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HomeMy WebLinkAboutContract 60037-FP1FORTWORTH. -FP1 City Secretary 60037 Contract No. Date Received 10/21/2024 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: McPherson Boulevard Phase 1 City Project No.: 103880 Improvement Type(s): ❑ Paving © Drainage ❑ Street Lights ❑ Traffic Signals Original Contract Price: $725,591.24 Amount of Approved Change Order(s): $188,945.55 Revised Contract Amount: $914,536.79 Total Cost of Work Complete: $914,536.79 Justin Roberts (Oct 18, 202414:27 CDT) Oct 18 f2024 Contractor Date Sr. Project Manager Title Venus Construction Company Company Name Oct 18, 2024 Project Inspector Date lzeldeen Ahmed P. E Izeldeen Ahmed,P.E (Oct 21, 202410:10 CDT) Oct 21, 2024 Project Manager Date I Re ecca Owen (Oct 21, 202410:34 CDT) Oct 21, 2024 CFA Manager Date Oct 21, 2024 Lauren Prieur (Oct 21, 2024 10:48 CDT) TPW Director Date cp*-C�J Oct 21, 2024 Asst. City Manager Date OFFICIAL RECORD CITY SECRETARY FT. WORTH, TX Page 1 of 2 Notice of Project Completion Project Name: McPherson Boulevard Phase 1 City Project No.: 103880 City's Attachments Final Pay Estimate Change Order(s): ® Yes ❑ N/A Contractor's Attachments Affidavit of Bills Paid Consent of Surety Statement of Contract Time Contract Time 200 WD Days Charged: 137 Work Start Date: 1/16/2024 Work Complete Date: 9/16/2024 Completed number of Soil Lab Test: 584 Completed number of Water Test: 0 Page 2 of 2 FoRTWoRTH CITY OF FORT WORTH FINAL PAYMENT REQUEST Contract Name McPHERSON BOULEVARD, PHASE 1 Contract Limits Project Type STORM DRAIN City Project Numbers 103880 DOE Number 3880 Estimate Number 1 Payment Number 1 For Period Ending 9/16/2024 WD City Secretary Contract Number Contract Time 2WD Contract Date Days Charged to Date 200 Project Manager NA Contract is 100.00 Complete Contractor VENUS CONSTRUCTION COMPANY 1426 S. MAIN P 0 BOX 90 MANSFIELD , TX 76063 Inspectors S. GARCIA / D. WATSON Monday, October 21, 2024 Page I of 4 City Project Numbers 103880 DOE Number 3880 Contract Name McPHERSON BOULEVARD, PHASE 1 Estimate Number I Contract Limits Payment Number 1 Project Type STORM DRAIN For Period Ending 9/16/2024 Project Funding UNIT III. STORM DRAIN IMPROVEMENT Item Description of Items Estimated Unit Unit Cost Estimated Completed Completed No. Quanity Total Quanity Total --------------------------------------- I LARGE STONE RIPRAP, DRY (CO 1) 391 SY $142.71 $55,799.61 391 $55,799.61 2 TRENCH SAFETY (CO 1) 1354 LF $0.73 $988.42 1354 $988.42 3 21" RCP, CLASS (CO 1) 1354 LF $87.52 $118,502.08 1354 $118,502.08 4 5- 5X3 BOX CULVERT (CO 1) 106 LF $2,069.01 $219,315.06 106 $219,315.06 5 6- 5X3 BOX CULVERT (CO 1) 0 LF $2,487.84 $0.00 0 $0.00 6 4' STORM JUNCTION BOX 3 EA $5,983.01 $17,949.03 3 $17,949.03 7 HEADWALL, BOX CULVERT (CO 1) 55 CY $1,139.05 $62,647.75 55 $62,647.75 8 10' CURB INLET (CO 1) 7 EA $6,816.32 $47,714.24 7 $47,714.24 9 2-4"X3'& N-5'XTBOX CULVERT (CO 1) 90 LF $1,729.30 $155,637.00 90 $155,637.00 10 5'X3' BOX CULVERT (CO 1) 88 LF $475.20 $41,817.60 88 $41,817.60 11 -------------------------------------- 3-4'X3'BOX CULVERT (CO 1) 168 LF $1,155.75 $194,166.00 168 $194,166.00 -------------------------------------- Sub-Total of Previous Unit $914,536.79 $914,536.79 Monday, October 21, 2024 Page 2 of 4 City Project Numbers 103880 Contract Name McPHERSON BOULEVARD, PHASE 1 Contract Limits Project Type STORM DRAIN Project Funding Contract Information Summary Original Contract Amount Change Orders Change Order Number 1 Total Contract Price DOE Number 3880 Estimate Number 1 Payment Number 1 For Period Ending 9/16/2024 $725,591.24 $188,945.00 $914,536.79 Total Cost of Work Completed $914,536.79 Less % Retained $0.00 Net Earned $914,536.79 Earned This Period $914,536.79 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 $914,536.79 Monday, October 21, 2024 Page 3 of 4 City Project Numbers 103880 DOE Number 3880 Contract Name McPHERSON BOULEVARD, PHASE 1 Estimate Number 1 Contract Limits Payment Number 1 Project Type STORM DRAIN For Period Ending 9/16/2024 Project Funding Project Manager NA City Secretary Contract Number Inspectors S. GARCIA / D. WATSON Contract Date Contractor VENUS CONSTRUCTION COMPANY Contract Time 20 WD 1426 S. MAIN P O BOX 90 Days Charged to Date 200 WD MANSFIELD, TX 76063 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 $914,536.79 Less % Retained $0.00 Net Earned $914,536.79 Earned This Period $914,536.79 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 $914,536.79 Monday, October 21, 2024 Page 4 of 4 DEVELOPER.AWARDED-PROJECT CHANGE ORDER. IPROJECTHAME: IAd+vertm B°I!°varA. Ph3z1 cNu;c 41 CONTRAGT. IfA+NSan5eWv5Mm Obh (B, PYAm. fLl SCeel tMls 'R N . ICPAA 23LA190 I CRYPARTICIPATIONi O`.S IDm ICDYPROJECTA INMO 1 7IFO ]A,fAOTC0l3f•10]T10�E0w I 1LE% N-28111F27212 1 INSPECTOR: Sergio Glyd. Phom No: W-647-2524 PROIECTMANAGM Dlrr Gk.. Ph —ND: R174926251 ; . ' . LpRAAGTNTT IAYN6 3 FET,ICiIif I nAtER tflTER DEAYUGE lAN1fIAtT T � �` aNd DAYS P..e P...bw Gsn PMYur ax/rat _ ��r Hgfl lOrON:LV.NRUL} IS/a beeu IebGul bb RlTllt]V Sequ t. ,E.ut IME fuxia N 240 - ko+mRcrioINTE lus I sa°e ina°� I ua lausw ua u,EwAs mm bm I xa ITqa()nyuErRravfRaP.Iwlyaj/E,a�n�ts ub ,bev nuaes lTm IIliJ. �(IUUTAUOUrt 3GT4 I SOIT ;,bLR]t I f0.E° �fllSl*alaaaf°N !,],Tull, �]bD0 5T,5]N.le Jn]baT xU REn3lD COTTlDUA[ D.v.emel� Sl?, ATa.el Clt/GftA'A 1G00x1E TOILL REHSEOCOIRMGT e,,aT]Tl.el 1 IYeu .,. °.�cemm.s.a.I<rGwpr b�r.bm�Pe r IIFII nELOEiIAi'vMvl I DIM ACE I 101N PAYITFL/ Nrt00,yyl 1ppT / OLLWlrtYp Lxr! 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J �'WPO NxmF Na=el1 11 TOT: PIe}ecIFAFItI e 1 TA>•, _ _ Tlb: CUM Vincent Attorney In Fact Rloomfield Properties, INC. -nr;..-il ---npr Rbneo. W2, DII WAVING, DRAINAGE, X-27212 STREET LIGHT IMPROVEMENTS GURREN GGNSTRUCIGN �i Trio STMIpARp3FOROO Q!! FOR BOULEVARD, SHui covE�rsii olanu aRG1E: E. CPHERSON LOCATED IN CTIY OF FORT WORTH TARRANT COUNTY, TEXAS WATER S1UDY: V/45-201&d13 $EW ER STUDY: TJJ3:5)J-LVS L SITE d AVTREPARKER MAYOR DAVID COOKE ' CJIYMANAGER A1K:HAEEOWEN. P.E. - VICINITY MAP C' 9JGWEER, IRANS.°O.RTAiKJN AND PJBLX: WORKS DEPARTMENT It" CHRISTOPHER P. HARDER. P.E.'S DIRECTOR. WATER DEPARTMENT IPRC NO. 21-0181 CITY PROJECT NO. 103880 FID NO. 30114-0200431-103880-EO7685 I FILE NO. K-2883 I s OWNEDIDEVELOPED BY: ENGINUA.ITIRVEYOR: H ,LP D GOODWIN' AAARSHALLI ma mn�� iv:" cuLexrarerns-Pwauss-slm�vens •va r+mynor...Awn nrr®T NOVEIYIBER 2023 UNIT I LWECTOR'S DESIGNEEFOR CONSTRUCTION oATE PLAIIAPPROVAL R SOLUT01I NO.01-I62JN RM ED DATE PROJECT MANAGER REVIEWED I sra.+..awaA.aTrnp.us a.aa X-27212 t * A \_/ sD T 'A' ..JIM uxessaxeouSnAeo 'EDD= "W" h 1� S.D. LINE "A" S.D. LINE "AB" m 74 T NOR <i Fs LU REVIEWED I 0 "A-8" Mwo z O a 0 "MAWA& S.D. LINE o LP W 750 745 740 740 735 ff a'' -4Ga 4- W4 735 730 730 w 1- -All -Fl 725 720 715 H 725 L 720 15 of 37 CULWRM A, 715 &&D.UnE'"' m N El REVIEWED 0 IA 0d0 S.D. LINE "A-8" 0 0 755 755 a. 750 750 745 745 740 740 u 735 I 735 F a 0 73 730 a L 725 I 725 jlg 16of37 I 720 720 sa natrP� •A• cPrcoer ur}xro -WYW AfP-PAP CAIQA Yas-Iw.r..l-.silrsr al' tTt71 n'nf s M REDOING GFADAIKNIF �FDDIHG OYI�ESYn IFUCFM SING S ]PCN N I IN t�t/I KCM SS�iFF ]r�WCx Sf]0 ] 1 FII ror]usmrroa 750 745 740 735 730 725 720 715 , s . ml.I.b[am16' wc<w L ( iFSre'.'•S.i . � ITV I <�ia - narcn..u< �\ 'i Ym SYYrS.Yw IPnMUJ \ � • �u� uu.M1.ev.ry S.D. LINE "G" in H 14 a�333��y`y� cif y4��F �a�za 1 Y a I 3E8 _ {() m' — W a W x W j I VIEWED I RE O - 3 m w J /:�llGk�l✓E O o "A-10" W a S.D. LI)VL cc o c W = U 750 U 745 - — Y� -__ nYorcua• 1 740 735 Sc=t� a arc 730 - r.,,,by ] - - - - --�. "��_�.•�_.. � _. � � .:� 725 Him � 720 a< t 17 of 37 715 S.D. LINE YF' ronranrrnFr REVIEWED ,Ilaw,.ca n. x:i N W+E B RD..4-1 W clfG I ✓EFN00 Mt(. _y��R w,yRAE� �A�• M. .yl%w '. am lel leh EbyMJr11 � lFJ � lM' eEDOWG GRAOATWNS d'TNKRNE6I OF eeoolNc SIFVESNE KSRG 'SA tYC11y a�10 CULVERT "D" S.D. LINE 'B-7" ' . fM tO'RESCAtE .i� 745 745 - ---- I740 -- — Mart -- 735 O —� 730 ti .• c 725 n, 5 cA gR 4� -i •. s: . •a' a a 3 720 715 710 2 _ 740 _i 735 zz 2 )I — 730 8 j 1 725 1 �,- ),%� 720 L J 715 `sJ18of37 710 755 C.D. LINE A-7A1 I' REVIEWED A-- S.D. LIVE x - -.---_---_---- —_. L- - nA.a,.R��nlray.a�n.aa �, 750 - ..._III _ .. _II 750 745 - -_ _ 745 740 s. 740 -�`- 735 h 735 730 R - 730 LLJ 725 725 O �rc ii F R fi1 .0 N 3 N LL W O 745 740 735 730 725 720 715 710 H a� S.D. LINE "B-6A" S.D. LINE "B-811 745 v 740 wd.Ti I 735 i V o $v., - I 730 725 ok: u.a¢ 720 L J 715 °19of37 710 •5.MUiE'AJA', AA', •EF6A','B-6 N REVIEWED Rraw..aaa�.�.il,.r�+. wt m.xv ,11+E 8 �wr_f•u - i..i_RE�t�r P Nis N_ s 70 J PUNRE OEFR CREFN I � - � O MEADOW PNASFG , fUNPE DFER CPEfK - o i M S i9 r o 9' _ I', _ Rb.McPHER50N80ULEVAHD�;-- _ - cc N _ LL uj _ ___ - _ i HIINlFR'S RIDGE HUMERES �1 i ammnRun• ,ate" L J uti Vim. Tv�amvrois.�wuc-u-n+e..+mr. YIIIIIYICGFND v. -,t �Y,E rfro m�l-� ��� ..-."- e30 _ rr[n v�FaK.�[Liur:3 IVAiER SNDY: Vl3LXli6313 ISEWERSNDY:202}257749$t ��m'♦ I a of 37n -0_ `µ`E eLnR M OVERALL arw>+a-rse..la.rzaa.Rroz.x+ �;tt Nor �•'r SEWER LAYOUT A�-rOr rr�Mrrr\w�ti,. .. ���.,. �1 f.ti1R>mw 8 „ I,.n.uuai lucsr' LI I 3M mesas uwxeaaoxeouRwKno � _ _ __ - a � u -----------c. .a:R xFaaox Rom - - .. _I r m//� rorrurronern JJJ((( � I FUTURE DEER I ' CREEK uE—M , Q Lu romanrroa > - I MIIIY IFGFNO � REVIEWED tRo� Q,-¢ SEWER LINE "0S-111 a --- w rrnuR -_._ ICAFF WZ' U R�inE 745745 740 740 735 ., .., �. . ---- --- i $ 735 1 730 -- — — -- —= — 730 r C t 1 I I I S 725 _ R�, _ _ 725 715 a715. ; 731 of 37 k - W%UN E E 710 f f E @ R @ k E R 710 osr �'_�T'�'-�:^"_^.,:'.Pi"r'wm um �d �m .,.m Am .,� .m ,.m O"l►Kilrl'..v`�lwv>�r.Wc—.<, .. su ,y,...r..,.�.o l 8 REVIEWED I f .<«»..ull °•" i 1 3 M mnoanuc.,9,.,I I Eommfd,.u.cn w. I. lae.nu�v.:.auav l«wur� I N I r<rxensoN eomcvAno - i � .. �, G4 I s mru�nnuc.w.r —EDEER —1K icl IAEA— LLL1 0 J row.rieroirarE O F u MLIIY lEGfND 2 SEWER LTNE "OS -I" III rRGnIEECAIE W 740 - - - i "S d"l L - -- _ - _ i _ :_-- - --�- — 740 a U n V. 736 I -' -- - 735 730 �� 730 z si +�I ��„�„� Irk , Sx i F; I jl 725 ° 1f3 725 720 FN I al., 1 t 720 F- s\ 715 xe, yx �33� i 715 sb� i t32 of 37 705 705 ss.uxE •OS•7• ' ...:,.w a. •w. .,., .am ..w .sw ,..mats�m.oxw-.-.!can .a ..+. c c (REVIEWED •. � REINIEee0rn.11Dltq m�[�l��fari..r 11 Mvoara urn ��IYNYIAriCO///Hs (] E¢ D[EACA[[A \\ C MEADOWS PH! - UDI Y[[O[N.au.raeuerurt J� \ FDNAE CtEEK (411 \ MEADOWS J f d COYRIGD,AYIf \\ '" M � a.4� o N 0 Z 41 S Q SEER LTNE "OS—V SEWER LINE "OS-2" SEWER LINE "OS—Y v0i a 0 W I �1 _ _ _ i • IAOFlIE SCAIE W u 745 • a «w.. 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TRANSPORTATION AND PUBLIC WORKS September 24, 2024 Venus Construction Company 1426 S Main St Mansfield, TX 76063 RE: Acceptance Letter Project Name: McPherson Blvd Phase 1 Project Type: Sewer, Drainage,Paving & Street Lights City Project No.: 103880 To Whom It May Concern: On September 24, 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 October 11, 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 October 11, 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- 264-2932. Sincerely, lzeldeeh Ahmed P. E Izeldeen Ahmed,P.E (Oct 21, 2024 10d0 CDT) Izeldeen Ahmed, P.E., Project Manager Cc: Sergio Garcia, Inspector Donald Watson, Inspection Supervisor Oscar Aguillon, Senior Inspector Andrew Goodman, P.E., Program Manager GM Civil Engineering & Surveying, Consultant Venus Construction Company, Contractor Bloomfield Homes, LP, Developer File E-Mail: TPW_Acceptance@fortworthtexas.gov Rev. 8/20/19 Signature: Signature: Email: tpw_greensheet_cfa@fortworthtexas.gov Email: tpwcfafiscal@fortworthtexas.gov Signature: Email: zz_fin_capitalasset@fortworthtexas.gov 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 Samuel McAda, Vice President Of Venus Construction Company, known to me to be a credible person, who being by me duly sworn, upon his oath deposed and said; That all persons, firms, associations, corporations, or other organizations furnishing labor and/or materials have been paid in full; That the wage scale established by the City Council in the City of Fort Worth has been paid in full; That there are no claims pending for personal injury and/or property damages; On Contract described as; 1 1 eflu �GS� Contract Description �Y"v' ) BY Name or Title Subscribed and sworn before me on this date Day of Month, Year. psi Notary Public County, State %,ill I II II PRYRP e'Qp°- O %fo 1286g2�^ CONSENT OF SURETY COMPANY TO FINAL PAYMENT PROJECT: McPherson Blvd, Phase 1. (name, address) Bond Number:CA 5176515 OWNER ❑ ARCHITECT ❑ CONTRACTOR ❑ SURETY ❑ OTHER ❑ TO (Owner) Bloomfield Homes, LP & City of Fort Worth CONTRACT FOR: McPherson Blvd, 1050 E. Hwy 114,Ste 210 200 Texas St Phase 1 Southlake, TX 76092 Fort Worth, TX 76102 PROJECT NO.: 103880 CONTRACTOR: CONTRACT DATE: Venus Construction Company 1426 S. Main FINAL CONTRACT PRICE: Mansfield, TX 76063 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 Co.) Great American Insurance Company P.O. Box 5425 Cincinnati, OH 45201-5425 , SURETY COMPANY, on bond of (here insert name and address of Contractor) Venus Construction Company 1426 S. Main Mansfield, TX 76063 ,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) Bloomfield Homes, LP & City of Fort Worth 1050 E. Hwy 114,Ste 210 200 Texas St Southlake, TX 76092 Fort Worth, TX 76102 , as set forth in the said Surety Company's Bond. OWNER, IN WITNESS WHEREOF, the Surety Company has hereunto set its hand this lath (SEAL) day of October 2024 Great American Insurance Company Surety ompany By 56 Signature of Authorized Representative Lloyd Ray Pitts Jr - Attorney -In -Fact Title GREAT AMERICAN INSURANCE COMPANY® Administrative Office: 301 E 4TH STREET • CINCINNATI, OHIO 45202 • 513-369-5000 • FAX 513-723-2740 The number of persons authorized by this power of attorney is not more than TWO No.0 20935 POWER OF ATTORNEY KNOW ALL MEN BY THESE PRESENTS: That the GREATAMERICAN INSURANCE COMPANY, acorporation organized and existing under and by virtue of the laws of the State of Ohio, does hereby nominate, constitute and appoint the person or persons named below, each individually if more than one is named, its true and lawful attorney -in -fact, for it and in its name, place and stead to execute on behalf of the said Company, as surety, any and all bonds, undertakings and contracts of suretyship, or other written obligations in the nature thereof, provided that the liability of the said Company on any such bond, undertaking or contract of suretyship executed under this authority shall not exceed the limit stated below. Name Address Limit of Power LLOYD RAY PITTS, JR. BOTH OF BOTH WILLIAM D. BIRDSONG DALLAS, TEXAS $100,000,000 This Power of Attorney revokes all previous powers issued on behalf of the attomey(s)-in-fact named above. IN WITNESS WHEREOF the GREATAMERICAN INSURANCE COMPANY has caused these presents to be signed and attested by its appropriate officersand its corporate seal hereunto affixed this 10TH day of DECEMBER 2020 Attest GREATAMERICAN INSURANCE COMPAN Assistant Secreuny Divishmud Senior Vice President STATE OF OHIO, COUNTY OF HAMILTON - ss; MARK VICARIO (877-377-2405) On this 10TH day of DECEMBER 2020 before the personally appeared MARK VICARIO, to me known, being duly sworn, deposes and says that he resides in Cincinnati, Ohio, that he is a Divisional Senior Vice President of the Bond Division of Great American Insurance Company, the Company described in and which executed the above instrument; that he knows the seal of the said Company; that the seal affixed to the said instrument is such corporate seal; that it was so affixed by authority of his office under the By -Laws of said Company, and that he signed his name thereto by like authority. SUSAN A KOHORST Notary Public State of Ohio My Comm. Expires May 18, 2025 This Power ofAttomey is granted by authority of the following resolutions adopted by the Board of Directors of Great American Insurance Company by unanimous written consent dated June 9, 2008. RESOLVED: That the Divisional Pivsident, the several Divisional Senior Tice Presidents, Divisional f?ce Presidents mud Divisonal Assistant Irce Presidents, or any one of them, be and hereby is authorized, from tine to time, to appoint one or more Aitorne):s-in-Fact to execitte on behalf of the Company, cis surer); any and all bands, undertakings and contracts ofsure0tship, or other written obligations in the nature thereof- to prescribe their respective duties and the respective limits of their authority; and to revoke any such appointment at any time. RESOLVED FURTHER: That the Company seal and the signature of any of the aforesaid officers and any Secretary or Assistant Secretary of the Compare), may be affixed by> facsimile to any power of aito ney or certificate of either given f w• the execution of any bond, undertaking, contract oJ'sur etyship, or other written obligation in the nature thereof, such signature and seal when so used being hereby adopted by the Company as the original signature of stick officer and the original seal of the Compaq,, to be valid and binding upon the Company with the sane force and effect as though manually affixed. CERTIFICATION 1, STEPHEN C. BERAHA, Assistant Secretary of Great American Insurance Company, do hereby certify that the foregoing Power of Attorney and the Resolutions of the Board of Directors of June 9, 2008 have not been revoked and are now in fiull force and effect. Sigttdd and sealed this 11th day of October 2024 f44, Assistant Sacmlatl' 81029AH (03/20) y- Great American Insurance Company of New York GREA AMERfCAN Great American Alliance Insurance Company 14suRANC9 GROUP Great American Insurance Company IMPORTANT NOTICE: To obtain information or make a complaint: 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 at: P.Q. Box 149104 Austin, TX 78714-9091 VAX: 1-512490-1007 Your notice of claim against the attached bond may be given to the surety company that issued the bond by sending it by certified or registered mail to the following address: Mailing Address: Great American Insurance Company P.O. Box 2119 Cincinnati, Ohio 45202 Physical Address: Great American Insurance Company 301 E. Fourth Street Cincinnati, Ohio 45202 You may also contact the Great American Insurance Company Claim office by: Fax; 1-888-290-3706 Telephone: 1-513-369-5091 Email: bortdclaims@gaic.com PREMIUM OR CLAIM DISPUTES: If you have a dispute concerning a premium, you should contact the agent first, If you have a dispute concerning a claim, you should contact the company first. If the dispute is not resolved, you may contact the Texas Department of Insurance. ATTACH THIS NOTICE TO YOUR BOND: This notice is for information only and does not become a part or condition of the attached document. 17,9667A () Oil 6)