2012-148ORDINANCE NO. 2�12-148
AN ORDINANCE ACCEPTING BIDS AND AWARDING A PUBLIC WORKS CONTRACT FOR
THE CONSTRUCTION OF THE FM 2499 UTILITY RELOCATION PROJECT; PROVIDING
FOR THE EXPENDITURE OF FUNDS THEREFOR; AND PROVIDING AN EFFECTIVE DATE
(BID 4957-AWARDED TO SMB ENTERPRISES, INC. 1N THE AMOUNT OF $192,989).
WHEREAS, the City has solicited, received and tabulated competitive bids for the
construction of public works or improvements in accordance with the procedures of State law and
City ordinances; and
WHEREAS, the City Manager or a designated employee has received and recommended that
the herein described bids are the lowest responsible bids for the construction of the public worlcs 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 worl�s 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
4957
CONTRACTOR
SMB Enterprises, Inc.
AMOUNT
$192,989
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 sha11 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 worlcs 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 talce any actions that may be required or permitted to be performed by the City of Denton
under Bid 4857 to the City Manager of the City of Denton, Texas, or his designee.
SECTION 5. Upon acceptance and approval of the above competitive bids and the execution
of contracts for the public worlcs 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 6. This ordinance shall become effective immediately upon its passage and
approval.
PASSED AND APPROVED this the � day of , 2012.
ATTEST:
JENNIFER WALTERS, CITY SECRETARY
,
BY:
APPROVED AS TO LEGAL FORM:
ANITA BURGESS, CITY ATTORNEY
BY:
5-ORD- 4957
CONTRACT AGREEMENT
STATE OF TEXAS
§ COUNTY OF DENTON §
THIS AGREEMENT, made and entered into this 17 day of Julv A.D., 2012, by and
between City of Denton of the County of Denton and State of Texas, acting through
George C. Campbell thereunto duly authorized so to do, hereinafter termed
"OWNER," and
SMB Enter�rises Inc
3201 Carmel Street
Denton. TX 76205
Of the City of Denton, County of Denton and State of Texas , hereinafter termed
"CONTRACTOR."
WITNESSETH: That for and in consideration of the payments and agreements hereinafter
mentioned, to be made and perfarmed by OWNER, and under the conditions expressed in the bonds
attached hereto, CONTRACTOR hereby agrees with OWNER to commence and complete
performance of the work specified below:
Bid # 4957 — FM 2499 Utility Relocation I
in the amount of $192,989 and all extra worlc in connectioii therewith, under the terms as stated in
the General Conditions of the agreement; and at his (or their) own proper cost and expense to
furnish all materials, supplies, machinery, equipment, tools, superintendence, labor, insurance, and
other accessories and services necessary to complete the work specified above, in accordance with
the conditions and prices stated in the Proposal and the Performance and Payment Bonds, attached
hereto, and in accordance with all the General Conditions of the Agreement, the Special Conditions,
the 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; and plans, which includes all maps, plats, blueprints, and other drawings and printed or
written explanatory matter thereof, and the Specifications therefore, as prepared by:
City of Denton Staff
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 Ciiy and Contractor that Contractor is
an independent contractor and shall not be deemed to be or considered an employee of the City of
Denton, Texas, for the purposes of income tax, withholding, social security taxes, vacation or sick
leave benefits, worker's compensation, or any other City employee benefit. City shall not have
supervision and control of Contractor or any employee of Contractor, and it is expressly understood
that Contractor shall perfornl the services hereunder according to the attached specifications at the
general direction of the City Manager of the City of Denton, Texas, or his designee under this
agreement.
Indemnification
Contractor 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 and/or personal injury, including death, to any and all persons, of
whatsoever kind or character, whether real or asserted, arising out of the Work 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 work on or after the date established for
the start of work as set forth in written notice to commence work and complete all work wiihin 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 books, records and computations
pertaining to this agreement. The CONTRACTOR shall retain such books, 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 all audit tasks are completed and resolved. These books, 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 books, 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 "books", "records", "documents" and "other evidence", as used above, shall be construed to
include drafts and electronic fi�es, even if such drafts or electronic files 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:
Citv of Denton
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BY: .�-
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CONTRACTOR
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PHONE NUMBER
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FAX NUMBER
BY:
TITLE
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APPROVED AS TO FORM: PRINTED NAME
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PERFORMANCE BOND
STATE OF TEXAS §
COUNTY OF DENTON §
KNOW ALL MEN BY THESE PRESENTS: That SMB Enterprises, Inc. whose
address is 3201 Carmel Street Denton TX 76205
hereinafter called Principal, and � , a corporation
organized aild existitzg under the laws of the State of , 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 ihe
State of Texas, hereinafter called O , in the penal sum of One H dred Nine Two
Thousand, Nine Hundred Eigh T Nina��0/100 DOLLARS ($192,98 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, ii� 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 ouxselves, our heirs, executors,
administrators, successors, and assigns, jointly and severally, firmly by these presents. This
Bond sllall autoinatically 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
Suppleinental 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 N�ber 2012-148, with the City of
Denton, the O�er, dated the 17 day of J� A.D. 2012, for Bid # 4957- FM 2499 Utilitv
Relocation I
NOW, THEREFORE, if the Principal shall well, truly and faithfully perform and fulfill
all of the undertakings, covenants, terms, conditions and agreements of sa.id Contract in
accordance with the Plans, Specifications and Contract Documents during the original term
thereof and any extension thereof which may be granted•by the Owner, with or without notice to
the Surety, and during the life of any guaranty or warranty required under this Contract, and shall
also well and truly perform and fulfill all the undertakings, covenants, terms, conditions and
agreeinents of any and all duly authorized modifications of said Contract that may hereafter be
made, ilotice of which modifications to the Surety being hereby waived; and, if the Principal
shall repair andlor replace all defects due to faulty materials and workmanship that appear within
a period of two (2) years from the date of final completion and final acceptance of the Worlc by
the Owner; and, if the Principal sha11 fully indemnify and save harmless the Owner from all costs
and da.ulages which Owner may suffer by reason of failure to so perform herein and shall fully
reimburse and repay Owner a11 outlay and expense which the Owner may incur in malcing good
any default or deficiency, then this obligation sha11 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 sa.id Surety, for value received, hereby stipulates
and agrees that no change, extension of time, alteration or addition to the terms of the Contract,
or to the Work to be performed thereunder, or to the Plans, Specifications, Drawings, etc.,
accompanying the same, shall in anywise affect its obligation on this Bond, and it does hereby
waive notice of any such change, extension of time, alteration or addition to the terms of the
Contract, or to the Work to be performed thereunder, or to the Plans, Specifications, Drawings,
etc.
This Bond is given pursuant to the provisions of Chapter 2253 of the Texas Government
Code, as amended, and any other applicable statutes of the State of Texas.
The undersigned and designated agent is hereby designated by the Surety herein as the
Resident Agent in Denton County to whom any requisite notices may be delivered and on whom
service of process may be had in matters arising out of such suretyship, as provided by Article
7.19-1 of the Insu.rance Code, Vernon's Annotated Civil Statutes of the State of Texas.
IN WITNESS WHEREOF, this i�nstrument is executed in four cop�, each one of which
shall be deemed an original, this th��j 5 day of 'i,(,�, �01 ��
ATTEST:
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ATTEST:
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BY:
R�SIDENT
SURETY
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BY: �.—C�+ t , '
BY: �
AT ORNEY-IN-FACT
The Resident Agent of the Surety in Denton County, Texas for delivery of notice and service of
the process is:
► �.�ui�i
STREET ADDRESS:
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(NOTE: Date of Performance Bond must be date of Contract. If Resident Agent is not a corporation,
give a person's name.)
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PAYMENT BOND
STATE OF TEXAS §
COUNTY OF DENTON §
KNOW ALL MEN BY THESE PRESENTS: That SMB Enterprises, Inc.✓ ,
whose address is 3201 Carmel Street Denton TX 76205 hereinafter called Principal, and
r.t,YD S� �� corporation organized and existing under the laws
of the State of , and fully authorized to transact business in the State of
Texas, as Stuety, are held and firmly bound unto the City of Denton, a municipal corporation
organized and existing under the laws of tlie State of Texas, hereinafter called Owner, and unto
all persoils, firms, and corporations who may furnish materials for, or perform labor upon, the
building or unprovements hereinafter re�f 'ed to, in the penal sum of One Hundred Ninet Two
Thousand, Nine Hundred Eighty Nine�and 0/100 DOLLA.RS ($192;98 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 a�nount of any Change Order or Supplemental Agreement which increases the
Contract price, but in no event shall a Change Order or Supplemenfal Agreement which reduces
the Contract price decrease the penal sum of this Bond.
THE OBLIGATION TO PAY SANIE is conditioned as follows: Whereas, the Principal
entered into a certain Contract, identified by Ordinance Number 2012-148, with the City of
Denton, the O�er, dated the 17 day of Ju�l � A.D. 2012�r Bid # 4957 — FM 2499 Utilitv
Relocation I
NOW, THEREFORE, if the Principal sl�all well, truly and faithfully perform its duties
and malce prompt payment to all persons, firms, subcontractors, corporations and claimants
supplyiizg 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 shall be
void; otherwise it shall remain in fu11 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 Worlc 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
waiye notice of any such change, extension of time, alteration or addition to the terms of the
Contract, or to the Work �o be perfarmed thereunder, or to the Plans, Specifications, Drawings,
etc.
.�
This Bond is given pursuant to the provisions of Chapter 2253 of the Texas Government
Code, as amended, and any other applicable statutes of the State of Texas.
The undersigned and designated agent is hereby designated by the Surety herein as the
Resident Agent in Denton County to whom any requisite notices may be delivered and on whom
service of process may be had in matters arising out of such 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 in$trument i�executed in four copies, each one of which
shall be deemed an original, this the � day of ,� i,�,�, �� a.✓
ATTEST:
I:
ATTEST:
PRINCIPAL
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SURETY
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BY: (�`'� `��Prc/l'q� � � (�
BY:
A RNEY-IN-FACT
The Resident Agent of the Sureiy in Denton County, Texas for delivery of notice and service of
the process is:
NAME: �i,��1w��,�S(,cr('.�'t�Q. 1�0u�, �1 G
STREET ADDRESS�C%
(NOTE: Date of Payment Bond must be date of Contr^act.
cor�poration, give a person's name.)
•; ,
If Resident Agent is not a
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INSLIROR5I,� EI�iNITY
______ _ �C,!o�r a�,�
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P.O. Box 2683 • 225 South Fifth Street • Waco, TX 76702-2683
www.insurorsindemnity.com • 254-759-3702 • Fax 254-755-6399
BOND RIDER (GENERAL)
It is hereby understood and agreed that the following terms and conditions shall apply to the Performance Bond and/or
the Payment Bond, NO. CNB-14548-00 •
1. If the Obligee of the bonds is a governmental entity in t he State of Texas, then notwith standing anything stated in the
Performance Bond and/or in the Payment Bond, then the Performance Bond and/or the Payment Bond is issued
pursuant to Chapter 2253 of the Texas Government Code, as amended; or
If the Obligee of the bonds is a private entity and the Owner of a private project located within the State of Texas,
then, notwithstanding anything stated in the Payment Bond, the Payment Bond is issued pursuant to Chapter 53 of
the Texas Property Code, as amended, and the Payment Bond is conditional upon the prompt payment for all labor,
subcontracts, materials, specially fabricated materials, and normal and usual extras not exceeding fifteen (15%)
percent of the contract price, and the Owner in order to make the Payment Bond effective must note its approval of
the Payment Bond on the face of said Payment Bond and the Owner must cause the Payment Bond to be recorded,
along with a copy of the contract, with the County Clerk of the County in which the project is located in whole or in
part; and any suit under the PerFormance Bond, if any, must be filed within two (2) years and a day of the project
being completed by the Principal or if the Principal does not complete the project, within two (2) years and a day of
the Principal being defaulted or the Principal having abandoned the project; or
3. If the Principal is a subcontractor, then any suit under the Payment Bond must be filed within two (2) years and a day
of the last furnishing of a service, labor or material, as defined by the Payment Bond, to the Principal; and any suit
under the PerFormance Bond must be instituted within two (2) years and a day of the Principal completing its
subcontract or if the Principal does not complete its subc ontract within two (2) years and a day of the Principal being
defaulted; and
4. As to any Payment Bond and/or to any PerFormance Bond to which this Rider is attached, any change order or
modifications which alone, or in conjunction with any other change order or modification, increases or decreases the
Contract price by more than fifteen percent (15°/a) must be consented to by the Surety in writing and an additional
bond fee must be paid for any increase in the Contract price;
5. As to any Payment Bond and/or to any Performance Bond to which this Rider is attached, the Obligee must pay the
Principal in strict accordance with the Contract or Subcontract;
6. As to any Paymenf Bond and/or to any Performance Bond to which this Rider is attached, the Bond does not provide
coverage for, and the surety shall not be liable for, losses caused by acts of terrorism, riot, civil insurrection, or acts of
war.
7. As to any Payment Bond and/or to any Performance Bond to which this Rider is attached, the Bond does nat provide
coverage for, and the surety thereon shall not be liable for, molds, living or dead fungi, bacteria, allergens, histamines,
spores, hyphae, or mycotoxins, or their related products or parts, nor the remediation thereof, nor the consequences
of their occurrence, existence, or appearance.
SIGNED, SEALED AND DATED this 31st day of ��iy , zo�z
PRINCIPA ' B Enterprlses, Inc.
= (Seal)
BY� (���
(title)
INSUR INDEM TY M ANY
� �SP,�'�
By: �
heri . Allen, Attorney-in-Fact
Rider— Pertormance & Payment Bond General (02-06)
INSLIRORS I �INITY P.O. Box2683 • 225 South Fifth Street • Waco, Texas 76702 2683
/%��� www.insurorsindemnity.com • 254-759 3700 • Fax 254-755-6399
IMPORTANT NOTICE - AVISO IMPORTANTE
To obtain information or make a complaint:
You may call Insurors Indemnity Company's toll-free
telephone number for information or to make a complaint
at:
1-800-933-7444
You may also write to Insurors Indemnity Company at:
P.O. Box 2683
Waco, TX 76702-2683
Or
225 South Fifth Street
Waco, TX 76701
You may contact the Texas Department of Insurance to
obtain information on companies, coverages, rights or
complaints at
1-800-252-3439
You may write the Texas Department of Insurance at:
P.O. Box 149104
Austin, TX 78714-9104
Fax:512-475-1771
Web: httv://www.tdi.state.tx.us
E-mail: ConsumerProtection(�a,tdi.state.tx.us
PREMIiJM OR CLAIM DISPUTES:
Should you have a dispute concerning your premium or
about a claim, you should contact the agent or the
company �irst. If the dispute is not resolved, you may
contact the Texas Department of Insurance.
ATTACH THIS NOTICE TO YOUR POLICY:
This notice is for information only and does not become a
part or condition of the attached document.
Para obtener infoi�rnacion o para someter una queja:
Usted puede llamar al numero de telefono gratis de
Insurors Indemnity Company's para informacion o para
someter una queja al
1-800-933-7444
Usted tanbien puede escribir a Insurors Indemnity
Company:
P.O. Box 2683
Waco, TX 76702-2683
O
225 South Fifth Street
Waco, TX 76701
Puede comunicarse con el Departamento de Seguros de
Texas para obtener informacion acerca de companias,
coberturas, derechos o quejas al
1-800-252-3439
Puede escribir al Departamento de Seguros de Texas:
P.O. Box 149104
Austin, TX 78714-9104
Fax:512-475-1771
Web: http://www.tdi.state.tx.us
E-mail: ConsumerProtection(�a,tdi.state.tx.us
DISPUTAS SOBRE PRIMAS O RECLAMOS:
Si tiene una disputa concemiente a su prima o a un
reclamo, debe comunicarse con el agente o la compania
primero. Si no se resuelve la disputa, puede entonces
comunicarse con el departamento (TDI).
UNA ESTE AVISO A SU POLIZA:
Este aviso es solo para proposito de informacion y no se
convierte en parte o condicion del documento adjunto y
esta dado para acatar con Section 2253.021 Government
Code y Section 53.202, Property Code efectivo,
Septiembre 1, 2001.
INSLIRORS I 1VINITY
.af�r��r�r.��.G
�
POWER OF ATTORNEY of INSURORS INDEMNITY COMPANY
Waco, Texas
KNOW ALL PERSONS BY THESE PRESENTS:
Number: CNB-14548-00
That INSURORS INDEMNITY COMPANY;'Waco, Texas, organized and existing under the laws of the State of
Texas, and authorized and licensed to do business in t e State of Texas and the United States of America, does
hereby make, constitute and appoint
Sheri R. Allen f the Citv of Denton, State of TX
as Attorney in Fact, with full power and authority hereby conferred upon him to sign, execute, acknowledge and
deliver for and on its behalf as Surety and as its act and deed, all of the following classes of document, to-wit:
Indemnity, Surety and Undertakings that may be desired by contract, or may be given in any action
or proceeding in any court of law or equity; Indemnity in all cases where indemnity may be lawfully
given and with full power and authority to execute consents and waivers to modlfy or change or
extend any bond or document executed far this Company.
,
Att�st: c�-+��w� �� ��nc�J
Tammy Tieperm n Secretar
`
State of Texas
County of McLennan
INSURORS I DEMNITY MPANY
.�
By
T o as . Chase, Jr, Chairma nd CEO
On the 8fh day of July, 2009, before me a Notary Public in the State of Texas, personally appeared Thomas G. Chase,
Jr. and Tammy Tieperman, who being by me duly sworn, acknowledged that they executed the above Power of Attomey in their
capacities as Chairman and Chief Executive Officer, and Corporate Secretary, respectively, of Insurors Indemnify Company,
and acknowledged said Power of Attorney to be the voluntary act an eed of the Company.
..... ......................�....... _��� I.G(�`v !N�
3HERRI WHITENOUSE
�''',� NoterV Publlc Notary Public, Sfate of Texas
5TATE OF TEXA5
My Comm Exp 061�1I2013
Y���!!!►��M��������������o��������•
Insurors Indemnity Company certifies that this Power of Attorney is granted under and by authority of the
following resolutions of the Company adopted by the Board of Directors on July 8, 2009:
F2ESOLVED, that all bonds, undertakings, contracts or other obligations may be executed in the name of the Company
by persons appolnted as Attorney in Fact pursuant to a Power of Attorney issued in accordance with these Resolutions. Said
Power of Attorney shall be executed in the name and on behalf of the Company either by the Chairman and CEO or the
President, under their respective designation. The signature of such officer and the seal of the Company may be affixed by
facsimile to any Power of Attorney, and, unless subsequently revoked and subject to any limitation set forth therein, any such
Power of Attorney or certificate bearing such facsimfle slgnature and seal shall be valid and binding upon the Company and any
such power so executed and certified by facsimile signature and seal shall be valid and binding upon the Company with respect
to any bond or undertaking to which it is validly attached.
RESOLVED, that Attorneys in Fact shall have the power and authoriiy, subject to the terms and limitations of the
Power of Attorney issued to them, to execute and deliver on behalf of the Company and to attach the seal of the Company to
any and all bonds and undertakings, and any such instrument executed by such Attorneys in Fact shall be binding upon the
Company as if signed by an Executive Officer and sealed and attested to by the Secretary or Assistant Secretary of the
Company.
I, Tammy Tieperman, Secretary of Insurors Indemnity Company, do hereby certify that the foregoing is a true excerpt
from the Resolutions of the said Company as adopted by its Board of Directors on July 8, 2009, and that this Resolution is in full
force and effect. I certify that the foregoing Power �f Aktorney is in full force and effect and has not been revoked.
In Witness Whereof, I have set rny har�d :�rid. fi�e seal of WSURORS INDEMNITY�OMPANY on this 31st
day of July , 2012 � �
�
��[�._ rn w `� l,�- Y� C�
Tammy Tiep r an, ecretary
NOTE: IF YOU HAVE ANY QUE�TIOP! FtEGARDIiVG 7HE VALIDITY OR WORDING OF THIS POWER OF ATTORNEY,
PLEASE CALL 800 933 7444 OR WRI`fF TO US P�T' P. O, BOX 2683, WACO, TEXAS 76702-2683 OR EMAIL US AT
CITY OF DENTON
INSURANCE REQUIREMENTS FOR CONTRACTORS
Bidder's attention is directed to tlie insurance requirements below. It is Iziglzly recommenrled
tlzat bidders confer with tlzeir respective insurance carriers or bt�okers to determine in c�clvance
of Bid submission the availability of insurance certificates and endorsements as prescribed
and provided laerein. If an apparent low bidder fails to corrtply strictly witlz tlxe insurance
requirements, tlzat bidder may be disqualified from award of tlze contract. Upon bid award, all
insurance requirements shall become coiatractual obligations, whicla tlze successful bidder
slaall ]aave a duty to maintain througlzout the course of tliis contract.
STANDARD PROVISIONS:
Without Zimiting any of the other obligations or liabilities of the Contractor, the Contractor shall
p�ovide and maintain untiZ the contracted work has been completed and accepted by the City of
Denton, Owner, the minimum insurance coverage as indicated he�einafter.
As soon as practicable after notification of bid award, Contf-actor shall file with the Purchasing
Department satisfactory certificates of insurance, containing the bid number and title of the
project. Contractor may, upon written request to the Purchasing Department, ask for
clarification of any insurance requirements at any time; however, Contractors are strongly
advised to make such requests prior to bid opening, since the insurance requirements may not be
modified or waived after bid opening unless a wNitten exception has been submitted with the bid.
Co�ztractor slzall not commence any work or deliver any material until !ae or she receives
notification tliat tlae contract has been accepted, approved, and signed by the City of Denton.
All insurance policies proposed or obtained in satisfaction of these requirements shall comply
with the following general specifications, and shall be maintained in compliance with these
gene� al specifications throughout the du�ation of the Contract, or longe�, if so noted.•
• Each policy shall be issued by a company authorized to do business in the State of
Texas with an A.M. Best Company rating of at least A.
• Any deductibles or self-insured retentions shall be declared in the bid proposal. If
requested by the City, the insurer sha11 reduce or elimuiate such deductibles or
self-insured retentions with respect to the City, its . officials, agents, employees and
volunteers; or, the eontractor 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
insu.rance 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.
• Cancellaiion: The City requires 30 day written notice should any of tlae
policies described on the certificate be cancelled or materially changed
before the 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 years beyond the contract
expiration, such that occurrences arising during the contract term which give
rise to claims made after expiration of the contract shall be covered.
� Should any of the required insurance be provided under a form of coverage that
includes a general annual aggregate limit providing for claims investigation or
legal defense costs to be included in the general annual aggregate limit, the
Contractor shall either double the occurrence limits or obtain Owners and
Contractors Protective Liability Insurance.
• Should any required insurance lapse during the contract term, requests for
payments originating after such lapse shall not be processed until the City
receives satisfactory evidence of reinstated coverage as required by this contract,
effective as of the lapse date. If insurance is not reinstated, City may, at its sole
option, terminate this agreement effective on the date of the lapse.
CI - 10
SPECIFIC ADDITIONAL INSURANCE REQUIREMENTS:
All insurance polzcies proposed or obtained in satisfaction of this Contract slzall additionally
comply with tlie following marked specifications, and shall be maintained in compliance witlz
these additional specifications throughout tlte duration of tlae Contract, or longer, if so �zote�l:
[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 and
umbrella or excess policies.
If the Commercial General Liability form (ISO Form CG 0001 current edition) is used:
� Coverage A shall include premises, operations, products, and completed
operations, independent contractors, contractual liability covering this contract
and broad form property damage coverage.
� Coverage B shall include personal injury.
• Coverage C, medical payments, is not required.
If the Comprehensive General Liability form (ISO Form GL 0002 Current Edition and
ISO Form GL 0404) is used, it shall include at least:
Bodily injury and Properiy Damage Liability for premises, operations, products
and completed operations, independent contractors and property damage
resulting from explosion, collapse or underground (XCU} exposures.
Broad form contractual liability (preferably by endorsement) covering tlus
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 $500,000.00 either in a single policy or in a combination of
basic and umbrella or excess policies. The policy will include bodily injury and property
damage liability arising out of the operation, maintenance and use of all automobiles and
mobile equipment used in conjunction with this contract.
Satisfaction of the above requirement shall be in the form of a policy endorsement for:
any auto, or
all owned, hired and non-owned autos.
CI - 11
[X] Workers Compensation Insurance
Contractor sha11 purchase and maintain Worker's Compensation insurance which, in addition
to meeting the minimum statutory requirements for issuance of such insurance, has
Employer's Liability limits of at least $100,000 for each accident, $100,000 per each
employee, and a$500,000 policy limit for occupational disease. The City need not be
named as an "Additional Insured" but the insurer shall agree to waive all rights of
subrogation against the City, its officials, agents, employees and volunteers for any work
performed for the City by the Named Insured. For building or construction projects, the
Contractor sha11 comply with the provisions of Attachment 1 in accordance with §406.096
of the Texas Labor Code and rule 28TAC 110.110 of the Texas Worker's Compensation
Cominission (TWCC).
[] Owner's and Contractor's Protective Liability Insurance
The Contractor shall obtain, pay for and maintain at all tirries during the prosecution of the
work under this contract, an Owner's and Contractor's Protective Liability insurance policy
naming the City as insured for property damage and bodily injury which may arise in the
prosecu�io� of the work or Contractor's operations under this eontract. Coverage shall be on
an"occurrence" basis, and the policy shall be issued by the same insurance company that
carries the Contractor's liability insurance. Policy limits will be at least combined bodily
injury and property damage per occurrence with a aggregate.
[ ] Professional Liability Insurance
Professional liability insurance with limits not less than per claim with
respect to negligent acts, errors or omissions in connection with professional services is
required under this Agreement.
[ ] Builders' Risk Insurance
Builders' Risk Insurance, on an All-Risk form for 100% of the completed value shall be
provided. Such policy shall include as "Named Insured" the City of Denton and all
subcontractors as their interests may appear.
CI - 12
[ ] Commea�cial Crime
Provides coverage for the theft or disappearance of cash or checks, robbery inside/outside
the premises, burglary of the premises, and employee fidelity. The employee fidelity
portion of this coverage should be written on a"blanket" 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 extra hazardous contracts and
specific service agreements. If such additional insurance is required for a specific contract,
that requirement will be described in the "Specific Conditions" of the contract specifications.
CI - 13
ATTACHMENT 1
[X] Worker's Compensation Coverage for Building or Construction Projects for
Governmental Entities
A. Definitions:
Certificate of coverage ("certificate")-A copy of a certificate of insurance, a certificate
of authority to self-insure issued by the commission, or a coverage agreement (TWCC-
81, TWCC-82, TWCC-83, or TWCC-84), showing statutory workers' compensation
insurance coverage for the person's or entity's employees providing services on a
project, for the duration of the project.
Duration of the project - includes the time from the beginning of the work on the project
until the contractor's/person's work on the project has been completed and accepted by
the governmental entity.
Persons providing services on the project ("subcontractor" in §406.096) - includes all
persons or entities performing all or part of the services the contractor has undertaken to
perform on the project, regardless of whether that person contracted directly with the
contractor and regaxdless of whether that person has employees. This includes, without
limitation, independent contractors, subcontractors, leasing companies, motor carriers,
owner-operators, employees of any such entity, or employees of any entity which
furnishes persons to provide services on the project. "Services" include, without
limitation, providing, hauling, or delivering equipment or materials, or providing labor,
transportation, or other service related to a project. "Services" does not include
activities unrelated to the proj ect, 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 a.11 employees of the
Contractor providing services on the project, for the duration of the project.
C. The Contractor must provide a certificate of coverage to the governmental entity prior to
being awarded the contract.
D. If the coverage period shown on the contractor's current certificate of coverage ends
during the duration of the proj ect, 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 proj ect, and
provide to the governmental entity:
CI - 14
1) a certificate of coverage, prior to that person beginning work on the project, so the
governmental entity will have on file certificates of coverage showing coverage for
all persons providing services on the project; and
2) no later than seven days after receipt by the contractor, a new certificate of coverage
showing extension of coverage, if the coverage period shown on the current
certificate of coverage ends during the duration of the project.
F. The contractor shall retain a11 required certificates of coverage for the duration of the
project and for one year thereafter.
G. The contractor shall notify the governmental entity in writing by certified mail or
personal delivery, within 10 days after the contractor knew or should have known, of
any change that materially affects the provision of coverage of any person providing
services on the project.
H. The contractor shall post on each project site a notice, in the text, form and manner
prescribed by the Texas Worlcers' Compensation Commission, informing all persons
providing services on the project that they are rec�uired to be covered, and stating how a
person may verify coverage and report lack of coverage.
I. The contractor sha11 contractually require each person with whom it contracts to provide
services on a project, to:
1) provide coverage, based on proper reporting of classification codes and payroll
amounts and filing of any coverage agreements, which meets the statutory
requirernents of Texas Labor Code, Section 401.011(44) for alI of its employees
providing services on the project, for the duration of the project;
2) provide to the contractor, prior to that person begiruung work on the project, a
certificate of coverage showing that coverage is being provided for all employees of
the person providing services on the project, for the duration of the project;
3) provide the contractor, prior to the end of the coverage period, a new certificate of
coverage showing extension of coverage, if the coverage period shown on the current
certificate of coverage ends during the duration of the project;
4) obtain from each other person with whom it contracts, and provide to the contractor:
a) certificate of coverage, prior to the other person beginning worlc 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 duration of the proj ect and
for one year thereafter;
6) notify the governmental entity in writing by certified mail or personal delivery,
within 10 days after the person knew or should have known, of any change that
materially affects the provision of coverage of any person providing services on the
project; and
7) contractually require each person with whom it contracts, to perform as required by
paragraphs (1) -(7), with the certificates of coverage to be provided to the person for
whom they are providing services.
J. By signing this contract or providing or causing to be provided a certificate of coverage,
the contractor is representing to the governmental entity that a11 employees of the
contractor who will provide services on the project will be covered by workers'
compensation coverage for the duration of the project, that the coverage will be based on
proper reporting of classification codes and payroll amounts, and that all coverage
agreements will be filed with the appropriate insurance carrier or, in the case of a self-
insured, with the commission's Division of Self-Insurance Regulation. Providing false
or misleading information may subject the contractor to ad�nuustrative penalties,
criminal penalties, civil penalties, or other civil actions.
K. The contractor's failure to coinply with any of these provisions is a breach of contract by
the contractor which entitles the govemmental entity to declare the contract void if the
contractor does not remedy the breach within ten days after receipt of notice of breach
from the governmental entity.
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 USE 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 recards 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 176.006, 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 7�h 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 offcer named in this section receiving or likely to receive taxable income, other than investment income, from the
filer of the questionnaire?
0 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 officer named in this section AND the taxable income is not received from the local governmental entity7
� Yes � 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?
� Yes � No
D. Describe each affiliation or business relationship.
4
Signature of person doing business with the governmental entity Date
Adopled 06/29/2007
CIQ-1
Project Name
FM 2499 Utility Relocation Phase I
BID TABULATION SHEET
Calendar Days 90
Bid No. 4957
P.O. No.
Item Description Quantity Unit Unit Price Total
103.3 Surety Bonds 1 LS $�� ��� / LS $ g� �
Unit Price In Words � 1` �Z f ��� c,+,5cwu.( �'! �c� ct��.�l ��t� L���
107.20. Project Signs 2 EA $��U� / EA $�6 U
Unit Price In Words �ou-✓ �'��'�'`� -e-+bj � T !%l.o l l��S
201 Temporary Erosion Control 675 LF $ Lj / LF $ Z? a�
Unit Price In Words �o u-✓ p j��c- v S
202.6 Seeding Turf Grass 1,500 SY $ / SY $ D ��
Unit Price In Words ��t�`-✓ � r( 5
203.3 General Site Preparation 1 LS $�� o d/ LS $ a� d�
Unit Price In Words � r�,� � f.V°ws u�r.�-� r(��(,✓ �,,�,�,�i,e(,{ '�(/� ✓S
502.1.2 4' I.D. Concrete Manhole Adjustment 7 VF $� 7�% / VF $� 7� t%
Unit Price In Words i ri �,�t,vt.r.C,f�c�CJ� S-2-V2w� (�.o f�� �
507-A 10" C900 PVC Force Main 410 LF $ "7 � / LF $ �� y J�o
Unit Price In Words p v� v 1 — r�V � �`Y � 1 a.-✓ S
507-B 18" Steel Encasement Pipe 242 LF $ � Z / LF $ �� �
Unit Price In Words �` � 1 �' �'wo G[� �I�� �j
507-C 16" Steel Split Casing 125 LF $ 3 6.S / LF $ tf S" Z.
Unit Price In Words � V� J�-e �-�'�-'� re"� s 1 j<T - I' � v� � �/ u.✓
801 Barricades, Warning Signs and Detours 1 LS $�(�O �/ LS $ � d� �
Unit Price In Words Q�/t.� -�/► t31.c- � f�G� r/ S
SS01 Cut and Plug Existing Force Main 2 EA $ 7�� / EA $( �( Q�
Unit Price In Words 5� V�, � �,C,t•��v` �( U-c/
SS07 Remove Manhole Cone 1 EA $�� C7 / EA $ QD�%
Unit Price In Words .e ( y, � w�,C�.✓'� 1 �/"�
SS08 Tie to Existing Force Main � 2 EA $ 3 6 �� / EA $ 7 2 a �
Unit Price In Words � t� d e�-� �^-�'�7�vt S> � �� O f f�J
TOTAL BASE BID: 1� S � 6�.��
506-A 18" Steel Split Casing 140 LF $� 6 3 / LF $ b��2-a
Unit Price In Words �D �f � 1 j� '� `� h r�`e- Ut�( l�-✓ �
P-3
Project Name
FM 2499 Utility Relocation Phase I
BID TABULATION SHEET
Calendar Days
Bid No.
P.O. No.
.�
4957
Item Description Quantity Unit Unit Price Total
TOTAL BASE BID + ITEM 506-A: �I Z- Q�GI � a`�
506-B 21" Steel Split Casing with Joint Restraints 140 LF $ S 3� / LF $�� �� v
Unit Price In Words f�1►G �y� ��'��`� �- o� �� II u-�'S
TOTAL BASE BID + ITEM 506-B: �ZCU � S�� � c O
P-4
BID SUMMARY
TOTAL BASE BID PRICE IN WORDS:
d (� e �Q✓� � 1,�r�vL r `-( - �C, I "�l �2 ! � �'+, o t,t � r.�-��, t� we, �,,vs.�GQr�
- .
Cj- ( ��'`� - �irv,e. C� 4� I�S �` ���� �(� �S
�GC
TOTAL BASE BID + ITEM 506-A PRICE IN WORDS:
� we Vlcti.n.�{-d �h �V � n�� � fwo f" �,octiS cr, �+.r.t �U N'� e Vr, �-�-,�,�,Qv-� [il
�L'f�,�r� �N r�'� Gl,t� ( f u�✓�j � Z�G✓o c��2��
TOTAL BASE BID + ITEM 506-B PRICE IN WORDS:
t�,,�a l�.wvr,l ✓ cc� -1-� o`� �/t,o v�. s�c,�. c,� �- i �����,i.. c_rJ� N i�l, � U�a ��c� � S
, - ('�"� 2� vp C-� �it �S
Items 506-A a.nd 506-B represent a pipe alternate option for this project. The bidder must submit a
bid for both Items 506-A and 506-B. The award of the contract will be based on the Tota1 Base Bid
plus the pipe alternate selected by the City. The decision on which pipe alternate to award will be
made solely at the discretion of the City. The lowest responsive proposal for purposes of award
shall be the conforming responsible bidder offering the lowest cost for the base bid plus the pipe
altemate selected by the City.
In the event of the award of a contract to the undersigned, the undersigned will fui�lish a
performance bond and a payment bond for the full amount of the contract, to secure proper
compliance with the terms and provisions of the contract, to insure and guarantee the work until
final completion and acceptance, and to guarantee payment for all lawfi.il cla.ims for labor
�
performed and materials furnished in the fulfillment of the contract.
It is understood that the work proposed to be done sha.11 be accepted, when fully completed and
finished in accordance with the plans and specifications, to the satisfaction of the Engineer.
The undersigned certifies that the bid prices contained in this proposal have been carefully checked
and are submitted as correct and final.
Unit and lump sum prices as shown for each item listed in this proposal, shall control over
extensions. �
The undersigned agrees this bid becomes the properly of the City of Denton after the official
opening.
P-5
The undersigned affirms that they are duly authorized to execute this contract.
Vendor hereby assigns to purchaser any and all claims far overcharges associated with this
contract which arise under the antitrust laws of the United States, 15 USCA Section 1 et seq., and
which arise under the antitrust laws of the State of Texas, Tex. Bus. & Com. Code,
Section 15.01, et Seq.
. �
Receipt is hereby acknowledged of the following addenda to the plans and specifications:
AddendumNo. 1 dated ( Received T',.
Addendum No. 2 dated r!` Received �
Addendum No. 3 dated Received
Addendum No. 4 dated Received
Addendum No. 5 dated Received
���.� �ec,s--, N i �',_. �1
CONTRACTOR
BY _=�,�i�-�- �,,-,✓✓��
_�n 1 C�-- M.e a
Street Address
`�:�`�'x 1 le 'a b 5
City and State
Seal & Authorization
(If a Corporation) ��(a —� , � - a���
Telephone
P-7
VEND012 C011�LIANCE 'I'O STATE LAW
The 1985 Session of the Texas Legislature passed House Bill 620 relative to the award of contracts
to non-resident bidders. This law provides that, in order to be awarded a contract as low bidder,
non-resident bidders (out-of-state contractors whose corporate offices or principal place of business
are outside of the State of Texas) bid projects for construction, improvements, supplies or services
in Texas at a.0 amount lower than the lowest Te�as resident bidder by the same amount that a Texas
resident bidder would be required to underbid a non-resident bidder 'rri order to obtain a cornparable
contract in the state in which the non-resident's principal place of business is located. The
appropriate blanks in Section A below must be filled out by all out-of-state or non-resident bidders
in order for your bid to meet specifications. The failure of out-of-state or non-resident contractors
io do so will automatically disqualify that bidder. Resident bidders must check the blank in Section
B.
A. Non-resident bidders in (give state), our principal place of business,
are required to be percent lower than resident bidders by state law.
A copy of the statute is attached.
Non-resident bidders in (give state), our principal place of business,
are not required to underbid resident bidders.
B. Our principal place of business or corporate offices are in the State of Texas: �/
C1�� '
�S �M. �-� � �'-� '
co�arr�
BY �°-�-� C�� ��
������
Street Address
��
City and State
THIS FORM MUST BE RETURNED WITH YOUR BID.
• �,
CONTR.ACTOR COMPLIANCE TO TEXAS SALES TAX CODE
Comply with all requirements of the Texas Sales T� Code. The Contractor hereby certifies that
the Contract Amount is divided as follows:
Materials incorporated into the Project
(resold to the Owner as defined in Tax Code)
All other charges and costs
Tota1
The total must equal the total amount of the Contract.
CONTRACTOR:
� `�,��c-� r�, , �� ,
co�arr� '
BY ��� ('
3 �a ] Ca.r r,._.i1
5treet Address
��.�� �
City and State
4�
�
$ ,D O D 0 .
D�
$ � O /�
$ 7 �U / � �
THIS FORM SHALL BE EXECUTED AT THE TIl12E OF EXECUTION OF THE
CONTRACT AND SHALL BE MADE A PART OF THE CONTRACT.
��
COIVFLICT OF INTEREST C�UES�9OIVNA�RE
For vendor or other person doing business with local governmental entity
This questionnaire reflects changes made to the law by H.B. 1491, SOth Leg., Regular Session.
FO�n� CIQ
OFFICE USE ONLY
This questionnaire is being filed in accordance with Chapter 176, Local Government Code Date Received
by a person who has a business relationship as defined by Section 176.001(1-a) wiih a local
governmental entity and the person meets requirements under Section 176.006(a).
By law this questionnaire must be filed with the records administrator ofthe local governmental
entity not laterthan the 7th business day afterthe date the person becomes aware offacts
that require the statement to be filed. See Section 176.006, Local Government Code.
A person commits an ofFense if the person knowingly violates Seciion 176.006, Local
Government Code. An offense under this section is a Class C misdemeanor.
Name of person who has a business relationship with local governmental entity.
❑ Check fhis 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.)
Name of local government officer with whom filer has 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 � No
B. Is the filer of the questionnaire receiving or likely to receive taxable income, other than investmenf income, from or at the
direction of the local government officer named in this section AND the taxable income is not received from the local
governmental entity?
� Yes � 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?
� Yes � No
.
D. Describe each employment or business relationship with the local government officer named in this section.
�! "� `-�,— �
c
Signature of person doing business with the governmental entity Date
Adopted 06/29/2007
"`�„°�RO� CERTIFICATE OF LIA�ILITY INSURANCE si2i2o�2 "'
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 CONSTI7UTE 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 15 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 CONTACT �n AC312
NAME: Y
Swingle, �.'0111I1S and Associates PHONE �g'72�387-3000 FAX �g�p�387-3808
AIC No :
13760 Noel Road Suite 600 E-MAIL
� nnnRFCC• aacaley@ swinglecollins . com
Dallas TX 75240
INSURED -/
SMB Enterprises Inc."
3201 Carmel
CJ' �p1�'
`�� S�
INSURERAAI[L@P1C8 First Llo ds Ins Co 1152
iNSUReR e America First Ins Co
INSURER E :
�Denton TX 76205 IINSURERF: I �
COVERAGES CERTIFICATE NUMBER:12-13 New Acord form 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 DDL SUBR pOLICY EPF POLICY EXP
LTR 1YPE OF INS NCE INSR WVD POLICY NUMBER MMI�D/YYYY MMIDD/YYYY LIMITS
GENERAL LIABILITY EACH OCCURRENCE $ 1� OOO � OOO
DA GE TO RENTED
X COMMERCIAL GENERAL LIABILITY MISES Ea occurrence $ 100 , 000
A CLAIMS-MADE � OCCl1R � BP9811429 1/1/2012 1/1/2013 MED EXP (Any one person) 5 5� 000
- PERSONAL & ADV INJURY 5 1� OOO � OOO
GENERAL AGGREGATE $ 2� OOO � OOO �
GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS -COMPIOP AGG ^y 2� OOO � OOO
POLICY X PR� LOC $
AUTOM061LE LIABILI E�a ecB.latleD,51NGLE LIMIT $ 1 OOO OOO /
A X ANY AUTO / B�rfLY INJl1RY (Per person) $
ALLOWNED SCHEDULED A8577997{/ 1/1/2012 1/1/2013 BODILYINJURY(Peraccidenp �
AUTOS AUTOS
X HIRED AUTOS X NON-OWNED PROPERTY �AMAGE $
AUTOS Per accident
PIP-Basic $ $ ���
X UMBRELLA LIAB X OCCUR ' EACH OCCURRENCE $ 2� OOO � OOO
B EXCESS LIAB CLAIMS-MA�E
AGGREGATE $ 2 � OOO � OOO
DED X RETENTIONS 1D,000 U8578397 1/1/2012 1/1/2013 $
j� WORKERS COMPENSATION WC STATU- OTH-
AND EMPLOYERS' LIABILITY Y� N X TORY LIMIT E
ANY PROPRIETOR/PARTNER/EXECUTIVE .L. EACH ACCIDENT $ JrOO OOO
OFFICER/MEMBER EXCLU�ED7 ❑ N I A �
(MandatorytnNH) C9812627 1/1/2012 1/1/2013 E.L.DISEASE-EAEMPLOYE $ $�� ��� �
If yes, tlescri6e under �
DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 500 000
A Contractor's Equipment BP9811429 1/1/2012 1/1/2013 LIMIT $75,000
special fOTID DEDUCTIBLE $1,000
DESCRIPTION OF OPERATIONS 1 LOCATIONS 1 VEHICLES (Attach ACORU ��i, Additional Remarks Schedule, if more space is required)
The City of Denton, its officals, agents, employees and volunteers �ar included as Additional Insured as
respects General & Auto Liabilitv as required by written contract4� The General I,i zlity poli�c contains
a special provision with Primary & Non-Contributory wording as required by written contract.`� Waiver of
Subro applies as respects Workers Compensation as required by written contract.
�----
CERTIFICATE HOLDER CANCELLATION
City of Denton✓
901-B Texas St
Denton, TX 76209
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCF WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVE
✓
Swingle/MAA �-� -y� ����>�
ACORD 25 (2010l05) O 1988-2010 ACORD CORPORATION. All rights reseroed.
INS025 r�mnnsi m Thu A(_f1R11 nnmc anrl innn are renietnrerl m�r4c nf 6(_(1Rfl
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