurance: Puede escribir al Departmento de Seguros de Texas: P.O. Box 149104 P.O. Box 149104 Austin,TX 78714-9104 Austin,TX 78714-9104 Fax: (512)475-1771 Fax: (512)475-1771 Web: httn://www.tdi.state.tx.us Web: htto://www.tdi.state.tx.us Email:ConsumerProtection@tdi.state.tx.us Email:ConsumerProtection@tdi.state.tx.us PREMIUM OR CLAIM DISPUTES: DISPUTAS SOBRE PRIMAS 0 RECLAMOS: Should you have a dispute concerning your premium Si tiene una disputa concerniente a su prima o a un or about a claim you should first contact the reclamo, debe comunicarse con el Washington Washington International Insurance Company and/or International Insurance Company and/or North North American Specialty Insurance Company and/or American Specialty Insurance Company and/or Westport Insurance Corporation. If the dispute is not Westport Insurance Corporation primero. Si no se resolved,you may contact the Texas Department of resuelve la disputa, puede entonces comunicarse Insurance. con el Departmento de Seguros de Texas. ATTACH THIS NOTICE TO YOUR POLICY: , UNA ESTE AVISO A SU POLIZA This notice is for information only and does not Este aviso es solo para proposito de infromacion y no become a part or condition of the attached se converte en parte o condicion del documento document. adjunto.