2008-186ORDINANCE NO. 2AM-19
AN ORDINANCE ACCEPTING COMPETITIVE BIDS AND AWARDING A PUBLIC WORKS
CONTRACT FOR OLD NORTH ROAD DRAINAGE IMPROVEMENTS; PROVIDING FOR
THE EXPENDITURE OF FUNDS THEREFOR; AND PROVIDING AN EFFECTIVE DATE (BID
4083-AWARDED TO THE LOWEST RESPONSIBLE BIDDER MEETING SPECIFICATION,
J.T. DERSNER, INC. IN THE AMOUNT OF $437,158.50).
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
4083 J.T. Dersner, Inc.
AMOUNT
$437,158.50
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. 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 5. This ordinance shall become effective immediately upon its passage and
approval.
PASSED AND APPROVED this the day of ,2008.
MARK A. BU , MAYOR
ATTEST:
JENNIFER WALTERS, CITY SECRETARY
BY: 4-2
APPROVED AS TO LEGAL FORM:
JOHN M. KNIGHT, INTERIM CITY ATTORNEY
BY:
3-O id 4083
CONTRACT AGREEMENT
STATE OF TEXAS
§ COUNTY OF DENTON §
THIS AGREEMENT, made and entered into this 19 day of August A.D., 2008, 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
J.T. Dersner, Inc.
225 Idlewild
Prairie. TX 75051
of the City of Grand Prairie, County of Dallas and State of Texas , hereinafter termed
"CONTRACTOR."
WITNESSETH: That for and in consideration of the payments and agreements hereinafter
mentioned, to be made and performed by OWNER, and under the conditions expressed in the bonds
attached hereto, CONTRACTOR hereby agrees with OWNER to commence and complete
performance of the work specified below:
Bid 4083-Old North Road Drainage Improvements
in the amount of $437,158.50 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 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 Engineering staff
all of which are referenced herein and made a part hereof and collectively evidence and constitute
the entire contract.
CA- l
Independent Status
It is mutually understood and agreed by and between City and Contractor that Contractor is
an independent contractor and shall not be deemed to be or considered an employee of the City of
Denton, Texas, for the purposes of income tax, withholding, social security taxes, vacation or 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 specifications at the
general direction of the City Manager of the City of Denton, Texas, or his designee under this
agreement.
Indemnification
Contractor covenants and agrees to and does hereby indemnify, hold harmless and defend, at
its own expense, Owner, its officers, servants and employees, from and against any and all claims or
suits for property loss or damage and/or personal injury, including death, to any and all persons, of
whatsoever kind or character, whether real or asserted, arising out of the Work and services to be
performed hereunder by Contractor, its officers, agents, employees, subcontractors, licensees or
invitees, whether or not caused, in whole or in part, by the alleged negligence of the officers,
servants, employees, of the Owner. Contractor likewise covenants and agrees to, and does hereby,
indemnify and hold harmless Owner during the performance of any of the terms and conditions of
this Contract, whether arising out of in whole -or in part, any and all alleged acts or omissions of
officers, servants, or employees of Owner. The provisions of this paragraph are solely for the
benefit of the parties hereto and not intended to create or grant any rights, contractual or otherwise,
to any other person or entity.
Choice of Law and Venue
This agreement shall be governed by the law of the State of Texas and venue for its
construction and enforcement shall lie in the courts of Denton County, Texas.
The CONTRACTOR hereby agrees to commence work on or after the date established for
the start of work as set forth in written notice to commence work and complete all work within the
time stated in the Proposal, subject to such extensions of time as are provided by the General and
Special Conditions.
The OWNER agrees to pay the CONTRACTOR in current funds the price or prices shown
in the Proposal, which forms a part of this contract, such payments to be subject to the General and
Special Conditions of the Contract.
CA-2
Right to Audit
The OWNER shall have the right to audit and make copies of the 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 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.
CA-3
IN WITNESS WHEREOF, the parties of these presents have executed this agreement in the
year and day first above written.
ATTEST:
(SEAL)
ATTEST:
APPROVED AS TO FORM:
CONTRACT OR
l.,/" Tel
MAILING ADDRESS
PHONE NUMBER
FAX NUMBER
BY: W, o Si- ~e /
TITLE
/ /~+/Sci ~
PRINTED NAME
C ATTO EY
(SEAL)
CA-4
City of Denton
OWNF.R
PERFORMANCE BOND
Bond No. 3-973-581
STATE OF TEXAS
COUNTY OF DENTON
KNOW ALL MEN BY THESE PRESENTS: That J.T. Dersner, Inc. whose address is
225 Idlewild, Grand prairie, TX 75051 hereinafter called Principal, and
West American Insurance Company a corporation organized and existing under the
laws of the State of Indiana and * fully authorized to transact business in the State of
Texas, as Surety, are held and firmly bound unto the City of Denton, a municipal corporation
organized and existing under the laws of the State of Texas, hereinafter called Owner, in the
penal sum of Four Hundred "thirty Seven Thousand One Hundred Fifty Eight and 50/100
DOLLARS ($437,158.50) plus ten percent of the stated penal sum as an' additional sum of
money representing additional court expenses, attorneys' fees, and liquidated damages arising out
of or connected with the below identified Contract, in lawful money of the United States, to be
paid in Denton County, Texas, for the payment of which sum well and truly to be made, we
hereby bind ourselves, our heirs, executors, administrators, successors, and assigns, jointly and
severally, firmly by these presents. This Bond shall automatically be increased by the amount of
any Change Order or 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 Number 2008-186, with the City of
Denton, the Owner, dated the 19th day of August A.D. 2008, for Bid #4083 Old North Road
Drainage.
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.
PB - 1
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 four copies, each one of which
shall be deemed an original, this the 19th day of August , 2008
ATTEST:
BY:(&01-- r
SECRETARY
PRINCIPAL
J. T. Dersner Inc.
BY:
PRESIDENT
TE?S7CXX
WITNESS:
BY:
Sandy Roney, agency R resentative
SURETY
West American Insurance Com any
BY:
ATTORNEY-IN-FACT
Carolyn J. Goodenough
The Resident Agent of the Surety in Denton County, Texas for delivery of notice and service of
the process is:
NAME: Ray Watson Mullis Newby Hurst LP
STREET ADDRESS: 5057 Keller Springs Rd., Ste 400, Addison TX 75001
(NOTE: Date of Performance Bond must be date of Contract. If Resident Agent is not a corporation,
give a person's name)
PB-2
PAYMENT BOND
Bond No. 3-973-581
STATE OF TEXAS
COUNTY OF DENTON
KNOW ALL MEN BY THESE PRESENTS: That J.T. Dersner, Inc. ,
whose address is 225 Idlewild, Grand Prairie, TX 75051 hereinafter called Principal, and
West American Insurance Company , a corporation organized and existing under the laws
of the State of Indiana , 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 Four Hundred Thirty Seven
Thousand One Hundred Fifty Eight and 50/100DOLLARS ($437,158.50) 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 Ordinance Number 2008-186, with the City of
Denton, the Owner, dated the 19th day of August A.D. 2008, for Bid #4083 Old North
Road Drainage.
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.
PB-3
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 four copies, each one of which
shall be deemed an original, this the 19th day of August , 2008 .
ATTEST:
PRINCIPAL
J. T. Dersne Inc.
BY: GGNV\
SECRETARY BY: 4 11156new /~k Z,4'11
PRESIDENT
SXXXX
WITNESS:
SURETY
West American Insuran ompany
BY:
Sandy Roney, \gency R resentative BY:
ATTORNEY-IN-FACT
Carolyn J. Goodenough
The Resident Agent of the Surety in Denton County, Texas for delivery of notice and service of
the process is:
NAME: _ Ray Watson Mullis Newby Hurst LP
STREET ADDRESS: 5057 Keller Springs Rd., Ste 400, Addison TX 75001
(NOTE: Date of Payment Bond must be date of Contract. If Resident Agent is not a
corporation, give a person's name)
PB-4
CERTIFIED COPY OF POWER OF ATTORNEY
THE OHIO CASUALTY INSURANCE COMPANY
WEST AMERICAN INSURANCE COMPANY
No. 40-278
Know All Men by These Presents: That THE OHIO CASUALTY INSURANCE COMPANY, an Ohio Corporation, and WEST AMERICAN INSURANCE COMPANY,
an Indiana Corporation, pursuant to the authority granted by Article III, Section 9 of the Code of Regulations and By-taws of The Ohio Casualty Insurance Company and
West Aierican Insurance Company, do hereby nominate, constitute and appoint Wilbert R. Watson or Carolyn J. Goodenough of Addison, Texas its true and lawful agent (s)
and attorney (s)-in-fact, to make, execute, seal and deliver for and on its behalf as surety, and as its act and deed any and all BONDS, UNDERTAKINGS, and
RECOGNI%ANCES, not exceeding in any single instance TEN MILLION ($10,000,000.00) DOLLARS, excluding, however, any bond(s) or undertaking(s) guaranteeing the
payment of notes and interest thereon
And the execution of such bonds or undertakings in pursuance of these presents, shall be as binding upon said Companies, as fully and amply, to all intents and purposes, as if they
had been duly executed and acknowledged by the regularly elected officers of the Companies at their administrative offices in Fairfield, Ohio, in their own proper persons.
The authority granted hereunder supersedes any previous authority heretofore granted the above named attomey(s)-in-fact.
In WITNESS WHEREOF, the undersigned officer of the said The Ohio Casualty Insurance Company and West American Insurance Company
has hereunto subscribed his name and affixed the Corporate Seal of each Company this 3rd day of October, 2007.
SEAL # SEAL 91
! ~r it Q
N
Sam Lawrence, Assistant Secretary
STATE OF 01110,
COUNTY OF BUTLER
On this 3rd day of October, 2007 before the subscriber, a Notary Public of the State of Ohio, in and for the County of Butler, duly commissioned and qualified, came Sam
Lawrence, Assistant Secretary of THE OHIO CASUALTY INSURANCE COMPANY and WEST AMERICAN INSURANCE COMPANY, to me personally known to be the
individual and officer described in, and who executed the preceding instrument, and he acknowledged the execution of the same, and being by me duly swom deposes and says,
that he is the officer of the Companies aforesaid, and that the seats affixed to the preceding instrument are the Corporate Seals of said Companies, and the said Corporate Seals and
his signature as officer were duty affixed and subscribed to the said instrument by the authority and direction of the said Corporations.
IN TESTIMONY WHEREOF, t have hereunto set my hand and affixed my Official Seal at the City of Hamilton, State of Ohio, the day and year first above written.
o~
~.,~ut
Notary Public in and for County of Butler, State of Ohio
My Commission expires August 5, 2012
This power of attorney is granted under and by authority of Article Ill. Section 9 of the Code of Regulations and By-Laws of The Ohio Casualty Insurance Company
and West American Insurance Company, extracts from which read:
Article 111, Section 9. Appointment of Attomeys-in-Fact. The Chairman of the Board, the President, any Vice-President the Secretary or any Assistant
Secretary of the corporation shall be and is hereby vested with full power and authority to appoint attomeys-in-fact for the purpose of signing the name of the
corporation as surety to, and to execute, attach the seal of the corporation to, acknowledge and deliver any and all bonds, recognizances, stipulations, undertakings or
other instruments of suretyship and policies of insurance to be given in favor of any individual, Firm, corporation, partnership, limited liability company or other entity,
or the official representative thereof, or to any county or state, or any official board or boards of any county or state, or the United States of America or any agency
thereof Or to any other political subdivision thereof
This instrument is signed and sealed as authorized by the following resolution adopted by the Boards of Directors of the Companies on October 21, 2004:
RESOLVED, That the signature of any officer of the Company authorized under Article Ill, Section 9 of its Code of Regulations and By-laws and the
Company seal may be affixed by facsimile to any power of attomey or copy thereof issued on behalf of the Company to make, execute, seal and deliver for and on its
behalf as surety any and all bonds, undertakings or other written obligations in the nature thereof, to prescribe their respective duties and the respective limits of their
authority, and to revoke any such appointment. Such signatures and seal are hereby adopted by the Company as original signatures and seal and shall, with respect to
any hond, undertaking or other written obligations in the nature thereof to which iris attached, be valid and binding upon the Company with the same force and effect as
though manually affixed.
CERTIFICATE
I, the undersigned Assistant Secretary of The Ohio Casualty Insurance Company and West American Insurance Company, do hereby certify that the foregoing power of attomey,
the referenced By-Laws of the Companies and the above resolution of their Boards of Directors are true and correct copies and are in full force and effect on this date.
IN WITNESS WHEREOF, I have hereunto set my hand and the seals ofthe Companies this 19th day of August 200$
SEAL
5-4300 3/99 Assistant Secretary
A Memtx;r of
Litt ri-Y Liberty Agency Underwriters
I'''1ui11.i1. 9450 Seward Road, Fairfield, Oil 45014 1-800-843-6446
TEXAS
IMPORTANT NOTICE
To obtain information or make a
complaint:
You may call toll-free for information or
to make a complaint at
1-800-843-6446
You may contact the Texas Department
of Insurance to obtain information on
companies, coverages, rights or
complaints at
1-800-252-3439
You may write the Texas Department of
Insurance
P. O. Box 149104
Austin, TX 78714-9104
FAX 4 (512) 475-1771
Web: http://xvnv-,v.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 aeent or call
1-800-843-6446 If the dispute is not
resolved; you may contact the Texas
Department of Insurance.
ATTACH THIS NOTICE TO YOUR
POLICY:
This notice is for information only and
does not become a part or condition of
the attached document.
TEXAS
AVISO IMPORTANTE
Para obtener informacion o para someter
una queja:
Usted puede Ilamar at numero de
telefono gratis para informacion o para
someter una queja at
1-800-843-6446
Puede comunicarse con el Departamento
de Seguros de Texas para obtener
infortnacion acerca de companies,
coberturas, derechos o quejas at
1-800-252-3439
Pucde escribir at Departamento de
Seguros de Texas
P. O. Box 149104
Austin, TX 78714-9104
FAX # (512) 475-1771
Web: http://NN,-vvw.tdi.state.tx.us
E-Mail: ConsumerProtection a tdi.state tx.us
DISPUTAS SOBRE PRIM.AS O
RECLAMOS:
Si tiena una disputa concemiente a su
prima o a un reclamo, debe comunicarse
o Ilamar 1-800-843-6446
Si no se resuelve la disputa, puede
entonces comunicarse con el
departamento (TDl)
UNA ESTE AVISO A SU POLIZA:
Este aviso es solo para proposito de
informacion y no se convierte en parte o
condicion del documento adjunto.
NP 70680901
CERTIFICATE OF INSURANCE
ISSUEDADD/YY)
Certificate It 66783 3541
09/02/ 09/02/08
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND
CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE
MULLIS
DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE
•
POLICIES BELOW.
BONDS AND INSURANCE
COMPANIES AFFORDING COVERAGE
5057 Keller Springs Road ■ Suite 400 ■ Addison, Texas 75001
COMPANY A
LETTER
Ohio Casualty Insurance Company
972.201.0100 ■ a~ww.mnhins.com ■ Fax 972.201.0123
COMPANY
B
INSURED
LETTER Texas Mutual Insurance Company
J T Dersner, Inc.
COMPANY
C
225 Idlewild Rd.
LETTER
Grand Prairie, TX 75051
COMPANY
D
LETTER
COMPANY E
LETTER
COVERAGES °
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.
CO
ISO
TYPE OF INSURANCE
POLICY NUMBER
POLICY EFFECTIVE
DATE (MM/DD/YY)
POLICY EXPIRATION
DATE (MM/DDNY)
LIMBS
A
GEN
ERAL LIABILITY
GENERAL AGGREGATE
S 2,000,000
X
COMMERCIAL GENERAL LIABILITY
BKW 53285665
12/05107
12/05/08
PRODUCTS-COMP/OP AGG.
S 2,000,000
CLAIMS MADE OCCUR
PERSONAL & ADV. INJURY
S 1,000,000
OWNERS & CONTRACTORS' PROT.
EACH OCCURRENCE
$ 1,000,000
X
-Blank e2.Additional Insured
FIRE DAMAGE (Any one fire
S 100,000
MED. EXPENSE (Anyone person)
$ 10,000
A
AUTOMOBILE LIABILITY
COMBINED SINGLE
X ANY AUTO
LIMIT
$
11000,000
BAA 53285665
12/05/07
12/05/08
X
ALL OWNED AUTOS
BODILY INJURY
X
SCHEDULED AUTOS
(Per person)
S
X
HIRED AUTOS
BODILY INJURY
X
NON-OWNED AUTOS
(Per accident)
$
P GARAGE LIABILITY
PROPERTY DAMAGE
S
A
EXCESS LIABILITY
EACH OCCURRENCE
S 2,000,000
X
UMBRELLA FORM
AGGREGATE
S 2,000,000
USO 53285661
12/05/07
12/05/08
OTHER THAN UMBRELLA FORM
WORKER'S COMPENSATION
STATUTORY LIMITS
B
AND
EACH ACCIDENT
S 1,000,000
TSF0001144211
04/23/08
04/23/09
EMPLOYERS' LIABILITY
DISEASE-POLICY LIMIT
S 1,000,000
DISEASE-EACH EMPLOYEE
S 1,000,000
A
OTHER
Rented/Leased Equipment
BM053285665
12/05107
12/05/08
Limit $1,500,000 w/ $1,500,000 Agg
Owned Contractors Equipment-
$1,000 deductible
P-, q,h-,hjIP On RIP
Actual Cash Value
DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/SPECIAL ITEMS RE: Bid# 4083 Old North Road Drainage
The City of Denton is included as additional insured to general liability & auto. Waiver of subrogation added in favor of the same to include all policies.
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
City of Denton
EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO
901B Texas Street
MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE
Denton
TX 76209
,
LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR
LIABILITY OF ANY KIND UPON THE COMPANY, ITS AGENTS OR REPRESENTATIVES.
AUTHORIZED REPRESENTATIVE
CITY OF DENTON
INSURANCE REQUIREMENTS FOR CONTRACTORS
Bidder's attention is directed to the insurance requirements below. It is highly recommended
that bidders confer with their respective insurance carriers or brokers to determine in advance
of Bid submission the availability of insurance certificates and endorsements as prescribed
and provided herein. If an apparent low bidder fails to comply strictly with the insurance
requirements, that bidder may be disqualified from award of the contract. Upon bid award, all
insurance requirements shall become contractual obligations, which the successful bidder
shall have a duty to maintain throughout the course of this contract.
STANDARD PROVISIONS:
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.
As soon as practicable after notification of bid award, Contractor shall file with the Purchasing
Department satisfactory certificates of insurance, containing the bid number and title of the
project. Contractor may, upon written request to the Purchasing Department, ask for
clarification of any insurance requirements at any time; however, Contractors are strongly
advised to make such requests prior to bid opening, since the insurance requirements may not be
modified or waived after bid opening unless a written exception has been submitted with the bid.
Contractor shall not commence any work or deliver any material until he or she receives
notification that the contract has been accepted, approved, and signed by the 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.
• Any deductibles or self-insured retentions shall be declared in the bid 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.
CI-9
• That such insurance is primary to any other insurance available to the
additional insured with respect to claims covered under the policy and that this
insurance applies separately to each insured against whom claim is made or
suit is brought. The inclusion of more than one insured shall not operate to
increase the insurer's limit of liability.
• Cancellation: The 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 term which give
rise to claims made after expiration of the contract shall be covered.
• Should any of the required insurance be provided under a form of coverage that
includes a general annual aggregate limit providing for claims investigation or
legal defense costs to be included in the general annual aggregate limit, the
Contractor shall either double the occurrence limits or obtain Owners and
Contractors Protective Liability Insurance.
• Should any required insurance lapse during the contract term, requests for
payments originating after such lapse shall not be processed until the City
receives satisfactory evidence of reinstated coverage as required by this contract,
effective as of the lapse date. If insurance is not reinstated, City may, at its sole
option, terminate this agreement effective on the date of the lapse.
CI_ 10
SPECIFIC ADDITIONAL INSURANCE REQUIREMENTS:
All insurance policies proposed or obtained in satisfaction of this Contract shall additionally
comply with the following marked specifications, and shall be maintained in compliance with
these additional specifications throughout the duration of the Contract, or longer, if so noted.
[X ] A. General Liability Insurance:
General Liability insurance with combined single limits of not less than
$1,000,000.00shall be provided and maintained by the Contractor. The policy shall be
written on an occurrence basis either in a single policy or in a combination of
underlying and umbrella or excess policies.
If the Commercial General Liability form (ISO Form CG 0001 current edition) is used:
• Coverage A shall include premises, operations, products, and completed
operations, independent contractors, contractual liability covering this contract
and broad form property damage coverage.
• Coverage B shall include personal injury.
• Coverage C, medical payments, is not required.
If the Comprehensive General Liability form (ISO Form GL 0002 Current Edition and
ISO Form GL 0404) is used, it shall include at least:
Bodily injury and 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 $500,000.00 either in a single policy or in a combination of
basic and umbrella or excess policies. The policy will include bodily injury and property
damage liability arising out of the operation, maintenance and use of all automobiles and
mobile equipment used in conjunction with this contract.
Satisfaction of the above requirement shall be in the form of a policy endorsement for:
any auto, or
all owned, hired and non-owned autos.
Cl - 11
[xl
Workers Compensation Insurance
Contractor shall purchase and maintain Worker's Compensation insurance which, in addition
to meeting the minimum statutory requirements for issuance of such insurance, has
Employer's Liability limits of at least $100,000 for each accident, $100,000 per each
employee, and a $500,000 policy limit for occupational disease. The City need not be
named as an "Additional Insured" but the insurer shall agree to waive all rights of
subrogation against the City, its officials, agents, employees and volunteers for any work
performed for the City by the Named Insured. For building or construction projects, the
Contractor shall comply with the provisions of Attachment 1 in accordance with §406.096
of the Texas Labor Code and rule 28TAC 110.110 of the Texas Worker's Compensation
Commission (TWCC).
Owner's and Contractor's Protective Liability Insurance
The Contractor shall obtain, pay for and maintain at all times during the prosecution of the
work under this contract, an Owner's and Contractor's Protective Liability insurance policy
naming the City as insured for property damage and bodily injury which may arise in the
prosecution of the work 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 with a
Fire Damage Legal Liability Insurance
aggregate.
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 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.
Cl - 12
[ ] Commercial Crime
Provides coverage for the theft or disappearance of cash or checks, robbery inside/outside
the premises, burglary of the premises, and employee fidelity. The employee fidelity
portion of this coverage should be written on a "blanket" basis to cover all employees,
including new hires. This type insurance should be required.if the contractor has access to
City funds. Limits of not less than each occurrence are required.
[ ] Additional Insurance
Other insurance may be required on an individual basis for extra hazardous contracts and
specific service agreements. If such additional insurance is required for a specific contract,
that requirement will be described in the "Specific Conditions" of the contract specifications.
Cl - 13
ATTACHMENT 1
[X] Worker's Compensation Coverage for Building or Construction Projects for
Governmental Entities
A. Definitions:
Certificate of coverage ("certificate ")-A copy of a certificate of insurance, a certificate
of authority to self-insure issued by the commission, or a coverage agreement (TWCC-
81, TWCC-82, TWCC-83, or TWCC-84), showing statutory workers' compensation
insurance coverage for the person's or entity's employees providing . services on a
project, for the duration of the project.
Duration of the project - includes the time from the beginning of the work on the project
until the contractor's/person's work on the project has been completed and accepted by
the governmental entity.
Persons providing services on the project ("subcontractor" in §406.096) - includes all
persons or entities performing all or part of the services the contractor has undertaken to
perform on the project, regardless of whether that person contracted directly with the
contractor and 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 foodibeverage 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:
Cl - 14
1) a certificate of coverage, prior to that person beginning work on the project, so the
governmental entity will have on file certificates of coverage showing coverage for
all persons providing services on the project; and
2) no later than seven days after receipt by the contractor, a new certificate of coverage
showing extension of coverage, if the coverage period shown on the current
certificate of coverage ends during the duration of the project.
F. The contractor shall retain 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.
1. 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) certificate of coverage, prior to the other person beginning work on the project;
and
b) a new certificate of coverage showing extension of coverage, prior to the end of
the coverage period, if the coverage period shown on the current certificate of
coverage ends during the duration of the project;
CI - 15
5) retain all required certificates of coverage on file for the 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.
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 governmental entity to declare the contract void if the
contractor does not remedy the breach within ten days after receipt of notice of breach
from the governmental entity.
Cl - 16
CONFLICT OF INTEREST QUESTIONNAIRE FORM CIQ
For vendor or other person doing business with local governmental entity
This questionnaire reflects changes made to the law by H.B. 1491, 80th Leg., Regular Session.
OFFICE USE ONLY
This questionnaire is being filed in accordance with chapter 176 of the Local Government Code by a
person doing business with the governmental entity.
Date Received
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.
1 Name of person who has a business relationship with local governmental entity.
a6L
2
Check this box if you are filing an update to a previously filed questionnaire.
(The law requires that you file an updated completed questionnaire with the appropriate filing authority not later than the 70 business
day after the date the originally filed questionnaire becomes incomplete or inaccurate.)
rName of local government officer with whom filer has an employ ent or business relationship.
ame of Officer
This section, (item 3 including subparts A, B, C & D), must be completed for each officer with whom the filer has an employment or other business
relationship as defined by Section 176.001(1-a), Local Government Code. Attach additional pages to this Form CIQ as necessary.
A. Is the local government officer named in this section receiving or likely to receive taxable income, other than investment income, from the
filer of the questionnaire? I-X/
Yes u No
B. Is the filer of the questionnaire receiving or likely to receive taxable income, other than investment income, from or at the direction of the
local government officer named in this section AND the taxable income is not received from the local governmental entity?
= Yes No
C. Is the filer of this questionnaire employed by a corporation or other business entity with respect to which the local government officer
serves as an officer or director, or holds an owne ship of 10 percent or more?
0 Yes No
D. Describe each affiliation or business relationship.
4
Signature of person doing business with the governmental entity Date
CIQ - I
Adopted 06292007
Project Name: Old North
Paving and Drainage Improvements
Bid Opening
BID TABULATION SHEET
Work. Days
Bid. No.
P.O. No.
50
4083
Item
Description.
Quantity
Unit
UnitPriee
Total
103.1
Contractors Warranties and Understandings
1
LS
$
S Q .
Unit Price In Words • U ( t''A ~S
107.19.3
Trench Safe System for Trench Depth over 5-FT 1,500
LF
00
$
00.
Unit Price In Words
201
Erosion Control
1
LS
S"0•()(~
$
Unit Puce In Words
202.5
Soddiii
300 '
SY
$
SOD, Q
Unit Price In Words
203.3
General Site Preparation 1
LS
$
. 0
Unit Price In Words !j
508.3
18" Reinforced Concrete Storm Sewer Pipe Class III 1 15 LF r
$
2 . S7
Unit Price In Words ~f l r ~~TS
508.3
24" Reinforced Concrete Storm Sewer Pipe Class III
20
LF
$
O
Unit Price In Words
qr
508.3
18" Reinforced Concrete Storm Sewer Pipe Class IV
39
LF
$
3 a
Unit Price In Words
4AZ
508.3
30" Reinforced Concrete Storm Sewer Pipe Class IV
128
LF
OQ
$
r
Unit Price In Words ~f /L 1w
508.3
48" Reinforced Concrete Storm Sewer Pipe Class III
'e
458
LF
$
ae,
Q 7 0
Unit Price In Words
v
508.3
54" Reinforced Concrete Storm Sewer Pipe Class III
MA LF
$
423
2
0-0c)
0
,
Unit Price In Words ~U S / /CJ O
i s
702
Junction Box with accessType M (MH-M: TxDOT Item 465)
3
EA C7
$
t7 JQD S
Unit Price in Words e /I
702
10' Recessed Curb Inlet
3
EA
3
$
z9 C2
Unit Price In Words 1'/ A B Z~S ~d ~dCr7 f
702
15' Recessed Curb Inlet
3
EA
$
Q
a /
Unit Price In Words Q ~N Ts
Project Name: Old North
Paving and Drainage Improvements
Bid Opening
BID TABULATION SHEET
Work Days
Bid No.
P.O_ No.
50
4083
Item
Description
Quantity
Unit
Unit Price
Total
702 2
0 Recessed Curb Inlet
I
EA
,5 &SQ
$
~~s~ • 0
Unit Price In Words G!f ~I i / 0
801.1
Barriers& Warning Wor Detour Sign~
I
LS
00
Unit Price In Words
Jci~w
803.3
Ri (5") 16
SY
/0 1)
$
• O
Azle
Unit Price In Words V
806.4
Ccvers
Frames, Grates, Rings, &
11 EA lJ(!•
$
SS'
y
Unit Price In Words
SC-4
Project Signs
2
EA
$
Unit Price In Words
SP-2.2
As halt Sawcut
3000 U
0-1
$
Unit Price In Words
SP-3
HEADWALL (CH - FW - 45) (DIA= 54 II9)TxDOT Item 466
1
EA
• Q
$
2S O. 00
Unit Price In Words S f
SP-4
Add ;Steel Casing with Spacers (6" sanitary sewer)
3 EA
log
$
-6-712
'f
Unit Price In Words • r r son
SP-4 F.xistina_ 6" Water i,ine Adj11strnent t
ER S
Unit Price In Words /
SP4
Existing 12' Water Line Adjustment 2
EA
Sa • C~
$
Unit Price In Words 441nc 14,~ey we
SP-4
Existing Water Service Adjustment 3-
EA Soo • o
r
$ ~J 0
•
Unit Price In Words V {
BASE BID TOTAL: 11371,59--s-0
P-4 Attachment t-ADI
BID SUMMARY
TOTAL PRICE IN WORDS BASE BID:
In the event of the award of a contract to the undersigned, the undersigned will 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
until final completion and - acceptance, and to guarantee payment for all lawful claims for
labor performed and materials famished in the fulfillment of the contract.
It is understood 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 undersigned certifies that the bid prices contained in this proposal have been carefully
checked and are submitted as correct and final.
Unit and lump sum prices as shown for each item listed in this proposal shall control over
extensions.
The undersigned agrees this bid becomes the property of the City of Denton after the
official opening.
The undersigned affirms that they are duly authorized to execute. 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 1
et seq., and which arise under the antitrust laws of the State of Texas, Tex. Bus. & Com.
Code, Section 15.01, et seq.
P-5
1
I
I
1
1
1
1
1
1
1
1
1
►
1
►
Receipt is hereby acknowledged of the following addenda to the plans and specifications:
Addendum No. 1 dated `71 ~Q T.
Received 711/,0 9
Addendum No. 2 dated Received
Addendum No. 3 dated Received
Addendum No. 4 dated Received
Addendum No. 5 dated Received
CONTRA TOR
BY
S eet Address
City and Stat
Seal & Authorization /
(If a Corporation) ~G 733 ~~7~
Telephone
P-6
VENDOR COMPLIANCE TO STATE LAW
The 1985 Session of the Texas Legislature passed House Bill 620 relative to the award of
contracts to non-resident bidders.. This law provides that, in order to be awarded a contract
as low bidder, non-resident bidders (out-of-state contractors whose corporate offices or
principal place of business are outside of the State of Texas) bid projects for construction,
improvements, supplies or services in Texas at. an amount lower than the lowest Texas
resident bidder by the same amount that a Texas resident bidder would be required to
underbid a non-resident bidder in order to obtain a comparable contract in the state in which
the non-resident's principal place of business is located. The appropriate blanks in Section
A below must be filled out by all out-of-state or non-resident bidders in order for your bid to
meet specifications. The failure of out-of-state or non-resident contractors to do so will
automatically disqualify that bidder. Resident bidders must check the blank in Section B.
A. Non-resident bidders in
busine d
(give state), our principal place of
ss, are require to be percent lower than resident
bidders by state law. A copy of the statute is attached.
Non-resident bidders in (give state), our principal place of
business, are not required to underbid resident bidders.
B. Our principal place of business or corporate offices are in the State of Texas:
BIDDER:
1T0{n;17 Y-~, - 6
COMPANY
BY
9treet Address
za
City and State /
THIS FORM MUST BE RETURNED WITH YOUR BID.
P-7
~ u
~Q
0
pica ~
z N C
a o ti
1 'O • .CC
i O l~ o u
y ! v u `
LI~y
OJ H~;
Fh
O
I
a
0
v
~
m
u
a
~
N
3
u
d
L
u N
p
c
m
~
G n
uFx•
T
A
:e
~
A
C
G
d
O
Q
N A
~
C
c
En
d
F f
O)
N
c0
r
U
X
W
I
T
H
Im
Z
o
d
O
z
z
F
b
a
I
n
N
X,0
r
W
z
W 0)
CJ
z
WQ 'IT
z
o
Z F- 0
O
F. N
in "o
0
Q X
W
O
E
n
x
X F
o
c
ZwL
O
FO
u
LIJ ~
z
0000°
v
ol
o i
LL ~ r
E-°
E-°
O
a
V)
a
~ M
~Zo
LLJI It
U0
Q
Z
VJ
i
J
Q
Q
0
N
N
CD
00
0
N
U
Ln
L
1`
x
F
W
C
O
73
y
7
LLB
W
u~
En
o
W
a A
0 Z
A
N~
00
I0
^F
cNVC7
IN
E
°
io
o
z
w`
o
>
c
G
vsi
u
10 C
F O O O
O
Z:
1°
tn
tn
vi
v;
co
co
co
co
00
co
co
co
O
O I
i
°
C,
co
°o
o
°
o
M
c
X
W
U i
~ I
t
a
'1
~
16
L
t`
u-
N
N
N
C
U
O
a0
rn
O
O
10
N
O
t'~1
111
10
O
p`,
~
In
1n
r -
N
O
i
a
U
C4
a
1
u
O
v~
)
oA
V
-a I
i
I
1
CD
o
0
°
E
.
ZI
10
10
to
1n
In
°1
oo
N
10
~
1n
In
°1
CD
°o
1n
o
v1
~m
°1
C.
1n
0
10
o
N I
~ C 1
U 00
O m
U
0
I U
I ~
G
I Q
c 1
0
N
V
o r
I z
o 2
°1 r
00
O O
c c
f
o
> I z - z z
d E E E
u
N
N y
Z
1~+1
M n
C
~ F
O
E°-
F o
m
E
I o
F
L
1 ~
C
I ~
r
I Q
c
? s
1 u
u i a
ai
i
F '
I
.d
I
o
G
of
I
vi
F
-v
a
O
~i z
o ~
'CS U
aU.
U
City of Denton, Texas
Invoice Attachment
1 Vendor Name:
2 Project Name:
3 Purchase Order Number:
4 Vendor Invoice Number:
5 Vendor Invoice Date:
6 The following is period estimate number for the period from to
7 Is this the final invoice for this project? Yes No
8 Original contract amount 8
9 Approved change orders 9
10 Add lines 8 and 9. This is the current contract amount. 10
Project Totals To Date
11 Enter the amount of work performed on original contract.
12 Enter the amount of work performed on approved change orders.
'i 3 Enier the amouni of maieriais on hand.
14 Add lines 11, 12, and 13. This is the total value of work performed
15 Multiply line 14 by .05. This is the amount retained (5%).
16 Subtract line 15 from line 14. This is the net amount earned.
17 Enter the amount of all previous payments.
18 In 18a, subtract 17 from 16a. In 18b, enter the amount from 16b.
This is the balance due with this invoice.
The amount in 18a MUST equal the amount in 18b.
Period Totals
11a 11b
12a 12b
i3a
i3b
14a
14b
15a
15b
16a
16b
17
18a
18b
The undersigned Contractor certifies that all work, including materials on hand, covered by this schedule has been completed or delivered and stored
in acordance with the Contract Documents, that all amounts have been paid by him for work, materials, and equipment for which previous periodic
payments were issued and received from the City of Denton, and that the current payment shown herein is now due.
Signed
Page 1
Date
27
Instructions to Invoice Attachment
THE INVOICE ATTACHMENT IS NOT A SUBSTITUTE FOR A NOTARIZED APPLICATION FOR PERIODIC PAYMENT.
THAT DOCUMENT IS STILL NECESSARY AND SHOULD BE INCLUDED WITH THE INVOICE ALONG WITH THIS INVOICE ATTACHMENT.
Use You are bound under a construction contract with the City of Denton.
this Your contract includes a clause for the withholding of relainage.
form if You are submitting an invoice for payment to the City of Denton.
Lines 1 - 5 Enter the information required for a payment to be processed. It includes a valid purchase order number issued
by the City of Denton. as well as your invoice number and date. Your invoice will not be paid without this information.
Line 6 Specify the construction period for which you are seeking payment. Include the period number and period dales.
Line 7 Check "Yes" if this is the final invoice for this project. The final invoice should include the release of retainage that has been withheld.
Line 8 Enter the original contract amount approved by the City of Denton.
Line 9 Enter the amount of any approved change orders.that increases or decreases the amount of the original contract.
Line 10 This amount should be the total value of the contract after all changes have been applied.
Line 11a Enter the amount of work performed on the original contract from inception to date. Show project totals only.
Line 11 b Enter the amount of work performed on the original contract in this reporting period only. Do not include any prior periods in this calculation.
Line 12a Enter the amount of any additional work performed from inception to date. Show project totals only.
Line 12b Enter the amount of any additional work performed in this reporting period only. Do not include any prior periods in this calculation.
Line 13a Enter the amount of any materials on hand from inception to date. Show project totals only.
Line 13b Enter the amount of any materials on hand in this reporting period only. Do not include any prior periods in this calculation.
Line 14a -14b These lines identify the value of the work performed for the project from its beginning as well as the value of work performed this period.
Line 15a Enter the amount retained based upon the value of work performed on the project to date.
Line 15b Enter the amount retained based upon the value of work performed this period.
Line 16a This is the amount earned on the project after retainage has been withheld.
Line 16b This is the amount earned in the current period. It should equal the payment amount you are expecting from the City of Denton.
Line 17 Enter the amount of all previous payments you have received on this project.
Line 18a This is the amount due based upon the project totals to date. It is the cumulative total of all transactions related to this project.
Line 18b This is the amount due based upon current period totals. It should match the invoice attached to this schedule.
Line 18a and line 18b MUST be the same amount. It is the reconcilation between period and project totals.
You must sign and date the Invoice Attachment. The Invoice Attachment should be mailed along with the invoice for payment.
Page 2
28