TexasBank 2R-CS051128COPPELL
November 28, 2005
Stephen Siegfried
Project Solutions Group
550 Hemdon Pkwy, Suite 500
Hemdon VA 20170
TexasBank Addition, Lot 2R Block A
Cr6me de la Cr~me
Final Acceptance
Dear Mr. Siegfried:
Representatives of the City of Coppell have confirmed a final inspection of paving and utilities for
the referenced project. The two-year maintenance bonds and as-built drawings have been received
from the contractor. Maturity on the bonds will be two years from the date of this letter.
You may notify the MS4 (City of Coppell) at any time during the two-year maintenance period if
stabilization of the site per the SWPPP permit can be demonstrated. If so, complete and submit a
Notice of Termination (NOT) to discontinue coverage under the SWPPP permit.
A follow-up inspection of the facilities will be conducted prior to the lapse of the two-year bond
period. If any punchlist items are noted at that time, you will be contacted to make repairs. Thanks
for your cooperation.
Sincerely,
Rick O'Dell
Construction Inspector
Keith Marvin, P.E.
Assistant City Engineer
Office Phone: (972) 304-7090
Fax: (972) 304-3570
Ken Griffin, P.E., Director of Engineering & Public Works
Glenn Hollowell, P.E., Asst. Director of Public Works
Greg Jones, Chief Building Official
Tim Oates, Interim Fire Chief
255 PARKWAY ~ PO.BOX 9478 ~ COPPeLL TX 75019 ~A TEL 972//~62 0022 ~r FAX 972/304 3673
~--..
MAINTENANCE BOND
Bond No. S-903 4089
KNOW ALL MEN BY THESE PRESENTS, That we, North Texas Bomanite, Inc., 11107 Morrison Lane,
Dallas, TX 75229-5608
(hereinafter called the .Principalj as Principal, and the
organized under the laws of the State of Arizona
, a corporation duly
and duly licensed to transact business in the
Washine:ton International Insurance COmDany
State of
Texas
(hereinafter called the .Surety"), as Surety are held and firmly bound unto
City of Coppell, 255 Parkway Blvd., Coppell, TX
(hereinafter called the .Obligee-), in the
sum of Two Thousand Eight Hundred Twenty-Five And No/100ths - - - - - - - - - - - --
($ 2,825.00 ) for the payment of which are well and truly to be made, we, the said Principal and the
said Surety, bind ourselves, our heirs, executors, administrators, successors and assigns, jointly and
severally, firmly by these presents.
Signed and sealed this 20th day of
October
,_z~
THE CONDITION OF THIS OBLIGATION is such, that WHEREAS, the said Principal has heretofore
entered into a contract with Workman Commercial Construction Services, Ltd. dated
Four Inch Integral Colored, Stamped Median Pavement & Seal for Creme de la Creme,
June 1,2005 ,for COD Dell, Texas
WHEREAS, the obligee has requested that said work be guaranteed against failure because of defective
workmanship or material, performed or fumished by said principal for a period of 2 years from date of
completion and acceptance, normal wear and tear excepted.
NOW THEREFORE, if the said Principal shall indemnify and save harmless the obligee against loss or
damage occasioned directly by the failure of said materials or workmanship, then this obligation to be void,
otherwise to remain in full force and effect. It is understood, however, that this bond shall not include loss or
damage by failure of workmanship or materials due to hurricane, cyclone, tornado, earthquake, volcanic
eruption or any similar disturbance of nature, nor military, naval or usurped power, insurrection, riot or civil
commotion, nor any act of God.
It is further understood and agreed that the total liability of the surety under this bond shall in no event
exceed the sum of Two Thousand Eight Hundred Twenty-Five And No/100ths - - - - - - - - - - --
Dollars.
No right of action shall accrue upon or by reason of this obligation, to or for the use or benefit of any person,
firm or corporation, other than the obligee herein named.
North Texas Bomanite, Inc.
Principal
By: _.~. (',
"5<.~ii J. ~_l~
Washington International Insurance Company
Surety
)
, Pr~~;.J~
By:
~k6~4
Patricia Lee Bartlett Attomey-in-Fact
~
POLICYHOLDER DISCLOSURE
NOTICE OF TERRORISM INSURANCE COVERAGE
ENDORSEMENT
Coverage for acts of terrorism as defined in S 102(1) of the Terrorism Risk Insurance
Act of 2002 (lithe Act") is already included in this surety bond. You should know that,
effective November 26, 2002, under your existing coverage, any losses caused by
certified acts of terrorism would be partially reimbursed by the United States under a
formula established by federal law. Under this formula, the United States pays 90%
of covered terrorism losses exceeding the statutorily established deductible paid by
the insurance company providing the coverage. The portion of your annual premium
that is attributable to coverage for acts of terrorism is ~
As your insurance/surety company we are sending you this notice to comply with the Terrorism Risk
Insurance Act of 2002.
For questions regarding this notice please visit our website www.nassuretV.com or you may call our
office at 630- 227- 4825.
REV: 2/03 agent notice
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NAS SURETY GROUP
NORTH AMERICAN SPECIALTY INSURANCE COMPANY
WASHINGTON INTERNATIONAL INSURANCE CaMP ANY
GENERAL POWER OF ATTORNEY
KNOW ALL MEN BY THESE PRESENTS, THAT North American Specialty Insurance Company, a corporation duly organized and existing under
laws of the State of New Hampshire, and having its principal office in the City of Manchester, New Hampshire, and Washington International
Insurance Company, a corporation organized and existing under the laws of the State of Arizona and having its principal office in the City of ltasca,
Illinois, each does hercby make, constitute and appoint:
SAMMY JOE MULLIS, JR., JOHN WILLIAM NEWBY, ROBERT DONALD HURST,
PATRICIA LEE BARTLETT, JULIE STORM, WILBERT RAYMOND WATSON,
CAROLYN J. GOODENOUGH and KR YST AL LEA WEBER, jointly or severally
Its true and lawful Attorney(s)-in-Fact, to make, execute, seal and deliver, for and on its behalf and as its act and deed, bonds 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 cxceed the
amount of:
TEN MILLION (10,000,000.00) DOLLARS
This Power of Attorney is granted and is signed by facsimile under and by the authority of the following Rcsolutions adopted by the Boards of
Directors of both North American Specialty Insurance Company and Washington International Insurance Company at mectings duly called and held
on the 24th of March, 2000:
"RESOLVED, that any two of the President, any Executive Vice President, any Vice President, any Assistant Vice President, the Secretary or any
Assistant Secretary be, and each or any of them hereby is authorized to execute a Powcr of Attorney qualifying the attorney named in the given Power
of Attorney to execute on behalf ofthe Company bonds, undertakings and all contracts of surety, and that each or any of them hercby is authorized to
attest to the execution of any such Power of Attorney and to attach therein the seal of the Company; and it is
FURTHER RESOLVED, that the signature of such officers and the seal of the Company 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 Company when so affixed and in the future with regard to any bond, undertaking or contract of surety to which it is attached."
~\,,,\\UIIIIJI1"II" A"? "\ ~~ ""~";;'tOiAl"""""
~~t.~.!!.~~~ By ~- ~ 0 . - ",~~'I"'J'';'"
~"fP1'~'f:"'{,,~ ~ I~. '~"..
l!/ SEAL ~"~~ !~\CORPORATE\~\
_ . .0- raul D. Amstutz, Prrsldeat &: Chid EXK'utive omcer of WashiDgton loter...tlonaIIDsurance Compa.y '" i .... I -
i~\~ 11173 ",j~~ V1<<l'residentorNorthAmerlcaaSpedaltylnsu..n<<Company \: SEAL /gl
\~~~,. #.~o~ tM2- '!j,"'~...OOOIIA./~i
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~"'llln:I;n\'\\\\*~ "" ~~'.."'"tr~",',..,.........
By
Sleven P. ADdenoll, ~xKulin Vice Pmiden. of Washington InlernalionallDsuraDu Company tit
Vice PresideDI of North Ameriup Specialty Insurance Company
IN WITNESS WHEREOF, North American Specialty Insurance Company and Washington International Insurance Company have caused their
official seals to be hereunto affixed, and these presents to be signed by their authorized officers this ~day of November , 20~.
North American Specialty Insurance Company
Washington International Insurance Company
State of l11inois
County of Du Page
ss:
On this ---.!2... day of November ,20..2i.., before me, a Notary Public personally appeared Paul D. Amstutz , President and CEO of
Washington International Insurance Company and Vice President of North American Specialty Insurance Company and Steven P. Anderson
Executive Vice President of Washington International Insurance Company and Vice President of North American Specialty Insurance Company,
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 their respective companies.
--
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JIIOWIIW' "'*'C ...,. OJ IU....
",,~.............
~ c2- ;::Y'~
Yasmin A. Patel, Notary Public
I, James A. CarPenter ,the duly elected Assistant Secretary of North American Specialty Insurance Company and Washington
International Insurance Company, do hereby certify that the above and foregoing is a true and correct copy of a Power of Attorney given by said North
American Specialty Insurance Company and Washington International Insurance Company, which is still in full force and effect.
IN WITNESS WHEREOF, I have set my hand and affixed the seals of the Companies this 20th day of October
,2005 .
~'#/5~
James A.. Carpenter, Vice PrcshJcnt & Assistant Sccn:tary of Washington Intcmationallnsurance Company &
Assistanl Secretary of North American Specialty Insurance Company
~
IMPORTANT NOTICE
In order to Obtain Information or Make a Complaint:
You may call Washington International Insurance Company and/or North
American Specialty Insurance Company at the following toll-free number:
800/338-0753
or
You may write to them at the following address:
Washington International Insurance Company
NAS Surety Group
1200 Arlington Heights Road #400
Itasca, n.. 60143
You may also contact the Texas Department of Insurance to obtain information on
companies, coverages) rights or complaints at:
800/252-3439
You may write the Texas Department of Insurance at the following address:
POBox 149104
Austin, TX 78714-9104
;/
I.C.W. GROUP
~INSURANCE COMPANY OF THE WEST
[JEXPLORERINSURANCECOMPANY
~ INDEPENDENCE CASUALTY AND SURETY COMPANY
11455 EL CAMINO REAL * SAN DIEGO, CA 92130-2045
P.O. BOX 85563, SAN DIEGO, CA 92186-5563 (858) 350-2400 FAX (858) 350-2707
MAINTENANCE BOND
BOND NO. 2164993
KNOW ALL MEN BY THESE PRESENTS, That we, KCK Utility Construction. Inc.. 202 West Main Street. Suite 100. Allen.
TX 75013, as Principal, and Independence Casualty and Surety Company and Insurance Company of the West, a
Corporation organized under the laws of the States of Texas and California and duly authorized to do business in the State of
Texas, as Surety, are held and firmly bound unto City of Coppell. 500 Southwestern Blvd.. Coppell. TX 75019, as Obligee, in
the penal sum of *Fifty-Six Thousand. Seven Hundred Seventy-Three and 95/100* ($*56.773.95*), to which payment well and
truly to be made we do bind ourselves, our heirs, executors, administrators, successors and assigns jointly and severally, firmly
by these presents.
WHEREAS, the said Principal has caused to be constructed the Water. Sanitary Sewer and Drainae:e for Creme DeLa Creme.
Coppell. Texas
WHEREAS, said Obligee requires that the Principal furnish a bond conditioned to guarantee for the period of two (2) year(s)
after approval of the final estimate on said job, by the owner, against all defects in workmanship and materials which may
become apparent during said project, and
WHEREAS, the said contract has been completed, and was approved on the _ day of
, 2005.
NOW, THEREFORE, THE CONDITION OF THIS OBLIGATION IS SUCH that, if the Principal shall indemnify the
Obligee for all loss that the Obligee may sustain by reason of any defective materials or workmanship which become apparent
during the period of two (2) year(s) from and after date of final acceptance, then this obligation shall be void, otherwise to
remain in full force and effect.
SIGNED, SEALED AND DATED this 20th day of October, 2005.
KCK Utility Construction. Inc.
Principal
i\SUAL TY AND SURETY COMPANY
PANY OF THE WEST
Surety
TERRORISM COVERAGE DISCLOSURE
The Terrorism Risk Insurance Act of 2002 (the "Act") establishes a program under which
the Federal Government will share in the payment of covered losses caused by certain
acts of international terrorism. Weare providing you with this notice to inform you of
the key features of the Act, and to let you now what effect, if any, the Act will have on
the premium.
Under the Act, insurers are required to provide coverage for certain losses caused by
international acts of terrorism as defined in the Act. The Act further provides that the
Federal Government will pay a share of such losses. Specifically, the Federal
Government will pay 90% of the amount of covered losses caused by certain acts of
terrorism that is in excess of the statutorily established deductible for that year. The Act
also caps the amount of terrorism-related losses for which the Federal Government or an
insurer can be responsible at $100,000,000,000.00, provided that the insurer has met its
deductible.
Please note that passage of the Act does not result in any change in coverage under the
attached policy or bond (or the policy or bond being quoted). Please also note that no
separate additional premium charge has been made for the terrorism coverage required by
the Act. The premium charge that is allocable to such coverage is inseparable from and
imbedded in the overall premium.
.......
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~ ,-'
..........
No. 0004738
ICW GROUP
Power of Attorney
Insurance Company of the West
The Explorer Insurance Company Independence Casualty and Surety Company
KNOW ALL MEN BY THESE PRESENTS: That Insurance Company of the West, a Corporation duly organized under the laws of the State of California, The
Explorer Insurance Company, a Corporation duly organized under the laws of the State of Arizona, and Independence Casualty and Surety Company, a Corporation
duly organized under the laws of the State of Texas, (collectively referred to as the "Companies"), do hereby appoint
JOHN A. MILLER, SR., JOHN A. MILLER, II, SHERYL A. KLUTTS, K. R. HARVEY, JOHN R. STOCKTON
their true and lawful Attorney(s)-in-Fact with authority to date, execute, sign, seal, and deliver on behalf of the Companies, fidelity and surety bonds, undertakings,
and other similar contracts of suretyship, and any related documents.
INSURANCE COMPANY OF THE WEST
THE EXPLORER INSURANCE COMPANY
INDEPENDENCE CASUALTY AND SURETY
COMPANY
John H. Craig, Assistant Secretary
John L. Hannum, Executive Vice President
State of California
County of San Diego
On December 5,2003, before me, Mary Cobb, Notary Public, personally appeared John L. Hannum and John H. Craig, personally known to me to be
the persons whose names are subscribed to the within instrument, and acknowledged to me that they executed the same in their authorized capacities, and that by
their signatures on the instrument, the entity upon behalf of which the persons acted, executed the instrument.
} ss.
Witness my hand and official seal.
I@......MARYCOBB I
,... .....y . COMM.#1321341
0,. NOTARYPUBUC-CAllfORNIA fJ
en ~.. SAN OlEGO COUNTY 0
(.), My CommissIOn Expires ...
I . .. S:PTEMBER 20. 2005 ,
~Cd-6h
Mary Cobb, Notary Public
RESOLUTIONS
This Power of Attorney is granted and is signed, sealed and notarized with facsimile signatures and seals under authority of the following resolutions adopted by
the respecti ve Boards of Directors of each of the Companies:
"RESOL VED: That the President, an Executive or Senior Vice President of the Company, together with the Secretary or any Assistant
Secretary, are hereby authorized to execute Powers of Attorney appointing the person(s) named as Attorney(s)-in-Fact to date, execute, sign,
seal, and deliver on behalf of the Company, fidelity and surety bonds, undertakings, and other similar contracts of suretyship, and any related
documents.
RESOL VED FURTHER: That the signatures of the officers making the appointment, and the signature of any officer certifying the validity
and current status of the appointment, may be facsimile representations of those signatures; and the signature and seal of any notary, and the
seal of the Company, may be facsimile representations of those signatures and seals, and such facsimile representations shall have the same
force and effect as if manually affixed. The facsimile representations referred to herein may be affixed by stamping, printing, typing, or
photocopying. "
CERTIFICATE
I, the undersigned, Assistant Secretary of Insurance Company of the West, The Explorer Insurance Company, and hldependence Casualty and Surety Company, do
hereby certify that the foregoing Power of Attorney is in ii.lll force and effect, and s not been revoked, and that the above resolutions were duly adopted by the
respective Boards of Directors of the Companies, and are nO~lll force.
IN WITNESS WHEREOF, I have set my hand this ~ ClZfJ.. day of ,dtJ(} <)-:-
John H. Craig, Assistant Secretary
To verify the authenticity of this Power of Attorney you may call 1-800-877-] I J] and ask for the Surety Division. Please refer to the Power of Attorney Number,
the above named individual(s) and details of the bond to which the power is attached. For infOlmation or filing claims, please contact Surety Claims, ICW Group,
1]455 EI Camino Real, San Diego, CA 92130-2045 or call (858) 350-2400.
~
Bond No. 089336
MAINTENANCE BOND
STATE OF TEXAS }
COUNTY OF DALLAS }
KNOW ALL MEN BY THESE PRESENTS: THAT Workman Commercial Construction
Services. Ltd. Bv: Workman Interests LLC GenAral PartnAr
as Principal,
, a corporation organized
and Carolina Casualtv Insurance Company
under the laws of Florida
, as sureties,
do hereby expressly acknowledge themselves to be held and bound to pay unto the
City of Coppell a Municipal Corporation, Texas, the sum of
Cents ($ 15 000 00---
Dollars and
) , for the payment of which sum
Fifteen Thousand and no/100-------
will and truly be made unto said City of CoppAII , and its successors, said
principal and sureties do hereby bind themselves, their assigns and successors jointly and
severally.
TIllS obligation is conditioned; however, that whereas I
the said
Workman Commercial Construction Service!; I tei Ay' Workman IntArA!;!!; I I r. f.:l'mAral Partnl'>r
has this day entered into a written contract with the said
CaDDell Creme de la Creme. L.P. to build and construct
Cappell Creme de la Creme, Lat 2R, Block-A
which contract and the plans and specifications therein mentioned, adopted by the
CaDDell Creme de la Creme. L.P. are hereby expressly made a part thereof as through the same
were written aI.}d embodied herein.
WHEREAS, under the plans, specifications, and contract, it is provided that the
Contractor will maintain and keep in good repair, the work herein contracted to be done and
performed, for a period of two (2) years from the date of the acceptance of said work, and to do
all necessary repairs and/or reconstruction in whole or in part of said improvements that should
be occasioned by settlement of foundation, defective workmanship or materials furnished in the
construction or any part thereof or any of the accessories thereto constructed by the Contractor.
It being understood that the purpose of this section is to cover all defective conditions arising by
reason of defective material and charge the same against the said Contractor, and sureties on this
obligation, and the said Contractor and sureties hereon shall be subject to the liquidation damages
mentioned in said contract for each day's failure on its' part to comply with the terms of said
Maintenance Bond
Page 1 of2
provisions of said contract. Now, therefore, if the said Contractor shall keep and perfonn its I
said agreement to maintain said work and keep the same in repair for the said maintenance period
of two (2) years, as provided, then these presents shall be null and void, and have not further
effect, but if default shall be made by the said Contractor in the performance of its' contract to so
maintain and repair said work, then these presents shall have full force and effect, and said
City of Coppell shall have and receive from the said Contractor and its I principal
and sureties damages in the premises, as provided; and it is further agreed that this obligation
shall be a continuing one against the principal and sureties, hereon, and that successive recoveries
may be and had hereon for successive branches until the full amount shall have been exhausted;
and it is further understood that the obligation herein to maintain said work shall continue
throughout said maintenance period, and the same shall not be changed, diminished or in any
manner affected from any cause during said time.
Workman Commerical Construction Services, Ltd.
IN WITNESS WHEREOF, the said By: Workman Interests, LLC General Partner has
caused these presents to be executed by '1;,-,,,,,,,"~. ~cL
and the said Carolina Casual:tv Insurance Comoanv has caused these presents to
be executed by its Attorney in fact and the said Attorney in fact
Williilm n Rilldwin , has hereunto set his hand, the :>7'" day of
()('tnhAf
,20 0<;
PRINCIPAL
SURETY
Workman Commerical Construction Services, Ltd.
:::wo~~' ~~""
lJ~l~ 9vf~~ b-e^^~ - Dl= LA.J
Carolina Casual;ty Insurance Company
By: ~"'--
Title:
Title: William D. Baldwin, Attorney-in-Fact
WITNESS:
\111~hr, J\ (W\rn()f)
\
A4
( [
f~
NOTE: Date of Maintenance Bond must not be prior to date of Contract.
Maintenance Bond
Page 2 of2
.- POWER OF ATTORNEY
CAR~LJINA CASUALTY INSURANCE COMPANy
JACKSONVILLE, FLORIDA
No. 294
KNOW ALL MEN BY THESE PRESENTS: that CAROLINA CASUALTY INSURANCE COMPANY ("Company") a corporation duly
organized and existing under the laws of the State of Florida, having its principal office in Jacksonville, Florida, has made, constituted and
appointed, and does by these presents make, constitute and appoint: William D. Baldwin, Michael B. Hill, Glenn E. Ganci, Brady Cox, Cindy
Fowler of Baldwin Insurance & Bonding Agency, Inc. of Richardson, TX
its true and lawful Agent and Attorney-in-Fact, with the power and authority hereby conferred in its name, place and stead, to execute, seal,
acknowledge and deliver: any and all bonds and undertakings providing that no single obligation shall exceed Fifteen Million and 00/1 00 Dollars
($15,000,000.00)
and to bind the Company thereby as fully and 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.
This Power of Attorney is granted pursuant to the Minutes of the Special Meeting of the Board of Directors of Carolina Casualty Insurance Company
held on March 30, 1966, to wit:
RESOLVED: "That the following Officers of the Carolina Casualty Insurance Company, Chairman of the Board, President, Secretary and
Treasurer, or either of them, are hereby authorized to execute on behalf of Carolina Casualty Insurance Company, Powers of Attorney
authorizing and qualifying the Attorney-in-Fact named therein to execute bonds on behalf of the Carolina Casualty Insurance Company,
and further, that the said Officers of the Company mentioned, are hereby authorized to affix the corporate seal of the said Company to
Powers of Attorney executed pursuant hereto".
RESOLVED FURTHER, this Power of Attorney limits the acts of those named therein to the bonds and undertakings specifically named therein,
aria they have no authority to bind the company except in the manner and to the extent therein stated.
: i ~ -' ' t '-'
RESOLVED FURTHER, this Power of Attorney revokes all previous powers issued in behalf of the Attorney-in-Fact named above.
RESOLVED FURTHER, that the signature of any authorized officer and the seal of the Company may be affixed by facsimile to any power of
attorney or certification thereof authorizing the execution and delivery of any bond, undertaking, recognizance, or other suretyship obligations of the
Company; and such signature and seal when so used shall have the same force and effect as 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,
ri~twithstanding the fact that they may have ceased to be such at the time when such instruments shall be issued.
~ WITNESS WHEREOF the Carolina Casualty Insurance Company has caused these presents to be signed and attested by its appropriate officers
i~.1 its corporate seal hereunto affixed this l1f-h day of ~ppf-pmhPr , 2003.
:;~~
. Betty . utherland
Vice President and Secretary
Carolina sualty Insurance Company
By:
Armin W. Blumberg
President and Chief Executive Office
t--
~L
\V~~ING:
:1 .~~ -\.. .
l". ,
'.,',",,'
-, ,\.,
THIS POWER OF A TTORNEY INVALID IF NOT PRINTED ON GREEN "MONITOR" SECURITY PAPER.
STATE OF FLORIDA)
88
1..,',
COUNTY OF DUVAL)
On this -5th... day of SE>..pf-pffihPr , 2003, before me personally came Betty C. Sutherland to me known, who, being by me duly
sWorn, did depose and say: that she is Secretary of Carolina Casualty Insurance Company, the Corporation described in and which executed the
above instrument; and thaebc/she knows the seal of said Corporation; that the seal affixed to the said instrument is such corporate seal; that it was so
affixed by order of the Board of Directors of said Corporation and th~he signed hislher name thereto by like order.
IN WITNESS WHEREOF, I have hereunto set my hand ad affixed my official seal; the day and
ZMUS
arARY PUBUC E OF FLORIDA
CERTIFICATE COMMISSION NO. DD15]613
. . MY COMMISSIO.l)l EXP. SEPj" 22,.2006.
I, the undersigned, Secretary of CAROLINA CASUALTY INSURANCE COMPANY, DO HEREBY C at thefO'fl!gl1trrg-Is"1r'Jtfst, true,
correct and complete copy of original Power of Attorney; that the said Power of Attorney has not been revoked or rescinded and that the authority of
the Attorney-in-Fact set forth therein, who executed the bond to which this Power of Attorney is attached, is in full force and effect as of this date.
Given under my hand and the seal of the Company, this 27th day of October 2005
c ':
r-
IMPORTANT NOTICE
TO OBTAIN INFORMATION OR TO MAKE A COMPLAINT
You may contact the Texas Department of Insurance 10 obtain information on companies,
coverages, rights or complaints at
1-800- 252-3439
You may write the Texas Department ofInsurance:
P.o. Box 149104
Austin. Texas 78714-9104
FAX No. (512) 475-1771
PREMIUM OR CLAIM DISPUTES
Should you have a dispute concerning your premium or about a claim, you should contact
the company first. 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 docs not become a part or condition of the
attached document.