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HomeMy WebLinkAbout1999-270ORDINANCE NO 1 ` Cg / fi AN ORDINANCE ACCEPTING COMPETITIVE BIDS AND AWARDING A PUBLIC WORKS CONTRACT FOR THE CONSTRUCTION OF HICKORY CREEK SANITARY SEWERLINE CROSSINGS PHASE II, PROVIDING FOR THE EXPENDITURE OF FUNDS THEREFOR, AND PROVIDING AN EFFECTIVE DATE (BID 2387 — HICKORY CREEK SANITARY SEWERLINE CROSSINGS AWARDED TO OSCAR RENDA CONTRACTING, INC IN THE AMOUNT OF $549,115 50) WHEREAS, the City has solicited, received and tabulated competitive bids for the construction of public works or improvements in accordance with the procedures of STATE law and City ordinances, and WHEREAS, the City Manager or a designated employee has received and recommended that the herein described bids are the lowest responsible bids for the construction of the public works or improvements described in the bid invitation, bid proposals and plans and specifications therein, NOW, THEREFORE, THE COUNCIL OF THE CITY OF DENTON HEREBY ORDAINS SECTION I That the following competitive bids for the construction of public works or improvements, as described in the "Bid Invitations", "Bid Proposals" or plans and specifications on file in the Office of the City's Purchasing Agent filed according to the bid number assigned hereto, are hereby accepted and approved as being the lowest responsible bids BID NUMBER CONTRACTOR AMOUNT 2387 OSCAR RENDA CONTRACTING, INC. $549,115.50 SECTION II That the acceptance and approval of the above competitive bids shall not constitute a contract between the City and the person submitting the bid for construction of such public works or improvements herein accepted and approved, until such person shall comply with all requirements specified in the Notice to Bidders including the timely execution of a written contract and furnishing of performance and payment bonds, and insurance certificate after notification of the award of the bid SECTION III That the City Manager is hereby authorized to execute all necessary written contracts for the performance of the construction of the public works or improvements in accordance with the bids accepted and approved herein, provided that such contracts are made in accordance with the Notice to Bidders and Bid Proposals, and documents relating thereto specifying the terms, conditions, plans and specifications, standards, quantities and specified sums contained therein SECTION IV That upon acceptance and approval of the above competitive bids and the execution of contracts for the public works and Improvements as authorized herein, the City Council hereby authorizes the expenditure of funds in the manner and in the amount as specified in such approved bids and authorized contracts executed pursuant thereto SECTION V That this ordinance shall become effective immediately upon its passage and approval / r/ii/7 PASSED AND APPROVED this the � — day of 1999 ATTEST JENNIFER WALTERS, CITY SECRETARY BY�4Q� APPROVED AS TO LEGAL FORM HERBERT L PROUTY, CITY ATTORNEY BY '% /l�G' ez Z e V_ 2387-HICKORY CREEK SEWERLINES ORDINANCE ATTACHMENT TABULATION SHEET Bid # 2387 Date 7/20/99 HICKORY CREEK SEWERLINE CROSSINGS No Qty D96CRIPTION VENDOR VENDOR VENDOR OSCAR RENDA EARTH CONTRACTING, BUILDERS LINDER STAHL INC HICKORY CREEK CROSSING $346,007 25 $463,542 50 $350,433 00 PHASE II HICKORY CREEK CROSSING $203,108 25 $299,397 50 $228,621 00 2 PHASE II (ALTERNATE) TOTAL AMOUNT $549,115 50 $762,940 00 $579,054 00 ADDENDUM YES YES YES BID BOND YES YES YES CONTRACT AGREEMENT STATE OF TEXAS § COUNTY OF DENTON § THIS AGREEMENT, made and entered into this AUGUST day of 17 A D , 1999, by and between CITY OF DENTON of the County of DENTON and State of Texas, acting through MICHAEL W JEZ thereunto duly authorized so to do, hereinafter termed "OWNER," and OSCAR RENDA CONTRACTING, INC 522 BENSON LAKE ROANOKE, TX 76262 of the City of and State of ROANOKE , County of DENTON TEXAS , hereinafter termed "CONTRACTOR " WITNESSETH That for and in consideration of the payments and agreements hereinafter mentioned, to be made and performed by OWNER, and under the conditions expressed in the bonds attached hereto, CONTRACTOR hereby agrees with OWNER to commence and complete performance of the work specified below BID Il 2387-HICKORY CREEK SANITARY SEWERLINE CROSSINGS in the amount of $549,115 50 and all extra work in connection therewith, under the terms as stated in the General Conditions of the agreement, and at his (or their) own proper cost and expense to furnish all materials, supplies, machinery, equipment, tools, superintendence, labor, insurance, and other accessories and services necessary to complete the work specified above, in accordance with the conditions and prices stated in the Proposal attached hereto, and in accordance with all the General Conditions of the Agreement, the Special Conditions, the Notice to Bidders (Advertisement for Bids), Instructions to Bidders, and the Performance and Payment Bonds, all attached hereto, and in CA-1 accordance with the plans, which includes all maps, plats, blueprints, and other drawings and printed or written explanatory matter thereof, and the Specifications therefore, as prepared by ENGINEERING DEPARTMENT all of which are made a part hereof and collectively evidence and constitute the entire contract Independent Status It is mutually understood and agreed by and between City and Contractor that Contractor is an independent contractor and shall not be deemed to be or considered an employee of the City of Denton, Texas, for the purposes of income tax, withholding, social security taxes, vacation or sick leave benefits, worker's compensation, or any other City employee benefit City shall not have supervision and control of Contractor or any employee of Contractor, and it is expressly understood that Contractor shall perform the services hereunder according to the attached specifications at the general direction of the City Manager of the City of Denton, Texas, or his designee under this agreement Indemnification Contractor shall and does hereby agree to indemnify and hold harmless the City of Denton from any and all damages, loss, or liability of any kind whatsoever, by reason of injury to property or third persons occasioned by any error, omission or negligent act of Contractor, its officers, agents, employees, invitees, and other persons for whom it is legally liable, with regard to the performance of this Agreement, and Contractor will, at its cost and expense, defend and protect the City of Denton against any and all such claims and demands Choice of Law and Venue This agreement shall be governed by the law of the State of Texas and venue for its construction and enforcement shall lie in the courts of Denton County, Texas The CONTRACTOR hereby agrees to commence work on or after the date established for the start of work as set forth in written notice to commence work and complete all work within the tune stated in the Proposal, subject to such extensions of time as are provided by the General and Special Conditions The OWNER agrees to pay the CONTRACTOR in current funds the price or prices shown in, the Proposal, which forms a part of this contract, such payments to be subject to the General and Special Conditions of the Contract CA-2 IN WITNESS WHEREOF, the parties of these presents have executed this agreement in the year and day first above written ATTEST 41[7 1 ss-, e-cowrA&Y S,LlP,k&N L_ WE«Y APPROVED AS TO CITY AT BID 2387 8/99 CITY OF DENTON (SEAL) ©Sca�z �E'NOR �ovNztct'wG, .�.�vc. CONTRACTOR 52 a 8C-AAo.✓ Ga^-6e- t'OANO/«. , x fS %lo,>loZ MAILING ADDRESS 81i—W9l- ,Z703 PHONE NUMBER _ CA-3 0— Holt- F14 3 sN C. �6tdw4lU PRINTED NAME (SEAL) PERFORMANCE BOND Bond #8149-24-01 STATE OF TEXAS § COUNTY OF DENTON § KNOW ALL MEN BY THESE PRESENTS That OSCAR RENDA CONTRACTING, INC whose address is 522 BENSON LANE, ROANOKE, TX 76262, hereinafter called Principal, and Federal Insurance Company a corporation organized and existing under the laws of the State of TEXAS and fully authorized to transact business in the State of Texas, as Surety, are held and firmly bound unto the City of Denton, a municipal corporation organized and existing under the laws of the State of Texas, hereinafter called Owner, in the penal sum of FIVE HUNDRED FORTY NINE THOUSAND ONE HUNDRED FIFTEEN AND 501100 DOLLARS ($549,115 50) plus ten percent of the stated penal sum as an additional sum of money representing additional court expenses, attorneys' fees, and liquidated damages arising out of or connected with the below identified Contract, in lawful money of the United States, to be paid in Denton County, Texas, for the payment of which sum well and truly to be made, we hereby bind ourselves, our heirs, executors, administrators, successors, and assigns, jointly and severally, firmly by these presents This Bond shall automatically be increased by the amount of any Change Order or Supplemental Agreement which increases the Contract price, but in no event shall a Change Order or Supplemental Agreement which reduces the Contract price decrease the penal sum of this Bond THE OBLIGATION TO PAY SAME is conditioned as follows Whereas, the Principal entered into a certain Contract, identified by Ordinance Number 99-270 , with the City of Denton, the Owner, dated the 17 day of AUGUST A D 1999, a copy of which is hereto attached and made a part hereof, for BID # 2387-HICKORY CREEK SANITARY SEWERLINE CROSSING NOW, THEREFORE, if the Principal shall well, truly and faithfully perform and fulfill all of the undertakings, covenants, terms, conditions and agreements of said Contract in accordance with the Plans, Specifications and Contract Documents during the original term thereof and any extension thereof which may be granted by the Owner, with or without notice to the Surety, and during the life of any guaranty or warranty required under this Contract, and shall also well and truly perform and fulfill all the undertakings, covenants, terms, conditions and agreements of any and all duly authorized modifications of said Contract that may hereafter be made, notice of which modifications to the Surety being hereby waived, and, if the Principal shall repair and/or replace all defects due to faulty materials and workmanship that appear within a period of one (1) year from the date of final completion and final acceptance of the Work by the Owner, and, if the Principal shall fully indemnify and save harmless the Owner from all costs and damages which Owner may suffer by reason of failure to so perform herein and shall fully reimburse and repay Owner all outlay and expense which the Owner may incur in making good any default or deficiency, then this obligation shall be void, otherwise, it shall remain in full force and effect PB - I PROVIDED FURTHER, that if any legal action be filed upon this Bond, exclusive venue shall lie in Denton County, State of Texas AND PROVIDED FURTHER, that the said Surety, for value received, hereby stipulates and agrees that no change, extension of time, alteration or addition to the terms of the Contract, or to the Work to be performed thereunder, or to the Plans, Specifications, Drawings, etc , accompanying the same, shall in anywise affect its obligation on this Bond, and it does hereby waive notice of any such change, extension of time, alteration or addition to the terms of the Contract, or to the Work to be performed thereunder, or to the Plans,, Specifications, Drawings, etc This Bond is given pursuant to the provisions of Chapter 2253 of the Texas Government Code, as amended, and any other applicable statutes of the State of Texas The undersigned and designated agent is hereby designated by the Surety herein as the Resident Agent in Denton County to whom any requisite notices may be delivered and on whom service of process may be had in matters arising out of such suretyship, as provided by Article 7 19-1 of the Insurance Code, Vernon's Annotated Civil Statutes of the State of Texas IN WITNESS WHEREOF, this instrument is executed in 4 copies, each one of which shall be deemed an original, this the 17 day of AUGUST 1999 ATTEST BY ---� Assn. SECRETARY rnaovr-, L - L-A-,ed ATTEST BY X44�z, Dianne Gass PRINCIPAL Oscar BY Vbt I C , Inc Federal Insurance Company BY .A ATTORNEY -IN -FACT Arnim I Gerstenmeier The Resident Agent of the Surety in Denton County, Texas for delivery of notice and service of the process is NAME John L. Mondics STREET ADDRESS 8235 Douglas Ave , Suite 828, Dallas, 'Texas 75225 (NOTE Date of Performance Bond must be date of Contract If Resident Agent is not a corporation, give a person's name ) PB-2 C Chubb POWER Federal Insurance Company Attn Surety Department OF Vigilant Insurance Company 15 Mountain View Road $uroty ATTORNEY Pacific Indemnity Company Warren, NJ 07059 Know All by These Presents, That FEDERAL INSURANCE COMPANY, an Indiana corporation VIGILANT INSURANCE COMPANY, a New York corporation, and PACIFIC INDEMNITY COMPANY, a Wisconsin corporation do each hereby constitute and appoint Arnim I. Gerstenmeier, John L Mondies and Larry D Greenhaw of Dallas, Texas --------------------------- each as their true and lawful Attomey-In-Fact to execute under such designation In their names and to affix their corporate seals to and deliver for and on their behalf as surety thereon or otherwise, bonds (other than bail bonds) and undertakings given or executed In the course of he business (but not to include any Instruments emending or altering the same, nor consents to the modification or alteration of any Instrument referred to in sold bonds or obligations) In Witness Whereof, sold FEDERAL INSURANCE COMPANY, VIGILANT INSURANCE COMPANY and PACIFIC INDEM9 9 COMPANY have each executed and attested these presents and affixed their corporate seals on this 1 Ohh day of February , zs;*Z� 4 �& 4 meth C V79intlel, AW91AKS& Ilififfiry 4 -Ilf e� Fra it Ron VI President STATE OF NEW JERSEY County of Somerset 1 On this loth day of February, 1999 before me a Notary Public of New Jersey personalty came Kenneth C Wendel to me known to be Areletant Secretary of FEDERAL INSURANCE COMPANY, VIGILANT INSURANCE COMPANY and PACIFIC INDEMNITY COMPANY the companies which executed the foregoing Power of Attorney and the eski Kenneth C Wendel being by me duty sworn did depose and say that he Is Assistant Secretary of FEDERAL INSURANCE COMPANY, VIGILANT INSURANCE COMPANY, and PACIFIC INDEMNITY COMPANY and known the corporate seals thereof that the awls affixed tolthe foregoing Power of Attorney are such corporate eesb and were thereto affixed by authority of the By Laws of mid Companies, and that he signed said Power of Attorney as Assistant Secretary of said Companies by like authority and that he Is acquainted wnh Frank E Robertson and knows him to be Vie President of geld Companies, and that the signature of Frank E Roberson, subscribed to said Power of Attorney Is in the genuine handwriting of Frank E Robeneon and was thereto subscribed by authority of sski By -Lawn and In deponent a presence Notarial Seal + z� J� / o� OTAR '� ., FUSLIC OANNE K RUSSAM0181 ',IyTyy� Notary Pubho State of New Jeraey No 2214608 CERTIFICATION commission Expire, June 17200S Extract from the By Laws of FEDERAL INSURANCE COMPANY, VIGILANT INSURANCE COMPANY, and PACIFIC INDEMNITY COMPANY All powers of attorney for and on behalf of the Company may and shall be executed In the name and on behalf of the Company, either by the Chairman or the President or a Vice President or an Assistant Vice President, jointly with the Secretary or an Assistant Secretary, under their respective designations The signature of such officers may be engraved, printed or lithographed The signature of each of the following officers Chairman, President, any Vice President, any Assistant Vice President, any Secretary, any Assistant Secretary and the seal of the Company may be affixed by facsimile to any power of attorney or to any ceraRcate relating thereto appointing Assistant Secretaries or Attomeys-in-Fact for purposes only of executing and afteedng bonds and undertakings and other writings obligatory in the nature thereof and any such power of attorney or certificate bearing such facsimile signature or facsimile seal shall be valid and binding upon the Company and any such power so executed and certified by such facsimile signature and facsimile seal shall be valid and binding upon the Company with respect to any bond or undertaking to which it Is attached " I Kenneth C Wendel, Assistant Secretary of FEDERAL INSURANCE COMPANY, VIGILANT INSURANCE COMPANY, and PACIFIC INDEMNITY COMPANY (the "Com panles") do hereby certify that (1) the foregoing extract of the By -Laws of the Companies Is true and correct, (II) the Companies are duly licensed and aulherized to barreect surety business In all 50 of the United States of America and the Dle61et of Columbia and are augndzed by the U S Treasury Department, furl er, Federal and Vigilant are bcenaed In Puerto Rlco and the U S Virgin Islands and Federal Is licensed In American Soma, Guam, and each of the Provinces of Canada except Prince Edward Island and (III) the foregoing Power of Attorney Is true, correct and in full force and effect Given under my hand and seals of said Companies at Warren, NJ this 17 th day of At g1 r.; r _ t 999 �gU _"F' I yy9h1�'pP a1V' tic e e MouN� Y aw Kenneth CWendel,-Assistant Secretary IN THE EVENT YOU WISH TO NOTIFY US OF A CLAIM, VERIFY THE AUTHENTICITY OF THIS BOND OR NOTIFY US OF ANY OTHER MATTER, PLEASE CONTACT US AT ADDRESS LISTED ABOVE, OR BYI Telephone (908) 903-3485 Fax (908) 903-3656 e-mail surety@chubb com Form 1610MX (Ed 1 NON•CONSENT PAYMENT BOND STATE OF TEXAS § Bond 118149-24-01 COUNTY OF DENTON § KNOW ALL MEN BY THESE PRESENTS That OSCAR RENDA CONTRACTING, INC , whose address is 522 BENSON LANE, ROANOKE, TX 76262, hereinafter called Principal, and Federal Insurance Company a corporation organized and existing under the laws of the State of TEXAS , and' fully authorized to transact business in the State of Texas, as Surety, are held and firmly bound unto the City of Denton, a municipal corporation organized and existing under the laws of the State of Texas, hereinafter called Owner, and unto all persons, firms, and corporations who may furnish materials for, or perform labor upon, the building or improvements hereinafter referred to, in the penal sum of FIVE HUNDRED FORTY NINE THOUSAND ONE HUNDRED FIFTEEN AND 501100 ---- DOLLARS ($ 549,115 50) in lawful money of the United States, to be paid in Denton, County, Texas, for the payment of which sum well and truly to be made, we hereby bind ourselves, our heirs, executors, administrators, successors, and assigns, jointly and severally, firmly by these presents This Bond shall automatically be increased by the amount of any Change Order or Supplemental Agreement which increases the Contract price, but in no event shall a Change Order or Supplemental Agreement which reduces the Contract price decrease the penal sum of this Bond THE OBLIGATION TO PAY SAME is conditioned as follows Whereas, the Principal entered into a certain Contract, identified by Ordinance Number 99-270, with the City of Denton, the Owner, dated the 17 day of AUGUST A D 1999 a copy of which is hereto attached and made a part hereof, for BID 2387 - HICKORY CREEK SANITARY SEWERLINE CROSSINGS NOW, THEREFORE, if the Principal shall well, truly and faithfully perform its duties and make prompt payment to all persons, firms, subcontractors, corporations and claimants supplying labor and/or material in the prosecution of the Work provided for in said Contract and any and all duly authorized modifications of said Contract that may hereafter be made, notice of which modifications to the Surety being hereby expressly waived, then this obligation shall be void, otherwise it shall remain in full force and effect PROVIDED FURTHER, that if any legal action be filed on this Bond, exclusive venue shall lie in Denton County, Texas AND PROVIDED FURTHER, that the said Surety, for value received, hereby stipulates and agrees that no change, extension of time, alteration or addition to the terms of the Contract, or to the Work to be performed thereunder, or to the Plans, Specifications, Drawings, etc , accompanying the same, shall in anywise affect its obligation on this Bond, and it does hereby waive notice of any such change, extension of time, alteration or addition to the terms of the Contract, or to the Work to be performed thereunder, or to the Plans, Specifications, Drawings, etc PB-3 This Bond is given pursuant to the provisions of Chapter 2253 of the Texas Government Code, as amended, and any other applicable statutes of the State of Texas The undersigned and designated agent is hereby designated by the Surety herein as the Resident Agent in Denton County to whom any requisite notices may be delivered and on whom service of process may be had in matters arising out of such suretyship, as provided by Article 7 19-1 of the Insurance Code, Vernon's Annotated Civil Statutes of the State of Texas IN WITNESS WHEREOF, this instrument is executed in 4 copies, each one of which' shall be deemed an original, this the 17 day of AUGUST , 1999 n ATTEST BY ASST- SECRETARY j'( wee+ ATTEST BY Dianne Gass PRINCIPAL Oscar Re4d gontrdct9ff9',�, Inc 40111:1 Federal Insurance Company BY Awn-" !l Y(�IOY:yNt6t(it� ATTORNEY -IN -FACT Arnim I Gerstenmeler The Resident Agent of the Surety in Denton County, Texas for delivery of notice and service of the process is NAME John L Mondics STREET ADDRESS 8235 Douglas Ave., Suite 828, Dallas, lexas 75225 (NOTE Date of Payment Bond must be date of Contract !f Resident Agent is not a corporation, give a person's name ) Chubb POWER Federal Insurance Company Attn Surety Department OF Vigilant Insurance Company 15 Mountain View Road SUrillity ATTORNEY Pacific indemnity Company Warren, NJ 07059 Know All by These Presents, That FEDERAL INSURANCE COMPANY, an Inde rat corporation, VIGILANT INSURANCE COMPANY, a New York corporation, and PACIFIC INDEMNITY COMPANY, a Wisconsin corporation, do each hereby constitute and appoint Arnim I Gerstenmeier, John L. Mondies and Larry D. Greenhaw of Dallas, Texas --------------------------- each as their true and lawful Attomey-In-Fed to execute under such designation In their names and to affix their corporate seals to and deliver for and on their behalf as surety thereon or otherwise, bonds (other then ball bonds) and undertakings given or executed In the course of Rs business (but not to include any insbumerde amending or altering the same, nor consenta to the modification or situation of any Instrument referred to In sold bonds or obllgetbns) In Witness Whereof, sold FEDERAL INSURANCE COMPANY, VIGILANT INSURANCE COMPANY and PACIFIC INDEMN919TY9 COMPANY have eachexecutedand aftested these presents and affixed their corporate seals on this 1 Ohh day of Feb ruarY , �b4� nneth C en Iel,s sta!-I Fro k E Robe Vlc President STATE OF NEW JERSEY County or Somerset Jes On this loth day or February, 1999 before me a Notary Public of New Jersey personally come Kenneth C Wendel to me known to be Assistant Secretary of FEDERAL INSURANCE COMPANY, VIGILANT INSURANCE COMPANY and PACIFIC INDEMNITY COMPANY the companies which executed the foregoing Pourer of Attorney, and the said Kenneth C Wendel being by me duty awom did depose and say that he Is Assistant Secretary of FEDERAL INSURANCE COMPANY, VIGILANT INSURANCE COMPANY, and PACIFIC INDEMNITY COMPANY and knows the corporate settle thereof that the seals oohed to the foregoing Power of Attomey are such corporate Beals and were thereto affixed by authority of the By -Laws of sold Companies, and that he signed cold Fewer of Attorney as Assistant Secretary or sold Companies by like outhorgyr and that he Is s squalyded with Frank E Robertson and knows him to be Vice President of geld Companies and that the signature of Frank E Robertson, subscribed to sea Power of Attorney is in the genuine handwriting or Frank E Robertson, and wee thereto subscribed by authority of geld %,Laws and in deponents presence Notedel6esl K sty p� OTAR FUBLIC OANNE K RUSSAIPIotai ' ,,,a9 Notary Publio State of New Jersey No 2214e0e CERTIFICATION commission Expires June 1T 2003 Extract from the By -Laws of FEDERAL INSURANCE COMPANY, VIGILANT INSURANCE COMPANY, and PACIFIC INDEMNITY COMPANY All powers of attorney for and on behalf of the Company may and shall be executed in the name and on behalf of the Company either by the Chairman or the President or a Vice President or an Assistant Vice President, Jointly with the Secretary or an Assistant Secretary, under their respective designations The signature of such officers may be engraved, printed or lithographed The signature of each of the following officers Chairman President, any Vice President any Assistant Vice President, any Secretary any Assistant Secretary and the seal of the Company may be affixed by facsimile to any power of attorney, or to any certificate relating thereto appointing Assistant Secretaries or Attomeys-In-Faot for purposes only of executing and attesting bonds and undertakings and other writings obligatory in the nature thereof, and any such power of attorney or certificate bearing such facsimile signature or facsimile seal shall be valid and binding upon the Company and any such poweriso executed and certified by such facsimile signature and facsimile seal shall be valid and binding upon the Company with respect to any bond or undertaking to which it Is attached " I Kenneth C Wendel, Assistant Secretary of FEDERAL INSURANCE COMPANY, VIGILANT INSURANCE COMPANY, and PACIFIC INDEMNITY COMPANY (the Companies') do hereby oerttythel (1) the foregoing extract of the By Laws of the Companies Is true and correct, (II) the Componloor Columbia and are dauthorFmthe by e UU S Tremutygoonsed and authorized faDepartment, further, Federal nti Vigilant are licensed In Puerto ingtheact surely business in all 50 of the United Swites of Rico and the District of and the U S Islands, and Federal Is Ikxmeed in American Samoa, Guam, and each of the Provinces of Canada except Prince Edward Island, and (III) the foregoing Power of Attorney Is true, correct and in full force and effect Given under my hand and seals of said Companies at Warren, NJ this 17 th day of August, 1999 Kennethlel Assistant retary IN THE EVENT YOU WISH TO NOTIFY US OF A CLAIM, VERIFY THE AUTHENTICITY OF THIS BOND OR NOTIFY US OF ANY OTHER MATTER, PLEASE CONTACT US AT ADDRESS LISTED ABOVE, OR BY Telephone (908) 903-3485 Fax (908) 903-3656 e-mail surety@chubb corn Form 15.104226 (Ed 14M NON -CONSENT CITY OF DENTON INSURANCE REQUIREMENTS FOR CONTRACTORS Bidder's attention is directed to the insurance requirements below It is highly recommended that bidders confer with their respective insurance carriers or brokers to determine in advance of Bid submission the availability of insurance certificates and endorsements as prescribed and provided herein If an apparent low bidder fails to comply strictly with the insurance requirements, that bidder may be disqualified from award of the contract Upon, bid award, all insurance requirements shall become contractual obligations which the successful bidder shall have a duty to maintain throughout the course of this contract STANDARD PROVISIONS. Without limiting any of the other obligations or liabilities of the Contractor, the Contractor shall provide and maintain until the contracted work has been completed and accepted by the City of Denton, Owner, the minimum insurance coverage as indicated hereinafter As soon as practicable after notification of bid award, Contractor shall file with the Purchasing Department satisfactory certificates of insurance, containing the bid number and title of the project Contractor may, upon written request to the Purchasing Department, ask for clarification of any insurance requirements at any time, however, Contractors are strongly advised to make such requests prior to bid opening, since the insurance requirements may not be modified or waived after bid opening unless a written exception has been submitted with the bid Contractor shall not commence any work or deliver any material until he or she receives notification that the contract has been accepted, approved, and signed by the City of Denton All insurance policies proposed or obtained in satisfaction of these requirements shall comply with the following general specifications, and shall be maintained in compliance with these general specifications throughout the duration of the Contract, or longer, if so noted Each policy shall be issued by a company authorized to do business in the State of Texas with an A M Best Company rating of at least A Any deductibles or self -insured retentions shall be declared in the bid proposal If requested by the City, the insurer shall reduce or eliminate such deductibles or self -insured retentions with respect to the City, its officials, agents, employees and volunteers, or, the contractor shall procure a bond guaranteeing payment of losses and related investigations, claim administration and defense expenses Liability policies shall be endorsed to provide the following •• Name as additional insured the City of Denton, its Officials, Agents, Employees and volunteers •• That such insurance is primary to any other insurance available to the additional insured with respect to claims covered under the policy and that this insurance applies separately to each insured against whom claim is made or suit is brought The inclusion of more than one insured shall not operate to increase the insurer's limit of liability • All policies shall be endorsed to read "SAID POLICY SHALL NOT BE CANCELLED, NONRENEWED OR' MATERIALLY CHANGE WITHOUT 30 DAYS ADVANCED WRITTEN NOTICE BEING GIVEN TO THE OWNER (CITY) EXCEPT WHEN THE POLICY IS BEING CANCELLED FOR NONPAYMENT OF PREMIUM IN WHICH CASE 10 DAYS ADVANCE WRITTEN NOTICE IS REQUIRED" • Should any of the required insurance be provided under a claims -made form, Contractor shall maintain such coverage continuously throughout the term of this contract and, without lapse, for a period of three years beyond the contract expiration, such that occurrences arising during the contract term which give rise to claims trade after expiration of the contract shall be covered • Should any of the required insurance be provided under a form of coverage that includes a general annual aggregate limit providing for claims investigation or legal defense costs to be included in the general annual aggregate limit, the Contractor shall either double the occurrence limits or obtain Owners and Contractors Protective Liability Insurance • Should any required insurance lapse during the contract term, requests for payments originating after such lapse shall not be processed until the City receives satisfactory evidence of reinstated coverage as required by this contract, effective as of the lapse date If insurance is not reinstated, City may, at its sole option, terminate this agreement effective on the date of the lapse SPECIFIC ADDITIONAL INSURANCE REQUIREMENTS All insurance policies proposed or obtained in satisfaction of this Contract shall additionally comply with the following marked specifications, and shall be maintained in compliance with these additional specifications throughout the duration of the Contract, or longer, if so noted [X] A General Liability Insurance: General Liability insurance with combined single limits of not less than $1,000,000 shall be provided and maintained by the Contractor The policy shall be written on an occurrence basis either in a single policy or in a combination of underlying and umbrella or excess policies If the Commercial General Liability form (ISO Form CG 0001 current edition) is used • Coverage A shall include premises, operations, products, and completed operations, independent contractors, contractual liability covering this contract and broad form property damage coverage • Coverage B shall include personal injury • Coverage C, medical payments, is not required If the Comprehensive General Liability form (ISO Form GL 0002 Current Edition and ISO Form GL 0404) is used, it shall include at least • Bodily injury and Property Damage Liability for premises, operations, products and completed operations, independent contractors and property damage resulting from explosion, collapse or underground (XCU) exposures • Broad form contractual liability (preferably by endorsement) covering this contract, personal injury liability and broad form property damage liability 1XI Automobile Liability Insurance Contractor shall provide Commercial Automobile Liability insurance with Combined Single Limits (CSL) of not less than $1,000,000 either in a single policy or in a combination of basic and umbrella or excess policies The policy will include bodily injury and property damage liability arising out of the operation, maintenance and use of all automobiles and mobile equipment used in conjunction with this contract Satisfaction of the above requirement shall be in the form of a policy endorsement for • any auto, or • all owned, hired and non -owned autos [XI Workers Compensation Insurance Contractor shall purchase and maintain Worker's Compensation insurance which, in addition to meeting the minimum statutory requirements for issuance of such insurance, has Employer's Liability limits of at least $100,000 for each accident, $100,000 per each employee, and a $500,000 policy limit for occupational disease The City need not be named as an "Additional Insured" but the insurer shall agree to waive all rights of subrogation against the City, its officials, agents, employees and volunteers for any work performed for the City by the Named Insured For building or construction projects, the Contractor shall comply with the provisions of Attachment 1 in accordance with §406 096 of the Texas Labor Code and rule 28TAC 110 110 of the Texas Worker's Compensation Commission (TWCC) [ I Owner's and Contractor's Protective Liability Insurance The Contractor shall obtain, pay for and maintain at all times during the prosecution of the work under this contract, an Owner's and Contractor's Protective Liability insurance policy naming the City as insured for property damage and bodily injury which may arise in the prosecution of the work or Contractor's operations under this contract Coverage shall be on an "occurrencebasis, and the policy shall be issued by the same insurance company that carries the Contractor's liability insurance Policy limits will be at least combined bodily injury and property damage per occurrence with a aggregate [ I Fire Damage Legal Liability Insurance Coverage is required if Broad form General Liability is not provided or is unavailable to the contractor or if a contractor leases or rents a portion of a City building Limits of not less than each occurrence are required [ I Professional Liability Insurance Professional liability insurance with limits not less than per claim with respect to negligent acts, errors or omissions in connection with professional services is required under this Agreement [ I Builders' Risk Insurance Builders' Risk Insurance, on an All -Risk form for 100% of the completed value shall be provided Such policy shall include as "Named Insured" the City of Denton and all subcontractors as their interests may appear [ I Additional Insurance Other insurance may be required on an individual basis for extra hazardous contracts and specific service agreements If such additional insurance is required for a specific contract, that requirement will be described in the "Specific Conditions" of the contract specifications ATTACHMENT 1 [XI Worker's Compensation Coverage for Budding or Construction Projects for Governmental Entities A Definitions 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 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 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 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 overage agreements, which meets the statutory requirements of Texas Labor Code, Section 401011(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, (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 BID # 2387 PROPOSAL TO THE CITY OF DENTON, TEXAS FOR THE CONSTRUCTION OF h DENTON,TEXAS The undersigned, as bidder, declares that the only person or parties interested in this proposal as principals are those named herein, that this proposal is made without collusion with any other person, firm, or corporation, that he has carefully examined the form of contract, Notice to Bidders, specifications and the plans therein referred to, and has carefully examined the locations, conditions, and classes of materials of the proposed work and agrees that he will provide all the necessary labor, machinery, tools, apparatus, and other items incidental to construction, and will do all the work and famish all the materials called for in the contract and specifications in the manner prescribed herein and according to the requirements of the City as therein set forth It is understood that the following quantities of work to be done at unit prices are approximate only, and are intended principally to serve as a guide in evaluating bids It is agreed that the quantities of work to be done at unit prices and material to be furnished may be increased or diminished as may be considered necessary, in the opinion of the City, to complete the work fully as planned and contemplated, and that all quantities of work whether increased or decreased are to be performed at the unit prices set forth below except as provided for in the specifications It is further agreed that lump sum pries may be increased to cover additional work ordered by the City, but not shown on the plans or required by the specifications, in accordance with the provisions to the General Conditions Smularly, they may be decreased to cover deletion of work so ordered It is understood and agreed that the work is to be completed in full within the number of workdays shown on the bid tabulation sheet P - 1 Accompanying this proposal is a certified or cashier's check or Bid Bond, payable to the Owner, in the amount of five percent of the total bid It is understood that the bid security accompanying this proposal shall be returned to the bidder, unless in case of the acceptance of the proposal, the bidder shall fail to execute a contract and file a performance bond and a payment bond within fifteen days after its acceptance, in which case the bid security shall become the property of the Owner, and shall be considered as a payment for damages due to delay and other inconveniences suffered by the Owner on account of such failure of the bidder Owner reserves the right to reject any and all bids Owner may investigate the prior performance of bidder on other contracts, either public or private, in evaluating bid proposals Should bidder alter, change, or qualify any specification of the bid, Owner may automatically disqualify bidder The undersigned hereby proposes and agrees to perform all work of whatever nature required, in strict accordance with the plans and specifications, for the following sum or prices, to wit ** PLEASE RETURN BID TABULATION SHEET AND SUMMARY SHEET IN DUPLICATE ** P-2 Hickory Creek Sanitary Sewer Orossings Phase II BID TABULATION SHEET 121 Contractors Warranties and Understandmgs Umt Pnce In Words f_") Lzal ,�% DL 2 12 9-A 16" Steel Sanitary Sewer - Epoxy Lined, Tape Coated Umt Pnce In Words T VJo v ,f p e q 2 12 9-B 16" Steel Sanitary Sewer - Epoxy Lined, Fusion Bonded Umt Pnce In Words T-ojo KuAl t 2 12 9-C 30" Steel Sanitary Sewer - Epoxy Lined, Tape Coated Unit Pnce In Words vo R04 0 e 2 12 9-D 16" Steel Sanitary Sewer - Epoxy Lined, Fusion Bonded Umt Pnce In Words \(Jo HoNp 2 12 14-A 16" Sanitary Sewer Umt Pnce In Words vE 2 12 14-B 30" Samtary Sewer Umt Pnce In Words 2 24-A Gabion Mattress (9" Depth) Urut Pnce In Words 2 24-C 3' X 3' Gabion Basket Unit Pnce In Words OLE , 3-D Remove Concrete Footer Un}t Pnce In Words 3-E Remove Concrete Piers UrMt Pnce In Words 3-F Remove Concrete Rip Rap Urut Pnce In Words ML P3 Work Days 80 Bid NO 2387 _ PO No - LS J $ ,(5 00 /LS $ /5o/)D -70 �i9--- LF $ 1 /LF $ Sii�OO T �,,V QoliLfflf �45 �&- LF $ 2-3 0 /LF $ 33 �Sp fq �a or t10 LF $ Z Y U /LF $ a 6,YOO Pv cY 48 LF $ Z'?O /LF $ 1 y 000 ZH TY Voll 42 LF $ / /LF $ (pg S2xz!2a i ) 19 LF IS /LF $ q f/ q- -.e 670 1 SY $ /SY 1 $ 3a-) q-' e=kq 93 1 /CY $ / < /CY $,1?/ 80 1 EA $ Z Q /EA $ pU 9� 5 EA S/ 0 n /EA $ 248 i SY $ / /EA $ Hickory Creek Sanitary Sewers Work Days SO Crossings Phase it Bid No „�— BID TABULATION SHEET PO No Item IDescription Quantity Unit Unit Price I Total 3 1 Pre aration of Right of Way I - LS /LS I $ Unit Pnce In Words 7Z > - 33 Unclassified Excavation 1 181 1 CY Is r7 /CY $ Unit Pnce In Words - 7 U S 3 7 Co}npacted Fill 30 CY I $ /CY $ Unit Pnce In Words - ,U S 3107 Hydromulch 1565 SY Is 3 /SY Unit Pnce In Words ' 3 12 Temporary Erosion Control LS $ le /LS $ U t Pnce In Words - 7 6-A-1 Concrete Manhole (5' Internal Diameter) 5 1 EA $ /EA $ / Unit Pnce In Words &NY - S 7 6-A-1 Concrete Manhole (6' Intemal Diameter) 3 EA 1 $ /EA 1 $ Ur4t Pnce In Words _ _ F - > deepl 7 6-B-1 Reinforcing Piers -16" Sanitary Sewer LF $ j Q /LF ' CEO Unit Pnce In Words =- 7 6-13-2 Reinforcing Piers - 30" Sanitary Sewer v LF $ J /LF U t Pnce In Words - _ d WS-26 Abandon Existing Manhole 3 1 EA $ /EA $ Q6 Unit Pnce In Words = re n- WS-30 Break Into Existing Manhole 1 EA I $ oD /EA $ Unit Pnce In Words SP-10 R I ock Excavation 50 1 CY S / /CY $ L] Unit Pnce In Words - LLja 1 G/ZD P4 Hickory Creek Sanitary Sewer Crossings Phase II BID TABULATION SHEET Work Days Bid No PO No 2387 :N Item Description Quantity I Unit I Unit Prlce Total SP-37 Excavation Protection 1 419 1 LF $ / /LF 1 $ 'el1l go Unit Pnce In Words �r - SP-40 Cut and Plug Existing Samtary Sewer �r-6 I EA $ /EA $ Umt Pnce In Words SP-41 Remove Samtary Sewer 614 1 LF $ /EA $ , Unit Pnce In Words Y- SP-71 lBypass Pumping LS $/ 0 /LS $ v aY ) Unit Pnce In Words y— — - SP-72 Geotechmcal Design LS $ S $ /e_) (X) Unit Pnce In Words Y ac- - Is 1 $ Unit Pnce In Words $ $ Unit Pnce In Words $ $ Umt Pnce In Words $ $ Unit Pnce In Words Is 1 $ Unit Pnce In Words Is 1 $ TOTAL -44-G 00 1S P5 Hickory Creek Sanitary Sewer Crossings Phase II - Alternate I BID TABULATION SHEET Work Days Bid No PO No 50 Item IDescription I Quantity I Unit I Unit Price ITotal 2 12 9-C 30" Steel Sanitary Sewer - Epoxy Lated, Tape Coated I �O I LF $ Z O /LF 1 $ 43 UmtPnceInWords TK(d H0uDp:p FoFT`E ILAR 2 12 9-D 30" Steel Sanitary Sewer - Epoxy Lined, FusBonded i ao - 75@' LF qion $ Z p Q /LF I $ Unit Pnce In Words r vJ o I-WAJDREQ = i 2 12 14 30" Sanitary Sewer -14%-/to LF $}&6';'- /LF $ Unit Price In Words 0 t✓;r- unr R z Q j2o4 t eve 2 24-A Gabion Mattress (9" Depth) 1 425 1 SY Is /SY Unit Price In Words )A- - - - 2 24-C 3' X 3' Gabion Basket 93 /CY I $ /CY $/ 9/D Unit Price In Words - y 3-1) Remove Concrete Footer 12 1 /EA $ / D /EA $ Unit Pnce In Words Z ri- -L&QTIS 3-E Remove Concrete Piers 1 7 1 EA $ % /EA $ U t Price In Words - i- - 3 1 Preparation of Right of Way I I LS $ ft/LS $ [�V) Unit Price In Words - y _ e - 33 Unclassified Excavation 1 106 1 Cy Is rl /CY $ Unit Price In Words 37 Compacted Fill 20 1 CY Is/0 /CY $ ao U Urut Pnce In Words y _ ,U 3 107 Hydromulch 1 1565 1 SY $ a 5 /SY $ Umt Pnce In Words = _ _ f j = - 3 12 Te porary Erosion Control LS $ /LS ft U t Price In Wo U f = D P6 Hickory Creek Sanitary Sewer Work Days 50 Crossings Phase II - Alternate I Bid No 23g7 BID TABULATION SHEET PO No Item IDescription Quantity Unit I Unit Price I Total 7 6-A-1 I Concrete Manhole (6' Internal Diameter) 5 EA $ /EA $ Unit Price In Words L&z- 7 6-B-1 Remforcmg Piers - 30" Sanitary Sewer Aito -Be- I LF $ Zpo /LF I $Pape Unit Price In Words a aU_ - 7 WS-30 Break Into Existmg Manhole 3 EA $ 5 L *D /EA $ Unit Price In Words _ - SP-10 Rock Excavation 50 1 CY Is/ /CY $ Unit Pnce In Words )L SP-37 Excavation Protection 288 LF $ / /LF I $ Unit Price In Words y - SP-40 Cut and Plug Existing Sanitary Sewer , al - EA 1 $ /EA $ Unit Price In Words p = y- - �— SP-41 Remove Sanitary Sewer 390 J. LF $ /LF $ t� Unite Price In Words p y SP-71 B ass Pumping LS $ S000 /LS $ 5000 Unit Price In Words SP-72 Geotechmcal Design LS I $ S000 /LS $ S()00 Unit Price In Words Is 1 $ $ $ $ $ TOTAL -40 3 U 8. z 5 P7 BID SUMMARY TOTAL BID PRICE IN WORDS F I V r H U ni O a i 0 F0 2 TY IV i ni f 6NL %lloufnur� iA woOZE0 F LVTcCA/ DotLR2s Amin F,FtV f Livrl In the event of the award of a contract to the undersigned, the undersigned will furnish a performance bond and a payment bond for the full amount of the contract, to secure proper compliance with the terms and provisions of the contract, to insure and guarantee the work until final completion and acceptance, and to guarantee payment for all lawful claims for labor performed and materials furnished in the fulfillment of the contract It is understood that the work proposed to be done shall be accepted, when fully completed and finished in accordance with the plans and specifications, to the satisfaction of the Engineer The undersigned certifies that the bid prices contained in this proposal have been carefully checked and are submitted as correct and final Unit and lump sum prices as shown for each item listed in this proposal, shall control over extensions �— Zj G • L�vc CONTRAC R BY S N sv civ •"tr Street Address �n.oKC-1 I &-xar `?&Aiea, City and State Seal & Authorization (If a Corporation) $ 17 — ~f C? — 2 -703 Telephone A D LC f --2 ti.2.ket 41, '* a — —I tl dgct B I 171� lulu PROJECT Hickory Creek Sanitary Sewer Crossing Phase II Hickory Creek Sanitary Sewer Crossing Phase II Alternate 1 TOTAL WORK DAYS BID 80 $ -5V4 , 00-7 50 $ 'ZO3a 108 $ 7nl I S•� Both portions of this project will be awarded to one contractor Award of bid will be based on either the total for Hickory Creek Sanitary Sewer Crossings, or for both the Sewer Crossings and Alternate #1 These items have been separated for bookkeepeing purposes Workdays will be kept separately on each section of the project Please note that as tins project is to be performed in an area controlled by the United Sates of America, tins project MUST be under construction no later than September 10' If we are not under construction by this date, our ability to enter the Waters of the United States of America will not be permitted M SENT BY Mondics/Greenhaw Ins, r 8— 2-88 11:18 I 2148071855y 840 348 73029# 3 me CATE go A//IIRIIm � r' nr.i Mur.N�Rsalogrwnher IniUIIDp �rr.n PT Inc 96 0ouW99 Aw. am. a 00YPANIED AFFORDING COVERAGE — C891s - — __-- Lmm A UMW Padb bee, Ce COMIMN�.. Y.�•-_. LETTER B Tom Mfmlwrsr ow4L Ina. --- oenr Rands Contv*% Inc. °mPPA Y C AOany, hwnarlao Ce MBorden Lane :._.-...._.,..._.._.� ___._.....�.,._ ..._.._.._. �- • __--_ _ _ -- _-- NDsnoke TX 7EEE11 j LHTTBP D INDICATED, NOTWITHSTANDIN ANY NIQUIREMENT, TERM OR CONDITION OF ANY CONTRAOr OR OTHER DOCUMENT WITN RESPECT ITC WHICH THIS CERTIFICATE MAY OC IOOUND OR MAY PORTAIN, THE INOURIINOB APPORDLO BY THE POLICIES DIIBORISED HEREIN 19 SUBJECT TO ALL THE TERMS EXCLUSIONS AND CONDITIONS OF OUCH POLICIES LIMITS SHOWN MAY NAVE BEEN RNDUCND IV PAID CLAIMS A, _ TVPC Or INSURANCE �......~...�. POUCY NUMIM DATE M RM OATS DBAODnvJ -... _ ....•,... 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