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2004-016
FILE REFERENCE FORM I 2004-016 I X Additional File Exists Additional File Contains Records Not Public, According to the Public Records Act Other FILE(S) Date Initials Change Order No. 1 [Approved by PUB] 05/10/04 .~1~ Change Order No. 2 - Ordinance 2004-371 12/07/04 )P~ O INANCE NO. AN ORDINANCE ACCEPTING COMPETITIVE BIDS AND AWARDING A PUBLIC WORKS CONTRACT FOR THE CONSTRUCTION OF HICKORY CREEK BASIN SANITARY SEWER REPLACEMENTS AND LINERS; PROVIDING FOR THE EXPENDITURE OF FUNDS THEREFORE; AND PROVIDING AN EFFECTIVE DATE (BID 3107-HICKORY CREEK BASIN SANITARY SEWER REPLACEMENTS AND LINERS AWARDED TO CIRCLE C CONSTRUCTION IN THE AMOUNT OF $1,995,275.50). WHEREAS, the City has solicited, received and tabulated competitive bids for the construction of public works or improvements in accordance with the procedures of State law and City ordinances; and WHEREAS, the City Manager or a designated employee has received and recommended that the herein described bids are the lowest responsible bids for the construction of the public works or improvements described in the bid invitation, bid proposals and plans and specifications therein; NOW, THEREFORE, THE COUNCIL OF THE CITY OF DENTON HEREBY ORDAINS: SECTION 1. 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 Purchasing Agent filed according to the bid number assigned hereto, are hereby accepted and approved as being the lowest responsible bids: BID NUMBER 3107 CONTRACTOR Circle C Construction AMOUNT $1,995,275.50 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 of a 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 pubhc 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 o f 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 d0'~ dayof ATTEST: JENNIFER WALTERS, C1TY SECRETARY ( ~ ,2004. APPROVED AS TO LEGAL FORM: HERB~~TTORNEY CONTRACT AGREEMENT STATE OF TEXAS § COUNTY OF DENTON § THIS AGREEMENT, made and entered into this 20th day of January A.D., 2004, by and between and Stat~.of Texas, acting through hereinafter termed "OWNER,'! and William O. Schultz, Inc., dba Cir.c. le:"C" COfistruction.Company 500 W. Trammell Street City of Denton of the CoUnty of Denton Michael A. Conduff thereunto duly authorized so to do, Fort Worth, Texas 76140 of the City of [or_.t Worth termed "CONTR_ACTOR." , CoUnty of Tarrant and State of Texas , hereinafter · wrrNESSETH: 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 3107 - HiCkory Creek Basin Sanitary-Sewer Replacements in' the amount of $1.,856,54_5.50 and al! 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 a nd o n file i n t he o ~ce o f t he Purchasing A gent, and i n a cco rdauce w ith t he 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 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 gc~neral 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 indemu~fy, hold harmless and defend, at · its own expense, Owner, its officers, servants and employees, from and against any and all.claims-°r suits for property loss or damage and/or personal injury, including death,- to any and all persons, of whatsoever kind or character, whether real or asserted, arising out of the Work and services to be performed hereunder by Contractor, 'its officers, agents, employees, subcontractors, licensees or ' invitees, whether or not caused, in whole or in part, by the alleged negligence of the officers, servants, employees, of the Owner. Contractor likewise covenants'and agrees to, and does hereby, indemnify and hold harmless Owner during the performance of any of the terms and conditions-of this Contract, whether'arising out of in whole or in part, any and all alleged acts~ or omissions of offiCerS~ 'servants, or employees of Owner. The provisions of this paragraph are solely for the benefit of the parties hereto and not intended to create or grant any rights, contractual or otherwise, to any other person or entity. Choice of Law and Ve hue This agreement shall be g0vemed 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 CONTRACTOK 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 CONTRACTOK 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 pa,-ties of these presents have executed this agreement in the yeai' and day first above written. BY: City of Denton APPROVED AS TO FORM: CITY ATTORN~ CA - 3 William J. Schultz, Inc., dba Circle "C" Construction Company :CONTRACTOR · 500 W. Trammell Fort Worth', TX,~.76140 MAmINGADDRESS 817/293~1863 .. PHONENUM~BK 817/293-1957 ' ' FAX NUMBBR BY: TITLE William d. Schultz, President PRINTED NAME Bond No. 6196733 PERFORMANCE BOND STATE OF TEXAS CO~ OY DEiVrON,. § William J. Schultz, Inc., dba~z'~ I~NOW A~LL MIeN BY ~SE P~SE~S: ~t circle "c" Construct~ o~ CoMpaqy whos~ ~oss is 500 W~mme~ S~Oet~ Yo~ ~o~ TX 76140, horo~ caHo~ P~ciple, ~d'~f~ I~ura~ . ~omoan~ of A~ri~co~orafion organized. ~d exis~g ~der ~e laws of~e State of' Washi. n~on , ~d ~y au~o~ to ~aet b~s ~ ~e State of Text, ~ S~e~, ~e held ~d ~y bo~d ~to ~e Ci~ of Denton, a m~cip~ co~orafion organ~z~ ~d e~s~ ~der ~e ~ws of~e State ofTex~, h~e~ c~ed ~er. ~ ~e ~en~ ~ of One ~ 1 i o~, E i ~ht~dred Fifty'-~Six T,h~qsand,, Five Hundred. Fort.y-~ive and 5~DOLL~($1,~6,545.50~I~ ten p~c~t of ~e'smt~ pe~ ~ ~.~ ~fionM ~ 0f money r~resen~g ~fionM co~ expe~, a~omeys' fees, ~d Hq~dated ~ages ~s~g out of o~ co~ected ~ ~e below iden~ Con. act, ~ la~ money of ~e U~ted Smt~, to be p~d ~ Denton C0~, Text, for · e pa~ent of wMeh S~ well ~d ~y to be made, we hereby b~d o~elves, o~ hefts, ex~utors, ~-~s~tors, suece~s0rs, ~d ~sf~, jolty ~d sev~y, ~y by ~ese presents. ~S Bond s~l automafic~y b'e ~cre~ed by ~e ~o~t 0f ~y ~ge Ord~ or Supplem~ A~eem~t, w~eh ~e~ ~e Con~t price, but ~ no ev~t.s~ a C~ge ~ or Suppl~ A~eem~t, wMeh r~uces ~e. Con~t p~ce, deere~e ~e pe~ s~ offs Bond. · ~.OBLIGATION TO PAY .S~ .is eon~fioned ~ foHows:' ~e~, ~e P~cipM ~t::a ~to a cen Conm~t, iden~ by Or~n~ce N~b~4-'016, ~ ~e CiV of D~to~ ' · e O~er, dated ~e 20~ · ~y of ~ A.D. 2004~, a copy of wMch is hereto a~ached ~d m~e~p~ h~eof, for Bid 3107 - ~cko~ ~eek B~M S~t~ Sew~ Re~l~ts ~. of ~e .~de~.~n~, c Ov~m~, t~s, c0n~o~ ~d ~e~ of s~d Con~aet .~ ~eor~ce ~ t he P 1~, S pee~eafio~ a nd C on~~ D oo~ts d ~g t he o fi~ t e~ t h~f ~d any · exte~fon ~er~f w~ch may be ~ted by ~e 0~, ~ or ~out notice to'~e S~e~, ~d ' d~g ~e Hfe of ~y ~ or w~V r~ ~der ~S COn. act, ~d S~ ~o well ~d ~y peffo~ ~d ~fiH ~ ~e.~de~aMngs, cOy~ts, te~, con~fio~ md a~eemenm of ~y ~d ~ d~y'au~o~ mod~fic~o~ of s~d Con~t ~t may h~e~er be m~e, notice of w~ch mo~ca~o~ to ~e S~e~ berg hereby'w~ved; ~d, ~.~e P~cip~ s~ r~ ~or'r~laee aH def6cts' due to fa~ mated~s ~d wor~p ~t appe~ ~ apical of one (1) ye~ ~om · e ~te of ~ comple~on ~d ~ acc~tmce of ~e Work by ~e O~; ~, if ~e P~eipal sh~ ~ly ~d~ni~ ~d save h~ess ~e ~er ~m ~ costs ~d d~ages wMch O~er may s~ by re.on of f~e to so peffo~ h~e~ ~d s~ ~ly re~b~se ~d r~ay O~er ~ outlay ~d e~:e wMch ~e O~er may ~c~ ~ m~g good ~Y defa~t or deficiency, ~en ~s obHga6on sh~ be void; o~se, it sh~ r~ ~ ~ force '~d effect. PB- 1 PROVIDED FURTI-I~R, that if any legal action be filed upon this Bond, exclusive venue shall lie in Denton County, State of Texas. AND PROVIDBD FURTHER, that the said Surety, for value received, hereby stipulates aud. agrees that no change, extension of fi,ne, 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 o£the State of Texas. The undersigned and designated agent is hereby designated by the Surety herein as the Kesident 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 exec~ldn 4 copies, each one of which shall be deemed an original, this the 20th day of January, 2004. - _Ail~B~r ety .' BY:.~ PRINCIPbd~ Wil.lfam J. Schultz, Inc., dba~ · Circl.e "C". Construction Company PRBSIDElX~, :, ~liam J. Schultz SURETY Safeco Insurt~nce Company of Ameri~ca/ : Sheryl A. Klutts ~"ae Resident Agent of the Surety in Denton County, Texas for delivery of notice and service of the process is: NAME~ Pauline Lesch, Denton County Resident Agent STKEETZ~J)DRESS: 206 Elm Street~ Suite 105, Lewisville, TX 75057 (NOTE: ' Date of Performance Bond must be date of Contract. If Resident Agent is not a corporation, give a person's name.) PB - 2 -:% Bond No. 6196733 · PAYMENT BOND STATE OF TEXAS CO~ OF DENTON § William J. Schultz, inc., dba~'''~ KNOW ALL lvIEN BY l~-IESlq ?PJBSElqTS: ~il~at Circle "C" Construction~ Company. whose address is :500 W. Trammell Street, Fort Worth,. T~as. 76140, hereinafter .called Principal, and 'Safeco Insuranc'e Comvan.y of America,u~ a corPoration organized and existing under'the laws of the State Of Washinqton , and fully anthgrized to .tran.~act business in the State of Texas/as Surety, are held'and firmly bound unto the City of Denton, a municipal corporation organic, ed and existing under.the laws of.the State of Texas, hereinafter called Owner, and unto all persons, firms, and corporations who may.fumish materials for, or perform labor upon, the building or improvements hereiu,~er referred to, in the penal sum of One ~titlion~Eiqht Hundred~.Fifty-S_ix Thousand, Five Hundr. ed Forty-Five and .50Z!00 DOLL.~J~.S ~1,856,545.50.~ lawful.re°ney of the U~ted States, to be paid in Denton, County, · Texas, for the payment o f.which sum well and truly to be made, we hereby bind ourselves, our heirs, executors, samlulstrators~ successors,' and assigns, jointly and severally, fmnly by these presents. This Bond .shall automatically be .increased by the amount of any Cliange 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 s-m of tM~ Bond. THE oBLIGATION TO PAY SAME is conditioned as follows: Whercas, the Priucipal entered into a certain Contract, identified by Ordinance Number 200~4- 016, with the City of Denton, the Owner, dated the 20th day of. ~annsaW A.D... 2004~,~, 'a coPy of which is hereto attached and made a part/hereof,."for'Bid 3107 ~ Hickory'Creek Basin Sauitar~ sewer Replacements and Liners/' ' NOW, THEREFORE, if the Principal sha~l well,·truly and falflifully .perform its duties and make promPt payment to all p~rs0ns, firms, subcontractors, corporations and claimants .supplying labor and/or material in the prosecution of the W0rk 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 FUROR, that if any legal action be filed·on this Bo~d, 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, shal~ in' anywise affect Rs obligation on this Bond, 'and it. does hereby waive notice of any such change, extension of time, alteration or additi°n 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 tho 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 Kesident 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 inS~ent is executed in'4 copies, each one of which shall deemed an original, this the 20th day oft~, 2004. ~'/- ATTEST: · ~Surety' BY: ~ John A. Miller PRINCIPAL William J. Schultz, Inc., dba Circle "C" Construction Company BY: William J. Schultz SURETY Safeco InsuraT~e Company of Ameri9~/ ATTORNBY-IIq-FACT Sheryl A. Klutts The Resident Agent of the Surety in Denton County, Texa~ for delivery of notice and sendce of the process is: NAME:' Pauline Lesch, Denton County Resident Agent STRBETADDRBSS: 206 Elm Street, Suite 105, Lewisville, TX 75057 (NOTE: Date of Payment Bond must 'be date of Contract. If Resident Agent is not a corporation, give a person's name.) · PB-4 SAFECOTM State of Texas Surety Bond Claim Notice In accordance with Section 2253.021 (f) of the Texas Government Code and Section 53.202(6) of the Texas Property Code, any notice of claim to the named surety under this bond(s) should be sent to.' SAFECO Surety Adams Building 4634 154th PL NE Redmond, WA 98052 Mailing Address: SAFECO Surety PO Box 34526 Seattle, WA 98124 Phone: (425) 376-6535 Fax: (425) 376-6533 www. SAFECO.com EXHIBIT B IMPORTANT NOTICE TO SURETY BOND CUSTOMERS REGARDING THE TERRORISM RISK INSURANCE ACT OF 2002 As a surety bond customer of one of the SAFECO insurance companies (SAFECO Insurance Company of Americal General Insurance Company of America, First National Insurance Company, American States Insurance Company or American Economy Insurance Company), it is our duty to notify you that the Terrorism Risk Insurance Act of 2002 extends to "surety insurance". This means that under certain cimumstances, we may be eligible for reimbursement of certain surety bond losses by the United States government under a formula established by this Act. Under this formula, the United States government pays 90% of losses caused by certified acts of terrorism that exceed a statutorily established deductible to be paid by the insurance company providing the bond. The Act also establishes a $100 billion cap for the total of all losses to be paid by all insurers for certified acts of terrorism. Losses on some or all of your bonds may be subject to this cap. This notice does not modify any of the existing terms and condition so this bond, the underlying agreement guaranteed by this bond, any statutes governing the terms of this bond or any generally applicable rules of law. At this time there is no premium change resulting from this Act. SAFECO' POWER OF ATTORNEY SAFECO INSURANCE COMPANY OF AMERICA GENERAL INSURANCE COMPANY OF AMERICA HOME OFFICE: SAFECO PLAZA SEATTLE, WASHINGTON 98185 NO. 7498 KNOW ALL BY THESE PRESENTS: ~' That SAFECO INSURANCE COMPANY OF AMERICA'~nd GENERAL IN~.~URANCE COMPANY OF AMERICA, each a Washington corporation, does each hereby appoint .~ ******************************J'*l'~q A. MR,LEE; SHERYL A. KLUTI'S~, JO[-~ A. MR,LER, II; K.R. HARVEY; Fort Worth, *ex~************************************** its tree and lawful attomey(s)-in-fact, with full authority to execute on its behalf fidelity and surety bonds or undertakings and olher documents of a similar character issued in the course of its business, and to bind the mspoctJve company thereby. IN WITNESS WHEREOF, SAFECO INSURANCE COMPANY OF AMERICA and GENERAL INSURANCE COMPANY OF AMERICA have each executed and attested these presents R.A. PIERSON, SECRETARY day of April , 1999 W. RANDALL STODDARD, PRESIDENT CERTIFICATE Extract from the By-Laws of SAFECO INEURANCE COMPANY OF AMERICA and of GENERAL INSURANCE COMPANy OF AMERICA: "Article V, Section 13. - FIDELITY AND SURETY BONDS ... the President, any Vice President, the Seore~ary, and any Assistant Vice President appointed for that purpose by the officer in charge of surety operations, shall each have authadty to appoint individuals as attomeys-in-foct or under other appmpriato titles with au~odty to execute on behalf of the company fidelity and surety bonds and other documents of similar character issued by the company in the course of its business... On any instrument making or evidencing such appointment, the signatures may be affixed by facsimile. On any instrument conferring such authority or on any bond or undertaking of the company, the seal, or a facsimile thereof, may be impressed or affixed or in any other manner reproduced; pro'~,ided, however, that the seal shall not be necessary to the validity of any such instrument or undertaking." Extract from a Resolution of the Board of Directors of SAFECO INSURANCE COMPANY OF AMERICA and of GENERAL INSURANCE COMPANY OF AMERICA adoptsd July 28, 1970. "On any certificate executed by the Secretary or an assistant secmtsry of the Company setting out, (i) The provisions of Article V, Section 13 of the By-Laws, and (ii) A copy of the power-of.-attomey appointment, executsd pursuant thereto, and (iii) 'Certi~ying that said power-of-attoreey appointment is in full force and effect, the signature of the certffifing officer may be by facsimile, and the seal of the Company may be a facsimile thereof." I, R.A. Pierson, Secretary of SAFECO INSURANCE COMPANY OF AMERICA and of GENERAL INSURANCE COMPANY OF AMERICA, do hereby certify that the foregoing extracts of the By-Laws and of a Resolution of the Board of Directors of these corpamtions, and of a Power of Atfomey issued pursuant thereto, are tree and con'ect, and that both the By-Laws, the Resolution and the Power of Attorney are still in full force and effect. IR WITNESS WHEREOF, I have hereunto set rey hand and affixed the facsimile seal of said corpomtian R.A. PIERSON, SECRETARY S~974/SAEF 7/98 ® Registered trademark of SAFECO Corporation. 4/21/99 PDE 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. .ds soon as practicable after notification of bid award, Contractor shall file with the Purchasing Department satisfactory certificates of insurance, containing thc 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. Ail insurance policies proposed or obtained in satisfaction of these requirements shall comply with the following general specifications, and shall be maintained in compliance with these general specifications throughout the duration of the Contract, or longer, if so noted: Each policy shall be issued by a company authorized to do business in the State of Texas with an A.M. Best Company rating of at least _. 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: · 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 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 liabihty. · AH policies shall be endorsed to read: "SAID POLICY SHALL NOT BE CANCELLED, NONRENEWED OR MATERIALLY CHANGE WITHOUT 30 DAYS ADVANCED WRITTEN NOTICE BEING GIVEN TO THE OWNER (CITY) EXCEPT WHEN THE POLICY IS BEING CANCELLED FOR NONPA YJglENT OF PREMIU31 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 RBQUIRElvlENTS: 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: IX] 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 pohcies. If the Commercial General Liability form (ISO Form CG 0001 current edition) is used: · Coverage A shall include premises, operations, products, and completed operations, independent contractors, contractual liability covering this contract and broad form property damage coverage. · Coverage B shall include personal injury. · Coverage C, medical payments, is not required. If the Comprehensive General Liability form (ISO Form GL 0002 Current Edition and ISO Form GL 0404) is used, it shall include at least: Bodily injury and Property Damage Liability for premises, operations, products and completed operations, independent contractors and property damage resulting from explosion, collapse or underground (XCU) exposures. · Broad form contractual liability (preferably by endorsement) covering this contract, personal injury liability and broad form property damage liability. [X] Automobile Liability Insurance: Contractor shall provide Commercial Automobile Liability insurance with Combined Single Limits (CSL) of not less than $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 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 fights of subrogation against the City, its officials, agents, employees and volunteers for any work performed for the City b y the Named Insured. For building or construction projects, the Contractor shall comply with the provisions of Attachment 1 in accordance with §406.096 of t he Texas Labor C ode and rule 2 8TAC 1 10.110 o f t he 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 pohcy 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, o n an A Il-Risk form for 1 00% o f t he completed value s hall b e 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. (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 s hall post o n e ach project s itc a notice, i n t he 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 amounts and filing of any coverage agreements, which meets the statutory requirements of Texas Labor Code, Section 401.011(44) for all of its employees providing services on the project, for the duration of the project; (2) provide to the contractor, prior to that person beginning work on the project, a certificate of coverage showing that coverage is being provided for all employees of the person providing services on the project, for the duration of the project; (3) provide the contractor, prior to the end of the coverage period, a new certificate of coverage showing extension of coverage, if the coverage period shown on the current certificate of coverage ends during the duration of the project; (4) obtain from each other person with whom it contracts, and provide to the contractor: (a) a certificate of coverage, prior to the other person beginning work on the proj eot; and Co) 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 t he certificates o f coverage t o b e provided t o t he person for whom they are providing services. By signing this contract or providing or causing to be provided a certificate of coverage, the contractor is representing to the governmental entity that all employees of the contractor who will provide services on the project will be covered by workers' compensation coverage for the duration of the project, that the coverage will be based on proper reporting of classification codes and payroll amounts, and that all coverage agreements will be filed with the appropriate insurance carder 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. 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. [] 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. ATTACItMENT1 ix] 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 f~om 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 carders, owner-operators, employees of any such entity, or employees of any entity which fumishes persons to provide services on the project. "Services" include, without limitation, providing, hauling, or dehvering 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 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. If t he c overage period sh own o n t he contractor's current certificate o f c overage 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: HICKORY CREEK BASIN SANITARY SEWER REPLACEMENTS AND LINERS Description Work Days Bid No. 3107 P.O. No. BID TABULATION SHEET I Quantity Unit Unit Price Total °° s ~-oo~ 1 LS $ /~,~OOO / LS 5,207 SDR-35 San[~ UnltPticelnWo~ls ~ / /' ~cc/ 7L Lc) O 2.12-C ]8' Cla-~ 51 Ductile Iron Pipe for S/anita~ Sewer u~it~ic~wo~t~ ~/~o~-/-~/ /-//ae W831 18' HDPE DR-111 by open cut 2.12-D [10' SOR-35SanRarySewerPIpe ' ~ x9 0/~ 00 no//oo 2.12 -E I10' Class 51 DuPle Iron Pipe for ,.~nita~, ~ewer ~. '"70//0 d ~ /?°//o0 UlfitPficeIuWords ~4.o0 ~4 /?O///oo 6,07;I 3,1 Iemparation of Right of Way 3.10.4 [Broadcast Se~d[ng Unit Pfice In Words O~ ~. ~ '5"~,'//o O 51oc~ ~ U~itPfic~r-Worcts ~'~.,'.., ~' 'O°/~o I I / .5-0 / sv Z&$9 'Y~ NS13, NS15 Co~crete Manho e (4 .D.) ] 76 10/31/2003 P-3. Item Description L2-A Construct Concrete Curb & Gutter HICKORY CREEK BASIN SANITARY SEWER REPLACEMENTS AND UNERS BID TABULATION SHEET Work Days Bid No. 3107 P.O. No. Quantity Unit Unit Price Total 1,804 LF $ /~-~OILF $ Z7060°° ~/S27 tRemove Existing Manhole I' 62 SP-37 tExcavation P mtectlon SP-43 I Aspha, Saw Cut U~it ~ice ]= Words SP-2 IConcmte Saw Cut 3-A I D~lish and Remove ~nc~e Paving 97 /0 O0 /BY iS C~O O0 5.8 [Reinforced Coflcmte Paving I 76 3-C }Demolish/Remove Concrete Sid;walk and Driveways I 189 UaitPficelnWords ~'~'0 wZ /10///00 89 U~t ~ ~ Wo~ 7.6 I E.m ~pth for 4' Diameter Sanita, .'wer .h~e · ] 114 7.6 I~ra ~pth for 4' DialeCt ~nlta~ ~r Drop M~hole [ 9 6,4 }Sl~ve ~se ~ Water Un.J2' Steep Casi~ PI~ I 160 i/~ ;OOO o O Sleeve Case Ex. Water Une-20" Ste~ Casing Pipe 20 /. /'/o/'/o0 HICKOHY CREEK BASIN SANITARY SEWER REPLACEMENTS AND LINEHS ][tem BID TABULATION SHEET Work Days Bid No. 3107 P.O. No. 16. Bore and Steel Encasement Description 1 Qtmntity Uniq UnitPrlceoo [ Total 10S LF $ Z~'O /LF $ Z~?~ 16' RR Bore end Steel Encasement Unitl~iceI~Words ~gt~O ~/..~.~'0//'~'0/ ~'~ Relate FH 1 Pl~s ,l~ncm~ En~.ment ol;" ~n,~ ~wer I 120 WS21 lC~ and Plug E~s~ng ~nita~ Sewer Lfne ~ 14 I ~, I$/oo ,~,15/~oo, 7.6 [Ex'tm Depth for 5' Diameter Sanitary Sewer Drop Manhole ~/S34 [Manhole Uning for 5' Diameter Manhole SP-IO [Hock Excavation UnitPdcehWords ~.,.~ ~ SPECIAL ]Almndon Existing 6' Sanitary .Sewer SPECIAL ]Abandon Existin~l 8' Sanitary Sewer WS35 Unit Prlce In .W. ords /~o/9 $,t Plum~t.t R~;:i~cDrPdsE DR-,1, or certa-lock 0900 nJPVC NS31 ]Pipe Enlargement 6' to 8' I ~ I ~ I$~°° ,~ I$ ??z¢°° t~ JPIpe Enlargement 8' to 8' ~' [ U~it Prie~ In Words ~ /'~ 0///0 ~, Unit Price In Words ,t//,.,q,- o o/L~ Wo~ Day~ Bid No. . 3107 P.O. No. BID TABULATION SHEET TOTRL P.05 Item ws14 HICKORY CREEK BASIN SANITARY SEWER Work Days REPLACEMENTS AND LINERS Bid No. 3107 ALTERNATE NO. 1 MANHOLE REHAB SHEETS MH-1,2,3 & 4 P.O. No. BID TABULATION SHEET I Description Quantity t Unit Unit Price t Total Replace Manh01e Frame and Cover (Paved Area) 4 [EA $ /,,.~O0°°/EA I$~o~o°° Unit Price In Words WS14 I Replace Manhole Frame and Cover (Not Paved) I 4 Unit Price In Words I EA t$ /~OO°°/EA I$ z//~o~oO W$34 IManhole Lining for 4' Diameter Manhole Unit Price In Words 480 ] VF]$ ~,$-O 8.1 I Barficades, Warning Signs and Detoum Unit Price In Words ~P-43 Asphalt Saw Cut Unit l~ice In Words 6O 5P-2 Concrete Saw Cut I Unit Price In Words 20 ] LF]$ ~ ao iLF 15 /ZoOO Demolish/Remove Concrete Sidewalk and Driveways Unit Price, In Wol'd~ /SY $ 8.3A IConstruct Concrete Sidewalk Unit Price In Words SUBTOTAL ALT~RNATENO. ! /,,~R 7~ O o rJ HICKORY CREEK BASIN SANITARY SEWER REPLACEMENTS AND LINERS BID TABULATION SUMMARY SHEET Work Days Bid No. 3107 P.O. No. 10/31/2003 Attachment AD 1-1 BID SUMMARY TOTAL BASE BID PRICE IN WORDS or, ~ r~,'/h ~ '~ ~ ,j,l,~ A ~. ~,, ~ TOTAL BASE B~ PLUS ~A~ No. 1 P~CE ~ WO~S ~n~ m/ll/b~ Alternate bid items: The additive alternate bid items may be added to the total base bid prior to award of a contract. Award of the contract will be based on items actually included in the Project. The decisioa to add the alternate items listed will be solely at the discretion of the City. The lowest responsive proposal for purposes of award shall be the conforming responsible Bidder offering the lowest aggregate amount for the base bid pins those additive alternate bid items providing the most features of the work as selected by the City. The City may or may not choose to incorporate any or all of the additive alternate items listed in the Proposal. In the event of the ~ward of a contract to the undersigned, the undersigned will furnish a perfonnunce bond and a payment bond for the full amount of the contract, to secure proper compliance with the terms and provisions of the contract, to insure and guarantee the work until final completion and acceptance, and to guarantee payment for all lawful claim.q 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 thia proposal, shall control over exteasions. Receipt is hereby acknowledged of the following addenda to the plans and specifications: Addendnm No. 1 dated Addendnm No. 2 dated Addendum No. 3 dated Addendnm No. 4 dated Addendum No. 5 dated II- ~q-o$ Received. Received Received Received Received P- 9 BID SUMMARY TOTAL BASE BID PRICE IN WORDS In the event of the award of a contract to the undersigned, the undersigned will furnish a performance bond and a payment bond for the full amount of the contract, to secure proper compliance with the terms and provisions of the contract, to insure and guarantee the work until final completion and acceptance, and to guarantee payment for all lawful claims for labor performed and materials 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 con*ct and final. Unit and lump sum prices as shown for each item listed in this proposal, shall control over extensions. Receipt is hereby acknowledged of the following addenda to the plans and specifications: AddenduraN°. 1 dated //-.Z Addendum No. 2 dated / / - Addendum No. 3 dated Addendum No. 4 dated Addendum No. 5 dated Received Received Received Received Received P-9 BY Street Address City ~nd State Seal & Authorization (If a Corporation) ~/7 - z 93 -1565 T~lephon¢ P- 10 ,ACO, RD." CERTIFICATE OF LIABILITY INSURANCE I DATE(MtWDD/YY)01/29/2004 PRODUCER Serial # THIS CERTiFiCATE IS ISSUED AS A MA'Fi-ER OF INFORMATION JOHN A. MILLER&ASSOCIATES, INC. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE '~ HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR P. O. BOX 7214 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. FORT WORTH, TX 76111-0214 PHONE: (817) 834~7111 FAX: (817) 834-711~/- INSURERS AFFORDING COVERAGE NAIC# iNSURED .J INSURERA: ST. PAUL FIRE & MARINE INS. CO. ~ 24767 WILLIAM J, SCHULTZ, INC, DBA CIRCLE "C" CONSTRUCTION COMPANY, ET,~L INSURER B: P. O. BOX 40328 k~.. INSURER C: IFORT WORTH, TX 76140~'~ INSURERINSURER E:D: COVERAGES ,.~ THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES, AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTR NSR[ TYPE OF INSU E POLICY NUMBER DATE MM/~I~3/YY} DATE IMM/DD/YY) LIMITS GE~NERAL LIABILITY ~/' EACH OCCURRENCE 1,000,000 X COMMERCIAL GENERAL LIABILITY P~'It~ISEB lEa occurence} 300,000 ICLAIMSMADE ~-~ OCCURI ~' ~DE~v.p A X ~ $5,000 P.D. DED. r~ KC09100112 ~ 08/12/03 08/12/04 /'~ PERSORAL&ADVINJURy(An¥°nepers°nl 1,000,00010'000 ~X CONTRACTUAL, XCU f GENERALAOGREGATE 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/DP AGG 2,000,000 --I POL,CY r-- LOC ~- ANY AUTO ~' COMBINED SINGLE LIMIT -- (Ne accident) $ 1,000,000~ -- ALL OWNED AUTOS ~ODILY INJURY A X SCHEDULEDAUTOS KV09100082~'' 08/12/03 08/12/04 ~' (Perpetson) $ '~' HIRED AUTOS f / BODILY INJURY (per 8~nee~) $ OTHER THAN I OCCUR [] CLAIMS MADE AGGREGATE $ $ EMPLOYERS'LIABILiTY WVS9100115 ~'' 08/12/03 08/12/04 ~' -X IT~,,S~I ,,~O~- ANY PROPRIETOR/PARTNER/EXECUTIVE EL EACH ACCIDENT $ 1,000,000 A DFFICER/MEMSER EXCLUDED? EL DISEASE - EA EMPLOYEE $ 1,000,000 sPY~cIAL PROVISIONS below EL DISEASE - POLICY LIMIT $ 1,000,000 ~,==CkiPTION OF OPERATI ON S~'LODATION SNEHIC LES/EXC LUSlON S ADDED BY ENDORSEMENT/SPECIAL PROVISIONS PROJECT: BID 3107 - HICKORY CREEK BASIN SANITARY SEWER REPLACEMENTS & LINERS THE CITY OF DEhLTON, IT'S OFFICIALS, AGENTS, E~-J~.OYEES AND VOLUNTEERS ARE INCLUDED AS ADDITIONAL INSUREDS ON AL POL C['~IES (EX. PT WORKER'S COMPENSATION)Y'ALL LIABILITY POLICIES APPLY ON A PRIMA~.~_~..~ RELATION TO T~E ADDITIONAL INSURED'S OWN POLICY, WHICH WILL BE N~R!~UT?,!~-. A WAIVER-OF SUBROGATION IN FAVOR OF THE ADDIT ONAL NSUREDS IS INCLUDED ON THE WORKER~S~COMPENSATION POLICY. CERTIFICATE HOLDER CANCELLATION CITY OF DENTON___~DATETHEREOF'THEISSUING INSURER WILL~/O~I~MAIL 30 GAY~"~"~SWRrl-rEN 901B TEXAS STREET ~.~~E DENTON, TEXAS 76201 ~ ~ ~F. XX) ........ : ....... ACORD 25 (2001108) 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 er negatively amend, extend or alter the coverage afforded by the policies iisted thereon. ACORD 25 (2001108) COPY NOTICE TO DESCRIBED P~BRSONS OR ORGANIZATIONS OF MATERIAL CHANGE OR POLICY CANCELLATION ENDORSEMENT m,SItbul This endorsement changes: · your General Rules; or · any state-required endorsement that changes the Policy Changes or Cancellation. rules in your General Rules, (GENERAL LIABILITY POLICY) How Coverage Is Changed There are two changes explained below, The following is added to the Policy Changes section. This change describes other persons or organizations we'll notify if a material change is made to your policy, Such change does not benefit any persons or organizations not described below, We'll mail or deliver written notice of a material change to your policy during its policy period to the described persons or organizations, The described persons or organizations and the number of days notice before the change will take effect are shown below. Mater/a/ change means a reduction in the applicable: · coverage; or · limits of coverage. The following is added to the Cancellation section. This change describes other persons or organizations weql notify if your policy is canceled by you or us. Such change does not benefit any persons or organizations not described below. We'll also mail or deliver a notice of cancellation to the described persons or organizations. The described persons or organizations and the number of days notice of cancellation before coverage. will end are shown b~low. No other change applies to the Cancellation rule. Other Terms All other terms of your policy remain the same. Described Persons Or Organizations (Name) The Eirst' naaed ~.nsured anti all cert~flcate holders regulr~ng at least the n~mber o£ days sho~m below. (Address) PO Box 40328 Ft. Worth, TX 76140 Number Of Days Notice 60 For material change or cancellation, other than nonpayment of premium 10 For nonpayment of premium Name of Insured Policy Number KC09100112 Effective Date 08/i2/03 WILLIAM $. SCHULTZ, INC. Processing Date 08/25/03 13:10 001 D0084 Ed~ 10-00 Printed in U.S.A. Endorsement ©St. Paul Fire and Marine Insurance Co. 2000 All Rights Reserved Page 1 of 1 "": TE 02 O2A (Ecl. Effective 3/92) CANCEI~LATION PROVISION OR COVERAGE CHANGE ENDORSEMENT This endorsement modifies the insurance provided under the following: BUSINESS AUTO COVERAGE FORM GARAGE COVERAGE FORM TRUCKERS COVERAGE FORM ' This endorsement changes the policy effective on the inception date of the policy unless another date is indicated below: Endorsement Effective o8/1 ./o3 Named Insured WILLIAM $. SCHULTZ, INC. Policy Number KV09100082 Countersigned by (Authorized Representative) 60 * da'~s before this policy is cancelled or materially changed to reduce or restrict coverage.we will mail notice of the cancellation or change to: The first named insured and to all certificate holders requiring at least the number of days shown above. * except 10 days for non payment of premium. (Enter Name and Address) FORM TE 02 02A- CANCELLATION PROVISION OR COVERAGE CHANGE ENDORSEMENT Texas Standard Automobile Endorsement Revised MarOh 18, 1992 WC 42 06 01 (WORKER'S COMPENSATION POLICY] TEXAS NOTICE OF MATERIAL CHANGE ENDORSEMENT This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated. (The following "attaching clause" need be completed only when this endorsement is issued subsequent to preparation of the policy.) This endorsement, effective on 08/12/03 at 12:01 A.M. standard time, forms a part of (Date) Policy No. t~VS9100115 Endorsement No. of the ST. PAUL FIRE AND I~J~TNE INSURANCE COY,_PAN¥ NCCI Carrier Code 13706 (Name of Insurance Company) issuedto: t~ILLIAM J. SCHULTZ, INC. Policy Expiration Date: 08/12/04 Premium (if any) $ Authorized Representative This endorsement applies only to the insurance provided by the policy because Texas is shown in Item 3.A. of the Information Page. In the event of cancelation or other material change of the policy, we will mail advance notice to the person or organization named in the Schedule. The number of days advance notice is shown in the Schedule. This endorsement shall not operate directly or indirectly to benefit anyone not named in the Sche- dule, Schedule 1. Number of days advance notice: 60 days except: 10 days for non payment: of pramS, urn. 2. Notice willbe mailed to: The first named insured and to all cert:if~cate holders requiring t:he number of days shourn above.