HomeMy WebLinkAbout061249-FP1 - Construction-Related - Contract - CIMA General Contractors-FP1
City Secretary 61249
Contract No.
FORT WORTH.
Date Received 5/13/2026
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: UPS Staging — Liberty Connection
City Project No.: 105301
Improvement Type(s): ❑x Paving ❑ Drainage ❑ Street Lights ❑ Traffic Signals
Original Contract Price:
$7,263.95
Amount of Approved Change Order(s):
-$3,389.00
Revised Contract Amount:
$3,874.95
Total Cost of Work Complete:
$3,874.95
202608.33.07 CDT)
Contractor
Vice President of Construction
Title
CIMA General Contractors
Company Name
Hecto Mo to a (May 11, 2026 09:04:46 CDT
Project Inspector
� / , -,#� y
Project Manager
CFA Manager
d1,7R:_1
Lauren Prieur (May 13, 2026 16:40:20 CDT)
TPW Director
05/11/2026
Date
05/11/2026
Date
05/13/2026
Date
05/13/2026
Date
05/13/2026
Date
OFFICIAL RECORD
CITY SECRETARY
FT. WORTH, TX Page 1 of 2
Notice of Project Completion
Project Name: UPS Staging — Liberty Connection
City Project No.: 105301
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: 39 WD
Work Start Date: 9/26/2024 Work Complete Date: 12/11/2024
Completed number of Soil Lab Test: 6
Completed number of Water Test: 0
Page 2 of 2
EDDY WORTH
CITY OF FORT WORTH
FINAL PAYMENT REQUEST
Contract Name UPS STAGING - LIBERTY CONNECTION
Contract Limits
Project Type PAVEMENT
City Project Numbers 105301
DOE Number 5301
Estimate Number I Payment Number I
City Secretary Contract Number
Contract Date
For Period Ending 12/11/2024
AID
Project Manager NA
Contractor CIMA GENERAL CONTRACTORS
1017 LONG PRAIRIE RD, STE 200
FLOWER MOUND, TX 75022
Inspectors G.DEYON / H.MONTOYA
Contract Time 4WD
Days Charged to Date 39
Contract is 100.00 Complete
Monday, January 6, 2025 Page 1 of 4
City Project Numbers 105301
Contract Name UPS STAGING - LIBERTY CONNECTION
Contract Limits
Project Type PAVEMENT
Project Funding
UNIT III: PAVEMENT IMPROVEMENTS
DOE Number 5301
Estimate Number 1
Payment Number 1
For Period Ending 12/11/2024
Item
Description of Items
Estimated Unit
Unit Cost
Estimated
Completed
Completed
No.
Quanity
Total
Quanity
Total
---------------------------------------
1
REMOVE GUARDRAIL (CO#1)
0 LF
$43.00
$0.00
0
$0.00
2
8" CONC PVMT (4500 PSI)
33 SY
$16.50
$544.50
33
$544.50
3
TRAFFIC CONTROL
I MO
$1,160.00
$1,160.00
1
$1,160.00
4
HYDRATED LIME
2 TN
$375.00
$750.00
2
$750.00
5
8" LIME TREATMENT
53 SY
$14.65
$776.45
53
$776.45
6
TOPSOIL
20 CY
$30.00
$600.00
20
$600.00
7
BLOCK SOD PLACEMENT
2 SY
$22.00
$44.00
2
$44.00
8
TxDOT GUARDRAIL END TREATMENT
0 EA
$895.00
$0.00
0
$0.00
(INSTALL)(CO# 1)
Sub -Total of
Previous Unit
$3,874.95
$3,874.95
Monday, January 6, 2025 Page 2 of 4
City Project Numbers 105301
Contract Name UPS STAGING - LIBERTY CONNECTION
Contract Limits
Project Type PAVEMENT
Project Funding
Contract Information Summary
Original Contract Amount
Change Orders
Change Order Number 1
Total Contract Price
DOE Number 5301
Estimate Number I
Payment Number 1
For Period Ending 12/11/2024
$7,263.95
($3,389.00)
$3,874.95
Total Cost of Work Completed $3,874.95
Less % Retained $0.00
Net Earned $3,874.95
Earned This Period $3,874.95
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
$3,874.95
Monday, January 6, 2025 Page 3 of 4
City Project Numbers 105301
Contract Name UPS STAGING - LIBERTY CONNECTION
Contract Limits
Project Type PAVEMENT
Project Funding
Project Manager NA
Inspectors G.DEYON / RMONTOYA
Contractor CIMA GENERAL CONTRACTORS
1017 LONG PRAIRIE RD, STE 200
FLOWER MOUND, TX 75022
DOE Number 5301
Estimate Number 1
Payment Number 1
For Period Ending 12/11/2024
City Secretary Contract Number
Contract Date
Contract Time 45 WD
Days Charged to Date 39 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 $3,874.95
Less % Retained $0.00
Net Earned $3,874.95
Earned This Period $3,874.95
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 $3,874.95
Monday, January 6, 2025 Page 4 of 4
Docusign Envelope ID: F1DB5D1A-D140-4471-A2C5-28B460BADBIC
DEVELOPER -AWARDED -PROJECT CHANGE ORDER
PROJECT NAME:
UPS Staging - Liberty Connection
CHANGE
CONTRACT:
Paving Im rovements
ORDER No:
CFA#
24-0018 CITY PARTICIPATION: NO
CITY PROJECT #
105301
CITY SECRETARY CONTRACT #
61249
FID #
30114-0200431-105301-EO7685
X #
N/A
FILE #
K-3227
INSPECTOR:
Hector Montoya
Phone No:
817-392-8306
REVIEWED
PROJECT MANAGER:
Debbie Willhelm
Phone No:
817-392-2481
By Debbie J. Willhelm at 8:25 am, Dec 06, 2024
CONTRACT UNIT
CONTRACT
DAYS
WATER
SEWER
DRAINAGE
PAVING
STREET LIGHTS
Developer
Cost
City Cost
Developer Cost
City Cost
Developer
Cost
City Cost
Developer
Cost
City Cost
Developer
Cost
City Cost
ORIGINAL CONTRACT
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$7,263.95
$0.00
$0.00
$0.00
45
EXTRAS TO DATE
$0.00
$0.00
1 $0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
CREDITS TO DATE
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
CONTRACT TO DATE
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$7,263.95
$0.00
$0.00
$0.00
45
AMOUNT OF PROP. CHANGE ORDER
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$ (3,389.00)
$0.00
$0.00
11 $0.00
0
REVISED CONTRACT AMOUNT
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$3,874.95
$0.00
$0.00
1 $0.00
45
TOTAL REVISED CONTRACT AMOUNT PER
UNIT
$0.00
$0.00
$0.00
$3,874.95
$0.00
REVISED COST SHARE
Dev. Cost:
$3,874.95
City Cost:
$0.00
TOTAL REVISED CONTRACT
$3,874.95
Revised: 12-17-2018 Page 1
Docusign Envelope ID: F1DB5D1A-D140-4471-A2C5-28B460BADBIC
You are directed to make the following changes in the contract documents:
I INIT IV- PGVFMFNT IMPROVEMENTS
PAY ITEM #
CITY BID ITEM
QUANTITY
UNIT
ITEM DESCRIPTION
CFW Unit
UNIT PRICE
Developer
City Cost
TOTAL
#
Price
Cost
1
241.0550
(58.00)
LF
Remove Guardrail
$0.00
$43.00
$ (2,494.00)
$ -
$ (2,494,00)
8
544.2001
(1.00)
EA
TxDOT Guardrail End Treatment (Install)
$0.00
$895.00
$ (895.00)
$ -
$ (895.00)
TOTAL UNIT IV: PAVEMENT IMPROVEMENTS $ (3,389A0) � - l� �o�•��l
Asterisk (*) indicates New Pay Item
Revised: 12-17-2018 Page 2
Docusign Envelope ID: F1DB5D1A-D140-4471-A2C5-28B460BADBIC
REASONS FOR CHANGE ORDER Existing guardrail did not require modification, so that work was removed from the contract. Changes correspond to Plan Revision 1, sheets C-04 & C-05 of the
construction plans.
RECOMMENDED: APPROVED: APPROVED:
Kimley-Horn & Associates, Inc. United Parcel Service, Inc., an Ohio Corporation CIMA General Contractors, Inc.
Stg-d by:
By: �I By:�I, ma.&.,,� By:
909321172C2MC4...
Name: James Matthews Name: Kathleen Malone Name: Je Miller
Title: P.E. Title: Vice President Title: Vice President of Construction
APPROVAL RECOMMENDED:
CFW - Funding Department
APPROVED:
CFW - Assistant City Manager
By: N/A By:
Name:
Title:
RECOMMENDED:
CFW - *Contract Compliance Manager
By: N/A
Name: DebbieJ. Wilhelm
Title: Senior Professional Engineer
M&C Number: N/A
M&C Date Approved: N/A
APPROVED AS TO FORM AND LEGALITY:
CFW - Assistant City Attorney
By:
Name:
Name:
Title:
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
Fa] There are NO City Funds associated with this Contract
❑There are City Funds associated with this Contract
Revised: 12-17-2018 Page 3
FORT WORTH;.
TRANSPORTATION AND PUBLIC WORKS
December 20, 2024
CIMA General Contractors
1017 Long Prairie Rd Ste 200
Flower Mound, TX 75022
RE: Acceptance Letter
Project Name: UPS Staging— Liberty Connection
Project Type: Paving
City Project No.: 105301
To Whom It May Concern:
On December 11, 2024 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 December 11,
2024, 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-
392-2481.
Sincerely,
Andrew Goodman, Project Manager
Cc: Hector Montoya, Inspector
Gary Deyon, Inspection Supervisor
Edward Davila, Senior Inspector
Andrew Goodman, Program Manager
Kimberly -Horn, Consultant
CIMA General Contractors, Contractor
United Parcel Services, Developer
File
E-Mail: TPW_Acceptance@fortworthtexas.gov
Rev. 08/20/19
STATE OF TEXAS
COUNTY OF TARRANT
BEFORE ME, the
BILLS PAID AFFIDAVIT
OF ORIGINAL CONTRACTOR
undersigned authority, on this day personally appeared
Jim Wilkinson known to me to be the person whose name is subscribed hereto and upon
his/her oath deposes and says:
1. "My name is Jim Wilkinson, I am over eighteen years of age. I have personal
knowledge of the facts stated by me in this Affidavit and they are true and correct.
2. "1 am the Vice President of CIMA General Contractors, Inc. ("Contractor") and am
authorized to make the statements herein made by me on behalf of Contractor and such
statements shall be binding upon Contractor.
3. "Contractor's business address is:
CIMA General Contractors, Inc.
1017 Long Prairie Rd., Suite 200
Flower Mound, TX 75022
4. "Contractor supplied labor and/or materials under an original contract with UNITED
PARCEL SERVICE, INC., an Ohio corporation ("Owner"), the owner of the projected
called: Liberty Way Rd EXTENSION, roughly 470 sq.ft. of newly paved road
("Liberty Extension" herein so called) situated at 13700 Independence Parkway, Fort
Worth, Texas 76177 and being more particularly described on Exhibit "A" attached
hereto and fully incorporated herein for all purposes. Contractor has paid each of its
subcontractors, laborers, and materialmen in full for all labor and materials provided to
it for construction on the Construction Site.
5. In consideration of the funds paid to Contractor by Owner in reliance on this affidavit,
Contractor waives and releases all of Contractor's statutory and constitutional
mechanic's lien rights connected with the construction of the above described
Improvements Liberty Way Extension.
SUBSCRIBED and SWORN this the 3rd day of September, 2025,
Afliant:
ltz'�--roov
(Signature)
Jim Wilkinson -Vice President
(Printed Name and Title)
STATE OF TEXAS
COUNTY OF TARRANT
This instrument was subscribed and sworn before me on the 3`d day
of September, 2025.
NOTARY PUBLIC, STATE OF TEXAS
TERI D. JONES Soo2
Public, State of Texas
Notary s
Comm. Expires 08.28-2028 (Notary's Printed Name)
Notary ID 135063543 • pg/2812p2g
My Commission Expires:
Exhibit "A'1
PROJECT Location: See below
Project: Liberty Extension consist of a tiny section highlighted below in red circle where the arrow is
pointing. This section of the project is known as Liberty Extension, approximately 470 sq. ft. extension to the
public road section.
LOCATION MAP
N.T.S.
MAPSCO NO. TAR-009P
COUNCIL DISTRICT 7
NIT (REF. \
ET G12)
PAVING CONNECT TO -�
LONGITUDINAL BUTT
0512 ON SHEET C41)
31TUDINAL JOINT (REF. -
.IL 519 ON SHEET C42)
NED DUMMY JOINTS
516 ON SHEET C-12)
PROP. LIBERTY
WAY PAVEMENT
:OF EXISTING PVMT.
t!-� �
ENOTREATMENT
ALSO KNOWN AS: Community Facilities Agreement CFA number 105301
t
PAVING
- - PAVING
PRIVATE
PROP. DO
DETAIL R;
LOCATION DESCRIPTION BELOW, FROM CIVIL PLANS:
Liberty Extension is a tiny section located within the overall larger project location described as:
THE CITY OF FORT WORTH, TEXAS
PLANS FOR THE CONSTRUCTION OF WATER, SEWER, PAVING, & DRAINAGE
IMPROVEMENTS TO SERVE
UPS INDEPENDENCE LIBERTY WAY STAGING LOT
(ALLIANCE GATEWAY ADDITION, LOT 1R213, BLOCK 1)
(ALLIANCE GATEWAY ADDITION, LOT 4, BLOCK 2)
006219-1
MAINTENANCE BOND
Page 1 of /I
1 SECTION 00 621E Bond No. HSHNSU0858071
2 MAINTENANCE BOND
3
4 THE STATE OF TEXAS §
5 § KNOW ALL BY THESE PRESENTS:
6 COUNTY OFTARRANT §
7
8 That we CIMA -G eracontw ors.loc , known as
9 "Principal" herein and Harco National Insurance Compaq_______, a corporate surety
10 (sureties, if more than one) duty authorized to do business in the State of Texas, known as
11 "Surety" herein (whether one or more), are held and firmly bound unto the Developer,
12 (— BT-OH. LLC __), authorized to do business in Texas ("Developer") and the City
13 of Fort Worth, a Texas municipal corporation ("City"), in the sum of
14 Seven Thousand Two Hundred Sixty Three and 951100 Dollars ($ 7,263.95 ) lawful
15 money of the United States, to be paid in Fort Worth, Tarrant County, Texas, for payment of
16 which sum wet[ and truly be made jointly unto the Developer and the City as dual obligees
17 and their successors, we bind ourselves, our heirs, executors, administrators, successors
18 and assigns, jointly and severally, firmly by these presents.
19 WHEREAS, Developer and City have entered into an Agreement for the construction of
20 community facilities in the City of Fart Worth by and through a Community Facilities
21 Agreement, CFA Number City Project #105301 and
22 WHEREAS, the Principal has entered into a certain written contract with the
23 Developer awarded the 25Eh day of January , 2024 , which
24 Contract is hereby referred to and a made part hereof for all purposes as if fully set forth
25 herein, to furnish all materials, equipment labor and other accessories as defined by taw, in
26 the prosecution of the Work, including any Work resulting from a duty authorized Change
27 Order (collectively herein, the "Work") as provided for in said Contract and designated as
28 UPS Staging— Liberty Connection; and
29
CRY OF FORT WORTia UPS Staging— Liberty Connection
STANDARD CONSTRUCTION SPECIFICATION 00CUMi NTS'- D:VEcLOJIFR AWAR01:1) PROJECTS, CPN 705307
Revised January 31, 2012
006219-2
MAINTENANCE BOND
Page 2 of 4
1 WHEREAS, Principal binds itself to use such materials and to so construct the Work
2 in accordance with the plans, specifications and Contract Documents that the Work is and
3 will remain free from defects in materials or workmanship for and during the period of two
4 (2) years after the date of Final Acceptance of the Work by the City ("Maintenance Period");
5 and
6 WHEREAS, Principal binds itself to repair or reconstruct the Work in whole or in part
7 upon receiving notice from the Developer and/or City of the need thereof at any time within
8 the Maintenance Period.
9 NOW THEREFORE, the condition of this obligation is such that if Principal shall
10 remedy any defective Work, for which timely notice was provided by Developer or City, to a
11 completion satisfactory to the City, then this obligation shalt become null and void;
12 otherwise to remain in full force and effect.
i 3 PROVIDED, HOWEVER,. if Principal shall fait so to repair or reconstruct any timely
14 noticed defective Work, it is agreed that the Developer or City may cause any and at[ such
15 defective Work to be repaired and/or reconstructed with all associated costs thereof being
16 borne by the Principal and the Surety under this Maintenance Bond; and
17 PROVIDED FURTHER, that if any legal action be filed on this Bond, venue shalt tie in
18 Tarrant County, Texas or the United States District Court for the Northern District of Texas,
19 Fart Worth Division; and
20 PROVIDED FURTHER, that this obligation shalt be continuous in nature and
21 successive recoveries may be had hereon for successive breaches.
22 IN WITNESS WHEREOF, the Principal and the Surety have each SIGNED and
23 SEALED this instrument by duty authorized agents and officers on this the 26t_h_day of,.
24 - - _....June.. -..__. -- 2024 -
25
26
27
CITY OF FORT WORTH UPS Staging- Liberty Ccrtnecrion
STANDARD CONSTRUCTION SPECIFICATION DOCUMENTS - DEVELOPER AWARDED PROJECTS CPN 705301
Revised January 31, 2012
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
ATTEST:
(Principal) Secretary
Witness as to Principal
ATTEST:
(Surety) Secretary
006219-3
MAINTENANCE BOND
Page 3 of 4
PRINCIPAL:
CIMA General Contractors Inc.
•
BY: ----- -
Signature
Naha 12ob;so,-, - g« OK%ce P
Name and Title
Address:_-1017 Long Prairie Rd, Ste 200
Flower Mound, TX 75022
SURETY:
Harco Nationa Insurance Company
BY:
Signature
Rick Clements_ Attorney -in -Fact
Name and Title
Address: PO Box 1299
Amarillo, TX 79105
Witness as to Surety Telephone Number: (a066�- -0400
CITY OF FORT WORTH UPS Staging - liberty Connection
STANDARD CONSTRUCTION SPECIFICATION DOCUMENTS DrNFLOPER AWARDED PROJECTS CPN 705301
Revised January 31. 2012
006219-4
MAINTENANCE BOND
Page 4of4
1 *Note: If signed by an officer of the Surety Company, there must be on file a certified
2 extract from the by-laws showing that this person has authority to sign such
3 obligation. If Surety's physical address is different from its mailing address, both
a must be provided.
A
6 The date of the bond shall not be prior to the date the Contract is awarded.
7
CITY OF FORT WORTH
UPS Staging- Liberty Conn ecrion
STANDARD CONSTRUCTION SPECIFICATION DOCUMENTS - DEVELOPER AWARDED 11110JECTS CPN 705301
Revised January 31, 2012
POWER OF ATTORNEY Bond# HSHNSU0858071
HARCO NATIONAL INSURANCE COMPANY
INTERNATIONAL FIDELITY INSURANCE COMPANY
Member companies of [AT insurance Group, Headquartered: 4200 Six Forks Rd, Suite 1400, Raleigh, NC 27609
KNOW ALL MEN BY THESE PRESENTS: That HARCO NATIONAL INSURANCE COMPANY, a corporation organized and existing under the laws of
the State of Illinois, and INTERNATIONAL FIDELITY INSURANCE COMPANY, a corporation organized and existing under the laws of the State of New
Jersey, and having their principal offices located respectively in the cities of Rolling Meadows, Illinois and Newark, New Jersey, do hereby constitute and
appoint
RICK CLEMENTS, LAUREN LANE, STEPHANIE TAYLOR, CORY B. BENTLEY, ROBERT B. BENTLEY
Amarillo, TX
their true and lawful attorneys) -in -fact to execute, seal and deliver for and on its behalf as surety, any and all bonds and undertakings, contracts of
indemnity and other writings obligatory in the nature thereof, which are or may be allowed, required or permitted by law, statute. rule, regulation, contract
or otherwise, and the execution of such instrument(s) in pursuance of these presents, shall be as binding upon the said HARCO NATIONAL
INSURANCE COMPANY and INTERNATIONAL FIDELITY INSURANCE COMPANY, as fully and amply, to all intents and purposes, as if the same had
been duly executed and acknowledged by their regularly elected officers at their principal offices.
This Power of Attorney is executed, and may be revoked, pursuant to and by authority of the By -Laws of HARCO NATIONAL INSURANCE COMPANY
and INTERNATIONAL FIDELITY INSURANCE COMPANY and is granted under and by authority of the following resolution adopted by the Board of
Directors of INTERNATIONAL FIDELITY INSURANCE COMPANY at a meeting duly held on the 13th day of December, 2018 and by the Board of
Directors of HARCO NATIONAL INSURANCE COMPANY at a meeting held on the 13th day of December, 2018.
"RESOLVED, that (1) the Chief Executive Officer, President, Executive Vice President, Senior Vice President, Vice President, or Secretary of the
Corporation shall have the power to appoint, and to revoke the appointments of, Attorneys -in -Fact or agents with power and authority as defined or limited
in their respective powers of attorney, and to execute on behalf of the Corporation and affix the Corporation's seal thereto, bonds, undertakings,
recognizances. contracts of indemnity and other written obligations in the nature thereof or related thereto; and (2) any such Officers of the Corporation
may appoint and revoke the appointments of joint -control custodians, agents for acceptance of process, and Attorneys -in -fact with authority to execute
waivers and consents on behalf of the Corporation; and (3) the signature of any such Officer of the Corporation and the Corporation's seal may be affixed
by facsimile to any power of attorney or certification given for the execution of any bond, undertaking, recognizance, contract of indemnity or other written
obligation in the nature thereof or related thereto, such signature and seals when so used whether heretofore or hereafter, being hereby adopted by the
Corporation as the original signature of such officer and the original seal of the Corporation, to be valid and binding upon the Corporation with the same
force and effect as though manually affixed."
IN WITNESS WHEREOF, HARCO NATIONAL INSURANCE COMPANY and INTERNATIONAL
FIDELITY INSURANCE COMPANY have each executed and attested these presents
on this 31 st day of December, 2023
'�tysu�•.
TYtp
�0 JG,p STATE_ Of: NEW JERSEY STATE OF ILLINOIS 0,-pp9o.gr•. n .
ty pRQ0R9/ P= County of Essex County of Cook
c SEAL� �^ :z: SEAL 'o_
} y 1904
f ER a� Michael F. Zurcher
d�lHi * t Executive Vice President, Harco National Insurance Company
and International Fidelity Insurance Company
On this 31 st day of December, 2023 , before me came the individual who executed the preceding instrument, to me personally known, and,
being by me duly sworn, said he is the therein described and authorized officer of HARCO NATIONAL INSURANCE COMPANY and
INTERNATIONAL FIDELITY INSURANCE COMPANY; that the seals affixed to said instrument are the Corporate Seals of said Companies: that the
said Corporate Seals and his signature were duly affixed by order of the Boards of Directors of said Companies.
'PINY CR
IN TESTIMONY WHEREOF. I have hereunto set my hand affixed my Official Seal, at the City of Newark,
&
G . New Jersey the day and year first above written.
�OTAy
OF NON Cathy Cruz a Notary Public of New Jersey
My Commission Expires April 16, 2029
CERTIFICATION
I, the undersigned officer of HARCO NATIONAL INSURANCE COMPANY and INTERNATIONAL FIDELITY INSURANCE COMPANY do hereby certify
that I have compared the foregoing copy of the Power of Attorney and affidavit, and the copy of the Sections of the By -Laws of said Companies as set
forth in said Power of Attorney, with the originals on file in the home office of said companies, and that the same are correct transcripts thereof, and o1 the
whole of the said originals, and that the said Power of Attorney has not been revoked and is now in full force and effect.
IN TESTIMONY WHEREOF, I have hereunto set my hand on this day. June 26, 2024
A02200
I r_4
Irene Martins, Assistant Secretary
IMPORTANT NOTICE
To obtain information or make a complaint:
You may contact Harco National Insurance Company
at:
I -800-333-4167
You may also write to: Harco National Insurance
Company c/o IAT Surety at:
Attn: Claims Department
One Newark Center, 20" Floor
Newark, NJ 07102
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:
P. O. Box 149104
Austin, TX 78714-9104
Fax: (512) 490-1007
Web: www.tdi.texas.yov
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 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 BOND:
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 presentar una queja:
Usted puede comunicarse con su Harco National
Insurance Company al:
1-800-333-4167
Usted tambien puede escribir a Harco National
Insurance Company c/o IAT Surety at:
Attn. Claims Department
One Newark Center, 20", Floor
Newark, NJ 07102
Puede comunicarse con el Departamento de Seguros de
Texas para obtener informacion accrea de companies,
coberturas, derechos o que.jas al:
1-800-252-3439
Puede escribir al Departamento de Seguros de Texas:
P. O. Box 149104
Austin, TX 78714-9104
Fax: (512) 490-1007
Web: www.tdi.texas.gov
E-mail: Cons umerProtectionntdi.texas. gov
DISPUTAS SOBRE PRIMAS O RECLAMOS:
Si ticne 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 FIANZA DE GARANTIA:
Este aviso es solo para proposito de informacion y no
se convierte en parte o condicion del documento
adjunto.