signed application

I&P
REVIEW BY FORT BEND COUNTY COMMISSIONERS COURT
On this 6th day of October, 2015, Commissioners Court came on to be heard and
reviewed the accompanying notice
of Cruz Tee Inc on behalf of Cinco Southwest MUD No 2
Job Location 9423 Spring Green Blvd .. Katy, TX 77494
Date 9/22/2015 Bond No. 95008664, Permit No. 2015-3120 to make use of certain Fort
Bend County property subject to, "A Revised Order Regulating the Laying,
Construction, Maintenance, and Repair of Buried Cables, Conduits, and Pole Lines, In,
Under, Across or Along Roads , Streets, Highways, and Drainage Ditches in Fort Bend
County, Texas, Under the Jurisdiction of the Commissioners Court of Fort Bend
County, Texas," as passed by the Commissioners Court of Fort Bend County, Texas
of the Minutes of the
the 3rd day of August, 1987, recorded in Volume
Commissioners Court of Fort Bend County, Texas, to the extent that such order is not
inconsistent with Article 1436a, Vernon's Texas Civil Statutes. Upon Motion of
Commissioner
{J B{ !J.l.lJ
, seconded by Commissioner
/);1
duly put and carried , it is ORDERED, ADJUDGED AND
Df'=CREED that said notice of said above purpose is hereby acknowl edged by the
Commissioners Court of Fort Bend County, Texas, and that said notice be placed on
record according to the regulation order thereof.
4A
a(( r<tO.v )
I
Notes:
1. Evidence of review by the Commissioners Court must be kept on the job site and
failure to do so constitutes grounds for job shutdown.
2. Written notices are requ ired:
a. 48 hours in advance of construction start up, and
b. when construction is completed and ready for final inspection
Mail notices to: Permit Administrator
Fort Bend County Engineering
301 Jackson Street
Richmond, Texas 77469
281-633-7 500
3. This permit expires one (1) yea r from date of permit if construction has not
commenced.
By:
~ 9- ~ 1f(
fro{
foll. County Ellg'if1eer
Presented to Commissioners Court and
approved.
Recorded i~Vokm(°
ID
By:
N/A
Drainage District Engineer/Manager
u
I
Minutes of Commissioners Court
7
County of Fort Bend
Engineering Department
Johnny Ortega
Permit Administrator
301 Jackson Street
Richmond , Texas 77469
Phone: (28 1) 633-7500
Permit Application Review Form For
Cable, Conduit, and Pole Line Activity
In Fort Bend County
Permit No.
2015-3120
The following "Notice of Proposed Cable, Conduit, and/or Pole Line activity in Fort Bend County" and
accompanying attachments have been reviewed and the notice conforms to appropriate regulations set
by Commissioner's Court of Fort Bend County, Texas.
X
X
(1) Complete Application Form:
X
a. Name of road, street, and/or drainage ditch affected.
X
b. Vicinity map showing course of directions
X
c. Plans and specifications
(2) Bond :
District Attorney, approval when applicable.
Perpetual bond currently posted.
No:
Amount:
X
Performance bond submitted.
No: 95008664
Amount: $10,000.00
Cashier's Check
No:
Amount:
(3) Verbal permission given for emergencies, to start construction before approved in
- - - - - - Commissioner's Court.
Precinct Engineer Acknowledgment
Date
Precinct Commissioner Acknowledgment
Date
(4)
Drainage District Approval when applicable
We have reviewed this project and agree it meets minimum requirements.
09/29/2015
Johnny Ortega CFM/Permit Administrator
Date
PERFORMANCE BO NO COYERING Al.I. CAB!.E. CONOlllT ANO/OR POLE !.! NE
ACT IYITX IN. l lNQER. ACROSS OR ALONG FORT BENO COIJ NTX ROAQS
AUTHORIZED
BON 0 N0_ _....95..0086
..._.;.
64" " - - THE STATE OF TEXAS
§
KNOW ALL MEN BY THESE PRESENTS:
COUNTY O F FORT BEND
§
THAT WE
Cruz Tee, Inc.
whose
address is
Houston, TX 77064
,Texas, hereinafter called the Principal.
and
The Gu!l"antee Co. Of North America USA
, a Corporation existing under and b~' virtue of
the laws of the State of Mictigan and auth orized to do an indemnifying business in the State of
Texas, and whose principal office is located at One Towne Square Ste 1470, Southfield, Ml 48076 , whose
officer residing in the State of Texas, auth orized to accept service in all snits and actions brought
withinsaidStateis TX
andwhoseaddressis l999 Bryan St,Ste 9 00 Dall as,TX 75,2 01
hereinafter called the Surety, and held and firmly bound nnto, Robert E. Hebert, County Judge
of Fort Bend County, Texas, or his successors in office, in the fnll sum of Ten Thousand Dollars
Dollars($ 10.000 ) current, lawful money of the United States of America, to be paid to said
Robert E. Hebert, County Judge of Fort Bend County, Texas, or his successors in office, to which
payment well and truly to be made and done, we, the undersigned, bind ourselves and each of ns,
our heirs, executors, administrators, successors, assigns, and legal representatives, jointly and
severally, by these presents.
THE CONDITION OF THIS BOND IS SUCH THAT, WHEREAS, the above bound en
principal contemplates laying, constructing, maintaining and/or repairing one or more cables,
conduits, and/or pole lines in, under, across and/or a long roads, streets and highways in the
County of Fort Bend, and the State of Texas, under the jurisdiction of the Commission ers' Court
of Fort Bend County, Texas, pursuant to the Commissioners' Court order adopted on the .ll1 day
of December, A.O. 1..2.aQ, recorded in Volume .lJ., of the Commissioners' Court Minntes of Fort
Bend County, Texas, regulating same, which Commissioners' Court order is hereby r eferred to
and made a part hereof for all p urposes as though fu lly set out herein;
AND WHEREAS, the principal desires to provide Fort Bend County with a performance
bond covering all such cable, conduit and/or pole line activity;
NOW, THEREFORE, if the above bounden principal shall fai thfully perform all its cable,
conduit and/or pole line activity (including, but not limited to the laying, construction,
maintenance and/or repair of cables, conduits and/or pole lines) in, under, across and/or along
roads, streets and highways in the Coun ty of Fort Bend and State of Texas, under th e
jurisdiction of the Commissioners Court of Fort Bend County, Texas, pursuant to and in
accordance with minimum requirements and conditions of the above mentioned Commissioners'
Court order set forth and specified to be by said principal done and performed, at the time and
in the manner therein specified, and shall pay over and make good and reimburse Fort Bend
County, all loss and damages which Fort Bend County may sustain by reason of any failure or
defa ult on the part of said principal, then this obligation shall be null and void, otherw;se to
remain in full force and effect.
This bond is payable at the County Courthouse in the County of Fort Bend and State of
Texas.
It is understood that at any time Fort Bend County deems itself insecure under th is bond ,
It may require further and/or additional bonds of the principal.
EXECUTED this
<
CCM I Oth I (
# I~
Fort BenCI Ci5unty 'Clerk
Return Admin Serv Coord
F
14th
day of
September
2.015
The Guara ntee Company of North America USA
THE
GUARANTEE'w
Southfield, Mkhigan
POWER OF ATTORNEY
POWER OF ATIORNEY NUMBER (must match bond number on bond) :
95008664
Fort Bend Cou nty Cable Line Performance Bond
Ten Thousand Dollars ($10,000.00)
KNOW ALL BY THESE PRESENTS: That THE GUARANTEE COMPANY OF NORTH AMERICA USA, a corporation organized and existing under the
laws of the state of Michigan. having its principal office in Southfield, Michigan, does hereby constitute and appoint
Misty Witt. The Woodlands, TX
Its true end lawful attomey(s)-in-fact to execute, seal and deliver for end on its behalf as surety, any and all bonds end undertakings, contracts of
Indemnity and other writings obligatory in the nature thereof. which ere or may be allowed, required or permitted by law, statute . rule, regulation, contract
or otherwise.
The execution of such lnstrument(s) In pursuance of these presents, shall be as binding upon TH E GUARANTEE COM PANY OF NORTH AMERICA
USA as fully and amply. to all Intent s and purposes. as If the same had been duly executed and acknowledged by Its regularly elected officers at the
principal office.
The Po.ver of Altomey ls executed and may be certified so. and may be revoked, pursuant to and by authority of Article IX, Section 9.03 of the By-Laws
adopted by the Boerd of Directors of THE GUARANTEE COMPAN Y OF NORTH AM ERICA USA at a meeting held on the 31 91 day of December. 2003.
The President. or any Vice President. acting with any Secretary or Assistant Secretary, shell have p<:M1er and authority·
1.
2.
3.
4.
To appoint Attomey(s)-ln-fact, and to authorize them to execute on behalf of the Company, and attach the Seal of the Company thereto, bonds
and undertakings. contracts of indemnity end other writings obligatory in the nature thereof, and
To revoke, at any time, any such Attorney-In-fact and revoke the authority given, except es provided below
In connection with obligations in favor of the Florida Department of Transportation only, it is agreed that the po.ver and authority hereby given
to the Attorney-In-Fact Includes any and all consents for the release of retained percentages and/or final estimates on engineering and
construction contracts required by the State of Florida Department of Transportation. tt Is fully understood that consenting to the State of
Florida Department of Transportation making payment of the final estimate to the Contractor and/or Its assignee , shall not relieve this su rety
company of any of its obligations under its bond.
In connection with obligations in favor of the Kentucky Department of Highways only, it is agreed that the power and authority hereby given to
the Attorney-in-Fact cannot be modified or revoked unless prior written personal notice of such intent hes been given to the Commissioner Department of Highways of the Commonwealth of Kentucky at least thirty (30) days prior to the modification or revocation .
Further, th is Power of Attorney ls signed and seated by facsimile pursuant to resolution of the Boerd of Directors of the Company adopted at a meeting
duly called and held on the 6th day of December 2011 , of which the follo.ving is a true excerpt:
RESOLVED that the signature of any authorized officer end the seal of the Company may be affixed by facs11T1ile to any Power of Attorney or certification
thereof authorizing the execution and delivery of any bond. undertaking, contracts of indemnity and other writings obligatory in the nature thereof. and
such signature and seal when so used shall have the same force and effect as though manually affixed.
IN WITNESS WHER EOF , THE GUARANTEE COMPANY OF NORTH AMERICA USA has caused this Instrument to be signed and
Its corporate seal to be affixed by Its authorized officer, this 23rd day of February, 2012.
TliE GUARANTEE COM PAN Y OF NORTli AM ERICA USA
STATE OF MICHIGAN
County of Oakland
Stephen C. Ruschak, Vice President
Randall Mu sselman, Secretary
On this 23rd day of February, 2012 before me came the Individuals who executed the preceding Instrument, to me personally kno.vn, and being by me
duly swom , said that each Is the herein described and authorized officer of The Guarantee Company of North America USA; that the seal affixed to said
Instrument Is the Corporate Seal of said Company; that the Corporate Seal and each signature were du ly affixed by order of the Boerd of Directors of
Cynthia A. Takai
Notary Public. State of Michigan
County of Oakland
My Commission Expires February 27, 2018
Acting in Oal<Jand County
IN WITNESS WHEREOF. I have hereunto set my hand at The Guarantee
Company of Norih .America USA of11ces the day and year ab011e written.
pl' •
-~·,;.
,:
•
~'\·
I. Randall Musselman. Secretary of THE GUARANTEE COMPAN Y OF NORT H AM ERICA USA, do hereby certify that the. a.b.W~ 'aliCf tSggqr~g Is a true
end correct copy of a Power of Attorney executed by TliE GUARANTEE COMPANY OF NORTli AM ERI CA USA : •NhL~ Js'stil in
-
IN W ITNESS WHEREO F, I have thereunto set my hand and attached the seal of said Company this
..::> -
?J 4.th
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- .:-. .
dll.Y 9,(' Se'ptemberl-
~.,;..-.u:::::::t:::..G41!~a.-.e.....--..,,....,......_....4...-...___'·
Randall Musselman, Secr etary
tunforce'!lrtd elfect
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Texas Consumer Notice
1. IMPORTANT NOT ICE
To obtain information or make a complaint:
AVISO IMPORTANTE
Para obtener informacion o para someter una q ueja:
2. You may contact your agent at:
Puede comunicarse con su agent al
3. You may call The Guarantee Company of North
Usted puede llamar al numero de telefono gratis de
The Guarantee Company of North America USA's
para informacion o para someter una queja al:
1-866-328-0567
America USA's toll-free telephone number for
information or to make a complaint at: 1-866328-0567
4. You may also write to The Guarantee Company
of North America USA at:
One Towne Square, Suite 1470
Southfield, Michigan 48076
Web: www.acoa.com
E-mail: lnfo@qcna.com
Fax: 248-750-0431
5. You may contact the Texas Department of
Insurance to obtain information on companies,
coverages, rights or complaints at: 1-800-2523439
6. You may write the Texas Department of
Insurance:
P.O. Box 149104
Austin, TX 787 14-9104
Fax: (512) 475-1771
Web: http://Ww.tdl.state.be.us
E-mail: ConsumerProtection@tdi.state .be.us
7.
PREMIUM OR CLAIM DISPUTES
Should you have a dispute concerning your
premium or about a claim you should contact the
(agent) (company) (agent or the company) first.
If the dispute is not resolved, you may contact
the Teas Department of Insurance.
8.
ATTACH THIS NOTICE TO YOUR POLICY:
This notice 1s for information only and does not
become a part or condition of the attached
document.
Usted tambien puede escribir a to The Guarantee
Company of north America USA,
One Towne Square, Suite 1470
Southfield, Michigan 48076
Web: www.qcna.com
E-mail : lnfo@gcna.com
Fax: 248-750-0431
Puede comunicarse con el Departamento de Seguros de
Texas para obtener informacion acerca de companies,
coberturas, derechos o quejas al: 1-800-252-3439
Puede escribir al Departmento de Seguros de Texas:
P.O. Box 149104
Austin, TX 78714-9104
Fax: (512) 475-1771
Web: http://ww.tdi.state.be.us
E-mail: ConsumerProtection@tdi.state.be. us
OISPUTAS SOBRE PRIMAS 0 RECLAMOS:
Si tiene una disputa concerniente a su prima o a un
reclamo, debe comunicarse con el (agente) (la
compania) agente o la compania) primero. Si no se
resuelve la disputa, puede entonces comunicarse con el
departamento (TO I).
UNA ESTE AVISO A SU POLIZA: Este aviso es solo
para proposito de informacion y nose convierte en parte
o condicion del document adj unto.
Pt:REORl\:IA"iCE BOND COYER!NC Al.I. CARI E CPNQ!J!T ANDIOR POI EI INE
ACTIVII\ IN L 1'QER ACROSS OR Al O"iG FORT RENQ COliNIX ROADS
A THORIZED
BOND N0_ _ _9_5008664....,.
......_ __
THE STATE OE TEXAS
§
COUNTI OF FORT BE D
§
K..~O\
THAT WE
address i
ALL MEN BY THESE PRESENTS:
wbese
Cruz Tee, Inc.
,Ten" llerelnlfter caUl'd lbe PrinC'ipal.
ll<V!'nll, TX T7064
lhe Gua-an:ee Co. Ol l\lof"J'o Merica USA
ud
, a Corporation emdag wader and by virtme of
the In or the State of Miehgan and aathorized 10 do an indemaifytag bastneu Ill the State of
Texas, and "hose prindpal ofnce Is luC'•ted at One rowne Squat'8 S1e 1470, South6eld, Ml 48076 , whose
omcer raiding la the Stale of T as, authorized 10 accept service Ill aU saib and acliou broaabt
witllinsaidSCateis TX
andwboseaddressts1999 Bryan St.S t e 900 Da ll as . TX 75,2 01
berelnafter caUed the Surety, and hdd and ftrmty boaad aato, Robert E. Hebert. Coa•ty Jadge
or Fort Bnd County, T eus, •r Ills sacceuon ill emu, la tbe ruu Hm or Ten Thousand Doi~
Dollan (S 10.000
) cnrrmt, la"flll money of the United Stites or America, to be paid to said
Robert E. Hebert, County Judge or fort Bead County, Te:u,,, Gr bb Rtteuers in of'nce, to l1111icb
payment 1''eU and truly to be made and dome, 1.-e, tile uderslgned, bind earwhra and acll of us,
our bein. executers, administrators. successors, assigns, and le:•I representatives, join~· and
severaUy, by dlese presents.
THE CONDITION OF THIS BONO IS SUCH THAT, WHEREAS, the above bewiden
principal contemplates laying, constracdag. mamtaillhlg and/or repairing oae or mere cables,
coadaits, and/or pole lines ia, aader, across and/or aJon; roads, streets ud blt;ll1nys in tbe
Coanry or Fort Bead, and tile tare efTeus, under the jarisdictiea of tbe Commissioners' Court
of Fort Bead County. Texas. parsaant to the Comad.uloun' Coan enter adopl2d o• theJ.a day
of DuCmbq· A.D. llll. recenlfd in Volume .lJ, of tbe CoannbliOC1•1' C•rt Miaates or Eert
Bead Ceanty, Tex.s, regu.lating ume, which Commiuloaer1' Coart order ii bereby referred to
and made a part hereof ror aU purposes H tbo.r;tb faJly HC out berebi;
AND WHEREAS, the prladpal desires to provide Fort Raid Collllty "frill! a perrormance
bond co,·ering au sccb able, cond•it Hdlor pole line adivity;
NOW, THEREFORE, If lbe above bounden pl'indpal shaU faltbtaUy perform all its able.
ceadait Hdlor pole line activity (indodinc, bat aot limlled to lbe la)img, cemtrucde.n ,
maintenance and/or repair or ables, conduits a11d/or pole lines) ia. Hder, acreu and/or aloae
roads, streets and lligbways In tile County of fort Bend aad SCate er Tuas, under the
jarildic:tion or the Commissioners Court of Fort Bead County, Tuas, parnant tu and tn
accordance ~itb minimum nqairementll aad conditions or U1e above mattoned CommlssJoaen'
Court order set forth and specifted to be by said principal done a11d perfermed, at tbe time and
in tbe -oner tberdll ipecified, and 1baU pay over and ... te gMd and retmbane Fort Bead
County, aU loss and damages wbkb Fort Beed County may iastain b'' reaon of any failure or
default on tbe part er said prfadpal, then this ob6gation sbal be aaU and void, olherwise to
reauin In fall force and effect.
T hb bond is payable at tbe County CoartJaoue ia the County ef Fort Bend and State or
Texu.
II is aodentood that at any time Fort Bet1d County deems l1seJftasecare under this bond,
it may req uire Cuther and/or additional bonch of the prfndpaL
EXEC UTED tbis
. ........~ t •
.ii J k t l .. . .
•4 t11
• , ....__ ..- ..... a....tt.J..
day of
Septe!rber
.... 1'-h.&. ••; ...
J:'.)('
2015
The Guarant~C' Company of North America USA
M
GU RA Tee··
Southf eld, Mic:hit,fJ r>
POWER OF ATTORNEY
POWER OF ATTORNEY NUMBER (must match bond number on bond):
95008664
Fort Bend County Cable Line Performance Bond
Ten Thousand Dollars ($10,000.00)
KNOW ALL BY ll4ESE PRESENTS That ll4E GUARANTEE COMPANY OF NORll4 AMERICA USA, e c0f"P()f9tion orga"tZed end existing under the
laws °'the Slate of Mu:tugen havtng its p(mc:pal olrlee n Southfteld. Mtchtgan . does hereby consrtute and appotnt
Misty Witt, The Woodlands. TX
its lrue and wfUt attomeyh)-in-fad o execute. se ood deliver for and on Its behalf as surety, '«IY and all bonds and unde-1.tcing conlracts d
indemnity and c:ither writings obl1gatay tn the natu~ thereof. wt11cll are or may be allowed. re:;iuired or penntted by law sta.u:e, rule regutabon contract
orc:itherwise
The a~cution ~ 1UCh tn .trument( 11'1 r<;uan~ of
p
nt , sh be e binclng upon ll4E GU~ COMP ANY OF NORlli AMERICA
USA as f\lly and ampty to 1!1 ll"llerts and purposes. as Ir the same had been duly executed and acknowledged by its reg:utar1y -'-cted oft!c:ecs at the
pnnopel office.
The PO'Ner of Attorney rs exect.ted and may be certl1ied so and may be reVcked pursual't to and by authority d ArtJc.e IX. Section 9 03 0( the By-Laws
adopted by the Soard d Directors of lliE GUARANTEE COMPAN Y OF NORll4 AM ! RICA USA at a meeting held on the 3 • 'day of Oe~ber. 2003.
The Pres.dent or any V'ce President acting With any Secrecary or Assistant S.C.tary, stlall have power and autror.ty:
2
3
4.
To
oint Altome')'( ., f.lct ..d to a.tt-or.ze them to encute
behAlf of • Company, end
ctt t e
d the Company thereto bonds
and u'ldertalongs contrads 0( demn'ty and dher wnbngs obllgat ory m the nature therect a d
To revoke at ny tme any sucll Altorn._in.fact and rev oke tile autfy.)o.>y given, except as prCMded oetow
In connection w:th obliQ:ltials m favor d the rtond D-partment of Transpottation only. t s !)'eed ltlllt ttie power and uthooty h~reby g1~
to the Attorney- n-fact includes eny and all consents for the release of retained pe~oes an~ 11.-a1 estimates ori en~neertng and
constructlon contracts required by the St.re of Flof1da Department of Transportation. !t IS flJI / n,je!'Stood that consenthg to Che Stale of
Flonda Department 0( Transp<irtlltJon melong pa~ent of the r!nal estimate to the Contractor and/or Its a signee shall not reheve this surety
company of any of ts obligaliors under its borld.
In conned!on with ollfigafions in favor cl the Ke· tucky Dep artment d Highways only, it is aweed that the power and authonty hereby given to
the Attomey.tn- Fad cannot be m<:d'ied a revol!ed u leu pncx wntten persorial nolice of such 'nte~t as been given lo ll'e Commssloner Department d Hlg11ways of t:'e Com."OOOWellth of Kentucky 91 least th rty (30) days prior to the i:"'~cat.oo or revocation
Funher ttus Power af Altom~/ IS 519ned •"d sea.ed by !aCSlrTllfe pursuant to rasoM:oo o! the Boerd d Dilectors d the Com?ll'l'f d~ed at e m- >ng
cllly caned e.n d held on the 6th day of December 2011 , of which the ~ng !s • true excerpt
RESOLVED !hal the signature of '«IY a.ithorized ot5cef and the seal of tile Company may be al'ixed by faesmle to any Power of AJ!,..,..•y or cert1fieabon
thered authonzing the necuhon and delive-y d any bor>d. undertalcing. contracts cl indemnity and dher 'tWTltings obhgatay n e natu•e thereof and
such signature and seal When so used shall have the same face and affect as lt>ough manua' ty aftlxed.
IM WITNESS WHEREOF THE OUARAN~E COM PANY OF NORTH AME.RICA USA has ca.used tnis insln.mert to be signed and
Its corporate seal to t::e a!'hed by Its aulhOlized olficer. th s 23rd day 0( February 2012
lliE GUARANTEE COM PANY Of NORlli AM ERICA USA
STATE OF MICHIGAN
Counl y of Oaldand
stephtn c. Rusch ak, Vice President
Randall Musselman, Secretary
On this 23rd day 0( February 2012 t>efcre me came the 1ndllllduals who executed the preceding instrument. to me persona'ly known and being by me
duly 5W'Ol'Tl said that etch s the herein described and authonzed oll'icer of The Guarantee Company 0( Nath Amenca USA. that the seal afftxed lo said
lnsuument 1s the Corpc:nte Seal of said Company that the Corporate Seal end eaOh signature were duly aftbced by order cl the Bclerd cl Directors d
IN WITNESS WHEREOF. I have hereuNo set my hand at The Guarant ee
Company o< Nonh Mlerica USA ol'!lces the day and year abole wntten
Cynthta A Tali.a!
Notary Pllbbc Sta~ "Miclugan
County of Oakbnd
My Comm1ssion Eq>re3 Febrvary 27. 2018
Aclmg 111 Oakland Covnty
I Randall Musselman Secretary d lliE GUARAN~ E COM PANY OF NORTH AM ERIC A USA. do hereby certify that tile abo\l'e and foregoing IS a true
and CCffl!'d copy ol Poirer°' Attom~ e.teculed by THE GUA RANTI:E COMPANY OF NORlli AMERIC A USA. wtuch 15 SUI '" ru• fon;e and effect
IN w•TNCSS WHEREOF I have 1hereun10 set my hand and al!ached the seal cl said Company lh15 14th
Randall Musselman, Secret ary
., cl Srptember
2015
Texas Consumer Notice
1
IMPORTANT NOTICE
To otxam information or make a complain ·
AV150 Jrlf»ORTANTE
2
You may con•act yoll" agent at
Puede comlll"1Carse con su agent al
3
You may call The Guarantee Company of l\lorth
America USA s toll-free telephone number for
information or to make a complaint at 1-866-
328-0567
4
You may also wrtte to The Guarantee Company
of North Amenca USA at·
One Towne Square Slite 1470
Southfield Michigan 48076
Web
Email
Fax 248-750-0431
5
You may contact the Texas Departmert of
I
arce to .. .ta1n info ~o r on com nies,
coverages rights or complaints at 1-800-2523439
6
You may wnte the Texas Department of
Insurance
P.O Box 149104
Austin TX 78714-9104
Fax· (51 2) 475 1771
Web
E-ma11·
7
PREMIUM OR CLAIM DISPUTES
Should you have a dispute concerning your
premium or about a claim you should contact the
(agent) (company) (agent or the company) first.
If the d1
• is n r n lved you may oonlact
the Teas Department of Insurance
8
ATIACH THIS NOTICE TO YOUR POLICY
This notice 1s for 1rtormat1on only and does not
become a part or cond•t.on or the attached
documert
Para obtener informacion o para someter una
q ueia
Usted puede lamar al ~mero de telefono grabs de
The Guararrtee Compary o North Amerca JSA's
para 1nforriiac1on o para some er una queia al
1-866-328-0567
Usted tamblen puede escnb1r a to The Guarantee
Company of nort Amenca USA,
One ToW"le Square, Suite 1470
Southfeld, \fchtgan 48076
Web
E-m 11· .........................__ _
Fax 248-750-0431
Puede comufl' rse con ei De rtamento de Seguros de
- exas para obte 'ler i nformacion acerca de companies,
coberturas derecros o queias al 1-800-252-3439
Puede escrib"r a Oeparmento de SeglXos de Texas
P.O Box 149104
Aus• n, TX 7871 4-9 04
Fax (512) 475-1
Web h· ,
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E-mail '-AnsumerPlote@n@td'
n1
DISPUTAS SOBRE PRIMAS 0 RECLAMOS·
SI tie11e una drsputa concemente a su p'lma o a un
reclamo debe comunicarse con el (agente) (la
compania) agente o la co-npania) pnmero S1nose
resuelve la d1sputa, puede entonces comurncarse con el
d
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UNA ESTE AVISO A SU POLIZA Este avtso es solo
para proposito de informac1on y nose conv1erte en parte
o cond"c1on def document adj unto
CIVIL PLANS
FOR
WATER, SANITARY SEWER, AND
STORM SEWER CONNECTION EXTENSIONS
SERVING CROSSING AT CINCO RANCH
ON BEHALF OF:
CINCO SOUTHWEST MUD NO. 2
LOCATED IN
CITY OF HOUSTON ETJ, FORT BEND COUNTY, TEXAS
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WATER PLAN & PROFILE
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