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Backup Documents 11/12/2019 Item #16F 7 ORIGINAL DOCUMENTS CHECKLIST & ROUTING SLIP TO ACCOMPANY ALL ORIGINAL DOCUMENTS SENT TO 16 F ? THE BOARD OF COUNTY COMMISSIONERS OFFICE FOR SIGNATURE Print on pink paper. Attach to original document. The completed routing slip and original documents are to be forwarded to the County Attorney Office at the time the item is placed on the ageisda. All completed routing slips and original documents must be received in the County Attorney Office no later than Monday preceding the Board meeting. **NEW** ROUTING SLIP Complete routing lines#1 through#2 as appropriate for additional signatures,dates,and/or information needed. If the document is already complete with the exception of the Chairman's signature,draw a line through routinglines#1 through#2,complete the checklist,and forward to the County Attorney Office. Route to Addressee(s) (List in routing order) Office Initials Date 1. 2. 3. County Attorney Office County Attorney Office SRT 12/09/19 4. BCC Office Board of County Commissioners \�\�/51 \Z\\a\\ 5. Minutes and Records Clerk of Court's Office cr ralg)1141 3:1 -. PRIMARY CONTACT INFORMATION Normally the primary contact is the person who created/prepared the Executive Summary. Primary contact information is needed in the event one of the addressees above,may need to contact staff for additional or missing information. Name of Primary Staff Lisa Jacob/Pelican Bay services Division Contact Information 239-597-17 9 Contact/Department J Agenda Date Item was November 12,2019 Agenda Item Number 16F7 Approved by the BCC 12G3Type of Work Order under Agreement No. 14- Number of Original 1 Document Attached 6213,"Utility Contractors,"for Pelican Bay Documents Attached Lake 2-9 Restoration to Quality Enterprises USA, Inc., in the amount of$682,722.70 PO number or account N/A number if document is to be recorded INSTRUCTIONS & CHECKLIST Initial the Yes column or mark"N/A" in the Not Applicable column, whichever is Yes N/A(Not appropriate. (Initial) Applicable) 1. Does the document require the chairman's original signature STAMP OK SRT 2. Does the document need to be sent to another agency for additional signatures? If yes, SRT provide the Contact Information(Name;Agency; Address; Phone)on an attached sheet. 3. Original document has been signed/initialed for legal sufficiency. (All documents to be SRT signed by the Chairman, with the exception of most letters,must be reviewed and signed by the Office of the County Attorney. 4. All handwritten strike-through and revisions have been initialed by the County Attorney's SRT Office and all other parties except the BCC Chairman and the Clerk to the Board 5. The Chairman's signature line date has been entered as the date of BCC approval of the SRT document or the final negotiated contract date whichever is applicable. 6. "Sign here"tabs are placed on the appropriate pages indicating where the Chairman's SRT signature and initials are required. 7. In most cases(some contracts are an exception),the original document and this routing slip SRT should be provided to the County Attorney Office at the time the item is input into SIRE. Some documents are time sensitive and require forwarding to Tallahassee within a certain time frame or the BCC's actions are nullified. Be aware of your deadlines! 8. The document was approved by the BCC on 11/12/2019 and all changes made during SRT the meeting have been incorporated in the attached document. The County an option for Attorney's Office has reviewed the changes, if applicable. this line. _ 9. Initials of attorney verifying that the attached document is the version approved by the C N/A is not BCC, all changes directed by the BCC have been made, and the document is ready for the an option for Chairman's signature. this„litre,,, 16F7 Ann P. Jennejohn From: Ann P. Jennejohn Sent: Tuesday, December 10, 2019 3:54 PM To: JacobLisa Subject: Item #16F7 (11-12-2019 BCC Meeting) Attachments: Backup Documents 11_12_2019 Item #16F 7.pdf Hi Lisa, A copy of Item #16F7, from the Board's November 12, 2019 Meeting is attached for your records. Thank you! Ann Jennejohn BMR Senior Deputy Clerk „ <<ie Clerk to the Value Adjustment Board Office: 239-252-8406 Fax: 239-252-8408(if applicable) Ann.Jennejohn@CollierClerk.com Office of the Clerk of the Circuit Court &Comptroller of Collier County k •'` 3299 Tamiami Trail,Suite#401 Naples, FL 34112-5324 www.CollierClerk.com 1 16F7 WORK ORDER/PURCHASE ORDER Contract 14-6213 "Utility Contractors" Contract Expiration Date:July 7,2020 This Work Order is for Utility Contractor services for work known as: Project Name: Restoration of Lake 2-9 Project No: 51026.1 The work is specified in the proposal dated October 15, 2019 which is attached hereto and made a part of this Work Order. In accordance with Terms and Conditions of the Agreement referenced above, this Work Order/Purchase Order is assigned to: Quality Enterprises USA,Inc. Scope of Work: As detailed in the attached proposal and the following: * Task I Paving&Grading * Task II Miscellaneous Items * Task III Bid Alternate—Additional Wall Length&Rip Rap Schedule of Work: Complete work within 180 days from the date of the Notice to Proceed which is accompanying this Work Order. The Consultant agrees that any Work Order that extends beyond the expiration date of Agreement#46-3758 will survive and remain subject to the terms and conditions of that Agreement until the completion or termination of this Work Order. Compensation: In accordance with the Agreement referenced above, the County will compensate the Firm in accordance with following method(s): ®Negotiated Lump Sum (NLS) jLump Sum Plus Reimbursable Costs(LS+RC) ❑Time & Material (T&M) (established hourly rate— Schedule A) ❑ Cost Plus Fixed Fee (CPFF), (define which method will be used for which tasks) as provided in the attached proposal. Task I $454,742.32 NLS Task II $142,362.00 NLS Task III $ 85,618.38 NLS TOTAL FEE $682,722.70 PREPARED BY: rtx /]')r( <<ctt•Ii yy /�� // �//�� Mary MLCaughtry, Omat Ons Analyst Date APPROVED BY: /-/I Lisa Jacob, Proje nager Date Page 1 of 2 16F7 By the signature below, the Firm (including employees, officers and/or agents) certifies, and hereby discloses, that,to the best of their knowledge and belief, all relevant facts concerning past,present, or currently planned interest or activity (financial, contractual, organizational, or otherwise) which relates to the proposed work; and bear on whether the Firm has a potential conflict have been fully disclosed. Additionally, the Firm agrees to notify the Procurement Director, in writing within 48 hours of learning of any actual or potential conflict of interest that arises during the Work Order and/or project duration. ACCEPTED BY: Quality Enterprises USA,Inc. /0/%//9 Lour.Gaudio,Vice President Date BOARD OF COUNTY COMMISSIONERS ATT5 ' ' COLLIER COU " ORIDA CPST'A4.K.KWZEL,CLERK $X � jb� ,� • Ce , "•::; - 4".1. ' ' 4 a Ilia ' ' St as S Wil '• L.McDanie,Jr.,Chaim. " 'Sgnar . / ; Approve. .• to f. % egality , N' Sc► tt 'ch,Deputy County Attorney Agend Date 1 � Data �t O—, Recd 1. v .uputy Clerk. 40 Page 2 of 2 I,, 16F7 Co eY County Pelican Bay Services Division REQUEST FOR QUOTATIONS FOR MULTIPLE PROJECTS UNDER CONTRACT#14-6213 "UTILITY CONTRACTORS" Date: 09/30/2019 From: Lisa Jacob, Project Manager 239-438-5239, Telephone Number 239-597-4502, Fax Number Lisa.JacobAcolliercountvfl.gov To: All Awarded Vendors on Contract#14-6213-Utility Contractors Subject: Pelican Bay Lake 2-9 Restoration (Re-Quote with Revised Scope of Work) The Pelican Bay Services Division (PBSD) is soliciting quotes for the referenced project. RFQ Due Date: Tues, October 15, 2019 at 3:00 PM _ Number of Days to Substantial Completion: 120 days from date of NTP Number of Days to Final Completion: 180 days from date of NTP Attached "Pelican Bay Lake 2-9 Restoration Tasks and Specs: Specifications" Your quotation response for this project is due no later than the date and time specified above.We will not accept any quotation responses later than the noted time and date. If your firm is unable to respond electronically, your quotation must be received in the office of the PBSD at the below referenced address no later than the time and date specified.We look forward to your participation in this request for information/quotation process. Quality Enterprises USA. Inc. Firm's Complete Legal Name 239-435-7200 239-435-7202 Telepho N umber • �tuce Vice President Title Louis J. Gaudio 10/15/19 Print Name Date Pelican Bay Services Division 1801 Laurel Oak Drive,Suite 302 I Naples,Florida 34108 I Tel.239-597-1749 Fax 239-597-4502 CAC 1 6 F 7 W , o N < c • vir ,� p z gd w A W N (—,m CT A W N -'-'•1 .-+p CD 09 V CA CA A W N G) m C 7m m d C GI U ns— G� �! ,rri 0. m meg: 3 �Nm ns-43 G)? G) ii m _ f` 000 � g to a .: m ' 078 ° � OW lG�v Op d F F: 33 0�m H o'=,-GIm = �r' F � r + 'E �a aE 0i) ' co0 a- i r z PSC a s z cEia < co r � m a Cr • M'"� i • • g , co 3 a' ^ a a • � g Si t ' 3 c " ' To * w o ki- • 8 o ,. c 26 0 'o Q. a '; co q m J t N a Qs ! r-' N m7+ N q n C a N a C C m 5 N a � , o; y fA a X ' t SR n n S. , i p + ED ! �t 1 ��...I....S -.—jNN CA CA iS f0 W �.' li ED CA t f Oa`b' R7 S. rnNNr ( rrrr;, rrNrRl rr()NNr ' ;.../ T { -<-(— NNNN NNTT TTj-C.((n • • C �fp yt✓y,, +`. MM 4IA of 41903 f»fAM yNtA NiAN D i'- 7 P • NN JW�p CT VC.) N CpQ�JJ O r t ' �� 000 , -- OO ON N 01 r...)co V CO N CT 0�p (D pOV�GVo -_ • p pp pp Gptp pps� p R S A W� t...-1 SOBS • • • C07i O�A win S CO .} Nf NHHIL"' tA I - MMM . y►yfMNfMMMMMHM •H. i iii:g; _ r� J 7 Np V Co p CO N: V��ONan V W O W CT A:1 ?O/COW!trl OAA . OGW 'L-14 p 0 0 p pS pp S O• N+O N R O f.',33 CA EXHIBIT A 16 F 7 PUBLIC PAYMENT BOND Bond No. 9336109 Contract No. 14-6213 KNOW ALL MEN BY THESE PRESENTS: That Quality Enterprises USA, Inc. , as Principal, and Fidelity and Deposit Company of Maryland , as Surety, located at 1299 Zurich Way, Schamburg, IL 60196 /`Business Address) are held and firmly bound to Collier County Board of County Commissioners Six Hundred Eighty Two housand Seven Hundred as Oblige in the sum of r..o„:y r �n..ua.a rni�nn ($682,722.70 ) for the payment whereof we bind ourselves, our heirs, executors, personal representatives, successors and assigns,jointly and severally. WHEREAS, Principal has entered into a contract dated as of the 1st day of November, 2019, with Oblige for Pelican Bay Lake 2-9 Restoration in accordance with drawings and specifications, which contract is incorporated by reference and made a part hereof, and is referred to as the Contract. THE CONDITION OF THIS BOND is that if Principal: Promptly makes payment to all claimants as defined in Section 255.05(1), Florida Statutes, supplying Principal with labor, materials or supplies, used directly or indirectly by Principal in the prosecution of the work provided for in the contract, then this bond is void; otherwise it remains in full force. Any changes in or under the Contract and compliance or noncompliance with any formalities connected with the Contract or the changes do not affect sureties obligation under this Bond. The provisions of this bond are subject to the time limitations of Section 255.0592. In no event will the Surety be liable in the aggregate to claimants for more than the penal sum of this Payment Bond, regardless of the number of suits that may be filed by claimants. IN WITNESS WHEREOF, the above parties have executed this instrument this 1st day of November , 2019 , the name of under-signed representative, pursuant to authority of its governing body. Signed, sealed and delivered in the presence of: PRINCIPAL: / / Quality Enterprises USA, Inc. 7a\r4 1(i 11,,,r - By: Witnesses as tb Principal Name: Louis J. Gaudio Margarita,,Negron Its: Vice President STATE OF Florida COUNTY OF Coll ter The foregoing instrument was acknowledged before me this 1st of November 2019 , by Louis J. Gaudio , as Vice President of Quality Enterprises , a Virginia corporation, on behalf of the corporation. He/she is personally known to me OR has produced N/A - Known as identification and did (did not) take an oath. My Commission Expires: 2/11/22 1,-1 fir ,'Li 1, (Signature of Notary) =o<+�S°`•” , MARCIE L.COHEN .�. :,.' MY COMMISSION#GO 152066 Name: Marcie L. Cohen = ;•��cA: EXPIRES:February 11,2022 (Legibly Printed) -,r,i ,f°• Bonded Thru Notary Public Underwriters (AFFIX OFFICIAL SEAL) Notary Public, State of Florida Commission No.: GG 152066 Page-12- ATTEST: SURETY: 16 F 7 (Printed Name) (Business Address) (Authorized Signature) Witness as to Surety (Printed Name) OR FideIitkInd.Deep st mpany of Maryland _l ✓ r �f t As Attorney in Fa t aniel J. (Attach Power of Attirney) Witnesses Devon C. Heath 1299 Zurich Way Schaumburg, IL 60196 (Business Address) Daniel J. Grygo (Printed Name) 1-847-605-6000 (Telephone Number) STATE OF Virginia Citygi OF Virginia Beach The foregoing instrument was acknowledged before me this 1st day of November 2019 , by Daniel J. Grygo as Attorney-in-Fact of Fidelity and Deposit Company of Maryland , Surety, on behalf of Surety. He/She is personally known to me OR has produced as identification and who did (did not) take an oath. My Commission Expires: September 30, 2022 (Signature of Notary) Name: Terri K. Strawhand (Legibly Printed) (AFFIX OFFICIAL SEAL) Notary Public, State of Virginia TERRI K STRAWHAND Commission No.: 247448 Notary Public Commonwealth of Virginia Reg.#247448 My Commission Expires 9/30/2022 Page-13- EXHIBIT A-2 16 F 7 PUBLIC PERFORMANCE BOND Bond N0. 9336109 Contract No. 14-6213 KNOW ALL MEN BY THESE PRESENTS: That Quality Enterprises USA, Inc. , as Principal, and Fidelity and Deposit Company of Maryland , as Surety, located at 1299 Zurich Way,Schaumburg, IL 60196 (Business Address) are held and firmly bound to Collier County Board of County Commissioners , as Oblige in the sum of Six Hundred Eighty Two Thousand Seven Hundred Twenty Two Dollars and 70/100 ($ 682,722.70 ) for the payment ..whereof we bond ourselves, our heirs, executors, personal representatives, successors and assigns, jointly and severally. WHEREAS, Principal has entered into a contract dated as of the 1st day of November , 2019 , with Oblige for Pelican Bay Lake 2-9 Restoration in accordance with drawings and specifications, which contractor is incorporated by reference and made a pat hereof, and is referred to as the Contract. THE CONDITION OF THIS BOND is that if Principal: 1. Performs the Contract at the times and in the manner prescribed in the Contract, and 2. Pays Oblige any and all losses, damages, costs and attorneys' fees that Oblige sustains because of any default by Principal under the Contract, including, but not limited to, all delay damages, whether liquidated or actual, incurred by Oblige; and 3. Performs the guarantee of all work and materials furnished under the Contract for the time specified in the Contract, then this bond is void; otherwise it remains in full-force. Any changes in or under the Contract and compliance or noncompliance with any formalities connected with the Contract or the changes do not affect Sureties obligation under this bond. The Surety, for value received, hereby stipulates and agrees that no changes, extensions of time, alterations or additions to the terms of the Contract or other work to be performed hereunder, or the specifications referred to therein shall in anywise affect its obligations under this bond, and it does hereby waive notice of any such changes, extensions of time, alternations or additions to the terms of the Contract or to work or to the specifications. ; Page -14- 16F 7 • This instrument shall be construed in all respects as a common law bond. It is expressly understood that the time provisions and statute of limitations under Section 255.05, Florida Statutes, shall not apply to this bond. In no event will the Surety be liable in the aggregate to Oblige for more than the penal sum of this Performance bond regardless of the number of suits that may be filed by Oblige. IN WITNESS WHEREOF, the above parties have executed this instrument this 1st day of November , 2019 , the name of each party being affixed and these presents duly signed by its undersigned representative, pursuant to authority of its governing body. Signed, sealed and delivered in the presence of : PRINCIPAL: Quality Enterprises USA, Inc. Isa C rera s11/7V" Witnesses as to nncipal Name: Louis J. Gaudio Margarita Negion Its: Vice President STATE OF Florida COUNTY OF Collier The foregoing instrument was acknowledged before me this 1st day of Nn,,Pmber 201 9 , by Louis J. Gaudio , as Vi CP Precirient Of Quality Enterprises USA, Inc. , a Virginia corporation, on behalf of the corporation. He/She is personally known to me OR has produced N/A - Known as identification and did (did not) take an oath. �<�P ••. MARCIE L.COHEN (Signature of Notary) MY COMMISSION#GG 152066 Ww,8`: EXPIRES:February 11,2022 Name: Marcie L. Cohen EP°` �' Bonded Thai Notary Public Underwriters (Legibly Printed) (AFFIX OFFICIAL SEAL) Notary Public, State of Florida Commission No.: GG 152066 • Page -15- `l ATTEST: SURETY: 1 6 F 7 (Printed Name) (Business Address) (Authorized Signature) Witness as to Surety (Printed Name) • OR Fidelity ant deposit company of Maryland As Attorney in Fact Danieli Biroygo (Attach Power of Attorney) Witnesses Devon C. Heath 1299 Zurich Way Schaumburg, IL 60196 (Business Address) Daniel J. Grygo (Printed Name) 1-847-605-6000 (Telephone Number) STATE OF Virginia City gotioorwOF Virginia Beach The foregoing instrument was acknowledged before me this 1st day of November , 2019 by Daniel J. Grygo as Attorney-in-Fact of Fidelity and Deposit Company of Maryland , Surety, on behalf of Surety. He/She is personally known to me OR has produced as identification and who did (did not) take an oath. My Commission Expires: September 30,2022 • (Signature of Notary) Name: Terri K. Strawhand (Legibly Printed) (AFFIX OFFICIAL SEAL) Notary Public, State of Virginia TERRI KSTRAWHAND Commission No.: 247448 Notary Public Commonwealth of Virginia Reg.#247448 My Commission Expires 9/30/2022 Page-16- r?�JJ Bond Number 9336109 1 6 F Obligee f o111,Cmmry Board of Count,Commkanncrc ZURICH AMERICAN INSURANCE COMPANY COLONIAL AMERICAN CASUALTY AND SURETY COMPANY FIDELITY AND DEPOSIT COMPANY OF MARYLAND POWER OF ATTORNEY KNOW ALL MEN BY THESE PRESENTS:That the ZURICH AMERICAN INSURANCE COMPANY,a corporation of the State of New York, the COLONIAL AMERICAN CASUALTY AND SURETY COMPANY, a corporation of the State of Illinois, and the FIDELITY AND DEPOSIT COMPANY OF MARYLAND a corporation of the State of Illinois (herein collectively called the "Companies"), by Robert D.Murray,Vice President,in pursuance of authority granted by Article V,Section 8,of the By-Laws of said Companies,which are set forth on the reverse side hereof and are hereby certified to be in full force and effect on the date hereof,do hereby nominate,constitute, and appoint Daniel J.Grygo ,its true and lawful agent and Attorney-in-Fact,to make,execute, seal and deliver,for,and on its behalf as surety,and as its act and deed: any and all bonds and undertakings,and the execution of such bonds or undertakings in pursuance of these presents, shall be as binding upon said Companies, as fully and amply, to all intents and purposes,as if they had been duly executed and acknowledged by the regularly elected officers of the ZURICH AMERICAN INSURANCE COMPANY at its office in New York, New York., the regularly elected officers of the COLONIAL AMERICAN CASUALTY AND SURETY COMPANY at its office in Owings Mills, Maryland., and the regularly elected officers of the FIDELITY AND DEPOSIT COMPANY OF MARYLAND at its office in Owings Mills, Maryland.,in their own proper persons. The said Vice President does hereby certify that the extract set forth on the reverse side hereof is a true copy of Article V,Section 8,of the By-Laws of said Companies,and is now in force. IN WITNESS WHEREOF, the said Vice-President has hereunto subscribed his/her names and affixed the Corporate Seals of the said ZURICH AMERICAN INSURANCE COMPANY, COLONIAL AMERICAN CASUALTY AND SURETY COMPANY, and FIDELITY AND DEPOSIT COMPANY OF MARYLAND,this 19th day of June,A.D.2019. ATTEST: ZURICH AMERICAN INSURANCE COMPANY COLONIAL AMERICAN CASUALTY AND SURETY COMPANY FIDELITY AND DEPOSIT COMPANY OF MARYLAND SEAL By: Robert D.Murray \ N7 Vice President .te 4.6 /j''` / G tom`4 By: Dawn E.Brown acoe ffi Secretary State of Maryland County of Baltimore On this 19th day of June, A.D.2019, before the subscriber,a Notary Public of the State of Maryland,duly commissioned and qualified,Robert D. Murray,Vice President and Dawn E.Brown,Secretary of the Companies,to me personally known to be the individuals and officers described in and who executed the preceding instrument,and acknowledged the execution of same,and being by me duly sworn,deposeth and saith,that he/she is the said officer of the Company aforesaid,and that the seals affixed to the preceding instrument are the Corporate Seals of said Companies,and that the said Corporate Seals and the signature as such officer were duly affixed and subscribed to the said instrument by the authority and direction of the said Corporations. IN TESTIMONY WHEREOF,I have hereunto set my hand and affixed my Official Seal the day and year first above written. '`,1t 'dll77// 1.140 )t Imo.. ¢Anjyr!,•' Constance A.Dunn,Notary Public ;;p ��� My Commission Expires:July 9,2023 EXTRACT FROM BY-LAWS OF THE COMPANIES 1, 6 F 7 "Article V,Section 8,Attorneys-in-Fact. The Chief Executive Officer,the President,or any Executive Vice President or Vice President may, by written instrument under the attested corporate seal, appoint attorneys-in-fact with authority to execute bonds, policies, recognizances, stipulations, undertakings, or other like instruments on behalf of the Company, and may authorize any officer or any such attorney-in-fact to affix the corporate seal thereto;and may with or without cause modify of revoke any such appointment or authority at any time." CERTIFICATE I, the undersigned, Vice President of the ZURICH AMERICAN INSURANCE COMPANY, the COLONIAL AMERICAN CASUALTY AND SURETY COMPANY, and the FIDELITY AND DEPOSIT COMPANY OF MARYLAND,do hereby certify that the foregoing Power of Attorney is still in full force and effect on the date of this certificate;and I do further certify that Article V,Section 8,of the By-Laws of the Companies is still in force. This Power of Attorney and Certificate may be signed by facsimile under and by authority of the following resolution of the Board of Directors of the ZURICH AMERICAN INSURANCE COMPANY at a meeting duly called and held on the 15th day of December 1998. RESOLVED: "That the signature of the President or a Vice President and the attesting signature of a Secretary or an Assistant Secretary and the Seal of the Company may be affixed by facsimile on any Power of Attorney...Any such Power or any certificate thereof bearing such facsimile signature and seal shall be valid and binding on the Company." This Power of Attorney and Certificate may be signed by facsimile under and by authority of the following resolution of the Board of Directors of the COLONIAL AMERICAN CASUALTY AND SURETY COMPANY at a meeting duly called and held on the 5th day of May, 1994, and the following resolution of the Board of Directors of the FIDELITY AND DEPOSIT COMPANY OF MARYLAND at a meeting duly called and held on the 10th day of May, 1990. RESOLVED: "That the facsimile or mechanically reproduced seal of the company and facsimile or mechanically reproduced signature of any Vice-President, Secretary,or Assistant Secretary of the Company,whether made heretofore or hereafter,wherever appearing upon a certified copy of any power of attorney issued by the Company,shall be valid and binding upon the Company with the same force and effect as though manually affixed. IN TESTIMONY WHEREOF,I have hereunto subscribed my name and affixed the corporate seals of the said Companies, this 1st day of November ,20I9 . wo OEioj�� G� 6_ �56 4'. i�� _NV • z .° ' SEAL $tea ger tfi 1 Brian M.Hodges,Vice President TO REPORT A CLAIM WITH REGARD TO A SURETY BOND,PLEASE SUBMIT A COMPLETE DESCRIPTION OF THE CLAIM INCLUDING THE PRINCIPAL ON THE BOND,THE BOND NUMBER,AND YOUR CONTACT INFORMATION TO: Zurich Surety Claims 1299 Zurich Way Schaumburg,IL 60196-1056 www.reportsfclaimsazurichna.com 800-626-4577