1997-032 ORDINANCE NO (~']Q~'~-
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 C~ty has sohc~ted, received and tabulated competitive bids for the
constructxon of pubhc works or improvements m accordance with the procedures of STATE law
and C~ty ordinances, and
WHEREAS, the Cxty Manager or a designated employee has received and recommended that
the herexn described b~ds are the lowest responsible b~ds for the construction of the pubhc works or
~mprovements described in the bxd xnwtat~on, b~d proposals and plans and spemficatmns there~n,
NOW, THEREFORE,
THE COUNCIL OF THE CITY OF DENTON HEREBY ORDAINS
SECTION I That the followang competxtlve bids for the constructxon of pubhc works or
~mprovements, as described m the "Bid Inwtatxons", "B~d Proposals" or plans and spemficatxons on
file in the Office of the C~ty's Purchasing Agent filed according to the b~d number assigned hereto,
are hereby accepted and approved as being the lowest responsible b~ds
BID
LqI2MBER CD2,,JTRAC TO R AMOIJNT
1991 D & L CONSTRUCTION SERVICES $ 15,660 00
SECTION II That the acceptance and approval of the above competmve b~ds shall not
constitute a contract between the Cxty and the person submitting the b~d for construction of such
pubhc works or xmprovements here~n accepted and approved, until such person shall comply w~th
all reqmrements spemfied xn the Nottce to Bxdders ~nclu&ng the t~mely execution of a written
contract and fummlung of performance and payment bonds, and insurance certfficate after
not~ficatxon of the award of the b~d
SECTION III That the Cxty Manager xs hereby authorized to execute all necessary written
contracts for the performance of the construction of the pubhc works or ~mprovements xn accordance
wxth the bids accepted and approved here~n, provxded that such contracts are made xn accordance
wxth the Notme to B~dders and B~d Proposals, and documents relatxng thereto specifying the terms,
cond~tmns, plans and specfficat~ons, standards, quantities and spemfied sums contmned thermn
3.
SEC_,IlO~_I~ That upon acceptance and approval of the above compettt~ve b~ds and the
executton of contracts for the pubhc works and ~mprovements as authorized here~n, the Ctty Councd
hereby authorizes the expenditure of funds in the manner and tn the amount as spectfied tn such
approved bids and authorized contracts executed pursuant thereto
SECTION V_ That thts ordinance shall become effecttve tmmedtately upon its passage and
approval
PASSED AND APPROVED this the 2'/t~a' day of'~ ,1997
ATTEST
JENNIFER WALTERS, CITY SECRETARY
APPROVED AS TO LEGAL FORM
HERBERT L PROUTY, CITY ATTORNEY
2
DATE FEBRUARY 4, 1997
C~~REPORT
TO Mayor and Members of the City Council
'FROM Ted Benavldes, City Manager
SUBJECT BID It 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
SIIMMAR¥: 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.. DEPARTMEi~TSD]LG~FECTED. Community Development Block
Grant (CDBG), Residents near each demolition site
FISCAL IMPACT. This project is funded from CDBG funds, account #219-05A-CDA7-8502
Attachment Tabulation Sheet
Respectfully submitted
Ted Benavides
City Manager
Approved
Name Tom D Shaw, C P M
Title Purchasing Agent
823 AGENDA
3
CONTRACT AGREEMENT
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
thereunto duly authorized so to do, hereinafter termed "OWNER," and
D & L CONSTRUCTION SERVICES
611 S. RUDDY.?.?.
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 - D~OLITION AND CF~RING #26
in the amount of ~15~660.00 and all extra work in
connection ~herewith, 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 - i
blueprints, and o~her drawings and printed or written explanatory
matter ~hereof, and the Specifications therefore, as prepared by
CITY OF DENTON CDu~ DEPa~V~f~NT
all of which are made a part ~ersof and collectively evidence and
constitute the entire contract.
Indenendent 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 ~he 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 th~s 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 thisAgreement, and Contractor will, at its cost and
expense, defend and protect the City of Denton against any and all
such cla~ims 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 couMts 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 ;ihre2te presents have
executed this agreement in the year and day above written.
CITY OF DENTON
(SEAL)
ATTEST:
D & L CONSTRUCTION SERVICES
CONTRACTOR
~ILING ~DRESS
PHONE N~BER
FAX NUMBER
TITLE
PRINTED NAME
APPROVED AS TO FORM: (SEAL)
dity Attorney (t
AAA0184D
Rev. 04/05/96
CA - 3
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 ,nsursnce carriers or brokers
to determine in advance of Bid submission the availability of insurance cert, flcates and
endorsements ss prescribed end provided herein If an apparent Iow bidder fails to
comply strictly with the insurance requirements, that bidder may be disqualified from
award of the contract Upon bid award, ell ,nsurance requirements shall become
contractual obligations which the successful bidder shall have a duty to matnta~n
throughout the course of this contract.
STANDARD PROVISIONS:
W~thout hmlt~ng any of the other obhgations or habiht~es of the Contractor, the
Contractor shall provide and maintain until the contracted work has been completed
and accepted by the C~ty of Denton, Owner, the m~mmum insurance coverage as
Ind~cated hereinafter
As soon as practicable after notification of b~d award, Contractor shall file w~th the
Purchasing Department satisfactory certificates of insurance, conta~mng the b~d
number and t~tie of the project Contractor may, upon wntten request to the
Purchasing Department, ask for clarification of any ~nsurance requirements at any
time, however, Contractors are strongly adwsed to make such requests pnor to b~d
opemng, since the insurance requirements may not be modified or waived after b~d
opening unless a written exception has been submitted w~th 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 C~ty of Denton
All insurance pohc~es proposed or obtained ~n satisfaction of these requirements shall
comply w~th the following general specifications, and shall be maintained ~n
comphance w~th these general spec~flcations throughout the duration of the Contract,
or longer, ~f so noted
· Each pohc¥ shall be ~ssued by a company autho.zed to do bus.ness ~n the
State of Texas w~th an A M Best Company rating of at least .~
· Any deductibles or self-insured retentions shall be declared ~n the b~d
proposal If requested by the City, the ~nsurer shall reduce or ehmmate
such deductibles or self-insured retentions w~th respect to the C~ty, ~ts
A*~A00350
REVISED 10/12/84 CI - 1
Insurance Requirements
Page 2
officials, agents, employees and volunteers, or, the contractor shall procure
a bond guarantemng payment of losses and related investigations, claim
administration and defense expenses.
· L,ablllty polic,es shall be endorsed to prov,de the following.
e· Name as additional insured the City of Denton, ,ts Officials, Agents,
Employees and volunteers.
· · That such insurance ts primary to any other ~nsurance available to the
additional insured with respect to cia,ms covered under the pohcy and
that th,s ~nsurance apphes separately to each insured aga,nst whom
clmm ts made or su,t ts brought The inclusion of more than one
insured shall not operate to increase the ~nsurer's hm~t of liability
· All pohc~es shall be endorsed to provide thirty(30) days pr,or written notme
of cancellation, non-renewal or reduction ,n coverage
· Should any of the requ,red ~nsurance be prowded under a claims-made
form, Contractor shall mmnta~n such coverage continuously throughout the
term of th~s contract and, w,thout lapse, for a period of three years beyond
the contract expiration, such that occurrences ans,ng during the contract
term which give nse to clmms made after expiration of the contract shall
be covered.
· Should any of the required insurance be prowded under a form of coverage
that ~ncludes a general annual aggregate hm~t prowdmg for claims
investigation or legal defense costs to be ~ncluded ,n the general annual
aggregate hmit, the contractor shall either double the occurrence hm~ts or
obtain Owners and Contractors Protect,ye L~ab~hty 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 ewdence of reinstated coverage as required by th~s
contract, effective as of the lapse date If ~nsurance ~s not re,nstated, C~ty
may, at ~ts sole option, terminate th~s agreement effective on the date of
the lapse
AAA003~O
REVISED 10/12/94 CI - 2
Insurance Requ,rements
Page 3
SPECIFIC ADDITIONAL INSURANCE REQUIREMENTS:
Ali insurance polic,es proposed or obtained ~n satisfaction of '(h;s Contract shall
add~t,onally comply w~th the following marked spec;f,cat;ons, and shall be mmntmned
in compl,ence w;th these add,tional speciflcat,ons throughout the duration of the
Contract, or longer, ,f so noted
General Liab,lity Insurance:
General L~ab~llty ;nsurance w,th combined single I,m,ts of not less than
l, 000,0o0.0Oshall be prov,ded and mainta~ned by the contractor The policy
shall be written on an occurrence basis e,ther ~n a single policy or ~n a
comb,nat~on of underly;ng and umbrella or excess policies
If the Commercial General L,ab,l,ty form (ISO Form CG 0001 current
ed,t;on) ~s used
· Coverage A shall include premises, operations, products, and
completed operations, ,ndependent contractors, contractual I;ab~I~W
covenng th~s contract and broad form property damage coverage
· Coverage B shall ~nclude personal ~njury
· Coverage C, medical payments, ~s not required
If the Comprehensive General L~ab,hty form (ISO Form GL 0002 Current
Edit;on and ISO Form GL 0404) ~s used, ~t shall ~nctude at least
· Bodily ~njury and Property Damage L,abd;ty for prem;ses,
operations, products and completed operations, independent
contractors and property damage resulting from explosion, collapse
or underground (XCU) exposures
· Broad form contractual i~ab;l,ty (preferably by endorsement)
covering th~s contract, personal ~njury habH~ty and broad form
property damage I,ab~hty
AAA00350
REVISED 10/12m4 CI - :3
Insurance Requirements
Page 4
Automobile Liability Insurance:
Contractor shall provide Commercial Automobile Liability insurance w,th
Comb;ned S~ngle Limits (CSL) of not less than $5o0,0oo.00 either in a s~ngle
policy or in a combination of basic and umbrella or excess policies. The policy
will include bodily injury end property damage liability arising out of the
operation, maintenance and use of all automobiles and mobile equipment used
in conjunction with this contract.
Satisfact~on of the above requirement shall be ~n the form of a pohc¥
endorsement for
· any auto, or
· all owned, hired and non-owned autos
Workers Compensation Insurance
Contractor shall purchase and maintain Worker's Compensation insurance
which, in addition to meeting the m~mmum statutory requirements for issuance
of such insurance, has Employer's Llab~hty limits of at least $100,000 for each
accident, $100,000 per each employee, and a $500,000 policy hm~t for
occupational d~sease. The City need not be named as an "Additional Insured"
but the insurer shall agree to waive all rights of subrogation against the C~ty,
~ts officials, agents, employees and volunteers for any work performed for the
C~ty by the Named Insured For building or construction projects, the
Contractor shall comply w~th the provisions of Attachment 1 m 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 Llab~l.ty 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 L~abll~ty ~nsurance pohcy naming the City as insured for property
damage and bodily ~niurY which may arise in the prosecution of the work or
contractor's operations under this contract Coverage shall be on an
AA~00360
~L=V~SEO lo/12/~4
Insurance Requirements
Page 5
"occurrence" bas~s, and the policy shall be ~ssued by the same insurance
company that carr,es the contractor's hab~hty ;nsurance Policy limits w~ll be
at least combined bodily ~niury and property damage per
occurrence w~th a aggregate.
[ ] Fire Damage Legal Liability Insurance
Coverage ~s required ,f Broad form General Lmb,hty ~s not prowded or ~s
unavailable to the contractor or ~f a contractor leases or rents a port~on of a
C~ty building Limits of not less than each occurrence are required
[ ] Professional Liab;lity Insurance
Professional hab~hty insurance w~th limits not less than per claim
w~th respect to negligent acts, errors or omissions ,n connection w~th
professional services ~s required under this Agreement
[ ] Builders' Risk Insurance
Builders' Risk Insurance, on an AlI-R~sk form for 100% of the completed value
shall be provided Such policy shall ~nclude as "Named Insured" the C~t¥ of
Denton and all subcontractors as the,r interests may appear
[ ] Additional Insurance
Other insurance may be required on an ~ndivldual basis for extra hazardous
contracts and specific serwce agreements If such additional insurance ~s
required for a specific contract, that requirement w~ll be described m the
"Specific Conditions" of the contract specifications
AAA00350
REVI~ED 10112/94 CI - 5
Insurance Requirements
Page 6
ATI'ACHMENT 1
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 certlf,cata of author,ty to self-,nsure ~ssued by the commission, or a
coverage agreement (TWCC-81, TWCC-82, TWCC-83, or TWCC-84),
show,ng statutory workers' compensation insurance coverage for the
person's or entlty's employees prowdlng services on a project, for the
duration of the project
Duration of the project - includes the time from the beg~nmng 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 prowd~ng services on the project ("subcontractor" ~n §406 096) -
~ncludes 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 d~rectly w~th the contractor and regardless of
whether that person has employees. Th~s ~ncludes, without hm~tatlon,
independent contractors, subcontractors, leasing compames, 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, w~thout hmltat~on, prowdlng, hauhng, or dehvenng
equipment or materials, or providing labor, transportation, or other serwce
related to a project "Serwces" does not include act~wtles unrelated to the
project, such as food/beverage vendors, office supply dehvenes, and
dehvery of portable toilets
B The contractor shall prowde coverage, based on proper reporting of
classification codes and payroll amounts and fihng of any overage
agreements, which meets the statutory requirements of Texas Labor Code,
Section 401 011 (44) for all employees of the contractor providing serwces
on the project, for the duration of the project
AAA00350
REVISED 10112/94 CI - 6
Insurance Requirements
Page 7
C The Contractor must provide a certificate of coverage to the governmental
entity pr,or to be,rig 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, pnor
to the end of the coverage period, file a new certificate of coverage w~th
the governmental entity showing that coverage has been extended
E The contractor shall obtain from each person prowd~ng serwces on a
project, and provide to the governmental entity
(1) a certificate of coverage, prior to that person beg,nmng work on the
project, so the governmental entity w~ll have on f,le certificates of
coverage showing coverage for all persons prowd~ng 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 dunng the
duration of the prolect
F The contractor shall retain all required certificates of coverage for the
durat,on of the project and for one year thereafter
G The contractor shall notify the governmental entity ~n writing by certified
mall or personal delivery, w~thm 10 days after the contractor knew or
should have known, of any change that matenally affects the prows~on of
coverage of any person prowdmg serwces on the project
H The contractor shall post on each project s~te a not~ce, ~n the text, form and
manner prescribed by the Texas Workers' Compensation Commission,
inform~ng all persons prowd~ng serwces on the project that they are
required to be covered, and stating how a person may verify coverage and
report lack of coverage
AAA00350
.EV~SEO ~o~;/~4 CI - 7
Insurance Requirements
Page 8
I. The contractor shall contractually requ;re each person with whom ~t
contracts to provide serv;ces on a project, to
(1) prov;de coverage, based on proper reporting of class;flcation codes
and payroll amounts and fihng of any coverage agreements, which
meets the statutory requ;rements of Texas Labor Code, Sect;on
401 011 (~. ~.} for all of its employees prov;d;ng serv;ces on the project,
for the durat;on of the project,
(2) prowde to the contractor, pr;or to that person beg~nmng work on the
project, a certificate of coverage show;rig that coverage as be;ng
prowded for all employees of the person prov;d;ng serv;ces on the
project, for the duration of the project,
(3) prowde the contractor, pr;or to the end of the coverage per;od, a new
certificate of coverage showing extension of coverage, ;f the coverage
per~od shown on the current certificate of coverage ends during the
duration of the project,
(4) obtain from each other person w~th whom ~t contracts, and prowde to
the contractor
(a) a cert;flcate of coverage, pr;or to the other person beginning
work on the prolect, and
(b) a new certificate of coverage showing extens;on of coverage,
prior to the end of the coverage per;od, ~f the coverage per~od
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) not~fy the governmental ent;ty ~n wr~t;ng by certified ma;I or personal
delivery, w~thm 10 days after the person knew or should have known,
of any change that mater~ally affects the prov;slon of coverage of any
person providing serwces on the project, and
AAA00360
REVISED 10112/94 Gl - 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 serwces
J By signing this contract or providing or causing to be provided a certificate
of coverage, the contractor is representing to the governmental ent~W that
all employees of the contractor who will provide services on the project w~ll
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, w~th
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 ent~tles 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.
AA/,00350 CI - 9
.EV~SED
BID NUMBER ].99[ BID PROPOSALS Page 2 of
City of Denton, Taxae 801 B Texee St.
Puroheelng Deperlment Denton, Texas 78201
ITEM DESCRIFTION QUAN PRICE AMOUNT
DEMOLITION & CLEARING #26
1 531 Wainwright Street 1 ea $
2 622 E Prairie Street iea $__
3 1006 E Prairie Street 1 ea $
4 1008 E Prairie Street 1 ea $
5 1023 E Prairie Street 1 aa $~
6 529 Avenue S 1 aa $
VENDOR MUST COMPLY WITH ALL ATTACHED SPECIFICATIONS
We quote the above f o b delivered to Denton, Texas Shipment can be made ~n days from receipt of order Terms net/30
unless otherwise indicated
In submitting the above bid, the vendor agrees that acceptance of any or ail b~d Rems by the City of Denton Texas w~th~n a
reasonable period of time constltues a contract The completed Bid Proposal must be properly priced, signed and returned
City State ZlO SIgnalure
FEB -ll'97(TUE) 15 40 RAMEY & KING TEL 1 817 2451050 P 001
[ ~,,l~', .....
,,.,., ~,... L...~" ~ _
~"I ....
.... ~ ................. ~ ~1~ ; ~ ~ ~
~L I~R~
RAM~ & gNe
FEB -II'97{TUE) 14 42 RAMEY & KING TEL 1 817 24~ 1050 P 002
~..'--'..~.~.,-*. ....................................................................... ~ ,~? .....
THIS BI~ I~ A ~R~Y I~URANOE O0~A~, SU~E~ ~ ~E ~OND~ION~ SH~ ON ~E R~E
SlOE OF ~ ~M
x ~ ~ ....
FEB 07'97 lB 15 FR TWCIF UNDERWRITING 51~ 505679? TO 91817~431050 P 08 CE
TEXAS WORKERS COMP;NSA~=N~NaURANCEFUN= PROPOSALACCEPTANCE FORM and INVOICE
QUOTE NUMBER TSF-QO00174162 970222 1 QUOTe ~SSUE~ 2~
Applleen~ DARRELL ~WSON Proposed Effletlve/~plratlen Da~ 2 22 1997
Agan~ RAMEY & KING INS ~SOCS INC FID No 465117859
Unde~r VIVIAN LUBENOW Re~ewal ~
Estimated Annual Premium 5 4e5 oo Amount of Check Attached $_
Reporting Mods. ~UA~....R~..~ Check Number
Deposit Premium ~
w~ll th1= polmy premium be ~nanaed? ~ Yes ~ ~
NO~ ~ ~ect~on ~ net applicable to SB/PP
~ None ~ $~ per A~mdent ~ $ Annual Aggrega[e
~ $ / per Accident / Annual Aggregate
NOTE If a ded~bble ~tion o~er ~n NONE ~a selee~ you m~t also at.ch a s~gned "Ded~#~/e Noeco of Elco#on to Aacept Tex~
1) Th,s quote Is valid for ~ (30) dave after quote (and those of Its aff~l~etes) filed w~th the Taxa=
Issue date pnn~ed above an~ ~a void a~er that t~me Employment Commission and the apphcant hereb~
2} The un~erelgned ca.flee ~at he/she la a dul~ waives any ¢onfldent~ahW of such ~nformatlon and
authenzed owner, off~cer pa~ner or employee of reoords m favor of the Fund
the apphcant or a~thorlzed a~ent or represe~tattve 6) Thru e~reement for insurance and the rights and
specified above The ~nders~gned hereby aa=opts obhgatlons of the pan,es arising therefrom shall be
the proposal offered bv the Texa~ Workers' construed ~n accordance w~th the laws of the state
Compensation Insurance Fund. together w~th ~e of Texas w~th venus In Trows Count. Texas
terms end conditions se~ fo~h here~n and agrees to 7} In the event of default on payment of any premiums
be respona,ble for paV~ent of deposit pre~lum due under any pohcv rssued as a result of
stipulated ~n the proposal proposal ail pram,urns due and unpaid shall
3) it ~s understood and agreed ~at insurance =overage become due and payable at the off,cee of the Fund
shall not beoome effective u~til payment of the In Austin Trows Count, Texas
depemt premtum ~s recorded by the F~nd and ~e 8) Agent agrees that commisa~ons wdl hot be prod on
apphoant a au~onzed agent or representative ~ha~ additional collection effo~ bv the Fund
ooverage ~s bound The depositing of a oheok or 9) The Fund Js not protected by an Insurance guaranW
receipt of funds from an a~phcant or a~plJoant, fund or other solvency prote=aon arrangements
authonzed agent or representable ~oe. not 10) The amount of your est~m~te~ annual premium as
hsted on thts quote must agree w~th the amount
consfl~te approval of or binding of =overage for the
apphcent by the Fund unless and until the Fund you remit to the Fund if you have been verbally
4} The undersigned ~e~fles that the.payroll reposed .ssued If the amount listed below as your est mated
by classlfloation oode. ~n applmante apphgat~on for annual premium ~s altered ~n any way your
pavrolls by classification oode for the period of 1 1} Th~s ~roposal acceptance form MUST be s gne~
coverage requea~d The a~phcant u~derstands end both you and your agent an~ returned w th ~our
agrees that any matenal change in payroll depos~ premium Coverage w~ll not be bound
exposures must be promptly reposed to the Fund thls stg~ed form and deposltprem~um Is rede,veal
and adjustments ~n premium may be made by the 12) By signing th~s Proposal Acceptance Form the
Fund ~ ~ ep~cant a~cant~ agent ee~lfy ~at They
6) The Fund ~s authorized ~ have aooes~of the hayseed unders~and agree to a of the terms
apphcant s employment inform~ and records and candlflo~ of thru
~ Th~exa~ WoOers Compensation Insurance Fund
Please Remit Payme~ To P ~aox ~41843
FEB 07'57 IS 15 PR TWCIF UNDERWRITING 512 505S797 TO 918172431050 P 07x08
;exas Workers'
Campematlon UNDERWRITING QUOTE SHEET
Insumnce
Fund ® SUMMARY PAGE
Quote Number TSF-QO001'74162 9-/0222 1 Quote Issue Date 2-06- 199-/
Undemvr~ter' V I V I AN LUBENOW
Produoer 09013 RAMEV & KING INS ASSOCS INC
830 S I H - 36 E ,VA
DENTON, TX ?8205-'/829
Contaot JEFF KING (817) 382-9591 FAX (817) 243-1050
Apphcent DARRELL LAWSON
DBAt O & L CONSTRUCTION
611S RUDDELL
DENTON, TX 76255
FedlD 4561178§§ Ent~ SOLE PROPRIETOR
Sm Code 1521 E INGLE-FAMI LY HOUS IN Group
Best Hazard
Conta¢l DARREL LAWSON [817} 566-1384
Proposed Coverage Period 2-22-1997 to 2-22- 19g8
PREMIUM QUOTE SUMMARY
COVERAGE A
CLASS DESCRIPTION RATE PAYROLL PREMIUM
5190 ELECTRICAL WIRING & DRIVERS 12 BIDO 5,000 OD 631 00
5403 CARPENTRY NeC 34 5800 ~0,0O0 00 3,456 00
51S3 AIR CONDTIONING SYSTEMS-HEATING 13 5oDD 5,000 OD 8?5 oD
Total Estimated Btmnderd Premium 4 7B2 O0
Prorate Footer I OOOO
RATE TIER ADJUSTMENT [ 12,50 ) 595 O0
INCREASED LIMITS DO
WAIVER OF SUBROGATION OD
TOTAL PREMIUM SUBJECT TO MODIFICATIONS , 5,357 0o
PREMIUM MODIFIED TO REFLECT EXPERIENCE MOD OF ( } O0
PREMIUM MODIFIED TO REFLECT SCHEDULE RATING OF { } O0
DEDUCTIBLE PREMIUM , , 00
PREMIUM DISCOUNT, IF APPLICABLE ( 50 ] 32 DO-
EXPENSE CONSTANT CHARGE 140 00
Total Payroll 20,000 00 Estimated Annual Premmm 5,465 00
Audi1 Frequency QUARTERLY - 40% Deposit Premium 2,156 00
Installments N I A
Installment Premium NIA Mmtmum Premium 500 00 ~
COVERAGE B
Standard Admlraltv/F E LA Offshore
Bodily Inju~ By Ac=ident 100 ,O00 o Each Accldent 0 Upper
Bodily injury By Disease 100,500 Eaoh Employee 0 Lower
Boddy Injury By Disease 5DO. 0O0 O Pohoy [Jm]t
ENDORSEMENTS MADE PART OF THIS QUOTATION
WCQO 00 00A WCDO 00 01 WCO0 04 05
WC42 03 010 WC42 03 08