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2015-312ORDINANCE NO. 2015 -312 AN ORDINANCE ACCEPTING COMPETITIVE BIDS AND AWARDING A PUBLIC WORKS CONTRACT FOR THE CONSTRUCTION OF THE COUNTRY CLUB MOBILE HOME PARK, NETTIE SCHULTZ PARK, AND WOODHAVEN STREET SANITARY SEWER REPLACEMENTS PROJECT FOR THE CITY OF DENTON; PROVIDING FOR THE EXPENDITURE OF FUNDS THEREFOR; AND PROVIDING AN EFFECTIVE DATE (BID 5877- AWARDED TO THE LOWEST RESPONSIBLE BIDDER MEETING SPECIFICATION, DICKERSON CONSTRUCTION COMPANY, IN THE AMOUNT OF $1,002,073). WHEREAS, the City has solicited, received and tabulated competitive bids for the construction of public works or improvements in accordance with the procedures of State law and City ordinances; and WHEREAS, the City Manager or a designated employee has received and recommended that the herein described bids are the lowest responsible bids for the construction of the public works or improvements described in the bid invitation, bid proposals and plans and specifications therein; NOW, THEREFORE, THE COUNCIL OF THE CITY OF DENTON HEREBY ORDAINS: SECTION 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 CONTRACTOR AMOUNT 5877 Dickerson Construction Company $1,002,073 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 City Manager is hereby authorized to execute all necessary written contracts for the performance of the construction of the public works or improvements in accordance with the bids accepted and approved herein, provided that such contracts are made in accordance with the Notice to Bidders and Bid Proposals, and documents relating thereto specifying the terms, conditions, plans and specifications, standards, quantities and specified sums contained therein. SECTION 4. The City Council of the City of Denton, Texas hereby expressly delegates the authority to take any actions that may be required or permitted to be performed by the City of Denton under File 5877 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 .... day of e;t -j .ITIT_, 2015. ATTEST: JENNIFER WALTERS, CITY SECRETARY BY: APPROVED AS TO LEGAL FORM: ANITA BURGESS, CITY ATTORNEY BY :�y� ..... .�� w. CONTRACT AND BE'TWEETI CITY OF DENTON, TEXAS AND DICKERSON CONSTRUCTION (IFB 5877) STATE OF TEXAS § COUNTY OF DENTON § THIS AGREEMENT, made and entered into this 20 th day of October A.D., 2015, 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 Dickerson Construction Co Inc 1130 N. Louisiana Celina TX 75009 of the City of Celina, County of Collin, and State of Texas , hereinafter termed "CONTRACTOR." WITNESSETH: That for and in consideration of the payments and agreements hereinafter mentioned, to be made and performed by OWNER, and under the conditions expressed in the bonds attached hereto, CONTRACTOR hereby agrees with OWNER to commence and complete performance of the work specified below: IFB #5877 — COUNTRY CLUB MOBILE HOME PARK, NETTIE SHULTZ PARK, AND WOODHAVEN STREET SANITARY SEWER REPLACEMENTS in the amount of $1,002,073.00 and all extra work in connection therewith, under the terms as stated in the General Conditions of the agreement; and at his (or their) own proper cost and expense to furnish all materials, supplies, machinery, equipment, tools, superintendence, labor, insurance, and other accessories and services necessary to complete the work specified above, in accordance with the conditions and prices stated in the Proposal 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 the plans, which includes all maps, plats, blueprints, and other drawings and printed or written explanatory matter thereof, and the Specifications therefore, as prepared by: C1tv of Denton E,CI i ti( ", i l y,mmServices all of which are referenced herein and made a part hereof and collectively evidence and constitute the entire contract. It is mutually understood and agreed by and between City and Contractor that Contractor is an independent contractor and shall not be deemed to be or considered an employee of the City of Denton, Texas, for the purposes of income tax, withholding, social security taxes, vacation or sick leave benefits, worker's compensation, or any other City employee benefit. City shall not have supervision and control of Contractor or any employee of Contractor, and it is expressly understood that Contractor shall perform the services hereunder according to the attached IFB 5877 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 HIND 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, OR 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 THE 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 within the time stated in the Proposal, subject to such extensions of time as are provided by the General and Special Conditions. The OWNER agrees to pay the CONTRACTOR in current funds the price or prices shown in the Proposal, which forms a part of this contract, such payments to be subject to the General and Special Conditions of the Contract. 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 kept until all audit tasks are completed and resolved. These books, records, documents and other evidence shall be available, within 10 business days of written IFB 5877 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 thereof. Each of the terms "books" "records" "documents" 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 final printed document. IFB 5877 IN WITNESS WHEREOF, the parties of these presents have executed this agreement in the year and day first above written. ATTEST: .. _a APPROVED AS TO FORM: I. °I. f ATTORNEY IFB 5877 City of Denton— OWNER ) (SEAL) (tv CONTRACTOR NAME MAILING ADDRESS PHONE NUMBER 94) - .3 81 -21043 ITAX NUMBER BY: AUTHORIZED AGENT —was r�1 PRINTED NAME (SEAL) TITLE MAX-13 %'."q 01 r I U NOW*] 010 VAN I LINE '1 1 I ' I • Without limiting any of the other obligations or liabilities of the Contractor, the Contractor shall provide and maintain until the contracted work has been completed and accepted by the City of Denton, Owner, the minimum insurance coverage as indicated hereinafter. Contractor shall file with the Purchasing Department satisfactory certificates of insurance including any applicable addendum or endorsements, containing the contract 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, Contractor shall not commence any work or deliver any material until he or she receives notification that the contract has been accepted, approved, and signed by the City of Denton. All insurance policies proposed or obtained in satisfaction of these requirements shall comply with the following general specifications, and shall be maintained in compliance with these general specifications throughout the duration of the Contract, or longer, if so noted. • Each policy shall be issued by a company authorized to do business in the State of Texas with an A.M. Best Company rating of at least A or better. • Any deductibles or self - insured retentions shall be declared in the proposal. If requested by the City, the insurer shall reduce or eliminate such deductibles or self - insured retentions with respect to the City, its officials, agents, employees and volunteers; or, the contractor shall procure a bond guaranteeing payment of losses and related investigations, claim administration and defense expenses. • Liability policies shall be endorsed to provide the following: Name as Additional Insured the City of Denton, its Officials, Agents, Employees and volunteers. �^ That such insurance is primary to any other insurance available to the Additional Insured with respect to claims covered under the policy and that this insurance applies separately to each insured against whom claim is made or suit is brought. The inclusion of more than one insured shall not operate to increase the insurer's limit of liability. • Cancellation: City requires 30 day written notice should any of the 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 tern 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. 03,1010 � �i 1 11 711101IM-3 011%,1111,111 1''', ...... . ...... [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. If the Comprehensive General Liability form (ISO Form GL 0002 Current Edition and ISO Forrn GL 0404) is used, it shall include at least: • Bodily injury and Property Damage Liability for premises, operations, products and completed operations, independent contractors and property damage resulting from explosion, collapse or underground (XCU) exposures. • Broad form contractual liability (preferably by endorsement) covering this contract, personal injury liability and broad form property damage liability. [X] Automobile Liability Insurance: Contractor shall provide Commercial Automobile Liability insurance with Combined Single Limits (CSL) of not less than $500,000 either in a single policy or in a combination of basic and umbrella or excess policies. The policy will include bodily injury and property damage liability arising out of the operation, maintenance and use of all automobiles and mobile equipment used in conjunction with this contract, iPIRMEN MOM • any auto, or • all owned hired and non-owned auti [X] Workers' Compensation Insurance E= UMMMFAGM= Coverage is required if Broad form General Liability is not provided or is unavailable to the contractor or if a contractor leases or rents a portion of a City building. Limits of not less than each occurrence are required. Professional Liability Insurance Professional liability insurance with limits not less than $1,000,000.00 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. ATTACHMENT 1 [X] Workers' Compensation Coverage for Building or Construction Projects for Governmental Entities A. Definitions: Certificate of coverage ( "certificate ") -A copy of a certificate of insurance, a certificate of authority to self - insure issued by the commission, or a coverage agreement (TWCC -81, TWCC -82, TWCC -83, or TWCC -84), showing statutory workers' compensation insurance coverage for the person's or entity's employees providing services on a project, for the duration of the project. Duration of the project - includes the time from the beginning of the work on the project until the contractor's /person's work on the project has been completed and accepted by the governmental entity. Persons providing services on the project ( "subcontractor" in §406.096) - includes all persons or entities performing all or part of the services the contractor has undertaken to perform on the project, regardless of whether that person contracted directly with the contractor and regardless of whether that person has employees. This includes, without limitation, independent contractors, subcontractors, leasing companies, motor carriers, owner- operators, employees of any such entity, or employees of any entity which furnishes persons to provide services on the project. "Services" include, without limitation, providing, hauling, or delivering equipment or materials, or providing labor, transportation, or other service related to a project. "Services" does not include activities unrelated to the project, such as food/beverage vendors, office supply deliveries, and delivery of portable toilets. B. The contractor shall provide coverage, based on proper reporting of classification codes and payroll amounts and filing of any overage agreements, which meets the statutory requirements of Texas Labor Code, Section 401.011(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 contract. D. If the coverage period shown on the contractor's current certificate of coverage ends during the duration of the project, the contractor must, prior to the end of the coverage period, file a new certificate of coverage with the governmental entity showing that coverage has been extended. E. The contractor shall obtain from each person providing services on a project, and provide to the governmental entity: 1. a certificate of coverage, prior to that person beginning work on the project, so IFB 5877 the governmental entity will have on file certificates of coverage showing coverage for all persons providing services on the project; and 2. no later than seven days after receipt by the contractor, a new certificate of coverage showing extension of coverage, if the coverage period shown on the current certificate of coverage ends during the duration of the project. F. The contractor shall retain all required certificates of coverage for the duration of the project and for one year thereafter. G. The contractor shall notify the governmental entity in writing by certified mail or personal delivery, within 10 days after the contractor knew or should have known, of any change that materially affects the provision of coverage of any person providing services on the project. H. The contractor shall post on each project site a notice, in the text, form and manner prescribed by the Texas Workers' Compensation Commission, informing all persons providing services on the project that they are required to be covered, and stating how a person may verify coverage and report lack of coverage. I. The contractor shall contractually require each person with whom it contracts to provide services on a project, to: 1. provide coverage, based on proper reporting of classification codes and payroll amounts and filing of any coverage agreements, which meets the statutory requirements of Texas Labor Code, Section 401.011(44) for all of its employees providing services on the project, for the duration of the project; 2. provide to the contractor, prior to that person beginning 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. a certificate of coverage, prior to the other person beginning work on the proj ect; 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; IFB 5877 5. retain all required certificates of coverage on file for the duration of the project and for one year thereafter; 6. notify the governmental entity in writing by certified mail or personal delivery, within 10 days after the person knew or should have 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 all 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 administrative penalties, criminal penalties, civil penalties, or other civil actions. K. The contractor's failure to comply with any of these provisions is a breach of contract by the contractor which entitles the govermnental 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. 1FB 5877 IFB 5877 - Pricing Sheet for Construction of Wastewater Improvements for Country Club MHP, Nettie Schultz Park and Woodhaven St Respondent's Name: Dickerson Construction II Principal Place of Business (City and State) Celina, TX III Respondent is a Corporation, Partnership, sole Proprietorship, Indvidual? Corporation Total calendar days after Notice to Proceed is issued by City for substatial IV completion (Maximum of 180): 180 V JTotal calendar days after Notice to Proceed is issued by City for project start: 45 Wastewater Proposal Pricing: Item Description Quantity Unit Unit Price Total 1 Excavation Protection 5530 LF $ 2.00 $ 11,060.00 2 Temporary Erosion Control 1 LS ! $ 11,000.00 $ 11,000.00 3 4' I.D. Concrete Manhole (0 -6 ft deep) 17 EA $ 3,000.00 $ 51,000.00 4 5' I.D. Concrete Manhole (0 -6 ft deep) 2 EA $ 4,500.00 $ 9,000.00 5 4' I.D. Concrete Drop Manhole (0 -6 ft deep) 5 EA $ 3,350.00 $ 16,750.00 6 5' I.D. Concrete Drop Manhole (0 -6 ft deep) 1 EA $ 5,000.00 $ 5,000.00 7 4' I.D. Fiberglass Manhole (0 -6 ft deep) 1 EA $ 7,500.00 $ 7,500.00 8 Additional Concrete Manhole Depth ( >6 ft deep) 82 VF $ 200.00 $ 16,400.00 9 4" Sanitary Sewer Service 27 EA $ 3,000.00 $ 81,000.00 10 6" Sanitary Sewer Service 1 EA $ 4,000.00 $ 4,000.00 11 8" Sanitary Sewer with Pavement Repair 1596 LF $ 142.00 $ 226,632.00 12 8" Sanitary Sewer Unpaved 385 LF $ 68.00 $ 26,180.00 13 10" Sanitary Sewer with Pavement Repair 99 LF $ 145.00 $ 14,355.00 14 10" Sanitary Sewer Unpaved 3450 LF $ 70.00 $ 241,500.00 15 8" Sanitary Sewer in Casing 30 LF $ 35.00 $ 1,050.00 16 10" Sanitary Sewer in Casing 220 LF $ 40.00 $ 8,800.00 17 16" Steel Casing by Bore 250 LF $ 335.00 $ 83,750.00 18 Cut and Plug Existing Sanitary Sewer Line 7 EA $ 500.00 $ 3,500.00 19 Abandon Existing Manhole 7 EA $ 1,000.00 $ 7,000.00 20 Remove Existing Manhole 11 EA $ 1,000.00 $ 11,000.00 21 Bypass Pumping 1 LS $ 25,000.00 $ 25,000.00 22 Water Main Lowering 3 EA $ 4,500.00 $ 13,500.00 23 Concrete Drainage Channel /Sidewalk Repair 3937 SF $ 8.00 $ 31,496.00 24 12" Sleeve Pipe 3 EA $ 1,000.00 $ 3,000.00 25 Seeding Turf Grass 12800 SY $ 2.00 $ 25,600.00 Wastewater Total $ $ 935,073.00 Common ........ Items Proposal Pricing: _ Item Description Quantity Unit Unit Price Total 70 Surety Bonds 1 LS $ 30,000.00 $ 30,000.00 71 Project Signs 2 EA $ 1,000.00 $ 2,000.00 72 General Site Preparation 1 LS $ 15,000.00 $ 15,000.00 73 Barricades, Warning Signs and Detours 1 LS $ 20,000.00 $ 20,000.00 Common Items Total $ 67,000.00 Base Bid Total (Wastewater +Common) $ 1,002,073.00 BID SUMMARY TOTAL BASEBU) PRI%'.'E IN WORDS- 6to The award of the conttuct %rill be b&wd on the `Total Buc Bid.1be lowest responsive proposal for purposes of award shall be the conforining responsible bidder offiering the lowest cost for the base bid. In the event of the award of a contract to the undemigned, the undersigned M411 furnish a performance bond and a payment bond for the full arnount of the c►iltraM to secure proper compliance with the iems and provisions of the contract, to insure and guarantee the work u Wil final completion and a and to gumnice payment for all lawful claims for labor performed and materials furnished in the fullidirnent of the contract. It is understood ftt the work proposed to be done shall be accepted, when fully completed and finished in accordance with the plans and sp=i fications, it) the satisfaction or the Lngimcr. The undersigned certifies that the bid prices contained in this pray sal have been carefully checked and are sutnitted as correct and final. Unit and lump sum prices as shown for each item listed in this proposal. shall control over extensions. The undersigtied agrees this bid becomes the property of the City of Denton after the official opening. The undersigned affin-n-s that they are duly authorized to exceatc this contract. Vendor hereby assigns to purchaser any and all claims for overcharges associated with this contract which arise under the antitrust laws of the United States, 15 USCA Section 19 "se 7 and which arise under the antitrust laws of the State of Tcxas, Tex. Bus. & Com. Code. Section 15.0 1, g "Sc , WW iiiiiiiiI III IIIIJI11111 11 111� I III Ill Jill 11111111 iiiiiiiiiiii'lli�ilill Illir 111111111111111111111 1111�11111 Addendurn No. I dated 7, Addendum No 2 dawd Addendum No. 3 deed Ad&ndum'46. 4 dated ........... Addendum No. 5 daled, ... ............ ...... ....... tAddrcss it and Statc Sad & Authorization (If a Corpomfion) Tc1cphone am, A. Non-resident bidders in I ve statc), our principal place of busines& are required to be Wders by state law. __pement lower than resident bi A copy of -ffic statute is attacha Non-resident bidders in - --.1 : . ..... . .... .. .. .. ........... (give Mate), our prim pal place of business. . ....... are not required to underbid resident bidders. B. Our principal place of business or corporate offices are i ) the State of Texas, 1,11111 COMPANY BY .......... .......... 3c.......... ... ... Street Address City and State THL13 FD BMML LST —BE kl-,',jT- LII&ERAIIN —MI—JR-UM. I= Comply with all requirements of the Texas Sales Tax Code. The Contrddur hemby cedifies that the Contract Amount 6 divided as follows: MaterWs incorporated into the Pmjact 9�= �� IM Ile total must equal the total amount of the Contract CONTRACTOR: CNA �-o - - --- - ----------------------------- ---- ----- kz-! +fir r ..... ... ............ Street Addrc,% C4 and State 4 - - - --------- I A N x"51 , 18 t_ QN ' AIM RE CONFLICT OF INTEREST QUESTIONNAIRE FORM - For vendor Y t. ther pema doing busimm + iocai gavemmental D m_@ of perain_ t qav 1 "af3flir. ElCheek this box if you are tiling an updM to a previously tiled quetatlairlirsalre. (The law requires that you file air updated Completed questionnaire with the epproprisate filing authority not later than the 7th businew day after the data the originally filed questionnaire becomes incorrOote or irra 6dr�te.� Name of local gwvamment officer vAth whom filer hv4 emplaymentar business relationship. Name of Offica This eec6on (Rates 3 Including subparts A, B, C & D) must be cornftleed for each officer with whom the filer has an employment or other business, relabonshilp as defined by Section 170.001(1 -a), Local Government Cam. Attach additional page's to thia Fora CIO as necessary. A to die local government officer named in this section remiving or likely to rewhe taxable income, other tf;an Investment inome, from the Mier of" queetionnairs? S. is the filer of the questionr6ire racalrviing or Ilk* to recelue taxable income, other than investmerd income, from or at the direction of the tocel government officer named in this section AND the taxable income is not received from the local governmental antity? "yes W C. Is the filer of this que lonnalre employed oy a corporation or other business entity wb respect to Which the local governimant officer sera as an ofkAr or direr, or holds an ownership c - 10 percent or more? ED YMS ED No D. Describe each employment or bAneas ratatlonship with the local acivernmart, officer named in thia aWjorl, ftr Oja of persm 4k00q bmiriese Wth ft gweMrrrantal 811111y [ Adopled 0612912007 AC "R0 CERTIFICATE OF LIABILITY INSURANCE THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. T CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES asLmvv THIS CERTIFICATE or INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING |mouRsR(m).AuTnomIZso REPRESENTATIVE onPRODUCER, AND THE CERTIFICATE HOLDER. /MpmmTAmr: n the certificate holder ioan ADDITIONAL INSURED, the pnxxv(iou) must uoendorsed. n SUBROGATION |a WAIVED, subject wo the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights uothe certificate holder in lieu of such endorsement(s). PRODUCER Hotchkiss Insurance Agency, LLC PHONE �AX 972-512-7799 4120 International Parkway n, , Carrollton TX 75007 ADDRESS, dallascerts@hiallc.corn INSURER ^Jexma Mutual Insurance INSURED DICKCON-01 Dickerson Construction Co,|no JLD Trucking, Inc. INSURER 0: P.O. Box 181 Celina TX75008 COVERAGES CERTIFICATE NUMBER: 1571025588 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERMOD 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, COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ PRO POLICY ANY AUTO BODILY INJURY (Per person) t ALL OWNED SCHEDULED AUTOS AU TOS BODILY INJURY (Per accident) UMBRELLA LIA OCCUR EACH OCCURRENCE S EXCESS LIAB CLAIMS-MADE AGGREGATE 16 OTH- AND EMPLOYERS' LIABILITY AL OFFICER/MEMBER EXCLUDED? N/A (Mandatory In NH) $1.000,000 if yes, describe under ]DESCRIPTION OF OPERATIONS below I.r - E.L DISEASE - POLICY LIMIT $ 1.000,000 - . ._ ... . ................ . ..... DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) The workers compensation policy includes blanket waiver of subrogation form WC420304B. RE: #IFB 5877, Country Club Mobile Home Park Sanitary Sewer Replacements CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Denton ACCORDANCE WITH THE POLICY PROVISIONS. 901 -A Texas St Denton TX 76209 AtrrHORVED REPRESENI'A'rivE AAA @198u-2W4AcOmo CORPORATION. All rights reserved. ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD WORKERS' COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 42 03 04 B TEXAS WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT This endorsement applies only to the insurance provided by the policy because Texas is shown in Item 3.A. of the Information Page. We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce our right against the person or organization named in the Schedule, but this waiver applies only with respect to bodily injury arising out of the operations described in the Schedule where you are required by a written contract to obtain this waiver from us. This endorsement shall not operate directly or indirectly to benefit anyone not named in the Schedule. The premium for this endorsement is shown in the Schedule, Schedule 1, ( ) Specific Waiver Name of person or organization ( X ) Blanket Waiver Any person or organization for whom the Named Insured has agreed by written contract to furnish this waiver. 2. Operations: ALL TEXAS OPERATIONS 3. Premium The premium charge for this endarsernent shall be 2_, 00 percent of the premium developed on payroll in connection with work performed for the above person(s) or organizations) arising out of the operations described. 4. Advance Premium INCLUDED, SEE INFORMATION PAGE, 1 his endorsement changes the policy to which it is attached effective on the inception date of the policy unless a different date is indicated below (The following "attaching clause" need be completed only when This endorsement is issued subsequent to preparation of the policy I This endorsement, effective on at 12 01 A M standard time, forms a part of Policy No TSF- 0001129369 20150306 of the Texas Mutual Insurance Company Issued to D I CKERSON CONSTRUCTION CO INC Premium $ NCCI Carrier Code 29939 WC420304B (ED. 6 -01 -2014) Endorsement No. lu Authorized Representative INSURED'S COPY GUSER 3 -05 -2015 DATE (MM/DDfYYYY) AC R" CERTIFICATE OF LIABILITY INSURANCE 10 /22/2015 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the Certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorserrient(s), PRODUCER CONTACT Ann Macomber AX, Scarbrough Medlin & Associates, Inc. 121,.��333 x144 F 214.423.3350 5700 Granite Pkwy, #500 INSURER(S) AFFORDING COVERAGE NAIC # Plano TX 75024 INSURER A.MaXUM Indemni Company 26743 INSURED Dickerson Construction Co. Inc. INSURERB.EMC Insurancll�,"Companies P.O. Box 181 INSURER C 1130 N Louisiana Dr INSURER D: Celina, TX 75009 INSURER E: INSURER F COVERAGES CERTIFICATE NUMBER:Master 15-16 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. Tl� I I TYPE OF INSURANCE ONM POLICY EFF MNSR 7 PLICY POLICY EXP UBER MwD0fYYYYMM1DDrYYYY) GENERAL LIABILITY GLP-6026463-01 4/11/2015 04/11/2016 EACH OCCURRENCE $ 1,000,000 X COMMEW.,1A]. GENERAL LIABILITY Pr"'E� MISF $ 100,000 �nlrmprlqp.) A CLAIMS-MADE [i] OCCUR ........ . .. .. ....... . ...... MED EXP (Any one person) $ 1,000 PERSONAL & ADV INJURY $ 1,000,000 GENERAL AGGREGATE S 2,000,000 AGGREGATE LIMIT APPLIES PER: 2,000,00 PRODUCTS - COMP /OP AGO 0 _S��N'I_ JVRO� I—] LOG AUTOMOBILE LIABILITY 5E23131 04/11/2015 04/11/2016 COMBINED SINGLE L MIT TIT aaocidenli $ 1, 000, 000 B ANY AUTO BODILY INJURY (Per person) ALL OWNED SCHEDULED BODILY INJURY (Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS --- AUTOS UMBRELLA LIAB OCCUR .......... EXC-6026464-01 4/11 /201504/11/2016 EACH OCCURRENCE $ 1,000,000 A EXCESS LIAB CLAIMS-MADE AGGREGATE $ 1,000,000 DFfl RFTFNTION $ WORKERS COMPENSATION WC STATU OTH- J AND EMPLOYERS' LIABILITY Y/N ANY PROPRIETOR/PARTNER/EXECUTIVE F--1 NT EACH ACCIDE1 OFFICER/MEMBER EXCLUDED? N/A Mandatory in NH) E L DISEASE - EA EMPLOYEE $ If yes, describe under . . . ........ OF OPERATIONS below EJ_ DISEA SE - POLICY LIMIT $ _DESCRIPTION B Inland Marine . . . . . . . ..................... . .. --- ---- - - 5C23131 04/11/2015 04/11/2016 Scheduled Equipment $1,085,263 DESCRIPTION OF OPERATIONS/ LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space Is required) Re:#IFB5877.AdditionalInsuredOwners, Lessees or Contractors, CG2010 Per Written Contract Additional Insured -Owners,Lessees OrContractors - Completed Operations, CG203 Agg. Limits of Ins.Per Project E255;Primary Or Noncontributory Clause, E756 Waiver of Transfer of Rights of Recovery Against Others to Us,CG2404 Per WrittenContract- GL, AL, EL CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Denton, its Officials, Agents, ACCORDANCE WITH THE POLICY PROVISIONS. Employees & Volunteers 901-A Texas St. AUTHORIZED REPRESENTATIVE Denton, TX 76209 Rod Medlin/ANNMAC ACORD 25 (2010/05) @ 1988-2010 ACORD CORPORATION. All rights reserved. INS02-Signinn.mni Thn Ar-kt-)Pn nnmn 4 Innn — iafmraff mnrlra of Ar`('1Pn PERFORMANCE BOND STATE OF TEXAS COUNTY OF DENTON § Bond No. 457073P KNOW ALL MEN BY THESE PRESENTS: That Dickerson Construction Co., Inc., whose address is 1130 N. Louisiana, Celina. TX 75009, hereinafter called Principal, and Dgy w �� ' �aaa i � �tt:l?, a corporation organized and existing under the laws of the State of California , and bully authorized to transact business in the State of Texas, as Surety, are held and firmly bound unto the City of Denton, a municipal corporation organized and existing under the laws of the State of Texas, hereinafter called Owner, in the penal sum of one rnillion, two 0iousaand ,, y a�t�atlir° e Wdol_lars gaid aao CENTS ($1,002.073.00), in lawful money of the United States, to be paid in Denton County, Texas, for the payment of which sum well and truly to be made, we hereby bind ourselves, our heirs, executors, administrators, successors, and assigns, jointly and severally, firmly by these presents. This Bond shall automatically be increased by the amount of any Change Order or Supplemental Agreement, which increases the Contract price, but in no event shall a Change Order or Supplemental Agreement, which reduces the Contract price, decrease the penal sum of this Bond. THE OBLIGATION TO PAY SAME is conditioned as follows: Whereas, the Principal entered into a certain Contract, identified by IFB # 5877', with the City of Denton, the Owner, dated the 20th day of October A.D., 2015, for IFB # 5$7 untrxClub Mobile Horne Park, Nettie Shultz Park a��Ll Woc�dlia ez� Meet Sailila� Sewer lie �lac��e��t , �� ,� ! NOW, THEREFORE, if the Principal shall well, truly and faithfully perform and fulfill all of the undertakings, covenants, terms, conditions and agreements of said Contract in accordance with the Plans, Specifications and Contract Documents during the original term thereof and any extension thereof which may be granted by the Owner, with or without notice to the Surety, and during the life of any guaranty or warranty required under this Contract, and shall also well and truly perform and fulfill all the undertakings, covenants, terms, conditions and agreements of any and all duly authorized modifications of said Contract that may hereafter be made, notice of which modifications to the Surety being hereby waived; and, if the Principal shall repair and/or replace all defects due to faulty materials and workmanship that appear within a period of 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 Owner may suffer by reason of failure to so perform herein and shall fully reimburse and repay Owner all outlay and expense which the Owner may incur in making good any default or deficiency, then this obligation shall be void; otherwise, it shall remain in full force and effect. IFB 5877 PROVIDED FURTHER, that if any legal action be filed upon this Bond, exclusive venue shall lie in Denton County, State of Texas. AND PROVIDED FURTHER, that the said Surety, for value received, hereby stipulates and agrees that no change, extension of time, alteration or addition to the terms of the Contract, or to the Work to be performed thereunder, or to the Plans, Specifications, Drawings, etc., accompanying the same, shall in anywise affect its obligation on this Bond, and it does hereby waive notice of any such change, extension of time, alteration or addition to the terms of the Contract, or to the Work to be performed thereunder, or to the Plans, Specifications, Drawings, etc. This Bond is given pursuant to the provisions of Chapter 2253 of the Texas Government Code, as amended, and any other applicable statutes of the State of Texas. The undersigned and designated agent is hereby designated by the Surety herein as the Resident Agent in Denton County to whom any requisite notices may be delivered and on whom service of process may be had in matters arising out of such suretyship, as provided by Article 7.19 -1 of the Insurance Code, Vernon's Annotated Civil Statutes of the State of Texas. IN WITNESS WHEREOF, this instrument is executed in three copies, each one of which shall be deemed an original, this the 20th day of: October , m_ m2015 ATTEST BY:.. m �� SECRL'1" l Y' A B PRINCIPAL Dicker:;c a Co��t�uction + c n g :lac . BY: PRESIDENT The Resident Agent of the Surety in Denton County, Texas for delivery of notice and service of the process is: NAME:, Sheri R,_ Allen, K & S Groin, Inc. STREET ADDRESS: j 24 Oli d .Tgwn l ly . N,, Su to 2 0 Ar 1e, ,Texas 76226 (NOTE: Date of Performance Bond must be date of Contract. If Resident Agent is not a corporation, give a person's name.) IFB 5877 PAYMENT BOND STATE OF TEXAS COUNTY OF DENTON Bond No. 457073P KNOW ALL MEN 13Y THESE PRESENTS: That Dickerson Construction Co- Inc,, whose address is 1130 N. Louisiana; Celina, TX 75009, hereinafter called Principal, and Developers Surety and Indemnity Company a corporation organized and existing under the laws of the State of California , and fully authorized to transact business in the State of Texas, as Surety, are held and firmly bound unto the City of Denton, a municipal corporation organized and existing under the laws of the State of Texas, hereinafter called Owner, and unto all persons, firms, and corporations who may :furnish materials for, or perform labor upon, the building or improvements hereinafter referred to, in the penal sum of one million, two thousand, severity - three dollars and no CENTS ($1,002,073.00), in lawful money of the United States, to be paid in Denton, County, Texas, for the payment of which sum well and truly to be made, we hereby bind ourselves, our heirs, executors, administrators, successors, and assigns, jointly and severally, firmly by these presents. This Bond shall automatically be increased by the amount of any Change Order or Supplemental Agreement which increases the Contract price, but in no event shall a Change Order or Supplemental Agreement which reduces the Contract price decrease the penal sum of this Bond. THE OBLIGATION TO PAY SAME is conditioned as follows: Whereas, the Principal entered into a certain Contract, identified by IFB ## 5877, with the City of Denton, the Owner, dated the 20th day of October A.D., 2015, for IFB # 5877 Country Club Mobile.. Home Park, Nettie Schul, Park' and Woodliavgn lre I g��iq S.cwer l� )higrrertjents NOW, THEREFORE, if the Principal shall well, truly and faithfully perform its duties and make prompt payment to all persons, firms, subcontractors, corporations and claimants supplying labor and/or material in the prosecution of the Work provided for in said Contract and any and all duly authorized modifications of said Contract that may hereafter be made, notice of which modifications to the Surety being hereby expressly waived, then this obligation shall be void; otherwise it shall remain in full force and effect. PROVIDED FURTHER, that if any legal action be filed on this Bond, exclusive venue shall lie in Denton County, Texas. AND PROVIDED FURTHER, that the said Surety, for value received, hereby stipulates and agrees that no change, extension of time, alteration or addition to the terms of the Contract, or to the Work to be performed thereunder, or to the Plans, Specifications, Drawings, etc., accompanying the same, shall in anywise affect its obligation on this Bond, and it does hereby waive notice of any such change, extension of time, alteration or addition to the terms of the Contract, or to the Work to be performed thereunder, or to the Plans, Specifications, Drawings, etc. IFB 5877 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 instrument is executed in three copies, each one of which shall be deemed an original, this the 20th day of October ., _ 2015 . ATTEST; SL CITY PRINCIPAL Dickerson ConstrLIC6011 Company, I;ic. BY; _ w RE1 SI1 151iI "I" SURETY Develcn a z` W Surety armed Inc lei snit Cot -wan ATTORNEY -IN -FACT Roxanne G. Hebert The Resident Agent of the Surety in Denton County, Texas for delivery of notice and service of the process is; NAME; Sheri R. Allen, K & S Group, Inc. STREET ADDRESS; 1,24 Old 'Town Blvd. �, Suite 200 ee 'I e 76226 (NOTE, Date of Payment Bond must be date of Contract. If Resident Agent is not a corporation, give a person's name.) IFB 5877 POWER OF ATTORNEY FOR DEVELOPERS SURETY AND INDEMNITY COMPANY INDEMNITY COMPANY OF CALIFORNIA PO Box 19725, IRVINE, CA 92623 (949) 263.3300 KNOW ALL BY THESE PRESENTS that except as expressly limited, DEVELOPERS SURETY AND INDEMNITY COMPANY and INDEMNITY COMPANY OF CALIFORNIA, do each hereby make, constitute and appoint: ** *Sharon Groppell, Francine Hay, Misty D. Amaya, Angela P. Hyle, Anthony C. Gruppo, Sharon Cavanaugh, Kurt A. Risk, Roxanne G. Hebert, Beverly A. Ireland, David R. Groppell, Sue Kohler, Jointly or severally' as thelr true and lawful Atlorney(s) -in -Fact, to make, execute, deliver and acknowledge, for and on behalf of said corporations, as sureties, bonds, undertakings and contracts of surelyshipgIvIrg and granting unto said Attorney(s)4n -Fact full powar and authority to do and to perform every act necessary, requisite or proper to bo dona in connection herewith as each of said curporaflons could do, but reserving to each of said corporation& flint power of substitution and revocation, and all of ft acts of saldAttorney(s) -in -Fact, pursuant to these presents, are hereby ratified and confirmed. This Power of Attorney Is granted and Is signed by facsimile under and by authority of the following resolutions adopted by the respective Boards of Directors of DEVELOPERS SURETY AND INDEMNITY COMPANY and INDEMNITY COMPANY OF CALIFORNIA, effective as of January 1st, 2008, RESOLVED, that a combination of any two of the Chairman of the Board, the President, Executive Vice•Presiiderd, Sonior Vice - President or any Vice President of the corporations be, and that each of them hereby Is, authorized to execute his Power of Attorney, quallMng the attorney(s) named In the Power of Attorney to execute, on behalf of he. corporations, bonds, undertakings and contracts of suratyshtp; and that the Seoretary or anyAsatslant Secretary of either of he corporatlons be, and each of them hereby Is, authorized to attest the execution of any such Power of Attorney; RESOLVED, FURTHER, that the signatures of such officers may be affixed to any such Power of Attorney or to any certificate relating thereto by facsimile, and any such Power of Attorney or certificate bearing such facsimile signatures shall be valid and binding upon the corporations when so affixed and in the future with respect to any bond, undertaking or contract of suretyship to which it is attached. IN WITNESS WHEREOF, DEVELOPERS SURETY AND INDEMNITY COMPANY and INDEMNITY COMPANY OF CALI their respective officers and aftested by their respective Secretary or Assistant Secretary this January 29, 2015. Daniel Young, Senior Vice - President OCT' By, Mark Lansdon, Vice Praaidenl' � " , tow FORNIA have severally caused these presents to be signed by AN O A. 0 'POuf OCT. 5C 1967 A notary public or other officer completing this certificate verifies or4y the identity of the Individual who signed the doctient to which this certtticete fa attached, and not the Iruthfttlness, accura , or validl( of that doctUrrent. State of California County of Orange On January 29,205 before me, LuWdl R®-ayrrtcrm N lard' e bite _. Dale Ware i eerk CieGae aqd ilia of q1w Mar personally appeared __._..- _ _. Darilel Youn and Mark Lansdon ... Naa�iele #swl auamatai who proved to me orl the basis of satisfactory evidence to be the porson(s) whose namo(s) Were subsc6hod to the within instrument and ooknoMeriged to are that helshaffhey executed he some In histherithek oulhorized capacily(es), and that by hiaherltheir aignati,re(s) on the Instrument the porson(s), or the entity upon behalf of ilt LUCILLI D20"81045 which the person(s) acted, executed the instrument. Commiuion Notary PubN I certify under PENALTY OF PERJURY under the laws of the State of Califomla that the foregoing paragraph Is O'finto true and correct, CliMM. WITNESS my hand and official seal. Place Notary Seal Above Signature --�- ry U oils y end, Notary Public CERTIFICATE The undersigned„ as Secretary or Assistant Secretary of DEVELOPERS SURETY AND INDEMNITY COMPANY or INDEMNITY COMPANY OF CALIFORNIA, does hereby certify that the foragokig Power olAttorney ramalins In full force and has not been revoked and, furthermore, that the provisions of the resolutions of the respective Boards of Directors of said corporations set forth In the Power of Afforne,y are in force as of the date of this Certificate, This Certificate is executed in the City of Irvine, California, this 20th day of October 2015 By, Af4,sfaln!r� tary ID- 1360(Rev.01115) IMPORTANT NOTICE To obtain information or make a complaint: AVISO IMPORTANCE Para obtener informacion o para someter una queja: You may call the Surety's toll free telephone number Usted puede llamar al numero de telefono gratis de for information or to make a complaint at: para informacion o pare someter una queja al: 1- 800 - 782 -1546 You may also write to the Surety at: P.O. Box 19725 Irvine, CA 92623 -9725 You may contact the Texas Department of Insurance to obtain information on companies, coverage, 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: http: / /www.tdi.state.tx.us E -mail: ConsumerProtection @tdi.state.tx.us PREMIUM OR CLAIM DISPUTES: Should you have a dispute concerning your premium or about a claim you should contact the Surety first. If the dispute is not resolved, you may contact the Texas Department of Insurance. 1- 800 - 782 -1546 Usted tambien puede escribir al Surety: P.O. Box 19725 Irvine, CA 92623 -9725 Puede comunicarse con el Departamento de Seguros de Texas para obtener informacion acerca de compa- nies, coberturas, derechos o quejas al: 1- 800 - 252 -3439 Puede escribir al Departmento 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 @tdi.state.tx.us DISPUTAS SOBRE PRIMAS O RECLAMOS: Si tiene una disputa concerniente it so prima o a un reclamo, debe comunicarse con el Surety primero. Si no se resuelve la dispute, puede entonces comuni- carrse con el departamento (TDI). ATTACH THIS NOTICE TO YOUR POLICY: UNA ESTEAVISOA SU POLIZA: Este aviso es solo This notice is for information only and does not para proposito de informacion y no se convierte en become a part or condition of the attached document. parte o condicion del documento adjunto. AmTrust Surety rrre, An AmTrust Financial Company Developers Surety and Indemnity Company Indemnity Company of California CorePointe Insurance Company 17771 Cowan, Suite 100 Irvine, CA 92614 1- 800 - 782 -1546 m0.Ar jrustSur jy from ID -1404 (TX) (Rev. 4/15)