2012-021ORDINANCE NO. 2012-021
AN ORDINANCE ACCEPTING PROPOSALS AND AWARDING A PUBLIC WORKS
CONTRACT FOR THE CONSTRUCTION OF PEDESTRIAN TRAILS AND SIDEWALK
IMPROVEMENTS AT THE CITY OF DENTON QUAKERTOWN PARK; PROVIDING FOR
THE EXPENDITURE OF FUNDS THEREFOR; AND PROVIDING AN EFFECTIVE DATE (BID
4885-AWARDED TO JDC CONSTRUCTION COMPANY IN THE AMOUNT OF $145,776).
WHEREAS, the City has solicited, received and tabulated competitive bids for the
construction of public worlcs 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 1. The following competitive bids for the construction of public worlcs 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
4885
CONTRACTOR
JDC Construction Company
AMOUNT
$145,776
SECTION 2. 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 worlcs
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 3. 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 4. The City Council of the City of Denton, Texas hereby expressly delegates the
authority to take any actions that may be required or permitted to be performed by the City of Denton
under Bid 4885 to the City Manager of the City of Denton, Texas, or his designee.
SECTION 4. Upon acceptance and approval of the above competitive bids and the execution
of contracts for the public worl�s 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 5. This ordinance shall become effective immediately upon its passage and
approval.
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PASSED AND APPROVED this the _� day of ,2012.
ATTEST:
JENNIFER WALTERS, CITY SECRETARY
BY:
APPROVED AS TO LEGAL FORM:
ANITA BURGESS, CITY ATTORNEY
BY:
3-ORD-Bi 85
CONTRACT AGREEMENT
STATE OF TEXAS
§ COUNTY OF DENTON §
THIS AGREEMENT, made and entered into this 7 day of February A.D., 2012, by and
between City of Denton of the County of Denton and State of Texas, acting through
Geor�e C. Campbell thereunto duly authorized so to do, hereinafter tenned
"OWNER," and
JDC Construction Companv
121 N. Ballard Avenue
Wvlie TX 75098
of the City of Wvlie, County of Collin 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 coirunence and complete
performance of the worlc specified below:
Bid # 4885 — Qualcertown Park Sidewallc — Trail Im�rovements
in the amount of $145,776 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 worlc specified above, in accordance with
the conditions and prices stated in the Proposal and the Performance and Payment Bonds, attached
hereto, and in accordance with all the General Conditions of the Agreement, the Special Conditions,
tlie Notice to Bidders (Advertisement for Bids), and Instructions to Bidders, as referenced herein
and on file in the office of the Purchasing Agent, and in accordance with all local, state and federal
laws; aa.zd plans, which includes all maps, plats, blueprints, and other drawings and printed or
written explanatory matter thereof, and the Specifications therefore, as prepared by:
Allison Engineering Group — Denton Texas
all of which are referenced herein and made a part hereof and collectively evidence and constitute
the entire contract.
CA-1
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 sicic
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 lus designee under this
agreement.
Indemnification
Contractor covenants and agrees to and does hereby indemnify, hold harmless and defend, at
its own expense, Owner, its officers, servants and employees, from and against any and all claims or
suits for property loss or damage andlor personal injury, including death, to any and all persoiis, of
whatsoever kind or character, whether real or asserted, arising out of the Worlc and services to be
performed hereunder by Contractor, its officers, agents, employees, subcontractors, licensees or
invitees, whether or not caused, in whole or in part, by the alleged negligence of the officers,
servants, employees, of the Owner. Contractor likewise covenants and agrees to, and does hereby,
indemnify and hold harmless Owner during the performance of any of the terms and conditions of
this Contract, whether arising out of in whole or in part, any and all alleged acts or omissions of
officers, servants, or employees of Owner. The provisions of this paragraph are solely for the
benefit of the parties hereto and not intended to create or grant any rights, contractual or otherwise,
to any other person or entity.
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 worlc on or after the date established for
the start of worlc as set forth in written notice to commence worlc and complete all worlc 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
Right to Audit
The OWNER shall have the right to audit and make copies of the boolcs, records and computations
pertaining to this agreement. The CONTRACTOR shall retain such boolcs, records, documents and
other evidence pertaining to this agreement during the contract period and five years thereafter,
except if an audit is in progress or audit findings are yet unresolved, in which case records shall be
lcept until a11 audit tasks are completed and resolved. These boolcs, records, documents and other
evidence shall be available, within 10 business days of written request. Further, the
CONTRACTOR shall also require all Subcontractors, material suppliers, and other payees to retain
all boolcs, records, documents and other evidence pertaining to this agreement, and to allow the
OWNER similar access to those documents. All books and records will be made available within a
50 mile radius of the City of Denton. The cost of the audit will be borne by the OWNER unless the
audit reveals an overpayment of 1% or greater. If an overpayment of 1% or greater occurs, the
reasonable cost of the audit, including any travel costs, must be borne by the CONTRACTOR
which must be payable within five business days of receipt of an invoice.
Failure to comply with the provisions of this section shall be a material breach of this contract and
shall constitute, in the OWNER'S sole discretion, grounds for termination thereo£ Each of the
terms "boolcs" "records" "documents" and "other evidence" as used above shall be construed to
, > > >
include drafts and electronic files, even if such drafts or electronic iiles are subsequently used to
generate or prepare a final printed document.
CA-3
IN WITNESS WHEREOF, the parties of these presents have executed this agreement in the
year and day first above written.
ATTEST:
City of Denton
(SEAL)
ATTEST:
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APPROVED AS TO FORM:
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PRINTED
SIGNATURE
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(SEAL)
PERFORMANCE BOND
STATE OF TEXAS §
COUNTY OF DENTON §
Bond No. 4386074
KNOW ALL MEN BY THESE PRESENTS: That JDC Construction Com�anv,✓
whose address is 121 N. Ballard Avenue W lie TX 75098
hereinafter called Principal, and SureTec Insurance Company , a corporation
organized and existing under the laws of the State of Texas , and
fully authorized to transact business in the State of Texas, as Surety, are held and firmly bound
unto the City of Denton, a municipal corporation organized and existing under the laws of the
State of Texas, hereinafter called Owner, in the pe 1 sum of One HLU red Fort Five
Thousand, Seven Hundred Seventy Six and no/100 �LLARS ($145,776 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 Suppleinental
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 tlus
Bond.
THE OBLIGATION TO PAY SAME is conditioned as follows: Whereas, the Principal
entered into a certain Contract, identified by Ordinance Nu�nber 2012-021, with the City of
Denton, the Owner, dated the 7 day f Februarv A.D.2012�or Bid # 4885- Quakertown Parlc
Sidewalk — Trail Improvements �
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 undertalcings, 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 two (2) years from the date of fmal 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 sha11 fully
reimburse and repay Owner all outlay and expense which the Owner may incur in malcing good
any default or deficiency, then this obligation shall be void; otherwise, it shall remain in full
force and effect.
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PROVIDED FURTHER, that if any legal action be filed upon this Bond, exclusive venue
shall lie in Denton County, State of Texas.
AND PROVIDED FURTHER, that the said Surety, for value received, hereby stipulates
and agrees that no change, extension of time, alteration or addition to the terms of the Contract,
or to the Work to be performed thereunder, or to the Plans, Specifications, Drawings, etc.,
accompanying the same, shall in anywise affect its obligation on this Bond, and it does hereby
waive notice of any such change, extension of time, alteration or addition to the terms of the
Contract, or to the Worlc to be performed thereunder, or to the Plans, Specifications, Drawings,
etc.
This Bond is given pursuant to the provisions of Chapier 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 four co .ies, each one of which
shall be deemed an original, this the 7th day of February � 2o�z
ATTEST:
BY:
SECRETARY
ATTEST:
BY: �,i111,��, 1�1�
Connie Kregel, Wit ss
PRINCIPAL
�DC Construction Company
BY: �'
PRES T
SURETY
SureTec Insurance Company
:
1�Y-IN-F�'t
Tadd �IcIntosh
The Resident Agent of the Surety in Denton County, Texas for delivery of notice and service of
the process is:
NAM$: Jeffrey Todd F9cIntosh
STREET ADDRESS: 2sos N. Plano Raad, Suite 2200, Richardson, TX 75082
(NOTE: Date of Performance Bond naust be date of Contract. If Resident Agent is not a corpo�°ation,
give a person's nanze.)
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PAYMENT BOND
STATE OF TEXAS § Bond No. 4386074
COUNTY OF DENTON §
KNOW ALL MEN BY THESE PRESENTS: That JDC Construction Company,✓
whose address is 121 N. Ballard Avenue, WY,�ie TX 75098
hereinafter called Principal, aiid SureTec I�surance Company , a corporation
organized and existing under the laws of the State of TeXas and fully authorized to transact
business in the State of Texas, as Surety, are held and firmly bound unto the City of Denton, a
municipal corporation organized and existing under the laws of the State of Texas, liereinafter
called Owner, and unto all persons, firms, and corporations who inay furnish materials for, or
perform labor upon, the building or improvements hereinafter referred to, in the penal s m of _
One Hundre Fort Five Thousand Seven Hundred Sevent Six and no/100�OLLARS
($145,776 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 Num er 2012-021, with the City of
Denton, the Owner, dated the 7 da of Februarv A.D. 2012y�Bid # 4885 — Quakertown Park
Sidewalk — Trail Improvements �
NOW, THEREFORE, if the Principal shall well, truly and faithfully perform its duties
and malce prompt payment to all persons, firms, subcontractors, corporations and claimants
supplying labor and/or material in the prosecution of the Worlc 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 sha11 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 Worlc to be performed thereunder, or to the Plans, Specifications, Drawings,
etc.
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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 wlzoin
service of process may be had in matters arising out of such surety, 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 'u1 four co s, each one of which
shall be deemed an original, this the �tn day of February , 20�2�
ATTEST:
BY:
SECRE Y
ATTEST:
BY: l�U�l.l�l, �1�
Connie Kregel, With ss
PRINCIPAL
�DC Constructian Company
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SURETY
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SureTec Insurance Company
Jeffrey
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-IN-F CT
The Resident Agent of the Surety in Denton County, Texas for delivery of notice and �er.vi��e �� i
the process is:
j�AME: Jeffrey Todd �IcIntosh
STREET ADDRESS: 2505 N. Plano Road, 5uite 2200, Richardson, TX 75082
(NOTE: Date of Payment Bond must be date of Contract. If Resident Agent is not a
corporation, give a person's name.)
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POA #: 1810024
SureTec Insurance Company
LIMITED POWER OF ATTORNEY
Know All Men by These Presenis, That SURETEC INSURANCE COMPANY the "Company"), a corporation duly organized and
existing under the laws of the State of Texas, and having its principal office in Houston, Harris Caunty, Texas, does by these presents
make, constitute and appoint � '
Jeffrey Todd Mcintos ,It�Connie Jean Kregel
its true and lawful Attorney-in-fact, with full power and authority hereby conferred in its name, place and stead, to execute, acknowledge
and deliver any and all bonds; recognizances, undertakings or other instruments or contracts of suretyship to include waivers t� the
conditions of contracts and consents of surety for:
Five Millian and 00/100 Dollars ($5,000,000.00) �
and to bind the Company thereby as fully and to the same extent as if such bond were signed by the President, sealed with the corporate
seal of the Compa.ny and duly attested by its Secretary, hereby ratifying and coniurning all�that the said Attorney-in-Fact may do in the
premises. Said appointment shall continue in force_until 12/31/20i3 and is made under and by authority of the following •
resolutions of the Board of Directors of the SureTec Insurance Company:
Be te Resolved, that the President, any Vice-President, any Assistant Vice-Yresident, any Secretary or any Assistant Secretary shall be and is
hereby vested with full power and authority to appoint any one or more suitabie persons as Attorney(s)-in-Fact to represent and act for and on
behalf af the Company subject to the follawing provisions:
;4ttorney-in-Fact may be given full power and authority for and in the name of and of behalf of the Company, to execute, acknowledge and
deliver, any and all bonds, recognizances, contracts, agreements or indemnity and other conditional or obligatory undertakings and any and all
notices and documents canceling or ternunating the Company's liability thereunder, a�id any such instruments so executed by any such
Attorney-in-Fact sha.11 be binding upon the Company as if signed by the President and sealed and effected by the Corporate Secretary.
Be it Resolved, that the signature of any authorized officer and seal of the Company heretofore or hereafter affixed to any power of attomey or
any certificate relating thereto by facsimile, and any power of attorney or certificate bearing facsimile signature or facsimile seal shall be valid
and binding upon the Company with respect to any bond or undertaking to which it is attached, (Adopted at a meetirig held on 20`�' of Aprtl,
1999.)
In Witness Whereof, SURETEC INSURANCE CONIPANY has caused these presents to be signed by its President, and its corporate seal
to be hereto affixed this 3rd day of September, A.D. 2010.
,��Y����� SURETEC INS E C ANY
,ay�aAN�FC� B
��r x ...9 � �t Y• —
w y w � D� John o Jr., resident
State ofTexas ss: �,'�tit4,� + ���
County of Harris - "f
pllx,l ��
On this 3rd day of September, A.D. 2010 before me personally came John Knox Jr., to me known, who, being by me duly sworn, did depose and say, that
he resides in Houston, Texas, that he is President of SURETEC INSURANCE COMPfsNY, the company described in and which executed the above
instrument; that he knows the seal of said Company; that the seal affixed to said instrument is such corporate seal; that it was sa affixed by order of the
Board of Directors of said Company; and that he signed his name thereto by like order.
a�u��i��, ,/ � �
`�4pY��s�. JACQUELYN MALDONADO � - � �
a'`°' °z Notary Public, State of Texas
:,,,;���,; M Commission Expires acq ely VIaldo ado, Notary Public
'�.',;:o��;;= Y Moy 1 e, 2013 y comm sion ex s May 18, 2013
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I, M. Brent �eaty, Assistant Secretary of SURETEC INSURANCE COMPANY, do hereby certify that the above and foregoing is a lrue and con•ect copy
of a Power of Attomey, executed by said Company, which is stil] io full force and effect; and furthermore, the resolutions of the Board of Directors, set
out in the Power of Attorney aze in full force and effect.
Given under rny hand and the seal of said Company at Houston, Texas th?s `7th ay of. February � 2012 - .D.
M. Brent Beaty, Assistant Secretary
Any instrument issued in excess of the penalty stated abovc Is to4ai�� vol:; and witi�out any validity.
For veriflcatlon of the authority of this power you may caU (7 i'1 812-08?� any l�!�siness day between 8:00 am and 5:00 pm CST
b ��,,.
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SureTec Insurance Company
THIS BOND RIDER CONTAINS IMPORTANT COVERAGE INFORMATION
Statutoiy Complaint Notice
To obtain infonnnation or malte a coinplaint: You may call the Surety's toll fiee telephone ntunber for iuformation or to malce a
complaint at: 1-866-732-0099. You may also write to the Surety at:
SureTec Insurance Company
9737 Great Hilis Trail, Suite 32d
Austin, Tx 78759
You may contact the Texas De�arhnent of Iusurance to oUtain iufoi7nation on co�npaakies, .coverage,:rights or complaints at 1-80Q-252-
3439. You may write tlie Texas Depai�anent of Insi.uance at
PO Box 149104
Austin, TX 78714-9104
Fax#: 512-475-1771
VJeb: http://www.tdi.state.�.us
Email: ConswnerProtection@tdi.state.tx.us
PREM1[JM OR CLAIlVI DISPUTES: Shouldyou have a dispute coucerning your premiu�n or about a claun, you should contact the
Surety iu-st. If t7ie dis�ute is not resolved, you may contact the Texas Departinent of Instu•auce.
- Terrorism Risks Egclu�ion
The Bond to which tlus Rider is attached does not provide coverage for, and the surety sha11 not be liable for,
losses caused by acts of terrorism, riot, civil insurrection, or acts of war.
Egclusion of Liability for
Mold, Mycotogins, Fungi & Environmental Hazards
The Bond to which this Rider is attached does not provide coverage for, and the surety thereon shall not be
liable for, molds, living or dead fungi, bacteria, allergens, lusta7nuies, spores, hyphae, or mycoto�ns, or their
related products or parts, nor for any environnlental l�azards, Uio-hazards, hazardous materials, enviromnental
spills, contamination, or cleanup, nor the remediation thereof, nor the consequences to persons, property, or the
performance of the Uonded obligatioiis, of the occurrence, existence, or appearance thereof.
Texas Rider 010106
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OTAL Lt7MP SUM BID, WQItDS AIYD F[GURES, (ffEMS 1-25): �jI
ONE HUNDRED FORTY FIVE THOUSAND SEVEN HUNDRED SEVENTY �
Uallars nnd
,.,,�,,, N O ��,,,� � 145, 776.00
Nares EclknaledqurnUYJesero f�uaodan CmsWCtlm pens fa Quakaloxn Sldowdke d Tr� Dy Nusuil Ertyln�efnp (3rrouP� hc. defed 0.�IS10ff.
Faclr pay Ham d�dt indndraNlabar. mafe�daf; �rvMwS, and aqulM�nl nea�asery to Oerlarm aM fh9 r[ark asdma�atE�MlnlA9+onr�Gid�ct a�ocWmenlz
The lump sum lotel pr�Ce aholiLe Ihe bas�s o! Mfd �rxsaAbn Ibr Awq�shinp er�dlntfWlhpol kwm olwark �H�lefa !rt ptpee.
Bktama�nlssha7bsahnwnlnK+adcendtpurea lnca�oldasarepancy,lheamounfslwwn►nwardswWpaver�
By sigrlfug and sub�nl�fing!ltls hid fon��, �he bld�ler cer!{Jles tb�rl he htrs �horoagJlly nevle►ved Ihe pinR�s �rnd spec�cnrio►�s,1�as �ksJted
t/re slre trNd becniue fmui/inr utilh Ihe ��isting vislble cnu'rlilloi�r, nnd I/tal he hvs strbs�eiled a!1 q�re.slions e�rd clnrifrcatious res�rlli�fg
jra�n suc6 re�tie►tis rrnr! visi�s to tlre Eugirteer e�uUorOwirer,
The �mdcrsig»etl bi�lderdck�iowle�lges rectie�ipl of tliefallou�riig A�Ide►rrin: (ljnone is receh�rl, ehei� ►►�r1te NQN c tl�e blauks).
Add�HiumTlo. I DateR«xived: �-5-12 JAY DAVI
ar•
Addmdum i�lo. 2 Datc Reccived: �;�,,
Adde�du�a Ato. 9 Date Reccived: �yy,
—__._
Signed:_ * ,�--- �� �
Name; _in��� '
Cc�mpany:.d�-G�I���TRs�T19N �. �. _.
Address:
12_1 N BALLARD AVE WYLIE TEXAS 75098
-� -�____.__
Emait: VERIZON.NET
Date: 1-10-11
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Phone: 972 442 1904
Fax: -�
_.�72 442 3884
CITY �F DENTON
INSURANCE REQUIREMENTS FOR CONTRACTORS
Bidder's attention is clirectecl to tlie insut�c�nce requirements below. It zs Iziglzdy recommended
tlaat bidders confer witlz tJzeir respective i�ZSUrance ccrrriers or brokers to deter�zine in arlva�zce
of Bid submission the availcrbility of i�sut•ance certificates ancl endorseme�zts �cs p�escribed
and provided herein. If an apparent low bidder fails to comply strictly with tlze insurmzce
re�,�uirenzeizts, thc�t bicicler may be rlisquc�lif erl from awartl of tlie corztrc�ct. Upo�z bid award, all
insurarzce requirerazents sliccll become contractual obligations, wlziclz ttae successficl bidder
shall have a rluty to maintain tlzrouglaout tlie course of tlzis contract.
STANDARD PROVISIONS:
Without Zinziting any of the other obligations or liabilities of the ContNacto�, the Contractor shall
provide and maintain until the conh acted work has been completed and accepted by the City of
Denton, Ownei°, the nzininzu�n insu�ance coverage as indicated hereinafte�.
As soon as practicable after notification of bid award, ContYactoY shall file with the Purchasing
Department satisfactory ce�tificates of insurance, containing the bid number and title of the
project. Cont�actoY naay, upon written reqzaest to the Purchasing Depa�°ttnent, ask for
claNification of any insurance requiNements at any time; however, Cont� actors are stNOngly
advised to make such requests prior to bid opening, since the insu�ance requi�ements n�ay not be
modified or waived after bid opening unless a written exception has been submitted with the bid.
Contractor slzall not commence any wo�k or rleliver any n2aterial until 1ae or slae receives
notification tlzat tlze contract has been accepted, approved, ancl sig�2ed by tlie City of Dentorz.
All insu�ance policies p�oposed or obtained in satisfaction of these i�equi� ements shall co»zply
with the following general specifications, and shall be maintained in compliance with these
gene��al specifications th�°oughout the duration of the Contract, or Zonger, 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- VII or better.
• Any deductibles or self-insured retentions shall be declared in the bid proposal: If
requested by the City, the insurer shall reduce or eluninate such deductibles or
self-insured retentions with respect to the City, its officials, agents, employees and
volunteers; or, the contractor shall procure a bond guaranteeing payment of losses and
related investigations, claim administration and defense expenses.
• Liability policies shall be endorsed to provide the following:
• Name as additional insured the City of Denton, its Officials, Agents,
Employees and volunteers.
CI-9
• 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.
� Ca�zcellation: Tlae Crty requires 30 day written notice should any of tlie
policies clescribed on t12e certificate be ca�zcelted or materially cliccngecl
before tlie expiration date.
• 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 yeaxs 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, ternunate this agreement effective on the date of the lapse.
CI - 10
SPECIFIC ADDITIONAL INSURANCE REQUIREMENTS:
All inscar�nce polzcres proposed or obt�isiecl in satisfc�ction of tlxis Contract slzall �dditionally
comply with tlae following marked specificatio�zs, a�zcl slaall be mc�intc�ined in compliance with
tlaese additional specifications tlzrouglzout tlze daiyation of tlae CoYZtract, or longer, if so �iotec�:
[X] A. General Liability Insurance:
General Liability insurance with combined single limits of not less than $1,000,000.00
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 aild
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 coinpleted
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 sha11 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 (XCL� 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 $500,040.00 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 end�rsement for:
any auto, or
all owned, hired and non-owned autos.
CI - 11
[X] Workers' Compensation Insurance
Contractor shall purchase and maintain Worlcer's Compensation insurance which, in addition
to rneeting 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 worlc
performed for the City by the Named Insured. For building or construction proj ects, 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 Worlcer'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
worlc 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 worlc 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
cai-ries the Contractor's liability insurance. Policy limits will be at least combined bodily
injury and property damage per occurrence with a aggregate.
[ ] 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' Rislc Insurance, on an All-Risk form for 100% of the completed value shall be
provided. Such policy sha11 include as "Named Insured" the City of Denton and all
subcontractors as their interests may appear.
CI - 12
[ ] Commercial Crime
Provides coverage for the theft or disappearance of cash or checics, robbery inside/outside
the premises, burglary of the premises, and employee fidelity. The employee fidelity
portion of this coverage should be written on a"blanlcet" basis to cover all employees,
including new hires. This type insurance should be required if the contractor has access to
City funds. Limits of not less than each occurrence are required.
[ ] Additional Insurance
Other insurance may be required on an individual basis for e�tra 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.
CI - 13
ATTACHMENT 1
[X] Workers' 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 worlcers' compensatioii
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 worlc 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 pai-t of the services the contractor has undei-talcen to
perform on the proj ect, 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 coinpanies, motor carriers,
owner-operators, employees of any such entity, o� 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.
C. The Contractor must provide a certificate of coverage to the goveinmental entity prior to
being awarded the contract.
D. If the coverage period shown on the cont�actor'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:
CI - 14
1) a certificate of coverage, prior to that person beginning worlc 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
proj ect and for one year thereafter.
G. The contractor shall notify the governmental entity in writing by certified inail or
personal delivery, within 10 days after the contractor lcnew or should have lcnown, of
any change that materially affects ihe 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, foi7n and manner
prescribed by the Texas Worlcers' Compensation Commission, informing all persons
providing services on the project that they axe required to be covered, and stating how a
person may verify coverage and report lack of coverage.
I. The contractor shall contractually require each person with whom it contracts to provide
services on a proj ect, 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 worlc 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) certificate of coverage, prior to the other person beginnulg 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;
CI - 15
5) retain all required certificates of coverage on file for the duxation 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 lcnown, of any change that
materially affects the provision of coverage of any person providing seivices on the
project; and
7) contractually require each person with whom it contracts, io 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 seivices on the project will be covered by worlcers'
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 governrnental entity.
.
CI - 16
CONFLICT OF INTEREST QUESTIONNAIRE FORM CIQ
For vendor or other person doin business with local overnmental entit
This questionnaire reflects changes made to the law by H.B. 1491, 80th Leg., Regular Session. OFFICE U5E ONLY
This questionnaire is being filed in accordance with chapter 176 of the Local Government Code by a Date Received
person doing business with the governmental entity.
By law this questionnaire must be filed with the records administrator of the local government not
later than the 7th business day after the date the person becomes aware of facts that require the
statement to be filed. See Section 176.006, Local Government Code.
A person commits an offense if the person violates Section 176,�06, Local Government Code. An
offense under this section is a Class C misdemeanor.
1 Name of person who has a business relationship with local governmental entity.
2
� Check this box if you are filing an update to a previously filed questionnaire.
(The law requires that you file an updated completed questionnaire with the appropriate filing authority not later than the 7th business
day after the date the originally filed questionnaire becomes incomplete or inaccurate.)
3
Name of local government officer with whom filer has an employment or business relationship.
Name of Officer
This section, (item 3 including subparts A, B, C& D), must be completed for each officer with whom the filer has an employment or other business
relationship as defined by Section 176.001(1-a), Local Government Code. Attach additional pages to this Form CIQ as necessary.
A. Is the local government officer named in this section receiving or likely to receive taxable income, other than investment income, from the
filer of the questionnaire?
� Yes 0 No
B. Is the filer of the questionnaire receiving or likely to receive taxable income, other than investment income, from or at the direction of the
local government o�cer named in this section AND the taxable income is not received from the local governmental entity?
0 Yes 0 No
C. Is the filer of this questionnaire employed by a corporation or other business entity with respect to which the local government officer
serves as an officer or director, or holds an ownership of 10 percent or more?
0 Yes 0 No
D. Describe each affiliation or business relationship.
4
Signature of person doing business with the governmental entity Date
Adopted 06/29/2007
CIQ - 1
,.r�� pP ID: DB
��'���" DATE (MMIDDIYYYY)
�,�.f- CERTIFI�ATE OF LIABILITY INSURANCE 02/17/12
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to
the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the
certificate holder In lieu of such endorsement(s).
PRODUCER 504-834-5080
Cory, Tucker 8� Larrowe, Inc. 504-835-7�
P. O. Box 6646
Metairie, LA 70009-6646
Clint Romig
INSURED �ay Davis Company, Inc. DBA
JDC Construction Company� �� �
P. O. Box 1201 �
Wylie, TX 75098 ����%
ry �1
JDCDA-1
INSURER�S) AFFORDING
�r,su�R n : Travelers Lloyds
�r,suReRe:Travelers IndemnityC�
�r,sur�RC:Travelers Ind. Co. of A
�NSU�RO:Travelers Ind Co - Con
INSURER E :
ut 117910
COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY 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.
INSR 7ypE OF INSU NCE AD�L SUBR pOLICY NUMBER MMIDDY/YYYY MMIDDY� LIMITS
LTR
GENERAL LIABILITY E H OCCURRENCE $ 'I ,OOO,OO
AMAGET R
/4 X COMMERCIAL GENERAL LIABILITY / X 06A218714 08l19l11 08/19/12 PREMISES Ea occurrence $ 300,000
CLAIMS-MADE � OCCUR' MED EXP (Any one person) $ 5,00
PERSONAL&ADVINJURY $ 'I,OOO,OO
GENERALAGGREGATE $ Y,OOO�OO
GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 2,000,000
POLICY PRO- LOC $
AUTOMOBILE LIABILITY X X C MBINED SINGLE LIMIT
/ aaccident) $ �,���,���
B X ANYAUTO ✓ BA6203R772 � 08119/11 08l19/12
BO�ILY INJURY (Per person) $
ALLOWNEDAUTOS BO�ILYINJURY(Peraccident) $
SCHEDULEDAUTOS
PROPERTY DAMAGE $
HIRED AUTOS (Per accident)
NON-OWNED AUTOS $
$
X UMBRELLA LIAB OCCUR EACH OCCURRENCE $ S,OOO�OOO
EXCESSLIAB CLAIMS-MADE � AGGREGATE $ S,OOO�OOO�
D X CUP5721B54A 08/19/11 08/19/12
DEDUCTIBLE $
RETENTION $ $
WORKERS COMPENSATION WC STA - OTH-
AND EMPLOYERS' LIABILITY TOR
C ANYPROPRIETORIPARTNER/EXECUTIVE YIN 1�6212R85A � 08l19111 08/19/12 E.L.EACHACCIDENT $ �,�0���00 �
OFFICERlMEMBER EXCLUDED7 � N 1 A X
(MandatoryinNHy E.L.DISEASE-EAEMPLOYEE $ �,���,�DO ✓
If yes, describe under
DESCRIPTIONOFOPERATIONSbelow E.L.DISEASE-POLICYLIMIT $ 'I,OOO,OOO
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Re�arrcs Schedule, if more space Is required)
RE: Bid #4885 Quakertown Park Sidewalk - Trail Improvements/
DENT002
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
City of Denton, its Officials,
ACCORDANCE WITH THE POLICY PROVISIONS.
Agents, Employees and
Volunteers AUTHORIZED REPRESENTATIVE
901 B Texas Street % ,,� r �.
Denton, TX 76209 4'�y��� •',� r1�le.'��
O 1988-2009 ACORD CORPORATION. All rights reserved.
ACORD 25 (2009/09) The ACORD name and logo are regfstered marks of ACORD
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COMMERCIAL GENERAL LIA8ILITY
THIS EEVDORS�MEf�T CHANGES THE POLICY. PL,�AS� I��AD IT CAREFULLY
BLAIVKET ADdl7'14NAL lNSURED
(CONTRACTORS}
This endorsement modifies insurance provided underthe following:
GOIUIMERCIAL GENERAL LIABILITY COVERAGE PART
1, WHO IS AN INSURED —(Section II) is amended
#o include any person or organization that you
agree in a"written contracE requiring insurance"
to include as an additional insured on ihis Cover-
age Part, but:
a)
b)
Only wiih raspect to liabllity for "bodiiy injury",
"property damage" or "personal injury"; and
If, and oniy to tha extent that, the injury or
damage is caused by acts or omissians of
you or your subcontractor in the performance
of "your work" to which the "written contract
requiring insurance" applies, Tfie person or
organization does not qualify as an additlorlal
insured with respecl to the fndependent aCts
or omissians of such person or organfzation.
2. Tha insurance provided to lhe additional insured
by th(s endorsemer�t is Ilmited as foElaws:
a) In the eveni that the i.imits of Insurance of
ihis Coverage Part shown in #he Daclarations
exceed the limits of liability required by the
"written contract requiring insurance", fhe in-
surance provided to the additional insured
shall 6e limfted ta the Iimits of liabllity re-
quired by that "written contract requiring in-
surance". 7his endorsement shall not in-
crease the limits of insurance described in
Section Ilf — Limits Of Insurance.
b) The insurance provided to the additional in-
sured does not apply to "bodily inj�ry", "prop-
erty damage" or "personal Enjury" ansing out
of the rendering of, or iaflure to render, any
professionaf archiiectural, engineering or sur-
veying services, including;
i.
il.
The preparing, approving, or failing to
prepare or approve, maps, shop draw-
ings, opinions, reports, surveys, field or-
ders or change orders, or the preparing,
approving, or failing to prepare or ap-
prove, dr�wings and specificeUons; and
Supervisory, inspection, archiiectural or
engineering activities.
c) 7he insurance provided to the additionaf in-
sured doss not appiy fo "bodily injury" or
"property damage" caused by "your work"
and included in the "products-cornpleted op-
erations hazard" unlsss the "written conlract
requiring insurance" speciflcally requires you
fo provide such coverage for that additlonal
insured, and then the insurance provfded to
the additionai insured applies only to such
"badily injury" or "prope►iy damage" that oc-
curs before the end of the period of time for
which ihe "wrilten contract requiring insur-
ance" requires you to provide such coverage
or the end of the policy period, whichever is
earlier.
3. The insut'arice providad to the additional insured
by this endorsement is excess over any �alid and
coliectible "other insurancs", whether primary,
excess, contingent or on any other basis, thai is
availabls to the additional insured for a Ioss we
cover under this endorsement. Nowever, if the
"wriften contract requiring Insurance" specifically
requtres that this insurance apply on a primary
basis or a primary and non-contributory basis,
this insurance is primary to "other insurance"
availabie to the additlona! insured which covers
lhat person or organizatfoR as a named insured
for such ioss, and we will not share with ihat
"other insurance". But the insurance provided to
the additional insured by this endorsement still is
excess over any ua�id and collectible "other in-
surance", whether pr{mary, excess, contingent or
on any other basis, that is avaifable to the addi-
tional insured when that person or organization fs
an additional insured under such "other insur
ance".
4. As a condltion of coverage provided to ihe
additlonal insured by thls endorsemant:
a) The additional insured must give us written
notice as soon as praciicable of an "occur-
rence" or an offense which rnay result In a
cl�im. To the extent possible, such notice
should include:
Cf3 D2 46 08 a5 � 2p05 The St, Paul Travelers Companie5, Ir1c. Page 1 of 2
oo�aoe
COMMERCIAL GEN�RAL LIABILITY
i. How, when and where the "occurrence"
or offense took place;
ii. The names and addresses of any injured
persons and witnesses; and
ifi. The nature and location of any Injury or
damaga arlsing out of the "ocCUrrence" or
offense.
bj If a claim is made ar "sulY' is broughi against
the addit€anal insured, ihe additlonal insured
must;
i. Immediately record the specifics of the
claim or "suit" and the date received; and
G�
d)
ii. fVotify us as soon as practicable.
The additional insured must see to it tha# we
recelve writ#en notice of the cfaim or "suit" as
soon as practicable.
The additional insured must fmmediately
send us copies of afl legal papers receEved in
connection wilh the claim or "suit", cooperate
wfth us in the investigatlon or setllement of
the ctaim or defense against the "suit", and
oihenrvise comply with all policy conditians.
The addltlonal insured must tender the de-
fens� ar�d Indemnity of any cfaim or "suit" to
any provider of "other insucance" which would
cover th8 additional insured For a loss we
aaver under this endorsement, Nowever, this
condition does not affect whether the insur-
ance provided to the additional ins�red by
ihis endorsement is prlmary to "ofher insur-
ance" avaikable to the additional insur0d
wt�ich covers lhai person ar organization as a
named insured as described in paragraph 3.
above.
5. ihe fo{lowing definitlon is added io SEC7{ON V.
� DEFINITIONS:
"Written contract requiring insurance" means
that part of any written contract or agreement
under which you are required to inctude a
person or organization as an additionaf in-
sured on this Coverage Parl, provided that
the "bodily injury" and "property damage" oc-
curs and the "pe�sOnal injury" is caused by an
offense comm(ttad:
a. After the signing and execution of the
contract or agreement by you;
b. While that part of the contract or
agreement is in effect; anc!
c. gefore the end of the policy periocl.
Page 2 of 2 � 2005 The Sk. Raul Travelers Companies, Inc. CG D2 46 O8 OS
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0011D8
COMMERCIAL G�NERAL LIABILI�'Y
THIS �NDORSEMENT CHANGES THE POLICY. PLEASE READ �T CAREFULLY,
C�NTRACT�RS XTEND ENDORSEMENT
This endorsement modi�es insurance p�ovided under ihe foltowing:
COMMERCIAL G�NERAL LIABILITY COVERAG� PART
GENERAL D�SGFtIPTION OF COVERAGE – Provlsions A: H. and J.-N. of this endorsement broaden coverage,
and provision I. of thls endorsement may fimit caverage. The following listing is a general coverage description
only. Limitations and exclusions may apply to these coverages. Read all the PROVI51oN5 of this endorsement
carefully to determine �ights, duties, and what is and is nol covered.
A. �roadened Named Insured
B. Extension of Coverage – Damage To Premises
Rented To You
• Perils of fire, explosion, lightning, smoke, water
• Limit increased ta $300,OOD
C. Blanket Waiver oF Subrogation
D. Blanket Additional Insured -- Managers or Lessors
of Premises
E, Incidental Medical Malpractice
F. Extension of Coverage– Bodily fnjury
G. Contractual Liabiliiy–Railroads
PROVlSIONS
A. BR�ADENED NAMED INSURED
1. The Narned Insured in Item 1. of the Declara-
tions is as follows:
The pe�son or organization named in Item 1.
of the Declara#ions anci any organization,
other than a partnership, joint venture o"r lirn-
iled liebility company, of which you maintain
ownership or in whlch you maintain the major-
ity interest on the effective date of the policy,
However, coverage for any such additional
organization will cease as of the date, if any,
during the policy period, lhat you no longer
maintain ownership of, or the majority interesl
in, sucn organization.
2. WhiO 15 AN INSURED (Section tE) Item 4.a.
is deleted and replaced by the following;
a. Coverage under this pravision is afforded
only until th� 980th day after you acquire
pr form the organization or the snd of the
policy period, whichever is earlier.
H. Additlonal Insured – State or Politiaal Subdlvisions
I. Other insurance Condition
J. Increased Supplementary Payments
• Cost of bail bands increased to $2,500
• Loss of earnings increased to $500 per day
K. Knowledge and Notice of Occurrence or Offense
L. Unintentionak Omissfon
M. Personal Injury – Assumed by Contract
N. Blanket Additional Insured –Lessor of Leased
Equipment
3. 7his Provislon A. does not apply to any per
son ot oCganization for which coverage is ex-
cluded by endorsement.
R. EXTENSIDiV OF COV�RAGE – DAMAGE TO
PREMlSES REN�'�I� TO YOU
9. The last paragraph of COVERAGE A. BOD-
ILY INJURY AND PROP�RTY DAMAGE Lf-
A61�17Y (Sectian I– Coverages) is deleted
and replaced by the following:
Exclusiorts c. through n. do nol apply to dam-
age to premises while rented lo you, or tern-
porarlly occupied by yau with permission of
the owner, caused by:
a. Fire;
b. Explosio�;
c. Lightning;
d. Smolce r�sulting from such fire, explosion,
or lightning; or
e, Water.
A separale kimlt of insurance applies to this
coverage as described in Seatian fll Limits 4f
Insuranee.
Cc3 D316 07 04 Copyrlght, The 7raveiers Indemnity Company, 2004
Page 1 of 6
COMMEFtCIAL GENERAL LIABILITY
2. This insurance does not apply to damage lo
premises whlie rented ta you, or temporarily
occupied by you with permission of the
owner, caused by:
a. Rupture, bursti�g, or operation of pres-
sure relief devices;
b. Rupture or bursting due to expansian or
swelling of the contents of any �uilding or
s�'ucture, eaused by or resulEing from wa-
ter;
c. Explosion of steam boilers, steam pipes,
steam engines, or sleam turbines.
3. Paragraph 8. of LkMITS OF INSURANCE
(Seckion III) is deleted and replaced by 1he
following:
Subject to 5. above, itte Damage To Prem-
ises Rented To Yau Limlt is the most we wi{I
pay under COVERAGE A. for the sum of all
damages becausa of "property damage" to
any one premises while rented to you, or
tempararily occupied by you wiih pemlisslon
of the owner, caused by; fire; expfoslon; iiqht-
ning; smoke resulting from such ftre, explo-
sion, or [igh#ning; or water. The Damage 70
Premises Rentad To You Limit will apply to all
"property damage" proximately aaused by the
seme "occurrence", whether such darnage
results from; fi�e; explosion; lightning; smoke
resulting from such fire, expfoslon, or light-
ning; or water; or any combination af any of
these causes.
The Damage To Premises Rented To You
Limit will be the higher oi:
a. $300,U0�; or
b. The amount shawn on the Declarations
for Damage Ta Premises Rented 'fo You
Limit,
4. Paragraph a. of ihe definition of "insured con-
tracY' (DEFiNI710N5 — Sectlon 1� is deleted
and replaced by the fallowing:
a. A contrect for a lease of premises. Mow-
ever, that parilon of the contract for a
lease of premises that indemnifies any
person or or�anizatlon for damage to
premises while rented io you, or iempo-
rariEy occupied by you with permission of
the awner, caused by: fire; explosion;
ligh#ning; smoke resulting from such fire,
explosion, or lightning; or water, is not an
"insured contract";
6. Thfs Provision 8. does not apply if coverage
for' Damage To Premises Rented To You of (
COVERAGE... A. BODILY IIVJtJRY AND
PROP�RTY �AMAGE �IABl�.ITY (Section I --
Coverages} is excluded by endorsement.
C. BLANKET WAIVER OF SUBROGAT[ON
We wafve any tight of recovery we may have
against any person or organfzation because of
payments we make for injury or damage arising
out of: premises owned or occupied �y or rented
or loaned to you; ongoing operations performed
by you or on your behalf, done under a Contracl
with that person or organization; "your work'; or
"your products", We waive this �ight where you
ha�e agreed ta do so as part of a written contract,
executed by you before the "bodily injury" or
"property damage" occurs or the "personal injury"
or "advertising injury" offense Is committed.
D. BLAN}CE7 ApDll'IONAL INSURED — MANAG-
ERS OR LE350iiS OF PREMISES
WHO IS AN INSUR�D (Sectlon II) is amended to
inctude as an fnsured any person or organizaiion
(referred to below as "additional insured"} with
whom you have agreed in a written confract, exe-
cuted before the "bpdily injury" or "property dam-
age" occurs or the "persanal injury" or "adveRis- (�
ing injury" offense (s committed, #o name as an
additional insured, but only with respect io liability
arising oui of the ownership, malntenance or use
ofthat part of any premises leased ta you, subject
to the fol(owing prnvisions:
1. Limits of Insurance. The limits of insurance
afforded to the additional insured shall be the
limits which you agreed to provide in the writ-
ten contract, or the limits shown on the Decla-
rations, whiohever are less.
E. The insurance afforded to the addltlonal In-
sured daes not apply to:
a. Any "bodtly injury" or "property damage"
that occurs, or "personal injury" or "adver-
tising inJury" caused by an offanse which
is cammltted, after you cease to be a tan-
anE 1n thal premises;
b. Any premises for which coverage is ex-
cluded by endorsement; or
c. Structural atterations, new construction or
demolition operations perFormed by or on
behalf of suoh addltional Insured.
3. The insuranoe afforded to the additional in- �
sured is excess over any valld and collectible
Page 2 of 6 Copyright, The Travelers Indernnity Company, 2D04 CG D316 O7 04
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"other insurance" available to such additlonal
insured, unless yau have agreed in iha writ-
ten contracl that this insurance must be pri-
mary lo, or non-contrlbutory with, such "other
insurance".
E. II�CIDENTAL MEDtCAL MALPRACTICE
1. The following is added to paragraph 1. Insur-
ing Agreement of COVERAGE A. – BODILY
INJtlRY AND PROPERTY pAMAGE LIABIL-
ITY {Seciion I -- Cavarages}:
"Bodily injury" arising out of the rendering oF,
or failure 10 render, the failowing will be
deemed to be caused by an "occurrence";
a. Medical, surgical, dental, laboratory, x-ray
or nursing servlce, advice or instruction,
or the refated furnishing of Food or bever-
ages;
b. The furnishing or dispensing af drugs or
medical, dental, or surgical supplies or
appliances;
c. Flrst aid; or
d. "Good Samaritan services." As used in
this Provision E., "Good Samaritan ser-
vices" ere ihose medical services � ren-
dered or provided in an emergency end
for which no remuneration is demanded
orreceived.
2. Pa�agraph 2.a.(1�(d) of WHO IS AN IN-
SURED (Section II) deBS not apply to any
registered nurse, Iicensed practical nurse,
emergency medical technician or paramedic
empfoyed by you, but only while perfarming
the services descr(bed in paragraph 7. above
and whlle acfing within the scope af their em-
ployment by you. Any "employess" rendering
"Good Samarilan services" wilE be deemed to
be acting within fhe scope of their emplpy-
ment by yau.
3, it�e following exclusion is added to paragraph
2. Exclusions of COVERAGE A. – BODILY
INJURY AND PROPERTY DAMAGE LIABIL-
17Y (Section I – Coverages);
(This insurar�ce does not apply to:} "BOdify in-
jury" or "property damage" arising out of the
w�llful violation of a penal slatule or ordlnance
relating to the sale of pharmaceu#Icals com-
mikted by or with the knowledge or consent of
the Insured.
4, For the purp�ses of detercnining the applica-
ble limits of insurance, any act or omisslon
COMMEE2CIAL G�NERAL LIABILITY
tagether with all related acts or omissions in
the furnishing of the sesvices described in
paragraph 1. above to any ona person will be
deemed one "occu�renae",
5. This Provfsion E. does nof apply if you are in
the business or occupation of providing any of
the seivices descrihed in pafagraph 1. aboVe.
6. 7he insurance provided by this Provision E.
shall be excess over any vafid and coflectible
"other insurance" available to the Insured,
whether primary, excess, contingent or on
any other basis, excspt for €nsurance thai you
bought specificalfy to apply in excess of the
Llmits of Insurance shown on the Declara-
tions di this Coverage Part.
F. EXTENSION OF COVERAOE – BQD{L.Y IN-
JURY
The definition of "bodiiy injury" (DEFINITIONS –
Section V} is deleted and replaced by the follow-
ing;
"Bodily injury" means bodily injury, mental an-
guish, mental injury, sfaock, fright, disability, hu-
miliation, sickness or disease sustained by a per-
son, includfne death resulting from any of these at
any time.
G. CON7FiACTUALLIABILITY–RAILROADS
1. Paragraph c. of the definifion of "insured con-
tract" (DEFINITIONS – Section V) is deleted
and replaced by the following:
c. Any easement or license agreement;
2. Paragraph f.(1j of the deflnitlon of "Insured
contract" {DEFINITIONS – Sectlon V) is da-
leted.
H. ADDITIONAL INSUREQ – 57�17'E OR POLITI-
CI�1L SUBDIVISIONS – PERMirs
WHO IS AN INSURED (Secfion II) is amended #o
include as an insured any staie or political subdi-
vision, subject io the following provisions;
1. This insurance appiies only when required to
be provided by you by an ordinance, law or
building code and only with respecf to opera-
tions performed by you or on your behalf for
whlch the slate or political subdlvlsion has is-
sued a permit.
2, Th(s inSUrance does not apply to:
a. "Bodily injury," "property damage," "per-
sonal InJury" or "advertising injury" arising
out of operatians perfor�ed for the state
or polikical subdivision; or
CG DS 16 O7 04 Copyright, The Travelers Indemnity Gompany, 2004
Page 3 of 6
COMMERCIAL GENERAL LiA81L.ITY
b. "Bodlly injury" or "property darr�a�e" in-
cluded ln the "pmducts-completed opera-
tions hazard".
I. OTHER INSURANC� CONDITION
A. COMMERCIAL GENERAL LIABILITY CON-
DITIONS (Section IV), paragraph 4. (Oiher
Insurance} is defeted and replaced by the fol-
lowing:
4. Other Insurance
page 4 of 6
If valid and collectible "other insurance" is
available to the insured for a loss we
cover under Coverages A or B of this
Coverage Part, our obligations a�e limited
as follows:
a. Ptimary Insurance
This insurance is primary except
when b, below applles. If this insur-
ance is primary, our obligations are
not atfected unless any of the "other
insurance" is also primary. Then, we
will share with al[ that "other insu�
ance" by the method described In c.
below,
b. Excess tnsuranee
This insurance is excess over any of
#he "other insurance", whether p�i-
mary, excess, carttingent or on any
other basls:
(1) That is Fire, Exlended Coverage,
Buildor's Risk, Installatfon Risk,
or simifar coverage for "your
work"•
(2) Thst is Fire insurance for prem-
ises renled to you or temporarily
ocoupied by you with permission
of the owner;
(3) That is insut'ance purchased by
you to cover your liabiliiy as a
tanant for "property damage" to
premises renied to you or tempo-
rarily occupied by you wlih per-
mission of tha owner; or
(4} If ihe loss arises out of the main-
tenance or ase af aircraft,
"autos", or watercraft to the ex-
tent not sub)ecl ta �xclusion g. of
Section I— Coverage A— Bodily
Injury And Property Damage Li-
ability; or
insured under any other policy,
including any umbreila or excess (
policy.
When this insurance is excess, we
will have no duty under Coverages A
or B to defend ihe insured against
any °suit" if any provider of "other in-
suranCe" has a duty to defend the fn-
sured against that "suit". If no pro-
vider of "ott�er insurance" defends,
we will u�denake to do so, but wa will
be en#itled to the insured's rights
against all those providers of "other
insurance".
When th(s insurance is excess over
"oFher insurance", we will pay only
our share of the amaunt of the loss, if
any, that exceeds the sum of:
{1} 7he tota) amount that all such
"other insurance" would pay for
the loss in the absence of this in-
surance;and
(2) The totaf of ell deductiqle and
salf-insured amou�ts under that
"other insurance".
We wil! sitare the remaining loss, 14
any, with any "other insurance" thak is {.
nof described in this Excess Insur
anee provision.
c. Method Of Sharir�g
1f all of the "other fnsurance" permits
contribution by equal shares, we wiil
follow fhis methnd also. Under this
approach each pravider of insurance
coniributes equal amounts until it has
paid its appEicable limif of insurance
or none of the loss remalns, which-
ever comes first.
If any of the "other Insurance" does
not permEt coniribution by equai
shares, we will cantribute by limits,
Under this method, the share of each
provider of i�tsurance is based on the
ratio of its applicable limit of insur-
ance to the total appiicable limits of
insurance of all providers of Insur-
ance,
B. ihe following defin{tion is added to DEFINITfONS
(Section V):
��othsr insurance":
(8j That is available to the inSUred a. Means Insurance, or the funding of losses,
when the insured is an additlonal that is provided by, through or on behaEf oF.
Gopyright, The Travelers lndemnity Company, 2004 CG D318 07 04
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(1) Another insurance company;
(2) Us or any of our affiliated insurance Com-
panies, except when the Non aumulatlon
of Each �ccurt'ence Limit section of
Paragraph 5 of LIMITS OF INSURAMCE
(Section III) or the Non cumulation of Per-
sonal and Adveriising Injury limit sections
of Paragraph 4 of LIMiTS OF INSUR-
ANCE (Section III) applies;
�3) Any rlsk retention group;
{q) Any self-insura�ce method or program,
otherthan any funded by you and over
which ihis Coverage Part applies; or
(S) Any similar risk transfer or risk manage-
meni method.
b. �oes not include umbrella insurance, or ex-
eess insurance, that you bought specifica�ly to
apply fn exoess of the Limits of lnsurance
shawn on the Declaratlons o# this Coverage
Part.
J. lNCREASED SUPPLEMENTARY PAYMENTS
Pa�agraphs 1.b. and 1.d, of SUppLEMENTARY
PAYMENTS – CoVERAGES A AND g(Sedion I
– Coverages) are amended as follows:
1. In paragraph 't.b., the amount we will pay for
the cosi of bai) bands ls Increased to $2500.
Z. In paragraph 1.d., the amount we wlfl pay for
loss of earnings is increased to $500 a day.
K. KNOWLE�GE AND NOTICE OF OCCLiR�
R�NCE OR OFFENSE
�I. The following is added to COMMERCIAL
G�NERAL LIABILITY CONDITIONS (Section
IV}, paragraph 2. (Duties In The Event of Oc-
currence, Offense, Claim or Suit);
Notice of an 'bccurreoce" or of an offense
whlch may result in a claim musi be given as
soon as practicable afier knowledge of the
"occurrence" or offense has been reported to
you, one of your "executive offlcers" (if you
ara a corporatinn), one of your partners who
is an indlvidual (if you are a partnershlp), one
of your managers (if you are a limited fiabifity
company), or an "employee" (suah as an in-
surance, loss control ar risk manager or ad-
ministrator} designated by you to give such
notice.
Knowledge by any other "employee" of an
"occurrence" or offense doss not Imply #hat
yau also have such knowledge.
CaMM�RCIAL GENERAL LIABItITY
2. Natice of an "occurrence" or of an offense
which may result in a claim wlll be deemed to
be given as soon as practicable to us if It Is
given in good faith as soon as praclicable to
your workers' compensa#lon insurer. This ap-
plies anly if you subsequently give notice of
fhe "oceurrence" or offense lo us as saan as
practicabie after y4u, qne vf your "executive
o�cers" (if you are a corporation}, one of your
pariners wno is an individual (if you are a
parfnership), one of your managers (if you are
a limited liability company), or an "employee"
(such as an insurance, loss control or risk
manager or administrator} designated by you
to glve such notice discovers that the "occur-
rence" or affense may involve this policy.
3. This Provision K. does not apply. as respecis
fhe speciflc number of days within which you
are required ta notify us in wrlting of the
abrupl commencement of a discharge, re-
lease or escape of "pollutants" lhat causes
"bodily injury" �r "properiy damage" which
may otherwlse be covered under Ehis paliay.
L. UNINT�N710NA1, OMISSfON
7he following is added to COMMERClAL GEN-
ERAL LIABILITY CONDITIONS (Sectian IN),
paragraph B. (Representaifans):
The unintentional omission of, or uninlentlonal
error in, any inforrnatfon provided by yau which
we reUed upon in issuing this policy shall not
pt�ejUdice your rights under this insurance. How-
ever, this Provision L. does not affect our right ta
collect additional premium or to exercise our right
of cancellation or nonrenewal in accordance with
applicable state insurance laws, codes or regula-
tions.
M. PERSONAL (NJURY – ASSUMED BY CON-
TRACT
1. The following is added io Exclusion e. {1) of
Paragraph 2., Excfusians of Caverage e.
Persanai Injury, Advertising InJury, and
Web Site Injury Liability of the Web XT�Nn
Liability endorsement:
Solely for the purposes of liabilily assumed in
an "insured contract", reasonable attomey
Fees and necessary litigation expenses in-
curred by or for a party other than an insured
are deemed to be damages because af "per-
sonal injury" provided;
(a} Liabilfly to such party ior, ar for the cast
of, thet party's defense has also been as-
CG D316 07 04 Capyright, The Travelers lndemnity Company, 2004 Page 5 of 8
ao„oe
COMMERCIAL GE�V�RAL LIABILITY
sumed in the same "insured contract";
and
�b) Such attorney fees and litigation ex-
penses are for defense of that party
against a civil or aiternative dfsputa reso-
lution procesdEng fn whlch damages to
whlch this insurance applies are alleged.
2. Paragraph 2.d. of SLIPPL�MENTARY PAY-
MENYS - COVERAGES A AND B(5ection f
- Coverages) is deleted and replaced by the
following:
d. The allegations in the "suit" and the in-
formation we know about the "occur-
rence" or offense are such #hat no canilict
appears to exist beiween the interests of
the insured and the interesis of the in-
demnitee;
3. The third sentenCe af Paragraph 2 of SUP-
PLEM�N7ARY PAYMENTS - COVERAGES
A AND B(Section I-� Coverages) is deleted
and replaced by ihe following:
Notwithstanding the provisions of Paragraph
2.b.(2) af Sectior� I- Coverage A- Bodily In-
jury And Property Qamage Liability, or the
provisions of Paragraph 2.e.(7) of 5ection I-
Co�erage B- Persanal Injury, Advartising In-
jury And Web Site Injury Liabif[ty, such pay-
ments will not be deemed to be damages for
"bodily inJury" and "property damage", or
damages for "personal injury", and will not re-
duce the iimits of insurance.
4. This provision M. does noi apply if coverage
for "persanal injury" liability is excluded by
endorsement.
N. 6LANKET AD�iTtONAL INSURED -- LES50R
O� LEASED EQUIPMEN� �
WHO IS AN INSURED (Section iq is amendsd to
include as an insu�ed any person ar organizatlon
(referred to below as "additional insured") with
whom you have agreed in a written contract, exe-
cuted before the "bodify injury" or "property dam-
age" occurs or the "personal injury" or "advertis-
Ing injury offense is committed, to name as an
��
additional insured, but nnly with respect io iheir li-
ability for "badily injury", "property damage", "per-
sonal inJury" or "advertising injury" caused, in
whole ot in part, by your acts or omissions in the
malntenance, operatian or use of equipment
leased to you by such addilional insured, subject
ta the Following provislons:
1. Limits of Insurance, The limlts of insurance
afforcled ta the ac3ditionel insured shall be the
limits which you agreed ta pro�fde in the wrlt-
ten contract, orthe limits shown on the DeCla-
raUons, whichever are less.
Z. i'he insurance afForded to the additional in-
sured does not apply to any "bodify injury" or
"property damage" that oocurs, or "personal
in]ury" or "advertising injury" causad by an of-
fense which is committed, after the equipment
lease expires.
3. The insurance afforded to the additional in-
sured is excess over any valid and collectible
"other insuranca" available to such additional
insured, unless you have agreed in the writ-
ten contract that this insurance must be pri-
mary to, or non-aontHhutory with, such "other
insurance".
Page 8 of 6 Capyrighf, The Travelers Indemnity Company, 2004 CG D3 16 07 44
THIS EN�ORSEM�NT CHANGES THE POLICY. PLEASE READ IT CAREFULlY.
TEXAS GHANGES - CANCELLATtON AND
NONRENEWAL PR(�VISIONS FOR CASUALTY LINES
AND COMM�RCIAL PACKAGE P�LICIES
This endorsement modifies insurance provided under the following:
COMMERCIAL GENE#�AL LIABILITY COVERAGE t'AIZT
COMMERCIAL LfA81l.ITY UMBREI.LA COVERAGE PART
EMPLOYMENT-RELA7�b I'fiACTICES LlABtLITY
FARM C�VERAGE PART—FARM LlABILITY COVERAGE FORM
LIQUOR LIABILITY C�VERAGE PAR7
pOLI�UT�ON LIABIi.ITY COVERAGE PART
PRC1DlJCTS/�OMPL,�TED OPERAT[OIVS LIABIl,17Y COVERAGE PART
This endorsemeni also modifles insurance provided under the following when wrltten as part af a Commercial
Package Policy;
CAPITAL ASSETS PRQGRAM (OUTPUT POLtCYj COVERAGE PART
CaMMERCIAL GENEi3AL LIABIUTY COVERAGE PAR7
COMMERCIAL INLAND MAFiIN� COVERAGE PART
COMMERCIAL LIABILI7Y UMBRELLA COVERAGE PART
CaMMERCIAL PROPERTY COVERAGE PAftT
CREME AND FIDELITY COV�RAGE PART
�MPLOYMENT-RELATED PRAC7IC�S LIABILITY
E(�UIPMEN'C BREAKDOWN GOVERAGE PART
FARM COVERAGE PART — FARM LIABiUTY COVEf�AGE FORM
FARM COU�RAGE PART — LIVESTOCK COVERAGE FOFtM
FARM COVERAG� PART — MOBILE AGRIGULTURAL MACHINERY AND EQUIPMENT COV�RAGE
FQRM
GLASS COVERAGE FORM
LIQUOR LIABILITY COVERAGE PART
POLLUTION LIABILI7Y GOV�RAGE PART
PRODUCTSlCOMPLE7ED OPERATIQNS LtABILITY GOVERAGE PART
A. f'aragraph 2. of the Cartcellation Common Policy
Conditlon is replaced by the following:
2. We may cancel this policy by mailing or deliv-
ertng to the flrst iVamed Insured written nottce
of cancellation, statfng Ehe rea5on %r Cancel-
faiion, at least 10 days before the effective
date of cancellation,
H�wever lf this policy covers a condominfum
association, and the candominium property
contains at least one residence or the con-
dominium declarations conform witft the
Texas Uniform Candominium Act, then the
notice of cancellation, as described above,
will be provided to the �irst Named Insured
30 days hefore the e(fective date of cancella-
tion. We will also provide 30 days' written na-
tice to each unit-owner to whom we issued a
certifcate or memorandum of insurar�ce, by
maillr�g or delivering ihe notice to each las#
mailing address knawn to us.
The permissihle reasons for canceklation are
as follows:
a.
b.
If this policy has been in effect for 8U
days or less, we may cancel for any rea-
son except, that under the provisions oi
khe Texas Insurance Code, we may noi
canoel this policy solely because the poli-
cyholder is an elected official.
If this policy has been in effect for mo�e
than 60 days, or if it is a renewal or con-
tinuation of a policy issued by us, we may
cancel only for one or mare of the foltow-
fng reasons:
(1 y Fraud In obtaining coverage;
(2) Failure to pay premiums when due;
{L 02 75 d9 07 �(SO Properties, fnc., 2�06 Page 1 of 2
(3) An increase in hazard withln the con-
trok of Ehe Insured which would pro-
duce an increase in rate;
(4) Loss of aur reinsuranae coverfng all
or part of the risk covered by the pol-
icy; or
(5) If we have been plaCed in supervi-
sion, conservatorship or receivership
and the cancellation is approved or
directed by the supervisor, conserva-
tor or receiver.
B. The following condilion is added and supe�sedes
any provision ta the contrary:
NONRENEWAL
1. We may elect not to renew tnis policy axcept,
that under the provisions of the Texas Insur-
ance Code, we may not refuse to renew this
policy solely because the policyholder is an
elecled officiaE.
Z. This Paragraph, 2., appiies unless the policy
quali�es under Paragraph 3. below.
If we elect not to renew this poiicy, we may do
so by mailing �r delivering to the first Narrted
Insured, at the last mailing address known to
us, written notice of nonrenewal, stating the
reason for nonrenewal, at [east 60 days be-
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fore the expiration daie. If notice 1s mailed or
delivered less than 60 days before the expira�
tlon date, ihis policy will remain in effect until
the 61st day efter the date on which the no-
tice is mailed or delivered. Earned premium
for any perlod of coverage that extends be-
yond the expiration date will be computed pro
rata based on the prev[ous year's prernlum.
3, If this policy covers a condominium associa-
tian, and the condomin[um property contains
at least one residence or the condorr�inium
declara33ons conforEn with ihe Texas Uniform
Condominium Act, then we wlll rrzail or deliver
written notice of nonrenewal, at ieast 30 days
before the expiration or anniversary date of
the policy, to:
a. The first Named Insured; and
b. Each unit-owner to whom we Issued a
cerl3iicate or memorandum of Insurance.
We will mail or deliver such notice io each
last mailing address known to us,
a, ff notice is malled, proof of mailing will be suf-
floient proof of notice.
5. The transfer of a policyholder between admit-
#ed cnmpanies within the seme Insurance
group is not considered a refusal to renew.
Page 2 of 2 � ISQ Propenies, Inc., 2006 IL 02 75 09 �T
001T2d
COMMERClAL AUTO
THIS ENDCIRSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
AUTO COVERAG� PLUS ENDURSEMENT
This endorsemenl modifles insurance provided under the following:
BUSINESS AUTO COVERAGE FORM
Wlth respect to coverage provided by this endorse-
ment, the provisions of ihe Coverage Form apply
unfess modified by the endorsement.
A. P�RSONAL EPFECTS COVERAG�
SECTION III — PHYSICAL DAMAGE COVER-
AGE, A. Coverage, 4. Coverage Extensions is
amended by adding the following:
Personal Effects Coverage
We will pay up to $400 for "loss" to wearing ap-
parel and other personal effects which are:
(1) owned by an "insured'; and
(2j in or on your covered "auto';
in the event of a total theft "loss" of your covered
"auto".
No deductib(es apply to Personal Effects Cover-
age,
H. AUTO LOAN l�EASE GAP COVERAGE
SECTION III — PFiYSICAL DAMAGE COVER-
A(3E, A. Coverage, 4. Coverage Extensians Is
amended by adding the fallowing:
Auto Loan Lease Gap Coverage for Private
Passenger7ype Vehicles
In the event of a fotal "loss" to a covefed "suto" of
the private passenger type sh�wn in the Schedule
or Declarations for which Physica{ Damage Cov-
erage is provided, we wiil pay any unpaid amount
due on tha lease or loan for such covered "auto"
less the follouving:
(1) 7he amount paid underthe Physicai Damage
Caverage Section of the policy for tttat "auto";
and
(d) Costs for extended warranties, Credit Life
Insurance, Health, Accideni or Disability
Insurance purchased with the laan or
lease; and
(ey Carry-over halances from previous loans
or leases.
C, COV�FtAGE EXT�N310N — AUDIO, VISUAL
AAfD DATA ELECTRONIC �QUIPMEN7 [UaT
p�SIGNED SOLELY FOR THE PRODUCTION
OF SOUND
SEC710N III — PHYSICAI. DAMAGE COVER-
AGE, B. �xclusions, axception paragraph a. io
exclusions 4.c & 4.Q is deleted and replaced wikh
ihe Following:
a. �quipment and accessories used with such
equlpment, except tapes, records or discs,
provided such equipment is permanenily in-
stalled in the covered "auto" at ihe time of the
"loss" or is removable from a housing unii
which is permanently installed in the covered
"�ufo" at ihe time of the "loss", and such
equipment is designed to be solely operated
by use of the power from the "auto's" eEectri-
cal system, ir1 or upan the covered "auto"; or
D. WAIVER OF DEDUCTIBLE —GLASS
SECTtON III — PHYSICAL DAMAGE COVER-
AGE, Q. Deductibte is amended by adding the
foll9wing:
No deduclible for a ao�ered "auto" wiil apply to
glass damage if the glass fs repaired ralher than
replaced.
E. HiRED AUT� �HYSICAI. DAMAGE COVER-
AGE
(2j Any: SECTION III — PMYSICAL DAMAG� COVER-
(a) Overdue fease/loan paymenis at the time AGE, A. Caverage, 4. Coverage Extensions is
vf the "loss"; ame�ded by adding the following:
(b) Financial penalties irr►posed under a Hired Auta Physicai Damage Coverage Exten-
lease for excessive use, abnormal wear sion
and tear or high mileage: If hfred "autos" are covered "autos" for Liability
(c) Security deposits not returned by the les- Coverage and this pokicy also provides Physical �
sor; Damage Caverage for an owned "auto", then the
CA T4 20 07 06 Includes fhe copyrlehted material of Insurance Servicas Offlce, lnc, w{th ks permission. Page 1 of 2
Includes the copyrighted materlal oi The St. Paul Trave[ers CompaNes, Irsc.
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COMMERClAL AUTO
Physical Damage Coverage is extended ta
"autos" that you hire, rent or borrow subject to the
foilowing:
(1) The most we wll[ pay for "loss" fn any one
"accident" to a hired, rented or borrowed
"aulo" is the lesser of:
{a) $50,000;
(bj The actual cash vakue of ihe dam-
aged or stolen property 2s of the time
af the "loss' ; or
tc) 1'he cost of repaEring or repfacing ihe
dama�ed or stolen properly with
ofher property of like kind and quality,
(2) An adjustment for depreciafian and
physical condltion wfll be made in deter-
rnfning actual cash value in the eveni of a
total "loss".
(3j If a repafr or replacement resuits in better
than Iike kind or quali#y, we wUl not pay
for the amount of betterment.
{4) A deductible equai to the hlghest Physical
�amage deductible appl(cable to any
owned covered "auto".
(5) This Coverage �xtension does not apply
to:
�a) Any "auto" that is hired, rented or bor-
rowed with a driver; ar
(b) Any "auio" that is hired, rented or bor-
rowed from your "employee",
F. BLANKET WAIVER OF SUBROGAYION
S�CTION IV — BUSINESS AU70 CONDITiON3,
A. �oss Conditions, 8. Transfer Of Rights Of
Recovery Against oihers To Us is deleted and
replaced by the foilowing:
5. Transfer Of RigFlts Of Recovery Against
athers To Us
We waive any right of recovery we may have
against any psrson or organization to Ehe ex-
tent required of you by a written contract exe-
cuted prior to any "accidant" or "ioss", pro-
vided thaf the "accidenY' or "loss" arises out of
#he operations contemplated by such con-
tract. Th� waiver applies only to the person or
organization designated in such contract.
G. BLANKET ADDITIONAL INSURED
SECTION li — LIABILITY COVERAGE, part A. 1.
Who Is An Insured, paragraph c. is amended by
adding the following:
Any peCSOn or' organization lhat you are required
to include as an additional insured on this Cover-
age Form In a wrftten contract or agreement that
is signed and execuied by you before the "bodily
injury" or "property damage" occurs and ihat is in
effect during the pollcy period is an "insured" for
Liabillty Coverage, but on{y for damages lo whfch
this insurance applies and only to the extent fhat
person or arganization qualiffes as an "insured"
under the Who Is An Insured provision contained
in SecEion II.
H. EMPLOI�� HIR�C) AU74S
SECTION II — LkABILITY COVERAGE, A. Cov-
erage, 1. Who Is An insured fs amended by add-
ing the following:
An "employee" of yours is an "insured" whils op-
erating an "auto" �ired or rentad under a con#ract
or agreement in that "employee's" name, with
you� permission, whi{e performirtg duiies related
to the conduct of youe business.
I. COVERAGE EXTENSION — YRAIL�I2S
SEC710N I-- COVERED AUTOS, C. Certain
Trailers, MoOile Equipment attd Temparary
3ubsfttute Autos, paragraph 1. is deleted and
replaaed by the following:
"Trailers" with a Ioad capacity af 3,000
pounds or less designed primarily for travel
on public raads.
Page 2 of 2 Includes the oopyrighted materiai oF Insurance SeNices Office, Inc. with Its permission. CA T4 ZD �7 06
lnctudea the aopyrlghled material ol The St. Paul Travelars Companies, Inc,
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COMM�RCIAL AU70
THfS ENDORSEMENT CHANGES THE POI�ICY. PLEASE READ IT CAREFUI.LY.
TEXAS CHANGES - CANCELLATl4N
AND Nt'�NaENEWAL
This endorsement modifies insurance provided under the following:
HU$INESS AUTO COVERAGE FORM
BUSINESB AUTa PHYSICAL DAMAGE COVERAGE F�RM
GARAG� CUVE�tAGE FORM
MOTOR CARRiER COVEFtAG� FORM
TRUCKERS COVERAGE FORM
Wlih respect to coverage provided by this endorsement, the pro�lsions of the Coverage Form apply unless
modified by the endorsement,
A. Paragraphs �. and 6, of the Cancellation
Cotnmon Paiicy Conditlan are repEaced by the
following:
2. We may cancel lhis policy by mailing or de-
I(vering to the first Named Insured wt'itten no-
tice af cancellatia�, staking the reason for
aancellation, at ieast 10 days before the ef-
fective date oi cancellat{on,
ihe permissible reasons far cancellation are
as follows:
a,
b.
If this policy nas been in effect for 60
days or less, we may canael for any rea�
son except, thal under the provisions of
the Texas Insurance Code, we may not
cancel this policy solely beca�se the poU-
cyholder is an elected offialaJ,
if this policy has been in effect for more
Ehan 60 clayS, or if it is a renewal or con-
tinuatlon of a policy issued by us, we may
cancel only for one or more of the foilow-
ing reaso�s:
(1) Fraud in obtaining coverage;
(2) �allure to pay premiums when due;
{3) An increase in hazard within the con-
tro! of the insured which would pro-
duce an increase in rate;
(4) Loss af reinsurance covering all ar
paR of the risk covered by ihe poliay;
or
(5) If we have been pfaced in supervl-
skon, conservatarship or recaivership
and the cancellatfon is approved or
directed by the supervisor, conserva-
tor or receiver.
5. If this policy is oanceled, we wili send the frst
Named Insu�ed any premium refund due. The
refund wf11 be pro rata, subjeet to the policy
rrtinimum premfum. ihe cancellation will �e
effective even if we have not made or offered
a refund.
B. The foUowing Condition is added:
1. Nonrenewal
{a) We may elect to renew #his poflcy except
ihat under the provisions of the 'fexas In-
surance Code, we may not refuse to re-
new this policy soEefy because the palicy-
holder is an elected oFficial.
(b) If we elect not to renaw this policy, we
may do so by mailing or delivering to the
first Named Insured, at the last mailing
address known to us, written notice of
nonrenewal, stating the reason for nonre-
newal, at least 80 deys before the expira-
tion daie. If notice is mailed or delivered
less than 60 days before the expiration
date, fhis poEicy will remain in effect untif
the 81st day after the dale on which the
notice is mailed or de{ive�ed. Earned
• premium far any period of coverage that
extends beypnd the expiration date will
be computed pro reta based nn the pre-
vious yeaPs premium.
GA FO 57 03 01 Capyright 2004 The St Paul iravele�s Companies Inc, All rights reserved. Page 7 oi 1
oneaaa Encludes copyrightsd material of Insurance Senrices Office, Inc. with its permfssion.
TRAVELERSJ*
ONe TOWER SRUARE
HARTFORDi CT 06Y83
WORKERS CaMP�NsATIo1V
AND
EMPLOYERS LIABILITY POLiCY
ENDORSE�IENT WC 42 03 04 ( Aj — OOt
POLICY NUMBER: (4THUB-621 2R86-A-11 )
TEXAS WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS
ENDaRSEMENT
This endorsemeni applies only to the Insurence provided by the policy because Texas is sftown in Item 3.A. of the
Infarmatio� Page.
We have the right to recover aur paymeMs from anyone liable for an injury coVer.ed.by this pol(cy. We wiU not
enforce our clght against the person or orgar�ization named In the Schedule, but this waiver appltes anly with
respect to bodily injury arising out ofthe operations described in the Schedule where you are required by a wrilten
contract to abtaln this waiver from us.
This endorsement shall not operate directfy or indirectly to benefif anyone not named in the Schedule.
The premlum for this endorsement is sh4wn In the Schedule.
Schedule
1. �] Speeffio Walver
Name of person or organizaiion
�X Blanket Waiver
Any person o� organization for whom the Named Insured has agreed by wriiten contracl to furnish this
waive r.
2. Operations:
ALL TEKAS OPERATIONS
3. Pramium:
The premium charge for this endorsement shakl be 2 perce�t af tha premlum developed on payroll in
cannection with work performed %r the above person(s) or onganization(s) arising out of the operations
describe.
4. Advance Premium: $
DATE OF ISSUE: 08-18-11 ST ASSIGN: Page i of 1
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PQI.ICY NUMBER: 4TSM-CUP-5721654A-TCT-11
UMBRELLA
ESSUE DATE: 08-30-11
THIS ENDORSEMENT CHANGES TWE POLICY. PLEASE READ IT CAREFULLY.
SCHEDULE OF UNDERLYING INSURANCE
This endorsement modifies fnsurance provided underthe foElowing:
CQMMERCiAL EXCE33 L�ABILITY [UMBRELLA) INSURAHCE
Item 6 of the Declarations to include;
POLICY LIMliS (000 OMI7TED) COVERAGE COMPANY
CO 6A218714 11 1�00 EACH QCCURRENCE CGL TI.0
10�0 EACH PER50N OR �RG.
2000 GEN. AGG.
2000 PROD/COMP DPS AGG.
UB 6212R86A 11 1000 PER ACCIDEWT EMPLOYERS TIA
1000 POLICY LIMIT 60R LIABILITY
DISEASE
1000 PER EMPLOYEE (DI5EA5E)
BA 6203R772 11 CNS 1000 CSL BAP IND
THE POLICTES SWDWN ABOVE ARE ISSUED IP1 4NE OR MORE OF 7HE 7FtAVELERS COMPANT�S.
THE ABOVE COMPANY(5) 'I'RAN5LATB5 AS FOLLOWS.
TLC: 'fHE TRAVEL,ERS LLOYDS INSURANCH COMPANY
INp: THE TRAVELERS INOEMNITY COMPANY
TiA: THE TRAVELERS INDEMNITY COMPANY OF AMERICA
PRODUCER: CORY 7UCKHR & LARROWE
CG DO 2� 04 96
OFFICE: NEw oR�EANS 12s
Page 1 of t