HomeMy WebLinkAboutContract 61375-FP1FORT WORTH,
-FP1
City Secretary 61375
Contract No.
Date Received 4/24/2025
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: South Tract McAlister and 1-35
City Project No.: 104889
Improvement Type(s): ❑x Paving ❑ Drainage ❑x Street Lights ❑ Traffic Signals
Original Contract Price:
Amount of Approved Change Order(s):
Revised Contract Amount:
Total Cost of Work Complete
,7ole AnvaGo
Jose Arevalo (ADr 22, 2025 08:09 CDT)
Contractor
Project Manager
Title
Integra Premier Construction
Company Name
&Wt CAUV
Matt Cain (ADr 22, 2025 09:47 CDT)
Project Inspector
� ��
Khal Jaafa ri P fAor 202515:57 CDT
Project Manager
Kandice Men i, k 111-24. 202516'. 14 CDT
CFA Manager
de .7,:.1
Laurcn Pricur (Apr 24. 202516. 15 CDT;
TPW Director
Asst. City Manager
$ 29,311.22
$ 29,311.27
Apr 22, 2025
Date
Apr 22, 2025
Date
Apr 24, 2025
Date
Apr 24, 2025
Date
Apr 24, 2025
Date
Apr 25, 2025
Date
OFFICIAL RECORD
CITY SECRETARY Page 1 of 2
FT. WORTH, TX
Notice of Project Completion
Project Name: South Tract McAlister and 1-35
City Project No.: 104889
City's Attachments
Final Pay Estimate ❑x
Change Order(s): ❑x Yes ❑ N/A
Contractor's Attachments
Affidavit of Bills Paid,
Consent of Surety'
Statement of Contract Time
Contract Time 45 WD
Days Charged: 109 WD
Work Start Date: 8/19/2024 Work Complete Date: 3/7/2025
Completed number of Soil Lab Test:42
Completed number of Water Test: 12
Page 2of2
FoRTWORTH
CITY OF FORT WORTH
FINAL PAYMENT REQUEST
Contract Name SOUTH TRACT OF MCALISTER RD. & I-35 W
Contract Limits
Project Type PAVING & STREETLIGHTS
City Project Numbers 104889
DOE Number 4889
Estimate Number 1 Payment Number 1 For Period Ending
City Secretary Contract Number
Contract Date
Project Manager NA
Contractor INTEGRA PREMIER CONSTRUCTION
P.O.BOX 961
WAXAHACHIE , TX 75165
Inspectors G.DEYON / M.CAIN
Contract Time
Days Charged to Date
Contract is 100.00
3/7/2025
WD
4WD
109
Complete
Thursday, March 27, 2025 Page 1 of 4
City Project Numbers 104889 DOE Number 4889
Contract Name SOUTH TRACT OF MCALISTER RD. & I-35 W Estimate Number I
Contract Limits Payment Number 1
Project Type PAVING & STREETLIGHTS For Period Ending 3/7/2025
Project Funding
UNIT IV: PAVING IMPROVEMENTS
Item
Description of Items
Estimated Unit
Unit Cost
Estimated
Completed
Completed
No.
Quanity
Total
Quanity
Total
1
REMOVE SIDEWALK
718 SF
$4.15
$2,979.70
718
$2,979.70
2
REMOVE CONC CURB & GUTTER
80 LF
$18.15
$1,452.00
80
$1,452.00
3
6" FLEXIBLE BASE, TYPE A, GR-1
121 SY
$13.00
$1,573.00
121
$1,573.00
4
7" CONCRETE DRIVEWAY
1084 SF
$11.78
$12,769.52
1084
$12,769.52
5
BARRIER FREE RAMP, TYPE P-1
2 EA
$1,220.00
$2,440.00
2
$2,440.00
Sub -Total of Previous Unit $21,214.22 $21,214.22
UNIT V: STREET LIGHT IMPROVEMENTS
Item Description of Items
Estimated Unit
Unit Cost
Estimated
Completed
Completed
No.
Quanity
Total
Quanity
Total
1 2" CONDT PVC SCH 80 (T) (#2 COPPER XHHW)
15 LF
$202.67
$3,040.05
15
$3,040.05
(CO# 1)
2 GROUND BOX TYPE B
1 EA
$640.00
$640.00
1
$640.00
3 FURNISH/INSTALL RDWY ILLUM
1 EA
$1,500.00
$1,500.00
1
$1,500.00
FOUNDATION TY 11
4 RELOCATE STREET LIGHT POLE
1 EA
$2,917.00
$2,917.00
1
$2,917.00
Sub -Total of Previous Unit
$8,097.05
$8,097.05
Thursday, March 27, 2025 Page 2 of 4
City Project Numbers 104889
Contract Name SOUTH TRACT OF MCALISTER RD. & I-35 W
Contract Limits
Project Type PAVING & STREETLIGHTS
Project Funding
Contract Information Summary
Original Contract Amount
Change Orders
Change Order Number 1
Total Contract Price
DOE Number 4889
Estimate Number 1
Payment Number 1
For Period Ending 3/7/2025
$29,311.22
$0.05
$29,311.27
Total Cost of Work Completed $29,311.27
Less % Retained $0.00
Net Earned $29,311.27
Earned This Period $29,311.27
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
$29,311.27
Thursday, March 27, 2025 Page 3 of 4
City Project Numbers 104889
Contract Name SOUTH TRACT OF MCALISTER RD. & I-35 W
Contract Limits
Project Type PAVING & STREETLIGHTS
Project Funding
Project Manager NA
Inspectors G.DEYON / M.CAIN
Contractor INTEGRA PREMIER CONSTRUCTION
P.O.BOX 961
WAXAHACHIE , TX 75165
DOE Number 4889
Estimate Number 1
Payment Number 1
For Period Ending 3/7/2025
City Secretary Contract Number
Contract Date
Contract Time 45 WD
Days Charged to Date 109 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 $29,311.27
Less % Retained $0.00
Net Earned $29,311.27
Earned This Period $29,311.27
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
$29,311.27
Thursday, March 27, 2025 Page 4 of 4
PROJECT NAME:
CONTRACT:
CFA #
CITY PROJECT #
FID #
WATER PROJECT #
SEWER PROJECT #
FILE #
INSPECTOR: Jeremy Koonce
PROJECT MANAGER: Khal Jaafari, P.E.
DEVELOPER -AWARDED -PROJECT CHANGE ORDER
SOUTH TRACT OF MCALISTER RD. & 1-35W
WATER, SEWER, PAVING, STREET LIGHT IMPROVEMENTS
CFA24-0015 I CITY PARTICIPATION:I
104889
30114-0200431-104899-EO7685
K-3112,X-27801
WATER
Developer
Cost
City Cost
ORIGINAL CONTRACT
$115,173.66
$0.00
EXTRAS TO DATE
CREDITS TO DATE
CONTRACT TO DATE
$115,173.66
$0.00
AMOUNT OF PROP. CHANGE ORDER
$0.00
REVISED CONTRACT AMOUNT
$115,173.66
$0.00
TOTAL REVISED CONTRACT AMOUNT PER
UNIT
$115,173.66
REVISED COST SHARE
Dev. Cost:
TOTAL REVISED CONTRACT
Me
CHANGE
ORDER No:
1
Phone No:
832-527-5406
RECEIVED
Phone No:
817-392-7872
By Khal Jaafari
at 1:46 pm, Jun 25, 2024
CONTRACT UNIT
SEWER
DRAINAGE
PAVING STREET LIGHTS
CONTRACT
Developer
Developer
Developer
Developer
DAYS
Cost City Cost
Cost City Cost
Cost
City Cost Cost
City Cost
$102,133.70 $0.00
$0.00
$21,214.22
$0.00 $8,097.00
$0.00
45
$102,133.70 $0.00
$0.00 $0.00
$21,214.22
$0.00 $8,097.00
$0.00
45
$0.00
$0.00
$0.00
$0.05
0
$102,133.70 $0.00
$0.00 $0.00
$21,214.22
$0.00 $8,097.05
$0.00
45
$102,133.70
$0.00
$21,214.22 $8,097.05
$246,618.63
City Cost:
$0.00
$246,618.63
Revised: 12-17-2018 Page 1
You are directed to make the following changes in the contract documents:
CITY BID ITEM
PAY ITEM # # QUANTITY
Unit V: Street Lights
1 26-05-33 15
1 26-05-36 15
Asterisk (') indicates New Pay Item
REASONS FOR CHANGE ORDER
UNIT ITEM DESCRIPTION
LF 2605.3015 2" CONDT PVC SCH 80 (T) (#2 COPPER XHHW)
LF 2605.3015 2" CONDT PVC SCH 80 (T) (#2 COPPER XHHW)
GRAND TOTAL
Amended the 2" conduit pay item unit price to reflect correct decimal place
RECOMMENDED: APPROVED:
Winkelmann & Associates, Inc. Bomac McAlister Investments, LLC
By: III W By: -:-7
Name: Will Winkelmann Name: Kevin McIntosh
Title: P.E. Title: Partner
APPROVAL RECOMMENDED: APPROVED:
CFW - Sponsoring Department CFW - Assistant City Manager
By: N/A By: N/A
Name: N/A Name: N/A
UNIT PRICE TOTAL
$ 202.67 $ 3,040.05
$ (202.67) $ (3,040.00)
$0.05
RECEIVED
By Khal Jaafari at 1:46 pm, Jun 25, 2024
APPROVED:
Integra Premier Construction, LLC
By:
Name: John Torrez v
Title: VP
APPROVED AS TO FORM AND LEGALITY:
CFW - Assistant City Attorney
By: N/A
Name: N/A
Revised: 12-17-2018 Page 2
Title:
RECOMMENDED:
CFW - *Contract Compliance Manager
By:
Name: N/A
Title:
M&C Number: N/A
M&C Date Approved: N/A
Title: Title:
* Contract Compliance Manager (Project Manager):
By signing I acknowledge that I am the person responsible
for the monitoring and administration of this contract, include
ensuring all performance and reporting requirements.
There are NO City Funds associated with this Contract
El There are City Funds associated with this Contract
Revised: 12-17-2018 Page 3
FORTWORTH.
M,
TRANSPORTATION AND PUBLIC WORKS
March 24, 2025
Integra Premier Construction
P.O. Box 961
Waxahachie, TX. 75165
RE: Acceptance Letter
Project Name: South Tract McAlister and 1-35
Project Type: water, sewer, paving, street lights
City Project No.: 104889
To Whom It May Concern:
On March 14, 2025 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 March 21, 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 March 21, 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)
392-7872.
Sincerely,
Khal Jaafari P//(APi , 2025 15:57 CDT)
Khal Jaafari, Project Manager
Cc: Matt Cain, Inspector
Gary Deyon, Inspection Supervisor
Edward D'Avila, Senior Inspector
Andrew Goodman, Program Manager
Winkelmann & Associates, Consultant
Integra Premier Construction, Contractor
BOMAC McAlister Investments LLC., Developer
File
E-Mail: TPW_Acceptance@fortworthtexas.gov
Rev. 8/20/19
AFFIDAVIT
STATE OF TEXAS
COUNTY OF ELLIS
Before me, the undersigned authority, a notary public in the state
and county aforesaid, on this day personally appeared Stephanie Torrez,
President Of Integra Premier Construction, LLC, 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,
IPRC 23-0070, CFA24-0015
—B
�_-� Stephanie Torrez, President
Subscribed and sworn before me on this date 8`l' of April 2025.
�. 0AI Dim -
Notary J}blic
Ellis County, Texas
JILLIAN ASHLEY OWENS
'0* :Notary Public, State of Texas
••P= Comm. Expires 03-26-2026
Notary ID 131505682
nm�
TOKIOMARINE
VNHCC
Consent of Surety
BOND NO: 100863361
PRINCIPAL: Integra Premier Construction LLC
324 Hunter Pass
Waxahachie, TX 75165
OBLIGEE: Bomac McAlister Investments LLC
PO Box 96011
Southlake, TX 76092
PROJECT NAME: WellMed Shell Building (McAlister & 1-35)
CONTRACT DATED: March 12, 2024 CONTRACT: Community Facilities Agreement, CFA 24-0015
The Texas Bonding Company hereby consents to:
(Name of Surety)
confirm that no changes have been made to the preen sheets or affidavits submitted for contract closeout.
Nothing herein contained shall be held to vary, waive, alter or extend any of the terms, conditions, agreements, or
warranties of the above mentioned bond or contract.
Signed and sealed this 7th day of April 2025 .
Surety:
Texas Bonding Company
ouD I N G no�
Qc
=ul: By.
Timothy W. Horton, Attorney -In -Fact
�P
07-15
A,`TOKIOMARINE
H C C
POWER OF ATTORNEY
KNOW ALL MEN BY THESE PRESENTS:
That Texas Bonding Company, an assumed name of American Contractors Indemnity Company of the State of California, a California
corporation, does hereby appoint,
TIMOTHY W HORTON
its true and lawful Attorney -in -Fact, with full authority to execute on its behalf bond number 100863361
issued in the course of its business and to bind the Company thereby, in an amount not to exceed
********* UNLIMITED ********* (***UNLIMITED ***).
This Power of Attorney is granted and is signed and sealed by facsimile under and by the authority of the following resolutions adopted
by the Board of Directors of TEXAS BONDING COMPANY at a meeting duly called and held on the 1st day of September, 2011.
"Be it Resolved, that the President, any Vice -President, any Assistant Vice -President, any Secretary or any Assistant Secretary shall be
and is hereby vested with full power and authority to appoint any one or more suitable persons as Attorn ey(s)-i n- Fact to represent and
act for and on behalf of the Company subject to the following provisions:
Attorney -in -Fact may be given full power and authority for and in the name of and on behalf of the Company, to execute, acknowledge
and deliver, any and all bonds, recognizances, contracts, agreements or indemnity and other conditional or obligatory undertakings,
including any and all consents for the release of retained percentages and/or final estimates on engineering and construction contracts,
and any and all notices and documents canceling or terminating the Company's liability thereunder, and any such instruments so
executed by any such Attorney -in -Fact shall be binding upon the Company as if signed by the President and sealed and effected by the
Corporate Secretary.
Be it Resolved, that the signature of any authorized officer and seal of the Company heretofore or hereafter affixed to any power of
attorney or any certificate relating thereto by facsimile, and any power of attorney or certificate bearing facsimile signature or facsimile
seal shall be valid and binding upon the Company with respect to any bond or undertaking to which it is attached."
The Attorney -in -Fact named above may be an agent or a broker of the Company. The granting of this Power of Attorney is specific to
this bond and does not indicate whether the Attorney -in -Fact is or is not an appointed agent of the Company.
IN WITNESS WHEREOF, Texas Bonding Company has caused its seal to be affixed hereto and executed by its President on this 20th
day of November, 2024. ` �oNq�NG'�o
�,: -•.. a: TEXA "ONDINGCOMPANY
=Q:
su; z- By: AA
Ada`m S. Pessin, President
F
A Notary Public or other officer completing this certifica "%ifies only the identity of the individual who signed the document to which
this certificate is attached, and not the truthfulness, accuracy, or validity of that document.
State of California
County of Los Angeles
On this 20th day of November, 2024, before me, D. Littlefield, a notary public, personally appeared Adam S. Pessin, President of Texas
Bonding Company, who proved to me on the basis of satisfactory evidence, to be the person whose name is subscribed to the within
instrument and acknowledged to me that he executed the same in his authorized capacity, and that by his signature on the instrument
the person, or the entity upon behalf of which the person acted, executed the instrument.
I certify under PENALTY OF PERJURY under the laws of the State of CALIFORNIA that the foregoing paragraph is true and correct.
WITNESS my hand and offal seal.
0. LU LErIELO
� 0-Y
Notary pUAMc • GBforntaLos Angeles [aunty
Signature r V�h + (seal) ,Co m.ExpiresJon31, 028ti
I, Kio Lo, Assistant Secretary of Texas Bonding Company, do hereby certify that the Power of Attorney and the resolution adopted by
the Board of Directors of said Company as set forth above, are true and correct transcripts thereof and that neither the said Power of
Attorney nor the resolution have been revoked and they are now in full force and effect.
IN WITNESS WHEREOF, I have hereunto set my hand and affixed the seals of said Companies at Los Angeles, California this
7th day of April 2025
Bond No. 100863361
Agency No. 700245 =w 'z= Kio Lo, As & nt Secretary
=Y C:
ST
V0
Visit tmhcc.com/surety for more information`,
qTF OF iE `` HCCSOZZPOATBC12/2024
TEXAS COMPLAINT NOTICE
IMPORTANT NOTICE
To obtain information or make a complaint:
1. You may contact your agent.
2. You may call the company's toll free telephone
number for information or to make a complaint at:
1-800-486-6695
3. You may also write to the company at:
4. You may contact the Texas Department of
Insurance to obtain information on companies,
coverages, rights, or complaints at:
1-800-252-3439
5. You may write to the Texas Department of
Insurance at:
Consumer Protection (111-1A)
P.O. Box 12030
Austin, Texas 78711-2030
Fax No. 512- 490-1007
Web: 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.
ATTACH 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:
1. Puede comunicarse con su agente.
2. Usted puede Ilamar al numero de telefono gratis
de la compania's para informacion o para someter
una queja al:
1-800-486-6695
3. Usted tambien puede escribir a la compania:
4. Puede comunicarse con el Departamento de
Seguros de Texas para obtener informacion
acerca de companias, coberturas, derechos, o
quejas al:
1-800-252-3439
5. Puede escribir al Departamento de Seguros de
Texas al:
Consumer Protection (111-1A)
P.O. Box 12030
Austin, Texas 78711-2030
Fax No. 512- 490-1007
Web: 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
compania primero. Si no se resuelve la disputa,
puede entonces comunicarse con el departamento
(TDI).
UNA ESTE AVISO A SU POLIZA
Esta aviso es solo para proposito de informacion y no
se convierte en parte o condicion del documento
adjunto.
HCCSOTX_COM PLAI NT2023/06
TOKIOMARINE
\� HCC
Fraud Warnings and Privacy Notice
Fraud Warnings
Any person who knowingly presents a false or fraudulent claim for payment of a loss or benefit or knowingly presents false
information in an application for insurance is guilty of a crime and may be subject to fines and confinement in prison.
APPLICABLE IN ALABAMA
Any person who knowingly presents a false or fraudulent claim for payment of a loss or benefit or who knowingly presents false
information in an application for insurance is guilty of a crime and may be subject to restitution, fines or confinement in prison,
or any combination thereof.
APPLICABLE IN ARKANSAS, LOUISIANA AND WEST VIRGINIA
Any person who knowingly presents a false or fraudulent claim for payment of a loss or benefit or knowingly presents false
information in an application for insurance is guilty of a crime and may be subject to fines and confinement in prison.
APPLICABLE IN CALIFORNIA
For your protection California law requires the following to appear on this form. Any person who knowingly presents false or
fraudulent information to obtain or amend insurance coverage or to make a claim for the payment of a loss is guilty of a crime
and may be subject to fines and confinement in state prison.
APPLICABLE IN COLORADO
It is unlawful to knowingly provide false, incomplete, or misleading facts or information to an insurance company for the purpose
of defrauding or attempting to defraud the company. Penalties may include imprisonment, fines, denial of insurance, and civil
damages. Any insurance company or agent of an insurance company who knowingly provides false, incomplete, or misleading
facts or information to a policyholder or claimant for the purpose of defrauding or attempting to defraud the policyholder or
claimant with regard to a settlement of award payable from insurance proceeds shall be reported to the Colorado Division of
Insurance within the Department of Regulatory Agencies.
APPLICABLE IN THE DISTRICT OF COLUMBIA
WARNING: It is a crime to provide false or misleading information to an insurer for the purpose of defrauding the insurer or any
other person. Penalties include imprisonment and/or fines. In addition, an insurer may deny insurance benefits, if false
information materially related to a claim was provided by the applicant.
APPLICABLE IN FLORIDA
Any person who knowingly and with intent to injure, defraud, or deceive any insurer files a statement of claim or an application
containing any false, incomplete, or misleading information is guilty of a felony of the third degree.
APPLICABLE IN HAWAII
For your protection, Hawaii law requires you to be informed that presenting a fraudulent claim for payment of a loss or benefit is
a crime punishable by fines or imprisonment, or both.
APPLICABLE IN KANSAS
Any person who, knowingly and with intent to defraud, presents, causes to be presented or prepares with knowledge or belief
that it will be presented to or by an insurer, purported insurer, broker or any agent thereof, any written statement as part of, or in
support of, an application for the issuance of, or the rating of an insurance policy for personal or commercial insurance, or a
claim for payment or other benefit pursuant to an insurance policy for commercial or personal insurance which such person
knows to contain materially false information concerning any fact material thereto; or conceals, for the purpose of misleading,
information concerning any fact material thereto commits a fraudulent insurance act.
APPLICABLE IN KENTUCKY
Any person who knowingly and with intent to defraud any insurance company or other person files an application for insurance
containing any materially false information or conceals, for the purpose of misleading, information concerning any fact material
thereto commits a fraudulent insurance act, which is a crime.
APPLICABLE IN MAINE
It is a crime to knowingly provide false, incomplete or misleading information to an insurance company for the purpose of
defrauding the company. Penalties may include imprisonment, fines or denial of insurance benefits.
TM HCCZZM_FRAU DPRI VACY01 /2023
TOKIOMARINE
HCC
Fraud Warnings and Privacy Notice
APPLICABLE IN MARYLAND
Any person who knowingly or willfully presents a false or fraudulent claim for payment of a loss or benefit or who knowingly or
willfully presents false information in an application for insurance is guilty of a crime and may be subject to fines and confinement
in prison.
APPLICABLE IN MINNESOTA
Any person who files a claim with intent to defraud or helps commit a fraud against an insurer is guilty of a crime.
APPLICABLE IN NEW JERSEY
Any person who includes any false or misleading information on an application for an insurance policy is subject to criminal and
civil penalties.
APPLICABLE IN OHIO
Any person who, with intent to defraud or knowing that he/she is facilitating a fraud against an insurer, submits an application or
files a claim containing a false or deception statement is guilty of insurance fraud.
APPLICABLE IN OKLAHOMA
WARNING: Any person who knowingly, and with intent to injure, defraud or deceive any insurer, makes any claim for the
proceeds of an insurance policy containing any false, incomplete or misleading information is guilty of a felony.
APPLICABLE IN OREGON
Material misstatements, misrepresentations, omissions or concealments by an insured that are fraudulent or material to the
insurance contract, the risk assumed, or the interests of an insurer and are relied upon by an insurer may result in policy
rescission, cancellation, or denial of claim.
APPLICABLE IN TENNESSEE, VIRGINIA AND WASHINGTON
It is a crime to knowingly provide false, incomplete or misleading information to an insurance company for the purpose of
defrauding the company. Penalties include imprisonment, fines or denial of insurance benefits.
APPLICABLE IN VERMONT
Any person who knowingly presents a false statement in an application for insurance may be guilty of a criminal offense and
subject to penalties under state law.
NOTICE TO NEW YORK APPLICANTS:
Any person who knowingly and with intent to defraud any insurance company or other person files an application for insurance
or statement of claim containing any materially false information or conceals for the purpose of misleading, information
concerning any fact material thereto, commits a fraudulent insurance act, which is a crime, and shall also be subject to a civil
penalty not to exceed five thousand dollars and the stated value of the claim for each such violation.
TM HCCZZM_FRAU DPRI VACY01 /2023
Rev. January 1, 2023
WHAT DOES TOKIO MARINE HCC DO WITH YOUR
PERSONAL INFORMATION?
Financial companies choose how they share your personal information. Federal law gives
consumers the right to limit some but not all sharing. Federal law also requires us to tell you
how we collect, share, and protect your personal information. Please read this notice carefully to
understand what we do.
The types of personal information we collect and share depend on the product or service you
have with us. This information may include:
Account and transaction information;
Contact and demographic information;
■ Financial information;
Claims information; and
■ Credit history.
All financial companies need to share customers' personal information to run their everyday
business. In the section below, we list the reasons financial companies can share their
customers' personal information; the reasons Tokio Marine HCC chooses to share; and whether
you can limit this sharing.
k
asons we can share your personal information
For our everyday business purposes —
such as to process your transactions, maintain
your account(s), respond to court orders and
legal investigations, or report to credit bureaus
For our marketing purposes —
to offer our products and services to you
For joint marketing with other financial
companies
For our affiliates' everyday business purposes —
information about your transactions and experiences
For our affiliates' everyday business purposes —
information about your creditworthiness
For our affiliates to market to you
For nonaffiliates to market to you
Does Tokio Marine HCC share?
Yes No
Yes No
Yes No
Yes No
Yes Yes
Yes Yes
No N/A
■ Call (888) 688-0775 — our menu will prompt you through your choice(s).
■ Email us online: Drivacvgolicv cDtmhcc.com.
Please note:
When you are no longer our customer, we continue to share your information as described in
this notice.
However, you can contact us at any time to limit our sharing.
Call (888) 688-0775 or send us an email at DrivacvDolicv(a)tmhcc.com.
TM HCCSZZPRI VACYNOTICE01 /2023
Who is providing this notice?
How does Tokio Marine HCC protect my To protect your personal information from unauthorized access
personal information? and use, we maintain reasonable administrative, technical and
physical safeguards designed to protect your personal information
against accidental, unlawful or unauthorized destruction, loss,
alteration, access, disclosure or use.
How does Tokio Marine HCC collect my We collect your personal information, for example, when you:
personal information? ■ Sign up for and use our services, including when you choose to
provide us with your information online or offline;
■ Interact with our website and mobile applications;
■ Obtain an insurance product from us through a broker, where we
may collect personal information from your broker in order to prepare
your quote and/or your insurance policy; and/or
■ Submit an insurance claim, so we can properly handle your claim.
We may also collect your personal information from others, such as
credit bureaus, affiliates, or other companies.
Why can't I limit all sharing? Federal law gives you the right to limit only:
■ sharing for affiliates' everyday business purposes —information
about your creditworthiness;
■ affiliates from using your information to market to you; and
■ sharing for nonaffiliates to market to you.
State laws and individual companies may give you additional rights to
limit sharing.
What happens when I limit sharing Your choices will apply to everyone on your account.
for an account I hold jointly with
someone else?
Affiliates Companies related by common ownership or control. They can be
financial and nonfinancial companies.
■ Our affiliates include our family of companies, available at
https.11www. tokiomarinehd.comlenlcompan vlaboutlgrouD. html.
Nonaffiliates Companies not related by common ownership or control. They can be
financial and nonfinancial companies.
Joint marketing A formal agreement between nonaffiliated financial companies that
together market financial products or services to you.
■ Our joint marketing partners include categories of companies such
as insurance companies.
Other important information r-,
7w� �6=
For more information, please review our privacy policy, located at httr)s://www.tmhcc.com/en-us/legal/privacy-r)olicv.
TMHCCSZZPRI VACYNOTICE01 /2023