ST0301A-CL101215 t {ChemicaI Lime
A Lhoist Group Company k,
12/15/2010
Notice of Bond Claim
AON Risk Services Southwest Inc. Job #: 208196
2711 N. Haskell Ave Suite 800 Job Address: JRJ -10112 BETHEL ROAD II
Dallas TX 75204
COPPELL, TX • •
Prime Contractor: JRJ Paving LP
CMRRR:
Sub Sub Contractor: Colonial American Casualty and
Certified Article Number Surety
Supplier: Chemical Lime Company
7160 3901 9848 7468 9121 Amount Due: 6,310.14
SENDERS RECORD Delivery Months: September 2010 ,
Gentlemen:
We understand you are the Surety on a Payment bond covering the above referenced project
and that the Prime Contractor listed above is the Principal on the bond. If we are incorrect in
these understandings, please advise immediately. Our company furnished materials for use on
the subject construction project. We hereby make claim for the balance due listed above
which is unpaid as of this date.
This notice is to perfect a bond claim under Chapter 2253 of the Texas Property Code on
behalf of our company. A copy of this notice is being sent to the Governmental Authority
who issued the contract on this project. The purpose of this letter is also to perfect a Claim
against said Government Agency in the event your Bond was not furnished in compliance.
Enclosed you will find the following:
1. Sworn statement of account
2. Invoice(s) identifying materials furnished.
The nature of the materials furnished was lime slurry. If you have any question concerning
the above, please call Alice Barboza, Credit Department at (817) 806 -1617.
NOTE: This claim letter is merely to protect rights on the job. We realize that end -of -month
shipments sometimes are on the following month's draw, thereby causing delay of payment.
Sincerely,
1764 ° Certified Article Number
Alice Barboza
Credit Department 7160 3901 9848 7468 9145 Certified Article Number
(817) 806 -1617 SENDERS RECORD 7160 3901 9848 7468 9138
CMR
SENDERS RECORD
JRJ Paving LP Colonial American Casualty and Surety
PO Box 59934 Bond #08999827
Dallas TX 75229 3910 Keswick Road
Baltimore MD 21211
cc: First Class Mail
City of Coppell
255 Parkway Boulevard
Coppell TX 75019
PO Box 985004, Fort Worth, TX 76185 -5004 3700 Hulen Street, Fort Worth, TX 76107
Td• 1417717A1C4 Far• A17717Af1CQ
Cir
Chemical Lime
,,-' A A Lhoist Group Company
SWORN STATEMENT OF ACCOUNT
THE STATE OF TEXAS
COUNTY OF Tarrant
BEFORE ME, the undersigned authority, personally appeared Alice Barboza, who, upon oath,
stated that:
I am the Credit Analyst and authorized agent for Chemical Lime Ltd., partnership under the
laws of the State of Texas.
Pursuant to a contract and /or agreement with JRJ PAVING LP on the project known as
COPPELL, Texas, Chemical Lime Ltd. provided labor materials in connection with the
improvements to the project generally described as lime products.
The total price for the labor and /or materials provided by Chemical Lime Ltd. on the following
unpaid invoices is as follows:
Date of Invoice Approximated Date
Invoice Number Of Delivery Amount Unpaid
09/06/2010 301972252 09/01/2010 2,258.64
09/16/2010 301983105 09/15/2010 1,447.21
09/20/2010 301990165 09/17/2010 2,604.29
Total Amount Due: 6,310.14
The amount claimed herein for such materials is just and correct and all and lawfuly offsets,
payments and credits known to Chemical Lime Ltd. have been allowed. True and correct
copies of the unpaid invoices, which reasonably identify the labor and /or materials provided,
the job and destination of delivery are attached hereto. d �/1
Alice Barboz
jr SUBSCRIBED and SWORN to BEFORE ME, this the /,, day of / , 2010 to
cer which witness my hand and seal of office.
."*.\ ,,,; , ��,,;= i ;;3X CCJ°JPMAN
Notar Public, in/ nd for the State of Texas >; A , , °;,aoa [ x IF Es
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4,i ._ relnber 9, GOt t
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PO Box 985004, Fort Worth, TX 76185 -5004 3700 Hulen Street, Fort Worth, TX 76107
Lhoist North America
Lhoist Group DUPLICATE
Remit To: Invoice
Chemical Lime, Ltd. 1101413218 09/06/2010
5274 Paysphere Circle
CHICAGO , IL - 60674 Billing reference
301972252 09/06/2010
(800) 365-6724
Your PO Number
12671
Sold -to Customer 1 21 5 21
JRJ PAVING LP
Bill -to: Customer No 121521 ATTN ACCOUNTS PAYABLE
JRJ PAVING LP Contract Number
ATTN ACCOUNTS PAYABLE 0070054075
PO BOX 59934 Payer 121521
DALLAS TX 75229
Payment Terms:
Payment due on or before 10/06/2010
Net Due 30 Days After Invoice
Currency: USD
BOL No Unit
Item Date Ref No Mat No Material Description / Packaging Qty UoM Price Amount Tax
1 09/01/2010 106490584 Shipping point: HURST Means of transport: Truck
Ship -to: 208196 / JRJ -10112 BETHEL ROAD II
/ COPPELL TX 75019
1163 Lime Slurry / Bulk 9.449 TON 123.00 1,162.22
Total 09/01/2010 106490584 9.449 1,162.22
2 09/01/2010 106490875 Shipping point: HURST Means of transport: Truck
1163 Lime Slurry / Bulk 8.914 TON 123.00 1,096.42
Total 09/01/2010 106490875 8.914 1,096.42
ITEM SUMMARY: Mat No Description Qty UoM
1163 Lime Slurry 18.363 TON
Sub Total 2,258.64
Tax 0.00
Total Due 2,258.64
Page 1 Of 1
Lhoist North America
Lhoist Group DUPLICATE
Remit To: Invoice
Chemical Lime, Ltd. 1101413733 09/16/2010
5274 Paysphere Circle
CHICAGO , IL - 60674 Billing reference
(800) 365-6724 301983105 09/16/2010
Your PO Number
12671
Sold -to Customer 121521
JRJ PAVING LP
Bill -to: Customer No 121521 ATTN ACCOUNTS PAYABLE
JRJ PAVING LP Contract Number
ATTN ACCOUNTS PAYABLE 0070054075
PO BOX 59934 Payer 121521
DALLAS TX 75229
Payment Terms:
Payment due on or before 10/16
Net Due 30 Days After Invoice
Currency: USD
BOL No Unit
Item Date Ref No Mat No Material Description / Packaging Qty UoM Price Amount Tax
1 09/15/2010 29268 Shipping point: HURST Means of transport: Truck
Ship -to: 208196 / JRJ -10112 BETHEL ROAD II
/ COPPELL TX 75019
1163 Lime Slurry / Bulk 11.766 TON 123.00 1,447.21
Total 09/15/2010 29268 11.766 1,447.21
ITEM SUMMARY: Mat No Description Qty UoM
1163 Lime Slurry 11.766 TON
Sub Total 1,447.21
Tax 0.00
Total Due 1,447.21
Page 1 of 1
Lhoist North America
Lhoist Group DUPLICATE
Remit To: Invoice
Chemical Lime, Ltd. 1101413975 09/20/2010
5274 Paysphere Circle Billing reference
CHICAGO , IL - 60674 301990165 09/20/2010
(800) 365 -6724 Your PO Number
12671
Sold -to Customer 1 215 21
JRJ PAVING LP
Bill -to: Customer No 121521 ATTN ACCOUNTS PAYABLE
JRJ PAVING LP Contract Number
ATTN ACCOUNTS PAYABLE 0070054075
PO BOX 59934 Payer 121521
DALLAS TX 75229
Payment Terms:
Payment due on or before 10/20/2010
Net Due 30 Days After Invoice
Currency: USD
BOL No Unit
Item Date Ref No Mat No Material Description / Packaging Qty UoM Price Amount Tax
1 09/17/2010 106545480 Shipping point: HURST Means of transport: Truck
Ship -to: 208196 / JRJ -10112 BETHEL ROAD II
/ COPPELL TX 75019
1163 Lime Slurry / Bulk 10.541 TON 123.00 1,296.54
Total 09/17/2010 106545480 10.541 1,296.54
2 09/17/2010 106545853 Shipping point: HURST Means of transport: Truck
1163 Lime Slurry / Bulk 10.632 TON 123.00 1,307.75
Total 09/17/2010 106545853 10.632 1,307.75
ITEM SUMMARY: Mat No Description Qty UoM
1163 Lime Slurry 21.173 TON
Sub Total 2,604.29
Tax 0.00
Total Due 2,604.29
Page 1 of 1
Chemical Lime
A Lhoist Group Company
Project Statement of Account
12/15/2010
121521
JRJ PAVING LP
ATTN ACCOUNTS PAYABLE
PO BOX 59934
DALLAS TX 75229
Ship -to: 208196 JRJ -10112 BETHEL ROAD II
Date PK Accountfrng Invoice .. 1 rrionth 2 rnon h 3 ; month 4 month +
Ref +. Ref.
09/06/2010 01 1101413218 301972252 2,258.64
09/16/2010 01 1101413733 301983105 1,447.21
09/20/2010 01 1101413975 301990165 2,604.29
10/04/2010 01 1101414762 302012123 2,316.95
11/11/2010 01 1101416884 302059308 1,276.14
Total balance for the notice period 1,276.14 2,316.95 6,310.14
0.00
i otai y, yU i.1 i
PK Description:
01 Invoice
Remittance Address: Chemical Lime Company
5274 Paysphere Circle
CHICAGO, IL 60674
For questions concerning this
statement, please contact
Alice Barboza at: (817)
806 -1617.
PO Box 985004, Fort Worth, TX 76185 -5004 3700 Hulen Street, Fort Worth, TX 76107
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