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HomeMy WebLinkAboutContract 57635-FP2-FP2 City Secretary 57635 Contract No. FORT WORTH. Date Received 07/17/2024 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: Tradition Phase 4C City Project No.: 103628 Improvement Type(s): x❑ Paving ❑ Drainage ❑ Street Lights ❑ Traffic Signals Original Contract Price: $1,772,043.00 Amount of Approved Change Order(s) $90,030.00 Revised Contract Amount: Total Cost of Work Complete: CaGeb C&wteYr Caleb Chalmers (Jul 17, 2024 05:52 CDT) Contractor Operations Manager Title RPMX Construction Company Name $1,862,073.00 $1,862,073.00 J u 117, 2024 Date I� s Joey Silva (Jul 17, 202408:22 CDT) J 1.1 l 17, 2024 Project Inspector Date a� "� 5 , P�.�., F?� J u 117, 2024 Project Manager Date Rebecca 0 en (Jul 17, 2024 08:43 CDT) J LI 117, 2024 CFA Manager Date 46.11 Lauren Prieur (Ju117, 202408:53 CDT) Jul 17, 2024 TPW Director Date om�---) J u 117, 2024 Asst. City Manager Date OFFICIAL RECORD CITY SECRETARY FT. WORTH, TX Page 1 of 2 Notice of Project Completion Project Name: Tradition Phase 4C City Project No.: 103628 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 230 WD Days Charged: 282 WD Work Start Date: 3/6/2023 Work Complete Date: 7/3/2024 Completed number of Soil Lab Test: 1048 Completed number of Water Test: 18 Page 2of2 FoRTWORTH CITY OF FORT WORTH FINAL PAYMENT REQUEST Contract Name TRADITION, SOUTH PHASE 4C Contract Limits Project Type PAVING City Project Numbers 103628 DOE Number 3628 Estimate Number 1 Payment Number 1 City Secretary Contract Number Contract Date 3/6/2023 For Period Ending Project Manager NA Contractor RPMX CONSTRUCTION 5208 TENNYSON PARKWAY SUITE 130 PLANO, TX 75024 Inspectors M.GLOVER / J.DAVIS Contract Time Days Charged to Date Contract is 100.00 7/3/2024 WD 23WD 282 Complete Tuesday, July 9, 2024 Page 1 of 5 City Project Numbers 103628 DOE Number 3628 Contract Name TRADITION, SOUTH PHASE 4C Estimate Number I Contract Limits Payment Number 1 Project Type PAVING For Period Ending 7/3/2024 Project Funding UNTI IV: PAVING Item Description of Items Estimated Unit Unit Cost Estimated Completed Completed No. Quanity Total Quanity Total 53 HYDRATED LIME @ 36 lbs./S/Y. (COLLECTOR) 130 TN $190.00 $24,700.00 130 $24,700.00 54 HYDRATED LIMA @ 30lbs./S.Y. (RESIDENTIAL) 307 TN $190.00 $58,330.00 307 $58,330.00 55 6" LIME TREATED SUBGRADE (COLLECTOR) 7222 SY $3.00 $21,666.00 7222 $21,666.00 56 6" LIME TREATED SUBGRADE (RESIDENTIAL) 20456 SY $3.00 $61,368.00 20456 $61,368.00 57 6" CONCRETE PAVEMENT (RESIDENTIAL) 19256 SY $50.00 $962,800.00 19256 $962,800.00 58 7" CONCRETE PAVEMENT (COLLECTOR) 6869 SY $56.00 $384,664.00 6869 $384,664.00 59 Y CONC SIDEWALK 2520 SF $7.25 $18,270.00 2520 $18,270.00 60 6' CONC SIDEWALK 16380 SF $7.25 $118,755.00 16380 $118,755.00 61 R-1 RAMP 18 EA $2,700.00 $48,600.00 18 $48,600.00 62 TOPSOIL 139 CY $75.00 $10,425.00 139 $10,425.00 63 P-1 RAMP (CO #1) 14 EA $2,550.00 $35,700.00 14 $35,700.00 64 FURNISH/INSTALL ALUM SIGN GROUND 18 EA $250.00 $4,500.00 18 $4,500.00 MOUNT CITY STD 65 TRAFFIC CONTROL 1 LS $3,500.00 $3,500.00 1 $3,500.00 66 TYPE III BARRICADE 6 EA $900.00 $5,400.00 6 $5,400.00 67 CONCRETE HEADER 5 EA $900.00 $4,500.00 5 $4,500.00 68 CONNECT TO EXISTING PAVEMENT 1 EA $3,000.00 $3,000.00 1 $3,000.00 69 SAWCUT 145 LF $12.00 $1,740.00 145 $1,740.00 70 STRIPING 1 LF $6,000.00 $6,000.00 1 $6,000.00 71 REMOVE STRIPING I LS $150.00 $150.00 1 $150.00 72 RI-1 STOP SIGN 15 EA $85.00 $1,275.00 15 $1,275.00 73 ST MARKER BLADE 72 EA $25.00 $1,800.00 72 $1,800.00 74 10" CONCRETE PAVEMENT (ARTERIAL) (CO 246 SY $200.00 $49,200.00 246 $49,200.00 #1) 75 8" LIME TREATED SUBGRADE (ARTERIAL) 276 SY $25.00 $6,900.00 276 $6,900.00 (CO #1) 76 HYDRATED LIME @36lbs/SY (ARTERIAL) (CO 5 TN $400.00 $2,000.00 5 $2,000.00 #1) 77 REMOVE RAMPS & SIDEWALK (CO #1) 69 SY $15.00 $1,035.00 69 $1,035.00 78 REMOVE CONCRETE CURB & GUTTER (CO #1) 231 LF $15.00 $3,465.00 231 $3,465.00 79 10' CONC SIDEWALK (CO #1) 118 LF $95.00 $11,210.00 118 $11,210.00 80 CONNECT TO EXISTING PAVEMENT (CO #1) 278 LF $40.00 $11,120.00 278 $11,120.00 Tuesday, July 9, 2024 Page 2 of 5 City Project Numbers 103628 DOE Number 3628 Contract Name TRADITION, SOUTH PHASE 4C Estimate Number I Contract Limits Payment Number 1 Project Type PAVING For Period Ending 7/3/2024 Project Funding Sub -Total of Previous Unit $1,862,073.00 $1,862,073.00 Tuesday, July 9, 2024 Page 3 of 5 City Project Numbers 103628 Contract Name TRADITION, SOUTH PHASE 4C Contract Limits Project Type PAVING Project Funding Contract Information Summary Original Contract Amount Chanhe Orders Change Order Number 1 DOE Number 3628 Estimate Number 1 Payment Number 1 For Period Ending 7/3/2024 $1,772,043.00 $90,030.00 Total Contract Price $1,862,073.00 Total Cost of Work Completed $1,862,073.00 Less % Retained $0.00 Net Earned $1,862,073.00 Earned This Period $1,862,073.00 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 $1,862,073.00 Tuesday, July 9, 2024 Page 4 of 5 City Project Numbers 103628 Contract Name TRADITION, SOUTH PHASE 4C Contract Limits Project Type PAVING Project Funding Project Manager NA Inspectors M.GLOVER / J.DAVIS Contractor RPMX CONSTRUCTION 5208 TENNYSON PARKWAY SUITE 130 PLANO , TX 75024 DOE Number 3628 Estimate Number 1 Payment Number 1 For Period Ending 7/3/2024 City Secretary Contract Number Contract Date 3/6/2023 Contract Time 230 WD Days Charged to Date 282 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 $1,862,073.00 Less % Retained $0.00 Net Earned $1,862,073.00 Earned This Period $1,862,073.00 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 $1,862,073.00 Tuesday, July 9, 2024 Page 5 of 5 DEVELOPER -AWARDED -PROJECT CHANGE ORDER PROJECT NAME: Tradition - Phase 4C CONTRACT: (A) Water/Sewer/Storm Drain, (B) Paving, (C) Street Lights CFA # 22-0057 CITY PARTICIPATION:I 0% CITY PROJECT # 103628 FID # 130114-0200431-103628-EO7685 FILE # IX-27070 INSPECTOR: Jesse Davis Phone No: 817-863-3705 PROJECT MANAGER: Arash Emami Saleh Phone No: 817-392-2373 REVIEWED By Arash Emami Sa/eh at 9:45 am, Jul 05, 2024 CHANGE ORDER No: 1 CONTRACT UNIT WATER SEWER DRAINAGE PAVING Developer Developer Cost City Cost Developer Cost City Cost Cost City Cost Developer Cost City Cost ORIGINAL CONTRACT $802,748.80 1 $0.00 $1,668,607.40 $0.00 $1,247,512.50 $0.00 $1,772,043.00 $0.00 EXTRAS TO DATE CREDITS TO DATE CONTRACT TO DATE I $802,748.80 AMOUNT OF PROP. CHANGE ORDER I $4,284.00 REVISED CONTRACT AMOUNT I $807,032.80 TOTAL REVISED CONTRACT AMOUNT $0.00 I $1,668,607.40 $0.00 I $1,247,512.50 $0.00 $1,772,043.00 $0.00 $7,154.50 I $100,182.50 I $90,030.00 $0.00 I $1,675,761.90 I $0.00 ' $1,347,695.00 $0.00 I $1,862,073.00 I $0.00 PER UNIT $807,032.80 REVISED COST SHARE I Dev. Cost: TOTAL REVISED CONTRACT $1,675,761.90 I $1,347,695.00 I $1,862,073.00 $5,909,928.14 (City Cost: You are directed to make the following changes in the contract documents ITEM PAY ITEM# ICITY QUANTITY I UEW N# 1 NIT WATER TOTAL 3301.0002 15 (220) LF 3305.0109 17 (220) LF 3305.0113 18 2 EA 3331.4115 20 (241) LF 3331.4116 21 7 LF 3331.4201 22 (557) LF 1 1 3331.4208 23 521 LF 3331.4205 24 27 LF 3339.0001 27 2 VF 3339.1003 1 29 (32) VF 1 3305.1104 1 31 1 15 1 LF 1 3331.3201 1 NEW 1 2 1 EA 3331.4205 1 NEW 1 23 LF 1 SEWER TOTAL 3137.0104 33 49 SY 3305.0109 34 (107) LF 3305.0112 35 (3) EA $5,910,028.14 ITEM DESCRIPTION Adjust Water Valve Rim to Grade Post -CCTV Ins ection Trench Safety Trench Water Stops 8" SDR-26 PVC Sewer P,( e 8" PVC Sanitary Sewer Pipe w/CSS Backfill 10" SDR-26 PVC Sewer Ppe 12" SDR-26 PVC Sewer Pipe 10" DIP Sewer Pie Epoxy Manhole Liner 4' Extra Deeth Manhole 24" Steel Casing By Other Than Open Cut 6" Sewer Service (SDR-35 PVC) 10" DIP Sewer Pipe w/CSS Bac II Medium Riprap, dry Trench Safely Concrete Collar STREET LIGHTS CONTRACT Developer DAYS Cost City Cost $217,465.44 $0.00 230 $217,465.44 $0.00 I 230 $o.00 I I 0 $217,465.44 I $0.00 I 230 $217,465.44 $0.00 Ij I UNIT PRICE TOTAL $4,284.00 $4.284.00 $4,284.00 $3.70 ($814.00) $0.60 ($132.00) $1,290.00 $2,580.00 $61.70 ($14,869.70) $90.30 $632.10 $87.40 ($48,681.80) $110.00 $57,310.00 $170.70 $4,608.90 $531.001 $1,062.00 $172.001 (S5,504.00) $219.001 $3,285.00 $1,884.001 $3,768.00 $170.001 $3,910.00 1 $7,154.50 $97.001 $4,753.00 $0.20 ($21.40) $477.00 ($1.431.00) Revised: 10-12-2011 Page 1 3341.0201 36 10 LF 21" RCP, Class III $73.10 $731.001 3341.0205 37 (22) LF 24" RCP, Class III $88.20 (S1,940.40)] 3341.0208 38 41 LF 27" RCP, Class III $98.00 $4,018.001 3341.0309 39 (199) LF 36" RCP, Class III $157.80 (S31.402.20)1 3341.0402 40 (3) LF 42" RCP, Class III $218.00 ($654.00)1 3349.0102 44 (4) EA 4' Manhole Riser $2,678.00 (S10,712.00)1 9999.0002 NEW 1 EA 12' x 12' Junction Box 1 $22,890.00 $22,890.001 3349,5003 NEW 1 1 EA 20' Curb Inlet 1 $11.504.00 $11,504.001 3349.4106 NEW 1 I EA 1 27" Sloped End Headwall 1 $5,289.00 $5,289.001 9999.0008 NEW 1 2 I EA Single 4' x 3' R.C.B. Headwall 1 $9,387.001 $18,774.00 9999.0009 NEW 1 87 I LF 4' x 3' R.C.B., Class III 1 $320.501 $27,883.50 9999.0010 I NEW 1 327 SY 1 Concrete Flume (6' Width) 1 $146.001 $47,742.00 9999.0011 I NEW 1 1 EA 1 Remove Ex. 21" RCP & 10' Curb Inlet 1 $2,759.001 $2,759.00 DRAINAGE TOTAL 1 1 $100,182.50 3213.0506 63 2 EA P-1 Ramp $2,550.001 $5,100.00 NEW 246 SY 1 10" Concrete Pavement (Arterial) $200,001 $49,200.00 NEW 276 SY 1 8" Lime Treated Subgrade (Arterial) I $25.001 $6,900.00 NEW 5 Ton 1 Hydrated Lime@ 3616s/SY (Arterial) I $400.00I1j $2,000.00 NEW 69 SY 1 Remove Ramps & Sidewalk I $15.00 $1,035.00 NEW 231 I LF Remove Concrete Curb & Gutter I $15.001 $3,465.00 NEW 118 I LF , 10' Conc Sidewalk I $95.001 $11,210.00 NEW 278 1 LF I Connect to Existing Pavement 1 $40.001 $11,120.00 PAVING TOTALI 1 1 $90,030.00 REASONS FOR CHANGE ORDER TOTAL 1 $201,651.001 1. Added Turn Lane on Winding Meadows Drive 2. Added Detention Pond per Approved Drainage Study & associated revisions to Drainage and Sewer Quantities NO CITY FU50S INVOLVED IN THIS CONTRACT, DEVELOPER IS RESPONS[SLE FOR. 100% 0,F THE CHANGE ORDER CQST AND NO REIMBURSEMENT FikOtiA THE CITY W U OF $QUrpHT DY THE DEVELOPER, RECO`Ui KDF:tSS APPROVEZ_ APPROVED: APPROVED: Goodutist ar.6 Marsi iefi. Inc- HTMWY 1 ita 4r r x P FtP?V XC'u se�=Orp; l.LG :a+.;f Gaas San, Pnc if:�t��_ Set at�ached BY., By: By: 8}r C�r— Name: KIa4i Saar<e, F.E. Name: Robert Witte Name:G ;/�j rz*4w name: Stryker Ntctmis Title: Project Engineer TNe: Sr. -Managing Director Title: g � �/ 7ide: Project Manager REVIEWED By Arash Emami Saleh at 9:45 am, Jul 05, 2024 Revised: 10-12-2011 Page 2 DocuSign Envelope ID: 55AA667A-5EB8-4DDE-A964-5403DF927292 HT HWY 114 DEVELOPMENT LP By: HT Hwy 114 Development LLC, its general partner By: HT Hwy 114 LP, its sole member By: Hines Hwy 114 LLC, its general partner By: Hines Hwy 114 Associates LP, its sole member By: Hines Investment Management Holdings Limited Partnership, its general partner DS ER D—Slflned by: By:." lw x� N8tff8"1K23bert W. Witte Title: Senior Managing Director REVIEWED By Arash Emami Sa/eh at 9:45 am, Jul 05, 2024 FORTWORTH. TRANSPORTATION AND PUBLIC WORKS July 5, 2024 RPMX Construction, LLC 5208 Tennyson Street Suite 130 Plano, Texas 75024 RE: Acceptance Letter Project Name: Tradition Phase 4C Project Type: Paving City Project No.: 103628 To Whom It May Concern: On June 7, 2024 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 July 5, 2024. 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 July 5, 2024, 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- 392-2373. Sincerely, Arash Emami Saleh, Project Manager Cc: Joey Silva , Inspector Mike Glover, Inspection Supervisor Randy Horton , Senior Inspector Andrew Goodman, Program Manager Goodwin and Marshall, Consultant RPMX Construction , Contractor Hines, Developer File E-Mail: TPW_Acceptance@fortworthtexas.gov Rev. 8/20/19 CONDITIONAL BILLS PAID AFFIDAVIT STATE OF TEXAS COUNTY OF COLLIN BEFORE ME, the undersigned authority, on this day personally appeared Amy Stavola, known to me to be a credible person and officer of RPM xConstruction, LLC, a Texas Corporation (hereinafter called "Contractor"), and who, being duly sworn, upon his oath declares and acknowledges as follows: 1. I am the duly authorized agent for the said Contractor, which has authorized me to make this affidavit, and all of the recitations herein are true and correct. 2. Pursuant to an agreement -dated 12/16/2022 between HT Hwv 114 DeveloAment, LP and RPM xConstruction, LLC, contractor has supplied materials and performed labor in connection with the construction of improvements upon certain real property owned by the Owner in Tarrant County, Texas. Said improvements are more particularly described as paving for Tradition South Phase 4C in Fort Worth, Texas (the "Improvements"). 3. Contractor has actual knowledge that all bills owed by Owner to Contractor and all bills owed by Contractor to others for materials supplied or labor performed in connection with the Improvements have been fully paid and satisfied, except for $263,301.15 which includes retainage left to bill. Contractor does further warrant that should any claim or lien be filed for material supplied or labor performed by virtue of Contractor's participation in the construction of said Improvements, Contractor will immediately furnish a bond pursuant to Texas Property Code, Sections 53.236 through 53.238, for release of each such lien, and obtain settlement of any such liens and furnish Owner written full release of such liens. Should Contractor be unable to obtain such release, Contractor agrees to fully indemnify and hold harmless the Owner for any and all costs they may incur by reason of such lien. EXECUTED this 91' day of July 2024. By: Name: Amy avola Title: Accounting Supervisor SUBSCRIBED AND SWORN TO BEFORE ME by the said Amv Stavola, Accounting Supervisor, on this the 91h day of July 2024, to certify which witness my hand and seal of office. o`�` UREiy �pP Par Pie 90S 9TE 0 F Notary Public in and for the State of Texas CONSENT OF OWNER ❑ SURETY COMPANY ARCHITECT ❑ TO FINAL PAYMENT CONTRACTOR ❑ SURETY ❑ AIA DOCUMENT G707 OTHER Bond No. 2327555 PROJECT: Tradition, South Phase 4C, CPN ##103628 (name, address) TO (Owner) [ City of Fort Worth ] ARCHITECT'S PROJECT NO: 200 Texas Street Fort Worth, TX 76102 CONTRACT FOR: ] CONTRACT DATE: CONTRACTOR: RPM xConstruction, LLC 6500 Meyer Way, Suite 100 McKinney, TX 75070 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) Swiss Re Corporate Solutions America Insurance Corporation 1200 Main St., Suite 800 Kansas City, MO 64105 , SURETY COMPANY, on bond of (here insert name and address of Contractor) RPM xConstruction, LLC 6500 Meyer Way, Suite 100 McKinney, TX 75070 , 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 200 Texas Street Fort Worth, TX 76102 as set forth in the said Surety Company's bond. IN WITNESS WHEREOF, ,OWNER, the Surety Company has hereunto set its hand this 16th day of July 2g24 Swiss Re Corporate Solutions America Insurance Corporation Surety Company 1 r"-., Vf h 9. � J 1ltJ\ _ 4 1 Si ature of Authorized Repre tative Attest. {Seal): Andrea Rose Crawford Attornev-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 AIA DOCUMENT G707 • CONSENT OF SURF I'Y COMPANY TO FINAL PAYMENT + APRIL 1970 EDITION • AIA® ONE PAGE © 1970 9 THE AMERICAN INSTITUTE OF ARCHITECTS, 1735 New York Ave„ NW, WASHINGTON, D.C. 20006 SWISS RE CORPORATE SOLUTIONS SWISS RE CORPORATE SOLUTIONS AMERICA INSURANCE CORPORATION ("SRCSAIC") SWISS RE CORPORATE SOLUTIONS PREMIER INSURANCE CORPORATION ("SRCSPIC") WESTPORT INSURANCE CORPORATION ("WIC") GENERAL POWER OF ATTORNEY KNOW ALL MEN BY THESE PRESENTS, 7'I IAT SRCSAIC, a corporation duly organized and existing under laws of the State of Missouri, and having its principal office in the City of Kansas City, Missouri, and SRCSPIC, a corporation organized and existing under the laws of the State of Missouri and having its principal office in the City of Kansas City, Missouri, and WIC, organized under the laws of the State of Missouri, and having its principal office in the City of Kansas City, Missouri, each does hereby make, constitute and appoint: JOHN R. WARD, THOMAS DOUGLAS MOORE, EMILY ALLYSON MIKESKA, ALLYSON W. DEAN, MONICA RUBY VEAZEY, JOIIN WILLIAM NEWBY, TROY RUSSELL KEY, DEBRA LEE MOON, ANDREA ROSE CRAWFORD, SANDRA LEE RONEY, FAITII ANN I IILTY, ANDREW GARETH ADDISON. PATRICK TI IOMAS COYLE, MICHAEL DONALD HENDRICKSON. BRYAN KELLY MOORE, ELIZABETII ORTIZ. ANA OWENS. BETTY J REEn. AND ANDREW PATRICK CLARK JOINTLY OR SEVERALLY Its true and lawful Attomey(s)-in-Fact, to make, execute, seal and deliver, for and on its behalf and as its act and deed, bonds or other writings obligatory in the nature of a bond on behalf of each of said Companies, as surety, on contracts of suretyship as are or may be required or permitted by law, regulation, contract or otherwise, provided that no bond or undertaking or contract or suretyship executed under this authority shall exceed the amount of: TWO HUNDRED MILLION (S200,000,000.00) DOLLARS 'this Power of Attorney is granted and is signed by facsimile under and by the authority of the following Resolutions adopted by the Boards of Directors of both SRCSAIC and SRCSPIC at meetings duly called and held on the 18th of November 2021 and WIC by written consent of its Executive Committee dated July 18, 2011. "RESOLVED, that any two of the President, any Managing Director, any Senior Vice President, any Vice President, the Secretary or any Assistant Secretary be, and each or any of them hereby is, authorized to execute a Power of Attorney qualifying the attorney named in the given Power of Attorney to execute on behalf of the Corporation bonds, undertakings and all contracts of surety, and that each or any of them hereby is authorized to attest to the execution of any such Power of Attorney and to attach therein the seal of the Corporation; and it is FURTHER RESOLVED, that the signature of such officers and the seal of the Corporation may be affixed to any such Power of Attorney or to any certificate relating thereto by facsimile, and any such Power of Attorney or certificate bearing such facsimile signatures or facsimile seal shall be binding uuon the Corporation when so affixed and in the future with regard to anv bond, undertaking or contract of surety to which ;`�jVOPPORgTFYs� ;;,5a aPORq BV C S E A L �s 19730, is �ssoU ..L�: Erik Janssens, Senior Vice President of SRCSAIC & Senior Vice President of SRCSPIC & Senior Vice President orwic BYa� 'J Gerald Jagrmrsld, Vise President of SRCSAIC & Vice President of SRCSPIC & Vice President of W IC it is attached." IN WITNESS WHEREOF, SRCSAIC, SRCSPIC, and WIC have caused their official seals to be hereunto affixed, and these presents to be signed by their authorized officers this 111h day of January 20 24 Swiss Re Corporate Solutions America Insurance Corporation State of Illinois Swiss Re Corporate Solutions Premier Insurance Corporation County of Cook ss Westport Insurance Corporation On this 11 th day of January 120 24 ' before me, a Notary Public personally appeared Erik Janssens , Senior Vice President of SRCSAIC and Senior Vice President of SRCSPIC and Senior Vice President of WIC and Gerald Jaerowski , Vice President of SRCSAIC and Vice President of SPCSPIC and Vice President of WIC, personally known to me, who being by me duly sworn, acknowledged that they signed the above Power of Attorney as officers of and acknowledged said instrument to be the voluntary act and deed of their respective companies. ot�talal-saa� Ct�IR1S71NAtuWNISCO wwtYtxtatla,etAtF9Fut+ats . eertastt>�t � i<at111a, (�C.O I, Jeffrev Goldbei-R., the duly elected Senior Vice President and Assistant Secretary of SRCSAIC and SRCSPIC and WIC, do hereby certify that the above and foregoing is a true and correct copy of a Power of Attorney given by said SRCSAIC and SRCSPIC and WIC, which is still in full force and effect. IN WITNESS WHEREOF, I have set my hand and affixed the seals of the Companies this 16th day of July , 20 24_. Jeffrey Goldberg, Senior Vice President & Assistant Secretary of SRCSAIC and SRCSPIC and WIC IMPORTANT NOTICE In order to obtain information or make a complaint: You may contact Jeffrey Goldberg, Vice President - Claims, at 1-800-338-0753. You may call Swiss Re Corporate Solutions America Insurance Corporation or Swiss Re Corporate Solutions Premier Insurance Corporation's toll -free number for information or to make a complaint at: 1-800-338-0753 You may also write to Swiss Re Corporate Solutions America Insurance Corporation or Swiss Re Corporate Solutions Premier Insurance Corporation at the following address: 1450 American Lane, Suite 1100 Schaumburg, IL 60173 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 149104 Austin, TX 78714-9104 Fax: (512) 475-1771 Web: httn://www.tdi.state.tx.us E-mail: Cons umerProtectionnu tdi.state.tx.us PREMIUM OR CLAIM DISPUTES: Should you have a dispute concerning your premium or about a claim you should first contact the Swiss Re Corporate Solutions America Insurance Corporation or Swiss Re Corporate Solutions Premier Insurance Corporation. 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. AVISO IMPORTANTE Para obtener informacion o para someter un queja: Puede comunicarse con Jeffrey Goldberg, Vice President - Claims, a] 1-800-338-0753. Usted puede llamr al numero de telefono gratis de Swiss Re Corporate Solutions America Insurance Corporation o Swiss Re Corporate Solutions Premier Insurance Corporation's para informacion o para someter una queja al: 1-800-338-0753 Usted tambien puede escribir a Swiss Re Corporate Solutions America Insurance Corporation o Swiss Re Corporate Solutions Premier Insurance Corporation al: 1450 American Lane, Suite 1100 Schaumburg, IL 60173 Puede escribir al Departmento de Seguros de Texas para obtener informacion acerca de companias, coberturas, derechos o quejas al: 1- 800-252-3439 Puede escribir al Departmento de Seguros de Texas: P.O. Box 149104 Austin, TX 78714-9104 Fax: (512) 475-1771 Web: htty://www.tdi.state.tx.us E-mail:ConsumerProtection(a),tdi.state.tx.us DISPUTAS SOBRE PRIMAS O RECLAMOS: Si tiene una disputa concerniente a su prima o a un reclamo, debe comunicarse con el Swiss Re Corporate Solutions America Insurance Corporation o Swiss Re Corporate Solutions Premier Insurance Corporation primero. Si no se resuelve la disputa, puede entonces comunicarse con el Departmento de Seguros de Texas. UNA ESTE AVISO A SU POLIZA: Este aviso es solo para proposito de infromacion y no se converte en parte o condicion del documento adjunto.