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HomeMy WebLinkAboutC2013-068 - 1/22/2013 - Approved(Revised 6/27/99) ETHEL EYERLY SENIOR CENTER EXPANSION PHASE 1 (CDBG FUNDS) CITY PROJECT NUMMP. E11126 TABLE OF CONTENTS NOTICE TO BIDDERS (Revised 7/5/20130) NOTICE TO CONTRACTORS - A Insurance Requirements (Revised March 2009) NOTICE TO CONTRACTORS - B Worker's Compensation Coverage For Building or Construction Projects For Government Entities PART A - SPECIAL PROVISIONS A -1 Time and Place of Receiving Proposals /Pre --Bid Meeting A -2 Definitions and Abbreviations A--3 Description of Project A -4 Method of Award A -5 Items to be Submitted with Proposal. A -6 Time of Completion /Liquidated Damages A--7 Workers Compensation Insurance Coverage A -8 Faxed Proposals A -9 Acknowledgment of Addenda A -10 rage Rates (Revised 7/5/00) A -11 Cooperation with Public Agencies (Revised 7/5/00) A -12 Maintenance of Services A 1; At-@a Aaeeos and NOT USED A -14 Construction Equipment Spillage and Tracking A -15 Excavation and Removals A-16 Disposal /Salvage of Materi A -31 Amended Policy on Extra Work and Change Orders A -32 Amended "Execution of Contract" Requirements A -33 Conditions of Work A -34 Precedence of Contract Documents Speeial NOT USED A -36 Ether Submittals (Revised 9/18/00) A 3W Amended " NEST USED A-38 Worker's Compensation Coverage for Building or Construction Projects for Government Entities A -39 Certificate of Occupancy and Final.Acceptance A-40 Amendment to Section 8-8 -6: Partial Estimates NOT USED A -42 OSHA Rules &.Regulations A--43 Amended Indemnification & Hold Harmless (9/98) A -44 Charge Orders (4/26/99) A -45 As Built Dimensions and Drawings (7/5/00) NOT USED NOT USED A -48 Overhead Electrical. Wires {7/5/00} A. -49 Amend "Maintenance guaranty" (8/24/00) A -50 Windstorm Certification' A -51 Amended Prosecution and Progress Submittal Transmittal Form .Attachment 1 - Project Sign - PART B - GENERAL PROVISIONS PART C - FEDERAL WAGE RATES AND REQUIRENENTS PART C -1 -- FEDERALLY. REQUIRED LANGUAGE PART T - TECHNICAL SPECIFICATIONS DIVISION 2 Section 02050 Section. 02230 Section 02316 Section 02317 Section 02362 Section 02775 SITEWORR Selective Demolition Partial Site Clearing Structural Excavation and Backfill Excavation and Fill Termite Control Concrete Sidewalks DIVISION 3 - CONCRETE Section 0310€3 - Concrete Formwork Section 0320€3 - Concrete Reinforcement Section 03300 - Cast -in. -Place Concrete Section 03370 - Concrete Curing DIVISION 4 - MASONRY Section. 04100 Mortar and Masonry Grout Section 0482€; - Reinforced Unit Masonry Assemblies Page 2 of 5 DIVISION 5 - METALS Section 05120 - Structural Steel Section 05310 - Steel Decking Section 05400 - Cold- Farmed Metal Framing Section 05500 - Metal Fabrications DIVISION F - WOOD AND PLASTICS Section 06112 - Rough Carpentry Section 06200 - Finish Carpentry Section 06400 - Architectural Woodwork DIVISION 7 - THERMAL AND MOISTURE PROTECTION Section 07214 - Foamed-In-Place Masonry Wall Insulation Section 07460 - Preformed Metal Soffits Section 07550 - Modified Bitumen Roof System. Section: 07600 Flashing and Sheet Mewl Section 07840 - Firestopping Section 07900 - Joint Protection DIVISION 8 - DOOR AND WINDOW'S Section €38110 - Standard Steel Frames Section 08160 - Aluminum Sliding Glass Doors .Section 082:12 - Flush Wood doors Section 08331 - Overhead Coiling Counter Fire Doors Section 08400 - Aluminum Entrances and Storefronts Section 08710 _ boor Hardware Section 08713.- Power Door Operators Section 08800 -- Glazing DIVISION 9 - FINISHES Section 09300 - Tile Section 09510 - Acoustical Ceilings Section 09650 - resilient Flooring Section 09900 - Paints and Coatings DIVISION 10 - SPECIALTIES Section 10170 -- Plastic Toilet Compartments Section 10440 - Signage Section 10523 Fire Extinguisher Cabinet Section 10800 - Toilet and Bath Accessories DIVISION 15 -- Mechanical Section 15050 - Basic Materials Methods Section 15051 - Starting of Systems Section 1507€1 -- Inside Utility Trench Excavation, Sackfill and Compaction Section 15080 - Outside Utility 'drench Excavation, Backfill and Compactiaxa Section 15140 - Supports and Anchors Section 1.51.7€1 - Motors and Motor Controllers Section 15190 - System Identification & Pipe Marking Section 15240 - Sound & Vibration Control Section 15260 Piping Insulation Section 15290 - Duct Insulation Section 154111 - Plumbing Wiping & Valves Section 15440 - Plumbing Fixtures Section 15530 - Refrigerant Piping Section 15671 - Air Cooled Condensing Unit Page 3 of 5 Section 15854 Section 15860 Section 15851 Section 15885 Section 15890 Section 15910 Section 15950 Section 15990 - "Dx" Fan Coil. Unit - Power Ventilators - Air Distribution Devices - Air Filters - Metal. Ductwork - Ductwork Accessories - Controls Testing, Adjusting, & Balancing DWISIQN 16 SECTION 16010 - SECTION 16060 SECTION 16075 - SECTION 16123 SECTION 16136 - SECTION 16140 - SECTION 16441. - SECTION 16510 - SECTION 16740 - - ELECTRICAL ELECTRICAL GENERAL PROVISIONS GROUNDING ELECTRICAL IDENTIFICATION WIRE AND CABLE RACEWAYS WIRING DEVICES DISCONNECT SWITCHES LUMINAIRES TELEPHONE I DATA SYSTEM Appendix A- ASBESTOS SURVEY REPORT LIST OF DRAWINGS Sheet #1 TITLE SHEET Sheet. #2 ACCESSIBILITY DATA SHEET Sheet #3 EGRESS PLAN, VAIN CANOPY PLAN, & DETAILS Sheet #A- SITE PLAITS, CANOPY SECTIONS Sheet #5 SITE DETAILS Sheet #6 . SELECTIVE DEMOLITION PLAN Sheet #7 FLOOR PLAN, ROOM FINISH SCHEDULE, & DETAILS Sheet #8 REFLECTED CEILING PLAN, ROOT:' PLAN, & DETAILS Sheet #9 EXTERIOR ELEVATIONS & INTERIOR ELEVATIONS Sheet #10 PARTITION SCHEDULE & WALL SECTIONS Sheet #11 DOOR SCHEDULE, DOOR & 14INDOW DETAILS Sheet 412 STRUCTURAL NOTES Sheet #13 FOUNDATION PLAN, ROOF FRAMING PLAN, DETAILS Sheet #14 DETAILS Sheet #15 MECHANICAL DEMOLITION PLAN Sheet Sheet #16 MECHANICAL FLOOR PLAN #23 Sheet #17' ADDITIVE ALTERNATE BID #1 MECRANICAL FLOOR PLAN Sheet #18 ADDITIVE ALTERNATE BID #1 MECHANICAL FLOOR PLAN Sheet #19 ADDITIVE ALTERNATE BID #1 MECHANICAL SCHEDULE PIAN Sheet #20 BASE BIT? AND ADDITIVE ALTERNATE BID #1 MECHANICAL DETAIL PLAN Sheet #21 ELEC'T'RICAL DEMO PLAN Sheet #22 ALTERNATE #1 ELECTRICAL DEMO PLAN Sheet #23 ELECTRICAL POWER PLAN Sheet #24 ALTERNATE #1 ELECTRICAL POWER PLAN Sheet #25 ELECTRICAL LIGHTING PLAN Sheet #26 FIRE ALARM & SECURITY PLAN Sheet #27 ELECTRICAL LEGEND & DETAILS Sheet #28 DEMOLITION PLUMBING PLAN Sheet #29 PLUMBING PLAN Sheet #30 PLUMBING SCH8DULES & DETAILS Page 4 of 5 NOTICE AGREEMENT PROPOSAL /DISCLOSURE STATEMENT PERFORMANCE HONK PAYMENT BOND Page 5 of 5 NOTICE TO BIDDERS NOTICS TO BIDDERS Sealed proposals, addressed to the City of Corpus Christi, Texas for: ZTMM ZySRLY SSNIOR CENTER =PANSTON P1 ASH 1 (CDBG F'MS) , Project No. 811126 Consists of all 'Work for an addition and remodel of existing Facility including selective demolition of existing interior and exterior walls, standard steel doors and frames, and flooring. The addition shall include site clearing and stripping; concrete sidewalks, termite control; cast -in -place concrete; concrete slab on grade; metal fabrications; steel roof joists and metal roof deck; masonry walls; rough carpentry; finish carpentry and architectural wood casework; exterior masonry sealant; blanket insulation and masonry foam insulation; gutters and downspouts; modified bitumen roofing; fire stopping; joint, sealants; standard steel doors and frames; flush wood doors; aluminum storefront; door hardware; glazing; ceramic tile; VCT flooring; suspended acoustic ceiling systems; paint and coatings; mechanical systems; replacement of existing mechanical system; plumbing system and fixtures; electrical power system and lighting fixtures; final site clean -up and proper disposal.of debris /waste and is funded through the Comm m ity Development Act of 1974 (Community Development Block Grauts - CDBQ) ; complete in accordance with the plans, specifications, and contract documents; Bids will be received at the office of the City Secretary until 2:00 PM on edtse fl.2, October 10, 2012 and then publicly opened and read. Any bid received after closing time will be returned unopened. A pre -bid meeting is scheduled for Wednesday, October 3, 2012 beginning at 10;.00 A%, at the Engineering Services Main Conference Room, 3 __ _ Floor City Hall, 1201 Leopard Street., Corpus Christi., Texas. The pre -bid meeting will be conducted by City staff and Project Architect Chuck Anaastos, A.I.A. will be available for questions and answers. .At bid bond in the amount of 5'k of the highest amount bid must accompany each proposal. Failure to provide the bid bond will constitute a aeon- responsive proposal which will not be considered. Failure to provide required performance and payment bonds for contracts over $25,000.00 will result in-forfeiture of the SAS bid bond to the C'it'y' as liquidated damages. Bidder's plan deposit is subject to mandatory forfeiture to the City if bidding documents are not returned to the City within two weeks of receipt of.bids. Plans, proposal forms, specifications and contract documents may be procured from the City Engineer upon a deposit of Fifty and xxo /100 Dollars ($50.00) as a guarantee of their return in good condition within two weeks of bid date. Documents can be obtained by mail, upon receipt of an additional Ten and no/3.00 ($10.00) which is a non - refundable postage /handling charge. The bidder is hereby notified that the owner has ascertained the wage rates which prevail in the locality in which this work is to be done and that such wage scale is set out in the contract documents obtainable at the office of the City Engineer and the Contractor shall pay not less than the wage rates so shown for each craft or type: of "laborer," "wor7cman," or "mechanic" employed on this project. The City reserves the right to reject any or all bids, to waive i NOTICE TO CONTRACTORS - A NOTICE TO CONTRACTORS - A INSURANCE REQUIREMENTS Revised March, 2009 A Certificate of Insurance indicating proof of coverage in the following amounts is required: TYPE OF INSURANCE MINIMM INSLUMNCE COVERAGE 30 -Day Notice of Cancellation required on Bodily Injury and Property Damage all certificates PER OCCLMRENCE / AGGREGATE Commercial Genera. Liability .including: $2,000,000 COMBINED SINGLE LIMIT 1. Commercial Form 2. Premises - Operations 3. Explosion and Collapse Hazard 4. Underground Lazard 5. Products/ Completed Operations Hazard 6. Contractual Liability 7. Broad Form Property Damage 8. Independent Contractors 9. Personal Injury AUTOMOBILE LIABILITY - -OWNED NON - -OWNED $1,000,000 COMBINED SINGLE LIMIT OR RENTED WHICH COMPLIES WITH THE TEXAS WORKERS' WORKERS' COMPENSATION COMPENSATION ACT AND PARAGRAPH II OF THIS EXHIBIT EMPLOYERS' LIABILITY $500,000 EXCESS LIABILITY $1,000,000 COMBINED SINGLE LIMIT PROFESSIONAL POLLUTION LIABILITY/ $2,000,000 COMBINED SINGLE LIMIT ENVIRONMENTAL IMPAIRMENT COVERAGE Not limited to sudden & accidental ❑ REQUIRED di5oharge; to include. long -term environmental impact for the disposal of � NOT REQUIRED contaminants BUILDERS' RISK See Section B -6 -11 and Supplemental Insurance Requirements X REQUIRED ❑ NOT REQUIRED INSTALLATION FLOATER See Section B -6 -11 and Supplemental Insurance Requirements ❑ REQUIRED X NOT REQUIRED Page 1 of 2 The City of Corpus Christi must be named as an additional insured on all coverages except, worker's compensation liability coverage. The name of the project must be listed under "description of operations" on each certificate of insurance. For each insurance coverage, the Contractor shall obtain an endorsement to the applicable insurance policy, signed by the insurer, providing the City with thirty (30) days prior written notice of cancellation of or material change on any coverage. The Contractor shall provide to the City the other endorsements to insurance policies or coverages which are specified in section B -6--11 or Special Provisions section of the contract. A completed "Disclosure of interest" must be submitted with your proposal. Should you have any questions regarding Insurar=a requiremants, please contact the Contract Administrator at 880 -3500. Page 2 of 2 NOTICE TO CONTRACTORS - B NO T' I CE TO CONTRACTORS - R WORKER'S COMPENSATION INSURANCE REQUIREMENTS Page 1 of 11 Texas Administrative Code TITLE 28 INSURANCE PART 2 TEXAS DEPARTMENT OF INSURANCE, DIVISION OF WORKERS' COMPENSATION CHAPTER 110 REQUIRED NOTICES OF CO'V'ERAGE SUBCHAPTER R EMPLOYER. NOTICES RULE §110.110 Reporting Requirements for Building or Construction Projects for Governmental Entities (a) The following wards and terms, when used in this rule, shall have the following meanings, unless the context clearly indicates otherwise. Terms not defined in this rule shall have the meaning defined in the Texas Labor Code, if so defined. (1) Certificate of coverage (certificate) - -A copy of a certificate of insurance, a certificate of authority to self-insure issued by the commission, or a workers' compensation coverage agreement (TWCC -81, TWCC -82, TWCC -83, or TWCC -84), showing statutory workers' compensation insurance coverage for the person's or entity's employees (including those subject to a coverage agreement) providing services on a project, for the duration of the project. (2) Building or construction--Has the meaning defined in the Texas Labor Cade, §406.096(e)(1). (3) Contractor --A person bidding for or awarded a building or construction project by a governmental entity. (4) Coverage -- Workers' compensation insurance meeting the statutory requirements of the Texas Labor Code, §401.011(44). (5) Coverage agreement - -A written agreement on form TWCC -81, form TWCC -82, form TWCC -83, or form TWCC -84, filed with the Texas Workers' Compensation Commission which establishes a relationship between the parties for purposes of the Texas Workers' Compensation Act, pursuant to the Texas Labor Code, Chapter 406, Subchapters 1~ and G, as one of employer /employee and establishes who will be responsible for providing workers' compensation coverage for persons providing services on the project. (6) Duration of the project—Includes the time from the beginning of work on the project until the work on the project has been completed and accepted by the governmental entity. (7) Persons providing services on the project ( "subcontractor" in §406.096. of the Act) - -With the exception of persons excluded under subsections (h) and (i) of this section, includes all persons or entities performing all or part of the services the contractor has undertaken to perform on the project, regardless of whether that person contracted directly with the contractor and regardless of whether that person has employees. This includes but is not limited to independent contractors, subcontractors, leasing companies, motor carriers, owner-operators, employees of any such entity, or employees of any entity fishing persons to perform services on the project. Page 2 of l 1 "Services" includes but is not limited to providing, hauling, or delivering equipment or materials, or providing labor, transportation, or ether service related to a project. "Services" does not include activities unrelated to the project, such as food/beverage venders, office supply deliveries, and delivery of portable toilets. (8) Project -- Includes the provision of all services related to a building or construction contract for a governmental entity. (b) Providing or causing to be provided a certificate of coverage pursuant to this rule is a representation by the insured that all employees of the insured who are providing services on the project are covered by workers' compensation coverage, that the coverage is based on proper reporting of classification codes and payroll amounts, and that all coverage agreements have been filed with the appropriate insurance carrier or, in the case of a self - insured, with the commission's Division of Self - Insurance Regulation. Providing false or misleading certificates of coverage, or failing to provide or maintain required coverage, or failing to :report any change that materially affects the provision of coverage may subject the contractor or other person providing services on the project to administrative penalties, criminal penalties, civil penalties, or other civil actions. (c) A governmental entity that enters into a building or construction contract on a project shall; (l) include in the bid specifications, all the provisions of paragraph (7) of this subsection, using the language required by paragraph (7) of this subsection; (2) as part of the contract, using the language required by paragraph (7) of this subsection, require the contractor to perform as :required in subsection (d) of this section; (3) obtain from the contractor a certificate of coverage for each person providing services on the project, prior to that person beginning work on the project; - (4) obtain from the contractor a new certificate of coverage showing extension of coverage: (A) before the end of the current coverage period, if the contractors current certificate of coverage shows that the coverage period ends dung the duration of the project; and (B) no later than seven days after the expiration of the coverage for each other person providing services on the project whose current certificate shows that the coverage period ends during the duration of the project; (S) retain certificates of coverage on file for the duration of the project and for three years thereafter; (6) provide a copy of the certificates of coverage to the commission upon, request and to any person entitled to them by law, and (7) use the language contained in the following Figure 1 for bid specifications and contracts, without any additional words or changes, except those required to accommodate the specific document in which they are contained or to impose stricter standards of documentation: Attached Page 3 of I I (d) A contractor shall: (1) provide coverage for its employees providing services on a project, for the duration of the project based on proper reporting of classification codes and payroll amounts and filing of any coverage agreements; (2) provide a certificate of coverage showing workers' compensation coverage to the governmental entity prior to beginning work on the project, (3) provide the governmental entity, prior to the end of the coverage period, a new certificate of coverage showing extension of coverage, if the coverage period shown on the contractor's current certificate of coverage ends during the duration of the project; (4) obtain from each person providing services on a project, and provide to the governmental entity: (A) a certificate of coverage, prior to that person beginning work on the project, so the governmental entity will have on file certificates of coverage showing coverage for all persons providing services on the project; and (B) no later than seven days after receipt by the contractor, a new certificate of coverage showing extension of coverage, if the coverage period shown on the current certificate of coverage ends during the duration of the project; (5) retain all required certificates of coverage on file for the duration of the project and for one year thereafter; (6) notify the governmental entity in writing by certified mail or personal delivery, within ten days after the contractor knew or should have known, of any change that materially affects the provision of coverage of any person providing services on the project; (7) post a notice on each project site informing all persons providing services on the project that they are required to be covered, and stating how a person may verify current coverage and report failure to provide coverage. This notice does not satisfy other pasting requirements unposed by the Act or other commission rules. This notice must be printed with a title in at least 30 point bold type and text in at least 19 point nonnal type, and shall be in both English and Spanish and any ether language common to the worker population. The text for the notices shall be the following text provided by the conirnission on the sample notice, without any additional words or changes: Attached Qra hie (8) contractually require each person with whom it contracts to provide services on a project to: (A) provide coverage based on proper reporting of classification codes and payroll amounts and filing of any coverage agreements for all of its employees providing services on the project, for the duration of the project; (B) provide a certificate of coverage to the contractor prior to that person beginning work on the project; (C) include in all contracts to provide services on the project the language in subsection (e)(3) of this section; Page 4 of 11 (D) provide the contractor, prior to the end of the coverage period, a new certificate of coverage showing extension of coverage, if the coverage period shown on the current certificate of coverage ends during the duration of the project; (E) obtain from each other person with whore it contracts, and provide to the contractor: (i) a certificate of coverage, prior to the other person beginning work on the project; and (ii) prior to the end of the coverage period, a new certificate of coverage showing extension of the coverage period, if the coverage period shown on the current certificate of coverage ends during the duration of the project; (P) retain all required certificates of coverage on file for the duration of the project and for one year thereafter; (G) notify the governmental entity in writing by certified mail or personal delivery, within ten days after the person knew or should have known, of any change that materially affects the provision of coverage of any person providing services on the project; and (H) contractually require each other person with whom it contracts, to perform as required by subparagraphs (A) -(H) of this paragraph, with the certificate of coverage to be provided to the person for whom they are providing services. (e) A person providing services on a project, other than a contractor, shall: (1) provide coverage for its employees providing services on a project, for the duration, of the project based on proper reporting of classification codes and payroll amounts and filing of any coverage agreements; (2) provide a certificate of coverage as required by its contract to provide services on the project, prior to beginning work on the project; (3) have the fallowing language in its contract to provide services on the project: "By signing this contract or providing or causing to be provided a certificate of coverage, the person signing this contract is representing to the governmental entity that all employees of the person signing this contract who will provide services on the project will be covered by workers" compensation coverage for the duration of the project, that the coverage will be based on proper reporting of classification codes and payroll amounts, and that all coverage agreements will be filed with the appropriate insurance carrier or, in the case of a self-insured, with the commission's Division of Self - Insurance Regulation. Providing false or misleading information may subject the contractor to administrative penalties, criminal penalties, civil penalties, or other civil actions." (4) provide the person for whom it is providing services on the project, prior to the end of the coverage period shown on its current certificate of coverage, a new certificate showing extension of coverage, if the coverage period shown on the certificate of coverage ends during the duration of the project; (5) obtain from each person providing services on a project under contract to it, and provide as required by its contract: (A) a certificate of coverage, prior to the other person beginning work on the project; and (B) prior to the end of the coverage period, a new certificate of coverage showing extension of the coverage period, if the coverage period shown on the current certificate of coverage ends during the duration of the project; Page 5 of 1 l (f) retain all required certificates of coverage on file for the duration of the project and for one year thereafter; (7) notify the governmental entity in writing by certified mail or personal delivery, of any change that materially affects the provision of coverage of any person providing services on the project and send the notice within ten days after the person knew or should have known of the change; and (S) contractually require each other person with whom it contracts to: (A) provide coverage based on proper reporting of classification codes and payroll amounts and filing of any coverage agreements for all of its employees providing services on the project, for the duration of the project; (B) provide a certificate of coverage to it prior to that other person beginning work on the project; (C) include in all contracts to provide services on the project the language in paragraph (3) of this subsection; (D) provide, prior to the end of the coverage period, a new certificate of coverage showing extension of the coverage period, if the coverage period shown on the current certificate of coverage ends during the duration of the project; (1;) obtain from each other person under contract to it to provide services on the project, and provide as required by its contract: (i) a certificate of coverage, prior to the other person beginning work on the project.; and (ii) prior to the end of the coverage period, a new certificate of coverage showing extension of the coverage period, if the coverage period shown on the current certificate of coverage ends during the duration of the contract; (F) retain all required certificates of coverage on file for the duration of the project and for one year thereafter; (G) notify the governmental entity in writing by certified mail or personal delivery, within ten days after the person knew or should have known, of any change that materially affects the provision of coverage of any person providing services on the project; and (H) contractually require each person with whom it contracts, to perform as required by this subparagraph and subparagraphs (A)- (G) of this paragraph, with the certificate of coverage to be provided to the person for whom they are providing services. (f) If any provision of this rule or its application to any person or circumstance is held invalid, the invalidity does not affect other provisions or applications of this rule that can be given effect without the invalid provision or application, and to this end the provisions of this rule are declared to be severable. (g) This rule is applicable for building or construction contracts advertised for bid by a governmental entity on or after September 1, 1994. This rule is also applicable for those building or construction contracts entered into on or after September 1, 1994, which are not required by law to be advertised for bid. Page 6 of 11 (h) The coverage requirement in this rule does not apply to motor carriers who are required pursuant to Texas Civil Statutes, .Article 6675c, to register with the Texas Department of Transportation and who provide accidental insurance coverage pursuant to Texas Civil Statutes, .Article 6675c, §46). (i) The coverage requirement in this rule does not apply to sole proprietors, partners, and corporate officers who meet the requirements of the Act, §406.097(c), and who are explicitly excluded from coverage in accordance with the Act, §406.097(x) (as added by House Bill 1089, 74th Legislature, 1995, § 1.20). This subsection applies only to sole proprietors, partners, and corporate executive officers who are excluded from coverage in an insurance policy or certificate of authority to self-insure that is delivered, issued for delivery, or renewed on or after January 1, 1996. Source Note;: The provisions of this §110.114 adopted to be effective September 1, 1994, 19 TexReg 5715; amended to be effective November 6, 1995, 20 TexR.eg 8609 Page 7 of 11 T28S110.1 I0(d)(7) " QUIR D WORKERS' COMPENSATIOAT COVERAGEtr "The law requires that each person working on this site or providing services related to this construction project must be covered by workers ` compensation insurance. This includes persons providing, hauling, or delivering equipment or materials, or providing labor or transportation or other service related to the project, regardless of the identity of their employer or status as an employee. " "Call the Texas Yorkers' Compensation Commission at 512 - 440 -3 789 to receive information on the legal requirement for coverage, to verify whether your employer has provided the required coverage, or to report an employer`s failarre to provide coverage." Page 8 of 11 TUS110.110(c)(7) Article . Workers' Compensation Insurance Coverage. A. ,Definitions: Certificate of coverage r "cert f care' j- A copy of a certificate of insurance, a certificate of authority to self - insure issued by the commission, or a coverage agreement (TWCC 81,. TWCC- 82, TWCC 83, or TWCC -84), showing statutory workers' compensation insurance coverage for the person's or entity's employees providing services on a project, for the duration of the project. Duration of the project _ includes the time from the beginning of tine work on the project until the contractor's!person's work on the project has been completed and accepted by the governmental entity. Persons providing services on the project ("subcontractor" in §406096) - includes all persons or entities performing all or part of the services the contractor has undertaken to perform on the project, regardless of whether that person contracted directly with the contractor and regardless of whether that person lain employees. This includes, without limitation, independent contractors, subcontractors, leasing companies, motor carriers, owner- operators, employees of any such entity, or employees of any entity which furnishes persons to provide services on the project. "Services" include, without limitation; providing, hauling, or delivering equipment or materials, or providing labor, transportation, or other service related to a project "Services" does not include activities unrelated to the project, such as food/beverage vendors, off ice supply deliveries, and delivery ofportable toilets. B. The contractor shall provide coverage, hosed on proper reporting of class f cation codes and payroll amounts andfiling of any coverage agreements, which. meets the statutory requirements of Texas Labor Code, Section 4111.011(44) for all employees of the contractor providing services on the project, for the duration of the project. C. The Contractor must provide a certificate of coverage to the governmental entity prior to being awarded the contract. D. Ifthe coverage period shown on the contractor's current certificate of coverage ends during the duration of the project, the contractor must, prior to the end of the coverage period file a new certificate of coverage with the governmental entity showing that coverage has been extended K The contractor shall obtain from each person providing services on a project, and provide to the governmental entity: (1) a certificate of coverage, prior to that person beginning work on the project, so the governmental entity will have on fate certificates of coverage showing coverage for all persons providing services on the project, and (2) no later than seven days after receipt by the contractor, a new certiflcate of coverage showing extension of coverage, if the coverage period shown on the current certificate of coverage ends during the duration of the project. Page 9 of 11 R The contractor shall retain all required certificates of coverage_ for tote. duration of the project and for one year thereafter. C. The contractor shall notify the governmental entity in writing by certified mail or personal delivery, within 10 days after the contractor knew or should have known, of any change that materially affects the provision of coverage of any person providing services on the project_ H. The contractor shall post on each project site a notice, in the text, form and manner prescribed by the Texas Workers' Compensation Commission, informing all persons providing services on the project that they are required to be covered, and stating how aperson may verify coverage and report lack of coverage. L The contractor shall contractually require each person with whom it contracts to provide services on a project, to: (1) provide coverage, based on proper reporting of classification codes and payroll amounts and ding of any coverage agreements, which meets the statutory requirements of Texas .Labor Code, Section 401.011(44) for all of its employees providing ,services on the project, for the duration of the project; (2) provide to the contractor, prior to that-person beginning work on the project, a certificate of coverage showing that coverage is being provided, for all employees of the person providing services on the project, for the duration of the projects (3) provide the contractor, prior to the end of the coverage period a new certificate of coverage showing extension of coverage, of the coverage period shown on the current certificate of coverage ends during the duration of the projects (4) obtain from each other person with whom it contracts, and provide to the contractor: (a) a certificate of coverage, prior to the other person beginning work on the project; and (b) a new certificate of coverage showing extension of coverage, prior to the end of the coverage period, if the coverage period shown on the current certificate of coverage ends during the duration o, f'the project, (S) retain all rewired certificates of coverage on file for the duration of the project and for one year thereafter; (G) notify the governmental entity in writing by certified mail or personal delivery, within I0 days after the person knew or should have known, of any change that materially affects the provision of coverage of any person providing services on the project; and (7) contractually require each person with whom it contracts, to perform as required by paragraphs (1) - (7), with the certificates of coverage to be provided to the person for whom they are providing services. . J By signing this contract or providing or causing to be provided a certificate of coverage, the contractor is representing to the governmental entity that all employees of the contractor who will provide services on the project will be covered by wormers' compensation coverage for the duration of the project, that the coverage will be based on proper reporting of classification codes andpayroll amounts, and that all coverage agreements will be filed with the appropriate insurance carrier or, in the case of a set insured, with the commission's .division of Self- Page 10 of 11 Insurance Regulation. Provi&ngfalse or misleading information may subject the contractor to administrative penalties, criminal penalties, civil penalties, or other civil actions. K. The contractor's failure to comply with any of these provisions is a breach of contract by the contractor which entitles the governmental entity to declare the contract void fthe contractor does not remedy the breach within ten days after receipt of notice of breach from the governmental entity. Page 11 of 11 PART A SPECIAL PROVISIONS ETHEL EYERLY SENIOR CENTER EXPANSION PHASE 1(CDBG FINDS) PROJECT NO. E11126 SECTION A - SPECIAL PROVISIONS A-1 Time and Place of Receiving Proposals/Pre-Did Meeti ag Sealed proposals will be received in conformity with the official advertisement inviting bids for the project. Proposals will he received in the office of the City Secretary, located on the first floor of City Fall., 1201 Leopard Street, until 2:00 .m., Nedrxes , October 10, 2012. Proposals mailed should be addressed in the following manner: Giby f. r=er- .,...,....Ghrri .sb..i City Secretary's Office City of Coryas Christi 1201 Leopard Street Corpus Christi, Texas 78401 ATTN., BED PROPOSAL - ETHEL SYERLY SMUOR CENTER EXPANSION PHASE 1 (CDAG fig) PROJECT NO. E11126 Anv Dronosa,ls not nhvei.caliv in Dossession of the City Secretary's Office at the time and date of.bid opening will be deemed late and nonres onsive. Late proposals will be returned unopened to the proposer. The proposer is solel remasibl,e for delivery to the City Secretary's Office. DeliveEX of Lt tr000sal, bar the Dr000ser, their acent /representative, V.S. Kail, or other del Ice will be deemed non- resp=Slve it not in Iaosse, s Of five prior to the date and time of bid openincr. A pre -bid meeting will be held on Wedneadayy, October 3, 2012._._beg nniAg at 1000 a.m. The meeting will convene at the Engineering Services Main Conference Room, 3'" Floor City Hall, 1201 Leopard Street, Corpus Christi,, TX. and will include a discussion of the project elements. if requested, a site visit will follow. The project is funded by CDEG, Cox=unity Development Block Grants. No additional or separate visitations will be conducted by the Cit A -2 Definitions and Abbx*vi.ati.ona Section H -1 of the General. Provisions will govern. A -3 Descriotion of Protect Consists of all Work for an addition and remodel of existing Facility including selective demolition of existing interior and exterior walls, standard steel doors and frames, and flooring. The addition shall include site clearing and stripping; concrete sidewalks, termite control; cast -in- place concrete; concrete slab on grade; metal fabrications; steel roof joists and metal roof deck; masonry walls; rough carpentry; finish carpentry and architectural wood casework; exterior masonry sealant; blanket insul.ati.on and masonry foam insulation; gutters and downspouts; modified bitumen roofing: fire stopping, joint sealants; standard steel doors and frames; flush wood doors; aluminum storefront; door hardware; glazing; ceramic tile; VCT flooring; suspended acoustic ceiling systems; paint and coatings; mechanical geeti= A - SP (Revised 12/15/04) Page 1 of 23 systems; replacement of existing 'mechanical system, plumbing system and fixtures: electrical power system and lighting fixtures; final site clean -up and proper disposal of debris /waste and in funded by MBG Ccamunity Development Block Grants; complete in accordancce with the plans, specifications, and contract documents; A -4 Method of Award The bids will be evaluated based on the Total ,Base Hid plus Additive Alternate Bid #1, subject to availability of funding. The City reserves the right to reject any or all bids, to waive irregularities and to accept the bid which, in the City's opinion, is Most advantageous to the City and in the best interest of the public. ,A. -5 Items to be Submitted with Syr osal The following items are required to be submitted with the proposal: 1. 5% Bld Bond (Must reference 8THi3L_ zy .XgLX.SMUOR CisW2R 13 %PANSION _. PHASE 1 (CI)BO _3 S), Projegt„No. 211126 as identified in the Proposal) (A Cashier's Check, certified check, money order or bank draft from any State or National Bank will also be acceptable.) 2. Disclosure of Interests Statement A-6 Time of Completion/Liquidated Damacres The working time for completion of the Project will be 180 calendar !Las. The Contractor shall commence work within ten (10) calendar days after receipt of written notice from the Director of Engineering Services or designee ( "City Engineer") to proceed. For each calendar day that any work remains incomplete after the time specified in the Contract for completion of the work or after such time period as extended pursuant to other provisions of this Contract:, $100 per calendar day will be assessed against the Contractor as liquidated damages. Said liquidated damages are not imposed as a penalty but as an estimate of the damages that the City will sustain from delay in completion of the work, which damages by their nature are not capable of precise proof. The Director of Engineering services (City Engineer) may withhold and deduct from monies otherwise due the Contractor the amount of liquidated damages due the City- A-7 Workers C2Wensation Insurance Coverage If the Contractor's workers' compensation insurance coverage for its employees working on the Project is terminated or canceled for any reason, and replacement workers' compensation insurance coverage meeting the requirements of this Contract is not in effect on the effective date of cancellation of the workers' compensation insurance coverage to be replaced, then, any Contractor employee not covered by the required workers' compensation insurance coverage must not perform any work on the Project. Furthermore, for each calendar day including and after the effective date of termination or cancellation, of the Contractor's workers' compensation insurance coverage for its employees working on the Project until the date replacement workers' compensation insurance coverage, meeting the requirements of this Contract, is in effect for those Contractor employees, Section A - SP (aeviged 12/15/04) Page 2 of 23 liquidated damages will be assessed against and paid by the Contractor at the highest daily rate elsewhere specified in this Contract. Such liquidated damages will accumulate without notice from the City Engineer to the Contractor and will be assessed and paid even if the permitted time to complete the Project has not expired. in accordance with other requirements of - this Contract, the Contractor shall not permit subcontractors or others to work on the Project unless all such individuals working on the Project are covered by workers, compensation insurance and unless the required documentation of such coverage has been provided to the Contractor and the City Engineer. A -8 Faxed Proposals Proposals faxed directly to the City will be considered non - responsive. Proposals must contain original signatures and guaranty and be submitted in accordance with Section B -2 of the General Provisions. A-9 Ackaaowledament of Addenda The contractor shall acknowledge receipt of all addenda received in the appropriate space provided in the proposal.. Failure to do so will be interpreted as non - receipt. Since addenda can have significant impact on the proposal, failure to acknowledge receipt, and a subsequent interpretation of non- receipt, could have an adverse effect when determining the lowest responsible bidder. A -10 !!Ek 'e__'Flates. (Revised 7/5/04) Labor preference and swage rates for BUILDING CONSTRUCTION. Mi muz Parevai.l.im Vktge Shales . The Corpus Cbristi City Council ban determined the general prevailirxg minim hourly wage rates for Meces County, 'Texas as set out in Part C. The ctntractor and any subeztractor mist not pay less than the specified wage rates to all laborers, mrlmteri, and mechmucs eplayed by them in the exm=im of the Contract. Me C cntractor or subcontractor shall forfeit sixty collars ($60.04) per calezvUr day, or portion thereof, for each laborer, wxrkman, or mechanic employed, if such perm, is paid less than the qpecified rates for the classification of work performed. The 03Z a Or and each subcatractor mist keep an aerate record shod the r yr .s and classif ications of all laborers, workmen, and panics erqloyed by then in tic n with the Project and ab=M the actual wages paid to each worker. The motor will mks bi- weekly rifled p%mD11 skmttal.s to the arty Mwjn�eer. The Omtrar-tor will also detain dies of such certified payrolls from all subcat=actors and others working on the Project. 'These docmmts will also be submitted to the City Ergireer bi- weekly. (See section for Ddnority/Minority Business Enterprise Participation Policy for additicmal reW=eren.ts � the proper form ari =&Mt of the payroll s Ammttals. ) Cne and cue -half (1%) times the specified hckrrly wage mat be paid for all hours worked in excess of 40 hc= i:cn any one week and for all hours worked on. Sumtys or holidays. (See Section B-1 -3„ Definition of Texas, and Section B -7 -5, W=king Hcaurs, ) Section A - SP (Revised 12/15/04) Page 3 of 23 A -71 with Public (Revised 7 /S /00) 7he Contractor sisall cooperate with all public and private agencies with facilities cpeeaaating within the limits of the Project. 7be Contractor shall provide a forty -eight (48) tour notice to any applicable agency when work is anticipated to proceed in the vicinity of any facility by use was 811 at 811 and the Icne Star Notification Ompany at 1 -800- 669 -8344. Fes,' the tmtraetorIz Renee, the following tell r=tms are listed. City wise= 826 -3500 City project Manager 826 -3598 Project Architect 884 -44122 (946 -0069 mobile) aawk Anastos Associates, LLC Traffic Engineering 826 -3540 Police Deparbrgmt 886 -2600 water Depart 826 -1881 (826 -1888 after tours) was?tewrrater Dqpartuemt 826 -1800 (1926 -1818 after bours) Gas Department 885 -6900 (885 - 693..3 after hov=) Storm Water Department 826 -1875 (826 -3140 after hours) Parks & Faar*atic a Department 826 -3461 Streets Cperati€xss 826 -1940 Solid Waste Services 826 -1940 A E P 1- 877 - 373 -4858 S B C/ AT&T 881 -2511 (1- 800 - 824- 4424,after his) City Street Div. for Traffic Signal /Faber Optic locate 826 -1946 826 -3547 Cablevisica 857 -5000 (857 -5060 after hours) ACSI (Fiber Optic) 887 -9200 (Pager 800 - 724 -3624) KWIC (Fiber 4pt4a) 813 -1124 (pager 888 -204- 1679) ChoiceCbm (Fiber optic) 881 -5767 (Pager 850 -2981) CUT= (Faber Optic) 512/935 -0958 (Mobile) Brooks Fiber C)pti c (MAN) 972- 753 -4355 A -12 Maintenance of services The Contractor shall take all precautions in protecting existing utilities, both above and below ground. The Drawings show as much information as can be reasonably obtained from existing as- built drawings, base maps, utility records, etc. and from as much field work as normally deemed necessary for the construction of this type of project with regard to the location and nature of underground utilities, etc. However, the accuracy and completeness of such information is not guaranteed. it is the contractor's sole and complete responsibility to locate such underground features sufficiently in advance of his operations to preclude damaging the existing facilities. if the Contractor encounters utility services along the line of this work, it is his responsibility to maintain the services in continuous operation at his own. expense. In the event of damage to underground utilities, whether shown in the drawings, the Contractor shall make the necessary repairs to place the utilities back in service to construct the work as intended at no increase in the Contract price. All such repairs must conform to the requirements of the company or agency that owns the utilities. where existing sewers are encountered and are interfered with (i.e. broken, cut, etc.), flow must be maintained. Sewage or other liquid must be handled by the Contractor either by connection into tither sewers or by temporary pumping to a satisfactory outlet, all with the approval of the City Engineer. Sewage or other liquid must not be pumped, bailed or Plumed over the streets section A - SP (Revised 12/15104) Page 4 of 23 or ground surface and Contractor must pay for all fines and remediation that may result, if sewage or other liquid contacts the streets or ground surface. it is also the Contractor's responsibility to make all necessary repairs, relocations and adjustments to the satisfaction of the City Engineer at no increase in the Contract price. Materials for repairs, adjustments or relocations of sewer service lines mast be provided by the Contractor. A -13 Area Aocess and 'traffic Control (Not Used) A -14 construction ESRLVment.ftillqg a and Trackia The Contractor shall keep the adjoining streets free of tracked and /or spilled materials going to or from the construction area. Hand labor and /car mechanical equipment mast be used where necessary to keep these roadways clear of job - related materials. Such work must be completed without any increase in the Contract price. Streets and curb line must be cleaned at the end of the work day or more frequently, if necessary, to prevent material from washing into the storm sewer system. No visible material that could be washed into storm sewer is allowed to remain on the Project site or adjoining streets. A -15 RxcaVation and Removals The excavated areas behind curbs and adjacent to sidewalks and driveways must be filled with "clean" dirt. "Clean" dirt is defined as dirt that is capable of providing a good growth of grass when applied with seed /sod and fertilizer. The dirt must be free of debris, caliche, asphalt, concrete and any other material that detracts from its appearance or hampers the growth of grass. All existing concrete and asphalt within the limits of the Project must be removed unless otherwise noted. All necessary removals including but not limited to pipe, driveways, sidewalks, etc., are to be considered subsidiary to the bid item for "Street Excavation "; therefore, no direct payment will be made to Contractor. section A - SP (Revised 12115/04) Page 5 of 23 A. -16_ Disposal/Salvage of materials Excess excavated material, broken asphalt, concrete, broilers culverts and other unwanted material becomes the property of the Contractor and must be removed from the site by the Contractor. The cost of all hauling is considered subsidiary; therefore, no direct payment will be made to Contractor. A -17 Field office (Not Used) A -18 Schedule and Secmence. of Constructions The contractor shall submit to the City Engineer a work plan based only on cALmm t days. This plan must detail the schedule of work and must be submitted to the City Engineer at least three (3) working days prior to the pre - construction meeting. The plan must indicate the schedule of the following work items: 1. Initial Schedule: Submit to the City Engineer three (3) days prior to the Pre - Construction Meeting an initial constructions Progress schedule for review. 2. Items to include: Show complete sequence of construction by activity, identifying Work of separate stages and other logically grouped activities. Identify the first work day of.each week. 3. Submittal Dates: Indicate submittal dates required for all submittals. 4. Re- SubmiSSion; Revise and resubmit as required by the city Engineer. S. Periodic Update: Submit Updated construction Progress Schedule to show actual progress of each stage by percentage against initial Schedule. A -19 Construction Project L43Lcut and Control The drawings may depict but not necessary include. lines, slopes, grades, sections, measurements, bench marks, baselines, etc. that are normally required to construct a project of this nature. Major controls and two (2) .bench marks required for project layout, will be provided by the City or Consultant Project Engineer_ The Contractor shall furnish all lines, slopes and measurements necessary for control of the work. If, during construction,, it is necessary to disturb or destroy a control point or bench mark, the Contractor shall provide the City or Consultant section A - SP (R vieed 12/15/04) Page 6 of 23 Project Engineer 48 hours notice so that alternate control points can be established by the City or Consultant Project Engineer as necessary, at no cast to the Contractor. Control points or bench marks damaged as a result of the Contractor's negligence will be restored by the City or Consultant Project Engineer at the expense of the Contractor. if, for whatever reason, it is necessary to deviate from proposed line and grade to properly execute the work, the Contractor shall obtain approval of the City or Consultant Project Engineer prior to deviation. if, in the opinion of the City or Consultant Project Engineer, the required deviation would necessitate a revision to the drawings, the Contractor shall provide supporting measurements as required for the City or Consultant Project Engineer to revise the drawings. The Contractor shall tie in or reference all valves and manholes, both existing and proposed, for the purpose of adjusting valves and manholes at the completion of the paving process. Also, the City or Consultant Project Engineer may require that the Contractor furnish a maximum of two (2) personnel for the purpose of assisting the measuring of the completed work. The Contractor shall provide the following certification for documentation and verification of compliance with the Contract Documents, plans and specifications. Said compliance certification shall be provided and prepared by a Third Party independent Registered Professional Land Survey (R.P.L.S.) Licensed in the state of Texas retained and paid by the Contractor. The Third Party R.P.L.S. shall be approved by the City prior to any work. Any discrepancies shall be noted by the Third Party Surveyor and certify compliance to any regulatory permits. Following is the minimum schedule of documentation required: Streets: • All curb returns at paint of tangency /point of circumference • Curb and gutter flow line - both sides of street on a. toff' interval; • Street crowns on a 200' interval and at all intersections. wastewater: • All rim /invert elevations at manholes; • All intersecting lines in manholes; • Casing elevations (top of pipe and flow line) ('TXDOT and RR permits). Water. • All top of valves box; • Valves vaults riot, • Casing elevations (top of pipe and flow line) (TXDOT and RR permits). Stormwa.ter • All rim /invert elevations at manholes; • All intersecting lines in manholes; • Casing elevations (top of pipe and flaw line) (TXDOT and RR permits). A -20 TestiM and Certification All tests required under this item must be done by a recognized testing laboratory selected by the City Engineer. The cost of the laboratory testing will be borne by the City. In the event that any test fails, that test must be done over after corrective measures have been taken, and the cost of retesting will be borne by the Contractor and deducted from the payment to the Contractor. Section A - SP Mevimed 12/15/64) Page 7 of 23 The Contractor must provide all applicable certifications to the City Engineer. A -21 Project S12as The Contractor must furnish and install 1 Project sign as indicated on the following drawings. {Attachment 11 The sign must be installed before construction begins and will be maintained throughout the Project period by the Contractor. The location of the sign will be determined in the field by the City Engineer. The contractor must furnish and install an additional sign, for "CDBG" as indicated in Part C -1 - Federally Required Language section of the specifications. A -22 Kizxorit ji4 inorit Susiaess MxteERrise Partici atiOn Polio (Revised 70 /98) Poligy It is the policy of the City of Corpus Christi that maximum opportunity is afforded minorities, women and Minority Business Enterprises to participate in the performance of contracts awarded by the City, of Corpus Christi in support of Equal Employment Opportunity goals and objectives of the Affirmative Action Policy Statement of the City dated October, 1989, and any amendments thereto. in accordance with such policy, the City has established goals, as stated herein., both for minority and female participation by trade and for Minority Business Enterprise. 2. Definitions a. Prime Contractor: Any person, firm., partnership, corporation, association 6r joint venture as herein provided which has been awarded a City contract. b. Subcontractor: Any named person, firm, partnership, corporation, association, or joint venture as herein identified as providing work, labor, services, supplies, equipment, materials or any combination of the foregoing under contract with a prime contractor on a City contract. C. Minority Business Enterp rase: A business enterprise that is owned and controlled by one or more minority person(s). Minority persons include Blacks, Mexican- Americans and other persons of Hispanic origin, American Indians, Alaskan Natives, and Asians or Pacific Islanders. For the purposes of this section, women are also considered as minorities. Minority person(s) must collectively own, operate and /or actively manage, and share in payments from such an enterprise in the manner hereinafter set forth: 1. Owned (a) For a sole proprietorship to be deemed a minority business enterprise, it must be owned by a minority .person. section a - SP (Revised 12/15/04) Page 8 of 23 (b) For an enterprise doing business as a partnership, at least 51.0V of the assets or interest in the partnership property must be owned by one or more minority person(s). (c) For an enterprise doing business as a corporation, at least 51.01 of the assets or interest in the corporate shares must be awned by one or more minority person(s). 2. Controlled The primary power, direct or indirect, to manage a business enterprise rests with a minority person(s). 3. Share in ?Ay5enta Minority partners, proprietor or stockholders, of the enterprise, as the case may be, must be entitled to receive 51.01 or more of the total profits, bonuses, dividends, interest: payments, commissions, consulting fees, rents, procurement, and subcontract payments, and any other monetary distribution paid by the business enterprise. d. Minority: See definition under Minority Business Enterprise. e. Female Owned Business Enterprise: A sole proprietorship that is owned and controlled by a woman, a partnership at least 51.0% of whose assets or partnership interests are owned by one or more women, or a corporation at least 51,0* of whose assets or interests in the corporate shares are owned by one or more women. f. Joint Venture: A joint venture means an association of two or more persons, partnerships, corporations, or any combination thereof, founded to carry on a single business activity which is limited in scope and direction. The degree to which a joint venture may satisfy the stated MBE goal cannot exceed the proportionate interest of the MBR as a member of the joint venture in the work to be perforated by the joint venture. For example, a joint venture which is to perform 50.0k of the contract work itself and in which a minority joint venture partner has a 50.0t- interest, shall be deemed equivalent to having minority participation in 25.0° of the work. Minority members of the joint venture must have either financial, managerial, or technical skills in the work to be performed by the joint venture. 3. Goals a. The goals for participation by minorities and Minority Business Enterprises expressed in percentage terms for the Contractor's aggregate work force on all construction work for the Contract award are as follows: Minority Participation (Percent) 45 % Minority Business Interprise Participation (Percent) 15-% Seation A - SP (Rev -1001 12/15/04) Page 9 of 23 b. These goals are applicable to all the construction. work (regardless of federal participation) performed in the Contract, including approved change orders. The hours of minority employment must be substantially uniform throughout the length of the Contract and in each trade. The transfer of minority employees from Contractor to Contractor or from project to project for the sole purpose of meeting the Contractor's percentage is prohibited. 4. Compliance a. Upon completion of the Project, a final breakdown. of ME participation, substantiated by copies of paid invoices, shall be submitted by the Contractor to the City Engineer. b. The Contractor shall make bi- weekly payroll submittals to the City Engineer. The Contractor is to indicate the percent of minority and female participation, by trade, which has been utilized on the Project. Along with the request for final payment on the Project, the Contractor will indicate, in writing, the overall participation in these areas which have been achieved. The City Engineer may withhold monthly or final payments to the Contractor for failure to submit bi- weekly payrolls in a timely fashion or to submit overall participation information as required. A -23 In ection Re ired (Revised 7 /5 /00) The Contractor shall assure the appropriate building inspections by the Building inspection Division at the various intervals of work for which a permit is required and to assure a final inspection after the building is completed and ready for occupancy. Contractor must obtain the Certificate of occupancy, when applicable. Section B -6 -2 of the General Provisions is hereby amended in that the Contractor must pay all fees and charges levied by the City's Building Inspection department, and all other City fees, including water /wastewater meter fees and tap fees as required by City. A -24 surety Bands Paragraph two (2) of Section B -3 -4 of the General Provisions is changed to read as follows: RNo surety will be accepted by the City from any Surety Company who is now in default or delinquent on any bonds or who has an interest in any Litigation against the City. All bonds must be issued by an approved Surety Company authorized to do business in the State of Texas. if performance and payment bonds are in an amount in excess of ten percent (10%-) of the Surety Company's capital and surplus, the Surety Company shall provide certification satisfactory to the City Attorney that the surety Company has reinsured the portion of the bond amount that exceeds ten percent (10%,) of the Surety Company's capital and surplus with reinsurer(s) authorized to do business in the State of Texas. The amount of the bond reinsured by any reinsures may not exceed ten percent (1€%) of the reinsurer's capital and surplus. For purposes of this section, the amount of allowed capital and surplus will be verified through the State Board of Insurance as of the date of the last annual statutory financial statement of the Surety Company or rei.nsurer authorized and admitted to do business in the State of Texas. The Surety shall designate an agent who is a resident of Nueces County, Section A - 8P (Revised 22/15/04) Page 10 of 23 Texas. Each bond must be executed by the Contractor and the surety. For contracts in excess of $100,000 the bond gust be executed by a Surety company that is certified by the United States Secretary of the Treasury or must obtain reinsurance for any liability in excess of $100,000 from a reinsurer that is certified by the United States Secretary of the Treasury and that meets all the above requirements. The insurer or reinsurer must be lasted in the Federal Register as holding certificates of authority on the date the bond was issued." A -25 Sales Tax I3xemption NO LOWER APMICABLR (6111198) r deleted it7k its entiret-y and Taw Exemption fe- l .....s iig ....7...1-.4_F.......be i....... i. n... .._'.f.....'...ce ......R-.i. thereof—. Geatrraets f-gr- to by the City Ger-pus real preperby awarded gales, 99 use T-ames r and tinless r / f issues a ry A -25 Supplemental Insurance Requirements For each insurance coverage provided in accordance with section B --6 -11 of the Contract, the Contractor shall obtain an endorsement to the applicable insurance policy, signed by the insurer, stating: In the event of cancellation or material change that reduces or restricts the insurance afforded by this coverage part, each insurer covenants to mail prior written notice of cancellation or material changs to: Section A - SP (Revised 12/15/04) Page 11 of 23 W- 11011.0-0 / f issues a ry A -25 Supplemental Insurance Requirements For each insurance coverage provided in accordance with section B --6 -11 of the Contract, the Contractor shall obtain an endorsement to the applicable insurance policy, signed by the insurer, stating: In the event of cancellation or material change that reduces or restricts the insurance afforded by this coverage part, each insurer covenants to mail prior written notice of cancellation or material changs to: Section A - SP (Revised 12/15/04) Page 11 of 23 1. Name: City of corpus Christi Engineering services Department Attn: Contract Administrator 2. Address: P.O. Box 9277 Corpus Christi, Texas 78469 -9277 3. Number of days advance notice: 30 The Contractor shall provide to the city Engineer the signed endorsements, or copses thereof certified by the insurer, within thirty (30) calendar days after the date the City Engineer requests that the Contractor sign: the Contract documents. Within thirty (30) calendar days after the date the City Engineer requests that the Contractor sign the Contract documents, the Contractor shall provide the City Engineer with a certificate of insurance certifying that the Contractor provides worker's compensation insurance coverage for all employees of the Contractor employed on the Project described in the Contract. For each insurance coverage provided in accordance with Section B -6 -11 of the Contract, the Contractor shall obtain an endorsement to the applicable insurance policy, signed by the insurer, stating that the City is an additional insured under the insurance policy. The City need not be named as additional insured on Worker's Compensation coverage. For contractual liability insurance coverage obtained in accordance with section B -6-11 (a) of the Contract, the Contractor shall obtain an endorsement to this coverage stating: Contractor agrees to indemnify, save harmless and defend the City, its agents, servants, and employees, and each of them against and hold it and theta harmless from any and all lawsuits, claims, demands, liabilities, losses and expenses, including court costs and attorneys' fees, for or on account of any injury to any person, or any death at any time resulting from such injury, or any damage to any property, which may arise or which may be alleged to have arisen out of or in connection with the work covered by this Contract. The foregoing indemnity shall apply except if such injury, death or damage is caused directly by the negligence or other fault of the City, its agents, servants, or employees or any person indemnified hereunder. A -27 Reqp*nsibility for Damage Claims- Paragraph (a) General Liability of Section B -6 -11 of the General Provisions is amended to include: Contractor must provide Builder's Risk insurance coverage for the term of the contract up to and including the date the City finally accepts the Project or work. Builder's Risk coverage must be an "All Risk" form. Contractor must pay all costs necessary to procure such Builder's Risk insurance coverage, including any deductible. The City must be named additional insured on any policies providing such insurance coverage. Section A - SP (Retuned 12115/04) Page 12 at 23 A -28 Considerations for Contract Award and Execution To allow the City Engineer to determine that the bidder is able to perform its obligations under the proposed contract, then prior to award, the City g gi.neer may require a bidder to provide documentation concerning: 1. Whether any liens have been filed against bidder for either failure to pay for services or materials supplied against any of its projects begun within the preceding two (2) years. The bidder shall specify the name and address of the party holding the lien, the amount of the lien, the basis for the lien claim, and the date of the release of the lien. If any such lied has not been released, the bidder shall state why the claim has not been paid, and 2. Whether there are any outstanding unpaid claims against bidder for services or materials supplied which relate to any of its projects begun within the preceding two (2) years. The bidder shall specify the name. and address of the claimant, the amount of the claim, the basis for the claim, and an explanation why the claim has not been paid. A bidder may also be required to supply construction references and a financial statement., prepared no later than ninety (50) days prior to the city Engineer's request, signed and dated by the bidders owner, president or other authorized party, specifying all current assets and liabilities. A -29 Contractor's Field Administration Staff The Contractor shall employ for this Project, as its field administration staff, superintendents and foremen who are careful and competent and acceptable to the City Engineer. The criteria upon which the City Engineer Makes this determination may include the following: 1. The Superintendent must have at least five (5) years recent experience in field management and oversight of projects of a similar size and complexity to this Project. This experience must include, but not necessarily limited to, scheduling of manpower and materials, safety, coordination. of subcontractors; and familiarity with the submittal process, federal and .state wage rate requirements, and City contract close -out procedures. The superintendent shall be present, on the job site, at all times that work is being performed. 2. Foremen, if utilized, shall have at least five (5) years recent experience in similar dark and be subordinate to the superintendent. Foremen cannot act as superintendent without prior written approval from the city. Documentation concerning these requirements will be reviewed by the City Engineer. The Contractor's field administration staff, and any subsequent substitutions or replacements thereto, must be approved by the City Engineer in writing prior to such superintendent assuming responsibilities on the Project. Such written approval of field administration staff is a prerequisite to the city Engineer's obligation to execute a contract for this Project. If such approval is not obtained, the award may be rescinded. Further, such written approval is also necessary prior to a change in field administration staff during the term of this Contract. If the Contractor fails to obtain prior written approval of the City Engineer concerning any substitutions or replacements in its field administration staff for this Project during the term of the Contract, such a. failure constitutes a basis to annul the Contract pursuant to section B -7 -13. Section A - SP (Revised 12/15/04) Page 13 of 23 A -3€1 Amended "Consideration of Contract" R rements Finder "General Provisions and Requirements for Municipal Construction contracts" Section B -3 -1 Consideration of contract add the following text: Within five (5) working days following the public opening and reading of the proposals, the three (3) apparent lowest bidders (based on the Base Bad only) must submit to the City Engineer the following information: 11 A. list of the major components of the work; 2. A list of the products to be incorporated into the Project; 3. A schedule of values which specifies estimates of the cost for each major component of the work; 4. A schedule of anticipated monthly payments for the Project duration, S. The names and addresses of MEL firms that will participate in the Contract, along with a description of the work and dollar amount for each firm; and substantiation, either through appropriate certifications by federal agencies or. signed affidavits. from the M13E firms, that such MBE firms meet the guidelines contained herein. Similar substantiation will be required if the Contractor is an MBE. If the responses do not clearly show that KBE participation will meet the requirements above, the bidder must clearly demonstrate, to the satisfaction of the City Engineer, that a good faith effort has, in fact, been made to meet said requirements but that meeting such requirements is not reasonably possible. 6. A list of subcontractors that will be working on the Project. This list may contain more than one subcontractor for major components of the work if the Contractor has not completed his evaluation of which subcontractor will perform the work. The city Engineer retains the right to approve all subcontractors that will perform work an the Project. The Contractor shall obtain written approval by the City Engineer of all of its subcontractors prior to beginning work on the Project. if the City Engineer does not approve all proposed subcontractors, it may rescind the Contract award. In the event that a subcontractor previously listed and approved is sought to be substituted for or replaced during the term of the Contract, then the city Engineer retains the right to approve any substitute or replacement subcontractor prior to its participation in the Project. Such approval will not be given if the replacement of the subcontractor will result in an increase in the Contract price. Failure of the Contractor to comply with this provision constitutes a basis upon which to annul the Contract pursuant to Section B -7 -13; 7. A preliminary progress schedule indicating relationships between the major components of the work. The final progress schedule must be submitted to the City Engineer at the pre- construction conference; 8. Documentation required pursuant to the Special Provisions A -28 and A -29 concerning Considerations for Contract Award and Execution and the Contractor's Field Administration Staff. Section A - SP (Revised 12/15/04) Page 14 of 23 9. Documentation as required by Special, Provision A -35 -K, if applicable. 10. Within five (5) days following bid opening, submit in letter farm, information identifying type of entity and state, i.e., Texas (or other state) Corporation or Partnership, and same (a) and Title (a) of individual (s) authorized to execute contracts on behalf of said entity. A -31 Amended PolLol on mctra Wbrk and SIEM Orders Under "General Pro'v'isions and Requirements for Ym nic pal. Construction. C=tracts" B -8 -5 Policy on Extra 'Work and �e Girders the present text is deleted and replaced with the following: Conatractor acknowledges that the City has no obligation to pay for any extra work for which a age order has not been signed by the Director of Engineering Services or his designee. The Contractor also acknowledges that the City Erxj neer may authorize change orders which do not exceed $25,000.00. The Contractor acknowledges that any change order in an amount in excess of $25,000.00 must also be approved by the City Council.. A -32 Awamded Rftecutioa of Contractft Requix*Met.ts Under "Oral Provisions and Requirements for ML nicipal Construction Contracts" H -3 -5 Execution of Contract add the following: The award of the Contract may be rescinded at any time prior to the date the City Engineer delivers a contract to the Contractor which bears the signatures of the City Manager, City Secretary., arsd City Attorney, or their authorized designees. Contractor has no cause of action of any kid., including for breach of contract, against the City, nor is the City obligated to perform under the Cmv -Tact, until the date the City der delivers the signed Contracts to the Contractor. A -33 Conditions of Work Each bidder must familiarize himself fully with the conditions relating to the completion of the Project. Failure to do so will not excuse a bidder of his obligations to carry out the provisions of this Contract. Contractor is reminded to attend the M�tozlr Pre -Bid ideating referred to in Special Provision A -I. A -34 Precedence of Contract Documents in case of conflict in the Contract documents, first precedence will be given to addenda issued during the bidding phase of the Project, second precedence will be given to the Special Provisions, third precedence will be giver) to the construction plans, fourth precedence will be given to the Standard Specifications and the General Provisions will be given last precedence. in the event of a conflict between any of the Standard Specifications with any other referenced specifications, such as the Texas Department of Public Transportation Standard Specifications for Highways, Streets and Bridges, ASTM specifications, etc., the precedence will be given to addenda, Special Provisions and Supplemental. Special Provisions (if applicable), construction plans, referenced specifications, Standard specifications, and Cameral Provisions, in that order. Section A - SP (RevLee4 12/15/04) Page 15 of 23 A -3S CitX Water Facil.itieg: Special Requ Aremextts (Not Coed) employees, Standard Speeifieatleas. PAI trash generated by the GerbtFaetev ev his agents, ein subeen4r-aeter-s, must he eentalned at all times at the wate Section A - SP (Revised 12/15/04) Page 26 of 23 trensper-babien; r reinstallation, p pumps, items, other ! ! PAI trash generated by the GerbtFaetev ev his agents, ein subeen4r-aeter-s, must he eentalned at all times at the wate Section A - SP (Revised 12/15/04) Page 26 of 23 • than vramge, bl�ueF - -ers while. Back empil - - -un#fa must - previde . ... ...... .... . . MON semplany name and individual employee identigileabien. —01111MI NO- s .......... .. .... sperm illftio MAIN 0 abing, by W007-10-1-w- NOW- ff- am W-0 Will Section A - 9P (Revised 12/15/04) Page 17 of 23 Section A - 9P (Revised 12/15/04) Page 17 of 23 A -36 Other Submittals 1. Shop Drawing Submittal: The contractor shall follow the procedure outlined below when processing Shop }drawing submittals: a. Quantity: Contractor shall submit number required by the City to the City Engineer or his designated representative. b. Reprodu.cibles: in addition to the required copies, the Contractor shall also submit one (1) reproducible transparency for all shop drawings. C. Submittal Transmittal Forms- Contractor shall use the Submittal Transmittal Form attached at the anti of this Section.; and sequentially number each transmittal form. Resubmittals must have the original submittal number with an alphabetic suffix, Contractor must identify the Contractor, the Subcontractor or supplier; pertinent Drawing sheet and detail number(s), and specification Section number, as appropriate, on each submittal form. d. Contractor's Stamp: Contractor must apply Contractor's stamp, appropriately signed or initialed, which certifies that review, verification of Products required, field dimensions, adjacent construction work, and coordination of information, is all in accordance with the requirements of the Project and Contract documents. e. Scheduling: Contractor must schedule the submittals to expedite the Project, and deliver to the, City Engineer for approval, and coordinate the submission of related items. f. barking: Contractor must mark each copy to identify applicable products, models, options, and other data. Supplement manufacturers' standard data to provide information unique to this Project. section A - SP (Revised 12/15/04) Page 18 of 23 g. Variations: Contractor must identify any proposed variations from the Contract documents and any Product or system limitations which may be detrimental to successful performance of the completed worst. h. Space Requirements: Contractor must provide adequate space for Contractor and Engineer review stamps on all submittal fortes. I Resubmittals: Contractor must revise and resubmit submittals as required by City Engineer and clearly identify all changes made since previous submittal. j. Distribution.: Contractor must distribute copies of reviewed submittals to subcontractors and suppliers and instruct subcontractors and suppliers to promptly report, thru Contractor, any inability to comply with provisions. 2. Sa ?les: The Contractor must submit samples of finishes from the full range of manufacturers, standard colors, textures, and patterns for City Engineer's selection. 3. Test and Repair Report When specified in the Technical. Specifications Section, Contractor must submit three (3) copies of all shop test data, and repair report, and all on -site test data within the specified time to the City Engineer for approval. Otherwise, the related equipment will not be approved for use on the project. A -37 Amended "Arranges nt and Charge for water F=niahed by the City" MW USED) A -38 Worker's Compensation Coverage for Buildinq or Construction Proiects for Government Emati,ties The requirements of 'tNotice to Contractors 'B'n are incorporated by reference in this Special Provision. A -39 Certificate of Occ tance i The issuance of a certificate of occupancy for improvements does not constitute final acceptance of the improvements under General Provision B -8- 9. A -40 Amendment to Section. B -8 -6t Partial. Estimates General Provisions and Requirements for Municipal Construction Contracts Section B -8 -6: Partial Estimates is amended to provide that approximate estimates from which partial payments will be calculated will not include the net invoice value of acceptable, non - perishable materials delivered to the Section A - SY (Revised 12/151041 Page 19 of 23 Project worksite unless the Contractor provides the City Engineer with documents, satisfactory to the City Engineer, that show that the Material supplier has been paid for the materials delivered to the Project worksite. A- 41 .Ozone Advisory (NOT US=) A -42 OSEEA Rules & Reaulations It is the responsibility of the Contractor(s) to adhere to all applicable 0SRA rules and regulations whale performing any and all City - related projects and or jobs. A -43 Amended Indeppification & Hold Harmless Under "General Provisions and Requirements for Municipal Construction. Contracts" B -6 -21 Indemnification & Hold Harmless, text is deleted in its entirety and the following is substituted in lieu thereoft The Contractor shall hold the City, its officials, employees, attorneys, and agents harmless and shall indemnify the City, its officials, employees, attorneys, and agents from any and all damages, injury or liability whatsoever from an act or omission of the contractor, or any subcontractor, supplier, materialman, or their officials, employees, agents, or consultants, or any work done under the contract or in connection therewith by the contractor, or any subcontractor, supplier, materialman, or their officials, employees, agents, or consultants, The contractor shall hold the City, its officials, employees,.attorneys, and agents harmless and shall indemnify the City, its officials, employees, attorneys, and agents from any and all damages, injury, or liability whatsoever from a negligent act or omission of the city, its officials, employees, attorneys, and agents that directly or indirectly causes injury to an employee of the contractor, or any subcontractor, supplier or materialman. A -44 Chgp_ge Orders Should a change order(s) be required by the engineer, Contractor shall furnish the engineer a complete breakdown as to all prices charged for work of the change order (unit prices, hourly rates, sub- contractor I a costs and breakdowns, cost of materials and equipment, wage rates, etc.) . This breakdown information shall be submitted by contractor as a basis for the prase of the change order. A -45 As -Built Dimensions and Drawi a (7/5/00) (a) Contractor shall make appropriate daily measurements of facilities constructed and keep accurate records of location (horizontal and vertical) of all facilities. (h) Upon completion of each facility, the Contractor shall furnish Owner with one set of direct prints, marked with red pencil, to show as -built dimensions and locations of all work constructed. As a minimum, the final, drawings shall include the following: Section A - SP (Devised 12115/04) Page 20 of 23 (1) Horizontal and vertical dimensions due to substitutions /field changes. 2) Changes in equipment and dimensions due to substitutions. (3) "Nameplate" data on all installed equipment. (4) Deletions, additions, and changes to scope of work. (5) Any other changes made. A -46 Disposal of Highly Chlorinated water (7!5/00) (NOT USED) Vae C-entraeter it te the City fier be geL- the disposal fe-r- of P&peiinee emea-vated shall responsible ef watei- used r iin the l r wetlands or eavirementally seasiti-ite areas. EPA, it These are regulated by numerous be the Gea#3�aetevls l ete. will toespensibility in the The "Bpesal be to all watev the Gity for- aaed pr-ejeet. metheds There be et shall submitted for- diSpef3a! hi approval.- shall as separate pay ef- A -47 8re-ConstrnctioXx EM10ratpry EMCavatians (7 /5100) (Nat Used) shall then it te the City fier prepare a repert and submit indieating the Owner- appreval of P&peiinee emea-vated and l as well as I distamee It 9 the ww.ist w the pa-It --be-line and elexv�atiena a# pipelines. A -48 Overhead Electrical Wires (7/5/00) Contractor shall Comply With all OSHA safety requirements with regard to proximity of construction equipment beneath overhead electrical wires. 'there Section A - SP (Revised 12/15/04) 1Pege 21 of 23 are many overhead wires crossing the construction route and along the construction, route. Contractor shall use all due diligence, precautions, etc., to ensure that adequate safety is provided for all of his employees and operators of equipment and with regard to ensuring that no damage to existing overhead electrical wires or facilities occurs. Contractor shall coordinate his work with AEP /CP&L and inform AEP /CP &L of his construction schedule with regard to said overhead lines. Some overhead lines are shown in the construction plans, while others are not. It shall be the Contractor's sole responsibility to provide for adequate safety with regard to overhead lines whether shown in the plans or not. A -49 Amended "Maintenance Guar5Bt " (8/24 /00) Under "General Provisions and Requirements for Municipal Construction Contracts ", B -8 -11 Maintenance Guaranty, add the following: "The Contractor's guarantee is a separate, additional remedy available to benefit the City of Corpus Christi. Neither the guarantee nor expiratiorn of the guarantee period will operate to reduce, release, or relinquish any rights or remedies available to the City of Corpus Christi for any claims or causes of action against the Contractor or any other individual or entity.,' A -50 Wisidstorm Certification The entire new addition, roof repairs, roof tie -ins, aluminum storefront, canopy and structural modifications of the existing building shall be inspected during construction by the project structural engineer (Wilkerson & Sanders, Inc.) (Certified Windstorm Inspector) that it complies with the requirements of the State Board of Insurance, Engineering Division, for the TCPIA. Contractor shall provide the services of the project structural engineer (Wilkerson & Sanders, Inc.) for this certification and include the cost in the Total Base Bid.. A Form WPI -1 {Inspector Application} shall be submitted to the Texas Department of Insurance prior to commencing construction and a Form WBi- 2 -BC -5 shall, be submitted to the Texas Department of Insurance indicating the certified Windstorm inspector (Wilkerson & Sanders, Inc.) has inspected the building for issuance of a WPI- -& by the Texas department of Insurance. The WPI -8 shall be provided to the.Owner with the close -out documents. A-°51 Amended Prosecution and Progress Under "General Provisions and Requirements for Municipal Construction Contracts", B -7 Prosecution and Progress, add the following: Funds are appropriated by the City, on a yearly basis. If funds, for any reason, are not appropriated in any given year, the City may direct suspension or termination of the contract. If the Contractor is terminated or suspended and the City request remobilization at a later date, the Contractor may request payment for demobilization / remobilization costs_ such oasts shall be addressed through a change order to the contract." Section A - SP (Revised 12/15/04) Page 22 of 23 SUBMITTAL TRANSMITTAL FORM PROJECT., ETHEL EYERLY SENIOR CENTER MANSa ka E I & vBG PROJECT No. E11126 �UNIIS Owkmm�yy:���pp �CygII�T��YyyggrrE)P�'y�C�ORPUS CHRITST�I@ ENGI ZZRi CXVCA ANASTOS ASSOCIATES, LLC CONTRACTOR: SUBMITTAL DATE: SUMaTT,FaL HUM BR. APPLICABL39 SPHCIFICATION Oft. DRAWING SUBMITTAL Section A - SP (Revived 12/15/04) Page 23 of 23 AGREEMENT THE STATE OF TEXAS § COUNTY OF NUECES § THIS AGREEMENT is entered into this 22Ni3 -- day of JANUARY, -2013 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 Henock Construction, LLC termed in the Contract Documents as "Contractor," upon these terms, performable in Nueces County, Texas: In consideration of the payment of $255,636.00 by City and other obligations of City as set out herein, Contractor will construct and complete certain improvements described as follows: ETHEL EYERLY SENIOR CENTER EXPANSION PHASE 1 (CDBG FUNDS) PROJECT NO. E11126 (TOTAL BASE BID: $255,636.00) 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. Page 1 of 3 Rev. Jun -2010 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 180 CALENDARIDAYS 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 I ATTEST: GJA- City Secretary APPROV D AS TO LEGAL FORM: By: Asst. City Attorney LATTESSwr GrpoGatiom �S:eal Below.) (Note If Person =signi g far corporation rs not Presrden.x aitach -copy ofauthodration. CITY OF CORPUS CHRISTI By: 0'1, Oscar Martinez Assistant City Manager Public Works, Utilities, and Transportation By: – Daniel Biles, P.E. Director of Engineering Services CONTRACTOR 1731 S. San Marcos St. Blda. 906 (Address) San Antonio, TX 78207 (City) (State) (ZIP) 2101661 -2737 * 2101661 -2705 (Phone) (Fax) Page 3 of 3 Rev. Sun -2010 Qyj LZ LF � r«,..,.�. �3 PROPOSAL FORM F0 R ETHEL EYERLY SENIOR CENTER EXPANSION PHASE 1 (CDBG FUNDS) PROJECT NO. E11126 bEPARTMNT OF ENGINEERING SERVICES CITY OF CORPUS CHRISTI, TEXAS PROPOSAL FORM PAGE I OF 6 P R® P O S A L Place: - Date e- — - ._...- -- -- - Proposal Of Hencok Construction, LTC a Corporation organized and existing under the Laws of the State of Texas OR a Partnership or Individual doing business as TO: The City of Corpus Christi, Texas Gentlemen: The undersigned hereby proposes to furnish all labor and materials, tools, and necessary equipment, and to perform the work required for- ETHEL EYERLY SENIOR CENTER EXPANSION PEE 1 (CDEG FUNDS) PROJECT NO. E21126 at the locations set out by the plans and specifications and in strict accordance with the contract documents for the following prices, to wit: PROPOSAL FORM PAGE 2 Of 6 I ETEHEL EYERLY SENIOR CENTER EXPANSION PHASE 1 (CDBG FUNDS) IV BID PROJECT NO. E11126 DESCRIPTION BID ITEM ESTENSIOI+I ITEM BASE BID I II IIT Consisting of all work for the BID QTY & DESCRIPTION BI ITEM UNIT 1. 1 L. S. Consisting of all work for the facility and Remodel of Room A110 renovation of the existing D1EXT11N;1:10,q _._.__._.._..._. _._..._ ...- - ._ ._ ............. ._._......i�u�ld=rrg, _.adcl' an ss i o k as plans, specifications and contract shown and in accordance with the documents; complete and in place plans, specifications and contract per LUMP SUM. p pdocuments;-- com fete- and__rn__..1ace -- per LUMP SUM. TOTAL BASE BID (BID ITEM 1) ADDITIVE ALTERNATE BID #1 I II III IV BID QTY S DESCRIPTION BID ITEM ESTENSIOI+I ITEM UNIT AA1. 1 L.S. Consisting of all work for the replacement of the existing HVP,C System and Suspended Acoustic Ceiling System of the existing facility and Remodel of Room A110 as shown and in accordance with the plans, specifications and contract documents; complete and in place per LUMP SUM. TOTAL ADDITIVE ALTERNATE BID #1: $ ( ADDITIVE ALTERNATE BID ITEM Al) BgID Subt4kRY : °DOTAL BASE BID TOTAL BASF, BID + ot, ADDITIVE ALTERNATE BID #1: $ j 2-14 PROPOSAL FARM PAGE 3 or s The undersigned hereby declares that he has visited the site and has carefully examined the plans, specifications and contract documents relating to the work covered by his bid or bids, that he agrees to do the work, and that no representations made by the City are in any sense a warranty but are mere estimates for the guidance of the Contractor. Upon notification of award of contract, we will within ten (1 p) calendar days execute the formal contract and will deliver a Performance Bond (as required) for the faithful performance of this contract and a Payment Bond as r glli YAK_.__... isure payment or al labor and materials. The bid bond attached to thzs proposal, in the amount of 5% of the highest amount bid, is to become the property of the City of Corpus Christi in the event the contract and bonds are not executed within the time above set forth as liquidated damages for the delay and additional work caused. thereby. Minority /Minority Business Enterprise Participation; The apparent low bidder shall, within five days of receipt of bids, submit to the City Engineer, in writing, the names and addresses of MBE firms participating in the contract and a description of the work to be performed and its dollar value for laid evaluation purpose. Dumber of Signed Sets of Documents: The contract and all bonds will be prepared in not less than four counterpart (original signed) sets. TiMe of Completion: The undersigned agrees to complete the work within 180 calendar days from the date designated by a Work Order. The undersigned further declares that he will provide all necessary tools and apparatus, do all the work and furnish all materials and do everything required to carry out the above mentioned work covered by this proposal, in strict accordance with the contract documents and the requirements pertaining thereto, for the SUM or sums above set forth. Receipt of the following addenda is acknowledged (addenda number) - Addenda 1, Addenda 2, Addenda 3 Respectfu41!H? bmi eda Name: no P W BY= ` (SEAL - IF BIDDER IS a Corporation) Address. 173 n Marcos St. Bldq,gos �172 . U. Sox) (Street) San Antonio, TX 78207 (City) (State) (Zip) Telephone, 210 -661 -2737 PROPOSAL PORN PAGE 4 OF 6 COUNTY OF NUECES. KNOW ALL BY THESE PRESS: . That Heno ok Construction, 'LLC of the City of. Sant .Antonio , County of Bexar, and State- of Texas . ....._., as principal ( "Principal "), and Developers Surey and Indemnity Company a solvent company deity 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 Qty of Corpus Christi, a Home Rule municipal corporation of Nueces County, Texas ("City". or "OWKER"), and unto all Subcontractors, Workers, laborers, mechanics acid suppliers .as their interests may appear, all of whorl shall have.a right to sue upon this bond in.the penal sum of U.S. Dollars:,( 255'636.00 U.S) tole paid in Nueces County, Texas, for the payment cif which sum i 'well 'and truly to be made; We, said Principal and Surety, bind. ourselves and our heirs, executors, adrninistrators, successors and assigns, jointly and severally, firmly by these presents: I Conditions of this. bond are such. that; whereas, Princ"ipa4 has entered into a .certain written contract with the City of Carpus Christi (OWNER), date the _22ND day Of JANUARY, RY, 20133 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: ETHEL. EYERLY`SENIOR CENTER EXPANSION PHASE. I (CDBia FUNDS) PROJECT NO, Ell 126 (TO. TAL BASE BID. $2661636.00) 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 dais obligation shalt be and become null and void: othervAse to remain in full force and effect. Surety, for vatue 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 saute shall in anywise affect. its obligation on this bond, and it noes 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 t if any legal action be filed an this bond, venue shall lie in Nueces County, Texas, The undersigned agen tis hereby designated by the Suret as the Agent in Nueces County to whom . any requisite . notices: may be delivered. and on whom service of process maybe 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 co pies, each one of which shall be deemed an original, this the 2M day of January 201:3. ATTrkl,___ Secie_tar� Address: 1731 S. San Marcos St. Bldg. 906. San Antonio, TX 78207 Address:. P.O. Box 19725 Irvine, CA 92623 Telephone: 972- . 870-0400 Fax: 972-870-0422 E-Mail: Srauch@lnsrodico.com Rev Date May 2011 Payment Bond . page 2 of 3 y,as e.A,r sar !\:i G0.i Yir Crs3al. ur I1GrJr1.I isR -eiF 6 4i A kii -.vElf 6l 11[ 4-JU Lj—_.Z„1 k,,,UUtILY Y':: J -I °- BYi no. fi and Service of pr a ess Name: Randy. Lee Ag.e`ncy: Higginbotham, Swantner & Gordon Address: 500 N. Shoreline Blvd., Ste 1200 (Physical Street Address) Corpus Christi, TX 78401 C ) (State) (zip) Teie phone: 361 -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 roust be attached hereto. Note: Date of Payment Bond must not be prior to date of contract. END Rev. Date May 2011 Payment Bond Wage 3 of 3 . Henock Construction, LLC Bond No.: 799941P POWER OF ATTORNEY FOR DEVELOPERS SURETY AND INDEMNITY COMPANY INDEMNITY COMPANY OF CALIFORNIA PO Box 19725, IRVINE, CA 92623 (949) 263 -3300 KNOW ALL BY THESE PRESENTS that except as expressly limited, DEVELOPERS SURETY AND INDEMNITY COMPANY and INDEMNITY COMPANY OF CALIFORNIA, do each hereby make, constitute and appoint: * * *Rosslyn Davis, Steve Rauch, Keith DeGarmo, jointly or severally * ** as their true and lawful Attomey(s) -in -Fact, to make, execute, deliver and acknowledge, for and on behalf of said corporations, as sureties, bonds, undertakings and contracts of surety- ship giving and granting unto said Attomey(s) -in -Fact full power and authority to do and to perform every act necessary, requisite or proper to be done in connection therewith as each of said corporations could do, but reserving to each of said corporations full power of substitution and revocation, and all of the acts of said Attomey(s) -in -Fact, pursuant to these presents, are hereby ratified and confirmed. This Power of Attorney is granted and is signed by facsimile under and by authority of the following resolutions adopted by the respective Boards of Directors of DEVELOPERS SURETY AND INDEMNITY COMPANY and INDEMNITY COMPANY OF CALIFORNIA, effective as of January 1st, 2408. RESOLVED, that a combination of any two of the Chairman of the Board, the President, Executive Vioe - President, Senior Vice - President or any Vice President of the corporations be, and that each of them hereby is, authorized to execute,this Power of Attorney, qualifying the attomey(s) named in the Power of Attorney to execute, on behalf of the corporations, bonds, undertakings and contracts of suretyship; and that the Secretary or any Assistant Secretary of either of the corporations be, and each of them hereby is, authorized to attest the execution of any such Power of Attorney; RESOLVED, FURTHER, that the signatures of such officers may be affixed to any such Power of Attorney or to any certificate relating thereto by facsimile, and any such Power of Attorney or certificate bearing such facsimile signatures shall be valid and binding upon the corporations when so affixed and in the future with respect to any bond, undertaking or contract of suretyship to which it is attached. IN WITNESS WHEREOF, DEVELOPERS SURETY AND INDEMNITY COMPANY and INDEMNITY COMPANY OF CALIFORNIA have severally caused these presents to be signed by their respective officers and attested by their respective Secretary or Assistant Secretary this Oc t ob e 4 th 2011 . r / By: Daniel Young, Senior Vice- Presid t By: ve A. Tvedt, Vice - President State of California County of Orange Aida f;�.. �� •C, O:li�PANY 6�•: mac=. q OGT. J. f� 2 OCT.5 u+= ill j -• 1936 ' 1967 �y41Fr3F�` tOW .. i On October 4th 2011 before me, Antonio Alvarado - Notary Public Date Here Insert Name and Title of the Officer personally appeared �s,� ..... . i Daniel Young and Steve A. Tvedt Name(s) of Signer(s) who proved to me on the basis of satisfactory evidence to be the person(s) whose name(s) islare subscribed to the within instrument and acknowledged to me that helshelthey executed the same in hislherltheir authorized capadty(ios), and that by hislherltheir signature(s) on the instrument the person(s), or the entity upon behalf of which the persons) acted, executed the instrument. I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph is true and correct. WITNESS my hand and official seal Signatures. / r CERTIFICATE The undersigned, as Secretary or Assistant Secretary of DEVELOPERS SURETY AND INDEMNITY COMPANY or INDEMNITY COMPANY OF CALIFORNIA, does hereby certify that the foregoing Power of Attorney remains in full force and has not been revoked and, furthermore, that the provisions of the resolutions of the respective Boards of Directors of said corporations set forth in the Power of Attorney are in force as of the date of this Certificate. This Certificate is executed in the City of Irvine, California, this 28t1 ,Y of Jarnlary, 201.3 By: [! Gregg Okura, As nt Secretary ID- 13BONS(Rev.10111) IMPORTANT NOTICE To obtain information or make a complaint: You may call the Surety's toll free telephoeo number for information or to make a complaint at: 1- 800 - 782 -1546 You may also write to the Surety at: P.O. Box 19725 Irvine, CA 92623 -9725 You may contact the Texas Department of Insurance to obtain information on companies, coverage, rights or complaints at: 1 -800- 252 -3439 You may write the Texas Department of Insurance at: 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 PREMIUM OR CLAIM DISPUTES: Should you have a dispute concerning your premium or about a claim you should contact the Surety first. If the dispute is not resolved, you may contact the Texas Department of Insurance. ATTACH THIS NOTICE TO YOUR. POLICY: This notice is for information only and does not become a part or condition of the attached document. AVISO IMPORTANCE Para obtener informacion o para someter una queja: Usted puede llamar al numero de telefono gratis de para informacion a para someter una queja al: 1- 800 -782 -1546 Usted tanbien puede escribir a Surety at: P.O. Box 19725 Irvine, CA 92623 -9725 Puede comunicarse con el Departamento de Seguros de Texas para obtener informacion acerca de compa- nias, coberturas, derechos o quejas al: 1-800- 252 -3439 Puede escribir al Departmento 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: ConsumerProtection @tdi.state.tx.us DISPUTES SOBRE PRIMAS O RECLAMOS: Si tiene una dispute concerniente a su prima o a un reclamo, debe comunicarse con el Surety primero. Si no se resuelve la disputa, puede entonces comuni- carrse con el departamento (TDI). UNA ESTEAVISOA SU POLIZA: Este aviso es solo para proposito de informacion y no se convierte en parte o condicion.del documento adjunto. 424E 1cp Insco Insurance Services, Inc. Underwriting Manager for: Developers Surety and Indemnity Company • Indemnity Company of California 17771 Cowan, Suite 100 Irvine, CA 92614 1- 800 - 782 -1546 www.inscoDico.com ID -1404 (TX) (Rev. 5112) COUNTY OF NUECES § KNOW ALL BY THESE PRESENTS: That Henock Cots #auction LLC of the Cit , _of. San Antonio 0unty of Bexar , and State of Texas; as 'principal (" Principal ), and Developers Surety and Indemnityy Company a solvent Company duly'.authorized Under the laws of the Stag of Texas to act as surety on bonds for principals ( "Surety"), are held and firmly bound unto the: City of Corpus Christi, a Home Rifle Municipal corporation of Nueces County, Texas ("City" or OWNER'), in the penal sum of TWO HUNDRED FIFTY-FIVE THOUSAN Slx HUNQRrzD THIRTY -5Ix AND N011 €tii. U.S. Dollars ($250 e &3f.0 U.S. to be paid in Nukes Coui,ty, Texps, for thO.payrnent ref which sum well and truly to be made, We, said principal and Surety, bind ourselves and our heirs, executors, administrators, successors and assicgns, jointly and severally, firmly by these. presents: Conditions of this bond are'such that, whereas, Principal has enter ,6d into a certain written contract witd the City of Carpus Christi (OWNER), dated the .� ND of JANUARY 20'I3, which A reern ent is.hereby refer,ced:to and made e parr hereof as fully and to the same extent as if spied at length herein . for the construction of: ET IEL EYERLY_SENICR CENTER EXPANSION PHASE 1 (CDBC, FUNDS) PROJECT NO. El 1126 (TOTAL 'BASE 'BID: $2660636.100) Now therefore; the ondi.b.on 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 acc� rdin. to the true intent and meaning of said Agreement hereto annexed; and if the Principal shall repair andlor Nulty replace all defects due to materials and/or workmanship that::appear within a period of one ('1) year from the date of completion oriel acceptance ,of improvements by the City(OWNGR), theta 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, onto the work pesfcirrned', thereunder, sir to the plans, specifications, drawings, ate., accompanying the sage 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, car to the work to tie performed thereunder, (Rev. gate May 2011) Performance Bond Page I of '3 Provided further, that this band is executed pursuant to Chapter 2253, T6xas Government Code, as amended. e Provided further, that if any legal action be filed on this bond, ven€� due e s'�ia(3 lie in County, Texas, The undersigned argent is hereby designated by the Su. rety as the. Resident Agent in Nue 5 Cnt,ntjr to whom any rEt isite notic.:es maybe delivered and on .horn service of process may be had in Matters arising 'ou# cif. such Sections 3503. suretyship da vided bar ` 001 to 35©3 .C)p �; Texas ti��iraince Cci e as amen ed . 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 28t1, shay of January , 20133• PRINCIPAL SURETY Henock Co stru ion, LLC — — Developers Surety and Indemnity Company I i By:_ By. . �_. irl -fact atde: esiden Attorney- Steve Rauch' A !.$ GV S ecretary Address: 1731 S. San Marcos St. Bldg 906 P.O. Box 19725 Address: San Antonio, TX 78207 Irvine, CA 92623 - Telephone: 972 -870 -0404 Fax, 972- 870 -0422 E- Mail,_ Srauch @inscodico.com (Rev gate May 2011) Performance Bonn. Page 2 of 3 Name and address of Resident Agent. of Surety in: Nue !� y, T�x�as, ft�r f�sti�� n6tice and service of process; Name: Randy Lee Higginbotham, Swantner & Gordon Agency: _ ' 500 N. Shoreline Blvd., Ste 1200 (Physical Street Address) Corpus Christi, TX 78401 (City) (State) (zip) Telephone, 361 -883 -1711 rrnl@s-gins.com i E -Mail: Note: Band shall be issued by a solvent Surety company authorized to do business in Texas, and shall. meet any € ther requirements established by law or by OWNER under applicable lair. Nate: Surety Agent's Original Power of Attorney must be attached hereto. Note: late of Performance Bored must not be prior to date of contract. END (Rev male May 2411) Performance Bond page 3 of 3 Heniock Construction, LLC POWER OF ATTORNEY FOR Bond No.: 799941P DEVELOPERS SURETY AND INDEMNITY COMPANY INDEMNITY COMPANY OF CALIFORNIA PO Box. 19725, IRVINE, CA 92623 (949) 263 -3300 KNOW ALL BY THESE PRESENTS that except as expressly limited, DEVELOPERS SURETY AND INDEMNITY COMPANY and INDEMNITY COMPANY OF CALIFORNIA, do each hereby make, constitute and appoint: * * *Rosslyn Davis, Steve Rauch, Keith DeGarmo, jointly or severally * ** as their true and lawful Attomey(s) -in -fact, to make, execute, deliver and acknowledge, for and on behalf of said corporations, as sureties, bonds, undertakings and contracts of surety- ship giving and granting unto said Attorney(s)-in-Fact full power and authority to do and to perform every act necessary, requisite or proper to be done in connection therewith as each of said corporations could do, but reserving to each of said corporations full power of substitution and rovocation, and all of the acts of said Attomey(srin -Fact, pursuant to these presents, are hereby ratified and confirmed. This Power of Attorney is granted and is signed by facsimile under and by authority of the following resolutions adopted by the respective Boards of Directors of DEVELOPERS SURETY AND INDEMNITY COMPANY and INDEMNITY COMPANY OF CALIFORNIA, effective as of January 1 st, 2008. RESOLVED, that a combination of any two of the Chairman of the Board, the President, Executive Vice - President, Senior Vice- President or any Vice President of the corporations be, and that each of them hereby is, authorized to execute_this Power of Attorney, qualifying the attomey(s) named in the Power of Attomey to execute, on behalf of the corporations, bonds, undertakings and contracts of suretyship; and that the Secretary or any Assistant Secretary of either of the corporations be, and each of them hereby is, authorized to attest the execution of any such Power of Attomey; RESOLVED, FURTHER, that the signatures of such officers may be affixed to any such Power of Attorney or to any certificate relating thereto by facsimile, and any such Power of Attomey or certificate bearing such facsimile signatures shall be valid and binding upon the corporations when so affixed and in the future with respect to any bond, undertaking or contract of suretyship to which it is attached. IN WITNESS WHEREOF, DEVELOPERS SURETY AND ;NDEMNITY COMPANY and INDEMNITY COMPANY OF CALIFORNIA have severally caused these presents to be signed by their respective officers and attested by their respective Secretary orAssistant Secretary this Oc tober 4th 2011 . sy: Daniel Young, Senior Vice - President By:-— + _ Ste A. Tvedt, Vice - President State of Califomia County of Orange On October 4th 2011 Date personally appeared , fit AND ryas O�Nt�ANY OCT 's t0 2 OCT.5 nW ° 1936 g LO 1967 9� ., �OVd,�• ''� � �g41FO' ;' before me, Antonio Alvarado — Notary Public Here Insert Name and Titte of the Officer ANiOW AWAVA" * COMFL Wpkw Aug. 9.201'3 Place Notary Seal Above Daniel Young and Steve A. Tvedt Name(s) of Signer(s) who proved to me on the basis of satisfactory evidence to be the person(s) whose name(s) islare subscribed to the within instrument and acknowledged to me that helshelthey executed the same in hislherltheir authorized capadty(ies), and that by hislherltheir signature(s) on the instrument the person(s), or the entity, upon behalf of which the person(s) acted, executed the instrument. I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph is true and correct. WITNESS my hand and official seal. Signature CERTIFICATE The undersigned, as Secretary or Assistant Secretary of DEVELOPERS SURETYAND INDEMNITY COMPANY or INDEMNITY COMPANY OF CALIFORNIA, does hereby certify that the foregoing Power of Attorney remains in full force and has not been revoked and, furthermore, that the provisions of the resolutions of the respective Boards of Directors of said corporations set forth in the Power of Attorney are in force as of the date of this Certificate. This Certificate is executed in the City of Irvine, California, this 28 `-"day of '7anuar7r 2013 By: V L/ Gregg Okura, Assistant t-ry ID- 138ONS(Rev.10111) IMPORTANT NOTICE To obtain information or make a complaint: You may call the Surety's toll free telephoen number for information or to make a complaint at: 1 -800 -782 -1546 You may also write to the Surety at: F.O. Sox 19725 Irvine, CA 92623 -9725 You may contact the Texas Department of Insurance to obtain information on companies, coverage, rights or complaints at: I -800- 252 -3439 You may write the Texas Department of Insurance at: P.O. Box 149104 Austin, TX 78714 -9104 Fax# 512475 -1771 web: http: / /www.tdi.state.tx.us E -mail: ConsumerProtection @ tdi.state.tx.us PREMIUM OR CLAIM DISPUTES: Should you have a dispute concerning your premium or about a claim you should contact the Surety first. If the dispute is not resolved, you may contact the Texas Department of Insurance. ATTACH THIS NOTICE TO YOUR POLICY: This notice is for information only and does not become a part or condition of the attached document. AVISO IMPORTANCE Para obtener informacion o para someter una queja: Usted puede llamar al numbre de telefono gratis de para informacion o para someter una queja al: 1- 800 -782 -1546 Usted tanbien puede escribir a Surety at: P.O. Box 19725 Irvine, CA 92623 -9725 Puede comunicarse con el Departamento de Seguros de Texas para obtener informacion acerca de compa- nias, coberturas, derechos o quejas al: 1- 800 -252 -3439 Puede escribir al Departmento 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: ConsumerProtection @tdi.state.tx.us DISPUTAS SOBRE PRIMAS O RECLAMOS: Si tiene una disputa concerniente a su prima o a un reclamo, debe comunicarse con el Surety primero. Si no se resuelve la disputa, puede entonces comuni- carrse con el departamento (TDI). UNA ESTEAVISOA SU POLIZA: Este aviso es solo para proposito de informacion y no se convierte en parte o condition del documento adjunto. 4�7C CO o Q 4 Insco Insurance Services, Inc. Underwriting Manager for: Developers Surety and Indemnity Company - Indemnity Company of California 17771 Cowan, Suite 100 Irvine, CA 92614 1 -800- 782 -1546 www.inscoDico.com ID -1404 (TX) (Rev. 5/12) Cny Of SU?PLIER NUMBER PusTO BE ASSIGNED B�"'M- PURCHASING DIVISION CITY OF CORPUS CHRISTI DISCLOSURE OF INTEREST C it 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 "NAe See reverse side for Filing Requirements, Certifications and definitions_ COMPANY SAM:. Henock Construction, LLC P. O. BOX: STREET ADDRESS: - _ CITy•. 3731 S. San. Marcos St. Bldg:906... San _Antonio .TX SIP -78207 F i PM IS: I. 4. Corporation 8 Association 2 Tartnership CL 3. Sole Owner 5.0ther 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 „ownership of Corpus Christi having an interest" constituting 3% or more of the `fi rm. •• ownership in the above named Name Job 'Title and City Department (if known.) N/A 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 N/A 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 N/A Name Board, Commission or Committee 4. Stage 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." N/A Name Consultant PROPOSAL FORM PAGE S OF 6 FILING REQUIRENENTS 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 3-n 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 1gn 2 writing filed with the City Secretary. [Ethics Ordinance Section 2 -343. 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 Title pgrson: Henock Perez President ITYPe or Prino Signature of Date Certifying Persona: 10/10/12 DEF 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 Murticipal Court 3udges of the City of Corpus Christi, Texas. f- "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 teens of venture or partnership agreements." 9- "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. PROPOSAL FORM PAGE 6 OF 6 HENOC -2 OP ID: AW CERTIFICATE OF LIABILITY INSURANCE DATE {MMlOp1WYYl n ro. Ian. THIS CERTIFICATE IS ISSUED AS A (NATTER 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. . INIPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) 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 Phone: 972- 644 -2688 BAurance COX AGENCY, Bo Fax: 972- 644-8035 Insurance 8< Construction Bonds CONTACT NAME Am Coke, ACSR, CISR, CIC PHONE . 972 - 3313704 n c No : 972 - 3313722 5930 Preston View Blvd Ste 200 Dallas, TX 75244 E-MAIL Ds: am baldwina n com ProCYEJ(P LIMITS Brent Baldwin INSURER(S) AFFORDING COVERAGE NAIC N INSURFRA: Cincinnati Insurance Companies 10677 INSURED Henock Construction, LLC 1731 S. San Marcos Bldg 906 San Antonio, TX 78207 -7095 INsupme American Hallmark Insurance 43494 INsuRmc: Westchester Fire Insurance Co. DAMAGE TO RENTED $ 1QO,oDD MEDEXP (Anyone person) $ 5,000 INSURER D $ 11000,000 INSURERE: GENERALAGGREGATE INSURER F: GEN'LAGGRE GATE LIMiTAPPLIE$FER: P L1 X Y PRO- PRODUCTS- COMPIOFAGG f r%xjcm Af_Ce L`C0TIC1t ATC IJIIMQCO. owiar�u• 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. ILTR TYPEOFINSURANCE AODL SU POLICYNUMBER POUCYEFF ProCYEJ(P LIMITS • GENERAL LIABILITY X COMMERCSALGENERALLIABILITY CLAIMS -MADE OCCUR EPP0163572 !(/ / 16/0912012 101091201.3 EACHOCCURRENCE $ 1,00o,000 DAMAGE TO RENTED $ 1QO,oDD MEDEXP (Anyone person) $ 5,000 PERSONAL &ADVINJURY $ 11000,000 GENERALAGGREGATE $ 2,000,000 GEN'LAGGRE GATE LIMiTAPPLIE$FER: P L1 X Y PRO- PRODUCTS- COMPIOFAGG $ 2,000,600 $ • AUTOMOBILEUABIU`Y ANY AUTO ALLOWNER SCHEDULED AUTOS NON-OWNED NON -OWNED HIREDAUTOS AUTOS EBA 016 35 72 / 1010912012 10109/2013 / / V{ COMBINE ASINGLELIMIT 1,000,060 X BODILY INJURY (Per person) $ BODILY INJURY Peraccident ( ) $ PROPERTYDAMAGE p $ $ A X UMBRELLA LIAB E)(CESSLIAB X OCCUR CLAIMS -MADE EPP0163572 1010912012 10/0912013 EACHOCCURRENCE $ 1,000,000 AGGREGATE $ 11000,000 B WOWERSCOMPENSATION I AND EMPLOYERS' LIABILITY ANY PROPRIETE EXCNERIEECU7VE Indatoryi If yes, describe e under under - If NrA AHWC0712 10/09/2012 1010912013 X I WCSTATU- 1 10 TH- E.L. EACHACCIOENT $ 1,000,000 E.. $ 1,000,000 E.L. DI A - POLICYIIL4 I 1,000,000 C Builders Risk 121091583001 / 02!1812013 02118120'14 V Limit 255,636 Ded 1,000 DESCRIPTION OF OPERATIONS i LOCATIONS 1 VEHICLES {Attach ACORD 101, Additional Remarks Schedule, if more space is required) Project: E11126 Ethel Eyerly Senior Center Expansion Phase 1 (CDBG Hands) / * *Please see the Attached ** V CITYCIO City of Corpus Christi Dept of Engineering Services Attn: ContractAdministrator PO Box 9277 Corpus Christi, TX 78469-9277 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 11� 06?1j ` cV 19HB- 2UIUACORD CORPORATION. All rights reserved. ACORD 25 (201010 5) The ACORD name and logo are registered marks ofACORD NOTEPAD. HOLDER CODE CITYCIO HENOC -2 INSUREWSMAurz Henock Construction, LLC OP ID: AW A Blanket Additional Insured is provided for The City of Corpus Christi with respects to the General Liability and Auto Liability as their interest may appear as per written contract. The General Liability, Auto Liability and Workers' Compensation policies include a blanket notice of cancellation to certificate holders endorsement, providing for 30 days' advance notice if the policy is canceled the company other than for non payment of premium, 10 days' notice after by the polio Y is canceled for non payment of premium. Notice is sent to certificate holders with mailing addresses on file with the agent or the company. The endorsement does not provide for notice of cancellation if the named insured requests cancellation. City of Corpus Christi is listed as loss payee and additional insured as their interest rpay appear to the Builders Risk Policy with a 30 notice of cancellation, except 10 Day for non payment of premium. Umbrella follows form. * *Endorsements Attached ** PAGE 2 DATE 02/21/13 Policy Nurnber EPP 0163572 V THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. CONTRACTORS' COMMERCIAL GENERAL LIABILITY "%w BROADENED ENDORSEMENT This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART A. Endorsement - Table of Contents: Coverage: B ins on Pave; 1. ' Employee Benefit Liability Coverage 2. ............... ......................... ...... ......... 2 Unintentional Failure to Disclose Hazards, 3. ............. 7 Damage to Premises Rented to You 4. ....... ......................... ...... Supplementary Payments 5. ................................................... Medical Payments ................ ...--..... ..:....}6. Volluntary Property Damage tCovera ga a. ...r . ..C.o.n.t.r.o..l ........,....., g Liability Coverage (Coverage b.) ........................................................... 7. 180 Day Coverage for Newly Formed or Acquired Organizations ............ ............................... 10 8. •. ...... Giver of Subrogation ......................... ........ ...................... ................. ........................... 10 Automatic Additional Insured - Specified Relationships: .................... ............................... ... 10 • Managers or Lessors of Premises; " " " - -- • Lessor of Leased Equipment; • Vendors; • State or Political Subdivisions - Permits Relating to Premises; • State or Political Subdivisions - Permits; and • Contractors' Operation s 10. Broadened Contractual Liability - Work Within 50' of Railroad Property ................................ 14 11. ......... . - -..... Property Damage to Borrowed Equipment ...................... 12. Employees as Insureds - Specified Health Care Services: .......... ..... Nurses; .......14 • Emergency Medical Technicians-, and • Paramedics 13. Broadened Notice of Occurrence ............................ 14 B. Limits of Insurance: The Commercial General Liability Limits of Insurance apply to the insurance provided by this endorse- ment, except as provided below: 1. . Employee Benefit Liability Coverage Each Employee Limit: $ 1,000,000 Aggregate Limit: $ 3,000,000 Deductible: $ 1,000 3. Damage to Premises Rented to You The lesser of: A. The Each Occurrence Limit shown in the Declarations; or b. $500,000 unless otherwise stated $ 4. Supplementary Payments a. Hail bonds: $ 1 ,000 b, Loss of earnings: $ 350 `r S. Medical Payments Medical Expense Limit: $ 10,000 Includes copyrighted material of Insurance GA 233 02 07 Services Office, Inc., with its permission. Page 1 of 15 Policy Plumber EPP 0163572 6. Voluntary Property Damage (Coverage a.) and Care, Custody or Control Liability Coverage (Coverage b.) Limits of insurance (Each Occurrence) Coverage a. $1,000 Coverage b. $5,000 unless otherwise stated $ Deductibles (Each Occurrence) Coverage a. $250 Coverage b. $250.unless otherwise stated $ COVERAGE PREMIUM BASIS RATE ADVANCE PREMIUM (a) Area (For Limits in Excess of (For Limits in Excess of a. The following is added to SECTION I (b) Payroll $5,000) $5,000) Liability Coverage. {(c) Gross Sales (1) Insuring Agreement ity to pay sums or perform d) Units (a) We will pay those sums that unless explicitly provided for the insured becomes legally e Other obligated to pay as dam- meats. b. Care, Custody This insurance applies to sured, or of any other per- $ or Control ror or omission, is negli- sured is legally liable, to gently . committed in the O 1_ ANNUAL PREMIUM plies. We will have the right 11. Property Damage to Borrowed. Equipment Each Occurrence limit: $ 10,000 Deductible. $ 250 C. Coverages: have used up the ap- plicab #e limit of insur- 1. Employee Benefit Uability Coverage ance in the payment of a. The following is added to SECTION I judgments or settle- - COVERAGES- Employee Benefit ments. Liability Coverage. No other obligation or liabil- (1) Insuring Agreement ity to pay sums or perform acts or services is covered (a) We will pay those sums that unless explicitly provided for the insured becomes legally under Supplementary Pay- obligated to pay as dam- meats. ages caused by any act, er- ror or omission of the in- (b) This insurance applies to sured, or of any other per- damages only if the act, er- son for whose acts the in- ror or omission, is negli- sured is legally liable, to gently . committed in the which this insurance ap- administration" of your ,employee plies. We will have the right benefit . pro - and duty to defend the in- gram "; and sured against any "suit" seeking those damages. 1) Occurs during the pol- However, we will have no icy period; or duty to defend against any "suit" 2) Occurred prior to the seeking damages to effective date of this which this insurance does endorsement provided: not apply. We may, at our discretion, investigate any a) You did not have report of an act, error or knowledge of a omission and settle any claim or "suit" on claim or "suit" that may re- or before the ef- sult. But: fective date of this 1) The amount we will pay endorsement_ for damages is limited You will be as described in SEC- deemed to have TION IN - L.IMITS OF knowledge of a INSURANCE; and claim or "suit" 2) Our right and duty to when any authorized repre- defend ends when we sentative "; Includes copyrighted material of insurance GA 233 02 07 Services Office, Inc., with its permission. Page 2 of 15 - Policy Number EPP 0163572 i) Reports all, or formance of investment any Part, of the vehicles; or act, error or Damage or Personal and omission to us 3) Advice given to any or any other person with respect to insurer; that persos decision n ii) Receives a to participate or not to written or ver- participate in any plan included in the -em- clairn for dam- ployee benefit ro- "_ p ages because gram of the act, er- (f) Workers' Compensation ror or omis- and Similar Laves Sion; and Dishonest, Fraudulent, b) There is no other Any claim arising out of your failure to comply with applicable insur- the mandatory provisions of ante. any workers' compensation, (2) Exclusions unemployment cornpensa- bon insurance, social secu- This insurance does not apply city or disability benefits law to or any similar taw_ (a) Bodily Injury, Property (g) ERISA Damage or Personal and Damages for which any in- Advertising Injury sured is .liable because of `Bodily injury ", "property liability imposed on a fiduci. damage" or "personal and ". ary by the Employee Re- Income Security advertising advertising injury Act of 1974, as now (b) Dishonest, Fraudulent, hereafter amended, or by Criminal or Malicious Act any similar federal, state or local laws. Damages arising out of any intentional, dishonest, (h) Av6lable Benefits fraudulent, criminal or mali- cious act, error or. omission, Any maim for benefits to the committed by any insured, including the willful or neck- extent that such benefits are available, with reason - less, violation of any statute. able effort and coo eration the of the insured, from ap- (c) Failure to Perform a Con- pliicable funds accrued or tract other collectible insurance. Damages arising out of fail- (t Taxes, Fines or Penalties ure of performance of con- tract by any insurer. Taxes, fines or penalties, including those imposed (d) Insufficiency of Funds under the Internal Revenue Code or any similar state or Damages arising out of an local law. insufficiency of funds to meet any obligations under ) to Employment-Related Empl y any plan included in the es "employes benefit pro - graw. Any liability arising out of any_ (e) Inadequacy of Perform- ance of Investment 1 Ad- (1) Refusal to employ; vice Given With Flespect (2) Termination of em- to Participation ployment; Any claim based upon: (3) Coercion, dernotion, 1) Failure of any invest evaluation, reassign- ment to perform; meat, discipline, defa- mation, harassment, 2) Errors in providing in- humiliation, discrimina- formation on past per- lion or other employ - Includes copyrighted material of Insurance GA 233 02 07 Services Office, Inc., with its permission. Page 3 of 15 Policy Number EPP 0163572 ment- rdlated practices, acts or omissions,-.or (4) Consequential liability as a result of (1), (2) or (3) above. This exclusion applies whether the insured may be held liable as an employer or in any other capacity and to any obligation to share damages with or repay someone else who must pay damages because of the injury_ (3) Supplementary Payments SECTION I - COVERAGES, SUPPLEMENTARY PAY - MENTS - COVERAGES A AND 13 also apply to this Coverage_ b, Who is an Insured As respects Employee Benefit Liabil- ity Coverage, SECTION II - WHO .IS AN INSURED is deleted in its en- tirety and replaced by the following: (1) If you are designated in the Declarations as: (a) An individual, you and your spouse are insureds, but only with respect to the conduct of a business of which you are the sole owner. (b) A partnership or joint ven- ture, you are an insured. Your members, your part- ners, and their spouses are also insureds but only with respect to the conduct of your business. (c) A limited liability company, you are an insured. Your members are also insureds, but only with respect to the conduct of your business. Your managers are in- sureds, but only with re- spect to their duties as your managers. (d) An organization other than a partnership, joint venture or limited liability company, you are an insured. Your executive officers" and di- rectors are insureds, but only with respect to their duties as your officers or & rectors. Your stockholders are also insureds, but only with respect to their liability as stockholders. (e) A trust, you are an insured. Your trustees are also in- sureds, but only with re- spect to their duties as trustees. (2) Each of the following is also an insured: (a) Each of your "employees" _ who is or was authorized to administer your "employee benefit program ", (b) Any persons, organizations or employees having proper temporary authori- zation to administer your "employed benefit program" if you die, but only until your legal representative is ap- pointed. (e) Your legal representative if you die, but only with re- spect to duties as such. That representative will have all your rights and du- ties under this Coverage Part. (3) Any organization you newly ac- quire or form, other than a part- nership, joint venture or limited liability company, and over which you maintain ownership or majority interest, will qualify as a Named Insured if no othr similar insurance applies to that organization. However, cover- age under this provision: (a) Is afforded only until the 180th day after you acquire or form the organization or the end of the policy period, whichever is earlier; and (b) Does not apply to any act, error or omission that was committed before you ac- quired or formed the or- ganization. c. Limits of Insurance As respects Employee Benest Liabii lty Coverage, SECTION III - LIMITS OF INSURANCE is deleted in its en- tirety and replaced by the following: (1) The Limits of Insurance shown in Section B. Limits of insur- ance, 1. Employee Benefit Li- ability Coverage and the rules below fix the most we will pay regardless of the number of: (a) Insureds; Includes copyrighted material of Insurance GA 233 02 07 Services Office, Inc., with its permission. Page 4 of 15 Policy Number EPP 0163572 (b) Claim made or "suits" brought; (b) The deductible amount stated in the Declarations (c) Persons or organizations applies to all damages malting claims or bringing sustained by any one "em_ "suits "; ployee,, indudIng such (d) Acts, errors or omissions; or employee's" dependents and beneficiaries, because (e) Benefits included in our of all acts, errors or omis- sions to which this insur- employee benefit pro -, ".. ance applies. gram (2) The Aggr ate Limit shown in Section B. Emits of Insurance, (a) The terms of this insurance, including those with respect I. Employee Benefit Liability to: Coverage of this endorsement 1) Our right and duty to is the most we will pay for all damages because of acts, er- defend the insured against any "suits" rors or. omissions negligently seeking those dam - committed in the 'administra- ages; and ton' of "employee benefit your 2) Your duties, and the duties of any other in- (3) Subject to the limit described in volved insured, in the (2) above, the Each Employee event of an act, error or Limit shown in Section B. Limits omission, or claim, of Insurance, 1. Employee Benefit Liability Coverage of apply irrespective of the this endorsement is the most we application of the deductible will pay for all damages sus- amount tained by any one "employee ", including damages sustained by A We may pay any part or all such "employee's" dependents of the deductible amount to effect settlement of and beneficiaries, as a result of: any claim or "suit" and, upon (a) An act, error or omission; or notification of the. action taken, you shall promptly (b) A series of related acts, er- reimburse us far such part rors or omissions, regard- of the deductible amount as less of the amount of time we have paid_ that lapses between such acts, errors or omissions, d, Additional Conditions negligently committed in the As respects Employee Benefit Li. "administration" of your "em- ployee benefit program ". ability Coverage, SECTION iv - WUMEiRC1AL GENERAL LIABIL- ITY CONDITIONS is amended as However, the amount paid un- follows; der this endorsement shall not exceed, and will be subject to (1) Item 2. Duties in the Event of the limits and restrictions that Occurrence, offence, Claim or apply to the payment of benefits Suit is deleted in its entirety and in any plan included in the "em- replaced by the following: ployee benefit program " - 2. Duties in the Event of an Act, Error or (4) Deductible Amount Omission, or Claim or Suit (a) Our obligation to pay dam- a• You must see to it that we are noti- ages on behaff of the in- fled as soon as practicable of an act, 5ured appll6s only t0 the o the error or omission which may result in amount of damages a claim- To the extent possible, no- of the deductible tics should include: amount stated in the Deola- (1) What the act, error or omission rations as applicable to Each Employee. The limits was and when it occurred; and of insurance shall not be (2) The names and addresses of reduced by the amount of anyone who may suffer dam - this deductible. ages as a result of the act, error or omission. Includes copyrighted material of Insurance GA 233 02 07 Services Office, Inc., with its permission. page 5 of 15 raiicy ivumoer tvF Ulbi5/Z b. If a claim is made or "suit" is brought against any insured, you must: (1) Immediately record the specifics of the claim or "suit' and the date received; and (2) Notify us as soon as practicable. You must see to it that we receive written notice of the claim or "suit" as soon as practicable. c. You and any other involved insured must: (1) Immediately send us copies of any demands, notices, sum- monses or legal papers re- celved in connection with the claim or "suit"; (2) Authorize us to obtain records and other information; (3) Cooperate with us in the investi- gation or settlement of the claim or defense against the "suit'; and (4) Assist us, upon our request, in the enforcement of any right against any person or organiza- tion which may be liable to the insured because of an act, error or omission to which this insur- ante may also apply, d. No insured will, except at that in- sured's own cost, voluntarily make a payment, assume any obligation, or incur any expense without our con- sent. (2) Item 5. Other Insurance is de- leted in its entirety and replaced by the following: 5. Other Insurance If other valid and collectible insurance is available to the insured for a loss we cover under this Coverage Part, our obligations are limited as follows: a. Primary Insurance This insurance is pri- mary except when c. below applies. If this insurance is primary, 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 b. below. b. Method of Sharing If all of the other insur- ance permits contribu- tion by equal shares, we will follow this method also. Under this approach each in- surer contributes equal amounts until it has paid its applicable limit of insurance or none of the . loss remains, whichever comes first. If any of the other in- surance does not per - mit contribution by equal shares, we will contribute by limits. Under this method, each insurer's share is based on the ratio of its applicable limit of in- surance to. the total ap- plicable limits of insur- ance of all insurers. c. No Coverage This insurance shall not cover any loss for which the insured is entitled to recovery un- der any other insur- ance in force previous to the effective date of this Coverage Part e. Additional Definitions As respects Employee Benefit Li- abiliity Coverage, SECTION V - DEFINITIONS is amended as fol- lows: (1) The, following definitions are added: 1. "Administration" means a Providing information to "employees ", including their dependents and beneficiaries, with re- spect to eligibility for or scope of "employee benefit programs b. Interpreting the "ern- ployee benefit pro- grams"; c- Handling records in connection with the 'employee benefit pro- grams"; or d. Effecting, continuing or terminating any "em- ployee's" participation GA 23:i 02 07 Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 6 of 15 roiicy Number EPP 0163572 in any benefit included in the *employee bene- benefits, workers' com- ftt program". pensation and disability However, "administration" benefits; and does not include: d. Vacation plans, includ- a. Handling payroll de- ing buy and sell pro - grams; leave of ab- ductions; or sence programs, in- b- The failure to effect or cluding military, mater - nity, maintain an y insurance amily, and civil leave; tuition or adequate limits of coverage of insurance, assis- tance plans; transpor- including but not limited tation and health club subsidies. to unemployment in- surance, social security benefits, workers' com- (2) The following definitions are deleted in their entirety and re- pensation and disability Placed by the following: benefits. 2. "Cafeteria plans" means 21. "Suit" means a civil ceeding in which money Plan authorized by applica- damages because of an ble law to allow "employ- act, error or omission to ees" to elect to pay for ter which this insurance applies tain benefits with pre -tax dollars. are alleged. "Sult" includes: 3. "Employee benefit pro. a. An arbitration pro. ceeding In which such grams" means a program pproviding some or all of the damages are claimed and to which the in. following benefits to "em- ployaes , whether provided sured must submit or does submit with through a "cafeteria plan" or our consent; otherwise: a. Group life insurance; b. Any other alternative dispute resolution pro- group accident or health insurance; den. ceeding in which such damages are claimed tal, vision and hearing and to which the in- plans; and flexible sured submits with our spending accounts; consent; or Provided that no one other than an "em- c- An g. of a civil Ployee" may subscribe nx eed n to such benefits and such benefits are made 8. "Employee" means a Per- generally available to those "employees" who son actively empbyed, for merl employed, on leave satisfy the plan's eligi- of absence or disabled, or retired. "Employee" in- bility requirements; cludes a "leased worker". b. Profit sharing plans, "Employee" does not in- "temporary employee savings clude a worker ". Plans, employee stock 2. Unintentional Failure to Disclose Haz- ownership plans, pen- ards sign plans and stock subscription plans, SECTION IV - COMMERCIAL GENERAL Provided that no one LIABILITY CONDMONS, 7. Represen- other than an "em- tations is hereby amended by the addi- Ployee" may subscribe tion.ofthe following: to such benefits and such benefits are made Based on our dependence upon your generally available to representations as two existing hazards, if all "ernppioyees" who unintentionally you should fail to disclose. all such hazards are eligibte under the at the inception date of plan fnr such benefits; your policy, we will not reject coverage under this Coverage Part based solely on c. Unemployment insur- such failure. ante, social security GA►233 02 07 Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 7 of 16 vi....y ,lumuci Lrr uioJJ /L 3. Damage to Premises Rented to You e) Settling, cracking, a. The last Subparagraph of Paragraph 2. SECTION shrinking or ex- . I - COVERAGES, COVERAGE A. - BODILY INJURY AND PROPERTY DAMAGE, 2. LI- pansion; or Nesting or infesta- ABILITY Exclusions is hereby de- ti ties, or discharge feted and replaced by the following: release pf waste products or Exclusions c. through q. do not apply secretions, by in- to damage by fire, explosion, fight sects, birds, ro- ning, smoke or soot to premises while rented to you or temporarily dents or other animals. th e owner_ by you with permission of (b) Loss caused directly or indi- rectly by any of the follow - b. The insuranoe provided under SEC- TION I - COVERAGES, COVERAGE ing: A. BODILY INJURY AND PROP 1) Earthquake, volcanic ERTY DAMAGE LIABILITY applies eruption, landslide or to "property damage arising out of water damage to premises that are any other earth rrrove- mast; both rented to and occupied by you. 2) Water that backs up or (1) As respects Water Damage Le- overflows from a gal Liability, as provided in sewer, drawn or sump; Paragraph 3.b, above: 3) Water under the The exclusions under SECTION ground surface press - I - COVERAGES, COVERAGE ing on, or flowing or A. BODILY INJURY AND seeping through: PROPERTY DAMAGE LIABIL- ITY, 2. Exclusions, other than L a) Foundations, War and the Nuclear Energy Liability Exclusion, are deleted walls, floors or paved surfaces; and the following are added: b) Basements, This insurance sloes not apply whether paved or not: or to: (a) "Property damage ": c) Doors, windows or other openings. 1) Assumed in any con- tract; or (c) Loss caused by or resulting 2) Loss caused by or re- from water that leaks or flows from plumbing, heat - sultinq from any of the ing, air conditioning, or fire following: on protection systems caused by or from freez- a) Wear and tear,. ing, unless. b) Rust, corrosion, 1) You did your best to fungus, decay, deterioration, . hid- maintain heat in the building or structure; or den or latent de- fect or any quality 2) You drained the in property that causss it to dam- equipment and shut off the water supply if the age or destroy it- heat was not main- tained. C) Smog; (d) Loss to or damage to: d) Mechanical 1) Plumbing, heating, air breakdown in- conditioning, fire pro- cluding rupture or tection systems, or bursting caused other equipment or ap- by centrifugal pliances; or force; 2) The interior of any building or structure, or to personal property in the building or structure GA 233 02 07 Includes copyrighted material of Insurance Services office, Inc., with its permission. Page 8 of IS Noiicy NUMOer tFF V1bi5/z 4. caused by or resulting from rain, snow, sleet or ice, whether driven by wind or not. C. Limit of Insurance The Damage to Premises Rented to You Limit as shown in the Declara- irons is amended as foilows: (2) Paragraph 6. of SECTION III - LIMITS OF INSURANCE is hereby deleted and replaced by the following: 6. Subject to 5, above, the Damage to Premises Rented to You Limit is the most we wilf pay under COVERAGE A. BODILY INJURY AND PROPERTY DAMAGE LIABILITY, for damages because of "property damage" to premises while rented to you or temporarily occupied by you with permission of the owner, arising out of any one "occurrence" to which this insurance ap- plies. (3) The amount we will pay is lim- ited as described in Section B. Limits of Insurance, 3. Dam- age to Premises Rented to You of this endorsement. Supplementary Payments Under SECTION I - COVERAGE, SUP- PLEMENTARY PAYMENTS - COVER - AGES A AND B: a. Paragraph 2. is replaced by the fol- lowing: Up to the limit shown in Section B. Limits of Insurance, Ca. Bail Bonds of this endorsement for cost of bail bonds required because of accidents or traffic law violations arising out of the use of any vehicle to which the Bodily Injury Liability Coverage ap- plies. We do not have to furnish these bonds. b. Paragraph 4. is replaced by the fol- lowing: All reasonable expenses incurred by the insured at our request to assist us in the investigation or defense of the claim or "suit ", including actual loss of earnings up to the limit shown in Section B. Limits of Insurance, 4.b. Loss of Earnings of this en- dorsement per day because of time off from work. 5. Medical Payments The Medical Expense Limit of Any one Person as stated in the Declarations is amended to the limit shown in Section B. Limits of Insurance, 5. Medical pay- ments of this endorsement. 6. Voluntary Property Damage and Care, Custody or Control Liability coverage a. Voluntary Property Damage Cov- erage We will pay for "property damage" to property of others arising out of op- erations incidental tco the insured's business when: (1) Damage is caused by the in- sured; or (2) Damage occurs while in the in- sured's possession. With your consent, we will matte these payments regardless of fault. b. Care, Custody or Control Liability Coverage SECTION I - COVERAGES, COV- ERAGE A. BODILY INJURY AND PROPERTY DAMAGE. LIABILITY, 2. Exclusions, j. Damage to Property, Subparagraphs 3, 4 and 5 d not apply to "Property damage- to the property of others described therein_ With respect to the insurance provided by this section of the endorsement, the fol- lowing additional provisions apply: a. The Limits of Insurance shown in the Declarations are replaced by the lim- its designated in Section B. Umits of Insurance, 6. Voluntary Property Damage and Care, Custody or Control Liability Coverage of this endorsement with respect to cover- age provided by this endorsement. These limits are inclusive of and not in addition to the limits being re- placed. The Limits of insurance shown in Section B. Limits of lmwr- ance, 6. Voluntary Property Dam- age and Cate, Custody or Control Liability Coverage of this endorse- ment fix the most we will pay in any one 'occurrence" regardless of the number of: (1) Insureds; (2) Claims made or "suits" brought, or (3) Persons or organizations mak- ing claims or bringing *suits". Includes copyrighted material of Insurance GA 233 02 07 Services Office, Inc., with its permission. Page 9 of 15 Noncy Nurnber W- FU1b35 /1 b. Deductible Clause (1) Our obligation to pay damages on your behalf applies only to the amount of damages for each "occurrence" which are in ex- cess of the deductible amount stated in Section 13. Limits of Insurance, G. Voluntary Prop- erty Damage and Care, Cus- tody or Control Liability Cov- erage of this endorsement. The limits of insurance will not be re- duced by the application of such deductible amount. (2) Condition 2. Duties in the Event of Occurrence, Offense, Claim or Suit, apphes.to each claim or "suit" irrespective of the amount. (3) We may pay any part or all of the deductible amount to effect settlement of any claim or "suit" and, upon notification of the ac- tion taken, you shall promptly reimburse us for such part of the deductible amount as has been paid by us, 7. 180 Day Coverage for Newly Formed or Acquired Organizations SECTION Il - WHO IS AN INSURED is amended as follows: Subparagraph a. of Paragraph 4. is hereby deleted and replaced by the fol- lowing: a. Insurance under this provision is af- forded only until the 180th day after you acquire or form the organization or the end of the policy period, whichever is eadier, 8. Waiver of Subrogation SECTION IV - COMMERCIAL GENERAL LIABILITY CONk]MONS, 9. Transfer of Rights of Recovery Against Others to Us is hereby amended by the addition of the following: We waive any right of recovery we may have because of payments we make for injury or damage arising out of your on. going operations or "your work" done un- der a written contract requiring such waiver with that person or organization and included in the "products - completed operations hazard ". However, our rights may only be waived prior to the "occur- rence" giving rise to the injury or damage for which we make payment under this Coverage Part. The insured must do nothing after a loss to impair our rights. At our request, the insured will bring "suit' or transfer those rights to us and help us enforce those rights. S. Automatic Additional Insured - Speci- fied Relationships a. The following is hereby added to SECTION 11 - WHO IS AN INSURED: (1) Any person or organization de- scribed in Paragraph 9.a.(2) below (hereinafter referred tows additional insured) whom you are required to add as an addi- tional insured under this Cover- age Part by reason of: (a) A written contract or agreement; or (b) An oral agreement or con- tract tract where a certificate of insurance showing that per- son or organization as an additional insured has been issued, is an insured, provided: (a) The written or oral contract or agreement is: 1) Currently in effect or becomes effective during the policy pe- riod; and 2) Executed prior to an "occurrence" or offense to which this insurance would apply; and (b) They are not specfically named as an additional in- sured under any other pro- vision of, or endorsement added to, this Coverage Part. (2) Only the following persons or organizations are additional in- sureds under this endorsement, and insurance coverage pro- vided to such additional in. sureds is limited as provided herein: (a) The manager or lessor of a Promises leased to you with whom you have agreed per Paragraph 9.a.(i) above to Provide insurance, but only with respect to liability aris- ing out of the ownership, maintenance or use of that part of a premises leased to You, subject to the following additional exclusions: This insurance does not apply to: 1) Any „occurrence" which takes place after Includes copyrighted material of Insurance GA 233 02 07 Services Office, Inc., with its permission_ Page 10 of 15 Policy Number EPP 0163572 You cease to be a ten. ant in that promises. cJ An y physical or 2) Structural alterations, chemical change in the product new construction or demolition operations made intentionally by the vendor; performed by or on be- half of such d) Repackaging, un- .additional insured. - less unpaged (b) Any person or organization solely for the pur- pose of inspection, from which you lease demonstration, equipment with whom you testing, or the have agreed per Paragraph substitution of 9,a -(1) above to provide in- parts under in- surance. Such Person(s) or structions from the organization(s) are insureds manufacturer, and solely with respect to their then repackaged liability arising out of the in the original maintenance, operation or container; use by you of equipment leased to you by such e} Any failure to o per- son( s) or organizations(s). make such in- How ever, this insurance sPections, adjust - does not apply to any "oc. ments, tests or ^ currents which takes place after the equipment lease servicing as. the vendor has expires. Make or agr (c) Any person or organization ly under- takes to make in (referred to below as ven- the usual course dor) with whom you have of business, in agreed per Paragraph connection with 9.a.(1) above to provide En- the distribution or surance, but only with re- sale of the prod - SPOOt to "bodily injury" or ucts; "property damage" arising out of "your products" which Demonstration, in- are distributed or sold in the stailation, regular course of the ven- it op- er or repair dor's business, subject to ep- such s, except such the following additional ex- operations elusions: Performed at the the vendor's promises 1) The insurance afforded in connection with the vendor does not the sale of the apply to: product; . a) "Bodily injury" or 9) Products which, °property damage" after distribution or for which the ven- sale by you, have dor is obligated to been labeled or pay damages by relabeled or used reason of the as- as a container, sumption of liabil- part or ingredient ity in a contract or of any other thing agreement This or substance by or exclusion does not for the vendor. apply to liability for damages that the 2) This insurance does vendor would have in the ab. not apply to any in- sured person or or- sence of the con- ganizatinn: tract or agree- a) From whom you ment have acquired b ) Any express war - such products, or unauthorized any ingredient, by you, by part or container, entering into, ac- includes copyrighted material of Insurance GA 233 02 07 Services office, Inc., with its permission. page 11 of 1s Porky Number EPP 0163572 companying or containing such 2) This insurance does "bodily products; or not apply to in- jury ", "property lam- b) When liability in- cluded within the age" or "personal and advertising injury" aris- "products- ing out of operations completed opera. performed for the state lions hazard" has or political subdivision. been excluded (f) Any person or organization under this Cover- age Part with re- . with which you have agreed spect to such per Paragraph 9.a.(1) above to provide insurance, products, but only with respect to li- (d) Any state or political subdi- ability arising out of "your vision with which you have work" performed for that agreed per Paragraph additional insured by you or 9A.0) above to .provide in- on your behalf. A person or surance, subject to the fol. organization's status as an lowing additional provision: insured under this provision of this "endorsement contin- This insurance applies only ues for only the period of with respect to the following time required by the written hazards for which the state contract or agreement, but or political subdivision has in no event beyond the ex- issued a permit in connec- piration date of this Cover - tion with premises you own, age Part. If there is no rent or control and to which this insurance applies: written contract or agree - ment, or if no period of time 1 } The existence, mainte- is required by the written contract or nance, repair, con- struction, erection, or agreement, a person or organization's removal of advertising status as an insured under this endorsement ends signs, awnings, cano- PIGS. cellar entrances, when your operations for that insured coal holes, driveways, are completed, manholes, marquees, hoist (3) Any insurance provided to an away openings, sidewalk vaults, streel additional insured designated under Paragraph 9.a.(2): banners, or decora- tions and similar expo- (a) Subparagraphs (e) and (f) sures; or does not apply to "bodily 2) The construction, erec- injury" or "property damage- included within the -prod - tion, or removal of ele- vators; or ucts-completed operations "; hazard 3) The ownership, main- tenance, (b) Subparagraphs (a), (b), (d), or use of any elevators (e) and (lf) does not apply to covered by this insurance. bodily injury ", "property damage" or "personal and (e) Any. state or political subdi- advertising injury" arising vision with which you have out of the sole negligence agreed per Paragraph P 9.a,(7) above to provide in- or willful misconduct of the additional insured or their "employees" surance, subject to the fol- agents, or any towing provisions: other representative of the additional insured; or 1) This insurance applies ar ty with respect to op- (c} Subparagraph (f) does not apply to "bodily " erations performed by injury , "Property you or on your behalf damage" or "per - for which the state or sonal and advertising injury" political subdivision has arising out of: issued a permit. 1) Defects in design fur- nished by or on behalf GA 233 02 07 Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 12 of 15 r011cy Number EPP 0163572 Of the additional in- sured; or 2) The rendering of, or failure to render, any Professional architec- tural, engineering or surveying services, in- cluding: a) The preparing, approving or fail- ing to prepare or approve maps, shop drawings, opinions, reports, surveys, field or- ders, change or- ders or drawings and specifications; and b) Suparvlsory, in- spectlon, archi- tectural or engi- neering activities. 3) "Your work" for which a consolidated (wrap -up) insurance Program has been provided by the primecontractor- project manager or owner of the construction project in which you are in- volved. b. Only with regard to insurance pro- vided to an additional insured desig- nated under Paragraph 9,a,(2) Sub- Para U � raph (f) above, SECTION Ni - o include.- INSURANCE is amended to include: The limits applicable to the additional insured are those specified in the written contract or agreement or in the Declarations of this Coverage Part, whichever are less. if no limits are specified in the written contract or agreement, or if there is no written contract or agreement, the limits ap- plicable to the additional insured are those specified in the Declarations of this Coverage Part. The limits of In- suranoe are inclusive of and not in addition to the limits of insurance shown in the Declarations. C. SECTION Iv - COMMERCIAL GEN- ERAL UABIUTY CONDITIONS is hereby amended as follows: (1) Condition S. Other Insurance is amended to include; (a) Where required by a written contract or agreement, this insurance is primary and I or noncontributory as re- spects any other insurance policy issued to the addi- tional insured, and such other insurance policy shall be excess and / or noncon- tributing, whichever applies, With this insurance. (b) Any insurance provided by this endorsement shall be primary to other insurance available to the additional insured except: 1) As otherwise provided in SECTION iY _ COMMERCIAL GEN- ERAL UABIUTY CONDITIONS, S. Other insurance, b; Excess Insurance; or 2) For any other valid and coil4ctible insurance available to the addi- tonal Insured as an additional insimed by attachment of an en- dorsement to another insurance policy that is written on an excess basis. In such case, the coverage provided under this endorse - went shall also be ex- oess. (2) Condition 11. Conformance to Specific Written Contract or Agreement is hereby added: 11. Conformance to Sp®cific Written Contract or Agreement GA 233 02 07 Includes copyrighted material of Insurance Services Office, inc., with its permission. With respect to additional insureds described in Para- graph $:a.(2)M above only: If a written contract or agreement the additional insured spedfles that coverage for the additional insured: a- Be provided by the ln- surance Services of- fice additional insured form number CG 20 10 or CG 20 37 (where edition specified); or b. Include coverage for completed operations; or c. Include coverage for "your work" - and where the limits or cov- erage provided to the addi- Page 13 of 15 Policy plumber EPP 0163572 tonal insured is more re- 11. of this endorsement fix the strictive than was specifi- cally required in that written most we will pay in any one 'bc- . currence" regardless of the contract or agreement, the number of: terms . Paragraphs 9.a.(3)(), 9.a.(3)(b) or 9.b. (a) Insureds; above, or any combination thereof, shall be interpreted (b) Claims made or „ suits" as providing the limits or brought; or coverage required by the terms of the written contract (c) Persons or organizations making claims or bring or agreement, but only to "suits ". the extent that such limits or coverage is included within (2) Deductible Clause the terms of the Coverage Part to which this endorse- a Our obi' y (? obligation to pa dam - ment is attached. If, how- ages on your behalf aipplies aver, the written contract or only to the amount of dam - agreement specifies the In- ages for each "occurrence" surance Services Office which are in excess of the additional insured form Deductible amount stated in number CG 20 10 but does Section B. Limits of Insulr- not specify which edition, or ance, 11. of . this. endorse - specifies an edition that ment. The limits of insur. does not exist, Paragraphs 9.a.(3)(a) 9.a.(30) ance will not be reduced by the application of such De- and of this endorsement shall not ducable amount, apply and Paragraph 9.b. of this endorsement shall ap- (b) Condition 2. Duties in the ply- Event of Occurrence, of- tense, Claim or Suit, app 10. Broadened Contractual Liability - Work plies to each claim or "suit Within 50' of Railroad Property irrespective of the armount. It is hereby agreed that Paragraph f.(1) of (c) We may pay any part'or all Definition 12. "Insured contract" (SEC- of the deductible amount to TION V - DEFINITIONS) is deleted. effect settlement of any 11. Property Damage to Borrowed Equip- claim or 'suit" and, upon notification of the action ment taken, you shall promptly a. The following is hereby added to 1=x- reimburse us for such part clusion j. Damage to Property of Paragraph 2., Exclusions of SEC- 110N I - COVERAGES, COVERAGE of the deductible amount as has been paid by us. A. BODILY INJURY AND PROP- 12. Employees as Insureds - Specified Health Care Services ERTY DAMAGE LIABILITY: Paragraphs (3) and (4) of this exclu- It is hereby agreed that Paragraph 2.a.0)(d) of SECTION II - WHO IS Sion do not apply to tools or equip- AN INSURED, does not apply to your "em- ment loaned to you, provided they ployees" who provide professional health are not being used to perform opera - tions at the time of loss, care services on your behalf as duly li- censed: b. With respect to the insurance pro- a. Nurses; vided by this section of the en- dorsement, the following additional b. Emergency Medical Technicians, or provisions apply: c. Paramedics, (1) The Limits of insurance shown in the Declarations are replaced by the limits designated in Sec- in the jurisdiction where an "occurrence" or offense to which this insurance applies Von B. Limits of Insurance, 11. takes place. of this endorsement with respect to 13. Broadened Notice of Occurrence coverage provided by this endorsement. These limits are Paragraph a. of Condition 2. Duties in inclusive of and not in addition to the limits being replaced. The the Event of Occurrence, offense, Claim or Suit (SECTION IV - COMMER- Limits of Insurance shown in Section B. Limits of Insurance, CIAL GENERAL UABILITY CONDI- Includes copyrighted material of Insurance GA 233 02 07 Services Office, Inc., with its permission. Page 14 of 15 Nolicy.Number EPP 0163572 TIONS) is hereby deleted and replaced by the following: a. You must see to it that we are noti- fied as soon as practicable of an "occurrence" or an offense which may, result in a claim. To the extent Possible, notice should include. (1) Now, when and where the "oc- currence" or offense took place; (2) The names and addresses of any injured persons and wit_ nesses; and (3) The nature and location of any injury or damage arising out of the "occurrence" or offense. This requirement applies only when the "Occurrence" or offense is known to an "authorized representative ". GA 233 02 07 Includes copyrighted material of insurance . Services Office, Inc., with its permission. Page 15 of -is LIM THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ if CAREFULLY. ADDITIONAL INSURED This ndorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM GARAGE COVERAGE FORM This endorsement changes the policy effective on the inception date of the policy unless another date is indi- cated below. Endorsement Effective: 10 -09 -x012 Named Insured: NENOCK CONSTRUCTION LLC Countersigned by: Policy Number: ENA 016 35 72 With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by the endorsement. SECTION 11 - LIABILITY COVERAGE, A. Cover- age, I. Who is an Insured is amended to include as an insured any person or organization with which you have agreed in a valid written contract to provide insurance as is afforded by this policy. This provision is limited to the scope of the valid written contract. This provision does not apply unless the valid written contract has been executed prior to the "bodily injury" or "property damage ". AA 4171 11 05 n M THIS ENDORSEMENT CHANCES THE POLICY. PLEASE READ ii CAREFULLY. BLANKET WAIVER OF SUBROGATION - AUTO This endorsement modifies insurance provided under the foflovdng: BUSINESS AUTO COVERAGE FORM This endorsement changes the policy effective on the inception date of the policy unless another date is indi- cated below. Endorsement Effective: Policy Number 10-09-2012 M' 016 35 72 Named Insured: LLC Countersigned by: With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by the endorsement_ 1. Blanket Waiver of Subrogation SECTION IV - BUSINESS AUTO CONDI- TIONS, A. Loss Conditions, S. 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 any person or organization because AA 4172 09 09 of payments we make for "bodily injury" or "property damage" arising out of the operation of a covered "auto" when you have assumed liability for such "bodily injury" or "property damage" under an "insured contract" pro- vided the 'bodily injury" or "property damage" occurs subsequent to the execution of the "in- sured contract ". I'U1f(.y 1V41111LC1 CrrutUJ_)/L THIS ENDORSEMENT CHANGES THE POUCY. PLEASe MAD ff CAREFULLY, EARLIER NOTICE OF CANCELLATION PRUVIDED BY US This era Esg;rmnl mo aev inwrance provided ran -dL4r the fbfowjnn : BUSIWESSOWNEW6 PACKA(iP POLICY CLAIMS -MADE EXCESS UARIWTY COVERAGE PART c{UUI!JaCIAL AUTO COVERAQE PART C€.? M&MALGENERAL LIABILiTYCOVERArE PANT COIIIMIAL INLAND VAS OOVEEFIAGE PART COMMMC)AL IxROPEMN COVERAGE PART COMMERCIAL UMBRELLA UARI LITY COVERAqE PART CR EAND r -dWUTY COVERAGE PART DENMrS PACKAGE POLICY Y EXCESS UARIUTY COVERAGE PART EARN COVERAGE PART LIWOR Llfi,WTV CQVi CIE PART MACHINERY AND 1uWP3AENTCOVERAGE PAR -f PROD UM i C t.I;" e!) OPERATIONS UABILITY COVERAGE PAAT PROPESSID14AL UAVIIJTY COVERAGE PART PROMSIONAL OMPREL A UABILI.TY COVERAW PART PROFMSIONAL UMBRELLA I IARILM COVERAGE PART CLAIMS -MADE SCREDULrt l For any -,Aak orUl pemlitted mwron other then aonpaympgt of pmnilvm, tho WMW of clays rpqukad fvr nvGop of aancolhtion, as provided in Parag "app 2. of gl*F� 1ht- conwtan Poffq Cond11I011 rir as t3moW6d by tAn app cable z3tato carkcaiJ4310 rt �i�d�rw��ri�r�t, 3s a +��st?;3s4� to the rju,7:be-r M days chown in ft MA- fie atws, Includeq Qopyrigbte 3 ri l �i Ir��. ar ne IA 4006 05 0 TAmbs offs , I%%, VA{ h its pwt7 iw;' fm "..ter . emu ... u "I f WiVJJ14 CANCELLATION NOTIFICAMN This andorwrr nt njodifje3: R;oqL dyer the fpflowittq ISUSINESSOWNERS Pjly�f {�KKAGE PO4,1CY VERAGE PART COMMERCIAL AUTO MN!t- CIAI. %0149RAI, LIARtUT' COVERAGE PART COUNEROAL INLAND RIAMNE COV15PAGE PART COMMERCIAL OUTPUT PIROGRANI - PROPERTY COVERAGtz PART COMiI E110AL PAOPFRTY COVERAGE PART COMME IAA UMBRELLA IJABIUTY COVERAGE PART CONTRACTowa ERRORS AND OFAI SIONSMVl RAGE PART CLAIMS-MADE r,cftTAACYOFVS LIMITED POLLU11014 IJABILITY COVERAGE: PART CF WE AND FIDELITY CGVMAGE PART D TMI'S PACitAGa• PCUCY ELECTRIC DATA LIABlUTY COVERAGE PART EMPLOYEE SENEHT UARILITY vaAGE PART EMPLOYMENT PRACTICES LIADR -ITY COVERAGE PART EXCESS UABIF ITY COVERAGE FART EXC S WORKERS COMPENSATION AND 5rjgpLC1fEFT.5 LJ A9ILET'7 rOVERAQ5 PART PARM COVERAGE PART aOLF ARSE CREMICAL APPLICATION LII6UITEn LJAPA13TY eovt. gME DART HOiF4 ONE COVERAGE PART INTERNET LIABILITY COVERAGE PART LIt POR LJABILIT'Y COVERAGE DART 1 ACtlINERY A14D EQWPNl TC0VIPAide PAp-r ANUFACTURWS ERRORS AND OMSstous COVEiiAGL BART CLAIMS -MADE MORTGAQEHOLDERS ERRORS AND OWSMNS COVERAGE PART POLLIMON #LABILITY COVERAGE PART PRODUCT tNiTHDRAWAL COVERAGE PART PRODUCT'S / corOPl_ETED OPERATIONS COVERA 1W PART PROFESSIONAL J.IABIL TY COVERAGE PART PROFESSIONAL UMBRE=LLA LIABILITY COVER ACE PAPl- PPIOI�ESSIONAL ULARREFLtA L#ASILITY COVERAGE PART - CLAIM 4MADE. SCHEDULE Ngtn9 of Persm crOrganiz to,3: I -FOR VHOH YOU ARE REquIRED IN A WR..T''Ti 0OI A(rT TR,*;V *AS EyEf;UTED 'OK QED AFT%R TW EARLIER OF THE F0LLQ§nWG DATES4 A. fHV ItiF#'01TV9 VAIE OF TqI£ p4oLlCy, OR E3. THE IZFIFECTIVE DATE OF TfE ORIU114AL paL,,U air" 'I�"jr TRS� E'S�1.�A`{ x~� A C;E £1�#!� v� 1El� �ECEFfFldia AND 2. FOR RFi[tE� You ifs R i)l? f�SY1 X" THAT 80a WRITTEN CONTRACT AS REFERRED TO IM I. ABOVE TO PRDVXIIE CANOWLA'I Y0W NOTICE, R1laifirrg Addmss: if FILE VITH AGENtir DALLAS ,. TX 75240 carec -cha en Noli it alto, 411110 OVOM ar oftormliatlon, rei�v t rn it or IIu tl #i�; ttc��► t.6 the 14t Nrarn;-,Lti InOvr0d r Rd � m person ar0f9JRrli.:a ?i0r, schf dule, 3A 407 08 p9 r V11Ly Ivu,114G1 Lum wiv✓✓ fL n "PHIS ENDORSEMENT CHAN F,S THE PL3UCY. PLEASE READ fT CAREFULLY, EARLIER NOTICE OF CANCELLATION PRUVIDED BY US This ender €SPme-W moffks int;wr nr ,-s provided undc4rI)a fbtoWing: 9USIWES9 ?lf NeF1 PACKAU POLICY CLAIMS MADE EXCOS #. ABIWTY COVERAGE PART �. COM ICIAL, AUTO COVERAGE PART COMMERCIAL GENSHAL LIASII iTY COVERAGE PART COIIiIMSCI,AL INLAND VARW OOVERAGE PART 00MMERML PROPERTY COVE-RAGE PA€ COMMERCIAL Ultf#I:tRELLA IIJARIL,ITY CO ERA I: PART CFW AN0I"tI3EUTY COVERAGE PART RENWS PACKAGE POLICY t ECM LIABILITY COWRACE PART FARM COVERAGE PART LIQUOR LIAMUTY COVERAGE PARS' MACHINERY AND EQUIPMENT COVERAGE PART POLLUTION UAMLITY COVERAGE PART PRODUMi COMINXTED OPERATIONS UABILITV COVERAGE PAST ST PROFESSIONAL UABIUTY COVERAGE PART PROFESSIONAL IJURFIELLA UASILITY COVERAGE PART PRO FWSION AI, UMBRELLA I..I,ABILITY COVERAGE PAIN CLAIPdI -MAVE . SCHEDULE E V / Number of D.iy* Not, -,a fir! For aray y #Mltstorlly P%mitfed rowan other lien r "PA'fo"a ; '41 Of Pronlium, the mum s Of dl�Y$ requ €e-d tar tioko- of cancolkatioll, as provided in Paragraph 2. of 81tilet 1hc- i;a�cell�Ia�� mar; Pof Cy Cor)di{ loll or ns wror�d4d by "n applicable stags oanQokla6o3 i �t�d�i���r��rts, 3s i +a� <�;��od to he nbcrbe�r 0, days shown in the SOW. Ie 40va, loclud69 oop figLils� T4kgdEkj of Ire: it r~o IA 4086 05 09 G -mict5 O -IcQ, Irxc., -yaith its porrnis; ;Jon, Noncy iV umoer LbA V10 s5 « This emdcus43m$rkt mz)difiaz� XpyLded un4er the foliovdiiq_ RUMNESSt~71l HERS PACKAGE POA ICY CMIMERCLAIL AUTO COVERAGE PART 4DLAM -N ADE FXC1: -$S LIABILITY COVERAGE PAS OMMeRCI!AL QKNERAL, 41ARIIAT Y COVERAGE PAR.'S COUNIIr# IALINLAND MARINE COVERAGE PART C0#AM'RW L OUTPUT PROORAM - PROPERTY COVERAGI` PART COMME80AL PAOPERTY 00V 3AGE PART 1GOUMEROA1. UMBRELLA UASILITT COVERAGE PAIN WNTRAC OR'S ERRORS AND OMISSIc S VERAOE PART CLAIMS -MAD CONTRACTOWS UMiT'ED POLLU11OR LIABILITY COVERAGES PAI~ T C#O#E AND FIDELITY COVER AG E FLIRT DEN71aS PACKAGE I~'OUQY ELECTP4NfC DAT4 UABIUT'Y COVERAGE PART EMPLOYEE BENEFIT FIT MARILITY COVEAA6r: PART EMPLOYMENT PRAC'TtM L.IAML.ITY COVERAGE PART EXCESS UABILITY COVERAGE PART EXC4 WORKERS COMPMATION AND ERIPLOYEAS LIAMLIV COVERAGE PAIN PARM COVERAGE PART CkW COURSE CREPICAL APPLICATION L lNIITED UAFAtJTV a0VERA PART l 000 -0NE COVERAGE PART INTERNET LtABIL.ITV COVERAGE PART L1Clw OR LIABILITY COVERAGE PART IMJIAChIKERY ANN EOt IPMENT COVERAGE PANT' ANUFACTUREWS ERROR%AND MiSS1DNSCOVERAGL PART CL AIM54AADE I&ORTGAQtKOLDERS ERRORS AND OU15S€ONS COVERAGE PART PGLLa3T3m LiAsuTY COVERAGE PART PRODUCT WITHDRAWAL COVERAGE PART PRODUCTS I COMPLETED OPERATIONS COVERAGt PAID PROFESSIONAL. €.IABILJT'Y COVERAGE PART PROFESSIONAL 01ADRELLA L,tABt..1TY COVERAGE PART' PROFESSIONAL UMBRELLA LIAI ITY COVEAAGE PART - CLAIMS- -ADC SCHEDULE W m$ of P?rs",orOrgarEizcdum-. I -FOR WHOM YOU ARE REgUIRE.D Its A WRITTEA OuE€MA;,'€ TfgAV VAr, I.YJECUTED DH qR f11;'r%n TIAE EARLIER OF THE FOLLOWING 33A'PlwSs . A« THU AEF1KC1T tE }3AIE OF Tail$ PaLicya OR I3. THE EFFECTIVE DATE OF TI#E DRJG€ IRAL i0LjU1( OF VIiXCH Iola POI.IDY 1$ A RMEW4L OR REPLACEMENT, AWD 9- FOR WHOM YOU ME RIMUiRR13 IN THAT 80k WRITTEN COflTKAcT A$ REFERRED TO €K 1, ABOVE TO PNOVIDE CQ1 LL,AT3 VW NOT ICe, Mailing Address: M# FILE KITH AGEWCV DALLAS , TX 7SV4 0 "00112tion Np3ELit;Aliort In tlli� ovlmt vt 00norllation, we agr i ;* to mail or rielivi; not1(k:xttiof, to the flat Nrarn 'otl 1111 ri ?d aMd khr* person orargjaniZatioh ShOW1i 111 "10 t.:,hc� dtzlo, iA 4,09108 09 AHWC0712 WORKERS' COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY TEXAS NOTICE OF MATERIAL CHANGE ENDORSEMENT WC 42 06 01 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: ap 2. Notice will be mailed to: PER LIST ON FILE 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 preparafion of the policy.) WC420601 (ED. 1.94) INSUREDS COPY CRC,Crer Rip CaCICrump 7557 Rambler Road, Suite 300, Dallas, Texas 75231 -4163 Telephone (214) 363 -7636 Facsimile (214) 691 -5460 e08 0 6690eooeoeeoee eeOeeeeee0e♦ eeo *Y9eeeeeeee ®eeOe08eeoeAeee0e040 p 86 @A INSURANCE BINDER Date of Issuance: February 19, 2013 Binder Number: 13235203 Binder Period:. From: 2/18/2013 12:01 A.M. To: 411 8/201 3 12:01 A.M. Standard Time at the address of the named insured stated herein. This binder will be terminated upon delivery of formal policy(ies) or Certificate(s). In accordance with your instructions and in reliance upon the statements made in your application, insurance is effective as follows: Insurer(s): Assigned Policy(ies) or Certificate(s) Number(s) Insured Name: Mailing Address: Westchester Fire Insurance Company 121091583001 Hencock Construction i_LC 1731 S. San Marcos Bldg 906 . San Antonio TX 78207 Policy Period: From: 2118/201312:01 A.M. To: 2118/201A 12:01 A.M. Standard Time at the address of the named insured stated herein. This binder will be terminated upon delivery of formal policy(ies) or Certificate(s). Coverage Type Premium Builders Risk/COC $7,500.00 Total fees & taxes Fees (Fully Earned) $250.00 Grand Total $7,750.00 * *Due to !don- Admitted & Reinsurance Reform Act (NRRA) please be advised that we may have to revise taxes resulting in additional or return tax dollars ** Conditions and/or exclusions: See attached for terms and conditions. Tax Filing Responsibility: Not Applicable Minimum Earned Premium Percent: 0.00% Minimum Earned Premium Amount: $0.00 Producer: _Baldwin_ Insurance,& Bonding Agency, Inc. 5930 Preston View Blvd, Suite 200 Dallas TX 75240 BY: Cancellation: This binder may be cancelled by the insured by surrender thereof to Crump Insurance Services, Inc. or any of its authorized representatives, or by mailing to Crump Insurance Services, Inc. written notice stating when therea ned fter the cancellation shall be effective. THE INSURANCE UNDER THIS BINDER CANNOT BE CANCELLED FLAT; ear premium must be paid for the time that insurance has been in force. This binder may be cancelled by Crump insurance Services, Inc. by mailing to the insured at the address stated on this binder, written notice stating when not less than ten (10) days thereafter, such cancellation shall be effective. The mailing of notice as aforesaid shall be sufficient proof of notice. Delivery of such written notice either by the insured or by Crump Insurance Services, Inc. shall be equivalent to mailing. In the event of cancellation by the insured, the earned premium will be computed short -rate in aceardance with the company's customary short-rate table, subject to a minimum premium if applicable, and if cancelled bythe insurer(s), the earned premium wilt be computed pro -rata. The insurance provided is controlled by the terms, conditions, and limitations of the policy(ies) or certificate(s) in current use by the Insurer(s) unless otherwise specified. This binder is based upon fax and/or mail and/or telephone and/or e-mail advices from the insurer(s) and is issued by the undersigned shown above without any liability whatsoever as an insurer. Terms of this binder which are in conflict with the statutes of any State, Province or Territory wherein this binder is issued are hereby amended to conform to such statutes. Westchester Fire Insurance Company TO: Deana Crowson FROM: Bill Kozik COMPANY: CRUMP INSURANCE SERVICE DATE SENT: 02!1912013 FAX or EMAIL: Builders Risk Coverage Binder Policy# 121091583 001 RE- Hencock Construction LLC Mailing Address: 1731 S. San Marcos Bldg 9C6, San Antonio, TX 78207 Thank you for binding the captioned account. Please read this binder carefully, as the limits, coverage, exclusions, and any other terms and conditions may vary from those you requested in your submission and/or from the expiring policy. This binder is valid for 60 days from the effective date shown below. Please contact me with any questions that you may have. Effective Date: 0211812013 Expiration Date: 08/18/2013 Company: Westchester Fire Insurance Company (Admitted) Coverage: Builders Risk Xtra Coverage Form(s)- ' Builders Risk XTRA Coverage Form ACE0444 (02 -09) Covered Perrls: Risks of direct physical loss subject to the terms, conditions and exclusions in the policy forms and excluding Flood and Earth Movement Valuation: Replacement Cost Coinsurance: None. Final project completed value required within 60 days of policy expiration. Job Site Location: 654 Graham, Corpus Christi, Texas, 78418 Construction: Joisted Masonny Project Renovated comml bldg Description: Total Insured Values: $ 256,636 Occurrence Limit of Insurance: All covered causes of loss in any one occurrence $ 255,636 Westchester Fire Insurance Company Sub - limits of Insurance The Sub - limits and Aggregate Sub - limits of Insurance below are the most we will pay for Toss in an one occurrence for the coverage or Extension of Coverage. y The Sub- limits and Aggregate Sub - limits of Insurance are part of and not in addition to the Occurrence Limit of Insurance shown above_ New Construction: Escalation Clause: $ 255,636 Temporary Structures: Not Covered Property in Transit: $ 100,000 $ 100,000 Property in Temporary Storage or Staging Areas: $ 100,000 Existing Buildings or Structures: $ Not Covered Coverage Extensions: Debris Removal: Protection of Property.- $ 25,000 Protection service Charges: $ .25,000 Fire Protection Systems: $ 25,000 Valuable Papers and Records: $ 25,000 Installed Trees and Shrubs: $ 25,000 Expediting Expense.- $ 25,000 Loss Data Preparation Costs: $ 25,000 Contract Penalty: $ 5,000 Furniture and Fixtures: $ 1,000 Construction and Office Trailers: $ 1,000 Ordinance or Law Coverage: $ 1,000 Coverage A: $ Not Covered Coverage B: $ Not Covered Coverage C: $ Not Covered Any one occurrence: $ Not Covered Testing Coverage: Named Windstorm: $ Included Soft Costs Coverage: $ Included However, we will not pay more than the Sub -limit of Insurance $ Not Covered Costs. shown below for each covered category of Soft Westchester Fire Insurance Company 1. Advertising and promotional expenses; $ Not Covered 2. Architectural andror engineering supervisory services and consuting $ Not Covered fees; 3. Audit and bookkeeping services; $ Not Covered 4. Commissions or Fees for the renegotiation of leases; $ Not Covered 5. Fees for licenses and permits; $ Not Covered 6. Insurance premiums for the Builders Risk, Workers' Compensation and $ Not Covered General Liability Insurance; 7. Interest on the construction loan; Not Covered 8. Realty taxes and other assessments; $ Not Covered 9. Rental or lease expense of construction equipment; $ Not Covered 10. Legal and accounting fees $ Not Covered Other: Not Applicable $ Soft Costs Escalation Clause: Not Covered Loss.of Rents Coverage: $ Not Covered Business Income Coverage: $ Not Covered The Period of Indemnity for Soft Costs, Loss or Rents or Business Income is not covered. The Aggregate sub - limits of Insurance below for the perils of Earth Movement and Flood are the most we will pay for loss in any one occurrence and during a policy year for all coverage(s) and Coverage Extensions, including Soft Costs, Business Income and Loss of Rents, in or endorsed on this policy. The Aggregate Sub -limit of Insurance below for Pollutant Clean Up is the most we will pay for loss in any one occurrence and during a policy year. Aggregate Sub limits of Insurance: Earth Movement per Occurrence: $ Not Covered Earth Movement Annual Aggregate: $ Not Covered Flood per Occurrence: Not Covered Flood Annual Aggregate; $ Not Covered Pollutant Clean Up per Occurrence: $ 25,000 Pollutant Clean Up Annual Aggregate: $ 25,000 Green Endorsements Conservation and Energy Tax: $ Not Covered Debris Removal: $ Not Covered Westchester Fire Insurance Company Enhanced LEED Standard: $ Not Covered Repair Enhancement: $ Not Covered Deductibles AOP: $ 1,000 Earth Movement: $ Not Covered Flood: $ Not Covered Named Windstorm: $ 100,000 Soft Costs: $ Not Covered .Business Income: $ Not Covered Loss of Rents: $ Not Covered Testing: $ Premium — Non reporting Annual rate: $ various Term Premium excluding TRIPRA: $ 7,500 Term TRIPRA Premium: $ Rejected Total Term Premium: $ 7,500 Minimum Earned Premium: $ 7500 Any applicable taxes, surcharges or fees, etc. are in addition to the above stated premium. The actual taxes, surcharges or fees, etc. will be those in effect on the date coverage is bound. The insured is responsible for paying these taxes, surcharges or fees in addition to the above stated premium. Terms & City of Corpus as Al Conditions: Mandatory All policy form endorsernents including but not limited to Pollution & Contamination, Exclusions and Electronic Data /Cyber Risk, and Nuclear, Biological Chemical Radiological Exclusions Amendments: Remarks: The terms, conditions, limits and exclusions of this binder supersede the submitted information and specifications submitted to us for consideration, and all prior binders. Actual coverage will be determined by and in accordance with the policy as issued by the insurer. The insurer is not bound by any statements made in the submission purporting to bind the insurer unless such statement Is in the actual policy. Westchester Fire Insurance Company This binder has been constructed in reliance on the information and specifications provided in the submission. A material change or misrepresentation of the submission information and specifications may void this binder. Attached please find a Disclosure Notice required by the Terrorism Risk Insurance Program Reauthorization Act of 2007 ('TRIPRA" ). Please be advised that we do not review Certificates of Insurance or Evidences of Commercial Property Insurance issued by you, or by any party, relating to this policy of insurance either for content or accuracy. Accordingly, we request that you do not provide copies of certificates or evidences to us for review or for our records. Authority is granted to you for the limited purpose of issuing unmodified ACORD Certificates ( ACORD 25.S for Casualty and ACORD 24 for Property and Inland Marine) and unmodified Evidence of Commercial Property Insurance ( ACORD 27 and 28) only. It is your responsibility to see that any Certificate or Evidence provides an accurate representation of the coverage Form and endorsements applicable to this policy at the time the Certificates or Evidences is issued. Any modification of the approved ACORD forms specifically set forth above, or the issuance of a non - approved Certificates of Insurance ACORD or other is prohibited. Certificates of Insurance or Evidence of Commercial Property Insurance may only be issued as a matter of information. You have no authority by virtue of a Certificate, Evidence, or otherwise, to amend, extend or otherwise alter coverage afforded under this policy. Certificates of Insurance or Evidences of Commercial Property Insurance are never recognized as endorsements or policy change requests. You must submit a separate written request if an endorsement or policy change (including but not limited to adding additional insureds. loss payees and mortgagees andfor alteration of notice requirements .for cancellation) is requested. In the event a policy change is requested, the underwriter will advise if the request is acceptable to the Company. AUTHORIZED BY: Bill Kozik Westchester Fire Insurance Company Insurance Company HencocK Construction LLC Policyholder 121091583 001 Policy Number CRUMP INSURANCE SERVICE BrokerlProducer POLICYHOLDER DISCLOSURE NOTICE OF TERRORISM INSURANCE COVERAGE You were notified that under the Terrorism Risk insurance Act, as amended, that you have the right to purchase insurance coverage for losses resulting from acts of terrorism, as defined in Section 102 {1} of the Act: The term "act of terrorism" means any act that is certified by the Secretary of the Treasury - - -in concurrence with the Secretary of State, and the Attorney General of the United States - -to be an act of terrorism; to be a violent act or an act that is dangerous to human life, property, or infrastructure; to have resulted sn damage within the United States, or outside the United States in the case of certain air carriers or vessels or the premises of a United States mission; and to have been committed by an individual or individuals as part of an effort to coerce the civilian population of the United States or to influence the policy or affect the conduct of the United States Government by coercion. YOU SHOULD KNOW THAT WHERE COVERAGE IS PROVIDED FOR LOSSES RESULTING FROM CERTIFIED ACTS OF TERRORISM, SUCH LOSSES MAY BE PARTIALLY REIMBURSED BY THE UNITED STATES GOVERNMENT UNDER A FORMULA ESTABLISHED BY FEDERAL LAW. HOWEVER, SUCH POLICIES MAY CONTAIN OTHER EXCLUSIONS WHICH MIGHT AFFECT COVERAGE, SUCH AS AN EXCLUSION FOR NUCLEAR EVENTS. UNDER THE FORMULA, THE UNITED STATES GOVERNMENT GENERALLY REIMBURSES 85% OF COVERED TERRORISM LOSSES EXCEEDING THE STATUTORILY ESTABLISHED DEDUCTIBLE PAID BY THE INSURANCE COMPANY PROVIDING THE COVERAGE. THE PRENUM FOR THIS COVERAGE IS PROVIDED BELOW AND DOES NOT INCLUDE ANY CHARGES FOR THE PORTION OF LOSS THAT MAY BE COVERED BY THE FEDERAL GOVERNMENT UNDER THE ACT. YOU SHOULD ALSO KNOW THAT THE TERRORISM RISK INSURANCE ACT, AS AMENDED, CONTAINS A $100 BILLION CAP THAT LIMITS U.S. GOVERNMENT REIMBURSEMENT AS WELL AS INSURERS' LIABIITY FOR LOSSES RESULTING FROM CERTIFIED ACTS OF TERRORISM WHEN THE AMOUNT OF SUCH LOSSES IN ANYONE CALENDAR YEAR EXCEEDS $100 BILLION. IF THE AGGREGATE INSURED LOSSES FOR ALL INSURERS EXCEED $100 BILLION, COVERAGE MAY BE REDUCED. You elected N ®r to purchase terrorism coverage under the Act at the price indicated. ACCORDINGLY, WE WILL NOT PROVIDE THIS COVERAGE AND YOU DO NOT OWE THE ADDITIONAL PREMIUM FOR THAT COVERAGE INDICATED BELOW. Terrorism coverage described by the Act under your policy was made available to you for additional premium in the amount of $ 300, however you elected to decline such coveraae TRIA15c