2013-081ORDINANCE NO. 2013-081
AN ORDINANCE ACCEPTING COMPETITIVE BIDS AND AWARDING A PUBLIC WORKS
CONTRACT FOR THE CLEARING OF SANITARY SEWER EASEMENTS AND
1NSTALLATION OF GATES AT MULTIPLE LOCATIONS AS SPECIFIED 1N BID 5171-
SANITARY SEWER EASEMENT CLE�IRING AND GATE INSTALLATION; PROVIDING FOR
THE EXPENDITURE OF FUNDS THEREFOR; AND PROVIDING AN EFFECTIVE DATE (BID
5171-AWARDED TO THE LOWEST RESPONSIBLE BIDDER MEETING SPECIFICATION,
DCI CONTRACTING, INC.1N THE NOT TO EXCEED AMOLINT OF $318,860.00).
WHEREAS, the City has solicited, received and tabulated competitive bids for the
construction of public works or improvements in accordance with the procedures of State law and
City ordinances; and
WHEREAS, the City Manager or a designated employee has received and recommended that
the herein described bids are the lowest responsible bids for the construction of the public works or
improvements described in the bid invitation, bid proposals and plans and specifications therein;
NOW, THEREFORE,
THE COUNCIL OF THE CITY OF DENTON HERESY ORDAINS:
SECTION 1. The following competitive bids for the construction of public works or
improvements, as described in the "Bid Invitations", "Bid Proposals" or plans and specifications on
file in the Office of the City's Purchasing Agent filed according to the bid number assigned hereto,
are hereby accepted and approved as being the lowest responsible bids:
BID
NUMBER
5171
CONTRACTOR
DCI Contracting, Inc.
AMOUNT
$318,860
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 works
or improvements herein accepted and approved, until such person shall comply with all requirements
specified in the Notice to Bidders including the timely execution of a written contract and furnishing
of performance and payment bonds, and insurance certificate after notification of the award of the
bid.
SECTION 3. The Ciry 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 pernutted to be performed by the City of Denton
under Bid 5171 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 works and improvements as authorized herein, the City Council hereby
authorizes the expenditure of funds in the manner and in the amount as specified in such approved
bids and authorized contracts executed pursuant thereto.
SECTION 6. This ordinance shall become effective immediately upon its passage and
approval.
PASSED AND APPROVED this the �/l� day of l l , 2013.
MARK A. BURROUGHS, MAYOR
ATTEST:
JENNIFER WALTERS, CITY SECRETARY
BY:
APPROVED AS TO LEGAL FORM:
ANITA BURGESS, CITY ATTORNEY
„
BY: �' .
a-o�-a� �i
CONTRACT AGREEMENT
STATE OF TEXAS
§ COUNTY OF DENTON §
THIS ,4GREEMENT, made and entered into this 2nd day of April A.D., 2013, by
and between City of Denton of the County of Denton and State of Texas, acting tluough
Gearge C. Campbell thereunto duly authorized so to do, hereinaft�x termed
"OWNER," and
DCI Contractin� Inc
2045 E Hwv 380 Suite 100
Decatur TX 76234
of the City of Decatur, County of Wise 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 coinmence and complete
performance of the work specified below:
Bid 5171-Sanitary Sewer Easement Clearin� and Gate Installation
in the amount of $318,860 and all extra worlc in connection therewith, under the terrns 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 (Bonds will be for the amount of the Gate Installation Oi�ly-$100,000), and in accardance
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 En ing eerin� staft
all of which are referenced herein ai7d 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 ar 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 peiform 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.
Indemnificatioe�
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 ofticers,
servants, employees, of the Owner. Contractor likewise covenants and agrees to, and does hereby,
indemnify and hold harnlless 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 agreernent shall be governed by the law of the State of Texas and venue for its
construction and enforceinent shall lie in the coui-ts of Denton County, Texas.
The CONTRACTOR hereby agrees to coinmence worlc on or af�er the date established for
the start of work as set forth in written notice to commence worlc and complete all work within the
time stated in the Proposal, subject to such extensions of time as are provided by the General and
Special Conditions.
The OWNER agrees to pay the CONTRACTOR in current funds the price or prices shown
in the Proposal, which forms a part of this conhact, 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 malce copies of the boolcs, records and computations
pertaining to this agreeinent. 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 fii7dings are yet unresolved, in which case records shall be
kept until all audit tasks are completed and resolved. These books, records, documents and other
evidence shall be available, witl�in 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 witlun a
50 mile radius of the City of Denton. The cost of the audit will be boi7ze by the OWNER unless the
audit reveals an overpayil�ent of 1% or greater. If an overpayment of 1% or greater occurs, the
reasonable cost of the audit, including any travel costs, nlust 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 tei-mination thereof. Each of the
terms "books", "records", "docLUnents" and "other evidence", as used above, shall be construed to
include drafts and electronic files, even if such drafts or electronic files are subsequently used to
generate or prepare a fuial printed docuinent.
CA-3
IN WITNESS WHEREOF, the parties of these presents have executed this agreement in the
year and day first above written.
ATTEST:
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ATTEST:
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�hriS'�iYle M. UIJd�LL
APPROVED AS TO FORM:
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BY: ri 'i
`A-� � ITA BURGESS; C " ATTORNEY
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CA-4
City of Denton
O WNER
BY:
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CONTRACTOR
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Bond No. 105873181 PEI2FO12MANC�+ BONI)
STATE OF TEXAS §
COUNTY OF DENTON §
KNOW ALL MEN BY THESE PRESENTS: That DCI Contractin�, Inc.� whose
address is 2045 E Hwy 380 Suite 100 Deca -ir, TX 76234 hereinafter called Principal, and
TravelefSAmeruaaty and Surety compan � a corporation organized and existing under the
laws of the State of Connecticut , 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 eYisting under the laws of the State� Texas, hereinafter lled Owner, in the
penal sum of One Hundred Thousand and 0/100 �OLLARS ($100,U0 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 otitrselves, our heirs, executors,
administrators, successors, and assigns, jointly and severally, firn11y by these presents. This
Bond shall automatically be increased by the amount of any Change Order ar Supplemental
Agreement, which increases the Contract price, but in no event shall a Change Order or
Supplemental Agreement, wliich 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 Nuinber 013-081, with the City of
Denton, the Owner, dated the 2-nd- da-y--of-Apr-il-A_D.-2O1-3,- or Bid #5171-Sanitarv Sewer
Easement Clearin and Gate Installation. (Performance Bond covers G e Installation
n y as specified in Contract Agreement dated 4/2/2013)�
NOW, THEREFORE, if the Principal shall well, truly and faithfi�lly perform and fulfill
all of the undertakings, covenants, ternls, conditions and agreements of said Contract in
accordance with the Pla.ris, Specifications and Contract Documents during the original term
thereof and any extension thereof which may be granted by the Orvner, with or without notice to
the Surety, and during the life of any guaranty or warranty required Lmder this Contract, and shall
also well and truly perform and fulfill all the undei�takings, 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 worlunauship that appear within
a period of two (2) years from the date of final completion and final acceptance of the Work by
the Owner; and, if the Principal shall fully indemnify and save harmless the Owner from all costs
and damages which Owiier may suffer by reason of failure to so perform herein and shall fully
reimburse and repay Owner all outlay and expense which the Owner may incur in making good
any default or deficiency, then this obligation shall be void; otherwise, it shall remain in full
force and effect.
�;
PRQVIDED FURTHER, that if any l�gal action be filed upan this Bond, exclusive venue
shall lie in Denton County, State of Texas.
AND PR4VIDED FURTHER, that the said Surety, for value received, hereby stipulates
and agrees that no change, extension of time, alteratian or addition to the terms o£ tlie Cont�act,
or to the Work to be performed thereunder, or to the Plans, Specifications, Drawings, etc.,
accompanying tk�e same, shall in anywise affect its obligation on this Bond, and it does hereby
waive notice of any such change, extension of time, alteration ox 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 givez� pursuant to the �rovisions of Chapter 2253 of t�xe Texas Government
Code, as anr�ended, and any othex applicable statutes of the State of Texas.
The u�dersigned and designated age�nt is hereby designated by the Surety herein as the
Resident Agent in Denton County to whom any requisxte 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 copies each or�e of which
shall be deemed an originai, tilis the 16th day of April _, 2013 �.
ATTEST:
PR�VCIPAL
DCI Contr ' g, Inc v
BY:
VICE PRES DEN avid M. Proctor B'
SIDENT Michae�H. Davis
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ATTES :
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BY: �� ��
Ma ia J. ' ler
SURETY
Travelers Ca lt ret Company of America
BY: v..�
ATTORN Y-IN-�ACT
. Robert G. Chapman
The Resident Agent of the Su�rety in Denton County, Texas fox delivery of notice and service of
the process is:
NAME: Carmen Mims
STREET ADDRESS: 1301 E. Collins Blvd Suite 111 Richardson, TX 75081
(NOTE: Date of Performance Bond r�ust be dafe of Contract. If Resident Agent is not a corporation,
give a perso�t's name.)
PB-2
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Bond N0. 10587318i PAYMEIVT B>OND
STATE O�' TEXAS §
COUNTY OF DENTON §
KNOW ALL MEN BY THESE PRESENTS: That DCI Contractin ,g Inc•',✓
whose address is 2045 E Hwy 380 Suite 100, TX 76234 hereinafter called Principal, and
Travelo.�SAmericaty and su�-ty company a corporation organized and existing �nder the laws
of the State of , and fiilly authorized to transact business in the State of
Texas, as Surety, are held and firmly bound unto the City of Denton, a municipal corporation
organized and existing under the laws of the State of Texas, hereinafter called Owner, and unto
all persons, firms, and corporations who may furnish materials for, or perform labor upon, the
building or improvemen hereinafter refened to, in the penal sum of One Hundred Thousand
and 0/100DOLLARS�l00,00�n 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�b�e 2013-081, with the City of
Denton, the Owner, dated the 2nd day of April �.D. 2013�tor Bid #5171-Sanitary Sewer
Easement Clearin� and Gate Installation- (Payment Bond covers/Gate Installation Only
as specified in Contract Agreement dated 4/2/2013)l�
NOW, THEREFORE, if the Principal shall well, truly and faithfully perform its duties
and make prompt payment to all persons, firms, subcontractors, coiporations 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 shall be
void; otherwise it shall remain in full force and effect.
PROVIDED FURTHER, that if any legal action be tiled 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 Warlc 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 gxven pwrsuaz�t to the prov�isiox�s o� Chapter 2253 of the Texas Government
Code, as amended, and any o#her appiicable statutes of the State of Texas.
The undezsigned and designat�d agent is hereby designated by the Surety herein as the
Resident Agent in Denton County io wham any requisite not'rces ma.y be delkvered and on whom
service of process may be had in matters arising out of such s�.Erety, as provided by Axticle 7.I9-1
of the Insurance Code, Vernon's Annotated Civil Statutes of the State of Texas.
�T WYTNESS WI�EREOF, #his instrument is executed 'm £our co 'es, each one of wlnxck�
sha11 be deerned an original, this the �6tn day of April , 2013 .
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ATTEST•
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BY:
Marc a J. M er
PR�IVC�PAL
DCI Contractin , Inc. �
BY:
� �' Michael H. Davis
SURETY
Travelers Cas lt & e Com an of America
BY:
A �R -IN-FACT
Robert G. Chapman
The Resident Agent of the Surety in Denton County, Texas for delivery of natice and service af
the pracess is:
NAME: Carmen Mims
STREET ADDRESS: 1301 E. Collins Blvd, Suite 111, Richardson, TX 75081
(NOTE: Date of Payment Bond must be date of Cont�^act.
corporation, give a pewsan's natne.)
. � ,�
If Resident Agent is not a
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WARNING: THIS POWER OF ATTORNEY IS INVALID WITHOUT THE RED BORDER
,�, POWER OF ATTORNEY
TRAVELERSJ Farmington Casualty Company St. Paul Mercury Insurance Company
Fidelity and Guaranty Insurance Company Travelers Casualty and Surety Company
Fidelity and Guaranty Insurance Underwriters, Inc. 'IYavelers Casualty and Surety Company of America �
St. Paul Fire and Marine Insurance Company United States Fidelity and Guaranty Company
St. Paul Guardian Insurance Company
Attorney-In Fact No. 223296
Certificate No. o � � � � � � "' �
KNOW ALL MEN BY THESE PRESENTS: That 3t. Paul Fire and Marine Insurance Company, St. Paul Guazdian Insurance Company and St. Paul Mercury Insurance
Company aze corporations duly organized under the laws of the State of Minnesota, that Fannington Casualry Company, Travelers Casualry and Surety Company, and
Travelers Casualry and Surety Company of America are corporations duly organized under the laws of the State of Connecticut, that United States Fidelity and Guaranty
Company is a corporation duly organized under the laws of the State of Maryland, that Fidelity and Guaranty Insurance Company is a corporation duly organized under
the laws of the State of Iowa, and that Fidelity and Guaranty Insurance Underwriters, Inc., is a corporation duly organized under the laws of the State of Wisconsin
(herein collectively called the "Companies"), and that the Companies do hereby make, constitute and appoint
Cloyd W. Barnes, David G. Chapman, Robert G. Chapman!�Marcia J. Miller, and Nathan G. Chapman
of the City of Lansing , State of Michigan , their true and lawful Attorney(s)-in-Fact,
each in their separate capacity if more than one is named above, to sign, execute, seal and acknowledge any and all bonds, recognizances, conditional undertakings and
other writings obligatory in the nature thereof on behalf of the Companies in their business of guaranteeing the fidelity of persons, guaranteeing the performance of
contracts and executing or guaranteeing bonds and undertakings required or permitted in any actions or proceedings allowed by law.
IN WITN�S$ WHEREOF, the Comp�e�s�have caused this instrument to be signed and their corporate seals to be hereto affixed, tlus
J Uly
day of ,
Farmington Casualty Company
Fidelity and Guaranty Insurance Company
Fidelity and Guaranty Insurance Underwriters, Inc.
St. Paul Fire and Marine Insurance Company
St. Paul Guardian Insurance Company
18th
St. Paul Mercury Insurance Company
'IYavelers Casualty and Surety Company
'IYavelers Casualty and Surety Company oFAmerica
United States Fidelity and Guaranly Company
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�7 � �' c� : ! i a : —'— . � = W HARTFORD. � {HA�iF6� � e ����
�°qy�c�S,a 19%%� 1951 � ��^` �+;SEAL,:o3 5�'+.58AL;3� � CONN. o t caun. � �, 1896 �
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�ry
State of Connecticut
City of Hartford ss.
By:
Georg Thompson, enior ice President
18th July 2011
On this the day of , before me personally appeazed George W. Thompson, who acknowledged
himself to be the Senior Vice President of Farmington Casualty Company, Fidelity and Guazanty Insurance Company, Fidelity and Guazanty Insurance Underwriters,
Inc., St. Paul Fire and Marine Insurance Company, St. Paul Guardian Insurance Company, St. Paul Mercury Insurance Company, Travelers Casualty and 5urety
Company, Travelers Casualty and Surety Company of America, and United States Fideliry and Guaranty Company, and that he, as such, being authorized so to do,
executed the foregoing instrument for the purposes therein contained by signing on behalf of the corporations by himself as a duly authorized officer.
G•T�
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In Witness Whereof, I hereunto set my hand and official seal. ��%i � W w" �� �Vn"^^""' ��
My Commission expires the 30th day of June, 2016. � p�L�p # / Marie C. Tetreault, Notary Public
,Syv �,`fi V
58440-6-11 Printed in U.S.A. �
WARNING: THIS POWER OF ATTORNEY IS INVALID WITHOUT THE RED BORDER !N�
WARNING: THIS POWER OF ATTORNEY IS INVALID WITHOUT THE RED BORDER
This Power of Attomey is granted under and by the authority of the following resolutions adopted by the Boazds of Directors of Farnungton Casualty Company, Fidelity
and Guazanty Insurance Company, Fideliry and Guaranry Insurance Underwriters, Inc., St. Paul Fire and Marine Insurance Company, St. Paul Guardian Insurance
Company, St. Paul Mercury Insurance Company, Travelers Casualty and Surery Company, Travelers Casualry and Surery Company of America, and United States
Fidelity and Guazanty Company, which resolutions aze now in full force and effect, reading as follows:
RESOLVED, that the Chairtnan, tlte President, any Vice Chairman, any Executive V�ice President, any Senior Vice President, any V'ice President, any 5econd Vice
President, the Treasurer, any Assistant TYeasurer, the Corporate Secretary or any Assistant Secretary may appoint Attorneys-in-Fact and Agents to act for and on behalf
of the Company and may give such appointee such authoriry as lus or her certificate of authoriry may prescribe to sign with the Company's name and seal with the
Company's seal bonds, recognizances, con�acts of indemniry, and othec writings obligatory in the nature of a bond, recognizance, or conditional undertaking, and any
of said officers or the Boazd of D'uectors at any tune may remove any such appointee and revoke the power given him ar her; and it is
FURTHER RESOLVED, that the Cha'vxnan, the President, any Vice Chairman, any Executive Vice President, any Senior Vice President or any Vice President may
delegate all or any part of the foregoing authoriry to one or more officers or employees of this Company, provided that eaclt such delegation is in writing and a copy
thereof is filed in the office of the Secretary; and it is
FURTHER RESOL�TED, that any bond, recognizance, contract of indemnity, or writing obligatory in the nature of a bond, recognizance, or condiROnal undertaking
shall be valid and binding upon the Company when (a) signed by the President, any Vice Chauman, any Executive Vice President, any Senior Vice President or any �ice
President, any Second Vice President, the Treasurer, any Assistant Treasurer, the Corporate Secretary or any Assistant Secretary and duly attested and sealed with the
Company's seal by a Secretary or Assistant Secretary; or (b) duly executed (under seal, if required) by one or more Attorneys-in-Fact and Agents pursuant to the power
prescribed in his or her certificate or their certificates of authority or by one or more Company officers pursuant to a written delegation of authority; and it is
FURTHER RESOLVED, that the signature of each of the following officers: President, any Execudve Vice President, any Senior Vi ce President, any Vice President,
any Assistant Vice President, any Secretary, any Assistant Secretary, and the seal of the Company may be aff'ixed by facsimile to any Power of Attorney or to any
certif'icate relating thereto appointing Resident Vice Presidents, Resident Assistant Secretaries or Attorneys-in-Fact for purposes only of executing and attesting bonds
and undertaldngs and other writings obligatory in the nature thereof, and any such Power of Attorney or certificate bearing such facsunile signature or facsunile seal
shall be valid and binding upon the Company and any such power so executed and certified by such facsimile signature and facsimile seal shall be valid and binding on
the Company in the future with respect to any bond or understanding to which it is attached.
I, Kevin E. Hughes, the undersigned, Assistant Secretary, of Farnvngton Casualty Company, Fidelity and Guazanty Insurance Company, Fidelity and Guazanty Insurance
Underwriters, Inc., St. Paul Fire and Marine Insurance Company, St. Paul Guazdian Insurance Company, St. Paul Mercury Insurance Company, Travelers Casualty and
Surery Company, Travelers Casualty and 3urety Company of America, and United States Fideliry and Guazanty Company do hereby certify that the above and foregoing
is a hve and correct copy of the Power of Attomey executed by said Companies, which is_ in full force and effect and has not been revoked.
IN TESTIMONY WHEREOF, I have hereunto set my hand and affixed the seals of said Companies this 16 th day of Ap r il 2013
ri✓'' �
Kevin E. Hughes, Assistant Sec tary
G�SU p�}1TiI�(� F10.Ew6� ��S � �,..+��q'r. Jp�t� ANp �� � YA��
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����a � � 1951 � � �'rySEALlo�:' '-�`:.SEi'A.L%3€ d CONN. p 7y¢+�,�CONM� /jY. N �
d�y � F�j � � �Men N�E`O `�ls : AN�ff , d!S'.....�.••*�adD Ld� n��D; �� y.0�+i' � A��
���..n+" ��xm�wnm
To verify the authenticity of this Power of Attorney, call 1-800-421-3880 or contact us at www.travelersbond.com. Please refer to t e Attomey-In-Fact number, the
above-named individuals and the details of the bond to which the power is attached.
� CIT�( OF DEtVTON
INSUR�►NCE REQUIREIldIENTS FO&� CONTRACTORS
Bidder's attention is directed to tlie insura�zce reqicirenze�zts below. It i� /iiglaly recorrcn�ended
tliat bi�lrlers confer witlt tlaeir respective irzsa�wance ccz�riers or brokers to determine in advr�nce
of Bi�l submissio�z tlte avaalability of' insur�cnce certificates r�nd endors�me►its as prescrrberl
a�zd provi�led lzerein. If crn rcpparent low bic�der fr�ils to comply strictly witlz t/ae iresurrrnce
requirements, tltc�t bidder nury be disc�a�alified fronz award of the co�Ztract. Uposi bi�l award, all
insacrance reqalirements sJaal/ become con.tractual obli;atio�z�, whiclt tlie saiccessficl bidder
slaalllzave a duty to mni�ztain t/trouglaout tdte course of tltis corttract. •
STANDARD PIgOVISIONS:
Without lzmiting a�zy of the otlzei� obligationa� or liabilities of the Contrcrcto�°, the Contracto�° shall
provide and maintain irntil the contracted �-i�or�k has been completed and accepted by the City of
Denton, Orvner, the minimu»2 insurance covercrge as indicated he�^einafte��.
As soon as p�°acticable ccfter notiftcation of bid cn-t�ar�c�, Contracto�° shall file mith the Purchasing
Department sc�tisfc�ctory cer�tzficates of insu�°crnce, col�taining the bicl nurnber and title of the
p�oject. Contractoi^ mcry, zr�on rvi°itten r•eqarest to the Pu��chccsing Department, ask foN
clarifrcation of c�ny insu��crnce �°equirements ut crny time; horvever, C'ontractors are strongly
advised to make szrch r•eyzcesls prior� to bid openirrg, since the irr,surance requirements may not be
modified or tinaived afler bid opening zcnless a written exception ha� been submitted witlz the bid.
Contractor s1tall no1 canzr�T.e��ce �rny work ar rle/iver ttny material d�ntil he or she receives
notificatioiZ tltat the cantract ]tcss been rd�eceptecl, �pproved, and �i,ned by tlae City ofDenton.
All insia��i�nce policies ��•oposed o�° obtaihed in scrti.sfactio�� of these �°equi� erraents shall comply
with the follo�-ving generccl S�ecificaCions, crl�cl shcrll be mcci��tc�ined in compliance with ihese
general specifications th�°oi�ghotrl the dLn°atzon vf the Contract, or• longer°, if so noted:
• Each policy shall be issued by a company authorized to do business in the State of
Texas with an A.M. Bes# Company rating of at least A- VII or better.
• Any deductibles or selt=insured retentions shall be declared in the bid proposal. If
requested by the City, the insurzr shall reduce or eliminate such deductibles or
self-insured retentions with respect to the City, its officials, agents, employees and
volunteers; or, the contractor shall procure a bond guaranteeing payment of losses and
related investigations, claim admiiustration and defense expenses.
• Liability policies shall be endorsed to provide the following:
• Name as additional insured the City of Dentan, its Officials, Agents,
Einployees aild volunteers.
CI-9
• That such insurance is priinaiy to any other insurance available to the
additional insured with respect to claims covered under the policy and that this
_ insurance applies sepa�ately to each insured against whom claim is nzade or
suit is brought. The inclusion of more than one iusured shall not operate to
increase the insLU�er's limit of liability.
• Ca�ce/lntion: �he City �•eyuires 30 day wriften notice slzould ahy of tlze
policies desc�•eGed on tJze ce�•tifrcate be ca�zcelled or nzaterin/ly clianged
before the �rpiratioiz date.
• Should any of the required insurance be provicled undei� a claims-made form,
Contractor shall maintain such coverage continuous�y 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 terin which give
rise to claims made after expiration of the contract shall be covered.
• 5hould any of t11e required insurance be provided Lu�der � form of coverage that
includes a general amlual aggregate limit providing for claims investigation or
legal deiense 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 teim, requests far
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 tlus agreement effective on the date of the lapse.
CI - 10
SPECIFIC ADDITI�NAL INS�JRANC� R�QUIREMENTS:
All insurance policies proposed or obtai�ze�i i�a 5atisfnction of this Contract shr�ll ndditionally
comply with the folloiving marked specificr�tions, and shnll be m�intained in compliance with
these arfrlitional specifictctions tlarouglaoact tlae dacrc�tio�z of tlie C'o�ztract, o� longer, if so noterl:
[X] A. General Liability Instnrance:
General Liability insurance with comUined 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 eiiher in a single policy or in a combination of underlying and
umbrella or eYCess policies.
If the Coininercial General Liability fornl(ISO Form CG 0001 cui7ent 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 t•equired.
If the Comprehensive General Liability foi7n (ISO Form GL 0002 Current Edition a�id
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 froin explosion, collapse or undergrotmd (XCU) exposures.
Broad form contractual liability (preferably by endorsement) covering this
contract, personal injury liability and broa.d forn� property damage liability.
[X] Automobile g,iability Imsur�a��ceo
Contractor shall provide Commercial Automobile Liability insurance with Combined Single
Limits (CSL) of not less than �50�➢,000.00 either in a single policy or in a combination of
basic and umbrella or excess policies. The policy will in�clude 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 ov�med, hired and non-o�vned autos.
CI - 11
[X] Workers' Compensation Insurance
Contractar shall purchase and maintain Worlcer's Compensation insurance which, in addition
to nleeting the minimum statutory requirements for issuance of such insurance, has
Employer's Liability limits of at least $100,U00 for each accident, $100,000 per each
employee, and a$500,000 policy limit for occupational disease. The City need not be
named as an "Additional Insured" but the insurer shall agree to waive all rights of
subrogation against the City, its officials, agents, employees and volunteers for any work
performed for the City by the Named Insured. For building or construction projects, the
Contractor shall comply with the provisions of Attaclunent 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 a�c� Contr�cto�-'s Proa�c�av� Liability Insuranc�e
The Contractor shall obtain, pay for and maintain at all times during the prosecution of the
work under this contract, an Qwner's �ind Contractor's Protective Liability insurance policy
naming the City as instued for property damage and bodily injury wluch 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
carries the Contractor's liability insurance. Policy limits will be at least combined bodily
injury and property damage per occurrence witli a aggregate.
[ ] Professional Liabili�y Inswra�ce
Professional liability insurance with limits not less than per claim with
respect to negligent acts, errors or omissions in comiection with professional services is
required under this Ae eeinent.
[ ] Builders' I�isk Ins.ur�nce
Builders' Risk Insurance, on �n All-F.islc farm for 100% of the completed value shall be
provided. SLich policy shall iuclude as "Named Insured" the City of Denton and all
subcontractors as their interests may appPar.
CI - 12
[ ] Cornmercial Crime
Provides cover�ge for the theft or disappearance of cash or checics, robbery inside/outside
the premises, burglary of the premises, aiid employee fidelity. The employee fidelity
portion of this coverage should be written oii a"blanlcet" basis to cover all employees,
including new hires. This type insurance should be required if the contractor l�as access to
City funds. Limits of not less than each occurrence are required.
[ ] Additional Insura�ce
Other insurance may be required ou an individual basis for extra hazardous contracts and
specific service agreements. If such additional insurance is required for a specific contract,
that requirement �vill be described in the "Specific Conditions" of the contract specifications.
CI - 13
AT�'AC�-IMEN'I' 1
[X] Workers' Compensati�o�► Coverage for Building oe� Comstructian Projects for
Govern►nental Entities
A. Deiinitions:
Certificate of coverage ("certificate")-A copy of a cei�tificate of insurance, a certificate
of authority to self-insure issued by tr�e conlinission, or a coverage agreement (TWCC-
81, TWCC-82, TWCC-83, or TWCG34), showing statutory workers' compensation
insurance coverage for the persoi�'s or entity's employees providing services on a
project, for t17e� durati�n 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 worlc on the project has been completed and accepted by
the governll�ental 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
perfonn on the project, regardless of whether that person contracted directly with the
contractor and regardless of ��hether that person has employees. This includes, without
limitation, independent contrar,tors, 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
liinitation, 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 a# a.ny 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 governmental entity prior to
being awarded the contra�ct.
D. If the coverage period shown on the contractor's current certificate of coverage ends
during the duration flf the project, the contractar must, prior to the end of the coverage
period, file a new ce:tificate 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 begirn�ing worlc on the project, so the
govermnental entity will have on tile certificates of coverage showing coverage far
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 i�etain all required certificates of coverage for the duration �f the
project and for one year thereafter.
G. The contractor shall notity the governmental entity in wrrting by certified mail or
personal delivery, within 10 days after the contractor lcnew or should have known, of
any chailge that 7uaterially affects the provision of coverage of any person providing
services on the project.
H. The coi�tractor shall post on each project site a notice, in the text, form and manner
prescribed by the Texas Workers' Compensation Coinmission, ulfoiming all persons
providing services on the project that they are required to be covered, and stating how a
person n�ay verify coverage and report l�ck of coverage.
I. The contractor shall contractually require eacl� person with whom it contracts to provide
services an a proj ect, tr�:
1) provide coverage, Uased on proper reporting of classification codes and payroll
amounts and filing of any coverage agreeinents, which meets the statutory
requirements of TeYas Labor Code, Section 401.011(44) for all of its employees
providing services on #he project, for the duration of the project;
2) provide to the co�tractor, pri��r to th�f person beginning work on the project, a
certificate of coverage sho��ving that coverage is being provided for all employees of
the person proviciin� services on the project, for the dui•ation of the project;
3) provicie the contractor, prior to the end of the coverage period, a iiew certificate of
coverage sho�ving e;�ctension of coverage, if the coverage period shown on the current
certificate of coverage eizcls during the duration of the project;
4) obtain fi•om 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 certi6cate of coverage showing extezzsion of coverage, prior to the end of
the coverage period, if the coverage period shown on the current certificate of
coverage ends diiring the duration of the project;
CI - 15
5) retain all required certificates of coverage on file for t11e duration of the project and
for one pear thereaftei;
6) notify the goverrunental entity in writing by certified mail or personal delivery,
within 10 days after the person ltnew or shoulci have Icnown, of any change that
materially affects the provision of coverage of �ny person providing services on the
project; and
7) contractually rec�uire eac11 person with whom it conh•acts, to perforin as required by
paragra�hs (1) -(7), with the certificates of coverage to Ue 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 contractoi� is representing to the governmental entity that all employees of the
contractor vrho �vill provide services on the project will be covered by workers'
compensation coverage for the duratian of the project, that the coverage will be based on
proper reporting of classification cocles and payroll amounts, and that all coverage
agreements will be filed with the appropriate insurance carrier or, in tne case of a self-
insured, �vith t��e convnissiorl's Division of Self-Insurauce 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 wliicl� entitles the governmental entity to declare the contract void if the
contractor do�s not remeciy the breach withiu ten days after receipt of notice of breach
from the govermneiltal entity.
CI - 16
NFLICT OF INTEREST C�U�STI�h9NAIRE
For vendor or other person dounel business with local governmental ent
This questionnaire reflects changes made to the law by H.B. 1491, 80th Leg., Regular Session
FORM CIQ
OFFICE USE ONLY
This questionnaire is being filed in accordance with chapter 176 of the Local Government Code by a I 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 176.006, Local Government Code. An
offense under this section is a Class C misdemeanor.
Name of person who has a biasiness re9ationshi� with local governm4ntal entity.
� Check this box if you are filing an updat� to a previously faled 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 v�ith whom filer has an em�l�yrroent 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-al, Lor,al Government Code. Attach additional pages to this Form CIQ as necessary.
A. Is the local government officer namecl in this section receiving or likely to receive taxable income, other than investment income, from the
filer of the questionnaire?
0 Yes � No
B. Is the filer of the questionnaire receiying or likely to r�ceive taxable income, other than investment income, from or at the direction of the
local government officer named in this seciion 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.
Signature of person doing business with the governmental entity
CIQ - 1
Date
Adopted 06/29l2007
SID #5171
PROPOSAL
TO
THE CITY OF DENTON, TEXAS
FOR THE CONSTRLTCTIQN OF
SAlyITARY SEWER EASEMENT CLEARING AND GATE
INSTALLLATION
II'
DENTON, TEXAS
The undersigned, as bidder, declares that the only persoil or parties interested in this proposal as
principals are those named herein, that tlus proposal is made without collusion with any other
person, firm, or corporation; that he has carefully examined the form of contract, Not�ce to Bidders,
specifications and the plans therein refen•ed to, and has carefully examuied the locations,
conditions, and classes of rnaterials .of the proposed work and a�ees that he wi11 provide all the
necessary labor, inachinery, tools, apparatus, and other items incidental to construction, and wiil do
all the work and fumish all the materials called for in the contract and specifications in the manner
prescribed herein and according to the requirements of the City as therein set forth.
It is understood that the following quantities of woxk to be done at uriit prices are approxunate only,
and are intended principally to serve as a guide in evaluating bids.
It is a�eed that the quantities of work to be done at unit prieas and material to be fiunished may be
ulcreased or dimiuished as may be considered necessary, in the opinion of the City, to complete the
work fully as planned and contemplated, and that all quantities of work whether increased or
decreased are to be performed at the unit prices set forth below except as provided for in tlle
specifications. The oontractor shall provide the numeric unit price and the unit price in words for
each quantity. Unit price in words governs Qver the nurneric price given.
It is further ab eed that change orders may be negotiated between the contractor and Gity #o cover
additional wark ordered by the Ciiy, but not shown on the plans or required by the specifications, in
accordance with the General Pravisions. Similarly, change orders may be negotiated to cover
deletion of work so ordered.
P-1
Project Name Calendar Days 365
- -- . _ __ _ __ ___
Sanitary Sewer Easement Clearing and Gate lnstalfation Bid Na 5171
_ _ - : P.O. No.
_ _ BID TABULATION SHEET
�tem Description Quantity Unit ; Unit Pcice ` Total
103.3 - Surety Bands 1 L3 $�i�0oo / LS $�gi Ooa .
Unit Price In Words sG1G1�'i -�a �Se�aA flo �cA.lsS •
�
SS10-A 16' Easement Clearing 79;000 LF $'2 •�.d '/ LF �'►l3 $e�
Unit Price In Words 1 r10- Da��l.Q.S TaS'c*'1t`! �-i'c•�`aS
SS10-B 26' Easement Clearing 10,900 LF $���� / LF $�1,e4 0
Unit Price In Words '�iR.,�� -Deu..ea.S Con-ti - �Se�s� 5
SS11 Gate Installation 100 EA $ �� o o� 1 EA $ �o o,n e o
: 1� 1 � •
TOTAL BASE BID PRIGE IN WORDS:
'�TN'�ZEE - HuaD[ti� �tr� �'t��SD.,•� D �1(s�i - Kv�+DRC� Skz N Da �•.d�. S
The award of the contract will be based on the Total Base Bid. The lowest responsive proposal for
purposes of award shall be the conforming responsible bidder offering the lowest cost for the base
bid.
In tlie event of the award of a contract to the undersigned, the undersigned wi11 furnish a
perFormance bond and a payment bond .for the full amount of the contract, to secure proper
compliance with the terms and provisions of the contract, to insure and guarantee the work uritil
final completion and acceptance, and to guarantee payment for all lawful clauns for labor
performed and materials fiirnished in the fiilfillmerit of the contract.
It is tuzderstood that the work proposed to be done shall be accepted, when fully completed and
finished in accordance with the plans and specifications, to the satisfaction of the Engineer.
The undersi�ed certifies that the bid prices contained in this proposal have been carefully checked
and are submitted as co�sect 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 property of the City of Denton after tha official
opening.
The undersigned affirms that they are duly authorized to execute this contract.
Vendor hereby assigns to purchaser any and all clairns for overchasges associated with this
contract which arise under the antitrus# laws of the United States, 15 USCA Section 1 et seq., aild
which arise under the antitrust laws of the State af Texas, Tex. Bus. & Com. Code,
Section 15.01, et se .
�!
Receipt is hereby acknowledged of �t}le follovaing addenda to the plans and specifications:
Addendum No. 1 dated ,� -�5 -! 3 Received ,�
Addendtun No. 2 dated Received
Addendum. No. 3 dated Received
Addendum No. 4 dated Received
Addendum No. 5 dated : Received
�C � Cor�k( a_c_�; +na T vtC. .
CONTR.ACTOR
BY
C� rE� 51�e.�r c�n .�f • t�.
�ay5 �. �su 38A, S�-L�e �oo
Street Address
7e.ca��r E T K 1 �.o � 3�
City and State
Seal & Authorization
(If a Corporation) ���- �a� � o�aa
Telephone
P-5
VENDOR COMPLIANCE TO STATE LAW
The 1985 Session of the Texas Legislature passed House Bill 620 relative to the awa.rd 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 pi?ncipal place of business
are outside of the State of Texas) bid projects for construction, improvements, supplies or services
in Texas at an ausoiult lower than the lowest Texas resident bidder by the sa.ine amoluzt#hat a Tex�s
resident bidder would be required to underbid a non-resident bidder in arder to obtain a comparable
contract in the state in which the non-resident's principal place of business is located, The
appropriate blanks iu 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
to do so will automatically disquali�y that Uidder. 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 thati resident bidders by state la�v.
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, Ot�r principal place of business or corparate offices are in the State of Texas: �
�:1����]�l:ii
,�i Ci Can�ro_Ck, Yl�t , �'r1c.
COMPANY
BY J`J
C-��eq S�e.+r,n,�a-n , V � r�•
,�0�15 E. klwti � , 5.��-Fe �oo
Street Address
cQ� F-rx `t�a��
City and State
THIS F�RM MUST BE RETURNED WITH YQUR BID.
. �
CONTRACTOR COMPLIANCE TO TEXAS SALES TAX CODE
Comply with all requirements of the Texas Sales Tax 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)
A11 other charges a.nd costs
Total
The total must eqLial the total amount of the Contract.
CONTRACTOR:
g qo �oo 0
$ ZZ8,aG�
� 3i 8 , �6a
�Ca �n��ar�na . T'r'LC.
COMPANY
BY -
� rea� �hP�c rv�D-x� k V � �.
�0�15 E. �k�su 3go, �u:►ke loo
Street Address
�����, Tx � � a��
City and State
THIS F�RM SI3ALL BE E�+ CUTED AT THE TIME QF EXECUT�ON OF TFIE
CONTRACT AND SHALL BE MADE A PART OF THE CONTRACT.
P-7
CONFLICT OF INTEREST QUESTIONNAIRE
For vendor or other person doing business with local governmental entity
This questionnaire reflects changes made to the law 6y H.B. 1491, 80th Leg., Regular Session.
This questionnaire is being filed in accordance with Chapter 176, Local Government Code
by a person who has a business relafionship as defined by Section 176,001(1-a) with a Iocal
governmental entiry and the person meets requirements under Section 176.006{a).
By law th[s questiannaire must be filed with the records administrator of th� local govemmental
entity notlaterthan the 7fh business day afterfhe date the person becomes aware offacts
that r�quire the statement to be filed. See Section 176.006, Local Government Code.
A person commits an offense if the person knowingly violates Section 176.D06, Local
Government Code. An offense underthis section is a Class C misdemeanor.
Name of person w4o has a business relationship with local governmental entity.
C-� Y�q S1ne� rr��►-n � v��.
❑ Check this box ifyou are filing an update to a previously filed questionnaire.
FORM CIQ
OFFICE U5E ONLY
Date Received
(The law requires that you file an updated complefed questionnaire with the appropriate filing authority not
later than the 7th business day after the date the originafly filed questionnaire becomes incomplete or inaccurate.)
IVame of locai government officerwlth whom filer has employment or business relafionship.
I� O�f1.�
Narne of Offcer
This seciion (item 3 including subparts A, B, C& D) must 6e completed for each o�cer with whom the filer has an
employment or other business relationship as defined by Section �76,001(1-a), Local Govemment 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 n No
L�J
B. Is the filer of the questionnaire recei�ing or likely to receive taxable income, other than investment income, from or at the
direction of the local government o�cef named in this section AND the taicable income is not received from the local
governmental entity?
� Yes � No
C. Is the filer of this questionnaire employed 6y a corporation or other business entfty with respect to which the local
govemment officer serves as an officer or director, or holds an ownership of 10 percent or more?
� Yes � No
D. Describe each employment or business relationshtp with the iocal government officer named in this section.
1� o�n.�
Signature of pe doing 6usiness with the govemmental entity
�-�8-��
Date
Adapted �S/29/2007
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,a��sro ���-�BFICA�E OF LdA�3�LI�Y �NSUt�6�CE DATE(MMID�lYYYY)
04123/20'i 3
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPOfV 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 aR PRODUCER, AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must 6e 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 nat confer rights to the
certificate holder in lieu of such endorsement(s).
PRODUCER Phone: 517-321-4600 NAME:CT Marci Kohler
David Chapman Agency, Inc. Fax: 517-321-9443 PHONE 517-321-4600 F'4X 517-321-9443
5700 W. Mt. Hop e Highway ,vc No Ext: AIC No :
Lansing, MI 48�J17- E�MA�� mkohlern davidcha mana enc com ',
David Chapman ADORESS: 1,:, P 9 Y•
PRODUCER
ri icrnn�oo in �e. DAVCO-'I I
INSURED uci contracting� �IIC:.fi
2045 E. US Hwy 380, #100
Decatur, TX 76234
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INSURER(S) AFFORDING COVERAGE
iNSUReRn:Great Midwest Insurance Com
iNSUReR s: The Accident Fund Co
INSURER C :
INSURER D :
INSURER E :
NAIC #
10166
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.
ILTR TYPE OF INSURANCE DDL aR pOLICY NUMBER MMIDI DY� MM �D� LIMITS
GENERALLIABILITY 'EACHOCCURRENCE $ 'I�OOO�OO �
A X COMMERCIALGENERALLIABILITYf X/ PP00025560-01� 12I16/2012 12/16l2013 pREMISES Eaoccurtence S 300,40
CLAIMS-MADE a OCCUR� MED EXP (Any one persanJ S 5,00
X X,C,U included `� PERSONAL 8 ADV INJURY S �,���,QO
X Contractual liab � GENERALAGGREGATE S Z,U�0,00 �
GEN'LA�GREGATELIMITAPPLIESPER: PRODUCTS-COMP/OPAGG $ 2,000�00
POLICY X PR� LOC $
AUTOMOBILE LIABILITY`� )( �ONIBINED SINGLE LIMIT a � OOO,OO �
A x ANY AUTO� CA00025465-01 � 12/16/2012 12/16/2013 �Ea accident) �
BODILY INJURY (Per person) $
ALL OWNED AUTOS BODILY INJURY (Per accidentJ $
SCHEDULED AUTOS
PROPERTY DAMAGE $
i� HIREDAUTOS (Peraccident)
X NON-OWNED AUTOS $
$
UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ S�OOO�OO
E%CESS LIAB CLAIMS-MADE AGGREGATE $ S�OOO�OO
A X CX00000235-01 12/16/2012 12/16/2013
DEDUCTIBLE 3
X RETENTION $ 'IO,OOO §
WORKERS COMPENSATION ✓ X T RY L MITS ��ER
ANq EMPLOYERS' LIABILITY Y� N /
B ANYPROPRIETORIPARTNERIEXECUTIVE WCV0321618 'I'II'I6/2O'I2 11/1612013 E.L.EACHACCIDENT $ 'I�OOO,OO �
OFFICER/MEMBER EXCLUDED7 � N � /
(Mandatory in NH) ALL STATES, INCL TEXAS� E.L. DISEASE-EA EMPLOYE $ 'I,OOO,OO /
If yes, describe under ,
DESCRIPTIONOFOPER4TIONSbelaw E.L.DISEASE-POLICYLIMIT $ �,OOO,OO
DESCRIPTION OF OPERATION5/ LOCATIONS 1 VEHICLES �Attach ACORD 101, Additional Remarks Schedule, if more space is required)
Ref: Sanitary Sewer Easement Clearing and Gate Installation, Denton Texax ✓
Cit of Denton, its Officials Aqents{ Employees and Volunteers are named as
a3di iona insureds on Genera� Liability and Umbrella per CG2033r30-Day /
otlT`ice o Cf ancellation is provided for General Liability, Auto Liability,
Umhrella and Workers Comp. Such insurances available to all additional
C
City of Denton `�
215 E McKinney Street
Denton, TX 76201
ACORD 25 (2009/09)
CITYDEN
CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCOR�ANCE WITH THE POLICY PROVISIONS.
AUTHORIZE� REPRESENTATIVE /
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The ACORD name and logo are registered marks of ACORD