MA 06/07-CS090629
~ Liberty,
\fJ Mutual.
CONTRACT PREMIUM
AUDIT REPORT
Liberty Mutual Surety
1001 4th Avenue
Suite 1700
Seattle, WA 98154
WITHOUT PREJUDICING YOUR RIGHT OR AFFECTING OUR LIABILITY FOR BOND(S) DESCRIBED IN PART I, PLEASE
COMPLETE INFORMATION AS AVAILABLE IN PART II AND FAX TO THE SURETY FAX NUMBER LISTED BELOW.
THANK YOU FOR YOUR ASSISTANCE.
DATE 06/29/2009
SERVICE CENTER DALLAS
FAX #
PART 1- BOND INFORMATION.
CONTRACTOR
LAUGHLEY BRIDGE & CONSTRUCTION, INC.
1593 HUNTERGLENN DRIVE
ALEDO TX 76008-2892
Please respond by fa."'-
972-808-4755
Thanks - Rachel
OWNER
CITY OF COPPELL, PURCHASING DEPARTMENT
255 PARKWAY BLVD
COPPELL TX 75019
BOND NUMBER 6421129
Effective Date 06/14/2007
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Corotracl ANNUAL CONCRETE CONTRACT, COPPELL-REINFORCED CONCRETE
Description PAVEMENT REPAIRS.
Contract Price $278,000
BONDS:
Performance $278,000
Payment
PART 11- AUDIT INFORMATION
1. IF CONTRACT COMPLETED PLEASE PROVIDE THE FOLLOWING INFORMATION:
a. Approximate completion date and/or acceptance date ...............................................
b. Final contract price ........................................................................... $
c. Sales tax .................................................................................... $
d. Total contract price ........................................................................... $
2. IF CONTRACT UNCOMPLETED PLEASE PROVIDE THE FOLLOWING INFORMATION:
a. Probable completion date ......................................................................
b. Approximate percentage or dollar amount of contract completed or delivered . . . . . . . . . . . . . . . . . . . . . . . . . . . .
3.
ARE THERE ANY CLAIMS, ASSIGNMENTS, STOP NOTICES, OR LIENS ON FILE?
YES
NO
4. REMARKS:
Date
1/1 j09
.. ,
~/U1
Signature ~
6/:2/& f
Title~W
S-3273/FN 8/04
135-3
IFD