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HomeMy WebLinkAboutC2015-035 - 6/23/2015 - Approved ( 4A. 2015-035 6/23/15 M2015-070 J.S. Haren Company CONTRACT DOCUMENTS FOR CONSTRUCTION OF CITY-WIDE LIFT STATION REPAIRS SECTION 4 LIFT STATION ODOR CONTROL PROJECT NUMBER E10142 kbW Illaillr • ® i PSE .TC� %k •*�1. " ►t�j s* ' • Cityof MARK A. MAHONEY ti4.o.. 62015 Corpus . .„ $k" ' r•`'` n is Christi URBAN ENGINEERING 2725 Swantner Corpus Christi, TX 78404 (361) 854-3101 TBPE FIRM No.: 145 TBPLS FIRM No.: 10032400 APRIL 2, 2015 Record Drawing Number STL-210 UE Job No.: 26175.84.01 Ilr 00 01 00 TABLE OF CONTENTS Division/ bib Section Title Division 00 Procurement and Contracting Requirements 00 11 16 Invitation to Bid (Rev 03/10/2015) 00 21 13 Instructions to Bidders (Rev 03/10/2015) fig 00 30 00 Bid Acknowledgment Form (Rev 03/10/2015) 00 30 01 Bid Form (Rev 03/23/2015) p 00 30 02 Compliance to State Law on Nonresident Bidders ►n 00 30 04 Conflict of Interest Questionnaire 00 30 05 Disclosure of Interest 00 30 06 Non-Collusion Certification 00 45 16 Statement of Experience 00 52 23 Agreement(Rev 03/23/2015) 00 6113 Performance Bond (Rev 7/3/2014) 00 61 16 Payment Bond (Rev 7/3/2014) 00 72 00 General Conditions (Rev3/23/2015) 00 72 01 Insurance Requirements(Rev 7/3/2014) i. 00 72 02 Wage Rate Requirements(Rev 03/11/2015) 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 lr 01 29 00 Application for Payment Procedures(Rev 03/11/2015) r ` 01 29 01 Measurement and Basis for Payment 01 3100 Project Management and Coordination ( 01 31 13 Project Coordination 01 31 14 Change Management 01 33 00 Document Management 01 33 01 Submittal Register(Rev 7/3/2014) 01 33 02 Shop Drawings 01 33 03 Record Data 01 33 04 Construction Progress Schedule Table of Contents 00 0100-1 City-Wide Lift Station Repairs—Section 4 Lift Station Odor Control, Project No.(E10142) REV 03-10-2015 r. 4 I r Division/ Title Section 0133 05 Video and Photographic Documentation 01 35 00 Special Procedures 0140 00 Quality Management 01 70 00 Execution and Closeout Requirements Part S Standard Specifications-NONE Part T Technical Specifications Technical Special Provisions 2B1[1] Site Grading 262[1] Structural Excavation and Backfill 2B3[1] Pipe Trench Excavation and Backfill 3A[1] Concrete Form Work 3B[1[ Concrete Reinforcement 3C1[1] Normal Weight Aggregate Concrete 3C4[1] Concrete Structures 9K[1] Painting-General 1161[2] Bioflter Odor Control System 11G3[3] Danger Signs(Outdoor) 15C3[3] Polyvinyl Chloride Pipe and Fittings 15C5[1] Installation of Process Piping rir 15C14[1] Pipe Hangers and Supports 15C15[1] PVC and Fittings for Air Service mot 01011 Equipment Documentation Requirements 16010 Electrical General Requirements 16170 Grounding and Bonding •rr 16402 Electrical Wiring Systems 16410 Enclosed Switches and Circuit Breakers 16450 Enclosed Adjustable Frequency Controller(1-500 HP) +i END OF SECTION Table of Contents 00 0100-2 City-Wide Lift Station Repairs—Section 4 Lift Station Odor Control, Project No. (E10142) REV 03-10-2015 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: it City-Wide Lift Station Repairs—Section 4 Lift Station Odor Control Owner's Project Identification No. E10142 A. This project consists of modifications and improvements to an existing lift station including installation of blower,odor control unit,air piping, concrete pad, electrical and miscellaneous items of work required to complete project in accordance with plans, specifications, and contract documents. 1.02 The Engineer's Opinion of Probable Construction Cost for the Project is$216,320. The Project is to be substantially complete and ready for operation within 150 days. The Project is to be complete and eligible for Final Payment 30 days after the date for Substantial Completion. r„ ARTICLE 2—EXAMINATION AND PURCHASE OF DOCUMENTS 2.01 Advertisement and bidding information for the Project can be found at the following website: Fr http:/www.civcastusa.com/ 2.02 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. 2.03 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 Wednesday,April 22,2015 A. at 2:00 pm at the following location: tr, City Hall Building—Capital Programs Conference Room 1 or 2 3`d floor,Capital Programs Department(formerly"Engineering Department"l 1201 Leopard Street, Corpus Christi,Texas 78401 b. 140 Invitation to Bid 00 11 16-1 City-Wide Lift Station Repairs—Section 4 Lift Station Odor Control, Project No. E10142 REV 03-10-2015 rr ) 1/2 ARTICLE 4—QUESTIONS REGARDING BIDDING PROCESS OR SOLICITATION DOCUMENTS 4.01 Questions are to be submitted using the Question and Answer process on the Owners 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 5:00 p.m. 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 3 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. Bidders submitting bids electronically through the CivCast System at www.CivCastUSA.com shall scan and upload a copy of Bid Bond as an attachment to their bid. Cashier's check, certified check, money order or bank draft must be enclosed in a sealed envelope, plainly identified on the outside as containing bid documents,the bidder's name and the job name and number and delivered as required in Article 7 below. 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. Invitation to Bid 00 11 16-2 City-Wide Lift Station Repairs—Section 4 Lift Station Odor Control, Project No. E10142 REV 03-10-2015 2 3. The Bid Bond must reference the Project by name as identified in Article 1. 4. Bidders may provide their surety's standard bid bond form if revised to meet these Bid Bond Requirements. 6.04 Failure to provide an acceptable Bid Security will constitute a non-responsive Bid which will not be considered. tom 6.05 Failure to provide the required Performance and Payment Bonds will result in forfeiture of the Bid Security to the City as liquidated damages. ARTICLE 7—DELIVERY OF BIDS 7.01 Electronic Bids must be submitted to the CivCastUSA website at www.CivCastUSA.com no later `' than Wednesday, May 6,2015,at 2:00 pm,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. If submitting a hard copy bid or bid security by cashier's check or money order, please address envelopes or packages: City of Corpus Christi City Secretary's Office City Hall Building, 1st Floor i" 1201 Leopard Street Corpus Christi,Texas 78401 Attention: City Secretary rim Bid—City-Wide Lift Station Repairs—Section 4 Lift Station Odor Control, Project No. E10142 All envelopes and packages(including FEDEX envelopes) must clearly identify,on the OUTSIDE of the package,the project name and number and that bid documents are enclosed. 7.02 Bids will be publicly opened and read aloud at Wednesday, May 6, 2015 at 2:00 pm,at the following location: City Hall Building-City of Corpus Christi First Floor �9t City Council Chambers or Staff Room 1201 Leopard Street Corpus Christi,Texas 78401 Ore ARTICLE 8—AWARD OF CONTRACT 8.01 It is the intent of the Owner to award this Contract to either the lowest responsible Bidder or the Bidder who provides the best value 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 to` formalities. Bids may not be withdrawn within 90 days from the date on which Bids are opened. Sim Invitation to Bid 00 11 16-3 City-Wide Lift Station Repairs—Section 4 Lift Station Odor Control, Project No. E10142 REV 03-10-2015 Y.. 3 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 3 Workers' Compensation Insurance, as required by the General Conditions and SECTION 00 72 01 INSURANCE REQUIREMENTS. 9.03 Performance and Payment Bonds are required. 3 END OF SECTION a I I 1 Invitation to Bid 00 11 16-4 I City-Wide Lift Station Repairs—Section 4 Lift Station Odor Control, Project No. E10142 REV03-10-2015 1 Aim r.. 00 72 01 INSURANCE REQUIREMENTS ARTICLE 1—INSURANCE REQUIREMENTS 1.01 CONTRACTOR'S INSURANCE AMOUNTS 6. 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 Li. Commercial Form 2. Premises-Operations 3. Explosions and Collapse Hazard 4. Underground Hazard 5. Products/Completed Operations Hazard $1,000,000 Per Occurrence 6. Contractual Liability $2,000,000 Aggregate 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 isor ❑ Required X- Not Required soy Installation Floater Equal to Contract Price ❑ Required X- Not Required Owner's Protective Liability Equal to Contracto- r's liability insurance Cl Required X- Not Required !w 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 City-Wide Lift Station Repairs-Section 4 Lift Station Odor Control, Project No.: E10142 REV 07-03-2014 3 3 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. 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 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. 3 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 3 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 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 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" endorsement if Contractor is not domiciled in Texas and policy is not written in accordance with Texas Department of Insurance rules. 3 Insurance Requirements 00 72 01-2 City-Wide Lift Station Repairs-Section 4 Lift Station Odor Control, Project No.: E10142 REV 07-03-2014 tot 2. Claims for damages because of bodily injury, occupational sickness or disease, or death of Contractor's employees. 3. United States Longshoreman and Harbor Workers' Compensation Act and Jones Act coverage (if applicable). 4. Foreign voluntary worker compensation (if applicable). tips 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; e 2. Claims for damages insured by reasonably available personal injury liability coverage 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 ion 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) 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. top 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 t"" Work. 1) Provide coverage under the Contractor's Installation Floater that includes: l•. a) Faulty or Defective workmanship, materials, maintenance, or construction; b) Cost to remove Defective or damaged Work from the Site or to protect `or it from loss or damage; c) Cost to cleanup and remove pollutants; .. d) Coverage for testing and startup; e) Any loss to property while in transit; ,w 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 City-Wide Lift Station Repairs-Section 4 Lift Station Odor Control, Project No.: E10142 REV07-03-2014 t 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 property for which the Contractor is legally liable. Provide limits of insurance adequate to cover the value of the installation. Pay any deductible carried 3 under this coverage and assume responsibility for claims on materials, 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. 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 Engaged by the Named Insured" or its equivalent. D. Purchase and maintain automobile liability insurance against claims for damages because of bodily injury or death of any person or property damage arising out of the ownership, maintenance, or use of any motor vehicle. .13 E. Purchase and maintain umbrella or excess liability insurance written over the underlying 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 3 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 3 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 City-Wide Lift Station Repairs-Section 4 Lift Station Odor Control, Project No.: E10142 REV 07-03-2014 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. 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 liability provided in this Section or required by Laws or Regulations,whichever is greater. tow 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 ti" 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 r" 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 meet the coverage requirement. 1.04 OWNER'S PROTECTIVE LIABILITY INSURANCE top 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 ry that 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. law 1.05 PROPERTY INSURANCE ter 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 i.. 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. try 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: war 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 City-Wide Lift Station Repairs-Section 4 Lift Station Odor Control, Project No.: E10142 REV 07-03-2014 r. 3 3 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 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 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. 8. Provide primary coverage for all losses and damages caused by the perils or causes of loss covered. 9. Not include a co-insurance clause. 3 10. Include a broad exception for ensuing losses from physical damage or loss with respect to any Defective workmanship, design, or materials exclusions. 3 11. Include testing and startup. 12. Be maintained in effect until the Work as a whole is complete, unless otherwise agreed to in writing by Owner and Contractor. 3 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 insured. C. Pay for costs not covered by the policy deductible. D. Notify builder's risk insurance provider 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. 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 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. 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 City-Wide Lift Station Repairs-Section 4 Lift Station Odor Control, Project No.: E10142 REV 07-03-2014 f r it 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 w 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. 11r 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. ire 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 row 2.01 ACCEPTABLE EVIDENCE OF INSURANCE 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; lot 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. war 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. w. 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. to`" Insurance Requirements 00 72 01-7 City-Wide Lift Station Repairs-Section 4 Lift Station Odor Control, Project No.: E10142 REV 07-03-2014 rlMf 3 j 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 3 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. 3 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 3 the expiration of existing policies. B. Provide evidence of continuation of insurance coverage at final payment and for the following 3 years. 3 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 Corpus Christi,TX 78469-9277 B. Submit questions regarding insurance requirements to the Construction Contract Administrator by calling 361-826-3530. ARTICLE 3—TEXAS WORKERS'COMPENSATION INSURANCE REQUIRED NOTICE 3.01 WORKERS' COMPENSATION INSURANCE COVERAGE A. Definitions: 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. Insurance Requirements 00 72 01-8 City-Wide Lift Station Repairs-Section 4 Lift Station Odor Control, Project No.: E10142 REV 07-03-2014 r tit 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 L 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 irs 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 ar 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. �•• 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 1ir providing services on the Project,for the duration of the Project. C. The Contractor must provide a certificate of coverage to the governmental entity prior to being awarded the Contract. D. 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: fi 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 trim 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 1► 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. Ism ~' Insurance Requirements 00 72 01-9 City-Wide Lift Station Repairs-Section 4 Lift Station Odor Control, Project No.: E10142 REV 07-03-2014 r 3 I 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 3 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 3 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 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. 3 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 3 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 breach 3 from the governmental entity. END OF SECTION Insurance Requirements 00 72 01-10 City-Wide Lift Station Repairs-Section 4 Lift Station Odor Control, Project No.: E10142 REV 07-03-2014 00 73 00 SUPPLEMENTARY CONDITIONS r.. 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. Imp 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. owl ARTICLE 1—DEFINITIONS AND TERMINOLOGY r SC-1.01 DEFINED TERMS A. The members of the OPT as defined in Paragraph 1.01.A.41 consists of the following organizations: 11111, City of Corpus Christi,Texas Urban Engineering +r 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: t.. 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 kir 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 yr days and residual impacts in the Contract Price. 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 two April 3 October 4 May 4 November 3 June 4 December 3 3. A total of 18 rain days have been set for this Project. An extension of time due to rain days will be considered only after 18 rain days have been exceeded in a calendar year and the OAR has determined that a detrimental impact to the construction schedule Supplementary Conditions 00 73 00-1 City-Wide Lift Station Repairs-Section 4 Lift Station Odor Control, Project No.: E10142 11-25-2013 resulted from the excessive rainfall. Rain days are to be incorporated into the 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. 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." SC-5.06 HAZARDOUS ENVIRONMENTAL CONDITIONS AT SITE A. 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 25 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 City-Wide Lift Station Repairs-Section 4 Lift Station Odor Control, Project No.: E10142 11-25-2013 r ' 00 52 23 AGREEMENT This Agreement,for the Project awarded on June 23,2015 , is between the City of Corpus Christi (Owner)and J.S. Haren Company (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: City-Wide Lift Station Repairs—Section 4 Lift Station Odor Control Project No: E10142 This project consists of modifications and improvements to an existing lift station including installation of blower, odor control unit, air piping, concrete pad,electrical and miscellaneous items of work required to complete project in accordance with plans, specifications, and contract documents. ARTICLE 2—DESIGNER AND OWNER'S AUTHORIZED REPRESENTATIVE 2.01 The Project has been designed by: Urban Engineering 2725 Swantner Corpus Christi,TX 78404 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,TX 78411 ARTICLE 3—CONTRACT TIMES 3.01 Contract Times A. The Work is required to be substantially completed within 150 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 180 days after the date when the Contract Times commence to run. B. Milestones, and the dates for completion of each, are as defined in SECTION 0135 00 SPECIAL PROCEDURES. 3.02 Liquidated Damages Agreement 00 52 23-1 City-Wide Lift Station Repairs—Section 4 Lift Station Odor Control, Project No. E10142 REV 03-23-2015 A. Owner and Contractor recognize that time limits for specified Milestones,Substantial Completion, and completion and readiness for Final Payment as stated in the Contract Documents 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. Substantial Completion: Contractor shall pay Owner$500.for each day that expires after the time specified in Paragraph 3.01 for Substantial Completion until the Work is substantially complete. 2. Completion of the Remaining 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. 3. Liquidated damages for failing to timely attain Substantial Completion and Final Completion are not additive and will not be imposed concurrently. 4. Milestones: Contractor agrees to pay Owner liquidated damages as stipulated in SECTION 01 35 00 SPECIAL PROCEDURES for failure to meet Milestone completions. 5. 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 BID FORM. 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 $ 196,000.00 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. Agreement 00 52 23-2 City-Wide Lift Station Repairs—Section 4 Lift Station Odor Control, Project No. E10142 REV 03-23-2015 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 Substantial Completion. The balance will be held as retainage. 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 Substantial 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 Substantial Completion. Owner may, at its sole discretion,elect to hold retainage in the amounts set forth above for progress payments prior to Substantial 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. Agreement 00 52 23-3 City-Wide Lift Station Repairs—Section 4 Lift Station Odor Control, Project No. E10142 REV 03-23-2015 C. The Contractor is familiar with Laws and Regulations that may affect cost, progress, and performance of the Work. D. The Contractor has carefully studied the following Site-related reports and drawings as identified in the Supplementary Conditions: 1. Geotechnical Data Reports regarding subsurface conditions at or adjacent to the Site; 2. Drawings of physical conditions relating to existing surface or subsurface structures at the Site; 3. Underground Facilities referenced in reports and drawings; 4. Reports and drawings relating to Hazardous Environmental Conditions, if any, at or adjacent to the Site; and 5. Technical Data related to each of these reports and drawings. E. 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. F. The Contractor has considered the items identified in Paragraphs 7.01.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. G. 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. H. 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. I. 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. J. 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. K. The Contract Documents are generally sufficient to indicate and convey understanding of all terms and conditions for performance and furnishing of the Work. Agreement 00 52 23-4 City-Wide Lift Station Repairs—Section 4 Lift Station Odor Control, Project No. E10142 REV 03-23-2015 L. 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 0100 TABLE OF CONTENTS. 2. Drawings listed in the Sheet Index. 3. Addenda. 4. Exhibits to this Agreement: a. Contractor's Bid Form. 5. 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 Agreement will be required. The sequence of signatures will be completed in the following order: A. CONTRACTOR—Agreement must be signed by a person authorized to bind the firm or company. If Contractor is a Corporation, agreements 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 City-Wide Lift Station Repairs—Section 4 Lift Station Odor Control, Project No. E10142 REV 03-23-2015 ATTEST) 4,; coPRISTl / -R, Ll u`Alfi ----- City Secretary J. Edmonds, P.E. Director of Capital Programs APPROVED AS TO LEGAL FORM L I -°14Qt ilui 'ma Al .__ __ /l/G 1Y COPP I 4 '7 *- I / sst.City Attorney SECRET ATTEST(IF CORPORATION) CONTRACTOR dait2all J.S. Haren Company (Seal Below) By: Ci��/4 -..-- Note: Attach copy of authorization to sign if Person signing for Contractor is not President, Title: P(ei dQ i F Vice President, Chief Executive Officer, or Chief Financial Officer 1175 Highway 11 North Address Athens,TN 37303 -:-.RF� - City State Zip z._ ti " 423/745-5000 - - Phone + N 00 30 00 BID ACKNOWLEDGEMENT FORM ARTICLE 1—BID RECIPIENT 1.01 In accordance with the DrAvin s,Specifications,and Contract Documents,this Bid Proposal is submitted by J J 1UYn C,. .mpa (type or print name of company)on:Wednesday,May 6,2015 at 2:00 pm for City-Wide Lift Station Repairs—Section 4 Lift Station Odor Control,Project No.E10142. 1.02 Submit Bids,Bid Security and all attachments to the Bid(See Section 7.01 below)to the City's electronic bidding website at https://www.civcastusa.com. If submitting hard copy bids or bid security in the form of a cashier's or certified check,please send to: The City of Corpus Christi,Texas City Secretary's Office 1201 Leopard Street Corpus Christi,Texas 78401 Attention: City Secretary Bid-City-Wide Lift Station Repairs—Section 4 Lift Station Odor Control, Project No. E10142 All envelopes and packages(including FEDEX envelopes) must clearly identify,on the OUTSIDE of the package,the project name and number and that bid documents are enclosed. 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: M *44 Addend" mmd4I l2e Signature/ciCnovuledgitigFi2eceit,=3.` A'{$42#°„n9k Fq'(,. 3 E t - .tft00 bfiL" tot idA.fi Fr. at Bid Acknowledgement Form 00 30 00-1 City-Wide Lift Station Repairs—Section 4 Lift Station Odor Control,Project No.E10142 REV 03-10-2015 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. 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 Bid Acknowledgement Form 00 30 00-2 Gty-Wide Lift Station Repairs—Section 4 Lift Station Odor Control,Project No.E10142 REV 03-10-201S 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. 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 the BID FORM. A. Extended amounts have been computed in accordance with Paragraph 13.03 of the General Conditions. B. 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. C. Unit Price and figures column will be used to compute the actual Bid price. ARTICLE 5—EVALUATION OF BIDDERS 5.01 The contract may be awarded either to the lowest responsible bidder or to the bidder who provides the best value for the Owner. The Owner will consider the greatest amount bid,the Bidder's responsibility,the Bidder's safety record,the Bidder's indebtedness to Owner 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 or value,and whether the Bidder has met the minimum specific project experience requirements,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 Acknowledgement Form 00 30 00-3 city-Wide Lift Station Repairs—Section 4 Lift Station Odor Control,Project No.E10142 .ST REV 0340-2015 ARTICLE 6—TIME OF COMPLETION 6.01 Bidder will complete the Work required to be substantially completed within 150 days after the date when the Contract Times commence to run as provided in Paragraph 4.01 of the General Conditions. Bidder will complete the Work required for final payment in accordance with Paragraph 15.06 of the General Conditions within 180 days after the date when the Contract Times commence to run. 6.02 Bidder agrees that the Work will be substantially complete and will be completed and ready for final payment in accordance with Paragraph 15.06 of the General Conditions within the number of days indicated. ARTICLE 7—ATTACHMENTS TO THIS BID 7.01 In compliance with the Bid Requirements in SECTION 0011 16 INVITATION TO BID,the following are made a condition of this Bid: A. Bid Security. B. SECTION 00 30 00 BID ACKNOWLEDGEMENT FORM and documentation of signatory authority. C. Bid Form. 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. Bid Acknowledgement Form 00 30 00-4 City-Wide Lift Station Repairs—Section 4 Lift Station Odor Control,Project No.E10142 REV 03.10.2015 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. 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: ��`E)1 VW ('[1fnpa (typed or printed fulllegal name of Bidder) By: 0,//4�ll� �^ (individual's signature) Name: J .:i\Cu(l) t� (typed or printed) Title: CIO It (typed or printed)( < I" �� �' Oj Attest: aC1 nti°i-) (individual's signature) State of Residency: Federal Tax Id. No. (ta Ittrne) Address for giving notices: 111 1-ligt- ,4 it kpt-t 1 Phone: 4a--3- Email: j, I c1 -C Qc't' CCM (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 Acknowledgement Form 00 30 00-5 City-Wide Lift Station Repairs—Section 4 Lift Station Odor Control,Project No. E10142 REV 03.10.2015 00 30 01 BID FORM 00 30 01 BID FORM Project Name: City-Wide Lift Station Repairs-Section 4 Lift Station Odor Control Project Number: E10142 Owner: City of Corpus Christi Bidder: �, � � fl ('C ' ',L) OAR: Designer: Urban Engineering Basis of Bid Item DESCRIPTION UNIT ESTIMATED UNIT PRICE EXTENDED QUANTITY AMOUNT Base Bid Part A•General(per SECTION 01 29 01 MEASUREMENT AND BASIS FOR PAYMENT) Al Mobilization LS 1 $ j# •r• $ A2 Lift Station Odor Control LS 1 $;; i G,) $ } '•� , A3 Odor Control Electrical LS 1 $ $ A4 Utility Unforeseen Allocation LS 1 $ 10,000.00 $ 10,000.00 SUBTOTAL PART A-GENERAL(Items Al thru A4) !SUBTOTAL PART A-GENERAL (Items Al thru A4) $ 1(‘‘ .• Contract Times Bidder agrees to reach Substantial Completion in 150 days Bidder agrees to reach Final Completion in 180 days Bid Form Page 1 of 1 City-Wide Lift Station Repairs-Section 4 Lift Station Odor Control, Project No. E10142 REV 03-23-2015 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. rd Bidder qualifies as a nonresident bidder whose principal place of business or residency is in the State of 1!-inl u( csL ❑ 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: �, �j e jc YlfN (typed or pri ted) By: (signature--attach evidence of authority to sign) Name: .'S. f 1(111('vl (typed or printed) • Title: Pi Business address: ( 1110h t Ktt t h Airk :1 11 ) A--)k) Phone: 14513 ivy* } � Email: 1 CAll.lr.(011.02l.tol C1� END OF SECTION Compliance to State Law on Nonresident Bidders 00 30 02-1 City-Wide Lift Station Repairs-Section 4 Lift Station Odor Control, Project No. E10142 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. LI Name of person who has a business relationship with local governmental entity. N00-- J Gheck this box if you are filing an update to a previously filed 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. 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? Yes No 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? Yes No 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? Yes No D. Describe each employment or business relationship with the local government officer named in this section. ',774 - 51016 Signature of person coing 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 CITY PURCHASING DIVISION City CITY OF CORPUS CHRISTI oof f chi U DISCLOSURE OF INTEREST City of Corpus Christi Ordinance 17112,as amended,requires all persons or firms seeking to do business with the City to provide the following information. Every question must be answered. If the question is not applicable, answer with "NA". See reverse side for Filing Requirements, Certifications and definitions. COMPANY NAME: J.S.�a IPA l_J•5cm9 P.O.BOX: NI A- STREET STREET ADDRESS: I I J HI�� l �J. CITY: Kn. TN ZIP: am3- FIRM IS: 1. Corporation v"/ 2. Partnership _ 3. Sole Owner ❑ 4. Association _ 5. Other _ DISCLOSURE QUESTIONS If additional space is necessary,please use the reverse side of this page or attach separate sheet. 1. State the names of each `employee" of the City of Corpus Christi having an "ownership interest" constituting 3%or more of the ownership in the above named"firm." Name Job Title and City Department(if known) 11i'r 2. State the names of each "official" of the City of Corpus Christi having an "ownership interest" constituting 3%or more of the ownership in the above named"firm." Name Title 1\\1 3. State the names of each"board member"of the City of Corpus Christi having an "ownership interest" constituting 3%or more of the ownership in the above named"firm." Name Board,Commission or Committee 01k 4. State the names of each employee or officer of a "consultant" for the City of Corpus Christi who worked on any matter related to the subject of this contract and has an "ownership interest" constituting 3%or more of the ownership in the above named"firm." Name Consultant 0\fr 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: J .� r(,n Title: Pi C,...\„)&11Lk (Type or Print) Signature of Certifying Date: t 16 Person: DEFINITIONS a. "Board member." A member of any board, commission, or committee appointed by the City Council of the City of Corpus Christi,Texas. b. "Economic benefit". An action that is likely to affect an economic interest if it is likely to have an effect on that interest that is distinguishable from its effect on members of the public in general or a substantial segment thereof. c. "Employee." Any person employed by the City of Corpus Christi, Texas either on a full or part- time basis,but not as an independent contractor. d. "Firm." Any entity operated for economic gain,whether professional, industrial or commercial,and whether established to produce or deal with a product or service, including but not limited to,entities operated in the form of sole proprietorship, as self-employed person, partnership, corporation,joint stock company,joint venture, receivership or trust, and entities which for purposes of taxation are treated as non-profit organizations. e. "Official." The Mayor, members of the City Council, City Manager, Deputy City Manager, Assistant City Managers,Department and Division Heads,and Municipal Court Judges of the City of Corpus Christi,Texas. 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: City-Wide Lift Station Repairs-Section 4 Lift Station Odor Control Project No: E10142 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: ,J'S T(in ( ;mii iZ (type or prin d) By: (signature--attach evidence of authority to sign) Name: J5.IV kcn �y (typed or printed) Title: Pt(giCVO Business address: I V1 1-\19\la"y t krjAh nv(.g, -11\1 : '13 Phone: (t•11 ;; IU\ Email: rt\th(R1 00 ,e'CM END OF SECTION Non-Collusion Certification 00 30 06-1 City-Wide Lift Station Repairs-Section 4 Lift Station Odor Control,Project No. E10142 11-25-2013 Corporations Section �E Hope Andrade P.O.Box 13697 VII: r` Secretary of State Austin,Texas 78711-3697 x�`, \ Office of the Secretary of State CERTIFICATE OF FILING OF J.S. Haren Company File Number: 801081739 The undersigned, as Secretary of State of Texas, hereby certifies that an Application for Registration for the above named Foreign For-Profit Corporation to transact business in this State has been received in this office and has been found to conform to the applicable provisions of law. ACCORDINGLY, the undersigned, as Secretary of State, and by virtue of the authority vested in the secretary by law,hereby issues this certificate evidencing the authority of the entity to transact business in this State from and after the effective date shown below for the purpose or purposes set forth in the application under the name of J.S. Haren Company • The issuance of this certificate does not authorize the use of a name in this state in violation of the rights of another under the federal Trademark Act of 1946,the Texas trademark law,the Assumed Business or Professional Name Act,or the common law. Dated: 02/02/2009 Effective: 02/02/2009 • T�f �II� q� ? Z rp \ � Hope Andrade ?.4ll ��, Co Secretary of State rp Come visit us on the inter-net at http://www.sos.state.tx.us/ Phone:(512)463-5555 Fax: (512)463-5709 Dial:7-1-1 for Relay Services Prepared by:Linda Gemuendcn TID: 10308 Document:244918620002 CONSENT TO ACTION TAKEN IN LIEU OF 'SPECIAL MEETING OF J.S. HAREN COMPANY THE UNDERSIGNED PERSON, being the sole shareholder of J. S. HAREN COMPANY, does, as is evidenced by his signature below, hereby consent to and ratify the following action taken by the shareholder without the necessity of a call to or a formal meeting of the shareholder; and WHEREAS the shareholder performs the duties director pursuant to TCA §48-18- 101 (c), and the following action, taken by written consent, is in accordance with the provisions of the by-laws of the corporation and the General Corporation act of Tennessee. 1. Election of New Officers. The persons whose names appear below are appointed of the corporation to serve for a period of one year or until their successors are appointed and shall qualify: President: J. Skyler Haren Secretary: Jennifer L.Adkins Asst. Secretary: Cassandra L. Haren 2. Execution of Documents. The duly elected President, signing singularly or any two of the other duly elected officers, signing jointly,were authorized, on behalf of the corporation, to execute any and all documents necessary and incident of the routing business of the corporation, including specifically the power to execute agreement, instruments, tax returns and other routine documents of the corporation. IN WITNESS WHEREOF, the above corporation actions were taken by the undersigned for on behalf of the corporation this the MT day of (nr,2009. "PREIN"u' \\ .. COQ''% J. Skyler Haren, Shareholder GoRPoq SVAL .; ANNE ',76.414s.5 //l1111I111i1\ll\\\\\ 00 61 13 PERFORMANCE BOND BOND NO. EAIC291600166 Contractor as Principal Surety Name: J.S.Haren Company Name: Endurance American Insurance Company Mailing address(principal place of business): Mailing address(principal place of business): 1175 Highway 11 North 750 Third Avenue Athens,TN 37303 New York, NY 10017 Physical address(principal place of business): Owner 750 Third Avenue Name: City of Corpus Christi,Texas New York, NY 10017 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: Corpus Christi,Texas 78469 Delaware 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): #E10142 City-Wide Lift Station Repairs Section 4 212-209-6525 Lift Station Odor Control Telephone(for notice of claim): 212-209-6525 Local Agent for Surety Adecca Name: Amanda Calderon Award Date of the Contract: June 23,2015 Address: 400 Mann St, Ste 703 Contract Price: $196,000.00 Corpus Christi, TX 78401 Telephone: 361-814-2342 Bond Email Address: amanda.calderon@adeccana.com Date of Bond: July 2, 2 01 5 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 Proj#E10142 City-Wide Lift Sta Repairs Sect 4 Lift Sta Odor Control 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 Principal Surety Signature: Z Signature: '� 1 JName: 3i-/ re n Name: Kelly L. Ber A Title: -?rpSjI J Title: Attorney-in-fact Email Address: 3S 1-10 re)3...41:a •E On Email Address: kelly@bondssoutheast.com (Attach Power of Attorney and place surety seal below) 2Q.. �QORATE .w= 411111111111'110‘c END OF SECTION Performance Bond 00 61 13-2 Proj#E10142 City-Wide Lift Sta Repairs Sect 4 Lift Sta Odor Control 7-8-2014 00 61 16 PAYMENT BOND BOND NO. EAIC291600166 Contractor as Principal Surety Name: J.S.Haren Company Name: Endurance American Insurance Company Mailing address(principal place of business): Mailing address(principal place of business): 1175 Highway 11 North 750 Third Avenue Athens,TN 37303 New York, NY 10017 Physical address(principal place of business): Owner 750 Third Avenue Name: City of Corpus Christi,Texas New York, NY 10017 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: Corpus Christi,Texas 78469 Delaware 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): 11E10142 City-Wide Lift Station Repairs Section 4 212-209-6526 Lift Station Odor Control Telephone(for notice of claim): 212-209-6525 Local Agent for Surety Adecca Name: Amanda Calderon Award Date of the Contract: June 23,2015 Address: 400 Mann Street, Ste 703 Contract Price: $196,000.00 Corpus Christi, TX 78401 Bond Telephone: 361-814-2342 Email Address:amanda.calderon©adeccana.com Date of Bond: July 2, 201 5 The address of the surety company to which any (Date of Bond cannot be earlier than Award Date notice of claim should be sent may be 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 Proj#E10142 City-Wide Lift Sta Repairs Sect 4 Lift Sta Odor Control 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 Principal Surety I Signature: G� Signature: ! l .. A i. _ Name: FJ _J /4i!j Name: Ke ly L. Be ry Title: Pito Si CL' �L� Title: Attorney-in-fact / Email Address: nl&Ctid.( alb Email Address: kelly@bondssoutheast.com (Attach Power of Attorney and place surety seal below) y • % '? TEN END OF SECTION Payment Bond Form 00 61 16-2 Proj#E10142 City-Wide Lift Sta Repairs Sect 4 Lift Sta Odor Control 7-8-2014 ENDURANCE AMERICAN INSURANCE COMPANY EAIC291600185 Seal Number:29 POWER OF ATTORNEY 4(jtow aft Wen 6y these(Presents that ENDURANCE AMERICAN INSURANCE COMPANY,a Delaware corporation(the"Corporation'),with offices at 750 Third Avenue,New York,New York 10017,has made,constituted and appointed and by these presents,does make,constitute and appoint GREGORY E.NASH,PHIWP H.CONDRA,KELLY L.BERRY its true and lawful Attorney(s)-in-fact,at NASHVILLE in the State of TN and each of them to have full power to act without the other or others,to make,execute,seal and deliver for and on its behalf bonds,undertakings or obligations in surety or co-surety with others,also to execute and deliver on its behalf renewals,extensions,agreements,waivers,consents or stipulations relating to such aforesaid bonds,undertakings or obligations provided,however,that no angle bond or undertaking so made,executed and delivered shall obligate the Corporation for any portion of the penal sum thereof in excess of the sum of SEVEN MILLION FIVE HUNDRED THOUSAND Dollars($7,500,000.00). Such bonds and undertakings for said purposes,when duly executed by said attomey(s)-in-fact,shall be binding upon the Corporation as fully and to the same extent as if signed by the President of the Corporation under its corporate seal attested by its Corporate Secretary.31 This appointment is made under and by authority of certain resolutions adopted by the Board of Directors of the Corporation by unanimous written consent on the 21e day of July,2011,a copy of which appears below under the heading entitled"Certificate'. 31 This Power of Attorney is signed and sealed by facsimile under and by authority of the following resolution adopted by the Board of Directors of the Corporation by unanimous written consent on the 210 day of July,2011 and said resolution has not since been revoked,amended or repealed: RESOL -s,tbaf,j COREr A CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DDYYYY) 7/2/2015 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 CONTACT Tracy Phillips Brock Insurance AgencyPNE - - IAHO/C.No.PxtL (706)866-3394 (A/C,No):(706)861-4619 823 Chickamauga Avenue AIL ADDRESS:tracyp@brockins.com P.O. BOX 460 INSURER(S)AFFORDING COVERAGE NAIC it Rossville GA 30741 INSURERA:The Charter Oak Fire Insurance INSURED / INSURER B:Travelers Property Casualty J. S. Haren Company INsuRERc:Travelers Casualty & Surety 1175 Highway 11 North INSURERD: INSURER E: Athens TN 37303 INSURERF: COVERAGES CERTIFICATE NUMBER:14/15 Master 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 ADDL SUBR P LTR TYPE OF INSURANCE INSR WVD POLICY NUMBER (MM/DDY/YYYY) (MM/DO//YICY YYY) LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY / DAMAGE TO RENTED I PREMISES(Ea occurrence) $ 300,000 A CLAIMS-MADE X I OCCUR X DT-CO-0F96197-14 10/1/2019 10/1/2015 MED Exp(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 --- / GENERAL AGGREGATE $....,-- 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000 $ i POLICY X PRO- LOC AUTOMOBILE LIABILrfY COMBINED SINGLE LIMIT (Eaacciden_1) $ 1,000,000 B X 1 ANY AUTO BODILY INJURY('er person) $ / IALL OWNED —'SCHEDULEDX DT-810-0F799728-14-TIL 10/1/2014 10/1/2015 BODILY INJURY(Per accident) $ iAUTOS — AUTOS X HIRED AUTOS x NON-OWNED PROPERTY DAMAGE _ AUTOS (Per accident) $ Medical payments $ 2,000 X UMBRELLA LIAB X OCCUR / EACH OCCURRENCE _ $ 5,000,000 B EXCESS LIAB ___CLAIMS-MADE AGGREGATE $ 5,000,000 DED X RETENTION$ 10,000 DT-CUP-0F796197-14-TIL 10/1/2014 10/1/2015 $ C WORKERS COMPENSATION Zr WC STATU- 0TH- AND EMPLOYERS'LIABILITY /i N X TORY LIMITS ER ANY PROPRIETOR/PARTNERJEXECU t,./1;/ NE E.L.EACH ACCIDENT $ 500,000 'OFFICER/MEMBER EXCLUDED? N/A (Mandatory in NH) OTAUB-5910B24-5-19 10/1/2014 10/1/2015 E.L.DISEASE-EA EMPLOYEE$ 500 000 [(yes,describe under _.—r DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT S 500,000 B Installation Floater 660-9D91677 10/1/2014 10/1/2015 Limit:$1,500,000 $1,000 Leased & Rented Equipment, Lima:$100,000 Deductible DESCRIPTION OF OPERATIONS i LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) Re: City-Wide Lift Station Repairs - Section 4 Lift Station Odor Control Project # E10142 Certificate holder is listed as additional insured with respect to the General and Auto Liability policies. Waiver of Subrogation applies under the Workers Compensation policy. 30 days notice of cancellation applies under the General Liability policy. 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 ACCORDANCE WITH THE POLICY PROVISIONS. P.O. Box 9277 Corpus Christi, TX 78469 AUTHORIZED REPRESENTATIVE C Vaughan, III/TRACY --- 1,-` ACORD 25(2010/05) ©1988-2010 ACORD CORPORATION. All rights reserved. INSo9R r->nrnnc'm The,Af^.(11Prl Warn.and Innn aro retnicf.rorl rnerke of AR(lRrl • . DI-CO-0196197-1cl 15.Garen Company COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ iT CAREFULLY. CONTRACTORS XTENW ENDORSEMENT This endorsement modifies insurance provided under the following: / COMMERCIAL.GENERAL:LIABILITY COVERAGE PART GENERAL DESCRIPTION oF.COVERAGE-This endorsement broadens coverage. However;coverage for any injury, damage or medical expenses described in any of the provisions of this endorsement may be excludedor limited by anotherendorsement to this Coverage Part,and these coverage broadening provisions do not apply to the extent that coverage is excluded or limited:by such an endorsement.The following listing is a general cover•• age description only.Limitations:and exclusions may apply to these coverages.Read all the provisions of this en- dorsement and the rest of your:policy carefully to determine rights,duties, and what Is andis not`covered.. " . A: Aircraft Chartered With Pilot ' H. Blanket Additional Insured -• Lessors Of Leased B..Damage To Premises.Rented To You Equipment C. Increased Supplementary Payments I. Blanket Additional .insured - States Or Political D Incidental Medical Malpractice Subdivisions-Permits. J. Knowledge And Notice Of Occurrence Or Offense E". Who Is An Insured Newly Acquired Or.Formed Organizations • K. Unintentional Omission . / F. Who is An Insured = Broadened Named Insured L. Blanket Waiver Of Subrogation :V -Unnamed Subsidiaries M. Amended Bodily Injury Definition; 0 Blanket Additional Insured -:-Owners, Managers N. Contractual Liability-Railroads ' i Or Lessors Of Premises. • • PROVISIONSDA�11AGE Li_ ✓ .. INJURY AND. PROPERTY . . r® R. AIRCRAFT CHARTERED WtThIPILO'T ABILITY: The following is added to Exclusion.g. Aircraft, Exclusions C. and g. through n..do not apply Auto Or Watercraft,in Paragraph 2,.of SECTION : to "premises damage° .Exclusion f(1)(a) ` I -- COVERAGES ...COVERAGE A BODILY IN does n.ot,apply to "premises damage"caused . JURY AND Pi PERT.Y DAMAGE LIASIL,ITY: by: ' This exclusion does not apply la an aircraft that a Fire; - is: • b ion; Explos (a) Chartered with a pilot to any insured; c, .Lightning: (b):.Not owned by any insured;and , " d. Smoke resulting from such fire,explosion, . (c) Netbeing used to carry any person or prop- or lightning;or erty for a charge. "e. Water, B. :DAMAGE TO PREMISES RENTED TO.YOU unless Exclusion I.of Section 1-Coverage A '1.. The first.paragraph of the exceptions in Ex- - Bodily:Injury And Property;Damage Liability ciusion 1., damage To Property, in Para- : is replaced 'by another endorsement to this graph 2. .of.SECTION; 1 - COVERAGES - . : . Coverage Part that has Exclusion.All Poilu- . COVERAGE: A BODILY INJURY AND • • do r Da n Injury O mageE `or Total Pollution x PROPERTY_DAMAGE LIABILITY is deleted elusion in its title.; - 2. The following replaces the Iasi paragraph of A fseparate Limit of insurance applies to — -- Paragraph:2„ Exclusions,_.of SECTION 1 -: ''premises.damage". as described in Para COVERAGES COVE,RAGE `A. BODILY graph 6.. of SECTION Iii - LIMIT'S OF iN- ._ : . ' SURANCE. CO D3 16 ii 11 c 2011 The l revelers Indemnity Company.Air rights reserved. Page I of 6 ,,,G1 OD.: is. ,/ DT-81O-OF'79972S-I4-TIL ).S Harcn Company • • COMMERCIAL AUTO t I 7 IS ENDORSEMENT CHANGES THE POLICY, PLEASE READ IT CAREFULLY. • • . . . BUSINESS AUTO EXTENSION ENDORSEMENT This/endorsement Modifies Insurance provided under the following: I BUSINESS AUTO COVERAGE FORM : With respect to coverage provided by this endorsement,the provisions"of the Coverage Form applir unless modi- flled by the endorsement. • GENERAL DESCRIPTION OF COVERAGE—This endorsemenbroadens coverage.However,Cov t: erage for any •injury,damage"or medical expenses described any of the provisions of this endorsement may tie excluded or limited:by another endorsement to the..Coverage Part,and these coverage broadening provisions do not apply to the exteiTtahat covera9e is excluded or Limited bysuch an endorsement The following listing is a general covet- . ' _•age description only. Limitations and exclusions may apply tothese coverages,Read al1'the provisions.of this en-. dorsement and the restof your policy carefully todetebitine rights,duties,arid.what is and.is not covered, " / 'A` BROAD FORM NAMED"INSURED'" • H HIRED AUTO:PHYSICAL. DAMAGE —LOSS . :- . •• • OF USE_--INCREASED LIMIT. I ' CJ ., :B:•"BLANKET'ADDITIONAL INSURED . . • • 7.. , PHYSICAL DAMAGE.— TRANSPORTATION. ::':, ' • . EXPENSES--,INCREASED LIMIT C.. EMPLOYEE HIRED AUTO J. PERSONAL.EFFECT•S: • D. •EMPLOYEES AS'INSURED Ki AIRBAGS " ":"' E. SUPPLEMENTARY PAYMENTS--INCREASED . L...NOTICE AND KNOWLEDGE OF ACCIDENT" V LIMITS ..• . ARtosS F HIRED AUTO -- LiMISED WORLDWIDE • i'lL. BLANKET WAIVER OF SUBTIOGATION .. . COVERAGE :"INDENINITYBASIS`:.: • - . .. G WAIVER OF DEDUCTIBLE—GLASS • , N:. UNINTENTIONALFRRORS OR orntssip s " PROVISIONS. A BROADFORM"NAMED INSURED :.• • . executed by you before the •"bodily injury" or the following Is added to Paragraph Aa.,Who Is "property damage""occurs and that:is in effect::,' An• `Insured;'of SECTION it 7 UABIL,1TY CO •V' •dunrigthe policy period,to:be.natrited •as an addr • ERAGE ,` red"for•Lfabillty Cover 'tlonal insured is an "insured Any organizatPon ou newt a oTre"or corm dur- age,but only.for damages to Which',this insurance .. y ]r applies and only to the extent that person or or-_ .Ing the policy period ovet',•which you. maintain'.• . :ganization qualifies as an 'Insure'd" under the 50%lor more.ownership interest and that is inot . • Who.Ispn insured provision contained in Section: - •• separately insured for Business Auto.:Coverage, .: • II .. . ` .. _ Coverage under this provision is afiiorded only"un=': C. EMPLOYEE HIRED AUTO • 4 ti!the 180th`dayafter you"acquire"orform the sOr- •• " •. . ganization or the.and of the.policyperiod,.which- ' . 1. '.The. following Is added to Paragraph Al., i ever'is earlier,` . . " " . ""•. .Who Is An :Insured;. of SECTION F. - LL; .. B' • TBL.ANISETADDITIONAL INSURED '..c" ; ;.;t :>'IBILITY"COVERAGE , he following is.added to Paragraph_ ,� n':A;'i. _ employee o yours is an "insured".rlh le .: -. Who.Is An,insured,_of SECTION II -•LIAB.ILITY ., operating an auto„hired 9r,rented undera COVERAGE: • oor aagree tat'"emeplooree's j a c nfract' rnenf Tn b - An •••:._. n me;with Y to pemtissian,white p n rm(rig _ y.person'orarganization who.Is required under . :dttres.related to the cpnduct o€.your buss ':a written.contract or agreement between you and : :" ::•• - ness. . • • • that person or organization; 'that is signed end CA T3 53 03 10 S 2050 The Travelers indemnity Company. Page i of 4 includes copyrighted material o;Insurance Services Office Inc,with Its permission. - POLICY NUMBER: DT-810-0F799728-TIL-14 ISSUE DATE: 02-04-15 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. DESIGNATED ENTITY - NOTICE OF CANCELLATION/NONRENEWAL PROVIDED BY US This endorsement modifies insurance provided under the following: ALL COVERAGE PARTS INCLUDED IN THIS POLICY SCHEDULE CANCELLATION: Number of Days Notice of Cancellation: 30 DAYS NONRENEWAL: Number of Days Notice of Nonrenewal: 30 DAYS PERSON OR ORGANIZATION: ANY PERSON OR ORGANIZATION TO WHOM YOU HAVE AGREED IN A WRITTEN CONTRACT THAT NOTICE OF CANCELLATION OR NONRENEWAL OF THIS POLICY WILL BE GIVEN, BUT ONLY IF: 1. YOU SEND US A WRITTEN REQUEST TO PROVIDE SUCH NOTICE, INCLUDING THE NAME AND ADDRESS OF SUCH PERSON OR ORGANIZATION, AFTER THE FIRST NAMED INSURED RECEIVES NOTICE FROM US OF THE CANCELLATION OR NONRENEWAL OF THIS POLICY; AND 2. WE RECEIVE SUCH WRITTEN REQUEST AT LEAST 14 DAYS BEFORE THE BEGINNING OF THE APPLICABLE NUMBER OF DAYS SHOWN IN THIS ENDORSEMENT ADDRESS: PROVISIONS: A. If we cancel this policy for any statutorily permit- B. If we decide to not renew this policy for any statu- ted reason other than nonpayment of premium, torily permitted reason, and a number of days is and a number of days is shown for cancellation in shown for nonrenewal in the schedule above, we the schedule above, we will mail notice of cancel- will mail notice of the nonrenewal to the person or lation to the person or organization shown in the organization shown in the schedule above. We schedule above. We will mail such notice to the will mail such notice to the address shown in the address shown in the schedule above at least the schedule above at least the number of days number of days shown for cancellation in the shown for nonrenewal in the schedule above be- schedule above before the effective date of can- fore the expiration date. cellation. IL T4 00 12 09 ©2009 The Travelers Indemnity Company Page 1 of 1 POLICY NUMBER: DT-CO-0F796197-COF-14 ISSUE DATE: 01-29-15 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. DESIGNATED ENTITY - NOTICE OF CANCELLATION/NONRENEWAL PROVIDED BY US This endorsement modifies insurance provided under the following: ALL COVERAGE PARTS INCLUDED IN THIS POLICY SCHEDULE CANCELLATION: Number of Days Notice of Cancellation: 30 NONRENEWAL: Number of Days Notice of Nonrenewal: PERSON OR ORGANIZATION: ANY PERSON OR ORGANIZATION TO WHOM YOU HAVE AGREED IN A WRITTEN CONTRACT THAT NOTICE OF CANCELLATION OR NONRENEWAL OF THIS POLICY WILL BE GIVEN, BUT ONLY IF: 1. YOU SEND US A WRITTEN REQUEST TO PROVIDE SUCH NOTICE, INCLUDING THE NAME AND ADDRESS OF SUCH PERSON OR ORGANIZATION, AFTER THE FIRST NAMED INSURED RECEIVES NOTICE FROM US OF THE CANCELLATION OR NONRENEWAL OF THIS POLICY; AND RECEIVES NOTICE FROM US OF THE CANCELLATION OF THIS POLICY; AND 2. WE RECEIVE SUCH WRITTEN REQUEST AT LEAST 14 DAYS BEFORE THE BEGINNING OF THE APPLICABLE NUMBER OF DAYS SHOWN IN THIS ENDORSEMENT. ADDRESS: PROVISIONS: A. If we cancel this policy for any statutorily permit- B. If we decide to not renew this policy for any statu- ted reason other than nonpayment of premium, torily permitted reason, and a number of days is and a number of days is shown for cancellation in shown for nonrenewal in the schedule above, we the schedule above, we will mail notice of cancel- will mail notice of the nonrenewal to the person or lation to the person or organization shown in the organization shown in the schedule above. We schedule above. We will mail such notice to the will mail such notice to the address shown in the address shown in the schedule above at least the schedule above at least the number of days number of days shown for cancellation in the shown for nonrenewal in the schedule above be- schedule above before the effective date of can- fore the expiration date. cellation. IL T4 00 12 09 ©2009 The Travelers Indemnity Company Page 1 of 1 TRAVELERS J� WORKERS COMPENSATION AND ONE TOWER SQUARE EMPLOYERS LIABILITY POLICY HARTFORD, CT 06183 ENDORSEMENT WC 99 06 R4 (00) POLICY NUMB '. (DTAUB-5910B24-5-14) NOTICE OF CANCELLATION OR NONRENEWAL TO DESIGNATED PERSONS OR ORGANIZATIONS The following is added to PART SIX—CONDITIONS: Notice Of Cancellation Or Nonrenewal To Designated Persons Or Organizations If we cancel or non-renew this policy for any reason other than non-payment of premium by you, we will provide notice of such cancellation or non-renewal to each person or organization designated in the Schedule below. We will mail or deliver such notice to each person or organization at its listed address at least the number of days shown for that person or organization before the cancellation or nonrenewal is to take effect. You are responsible for providing us with the information necessary to accurately complete the Schedule below. If we cannot mail or deliver a notice of cancellation or nonrenewal to a designated person or organization because the name or address of such designated person or organization provided to us is not accurate or complete, we have no responsibility to mail, deliver or otherwise notify such designated person or organization of the cancellation or nonrenewal. SCHEDULE Number of Name and Address of Designated Persons or Organizations: Days Notice ANY PERSON OR ORGANIZATION WITH WHOM YOU HAVE AGREED IN A WRITTEN 30 CONTRACT THAT NOTICE OF CANCELLATION OR NONRENEWAL OF THIS POLICY WILL BE GIVEN, BUT ONLY IF: 1. YOU SEE TO IT THAT WE RECEIVE A WRITTEN REQUEST TO PROVIDE SUCH NOTICE, INCLUDING THE NAME AND ADDRESS OF SUCH PERSON OR ORGANIZATION, AFTER THE FIRST NAMED INSURED RECEIVES NOTICE FROM US OF THE CANCELLATION OR NONRENEWAL OF THIS POLICY; AND 2. WE RECEIVE SUCH WRITTEN REQUEST AT LEAST 14 DAYS BEFORE THE BEGINNING OF THE APPLICABLE NUMBER OF DAYS SHOWN IN THIS ENDORSEMENT. ADDRESS: THE ADDRESS FOR THAT PERSON OR ORGANIZATION INCLUDED IN SUCH WRITTEN REQUEST FROM YOU TO US. DATE OF ISSUE: 02-19-15 ST ASSIGN: Page 1 of 3 ©2013 The Travelers Indemnity Company.All rights reserved. TRAVELERS WORKERS COMPENSATION AND ONE AR TOWER TQ6E HARTFORD,, CCT 06183 EMPLOYERS LIABILITY POLICY ENDORSEMENT WC 00 03 13 (00)-01 POLICY NUMBE . (DTAUB-5910B24-5-14) WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT 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 (This agreement applies only to the extent that you perform work under a written contract that requires you to obtain this agreement from us) This agreement shall not operate directly or indirectly to benefit any one not named in the Schedule SCHEDULE DESIGNATED PERSON: DESIGNATED ORGANIZATION: ANY PERSON OR ORGANIZATION FOR WHICH THE INSURED HAS AGREED BY WRITTEN CONTRACT EXECUTED PRIOR TO LOSS TO FURNISH THIS WAIVER } DATE OF ISSUE: 10-14-19 ST ASSIGN: 5' TRAVELERS WORKERS COMPENSATION AND ONE TOWER SQUARE EMPLOYERS LIABILITY POLICY HARTFORD, CT 06183 ENDORSEMENT WC 99 06 R4 (00) POLICY NUMBER: (DTAUB-5910B24-5-14) Number of Name and Address of Designated Persons or Organizations: Days Notice All other terms and conditions of this policy remain unchanged. This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated. (The information below is required only when this endorsement is issued subsequent to preparation of the policy.) Endorsement Effective Policy No. Endorsement No. Insured Premium $ Insurance Company Countersigned by DATE OF ISSUE: 02-19-15 ST ASSIGN: Page 3 of 3 ©2013 The Travelers Indemnity Company.All rights reserved. TRAVELERS` WORKERS COMPENSATION AND ONE TOWER SQUARE EMPLOYERS LIABILITY POLICY HARTFORD, CT 06183 ENDORSEMENT WC 99 06 R4 (00) POLICY NUMBER: (DTAUB-5910B24-5-14) Number of Name and Address of Designated Persons or Organizations: Days Notice DATE OF ISSUE: 02-19-15 ST ASSIGN: Page 2 of 3 ©2013 The Travelers Indemnity Company.All rights reserved.