HomeMy WebLinkAboutContract 45719-FP1 CITY SEtRETAW
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Department of TP&W Const. Services •-----
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Project anger 510— .— '�' WMO H
Risk Managemen4J. a ae . `b
D.O.E. Brotherton f
CFA Westemtan/Scanned)e
nw Prme ft people have been Co&M rbncennfng the request for final TION AND PUBLIC WORKS J q
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PROJECT COMPLETION
Clearance Concluded By Shameita Kennedy D.O.E.No-: 7197
C /sye9
Regarding contract 117197 for STONE CREEK RANCH PH IV-WATER&SEWER as requited by the
WATER DEPARTMENT as approved by City Council on N/A through M&C N/A the director of the
WATER DEPARTMENT upon the recommendation of the Assistant Director of the Transportation&Public Works
Department has accepted the project as complete.ECIEV{{�
Original Contract Prices: a t� 5633,841.00
Amount of Approved Change Orden: MAR 2 3 Z415 NQ
Revised Contract Amount: B
By-
Total Coat Work Completed: $633,841.00
Less Deductions:
Liquidated Damages: Days®5210.00/Day
Pavement Deficiencies:
Total Deduction Amount:
Total Cost Work Completed: $633,841.00
Less Previous Payments: $0.00
Final Payment Dae $633,941.00
f
Recommended for Acceptance ~ N� Date
Asst. Director,TPW - Infrastructure Design and Construction
31231(S-
Accepted 3 �S Date
Director, WATER DEPARTME /sc' 23
J
City Manager Dafie�
Comments: P265-541200-602150224583,P275-541200-702130224583
a
OFFICIAL RECORD
CITY SECRETARY
FT.WORTH,TX
FORT WORTH
CITY OF FORT WORTH
FINAL PAYMENT REQUEST
Contract Name STONE CREEK RANCH PHASE IV
Contract Limits
Project Type WATER&SEWER
City Project Numbers 02245
DOE Number 7197
Estimate Number 1 Payment Number 1 For Period Ending 1/10/2015
CD
City Secretary Contract Number 117197 Contract Time 15ED
Contract Date Days Charged to Date 180
Project Manager Jaafari Contract is 100.00 %Complete
Contractor CONATSER CONSTRUCTION TxLP
5327 WICH[TA ST
FORT WORTH, TX 76119
Inspectors LAYER / DOVERS
OFFICIAL RECORD
CITY SECRETARY
FT.WORTH,TX
Tuesday,February 10,2015 Page 1 of 5
City Project Numbers 02245 DOE Number 7197
Contract Name STONE CREEK RANCH PHASE IV Estimate Number I
Contract Limits Payment Number I
Project Type WATER&SEWER For Period Ending 2/10/2015
Project Funding
WATER
Item Description of Items Estimated Unit Unit Cost Estimated Completed Completed
No. Quanity Total Quanity Total
1 TRENCH SAFETY FOR WATER 4583 LF $0.50 $2,291.50 4583 $2,291.50
2 DUCTILE IRON WATER FITTINGS W/RES 2.4 TN $4,000.00 $9,600.00 2.4 $9,600.00
3 8"WATER PIPE 4304 LF $32.00 3137,728.00 4304 $137,728.00
4 12"WATER PIPE 279 LF $46-00 $12,834.00 279 $12,834.00
5 8"WATER PIPE,CSS BACKFILL 14 LF $30.00 $420.00 14 $420.00
6 FIRE HYDRANT 4 EA $3,200.00 $12,800.00 4 $12,800.00
7 CONNECTION TO EXISTING 4"-12"WATER 5 EA $800.00 $4,000.00 5 $4,000.00
8 1"WATER SERVICE 123 EA $450-00 $55,350.00 123 $55,350.00
9 2"WATER SERVICE I EA $1,200-00 $1,200.00 1 $1,200.00
10 8"GATE VALVE 12 EA $1,050.00 $12,600.00 12 $12,600.00
11 12"GATE VALVE 1 EA $2,000-00 $2,000.00 1 $2,000.00
12 MJ SOLID SLEEVE 5 EA $500.00 $2,500.00 5 $2,500.00
13 CITY BONDS FOR AL1,W/S IMP I LS $4,500.00 $4,500.00 1 $4,500.00
14 METER BOX TYPE A 124 EA $50.00 $6,200.00 124 $6,200.00
Sub-Total of Previous Unit $264,023.50 $264,023.50
SEWER
Item Description of Items Estimated Unit Unit Cost Estimated Completed Completed
No. Quanity Total Quantity Total
1 POST CCTV INSPECTION 4285 LF $2-00 $8,570.00 4285 $8,570.00
2 MANHOLE VACUUM TESTING 22 EA $100.00 $2,200.00 22 $2,200.00
3 MANHOLE ADJUSTMENT MINOR 9 EA $500.00 $4,500.00 9 $4,500.00
4 TRENCH SAFETY 4285 LF $1.00 $4,285.00 4285 $4,285.00
5 TRENCH WATER STOPS 22 EA $200.00 $4,400.00 22 $4,400.00
6 4"SEWER SERVICE 122 EA $475.00 $57,950.00 122 $57,950.00
7 8"SEWER PIPE 3360 LF $38.00 6127,680.00 3360 $127,680.00
8 8"SEWER PIPE CSS BACKFILL 170 LF $30.00 $5,100.00 170 $5,100.00
9 8"DIP SEWER PIPE 847 LF $55.00 $46,585-00 847 $46,585.00
10 10"DIP SEWER 78 LF $65.00 $5,070.00 78 $5,070.00
1 l EPDXY MANHOLE LINER 55.3 VF $175.00 $9,677.50 55.3 $9,677.50
12 4'MANHOLE 21 EA $2,800.00 $58,800.00 21 $58,800.00
Tuesday,February 10,2015 OEMI,AL RECORD
CITY SECRETARY
FT. WORTH, TX
I
City Project Numbers 02245 DOE Number 7197
Contract Name STONE CREEK RANCH PHASE IV Estimate Number I
Contract Limits Payment Number I
Project Type WATER&SEWER For Period Ending 2/10/2015
Project Funding
I
13 4'DROP MANHOLE I EA $4,000.00 $4,000.00 1 54,000.00
14 4'EXTRA DEPTH MANHOLE 140 VF $150.00 $21,000-00 140 $21,000.00
15 ABANDON SANITARY SEWER IN PLACE 6 EA $400.00 $2,400.00 6 $2,400.00
16 CONNECT TO EXISTING SANITARY SEWER 4 EA $1,500.00 $6,000.00 4 $6,000.00
MANHOLE
17 CONNECTTO EXISTING SANITARY SEWER I EA $1,000.00 $1,000.00 1 $1,000.00
18 4"CHINEY SEWER SERVICE 1 EA $600.00 $600.00 1 $600.00
Sub-Total of Previous Unit $369,817.50 $369,817.50
Tuesday,February 10,2015 Page 3 of
OFFICIAL RECORD
CITY SECRETARY
FT. WORTH TX
City Project Numbers 02245 DOE Number 7197
Contract Name STONE CREEK RANCH PHASE IV Estimate Number I
Contract Limits Payment Number 1
Project Type WATER&SEWER For Period Ending 2/102015
Project Funding
Contract Information Summary
Original Contract Amount $633,841.00
Change Orders
Total Contract Price $633,841.00
Date tL-r L _1 Total Cost of Work Completed $633,841.00
o Leas %Retained $0.00
3l� �S Net Earned $633,841.00
Date Earned This Period $633,841.00
Inspection�8�e
Retainage This Period $0.00
Date Less Liquidated Damages
Project
Days® /Day $0.00
Date Z3'�� LessPavement Deficiency $0.00
Ass�!:!��gnandC nstru "on Less Penalty 50.00
to 3 e- Less Previous Payment $0.00
Director/Contracting Dep t $ Plus Material on Hand Less 15% $0.00
Balance Due This Payment $633,841.00
OFAXECORD
Tuesday,Febru y 10,2015 age o
CITY SECRETARY
FT. WORTH, TX
aaZ15'
p CDC
City Project Numbers 02245 MAR 2 3 2015 DOE Number 7197
Contract Name STONE CREEK RANCH PHASE IV timate Number 1
Contract Limits By. ayment Number 1
Project Type WATER&SEWER or Period Ending 2/102015
Project Funding
Project Manager Jaafari City Secretary Contract Number 117197
Inspectors LAYER / DOVERS Contract Date
Contractor CONATSER CONSTRUCTION TxLP Contract Time 150 CD
5327 WICHITA ST Days Charged to Date 190 CD
FORT WORTH, TX 76119 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 $633,841.00
Less %Retained $0.00
Net Earned $633,841.00
Earned This Period $633,841.00
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
Bahmce Due This Payment $633,841.00
Tumday,Febnuay 10,2015 OFFIM KECORD
CITY SECRETARY
FT. WORTH, TX
FORTWORTH rev 03/05/07
TRANSPORTATION&PUBLIC WORKS
FINAL STATEMENT OF CONTRACT TIME
FINAL STATEMENT NO.:1
NAME OF PROJECT: Stone Creek ranch Phase IV
PROJECT NO.: P265-602150224583 CONTRACTOR: Conatser
P275-702130224583 DOE NO.: 7197
PERIOD FROM:0721/14 TO: 01/16/15 FINAL INSPECTION DATE: 9-Feb
WORK ORDER EFFECTIVE:6/302014 CONTRACT TIME: 150 Z5 Wo CD
DAY OF DAYS REASON FOR DAYS DAY OF DAYS REASON FOR DAYS
MONTH CHARGED DURING CREDITED MONTH HARR GE CREDITED
1. 16.
2. 17.
3. 18.
4. 19.
5. 20.
6. 21.
7. 22.
S. 23.
9. 24.
10. 25.
11. 26.
12. 27.
13. 28.
14. 29.
15. 30.
31.
SAT,SUN, RAIN,TOO WET, UTILITIES OTHERS* DAYS TOTAL
&HOLIDAYS &TOO COLD RELOCATIONS CHARGED DAYS
THIS
PERIOD 180 180
PREVIOUS
0 0
PERIOD
TOTALS 180 180
TO DATE
*REMARKS:
--loz 2
NTRACTOR DATE INSPECTOR f
_ ENGINEERING DEPARTMENT AB(Mia !
The City of Fort Worth•1000 Throckmorton Street•Fort Worth, ft, ft ��. wy' i
(817)392-7941 •Fu:(817)392-7845 p�f
FORTWORTH
TRANSPORTATION AND PUBLIC WORKS
PIPE REPORT FOR
PROJECT NAME: Stone Crc&Ranch Phare IV
PROJECT NUMBER: P265-602150224583 P275-702130224583
DOE NUMBER: 7197
WATER
PIPE LAID SIZE TYPE OF PIPE LF
Yes 8 PVC 4318
Yes 12 PVC 279
FIRE HYDRANTS: 4 VALVES(16"OR LARGER) None
PIPE ABANDONED SIZE TYPE OF PIPE LF
None
DENSITIES: Yes
NEW SERVICES: 1 PQPK 123 Ea
2 copper 1 Ea
SEWER
PIPE LAID SIZE TYPE OF PIPE LF
Yes 8 PVC 3530
Yes 8 DIP 847
Yes 10 DIP 78
PIPE ABANDONED SIZE TYPE OF PIPE LF
None
DENSITIES: Yes
NEW SERVICES: 4 PVC 122 Ea
TRANSPORTATION AND PUBLIC WORKS
The City of Fort Worth•1000 Throckmorton Street•Fort Worth,TX 76012-6 1OFFICIAL RECORD
(817)392-7941 •Fag:(817)392-7845 CITY SECRETARY
FT. WORTH TX
FORTWORTH RE00/07
TRANSPORTATION AND PUBLIC WORKS
PERFORMANCE EVALUATION OF CONTRACTOR
CONTRACTOR&PROJECT DATA
Name of Contractor Project Name
Conatser Stone Creek Ranch PH IV
DOE hupector DOE Number
Keith Dovers 7197
ELupector Project Manager
Q Water 0 wastewater[:] Storm DrainagePamnent Khal Jaafari
initial Contract Amount r4feciD fficulty
$633,841.00 O Simple ® Routine Q Complex
Final Contract Amount Date
$633,841.00 2/7/2015
In PERFORMANCE EVALUATION
0-Inadequate I-Deficient 2-Standard 3-Good 4-Excellent
ELEMENT WEIGHT(x) APPLICABLE /N) RATING(0-4) MAX SCORE SCORE
1 Submission of Documents 2 Y 3 8 6
2 Public Notifications 5 Y 2 20 10
3 Plans on Site 5 Y 3 20 15
4 Field Supervision 15 Y 3 60 45
5 Work Performed 15 Y 3 60 45
6 Finished Product 15 Y 3 60 45
7 Job Site Safety 15 Y 3 60 45
8 Traffic Control Maintenance 15 Y 3 60 45
9 Daily Clean Up 5 Y 3 20 15
10 Citizen's Complaint Resolution 5 N
11 Property Restoration 5 Y 3 20 15
12 After Hours Response 5 N
13 Project Completion 5 Y 3 20 15
TOTAL ELEMENT SCORE(A) 301
BONUS POINTS(25 Maximum)(B)
TOTAL SCORE(TS) 301
IIn CONTRACTOR'S RATING
Maximum Score(MS)=448 or sum of applicable element score maximums which= 408
Rating(ITS/MS)" 100%) 301 / 409 74%
Performance Category Good
<20%=Inadequate 20•/to<40%—Deficient 40.04 to<60%=Standard 60%to<80%=Good 2!80916=Excellent
Inspector's Comments(INCLUDING EXPLANATION OF BONUS POINTS AWARDED)
Signature DOE Inspector A�� liL'�'•� Signature Contractor
Signature DOE Inspector's Supervisor
CONTRACTOR'S COMMENTS
TRANSPORTATION AND PUBLIC WORKS
The City of Fort Worth•1000 Throc)<morton Street•Fort Worth,TX 76012-6p11
(817)392-7941 •Fax:(817)392-7845 OFFICIAL RECORD
CITY SECRETARY
FT. WORTH, TX
FORTWORTH REV:02/221
07
TRANSPORTATION AND PUBLIC WORKS
CONTRACTOR'S EVALUATION OF CITY
PROJECT INFORMATION Date: 2/7/2015
Name of Contractor Project Name
Conatser Stone Creek Ranch PH W
DOE Inspector Project Manager
Keith Dovers Khal Jaafari
DOE Number J.Project Dexulty Type of Cowart
7197 0 Simple Q Routine 0 Complex Q Water E] Waste WaterO Storm Drainage Pavement
Initial Contract Amount Final Contract Amount
$633,641.00 $633,641.00
11)PERFORMANCE EVALUATION
0-Inadequate 1 -Deficient 2-Standard 3-Good 4-Excellent
ELEMENT RATING ELEMENT RATING
(0-4) (0-4)
INSPECTION EVALUATION IPLANS&SPECIFICATIONS
1 Availability of Inspector I 1 Accuracy of Plans to Existing Conditions
2 Knowledge of Inspector 2 Choty&Sufficiency of Details
3 Accuracy of Measured Quantities 3 ApplicabihV of SEEifications
4 Display Of Professionalism 4 Accuracy of Plan Quantities ti
5 Citizen Complaint Resolution PROJECT MANAGER EVALUATION
6 Performance-Setting up Valve Crews,Labs 1 Knowledge And/Or Problem Resolution
ADMINISTRATION 2 Availability of Project Manager
1 Chan Le Order Processing Time 3 Communication
2 Timhiness of Contractor Payments 4 Resolution of Utility Conflicts
3 Bid Opening to Pre-Con Meeting Timeframe
III)COMMENTS&SIGNATURES
COMMENTS
Signature Contractor
Signature DOE Inspector
Signature DOE Inspector's Supervisor 7
INSPECTOR'S COMMENTS
TRANSPORTATION AND PUBLIC WORKS
The City of Fort Worth•1000 Throckmorton Street•Fort Worth, IX 012-6311
(817)392-7941 •Fax:(817)392-7845 OFFICIAL RECORD
CITY SECRETARY
FT. WORTH,TX
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 Brock Huggins, Vice-President of Conatser Management Group,
Inc.,general partner of Conatser Construction TX,LP,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;and
That there are no claims pending for personal injury and/or property damages;
On Contract described as:
STONE CREEK RANCH,PH IV
WATER,SANITARY SEWER
PAVING,DRAINAGE AND STREET
LIGHT IMPROVEMENTS
City Project#:N/A
CITY OF FORT WORTH
STATE OF TEXAS
CONATSER CONSTRUCTION TX, LP
Aza�!�q �
Brock Huggins
Subscribed and sworn to before me this 9a'day of January,2015.
Bertha u
Public for anulis
Notary Publipu in Tarrant Texas
State of Texas=` OFFICIAL RECORD
,- My commission expires:09/18/2015 CITY SECRETARY
FT. WORTH, TX
OWNER
ARCHITECT ❑
CONSENT OF SURETY CONTRACTOR p
TO FINAL PAYMENT SURETY ❑
OTHER ❑
BOND NO.: 0185056
TO OBLIGEE:
(Nanne andAddness) CONTRACT FOR:Water,Sanitary Sewer,
LGI HOMES-TEXAS,LLC Paving,Drainage&Street
1450 Lake Robbins Drive,Suite#430 Light Improvements
The Woodlands,TX 77380
PROJECT: CONTRACT DATED:May,2014
(Name and Address)
Stone Creek Ranch,IV
Fort Worth,TX
PRINCIPAL: CONATSER CONSTRUCTION TX,L.P.
At the request of the Obligee and the Principal indicated above,(Insert name and address ofsurety)
Berkley Insurance Company,412 Mt.Kemble, Suite 310N,Morristown,NJ 07960
,SURETY,
on bond of
(Insert name and address ofContraetor) CONATSER CONSTRUCTION TX,L.P.
5327 Wichita Street
Fort Worth,TX 76119
,CONTRACTOR,
and conditioned on the representation by Obligee that all Contract provisions relating to the payment of final
payment under the Contract have been satisfied by Principal as of the date of final payment,and that no claims
by Obligee or any third party are known or believed by Obligee or its representatives to exist as of the date of
final payment,representations as to the truth and accuracy of the foregoing conditions being deemed to have
been made by Obligee in connection with this request for Consent of Surety,hereby approves of the final
payment to the Principal,and agrees that final payment in accordance with the terms hereof shall not relieve the
Surety of its obligations to
(Insert name and address ofobligee)
LGI HOMES-TEXAS,LLC
1450 Lake Robbins Drive,Suite#430
The Woodlands,TX 77380 ,OBLIGEE,
as set forth in said Surety's bond.
IN WITNESS WHEREOF,the Surety has hereunto set its hand on this date: January 07,2015.
(Insert in writing the month followed by the numeric date andyear)
Berkely Insurance Company
t 6 9
lk��.C),\ ,A) � ���) I
(Signature of authorise representative
V.DeLene Marshall,Attorney-In-Fact
(Printed name and title)
(Seat):
N
IAL RECORDSECRETARYORTH, TX
No.BI-7280c
POWER OF ATTORNEY
BERKLEY INSURANCE COMPANY
WILMINGTON,DELAWARE
NOTICE: The warning found elsewhere in this Power of Attorney affects the validity thereof. Please review carefully.
KNOW ALL MEN BY THESE PRESENTS, that BERKLEY INSURANCE COMPANY (the"Company'), a corporation duly
organized and existing under the laws of the State of Delaware,having its principal office in Greenwich,CT,has made,constituted
and appointed, and does by these presents make, constitute and appoint: Ricardo J. Reyna, Don K Cornell, Lisa M. Bognor~
Vega DeLene Marshall or Sophinie Hunter of Aon Risk Services Southwest,Inc.of Dallas, TX its true and lawful Attorney-in-
Fact, to sign its name as surety only as delineated below and to execute, seal, acknowledge and deliver any and all bonds and
undertakings,with the exception of Financial Guaranty Insurance,providing that no single obligation shall exceed Fifty Million
E and 00/100 U.S.Dollars(U.S.S50,000,000.00),to the same extent as if such bonds had been duly executed and acknowledged by
the regularly elected officers of the Company at its principal office in their own proper persons.
e0 e
H
This Power of Attorney shall be construed and enforced in accordance with,and governed by,the laws of the State of Delaware,
without giving effect to the principles of conflicts of laws thereof. This Power of Attorney is granted pursuant to the following
a resolutions which were duly and validly adopted at a meeting of the Board of Directors of the Company held on January 25,2010:
0
.q E RESOLVED,that,with respect to the Surety business written by Berkley Surety Group,the Chairman of the Board,Chief
w Executive Officer, President or any Vice President of the Company, in conjunction with the Secretary or any Assistant
E t! Secretary are hereby authorized to execute powers of attorney authorizing and qualifying the attorney-in-fact named therein
m 2 to execute bonds,undertakings, recognizances, or other suretyship obligations on behalf of the Company, and to affix the
c c corporate seal of the Company to powers of attorney executed pursuant hereto; and said officers may remove any such
o ° attomey-in-fact and revoke any power of attorney previously granted;and further
o .o RESOLVED,that such power of attorney limits the acts of those named therein to the bonds,undertakings,recognizances,
y or other suretyship obligations specifically named therein, and they have no authority to bind the Company except in the
manner and to the extent therein stated;and further
Qc RESOLVED,that such power of attorney revokes all previous powers issued on behalf of the attorney-in-fact named; and
u further
R RESOLVED,that the signature of any authorized officer and the seal of the Company may be affixed by facsimile to any
c power of attorney or certification thereof authorizing the execution and delivery of any bond,undertaking,recognizance,or
E other suretyship obligation of the Company;and such signature and seal when so used shall have the same force and effect as
cc
a 3 though manually affixed. The Company may continue to use for the purposes herein stated the facsimile signature of any
person or persons who shall have been such officer or officers of the Company,notwithstanding the fact that they may have
c n ceased to be such at the time when such instruments shall be issued.
0 E
y n IN WITNESS WHEREOF,the Company has cau d these resents to be signed and attested by its appropriate officers and its
a corporate seal hereunto affixed this day of M 2014.
0
o Attest: �� / Berkley Insurance Company
B (Seal) By By
cc Ira S.Lederman iffy .Ha&er
c Senior Vice President&Secretary ce President
0
WARNING:THIS POWER INVALID IF NOT PRINTED ON BLUE"BERKLEY"SECURITY PAPER
STATE OF CONNECTICUT)
H .ss:
COUNTY OF FAIRFIELD )
0 9
o Sworn to before me, a Notary Public in the State of Connecticut,this Oday of 2014,by Ira S.Lederman and
5 Jeffrey M.Hafter who are sworn to me to be the Senior Vice President and Secretary,and 114 Senior Vi President,respectively,of
c Berkley Insurance Company. MAFAA C.FILMOSAM C.
>, u NOTARY PUBLIC l �C
Q c My COMMISSION� EXEXPIM otary Public,State of Connecticut
�j W AFrAPPALp,,
CERTIFICATE
I,the undersigned,Assistant Secretary of BERKLEY INSURANCE COMPANY,DO HEREBY CERTIFY that the foregoing is a
v true,correct and complete copy of the original Power of Attorney;that said Power of Attorney has not been revoked or rescinded
Q v and that the authority of the Attorney-in-Fact set forth therein, who executed the bond or undertaking to which this Power of
3 " Attorney is attached,is in full force and effect as of this date.
Given under my hand and seal of the Company,this day of r
(Seal) OFFICIAL RECORD
An a
CITY SECRETARY
FT,WORTH,TX
IMPORTANT NOTICE
To obtain information or make a complaint:
You may call Berkley Surety Group, LLC and its affiliates by
telephone for information or to make a complaint:
BERKLEY SURETY GROUP, LLC
Please send all notices of claim on this bond to:
Berkley Surety Group, LLC
(866) 768-3534
412 Mount Kemble Avenue, Suite 31 ON
Morristown, NJ 07960
Attn: Surety Claims Department
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: http://www.tdi.state.tx.us
E-mail: Cons umerProtection(aD-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 Berkley Surety Group, LLC 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 01-
condition
rcondition of the attached document and is given toFMFIIIIAL h T
legal and regulatory requirements.
SECRETARY
WORTH,TX