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HomeMy WebLinkAbout063875-FP1 - Construction-Related - Contract - Muckleroy & Falls-FP1 City Secretary Contract No. 63875 FORT WORTH. Date Received 8/5/2026 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: Plaza Parking Garage Expansion City Project No.: 105641 Improvement Type(s): 0 Paving ❑ Drainage 0 Street Lights 0 Traffic Signals Original Contract Price: $1,282,609.19 Amount of Approved Change Order(s): -$132,431.12 Revised Contract Amount: $1,150,178.07 Total Cost of Work Complete: $1,150,178.07 Twr 2WehteY Tim Carpenter 1, ul 3� 9n26 0134 09 CDT) Contractor Project Manager GC Title Muckleroy & Falls Company Name Gaws Thomas (Aug 2 2026 09:16:20 CDT) Project Inspector .q PC - Project Manager CFA Manager de .Z, Lauren Prieur (Aug 5. 2026 12:03:24 CDT) TPW Director 07/31 /2026 Date 08/02/2026 Date 08/05/2026 Date 08/05/2026 Date 08/05/2026 Date OFFICIAL RECORD CITY SECRETARY FT. WORTH, TX Page 1 of 2 Notice of Project Completion Project Name: Plaza Parking Garage Expansion City Project No.: 105641 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: 200 WD Days Charged: 95 WD Work Start Date: 12/1/2025 Work Complete Date: 6/16/26 Completed number of Soil Lab Test: 98 Completed number of Water Test: 0 Page 2 of 2 FoRTWORTH CITY OF FORT WORTH FINAL PAYMENT REQUEST Contract Name PLAZA PARKING GARAGE EXPANSION Contract Limits Project Type PAVING, STREET LIGHT, TRAFFIC SIGNAL City Project Numbers 105641 DOE Number 5641 Estimate Number I Payment Number I For Period Ending 6/16/2026 WD City Secretary Contract Number Contract Date Project Manager NA Contractor MUCKLEROY & FALLS P.O. BOX 100206 FORT WORTH, TX 76185 Inspectors G. DEYON / G. THOMAS Contract Time 20WD Days Charged to Date 95 Contract is 100.00 Complete Friday, July 31, 2026 Pagel of 5 City Project Numbers 105641 Contract Name PLAZA PARKING GARAGE EXPANSION Contract Limits Project Type PAVING, STREET LIGHT, TRAFFIC SIGNAL Project Funding UNIT IV: PAVING IMPROVEMENTS DOE Number 5641 Estimate Number 1 Payment Number 1 For Period Ending 6/16/2026 Item Description of Items Estimated Unit Unit Cost Estimated Completed Completed No. Quanity Total Quanity Total --------------------------------------- 1 REMOVE SIDEWALK 2073 SF $1.15 $2,383.95 2073 $2,383.95 2 REMOVE ADA RAMP 2 EA $350.00 $700.00 2 $700.00 3 REMOVE DETECTABLE WARNING SURFACE 1 EA $100.00 $100.00 1 $100.00 4 REMOVE CONCRETE DRIVE 560 SF $1.15 $644.00 560 $644.00 5 REMOVE ASPHALT PVMT 1345 SY $6.50 $8,742.50 1345 $8,742.50 6 REMOVE CONC CURB&GUTTER 320 LF $10.50 $3,360.00 320 $3,360.00 8 HYDRATED LIME(CO#1) 0 TN $330.00 $0.00 0 $0.00 9 6" LIME TREATMENT(CO#1) 0 SY $15.00 $0.00 0 $0.00 10 2" ASPHALT PVMT TYPE D (DG-D) 915 SY $60.00 $54,900.00 915 $54,900.00 11 10" LIME TREATMENT(CO#1) 0 SY $15.00 $0.00 0 $0.00 12 6"CONC PVMT 2480 SY $183.38 $454,782.40 2480 $454,782.40 13 1 4" CONC SIDEWALK, ADJACENT TO CURB 3910 SF $17.83 $69,715.30 3910 $69,715.30 14 1 6" CONCRETE DRIVEWAY 350 SF $54.81 $19,183.50 350 $19,183.50 15 2 BARRIER FREE RAMP, TYPE U-1 1 EA $2,083.00 $2,083.00 1 $2,083.00 16 3 BARRIER FREE RAMP, TYPE M-I 1 EA $2,083.00 $2,083.00 1 $2,083.00 17 6" CONC CURB AND GUTTER 345 LF $21.92 $7,562.40 345 $7,562.40 18 6" SLD PVMT MARKING HAS (Y) 480 LF $2.25 $1,080.00 480 $1,080.00 19 PREFORMED THERMOPLASTIC CONTRAST 35 LF $8.75 $306.25 35 $306.25 MARKINGS - 24" CROSSWALK 20 PREFORMED THERMOPLASTIC CONTRAST 15 LF $8.75 $131.25 15 $131.25 MARKINGS - 24" STOP BARS 7 6"-12" TREE REMOVAL 4 EA $750.00 $3,000.00 4 $3,000.00 Sub -Total of Previous Unit $630,757.55 $630,757.55 UNIT V: STREET LIGHTING IMPROVEMENTS Item Description of Items Estimated Unit Unit Cost Estimated Completed Completed No. Quanity Total Quanity Total ---------------------------------- 1 2" CONDT PVC SCH 80 (T) 405 LF $357.93 $144,961.65 405 $144,961.65 2 2" CONDT PVC SCH 80 (B) 630 LF $393.93 $248,175.90 630 $248,175.90 Sub -Total of Previous Unit $393,137.55 $393,137.55 -------------------------------------- Friday, July 31, 2026 Page 2 of 5 City Project Numbers 105641 Contract Name PLAZA PARKING GARAGE EXPANSION Contract Limits Project Type PAVING, STREET LIGHT, TRAFFIC SIGNAL Project Funding UNIT VI: TRAFFIC SIGNAL IMPROVEMENTS DOE Number 5641 Estimate Number 1 Payment Number 1 For Period Ending 6/16/2026 Item Description of Items Estimated Unit Unit Cost Estimated Completed Completed No. Quanity Total Quanity Total --------------------------------------- 1 FURNISH/INSTALL 3-SECT SIGNAL HEAD 0 EA $8,222.61 $0.00 0 $0.00 ASSEMBLY(CO#1) 2 FURNISHANSTALL PED SIGNAL HEAD 2 EA $4,046.23 $8,092.46 2 $8,092.46 ASSMBLY 3 FURNISH/INSTALL AUDIBLE PEDESTRIAN 4 EA $5,302.61 $21,210.44 4 $21,210.44 PUSHBUTTON 4 5/C 14 AWG MULTI -CONDUCTOR 20 LF $15.52 $310.40 20 $310.40 CABLE(CO#1) 5 20/C 14 AWG MULTI -CONDUCTOR 0 LF $44.09 $0.00 0 $0.00 CABLE(CO#1) 6 3/C 14 AWG MULTI -CONDUCTOR 170 LF $12.84 $2,182.80 170 $2,182.80 CABLE(CO#1) 7 NO 8 BARE ELEC CONDR 25 LF $27.45 $686.25 25 $686.25 8 FURNISH/INSTALL 10' - 20' PED POLE ASSMBLY 1 EA $6,174.47 $6,174.47 1 $6,174.47 9 INSTALL SIGNAL POLE (TYPE 41, 43, 45) 1 EA $31,348.53 $31,348.53 1 $31,348.53 10 TY 1 SIGNAL FOUNDATION 1 EA $15,911.47 $15,911.47 1 $15,911.47 11 DISPOSE/SALVAGE OF POLE AND MAST ARM 1 EA $30,053.23 $30,053.23 1 $30,053.23 ASSEMBLY (CO#1) 12 SPAN WIRE 1/4"(CO#1) 0 LF $35.18 $0.00 0 $0.00 13 SPAN WIRE 3/8"(CO#1) 0 LF $63.59 $0.00 0 $0.00 14 40' TIMBER POLE CL 2(CO#1) 0 EA $9,931.47 $0.00 0 $0.00 15 FURNISH/INSTALL ALUM SIGN EX. POLE 2 EA $3,363.23 $6,726.46 2 $6,726.46 MOUNT 16 REMOVE SIGN PANEL 2 EA $1,793.23 $3,586.46 2 $3,586.46 -------------------------------------- Sub -Total of Previous Unit $126,282.97 $126,282.97 Friday, July 31, 2026 Page 3 of 5 City Project Numbers 105641 Contract Name PLAZA PARKING GARAGE EXPANSION Contract Limits Project Type PAVING, STREET LIGHT, TRAFFIC SIGNAL Project Funding Contract Information Summary Original Contract Amount Change Orders Change Order Number 2 Change Order Number 3 DOE Number 5641 Estimate Number 1 Payment Number 1 For Period Ending 6/16/2026 $1,282,609.19 ($31,542.00) ($100,889.12) Total Contract Price $1,150,178.07 Total Cost of Work Completed $1,150,178.07 Less % Retained $0.00 Net Earned $1,150,178.07 Earned This Period $1,150,178.07 Retainage This Period $0.00 Less Liquidated Damages Days @ / 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 $1,150,178.07 Friday, July 31, 2026 Page 4 of 5 City Project Numbers 105641 Contract Name PLAZA PARKING GARAGE EXPANSION Contract Limits Project Type PAVING, STREET LIGHT, TRAFFIC SIGNAL Project Funding Project Manager NA Inspectors G. DEYON / G. THOMAS Contractor MUCKLEROY & FALLS P.O. BOX 100206 FORT WORTH, TX 76185 DOE Number 5641 Estimate Number 1 Payment Number 1 For Period Ending 6/16/2026 City Secretary Contract Number Contract Date Contract Time 200 WD Days Charged to Date 95 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 $1,150,178.07 Less % Retained $0.00 Net Earned $1,150,178.07 Earned This Period $1,150,178.07 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 $1,150,178.07 Friday, July 31, 2026 Page 5 of 5 }/ §/ - g \ ) } ( 0 L6 \ (, )i\$ m ) ) \ w� )\ k } OZ 00 LL )c S \JkIJ}k/ / \£}!I!£ \\ a :::; 0 a's, U) 0 §22j§)�\ ) § \ § § } \\0 / w \)�W. il ()/[(\& & \/§§05k � K:mB$§- H °o'M oro m `m c`Oo �M H al fh (V ^ Oi (j0000 U � Oo o m W U ^ m rna{ N m n m? a uivNovi M O V U V 'o N y o m PLO c S a a co a o b� U m d o U V U o m v a N ¢ ¢ ¢ d a U � ZQ � LL W J LL LL Q LL LLI IL Q IL H Z o O 0 0 O 0 0 O Q? O h N N N V m ❑ � � N fO�J U y� y Mr�M W N M Q a a `m °w z W W Oi 2 g o U o K U 6 W O w IL IL m N C U m U a o m E m ° $ u o @ E m C m C L y W a H o � EY�m U L LL' U mpO� O —'� - z U U m o J N N E o m rr a d m CO zI F Z Q Q Z Z N N O N M N co E o m O Z n � m c � O a a n N a! U U O U C o Q a cl W Q N 0 a o o z T Z Z N Q W aa Ly K U m Z F LAj M m FORT WORTH, TRANSPORTATION AND PUBLIC WORKS July 7, 2026 Muckleroy & Falls 3200 Riverfront Dr., Suite 200 Ft. Worth, TX 76107 RE: Acceptance Letter Project Name: Plaza Parking Garage Expansion Project Type: Sewer, Paving, Street Lights City Project No.: 105641 To Whom It May Concern: On June 25, 2026 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 July 6, 2026. 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 July 6, 2026, which is the date of the punch list completion and will extend of two (2) years in accordance with the Contract Documents. If you have any questions concerning this letter of acceptance, please feel free to contact me at 817- 392-6826. Sincerely, Izeldeen Ahmed, Project Manager Cc: Gavis Thomas, Inspector Gary Deyon, Inspection Supervisor Lorrie Pitts, Senior Inspector Andrew Goodman, Program Manager Baird, Hampton & Brown, Consultant Muckleroy & Falls, Contractor Tarrant County, Developer File E-Mail: TPW_Acceptance@fortworthtexas.gov Rev. 8/20/19 AFFIDAVIT STATE OF TEXAS COUNTY OF WISE Before me, the undersigned authority, a notary public in the state and county aforesaid, on this day personally appeared Harmon R Fisher, II1, President Of 2L 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; Project: Tarrant County Plaza Garage BY Z 1 W'- _7 Harmon R Hi-s ier, III, President Subscribed and sworn before me on this date 20th of July, 2026. eA LtI CHEYENNEyyINTERS lOTAM PUBLIC, STATE Of TE%AS ID0134819856 otary PublicOMM.EEP. 03-21-2028 WISE, TX LUMir, 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 Matt Barnes, President of Southwest Region, Lumin8 Transportation Technologies, 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; full; That the wage scale established by the City Council in the City of Fort Worth has been paid in That there are no claims pending for personal injury and/or property damages; On Contract described as; Tarrant County Plaza Garage Completion Date: 6/16/2026 Subscribed and sworn before me on this 15th of July 2026. Notary Public Tarrant, Texas Regional office: 821 E Enon Ave Fort Worth, Tx. 76140 (817) 561-7400 BY I , /. A 9*J Matt Barnes /President of SW Region Lumin8 Transportation Technologies, LLC �Z n- Carlos Veloz Salas = (P Exp.10/912027 CO ID No.134597239 T �TF0 V� \ www.lumin8.com Corporate Office: 5920 Lamar St Arvada, Colorado 80003 (303)422-7985 CONSENT OF OWNER ❑ SURETY COMPANY ARCHITECT ❑ TO FINAL PAYMENT CONTRACTOR ❑ SURETY ❑ AIA DOCUMENT G707 OTI4ER Bond No. 2369925 PROJECT: Tarrant County Plaza Garage - Public Work (name, address) TO (Owner) [ City of Fort Worth ] ARCHITECT'S PROJECT NO: 1000 Throckmorton Street Fort Worth, TX 76102-6312 CONTRACT FOR: [ ] CONTRACT DATE: CONTRACTOR: HM & MF, Ltd dba Muckleroy & Falls 3200 Riverfront Dr., Suite 200 Fort Worth, TX 76107 In accordance with the provisions of the Contract between the Owner and the Contractor as indicated above, the (here insert name and address of Surety Company) Swiss Re Corporate Solutions America Insurance Corporation 1200 Main St., Suite 800 , SURETY COMPANY, on bond of (here insert name and address of Contractor) I-IM & MF, Ltd dba Muckleroy & Falls 3200 Riverfront Dr., Suite 200 Fort Worth, TX 76107 , CONTRACTOR, hereby approves of the final payment to the Contractors, and agrees that final payment to the Contractor shall not relieve the Surety Company of any of its obligations to (here insert name and address of Owner) City of Fort Worth 1000 Throckmorton Street Fort Worth, TX 76102-6312 ,OWNER, as set forth in the said Surety Company's bond. IN WITNESS WHEREOF, the Surety Company has hereunto set its hand this 13th day of July 2Q26 Swiss Re Corporate Solutions America Insurance Surety Company C-a s��z Signature of Authorized Representative Attest: (Seal): i Debra Lee Moon Attorney -In -Fact Itic NOTE: This form is to be used as a companion document to AIA DOCUMENT G706, CONTRACTOR'S AFFIDAVIT OF PAYMENT OF DEBTS AND CLAIMS Current Edition AIA DOCUMENT G707 • CONSENT OF SURETY COMPANY TO FINAL PAYMENT • APRIL 1970 EDITION • AIA® ONE PAGE © 1970 • THE AMERICAN INSTITUTE OF ARCHITECTS, 1735 New York Ave., NW, WASHINGTON, D.C. 20006 SWISS RE CORPORATE SOLUTIONS SWISS RE CORPORATE SOLUTIONS AMERICA INSURANCE CORPORATION ("SRCSAIC") SWISS RE CORPORATE SOLUTIONS PREMIER INSURANCE CORPORATION ("SRCSPIC") SWISS REINSURANCE AMERICA CORPORATION ("SRAC") GENERAL POWER OF ATTORNEY KNOW ALL MEN BY THESE PRESENTS, THAT SRCSAIC, a corporation duly organized and existing under laws of the State of Missouri, and having its principal office in the City of Kansas City, Missouri, and SRCSPIC, a corporation organized and existing under the laws of the State of Missouri and having its principal office in the City of Kansas City, Missouri, and SRAC, a corporation organized and existing under the laws of the State of New York and having its principal office in the City of Armonk, New York, each does hereby make, constitute, and appoint: JOHN R WARD, THOMAS DOUGLAS MOORE, EMILY ALLISON MIKESKA, ALLYSON W DEAN, TROY RUSSELL KEY, DEBRA LEE MOON, ANDREA ROSE CRAWFORD, SANDRA LEE RONEY. FAITH ANN HILTY, ANDREW GARETH ADDISON, ELIZABETH ORTIZ. ANA OWENS. ANDREW PATRICK CLARK. KIMBERLY ROCHELLE GONZALEZ. CRYSTAL GAIL LANGHORN, STEVEN WAYNE LEWIS, SHERI RENEE ALLEN, PEGGY GRADEL HOGAN. TERESA AYALA, KELLI A GORHAM, MARK ROBERT ADAMS. CORY KIPER. ROSS RUDOLPH LARIS AND BAILEE MARIE ISLAS JOINTLY OR SEVERALLY Its true and lawful Attomey(s)-in-Fact, to make, execute, seal and deliver, for and on its behalf and as its act and deed, bonds, consents of surety, or other writings obligatory in the nature of a bond on behalf of each of said Companies, as surety, on contracts of suretyship as are or may be required or permitted by law, regulation, contract or otherwise, provided that no bond or undertaking or contract or suretyship executed under this authority shall exceed the amount of: TWO HUNDRED FIFTY MILLION (250,000,000.00) DOLLARS This Power of Attorney is granted and is signed by facsimile under and by the authority of the following Resolutions adopted by the Boards of Directors of both SRCSAIC and SRCSPIC at meetings duly called and held on the I8" of November 2021 and SRAC at a meeting duly called and held on the 7" of November 2025: "RESOLVED, that any two of the President, any Managing Director, any Senior Vice President, any Vice President, the Secretary or any Assistant Secretary be, and each or any of them hereby is, authorized to execute a Power of Attorney qualifying the attorney named in the given Power of Attorney to execute on behalf of the Corporation bonds, undertakings and all contracts of surety, and that each or any of them hereby is authorized to attest to the execution of any such Power of Attorney and to attach therein the seal of the Corporation; and it is FURTHER RESOLVED, that the signature of such officers and the seal of the Corporation may be affixed to any such Power of Attorney or to any certificate relating thereto by facsimile, and any such Power of Attorney or certificate bearing such facsimile signatures or facsimile seal shall be binding upon the Corporation when so affixed and in thefuture with regard to any bond, undertaking or contract of surety to which it is attached" ' 'CIS• �'M "... .� E "^►, P°RHEij%r+f Rtt gY F.. ...... FR�C^L "► Dt . Senior Vice 1C & Senior Vlre Presl4.nt f Q;:' °FtPORAT SEAL €, SEAL ofSRCSPIC& SeNor Vke Praldmt.iSRAC f=' SEAL •S p e LL t �.'•. 19 1940 •• tt '�••'••*IrJSOVP:' ,,i tD•••NF °Q. l�l S WY i4f 0 4.,*.,+�'A "••..,*.w'° Gabrld Jarq.ez, Seobr Vk P (dent of SR C & Senior Vice President �,� S N�.+ of SRCSPIC & - for Vltt Pr en of SRAC IN WITNESS WHEREOF, SRCSAIC, SRCSPIC, and SRAC have caused their official seals to be hereunto affixed, and these presents to be signed by their authorized officers this_26th day of January , 20 26 . Swiss Re Corporate Solutions America Insurance Corporation Stale of Illinois Swiss Re Corporate Solutions Premier Insurance Corporation County of Cook 0 Swiss Reinsurance America Corporation On this 26th day of January , 20 26 . before me, a Notary Public personally appeared David Satory Senior Vice President of SRCSAIC and Senior Vice President of SRCSPIC and Senior Vice President of SRAC, and Gabriel 1ac°uez._Senior Vice President of SRCSAIC and Senior Vice President of SRCSPIC and Senior Vice President of SRAC, personally known to me, who being by me duly sworn, acknowledged that they signed the above Power of Attorney as officers of and acknowledged said instrument to be the voluntary act and deed of eir respective companies. OFFICIAL SEAL KAREN M SZWEDA Nolary Public, State of Illinois Commission No 978628 M Cornrniui°n Expires September 26. 2027 Karen zweda, Notary 1, Jeffrey Goldberg, the duly elected Senior Vice President and Assistant Secretary SRCSAIC and SRCSPIC and SRAC, do hereby certify that the above and foregoing is a true and correct copy of a Power of Attorney given by said SRCSAIC and SRCSPIC and SRAC, which is still in full force and effect. IN WITNESS WHEREOF, I have set my hand and affixed the seals of the Companies this 13th day of_ JUIY 20 26 i 1etTrey Goldberg, Senior lice Preside, sis.G rant J J Secretary of SRCSAIC and SRCSPIC and SRAC In order to obtain information or make a complaint: You may contact the Surety Claims Department at 1-816-235-3702 You may call Swiss Re Corporate Solutions America Insurance Corporation or Swiss Re Corporate Solutions Premier Insurance Corporation for information or to make a complaint at: 1-816-235-3702 You may also write to Swiss Re Corporate Solutions America Insurance Corporation or Swiss Re Corporate Solutions Premier Insurance Corporation at the following address: 1200 Main Street, Suite 800 Kansas City, MO 64105 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) 475-1771 Web: httn:Nwww.tdi.state.tx.us E-mail:Consu merProtectionntdi.state.tx. us PREMIUM OR CLAIM DISPUTES: Should you have a dispute concerning your premium or about a claim you should first contact the Swiss Re Corporate Solutions America Insurance Corporation or Swiss Re Corporate Solutions Premier Insurance Corporation. 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. Para obtener informacion o para someter un queja: Pucde comunicarse con Surety Claims Department at 1-816-235-3702. Ustcd puede llamar Swiss Re Corporate Solutions America Insurance Corporation o Swiss Re Corporate Solutions Premier Insurance Corporation para informacion o para someter una queja at: 1-816-235-3702 Usted tambien puede cscribir a Swiss Re Corporate Solutions America Insurance Corporation o Swiss Re Corporate Solutions Premier Insurance Corporation al: 1200 Main Street, Suite 800 Kansas City, MO 64105 Puede escribir at Departmento de Seguros de Texas para obtener informacion acerca de companias, coberturas, dcrechos o quejas at: 1- 800-252-3439 Pucde cscribir at Departmento de Seguros de Texas: P.O. Box 149104 Austin, TX 78714-9104 Fax: (512) 475-1771 Web: httn://www.tdi.state.tx.us E-mail:Cons u merProtection&tdi.state.tx. us DISPUTAS SOBRE PRIMAS O RECLAMOS: Si tiene una disputa conccrniente a su prima o a un reclamo, debe comunicarse con el Swiss Re Corporate Solutions America Insurance Corporation o Swiss Re Corporate Solutions Premier Insurance Corporation primero. Si no se resuelve la disputa, puede entonces comunicarse con el Departmento de Seguros do Texas. UNA ESTE AVISO A SU POLIZA: Este aviso es solo para proposito do infromacion y no sc converte en parte o condicion del documento adjunto.