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HomeMy WebLinkAboutContract 53510-FP1 City Secretary 53510 -FP1 Contract No. FORT WORTH, Date Received Aug 10,2021 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: MARKETPLACE PHASE I City Project No.: 102205 Improvement Type(s): Water ❑x Sewer ❑x Original Contract Price: $758,091.50 Amount of Approved Change Order(s): $61,991.00 Revised Contract Amount: $820,082.50 Total Cost of Work Complete: $820,082.50 Steph nNagel(Aug4,2 114:44CDT) Aug4,2021 Contractor Date Senior Project Manager Title Spring Valley Construction Company Company Name MAH-h�W4 yr Aug 2021 Matthew Wilson(Aug 6,202114:57 CDT) u g Project I nrlsoector Date Khal Jaafari P.E. g6,2 7:28 CDT) Aug 6,2021 Project Manager Date �eG��r�obe�tr oar LghaZV,7a�rie�I Evelyn Ro erts on behalf of Janie M(Aug 9,2021 0 :46 DT) Aug 9,2021 CFA Manager Date b"W-L5=L7� Aug0 2021 Dana Burghdoff(A g 10,20 08:48 CDT) g Asst. City Manager Date OFFICIAL RECORD Page 1 of 2 CITY SECRETARY FT. WORTH, TX Notice of Project Completion Project Name: MARKETPLACE PHASE I City Project No.: 102205 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: 200 CD Days Charged: 276 Work Start Date: 3/16/2020 Work Complete Date: 12/17/2020 Page 2 of 2 FORT WORTH CITY OF FORT WORTH FINAL PAYMENT REQUEST Contract Name MARKETPLACE PHASE 1 Contract Limits Project Type .WATER&SEWER City Project Numbers 102205 DOE Number 2205 Estimate Number I Payment Number 1 For Period Ending 8/4/2021 CD City Secretary Contract Number Contract Time 20UD Contract Date Days Charged to Date 276 Project Manager NA Contract is 100.00 Complete Contractor SPRING VALLEY CONSTRUCTION COMPANY 10950 ALDER CIRCLE DALLAS, TX 75238-1353 Inspectors OWEN / WILSON Wednesday,August 4,2021 Page 1 of 5 City Project Numbers 102205 DOE Number 2205 Contract Name MARKETPLACE PHASE 1 Estimate Number I Contract Limits Payment Number I Project Type WATER&SEWER For Period Ending 8/4/2021 Project Funding WATER Item Estimated Estimated Completed Completed Description of Items Unit Unit Cost No. Quanity Total Quanity Total --------------------------------------- 1 PVC,DUCTILE IRON,CONCRETE PRESSURE 54 EA $550.00 $29,700.00 54 $29,700.00 AND BURIED STEEL PIPE PRESSURE PLUG 2 TEMPORARY SERVICE CONNECTION 1 LS $750.00 $750.00 1 $750.00 3 STANDARD CLEANING WYE FOR WATER 8 EA $500.00 $4,000.00 8 $4,000.00 DISTRIBUTION PIPE 4 STANDARD CLEANING WYE FOR WATER 2 EA $650.00 $1,300.00 2 $1,300.00 TRANSMISSION PIPE 5 EMBEDMENT FOR WATER LINES 12"AND 555 CY $15.00 $8,325.00 555 $8,325.00 SMALLER 6 EMBEDMENT FOR WATER LINES 16"TO 24" 233 CY $17.00 $3,961.00 233 $3,961.00 7 EMBEDMENT FOR WATER SERVICES 6 CY $50.00 $300.00 6 $300.00 8 WATERLINE LOWERING DETAIL 1 EA $1,200.00 $1,200.00 1 $1,200.00 9 DUCTILE IRON WATER FITTINGS 1 TN $3,000.00 $3,000.00 1 $3,000.00 10 POLYVINYL CHLORIDE PVC PRESSURE PIPE 6" 79 LF $17.00 $1,343.00 79 $1,343.00 11 POLYVINYL CHLORIDE PVC PRESSURE PIPE 8" 535 LF $20.00 $10,700.00 535 $10,700.00 12 POLYVINYL CHLORIDE PVC PRESSURE PIPE 2272 LF $26.00 $59,072.00 2272 $59,072.00 12" 13 POLYVINYL CHLORIDE PVC PRESSURE PIPE 576 LF $67.00 $38,592.00 576 $38,592.00 16"co#1 15 1-1/2&2"WATER SERVICE co#1 29 EA $750.00 $21,750.00 29 $21,750.00 16 2"STANDARD CONCRETE METER BOX co#1 29 EA $850.00 $24,650.00 29 $24,650.00 17 WATER DISTRIBUTION GATE VALVE&BOX 31 EA $2,300.00 $71,300.00 31 $71,300.00 18 WATER TRANSMISSION GATE VALVE& 2 EA $6,500.00 $13,000.00 2 $13,000.00 VAULT 19 CONNECTION TO EXISTING WATER MAINS 2 EA $1,250.00 $2,500.00 2 $2,500.00 20 STANDARD FIRE HYDRANT 7 EA $3,000.00 $21,000.00 7 $21,000.00 21 WATER SAMPLING STATION 28 22 AUTOMATIC FLUSH VALVE W/SEWER 1 EA $5,000.00 $5,000.00 1 $5,000.00 SERVICE LINE 23 TEMPORARY AUTOMATIC FLUSHER 1 EA $2,500.00 $2,500.00 1 $2,500.00 24 DEMO EXISTING ARV VAULT CO#1 1 EA $1,500.00 $1,500.00 1 $1,500.00 25 ARV VAULT CO#1 1 EA $10,285.00 $10,285.00 1 $10,285.00 -------------------------------------- Sub-Total of Previous Unit $335,728.00 $335,728.00 -------------------------------------- Wednesday,August 4,2021 Page 2 of 5 City Project Numbers 102205 DOE Number 2205 Contract Name MARKETPLACE PHASE 1 Estimate Number I Contract Limits Payment Number I Project Type WATER&SEWER For Period Ending 8/4/2021 Project Funding SEWER Item Estimated Estimated Completed Completed Description of Items Unit Unit Cost No. Quanity Total Quanity Total --------------------------------------- 1 CONCRETE ENCASEMENT FOR UTILITY PIPES 10 CY $500.00 $5,000.00 10 $5,000.00 2 PRE CCTV INSPECTION 4953.5 LF $1.00 $4,953.50 4953.5 $4,953.50 3 POST CCTV INSPECTION 4953.5 LF $1.00 $4,953.50 4953.5 $4,953.50 4 POLYVINYL CHLORIDE(PVC)GRAVITY 4726.5 LF $32.00 W1,248.00 4726.5 $151,248.00 SANITARY SEWER PIPE 8"CO#1 5 SANITARY SEWER SERVICE 3 EA $1,500.00 $4,500.00 3 $4,500.00 6 MANHOLE 4'DIAMETER CO#1 42 EA $4,500.00 W9,000.00 42 $189,000.00 7 MANHOLE VACUUM TESTING 12 EA $200.00 $2,400.00 12 $2,400.00 8 4'DROP MANHOLE 2 EA $7,500.00 $15,000.00 2 $15,000.00 9 EPDXY LINERS FOR SANITARY SEWER 141.1 VF $325.00 $45,857.50 141.1 $45,857.50 STRUCTURES 10 8"DR-18 CO#1 278 LF $136.00 $37,808.00 278 $37,808.00 11 REMOVE&REPLACE CONCRETE PAVING CO#1 640 SF $28.00 $17,920.00 640 $17,920.00 12 BARRICADES CO#1 1 LS $3,214.00 $3,214.00 1 $3,214.00 13 HAUL DIRT TO ONSITE FOR BACKFILL CO#1 1 LS $2,500.00 $2,500.00 1 $2,500.00 -------------------------------------- Sub-Total of Previous Unit $484,354.50 $484,354.50 -------------------------------------- Wednesday,August 4,2021 Page 3 of 5 City Project Numbers 102205 DOE Number 2205 Contract Name MARKETPLACE PHASE 1 Estimate Number 1 Contract Limits Payment Number 1 Project Type WATER&SEWER For Period Ending 8/4/2021 Project Funding Contract Information Summary Original Contract Amount $758,091.50 Change Orders Change Order Number Change Order Number 1 $61,991.00 Total Contract Price $820,082.50 Total Cost of Work Completed $820,082.50 Less %Retained $0.00 Net Earned $820,082.50 Earned This Period $820,082.50 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 $820,082.50 Wednesday,August 4,2021 Page 4 of 5 City Project Numbers 102205 DOE Number 2205 Contract Name MARKETPLACE PHASE 1 Estimate Number I Contract Limits Payment Number I Project Type WATER&SEWER For Period Ending 8/4/2021 Project Funding Project Manager NA City Secretary Contract Number Inspectors OWEN / WILSON Contract Date Contractor SPRING VALLEY CONSTRUCTION COMPANY Contract Time 200 CD 10950 ALDER CIRCLE Days Charged to Date 276 CD DALLAS, TX 75238-1353 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 $820,082.50 Less %Retained $0.00 Net Earned $820,082.50 Earned This Period $820,082.50 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 $820,082.50 Wednesday,August 4,2021 Page 5 of 5 FORTWORTH. TRANSPORTATION AND PUBLIC WORKS January 12, 2021 Spring Valley Construction Company 10950 Alder Circle Dallas,TX 75238 RE: Acceptance Letter Project Name: McAlister Rd. Phase 1 Project Type:Water and Sewer City Project No.: 102205 To Whom It May Concern: On January 22, 2021 a final inspection was made on the subject project. There were no punch list items identified at that time. The final inspection indicates that the work meets the City of Fort Worth specifications and is therefore accepted by the City. The warranty period will start on January 22, 2021, which is the date of the final inspection 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, Khal Jaafari P.E. g6,2 v 7:28 CDT) Khal Jaafari, P.E., Project Manager Cc: Matthew Wilson, Inspector Mark Owen, Inspection Supervisor Edwin R. Rodriguez, Sr., Senior Inspector Victor V. Tornero,Jr., P.E., Program Manager Manhard Consulting, Consultant Spring Valley Construction Company, Contractor Vista Properties, Developer File E-Mail: TPW_Acceptance@fortworthtexas.gov Rev.08/20/19 DocuSign Envelope ID:A77C6E56-AEAO-44OB-AE28-C25469EBC706 REVIEWED DEVELOPER-AWARDED-PROJECT CHANGE ORDER BY khal Jaafari at 4:14 pm, Dec 17, 2020 PROJECT NAME: Southgate Marketplace Phase 1 CHANGE CONTRACT: A Water A-1 Sewer Paving, B-1 Storm Drain, C Street Li htS 8 Si n5 ORDER No: CFA# CFA19-0093 CITY PARTICIPATION: NO CITY PROJECT# 102205 DOE# X-26197 Al WATER PROJECT# 660008-0600430-102205-001480 SEWER PROJECT# 560008-0700430-102205-001380 FILE# N-2656 INSPECTOR: Matthew Wilson Phone No: 817-392-8306 PROJECT MANAGER: Khal Jaafari Phone No: 817-392-7872 CONTRACT UNIT WATER SEWER PAVING DRAINAGE STREETLIGHTS CONTRACT Developer Developer Developer Developer Developer Cost city Cost Cost city Cost cost City cost Cost Citycost cost city Cosl ORIGINAL CONTRACT $323,415.00 Samoa $434,676.50 $0.00 S587,864.62 s0.o0 $101,336.00 50.00 $53,910.00 $0.0.00 20 EXTRAS TO DATE $9.00 $0.00 $0.00 Moo $0.00 Samoa $0.00 50.00 50.00 60 0 CREDITS TO DATE $0.00 S0.00 $0.00 $0.00 $0.00 S0.00 $0.00 $0.o0 et) 50,00 0 $v CONTRACT TO DATE $323,415.00 $0.00 $434.676.50 $0.00 $597,864.62 $0.00 $101,336.00 $0.00 $53.910.00 $0.00 200 AMOUNT OF PROP.CHANGE ORDER $12.313.00 $0.00 $49,678.00 $0.00 $10,503.77 S0.00 50.00 S0.00 14,609.20 S0.00 7 REVISED CONTRACT AMOUNT $335728.00 $0.00 548l,35l.50 50.00 $577,360.89 $0.00 5701,376.00 S0.o0 $68,519.20 $0.60 207 TOTAL REVISED CONTRACTAMOUNT PER UNIT $335729.00 $IBl,75l.50 5577,760.89 5101,376,00 568,519.20 REVISED COST SHARE DeV.Cost: $1,567,298.59City Cost: TOTAL REVISED CONTRACT $1,567.298.59 You are directed to make the follown cha es ii the contract documents: CITY BID ITEM PAY STEM # il ITY UNIT ITEM DESCRIPTION UNIT PRICE TOTAL 13 1 WATER 3311.0541 LF Deduct 1G'DR-14 Water 67 -1072 15 1 WATER 3312.2203 EA 1-112 2-Inch Water Serivice 750 70 16 1 WATER 3312.2203 EA 2-inch Standard Concrete Meter Box 850 850 500 24 1 WATER 9999=0001 EA Demo Existing ARV Vault 1-2 1-2 25 1 WATER 3312.1002 EA ARV Vault 10285 10285 12313 WATERSUBTOTAL 32 -7264 4 2 SEWER 3331.4115 -227 LF Deduct 8"SOR-26 6 2 SEWER 3339.1001 -1 EA Deduct 4'Dla.hlanhole 4500 -450 10 25EWER 3305.3002 278 LF 8"DR-18 CL 10' 136 37808 11 2 SEWER 321300103 640 SF Remove 8 Replace Concrete He' 28 17920 12 2 SEWER 9999./XX12 1 LS Barricades 3214 3214 13 2EEWER 9999.0003 1 LS Haul Ditto Ons9e Location for Backfill 250 2500 49678 SEWER SUBTOTAL 9.61 -10503.73 8 3 PAVING 3213.0103 .1093 SF Reduced FM.1187 90 Feet -1003.73 PAVING SUBTOTAL 900 900 7 4STREET LIGHTS 3441.502 1 EA Relocate AddifionalL ht Pole per C' of Fort 3904 3904 8 4STREET LIGHTS 3441.3301 1 EA New 30.A Fourxlatwn 9 4 STREET LIGHTS 2605.3011 478 LF 2'PVC SCH 80 PVC 14 6692 10 4 STREET LIGHTS 3441.1401 478 LF #4 Alumnum Tri ex 1.9 908.20 11 4STREET LIGHTS 9999.tXg4 1 EA Remove Ground Boxand on 00 500 12 4 STREET LIGHTS 3441.103 1 EA T D Grouts Box 100 100 13 4 STREET LIGHTS 3441.3411 3 EA Reconnect Conducter at ht Poles with Breakawa Fuse Holders 235 14705 09.20 STREET LIGHTS SUBTOTAL 0096.47 TOTAL -Trench safety is included in Sewer Pipe pdce (1)Item 9 9999.0001 represents removal of an existing ARV Vaultn vft 1-35 W Senice Road (2)Ite m #9999.00D2 re presents bwrz das to be tempm,arly Installed for connection to existirg saver Ine (3)item#9999.0013 represents hauling dit from offsRe location to bacMi added sevrer Ine (3)Item#9999.0004 represents the demo5shiun and removal of an exietirg ground box m idrn TxDOT ROW (3)Item#9999.0005 represents the removal of an ehaling Street Light Foundation withn TxDOT ROW REASONS FOR CHANGE ORDER Reason 1: Water line ded ct is due to a conshuction revision from an outside plan set. Water department requested meter be placed on auto-flusher near F.Al,1187 Reason 2. Sewer line changes due to the stub being in the wrong location. Reason 3: The demo and replacement of the ARV vault is due to existing conditions. Reason 4: Reduced F.M.1187 TxDOT driveway is due to a request by TxDOT Reason 5: The relocation of the light pole is due to an overlook. NO CITY FUNDS INVOLVED IN THIS CONTRACT.DEVELOPER IS RESPONSIBLE FOR 100-A OF THE CHANGE ORDER COST AND NO REIIABU RSEMENT FROM THE CRY WILL BE SOUGHT BY THE DEVELOPER. RECOMMENDED: APPROVED: APPROVED::: (Consulting Engine r) (Dev 1-4) w hip (Contractornl/Y t T ar(j" IfJ`�/� Colton Wright Name: Brent Archer Name: Reece Bierhalter Name: Title:ProiectManaaer Title: Vice President Title: VP of Operations Page 1 Revised:10-12-2011 NOTICE: This document waives rights unconditionally and states that you have been paid for giving up those rights. It is prohibited for a person to require you to sign this document if you have not been paid the payment amount set forth below. If you have not been paid, use a conditional release form. UNCONDITIONAL WAIVER AND RELEASE ON FINAL PAYMENT Project: Southgate Marketplace Job No. 19040 The signer of this document has been paid in full for all labor, services, equipment, or materials furnished to the property or to Vista Ware Southgate #1. L.P (person with whom signer contracted) on the property of Vista Ware Southgate #1, L.P. (owner) located at Southeast Corner of 135W and FM 1187, Fort, Worth. TX (location)to the following extent:Southgate_Market €p ace(job description). The signer therefore waives and releases any mechanic's lien right, any right arising from a payment bond that complies with a state or federal statute, any common law payment bond right, any claim for payment, and any rights under any similar ordinance, rule, or statute related to claim or payment rights for persons in the signer's position. The signer warrants that the signer has already paid or will use the funds received from this final payment to promptly pay in full all of the signer's laborers, subcontractors, materialmen, and suppliers for all work, materials, equipment, or services provided for or to the above referenced project up to the date of this waiver and release. Date March 9.2021 Spring ValleX Construction C m an mpany Name) By: (Signature) Kennon Garms_-Vice_Presklent Finance (Title) STATE OF TEXAS COUNTY OF DALLAS This Conditional Waiver and Release on Progress Payment iwa4scknowledged before me on this 99th day of March 2021, Kennon Garms, on behalf of S rin Valle ConstructiV a T r ip . '111111111111►l11�I� �CPaY•�U�•�•• ��r�- Notary Public— to o T xa 4 $ �� �X ; y My Commission Expires: TF0Ft�+� rig •■....■ �� 11-1a�i��� ktflli�� Spring Valley Construction Company Job#19040 Unconditional Waiver&Release on Final Payment Consent of Surety OWNER ❑ to Final Payment ARCHITECT ❑ CONTRACTOR ❑ SURETY AIA DOCUMENT G707 OTHER Bond No.46BCSIF2215 TO OWNER: ARCHITECT'S PROJECT NO.: (Name and address) Ware Vista Southgate#1, L.P. CONTRACT FOR: Construction 8350 N. Central Expressway, Suite 1750 Dallas,TX 75206 PROJECT: Southgate Marketplace Phase I CFA (Name and address) SWC 135W and FM 1187, Fort Worth,TX 76027 CONTRACT DATED: January 17, 2020 In accordance with the provisions of the Contract between the Owner and the Contractor as included above, the Hartford Fire Insurance Compan One Hartford Plaza, Hartford, CT-06155-0001 (insert name and address of Surety) SURETY, on bond of Spring Valley Construction Company_ (Insert name and address of contractor) 10950 Alder Circle, Dallas,TX 75238 _ CONTRACTOR, hereby approves of the final payment to the Contractor, and agrees that final payment to the Contractor shall not relieve the Surety of any of its obligations to Ware Vista Southgate#1, L.P. (insert name and address of Owner) 8350 N. Central Expressway, Suite 1750, Dallas,TX 75206 OWNER, as set forth in the said Surety's bond. IN WITNESS WHEREOF,the Surety has hereunto set its hand on this date: April ,2021 (insert in wring the month followed by the numeric date and,year.) Hartford Fire Insurance Company "'uPl k Attest: (Seal): (Sigffitye ofauttw1yorney-in-Fact &sentaribe) Amber Jones, (Printed name and title Printed in cooperation with the American Institute of Architects(AIA) The language in this document conforms exactly to the language used in AIA Document G707-Consent of Surety Company to Final Payment- 1994 Edition. Direct Inquiries/Claims to: THE HARTFORD BONPOWER OF ATTORNEY HartfOne Hartrd Plaza ord,Conne tcut06155 B on d.C l a i m s Athetl a rlford.c om call:888-2663488 or fax:860-757-5835 KNOW ALL PERSONS BY THESE PRESENTS THAT: Agency Name: WEBER GROUP ADVISORS A enc Code: 46-508894 I� Hartford Fire Insurance Company, a corporation duly organized under the laws of the State of Connecticut Hartford Casualty Insurance Company,a corporation duly organized under the laws of the State of Indiana 0 Hartford Accident and Indemnity Company, a corporation duly organized under the laws of the State of Connecticut Hartford Underwriters Insurance Company,a corporation duly organized under the laws of the State of Connecticut Twin City Fire Insurance Company, a corporation duly organized under the laws of the State of Indiana Hartford Insurance Company of Illinois,a corporation duly organized under the laws of the State of Illinois Hartford insurance Company of the Midwest,a corporation duly organized under the laws of the State of lndiana Hartford Insurance Company of the Southeast,a corporation duly organized under the laws ofthe State of Florida having their home office in Hartford,Connecticut, (hereinafter collectively referred to as the"Companies")do hereby make, constitute and appoint, up to the amount of Unlimited : Julie Baumberger, Amber Jones, April Penny, Darrin J. Weber of DALLAS, Texas their true and lawful Attorney(s)-in-Fact, each in their separate capacity if more than one is named above, to sign its name as surety(ies) only as delineated above by ®, and to execute, seal and acknowledge any and all bonds, undertakings, contracts and other written instruments in the nature thereof,on behalf of the Companies in their business of guaranteeing the fidelity of persons,guaranteeing the performance of contracts and executing or guaranteeing bonds and undertakings required or permitted in any actions or proceedings allowed by law. In Witness Whereof, and as authorized by a Resolution of the Board of Directors of the Companies on May 23, 2016 the Companies have caused these presents to be signed by its Assistant Vice President and its corporate seals to be hereto affixed, duly attested by its Assistant Secretary. Further, pursuant to Resolution of the Board of Directors of the Companies,the Companies hereby unambiguously affirm that they are and will be bound by any mechanically applied signatures applied to this Power of Attorney. 1 L�3 L ip e � ��1 .�rternruell w ' 1��t' 8 e�rsy'�olt" .� ��`'n,eari • �ra1r1A� :'i Iri74 c Ait!?7�f I97� ✓V � L� � �,{.fJvr-f Shelby Wiggins,Assistant Secretary Joelle L.LaPierre,Assistant Vice President STATE OF FLORIDA SS. Lake Mary COUNTY OF SEMINOLE On this 13th day of February,2020,before me personally came Joelle LaPierre,to me known,who being by me duly swom,did depose and say: that(s)he resides in Seminole County,State of Florida;that(s)he is the Assistant Vice President of the Companies,the corporations described in and which executed the above instrument;that(s)he knows the seals of the said corporations;that the seals affixed to the said instrument are such corporate seals; that they were so affixed by authority of the Boards of Directors of said corporations and that(s)he signed his/her name thereto by/like authority- J C Y` y ¢NC, Jessica Noelle Ciccone 7r r.A. My Commission#FF029702 Expires June 20,2021 I,the undersigned,Assistant Vice President of the Companies, DO HEREBY CERTIFY that the above and foreggoing is a true and correct copy of the Power of Attorney executed by said Companies,which is still in full force effective as of Apri 1 2 7, 2 02I. Signed and sealed in Lake Mary, Florida. � �'4�� y�y �'„ � ��~'a e �� a �4�r �./�� • s�pw`¢�. ; c Keith D.Dozois,Assistant Vice President IMPORTANT NOTICE AVISO IMPORTANTE To obtain information or make a complaint: Para obtener informacion o para presentar una queja: You may contact your Agent. Usted puede comunicarse con su Agente. You may call The Hartford's Consumer Affairs toll- Usted puede llamar at numero de telefono free telephone number for information or to make gratuito de The Hartford's Consumer Affairs a complaint at: para obtener informacion o para presentar una queja at: 1-800-451-6944 1-800-451-6944 You may contact the Texas Department of Listed puede comunicarse con el Departamento Insurance to obtain information on companies, de 5eguras de Texas para obtener informacion coverages, rights, or complaints at: sobre companias, coberturas, derechos, o quejas at: 1-800-252-3439 1-800-252-3439 You may write the Texas Department of Insurance: Usted puede escribir at Departamento de Seguros de Texas a: 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 Sitio web: www.tdi._texas. E-mail: ConsumerPratection@tdi.texas.go v E-mail: ConsumerProtection@tdi.texas,gLv PREMIUM OR CLAIM DISPUTES: DISPUTAS POR PRIMAS DE SEGUROS 0 RECLAMACIONES: Should you have a dispute concerning your Si tiene una disputa relacionada con su prima premium or about a claim, you should contact the de seguro o con una reclamation, usted debe (agent) (company) (agent or the company) first. If comunicarse con (el agente) (la compania) (el the dispute is not resolved, you may contact the agente o la compania) primero. Si la disputa no Texas Department of Insurance. es resuelta, usted puede comunicarse con el Departamento de Seguros de Texas. ATTACH THIS NOTICE TO YOUR POLICY: ADJUNTE ESTE AVISO A SU POLIZA: Este aviso This notice is for information only and does not es solamente para propositos informativos y no become a part or condition of the attached se convierte en parte o en condition del document. documento adjunto. ®20IS by The HofHOrd.OassfffcaHon:latemafy C mIloRed.All fights IC54rv@d. No pert of this document may be rnprnduced.pubksh--doruBed ioeNf)l the pedmissron of The Hertford. i i THE Producer Compensation Notice HARTFORD i 4 You can review and obtain information on The Hartford's producer compensation practices at www.theharLford.com or at 1-800-592-5717 I i I i F 1(t i I 7 it I 5� �r 1}1F 1 t 7 1 t E HR 00 H093 00 0207 ©2007, The Hartford Page 1 of 1 i I