2008-187ORDINANCE NO. ADO a/
AN ORDINANCE ACCEPTING COMPETITIVE BIDS AND AWARDING A PUBLIC WORKS
CONTRACT FOR THE RECONSTRUCTION OF MINGO ROAD; PROVIDING FOR THE
EXPENDITURE OF FUNDS THEREFOR; AND PROVIDING AN EFFECTIVE DATE (BID
4093-AWARDED TO THE LOWEST RESPONSIBLE BIDDER MEETING SPECIFICATION,
JAGOE-PUBLIC COMPANY IN THE AMOUNT OF $887,825.80).
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
4093 Jagoe-Public Company $887,825.80
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 19~lt day of 32008.
Qw-'91
, MAYOR
MARK A. URRO G
71
ATTEST:
JENNIFER WALTERS, CITY SECRETARY
BY: r
APPROVED AS TO LEGAL FORM:
JOHN M. KNIGHT, INTERIM CITY ATTORNEY
BY:
3- -4093
CONTRACT AGREEMENT
STATE OF TEXAS
§ COUNTY OF DENTON §
THIS AGREEMENT, made and entered into this 19th day of Augustl 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
Jagoe-Public Company
PO Box 250
Denton. TX 76202
of the City of Denton, County of Denton and State of Texas , hereinafter termed
"CONTRACTOR."
WITNESSETH: That for and in consideration of the payments and agreements hereinafter
mentioned, to be made and 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 4093-Mingo Road Reconstruction
in the amount of $887,825.80 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:
Teague, Nall and Perkins
all of which are referenced herein and made a part hereof and collectively evidence and constitute
the entire contract.
CA-1
Independent Status
It is mutually understood and agreed by and between City and Contractor that Contractor is
an independent contractor and shall not be deemed to be or considered an employee of the City of
Denton, Texas, for the purposes of income tax, withholding, social security taxes, vacation or 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 an d 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.
City of Denton
OWNER
BY: 6~~
(SEAL)
ATTEST:
CONTRACTOR
JAGOE P_tJBLIC.,CO
P. O. Box 250
DENTON, TX 76202
MAILING ADDRESS
9 yo '3Bz z s sk/
PHONE NUMBER
~yo 3k2- l79Z-
APPROVED AS TO FORM:
CATTORNEY
CA-4
FAX NUMBER
V
BY: ~g~rz~~ SL'
TITLE
C-4e e-L-
PRINTED NAME
(SEAL)
PERFORMANCE BOND
STATE OF TEXAS
Bond No. 8216-15-75
COUNTY OF DENTON
KNOW ALL MEN BY THESE PRESENTS: That Jagoe-Public Company✓whose
address is PO Box 250 Denton, TX 76202 hereinafter called Principal, and
Federal 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 Eight Hundred Eighty Seven Thousand Eight Hundred Twenty Five and 80/100
DOLLARS ($887,825.80)/151us 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 2008-187, with the City of
Denton, the Owner, dated the 19th day of August A.D. 2008 copy of which is hereto
attached and made a part hereof, for Bid 4093-Mingo Road Reconstruction.--`
A.D. 2008, a copy of which is hereto attached and made a part hereof, for Bid 4093- Mingo
Road Reconstruction.
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 -00~
ATTEST:
BY:
ATTEST:
PRINCIPAL
Va oC.- Cc& <a
BY:
Vtc.E PRESIDENT
SURETY
Federal Insurance Company
BY:
Cindy owl Witness BY: rjylju ' I
ATTORT4 Y-IN-FAO T
Connie Jean Kregel
The Resident Agent of the Surety in Denton County, Texas for delivery of notice and service of
the process is:
NAME: Jeffrey Todd McIntosh, Allied North America Insurance Brokerage of Texas, LLC
STREET ADDRESS: 12770 Coit Rd., Ste. 750, Dallas, Tx 75251
(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
STATE OF TEXAS § Bond No. 8216-15-75
COUNTY OF DENTON §
KNOW ALL MEN BY THESE PRESENTS: That Jagoe-Public Company ✓
whose address is PO Bo 250 Denton, TX 76202, hereinafter called Principal, and
Federal 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 p9al sum of Eight Hundred Eighty
Seven Thousand Eight Hundred Twenty Five and 80/100-'DOLLARS ($887,825.80Kn 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 2008-187 with the City of
Denton, the Owner, dated the 19 day of August A.D. 2008 copy of which
is hereto attached and made a part hereof, for Bid 4093-Mingo Road Reconstruction.
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:
BY:
CRETA
ATTEST:
BY:
Cindy Fowle , Witness
PRINCIPAL
-P~l<< o 0-4-- /Vef 14A4
- UP
BY:
VtcE PRESIDENT
SURETY
Federal Insurance Company
BY: (,al1UA~(~t1h ~/LP4
ATTORNEY-IN-FAST
Connie Jean Kregel
The Resident Agent of the Surety in Denton County, Texas for delivery of notice and service of
the process is:
NAME:Jeffrey Todd McIntosh,Allied North America Insurance Brokerage of Texas, LLC
STREET ADDRESS: 12770 Coit Rd., Ste. 750, Dallas, TX 75251
(NOTE: Date of Payment Bond must be date of Contract. If Resident Agent is not a
corporation, give a person's name.)
PB-4
&X 16
Chubb POWER Federal Insurance Company Attn: Surety Department
C OF Vigilant Insurance Company 15 Mountain View Road
Surety ATTORNEY pacific indemnity Company Warren, NJ 07059
Know All by These Presents, That FEDERAL INSURANCE COMPANY,,✓an Indiana corporation, VIGILANT INSURANCE
COMPANY, by New York corporation, and PACIFIC INDEMNI COMPANY, a Wisconsin co!jrati on do each hereby constitute and
appoint Cynthia Watson Fowler, Connie Jean Kregel, effrey Todd McIntosh, rd ~1ia el Abbott, Uoyd Ray
is Jr., and Beverly Mrimble of Dallas, Texas
each as their true and lawful Attorney- tin- Fad to execute under such designation in their names and to affix their corporate seals to and deliver for and on their behalf as surety
thereon or otherwise, bonds and undertakings and other writings obligatory in the nature thereof (other than ball bonds) given or executed In the course of business, and any
Instruments amending or altering the same, and consents to the modification or alteration of any instrument referred to in said bonds or obligations.
In Witness Whereof, said FEDERAL INSURANCE C014EANY, VIGILANT INSURANCE 90MPANY, and PACIFIC INDEMNITY COMPANY have each executed and attested
these presents and affixed their corporate seals on this 7"'. day of J U ly, 2008 V
Kenneth C.endel, Assistant Secretary D Norris, Jr., Vice P i
STATE OF NEW JERSEY
ss.
County of Somerset
On this 7t". dayof July, 2008 before me, a Notary Public of New Jersey, personally came Kenneth C. Wendel, to me
known to be Assistant Secretary of FEDERAL INSURANCE COMPANY, VIGILANT INSURANCE COMPANY, and PACIFIC INDEMNITY COMPANY, the companies which
executed the foregoing Power of Attorney, and the said Kenneth C. Wendel, being by me duly sworn, did depose and say that he is Assistant Secretary of FEDERAL
INSURANCE COMPANY, VIGILANT INSURANCE COMPANY, and PACIFIC INDEMNITY COMPANY and knows the corporate seals thereof, that the seals affixed to the
foregoing Power of Attorney are such corporate seats and were thereto affixed by authority of the By- Laws of said Companies; and that he signed said Power of Attorney as
Assistant Secretary of said Companies by like authority; and that he is acquainted with David B. Norris, Jr., and knows him to be Vice President of said Companies; and that the
signature of David S. Norris, Jr., subscribed to said Power of Attorney Is In the genuine handwriting of David B. Norris, Jr., and was thereto subscribed by authority of said By-
Units and In deponent's presence.
Notarial Seal
STS" N B. BRRADTT J~isg►
of Now 1097
,w , J ; A R Y Notary Noto~ 22
G Commissron Expires Od. 25,2M Notary Public
PU8%.X
ti W tFp° CERTIFICATION
Extract from By. Laws of FEDERAL. INSURANCE COMPANY, VIGILANT INSURANCE COMPANY, and PACIFIC INDEMNITY COMPANY:
'Ali powers of attorney for and on behalf of the Company may and shag be executed in the name and on behalf of the Company, either by the Chairman or the
President or a Vice President or an Assistant Yoe President, jointly with the Secretary or an Assistant Secretary, under their respective designations. The
signature of such officers may be engraved, printed or lithographed. The signature of each of the following officers: Chairman, President, any Vice President, any
Assistant Vice President, any Secretary, any Assistant Secretary and the seal of the Company may be affixed by facsimile to any power of attorney or to any
certificate relating thereto appointing Assistant Secretaries or Attorneys- in- Fad for purposes only of executing and attesting bonds and undertakings and other
writings obligatory In the nature thereof, and any such power of attorney or certificate bearing such facsimile signature or facsimile seal shall be valid and binding
upon the Company and any such power so executed and certified by such facsimile signature and facsimile seal shall be valid and binding upon the Company
with respect to any bond or undertaking to which it is attached
I, Kenneth C. Wendel, Assistant Secretary of FEDERAL INSURANCE COMPANY, VIGILANT INSURANCE COMPANY, and PACIFIC INDEMNITY COMPANY
(the'Companles') do hereby car* that
(1) the foregoing extract of the By- Laws of the Companies is true and correct,
(g) the Companies are duly licensed and authorized to transact surety business In all 50 of the United States of America and the District of Columbia and are
authorized by the U.S. Treasury Department; further, Federal and Vigilant are licensed In Puerto Rico and the U.S. Virgin Islands, and Federal is licensed in
American Samoa. Guam, and each of the Provinces of Canada except Prince Edward Island; and
(Iii) the foregoing Power of Attorney is true, correct and In full force and effect.
Given under my hand and seals of said Companies at Warren, NJ this August 19th, 2008
enneth C. W I, Assistant Secretary
)N THE EVENT YOU WISH TO NOTIFY US OF A CLAIM, VERIFY THE AUTHENTICITY OF THIS BOND OR NOTIFY US OF ANY OTHER
MATTER, PLEASE CONTACT US AT ADDRESS LISTED ABOVE, OR BY Telephone (908) 903- 3493 Fax (908) 903- 3656
Forth 15-10.02256- U (Ed. 5- 03) CONSENT
0~'
a~~
Policyholder Information Notice
IMPORTANT NOTICE
To obtain information or make a complaint:
You may call Chubb's toll-free telephone number
for information or to make a complaint at
1-800-36-CHUBB
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 # (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 agent first.
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.
AVISO IMPORTANTE
Para obtener informacion o para someter una
queja:
Usted puede llamar al numero de telefono gratis
de Chubb's para informacion o para someter una
queja al
1-800-36-CHUBB
Puede comunicarse con el Departamento de
Seguros de Texas para obtener informacion acerca
de companias, coberturas, derechos o quejas al
1-800-252-3439
Puede escribir al Departamento de Seguros de
Texas
P.O. Box 149104
Austin, TX 78714-9104
FAX # (512) 475-1771
Web: http://www.tdi.state.tx.us
E-mail: Cons umerProtection@tdi. state. tx.us
D/SPUTAS SOBRE PR/MAS O RECLAMOS:
Si tiene una disputa concermente a su prima o a un
reclamo, debe comunicarse con el agente primero.
Si no se resueve la disputa, puede entonces
comunicarse con el departamento (TDI).
UNA ESTE AV/SO A SU POL/ZA:
Este aviso es solo para proposito de informacion y
no se convierte en parte o condicion del documento
adjunto.
Form 99-10-0299 (Rev. 1-08)
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.
Cl - 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 - I I
[X] 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 aggregate.
[ ] Fire Damage Legal Liability Insurance
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 I
[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
t he 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:
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;
Cl - 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.
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 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
Date Received
person doing business with the governmental entity.
By law this questionnaire must be filed with the records administrator of the local government not
later than the 7th business day after the date the person becomes aware of facts that require the
statement to be filed. See Section 176.006, Local Government Code.
A person commits an offense if the person violates Section 176.006, Local Government Code. An
offense under this section is a Class C misdemeanor.
1 Name of person who has a business relationship with local governmental entity.
2
Check this box if you are filing an update to a previously filed questionnaire.
(The law requires that you file an updated completed questionnaire with the appropriate filing authority not later than the 7th business
day after the date the originally filed questionnaire becomes incomplete or inaccurate.)
[!F
Name of local government officer with whom filer has an employment or business relationship.
Name of Officer
This section, (item 3 including subparts A, B, C & D), must be completed for each officer with whom the filer has an employment or other business
relationship as defined by Section 176.001(1-a), Local Government Code. Attach additional pages to this Form CIQ as necessary.
A. Is the local government officer named in this section receiving or likely to receive taxable income, other than investment income, from the
filer of the questionnaire?
0 Yes 0 No
B. Is the filer of the questionnaire receiving or likely to receive taxable income, other than investment income
from or at the direction of the
,
local government officer named in this section AND the taxable income is not received from the local governmental entity?
0 Yes = No
C. Is the filer of this questionnaire employed by a corporation or other business entity with respect to which the local government officer
serves as an officer or director, or holds an ownership of 10 percent or more?
Yes 0 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: Mingo Road Reconstruction Work Days
Bid No.
BID TABULATION SHEET P.O. No.
60 Calendar Days
4093
Item Spec. Description Quantity Unit Unit Price Total
BASE BID
1
1.21
i
ContrwoesWananties
andUnderstandin
I
LS
$ ewb- 06/ LS
$ l 000 . O O
sa
Unit Price In Words: oDo,,c-A En/ rg--.SA~-iD AA-cs A.-iD Z¢AA e-enj~
2
TxDOT
500
Mobilization
I
LS I
s 5-Coe r e°/ LS
$ S a O. G O
' r
Unit Price In Words: / : e% T/~.o ta,Sv4w o % ; ✓O d w,/g, ,g Ao lla /d T 7-coe a CE.,A3
3
3.1
Pre oration of Right-of-Way
1
LS I
S 3 eI00.00/ LS
$ 3 :L 0 6 . 00
r~,/~ i
Unit Price In Words: 7A"C Y~oa,l/ONO '~~✓e jPAEo yo%•S Zf.QO GEC/ Ves
4
8.1
Barricades, Signs and Traffic Control
~
I
LS
$ 000.00
/ LS
$ ~p CDO. 00
Unit Price In Words: 616C rAl- m&4-.,w Do/%,cb A.-!® Z Tito e-e v45
5
3.12
I
Ternporary Erosion C
ntrol
1
LS I
S 8O t7 0, OQ LS
j
$ 000, 00
o
)
Unit Price In Words: L 1i.`F'BW ~.~ou s~eKO -lAe S 4,40 pia Ce.-4
6
3.1
Mill Existing Asphalt Pavement
24,512
SY J
$ 1,7r / SY
$ B ~p. Oa
0C
Unit Price In Words: CWL AIIA L.< /9-1,v e~✓t F~✓E ~~.r.
7
3.7 l
Compacted Fill and Embanlanent
625
Cy
$ ~i Jr0 / Cy I
se/, g 7. ~t7
Unit Price In Words: ,(76&t e d /4~tI
8
TxDOT
275 1
8" Cement Treatment (34 Ibs/SY)
22
,
880
SY I
S A SY
/
,
-~ct'
Unit Price In Words: ~n/~ ~fel~i~~ ~.✓O -
Unit Ce~
9
TxDOT
275
Portland Cement
390
TN I
rr__
S l5~ 00 / TN
$ S DOS 0O
Unit Price In Words: ~✓E ~,v p,~ J~j ~l~a.,PS As►i0 ZtQe C.e..S
10
TxDOT
1
I
340
5" T 'B' As halt Pavement
21,710
SY
S l7 Z.5S / SY
$ 7 9 ,S O
Unit Price In Words: S LI&VAe• ~~q/~ie,yd a..{!J T f-i✓E eAV~s
11
TxDOT
340
13" T C As halt Pavement
21,310
SY
Is 402. f) / Sy
I
s .2 0/ , 3r0
/
Unit Price In Words: Ti eJ.GI✓~ Z, lljC res Q,~~O 7. 1c- ✓ bt7 1 jJf- C-e ~
12
TxDOT
340
12" T 'C' As halt Pavement
3,202
SY
p
$ O • O SY I
s AS '~9? O
1~
Unit Price In Words: /~/,;✓t ~ec.-rs
13 TxDOT
134
Backfrll Pavement Edges
14,080
L
F
ISO, O / LF
$ S qVa. on
/
Unit Price In Words: 09X- 22o/// A*-.a ~;~T C S
P-3
Project Name: Mingo Road Reconstruction Work Days 60 Calendar Days
Bid No. 4093
BID TABULATION SHEET P.O. No.
Item
Spec. Description
Quantity
Unit Unit Price
Total
14
SC-1
Pavement Markin
I
LS $ X04 04 LS
$ z 000.00
'I
Unit Price In Words: ~rtl~w/ ewe 14A6 a^i.D xfefi --.,,74S
15
SC-2 1
1'arkwayRmtoration
4,250 SY S.24:., / SY I
s
Unit Price In Words: 7i►f v
BASE BID SUBTOTAL Transfer to Bid Summary page) $ 88'1 8 zs. So
i-
t
P-4
BID SUMMARY
TOTAL PRICE IN WORDS BASE BID:
.2rf0 11
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 an d acceptance, and to guarantee payment for all lawful claims for
labor performed and materials furnished 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.
P-5
rl
i
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 (give state), our principal place of
business, are required to be percent lower than resident
bidders by state law. A copy of the statute is attached.
Non-resident bidders in' (give state), our principal place of
business, are not required to underbid resident bidders.
B. Our principal place of business or corporate offices are in the State of Texas: V/
BIDDER:
JAGOE PUBLIC CO.
P O. Box 250
DENTON, TX 76202
COMPANY
BY
Street Address
City and State
P-7
THIS FORM MUST BE RETURNED WITH YOUR BID.
CONTRACTOR COMPLIANCE TO TEXAS SALES TAX CODE
Comply with all requirements of the Texas Sales Tax Code. The Contractor hereby certifies
that the Contract Amount is divided as follows:
Materials incorporated into the Project $
(resold to the Owner as defined in Tax Code)
All other charges and costs $
Total
The total must equal the total amount of the Contract, based on the Base Bid
CONTRACTOR:
JAGOE PUBLIC CO.
P. O. Box 250
DENTON, TX 76202
COMPANY
BY U
Street Address
City and State
THIS FORM SHALL BE EXECUTED AT THE TIME OF EXECUTION OF THE
CONTRACT AND SHALL BE MADE A PART OF THE CONTRACT.
P-8
'I
'i
ACORD,. CERTIFICATE OF LIABILITY INSURANCE
DATE(MM/DD/YYYY)
8/26/2008
PRODUCER Phone: 972-455-1400 Fax: 972-387-8837
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Allied North America Insurance
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
Brokerage of Texas, LLC
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
12770 Coit Road
Suite 750
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
,
Dallas TX 75251
INSURERS AFFORDING COVERAGE
NAIC #
INSURED
Ja
oe-Publi
C
✓
INSURERA:Travelers Lloyds of TX Insuran
1564
g
c
ompany
0-
Hickory Creek Haulers
LLC
~
INSURER B: Phoenix Insurance Company
5623
,
3020 Fort Worth a1~R\~
INSURERc:Everest Indemnit Insurance C
10851
Denton TX 76201
INSURER D: Charter Oak Fire Insurance Cc
5615
INSURER E:
l.V V CRM"CJ
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIO
D 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS
INSR
LTR
DD'
POLICYNUMBER
POLICY EFFECTIVE
DATE MM/DD
POLICY EXPIRATION
DATE fMMIDD/YYi
.
LIMITS
A
GENERAL LIABILITY
C0492D371907
10/1/2007
10/1/2008
CH OCCURRENCE
$ 1 000,000
X
COMMERCIAL GENERAL LIABILITY
-
DAMAGE TO RENTED
PR
EMISES Ea occurence
$300,000
CLAIMS MADE Fx
]OCCUR
MED EXP (Any one person)
$5, 000
PERSONAL 8 ADV INJURY
$1
000
,
,000
GENERAL AGGREGATE
$ 2 0
00, 00 0
GENT AGGREGATE LIMIT APPLIES PER:
PRODUCTS -COMP/OPAGG
$2, 000,000
RO LOC
POLICY P
IECT F,
$
AU
TOMOBILE LIABILITY
BA492D373070
10/l/2007
10~1~2008
X
ANY AUTO ✓
COMBINED SINGLE LIMIT
(Ea accident)
$ 1, 000, 0 0 0
ALL OWNEDAUTOS
BODILY INJURY
$
SCHEDULEDAUTOS
(Per person)
HIRED AUTOS
BODILY INJURY
$
NON-OWNED AUTOS
(Per accident)
PROPERTY DAMAGE
$
(Per accident)
GARAGE LIABILITY
AUTO ONLY -EAACCIDENT
$
ANYAUTO
EAACC
OTHER THAN
$
AUTO ONLY: AGG
$
C
X
EXCESSIUMBRELLA LIABILITY
7100000006071
10/l/2007
10/1/2008
EACH OCCURRENCE
$8.000,000
X OCCUR FICLAIMS MADE
AGGREGATE
-$8000,000
DEDUCTIBLE
RETENTION $
$
D
WORKERS COMPENSATION AND
EMPLOYERS' LIABILITY
UP492D37320
10/1/2007
10/1/2008
X WCSTA NT WR-
ANY PROPRIETOR/PARTNER/EXECUTIVE
E.L. EACH ACCIDENT
$1,000,000
OFFICER/MEMBER EXCLUDED?
Ifyes
describe under
E.L. DISEASE - EA EMPLOYEE
$ 1 00 0 0 00
,
SPECIAL PROVISIONS below
E.L. DISEASE - POLICY LIMIT
$1,000,000
OTHER
DESCRIPTION OF OPERATIONS I LOCATIONS /VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT/ SPECIAL PROVISIONS
E: Mingo Road Reconstruction,&~
> Certificate holder its officers, agents, employees and volunteers are recognized as additional insureds on a
rimary, noncontributory basis nder all policies except workers' compensation, and all police u e a ever Of
ubro in favor of same.. The policies will not be cancelled, non-renewed or materially changed unless and until
e certificate holder receives 30 days' prior written notice.L--
%1M114VCLLJA I IVIV
City of Denton
901 B Texas Street
Denton TX 76209
ACORD 25 (2001/08)
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED
BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER
WILL ENDEAVOR TO MAIL 30-ffAYS WRITTEN NOTICE TO THE
CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO
SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON
THE INSURER, ITS AGENTS OR REPRESENTATIVES.
AUTHORIZED REPRESENTATIVE
TION 1988
IMPORTANT
If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A statement
on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s).
If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may
require an endorsement. A statement on this certificate does not confer rights to the certificate
holder in lieu of such endorsement(s).
DISCLAIMER
The Certificate of Insurance on the reverse side of this form does not constitute a contract between
the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it
affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon.
A 1%^ ne innn• ~nn~