HomeMy WebLinkAbout1999-231ORDINANCE NO jj—,�q3
AN ORDINANCE ACCEPTING COMPETITIVE BIDS AND AWARDING A PUBLIC WORKS
CONTRACT FOR THE CONSTRUCTION OF SIDEWALKS, PROVIDING FOR THE
EXPENDITURE OF FUNDS THEREFOR, AND PROVIDING AN EFFECTIVE DATE (BID 2368
— BELL AVENUE, KINGS ROW AND DALLAS DRIVE SIDEWALKS, AWARDED TO FLOYD
SMITH CONCRETE, INC IN THE AMOUNT OF $162,029 65)
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
2368 FLOYD SMITH CONCRETE, INC $162,029 65
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
PASSED AND APPROVED this the � day of 1999
JAC D LLER, MAYOR
ATTEST
JENNIFER WALTERS, CITY SECRETARY
BY
APPROVED AS TO LEGAL FORM
HERBERT L PROUTY, CITY ATTORNEY
BID 2368 - CONTRACTUAL ORD
ATTACHMENT 1
TABULATION SHEET
Bid # 2368 DATE 6-3-99
BELL AVE. KINGS ROW. DALLAS DR SIDEWALK
No
DES
RIRTION
VENDOR
VENDOR
VENDOR
VENDOR
VENDOR
FLOYD
DBR
ED WILSON
SENECA
CREATIVE 4
SMITH
CONST
TOTAL
$162,029.65
$165,381 50
$191,425 25
$194,002 00
$657,498 14
1
_CD pq -
CONTRACT AGREEMENT
STATE OF TEXAS §
COUNTY OF DENTON §
THIS AGREEMENT, made and entered into this 20 day of JULY A D., 1999, by and
between CITY OF DENTON of the County of DENTON and State of Texas, acting through
MICHAEL W. JEZ, City Manager, thereunto duly authorized so to do, hereinafter termed
"OWNER," and
FLOYD SMITH CONCRETE. INC a
P.O. BOX 1781
DENTON. TEXAS 76202
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 # 2368 - BELL AVENUE, KINGS ROW, DALLAS DRIVE. SIDEWALKS
in the amount of $162,029.65 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
Indermu ication
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, mvitees, 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 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 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
ATTEST;
�..► ►Ke I Ilky.
►'. .t+,
/M.., s
/�
(SEAL)
Flo u d sam-�/ Coxe�y�� 1,iC
CONTRACTOR
IO dox/10l
7� -16 zoz
MAILING ADDRESS
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PHONE NUMBER
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FAX :;'
BY
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Frond S7nir
PRINTEb NAME
(SEAL)
PERFORMANCE BOND
STATE OF TEXAS §
COUNTY OF DENTON §
KNOW ALL MEN BY THESE PRESENTS That FLOYD SMITH CONCRETE,
INC , whose address is P.O BOX 1781, DENTON, TX 76202, hereinafter called Principal,
and01V1Va;5;vC S ,-T4 CF f}—Q/G/9
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 ONE HUNDRED SIXTY TWO
THOUSAND TWENTY NINE AND 651100 DOLLARS ($162,029 65) 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 99-231, with the City of
Denton, the Owner, dated the 20 day of July A.D 1999, a copy of which is hereto attached
and made a part hereof, for BID # 2368 - BELL AVENUE, KINGS ROW, DALLAS
DRIVE SIDEWALKS
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 retrain in full force and effect
PB-1
PROVIDED FURTHER, that if any legal action be filed upon this Bond, exclusive
venue shall he 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 20 day of JULY 1999
ATTEST
PRINCIPAL
SECRETARY BY —� IMEN!
..
ATTEST; SURETY
i- SGc . T mE,eiC�
BY
BY y �Y%Lelti
ATTORN Y-IN FACT
The Resident Agent of the Surety in Denton County, Texas for delivery of notice and service
of the process is
NAME , Kl9/)1�✓ q- rIVC-y 7 2S
STREET ADDRESS S30 S J-J4- S& A Jelyi oty, Lc 7Ywao.r
(NOTE Date of Per Bond must be date of Contract If Resident Agent is not a
corporation, give a person's name)
PB-2
PAYMENT BOND
STATE OF TEXAS §
COUNTY OF DENTON §
KNOW ALL MEN BY THESE PRESENTS That FLOYD SMITH CONCRETE,
INC., whose address is P.O. BOX 1781, DENTON, TX 76202,hereinafter called Principal,
and L , a corporation organized and
existing under the laws of fhe 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
ONE HUNDRED SIXTY TWO THOUSAND TWENTY NINE AND 65/100 DOLLARS
($162,029.65) 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, admuustrators, 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 99-231, with the City of
Denton, the Owner, dated the 20 day of JULY A.D. 1999, a copy of which is hereto attached
and made a part hereof, for BID # 2368 - BELL AVENUE, KINGS ROW, DALLAS
DRIVE SIDEWALKS.
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 to 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 20 day of JULY 1999.
ATTEST
PRINCIPAL
j
PRESMEN/I
SECRETARY BY
t,
ATTEST SURETY
iIJE 1a fik
BY
BY
ATTORNEY -IN -FACT
The Resident Agent of the Surety in Denton County, Texas for delivery of notice and service
of the process is
NAME
STREET ADDRESS S3D S QS <&, fi, 1E-/yaN, T- 7",95
(NOTE Date of Payment Bond must be date of Contract If Resident Agent is not a
corporation, give a person's name )
2368 CONTRACT & BONDS & INSURANCE
.M
1 07/28/99 09 20 5 02/02 No 706
UNIVERSAL SURETY OF AMERICA
GENERAL POWER OF ATTORNEY CERTIFIED COPY
20000333y
Know All Men by These Presents, That UNIVERSAL SURETY OF AMERICA, a corporation duly organnaed and existing
under +he laws of the State of Texd v, and hawnt its v-mcival oM,e m Nuun of Texaa, dn,a by fbost , reasnts male
constitute and appoint
Cathy Miller
its true and lawful Attornay(s) in Fact, with Atli power and authority hereby conferred in its name, place and stead to
execute, acknowledge and deliver bonds for
Priampal; Floyd Smith Concrete, Inc
Obligee City of Denton, TX
Amcuat,S162,029 65
and to bind the Company thereby as fully and to the same extent as if such bonds were signed by the President, sealed with
the corporate seal of the Company and duly attested by its Secretary, hereby ratifying and conflmmng all that the said
Attoraay(s) is Fact may do within the above stated limitations Said appointment is made under and by authority of the
following resolution adopted by the Board of Directors of Universal Surety or America at a meeting hold on tha I Ith day of
July 1984
"Be It Resolved, that the President, and any Vice President, Secretary or any Assistant Secretary shall be and is hereby
vested with full power and authority to appoint any one or mesa suitable persons as Attorney(e) in Fact to represent and set
for and on behalf of the Company "
"RESOLVED that the signature of any officer of the corporation, and the seal of the corporation may be affixed or
printed by facsimile to any power of attorney of the corporation, and that such printed facsimile signature and seal &hall be
valid and binding upon the corporation "
In Witness Whereof, Universal Surety of America has caused these presents to be signed by its President, Jack
McReynolds and its corporate said to be bereto affixed this 2nd day of January, AD , 1998
UNIVERSAL SURETYO RICA
TtxN Jaak ids President
State of Texas
as
County of Harris
On tbis 2nd day of January, in the year of LOSS, before me Estela Lama, a notary pubhq personally appeared Jack
McReynolds, personally known to be the person who executed the within instrument as President, oa behalf of the
corporation therein named and acknowledged to me that the corporation executed it
I the undersigned Secretary of Universal Surety of America, hereby certify that the above and foregoing is a full, true
and correct copy of the Original Power of Attorney issued by said Company, and do hereby further certify that the said
Power of Attorney to still in affect
GIVEN under my hand and the seal of said company, at Houston, Texas, this 28th day of July
Asaistant Secretary
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
of 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 IO 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 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
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
lxl 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
[X] 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
[X] 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 I 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 tunes 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 "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
[ ] 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
[] 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
[ ] 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
[ ] 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
ATTACHMENT1
[xl 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 401 01 1(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
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 01 1(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 protect,
(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 protect, 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 protect,
(5) retain all required certificates of coverage on file for the duration of
the protect 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 protect, 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 protect will be covered by workers' compensation
coverage for the duration of the protect, 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 SUMMARY
TOTAL BID PRICE IN WORDS One hundred sixty two thousand
twenty nine and 65/100 dollars
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.
Ftoyd Smkth Concae.te Inc
role i
A/
W;'7201' F .,,/_,'owww, -
.,,
P 0 Box 1781
Street Address
Denton, TX 76202
City and State
Seal & Authorization
(If a Corporation) 940-565-0114
Telephone
B - 1
PROJECT
Bell Avenue Sidewalk
Kings Row Sidewalk
Dallas Drive Sidewalk
TOTAL
BID SUMMARY
WORK DAYS
15
12
28
1,301
$ 60,103.70
$ 39,918.05
$ 62,007.90
$ 162,029.65
All items accepted above will be awarded to one contractor Work days will be kept separately
for each item listed above The award of the bid shall be based on Items 1, 2, and 3 above Total
work days will be the sum of all sections of the bid awarded
ME
BELL AVENUE SIDEWALK BID TABULATION SHEET
Work Days 15
Bid No o73lyb
PO No
Item
Description Quantity Unit I Unit Price Total
121
Contractors Warranties and Understandings - LS $ 815.00 /LS $ 815.00
Unit Price In Words Ez t hundred fifteen and 00/100 collars
3-A
Remove Concrete Curb & Gutter
192
LF
$ 6.00 /LF
$ 1 152 00
Unit Price In Words Six and 00 100 dollars
3-B Rertiove Concrete Drives & Walks
159 SY
$ 16.20 /SY
$ 22575.80
Unit Price In Words aixteen un,. 20/100 dollars
3-1)
Remove Concrete Pad
5
1 SY
$ 16.20 /SY
I $ 81.00
Unit Pnce In Words Sixteen and 20/100 dollars
3 1
Preparation of Right of Way - LS
$ 500.00 /LS
$ 500.00
Unit Price In Words Five hundred and 00 100 dollars
33
Unclassified Excavation 1 151 1 CY
$ 10.00 /Cy
$ 1,510 00
Unit Price In Words Ten and 00/100 dollars
3 7 Compacted Fill 1 76 CY
$ 20.00 /CY
$ 1,520.00
Uni Pnce In Words Wenty and 00/100 dollars
3 9
Sod
590
�YF
$ 7.50 /LF
$ 4,425.00
Unit Pnce In Words Seven and 50/100 dollars
3 107
Hydromulch
1 89
1 SY
$ 6.50 /SY $ 578.50
Unit Price In Words Six and 50/100 dollars
3 12
Tergporary Erosion Control
-
LS
$ 250.00 /LS
$ 250.00
Unit Price In Words Two hundred f if ty and 00/100 dollars
57
Asphalt Patch (2" - Type D)
1 I Ton Is 75.00 /To
$ 75.00
Unit Price In Words Seventy five and 00/100 dollars
7 4 5-A
Class A Concrete- Sidewalk Toe Wall 1 10 1
CY Is
365.00
Uni Pnce In Words 'Three hundred sixty five and 00 100 dollars
8 1
Barricades, Warning Signs and Detours
LS
$ 500.00 /LS
$ 500.00
Um Pnce In Words Five hundred and 00/100 dollars
2/8/99 P 3
BELL AVENUE SIDEWALK BID TABULATION SHEET
Work Days
Bid No
P O No
Item Description Quantity I Unit I Unit Price
I Total
8 3 Drtt!eway 6" 159 1 SY $ 31.50/SY
$ 5,008.50
Unix Pnce In Words 'thirty one and 50/100 dollars
8 3A
4" Concrete Sidewalk
1 876
1 Sy
$ 31.05/Sy
$ 27,199.80
Umt Pnce In Words Thirq one and 05/100 dollars
812
Hanail
1 200
LF
$ 30.00/Lg $ 62000.00
Unit Pnce In Words 'shirty and 00/100 dollars
SP-2
Concrete Saw Cut 1 531
1 LF
$ 3.00/Lg
$ 19593.00
UmtPnce In Words Three and 00/100 dollars
SP-27 Adjust Sernce Lines
1 7
1 EA
$ 250.00/EA
$ 1,750.00
Unit Pnce In Words Two hundred fifty and 00/100 dollars
SP-31-A
I Remforcmg Steel - Sidewalk Toe Wall
1 67
1 LB
$ .30/LB
1 $ 20.1
UmtPnce In Words ------30/100 dollars
SP-37 Excavation Protection
1 10 1 LF
$ -0- /LF
$ -0-
Unit Pnce In Words NA
SP-39
Project Signs
I 1
I EA
$ 400.0q
UmtPnceIn Words Four hundred and 00/100 dollars
SP-45 Miscellaneous Spnnkler System Adjustment
I
I LS
$ 500.00'LS 1 $ 500.0
Unit Pnce In Words Five hundred and 00/100 dollars
Is
Is
Is
Is
Is
Is
Is
Is
TOTAL(Sixty thousand one hundred three & 70/100 dollars) $60 103.70
2/8/99 P 4
KINGS ROW SIDEWALK
BID TABULATION SHEET
Work Days
Bid No
PO No
Item IDescription
I Quantity I Unit I Unit Price I Total
121
Co tractors Warranties and Understandings
LS $ 551.00/LS 1 $ 551.00
Um Pnce In Words Five hundred fifty one and 00/100 dollars
3-A
Remove Concrete Curb & Gutter
1 80
1 LF
$ 6.00/LF
1 $ 480.00
Unit Pnce In Words Six and 00/100 dollars
3-C
Remove Concrete Steps
1
EA
$ 25.00/EA
$ 25.00
Unit Price In Words TwentM five and 00 100 dollars
3 1
Prearation of Right of Way
LS
Is 500.00/LS
1 $ 500.00
UmtPnceIn Words Five hundred and 00/100 dollars
33
Unclassified Excavation
1 125
1 CY
$ 10.00/Cy
$ 1,250.00
UmtPnceIn Words Ten and 00/100 dollars
3 7
Compacted Fill
30
1 CY
$ 20.00/CY
$ 600.0
UmtPnceIn Words Twenty and 00/100 dollars
39
Sod
614
1 LF
$ 7.50/LF
1 $ 4,605.00
UmtPnceIn Words Seven and 50/100 dollars
3 107
Hydromulch
142
1 Sy
$ 6.50/SY
1 $ 923.0
Unit Pnce In Words Six and 50/100 dollars
3 12
Terxrporary Erosion Control
LS
$ 250.00/LS
1 $ 250.00
Unit Pnce In Words Two hundred fifty and 00/100 dollars
8 1
Barricades, Warning Signs and Detours
LS
$ 500.00/LS 1
$ 500.0
UmtPrice In Words Five hundred and 00/100 dollars
83
Dnveway 6"
1 45
1 SY
$ 31.50/Sy
$ 1,417.5
UmtPnceIn Words Thirty one and 50/100 dollars
8 3A
4" Concrete Sidewalk
1 751
SY
$ 31.05/Sy
$ 23, 318.5
UmtPnceIn Words 'Thirty one and 05/100 dollars
P5
KINGS ROW SIDEWALK
BID TABULATION SHEET
Work Days
Bid No
PO No
Item Description
I Quantity Unit
Unit Price I Total
SP-2 Concrete Saw Cut
1 116 1 LF
$ 3.00/LF 1 $ 348.0
Umt Pnce In Words 'three and 00/100 dollars
SP-27
Adjust Service Lines
17
EA
$ 250.00/F
$ 4,250.0(
UmtPnceIn Words Wo hundred fifty and 00/100 dollars
SP-39
Project Signs
1
1 EA
$ 400.0gg;A
$ 400.0
UmtPnceIn Words Four hundred and 00/100 dollars
SP-45
Miscellaneous Sprinkler System Adjustment
LS
$ 500.00'LS
I $ 500.
Unit Pnce In Words Five hundred and 00/100 dollars
Is
$
Is
$
Is
$
E I
I
Is
$
TOTAL (Thi.rty nine thousand nine hundred eighteen & 05/100 dollars) $ 39,918.05
IM
DALLAS DRIVE SIDEWALK BID TABULATION SHEET
Work Days
Bid No c !k
PO No
Item
Description
I Quantity
I Unit I Unit Price I Total
121
Contractors Warranties and Understandings
I -
I LS $ &37•00/LS 1 $ 837.00
Unit Price In Words Eight hundred thirty seven and 00/100 dollars
2 13
Flex Base (6")
6
1 SY
$ 20.00/SY
$ 120.00
Unit Pnce In Words Twenty and 00/100 dollars
3-A
Remove Concrete Curb & Gutter
1 150
1 LF
$ 6.00/LF
1 $ 900.00
Unit Price In Words Six and 00/100 dollars
3-B
Remove Concrete Driveways
I 25
I SY
$ 16.20/Sy
$ 405.00
Unit Price In Words Sixteen and 20/100 dollars
3-F
Remove Concrete Median
1 11
1 SY
$ 16.20/SY
$ 178.20
Unit Price In Words Sixteen and 20/100 dollars
3-G
Remove Concrete - Other
20
SY
$ 18.00/SY
$ 360.00
Unit Price In Words Eliahteen and 00/100 dollars
3 1
Preparation of Right of Way
LS $ 500.00/LS
1 $ 500.00
Unit Price In Words Five hundred and 00/100 dollars
3 9
Sod
652_Y20
I SY
$ 7.50/Sy $ 4,890.00
Unit Price In Words Seven and 50/100 dollars
3 107
llydromulch
1 641
SY $ 3.00/SY
$ 1,923.00
Unit Pnce In Words Three and 00/100 dollars
3 12
Temporary Erosion Control
I LS
$ 250.00/LS
$ 250.00
Unit Price In Words Two hundred fifty and 00/100 dollars
57
Asphalt Patch (2" - Type D)
43
Ton
$ 75.00/To
$ 39225.00
Unit Price In Words Seventy five and 00/100 dollars
7 4 5-A
Class A Concrete- Sidewalk Retaining Wall
0 CY
$ -0- /CY
$ -0-
Unit Price In Words NA
8 1
Bamcades, Warning Signs and Detouis
I
LS
$ 750.OWLS
$ 750.00
Umt Pnce In Words Seven hudnred fifty and 00/100 dollars
83
Concrete Driveway 6"
41 1
SY
$ 31.50/Sy 1
$ 1,291.50
Unit Price In Words Thirty one and 50/100 dollars
4/30/99 P 7
DALLAS DRIVE SIDEWALK BID TABULATION SHEET
Work Days
Bid No
PO No
Item Description I Quantity
I Unit
I Unit Price
I Total
8 3A-1 4" Concrete Sidewalk 1 1164
1 SY
$ 31.05 /SY
$36,142.20
Unit Price In Words Thirty one and 05/100 dollars
8 3A-2
6" Concrete Sidewalk
166 SY
$ 31.50 /Sy $ 5,229.00
Unit Price In Words Thir Ly one and 50/100 dollars
SP-2
Concrete Saw Cut
1 364
1 LF
$ 3.00 /LF
$ 1,092.00
Unit Pnce In Words Three and 00/100 dollars
SP-27
Adjust Service Lines
1
EA
$ 250.00 /EA
$ 250.00
Unit Price In Words Two hundred fifty and 00/100 dollars
SP-31-A
I Reinforcing Steel - Sidewalk Retaining Wall
1 260
1 LB
$ .30 /LB
1 $ 78.00
Unit Pnce In Words ---- 30 100 dollars
SP-39 Tproject
Signs
1
I EA
$ 400.00/EA $ 400 00
Unit Price In Words Four hundred and 00/100 dollars
SP-43
Asphalt Saw Cut
1238
1 LF
$ 1 50/LF
$ 1,857 00
Unit Pnce In Words One and 50 100 dollars
SP-45
Miscellaneous Sprinkler System Adjustment
LS
$ 500.00/LS
1 $ 500.00
Unit Price In Words Film buildred and 00/100 dollars
3.3
Unclassified Excavation 1 79
1 CY
$ 10.00/LF
$ 790.00
Unit Price In Words Ten and 00/100 dollars
3.7
Compacted Fill
2 1
CY
$ 20.00
$ 40.00
Un t Price in Words Twenty and 00/100 dollars
Is
Is
Is
$
TOTAL(sixty two thousand seven & 90/100 dollars) $62,007 90
4/30/99 P 8
- - -1. --...... -, .. - - • •- -- - -- -- -- - - - „ -,
PRODUCER (940)382-9691 FAX (940)243-1050
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
Ramey & King Insurance
Y g
HOLDER THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
830 South I-35E, Suite A
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW
Denton, TX 76205-7829
COMPANIES AFFORDING COVERAGE
Bituminous
COMPANY
Attn Ext
A
INSURED Floyd Smith Concrete, Inc
COMPANY Texas Work Comp Ins Fund
P o Box 1781
Denton TX 76201
COMPANY
C
COMPANY
D
CGVERAGES
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED NOTWITHSTANDING ANY REQUIREMENT TERM OR CONDITION
OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS
CO TYPE OF INSURANCE POLICY NUMBER
LTR
POLICY EFFECTIVE POLICY EXPIRATION LIMITS
DATE(MMIDDIYY) DATE(MMIDDIYY)
GENERAL LIABILITY
GENERAL AGGREGATE S 2,000,000
X COMMERCAL�ENERALLIABILITY
PRODUCTS COMPIOPAGG S 2,000,000
A CLAIM, Ar)E X 01-UP CLP3044054
09/28/1998 09/28/1999 PERSONAL &ADV INJURY S 1,000,000
OWNER S& CnNTRACTOR S PROT
EACH OCCURRENCE $ 1,000,000
FIRE DAMAGE (Any one fire) S 50,000
MED EXP (Any one person) S 5,000
AUTOMOBILE LIABILITY
COMBINED SINGLE LIMIT S
ANY AUTO
ALL OWNED AUTOS
BODILY INJURY $
SCHEDULED AUTOS
(Per Person)
HIRED AUTOS
BODILY INJURY S
NON OWNED AUTOS
(Pee,oenq
(Per
PROPERTY DAMAGE S
GARAGE LIABILITY
AUTO ONLY EA ACCIDENT S
ANY AUTn
OTHER THAN AUTO ONLY
EACH ACCIDENT S
AGGREGATE S
EXCESS LIABILITY
EACH OCCURRENCE S
UMBRELLA P�PM
AGGREGATE $
OTHER THAR � iMBRELLA FORM
S
WORKERS COMPENSATION AND
X TORY LIMITS ER
EMPLOYERS LIABILITY
B TSF0001082227
EL EACH ACCIDENT S 100,000
09/28/1998 09/28/1999
THE PROPRIETOR, INCL
ELDISEASE POUCYLIMIT S 500,000
PARTNERS,EXECUTIVE
OFFICERS ARE EXCL
EL DISEASE EA EMPLOYEE S 100,000
OTHER
DESCRIPTION OF OPERATIONSILOCATIONSNEHICLESISPECIAL ITEMS
ITY OF DENTON, ITS OFFICIALS, AGENTS, EMPLOYEES AND VOLUNTEERS ARE NAMED AS ADDITIONAL INSURED
Bid 2368 - Bell Avenue, Kings Row, Dallas Drive,
Sidewalks
CERTIFICATE HOLDER
CANOWATI109
Said olicy shall not be cancelled, renewed, or
mate changed without SO days advance
w _ ten no ice bet g 4 n to the Ow-er, except
heu the p licy is bejn c"c�lled for non-
CITV OF DENTON
payment o prxmium, in hich case 10 days
advance w ltten no)(&96 is required
901E TEXAS STREET
AUTHORREDR RESEN VE
DENTON, TX 76201
Rame 1 I r
ACORD 2&S (1156)
CIACORO CORPORATION In
Jul-28-99 10 37A ALLSTATE INS-HOLT AGCY 940 566 5942 P.Ol
GkRTIFICATEOF INSURANCE
0 ALLSTATE INSURANCE COMPANY ® ALLSTATE INDEMNITY COMPANY ❑ ALLSTATE TEXAS LLOYD'S
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER THIS CERTIFI
CATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW
_ CERTIFICATE HOLDER NAMEDINSURED
Name and Addre eol Pert o, Whom this Certificate is lssuad _hams and Address of insured _
CITY OF DENTON FLOYD SMITH
PURCHASING DEPT PO BOX 1781
ATTN DENISE HARPOOL DENTON TX 76231
FKX—(940)349-7302
This Is to certify that policies of Insurance listed below have been Issued to the Insured named above subject to the expiration date Indicated below,
nolwithstandln0 any requirement, term or condition of any contract or other document with respnol to which this certificate may be Issued or may
pertain The Insurance afforded by the policies described herein Is subject to all the terms, exoluslors, and conditions of such policies
TYPE OF INSURANCE AND LIMITS
COMMERCIAL GENERAL LIABILITY Policy Effective Expiration
_ Number Date Date _
Limit _Amount
GENERAL AOORFGATE LIMIT Olhar than Products—Complefill orations
PRODUCTS — COMPLETED OPERATIONS AGGREGATE LIMIT_
EAPERSONAL AND ADVERTISING INJURY LIMIT $ _
CH OCCURRENC LIMIT _ _ _ $
Coverage_
EMPLOYERS'
LIABILITY
AUTOMOBILE LIABILITY
8 Policy Effective Et
Number Date _ —_ OI
STATUTORY — Oppliesonlvinthefollowin ep tales
BODILY INJURY BY ACCIDENT s
BODILY INJURY BY DISEASE
EACH ACCIDENT
EACH EMPLOYEE
POLICY LIMIT
Effective Expiration
i59731 Date _(V>/11 /99 Date O6 11 00
_ LttAila_ _
_ Combined Single Limit of Liability _
BODILY INJURY 6 PROPERTY DAMASE �I,SjOQ. DUO, EACH ACCIDENT
____ III liability Llmlb _—
SppIN InJur�_ — _f'—proporlif Boom Each _
j _ ••, +sW `1 "JAi�!a r�4c, dt w.w PERSON
r)OWNEO AUTOS OTHER THAN PRIVATE PASSENGER _ ti ACC
UMBRELLA LIABILITY Policy Ef" tivr Expiration
_ Number Datc Date _
EACH OCCURRENCE GENERALAGOREGATE T PRODUCTS —COMPLETED OPERRA
Policy
Number
Coverage Basle _
LJANYAUTO IN OWNED AUTOS C7(HIREDAUTOS
MSPECIFIEUOTOS M NON OWNED AUTOS
LJOWNEO PRIVATE PASSENGER AUTOS
OTHER jShow Policy Effective
type Of Policy) Number Dale e�Mrt_'wo
ol
DESCRIPTION OF OPERATIONSILOCATIONSIVEHICLESfRESTRICTIONSISPECIAL ITEMS
(SEE ATTACHED)
CANCELLATION
Number of days notice FOR ANY REASON OTHER THAN NONPAY07/27/99
(10 DAYS NOTICE FOR ?PAYIW OF PREMIIM2 _dreg flap ok"I Ive ONle
Shouldanyofthesbove eacribodpollcleabeoan oiled before the expiration date, the issuing company will endeavor to mail within the numbe,of
days entered above, written notice to the certificate hold named bova
khodaymithece
MOM
You're in WKsd hands.
io
Print trey Output Page L
1)/63SS1 V3R2M0 96051/ A0405345 01/27/99 11s48s36
Display Device s DRP21
User S300001
Insured FLOYD SMITH Pol N,� . 649599731
Phones ( 817 ) 565 - 0114 ++'ITEM LT9TING'" Agent 08 097821
Ins Line: AUTO-COMM
14
SEL YEAR MAKE/MODEL V1N
1 1999 FORD /EXPEDITION E 0365
2 1986 FORD /F1W FLATBED 3945
3 1981 FORD /FLATBED 41131
4 L991 FORD /250 XI.T 4446
5 1992 FORD TRUCK/F250 8972
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