HomeMy WebLinkAboutContract 56953 (2)-FP1
FORT WORTH.
City Secretary
Contract No. 56953
Date Received 04/17/2023
AT
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: LPC Bluestone
City Project No: 103519
Improvement Type(s): Water x❑ Sewer X1
Developer Cost
City Cost
Total Cost
Original Water Contract Price:
$298,030.91
$486,178.09
$784,209.00
Original Sewer Contract Price:
$359,423.00
$154,670.00
$514,093.00
Amount of Approved Change Orders(s):
$4,950.00
$4,345.00
$9,295.00
Revised Contract Amount:
$662,403.91
$645,193.09
$1,307,597.00
Total Cost of Work Complete:
$662,403.91
$645,193.09
$1,307,597.00
Wert LaircafteY
Wes Lancaster (Apr 14, 2023 12:32 CDT)
Contractor
Project Manager
Title
North Texas Contracting
Company Name
Jesse tvis(Apr 14, 202312:33 CDT)
Project Inspector
CJ,P.�.
Project Manager
pit„r.►.
leehecca Diane Owen (Apr 17, 2023 08:45 CDT)
CFA Manager
x
Lauren Prieur (Apr 17, 202311:16 CDT)
TPW Director
1Nilliam*11on (Aq 17. 202313:50 CDTI
Asst. City Manager
Apr 14, 2023
Date
Apr 14, 2023
Date
Apr 17, 2023
Date
Apr 17, 2023
Date
Apr 17, 2023
Date
Apr 17, 2023
Date
OFFICIAL RECORD
CITY SECRETARY
FT. WORTH, TX Page 1 of 2
Notice of Project Completion
Project Name: LPC Bluestone
City Project No.: 103519
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 75 WD Days Charged: 221
Work Start Date: 3/22/2022 Work Complete Date: 4/5/2023
Soil Lab Number of Tests: 252
Water Number of Tests: 12
Page 2of2
FoRTWoRTH
CITY OF FORT WORTH
FINAL PAYMENT REQUEST
Contract Name LPC BLUESTONE
Contract Limits
Project Type WATER & SEWER
City Project Numbers 103519
DOE Number 3519
Estimate Number 1 Payment Number 1
City Secretary Contract Number
Contract Date
Project Manager NA
Contractor NORTH TEXAS CONTRACTING, INC.
P.O. BOX 468
Inspectors
For Period Ending
KELLER , TX 76244
GLOVER / DAVIS
Contract Time
Days Charged to Date
Contract is 100.00
4/6/2023
WD
7WD
221
Complete
Thursday, April 6, 2023 Page 1 of 5
City Project Numbers 103519
Contract Name LPC BLUESTONE
Contract Limits
Project Type WATER & SEWER
Project Funding
WATER
Item
Description of Items
Estimated Unit
No.
Quanity
1
4"-12" PRESSURE PLUG
2 EA
2
MEDIUM STONE RIPRAP, GROUTED
118 SY
3
HYDROMULCH
4770 SY
4
DUCTILE IRON WATER FITTINGS
1 TN
W/RESTRAINT
5 TRENCH SAFETY
6 UTILITY MARKER POLE
7 CONCRETE ENCASEMENT FOR UTILITY PIPES
8 24" PVC WATER PIPE
9 24" DIP WATER. CLSM BACKFILL
10 12" PVC WATER PIPE
11 CONNECT TO EXISTING 24" WATER MAIN
12 COMBINATION AIR VALVE ASSEMBLY FOR
WATER
13 42" CASING BY OPEN CUT
14 2" WATER SERVICE, METER RECONNECTION
15 2" PRIVATE WATER SERVICE
16 12" GATE VALVE
17 24" GATE VALVE W/VAULT
18 8" BLOW OFF VALVE
19 FIRE HYDRANT ASSEMBLY W/AUTO
FLUSHING DEVICE
Sub -Total of Previous Unit $784,209.00 $784,209.00
SEWER
DOE Number 3519
Estimate Number 1
Payment Number 1
For Period Ending 4/6/2023
Unit Cost
Estimated
Completed
Completed
Total
Quanity
Total
$400.00
$800.00
2
$800.00
$120.00
$14,160.00
118
$14,160.00
$1.00
$4,770.00
4770
$4,770.00
$12,000.00
$12,000.00
1
$12,000.00
Item Description of Items
No.
1 15" SEWER ABANDONMENT PLUG
2 MEDIUM STONE RIPRAP, GROUTED
3 HYDROMULCH
4 POST CCTV INSPECTION
5 MANHOLE VACUUM TESTING
2155
LF
$5.00
$10,775.00
2155
$10,775.00
2
LS
$100.00
$200.00
2
$200.00
6
CY
$214.00
$1,284.00
6
$1,284.00
2045
LF
$210.00
$429,450.00
2045
$429,450.00
78
LF
$500.00
$39,000.00
78
$39,000.00
80
LF
$100.00
$8,000.00
80
$8,000.00
1
EA
$6,000.00
$6,000.00
1
$6,000.00
1
EA
$25,000.00
$25,000.00
1
$25,000.00
68
LF
$700.00
$47,600.00
68
$47,600.00
2
EA
$3,085.00
$6,170.00
2
$6,170.00
30
LF
$100.00
$3,000.00
30
$3,000.00
3
EA
$4,000.00
$12,000.00
3
$12,000.00
3
EA
$38,000.00
$114,000.00
3
$114,000.00
2
EA
$19,000.00
$38,000.00
2
$38,000.00
1
EA
$12,000.00
$12,000.00
1
$12,000.00
Estimated Unit
Quanity
1 EA
54 SY
5324 SY
1034 LF
4 EA
Unit Cost Estimated Completed Completed
Total Quanity Total
$500.00 $500.00 1 $500.00
$120.00 $6,480.00 54 $6,480.00
$1.00 $5,324.00 5324 $5,324.00
$1.00 $1,034.00 1034 $1,034.00
$200.00 $800.00 4 $800.00
Thursday, April 6, 2023 Page 2 of 5
City Project Numbers 103519
Contract Name LPC BLUESTONE
Contract Limits
Project Type WATER & SEWER
Project Funding
6 CONCRETE COLLAR
A
7 TRENCH SAFETY
1034 LF
8 UTLITY MARKER POLE
1 LS
9 TRENCH WATER STOPS
1 EA
10 24" CASING BY OTHER THAN OPEN CUT (CO
262 LF
#1)
11 15" SEWER PIPE (CO #1)
526 LF
12 15" SEWER PIPE, CLSM BACKFILL
30 LF
13 EPDXY MANHOLE LINER
71 VF
14 5" MANHOLE
l EA
15 DUCTILE IRON SEWER FITTINGS
1 TN
16 S MANHOLE W/BOLT DOWN LID
3 EA
17 15" DUCTILE IRON PIPE (CO #1)
448 LF
18 15" DUCTILE IRON PIPE,CLSM BACKFILL
30 LF
19 CONNECT TO EXISTING MANHOLE
I EA
Sub -Total of Previous
Unit
DOE Number 3519
Estimate Number 1
Payment Number 1
For Period Ending 4/6/2023
$500.00
$2,000.00
4
$2,000.00
$10.00
$10,340.00
1034
$10,340.00
$100.00
$100.00
1
$100.00
$600.00
$600.00
1
$600.00
$725.00
$189,950.00
262
$189,950.00
$150.00
$78,900.00
526
$78,900.00
$200.00
$6,000.00
30
$6,000.00
$400.00
$28,400.00
71
$28,400.00
$12,000.00
$12,000.00
1
$12,000.00
$1,000.00
$1,000.00
1
$1,000.00
$13,000.00
$39,000.00
3
$39,000.00
$270.00
$120,960.00
448
$120,960.00
$400.00
$12,000.00
30
$12,000.00
$8,000.00
$8,000.00
1
$8,000.00
$523,388.00
$523,388.00
Thursday, April 6, 2023 Page 3 of 5
City Project Numbers 103519
Contract Name LPC BLUESTONE
Contract Limits
Project Type WATER & SEWER
Project Funding
Contract Information Summary
Original Contract Amount
Change Orders
Change Order Number 1
DOE Number 3519
Estimate Number 1
Payment Number 1
For Period Ending 4/6/2023
$1,298,302.00
$4,950.00
Total Contract Price $1,307,597.00
Total Cost of Work Completed $1,307,597.00
Less % Retained $0.00
Net Earned $1,307,597.00
Earned This Period $1,307,597.00
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
$1,307,597.00
Thursday, April 6, 2023 Page 4 of 5
City Project Numbers 103519
Contract Name LPC BLUESTONE
Contract Limits
Project Type WATER & SEWER
Project Funding
DOE Number 3519
Estimate Number 1
Payment Number 1
For Period Ending 4/6/2023
Project Manager NA City Secretary Contract Number
Inspectors GLOVER / DAVIS Contract Date
Contractor NORTH TEXAS CONTRACTING, INC. Contract Time 75 WD
P.O. BOX 468 Days Charged to Date 221 WD
KELLER , TX 76244 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 $1,307,597.00
Less % Retained $0.00
Net Earned $1,307,597.00
Earned This Period $1,307,597.00
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
$1,307,597.00
Thursday, April 6, 2023 Page 5 of 5
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RECOilM1ENOPM _ APPROVED: APPROVED:
LPC Bluestone, GP, LLC, the general _
tConau° np En etr} (Unva'apevl Partner of LPC Bluestone, LP ICoovac;o )
Name: ! �°P+t'a"7'r N o. James G. Martell Name: Zacli Fusilier
Trde: C4410*4- of 10*161 OW&AW164: President nqe; Vice President
EL
APPROVALRECOMMENDEO: _ _ _APPROVED: _,- _ APPROVED AS TO FORM ANDLEOIWTY:
CFW • Spomo" Deparirrrenf CFW • Assistant CPj Manager CFlY Atalsfanr Cfry Alfdmey
Yis/rnLSooJ Dana HurandoFF /i2__.
By: 1ha Sod (010.30uL16Wp By; MM o210]CS COT) B� RkwdAMCradenl�tS.l]i!m<Op-
Taylor Gunderman Dana Burghdoff Richard McCracken
Name: �d _ Nune: New:
Engineering Manager Assistant City Manager Senior Assistant City Attorney
Ttto: ---- Mo:
RECOMMENDED:
/Ci•W - ' A lac! Gumpl�sn:4 irnneger
Namo; `drew Goodman, PE
We: Senior Professional Engineer
WAG Nranber. N/A
N/A
M&C Oato Approved:
AMST
a Contract Compliance Manager (Pro(eM Manager):
%ClNh8��8 r i GOOGt�Gf�G
By signing I acrrnoutedge that I am the pe son responsible
A-, S. Goodall �Mov i, 30i211:35COT)
for the monitoring and adminisiratiun of This contract, include
ensuring all performance and reporling requirements.
Janette S. Goodall
City Secretary OThere are NO City Funds associated Wth this Cordract
(OThere are City Funds a"o:lated with this Contract
p�9c ;t
flaviW: 12-17.2018
FORTWORTH
TRANSPORTATION AND PUBLIC WORKS
PIPE REPORT FOR:
PROJECT NAME:
LPC Bluestone
PROJECT NUMBER:
103519
DOE NUMBER:
N/A
WATER
PIPE LAID
SIZE
TYPE OF PIPE
LF
WATER
24"
C900
2045
WATER
12"
C900
FH1E HYDRANTS: 1
VALVES (16" OR LARGER)
3
PIPE ABANDONED
SIZE
TYPE OF PIPE
LF
DENSITIES:
Yes, All Passed
NEW SERVICES:
2"
Copper
30 LF
SEWER
PIPE LAID
SIZE
TYPE OF PIPE
LF
SEWER
15"
SDR-26
526
SEWER
15"
Ductile Iron
448
PIPE ABANDONED
SIZE
TYPE OF PIPE
LF
DENSITIES:
Yes, All Passed
NEW SERVICES:
Ai'!M TRANSPORTATION AND PUBLIC WORKS
FORTWORTH.
TRANSPORTATION AND PUBLIC WORKS
April 6, 2023
North Texas Contracting
4999 Keller -Haslet Road
Keller, Texas 76244
RE: Acceptance Letter
Project Name: LPC Bluestone
Project Type: Water & Sanitary Sewer
City Project No.: 103519
To Whom It May Concern:
On April 3, 2023 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 6, 2023. 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 April 6, 2023, 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-
392-6251.
Sincerely,
C'Y '.SW.,��.
Andrew Goodman, Project Manager
Cc: Jesse Davis, Inspector
Mike Glover, Inspection Supervisor
Randy Horton, Senior Inspector
Victor Tornero, Program Manager
Halff Associates, Inc., Consultant
North Texas Contracting, Contractor
Logistics Property Company, Developer
File
E-Mail: TPW_Acceptance@fortworthtexas.gov
Rev. 8/20/19
CONTRACTOR'S AFFIDAVIT OF FINAL PAYMENT AND RELEASE
THE STATE OF TEXAS
COUNTY OF Tarrant
KNOW ALL MEN BY THESE PRESENTS:
BEFORE ME, the undersigned authority, on this day personally appeared Wes Lancaster
("Affidant"), who after being by me duly sworn, deposes, and says that it is North Texas Contracting, Inc . a
Corporation (corporation, partnership, trade name) of Tarrant County
State of texas , (the "CONTRACTOR"), which said CONTRACTOR was awarded the
Contract dated the 12nd _ day of December , 2021 , for the construction project
of LPC Bluestone Water & Wastewater Improvements at LPC BLUESTONE (BLUESTONE ADDITION, LOT 1, BLOCK 1) (the "Work"),
for a total consideration of One Million Three Hundred Seven Thousand Five Hundred Ninety Seven and No/100 ($1,307,597.00 Dollars
to be paid to the said CONTRACTOR (the "Contract"), and that Affidant has full power of authority to make this
affidavit.
That LPG Bluestone, LP (the "OWNER") has approved the final
estimate on said Work, and that the said CONTRACTOR has fully satisfied and paid any and all claims that may
be covered by Texas Government Code, Chapter 2253, as amended, or any other applicable statutes or charter
provisions and that all just bills for labor and materials have been paid and discharged by said CONTRACTOR
insofar as they pertain to the Work in question.
That in addition to any funds which may have been previously paid by the OWNER, the CONTRACTOR
hereby accepts the amount of Sixty Five Thousand Three Hundred seventy Nine and W100 ($65,379.55) Dollars as FULL AND FINAL
PAYMENT under the aforementioned Contract, and hereby waives and releases any right Affidant and/or the
CONTRACTOR may have to pursue claims of any nature against the OWNER arising out of or in any manner
connected with the performance of the Work and/or the Contract, including but not limited to claims of third
parties that supplied material and/or labor for the Work for or through the CONTRACTOR ("Subcontractors"), as
well as claims for delay, additional compensation or for recovery of liquidated damages which may have been
withheld by the OWNER. The CONTRACTOR shall defend, hold harmless and indemnify the OWNER from
any such claims of such Subcontractors. The CONTRACTOR further releases the OWNER from any claim or
liability arising from any act or neglect of the OWNER related to or connected with the Contract. This affidavit
is given pursuant to the final payment provisions of the Contract and shall not be deemed to alter or modify the
terms of provisions of said Contract.
North Texas Contracting, Inc
(Company) .
By:
(A idant)
Was Lancaster
(Printed Name)
SUBSCRIBED AND SWORN TO BEFORE ME, this 13th day of April A.D. 2023
[Notary Seal] By:
(Notary Pu is in and for the State of Texas)
tpytY PUgG CARSON CLAY COLLIER
NOTARY PUBLIC
* * STATE OF TEXAS
'o�s��w MY COMM. EXP, 02-05-2024
NOTARY ID 13052756-2
(Printed Name of Notary)
2//!
My commission expires: ! /
CONSENT OF
SURETY COMPANY
TO FINAL PAYMENT
Conforms with the American Institute of
Architects, AIA Document G707
OWNER
❑
ARCHITECT
❑
CONTRACTOR
❑
SURETY
❑
OTHER
Bond No SU1179587
PROJECT:
(name, address)Sanitary Sewer and Water Line Construction at LPC Bluestone
TO (Owner)
Lewisville TX
ARCHITECT'S PROJECT NO:
CITY OF FORT WORTH AND LPC BLUESTONE, LP CONTRACT FOR:
200 Texas Street Sanitary Sewer and Water Line Construction at LPC Bluestone
Fort worth Tx 76102 _f CONTRACT DATE: 12/22/2021
CONTRACTOR: NORTH TEXAS CONTRACTING, INC.
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)
ARCH INSURANCE COMPANY
Harborside 3, 210 Hudson Street, Suite 300
Jersey City NJ 07311-1107 , SURETY COMPANY
on bond of (here insert name and address of Contractor)
NORTH TEXAS CONTRACTING, INC.
4999 Keller Haslet Rd.
Keller TX 76248
,CONTRACTOR,
hereby approves of the final payment to the Contractor, 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 LPC BLUESTONE, LP
200 Texas Street
Fort Worth TX 76102
as set forth in the said Surety Company's bond.
IN WITNESS, WHEREOF,
the Surety Company has hereunto set its hand this
Attest:. 111<<w�✓�
(Seal):
, OWNER,
14th day of April, 2023
ARCH INSURANCE COMPANY
Surety Company / I
�W t rt �c �1U1
Signature of Authorized Representative
Soohinie Hunter 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
ONE PAGE
00456
This Power ofAIto rney limits the acts of those named herein, and they have no authority to bind the Company except in the manner and to the extent herein staled.
Not valid far Note, Loan, Letter of Credit, Currency Rate, Interest Rate or Residential value Guarantees.
Know All Persons By These Presents: POWER OF ATTORNEY
That the Arch Insurance Company, a corporation organized and existing under the laws of the State of Missouri, having its principal administrative office in Jersey Ci,
New Jersey (hereinafter referred to as the "Company") does hereby appoint: ty
Don E. Cornell, Joshua Saunders, Kelly A. Westbrook, Mikaela Peppers, Ricardo J. Reyna, Robbi Morales, Sophinie Hunter, Tina McEwan and Tonle
Petranek of Dallas, TX (EACH)
its true and lawful Attomey(s)in-Fact, to make, execute, seal, and deliver from the date of issuance of this power for and on its behalf as surety, and as its act and deed:
Any and all bonds, undertakings, recognizances and other surety obligations, in the penal sum not exceeding One Hundred Fifty Million Dollars ($150,000,000.00).
This authority does not permit the same obligation to be split into two or more bonds In order to bring each such bond within the dollar limit of authority as set forth
herein.
The execution of such bonds, undertakings, recognizances and other surety obligations in pursuance of these presents shall be as binding upon the said Company as
fully and amply to all intents and purposes, as if the same had been duly executed and acknowledged by its regularly elected officers at its principal administrative
office in Jersey City, New Jersey.
This Power of Attorney is executed by authority of resolutions adopted by unanimous consent of the Board of Directors of the Company on August 31, 2022, true and
accurate copies of which are hereinafter set forth and are hereby certified to by the undersigned Secretary as being in full force and effect:
"VOTED, That the Chairman of the Board, the President, or the Executive Vice President, or any Senior Vice President, of the Surety Business Division, or their
appointees designated in writing and filed with the Secretary, or the Secretary shall have the power and authority to appoint agents and attorneys -in -fact, and to
authorize them subject to the limitations set forth in their respective powers of attorney, to execute on behalf of the Company, and attach the seal of the Company
thereto, bonds, undertakings, recognizances and other surety obligations obligatory in the nature thereof, and any such officers of the Company may appoint agents for
acceptance of process."
This Power of Attorney is signed, sealed and certified by facsimile under and by authority of the following resolution adopted by the unanimous consent of the Board of
Directors of the Company on August 31, 2022:
VOTED, That the signature of the Chairman of the Board, the President, or the Executive Vice President, or any Senior Vice President, of the Surety Business
Division, or their appointees designated in writing and filed with the Secretary, and the signature of the Secretary, the seal of the Company, and certifications by the
Secretary, may be affixed by facsimile on any power of attorney or bond executed pursuant to the resolution adopted by the Board of Directors on August 31, 2022, and
any such power so executed, sealed and certified with respect to any bond or undertaking to which it is attached, shall continue to be valid and binding upon the
Company. In Testimony Whereof, the Company has caused this instrument to be signed and its corporate seal to be affixed by their authorized officers, this 23rd day
of March, 2023.
Attested and Certified g�
Arch Insurance Company
4-t,,---
gan'A. Shulman, Secretary l�r%
STATE OF PENNSYLVANIA SS Stephen C. Ruschak, Executive Vice President
COUNTY OF PHILADELPHIA SSiouc
I, Michele Tripod!, a Notary Public, do hereby certify that Regan A. Shulman and Stephen C. Ruschak personally known to me to be the same persons whose names
are respectively as Secretary and Executive Vice President of the Arch Insurance Company, a Corporation organized and existing under the laws of the State of
Missouri, subscribed to the foregoing instrument, appeared before me this day in person and severally acknowledged that they being thereunto duly authorized signed,
sealed with the corporate seal and delivered the said instrument as the free and voluntary act of said corporation and as their own free and voluntary acts for the uses and
purposes therein set forth.
=Expket
nrttvanla-NosaayScsl(It, NothryhIgIcfi4c fAartty' es,ltty31, 202,3 Mich a pods, Notar ublic
CERTIFICATION ,cr If6u22 My commission expires 07/31/2025
I, Regan A. Shulman, Secretary of the Arch Insurance Company, do hereby certify that the attached Power of Attorney dated March 23, 2023 on behalf of the
person(s) as listed above is a true and correct copy and that the same has been in full force and effect since the date thereof and is in full force and effect on the date of
this certificate; and I do further certify that the said Stephen C. Ruschak, who executed the Power of Attorney as Executive Vice President, was on the date of execution
of the attached Power of Attorney the duly elected Executive Vice President of the Arch Insurance Company.
IN TESTIMONY WHEREOF, I have hereunto subscribed my name and affixed the corporate seal of the Arch Insurance Company on this 1"' day of April
2023
Regafi A. Shulman, -Secretary This Power of Attorney limits the acts of those named therein to the bonds and undertakings specifically named therein and they have no authority to bind the Company
except in the manner and to the extent herein stated.
PLEASE SEND ALL CLAIM INQUIRIES RELATING TO THIS BOND TO THE FOLLOWING ADDRESS: 'TIC$
Arch Insurance — Surety Division Q
3 Parkway, Suite 1500
Philadelphia, PA 19102 1.� WK"'Axt "Q
4 SW
s9n
To verify the authenticity of this Power o Attorne @ar1
f y, please contact Arch Insurance Company at SuretVAuthentic@arc insurance.com
Please refer to the above named Attorney -in -Fact and the details of the bond to which the power is attached.
AICPOA040120
Printed in U.S.A.
IMPORTANT NOTICE TO ALL TEXAS POLICYHOLDERS
IMPORTANT NOTICE
To obtain information or make a complaint:
You may call Arch Insurance Group's toll -free
telephone number for information or to make a
complaint at:
1-866-413-5550
You may also write to Arch Insurance Group at:
Arch Insurance Group
Harborside 3
210 Hudson Street, Suite 300
Jersey City, NJ 07311-1107
You may contact the Texas Department of
Insurance to obtain information on companies,
coverages, rights or complaints at:
1-800-252-3439
You may write the Texas Department of
Insurance:
P.O. Box 149091
Austin, TX 78714-9091
Fax: (512) 490-1007
Web: http://www.tdi.texas.gov
E-mail: ConsumerProtection@tdi.texas.gov
PREMIUM OR CLAIM DISPUTES:
Should you have a dispute concerning your
premium or about a claim you should contact
the Arch Insurance Group first. If the dispute is
not resolved, you may contact the Texas
Department of Insurance.
ATTACH THIS NOTICE TO YOUR POLICY:
This notice is for information only and does not
become a part or condition of the attached
document.
00 ML0042 44 04 16
AVISO IMPORTANTE
Para obtener informacion o para someter una
queja:
Usted puede Ilamar al numero de telefono gratis
de Arch Insurance Group para informacion o
para someter una queja al:
1-866-413-5550
Usted tambien puede escribir a Arch Insurance
Group:
Arch Insurance Group
Harborside 3
210 Hudson Street, Suite 300
Jersey City, NJ 07311-1107
Puede comunicarse con el Departamento de
Seguros de Texas para obtener informacion
acerca de companias, coberturas, derechos o
quejas al:
1-800-252-3439
Puede escribir al Departamento de Seguros de
Texas:
P.O. Box 149091
Austin, TX 78714-9091
Fax: (512) 490-1007
Web: http://www.tdi.texas.gov
E-mail: ConsumerProtection@tdi.texas.gov
DISPUTAS SOBRE PRIMAS O RECLAMOS:
Si tiene una disputa concerniente a su prima o a
un reclamo, debe comunicarse con el Arch
Insurance Group primero. Si no se resuelve la
disputa, puede entonces comunicarse con el
departamento (TDI).
UNA ESTE AVISO A SU POLIZA: Este aviso es
solo para proposito de informacion y no se
convierte en parte o condicion del documento
adjunto.
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