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Home My WebLink About1997-032ORDINANCE NO 9 / �Jr 4- AN ORDINANCE ACCEPTING COMPETITIVE BIDS AND PROVIDING FOR THE AWARD OF CONTRACTS FOR PUBLIC WORKS OR IMPROVEMENTS, PROVIDING FOR THE EXPENDITURE OF FUNDS THEREFOR, AND PROVIDING FOR AN EFFECTIVE DATE 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 NUMBE CONTRACTOR AMOUMT 1991 D & L CONSTRUCTION SERVICES $ 15,660 00 SECTION 11 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 1 SECTION TV 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 SEC_ 11ON—V That this ordinance shall become effective immediately upon its passage and approval PASSED AND APPROVED this the y� day of 1997 J MILLER, MAYOR ATTEST JENNIFER WALTERS, CITY SECRETARY APPROVED AS TO LEGAL FORM HERBERT L PROUTY, CITY ATTORNEY BY 6/%Ge�( DATE FEBRUARY 4, 1997 CITY C.OUN I .-REPORT TO Mayor and Members of the City Council FROM Ted Benavides, City Manager SUBJECT BID # 1991- DEMOLITION AND CLEARING #26 RECOMMENDATION: We recommend this bid be awarded to the lowest total bidder, Darrell Lawson dba D&L Construction Services, in the amount of $15,660 00 S110 AR : This bid is for the demolition of six (6) structures and clearing of the lots and preparation for mowing and property drainage Each of these structures has been determined to be uninhabitable, uneconomical to repair as well as a safety or health risk The structures are located at 531 Wainwright, 622 E Prairie, 1006 E Prairie, 1008 E Prairie, 1023 E Prairie and 529 Ave S PROGRAMS, DE.PARTMF.NTS OR GROIIPSAFFECTED- Community Development Block Grant (CDBG), Residents near each demolition site FiSCAI IMPACT. This project is funded from CDBG funds, account 4219-05A-CDA7-8502 Attachment Tabulation Sheet Approved \r\ Name Tom D Shaw, C P M Title Purchasing Agent 823 AGENDA K, Respectfully submitted Ted Benavides City Manager t, °z z z z° PA t Ig � r»1• fdryA, Q r M $ S $ $ $ S $ � O M f Sgq S pS 8S QqS SO pS W a O A a Q4 W QI W QI W N w O U 3 rW N N M ti n" W W W W W W ac J _ — - CONTRACT AGREEMENT 4 "U - STATE OF TEXAS S COUNTY OF DENTON S THIS AGREEMENT, made and entered into this 4 day of FEBRUARY A.D., 19 97 , by and between CITY OF DENTON of the County of DENTON and State of Texas, acting through TED BENAVIDES thersunto duly authorized so to do, hereinafter termed "OWNER," and D & L CONSTRUCTION SERVICES 611 S. RUDDELL DENTON, TEXAS 76201 of the City of DENTON , County of DENTON and State of 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 # 1991 - DEMOLITION AND CLEARING #26 in the amount of $15,660.00 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 accordance with the plans, which includes all maps, plats, CA - 1 blueprints, and other drawings and printed or written explanatory matter thereof, and the specifications therefore, as prepared by CITY OF DE=N CDBG DEPARTNEW - all of which are made a part hereof and collectively evidence and constitute the entire contract. 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. 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. This agreement shall be governed by the law of the State of Texas and venue for its construction and enforcement shall lie in the counts 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 time 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 price or prices shown in the Proposal, which contract, such payments to be subject to the Conditions of the Contract. CA - 2 in current funds the forms a part of this General and Special IN WITNESS WHEREOF, the parties of these presents have executed this agreement in the year and day first above written. ATTEST: n DDVnVFn AR mn rnpm? AAA0184D Rev. 04/05/96 CA - 3 D & L CONSTRUCTION SERVICES CONTRACTOR J dd L �t-rvi�� p ion -TK 7 6 Z NAILING ADDRESS 817- -S'6(0-63Aq PHONE NUMBER FAX NUMBER BY Crtge '4 TITLE �WW 111 kkjsoil PRINTED NAME (SEAL) 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 AAA00350 REVISED 10I12IB4 Cl - 1 Insurance Requirements Page 2 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 provide thlrty(30) days prior written notice of cancellation, non -renewal or reduction In coverage • 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 made 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 AAA00350 REVISED 10/12/94 Cl - 2 Insurance Requirements Page 3 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 M A General Liability Insurance: General Liability insurance with combined single limits of not less than $1,000,000.00shall 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 (XCLI) exposures • Broad form contractual liability (preferably by endorsement) covering this contract, personal injury liability and broad form property damage liability AAA00350 REVISED 10/12/94 Cl - 3 Insurance Requirements Page 4 (A Automobile Liability Insurance: Contractor shall provide Commercial Automobile Liability insurance with Combined Single Limits (CSL) of not less than $500.000.00 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 [xj 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 $500,00O 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) [ ] 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 AAA00350 REVISED 10/12/94 Cl - 4 Insurance Requirements Page 5 "occurrence" basis, 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 budding 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 AAA00350 REVISED 10/12/94 Cl - 5 Insurance Requirements Page 6 ATTACHMENT 1 [x] Worker's Compensation Coverage for Building 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 entitles 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 401 011(44) for all employees of the contractor providing services on the project, for the duration of the project AAA00360 REVISED 10/12/94 Cl - 6 Insurance Requirements Page 7 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 and 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 AAA00360 REVISED 10112/94 Cl - 7 Insurance Requirements Page 8 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 AAA00360 REVISED 10/12/84 Cl - 8 Insurance Requirements Page 9 (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. AAA00350 REVISED 10112194 CI - 9 BID NUMBER 1991 BID PROPOSALS Page 2 of City of Denton, Texas 9010 Texas S6 Purchasing Department Denton, Texas 76201 ITEM DESCRIPTION OUAN PRICE AMOUNT DEMOLITION & CLEARING #26 1 531 Wainwright Street 1 ea $ $4 -� EC $�35c 2 622 E Prairie Street 1 ea 3 1006 E Prairie Street 1 ea $ S� 4 1008 E Prairie Street 1 ea $ , (' �w $ 5 1023 E Prairie Street 1 Be. $ 6 529 Avenue S 1 ea VENDOR MUST COMPLY WITH ALL ATTACHED SPECIFICATIONS AND INSURANCE REQUIREMENTS. TOTALS We quote the above f o b delivered to Denton, Texas Shipment can be made in20days from receipt of order Terms net130 unless otherwise Indicated In submltting the above bid, the vendor agrees that acceptance of any or all bid Items by the City of Denton Texas within a reasonable period of time constltues a contract The completed Bid Proposal must be properly priced, signed and returned L4 & A" rAJej l I Melling A dreee t=�„ #a V Tx 7&2V I City State Zip C lei 9/7 9"7 Lil '2klu r r 5 CF,,'ics:-, Bidder Signature 43 -i Title Telephone FEB-11'91(TUE) 15 40 RAMEY & KING TEL 1 817 243 1050 P 001 RAMEY & NONG WIBIIRANCE SBO S. W% Rana A � Demon TX 7=054M A aOMPANY I LBTIa B NNaIED f•- - " 1 n01a'ANY C/ Low USA D & L 06111110111011111111 ` D e. PAWNS7x ) un I7NdM »I Do _ _ 11� E THIS 19 TO CERM THAT UM POUQU INOICATED, NOTYATHBTANOING ANY IN CERTIFICATB MAY BE ISSUED OR MAY EAcw8IOW R cONDW10Ne T SUc m[_ _ TYPE OF ImamA .x ! /pMw w apmw wm t ; 0.04 MADE 'X `O=IR j Owmm a commam" FROT , I » oSn/roT _ IB IS ISSUED AS A MATTER OF INPOR1 MAITON ONLY AND IDNTS UPON THE COMFICAYE HOLDER. THIS CRRTUICATe ND, I MND OR ALTER THE COYERAOB AFFORDED BY THE COMPANIES AFFORDING COVERAGE MBIT� ImAANaIn IF INSURANCE LISTED BELOW HAVE Etas+ ISSUED to THE E RCO COMMENT WITH R Fan T T PauTHIS IIpBMEM1• T9W OP Cg10Wla1 OF ANY CONTRACT ON OTHER aHERMEM WITH pOBPECT TO WHICH MB- STAIN, THE INBWIANCE AffOSDED 8Y THE POLICIES DESCRIBE1 HEREIN 19 SUBJECT TO ALL THE TENM& POLICIES, UTAITB BIRWFN MAY HAVE SEEN RIMUCED BY PAID CLAIMS FaIC1�A %s ' POLOY OIPI AWN " ' °IS PSIS NUMen OAIE O W4" OMBPIMIUDND I _ ECA3440iip 1fATBIBO 11AIBK7 '-MOM AOOReOAT9 it NIaDMD1&a Iwmp.mm iI PMMONAI • ADV Wien II SAM OCaNIQIca L� FIRE DAMAGE (,;v Pw IV) :I t mm MOM PwY wo P -w;)3 ICOMBINE) mnOMOM LIABILITY_ _ - __ 4 WAA:Oe0B9B4 7UOBIBB 7UOBlB7 310AX i um(T ! i X I ANYAUm I 0"m MRn6 BDOLV NINY ;s ALL , 1 Fr Pww o awmmn "'Rne BADLY WJRY IINSo Mane i rev wdame ;I 1 NON CO= MAD! 1 i -- ; _ ; OARIIOB Lw8L1IY PROP8TI1' DAMAeo )1 SACS OwwRBWE I! Ihislamumolm ' iUMBRELLA FUM I AGOREDAIB i I! anaN THAN LAB L A PORM 18`AIUTWTY uMDB 1 YWRIa7171adi'Q10AYb11 1 iEAW ACOIDRR 'I I AM I Deem Pa" 1A71Y ILI I Lwasm ONEASE - 6AG1 NpLOWE _ d MWVBW 1000000 1000W0 -- TW0000_ BoeGSS - mm sow Boom i A BUILDERS RISK i 8NIROee4Ba18 1110BN8 1110111197 i BXAW ENTON, TX , I I nm6RF= OP D6Ma 1. a Dodge van a 1B4NB1IT6DK0f00W ADDITIONAL INSURED` «�«� ' Ipph,+w A SHOULD ANY OF TI1e ABOVE DESCRIBED PaUCIES BE DANCIM= BEFORE TNe I E1pnAT10N DATE THEREOF, THE 18BUNG COMPANY WILL ENDEAVOR TO MARL DAYS WRRTBN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE OITY OF DEMON LET, No FALIRE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR ATTN. TOM SHAW4"WHABINO 001 B Tons B7' UABBITY OF ANY AND UPON THE COMPANY IT8 AGENTS On R�ERTATIVES. DEMON TX 7B7D1 ATNa GAMEY A KING INSURANCE \ PAkze-i,,,,,,,,,,,,,,,,,,,,„,_„,,,,,w,,,,„,_,,,.,, FEB -I1'97(TUE) 14 42 RAMEY & KING TEL 1 817 243 1050 P 002 THIS BINDER 18 A TEMPORARY INSURANCE CONTRACT, SUBJECT TO THE CONDITIONS SHOWN ON THE RVERSE SIDE OF THIS FORM -wimmth - - nKM MLFRANCS Gil South 11~ l' I' f }� 'IY „ I rL�. A. 1..1 �u--u N�,iv 7`n ,:lii:n..�.+� v4n.:� �,• ...14'\�fl�M ��:. 1�� My .�.. wt FEB 07'97 16 15 FR TWC1F UNDERWRITING 512 5056797 TO 918172431050 P 08 CE TEXAS WORKERS COMPENSATION INSURANCE FUND PROPOSAL ACCEPTANCE FORM and INVOICE QUOTE NUMBER TSF-0000174162 970222 1 QUOTE ISSUED 2-08 1997 Applicant DARRELLLAWSON Agent RAMEY a KING INS ASSOCS INC Underwrher VIVIAN LUBENOW Estimated Annual Premium 848800 Reporting Mode, QUA R a0% Deposit Premium 21a /NOTE fntsnm repam cannot be fin Will this policy premium be financed? ❑ Yes ❑ No Proposed Effective/Expiration Date 2 22 1997 FID No 465117869 Renewal of Amount of Check Attached Check Number If yes, which premium finance company? (NO7F A copy a/ a signed Premium Finance Agroemant must accompany this Jim) A107E This section is not applicable to SB/PP accounts Deductible Option Selected ❑ None ❑ $ per Accident Annual $ ❑ Aggregate ❑ $ / per Accident / Annual Aggregate NOTE ffa deductible option other than NONE is selected you must also attach a signed "Daductible Notico of Election to Accept Texas Workers Compensation Benefits" form and a "Deducobla Escrow Account and Security Agreement" and return with this form 1) This quote is valid for thirty (30) daya after quote (and those of Its affiliates) filed with the Texas issue data printed above and is void after that time 2) The undersigned he/she Employment Commission and the applicant hereby certifies that is a duly waives any confidentiality of such Information and authorized owner, officer partner or employee of records in favor of the Fund the applicant or authorized agent or representative 6) This agreement for Insurance and the rights and specified above The undersigned hereby accepts obligations of the parties arising therefrom shall be the proposal offered by the Texas Workers' construed in accordance with the laws of the state Compensation Insurance Fund, together with the of Texas with venue in Travis County, Texas terms and conditions set forth herein and agrees to 7) In the event of default on payment of any premiums be responsible for payment of deposit premium due under any policy issued as a result of this stipulated in the proposal roposal all premiums due and unpaid shall 3 it is understood and agreed that insurance coverage ecome due and payable at the offices of the Fund shall not become effective until payment of the in Austin Travis County, Texas deposit premium is recorded by the Pund and the 8) Agent agrees that commissions will not be paid on Fund agrees in writing to the applicant or accounts that become delinquent or which require applicants authorized agent or representative that additional collection effort by the Fund coverage is bound The depositing of a check or 9) The Fund is not protected by an insurance guaranty receipt of funds from an applicant or applicants fund or other solvency protection arrangements authorized agent or representative does not 10) The amount of your estimated annual premium as constitute approval of or binding of coverage for the listed on this quote must agree with the amount applicant by the Fund unless and until the Fund you remit to the Fund If you have been verbally provides written confirmation of coverage 4) The undersigned that the quoted a new amount a new written quote must be certifies payroll reported issued If the amount listed below as your estimated by classification codes in applicant's application for annual premium is altered in any way your coverage is a true and reasonable estimate of the insurance coverage will not be bound payrolls by classification code for the period of 11) This proposal acceptance form MUST be signed by coverage requested The applicant understands and both you and your agent and returned with your agrees that any material change in pa roll deposit premium Coverage will not be bound until exposures must be promptly reported t0 the Fund this signed form and deposit premium is received and adjustments in premium may be made by the 12) By si nin this Proposal Acceptance Form the Fund 6) The Fund is authorized to have access of the ap leant an licanta agent certify that they have read understa and agree to all of the terms applicants employment informat and records and conditions of this oposal The Texas Workers Compensation Insurance Fund Please Remit Pa ma To Y P Ow8ox 841043 Dallas, Texas 75284-1843 Please remit this signed Proposal Ace sp os Form and your check forthe amount of this quote he above address ( Help us by wining the quote or policy number on your ek ) Do not use the above address for othe respondence to the Fund Use of a standard envelope will facilitate the binding of a the undersigned request coverage as stated herein and agree to the terms and conditions as outlined above Applicant a Signature Date Printed Name Agent s Signature Data Printed Name Ps,oesa ice zo ssl For Office Use Drily Underwriter s Initials Accounting Initials INCI IRFn a rnpv FEB 07'97 16 15 FIR TWCiF UNDERWRITING 512 5056797 TO 918172431050 P 07/08 texas workers' Compensati UNDERWRITING QUOTE SHEET on LAInsurance Fund ® SUMMARY PAGE Quote Number TSF-0000174182 970222 1 Quote Issue Date 2-06-1997 Underwriter V I V I AN LUBENOW Producer 09013 RAMEY & KING INS ASSOCS INC 830E I H-35 E#A DENTON, TX 78205-7829 Contact JEFF KING Applicant DARRELL LAWSON DBAI 0 & L CONSTRUCTION 511 S RUDDELL DENTON, TX 75206 (017) 302-9891 FAX (817) 243-1050 Fed ID 466117850 Entity SOLE PROPRIETOR Sic Code 1521 SINGLE-FAMILY HOUSIN Group Best Hazard Contact DARREL LAWSON (017) 565-1384 Proposed Coverage Period 2-22-1997 to 2-22-1998 PREMIUM QUOTE SUMMARY COVERAGE CLASS DESCRIPTION RATE PAYROLL PREMIUM 5100 ELECTRICAL WIRING & DRIVERS 12 5100 5,000 00 631 00 5403 CARPENTRY NOC 34 5600 10,000 00 3,456 00 5183 AIR CONOTIONING SYSTEMS -HEATING 13 5000 5,000 00 875 ❑0 Total Estimated Standard Premium 4 752 00 Prorate Factor 1 0000 RATE TIER ADJUSTMENT ( 12.50 ► 595 00 INCREASED LIMITS DO WAIVER OF SUBROGATION 00 TOTAL PREMIUM SUBJECT TO MODIFICATIONS 5,357 00 PREMIUM MODIFIED TO REFLECT EXPERIENCE MOD OF ( ) 00 PREMIUM MODIFIED TO REFLECT SCHEDULE RATING OF ( ) DO DEDUCTIBLE PREMIUM 00 PREMIUM DISCOUNT, IF APPLICABLE ( SO 1 32 Do - EXPENSE CONSTANT CHARGE . , , , , 140 00 Total Payroll 20,000 00 Estimated Annual Premium 5,465 00 Audit Frequency QUARTERLY - 40% Deposit Premium Installments N/A Installment Premium N/A Minimum Premium COVERAGE B Standard Admiralty/F E LA Bodily Injury By Accident 100 , 000 0 Each Accident Bodily Injury By Disease 100,000 Each Employee Bodily Injury By Disease 500,000 D Policy Limit ENDORSEMENTS MADE PART OF THIS QUOTATION WC00 00 ODA WC00 00 01 WC00 04 06 WC42 03 01113 WC42 03 06 2.185 00 600 00 ' Offshore 0 Upper 0 Lower