HomeMy WebLinkAboutC2011-517 - 4/19/2011 - ApprovedAGREEMENT
THE STATE OF TEXAS §
COUNTY OF NUECES §
4 on- 6q
THIS AGREEMENT is entered into this 4TH day of APRIL, 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 RCM Constructors, Inc. termed in the Contract Documents as
"Contractor," upon these terms, performable in Nueces County, Texas:
In consideration of the payment of $443,673.10 by City and other obligations of
City as set out herein, Contractor will construct and complete certain improvements
described as follows:
WASTEWATER SERVICE LINE REPAIR AND CLEAN -OUT INSTALLATION AND
MANHOLE RING AND COVER ADJUSTMENT PROGRAM FY 2011
CONTRACT RENEWAL #1 - PROJECT NO. Eq Gq 66 ar /)�D3g
(TOTAL RENEWAL AMOUNT: $443,673.10)
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 -517
Page 1 of 3
4119111 Rev. Jun -2010
M2011 -093
RCM Constructors, 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
APPR VED AS TO LEGAL FORM:
JiL
By:
Asst. City Attorne
ATTEST: (If Corporation) 6" �
<%v
(Seal Below)
(Note. If Person signing for
corporation is not President,
attach copy of authorization
to sign)
RV
CITY OF CORPUS CHRISTI
By:/�?
Oscar Martinez
Assistant City Manager Public Works,
Utilities, and Transportation
By:
Daniel Biles, P.E.
Interim Director of Engineering Services
CONTRACTOR
RCM Constructors, Inc.
By:. X� (
Title: Plies 'dv F-J-�
P.O. Box 9338
(Address)
Corpus Christi, TX 78469
(City) (State)(ZIP)
3611299 -1191 * 361/299 -1201
(Prone) (Fax)
Page 3 of 3
Rev. Jun --2010
Project #: E12038
Funding: 530235-4200-33400-E12038
PO #: E12038CRC
Amount: $34,600.00
Project #: E12038
Funding: 530000 -4300- 32010 -E 12038
PO #: E12038CRC1
Amount: $89,073.00
P E R F O R M A N C E BOND
STATE OF TEXAS § BOND No, 58674770
COUNTY OF NUECES §
KNOW ALL BY THESE PRESENTS:
That RCM Constructors Inc. of the City of Corpus Christi , County of
Nueces , and State of Texas , as principal ( "Principal "), and WESTERN SURETY
COMPANY , a solvent company duly authorized under the
laws of the State of Texas to act as surety on bonds for principals ( "Surety "), are held
and firmly bound unto the City of Corpus Christi, a Home Rule municipal corporation of
Nueces County, Texas ( "City" or "OWNER "), in the penal sum of FOUR HUNDRED
FORTY -THREE THOUSAND, SIX HUNDRED SEVENTY -THREE AND 101100 _U.S.
Dollars ($ 443,673.10 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 4TH of
APRIL , 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:
WASTEWATER SERVICE LINE REPAIR AND CLEAN -OUT INSTALLATION AND
MANHOLE RING AND COVER ADJUSTMENT PROGRAM FY 2011
CONTRACT RENEWAL #1 - PROJECT NO. S49&456 +v l�a3g
(TOTAL RENEWAL AMOUNT. $443,673.10)
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 2011) 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 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 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 5TH
day of APRIL , 2012.
PRINCIPAL SURETY
RCM CONSTRUCTORS, INC. WESTERN SURETY COMPANY
By: —44 d By
�Xry-in-fact MARy ELLEN MOORE
Title:
ATTEST:
Secretary
Address: P.O. BOX 9338
CORPUS CHRISTI, TEXAS 78469
Address: P.O. BOX 870
CORPUS CHRISTI, TEXAS 78401
Telephone;_ _j6j-ag�_j 71 1 - -
Fax: 361 -561-2564
R. IT.- • 11. W. n
(Rev. Date May 2011) 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: RANDAL M. LEE
Agency: SWANTNER & GORDON INSURANCE AGENCY LLC.
Address: 500 N. SHORELINE BLVD, SUITE 1200
(Physical Street Address)
Telephone:
CORPUS CHRISTI, TEXAS 78401 -0361
(City) (State) (Zip)
351 -883 -1711
E -Mail: rml @s— gins.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.
Note: 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. Hate May 2011) Performance Bond Page 3 of 3
PAYMENT BOND
STATE OF TEXAS BOND No.
COUNTY OF NUECES §
KNOW ALL BY THESE PRESENTS:
58674770
That RCM Constructors_, Inc. of the City of Corpus Christi , County of
Nueces, and State of Texas, as principal ( "Principal "), and
WESTERN SURETY COMPANY , 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 FORTY -THREE THOUSAND, SIX HUNDRED SEVENTY -THREE
101100 U.S. Dollars ($ 443,673.10 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 4TH day of
APRIL , 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:
WASTEWATER SERVICE LINE REPAIR AND CLEAN -OUT INSTALLATION AND
MANHOLE RING AND COVER ADJUSTMENT PROGRAM FY 2011
CONTRACT RENEWAL #1 - PROJECT NO.EO4-56 451x2,03$
(TOTAL RENEWAL AMOUNT: $443,673.10)
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 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 2011) Payment 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 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 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
5TH day of APRIL , 2012.
PRINCIPAL
RCM CONSTRUCTORS, INC.
By:
Title: PY e & zl
ATTEST:
Secretary
Address: P.O. sox 9338
CORPUS CHRISTI, TEXAS 78469
SURETY
WESTERN SURETY COMPANY
Address: P.O. BOX 870
CORPUS CHRISTI, TEXAS 78403
Telephone: 361 -883 -1711
Fax: 361 -561 -2564
E- Mail: _ rnmoore @_s -dins, c.
(Rev. Date May 2011) Payment Bond Page 2 of 3
Attorn
-' -fact
MARY ELLEN MOORE
f '1
=i !
i
r,
Address: P.O. BOX 870
CORPUS CHRISTI, TEXAS 78403
Telephone: 361 -883 -1711
Fax: 361 -561 -2564
E- Mail: _ rnmoore @_s -dins, c.
(Rev. Date May 2011) 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: RANDAL M. LEE
Agency: SWANTNER & GORDON INSURANCE AGENCY LLC.
Address: Sac N. SHORELINE BLVD, SUITE 12
(Physical Street Address)
CORPUS CHRISTI, TEXAS 78401 -0351
(City) (State) (Zip)
Telephone: 361- 883 -1711
E -Mall: rml@s-gins.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.
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 Page 3 of 3
Western Surety Company
POWER OF ATTORNEY APPOINTING INDIVIDUAL ATTORNEY -IN -FACT
Know All Men By These Presents, That WESTERN SURETY COMPANY, a South Dakota corporation, is a duly organized and existing corporation
having its principal office in the City of Sioux Falls, and State of South Dakota, and that it does by virtue of the signature and seal herein affixed hereby
make, constitute and appoint
R M Lee, Mary Ellen Moore, Tami J Duncan, Steve Addkison, Cathleen Hayles, . Danielle
Harris, Individually
of Corpus Christi, TX, its true and lawful Attorney(s) -in -Fact with full power and authority hereby conferred to sign, seal and execute for and on its behalf
bonds, undertakings and other obligatory instruments of similar nature
- In Unlimited Amounts -
and to bind it thereby as fully and to the same extent as if such instruments were signed by a duly authorized officer of the corporation and all the acts of said
Attorney, pursuant to the authority hereby given, are hereby ratified and confirmed.
This Power of Attorney is made and executed pursuant to and by authority of the By -Law printed on the reverse hereof, duly adopted, as indicated, by
the shareholders of the corporation.
In Witness Whereof, WESTERN SURETY COMPANY has caused these presents to be signed by its Senior Vice President and its corporate seal to
be hereto affixed on this 9th day of February, 2012.
,nxx r, WESTERN SURETY COMPANY
SyRfl'}c�
�W 4Q�p OAarl^�T
x
Pau] . Bruflat, Senior Vice President
rxx,
State of South Dakota
ss
County of Minnehaha
On this 9th day of February, 2012, before me personally came Paul T. Bruflat, to me known; who, being by me duly sworn, did depose and say: that
he resides in the City of Sioux Falls, State of South Dakota; that he is the Senior Vice President of WESTERN SURETY COMPANY described in and
which executed the above instrument; that he knows the seal of said corporation; that the seal affixed to the said instrument is such corporate seal; that it was
so affixed pursuant to authority given by the Board of Directors of said corporation and that he signed his name thereto pursuant to like authority, and
acknowledges same to be the act and deed of said corporation.
My commission expires +
X D. KRELL P
November 30, 2012 s NOTARY PUBLIC ^ s
s s SOUTH DAKOTA SEAL s
+vyro5w5.4aati5�a�g�a��y��+
CERTIFICATE
ela k-11j,
D. Krell, No ry Public
I, L. Nelson, Assistant Secretary of WESTERN SURETY COMPANY do hereby certify that the Power of Attorney hereinabove set forth is still in
force, and further certify that the By -Law of the corporation printed on the reverse hereof is still in force. In testimony whereof I have hereunto subscribed
my name and affixed the seal of the said corporation this SM14 day of APRIL , 2012
, nxnx'�,yo
unErr�p WESTERN SURETY COMPANY
taReo�Rr��
ag
�llr
unum", um
L. Nelson, Assistant Secretary
Form F4260 -09 -06
%107
Western Surety Company,
Figure: 28 TAC §1.601(a)(3)
1 IMPORTANT NOTICE
To obtain information or make a complaint:
2 You may contact Western Surety Company at
605- 336 -0850.
3 You may calf Western Surety Company's toll -free
telephone number. for information or to make a
complaint at:
1- 800- 331 -6053
4 You may also write to Western Surety Company
at:
P.O. Box 5077
Sioux Falls, SO 57117 -5077
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 -9104
Fax: (512) 475 -1771
Web: http: / /www,tdi.state.tx,us
E -Mail: ConsumerProtection @tdi.state.tx.us
AVISO IMPORTANTE
Para obtener information o para someter una queja:
Puede comunicarse con Western Surety Company al
605- 336 -0850.
Usted Puede Ilamar al numero de telefono gratis de
Western Surety Company's para information o Para
someter una queja al:
1- 800 -331 -6053
Usted tambien puede escribir a Western Surety
Company:
P.O. Box 5077
Sioux Fails, SO 57117 -5077
Puede comunicarse con el Departamento de Seguros
de Texas para obtener informacion acerca de
companias, coberturas, derechos o quejas al:
1- 800 -282 -3439
Puede escribir al Departamento de Seguros de
Texas:
P.O. Box 149104
Austin, TX 78714 -9104
Fax: (512) 475 -1771
Web: http: / /Www.tdi.state.tx.us
E -Mail: Cons umerProtection@tdi.state.tx.us
7 PREMIUM OR CLAIM DISPUTES: DISPUTAS SOBRE PRIMAS O RECLAMOS:
Should you have a dispute concerning your Si tiene una disputa concerniente a su prima o a
premium or about a claim you should contact un reclamo, debe comunicarse con el Western
Western Surety Company first, If the dispute is not Surety Company primero. Si no se resuelve fa
resolved, you may contact the Texas Department disputa, puede entonces comunicarse con el
of Insurance. departamento (TDI).
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.
Form N29- 4.2008
UNA ESTE AVISO A SU POLIZA: Este aviso as
solo para proposito de informacion y no se
convierte en parte o candicion del documento
adjunto.
�y SUPPLIERNUMBER
TO BE ASSIGNED BY-CiTV --
PURCHASING DIVISION
City of CITY OF CORPUS CHRISTI
Corpus
Christi DISCLOSURE OF INTEREST
City of Corpus Christi Ordinance 17112, as amended, requires all persons or firms seeking to do business
with the City to provide the following information. Every question must be answered. If'the question is
not applicable, answer with "NA ". See reverse side for Filing Requirements, Certifications and
definitions.
COMPANY NAME:
P. O. BOX:
STREET ADDRESS:
P c� 30Y q3 3 g
FIRM IS: I. Corporation
4. Association
CITY: (f D " fjs CA iri s`lIi ZIP: Y V
2. Partnership ❑ 3. Sole Owner ❑
5. Other
DISCLOSURE QUESTIONS
If additional space is necessary, please use the reverse side of this page or attach separate sheet.
1. State the names of each 'employee" of the City of Corpus Christi having an "ownership interest"
constituting 3% or more of the ownership in the above named "firm."
Name .lob Title and City Department (if known)
2. ,State the names of each "official" of the City of Corpus Christi having an "ownership interest"
constituting 3% or more of the ownership in the above named "firm."
Name Title
3. State the names of each "board member" of the City of Corpus Christi having an "ownership interest"
constituting 3% or more of the ownership in the above named "firm."
Name Board, Commission or Committee
4. State the names of each employee or officer of a "consultant" for the City of Corpus Christi who
worked on any matter related to the subject of this contract and has an "ownership interest"
constituting 3% or more of the ownership in the above named "firm."
Name Consultant
FILING REQUIREMENTS
If a person who requests official action on a matter knows that the requested action will confer an
economic benefit on any City official or employee that is distinguishable from the effect that the action
will have on members of the public in general or a substantial segment thereof, you shall disclose that fact
in a signed writing to the City official, employee or body that has been requested to act in the matter,
unless the interest of the City official or employee in the matter is apparent. The disclosure shall also be
made in a signed writing filed with the City Secretary. [Ethics Ordinance Section 2 -349 (d)]
CERTIFICATION
I certify that all information provided is true and correct as of the date of this statement, that I have not
knowingly withheld disclosure of any information requested; and that supplemental statements will be
promptly submitted to the City of Corpus Christi, Texas as changes occur.
Certifying Person: a�Ct fit; �; g �� Title: P�i e S c' jo j
(Type or Print)
Signature of Certifying Date:
Person:
DEFINITIONS
a. "Board member." A member "of any board, commission, or committee appointed by the City
Council of the City of Corpus Christi, Texas.
b. "Economic benefit ". An action that is likely to affect an 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 general or a
substantial segment thereof.
c. "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 or service, 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.
e. "Official." The Mayor, members of the City Council, City Manager, Deputy City Manager,
Assistant City Managers, Department and Division Heads, and Municipal Court Judges of the City of
Corpus Christi, Texas.
"Ownership Interest." Legal or equitable interest, whether actually or constructively held, in a
firm, including when such interest is held 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 agreements."
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 recommendation.
RCMCOCI OP ID: SIKA
A NLY CERTIFICATE OF LIABILITY INSURANCE °" `
oaa�r105/'2
l2
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 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 OR PRODUCER, AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WANED, 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 Ileu of such endorsement(*).
PRODUCER 361 -883 -1711
CACT
NAAME-
Swantner & Gordon Ins Agcy -CC 361 -844 -0101
A Higginbotham Company
PO Box 870
Corpus Christi, TX 78403 -0670
PHONE 361- 883.1771 FAX
Arc No: 361- 844 -0101
E -MAIL
ADD s:
Mike Garza
INSURER (S) AFFORDING COVERAGE
NAIC 0
INSURER A: Amarka First Lloyds Ins. Co
11526
A
INSURED RCM Constructors, Inc.
P.O. Box 9338
Corpus Christi, TX 78469
INSURERS. Pwrlsss Indemnity Ins. Co.
18333
INSURER C: America First Ins. Co.
12696
INSURER D: Texas Mutual Ins Co
22945
$ 100,00
INSURER E :
$ 5,00
INSURER F:
COVERAGES CERTIFICATE NUMBER: REVISIAN NuASaFR•
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,
IL SR
TYPE OF INSURANCE
POLICY NUMBER
POLICY EFF
(MUM LILY 7CP
L1Mt'ra
GENERAL LIABILITY
EACH OCCURRENCE
$ 11000,00
A
X COMMERCIAL GENERAL LIABILITY
CLAIMS -MADE I OCCUR
GL687$555
07118111
07/18/12
PREMISES Eecccurrenee
$ 100,00
MED EXP (Any one Parson)
$ 5,00
X Broad Foam PD
PERSONAL & ADV INJURY
S 1,000,00
X
Cont+solustuah
GENERALAGGREGATE
$ 2,000,00
GEML AGGREGATE LIMIT APPLIES PER:
PRODUCTS - COMPIOP AGG
$ 2,000,00
POLICY F PRO- LOC
S
AUTOMOBILE
LIABILITY
Ea e=dentJ LE LIMIT
1,000,00
BODILY INJURY (Per person)
$
B
ANY AUTO
BASS76553
07118/11
07/18/12
HED
AUTOS NED X AUTOSULED
BODILY INJURY (Per accident)
$
HIRED AUTOS X NON -OWNED
AUTOS
X
PROPERTYDAMA
Per eaddent
$
$
X
UMBRELLALUIB
X OCCUR
EACH OCCURRENCE
$ 1,000,000.
AGGREGATE
$ 1,000,00
C
EXCESS LIAR
I CLAIMS -MADE
CUBSO5224
07/18/11
07/18/12
DED I I RETENTION$
$
D
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY
ANY PROPR IETORIPARTNERIEXECUTIVEYIN
OFFICERIMEMBEREX.CLUDED?
(Mandatory in NH)
It yes, dasaito under
DESCRIPTION OF OPERATIONS below
NIA
TSF00011191SII
07119/11
07/19/12
X WCSTATU OTH-
TORY LIMITS I ER
L.
E. EACH ACCIDENT
S 1,000,00
E.L. DISEASE -EA EMP40YEE
5 1,000,00
E.L. DISEASE - POLICY LIMIT
$ 1,000,00
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORO 101, Additional Remarlw Schedule, If more apace is raqulmd)
RE: Project #E10155 - Wastewater Service Line Repair & Clean -Out
Installation and Manhole Ring & Cover Adjuament Program FY 2011
Sea attached Notepad for additional coverages and provisions.
V1.V
CICC -CO
City of Corpus Christl
Engineering Services
Contract Administrator
P.O. Box 9277
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVE� /
O 1988.2010 ACORD CORPORATION. All rights reserved.
ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD
POLICY NUMBER: GL6676555
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
ADDITIONAL INSURED — OWNERS, LESSEES OR CONTRACTORS — AUTOMATIC STATUS WHEN
REQUIRED IN CONSTRUCTION AGREEMENT WITH YOU
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
A. Paragraph 2, under Section II —Who Is An Insured is amended to include as an additional insured any person
or organization when you and such person or organization have agreed in writing in a contract or agreement that
such person or organization be added as an additional insured on your policy. Such person or organization is an
additional insured only with respect to liability for "bodily injury ", "property damage" or "personal and advertising
injury" caused, in whole or in part, by:
1. Your acts or omissions; or
2. The acts or omissions of those acting on your behalf;
in the performance of your ongoing operations for the additional insured that are the subject of the written contract
or agreement provided that the "bodily injury" or "property damage" occurs, or the "personal and advertising injury"
is committed, subsequent to the execution of such contract.
A person's or organization's status as an additional insured under this endorsement ends when your operations
for that additional insured are completed.
We have no duty to defend an additional insured under this endorsement until we receive written notice of a claim
or "suit" as required in provision b, of Condition Z Duties In the Event Of Occurrence, Offense, Claim Or Suit
under SECTION N— COMMERCIAL GENERAL LIABILITY CONDITIONS.
B. With respect to the insurance afforded to these additional insureds, the following additional exclusions apply:
This insurance does not apply to:
1. "Bodily injury" or "property damage" arising from the sole negligence of the additional insured.
2. "Bodily injury" or "property damage" that occurs prior to you commencing operations at the location
where such "bodily injury" or "property damage" occurs.
3. "Bodily injury ", "property damage" or "personal and advertising injury" arising out of the rendering of, or
the failure to render, any professional architectural, engineering or surveying services, including:
a. The preparing, approving, or failing to prepare or approve, maps, shop drawings, opinions, reports,
surveys, field orders, change orders or drawings and specifications; or
b. Supervisory, inspection, architectural or engineering activities.
4. "Bodily injury" or "property damage" occurring after:
a. All work, including materials, parts or equipment furnished in connection with such work, on the
project (other than service, maintenance or repairs) to be performed by or on behalf of the
additional insured(s) at the location of the covered operations has been completed; or
b. That portion of "your work" out of which the injury or damage arises has been put to its intended use
by any person or organization other than another contractor or subcontractor engaged in performing
operations for a principal as a part of the same project.
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22 -132 (01 /0$) Page 1 of 2
5. Any person or organization specifically designated as an additional insured for ongoing operations by a
separate ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS endorsement issued by
us and made a part of this policy.
C. The limits of insurance applicable to the additional insured are those specified in a written contract or written
agreement or the limits of insurance as stated in the Declarations of this policy and defined in SECTION III --
LIMITS OF INSURANCE of this policy, whichever are less. These limits are inclusive of and not in addition to
the limits of insurance available under this policy.
D. With respect to the coverage afforded by this endorsement, SECTION N— COMMERCIAL GENERAL
LIABILITY is amended as follows:
1. The following is added to Condition 2. Duties In The Event Of Occurrence, Claim Or Suit:
An additional insured under this endorsement will as soon as practicable:
a. Give written notice of an "occurrence" or an offense, that may result in a claim or "suit" under this
insurance to us;
b. , Tender defense and indemnity of any claim or "suit" to all insurers whom also have insurance
available to the additional insured; and
c. Agree to advise us of any other insurance which the additional insured has for a loss we cover under
this Coverage Part.
However, this condition does not affect whether the insurance provided to the additional insured by this
endorsement is primary as described in Condition 4.a. as amended by this endorsement.
2. Condition 4. Other Insurance is amended as follows:
a. The following is added to paragraph a. Primary Insurance:
With respect to other insurance for which the additional insured is designated as a Named Insured, this
insurance will be primary if you and the additional insured have agreed in writing, in a contract or
agreement, that this insurance is primary or primary and non - contributory. Our obligations are not
affected unless any of the other insurance is also primary. Then, we will share with all that other
insurance by the method described in provision 4.c. Method of Sharing
b. The following is added to paragraph b. Excess Insurance:
When the written agreement between you and the additional insured does not require this insurance to
be primary or primary and non - contributory, this insurance is excess over any other insurance for which
the additional insured is designated as a Named Insured.
Regardless of the written agreement between you and the additional insured, this insurance is excess
over any other insurance whether primary, excess, contingent or on any other basis for which the
additional insured has been added as an additional insured by attachment of an endorsement or
otherwise.
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22 -132 (01108) Page 2 of 2
POLICY NUMBER: GL6876555
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
ADDITIONAL INSURED — AUTOMATIC STATUS WHEN REQUIRED IN A CONSTRUCTION AGREEMENT
WITH YOU — CONTRACTORS — COMPLETED OPERATIONS
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
A. Paragraph 2. under SECTION 11 —WHO IS AN INSURED is amended to include any person or organization,
when you and such person or organization have agreed in writing in a contract or agreement that such person
or organization be added as an additional insured on your policy, but only with respect to liabilityfor "bodily
injury" or "properly damage ":
1. Caused by "your work' performed for that additional insured that is the subject of the written contractor
agreement; and
2. Included in the "products- completed operations hazard ".
The insurance provided by this endorsement applies only if the written contract or agreement is executed prior
to the "bodily injury" or "property damage ".
We have no duty to defend an additional insured under this endorsement until we receive written notice of a .
claim or "suit" as required in provision b" of Condition 2. Duties In the Event Of Occurrence, Of ens% Chaim
Or Suit under SECTION IV— COMMERCIAL GENERAL LIABILITY CONDITIONS.
B. With respect to the insurance provided by this endorsement, the following are added to paragraph 2. Exclusions
under COVERAGE A BODILY INJURY AND PROPERTY DAMAGE LIABILITY (SECTION I — COVERAGES):
This insurance does not apply:
1. To "bodily injury" or "property damage" arising out of any act or omission of the additional insured or the
additional insured's employees; or
2. To "bodily injury" or "property damage" that occurs prior to you commencing operations at the location
where such "bodily injury" or "property damage" occurs.
3, To "bodily injury" or "property damage" arising out of the rendering of, or the failure to render, any
professional architectural, engineering or surveying services including:
a. The preparing, approving or failure to prepare or approve, maps, shop drawings, opinions, reports,
surveys, field orders, change orders or drawing and specifications; and
b. Supervisory, inspection, architectural or engineering activities; or
C. With respect to the insurance afforded by this endorsement, the following is added to SECTION III — LIMITS OF
INSURANCE:
The Limits Of Insurance applicable to the additional insured are the lesser of:
1. The amount specified in a written contractor written agreement between you and the person or
organization described in paragraph A. above; or
2. The amount shown in the Declarations for this Coverage Part.
These Limits of Insurance are inclusive of, and not in addition to, the Limits of Insurance shown in the
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22 -135 (01108) Page 1 of 2
Declarations for this Coverage Part as described in this SECTION III — LIMITS OF INSURANCE,
D. With respect to the insurance afforded by this endorsement, SECTION IV — COMMERCIAL GENERAL
LIABILITY CONDITIONS is amended as follows:
1. The following is added to condition 2. Duties in The Event Of Occurrence, Offense, Claims Or Suit:
An additional insured under the
At�t+�ia�trfr#1tr endorsement must comply
provisions of this condition.
2. With respect to the insurance afforded by this endorsement, provision b. Excess Insurance of condition 4.
Other Insurance is replaced by the following:
4. Other Insurance
b. Excess Insurance
This insurance is excess over any other insurance for which the additional insured qualifies as
an insured whether primary, excess, contingent or on any other basis unless the written
contract orwritten agreement between you and the person of organization described above
specifically requires that this insurance be provided on either a primary basis or a primary and
noncontributory basis.
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22 -135 (01 /00) Page 2 of 2
POLICY NUMBER: GLSB76555
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US - WHEN REQUIRED IN A
CONTRACT OR AGREEMENT WITH YOU
This endorsement modifies insurance provided under the following:
COMMERCIAL_ GENERAL LIABILITY COVERAGE PART
The TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US Condition (Section N — COMMERCIAL
GENERAL LIABILITY CONDITIONS) is amended by the addition of the following:
We waive any right of recovery we may have against a person or organization because of payments we make for injury or damage
arising out of your ongoing operations or "your work" done under a contract with that person or organization and included in the
"products- completed operations hazard" provided:
1. You and that person or organization have agreed in writing In a contract or agreement that you waive such rights against that person
or organization; and
2. The injury or damage occurs subsequent to the execution of the written contract or agreement
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22 -126 (01108) Page 1 of 1
POLICY NUMBER: BA6876553
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
BUSINESS AUTO EXTENSION ENDORSEMENT
COVERAGEINDEX
Description
TEMPORARY SUBSTITUTE AUTO PHYSICAL DAMAGE
BROAD FORM INSURED
EMPLOYEES AS INSUREDS
ADDITIONAL INSURED BY CONTRACT, AGREEMENT OR PERMIT
SUPPLEMENTARY PAYMENTS
AMENDED FELLOW EMPLOYEE EXCLUSION
HIRED AUTO PHYSICAL DAMAGE
TOWING AND LABOR
PHYSICAL DAMAGE- ADDITIONAL TRANSPORTATION EXPENSE COVERAGE
RENTAL REIMBURSEMENT
EXTRA EXPENSE - BROADENED COVERAGE
PERSONAL EFFECTS COVERAGE
AIRBAG COVERAGE
LEASE GAP
GLASS REPAIR - WAIVER OF DEDUCTIBLE
DRIVE OTHER CAR FOR EXECUTIVE OFFICERS
UNINTENTIONAL FAILURE TO DISCLOSE HAZARDS
AMENDED DUTIES IN THE EVENT OF ACCIDENT, CLAIM, SUIT, OR LOSS
BODILY INJURY REDEFINED
EXTENDED CANCELLATION CONDITION
The following modifies insurance under the:
BUSINESS AUTO COVERAGE FORM
1. TEMPORARY SUBSTITUTE AUTO PHYSICAL DAMAGE
SECTION I - COVERED AUTOS, paragraph C. is changed by adding the following:
Page
1
2
2
2
2
3
3
3
3
4
4
4
4
4
5
6
7
7
7
7
If Physical Damage Coverage is provided under the Business Auto Coverage Form for an "auto" you
own, the Physical Damage coverages provided for that owned "auto" are extended to any "auto" you
do not own while used with the permission of its owner as a temporary substitute for the covered
"auto" you own that is out of service because of its breakdown, repair, servicing, "loss ", or destruction.
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16 -59f (05104) Page 1 of 7
2. BROAD FORM INSURED
SECTION II - LIABILITY COVERAGE - WHO IS AN INSURED is amended to include as an insured:
1. Any legally incorporated entity of which you own more than 50 percent of the voting stock during
the period for which this endorsement is effective, if there is no similar insurance available to that
organization. However, the Named Insured does not include any organization:
a. that is a partnership or joint venture, or
b. that is an insured under any other policy, or has exhausted its Limit of Insurance under any
other policy.
2. . Paragraph 1. b. above does not apply to a policy written to apply specifically in excess of this
policy.
3. Coverage for newly acquired or formed organizations is afforded only for 180 days from the date
of acquisition or formation.
4. Coverage does not apply to "bodily injury" or "property damage" that results from an "accident'
that occurred before you formed or acquired that organization.
3. EMPLOYEES AS INSUREDS
SECTION II - LIABILITY COVERAGE - WHO IS AN INSURED is amended to include as an insured:
Any employee of yours while using a covered "auto" you do not own, hire or borrow in your business
or your personal affairs.
�C 4. ADDITIONAL INSURED BY CONTRACT, AGREEMENT OR PERMIT
SECTION ll - LIABILITY COVERAGE - WHO IS AN INSURED is amended to include as an insured
any person or organization with whom you have agreed in writing in a contract, agreement or permit,
to provide insurance such as is afforded under this policy.
This provision 4. does not apply unless the written contract or agreement has been executed, or
permit has been issued, prior to the "bodily injury" or "property damage."
S. SUPPLEMENTARY PAYMENTS
SECTION It - LIABILITY COVERAGE, 2.a. Supplementary Payments, items (2) and (4) are replaced
by the following:
(2) Up to $2500 for cost of bail bonds (including bonds for related traffic violations) required because
of an "accident' we cover. We do not have to furnish these bonds.
(4) All reasonable expenses incurred by the insured at our request, including actual loss of earnings
up to $300 a day because of time off from work.
6. AMENDED FELLOW EMPLOYEE EXCLUSION
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16 -59f (05104) Page 2 of 7
SECTION 11 - LIABILITY, exclusion 5. FELLOW EMPLOYEE does not apply if the "bodily injury"
results from the use of a covered "auto" you own or hire.
The insurance provided under this provision 6. is excess over any other collectible insurance.
7. HIRED AUTO PHYSICAL DAMAGE
SECTION III - PHYSICAL. DAMAGE COVERAGE, A. COVERAGE, is amended by adding the
following:
If hired "autos" are covered "autos" for Liability Coverage, and if Comprehensive, Specified Causes of
Loss, or Collision coverage are provided under the Business Auto Coverage Form for any "auto" you
own, then the Physical Damage coverages provided are extended to "autos" you hire, subject to the
following limit and deductible:
The most we will pay for "loss" to any hired "auto" is $50,000 or Actual Cash Value or Cost of
Repair, whichever is smallest, minus a deductible.
The deductible will be equal to the largest deductible applicable to any owned "auto" for that
coverage. No deductible applies to "loss" caused by fire or lightning.
Subject to the above limit, deductible and excess provisions, we will provide coverage equal to the
broadest coverage applicable to any covered "auto" you own.
Subject to a maximum of $750 per "accident ", we will also cover loss of use of the hired "auto" if it
results from an "accident ", you are legally liable, and the lessor incurs an actual financial loss.
The insurance provided under this provision 7. is excess over any other collectible insurance.
8. TOWING AND LABOR
SECTION III - PHYSICAL DAMAGE COVERAGE, A.2.Towing, is replaced by the following:
We will pay towing and labor costs incurred, up to the limits shown below, each time a covered "auto"
classified and rated as a private passenger type, "light truck" or "medium truck' is disabled:
a. For private passenger type vehicles, we will pay up to $50 per disablement.
b. For "light trucks" that have a gross vehicle weight (GVW) of 10,000 pounds or less, we will pay up
to $50 per disablement.
c. For "medium trucks" that have a gross vehicle weight (GVW) of 10,001 - 20,000 pounds, we will pay
up to $150 per disablement.
However, the labor must be performed at the place of disablement.
S. PHYSICAL DAMAGE- ADDITIONAL TRANSPORTATION EXPENSE COVERAGE
SECTION ill - PHYSICAL DAMAGE COVERAGE, A.4. Coverage Extension, is amended to provide a
limit of $50 per day and a maximum limit of $1000.
10. RENTAL REIMBURSEMENT
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Copyright, Insurance Services Office, Inc., 1997
16 -59f (05104) Page 3 of 7
SECTION ill - PHYSICAL DAMAGE COVERAGE, A. COVERAGE, is amended by adding the
following:
We will pay for rental reimbursement expenses incurred by you for the rental of an "auto" because of
.'accident" or "loss ", other than theft, to a covered "auto ". We will pay only for those expenses incurred
after the first 24 hours following the "accident" or "loss" to the covered "auto."
The most we will pay for any one "accident" or "loss" is $1000. No deductible applies to this coverage.
11. EXTRA EXPENSE -BROADENED COVERAGE
Under SECTION 111 - PHYSICAL DAMAGE COVERAGE, A. COVERAGE, we will pay for the expense
of returning a stolen covered "auto" to you.
12. PERSONAL EFFECTS COVERAGE
A. SECTION III -PHYSICAL DAMAGE COVERAGE, A. COVERAGE, is amended by adding the
following-.
If you have purchased Comprehensive Coverage on this policy for an "auto" you own and that
"auto" is stolen, we will pay, without application of a deductible, up to $600 for "personal effects"
stolen with the "auto."
The insurance provided under this provision 12. is excess over any other collectible insurance.
B. SECTION V -DEFINITIONS is amended by adding the following:
"Personal effects" means tangible property that is worn or carried by an "insured ". "Personal
effects" does not include tools, jewelry, money or securities.
13. AIRBAG COVERAGE
SECTION III - PHYSICAL DAMAGE COVERAGE, B. EXCLUSIONS is amended by adding the
following:
If you have purchased Comprehensive or Collision Coverage under this policy, the exclusion relating
to mechanical breakdown does not apply to the accidental discharge of an air bag,
14.. LEASE GAP
A. SECTION III -PHYSICAL DAMAGE COVERAGE -LIMIT OF INSURANCE is amended by adding
the following:
The most we will pay for a "total loss" in any one "accident" is the greater of the:
1. Balance due under the terms of the loan or lease to which the damaged covered "auto" is
subject at the time of the "loss" less the amount of:
a. Overdue payments and Financial penalties associated with those payments as of the date
of the "loss ",
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16 -59f (05104) Page 4 of 7
b. Financial penalties imposed under a lease due to high mileage, excessive use or
abnormal wear and tear,
c. Costs for extended warranties, Credit Life Insurance, Health, Accident or Disability
Insurance purchased with the loan or lease,
d. Transfer or rollover balances from previous loans or leases,
e. Final payment due under a "Balloon Loan ",
f. The dollar amount of any unrepaired damage which occurred prior to the "total loss" of a covered "auto ",
g. Security deposits not refunded by a lessor,
h. All refunds payable or paid to you as a result of the early termination of a lease agreement
or as a result of the early termination of any warranty or extended service agreement on a
covered "auto ",
i. Any amount representing taxes,
j. Loan or lease termination fees, or;
2. The actual cash value of the damaged or stolen property as of the time of the "loss ".
B. ADDITIONAL CONDITIONS
This coverage applies only to the original loan or lease written on a covered "auto ".
C. SECTION V -DEFINITIONS is changed by adding the following:
As used in this endorsement:
"Total loss" means a "loss" in which the cost of repairs plus the salvage value exceeds the actual
cash value.
"Balloon loan" is one with periodic payments that are insufficient to repay the balance over the
term of the loan, thereby requiring a large final payment.
1 S. GLASS REPAIR - WANER OF DEDUCTIBLE
SECTION III - PHYSICAL DAMAGE COVERAGE is amended by adding the following to D.
DEDUCTIBLE:
No deductible applies to glass damage if the glass is repaired rather than replaced.
16. DRIVE OTHER CAR FOR EXECUTIVE OFFICERS
A. This provision 17. changes only those coverages where a limit and premium is shown in the
Declarations.
B. CHANGES IN LIABILITY COVERAGE:
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16 -59f (05104) Page 5 of 7
Any "auto" you do not own, hire or borrow is a'covered 'auto" for Liability Coverage while being
used by any of your "executive officers ", except:
Any "auto" owned by that "executive officer' or a member of that person's household, or
Any "auto" used by that "executive officer" while working in a business of selling, servicing,
repairing or parking "autos ".
C. CHANGES IN AUTO MEDICAL PAYMENTS AND UNINSURED MOTORISTS AND
UNDERINSURED MOTORISTS COVERAGE
The following is added to WHO IS AN INSURED:
Any individual "insured" and his or her "family members" are "insured" while "occupying" or while a
pedestrian when being struck by any "auto" you do not own except:
Any "auto" owned by that individual or by any "family member".
D. CHANGES IN PHYSICAL DAMAGE COVERAGE.
Any private passenger type "auto" you do not own, hire or borrow is a covered "auto" while in the
care, custody or control of any of your "executive officers" except:
Any "auto" owned by that individual or by any member of his or her household.
Any "auto" owned by that individual or his or her spouse while working in a business of selling,
servicing, repairing or parking "autos ".
E. ADDITIONAL DEFINITIONS:
As used in this endorsement:
"Executive officer" means a person holding any of the officer positions created by your charter,
constitution, by -laws or any other similar governing document, and that person's spouse, while a
resident of the same household.
"Family member" means a person related to an "executive officer" by blood, marriage or adoption
who is a resident of the individual's household, including a ward or foster child.
F. The insurance provided under this provision 17. will be:
Equal to the broadest of those coverages afforded any covered "auto ", and
Excess over any other collectible insurance.
17. UNINTENTIONAL FAILURE TO DISCLOSE HAZARDS
SECTION IV - BUSINESS AUTO CONDITIONS is amended by adding the following:
If you unintentionally fail to disclose any hazards or exposures existing as of the inception date of the
Business Auto Coverage Form, the coverage afforded by this policy will not be prejudiced. However,
you must report the undisclosed hazard or exposure as soon as practicable after its discovery, and we
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Copyright, Insurance Services Office, Inc., 1997
16 -59f (05/04) Page 6 of 7
have the right to collect additional premium for same.
i& AMENDED DUTIES IN THE EVENT OF ACCIDENT, CLAIM, SUIT, OR "LOSS"
SECTION IV - BUSINESS AUTO CONDITIONS, paragraph A.2.a. is amended by adding the
following:
You must give us notice of an "accident ", claim, "suit" or "loss" only when it is known to:
1. You, if you are an individual,
2. A partner, if you are a partnership,
3. A member, if you are a limited liability company, or
4. An executive officer or the "employee" designated by the Named Insured to give such notice; if
you are a corporation.
19. BODILY INJURY REDEFINED
Under SECTION V - DEFINITIONS, definition C. is replaced by the following:
"Bodily Injury" means physical injury, sickness or disease sustained by a person including mental
anguish, mental injury, shock, fright or death resulting from any of these at anytime.
20. EXTENDED CANCELLATION CONDITION
The COMMON POLICY CONDITIONS - CANCELLATION provision applies except as follows:
If we cancel for any reason other than nonpayment of premium, we will mail or deliver to the first
Named Insured written notice of cancellation at least 60 days before the effective date of cancellation.
This provision 20. does not apply in those states which require more than 60 days prior notice of
cancellation.
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Copyright, Insurance Services Office, Inc., 1997
16 -59f (05104) Page 7 of 7
Policy Number: BA6876553
Commercial Auto
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
WAIVER OF TRANSFER OF RIGHTS OF
RECOVERY AGSINST OTHERS TO US
This endorsement modifies insurance provided under the following:
BUSINESS AUTO COVERAGE FORM
SCHEDULE
Name of Person or Organization:
AS REQUIRED BY WRITTEN INSURED CONTRACT
(If no entry appears above, information required to complete this endorsement will be shown in
the Declarations as applicable to this endorsement.)
The TRANSFER OR RIGHTS OF RECOVERY AGAINST OTHERS TO US Condition (Sectlon IV
— BUSINESS AUTO CONDITIONS, A. Loss Conditions, 5. Transfer of Rights of Recovery
Against Others to Us) is amended by the addition of the following;
We waive any right of recovery we may have against the person(s) or organization(s) shown in
the Schedule above if you have agreed to waive such right in a written contract or agreement.
Our waiver only applies to payments we make for "bodily injury" or property damage" arising out
of an "accident' and resulting from the ownership, maintenance or use of a covered "auto ".
This waiver applies only to the person(s) or organization(s) shown in the Schedule above.
BLANK
Tei-imsKug WORKERS' COMPENSATION AND EMPLOYERS
LIABILITY INSURANCE POLICY WC 42 03 04 A
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.
Schedule
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 2.00 percent of the premium developed on payroll in
connection with work performed for the above person(s) or organizations) arising out of the operations described.
4. Advance Premium INCLUDED, SEE INFORMATION PAGE,
This endorsement changes the policy to which It is attached effective on the inception date of the policy uniess a different dale 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 an 07/19/11 at 12:01 A-M. standard time, forms a part of
Policy No. TSF- 0001119432 of the Texas Mutual Insurance Company
Issued to RCM CONSTRUCTORS INC
Endorsement No.
Premium $ f
d �t�
Authorized Representative
WC4203"A (ED. 1.01-2000)
INSURED'S COPY
rurruslu a u % uo
Policy Number: BA 6876553
Coverage is Provided In PEERLESS INDEMNITY INSURANCE COMPANY
Named Insured:
Agent:
RCM CONSTRUCTORS INC
HIGGINBOTHAM & ASSOCIATES INC
Agent Code: 8711144 Agent Phone: (351)4M3 -1711
THIS ENDORSEMENT CHANGES YOUR POLICY. PLEASE READ IT CAREFULLY.
WAIVER OF TRANSFER OF RIGHTS OF RECOVERY
AGAINST OTHERS TO US
The endorsement modifies Insurance provided under the following:
BUSINESS AUTO COVERAGE FORM
GARAGE COVERAGE FORM
The Transfer Of Rights of Recovery Against Others To Us Condition does not apply to the person(s), or
organization(s) shown in the Schedule, but only to the extent that subrogation is waived prior to the "accident' or
the gloss" under a contract with that person or organization.
SCHEDULE
Name(s) of Person(s) or Organization(s):
BLANKET AS REQUIRED BY WRITTEN CONTRACT
(If no name appears above, the information required to complete this endorsement will be shown in the
Declarations as applicable to this endorsement).
1"7(11/09)
INSURED COPY
mr4 Pi" 4 6878663 NTCODCME= PODM0WD J07379 ACAFPPN O0001S17 P8P 9
ENDORSEMENT
CI■■wnlnm s f oe# Af
NWdml .d America First
Tbmuo Insurance.
MV"0.Mw►*Aw&r
Policy Number: BA 8876553
Coverage Is Provided In PEERLESS INDEMNITY INSURANCE COMPANY
Named Insured:
Agent
RCM CONSTRUCTORS INC
HIGGINBOTHAM A ASSOCWTES INC
Agent Code: 8711144 Agent Phone: (381)883 -1711
f
COMMERCIAL AUTO COVERAGE PART DECLARATIONS EXTENSION
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT
CAREFULLY
AMENDMENT OF CANCELLATION PROVISIONS
This endorsement modifies insurance provided under t h
e following.
Business Auto Coverage Form
Garage Covver age Form
Motor Carrier Coverage Form
In the event of cancellation for any statutorily perm
I t t ed reasons other then nonpayment of premium, we ag
r ee to ma i 1 prior notice of cancellation to:
SCHEDULE
1. Name: BLANKET AS REQUIRED BY WRITTEN CONTRACT
2. Address:
3. Number of Dayas Advance Not Ice: _30,-„.,, except
f or non payment of premium.
FAILURE TO MAIL SUCH NOTICE SHALL NOT IMPOSE ANY
OBLIGATION OR LIABILITY OF ANY KIND UPON US.
Date Issued: 020232012
17 -59CA (06194)
INSURED COPY
------- lrwvm n An ACODU 1%VwMr,4C Pl 44
® WORKERS' COMPENSATION AND EMPLOYERS
e'j (aSM U LIABILITY INSURANCE POLICY t1
Ia==C *W WC 42 06 01
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 event 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 indirectly 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
ENGINEERING SERVICES
P.O. BOX 9277
CONTRACT ADMINISTRATOR
CORPUS CHRISTI, TX 78469 -9277
This endorsement changes the policy to which it Is attached effective on the inception date of the policy unless a different 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 April 5, 2012 at 12:01 A.M. standard time, forms a part of
Policy No. TSF- 0001119432 201 10719 of the Texas Mutual Insurance Company
Issued to RCM CONSTRUCTORS INC
Endorsement No. 2
Premium $ 0.00
Authorized Representative
WC420801 (ED. 1.94)
INSURED'S COPY WASENDRS 4 -05 -2012
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
ADDITIONAL INSURED - AMENDMENT OF CANCELLATION PROVISIONS
OR COVERAGE CHANGE
Any term or provision of the Cancellation Conditions of the policy or any endorsement amending or replacing such
Conditions is amended by the following:
If you have agreed in a written contract or written agreement to provide a person or organization who qualifies
as an additional insured under this policy a notice of cancellation and/or material change that reduces or
restricts the insurance afforded by this Coverage Part we agree to the following:
a. Provide 30 days prior written cancellation notice for reasons other than nonpayment of premium
and /or 30 days prior written notice of coverage change per schedule of additional insureds provided
to us.
Q 2010 Liberty Mutual Insurance Company. Al rights reserved.
Includes copyrighted material of Insurance Services office, Inc. with its permission,
17.491 (10110) Page 1 of 1