HomeMy WebLinkAboutContract 57267-FP1FORT WORTH.
City Secretary
-FP1
Contract No. 57267
Date Received 11/14/2023
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: Stonemont Harmon
City Project No.: 103404
Improvement Type(s): 0 Paving
Original Contract Price:
Amount of Approved Change Order(s):
Revised Contract Amount:
Total Cost of Work Complete:
W-1,
TlfFanv Mccov (Nov 14, 202315:43 EST)
Contractor
Project Manager
Title
Kajima Building
Company Name
Project Inspector
Project Manager
� ,��
Rebecca Diane Owen (Nov 14, 202315:59 CST)
CFA Manager
_A..
Lauren Pneur (Nov 14, 2023 17:24CST)
TPW Director
willia�Johnson 14.202318:48 CST)
Asst. City Manager
❑ Drainage ❑ Street Lights ❑ Traffic Signals
$175,550.96
$27,239.52
$202,790.48
$202,790.48
Nov 14, 2023
Date
Nov 14, 2023
Date
Nov 14, 2023
Date
Nov 14, 2023
Date
Nov 14, 2023
Date
Nov 14, 2023
Date
OFFICIAL RECORD
CITY SECRETARY Page 1 of 2
FT. WORTH, TX
Notice of Project Completion
Project Name: Stonemont Harmon
City Project No.: 103404
City's Attachments
Final Pay Estimate x❑
Change Order(s): ❑x Yes ❑ N/A
Contractor's Attachments
Affidavit of Bills Paid
Consent of Surety
Statement of Contract Time
Contract Time 120 WD
Work Start Date: 6/21 /2022
Completed number of Soil Lab Test: 412
Completed number of Water Test: 6
Days Charged: 239
Work Complete Date: 7/25/2023
Page 2 of 2
FoRTWORTH
CITY OF FORT WORTH
FINAL PAYMENT REQUEST
Contract Name STONEMOJNT HARMON
Contract Limits
Project Type PAVING
City Project Numbers 103404
DOE Number 3404
Estimate Number 1 Payment Number 1 For Period Ending 8/14/2023
WD
City Secretary Contract Number Contract Time 12WD
Contract Date 1/20/2022 Days Charged to Date 239
Project Manager NA Contract is 100.00 Complete
Contractor KAJIMA BUILDING & DESIGN GROUOP, INC.
3490 PIEDMONT RD. NE
ATLANTA , GA 30305
Inspectors CORODVA, R / STRANGE, T
Monday, October 9, 2023 Page 1 of 4
City Project Numbers 103404 DOE Number 3404
Contract Name STONEMOJNT HARMON Estimate Number I
Contract Limits Payment Number I
Project Type PAVING For Period Ending 8/14/2023
Project Funding
UNIT III: PAVING IMPROVEMENTS
Item
Description of Items
Estimated Unit
Unit Cost
Estimated
Completed
Completed
No.
Quanity
Total
Quanity
Total
1
REMOVE SIDEWALK
300 SF
$5.00
$1,500.00
300
$1,500.00
2
REMOVE CONCETE DRIVE (CO #1)
2037 SF
$5.50
$11,203.50
2037
$11,203.50
3
REMOVE CONC PVMT
48 SY
$45.00
$2,160.00
48
$2,160.00
4
REMOVE CONC CURB & GUTTER
167 LF
$7.50
$1,252.50
167
$1,252.50
5
UNCLASSIFIED EXCAVATION BY PLAN
87 CY
$221.00
$19,227.00
87
$19,227.00
6
EMBANKMENT BY PLAN
254 CY
$221.00
$56,134.00
254
$56,134.00
7
SWPPP 1 ACRE
1 LS
$1.00
$1.00
1
$1.00
8
9" CONC PVMT (CO #1)
504 SY
$175.62
$88,512.48
504
$88,512.48
9
4" CONC SIDEWALK
300 SF
$26.00
$7,800.00
300
$7,800.00
10
TRAFFIC CONTROL
2 MO
$7,500.00
$15,000.00
2
$15,000.00
Sub -Total of Previous Unit
$202,790.48
$202,790.48
Monday, October 9, 2023 Page 2 of 4
City Project Numbers 103404
Contract Name STONEMOJNT HARMON
Contract Limits
Project Type PAVING
Project Funding
Contract Information Summary
Original Contract Amount
Change Orders
Change Order Number 1
Total Contract Price
DOE Number 3404
Estimate Number 1
Payment Number I
For Period Ending 8/14/2023
$175,550.96
$27,239.52
$202,790.48
Total Cost of Work Completed $202,790.48
Less % Retained $0.00
Net Earned $202,790.48
Earned This Period $202,790.48
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
$202,790.48
Monday, October 9, 2023 Page 3 of 4
City Project Numbers 103404
Contract Name STONEMOJNT HARMON
Contract Limits
Project Type PAVING
Project Funding
DOE Number 3404
Estimate Number 1
Payment Number I
For Period Ending 8/14/2023
Project Manager NA City Secretary Contract Number
Inspectors CORODVA, R / STRANGE, T Contract Date 1/20/2022
Contractor KAJIMA BUILDING & DESIGN GROUOP, INC. Contract Time 120 WD
3490 PIEDMONT RD. NE Days Charged to Date 239 WD
ATLANTA , GA 30305 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 $202,790.48
Less % Retained $0.00
Net Earned $202,790.48
Earned This Period $202,790.48
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
$202,790.48
Monday, October 9, 2023 Page 4 of 4
DEVELOPER -AWARDED -PROJECT CHANGE ORDER
PROJECT NAME:
Stonemont Harmon
CHANGE
CONTRACT:
CS 57267
ORDER No:
CFA #
CFA21-0141 I
CITY PARTICIPATION:1 Yes
CITY PROJECT #
103404
1
FID #
30114-0200431-103404-EO7685
FILE #
K-2843, X-26951
INSPECTOR:
Travis Strang
Phone No: 682-328-6310
PROJECT MANAGER:
Debbie Willhelm
Phone No: 817-392-2481
WATER
SEWER
Developer
Cost
City Cost
Developer Cost City Cost
ORIGINAL CONTRACT
$329,449.45
$0.00
$660,934.72 $34,935.05
EXTRAS TO DATE
$0.00
$0.00
$0.00 $0.00
CREDITS TO DATE
$0.00
$0.00
$0.00 $0.00
CONTRACT TO DATE
$329,449.45
$0.00
$660,934.72 $34,935.05
AMOUNT OF PROP. CHANGE ORDER
($3,708.00)
$0.00
($81,407.95) ($17,222.08)
REVISED CONTRACT AMOUNT
$325,741.45
$0.00
$579,526.77 $17,712.97
TOTAL REVISED CONTRACT AMOUNT
PER UNIT
$325,741.45
$597,239.74
REVISED COST SHARE
Dev. Cost:
$1,108,058.70
TOTAL REVISED CONTRACT
CSC No. 57267-CO1
CONTRACT UNIT
PAVING
DRAINAGE
STREET LIGHTS & SIGNS
CONTRACT
Developer
Developer
DAYS
Developer Cost City Cost
Cost
City Cost
Cost
City Cost
$175,550.96 $0.00
$0.00
$0.00
$0.00
$0.00
120
$0.00 $0.00
$0.00
$0.00
$0.00
$0.00
0
$0.00 $0.00
$0.00
$0.00
$0.00
$0.00
0
$175,550.96 $0.00
$0.00
$0.00
$0.00
$0.00
120
$27,239.52 $0.00
$0.00
$0.00
$0.00
$0.00
0
$202,790.48 $0.00
$0.00
$0.00
$0.00
$0.00
120
$202,790.48
$0.00
$0.00
City Cost:
$17,712.97
$1,125,771.67
Revised: 10-12-2011 Page 1
You are directed to make the following changes in the%ontract documents:
CITY BID ITEM
PAY ITEM #
#
QUANTITY
UNIT
UNIT I - WATER
5
3311.0254
(28)
LF
6
3311.0261
28
LF
8
3311.0457
(246)
LF
9
3311.0461
246
LF
NEW 18*
3305.0116
5
CY
NEW 19*
3305.0005
1
EA
You are directed to make the following
changes in the contract documents:
CITY BID ITEM
PAY ITEM #
#
QUANTITY
UNIT
UNIT II - SEWER
6
3305.1104
(84)
LF
8
3331.4115
96
LF
9
3331.4116
96
LF
10
3331.4120
(96)
LF
11
3331.4208
(434)
LF
12
3331.4209
10
LF
13
3331.4212
(219)
LF
16
3339.1001
(1)
EA
NEW 18*
3305.0116
3
CY
NEW 19*
3339.1002
1
EA
NEW 20*
643
LF
You are directed to make the following changes in the%ontract documents:
CITY BID ITEM
PAY ITEM # # QUANTITY UNIT
UNIT III - PAVING
SF
8 3213.0301 8 I 1219 SY
Asterisk (*) indicates New Pay Item
ITEM DESCRIPTION
UNIT PRICE
Developer Cost
City Cost
8" DIP Water, CLSM Backfill
$122.00
($3,416.00)
$0.00
8" PVC Water Pipe
$47.00
$1,316.00
$0.00
12" DIP Water, CLSM Backfill
$171.00
($42,066.00)
$0.00
12" PVC Water Pipe
$73.00
$17,958.00
$0.00
Concrete Encasement for Utility Pipes
$300.00
$1,500.00
$0.00
12" Water Line Lowering
$21,000.00
$21,000.00
$0.00
Subtotal Unit I - Water Improvements
($3,708.00)
$0.00
ITEM DESCRIPTION
24" Casing By Other Than Open Cut
8" Sewer Pipe
8" Sewer Pipe, CSS Backfill
8" DIP Sewer Pipe, CSS Backfill
12" Sewer Pipe
12" Sewer Pipe, CSS Backfill
12" DIP Sewer
4' Manhole
Concrete Encasement for Utility Pipes
4' Drop Manhole
12" Sewer PVC C900 DR14 Pressure Pipe (Green)
Subtotal Unit II -Sanitary Sewer Improvements
UNIT PRICE
Developer Cost
City Cost
$525.00
($40,451.04)
($3,648.96)
$52.00
$4,992.00
$0.00
$55.00
$5,280.00
$0.00
$175.00
($16,800.00)
$0.00
$106.00
($44,233.28)
($1,770.72)
$200.00
$1,823.10
$176.90
$193.00
($30,287.70)
($11,979.30)
$5,900.00
($5,900.00)
$0.00
$300.00
$900.00
$0.00
$10,559.56
$10,559.56
$0.00
$50.87
$32,709.41
$0.00
($81,407.95)
($17,222.08)
ITEM DESCRIPTION UNIT PRICE Developer Cost City Cost
Remove Concrete Drive $5.50 $5,989.50 $0.00
9" Conc Pvmt $175.62 $21,250.02 $0.00
Subtotal Unit III - Paving Improvements $27,239.52 $0.00
GRAND TOTAL 1($57,876.43) 1 ($17,222.08) 1
REASONS FOR CHANGE ORDER Due to the extreme shortages of ductile iron pipe, water and sewer mains were installed with PVC per alternative TCEQ and CFW criteria. Additional SSMH
required to avoid TxDOT permit. Lowering of existing waterline required due to conflict with proposed sewer. Changes correspond to Plan Revisions 1-5 as
shown on sheets C-1.01, C-1.02, C-1.07, C-1.08, C-1.09, C-1.10 and C-2.04 of the construction plans
There are city funds involved in this contract. The Water Department is responsible for ($17,222.08) of this change order cost. Reimbursement from the city will
be sought by the developer.
[SIGNATURES APPEAR ON THE FOLLOWING PAGE]
Revised: 10-12-2011 Page 2
RECOMMENDED:
Kimley-Horn and Associates, Inc.
gs'aidoh ItUdGetoh
Brandon Middleton (May 25, 202315:51 CDT)
By:
Name: Brandon Middleton, PE
Title: Project Engineer
APPROVAL RECOMMENDED
CFW - Water Department
By: � Pr
Name: Taylor Gunderman, PE
Title: Engineering Manager
RECOMMENDED:
CFW - *Contract Compliance Manager
Da66.a. d. u/� i6w
By: a
Name: Debbie J. Willhelm, PE
Title: Senior Professional Engineer
M&C Number: N/A
M&C Date Approved: N/A
APPROVED:
APPROVED:
Stonemont Financial Group
Kajima Building and Design Group, Inc.
901sk whle ,
Zachary Smi-th
BY: Josh Wheeler (May 30, 202310:19 CDT)
BY: Zachary Smith Jun 6,202323:13 EDT)
Name: Josh Wheeler
Name: Zachary Smith
Title: Senior Vice President
Title: Project Manager
APPROVED:
APPROVED AS TO FORM AND LEGALITY:
CFW - AssistantCity Manager
CFW - Assistant City Attorney
By; oanaeurgndof (�dfizs,z�i3fl3acor)
By; Pmc,`�� zr,xoxzxsaxcor;
Name: Dana Burqhdoff
Name: Richard McCracken
Title: Assistant City Manager
Title: Senior Assistant City Attorney
ATTEST
* Contract Compliance Manager (Project Manager):
By signing I acknowledge that I am the person responsible
a
for the monitoring and administration of this contract, include
ensuring all performance and reporting requirements.
Jannette S. Goodall
❑ There are NO City Funds associated with this Contract
City Secretary
2 There are City Funds associated with this Contract
Revised: 10-12-2011 Page 3
FORTWORTH.
TRANSPORTATION AND PUBLIC WORKS
August 30, 2016
Kajima Building & Design Group, Inc
3490 Piemont Rd NE suite 900
Atlanta GA 30305
RE: Acceptance Letter
Project Name: Stonemont Harmon
Project Type: Water, Sewer and Paving
City Project No.: 103404
To Whom It May Concern:
On August 30, 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 September 28, 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 September 28,
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-
392-7872.
Sincerely,
Debbie Willhelm, Project Manager
Cc: Travis Strang, Inspector
Don Watson, Inspection Supervisor
Aaron Ybarra , Senior Inspector
Victor Tornero, Program Manager
Kimberly Horn, Consultant
Kajima Building and Design Group, Contractor
SFG FW Harmon, LLC, Developer
File
E-Mail: TPW_Acceptance@fortworthtexas.gov
Rev. 8/20/19
AFFIDAVIT
STATE OF OcOT I C1
COUNTY OF �WfU�
Before me, the undersigned authority, a notary public in the state
and county aforesaid, on this day personally appeared David Ledford, SVP
of Kajima Building and Design Group, 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; Agreement, CFA Number 21-0141
between Developer and City of Fort Worth
BY
Name or Title
Subscribed and sworn before me on this date Day of Month, Year.
4Cotaryli
µ`/r�mmiSs�o� CGr�s
County, State
c1G
DEVELOPMENT BOND
GUARANTEEING PERFORMANCE
AND PAYMENT OF IMPROVEMENTS
Bond No. I LICX1211604 1
KNOW ALL MEN BY THESE PRESENTS, that we, I SFG FW Harmon, LLC
3280 Peachtree Rd NE, S 2770
�( Atlanta, GA 30305 Z as Principal, andl ( Lexon Insurance Company )�a corporation organized and
existing under the laws of the State of I Texas � and fully authorized to transact
business in the State of Texas, as surety, are held and firmly bound unto CITY OF FORT
WORTH, TEXAS, 200 Texas Street, Fort Worth, Texas, 76102, as Obligee, in the penal sum
oif ($ 1,200,870.18 ) awful money of the United States of America, for the payment of
which well and truly to be made, we bind ourselves, our heirs, executors, administrators,
successors and assigns, jointly and severally, firmly by these presents.
WHEAREAS, k SFG FW Harmon, LLC � has agreed to construct in
k warehouse 1�, in the CITY OF FORT WORTH, TEXAS the
following improvements:
k Harmon Road warehouse
WHEREAS, in the event of bankruptcy, default or other nonperformance by
Principal, claims against Principal or the development, Obligee may be left without
adequate satisfaction.
NOW, THEREFORE, THE CONDITION OF THIS OBLIGATION IS SUCH, that
if the said Principal shall construct, or have constructed, the improvements herein
described, and shall pay for the cost of all labor, materials and equipment furnished in
connection with the construction of said improvements, and shall save the Obligee harmless
from any loss, cost or damage by reason of its failure to complete the construction of said
improvements or by reason of its failure to pay for the cost of same, then this obligation
shall be null and void, otherwise to remain in full force and effect; and upon receipt of a
claim by the City of Fort Worth indicating that the construction of said improvements has
not been completed, or that the costs for same have not been paid, the Surety will pay to the
City of Fort Worth such amount up to the amount of this bond which will allow the City of
Fort Worth to complete construction of said improvements and to pay for the costs of same.
We hereby agree with you that the draft(s) drawn under and in compliance with the terms
of this bond will be duly honored upon presentation at:
(Surety Lexon Insurance Company ]mail code•1 11
(Surety Address 12890 Lebanon Rd, Mt Juliet, TN 37122-2870
Attn: I Surety Claims
�or by facsimile to (surety:1 LexonClaimAdministration@sompo-intl.com
Fax Numbed (615) 553-9502 1confrimed by a phone call at� (615) 553-9500
PROVIDED FURTHER, that this bond shall automatically be increased by the
amount of any change order, supplemental agreement or amendment which increase the
price of the aforementioned contract.
PROVIDED FURTHER, that if any legal action be filed on this bond, the laws of
the State of Texas shall apply and that venue shall lie exclusively in Tarrant County, Texas.
AND PROVIDED FLIRTER, that the said surety, for value received, hereby
stipulates and agrees that no charge, extension of time, alteration or addition to the terms of
any contract for the public affect its obligation on this bond, and it does hereby waive notice
of any such change, extension of time, alteration or addition to the terms of such contract.
This bond is given pursuant to the provisions of Section 212.073 of the Texas Local
Government Code, as such may amended from time to time.
Signed, sealed and dated this 4th
DEVELOPER'S NAME
SFG FW Harmon, LLC
�rincipal
By:
day of March , 2022
SURETY COMPANY'S NAME
Lexon Insurance Company
lsurety
By:
Leigh Mc arthy I rney-in-Fact
Wp� 000'�'NTR '4
SEAL*
tTe of sue+
SOMPO INTERNATIONAL 11078
�INSILIFIANCEPOWER OF ATTORNEY
KNOW ALL BY THESE PRESENTS, that Endurance Assurance Corporation, a Delaware corporation, Endurance American Insurance Company, a Delaware
corporation, Lexon Insurance Company, a Texas corporation, and/or Bond Safeguard Insurance Company, a South Dakota corporation, each, a "Company' and
collectively, "Sompo International," do hereby constitute and appoint: Brook T. Smith, Raymond M. Hundley, Jason D. Cromwell, James H. Martin, Barbara Duncan,
Sandra L. Fusinetti, Mark A. Guidry, Jill Kemp, Lynnette Long, Amy Bowers, Deborah Neichter, Theresa Pickerrell, Sheryon Quinn, Beth Frymire, Leigh McCarthy,
Michael Dix, Susan Ritter, Ryan Britt as true and lawful Attorney(s)-In-Fact to make, execute, seal, and deliver for, and on its behalf as surety or co -surety; bonds and
undertakings given for any and all purposes, also to execute and deliver on its behalf as aforesaid renewals, extensions, agreements, waivers, consents or stipulations relating
to such bonds or undertakings provided, however, that no single bond or undertaking so made, executed and delivered shall obligate the Company for any portion of the
penal sum thereof in excess of the sum of One Hundred Million Dollars ($100,000,000.00).
Such bonds and undertakings for said purposes, when duly executed by said attorney(s)-in-fact, shall be binding upon the Company as fully and to the same extent as if
signed by the President of the Company under its corporate seal attested by its Corporate Secretary.
This appointment is made under and by authority of certain resolutions adopted by the sole shareholder of each Company by unanimous written consent effective the 15th
day of June, 2019, a copy of which appears below under the heading entitled "Certificate".
This Power of Attorney is signed and sealed by facsimile under and by authority of the following resolution adopted by the sole shareholder of each Company by
unanimous written consent effective the 151h day of June, 2019 and said resolution has not since been revoked, amended or repealed:
RESOLVED, that the signature of an individual named above and the seal of the Company may be affixed to any such power of attorney or any certificate relating thereto
by facsimile, and any such power of attorney or certificate bearing such facsimile signature or seal shall be valid and binding upon the Company in the future With respect
to any bond or undertaking to which it is attached.
IN WITNESS WHEREOF, each Company has caused this instrument to be signed by the following officers, and its corporate seal to be affixed this 15th day of
June, 2019.
Endurance Assurance Corporation
Richard Appel; !�)IA,&,§,,enior bounsel
"'5 PoR`,uranc C,
o RT
SEAL
;-a, 2002
u DELAWARE .'�D
Endurance American
/ Insurance Corn parry, +'
By L
Richard AppeI;,SVP„S.,Aemor Counsel
car, In's
0o
gTrd7's
SEAgL
,7%, DELAWARE,,
-,��7 •---- -boa,,:
,, 1..... ,,"'',, ACKNOWLEDGEMENT
Lexon Insurance Company
By. 7�
Richard Appel; Sj(R,4_Senidi Counsl
Bond Safeguard
Insurance, Company
/
Richard Appelt„$VP k§emordounse
�3iNStj
0UTH�?�nls
rn DAKOTA ; O
INSURANCE ' a
2�, COMPANY
On this 151h day of June, 2019, before me, personally came the above signatories known to me, who being duly sworn, did depose and say that he/tl�ay'I "�'tytf of jcer of each
of the Companies; and that he executed said instrument on behalf of each Company by authority of his office under th by- ws of each Company", 0".....
STI.IE
- a
- TEnNESSFE -
By; - aTury
Amy aylor,JNotublic My Commission Expires 5/.K3;'
CERTIFICATE 04
I, the undersigned Officer of each Company, DO HEREBY CERTIFY that:
1. That the original power of attorney of which the foregoing is a copy was duly executed on behalf of each Company and has not since been revoked amended or modified;
that the undersigned has compared the foregoing copy thereof with the original power of attorney, and that the same is a true and correct copy of the original power of
attorney and of the whole thereof,
2. The following are resolutions which were adopted by the sole shareholder of each Company by unanimous written consent effective June 15, 2019 and said resolutions
have not since been revoked, amended or modified:
"RESOLVED, that each of the individuals named below is authorized to make, execute, seal and deliver for and on behalf of the Company any and all bonds,
undertakings or obligations in surety or co -surety with others: RICHARD M. APPEL, BRIAN J. BEGGS, CHRISTOPHER DONELAN, SHARON L. SIMS,
CHRISTOPHER L. SPARRO, MARIANNE L. WILBERT
; and be it further
RESOLVED, that each of the individuals named above is authorized to appoint attorneys -in -fact for the purpose of making, executing, sealing and delivering bonds,
undertakings or obligations in surety or co -surety for and on behalf of the Company."
3. The undersigned further certifies that the above resolutions are true and correct copies of t e resolutions as so recorded and of the whole thereof.
IN WITNESS WHEREOF, I have hereunto set my hand and affixed the corporate seal this � day of f Yi X 20Z?,.
By:
Danle S. ne,a retary
NOTICE: U. S. TREASURY DEPARTMENT'S OFFICE OF FOREIGN ASSETS CONTROL (OFAC).
No coverage is provided by this Notice nor can it be construed to replace any provisions of any surety bond or other surety coverage provided. This Notice provides information concerning
possible impact on your surety coverage due to directives issued by OFAC. Please read this Notice carefully.
The Office of Foreign Assets Control (OFAC) administers and enforces sanctions policy, based on Presidential declarations of "national emergency". OFAC has identified and listed
numerous foreign agents, front organizations, terrorists, terrorist organizations, and narcotics traffickers as "Specially Designated Nationals and Blocked Persons'. This list can be located
on the United States Treasury's website — httos://www.treasurv.aov/resource-center/sanctions/SDN-List.
In accordance with OFAC regulations, if it is determined that you or any other person or entity claiming the benefits of any coverage has violated U.S. sanctions law or is a Specially
Designated National and Blocked Person, as identified by OFAC, any coverage will be considered a blocked or frozen contract and all provisions of any coverage provided are immediately
subject to OFAC. When a surety bond or other form of surety coverage is considered to be such a blocked or frozen contract, no payments nor premium refunds may be made without
authorization from OFAC. Other limitations on the premiums and payments may also apply.
Any reproductions are void.
Surety Claims Submission: LexonClaimAdministration(a.somr)o-intl.com
Telephone: 615-553-9500 Mailing Address: Sompo International; 12890 Lebanon Road; Mount Juliet, TN 37122-2870