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C2018-786 - 12/4/2018 - Approved
C2018-786 12/04/18 M2018-233 J.S. Haren Company 00 52 23 AGREEMENT This Agreement, for the Project awarded on December 4, 2018, is between the City of Corpus Christi (Owner)and J.S. Haren Company (Contractor). Owner and Contractor agree as follows: ARTICLE 1—WORK 1.01 Contractor shall complete all Work as specified or indicated in the Contract Documents. The Work is generally described as: McBride Lift Station and Force Main Improvements Project No. E14054 ARTICLE 2—DESIGNER AND OWNER'S AUTHORIZED REPRESENTATIVE 2.01 The Project has been designed by: Jeff Coym, PE—UA Engineering, Inc. 5656 S.Staples,Suite 230 Corpus Christi,Texas 78411 2.02 The Owner's Authorized Representative for this Project is: Kent Power,P.E.—Acting Construction Management Engineer City of Corpus Christi—Engineering Services 4917 Holly Rd.,#5 Corpus Christi,TX 78411 ARTICLE 3—CONTRACT TIMES 3.01 Contract Times A. The Work is required to be substantially completed within 350 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 380 days after the date when the Contract Times commence to run. B. Milestones,and the dates for completion of each,are as defined in SECTION 0135 00 SPECIAL PROCEDURES. 3.02 Liquidated Damages A. Owner and Contractor recognize that time limits for specified Milestones, Substantial Completion, and completion and readiness for Final Payment as stated in the Contract Documents are of the essence of the Contract. Owner and Contractor recognize that the Owner will suffer financial loss if the Work is not completed within the times specified in Paragraph 3.01 and as adjusted in accordance with Paragraph 11.05 of the General Agreement 00 52 23-1 McBride Lift Station and Force Main Improvements,Project No. E14054 Rev 06-22-2016 SCANNED ....................- ....... CONTRACT DOCUMENTS FOR CONSTRUCTION OF M'cBRIDE LIFT STATION AND ioM FORCE MAIN IMPROVEMENTS PROJECT NUMBER E140,54 ................ 101983 t 89385 -'pus coi C 1"i rl"' S .. 111........... LJA Engineering,,, Inc. TEXAS FIRM REGISTRATION NO. F-829 TETE F-1386/-FBPLS 10104001 5656 S. STAPLES, SUITE 110 5656 S. STAPLES STREET, SMITE 230 CORPUS CHRISTI, TX 78411 CORPUS CHRISTI, TEXAS 78411 (361) 992-2284 PHONE; 361.991.8550 WAP/ AI LJ'A.COM Record Drawing Number SAN 221 August 3, 2018 .................. 000100 TABLE OF CONTENTS Division/ Title Section Division 00 Procurement and Contracting Requirements 00 21 13 Invitation to Bid and Instructions to Bidders (Rev O1-13-2016) 00 30 00 Bid Acknowledgment Form (Rev 01-13-2016) 00 30 01 Bid Form (Rev 01-13-2016) 00 30 02 Compliance to State Law on Nonresident Bidders 00 30 05 Disclosure of Interest(Revo1-13-2016) 00 30 06 Non-Collusion Certification 004516 Statement of Experience (Rev 06-22-2016) 00 52 23 Agreement(Rev 06-22-2016) 006113 Performance Bond (Revo1-13-2016) 00 61 16 Payment Bond (Revo1-13-2016) 00 72 00 General Conditions (Rev 3-23-2015) 00 72 01 Insurance Requirements (Rev06-22-2016) 00 72 02 Wage Rate Requirements(Rev 06-12-2015) 00 72 03 Minority/ MBE/ DBE Participation Policy(Revo1-13-2016) 00 73 00 Supplementary Conditions Division 01 General Requirements 011100 Summary of Work(Rev 01-13-2016) 01 23 10 Alternates and Allowances 01 29 00 Application for Payment Procedures (Rev03-11-2015) 01 29 01 Measurement and Basis for Payment (Rev 01-13-2016) 01 31 00 Project Management and Coordination (Revo1-13-2016) 01 31 13 Project Coordination 01 31 14 Change Management 01 33 00 Document Management 01 33 01 Submittal Register(Rev 7/3/2014) 01 33 02 Shop Drawings 01 33 03 Record Data 01 33 04 Construction Progress Schedule 01 33 05 Video and Photographic Documentation 01 35 00 Special Procedures Table of Contents 000100- 1 McBride Lift Station and Force Main Improvements, Project No. E14054 Rev06-22-2016 Division/ Title Section 014000 Quality Management 01 50 00 Temporary Facilities and Controls 01 57 00 Temporary Controls 01 70 00 Execution and Closeout Requirements Part S Standard Specifications Division 02 Sitework 021020 Site Clearing and Striping(Rev 10-30-14) 021040 Site Grading(Rev 10-30-14) 021080 Removing Abandoned Structures (Rev 10-30-14) 022020 Excavation and Backfill for Utilities (Rev3-25-15) 022021 Control of Ground Water (Rev 10-30-14) 022022 Trench Safety for Excavations (Rev 10-30-14) 022040 Street Excavation (Rev 10-30-14) 022080 Embankment(Rev 10-30-14) 022100 Select Material (Rev 10-30-14) 022420 Silt Fence (Rev 10-30-14) 025202 Scarifying and Reshaping Base Course(Rev 10-30-14) 025205 Pavement Repair, Curb, Gutter, Sidewalk and Driveway Replacement(Rev 11-9-2016) 025223 Crushed Limestone Flexible Base (Rev 10-30-14) 025404 Asphalts, Oils and Emulsions (Rev 10-30-14) 025424 Hot Mix Asphaltic Concrete Pavement (Class A) (Rev3-25-15) 025612 Concrete Sidewalks and Driveways (Rev3-25-15) 025802 Temporary Traffic Controls During Construction (Rev 10-30-14) 025805 Work Zone Pavement Markings (Rev 10-30-14) 025807 Pavement Markings (Paint and Thermoplastic) (Rev 10-30-14) 025816 Raised Pavement Markers (Rev 10-30-14) 025818 Pavement Markers (Reflectorized) (TxDOT DMS-6130) 025828 Bituminous Adhesive for Pavement Markers (TxDOT DMS-6130) 026202 Hydrostatic Testing of Pressure Systems (Rev 10-30-14) 026206 Ductile Iron Pipe and Fittings (Rev 10-30-14) Table of Contents 000100-2 McBride Lift Station and Force Main Improvements, Project No. E14054 Rev 06-22-2016 Division/ Title Section Part S Standard Specifications Division 02 Sitework(Cont'd) 026210 Polyvinyl Chloride Pipe (AWWA C900 and C905 Pressure Pipe for Municipal Water Mains and Wastewater Force Mains (Rev3-25-15) 026214 Grouting Abandoned Utility Lines (Rev 10-30-14) 026404 Water Service Lines (Rev3-25-15) 026409 Tapping Sleeves and Tapping Valves (Rev3-25-15) 026602 Wastewater Force Mains (Rev 10-30-14) 027200 Control of Wastewater Flows (Temporary Bypass Pumping Systems) (Rev 10-30-14) 027203 Vacuum Testing of Wastewater Manholes and Structures (Rev 10-30-14) 027205 Fiberglass Manholes (Rev3-25-15) 027602 Gravity Wastewater Lines (Rev7-1-15) 027604 Disposal of Waste from Wastewater Cleaning Operations (Rev 10-30-14) 027606 Wastewater Service Line(Rev 10-30-14) 027611 Cleaning and Televised Inspection of Conduits (Rev3-25-15) 028040 Sodding (Rev3-25-15) 028340 Chain Link Security Fence (Rev 10-30-14) Division 03 Concrete 030020 Portland Cement Concrete (Rev 10-30-14) 032020 Reinforcing Steel (Rev 10-30-14) 037040 Epoxy Compounds (5-44) 038000 Concrete Structures (Rev3-25-15) Division 05 Metals 055420 Frames, Grates, Rings and Covers (Rev3-25-15) Part T Technical Specifications 016510-T Testing and Startup 022410-T Storm Water Pollution Prevention Plan 023800-T Caisson for Lift Station 026800-T Fusible Polyvinyl Chloride Pipe for Installation by Horizontal Directional Drill (HDD) 026900-T Horizontal Directional Drilling 028020-T Cement Stabilized Sand Table of Contents 000100-3 McBride Lift Station and Force Main Improvements, Project No. E14054 Rev 06-22-2016 C2iuisian/ Title Section' Part T Technical Specifications(Cont'd) 099020-T Painting 132520-T Biological Odor Control System 151020-T Check Valves 151030-T Eccentric Plug Valves 151620-T Submersible Pumps for Wastewater Electrical Specifications (Prepared By Bath Engineering,Joe B. Martinez, PE) 260126 Electrical Testing 260500 Common Work Results for Electrical 260519 Low Voltage Electrical Power Conductors and Cables 260519.01 Wire Connections and Devices 260526 Grounding and Bonding for Electrical System 260529 Hangers and Supports for Electrical System 260533 Raceways and Boxes for Electrical System 260543 Underground Ducts and Raceways for Electrical System 260553 Identification for Electrical System 260573 Electrical Power System Studies 262200 Low Voltage Transformers 262416 Panelboards 263213 Diesel Engine Generator Set 263600 Transfer Switches 266920 Packaged Electrical Control Room 409430 SCADA System 409443 Programmable Logic Controllers Appendix Title Geotechnical Report: Subsurface Investigation, Laboratory Testing Program, and 1 Foundation Recommendations for the Proposed McBride Lift Station and Force Main Rehabilitation (Rock Engineering &Testing Laboratory, Inc. 06-26-09) Supplement No. 1: Subsurface Investigation, Laboratory Testing Program and 2 Foundation Recommendations for the Proposed McBride Lift Station and Force Main Rehabilitation (Rock Engineering &Testing Laboratory, Inc. 04-13-16) 3 Limited Phase II Subsurface Investigation: McBride Lift Station Site Assessment, Corpus Christi,Texas,TWE Project No. 18.53.043 (Tulonay-Wong Engineers, Inc. 07-13-18) END OF SECTION Table of Contents 000100-4 McBride Lift Station and Force Main Improvements, Project No. E14054 Rev 06-22-2016 00 21 13 INVITATION TO BID AND INSTRUCTIONS TO BIDDERS ARTICLE I—DEFINED TERMS 1.01 Terms used in this Invitation to Bid and Instructions to Bidders have the meanings indicated in the General Conditions and Supplementary Conditions. ARTICLE 2—GENERAL NOTICE 2.01 The City of Corpus Christi, Texas (Owner) is requesting Bids for the construction of the following Project: McBride Lift Station and Force Main Improvements Project No. E14054 A. McBride Lift Station and Force Main Rehabilitation consists of new construction of an 18' diameter concrete lift station wet well with four (4) submersible 85 HP pumps, piping and controls, above grade pipes and manifold, 78 LF of new 36" diameter PVC gravity sewer line, three (3) new 5' diameter fiberglass manholes, new control building, new access hatches at each pump location, new standby generator, new transformer, SCADA system upgrade, site concrete paving, new odor control system, perimeter fencing with security electronic fencing, demolition and abandonment of existing lift station building and wet/dry wells, and new construction of 700 LF of 18" fusible PVC force main casing in 24" fusible PVC installed by directional drilling under TxDOT ROW of I1-1-37. 2.02 The Engineer's Opinion of Probable Construction Cost for the Project is$4.3 Million. The Project is to be substantially complete and ready for operation within 380 days. The Project is to be complete and eligible for Final Payment 30 days after the date for Substantial Completion. 2.03 Advertisement and bidding information for the Project can be found at the following website: www.CivCastUSA.com 2.04 Contract Documents may be downloaded or viewed free of charge at this website. This website will be updated periodically with Addenda, lists of interested parties, reports,or other information relevant to submitting a Bid for the Project. ARTICLE 3— DELIVERY AND OPENING OF BIDS 3.01 Bids must be received no later than 2:00pm—September 12,2018 to be accepted. Bids received after this time will not be accepted. It is the sole responsibility of the Bidder to deliver the Bid, electronic or hard copy, by the specified deadline. 3.02 Complete and submit the Bid Form,the Bid Bond and the Bid Acknowledgement Form along with all required documents identified in the Bid Acknowledgement Form. 3.03 Electronic Bids may be submitted to the CivCast website at www.civcastusa.com. Invitation to Bid and Instructions to Bidders 002113- 1 McBride Lift Station and Force Main Improvements, Project No. E14054 Rev O1-13-2016 3.04 If submitting a hard copy bid or bid security by cashier's check or money order, please address envelopes or packages: City of Corpus Christi Engineering Services Smart Board Conference Room City Hall Building, 3rd Floor 1201 Leopard Street Corpus Christi,Texas 78401 Attention: City Secretary Bid—McBride Lift Station and Force Main Improvements, Project No. E14054 All envelopes and packages (including FEDEX envelopes) must clearly identify, on the OUTSIDE of the package, the project name and number and that bid documents are enclosed. 3.05 Bids will be publicly opened and read aloud at 2:00pm — September 12, 2018, at the following location: City Hall Building— City of Corpus Christi First Floor City Council Staff Room or Council Chambers 1201 Leopard Street Corpus Christi,Texas 78401 3.06 The Owner will read aloud the names of the Bidders and the apparent Bid amounts shown on the Bid Summary for all Bids received in time to be considered. ARTICLE 4—PRE-BID CONFERENCE 4.02 A non mandatory pre bid conference for the Project will be held on September 4,2018—2:00pm at the following location: City Hall Building—Engineering Services Conference Room 1 or 2 3rd Floor, Engineering Services 1201 Leopard Street Corpus Christi,Texas 78401 Bids will not be accepted from Bidders who do not attend the conference. It is the Bidders' responsibility to sign in at the pre-bid conference to verify their participation. ARTICLE S—COPIES OF CONTRACT DOCUMENTS 5.01 Obtain a complete set of the Contract Documents as indicated in SECTION 00 52 23 AGREEMENT. 5.02 Use complete sets of Contract Documents in preparing Bids; Bidder assumes sole responsibility for errors or misinterpretations resulting from the use of incomplete sets of Contract Documents. Invitation to Bid and Instructions to Bidders 002113-2 McBride Lift Station and Force Main Improvements, Project No. E14054 Rev O1-13-2016 5.03 OPT makes copies of Contract Documents available for the sole purpose of obtaining Bids for completion of the Project and does not confer a license or grant permission or authorization for any other use. ARTICLE 6—EXAMINATION OF CONTRACT DOCUMENTS 6.01 Before submitting a Bid: A. Examine and carefully study the Contract Documents, including any Addenda and related supplemental data. B. Become familiar with all federal, state, and local Laws and Regulations that may affect cost, progress, or the completion of Work. C. Carefully study and correlate the information available to the Bidder with the Contract Documents, Addenda, and the related supplemental data. D. Notify the OAR of all conflicts, errors, ambiguities, or discrepancies that the Bidder discovers in the Contract Documents, Addenda, and the related supplemental data. E. Determine that the Contract Documents, Addenda, and the related supplemental data are generally sufficient to indicate and convey understanding of all terms and conditions for completion of Work. 6.02 The submission of a Bid will constitute an incontrovertible representation by the Bidder that the Bidder has complied with every requirement of this Article 5, that without exception the Bid is premised upon completion of Work required by the Contract Documents, Addenda, and the related supplemental data,that the Bidder has given the OAR written notice of all conflicts,errors, ambiguities, and discrepancies that the Bidder has discovered in the Contract Documents, Addenda, and the related supplemental data and the written resolutions provided by the OAR are acceptable to the Bidder, and that the Contract Documents, Addenda, and the related supplemental data are generally sufficient to indicate and convey understanding of all terms and conditions for completion of Work. ARTICLE 7—INTERPRETATIONS AND ALTERNATE BIDS 7.01 Submit all questions about the meaning or intent of the Contract Documents, Addenda, and the related supplemental data using the Owner's Bidding Website at www.civcastusa.com. Responses to questions submitted will be posted on the website by the Owner for the benefit of all Bidders. Responses will be posted for questions submitted by 5:00 p.m. seven (7) days prior to the date of the bid opening. Inquiries made after this period may not be addressed. 7.02 Submit any offer of alternate terms and conditions, or offer of Work not in strict compliance with the Contract Documents to the OAR no later than 14 days prior to the date for opening of Bids. OAR and Designer will issue Addenda as appropriate if any of the proposed changes to the Contract Documents are accepted. A Bid submitted with clarifications or taking exceptions to the Contract Documents, except as modified by Addenda, may be considered non-responsive. 7.03 Addenda may be issued to clarify, correct, or change the Contract Documents, Addenda or the related supplemental data as deemed advisable by the Owner or Designer. Modifications to the Contract Documents prior to the award of contract can only be made by Addenda. Invitation to Bid and Instructions to Bidders 002113-3 McBride Lift Station and Force Main Improvements, Project No. E14054 Rev O1-13-2016 Only answers in Addenda authorized by the Owner will be binding. Oral and other interpretations or clarifications will be without legal effect. ARTICLE S—BID SECURITY 8.01 Bidders must submit an acceptable Bid Security with their Bid as a guarantee that the Bidder will enter into a contract for the Project with the Owner within 10 days of Notice of Award of the Contract. The security must be payable to the City of Corpus Christi, Texas in the amount of 5 percent (5%) of the greatest amount bid. 8.02 Bid Security may be in the form of a Bid Bond or a cashier's check, certified check, money order, or bank draft from a chartered financial institution authorized to operate in the State of Texas. Bidders submitting bids electronically through the CivCast System at www.CivCastUSA.com shall scan and upload a copy of Bid Bond as an attachment to their bid. Cashier's check,certified check, money order or bank draft must be enclosed in a sealed envelope, plainly identified on the outside as containing bid documents, the bidder's name and the job name and number and delivered as required in Article 3 below. 8.03 Bid Bond Requirements: 1. A Bid Bond must guarantee, without qualification or condition, that the Owner will be paid a sum equal to 5 percent (5%)of the greatest amount bid if, within 10 calendar days of Notice of Award of the Contract, the Bidder/Principal: a. fails to enter into a contract for the Project with the Owner; or b. fails to provide the required Performance and Payment Bonds. 2. A Bid Bond may not limit the sum payable to the Owner to be the difference between the Bidder/Principal's bid and the next highest bidder. 3. The Bid Bond must reference the Project by name as identified in Article 1. 4. Bidders may provide their surety's standard bid bond form if revised to meet these Bid Bond Requirements. 8.04 Failure to provide an acceptable Bid Security will constitute a non-responsive Bid which will not be considered. 8.05 Failure to provide the required Performance and Payment Bonds will result in forfeiture of the Bid Security to the City as liquidated damages. 8.06 Owner may annul the Notice of Award and the Bid Security of the Bidder will be forfeited if the apparent Selected Bidder fails to execute and deliver the Agreement or Amendments to the Agreement. The Bid Security of other Bidders whom the Owner believes to have a reasonable chance of receiving the award may be retained by the Owner until the earlier of 7 days after the Effective Date of the Contract or 90 days after the date Bids are opened. 8.07 Bid Securities are to remain in effect until the Contract is executed. The Bid Securities of all but the three lowest responsible Bidders will be returned within 14 days of the opening of Bids. Bid Securities become void and will be released by the Owner when the Contract is awarded or all Bids are rejected. Invitation to Bid and Instructions to Bidders 002113-4 McBride Lift Station and Force Main Improvements, Project No. E14054 Rev O1-13-2016 ARTICLE 9—PREPARATION OF BID 9.01 The Bid Form is included with the Contract Documents and has been made available at the Owner's Bidding Website. Complete all blanks on the Bid Form by typing or printing in ink. Indicate Bid prices for each Bid item or alternate shown. 9.02 Execute the Bid Acknowledgement Form as indicated in the document and include evidence of authority to sign. 9.03 Acknowledge receipt of all Addenda by filling in the number and date of each Addendum. Provide a signature as indicated to verify that the Addenda were received. A Bid that does not acknowledge the receipt of all Addenda may be considered non-responsive. 9.04 Provide the name, address, email, and telephone number of the individual to be contacted for any communications regarding the Bid in the Bid Acknowledgement Form. 9.05 Provide evidence of the Bidder's authority and qualification to do business in the State of Texas or covenant to obtain such qualification prior to award of the Contract. ARTICLE 10—CONFIDENTIALITY OF BID INFORMATION 10.01 In accordance with Texas Government Code 552.110, trade secrets and confidential information in Bids are not open for public inspection. Bids will be opened in a manner that avoids disclosure of confidential information to competing Bidders and keeps the Bids from the public during considerations. All Bids are open for public inspection after the Contract is awarded, but trade secrets and confidential information in Bids are not typically open for public inspection. The Owner will protect this information to the extent allowed by Laws and Regulations. Clearly indicate which specific documents are considered to be trade secrets or confidential information by stamping or watermarking all such documents with the word "confidential" prominently on each page or sheet or on the cover of bound documents. Place "confidential" stamps or watermarks so that they do not obscure any of the required information on the document, either in the original or in a way that would obscure any of the required information in a photocopy of the document. Photocopies of"confidential" documents will be made only for the convenience of the selection committee and will be destroyed after the Effective Date of the Contract. Original confidential documents will be returned to the Bidder after the Effective Date of the Contract if the Bidder indicates that the information is to be returned with the Bid, and arrangements for its return are provided by the Bidder. ARTICLE 11—MODIFICATION OR WITHDRAWAL OF BID 11.01 A Bid may be withdrawn by a Bidder, provided an authorized individual of the Bidder submits a written request to withdraw the Bid prior to the time set for opening the Bids. 11.02 A Bidder may withdraw its Bid within 24 hours after Bids are opened if the Bidder files a signed written notice with the Owner and promptly, but no later than 3 days, thereafter demonstrates to the reasonable satisfaction of the Owner that there was a material and substantial mistake in the preparation of its Bid. The Bid Security will be returned if it is clearly demonstrated to the Owner that there was a material and substantial mistake in its Bid. A Bidder that requests to withdraw its Bid under these conditions may be disqualified from responding to a reissued invitation to Bid for the Work to be furnished under these Contract Documents. Invitation to Bid and Instructions to Bidders 002113-5 McBride Lift Station and Force Main Improvements, Project No. E14054 Rev O1-13-2016 ARTICLE 12—BIDS REMAIN SUBJECT TO ACCEPTANCE 12.01 All Bids will remain subject to acceptance for 90 days, but the Owner may, at its sole discretion, release any Bid and return the Bid Security prior to the end of this period. ARTICLE 1 —STATEMENT OF EXPERIENCE 13.01 The three lowest Bidders must submit the information required in SECTION 00 45 16 STATEMENT OF EXPERIENCE within 5 days of the date Bids are due to demonstrate that the Bidder meets the minimum requirements to complete the Work. ARTICLE 14—EVALUATION OF BIDS 14.01 The Owner will consider the amount bid, the Bidder's responsibilities, the Bidder's safety record, the Bidder's indebtedness to Owner, the Bidder's capacity to perform the work and/or whether the Bidder has met the minimum specific project experience requirements. 14.02 Owner may conduct such investigations as it deems necessary to establish the responsibility of the Bidder and any Subcontractors, individuals, or entities proposed to furnish parts of the Work in accordance with the Contract Documents. 14.03 Submission of a Bid indicates the Bidder's acceptance of the evaluation technique and methodology as well as the Bidder's recognition that some subjective judgments must be made by the Owner during the evaluation. Each Bidder agrees to waive any claim it has or may have against the OPT and their respective employees, arising out of or in connection with the administration, evaluation, or recommendation of any Bid. ARTICLE 15—AWARD OF CONTRACT 15.01 The Bidder selected for award of the Contract will be the lowest responsible Bidder that submits a responsive bid. Owner reserves the right to reject any and all Bids, including without limitation, non-conforming, non-responsive or conditional Bids. The Owner reserves the right to adopt the most advantageous interpretation of the Bids submitted in the case of ambiguity or lack of clearness in stating Bid prices and/or waive any or all formalities. 15.02 More than one Bid for the same Work from an individual or entity under the same or different names will not be considered. Reasonable grounds for believing that any Bidder has an interest in more than one Bid for the Work shall be cause for disqualification of that Bidder and the rejection of all Bids in which that Bidder has an interest. ARTICLE 16—MINORITY/ MBE/ DBE PARTICIPATION POLICY 16.01 Selected Contractor is required to comply with the Owner's Minority/ MBE / DBE Participation Policy as indicated in SECTION 00 72 03 MINORITY/ MBE/ DBE PARTICIPATION POLICY. 16.02 Minority participation goal for this Project has been established to be 45%. 16.03 Minority Business Enterprise participation goal for this Project has been established to be 15%. Invitation to Bid and Instructions to Bidders 002113-6 McBride Lift Station and Force Main Improvements, Project No. E14054 Rev O1-13-2016 ARTICLE 17—BONDS AND INSURANCE 17.01 Article 6 of the General Conditions and SECTION 00 72 01 INSURANCE REQUIREMENTS sets forth the Owner's requirements as to Bonds and insurance. When the Selected Bidder delivers the executed Agreement to the Owner, it must be accompanied by the required Bonds and evidence of insurance. 17.02 Provide Performance and Payment Bonds for this Project that fully comply with the provisions of Texas Government Code Chapter 2253. Administration of Bonds will conform to Texas Government Code Chapter 2253 and the provisions of these Contract Documents. ARTICLE 18—SIGNING OF AGREEMENT 18.01 The City Engineer or Director of Capital Programs will submit recommendation for award to the City Council for those project awards requiring City Council action. The Selected Bidder will be required to deliver the required Bonds and insurance certificates and endorsements along with the required number of counterparts(1)of the Agreement and attached documents to the Owner within 10 days.The Contract will be signed by the City Manager or his/her designee after award and the Bidder's submission of required documentation and signed counterparts. The Contract will not be binding upon Owner until it has been executed by both parties. Owner will process the Contract expeditiously. However, Owner will not be liable for any delays prior to the award or execution of Contract. ARTICLE 19—SALES AND USE TAXES 19.01 The Owner generally qualifies as a tax exempt agency as defined by the statutes of the State of Texas and is usually not subject to any City or State sales or use taxes, however certain items such as rented equipment may be taxable even though Owner is a tax-exempt agency. Assume responsibility for including any applicable sales taxes in the Contract Price and assume responsibility for complying with all applicable statutes and rulings of the State of Texas Comptroller. 19.02 It is the Owner's intent to have this Contract qualify as a "separated contract." ARTICLE 20—WAGE RATES 20.01 This Contract is subject to Texas Government Code Chapter 2258 concerning payment of prevailing wage rates. Requirements for paying the prevailing wage rates are discussed in SECTION 00 72 02 WAGE RATE REQUIREMENTS. Bidders must pay not less than the minimum wage shown on this list and comply with all statutes and rulings of the State of Texas Comptroller. ARTICLE 21—BIDDER'S CERTIFICATION OF NO LOBBYING 21.01 In submitting its Bid, Bidder certifies that it has not lobbied the City or its officials, managers, employees,consultants,or contractors in such a manner as to influence or to attempt to influence the bidding process. In the event it reasonably appears that the Bidder influenced or attempted to influence the bidding process, the City may, in its discretion, reject the Bid. Invitation to Bid and Instructions to Bidders 002113-7 McBride Lift Station and Force Main Improvements, Project No. E14054 Rev O1-13-2016 ARTICLE 22—CONFLICT C]FINTEREST 22.01 Bidder agrees to comply with Chapter 176 of the Texas Local Government Code and file Form CIQ with the City ofCorpus Christi City Secretary's Office, if required. For more information on Form O{land to determine if you need to file a Form OCL please review the information on the City Secretary's website at . ARTICLE 23—CERTIFICATE C]FINTERESTED PARTIES 23.01 Bidder agrees to comply with Texas Government Code section 2252.908 and complete Form 1295 Certificate ofInterested Parties as part of this contract, if required. For more information, please review the information on the Texas Ethics Commission website at . ARTICLE 24-REJECTION C]FBID 24.01 The following will because toreject aBid: A. Bids which are not signed byanindividual empowered tobind the Bidder. B. Bids which do not have an acceptable Bid Security, with Power ofAttorney, submitted as required byArticle 8. C. More than one Bid for same Work from an individual, firm, partnership or corporation. D. Evidence ofcollusion among Bidders. E. Sworn testimony or discovery in pending litigation with Owner which discloses misconduct or willful refusal by bidder to comply with subject contract or instructions of Owner. F. Fai|uretohaveanauthorizeda8entoftheBidderattendthemandatoryPre'BidConference, if applicable. G. Bids received from aBidder who has been debarred orsuspended byOwner. H. Bids received from a Bidder when Bidder or principals are currently debarred or suspended byFederal, State orCity governmental agencies. 24.02 The following may because to reject Bid orcause to deem a Bid non-responsive orirregular. The City reserves the right towaive any irregularities and any orall formalities: A. Poor performance in execution of work under a previous City of Corpus Christi contract. B. Failure to achieve reasonable progress on an existing City of Corpus Christi contract. Evidence of Bidder's recurring failure to complete an item of work within a timeframe acceptable to the City or in accordance with a City-accepted schedule is evidence of Bidder's failure toachieve reasonable progress under this subsection. C. Default on previous contracts orfailure to execute Contract after award. D. Evidence of failure to pay Subcontractors, Suppliers or employees in accordance with Contract requirements. E. Bids containing omissions, alterations of form, additions, qualifications or conditions not called for byOwner, orincomplete Bids may berejected. Invitation to Bid and Instructions to Bidders 002113-8 McBride Lift Station and Force Main Improvements, Project No. E14054 n""ol-13-2016 In any case of ambiguity or lack of clarity in the Bid,OWNER reserves right to determine most advantageous Bid or to reject the Bid. F. Failure to acknowledge receipt of Addenda. G. Failure to submit post-Bid information specified in Section 00 45 16 STATEMENT OF EXPERIENCE within the allotted time(s). H. Failure to timely execute Contract after award. I. Previous environmental violations resulting in fines or citations by a governmental entity(i.e. U.S. Environmental Protection Agency,Texas Commission on Environmental Quality, etc.). J. Bidder's Safety Experience. K. Failure of Bidder to demonstrate, through submission of the Statement of Experience, the experience required as specified in Section 00 45 16 STATEMENT OF EXPERIENCE, if that Section is included in the bidding documents. L. Evidence of Bidder's lack of sufficient resources, workforce, equipment or supervision, if required by inclusion of appropriate requirements in Section 00 45 16 STATEMENT OF EXPERIENCE. M. Evidence of poor performance on previous Projects as documented in Owner's project performance evaluations. N. Unbalanced Unit Price Bid: "Unbalanced Bid" means a Bid,which includes a Bid that is based on unit prices which are significantly less than cost for some Bid items and significantly more than cost for others. This may be evidenced by submission of unit price Bid items where the cost are significantly higher/lower than the cost of the same Bid items submitted by other Bidders on the project. O. Evidence of Bidder's lack of capacity to perform the Work. Evidence of Bidder's lack of capacity. Evidence of capacity to perform the Work will include a factual review of (i) all remaining work or incomplete work items under any existing city or non-city contract; (ii) ability to perform the Work with remaining sufficient resources, workforce, equipment and supervision/supervisory staff; (iii) ability in the past to timely complete the same or similar work in a good and workmanlike manner utilizing same or similar remaining resources or under the same or similar conditions. Evidence of incomplete work items under any existing City-awarded IDIQ or other contract for similar work may constitute a lack of capacity to perform the Work. END OF SECTION Invitation to Bid and Instructions to Bidders 002113-9 McBride Lift Station and Force Main Improvements, Project No. E14054 Rev O1-13-2016 00 72 01 INSURANCE REQUIREMENTS ARTICLE 1—INSURANCE REQUIREMENTS 1.01 CONTRACTOR'S INSURANCE AMOUNTS A. Provide the insurance coverage for at least the following amounts unless greater amounts are required by Laws and Regulations: Type of Insurance Minimum Insurance Coverage Commercial General Liability including 1. Commercial Form 2. Premises—Completed Operations 3. Explosions and Collapse Hazard 4. Underground Hazard 5. Products/Completed Operations $1,000,000 Per Occurrence Hazard $2,000,000 Aggregate 6. Contractual Liability 7. Broad Form Property Damage 8. Independent Contractors 9. Personal &Advertising Injury Business Automobile Liability-Owned, $1,000,000 Combined Single Limit Non-Owned, Rented and Leased Workers' Compensation Statutory Employer's Liability $500,000/500,000/500,000 Excess Liability/Umbrella Liability $1,000,000 Per Occurrence Required if Contract Price>$5,000,000 Contractor's Pollution Liability/ $1,000,000 Per Claim Environmental Impairment Coverage Not limited to sudden and accidental X Required ❑ Not Required discharge. To include long-term environmental impact for the disposal of pollutants/contaminants. Required if excavation>3 ft Builder's Risk(All Perils including Collapse) Equal to Full Replacement Cost of Structure and Contents Required for vertical structures and bridges X Required ❑ Not Required Installation Floater Equal to Contract Price Required if installing city-owned equipment ❑ Required X Not Required Insurance Requirements 00 72 01- 1 McBride Lift Station and Force Main Improvements, Project No. E14054 Rev 06-22-2016 1.02 GENERAL PROVISIONS A. Provide insurance coverages and limits meeting the requirements for insurance in accordance with Article 6 of the General Conditions and this Section. B. Provide endorsements to the policies as outlined in this Section. C. Obtain insurance from companies that are duly licensed or authorized in the State of Texas to issue insurance policies for the required limits and coverages. Provide insurance from companies that have an A.M. Best rating of A-VIII or better. D. Furnish copies of endorsements and documentation of applicable self-insured retentions and deductibles upon request by OPT or any named insured or additional insured. Contractor may block out (redact) any confidential premium or pricing information contained in any endorsement furnished under this Contract. E. The name and number of the Project must be referenced on the certificate of insurance. F. OPT's failure to demand such certificates or other evidence of the Contractor's full compliance with the insurance requirements or failure to identify a deficiency in compliance from the evidence provided is not a waiver of the Contractor's obligation to obtain and maintain the insurance required by the Contract Documents. G. Notify the Owner if the Contractor fails to purchase or maintain the insurance required by the Contract Documents. Contractor shall not be allowed to perform any Work on the Project until the required insurance policies are in effect. A Certificate of Liability Insurance shall be submitted to the OPT. H. Owner may exclude the Contractor from the Site and exercise Owner's termination rights under Article 16 of the General Conditions if Contractor fails to obtain or maintain the required insurance. I. Owner does not represent that the insurance coverage and limits established in this Contract are adequate to protect Contractor or Contractor's interests. J. The required insurance and insurance limits do not limit the Contractor's liability under the indemnities granted to Owner's Indemnitees in the Contract Documents. K. Provide for an endorsement that the "other insurance" clause shall not apply to the OPT where the OPT is an additional insured shown on the policy. Contractor's insurance is primary and non-contributory with respect to any insurance or self-insurance carried by the OPT for liability arising out of operations under this Contract. L. Include the Owner and list the other members of the OPT and any other individuals or entities identified in the Supplementary Conditions as additional insureds on all policies with the exception of the workers' compensation policy and Contractor's professional liability policy. 1.03 CONTRACTOR'S INSURANCE A. Purchase and maintain workers' compensation and employer's liability insurance for: 1. Claims under workers' compensation, disability benefits, and other similar employee benefit acts. Obtain workers' compensation coverage through a licensed insurance company in accordance with Texas law and written on a policy and endorsements approved by the Texas Department of Insurance. Provide insurance in amounts to meet all workers' compensation obligations. Provide an "All Other States" endorsement if Insurance Requirements 00 72 01-2 McBride Lift Station and Force Main Improvements, Project No. E14054 Rev 06-22-2016 Contractor is not domiciled in Texas and policy is not written in accordance with Texas Department of Insurance rules. 2. Claims for damages because of bodily injury, occupational sickness or disease, or death of Contractor's employees. 3. United States Longshoreman and Harbor Workers' Compensation Act and Jones Act coverage (if applicable). 4. Foreign voluntary worker compensation (if applicable). B. Purchase and maintain commercial general liability insurance covering all operations by or on behalf of Contractor. The expected coverage is that which would be included in a commercially available ISO Commercial General Liability policy and should provide coverage on an occurrence basis, against: 1. Claims for damages because of bodily injury,sickness or disease,or death of any person other than Contractor's employees; 2. Claims for damages insured by reasonably available personal injury liability coverage which are sustained; 3. By any person as a result of an offense directly or indirectly related to the employment of such person by Contractor; and 4. Claims for damages, other than to the Work itself, because of injury to or destruction of tangible property wherever located, including any resulting loss of use. C. Provide Contractor's commercial general liability policy that is written on a 1996 (or later) ISO commercial general liability form (occurrence form) and include the following coverages and endorsements: 1. Products and completed operations coverage as required in this Section. Insurance is to remain in effective for 3 years after final payment. Furnish evidence of the continuation of this insurance at final payment and again each year for 3 years after final payment to Owner and each named insured or additional insured. a. If required by Paragraph 1.01, provide and maintain Installation Floater insurance for property under the care, custody,or control of Contractor. Provide Installation Floater insurance that is a broad form or"All Peril" policy providing coverage for all materials,supplies, machinery,fixtures, and equipment which will be incorporated into the Work. 1) Provide coverage under the Contractor's Installation Floater that includes: a) Faulty or Defective workmanship, materials, maintenance, or construction; b) Cost to remove Defective or damaged Work from the Site or to protect it from loss or damage; c) Cost to cleanup and remove pollutants; d) Coverage for testing and startup; e) Any loss to property while in transit; f) Any loss at the Site; Insurance Requirements 00 72 01-3 McBride Lift Station and Force Main Improvements, Project No. E14054 Rev 06-22-2016 g) Any loss while in storage, both on and off the Site; and h) Any loss to temporary Project Works if their value is included in the Contract Price. 2) Coverage cannot be contingent on an external cause or risk or limited to property for which the Contractor is legally liable. Provide limits of insurance adequate to cover the value of the installation. Pay any deductible carried under this coverage and assume responsibility for claims on materials, supplies, machinery, fixture, and equipment which will be incorporated into the Work while in transit or in storage. 2. Blanket contractual liability coverage for Contractor's contractual indemnity obligations in Paragraph 7.14 of the General Conditions, and all other contractual indemnity obligations of Contractor in the Contract Documents. Industry standard ISO Contractual Liability coverage will meet this obligation. 3. Broad form property damage coverage. 4. Severability of interest. 5. Underground explosion and collapse coverage. 6. Personal injury coverage. 7. Endorsement CG 2032, "Additional Insured - Engineers, Architects or Surveyors Not Engaged by the Named Insured" or its equivalent. D. Purchase and maintain automobile liability insurance against claims for damages because of bodily injury or death of any person or property damage arising out of the ownership, maintenance or use of any motor vehicle. E. For Projects with a Contract Value that exceeds$5,000,000, purchase and maintain umbrella or excess liability insurance written over the underlying employer's liability, commercial general liability, and automobile liability insurance described in the paragraphs above. Provide coverage that is at least as broad as all underlying policies. Provide a policy that provides first-dollar liability coverage as needed. F. Provide Contractor's commercial general liability and automobile liability policies that: 1. Are written on an occurrence basis; 2. Include the individuals or entities identified in the Supplementary Conditions as additional insureds; 3. Include coverage for Owners Indemnitees as defined in Article 1 of the General Conditions; and 4. Provide primary coverage for all claims covered by the policies, including those arising from both ongoing and completed operations. G. Purchase and maintain insurance coverage for third-party injury and property damage claims, including clean-up costs that result from Hazardous Environmental Conditions which result from Contractor's operations and completed operations. Provide Contractor's pollution liability insurance that includes long-term environmental impacts for the disposal of pollutants/contaminants and is not limited to sudden and accidental discharge. The completed operations coverage is to remain in effect for 3 years after final payment. The Insurance Requirements 00 72 01-4 McBride Lift Station and Force Main Improvements, Project No. E14054 Rev 06-22-2016 policy must name OPT and any other individuals and entities identified in the Supplementary Conditions as additional insureds. H. Purchase and maintain applicable professional liability insurance, or have Subcontractors and Suppliers do so, if Contractor or any Subcontractor or Supplier will provide or furnish professional services under this Contract. I. The policies of insurance required by this Section must: 1. Include at least the specific coverages and be written for not less than the limits of liability provided in this Section or required by Laws or Regulations,whichever is greater. 2. Contain a provision that coverage afforded will not be canceled or materially changed until at least 30 days prior written notice has been given to Contractor, Owner, and all named insureds and additional insureds. 3. Remain in effect at all times when Contractor is performing Work or is at the Site to conduct tasks arising from the Contract Documents. 4. Be appropriate for the Work being performed and provide protection from claims resulting from the Contractor's performance of the Work and Contractor's other obligations under the Contract Documents, whether performed by Contractor, Subcontractor, Supplier, anyone directly or indirectly employed or retained by any of them, or by anyone for whose acts they may be liable. J. The coverage requirements for specific policies of insurance must be met directly by those policies and may not rely on excess or umbrella insurance provided in other policies to meet the coverage requirement. 1.04 PROPERTY INSURANCE A. Purchase and maintain builder's risk insurance in the amount of the full replacement cost of the Project. This policy is subject to the deductible amounts requirements in this Section or those required by Laws and Regulations and must comply with the requirements of Paragraph 1.06. This insurance shall: 1. Include the OPT,Contractor,and all Subcontractors,and any other individuals or entities identified in the Supplementary Conditions, as named insureds. 2. Be written on a builder's risk "all risk" policy form that includes insurance for physical loss or damage to the Work, temporary buildings, falsework, and materials and equipment in transit, and insures against at least the following perils or causes of loss: fire; lightning; windstorm; riot; civil commotion; terrorism; vehicle impact; aircraft; smoke; theft; vandalism and malicious mischief, mechanical breakdown, boiler explosion, and artificially generated electric current; earthquake; volcanic activity, and other earth movement; flood; collapse; explosion; debris removal; demolition occasioned by enforcement of Laws and Regulations; water damage (other than that caused by flood); and such other perils or causes of loss as may be specifically required by this Section. If insurance against mechanical breakdown, boiler explosion, and artificially generated electric current; earthquake; volcanic activity, and other earth movement; or flood, are not commercially available under builder's risk, by endorsement or otherwise, this insurance may be provided through other insurance policies acceptable to Owner and Contractor. Insurance Requirements 00 72 01-5 McBride Lift Station and Force Main Improvements, Project No. E14054 Rev 06-22-2016 3. Cover expenses incurred in the repair or replacement of any insured property. 4. Cover materials and equipment in transit or stored prior to being incorporated in the Work. 5. Cover Owner-furnished or assigned property. 6. Allow for partial utilization of the Work by Owner. 7. Allow for the waiver of the insurer's subrogation rights as set forth below. 8. Provide primary coverage for all losses and damages caused by the perils or causes of loss covered. 9. Not include a co-insurance clause. 10. Include a broad exception for ensuing losses from physical damage or loss with respect to any Defective workmanship, design, or materials exclusions. 11. Include testing and startup. 12. Be maintained in effect until the Work as a whole is complete, unless otherwise agreed to in writing by Owner and Contractor. B. Evidence of insurance provided must contain a provision or endorsement that the coverage afforded will not be canceled or materially changed or renewal refused until at least 30 days prior written notice has been given to Owner and Contractor and to each named insured. C. Pay for costs not covered by the policy deductible. D. Notify builder's risk insurance provider if Owner will occupy or use a portion or portions of the Work prior to Substantial Completion of all the Work as provided in Paragraph 15.04 of the General Conditions. Maintain the builder's risk insurance in effect during this Partial Occupancy or Use. E. Contractor may purchase other special insurance to be included in or to supplement the builder's risk or property insurance policies provided under this Section. F. Contractor, Subcontractors, or employees of the Contractor or a Subcontractor owning property items, such as tools, construction equipment, or other personal property not expressly covered in the insurance required by the Contract Documents are responsible for providing their own insurance. 1.05 WAIVER OF RIGHTS A. Insurance shall include a waiver of subrogation in favor of the additional insureds identified in SECTION 00 73 00 SUPPLEMENTARY CONDITIONS. B. All policies purchased in accordance with this Section are to contain provisions to the effect that the insurers have no rights of recovery against OPT, named insureds or additional insureds in the event of a payment for loss or damage. Contractor and insurers waive all rights against the Owner's Indemnities for losses and damages created by or resulting from any of the perils or causes of loss covered by these policies and any other applicable property insurance. None of these waivers extend to the rights Contractor has to the proceeds of insurance as trustee. C. Contractor is responsible for assuring that agreements with Subcontractors contains provisions that the Subcontractor waive all rights against Owner's Indemnitees, Contractor, Insurance Requirements 00 72 01-6 McBride Lift Station and Force Main Improvements, Project No. E14054 Rev 06-22-2016 named insureds and additional insureds, and the officers, directors, members, partners, employees, agents, consultants, and subcontractors of each and any of them, for all losses and damages created by or resulting from any of the perils or causes of loss covered by builder's risk insurance and other property insurance. 1.06 OWNER'S INSURANCE FOR THE PROJECT A. Owner is not responsible for purchasing and maintaining any insurance to protect the interest of the Contractor, Subcontractors, or others in the Work. The stated limits of insurance required are minimum only. Determine the limits that are adequate. These limits may be basic policy limits or any combination of basic limits and umbrella limits. In any event, Contractor is fully responsible for all losses arising out of, resulting from, or connected with operations under this Contract whether or not these losses are covered by insurance. The acceptance of evidence of insurance by the OPT, named insureds,or additional insureds does not release the Contractor from compliance with the insurance requirements of the Contract Documents. ARTICLE 2—EVIDENCE OF INSURANCE 2.01 ACCEPTABLE EVIDENCE OF INSURANCE A. Provide evidence of insurance acceptable to the Owner with the executed Contract Documents. Provide the following as evidence of insurance: 1. Certificates of Insurance on an acceptable form; 2. Riders or endorsements to policies; and 3. Policy limits and deductibles. B. Provide a list of"Additional Insureds" for each policy. C. Provide evidence that waivers of subrogation are provided on all applicable policies. D. Provide evidence of requirements for 30 days' notice before cancellation or any material change in the policy's terms and conditions, limits of coverage, or change in deductible amount. 2.02 CERTIFICATES OF INSURANCE A. Submit Certificates of Insurance meeting the following requirements: 1. Form has been filed with and approved by the Texas Department of Insurance under Texas Insurance Code §1811.101; or 2. Form is a standard form deemed approved by the Department under Texas Insurance Code §1811.101. 3. No requirements of this Contract may be interpreted as requiring the issuance of a certificate of insurance on a certificate of insurance form that has not first been filed with and approved by the Texas Department of Insurance. B. Include the name of the Project in the description of operations box on the certificate of insurance. Insurance Requirements 00 72 01-7 McBride Lift Station and Force Main Improvements, Project No. E14054 Rev 06-22-2016 2.03 INSURANCE POLICIES A. If requested by the Owner, provide a copy of insurance policies, declaration pages and endorsements, and documentation of applicable self-insured retentions and deductibles. B. Contractor may block out (redact) any proprietary information or confidential premium pricing information contained in any policy or endorsement furnished under this Contract. 2.04 CONTINUING EVIDENCE OF COVERAGE A. Provide updated, revised, or new evidence of insurance in accordance this Section prior to the expiration of existing policies. B. Provide evidence of continuation of insurance coverage at final payment and for the following 3 years. 2.05 NOTICES REGARDING INSURANCE A. Notices regarding insurance are to be sent to the Owner at the following address: City of Corpus Christi— Engineering Attn: Construction Contract Admin. P.O. Box 9277 Corpus Christi,TX 78469-9277 B. Submit questions regarding insurance requirements to the Construction Contract Administrator by calling 361-826-3530. ARTICLE 3—TEXAS WORKERS'COMPENSATION INSURANCE REQUIRED NOTICE 3.01 WORKERS' COMPENSATION INSURANCE COVERAGE A. Definitions: 1. Certificate of coverage ("certificate") -A copy of a certificate of insurance, a certificate of authority to self-insure issued by the commission, or a coverage agreement (TWCC- 81, TWCC-82, TWCC-83, or TWCC-84), showing statutory workers' compensation insurance coverage for the person's or entity's employees providing services on a project, for the duration of the Project. 2. Duration of the Project-includes the time from the beginning of the Work on the Project until the Contractor's/person's Work on the Project has been completed and accepted by the governmental entity. 3. Persons providing services on the Project ("Subcontractor" in §406.096) - includes all persons or entities performing all or part of the services the Contractor has undertaken to perform on the Project, regardless of whether that person contracted directly with the Contractor and regardless of whether that person has employees. This includes, without limitation, independent contractors, subcontractors, leasing companies, motor carriers, owner-operators, employees of any such entity, or employees of any entity which furnishes persons to provide services on the Project. "Services" include, without limitation, providing, hauling, or delivering equipment or materials, or providing labor, transportation, or other service related to a project. "Services" does not include Insurance Requirements 00 72 01-8 McBride Lift Station and Force Main Improvements, Project No. E14054 Rev 06-22-2016 activities unrelated to the Project, such as food/beverage vendors, office supply deliveries, and delivery of portable toilets. B. The Contractor shall provide coverage, based on proper reporting of classification codes and payroll amounts and filing of any coverage agreements, which meets the statutory requirements of Texas Labor Code, Section 401.011(44) for all employees of the Contractor providing services on the Project, for the duration of the Project. C. The Contractor must provide a certificate of coverage to the governmental entity prior to being awarded the Contract. D. If the coverage period shown on the Contractor's current certificate of coverage ends during the duration of the Project,the Contractor must, prior to the end of the coverage period,file a new certificate of coverage with the governmental entity showing that coverage has been extended. E. The Contractor shall obtain from each person providing services on a project, and provide to the governmental entity: 1. A certificate of coverage, prior to that person beginning Work on the Project, so the governmental entity will have on file certificates of coverage showing coverage for all persons providing services on the Project; and 2. No later than seven days after receipt by the Contractor, a new certificate of coverage showing extension of coverage, if the coverage period shown on the current certificate of coverage ends during the duration of the Project. F. The Contractor shall retain all required certificates of coverage for the duration of the Project and for one year thereafter. G. The Contractor shall notify the governmental entity in writing by certified mail or personal delivery, within 10 days after the Contractor knew or should have known,of any change that materially affects the provision of coverage of any person providing services on the Project. H. The Contractor shall post on each Project Site a notice, in the text, form and manner prescribed by the Texas Workers' Compensation Commission, informing all persons providing services on the Project that they are required to be covered, and stating how a person may verify coverage and report lack of coverage. I. The Contractor shall contractually require each person with whom it contracts to provide services on a project, to: 1. Provide coverage, based on proper reporting of classification codes and payroll amounts and filing of any coverage agreements,which meets the statutory requirements of Texas Labor Code, Section 401.011(44) for all of its employees providing services on the Project,for the duration of the Project; 2. Provide to the Contractor, prior to that person beginning Work on the Project, a certificate of coverage showing that coverage is being provided for all employees of the person providing services on the Project,for the duration of the Project; 3. Provide the Contractor, prior to the end of the coverage period, a new certificate of coverage showing extension of coverage, if the coverage period shown on the current certificate of coverage ends during the duration of the Project; Insurance Requirements 00 72 01-9 McBride Lift Station and Force Main Improvements, Project No. E14054 Rev 06-22-2016 4. Obtain from each other person with whom it contracts, and provide to the Contractor: a. A certificate of coverage, prior to the other person beginning Work on the Project; and b. A new certificate of coverage showing extension of coverage, prior to the end of the coverage period, if the coverage period shown on the current certificate of coverage ends during the duration of the Project; 5. Retain all required certificates of coverage on file for the duration of the Project and for one year thereafter; 6. Notify the governmental entity in writing by certified mail or personal delivery, within 10 days after the person knew or should have known, of any change that materially affects the provision of coverage of any person providing services on the Project;and 7. Contractually require each person with whom it contracts, to perform as required by paragraphs (1) - (7), with the certificates of coverage to be provided to the person for whom they are providing services. J. By signing this Contract or providing or causing to be provided a certificate of coverage, the Contractor is representing to the governmental entity that all employees of the Contractor who will provide services on the Project will be covered by workers' compensation coverage for the duration of the Project, that the coverage will be based on proper reporting of classification codes and payroll amounts, and that all coverage agreements will be filed with the appropriate insurance carrier or, in the case of a self-insured, with the commission's Division of Self-Insurance Regulation. Providing false or misleading information may subject the Contractor to administrative penalties, criminal penalties, civil penalties, or other civil actions. K. The Contractor's failure to comply with any of these provisions is a breach of contract by the Contractor which entitles the governmental entity to declare the Contract void if the Contractor does not remedy the breach within ten days after receipt of notice of breach from the governmental entity. END OF SECTION Insurance Requirements 00 72 01- 10 McBride Lift Station and Force Main Improvements, Project No. E14054 Rev 06-22-2016 00 30 00 BID ACKNOWLEDGEMENT FORM ARTICLE 1–BID RECIPIENT 1,01 In accordance with the Dra , gs fic tons, nd Contract Documents, this Bid Proposal is submitted by _ 111E-1�1 L01161� ��5 . lllt'�Lj (type or print name of company) on: September 12, 2018 – 2:00pm W"McBride Lift Station and Force Main Improvements, Project No. E14054. 1.02 Submit Bids, Bid Security and all attachments to the Bid (See Section 7.01 below) to the City's electronic bidding website at www.CivCastUSA.com. If submitting hard copy bids or bid security in the form of a cashier's or certified check, please send to: The City of Corpus Christi,Texas City Secretary's Office 1201 Leopard Street Corpus Christi,Texas 78401 Attention: City Secretary Bid–McBride Lift Station and Force Main Improvements, Project No. E14054 All envelopes and! packages (including FEDEX envelopes) must clearly identify, on the OUTSIDE of the package, the project name and number and that bid documents are enclosed. ARTICLE 2–BIDDERS'S ACKNOWLEDGMENTS 2.01 Bidder proposes and agrees, if this Bid is accepted,to enter into an Agreement with Owner on the form included in the Contract Documents,to perform all Work specified or indicated in Contract Documents for the Contract Price indicated: in this Bid or as modified by Contract Amendment. Bidder agrees to complete the Work within the Contract Times established in, the Agreement or as modified, by Contract Amendment and comply with the all other terms and conditions of the Contract Documents. 2.02 Bidder accepts all of the terms and conditions of SECTION OO 21 13 INVITATION AND INSTRUCTIONS TO BIDDERS, including those dealing with required Bonds. The Bid will remain subject to acceptance for 90 days after the opening of Bids. 103 Bidder accepts the provisions of the Agreement as to liquidated damages in the event of its failure to complete Work in accordance with the schedule set forth in the Agreement. 2.04 Bidder acknowledges receipt of the following Addenda: Addendum No. Addendum Date Signature Acknowledging Receipt V 17 Bid Acknowledgement Form 003000-1 McBride Lift Station and Force Main improvements, Project E14054] Rev01-13-2016 ARTICLE 3—BIDDER'S REPRESENTATIONS 3.01 The Bidder has examined and carefully studied the Contract Documents and the other related data identified in the Bidding Documents. 3.02 The Bidder has visited the Site and become familiar with and is satisfied as to the general, local, and Site conditions that may affect cost, progress,and performance of the Work. 3.03 The Bidder is familiar with Laws and Regulations that may affect cost,progress,and performance of the Work. 3.04 The Bidder has carefully studied the following Site-related reports and drawings as identified in the Supplementary Conditions: A. Geotechnical Data Reports regarding subsurface conditions at or adjacent to the Site; B. Drawings of physical conditions relating to existing surface or subsurface structures at the Site; C. Underground Facilities referenced in reports and drawings; D. Reports and drawings relating to Hazardous Environmental Conditions,if any,at or adjacent to the Site;and E. Technical Data related to each of these reports and drawings. 3.05 The Bidder has considered the: A. Information known to Bidder; B. Information commonly known to contractors doing business in the locality of the Site; C. Information and observations obtained from visits to the Site;and D. The Contract Documents. 3.06 The Bidder has considered the items identified in Paragraphs 3.04 and 3.05 with respect to the effect of such information,observations,and documents on: A. The cost, progress,and performance of the Work; B. The means, methods, techniques, sequences, and procedures of construction to be employed by Bidder;and C. Bidder's safety precautions and programs. 3.07 Based on the information and observations referred to in the preceding paragraphs,Bidder agrees that no further examinations,investigations,explorations,tests,studies,or data are necessary for the performance of the Work at the Contract Price,within the Contract Times,and in accordance with the other terms and conditions of the Contract Documents. 3.08 The Bidder is aware of the general nature of Work to be performed by Owner and others at the Site that relates to the Work as indicated in the Contract Documents. 3.09 The Bidder has correlated the information known to the Bidder, information and observations obtained from visits to the Site, reports and drawings identified in the Contract Documents,and Bid Acknowledgement Form 003000-2 McBride Lift Station and Force Main Improvements,Project E14054] Rev 01-13.2016 all additional examinations,investigations,explorations,tests,studies,and data with the Contract Documents. 3.10 The Bidder has given the OAR written notice of all conflicts,errors,ambiguities,or discrepancies that the Bidder has discovered in the Contract Documents, and the written resolution provided by the OAR is acceptable to the Bidder. 3.11 The Contract Documents are generally sufficient to indicate and convey understanding of all terms and conditions for performance and furnishing of the Work. 3.12 Bidder's entry into this Contract constitutes an incontrovertible representation by Bidder that without exception all prices in the Agreement are premised upon performing and furnishing the Work required by the Contract Documents. ARTICLE 4—BASIS OF BID 4.01 Bidder will complete the Work in accordance with the Contract Documents at the unit prices shown in the BID FORM. A. Extended amounts have been computed in accordance with Paragraph 13.03 of the General Conditions. B. Bidder acknowledges that the estimated quantities are not guaranteed, and final payment for all Unit Price items will be based on actual quantities provided, measured as provided in the Contract Documents. C. Unit Price and figures column will be used to compute the actual Bid price. ARTICLE 5—EVALUATION OF BIDDERS 5.01 The contract may be awarded either to the lowest responsible bidder or to the bidder who provides the best value for the Owner. The Owner will consider the amount bid, the Bidder's responsibility,the Bidder's safety record,the Bidder's indebtedness to Owner and whether the Bidder has met the minimum specific project experience requirements to determine the lowest responsible Bidder.The Owner reserves the right to waive any and all irregularities in determining the Bidders'responsibility or value,and whether the Bidder has met the minimum specific project experience requirements, and reserves the right to require the submission of additional information. 5.02 The Owner has the right to accept a Bid,reject any and all Bids,to waive any and all irregularities in the Bids, or to reject non-conforming, non-responsive or conditional Bids. In addition, the Owner reserves the right to reject any Bid where circumstances and developments have, in the opinion of the Owner,changed the responsibility of the Bidder. 5.03 Material misstatements in the documentation submitted to determine the Bidder's responsibility, including information submitted per SECTION 00 45 16 STATEMENT OF EXPERIENCE, may be grounds for rejection of the Bidder's Bid on this Project. Any such misstatement, if discovered after award of the Contract to such Bidder, may be grounds for immediate termination of the Contract. Additionally,the Bidder will be liable to the Owner for any additional costs or damages to the Owner resulting from such misstatements,including costs and attorney's fees for collecting such costs and damages. Bid Acknowledgement Form 00 30 00-3 McBride Lift Station and Force Main Improvements,Project E14054] Rev 01-13-2016 ARTICLE 6—TIME OF COMPLETION 6.01 Bidder will complete the Work required to be substantially completed within 350 days after the date when the Contract Times commence to run as provided in Paragraph 4.01 of the General Conditions. Bidder will complete the Work required for final payment in accordance with Paragraph 15.06 of the General Conditions within 380 days after the date when the Contract Times commence to run. 6.02 Bidder agrees that the Work will be substantially complete and will be completed and ready for final payment in accordance with Paragraph 15.06 of the General Conditions within the number of days indicated. ARTICLE 7—ATTACHMENTS TO THIS BID In compliance with the Bid Requirements in SECTION 00 2113 INVITATION TO BID AND INSTRUCTIONS TO BIDDERS,the following are made a condition of this Bid: A. Bid Security. B. SECTION 00 30 00 BID ACKNOWLEDGEMENT FORM and documentation of signatory authority. C. SECTION 00 30 01 BID FORM. D. SECTION 00 30 02 COMPLIANCE TO STATE LAW ON NONRESIDENT BIDDERS. E. SECTION 00 30 05 DISCLOSURE OF INTEREST. F. SECTION 00 30 06 NON-COLLUSION CERTIFICATION. ARTICLE 8—DEFINED TERMS 8.01 The terms used in this Bid have the meanings indicated in the General Conditions and the Supplementary Conditions. The significance of terms with initial capital letters is described in the General Conditions. ARTICLE 9—VENUE 9.01 Bidder agrees that venue shall lie exclusively in Nueces County,Texas for any legal action. ARTICLE 10—SIGNATORY REQUIREMENTS FOR BIDDERS 10.01 Bidders must include their correct legal name, state of residency, and federal tax identification number in the Bid Form. 10.02 The Bidder, or the Bidder's authorized representative, shall sign and date the Bid Form to accompany all materials included in the submitted Bid. Bids which are not signed and dated in this manner,or which do not contain the required documentation of signatory authority may be rejected as non-responsive. The individual(s)signing the Bid must have the authority to bind the Bidder to a contract,and if required,shall attach documentation of signatory authority to the Bid Form. Bid Acknowledgement Form 003000-4 McBride Lift Station and Force Main Improvements,Project E14054] RevOl-13.2016 10.03 Bidders who are individuals ("natural persons" as defined by the Texas Business Organizations Code §1.002), but who will not be signing the Bid Form personally, shall include in their bid a notarized power of attorney authorizing the individual designated as their authorized representative to submit the Bid and to sign on behalf of the Bidder. 10.04 Bidders that are entities who are not individuals shall identify in their Bid their charter or Certificate of Authority number issued by the Texas Secretary of State and shall submit with their Bid a copy of a resolution or other documentation approved by the Bidder's governing body authorizing the submission of the Bid and designating the individual(s) authorized to execute documents on behalf of the Bidder. Bidders using an assumed name (an "alias") shall submit a copy of the Certificate of Assumed Name or similar document, 10.05 Bidders that are not residents of the State of Texas must document their legal authority to conduct business in Texas. Nonresident Bidders that have previously registered with the Texas Secretary of State may submit a copy of their Certificate of Authority. Nonresident Bidders that have not previously registered with the,Texas Secretary of State shall submit a copy of the Bidder's enabling documents as filed with the state of residency,or as otherwise existing. ARTICLE 11—BID SUBMITTAL 11.01 This Bid is submitted by: Bidder: ttfcf) �CMWAA (typed or printed full legal name of didder) By: (individual's signature) ,J Name,: JP,KN (typed or printed) Title: r . (typed or printed) ,Attest: (in'dividual's signature) State of Residency: Federal Tax Id. No. I paxtb Address for giving notices: W 5' H Phone: E m a i (Attach evidence of authority to sign if the authorized individual is not the Bidder, but an individual signing on behalf of another individual Bidder, or if the authorized individual is a representative of a corporation, partnership, or joint venture.) END OF SECTION Bid Acknowledgement Form 003000-5 McBride Lift Station and Force Main Improvements, Project E14054] Rev 01-13-2016 00 30 01 BID FORM Project McBrkW Lift Station and Force Main Improvements Nance: wofect E14054 Owner: City of Carpus Christi Bidder OAR: LIA Engineering,Inc. Basis Of Bid Imtn DEBOW oer UliiT uttirpwa WARIUDOUNTo Base BW 01AA-Gattaal(per SECTION 0129 01 M]EASUIEMEtT AND BASIS FOR PAYA413q Al Mobilization(Max 5%) LS 1 A2 Bonds&Insurance IS 1 DapO A3 Site Clearing and Stripping AC 1 A4 Unsuitable Site Soff Removal and Replacement Sy 15 c�tJ AS Existing Lift Station and Sitework Demor'ition LS 1 0 v0 O 00 A6 Traffic Control Measures at Force Main Crossing LS 1 1 fl A7 Traffic Control Measures at Lift Station Site LS 1 "( A8 Storm Water Pollution Prevention Plan IS 1 L4 O 5 A9 Sod SF 460 A10 Allowance For Unanticipated Adjustments LS 1 S 50,000.00 ; 50,000:00 All Guard DAYS 20 S© StxvwAL PARTA-SAL(Items Al thru All) Pot B-LIFT STATIM„STRUCTURAL,PLWS&ODOR CONTROL(per SECTION 0129 01 MEASUREMENT AND BASIS FOR PAYMENT) B1 18'Diameter Reinforced Concrete Wet Well Caisson tS 1 Z B2 UltStation Pi . Valves,R!#W&A urtenances LS 1 • lac ?�G B3 Uft Station Pumps,Base& rts,All Accessories LS 1 $0p Blatricidng Filter Odor Control System Including I FRP B4 piping LS 1 85 Lift Station Bypass Operations LS 1 © It, tKINWAL PART S-UFT SrATHK STRUCMRAt,PUMPS&ODOR t]wnwL(items Bi thru 9% { "] Addendum No.S AVLadueent No.1 Page 1 of 4 Bid Fom Page McMde UR Station and Force Main Improvements,Project No.E14064 -of 4 Rev01-13-7A36 00 3001 BID FORM C-ilA}BM=BypASSSTS jam,pM 6 FITT M(per SECTION of 2801 MFAUMEMENT AND BASIS FOR PAYMENT) C1 360 SDR PVC Gravity Sewer(18'+Dev%) LF 78 .2 - __ C2 6'Dia.FRP Manhole(1W+ ) EA 2 a Off? C3 8'M.FRP Manhole(18'+Depth) EA 1 C4 18'PVC Force Main,Lift Station To McBride Lane LF 73 C5 18'C905 DR-18 PVC Force main,IH 37 Crossing LF EC17 1B° New Force Main Tie-Into Existing 18 Force Main, EA 3 McBride Lane 3'ARV on New 18'ForceMain EA►1W 45'Bend(DIM1) EA 7 18°11.25'Bend DIMI EA 1Directionally Dri ed 24'Fusib C906(DR-21 PVC CasingLF 700 La TH?'' 14 FJioEncased 18'Fusible C905(DR-18)PVC Force Main LF 700Trench Safety For 18'Dia.Wet Well LS 1 d- UI Trench Safety For Manholes EA 3 — 5 Q0- C14 ranch Safety For Gravity Seaver Une LF 78 AS - C15 Trench Safety For Force Mains LF3 9C� a6 Trench Safety For Bore Pit EA 2 -= C17 Manholes and Bypass Operations LS 1 l:, Q OCO, - t7 - C18 Well Pointing LS 1 f<sa O C19 2'PVC Water Service Line LF 35 O . C20 Hose Bib EA 2 CSC?; C21Fill Abandoned 16°Dia.Force Main wr/Hawable Fill LF 712 'c1. G22 Mpowance For unanticipated Disposal of Contami Groundwater LS 1 pwm AL PART c-WiGI LES,WPASS STE►uc RES,PIPES m RTTWO(loem a thm 021 d Aodertdrue No.5 Attadusent ft 1 ?age 2 of 4 8W Form -Page 2 of 4 McBride LBtstation and Force Main Intprovenumts,Project feo.E14054 Rev O1-13-2Q36 W W 01 BID FORM (Per SEMON 0129 01 MM%REMENT AK BASIS FOR PA Gi lConcrete Sidewalks and Driveways SF 119M0 Com. C2 IPCR Building Foundation LS 1 j p 1:3 Transformer Foundation LS 1 04 Generator Foundation LS 1 t 9 GS Biotriddrng Filter Odor Control Unit Foundation LS 1 C•6 7'Chain Link Fence w/3 Strand Barb Wire Top LF 325 07 18'Wide Security Gate w/Card Reader and Gate Opener LS 1 C8 5'Wide Personnel Gate EA 1 04 lBadcflow Preventer EA 1 _01.0 [Removable Removable Bollards EA 10 D11 Select Flli SY 200 .f- _ - D12 Demolish Edsft Concrete Traffic Wand SF D13 Saw Cut and Remove Existing Curb,Gutter,&HMAC LF 210 Q ILA Q J. 014 Mill 2-of Bft tng HMAC Pavement SY S22 D15 2-Type-D-HMAC SY 568 D16 Cement Stabilized Sand(7%Portland Cement) Cy 100 D17 8-Type-B-HMAC SY 522 4 - D-B Concrete Traffic Wand SF 500 D29 ADA Curb Ramp SY 55 ZGz_. %4p;-- . 4 U5 D20 IV Standard Curb and Gutter LF 10 D21 IWWcd"Pavement Markings 7Y.1 12 Solid 100 LF 150 L� Mill-Crosswalk _ Reflective Pavement Marldngs TY.1 18 'H) EA Dig Sol 100 Mil -Yield Line M active Pavement Ma ags TY.1 4") (Solid) (100LF 2 D3 Mil -Median Wand&gft ' cJ D24 Mfeclm Pavement Marlwigs TY.2(W)14-1(5011d)JIM LF 55 J, 3 Mll) Q _. irz5 Mil) LF loo 3 D..6 Remove and lace Existing Traffic Signs EA 2 PUffMAL PART D - CONE CURB. GUTTER, PAVEMENT, STABS & NBSCELUANEOUS SrFEWORKt�,t^f THRU of r-�- E-B.ECiRiGALOwSEMON012901 MEASUREMEWANDMWFOR PAYAifNT} El JAEP Electric Service Allooiance LS 1 E2 Electrical Demolition LS 1 E3 PCR Electrical Building EA 1 E4 Motor Control Center EA 1 ES Pump Controls EA 1 E6 Uffitin&Transformer&Panel EA 1 Z t` _ .. E7 Generator EA 1 - ES SCADA installation FA 1 E9 Electrical Installation LS 1 E10 instrument installation LS 1 Eli Testing TrainMg,Commissioning,O&M's LS 1 PJBWAL PART E-Ei.EMWAL(Ei THRU Eli] Adde dwn No.s Attachment No. Page 3 of 4 Bid Fom Page 3 of 4 McerWe Ldt swtfw and Force Main Improvements,Proierx Nio.E14054 Rev 01-13-2018 W 30 0189)FORM IND SUMMARY SUBTOTAL PART A-GENERAL(ttems Al thru Al) 1 5 d SUSTOrAL PART B-UFT STATION,STRUCTURAL,PUMPS&ODOR CONTROL {Items 61 thm Bs) 1 UBTOTAL PART C - MANHOLES, BYPASS STRUCTURES, PIPES & RTTINGS C1 thru C22) 21 SUBTOTAL PART D-CONCRETE CURB,GUTTER,PAVEMENT,SLABS&MISCELLANEOUS STTEWORK Dl THRU DM oqcn Jic> SUBTOTAL PART E-ELECTRICAL(El THRU Ell) Al 3l CgLIZ) AL PROJECT BASE BLD(PARTS A THRU E) Contract Times Bidder agrees to reach Substantial Completion in 350 days Bidder agrees to reach Final Completion in 380 days p4dmrdum m. S AW-dunent No.1 Pale 4 ora BW Fwm McBride Lit Station and Form Main Improvements,Project No.E14054 Page 4 of 4 Rev 01-13-2Q3fi 003002 COMPLIANCE TOSTATE 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 m 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 annmmmt by which a resident bidder would be required to underbid the nonresident bidder to obtain a comparable contract is the state in which the nonresident's principal place ufbusiness is located." "Nonresident bidder" refers toaperson who |snot aresident ofTexas. "Resident bidder" refers to a person whose principal place of business is in this state, including contractor whose ultimate parent company or majority owner has its principal place of business in this state. Check the statement that iscorrect for Bidder. M� Bidder qualifies as a nonresident bidder whose principal place of business or residency is in theStazeof . [] Bidder (includes parent company or majority owner) qualifies as a resident bidder whose principal place ofbusiness isimthe State ofTexas. 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 1,) UMINU \ L) �/~m��, Company Name: (typed or printed) By: (signture—ottachevidenceqfouthority to sign) Name: (typed or printed) Title: ' mL' Business address: IM-5 hao 1111h AJ kc-RS1 Phone: Email: END OF SECTION Compliance uaState Law onNonresident Bidders 083002-1 00 30 05 City of Corpus Christi Disclosure of Interest SUPPLIER NUMBER TO BE ASSIGNED BYCITY^ - PURCHASING DIVISION f CITY OF CORPUS CHRISTI C&MM DISCLOSURE OF INTEREST Ciof 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. I1 COMPANY NAME: J�. nu( n P.O.BOX: mf� STREET.ADDRESS: 1116 HM ' �3. CITY: Mhtm, Tf� ZIP:3W v FIRM IS: I. Corporation a 2. Partnership 8 3. Sole Owner ❑ 4. As= tion lJJ S. Other DISCLOSURE QUESTIONS If additional space is necessary,please use the reverse side of this page or attach separate sheet: 1. State the names of each employee" of the City of Corpus CMsti having an "ownership interest" constituting 3%or more of the ownership in the above named"firm." Name Job Title and City Department(if known) 2. State the names of each "official" of the City of Corpus Christi having an "ownership interest" constituting 3%or more of the ownership in the above named"firm." Name Title 3. State the names of each"board member"of the City of Corpus Christi having an"ownership interest" constituting 3%or more of the ownership in the above named"firm." Name Board,Commission or Committee 4. State the names of each employee or officer of a "consultant" for the City of Corpus Christi who worked on any matter related to the subject of this contract and has an "ownership interest" constituting 3 or more of the ownership in the above named"firm." Name Consultant 1\ City of Corpus Christi 003005-1 DWosure of interest ae„of S-mie 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 -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 prompt y submitted to the City of Corpus Christi,Texas as changes occur. Certifying Person. Title, 001 (Type or Print) Signature of Certifying � � � Date: Person: DEFINITIONS a. "Board member." A member of any board, commission, or committee appointed by the City Council of the City of Corpus Christi,Texas. b. "Economic benefit". An action that is likely to affect an economic interest if it is likely to have an effect on that interest that is distinguishable from its effect on members of the public in general or 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 firth, such as engineers and architects, hired by the City of Corpus Christi for the purpose of professional consultation and recommendation. City of Corpus Christi 003005-2 Disclosure of interest Rev 01-13-2016 003006 NON-COLLUSION CERTIFICATION STATE OF TEXAS COUNTY OF NUECES OWNER: City of Corpus Christi,Texas 1201 Leopard Street Corpus Christi,Texas 78401 CONTRACT: McBride Lift Station and Force Main Improvements Project No. E14054 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: 0, j- ,m,'n otm" ,, -tk'c� typed or printed) By: (signature--attoch evidence of outhority to sign) Name: JP, Ktt�r'9_ (typed or printed) Title: P)( 1A d((\,v Business address: jA 5q, rl ILI UL� Email: 1"V Phone: END OF SECTION Non-Coflusion Certification 00 30 06-1 McBride Lift Station and Force Main Improvements, Project No. E14054 11-25-2013 CONSENT TO At'�7'r[�ty�ret�- 'SPECIAL _ _ _ •,MT.mU O. GOP J S. KAREN Co " ANY �.i THE UNDERSIGNED PERSON, being the sole Shareholder COMPANY, does, as is evidenced by his sig 'e below der of J S. HAREN e following ��the shareholder without�n��of a�� and ratify meeting of the or a formal 101 c WHMEAS the shareholder Performs the duties duector ( ), and the following action, taken b Pursuant to TCA§48-18- PfOVWOns of the by-laws of the Y n G�nsoni7 in accordance with the Tennessee. �rporation and the General Corpor�on act of 1• Election of New Officers. 'The personawhote names appointed of the corporation to serve for a period of one yearappear below are successors are appointed and shall qui*.- Y� or until their President: J Skyler Hares Secr tw)-. Jennifer L.Adkins , Asst' Secretary.. Cassandra L.Hares 2. Execution of DOMMents. The duly elected President, any two of the other duly elected oin� Signing g fly or behalf of the corporation, to execute any �`lodo��authorized, on incident of the routing business of the co and Power to execute agreement ytax including specifically the documents ofthe corporation. returns and other mutine IN WITNESS WBh' WF, the above co for on behalf of the co corporation actions were taken b corporation this the-�day of Y -signed� 2009. N•SEIV • ' • C00'''�. �y.GORpo .•'�. '� J. Skyler Harem, Shareholder VIIA liiii[gUU1 corporations Section p Hope .Andrade .P.0.13ox 13697 5Secretary of State Austin,Texas 78711-3697 w ac • E-- C-5 Office of the Secretary of State CERTIFICATE OF FILING OF J.S. Haren Company File Number: 801081739 The undersigned, as Secretary of State of'Texas, hereby certifies that an Application for Registration for the above named Foreign For-Profit Corporation to transact business in this State has been received in this office and has been found to conform to the applicable provisions of law. ACCORDINGLY, the undersigned, as Secretary of State, and by virtue of the authority vested mi the secretary by law,hereby issues this certificate evidencing the authority of the entity to transact business in this State from and after the effective date shown below for the purpose or purposes set forth in the application under the name of J.S. Haren Company The issuance of this certificate does not authorize the use of a name in this state in violation of the rights of another under the federal Trademark Act of 1946,the Texas trademark law,the Assumed Business or Professional Name Act, or the common law. Dated: 02/02/2009 Effective: 02/02/2009 f ( Hope Andrade COD Secretary of State Come visit its on the internet at http:l/rvmv.sos.state.tx.us! Phone:(512)463-5555 lax: (512)463-5709 Dial: 7-1-1 for Relay Services Prepared by: Linda Gemuenden TID: 10308 Document: 244918620002 THE AMERICA.N INSTITUTE OF ARCHITECTS A IiI Document A 310 Bid Bond BOND # MNB1809121 KNOW ALL MEN BY THESE PRESENTS, that vve ,i. S. HAREN COMPANY 1175 Ifigbway 11 N Athens,I'N37303 as Principal, hereinafter called the Principal, and MERCHANTS NATIONAL BONDING, INC. P.O.Box 1449p 8 Dcs,,Nloines,IA 50306-3498 a corporation duly organized under the laws of the State of IA as Surety, hereinafter called the Surety, are held and firmly bound Unto City of Corpus Christi,TX 1201 Leopard St Corpus Christi,"lam 78401 (dere insen full name,andaddress or legal tifle:of()%vnci)� as Obligee,hereinafter called the Obli-gee, in the sun? of Five Percent of Amount Bid-------------------------------------------Dollars ( $ 5.(10% of attached bid), for the payment ol'which sum well and truly to be made, the said Principal and the said Surety, bind ourselves, our heirs, executors,administrators,SLICUSSors and assigns,jointly and severally, firmly by these presents. WHEREAS, the Principal has submitted a bid for Project# E14054 McBride Lift Station & Force Main Rehabilitation,Corpus Christi,TX (here insert full mune,address nand description ofproject) NOW, 'rHEREFORE, if the Obligee shall accept the bid or the Principal and the Principal shall enter into a Contract with the Obligee in accordance with the terms of such bid and give such bond or bonds as may be specified in the bidding or Contract Documents with good and sufficient surety for the faithful performance of such Contract and for the prompt payment of labor and material furnished in the prosecution thereof, or in the event of the failure of the Principal to enter such Contract and give such bond or bonds, if the Principal shall pay to the Obligee the difference not to exceed the penalty hereof between the amount specified in said bid and Such larger amount for which the Obligee may in good faith contract with another party to perform the Work covered by said bid then this obligation shall be null and void, otherwise to remain in full force and effect, Signed and scaled this 12th (lay of September 201,8,vMMPN, 1. S. FIAREN COMPANY -incipal) Sea]) Ll ............. (Witness) 'n MERCHANTS NATIONAL BONDING, INC. (Witness) I city 1,Iki-07,ATTOR,t)� -FAc,r Bonds�o theast,Inc. 1030 17"'Avenue Smith Nashville,'EN 37212 (615)321-MO AIA DOCUNMENTA310 BID BOND AJA N; FEBRUARY 1970 ED THE AIMERICAN fNS1H'trn01:ARCHri-ECTS, 1731 N.Y.AVE,N.W. WASI fINGTON,LK, 20006 WARNING: unlicensed photocopying violates U.S.copyright laNvs arid is subJect to legal prosectition. 4 . ....... - .. ter.•P1 _ _ . . r ,a''; MER-CHANT-Sftb, BONDING COMPANY, POWER OF ATTORNEY Know All Persons By These Presents,that MERCHANTS BONDING COMPANY(MUTUAL)and MERCHANTS NATIONAL BONDING,INC., both being corporations of the State of Iowa(herein collectively called the"Companies")do hereby make,constitute and appoint,individually, Gregory E Nash;Kelly L Berry;Phillip H Condra their true and lawful Attomey(s)-in-Fact, to sign its name as surety(ies) and to execute, seal and acknowledge any and all bonds, undertakings, contracts and other written instruments 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. This Power-of-Attomey is granted and is signed and sealed by facsimile under and by authority of the following By-Laws adopted by the Board of Directors of Merchants Bonding Company(Mutual) on April 23,2011 and amended August 14, 2015 and adopted by the Board of Directors of Merchants National Bonding,Inc.,on October 16,2015. "The President,Secretary,Treasurer, or any Assistant Treasurer or any Assistant Secretary or any Vice President shall have power and authority to appoint Attomeys4n-Fact, and to authorize them to execute on behalf of the Company, and attach the seal of the Company thereto,bonds and undertakings,recognizances,contracts of indemnity and other writings obligatory in the nature thereof." 'The signature of any authorized officer and the seal of the Company may be affixed by facsimile or electronic transmission to any Power of Attorney or Certification thereof authorizing the execution and delivery of any bond, undertaking, recognizance, or other suretyship obligations of the Company,and such signature and seal when so used shall have the same force and effect as though manually fixed." In connection with obligations in favor of the Florida Department of Transportation only,it is agreed that the power and aut hority hereby given to the Attomey4n-Fact includes any and all consents for the release of retained percentages and/or final estimates on engineering and construction contracts required by the State of Florida Department of Transportation. It is fully understood that consenting to the State of Florida Department of Transportation making payment of the final estimate to the Contractor and/or its assignee, shall not relieve this surety company of any of its obligations under its bond. In connection with obligations in favor of the Kentucky Department of Highways only,it is agreed that the power and authority hereby given to the Attomey-in-Fact cannot be modified or revoked unless prior written personal notice of such intent has been given to the Commissioner- Department of Highways of the Commonwealth of Kentucky at least thirty(30)days prior to the modification or revocation. In Witness Whereof,the Companies have caused this instrument to be signed and sealed this 5th day of April 2017 •'•'10N•�''1 .••"'••. 106 •+ �' PO Q'•. + .-* '. ' MERCHANTS BONDING COMPANY(MUTUAL) 14y�G�� R'4�'''Oy: + ©y0��0'p9'�y,�„ MERCHANT NATIONAL BONDING,INC. _O_ O:v: _O_ O� sv 2003 :Via;' L yr 1933 ;"c: By ........'-9 •• '•��Jr•' .`�a• President STATE OF IOWA •�''`•,••••'••+•• '••••••••• COUNTY OF DALLAS ss. On this this 5th day of April 2017 before me appeared Larry Taylor,to me personally known,who being by me duly sworn did say that he is President of MERCHANTS BONDING COMPANY(MUTUAL) and MERCHANTS NATIONAL BONDING, INC.; and that the seals affixed to the foregoing instrument are the Corporate Seals of the Companies;and that the said instrument was signed and sealed in behalf of the Companies by authority of their respective Boards of Directors. Amt ALICIA K.GRAM zCommission Ntfmber 7117430 • . My Commission Exp m 1 ; April 1,2020 Notary Public (Expiration of notary's commission does not invalidate this instrument) I,William Warner,Jr.,Secretary of MERCHANTS BONDING COMPANY(MUTUAL)and MERCHANTS NATIONAL BONDING,INC.,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 still in full force and effect and has not been amended or revoked. In Witness Whereof,I have hereunto set my hand and affixed the seal of the Companies on this 12th day of September 2018 . •••.�Ptt;ONgl••.••• �•�O�l16,co �•y o,kPO •4 6'p:w �O;p4POR9:°9y 's -o y -2003 �"y'~ 1933 :c; secretary POA 0018 (3117) , •••''`'�•�,;....••''' '•••.....•. 00 30 00 BID ACKNOWLEDGEMENT FORM ARTICLE 1–BID RECIPIENT 1,01 In accordance with the Dra , gs fic tons, nd Contract Documents, this Bid Proposal is submitted by _ 111E-1�1 L01161� ��5 . lllt'�Lj (type or print name of company) on: September 12, 2018 – 2:00pm W"McBride Lift Station and Force Main Improvements, Project No. E14054. 1.02 Submit Bids, Bid Security and all attachments to the Bid (See Section 7.01 below) to the City's electronic bidding website at www.CivCastUSA.com. If submitting hard copy bids or bid security in the form of a cashier's or certified check, please send to: The City of Corpus Christi,Texas City Secretary's Office 1201 Leopard Street Corpus Christi,Texas 78401 Attention: City Secretary Bid–McBride Lift Station and Force Main Improvements, Project No. E14054 All envelopes and! packages (including FEDEX envelopes) must clearly identify, on the OUTSIDE of the package, the project name and number and that bid documents are enclosed. ARTICLE 2–BIDDERS'S ACKNOWLEDGMENTS 2.01 Bidder proposes and agrees, if this Bid is accepted,to enter into an Agreement with Owner on the form included in the Contract Documents,to perform all Work specified or indicated in Contract Documents for the Contract Price indicated: in this Bid or as modified by Contract Amendment. Bidder agrees to complete the Work within the Contract Times established in, the Agreement or as modified, by Contract Amendment and comply with the all other terms and conditions of the Contract Documents. 2.02 Bidder accepts all of the terms and conditions of SECTION OO 21 13 INVITATION AND INSTRUCTIONS TO BIDDERS, including those dealing with required Bonds. The Bid will remain subject to acceptance for 90 days after the opening of Bids. 103 Bidder accepts the provisions of the Agreement as to liquidated damages in the event of its failure to complete Work in accordance with the schedule set forth in the Agreement. 2.04 Bidder acknowledges receipt of the following Addenda: Addendum No. Addendum Date Signature Acknowledging Receipt V 17 Bid Acknowledgement Form 003000-1 McBride Lift Station and Force Main improvements, Project E14054] Rev01-13-2016 ARTICLE 3—BIDDER'S REPRESENTATIONS 3.01 The Bidder has examined and carefully studied the Contract Documents and the other related data identified in the Bidding Documents. 3.02 The Bidder has visited the Site and become familiar with and is satisfied as to the general, local, and Site conditions that may affect cost, progress,and performance of the Work. 3.03 The Bidder is familiar with Laws and Regulations that may affect cost,progress,and performance of the Work. 3.04 The Bidder has carefully studied the following Site-related reports and drawings as identified in the Supplementary Conditions: A. Geotechnical Data Reports regarding subsurface conditions at or adjacent to the Site; B. Drawings of physical conditions relating to existing surface or subsurface structures at the Site; C. Underground Facilities referenced in reports and drawings; D. Reports and drawings relating to Hazardous Environmental Conditions,if any,at or adjacent to the Site;and E. Technical Data related to each of these reports and drawings. 3.05 The Bidder has considered the: A. Information known to Bidder; B. Information commonly known to contractors doing business in the locality of the Site; C. Information and observations obtained from visits to the Site;and D. The Contract Documents. 3.06 The Bidder has considered the items identified in Paragraphs 3.04 and 3.05 with respect to the effect of such information,observations,and documents on: A. The cost, progress,and performance of the Work; B. The means, methods, techniques, sequences, and procedures of construction to be employed by Bidder;and C. Bidder's safety precautions and programs. 3.07 Based on the information and observations referred to in the preceding paragraphs,Bidder agrees that no further examinations,investigations,explorations,tests,studies,or data are necessary for the performance of the Work at the Contract Price,within the Contract Times,and in accordance with the other terms and conditions of the Contract Documents. 3.08 The Bidder is aware of the general nature of Work to be performed by Owner and others at the Site that relates to the Work as indicated in the Contract Documents. 3.09 The Bidder has correlated the information known to the Bidder, information and observations obtained from visits to the Site, reports and drawings identified in the Contract Documents,and Bid Acknowledgement Form 003000-2 McBride Lift Station and Force Main Improvements,Project E14054] Rev 01-13.2016 all additional examinations,investigations,explorations,tests,studies,and data with the Contract Documents. 3.10 The Bidder has given the OAR written notice of all conflicts,errors,ambiguities,or discrepancies that the Bidder has discovered in the Contract Documents, and the written resolution provided by the OAR is acceptable to the Bidder. 3.11 The Contract Documents are generally sufficient to indicate and convey understanding of all terms and conditions for performance and furnishing of the Work. 3.12 Bidder's entry into this Contract constitutes an incontrovertible representation by Bidder that without exception all prices in the Agreement are premised upon performing and furnishing the Work required by the Contract Documents. ARTICLE 4—BASIS OF BID 4.01 Bidder will complete the Work in accordance with the Contract Documents at the unit prices shown in the BID FORM. A. Extended amounts have been computed in accordance with Paragraph 13.03 of the General Conditions. B. Bidder acknowledges that the estimated quantities are not guaranteed, and final payment for all Unit Price items will be based on actual quantities provided, measured as provided in the Contract Documents. C. Unit Price and figures column will be used to compute the actual Bid price. ARTICLE 5—EVALUATION OF BIDDERS 5.01 The contract may be awarded either to the lowest responsible bidder or to the bidder who provides the best value for the Owner. The Owner will consider the amount bid, the Bidder's responsibility,the Bidder's safety record,the Bidder's indebtedness to Owner and whether the Bidder has met the minimum specific project experience requirements to determine the lowest responsible Bidder.The Owner reserves the right to waive any and all irregularities in determining the Bidders'responsibility or value,and whether the Bidder has met the minimum specific project experience requirements, and reserves the right to require the submission of additional information. 5.02 The Owner has the right to accept a Bid,reject any and all Bids,to waive any and all irregularities in the Bids, or to reject non-conforming, non-responsive or conditional Bids. In addition, the Owner reserves the right to reject any Bid where circumstances and developments have, in the opinion of the Owner,changed the responsibility of the Bidder. 5.03 Material misstatements in the documentation submitted to determine the Bidder's responsibility, including information submitted per SECTION 00 45 16 STATEMENT OF EXPERIENCE, may be grounds for rejection of the Bidder's Bid on this Project. Any such misstatement, if discovered after award of the Contract to such Bidder, may be grounds for immediate termination of the Contract. Additionally,the Bidder will be liable to the Owner for any additional costs or damages to the Owner resulting from such misstatements,including costs and attorney's fees for collecting such costs and damages. Bid Acknowledgement Form 00 30 00-3 McBride Lift Station and Force Main Improvements,Project E14054] Rev 01-13-2016 ARTICLE 6—TIME OF COMPLETION 6.01 Bidder will complete the Work required to be substantially completed within 350 days after the date when the Contract Times commence to run as provided in Paragraph 4.01 of the General Conditions. Bidder will complete the Work required for final payment in accordance with Paragraph 15.06 of the General Conditions within 380 days after the date when the Contract Times commence to run. 6.02 Bidder agrees that the Work will be substantially complete and will be completed and ready for final payment in accordance with Paragraph 15.06 of the General Conditions within the number of days indicated. ARTICLE 7—ATTACHMENTS TO THIS BID In compliance with the Bid Requirements in SECTION 00 2113 INVITATION TO BID AND INSTRUCTIONS TO BIDDERS,the following are made a condition of this Bid: A. Bid Security. B. SECTION 00 30 00 BID ACKNOWLEDGEMENT FORM and documentation of signatory authority. C. SECTION 00 30 01 BID FORM. D. SECTION 00 30 02 COMPLIANCE TO STATE LAW ON NONRESIDENT BIDDERS. E. SECTION 00 30 05 DISCLOSURE OF INTEREST. F. SECTION 00 30 06 NON-COLLUSION CERTIFICATION. ARTICLE 8—DEFINED TERMS 8.01 The terms used in this Bid have the meanings indicated in the General Conditions and the Supplementary Conditions. The significance of terms with initial capital letters is described in the General Conditions. ARTICLE 9—VENUE 9.01 Bidder agrees that venue shall lie exclusively in Nueces County,Texas for any legal action. ARTICLE 10—SIGNATORY REQUIREMENTS FOR BIDDERS 10.01 Bidders must include their correct legal name, state of residency, and federal tax identification number in the Bid Form. 10.02 The Bidder, or the Bidder's authorized representative, shall sign and date the Bid Form to accompany all materials included in the submitted Bid. Bids which are not signed and dated in this manner,or which do not contain the required documentation of signatory authority may be rejected as non-responsive. The individual(s)signing the Bid must have the authority to bind the Bidder to a contract,and if required,shall attach documentation of signatory authority to the Bid Form. Bid Acknowledgement Form 003000-4 McBride Lift Station and Force Main Improvements,Project E14054] RevOl-13.2016 10.03 Bidders who are individuals ("natural persons" as defined by the Texas Business Organizations Code §1.002), but who will not be signing the Bid Form personally, shall include in their bid a notarized power of attorney authorizing the individual designated as their authorized representative to submit the Bid and to sign on behalf of the Bidder. 10.04 Bidders that are entities who are not individuals shall identify in their Bid their charter or Certificate of Authority number issued by the Texas Secretary of State and shall submit with their Bid a copy of a resolution or other documentation approved by the Bidder's governing body authorizing the submission of the Bid and designating the individual(s) authorized to execute documents on behalf of the Bidder. Bidders using an assumed name (an "alias") shall submit a copy of the Certificate of Assumed Name or similar document, 10.05 Bidders that are not residents of the State of Texas must document their legal authority to conduct business in Texas. Nonresident Bidders that have previously registered with the Texas Secretary of State may submit a copy of their Certificate of Authority. Nonresident Bidders that have not previously registered with the,Texas Secretary of State shall submit a copy of the Bidder's enabling documents as filed with the state of residency,or as otherwise existing. ARTICLE 11—BID SUBMITTAL 11.01 This Bid is submitted by: Bidder: ttfcf) �CMWAA (typed or printed full legal name of didder) By: (individual's signature) ,J Name,: JP,KN (typed or printed) Title: r . (typed or printed) ,Attest: (in'dividual's signature) State of Residency: Federal Tax Id. No. I paxtb Address for giving notices: W 5' H Phone: E m a i (Attach evidence of authority to sign if the authorized individual is not the Bidder, but an individual signing on behalf of another individual Bidder, or if the authorized individual is a representative of a corporation, partnership, or joint venture.) END OF SECTION Bid Acknowledgement Form 003000-5 McBride Lift Station and Force Main Improvements, Project E14054] Rev 01-13-2016 00 30 01 BID FORM Project McBrkW Lift Station and Force Main Improvements Nance: wofect E14054 Owner: City of Carpus Christi Bidder OAR: LIA Engineering,Inc. Basis Of Bid Imtn DEBOW oer UliiT uttirpwa WARIUDOUNTo Base BW 01AA-Gattaal(per SECTION 0129 01 M]EASUIEMEtT AND BASIS FOR PAYA413q Al Mobilization(Max 5%) LS 1 A2 Bonds&Insurance IS 1 DapO A3 Site Clearing and Stripping AC 1 A4 Unsuitable Site Soff Removal and Replacement Sy 15 c�tJ AS Existing Lift Station and Sitework Demor'ition LS 1 0 v0 O 00 A6 Traffic Control Measures at Force Main Crossing LS 1 1 fl A7 Traffic Control Measures at Lift Station Site LS 1 "( A8 Storm Water Pollution Prevention Plan IS 1 L4 O 5 A9 Sod SF 460 A10 Allowance For Unanticipated Adjustments LS 1 S 50,000.00 ; 50,000:00 All Guard DAYS 20 S© StxvwAL PARTA-SAL(Items Al thru All) Pot B-LIFT STATIM„STRUCTURAL,PLWS&ODOR CONTROL(per SECTION 0129 01 MEASUREMENT AND BASIS FOR PAYMENT) B1 18'Diameter Reinforced Concrete Wet Well Caisson tS 1 Z B2 UltStation Pi . Valves,R!#W&A urtenances LS 1 • lac ?�G B3 Uft Station Pumps,Base& rts,All Accessories LS 1 $0p Blatricidng Filter Odor Control System Including I FRP B4 piping LS 1 85 Lift Station Bypass Operations LS 1 © It, tKINWAL PART S-UFT SrATHK STRUCMRAt,PUMPS&ODOR t]wnwL(items Bi thru 9% { "] Addendum No.S AVLadueent No.1 Page 1 of 4 Bid Fom Page McMde UR Station and Force Main Improvements,Project No.E14064 -of 4 Rev01-13-7A36 00 3001 BID FORM C-ilA}BM=BypASSSTS jam,pM 6 FITT M(per SECTION of 2801 MFAUMEMENT AND BASIS FOR PAYMENT) C1 360 SDR PVC Gravity Sewer(18'+Dev%) LF 78 .2 - __ C2 6'Dia.FRP Manhole(1W+ ) EA 2 a Off? C3 8'M.FRP Manhole(18'+Depth) EA 1 C4 18'PVC Force Main,Lift Station To McBride Lane LF 73 C5 18'C905 DR-18 PVC Force main,IH 37 Crossing LF EC17 1B° New Force Main Tie-Into Existing 18 Force Main, EA 3 McBride Lane 3'ARV on New 18'ForceMain EA►1W 45'Bend(DIM1) EA 7 18°11.25'Bend DIMI EA 1Directionally Dri ed 24'Fusib C906(DR-21 PVC CasingLF 700 La TH?'' 14 FJioEncased 18'Fusible C905(DR-18)PVC Force Main LF 700Trench Safety For 18'Dia.Wet Well LS 1 d- UI Trench Safety For Manholes EA 3 — 5 Q0- C14 ranch Safety For Gravity Seaver Une LF 78 AS - C15 Trench Safety For Force Mains LF3 9C� a6 Trench Safety For Bore Pit EA 2 -= C17 Manholes and Bypass Operations LS 1 l:, Q OCO, - t7 - C18 Well Pointing LS 1 f<sa O C19 2'PVC Water Service Line LF 35 O . C20 Hose Bib EA 2 CSC?; C21Fill Abandoned 16°Dia.Force Main wr/Hawable Fill LF 712 'c1. G22 Mpowance For unanticipated Disposal of Contami Groundwater LS 1 pwm AL PART c-WiGI LES,WPASS STE►uc RES,PIPES m RTTWO(loem a thm 021 d Aodertdrue No.5 Attadusent ft 1 ?age 2 of 4 8W Form -Page 2 of 4 McBride LBtstation and Force Main Intprovenumts,Project feo.E14054 Rev O1-13-2Q36 W W 01 BID FORM (Per SEMON 0129 01 MM%REMENT AK BASIS FOR PA Gi lConcrete Sidewalks and Driveways SF 119M0 Com. C2 IPCR Building Foundation LS 1 j p 1:3 Transformer Foundation LS 1 04 Generator Foundation LS 1 t 9 GS Biotriddrng Filter Odor Control Unit Foundation LS 1 C•6 7'Chain Link Fence w/3 Strand Barb Wire Top LF 325 07 18'Wide Security Gate w/Card Reader and Gate Opener LS 1 C8 5'Wide Personnel Gate EA 1 04 lBadcflow Preventer EA 1 _01.0 [Removable Removable Bollards EA 10 D11 Select Flli SY 200 .f- _ - D12 Demolish Edsft Concrete Traffic Wand SF D13 Saw Cut and Remove Existing Curb,Gutter,&HMAC LF 210 Q ILA Q J. 014 Mill 2-of Bft tng HMAC Pavement SY S22 D15 2-Type-D-HMAC SY 568 D16 Cement Stabilized Sand(7%Portland Cement) Cy 100 D17 8-Type-B-HMAC SY 522 4 - D-B Concrete Traffic Wand SF 500 D29 ADA Curb Ramp SY 55 ZGz_. %4p;-- . 4 U5 D20 IV Standard Curb and Gutter LF 10 D21 IWWcd"Pavement Markings 7Y.1 12 Solid 100 LF 150 L� Mill-Crosswalk _ Reflective Pavement Marldngs TY.1 18 'H) EA Dig Sol 100 Mil -Yield Line M active Pavement Ma ags TY.1 4") (Solid) (100LF 2 D3 Mil -Median Wand&gft ' cJ D24 Mfeclm Pavement Marlwigs TY.2(W)14-1(5011d)JIM LF 55 J, 3 Mll) Q _. irz5 Mil) LF loo 3 D..6 Remove and lace Existing Traffic Signs EA 2 PUffMAL PART D - CONE CURB. GUTTER, PAVEMENT, STABS & NBSCELUANEOUS SrFEWORKt�,t^f THRU of r-�- E-B.ECiRiGALOwSEMON012901 MEASUREMEWANDMWFOR PAYAifNT} El JAEP Electric Service Allooiance LS 1 E2 Electrical Demolition LS 1 E3 PCR Electrical Building EA 1 E4 Motor Control Center EA 1 ES Pump Controls EA 1 E6 Uffitin&Transformer&Panel EA 1 Z t` _ .. E7 Generator EA 1 - ES SCADA installation FA 1 E9 Electrical Installation LS 1 E10 instrument installation LS 1 Eli Testing TrainMg,Commissioning,O&M's LS 1 PJBWAL PART E-Ei.EMWAL(Ei THRU Eli] Adde dwn No.s Attachment No. Page 3 of 4 Bid Fom Page 3 of 4 McerWe Ldt swtfw and Force Main Improvements,Proierx Nio.E14054 Rev 01-13-2018 W 30 0189)FORM IND SUMMARY SUBTOTAL PART A-GENERAL(ttems Al thru Al) 1 5 d SUSTOrAL PART B-UFT STATION,STRUCTURAL,PUMPS&ODOR CONTROL {Items 61 thm Bs) 1 UBTOTAL PART C - MANHOLES, BYPASS STRUCTURES, PIPES & RTTINGS C1 thru C22) 21 SUBTOTAL PART D-CONCRETE CURB,GUTTER,PAVEMENT,SLABS&MISCELLANEOUS STTEWORK Dl THRU DM oqcn Jic> SUBTOTAL PART E-ELECTRICAL(El THRU Ell) Al 3l CgLIZ) AL PROJECT BASE BLD(PARTS A THRU E) Contract Times Bidder agrees to reach Substantial Completion in 350 days Bidder agrees to reach Final Completion in 380 days p4dmrdum m. S AW-dunent No.1 Pale 4 ora BW Fwm McBride Lit Station and Form Main Improvements,Project No.E14054 Page 4 of 4 Rev 01-13-2Q3fi 003002 COMPLIANCE TOSTATE 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 m 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 annmmmt by which a resident bidder would be required to underbid the nonresident bidder to obtain a comparable contract is the state in which the nonresident's principal place ufbusiness is located." "Nonresident bidder" refers toaperson who |snot aresident ofTexas. "Resident bidder" refers to a person whose principal place of business is in this state, including contractor whose ultimate parent company or majority owner has its principal place of business in this state. Check the statement that iscorrect for Bidder. M� Bidder qualifies as a nonresident bidder whose principal place of business or residency is in theStazeof . [] Bidder (includes parent company or majority owner) qualifies as a resident bidder whose principal place ofbusiness isimthe State ofTexas. 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 1,) UMINU \ L) �/~m��, Company Name: (typed or printed) By: (signture—ottachevidenceqfouthority to sign) Name: (typed or printed) Title: ' mL' Business address: IM-5 hao 1111h AJ kc-RS1 Phone: Email: END OF SECTION Compliance uaState Law onNonresident Bidders 083002-1 00 30 05 City of Corpus Christi Disclosure of Interest SUPPLIER NUMBER TO BE ASSIGNED BYCITY^ - PURCHASING DIVISION f CITY OF CORPUS CHRISTI C&MM DISCLOSURE OF INTEREST Ciof 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. I1 COMPANY NAME: J�. nu( n P.O.BOX: mf� STREET.ADDRESS: 1116 HM ' �3. CITY: Mhtm, Tf� ZIP:3W v FIRM IS: I. Corporation a 2. Partnership 8 3. Sole Owner ❑ 4. As= tion lJJ S. Other DISCLOSURE QUESTIONS If additional space is necessary,please use the reverse side of this page or attach separate sheet: 1. State the names of each employee" of the City of Corpus CMsti having an "ownership interest" constituting 3%or more of the ownership in the above named"firm." Name Job Title and City Department(if known) 2. State the names of each "official" of the City of Corpus Christi having an "ownership interest" constituting 3%or more of the ownership in the above named"firm." Name Title 3. State the names of each"board member"of the City of Corpus Christi having an"ownership interest" constituting 3%or more of the ownership in the above named"firm." Name Board,Commission or Committee 4. State the names of each employee or officer of a "consultant" for the City of Corpus Christi who worked on any matter related to the subject of this contract and has an "ownership interest" constituting 3 or more of the ownership in the above named"firm." Name Consultant 1\ City of Corpus Christi 003005-1 DWosure of interest ae„of S-mie 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 -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 prompt y submitted to the City of Corpus Christi,Texas as changes occur. Certifying Person. Title, 001 (Type or Print) Signature of Certifying � � � Date: Person: DEFINITIONS a. "Board member." A member of any board, commission, or committee appointed by the City Council of the City of Corpus Christi,Texas. b. "Economic benefit". An action that is likely to affect an economic interest if it is likely to have an effect on that interest that is distinguishable from its effect on members of the public in general or 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 firth, such as engineers and architects, hired by the City of Corpus Christi for the purpose of professional consultation and recommendation. City of Corpus Christi 003005-2 Disclosure of interest Rev 01-13-2016 003006 NON-COLLUSION CERTIFICATION STATE OF TEXAS COUNTY OF NUECES OWNER: City of Corpus Christi,Texas 1201 Leopard Street Corpus Christi,Texas 78401 CONTRACT: McBride Lift Station and Force Main Improvements Project No. E14054 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: 0, j- ,m,'n otm" ,, -tk'c� typed or printed) By: (signature--attoch evidence of outhority to sign) Name: JP, Ktt�r'9_ (typed or printed) Title: P)( 1A d((\,v Business address: jA 5q, rl ILI UL� Email: 1"V Phone: END OF SECTION Non-Coflusion Certification 00 30 06-1 McBride Lift Station and Force Main Improvements, Project No. E14054 11-25-2013 CONSENT TO At'�7'r[�ty�ret�- 'SPECIAL _ _ _ •,MT.mU O. GOP J S. KAREN Co " ANY �.i THE UNDERSIGNED PERSON, being the sole Shareholder COMPANY, does, as is evidenced by his sig 'e below der of J S. HAREN e following ��the shareholder without�n��of a�� and ratify meeting of the or a formal 101 c WHMEAS the shareholder Performs the duties duector ( ), and the following action, taken b Pursuant to TCA§48-18- PfOVWOns of the by-laws of the Y n G�nsoni7 in accordance with the Tennessee. �rporation and the General Corpor�on act of 1• Election of New Officers. 'The personawhote names appointed of the corporation to serve for a period of one yearappear below are successors are appointed and shall qui*.- Y� or until their President: J Skyler Hares Secr tw)-. Jennifer L.Adkins , Asst' Secretary.. Cassandra L.Hares 2. Execution of DOMMents. The duly elected President, any two of the other duly elected oin� Signing g fly or behalf of the corporation, to execute any �`lodo��authorized, on incident of the routing business of the co and Power to execute agreement ytax including specifically the documents ofthe corporation. returns and other mutine IN WITNESS WBh' WF, the above co for on behalf of the co corporation actions were taken b corporation this the-�day of Y -signed� 2009. N•SEIV • ' • C00'''�. �y.GORpo .•'�. '� J. Skyler Harem, Shareholder VIIA liiii[gUU1 corporations Section p Hope .Andrade .P.0.13ox 13697 5Secretary of State Austin,Texas 78711-3697 w ac • E-- C-5 Office of the Secretary of State CERTIFICATE OF FILING OF J.S. Haren Company File Number: 801081739 The undersigned, as Secretary of State of'Texas, hereby certifies that an Application for Registration for the above named Foreign For-Profit Corporation to transact business in this State has been received in this office and has been found to conform to the applicable provisions of law. ACCORDINGLY, the undersigned, as Secretary of State, and by virtue of the authority vested mi the secretary by law,hereby issues this certificate evidencing the authority of the entity to transact business in this State from and after the effective date shown below for the purpose or purposes set forth in the application under the name of J.S. Haren Company The issuance of this certificate does not authorize the use of a name in this state in violation of the rights of another under the federal Trademark Act of 1946,the Texas trademark law,the Assumed Business or Professional Name Act, or the common law. Dated: 02/02/2009 Effective: 02/02/2009 f ( Hope Andrade COD Secretary of State Come visit its on the internet at http:l/rvmv.sos.state.tx.us! Phone:(512)463-5555 lax: (512)463-5709 Dial: 7-1-1 for Relay Services Prepared by: Linda Gemuenden TID: 10308 Document: 244918620002 THE AMERICA.N INSTITUTE OF ARCHITECTS A IiI Document A 310 Bid Bond BOND # MNB1809121 KNOW ALL MEN BY THESE PRESENTS, that vve ,i. S. HAREN COMPANY 1175 Ifigbway 11 N Athens,I'N37303 as Principal, hereinafter called the Principal, and MERCHANTS NATIONAL BONDING, INC. P.O.Box 1449p 8 Dcs,,Nloines,IA 50306-3498 a corporation duly organized under the laws of the State of IA as Surety, hereinafter called the Surety, are held and firmly bound Unto City of Corpus Christi,TX 1201 Leopard St Corpus Christi,"lam 78401 (dere insen full name,andaddress or legal tifle:of()%vnci)� as Obligee,hereinafter called the Obli-gee, in the sun? of Five Percent of Amount Bid-------------------------------------------Dollars ( $ 5.(10% of attached bid), for the payment ol'which sum well and truly to be made, the said Principal and the said Surety, bind ourselves, our heirs, executors,administrators,SLICUSSors and assigns,jointly and severally, firmly by these presents. WHEREAS, the Principal has submitted a bid for Project# E14054 McBride Lift Station & Force Main Rehabilitation,Corpus Christi,TX (here insert full mune,address nand description ofproject) NOW, 'rHEREFORE, if the Obligee shall accept the bid or the Principal and the Principal shall enter into a Contract with the Obligee in accordance with the terms of such bid and give such bond or bonds as may be specified in the bidding or Contract Documents with good and sufficient surety for the faithful performance of such Contract and for the prompt payment of labor and material furnished in the prosecution thereof, or in the event of the failure of the Principal to enter such Contract and give such bond or bonds, if the Principal shall pay to the Obligee the difference not to exceed the penalty hereof between the amount specified in said bid and Such larger amount for which the Obligee may in good faith contract with another party to perform the Work covered by said bid then this obligation shall be null and void, otherwise to remain in full force and effect, Signed and scaled this 12th (lay of September 201,8,vMMPN, 1. S. FIAREN COMPANY -incipal) Sea]) Ll ............. (Witness) 'n MERCHANTS NATIONAL BONDING, INC. (Witness) I city 1,Iki-07,ATTOR,t)� -FAc,r Bonds�o theast,Inc. 1030 17"'Avenue Smith Nashville,'EN 37212 (615)321-MO AIA DOCUNMENTA310 BID BOND AJA N; FEBRUARY 1970 ED THE AIMERICAN fNS1H'trn01:ARCHri-ECTS, 1731 N.Y.AVE,N.W. WASI fINGTON,LK, 20006 WARNING: unlicensed photocopying violates U.S.copyright laNvs arid is subJect to legal prosectition. 4 . ....... - .. ter.•P1 _ _ . . r ,a''; MER-CHANT-Sftb, BONDING COMPANY, POWER OF ATTORNEY Know All Persons By These Presents,that MERCHANTS BONDING COMPANY(MUTUAL)and MERCHANTS NATIONAL BONDING,INC., both being corporations of the State of Iowa(herein collectively called the"Companies")do hereby make,constitute and appoint,individually, Gregory E Nash;Kelly L Berry;Phillip H Condra their true and lawful Attomey(s)-in-Fact, to sign its name as surety(ies) and to execute, seal and acknowledge any and all bonds, undertakings, contracts and other written instruments 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. This Power-of-Attomey is granted and is signed and sealed by facsimile under and by authority of the following By-Laws adopted by the Board of Directors of Merchants Bonding Company(Mutual) on April 23,2011 and amended August 14, 2015 and adopted by the Board of Directors of Merchants National Bonding,Inc.,on October 16,2015. "The President,Secretary,Treasurer, or any Assistant Treasurer or any Assistant Secretary or any Vice President shall have power and authority to appoint Attomeys4n-Fact, and to authorize them to execute on behalf of the Company, and attach the seal of the Company thereto,bonds and undertakings,recognizances,contracts of indemnity and other writings obligatory in the nature thereof." 'The signature of any authorized officer and the seal of the Company may be affixed by facsimile or electronic transmission to any Power of Attorney or Certification thereof authorizing the execution and delivery of any bond, undertaking, recognizance, or other suretyship obligations of the Company,and such signature and seal when so used shall have the same force and effect as though manually fixed." In connection with obligations in favor of the Florida Department of Transportation only,it is agreed that the power and aut hority hereby given to the Attomey4n-Fact includes any and all consents for the release of retained percentages and/or final estimates on engineering and construction contracts required by the State of Florida Department of Transportation. It is fully understood that consenting to the State of Florida Department of Transportation making payment of the final estimate to the Contractor and/or its assignee, shall not relieve this surety company of any of its obligations under its bond. In connection with obligations in favor of the Kentucky Department of Highways only,it is agreed that the power and authority hereby given to the Attomey-in-Fact cannot be modified or revoked unless prior written personal notice of such intent has been given to the Commissioner- Department of Highways of the Commonwealth of Kentucky at least thirty(30)days prior to the modification or revocation. In Witness Whereof,the Companies have caused this instrument to be signed and sealed this 5th day of April 2017 •'•'10N•�''1 .••"'••. 106 •+ �' PO Q'•. + .-* '. ' MERCHANTS BONDING COMPANY(MUTUAL) 14y�G�� R'4�'''Oy: + ©y0��0'p9'�y,�„ MERCHANT NATIONAL BONDING,INC. _O_ O:v: _O_ O� sv 2003 :Via;' L yr 1933 ;"c: By ........'-9 •• '•��Jr•' .`�a• President STATE OF IOWA •�''`•,••••'••+•• '••••••••• COUNTY OF DALLAS ss. On this this 5th day of April 2017 before me appeared Larry Taylor,to me personally known,who being by me duly sworn did say that he is President of MERCHANTS BONDING COMPANY(MUTUAL) and MERCHANTS NATIONAL BONDING, INC.; and that the seals affixed to the foregoing instrument are the Corporate Seals of the Companies;and that the said instrument was signed and sealed in behalf of the Companies by authority of their respective Boards of Directors. Amt ALICIA K.GRAM zCommission Ntfmber 7117430 • . My Commission Exp m 1 ; April 1,2020 Notary Public (Expiration of notary's commission does not invalidate this instrument) I,William Warner,Jr.,Secretary of MERCHANTS BONDING COMPANY(MUTUAL)and MERCHANTS NATIONAL BONDING,INC.,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 still in full force and effect and has not been amended or revoked. In Witness Whereof,I have hereunto set my hand and affixed the seal of the Companies on this 12th day of September 2018 . •••.�Ptt;ONgl••.••• �•�O�l16,co �•y o,kPO •4 6'p:w �O;p4POR9:°9y 's -o y -2003 �"y'~ 1933 :c; secretary POA 0018 (3117) , •••''`'�•�,;....••''' '•••.....•. 00 52 23 AGREEMENT This Agreement, for the Project awarded on December 4, 2018, is between the City of Corpus Christi (Owner) and J.S. Haren Company (Contractor). Owner and Contractor agree as follows: ARTICLE 1—WORK 1.01 Contractor shall complete all Work as specified or indicated in the Contract Documents. The Work is generally described as: McBride Lift Station and Force Main Improvements Proiect No. E14054 ARTICLE 2—DESIGNER AND OWNER'S AUTHORIZED REPRESENTATIVE 2.01 The Project has been designed by: Jeff Coym, PE—LJA Engineering, Inc. 5656 S. Staples,Suite 230 Corpus Christi,Texas 78411 2.02 The Owner's Authorized Representative for this Project is: Kent Power, P.E.—Acting Construction Management Engineer City of Corpus Christi—Engineering Services 4917 Holly Rd.,#5 Corpus Christi,TX 78411 ARTICLE 3—CONTRACT TIMES 3.01 Contract Times A. The Work is required to be substantially completed within 350 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 380 days after the date when the Contract Times commence to run. B. Milestones,and the dates for completion of each,are as defined in SECTION 0135 00 SPECIAL PROCEDURES. 3.02 Liquidated Damages A. Owner and Contractor recognize that time limits for specified Milestones, Substantial Completion, and completion and readiness for Final Payment as stated in the Contract Documents are of the essence of the Contract. Owner and Contractor recognize that the Owner will suffer financial loss if the Work is not completed within the times specified in Paragraph 3.01 and as adjusted in accordance with Paragraph 11.05 of the General Agreement 005223- 1 McBride Lift Station and Force Main Improvements, Project No. E14054 Rev 06-22-2016 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$950 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$400 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 BID FORM. Unit prices have been computed in accordance with Paragraph 13.03 of the General Conditions. Contractor acknowledges that estimated quantities are not guaranteed, and were solely for the purpose of comparing Bids, and final payment for all unit price items will be based on actual quantities, determined as provided in the Contract Documents. Total Base Bid Price $ 3,437,000.00 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. 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. Agreement 005223-2 McBride Lift Station and Force Main Improvements, Project No. E14054 Rev 06-22-2016 C. Payment will be made for the amount determined per Paragraph 5.02.13, 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; 2. Drawings of physical conditions relating to existing surface or subsurface structures at the Site; 3. Underground Facilities referenced in reports and drawings; Agreement 005223-3 McBride Lift Station and Force Main Improvements, Project No. E14054 Rev 06-22-2016 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. 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, Agreement 005223-4 McBride Lift Station and Force Main Improvements, Project No. E14054 Rev 06-22-2016 correspondence, instructions,drawings, receipts,vouchers, memoranda,and similar data relating to the Cost of the Work and the Contractor's fee. The Contractor shall preserve all such documents for a period of 3 years after the final payment by the Owner. ARTICLE 9—CONTRACT DOCUMENTS 9.01 Contents: A. The Contract Documents consist of the following: 1. Specifications, forms, and documents listed in SECTION 00 0100 TABLE OF CONTENTS. 2. Drawings listed in the Sheet Index. 3. Addenda. 4. Exhibits to this Agreement: a. Contractor's Bid Form. b. N/A. 5. Documentation required by the Contract Documents and submitted by Contractor prior to Notice of Award. B. There are no Contract Documents other than those listed above in this Article. C. The Contract Documents may only be amended, modified, or supplemented as provided in Article 11 of the General Conditions. ARTICLE 10—CONTRACT DOCUMENT SIGNATURES One original of the signed Agreement will be required. The sequence of signatures will be completed in the following order: A. CONTRACTOR —Agreement must be signed by a person authorized to bind the firm or company. If Contractor is a Corporation, agreements must be Attested; B. ASSISTANT CITY ATTORNEY for the City; C. DIRECTOR OF ENGINEERING SERVICES; D. CITY SECRETARY for the City. Agreement 005223-5 McBride Lift Station and Force Main Improvements, Project No. E14054 Rev 06-22-2016 ATTEST CITY OF CORPUS CHRISTI Digitally signed by Jeff Edmonds Rebecca HUerta Digitallysigned by Rebecca 6-00' emcn effre Edmonds,o.om,Engineering. Date:2019.01.09 11:59:40-06'00' email 2019.01.08 08 39 05 m,'00' US Date:2019.01.08 08:39:05-06'00' Rebecca Huerta J.H. Edmonds, P.E. City Secretary Director of Engineering Services M2018-233 AUTHORIZED APPROVED AS TO LEGAL FORM: 12/04/18 BY COUNCIL AL o rairy 69�aa ev Ka t M��wa` R H/M L Digitally s Hoed by City S DN-cn Kent Mcllyer o ou emal kenhnc@cctexes.com, DN:Cn RH/ML 0 City ECfetdfy,Ouxity Secretary, email mOn'que@Cctexas.COm C US Date.2919.91.93 29.94.39-9fi'99' Date:2019.01.08 16:58:36-06'00' Assistant City Attorney ATTEST(IF CORPORATION) CONTRACTOR Cassandra Haren J.S. Haren Company (Seal Below) By: J. S. Haren Note: Attach copy of authorization to sign if Title: President person signing for CONTRACTOR is not President, Vice President, Chief Executive Officer, or Chief 1175 Hwy 11 North Financial Officer Address Athens, TN 37303 City State Zip 423/745-5000 TN 37303 Phone Fax jsharen@jsharen.com EMail END OF SECTION Agreement 005223-6 McBride Lift Station and Force Main Improvements, Project No. E14054 Rev06-22-2016 006113 PERFORMANCE BOND BOND NO. TXC609718 Contractor as Principal Surety Name: J.S.Haren Company Name: Merchants Bonding Company(Mutual) Mailing address(principal place of business): Mailing address(principal place of business): 1175 Hwy.11 North P.O.Box 14498 Athens,TN 37303 Des Moines,IA 50306-3498 Physical address(principal place of businessr Owner 6700 Westown Pkwy Name: City of Corpus Christf,Texas West Des Moines,IA 50266 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: IA Corpus Christi,Texas 78464 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): Proiect No.E14054 800-678-8171 McBride Uft Station and Force Main Telephone(for notice of claim): Imprayements 800-678-8171 Local Agent for Surety Name: Scott D.Chapman Award Date of the Contract: December 4.2018 Address: 25025 N 1-45 Freeway Ste 525 The Woodlands,TX 77380 Contract Price: 53.437.000.00 Bond Telephone: (832)702-8344 Email Address: soott.chapman@usi.com Date of Bond: 12-1-1-1 The address of the surety company to which any (Date of Bond cannot be earlier than Award Date notice of claim should be sent maybe obtained of the Contract) from the Texas Dept of Insurance by cuffing the following toll-free number.•1.800-252-3439 Performance Bond 00 6113-1 E140S4 McBride Lift Station and Force Main Improvements 7-8-2014 Surety and Contractor,intending to he 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 farce 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 PrincipalSurety Merchants Bonding Company(Mu,tual) Signature: Signature: Name: -14a ml 1„ Name: Kelly L Berry,Attcmey.in-Fact Title: RPS1'6AJ- Title: Attorney-in-Fact Email Address: J,-'�haj .0en J01 Email Address: kelly@bondssoutheast.corn N na (Attach Power of Attorney and place surety sea]below) END OF SECTION Performance Bond 006113-2 E14054 McBride Lift Station and Force Main Improvements 7-8-2014 MER.CHANT� BONDING COMPANYro POWER OF ATTORNEY Know All Persons By These Presents,that MERCHANTS BONDING COMPANY(MUTUAL)and MERCHANTS NATIONAL BONDING,INC., both being corporations of the State of Iowa(herein collectively called the"Companies")do hereby make,constitute and appoint,individually, Gregory E Nash;Kelly L Berry;Phillip H Condra their true and lawful Attomey(s)-in-Fact, to sign its name as surety(ies) and to execute, seal and acknowledge any and all bonds, undertakings, contracts and other written instruments 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. This Power-of-Attomey is granted and is signed and sealed by facsimile under and by authority of the following By-Laws adopted by the Board of Directors of Merchants Bonding Company (Mutual)on April 23, 2011 and amended August 14, 2015 and adopted by the Board of Directors of Merchants National Bonding,Inc.,on October 16,2015. "The President, Secretary,Treasurer, or any Assistant Treasurer or any Assistant Secretary or any Vice President shall have power and authority to appoint Attomeys-in-Fact, and to authorize them to execute on behalf of the Company, and attach the seal of the Company thereto, bonds and undertakings,recognizances,contracts of indemnity and other writings obligatory in the nature thereof." "The signature of any authorized officer and the seal of the Company may be affixed by facsimile or electronic transmission to any Power of Attorney or Certification thereof authorizing the execution and delivery of any bond, undertaking, recognizance, or other suretyship obligations of the Company,and such signature and seal when so used shall have the same force and effect as though manually fixed." In connection with obligations in favor of the Florida Department of Transportation only,it is agreed that the power and aut hority hereby given to the Attorney-in-Fact includes any and all consents for the release of retained percentages and/or final estimates on engineering and construction contracts required by the State of Florida Department of Transportation. It is fully understood that consenting to the State of Florida Department of Transportation making payment of the final estimate to the Contractor and/or its assignee, shall not relieve this surety company of any of its obligations under its bond. In connection with obligations in favor of the Kentucky Department of Highways only,it is agreed that the power and authority hereby given to the Attomey-in-Fact cannot be modified or revoked unless prior written personal notice of such intent has been given to the Commissioner- Department of Highways of the Commonwealth of Kentucky at least thirty(30)days prior to the modification or revocation. In Witness Whereof,the Companies have caused this instrument to be signed and sealed this 5th day of April 2017 P11P!!ql �'��• :•OWN '�Q�o• 4 RMUT ,q%:O 4OGORP099 '9y�S MERCHANTMERCHANTS NATIONAL BONDINGBONDING COMPANY,( INC.UAL} 2003 ;o y.r 1933 c. By l .••4 .. ..•.,a��. •..... �•��. President STATE OF IOWA •••�``•�'••``��'• •••••••••• COUNTY OF DALLAS ss. On this this 5th day of April 2017 before me appeared Larry Taylor, to me personally known, who being by me duly sworn did say that he is President of MERCHANTS BONDING COMPANY (MUTUAL)and MERCHANTS NATIONAL BONDING, INC.; and that the seals affixed to the foregoing instrument are the Corporate Seals of the Companies;and that the said instrument was signed and sealed in behalf of the Companies by authority of their respective Boards of Directors. AUCIA K.GRAM i .. Commission Number 767430 _ My Commission Expires /Cpw?. April 1,2020 Notary Public (Expiration of notary's commission does not invalidate this instrument) I,William Warner,Jr.,Secretary of MERCHANTS BONDING COMPANY(MUTUAL)and MERCHANTS NATIONAL BONDING,INC.,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 still in full force and effect and has not been amended or revoked. In Witness Whereof,I have hereunto set my hand and affixed the seal of the Companies on this 17th day of December 2018 �.tPQ/yiq 4ip•, ;�0�,1•`DEtP09:°9'� �I/� 2003 4938`+ `'y, ..✓�' Secretary POA 0018 (3117) •,,"'ago •`�,,, .•�••' '- r' tly 006116 PAYMENT BOND BOND NO. TXC609718 Contractor as Principal Surety Name: J.S.Haren Comoanv Name: Merchants Bonding Company(Mutual) Mailing address(principal place of business): Mailing address(principol place of business): 1175 Hwy 11 North P.O.Box 14498 Athens,TN 37303 Des Moines,IA 50306-3498 Physical address(principal place of business): Owner 6700 Westown Pkwy Name: City of Corpus Christi,Texas West Des Moines,IA 50266 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: lA Corpus Christi,Texas 78469 By submitting this Bond,Surety offirms 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): Proiect No.E14054 I (800)678-8171 McBride Lift Station and Force Main ! Improvements Telephone(for notice of claim): �! (800)678-8171 Local Agent for Surety Name: Scott D.Chapman Award Date of the Contract: December 4.2018 Address: 25025 N 1-45 Freeway Ste 525 The Woodlands,TX 77380 Contract Price: $3.437000.00 Bond Telephone: (832)702-8344 C) Email Address: soott.chapman@usi.com Date of Bond: 12-)1-1 b The address of the surety company to which any (Date of Bond cannot be earlier than Award Date notice of claim should be sent may be obtained of Contract) from the Texas Dept,of Insurance by calling the following toll-free number.-1-800-2S2-3439 Payment Bond Form 00 6116-1 E14054 McBride Lift Station and Force Main Improvements 7-8-2014 Suretyand Contractor,intending to be legally bound and obligated to Owner do each cause this Payment ' Gonad to be duly executed on.its behalf by its authorised officer,went 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 andprovisions of Chapter I 22:53 and Chapter 2269 of the Texas Government Code as amended and all liabilities on this boned shall be determined in accordance with the provisions o,f said Chapter to the some extent as if it were copied at length herein. Venue shall lie exclusively in Nueces County, Texas for any legal action. Contractor aras Principal Surety Merchants Band,' g.�Camp.a�r�y(MuiJu a Signature: Signature: Name: 1 ,m „ . _......._. Name, Keily L Berry,Attca ey-in-Fact VI w Title: a Title: Attorney-in-Fact Entail A dadress: Emaii Address: Kelly@bondssoutheast.com (attach Power of Attorney nand'plarce sarrety seal below) ,r a e., e END CSE SECTION Payment Bond Form 006116-2 E14054 McBride Lift Station and Force Main improvements 7-5-2014 MER.CHANT� BONDING COMPANYro POWER OF ATTORNEY Know All Persons By These Presents,that MERCHANTS BONDING COMPANY(MUTUAL)and MERCHANTS NATIONAL BONDING,INC., both being corporations of the State of Iowa(herein collectively called the"Companies")do hereby make,constitute and appoint,individually, Gregory E Nash;Kelly L Berry;Phillip H Condra their true and lawful Attomey(s)-in-Fact, to sign its name as surety(ies) and to execute, seal and acknowledge any and all bonds, undertakings, contracts and other written instruments 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. This Power-of-Attomey is granted and is signed and sealed by facsimile under and by authority of the following By-Laws adopted by the Board of Directors of Merchants Bonding Company (Mutual)on April 23, 2011 and amended August 14, 2015 and adopted by the Board of Directors of Merchants National Bonding,Inc.,on October 16,2015. "The President, Secretary,Treasurer, or any Assistant Treasurer or any Assistant Secretary or any Vice President shall have power and authority to appoint Attomeys-in-Fact, and to authorize them to execute on behalf of the Company, and attach the seal of the Company thereto, bonds and undertakings,recognizances,contracts of indemnity and other writings obligatory in the nature thereof." "The signature of any authorized officer and the seal of the Company may be affixed by facsimile or electronic transmission to any Power of Attorney or Certification thereof authorizing the execution and delivery of any bond, undertaking, recognizance, or other suretyship obligations of the Company,and such signature and seal when so used shall have the same force and effect as though manually fixed." In connection with obligations in favor of the Florida Department of Transportation only,it is agreed that the power and aut hority hereby given to the Attorney-in-Fact includes any and all consents for the release of retained percentages and/or final estimates on engineering and construction contracts required by the State of Florida Department of Transportation. It is fully understood that consenting to the State of Florida Department of Transportation making payment of the final estimate to the Contractor and/or its assignee, shall not relieve this surety company of any of its obligations under its bond. In connection with obligations in favor of the Kentucky Department of Highways only,it is agreed that the power and authority hereby given to the Attomey-in-Fact cannot be modified or revoked unless prior written personal notice of such intent has been given to the Commissioner- Department of Highways of the Commonwealth of Kentucky at least thirty(30)days prior to the modification or revocation. In Witness Whereof,the Companies have caused this instrument to be signed and sealed this 5th day of April 2017 P11P!!ql �'��• :•OWN '�Q�o• 4 RMUT ,q%:O 4OGORP099 '9y�S MERCHANTMERCHANTS NATIONAL BONDINGBONDING COMPANY,( INC.UAL} 2003 ;o y.r 1933 c. By l .••4 .. ..•.,a��. •..... �•��. President STATE OF IOWA •••�``•�'••``��'• •••••••••• COUNTY OF DALLAS ss. On this this 5th day of April 2017 before me appeared Larry Taylor, to me personally known, who being by me duly sworn did say that he is President of MERCHANTS BONDING COMPANY (MUTUAL)and MERCHANTS NATIONAL BONDING, INC.; and that the seals affixed to the foregoing instrument are the Corporate Seals of the Companies;and that the said instrument was signed and sealed in behalf of the Companies by authority of their respective Boards of Directors. AUCIA K.GRAM i .. Commission Number 767430 _ My Commission Expires /Cpw?. April 1,2020 Notary Public (Expiration of notary's commission does not invalidate this instrument) I,William Warner,Jr.,Secretary of MERCHANTS BONDING COMPANY(MUTUAL)and MERCHANTS NATIONAL BONDING,INC.,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 still in full force and effect and has not been amended or revoked. In Witness Whereof,I have hereunto set my hand and affixed the seal of the Companies on this 17th day of December 2018 �.tPQ/yiq 4ip•, ;�0�,1•`DEtP09:°9'� �I/� 2003 4938`+ `'y, ..✓�' Secretary POA 0018 (3117) •,,"'ago •`�,,, .•�••' '- r' tly DATE(MMIDD/YYYY) AC"R" CERTIFICATE OF LIABILITY INSURANCE 12/19/2018 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 have ADDITIONAL INSURED provisions or 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 Deena Lamb NAME: Brock Insurance Agency PHONEo (706)866-3394 FAX NExt): C,No (706)861-4619 A/C A/ 823 Chickamauga Avenue E-MAIL deenal@brockins.com ADDRESS: P.O.Box 460 INSURER(S)AFFORDING COVERAGE NAIC# Rossville GA 30741 INSURERA: The Travelers Indemnity Company ofAmerica 25666 INSURED INSURER B: The Travelers Indemnity Company 25658 J.S.Haren Company INSURER C: Travelers Property Casualty Company of America 25674 1175 Highway 11 North INSURER D: Westchester Fire Insurance Compayn INSURER E Athens TN 37303 INSURER F COVERAGES CERTIFICATE NUMBER: CL18121916862 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 CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE 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 INSURANCEAUULbUBK POLICY EFF POLICY EXP LTR INSD WVD POLICY NUMBER MMIDD/YYYY MMIDD/YYYY LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1'000'000 CLAIMS-MADE FX OCCUR PREM SDAMAGES Ea oNcurDreme $ 300,000 MED EXP(Any one person) $ 5,000 A Y DTCOOF796197-TIA-18 10/01/2018 10/01/2019 PERSONAL&ADV INJURY $ 1'000'000 GEN'LAGGREGATE LIMITAPPLIES PER: GENERAL AGGREGATE $ 2'000'000 X POLICY ❑ PRO ❑ LOC PRODUCTS-COMP/OP AGG $ 2,000,000 PJECT OTHER: Employee Benefits- $ 1,000,000 AUTOMOBILE LIABILITY 6E�itRBIN♦`C7 81NC,E+I"T $ 1,000,000 Ea accident X ANYAUTO BODILY INJURY(Per person) $ B OWNED SCHEDULED Y DT-810-OF799728-IND-18 10/01/2018 10/01/2019 BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY Per accident Medical payments $ 2,000 X UMBRELLA LIAB OCCUR EACH OCCURRENCE $ 5'000'000 C EXCESS LAB HCLAIMS-MADE Y DTSM-CUP-8J380799 10/01/2018 10/01/2019 AGGREGATE $ 5'000'000 DED I X1 RETENTION $ 10'000 $ WORKERS COMPENSATION X1 SPER TATUTE EORH AND EMPLOYERS'LIABI LI TY Y/N 500,000 ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ P` OFFICER/MEMBER EXCLUDED? N/A UB7J031590-18-26-G 10/01/2018 10/01/2019 (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 500,000 If yes,describe under 500,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ Pollution Liability D Y 671473077001 12/18/2018 12/18/2019 limit 1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,maybe attached if more space is required) Re:McBride Lift Station&Force Main Improvements,Corpus Christi,TX Project E14054 Certificate Holder is listed as additional insured with respect to the General and Auto Liability policies.Waiver of Subrogation applies under the General and Auto Liability policies and Workers Compensation policy.30 days notice of cancellation applies. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN City of Corpus Christi Engineering Services ACCORDANCE WITH THE POLICY PROVISIONS. 1201 Leopard Street AUTHORIZED REPRESENTATIVE Corpus Christi TX 78401 — @ 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD ADDITIONAL COVERAGES Ref# Description Coverage Code Form No. Edition Date Employee Benefits-Aggreate Limit 1 Limit 2 Limit 3 Deductible Amount Deductible Type Premium 2,000,000 Ref# Description Coverage Code Form No. Edition Date Uninsured motorist combined single limit UMCSL Limit 1 Limit 2 Limit 3 Deductible Amount Deductible Type Premium 500,000 Ref# Description Coverage Code Form No. Edition Date Drug Free Credit DRUGF Limit 1 Limit 2 Limit 3 Deductible Amount Deductible Type Premium -$936.00 Ref# Description Coverage Code Form No. Edition Date Experience Mod Factor 1 EXP01 Limit 1 Limit 2 Limit 3 Deductible Amount Deductible Type Premium Ref# Description Coverage Code Form No. Edition Date Expense constant EXCNT Limit 1 Limit 2 Limit 3 Deductible Amount Deductible Type Premium $250.00 Ref# Description Coverage Code Form No. Edition Date Premium discount PDIS Limit 1 Limit 2 Limit 3 Deductible Amount Deductible Type Premium -$5,121.00 Ref# Description Coverage Code Form No. Edition Date WC&Employer's liability WCEL Limit 1 Limit 2 Limit 3 Deductible Amount Deductible Type Premium 500,000 500,000 500,000 Ref# Description Coverage Code Form No. Edition Date Terrorism TERRO Limit 1 Limit 2 Limit 3 Deductible Amount Deductible Type Premium $305.00 Ref# Description Coverage Code Form No. Edition Date Catastrophe CATAS Limit 1 Limit 2 Limit 3 Deductible Amount Deductible Type Premium $383.00 Ref# Description Coverage Code Form No. Edition Date Limit 1 Limit 2 Limit 3 Deductible Amount Deductible Type Premium Ref# Description Coverage Code Form No. Edition Date Limit 1 Limit 2 Limit 3 Deductible Amount Deductible Type Premium rOFADTLCV Copyright 2001,AMS Services,Inc. DATE(MM/DD/YYYY) ,4c�o�zo® EVIDENCE OF PROPERTY INSURANCE 12/18/2018 THIS EVIDENCE OF PROPERTY INSURANCE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE ADDITIONAL INTEREST NAMED BELOW. THIS EVIDENCE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS EVIDENCE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE ADDITIONAL INTEREST. AGENCY PHONE COMPANY A/C No Ext: US ASSURE INSURANCE SERVICES OF FLORIDA, INC. American Zurich Insurance Company P.O. BOX 10610 JACKSONVILLE, FL 32247-0120 FAXE-MAIL efrank@farmerbrown.com A/C NO)7 ADDRESS: CODE: A0218049 SUB CODE: AGENCY CUSTOMER ID#: INSURED LOAN NUMBER POLICY NUMBER J.S Haren Corp ER12360170 1175 hwy 11 N EFFECTIVE DATE EXPIRATION DATE Athens,TN 37303 CONTINUED UNTIL 12/19/2018 12/19/2019 El TERMINATED IF CHECKED THIS REPLACES PRIOR EVIDENCE DATED: PROPERTY INFORMATION LOCATION/DESCRIPTION 1200 McBride Lane Corpus Christi,TX 78407 McBride Lift Station&Force Main Improvements, Corpus Christi,TX Project E14054 30 days notice of cancellation applies. Certificate holder is also an additional insured on the policy 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 EVIDENCE OF PROPERTY INSURANCE 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. COVERAGE INFORMATION COVERAGE/PERILS/FORMS AMOUNT OF INSURANCE DEDUCTIBLE Builders Risk Coverage Form $25,000 Any One Building or Structure $3,500,000 All Covered Property at all Locations $3,500,000 REMARKS(including Special Conditions CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. ADDITIONAL INTEREST NAMEANDADDRESS MORTGAGEE X ADDITIONAL INSURED City of Corpus Christi LOSS PAYEE 1201 Leopard Street LOAN# Corpus Christi,TX 78401 AUTHORIZED REPRESENTATIVE ACORD 27 (2009/12) ©1993-2009 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD 9 Disclosure Statement Z U RI CW It is our pleasure to present the enclosed policy to you for presentation to your customer. INSTRUCTION TO AGENT OR BROKER: WE REQUIRE THAT YOU TRANSMIT THE ATTACHED/ENCLOSED DISCLOSURE STATEMENT TO THE CUSTOMER WITH THE POLICY. Once again, thank you for your interest, and we look forward to meeting your needs and those of your customers. U-GU-873-A CW (06/11) Page 1 of 1 9 Disclosure Statement Z U RI CW NOTICE OF DISCLOSURE FOR AGENT& BROKER COMPENSATION If you want to learn more about the compensation Zurich pays agents and brokers visit: http://www.zurichnaproducercompensation.com or call the following toll-free number: (866)903-1192. This Notice is provided on behalf of Zurich American Insurance Company and its underwriting subsidiaries. U-GU-874-A CW (06/11) Page 1 of 1 ZURICH Texas Important Notice IMPORTANT NOTICE AVISO IMPORTANTE To obtain information or make a complaint: Para obtener informacion o para presentar una queja: You may call Zurich North America's toll-free telephone Usted puede Ilamar al numero de telefono gratuito de number for information or to make a complaint at: Zurich North America's para obtener informacion o para 1-800-382-2150 presentar una queja al: 1-800-382-2150 You may contact the Texas Department of Insurance to obtain information on companies, coverages, rights, or Usted puede comunicarse con el Departamento de Se- complaints at: guros de Texas para obtener informacion sobre com- 1-800-252-3439 panias, coberturas, derechos, o quejas al: 1-800-252-3439 You may write the Texas Department of Insurance: Usted puede escribir al Departamento P.O. Box 149104 de Seguros de Texas a: Austin, TX 78714-9104 P.O. Box 149104 Fax: (512)490-1007 Austin, TX 78714-9104 Web: www.tdi.texas.gov Fax: (512)490-1007 E-mail: ConsumerProtection@tdi.texas.gov Sitio web: www.tdi.texas.gov E-mail: ConsumerProtection@tdi.texas.gov PREMIUM OR CLAIM DISPUTES: Should you have a dispute concerning your premium or DISPUTAS POR PRIMAS DE SEGUROS O about a claim, you should contact the company first. If RECLAMACIONES: the dispute is not resolved, you may contact the Texas Si tiene una disputa relacionada con su prima de seguro Department of Insurance. o con una reclamacion, usted debe comunicarse con la compania primero. Si la disputa no es resuelta, usted ATTACH THIS NOTICE TO YOUR POLICY: puede comunicarse con el Departamento de Seguros de This notice is for information only and does not become Texas. a part or condition of the attached document. ADJUNTE ESTE AVISO A SU POLIZA: Este aviso es solamente para propositos informativos y no se con- vierte en parte o en condicion del documento adjunto. U-GU-296-E(06/15) Page 1 of 1 �`� US Assure PAYMENT INSTRUCTIONS FOR THE ZURICH BUILDERS RISK INSURED Thank you for trusting the Builders Risk Plan insured by Zurich for your construction project. The following policy is not your invoice. A separate premium invoice for your Zurich Builders Risk policy will be mailed directly to you within 48 hours after being issued by your agent. The premium invoice will be addressed from US Assure, the exclusive program administrator and services provider for the Builders Risk Plan insured by Zurich. To help ensure no lapse in coverage occurs, payment for your policy should be remitted to US Assure at the following address by the due date shown on the invoice: US Assure P.O. Box 935597 Atlanta, GA 31193-5597 For billing-related support, contact our dedicated team at (855) 872 - 7787 Monday through Friday, 7:30 a.m. to 7:30 p.m. Eastern time. Your insurance agent or broker continues to be your primary contact for policy servicing and general inquiries. BUILDERS RISK COVERAGE DECLARATIONS The Declarations, Supplemental Declarations, Common American Zurich Insurance Company Policy Conditions, Commercial Inland Marine Conditions, A Stock Company Coverage Form(s)And Endorsement(s), if any, issued to Administrative Office: 1299 Zurich Way and forming a part thereof, complete the Commercial Schaumburg, IL 60196 Phone: 800-382-2150 Insurance Policy numbered as follows: THIS IS A COINSURANCE CONTRACT ❑x New Policy ER12360170 ❑ Renewal of Please read your policy. ❑ Rewrite of In return for the payment of the premium, and subject to all terms of this policy, we agree with you to provide the insurance as stated in this policy. 1. Named Insured and Mailing Address: 2. Producer Information: J.S Haren Corp A Name: US ASSURE INSURANCE SERVICES OF FLORIDA, INC. 1175 hwy 11 N P.O. BOX 10610 Athens, TN 37303 JACKSONVILLE, FL 32247-0120 B Telephone# C Fax# D Zurich Producer#A0218049 3. Policy Period— From: 12/19/2018 To: 12/19/2019 E Field Office Name 12:01 a.m. at your mailing address above. F Field Office Code 4. Form of Business: ❑ Individual ❑ Partnership ❑x Corporation ❑ Joint Venture ❑ Other 5. Limits of Insurance (either One-Shot or Reporting Form as indicated below) ❑x SUPPLEMENTAL DECLARATIONS (If this box is checked, Supplemental Declarations is attached to and forms a part of this policy) ❑ Reporting Form (continuous policy) ❑x One-Shot(non-reporting form/single structure policy) ❑ Annual Rate ❑ Monthly Rate (HBIS —4) ❑ 1-4 Family Dwellingx❑ Commercial Structure Property Location A) Any one building or structure $ 1200 McBride Lane B) All covered property at all locations $ Corpus Christi,TX 78407 C) Rate Per Report D) Premium Per Report New Construction E) Total Taxes and Surcharges Per Report A) Any one building or structure $ 3,500,000 (per attached endorsement—N/A in NY) B) All covered property at all locations $ 3,500,000 F) Total Fully Earned Policy Premium Per Report (same as A unless otherwise noted) Remodeling D) Renovations and improvements $ E) Existing buildings or structures $ F) Rate $ 0.112 G) Premium $ 3,920.00 H) Total Taxes and Surcharges $ 0.00 (per attached endorsement) I) Total Fully Earned Policy Premium $ 3,920.00 (minimum premium applicable) 6. Deductible: 0$500 ❑$1,000 ❑$2,500 ❑$5,000 ❑x Other $25,000 7. Forms Applicable To This Coverage Part: SEE SCHEDULE OF FORMS AND ENDORSEMENTS Countersigned: By: Date Authorized Representative FM-170001 (04-10) THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. POLICY CHANGES Policy Change Number POLICY NUMBER POLICY CHANGES COMPANY EFFECTIVE ER12360170 From 12/19/2018To 12/19/2019 American Zurich Insurance Company NAMED INSURED AUTHORIZED REPRESENTATIVE J.S Haren Corp US ASSURE INSURANCE SERVICES OF FLORIDA, INC. 1175 hwy 11 N P.O. BOX 10610 Athens,TN 37303 JACKSONVILLE, FL 32247-0120 COVERAGE PARTS AFFECTED Builders Risk Coverage CHANGES Additional Insured: City of Corpus Christi 1201 Leopard Street Corpus Christi,TX 78401 Authorized Representative Signature Copyright, Insurance Services Office, Inc., 1983 IL 12 01 11 85 Copyright, ISO Commercial Risk Services, Inc., 1983 Page 1 of 1 BUILDERS RISK COVERAGE SUPPLEMENTAL DECLARATIONS Policy Number: ER12360170 Policy Type: ❑ Reporting Form (continuous policy) OR ❑x One Shot(non-reporting form/single structure policy) ADDITIONAL COVERAGES (COVERAGE FORM) LIMIT OF INSURANCE a. Collapse Included b. Scaffolding, Construction Forms And Temporary Structures $ 50,000 Re-erection Of Scaffolding $ 25,000 c. Debris Removal $ 50,000 d. Back-Up Or Overflow Of Sewers, Drains Or Sumps $ 25,000 e. Fire Department Service Charge $ 25,000 f. Valuable Papers And Records $ 50,000 g. Pollutant Clean-Up And Removal $ 25,000 h. Ordinance Or Law— Direct Damage Loss To The Undamaged Portion Of The Building Included Demolition Cost $ 1,000,000 Increased Cost Of Construction $ 1,000,000 Combined Aggregate For Demolition Cost And Increased Cost Of Construction $ 1,000,000 i. Preservation Of Property Included j. Rewards $ 25,000 k. Property At A Temporary Storage Location $ 175,000 I. Property In Transit $ 175,000 m. Claim Preparation Expense $ 10,000 n. Contract Penalties $ 25,000 OPTIONAL ADDITIONAL COVERAGES (ENDORSEMENTS) ❑ Business Income (HBIS-95) $ Anticipated Project Completion Date Monthly Limit Of Indemnity (fraction) Deductible Period days Civil Authority Included ❑ Business Income And Extra Expense (HBIS-82) $ Anticipated Project Completion Date Monthly Limit Of Indemnity (fraction) Deductible Period days Business Income Included Extra Expense Included Civil Authority Included ❑ Development Or Subdivision Fences, Walls And Signs (HBIS-58) $ ❑ Expediting Expense (HBIS-93) $ ❑ Extra Expense (HBIS-92) $ ❑ Marine Model Home Contents Coverage (❑ HBIS-52—OR -- ❑ HBIS-77) $ ❑ Soft Costs Coverage (HBIS-88) $ Anticipated Project Completion Date Deductible Period days Expense To Mitigate Loss Included Civil Authority Included OPTIONAL COVERAGE EXTENSION (ENDORSEMENT) ❑ Builders Risk Green Building Coverage Extension (HBIS-96) Aggregate Limit Of Liability $ "LEEDO Building Rating" HBIS-91 (06 17) Policy Number ER12360170 SCHEDULE OF FORMS AND ENDORSEMENTS Named Insured: J.S Haren Corp Effective Date: 12/19/2018 12:01 A.M., Standard Time Agent Name: US ASSURE INSURANCE SERVICES OF FLORIDA,INC. Agent No.: A0218049 FM170001(04/10),IL1201(11/85),HBIS-91(06/17),U-GU-619-A CW(IO/02),40471(06/17),HBIS-1(04/09),HBIS-66 (06/17),HBIS-67(04/09),HBIS-83(06/17),HBIS-84(04/09),U-GU-630-D CW(01/15),U-GU-767-B CW(01/15), IL0003(09/08), CM0001(09/04), CM0112(09/13),IL0171(09/07),IL0017(11/98),IL0288(09/07),U-GU-1191-A CW(03/15),U-GU-319-17(01/09) U-GU-619-A CW(10/02) r� Builders Risk Coverage Form ZURICH Various provisions in this policy restrict coverage. Read the entire policy carefully to determine rights, duties and what is and is not covered. Throughout this policy, the words "you" and "your" refer to the Named Insured shown in the Declarations. The words "we", "us"and "our" refer to the Company providing this insurance. Words and phrases that appear in quotation marks have special meaning. Refer to Section F. DEFINITIONS. Coverage provided by Coverage Form is also subject to all Conditions in the Common Policy Conditions and Commercial Inland Marine Conditions forms. A. COVERAGE We will pay for direct physical loss or damage to Covered Property from a Covered Cause of Loss described in this Coverage Form. 1. Covered Property, as used in the Coverage Form, means: Property which has been installed, or is to be installed in any "commercial structure" or any one to four family dwelling, private garage or other structure that will be used to service the "commercial structure" or one to four family dwelling at the location which you have reported to us. This includes: a. Your property; b. Property of others for which you are legally responsible; c. Paving, curbing,fences and outdoor fixtures; d. Trees, shrubs, plants, grass, lawns and landscaping materials installed by you or on your behalf; e. Completed single family dwelling which is being used as a model home when reported to us as such on monthly reports with an amount shown; and f. Foundations of buildings and foundations of structures in the course of construction. 2. Property Not Covered Covered Property does not include: a. Existing buildings or structures to which an addition, alteration, improvement, or repair is being made, unless specifically endorsed; b. Plans, blueprints, designs or specifications, except as provided in paragraph A.4. Additional Coverage of this Coverage Form; c. Land and water; d. "Existing inventory", unless specifically endorsed; e. Contractors' tools, equipment, machinery and property of a similar nature not designated to be a permanent part of the location which you have reported to us; and f. Outdoor trees, shrubs, plants, grass, lawns and landscaping materials that existed prior to the policy's effective date at a location which you have reported to us. 3. Covered Cause Of Loss Covered Cause of Loss means risk of direct physical loss or damage to Covered Property except those causes of loss listed in Section B. EXCLUSIONS. 40471 (06-17) Page 1 of 12 Includes copyrighted material of Insurance Services Office,Inc.,with its permission. 4. Additional Coverages a. Collapse We will pay for direct physical loss or damage to Covered Property, caused by "collapse" of all or part of a building or structure insured under this Coverage Form, if the "collapse" is caused by one or more of the following: (1) Fire; lightning; windstorm; hail; explosion; smoke; aircraft; vehicles; riots; civil commotion; vandalism; breakage of glass;falling objects;weight of snow, ice or sleet; (2) "Water damage"; but only if the causes of loss are otherwise covered in this Coverage Form; (3) Hidden decay; (4) Hidden insect or vermin damage; (5) Weight of people or personal property; (6) Weight of rain that collects on a roof; or (7) Use of defective materials or methods in construction, remodeling or renovation if the "collapse" occurs during the course of the construction, remodeling or renovation. This Additional Coverage does not increase the Limits of Insurance provided in the Coverage Form. b. Scaffolding, Construction Forms And Temporary Structures (1) We will pay for direct physical loss or damage caused by or resulting from a Covered Cause of Loss to scaffolding, construction forms and temporary structures, including fully enclosed office and tool trailers, but only while they are at a construction site you have reported to us. The most we will pay for this Additional Coverage is the Limit of Insurance shown in the Supplemental Declarations for Scaffolding, Construction Forms And Temporary Structures. (2) We will also pay for the cost of re-erection of the scaffold if the loss or damage of the scaffolding is caused by or results from a Covered Cause of Loss. The most we will pay for this Additional Coverage is the Limit of Insurance shown in the Supplemental Declarations for Re-erection Of Scaffolding. No deductible applies to this Additional Coverage. c. Debris Removal We will pay your expenses to remove debris of Covered Property caused by or resulting from a Covered Cause of Loss under this Coverage Form. The expenses will be paid only if they are reported to us in writing within 180 days of the date of direct physical loss or damage. If the sum of the loss or damage and debris removal expenses exceeds the Limit of Insurance applicable to the property, we will pay an additional amount of debris removal expenses you incur in excess of the Limit of Insurance applicable to the property up to, but not exceeding the Limit of Insurance shown in the Supplemental Declarations for Debris Removal. This Additional Coverage does not apply to costs to: (1) Extract"pollutants"from land or water; or (2) Remove, restore or replace polluted land or water. No deductible applies to this Additional Coverage. d. Back-Up Or Overflow Of Sewers, Drains Or Sumps We will pay for loss or damage to Covered Property caused by water that backs up or overflows from a sewer, drain or sump from within the reported location. The most we will pay for this Additional Coverage is the Limit of Insurance shown in the Supplemental Declarations for Back-Up Or Overflow Of Sewers, Drains Or Sumps. No deductible applies to this Additional Coverage. e. Fire Department Service Charge When the fire department is called to save or protect Covered Property from a Covered Cause of Loss, we will pay for your liability for the fire department service charges which are: (1) Assumed by contract or agreement prior to loss or damage; or 40471 (06-17) Page 2 of 12 Includes copyrighted material of Insurance Services Office,Inc.,with its permission. (2) Required by local ordinance or law. The most we will pay for this Additional Coverage is the Limit of Insurance shown in the Supplemental Declarations for Fire Department Service Charge. No deductible applies to this Additional Coverage. f. Valuable Papers And Records We will pay for direct physical loss or damage to "valuable papers and records" caused by or resulting from a Covered Cause of Loss. When there is a duplicate, we will pay for the blank materials for reproducing the records and labor to transcribe or copy the records. When there is no duplicate, we will pay the costs to research, replace, restore or reproduce the lost information on lost or damaged "valuable papers and records". The most we will pay for this Additional Coverage is the Limit of Insurance shown in the Supplemental Declarations for Valuable Papers And Records. No deductible applies to this Additional Coverage. g. Pollutant Clean-Up And Removal We will pay your expense to extract"pollutants"from land or water at locations reported to us if the discharge, dispersal, seepage, migration, release or escape of the "pollutants" is caused by or results from a Covered Cause of Loss that occurs during the policy period. The expenses will be paid only if they are reported to us in writing within 180 days of the date on which the Covered Cause of Loss occurs. This Additional Coverage does not apply to costs to test for, monitor or assess the existence, concentration or effects of"pollutants". But we will pay for testing which is performed in the course of extracting the"pollutants" from land or water. The most we will pay for this Additional Coverage is the Limit of Insurance shown on the Supplemental Declarations for Pollutant Clean-Up And Removal for the sum of all expenses which are incurred as a result of all Covered Causes of Loss during each separate 12 month period from the effective date of the policy. No deductible applies to this Additional Coverage. h. Ordinance Or Law—Direct Damage (1) Coverage For Loss To Undamaged Portion Of The Building Or Structure (a) If a Covered Cause of Loss occurs to Covered Property at the construction site reported to us, we will pay for loss or damage to the undamaged portion of the property as a consequence of enforcement of any ordinance or law that: (i) Requires the demolition of parts of the same property not damaged by a Covered Cause of Loss; (ii) Regulates the construction or repair of property, or establishes zoning or land use requirements at the construction site; and (iii) Is in force at the time of loss or damage. (b) Coverage for loss or damage to the undamaged portion of the structure is included within the applicable Limit of Insurance for that location. This is not additional insurance. (2) Demolition Cost Coverage (a) If a Covered Cause of Loss occurs to Covered Property at the construction site reported to us, we will pay the cost to demolish and clear the construction site of undamaged parts of the property, as a consequence of enforcement of building, zoning or land use ordinance or law. (b) The most we will pay for Demolition Cost Coverage is the amount of loss or damage or the Limit of Insurance shown in the Supplemental Declarations for Demolition Cost,whichever is less. (3) Increased Cost Of Construction Coverage (a) If a Covered Cause of Loss occurs to Covered Property at the construction site reported to us, we will pay for the increased cost necessary to repair, rebuild or reconstruct the damaged portions of that Covered Property when the increased cost is a consequence of enforcement of building, zoning or land use ordinance or law. If the Covered Property is repaired or rebuilt, it must be intended for the 40471 (06-17) Page 3 of 12 Includes copyrighted material of Insurance Services Office,Inc.,with its permission. same occupancy as the property prior to the loss or damage, unless otherwise required by zoning land use ordinance or law. (b) If the ordinance or law requires relocation to another site, we will pay the increased cost of construction at the new site as set forth below in paragraph (c) below. (c) The most we will pay for Increased Cost of Construction Coverage is the amount of loss or damage or the Limit of Insurance shown in the Supplemental Declarations for Increased Cost Of Construction, whichever is less. (d) We will not pay under this coverage for costs associated with the enforcement of any ordinance or law that was in effect prior to the start of the construction at the location you have reported to us. (4) The most we will pay in total for Demolition Cost Coverage and Increased Cost of Construction Coverage for loss or damage from any one occurrence is the Limit of Insurance shown in the Supplemental Declarations for Combined Aggregate For Demolition Cost And Increased Cost Of Construction. (5) We will not pay under this Additional Coverage for costs associated with the enforcement of any ordinance or law which requires any insured or others to test for, monitor, clean up, remove, contain, treat, detoxify or neutralize, or in any way respond to or assess the effects of"pollutants". (6) We will not pay under this Additional Coverage for costs associated with the enforcement of any ordinance or law for existing buildings or structures, or any renovation, remodeling or other work being done on such buildings or structures, even if the existing building or structure is endorsed on this policy. i. Preservation Of Property If it is necessary to move Covered Property from the location reported to us or described on the Declarations, to preserve it from loss or damage by a Covered Cause of Loss, we will pay for any direct physical loss or damage to that property: (1) While it is being moved or while temporarily stored at another location; and (2) Only if the loss or damage occurs within 30 days after the property is first moved. This Additional Coverage is part of, and not in addition to, the Limit of Insurance applicable to the Covered Property. j. Rewards At our option, we may reimburse you for rewards you pay, other than to you, your partners or officers, for information which leads to the conviction of any one or more persons responsible for loss or damage covered under this Coverage Form. Payment and the amount of any reimbursement will be at our sole discretion. The most we will pay for this Additional Coverage is the Limit of Insurance shown in the Supplemental Declarations for Rewards. k. Property At A Temporary Storage Location We will pay for direct physical loss or damage caused by a Covered Cause of Loss to Covered Property while temporarily in storage at a location other than a location which you have reported to us. We will not pay under this Additional Coverage for property in storage if the property has not been specifically allocated to or otherwise identified with a covered building or structure. The most we will pay for this Additional Coverage is the Limit of Insurance shown in the Supplemental Declarations for Property At A Temporary Storage Location. I. Property In Transit We will pay for direct physical loss or damage caused by a Covered Cause of Loss to Covered Property while in transit. The most we will pay for this Additional Coverage is the Limit of Insurance shown in the Supplemental Declarations for Property In Transit. m. Claim Preparation Expense We will reimburse your actual costs for reasonable and necessary claim preparation expenses, as requested by us for determining the amount of loss or damage, prior to finalizing a claim adjustment, as a result of a Covered Cause of Loss. 40471 (06-17) Page 4 of 12 Includes copyrighted material of Insurance Services Office,Inc.,with its permission. (1) Claim preparation expense means the expense incurred by you for: (a) Your employees to produce or certify any particulars or details contained within your books or documents, or such other proofs, information or evidence required by us; (b) Taking inventory, conducting independent appraisals, or gathering and preparing other data to substantiate the amount of loss or damage; and (c) Services provided by accountants, auditors, contractors, architects and engineers or other professionals solely for the purpose of determining the amount of loss or damage. (2) Claim preparation expense does not mean the expense incurred for: (a) Negotiating or presenting any claim that we have disputed or denied; (b) Attorneys, public adjusters, loss appraisers or loss consultants; or (c) Examinations under oath, even if requested by us. This Additional Coverage does not apply until a claim for covered loss or damage to Covered Property has been submitted to and accepted by us. In the event that the amount of covered loss or damage does not exceed the applicable Deductible, no coverage will apply under this Additional Coverage. The most we will pay for this Additional Coverage in any one occurrence is the Limit of Insurance shown in the Supplemental Declarations for Claim Preparation Expense. No deductible applies to this Additional Coverage. In. Contract Penalties If the first Named Insured is a general contractor, we will pay contractual penalties the first Named Insured is legally liable to pay under the provisions of a written construction contract signed prior to the start of construction for late or non-completion of construction at the location which you have reported to us. Those penalties must be the result of direct physical loss or damage to Covered Property from a Covered Cause of Loss at the location which you have reported to us. The most we will pay for this Additional Coverage in any one occurrence is the Limit of Insurance shown in the Supplemental Declarations for Contract Penalties. No deductible applies to this Additional Coverage. Paragraph 2.e. of Section B. EXCLUSIONS does not apply to this Additional Coverage. B. EXCLUSIONS 1. We will not pay for loss or damage caused directly or indirectly by or resulting from any of the following. Such loss or damage is excluded regardless of any other cause or event that contributes concurrently or in any sequence to the loss or damage. a. Governmental Action Seizure or destruction of property by order of any governmental authority. But we will pay for loss or damage caused by or resulting from acts of destruction ordered by governmental authority and taken at the time of a fire to prevent its spread, if that fire would be covered under this Coverage Form. b. Nuclear Hazard Nuclear reaction or radiation, or radioactive contamination, however caused. But if nuclear reaction or radiation contamination results in fire, we will pay for the loss or damage caused by that fire. c. War And Military Action (1) War, including undeclared or civil war; (2) Warlike action by a military force, including action hindering or defending against an actual or expected attack by any government, sovereign or other authority using military personnel or other agents; or (3) Insurrection, rebellion, revolution, usurped power or action taken by governmental authority in hindering or defending against any of these. 40471 (06-17) Page 5 of 12 Includes copyrighted material of Insurance Services Office,Inc.,with its permission. d. Earth Movement (1) Any earth movement (other than sinkhole collapse), such as an earthquake, landslide, mine subsidence or earth sinking, rising or shifting. But if earth movement results in fire or explosion, we will pay for the loss or damage caused by that fire or explosion. (2) Volcanic Action Volcanic eruption, explosion or effusion. But if volcanic eruption, explosion or effusion results in fire, building glass breakage or volcanic action, we will pay for the loss or damage caused by that fire, building glass breakage or volcanic action. Volcanic action means direct loss or damage resulting from the eruption of a volcano when the loss or damage is caused by: (a) Airborne volcanic blast or airborne shock waves; (b) Ash, dust or particulate matter; or (c) Lava flow. All volcanic eruptions that occur within any 168 hour period will constitute a single occurrence. Volcanic action does not include the cost to remove ash, dust or particulate matter that does not cause direct physical loss or damage to the described property. This exclusion does not apply to Covered Property while in transit. e. Water (1) Flood, surface water, waves, tides, tidal waves, tsunami, overflow of any body of water or their spray, all whether driven by wind or not; (2) The interior of any building or structure caused by or resulting from rain, snow, sleet, ice, sand or dust, whether driven by wind or not, unless: (a) The building or structure first sustains damage by a Covered Cause of Loss to its roof or walls through which the rain, snow, sleet, ice, sand or dust enters; or (b) The loss or damage is caused by or results from thawing of snow, sleet or ice on the building or structure. (3) Mudslide or mudflow; (4) Water that backs up or overflows from a sewer, drain or sump, except as provided in the Back-Up Or Overflow Of Sewers, Drains Or Sumps Additional Coverage; (5) Water under the ground surface pressing on, or flowing or seeping through: (a) Foundations, walls,floors or paved surfaces; (b) Basements, whether paved or not; or (c) Doors, windows or other openings. (6) Water, other liquids, powder or molten material that leaks or flows from plumbing, heating, air conditioning or other equipment(except fire protective systems) caused by or resulting from freezing unless you: (a) Do your best to maintain heat in the building or structure; or (b) Drain the equipment and shut off the supply if the heat is not maintained. But if water, as described in e.(1) through e.(5) above, results in fire, explosion or sprinkler leakage, we will pay for the loss or damage caused by that fire, explosion or sprinkler leakage. 2. We will not pay for a loss or damage caused by or resulting from any of the following: a. Delay, loss of use, or loss of market. This does not include "profit" if reported in compliance with the Reporting Provisions Additional Condition. b. Dishonest or criminal acts by you, any of your partners, employees or leased employees, directors, trustees, authorized representatives or anyone to whom you entrust the property for any purpose. This exclusion applies: 40471 (06-17) Page 6 of 12 Includes copyrighted material of Insurance Services Office,Inc.,with its permission. (1) While acting alone or in collusion with others; and (2) Whether or not occurring during the hours of employment. This exclusion does not apply to acts of physical destruction by your employees or leased employees. This exclusion does not apply to Covered Property while it is entrusted to others who are carriers for hire. c. Unexplained or mysterious disappearance except for property in custody of a carrier for hire. d. Shortage of property found upon taking inventory. e. Penalties for noncompliance with contract conditions. f. "Collapse", except as provided in the Collapse Additional Coverage. g. (1) Wear and tear. (2) Any quality in the property itself that causes it to damage or destroy itself; or that causes gradual deterioration. (3) Insects, vermin, rodents. (4) Corrosion, rust,fungus, mold, mildew, rot. (5) Dampness, changes in or extremes of temperatures: (6) Settling, cracking, shrinking, or expansion of any Covered Property. h. Rain, snow, sleet, sand or dust that damages Covered Property that is in the open awaiting installation at the location reported to us. This does not apply to Covered Property in the custody of a carrier for hire. I. Artificially generated electrical current; mechanical breakdown; rupturing or bursting caused by centrifugal force. j. Testing, start-up, commissioning, examination or trial of Covered Property such as boilers, ovens, stoves, turbines, pumps, process equipment or equipment of a similar nature to prove their ability or function. This includes any form of testing making use of feedstock, including operational tests, performance tests, or other tests performed in conjunction with such testing. This exclusion does not apply to "electrical testing", "mechanical testing", "pneumatic testing" or "hydrostatic testing" used in the start-up and testing of building systems that are intended to service a building. 3. We will not pay for loss or damage caused by or resulting from any of the following. But if loss or damage by a Covered Cause of Loss results, we will pay for the resulting loss or damage caused by that Covered Cause of Loss. a. Weather conditions which contribute in any way to a cause or event excluded in paragraph 1. above to produce the loss or damage. b. Acts or decisions, including the failure to act or decide, of any person, group, or organization representing a governmental, regulatory or controlling body. c. Faulty, inadequate or defective: (1) Planning, zoning, development, surveying, siting; (2) Design, specifications,workmanship, repair, construction, renovation, remodeling, grading, compaction; (3) Materials used in repair, construction, renovation or remodeling; or (4) Maintenance; of all or part of any Covered Property wherever located. d. The discharge, dispersal, seepage, migration, release or escape of "pollutants", except as provided under Pollutant Clean-Up And Removal Additional Coverage. C. LIMITS OF INSURANCE The most we will pay for loss or damage to any one building or structure is the lesser of the Limit of Insurance shown in the Declarations for that one building or structure or the "total estimated completed value" that was reported to us for that one building or structure. The most we will pay for loss or damage in any one occurrence is the Limit of Insurance shown in the Declarations for all Covered Property at all locations. 40471 (06-17) Page 7 of 12 Includes copyrighted material of Insurance Services Office,Inc.,with its permission. D. DEDUCTIBLE We will not pay for loss or damage in any one occurrence until the amount of covered loss or damage exceeds the Deductible shown in the Declarations. We will then pay the amount of the covered loss or damage which exceeds the Deductible, up to the applicable Limit of Insurance. E. ADDITIONAL CONDITIONS The following conditions apply in addition to the Common Policy Conditions and the Commercial Inland Marine Conditions: 1. Coverage Territory The coverage territory is United States of America(including its territories and possessions). 2. Where Coverage Applies This coverage applies to Covered Property while within the coverage territory while: a. At any construction site you have reported; b. Temporarily at other premises, if the property has been designated to be installed at a location you have reported to us; or c. In transit except imports or exports while ocean marine coverage applies. 3. When Coverage Begins And Ends We will cover risk of loss or damage from the time when you are legally responsible for the Covered Property on or after the effective date of this policy if all other conditions are met. Coverage will end at the earliest of the following: a. Once your interest in the Covered Property ceases; b. Ninety days after initial occupancy of the Covered Property unless: (1) That building is being used as a model home; (2) That building is being remodeled and is a single family dwelling; or (3) That building is being used as a"model home leaseback". c. When the Covered Property is leased to or rented to others: (1) For a single family dwelling,when the building is leased or rented to others; (2) For a two, three or four family dwelling, when 50% or more of the units in the structure are leased to or rented to others; or (3) For a "commercial structure", when 75% or more of the square footage space is leased to or rented to others. This does not apply to pre-leases established prior to construction. d. When you abandon the reported location with no intention to complete it; e. At the end of 12 months from the month when you first reported the location to us unless you report the location again and pay an additional premium. If the location is reported again and the additional premium is paid, coverage will end at the end of 12 months from the month when you re-reported the location to us as described in the Reporting Provisions Additional Condition. You have the option to report the same location a third time at the end of the second 12 month period, provided the required additional premium is paid. Coverage for this third 12 month term will end at the end of 12 months from the month you re-reported the location for a third term; or For coverage on existing buildings or structures that are being or have been remodeled, at the end of 12 months from the month when you first reported the location to us unless you report the location again and pay an additional premium. If the location is reported again and the additional premium is paid, coverage will end at the end of 12 months from the month when you re-reported the location to us as described in the reporting provision below. There is no option to report a third year. f. When permanent property insurance applies; or 40471 (06-17) Page 8 of 12 Includes copyrighted material of Insurance Services Office,Inc.,with its permission. g. Once the Covered Property is accepted by the owner or buyer and: (1) The contractor has been paid in full; whether procured by any insured hereunder or by the owner or purchaser; or (2) The transfer of ownership has taken place. 4. Reporting Provisions a. Each month you must report to us the "total estimated completed values" of all Covered Property for each location started during the previous month. This report must be made on the form we provide. For the purpose of these reports, a location is started when you first put any building materials (including the foundation)on the construction site. If your policy is endorsed to provide coverage for existing structures that you are renovating or adding onto and for which you seek coverage, a location is started on the earlier of the following: (1) When you first put any building materials, which includes any new, altered or expanded foundation, on the site; or (2) When you acquire title to the existing structure. b. You must pay premiums based on the "total estimated completed value" of the Covered Property using the rate we furnish. You must send your premium payment with the report for the reported locations to be covered. We must receive your report and the accompanying premium payments at the address designated in our form by the last business day of the month in which the report is due, or the report is late. c. If a report is received late, coverage begins on the day the report is received, and there is no coverage for any loss or damage that occurred before that report was received. Our acceptance of a report of values and premium payment does not waive or change any part of this policy or stop us from asserting any right we have under the terms of this policy. d. The premium charged is fully earned and no refund is due you when coverage ends. e. A dwelling being used as a model home must be reported and should be identified as a model home. f. You will keep accurate construction records regarding property we cover under this policy. This includes the "total estimated completed value" of the Covered Property and a record of all contracts of sale dealing with the Covered Property. g. If at the end of 12 months from the time you first reported a start to us, you still have that location in your inventory, you may report that location to us a second time. If at the end of the second 12 months from the time you first reported a start to us, you still have that location in your inventory, you may report that location to us a third time. For coverage on existing buildings or structures that are being or have been remodeled, if at the end of 12 months from the time you first reported a start to us, you still have that location in your inventory, you may report that location to us a second time. There is no option to report a third time. h. Cancellation of this policy will not affect the insurance in force on any location which you have reported to us or on any location which started before the effective date of the cancellation notice if that location is reported on the report due and premium payment is made. However, you cannot report any location currently in your inventory a second time after the effective date of cancellation. However, coverage may be canceled on any location if notice is given in writing in accordance with the cancellation provision in the Common Policy Conditions, or state amendatory endorsements. 5. Mortgage Holders Clause a. The term mortgage holder includes trustees. b. We will pay for covered loss or damage to Covered Property to each mortgage holder shown on a Certificate of Insurance issued by the current Agent of Record. c. The mortgage holder has the right to receive payment for loss or damage even if the mortgage holder has started foreclosure or similar action on the Covered Property. d. If we deny your claim because of your acts or because you have failed to comply with the terms of this Coverage Part, the mortgage holder will still have the right to receive payment for loss or damage to Covered Property if the mortgage holder: 40471 (06-17) Page 9 of 12 Includes copyrighted material of Insurance Services Office,Inc.,with its permission. (1) Pays any premium due under this Coverage Part at our request if you have failed to do so; (2) Submits a signed, sworn proof of loss within 60 days after receiving notice from us of your failure to do so; and (3) Has notified us of any change in ownership, occupancy or substantial change in risk known to the mortgage holder. All of the terms of this Coverage Part will then apply directly to the mortgage holder. e. If we pay the mortgage holder for any loss or damage and deny payment to you because of your acts or because you have failed to comply with the terms of this Coverage Part: (1) The mortgage holder's rights under the mortgage will be transferred to us to the extent of the amount we pay; and (2) The mortgage holder's rights to recover the full amount of the mortgage holder's claim will not be impaired. At our option, we may pay to the mortgage holder the whole principal on the mortgage plus any accrued interest. In this event, your mortgage and note will be transferred to us and you will pay your remaining mortgage debt to us. f. If we cancel this policy, we will give written notice to the mortgage holder at least: (1) 10 days before the effective date of cancellation if we cancel for non-payment of premium; or (2) 30 days before the effective date of cancellation if we cancel for any other reason. g. We will not notify the mortgage holder if: (1) You cancel this policy, or (2) Coverage ends for any reason other than if we cancel the policy. 6. Waiver Of Coinsurance If there is loss or damage to Covered Property and the cost to repair or replace such property is less than or equal to$25,000,we will adjust the loss or damage without regard to the Coinsurance Additional Condition. 7. Coinsurance If the reported value is less than the "total estimated completed value", you will bear a portion of any loss or damage. The amount we will pay is determined by the following steps: a. Divide the reported value by the"total estimated completed value"of the Covered Property; b. Multiply the total amount of the covered loss or damage before the application of any deductible by the percentage determined in paragraph a.; and c. Subtract the deductible from the figure determined in paragraph b. Example No. 1 (This example assumes there is no penalty for underinsurance.) Deductible $1,000 Reported Value $100,000 "Total Completed Estimated Value" $100,000 Amount of loss or damage $60,000 a. Reported value divided by"total estimated completed value" $100,000/$100,000 = 1.00 b. Amount of loss or damage multiplied by percentage in paragraph a. $60,000 x 1.00 =$60,000 c. Deductible amount subtracted from result of paragraph b. $60,000-$1,000 = $59,000 40471 (06-17) Page 10 of 12 Includes copyrighted material of Insurance Services Office,Inc.,with its permission. Example No. 2 (This example assumes there is a penalty for underinsurance) Deductible $1,000 Reported Value $100,000 "Total estimated completed value" $120,000 Amount of loss or damage $60,000 a. Reported value divided by"total estimated completed value" $100,000/$120,000 = .833 b. Amount of loss or damage multiplied by percentage in paragraph a. $60,000 x .833= $49,980 c. Deductible amount Subtracted from result of paragraph b. $49,980-$1,000 = $48,980 8. Liberalization Clause If we adopt any revision which would broaden the coverage under this Coverage Form without additional premium within 60 days prior to or during the policy period, the broadened coverage will immediately apply to this Coverage Form. 9. Interest Of Subcontractors, Sub-Subcontractors, Suppliers We cover the interest which your subcontractors, your sub-subcontractors and your suppliers have in the Covered Property, but only while such property is situated at a construction site you have reported to us. This condition does not impair any right of subrogation we would otherwise have. 10. Unintentional Failure To Disclose Hazards Your failure to disclose all hazards existing as of the inception date of the policy shall not affect the coverage afforded by this policy, provided such failure to disclose all hazards is not intentional and the hazard is reported to us as soon as practicable after you learn about it. F. DEFINITIONS 1. "Collapse" means the abrupt falling down or the caving in of a building or structure or a part of a building or structure with the result that the building or structure cannot be occupied for its intended use: a. A part of a building or structure that is in danger of falling down or caving in is not considered to be in a state of collapse; b. A part of a building or structure that is standing is not considered to be in the state of collapse even if it is separated from another part of a building or structure; c. A building or structure that is standing or any part of a building or structure that is standing is not considered to be in the state of collapse even if it shows evidence of cracking, bulging, sagging, bending, leaning, settling, shrinkage or expansion. 2. "Commercial structure" means any structure other than a one to four family dwelling. 3. "Electrical testing" means the testing of systems that are operated by electricity, excluding service equipment and service conductors, electrical systems greater than 600 volts nominal and electrical systems that are greater than single phase. 4. "Existing inventory" means buildings or structures where construction was started and more than 30%of the"total estimated completed value"was completed prior to the inception date of this policy. 5. "Hydrostatic testing" means testing through the use of water or other fluids, which are processed through the machinery or system being tested. 6. "Mechanical testing" means testing of moving parts of equipment and components, which are part of the buildings or structures insured, by operation of such equipment or components. 40471 (06-17) Page 11 of 12 Includes copyrighted material of Insurance Services Office,Inc.,with its permission. 7. "Model home leaseback" means a dwelling purchased from the Insured and is then leased back to the Insured, by the purchaser, to be used by the Insured as a model home until the purchaser occupies the dwelling as a residence. 8. "Overhead" means those business expenses, other than materials and labor, incurred either directly or indirectly due to the construction of a dwelling or structure. 9. "Pollutants" mean any solid, liquid, gaseous or thermal irritant or contaminant, including smoke, vapor, soot fumes, acids, alkalis, chemicals and waste. Waste includes materials to be recycled, reconditioned or reclaimed. 10. "Pneumatic testing" means testing through the use of compressed air or other gas to fill test cavities which is processed through the machinery or system being tested. 11. "Profit" means the difference between the selling price of the land and completed structure and your cost of the land and the completed structure. If you do not have a signed contract for the sale of the completed structure and land, the allowance for"profit"will not exceed 20%. 12. "Total estimated completed value" means all costs associated with the building and designing of the Covered Property including labor, 'overhead"and materials and if included, "profit'. 13. "Valuable papers and records" means inscribed, printed or written documents, manuscripts or records, including abstracts, books, deeds, drawings, films, maps or mortgages. However, "valuable papers and records" does not mean: a. Money or securities; b. Converted data; or c. Programs or instructions used in your data processing operation, including the materials on which the data is recorded. 14. "Water damage" means accidental discharge or leakage of water or steam as the direct result of the breaking apart or cracking of any part of a system or appliance (other than a sump system including its related equipment and parts)containing water or steam. 40471 (06-17) Page 12 of 12 Includes copyrighted material of Insurance Services Office,Inc.,with its permission. Non-Reporting Endorsement ZURICH""" THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. This endorsement modifies insurance provided under the: BUILDERS RISK COVERAGE FORM Section E.ADDITIONAL CONDITIONS is amended as follows: 1. Paragraph e. of Additional Condition 3.When Coverage Begins And Ends is replaced by the following: e. Upon expiration of the policy. 2. Additional Condition 4. Reporting Provisions is replaced by the following: 4. Reporting Provisions a. The premium charged is fully earned and no refund is due to you when coverage ends. b. You will keep accurate construction records regarding property we cover under this policy. This includes the "total estimated completed value" of the property and a record of all contracts of sale dealing with the property. 3. Additional Condition 7. Coinsurance is replaced by the following: 7. Coinsurance If the limit of insurance is less than the "total estimated completed value" of the property insured, you will bear a portion of any loss. The amount we will pay is determined by the following steps: a. Divide the limit of insurance by the "total estimated completed value"of the Covered Property; b. Multiply the total amount of the covered loss, before the application of any deductible, by the percentage determined in paragraph a.; c. Subtract the deductible from the figure determined in paragraph b. Example No 1. (This example assumes there is no penalty for underinsurance.) Deductible $1,000 Reported value $100,000 "Total Completed Estimated Value" $100,000 Amount of loss or damage $60,000 a. Limit of Insurance/Total Estimated Completed Value $100,000/$100,000 = 1.00 b. Amount of loss x percentage in A $60,000 x 1.00 = $60,000 c. Deductible amount subtracted from results in B HBIS-1 (04-09) Page 1 of 2 Includes copyrighted material of Insurance Services Office, Inc.,with its permission. $60,000 - $1,000 =$59,000 Total amount of loss payable = $59,000 Example No. 2 (This example assumes there is a penalty for underinsurance.) Deductible $1,000 Limit of Insurance $100,000 "Total Completed Estimated Value" $120,000 Amount of loss $60,000 a. Limit of Insurance/Total Estimated Completed Value $100,000/$120,000 = .833 b. Amount of loss x percentage in A $60,000 x .833 = $49,980 c. Deductible amount subtracted from results in B $49,980- $1,000 = $48,980 Total amount of loss payable = $48,980 All other terms, conditions, provisions and exclusions of the policy remain the same. HBIS-1 (04-09) Page 2 of 2 Includes copyrighted material of Insurance Services Office, Inc.,with its permission. Windstorm Or Hail Deductible ZURICH" THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. This endorsement modifies insurance provided under the: Builders Risk Coverage Form Schedule Windstorm Or Hail Deductible I. ❑ Dollar Deductible of$ ; OR II. W1 Percentage Deductible of 3 %, subject to a minimum Deductible of$ 25,000 For loss or damage caused by windstorm or hail, Section D. DEDUCTIBLE is replaced by the following: The Windstorm Or Hail Deductible applies to loss or damage to Covered Property caused directly or indirectly by windstorm or hail, regardless of any other cause or event that contributes concurrently or in any sequence to the loss or damage. If loss or damage from a covered weather condition other than windstorm or hail occurs, and that loss or damage would not have occurred but for windstorm or hail, such loss or damage shall be considered to be caused by windstorm or hail and therefore part of the windstorm or hail occurrence. With respect to Covered Property, no other deductible applies to windstorm or hail. The Windstorm Or Hail Deductible applies whenever there is an occurrence of windstorm or hail. WINDSTORM OR HAIL DEDUCTIBLE CLAUSE 1. Non Reporting Form a. When I. Dollar Deductible is selected in the Schedule above, this Windstorm Or Hail Deductible applies separately to each building or structure that sustains loss or damage if two or more buildings or structures sustain loss or damage. b. When II. Percentage Deductible is selected in the Schedule above, the amount of the Windstorm Or Hail Deductible will be determined by multiplying the percentage shown in the Schedule above by the Limit of Insurance applicable to the property described in the Declarations that has sustained loss or damage subject to the minimum Deductible stated in II. above. This Windstorm Or Hail Deductible is calculated separately for, and applies separately to, each building or structure, if two or more buildings or structures sustain loss or damage. c. We will not pay for loss or damage to Covered Property until the amount of loss or damage exceeds the applicable Windstorm Or Hail Deductible. We will then pay the amount of loss or damage in excess of the Windstorm Or Hail Deductible up to the "total estimated completed value" for the building or structure that sustained loss or damage. In no event will we pay more than the Limit of Insurance in the Declarations. 2. Reporting Form a. When I. Dollar Deductible is selected in the Schedule above, this Windstorm Or Hail Deductible applies separately to each building or structure that sustains loss or damage if two or more buildings or structures sustain loss or damage. b. When II. Percentage Deductible is selected in the Schedule above, the amount of the Windstorm Or Hail Deductible will be determined by multiplying the percentage shown in the Schedule above by the "total estimated completed value" of the location reported to us that has sustained loss or damage subject to the minimum Deductible stated in II. above. This Windstorm Or Hail Deductible is calculated separately for, and applies separately to, each building or structure reported to us, if two or more buildings or structures sustain loss or damage. HBIS-66(06-17) Page 1 of 2 Includes copyrighted material of Insurance Services Office,Inc.,with its permission. c. We will not pay for loss or damage to Covered Property until the amount of loss or damage exceeds the applicable Windstorm Or Hail Deductible. We will then pay the amount of loss or damage in excess of the Windstorm Or Hail Deductible up to the reported "total estimated completed value" for the building or structure that sustained loss or damage. In no event will we pay more than the Limit of Insurance in the Declarations. 3. Deposit Premium Form a. When I. Dollar Deductible is selected in the Schedule above, this Windstorm Or Hail Deductible applies separately to each building or structure that sustains loss or damage if two or more buildings or structures sustain loss or damage. b. When II. Percentage Deductible is selected in the Schedule above, the amount of the Windstorm Or Hail Deductible will be determined by multiplying the percentage shown in the Schedule above by the "total estimated completed value"of the location that has sustained loss or damage subject to the minimum Deductible stated in II. above. This Windstorm Or Hail Deductible is calculated separately for, and applies separately to, each building or structure, if two or more buildings or structures sustain loss or damage. c. We will not pay for loss or damage to Covered Property until the amount of loss or damage exceeds the applicable Windstorm Or Hail Deductible. We will then pay the amount of loss or damage in excess of the Windstorm Or Hail Deductible up to the "total estimated completed value" for the building or structure that sustained loss or damage. In no event will we pay more than the Limit of Insurance in the Declarations. All other terms, conditions, provisions and exclusions of this policy remain the same. HBIS-66(06-17) Page 2 of 2 Includes copyrighted material of Insurance Services Office,Inc.,with its permission. 0 Deductible Amendatory Endorsement ZURICH' THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. This endorsement modifies insurance provided under the: BUILDERS RISK COVERAGE FORM Section D. DEDUCTIBLE replaced by the following: D. DEDUCTIBLE We will not pay for loss or damage in any one occurrence until the amount of covered loss or damage exceeds the Deductible shown in the Declarations. We will then pay the amount of covered loss or damage which exceeds the Deductible, up to the Limit of Insurance. This Deductible applies separately to each building or structure, described in the Declarations or reported to us, if two or more locations sustain loss or damage. All other terms, conditions, provisions and exclusions of this policy remain the same. HBIS-67(04-09) Page 1 of 1 Includes copyrighted material of Insurance Services Office, Inc.,with its permission. 0 Changes In Cancellation Condition ZURICH " THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. This endorsement modifies insurance provided under the: Builders Risk Coverage Form Common Policy Conditions Section A. Cancellation, Paragraph 5. is replaced with the following: The premium for this coverage is fully earned and no refund is due when the policy is cancelled. All other terms, conditions, provisions and exclusions of the policy remain the same. HBIS-83(06-17) Page 1 of 1 Includes copyrighted material of Insurance Services Office, Inc.,with its permission. Changes In Valuation Condition ZURICH""" THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. This endorsement modifies insurance provided under the: BUILDERS RISK COVERAGE FORM The Valuation General Condition in Commercial Inland Marine Conditions is replaced by the following: Valuation In the event of loss or damage, the value of the property will be determined as of the time of the loss or damage. 1. The value of the property will not be more than the amount necessary to replace the structure or repair the structure, whichever is less, to the same point of completion that had been achieved immediately before the loss or damage. 2. If the loss or damage involves building materials which have not been installed, the value of the property will not be more than the amount necessary to replace the materials with like kind and quality. All other terms, conditions, provisions and exclusions of the policy remain the same. HBIS-84(04-09) Page 1 of 1 Insured Name: Policy Number: Effective Date: 0 ZURICH THIS DISCLOSURE IS ATTACHED TO AND MADE PART OF YOUR POLICY. DISCLOSURE OF IMPORTANT INFORMATION RELATING TO TERRORISM RISK INSURANCE ACT SCHEDULE* Premium attributable to risk of loss from certified acts of terrorism for lines of insurance subject to TRIA: $0 *Any information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. Disclosure of Premium In accordance with the federal Terrorism Risk Insurance Act ("TRIA"), as amended, we are required to provide you with a notice disclosing the portion of your premium, if any, attributable to the risk of loss from terrorist acts certified under that Act for lines subject to TRIA. That portion of premium attributable is shown in the Schedule above. The premium shown in the Schedule above is subject to adjustment upon premium audit, if applicable. B. Disclosure of Federal Participation in Payment of Terrorism Losses The United States Government may pay a share of insured losses resulting from an act of terrorism. The federal share will decrease by 5% from 85% to 80% over a five year period while the insurer share increases by the same amount during the same period. The schedule below illustrates the decrease in the federal share: Januaryl, 2015— December 31, 2015 federal share: 85% Januaryl, 2016— December 31, 2016 federal share: 84% Januaryl, 2017— December 31, 2017 federal share: 83% Januaryl, 2018— December 31, 2018 federal share: 82% Januaryl, 2019— December 31, 2019 federal share: 81% Januaryl, 2020— December 31, 2020 federal share: 80% C. Disclosure of$100 Billion Cap on All Insurer and Federal Obligations If aggregate insured losses attributable to terrorist acts certified under TRIA exceed $100 billion in a calendar year (January 1 through December 31) and an insurer has met its deductible under the program, that insurer shall not be liable for the payment of any portion of the amount of such losses that exceeds $100 billion, and in such case insured losses up to that amount are subject to pro rata allocation in accordance with procedures established by the Secretary of Treasury. D. Availability As required by TRIA, we have made available to you for lines subject to TRIA coverage for losses resulting from acts of terrorism certified under TRIA with terms, amounts and limitations that do not differ materially from those for losses arising from events other than acts of terrorism. E. Definition of Act of Terrorism under TRIA TRIA defines "act of terrorism" as any act that is certified by the Secretary of the Treasury, in accordance with the provisions of the federal Terrorism Risk Insurance Act ("TRIA"), to be an act of terrorism. The Terrorism Risk Insurance Act provides that the Secretary of Treasury shall certify an act of terrorism: 1. To be an act of terrorism; 2. To be a violent act or an act that is dangerous to human life, property or infrastructure; U-GU-630-D CW(01/15) Copyright©2015 Zurich American Insurance Company Page 1 of 2 Includes copyrighted material of Insurance Services Office, Inc.,with its permission. I To have resulted in damage within the United States, or outside of the United States in the case of an air carrier (as defined in section 40102 of Title 49, United States Code) or a United States flag vessel (or a vessel based principally in the United States, on which United States income tax is paid and whose insurance coverage is subject to regulation in the United States), or the premises of a United States mission; and 4. To have been committed by an individual or individuals as part of an effort to coerce the civilian population of the United States or to influence the policy or affect the conduct of the United States Government by coercion. No act may be certified as an act of terrorism if the act is committed as part of the course of a war declared by Congress (except for workers' compensation) or if losses resulting from the act, in the aggregate for insurance subject to TRIA, do not exceed $5,000,000. U-GU-630-D CW(01/15) Copyright©2015 Zurich American Insurance Company Page 2 of 2 Includes copyrighted material of Insurance Services Office, Inc.,with its permission. 09 ZURICH CAP ON LOSSES FROM CERTIFIED ACTS OF TERRORISM Insureds Name Policy Number Effective Endorsement Date Number THIS ENDORSEMENT CHANGES YOUR POLICY. PLEASE READ IT CAREFULLY. This endorsement modifies your insurance: COMMERCIAL INLAND MARINE COVERAGE PART A. Cap on Losses From Certified Terrorism Losses "Certified act of terrorism" means an act that is certified by the Secretary of the Treasury, in accordance with provisions of the federal Terrorism Risk Insurance Act ("TRIA"), to be an act of terrorism. The Terrorism Risk Insurance Act provides that the Secretary of Treasury shall certify an act of terrorism: 1. To be an act of terrorism; 2. To be a violent act or an act that is dangerous to human life, property or infrastructure; 3. To have resulted in damage within the United States, or outside of the United States in the case of an air carrier(as defined in section 40102 of Title 49, United States Code)or a United States flag vessel(or a vessel based principally in the United States, on which United States income tax is paid and whose insurance coverage is subject to regulation in the United States), or the premises of a United States mission; and 4. To have been committed by an individual or individuals as part of an effort to coerce the civilian population of the United States or to influence the policy or affect the conduct of the United States Government by coercion. No act may be certified as an act of terrorism if the act is committed as part of the course of a war declared by Congress (except for workers' compensation) or if losses resulting from the act, in the aggregate for insurance subject to TRIA, do not exceed $5,000,000. If aggregate insured losses attributable to one or more "certified acts of terrorism" exceed $100 billion in a calendar year (January 1 through December 31) and we have met our insurer deductible under the Terrorism Risk Insurance Act, we shall not be liable for the payment of any portion of the amount of such losses that exceeds $100 billion, and in such case insured losses up to that amount are subject to pro rata allocation in accordance with procedures established by the Secretary of Treasury. B. Application of Other Exclusions The terms and limitations of a terrorism exclusion or any other exclusion, or the inapplicability or omission of a terrorism exclusion or any other exclusion, do not serve to create coverage which would otherwise be excluded, limited or restricted under this policy. Copyright©2015 Zurich American Insurance Company U-GU-767-B CW(01/15) Includes copyrighted material of Insurance Services Office,Inc.,with its permission. Page 1 of 1 IL 00 03 09 08 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. CALCULATION OF PREMIUM This endorsement modifies insurance provided under the following: CAPITAL ASSETS PROGRAM (OUTPUT POLICY) COVERAGE PART COMMERCIAL AUTOMOBILE COVERAGE PART COMMERCIAL GENERAL LIABILITY COVERAGE PART COMMERCIAL INLAND MARINE COVERAGE PART COMMERCIAL PROPERTY COVERAGE PART CRIME AND FIDELITY COVERAGE PART EMPLOYMENT-RELATED PRACTICES LIABILITY COVERAGE PART EQUIPMENT BREAKDOWN COVERAGE PART FARM COVERAGE PART LIQUOR LIABILITY COVERAGE PART MEDICAL PROFESSIONAL LIABILITY COVERAGE PART OWNERS AND CONTRACTORS PROTECTIVE LIABILITY COVERAGE PART POLLUTION LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART RAILROAD PROTECTIVE LIABILITY COVERAGE PART The following is added: The premium shown in the Declarations was com- puted based on rates in effect at the time the policy was issued. On each renewal, continuation, or anni- versary of the effective date of this policy, we will compute the premium in accordance with our rates and rules then in effect. IL 00 03 09 08 © ISO Properties, Inc., 2007 Page 1 of 1 Wolters Kluwer Financial Services I Uniform Forms TM COMMERCIAL INLAND MARINE CM 00 01 09 04 COMMERCIAL INLAND MARINE CONDITIONS The following conditions apply in addition to the 6. As often as may be reasonably required, Common Policy Conditions and applicable Additional permit us to inspect the property proving the Conditions in Commercial Inland Marine Coverage loss or damage and examine your books and Forms: records. LOSS CONDITIONS Also permit us to take samples of damaged A. Abandonment and undamaged property for inspection, test- ing and analysis, and permit us to make cop- There can be no abandonment of any property to ies from your books and records. us. 7. We may examine any insured under oath, B. Appraisal while not in the presence of any other insured If we and you disagree on the value of the prop- and at such times as may be reasonably re- erty or the amount of loss, either may make writ- quired, about any matter relating to this insur- ten demand for an appraisal of the loss. In this ance or the claim, including an insured's event, each party will select a competent and im- books and records. In the event of an exami- partial appraiser. The two appraisers will select nation, an insured's answers must be signed. an umpire. If they cannot agree, either may re- g. Send us a signed, sworn proof of loss con- quest that selection be made by a judge of a court taining the information we request to settle having jurisdiction. The appraisers will state sepa- the claim. You must do this within 60 days rately the value of the property and amount of after our request. We will supply you with the loss. If they fail to agree, they will submit their necessary forms. differences to the umpire. A decision agreed to by any two will be binding. Each party will: 9. Immediately send us copies of any demands, notices, summonses or legal papers received 1. Pay its chosen appraiser; and in connection with the claim or suit. 2. Bear the other expenses of the appraisal and 10. Cooperate with us in the investigation or set- umpire equally. tlement of the claim. If there is an appraisal, we will still retain our right D. Insurance Under Two Or More Coverages to deny the claim. If two or more of this policy's coverages apply to C. Duties In The Event Of Loss the same loss or damage, we will not pay more You must see that the following are done in the than the actual amount of the loss or damage. event of loss or damage to Covered Property: E. Loss Payment 1. Notify the police if a law may have been bro- 1. We will give notice of our intentions within 30 ken. days after we receive the sworn proof of loss. 2. Give us prompt notice of the loss or damage. 2. We will not pay you more than your financial Include a description of the property involved. interest in the Covered Property. 3. As soon as possible, give us a description of 3. We may adjust losses with the owners of lost how, when and where the loss or damage oc- or damaged property if other than you. If we curred. pay the owners, such payments will satisfy 4. Take all reasonable steps to protect the Cov- your claim against us for the owners' prop- ered Property from further damage, and keep erty. We will not pay the owners more than a record of your expenses necessary to pro- their financial interest in the Covered Prop- tect the Covered Property, for consideration erty in the settlement of the claim. This will not in- 4. We may elect to defend you against suits crease the Limit of Insurance. However, we arising from claims of owners of property. We will not pay for any subsequent loss or dam- will do this at our expense. age resulting from a cause of loss that is not a Covered Cause of Loss. Also, if feasible, 5. We will pay for covered loss or damage within set the damaged property aside and in the 30 days after we receive the sworn proof of best possible order for examination. loss if you have complied with all the terms of this Coverage Part and: 5. You will not, except at your own cost, volun- tarily make a payment, assume any obliga- a. We have reached agreement with you on tion, or incur any expense without our con- the amount of the loss; or sent. b. An appraisal award has been made. CM 00 01 09 04 Copyright, ISO Properties, Inc., 2003 Page 1 of 3 UNIFORM 6. We will not be liable for any part of a loss that must do nothing after loss to impair them. But you has been paid or made good by others. may waive your rights against another party in F. Other Insurance writing: 1. You may have other insurance subject to the 1. Prior to a loss to your Covered Property. same plan, terms, conditions and provisions 2. After a loss to your Covered Property only if, as the insurance under this Coverage Part. If at time of loss, that party is one of the follow- you do, we will pay our share of the covered ing: loss or damage. Our share is the proportion a. Someone insured by this insurance; or that the applicable Limit of Insurance under this Coverage Part bears to the Limits of In- b. A business firm: surance of all insurance covering on the (1) Owned or controlled by you; or same basis. (2) That owns or controls you. 2. If there is other insurance covering the same This will not restrict your insurance. loss or damage, other than that described in 1. above, we will pay only for the amount of GENERAL CONDITIONS covered loss or damage in excess of the A. Concealment, Misrepresentation Or Fraud amount due from that other insurance, This Coverage Part is void in any case of fraud, whether you can collect on it or not. But we intentional concealment or misrepresentation of a will not pay more than the applicable Limit of material fact, by you or any other insured, at any Insurance. time, concerning: G. Pair, Sets Or Parts 1. This Coverage Part; 1. Pair Or Set 2. The Covered Property; In case of loss or damage to any part of a pair or set we may: 3. Your interest in the Covered Property; or a. Repair or replace any part to restore the 4. A claim under this Coverage Part. pair or set to its value before the loss or B. Control Of Property damage; or Any act or neglect of any person other than you b. Pay the difference between the value of beyond your direction or control will not affect this the pair or set before and after the loss or insurance. damage. The breach of any condition of this Coverage Part 2. Parts at any one or more locations will not affect cover- In case of loss or damage to any part of Cov- age at any location where, at the time of loss or ered Property consisting of several parts damage, the breach of condition does not exist. when complete, we will only pay for the value C. Legal Action Against Us of the lost or damaged part. No one may bring a legal action against us under H. Recovered Property this Coverage Part unless: If either you or we recover any property after loss 1. There has been full compliance with all the settlement, that party must give the other prompt terms of this Coverage Part; and notice. At your option, the property will be re- 2. The action is brought within 2 years after you turned to you. You must then return to us the first have knowledge of the direct loss or amount we paid to you for the property. We will damage. pay recovery expenses and the expenses to re- pair the recovered property, subject to the Limit of D. No Benefit To Bailee Insurance. No person or organization, other than you, having I. Reinstatement Of Limit After Loss custody of Covered Property will benefit from this insurance. The Limit of Insurance will not be reduced by the payment of any claim, except for total loss or E. Policy Period, Coverage Territory damage of a scheduled item, in which event we We cover loss or damage commencing: will refund the unearned premium on that item. 1. During the policy period shown in the Decla- J. Transfer Of Rights Of Recovery Against Oth- rations; and ers To Us 2. Within the coverage territory. If any person or organization to or for whom we F. Valuation make payment under this Coverage Part has rights to recover damages from another, those The value of property will be the least of the fol- rights are transferred to us to the extent of our lowing amounts: payment. That person or organization must do 1. The actual cash value of that property; everything necessary to secure our rights and Page 2 of 3 Copyright, ISO Properties, Inc., 2003 CM 00 01 09 04 2. The cost of reasonably restoring that property In the event of loss or damage, the value of prop- to its condition immediately before loss or erty will be determined as of the time of loss or damage; or damage. 3. The cost of replacing that property with sub- stantially identical property. CM 00 01 09 04 Copyright, ISO Properties, Inc., 2003 Page 3 of 3 COMMERCIAL INLAND MARINE CM 01 12 09 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. TEXAS CHANGES This endorsement modifies insurance provided under the following: COMMERCIAL INLAND MARINE COVERAGE PART A. Loss Condition B. Appraisal in the Commercial B. Paragraph 8. of Loss Condition C. Duties In The Inland Marine Conditions is replaced by the Event Of Loss in the Commercial Inland Marine following: Conditions is replaced by the following: B. Appraisal 8. Send us a signed, sworn proof of loss 1. If we and you disagree on the value of the containing the information we request to settle property or the amount of loss, either may the claim. You must do this within 91 days after make written demand, within 60 days after our request. We will supply you with the our receipt of a signed, sworn proof of loss, necessary forms. for an appraisal of the loss. In this event, C. Paragraph 2. of General Condition C. Legal each party will select a competent and Action Against Us in the Commercial Inland impartial appraiser. The two appraisers will Marine Conditions is replaced by the following: select an umpire. If they cannot agree for 2. The action is brought within two years and one 15 days upon such umpire, either may day from the date the cause of action first request that selection be made by a judge accrues. A cause of action accrues on the date of a court having jurisdiction. The of the initial breach of our contractual duties as appraisers will state separately the value of alleged in the action. the property and amount of loss. If they fail to agree, they will submit their differences D. Paragraphs A.5.a. and A.5.b. of the Coverage to the umpire. A decision agreed to by any Extensions and Section F. Definitions in the two will be binding. Each party will: Equipment Dealers Coverage Form are deleted. a. Pay its chosen appraiser; and b. Bear the other expenses of the appraisal and umpire equally. 2. If there is an appraisal: a. You will still retain your right to bring a legal action against us, subject to the provisions of the Legal Action Against Us Commercial Inland Marine Condition; and b. We will still retain our right to deny the claim. CM 01 12 09 13 © Insurance Services Office, Inc., 2012 Page 1 of 1 Wolters Kluwer Financial Services I Uniform FormsTM IL 01 71 09 07 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. TEXAS CHANGES - LOSS PAYMENT This endorsement modifies insurance provided under the following: COMMERCIAL INLAND MARINE COVERAGE PART CRIME AND FIDELITY COVERAGE PART EQUIPMENT BREAKDOWN COVERAGE PART A. Loss Payment (2) We will notify you in writing as to 1. With respect to the Crime And Fidelity Cover- whether: age Part and Equipment Breakdown Coverage (a) The claim or part of the claim will be Part, the following conditions are added. paid; 2. With respect to the Commercial Inland Marine (b) The claim or part of the claim has Coverage Part, the following conditions replace been denied, and inform you of the Item E. Loss Payment in the Commercial In- reasons for denial; land Marine Loss Conditions: (c) More information is necessary; or a. Claims Handling (d) We need additional time to reach a (1) Within 15 days after we receive written decision. If we need additional time, notice of claim, we will: we will inform you of the reasons for (a) Acknowledge receipt of the claim. If such need. we do not acknowledge receipt of We will provide notification, as described the claim in writing, we will keep a in (2)(a) through (2)(d) above, within: record of the date, method and con- (i) 15 business days after we re- tent of the acknowledgment; ceive the signed, sworn proof of (b) Begin any investigation of the claim; loss and all information we re- and quested; or (c) Request a signed, sworn proof of (ii) 30 days after we receive the loss, specify the information you signed, sworn proof of loss and must provide and supply you with the all information we requested, if necessary forms. We may request we have reason to believe the more information at a later date, if loss resulted from arson. during the investigation of the claim If we have notified you that we need ad- such additional information is neces- ditional time to reach a decision, we sary. must then either approve or deny the claim within 45 days of such notice. ILTX 01 71 09 07 © ISO Properties, Inc., 2006 Pagel of 2 Wolters Kluwer Financial Services I Uniform FormsTM b. We will pay for covered loss or damage Catastrophe or Major Natural Disaster within 5 business days after: means a weather related event which is: (1) We have notified you that payment of (1) Declared a disaster under the Texas the claim or part of the claim will be Disaster Act of 1975; or made and have reached agreement with (2) Determined to be a catastrophe by the you on the amount of loss; or State Board of Insurance. (2) An appraisal award has been made. d. The term "business day", as used in this However, if payment of the claim or part of endorsement, means a day other than Sat- the claim is conditioned on your compliance urday, Sunday or a holiday recognized by with any of the terms of this policy, we will the state of Texas. make payment within 5 business days after B. With respect to the Commercial Inland Marine the date you have complied with such Coverage Part the following is added: terms. We will not be liable for any part of a 'loss" that c. Catastrophe Claims has been paid or made good by others. If a claim results from a weather related ca- tastrophe or a major natural disaster, the claim handling and claim payment dead- lines described in a. and b. above are ex- tended for an additional 15 days. Page 2 of 2 © ISO Properties, Inc., 2006 ILTX 01 71 09 07 COMMON POLICY CONDITIONS All Coverage Parts included in this policy are subject to the following conditions. A. Cancellation D. Inspections And Surveys 1. The first Named Insured shown in the Declara- 1. We have the right to: tions may cancel this policy by mailing ordeliv- a. Make inspections and surveys at anytime; ering to us advance written notice of cancella- tion. b. Give you reports on the conditions we find; 2. We may cancel this policy by mailing or deliv- and ering to the first Named Insured written notice c. Recommend changes. of cancellation at least: 2. We are not obligated to make any inspections, a. 10 days before the effective date of cancel- surveys,reports or recommendations and any lation if we cancel for nonpayment of pre- such actions we do undertake relate only to mium; or insurability and the premiums to be charged. b. 30 days before the effective date of cancel- We do not make safety inspections.We do not lation if we cancel for any other reason. undertake to perform the duty of any person or organization to provide for the health or safety 3. We will mail or deliver our notice to the first ofworkers orthe public.And we do notwarrant Named Insured's last mailing address known that conditions: to us. 4. Notice of cancellation will state the effective a. Are safe or healthful; or date of cancellation.The policy period will end b. Comply with laws, regulations, codes or on that date. standards. 5. If this policy is cancelled,we will send the first 3. Paragraphs 1.and 2.of this condition apply not Named Insured any premium refund due.If we only to us, but also to any rating,advisory, rate cancel, the refund will be pro rata. If the first service or similar organization which makes in- Named Insured cancels,the refund maybe less surance inspections, surveys, reports or rec- than pro rata.The cancellation will be effective ommendations. even if we have not made or offered a refund. 6. If notice is mailed, proof of mailing will be suffi- 4. Paragraph 2.of this condition does not apply toany inspections,surveys,reports orrecommen- cientproof of notice. dations we may make relative to certification, B. Changes under state or municipal statutes, ordinances or regulations, of boilers, pressure vessels or This policy contains all the agreements between elevators. you and us concerning the insurance afforded.The first Named Insured shown in the Declarations is E. Premiums authorized to make changes in the terms of this Thefirst Named Insured shown in the Declarations: policy with our consent.This policy's terms can be amended orwaived only by endorsement issued by 1. Is responsible forthe payment of all premiums; us and made a part of this policy. and C. Examination Of Your Books And Records 2. Will be the payee for any return premiums we We may examine and audit your books and pay. records as they relate to this policy at any time dur- ing the policy period and upto three years afterward. Page 1 of 2 L 00 17 1198 Copyright,Insurance Services Office,Inc.,1998 F. TransferOf Your Rights And Duties UnderThis If you die,your rights and duties will be transferred Policy to your legal representative but only while acting Your rights and duties underthis policy may not be within the scope of duties as your legal represen- transferred without ourwritten consent except in the tative. Until your legal representative is appointed, case of death of an individual named insured. anyone having proper temporary custody of your propertywill have your rights and duties butonlywith respect to that property. Page 2 of 2 L 00 17 1198 Copyright,Insurance Services Office,Inc.,1998 IL 02 88 09 07 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. TEXAS CHANGES - CANCELLATION AND NONRENEWAL This endorsement modifies insurance provided under the following: COMMERCIAL INLAND MARINE COVERAGE PART CRIME AND FIDELITY COVERAGE PART EQUIPMENT BREAKDOWN COVERAGE PART FARM COVERAGE PART— LIVESTOCK COVERAGE FORM FARM COVERAGE PART— MOBILE AGRICULTURAL MACHINERY AND EQUIPMENT COVERAGE FORM A. The following is added to Paragraph 2. of the B. The following condition is added: Cancellation Common Policy Condition: NONRENEWAL We may cancel this policy for any reason except, We may elect not to renew this policy except, that that under the provisions of the Texas Insurance under the provisions of the Texas Insurance Code, Code, we may not cancel this policy solely be- we may not refuse to renew this policy solely be- cause the policyholder is an elected official. cause the policyholder is an elected official. ILTX 02 88 09 07 © ISO Properties, Inc., 2006 Page 1 of 1 Wolters Kluwer Financial Services I Uniform FormsTM 0 SANCTIONS EXCLUSION ZURICH ENDORSEMENT THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY The following exclusion is added to the policy to which it is attached and supersedes any existing sanctions language in the policy, whether included in an Exclusion Section or otherwise: SANCTIONS EXCLUSION Notwithstanding any other terms under this policy, we shall not provide coverage nor will we make any payments or provide any service or benefit to any insured, beneficiary, or third party who may have any rights under this policy to the extent that such cover, payment, service, benefit, or any business or activity of the insured would violate any applicable trade or economic sanctions law or regulation. The term policy may be comprised of common policy terms and conditions, the declarations, notices, schedule, coverage parts, insuring agreement, application, enrollment form, and endorsements or riders, if any, for each coverage provided. Policy may also be referred to as contract or agreement. We may be referred to as insurer, underwriter, we, us, and our, or as otherwise defined in the policy, and shall mean the company providing the coverage. Insured may be referred to as policyholder, named insured, covered person, additional insured or claimant, or as otherwise defined in the policy, and shall mean the party, person or entity having defined rights under the policy. These definitions may be found in various parts of the policy and any applicable riders or endorsements. ALL OTHER TERMS AND CONDITIONS OF THIS POLICY REMAIN UNCHANGED U-GU-1191-ACW (03/15) Page 1 of 1 Important Notice — In Witness Clause ZURICH In return for the payment of premium, and subject to the terms of this policy, coverage is provided as stated in this policy. IN WITNESS WHEREOF, this Company has executed and attested these presents and, where required by law, has caused this policy to be countersigned by its duly Authorized Representative(s). President Corporate Secretary QUESTIONS ABOUT YOUR INSURANCE? Your agent or broker is best equipped to provide information about your insurance. Should you require additional information or assistance in resolving a complaint, call or write to the following (please have your policy or claim number ready): Zurich in North America Customer Inquiry Center 1299 Zurich Way Schaumburg, Illinois 60196-1056 1-800-382-2150 (Business Hours: 8am -4pm [CT]) Email: info.source@zurichna.com U-GU-319-F (01/09) Page 1 of 1 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, on this C to include t; an additional insured Lessees or Contractors — Completed on this Coverage Part;and 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 20 10 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 08 13 ©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 notice as soon as practicable of an "occur- limits of liability required by the "written con- rence" or an offense which may result in a tract requiring insurance" will be considered claim. To the extent possible, such notice to include the minimum limits of liability of any should include: Umbrella or Excess liability coverage required 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 Sec- to the additional insured under which that person 5. The following is added to the DEFINITIONS Sec- 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 in effect. the policy period and: CG D6 04 08 13 0 2013 The Travelers Indemnity Company.All rights reserved. Page 3 of 3 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 E. Who Is An Insured — Newly Acquired Or Formed J. Knowledge And Notice Of Occurrence Or Offense 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) — 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 SUPPLEMENTARY PAYMENTS — COVER- The Damage To Premises Rented To You AGES A AND B of SECTION I — COVER- Limit will be: 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: "Occurrence" also means an act or omission a. A contract for a lease of premises. How- 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 SECTION II—WHO IS AN INSURED: 5. The following is added to the DEFINITIONS 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 oraril your "employees" who is a nurse practi- p y occupied p b y you with permission tioner, registered nurse, licensed practical of the owner; or nurse, nurse assistant, emergency medi- b. The contents of any premises while suchcal technician or paramedic; or premises is rented to you, if you rent such (ii) First aid or"Good Samaritan services" by premises for a period of seven or fewer consecutive days. any of your "employees" or "volunteer 6. The following replaces Paragraph 4.b.(1)(b) workers", other than an employed or vol- 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 lim- 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 form the organization or the end of the Sale Of Pharmaceuticals 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 2 Until the end of the policy consent of, the insured. ( ) p y period, when that date is later than 180 days after you 5. The following is added to the DEFINITIONS 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 injury" or "advertising injury" caused by an of- Insured. 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, II—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 equipment lessor will be the minimum limits premises owner, manager or lessor will be which you agreed to provide in the written the minimum limits which you agreed to pro- contract or agreement, or the limits shown on vide in the written contract or agreement, or the Declarations, whichever are less. the limits shown on the Declarations, which- ever are less. b. The insurance provided to such equipment lessor does not apply to any"bodily injury" or b. The insurance provided to such premises owner, manager or lessor does not apply to: "property damage" that occurs, or "personal 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 c. The insurance provided to such premises non-contributory with, such other insurance, 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- The following is added to SECTION II —WHO IS surance must be primary to, or non- AN INSURED: contributory with, such other insurance, in 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- erations. that is Y partner,artner, J oint venture 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 0 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 leted. injury" in the DEFINITIONS Section: Page 6 of 6 0 2011 The Travelers Indemnity Company.All rights reserved. CG D3 16 11 11 POLICY NUMBER: DT-CO-OF796197-TIA-18 ISSUE DATE: 10-03-18 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 TO WHOM YOU HAVE AGREED IN A WRITTEN CONTRACT THAT NOTICE OF CANCELLATION OR NONRENEWAL OF THIS POLICY WILL BE GIVEN, BUT ONLY IF: 1. YOU SEND US A WRITTEN REQUEST TO PROVIDE SUCH NOTICE, INCLUDING THE NAME AND ADDRESS OF SUCH PERSON OR ORGANIZATION, AFTER THE FIRST NAMED INSURED RECEIVES NOTICE FROM US OF THE CANCELLATION OR NONRENEWAL OF THIS POLICY; AND 2. WE RECEIVE SUCH WRITTEN REQUEST AT LEAST 14 DAYS BEFORE THE BEGINNING OF THE APPLICABLE NUMBER OF DAYS SHOWN IN THIS ENDORSEMENT. ADDRESS: THE ADDRESS FOR THAT PERSON OR ORGANIZATION INCLUDED IN SUCH WRITTEN REQUEST FROM YOU TO US. 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 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 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 B. BLANKET ADDITIONAL INSURED USE—INCREASED LIMIT C. EMPLOYEE HIRED AUTO I. PHYSICAL DAMAGE — TRANSPORTATION EXPENSES—INCREASED LIMIT D. EMPLOYEES AS INSURED J. PERSONAL PROPERTY E. SUPPLEMENTARY PAYMENTS — INCREASED K. AIRBAGS LIMITS L. NOTICE AND KNOWLEDGE OF ACCIDENT OR F. HIRED AUTO — LIMITED WORLDWIDE COV- LOSS ERAGE—INDEMNITY BASIS M. BLANKET WAIVER OF SUBROGATION G. WAIVER OF DEDUCTIBLE—GLASS N. UNINTENTIONAL ERRORS OR OMISSIONS PROVISIONS A. BROAD FORM NAMED INSURED this insurance applies and only to the extent that The following is added to Paragraph A.1., Who Is person or organization qualifies as an "insured" An Insured, of SECTION II —COVERED AUTOS under the Who Is An Insured provision contained LIABILITY COVERAGE: in Section II. Any organization you newly acquire or form dur- C. EMPLOYEE HIRED AUTO ing the policy period over which you maintain 1. The following is added to Paragraph A.1., 50% or more ownership interest and that is not Who Is An Insured, of SECTION II — COV- separately insured for Business Auto Coverage. ERED AUTOS LIABILITY COVERAGE: Coverage under this provision is afforded only un- An "employee" of yours is an "insured" while til the 180th day after you acquire or form the or- operating an "auto" hired or rented under a ganization or the end of the policy period, which- contract or agreement in an "employee's" ever is earlier. name, with your permission, while performing duties related to the conduct of your busi- B. BLANKET ADDITIONAL INSURED ness. The following is added to Paragraph c. in A.1., 2. The following replaces Paragraph b. in B.5., Who Is An Insured, of SECTION II —COVERED Other Insurance, of SECTION IV — BUSI- AUTOS LIABILITY COVERAGE: NESS AUTO CONDITIONS: Any person or organization who is required under b. For Hired Auto Physical Damage Cover- a written contract or agreement between you and age, the following are deemed to be cov- that person or organization, that is signed and ered"autos"you own: executed by you before the "bodily injury" or (1) Any covered "auto" you lease, hire, "property damage" occurs and that is in effect rent or borrow; and during the policy period, to be named as an addi- (2) Any covered "auto" hired or rented by tional insured is an "insured" for Covered Autos your "employee" under a contract in Liability Coverage, but only for damages to which an "employee's" name, with your CA T3 53 02 15 ©2015 The Travelers Indemnity Company.All rights reserved. Page 1 of 4 Includes copyrighted material of Insurance Services Office, Inc.with its permission. COMMERCIAL AUTO permission, while performing duties (a) With respect to any claim made or "suit" related to the conduct of your busi- brought outside the United States of ness. America, the territories and possessions However, any"auto" that is leased, hired, of the United States of America, Puerto rented or borrowed with a driver is not a Rico and Canada: covered"auto". (i) You must arrange to defend the "in- D. EMPLOYEES AS INSURED sured"against, and investigate or set- The following is added to Paragraph A.1., Who Is tle any such claim or "suit" and keep An Insured, of SECTION II —COVERED AUTOS us advised of all proceedings and ac- LIABILITY COVERAGE: tions. An em (ii) Neither you nor any other involved Any "employee" of yours is an 'Insured"while us- ing a covered "auto"you don't own, hire or borrow "insured" will make any settlementwithout our consent. in your business or your personal affairs. E. SUPPLEMENTARY PAYMENTS — INCREASED (iii) We may, at our discretion, participate LIMITS in defending the "insured" against, or in the settlement of, any claim or 1. The following replaces Paragraph A.2.a.(2), "suit". of SECTION II—COVERED AUTOS LIABIL- (iv) We will reimburse the "insured" for ITY COVERAGE: sums that the "insured" legally must (2) Up to $3,000 for cost of bail bonds (in- pay as damages because of "bodily cluding bonds for related traffic law viola- injury" or"property damage" to which tions) required because of an "accident" this insurance applies, that the "in- we cover. We do not have to furnish sured" pays with our consent, but these bonds. only up to the limit described in Para- 2. The following replaces Paragraph A.2.a.(4), graph C., Limits Of Insurance, of of SECTION II —COVERED AUTOS LIABIL- SECTION II — COVERED AUTOS ITY COVERAGE: LIABILITY COVERAGE. (4) All reasonable expenses incurred by the (v) We will reimburse the "insured" for "insured" at our request, including actual the reasonable expenses incurred loss of earnings up to $500 a day be- with our consent for your investiga- cause of time off from work. tion of such claims and your defense F. HIRED AUTO — LIMITED WORLDWIDE COV- of the "insured" against any such " ERAGE—INDEMNITY BASIS suit", but only up to and included within the limit described in Para- The following replaces Subparagraph (5) in Para- graph C., Limits Of Insurance, of graph B.7., Policy Period, Coverage Territory, SECTION II — COVERED AUTOS of SECTION IV — BUSINESS AUTO CONDI- LIABILITY COVERAGE, and not in TIONS: addition to such limit. Our duty to (5) Anywhere in the world, except any country or make such payments ends when we jurisdiction while any trade sanction, em- have used up the applicable limit of bargo, or similar regulation imposed by the insurance in payments for damages, United States of America applies to and pro- settlements or defense expenses. hibits the transaction of business with or (b) This insurance is excess over any valid within such country or jurisdiction, for Cov- and collectible other insurance available ered Autos Liability Coverage for any covered to the "insured" whether primary, excess, "auto" that you lease, hire, rent or borrow contingent or on any other basis. without a driver for a period of 30 days or less and that is not an "auto" you lease, hire, rent (c) This insurance is not a substitute for re- ar borrow from an of quired or compulsory insurance in any y your "employees", country outside the United States, its ter- partners (if you are a partnership), members ritories and possessions, Puerto Rico and (if you are a limited liability company) or Canada. members of their households. Page 2 of 4 ©2015 The Travelers Indemnity Company.All rights reserved. CA T3 53 02 15 Includes copyrighted material of Insurance Services Office, Inc.with its permission. COMMERCIAL AUTO You agree to maintain all required or (2) In or on your covered"auto". compulsory insurance in any such coun- This coverage applies only in the event of a total try up to the minimum limits required by theft of your covered"auto". local law. Your failure to comply with No deductibles apply to this Personal Property compulsory insurance requirements will not invalidate the coverage afforded by coverage. this policy, but we will only be liable to the K. AIRBAGS same extent we would have been liable The following is added to Paragraph B.3., Exclu- had you complied with the compulsory in- sions, of SECTION III — PHYSICAL DAMAGE surance requirements. COVERAGE: (d) It is understood that we are not an admit- Exclusion 3.a. does not apply to "loss" to one or ted or authorized insurer outside the more airbags in a covered "auto" you own that in- United States of America, its territories flate due to a cause other than a cause of "loss" and possessions, Puerto Rico and Can- set forth in Paragraphs A.1.b. and A.1.c., but ada. We assume no responsibility for the only: furnishing of certificates of insurance, or a. If that "auto" is a covered "auto"for Compre- for compliance in any way with the laws hensive Coverage under this policy; of other countries relating to insurance. b. The airbags are not covered under any war- G. WAIVER OF DEDUCTIBLE—GLASS ranty; and The following is added to Paragraph D., Deducti- c. The airbags were not intentionally inflated. ble, of SECTION III — PHYSICAL DAMAGE We will pay up to a maximum of $1,000 for any COVERAGE: one"loss". No deductible for a covered "auto" will apply to L. NOTICE AND KNOWLEDGE OF ACCIDENT OR glass damage if the glass is repaired rather than LOSS replaced. The following is added to Paragraph A.2.a., of H. HIRED AUTO PHYSICAL DAMAGE— LOSS OF SECTION IV—BUSINESS AUTO CONDITIONS: USE—INCREASED LIMIT Your duty to give us or our authorized representa- The following replaces the last sentence of Para- tive prompt notice of the "accident" or "loss" ap- graph AA.b., Loss Of Use Expenses, of SEC- plies only when the "accident" or "loss" is known TION III—PHYSICAL DAMAGE COVERAGE: to: However, the most we will pay for any expenses (a) You (if you are an individual); for loss of use is $65 per day, to a maximum of (b) A partner(if you are a partnership); $750 for any one"accident". (c) A member (if you are a limited liability com- I. PHYSICAL DAMAGE — TRANSPORTATION pany); EXPENSES—INCREASED LIMIT (d) An executive officer, director or insurance The following replaces the first sentence in Para- manager (if you are a corporation or other or- graph A.4.a., Transportation Expenses, of ganization); or SECTION III — PHYSICAL DAMAGE COVER- (e) Any "employee" authorized by you to give no- AGE: tice of the"accident" or"loss". We will pay up to $50 per day to a maximum of M. BLANKET WAIVER OF SUBROGATION $1,500 for temporary transportation expense in- The following replaces Paragraph A.5., Transfer curred by you because of the total theft of a cov- Of Rights Of Recovery Against Others To Us, ered "auto"of the private passenger type. of SECTION IV — BUSINESS AUTO CONDI- J. PERSONAL PROPERTY TIONS: The following is added to Paragraph AA., Cover- 5. Transfer Of Rights Of Recovery Against age Extensions, of SECTION III — PHYSICAL Others To Us DAMAGE COVERAGE: We waive any right of recovery we may have Personal Property against any person or organization to the ex- We will a u to $400 for "loss" to wearing a tent required of you by a written contract pay p 9 p- signed and executed prior to any "accident" parel and other personal property which is: or"loss", provided that the"accident" or"loss" (1) Owned by an"insured"; and arises out of operations contemplated by CA T3 53 02 15 ©2015 The Travelers Indemnity Company.All rights reserved. Page 3 of 4 Includes copyrighted material of Insurance Services Office,Inc.with its permission. COMMERCIAL AUTO such contract. The waiver applies only to the The unintentional omission of, or unintentional person or organization designated in such error in, any information given by you shall not contract. prejudice your rights under this insurance. How- N. UNINTENTIONAL ERRORS OR OMISSIONS ever this provision does not affect our right to col- The following is added to Paragraph B.2., Con- lect additional premium or exercise our right of cealment, Misrepresentation, Or Fraud, of cancellation or non-renewal. SECTION IV—BUSINESS AUTO CONDITIONS: Page 4 of 4 ©2015 The Travelers Indemnity Company.All rights reserved. CA T3 53 02 15 Includes copyrighted material of Insurance Services Office, Inc.with its permission. POLICY NUMBER:DT-810-OF799728-IND-18 ISSUE DATE: 10-03-18 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. DESIGNATED ENTITY - NOTICE OF CANCELLATION 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 PERSON OR ORGANIZATION: ANY PERSON OR ORGANIZATION TO WHOM YOU HAVE AGREED IN A WRITTEN CONTRACT THAT NOTICE OF CANCELLATION OF THIS POLICY WILL BE GIVEN, BUT ONLY IF: 1. YOU SEND US A WRITTEN REQUEST TO PROVIDE SUCH NOTICE, INCLUDING THE NAME AND ADDRESS OF SUCH PERSON OR ORGANIZATION, AFTER THE FIRST NAMED INSURED RECEIVES NOTICE FROM US OF THE CANCELLATION OF THIS POLICY AND, 2. WE RECEIVE SUCH WRITTEN REQUEST AT LEAST 14 DAYS BEFORE THE BEGINNING OF THE APPLICABLE NUMBER OF DAYS SHOWN IN THIS SCHEDULE. ADDRESS: THE ADDRESS FOR THAT PERSON OR ORGANIZATION INCLUDED IN SUCH WRITTEN REQUEST FROM YOU TO US. . PROVISIONS: If we cancel this policy for any statutorily permitted above.We will mail such notice to the address shown reason other than nonpayment of premium, and a in the schedule above at least the number of days number of days is shown for cancellation in the shown for cancellation in the schedule above before schedule above, we will mail notice of cancellation to the effective date of cancellation. the person or organization shown in the schedule IL T4 05 03 11 ©2011 The Travelers Indemnity Company.All rights reserved. Page 1 of 1 AW TRAVELERSJ ' WORKERS COMPENSATION AND ONE TOWER SQUARE EMPLOYERS LIABILITY POLICY HARTFORD CT 06183 ENDORSEMENT WC 00 03 13 (00)- 001 POLICY NUMBER: UB-7J031590-18-26-G WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce our right against the person or organization named in the Schedule. (This agreement applies only to the extent that you perform work under a written contract that requires you to obtain this agreement from us.) This agreement shall not operate directly or indirectly to benefit any one not named in the Schedule. SCHEDULE DESIGNATED PERSON: DESIGNATED ORGANIZATION: ANY PERSON OR ORGANIZATION FOR WHICH THE INSURED HAS AGREED BY WRITTEN CONTRACT EXECUTED PRIOR TO LOSS TO FURNISH THIS WAIVER. DATE OF ISSUE: 10-02-18 ST ASSIGN: PAGE 1 OF ATAk WORKERS COMPENSATION TRAVELERS J AND ONE TOWER SQUARE EMPLOYERS LIABILITY POLICY HARTFORD CT 06183 ENDORSEMENT WC 99 06 R3 (00)- 001 POLICY NUMBER: UB-7J031590-18-26-G NOTICE OF CANCELLATION TO DESIGNATED PERSONS OR ORGANIZATIONS The following is added to PART SIX—CONDITIONS : Notice Of Cancellation To Designated Persons Or Organizations If we cancel this policy for any reason other than non-payment of premium by you, we will provide notice of such cancellation to each person or organization designated in the Schedule below. We will mail or deliver such notice to each person or organization at its listed address at least the number of days shown for that person or organiza- tion before the cancellation is to take effect. You are responsible for providing us with the information necessary to accurately complete the Schedule below. If we cannot mail or deliver a notice of cancellation to a designated person or organization because the name or address of such designated person or organization provided to us is not accurate or complete, we have no responsibility to mail, deliver or otherwise notify such designated person or organization of the cancellation. SCHEDULE Name and Address of Designated Persons or Organizations: Number of Days Notice ANY PERSON OR ORGANIZATION WITH WHOM YOU HAVE AGREED IN A WRITTEN CONTRACT THAT NOTICE OF CANCELLATION OF THIS POLICY WILL BE GIVEN 30 , BUTONLY IF: 1. YOU SEE TO IT THAT WE RECEIVE A WRITTEN REQUEST TO PROVIDE SUC HNOTICE, INCLUDING THE NAME AND ADDRESS OF SUCH PERSON OR ORGANIZ ATION,AFTER THE FIRST NAMED INSURED RECEIVES NOTICE FROM US OF TH ECANCELLATION OF THIS POLICY; AND 2. WE RECEIVE SUCH WRITTEN REQUEST AT LEAST 14 DAYS BEFORE THE BEGINNING OF THE APPLICABLE NUMBER OF DAYS SHOWN IN THIS ENDORSEMENT. ADDRESS: THE ADDRESS FOR THAT PERSON OR ORGANIZATION INCLUDED IN SUCH WRIT TENREQUEST FROM YOU TO US. All other terms and conditions of this policy remain unchanged. This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated. (The information below is required only when this endorsement is issued subsequent to preparation of the policy.) Endorsement Effective Policy No. Endorsement No. Insured Premium $ Insurance Company Countersigned by DATE OF ISSUE: 10-02-18 ST ASSIGN: Page 1 of i ©2013 The Travelers Indemnity Company.All rights reserved.