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Home My WebLink AboutContract 60158-FP4-FP4 City Secretary 60158 Contract No. FORT WORTH. Date Received 3/5/2025 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: Hampton Tract Ph 2 City Project No.: 104313 Improvement Type(s): Water x❑ Sewer x❑ Original Contract Price: $2,481,817.60 Amount of Approved Change Order(s): $1,800.00 Revised Contract Amount: $2,483,617.60 Total Cost of Work Complete: $2,483,617.60 Feb 12, 2025 Contractor Date Vice President Title Burnsco Construction, Inc. Company Name Mail -Cain Feb 12 2025 Matt Cain (Feb 12, 2025 13:17 CST) Project Inspector Date Z�4 , a- A Mar 5, 2025 Project Manager Date Mar 5, 2025 JUndi(Mar 4202513:45 CST) CFA Manager Date �� Mar 5, 2025 TPW Director Date 06)� Mar 5, 2025 Asst. City Manager Date OFFICIAL RECORD CITY SECRETARY Page 1 of 2 FT. WORTH, TX Notice of Project Completion Project Name: Hampton Tract Ph 2 City Project No.: 104313 City's Attachments Final Pay Estimate x❑ Change Order(s): ❑x Yes ❑ N/A Pipe Report: x❑ Yes ❑ N/A Contractor's Attachments Affidavit of Bills Paid Consent of Surety Statement of Contract Time Contract Time: 300 WD Days Charged: 249 WD Work Start Date: 10/5/2023 Work Complete Date: 12/23/2024 Completed number of Soil Lab Test: 375 Completed number of Water Test: 18 Page 2of2 FoRTWORTH CITY OF FORT WORTH FINAL PAYMENT REQUEST Contract Name HAMPTON TRACT PHASE 2 Contract Limits Project Type WATER & SEWER City Project Numbers 104313 DOE Number 4313 Estimate Number 1 Payment Number 1 City Secretary Contract Number Contract Date For Period Ending 12/23/2024 WD Project Manager NA Contractor BURNSCO CONSTRUCTION, INC. 6331 SOUTHWEST BLVD FORT WORTH, TX 76132 Inspectors G. DEYON / M.CAIN Contract Time 30WD Days Charged to Date 249 Contract is 100.00 Complete Tuesday, February 11, 2025 Page 1 of 5 City Project Numbers 104313 Contract Name HAMPTON TRACT PHASE 2 Contract Limits Project Type WATER & SEWER Project Funding UNIT I- A: WATER IMPROVEMENTS Item Description of Items Estimated Unit No. Quanity 1 4"-12" PRESSURE PLUG 2 EA 3 4' WIDE ASPHALT PVMT REPAIR, ARTERIAL 15 LF 4 TRENCH SAFETY 9169 LF 5 CONCRETE ENCASEMENT FOR UTILITY PIPES 5 CY 6 20" STEEL CASING BY OPEN CUT 138 LF 7 DUCTILE IRON WATER FITTINGS W/ 4 TN RESTRAINT 9 FIRE HYDRANT W/ GATE VALVE 10 EA 10 CONNECTION TO EXISTING 4"-12" WATER 1 EA MAIN 11 1" WATER SERVICE (IRRIGATION) 8 EA 12 1" WATER SERVICE (DOMESTIC) 227 EA 13 8" GATE VALVE & BOX 28 EA 14 TRAFFIC CONTROL 1 MO 2 8" WATER LOWERING 20 EA 8 8" PVC WATER PIPE 9169 LF Sub -Total of Previous Unit ------------------- UNIT I- B: WATER IMPROVEMENTS Item Description of Items Estimated Unit No. Quanity 1 4"-12" PRESSURE PLUG 1 EA 2 TRENCH SAFETY 643 LF 3 DUCTILE IRON WATER FITTINGS W/ 1 TN RESTRAINT 4 8" DIP WATER 5 8" PVC WATER PIPE 6 FIRE HYDRANT W/ GATE VALVE 7 CONNECTION TO EXISTING 4"-12" WATER MAIN 8 8" GATE VALVE & BOX 9 TRAFFIC CONTROL DOE Number 4313 Estimate Number 1 Payment Number 1 For Period Ending 12/23/2024 Unit Cost Estimated Completed Completed Total Quanity Total $310.00 $620.00 2 $620.00 $173.00 $2,595.00 15 $2,595.00 $0.10 $916.90 9169 $916.90 $400.00 $2,000.00 5 $2,000.00 $160.00 $22,080.00 138 $22,080.00 $6,000.00 $24,000.00 4 $24,000.00 $7,360.00 $73,600.00 10 $73,600.00 $2,600.00 $2,600.00 1 $2,600.00 $1,510.00 $12,080.00 8 $12,080.00 $1,500.00 $340,500.00 227 $340,500.00 $2,500.00 $70,000.00 28 $70,000.00 $2,500.00 $2,500.00 1 $2,500.00 $5,250.00 $105,000.00 20 $105,000.00 $54.20 $496,959.80 9169 $496,959.80 $1,155,451.70 $1,155,451.70 Unit Cost Estimated Completed Completed Total Quanity Total $310.00 $310.00 1 $310.00 $0.10 $64.30 643 $64.30 $6,000.00 $6,000.00 1 $6,000.00 260 LF $68.00 $17,680.00 260 $17,680.00 383 LF $54.20 $20,758.60 383 $20,758.60 1 EA $7,360.00 $7,360.00 1 $7,360.00 1 EA $1,300.00 $1,300.00 1 $1,300.00 2 EA $2,500.00 $5,000.00 2 $5,000.00 1 MO $1,500.00 $1,500.00 1 $1,500.00 Tuesday, February 11, 2025 Page 2 of 5 City Project Numbers 104313 Contract Name HAMPTON TRACT PHASE 2 Contract Limits Project Type WATER & SEWER Project Funding DOE Number 4313 Estimate Number 1 Payment Number 1 For Period Ending 12/23/2024 Sub -Total of Previous Unit $59,972.90 $59,972.90 ------------- UNIT H: SANITARY IMPROVEMENTS Item Description of Items Estimated Unit No. Quanity 1 CONCRETE ENCASE SEWER PIPE (CO 2) 4 CY 2 LARGE STONE RIPRAP, DRY 160 SY 3 POST -CCTV INSPECTION 9509 LF 4 MANHOLE VACUUM TESTING 38 EA 5 MANHOLE ADJUSTMENT, MINOR 1 EA 6 TRENCH SAFETY 9509 LF 7 TRENCH WATER STOPS 24 EA 8 IMPORTED EMBEDMENT/ BACKFILL, CSS 640 LF 9 20" STEEL CASING BY OPEN CUT 160 LF 10 4" SEWER SERVICE 227 EA 11 8" SEWER MAIN 9268 LF 12 8" DIP SEWER MAIN 241 LF 13 EPDXY MANHOLE LINER 34 VF 14 4' MANHOLE 39 EA 15 EXTRA DEPTH MANHOLE (>6.0) 138 V F 16 TRAFFIC CONTROL 1 MO Sub -Total of Previous Unit Unit Cost Estimated Completed Completed Total Quanity Total $450.00 $1,800.00 4 $1,800.00 $96.00 $15,360.00 160 $15,360.00 $3.00 $28,527.00 9509 $28,527.00 $145.00 $5,510.00 38 $5,510.00 $1,100.00 $1,100.00 1 $1,100.00 $1.00 $9,509.00 9509 $9,509.00 $350.00 $8,400.00 24 $8,400.00 $52.00 $33,280.00 640 $33,280.00 $160.00 $25,600.00 160 $25,600.00 $1,440.00 $326,880.00 227 $326,880.00 $62.00 $574,616.00 9268 $574,616.00 $121.00 $29,161.00 241 $29,161.00 $400.00 $13,600.00 34 $13,600.00 $4,250.00 $165,750.00 39 $165,750.00 $200.00 $27,600.00 138 $27,600.00 $1,500.00 $1,500.00 1 $1,500.00 $1,268,193.00 $1,268,193.00 Tuesday, February 11, 2025 Page 3 of 5 City Project Numbers 104313 Contract Name HAMPTON TRACT PHASE 2 Contract Limits Project Type SANITARY Project Funding Contract Information Summary Original Contract Amount Change Orders Change Order Number 2 DOE Number 4313 Estimate Number 1 Payment Number 1 For Period Ending 12/23/2024 $2,481,817.60 $1,800.00 Total Contract Price $2,483,617.60 Total Cost of Work Completed $2,483,617.60 Less % Retained $0.00 Net Earned $2,483,617.60 Earned This Period $2,483,617.60 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 $2,483,617.60 Tuesday, February 11, 2025 Page 4 of 5 City Project Numbers 104313 Contract Name HAMPTON TRACT PHASE 2 Contract Limits Project Type SANITARY Project Funding Project Manager NA Inspectors G. DEYON / M.CAIN Contractor BURNSCO CONSTRUCTION, INC. 6331 SOUTHWEST BLVD FORT WORTH, TX 76132 DOE Number 4313 Estimate Number 1 Payment Number 1 For Period Ending 12/23/2024 City Secretary Contract Number Contract Date Contract Time 300 WD Days Charged to Date 249 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 $2,483,617.60 Less % Retained $0.00 Net Earned $2,483,617.60 Earned This Period $2,483,617.60 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 $2,483,617.60 Tuesday, February 11, 2025 Page 5 of 5 PROJECT NAME: CONTRACT: CFA # CITY PROJECT # CITY SECRETARY CONTRACT # IFID# ISEWER PROJECT # IFILE # INSPECTOR: PROJECT MANAGER: DEVELOPER -AWARDED -PROJECT CHANGE ORDER Hampton Tract Ph 2 Utilities 22-0253 104313 30114-0200431-104313-EO7685 X-27600 George Marquez WATER Developer CITY PARTICIPATION:( NO Phone No: Phone No: 817-392-6826 CONTRACT UNIT SEWER DRAINAGE Cost City Cost Developer Cost City Cost Developer Cost ROM ORIGINAL CONTRACT $1,215,424.60 $1,266,393.00 $0.00 $2,439,733.00 EXTRAS TO DATE $0.00 $0.00 $0.00 CREDITS TO DATE $0.00 $0.00 $0.00 CONTRACT TO DATE $1,215,424.60 $1,266,393.00 $2,439,733.00 (AMOUNT OF PROP. CHANGE ORDER $0.00 $1,800.00 411 REVISED CONTRACT AMOUNT $1,215,424.60 $1,268,193.00 $2.439,733.00 TOTAL REVISED CONTRACT AMOUNT PER UNIT $1,215,424.60 $1,268,193.00 $2,439,733.00 REVISED COST SHARE Dev. Cost: $7,965,973.79 City ( TOTAL REVISED CONTRACT $7,965,973.79 REVIEWED By Andrew Goodman at 4:11 pm, Feb 03, 2025 CHANGE ORDER No: 2 PAVING STREET LIGHTS Developer Developer Cost MIJEliffdkilift Cost City Cost $2,730,853.15 $364,501.64 $0.00 $0.00 _ $0.00 $0.00 $52,731.60 $2,730,853.15 $311,770.04 $2,730,853.15 $311,770.04 $2,730,853.15 $311,770.04 CONTRACT DAYS 300 W D 300 W D 300 WD Revised: 12-17-2018 Page 1 REVIEWED By Andrew Goodman of 4:11 pm, Feb 03, 2025 You are directed to make the followinq changes in the contract documents: CITY BID ITEM PAY ITEM # # QUANTITY UNIT ITEM DESCRIPTION I UNIT PRICE TOTAL 1 0330.0001 4 CY Concrete Encase Sewer Pipe $450.00 $1,800.00 $1,800.00 Asterisk (*) indicates New Pay Item REASONS FOR CHANGE ORDER Change order required to reconcile total contract amount for Sanitary Sewer Section. PM Note: CFA was executed without cost of Line Item #1 in Unit II: Sewer Improvements. Change Order includes missing cost to rectify missing cost on Line Item #1. Revised: 12-17-2018 Page 2 RECOMMENDED: Shield Engineering ring (�1�y1/,1l r Name: 174 k b qc,," Title: PC03rJ , AA14V— APPROVAL RECOMMENDED: CFW - Sponsoring Department N/A By: Name: Title: RECOMMENDED: CFW - "Contract Comoliance Manager By: L� _'yy Andrew Goodman Name: Title: Engineering Manager M&C Number: M&C Date Approved: REVIEWED By Andrew Goodman at 4:11 pm, Feb 03, 2025 APPROVED: APPROVED: DR Horton Burnsco Cors(ru ion lnc. l/(.I�j� By: � � � By: Name: `�/ �/t7s �' {��+' Name: Albert Grantges Title: `r ` C �ar\� 1/Q VelOA-111kTitie: Vice President APPROVED: CFW - Assistant City Manager N/A By: Name: Title: APPROVED AS TO FORM AND LEGALITY: CFW -Assistant City Attorney By: N/A Name: Title: ATTEST * Contract Compliance Manager (Project Manager): By signing I acknowledge that I am the person responsible N/A for the monitoring and administration of this contract, include ensuring all performance and reporting requirements. Jannette S. Goodall City Secretary Fvl There are NO City Funds associated with this Contract IJ There are City Funds associated with this Contract Revised: 12-17-2018 Page 3 FORT WORTH, TRANSPORTATION AND PUBLIC WORKS PIPE REPORT FOR: PROJECT NAME: Hampton Tract Ph.2 CITY PROJECT NUMBER: 104313 WATER PIPE LAID SIZE TYPE OF PIPE LF C900 8" PVC 9552 C900 8" DIP 260 FIRE HYDRANTS 11 VALVES (16" OR LARGER N/A PIPE ABANDONED SIZE TYPE OF PIPE LF N/A DENSITIES; Yes NEW SERVICES: 1" Copper (Irrigation) 8 1" Copper (Domestic) 227 SEWER PIPE LAID SIZE TYPE OF PIPE LF SDR26 8" PVC 9268 SDR26 8" DIP 241 PIPE ABANDONED SIZE TYPE OF PIPE LF N/A DENSITIES; Yes NEW SERVICES: 4" PVC 227 TRANSPORTATION AND PUBLIC WORKS The City of Fort Worth • 1000 Throckmorton Street • Fort Worth, TX 76012-6311 (817) 392 - 7941 • Fax: (817) 392 - 7845 FORTWORTH. M, TRANSPORTATION AND PUBLIC WORKS January 27, 2025 Burnsco Construction, Inc. 6331 Southwest Blvd. Benbrook, TX. 76132 RE: Acceptance Letter Project Name: Hampton Tract Ph.2 Project Type: water, sewer, paving, storm drain, street lights City Project No.: 104313 To Whom It May Concern: On December 23, 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 January 27, 2025. 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 January 27, 2025, 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) 392-6826. Sincerely, George Marquez, Project Manager Cc: Matt Cain, Inspector Gary Deyon, Inspection Supervisor Edward D'Avila, Senior Inspector Andrew Goodman, Program Manager Shield Engineering, Consultant Gilco Contracting, Inc., Contractor D.R. Horton, Developer File E-Mail: TPW_Acceptance@fortworthtexas.gov Rev. 8/20/19 AFFIDAVIT STATE OF TEXAS CAI! J]i��sT�ll : ; :: ►�1 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 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; Hampton Tract Phase 2 - Water, Sanitary Sewer and Storm Drain BY f Ab rantges, Cont t Manager Subscribed and sworn before me on this date 12th of February, 2025. Notary Public Tarrant County, Texas KASSANi7RA CANALB - D P{zY P�jAI. 2; n: Notary public, State of Texas Comm. Expires 41 23 2427 .,T..... +� Notary la 134158873 S CONSENT OF SURETY COMPANY TO FINAL PAYMENT Conforms with the American Institute of Architects, AIA Document G707 OWNER ❑ ARCHITECT ❑ CONTRACTOR ❑ SURETY ❑ OTHER Bond No 022236960 PROJECT: (name, address)Sunnycreek Phase 2 (Hampton Tract 2) - Water, Sanitary Sewer, Storm Drain Improvements TO (Owner) ID.R. HORTON - TEXAS, LTD AND CITY OF FORT WORTH 6751 North Freeway Fort Worth TX 76131 CONTRACTOR: BURNSCO CONSTRUCTION, INC. Fort Worth TX 7 ARCHITECT'S PROJECT NO: CONTRACT FOR: Sunnycreek Phase 2 (Hampton Tract 2) - Water, Sanitary Sewer, Storm Drain Improvements --J CONTRACT DATE: 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 as set forth in the said Surety Company's bond. IN WITNESS, WHEREOF, the Surety Company has hereunto set its hand this Attest: (Seal): 29th day of January, 2025 IMERTY MUTUAL INSURANCE COMPANY Surety Company Signs re of Authorized Representative aSo`phinie, H ntar Title , OWNER, Attornev-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 SURETY West American Insurance Company 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. Kelp A. Westbrook; Mikaela I r , P. ' Reyna; Robbi Morales; . -: • inie 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 p _ Liberty Mutual Insurance Company The Ohio lty SU JP oa °Ra�ti `�P�°aPO�&� 4PaoaN°"La��' WesttAmericanaInsuran Insurance ce Company �'Fo c+ Q 3° map �c ui;1912y 0 0 1919 2 1991 m �o a o on MPS�`•aD `!s �NDIANO' •da3 B U y: David M. Carey, Assistant Secretary a m State of PENNSYLVANIA '- N B County of MONTGOMERY ss o E o: On this 23rd day of >,pril 2021 before me personally appeared David M. Carey, who acknowledged himself to be the Assistant Secretary of Liberty Mutual Insurance 26) 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 Nm therein contained by signing on behalf of the corporations by himself as a duly authorized officer. 7 _0= 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. O r.� PA& a O ` r(�— ONCommonwealth. of Pa�nspvania - 40tary seal Br pot` Teresa Pastella, Notary Public N •— O F' r, OF Montgomery County O E My commission expires March 28, 2025 O O tt\\ �'a- Commission number 1126044 By• ++ °1rSY� ��@ ®C+ Member, Pennsylvania Association of Notaries Teresa Pastella, Notary Public Q O r,Zy ?' A O C a; 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 .00 •� Insurance Company, and West American Insurance Company which resolutions are now in full force and effect reading as follows: a M ARTICLE IV— OFFICERS: Section 12. Power of Atto =,y 00 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 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 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 -a 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 a) Z 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-ir fact under the f m 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. LL 2 ARTICLE All — 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 ful 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 29th day of January , 2025 P� 1NSu� P�ZX INS& \NSUp 3°opror�roy�c� �pr°opro�T�Pgy� �P?oav0 '10cn 1912 oy1919�o a 1991 0 dj��iSgcxuS`�aa yob hamvs� da Ys, vNDtANP da By. Renee C. Llewellyn, Assistant Secretary � * t, Hl * 1,� dM * >•� LMS-12873 LMIC CCIC WAIC Multi Co 02/21 0 . Liberty Mutual. 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 114 A) P. O. Box 149091 Austin, TX 78714-9091 FAX: (512) 490-1007 Web: httn://www.tdi.texas.aov E-mail: ConsumerProtection4..tdi.texas.eov PREMII M 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. NP70680901 LMS-15292 10/15 TEXAS AVISO IMPORTANTE Para obtener informacion 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 companies, coberturas, derechos o quejas al 1-800-252-3439 Puede escribir al Departamento de Seguros de Texas Consumer Protection (1 11-1 A) P. O. Box 149091 Austin. TX 78714-9091 FAX # (512) 490-1007 Web: http://www.tdi.texas.gov E-mail: ConsumerProtectionntdi.texas.aov 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.