HomeMy WebLinkAboutContract 53863-FP4City Secretary 53863 -FP4
Contract No.
FORTWORTHo
Date Received May 12, 2021
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: TRAILS OF ELIZABETH CREEK PHASE 7
City Project No.: 102285
Improvement Type(s)
Original Contract Price:
Water � Sewer 0
Amount of Approved Change Order(s):
Revised Contract Amount:
Total Cost of Work Complete:
Albert Grqv,tqes
Albert Grantges (May 7, 202108:58 CDT)
Contractor
Vice President
Title
Burnsco Construction, Inc.
Company Name
��
William Roberson (May7,202108:59CDT)
Project Inspector
��Gt�L7GlGr�Gl�/ ��
Khal Jaafarl P.E (Mzy 1Q 202111:09 CDT)
Project Manager
�iuue-Sc�Ce�tMa��
Janie Scarlett Morales (May 11, 202108:14 CDT;
CFA Manager
DAnA BU�GfI�Cloff
Dana Burghdoff �ay ll, 202ll2:36 CDT)
Asst. City Manager
May 7, 2021
Date
May 7, 2021
Date
May 10, 2021
Date
May 11, 2021
Date
May 11, 2021
Date
$999,184.40
$8,230.00
$1,007,414.40
$1,007,414.40
OFFICIAL RECORD
CITY SECRETARY
FT. W�RTH, TX
Page 1 of 2
Notice of Project Completion
Project Name: TRAILS OF ELIZABETH CREEK PHASE 7
City Project No.: 102285
City's Attachments
Final Pay Estimate x❑
Change Order(s): x❑ Yes ❑ N/A
Pipe Report: x❑ Yes ❑ N/A
Contractor's Attachments
Affidavit of Bills Paid
Consent of Surety
Statement of Contract Time
Contract Time: 170 CD Days Charged: 193
Work Start Date: 5/6/2020 Work Complete Date: 4/12/2021
Completed number of Soil Lab Test: 981
Completed number of Water Test: 19
Page 2 of 2
�'���r ���Tx
CITY OF FORT WORTH
FINAL PAYMENT REQUEST
Contract Name TRAILS OF ELIZABETH CREEK PHASE 7
Contract Limits
Project Type WATER & SEWER
City Project Numbers 102285
DOE Number 22g5
Estimate Number 1 Payment Number 1
City Secretary Contract Number
Contract Date
For Period Ending 4/27/2021
WD
Project Manager NA
Contractor BURNSCO CONSTRUCTiON, INC.
6331 SOUTHWEST BLVD
FORT WORTH� TX 76132
Inspectors D1CKINSON / CHAMBERS
Contract Time 9�JD
Days Charged to Date 193
Contract is 100.00 Complete
Thursday, May 6, 2021 Page 1 of 5
City Project Numbers 102285
Contract Name TRAILS OF ELIZABETH CREEK PHASE 7
Contract Limits
Project Type WATER & SEWER
Project Funding
WATER
DOE Number 2285
Estimate Number 1
Payment Number 1
For Period Ending 4/27/2021
Item Description of Items Estimated Unit Unit Cost Estimated Completed Completed
No. Quanity Total Quanity Total
1 8" WATERPIPE 5736 LF $23.00 $131,928.00 5736 $131,928.00
2 8" GATE VALVE 18 EA $1,280.00 $23,040.00 18 $23,040.00
3 FIRE HYDRANT 6 EA $3,540.00 $21,240.00 6 $21,240.00
4 DUCTILE IRON WATER FITTINGS 4.24 TN $6,150.00 $26,076.00 4.24 $26,076.00
W/RESTRAINT
5 1" WATER SERVICE I 11 EA $770.00 $85,470.00 111 $85,470.00
6 TRENCH SAFETY 5859 LF $0.10 $585.90 5859 $585.90
7 CONNECTION TO EXISTING 4"-12" WATER 8 EA $500.00 $4,000.00 8 $4,000.00
MAIN
8 WATER TESTING 5736 LF $0.05 $286.80 5736 $286.80
9 1" WATER SERVICE 52 EA $830.00 $43,160.00 52 $43,160.00
10 1" WATER SERVICE CO#1 1 EA $830.00 $830.00 1 $830.00
11 1 1/2" WATER SERVICE CO#3 2 EA $1,250.00 $2,500.00 2 $2,500.00
12 11/2"WATERSERVICECO#3 2 EA $1,350.00 $2,700.00 2 $2,700.00
Sub-Total of Previous Unit $341,816J0 $341,816.70
SEWER
Item Description of Items Estimated Unit Unit Cost Estimated Completed Completed
No. Quanity Total Quanity Total
1 8" SEWER PTPE CO#2 8409 LF $35.10 $295,155.90 8409 $295,155.90
2 4" SEWER SERVICE CO#2 194 EA $650.00 $126,100.00 194 $126,100.00
3 POSTCCTVINSPECTION 9117 LF $2.00 $18,234.00 9117 $18,234.00
4 4'MANHOLECO#2 24 EA $2,590.00 $62,160.00 24 $62,160.00
5 4' DROP MANHOLE 9 EA $4,550.00 $40,950.00 9 $40,950.00
6 EXTRA DEPTH 4' MANHOLE 145 VF $150.00 $21,750.00 145 $21,750.00
7 8" SEWER PIPE, CSS BACKFILL 330 LF $43.00 $14,190.00 330 $14,190.00
8 MANHOLE VACWM TESTING CO#2 34 EA $110.00 $3,740.00 34 $3,740.00
9 TRENCH SAFETY 9117 LF $1.00 $9,117.00 9117 $9,117.00
10 TRENCH WATER STOP CO#2 18 EA $300.00 $5,400.00 18 $5,400.00
ll CONCRETE ENCASEMENT CO#2 40 CY $400.00 $16,000.00 40 $16,000.00
12 EPDXY MANHOLE LINER 67.5 VF $280.00 $18,900.00 67.5 $18,900.00
13 CONCRETE COLLAR 9 EA $400.00 $3,600.00 9 $3,600.00
Thursday, May 6, 2021 Page 2 of 5
City Project Numbers 102285
Contract Name TRAILS OF ELIZABETH CREEK PHASE 7
Contract Limits
Project Type WATER & SEWER
Project Funding
DOE Number 2285
Estimate Number 1
Payment Number 1
For Period Ending 4/27/2021
14 CONNECT TO EXISTING SEWER MAIN 5 EA $500.00 $2,500.00 5 $2,500.00
15 4' MANHOLE W/HYDRAULIC SLIDE 1 EA $2,790.00 $2,790.00 1 $2,790.00
16 8" END & PLUG 8 EA $20.00 $160.00 8 $160.00
17 15" SEWER PIPE SDR 26 CO#2 708 LF $35.10 $24,850.80 708 $24,850.80
Sub-Total of Previous Unit �66s,s9�.�o �66s,s9�.�o
Thursday, May 6, 2021 Page 3 of 5
City Project Numbers 102285
Contract Name TRAILS OF ELIZABETH CREEK PHASE 7
Contract Limits
Project Type WATER & SEWER
Project Funding
Contract Information Summary
Original Contract Amount
Change Orders
Change Order Number 3
Change Order Number 4
Change Order Number 2
DOE Number 2285
Estimate Number 1
Payment Number 1
For Period Ending 4/27/2021
$999,184.40
$5,200.00
$830.00
$2,200.00
Total Contract Price $1,007,414.40
Total Cost of Work Completed $1,007,414.40
Less % Retained $0.00
Net Earned $1,007,414.40
Earned This Period $1,007,414.40
Retainage This Period $0.00
Less Liquidated Damages
Days @ / Day
LessPavement Deficiency
Less Penalty
Less Previous Payment
Plus Material on Hand Less 15%
Balance Due This Payment
$0.00
$0.00
$0.00
$0.00
$0.00
$1,007,414.40
Thursday, May 6, 2021 Page 4 of 5
City Project Numbers 102285
Contract Name TRAILS OF ELIZABETH CREEK PHASE 7
Contract Limits
Project Type WATER & SEWER
DOE Number 2285
Estimate Number 1
Payment Number 1
For Period Ending 4/27/2021
Project Funding
Project Manager NA
Inspectors DICHINSON / CHAMBERS
Contractor BURNSCO CONSTRUCTION, INC.
6331 SOUTHWEST BLVD
FORT WORTH � TX 76132
City Secretary Contract Number
Contract Date
Contract Time 90 WD
Days Charged to Date 193 WD
Contract is .000000 Complete
CITY OF FORT WORTH
SUMMARY OF CHARGES
Line Fund Account Center Amount Gross Retainage Net
Funded
Total Cost of Work Completed
Less % Retained
Net Earned
Earned This Period $1,007,414.40
Retainage This Period $0.00
Less Liquidated Damages
0 Days @ $0.00 / Day
LessPavement Deficiency
Less Penalty
Less Previous Payment
Plus Material on Hand Less 15%
Balance Due This Payment
$1,007,414.40
$0.00
$1,007,414.40
$0.00
$0.00
$0.00
$0.00
$0.00
$1,007,414.40
Thursday, May 6, 2021 Page 5 of 5
FORTWORTH���
TRANSPORTATION AND PUBLIC WORKS
April 1, 2021
Burnsco Construction, Inc.
6331 Southwest Blvd
Benbrool<, TX 76132
RE: Acceptance Letter
Project Name: Trails Of Elizabeth Creek
Project Type: Water,Sewer, Storm, Paving and Street Lights
City Project No.: 102285
To Whom It May Concern:
On April 1, 2021 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 April 12, 2021. The final inspection and
the corrected punch list items indicate that the worl< meets the City of Fort Worth specifications and is
therefore accepted by the City. The warranty period will start on April 12, 2021, which is the date of the
punch list completion and will extend of two (2) years in accordance with the Contract Documents.
If you have any questions concerning this letter of acceptance, please feel free to contact me at 817-
392-7872.
Sincerely,
��Gt�L7GtGt��/� ��.
KhalJaafari P.E, (M y 10, 202111:09 CDT)
Khal Jaafari, Project Manager
Cc: Riley Roberson, Inspector
Mil<e Glover, Inspection Supervisor
Daniel Roy, Senior Inspector
Victor Tornero, Program Manager
UA Engineering, Inc, Consultant
Burnsco Construction, Inc, Contractor
Forestar Real Estate Group, Developer
File
E-Mail: TPW_Acceptance@fortworthtexas.gov
Rev. 8/20/19
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WATER DEPARTMENT ; �, - ,
FINAL/PREFINAL INSPECTION PUNCH LIST
Crew Leader: � Date of Inspection: '
Location of Inspection: � � '
ITEMS TO BE CORRECTED
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Inspector•
Estimated Date of Completion:
PROJECT NAME:
PROJECT NUMBER:
DOE NUMBER:
PIPE LAID
PVC
DIP
FIRE HYDRANTS: 6
PIPE ABANDONED
DENSITIES:
NEW SERVICES:
PIPE LAID
SDR-26
PIPE ABANDONED
DENSITIES:
NEW SERVICES:
�ORTWORTH
TRANSPORTATION AND PUBLIC WORKS
PIPE REPORT FOR:
Trails of Elizabeth Creek Phase 7
102285
N/A
WATER
SIZE TYPE OF PIPE
8" Water PVC
VALV�S (16" OR LARGER)
SIZE TYPE OF PIPE
1" Copper
1 1/2 " Copper
SEWER
SIZE TYPE OF PIPE
g" SDR-26 Sewer
SIZE
4"
TYPE OF PIPE
PVC Sewer
TRANSPORTATION AND PUBLIC WORKS
-��s The Cit�� of Foit Worth • 1000 Throckmorton Stieet • Foit �Uoxth, TZ 76012-6311
' (817) 392 - 7941 • Fax (817) 392 - 7845
LF
5736
LF
164
4
LF
9117
LF
210
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 app�ared Ab Grantges,
Contract Mgr, Of Burnsco Construction, known to me to be a credible
person, who being by me duly sworn, upon his oath deposed and said;
Th.at all persons, firms, assflciations, corporatians, 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 ciescribed as;
Trails of Elizabeth Creek Ph. 7- Water, Sanitary Sewer and �torm Drain
BY
A Grantges, ntract Manager
Subscribed and swbm before me on this date 3rd of May, 2021.
� _�,� � ��� � �� �
Notary Aublic
Tarrant Couniy, Texas
�.�`'Rva''�., TH�R�SA P. BOARDtvIAN
, {�,... �e
�r°�� �= Notary Public, State of 7exas
�q�• ;�a� Comm. Expires 04-13-2D24
��%F"' jF. �
'n„°°;,,ti�`� NOtefy ID 10589p53
CONSENT QF
SURETY COMPANY
TO FiNAL PAYMENT
Conforms with the American lnstitute of
ArchEtects, AIA Document G707
OWNER ❑
ARCHlTECT ❑
CON7RACTOR ❑
SURETY ❑
�THEFt
Bond No d22226658
pRo.��cr:
(ildEne, edCffBSS��rails of Elizabeths Creek Phase 7- Water, Sanitary Sewer and Dreinage Improvements
TO (Owner)
Fort Worth
FORESTAR US�A�) R�AL ESTATE GROUP, INC. AND—I A��HITECT'S PROJECT �VO:
CITY OF FOt�r WORTH CONTRACT �OR:
14755 Preston Raad, 5uite 130 Trails of Elizabeth Creek Phase 7- Water, Sanitary Sewer and
Drainage Improvements
Dallas TX 75254 � CONTRACT DATE:
CONT�ACTOR; BURNSCO CONSTRUCTION, INC.
In accordance with the provisians of the Contract between the Owner and the Conta-actor as indicated above, ihe
�here insert name and address of Surety Company}
LIBERTY MUTUAL INSURANCE COMPANY
'I76 Berkeley 5treet
Baston EVIR 42116 , SURETY COMPANY
on bond of (here insert neme end address of Contractor)
BURNSCO CONSTRUCTION, INC.
6331 5ouihwest Baule�ard
Benbrook TX 76132
22nd t�ay of Marcn, 2Q21
hereby approves af the �r►al payment to the Contractor, and agrees that final payment to the Contractor shall not relieve
the Surety Company of any of its abligatians ta (here insert name and address of pwnerl
�ORESTAR (U5A} REAL ESTA�E GROUP, I�iC. AND CITY OF FORT WORTH
14755 Preston Road, Suite 130
Dallas TX 75254
as set forth in the said Surety Company's band.
IN WITNESS, WHEREOP,
the Surety Campany has hereunto set its hand this
Attest: , - , ;
(3ea1): �..F ;^.�, ;1 t���,�:.�._..
TX
, CONTRACTQR,
, DWNER,
LIBERTY MIJTUAL I�ISURANCE COMPA�fY
Surety Company
41 '
,S�G.'r d'
Signature of Authorized Kepresentative
So hinfe Hunter Attarne -in-Fact
Title
�kQTE: This form is Yo be used as a companion documenf to AIA OOCl1#tAENi G706, C4NTRqCTOR'S AFFI�AV17 OF PAYMENT OF DEB75 AND CLAIMS,
Current Edition
DlVE PAGE
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st�€��i�
This Power of Attorney limits the acts of those named herein, and they have no author'sty to
bind the Company except in [he manner and to the extent herein sfated.
Liberty Mutual Insurance Company
The Ohio Gasualty Insurance Campany
West American Insurance Company
Certificate No: 8200743
POWER OF ATTORNEY
KNOWN ALL PERSONS BY THESE PRESENTS: That The Ohia Casualfy InsuranCe Company is a Cofpafa6on duly organized undef tfi�e laws af the State of New Hampshire, that
Liberiy Mutual lnsurance Company is a corporation ciuiy organized under the laws af the Sfate of Massachusetts, and West American Insurance Company is a corporation duly organized
under the laws of the Stafe of Indiana (herain collectively calied the "Campanies"}, pursuant to and by auihoriiy herein set forth, does hereby name, constitute and appo€nY,
RoUbf Morales, Don f„ Comcll, Sophinie Hunter, Tin� 11�cEwan, Tnnie Petranek, Ricardo 7_ Reyna, Ioshua Saunders, Kellv A. Westbrook
all of the ci#y of Dal las state of CX each Individually d Yhere be more than one namsd, its true and lawiul attarney in-fact ta make,
execute, seal, acknowledge and deliver, for and on its behalf as surety and as iis act and deed, any and all underka[cings, bonds, recognizanc�es and other surety obligations, in pursuance
of these presents antl shall be as binding �pon the Companies as if they have been duly sigr�ed by fhe president and aflested by t�e secretary of the Companies in their own proper
persons.
IN WITN ES5 WHEREOF, this Power pf At#orney has been su6scribed by an authorized officer pr official of ihe Companies and the corporate seals of fhe Campanies have been affixed
lhereto this 19th day of March , 2019 .
�
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C
� 5tate of PENNSYLVANlA
} � County af MONTGOMEf2Y ss
Liberfy Mutual fr�surance Company
P4 1NSU/�+4 P�ZY iNs�� � vssuqq The Qhio Casualry Insurance Company
j'�����P��r�.oyfi � 2c°RPO�rF9y �P�oRPORaT�'t'� WestAmericanlnsuranceCompany �
4 �
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�� 1912 y Q o y 19'E 9� 0 4'1991 0 I % �� � �
rd,�q`�SA�k„5� aa� � fi`�HAM45��ya �s �Nb�AaP da� G�-���� � a�
��7 * �'� ''H1 :r F-� 9,y ,r �N BY � / . ' in
�avid M. Carey, Assistant Secretary �
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n� On this 19th day of March , 2U I 9 before me personally appeared �avid M. Carey, who acknowledged himself to 6e the AssisYa[�t Secretary of Lit�erty Mutual Insurance o
o� Company, The Ohia Casualfy Company, and Wesi American Insurance Company, and that he, as such, being authorized so to do, execuie the foregaing irrstrument for ihe purposes —�
�� therein contained by signing on behalf of ihe corporations by himself as a cluly auihorized o�cer. � w
��
�� IN WI7NES5 WHEREOF, I have hereunto s�bscribed my name and affixed my notarial seal al King of Prussia, Pennsyfvania, an 1he day and year first ahove written. � Q
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p � �� °i -z ^,- � COMMONWEALTF{ pF PENNSYLVANIA � �
— � , .; . { - ..,.,.....
� � �,� - o N ta s, Seal ...I //�� 66 .F -�
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O � ,� ppc L9�n�n ���p_, Montgo�ery Co��y By; .L.�.(.Q2�-i �t�t-C.� �% � f6
� [�4 �; - h � a "��, �✓� Cci�i n�s �o� �xPirzs h.ia•cl� �8, 2021 ���. �
�°} _._ _. ___ eresa Pastella, Notary Pu61ic Q�
�� '.`�: nber Pen� s�l -�a Aascc'aPv 3 c° Naa��_s a
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.�v This Power of Attorney is made and executed pursuant fo and py authority of the following By-laws and Auihorizations of The Ohio Casualty Insuranee Company, Liberty Mutual � 6'
c
o.� Insurance Company, and West American lnsurance Company whlch resolutions are now in i�ll fotce and effect reading as follows: o�
� a,i ARTICLE IV-OFFICERS:Section 12. PowerofAttomey. �^�
�@ Any officer or other o�c3al of the Corporafion authorized for that purpose ir� writing by ihe Chairman or the President, and subject to such limitation as ihe Chairman or the ��
� � President may prescribe, shall appoint such attomeys in-fact, as may be necessary to act in behalf of the Corporation to make, execute, seai, acknowledge and deliver as surety a o
c4 � any and all undertakings, bonds, recognizances and other surety nbligations. Such attorneys imfact, subject to the limitations set forth in tl�eir respective powers of at#orney, shall � N
�� have #ull power to bind ihe Corporation by their signature and execution of any such instruments and to attach C�ereto the seal of the Corporation. When sa executed, such '-' °Q
� L instrumenls shall be as binding as if signed py the President and attested to 6 the 5ecreta An ower or authori ranted to an re resentative or attorns an fact under ihe � c.�-}
� c�i Y fY Y P �Y 9 Y P Y- -
provisions of this article may be revoked at any time by the Bpard, the Chairman, the President ar by the offic�er o� officers granting such power or authorfty. �°O
ARTICLE Y[III - Execution of Contracts: 5ection 5. Sutety Bonds and Undertakings. ��
co
Any offcer of the Company au#horized for that purpose in writing hy the chafrman or the president, and subject to such iimEtations as the ct�airman pr the president may prescrfbe, ��'-
shall appoint such attorneys-in-fact, as may 6e necessary fo act in behalf of the Company fo make, execute, seal, acknowledge and deliver as surety any and all undertakings,
6onds, recognizances and other surety obligations. Such attorneys-in facf suhject to the limitations set forth in their respective powers of atforney, shall have full power to binct the
Company by their signature and execution of any such instrumenfs and io attach thereto Ihe seai of the Cnmpany. When so executed such irtstruments shall be as bfnding as if
signed 6y the president and attested by the secretary.
Certiffcate ai �esi�nation - The President of the Gompany, acting pursuani io the Bylaws of the Company, authorizes Davitl M. Garey, Assistant 5ecretary to appoint suci� attomeys-in-
fact as may be necessary to act on behalf of the Company to make, execute, seai, acknowledge and deliver as surety any and aEl undertakings, bands, recognizances and other surety
obligafions.
Authorization - By unanimous conseni of the Camgany's Board of Directors, t�e Company oo-nsents tha[ facsimile or mechanically reproduced signature of any assistant secretary of the
Company, wherever appearing upon a certifietl copy of any power of attorney issued by fhe Gompany in connection witn surety bonds, shall be valitl and 6inding upon t�e Compa�y with
the same force and effect as though manually affixetl.
1 Renee C. �lewellyn, the undersigned, Assistant Secretary, The Ohio Casualty Insurance Company, Liherty Mutual Ensurar�ce Company, and West American Insurance Company do
hareby certify lhat the original power of aftomey of which ihe foregoing is a full, true antl correct copy of the Power of tittorrey executed by said Companies, is in full force and eHect and
has not been revoked.
IN 7ESTIMONY WHEREpF, I have hereunto set my hand and af�xed the seals of said Companies Yhis 22nd day oi tilarch , 2021 .
A` �N5URR P4�y fMSV � tiNSURR
� =40RP�R4T�0'�IS '�J=`oi�P4Rq1F�� `W=�RPQR,q�lf'C
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4 9'12 h o y 1919 � o Q'! 991 0 �,,,
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Y�"`F9j7 �"°$ a a y�dyyAMPS �da� �S��N��aNp��a By Renee C. Llewellyn, AssistanY 5ecretary �
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TEXAS
IMPORTANT NOTICE
To obtain Enfor�nation or make a complaini:
You may caIl toll-free for information or to
make a complaint at
1-877-751-2640
You may also write to:
2200 Renaissance Bivd., Ste. 4Q0
King of Pr�ssia, PA 19406-2755
Yau may contact the Texas Departmeilt of
lnsurance to o6tain information an companies,
coverages, rights or cornplaints at
1-800-252-3439
You may write the Texas Department of Inslirance
Consu�r,er ProtecLion (1 1 ] - [ A)
P. O. Box rt 49091
Austin, TX 78714-9091
FAX: (512) 490-1007
Web: hitpJ/www.tdi.iexas.��,ov
E-mail: ConsumerProtection tdi.texas. ov
PR�MIUM OR CLAiM DISPLITES:
Should you have a dispute concerning your
preEnium or about a clai�n you should �rst
co�ltact the agent or call 1-800-843-6446.
If the dispute is not resolved, �o�a may contact the
Texas Department of [nsurance.
ATTACH THIS NOTICE TO YOUR
�'OLICY:
This notice rts for infonnation only a�id does not
become a part or condition of the attached
document.
TEXAS
AVI50 IMPORTANTE
Para obtener informacion o para someter u�ia
queja:
Usted puede Ilamar al numero de telefona gratis
para informacion o para someter una queja al
1-877-751-2640
Usted tambien puede escribir a:
2200 Renaissance Blvd., Ste. 400
King of Prussia, PA 19406-2755
Puede comunicarse con el Departamerato de
Seguros de Texas para obtener informacion
acerca de companias, cober�uras, d�rechos o
quejas al
1-800-252-3439
Puede escribir al DepartamEnto de Seguros
de TExas Consu�ner Prote�ction (1 1 1- [ A)
P_ 4. Box 149091
Austin, TX 78714-9091
FAX � (512) 490- i 007
Web: htlp://www,tc�i.texas. ,�ov_
E-mail: Cons�merProtection tdi.texas.�ov
DISPUTAS SOBRE PRiMAS O RECLAMOS:
Si tiena una disputa concerniente a su prima o a
un rec�arno, debe comunicarse con el agente o
primero. Si r�o se resuel�e �a disp�ata, puede
entaraces comunicarse ca� el cEepartamento (TDI)
UNA ESTE AV1S0 A SU POLIZA:
Este aviso es solo para proposita c�e informacion
y no se convierte en parte o condicion del
documcnto adjunta.
Nl'706809Q1
LMS-95292 10f15