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Home My WebLink AboutContract 56788-FP2City Secretary Contract No. 56788 -FP2 ------- Date Received 2/12/2025 02/20/2025 AMENDED 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: The Library City Project No: 102561 Improvement Type(s): Notice amended with revised number of construction days charged. Water� Sewer� Water Oriqinal Contract Amount Sewer Oriqinal Contract Amount Water-Amount of Approved Change Orders(s): Sewer-Amount of Aooroved Change Order(s): Revised Contract Amount: Total Cost of Work Complete: An��b#io�04 CSTJ Contractor Owner/ GM Title Dagger Contracting Company Name f,.....(.t Daniel Ro� {Feb 12 2025 10:18 CST) Project Inspector �� Project Manager Kana.Feb 12 202514:29 CSTJ CFA Manager ;e._z...., Lill!imtc eci�!i!C !E�!iz I� �g�� i!·;l� ��Il TPW Director � Asst. City Manager Developer Cost City Cost Total Cost $91,045.70 $63 282.30 $154,328.00 $56,613.00 $0.00 $56,613.00 $15,205.85 $0.00 $15,205.85 $30,603.00 $0.00 $30,603.00 $193,467.55 $63,282.30 $256,749.85 $193,467.55 $63,282.30 $256,749.85 Feb 12, 2025 Date Feb 12, 2025 Date Feb 12, 2025 Date Feb 12, 2025 Date Feb 12, 2025 Date Feb 12, 2025 Date Page 1 of 2 Notice of Project Completion Project Name: The Library City Project No.: 102561 City's Attachments Final Pay Estimate 0 Change Order(s): 0 Yes ❑ N/A Pipe Report: 0 Yes ❑ N/A Contractor's Attachments Affidavit of Bills Paid � Consent of Surety �� Statement of Contract Time Contract Time 30 WD Days Charged: 92 Work Start Date: 4/1/2022 Work Complete Date: 4/26/2023 Soil Lab Number of Tests: 0 Water Number of Tests: 7 Page 2 of 2 FORTWORTH CITY OF FORT WORTH F1NAL PAYMENT REQUEST Contract Name WATER AND SEWER IMPROVEMENTS TO SERVE THE LIBRARY Contract Limits Project Type WATER City Project Numbers 102561 DOE Number 2561 Estimate Number 1 Payment Number 1 City Secretary Contract Number Contract Date 2/17/2022 Project Manager NA Contractor DAGGER CONTRACING, INC. P.O.BOX 1040 ROANOKE , TX 76262 Inspectors GLOVER, M/ JOHNSON, S For Period Ending 4/26/2023 WD Contract Time �� Days Charged to Date 133 Contract is 100.00 Complete Monday, May 1, 2023 Page 1 of 5 City Project Numbers 102561 Contract Name WATER AND SEWER IMPROVEMENTS TO SERVE THE LIBRARY Contract Limits Project Type WATER Project F+unding L?NTI' I: WATER IMPROVEMENTS Item Description of Items No. 1 REMOVE 6" WATER LINE 2 4"-12" PRESSURE PLUG 3 5' WIDE ASPHALT PVMT REPAIR, RESIDENTIAL (CO #1) 4 2" ASPHALT PVMT TYPE C(CO #1) 5 TEMPORARY WATER SERVICES (CO# 1) 6 EXPLORATORY EXCAVATION OF EXISTING UTILITIES 7 TRENCHSAFETY 8 6" PVC WATER PII'E (CO #1) 9 DUCTILE IRON WATER FITTINGS W/ RESTRAINT (CO #1) 10 8" PVC WATER PIPE (CO #1) 11 FIRE HYDRANT (CO # 1) 12 CONNECTION TO EXISTING 4"-12" WATER MAIN 13 2" WATER SERVICE (CO #1) 14 6" GATE VALVE (CO #1) 15 8" GATE VALVE (CO #1) 16 TRAFFIC CONTROL 17 KUPFERLE #9700 AUTOMATIC FLUSHING DEVICE (CO #1) DOE Number 2561 Estimate Number 1 Payment Number 1 For Period Ending 4/26/2023 Estimated Unit Unit Cost Estimated Completed Completed Quanity Total Quanity Total 299 LF $15.00 $4,485.00 299 $4,485.00 1 EA $650.00 $650.00 1 $650.00 420 LF $112.50 $47,250.00 420 $47,250.00 467 SY $71.50 $33,390.50 467 $33,390.50 0 LS $3,000.00 $0.00 0 $0.00 1 EA $1,000.00 $1,000.00 1 $1,000.00 452 LF $2.00 $904.00 7 LF $115.75 $810.25 0.5 TN $13,000.00 $6,500.00 452 $904.00 7 $810.25 0.5 $6,500.00 446 LF $108.35 $48,32410 446 $48,32410 1 EA $4,105.00 $4,105.00 1 $4,105.00 1 EA $2,000.00 $2,000.00 1 $2,000.00 2 EA $3,240.00 $6,480.00 1 EA $1,815.00 $1,815.00 1 EA $2,480.00 $2,480.00 1 MO $2,500.00 $2,500.00 1 EA $6,840.00 $6,840.00 2 $6,480.00 1 $1,815.00 1 $2,480.00 1 $2,500.00 1 $6,840.00 Sub-Total of Previous Unit $169,533.85 $169,533.85 iJNTI' II: SANTI'ARY SEVVER IMPROVEMENTS Item Description of Items No. 1 6"-12" TREE REMOVAL 2 12"-18" TREE REMOVAL 3 MEDNM STONE RIPRAP, DRY (CO # 1) 4 POST-CCTV INSPECTION 5 TRENCHSAFETY 6 TRENCH WATER STOPS Estimated Unit Unit Cost Estimated Completed Completed Quanity Total Quaniry Total 2 EA $850.00 $1,700.00 2 $1,700.00 1 EA $1,250.00 $1,250.00 1 $1,250.00 33 SY $108.00 $3,564.00 33 $3,564.00 272 LF $2.00 $544.00 272 $544.00 272 LF $2.00 $544.00 272 $544.00 3 EA $750.00 $2,250.00 3 $2,250.00 Monday, May 1, 2023 Page 2 of 5 City Project Numbers 102561 DOE Number 2561 Contract Name WATER AND SEWER IMPROVEMENTS TO SERVE THE LIBRARY Estimate Number 1 Contract Limits Payment Number 1 Project Type SEWER For Period Ending 4/26/2023 Project F+unding 7 8" SEWER PIPE (CO #1) 272 LF $81.00 $22,032.00 272 $22,032.00 8 EPDXY MANHOLE LINER (CO #1) 23 VF $528.00 $12,144.00 23 $12,144.00 9 4' MANHOLE (CO #1) 4 EA $6,387.00 $25,548.00 4 $25,548.00 10 UTILITY SERVICE SURFACE RESTORATION 470 EA $3.00 $1,410.00 470 $1,410.00 (CO #1) 11 MANHOLE VACUUM TESTING (CO #1) 4 EA $150.00 $600.00 4 $600.00 12 CUT & REMOVE EXISTING CHAIN LINK FENCE 12 LF $15.00 $180.00 12 $180.00 (CO #1) 13 INSTALL DOUBLE SWING GATE ON 6' CHAIN 1 LS $4,490.00 $4,490.00 1 $4,490.00 LINK FENCE 14 MINOR ADDED CLEARING W/ HAUL OFF 2 DY $5,480.00 $10,960.00 2$10,960.00 TRUCKING Sub-Total of Previous Unit �87,216.00 �87,216.00 Monday, May 1, 2023 Page 3 of 5 City Project Numbers 102561 DOE Number 2561 Contract Name WATER AND SEWER IMPROVEMENTS TO SERVE THE LIBRARY Estimate Number 1 Contract Limits Payment Number 1 Project Type SEWER For Period Ending 4/26/2023 Project F+unding Contract Information Summary Original Contract Amount Change Orders Change Order Number 1 Change Order Number 1 Total Contract Price $210,941.00 �is,zos.ss $30,603.00 $256,749.85 Total Cost of Work Completed $256,749.85 Less % Retained $0.00 Net Earned $256,749.85 Earned This Period $256,749.85 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 $256,749.85 Monday, May 1, 2023 Page 4 of 5 City Project Numbers 102561 Contract Name WATER AND SEWER IMPROVEMENTS TO SERVE THE LIBRARY Contract Limits Project Type SEWER Project F+unding DOE Number 2561 Estimate Number 1 Payment Number 1 For Period Ending 4/26/2023 Project Manager NA City Secretary Contract Number Inspectors GLOVER, M/ JOHNSON, S Contract Date 2/17/2022 Contractor DAGGER CONTRACING, INC. Contract Time 25 WD P.O.BOX 1040 Days Charged to Date 133 WD ROANOKE, TX 76262 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 $256,749.85 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 $256,749.85 $0.00 $256,749.85 $0.00 $0.00 $0.00 $0.00 $0.00 $256,749.85 Monday, May 1, 2023 Page 5 of 5 �--1 � U MI W � � �� /''� �'d / O z � U � � � W � i.� z z� ¢ W �"' = O U � 0 � W i� Z O Q a U �- Q a {,_- U � N W (D N N 0 M m � 2' o 0 � �i O � � � � � '`'J' M M :7 � cy � Q F-L- v�Oi U� r�i X Y # H � Z � U Xk IL'I �k � U Q Z F- �- U O U n�. w � a ai � -� F- � �� il �k Q��o�W a� v v v LL� LL '� � C�O N M � � � � 00 W Z Z C C o O a a C C O � N � C -p L 0 O p � � � � � � Q � W Q Z � ¢ O � �' U U W W � �- o N � z d U � � u� u� o F- Q N N � M O � U N O O O o O O O � U O O O O O O ~ � N V�1 1�A t�A V�i N � U o J o W � � N 4 a o 0 o a o a� a+ � � N 1�// N 1�/1 p C�i O M O U N N ai N lD 0 o a o 0 0 0 � v o 0 0 0 0 0 �` � � v�i u�i ti w u z o > � a "' � o 0 0 0 0 0 p o 0 0 0 0 0 O o 0 0 0 0 0 Gl a+ 1n � N VI N V/ C�i O O U � � V o 0 0 0 0 o y 0 0 0 0 0 0 � � W � In 1n N N N V/ V N � � G .�' °° U Z o U � � ¢ N n F- p u�i z � o 0 0 0 0 o tNi) O a V o 0 0 0 0 0 0 a .. � �, �, � � � a�, o O U �' o 0 0 0 0 0 V o 0 0 0 0 0 � N N N N N N p lI) � U o ^ w � w `Y � � o 0 0 0 � m 0 o a o a M o o M o 1D � /A O � o o � � N N N C�1 O � N N 1�A ❑ U 1q M M M U oNo o � oNo � oNp � N o o N o cV M N � M � N M V in �n 'n ap � N N M M � N 3 � � � � � a � o o a p N N 0 p � o 0 o N V v� w � � � U � � N � O K W d H U � � W � O I- � � z a C7 � U t=i� O H = Q � 2 ~ � U W V F- Z� U fq Q w Q n: Q� o F � Q o � � ❑ uWi � z¢ a Z w � � OO � U p��j K Fa- z¢� a� z w� o � � W Z O � H O � U � ¢ � O d � a 0 � .N-. a�i N .� � F FORTWORTH TRANSPORTATION AND PUBLIC WORKS PIPE REPORT FOR: PRO,T�CT NAME: The Library CITY PROJ�CT NUMBER: CPN # 102561 WAT�R PIP� LAID SIZE TYP� OF PIPE LF 8" PVC 8" PVC 446 FIR� HYDRANTS: 1 PIPE ABANDONED D�NSITI�S: NEW SERVICES: brow of 4+47 VALVES (16" OR LARGER) SIZE TYPE OF PIPE LF SEW�R PIPE LAID SIZE TYPE OF PIPE LF 8" PVC 8" PVC 272 PIPE ABANDONED SIZE TYPE OF PIP� LF DENSITIES: NEW SERVICES: TRANSPORTATION f1ND PUBLIC ��/ORKS The City of Fort Worth • 1000 Throckmorton Street • Fort Wordi, T�i 76012-6311 (817) 392 - 7941 • Fax: (817) 392 - 7845 FORTWORTH�� --� TRANSPORTATION AND PUBLIC WORI<S April 26, 2023 Dagger Contracting PO Box 1040 Roanol<e, TX. 76262 RE: Acceptance Letter Project Name: The Libary Project Type: Water and Sewer Improvements City Project No.: 102561 To Whom It May Concern: On April 21, 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 April 26, 2023. The final inspection and the corrected punch list items indicate that the wori< meets the City of Fort Worth specifications and is therefore accepted by the City. The warranty period will start on April 26, 2023, which is the date of the punch list completion and will extend oftwo (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)392-6251. Sincerely, �G►�dvu� �o� Andrew Goodman , Project Manager Cc: Steven Johnson, Inspector Mil<e Glover, Inspection Supervisor Daniel Roy, Senior Inspector Victor Tornero, Program Manager RPGA Design group Inc, Consultant Dagger Contracting, Contractor Robert P. Garza, Developer File E-Mail: TPW_Acceptance@fortworthtexas.gov Rev. 8/20/19 FINAL BILLS PAID AFFIDAVIT THE STATE OF TEXAS COUNTY OF DENTON BEFORE ME, the undersigned authority, personally appeared _Andrew Nord_ (hereinafter referred to as "Contractor"), known to me to be a credible person, and after being by me duly sworn, upon oath stated and affirmed that: "My name is _Andrew Nord and I am the _Owner / GM of Dagger Contracting, LLC_, hereafter sometimes referred to in this affidavit as "Contractor". Contractor's business address is PO Box 1040 Roanoke, TX 76262 . The undersigned Contractor has personal knowledge of the facts stated herein and has full authority to make the agreements in this affidavit on behalf of Contractor. Pursuant to and in accordance with a written construction contract between Dagger Contracting, LLC_, Contractor, and _RPGA / City of Fort Worth_, Owner, Contractor furnished materials and labor for the construction, renovation, or repair of improvements located on or relating to project known as The Library_located at 1530 Rio Grand Ave_, City of _Fort Worth_, _Tarrant County, Texas. All work provided for under said written construction contract, together with all changes and supplements thereto, has been fully completed in accordance with the terms and provisions thereof. Contractor has paid each of its subcontractors, laborers, suppliers and materialmen in full for all labor and materials provided to Contractor for or in connection with the construction, renovation, or repair of improvements on or relating to the subject Property, or any portion thereof, excepting only the amounts owed for the following specified bills to the persons identified below. Contractor warrants and represents that the following specified bills wi II be paid to Contractor by Owner/Administrator in reliance on this Final Bills Paid Affidavit: Name of Pa ee Address Tele hone No. Amount Owed Other than the above specified bills owed to the above referenced persons, Contractor is not aware of any unpaid bills, claims, demands, or causes of action by any of its subcontractors, laborers, suppliers, or materialmen for or in connection with the furnishing of labor or materials, or both, for the construction, renovation, or repair of improvements located on or related to the subject Property. In consideration of the funds paid to Contractor by Owner and by Lender on behalf of Owner in reliance on this affidavit, Contractor waives and releases all of Contractor's statutory and constitutional mechanic's lien rights connected with the construction of the Project, conditioned on the actual payment or collection if payment is made by check or draft. Contractor further understand that this Final Bills Paid Affidavit is being given pursuant to and in accordance with Sections 53.085 and 53.259 of the Texas Property Code and that the intentional, knowing, or reckless making of a false or misleading statement in this Affidavit constitutes an offense under said Section and is a Class A misdemeanor. Contractor hereby indemnifies and holds harmless Owner from any and all claims, demands or causes of action, and any costs, expenses, and attorney's fees incurred in connection therewith, arising from or connected with, the https://daggercontracting.sharepoint.com/sites/DaggerContractingLLC/Shared Documents/Closed Contracts/21022 - The Library (Fort Worth)/12_Paperwork/Job Close-Out Templates/Affidavit of Bills Paid - Final.doc statements and representations contained herein." EXECUTED this _1 st day of _May , 2023. THE STATE OF TEXAS COUNTY OF _Denton_ / By: �/l� ( Printed Name: ndrew Nortl-- Title: Owner / GM Before me, the undersigned authority, on this day personally appeared_Andrew Nord , who first being duly sworn by me to be the person whose name is subscribed to the foregoing Final Bills Paid Affidavit, acknowledged that he/she has the authority to make this Final Bills Paid Affidavit, and further acknowledged to me that he/ she executed the same for the purpose and consideration therein expressed. GIVEN UNDER MY HAND AND SEAL OF OFFICE, on this th 1st �'cTa� _ y_, 2023_ �- N Public in and for the State of TEXAS (NOTARY SEAL) Printed Name: Josh Hodsdon Commission Expires:_6/1/23 \��,��,,,,<<� .�� `''`:�.. y ��5�'� � . � •` N• Q � , ' O �.qv G , ' � � e� ��^.. 2 - = �. �� : � :°�7 � ,., : * = ; � .9,9��'OF lE6yg°�;� ��• i 'tl •. � � 302, rj, . ,'�� %�P. Q[�-�� I�lIIY15+�. https://daggercontracting.sharepoint.com/sites/DaggerContractingLLC/Shared Documents/Closed Contracts/21022 - The Library (Fort Worth)/12_Paperwork/Job Close-Out Templates/Affidavit of Bills Paid - Final.doc CONSENT OF SURETY COMPANY TO FINAL PAYMENT Conforms with the American Instkute of Architecta, AIA Document G707 OWNER ❑ ARCHITECT ❑ CONTRACTOR ❑ SURETY ❑ OTHER Bond No NTX 3797 PROJECT: (neme, eddt'ess)Water and Sewer Improvements to serve The Library TO (Owner) The Library � ASFW APARTMENTS, L.P. 1500 W Jarois St. Fort Worth Fort Worth TX � ARCHITECT'S PROJECT NO: CONTRACT FOR: Water and Sewer Improvements to serve TF�e Library nc �s�o2 _f CONTRACT DATE: 2n��2o22 CONTRACTOR: DAGGER CONTRACTING, LLC In accordance with the provisions of the Contract between the Owner and the Contractor as indicated above, the (here i�ert neme end addreas of Surety Companyl MERCHANTS NATIONAL BONDING, INC. 6700 Westown Parkway West Des Moines IA 50266 , SURETY COMPANY on bond of (hero insxt neme end address of Camactorl DAGGER CONTRACTING, LLC 660 North Carroll Avenue, Suite 130 Southlake TX 76092 , CONTRACTOR, hereby approves of the fmal 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) ASFW APARTMENTS, L.P. 1500 W Jarvis St. Fort Worth TX 76102 , OWNER, as set forth in the said Surety Company's bond. IN WITNESS, WHEREOF, the Surety Company has hereunto set its hand this 27th day of April, 2022 MERCHANTS NATIONAL BONDING, INC. Surety Company Attest: (Seal): '�,�, h��riz Signature of Authorized Mikaela Pe�ners Attorney-in-Fact - Title NOTE: TAis furm ia to be used as a companion document to AtA DOCUMENT G706, CONTRACTOR'S AFfIDAV1T OF PAYMEM OF DEBTS AND CLAIMS, Cune�t EcHtien ONE PAGE MERCHANTS BONDING COMPANY-,. POWER OF ATTORNEY Know All Persons By These Presents, that MERCHANTS BONDING COMPANY (MUTUAL) and MERCHANTS NATIONAL BONDING, INC., both being corporations of the State of lowa, d/b/a Merchants National Indemnity Company (in Calrfomia ony) (herein collectivey called the "Companies") do hereby make, constitute and appoint, individualty, Don E Comell; Josh Saunders; Kelly A Westbrook; Mikaela Peppers; Ricardo J Reyna; Robbi Morales; Sophinie Hunter; Tina McEwan; Tonie Petranek their true and lawful Attorney(s)-in-Fact, to sign its name as surety(ies) and to execute, seal and adcnowledge any and all bonds, undertakings, contracts and other written instruments in the nature thereof, on behalf of the Companies in their business of guaranteeing the fidelity of persons, guaranteeing the performance of contracts and executing or guaranteeing bonds and undertakings required or permitted in any actions or proceedings allowed by law. This Power-of-Attomey is granted and is signed and sealed by facsimile under and by authority of the following By-Laws adopted by the Board of Directors of Merchants Bonding Company (Mutual) on April 23, 2011 and amended August 14, 2015 and adopted by the Board of Directors of MerchantsNational Bonding, Inc., on Odober 16, 2015. 'The President, Secretary, Treasurer, or any Assistant Treasurer or any Assistant Secretary or any Vice President shall have power and authority to appoint Attorneys-in-Fact, and to authorize them to execute on behalf of the Company, and attach the seal of the Company thereto, bonds and undertakings, recognizances, contracts of indemnity and other writings obligatory in the nature thereof." "The signature of any authorized officer and the seal of the Company may be affixed by facsimile or electronic transmission to any Power of Attomey or Certification thereof authorizing the execution and delivery of any bond, undertaking, recognizance, or other suretyship obligations of the Company, and such signature and seal when so used shall have the same force and effect as though manually fixed." In connedion with obligations in favor of the Florida Department of Transportation only, it is agreed that the power and aut hority hereby given to the Attorney-in-Fact includes any and all consents for the release of retained percentages and/or final estimates on engineering and construction contracts required by the State of Florida Department of Transportation. It is fully understood that consenting to the State ofFlorida Department of Transportation making payment of the final estimate to the Contrador and/or its assignee, shall not relieve this surety company of any of its obligations under its bond. In connection with obligations in favor of the Kentucky Department of Highways only, it is agreed that the power and authority hereby given to the Attomey-in-Fact cannot be modified or revoked unless prior written personal notice of such intent has been given to the Commissioner- Department of Highways of the Commonwealth of Kentucky at least thirty (30) days prior to the mod�cation or revocation. In Witness Whereof, the Companies have caused this instrument to be signed and sealed this 8th day of December , 2022 • '•��........... ��. P�10Nq� ••.,� v��p�R4��Z % '_' 2003 0;,�; •.�d�•. : �� : •,�� •. .:O .•'� .•---•. .•' 0�� • ��f '• � �. A . � 00, ORP09q.9 . • � �;�G J� :y,L � . �: _ -o- o: . :_� :3' a'• 1933 :s•. � �� •cti. . . . 6�;k. . . • •�:�� . . . . '.: . MERCHANTS BONDING COMPANY (MUTUAL) MERCHANTS NATIONAL BONDING, INC. d/bla MERCHANTS NATIONAL INDEMNITY COMPANY By STATE OF IOWA ••,,�� .•• •. � � �� . President COUNTY OF DALLAS ss. """' On this 8th day of December 2022 , before me appeared Larry Taylor, to me personalty known, who being by me duly sworn did say that he is President of MERCHANTS BONDING COMPANY (MUTUAL) and MERCHANTS NATIONAL BONDING, INC.; and that the seals affixed to the foregoing instrument are the Corporate Seals of the Companies; and that the said instrument was signed and sealed in behalf of the Companies by authority of their respective Boards of Directors. '�'"° Kim Lee � ; ` ,�_ '�'. Cammissan Number 7C2'37 ` �,Q ? � '.� �1y Commission Expres � ?,pril 14, 2Q24 Notary Public (Expiration of notary's commission does not invalidate this instrument) I, William Warner, Jr., Secretary of MERCHANTS BONDING COMPANY (MUTUAL) and MERCHANTS NATIONAL BONDING, INC., do hereby certify that the above and foregoing is a true and coRect copy of the POWER-0E-ATTORNEY executed by said Companies, which is still in full force and effect and has not been amended or revoked. In Witness Whereof, I hav�e hereunto set my hand and affixed the seal of the Companies on this 27th day of April , 2023 . ��.........�� .•---•.� ��.••P�10Nq�••.,� � •�\NG.CO,�'•� _ - . a �POR �0 , .00�ORp�q Aq'• �%✓ ==d : �y : v0 '��' : Z . ; ' ca '�.► :y,.c : • • :2:2 _p_ 0:0: .fy-.'= -o- o; : ' _ � 2003 � z : � a'• 1933 ' e • secretary =� � � '�`�'= ' y�'•• 'c:' . ••a��...,�,...;��: •,6,�W..� ..•;:d.. __- _ _ POA 0018 (10/22) '•''••••••••• ••••• MERCHANT�S� BONDING COMPANY�: MERCHAN"fS BONDWG CUMPANY (MUTUAL) P.O. BOx 14498. DES MOINES. IUwA 50306-3498 PHONE: (800) G78-8171 Fnx: (515) 243-3854 IMPORTANT NOTICE To obtain information or make a complaint: You m8y cont2ct your insurance agent at the telephone number provided by your insurance agent. You may call Merchants Bonding Company (Mutual) toll-free telephone number for information or to make a complaint at: 1-800-678-8171 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. O. Box 149104 Austin, TX 78714-9104 Fax: (512) 490-1007 Web: www.tdi.texas.aov E-mail: ConsumerProtection@tdi.texas.gov PREMIUM AND CLAIM DISPUTES: Should you have a dispute concerning your premium or about a claim you should contact the agent 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. SUP 0032 TX (2/15j