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2005-029
ORDINANCE NO. ~'~00~7.~- ~,~ q AN ORDINANCE ACCEPTING COMPETITIVE BIDS AND AWARDING A PUBLIC WORKS CONTRACT FOR THE CONSTRUCTION OF SDEWALKS FOR THE CITY OF DENTON; PROVIDING FOR THE EXPENDITURE OF FUNDS THEREFORE; AND PROVDING AN EFFECTIVE DATE (BD 3272-PRAIKIE, CRAWFORD, PAISLEY SDEWALKS AWARDED TO FLOYD SMITH CONCRETE, INC. IN TIlE AMOUNT OF $162,145.18). 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. That 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 Pumhasing Agent filed according to the bid number assigned hereto, are hereby accepted and approved as being the lowest responsible bids: BID NUMBER CONTRACTOR AMOUNT 3272 Floyd Smith Concrete, Inc. $162,145.18 SECTION 2. That 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 ora written contract and furnishing of performance and payment bonds, and insurance certificate after notification of the award of the bid. SECTION 3. That 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. That 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. That this ordinance shall become effective immediately upon its passage and approval. PASSED AND APPROVED this the /¢~f/~ day of ~q~ ,2005. ATTEST: JENNIFER WALTERS, CITY SECRETARY APPROVED AS TO LF]GAL FORM: HERBERT L. e~ ~Y, CITY ATTORNEY 3-ORD-Bid 327~ CONTRACT AGREEMENT STATE OF TEXAS § COUNTY OF DENTON § THIS AGREEMENT, made and entered into this 18th day of January A.D., 2005, by and between City of Denton of the County of Denton and State of Texas, acting through Michael A. Conduff thereunto duly authorized so to do, hereinafter termed "OWNER," and Floyd Smith Concrete, Inc. PO Box 1781 Denton, TX 76202 of the City of Denton , County of Denton "CONTRACTOR." and State of Texas , hereinafter termed 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 #3272 - Prairie, Crawford, and Paisley Street Sidewalks in the amount of $162,145.18 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 ali materials, supplies, machinery, equipment, tools, superintendence, labor, insurance, and other accessories and services necessary to complete the work specified above, in accordance with the conditions and prices stated in the Proposal and the Performance and Payment Bonds, attached hereto, and in accordance with all the General Conditions of the Agreement, the Special Conditions, the Notice to Bidders (Advertisement for Bids), and Instructions to Bidders, as referenced herein and on file in the office of the Purchasing Agent, and in accordance with the plans, which includes all maps, plats, blueprints, and other drawings and printed or written explanatory matter thereof, and the Specifications therefore, as prepared by: City of Denton Engineering Department 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 iris designee under this agreement. Indemnification Contractor covenants and agrees to and does hereby indemnify, hold harmless and defend, at its own expense, Owner, its officers, servants and employees, from and against any and all claims or suits for property loss or damage and/or personal injury, including death, to any and all persons, of whatsoever kind or character, whether real or asserted, arising out of the Work and services to be performed hereunder by Contractor, its officers, agents, employees, subcontractors, licensees or invitees, whether or not caused, in whole or in part, by the alleged negligence of the officers, servants, employees, of the Owner. Contractor likewise covenants and agrees to, and does hereby, indemnify and hold harmless Owner during the performance of any of the terms and conditions of this Contract, whether arising out of in whole or in part, any and all alleged acts or omissions of officers, servants, or employees of Owner. The provisions of this paragraph are solely for the benefit of the parties hereto and not intended to create or grant any fights, 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 IN WITNESS WHEREOF, the parties of these presents have executed this agreement in the year and day first above written. ATTEST: BY: City of Denton ATTEST: (SEAL) CONTRACTOR AP PROVE/~ T O/~: CITY ATTORNEY' MAILING ADDRESS PHONE NUMBER BY: FAX NUMBER l~Nrr ED NAME (SEAL) CA- 3 POWER OF ATTORNEY K ow All Men by These Presents: (Irrevocable) No. SP- That this Power of Attorney is not valid or in effect unless attached to the bond which it authorizes executed, but may be detached by the approving officer if desired. That Western Sum.._.~.,q~any, a co~poradon, does hereby make, constitute and appoint the following THREE I I authorized individuals: AUTHORIZED INDIVIDUALS CATHY MIL/ER' JEFFREY PARKS:::K. ING AUTHORIZED IN,1MVIDUALS JAMES ED~IARD KING ,.' · in the City of DENTON , State ~ TEXAS wi~ limimd auth~ty, its we and law~l Aanmey(s) in fact with ~11 power and authority he.by centred, to sign. execute, ac~owledge and deliver hir and on its behalf as Surety, the ~llowing described bond: BIDt PERFORMANCE~ AND/OR PAYMENT BOND~ IN ADDITION THE RELATED TRANSACTIONS SUCR AS CONSENTS OF SURETY~ RIDERS~ AND LETTERS OF INTENT~ MAINTENANCE AND WARRANTY BONDS~ PROVIDING THE BOND PENALTY/ DOES NOT EXCEED FIVE MILLION AND NO/lDO DOLLARS (*'5.000.0OO.00).~''' ********************************************************************** The acknowledgment and execution of such bond by the said Attorney in Fact shall be as binding upon this Company as if such bond had been executed and acknowledged by the regularly elected officers of this Company. All authority hereby conferred shall expire and terminate, without notice, unless used before midnight of DECEMBER 31, 2007, but until such rime shall be irrevocable and in full force and effect. the following is a tree and exact copy of Section 7 of the By-Laws of Western Surely Company. duly adopted and now Powers of Attorney, or other obligations o£ the corporation shall be executed in the corporate name of the Company t, Treasurer, or any Vice President, or by such other officers as the Board of Directors may authorize. Ti~e President, any Vice or the Treasurer may appohtt Attorneys in Fact ur Agents who shall have authority lo issue bonds, policies, or underlakings in the e seal is not necessary for the validity of any bonds, policies, undertakings, Powers of Attorney or other obligations of Ihe corporation. The ~finted by facsimile." may be increased if there is attached to 9ds Power, written authority so authorizing in the form of an endorsement, [crier or Officer, lJndetwrifing Officer. President, Vice President. Assistant Vice Pmaidang Treasurer, Secretary or Assistant SecretaB~ of Western said increa.~e. Company has caused these presents to be executed by its Senior Vice President with its corporate seal affixed this 1st da: 2002 WESTE]I,N SURETY COMPANY COLrNTY OF MINNEHAHA Senior Vice Pre. dent On. this 1St day of April , in the year 2002 . before me. a Notary Public. personaL)y appeared Paul T. Bruflat. who being by me duly sworn, acknowledged that he signcd the above Power of Attorney ~ thc aforesaid officer of WESTERN SURETY COMPANY;and- acknowledged said insLmmcnt to be the voluntm3' scl and deed of said corporation. -- ~ la testimony wbereof. I beve hereunto set my hand and the seal of Westem Surety Company this* ~ ~ day o~-~ .~[~.~- W E S T E R--,N SURETY (7OMPANY *IMPORTANT: This date must be filled in before it is attached // J .....:..-- /'~ ltd the bond and it must be the same date as the bond. I By ~/~.~ ~/ ~"~ Form 749-4-2002 ' ~ Senior ¢' ice ~rej~ent PERFORMANCE BOND STATE OF TEXAS COUNTY OFDENTON § KNOW ALL MEN BY THESE PRESENTS: That Floyd Smith Concrete, Inc. whose ~.sosxc~S is PO Box,,1781, Denton, TX/76202 hereinafter called Principal, and CI '~IA3r~4fl. ~i (A'YYh~(IJQ. L~/~ corporation organ/zed and existing under the laws of the State of~,a~r_F/~..~%j '. and ~lly authorized to transact business in the State of Texas, as Surety, are held and firmly bound unto the City of Denton, a municipal corporation organized and existing under the laws of the State of Texas, hereinafter called,Owner, in the penal sum of One hu~ed sixty two thousand one hundred forty five and 18/100 ~ DOLLARS ($162,145.18)~his 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 2005-02,9 , with the City of Denton, the Owner, dated the 18th day of January A.D. 2005,~a/copy of which is hereto attached and made a part he/r~of, for Bid #3272 - Prairie, Crawford, and Paisley Street Sidewalks x/ NOW, THEREFORE, if the Principal shall well, lntly 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 one (1) year from the date of final completion and £mal 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. PROVIDED. FURTHER, that if any legal action be filed upon this Bond, exclusive venue shall lie in Denton County, State of Texas. AND PROVIDED FURTI-IBR, 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 t~.s, each one of which shall be deemed an original, this the ~day of~l~, ~ . ATTEST: PRINCIPAL BY: SECRETARY ATTEST: BY: S~ ATTORNEY-IIq-FACT The Resident Agent of the Surety in Denton County, Texas for delivery of notice and service of the process is: (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 Floyd Smith Concrete, Inc. , whose address is PO Box 1781 Denton, TX 7620~ I .// , hereinafter called Principal, and L~ _~-!-?~°. 3([h~;l I ~.f_ .-~. ()_}flrhf~f~/'a corporation organized and · ~ existing under the laws of the State of '~.,~.~(lf~ , 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/perforrn labor upon, the building o~/ improvements hereinafter referred to, in~fe penal sum of One hundre~l/sixty two thousand one hundred forty five and 18/100 DOLLARS ($162,145.18)d,~ 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, fu-miy 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 2005-.029 , with the City of Denton, the Owner, dated the 18th day of January A.D. _2005 ,,~a copy of which is hereto j attached and made a part hereof, for Bid #3272 - Prairie, Crawford, and Paisley Street Sidewalks ~ NOW, THEREFORE, if the Principal shall well, m~ly and faithfully perform its duties and make prompt payment to all persons, farms, 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 oft'mae, 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, Vemon's Annotated Civil Statutes of the State of Texas. IN WITNESS WHEREOF, this immanent is executed in 4 co. lfies, each one of which shall be deemed an original, this the ~'~.vk day of~l~, ~:tx/- ATTEST: PRINCIPAL ATTEST: BY: SURETY A-TTORNEY-IN~FACT The Resident Agent of the Surety in Denton County, Texas for delivery of notice and service of the process is: STREET ADDRESS: .'~/~F) ~t[_~ f~ ~- ~gfI'[T.f3[Trf"q(f'>°rf')~ (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 shah 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 shah 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 shah comply with the following general specifications, and shah 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 pol/cies shall be endorsed to provide the following: o. 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 ag~mst 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 hability. · All policies shall be endorsed to read: "SAID POLICY SHALL NOT BE CANCELLED, NONRENEWED OR MATERL4LLY CHANGE 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 clahns-made form, Contractor shall mainta'm 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 shah 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: Ix] 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 wrkten 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 000! 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. 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. 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). [] [1 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 tiffs contract, an Owner's and Contractor's Protective Liability insurance policy naming the City as iiisured 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 build'mg. 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 sen, ices 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 "blar~ket" 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 reqfftred 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. ATTACHMENT1 ix] Worker's Compensation Coverage for Building or Construction Projects for Governmental Entities A. Definitions: Do 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 ail 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 d/rectly 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 Ylmitation, provid'mg, 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. The contractor shail provide coverage, based on proper report'mg of classification codes and payroll amounts and filing of any overage agreements, wh/ch meets the statutory requirements of Texas Labor Code, Section 401.011(44) for ail employees of the Contractor providing services on the project, for the duration of the project. The Contractor must provide a certificate of coverage to the govemmentai entity prior to being awarded the contract. 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. 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. The contractor shall retain all required certificates of coverage for the duration of the project and for one year thereafter. 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. 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. 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 mounts 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 proj eot; (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 ~om 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 [. 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 requked 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 provid'mg services. By signing this contract or providing or causing to be provided a certificate of coverage, the contractor is represenfmg 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 mounts, and that all coverage agreements will be filed with the appropriate insurance carder or, in the case of a self- insured, with the commission's Division of Self-Insurance Regulation. Provid'mg false or misleading information may subject the contractor to administrative penalties, criminal penalties, civil penalties, or other civil actions. · 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. ' B~D ~/~272 ADDENDUM #1 Addendum #1 to be returned with Bid Proposal The attached pages are changes to the bid specifications. NO OTHER CHANGES AT TH IS TIME. TMs form shall be signed und ret#rned with your bid. Signature: Comtnmy: Title: ~'r~Ject Name: Prairie, Cmwford and Palslay Street Sidewalks Work Days = ~ 60 ~ Bid NO. 327Z A'I-FACHMENT ¶-AD1', BID TABULATtON SHEET P.O, NO. ~ of Cen~'ete C, utb & I 250 LF Remove Conm'~te Sidewalks and Driveways 430 c~, ~ I SY 3.12 Pirate 5,7-B $,2-A B.2-A, Plaus SP-100, Ha'~s do flat5 P.3 u~u.lu'~vv~ v~:l~ ~v d~ I~VZ ~rT~ OY D~TON PURCHASING #6487 P.006/006 P~ject Neme: Prakfe, Cmwford and Paisley Street Sidewalks Wo~ Deys 60 , Bid No. 3272 AT'rACHMENT 'I-ADt: BID TABULAYION SHEET P.O. No. L3A-3 4" C~m~ Sidewalk - Curb I"" C°"~ Sid~alk ' Curb ~' Ramp T~ ~! ......... 4" ~n~z Sid~slk - C~ Unit Price Ia Worgs Uait Pfi~ In Wo~ls ~ut NCI'CO0 i000 ,~ l l,~r~ · ,o lsvJs dvllcrS Re, hove, Relocate aed ] High C~la Link Fenc~ U~ng Existing F~ce 6m 3,ag / ~ TOTAL BID SUMMARY TOTAL BASE BID PRICE IN WORDS one/ c , dr d In the event of the award of a contract to the undemigned, the undersigned will furnish a performance bond and a payment bond for the full amount of the contract, to secure proper compliance with .the terms and provisions of the contract, to insure and guarantee the work until final completion and acceptance, and to ~mrantee payment for all lawful claima 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. · Vendor hereby assigns to purchaser any and all claims for overcharges associated with this contract which arise under the antitrust laws of the United States, 15 USCA Section 1 et seq., and which arise under the antitrust laws of the State ofTexas, Tex. Bus. & Com. Code, Section 15.01, et seq. P-5 Receipt is hereby acknowledged of the following addenda to the plans and specifications: Addendum No. i dated Addendum No. 2 dated Addendum No. 3 dated Addendum No. 4 dated Addendum No. 5 dated Received Received Received Received Received Street Address City and State Seal & Authorization (If a Corporation) Telephone P-6 VENDOR COMPLIANCE TO STATE LAW The 1985 Session of the Texas Legislature passed House Bill 620 relative to the award of contracts to non-resident bidders. This law provides that, in order to be awarded a contract as low bidder, non-resident bidders (out-of-state contractors whose corporate offices or principal place of business are outside of the State of Texas) bid projects for construction, improvements, supplies or services in Texas at an mount 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 winch 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 fo~ 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-residbnt 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: B~DER: Street Address City and State THIS FORM MUST BE RETURNED WITH YOUR BID P-7 CONTRACTOR COMPLIANCE TO TEXAS SALES TAX CODE Comply with all requirements of the Texas Sales Tax Code. Tlie 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. CONTRACTOR: Street Address City and State THIS FORM SI/ALL BE EXECUTED AT TIlE TIME OF EXECUTION OF TI:gE, CONTRACT AND SHALL BE MADE A PART OF THE CONTRACT. P~8 U.S. DEPARTMENT OF HOUSING AD URBAN DEVELOPMENT COMMUNITY DEVELOPMENT .BLOCK GRANT PROGRAM CONTRACTOR'S CERTIFICATION CONCERNING LABOR STANDARDS AND PREVAILIN~ TO (.4pprop~fate Recipient): COMMUNITY DEVELOPMENT DMSON cio BARBARA ROSS WAGE REQUIREMENTS DATE /'~ -/~_ ~) ~-~ PROJECT NUMRER S~3-MC-4~8-0036 PROJECT NAME Prairie, Cmwford & Paisley St Sidewalks ' 1. The undersigned, having executed a contract with THE CITY OF DENTON for the construction of the above-identified project, acknowledges that: ia) The Labor Standards provisions are included in the aforesaid contract: {bi Correction of any infractions of the aforesaid conditions, including infractions by any of his/her subcontractors and any lower tier contractors is his/her responsibility: 2. He/She certifies that: {a) Neither he/she nor any firm, partnership or association in which he/she has substantial interest is designated as an ineligible contractor by the Comptroller General of the United States pursuant to Section 5.6 (bi of the Regulations of the Secretary of Labor, Pm'tS(29 CFR, PortS) or pursuant to Section 3ia) of the Davis-Bacon Act, as amended (#0 []..S.C. 275a-2(a)), (b} No par~ of the aforementioned contract has been or will be subcontracted to any subcontractor if such sub- contractor or any firm, corporation, partnership or association in which such subcontractor has a substantial interest is designated ss an ineligible contractor pursuant to any of the aforementioned regulatory or statutory provisions. 3. He/She agrees to obtain and forward to the aforementioned recipient within ten days after the execution of any subcontract, including those executed by his subcontractors and any lower tier subcontracts, a Subcontractor's Certification Concerning Labor Standards and Prevailing Wage Requirements executed by the subcontractors. 4. He/She certifies that: {a) The legal name and the business address of the undersigned are: FI o~/~ 5,,y/,-~ ~ _~4'~--e ~'-n ~-. FED ID OR SS # /?..,~-'"~ ~ ~ ~'~[ 0 ~'~ * RACE ~-'~"~3't, "~ ~ ~.0 ~L Information is optional. In the absence of a response, staff will determine race based on available information. {bi The undersigned is: (Check One) {li A SINGLE PROPRIETORSHIP ~ CORPORATION ORGANIZED IN THE STATE OF {2) A PARTNERSHIP i4i OTHER ORGANIZATIONS (Describe) (C} The name, title and address of the owner, partners or officers Of the undersigned are: NAME TITLE ADDRESS )rint or T~pe Name of Contractor CD - 4 U, S. DEPARTMENT OF HOUSING AND Ul~AN DEVELOPMENT CERTIFICATION OF CONTRACTOR/SUBCONTRACTOR REGARDING EQUAL EMPLOYMENT OPPORTLTN1TY This certification is required pursuant to Executive Order 11246 (30 F. R. 1231-25). 'I~e implementing rules and regulations provide that any bidder or prospective contractor, or any of their proposed subcontractors, shah state as an initial part of the bid or negotiations of the cuntract whether it has participated in any previous contract or subconlract subject to the equal opportunity amployment clause' lms flied all compliance yep•frs due under applicable instructions. . and, if so, whether it Wh~re ihe certification indicat~ that the bidder has not flied a Compliance Cc'port due under applicable inslmctions, such bidder shall be required to submit a compliance report within seven calendar days al[er bid cloning. No contract shall be awarded unless such report is submiited. CERTIFICATION BY BIDDER NAME AND ADDRESS OF BIDDER (include ZIP ~ode) ~ '-,-----.------ Bidder has participated in a previous contract or subcontract subject to the Equal Opportunity Clause. Ye~ [] No 2..Compliance reports were required to be flied in connection with such contrac /~//~-~ []No · ' t or subcontract. 3, Bidder has filed all compliance reports due under applicable instructions, including SF-100 4.' Have you ever been or are you being considered for sanction due to violation of Executive Order El Yes ~ NAME AND TITLE OF SIGNER (Please type). DATE CD - 6 A COPY OF THIS FORM MUST BE SIGNED BY EACH PROPOSED CONTRACTOR AND SUBCONTRACTOR. CERTIFICATION OF PROPOSED CONTRACTOR/SUBCONTRACTOR REGARDING SECTION 3 AND SEGREGATED FACILITIES Name of Prirae Contractor or Subcontractor Prairie, Crawford and Paisley Street Sidewalks ?rojeet Name B-01-MC-48-0036 Project Number The undersigned hereby certifies that: A) Section 3 provisions are included in the Contract B) As contractor/subcontractor I agree to recruit new employees from the project neighborhood. New hires will be tracked and information submitted to the City of Denton for verification. NOTE: SECTION 3 COMPLIANCE INFORMATION MUST BE SUBMITTED TO THE COMMUNITY DEVELOPMENT OFFICE, 1 O1 SOUTH LOCUST STREET, SUITE 500. ,4 BREAKDOWN OF SUBCONTRACTORS MUST BE INCLUDED. D) No segregated facilities wilt be rna'retained. · NAME AND TITLE OF SIGNER (PRINT OR TYPE) Date CD - 8 ACORD CERTIFICATE OF LIABILITY INSURANCE 01/27/2o0s PRODUCE~ (94o)382-9691 FAX (940)243-1050 THISCERTiFICATEISlSSUEDASA MATTER OF INFORMATION Ramey & King Tnsurance ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE · HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 5 0,ort, -35E ALTER T"EOOVE' OEAFFORDEODYT.EPOL.C.ES"ELO, ,. De.to.,-rx 7620 PLs Dana Hilliard RE AFFORDING COVERAGE NAIL# ~NSUR~ Floyd Smith Concrete, ThCs/' ~.~[ mSURER~ Trinity Unlversal 19887 P.O. Box 1781~ ~NSURE~B: Texas Mutual Ins. Co. TXMUT Denton, TX 76202-178! ~NSUR~C: COVERAGES THE POUCIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POUCY PER]OD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDI'RON OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POECIE8 DESCRIBED HEREIN IS SUBSECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS, INSR GENERAL UABILITY ~/~ GLA10400460305 '1)9/28/2004 09/2~/200S{~~EACHOCCURRENCE $ ~1000,000 A __ PE}~NAL & ADV INJURY $ 1,000,000 WOR~ERS=OMr~N~T,O,.~HOL// TSF000108222; ,D"'9/28/2004 09/28/200~" I.o...,,~,.~1 I%~' B ANY PRO PRIETO PJPAF~NER~F_XECUTIV EI E.L EACH ACCIDENT $ 100, OO0 SPECIAL PROVISIONS below E.L. DISE~.SE - POUCY LIMIT $ 100 ~ 000 DESCRIPTION OF OPER,~TIQNE I LOCATIONS I VEHICLES I EXCLU. SIO_N S ADDED BY ENDOR~E_MENT] ~PEC~L SF,V'OVrSIONS ~roJect: Prairie, Crawford, and Pa~sley Street Sidewalks (/ Said ~olicy shall not be cancelled, nonrenewed or r~aterially changed without 30 days advanced written aotice being given to the owner (city) except when the policy is be~c-~ncelled for non payment of =remium in which case 10 days adcanced written not~ce is required. ;ertificate holder is listed as an A~dd~tional Tnsured with respects to General Liability coverage.~''- CERTIFICATE HOLDER City of Denton//'// 901 B Texas Street Denton, TX 76201 ACORD28 (2001108) FAX: (940)349-7302 CANCELLATION SHOULD A NY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATrON DATE THEREOF. THE ISSUING INSURER WILL ENDEAVOR TO MAIL -- DAYS WRI'r T~ NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMFOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE IN;~L]RER, ITS AGENTS OR REPRESENTATIVES. ©ACORD CORPORATION 1988 IMPORTANT If the certificate holder is an ADDITIONAL INSURED, the policy(les) 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. ACORD 25 (2001108) M~r O? OS 04:26p Holt R~emc~-Rllstate Ims 940 566 5942 p. 1 Allstale. You're in good hands. ALLSTATE COUNTY MUTUAL INSUPJkNCE COMPANY Home Office Irving, Texas Calendar Date : 03/07/2005 TEXAS CUSTOMER SERVICE REQUEST COMMERCIAL AUTO POLICY Policy Number: 048637347 11/23 BUSINESS NAME 8USN ADDRESS CITY HOME PHONE FLOYD SMITH PO BOX 1781 DENTON ST: TX ZIP: 76202 ( ) BUSINESS PHONE : ( 940 ) 565 - 0114 C~NGE POLICY INTERESTED PARTY . Dir Code: ODOUOO Name: CITY OF DENTON BID 3272 Address: 901 B TEXAS STREET City: DENTON State: TX Zip: 76201 Dir Code: 000000 ' ~' Name: CITY OF DENTON V~BID #3272 Address: 901B TEXAS ST City: DENTON State: TX Zip: 76201 THIS ENDORSEMENT HAS AFFECTED THE FOLLOWING POLICY FORMS: Forms Added: TE2OO1A 0392 ADDITIONAL INSUREDS THIS REQUEST IS SUBJECT TO POLICY TERMS AND IS EFFECTIVE ONLY IF THE POLICY NOTED IS CURRENTLY IN FORCE EFFECTIVE 04:25 PM 03/07/2005 Notice: it is a crime to knowingly provide false, incomplete or misleading information to an insurance company for the purpose of defrauding the company. Penalties include imprisonment, fines and denial of insurance benefits. POLI~YHOLDER's Signature l/~r~'2~. ~'~/L'/O~ NO: 097821 LOC: F47 AGEN~ Si ghatu~e 940-566-2234 Agent's Phone# Page I of O1 Fe~ 03 OS OS:OBp Holt R~eno~-Rllstate Ins 840 Ails ate. You're in good hands. CERTIFICATE OF INSURANCE ALLSTATE INSURANCE CO ALLSTATE INDEMNITY CO ALLSTATE LLOYD'S ~'~S CERTIFICATE iS ISSUED AS A M A'~-E R OF INFORMATION ONLY A-~ CONFERS NO RIGHTS UPON THE CERTIFICATE I-IOLDER. THiS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW, CERTIFICATE HOLDER NAMED INSURED Name and Addr=ss of Pa~ty to~Vhom fl~is Certificate is Issued Name and Address o[lnsured City of Denton~ Attn: Purchasing D~pt. Floyd Smith Concrete 901-8 T~xas Street POBox 178[ D~nton, TX 7620t Denton TX 76202 Bi,d.# 3,272 ........... ,:.,od be!ow have been issued to the jnsm;d named above aubjnct to ~he expiration date indicated below, notwithstanding any ~qulrem~.nt, term condition of any contract or other document with ~espact to which 1~.is certificate ray bo issued or may pertain. Thc insurance afforded by thc policies decribod herein is subject to all the terms, excluslons, and conditions of such policies. TYPE OF INSURANCE AND LIMITS COMMERCIAL O'~q ERAL LIABILITY Policy Effective ~.xpiration Number Date Date Limit Amount General Aggregate Limit (o~ducts-Completed Operations) $ products-Completed Operations Agg:~gate Limit Personal and Advertising lnjuPy Limit Each Oc~u.=nc~ Limit Physical Damage Limit Medical Expmse Limit Workers' Compensation & Policy Effective Expiration Employer's Liabili~ Number Date Date Coverage Limits 'Workers' Comp=nsatio'"--~'--' STATUTORY- applies only in ~e following sta~es: BODILY 1N~ BY ACCIDENT $ EACH ACCIDENT EMPLOYER'S BODILY INJURY BY DISEASE $ EACH EMPLOYEE LIABILITY BODILY INJURY BY DISEASE S POLICY LIMIT AUTOMOgiLE LIABILITY Policy Effective Expiration Number 048637347 Date 11/23104 Date 11/23/05 ANY AUTO X OWNED AUTOff' HIRED AUT~ -- SPEC1FIED.~U~OS _X_NON-OW~'DAUTO~" "~WNED PRIVATE PASSENGER AUTOS ~OWNED AUTOS OTHER THAN PRIVATE PASSENGER BODILY 1NIURY & PROPERTY DAMAGE ~ Split Liability limiis Bodily Injury Property Damage Each $ $ $ $ $ $ U M BRELI~- LIABILITY Limits Combined Single Limit of Liability $1,00~,000.0~ ~ EACH ACCIDENT J Policy Effectiw Expiration Number Date Date EACH OCCURRENCE GENERAL AFFREGATE PRODUCTS-COMPLETED OPERATIONS AGGREGATE $ $ OTHER (Show policy Effective Expiration Type of Policy) Number Date Date DESCRIPTION OF OPERATIOlqS/LOCATION. S;R~ESTREICTIONiSfSPE/~CI~L ITEIV~,,/ Auto Listing A~ched ~ [~l t ~ ~ ~1~,~/ Number of days notice 30 Ii ~ll ~U~ ~' 9X~ i ~ 0H03/05 Au~orized ~¢pr¢~en~ Date R2853-1 ~F~2~-2005 00:0~ FROM:FLOYD SMITH CONCQETE 940-565-0114 CERTIFICATE OF INSURANCE t, LLSTATE COUNTY MUTUAL INSURANCE COMPANY tOME OFFICE - IRVING, TEXAS 75063 tereby certifies that the following insurance is in force: POLICYHOLDER POLICY NUMBER FLOYD SMITH 048637347 BAP DBA FLOYD -~MITH CONCRETE PO BOX t781 DENTON, TX 76202-t781 ['he person or organization designated below is described in the policy as: CITY OF DENTON BID 3272 AT 901 B TEXAS STREET DENTON, TX 7620t ~'overages designated are afforded as stated below: AS THEIR INTEREST MAY APPEAR To the person or organization stated above: This policy, as respects the interest of the loss payee, additional interested named herein, may be cancelled by the Company during the policy period b! written notice at its last address known to the Company. Proof of such mailing is deemed sufficient proof of such notice. This Certificate of Insurance neither affirmatively nor negatively amends, extend referred to above. BU1380-1 BUl14-2 T0:~497302 EFFECTIVE DATE OF CERTIFICATE 02/04/05 ~LICY PERIOD /04 TO 11/23/05 [:01 A.M. STANDARD TIME LIENHOLDER (Loss Payable Clause ADDITIONAL INTERESTED PARTY ADDITIONAL INSURED CERTIFICATE HOLDER ,a.rty.. additional insured or certificate holder pwng such person or organization t0 days or alters the coverage afforded by the policy PAGE I OF 1