Loading...
HomeMy WebLinkAboutContract 55972-FP2 City Secretary Contract No. 55972 -FP2 FORT WORTH., Date Received Sept. 19,2022 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: Litsey Creek Cottages City Project No.: 103173 Improvement Type(s): ❑x Paving ❑x Drainage ❑x Street Lights ❑ Traffic Signals Original Contract Price: $1,101,676.88 Amount of Approved Change Order(s): $815.84 Revised Contract Amount: Total Cost of Work Complete: $1,102,492.72 Samuel Heath(Sep 14,202214:01 CDT) Sep 14, 2022 Contractor Date Project Manager Title Ridgemont Company Name RileyR epj 212214:21CDT) Sep 14, 2022 Project Inspector Date `ems'Uy Se 14 2022 Kiran Konduru,P.E.(Sep 14,202215:45 CDT) p e Project Manager Date T�vrie S�drle�f Morales Sep 14, 2022 J.^'^<.-•'e��PAera4eT(Seg 14r2A2.2-�5�17 6DT) CFA Manager Date /0 - Sep 14, 2022 Interim TPW Director Date William Johnson(S 15,202208:12 CDT) Sep 15, 2022 Asst. City Manager Date OFFICIAL RECORD CITY SECRETARY FT. WORTH, TX Page 1 of 2 Notice of Project Completion Project Name: Litsey Creek Cottages City Project No.: 103173 City's Attachments Final Pay Estimate ❑x Change Order(s): ❑x Yes ❑ N/A Contractor's Attachments Affidavit of Bills Paid r. Consent of Surety ; Statement of Contract Time Contract Time: 150 WD Days Charged: 216 Work Start Date: 8/23/2021 Work Complete Date 08/2/2022 Completed number of Soil Lab Test: 284 Completed number of Water Test: 29 Page 2 of 2 FORT WORTH CITY OF FORT WORTH FINAL PAYMENT REQUEST Contract Name LITSEY CREEK COTTAGES Contract Limits Project Type DRAINAGE,PAVING AND STREETLIGHT IMPROV City Project Numbers 103173 DOE Number 1730 Estimate Number 1 Payment Number 1 For Period Ending 8/2/2022 WD City Secretary Contract Number Contract Time 15WD Contract Date 6/22/2021 Days Charged to Date 216 Project Manager NA Contract is 100.00 Complete Contractor RIDGEMONT COMPANY 1520 W.WALNUT HILL LANE IRVING, TX 75038 Inspectors GLOVER/ ROBERSON Monday,September 12,2022 Page 1 of 5 City Project Numbers 103173 DOE Number 1730 Contract Name LITSEY CREEK COTTAGES Estimate Number 1 Contract Limits Payment Number 1 Project Type DRAINAGE,PAVING AND STREETLIGHT IMPROVEMEN For Period Ending 8/2/2022 Project Funding UNIT III DRAINAGE IMPROVEMENTS Item Estimated Estimated Completed Completed Description of Items Unit Unit Cost No. Quanity Total Quanity Total 1 REMOVE 18"STROM LINE 51 LF $47.50 $2,422.50 51 $2,422.50 2 REMOVE HEADWALUSET 2 EA $500.00 $1,000.00 2 $1,000.00 3 CONCRETE RIPRAP 240 SY $60.00 $14,400.00 240 $14,400.00 4 TRENCH SAFETY 1969 LF $1.00 $1,969.00 1969 $1,969.00 5 21"RCP,CLASS lII 397 LF $59.00 $23,423.00 397 $23,423.00 6 24"RCP,CLASS III 120 LF $63.00 $7,560.00 120 $7,560.00 7 30"RCP,CLASS lII 562 LF $79.00 $44,398.00 562 $44,398.00 8 42"RCP,CLASS III 459 LF $132.00 $60,588.00 459 $60,588.00 9 48"RCP,CLASS lII 431 LF $155.00 $66,805.00 431 $66,805.00 10 30"SET, 1 PIPE 2 EA $7,000.00 $14,000.00 2 $14,000.00 11 42"SET, 1 PIPE 3 EA $8,100.00 $24,300.00 3 $24,300.00 12 15'CURB INLET 5 EA $5,900.00 $29,500.00 5 $29,500.00 13 20'CURB INLET 1 EA $9,600.00 $9,600.00 1 $9,600.00 14 T DROP INLET 3 EA $6,100.00 $18,300.00 3 $18,300.00 15 24"RCP,CLASS III 120 LF $63.00 $7,560.00 120 $7,560.00 16 21"RCP,CLASS lII 397 LF $59.00 $23,423.00 397 $23,423.00 17 TRENCH SAFETY 2525 LF $1.00 $2,525.00 2525 $2,525.00 18 CONCRETE RIPRAP 240 SY $60.00 $14,400.00 240 $14,400.00 19 5'STORM JUNCTION BOX 4 EA $6,500.00 $26,000.00 4 $26,000.00 20 REMOVE 6'X4'STORM CULVERT 1 EA $1,800.00 $1,800.00 1 $1,800.00 21 CONNECT EX.STORM RCP 3 EA $1,750.00 $5,250.00 3 $5,250.00 22 CONNECT TO EX.JUNCTION BOX 1 EA $2,625.00 $2,625.00 1 $2,625.00 -------------------------------------- Sub-Total of Previous Unit $401,848.50 $401,848.50 -------------------------------------- UNIT IV PAVING IMPROVEMENTS Item Estimated Estimated Completed Completed Description of Items Unit Unit Cost No. Quanity Total Quanity Total 1 REMOVE SIDEWALK 48 SF $1.00 $48.00 48 $48.00 2 REMOVE FENCE 1304 LF $1.00 $1,304.00 1304 $1,304.00 3 REMOVE CONC PVMT 160 SY $7.00 $1,120.00 160 $1,120.00 4 REMOVE ASPHALT 545 SY $5.00 $2,725.00 545 $2,725.00 Monday,September 12,2022 Page 2 of 5 City Project Numbers 103173 DOE Number 1730 Contract Name LITSEY CREEK COTTAGES Estimate Number 1 Contract Limits Payment Number 1 Project Type DRAINAGE,PAVING AND STREETLIGHT IMPROVEMEN For Period Ending 8/2/2022 Project Funding 5 6"LIME TREATMENT 9328 SY $3.00 $27,984.00 9328 $27,984.00 6 7"CONC PVMT 9328 SY $38.00 $354,464.00 9328 $354,464.00 7 4"CONCPVMT 23549 SF $5.88 $138,468.12 23549 $138,468.12 8 BARRIER FREE RAMP,TYPE P-1 14 EA $2,350.00 $32,900.00 14 $32,900.00 9 4'SLD PVMT MARKING HAS(Y) 4652 LF $4.48 $20,840.96 4652 $20,840.96 10 24"SLD PVMT MARKING HAE(W) 72 LF $13.00 $936.00 72 $936.00 11 BLOCK SOD PLACEMENT 2722 SY $8.00 $21,776.00 2722 $21,776.00 12 REMOE GRAVEL PAVEMENT 2573 SY $1.00 $2,573.00 2573 $2,573.00 Sub-Total of Previous Unit $605,139.08 $605,139.08 UNIT V STREETLIGHT IMPROVEMENTS Item Estimated Estimated Completed Completed Description of Items Unit Unit Cost No. Quanity Total Quanity Total 1 FURNISH/INSTALL ELEC SERV PEDESTAL 1 EA $1,173.94 $1,173.94 1 $1,173.94 2 2"CONDT RM(RISER) 20 LF $8.20 $164.00 20 $164.00 3 2"CONDT PVC SCH 80(T) 4928 LF $1.15 $5,667.20 4928 $5,667.20 4 GROUND BOX TYPE B W/APRON 21 EA $210.00 $4,410.00 21 $4,410.00 5 FURNISH/INSTALL TYPE 33B ARM 15 EA $556.00 $8,340.00 15 $8,340.00 6 LED LIGHTING FIXTURE 15 EA $1,100.00 $16,500.00 15 $16,500.00 7 RDWY IINM FOUNDATION TY L2,AND 4 15 EA $850.00 $12,750.00 15 $12,750.00 8 FURNSIH/INSTALL RDWAY IINM TY 11 POLE 15 EA $3,100.00 $46,500.00 15 $46,500.00 Sub-Total of Previous Unit $95,505.14 $95,505.14 Monday,September 12,2022 Page 3 of 5 City Project Numbers 103173 DOE Number 1730 Contract Name LITSEY CREEK COTTAGES Estimate Number 1 Contract Limits Payment Number 1 Project Type DRAINAGE,PAVING AND STREETLIGHT IMPROVEMEN For Period Ending 8/2/2022 Project Funding Contract Information Summary Original Contract Amount $1,101,676.88 Change Orders Change Order Number 1 $815.84 Total Contract Price $1,102,492.72 Total Cost of Work Completed $1,102,492.72 Less %Retained $0.00 Net Earned $1,102,492.72 Earned This Period $1,102,492.72 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 $1,102,492.72 Monday,September 12,2022 Page 4 of 5 City Project Numbers 103173 DOE Number 1730 Contract Name LITSEY CREEK COTTAGES Estimate Number 1 Contract Limits Payment Number 1 Project Type DRAINAGE,PAVING AND STREETLIGHT IMPROVEMEN For Period Ending 8/2/2022 Project Funding Project Manager NA City Secretary Contract Number Inspectors GLOVER/ ROBERSON Contract Date 6/22/2021 Contractor RIDGEMONT COMPANY Contract Time 150 WD 1520 W.WALNUT HILL LANE Days Charged to Date 216 WD IRVING, TX 75038 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 $1,102,492.72 Less %Retained $0.00 Net Earned $1,102,492.72 Earned This Period $1,102,492.72 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 $1,102,492.72 Monday,September 12,2022 Page 5 of 5 - q 0 q 0 > - - �-- -- — - 0 p m G a @ - & - -- - - �t - 04 ; � /| � ;� ■ W )LU - $ � k § § LLJ lf . . . .. . ■ � 2 ■� w ui x © # cc � � a 22B k w mw w § � 0 §¢ § & 2 d 2 ■ u o & E b 451 � k § § § ; ■ - & a § - g CL k ƒ 2 2 2 46 � § � § ■ § § � � � ■ § � � � § § § t§ p ■ § § ■ d � � � ■ § K 2 2 � § � k � . . a QQ2 � x � ■� . . ..8 . � $..f_ � N O N N O p 88 8ug� $$8`a, 88.-44 4 ww wwwwNNw NwNw„� $ N $ 8�8Q8888 888� � a N� NNNb'ww wNN�+ O � W Lij Y CL cc m a LE vm 9 d m M�p�p ice UU w E N d FORT NORTH. TRANSPORTATION AND PUBLIC WORKS August 25,2022 Ridgemont Residntial 1520 W. Walnut Hill Ln. Irving,TX. 75038 RE: Acceptance Letter Project Name: Litsey Creek Cottages Project Type: Water, Sewer, Paving, Drainage &Street Lights City Project No.: 103173 To Whom It May Concern: On August 2, 2022 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 August 25, 2022. 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 August 25, 2022,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 682- 201-6278. Sincerely, Kiran Konduru,P.E.(Sep 14,202215:45 CDT) Kiran Konduru, Project Manager Cc: Riley Roberson, Inspector Mike Glover, Inspection Supervisor Daniel Roy,Senior Inspector Victor Tornero, Program Manager John D. Ainsworth, Consultant Ridgemount Residentia, Contractor MCA Litsey Creek Owner LP, Developer File E-Mail: TPW_Acceptance@fortworthtexas.gov Rev.8/20/19 Affidavit of Bills Paid (Stationary).d ocx Aa AFFIDAVIT STATE OF Texas COUNTY OF Dallas Before me, the undersigned authority, a notary public in the state and county aforesaid, on this day personally appeared Name, Title Of Company, 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; Contract rlption Litsey Creek Endeavor#103173 BY Nam r Title Kevin D.Mezger Principal Subscribed and sworn before me on this 8th Day =116M4-72 , Q� Yp RNE R blic Notary Public Donna Turner /V EXAS � OFPg MyComm.Exp.12123J2Q23 County, State Dallas County,Texas 80884m2 � ... 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 CFA#2 _ Litsey Creek Endeavor Job No. 103173 The signer of this document has been paid in full for all labor, services, equipment, or materials furnished to the property or to MCA Litsey Creek Owner LP (person with whom signer contracted) on the property of MCA Litsey Creek Owner LP (owner) located at 6501 Oak Grove Rd., Ft .Worth, TX (location) to the following extent: Litsey Creek Endeavor Project#103173 Oob 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 8/8/22 Ridgemont Residential,LLC (Company name) By (Signature) Member (Title) SUBSCRIBED AND SWORN TO BEFORE ME, the undersigned, a Notary Public on this 8th day of August, 2022 to certify which witness by hand and seal of office. DONNATURNER Notary Public * * STATE OF TEXAS My Comm.Exp.1212aQ023 Notary Public, State of Texas l� NOTARY ID 116a884.2 CONSENT OF OWNER SURETY COMPANY ARCHITECT TO FINAL PAYMENT CONTRACTOR SURETY AIA DOCUMENT G707 OTHER Bond No. PRF9382554 PROJECT: Water, Sewer, Paving,Drainage, and Street Light Improvements to serve Litsey Creek (name,address) Cottages, CFA21-0045,Fort Worth,TX TO(Owner) [ City of Fort Worth and ] ARCHITECT'S PROJECT NO: MCA Litsey Creek Owner,LP CONTRACT FOR: ] CONTRACT DATE: CONTRACTOR: Ridgemont Residential, LLC 1520 W. Walnut Hill Lane Irving, TX 75038 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) Colonial American Casualty and Surety Company 1299 Zurich Way, 5th Floor Schaumburg,IL 60196-1056 , SURETY COMPANY, on bond of(here insert name and address of Contractor) Ridgemont Residential,LLC 1520 W. Walnut Hill Lane Irving,TX 75038 , 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 and MCA Litsey Creek Owner, LP ,OWNER, as set forth in the said Surety Company's bond. IN WITNESS WHEREOF, the Surety Company has hereunto set its hand this 13th day of September 2Q22 Colonial American Casualty and Surety Company Surety Company Signature of Authorized Representative Attest: (Seal): Debra Lee Moon Attoriiey-In-,Fact Title - NOTE: This form is to be used as a companion document to AIA DOCUMENT G706,CONTRACTOR'S AFFIDAVIT OF PAYMENT OF Dl;b.TS AND CLA_s, Current Edition AIA DOCUMENT 6707 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 ZURICH AMERICAN INSURANCE COMPANY COLONIAL AMERICAN CASUALTY AND SURETY COMPANY FIDELITY AND DEPOSIT COMPANY OF MARYLAND POWER OF ATTORNEY KNOW ALL MEN BY THESE PRESENTS:That the ZURICH AMERICAN INSURANCE COMPANY,a corporation of the State of Now York, the COLONIAL AMERICAN CASUALTY AND SURETY COMPANY, a corporation of the State of Illinois, and the FIDELITY AND DEPOSIT COMPANY OF MARYLAND a corporation of the State of Illinois (herein collectively called the "Companies"), by Robert D.Murray,Vice President,in pursuance of authority granted by Article V,Section 8,of the By-Laws of said Companies,which are set forth on the reverse side hereof and are hereby certified to be in full force and effect on the date hereof,do hereby nominate,constitute, and appoint Sammy Joe MULLIS,JR., Suzanne Elizabeth NIEDZWIEDZ,John William NEWBY,Joshua D.TRITT,Sandra Lee RONEY,Debra Lee MOON,Andrea Rose CRAWFORD,Troy Russell KEY,Cheri Lynn IRBY of Addison,Texas,EACH,its true and lawful agent and Attorney-in-Fact,to make,execute,scat and deliver,for,and on its behalf as surety,and as its act and deed: any and all bonds and undertakings,and the execution of such bonds or undertakings in pursuance of these presents,shall be as binding upon said Companies,as fully and amply,to all intents and purposes, as if they had been duly executed and acknowledged by the regularly elected officers of the ZURICH AMERICAN INSURANCE COMPANY at its office in New York,New York.,the regularly elected officers of the COLONIAL AMERICAN CASUALTY AND SURETY COMPANY at its office in Owings Mills, Maryland., and the regularly elected officers of the FIDELITY AND DEPOSIT COMPANY OF MARYLAND at its office in Owings Mills, Maryland., in their own proper persons. The said Vice President does hereby certify that the extract set forth on the reverse side hereof is a true copy of Article V,Section 8,of the By-Laws of said Companies,and is now in force. IN WITNESS WHEREOF, the said Vice-President has hereunto subscribed his/her names and affixed the Corporate Seals of the said ZURICH AMERICAN INSURANCE COMPANY, COLONIAL AMERICAN CASUALTY AND SURETY COMPANY, and FIDELITY AND DEPOSIT COMPANY OF MARYLAND,this 19th day of February,A.D.2021. o co ATTEST: ZURICH AMERICAN INSURANCE COMPANY COLONIAL AMERICAN CASUALTY AND SURETY COMPANY FIDELITY AND DEPOSIT COMPANY OF MARYLAND By: Robert D. Murray Vice President By: Dawn E.Brown Secretary State of Maryland County of Baltimore On this 19th day of February, A.D.2021, before the subscriber,a Notary Public of the State of Maryland,duly commissioned and qualified,Robert D. Murray,Vice President and Dawn E.Brown,Secretary of the Companies,to me personally known to be the individuals and officers described in and who---- executed the preceding instrument,and acknowledged the execution of same,and being by me duly sworn,deposeth and saith,that he/she is the said oflricer of--' _ the Company aforesaid,and that the seals affixed to the preceding instrument are the Corporate Seals of said Companies,and that the said Corporate,6eals and the signature as such officer were duly affixed and subscribed to the said instrument by the authority and direction of the said Corporations. IN TESTIMONY WHEREOF,I have hereunto set my hand and affixed my Official Seal the day and year first above written. ;_ CL _ Constance A.Dunn,Notary Public L ry ';' „���'' My Commission Expires:July 9,2023 Authenticity of this bond can be confirmed at bondvalidator.zurichna.com or 410-559-8790 EXTRACT FROM BY-LAWS OF THE COMPANIES "Article V,Section 8,Attorneys-in-Fact.The Chief Executive Officer,the President,or any Executive Vice President or Vice President may, by written instrument under the attested corporate seal, appoint attorneys-in-fact with authority to execute bonds, policies, recognizances, stipulations, undertakings, or other like instruments on behalf of the Company, and may authorize any officer or any such attorney-in-fact to affix the corporate seal thereto;and may with or without cause modify of revoke any such appointment or authority at any time." CERTIFICATE I, the undersigned, Vice President of the ZURICH AMERICAN INSURANCE COMPANY, the COLONIAL AMERICAN CASUALTY AND SURETY COMPANY, and the FIDELITY AND DEPOSIT COMPANY OF MARYLAND, do hereby certify that the foregoing Power of Attorney is still in full force and effect on the date of this certificate;and I do further certify that Article V,Section 8,of the By-Laws of the Companies is still in force. This Power of Attorney and Certificate may be signed by facsimile under and by authority of the following resolution of the Board of Directors of the ZURICH AMERICAN INSURANCE COMPANY at a meeting duly called and held on the 15th day of December 1998. RESOLVED:"That the signature of the President or a Vice President and the attesting signature of a Secretary or an Assistant Secretary and the Seal of the Company may be affixed by facsimile on any Power of Attorney...Any such Power or any certificate thereof bearing such facsimile signature and seal shall be valid and binding on thcCompany." This Power of Attorney and Certificate may be signed by facsimile under and by authority of the following resolution of the Board of Directors of the COLONIAL AMERICAN CASUALTY AND SURETY COMPANY at a meeting duly called and held on the 5th day of May, 1994, and the following resolution of the Board of Directors of the FIDELITY AND DEPOSIT COMPANY OF MARYLAND at a meeting duly called and held on the 1 Oth day of May,1990. RESOLVED:"That the facsimile or mechanically reproduced seal of the company and facsimile or mechanically reproduced signature of any Vice-President, Secretary, or Assistant Secretary of the Company, whether made heretofore or hereafter, wherever appearing upon a certified copy of any power of attorney issued by the Company,shall be valid and binding upon the Company with the same force and effect as though manually affixed. IN TESTIMONY WHEREOF,I have hereunto subscribed my name and affixed the corporate seals of the said Companies, this 13th day of September , 2022 of 8SAL 4 Ww �Ma'*iMN� By: Brian M.Hodges Vice President TO REPORT A CLAIM WITH REGARD TO A SURETY BOND,PLEASE SUBMIT A COMPLETE DESCRIPTION OF THE CLAIM INCLUDING THE PRINCIPAL ON THE BOND,THE BOND NUMBER,AND YOUR CONTACT INFORMATION TO: Zurich Surety Claims 1299 Zurich Way Schaumburg,IL 60196-1056 www.EMortsfclaims(a�zurichna.com 800-626-4577 ZURICHy Texas Important Notice IMPORTANT NOTICE AVISO IMPORTANTE To obtain information or make a complaint: Para obtener informaci6n o para presentar una queja: You may call Zurich North America's toll-free telephone Usted puede Ilamar al numero de telefono gratuito de number for information or to make a complaint at: Zurich North America's para obtener informacion o para 1-800-382-2150 presentar una queja al: 1-800-382-2150 You may contact the Texas Department of Insurance to obtain information on companies, coverages, rights, or Usted puede comunicarse con el Departamento de Se- complaints at: guros de Texas para obtener informacion sobre com- 1-800-252-3439 panias, coberturas, derechos, o quejas al: 1-800-252-3439 You may write the Texas Department of Insurance: Usted puede escribir al Departamento P.O. Box 149104 de Seguros de Texas a: Austin,TX 78714-9104 P.O. Box 149104 Fax: (512)490-1007 Austin,TX 78714-9104 Web: www.tdi.texas.gov Fax: (512)490-1007 E-mail: ConsumerProtection@tdi.texas.gov Sitio web: www.tdi.texas.gov E-mail: ConsumerProtection@tdi.texas.gov PREMIUM OR CLAIM DISPUTES: Should you have a dispute concerning your premium or DISPUTAS POR PRIMAS DE SEGUROS O about a claim, you should contact the company first. If RECLAMACIONES: the dispute is not resolved, you may contact the Texas Si tiene una disputa relacionada con su prima de seguro Department of Insurance. o con una reclamaci6n, usted debe comunicarse con la compaflia primero. Si la disputa no es resueita, usted ATTACH THIS NOTICE TO YOUR POLICY: puede comunicarse con el Departamento de Seguros de This notice is for information only and does not become Texas. a part or condition of the attached document. ADJUNTE ESTE AVISO A SU P6LIZA: Este aviso es solamente para prop6sitos informativos y no se con- vierte en parte o en condici6n del documento adjunto. U-GU-296-E(06/15) Page 1 of 1