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Home My WebLink AboutContract 62383-FP1-FPl City Secretary Contract No. 62383 ------ FORT WORTH® 2/20/2025 Date Received ____ _ 03/03/2025 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: Quiktrip No. 0996 City Project No.: 105951 Improvement Type(s): Water� Original Contract Price: Amount of Approved Change Order(s): Revised Contract Amount: Total Cost of Work Complete: ontt c Udbetter:Brett C Ledbetter (Feb 19, 2025 14:11 CST) Contractor CFO Title Mora Construction Inc. Company Name ? 11,::. Randan Harp (Feifit.iois 14:15 CST) Project InspectorAhmed Musa,, P. E.Ahmed Musa, P.E. (Feb 20, 2025 08:33 CST) Pr=anager Kandice Merrick (Feb 20, 2025 09:30 CST) CFA Man�erdf--� Lauren Prieur (Feb 20, 2025 09:40 CST) TPW Director Asst. City Manager Sewer� $36,750.00 $2,912.50 $39,662.50 $39,662.50 Feb 19, 2025 Date Feb 19, 2025 Date Feb 20, 2025 DateFeb 20, 2025 Date Feb 20, 2025 DateFeb 21, 2025 Date Page 1 of 2 Notice of Project Completion Project Name: Quiktrip No. 0996 City Project No.: 105951 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: 65 WD Days Charged: 30 WD Work Start Date: 12/23/2024 Work Complete Date: 2/14/2025 Completed number of Soil Lab Test: 18 Completed number of Water Test: 4 Page 2 of 2 FORTWORTH CITY OF FORT WORTH FINAL PAYMENT REQUEST Contract Name QUIKTRIP NO 996 Contract Limits Project Type WATER & SEWER City Project Numbers 105951 DOE Number 5951 Estimate Number 1 Payment Number 1 City Secretary Contract Number Contract Date Project Manager NA Contractor MORA CONSTRUCTION, INC. 109 S. STORY #E Inspectors For Period Ending 2/14/2025 WD Contract Time 6�VD Days Charged to Date 30 Contract is 100.00 Complete IRVING, TX 75060 T. GARDNER / R. HARP Monday, February 17, 2025 Page 1 of 4 City Project Numbers 10595] Contract Name QUIKTRIP NO 996 Contract Limits Project Type WATER & SEWER Project Funding UNIT I: WATER IMPROVEMENTS Item Description of Items �stimated Unit No. Quanity 1 6" PVC WATER PIPE 10 LF 2 FIRE HYDRANT 1 EA 3 TRENCH SAFETY 10 LF 4 METER BOX ADJUSTMENT 2 EA 5 TRAFFIC RATED METER BOX COVER (CO#1) 0 EA 6 2" WATER METER (DOMESTIC) (CO#2) 1 EA 7 1.5" WATER METER (IRRIGATION )(CO#2) 1 EA 8 2" WATER SERVICE (DOMESTIC) (CO#2) 10.5 LF 9 1.5" WATER SERVICE (IRRIGATION )(CO#2) 12.5 LF Sub-Total of Previous Unit iJNTl' II: SER'ER IMPROVEMENTS DOE Number 5951 Estimate Number 1 Payment Number 1 For Period Ending 2/14/2025 Unit Cost Estimated Completed Completed Total Quaniry Total $I50.00 $1,500.00 10 $1,500.00 $I1,000.00 $11,000.00 1 $I1,000.00 $145.00 $1,450.00 10 $1,450.00 $4,500.00 $9,000.00 2 $9,000.00 $875.00 $0.00 0 $0.00 $1,500.00 $1,500.00 1 $1,500.00 $1,500.00 $1,500.00 1 $1,500.00 $75.00 $787.50 10.5 $787.50 $70.00 $875.00 12.5 $875.00 $27,612.50 $27,612.50 Item Description of Items EsNmated Unit Unit Cost �stimated Completed Completed �'o. Quanity Total Quanity Total 1 6" SEWER SERVICE 1 EA $9,600.00 $9,600.00 1 $9,600.00 2 4" 2-WAY CLEANOUT 1 EA $850.05 $850.05 1 $850.05 3 TRENCH SAFETY 11 LF $145.45 $1,599.95 11 $1,599.95 Sub-Total of Previous Unit $l2,oso.00 $iz,oso.00 Monday, February 17, 2025 Page 2 of 4 City Project Numbers 10595] Contract Name QUIKTRIP NO 996 Contract Limits Project Type WATER & SEWER Project Funding Contract Information Summary Original Contract Amount Change Orders Change Order Number 1 Change Order Number 2 Total Contract Price DOE Number 5951 Estimate Number 1 Payment Number 1 For Period Ending 2/14/2025 $36,750.00 ��i,�so.00> $4,662.50 $39,662.50 Total Cost of Work Completed $39,662.50 Less % Retained $0.00 Net Earned $39,662.50 Earned This Period $39,662.50 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 $39,662.50 Monday, February 17, 2025 Page 3 of 4 City Project Numbers 10595] Contract Name QUIKTRIP NO 996 Contract Limits Project Type WATER & SEWER DOE Number 5951 Estimate Number 1 Payment Number 1 For Period Ending 2/14/2025 Project Funding Project Manager NA Inspectors T. GARDNER / R. HARP Contractor MORA CONSTRUCTION, INC. 109 S. STORY #E IRVING, TX 75060 City Secretary Contract Number Contract Date Contract Time 65 WD Days Charged to Date 30 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 $39,662.50 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 $39,662.50 $0.00 $39,662.50 $0.00 $0.00 $0.00 $0.00 $0.00 $39,662.50 Monday, February 17, 2025 Page 4 of 4 DEVELOPER-AWARDED-PROJECT CHANGE ORDER REVIEWED By Sandip Adhikari at 9:13 am, Dec 30, 2024 Revised: 10-12-2071 Page 1 INSPECTOR: Randall Harp Phone No: 682-213-0359 PROJECT MANAGER: Sandip Adhikari Phone No: 817-392-8424 han es in the wntract documents: CITY BID ITEM UNIT PRICE I TOTAL REASONS FOR CHANGE ORDER Changes correspond to Revision 1 as shown on Sheek 5, 8 8 7 on the cansWtian plans. The ewsting meter boxes are able to be adjusled within the proposed IaMscape Island and will no longer require a fraKc rated meter 6ox lid. The sewar design was revised to avoid additional charges for this work. These proposed NO CITY FUNDS INVOLVED IN THIS CONTRACT. DEVELOPER IS RESPONSIBLE FOR 700% OF THE CHANGE ORUER CDST AND NO REIbIBURSEMENT FROM TNE CITY WILL BE SOUGHT BY THE DEVELOPER. RECOMMENDE�: APPROVED: APPROVED: Kirkman Engineering, LlC QT Soulb. LLC Mora ConsWction, INCi. By: ��d�L cSC�iit�ti gy; _ gy. /� � . Name: Jonathan Schindler, P.E. Name: Thomas Edwards Name: Brett Ledbetter Title: Gvil Engineer Title: Division Real Estate Manager Title: CFO REVIEWED By Sandip Adhikari at 9:13 am, Dec 30, 2024 Revised: ib12-2011 Page 2 DEVELOPER-AWARDED-PROJECT CHANGE ORDER PROJECT NAME: C2uikTri No. 996 CHANGE CONTRACT: Water and Sewer Im rovements ORDER No: CFA # 24-0169 CIIY PARTICIPATION: No CITY PROJECT # 105951 Z FID # 301140200431-105951-E07fi85 FILE # X-28408 INSPECTOR: Randall Harp Phone No: 682-231-0359 PROJECT MANAGER: Ahmed Musa Phone No: 817-392-2084 CONTRACT UNIT WATER SEWER PAVING DRAINAGE STREET LIGHTS CONTRACT Developer Devalopar Developer Developer Developer DAYS Cost City Cost Cost C Cod Cost CI Cost Cost CI Cost Cost Ciry Cost ORIGINAL CONTRACT E24,700.00 50.00 f12,050.00 SO.OD SD-00 50.00 E0.00 50.00 50.00 SO.OD 65 EXTRAS TO �ATE 50.00 SO.OU f0.00 50.00 50.00 E0.00 $0.00 50.00 50.00 30.00 CREDITS TO DATE 51,750.00 {0.00 f0.00 �.00 50.00 S�•QU $O.UO 50.00 50.00 SO.Otl CONTRACT TO DATE $72,950.00 50.00 $72,050.00 50.00 E0.00 50.00 50.00 59.00 50.00 50.00 65 AMOUNT OF PROP. CHANGE ORDER ¢1,662.50 $0.00 50.00 50.00 50.00 $0.00 50.00 50.00 i0.00 O REVISEDCONTRACTAMOUNT 527,672.50 50.00 512,050.00 50.00 E0.00 50.00 $0.00 50.00 50.00 f0.00 65 TOTAL REVISED CONTRACT AMOUNT PER UNIT 527,612.50 E72,050.00 $0.00 $0.00 b0.00 REVISED CO3T SHARE Dev. COSt: E39,6621.50 ICI�y COS�: SO.00 TOTAL REVISED CONTRACT E39,662.50 REVIEWED By Ahmed Musa at 10:20 am, Feb 05, 2025 Revised: 10-12-2011 Page 1 You are directed to make the '6 REASONS FOR CHANGE ORDER ianges in ih�e wntred documents : iAdd lines as re� uired - DELETE THIS TEX'� CIiY BID ITEiM Add 2" and 7.5" water meters and copper service NO CITY FUNDS INVOLVEU IN TNIS CONTRACT. DEVELOPER IS RESPONSIBLE FOR 700 % OF THE CHANGE ORDER COST AND NO REIMBURSEMENT FROM THE CITY WILL BE SOUGHT BY THE DEVELOPER. RECOMMENDED: APPROYEO: APPROVED: Kirkman Engineering, LLC QT Squth, C�� Mora ConatryeUo�„ Inc ^l / / � � / j� � , By: �� .�� By: z�'-"� By: ' .. Name: John Gardner Name: TFamas Edwards Name: 6rett Ledbatter r�ue: Project Manager Title: Division Real Estate Maneger rqe: cFo APPROVAL RECOMMENDED: APPROVED: APPROVED AS TO FORM AND LEGALRY: CFW-FuntlrnpDepartment CFW-Assis7a,nfCiryManage� CFW-Ass�starxCdVA¢orney By N/A By. N/A 6V: WA Name: Name_ Name- TiUe: Tdle_ rRle RECOMMENDED: CFW -'Coniract ComA�rance Manager �' —� N�� Ahmed Musa T� Project Manager Aa&C Number: M&CDateApproved: n�i�. ATTEST ' Coneract Compliance Manager (ProjeM Manager�: By signing I acknowledqe that I am the person responsiUle N/A for the monitonng antl atlministration of this mntncl, lnclutle e�sunng all pertormance antl reporting requirements. Jannette S. Goodall Cdy Secretary 0 There are NO CM Funtls associated wHh Ihis Contract � There are CiN Funtls associatetl wiih ihis Contract REVIEWED By Ahmed Musa at 10:20 am, Feb O5, 2025 Revised: 10-12-2011 Page 2 FoRTWoRTH TRANSPORTATION AND PUBLIC WORKS PIPE REPORT FOR: PROJECT NAME: CPN 105951 QT 996 IPRC CFA Project CITY PROJECT NUMBER: 105951 WATER PIPE LAID SIZE TYPE OF PIPE LF 6" PVC 10 FIRE HYDRANTS: 1 PIPE ABANDONED N/A SIZE N/A VALVES (16" OR LARGER) TYPE OF PIPE N/A LF N/A DENSITIES: NEW SERVICES: 2"(1) 1.5"(1) N/A SEWER PIPE LAID SIZE TYPE OF PiPE LF N/A N/A PIPE ABANDONED SIZE Y11'/��[�l��l��l LF DENSITIES: NEW SERVICES: 6"(1) COPPER COPPER PVC TR�NSPORT:�TION 1�ND PUBLIC `��ORI�S The Citt� of Fort Worth • 1000 Throckmorton Stieet • Fort Wordi, TX 76012-6311 (817) 392 - 7941 • Fax: (817) 392 - 7845 ��rH� TRANSPORTATION AND PUBLIC WORKS February 6, 2025 Mora Construction, Inc P.O. Box 154897 Irving, Texas, 75015 RE: Acceptance Letter Project Name: 105951-QT 966 IPRC Express CFA Project Project Type: Developer City Project No.: 105951 To Whom It May Concern: On February 14, 2025 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 February 14, 2025, 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 8306. Sincerely, AG�med Mus�, P. E. Ahmed Musa, RE (Feb 20, 20L5 08:33 CST) Ahmed Musa, Project Manager Cc: Randall Harp, Inspector Troy Gardner, Inspection Supervisor Ariel Duarte, Senior Inspector Andrew Goodman, Program Manager Jonathan Schindler, Consultant Brett Ledbetter, Contractor QT South, LLC, Developer File E-Mail: TPW_Acceptance@fortworthtexas.gov Signature: � ��a� Email: Elisa.Winterrowd@fortworthtexas.gov Rev. 08/20/19 AFFIDAVIT' STATE OF TEXAS C�OUNTY OF TARRANT Bcforc n��c, t1�c undcrsigncd autllority, a notary public in thc �tatc and cuunty aforesaid, on this day personally appcarcd Rogcr Mora, Presid�nt Of Mora Constiuction, INC., known to i11e to bc a crcdibic person, who being by me duly sworn, upon his uath deposed and said; That all persons, firms, associations, corporations, or oth�r organizalions fu�7lishing labor and'or material, have been paid in Cull; That the wage scale establishcd by the City Council in thc City ofi Fort Worlh has been paid in Cull; That therc arc Ttu claitns pcnding for p�rs��nal injury andlor pmperty dama�es; On Contiac;t describcd as; Water and Sewer BY R�er Mora, President Subscribed and sworn beforc me on this datc 31 st of January, 2U25. � olary Publ� Tan-anl, Tcxas �a,0.V PGe BRETT CHARLES ? � LEDBETTER ,� Notary ID #10398250 9rFOF��+P My Commission Expires February 9, 2p27 CONSENT OF c�w��r:R ❑ SURETY COMPANY nrtcr�«ecr ❑ T� FI�1AL P�IYMENT cov��nc-roR ❑ SUR�TY ❑ AIA D�CUMENT G707 o�rxrR B[)Ild ��Q. PROJECT: Q'C #099fi - Sanitary Scwcr and Watcr improvcrr�cnts {I1i311iC, address) TO (Owncr} [ City of Fc�rt Wortl� 1000 Throckmortc�n Strcet �ort Worth, TX 7fiIO2-631Z 11RCHITEC'I''S PR01�,CT NO: CONTR1I,CT rOR: CONTRACT DATE: Novcrriber 25, 2024 CONTRACTOR: Mcjra Canstruction, inc. Po Box 154897 �rving, TX 7�015 In accordancc with thc provis'sons of thc Contract betwccn thc Owncr and thc Contractor as indicatcd abovc, thc (hcrc inscrt namc und address of Surcty Coinpasiy} Swiss Re Corporate Solutinns Axnerica Insurance Corporation 1200 Main St., Stsitc 800 on bond of (hcrc inscrt siami and address of Contractor) , SU�t1�TY COMPANY, Mara Construciion, Ine. 1'o 13tix 154$97 irving, TX 75015 , CONTRACTOR, hercby approves of Ehc fnal p�iyment to lhc Cantractors, a��d agrces that fin�tl paymcni to thc Contractar shall ��ot re�ic�e thc Surcfy Company of a�-�y of its ob1ig8110R5 iD (hcrc insert namc and address of Owncr) City of Fort Wortla 1000 Throckznorfon Street Fort Woril�, TX 7C 1 �2-6312 as Sct farth in thc said Surety Company's bo�1d. 1N WITNESS WHE�t1:OF, khc Surety Company I�as hcrctinto Set its hand tliis 19th � Attcst: .� (Sca]): _. day of I+ebruary 2QZS ,OWNGR, Swiss Rc Corporate Solutic�aas America Insurance Surcty Company `�-�5--�� `..\._ Si ��aturc of Authorizcd �� Rcprescntativc Debra L�e Moon Atforney��r��i��c� "fitic � � N07`[i: "I'l�is £or�n is ia bc uscd as a comp;tuiuia documcn� to AIA p{}CUMI;N'[' G7Ufi, CUN'I'RA[:�1�OR'S N�1 1Dl1V17' OI� PAY�UIIiNI' OP IJIiL3'I'S ANll C1.Ali�lS, Currcnt l:ditiozi AlA DOCUML-'N']� G707. CUVSE\7' OP SURE"1'Y COMPANY'I'{? I�[NAL PAYiYff \'T. /1E'EtIL 197U EiD]TIQN • 111A f+ O\'li PAUI: O 197U • THL �MIiRICnN IN5'I'17'U`i'13 OP ARCHI'I'i'.C"CS, ]735 NGw York r1vc., NW, WA51[INU"I'ON, ll.C. 2(10Q( SWISS RE CORPORATE SOLUTIONS SWISS RE CORPORATE SOLUTIONS AMERICA INSURANCE CORPORATION ("SRCSAIC") SWISS RE CORPORATE SOLUTIONS PREMIER INSURANCE CORPORATION ("SRCSPIC") WESTPORT INSURANCE CORPORATION ("WIC") GENERAL POWER OF ATTORNEY KNOW ALL MEN BY TfiESE PRESENTS, THAT SRCSAIC, a wrporation duly organized and existing under laws of the State of Missouri, and having its principal office in the City of Kansas City, Missouri, and SRCSPIC, a corpotation organized and existing under the laws of the State of Missouri and having its principal o�ce in the City of Kansas City, Missouri, and WIC, organized under the laws of the State of Missouri, and having its principal office in the City of Kansas City, Missouri, each does hereby make, constitute and appoint: .iOHN R. WARD, THOMAS DOUGLAS MOORE, EMILY ALIISON MIKESKA, ALLYSON W. DEAN, MONICA RUBY VEAZEY, .lOHN WILLlAM NEWBY, TROY RUSSELL KEY, DEBRA LEE MOON ANOREA ROSE CRAWFORD, SANDRA LEE RONEY, FAITH ANN HILTY, ANDREW GARETH ADDISON, PATRICK THOMAS COYLE, BRYAN KELLY MOORE, ELIZABETH ORTIZ, ANA OWENS, BETTY J. REEH, ANDREW PATRICK CLARK ANO KIMBERLY ROCHELLE GONZALEZ JOINTLY OR SEVERALLY Its true and lawful Attomey(s)-in-Fact, to make, execute, seal and deliver, for and on its behalf and as its act and deed, bonds or other writings obligatory in the nature of a bond on behalf of each of said Companies, as surety, on contracts of suretyship as are or may be required or permitted by law, regulation, contract or otherwise, provided that no bond or undertaking or wntract or suretyship executed under this authoriry shall exceed the amount of• TWO HUNOREO MILLION (5200,000,000.00) DOLLNRS This Power of Attorney is granted and is signed by facsimile under and by the authority of the following Resolutions adopted by the Boazds of Directors of hoth SRCSAIC and SRCSPIC at meetings duly called and held on the 18th of Novemiser 2021 and WIC by written consent of its Execurive Committee dated July 18, 2011. "RESOLVED, that any two of the President, any Managing Directar, any Senior Vice President, any Vice President, the Secretary or any Assistant Secretary be, and each or any of them hereby is, authorized to execute a Power of Attomey qualifying the attomey named in the given Power of Attorney to execute on behalf of the Corporation boads, undertakings and all contracts of surety, and that each or any of them hereby is authorized to attest to the execution of any such Power of Attorney and to attach therein the seal of the Corporation; and it is F[JRTHER RESOLVED, that the signature of such ofiicers and the seal of the Corporarion may be affixed to any such Power of Attomey or to any certifcate relating thereto by facsimile, and any such Aower of Attomey or certificate bearing such facsimile signatures or facsimile seal shall be bindine uuon the Co�poration when so afiixed and in the future with reeard to anv bond. undertaking or contract of surety to which it is attached." --., „ ..._ ,��,.,�� S EAL Jt�pNS PRF,yjFq,,�� !. f.,� C . ; `oRPORql��y�'I By �� C. � �.: S��. D�vld Satory, Senlor Vlce PrcsEdent of SRCSAIC Q� Seeior Vlee PresEdenl : m: of SRCSPIC & Swbr Viu Presldent of WIC .,M�Sso�p�.�o°�'�� B -C1�'o' �9^°� ' y ap ��.�,,,�� *„„��, Ccratd ie�rornid, Vla Presideat ofSRCSA[C1e Ylee Presideet ofSRCSPtC „� S N�a• n� �nn & Vtce Pres�denl of WIC IN WITNESS WHEREOF, SRCSAIC, SRCSPIC, and WIC have caused their official seals to be hereunw affixed, and these presents to be signed by their suthorized o�cers �jg 6TH d8�r Of DECEMBER ZO_ 24 State of Illinois County of Cook � Swiss Re Corporate Solutions America Iasurance Corporation Swiss Re Corporate Solutioas Premier Insurance Corporation Westport Insurance Corporat[on On this sT� day of DECEMBER , 20 24 , befote me, a Notary Public personally agpeared David Satory , Senior Vice President of SRCSAIC and Senioc Vice President of SRCSPIC and Senior Vice Presedent of W[C and Gerald Jaarowski , Vice President of SRCSAIC and Vice President of SPCSPIC and Vice President of WIC, personally known W me, who being by me duly swom, acknowledged that they signed the above Power of Attaney as officers of and acknowledged said insm►ment to be the voluntary act and deed of their �+espective companies. „�.� � : . ' �..�,�,au, ,1��.� t..��a+s.r�.n�wr - - Kacen A ' nkda, Notyy. I, Jeffrev Goldbera, the duly elected Senior Vice President and Assistant Secretary of SRCSA[C and SRCSPIC and WIC, do hereby cerx�fy thet t4te abo�re and foregoing is a true and correct wpy of a Power of Attomey given by said SRCSAIC and SRCSPIC and WIC, which is still iri full force and e�'ecr-, -�� IN WI7'NESS WHEREOF, I have set my hand and affixed the seals of the Companies this 1 Sth day nf__ Febi'U8N , 20 25 , _� -� -- _ �,';,�;�: �•r" :-r.., ' - � + _ Jeffrey Goldberg, Senior Vice President & - Assistant Secretary of SRCSAIC and SRCSPIC and WIC ��U'�� :\ \� In order to obtain information or make a complaint: You may contact the Surety Claims Department at 1-816-235-3702 You may call Swiss Re Corporate Solutions America Insurance Corporation or Swiss Re Corporate Solutions Premier Insurance Corporallon for information or to make a complaint at: 1-816-235-3702 You may also write to Swiss Re Corporate Solutions America Insurance Corporation or Swiss Re Corporate Solutions Premier Insurance Corporation at the following address: 1200 Main Street, Suite 800 Kansas City, MO 64105 You may contact the Texas Department of Insurance to obtain informatian 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: hitp://www_tdi.state.t�e_us E-mail:�o ns � merProtection(g�tdi.state.tx. �s PREMIUM OR CLAIM DISPUTES: Should you have a dispute concerning your premium or about a claim you should first contact the Swiss Re Corporate Solutions America Insurance Corporation or Swiss Re Corporate Solutions Premier Insurance Corporation. 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. � U'�C _\ Para obtener informacion o para someter un queja: Puede comunicarse con Surety Claims Department al 1-816-235-3702. Usted puede llamar Swiss Re Corporate Solutions America Insurance Corporation o Swiss Re Corporate Solutions Premier Insurance Corporation para informacion o para someter una queja al: 1-816-235-3702 Usted tambien puede escribir a Swiss Re Carporate Solutions America Insurance Corporation o Swiss Re Corporate Solutions Premier Insurance Corporation al: 120Q Main Street, Suite 8Q0 Kansas City, MO 64105 Puede escribir al Departmento de Seguros de Texas para obtener informacion acerca de companias, coberturas, derechos o yuejas al: 1- 800-252-3439 Puede escribir al Departmento de Seguros de Texas: P.O. Box 149104 AusHn, TX 787149104 Fax: (512} 475-1771 Web: httn://www.tdi.state.trc.�s E-mail:C:oncL merProtectionntdi.state.tx. Ls DISPUTAS SOBRE PRIMAS O RECLAMOS: Si tiene una disputa concerniente a su prima o a un reclamo, debe comunicarse con el Swiss Re Corporate Solutions America Insurance Corporation o Swiss Re Corporate Solutions Premier Insurance Corporallon primero. 5i no se resuelve la disputa, puede entonces comunicarse con el Departmento de Seguros de Texas. UNA ESTE AVISO A SU POLIZA: Este aviso es solo para proposito de infromacion y no se converte en parte o condicion del dacumento adjunto.