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HomeMy WebLinkAboutC2009-529 - 12/8/2009 - NA/a A r // 2009-529 12/08/09 l2CM Constructors F O R M S O F CONTRAC TS & B O N D S =t ,~` _-~' F O R DEPARTMENT OF ENGINEERING SERVICES CITY OF CORPUS CHRISTI, TEXAS Phone: 361/880-3500 -Fax: 3'61/880-3501 12/8/2009 PROJECT NOc E09011 A G R E E M E N T TSE STATE OF TEXAS ~ COUNTY OF NUECES § THIS AGREEMENT is entered into this 8th day of DECEr~ER, 2009, by and between the CITY OF CORPUS CHRISTI of the County of Nueces, State of Texas, acting through its duly authorized City Manager, termed in the Contract Documents as "City," and RCM Constructors, Inc. termed in the Contract Documents as "Contractor," upon these terms, performable in Nueces County, Texas: In consideration of the payment of $287,527.50 by City and other obligations of City as set out herein, Contractor will construct and complete certain improvements described as follows: MANHOLE RING & COVER ADJUSTMENT FY 2010 PROJECT NO. E09011 (FINAL RENEWAL PROJECT N0.7396) (TOTAL AMOUNT: $287,527.50) according to the attached Plans and Specifications in a good and workmanlike manner for the prices and conditions set out in their attached bid proposal supplying at their expense such materials, services, labor and insurance as required by the attached Contract Documents, including overseeing the entire job. The Contract Documents include this Agreement, the bid proposal and instructions, plans and specifications, including all maps, plats, blueprints, and other drawings, the Performance and Payment bonds, addenda, and related documents all of which constitute the contract for this project and are made a part hereof. Agreement Page 1 of 2 The Contractor will commence work within ten (10) calendar days from date they receive written work order and will complete same within a period NOT TO EXCEED ONE YEAR after construction is begun. Should Contractor default, Contractor may be liable for liquidated damages as set forth in the Contract Documents. City will pay Contractor in current funds for performance of the contract in accordance with the Contract Documents as the work progresses. Signed in 4 parts at Corpus Christi, Texas on the date shown above. ATTES City Secretary CITY OF RPUS C STI By: ~~ Juan Perales,:~ r., P.E., Assistant City Manager Engineering/Development Services APPRO AS TO FO By ~ ~~'~, Asst. City Attor y ~vrr.):: %~~~ -1 ~3e~1 ow 3 ;, . .~ ,. ._, If Pers9A siq~iag::for c ,lion ss scot Pr~sideat; a copy of suthorfzatiosr- . `~1 B c,~'`~ Y' Pete Anaya, P.E. Director of Engineering Services CONTRACTOR RCM Cons ructors Inc. By: ~ 1~... Title:~Yr°S~•1*~ P.O. BOX 9338 (Address) CORPUS CHRISTI, TX 78469 (City) (State)(ZIP) 361/299-1191 * 361/299-1201 (Phone) (Fax) Agreement Page 2 of 2 P E R F O R M A N C E B O N D s BOND NO. 58650278 STATE OF TEXAS § '` Rr10W ALL BY THESE PRESENTS: COUNTY OF NUECES § THAT RCM Constructors, Inc. of NUECE3 County, Texas, hereinafter called "Principal", and WESTERN SURETY COMPANY a corporation organized under the laws of the State of souTx DAKOTA , and duly authorized to do business in the State of Texas, hereinafter called "Surety", are held and firmly bound unto the City of Corpus Christi, a municipal corporation of Nueces County, Texas, hereinafter called "City", in the penal sum of TWO HUNDRED EIGHTY-SEVEN THOUSAND, FIVE HUNDRED TWENTY-SEVEN AND 50/100($287,527.50) DOLLARS, lawful money of the United States, to be paid in Nueces County, Texas, for the payment of which sum well and truly to be made we bind ourselves, our heirs, executors, administrators and successors, jointly and severally, firmly by these presents: THE CONDITION OF THIS OBLIGATION IS SUCB THAT: Whereas, the principal entered into a certain contract with the City of Corpus Christi, dated the 8TH of DECEt~ER 20 09 a copy of which is hereto attached and made a part hereof, for the construction of: MANHOLE RING ~ COVER ADJITSTMLNT FY 2010 PROJECT NO. E09011 (FINAL RENEWAL PROJECT N0.7396) (TOTAL AMOUNT: $287,527.50) -= NOW, THEREFORE, if the principal shall faithfully perform said work in accordance with the plans, specifications and contract documents, including any changes, extensions, or guaranties, and if the principal shall repair and/or replace all defects due to faulty materials and/or workmanship that appear within a period of one (1) year from the date of completion and acceptance of improvements by the City, then this obligation shall be void; otherwise to remain in full force and effect. PROVIDED FURTHER, that if any legal action be filed on this bond, venue shall lie in Nueces County, Texas. And that said surety for value received hereby stipulates that no change, extension of time, alteration or addition to the terms of the contract, or to the work performed thereunder, or the plans, specifications, drawings, etc., accompanying the same shall in anywise affect its obligation on this bond, and it does hereby waive notice of any such change, extension of time, alteration or Performance Bond Page 1 of 2 This bond is given to meet the requirements of Article 5160, ' Vernon's Civil Statutes of Texas, and other applicable statutes of the State of Texas. The undersigned agent is hereby designated by the Surety herein as the Agent Resident in Nueces County to whom any requisite notices may be delivered and on whom service of process may be had in matters arising out of such suretyship, as provided by Art. 7.19-1, Vernon's Texas Insurance Code. IN WITNESS WHEREOF, this instrument is executed in 4 copies, each one of which shall be deemed an original, this the 31sT day O f DECEMBER ~ 2 Q 09 PRINCIPAL RCM CONSTRJ,ICTORS, INC. By: ROLANDO MENDOZA, PRESIDENT (Print Name & Title) ATTEST Secretary CHARLES WEBB (Print Name) SURETY WESTERN SURETY COMPANY By: Attorney -fact MARY ELLEN MOORE (Print Name) ' °~,F,,,~w~~# . ~~ a , ~ Stt~M-~-.: ~eaea Eo~t~*~ Ta~c~ea fc~r.,: ,- ~£ p~'' df notice and az~a~ of prma~e~a .aC,~; ~, Ag@ACy: Contact Person: Address: Phone Number: SWANTNER & GORDON IPdSURANCE AGENCY MARY ELLEN MOORE P.O. BOX 870 CORPUS CHRISTI, TEXAS 78403 361-883-1711 (NOTE: Date of Performance Bond must not be prior to date of contract)(Revised 9/02) Performance Bond Page 2 of 2 P A Y M E N T B O N D BOND NO. 58650278 STATE OF TEXAS ~ COUNTY OF NUECES § ~iOW ALL BY THESE PRESENTS: THAT RCM Constructors, Inc. of NUECES County, Texas, hereinafter called "Principal", and wFSmFRN srrRFmv ~oMpANV a corporation organized under the laws of the State of souTx DAKOTA and duly authorized to do business in the State of Texas, hereinafter called "Surety", are held and firmly bound unto the City of Corpus Christi, a municipal corporation of Nueces County, Texas, hereinafter called "City", and unto all persons, firms and corporations supplying labor and materials in prosecution of the work referred to in the attached contract, in the penal sum of TWO HUNDRED EIGHTY-SEVEN THOUSAND, FIVE HUNDRED TWENTY-SEVEN__AND 50/100($287,527.50) DOLLARS, lawful money of the United States, to be paid in Nueces County, Texas, for the payment of which sum well and truly to be made we bind ourselves, our heirs, executors, administrators and successors, jointly and severally, firmly by these presents: THE CONDITION OF THIS OBLIGATION I3 SUCH THAT: Whereas, the principal entered into a certain contract with the City of Corpus Christi, dated the 8TH day DECEMBER 20 09 , a copy of which is hereto attached and made a part hereof, for the construction of: MANHOLE RING ~ COVER ADJUSTMENT FY 2010 PROJECT NO. E09011 ~+ (FINAL RENEWAL PROJECT N0.7396) (TOTAL AMOUNT: $287,527.50) NOW, THEREFORE, if the principal shall faithfully perform its duties and make prompt payment to all persons, firms, subcontractors, corporations and claimants supplying labor and material in the prosecution of the work provided for in said contract and any and all duly authorized modification of said contract that may hereinafter be made, notice of which modification to the surety is hereby expressly waived, then this obligation shall be void; otherwise to remain in full force and effect. PROVIDED FURTHER, that if any legal action be filed upon this bond, venue shall lie in Nueces County, Texas. ''~ And that said surety for value received hereby stipulates that no change, extension of time, alteration or addition to the terms of the contract, or to the work performed thereunder, or the plans, ~ specifications, drawings, etc., accompanying the same shall in anywise affect its obligation on this bond, and it does hereby waive notice of any such change, extension of time, alteration or Payment Bond Page 1 of 2 I ;:~+ This bond is given to meet the requirements of Article 5160, Vernon's Civil Statutes of Texas, and other applicable statutes of the State- of Texas. The terms "Claimant", "Labor" and "Material", '~~ as used herein are in accordance with and as defined in said Article. The undersigned agent is hereby designated by the Surety herein as the Agent Resident in Nueces County to whom any requisite notices may be delivered and on whom service of process may be had in matters arising out of such suretyship, as provided by Art. 7.19-1, Vernon's Texas Insurance Code. IN WITNESS WAEREOF, this instrument is executed in 4 copies, each one of which shall be deemed an original, this the 31sT day Of DECEMBER 2O 09 PRINCIPAL ROLANDO MENDOZA, PRESIDENT Print Name & Title) ATTEST ,`~ Secretary CHARLES WEBB (Print Name) SURETY WESTERN SURETY COMPANY . ... - -~? By• Attorney -fact MARY ELLEN MOORS (Print Name) - • ~ W F~~~, diif~ ~4f~. ~~~..~ ~ V~f.if:fSiD~Y ~ 4 .~ Ag@IICy: SWANTNER & GORDON INSURANCE AGENCY Contact Person: MARY ELLEN MOORS Address : p_ ~_ Box B 7 a CORPUS CHRISTI, TEXAS 78403 Phone Number: 361-883-1711 -' (NOTE: Date of Payment Bond must not be prior to date of contract) (Revised 9/02) Payment Bond Page 2 of 2 DATE (MMIDD/YYYY) coR CERTIFICATE OF LIABILITY INSURANCE OPI I ~ A RCl COC l 01/06/10 PRODUCER THIS CERTIFlCATE IS SUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RK3HTS UPON THE CERTIFICATE SWaataer io Gordon Ins Agcy-CC HOLDER. THIS CERTIFlCATE DOES NOT AMEND, EXTEND OR PO Sox 870 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Corpus Christi TX 78403-0870 Phax-e:36I-883-1711 Fax:361-844-0101 INSURERS AFFORDING COVERAGE NAiC s INSURED INSURER A >l~id C~tinent Casualty CO 23418 INSURER B: Southern Insurance Co 19216A ~~uucc~~~~ At~taC~Rolaudora, nza ~ INSURER C: RStTI Indeamaity Ccaopaay 22314 P.O. Sox 938 i 7846 INSURER D: Texas l4utual IIIB Co 22945 TX Corpus Chr st 9 ~ INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONOTiKNI OF ANY CONTRACT OR OTHER DOCUMENT W TTH RESPECT TO W HK:H THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED 8Y THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITK)N8 OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTR NSR TYPE OF INSURANCE POLICY NUMBER DATE OA MM!D LIMITS GENERALUABILTTY EACH OCCURRENCE S1,000,OOO A X COMMERCIAL GENERAL LIABILITY 04GL000763181 07/18/09 07/18/10 PREMISES Eaoocurenoe $ 100,000 CLAIMS MADE a OCCUR MED EXP (Arty one person) S excluded / PERSONALRADVINJURY $ 1,000,000 GENERAL AGGREGATE 2, GOO, OOO GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 2 , O O O , O O O POLICY X JECT LOC AUT OMOBAELUIBS.IT1/ ~ COMBINED SINGLE LIMIT 1 GOO OOO B X aNYAUro SAP5503638 07/18/09 07/18/10 (EaeooideM) , , ALL OWNED AUTOS ~ BODILY INJURY SCHEDULED AUTOS (Per person) $ X ]( HIRED AUTOS NON-OWNED AUTOS BODILY INJURY (Per aoddenq $ PROPERTYDAMAGE (Per accident) $ GARAGE LIABILITY AUTO ONLY - EA ACCIDENT S ANY AUTO OTHER THAN EA ACC $ - AUTO ONLY: AGG S E%CESS/UMBRELLALWBILITY EACH OCCURRENCE 1, GOO, OOO C X OCCUR ~ CLAIMSMADE N11m7049696 07/18/09 07/18/10 AGGREGATE $ 1,000,000 S DEDUCTIBLE $ X RETENTION $10 , 0 0 0 $ AND EMP COMPE LOYERS' LIABILITY X TORY LIMITS ER- D D?~CUTIVE~ EREXCLU CE ~I~ F O TSF0001119432 07/19/09 07/19/10 E.LEACMA(:CIDENT 500,000 DE I MB F (IYlnldetory in NH) lJ ,~ E.L. DISEASE - EA ENffrLO~ S SOD , O O O H yyeess desaibe under SPECIAL PROVISKNS below E.L. DISEASE • POLK:Y LIMIT S SOD , O O O OTHER DESCRIPTION OFOPERATIONS / LOCATK)NS !VEHICLES / EKCLUSKNiB ADDED BY ENDORS RS t il>s09011 Dsa:ihole Rinc is Cover Adjustaleat EMENT / SPECULL PROVISIONS 1PY 2010 .i Additional Insured ss required by ~rrittea insured contract applicable to -/ Gaasral Liability A Auto Liability, Waivsr of SubroQatioa as require8 by arrittaa insured contract applicable to Qeaeral Liability, Auto Liability ~ Workers Cat~ensation. See Attached Endorsesuats. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRSBED POLICIES BE CANCELLED BEFOR~E~ EKPIRATIOI CI`+L._L.~ DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 3O "'DAYS WRITTEN NOTICE TO THE CERTIFICATE MOLDER NAMED TO THE LEFT, BUT FAkURE TO DO SO SHALL City Of COrpus Chri Ht i r IMPOSE NO OBLIGATION OR LIABILrrY OF ANY KIND UPON THE INSURER, ITS AGENTS OR Dept. of Engrinesriagr Services REPRESENTArnES. Attn: Contract ABtainistrator P.O. BOX 9277 ALIT SENTATNE o s Christi TX ?8469-9277 ACORD 25 (2009/01) ®1988-2009 A OR ORATION. Ail rights reserved. The ACORD name and bgo are registered marks of ACORD IMPORTANT If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). DISCLAIMER This Certificate of Insurance does not constitute a contract between the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it affim-atively or negatively amend, extend or alter the coverage afforded by the policies listed thereon. . ACORO 25 POLICY NUM9ER: 04-OL-11007a31a1 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ fT CAREFULLY. OWNERS, LESSEES OR CONTRACTORS -SCHEDULED PERSON OR ORGANIZATION -ADDITIONAL INSURED This endorsement modifies insurance provided under the following: COMMERCIAL GENERA!, UABlUTY COVERAGE PART SCHEDULE. Name of Person or Organization: CITY OF CORPUS CHRISTI, TEXAS (If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement.) WHO 18 AN INSURED (Section 11) is amended to include as an insured the person or organization shown in the Schedule, but only with rasped to liability caused, in whole or in part by your performance of ongoing operations for that insured. This amendment applies only when you have agreed by written "insured contracP to designate the person or organization listed above as an additional insured subject to ail provisions and limitations of this policy. c~-~-/ ML 12 t~ (os oel Page 1 of 1 POLICY NUMBER: 04-C;L-000763181 '` COMMERCIAL GENERAL LIABILITY CG 24 0410 83 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name of Person or Organization: CITY OF CORPUS CHRISTI, TEXAS (if no entry appears above, information required to complete this endorsement will be shown in the DeGarations as applicable to this endor~ementJ The TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US Condition (Section N - COMMER- CIAL GENERAL LIABILITY CONDITIONS) is amended by the addition of the following: We waive any right of recovery we may have against the person or organization shown in the Schedule above because of payments we make for injury or damage arising out of your ongoing operations or "your work" done under a contrail with that person or organization and included in the "products-completed operations hazard". This waiver applies only to the person or organization shown in the Schedule shove. CG 24 0410 93 Copyright, Insurance Services Office, Inc., 1992 Page 1 of 1 ^ J/ POLICY NUMBER: BAP 5503638 00 THIS ENDORSEM//ENT CHANGES THE POLICY. ~T'EXAS ADDITIONAL This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM GARAGE COVERAGE FORM MOTOR CARRIER COVERAGE FORM TRUCKERS COVERAGE FORM COMMERCUIL AUTO CA tM 03 Ot3 04 PLEASE READ IT CAREFULLY. INSURED With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modi- fied by the ~dorsement. This endorsement changes the policy effective on the inception date of the policy unless another date is indicated below. Endorsement Effective: Countersigned By: 07/18/2009 `~ Named Insured: ~/ (Authorized Representative) RCM CONSTRUCTORS, INC SCHEDULE Name and Address of Additlonal Ins/cared: CITY OF CORPUS CHRISTI PO BOX 9277 Corpus Christi, TX 78469 (If no entry appears above, information required to complete this endorsement wilt be shown in the Declarations as applicable to this endorsement.) A. Who Is An Insured (Section II) is amended to include as an "insured" the person(s) or organiza- tion(s) ~-own in the Schedule, but only with re- spect to their legal liability for ads or omissions of a person for whom Liability Coverage is afforded under this policy. B. The additional insured named in the Schedule or Declarations is not required to pay. for any premi- ums stated in the policy or eamed from the policy. Any return premium and any dividend. if appNca- ble, declared by us shall be paid fio you. C. You are authorized b act for the additional insured named in the Schedule or Declarations in all mat- ters pertaining to this insurance. D. We will mail the additional insured named in the Schedule or Declarations notice of any cancella- tion of this poky. If we cancel, we will g'nre 10 days notice to the a~itional insured. E. The addifional insured named in the Schedule or Declarations wit retain any right of recovery as a claimant under this policy. CA 04 03 Of3 04 ©ISO Properties, Inc., 2003 Page 1 of 1 O POLICY NUMBER: BAP 5503638 00 ~ ~ COMMERCIAL AUTO CA 20 139 06 04 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. TEXAS CHANGES IN TRANSFER OF RIGHTS Of= RECOVERY AGAINST OTHERS TO US (WAfVER OF SUBROGATION} This endon;emeM modifies frtsun3nce provided under the following: BUSINESS AUTO COVERAGE FORM / BUSINESS AUTO PHYSICAL DAMAGE COVERAGE FORM `J GARAGE COVERAGE FORM MOTOR CARRIER COVERAGE FORM TRUCKERS COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modi- fied by the endorsement. This endorsement changes the pdicy effective on the inception date of the policy unless another date is indicated below. Endorsement Effective: Countersigned By: 07/18/2009 ,,~ Named Insured: RCM CONSTRUCTORS, INC (AUthorlZed Representative) SCHEDULE Name Of Person(s) Or Organization(s): .CITY OF CORPUS CHRISTI ~ AddiNonal Promium~ Included ~ (If no entry appears above, information required do complete this endorsement will be shown in the Dedarations as applicable th this endorsement.) The Transfer Of Rights Of Recovery Against Others To Us Condition does not apply to the person(s) or organiza- tion(s) shown in the Sd~edule. We will retain the additional premium shown above, reganiless of any early termr nation of this endorsement or the policy. CA 20 BS 06 04 ®ISO Properties, Inc., 2003 Page 1 of 1 O POLICY NUMBER: 04-GL-000763181 f AMENDMENT OF CANCELLATION PROVISIONS OR COVERAGE CHANGE In the event of cancellation or material change that reduces or restricts the insurance afforded by this Coverage Part, we agree to mall prior written notice of cancellation or material change to: SCHEDULE 1. Name: City of Corpus Christi T. Address: P.O. Box 9277, Corpus Christi, TX T8469 3. Number of days advance notice: 30 J~ Ml 90 06 (10 97j f POLICY NUMBER: sAP 5503638 00 COMMERCIAL AUTO CA 02 44 06 04 THiS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ~ TEXAS CANCELLATION PROVISION OR COVERAGE CHANGE ENDORSEMENT This endorsement modfies insurance provided under the following: / BUSINESS AUTO COVERAGE FORM ,d/ GARAGE COVERAGE FORM MOTOR CARRIER COVERAGE FORM TRUCKERS COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modi- fied by the endorsement. This endorsement changes the policy effective on the inception date of the policy unless another date is indicated below. Endon3ement Effective: Countersigned By: 07/18/2009 ~~ Named Insured: RCM CONSTRUCTORS, INC Authorized resentative SCHEDULE ,Number of Days' Notice 3 0 Name Of Person Or Organization CITY OF CORPUS CHRISTS IAddroSB PO BOX 9277 Corpus Christi, TX '78469 EXCEPT 10 DAYS IN THE EVENT OF NON-PAYMENT OF PREMIUM if this policy is canceled or materially changed to reduce or restrict coverage. we wiN mail notice of cancellation or change to the person or organization named in the Schedule. We will give the number of day's.. notice indicated in the Schedule. CA 02 44 06 04 ©ISO Properties, Inc., 2003 -Page 1 of 1 O WORKERS' COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 420601 TEXAS NOTICE OF MATERIAL CHANGE ENDORSEMENT This endorsement applies only to the insurance provided by the policy because Texas is shown in Item 3.A. of the Information Page. In the evert of cancellation or other material change of the policy, we will mail advance notice to the person or organization named in the Schedule. The number of days advance notice is shown in the Schedule. This endorsement shall not operate directly or indirediy to benefit anyone not named in the Schedule. Schedule 1. Number of days advance notice: 30 2. Notice will be mailed to: CITY OF CORPUS CHRISTI DEPT. OF ENGINEERING SERVICES ~' P.O. BOX 9277 CONTRACT ADMINISTRATOR CORPUS CHRISTI, TX 78469 This endorsement changes the policy to which it is attached effective on the inception date of the pokcy unless a different date is indicated below. (The following "attaching clause" need be completed only when this endorsement is i~ued subsequent to preparation of the policy.) This endorsement, effective on January 5 , 2010 at 12:01 A.M. standard time, forms a part of Policy No. TSF-0001 1 19432 20090719 o he Texas Mutual insurance Company Issued to RCM CONSTRUCTORS 1 NC ~" Endorsement No. 1 Premium $ 0.00 ~ ~ ~ ~ ~~ Authorized Representative WC410601 (ED.1-94) WASENDRS 1-05-2010 WORKERS' COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC420304A TEXAS WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT This endorsement applies only to the insurance provided by the policy because Texas is shown in Item 3.A. of the Information Page. We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce our right against the person or organization named in the Schedule, but this waiver applies only with respect to bodily injury arising out of the operations described in the Schedule where you are required by a written contract to obtain this waiver from us. This endorsement shall not operate directly or indirectly to benefit anyone not named in the Schedule. The premium for this endorsement is shown in the Schedule. Scha~iulp 1. ( ) Specific Waiver Name of person or organization ( X) Blanket Waiver Any person or organization for whom the Named Insured has agreed by written contract to furnish this waiver. 2. Operations: ALL TEXAS OPERATIONS 3. Premium The premium charge for this endorsement shall be 2 . QO percent of the premium devebped on payroll in connection with work performed for the above person(s) or organization{s) arising out of the operations described. 4. Advance Premium INCLUDED , SEE 1 NFORMAT (ON PAGE . This endorsement changes the poik~+ to which it is atlachod eBedive on the Inception date of the policy Mess a differerrt date is indicated below. (The following "attaching clause" need be completed only when this endorsement is issued subsequent to preparation of the policy.) This endorsement. effective on ~ at 12:01 A.M. standard time, fomw a part of Policy No. TSF-0001119432 20090719 of the Texas Muwal Insurance Company issued to RCM CONSTRUCTORS I NC Endorsement No. Premium $ / t ~""_'Z l~ Authorized Representative NrC420304A (ED.1-01 2000) INSURER'S COPY LXHAMILT 7-21-2009