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HomeMy WebLinkAboutContract 54044-FP4-FP4 FORTWORTH. City Secretary rJ4�44 Contract No. Date Received 08/28/2024 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: Crystal Springs City Project No.: 100252 Improvement Type(s): ❑x Paving ❑x Drainage ❑x Street Lights ❑ Traffic Signals Original Contract Price: $377,703.00 Amount of Approved Change Order(s): $65,783.32 Revised Contract Amount: $443,486.32 Total Cost of Work Complete: $443,486.32 Aug 27, 2024 Contractor Date Vice President Title Rumsey Construction, LLC Company Name Stanley Butterfield (A�r 27, 202409:23 T) A27, 2024 AugHershel Project Inspector Date Au 28 2024 g , Khal Jaafari P.E. (Aug 28, 202413:48 CDT) Project Manager Date ^ Aug 28, 2024 Rebecca Owen (Aug 28, 202414:07 CDT) CFFA MEager Date i✓ Aug 28, 2024 Lauren Prieur (Aug 28, 2024 14:26 CDT) TPW Dire or Date Aug 30, 2024 Asst. City Manager Date OFFICIAL RECORD CITY SECRETARY FT. WORTH, TX Page 1 of 2 Notice of Project Completion Project Name: Crystal Springs City Project No.: 100252 City's Attachments Final Pay Estimate ❑x Change Order(s): ❑x Yes ❑ N/A Contractor's Attachments Affidavit of Bills Paid ' Consent of Surety 0 Statement of Contract Time Contract Time 100 WD Days Charged: 641 Work Start Date: 8/03/2020 Work Complete Date: 10/12/2023 Completed number of Soil Lab Test: 188 Completed number of Water Test: 34 Page 2of2 FORT WORTH CITY OF FORT WORTH FINAL PAYMENT REQUEST Contract Name CRYSTAL SPRINGS - WATER, SANITARY SEWER, DRAINAGE, PAVING Contract Limits Project Type DRAINAGE, PAVING, LIGHTS City Project Numbers 100252 DOE Number 1252 Estimate Number 1 Payment Number 1 For Period Ending 10/26/2023 AID City Secretary Contract Number Contract Time IOWD Contract Date 6/10/2020 Days Charged to Date 641 Project Manager NA Contract is 100.00 Complete Contractor RUMSEY CONSTRUCTION, LLC 6617 VILLAGE SPRINGS DRIVE PLANO , TX 75024 Inspectors GARDNER / SUTTERFIELD Wednesday, August 7, 2024 Page 1 of 5 City Project Numbers 100252 DOE Number 1252 Contract Name CRYSTAL SPRINGS - WATER, SANITARY SEWER, DRAINAGE, PAVI Estimate Number 1 Contract Limits Payment Number 1 Project Type DRAINAGE, PAVING, LIGHTS For Period Ending 10/26/2023 Project Funding UNIT III: DRAINAGE IMPROVEMENTS Item Description of Items No. 1 24" RCP CLASS III 2 30" RCP CLASS III 3 CONCRETE COLLAR 4 4' STORM JUNCTION BOX 5 15' CURB INLET 6 CONCRETE RIPRAP 7 BLOCK RIPRAP GROUTED 8 TRENCH SAFETY (STORM) 9 CONTECH CDS TREATMENT UNIT (CDS5653- 10-C) Estimated Unit Unit Cost Estimated Completed Completed Quanity Total Quanity Total 242 LF $63.00 $15,246.00 242 $15,246.00 295 LF $83.00 $24,485.00 295 $24,485.00 3 EA $500.00 $1,500.00 3 $1,500.00 1 EA $5,700.00 $5,700.00 1 $5,700.00 1 EA $7,500.00 $7,500.00 1 $7,500.00 10 SY $144.00 $1,440.00 10 $1,440.00 40 SY $175.00 $7,000.00 40 $7,000.00 537 LF $1.00 $537.00 537 $537.00 1 EA $140,000.00 $140,000.00 1 $140,000.00 Sub -Total of Previous Unit $203,408.00 $203,408.00 UNIT IV: PAVING IMPROVEMENTS Item Description of Items No. ---------------- 1 7" CONC CURB AND GUTTER 2 PVMT MARKING 3 REMOVE CONC CURB & GUTTER 4 ASPHALT PVMT REPAIR, BEYOND DEFINED WIDTH, ARTERIAL Estimated Unit Unit Cost Estimated Completed Completed Quanity Total Quanity Total ----------------------- 262 LF $35.00 $9,170.00 262 $9,170.00 1 LS $16,250.00 $16,250.00 1 $16,250.00 780 LF $10.00 $7,800.00 780 $7,800.00 587 SY $225.00 $132,075.00 587 $132,075.00 --------------------------- Sub-Total of Previous Unit $165,295.00 $165,295.00 UNIT V: STREET LIGHT IMPROVEMENTS Item Description of Items No. ----------------- 1 LED LIGHTING FIXTURE 2 FURNISH/INSTALL ELEC SERV PEDESTAL (CO #1) 3 2" CONDT PVC SCH 80 (T) (CO #1) 4 2" CONDT PVC SCH 80 (T) (CO #1) 5 2" CONDT RM (T) (CO #1) 6 NO 8 INSULATED ELEC CONDR (CO #1) Estimated Unit Unit Cost Estimated Completed Completed Quanity Total Quanity Total ---------------------- 2 EA $4,500.00 $9,000.00 2 $9,000.00 1 EA $6,004.10 $6,004.10 1 $6,004.10 405 LF $19.75 $7,998.75 405 $7,998.75 75 LF $106.67 $8,000.25 75 $8,000.25 30 LF $33.33 $999.90 30 $999.90 1910 LF $4.71 $8,996.10 1910 $8,996.10 Wednesday, August 7, 2024 Page 2 of 5 City Project Numbers 100252 DOE Number 1252 Contract Name CRYSTAL SPRINGS - WATER, SANITARY SEWER, DRAINAGE, PAVI Estimate Number 1 Contract Limits Payment Number 1 Project Type DRAINAGE, PAVING, LIGHTS For Period Ending 10/26/2023 Project Funding 7 NO 8 BARE ELEC CONDR (CO #1) 535 LF $3.74 $2,000.90 535 $2,000.90 8 GROUND BOS TYPE B, W/APRON (CO #1) 5 EA $400.00 $2,000.00 5 $2,000.00 9 FURNISH/INSTALL UTILITY WASHINGTON 7 EA $4,254.76 $29,783.32 7 $29,783.32 POSTLITE SERIES LED AND POLE (CO #1) Sub -Total of Previous Unit $74,783.32 $74,783.32 Wednesday, August 7, 2024 Page 3 of 5 City Project Numbers 100252 DOE Number 1252 Contract Name CRYSTAL SPRINGS - WATER, SANITARY SEWER, DRAINAGE, PAVI Estimate Number 1 Contract Limits Payment Number 1 Project Type DRAINAGE, PAVING, LIGHTS For Period Ending 10/26/2023 Project Funding Contract Information Summary Original Contract Amount $377,703.00 Chan Orders Change Order Number 1 $65,783.32 Total Contract Price $443,486.32 Total Cost of Work Completed $443,486.32 Less % Retained $0.00 Net Earned $443,486.32 Earned This Period $443,486.32 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 $443,486.32 Wednesday, August 7, 2024 Page 4 of 5 City Project Numbers 100252 DOE Number 1252 Contract Name CRYSTAL SPRINGS - WATER, SANITARY SEWER, DRAINAGE, PAVI Estimate Number 1 Contract Limits Payment Number 1 Project Type DRAINAGE, PAVING, LIGHTS For Period Ending 10/26/2023 Project Funding Project Manager NA Inspectors GARDNER / SUTTERFIELD Contractor RUMSEY CONSTRUCTION, LLC 6617 VILLAGE SPRINGS DRIVE PLANO, TX 75024 City Secretary Contract Number Contract Date 6/10/2020 Contract Time 100 WD Days Charged to Date 641 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 $443,486.32 Less % Retained $0.00 Net Earned $443,486.32 Earned This Period S443,486.32 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 $443,486.32 Wednesday, August 7, 2024 Page 5 of 5 DEVELOPER -AWARDED -PROJECT CHANGE ORDER PROJECT NAME: Water, Sanitary Sewer, Drainage, and Paving Improvements to serve Crystal Springs CONTRACT: 54044 CFA # CFA20-0024 I CITY PARTICIPATION: NO CITY PROJECT # 100252 DOE# NA WATER PROJECT # 59601-5310350-0600413-100252-001580 SEWER PROJECT 9 59607-5310350-0700430-100252-001380 FILE # W-2393 INSPECTOR: Stanley Sutterfield Phone No: 817.240.4037 PROJECT MANAGER: Khal Jaafari, PE Phone No: 817.392.7872 WATER Developer Cost City Cost ORIGINAL CONTRACT $201,847.00 $0.00 EXTRAS TO DATE $0.00 $0.00 CREDITS TO DATE $0.00 $0.00 CONTRACT TO DATE $201,847.00 $0.00 AMOUNT OF PROP. CHANGE ORDER $ 30,316.00 $0.00 REVISED CONTRACT AMOUNT $232,163.00 $0.00 TOTAL REVISED CONTRACT AMOUNT PER UNIT $232,163.00 REVISED COST SHARE Dev. Cost: TOTAL REVISED CONTRACT CONTRACT UNIT CHANGE ORDER No: 1 RECEIVED By Khal Jaafari at 6:53 pm, May 23, 2023 I SEWER PAVING DRAINAGE STREET LIGHTS WORKING D I D I D I DAYS ... P" eve oper eve oper eve oper :ost City Cost Cost City Cost Cost City Cost Cost City Cost $79,514.00 $0.00 $165,295.00 I $0.00 $203,408.00 I $0.00 I $9,000.00 $0.00 I 100 $0.00 $0.00 $0.00 I $0.00 $0.00 I $0.00 I $0.00 $0.00 I 0 $0.00 $0.00 $0.00 I $0.00 $0.00 I $0.00 I $0.00 $0.00 I 0 $79,514.00 $0.00 $165,295.00 I $0.00 $203,408.00 I $0.00 I $9,000.00 $0.00 I 100 $ 4,450.00 $0.00 $0.00 I $0.00 $0.00 I $0.00 I $ 65,783.32 $0.00 I 0 $83,964.00 $0.00 $165,295.00 I $0.00 $203,408.00 I $0.00 I $74,783.32 $0.00 I 100 $83,964.00 $166,296.00 $203,408.00 $74,783.32 $759,613.32 City Cost: $0.00 $759,613.32 Revised: 10-12-2011 Page 1 RECEIVED By Khal Jaafari at 6:53 pm, May 23, 2023 You are directed to make the following changes in the contract documents: I CITY BI#D ITEM I I I I I PAY ITEM # QUANTITY UNIT ITEM DESCRIPTION UNIT PRICE TOTAL Unit I: Water Improvements 1 9999.0004 29 SY ASPHALT PVMT REPAIR, ARTERIAL (WATER) $ 225.00 $ 6,525.01 4 3311.0361 133 LF 10, PVC WATER PIPE $ 35.00 $ 4,655.01 5 3311.0461 60 LF 12" PVC WATER PIPE $ 40.00 $ 2,400.01 16 3305.0109 193 LF TRENCH SAFETY $ 1.00 $ 193.01 NEW ITEM 3312.0117 4 EA CONNECTION TO EXISTING 4" - 12" WATER MAIN $ 4,135.751 $ 16,543.01 Unit II: Sanitary Sewer Improvements 4,300.001 4,300.01 8 I 3309.01001 1 I EA I MANHO E VACUUM TESTING I$ 150.00 I$ 150.01 Unit V: Street Light Improvements NEW ITEM 2605.0111 1 EA FURNISH/INSTALL ELEC SERV PEDESTAL $ 6,000.00 $ 6,000.01 NEW ITEM 2605.3011 405 LF 2" CONDT PVC SCH 80 (T) $ 19.75 $ 8,000.01 NEW ITEM 2605.3012 75 LF 2" CONDT PVC SCH 80 (T) $ 106.67 $ 8,000.01 NEW ITEM 2605.3013 30 LF 2" CONDT RM (T) $ 33.33' $ 1,000.01 NEW ITEM 3441.1409 1910 LF NO 8INSULATED ELEC CONDR $ 4.71 $ 9,000.01 NEW ITEM 3441.1414 535 LF NO S BARE ELEC CONDR $ 3.74 $ 2,000.01 NEW ITEM 3441.1502 5 EA GROUND BOX TYPE B, W/ APRON $ 400.00 $ 2,000.01 NEW ITEM 3441.3035 7 EA FURNISH/INSTALL UTILITY WASHINGTON POSTLITE SERIES LED AND POLE $ 4,254.76 $ 29,783.3: GRAND TOTAL $100,549.3, REASONS FOR CHANGE ORDER (1) Water Line B needed to be lowered at easternmost connection to public system due to existing condition depth. (2) Pedestrian lighting along White Settlement to meet zoning landscape point system requirements. (3) Water Line A connection to existing 12-inch system needed adjusted due to field conditions. (4) An existing brick SSMH needed to be entirely replaced due to sidewalk grades. RECOMMENDED: Kimley-Horn and Associates, Inc. By: I'A41IX ,� Name: Brandon Middleton Title: Civil Engineer APPROVED: SW Crystal Springs, LLC By: Name: Aaron Sherman Title: Manager APPROVED: Rumsey Construction, LLC By: U raug Name: re hron Tine: Vice President Revised: 10-12-2011 Page 2 FORTWORTH. TRANSPORTATION AND PUBLIC WORKS August 2, 2024 Rumsey Construction LLC 4329 Reeder Carrollton, Texas 75010 RE: Acceptance Letter Project Name: Crystal Springs Project Type: water, sewer, drainage, paving, street lights City Project No.: 100252 To Whom It May Concern: On November 17, 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 January 25, 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 January 25, 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- 392-7872. Sincerely, Khal Jaafari P.E. (Aug 28, 2024 13:48 CDT) Khal Jaafari , Project Manager Cc: Hershel Stanley Sutterfield, Inspector Edgar Garcia, Inspection Supervisor Emanuel Nieto, Senior Inspector Emanuel Nieto, Program Manager Kimley Horn , Consultant Rumsey Construction, LLC, Contractor SW Crystal Springs, LLC, Developer File E-Mail: TPW_Acceptance@fortworthtexas.gov Rev. 8/20/19 AFFIDAVIT STATE OF Texas COUNTY OF Tarrant Before me, the undersigned authority, a notary public in the state and county aforesaid, on this day personally appeared Corey Caughron, VP Of Rumsey Construction, 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; Water, Sanitary Sewer, Drainage and Paving Improvements to Serve Crystal Springs City Project No. 100252 BY 7sda /4day rey Caughron, VP Subscribed and sworn before me on of February, 2024. Notary Public Denton, TX w SARAN PEREZ Notary Pub,State of Texas comm, YP� 1�91"2o2a N®ter x �dg7 �: CONSENT OF SURETY COMPANY TO FINAL PAYMENT AIA DOCUMENT G707 OWNER ❑x ARCHITECT ❑ CONTRACTOR ❑ SURETY ❑ OTHER PROJECT: Water, Sanitary Sewer, Drainage & Paving to serve Crystal Springs (name, address) Fort Worth, TX TO (Owner) CITY PROJECT NO: Stillwater Capital and The City of Fort Worth CONTRACT FOR: Public Water & Paving Fort Worth, TX CONTRACT DATE: June, 2020 BOND NO: 1077898 CONTRACTOR: Rumsey Construction, LLC 4329 Reeder Drive Carrollton, TX 75010 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 as it appears in the bond). The Hanover Insurance Company on bond of (here insert name and address of Contractor as it appears in the bond), Rumsey Construction, LLC , SURETY COMPANY, ,CONTRACTOR, hereby approves of the final payment to the Contractor, and agrees that final payment to the Contractor shall not relieve the Surety of any of Its obligations to (here insert name and address of Owner) Stillwater Capital and the City of Fort Worth as set forth in the said Surety's bond. IN WITNESS WHEREOF, the Surety has hereunto set its hand this 21st day of February The Hanover Insurance Company Surety , A , OWNER, Signature of A7,Attorn rized Representative r Attest: a4 Allyson W. Deaey-in-Fact (Seal): Title AIA DOCUMENT G707 • CONS NT OF SURETY TO FINAL PAYMENT • APRIL 1970 EDITION • AIA 0 • © 1970 • THE AMERICAN INSTITUTE OF ARCHITECTS, 1735 NEW YORK AVE., NW, WASHINGTON, D.C. 20006 ,2024 ONE PAGE THE HANOVER INSURANCE COMPANY MASSACHUSETTS BAY INSURANCE COMPANY CITIZENS INSURANCE COMPANY OF AMERICA POWER OF ATTORNEY THIS Power of Attorney 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 stated. KNOW ALL PERSONS BY THESE PRESENTS: ThatTHE HANOVER INSURANCE COMPANY and MASSACHUSETTS BAY INSURANCE COMPANY, both being corporations organized and existing under the laws of the State of New Hampshire, and CITIZENS INSURANCE COMPANY OF AMERICA, a corporation organized and existing under the laws of the State of Michigan, (hereinafter individually and collectively the "Company") does hereby constitute and appoint John R. Ward, Douglas Moore, Emily Mikeska, Eva O. Limmer and/or Allyson Dean Of Ward & Moore Insurance Services LP of Dallas, TX, Gatesville, TX and Temple, TX each individually, if there be more than one named, as its true and lawful attorney(s)-in-fact to sign, execute, seal, acknowledge and deliver for, and on its behalf, and as its act and deed any place within the United States, any and all surety bonds, recognizances, undertakings, or other surety obligations. The execution of such surety bonds, recognizances, undertakings or surety obligations, in pursuance of these presents, shall be as binding upon the Company as if they had been duly signed by the president and attested by the secretary of the Company, in their own proper persons. Provided however, that this power of attorney limits the acts of those named herein; and they have no authority to bind the Company except in the manner stated and to the extent of any limitation stated below: Any such obligations in the United States, not to exceed Thirty Five Million and No/100 ($35,000,000) in any single instance That this power is made and executed pursuant to the authority of the following Resolutions passed by the Board of Directors of said Company, and said Resolutions remain in full force and effect: RESOLVED: That the President or any Vice President, in conjunction with any Vice President, be and they hereby are authorized and empowered to appoint Attorneys -in -fact of the Company, in its name and as it acts, to execute and acknowledge for and on its behalf as surety, any and all bonds, recognizances, contracts of indemnity, waivers of citation and all other writings obligatory in the nature thereof, with power to attach thereto the seal of the Company. Any such writings so executed by such Attorneys -in -fact shall be binding upon the Company as if they had been duly executed and acknowledged by the regularly elected officers of the Company in their own proper persons. RESOLVED: That any and all Powers of Attorney and Certified Copies of such Powers of Attorney and certification in respect thereto, granted and executed by the President or Vice President in conjunction with any Vice President of the Company, shall be binding on the Companyto the same extent as if all signatures therein were manually affixed, even though one or more of any such signatures thereon may be facsimile. (Adopted October 7, 1981 — The Hanover Insurance Company; Adopted April 14, 1982 — Massachusetts Bay Insurance Company; Adopted September 7, 2001 — Citizens Insurance Company of America) IN WITNESS WHEREOF, THE HANOVER INSURANCE COMPANY, MASSACHUSETTS BAY INSURANCE COMPANY and CITIZENS INSURANCE COMPANY OF AMERICA have caused these presents to be sealed with their respective corporate seals, duly attested by two Vice Presidents, this 4th day of April, 2018. The Hanover Insurance Company The 1-8a nov�er insurance Company Massachusetts Bay lnsub-ance Company P Citizens Insurance Company of America� ' i �,a�"" Massachusetts Bay Insurance Company l t• jL .���� Cit izen.s Insurance Company of America 1"21 tp7� John C. Roche; E�,T and President: JamesH. Yaviecki, Vice President THE COMMONWEALTH OF MASSACHUSETTS ) COUNTY OF WORCESTER ) ss. On this 411 day of April, 2018 before me came the above named Vice Presidents of The Hanover Insurance Company, Massachusetts Bay Insurance Company and Citizens Insurance Company of America, to me personally known to be the individuals and officers described herein, and acknowledged that the seals affixed to the preceding instrument are the corporate seals of The Hanover Insurance Company, Massachusetts Bay Insurance Company and Citizens Insurance Company of America, respectively, and that the said corporate seals and their signatures as officers were duly affixed and subscribed to said instrument by the authoritv and direction of said Corporations. WANE J. MARINO NolwCOMM Pudk OF Yy{�pRMlr7� LamrN� 4. SA4S ESN Di.— 1. , a f so, Naan Puhiic My Co --,A— Erpi—u ,%-tan;h 4, 2022 I, the undersigned Vice President of The Hanover Insurance Company, Massachusetts Bay Insurance Company and Citizens Insurance Company of America, hereby certify that the above and foregoing is a full, true and correct copy of the Original Power of Attorney issued by said Companies, and do hereby further certify that the said Powers of Attorney are still in force and effect. GIVEN under my hand and the seals of said Companies, at Worcester, Massachusetts, this 215' day of February 2024 CERTIFIED COPY 4 Theodore G. Mariiner, Vice President Hanover Insurance Group - IMPORTANT NOTICE To obtain information or make a complaint: You may call The Hanover Insurance Company/ Citizens Insurance Company of America's toll -free telephone number for information or to make a complaint at: 1-800-608-8141 You may also write to The Hanover Insurance Company/ Citizens insurance Company of America at: 440 Lincoln Street Worcester, MA 01615 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: 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 agent or the company 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. Texas Complaint Notice Commercial Lines AViSO IMPORTANTE Para obtener informacion o para someter una queja: Usted puede Ilamar al numero de telefono gratis de The Hanover Insurance Company/Citizens Insurance Company of America's para informacion o para someter una queja al: 1-800-608-8141 Usted tambien puede escribir a The Hanover Insurance Company/Citizens Insurance Company of America al: 440 Lincoln Street Worcester, MA 01615 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 149104 Austin, TX 78714-9104 Fax: (512) 475-1771 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 agente o la com- pania primero. Si no se resuelve la disputa, puede entonces comunicarse con el departamento (1-DI). 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. The Hanover Insurance Company 1440 Lincoln Street, Worcester, MA 01653 181-1457 nv" Page t of f Citizens Insurance Company of America 1808 North Highlander Way, Howell, MI 48843 hanover.com