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C2015-146 - 2/23/2015 - NA
00 52 23 AGREEMENT This Agreement,for the project (contract renewal)approved on January 16, 2015, is between the City of Corpus Christi,Texas (Owner) and Haas-Anderson Construction, Ltd. (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 follows: Contract Renewal Pro).#E14021 Citywide Street Preventative Maintenance Program Year 2 IDIQ(Contract Renewal No. 1 of Original#E12215 Citywide Street Overlay&Sealcoat IDIQ Pilot Program) ARTICLE 2—DESIGNER AND OWNER'S AUTHORIZED REPRESENTATIVE 2.01 The Project has been designed by: Coym, Rehmet&Gutierrez Engineering LP 5656 So.Staples—Suite 230 Corpus Christi,TX 78411 2.02 The Owner's Authorized Representative for this Project is: Albert Pardo, P.E.—Construction Engineer City of Corpus Christi—Capital Programs 4917 Holly Bldg.#5 Corpus Christi,TX 78411 ARTICLE 3—CONTRACT TIMES 3.01 Contract Times A. The Work is required to be substantially completed within 365 days after the date when the Contract Times commence to run as provided in the Notice to Proceed and is to be completed and ready for final payment in accordance with Paragraph 15.06 of the General Conditions within 365 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 01 35 00 SPECIAL PROCEDURES. 3.02 Liquidated Damages 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 2015-146 2/23/15 y 13,2015 00 52 23-1 :ywide SPMP 09-25-2013 Haas-Anderson Construction Ltd INDEXED 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 0135 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 in SECTION 00 30 01 BID FORM EXHIBIT A. Unit prices have been computed in accordance with Paragraph 13.03 of the General Conditions. Contractor acknowledges that estimated quantities are not guaranteed, and were solely for the purpose of comparing Bids,and final payment for all unit price items will be based on actual quantities, determined as provided in the Contract Documents. Total Contract Amount $ 9,975,000.00 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. 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. Agreement—Revised February 13,2015 00 52 23-2 Contract Renewal#E14021 Citywide SPMP 09-25-2013 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. 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; Agreement—Revised February 13,2015 00 52 23-3 Contract Renewal#E14021 Citywide SPMP 09-25-2013 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. 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. Agreement—Revised February 13,2015 00 52 23-4 Contract Renewal#E14021 Citywide SPMP 09-25-2013 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. (Overlay Delivery Orders 1—5) Citywide Street Preventative Maintenance Program (SPMP)Year 2, Project No. E14021. 3. Addenda. 4. Exhibits to this Agreement: a. Contractor's Qid Form Exhibit ^. See Attachment"A"for New Unit Pricing for contract renewal Project No. E14021 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. Agreement—Revised February 13,2015 00 52 23-5 Contract Renewal#E14021 Citywide SPMP 09-25-2013 The effective date of the Contract is EZ LYl w9-a.� 023 2O, ATTEST CITY OF COR' TI 410., City Secretary Jef o:maker, P.E. A ing rector of Capital Programs APPROVED AS TO LEGAL FORM A _ . 1111.-.1.1.4 G . _- • Asst. City Attorney ATTEST(IF CORPORATION) CONTRACTOR (Seal Below) By: Darryl O. Haas Note: Attach copy of authorization to sign if Haas-Anderson Management LC,Person signing for Contractor is not President, Title: C,, ,- ,Orier Vice President, Chief Executive Officer, or Chief Financial Officer 1402 Holly Road Address - Corpus Christi,TX, 78417 City State Zip 361-853-2535 Phone Fax rmoore@haas-anderson.com Email END OF SECTION Agreement-Revised February 13,2015 00 52 23-6 Contract Renewal#E14021 Citywide SPMP 09-25-2013 SPMP YR 2 Renewal (Overlays) Time of completion: 1 YR (365 Calendar days) Citywide Street Overlay& Sealcoat IDIQ Program -Year 2 - SPMP YR i Renewal SPMP YR 2 Project No. E14021 Item Description Unit Unit Price Unit Price No. Mobilization/Bonds/Insurance;(not to exceed 5%of total bid amount)to be authorized A2-01 for payment concurrent with overall progress LS $ 550,000.00 $ 498,750.00 Traffic Control and SWPPP,Residential Streets;set-up,maintenance and removal, A2-02 EA $ 1,110.00 $ 1,110.00 complete In place per residential street Traffic Control and SWPPP,Collector Streets;set-up maintenance and removal, A2-03 EA $ 3,335.00 $ 3,335.00 complete in place per collector street Traffic Control and SWPPP,Arterial Streets;set-up maintenance and removal,complete A2-04 in place per arterial street EA $ 4,445.00 $ 4,445.00 A2-05 Ozone Days DAY $ 3,335.00 $ 3,335.00 Pavement Marking,Reflectorized Thermoplastic,Type 1,90 mill thickness(W)(8") A2-06 LF $ 0.50 $ 0.50 (Solid),complete in place with all surface preparation,application,etc. A2 07 Pavement Marking,Reflectorized Thermoplastic,Type 1,90 mill thickness (W)(4") LF $ 0.50 $ 0.50 (Broken),complete in place with all surface preparation,application,etc. Pavement Marking,Reflectorized Thermoplastic,Type 1,90 mill thickness(Y)(4") A2-08 LF $ 0.50 $ 0.50 (Solid),complete in place with all surface preparation,application,etc. A2-09 Raised Pavement Markers(Reflectorized),Type IC,IIAA,or IIC-R,as applicable complete EA $ 4.40 $ 4.40 in place with all surface preparation,application,etc. Speed Humps,marked with Thermoplastic,Type C,with no preheating or asphalt A2-10 EA $ 2,335.00 $ 2,335.00 required,125 mill,complete in place with all surface preparation,application,etc. Pavement Markings(White 24""Stop Bar"Markings),complete in place with all surface A2-11 LF $ 15.55 $ 15.55 preparation,application,etc. Pavement Markings(Crosswalk Markings),complete in place(total width of crosswalk) A2-12 LF $ 55.60 $ 55.60 complete in place with all surface preparation,application,etc. Pavement Markings White"ONLY",complete in place with all surface preparation, A2-13 EA $ 275.00 $ 275.00 application,etc. Pavement Markings White Turn Arrow Markings(Right,Left,Straight),complete in A2-14 EA $ 215.00 $ 215.00 place with all surface preparation,application,etc. Curb Painting(Yellow No-Parking Zone),complete in place with all surface preparation, A2-15 LF $ 3.35 $ 3.35 applications,etc. Curb Painting(Red Fire Zone),complete in place with all surface preparation, A2-16 LF $ 3.35 $ 3.35 applications,etc. Computerized Profilograph Services to include street surface evaluations with calibrated A2-17 HR $ 110.00 $ 110.00 vehicle and equipment and approved reports Landscape Improvements,complete in place including 4"clean Top Soil,Sod, A2-18 SY $ 110.00 $ 110.00 excavation,backfill,compaction,with established growth Door Hangars,complete in place delivered to the business and residences(two per A2-19 property) LS $ 11,000.00 $ 11,000.00 Attachment"A" Page 1 of 4 A2-20 Type 1 Self-Supported Temporary Sediment Control Fence, complete in place, maintained and removed LF $ 11.00 $ 11.00 A2-21 Temporary Erosion Control Log,complete in place,maintained and removed EA $ 33.00 $ 33.00 A2-22 Street Sweeping,complete in place per curb mile Mile $ 550.00 $ 550.00 A2-23 Irrigation System Allowance and Miscellaneous Planting Allowance LS $ 3,500.00 $ 3,500.00 A2-24 Allowance for unanticipated General Improvements LS $ 5,000.00 $ 5,000.00 Part B-HMAC and Road Base Improvement Activities Subgrade Repair up to 2"Depth(Cold/Hot)HMAC complete in place with B2-01 SY/IN $ 12.25 $ 12.45 excavation/removal,placement,compaction etc. Subgrade Repair up to 6"Depth(cement stabilization)complete in place with B2-02 excavation/removal,placement,compaction etc. SY $ 14.25 $ 14.76 Cement stabilized base with typically 4%cement,existing limestone base,3-6 inches, B2-03 SY $ 8.50 $ 8.91 complete in place with all grading,mixing,compaction,etc. B2-04 TX5-475 Triaxial Geogrid,complete in place with material and proper placement SY $ 3.50 $ 3.50 Base Repair,Upper 2"Depth(limestone)complete in place with excavation/removal, B2-05 placement,compaction etc. SY $ 7.75 $ 7.75 Base Repair,Additional 1"Depth(limestone)complete in place with B2-06 SY $ 3.70 $ 3.70 excavation/removal,placement,compaction etc. B2-07 HMAC Saw Cutting 2"Depth,complete in place LF $ 2.20 $ 2.20 B2-08 HMAC Saw Cutting Additional 1"Depth,complete in place LF $ 1.10 $ 1.10 B2 09 Patching/Small Area Surface Restoration-HMAC,Type"D"per square yard/inch SY/IN $ 11.10 $ 11.30 complete in place with small equipment placement,compaction,curing,hauling,etc. B2-10 Crack Seal complete in place with all surface preparation and application LF $ 4.50 $ 4.50 Asphalt material,AC-15P,for Sealcoat Per Single Course(one to five miles haul distance B2-11 from an approved site within City Limits)complete in place with all surface preparation, Gal application,curing,rolling/compaction,etc. Emulsion Cationic Grade(HFRS-2P)typically applied at a rate ranging from 0.35 to 0.40 B2-12 Gal/SY,(one to five miles haul distance from an approved site within City Limits), Gal complete in place per applied rates and requirements Trap Rock(Basalt)Grade 5 Type E per specified gradation,decanted and la abrasion, B2-13 applied at approximately 150SY/CY,(one to five miles haul distance from an approved Ton site within City Limits),complete in place,haul,rolled,compacted,etc. Asphalt material,AC-15P,for Sealcoat Per Single Course(over five miles haul distance B2-14 from an approved site within City Limits)complete in place with all surface preparation, Gal application,curing,rolling/compaction,etc. Emulsion Cationic Grade(HFRS-2P)typically applied at a rate ranging from 0.35 to 0.40 B2-15 Gal/SY,(over five miles haul distance from an approved site within City Limits), Gal complete in place per applied rates and requirements Trap Rock(Basalt)Grade 5 Type E per specified gradation,decanted and la abrasion, 82-16 applied at approximately 150SY/CY,(over five miles haul distance from an approved site Ton within City Limits),complete in place,haul,rolled,compacted,etc. Planing(Milling)(1"to 1 1/4")complete in place with all preparation,milling B2-17 SY $ 2.90 $ 2.90 operations,hauling,etc. Planing(Milling)Additional(1")complete in place with all preparation,milling B2-18 SY $ 1.00 $ 1.00 operations,hauling,etc. B2-19 Proof Rolling complete in place with equipment,operator,etc. Hour $ 167.00 $ 167.00 Attachment"A" Page 2 of 4 )10 Surface Treatment-HMAC,Type"D"per square yard/inch(one to five miles haul B2-20 distance from an approved site within City Limits)complete in place with tack coat(SS- SY/IN $ 6.60 $ 6.80 1H),placement,compaction,curing,hauling,etc. Surface Treatment-HMAC,Type"D"per square yard/inch(over five miles haul distance B2-21 from an approved site within City Limits)complete in place with tack coat(SS-1H), SY/IN $ 6.75 $ 6.95 placement,compaction,curing,hauling,etc. B2-22 Allowance for unanticipated Street Improvements LS $ 10,000.00 $ 10,000.00 Part C-Concrete Activities(Curb&Gutter/Driveways/Sidewalks etc.) Removal and Replacement of multiple small segments of concrete Curb&Gutter, C2-01 complete in place with demo,disposal,forms,rebar,concrete,compaction,curing, LF $ 110.00 $ 111.39 finish,etc. Removal and Replacement of 6"concrete driveway approaches, complete in place with C2-02 demo,disposal,forms,rebar,concrete,compaction,curing,finish etc. SF $ 22.25 $ 22.78 Replacement of stamped 6"concrete driveway approaches, complete in place with C2-03 SF $ 44.50 $ 44.50 demo,disposal,forms,rebar,concrete,curing,compaction,finish,etc. Replacement of"washed"6"concrete driveway approaches, complete in place with C2-04 demo,disposal,forms,rebar,concrete,compaction,curing,finish etc. SF $ 44.50 $ 44.50 Replacement of driveway approaches,complete in place with High Early Strength 6" C2-05 SF $ 33.35 $ 33.35 Concrete complete in place with activity C-03 above C2-06 Temporary Driveway Access;set-up,maintenance and removal EA $ 1,110.00 $ 1,110.00 Removal of and Replacement of 4"Concrete Sidewalk&Bike paths,complete in place C2-07 SF $ 22.25 $ 22.61 with all demo,hauling,disposal,etc. New 4"Concrete Sidewalk&Bike paths, complete in place with demo,disposal,forms, C2-08 SF $ 22.25 $ 22.61 rebar,concrete,compaction,curing,finish,etc. C2-09 Concrete Saw Cutting 4"Depth,complete in place LF $ 11.10 $ 11.10 C2-10 Concrete Saw Cutting Additional 1"Depth,complete in place LF $ 4.45 $ 4.45 Concrete Joint Repairs for concrete roadways,removal and replacement,complete in C2-11 LF $ 22.00 $ 22.00 place with removal,cleaning,disposal,and placement of new joint material,etc. C2-12 Allowance for unanticipated Concrete improvements LS $ 5,000.00 $ 5,000.00 Part D-Minor Utility Adjustments(Manhole Ring&Cover/Valve Boxes etc.) Sanitary Sewer Manhole Ring&Cover Adjustment,including New Manhole Ring& Cover Assembly with New Height Adjustment Rings,Stainless Steel Inflow Inhibitor and D2-01 EA $ 2,205.00 $ 2,205.00 with Concrete Collar,complete in place with demo,disposal,forms,rebar,concrete, curing,compaction,finish,etc. Storm Water Manhole Ring&Cover Adjustment,including New Manhole Ring and D2-02 Cover Assembly with New Concrete Collar,complete in place with demo,disposal, EA $ 2,000.00 $ 2,000.00 forms,rebar,concrete,curing,compaction,finish etc. Water Valve Adjustment with Concrete Collar,complete in place with demo,disposal, D2-03 EA $ 1,110.00 $ 1,110.00 forms,rebar,concrete,compaction,finish,etc. Replacement of Concrete Collars with High Early Strength Concrete(in addition to unit D2-04 EA $ 44.50 $ 44.50 price),complete in place with activity D-01 or D-02 above D2-05 Allowance for unanticipated Wastewater,Water and Stormwater improvements LS $ 5,000.00 $ 5,000.00 Part E-ADA Improvement Activities(Ramps/Approaches etc.) E2-01 Removal and Replacement of concrete Curb&Gutter Returns adjacent to ADA Ramps, LF $ 55.50 $ 57.26 complete in place with demo,disposal,forms,rebar,concrete,etc. Attachment"A" I , Page 3 of 4 404 ��i Removal and Replacement of 4"Concrete Sidewalk approaches to ADA Ramps, E2-02 complete in place with demo,disposal,forms,rebar,concrete,etc. SF $ 22.25 $ 22.61 New ADA TDLR Compliant Concrete Curb Ramp and Landings;complete in place with E2-03 demo,disposal,forms,rebar,concrete,delineators,etc. SF $ 2,225.00 $ 2,256.74 Remove and Replace ADA curb Ramps and Landings not in compliance with TDLR with E2-04 demo,disposal,forms,rebar,concrete,delineators,etc. SF $ 3,335.00 $ 3,366.74 New 4"Wide Concrete Header Curb(0 to 6"high)for offset elevation changes, E2-05 complete in place with demo,disposal,forms,rebar,concrete,compaction,curing, LF $ 67.00 $ 67.30 finish,etc. E2-06 Allowance for unanticipated ADA Improvements LS $ 5,000.00 $ 5,000.00 1 All bid items include the required labor,materials and equipment for the construction activities shown for a typical 365 calendar performance period 2 This an Indefinite Delivery Indefinite Quantity(IDIQ)Contract with a 365 calendar day base year with four(4) 1-year optional extensions. Each Delivery Order will include a specific performance period and cost based on the contract bid prices and quantities approved by the engineer and city. 3 This contract allows for an annual economic adjustment to the unit prices based on approved City indexes in January each year. Attachment"A" ` P Page 4 of 4 / II 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: Citywide Street Preventative Maintenance Program Year 2 E14021 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: Haas-Anderson Construction, Ltd. By: signature--attach evidence of authority to sign) Name: Darryl O. Haas F;:_;, G c Haas-Anderson 41641*6ii ta, Title: C"_:;,, .`,s ?rtner Business address: 1402 Holly Road Corpus Christi,Texas 78417 Phone: 361-853-2535 Email: rmoore@haas-anderson.com END OF SECTION Non-Collusion Certification 00 30 06-1 Citywide Street Preventative Maintenance Program Year 2—Project E14021 11-25-2013 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. Bidder qualifies as a nonresident bidder whose principal place of business or residency is in the State of X 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: Haas—Anderson Construction, Ltd. By: Name: Darryl O. Haas t. ;-i3a3-Anderson Management,LC - er Title: Business Address: 1402 Holly Road Corpus Christi,TX 78417 Phone: 361-853-2535 Email: rmoore@haas-anderson.com END OF SECTION Compliance to State Law on Nonresident Bidders 00 30 02-1 Citywide Street Preventative Maintenance Program Year 2—Project E14021 11-25-2013 00 30 05 City of Corpus Christi Disclosure of Interest i SUPPLIER NUMBER TO BE ASSIGNED BY CI FY = PURCHASING DIVISION �.v City of CITY OF CORPUS CHRISTI Corpus DISCLOSURE OF INTEREST Christi 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: Haas-Anderson Construction, Ltd. P.O.BOX: P.O. Box 7692, Corpus Christi,TX 78467 STREET ADDRESS: 1402 Holly Road CITY: Corpus Christi ZIP: 78417 - FIRM IS: 1. Corporation ❑ 2. Partnership X 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) none 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 none 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 none 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 none 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: Darryl 0 Haas Title: P '°"i nt, Haas-Anderson Management LC, (Type or Print) ' ' Signature of CertifyingZO7Date: Person: 01-19-2015 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 04 CONFLICT OF INTEREST QUESTIONNAIRE CONFLICT OF INTEREST QUESTIONNAIRE FORM CIQ For vendor or other person doing business with local governmental entity This questionnaire reflects changes made to the law by H.B. 1491, 80th Leg., Regular Session. OFFICE USE ONLY This questionnaire is being filed in accordance with Chapter 176, Local Government Code Date Received by a person who has a business relationship as defined by Section 176.001(1-a)with a local governmental entity and the person meets requirements under Section 176.006(a). By law this questionnaire must be filed with the records administrator of the local governmental entity not later than the 7th business day after the date the person becomes aware of facts that require the statement to be filed. See Section 176.006,Local Government Code. A person commits an offense if the person knowingly violates Section 176.006, Local Government Code.An offense under this section is a Class C misdemeanor. J Name of person who has a business relationship with local governmental entity. none riCheck 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.) 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. 01-19-2015 Signature of person doing business with the governmental entity Date Adopted 06/29/2007 00 61 13 PERFORMANCE BOND BOND NO.: 106041728 Contractor as Principal Surety Name: Haas-Anderson Construction, Ltd. Name: Travelers Casualty and Surety Company of America Mailing address(principal place of business): Mailing address(principal place of business): P.O. Box 7692 9601 McAllister Freeway, Suite 900 Corpus Christi,TX 78467 San Antonio, TX 78216 Physical address(principal place of business): Owner 9601 McAllister Freeway, Suite 900 San Antonio, TX 78216 Name: City of Corpus Christi,Texas Mailing address(principal place of business): Engineering Services Surety is a corporation organized and existing 1201 Leopard Street under the laws of the state of: Connecticut Corpus Christi,Texas 78401 8y 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): 210-525-3963 Contract Renewal Proj#E14021 Citywide Street Preventative Maintenance Program Year 2 Telephone (for notice of claim):267-675-3057 Original#E12215 Citywide Street Overlay and Sealcoat ID/IQ Pilot Program) Local Agent for Surety Name: Keetch & Associates Approved Date of Contract: Address: P. 0. Box 3280 January 16, 2015 Corpus Christi, TX 78463-3280 Contract Price: $9,975,000.00 Telephone: 361-883-3803 Bond Email: kwoods@keetchins.com Date of Bond: January 19, 2015 (Date of Bond cannot be earlier than Award Date The address of the surety company to which any of the Contract) notice of claim should be sent may be obtained Said Principal and Surety have signed and sealed from the Texas Dept. of Insurance by calling the this instrument in 4 copies,each one of which shall following toll-free number:1-800-252-3439 be deemed an original. Performance Bond 00 61 13 -1 Cont Ren Citywide SPMP Year 2#E14021 11-25-2013 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 abSignature: - Signature: Lt2C r J' oods Name: �, �] /y�Q-�S Name: KerY Pr;ideM, Haas-Anderson Management,LC, '` — Title: C., ,,.: ? partner Title: Attorney-in-Fact t. Email Address: "(1/9' Email Address: kwoods@keetchins.co'm (Attach Power of Attorney and place surety seal below) END OF SECTION Performance Bond 00 61 13 -2 Cont Ren Citywide SPMP Year 2#E14021 11-25-2013 00 61 16 PAYMENT BOND BOND NO.: 106041728 Contractor as Principal Surety Name: Haas-Anderson Construction, Ltd. Name: Travelers Casualty and Surety Company of America Mailing address(principal place of business): Mailing address(principal place of business): P.O. Box 7692 9601 McAllister Freeway, Suite 900 Corpus Christi,TX 78467 San Antonio, TX 78216 Physical address(principal place of business): Owner 9601 McAllister Freeway, Suite 900 San Antonio, TX 78216 Name: City of Corpus Christi,Texas Mailing address(principal place of business): Engineering Services Surety is a corporation organized and existing 1201 Leopard Street under the laws of the state of: Connecticut Corpus Christi,Texas 78401 By submitting this Bond,Surety affirms its authority to do business in the State of Texas and Contract its license to execute bonds in the State of Texas. Project name and number: Telephone (main number): 210-525-3963 Contract Renewal Proj#E14021 Citywide Street Preventative Maintenance Program Year 2 (Original#E12215 Citywide Street Overlay and Telephone (for notice of claim):267-675-3057 Sealcoat ID/IQ Pilot Program) Local Agent for Surety Name: Keetch & Associates Approved Date of Contract: Address: P. 0. Box 3280 January 16, 2015 Corpus Christi, TX 78463-3280 Contract Price: $9,975,000.00 Telephone: 361-883-3803 Bond Email: kwoods@keetchins.com Date of Bond: January 19, 2015 (Date of Bond cannot be earlier than Award Date The address of the surety company to which any of Contract) notice of claim should be sent may be obtained Said Principal and Surety have signed and sealed from the Texas Dept. of Insurance by calling the this instrument in 4 copies,each one of which shall following toll-free number:1-800-252-3439 be deemed an original. Payment Bond Form 00 61 16-1 Cont Ren Citywide SPMP Year 2 4E14021 11-25-2013 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 Principe Surety Signature: /� Signature: jiL ,1X f- al Name: Kerry ods Name: P. �• l e ry o Title: Pi-Aent� Haas-Anderson Management, �'aTitle: Attorney-in-Fact Email Address: .✓'/4 Email Address: kwoods@keetchins.Com (Attach Power of Attorney and place surety seal below) END OF SECTION Payment Bond Form 00 61 16-2 Cant Ren Citywide SPMP Year 2#E14021 11-25-2013 WARNING:THIS POWER OF ATTORNEY IS INVALID WITHOUT THE RED BORDER IA► POWER OF ATTORNEY TRAVELERSJ Farmington Casualty Company St.Paul Mercury Insurance Company Fidelity and Guaranty Insurance Company Travelers Casualty and Surety Company Fidelity and Guaranty Insurance Underwriters,Inc. Travelers Casualty and Surety Company of America St.Paul Fire and Marine Insurance Company United States Fidelity and Guaranty Company St.Paul Guardian Insurance Company Attorney-In Fact No. 225516 Certificate No. O O 5 5 8 8 6 22 KNOW ALL MEN BY THESE PRESENTS: That Farmington Casualty Company,St. Paul Fire and Marine Insurance Company,St. Paul Guardian Insurance Company,St.Paul Mercury Insurance Company,Travelers Casualty and Surety Company,Travelers Casualty and Surety Company of America,and United States Fidelity and Guaranty Company are corporations duly organized under the laws of the State of Connecticut,that Fidelity and Guaranty Insurance Company is a corporation duly organized under the laws of the State of Iowa,and that Fidelity and Guaranty Insurance Underwriters,Inc.,is a corporation duly organized under the laws of the State of Wisconsin(herein collectively called the"Companies"),and that the Companies do hereby make,constitute and appoint Betty J.Baxter,Kevin G.Keetch,Kerry J.Woods,Tracie Henderson,and Lonna Pokrant of the City of Corpus Christi ,State of Texas ,their true and lawful Attorney(s)-in-Fact, each in their separate capacity if more than one is named above,to sign,execute,seal and acknowledge any and all bonds,recognizances,conditional undertakings and other writings obligatory in the nature thereof on behalf of the Companies in their business of guaranteeing the fidelity of persons,guaranteeing the performance of contracts and executing or guaranteeing bonds and undertakings required or permitted in any actions or proceedings allowed by law. IN WITNESS WHEREOF,the Companies have caused this instrument to be signed and their corporate seals to be hereto affixed,this 6th day of August 2013 Farmington Casualty Company St.Paul Mercury Insurance Company Fidelity and Guaranty Insurance Company Travelers Casualty and Surety Company Fidelity and Guaranty Insurance Underwriters,Inc. Travelers Casualty and Surety Company of America St.Paul Fire and Marine Insurance Company United States Fidelity and Guaranty Company St.Paul Guardian Insurance Company ,.5(i _p/rt�Wn. �l ?p, FIRE P.1� SNS 71NSU ptY ANO SIIR� fVYA/0 2 � G i� 0}��' 'ma.yy c,;�' �` o4,o • c, o+ CICDRPOBATED N T �l-oOGYRATfm W::LAPP R.Ot�:•.C1^ oP m 3 �g ix 1_ WlCOWL ,te 19� A.w+/ :n: z n 2 HARTFORD, < i<i i 1H96 1982 0 - � F\ ? t r ' 'a 19 � . i .t•s E A L.,43/ i o CON CONN. f in di q� S 51 � ,,. .. .>" �•.• �ESBEL;a ; " 4y '+Eco+ �D 9 y s 4'fS.Nae` o�Y•.. ...*as N vi *%....1�a r4i AHt Fy nH ,{ TILS 4. u �'' ",r4.., I. 6 P/ <:1 State of Connecticut By: / City of Hartford ss. Robert L.Raney, enior Vice President On this the 6th day of August 2013 before me personally appeared Robert L.Raney,who acknowledged himself to be the Senior Vice President of Farmington Casualty Company, Fidelity and Guaranty Insurance Company,Fidelity and Guaranty Insurance Underwriters,Inc.,St.Paul Fire and Marine Insurance Company,St.Paul Guardian Insurance Company,St.Paul Mercury Insurance Company,Travelers Casualty and Surety Company,Travelers Casualty and Surety Company of America,and United States Fidelity and Guaranty Company,and that he,as such,being authorized so to do,executed the foregoing instrument for the purposes therein contained by signing on behalf of the corporations by himself as a duly authorized officer. G•Trr In Witness Whereof,I hereunto set my hand and official seal. TAR ), C My Commission expires the 30th day of June,2016. * AUBLO * Marie C.Tetreault,Notary Public 0'4* Ch's 58440-8-12 Printed in U.S.A. WARNING:THIS POWER OF ATTORNEY IS INVALID WITHOUT THE RED BORDER WARNING:THIS POWER OF ATTORNEY IS INVALID WITHOUT THE RED BORDER This Power of Attorney is granted under and by the authority of the following resolutions adopted by the Boards of Directors of Farmington Casualty Company,Fidelity and Guaranty Insurance Company,Fidelity and Guaranty Insurance Underwriters,Inc.,St.Paul Fire and Marine Insurance Company,St.Paul Guardian Insurance Company,St.Paul Mercury Insurance Company,Travelers Casualty and Surety Company,Travelers Casualty and Surety Company of America,and United States Fidelity and Guaranty Company,which resolutions are now in full force and effect,reading as follows: RESOLVED,that the Chairman,the President,any Vice Chairman,any Executive Vice President,any Senior Vice President,any Vice President,any Second Vice President,the Treasurer,any Assistant Treasurer,the Corporate Secretary or any Assistant Secretary may appoint Attorneys-in-Fact and Agents to act for and on behalf of the Company and may give such appointee such authority as his or her certificate of authority may prescribe to sign with the Company's name and seal with the Company's seal bonds,recognizances,contracts of indemnity,and other writings obligatory in the nature of a bond,recognizance,or conditional undertaking,and any of said officers or the Board of Directors at any time may remove any such appointee and revoke the power given him or her;and it is FURTHER RESOLVED,that the Chairman,the President,any Vice Chairman,any Executive Vice President,any Senior Vice President or any Vice President may delegate all or any part of the foregoing authority to one or more officers or employees of this Company,provided that each such delegation is in writing and a copy thereof is filed in the office of the Secretary;and it is FURTHER RESOLVED,that any bond,recognizance,contract of indemnity,or writing obligatory in the nature of a bond,recognizance,or conditional undertaking shall be valid and binding upon the Company when(a)signed by the President,any Vice Chairman,any Executive Vice President,any Senior Vice President or any Vice President,any Second Vice President,the Treasurer,any Assistant Treasurer,the Corporate Secretary or any Assistant Secretary and duly attested and sealed with the Company's seal by a Secretary or Assistant Secretary;or(b)duly executed(under seal,if required)by one or more Attorneys-in-Fact and Agents pursuant to the power prescribed in his or her certificate or their certificates of authority or by one or more Company officers pursuant to a written delegation of authority; and it is FURTHER RESOLVED,that the signature of each of the following officers:President,any Executive Vice President,any Senior Vice President,any Vice President, any Assistant Vice President,any Secretary,any Assistant Secretary,and the seal of the Company may be affixed by facsimile to any Power of Attorney or to any certificate relating thereto appointing Resident Vice Presidents,Resident Assistant Secretaries or Attorneys-in-Fact for purposes only of executing and attesting bonds and undertakings and other writings obligatory in the nature thereof,and any such Power of Attorney or certificate bearing such facsimile signature or facsimile seal shall be valid and binding upon the Company and any such power so executed and certified by such facsimile signature and facsimile seal shall be valid and binding on the Company in the future with respect to any bond or understanding to which it is attached. I,Kevin E.Hughes,the undersigned,Assistant Secretary,of Farmington Casualty Company,Fidelity and Guaranty Insurance Company,Fidelity and Guaranty Insurance Underwriters,Inc.,St.Paul Fire and Marine Insurance Company,St.Paul Guardian Insurance Company,St.Paul Mercury Insurance Company,Travelers Casualty and Surety Company,Travelers Casualty and Surety Company of America,and United States Fidelity and Guaranty Company do hereby certify that the above and foregoing is a true and correct copy of the Power of Attorney executed by said Companies,which is in full force and effect and has not been revoked. C IN TESTIMONY WHEREOF,I have hereunto set my hand and affixed the seals of said Companies this 19 day of January ••• ' '�0 15. -fir . �c a Kevin E.Hughes,Assistant Sec tary .i , '!I, k\0.E bMµyb 1.11 INS !!!!!!!...so tr 4q wv�ut 2 a ow°w N" 7", 0).---• ,G pr �p� Np N10w NtY,4- p W C 1 E GZ -. n� �RFOR 9 J: ; . 9 SGm NC "•� b" S INCORPoRA'a .. Y _- ma �!o A>�t w' OROT' ° 1/40'11 = 1982 0 t -. f 1 'I 977 a_,;,- rN a � i r:` .� � HARTFORD, a•tuarrorm, 5 ' m f 1951 ti f;,o.f 7 SE ALjo SEA,1,4, CONN. ,0 3 amu+• 1 0 1896 ,�(�� i ANCE G ��••...••' L -•.. 1..'s + 31 do Ls A1Ct rp b1 a Att To verify the authenticity of this Power of Attorney,call 1-800-421-3880 or contact us at www.travelersbond.com.Please refer to the Attorney-In-Fact number,the above-named individuals and the details of the bond to which the power is attached. WARNING:THIS POWER OF ATTORNEY IS INVALID WITHOUT THE RED BORDER GiSTPAIJL rail TRAVELERS IMPORTANT NOTICE TO OBTAIN INFORMATION OR MAKE A COMPLAINT: You may contact Travelers Casualty & Surety Company of America, Travelers Casualty & Surety Company, Travelers Indemnity Company, Standard Fire Insurance Company and/or Farmington Casualty Company for information or to make a complaint at: Travelers Bond Attn: Claims 1500 Market Street West Tower, Suite 2900 Philadelphia, PA 19102 (267) 675-3057 (267) 675-3102 Fax You may contact the Texas Department of Insurance to obtain the information on companies, coverages, rights or complaints at: Texas Department of Insurance P.O. Box 149104 Austin, TX 78714-9104 (800) 252-3439 ATTACH THIS NOTICE TO YOUR BOND. This notice is for information only and does not become a part or a condition of the attached document and is given to comply with Section 2253-021, Government Code, and Section 53.202, Property Code, effective September 1, 2001. Aco D CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) `----- 1/19/2015 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 Swantner&Gordon Insurance Agency PHONE Diann 6E1-42 aver FAX A Higginbotham Company (A/c,No,Ext):361-561-4276 (A/C.No):361-844-0101 P 0 Box 870 AIL ADDRESS:deisenhauer@s-gins.com Corpus Christi TX 78403-0870 INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:The Travelers Indemnity Co of Amer 25666 INSURED HAASA INSURER B:Travelers Property Casualty Co of A 25674 Haas-Anderson Construction Ltd / INSURER C:The Phoenix Insurance Company 25623 C. O. Box 7692 1/ Corpus Christi TX 78467-7692 INSURER D:Commerce&Industry Insurance Co 19410 INSURER E:The Travelers Indemnity Co of CT 25682 INSURER F: COVERAGES CERTIFICATE NUMBER:397309952 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE AUDL BUHR POLICY EFF POLICY EXP LTRINSD WVD POLICY NUMBER (MM/DDYYY) (MM/DD/YYYY) LIMITS A x COMMERCIAL GENERAL LIABILITY V /YC04D398656 9/1/2014 9/1/2015 J/ EACH OCCURRENCE $1,000,000 CLAIMS-MADE X OCCUR DAMAGE TO RENTED PREMISES(Ea occurrence) t$300,000 MED EXP(Any one person) $5,000 PERSONAL&ADVINJURY $1,000,000 GEN'LAGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 PRo- POLICY X JECT LOC PRODUCTS-COMP/OP AGG $2,000,000 _ OTHER: $ B AUTOMOBILE LIABILITY / Ea BA3D892937 9/1/2014 9/1/2015 COMBINED SINGLE LIMIT $1,000,000 X ANY AUTO v (BODILYdINJURY(Per person) $ ALLOS�ED SCHEDULED BODILY INJURY(Per accident) $ HIRED AUTOS NON-OWNED PROPERTY DAMAGE $ AUTOS (Per accident) E X UMBRELLALIAB X OCCUR ✓ CUP3E987368 9/1/2014 9/1/2015/ EACH OCCURRENCE $1,000,000 EXCESSLIAB CLAIMS-MADE V AGGREGATE $1,000,000 ✓ DED X RETENTION$10,000 $ C WORKERS COMPENSATION , UB4D402822 9/1/2014 9/1/2015 PER OTH- AND EMPLOYERS'LIABILITY Y/N X STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE ✓ E.L.EACH ACCIDENT $1,000,000 OFFICER/MEMBER EXCLUDED? N N/A J (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $1,000,000 ✓ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $1,000,000 D Excess Umbrella 6E044243588 9/1/2014 9/1/2015 Each Occurrence $19,000,000 Aggregate $19,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) See attached 101 See Attached... CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Corpus Christi-Capital Programs ACCORDANCE WITH THE POLICY PROVISIONS. Attn: Contracts Administrator P. O. Box 9277 AUTHORIZED REPRESENTATIVE Corpus Christi TX 78469-9277 Ci6 1 ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: HAASA LOC#: ARD ADDITIONAL REMARKS SCHEDULE Page 1 of 1 AGENCY NAMED INSURED Swantner&Gordon Insurance Agency Haas-Anderson Construction Ltd P. O. Box 7692 POLICY NUMBER Corpus Christi TX 78467-7692 • CARRIER NAIC CODE EFFECTIVE DATE: ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: CERTIFICATE OF LIABILITY INSURANCE The Commercial General Liability Policy includes a blanket automatic additional insured endorsement that provides additional insured status only when there is a written contract requiring such status. Form CG D6 04 08 13-Blanket Additional Insured(Contractors)/Form CG D3 16 11 11 -Contractors Xtend Endorsement(Blanket Additional Insured-Owners, Managers or Lessors of Premises; Blanket Additional Insured -Lessors of Lease Equipment; Blanket Additional Insured-State or Political Subdivisions-Permits) The General Liability policy includes a primary and non-contributory provision only when there is a written contract that requires it. Form CG D3 16 11 11 -Contractors Xtend Endorsement The Commercial General Liability Policy includes a blanket automatic waiver of subrogation endorsement that provides this feature only when there is a written contract that requires it. Form CG D3 16 11 11 -Contractors Xtend Endorsement The Commercial General Liability Policy includes an endorsement providing 30 days'notice of cancellation will be furnished to the certificate holder except 10 day notice of nonpayment of premium. Form IL T4 11 12 09 Designated Entity-Notice of Cancellation/Non-Renewal Provided by Us The Commercial General Liability policy includes Form CG D3 16 11 11 -Contractors Xtend Endorsement. Contractual Liability-With respect to operations performed within 50 feet of railroad property,the definition of insured contract in Section V Definitions 9."Insured Contract"Item c. is amended to read"Any easement of license agreement"and Item f.(1)is removed. The Business Auto Policy includes a blanket automatic additional insured endorsement that provides additional insured status when there is a written contract that requires such status. Form CA T3 53 02 12-Business Auto Extension Endorsement The Business Auto Policy includes a blanket automatic waiver of subrogation endorsement that provides this feature only when there is a written contract that requires it. Form CA T3 53 02 12-Business Auto Extension Endorsement The Business Auto Policy includes an endorsement providing 30 days'notice of cancellation will be furnished to the certificate holder except 10 day notice of nonpayment of premium where required by written contract. Form CA T3 25 09 99—Notice of Cancellation The Business Auto Policy includes Endorsement for Motor Carrier Policies of Insurance for Public Liability Under Sections 29&30 of the Motor Carrier Act of 1980-MCS-90(Rev.4-00)(Rev. 09-08) The Business Auto policy includes Endorsement CA 20 70 10 01 -Coverage for Certain Operations in Connection with Railroads where required by written contract The Workers Compensation Policy includes a blanket automatic waiver of subrogation endorsement that provides this feature only when there is a written contract that requires it. Form WC 42 03 04(B)-Texas Waiver of Our Right to Recover from Others Endorsement The Workers Compensation Policy includes an endorsement providing 30 days'notice of cancellation will be furnished to the certificate holder except 10 day notice of nonpayment of premium where require by written contract.WC 42 06 01 (00)-Texas Notice of Material Change Endorsement The Workers Compensation Policy includes Longshore and Harbor Workers'Compensation Act Coverage Endorsement Form WC 00 01 06 A Commercial Excess Liability(Umbrella)—Form UM 00 01 11 03 Except for the terms,definitions, conditions and exclusions of the Policy,the coverage provided by this Policy shall follow the terms,definitions, conditions and exclusions of the applicable underlying insurance. V Contract Renewal Proj.#E14021 Citywide Street Preventative Maintenance Program Year 2(Original#E12215 Citywide Street Overlay& Sealcoat ID/IQ Pilot Program) ACORD 101 (2008/01) ©2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD Haas-Anderson Construction, Ltd. J Travelers Indemnity Company of America vv C04D398656 09/01/14-09/01/15 COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BLANKET ADDITIONAL INSURED - AUTOMATIC STATUS IF REQUIRED BY WRITTEN CONTRACT (CONTRACTORS) This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART 1. The following is added to SECTION II —WHO IS (a) The Additional Insured — Owners, AN INSURED: Lessees or Contractors — Scheduled Any person or organization that: Person or Organization endorsement a. You agree in a "written contract requiring in- CG 20 10 07 04 or CG 20 10 04 13, the Additional Insured — Owners, surance" to include as an additional insured on this Coverage Part; and Lessees or Contractors — Completed Operations endorsement CG 20 37 b. Has not been added as an additional insured 07 04 or CG 20 37 04 13, or both of for the same project by attachment of an en- such endorsements with either of dorsement under this Coverage Part which those edition dates;or includes such person or organization in the (b) Either or both of the following: the endorsement's schedule; Additional Insured — Owners, Les- is an insured, but: sees or Contractors — Scheduled a. Only with respect to liability for"bodily injury", Person Or Organization endorsement "property damage"or"personal injury"; and CG 20 10, or the Additional Insured— b. Only as described in Paragraph (1), (2) or(3) Owners, Lessees or Contractors — Completed Operations endorsement below,whichever applies: CG 20 37, without an edition date of (1) If the "written contract requiring insur- such endorsement specified; ance" specifically requires you to provide the person or organization is an additional additional insured coverage to that per- insured only if the injury or damage is son or organization by the use of: caused, in whole or in part, by acts or (a) The Additional Insured — Owners, omissions of you or your subcontractor in Lessees or Contractors — (Form B) the performance of "your work" to which endorsement CG 2010 11 85; or the "written contract requiring insurance" (b) Either or both of the following: the applies;or Additional Insured — Owners, Les- (3) If neither Paragraph (1) nor(2)above ap- sees or Contractors — Scheduled plies: Person Or Organization endorsement (a) The person or organization is an ad- CG 20 10 10 01, or the Additional In- ditional insured only if, and to the ex- sured—Owners, Lessees or Contrac- tent that, the injury or damage is tors — Completed Operations en- caused by acts or omissions of you or dorsement CG 20 37 10 01; your subcontractor in the perform- the person or organization is an additional ance of"your work"to which the"writ- insured only if the injury or damage arises ten contract requiring insurance" sp- out of "your work" to which the "written plies; and contract requiring insurance"applies; (b) The person or organization does not (2) If the "written contract requiring insur- qualify as an additional insured with ance"specifically requires you to provide respect to the independent acts or additional insured coverage to that per- omissions of such person or organi- son or organization by the use of: zation. CG D6 04 0813 ©2013 The Travelers Indemnity Company.All rights reserved. Page 1 of 3 COMMERCIAL GENERAL LIABILITY 2. The insurance provided to the additional insured and collectible other insurance, whether primary, by this endorsement is limited as follows: excess, contingent or on any other basis, that is a. If the Limits of Insurance of this Coverage available to the additional insured when that per- Part shown in the Declarations exceed the son or organization is an additional insured, or is minimum limits of liability required by the any other insured that does not qualify as a "written contract requiring insurance", the in- named insured, under such other insurance. surance provided to the additional insured will 4. As a condition of coverage provided to the addi- be limited to such minimum required limits of tional insured by this endorsement: liability. For the purposes of determining a. The additional insured must give us written whether this limitation applies, the minimum "occur- limits of liability required by the "written con- notice as soon as practicable of an tract requiring insurance" will be considered rence" or an offense which may result in a to include the minimum limits of liability of any sinclude:Tthe extent possible, such notice Umbrella or Excess liability coverage required should for the additional insured by that"written con- (1) How, when and where the "occurrence" tract requiring insurance". This endorsement or offense took place; will not increase the limits of insurance de- (2) The names and addresses of any injured scribed in Section III—Limits Of Insurance. persons and witnesses;and b. The insurance provided to the additional in- (3) The nature and location of any injury or sured does not apply to "bodily injury", "prop- damage arising out of the"occurrence"or erty damage" or "personal injury" arising out offense. of the rendering of, or failure to render, any b. If a claim is made or"suit" is brought against professional architectural, engineering or sur the additional insured, the additional insured veying services, including: must: (1) The preparing, approving, or failing to prepare or approve, maps, shop draw- (1) Immediately record the specifics of the ings, opinions, reports, surveys, field or- claim or"suit"and the date received; and ders or change orders, or the preparing, (2) Notify us as soon as practicable. approving, or failing to prepare or ap- The additional insured must see to it that we prove,drawings and specifications; and receive written notice of the claim or"suit" as (2) Supervisory, inspection, architectural or soon as practicable. engineering activities. c. The additional insured must immediately send c. The insurance provided to the additional in- us copies of all legal papers received in con- sured does not apply to "bodily injury" or nection with the claim or"suit", cooperate with "property damage"caused by"your work"and us in the investigation or settlement of the included in the "products-completed opera- claim or defense against the "suit", and oth- tions hazard" unless the "written contract re- erwise comply with all policy conditions. quiring insurance" specifically requires you to d. The additional insured must tender the de- provide such coverage for that additional in- fense and indemnity of any claim or"suit" to sured during the policy period. any provider of other insurance which would 3. The insurance provided to the additional insured cover the additional insured for a loss we by this endorsement is excess over any valid and cover under this endorsement. However, this collectible other insurance, whether primary, ex- condition does not affect whether the insur- cess, contingent or on any other basis, that is ance provided to the additional insured by this available to the additional insured. However, if the endorsement is primary to other insurance "written contract requiring insurance" specifically available to the additional insured which cov- requires that this insurance apply on a primary ers that person or organization as a named basis or a primary and non-contributory basis, this insured as described in Paragraph 3.above. insurance is primary to other insurance available 5. The following is added to the DEFINITIONS Sec- to the additional insured under which that person or organization qualifies as a named insured, and tion: we will not share with that other insurance. But "Written contract requiring insurance" means that the insurance provided to the additional insured part of any written contract or agreement under by this endorsement still is excess over any valid which you are required to include a person or or- Page 2 of 3 ©2013 The Travelers Indemnity Company.All rights reserved. CG D6 04 08 13 COMMERCIAL GENERAL LIABILITY ganization as an additional insured on this Cover- a. After the signing and execution of the contract age Part, provided that the "bodily injury" and or agreement by you;and "property damage" occurs, and the "personal in- b. While that part of the contract or agreement is jury" is caused by an offense committed, during the policy period and: in effect. CG D6 04 08 13 ©2013 The Travelers Indemnity Company.All rights reserved. Page 3 of 3 Haas-Anderson Construction, Ltd. Travelers Indemnity Company of America C04D398656 09/01/14-09/01/15 COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. CONTRACTORS XTEND 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 excluded or limited by another endorsement 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 and is 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 —Unnamed Subsidiaries M. Amended Bodily Injury Definition G. Blanket Additional Insured — Owners, Managers N. Contractual Liability—Railroads Or Lessors Of Premises PROVISIONS INJURY AND PROPERTY DAMAGE LI- A. AIRCRAFT CHARTERED WITH PILOT 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 not apply to "premises damage"caused JURY AND PROPERTY DAMAGE LIABILITY: by: This exclusion does not apply to an aircraft that a. Fire; is: b. Explosion; (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) Not being 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 f. of Section I—Coverage A 1. The first paragraph of the exceptions in Ex- —Bodily Injury And Property Damage Liability clusion j., Damage To Property, in Para- is replaced by another endorsement to this graph 2. of SECTION I — COVERAGES — Coverage Part that has Exclusion —All Pollu- COVERAGE A BODILY INJURY AND tion Injury Or Damage or Total Pollution Ex- PROPERTY DAMAGE LIABILITY is deleted. clusion in its title. 2. The following replaces the last paragraph of A separate limit of insurance applies to Paragraph 2., Exclusions, of SECTION I — "premises damage" as described in Para- COVERAGES — COVERAGE A. BODILY graph 6. of SECTION III — LIMITS OF IN- SURANCE. CG D3 16 11 11 ©2011 The Travelers Indemnity Company.All rights reserved. Page 1 of 6 COMMERCIAL GENERAL LIABILITY 3. The following replaces Paragraph 6. of SEC- C. INCREASED SUPPLEMENTARY PAYMENTS TION III—LIMITS OF INSURANCE: 1. The following replaces Paragraph 1.b. of Subject to 5. above, the Damage To Prem- SUPPLEMENTARY PAYMENTS — COVER- ises Rented To You Limit is the most we will AGES A AND B of SECTION I — COVER- pay under Coverage A for damages because AGE: of "premises damage" to any one premises. b. Up to $2,500 for the cost of bail bonds The Damage To Premises Rented To You required because of accidents or traffic Limit will apply to all "property damage" law violations arising out of the use of any proximately caused by the same "occur- vehicle to which the Bodily Injury Liability rence", whether such damage results from: Coverage applies. We do not have to fur- fire;explosion; lightning; smoke resulting from nish these bonds. such fire, explosion, or lightning; or water; or any combination of any of these causes. 2. The following replaces Paragraph 1.d. of The Damage To Premises Rented To You SUPPLEMENTARY PAYMENTS — COVER- Limit will be: AGES A AND B of SECTION I — COVER- AGES: a. The amount shown for the Damage To d. All reasonable expenses incurred by the Premises Rented To You Limit on the insured at our request to assist us in the Declarations of this Coverage Part; or investigation or defense of the claim or b. $300,000 if no amount is shown for the "suit", including actual loss of earnings up Damage To Premises Rented To You to $500 a day because of time off from Limit on the Declarations of this Coverage work. Part. D. INCIDENTAL MEDICAL MALPRACTICE 4. The following replaces Paragraph a. of the 1. The following is added to the definition of"oc- definition of"insured contract" in the DEFINI- currence"in the DEFINITIONS Section: TIONS Section: a. A contract for a lease of premises. How "Occurrence" also means an act or omission committed in providing or failing to provide ever, that portion of the contract for a "incidental medical services", first aid or lease of premises that indemnifies any "Good Samaritan services"to a person. person or organization for "premises damage"is not an"insured contract"; 2. The following is added to Paragraph 2.a.(1)of 5. The following is added to the DEFINITIONS SECTION II—WHO IS AN INSURED: Section: Paragraph (1)(d) above does not apply to "bodily injury" arising out of providing or fail- "Premises damage" means "property dam- ing to provide: age"to: a. Any premises while rented to you or tem (i) "Incidental medical services" by any of porarily occupied by you with permission your "employees" who is a nurse practi- of the owner; or tioner, registered nurse, licensed practical nurse, nurse assistant, emergency medi- b. The contents of any premises while such cal technician or paramedic;or premises is rented to you, if you rent such (ii) First aid or"Good Samaritan services" premises for a period of seven or fewer by consecutive days. any of your "employees" or "volunteer workers", other than an employed or vol- 6. The following replaces Paragraph 4.b.(1)(b) unteer doctor. Any such "employees" or of SECTION IV—COMMERCIAL GENERAL "volunteer workers" providing or failing to LIABILITY CONDITIONS: provide first aid or"Good Samaritan ser- (b) That is insurance for"premises damage"; vices"during their work hours for you will or be deemed to be acting within the scope 7. Paragraph 4.b.(1)(c) of SECTION IV — of their employment by you or performing COMMERCIAL GENERAL LIABILITY CON- duties related to the conduct of your busi- DITIONS is deleted. ness. Page 2 of 6 ©2011 The Travelers Indemnity Company.All rights reserved. CG D3 16 11 11 COMMERCIAL GENERAL LIABILITY 3. The following is added to Paragraph 5. of 4. Any organization you newly acquire or form, SECTION III—LIMITS OF INSURANCE: other than a partnership, joint venture or lirn- For the purposes of determining the applica- ited liability company, of which you are the ble Each Occurrence Limit, all related acts or sole owner or in which you maintain the ma- omissions committed in providing or failing to jority ownership interest, will qualify as a provide "incidental medical services", first aid Named Insured if there is no other insurance or"Good Samaritan services"to any one per- which provides similar coverage to that or- son will be deemed to be one"occurrence". ganization. However: 4. The following exclusion is added to Para- a. Coverage under this provision is afforded graph 2., Exclusions, of SECTION I —COV- only: ERAGES-COVERAGE A BODILY INJURY AND PROPERTY DAMAGE LIABILITY: (1) Until the 180th day after you acquire or Sale Of Pharmaceuticals form the organization or the end of the policy period, whichever is earlier, if you "Bodily injury" or "property damage" arising do not report such organization in writing out of the willful violation of a penal statute or to us within 180 days after you acquire or ordinance relating to the sale of pharmaceuti- form it; or cals committed by, or with the knowledge or consent of,the insured. (2) Until the end of the policy period, when 5. The following is added to the DEFINITIONS that date is later than 180 days after you acquire or form such organization, if you Section: report such organization in writing to us "Incidental medical services"means: within 180 days after you acquire or form a. Medical, surgical, dental, laboratory, x-ray it, and we agree in writing that it will con- or nursing service or treatment, advice or tinue to be a Named Insured until the end instruction, or the related furnishing of of the policy period; food or beverages; or b. Coverage A does not apply to "bodily injury" b. The furnishing or dispensing of drugs or or "property damage" that occurred before medical, dental, or surgical supplies or you acquired or formed the organization; and appliances. c. Coverage B does not apply to "personal in- "Good Samaritan services" means any emer- jury" or "advertising injury" arising out of an gency medical services for which no compen- offense committed before you acquired or sation is demanded or received. formed the organization. 6. The following is added to Paragraph 4.b., Ex- F. WHO IS AN INSURED— BROADENED NAMED cess Insurance, of SECTION IV — COM- INSURED—UNNAMED SUBSIDIARIES MERCIAL GENERAL LIABILITY CONDI- TIONS: The following is added to SECTION II —WHO IS The insurance is excess over any valid and AN INSURED: collectible other insurance available to the in Any of your subsidiaries, other than a partnership, sured,whether primary, excess, contingent or joint venture or limited liability company, that is on any other basis, that is available to any of not shown as a Named Insured in the Declara- your "employees" or "volunteer workers" for tions is a Named Insured if you maintain an own- "bodily injury" that arises out of providing or ership interest of more than 50% in such subsidi- failing to provide "incidental medical ser- ary on the first day of the policy period. vices", first aid or "Good Samaritan services" No such subsidiary is an insured for"bodily injury" to any person to the extent not subject to or "property damage" that occurred, or "personal Paragraph 2.a.(1) of Section II — Who Is An Insured. injury" or "advertising injury" caused by an of- fense committed after the date, if any, during the E. WHO IS AN INSURED — NEWLY ACQUIRED policy period, that you no longer maintain an OR FORMED ORGANIZATIONS ownership interest of more than 50% in such sub- The following replaces Paragraph 4. of SECTION sidiary. Il—WHO IS AN INSURED: CG D3 16 11 11 ©2011 The Travelers Indemnity Company.All rights reserved. Page 3 of 6 COMMERCIAL GENERAL LIABILITY G. BLANKET ADDITIONAL INSURED—OWNERS, H. BLANKET ADDITIONAL INSURED— LESSORS MANAGERS OR LESSORS OF PREMISES OF LEASED EQUIPMENT The following is added to SECTION II —WHO IS The following is added to SECTION II —WHO IS AN INSURED: AN INSURED: Any person or organization that is a premises Any person or organization that is an equipment owner, manager or lessor and that you have lessor and that you have agreed in a written con- agreed in a written contract or agreement to in- tract or agreement to include as an insured on clude as an additional insured on this Coverage this Coverage Part is an insured, but only with re- Part is an insured, but only with respect to liability spect to liability for"bodily injury", "property dam- for "bodily injury", property damage", "personal injury"or"advertising injury"that: age", "personal injury"or"advertising injury"that: a. Is "bodily injury" or "property damage" that a. Is "bodily injury" or "property damage" that occurs, or is "personal injury" or "advertising occurs, or is "personal injury" or "advertising injury" caused by an offense that is commit- injury" caused by an offense that is commit- ted, subsequent to the execution of that con- ted, subsequent to the execution of that con- tract or agreement;and tract or agreement;and b. Arises out of the ownership, maintenance or b. Is caused, in whole or in part, by your acts or use of that part of any premises leased to omissions in the maintenance, operation or you. use of equipment leased to you by such equipment lessor. The insurance provided to such premises owner, The insurance provided to such equipment lessor manager or lessor is subject to the following pro- is subject to the following provisions: visions: a. The limits of insurance provided to such a. The limits of insurance provided to such premises owner, manager or lessor will be equipment lessor will be the minimum limits the minimum limits which you agreed to pro- which you agreed to provide in the written vide in the written contract or agreement, or contract or agreement, or the limits shown on the Declarations,whichever are less. the limits shown on the Declarations, which- ever are less. b. The insurance provided to such equipment b. The insuranceprovided to such lessor does not apply to any"bodily injury" or premises "property damage" that occurs, or "personal owner, manager or lessor does not apply to: injury" or"advertising injury" caused by an of- (1) Any "bodily injury" or "property damage" fense that is committed, after the equipment that occurs, or"personal injury"or"adver- lease expires. tising injury" caused by an offense that is c. The insurance provided to such equipment committed, after you cease to be a tenant lessor is excess over any valid and collectible in that premises;or other insurance available to such equipment (2) Structural alterations, new construction or lessor, whether primary, excess, contingent demolition operations performed by or on or on any other basis, unless you have behalf of such premises owner, lessor or agreed in the written contract or agreement manager. that this insurance must be primary to, or non-contributory with, such other insurance, c. The insurance provided to such premises owner, manager or lessor is excess over any in which case this insurance will be primary valid and collectible other insurance available to, and non-contributory with, such other in- to such premises owner, manager or lessor, surance. whether primary, excess, contingent or on I. BLANKET ADDITIONAL INSURED — STATES any other basis, unless you have agreed in OR POLITICAL SUBDIVISIONS—PERMITS the written contract or agreement that this in- surance must be primary to, or non- The following is added to SECTION II—WHO IS contributory with, such other insurance, in AN INSURED: which case this insurance will be primary to, Any state or political subdivision that has issued a and non-contributory with, such other insur- permit in connection with operations performed by ance. you or on your behalf and that you are required Page 4 of 6 ©2011 The Travelers Indemnity Company.All rights reserved. CG D3 16 11 11 COMMERCIAL GENERAL LIABILITY by any ordinance, law or building code to include (ii) A manager of any limited liability as an additional insured on this Coverage Part is company;or an insured, but only with respect to liability for (iii)An executive officer or director of "bodily injury", "property damage", "personal in- any other organization; jury"or"advertising injury"arising out of such op that is your partner, joint ventureerations. member or manager; or The insurance provided to such state or political (b) Any "employee" authorized by such subdivision does not apply to: partnership, joint venture, limited li- a. Any "bodily injury," "property damage," "per- ability company or other organization sonal injury"or"advertising injury" arising out to give notice of an "occurrence" or of operations performed for that state or po- offense. litical subdivision; or (3) Notice to us of such"occurrence"or of an b. Any "bodily injury" or "property damage" in- offense will be deemed to be given as cluded in the "products-completed operations soon as practicable if it is given in good hazard". faith as soon as practicable to your work- J. KNOWLEDGE AND NOTICE OF OCCUR- ers' compensation insurer. This applies RENCE OR OFFENSE only if you subsequently give notice to us The following is added to Paragraph 2., Duties In of the"occurrence"or offense as soon as The Event of Occurrence, Offense, Claim or practicable after any of the persons de- Suit, of SECTION IV — COMMERCIAL GEN- scribed in Paragraphs e. (1) or(2) above ERAL LIABILITY CONDITIONS: discovers that the"occurrence"or offense may result in sums to which the insurance e. The following provisions apply to Paragraph provided under this Coverage Part may a. above, but only for the purposes of the in- apply surance provided under this Coverage Part to you or any insured listed in Paragraph 1.or 2. However, if this Coverage Part includes an en- of Section II—Who Is An Insured: dorsement that provides limited coverage for "bodily injury" or "property damage" or pollution (1) Notice to us of such "occurrence" or of- costs arising out of a discharge, release or es- fense must be given as soon as practica- cape of"pollutants" which contains a requirement ble only after the "occurrence" or offense that the discharge, release or escape of "pollut- is known by you (if you are an individual), ants" must be reported to us within a specific any of your partners or members who is number of days after its abrupt commencement, an individual (if you are a partnership or this Paragraph e. does not affect that require- joint venture), any of your managers who ment. is an individual(if you are a limited liability K. UNINTENTIONAL OMISSION company), any of your "executive offi- cers" or directors (if you are an organiza- The following is added to Paragraph 6., Repre- tion other than a partnership,joint venture sentations, of SECTION IV — COMMERCIAL or limited liability company) or any "em- GENERAL LIABILITY CONDITIONS: ployee" authorized by you to give notice The unintentional omission of, or unintentional of an"occurrence"or offense. error in, any information provided by you which (2) If you are a partnership, joint venture or we relied upon in issuing this policy will not preju- limited liability company,and none of your dice your rights under this insurance. However, partners, joint venture members or man- this provision does not affect our right to collect agers are individuals, notice to us of such additional premium or to exercise our rights of "occurrence"or offense must be given as cancellation or nonrenewal in accordance with soon as practicable only after the "occur- applicable insurance laws or regulations. rence"or offense is known by: L. BLANKET WAIVER OF SUBROGATION (a) Any individual who is: The following is added to Paragraph 8., Transfer (i) A partner or member of any part- Of Rights Of Recovery Against Others To Us, nership or joint venture; of SECTION IV — COMMERCIAL GENERAL LI- ABILITY CONDITIONS: CG D3 16 11 11 ©2011 The Travelers Indemnity Company.All rights reserved. Page 5 of 6 COMMERCIAL GENERAL LIABILITY If the insured has agreed in a contract or agree- 3. "Bodily injury" means bodily injury, mental ment to waive that insured's right of recovery anguish, mental injury, shock,fright,disability, against any person or organization, we waive our humiliation, sickness or disease sustained by right of recovery against such person or organiza- a person, including death resulting from any tion, but only for payments we make because of: of these at any time. a. "Bodily injury" or "property damage" that oc- N. CONTRACTUAL LIABILITY—RAILROADS curs;or 1. The following replaces Paragraph c. of the b. "Personal injury" or "advertising injury" definition of"insured contract" in the DEFINI- caused by an offense that is committed; TIONS Section: subsequent to the execution of that contract or c. Any easement or license agreement; agreement. 2. Paragraph f.(1) of the definition of "insured M. AMENDED BODILY INJURY DEFINITION contract" in the DEFINITIONS Section is de- The following replaces the definition of "bodily feted. injury"in the DEFINITIONS Section: Page 6 of 6 ©2011 The Travelers Indemnity Company.All rights reserved. CG D3 16 11 11 Haas-Anderson Construction, Ltd. Travelers Indemnity Company of America 09/01/14-09/01/15 POLICY NUMBER: Co4n398656 ISSUE DATE:09 _01_ 2014 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: 30 PERSON OR ORGANIZATION: Any person or organization that is a certificate holder of a certificate of insurance issued for you that: 1. Refers to this policy and states that notice of cancellation or non-renewal of this policy will be provided to that person or organization; and 2. Is in effect, and is on file at the4 office of your agent or broker for this policy, at the time of the cancellation or non-renewal. 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 Haas-Anderson Construction, Ltd. Travelers Property Casualty Company of America BA3D892937 09/01/14-09/01/15 COMMERCIAL AUTO THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BUSINESS AUTO EXTENSION ENDORSEMENT This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modi- fied by the endorsement. GENERAL DESCRIPTION OF COVERAGE—This endorsement broadens coverage. However, coverage for any injury, damage or medical expenses described in any of the provisions of this endorsement may be excluded or limited by another endorsement to the Coverage Part, and these coverage broadening provisions do not apply to the extent that coverage is excluded or limited by such an endorsement. The following listing is a general cover- age description only. Limitations and exclusions may apply to these coverages. Read all the provisions of this en- dorsement and the rest of your policy carefully to determine rights, duties, and what is and is not covered. A. BROAD FORM NAMED INSURED H. HIRED AUTO PHYSICAL DAMAGE — LOSS OF USE—INCREASED LIMIT B. BLANKET ADDITIONAL INSURED I. PHYSICAL DAMAGE — TRANSPORTATION EXPENSES—INCREASED LIMIT C. EMPLOYEE HIRED AUTO J. PERSONAL EFFECTS D. EMPLOYEES AS INSURED K. AIRBAGS E. SUPPLEMENTARY PAYMENTS — INCREASED L. NOTICE AND KNOWLEDGE OF ACCIDENT LIMITS OR LOSS F. HIRED AUTO — LIMITED WORLDWIDE M. BLANKET WAIVER OF SUBROGATION COVERAGE—INDEMNITY BASIS G. WAIVER OF DEDUCTIBLE—GLASS N. UNINTENTIONAL ERRORS OR OMISSIONS PROVISIONS A. BROAD FORM NAMED INSURED executed by you before the "bodily injury" or The following is added to Paragraph A.1.,Who Is "property damage" occurs and that is in effect An Insured, of SECTION II — LIABILITY COV- during the policy period, to be named as an addi- ERAGE: tional insured is an "insured" for Liability Cover- age,Abut only for damages to which this insurance Any organization you newly acquire or form dur-theopolicyapplies and only to the extent that person or or- ing period over which you maintain ganization qualifies as an "insured" under the 50% or more ownership interest and that is not Who Is An Insured provision contained in Section separately insured for Business Auto Coverage. II Coverage under this provision is afforded only un- til the 180th day after you acquire or form the or— ganization or the end of the policy period, which- 1. The following is added to Paragraph A.1., ever is earlier. Who Is An Insured, of SECTION II — LI- B. BLANKET ADDITIONAL INSURED ABILITY COVERAGE: The following is added to Paragraph c. in A.1., An "employee" of yours is an "insured"while Who Is An Insured, of SECTION II — LIABILITY operating an "auto" hired or rented under a COVERAGE: contract or agreement in that "employee's" Any person or organization who is required under name, with your permission, while performing duties related to the conduct of your busi- a written contract or agreement between you and that person or organization, that is signed and Hess. CA T3 53 0212 ©2010 The Travelers Indemnity Company Page 1 of 4 Includes copyrighted material of Insurance Services Office,Inc.with its permission. COMMERCIAL AUTO 2. The following replaces Paragraph b. in B.5., within such country or jurisdiction, for Liability Other Insurance, of SECTION IV — BUSI- Coverage for any covered "auto" that you NESS AUTO CONDITIONS: lease, hire, rent or borrow without a driver for b. For Hired Auto Physical Damage Cover- a period of 30 days or less and that is not an age, the following are deemed to be cov- "auto" you lease, hire, rent or borrow from ered"autos"you own: any of your"employees", partners (if you are (1) Any covered "auto" you lease, hire, a partnership), members (if you are a limited rent or borrow; and liability company) or members of their house- s. „ (a)holdWith respect to any claim made or "suit" (2) Any covered"auto" hired or rented by your employee under a contract in brought outside the United States of that individual "employee's" name, America, the territories and possessions with your permission, while perform- of the United States of America, Puerto ing duties related to the conduct of Rico and Canada: your business. However, any"auto"that is leased, hired, (I) You must arrange to defend the "in- sured"against, and investigate or set- rented or borrowed with a driver is not a tle any such claim or "suit" and keep covered"auto". us advised of all proceedings and ac- D. EMPLOYEES AS INSURED tions. The following is added to Paragraph A.1.,Who Is (ii) Neither you nor any other involved An Insured, of SECTION II — LIABILITY COV- "insured" will make any settlement ERAGE: without our consent. Any"employee"of yours is an "insured"while us- (iii)We may, at our discretion, participate ing a covered"auto"you don't own, hire or borrow in defending the "insured" against, or in your business or your personal affairs. in the settlement of, any claim or E. SUPPLEMENTARY PAYMENTS — INCREASED "suit". LIMITS (iv)We will reimburse the "insured" for 1. The following replaces Paragraph A.2.a.(2), sums that the "insured" legally must of SECTION II—LIABILITY COVERAGE: pay as damages because of "bodily injury" or"property damage" to which (2) Up to $3,000 for cost of bail bonds (in- this insurance applies, that the "in- cluding bonds for related traffic law viola- sured" pays with our consent, but tions) required because of an "accident" only up to the limit described in Para- we cover. We do not have to furnish graph C., Limit Of Insurance, of SEC- these bonds. TION II—LIABILITY COVERAGE. 2. The following replaces Paragraph A.2.a.(4), (v) We will reimburse the "insured" for of SECTION II—LIABILITY COVERAGE: the reasonable expenses incurred (4) All reasonable expenses incurred by the with our consent for your investiga- "insured" at our request, including actual tion of such claims and your defense loss of earnings up to $500 a day be- of the "insured" against any such cause of time off from work. "suit", but only up to and included F. HIRED AUTO — LIMITED WORLDWIDE COV- within the limit described in Para- ERAGE—INDEMNITY BASIS graph C., Limit Of Insurance, of SECTION II — LIABILITY COVER- The following replaces Subparagraph (5) in Para- AGE, and not in addition to such limit. graph B.7., Policy Period, Coverage Territory, Our duty to make such payments of SECTION IV — BUSINESS AUTO CONDI- ends when we have used up the ap- TIONS: plicable limit of insurance in pay- (5) Anywhere in the world, except any country or ments for damages, settlements or jurisdiction while any trade sanction, em defense expenses. bargo, or similar regulation imposed by the (b) This insurance is excess over any valid United States of America applies to and pro- and collectible other insurance available hibits the transaction of business with or Page 2 of 4 ©2010 The Travelers Indemnity Company CA T3 53 0212 Includes copyrighted material of Insurance Services Office,Inc.with its permission. COMMERCIAL AUTO to the "insured" whether primary, excess J. PERSONAL EFFECTS contingent or on any other basis. The following is added to Paragraph A.4., Cover- (c) This insurance is not a substitute for re- age Extensions, of SECTION III — PHYSICAL quired or compulsory insurance in any DAMAGE COVERAGE: country outside the United States, its ter- Personal Effects ritories and possessions, Puerto Rico and Canada. We will pay up to $400 for "loss" to wearing ap- You agree to maintain all required or parel and other personal effects which are: compulsory insurance in any such coun- (1) Owned by an"insured";and try up to the minimum limits required by (2) In or on your covered"auto". local law. Your failure to comply with This coverage applies only in the event of a total compulsory insurance requirements will theft of your covered"auto". not invalidate the coverage afforded by this policy, but we will only be liable to the No deductibles apply to this Personal Effects same extent we would have been liable coverage. had you complied with the compulsory in- K. AIRBAGS surance requirements. The following is added to Paragraph B.3., Exclu- (d) It is understood that we are not an admit- sions, of SECTION III — PHYSICAL DAMAGE ted or authorized insurer outside the COVERAGE: United States of America, its territories Exclusion 3.a. does notapply to "loss" to one or and possessions, Puerto Rico and Can- ada. We assume no responsibility for the more airbags in a covered "auto"you own that in- furnishing of certificates of insurance, or flate due to a cause other than a cause of"loss" for compliance in any way with the laws set forth in Paragraphs A.1.b. and A.1.c., but of other countries relating to insurance. only: G. WAIVER OF DEDUCTIBLE—GLASS a. If that "auto" is a covered "auto" for Compre- hensive Coverage under this policy; The following is added to Paragraph D., De- b. The airbags are not covered under any war- ductible, of SECTION III—PHYSICAL DAMAGE COVERAGE: ranty;and No deductible for a covered "auto" will apply to c. The airbags were not intentionally inflated. glass damage if the glass is repaired rather than We will pay up to a maximum of $1,000 for any replaced. one"loss". H. HIRED AUTO PHYSICAL DAMAGE —LOSS OF L. NOTICE AND KNOWLEDGE OF ACCIDENT OR USE—INCREASED LIMIT LOSS The following replaces the last sentence of Para- The following is added to Paragraph A.2.a., of graph A.4.b., Loss Of Use Expenses, of SEC- SECTION IV—BUSINESS AUTO CONDITIONS: TION III—PHYSICAL DAMAGE COVERAGE: Your duty to give us or our authorized representa- However, the most we will pay for any expenses tive prompt notice of the "accident" or "loss" ap- for loss of use is $65 per day, to a maximum of plies only when the "accident" or "loss" is known $750 for any one"accident". to: I. PHYSICAL DAMAGE — TRANSPORTATION (a) You(if you are an individual); EXPENSES—INCREASED LIMIT (b) A partner(if you are a partnership); The following replaces the first sentence in Para- (c) A member (if you are a limited liability corn- graph A.4.a., Transportation Expenses, of pany); SECTION III — PHYSICAL DAMAGE COVERA- (d) An executive officer, director or insurance GE: manager(if you are a corporation or other or- We will pay up to $50 per day to a maximum of ganization); or $1,500 for temporary transportation expense in- (e) Any"employee"authorized by you to give no- curred by you because of the total theft of a coy- tice of the"accident"or"loss". ered"auto"of the private passenger type. CA T3 53 02 12 ©2010 The Travelers Indemnity Company Page 3 of 4 Includes copyrighted material of Insurance Services Office,Inc.with its permission. COMMERCIAL AUTO M. BLANKET WAIVER OF SUBROGATION such contract. The waiver applies only to the The following replaces Paragraph A.5., Transfer person or organization designated in such Of Rights Of Recovery Against Others To Us, contract. of SECTION IV — BUSINESS AUTO CONDI- N. UNINTENTIONAL ERRORS OR OMISSIONS TIONS: The following is added to Paragraph B.2., Con- 5. Transfer Of Rights Of Recovery Against cealment, Misrepresentation, Or Fraud, of Others To Us SECTION IV—BUSINESS AUTO CONDITIONS: We waive any right of recovery we may have The unintentional omission of, or unintentional against any person or organization to the ex- error in, any information given by you shall not tent required of you by a written contract prejudice your rights under this insurance. How- signed and executed prior to any "accident" ever this provision does not affect our right to col- or"loss", provided that the"accident"or"loss" lect additional premium or exercise our right of arises out of operations contemplated by cancellation or non-renewal. Page 4 of 4 ©2010 The Travelers Indemnity Company CA T3 53 02 12 Includes copyrighted material of Insurance Services Office,Inc.with its permission. Hass-Anderson Construction, Ltd. Travelers Property Casualty Company of America 09/01/14-09/01/015 J COMMERCIAL AUTO POLICY NUMBER: BA3D892937 ISSUE DATE: 09_01 ...2014 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. NOTICE OF CANCELLATION This endorsement modifies insurance provided by the following: BUSINESS AUTO COVERAGE FORM GARAGE COVERAGE FORM MOTOR CARRIER COVERAGE FORM TRUCKERS COVERAGE FORM SCHEDULE 1. Name: Any person or organization for whom the named insured has agreed by written contract to furnish this endorsement. Address: 2. Number of Days Notice: 30 (If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement.) PROVISIONS We will mail notice of cancellation or material limitation of these coverage forms to the person or organization shown above.We will mail the notice at least the Number of Days indicated above before the effective date of our action. CA T3 25 09 99 Page 1 of 1 Haas-Anderson Construction, Ltd. Travelers Property Casualty Company of America 09/01/14-09/01/15 BA3D892937 COMMERCIAL AUTO POLICY NUMBER: ISSUE DATE: 09-01-2014 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. COVERAGE FOR CERTAIN OPERATIONS IN CONNECTION WITH RAILROADS This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM GARAGE COVERAGE FORM MOTOR CARRIER COVERAGE FORM TRUCKERS COVERAGE FORM With respect to coverage provided under this endorsement, the provisions of the Coverage Form apply unless modified by the endorsement. SCHEDULE Scheduled Railroad Designated Job Site Any railroad where required by written contract (If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement.) With respect to the use of a covered"auto"in operations for or affecting a railroad designated in the Schedule at a Designated Job Site, the two exceptions contained in the definition of"insured contract" relating to construction or demolition operations performed within 50 feet of a railroad do not apply. CA 20 7010 01 ©ISO Properties, Inc., 2000 Page 1 of 1 Haas-Anderson Construction, Ltd. The Phoenix Insurance Company WORKERS COMPENSATION 09/01/14-09/01/15 AND EMPLOYERS LIABILITY POLICY ENDORSEMENT WC 42 03 04( B) POLICY NUMBER: UB4D402822 f TEXAS WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT This endorsement applies only to the insurance provided bythe policy because Texas is shown in Item 3.A. of the Information Page. We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce our right against the person or organization named in the Schedule, but this waiver applies only with respect to bodily injury arising out of the operations described in the Schedule where you are required by a written contract to obtain this waiver from us. This endorsement shall not operate directly or indirectly to benefit anyone not named in the Schedule. The premium for this endorsement is shown in the Schedule. Schedule 1.. 0 Specific Waiver Name of person or organization i:S Blanket Waiver Any person or organization for whom the Named Insured has agreed by written contract to furnish this waiver. 2. Operations: All Texas Operations 3. Premium: The premium charge for this endorsement shall be 2 percent of the premium developed on payroll in connection with work performed for the above person(s) or organization(s) arising out of the operations described. 4. Advance Premium: See schedule 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. Endorse 'en o. Insured � 'remi Insurance Company Countersigned by 1 f gif DATE OF ISSUE: 09-01-2014 ST ASSIGN: Page 1 of 1 ®Copyright 2014 National Council on Compensation Insurance,Inc.All Rights Reserved. Haas-Anderson Construction, Ltd. The Phoenix Insurance Company 09/01/14-09/01/15 TRAVELERS? WORKERS COMPENSATION AND EMPLOYERS LIABILITY POLICY Haas- ENDORSEMENT WC 42 06 01 (00) — POLICY NUMBER: UB4D402822 TEXAS NOTICE OF MATERIAL CHANGE ENDORSEMENT This endorsement applies only to the insurance provided by the policy because Texas is shown in item 3.A.of the Information Page. In the event of cancelation or other material change of the policy, we will mail advance notice to the person or organization named in the Schedule. The number of days advance notice is shown in the Schedule. This endorsement shall not operate directly or indirectly to benefit anyone not named in the Schedule. SCHEDULE 1. NUMBER OF DAYS ADVANCE NOTICE: 30 (or**) 2. NOTICE WILL BE MAILED TO: Any person or organization to whom you have agreed in a written contract that notice of cancellation or material limitations to 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 material limitation of the policy; and 2. We receive such written request at least 14 days before the beginning of the applicable number of days shown in this schedule. This endorsement does not apply when the reason for cancellation if non-payment of premium. ** Number of days Notice specified in the Certificate of Insurance to all holders of such certificates. DATE OF ISSUE: 09-01 -2014 ST ASSIGN: Haas-Anderson Construction, Ltd. The Phoenix Insurance Company 09/01/14-09/01/15 TRAVELERS WORKERS COMPENSATION AND EMPLOYERS LIABILITY POLICY ENDORSEMENT WC 00 01 06( A)— POLICY NUMBER: UB4D402822 LONGSHORE AND HARBOR WORKERS' COMPENSATION ACT COVERAGE ENDORSEMENT This endorsement applies only to work subject to the Longshore and Harbor Workers'Compensation Act in a state shown in the Schedule. The policy applies to that work as though that state were listed in Item 3.A.of the Information Page.General Section C. Workers'Compensation Law is replaced by the following: C. Workers'Compensation Law Workers' Compensation Law means the workers or workmen's compensation law and occupational disease law of each state or territory named in item 3.A. of the Information Page and the Longshore and Harbor Workers' Compensation Act(33 USC Sections 901-950). It includes any amendments to those laws that are in effect during the policy period. It does not include any other federal workers or workmen's compensa- tion law, other federal occupational disease law or the provisions of any law that provide nonoccupational disability benefits. Part Two (Employers Liability Insurance), C. Exclusions., exclusion 8, does not apply to work subject to the Longshore and Harbor Workers' Compensation Act. This endorsement does not apply to work subject to the Defense Base Act,the Outer Continental Shelf Lands Act, or the Nonappropriated Fund Instrumentalities Act. The rates for classifications with code numbers not followed by the letter"F"are rates for work not ordinarily subject to the Longshore and Harbor Workers' Compensation Act. If this policy covers work under such classifications, and if the work is subject to the Longshore and Harbor Workers' Compensation Act, those non-F classification rates will be increased by the longshore and Harbor Workers' Compensation Act Coverage Percentage shown in the Schedule. SCHEDULE Longshore and Harbor Workers' State Compensation Act Coverage Percentage Texas 64.0 DATE OF ISSUE: 09- 01-2014 ST ASSIGN: PAGE 1 OF Last