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C2015-027 - 4/28/2015 - Approved
,I d 2015-027 4/28/15 M2015-04? Grace Paving and Construction CONTRACT DOCUMENTS L FOR CONSTRUCTION OF L ID/IQ MINOR STREET PAVEMENT IMPROVEMENTS PROJECT No. E14034 AlF416k , , 111111•11111111 NM= 111111111111111V MEM MEW MM. Cirita Z�� It ,�S�Q:••• - .. 11t1 COIpUSAte pi FELIX H. OCAWAS, JR. Christi � ©.. R 33006 SSiONAI. 2�°" ECMS LLC Felix H. Ocanas, Jr. P.E. 1. I L LRecord Drawing No. STR 906 00 0100 TABLE OF CONTENTS Division/ Title Section Division 00 Procurement and Contracting Requirements 0011 16 Invitation to Bid(Rev 01/23/2015) 00 21 13 Instructions to Bidders (Rev 01/23/2015) 00 30 00 Bid Form (Rev 01/23/2015) 00 30 01 Bid Form Exhibit A(Rev 10/14/2014) 00 30 02 Compliance to State Law on Nonresident Bidders 00 30 04 Conflict of Interest Questionnaire 00 30 05 Disclosure of Interest N. 00 30 06 Non-Collusion Certification 00 45 16 Statement of Experience .. 00 52 23 Agreement(Rev 10/14/2014) 00 61 13 Performance Bond (Rev 7/3/2014) 00 61 16 Payment Bond (Rev 7/3/2014) 00 72 00 General Conditions 00 72 01 Insurance Requirements(Rev7/3/2014) 00 72 02 Wage Rate Requirements 00 72 03 Minority/MBE/DBE Participation Policy 00 73 00 Supplementary Conditions - Division 01 General Requirements 01 1100 Summary of Work 01 23 10 Alternates and Allowances irrr 0129 00 Application for Payment Procedures 01 29 01 Measurement and Basis for Payment it 01 31 00 Project Management and Coordination 01 31 13 Project Coordination 0131 14 Change Management 0133 00 Document Management M. 0133 01 Submittal Register(Rev 7/3/2014) 01 33 02 Shop Drawings 0133 03 Record Data 0133 04 Construction Progress Schedule Table of Contents 00 0100-1 ID/IQ Minor Street Pavement Improvements Project#E14034 REV 10-14-2014 Division/ Title Section 0140 00 Quality Management !1 0150 00 Temporary Facilities and Controls 0157 00 Temporary Controls 4 0170 00 Execution and Closeout Requirements Part S Standard Specifications 025202 Scarifying and Reshaping Base Course-(S-23) al 025205 Pavement Repair,Curb, Gutter,Sidewalk&Driveway Replacement-(S-54) 025220 Flexible Base-Chemically Stabilized—(S-24) 025222 Flexible Base-High Strength-(S-24A r 025402 Planing Asphaltic Surfaces-(S-27A) 025404 Asphalts, Oils,and Emulsions-(S-29) 025410 Crack Sealing-Asphalt(S36) 025412 Prime Coat-(S-30) 025416 Seal Coat-(S-31) 025418 Surface Treatment- (S-32) 025419 Slurry Seal (S-37) 1 025422 Cold Mix Limestone Rock Asphalt Pavement(Class A) (S-33) 025424 Hot Mix Asphalt Concrete Pavement(Class A)-(S-34) 025610 Concrete Curb and Gutter-(S-52) 025612 Concrete Sidewalks and Driveways-(S-53) 030020 Portland Cement Concrete-(S-41) 032020 Reinforcing Steel-(S-42) 038000 Concrete Structures-(S-41) r� Part T Technical Specifications W T-1 025614-Concrete Curb Ramps T-2 TXDOT Spec 351R-Flexible Pavement Structure Repair T-3 T-025802-Temporary Traffic Control During Construction ■I END OF SECTION Table of Contents 00 0100-2 ID/IQ Minor Street Pavement Improvements Project#E14034 REV 10-14-2014 00 11 16 INVITATION TO BID ARTICLE 1—GENERAL NOTICE 1.01 The City of Corpus Christi,Texas(Owner) is requesting Bids for the construction of the following Project: 10/10 MINOR STREET PAVEMENT IMPROVEMENTS Project No. E14034 This project is an Indefinite Delivery Indefinite Quantity(101Q)construction contract to perform minor street pavement repairs involving minor street pavement rehab/replacement, base repairs with limestone,and sub-grade stabilization throughout the City. The work will be issued in work orders called "Delivery Orders"that will provide specific scope and requirements. The work may include saw cutting, crack sealing,seal coats,milling,curb &gutter, driveway replacement,curb ramps, minor utility manhole ring&cover and valve adjustments,and gas line utility cut backfill (on a 24-hour notice) with limestone to an average depth of three (3)feet. 1.02 The Engineer's Opinion of Probable Construction Cost for the Project is$ 2,020,000. The Project is to be completed and ready for operation within 365 calendar days. ARTICLE 2—EXAMINATION AND PURCHASE OF DOCUMENTS 2.01 Advertisement and bidding information for the Project can be found at the following website: 2.02 http:/www.cctexas.com/business/supplierportal 2.03 Contract Documents may be downloaded or viewed free of charge at this website. It is the downloader's responsibility to determine that a complete set of documents, as defined in the Agreement are received. 2.04 This website will be updated periodically with Addenda, lists of interested parties, reports, or other information relevant to submitting a Bid for the Project. ARTICLE 3—PRE-BID CONFERENCE 3.01 A non-mandatory pre-bid conference for the Project will be held on Tuesday, March 3,2015 @2PM, Engineering Conference Room 1, at the following location: City Hall Building—City of Corpus Christi,Texas Capital Programs Department Third Floor 1201 Leopard Street Corpus Christi,Texas 78401 Invitation to Bid 00 11 16-1 ID/IQ Minor Street Pavement Improvements Project#E14034 REVO1-23-2015 ARTICLE 4—QUESTIONS REGARDING BIDDING PROCESS OR SOLICITATION DOCUMENTS 4.01 Questions are to be submitted using the Question and Answer process on the Owner's Bidding Website. Responses to questions submitted will be posted on the website by the Owner for the benefit of all Bidders. Responses will be posted for questions submitted by noon seven (7) days prior to the date of the bid opening. Inquiries made after this period may not be addressed. 4.02 A response to a question posted on the website that requires modification of the Contract Documents will be made by Addenda. Modifications to the Contract Documents prior to the award of contract can only be made by Addenda. Only answers in Addenda authorized by the Owner will be binding. Oral and other interpretations or clarifications will be without legal effect. ARTICLE 5—MINORITY/ MBE/DBE PARTICIPATION POLICY 5.01 Selected Contractor is required to comply with the Owner's Minority/MBE/DBE Participation Policy as indicated in SECTION 00 72 03 MINORITY/ MBE/DBE PARTICIPATION POLICY. 5.02 Minority participation goal for this Project has been established to be 45%of the Contract Price. 5.03 Minority Business Enterprise participation goal for this Project has been established to be 15% of the Contract Price. ARTICLE 6—BID SECURITY 6.01 Bidders must submit an acceptable Bid Security with their Bid as a guarantee that the Bidder will enter into a contract for the Project with the Owner within 10 days of Notice of Award of the Contract. The security must be payable to the City of Corpus Christi,Texas in the amount of 5 percent (5%) of the greatest amount bid. 6.02 Bid Security may be in the form of a Bid Bond or a cashier's check, certified check, money order, or bank draft from a chartered financial institution authorized to operate in the State of Texas. 6.03 Bid Bond Requirements: 1. A Bid Bond must guarantee, without qualification or condition, that the Owner will be paid a sum equal to 5 percent (5%) of the greatest amount bid if,within 10 calendar days of Notice of Award of the Contract, the Bidder/Principal: a. fails to enter into a contract for the Project with the Owner; or b. fails to provide the required Performance and Payment Bonds. 2. A Bid Bond may not limit the sum payable to the Owner to be the difference between the Bidder/Principal's bid and the next highest bidder. 3. The Bid Bond must reference the Project by name as identified in Article 7. 4. Bidders may provide their surety's standard bid bond form if revised to meet the Bid Bond Requirements. 6.04 Failure to provide an acceptable Bid Security will constitute a non-responsive Bid which will not be considered. Invitation to Bid 00 11 16-2 ,. ID/IQ Minor Street Pavement Improvements Project#E14034 REVO1-23-2015 ern r 6.05 Failure to provide required Performance and Payment Bonds will result in forfeiture of the Bid Security to the City as liquidated damages. ARTICLE 7—DELIVERY OF BIDS,BID OPENING 7.01 Sealed Bids (hard copy) must be submitted to the City Secretary's Office(City Hall Building, 1st "r' Floor, 1201 Leopard Street, Corpus Christi,Texas 78401) no later than 2:00 PM on Wednesday, March 11,2015 to be accepted. The bids will be publicly opened and read aloud at this time at the City Council chambers or staff room, 1st floor of the City Hall Building. Bids received after this time will not be accepted. Address envelopes or packages to: The City of Corpus Christi City Secretary's Office 1201 Leopard Street Corpus Christi,Texas 78401 Attention: City Secretary Bid-ID/IQ MINOR STREET PAVEMENT IMPROVEMENTS, Project No. E14034 ARTICLE 8—AWARD OF CONTRACT " 8.01 It is the intent of the Owner to award this Contract to the lowest responsible Bidder who submits a responsive Bid. The Owner reserves the right to adopt the most advantageous interpretation of the Bids submitted in the case of ambiguity or lack of clearness in stating Bid +► prices,to reject any or all Bids, and/or waive formalities. Bids may not be withdrawn within 90 days from the date on which Bids are opened. ARTICLE 9—OTHER CONTRACT REQUIREMENTS 9.01 Contractors for this Project must pay no less than the prevailing wage rates for the area established by the Owner and included in the Contract Documents. 9.02 Contractors for this Project must obtain and provide the necessary insurance, including Workers'Compensation Insurance, as required by the General Conditions and SECTION 00 72 01 INSURANCE REQUIREMENTS. 9.03 Performance and Payment Bonds are required. uri END OF SECTION WO Mm Invitation to Bid 00 11 16-3 ID/IQ Minor Street Pavement Improvements Project#E14034 REV01-23-2015 is 00 72 01 INSURANCE REQUIREMENTS ARTICLE 1—INSURANCE REQUIREMENTS 1.01 CONTRACTOR'S INSURANCE AMOUNTS ■" A. Provide the insurance coverage for at least the following amounts unless greater amounts are required by Laws and Regulations: Type of Insurance Minimum Insurance Coverage Commercial General Liability including 1. Commercial Form 2. Premises-Operations 3. Explosions and Collapse Hazard 4. Underground Hazard 5. Products/Completed Operations Hazard $1,000,000 Per Occurrence $2,000,000 Aggregate 6. Contractual Liability 7. Broad Form Property Damage 8. Independent Contractors 9. Personal &Advertising Injury Business Automobile Liability-Owned, Non-Owned, Rented and Leased $1,000,000 Combined Single Limit Workers'Compensation Statutory Employer's Liability $500,000/500,000/500,000 Excess Liability/Umbrella Liability $1,000,000 Per Occurrence ,,,. Contractor's Pollution Liability/ $2,000,000 Per Claim Environmental Impairment Coverage Not limited to sudden and accidental ❑ Required X Not Required r discharge. To include long-term environmental impact for the disposal of pollutants/contaminants. Builder's Risk(All Perils including Collapse) Equal to Contract Price ❑ Required X Not Required Installation Floater Equal to Contract Price ❑ Required X Not Required ,r Owner's Protective Liability Equal to Contractor's liability insurance ❑ Required X Not Required 1.02 GENERAL PROVISIONS A. Provide insurance coverages and limits meeting the requirements for insurance in accordance with Article 6 of the General Conditions and this Section. Insurance Requirements 00 72 01-1 ID/IQ Minor Street Pavement Improvements Project#E14034 REV 07-03-2014 I B. Provide endorsements to the policies as outlined in this Section. C. Obtain insurance from companies that are duly licensed or authorized in the State of Texas to issue insurance policies for the required limits and coverages. Provide insurance from companies that have an A.M. Best rating of A-VIII or better. D. Furnish copies of policies and endorsements, and documentation of applicable self-insured retentions and deductibles upon request by OPT or any named insured or additional insured. Contractor may block out(redact) any confidential premium or pricing information contained in any policy or endorsement furnished under this Contract. a E. The name and number of the Project must be referenced on the certificate of insurance. F. OPT's failure to demand such certificates or other evidence of the Contractor's full compliance with the insurance requirements or failure to identify a deficiency in a compliance from the evidence provided is not a waiver of the Contractor's obligation to obtain and maintain the insurance required by the Contract Documents. ■ G. Notify the Owner if the Contractor fails to purchase or maintain the insurance required by the Contract Documents. Contractor shall not be allowed to perform any Work on the Project until the required insurance policies are in effect. A Certificate of Liability Insurance shall be submitted to the OPT. H. Owner may exclude the Contractor from the Site and exercise Owner's termination rights under Article 16 of the General Conditions if Contractor fails to obtain or maintain the required insurance. I. Owner does not represent that the insurance coverage and limits established in this Contract are adequate to protect Contractor or Contractor's interests. J. The required insurance and insurance limits do not limit the Contractor's liability under the indemnities granted to Owner's Indemnitees in the Contract Documents. K. Provide for an endorsement that the "other insurance" clause shall not apply to the OPT where the OPT is an additional insured shown on the policy. Contractor's insurance is primary and non-contributory with respect to any insurance or self-insurance carried by the id OPT for liability arising out of operations under this Contract. L. Include the Owner and list the other members of the OPT and any other individuals or entities identified in the Supplementary Conditions as additional insureds on all policies with the exception of the workers'compensation policy and Contractor's professional liability policy. 1.03 CONTRACTOR'S INSURANCE ,11 A. Purchase and maintain workers' compensation and employer's liability insurance for: 1. Claims under workers' compensation, disability benefits, and other similar employee benefit acts. Obtain workers' compensation coverage through a licensed insurance , company in accordance with Texas law and written on a policy and endorsements approved by the Texas Department of Insurance. Provide insurance in amounts to meet all workers' compensation obligations. Provide an "All Other States" .34 endorsement if Contractor is not domiciled in Texas and policy is not written in accordance with Texas Department of Insurance rules. Insurance Requirements 00 72 01-2 ID/IQ Minor Street Pavement Improvements Project#E14034 REV 07-03-2014 I um um 2. Claims for damages because of bodily injury, occupational sickness or disease,or death of Contractor's employees. OP 3. United States Longshoreman and Harbor Workers' Compensation Act and Jones Act coverage(if applicable). 4. Foreign voluntary worker compensation (if applicable). i• B. Purchase and maintain commercial general liability insurance covering all operations by or on behalf of Contractor. Provide coverage on an occurrence basis,against: .. 1. Claims for damages because of bodily injury, sickness or disease, or death of any person other than Contractor's employees; 2. Claims for damages insured by reasonably available personal injury liability coverage m` which are sustained; 3. By any person as a result of an offense directly or indirectly related to the employment of such person by Contractor; 4. By any other person for any other reason; and 5. Claims for damages, other than to the Work itself, because of injury to or destruction um of tangible property wherever located, including any resulting loss of use. C. Provide Contractor's commercial general liability policy that is written on a 1996(or later) rum ISO commercial general liability form (occurrence form) and include the following coverages and endorsements: 1. Products and completed operations coverage as required in this Section. Insurance is "' to remain in effective for 3 years after final payment. Furnish evidence of the continuation of this insurance at final payment and again each year for 3 years after final payment to Owner and each named insured or additional insured. um a. Eliminate the exclusion with respect to property under the care,custody, and control of Contractor. Provide and maintain Installation Floater insurance for property under the care, custody,or control of Contractor in lieu of elimination of the exclusion,or if required by this Section. Provide Installation Floater insurance that is a broad form or"All Peril" policy providing coverage for all materials, supplies, machinery,fixtures, and equipment which will be incorporated into the mu Work. 1) Provide coverage under the Contractor's Installation Floater that includes: a) Faulty or Defective workmanship, materials, maintenance, or construction; b) Cost to remove Defective or damaged Work from the Site or to protect it from loss or damage; c) Cost to cleanup and remove pollutants; rr d) Coverage for testing and startup; e) Any loss to property while in transit; ,s f) Any loss at the Site; g) Any loss while in storage, both on and off the Site; and Insurance Requirements 00 72 01-3 10/10 Minor Street Pavement Improvements Project#E14034 REV 07-03-2014 h) Any loss to temporary Project Works if their value is included in the Contract Price. 2) Coverage cannot be contingent on an external cause or risk or limited to N property for which the Contractor is legally liable. Provide limits of insurance adequate to cover the value of the installation. Pay any deductible carried under this coverage and assume responsibility for claims on materials, 'r supplies, machinery,fixture, and equipment which will be incorporated into the Work while in transit or in storage. 2. Blanket contractual liability coverage for Contractor's contractual indemnity obligations in Paragraph 7.14 of the General Conditions, and all other contractual indemnity obligations of Contractor in the Contract Documents. rr 3. Broad form property damage coverage. 4. Severability of interest. 5. Underground explosion and collapse coverage. 6. Personal injury coverage. 7. Endorsement CG 2032, "Additional Insured-Engineers, Architects or Surveyors Not 'w Engaged by the Named Insured" or its equivalent. D. Purchase and maintain automobile liability insurance against claims for damages because N of bodily injury or death of any person or property damage arising out of the ownership, maintenance, or use of any motor vehicle. -11 E. Purchase and maintain umbrella or excess liability insurance written over the underlying err employer's liability, commercial general liability,and automobile liability insurance described in the paragraphs above. Provide coverage that is at least as broad as all underlying policies. Provide a policy that provides first-dollar liability coverage as needed. F. Provide Contractor's commercial general liability and automobile liability policies that: 1. Are written on an occurrence basis; 2. Include the individuals or entities identified in the Supplementary Conditions as additional insureds; 3. Include coverage for the respective officers, directors, members, partners, employees, agents, consultants, and subcontractors for each named insured or additional insured; 4. Provide primary coverage for all claims covered by the policies, including those arising from both ongoing and completed operations. G. Purchase and maintain insurance coverage for third-party injury and property damage claims, including clean-up costs that result from Hazardous Environmental Conditions which result from Contractor's operations and completed operations. Provide Contractor's pollution liability insurance that includes long-term environmental impacts for the disposal of pollutants/contaminants and is not limited to sudden and accidental discharge. The completed operations coverage is to remain in effect for 3 years after final payment. The policy must name OPT and any other individuals and entities identified in the Supplementary Conditions as additional insureds. Insurance Requirements 00 72 01-4 a ID/IQ Minor Street Pavement Improvements Project#E14034 REV 07-03-2014 I • rrr H. Purchase and maintain applicable professional liability insurance,or have Subcontractors and Suppliers do so, if Contractor or any Subcontractor or Supplier will provide or furnish professional services under this Contract. lila I. The policies of insurance required by this Section must: 1. Include at least the specific coverages and be written for not less than the limits of r liability provided in this Section or required by Laws or Regulations,whichever is greater. .r 2. Contain a provision that coverage afforded will not be canceled or materially changed until at least 30 days prior written notice has been given to Contractor, Owner, and all named insureds and additional insureds. +•• 3. Remain in effect at all times when Contractor is performing Work or is at the Site to conduct tasks arising from the Contract Documents. 4. Be appropriate for the Work being performed and provide protection from claims ""' resulting from the Contractor's performance of the Work and Contractor's other obligations under the Contract Documents, whether performed by Contractor, Subcontractor, Supplier, anyone directly or indirectly employed or retained by any of them, or by anyone for whose acts they may be liable. J. The coverage requirements for specific policies of insurance must be met directly by those policies and may not by rely on excess or umbrella insurance provided in other policies to Nor meet the coverage requirement. 1.04 OWNER'S PROTECTIVE LIABILITY INSURANCE MP A. Purchase and maintain an Owner's Protective Liability insurance policy with the Owner as the named insured and other members of the OPT as additional insureds. Provide a policy irethat will protect the OPT from claims which arise from operations under the Contract Documents. Provide this coverage in the same amounts required for the Contractor's liability insurance and from the same company that provides the Contractor's liability insurance. NW 1.05 PROPERTY INSURANCE or. A. Purchase and maintain builder's risk insurance in the amount of the full replacement cost of the Project. This policy is subject to the deductible amounts requirements in this Section or those required by Laws and Regulations and must comply with the requirements of Paragraph 1.06. This insurance shall: 1. Include the OPT,Contractor, and all Subcontractors, and any other individuals or entities identified in the Supplementary Conditions, as named insureds. .r 2. Be written on a builder's risk"all risk" policy form that includes insurance for physical loss or damage to the Work,temporary buildings,falsework, and materials and equipment in transit, and insures against at least the following perils or causes of loss: U. fire; lightning;windstorm; riot; civil commotion;terrorism;vehicle impact; aircraft; smoke;theft;vandalism and malicious mischief; mechanical breakdown, boiler explosion, and artificially generated electric current;earthquake;volcanic activity, and other earth movement;flood; collapse;explosion; debris removal; demolition occasioned by enforcement of Laws and Regulations;water damage (other than that Insurance Requirements 00 72 01-5 ID/IQ Minor Street Pavement Improvements Project#E14034 REV 07-03-2014 ma caused by flood); and such other perils or causes of loss as may be specifically required by this Section. If insurance against mechanical breakdown, boiler explosion, and artificially generated electric current; earthquake;volcanic activity,and other earth arw movement; or flood, are not commercially available under builder's risk, by endorsement or otherwise,this insurance may be provided through other insurance policies acceptable to Owner and Contractor. 3. Cover expenses incurred in the repair or replacement of any insured property. 4. Cover materials and equipment in transit or stored prior to being incorporated in the Work. 5. Cover Owner-furnished or assigned property. 6. Allow for partial utilization of the Work by Owner. 7. Allow for the waiver of the insurer's subrogation rights as set forth below. .41 8. Provide primary coverage for all losses and damages caused by the perils or causes of id loss covered. 9. Not include a co-insurance clause. 0 10. Include a broad exception for ensuing losses from physical damage or loss with respect to any Defective workmanship, design, or materials exclusions. ,10 11. Include testing and startup. +� 12. Be maintained in effect until the Work as a whole is complete, unless otherwise .01 agreed to in writing by Owner and Contractor. so B. Evidence of insurance provided must contain a provision or endorsement that the coverage afforded will not be canceled or materially changed or renewal refused until at least 30 days prior written notice has been given to Owner and Contractor and to each named iai insured. C. Pay for costs not covered by the policy deductible. ' D. Notifybuilder's risk insuranceprovider if Owner will occupy or use a portion or portions of the Work prior to Substantial Completion of all the Work as provided in Paragraph 15.04 of the General Conditions. Maintain the builder's risk insurance in effect during this Partial Occupancy or Use. 1 E. Contractor may purchase other special insurance to be included in or to supplement the builder's risk or property insurance policies provided under this Section. F. Contractor,Subcontractors, or employees of the Contractor or a Subcontractor owning property items,such as tools, construction equipment, or other personal property not expressly covered in the insurance required by the Contract Documents are responsible for Orli providing their own insurance. 1.06 WAIVER OF RIGHTS A. Insurance shall include a waiver of subrogation in favor of the additional insureds identified in SECTION 00 73 00 SUPPLEMENTARY CONDITIONS. oil B. All policies purchased in accordance with this Section are to contain provisions to the effect that the insurers have no rights of recovery against OPT, named insureds or additional Insurance Requirements 00 72 01-6 ID/IQ Minor Street Pavement Improvements Project#E14034 REV07-03-2014 ON insureds in the event of a payment for loss or damage. Contractor and insurers waive all rights against the Owner's Indemnities for losses and damages created by or resulting from rr any of the perils or causes of loss covered by these policies and any other applicable property insurance. None of these waivers extend to the rights Contractor has to the proceeds of insurance as trustee. C. Contractor is responsible for assuring that agreements with Subcontractors contains provisions that the Subcontractor waive all rights against Owner's Indemnitees,Contractor, named insureds and additional insureds, and the officers, directors, members, partners, .. employees, agents, consultants, and subcontractors of each and any of them,for all losses and damages created by or resulting from any of the perils or causes of loss covered by builder's risk insurance and other property insurance. 1.07 OWNER'S INSURANCE FOR THE PROJECT A. Owner is not responsible for purchasing and maintaining any insurance to protect the •• interest of the Contractor,Subcontractors,or others in the Work. The stated limits of insurance required are minimum only. Determine the limits that are adequate. These limits may be basic policy limits or any combination of basic limits and umbrella limits. In any event, Contractor is fully responsible for all losses arising out of, resulting from, or connected with operations under this Contract whether or not these losses are covered by insurance. The acceptance of evidence of insurance by the OPT, named insureds, or additional insureds does not release the Contractor from compliance with the insurance requirements of the Contract Documents. ARTICLE 2—EVIDENCE OF INSURANCE 2.01 ACCEPTABLE EVIDENCE OF INSURANCE o• A. Provide evidence of insurance acceptable to the Owner with the executed Contract Documents. Provide the following as evidence of insurance: 1. Certificates of Insurance on an acceptable form; 2. Riders or endorsements to policies; and 3. Policy limits and deductibles. .. B. Provide a list of"Additional Insureds" for each policy. C. Provide evidence that waivers of subrogation are provided on all applicable policies. or D. Provide evidence of requirements for 30 days' notice before cancellation or any material change in the policy's terms and conditions, limits of coverage,or change in deductible amount. 2.02 CERTIFICATES OF INSURANCE A. Submit Certificates of Insurance meeting the following requirements: 1. Form has been filed with and approved by the Texas Department of Insurance under Texas Insurance Code§1811.101; or 2. Form is a standard form deemed approved by the Department under Texas Insurance Code§1811.101. Insurance Requirements 00 72 01-7 ID/IQ Minor Street Pavement Improvements Project#E14034 REV07-03-2014 ei 3. No requirements of this Contract may be interpreted as requiring the issuance of a certificate of insurance on a certificate of insurance form that has not first been filed with and approved by the Texas Department of Insurance. B. Include the name of the Project in the description of operations box on the certificate of insurance. 41 2.03 INSURANCE POLICIES A. Provide a copy of insurance policies, declaration pages and endorsements, and documentation of applicable self-insured retentions and deductibles if requested by the Owner. B. Owner may require the deletion, revision, or modification of particular policy terms, conditions, limitations, or exclusions(except where policy provisions are established by Laws or Regulations binding upon either of the parties hereto or the underwriter of any such policies). Comply with these requests and submit a copy of the replacement certificate of insurance to Owner at the address provided below within 10 days of the requested change. 2.04 CONTINUING EVIDENCE OF COVERAGE A. Provide updated, revised, or new evidence of insurance in accordance this Section prior to ' 11 the expiration of existing policies. B. Provide evidence of continuation of insurance coverage at final payment and for the following 3 years. 41 2.05 NOTICES REGARDING INSURANCE A. Submit notices regarding insurance are to be sent to the Owner at the following address: City of Corpus Christi—Engineering Attn: Construction Contract Admin. P.O. Box 9277 ui Corpus Christi,TX 78469-9277 ,41 B. Submit questions regarding insurance requirements to the Construction Contract Administrator by calling 361-826-3530. ARTICLE 3—TEXAS WORKERS'COMPENSATION INSURANCE REQUIRED NOTICE 411 3.01 WORKERS' COMPENSATION INSURANCE COVERAGE A. Definitions: all 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 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. -41 Insurance Requirements 00 72 01-8 ID/IQ Minor Street Pavement Improvements Project#E14034 REV 07-03-2014 2. Duration of the Project- includes the time from the beginning of the Work on the Project until the Contractor's/person's Work on the Project has been completed and accepted by the governmental entity. 3. Persons providing services on the Project ("Subcontractor" in §406.096) -includes all persons or entities performing all or part of the services the Contractor has tr, 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,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 rori 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,office supply deliveries, and delivery of portable toilets. w. B. The Contractor shall provide coverage, based on proper reporting of classification codes and payroll amounts and filing of any coverage agreements,which meets the statutory requirements of Texas Labor Code, Section 401.011(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. w. D. If the 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. E. 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 file certificates of coverage showing coverage for all +O persons providing services on the Project; and 2. 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. F. The Contractor shall retain all required certificates of coverage for the duration of the Project and for one year thereafter. G. 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 a person may verify coverage and report lack of coverage. Insurance Requirements 00 72 01-9 ID/IQ Minor Street Pavement Improvements Project#E14034 REV 07-03-2014 r.. rr I. 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 filing 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 Project; 3. 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; 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 ,w the coverage period, 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 10 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 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. 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 if the Contractor does not remedy the breach within ten days after receipt of notice of breach407 from the governmental entity. S END OF SECTION Insurance Requirements 00 72 01-10011 ID/IQ Minor Street Pavement Improvements Project#E14034 REV 07-03-2014 NMI JIM 00 73 00 SUPPLEMENTARY CONDITIONS w These Supplementary Conditions amend or supplement SECTION 00 72 00 GENERAL CONDITIONS and other provisions of the Contract Documents. All provisions not amended or supplemented in these Supplementary Conditions remain in effect. wr The terms used in these Supplementary Conditions have the meanings stated in the General Conditions. Additional terms used in these Supplementary Conditions have the meanings stated below. NW ARTICLE 1—DEFINITIONS AND TERMINOLOGY SC-1.01 DEFINED TERMS A. The members of the OPT as defined in Paragraph 1.01.A.41 consists of the following organizations: City of Corpus Christi,Texas ECMS LLC ARTICLE 4—COMMENCEMENT AND PROGRESS OF THE WORK SC-4.04 DELAYS IN CONTRACTOR'S PROGRESS A. The allocation for delays in the Contractor's progress for rain days as set forth in General Conditions Paragraph 4.04.D are to be determined as follows: 1. Include rain days in developing the schedule for construction. Schedule construction so that the Work will be completed within the Contract Times assuming that these rain days will occur. Incorporate residual impacts following rain days such as limited access to and within the Site, inability to work due to wet or muddy Site conditions, delays in delivery of equipment and materials, and other impacts related to rain days when developing the schedule for construction. Include all costs associated with these rain days and residual impacts in the Contract Price. wei 2. A rain day is defined as any day in which the amount of rain measured by the National Weather Services at the Power Street Stormwater Pump Station is 0.50 inch or greater. Records indicate the following average number of rain days for each month: Month Day Month Days January 3 July 3 February 3 August 4 March 2 September 7 r. April 3 October 4 May 4 November 3 June 4 December 3 r 3. A total of 50 rain days have been set for this Project. An extension of time due to rain days will be considered only after 50 rain days have been exceeded in a calendar year .. and the OAR has determined that a detrimental impact to the construction schedule resulted from the excessive rainfall. Rain days are to be incorporated into the 'r' Supplementary Conditions 00 73 00-1 ID/IQ Minor Street Pavement Improvements Project#E14034 11-25-2013 schedule and unused rain days will be considered float time which may be consumed by the Owner or Contractor in delay claims. ARTICLE 5—AVAILABILITY OF LANDS; SUBSURFACE CONDITIONS AND PHYSICAL CONDITIONS; HAZARDOUS ENVIRONMENTAL CONDITIONS SC-5.03 SUBSURFACE AND PHYSICAL CONDITIONS A. This Supplementary Condition identifies documents referenced in General Conditions Paragraph 5.03.A which describe subsurface and physical conditions. 1. Geotechnical Reports include the following: NONE 2. Drawings of physical conditions relating to existing surface or subsurface structures at the Site (except Underground Facilities) include the following: NONE B. Delete Paragraph 5.03 entirely and insert the following: "5.03 Subsurface and Physical Conditions A. No reports of explorations or tests of subsurface conditions at or contiguous to the Site, or drawings of physical conditions relating to existing surface or subsurface structures at the Site, are known to Owner." C. Delete Paragraph 5.06 entirely and insert the following: "5.06 Hazardous Environmental Conditions at Site A. No reports of explorations or tests for Hazardous Environmental Conditions at or contiguous to the Site are known to Owner." ARTICLE 7—CONTRACTOR'S RESPONSIBILITIES SC-7.04 CONCERNING SUBCONTRACTORS, SUPPLIERS, AND OTHERS A. Add the following sentence to the end of Paragraph 7.04.A: "The Contractor must perform at least 50 percent of the Work, measured as a percentage of the Contract Price, using its own employees." END OF SECTION Supplementary Conditions 00 73 00-2 ID/IQ Minor Street Pavement Improvements Project#E14034 11-25-2013 00 52 23 AGREEMENT This Agreement,for the Project awarded on April 28,2015 , is between the City of Corpus Christi (Owner)and Grace Paving and Construction,Inc. (Contractor). Owner and Contractor agree as follows: ARTICLE 1—WORK 1.01 Contractor shall complete all Work as specified or indicated in the Contract Documents. The Work is generally described as: ID/IQ Minor Street Pavement Improvements Project#E14034 This project is an Indefinite Delivery Indefinite Quantity(IDIQ)construction contract to perform minor street pavement repairs involving minor street pavement rehab/replacement,base repairs with limestone,and sub-grade stabilization throughout the City. The work will be issued in work orders called"Delivery Orders"that will provide specific scope and requirements. The work may include saw cutting,crack sealing,seal coats,milling,curb&gutter,driveway/replacement,curb ramps,minor utility manhole ring&cover and valve adjustments,and gas line utility cut backfill(on a 24-hour notice) with limestone to an average depth of three(3)feet. ARTICLE 2—DESIGNER AND OWNER'S AUTHORIZED REPRESENTATIVE 2.01 The Project has been designed by: Felix H.Ocanas,Jr..P.E. ECMS(Engineering and Construction Management Services) LLC 5001 Oakmont Dr. Corpus Christi,Texas,78413 2.02 The Owner's Authorized Representative for this Project is: Phil Boehk,P.E.—Acting Construction Engineer City of Corpus Christi—Capital Programs 4917 Holly Rd.,Bldg.#5. Corpus Christi,Texas,78411 ARTICLE 3—CONTRACT TIMES 3.01 Contract Times A. The Work is required to be completed within 365 calendar days after the date when the Contract Times commence to run as provided in the Notice to Proceed and is to be completed and ready for final payment in accordance with Paragraph 15.06 of the General Conditions within 365 calendar days after the date when the Contract Times commence to run. Agreement 005223-1 ID/IQ Minor Street Pavement Improvements Project#E14034 REV 10-14-2014 3.02 Liquidated Damages A. Owner and Contractor recognize that time limits for completion are of the essence of the Contract. Owner and Contractor recognize that the Owner will suffer financial loss if the Work is not completed within the times specified in Paragraph 3.01 and as adjusted in accordance with Paragraph 11.05 of the General Conditions. Owner and Contractor also recognize the delays,expense, and difficulties involved in proving in a legal or arbitration proceeding the actual loss suffered by Owner if the Work is not completed on time. Accordingly, instead of requiring any such proof, Owner and Contractor agree that as liquidated damages for delay(but not as a penalty): 1. Completion of the Work: Contractor agrees to pay Owner$500 for each day that expires after the time specified in Paragraph 3.01 for completion and readiness for final payment until the Work is completed and ready for final payment in accordance with Paragraph 15.06 of the General Conditions. 2. Liquidated damages for failing to timely attain Completion are not additive and will not be imposed concurrently. 3. The Owner will determine whether the Work has been completed within the Contract Times. B. Owner is not required to only assess liquidated damages,and Owner may elect to pursue its actual damages resulting from the failure of Contractor to complete the Work in accordance with the requirements of the Contract Documents. ARTICLE 4—CONTRACT PRICE 4.01 Owner will pay Contractor for completion of the Work in accordance with the Contract Documents at the unit prices shown in the attached in SECTION 00 30 01 BID FORM EXHIBIT A. Unit prices have been computed in accordance with Paragraph 13.03 of the General Conditions. Contractor acknowledges that estimated quantities are not guaranteed,and were solely for the purpose of comparing Bids,and final payment for all unit price items will be based on actual quantities,determined as provided in the Contract Documents. Total Base Bid Price $ 1,880,404.50 ARTICLE 5—PAYMENT PROCEDURES 5.01 Submit Applications for Payment in accordance with Article 15 of the General Conditions. Applications for Payment will be processed by the OAR as provided in the General Conditions. 5.02 Progress Payments; Retainage: A. The Owner will make progress payments on or about the 25th day of each month during performance of the Work. Payment is based on Work completed in accordance with the Schedule of Values established as provided in the General Conditions. B. Progress payments equal to 95 percent of the total earned value to date for completed Work and properly stored materials will be made prior to Completion. The balance will be held as retainage. Agreement 005223-2 ID/IO Minor Street Pavement Improvements Project#E14034 REV 10-14-2014 C. Payment will be made for the amount determined per Paragraph 5.02.B, less the total of payments previously made and less set-offs determined in accordance with Paragraph 15.01 of the General Conditions. D. At the Owner's option,retainage may be required at a higher percentage rate if progress on the Project is considered to be unsatisfactory. If retainage in excess of the amount described above is held prior to Completion,the Owner will place the additional amount in an interest bearing account. Interest will be paid in accordance with Paragraph 6.01. E. At the Owner's option,Owner may pay Contractor 100 percent of the Work completed, less amounts withheld in accordance with Paragraph 15.01 of the General Conditions and less 200 percent of OAR's estimate of the value of Work to be completed or corrected to reach Completion. Owner may,at its sole discretion,elect to hold retainage in the amounts set forth above for progress payments prior to Completion if Owner has concerns with the ability of the Contractor to complete the remaining Work in accordance with the Contract Documents or within the time frame established by this Agreement. Release or reduction in retainage is contingent upon and consent of surety to the reduction in retainage. 5.03 Owner will pay the remainder of the Contract Price as recommended by OAR in accordance with Paragraph 15.06 of the General Conditions upon Final Completion and acceptance of the Work. ARTICLE 6—INTEREST ON OVERDUE PAYMENTS AND RETAINAGE 6.01 The Owner is not obligated to pay interest on overdue payments except as required by Texas Government Code Chapter 2251. 6.02 The Owner is not obligated to pay interest on moneys not paid except as provided in Texas Government Code Chapter 2252. ARTICLE 7—CONTRACTOR'S REPRESENTATIONS 7.01 The Contractor makes the following representations: A. The Contractor has examined and carefully studied the Contract Documents and the other related data identified in the Bidding Documents. B. The Contractor has visited the Site and become familiar with and is satisfied as to the general, local,and Site conditions that may affect cost, progress, and performance of the Work. C. The Contractor is familiar with Laws and Regulations that may affect cost, progress,and performance of the Work. D. The Contractor has considered the: 1. Information known to Contractor; 2. Information commonly known to contractors doing business in the locality of the Site; 3. Information and observations obtained from visits to the Site;and 4. The Contract Documents. Agreement 00 52 23-3 ID/IQ Minor Street Pavement Improvements Project#E14034 REV 10-14-2014 E. The Contractor has considered the items identified in Paragraphs 7.O1.D and 7.01.E with respect to the effect of such information,observations,and documents on: 1. The cost,progress, and performance of the Work; 2. The means, methods,techniques,sequences, and procedures of construction to be employed by Contractor; and 3. Contractor's safety precautions and programs. F. Based on the information and observations referred to in the preceding paragraphs, Contractor agrees that no further examinations, investigations,explorations,tests,studies, or data are necessary for the performance of the Work at the Contract Price,within the Contract Times, and in accordance with the other terms and conditions of the Contract Documents. G. The Contractor is aware of the general nature of Work to be performed by Owner and others at the Site that relates to the Work as indicated in the Contract Documents. H. The Contractor has correlated the information known to the Contractor, information and observations obtained from visits to the Site, reports and drawings identified in the Contract Documents,and all additional examinations,investigations,explorations,tests, studies,and data with the Contract Documents. I. The Contractor has given the OAR written notice of all conflicts, errors,ambiguities,or discrepancies that the Contractor has discovered in the Contract Documents,and the written resolution provided by the OAR is acceptable to the Contractor. J. The Contract Documents are generally sufficient to indicate and convey understanding of all terms and conditions for performance and furnishing of the Work. K. Contractor's entry into this Contract constitutes an incontrovertible representation by Contractor that without exception all prices in the Agreement are premised upon performing and furnishing the Work required by the Contract Documents. ARTICLE 8—ACCOUNTING RECORDS 8.01 Accounting Record Availability: The Contractor shall keep such full and detailed accounts of materials incorporated and labor and equipment utilized for the Work consistent with the requirements of Paragraph 13.01 of the General Conditions and as may be necessary for proper financial management under this Agreement. Subject to prior written notice,the Owner shall be afforded reasonable access during normal business hours to all of the Contractor's records, books,correspondence, instructions,drawings, receipts,vouchers, memoranda,and similar data relating to the Cost of the Work and the Contractor's fee. The Contractor shall preserve all such documents for a period of 3 years after the final payment by the Owner. ARTICLE 9—CONTRACT DOCUMENTS 9.01 Contents: A. The Contract Documents consist of the following: 1. Specifications,forms,and documents listed in SECTION 00 01 00 TABLE OF CONTENTS. 2. Drawings listed in the Sheet Index. Agreement 005223-4 ID/IQ Minor Street Pavement Improvements Project#E14034 REV 10-14-2014 3. Addenda. 4. Exhibits to this Agreement: a. Contractor's Bid Form Exhibit A. S. Documentation required by the Contract Documents and submitted by Contractor prior to Notice of Award. B. There are no Contract Documents other than those listed above in this Article. C. The Contract Documents may only be amended, modified, or supplemented as provided in Article 11 of the General Conditions. ARTICLE 10—CONTRACT DOCUMENT SIGNATURES Four original duplicates of the signed Contracts will be required. The sequence of signatures will be completed in the following order: A. CONTRACTOR—Contract must be signed by a person authorized to bind the firm or company. If Contractor is a Corporation contracts must be Attested; B. ASSISTANT CITY ATTORNEY for the City; C. DIRECTOR OF CAPITAL PROGRAMS; D. CITY SECRETARY for the City. Agreement 00 52 23-5 ID/IQ Minor Street Pavement Improvements Project#E14034 REV 10-14-2014 ATTEST �eS r ' STI q7 „if City Secretary J.H. Edmonds, P.E. Director of Capital Programs APPROVED AS TO LEGAL FORM • Asst. City Attorney ATTEST(IF CORPORATION CONTRACTOR ( Grace Pavin nd Con tr ction,Inc. (Seal Below) C ` By: Vw Note: Attach copy of authorization to sign if Person signing for Contractor is not President, Title: President Vice President, Chief Executive Officer, or Chief Financial Officer 4237 Baldwin Blvd. Address Corpus Christi, Texas 78405-3324 City State Zip 361 -883-3232 361 -883-1296 Phone Fax gracepaving@aol.com EMail END OF SECTION H2-0 ., AUT Y cnuNcil.._._ _1_4 I l5 SECRf(IIR�' Agreement 00 52 23-6 ID/IQ Minor Street Pavement Improvements Project#E14034 REV 10-14-2014 00 30 00 BID FORM ARTICLE 1—BID RECIPIENT 1.01 In accordance with the Drawings,Specifications,and Contract Documents,this Bid Proposal submitted on:Wednesday,March 11,2015 at 2 P.M. 1.02 Submit hard copy Bids,Bid Security,and all attachments to the Bid(See Section 7.01 below). The City of Corpus Christi City Secretary's Office 1201 Leopard Street Corpus Christi,Texas 78401 Attention: City Secretary Bid-ID/IQ Minor Street Pavement Improvements Project No.E14034 ARTICLE 2—BIDDERS'S ACKNOWLEDGMENTS 2.01 Bidder proposes and agrees,if this Bid is accepted,to enter into an Agreement with Owner on the form included in the Contract Documents,to perform all Work specified or indicated in Contract Documents for the Contract Price indicated in this Bid or as modified by Contract Amendment. Bidder agrees to complete the Work within the Contract Times established in the Agreement or as modified by Contract Amendment and comply with the all other terms and conditions of the Contract Documents. 2.02 Bidder accepts all of the terms and conditions of the Invitation to Bid and Instructions to Bidders,including those dealing with required Bonds. The Bid will remain subject to acceptance for 90 days after the opening of Bids. 2.03 Bidder accepts the provisions of the Agreement as to liquidated damages in the event of its failure to complete Work in accordance with the schedule set forth in the Agreement. 2.04 Bidder acknowledges receipt of the following Addenda: Addendum No. Addendum Date Sig re Acknowledging Receipt 3///)) ARTICLE 3—BIDDER'S REPRESENTATIONS 3.01 The Bidder has examined and carefully studied the Contract Documents and the other related data identified in the Bidding Documents. 3.02 The Bidder has visited the Site and become familiar with and is satisfied as to the general,local, and Site conditions that may affect cost,progress,and performance of the Work. Bid Form 00 30 00-1 ID/IQ Minor Street Pavement Improvements Project#E14034 REV mn3nms 3.03 The Bidder is familiar with Laws and Regulations that may affect cost,progress,and performance of the Work. 3.04 The Bidder has carefully studied the following Site-related reports and drawings as identified in the Supplementary Conditions: A. Geotechnical Data Reports regarding subsurface conditions at or adjacent to the Site; B. Drawings of physical conditions relating to existing surface or subsurface structures at the Site; C. Underground Facilities referenced in reports and drawings; D. Reports and drawings relating to Hazardous Environmental Conditions,if any,at or adjacent to the Site;and E. Technical Data related to each of these reports and drawings. 3.05 The Bidder has considered the: A. Information known to Bidder; B. Information commonly known to contractors doing business in the locality of the Site; C. Information and observations obtained from visits to the Site;and D. The Contract Documents. 3.06 The Bidder has considered the items identified in Paragraphs 3.04 and 3.05 with respect to the effect of such information,observations,and documents on: A. The cost,progress,and performance of the Work; B. The means,methods,techniques,sequences,and procedures of construction to be employed by Bidder;and C. Bidder's safety precautions and programs. 3.07 Based on the information and observations referred to in the preceding paragraphs,Bidder agrees that no further examinations,investigations,explorations,tests,studies,or data are necessary for the performance of the Work at the Contract Price,within the Contract Times,and in accordance with the other terms and conditions of the Contract Documents. 3.08 The Bidder is aware of the general nature of Work to be performed by Owner and others at the Site that relates to the Work as indicated in the Contract Documents. 3.09 The Bidder has correlated the information known to the Bidder,information and observations obtained from visits to the Site,reports and drawings identified in the Contract Documents,and all additional examinations,investigations,explorations,tests,studies,and data with the Contract Documents. 3.10 The Bidder has given the OAR written notice of all conflicts,errors,ambiguities,or discrepancies that the Bidder has discovered in the Contract Documents,and the written resolution provided by the OAR is acceptable to the Bidder. Bid Form 00 30 00-2 ID/IQ Minor Street Pavement Improvements Project p E14034 REV 01/23!2015 3.11 The Contract Documents are generally sufficient to indicate and convey understanding of all terms and conditions for performance and furnishing of the Work. 3.12 Bidder's entry into this Contract constitutes an incontrovertible representation by Bidder that without exception all prices in the Agreement are premised upon performing and furnishing the Work required by the Contract Documents. ARTICLE 4—BASIS OF BID 4.01 Bidder will complete the Work in accordance with the Contract Documents at the unit prices shown in SECTION 00 30 01 BID FORM EXHIBIT A. A. The Bidder selected for award of the Contract will be the lowest responsible Bidder that submits a responsive Bid. Owner will,at its discretion,award the Contract to the lowest responsible Bidder for the Base Bid,plus any combination of Add or Deduct Alternates. B. Extended amounts have been computed in accordance with Paragraph 13.03 of the General Conditions. C. Bidder acknowledges that the estimated quantities are not guaranteed,and final payment for all Unit Price items will be based on actual quantities provided,measured as provided in the Contract Documents. D. Unit Price and figures column will be used to compute the actual Bid price. ARTICLE 5—EVALUATION OF BIDDERS 5.01 The Owner will consider the greatest amount bid,the Bidder's responsibility,and whether the Bidder has met the minimum specific project experience requirements to determine the lowest responsible Bidder.The Owner reserves the right to waive any and all irregularities in determining the Bidders'responsibility,and whether the Bidder has met the minimum specific project experience requirements to determine the lowest responsible Bidder,and reserves the right to require the submission of additional information. 5.02 The Owner has the right to accept a Bid,reject any and all Bids,to waive any and all irregularities in the Bids,or to reject non-conforming,non-responsive,or conditional Bids. In addition,the Owner reserves the right to reject any Bid where circumstances and developments have,in the opinion of the Owner,changed the responsibility of the Bidder. 5.03 Material misstatements in the documentation submitted to determine the Bidder's responsibility,including information submitted per SECTION 00 4516 STATEMENT OF EXPERIENCE,may be grounds for rejection of the Bidder's Bid on this Project. Any such misstatement,if discovered after award of the Contract to such Bidder,may be grounds for immediate termination of the Contract. Additionally,the Bidder will be liable to the Owner for any additional costs or damages to the Owner resulting from such misstatements,including costs and attorney's fees for collecting such costs and damages. Bid Form 00 30 00-3 I0/IQ Minor Street Pavement Improvements Project U E14034 REV 01/23/2015 ARTICLE 6—TIME OF COMPLETION 6.01 Bidder agrees that the Work will be complete and ready for final payment in accordance with Paragraph 15.06 of the General Conditions within the number of days indicated in SECTION 00 30 01 BID FORM EXHIBIT A. ARTICLE 7—ATTACHMENTS TO THIS BID 7.01 All submittals must be in hard copy for this Project.In compliance with the Bid Requirements in SECTION 00 11 16 INVITATION TO BID,the following are made a condition of this Bid: A. Bid Security. B. SECTION 00 30 01 BID FORM and documentation of signatory authority. C. SECTION 00 30 01 BID FORM EXHIBIT A. D. SECTION 00 30 02 COMPLIANCE TO STATE LAW ON NONRESIDENT BIDDERS. E. SECTION 00 3004 CONFLICT OF INTEREST QUESTIONNAIRE. F. SECTION 00 30 05 DISCLOSURE OF INTEREST. G. SECTION 00 30 06 NON-COLLUSION CERTIFICATION. ARTICLE 8—DEFINED TERMS 8.01 The terms used in this Bid have the meanings indicated in the General Conditions and the Supplementary Conditions. The significance of terms with initial capital letters is described in the General Conditions. ARTICLE 9—VENUE 9.01 Bidder agrees that venue shall lie exclusively in Nueces County,Texas for any legal action. ARTICLE 10—SIGNATORY REQUIREMENTS FOR BIDDERS 10.01 Bidders must include their correct legal name,state of residency,and federal tax identification number in the Bid Form. 10.02 The Bidder,or the Bidder's authorized representative,shall sign and date the Bid Form to accompany all materials included in the submitted Bid. Bids which are not signed and dated in this manner,or which do not contain the required documentation of signatory authority may be rejected as non-responsive. The individual(s)signing the Bid must have the authority to bind the Bidder to a contract,and if required,shall attach documentation of signatory authority to the Bid Form. 10.03 Bidders who are individuals("natural persons"as defined by the Texas Business Organizations Code§1.002),but who will not be signing the Bid Form personally,shall include in their bid a notarized power of attorney authorizing the individual designated as their authorized representative to submit the Bid and to sign on behalf of the Bidder. Bid Form 003000-4 ID/IQ Minor Street Pavement Improvements Project#E14034 REV 01/23/201S 10.04 Bidders that are entities who are not individuals shall identify in their Bid their charter or Certificate of Authority number issued by the Texas Secretary of State and shall submit with their Bid a copy of a resolution or other documentation approved by the Bidder's governing body authorizing the submission of the Bid and designating the individual(s)authorized to execute documents on behalf of the Bidder. Bidders using an assumed name(an"alias")shall submit a copy of the Certificate of Assumed Name or similar document. 10.05 Bidders that are not residents of the State of Texas must document their legal authority to conduct business in Texas. Nonresident Bidders that have previously registered with the Texas Secretary of State may submit a copy of their Certificate of Authority. Nonresident Bidders that have not previously registered with the Texas Secretary of State shall submit a copy of the Bidder's enabling documents as filed with the state of residency,or as otherwise existing. ARTICLE 11-BID SUBMITTAL 11.01 This Bid is submitted by: Bidder: Grace Paving And Construction, Inc. (typed or printed full legal name of Bidder) By: (individual's signature) Name: Eddie M. Ortiz (typed or printed) Title: President (typed or printed) Attest: ‘tyi: (individual's signature) State of Residency: Texas Federal Tax Id.No. 74-2980782 Address for giving notices: 4237 Baldwin Blvd. Corpus Christi, Texas 78405-3324 Phone: 361-883-3232 Email: gracepaving@aol.com (Attach evidence of authority to sign if the authorized individual is not the Bidder,but an individual signing on behalf of another individual Bidder,or if the authorized individual is a representative of a corporation,partnership,or joint venture.) END OF SECTION Bid Form 00 3000-5 ID/IQ Minor Street Pavement Improvements Project q E14034 REV01/23/2015 00 30 01 BID FORM EXHIBIT A 00 30 01 BID FORM EXHIBIT A Project Name: ID/IQ Minor Street Pavement Improvements Project Number: £14034 Owner: City of Corpus Christi Bidder: OAR: Designer: ECMS, LLC Felix H. Ocanas,Jr., P. E. Basis of Bid Item DESCRIPTION UNIT i ESTIMATED UNIT PRICE EXTENDED QUANTITY AMOUNT Base Bid Part A•General(per SECTION 01 29 01 MEASUREMENT AND BASIS FOR PAYMENT) Ai Mobilization/Bonds/Insurance LS 1 $ 163,100.00 $ 163,100.00 A2 Traffic Control, Residential Streets Day 280 $ 524.25 $ 146,790.00 A3 Traffic Control,Arterial Streets Day 90 $ 640.75 $ 57,667.50 A4 Mobilization for 24-HR Notice (See General Notes) EA 50 $ 1,165.00 $ 58.250.00 A5 Traffic Control 24-HR Notice (See General Notes) EA 50 $ 3,145.50 $ 157,275.00 SUBTOTAL PART A-GENERAL(Al thru A5) $ 583,082.50 Part B-STREET IMPROVEMENTS(per SECTION 01 29 01 MEASUREMENT AND BASIS FOR PAYMENT) B1 Seal Coat, per single course SY 1,600 $ 3.47 $ 5,552.00 B2 Crack Seal,0-1" wide LF 1,000 $ 1.63 $ 1,630.00 Planing(Milling), 2" 63 SY 1,600 $ 6.62 $ 10,592.00 1,000 to 2,000 SY minimum per Delivery Order Planing (Milling), Additional 1" B4 SY 1,600 $ 5.83 $ 9,328.00 1000 to 2,000 SY minimum per Delivery Order B5 Ozone Days EA 5 $ 590.00 $ 2,950.00 Cement Stabilized Base with 4%Cement, existing B6 SY 700 $ 10.58 $ 7,406.00 limestone base, 3-6",complete in place per SY B6A Unanticipated Street Improvement Continengency LS 1 $20,000 $ 20,000.00 Range 1 to 100 SY - Localized Flexible Pavement Structure Repairs with saw cutting existing roadway, subgrade, base and surface treatment/repair using asphalt concrete (hot/cold mix). All work will be within 1/2-Mile Square Area. 07 Subgrade Repair up to 4-6" Depth (lime stabilization) I SY 100 $ 28.41 $ 2,841.00 B8 Base Repair, Upper 2" Depth (Limestone) SY 2,200 $ 10.48 $ 23,056.00 B9 Base Repair, Additional 1" Depth (Limestone) SY 10,000 $ 6.80 $ 68,000.00 B9A Base Repair- Utility Cuts- (See General Notes) SY/FT 2,750 $ 30.70 $ 84,425.00 B10 Surface Treatment Repair Upper 2" HMAC SY 14,750 $ 18.24 $ 269,040.00 B11 Surface Treatment Repair Additional 1" Depth HMAC SY 12,000 $ 10.22 $ 122,640.00 Range 100 to 250 SY- Localized Flexible Pavement Structure Repairs with saw cutting existing roadway. subgrade, base and surface treatment/repair using asphalt concrete (hot/cold mix). All work will be within 1-Mile Square Area. B12 Subgrade Repair up to 4-6" Depth (lime stabilization) SY 100 $ 29.56 $ 2,956.00 B13 Base Repair, Upper 2" Depth (Limestone) SY 2,400 $ 11.96 $ 28,704.00 B14 Base Repair, Additional 1" Depth (Limestone) SY 7,000 $ 7.75 $ 54,250.00 Bid Form Exhibit A Page 1 of 8 ID/IQ Minor Street Pavement Improvements Project#E14034 REV 10-14-2014 00 30 01 BID FORM EXHIBIT A Item DESCRIPTION UNIT I ESTIMATED UNIT PRICE EXTENDED QUANTITY AMOUNT B15 Surface Treatment Repair Upper 2" HMAC SY I 6,000 $ 19.71 $ 118,260.00 B16 Surface Treatment Repair Additional 1" Depth HMAC SY 6,000 $ 11.25 $ 67,500.00 Range 250 to 1000 SY- Localized Flexible Pavement Structure Repairs with saw cutting existing roadway; subgrade base and surface treatment/repair using asphalt concrete(hot/cold mix). All work will be within 3-Mile Square Area. B17 Subgrade Repair up to 4-6" Depth (lime stabilization) SY 100 $ 29.56 _ $ 2,956.00 B18 Base Repair, Upper 2" Depth (Limestone) SY 6,000 $ 12.06 $ 72,360.00 819 Base Repair,Additional 1" Depth (Limestone) SY 6,000 $ 7.48 $ 44,880.00 B20 Surface Treatment Repair Upper 2" HMAC SY 6,000 $ 19.71 $ 118,260.00 B21 Surface Treatment Repair Additional 1" Depth HMAC SY 6,000 $ 11.25 $ 67,500.00 SUBTOTAL PART B-STREET IMPROVEMENTS(81 thru 1321) $ 1,205,086.00 ran t,-K i A IMYKUVtMtN I S(per JCL I IUIN U i LB UI IVItAJUKCIVItIN I HIND bAJIJ t-UK VA i IVItN I)-INA Cl I NN I ( I $ - SUBTOTAL PART C-RTA IMPROVEMENTS(Item Cl) $ - Pari u•HUH IMYKUVtIVItN I J(per Jti,I JUIN U I Ly U I rvitAJUKtiVItIN I ANL)bAJIJ i-UK Ye-kir IVItIN I) New ADA Curb Ramp: Concrete Curb Ramps, meeting TDLR D1 SF 300 $ 17.50 $ 5,250.00 requirements, complete in place Remove and Replace ADA curb ramp: Removal and D2 SF 300 $ 20.65 $ 6,195.00 Replacement of ADA ramps not in compliance with TDLR SUBTOTAL PART D-ADA IMPROVEMENTS(Dl THRU D2) $ 6,195.00 , , fly ((r 4'-f S.oo van t-UKAINAUt IMYKUVtJVItN I J(peer Jtl I UN U I LJ U I IvItAJUKtivitN I ANU bAJIJ t-UK YATIVItIN I) Removal and Replacement of Curb &Gutter, complete in El LF 3,000 $ 16.79 $ 50,370.00 place Removal and Replacement of driveway approaches, E2 SF 1,000 $ 6.88 $ 6,880.00 complete and in place. Storm Water Manhole Ring&Cover Adjustment, with new Manhole Ring and Cover Assembly with New Concrete E3 Each 10 $ 855.50 $ 8,555.00 Height Adjustment Rings and with Concrete Collar, complete in place. I SUBTOTAL PART E-DRAINAGE IMPROVEMENTS(El THRU E3) $ 65,805.00 1 Part F-WAI LK IMRUVEMLN IS (per SLI.I IUN U1 L i U1 MLASUKLMLN I ANU BASIS FUK PAYIVILN I) Water Valve Adjustment with Concrete Collar, complete in Fl place Each 10 $ 643.10 $ 6,431.00 SUBTOTAL PART F-WATER IMPROVEMENTS(Fl) $ 6,431.00 Bid Form Exhibit A Page 2 of 8 ID/IQ Minor Street Pavement Improvements Project 4E14034 REV 10-14-2014 00 30 01 BID FORM EXHIBIT A Item DESCRIPTION UNIT ( ESTIMATED UNIT PRICE I EXTENDED QUANTITY I I AMOUNT Fart b-WAS IEWA I ER IMRUVEIVIENTS per SEL I IUN U1 LJ U.I. MtASUKtMEN I ANU BASIS I-UK I'AYMENI) Sanitary Sewer Manhole Ring & Cover Adjustment, including New Manhole Ring& Cover Assembly with new G1 HDPE Height Adjustment Rings, Stainless Steel Inflow Each 10 $ 855.50 $ 8,555.00 Inhibitor and with Concrete Collar,complete in place. SUBTOTAL PART G-WASTEWATER IMPROVEMENTS(G1) i $ 8,555.00 Bid Summary on next page Bid Form Exhibit A Page 3 of 8 ID/IQ Minor Street Pavement Improvements Project#E14034 REV 10-14-2014 00 30 01 BID FORM EXHIBIT A Item I DESCRIPTION UNIT ESTIMATED EXTENDED E UNIT PRICE I QUANTITY AMOUNI BID SUMMARY SUBTOTAL PART A-GENERAL(Items Al thru AS) $ 583,082.50 SUBTOTAL PART B-STREET IMPROVEMENTS(Items B1 thru B21) $ 1,205,086.00 SUBTOTAL PART C- RTA IMPROVEMENTS - NA $ X95-@g- SUBTOTAL PART D-ADA IMPROVEMENTS (Items D1 thru D2) $ ( itq - ob uS7�9&ee SUBTOTAL PART E- DRAINAGE IMPROVEMENTS (Items El thru E3) $ / 65,805.00 SUBTOTAL PART F-WATER IMPROVEMENTS (Items Fl) $ 6,431,00 SUBTOTAL PART G -WASTEWATER IMPROVEMENTS(Items G1) $ 8,555.00 `TOTAL PROJECT BASE BID (PARTS A THRU G) I $ I)B�ayON 50 1,881,348.50 Contract Times Bidder agrees to reach Final Completion in 365 days Its b 2 u C 14-i i ,,S — rt-n4 6fici 0/4-t Bid Form Exhibit A Page 4 of 8 ID/IQ Minor Street Pavement Improvements Project#E14034 REV 10-14-2014 00 30 02 COMPLIANCE TO STATE LAW ON NONRESIDENT BIDDERS Chapter 2252 of the Texas Government Code applies to the award of government contract to nonresident bidders. This law provides that: "a government entity may not award a governmental contract to a nonresident bidder unless the nonresident underbids the lower bid submitted by a responsible resident bidder by an amount that is not less than the amount by which a resident bidder would be required to underbid the nonresident bidder to obtain a comparable contract in the state in which the nonresident's principal place of business is located." "Nonresident bidder"refers to a person who is not a resident of Texas. "Resident bidder"refers to a person whose principal place of business is in this state,including a contractor whose ultimate parent company or majority owner has its principal place of business in this state. Check the statement that is correct for Bidder. 0 Bidder qualifies as a nonresident bidder whose principal place of business or residency is in the State of El' Bidder(includes parent company or majority owner)qualifies as a resident bidder whose principal place of business is in the State of Texas. The Owner will use the information provided in the State of Texas Comptroller's annual publication of other states'laws on contracts to evaluate the Bids of nonresident Bidders. Bidder: Company Name: (typed or printed) By: (signature—attach evidence of authority to sign) Name: (typed or printed) Title: Business address: Phone: Email: END OF SECTION Compliance to State Law on Nonresident Bidders 00 30 02-1 ID/IQ Minor Street Pavement Improvements Project#E14034 11-25-2013 00 30 04 CONFLICT OF INTEREST QUESTIONNAIRE CONFLICT OF INTEREST QUESTIONNAIRE FORM CIQ For vendor or other person doing business with local governmental entity This questionnaire reflects changes made to the law by H.B. 1491, 80th Leg., Regular Session. OFFICE USE ONLY This questionnaire is being filed in accordance with Chapter 176,Local Government Code Date Received by a person who has a business relationship as defined by Section 176.001(1-a)with a local governmental entity and the person meets requirements under Section 176.006(a). By law this questionnaire must be filed with the records administrator of the local governmental entity not later than the 7th business day after the date the person becomes aware of facts that require the statement to be filed. See Section 176.006,Local Government Code. A person commits an offense if the person knowingly violates Section 176.006, Local Government Code.An offense under this section is a Class C misdemeanor. ,J Name of person who has a business relationship with local governmental entity. N/A ElCheck this box if you are filing an update to a previously flied questionnaire. (The law requires that you file an updated completed questionnaire with the appropriate filing authority not later than the 7th business day after the date the originally filed questionnaire becomes incomplete or inaccurate.) 3 Name of local government officer with whom filer has employment or business relationship. N/A Name of Officer This section (item 3 including subparts A, B, C & D) must be completed for each officer with whom the filer has an employment or other business relationship as defined by Section 176.001(1-a), Local Government Code. Attach additional pages to this Form CIQ as necessary. A. Is the local government officer named in this section receiving or likely to receive taxable income, other than investment income, from the filer of the questionnaire? nYes F-7NoN/A B. Is the filer of the questionnaire receiving or likely to receive taxable income,other than investment income, from or at the direction of the local government officer named in this section AND the taxable income is not received from the local governmental entity? I-1YesnNo N/A C. Is the filer of this questionnaire employed by a corporation or other business entity with respect to which the local government officer serves as an officer or director, or holds an ownership of 10 percent or more? n Yes 1-7NoN/A D. Describe each employment or business relationship with the local government officer named in this section. Signature of person doing business with the governmental entity Date Adopted 06/29/2007 00 30 05 City of Corpus Christi Disclosure of Interest SUPPLIER NUMBER TO BE ASSIGNED BY CI ri PURCHASING DIVISION City of CITY OF CORPUS CHRISTI corpus DISCLOSURE OF INTEREST Chnsti City of Corpus Christi Ordinance 17112,as amended,requires all persons or firms seeking to do business with the City to provide the following information. Every question must be answered. If the question is not applicable, answer with "NA". See reverse side for Filing Requirements, Certifications and definitions. COMPANY NAME: Grace Paving And Construction, Inc. P.O.BOX: STREET ADDRESS: 4237 Baldwin Blvd. CITY: Corpus Christi ZIp:78405 3324 FIRM IS: 1. Corporation 2. Partnership ❑ 3. Sole Owner ❑ 4. Association S. Other DISCLOSURE QUESTIONS If additional space is necessary,please use the reverse side of this page or attach separate sheet. 1. State the names of each `employee" of the City of Corpus Christi having an "ownership interest" constituting 3%or more of the ownership in the above named"firm." NameN/A Job Title and City Department(if known) 2. State the names of each "official" of the City of Corpus Christi having an "ownership interest" constituting 3%or more of the ownership in the above named"firm." Name N/A Title 3. State the names of each"board member"of the City of Corpus Christi having an"ownership interest" constituting 3%or more of the ownership in the above named"firm." Name N/A Board,Commission or Committee 4. State the names of each employee or officer of a "consultant" for the City of Corpus Christi who worked on any matter related to the subject of this contract and has an `ownership interest" constituting 3%or more of the ownership in the above named"firm." NameN/A Consultant FILING REQUIREMENTS If a person who requests official action on a matter knows that the requested action will confer an economic benefit on any City official or employee that is distinguishable from the effect that the action will have on members of the public in general or a substantial segment thereof,you shall disclose that fact in a signed writing to the City official,employee or body that has been requested to act in the matter, unless the interest of the City official or employee in the matter is apparent. The disclosure shall also be made in a signed writing filed with the City Secretary. [Ethics Ordinance Section 2-349(d)] CERTIFICATION I certify that all information provided is true and correct as of the date of this statement,that I have not knowingly withheld disclosure of any information requested; and that supplemental statements will be promptly submitted to the City of Corpus Christi,Texas as changes occur. Certifying Person: Eddie M. Ortiz Title: President (Type or Print) Signature of Certifying (MA: Date: - f �c /2p 16— Person: l•�/ y DEFINITIONS a. "Board member." A member of any board, commission, or committee appointed by the City Council of the City of Corpus Christi,Texas. b. "Economic benefit". An action that is likely to affect an economic interest if it is likely to have an effect on that interest that is distinguishable from its effect on members of the public in general or a substantial segment thereof. c. "Employee." Any person employed by the City of Corpus Christi, Texas either on a full or part- time basis,but not as an independent contractor. d. "Firm." Any entity operated for economic gain,whether professional, industrial or commercial,and whether established to produce or deal with a product or service,including but not limited to,entities operated in the form of sole proprietorship, as self-employed person, partnership, corporation,joint stock company,joint venture, receivership or trust, and entities which for purposes of taxation are treated as non-profit organizations. e. "Official." The Mayor, members of the City Council, City Manager, Deputy City Manager, Assistant City Managers, Department and Division Heads,and Municipal Court Judges of the City of Corpus Christi,Texas. 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 terms of venture or partnership agreements." g. "Consultant."Any person or firm., such as engineers and architects, hired by the City of Corpus Christi for the purpose of professional consultation and recommendation. 00 30 06 NON-COLLUSION CERTIFICATION STATE OF TEXAS COUNTY OF NUECES OWNER: City of Corpus Christi,Texas 1201 Leopard Street Corpus Christi,Texas 78401 CONTRACT: ID/IQ MINOR STREET PAVEMENT IMPROVEMENTS Project N E14034 Bidder certifies that the it has not been a party to any collusion among Bidders in the restraint of freedom of competition by agreement to submit a Bid at a fixed price or to refrain from bidding;or with any official or employee of the Owner as to quantity,quality,or price in the prospective contract,or any other terms of said prospective contract;or in any discussion between Bidders and any official of the Owner concerning exchange of money or other thing of value for special consideration in the letting of a contract. Company Name: Grace Paving And Construction, Inc. (typed or printed) By: ` (/& nature—attach evidence of authority to sign) Name: Eddie M. Ortiz (typed or printed) Title: President Business address: 4237 Baldwin Blvd. Corpus Christi, Texas 78405-3324 Phone: 361-883-3232 Email: gracepaving@aol.com END OF SECTION Non-Collusion Certification 00 30 06-1 ID/IQ Minor Street Pavement Improvements Project#E14034 11-25-2013 00 61 13 PERFORMANCE BOND BOND NO. 1962860 Contractor as Principal Surety Name: Grace Paving and Construction, Inc. Name: THE HANOVER INSURANCE COMPANY Mailing address(principal place of business): Mailing address(principal place of business): 4237 Baldwin Blvd. 10375 RICHMOND AVENUE, SUITE 1050 Corpus Christi,TX 78405-3324 HOUSTON, TEXAS 77042 Physical address(principal place of business): Owner SAME Name: City of Corpus Christi,Texas Mailing address(principal place of business): Capital Programs Surety is a corporation organized and existing 1201 Leopard Street under the laws of the state of: NEW HAMPSHIRE Corpus Christi,Texas 78401 By submitting this Bond, Surety affirms its authority to do business in the State of Texas and Contract its license to execute bonds in the State of Texas. Project name and number: Telephone (main number): #E14034 ID/IQ Minor Street Pavement 713-243-7072 Improvements Telephone (for notice of claim): SEE ATTACHED Local Agent for Surety Name: SWANTNER & GORDON INS AGENCY Award Date of the Contract: April 28,2015 Address UITE 1200 500 N. SHORELINE BLVD. Contract Price: $1,880,404.50 CORPUS CHRISTI, TEXAS 78401 Telephone: 361-883-1711 Bond Email Address: mmoore@s—gins.com Date of Bond: MAY 1, 2015 The address of the surety company to which any notice of claim should be sent may be obtained (Date of Bond cannot be earlier than Award Date from the Texas Dept. of Insurance by calling the of the Contract) following toll-free number:1-800-252-3439 Performance Bond 00 61 13-1 #E14034 ID/IQ Minor Street Pavement Impr. 7-8-2014 Surety and Contractor,intending to be legally bound and obligated to Owner do each cause this Performance Bond to be duly executed on its behalf by its authorized officer, agent or representative. The Principal and Surety bind themselves,and their heirs,administrators, executors,successors and assigns,jointly and severally to this bond. The condition of this obligation is such that if the Contractor as Principal faithfully performs the Work required by the Contract then this obligation shall be null and void;otherwise the obligation is to remain in full force and effect. Provisions of the bond shall be pursuant to the terms and provisions of Chapter 2253 and Chapter 2269 of the Texas Government Code as amended and all liabilities on this bond shall be determined in accordance with the provisions of said Chapter to the same extent as if it were copied at length herein. Venue shall lie exclusively in Nueces County, Texas for any legal action. Contractor as PrifCCv ipal Surety //��ii�� Signature: ► 66Signature: ,,..-....,/„.1„:11e, <_ x1�n d,pez4 , Name: C�lE /2 7'f,z,, Name: MAREN MOORE Title: VAS[ -f- Title: pTTC1RNRY TN FACT Email Address: `� �, & , earl Email Address: mmoore@s—gins.com U Q (Attach Power of Attorney and place surety seal below) END OF SECTION Performance Bond 00 61 13-2 #E14034 ID/IQ Minor Street Pavement Impr. 7-8-2014 00 61 16 PAYMENT BOND BOND NO. 1962860 Contractor as Principal Surety Name: Grace Paving and Construction,Inc. Name: THE HANOVER INSURANCE COMPANY Mailing address(principal place of business): Mailing address(principal place of business): 4237 Baldwin Blvd. 10375 RICHMOND AVENUE, SUITE 1050 Corpus Christi,TX 78405-3324 HOUSTON, TEXAS 77042 Physical address(principal place of business): Owner SAME Name: City of Corpus Christi,Texas Mailing address(principal place of business): Capital Programs Surety is a corporation organized and existing 1201 Leopard Street under the laws of the state of: NEW HAMPSHIRE Corpus Christi,Texas 78401 By submitting this Bond, Surety affirms its authority to do business in the State of Texas and Contract its license to execute bonds in the State of Texas. Project name and number: Telephone (main number): #E14034 ID/IQ Minor Street Pavement Improvements 713-243-7072 Telephone (for notice of claim): SEE ATTACHED Local Agent for Surety Name: SWANTNER & GORDON INS AGENCY Award Date of the Contract: April 28, 2015 AddressSUITE 1200 500 N. SHORELINE BLVD. Contract Price: $1,880,404.50 CORPUS CHRISTI, TEXAS 78401 Telephone: 361-883-1711 Bond Email Address: mmoore@s—gins.com Date of Bond: MAY 1 , 2015 The address of the surety company to which any (Date of Bond cannot be earlier than Award Date notice of claim should be sent maybe obtained of Contract) from the Texas Dept. of Insurance by calling the following toll-free number:1-800-252-3439 Payment Bond Form 00 61 16-1 #E14034 ID/IQ Minor Street Pavement Impr. 7-8-2014 Surety and Contractor, intending to be legally bound and obligated to Owner do each cause this Payment Bond to be duly executed on its behalf by its authorized officer, agent or representative. The Principal and Surety bind themselves, and their heirs, administrators, executors,successors and assigns,jointly and severally to this bond. The condition of this obligation is such that if the Contractor as Principal pays all claimants providing labor or materials to him or to a Subcontractor in the prosecution of the Work required by the Contract then this obligation shall be null and void;otherwise the obligation is to remain in full force and effect. Provisions of the bond shall be pursuant to the terms and provisions of Chapter 2253 and Chapter 2269 of the Texas Government Code as amended and all liabilities on this bond shall be determined in accordance with the provisions of said Chapter to the same extent as if it were copied at length herein. Venue shall lie exclusively in Nueces County, Texas for any legal action. Contractor as Pri pal Surety Signature: &I;1 Signature: _ Name: 6d4/6 44- 7/Z Name: MA / F.T.T,FN MnnPF Title: �L_QA�� Title: ATTORNEY IN FACT Email Address: G _J,LCQ pa 1'z' 0 eiot,i"nt Email Address: mmoore@s-gi ns-rom 0 / U (Attach Power of Attorney and place surety seal below) END OF SECTION Payment Bond Form 00 61 16-2 #E14034 ID/IQ Minor Street Pavement Impr. 7-8-2014 " THE HANOVER INSURANCE COMPANY MASSACHUSETTS BAY INSURANCE COMPANY CITIZENS INSURANCE COMPANY OF AMERICA POWERS OF ATTORNEY CERTIFIED COPY KNOW ALL MEN BY THESE PRESENTS: That THE HANOVER INSURANCE COMPANY and MASSACHUSETTS BAY INSURANCE COMPANY,both being corporations organized and existing under the laws of the State of New Hampshire,and CITIZENS INSURANCE COMPANY OF AMERICA,a corporation organized and existing under the laws of the State of Michigan,do hereby constitute and appoint Steve Addkison,Tami J.Duncan,Mary Ellen Moore,Cathleen Hayles,Aaron J.Endris and/or Kerry McIntosh of Swanter&Gordon Insurance Agency,LLC.Of Corpus Christi,TX and each is a true and lawful Attomey(s)-in-fact to sign,execute,seal,knowledge and deliver for,and on its behalf,and as its act and deed any place within the United States,or,if the following line be filled in,only within the area therein designated any and all bonds,recognizances,undertakings,contracts of indemnity or other writings obligatory in the nature thereof,as follows: Any such obligations in the United States,not to exceed Ten Million and No/100($10,000,000)in any single instance and said companies hereby ratify and confirm all and whatsoever said Attomey(s)-in-fact may lawfully do in the premises by virtue of these presents. These appointments are made under and by authority of the following Resolution passed by the Board of Directors of said Companies which resolutions are still in effect "RESOLVED,That the President or any Vice President,in conjunction with any Vice President,be and they are hereby authorized and empowered to appoint Attorneys-in-fact of the Company,in its name and as its acts,to execute and acknowledge for and on its behalf as Surety any and all bonds,recognizances, contracts of indemnity,waivers of citation and all other writings obligatory in the nature thereof,with power to attach thereto the seal of the Company.Any such writings so executed by such Attorneys-in-fact shall be as binding upon the Company as if they had been duly executed and acknowledged by the regularly elected officers of the Company in their own proper persons."(Adopted October 7, 1981 -The Hanover Insurance Company;Adopted April 14,1982- Massachusetts Bay Insurance Company;Adopted September 7,2001-Citizens Insurance Company of America) IN WITNESS WHEREOF,THE HANOVER INSURANCE COMPANY, MASSACHUSETTS BAY INSURANCE COMPANY and CITIZENS INSURANCE COMPANY OF AMERICA have caused these presents to be sealed with their respective corporate seals,duly attested by two Vice Presidents, this 26th day of March 2015. THE HANOVER INSURANCE COMPANY °s*::"'N**4)\ 14—....7MASSACHUSETTS BAY INSURANCE COMPANY ,'f :) CITIZENS URANCE OMPRNY dF AMERICA15FJ >ts4tx � ' i pzs Robert Thomas,Vice President THE COMMONWEALTH OF MASSACHUSETTS ) ( ._,_""—^"" COUNTY OF WORCESTER )ss. JoeBrenstrom,Vice President On this 26th day of March 2015 before me came the above named Vice Presidents of The Hanover Insurance Company,Massachusetts Bay Insurance Company and Citizens Insurance Company of America,to me personally known to be the individuals and officers described herein,and acknowledged that the seals affixed to the preceding instrument are the corporate seals of The Hanover Insurance Company,Massachusetts Bay Insurance Company and Citizens Insurance Company of America,respectively,and that the said corporate seals and their signatures as officers were duly affixed and subscribed to said instrument by the authority and direction of said Corporations. KATHLEEN M. SIRARD ) � A. .C.1 Notary Pubtic //// r i�i Commonwealth of Massachusetts - (J n -4.ett'. , My Commission Expires K•., leen M.Sicard Notary P'u tic September 4, 2020 My ommission Expires September 04,2020 I,the undersigned Vice President of The Hanover Insurance Company,Massachusetts Bay Insurance Company and Citizens Insurance Company of America, hereby certify that the above and foregoing is a full,true and correct copy of the Original Power of Attorney issued by said Companies,and do hereby further certify that the said Powers of Attorney are still in force and effect. This Certificate may be signed by facsimile under and by authority of the following resolution of the Board of Directors of The Hanover Insurance Company, Massachusetts Bay Insurance Company and Citizens Insurance Company of America. "RESOLVED.That any and all Powers of Attorney and Certified Copies of such Powers of Attorney and certification in respect thereto,granted and executed by the President or any Vice President in conjunction with any Vice President of the Company,shall be binding on the Company to the same extent as if all signatures therein were manually affixed,even though one or more of any such signatures thereon may be facsimile." (Adopted October 7,1981-The Hanover Insurance Company;Adopted April 14,1982-Massachusetts Bay Insurance Company;AdoptedSeptember 7,2001-Citizens Insurance Company of America) GIVEN under my hand and the seals of said Companies,at Worcester,Massachusetts,thisjST day of MAY 213 .5_. THE HANOVER INSURANCE COMPANY MA S. HUSETT 1 IBAY I � - CE COMPANY CIT'EN I SU- i'CE ••' OF AMERICA J. I -e,Vice =s,-nth 4HAnover Insurance Group® IMPORTANT NOTICE AVISO IMPORTANTE To obtain information or make a Para obtener informacion o para someter complaint: una queja: You may call Hanover Insurance Usted puede Ilamar aI numbero de Company's toll-free telephone number telefono gratis de Hanover Insurance for information or to make a complaint at: Company para informacion or para someter una queja al: 1-800-608-8141 1-800-608-8141 You may also write: Hanover Insurance Company Usted tambien puede escribir: Premier Place Hanover Insurance Company Suite 850 Premier Place 5910 North Central Expressway Suite 850 Dallas,Texas 75206 5910 North Central Expressway Dallas,Texas 75206 You may contact the Texas Department of Insurance to obtain information on companies, coverages, rights or Puede communicarse con el complaints at Departamento de Seguros de Texas para obtener informacion acerca de 1-800-252-3439 companias, coberturas, derechos o quejas aI You may write the Texas Department of Insurance at: 1-800-252-3439 P.O. Box 149104 Austin,TX 78714-9104 Puede escribir al Departamento de FAX#(512)475-1771 Seguros de Texas Web: http://www.tdi.state.tx.us P.O. Box 149104 Email: Austin,Texas 78714-9104 ConsumerProtection @tdi.state.tx.us FAX# (512) 475-1771 Web: http://www.tdi.state.tx.us PREMIUM OR CLAIM DISPUTES: Email: Should you have a dispute concerning ConsumerProtection@tdi.state.tx.us your premium or about a claim you DISPUTAS SOBRE PRIMAS 0 should contact the agent or the company first. If the dispute is not resolved, you RECLAMOS: Si tiene una disputa may contact the Texas Department of concern iente a su prima o a un reciamo, Insurance. debe comunicarse con el agente o la compania primero. Si no se resuelve la ATTACH THIS NOTICE TO YOUR disputa, puede entonces comunicarse POLICY: This notice is for information con el departamento (TDI). only and does not become a part or condition of the attached document. UNA ESTE A VISO A SU POLIZA: Este aviso es solo para proposito de informacion y n se convierte en parte o condicion del documento adjunto. • 221-4828 (7-07) DATE ARD® CERTIFICATE OF LIABILITY INSURANCE 4/30/2015 DIYYYY) THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS 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 CONTNAME:ACT Renee Terrell Swantner&Gordon Insurance Agency PHONE361-883-1711Fxr 361-883-1711 FAX 361-844-0101 A Higginbotham Company ( )' (A/C.No): P.O. Box 870 AIDRESS:rterrell@s-gins.com Corpus Christi TX 78403-0870 INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:Valley Forge Insurance Company 20508 INSURED GRACE33 INSURER B:Continental Casualty Company 20443 Grace Paving&Construction, Inc. / INSURER C: 4237 Baldwin Blvd. V Corpus Christi TX 78405-3324 INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:385504896 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LIMITS LTR / INSD WVD POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY) A X COMMERCIAL GENERAL LIABILITY V C5084615983 7/12/2014 7/12/2015 EACH OCCURRENCE $1,000,000 DAMAGE TO CLAIMS-MADE X OCCUR ✓ PREMISES Ea occu ence) $100,000 MED EXP(Any one person) $5,000 PERSONAL&ADV INJURY $1,000,000 GE 'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 I/ _ POLICY X JE LOC PRODUCTS-COMP/OP AGG $2,000,000 OTHER: $ B AUTOMOBILE LIABILITY ✓ C5084615949 7/12/2014 7/12/2015 COMBINED SINGLE LIMIT (Ea accident) $1,000,000 X ANY AUTO -/ BODILY INJURY(Per person) $ AUTOWNED SCHEDULED v BODILY INJURY(Per accident) $ — NON-OWNED PROPERTY DAMAGE —$ HIRED AUTOS _ AUTOS (Per accident) $ / B X UMBRELLA LIAB X OCCUR " C5084615952 7/12/2014 7/12/2015/ EACH OCCURRENCE $5,000,000 V EXCESS LIAB CLAIMS-MADE J AGGREGATE $5,000,000 DED X RETENTION$10,000/ $ A WORKERS COMPENSATION J WC584615966 7/12/2014 7/12/2015 X PER STATUTE ERH AND EMPLOYERS'LIABILITY I ANY PROPRIETOR/PARTNER/EXECUTIVE YIN E.L.EACH ACCIDENT $1,000,000 OFFICER/MEMBER EXCLUDED? N N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $1,000,000 If If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space Is required) See attached Acord 101 Form for additional policy provisions and coverage information. See Attached... CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Corpus Christi Engineering ACCORDANCE WITH THE POLICY PROVISIONS. Contract Administrator P.O. Box 9277 AUTHORIZED R PRESENTATIVE Corpus Christi TX 78469-9277 ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: GRACE33 LOC#: AC R ADDITIONAL REMARKS SCHEDULE Page 1 of 1 AGENCY NAMED INSURED Swantner&Gordon Insurance Agency Grace Paving&Construction, Inc. 4237 Baldwin Blvd. POLICY NUMBER Corpus Christi TX 78405-3324 CARRIER NAIC CODE EFFECTIVE DATE: ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: CERTIFICATE OF LIABILITY INSURANCE General Liability policy includes a blanket automatic waiver of subrogation endorsement that provides this feature only when there is a written contract between the insured and certificate holder that requires it.(Contractors General Liability Extension Endorsement-Form G-18652-J 07/12). General Liability policy includes a blanket automatic additional insured endorsement that provides additional insured status to the certificate holder only when there is a written contract between the insured and certificate holder that requires such status.(Blanket Additional Insured- Owners,Lessees or Contractors-With Products-Completed Operations Coverage-Form G-140331-D 01/13). General Liability policy includes Primary&Non-Contributory on the Contractors General Liability Extension Endorsement-Form G-18652-J 07/12. Auto Liability policy includes a blanket automatic waiver of subrogation endorsement that provides this feature only when there is a written contract between the insured and certificate holder that requires it. (Contractors Extended BA Plus Coverage-Form CNA63359XX 04/12). Auto Liability policy includes a blanket automatic additional insured endorsement that provides additional insured status to the certificate holder only when there is a written contract between the insured and certificate holder that requires such status.(Designated Insured-Form CA 20 48 02/99). Workers'Compensation policy includes a blanket automatic waiver of subrogation endorsement that provides this feature only when there is a written contract between the insured and certificate holder that requires it. (Texas Waiver of Our Rights to Recover from Others Endorsement-Form WC 42 03 04 B 06/14). The Workers'Compensation policy includes an endorsement providing that 30 days notice of cancellation will be furnished to the certificate holder except 10 days notice of nonpayment of premium. (Texas Notice of Material Change Endorsement-Form WC 42 06 01 07/84). The General Liability policy includes an endorsement providing that 30 days notice of cancellation will be furnished to the certificate holder except 10 days notice of nonpayment of premium.(Texas Changes-Amended Cancellation provision or Coverage Change-Form CG 02 05 12/04). The Auto policy includes an endorsement providing that 30 days notice of cancellation will be furnished to the certificate holder except 10 days notice of nonpayment of premium. (Notice of Cancellation or Material Change Endorsement-Form CNA72315XX 02/13). RE:Project No. E14034 ID/IQ Minor Street Pavement Improvements; Complete Certificate Holder Name:City of Corpus Christi, its officers, officials,employees,volunteers and elected representatives ACORD 101 (2008/01) ©2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD CNA CNA63359XX(Ed 04/12) THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. \/CONTRACTORS EXTENDED COVERAGE ENDORSEMENT - BUSINESS AUTO PLUS - This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM I. LIABILITY COVERAGE name, with your permission, while performing duties related to the conduct of your business. A. Who Is An Insured "Policy," as used in this provision A. Who Is An The following is added to Section II, Paragraph Insured, includes those policies that were in force A.1.,Who Is An Insured: on the inception date of this Coverage Form but: 1. a. Any incorporated entity of which the 1. Which are no longer in force; or Named Insured owns a majority of the voting stock on the date of inception of 2. Whose limits have been exhausted. this Coverage Form; provided that, B. Bail Bonds and Loss of Earnings b. The insurance afforded by this provision Section II, Paragraphs A.2. (2) and A.2. (4) are A.1. does not apply to any such entity revised as follows: that is an "insured" under any other liability"policy"providing"auto"coverage. 1. In a.(2), the limit for the cost of bail bonds is 2. Any organization you newly acquire or form, changed from$2,000 to$5,000; and other than a limited liability company, 2. In a.(4), the limit for the loss of earnings is partnership or joint venture, and over which changed from$250 to$500 a day. you maintain majority ownership interest. C. Fellow Employee The insurance afforded by this provision A.2.: Section II, Paragraph B.5 does not apply. a. Is effective on the acquisition or formation Such coverage as is afforded by this provision C. date, and is afforded only until the end of is excess over any other collectible insurance. the policy period of this Coverage Form, or the next anniversary of its inception II. PHYSICAL DAMAGE COVERAGE date,whichever is earlier. A. Glass Breakage - Hitting A Bird Or Animal - b. Does not apply to: Falling Objects Or Missiles (1) "Bodily injury" or "property damage" The following is added to Section III, Paragraph caused by an "accident" that A.3.: occurred before you acquired or With respect to any covered "auto,"any deductible ryformed the organization; or shown in the Declarations will not apply to glass (2) Any such organization that is an breakage if such glass is repaired, in a manner "insured" under any other liability acceptable to us, rather than replaced. "policy"providing"auto"coverage. B. Transportation Expenses 3. Any person or organization that you are Section III, Paragraph A.4.a. is revised, with required by a written contract to name as an respect to transportation expense incurred by you, additional insured is an "insured"but only with to provide: = respect to their legal liability for acts or omissions of a person, who qualifies as an a. $60 per day, in lieu of$20; subject to 1111111 "insured" under Section II - Who Is An = Insured and for whom Liability Coverage is b. $1,800 maximum, in lieu of$600. afforded under this policy. If required by C. Loss of Use Expenses written contract, this insurance will be primary - and non-contributory to insurance on which Section III, Paragraph A.4.b. is revised, with the additional insured is a Named Insured. respect to loss of use expenses incurred by you, to provide: 4. An "employee" of yours is an "insured" while operating an "auto" hired or rented under a a. $1,000 maximum, in lieu of$600. contract or agreement in that "employee's" CNA63359XX Copyright,CNA Corporation,2000. Page 1 of 3 (Ed. 04/12) Includes copyrighted material of the Insurance Services Office used with its permission. CNA63359XX (Ed.04/12) D. Hired "Autos" d. A $100 per occurrence deductible applies to The following is added to Section III. Paragraph the coverage provided by this provision. A.: G. Diminution In Value 5. Hired "Autos" The following is added to Section III, Paragraph If Physical Damage coverage is provided under B.6.: this policy, and such coverage does not extend to Subject to the following, the "diminution in value" Hired Autos, then Physical Damage coverage is exclusion does not apply to: extended to: a. Any covered "auto" of the private a. Any covered "auto" you lease, hire, rent passenger type you lease, hire, rent or or borrow without a driver; and borrow, without a driver for a period of 30 b. Any covered "auto" hired or rented by days or less, while performing duties your"employee" without a driver, under a related to the conduct of your business; and contract in that individual "employee's" name, with your permission, while b. Any covered "auto" of the private performing duties related to the conduct passenger type hired or rented by your of your business. "employee"without a driver for a period of c. The most we will pay for any one 30 days or less, under a contract in that "accident" or "loss" is the actual cash individual "employee's" name, with your permission, while performing duties value, cost of repair, cost of replacement or $75,000, whichever is less, minus a related to the conduct of your business. $500 deductible for each covered auto. c. Such coverage as is provided by this No deductible applies to "loss" caused by provision is limited to a "diminution in fire or lightning. value" loss arising directly out of d. The physical damage coverage as is accidental damage and not as a result of provided by this provision is equal to the the failure to make repairs; faulty or physical damage coverage(s) provided on incompletemaintenanceor repairs; or the your owned "autos." installation off substandard rd parts. e. Such physical damage coverage for hired d. The most we will pay for "loss" to a covered of:auto" in any one accident is the "autos"will: lesser (1) Include loss of use, provided it is the consequence of an "accident" for (1) $5,000; or which the Named Insured is legally (2) 20% of the "auto's" actual cash value liable, and as a result of which a (ACV). monetary loss is sustained by the III. Drive Other Car Coverage—Executive Officers leasing or rental concern. (2) Such coverage as is provided by this The following is added to Sections II and III: provision will be subject to a limit of 1. Any "auto" you don't own, hire or borrow is a $750 per"accident." covered "auto" for Liability Coverage while being E. Airbag Coverage used by, and for Physical Damage Coverage while in the care, custody or control of, any of your The following is added to Section III, Paragraph "executive officers,"except: B.3.: a. An "auto" owned by that "executive officer" or The accidental discharge of an airbag shall not be a member of that person's household; or considered mechanical breakdown. b. An "auto" used by that "executive officer" F. Electronic Equipment while working in a business of selling, Section III, Paragraphs B.4.c and B.4.d. are servicing, repairing or parking "autos." deleted and replaced by the following: Such Liability and/or Physical Damage Coverage c. Physical Damage Coverage on a covered as is afforded by this provision. "auto" also applies to "loss" to any (1) Equal to the greatest of those coverages permanently installed electronic equipment afforded any covered"auto"; and including its antennas and other accessories. CNA63359XX Copyright,CNA Corporation,2000. Page 2 of 3 (Ed. 04/12) Includes copyrighted material of the Insurance Services Office used with its permission. CNA63359XX (Ed. 04/12) (2) Excess over any other collectible damage, against any person or organization for insurance. whom or which you are required by written 2. For purposes of this provision, "executive officer contract or agreement to obtain this waiver from means a person holding any of the officer us. positions created by your charter, constitution, by- This injury or damage must arise out of your laws or any other similar governing document, activities under a contract with that person or and, while a resident of the same household, organization. includes that person's spouse. You must agree to that requirement prior to an Such "executive officers" are "insureds" while "accident"or"loss." using a covered"auto"described in this provision. C. Concealment, Misrepresentation or Fraud IV. BUSINESS AUTO CONDITIONS The following is added to Section IV, Paragraph A. Duties In The Event Of Accident, Claim, Suit Or B.2.: Loss Your failure to disclose all hazards existing on the date The following is added to Section IV, Paragraph of inception of this Coverage Form shall not prejudice A.2.a.: you with respect to the coverage afforded provided (4) Your "employees" may know of an such failure or omission is not intentional. "accident" or "loss." This will not mean D. Other Insurance that you have such knowledge, unless such "accident" or "loss" is known to you The following is added to Section IV, Paragraph or if you are not an individual, to any of B.S.. your executive officers or partners or your Regardless of the provisions of Paragraphs 5.a. insurance manager. and 5.d. above, the coverage provided by this The following is added to Section IV, Paragraph policy shall be on a primary non-contributory A.2.b.: basis. This provision is applicable only when required by a written contract. That written (6) Your "employees" may know of contract must have been entered into prior to documents received concerning a claim "Accident"or"Loss." or"suit."This will not mean that you have E. Policy Period, Coverage Territory such knowledge, unless receipt of such documents is known to you or if you are Section IV, Paragraph B. 7.(5).(a). is revised to not an individual,to any of your executive provide: officers or partners or your insurance manager. a. 45 days of coverage in lieu of 30 days. B. Transfer Of Rights Of Recovery Against Others V. DEFINITIONS To Us Section V. Paragraph C. is deleted and replaced by $ the followin The following is added to Section IV, Paragraph g A.5. Transfer Of Rights Of Recovery Against "Bodily injury"means bodily injury,sickness or disease 8 Others To Us: sustained by a person, including mental anguish, We waive any right of recovery we may have, mental injury or death resulting from any of these. because of payments we make for injury or CNA63359XX Copyright,CNA Corporation,2000. Page 3 of 3 (Ed.04/12) Includes copyrighted material of the Insurance Services Office used with its permission. CNA POLICY NUMBER: COMMERCIAL AUTO CA 20 48 02 99 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. DESIGNATED INSURED This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM GARAGE COVERAGE FORM MOTOR CARRIER COVERAGE FORM TRUCKERS COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by this endorsement. This endorsement identifies person(s)or organization(s)who are "insureds" under the Who Is An Insured Provision of the Coverage Form.This endorsement does not alter coverage provided in the Coverage Form. This endorsement changes the policy effective on the inception date of the policy unless another date is indicated below. Endorsement Effective: Countersigned By: Named Insured: (Authorized Representative) SCHEDULE Name of Person(s)or Organization(s): SEE BLANK MANUSCRIPT O 0 l7 (If no entry appears above, information required to complete this endorsement will be shown in the Declarations as = applicable to the endorsement.) Each person or organization shown in the Schedule is an "insured" for Liability Coverage, but only to the extent that person or organization qualifies as an "insured" under the Who Is An Insured Provision contained in Section II of the Coverage Form. CA 20 48 02 99 Copyright, Insurance Services Office, Inc., 1998 Page 1 of 1 CNA G-18652-J (Ed.07/12) CONTRACTORS'GENERAL LIABILITY EXTENSION ENDORSEMENT It is understood and agreed that this endorsement amends the COMMERCIAL GENERAL LIABILITY COVERAGE PART as follows. The changes this endorsement makes do not apply with respect to any coverage that has been excluded or amended by another endorsement attached to this policy. SCHEDULE Coverage is summarized below. For particulars and limitations affecting each coverage, please refer to the corresponding policy provisions in the body of this endorsement. 1. Additional Insureds Seven additional insured extensions. 2. Bodily Injury—Expanded Definition 3. Broad Knowledge of Occurrence/Notice of Occurrence 4. Broad Named Insured 5. Broadened Liability Coverage For Damage To"Your Product"And"Your Work" Limit:$100,000. 6. Contractual Liability—Railroads Expanded definition of"insured contract." 7. Contractual Liability For Personal And Advertising Injury 8. Electronic Data Liability Loss of Electronic Data Limit: $100,000. 9. Expanded Personal And Advertising Injury-Discrimination Or Humiliation 10. Expected Or Intended Injury Reasonable force—"bodily injury"or"property damage." 11. General Aggregate Limits Of Insurance-Per Project 12. In Rem Actions 13. Incidental Health Care Malpractice Coverage 14. Joint Ventures/Partnership/Limited Liability Companies Coverage for your interest in such terminated or ended organizations. 15. Legal Liability/Alienated Premises/Borrowed Equipment Coverage Extended perils. Default limit increased to$500,000 for Damage to Premises Rented To You. $25,000 limit for"property damage"to borrowed tools or equipment at a jobsite. 16. Liberalization Clause 17. Liquor Liability Coverage Extension 18. Medical Payments Limits increased to$15,000. 8 Reporting increased to three years from the date of accident. 19. Non-owned Aircraft Coverage 20. Non-owned Watercraft Increased to 75 feet. 21. Primary And Non-Contributory To Other Insurance 22. Property Damage-Elevators 23. Supplementary Payments Cost of bail bonds increased to$5,000. Daily loss of earnings increased to$1,000. 24. Unintentional Failure To Disclose Hazards 25. Waiver of Subrogation-Blanket Waiver of subrogation where required by written contract or written agreement. 26. Wrap-Up Extension G-18652-J (Ed.07/12) Page 1 of 11 Copyright,CNA All Rights Reserved. G-18652-J (Ed. 07/12) 1. ADDITIONAL INSURED not apply to any "occurrence" which takes place after the equipment lease expires. SECTION II—WHO IS AN INSURED is amended to include as an insured any person or organization D. Lessor-Land (called additional insured)described in paragraphs A. An owner or other interest from whom land has through G. below whom you are required to add as an been leased by you but only with respect to additional insured on this policy under a written liability arising out of the ownership, maintenance contract or written agreement, provided the written or use of that specific part of the land leased to contract or written agreement: you and subject to the following additional i. Is currently in effect or becomes effective exclusions: during the term of this policy; and This insurance does not apply to: ii. Was executed prior to the "bodily injury," 1. Any "occurrence" which takes place after you "property damage" or "personal injury and cease to lease that land;or advertising injury" for which the additional insured seeks coverage. 2. Structural alterations, new construction or demolition operations performed by or on However, we will not provide the additional behalf of such additional insured. insured any broader coverage or any higher limit of insurance than the least that is: E. Lessor-Premises a. The maximum permitted by law; A manager or lessor of premises but only with respect to liability arising out of the ownership, b. Required in the written contract or written maintenance or use of that specific part of the agreement; premises leased to you and subject to the c. Afforded to you under this policy;or following additional exclusions: d. Described in the applicable paragraphs A. This insurance does not apply to: through G.below. 1. Any "occurrence" which takes place after you A. Controlling Interest cease to be a tenant in that premises; or Any persons or organizations with a controlling 2. Structural alterations, new construction or interest in you but only with respect to their liability demolition operations performed by or on arising out of: behalf of such additional insured. 1. Their financial control of you;or F. Mortgagee,Assignee or Receiver 2. Premises they own, maintain or control while A mortgagee, assignee or receiver but only with you lease or occupy these premises. respect to their liability as mortgagee,assignee,or receiver and arising out of the ownership, This insurance does not apply to structural maintenance,or use of a premises by you. alterations, new construction and demolition operations performed by or for such additional This insurance does not apply to structural insured. alterations, new construction or demolition operations performed by or for such additional B. Co-owner of Insured Premises insured. A co-owner of a premises co-owned by you and G. State or Governmental Agency or Subdivision covered under this insurance but only with respect or Political Subdivisions to the co-owner's liability as co-owner of such premises. A state or governmental agency or subdivision or political subdivision subject to the following C. Lessor-Equipment provisions: 1. Any person or organization from whom you 1. This insurance applies only with respect to the lease equipment, but only with respect to following hazards for which the state or liability for "bodily injury," "property damage" governmental agency or subdivision or or"personal and advertising injury"caused, in political subdivision has issued a permit or whole or in part, by your maintenance, authorization in connection with premises you operation or use of equipment leased to you own, rent, or control and to which this by such person or organization. insurance applies: 2. With respect to the insurance afforded to a. The existence, maintenance, repair, these additional insureds, this insurance does construction, erection, or removal of G-18652-J (Ed.07/12) Page 2 of 11 Copyright,CNA All Rights Reserved. G-18652-J • (Ed. 07/12) advertising signs, awnings, canopies, (3) An executive officer or the employee cellar entrances, coal holes, driveways, designated by you to give such notice, if you manholes, marquees, hoistaway are a corporation;or openings, sidewalk vaults, street banners, (4) A manager, if you are a limited liability or decorations and similar exposures; or company. b. The construction, erection, or removal of elevators; or B. NOTICE OF OCCURRENCE c. The ownership, maintenance or use of Your rights under this Coverage Part will not be any elevators covered by this insurance. prejudiced if you fail to give us notice of an "occurrence,"offense, claim or"suit"and that 2. This insurance applies only with respect to failure is solely due to your reasonable belief that operations performed by you or on your behalf the"bodily injury"or"property damage"is not for which the state or governmental agency or covered under this Coverage Part. However, you subdivision or political subdivision has issued shall give written notice of this"occurrence," a permit or authorization. offense, claim or"suit"to us as soon as you are aware that this insurance may apply to such 3. This insurance does not apply to: "occurrence,"offense claim or"suit." a. "Bodily injury," "property damage" or 4. BROAD NAMED INSURED "personal and advertising injury" arising out of operations performed for the A. Any subsidiary or affiliate organization, other than federal government, state or municipality; a partnership, joint venture or limited liability or company, in which a Named Insured specifically b. shown in the Declarations has management "Bodily injury" or "property damage" included within the "products-completed control, directly or through one or more subsidiary operations hazard." organizations, at the time of loss will qualify as a Named Insured but only if there is no other similar A governmental permit which requires you to add insurance available to such organization, nor the governmental entity as an additional insured similar insurance which would be available but for will trigger this Provision 1.as if the permit were a exhaustion of its limits. For the purpose of this written contract. provision, similar insurance means general liability 2. BODILY INJURY—EXPANDED DEFINITION or equivalent insurance, no matter whether its coverage is broader or narrower than that SECTION V—DEFINITIONS,the definition of"bodily provided by this insurance. But if the only other injury"is changed to read: similar insurance is for a "consolidated (wrap-up) program," then a subsidiary that qualifies as a "Bodily injury"means bodily injury, sickness or disease Named Insured on such project-specific insurance sustained by a person, including death, humiliation, can still qualify as a Named Insured on this shock, mental anguish or mental injury by that person insurance, but not for projects covered by the at any time which results as a consequence of the "consolidated (wrap-up)program." bodily injury,sickness or disease. [Please see Item 26.C.of this endorsement for the F4 3. BROAD KNOWLEDGE OF OCCURRENCE/ NOTICE definition of"consolidated (wrap-up)program."] OF OCCURRENCE B. This endorsement does not apply to any Condition 2. Duties in The Event of Occurrence, organization for which coverage is excluded by Offense, Claim or Suit of SECTION IV— another endorsement attached to this policy. COMMERCIAL GENERAL LIABILITY CONDITIONS is amended to add the following provisions: C. Only for the purpose of this endorsement: A. BROAD KNOWLEDGE OF OCCURRENCE 1. Management control means: You must give us or our authorized representative a. Ownership interest representing more notice of an "occurrence," offense, claim, or "suit" than 50% of the voting, appointment, or only when the "occurrence," offense, claim or designation power for the subsidiary "suit"is known to: organization's governing body;or (1) You, if you are an individual; b. Having the right, pursuant to a written contract, or pursuant to the by-laws, (2) A partner, if you are a partnership; charter, operating agreement, or similar document of a specifically shown Named Insured or controlled subsidiary G-18652-J (Ed.07/12) Page 3 of 11 Copyright,CNA All Rights Reserved. G-18652-J (Ed. 07/12) organization to select, appoint, or (a) Fire; designate a majority of the subsidiary (b) Smoke; organization's governing body. Such contract or document must have been (c) Collapse;or created prior to the time of loss;or (d) Explosion. c. Having the right, pursuant to a written trust agreement, to protect, control the B. The following paragraph is added to SECTION III use of, encumber or transfer and sell —LIMITS OF INSURANCE: property held by a trust. Subject to 5.above, $100,000 is the most we will 2. Governing body means the Board of Directors pay under Coverage A for the sum of damages of a corporation. arising out of any one"occurrence" because of "property damage"to"your product"and"your 3. Loss means: work"that is caused by fire, smoke, collapse or a. The occurring of the "bodily injury" or explosion and is included within the"product- "property damage"; or completed operations hazard." This sublimit does not apply to"property damage"to"your work" if b. The committing of the offense that caused the damaged work or the work out of which the the"personal and advertising injury." damage arises was performed on your behalf by a D. The insurance provided by this policy applies to subcontractor. Named Insureds when trading under their own C. This Provision 5. Broadened Liability Coverage names, or under such trading names or doing- For Damage To "Your Product" And "Your business-as (DBA) names as any should choose Work" does not apply if an endorsement of the to employ. same name is attached to this policy. 5. BROADENED LIABILITY COVERAGE FOR 6. CONTRACTUAL LIABILITY—RAILROADS DAMAGE TO "YOUR PRODUCT" AND "YOUR WORK" With respect to operations performed within 50 feet of railroad property,the definition of"insured contract"in A. Under SECTION I — COVERAGE A — BODILY SECTION V—DEFINITIONS is replaced by the INJURY AND PROPERTY DAMAGE LIABILITY, following: Paragraph 2. Exclusions is amended to delete "Insured Contract"means: exclusions k. and I. and replace them with the following: a. A contract for a lease of premises. However, that [This insurance does not apply to:] portion of the contract for a lease of premises that indemnifies any person or organization for k. Damage to Your Product damage by fire to premises while rented to you or "Property damage"to"your product"arising temporarily occupied by you with permission of out of it, or any part of it except when caused the owner is not an"insured contract"; by or resulting from: b. A sidetrack agreement; (1) Fire; c. Any easement or license agreement; (2) Smoke; d. An obligation, as required by ordinance, to (3) Collapse; or indemnify a municipality,except in connection with work for a municipality; (4) Explosion. e. An elevator maintenance agreement; I. Damage to Your Work f. That part of any other contract or agreement "Property damage"to"your work"arising out of it, pertaining to your business (including an or any part of it and included in the"products- indemnification of a municipality in connection with completed operations hazard." work performed for a municipality) under which you assume the tort liability of another party to pay This exclusion does not apply: for "bodily injury" or "property damage" to a third (1) If the damaged work or the work out of person or organization. Tort liability means a which the damage arises was performed liability that would be imposed by law in the on your behalf by a subcontractor;or absence of any contract or agreement. (2) If the cause of loss to the damaged work Paragraph f.does not include that part of any arises as a result of: contract or agreement: G-18652-J(Ed.07/12) Page 4 of 11 Copyright,CNA All Rights Reserved. G-18652-J (Ed. 07/12) (1) That indemnifies an architect, engineer or "Electronic data"means information,facts or surveyor for injury or damage arising out of: programs stored as or on, created or used on, or (a) Preparing, approving or failing to prepare transmitted to or from computer software or maps, shop drawings, (including systems and applications software), approve opinions, reports, surveys, field orders, hard or floppy disks,CD-ROMS, tapes,drives, oordersor drawings and cells,data processing devices or any other media changecanations;or which are used with electronically controlled equipment. (b) Giving directions or instructions, or failing D. For the purposes of the coverage provided by this to give them, if that is the primary cause endorsement, the definition of "property damage" of the injury or damage; in SECTION V- DEFINITIONS is replaced by the (2) Under which the insured, if an architect, following: engineer or surveyor, assumes liability for an 17. "Property damage"means: injury or damage arising out of the insured's rendering or failure to render professional a. Physical injury to tangible property, services, including those listed in (1) above including all resulting loss of use of that and supervisory, inspection, architectural or property. All such loss of use shall be engineering activities. deemed to occur at the time of the 7. CONTRACTUAL LIABILITY FOR PERSONAL AND physical injury that caused it; ADVERTISING INJURY b. Loss of use of tangible property that is not Under SECTION I-COVERAGE B-PERSONAL physically injured. All such loss of use shall be deemed to occur at the time of AND ADVERTISING INJURY LIABILITY, Paragraph 2. " t Exclusions is amended to delete exclusion e. the"occurrence"that caused it; or Contractual Liability. c. Loss of, loss of use of, damage to, This provision 7.does not apply to any person or corruption of, inability to access, or organization who otherwise qualifies as an additional data,"ty ethong fromly mphysicalhy "electronicnjryt insured on this Coverage Part. data," resulting injury to tangible property. All such loss of 8. ELECTRONIC DATA LIABILITY "electronic data" shall be deemed to occur at the time of the "occurrence" that A. Under SECTION I - COVERAGE A - BODILY caused it. INJURY AND PROPERTY DAMAGE, Paragraph 2. Exclusions is amended to delete exclusion p. For the purposes of this insurance,"electronic Electronic Data and replace it with the following: data"is not tangible property. [This insurance does not apply to:] E. If Electronic Data Liability is provided at a higher „,- limit by another endorsement attached to this p. Electronic Data policy, then the $100,000 limit provided by this Damages arising out of the loss of, loss of use of, Provision 8. Electronic Data Liability is part of, damage to, corruption of, inability to access, or and not in addition to,that higher limit. inability to manipulate "electronic data" that does g, EXPANDED PERSONAL AND ADVERTISING not result from physical injury to tangible property. INJURY-DISCRIMINATION OR HUMILIATION However,this exclusion does not apply to liability A. SECTION V - DEFINITIONS is amended to add for damages because of"bodily injury." the following to the definition of "Personal and B. The following paragraph is added to SECTION III advertising injury": -LIMITS OF INSURANCE: h. Discrimination or humiliation that results in Subject to 5.above, $100,000 is the most we will injury to the feelings or reputation of a natural pay under Coverage A for all damages arising out person, but only if such discrimination or of any one"occurrence" because of"property humiliation is: damage"that results from physical injury to (1) Not done intentionally by or at the tangible property and arises out of"electronic direction of: data." (a) The insured; or C. The following definition is added to the SECTION V-DEFINITIONS: (b) Any "executive officer," director, stockholder, partner, member or G-18652-J (Ed.07/12) Page 5 of 11 Copyright,CNA All Rights Reserved. G-18652-J (Ed. 07/12) manager (if you are a limited liability "property damage" included in the company)of the insured; and "products-completed operations hazard"; (2) Not directly or indirectly related to the and employment, prospective employment, 2. All medical expenses under Coverage C, past employment or termination of employment of any person or persons by that arise from "occurrences" or accidents any insured. which can be attributed solely to ongoing operations at that construction project. B. Under SECTION I— COVERAGE B —PERSONAL Such payments shall not reduce the AND ADVERTISING INJURY LIABILITY, General Aggregate Limit shown in the Paragraph 2. Exclusions is amended to add the Declarations, nor the Construction Project following additional exclusions: Aggregate Limit of any other construction [This insurance does not apply to:] project. Discrimination Relating To Room, Dwelling B. All: or Premises 1. Damages under Coverage B, regardless of "Personal or advertising injury"caused by the number of locations or construction discrimination directly or indirectly related to projects involved; the sale, rental, lease or sub-lease or 2. Damages under Coverage A, caused by prospective sale, rental, lease or sub-lease of "occurrences" which cannot be attributed any room, dwelling or premises by or at the solely to ongoing operations at a single direction of any insured. construction project, except damages Fines Or Penalties because of "bodily injury" or "property damage" included in the "products-completed Fines or penalties levied or imposed by a operations hazard";and governmental entity because of 3. Medical expenses under Coverage C caused discrimination. by accidents which cannot be attributed solely This provision 9.does not apply to any person or to ongoing operations at a single construction organization who otherwise qualifies as an project, additional insured on this Coverage Part. will reduce the General Aggregate Limit shown in 10. EXPECTED OR INTENDED INJURY the Declarations. Under SECTION I—COVERAGE A—BODILY C. The limits shown in the Declarations for Each INJURY AND PROPERTY DAMAGE LIABILITY, Occurrence, for Damage To Premises Rented To Paragraph 2. Exclusions is amended to delete You and for Medical Expense continue to apply, exclusion a. Expected or Intended Injury and but will be subject to either the Construction replace it with the following: Project Aggregate Limit or the General Aggregate Limit, depending on whether the "occurrence" can [This insurance does not apply to:] be attributed solely to ongoing operations at a a. Expected or Intended Injury particular construction project. "Bodily injury"or"property damage"expected D. When coverage for liability arising out of the or intended from the standpoint of the insured. "products-completed operations hazard" is This exclusion does not apply to"bodily provided, any payments for damages because of injury"or"property damage"resulting from the "bodily injury" or "property damage" included in use of reasonable force to protect persons or the "products-completed operations hazard," property. regardless of the number of locations involved will reduce the Products-Completed Operations 11. GENERAL AGGREGATE LIMITS OF Aggregate Limit shown in the Declarations. INSURANCE-PER PROJECT E. If a single construction project away from A. For each construction project away from premises owned by or rented to the insured has premises you own or rent, a separate been abandoned and then restarted, or if the Construction Project General Aggregate Limit, authorized contracting parties deviate from plans, equal to the amount of the General Aggregate blueprints, designs, specifications or timetables, Limit, is the most we will pay for the sum of: the project will still be deemed to be the same 1. All damages under Coverage A, except construction project. damages because of "bodily injury" or G-18652-J (Ed.07/12) Page 6 of 11 Copyright,CNA All Rights Reserved. G-18652-J (Ed. 07/12) F. The provisions of SECTION III — LIMITS OF C. SECTION V — DEFINITIONS is amended to add INSURANCE not otherwise modified by this the following new definition: endorsement shall continue to apply as stipulated. "Health care incident" means a negligent act, error 12. IN REM ACTIONS or omission by your "employees" or "volunteer workers" working on your behalf in the rendering Any action in rem against any vessel owned or of or failure to render professional health care operated by or for you, or chartered by or for you will beservices in any of the following capacities, or the treated in the same manner as though the action were in personam against you. related furnishing of food, beverages, medical supplies or appliances: In rem is a term used to designate actions instituted a. Physician; against the thing, as distinct from actions against the person,which are said to be in personam. b. Nurse; 13. INCIDENTAL HEALTH CARE MALPRACTICE c. Emergency medical technician; COVERAGE d. Paramedic; A. With respect only to "bodily injury" that arises out of a "health care incident," COVERAGE A — e. Chiropractor; BODILY INJURY AND PROPERTY DAMAGE f. Dentist; LIABILITY OF SECTION I — COVERAGES is amended to replace Insuring Agreement g. Athletic trainer; Paragraphs 1.b.(1)and 1.b.(2)with the following: h. Audiologist; b. This insurance applies to"bodily injury"only if i. Physical therapist; you are not in the business of providing professional health care services, and only if: j. Psychologist; (1) The "bodily injury" is caused by an k. Speech therapist; "occurrence" that takes place in the I. Other allied health professional; or "coverage territory." For the purpose of this insurance: m. Provider of first aid or Good Samaritan (a) "Bodily injury" caused by a "health services rendered in an emergency and for care incident" will be considered which no payment is demanded or received. caused by an"occurrence"; and D. SECTION I — COVERAGE A — BODILY INJURY (b) All acts, errors or omissions that are AND PROPERTY DAMAGE, Paragraph 2. logically connected by any common Exclusions is amended to add the following fact, circumstance, situation, additional exclusions.These new exclusions apply only to this Incidental Health Care Malpractice transaction, event, advice or decision Coverage: will be considered to constitute a single"occurrence"; [This insurance does not apply to:] (2) The "bodily injury" occurs during the Dishonesty or Crime policy period. All "bodily injury" arising Any dishonest, criminal or malicious act, error or from an "occurrence" will be deemed to have occurred at the time of the first act, omission. error, or omission that is part of the Clinical Trials/Product Testing "occurrence"; and Acts, errors or omissions that occur in the course B. With respect only to the insurance provided by this of human clinical trials or product testing. Provision 13., Exclusion 2.e. Employer's Liability of SECTION I — COVERAGE A — BODILY Medicare/Medicaid Fraud INJURY AND PROPERTY DAMAGE, is amended Medicare or Medicaid fraud or abuse. to append the following: Services Excluded by Endorsement Only for "bodily injury" not covered by other liability insurance (including state-sanctioned self Any "health care incident" for which coverage is insurance) available to the insured (or which excluded by endorsement. would be available but for exhaustion of its limits), E. SECTION V — DEFINITIONS is amended to add this exclusion does not apply to"bodily injury"that the following subparagraph to Paragraph f. of the arises out of a"health care incident." definition of"insured contract": G-18652-J (Ed. 07/12) Page 7 of 11 Copyright,CNA All Rights Reserved. G-18652-J (Ed.07/12) Paragraph f. does not include that part of any A. The following is added to SECTION II — WHO IS contract or agreement: AN INSURED: (4) Under which you assume another's tort 4. You are an insured when you had an interest liability for "bodily injury" arising out of the in a joint venture, partnership or limited rendering of or failure to render professional liability company which terminated or ended health care services. prior to or during this policy period, but only to F. SECTION II—WHO IS AN INSURED is amended the extent of your interest in such joint to add the following provisions: venture, partnership or limited liability company.This coverage does not apply: 1. Your "employees" are insureds with respect a. Prior to the termination date of any joint to: venture, partnership or limited liability a. "bodily injury"to a co-"employee" while in company; the course of the co-"employee's" b. If there is other valid and collectible employment by you or while performing insurance purchased specifically to insure duties related to the conduct of your the partnership, joint venture or limited business; and liability company; or b. "bodily injury" to a "volunteer worker" c. To a joint venture, partnership or limited while performing duties related to the liability company which is or was insured conduct of your business; under a "consolidated (wrap-up) when such"bodily injury"arises out of a insurance program." "health care incident." [Please see Item 26.C. of this endorsement 2. Your "volunteer workers" are insureds with for the definition of "consolidated (wrap-up) respect to: program."] a. "bodily injury" to a co-"volunteer worker" B. The last paragraph of SECTION II — WHO IS AN while performing duties related to the INSURED is deleted and replaced by the conduct of your business; and following: b. "bodily injury" to an "employee" while in Except as provided under the Contractors' the course of the "employee's" General Liability Extension Endorsement or by the employment by you or while performing attachment of another endorsement (if any), no duties related to the conduct of your person or organization is an insured with respect business; to the conduct of any current or past partnership, joint venture or limited liability company that is not when such "bodily injury" arises out of a shown as a Named Insured in the Declarations. "health care incident." 15. LEGAL LIABILITY/ALIENATED PREMISES/ 3. Paragraphs 2.a. (1)(a), (b) and (c) of BORROWED EQUIPMENT SECTION II — WHO IS AN INSURED do not apply to "bodily injury" for which insurance is A. Under SECTION I — COVERAGE A — BODILY provided this Provision 13. INJURY AND PROPERTY DAMAGE, Paragraph 2. Exclusions is amended to delete exclusion j. 4. Paragraph 2.a.(1)(d)of SECTION II—WHO IS Damage to Property in its entirety and replace it AN INSURED is deleted. with the following: G. With respect to the insurance provided by this [This insurance does not apply to:] Provision 13., the following is added to Paragraph 4.b.(1) of SECTION IV — COMMERCIAL j. Damage to Property GENERAL LIABILITY CONDITIONS: "Property damage"to: To the extent this insurance applies, it is excess (1) Property you own, rent,or occupy; over any of the other insurance (including qualified self insurance), whether primary, excess, (2) Premises you sell, give away or abandon, contingent or on any other basis, except for if the"property damage" arises out of any insurance purchased specifically by you to be part of those premises; excess of this policy. (3) Property loaned to you; 14. JOINT VENTURES / PARTNERSHIP / LIMITED (4) Personal property in the care, custody or LIABILITY COMPANIES control of the insured; G-18652-J (Ed. 07/12) Page 8 of 11 Copyright,CNA All Rights Reserved. G-18652-J (Ed. 07/12) (5) That particular part of real property on others that occurs while the equipment is being which you or any contractors or used to perform operations. subcontractors working directly or D. Paragraph 6. Damage To Premises Rented To indirectly on your behalf are performing You Limit of SECTION III — LIMITS OF operations, if the "property damage" arises out of those operations; or INSURANCE is replaced by the following: (6) That particular part of any property that 6. Subject to Paragraph 5. above, (the Each must be restored, repaired or replaced Occurrence Limit), the Damage To Premises because "your work" was incorrectly Rented To You Limit is the most we will pay performed on it. under SECTION — I — COVERAGE A for damages because of "property damage" to Paragraph (2)of this exclusion does not apply any one premises while rented to you or if the premises are"your work." temporarily occupied by you with the Paragraphs (3) and (4) of this exclusion do permission of the owner, including contents of such premises rented to you for a period of 7 not apply to "property damage" to tools or equipment loaned to you. A separate limit of or fewer consecutive days. The Damage To insurance applies to such tools or equipment Premises Rented To You Limit is the greater of: that are damaged while being used in your operations. a. $500,000; or Paragraphs (1), (3) and (4) of this exclusion b. The Damage To Premises Rented To do not apply to "property damage" (other than You Limit shown in the Declarations. damage by fire) to premises rented to you or E. Paragraph 4.b.(1)(a)(ii) of SECTION IV — temporarily occupied by you with the COMMERCIAL GENERAL LIABILITY permission of the owner, or to the contents of CONDITIONS is deleted and replaced by the premises rented to you for a period of 7 or following: fewer consecutive days. A separate limit of insurance applies to Damage To Premises (ii) That is property insurance for premises rented Rented To You as described in SECTION III— to you, for premises temporarily occupied by LIMITS OF INSURANCE. you with the permission of the owner; or for Paragraphs (3), (4), (5) and (6) of this personal property of others in your care, exclusion do not apply to liability assumed custody or control; under a sidetrack agreement. F. This Provision 15. does not apply if Damage To Paragraph (6) of this exclusion does not apply Premises Rented To You Liability under SECTION to "property damage" included in the —I—COVERAGE A is excluded by endorsement. "products-completed operations hazard." 16. LIBERALIZATION CLAUSE B. Under SECTION I — COVERAGE A — BODILY If we adopt a change in our forms or rules which would INJURY AND PROPERTY DAMAGE the last broaden coverage for contractors under this paragraph of Paragraph 2. Exclusions is deleted endorsement without an additional premium charge, and replaced by the following. your policy will automatically provide the additional Exclusions c. through n. do not apply to damage coverage as of the date the revision is effective in your by fire to premises while rented to you or state. temporarily occupied by you with permission of 17. LIQUOR LIABILITY the owner nor to the contents of premises rented to you for a period of 7 or fewer consecutive days. Under SECTION I—COVERAGE A—BODILY INJURY AND PROPERTY DAMAGE, Paragraph 2. A separate limit of insurance applies to this Exclusions is amended to delete exclusion c. Liquor coverage as described in SECTION III — LIMITS Liability. OF INSURANCE. This provision 17.does not apply to any person or C. The following paragraph is added to SECTION III organization who otherwise qualifies as an additional —LIMITS OF INSURANCE: insured on this Coverage Part. Subject to 5. above, $25,000 is the most we will 18. MEDICAL PAYMENTS pay under Coverage A for damages arising out of any one "occurrence" because of "property A. Paragraph 7. Medical Expense Limit, of SECTION damage" to tools or equipment loaned to you by III — LIMITS OF INSURANCE is deleted and replaced by the following: G-18652-J (Ed. 07/12) Page 9 of 11 Copyright,CNA All Rights Reserved. G-18652-J (Ed. 07/12) 7. Subject to Paragraph 5. above (the Each following is added to Paragraph 4.of SECTION IV— Occurrence Limit), the Medical Expense Limit COMMERCIAL GENERAL LIABILITY CONDITIONS: is the most we will pay under SECTION — I — COVERAGE C for all medical expenses If you have agreed in writing in a contract or because of "bodily injury" sustained by any agreement that this insurance is primary and non- one person. The Medical Expense Limit is the contributory relative to an additional insured's own greater of: insurance,then this insurance is primary and we will not seek contribution from that other insurance. For (1) $15,000;or the purpose of this Provision 21.,the additional (2) The amount shown in the Declarations for insured's own insurance means insurance on which Medical Expense Limit. the additional insured is a Named Insured. B. Paragraph 1.a.(3)(b)of SECTION I—COVERAGE This Provision 21. does not apply in situations where the endorsement on this policy affording coverage to C MEDICAL PAYMENTS, is replaced by the following: the additional insured specifies that this insurance is excess over any other insurance available to that (b) The expenses are incurred and reported to us additional insured. within three years of the date of the accident; 22. PROPERTY DAMAGE—ELEVATORS and This paragraph B. does not apply to medical A. Under SECTION I — COVERAGE A — BODILY expenseshispa iparagraph hed in the state of Missoto INJURY AND PROPERTY DAMAGE, Paragraph 2. Exclusions is amended such that exclusion k. 19. NON-OWNED AIRCRAFT Damage to Your Product, and subparagraph (3), (4)and (6)of exclusion j. Damage to Property do Under SECTION I—COVERAGE A—BODILY not apply "property damage" that results from the INJURY AND PROPERTY DAMAGE LIABILITY. use of elevators. Paragraph 2. Exclusions is amended such that exclusion g.Aircraft,Auto or Watercraft does not B. With respect only to the coverage provided by this apply to an aircraft you do not own, provided that: endorsement, Condition 4. Other Insurance in SECTION IV — COMMERCIAL GENERAL 1. The pilot in command holds a currently effective LIABILITY CONDITIONS is amended to add the certificate issued by the duly constituted authority following subparagraph b.(1)(a)(v): of the United States of America or Canada, designating that person as a commercial or airline 4. Other Insurance transport pilot; b. Excess Insurance 2. The aircraft is rented to you with a trained, paid (1) This insurance is excess over: crew; and 3. The aircraft does not transport persons or cargo (a) Anyof the ther insura , for a charge. whether primmary, exceecsss, g contingent or on any other basis: 20. NON-OWNED WATERCRAFT (v) That is Property insurance Under SECTION I—COVERAGE A—BODILY covering property of others INJURY AND PROPERTY DAMAGE LIABILITY, damaged from the use of Paragraph 2. Exclusions is amended to delete elevators. subparagraph(2)of exclusion g.Aircraft,Auto or 23. SUPPLEMENTARY PAYMENTS Watercraft and replace it with the following. [This exclusion does not apply to:] A. Under Section I — Supplementary Payments — Coverages A and B, Paragraph 1.b., the limit of (2) A watercraft you do not own that is: $250 shown for the cost of bail bonds is replaced (a) Less than 75 feet long; and by$5,000: B. In Paragraph 1.d.,the limit of$250 shown for daily (b) Not being used to carry persons or property loss of earnings is replaced by$1,000. for a charge. 24. UNINTENTIONAL FAILURE TO DISCLOSE 21. PRIMARY AND NON-CONTRIBUTORY TO OTHER HAZARDS INSURANCE If unintentionally you should fail to disclose all existing With respect to any person or organization that is an hazards at the inception date of your policy,we will not additional insured under this Coverage Part,the deny coverage under this Coverage Part because of such failure. G-18652-J(Ed.07/12) Page 10 of 11 Copyright,CNA All Rights Reserved. G-18652-J (Ed. 07/12) 25. WAIVER OF SUBGROGATION -BLANKET or during such operations of anyone acting on Under SECTION IV—COMMERCIAL GENERAL your behalf; nor LIABILITY CONDITIONS,The Transfer Of Rights Of 2. "Bodily injury" or "property damage" included Recovery Against Others To Us Condition is amended within the "products-completed operations by the addition of the following: hazard"that arises out of those portions of the We waive any right of recovery we may have against project that are not"residential structures." any person or organization because of payments we B. SECTION IV — COMMERCIAL GENERAL make for injury or damage arising out of: LIABILITY CONDITIONS is amended to add the 1. Your ongoing operations; or following subparagraph 4.b.(1)(c) to Condition 4. Other Insurance: 2. "Your work" included in the "products completed [This insurance is excess over:] operations hazard." (c) Any of the other insurance whether primary, However,this waiver applies only when you have agreed in writing to waive such rights of recovery in a insuexcrance contingent available toor any as other resultlsof that r contract or agreement, and only if the contract or insurance available to you as a your orbeing a participant in a "consolidated (wrap- agreement: up) insurance program," but only as respects 1. Is in effect or becomes effective during the term of your involvement in that "consolidated (wrap- this policy; and up)insurance program." 2. Was executed prior to loss. C. SECTION V — DEFINITIONS is amended to add 26. WRAP-UP EXTENSION: OWNER CONTROLLED the following definition: INSURANCE PROGRAM, CONTRACTOR "Consolidated (wrap-up)insurance program" CONTROLLED INSURANCE PROGRAM OR means a construction, erection or demolition CONSOLIDATED (WRAP-UP) INSURANCE project for which the prime contractor/project PROGRAMS manager or owner of the construction project has secured general liability insurance covering some Note:The following provision does not apply to any or all of the contractors or subcontractors involved public construction project in the state of Oklahoma, in the project,such as an Owner Controlled nor to any construction project in the state of Alaska, Insurance Program (O.C.I.P.)or Contractor that is not permitted to be insured under a Controlled Insurance Program (C.C.I.P.). "consolidated (wrap-up)insurance program" by applicable state statute or regulation: "Residential structure"means any structure where 30%or more of the square foot area is used or is If the endorsement EXCLUSION—CONSTRUCTION intended to be used for human residency including WRAP-UP or another exclusionary endorsement but not limited to single or multifamily housing, pertaining to Owner Controlled Insurance Programs apartments, condominiums,townhouses, co- (O.C.I.P.)or Contractor Controlled Insurance operatives or planned unit developments and also Programs(C.C.I.P.) is attached to this policy,then the includes their common areas and/or appurtenant following changes apply: structures(including pools, hot tubs,detached A. The following wording is added to the garages, guest houses or any similar structures). endorsement: When there is no individual ownership of units, residential structure does not include military With respect to a"consolidated (wrap-up) housing, college/university housing or dormitories, insurance program" project in which you are or long term care facilities, hotels, or motels. were involved,this exclusion does not apply to Residential structure also does not include those sums you become legally obligated to pay hospitals or prisons. as damages because of: This provision 26.does not apply to any person or 1. "Bodily injury," "property damage," or organization who otherwise qualifies as an "personal or advertising injury" that occurs additional insured on this Coverage Part. during your ongoing operations at the project, • All other terms and conditions of the Policy remain unchanged. Material used with permission of ISO Properties, Inc G-18652-J(Ed. 07/12) Page 11 of 11 Copyright,CNA All Rights Reserved. G-140331-D CNA (Edo 01/13) BLANKET ADDITIONAL INSURED -OWNERS, LESSEES OR CONTRACTORS — WITH PRODUCTS-COMPLETED OPERATIONS COVERAGE It is understood and agreed that this endorsement amends the COMMERCIAL GENERAL LIABILITY COVERAGE PART as follows: SCHEDULE(OPTIONAL) Name of Additional Insured Persons Or Organizations (As required by"written contract" per Paragraph A. below.) Locations of Covered Operations (As per the"written contract," provided the location is within the"coverage territory"of this Coverage Part.) A. Section II-Who Is An Insured is amended to include as an additional insured: 1. Any person or organization whom you are required by "written contract" to add as an additional insured on this Coverage Part; and 2. The particular person or organization, if any, scheduled above. B. The insurance provided to the additional insured is limited as follows: 1. The person or organization is an additional insured only with respect to liability for "bodily injury," "property damage,"or"personal and advertising injury"caused in whole or in part by: a. Your acts or omissions, or the acts or omissions of those acting on your behalf, in the performance of your ongoing operations specified in the"written contract";or b. "Your work"that is specified in the"written contract" but only for"bodily injury"or"property damage" included in the"products-completed operations hazard,"and only if: (1) The"written contract"requires you to provide the additional insured such coverage; and (2) This Coverage Part provides such coverage. 2. If the "written contract" specifically requires you to provide additional insurance coverage via the 10/01 edition of CG2010 (aka CG 20 10 10 01), or via the 10/01 edition of CG2037 (aka CG 20 37 10 01), or via the 11/85 edition of CG2010 (aka CG 20 10 11 85), then in paragraph B.1. above, the words 'caused in whole or in part by' are replaced by the words'arising out of'. 3. We will not provide the additional insured any broader coverage or any higher limit of insurance than: a. The maximum permitted by law; b. That required by the"written contract"; c. That described in B.1.above; or d. That afforded to you under this policy, whichever is less. G-140331-D (Ed.01/13) Page 1 of 2 Copyright,CNA All Rights Reserved. G-140331-D (Ed. 01/13) 4. Notwithstanding anything to the contrary in Condition 4. Other Insurance (Section IV), this insurance is excess of all other insurance available to the additional insured whether on a primary, excess, contingent or any other basis. But if required by the"written contract"to be primary and non-contributory, this insurance will be primary and non- contributory relative to insurance on which the additional insured is a Named Insured. 5. The insurance provided to the additional insured does not apply to"bodily injury,""property damage,"or"personal and advertising injury"arising out of: a. The rendering of, or the failure to render, any professional architectural, engineering, or surveying services, including: (1) The preparing, approving, or failing to prepare or approve maps, shop drawings, opinions, reports, surveys,field orders, change orders or drawings and specifications;and (2) Supervisory, inspection, architectural or engineering activities; or b. Any premises or work for which the additional insured is specifically listed as an additional insured on another endorsement attached to this Coverage Part. C. SECTION IV—COMMERCIAL GENERAL LIABILITY CONDITIONS is amended as follows: 1. The Duties In The Event of Occurrence, Offense, Claim or Suit condition is amended to add the following additional conditions applicable to the additional insured: An additional insured under this endorsement will as soon as practicable: (1) Give us written notice of an "occurrence" or an offense which may result in a claim or "suit" under this insurance, and of any claim or"suit"that does result; (2) Except as provided in Paragraph B.4. of this endorsement, agree to make available any other insurance the additional insured has for a loss we cover under this Coverage Part; (3) Send us copies of all legal papers received, and otherwise cooperate with us in the investigation, defense, or settlement of the claim or"suit";and (4) Tender the defense and indemnity of any claim or "suit" to any other insurer or self insurer whose policy or program applies to a loss we cover under this Coverage Part. But if the "written contract" requires this insurance to be primary and non-contributory, this provision (4) does not apply to insurance on which the additional insured is a Named Insured. We have no duty to defend or indemnify an additional insured under this endorsement until we receive from the additional insured written notice of a claim or"suit." D. Only for the purpose of the insurance provided by this endorsement, SECTION V—DEFINITIONS is amended to add the following definition: "Written contract"means a written contract or written agreement that requires you to make a person or organization an additional insured on this Coverage Part, provided the contract or agreement: 1. Is currently in effect or becomes effective during the term of this policy;and 2. Was executed prior to: a. The"bodily injury"or"property damage"; or b. The offense that caused the"personal and advertising injury," for which the additional insured seeks coverage under this Coverage Part. All other terms and conditions of the Policy remain unchanged. Material used with permission of ISO Properties, Inc. G-140331-D (Ed.01/13) Page 2 of 2 Copyright,CNA All Rights Reserved. POLICY NUMBER: COMMERCIAL GENERAL LIABILITY CG 02 0512 04 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. TEXAS CHANGES - AMENDMENT OF CANCELLATION PROVISIONS OR COVERAGE CHANGE This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART LIQUOR LIABILITY COVERAGE PART OWNERS AND CONTRACTORS PROTECTIVE LIABILITY COVERAGE PART POLLUTION LIABILITY COVERAGE PART PRODUCT WITHDRAWAL COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART RAILROAD PROTECTIVE LIABILITY COVERAGE PART In the event of cancellation or material change that reduces or restricts the insurance afforded by this Coverage Part, we agree to mail prior written notice of cancellation or material change to: SCHEDULE 1. Name: 'Per Schedule On File' 2. Address: Cancellation notification to the above entities will not apply to cancellation for non payment of premium 3. Number of days advance notice:30 Information required to complete this Schedule, if not shown above,will be shown in the Declarations. CG 02 0512 04 Copyright, ISO Properties, Inc.,2003 Page 1 of 1 CNA CNA72315XX (Ed. 02/13) NOTICE OF CANCELLATION OR MATERIAL CHANGE - DESIGNATED PERSON OR ORGANIZATION It is understood and agreed that this endorsement amends the BUSINESS AUTO COVERAGE FORM as follows: In the event of cancellation or material change that reduces or restricts the insurance provided by this Coverage Form,we agree to send prior notice of cancellation or material change to the person or organization scheduled below at the address scheduled below. This endorsement does not amend our obligation to notify the Named Insured of cancellation as described in the Common Policy Conditions or in another endorsement attached to this policy. SCHEDULE 1. Number of days advance notice: 10 Days if we cancel for non-payment of premium. 30 Days if the policy is cancelled for any other reason, or if coverage is restricted or reduced by endorsement. 2. Person or Organization's Name and Address Name: 'Per Schedule On File' Attention: Cancellation notification to the above Street Address: entities will not apply to cancellation City,State,ZIP: for non payment of premium e-mail address: All other terms and conditions of the Policy remain unchanged. 0 O CNA72315XX(02/13) Policy No: Page 1 of 1 Endorsement No: Effective Date: 07/12/2014 Insured Name: GRACE PAVING & CONSTRUCTION, INC. Copyright CNA All Rights Reserved. • WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 42 03 04 B (Ed. 6-14) TEXAS WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT This endorsement applies only to the insurance provided by the policy because Texas is shown in Item 3.A. of the Information Page. We have the right to recover our payments from anyone liable for an injury covered by this policy.We will not enforce our right against the person or organization named in the Schedule, but this waiver applies only with respect to bodily injury arising out of the operations described in the Schedule where you are required by a written contract to obtain this waiver from us. This endorsement shall not operate directly or indirectly to benefit anyone not named in the Schedule. The premium for this endorsement is shown in the Schedule. Schedule 1. ( ) Specific Waiver Name of person or organization ( ) Blanket Waiver Any person or organization for whom the Named Insured has agreed by written contract to furnish this waiver. 2. Operations:ALL TEXAS LOCATIONS AND OPERATIONS 3. Premium: The premium charge for this endorsement shall be 2 percent of the premium developed on payroll in connection with work performed for the above person(s)or organization(s)arising out of the operations described. 4. Advance Premium: SEE SCHD This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated. (The information below is required only when this endorsement is issued subsequent to preparation of the policy.) Endorsement Effective Policy No. Endorsement No. Insured Premium Insurance Company Countersigned by WC 42 03 04 B (Ed.06-14) Copyright 2014 National Council on Compensation Insurance,Inc.All Rights Reserved. • WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 42 06 01 (Ed. 7-84) TEXAS NOTICE OF MATERIAL CHANGE ENDORSEMENT This endorsement applies only to the insurance provided by the policy because Texas is shown in Item 3.A. of the Information Page. In the event of cancellation or other material change of the policy, we will mail advance notice to the person or organization named in the Schedule.The number of days advance notice is shown in the Schedule. This endorsement shall not operate directly or indirectly to benefit anyone not named in the Schedule. Schedule 1. Number of days advance notice: 3 0 2. Notice will be mailed to: 'PER SCHEDULE ON FILE' CANCELLATION NOTIFICATION TO THE ABOVE ENTITIES WILL NOT APPLY TO CANCELLATION FOR NON PAYMENT OF PREMIUM I0 O O O O O Immo This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated. (The information below is required only when this endorsement is issued subsequent to preparation of the policy.) Endorsement Effective Policy No. Endorsement No. mmam Insured Premium$ Insurance Company Countersigned by WC 42 06 01 (Ed.7-84)