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Home My WebLink About060409-FP3 - Construction-Related - Contract - Rumsey Construction-FP3 Ciry 5ecretary 60409 Contract No. F�RT ��RTH�� Date Recei�ed 1/9/2026 AT NOTICE DF PR�JECT COMPLETI�N �De�elaper Prajects) The Transpartation and Publi� Works Depar�ment upon the recommendatian of the Projeci Manager has accepted the failawing praject as complete: Project Name: Public Markert Gity Prajec# No.: 104792 Improvement Type(s): � Pa�irtg x❑ Qrair�age � Street Lights ❑ TrafFc 5ignals Original Cantract PricE: Amount of Appra�ed Change Order�s}: Re�iSed Cantract Amaunt: Tatal Cost of 1Nork Complete: ba,vi� flu�tclir,�.sv�sz �,��d��,�n��,z��;,.,�; �_,6,,,�,6�s��, Contractar Vice President Title Rumsey Construction Cornpany Name �r�e�P��. Project Irtspector � Praject Manager �� CFA Martager �.�,�..,..7,.�.Y,,. �a�r��, Pr��,r ��,n 9, zoz�„�,9_,s �T; TPW ❑irectar O1/07/2026 Date O1/07/2026 E3ate O1/O8/2026 Date O1/09/2026 Date O1/09/2026 Date $458,69�.2D $458,69�.ZD OFFICIAL RECORD CITY SECRETARY FT. WORTH, TX Page 1 of 2 Nr�tice of PrQject CompletiQn Pr�ject Name: Pubiic Markert Ciry Project Na.: 104792 City's Attachments Final Pay Estimate � Change C]rder(s}: ❑ Yes 0 NlA Contractor's Attachments AfF€davit of Bills PaEd � Cansent of Surety � Statement of Cvntract Time Contra�t Time:150 Days Charged:218 Wark 5tart Date: 219l2024 Wark Camplete �ate: fi1� 9l2�25 Completed number af Soif Lab Test: 235 CQmpleted n�mber of Water Test: � Page 2 of 2 F�RT ��RTH CIT� O�' FORT WflRTH FINAL PAYIV�NT REQUEST Conh•act Name FUBLiC MARKET Conh•act Limits Praject T�-pe I]RAIl�iAGE Cit�- Praject �Tumbers 104792 DDE lumber 4792 Estinsate �iumber 1 Fa�ment 1Vainber 1 For Period Ending 5/19/2025 WD Cit�- 5ecretAi�v Contract Nu�nber Cauh•act Date Fraject 14IanAger NA Conh�actoa R�SEY CaNSTRUCTT�N, LLC 6617 VII,LAGE SPRIlVGS DRI4'E PLANO, T'X 75D24 Inspectors M. GLaVER � 7. MANRY Contract Time 15�UD DaF•s Charged ta Date 21g Contract is 1DQ.00 Complete V47ednesday, August 6, 2425 Page 1 af 5 City Project Numbers 104792 Contract Name PUBLIC MARKET Contract Limits Project Type DRAINAGE Project Funding UNIT III: DRAINAGE IMPROVEMENTS DOE Number 4792 Estimate Number 1 Payment Number 1 For Period Ending 6/19/2025 Item Description of Items Estimated Unit Unit Cost Estimated Completed Completed No. Quanity Total Quanity Total 1 REMOVE 4' GRATE INLET 1 EA $1,562.00 $1,562.00 1 $1,562.00 2 21" RCP, CLASS III 59 LF $213.00 $12,567.00 59 $12,567.00 3 5' STORM JLTNCTION BOX 2 EA $9,707.00 $19,414.00 2 $19,414.00 4 10' CURB INLET 2 EA $9,925.00 $19,850.00 2 $19,850.00 Sub-Total of Previous Unit $53,393.00 $53,393.00 UNIT N: PAVING IMPROVEMENTS ltem Estimated Estimated Description of Items Unit Unit Cost No. Quanity Total 1 REMOVE SIDEWALK 2058 SF $1.10 $2,263.80 2 REMOVE CONC PVMT 534 SY $33.10 $17,675.40 3 REMOVE ASPHALT PVMT 645 SY $24.52 $15,815.40 4 REMOVE CONC CURB & GUTTER 542 LF $10.00 $5,420.00 5 HYDRATED LIME 19 TN $400.00 $7,600.00 6 6" LIME TREATMENT 1187 SY $5.80 $6,884.60 7 6"CONCPVMT 262 SY $71.19 $18,651J8 8 8" CONC PVMT 187 SY $85.68 $16,022.16 9 5" CONC SIDEWALK 1468 SF $10.74 $15,766.32 10 BARRIER FREE RAMP, TYPE P-1 3 EA $500.00 $1,500.00 11 6" CONC CURB AND GUTTER 775 LF $34.00 $26,350.00 12 6" SLD PVMT MARKING HAS (W) 50 LF $10.00 $500.00 13 UTILITY SERVICE SURFACE RESTORATION 1112 SY $6.55 $7,283.60 SODDING 14 TRAFFIC CONTROL 6 MO $4,569.00 $27,414.00 15 5" CONC PVMY 738 SY $62.91 $46,427.58 16 EROSION CONTROL 1 LS $21,250.00 $21,250.00 Completed Completed Quanity Total 2058 $2,263.80 534 $17,675.40 645 $15,815.40 542 $5,420.00 19 $7,600.00 1187 $6,884.60 262 $18,651J8 187 $16,02216 1468 $15,766.32 3 $1,500.00 775 $26,350.00 50 $500.00 1112 $7,283.60 6 $27,414.00 738 $46,427.58 1 $21,250.00 Sub-Total of Previous Unit �236,824.64 $236,824.64 UNTl' V: STREET LIGHTING IMPROVEMENT5 Item Estimated Estimated Completed Completed Description of Items Unit Unit Cost No. Quanity Total Quanity Total 1 2" CONDT PVC SCH 80 (T) 380 LF $35.00 $13,300.00 380 $13,300.00 Wednesday, August 6, 2025 Page 2 of 5 City Project Numbers 104792 Contract Name PUBLIC MARKET Contract Limits Project Type STREET LIGHTING Project Funding DOE Number 4792 Estimate Number 1 Payment Number 1 For Period Ending 6/19/2025 2 2" CONDT PVC SCH 80 (B) 500 LF $163.00 $81,500.00 500 $81,500.00 3 NO 2 INSULATED ELEC CONDR 2625 LF $4.22 $11,077.50 2625 $11,077.50 4 FURNISH/INSTALL GROUND BOX TYPE B, W/ 3 EA $2,400.00 $7,200.00 3 $7,200.00 APRON 5 FURNISH/INSTALLLED LIGHTING FIXTURE (70 6 EA $1,776.67 $10,660.02 6 $10,660.02 WATT ATBO COBRA HEAD) 6 FURNISH/INSTALL RDWAY IINM TY 18 POLE 6 EA $2,316.67 $13,900.02 6 $13,900.02 7 FURNISH/INSTALL TYPE 33A ARM 6 EA $576.67 $3,460.02 6 $3,460.02 8 FURNISH/INSTALL 240-480 VOLT SINGLE 1 EA $11,800.00 $11,800.00 1 $11,800.00 PHASE TRANSOCKET METERED PEDESTAL 9 FURNISH/INSTALLRDWAYRIUM 6 EA $2,596.50 $15,579.00 6 $15,579.00 FOLTNDATIONTY 18 SUb-TOtal Of PreVIOUS Urilt $168,476.56 $168,476.56 Wednesday, August 6, 2025 Page 3 of 5 City Project Numbers 104792 Contract Name PUBLIC MARKET Contract Limits Project Type STREET LIGHTING Project Funding Contract Information Summary Original Contract Amount Change Orders Total Cost of Work Completed $458,694.20 Less % Retained $0.00 Net Earned $458,694.20 Earned This Period $458,694.20 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 Total Contract Price DOE Number 4792 Estimate Number 1 Payment Number 1 For Period Ending 6/19/2025 $458,694.20 $458,694.20 $0.00 $0.00 $0.00 $0.00 $0.00 $458,694.20 Wednesday, August 6, 2025 Page 4 of 5 Cih� Frojert Vumbers 104792 Contract �iame PCTBLIC MARKET Contract Linsits Project T�-pe STREETLdGHTING Project Funding Project hiauager NA Inspectars M. GI,OVER r 7. MANRY Contractar RUMSEY CONSTRUCTIaN, IS,C 6617 V`II LACrE SPRINCrS DRNE PLAN� 3 T'X 75D24 Line Fund Acrount C'enter DUE 1\umber 4742 Estimate liumber 1 Pav ment �iuinber 1 Far Period Ending 611912D25 Citf• Secretary Cantract l�umber Contract Bate �OIIYL'ACf T1ll1P 15a w� Da��s Charged ta Date 21g WD Contrar# is DQQOOD �qmplete CTTY OF FORT W�RTH SUNIlVIARY QF CHARGES Amount Grass Retainage Fnnded Totxl Cost of �'4'ork Completed Less °/o Retaiued Net Earned Earned This Period 5458,694.20 Retainxge This Pen•iod $0.00 Less Liqnidated Damages 0 D�►-s � $D_60 1 Dx�• LessPavement Deficienc4• Less Penalh- Less Pa�e�zaus Favment Plus _l'Iaterial au Hand Less 15°�0 Salanre Due This Px�weut liet $458,69�_ZD $O.Ofl $458,69�_ZD �d.00 $0.40 $d.DO $O.DO �o.00 $458,69�.zo V47ednesday, August 6, 2425 Page 5 af 5 �� TRANSPORTATION AND PUBLIC WORKS June 19, 2025 RUMSEY CONSTRUCTION 4336 MARSH RIDGE CARROLLTON, TX 75010 RE: Acceptance Letter Project Name: Public Market Project Type: water, sewer,paving,lighting and drainage City Project No.: 104792 To Whom It May Concern: On July 10, 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 August 5, 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 August 5, 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- 392-7800. Sincerely, � Sandip Adhikari, Project Manager Cc: Stephen Barnard, Inspector Mike Glover , Inspection Supervisor Daniel,Roy, Senior Inspector Andrew Goodman, Program Manager KIMLEY HORN, Consultant RUMSY CONSTRUCTION, Contractor The Harden LLC, Developer File E-Mail: TPW_Acceptance@fortworthtexas.gov Rev. 8/20/19 BILLS PAID AFFII3AVIT FOR CONTRACT�R State of Texas County of Denton �EFORE E. the undersigned authority, on this day personally appeared �� t=� - - ), known to me to be a credible person and officer of ( Rumse� Construction lnr _ _ l and who, being duly sworn, upon his oatl� declares and acknowledges as fol�ows: 1. I am a duly authorized agent of ( RumseY Construction, lnc ), which has authorized �ne to make this affidavit, and all of the recitations hereiu are true and coirect. 2. Pursuant to Private Development Contract No. 104792 betWeell ( NE Construction ) and ( RumsP�v C'onstr�ction Inc ) foi (Public Market ), Rumsey Construction, Inc) has supplied materials and performed labor in connection with the construction of improvements on real property owned by (Harden, LLC by Wilks Development. LLCI ln the City Of Fort Worth ("the improvements") 3, ( Rumsey Construction,lnc ) has actual knowledge that all bills o�ved by (rvE construction 1 #o (Rumsey Construction, Inc 1 for materials supplied or labor performed in connection with the improvements have been fully paid and satisfied. 4, ( Rumsey Construction, Inc ) has actual knowledge that all bills owed by ( Rumsey Construction,lnc ) to others for materials supplied or labor performed in connection with the improvements have been fully paid and satisfied. 5. (Rumsey construct;on, inc ) has actual knowledge that there are no claims or liens fol• materials supplied or labor performed in connection with the Private Development Contract. (Rumsey construstion, �nc ) fiirther warrants that should any claim or Iien be filed for material supplied or labor performed in connection with the Private Development Contract, ( Rumsev construction.inc )«rill immediately furnish a bond pur•suant to Texas Property Code Sections 53.236 through 53.238 foi• release of each the claim or lien, obtain settlement of any ciaim or lien, and furnish the City of Fort Worth written fiill release. ( Rumsey Construction, mc � agrees to fiilly indemnify and hold 1larmless the City of Fort Worth from any and all costs that may accur bv reason of such claims or liens. EXECUTED this � �� day of (vOVt'M`4er . 20 �:� �vn�s�7 � r-4-r vri-r o �r� �y�.� sy %t�` NAME: ,��'cL, TITLE: ��tgn c,� STATE OF TEXAS COUNTY OF DENTON This instrument was acknowledged before me on �(' a�� a� � s by �bik �SG� �P p� �,�a.GL Of RiimcP�/ C;nnStnir.tinn a �r,r cotpor�lvMhi��i��Yi�lf of said cotporation. .�``��\��.� • � R 9�s��'% j� ti P,•' ��RY PVe.'• � i �W�. SOn /J [NOTARY PUBLIC STAMP] ' �� 2 ��`•.Z : ��OTARY PUBLIC = `��. � �' = — 9 -}-� _ T � • i F pF'CF'p.:' � '•.O ': F' '••�3523�fO.�' � \`� � � •• . � �� ///,p/Io3' 12 a12� \\\\\� C4NSENT OF c��i;jt o SUR�TY COMPANY nizc�iirr��.c4� ❑ TO FINAL PAYM�NT c�«��rr��c�r��z ❑ til'ft1�1�1' ❑ AIA U(?C'UML:N'1' CT707 c�i�in:�t f3oncI Nci. S13P1ti0�}10 001 NfZO.II:C'I': 1'4'alcr, Sc�vcr, Yavin�;, Lightinh anci Dr.�inage lmpro��c��ienls ta serve Puhlic Marl.et CYN (n�in,�. ,�ddress) 10=479Z -�n �U��'�1��7 � Ilarcien, LLC & Cilv of F{�r# �1'urth 13�1 Nlxrlcu�n Gatc Wav, St�ite ]OU 1� urt `i'orih, "I'\ 76126 � � CON"E,f2r1CTOR: �Z«rnse}° Cnnstr•uctir►n, Ine. -3336 ��arsh Rid�;e Carrolltun, "CX 75t}111 ,1EZ['E �f�I�EC"I�'S PROJI:C"I� NO: J C'U\�[.R�1�'�I I�OIZ: Watrr, Sc�vrr, Paviii�, CONTRAC"[� DA"fE: Na��c�iiber 2$, 2023 li� aca7rdance �vith t4�e peovisiuns ol�the Cc�ntract hch��een thc C)��nc�- and the Contr��ctor ns incficated ab«v�, lhe Ih�r� insrrt n,�rii� ancl ;ui�lr�.,s c�t�tiurrtr ComF�<}ri� } Pcnns�'��:inia lnsw•ance Cornp:in�, ��.(). I3o:� 3G�tG . SUR�'I'Y COMPANY. ()�tiah:i, h i; b81 U3 DIl 17011C� (}� IhCt� Ins�i'I n,�rii� an�l u�ltli'�55 ul�l u[iliaclUl') �tumsc�� Constructint�, Inc. �333G Marsh Rid;;c carroii�<�n, TX 7�1110 . CON'l'RACTOR. �7�1'��\' tlj)4)]'(1\'Z� U� l�ll' fllltll �)i11311C171 [ll 1�7t` ��t�lllf�ll:lt)I�ti. �111C� �l��i'Cl'.5 T�I�lC flll�l� �?�VI11CIli l0 i�� 011ll'ilCiOC S�1Z�� Ilpi i"e�ICVC E�l� Slll'�11' ��011l�)$I]� 11� tlll\ Uf II� O�]�It,illl[)]]ti [C? �h�f� iit;Ci't nam� ;�ild addi'CSS uf�Oti�nCfJ [�[arden, Li�C cSc Cii)' ol' �orl Wnrth 13Z1 Markuru G�itc W��, Suitc I00 Fort \Vorth, TX 7G12fi -C)11�NI;R. as s�i iaeth in ihc saicl Suf•etv C'ompany'� hond. I\ V,'f'I��f.:SS 11'k31�:Rl:OI�. Ehe Surtt� Cnm�ru�� f�,i; I��rruntc� ti�t it; lianci thi� 2-3th `~� . �K�� s� Attest: �1_ (Seal): cla�� t7f� Novcml�cr� Pcniis�}�l��auia lnsru•ancc Company, 2(!2� Surety Co npti��y �' �• � / � � _ _�( — � ...-- ----- "_ � f z1�-- Si��nat�n�e ofAuth izeci iZc��reseE�tativc -- -- � Allyson W. llc� �i Aktorizev-In-F��Ci "I�i[Ic \U'fli I'hi, fn��n i; ita E�e u;rd �i.c::cumpuniut= �ucumrtil Io;Vf1 I)[)('U�11i�1'T Ci7c16. �'UN'I Itr1l"!"[11t'S;1I�F11);1VIT O1 P�\1',\Ilf�''f O1- I)I{I�'i'ti :1VI�CLAi\9ti. l'ccrrc�it I:ili!inn .-1iA I)C1C'11�1L?v"I� : �?+77., C',)f�SEi�'f U1= SUR�'['1' ('C?MPANl''fO I�[VAI.. PAYAdIiI�lT • i11'R�I. 197i1 [:I�I"[']ON .,\�:\C� f)Nfi PA(i�i OO 19711 ."fl I�? �\btf I2iC'r1n� INS"f'i'f� il'i' Of ARCI11'fF.C"I�S. l7�? N��c Yor�::1�c,. N�Y. 4y'ASI ilNIiTON. D.C, >_UI1UG . .. � . . ' � ``��I�Iil1��/' ,.• . , / ' ,•'� �� , ( ,? �� ' � �. �,' t � • � i��i�� t`)''J�,��\',�' . ;' �` �, i (t , rd `�/ ` l . � ' .. . � ' . _ . . . , . • . .. . .. ' . ' : (�� /l' . `�� \ I��11 `•• . � � .. � -. . . � . � . �. - •. ' l, ; t O f , �) ): I �� : . � . � ' .. .. . � .. . �� ... . . . ,xt�r�, ��.a��`�(f � �1 � !)� r� , • �/ Y..; �� /: . , . � , �•� � ,� � `; . � � ' ;1�' ��. . �� > , - �,,: : . . . • � . _ � .,�� i ,:�� . � . . .. . , . . - . .. .. . ' . , . . . _S..r�'" �'��i�ir�ii�'�, , - . . . . . . � ., . . � � ' . . . . . ; `'. . , ' r. , . .. . � . . ' . � ' . . . . ' .. ' . �, . . . ,,, ( �. , . . ... . - . . i� - . � - . . . . . _ ' , , . . . � , . " . . . !' . ' . , . � . . � . . . . . . . - . I . ._ , - , ', . . ' . . . . . � . .. � . • ' . { c � . , . � . � . . . . . .. � . .. . . . . , . ' , ' . , t ' , . . .� � . . ' , � � ... ' . . . . . � � ' � i' . _ � , . . . . ,r, ' . . . . � . , .. � . . . ' � . . .. . . , . . . . . . . , ' . . . � � . . �. California lnsuranceCompany • Continent�l Indemnity CompAny • Illinois InsurAnce Company ' Pennsylvenia tnsurance Comps�ny I080S Ol�! A-lil! Rocirl • Omaha. 1�'eGraska GSlSd POWCR OF ATTORNCY NO. ACRADDOI OS23 KNOW .0.LL MEN BY THESE PIZGSENTS:1'hat the California lnsurancc Company, duly organi•r.ed and cxisting undcr thc la�vsof thc Stateof California and having i1s principal afficc in thc County of San Matco, California, and Continental Indemnity Company, Illinois Insurance Compony and Pennsylvania lnsurance Company, corporations duly organizcd and cxisting undcr thc la��•s ol'the Statc of Ne��• f�1e�ico and having their principal olfice in the Cpunty o!' Santa Fe, New Mexico does hereby nominate, constitute and appoint: Allyson W. Du~�n, Andrea Rose Crawlord, Colin E. Conly, Debra Lee Moon, Sandri Lee Roney. Troy Russell Key, A�i O�vens, Andrew (sareth Addison, Thomas Douglas Moore. Elizabeth Ortiz, Emily nllison �likesk�, Ho��rd Cou�n, Faith,lnn Hilty, nlyssa J. l.opez Kimberly R. Oonz�le� Cory KQer, Crystal Langhorn, Stev�n W. Le�vis, Tcresa �>yala Its true and lawl'ul agrm and attomey-in•I'act, to make, executc, seal and deliver 1�>r and on its bchalf as surety, and its act anJ deed any a�id all bonds, contracts. agreemems of indemnit}' and othrr undertakings in suretyship (NUT fNCLUDINC� bonds wilhout a tixed penalty or linancial guarantee} provided, ho��e��cr, that thc penal sum of any onc such insirument exccuicd hereunder shall no� e�cecd the sum of: "Un I im ited" This Power of'.�ttomey is granted and is signed and sealcd under and by the authority of the follo��ing licsolution adoptcd by thc I3oard of Dircctors of California lnsurance Cumpany, Continental InJemnity Company, Illinois Insurance CompAny and PennsylvaniA Insurance Company. ''RESOLV ED, Tha� the Presidcnt, Scnior V ice President, V ice i'residenl, Assisted V icc Presid�nt, Secretary, Treasurer and each of thcm hereby i�authorized to e�ecute po�vers of attorney, and such authority can be e�c:cuted hy use offacsimile signawre, ��hich may� be auested or acknowledged by any officer or attorncy of the Company, qualifying the attorney or attorneys named in given power ol'attorney, to execute in behalt'of, and ackno�vledge as thz act and decd of the California {nsurance Cornpany, Continental Indemnity Company, lllinois Insurance Company And Pennsylr•aniA Insurance Company, all hond undertakings and cantracts ofsuretyship, and to affi� the corporate scal thereto." fN WITNCSS WHEitEO(', California lnsuraoce Company, ContinentAl I�demnity Company,111inois Insurance Company a�d Pennsylvania lnsurance CompAny, has caused its ol'ticial seal to he hereunto alli�ed and �hese presents to br signed hy its July authorized ollicerifie lGthdayofnugust2023. Calil'ornia lnsurancc Comp:u�y, Contin:nu�l Indemni�y Company, Ulinois Insur�nCc C ��tpany, Pennsylvania lnsurancc Company 13v i � �� 1 J JeRF�y A. Sitver. Secrctary \/ STATE OF NEBRASKn COUNTY Of UOUGLAS SS: On this 16thdayofAug�,A.U. 2023, before rnca Nota�� Public of thc Sqie of Ncbraska, inand for thc County af Douglas, duly commi�sbncd and yualil'�ed, camc TtiE ABOVE OFPtCER OF THE COMt'ANY, to me personally kno�vn �o be the individual and ollicer described ii�, and �vho executed the preceding instrument, and he ackno��9edged the e�ecwion of the same, und being by me duly swom, deposed and said �hat he is tlie o!'ticer of the said Company aforesaid, and that the sc�l afii�cd to the preccding instrumenl is ihc Cotporatc Spl of said Company, and tht said Corporale scal and his si�nalure as ofticer werc dulq afli�cd aud subscribed to thc said instn�men� by tNe mitho�ity and dircctan of tl�e said corporation, �nd Usat Resolulio� adcpted by �hc t3oard of Dircuors of said Company, relcrred io ni Ihc prcceding ulstrumenl is no�v in force. IN TESTIMONY WNERF.OF, I have hereunto set nty hand, and alTi�ed mp O�cial Se�l at �he Co�my of I]o��'�'��• ��c Ja�• unJ yr•¢ ti§� above �critten. % GENERAL NOTARY • State o1 NebrasKa �� ~ �-��., �,)�__ y,�.�r--z_ �' LINDA S. OAVIS �� (Notary• I ublic) ��"'p My Comm. Exp. Seplember t, 202 1, ihe undcrsigned 011icer ol'the Cali(ornia lnsurxnce Company,a Cnlifornia Cor�oration of Foster Ciry, Califurnia. Conlinental Indemnity CompAny, lllinuis lnsur�nce Company and Pennsylvanie {nsurance CampAny, Ne�v Mcxico Corporalions of Santa Fe, Ne�v �Vte�ico, do herby certif'y Ihat the original I'OWEIi OP /1"l�"I�ORNLY of��hich (hr foregoing is full, true and correct copy is slill in ful! 1'orce and effect and has not been revoked. IN W IT�lESS W 1-{EItC01=, l have hrreunto sel my hanJ, and aflixed the Seal of said Company, on the 24th d�y, �� November 20 25 — ---� - t�� Jeffrcy �\. Silr•cr, Secretury IMPORTANT NOTICE-TEXAS This bond has been issued by one of the North American Casualty Group and/or SiriusPoint America Insurance Company insurance carriers listed below: Continental Indemnity Company Illinois Insurance Company Pennsylvania lnsurance Company California lnsurance Company SiriusPoint America Insurance Company To obtain information or make a complaint: You may call the insurance carrier's toll-free telephone number for infarmation or to make a complaint at: (877) 234-4420 Please send all notices of claim on this bond to: Applied Surety Underwriters - Surety Claims 10805 Old Mill Road Omaha, NE 68154 Phone: (877} 234-4420 Fax: (877) 234-4425 You may contact the Texas Department of Insurance to obtain information on companies, coverages, rights or complaints at: 1-800-252-3439 You may write the Texas Department of Insurance at: P. O. Box 149104 Austin, TX 78714-9104 Fax: (512) 475-1771 Web: http://www.tdi.state.tx.us E-mail: ConsumerProtection a(�.tdi.state.tx.us PREMIUM OR CLAIM DISPUTES: Should you have a dispute concerning your premium or about a claim you should contact your agent or Applied Surety Underwriters first. If the dispute is not resolved, you may contact the Texas Department of Insurance. ATTACH THIS NOTICE TO YOUR BOND: This notice is for information only and does not become a part or condition of the attached document and is given to comply with Texas legal and regulatory requirements. AS-10010-NAC {05-2022)