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HomeMy WebLinkAboutContract 60443-FP1FORT WORTH® -FPlCity Secretary Contract No. 60443 ------ Date Received 9/17/2025 9/24/2025 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: Westpoint Blvd and N Indigo Dr City Project No.: 104118 Improvement Type(s): � Paving □Drainage □Street Lights □Traffic Signals Original Contract Price: Amount of Approved Change Order(s): Revised Contract Amount: Total Cost of Work Complete: uiaMcQuie11 I eia Mc9uieo /Seo u zozs M·nos CPD Contractor VP Operations Title Gilco Contracting, Inc Company Name Adrian A@n1a /Ser 17 2025 14-44·2§ cpJ) Project Inspector Project Manager CFA Manager 121'-?n...... I aureo Prieur {See 17 202515?5W CPil TPW Director Asst. City Manager 09/17/2025 Date 09/17/2025 Date 09/17/2025 Date 09/17/2025 Date 09/17/2025 Date 09/17/2025 Date $3,477,671.95 $1,800.84 $3,479,472.79 $3,479,472.79 Page 1 of 2 Notice of Project Completion Project Name: Westpoint Blvd and N Indigo Dr City Project No.: 104118 City's Attachments Final Pay Estimate 0 Change Order(s): 0 Yes ❑ N/A Contractor's Attachments Affidavit of Bills Paid � Consent of Surety �� Statement of Contract Time Contract Time: 180 WD Days Charged: 242 WD Work Start Date: 1/11/2024 Work Complete Date: 2/25/2025 Completed number of Soil Lab Test: 1083 Completed number of Water Test: 31 Page 2 of 2 FORTWORTH CITY OF FORT WORTH FINAL PAYMENT REQUEST Contract Name MORNINGSTAR-WESTPOINT BLUD. & NORTHINDIGO SKY DRIVE Contract Limits Project Type PAVING City Project Numbers 104118 DOE Number 4118 Estimate Number 1 Payment Number 1 For Period Ending 2/25/2025 WD City Secretary Contract Number Contract Date Project Manager NA Contractor GILCO CONTRACTING, INC. 6331 SOUTHWEST BLVD. BENBROOK � TX 76132-1063 Inspectors D. WATSON / A. ARANDA Contract 15me g�� Days Charged to Date �4� Contract is 100.00 Complete Monday, March 24, 2025 Page 1 of 5 City Project Numbers 104118 DOE Number 4118 Contract Name MORNINGSTAR-WESTPOINT BLVD. & NORTHINDIGO SKY DRIVE Estimate Number 1 Contract Limits Payment Number 1 Project Type PAVING For Period Ending 2/25/2025 Project Funding UNTI' IV: PAVING IMPROVEMENTS Item Description of Items No. 1 7.5" CONC. PVMT (INDIGO SKY DRIVE) - 4,000 PSI 2 8" LIME TREATMENT 3 HYDRATED LIME (CO#1) 4 7.5" "STAMPED" CONC. PVMT (11-FT. WIDTH- DIAMETER) CENTRAL ISLAND, (WESTP 5 8" LIME TREATMENT 6 HYDRATED LIME 7 7" CONCRETE CURB (CENTRAL ISLAND CURB) 8 9.0" CONC. PVMT (WESTPOIN1� -4,000 PSI (#4@ 18) 9 8" LIME TREATMENT 10 HYDRATED LIME 11 4" OR 6" SPLITTER ISLAND (ROUND -ABOUT) 12 10" STAMPED COLORED CONCRETE CROSS- WALK 13 5-FOOT, 4" CONCRETE SIDEWALK 14 6-FOOT, 4° CONCRETE SIDEWALK 15 TRANSITION AREA 6' CONCRETE SIDEWALK 16 10-FOOT, 4" CONCRETE SIDEWALK 17 BARRIER FREE RAMP-TYPE P-1 (MODIFIED) 18 BARRIER FREE RAMP-TYPE M-2 19 BARRIER FREE RAMP-TYPE C-2 20 WHITE STOP BAR 21 6" YELLOW SOLID (DOUBLE) 22 6" WHITE SOLID 23 6" WHITE DASH W/ TYPE II CR 4" RPM'S 24 8" WHITE SOLID - ROUND -ABOUT 25 8" WHITE SOLID - 2" DASH --ROLTND-ABOUT 26 8" WHITE SOLID - 3" DASH - ROUND-ABOUT 27 12" WHITE SOLID CROSSWALK STRIP 28 18" WHITE SOLID 29 18" YELLOW SOLID Estimated Unit Unit Cost Estimated Completed Completed Quanity Total Quanity Total 3968 SY $61.95 $245,817.60 3968 $245,817.60 4226 SY $4.50 $19,017.00 4226 $19,017.00 214 TN $288.60 $61,760.40 214 $61,760.40 323 SY $255.55 $82,542.65 323 $82,542.65 344 SY 5 TN 230 LF 25650 SY $4.50 $1,548.00 344 $1,548.00 $288.60 $1,443.00 5 $1,443.00 $35.95 $8,268.50 230 $8,268.50 $73.05 �,873,732.50 25650 1,873,732.50 27317 SY $4.50 $122,926.50 27317 $122,926.50 547 TN $288.60 $157,864.20 547 $157,864.20 1189 SF $3030 $36,026.70 ll89 $36,026.70 1761 SF $30.30 $53,35830 1761 $53,358.30 250 SF 4828 SF 1780 SF 79004 SF 14 EA 8 EA 4 EA 22 LF 430 LF 2958 LF 6590 LF 770 LF 220 LF 41 LF 324 LF 1514 LF 31 LF $6.00 $1,500.00 $6.00 $28,968.00 $6.00 $10,680.00 $6.00 $474,024.00 $2,950.00 $41,300.00 $3,060.00 $24,480.00 $1,300.00 $5,200.00 $16.80 $369.60 $4.35 $1,870.50 $2.20 $6,507.60 $2.90 $19,111.00 $2.70 $2,079.00 $2J0 $594.00 $2.70 $110.70 $8.55 $2,770.20 $12.05 $18,243.70 $12.05 $373.55 250 $1,500.00 4828 $28,968.00 1780 $10,680.00 79004 $474,024.00 14 $41,300.00 8 $24,480.00 4 $5,200.00 22 $369.60 430 $1,870.50 2958 $6,507.60 6590 $19,111.00 770 $2,079.00 220 $594.00 41 $110.70 324 $2,770.20 1514 $18,243.70 31 $373.55 Monday, March 24, 2025 Page 2 of 5 City Project Numbers 104118 DOE Number 4118 Contract Name MORNINGSTAR-WESTPOINT BLVD. & NORTHINDIGO SKY DRIVE Estimate Number 1 Contract Limits Payment Number 1 Project Type PAVING For Period Ending 2/25/2025 Project Funding 30 WORDS AND ARROW 28 EA $788.25 $22,071.00 28 $22,071.00 31 24" WHITE CONTRAST CROSSWALK 89 LF $26.75 $2,380.75 89 $2,380.75 32 STREET BARRICADE TYPE III (STREET DEAD 176 LF $50.00 $8,800.00 176 $8,800.00 ENDS) 33 EMBANK PLAN (PARKWAY/MEDIAN 0 CY $52.00 $0.00 0 $0.00 ACCEPTABLE BACKFILL) (CO#1) 34 BLOCK SOD PLACEMENT (CENTRAL ISLAND 0 SY $5.92 $0.00 0 $0.00 IN ROUND-ABOU'1� (CO#1) 35 SEED HYDROMULCH (PARKWAYS AND 0 SY $1.53 $0.00 0 $0.00 MEDIANS) (CO#1) 36 FURNISH/INSTALL GROLTND MOLTNT POST, 0 EA $350.00 $0.00 0 $0.00 i.JNLESS AT THE INTERSETION, MOUNT TO 37 STREET NAME PLATE FOR STREET 0 EA $695.00 $0.00 0 $0.00 INTERSECTION (D3-1) (CO#1) 38 MISCELL SIGN WTTH STEEL POST (SEE SHEET 0 EA $415.00 $0.00 0 $0.00 86) (CO#1) 39 BRANDON INDUSTRIS SIGHNS AND POST 53 EA $2,410.00 $127,730.00 53 $127,730.00 (CO# 1) 40 HAUL DIRT ON STTE FOR BACKFILL (CO#1) 2 DY $2,900.00 $5,800.00 2 $5,800.00 41 8° LIME TREATMENT (CO#1) 31887 SY $0.32 $10,203.84 31887 $10,203.84 Sub-Total of Previous Unit �3,479,472.79 $3,479,472.79 Monday, March 24, 2025 Page 3 of 5 City Project Numbers 104118 DOE Number 4118 Contract Name MORNINGSTAR-WESTPOINT BLVD. & NORTHINDIGO SKY DRIVE Estimate Number 1 Contract Limits Payment Number 1 Project Type PAVING For Period Ending 2/25/2025 Project Funding Contract Information Summary Original Contract Amount Change Orders Change Order Number 1 $3,477,671.95 $1,800.84 Total Contract Price $3,479,472.79 Total Cost of Work Completed $3,479,472.79 Less % Retained $0.00 Net Earned $3,479,472.79 Earned This Period $3,479,472.79 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 $3,479,472.79 Monday, March 24, 2025 Page 4 of 5 City Project Numbers 104118 DOE Number 4118 Contract Name MORNINGSTAR-WESTPOINT BLVD. & NORTHINDIGO SKY DRIVE Estimate Number 1 Contract Limits Payment Number 1 Project Type PAVING For Period Ending 2/25/2025 Project Funding Project Manager NA Inspectors D. WATSON / A. ARANDA Contractor GILCO CONTRACTING, INC. 6331 SOUTHWEST BLVD. BENBROOK � TX 76132-1063 City Secretary Contract Number Contract Date Contract Time 85 WD Days Charged to Date 242 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 $3,479,472.79 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 $3,479,472.79 $0.00 $3,479,472.79 $0.00 $0.00 $0.00 $0.00 $0.00 $3,479,472J9 Monday, March 24, 2025 Page 5 of 5 v N O N N w Z W,^ �, � v W T Ll.� 0 2 � _ � Z Uo VO 0 Z W � Q' 0 v� O � a 0 � Z U H � Q � � Z } C ~ m U 0 J m � Lf� L[7 Z � � a Ll.� ll.� � a0 00 w � � � V V � � O O � Z � � � > r� c�-� � a o 0 Z � N N Z w N � V � � O Q' O Q' � Q � � O �(n N� Z r�i M Y � � H H �t � H W W � � Z � � Q � d � w� a�*ww� O Z Q � w ~ � � Q w d �U U U � � � � > O > N O � . � N � (Q � X � O O � 3 0 .. � `o w � � � � C @ f6 � C � � o ¢ c� � N � N M M ti ti � � Z Z � � C C L � aa w � N W � Z � Q � W Q � Q O � W � Q Z � � H ~ U U W w a� � O Z � d � U N � Q � o o � zo 0 U po 0 � V o 0 � T o 0 _ .. v� v� � U J p W w W � � a o 0 o � � m .. a�i o 0 � U o 0 N � � O O U � � � w V a � Z � � � o � o 0 Q o 0 ° � � d.. do ❑ U 0 0 0 � F U � � p Z � � � � U rn n = t7 V w « N (~j Z v V � rn � a � O1• v�`• v ti Z `y °D N M � a � o o � o � w r� � o r- o o � � rn '� > H v w w�� a m o rS ai ai p U t» ta ta O o 0 V o 0 T � � � d. U N W o a W � ;' y � d o o � a 0 0 0 N a+ � � N O � U N 0 0 0 V o 0 T � � a, U w o F o Q o 3 � a o o � o � � U v� v� � U O � � Z W � � H o � a � � j U Z �� F v=i O 2 Q ~ Z ~ V U W U� O� O W �Q H U U K U N � Q � � � W a W W Z o o O a Z m m � O� O V� O K � H Z � H � Z W J O �� o � � �n a � � w z o > o O W U � Q � ~ W � � , W � u'� N O N �C! O i m � � � N �1'i � � 7 O L � i � � L 0 � � � m � � � a U ? � a> 0 � ci � z •'- U � � � � � � T N F � C W 0 O � o � � a � U � a J � Y Q f7 Oo Z F N C N E � U O � U N C 0 U N .t-� C a� L N Y N � O � a> � '6 � m O } � N w N r C N N 01 C R L � V W i 0.' u�i O y l!A c� � L Z C a O _ � U � 0.' ur O � LL N N Z E O °1 y •— W c � lL U J J � � Z � W � � a O �� w w = c G V` � G O E 'w � W Y � O J d � a N a a � >. m � Q LL 0� Z H U z i� Z w W �) V d W W U Z W Z / � W � � C V W � � a��i � � F d N � m � � (E Z �������T�� TRANSPORTATION AND PUBLIC WORKS February 27, 2025 Gilco Contracting Inc 6331 Southwest Blvd Benbrook TX 76132 RE: Acceptance Letter Project Name: Westpoint Blvd and N Indigo Dr Project Type: Paving City Project No.: 104118 To Whom It May Concern: On February 27, 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 27, 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- 392-6826. Sincerely, �� ��� George Marquez P.E , Project Manager Cc: Adrian Aranda , Inspector Donald Watson , Inspection Supervisor Aaron Ybarra , Senior Inspector Andrew Goodman , Program Manager Welch Engineering INC, Consultant Gilco Contracting, Contractor FG Aledo Development LLC, Developer File E-Mail: TPW_Acceptance@fortworthtexas.gov Signature: ��k!� Donald Watson (Sep ll, 202515:0035 CDT) Email: Donald.Watson@fortworthtexas.gov Rev. 08/20/19 AFFIDAVIT STATE OF TEXAS COUNTY OF TARRANT Before me, the undersigned authority, a notary public in the state and county aforesaid, on this day personally appeared Rob Taylor, Accounts Receivable of Gilco Contracting, Inc., 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, Texas has been paid in full; That there are no claims pending for personal injury and/or property damages; On Contract described as Paving Improvements to serve: Morningstar — Westpoint Parkway . ,�° � � �'.� .�/� .� . _ `� � ,� BY: Rob �'avlor Subscribed and sworn before me on this 17th of February , 2025. � ,,,��„--_y""' OpP�P�6(�i KASSANDRA CANALES ���a:.�y� o_ Notary Public, State of Texas ; ;.'•.' `..+P; Comm. Expires 01-23-2027 � �'�; ;���``� Notary ID 134158873 ,�_ Notary Public Tarrant County, TX CONSENT OF SURETY COMPANY TO FINAL PAYMENT Conforms with the American Institute of Architects, AIA Document G707 OWNER ❑ ARCHITECT ❑ CONTRACTOR ❑ SURETY ❑ OTHER Bond No Q22236956 PROJECT: (name, 8ddf2SS)Westpoint Boulevard and North Indigo Sky Drive - Paving Improvements TO (Owner) FM 3325 & Gladstone Dr IFG ALEDO DEVELOPMENT, LLC OBO MORNINGSTAR MUNICIPAL UTILITY DISTRICT 1308 Norwood Drive, Suite 200 Bedford TX 76022 CONTRACTOR: GILCO CONTRACTING, INC. TX � ARCHITECT'S PROJECT NO: CONTRACT FOR: Westpoint Boulevard and North Indigo Sky Drive - Paving Improvements .� CONTRACT DATE: In accordance with the provisions of the Contract between the Owner and the Contractor as indicated abave, tha (here insert nama and address of Surety Companyl LIBERTY MUTUAL INSURANCE COMPANY 175 Berkeley Street Boston MA 02116 , SUFi�T"Y i;OMPANY on bond of (here insert neme and address of Contractor) GILCO CONTRACTING, INC. 6331 Southwest Boulevard Benbrook TX 76132 , ���"�i�ACTOR, hereby approves of the final payment to the Contractor, and agrees that final payment to the Contractor s1;;z11 not relieve the SureTy Company of any of its obligations to (here insert name and address of Owner) FG ALEDO DEVELOPMENT, LLC OBO MORNINGSTAR MUNICIPAL UTILITY DISTRICT 1308 Norwood Drive, Suite 200 Bedford TX 76022 as set forth in the said Surety Company's bond. IN WIT'NESS, WHEREOF, the Surety Company has hereunto set its hand this Attest: .a-t�m.�.. i'`yrx,,t';.���_re.....,__. (Seal): 17th day of February, 2025 , OWNER, LIBERTY MUTUAL INSURANCE COMPANY Sure Company Signa e of Authorized Representative �Qphinie H�mter Attornev-in-Fact Title NOTE: This form is to be used as a companion document to AIA DOCUMENT G706, CONTRACTOR'S AFFIDAYIT OF PAYMENT OF DESTS AND CLAIMS, Current Edition __ ONE PAGE � r�!s #����'�i i ` I /�`�, 1 l � 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 Mutual Insurance Company The Ohio Casualty Insurance Company West American Insurance Company Certifcate No: 82Q5467-022020 POWER OF ATTORNEY KNOWN ALL PERSONS BY THESE PRESENTS: That The Ohio Casualty Insurance Company is a corporation duly organizetl under the laws of the State of New Hampshire, that Liberty Mutual Insurance Company is a corporation duly organizetl 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 collecfively called the "Companies"), pursuant to and by authority herein set forth, does hereby name, constitute and appoint, Don E. Comell; Joshua Saunders; Kelly A. Westbrook; Mikaela Peppers; Ricardo J. Reyna; Robbi Morales; Sophinie Hunter; Tina McEwan; Tonie Petranel< all of the city of Dallas state of TX each individually if there be more than one named, its true antl lawful attorney-in-fact to make, execute, seal, acknowletlge and deliver, for and on its behalf as surety antl as its act and tleed, any and all undertakings, bonds, recognizances antl other surety obligations, in pursuance of these presents and shall be as binding upon the Companies as if they have been duly signetl by the presitlent antl 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 N � � c c� � State of PENNSYLVANIA a, County of MONTGOMERY Liberty Mutual Insurance Company P� 1NSU,pq P�,�{Y WSU� � �Nsu,pq The Ohio Casualty Insurance Company ,�J �pRPORqp �� yJ GORp�RqT 9y \G��ORP�R9r y� WestAme�an InsuranceCompany J 3 Fo m Q' 3 `�o c� p r �o � � 1912 0 0 1919 � � 1991 0 // �'� ,,,,�- > ���sS 4 C H U5�IC. daS' y0a� h• A M 45��� a�O �! � H D I A NP D (�,. r"�'js X� r r�'r/,. ej� * F� �H1 * ��a s�M * ��d gy. � ,%'" _ David M. Carey, Assistant Secretary � � �� �� On this 23rd tlay of April , 2021 before me personally appeared David M. Carey, who acknowledgetl himself to be the F�ssistant Secretary of l.iberty Mutual Insurance �� �� Company, The Ohio Casualty Company, and West American Insurance Company, and that he, as such, being authorized so to do, execute the foregoing instrwnent for the purposes �= �� therein contained bv sianina on behalf of the corporations bv himself as a dulv authorized officer. �' � i� � �'� C6 O � � dj O O ,� c� aS � �� cv � �� � �- o .� E.: IN WITNESS WHEREOF, I have hereunto subscribed my name antl affixed my notarial seal at King of Prussia, Pennsylvania, on the day and year first above written. �� �� � y� a Q Y�, �y��;`�- e� Commonwealth of Pennsylvania - Notary Seal . >,_ �, �? � �^� t Teresa Pastella, Notary Public � N'� � �°�� �,� � �� Niontgomery County � /� � � � My Commission expires Maroh.28, 2025 BY� ,f:� ���,.{� p d � �r � Commission number 1126044 � ---- --- �-- �5°��.�� 1�:�?;� a��� Member,PennsylvaniaAssociationofNotaries eresa Pastella, Notary Public _ �. Q o0 �, �a�� ;��; y,<<' � �r 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 �� Insurance Company, and West American Insurance Company which resolutions are now in full force and effect reading as follows: o� a ARTICLE IV— OFFICERS; Section 12. Power of Attorney. `o 0 Any offcer 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 -a �— 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 antl deliver as surety � C° any and all undertakings, bontls, recognizances and other surety obligations. Such attorneys-in-fact, subject to the limitations set forth in their respective powers of attorney, shall -o � have full power to bind the Corporation by their signature and execution of any such instruments antl to attach thereto the seal of the Corporation. When so executed, such o a� instruments shall be as binding as if signetl by the President and attested to by the Secretary. Any power or authority granted to any representative or attorney-in-fact under the �� provisions of this article may be revoked at any time by the Board, the Chairman, the Presitlent or by the officer or officers granting such power or authority. � Q ARTICLE XIII — Execution of Contracts: Section 5. Surety Bonds and Undertakings. Any o�cer 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 antl other surety obligations. Such attorneys-in-fact subject to the limitations set forth in their respective powers of attorney, shall have fuli power to bind the Company by their signature antl execution of any such instruments and to attach thereto the seal of the Company. When so executed such instruments shall be as bintling 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 antl all untlertakings, bonds, recognir.ances and other surety obligations. Authorization — By unanimous consent of the Company's Board of Directors, the Company consents that facsimile or mechanically reproducetl 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 bontls, shall be valid and binding upon the Company with the same force and effect as though manually affixed. I, Renee C. Llewellyn, the undersignetl, Assistant Secretary, The Ohio Casualty Insurance Company, Liberty Mutua! Insurance Company, antl 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 Aftorney executetl by saitl Companies, is in full force antl effect and has not been revoked. IN TESTIMONY WHEREOF, I have hereunto set my hand and affixed the seals of said Companies this 17th day of February , 2025 . y 1NSUR �,ZY INSU � iNSU,q �JQ'�oaPORqr'9'L� yJP'4�RPOq,qr�2 \VPGp�tPORqTA�'C� �� Fo rn Q= Fo c� � r `o cn ���_ 1912 � 0 1919 � � 1991 � Y 95, ,l`" S� y 26' Q-� O Q . y� B�/ • - . dd SA�H�S� aa °``"AMes� aa �s '"o,ANP aa Renee C. Llewellyn, Assistant Secretary �i> * �� �y1 * }�� d,H * 1�P LMS-12873 LMIC OCIC WAIC Multi Co 02/21 "� s" `� �� .� M�� � TEXAS IMPORTANT NOTICE To obtain information or nzake 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 Departinent of Insurance Consumer Protection (ll 1-lA) P. O. Box 149091 Austin, TX 78714-9091 FAX: (512) 490-1007 Web: httb://www.tdi.texas.gov E-mail: ConsumerProtection(a�tdi.texas.gov PREMIUM 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. TEXAS AVISO IMPORTANTF, Para obtener infornlacion o para soi��eter una queja: Usted puede llamar al numero de telefono gratis para informacion o para solneter u��a 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 obtenei- informacion acerca de companias, coberturas, d�rechos o quejas al 1-800-252-3439 Puede escribir al Departamento de Se�;ui•os de TeXas Consumer Protection (1 l l�1 A) P. O. Box 149091 Austin, TX 78714-9091 FAX # (512) 490-1007 Web: htt�://www.tdi.texas.gov E-mail: ConsuinerProtection(a�tdi.teYas_�ov DISPUTAS SOBRE PRIMAS O RE?CI.�f1MOS: Si tiena una disputa concerniente �a su �p�•in�a o a un reclamo, debe co�inunicarse con el a�eiite o primero. Si no se resuelve �la disp�.�ta, puede entonces comuiiicarse 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 condic�ion del documento adjunto. NP70680901 LMS-15292 10/15