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Home My WebLink AboutContract 58975-FP2-Fp2 City Secretary 58975Contract No. ______ _ Date Received Ol/3l/2025 2/13/25 NOTICE OF PROJECT COMPLETION (Developer Projects) The Transportation and Public Works Department upon the re commendation of the Project Manager has accepted the foll owing project as complete: Project Name: Clifton Riverside Mul tifamily City Project No.: 103898 Improvement Type(s): □ Paving □Drainage � Street Ligh ts □Traffic Signals Original Contract Price: $80,627.83 Amount of Approved Change Order(s): $0.00 Revised Contract Amount: $0.00 Total Cost of Work Complete: $80,627.83 Eduardo Roias Eduardo Rojas (Jan 30, 20� 08:21 CST) Jan 30, 2025 Contractor Date Project Manager/ Engineer Title Hurst Electric Company Name William Fauver (Jan 30, 202515:23 CST) Jan 30, 2025 Project Inspector Date Mosac<age MohaMmc<een, 'P. 15. Jan 30, 2025 Project Manager Date a�tl49 Jan 31, 2025 CFA Manager Date ;e......,� Lauren Prieur (Jan 311 202517:23 CST) Jan 31, 2025 TPW Director Date Feb 2, 2025 Asst. City Manager Date Page 1 of 2 Notice of Project Completion Project Name: Clifton Riverside Multifamily City Project No.: 103898 City's Attachments Final Pay Estimate 0 Change Order(s): ❑ Yes 0 N/A Contractor's Attachments Affidavit of Bills Paid � Consent of Surety � Statement of Contract Time Contract Time 103 WD Days Charged: 124 Work Start Date: 3/18/2024 Work Complete Date: 10/21/2024 Completed number of Soil Lab Test: 53 Completed number of Water Test: 14 Page 2 of 2 FORTWORTH CITY OF FORT WORTH FINAL PAYMENT REQUEST Contract Name CLIFTON RNERSIDE MULTIFAMILY Contract Limits Project Type STREET LIGHTING City Project Numbers 103898 DOE Number 3g9g Estimate Number 1 Payment Number 1 For Period Ending City Secretary Contract Number Contract Date Project Manager NA Contractor HURST ELECTRIC 229 W HURST BLVD HURST, TX 76053 Inspectors A. YBARRA / W. FAUVER Contract Time Days Charged to Date Contract is 100.00 1/1/2001 WD 6AJD 124 Complete Thursday, January 23, 2025 Page 1 of 4 City Project Numbers 103898 Contract Name CLIFTON RNERSIDI�, MUI; I'IPAMILY Contract Limits Project Type STREET LIGHTING Project Funding UNIT V: STREET LIGHTING IMPROVEMENTS Item Description of Items �stimated Unit No. Quanity 1 FURNISH/INSTALL CONDUIT-SCHEDULE 80 356 LF PVC 2 2 GROUND BOX TYPE B, W/APRON 2 EA 3 FURNISH/INSTALL 10' -14' WASHINGTON 5 EA STANDARD LIGHT POLE & FIXTURE LED 4 RDWY IINM FOUNDATION TY 7 � EA 5 FURNISH/INSTALL 8' WOOD LIGHT POLE ARM 2 EA 6 NO 6 BARE ELECT. CONDR SLD 356 EA 7 LED LIGHTING FIXTURE 2 EA 8 FURNISH/INSTALL 120-240V SINGLE PH. 1 EA METERED PEDESTAL Sub-Total of Previous Unit DOE Number 389g Estimate Number 1 Payment Number 1 For Period Ending 1/1/2001 Unit Cost Estimated Total $83.17 $29,608.52 $2,10112 $4,202.24 $4,895.89 $24,479.45 $916.00 $4,580.00 $150.00 $300.00 $4.08 $1,452.48 $2,230.00 $4,460.00 $11,54514 $11,545.14 Completed Completed Quaniry Total 356 $29,608.�2 2 $4,202.24 5 $24,479.45 5 $4,580.00 2 $300.00 356 $1,452.48 2 $4,460.00 1 $11,54514 $80,627.83 $80,627.83 Thursday, January 23, 2025 Page 2 of 4 City Project Numbers 103898 Contract Name CLIFTON RNERSIDI�, MUI; I'IPAMILY Contract Limits Project Type STREET LIGHTING Project Funding Contract Information Summary Original Contract Amount Change Orders Total Contract Price DOE Number 389g Estimate Number 1 Payment Number 1 For Period Ending 1/1/2001 $80,627.83 $80,627.83 Total Cost of Work Completed $80,627.83 Less % Retained $0.00 Net Earned $80,627.83 Earned This Period $80,627.83 Retainage This Period $0.00 Less Liquidated Damages Days @ / Day LessPavement De�ciency 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 $80,627.83 Thursday, January 23, 2025 Page 3 of 4 City Project Numbers 103898 Contract Name CLIFTON RNERSIDI�, MUI; I'IPAMILY Contract Limits Project Type STREET LIGHTING DOE Number 389g Estimate Number 1 Payment Number 1 For Period Ending 1/1/2001 Project Funding Project Manager NA Inspectors A. YBARRA / W. FAUVER Contractor HURST ELECTRIC 229 W HURST BLVD HURST , TX 76053 City Secretary Contract Number Contract Date Contract Time 60 WD Days Charged to Date 124 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 Less % Retained Net Earned Earned This Period $80,627.83 Retainage This Period $0.00 Less Liquidated Damages � Days @ $0.00 / Day LessPavement Deficiency Less Penalty Less Previous Payment Plus Material on Hand Less 15% Balance Due This Payment $80,627.83 $0.00 $80,627.83 $0.00 $0.00 $0.00 $0.00 $0.00 $80,627.83 Thursday, January 23, 2025 Page 4 of 4 ��x� TRANSPORTATION AND PUBLIC WORKS December 19, 2024 Hurst Electric 229 W. Hurst Blvd Hurst, TX 76053 RE: Acceptance Letter Project Name: Clifton Riverside Multifamily Project Type: Water and Sewer City Project No.: 103898 To Whom It May Concern: On December 20, 2024 a final inspection was made on the subject project. There were no punch list items identified at that time. The final inspection indicates that the work meets the City of Fort Worth specifications and is therefore accepted by the City. The warranty period will start on December 20, 2024, which is the date of the final inspection 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- 392-2243. Sincerely, Modadage Moka�rw�deen,�E Mosadage Mohammdeen, Project Manager Cc: William Fauver, Inspector Donald Watson, Inspection Supervisor Aaron Ybarra, Senior Inspector Andrew Goodman, Program Manager M M A Civil Engineering, Consultant Hurst Electric, Contractor Summit Land Development LLC, Developer File E-Mail: TPW_Acceptance@fortworthtexas.gov Rev. 08/20/19 CONSENT OF SURETY TO FINAL PAYMENT Conforms with the American Institute of Architects, AIA Document G707 TO OWNER: OPG Clifton Riverside Partners,LLC (Nnme nnd addressJ City of Fort Worth 200 Texas Street Fort Worth, TX 76102 PROJECT: Clifton Riverside Multifamily (Nm�ieondnddress) 2406 E Belknap Ft Worth, TX 76102 1093090 OWNER ARCHITECT CONTRACTOR SURETY OTHER ARCHITECT'S PROJECT NO.: CONTRACT FOR: Street Lighting CONTRACT DATED: 1 /09/2024 In accordance with the provisions of the Contract between the O�vner and the Conh�actor as indicated above, the (Inser� name ond nddress ofSan•eryJ The Hanover Insurance Company 440 Lincoln Street Worcester MA 01615 ❑ ❑ ❑ ❑x ❑ ,SURETY, on bond of (Inserl nauie and address ojConlrnclor) Hurst Electric, LP 229 W Hurst Blvd Hurst TX 76053 ,CONTRACTOR, hereby approves of the final payment to the Contractor, and agrees that final payment to the Contractor shall not relieve t6e Surety of any of its obligations to (lnsert name nnd nrl�iress ojOivne�) OPG Clifton Riverside Partners,LLC City of Fort Worth 200 Texas Street Fort Worth, TX 76102 , OWNER, as set forth in said Surety's bond. IN WITNESS WHEREOF, tlle Surety has hereunto set its hand on tllis date: D I f�`C� /� (/naer! in irriting rhe inonth foflo}red by lhe nun�eric dn(e nnd yem•.) �n �/ Attest: � - Q;Ij �/`./l� (1!' % "� G / The Hanover Insurance Company (Sto•et}) � �i � � (Signatto•e ofaudiorrzed �•epresentatire) C� I� �-�� (Printed nan�e a�d tiNe) � S-2134/AS 10/01 XDP THE HANOVERINSURANCECOMPANY MASSACHUSETTS BAY WSURANCE COMPANY CITIZENS INSURANCE COMPANY OF AMERICA 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 MASSACHUSE�ii�S BAY INSURANCE COMPANY, both being corporations organized and existing underthe 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, Michele Brockman, Suzanne Van Meter, Brett Atwell, Donovan Pawelek, Yousef Foteh andlor Lettie Tovar Of Insurica of Plano, 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, shail 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 acis 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 Million and No/100 ($30,000,000) 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 seai ofthe 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, shail be binding on the Company to 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 and affirmed by each Company on March 24, 2014) 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 23'd day of May, 2024 � �� •�°`�snsp�r ,�`�'^�� @, ��j.• c+.�# � � r � � iDIA � $ Thc lianu��er Inxura»cc Company tt�achusetts Etny (oserwace Company Citizena Insunnce Company,pf America � J s H. Kawfecki, Vlce Preeident STATE OF CONNECTICUT COUNTY OF HARTFORD ) ss. 7hc Hs�novcr lnsurancc Compan�� I► »chuseta Ray insuronce Compony t ns Insurance Company ofAmerka Ilen M. Mendoza, Vice President On this 23'd day of May, 2024 before me came the above named Executive Vice President and Vice President of The Hanover insurance Company, Massachusetts Bay Insurance Company and Citizens Insurance Company of America, to me personally known to be the individuais 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 authority and direction of said Corporations. � Wendy Latoumes �� Notaryr PubqC, 5tate of ConnecUcut �Y Gom+nisslon Expires Jui 31, 2025 � � , ' � �� fl�`�.. YP�n y �atou es, otary u "� Nty commfasi n ex ires July 31, 2025 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 _,�`� day of_�J�'(✓�''�� `�� CERTIFIED COPY The �n e lnaurance ompa • Ma ac Is Bay ins any Ci un sura ce Amy�ic�----�..� ohn Roweddcr, Vice Presideat Texas Complaint Notice Commercial Lines 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: 1-800-343-6044 You may also write to The Hanover Insurance Company/ Citizens Insurance Company of America at: 440 Lincoln Street Worcester, MA 01653 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. ATi�ACH 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 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: 1-800-343-6044 Usted tambien puede escribir a The Hanover Insurance Company/Citizens Insurance Company of America al: 440 Lincoln Street Worcester, MA 01653 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 (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. The Hanover Insurance Company � 440 Lincoln Street, Worcester, MA 01653 181-1457 p7/13) Page 1 0( I Citizens Insurance Company of America � 808 North Highlander Way, Howell, MI 48843 hanover.com CONSENT OF SURETY TO FINAL PAYMENT Conforms with the American Institute of Architects, AIA Document G707 TO OWNER: OPG Clifton Riverside Partners,LLC (Nnme nnd addressJ City of Fort Worth 200 Texas Street Fort Worth, TX 76102 PROJECT: Clifton Riverside Multifamily (Nm�ieondnddress) 2406 E Belknap Ft Worth, TX 76102 1093090 OWNER ARCHITECT CONTRACTOR SURETY OTHER ARCHITECT'S PROJECT NO.: CONTRACT FOR: Street Lighting CONTRACT DATED: 1 /09/2024 In accordance with the provisions of the Contract between the O�vner and the Conh�actor as indicated above, the (Inser� name ond nddress ofSan•eryJ The Hanover Insurance Company 440 Lincoln Street Worcester MA 01615 ❑ ❑ ❑ ❑x ❑ ,SURETY, on bond of (Inserl nauie and address ojConlrnclor) Hurst Electric, LP 229 W Hurst Blvd Hurst TX 76053 ,CONTRACTOR, hereby approves of the final payment to the Contractor, and agrees that final payment to the Contractor shall not relieve t6e Surety of any of its obligations to (lnsert name nnd nrl�iress ojOivne�) OPG Clifton Riverside Partners,LLC City of Fort Worth 200 Texas Street Fort Worth, TX 76102 , OWNER, as set forth in said Surety's bond. IN WITNESS WHEREOF, tlle Surety has hereunto set its hand on tllis date: D I f�`C� /� (/naer! in irriting rhe inonth foflo}red by lhe nun�eric dn(e nnd yem•.) �n �/ Attest: � - Q;Ij �/`./l� (1!' % "� G / The Hanover Insurance Company (Sto•et}) � �i � � (Signatto•e ofaudiorrzed �•epresentatire) C� I� �-�� (Printed nan�e a�d tiNe) � S-2134/AS 10/01 XDP THE HANOVERINSURANCECOMPANY MASSACHUSETTS BAY WSURANCE COMPANY CITIZENS INSURANCE COMPANY OF AMERICA 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 MASSACHUSE�ii�S BAY INSURANCE COMPANY, both being corporations organized and existing underthe 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, Michele Brockman, Suzanne Van Meter, Brett Atwell, Donovan Pawelek, Yousef Foteh andlor Lettie Tovar Of Insurica of Plano, 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, shail 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 acis 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 Million and No/100 ($30,000,000) 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 seai ofthe 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, shail be binding on the Company to 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 and affirmed by each Company on March 24, 2014) 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 23'd day of May, 2024 � �� •�°`�snsp�r ,�`�'^�� @, ��j.• c+.�# � � r � � iDIA � $ Thc lianu��er Inxura»cc Company tt�achusetts Etny (oserwace Company Citizena Insunnce Company,pf America � J s H. Kawfecki, Vlce Preeident STATE OF CONNECTICUT COUNTY OF HARTFORD ) ss. 7hc Hs�novcr lnsurancc Compan�� I► »chuseta Ray insuronce Compony t ns Insurance Company ofAmerka Ilen M. Mendoza, Vice President On this 23'd day of May, 2024 before me came the above named Executive Vice President and Vice President of The Hanover insurance Company, Massachusetts Bay Insurance Company and Citizens Insurance Company of America, to me personally known to be the individuais 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 authority and direction of said Corporations. � Wendy Latoumes �� Notaryr PubqC, 5tate of ConnecUcut �Y Gom+nisslon Expires Jui 31, 2025 � � , ' � �� fl�`�.. YP�n y �atou es, otary u "� Nty commfasi n ex ires July 31, 2025 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 _,�`� day of_�J�'(✓�''�� `�� CERTIFIED COPY The �n e lnaurance ompa • Ma ac Is Bay ins any Ci un sura ce Amy�ic�----�..� ohn Roweddcr, Vice Presideat Texas Complaint Notice Commercial Lines 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: 1-800-343-6044 You may also write to The Hanover Insurance Company/ Citizens Insurance Company of America at: 440 Lincoln Street Worcester, MA 01653 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. ATi�ACH 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 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: 1-800-343-6044 Usted tambien puede escribir a The Hanover Insurance Company/Citizens Insurance Company of America al: 440 Lincoln Street Worcester, MA 01653 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 (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. The Hanover Insurance Company � 440 Lincoln Street, Worcester, MA 01653 181-1457 p7/13) Page 1 0( I Citizens Insurance Company of America � 808 North Highlander Way, Howell, MI 48843 hanover.com