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HomeMy WebLinkAboutC2011-513 - 4/12/2011 - ApprovedA011 -S71.3 W AGREEMENT THE STATE OF TEXAS § COUNTY OF NUECES § THIS AGREEMENT is entered into this 7TH day of March 2012, 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 Ti -Zack Concrete. Inc. termed in the Contract Documents as "Contractor," upon these terms, performable in Nueces County, Texas: In consideration of the payment of $495,000.00 by City and other obligations of City as set out herein, Contractor will construct and complete certain improvements described as follows: ROLLED CURB AND GUTTER REPLACEMENT FY 2011 CONTRACT RENEWAL #1 PROJECT NO. E10154 (TOTAL BASE BID; $495,000.00) 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, The General and Special Provisions and Requirements for Municipal Construction Contracts of the City of Corpus Christi, 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. 2011 -513 Page 1 of 3 Rev. Jun -2010 4112111 M2011 -087 Ti -Zack Concrete, Inc. INDEXED Contractor shall indemnify, save harmless and defend the City of Corpus Christi in accordance with General Provision B-6-11 and Special Provision A -26 of the General and Special Provisions and Requirements for Municipal Construction Contracts of the City of Corpus Christi, Texas. The Contractor will commence work within ten (10) calendar days from date they receive written work order and will complete same within 365 CALENDAR DAYS 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. Page 2 of 3 Rev. Jun -2010 ATTEST: City Secretary APPROVED AS r TO LEGAL FORM: By. Asst. City Attorney "i4TTS..T:..(If Gorporation) BeJOWY, (Note::4fP0son signing for corporation is not President, g4a f 16"0py of authorization to sign) CITY OF CORPUS CHRISTI By:_ Y ?at— Oscar Martinez Assistant City Manager Public Works, Utilities, and Transportation aniel Vies, RE, T?Vr interim Director of Engineering Services CONTRACTOR _Ti -Zack Concrete. Inc. By:/I— 7�1 21 0't T i t I e: TR_05�' 1 39352 221 Ave. (Add ress) Le Center, MN 56057 (City) (State)(ZIP) 5071357 -6463 * 8661601 -8335 (Phone) (Fax) a 1 4—A- 9 2 AUTHORI&L IT MUKML,_�j 1, (( .LL °.d,... NARY -f�` Page 3 of 3 Rev. Jun -2010 y . PAY M ENT BO ND STATE OF TEXAS § BOND No. 16 0814 95 COUNTY OF NUECES § KNOW ALL BY THESE PRESENTS: That Ti -Zack Concrete, Inc. of the City of Le Center , County of Le Sueur, , and State of Minnesota , as principal ("Principal "), and The Guarantee C ompany of No America usA , a solvent company duly authorized under the laws of the State of Texas to act as surety on bonds for principals ( "Surety "), are held and firmly bound unto the City of Corpus Christi, a Home Rule municipal corporation of Nueces County, Texas ( "City" or "OWNER"), and unto all Subcontractors, workers, laborers, mechanics and suppliers as their interests may appear, -all of whom shall have a right to sue upon this bond in the penal sum of FOUR HUNDRED NINETY -FIVE THOUSAND AND NO/100 U.S. Dollars ($ 495,000.00 U.S. to be paid in Nueces County, Texas, for the payment of which sum well and truly to be made, We, said Principal and Surety, bind ourselves and our heirs, executors, administrators, successors and assigns, jointly and severally, firmly by these presents: Conditions of this bond are such that, whereas, Principal has entered into a certain written contract with the City of Carpus Christi (OWNER), dated the 7th day of March 2012 which Agreement is hereby referred to and made a part hereof as fully and to the same extent as if copied at length herein, for the construction of: ROLLED CURB AND GUTTER REPLACEMENT FY 2011 CONTRACT RENEWAL #1 PROJECT NO. E10154 (TOTAL BASE BID: $495,000.00) Now, therefore, the condition of this obligation is such, that if said Principal shall well and truly pay all Subcontractors, workers, laborers, mechanics and suppliers, all monies to them owing by said Principals for subcontracts, work, labor, equipment, supplies and materials done and furnished for the construction of improvements of said Agreement, then this obligation shall be and become null and void; otherwise to remain in full force and effect. Surety, for value received, stipulates and agrees that no change to the contract time or contract amount, and no alteration or addition to the terms of the contract, or to the work performed thereunder, or to the plans, specifications, drawings, etc., accompanying the same shall in anywise affect its obligation on this band, and it does hereby waive notice of any such change, extension of time, alteration or addition to the terms of the contract, or to the work to be performed thereunder. (Rev_ Date May 2011) Payment Bond Page I of 3 Provided further, that this bond is executed pursuant to Chapter 2253, Texas Government Code, as amended. Provided further, that if any legal action be filed on this bond, venue shall lie in Nueces County, Texas. The undersigned agent is hereby designated by the Surety as the Resident Agent 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 Sections 3543.041 to 3503.005, Texas Insurance Code, as amended. In witness whereof, said Principal and Surety have signed and sealed this instrument in 4 copies, each one of which shall be deemed an original, this the 23rd day of March , 2412. I, 0I r'[a]MAN Ti -Zack Concrete, Inc. By: /} Title: f rc-S NT ATTEST: Se etary Address: 39352 - 221st Ave Le Center, MN 56057 SURETY The Guarantee Company of North.Am USA By: 4&WA92;?= Attorney -in -fact Jonathan Pate Address: 25800 Northwestern Highway, Suite 720 So uthfield, MI 48075 -8410 Telephone: (248) 281 -0281 Fax: (248) 750 -0431 E- Mail:Thomas Holmes - tholmes @gcna.com 4 (Rev. date May 2019) Payment Bond Page 2 of 3 Name and address of Resident Agent of Surety in Nueces County, Texas, for delivery of notice and service of process: Name: Randy Lee Agency: Swatner & Gordon Insurance Agen LLC k Address: Sao N. Shoreline, Suite 1200 (Physical Street Address) Corpus Chr isti, TX 78401 -0361 (City) (State) (Zip) Telephone: (36 1) 883 -1711 E -Mail: rml@s-gins.com Note: Bond shall be issued by a solvent Surety company authorized to do business in 1 Texas, and shall meet any other requirements established by law or by OWNER under applicable law. Note: Surety Agent's Original Power of Attorney must be attached hereto. Note: Date of Payment Bond must not be prior to date of contract. END Rev. Date May 2011 Payment Bond I Page 3 of 3 The Guarantee Company of North America USA 25800 Northwestern Highway, Suite 720 Southfield, Michigan 48075 Phone: 248 - 281 -0281 Fax: 248 -750 -0431 Texas Consumer Notice 1 IMPORTANT NOTICE To obtain information or make a complaint: 2 You may contact your agent at: Pate Bonding, Inc 1276 So. Robert St., West St. Paul, MN 55118 (651 }457 - 6842 {P) / (651) 957 -7Pau{ ) 3 You may call The Guarantee Company of North America USA's toll -free telephone number for information or to make a complaint at: 1 -866- 328 -0567 Ext 1040 4 You may also write to The Guarantee Company of North America USA at: 25800 Northwestern Highway, Suite 720 Southfield, Michigan 48075 Web: www.acna.com E-mail: Info @gcna.com Fax: 248 -750 -0431 5 You may contact the Texas Department of Insurance to obtain information on companies, coverages, rights or complaints at: 1- 800 -252- 3439 6 You may write the Texas Department of Insurance: P.O. Box 149104 Austin, TX 78714 -91 04 Fax: (512) 475 -1771 Web: http://www.tdi.state.tx.us E -mail: ConsumerProtection @tdi.state.tx. us 7 PREMIUM OR CLAIM DISPUTES: Should you have a dispute concerning your premium or about a claim you should contact the (agent) (company) (agent or the company) first. If the dispute is not resolved, you may contact the Texas Department of Insurance. 8 ATTACH THIS NOTICE TO YOUR POLICY: This notice is for information only and does not become a part or condition of the attached document. "ISO IMPORTANTE Para obtener informacion o para someter una q ueja: Puede comunicarse con su agent al Usted puede Ilamar al numero de telefono gratis de The Guarantee Company of North America USA's para informacion o pars someter una queja al: 1- 866 - 328 -0567 Ext 1040 Usted tambien puede escribir a to The Guarantee Company of North America USA: 25800 Northwestern Highway, Suite 720 Southfield, Michigan 48075 Web: www.gena.com E -mail: Info(a)gcna.com Fax: 248 -750 -0431 Puede comunicarse con el Departamento de Seguros de Texas para obtener informacion acerca de companias, coberturas, derechos o quejas al: 1 -800- 252 -3439 Puede escribir al Departamento de Seguros de Texas: P.O. Box 149104 Austin, TX 78714 -91 04 Fax: (512) 475 -1771 Web: http: / /www.tdi,state.tx.us E -mail: Consu merP rote ction @td i.state.tx. us DISPUTAS SOBRE PRIMAS 0 RECLAMOS: Si tiene una disputa concerniente a su prima o a un reclamo, debe comunicarse con el (agente) (la compania) (agente o la compania) primero. Si no se resuelve ]a disputa, puede entonces comunicarse con el departamento (TD 1). UNA ESTE AVISO A SU POLIZA: Este aviso es solo pars proposito de informacion y no se convierte en parte o condicion del documento adj unto. C50083 Texas Consumer Notice 1 of 1 12/2/2009 State of County of On this ACKNOWLEDGMENT OF PRINCIPAL (Individual) day of and executed the foregoing instrument and acknowledge(s) to me that in the year _ before me personally come(s) to me known and known to me to be the person(s) who (is) (are) described in he _ executed the same, Notary Public ACKNOWLEDGMENT OF PRINCIPAL (Partnership) state of ) County of ) On this day of in the year before me personally comes) a member of the co- partnership of to me known and known to me to be the person who is described in and executed the foregoing instrument and acknowledges to me that he executed the same as for the act and deed of the said co- partnership, Notary Public ACKNOWLEDGMENT OF PRINCIPAL (Corporation) State of ,I °' I ti& ,_ C � ) County of Lt-suu ) On this n day of / t MC.44 in the year o10 before me personally come(s) to me known, who, being duly sworn, deposes and says that he is the of the C&P-R.r-ze . , a we. the corporation described in and which executed the foregoing instrument; that he knows the seal of the said corporation; the seal affixed to the said instrument is such corporate seal; that it was so affixed by the order of the Board of Directors of said corporation, and that he signed his name thereto by like order. LISA MARIE SIMON N tary Public �.. Notary Public- Minnesota 0My Comm, Exptrg Jan. 3h,2017 ACKNOWLEDGMENT OF SURETY State of Minnesota ) County of Dakota ) On this 23rd day of March in the year 2012, before me personally come(s) Jonathan Pate. Attorney(s) -in -Fact of The Guarantee Company Of North America USA with whom I am personally acquainted, and who, being by me duly savor -says that he is (are) the Attomey(s) -in -Fact of The Guarantee Company Of North America USA company described in and which executed the withi instrument; that he know(s) the porate seal of such company; and that seal affixed to the within instrument is such corporate seal and that it was a ed by order of the Boar it ors of said company, and that he signed said instrument as Attorney(s) -in -Fact of the said company by like order. f NEER ESOTA, 31, 2015 Notary Public THE GUARANTEE COMPANY OF NORTH AMERICA USA Southfield, Michigan POWER OF ATTORNEY KNOW ALL BY THESE PRESENTS: That THE GUARANTEE COMPANY OF NORTH AMERICA USA, a corporation organized and existing under the laws of the State of Michigan, having its principal office in Southfield, Michigan, does hereby constitute and appoint Jonathan Pate, Thomas M. Lahl, Thomas G. Kemp, Jennifer M. Boyles Pate Bonding, Inc. its true and lawful attorney(s) -in -fact to execute, seal and deliver for and on its behalf as surety, any and all bonds and undertakings, contracts of indemnity and other writings obligatory in the nature thereof, which are or may be allowed, required or permitted by law, statute, rule, regulation, contract or otherwise. The execution of such instrument(s) in pursuance of these presents, shall be as binding upon THE GUARANTEE COMPANY OF NORTH AMERICA USA as fully and amply, to all intents and purposes, as if the same had been duly executed and acknowledged by its regularly elected officers at the principal office. The Power of Attorney is executed and may be certified so, and may be revoked, pursuant to and by authority of Article IX, Section 9.03 of the By -Laws adopted by the Board of Directors of THE GUARANTEE COMPANY OF NORTH AMERICA USA at a meeting held on the 31 day of December, 2003. The President, or any Vice President, acting with any Secretary or Assistant Secretary, shall have power and authority: 1. To appoint Attorney(s) -in -fact, and to authorize them to execute on behalf of the Company, and attach the Seal of the Company thereto, bonds and undertakings, contracts of indemnity and other writings obligatory in the nature thereof and 2. To revoke, at any time, any such Attorney -in -fact and revoke the authority given, except as provided below 3. In connection with obligations in favor of the Florida Department of Transportation only, it is agreed that the power and authority hereby given to the Attorney -in -Fact includes any and all consents for the release of retained percentages and/or final estimates on engineering and construction contracts required by the State of Florida Department of Transportation. It is fully understood that consenting to the State of Florida Department of Transportation making payment of the final estimate to the Contractor and/or its assignee, shall not relieve this surety company of any of its obligations under its bond. 4. In connection with obligations in favor of the Kentucky Department of Highways only, it is agreed that the power and authority hereby given to the Attorney -in -Fact cannot be modified or revoked unless prior written personal notice of such intent has been given to the Commissioner — Department of Highways of the Commonwealth of Kentucky at least thirty (30) days prior to the modification or revocation. Further, this Power of Attorney is signed and sealed by facsimile pursuant to resolution of the Board of Directors of the Company adopted at a meeting duly called and held on the 6th day of December 2011, of which the following is a true excerpt: RESOLVED 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, contracts of indemnity and other writings obligatory in the nature thereof, and such signature and seal when so used shall have the same force and effect as though manually affixed. �p,M IN WITNESS WHEREOF, THE GUARANTEE COMPANY OF NORTH AMERICA USA has caused this instrument to be signed and its corporate seal to be affixed by its authorized officer, this 23rd day of February, 2012. THE GUARANTEE COMPANY OF NORTH AMERICA USA P NAME STATE OF MICHIGAN Stephen C. Ruschak, Vice President anda uss Iman, Secreta County of Oakland On this 23rd day of February, 2012 before me came the individuals who executed the preceding instrument, to me personally known, and being by me duly sworn, said that each is the herein described and authorized officer of The Guarantee Company of North America USA; that the seal affixed to said instrument is the Corporate Seal of said Company; that the Corporate Seal and each signature were duly affixed by order of the Board of Directors of Cynthia A. Take! Notary Public, State of Michigan County of Oakland My Commission Expires February 27, 2098 Acting in Oakland County IN WITNESS WHEREOF, I have hereunto set my hand at The Guarantee Company of North America USA offices the day and year above written. - 7a,40� I, Randall Musselman, Secretary of THE GUARANTEE COMPANY OF NORTH AMERICA USA, do hereby certify that the above and foregoing is a true and correct copy of a Power of Attorney executed by THE GUARANTEE COMPANY OF NORTH AMERICA USA, which is still in full force and effect. ,a w+Tft IN WITNESS WHEREOF, I have thereunto set my hand and attached the seal of said Corn is day of March, 2012. G� NA 01 and 11 Muss an, cre PERFORMANCE BOND STATE OF TEXAS § BOND No. 16081495 COUNTY OF NUECES § KNOW ALL BY THESE PRESENTS: That Ti Zack Concrete Inc. of the City of Le Center , County of _Le 5ueur, and State of Minnesota , as principal ( "Principal "), and The Guarantee Company of North America USA a solvent company duly authorized under the laws of the State of Texas to act as surety on bonds for principals ( "Surety "), are held and firmly bound unto the City of Corpus Christi, a Home Rule municipal corporation of Nueces County, Texas ( "City" or "OWNER "), in the penal sum of FOUR HUNDRED NINETY -FIVE THOUSAND AND NO /100 U.S. Dollars ( 495,000.00 U.S_. to be paid in Nueces County, Texas, for the payment of which sum well and truly to be made, We, said Principal and Surety, bind ourselves and our heirs, executors, administrators, successors and assigns, jointly and severally, firmly by these presents: Conditions of this bond are such that, whereas, Principal has entered into a certain written contract with the City of Corpus Christi (OWNER), dated the 7th of March , 2012, which Agreement is hereby referred to and made a part hereof as fully and to the same extent as if copied at length herein, for the construction of: ROLLED CURB AND GUTTER REPLACEMENT FY 2011 CONTRACT RENEWAL #1 PROJECT NO. E10154 (TOTAL BASE BID: $495,000.00) Now therefore, the condition of this obligation is such, that if said Principal shall faithfully perform said Agreement in accordance with the plans, specifications and contract documents, including any changes, extensions, or guarantees, and including all and singular covenants, conditions, and agreements in and by said contract agreed and covenanted by Principal to be observed and performed, and according to the true intent and meaning of said Agreement hereto annexed, 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(OWNER), then this obligation shall be void; otherwise to remain in full force and effect. Surety, for value received, stipulates and agrees that no change to the contract time or contract amount, and no alteration or addition to the terms of the contract, or to the work performed thereunder, or to 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 addition to the terms of the contract, or to the work to be performed thereunder. (Rev. Date May 2019) Performance Bond Page 1 of 3 Provided further, that this bond is executed pursuant to Chapter 2253, Texas Government Code, as amended. Provided further, that if any legal action be fled on this bond, venue shall lie in Nueces County, Texas. The undersigned agent is hereby designated by the Surety as the Resident Agent 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 Sections 3503.001 to 3503.005, Texas Insurance Code, as amended. In witness whereof, said Principal and Surety have signed and sealed this instrument in 4 copies, each one of which shall be deemed an original, this the 23rd day of March , 2012. PRINCIPAL SURETY Ti --Zack Concrete, Inc. By: /" 2 ,*- Title :e F"�` ATTEST: Se retary Address: 39352 - 221st Ave Le Center, MN 56057 The Guarantee Company of North America LTSA By: torney -in -fact Jonathan Pate Address: 25800 Northwestern Highway, Suite 720 Southfield, MI 48075 -8410 Telephone: (248) 281 -0281 Fax: (248) 750 -0431 E - Mail: Thomas Holmes - tholme s@gcna.com (Rev. Date May 2091) Performance Bond Page 2 of 3 Name and address of Resident Agent of Surety in Nueces County, Texas, for delivery of notice and service of process: Name: Randy Lee Agency: Swatner & Gordon Insurance Agency, LLC Address: 500 N. Sho reline, Su ite 1200 (Physical Street Address) Corpus Chrism, TX 78401 -0361 (City) (State) (zip) Telephone: - ( 361) 883 -1711 E -Mail: rml@s-giiis.com Note: Bond shall be issued by a solvent Surety company authorized to do business in Texas, and shall meet any other requirements established by law or by OWNER under applicable law. Nate: Surety Agent's Original Power of Attorney must be attached hereto. Note: Date of Performance Bond must not be prior to date of contract. END (Rev. Date May 2011) Performance Band Page 3 of 3 The Guarantee Company of North America USA 25800 Northwestern Highway, Suite 720 Southfield, Michigan 48075 Phone: 248 - 281 -0281 Fax: 248 -750 -0431 Texas Consumer Notice 1 IMPORTANT NOTICE To obtain information or make a complaint: 2 You may contact your agent at: Pate Bonding, Inc 1276 So. Robert St., West St. Paul, MN 55118 (651)457- 6842(P) / (651} 457- 7531(F) 3 You may call The Guarantee Company of North America USA's toll -free telephone number for information or to make a complaint at: 1- 866- 328 -0567 Ext 1040 4 You may also write to The Guarantee Company of North America USA at: 25800 Northwestern Highway, Suite 720 Southfield, Michigan 48075 Web: www.g_ona.com E -mail: Info @gcna.com Fax: 248 - 750 -0431 5 You may contact the Texas Department of Insurance to obtain information on companies, coverages, rights or complaints at: 1- 800 -252- 3439 6 You may write the Texas Department of Insurance: P.O. Box 149104 Austin, TX 78714 -91 04 Fax: (512) 475 -1771 Web: http:/Iwww.tdi.state.tx.us E -mail: ConsumerProtection @tdi.state.tx. us 7 PREMIUM OR CLAIM DISPUTES: Should you have a dispute concerning your premium or about a claim you should contact the (agent) (company) (agent or the company) first. If the dispute is not resolved, you may contact the Texas Department of Insurance. 8 ATTACH THIS NOTICE TO YOUR POLICY: This notice is for information only and does not become a part or condition of the attached document. "ISO IMPORTANTE Para obtener informacion o para someter Una q ueja: Puede comunicarse con su agent al Usted puede Ilamar al numero de telefono gratis de The Guarantee Company of North America USA's para informacion o para someter Una queja al: 1 -866- 328 -0567 Ext 1040 Usted tambien puede escribir a to The Guarantee Company of North America USA: 25800 Northwestern Highway, Suite 720 Southfield, Michigan 48075 Web: www.gcna.com E -mail: InfoCa gcna.com Fax: 248 -750 -0431 Puede comunicarse con el Departamento de Seguros de Texas para obtener informacion acerca de companias, coberturas, derechos o quejas al: 1 -800- 252 -3439 Puede escribir al Departamento de Seguros de Texas: P.O. Box 149104 Austin, TX 78714 -91 04 Fax: (512) 475 -1771 Web: http: / /www.tdi.state.tx.us E -mail: Co nsu merProtecti on @td i. state. tx. us DISPUTAS SOBRE PRIMAS 0 RECLAMOS: Si tiene Una disputa concerniente a su prima o a un reclamo, debe comunicarse con el (agente) (la compania) (agente o la compania) primero. Si no se resuelve la disputa, puede entonces comunicarse con el departamento (TD 1). UNA ESTE AVISO A SU POLIZA: Este aviso es solo para proposito de informacion y no se convierte en parte o condicion del documento adj unto. CS0083 Texas Consumer Notice 1 of 1 12/2/2009 ACKNOWLEDGMENT OF PRINCIPAL (Individual) State of ) County of ) On this day of F in the year before me personally come(s) , to me known and known to me to be the person(s) who (is) (are) described in and executed the foregoing instrument and acknowledge(s) to me that _ he _ executed the same. Notary Public ACKNOWLEDGMENT OF PRINCIPAL (Partnership) State of ) } County of ) On this day of in the year before me personally come(s) a member of the co- partnership of to me known and known to me to be the person who is described in and executed the foregoing instrument and acknowledges to me that he executed the same as for the act and deed of the said co- partnership. Notary Public ACKNOWLEDGMENT OF PRINCIPAL (Corporation) State of A t w bmN ) County of LF, feu ) On this rz day of I"Ir`1'L'� in the year before me personally come(s) 5 - r - 'T — to me known, who, being duly sworn, deposes and says that he is the of the �.r 2 ACk �01��-r� , fie.. the corporation described in and which executed the foregoing instrument; that he knows the seal of the said corporation; the seal affixed to the said instrument is such corporate seal; that it so affixed by the order of Ifig Board of Directors of said corporation, and that he signed his name thereto by like order. LISA MARIE SIMON Notary Public Notary Public— Minnesota t My Comm. Expires Jan. 31, 2017 '� ACKNOWLEDGMENT OF SURETY ...;...... cow. r..�............ W....q. State of Minnesota ) County of Dakota } On this 23rd day of March, in the year 2012, before me personally come(s) Jonathan Pate Attorney(s) -in -Fact of The Guarantee Company Of North America USA with whom I am personally acquainted, and who, being by me duty sw rn, says that he is (are) the A rney(s) -in -Fact of The Guarantee Company Of North America USA company described in and which executed the w! 'n instrument; that he know(s) corporate seas of such company; and that seal affixed to the within instrument is such corporate seal and that it was a axed by order of the�Beaad-e !rectors of said company, and that he signed said instrument as Atborney(s) -in -Fact of the said company by like order. 1 WANOA LEE FRANZ NOTARY PUBLIC - MINNESOTA Notary Public V My Commisslon Empires Jan. 31, 2015 THE GUARANTEE COMPANY OF NORTH AMERICA USA Southfield, Michigan POWER OF ATTORNEY KNOW ALL BY THESE PRESENTS: That THE GUARANTEE COMPANY OF NORTH AMERICA USA, a corporation organized and existing under the laws of the State of Michigan, having its principal office in Southfield, Michigan, does hereby constitute and appoint Jonathan Pate, Thomas M. Lahl, Thomas G. Kemp, Jennifer M. Boyles Pate Bonding, Inc. its true and lawful attorney(s) -in -fact to execute, seal and deliver for and on its behalf as surety, any and all bonds and undertakings, contracts of indemnity and other writings obligatory in the nature thereof, which are or may be allowed, required or permitted by law, statute, rule, regulation, contract or otherwise. The execution of such instrument(s) in pursuance of these presents, shall be as binding upon THE GUARANTEE COMPANY OF NORTH AMERICA USA as fully and amply, to all intents and purposes, as if the same had been duly executed and acknowledged by its regularly elected officers at the principal office. The Power of Attorney is executed and may be certified so, and may be revoked, pursuant to and by authority of Article IX, Section 9.03 of the By -Laws adopted by the Board of Directors of THE GUARANTEE COMPANY OF NORTH AMERICA USA at a meeting held on the 31 day of December, 2003. The President, or any Vice President, acting with any Secretary or Assistant Secretary, shall have power and authority: To appoint Attorney(s) -in -fact, and to authorize them to execute on behalf of the Company, and attach the Seal of the Company thereto, bonds and undertakings, contracts of indemnity and other writings obligatory in the nature thereof; and To revoke, at any time, any such Attorney -in -fact and revoke the authority given, except as provided below In connection with obligations in favor of the Florida Department of Transportation only, it is agreed that the power and authority hereby given to the Attorney -in -Fact includes any and all consents for the release of retained percentages and/or final estimates on engineering and construction contracts required by the State of Florida Department of Transportation. It is fully understood that consenting to the State of Florida Department of Transportation making payment of the final estimate to the Contractor and /or its assignee, shall not relieve this surety company of any of its obligations under its bond. In connection with obligations in favor of the Kentucky Department of Highways only, it is agreed that the power and authority hereby given to the Attorney -in -Fact cannot be modified or revoked unless prior written personal notice of such intent has been given to the Commissioner — Department of Highways of the Commonwealth of Kentucky at least thirty (30) days prior to the modification or revocation. Further, this Power of Attorney is signed and sealed by facsimile pursuant to resolution of the Board of Directors of the Company adopted at a meeting duly called and held on the 6th day of December 2011, of which the following is a true excerpt: RESOLVED 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, contracts of indemnity and other writings obligatory in the nature thereof, and such signature and seal when so used shall have the same force and effect as though manually affixed. IN WITNESS WHEREOF, THE GUARANTEE COMPANY OF NORTH AMERICA USA has caused this instrument to be signed and v° its corporate seal to be affixed by its authorized officer, this 23rd day of February, 2012. d THE GUARANTEE COMPANY OF NORTH AMERICA USA "'IfAME�p z Jel 4 4't-, STATE OF MICHIGAN Stephen C. Ruschak, Vice President andalI sse n, Secretary County of Oakland On this 23rd day of February, 2012 before me came the individuals who executed the preceding instrument, to me personally known, and being by me duly sworn, said that each is the herein described and authorized officer of The Guarantee Company of North America USA; that the seal affixed to said instrument is the Corporate Seal of said Company; that the Corporate Seal and each signature were duly affixed by order of the Board of Directors of Cynthia A. Takai IN WITNESS WHEREOF, I have hereunto set my hand at The Guarantee Notary Public, State of Michigan Company of North America USA offices the day and year above written. County of Oakland My Commission Expires February 27, 2098 v:.... ;' Acting in Oakland County �f I, Randall Musselman, Secretary of THE GUARANTEE COMPANY OF NORTH AMERICA USA, do hereby certify that the above and foregoing is a true and correct copy of a Power of Attorney executed by THE GUARANTEE COMPANY OF NORTH AMERICA USA, which is still in full force and effect. � ' P4TE# ' % IN WITNESS WHEREOF, I have thereunto set my hand and attached the seal of said C rdday of March, 2012. �G � anda I ussel an, ecretary A p® CERTIFICATE OF LIABILITY INSURANCE DATE {MM1pDNYYV) 03/20/2012 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CE=RTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE O R PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT. If the certificate holder is an ADDITIONAL INSURED, the policy(Ees) must be endorsed. 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). PRODUCER NAME: CONTA DARIAN T. HUNT House of Insurance Agency, Inc. AC Ext: 507- 357 -2221 arc No: 507- 357 -4940 Pd Box 205 E-MA A DD F I L E SS: dhuntl @frontiernet.net LeCenter, MN 56D57 INSURER {$)AFFORDING COVERAGE NAIC to INSURED 507- 357 -6463 507 - 357 -6463 INSURERB:St. Paul Surplus Lines Insurance Co Ti -Zack Concrete Inc. wsURERC: Travelers 39352 221st .Ave INSURER D: LeCenter, MN 56057 inwnoco c COVERAGES CERTIFICATE NUMBER. Kt :VISwN NUMISISR: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF MMIDDNYYY POLICY EXP MMIDDIYYYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1, 000, 0 0 0 C X COMMERCIAL GENERAL LIABILITY 4T CO 9112R714 TIL - �11 09/21/2011 09/21/2012 DAMAGETORENTE PREMISES Ea eccunence $ 300 CLAIMS -MADE [fl OCCUR S MED EXP (Any one person) $ 5,0()0 PERSONAL &AOV INJURY $ 1,000, GENERAL AGGREGATE $i® 2,000, 000 GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS - COMPIOP AGG $ 2,000,00 $ POLICY FX PRO- L C AUTOMOBILE LIABILITY Ee arB.eN ' GLE LIMIT BODILY INJURY (Per person) $ C ANY AUTO BA 9112 87 14 11 - CNS 09/21/2011 09/21/2012 BODILY INJURY (Per accident) $ X ALL OWNED SCHEDULED AUTOS AUTOS X X peOraccRldenDAMAGE $ HIRED AUTOS A�7CS $ nea P' Lvatt Pe -, ou Aam OR P... X UMBRELLA WA6 X OCCUR EACH OCCURRENCE $ 5, 000, 000 AGGREGATE $ 5, 000, C00 C EXCESS LIAB CLAIMS -MADE 4TSM- CUP- 9112R714- IND -11 09/21/2011 09/21/2012 DED RETENTION $ i $ WORKERS COMPENSATION _ X WC STATU- OTH- TORY LIMIT E AND EMPLOYERS' LIABILITY YIN E.L. EACH ACCIDENT $ 500,000 C ANY PROPRIETORIPARTNERIEXECUTIVE OFFICERIMEMBEREXCLUDED? N NIA 4TC- UB- 9112R714 - 11 09/21/2913 09/21/2012 IlMandatoryInNH) E.L. DISEASE - EA EMPLOYEE $ 500,000 E.L. DISEASE - POLICY LIMIT $ 500, 000 "yes, describe under DESCRIPTION OF OPERATIONS below .d $2,000,000 B Pollution Liability QCOS501381 09/06/2011 09/21/2012 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, it more space is required) The City of Corpus Christi is named as additional insured on all general liability (GL) and all automobile liability (Al) policies. Project Name: Rollad Curb & Gutter Replacement FY2011- Contract Renewal #1 Project Number: E10154 CERTIFICATE HOLDER GANGtL.L.A I IIJIV_ SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPiRATiON DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Corpus Christi V ACCORDANCE WITH THE POLICY PROVISIONS. Department of Engineering Sery Attn Contract AdminPO Box 9277 AUTHORIZED REPRESENTATIVE Corpus Christi, TX 78469 -9277 U 1958 -2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: 1001726 LOC #: ACORL7 ADDITIONAL REMARKS SCHEDULE Page of AGENCY NAMED INSURED House of Insurance Agency, Inc. Ti -Zack Concrete Inc. 39352 221st Ave POLICY NUMBER ADDL INSR LeCenter, MN 56057 CARRIER NAIC CODE EFFECTIVE DATE: LIMITS B AnnlTlr% DCMARKC THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: Certificate of Liability Insurance COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: INSR LTR TYPE OF INSURANCE ADDL INSR SUBR WVD POLICY NUMBER POLICY EFF IMMIDQtYYYYI POLICY EXP (MMIDDIYYYY) LIMITS B Contractor's Professional QCO5501381 09/06/2011 09/21/2012 2,000,000 ACORD 101 {2008101) O 20D8 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD i 4T C0 9112R714- T1L_'11'� - COMMERCIAL GENERAL LIABILITY THiS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY BL ANKET ADDIT IONAL INSURE This indorsement modifies insurance provided under the following: 't COMMERCIAL GENERAL LIABILITY COVERAGE PART 1. WHO IS AN INSURED - (Section 11) is amended to include any person or organization that you agree in a "written contract requiring insurance" to include as an additional insured on this Cover- age Part, but: a) Only with respect to liability for "bodily injury ", "property damage" or "personal injury"; and b) If, and only to the extent that, the injury or damage is caused by acts or omissions of you or your subcontractor in the performance of "your work" to which the "written contract requiring insurance" applies. The person or organization does not qualify as an additional insured with respect to the independent acts or omissions of such person or organization. 2. The insurance provided to,the additional insured by this endorsement is limited as follows: a) In the event that the Limits of Insurance of this Coverage Part shown in the Declarations exceed the limits of liability required by the "written contract requiring insurance ", the in- surance provided to the additional insured shall be limited to the limits of liability re- - quired by that "written contract requiring in- surance". This endorsement shall not in- crease the limits of insurance described in Section III -- Limits Of Insurance. b) The insurance provided to the additional in- sured does not apply to "bodily injury", "prop- erty damage" or "personal injury" arising out of the rendering of, or failure to render, any professional architectural, engineering or sur- veying services, including: The preparing, approving, or failing to prepare or approve, maps, shop draw- ings, opinions, reports, surveys, field or- ders or change orders, or the preparing, approving, or failing to prepare or ap- prove, drawings and specifications; and ii. Supervisory, inspection, architectural or engineering activities. c) The insurance provided to the addltlonai in- sured does not apply to "bodily injury" or "property damage" caused by "your work" and included in the "products- completed op- erations hazard" unless the "written contract requiring insurance" specifically requires you to provide such coverage for that additional insured, and then the insurance provided to the additional insured applies only to such "bodily injury" or "property damage" that oc- curs before the end of the period of time for which the "written contract requiring insur- ance" requires you to provide such coverage or the end of the policy period, whichever is earlier. 3. The insurance provided to the additional insured by this endorsement-is exoess over any valid and collectible "other insurance ", whether primary, excess, contingent or on any other basis, that is available to the additional insured for a loss we cover under this endorsement. However, if the "written contract requiring insurance" specifically requires that this insurance apply on a primary basis or a primary and non - contributory basis, this insurance is primary to 'other insurance" available to the additional insured which covers that person or organization as a named insured for such loss, and we will not share with that "other insurance ". But the insurance provided to the additional insured by this endorsement still is excess over any valid and collectible 'other in- surance", whether primary, excess, contingent or on any other basis, that is available to the addi- tional insured when that person or organization is an additional insured under such 'other insur- ance". 4. As a condition of coverage provided to the additional insured by this endorsement: a) The additions€ insured must give us written notice as soon as practicable of an "occur- rence" or an offense which may result in a claim. To the extent possible, such notice should include: CG D2 46 08 05 0 2005 The St. Paul Travelers Companies, Inc. page 'I of 2 4T —C)- 91128714— TIL -11 COMMERCIAL GENERAL LIABILITY i O� d� f0� �r n� o o� m� rte' r o�. o� mom' i. How, when and where the 'occurrence" or offense took place; H. The names and addresses of any injured persons and witnesses; and iii. The nature and location of any injury or damage arising out of the "occurrence" or offense. b) If a claim is made or "suit" is brought against the additional insured, the additional insured must: i. Immediately record the specifics of the claim or "suit" and the date received; and ii. Notify us as soon as practicable. The additional insured must see to it that we receive written notice of the claim or "suit" as soon as practicable. c) The additional insured must immediately send us copies of all legal. papers received in connection with the claim or "suit ", cooperate with us in the investigation or settlement of the claim or defense against the "suit ", and otherwise comply with all policy conditions. d) The additional insured must tender the de- fense and indemnity of any claim or "suit" to any provider of "other insurance' which would cover the additional insured for a loss we cover under this endorsement. However, this condition does not affect whether the insur- ance provided to the additional insured by this endorsement is primary to "other insur- ance" available to the additional insured which covers that person or organization as a named insured as described in paragraph 3. above. S. The following definition is added to SECTION V. - DEFINITIONS: "Written contract requiring insurance" means that part of any written contract or agreement under which you are required to include a person or organization as an additional in- sured on this Coverage Part, provided that the "bodily injury" and "property damage" oc- curs and the "personal injury" is caused by an offense committed; a. After the signing and execution of the contract or agreement by you; h. While that part of the contract or agreement is in effect; and c. Before the end of the policy period. Page 2 of 2 Q 2005 The St, Paul Travelers Companies, Inc. CG D2 46 08 05 002840 BA- 9112R714- 11 -CNS COMMERCIAL AUTO THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. AUTO COVERAGE PLUS ENDORSEMENJ This ndorsement modifies insurance provided under the following: . � BUSINESS AUTO COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modi- fied by the endorsement. GENERAL DESCRIPTION OF COVERAGE - This endorsement broadens coverage. However, coverage for any injury, damage or medical expenses described in any of the provisions of this endorsement may be excluded or limited by another endorsement to the Coverage part, and these coverage broadening provisions do not apply to the extent that coverage is excluded or limited by such an endorsement. The following listing is a general cover- age description only. Limitations and exclusions may apply to these coverages. Read all the provisions of this en- dorsement and the rest of your policy carefully to determine rights, duties, and what is and is not covered. A. BLANKET ADDITIONAL INSURED H. AUDIO, VISUAL AND DATA ELECTRONIC B. EMPLOYEE HIRED AUTO EQUIPMENT - INCREASED LIMIT C. EMPLOYEES AS INSURED D. SUPPLEMENTARY PAYMENTS - INCREASED LIMITS E.. TRAILERS -- INCREASED LOAD CAPACITY F. HIRED AUTO PHYSICAL DAMAGE G. PHYSICAL DAMAGE - TRANSPORTATION EXPENSES - INCREASED LIMIT b o o m m o A. BLANKET ADDITIONAL INSURED The following is added to Paragraph A.1., Who Is An Insured, of SECTION II - LIABILITY COV- ERAGE: Any person or organization who is required under a written contract or agreement between you and that person or organization, that is signed and executed by you before the "bodily injury" or "property damage" occurs and that is in effect during the policy period, to be named as an addi- tional insured is an "insured" for Liability Cover- age, but only for damages to which this Insurance applies and only to the extent that person or or- ganization qualifies as an "insured" under the Who is An Insured provision contained in Section IL B. EMPLOYEE HIRED AUTO 1. The following is added to Paragraph A.1., Who Is An Insured, of SECTION 11 -- LI- ABILITY COVERAGE: An "employee" of yours is an "insured" while operating a covered "auto" hired or rented under a contract or agreement in that "em- ployee's" name, with your permission, while I. WAIVER OF DEDUCTIBLE- GLASS J. PERSONAL EFFECTS K. AIRBAGS L. AUTO LOAN LEASE GAP M. BLANKET WAIVER OF SUBROGATION performing duties related to the conduct of your business. 2. The following replaces Paragraph b. in B.5., Other Insurance, of SECTION IV - BUSI- NESS AUTO CONDITIONS: b. For Hired Auto Physical Damage Cover- age, the following are deemed to be' cov- ered "autos" you own: (1) Any covered "auto" you lease, hire, rent or borrow; and (2) Any covered "auto" hired or rented by your "employee" under a contract in that individual "employee's" name, with your permission, while perform- ing duties related to the conduct of your business. However, any "auto" that is leased, hired, rented or borrowed with a driver is not a covered "auto ". C. EMPLOYEES AS INSURED The following is added to Paragraph A.1., Who Is An Insured, of SECTION Il - LIABILITY COV- ERAGE: CA T4 20 07 10 © 2010 The Travelers Indemnity Company. All rights reserved. Page 1 of 3 Includes copyrighted material of Insurance services Office, Inc, with its permission, 006917 BA- 9112R714- 11 -CNS COMMERCIAL AUTO Any "employee" of yours is an "insured" while us- ing a covered "auto" you don't own, hire or borrow in your business or your personal affairs. D. SUPPLEMENTARY PAYMENTS - INCREASED LIMITS 1. The following replaces Paragraph A.2.a.(2) of SECTION II - LIABILITY COVERAGE: (2) Up to $3,000 for cost of bail bonds (in- cluding bonds for related traffic law viola- tions) required because of an "accident" we cover. We do not have to furnish these bonds. 2. The following replaces Paragraph A.2.a.(4) of SECTION 11-- LIABILITY COVERAGE: (4) All reasonable expenses Incurred by the "Insured" at our request, including actual loss of earnings up to $500 a day be- cause of time off from work. E. TRAILERS - INCREASED LOAD CAPACITY The following replaces Paragraph C.1. of SEC- TION I - COVERED AUTOS: 1. "Trailers" with a load capacity of 3,000 pounds or less designed primarily for travel on public roads. F. HIRED AUTO PHYSICAL DAMAGE The following is added to Paragraph A.4., Cover- age Extensions, of SECTION III - PHYSICAL DAMAGE COVERAGE: Hired Auto Physical Damage Coverage If hired "autos" are covered "autos" for Liability Goverage but not covered "autos" for Physical Damage Coverage, and this policy also provides Physical Damage Coverage for an owned "auto ", then the Physical Damage Coverage is extended to "autos" that you hire, rent or borrow subject to the following: (1) The most we will pay for "loss" in any one "accident" to a hired, rented or borrowed "auto" is the lesser of: (a) $50,000; (b) The actual cash value of the damaged or stolen property as of the time of the "loss"; or (c) The cost of repairing or replacing the damaged or stolen property with other property of like kind and quality. (2) An adjustment for depreciation and physical condition will be made in determining actual cash value in the event of a total "loss ". (3) If a repair or replacement results in better . than like kind or quality, we will not pay for the amount of betterment. (4) A deductible equal to the highest Physical Damage deductible applicable to any owned covered "auto ". (5) This Coverage Extension does riot apply to: (a) Any "auto" that is hired, rented or bor- rowed with a driver; or (b) Any "auto" that is hired, rented or bor- rowed from your "employee ". G. PHYSICAL DAMAGE - TRANSPORTATION EXPENSES -INCREASED LIMIT The following replaces the first sentence in Para- graph A.4.a., Transportation Expenses, of SECTION III -- PHYSICAL DAMAGE COVER- AG E: We will pay up to $50 per day to a maximum of $1,500 for temporary transportation expense in- curred by you because of the total theft of a cov- ered "auto" of the private passenger type. H. AUDIO, VISUAL AND DATA ELECTRONIC EQUIPMENT - INCREASED LIMIT Paragraph C.2.. Limit Of Insurance, of SEC- TION III - PHYSICAL DAMAGE COVERAGE is deleted. { 1. WAIVER OF DEDUCTIBLE - GLASS The following is added to Paragraph D., Deducti- ble, of SECTION III -- PHYSICAL DAMAGE COVERAGE: No deductible for a covered "auto" will apply to glass damage if the glass is repaired rather than replaced. J, PERSONAL EFFECTS The following is added to Paragraph AA., Cover- age Extensions, of SECTION III - PHYSICAL DAMAGE COVERAGE: Personal Effects Coverage We will pay up to $400 for "loss" to wearing ap- parel and other personal effects which are: (1) Owned by an "insured "; and (2) In or on your covered "auto ". This coverage only applies in the event of a total theft of your covered "auto" No deductibles apply to Personal Effects cover- age. Page 2 of 3 @2010 The Travelers Indemnity Company. All rights reserved, CA T4 20 07 10 includes copyrighted material of Insurance Services Office, Inc, with its permission. F m m� n� o� o w� M a.rw� o� u� r+� BA- 9112R714- 11 -CNS K. AIRBAGS The following is added to Paragraph B.3., Exclu- sions, of SECTION Ill - PHYSICAL DAMAGE COVERAGE: Exclusion 3.a, does not apply to "loss" to one or more airbags in a covered "auto" you own that in- ffate due to a cause other than a cause of "loss" set forth in Paragraphs A.'I.b. and A.1.c., but only: a. If that "auto" is a covered "auto" for Compre- hensive Coverage under this policy; b. The airbags are not covered under any war- ranty; and c. The airbags were not intentionally inflated. We will pay up to a maximum of $1,000 for any one "loss ". L. AUTO LOAN LEASE GAP The following is added to Paragraph A.4., Cover- age Extensions, of SECTION III -- PHYSICAL DAMAGE COVERAGE: Auto Loan Lease Gap Coverage for Private Passenger Type Vehicles In the event of a total "loss" to a covered "auto" of the private passenger type shown in the Schedule or Declarations for which Physical Damage Cov- erage is provided, we will pay any unpaid amount due on the lease or loan for such covered "auto" less the following: (1) The amount paid under the Physical Damage Coverage Section of the policy for that "auto "; and COMMERCIAL AUTO (2) Any: (a) Overdue lease or loan payments at the time of the "loss "; (b) Financial penalties imposed under a lease for excessive use, abnormal wear and tear or high mileage; (c) Security deposits not returned by the les- sor; (d) Costs for extended warranlles, Credit Life Insurance, Health, Accident or Disability Insurance purchased with the loan or lease; and (e) Carry -over balances from previous loans or leases. j M. BLANKET WAIVER OF SUBROGATION The following replaces Paragraph A.5., Transfer Of Rights Of Recovery Against Others To Us, of SECTION IV --BUSINESS AUTO CONDI- TIONS: 5. Transfer Of Rights Of Recovery Against Others To Us We waive any right of recovery we may have against any person or organization to the ex- tent required of you by a written contract exe- cuted prior to any "accident" or "loss ", pro- vided that the "accident" or "loss" arises out of the operations contemplated by such con- tract. The waiver applies only to the person or organization designated in such contract. CA T4 20 07 10 © 2010 The Travelers Indemnity Company. All rights reserved. Page 3 of 3 Includes copyrighted material of Insurance Services Office, ]no. with Its permission. GOW 8 POLICY NUMBER: 4T L-1 i Y' ISSUE DATE: 09 1 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. DESIGNATED ENTITY - EARLIER NOTICE OF CANCELLATION NCNRENEW L / A PROVI BY US This endorsement modifies Insurance provided under the following: ALL COVERAGE PARTS INCLUDED €N THIS POLICY aim m� n o.�wnr■ b� �w SCHEDULE CANCELLATION: Number of Days Notice: 30 WHEN WE DO NOT RENEW (Nonrenewal): Number of Days Notice. 30 J NAME: CITY OF CORPUS CHRISTI DEPT OF ENGINEERING SERVICES ADDRESS: ATTN: CONTRACT ADMIN Po BOX 9277 CORPUS CHRISTI TX 78469 -9277 A. For any statutorily permitted reason other than nonpayment of premium, the number of days re- quired for notice of cancellation, as provided In the CONDITIONS Section of this Insurance, or as amended by any applicable state cancellation endorsement applicable to this Insurance, is in- creased to the number of days shown in the SCHEDULE above. B. For any statutorily permitted reason other than nonpayment of premium, the number of days re- quired for notice of When We Do Not Renew (Nonrenewal), as provided In the CONDITIONS Section of this Insurance, or as amended by any appllcable state When We Do Not Renew (Nonrenewa)) endorsement appllcable to this in- surance, Is increased to the number of days shown in the SCHEDULE above. C. We will mail notice of cancellation or nonrenewal or material llmitation of those coverage forms to the person or organization shown In the schedule above. We will mail the notice at least the Num- ber of Days Indicated above before the effective date to our action. IL T3 54 03 98 Copyright, The Travelers Indemnity Company, 1998 . Page 1 of 1 002618 POLICYNUMBER: BA- 91128714- 11 -CNS ISSUE DATE: 09-28-11 TH ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. J a � This endorsement modifies insurance provided under the following: ALL COVERAGE PARTS INCLUDED IN THIS POLICY SCHEDULE CANCELLATION: Number of Days Notice: 30 WHEN WE DO NOT RENEW (Nonrenewal): Dumber of Days Notice: 30 NAME:, CITY OF CORPUS CHRISTI DEPT OF ENGINEERING SERVICES ADDRESS' ATTN. CONTRACT ADMIN Po BOX 9277 CORPUS CHRISTI TX 78469 --9277 A. For any statutorily permitted reason other than nonpayment of premium, the number of days re- quired for notice of cancellation, as provided In the CONDITIONS Section of this Insurance, or as amended by any applicable state cancellation endorsement applicable to this Insurance, Is In- creased to the number of days shown In the SCHEDULE above. B, For any statutorily permitted reason other than nonpayment of premium, the number of days re- quired for notice of When We Do Not Renew ( Nonrenewal), as provided In the CONDITIONS Section of this Insurance, or as amended by any Counter Signed BY IL T3 54 03 98 applicable state When We Do Not Renew ( Nonrenewal) endorsement applicable to this in- surance, Is increased to the number of days shown In the SCHEDULE above. C. We will mail notice of cancellation or nonrenewal or material limitation of those coverage forms to the person or organization shown In the schedule above. We will mall the notice at least the Num- ber of Days Indicated above before the effective date to our action. Copyright, The Travelers Indemnity Company, 1998 Page 1 of i 128'19 "�' ®�t�'CL� ®5A� WORKERS COMPENSATION 1°[ G F[ AND ONE TOWER SQUARE EMPLOYERS LIABILITY POLICY HARTFORD, C 06183 ENDORSEMENT WC 99 06 11 (A) POLICY NUMBER: (4TCUS--9 -4 -1 ) V 4 NOTICE OF CANCELLATION Except for non - payment of premium by you, we agree that no cancellation or limitation of this policy shall become effective until the number of day's written notice specified in item 2 of the Schedule has been mailed to you and to the person or organization designated in item 1 of the Schedule at the address indicated. SCHEDULE 1, Name: CITY OF CORPUS CHRISTI DEPT OF ENGINEERING SERVICES ATTN: CONTRACT ADMIN Address: PO BOX 9277 CORPUS CHRISTI, TX 78469 -9277 2. Number of Days Written Notice: 30 Additional Days This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated. (The information below is required only when this endorsement is issued subsequent to preparation of the policy.) Endorsement Effective Policy No. Endorsement No, Insured Premium $ Insurance Company Countersigned by DATE OF ISSUE: 10 -06 -11 ST ASSIGN: Page 1 of 1 SI. 1 1 MNTBHI A Q B1-.:"NIGXFD M71TY cit" 01 CITYOF CORPUS (14RISTI coipw, DISCLOSURE OF INTEREST Christ] (Ay of Cmpts DOW Ckdhmnce 17112. as arnended. re(pims aH persons or Arms seeking W do business %viol tile AV to pwvwe we Rulowha huhmsion, R.eil%, cluestion inug he =1w" O 0 the vd- w clumdon is not ijpp hicakle- ans%' er %pith "NA See re\erse 06 for Filing RCqL1iI'eIllC11tS. CCI and definalons. COMPANY NANME: Ti-Zack Concrete. Inn, P. 0. BOX, s 393-52 2221" AN C]"FY: Le Center ZIP: �56057- FIRM IS: L CoqwVWn Pa - illerm L1 lip 3. Sole Owner 4, Association H Other DISCLOSURL QUS If additional space is neces.Ar). please LIS( tile NVU-SC Side of thii IMUe OFERMC11 SCINIrate sheet f. State the nairws ofeaJi - ernplooce - of the City ot'Cor - pus Clii ha\lillLy an - m llership interest" cmw4whT 3% or Inure of the m ncrdip in We above named "OrtV ga Job - Fitleand Cit~ Department (if known) NONE 2. State the names of each "official" of the Clux of Corpus Christi havhg all -- o"weWp imems'l cotw4mby 3% or mom of le ownership in [lie above named - firm." Name TWe NONE 3. State the nwnes of each - board member" of the Cit\ of Corpus Christi having an -- ow w'ship filterest cw9RwWg 3% or niore of the ownership in the Above named Wnn." Name Board. Conmikshn or ComnAw NN 0 N T' 4. State the name of each Qjupimee or officer of a -- consullaw" for dic City of Corpus Christi Ni ho vwrked on in\ matter rel,60d to the SUbjeCT Of Tllis Mltl and h0s all - Ownerqllip interest" coast wing A or mom of the ownership in flie above named "firm... Name Consultant x 0 N f7. If1L1lV`s REQUIREMENTS N7[S ff a person who requests oft €ciat action on a platter knows that the requested action will confer ail economic benefit on any City official or employee that is distinguishable front the effect that the action t, ill have on members of'the public, in general or a substantial segment thereof, you shall disclose that fact in a signed writina to the City official, employee or body that has been requested to act ill the platter unless the interest of the City official or eiuployze in the matter is apparent. The disclosure shall also be made in a signed writing filed with the City Secretar'v. ]l.:thics Ordinance Section 2- (d)] CERTIFICATION I certiN that at] information provided is true and correct as ofthe date of this statement. that I have not knowingly withheld disclosure of any information requested; and that supplemental statements ivilf be promptly' to the City of Corpus Christi, Texas as chanues occur. Certifying Person: Claris Hartvvig Titles Vice President II\po or Moo — Signature of Certifying Y - — Date; 4/3/2012 Person: DEFINITIONS €r. "Board member." A member of env board, commission. or committee appointed by the City Council of the City. o #'Corpus Christi.. Texas. b, "Economic bench€. Ern action that is likely to affect ail economic interest if it is likely to have an effect on that interest that is distinguishable from its effect on members of the public in yeneral or a substantial segment thereof. "Employee." Any person employed by the City of Corpus Christi_ Texas either on a full or part - time basis, but not as an independent contractor. d. "Firm." Any entity operated for economic gain, whether professional. industrial or commercial, and Whether established to produce or deal with a product o €' seryiCe, including but not limited to, entities operated in the form of sole proprietorship, as self - employed person, partnership, corporation, joint stock company, joint venture, receivership or trust. and entities which for purposes of taxation are treated as non- profit organizations. ::Official.' The Mayor.. members of the City Council, Cite Ivianager. Deputy City 1 1danager. Assistant Cite Managers, Department and Division Heads, and Ivlcurieipal Court Judges of the City of Corpus Christi, Texas. "Ownership. Interest." Legal or equitable interest. whether actually or constructively held.. in a firm. €ncludmQ when such interest is field through an agent.. trust. estate, or holding entity. "Constructively held" refers to holdings or control established through Voting trusts, proxies, or special terms of venture or partnership at„reentents." g. "Consultant." Any person or firm. such as engineers and architects, hired by the City of Corpus Christi for the purpose of professional consultation and reconinlendatign,