2007-287ORDINANCE NO. AW ! l r/ /
AN ORDINANCE ACCEPTING COMPETITIVE BIDS AND AWARDING A PUBLIC WORKS
CONTRACT FOR THE REPLACEMENT OF CHILLED WATER PIPING FOR THE CITY OF
DENTON MUNICIPAL BUILDING, CIVIC CENTER, AND EMILY FOWLER LIBRARY;
PROVIDING FOR THE EXPENDITURE OF FUNDS THEREFOR; AND PROVIDING AN
EFFECTIVE DATE (BID 3923-CHILLED WATER PIPING REPLACEMENT AWARDED TO
BRANDT ENGINEERING IN THE BASE BID AMOUNT OF $448,041 PLUS AN ESTIMATED
EMERGENCY RECOVERY PLAN ALLOWANCE OF $25,000 FOR A TOTAL NOT TO
EXCEED $473,041.
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
3923 Brandt Engineering $473,041
SECTION 2. City Council finds the bid submitted by Powers MEP Engineering did not
meet specifications and is therefore rejected.
SECTION 3. 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 4. 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 5. Upon acceptance and approval of the above competitive bids and the execution
of contracts for the public works and improvements as authorized herein, the City Council hereby
authorizes the expenditure of funds in the manner and in the amount as specified in such approved
bids and authorized contracts executed pursuant thereto.
SECTION 6. This ordinance shall become effective immediately upon its passage and
approval. h f /
PASSED AND APPROVED this the [-L day of e 4%( ,2007.
9ZQ -w u
PERR R. McNEILL, MAYOR
ATTEST:
JENNIFER WALTERS, CITY SECRETARY
APPROVED AS TO LEGAL FORM:
EDWIN M. SNYDER, CITY ATTORNEY
BY:
4-0RD- 3923
CONTRACT AGREEMENT
STATE OF TEXAS
§ COUNTY OF DENTON §
THIS AGREEMENT, made and entered into this 12th day of December A.D., 2007, 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
Brandt En ine eering
Dallas. Texas 75229
of the City of Dallas, 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 #3923 - Chilled Water Pining Replacement, as described in these Specifications
in the base bid amount of $448,041 plus an estimated Emergency Recovery Plan allowance of
$25,000 for a total not to exceed $473,041 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:
S. Toub & Associates, Inc.
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 and services to be
performed hereunder by Contractor, its officers, agents, employees, subcontractors, licensees or
invitees, whether or not caused, in part, by the alleged negligence of the officers,
servants, employees, of the Owner. tractor 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 whAla A; in part, any and all alleged acts or omissions of
officers, servants, or employees of Owner. e 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.
TTEST: _ kb
City of Denton
OWNER
BY:
(SEAL)
ATTEST:
CONTRACTOR
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MAILING ADDRESS
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PHONE NUMBER
APPROVED AS TO FORM:
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CA-4
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FAX UMBER
BY:
TITLE
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PRINTED NAME
(SEAL)
PERFORMANCE BOND
STATE OF TEXAS §
COUNTY OF DENTON §
KNOW ALL MEN BY THESE PRESENTS: That Brandt Engineering whose
address is 11245 Indian Trail, Dallas, Texas 75229 hereinafter called Principal, and
, a corporation organized and existing under the laws
of the State of and fully authorized to transact business in the State of
Texas, as Surety, are held and firmly bound unto the City of Denton, a municipal corporation
organized and existing under the laws of the State of Texas, hereinafter called Owner, in the penal
sum of Four hundred seventy-three thousand forty-one and 00/100 DOLLARS (5473,041.00) 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 2007-287, with the City of Denton,
the Owner, dated the 11th day of December A.D. 2007 , a copy of which is hereto attached
and made a part hereof, for Bid #3923 - Chilled Water Piping Replacement.
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 4 copies, each one of which
shall be deemed an original, this the day of
ATTEST: PRINCIPAL
BY:
SECRETARY
ATTEST:
BY:
BY:
PRESIDENT
SURETY
BY:
ATTORNEY-IN-FACT
The Resident Agent of the Surety in Denton County, Texas for delivery of notice and service of the
process is:
NAME:
STREET ADDRESS:
(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 §
COUNTY OF DENTON §
KNOW ALL MEN BY THESE PRESENTS: That Brandt Engineering ,
whose address is 11245 Indian Trail, Dallas, Texas 75229 hereinafter
called Principal, and , a corporation organized and
existing under the laws of the State of and fully authorized to transact business
in the State of Texas, as Surety, are held and firmly bound unto the City of Denton, a municipal
corporation organized and existing under the laws of 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 seventy-three thousand forty-one and 00/100 DOLLARS ($473,041.00) in lawful
money of the United States, to be paid in Denton, County, Texas, for the payment of which sum
well and truly to be made, we hereby bind ourselves, our heirs, executors, administrators,
successors, and assigns, jointly and severally, firmly by these presents. This Bond shall
automatically be increased by the amount of any Change Order or Supplemental Agreement which
increases the Contract price, but in no event shall a Change Order or Supplemental Agreement
which reduces the Contract price decrease the penal sum of this Bond.
THE OBLIGATION TO PAY SAME is conditioned as follows: Whereas, the Principal
entered into a certain Contract, identified by Ordinance Number 2007-287, with the City of Denton,
the Owner, dated the 11th day of December A.D. 2007 , a copy of which is hereto attached
and made a part hereof, for Bid #3923 - Chilled Water Piping Replacement.
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 4 copies, each one of which
shall be deemed an original, this the day of
ATTEST:
BY:
SECRETARY
ATTEST:
BY:
PRINCIPAL
BY:
PRESIDENT
SURETY
BY:
ATTORNEY-IN-FACT
The Resident Agent of the Surety in Denton County, Texas for delivery of notice and service of the
processis:
NAME:
STREET ADDRESS:
(NOTE: Date of Payment Bond must be date of Contract. If Resident Agent is not a corporation,
give a person's name.)
PB-4
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, ifso 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.
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.
• All policies shall be endorsed to read:
"SAID POLICY SHALL NOT BE CANCELLED, NONRENEWED OR
MATERLILLY CIIANGE WITHOUT 30 DAYS ADVANCED WRITTEN NOTICE
BEING GIVEN TO THE OWNER (CITY) EXCEPT WHEN THE POLICY IS
BEING CANCELLED FOR NONPAYMENT OF PREMIUM IN WHICH CASE 10
DAYS ADVANCE WRITTEN NOTICE IS REQUIRED":
• 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.
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:
W A. General Liability Insurance:
General Liability insurance with combined single limits of not less than $ 500,000 shall
be provided and maintained by the Contractor. The policy shall be written on an
occurrence basis either in a single policy or in a combination of underlying and
umbrella or excess policies.
If the Commercial General Liability form (ISO Form CG 0001 current edition) is used:
• Coverage A shall include premises, operations, products, and completed
operations, independent contractors, contractual liability covering this contract
and broad form property damage coverage.
• Coverage B shall include personal injury.
• Coverage C, medical payments, is not required.
If the Comprehensive General Liability form (ISO Form GL 0002 Current Edition and
ISO Form GL 0404) is used, it shall include at least:
• Bodily injury and Property Damage Liability for premises, operations,
products and completed operations, independent contractors and property
damage resulting from explosion, collapse or underground (XCi1) 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 $300,000 either in a single policy or in a combination of
basic and umbrella or excess policies. The policy will include bodily injury and property
damage liability arising out of the operation, maintenance and use of all automobiles and
mobile equipment used in conjunction with this contract.
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.
[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
Employees 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.
[ ] 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.
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 food/beverage vendors, office supply
deliveries, and delivery of portable toilets.
B. The contractor shall provide coverage, based on proper reporting of classification codes
and payroll amounts and filing of any overage agreements, which meets the statutory
requirements of Texas Labor Code, Section 401.011(44) for all employees of the
Contractor providing services on the project, for the duration of the project.
C. The Contractor must provide a certificate of coverage to the governmental entity prior
to being awarded the contract.
D. If the coverage period shown on the contractor's current certificate of coverage ends
during the duration of the project, the contractor must, prior to the end of the coverage
period, file a new certificate of coverage with the governmental entity showing that
coverage has been extended.
E. The contractor shall obtain from each person providing services on a project, and
provide to the governmental entity:
(1) a certificate of coverage, prior to that person beginning work on the project, so 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) 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;
(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.
11/14/2007 11:31 972404GO13
NOv.1412007 09:30 940 349 1302
BRANDT
CITY OF DENTON ?TMoRASING
CITY OF DENTON
BID FOR CHILLED WATER PIPING REPLACEMENT
PAGE 04/04
07045 8.004/004
ITEM
BID PROPOSAL FORM
DESCRIPTION
Tofumish a0 labor, material, tools, equipment, tranapertation, bonds, a0 applicable incigent'rals, and other
facTi ies, and to perform all work for tna Ch11ad Watar Piping Replacement Project
Dollars (s D'/-
we &PJ73
A46ekJa«c c S« aft ac Lora ,4 G a isdA4
Costs assaciatAd with Emergency Recovery Ran to keep any involved facility in full operation should an
eAsting chilled WOW or sewer Ine be ruptured. THIS post shall net beincl uded of the above Total Bass Bid,
2
(Per Addendum 42)
//•.s Do11er8 25~CW ®j )
RETURN ONE (1) COMPLETE ORIGINAL AND ONF (1) COPY OF EXECUTED BID
PROPOSAL
t7 BAAjpr Fo,1&Arcourv(?
Date Signature f Authorized Represent hive Company
PAGE I OF BID 03923 Bidder's Initials -L,
BRANDY
November 20, 2007
City of Denton
901-B Texas St.
Denton, Texas 76209
Attn: Director of Purchasing
Re: Chilled Water Replacement
Bid # 3923
Dear Sir/Madam:
Brandt Engineering is pleased to submit our proposal for the above referenced project. We have included a standard
AIA Contractor's Qualification Statement for your review. Please note there are several recently completed projects
with Texas Christian University and Southeastern Oklahoma State University. Several of these projects are
underground thermal utility projects that we performed. These would be excellent references should you wish to
contact any of them.
The bid proposal Addendum 42 requests pricing for an "Emergency Recovery Plan" in the event of a sewer or water
line rupture during construction. We understand the purpose of this request and your need to have some funds
identified for this event should it happen. However, it is not reasonable to put a firm price on any and all potential
events of this nature. We feel it would be more prudent to set aside an allowance to cover this type event. In the
case of a sewer line rupture the only real option to stop the flow and make an emergency repair. This would
probably entail closing the building for 4-8 hrs. In the event of a domestic water line rupture it would be the same
case as a sewer line. In the event of a chilled water line rupture we could do the same or bring in a temporary air
conditioning unit for that building. In any of these events there is no way for anyone to properly estimate this cost.
We will either over estimate in which the city would pay far too much or we'll under estimate in which case we are
taking an unreasonable risk. Therefore, we recommend an allowance be set aside for this event. $20,000 to $30,000
would be a reasonable amount.
We appreciate your consideration of our firm and look foiward to the opportunity to work with you. Please do not
hesitate to contact me directly should you have any questions or concerns.
Respectfully yours,
a4 t Serving the Industry Since 1952
BRANDT ENGINEERIN(
H VAC and Electrical Systems Contractors
Engineering- Installation - Service - Contrc
Wesley E. Baker
Mgr. of Special Projects
Fort Worth, Texas
Dallas, Texas
San Antonio, Texas
2461 East Long
Fart Worth, Texas 76106
11245 Indian Trail
Dallas, Texas 75229
11111 Iota
San Antonio, Texas 78217
Phone: 817-626-0033 Phone: 972-241-9411 Phone: 210-599-6120
Fax: 817-626-4173 Fax: 9724846013 Fax: 210-599-7921
Bond # 8188-86-23
PERFORMANCE BOND
STATE OF TEXAS
COUNTY OF DENTON
KNOW ALL MEN BY THESE PRESENTS: That Brandt Engineering ✓ whose
address is
Federal I
s, Texas 75229 hereinafter called Principal, and
a corporation organized and existing under the laws
of the State of Inalana , 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, hereinaft r called Owner, in the penal
sum of Four hundred seventy-three thousand forty-one and 00/100DOLLARS 473 041.00 pus
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 2007-287, with the City of Denton,
the Owner, dated the 11 th day of December A.D. 2007 , a copy of which is hereto attached
and made a part hereof, for Bid #3923 - Chilled Water Pining Replacement:-~
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 _4_ copies, each one of which
shall be deemed an original, this the 12 day of December , 2007
ATTEST:
BY: ti-r.t~f ~~2+-trJ
ARY
ATTEST:
PRINCIPAL
6 N , En teeclrl 0
BY:
PRES NT
SURETY
Federal Insurance Company
BY: AMW
BY: klo(o!/GL/ C'oll-cy
ATTORNEY-IN-FACT
William D. Birdsong
The Resident Agent of the Surety in Denton County, Texas for delivery of notice and service of the
process is:
NAME: William D. Birdsong, Wm. W. George & Associates, Inc.
STREET ADDRESS: 10,000 N. Central # 1100, Dallas, TX 75231
(NOTE: Date of Performance Bond must be date of Contract. If Resident Agent is not a corporation, give a
person's name.)
PB-2
~~7L
Bond # 8188-86-23
PAYMENT BOND
STATE OF TEXAS
COUNTY OF DENTON
KNOW ALL MEN BY THESE PRESENTS: That Brandt Engineering ✓ ,
whose address is 11245 Indian Trail D las Texas 75229 hereinafter
called Principal, and Federal Insurance Company a corporation organized and
existing under the laws of the the State of and fully authorized to transact business
in the State of Texas, as Surety, are held and firmly bound unto the City of Denton, a municipal
corporation organized and existing under the laws of 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 p in the penal sum of
Four hundred seventy-three thousand forty-one and 00/100•~jOLLARS f$473,041.00-rn 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 2007-287, with the City of Denton,
the Owner, dated the I Ith day of December A.D. 2007 , a copy of which is hereto attached
and made a part hereof, for Bid #3923 -Chilled Water Piping Reolacement.✓
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 4 copies, each one of which
shall be deemed an original, this the 12 day of December 2007✓
ATTEST:
/ Get t,~ u~4 0
BY.
ARY
ATTEST:
PRINCIPAL /p"
c,~.v.d-E ~Il ~Pfi^I V1 `O
BY:
PRES NT
Federal Insurance Company
B Y:
BY:
ATTORNEY-IN-FACT
William D. Birdsong -
The Resident Agent of the Surety in Denton County, Texas for delivery of notice and service of the
process is:
NAME: William D. Birdsong / Wm W. George & Associates, Inc.
STREET ADDRESS: 10,000 N. Central # 1100, Dallas, TX 75231
(NOTE: Date of Payment Bond must be date of Contract. If Resident Agent is not a corporation,
give a person's name.)
PB-4
\ 5T
NE Chubb POWER Federal Insurance Company Attn: Surety Department
OF Vigilant Insurance Company 15 Mountain View Road
Surety ATTORNEY Pacific Indemnity Company Warren, NJ 07059
Know All by These Presents, That FEDERALINSURANCE COMPANY,)n-Indiana corporation, VIGILANT INSURANCE COMPANY, a New VorkcDrporagon,
and PACIFIC INDEMNITY COMPANY, a Wisconsin corporation, do each hereby constitute and appoint William D. Birdsong,, William
W. George and Ginger Hoke of. Dallas, Texas-----------------------------------------------_-
each as their true and lawful Attorney-In-Fact 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 bell bonds) given or
executed in the course of business, and any instruments amending or alfering 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 COMPANY, VIGILANT INSURANCE COMPANY, and PACIFIC INDEMNITY COMPANY have each
executed end'attested these presents and affixed their corporate seals on this 6th day of February, 2003
Kenneth C. Wendel, Assistant Secretary f ran E. Robertson, P esident "
STATE OF NEW JERSEY
as.
County of Somerset I - -
On this 6th day of February, 2003 , before M. a Notary Pubfe of New Jersey, personally Dame Kenneth C. Wendel, to me known
b be-Assistant Seoretaryof FEDERAL INSURANCE COMPANY, VIGILANT INSURANCE COMPANY,.and,PACWIG INDEMNITYCOMPANYtheAmplanke-whion exxuled.ltre
foregoing Power of Atomey, and the said Kenneth C. Wendel being by me duly sworn, did depose and say twat 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 ere loregdng power of Attorney era
sugh.corpora. . als#0 were thereto affixed by authority of the Bylaws of said Companies; and that he signed said Power of Attorney esASslstant Seoretetyof saw Carripanles
by Ike aLM&,V' efi he is acquainted with Frank E. Robertson, and knows him to be Vie President of said Companies; and that the signature of Frank E. Robertson,
sr,bscribebt sppa18PC- t Attorney Is in the genuine handwriting of Frank E. Robertson, and was thereto subscribed by authority of said By-Lam and In deponents presence.
NotedafSeate.Y `0
4If L.NISHIMURA - \ .
l~~'"" G•. - > rAk' state of NOW Jyth,
F U 8L~ 'y"'~'!N11i Np 22-71980
0
In NOW
Notary Public
CERTIFICATIO
Extract from the By-Laws of FEDERAL INSURANCE COMPANY, VIGILANT INSURANCE COMPANY, and PACIFIC INDEMNITY COMPANY:
"All powers of attorney for and on behalf of the Company may and shall 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 Vie 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 oflioen:: "
Chairman, President, any Vice President, any Assistant Vie 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 Attomerys-In-Fact 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 "Companies) do hereby certify that .
(1) the.foregoing extract of the By-Laws of the Companies is tnre and correct,
(10 the Companies are duty 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
(N) 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 1 day of Oecekn I 00 -
~SUt CF ~,OFMIe/ a5URAIV
Ild
't`11t *aEW Pwe
U%100'
Kenneth C. Wendel, Assts Secretary
IN 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 908 903-3485 Fax 908 903-3656 e-mail: surety@chubb.com
o p Fidelity and Deposit Companies
Home Office: 3910 Keswick Road Baltimore, MD 21211
IMPORTANT NOTICE
To obtain information or make a complaint:
You may call the Fidelity and Deposit Company of Maryland, Colonial American Casualty and
Surety Company, and/or Zurich American Insurance Company's toll-free telephone number for
information or to make a complaint at:
1-800-654-5155
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
PREMIUM OR CLAIM DISPUTES: Should you have a dispute concerning the premium or
about a claim, you should first contact Fidelity and Deposit Company of Maryland or Colonial
American Casualty and Surety Company. 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.
58543M)(08/01)
ACORD_ CERTIFICATE OF LIABILITY INSURANCE OP ID PR
°°T INATD p
BBAlIDIL+1
12117/07
PIRMANUER
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
Wm. W. George 6 Associates, Inc
HOLDER. THIS CERTIFICATE DOES NOT AMEND
EXTEND OR
10,000 N. Central, #1100
,
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Dallas TX 75231
Phone: 214-691-5522 Fax: 214-691-1537
INSURERS AFFORDING COVERAGE
NAIC #
uwRw
Brandt Mechanical S
a
IxwRER A: ,,,,,,,s ~.Y
`
C
Brandt En
in
i
o.
4`
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eer
ng
INSURERS
.
Brandt Service Company,
any,
Brandt Electric, L. P.
wsuxu c:
P. 0. Box 29559
Dallas TX 75229
INSURER B:
ERE
COVERAGES
ME MOOESOF WSUR.AWE LISTED BEWW NAVE PEEN ISSUED TO THE INSURED NAMED ABOVE FOR TIE PC PERM INDICATED
M REMWEMENT. TERN ON CMgTCH OF ANY CONTRACT OR OTHER DOCUMENT VAM RESPECT TO VMCN THIS CENT ROAM RAY BE ISSUED OR
RAIy PEATAIM ME INSURANCE AFFORDED BY THE PCLIAES DESCRIBED WREN IS SUBJECT TO ALL THE TERNS ESCW90NS AND CONDITIONS OF AMM
PCUCIES AGMEBATE UBETS Mod WY HAVE BEEN RESICED BY PND CRAWS.
ASN
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FORE OF
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FOUST wA9ET1
6FECINE
PppTEY
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EAa OCCURRENCE
i 1,000,000
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C P 2037299 ~
06/01/07
06/01/08
.RENTED
Ses
PREMI
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s 300,000
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, 1,000
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CA2029626 - TX-
06/01/07
06/01/08
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ABLE AIDS
CA2929627 - OS
06/01/07
06/01/08
SCNEWLEDWTOS
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06/01/07
06/01/08
AGGREGATE
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,
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06/01/07
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ELEACHAMIDERE
1,000,000
OFEICER.NENBER E UIEM
EL OSEABE-EA PSI
, 1,000,000
PECAL PRDV,SRws e.M.
EL DisEA BE. PMCY UNIT
i 1,000,000
OMER
cRENUEPTO. OF DPEwTRS I I ..JIS.BEM. ADDED BY eHmRUAENT N SPECIAL PRmnBI NI
The City of Demtmn, its Officiala,Agents,Employees and vo unteers are named
as additional insured as required by written contract. Above insurance is
Primary 6 non-contributory with 30 day notice of cancellation (except 10
days for non-payment of premium) as required by written contracts aa.,+F
Subro ation as required by written contract✓
City of Denton
221 N. Elm
Denton TX 76201
CITYDE7 I BromDAa.aF mEAawEDESCwxeD PoLLEBBE CUw¢¢D BEFORE ME EIPIMTpx
DATE TRwEDF. ME.SL. W O IN..xu TD MA.
NOT OF TO TE CENTECAT E MATER x... TO TE HET, BUT ERRED TO DO IN
iXALL
IN POw NO DBIIGAM NOR UABBFTY OR AND A.. J. ME wwRFA m A6trt0OR
RvREBENTAINE&
AUMCSBaD R.wNESNNM rvE /
25 (2001108)
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.
Awrcu LO tzuuvuat