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HomeMy WebLinkAboutContract 59282-FP7FORT WORTHo -FP7 City Secretary Contract No. 59282 Date Received 11/21/2024 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: Cedarbrook Beltmill Phase 5 City Project No.: 104497 Improvement Type(s): Water x❑ Sewer x❑ Original Contract Price: $2,681,458.30 Amount of Approved Change Order(s):-$4,480.00 Revised Contract Amount: $2,676,978.30 Total Cost of Work Complete: $2,676,978.30 Nov 21, 2024 Contractor Date Vice President Title Burnsco Construction, Inc. Company Name If Nov 21, 2024 Project Inspector Date Ram Tiwan Nov 21 2024 Ram Tiwari (Nov 21, 2024 09:23 CST) 7 Project Manager Date n Nov 21, 2024 Rebecca Owen (Nov 21. 202416:24 CST) CFA Manager Date de.Fll ^- Nov 21 2024 Lauren Priew (Nov 21, 2024 16:42 CST, TPW Director Date Nov 22, 2024 Asst. City Manager Date OFFICIAL RECORD CITY SECRETARY Page 1 of 2 FT. WORTH, TX Notice of Project Completion Project Name: Cedarbrook Beltmill Phase 5 City Project No.: 104497 City's Attachments Final Pay Estimate ❑x Change Order(s): ❑x Yes ❑ N/A Pipe Report: © Yes ❑ N/A Contractor's Attachments Affidavit of Bills Paid Consent of Surety Statement of Contract Time Contract Time: 207 WD Days Charged: 207 WD Work Start Date: 7/10/2023 Work Complete Date: 9/11/2024 Completed number of Soil Lab Test: 809 Completed number of Water Test: 18 Page 2of2 FORT WORTH CITY OF FORT WORTH FINAL PAYMENT REQUEST Contract Name CEDARBROOK-BELTMILL PHASE 5 Contract Limits Project Type WATER & SEWER City Project Numbers 104497 DOE Number 4497 Estimate Number 1 Payment Number I City Secretary Contract Number Contract Date For Period Ending 9/11/2024 WD Project Manager NA Contractor BURNSCO CONSTRUCTION, INC. 6331 SOUTHWEST BLVD FORT WORTH, TX 76132 Inspectors M.GLOVER / E.WALKER Contract Time 13WD Days Charged to Date 207 Contract is 100.00 Complete Monday, September 30, 2024 Page 1 of 5 City Project Numbers 104497 DOE Number 4497 Contract Name CEDARBROOK-BELTMILL PHASE 5 Estimate Number I Contract Limits Payment Number 1 Project Type WATER & SEWER For Period Ending 9/11/2024 Project Funding UNFr I: WATER IMPROVEMENTS Item Description of Items Estimated Unit Unit Cost Estimated Completed Completed No. Quanity Total Quanity Total --------------------------------------- 1 8" WATER PIPE 8049 LF $62.90 $506,282.10 8049 $506,282.10 2 8" DIP WATER, CSS BACKFILL 540 LF $240.00 $129,600.00 540 $129,600.00 3 CASING BY OPEN CUT 401 LF $187.00 $74,987.00 401 $74,987.00 4 8" GATE VALVE 20 EA $2,400.00 $48,000.00 20 $48,000.00 5 FIRE HYDRANT 11 EA $6,760.00 $74,360.00 11 $74,360.00 6 AUTOMATIC FLUSHING DEVICE 1 EA $7,350.00 $7,350.00 1 $7,350.00 7 1" WATER SERVICE (CO#2) 218 EA $1,400.00 $305,200.00 218 $305,200.00 8 1 1/2" WATER SERVICE(CO#2) 0 EA $1,700.00 $0.00 0 $0.00 9 DUCTILE IRON WATER FITTINGS w/ 9 TN $4,500.00 $40,500.00 9 $40,500.00 RESTRAINT 10 4"-12" PRESSURE PLUG 2 EA $300.00 $600.00 2 $600.00 11 CONNECTION TO EXISTING 4"-12" WATER 2 EA $4,600.00 $9,200.00 2 $9,200.00 MAIN 12 TRENCH SAFETY 8589 LF $0.10 $858.90 8589 $858.90 13 2" WATER SERVICE (CO#2) 1 EA $2,800.00 $2,800.00 1 $2,800.00 Sub -Total of Previous Unit $1,199,738.00 $1,199,738.00 ------------------- UNIT U. SANITARY SEWER IMPROVEMENTS Item Description of Items Estimated Unit Unit Cost Estimated Completed Completed No. Quanity Total Quanity Total 1 8" SEWER PIPE 8219 LF $69.70 $572,864.30 8219 $572,864.30 2 8" SEWER CARRIER PIPE 82 LF $85.00 $6,970.00 82 $6,970.00 3 10" SEWER CARRIER PIPE 114 LF $93.00 $10,602.00 114 $10,602.00 4 10" DIP SEWER, CSS BACKFILL (CO#2) -113 LF $270.00 ($30,510.00) -113 ($30,510.00) 5 20" CASING BY OPEN CUT 671 LF $188.00 $126,148.00 671 $126,148.00 6 5' MANHOLE 1 EA $11,700.00 $11,700.00 1 $11,700.00 7 4'MANHOLE 34 EA $4,190.00 $142,460.00 34 $142,460.00 8 4' DROP MANHOLE 3 EA $6,420.00 $19,260.00 3 $19,260.00 9 4' FLAT TOP MANHOLE w/ WATERTIGHT LID 5 EA $4,490.00 $22,450.00 5 $22,450.00 10 4' EXTRA DEPTH MANHOLE 143 VF $180.00 $25,740.00 143 $25,740.00 11 5' EXTRA DEPTH MANHOLE 9 VF $300.00 $2,700.00 9 $2,700.00 12 EPDXY MANHOLE LINER 103 VF $350.00 $36,050.00 103 $36,050.00 Monday, September 30, 2024 Page 2 of 5 City Project Numbers 104497 Contract Name CEDARBROOK-BELTMILL PHASE 5 Contract Limits Project Type WATER & SEWER Project Funding 13 14 15 16 17 18 19 20 21 22 23 DOE Number 4497 Estimate Number 1 Payment Number 1 For Period Ending 9/11/2024 CSS ENCASEMENT FOR UTILITY PIPES 548 LF $47.00 $25,756.00 548 $25,756.00 4" SEWER SERVICE (CO#2) 213 EA $1,380.00 $293,940.00 213 $293,940.00 6" SEWER SERVICE 1 EA $2,100.00 $2,100.00 1 $2,100.00 CONNECT TO EXISTING SANITARY SEWER 3 EA $900.00 $2,700.00 3 $2,700.00 4" DIP SEWER SERVICE (CO#2) 0 EA $2,700.00 $0.00 0 $0.00 TRENCH SAFETY 8890 LF $1.00 $8,890.00 8890 $8,890.00 POST -CCTV INSPECTION 8890 LF $3.00 $26,670.00 8890 $26,670.00 MANHOLE VACUUM TESTING 43 EA $130.00 $5,590.00 43 $5,590.00 UTILITY MARKERS 5 LS $200.00 $1,000.00 5 $1,000.00 REMOVE & REPLACE CONCRETE DRIVEWAY 30 SY $180.00 $5,400.00 30 $5,400.00 10" PVC ASTM D2241 (PR 160), CSS 588 LF $270.00 $158,760.00 588 $158,760.00 BACKFILL(CO#2) ------------------------------------ Sub-Total of Previous Unit $1,477,240.30 $1,477,240.30 Monday, September 30, 2024 Page 3 of 5 City Project Numbers 104497 Contract Name CEDARBROOK-BELTMILL PHASE 5 Contract Limits Project Type WATER & SEWER Project Funding Contract Information Summary Original Contract Amount Change Orders Change Order Number 2 Change Order Number 2 DOE Number 4497 Estimate Number 1 Payment Number 1 For Period Ending 9/11/2024 $2,681,458.30 $3,500.00 ($7,980.00) Total Contract Price $2,676,978.30 Total Cost of Work Completed $2,676,978.30 Less % Retained $0.00 Net Earned $2,676,978.30 Earned This Period $2,676,978.30 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 $2,676,978.30 Monday, September 30, 2024 Page 4 of 5 City Project Numbers 104497 Contract Name CEDARBROOK-BELTMILL PHASE 5 Contract Limits Project Type WATER & SEWER Project Funding Project Manager NA Inspectors M.GLOVER / E.WALKER Contractor BURNSCO CONSTRUCTION, INC. 6331 SOUTHWEST BLVD FORT WORTH, TX 76132 DOE Number 4497 Estimate Number 1 Payment Number 1 For Period Ending 9/11/2024 City Secretary Contract Number Contract Date Contract Time 130 WD Days Charged to Date 207 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 $2,676,978.30 Less % Retained $0.00 Net Earned $2,676,978,30 Earned This Period $2,676,978.30 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 $2,676,978.30 Monday, September 30, 2024 Page 5 of 5 PROJECT NAME: CONTRACT: �CFA# ICITY PROJECT # IDOE # WATER PROJECT# SEWER PROJECT # FILE # INSPECTOR: PROJECT MANAGER: IORIGINAL CONTRACT EXTRAS TO DATE (CREDITS TO DATE ICONTRACT TO DATE (AMOUNT OF PROP. CHANGE ORDER IREVISED CONTRACT AMOUNT TOTAL REVISED CONTRACT AMOUNT PER UNIT REVISED COST SHARE TOTAL REVISED CONTRACT DEVELOPER -AWARDED -PROJECT CHANGE ORDER Cedarbrook Beltmill Phase 5 Water, Sewer, Paving, Drainage, Bridge, and Street Lights CFA23-0007 I CITY PARTICIPATION:( 104497 X-27582 30114-0200431-104497-EO7685 30114-0200431-104497-EO7685 W-2893 Eddie Walker Phone No: (469)-658-5100 Andrew Goodman Phone No: (817)-392-6251 I WATER Developer Cost I $1,196,238.00 I I $1,196,238.00 $3,500.00 I $1,199,738.00 I REVIEWED l By Andrew Goodman at 3:04 pm, Sep 25, 2023 NO CONTRACT UNIT I SEWER PAVING DRAINAGE STREET LIGHTS BRIDGE Developer City Cost Developer Cost City Cost Developer Cost CRY Cost Developer Cost City Cost Cost City Cost Developer Cost City Cost $1,486,220.30 $1,817,906.40 1 $649,657.50 1 I $253,296.10 I $1,005,596.80 $0.00 $0.00 $1,199,738.00 Dev. Cost: $15,172.50 I $1,485,220.30 $0.00 I $1,817,905.40 $0.00 I I I $649,657.50 I $0.00 I $253,296.10 $0.00 I I $1,020,769.30 I $0.00 ($7,980.00) I I $1,477,240.30 I $0.00 I $1,817,905.40 I $0.00 I $649,657.50 I $0.00 j $253,296.10 $0.00 I $1,020,769.30 I $0.00 $1,477,240.30 I $1,817,905.40 I $649,657.60 I $253,296.10 I $1,020,769.30 $6,418,606.60 Cam* ., Wy r $6,418,606.60 CHANGE ORDER No: CO2 CONTRACT DAYS 0 0 Revised: 10-12-2011 Page 1 REVIEWED By Andrew Goodman at 3:04 pm, Sep 25, 2023 fOIIOWinq t You are directPAY ITEAA #the CITY 81Din[TthEeM ITEM $I QUANTITYe ItS. UNIT ITEM DESCRIPTION WATER IMPROVEn1ENTS I i 3312.2003 9 EA 1" WATER SERVICE I 8 3312.2103 -7 EA 1 1/2" WATER SERVICE 13 3312.2203 1 EA 2" WATER SERVICE ` TOTAL PAY ITEM # I CITY BID ITEM # QUANTITY I UNIT I ITEM DESCRIPTION I SEWER IMPROVEM JUTS I 3331.4206 -588 LF 10" DIP SEWER. CSS BACKFILL I 14 3331.3101 4 EA 4" SEWER SERVICE I 17 3331.3106 -5 EA 4" DIP SEWER SERVICE I 23 3331.4202 588 LF 10" PVC ASTM D2241 (PR 160), CSS BACKFILL I TOTAL REASONS FOR CHANGE ORDER Reducing the sizes of irrigation water services, revised water line lowerings, and bridge escalators. NO CITY FUNDS INVOLVED IN THIS CONTRACT. DEVELOPER IS RESPONSIBLE FOR 100 % OF THE CHANGE ORDER COST AND NO REIMBURSEMENT FROM THE CITY WILL BE SOUGHT BY THE DEVELOPER RECOMMENDED: APPROVED: APPROVED: Peloton Land Solution -�•� D.R. Horton / Bumsco Construction. Inc. By.f/Y` By. By: Name: Ben Raef. P.E. NaName: Albert GrantgeS Title: Project Manager, Associate Principal Title: 11ld- of LAt-.►.1 Title: Vice President UNIT PRICE I TOTAL $1400.00 $12.600.00 $1:700.00-$11,900.00 $2,800.00 $2,800.00 $3.500.00 I UNIT PRICE TOTAL I $270.00 I -$158,760.00 $1.380.00 $5.520.00 $2.700.00 -$13,500.00 $270.00 $158 760.00 -S7,680.00 Revised: 10-12-2011 Page 2 FORTWORTH TRANSPORTATION AND PUBLIC WORKS PIPE REPORT FOR: PROJECT NAME: CEDARBROOK BELTMILL PHASE 5 CITY PROJECT NUMBER: 104497 WATER PIPE LAID SIZE TYPE OF PIPE PVC 8" PVC LF 8049 FIRE HYDRANTS: 11 VALVES (16" OR LARGER) N/A PIPE ABANDONED SIZE TYPE OF PIPE LF DENSITIES: YES NEW SERVICES: 7 COPPER I SEWER PIPE LAID SIZE TYPE OF PIPE LF PVC 8" PVC 8219 PIPE ABANDONED SIZE TYPE OF PIPE LF DENSITIES: YES NEW SERVICES: 4" PVC 209 EA 6" PVC 1 EA TRANSPORTATION AND PUBLIC WORKS The City of Fort Worth • 1000 Throckmorton Street • Fort Worth,IX' 76012-6311 (817) 392 - 7941 • Fax: (817) 392 - 7845 FORTWORTH. TRANSPORTATION AND PUBLIC WORKS September 11, 2024 BURNSCO CONSTRUCTION,INC. 6331 SOUTHWEST BLVD. BENBROOK,TEXAS 76132 RE: Acceptance Letter Project Name: CEDARBROOK-BELTMILL PHASE 5 Project Type: WATER,SEWER.STROM DRAIN City Project No.: 104497 To Whom It May Concern: On June 17, 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 September 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 September 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- 392-2237. Sincerely, Rain Tiwari Ram Tiwari (Nov 21, 2024 09:23 CST) RAM TIWARI P.E., Project Manager Cc: EDDIE WALKER, Inspector MIKE GLOVER, Inspection Supervisor DAIEL ROY, Senior Inspector ANDREW GOODMAN, Program Manager PELETON LAND SOUTIONS, Consultant BURNSCO CONSTRUCTION,INC., Contractor D R HORTON TX,LTD, 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 Ab Grantges, Contract Mgr, Of Burnsco Construction, known to me to be a credible person, who being by me duly sword, 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; Cedarbrook at Beltmill 5 - Water, Sanitary Sewer and Storm Drain BY � � Ab Grantges, 'fitract Manager Subscribed and sworn before me on this date 30th of September, 2024. �' VJ Notary Public Tarrant County, Texas CESILIA CANALE5 z Notary ID 9131652996 S My Commission Expires 'lfCr July 24, 2026 CONSENT OF SURETY COMPANY TO FINAL PAYMENT Conforms with the American Institute of Architects, AIA Document G707 OWNER ❑ ARCHITECT ❑ CONTRACTOR ❑ SURETY ❑ OTHER Bond No 022235993 PROJECT: (name, address)Cedarbrook-Beltmill Phase 5 - Water, Sanitary Sewer, Storm Drain Improvements Fort Worth TX TO (Owner) ID.R. HORTON -TEXAS, LTD AND CITY OF FORT ARCHITECT'S PROJECT N0: WORTH CONTRACT FOR: 6751 North Freeway Cedarbrook-Beltmill Phase 5 - Water, Sanitary Sewer, Storm Drain Improvements Fort Worth TX 76131 CONTRACT DATE: CONTRACTOR: BURNSCO CONSTRUCTION, 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) LIBERTY MUTUAL INSURANCE COMPANY 175 Berkeley Street Boston MA 02116 , SURETY COMPANY on bond of (here insert name and address of Contractor) BURNSCO CONSTRUCTION, INC. 6331 Southwest Boulevard Benbrook TX 76132 ,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) D.R. HORTON - TEXAS, LTD AND CITY OF FORT WORTH 6751 North Freeway Fort Worth TX 76131 , OWNER, as set forth in the said Surety Company's bond. IN WITNESS, WHEREOF, the Surety Company has hereunto set its hand this Attest: (Seal): 24th day of May, 2024 LIBERTY MUTUAL INSURANCE COMPANY Sure Company { Signat re of Authorized Representative SoDhinie Hunter Title Attorney -in -Fact 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 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. Liberty Liberty Mutual Insurance Company Mutual® The Ohio Casualty Insurance Company Certificate No: 8205467-022020 West American Insurance Company SURETY POWER OF ATTORNEY KNOWN ALL PERSONS BY THESE PRESENTS: That The Ohio Casualty Insurance Company is a corporation duly organized under the laws of the State of New Hampshire, that Liberty Mutual Insurance Company is a corporation duly organized under the laws of the State of Massachusetts, and West American Insurance Company is a corporation duly organized under the laws of the State of Indiana (herein collectively called the "Companies"), pursuant to and by authority herein set forth, does hereby name, constitute and appoint, Don E. Cornell; Joshua Saunders; Kelly A. Westbrook; Mikaela Peppers; Ricardo J. Reyna; Robbi Morales; Sophinie Hunter; Tina McEwan; Tonie Petranek all of the city of Dallas state of TX each individually if there be more than one named, its true and lawful attorney -in -fact to make, execute, seal, acknowledge and deliver, for and on its behalf as surety and as its act and deed, any and all undertakings, bonds, recognizances and other surety obligations, in pursuance of these presents and shall be as binding upon the Companies as if they have been duly signed by the president and attested by the secretary of the Companies in their own proper persons. IN WITNESS WHEREOF, this Power of Attorney has been subscribed by an authorized officer or official of the Companies and the corporate seals of the Companies have been affixed thereto this 23rd day of April , 2021 Liberty Mutual Insurance Company P� INSU/9 P�,4 INS& %Nst/Rq The Ohio Casualty Insurance Company J oaPOaar 2n yJ �oaPOR9T 9y �4P o0% op, ti� West American Insurance Company UJ j ?o obcn a•3 Fon �3 Foci Z 1912 n o 1919 1991 d' s`SACHUs� b efAMPsa .dD �(s �N°IANP Ab �,,.i- 'i U 7 * ��d �'yl * tid dyr * h� By: r to to David M. Carey, Assistant Secretary m State of PENNSYLVANIA - & County of MONTGOMERY ss g On this 23rd day of April 2021 before me personally appeared David M. Carey, who acknowledged himself to be the Assistant Secretary of Liberty Mutual Insurance CU aD -i-u Company, The Ohio Casualty Company, and West American Insurance Company, and that he, as such, being authorized so to do, execute the foregoing instrument for the purposes E r2 a) > therein contained by signing on behalf of the corporations by himself as a duly authorized officer. > a) IN WITNESS WHEREOF, I have hereunto subscribed my name and affixed my notarial seal at King of Prussia, Pennsylvania, on the day and year first above written. a0 N c— (0 (n p q PA a ��.iasv. Commonwealth or Pennsylvania -Notary Seel >,Z • e ,; <` Teresa Pastella, Notary Public ////�� N •(p O ` '�' Montgomery County r/ ^ - ' Lme-) E E O My commission expires March 28, 2025 By• ! O N Commission number 1126044 4 �� Teresa Pastella, Notary Public Q o ,p svr. `ems Member, Pennsylvania Association of Notaries V-.. Q1 Ny O I This Power of Attorney is made and executed pursuant to and by authority of the following By-laws and Authorizations of The Ohio Casualty Insurance Company, Liberty Mutual 3 •� Insurance Company, and West American Insurance Company which resolutions are now in full force and effect reading as follows: o0 ARTICLE IV- OFFICERS: Section 12. Power of Attorney, o 0 @ Any officer or other official of the Corporation authorized for that purpose in writing by the Chairman or the President, and subject to such limitation as the Chairman or the c cfl President may prescribe, shall appoint such attorneys -in -fact, as may be necessary to act in behalf of the Corporation to make, execute, seal, acknowledge and deliver as surety to = ca > C any and all undertakings, bonds, recognizances and other surety obligations. Such attorneys -in -fact, subject to the limitations set forth in their respective powers of attorney, shall c have full power to bind the Corporation by their signature and execution of any such instruments and to attach thereto the seal of the Corporation. When so executed, such o m Z L) instruments shall be as binding as if signed by the President and attested to by the Secretary. Any power or authority granted to any representative or attorney -in -fact under the to provisions of this article may be revoked at any time by the Board, the Chairman, the President or by the officer or officers granting such power or authority. tL a ARTICLE XIII - Execution of Contracts: Section 5. Surety Bonds and Undertakings. Any officer of the Company authorized for that purpose in writing by the chairman or the president, and subject to such limitations as the chairman or the president may prescribe, shall appoint such attorneys -in -fact, as may be necessary to act in behalf of the Company to make, execute, seal, acknowledge and deliver as surety any and all undertakings, bonds, recognizances and other surety obligations. Such attorneys -in -fact subject to the limitations set forth in their respective powers of attorney, shall have full power to bind the Company by their signature and execution of any such instruments and to attach thereto the seal of the Company. When so executed such instruments shall be as binding as if signed by the president and attested by the secretary. Certificate of Designation - The President of the Company, acting pursuant to the Bylaws of the Company, authorizes David M. Carey, Assistant Secretary to appoint such attorneys -in - fact as may be necessary to act on behalf of the Company to make, execute, seal, acknowledge and deliver as surety any and all undertakings, bonds, recognizances and other surety obligations. Authorization - By unanimous consent of the Company's Board of Directors, the Company consents that facsimile or mechanically reproduced signature of any assistant secretary of the Company, wherever appearing upon a certified copy of any power of attorney issued by the Company in connection with surety bonds, shall be valid and binding upon the Company with the same force and effect as though manually affixed. I, Renee C. Llewellyn, the undersigned, Assistant Secretary, The Ohio Casualty Insurance Company, Liberty Mutual Insurance Company, and West American Insurance Company do hereby certify that the original power of attorney of which the foregoing is a full, true and correct copy of the Power of Attorney executed by said Companies, is in full force and effect and has not been revoked. IN TESTIMONY WHEREOF, I have hereunto set my hand and affixed the seals of said Companies this 24th day of May , 2024 . 1NSUR �jlf INS& \NSUR �JPG°KP°Rq�,q'LC� GjJP401PORq�•R'9Z MVP 40µP0 17gTq�YC� J3 Fom Q3 Foci a 2 �oRt 19120 0 19190 2 1991 a,�9sS4CHUs��.da yO NAMPSa0 `' IA'oIANP •bb� By: Renee C. Llewellyn, Assistant Secretor * dM * Y , Y LMS-12873 LMIC OCIC WAIC Multi Co 02/21 F t ��SURETY TEXAS IMPORTANT NOTICE To obtain information or make a complaint: You may call toll -free for information or to make a complaint at 1-877-751-2640 You may also write to: 2200 Renaissance Blvd., Ste. 400 King of Prussia, PA 19406-2755 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 Consumer Protection (I I I-1A) P. O. Box 149091 Austin, TX 78714-9091 FAX: (512) 490-1007 Web: httD://www.tdi.texas.aov E-mail: ConsumerProtection4q,tdi.texas.aov PREMIUM OR CLAIM DISPUTES: Should you have a dispute concerning your premium or about a claim you should first contact the agent or call 1-800-843-6446. 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. NP 70 68 09 01 LMS-15292 10/15 TEXAS AVISO IMPORTANTE Para obtener infonnacion o para someter una queja: Usted puede llamar al numero de telefono gratis para informacion o para someter una queja al 1-877-751-2640 Usted tambien puede escribir a: 2200 Renaissance Blvd., Ste. 400 King of Prussia, PA 19406-2755 Puede comunicarse con el Departamento de Seguros de Texas para obtener informacion acerca de companias, coberturas, derechos o quejas a] 1-800-252-3439 Puede escribir al Departamento de Seguros de Texas Consumer Protection (111-1A) P. O. Box 149091 Austin, TX 78714-9091 FAX # (512) 490-1007 Web: httn://www.tdi.texas.2ov E-mail: ConsumerProtection4,tdi.texas.20v DISPUTAS SOBRE PRIMAS O RECLAMOS: Si tiena una disputa concerniente a su prima o a un reclamo, debe comunicarse con el agente o 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.