2001-363ORDINANCE NO ~00/' ~. ~
AN ORDINANCE ACCEPTING COMPETITIVE BIDS AND AWARDING A PUBLIC WORKS
CONTRACT FOR THE CONSTRUCTION OF PAVING IMPROVEMENTS ON DUNCAN AND
NEFF STREETS, PROVIDING FOR THE EXPENDITURE OF FUNDS TFIEREFORE, AND
PROVIDING AN EFFECTWE DATE (BID 2719 - DUNCAN AND NEFF STREET PAVING
AWARDED TO JAGOE PUBLIC COMPANY IN THE AMOUNT OF $65,603 25)
WHEREAS, the City has solicited, and received competitive sealed bids for the construction
of public works or improvement 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 respondent for the construction of the public works or
improvements described in the bid invitation, and plans and specifications therein, and
WHEREAS, Section 271 905 of the Local Government Code allows the City to award a
contract tO a bidder having its pnnmpal place of business in the City if its bid is within three per cent
of the lowest bid price received from a nonresident bidder if the governing body determines in
writing, that the local bidder offers the City the best combination of price and additional economic
development opportunities for the City created by the contract award, including the employment of
residents of the City and increased tax revenues to the City, and
WHEREAS, the City Manager or a designated employee has reviewed the heroin descnbed
bids for the materials, equipment, supplies or services as shown in the "Bid Proposals" subnntted
therefore and represents to the City Council that the herein described local bidder's bid is within
three per cent of lowest bid price received from a nonresident bidder, and
WHEREAS, the City Council has provided in the City Budget for the appropriation of funds
to be used for the purchase of the materials, equipment, supplies or services approved and accepted
herein, NOW, THEREFORE,
THE COUNCIL OF THE CITY OF DENTON HEREBY ORDAINS
SECTION 1 That the following competatave sealed bid for the construction of public works
or improvements, as described in the "Sealed Bid Invitations", or plans and specifications on hle in
the Office of the City's Pumhasing Agent filed accorchng to the bid number assigned hereto, and,
The City Council hereby deternunes that the vendor set forth below has its pnncipal place of
business in the City of Denton, Texas, its b~d is within three per cent of the lowest bid price received
from a nonresident bidder and such local bidder offers the City the best comblnaUon of price and
additional econormc development opportumtles for the C~ty created by this contract award The
following numbered bid for construction of a public works project from the below described local
bidder and as shown ~n the "Bid Proposals" on file in the office of the City Purchasing Agent, are
hereby accepted and approved
BD
NUMBER CONTRACTOR AMOUNT
2719 Jagoe Public Company $65,603 25
SECTION 2 That the acceptance and approval competitive sealed bid shall not consUtute a
contract bbtween the C~ty and the person submitting the bid for construction of such public works or
improvements herein accepted and approved, until such person shall comply w~th all requirements
specified in 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 public works or improvements in accordance
with the bids accepted and approved heroin, provided that such contracts are made in accordance
with the Not~ce to Bidders and Request for Sealed Bids, and documents relating thereto specifying
the terms, conchtlons, plans and spemficatlons, standards, quantities and specified sums contained
thereto
SECTION 4 That upon acceptance and approval of the above compeutlve sealed bids and
the execution of contracts for the public works and improvements as authorized herein, the City
Council t~ereby authorizes the expen&ture of funds in the manner and in the amount as specified ~n
such approved bids and authorized contracts executed pursuant thereto
SECTION 5
approval
PASSED AND APPROVED this . _
This ordinance shall become effective immediately upon its passage and
/¢}-¢~ dayof C~, ~/'ff~ ,2001
EULINE BROCK, MAYOR
ATTEST,
JENNIFER WA. LTERS, CItY SECRETARY
B¥~lq'll~d L-..o /~~
e~}o'" [
A VED AS TO LEGAL FORM
HERB ERT~~C ~Y ATTORNEY
Duncan & NefflStreet Paving Bxd # 2719 CITY OF DENTON
August 02, 2001
CONTRACT AGREEMENT
STATE OF TEXAS §
COUNTY OF DENTON §
THISiAGREEMENT, made and entered into this 18th day of September A D, 2001, by
and between
City of Denton of the County of Denton . and State of Texas, acting
through
thereunto duly authonzed so to do, hereinafter termed "OWNER," and
Jagoe Pubhc Co
3020 Ft Worth Dnve, P O Box 250
Denton, TX 76202
of the City of Denton., County of
termed "CONTRACTOR"
Denton and State of Texas , hereinafter
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 m the bonds
attached hereto, CONTRACTOR hereby agrees with OWNER to commence and complete
performance of the work specified below
Bid # 2719 Duncan & Neff Street Paving
~n the amount of $65, 603 25 _ and all extra work in connection therewith, under the terms as
stated ~n the General Conditions of the agreement, and at bas (or their) own proper cost and expense to
furmsh all nlatenals, supplies, macbanery, equipment, tools, supenntendence, labor, insurance, and
other accessories and serwces necessary to complete the work specified above, ~n accordance with the
condmons and prices stated m the Proposal and the Performance and Payment Bonds, attached hereto,
and in accordance wuth all the General Conditions of the Agreement, the Special Conditions, the
Notice to B~dders (Advertisement for Bids), and Instructions to Bidders, as referenced hereto and on
file m the office of the Purchasing Agent, and in accordance w~th the plans, winch includes all maps,
plats, bluepnnts, and other drawings and pnnted or written explanatory matter thereof, and the
Specfficat~ons therefore, as prepared by
City of Denton staff
all of wtuch are referenced here~n and made a part hereof and collectively ewdence and constitute the
entire contract
CA-1
116
Duncan & Neff Slxeet Paving Bid # 2719 CITY OF DENTON
August 02, 2001
Independent Status
It is mutually understood and agreed by and between City and Contractor that Contractor is an
~ndependent contractor and shall not be deemed to be or considered an employee of the C~ty of Denton,
Texas, for the purposes of ~ncome tax, wathholdmg, social security taxes, vacation or sink leave
benefits, worker's compensation, or any other C~ty employee benefit C~ty shall not have supervision
and control of Contractor or any employee of Contractor, and it ~s expressly understood that Contractor
shall perform the services hereunder according to the attached specfficat~ons at the general direction of
the City Manager of the C~ty of Denton, Texas, or his designee under this agreement
Indemmficat~on
Contractor shall and does hereby agree to ~ndemmfy and hold harmless the C~ty of Denton
from any and all damages, loss, or habfl~ty of any land whatsoever, by reason of injury to property or
third persons occasioned by any error, omission or neghgent act of Contractor, its officers, agents,
employees, mvltees, and other persons for whom ~t is legally liable, with regard to the performance of
th~s Agreement, and Contractor wall, at ~ts cost and expense, defend and protect the City of Denton
against any and all such clauns and demands
Choice of Law and Venue
Th~s agreement shall be governed by the law of the State of Texas and venue for its
construction and enforcement shall he m the courts of Denton County, Texas
The CONTRACTOR hereby agrees to commence work on or after the date estabhshed for the
start of work as set forth m written notace to commence work and complete all work wattun the time
stated m the Proposal, subject to such extensions of t~me 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, whmh forms a part of this contract, such payments to be subject to the General and
Spemal Condittons of the Contract
CA - 2
117
Duncan & Nefl~ Street Paving Bid # 2719 CITY OF DENTON
August 02, 2001
IN WITNESS WHEREOF, the part~es of these presents have executed this agreement xn the
year and dayi first above written
ATTEST
BY
OWNER
ATTEST
(SEA[)
CTOR
APPROVED AS TO FORM
CITY ATTORNg'V
pr)
MAILING ADDRESS
c/'~o ~ ~2_ - z J-,C/
PHONE NUMBER
FAX Nfl~JMBER
TITLE
PRINTED NAME
(SEAL)
CA- 3
118
Duncan & Neff ~treet Paving Bid # 2719 CITY OF DENTON
Augtmt 02, 200I
CONTRACT DOCUMENTS Having examined the Proposal, General Instructions, Materials,
Execution, Drawings, and Contract for (Bid # 2719) and Duncan & Neff Street Paving, and having
examined the prermses and mrcumstances affecting the work, the undersigned offer
OFFER 1 To furmsh all labor, material, tools, eqmpment, transportatmn, bonds, ali applicable taxes,
mcldentals, and other famhtms, and to perform all work for the said Sherman Drive Stone Matrix
Asphalt Overlay for the following area
BASE BID - Duncan & Neff Street Paving
In words ~ .~9.~ .,z~. ~.--,4 .v ~ ~-d ~ ~//~.<~ ~
D~c~ & NeffS~eet Pa~ng
WORKDAYS 25 Days
I01
' Neff Paving
Bid ['~o
BID TABULATION SHEET P O No --
Y Umt Umt Price ~
~or~ Bromon Cobol [ ~ I ....
~t ~ ~ Words ~ // w & ¢ s
¢7 , $ ~ .~
Umt Price h Words
7'~~h~tPav..t T eC) 9~ o.. z~_~:~ ~.
Umt Prm~ h Words
1 B~cade~mg S~d ~tours . ~J~ o . q ..... $ ~o, co
~~ords ~ ~ /~ ~
8P-15-B $ /~o. ~u
8P-39 , $ 6~
_~ ~t P~ ~ Wor~ / ~o
SP-43$ . o 0
P-45 , $ ~¢. o0
Umt Pnc~ ~ Words
Umt Pno~ In Words
TOTAL
Duncan Drive Pavag
B~d No
BID TABULATION SHEET P 0 No
Umt Price In Words ~"~'~ ,-
Unit Pn~ ~ Words
3 12 Tem or~mst~on~oI
S 7-A $
~t Prme ~ Wor~
Umt Price ~ Words
SF-15-A ustValvcBox I ~ / EA
Unit Pmce ~ Words
SP-39
Unit Price In Words
Cut
Unit Price In Words
Oo lEA
70 3,00 /LF t) oe~
$P-44
Mill
Unit Pnco In Words
/ SY $
'~P-45
),Broom
Umt Price In Words
/ $
$
TOTAL
PKOYECT
Duncan Drive Paving
NeffPawng
TOTAL
BID SLrMI~ARy
WORK DAYS
25
BID
Both paving sections vall be awarded to one contractor Award ofbzd wxll be based on the total
Thc two scctons are being separated for bookkeeping purposes Workdays will be kept
separately on each section of the project
104
Duncan & Neff Street Paving
B~d # 2719
CITY OF DENTON
August 02, 2001
Project Total Cost
MAT~S
BXAM/NATIgN OF SITE By s~mg the Proposal Form, contractor acknowledges he ~s an
anthonzed representatave and has examined the s~te and as aware of ail field cond~taons, winch may
affect the work
TAXES Tax shall no~ be included m your bad
Upon receipt of noti~ of acceptance of tins bad, wathm thmy (30) days of the date of tins proposal, I
(or we) agree~ tp ~eeute the formal contract wattun ten (10) days thereafter, and to dehver an Insurance
Certaficate, a ~Lfi[ETY BOND m the amount of ONE HUNDKED and TEN PERCENT (110%) of the
contract price for the fmthful performance of the contract, and a ONE HUNDRED PERCENT (100%)
STATUTORY~ PAYMENT BOND
The undersigned agrees to complete all work shown on the drawings and m the specaficat~ons w~thm
the tame lumts set forth below subject to adchtaonal days that may be added due to inclement weather
and/or other Justafied and reasonable extensions or tune as may be approved by the Owner
Contractors that are awarded contracts shall be prepared to munedxately sat down vath the C~ty of
Denton Kepresentatlves and present a plan that will illustrate how progression of work ~s to take place
to insure completaon of all work w~tlnn specified tune lun~ts The tune hrmts are as follows
All work ~s to be started and completed w~tinn 25 (twenty five) work days Work days are defined m
the Supplementary Concht~ons
If a contractor ~s awarded the project, the project must be completed w~than the dates shown above or
the contractor will be subject to hquadated damages as set forth below
A working d~ylas defined as a calendar day, m winch weather or other condmons not under the control
of the company wll perrmt the performance of the prmmpal umts of work underway for a continuous
period of not less than seven (7) hours between 7 00 A M and 6 00 P M
The undermgned agrees that the Owner may retain the sum, as prescribed m the North Texas Council
of Govemment~ General Prowsaons, from the amount to be paxd to the undermgned for each calendar
day that the work contemplated remains incomplete beyond the tune set forth, Sundays and hohdays
INCLUDED Tl-as amount as agreed upon as the proper measure ofhqmdated damages winch the
Owner will sustain per day by failure of the undersxgned to complete the work at the stipulated tame,
and ~s not to be, construed m any sense as a penalty
Duncan & Neff Street Paving B~d # 2719 CITY OF DENTON
August 02, 2001
Payment vail be made to the contractor wlfmu thurty (30) days after receipt of proper invoice and
written acceptance of pro3 eot f~om thc Owner's representatlve, all required material invoices,
documentation, etc and all written warran'aes from both contractor and manufacturer
I (or we) agree to promptly furmsh a correct and current fmanmal statement of condition with a hst of
owned eqmpmcnt and an expenence record of completed projects for examination by Owner and
architect, ff same m reqmred
SEAL (If by Corporation)
RESPECTFULLY SUBMITTED BY
(Title)
Denton. Tx 78202
106
Duncan & NefflStreet Paving
Bond No 111-3349-5790
2719
CITY OF DENTON
August 02,2001
PERFORMANCE BOND
STATE OF TEXAS
COUNTY OF DENTON §
KNO~ ALL MEN BY THESE PRESENTS That Jagoe Pubhc Company whose address
3020 Ft Worth Drive, P O Box 250, Denton, TX 76202 hereinafter called
Principal, anc~ ASSOCIATED INDEMNITY CORPORATION
a corporatlonlorgunlzed and existing under the laws of the State of California , and fully '
authorized to ~transact business m the State of Texas, as Surety, are held and firmly bound unto the City
of Denton, a ¢aunmlpal corporation organized and existing under the laws of the State of Texas,
hereinafter called Owner, m the penal sum of S~xty Five Thousand, Six Hundred and Three
DOLLARS and Twen ,ty F~ve cents ($ $65, 603 25 ) plus ten percent of the stated penal sum as an
addmonal stun of money representing addlUonal court expenses, attorneys' fees, and hquldated
damages arising out of or connected wxth the below identified Contract, tn lawful money of the United
States, to be gard m Denton County, Texas, for the payment of winch sum well and truly to be made,
we hereby brad ourselves, our heirs, executors, administrators, successors, and assigns, jointly and
severally, firmly by these presents This Bond shall automatmally be increased by the amount of any
Change Order or Supplemental Agreement, winch increases the Contract price, but in no event shall a
Change Ordei or Supplemental Agreement, which reduces the Contract price, decrease the penal sum
of tins Bond
THE OBLIGATION TO PAY SAME is conditioned as follows Whereas, the Principal
entered Into ~ certain Contract, Identified by Ordinance Number 2001- 363, with the City of Denton,
the Owner, dated the 18m day of September A D 2001 , a copy df which m hereto attached and
made a part hereof, for B~d #2719 Duncan & Neff Street Paving
NO,W, THEREFORE, ~fthe Pnnclpal shall well, truly and faithfully perform and fulfill all of
the undertahr~gs, covenants, terms, conditions and agreements of said Contract in accordance w~th the
Plans, Spemfieatlons and Contract Documents during the ong,nal term thereof and any extension
thereof winchlmay be granted by the Owner, with or w~thout notme to the Surety, and during the life of
any guaranty or warranty required under flus 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 smd Contract that may hereafter be made, notice of winch modifications to the Surety
being hereby ~atved, and, if the Prmclpal shall reparr and/or replace all defects due to faulty materials
and workman{inp that appear within a period of one (1) year from the date of final completion and
final acceptance of the Work by the Owner, and, ~fthe Prmmpal shall fully ~ndemmfy and save
harmless the uwner from all costs and damages which Owner may suffer by reason of farlure to so
perform herelfi and shall fully reimburse and repay Owner all outlay and expense winch the Owner
may incur in ~aklng good any default or deficiency, then this obligation shall be void, otherwase, ~t
shall remain in full force and effect
PB - 1
119
Duncan & Neff,Street Paving B~d # 2719 CITY OF DENTON
August 02, 2001
PROVIDED FURTHER, that if any legal action be filed upon this Bond, exclusive venue shall
lie in Denton~ County, State of Texas
AND PROVIDED FURTHER, that the said Surety, for value received, hereby stipulates and
agrees that no change, extension of time, alteration or addition to the terms of the Contract, or to the
Work to be performed thereunder, or to the Plans, Specfficattons, Drawings, etc, accompanying the
same, shall in anywise affect its obhgat~on on flus Bond, and ~t 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
Th~s Bond is given pursuant to the provm~ons of Chapter 2253 of the Texas Government Code,
as amended, and any other apphcable statutes of the State of Texas
The undermgned and designated agent is hereby designated by the Surety here~n as the Resident
Agent in Denton County to whom any reqmmte notices may be delivered and on whom servme of
process may Ibc had in matters arising out of such suretyship, as provided by Amcle 7 19-1 of the
Insurance Code, Vernon's Annotated Civil Statutes of the State of Texas
IN WITNESS WHEREOF, tlus instrument ~s executed ~n ?our
shall be deemed an original, this the 18th day of September , 2001
copies, each one of which
ATTEST
SECRETARY -
PRINCIPAL
~/t¢~ PRESIDENT
ATTEST SURETY
ASSOCIATED INDEMNITY CORPORATION
Rosomsry Weaver
The Resident Agent of the Surety ~n Denton County, Texas for dehvery of notice and serwce of the
process is
NAME Wmllis of Texas, Inc - Rosemary weaver
STREETAdDDRESS ~3355 Noel Road, Suite 400, DalJas, TX 75240-66J2
(NOTE Date of Performance Bond must be date of Contract
give a person's name )
PB - 2
If Remdent Agent ~s not a corporation,
120
Duncan & Neff Street Paving Bid # 2719 CITY OF DENTON
August 02, 2001
PAYMENT BOND
STATE OF TEXAS
COUNTY OF DENTON §
KNOW ALL MEN BY THESE PRESENTS That Jagoe Pubhc Company, whose address
,s 3020 Ft Worth Drive, P O Box 250, Denton, TX 76202
hereinafter called Principal, and ASSOCIATED INDEMNITY CORPORATION '
, a
corporatxon orgamzed and ernst,rig under the laws of the State of Calxforn~aand fully authorized to
transact business ~n the State of Texas, as Surety, are held and firmly bound unto the City of Denton, a
municipal corporation orgamzed and existing under the laws of the State of Texas, hereinafter called
Owner, and unto all persons, firms, and corporaUons who may furnish materials for, or perform labor
upon, the building or improvements hereinafter referred to, in the penal sum of Sixty Five Thousand,
Six Hundred and Three DOLLARS and Twenty F~ve cents ($65, 603 25), in lawful money of the
Umted Stated, 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 wtuch increases the Contract price, but in no event
shall a Change Order or Supplemental Agreement wluch reduces the Contract price decrease the penal
sum of this Bond
THE ,OBLIGATION TO PAY SAME is conditioned as follows Whereas, the Pnncipal
entered into a certain Contract, ~dentlfied by Ordinance Number 2001-363, vath the City of Denton,
the Owner, dated the 18t~ day of September A D 2001 , a copy of which is hereto attached
and made a part hereof, for Bid #2719 Duncan & Neff Street Pawng
NOW, THEREFORE, If the Principal shall well, truly and faithfully perform its duties and
make prompt payment to all persons, firms, subcontractors, corporations and claimants supplying labor
and/or material in the prosecution of the Work provided for in said Contract and any and all duly
authorized mgdfficattons of smd Contract that may hereafter be made, notice of which modfficatmns 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 th~s 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 t~me, alteratmn or adchhon 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 anyvase affect its obligation on this Bond, and it does hereby wmve 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, Specfficatlons, Drawings, etc
PB - 3
121
Duncan & N¢fflStreet Paving B~d # 2719 CITY OF DENTON
August 02, 2001
Th~s ]Bond m g~ven pursuant to the prows~ons of Chapter 2253 of the Texas Government Code,
as amended, ~and any other apphcable statutes of the State of Texas
The dndemgned and designated agent as hereby designated by the Surety hereto as the Resident
Agent m Dep_ton County to whom any requmte notmes may be dehvered and on whom service of
process may be had m matters arising out of such surety, as prowded by Arttcle 7 19-1 of the Insurance
Code, Vernon's Annotated C~wl Statutes of the State of Texas
IN WITNESS WHEREOF, thru ~nstmment m executed ~n 4 cop~es, each one of which shall
be deemed an original, thts the 18th day of_September, 2001
ATTEST PRINCIPAL
SEdRETARY /
PRESIDENT
ATTEST
SURETY
ASSOCIATED INDEMNITY CORPORATION
Posemary Weaver
7he Rcs~dentl Agent of the Surety ~n Denton County, Texas for dchvcry of notmc and servme of the
process ~s
NAME W~l~is of Texas~ Inc. - Rosemary Weaver
STREETADpKESS 13355 Noel Road, Suite 400, Dallas, Texas 75240-6612
(NOTE Date of Payment Bond must be date of Contract If Restdent Agent ts not a corporatton, gtve
a person's name)
PB - 4
I22
Duncan & Neff[Street Pavmg Bid # 2719 CITY OF DENTON
August 02, 2001
CITY OF DENTON
INSURANCE REQUIREMENTS FOR CONTRACTORS
Bidder's attention is chrected to the insurance requirements below It is highly recommended that
bidders confer w~th their respective insurance earners or brokers to determine an advance of Bid
submission the availability of insurance certificates and endorsements as prescribed and provided
hereto If anlapparent low bidder fails to comply strictly with the insurance requirements, that b~dder
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 habdlOes of the Contractor, the Contractor shall
provide andI 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 notffieatmn of bid award, Contractor shall file with the Purchasing
Department satisfactory certificates of insurance, containing the bid number and title of the
project Contractor may, upon written request to the Purchasing Department, ask for
clarfficatlonl 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 submatted with the bid
Contractor shall not commence any work or deliver any material until he or she receives notlficaUon
that the contract has been accepted, approved, and signed by the City of Denton
All insurance policies proposed or obtained in satisfaction of these requirements shall comply
with the following general specifications, and shall be maintained in compliance with these
general speeffications throughout the duration of the Contract, or longer, if so noted
Each policy shall be issued by a company authorized to do bus~ness ~n the State of Texas
w~th 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
r~tentlons w~th respect to the City, its officials, agents, employees and volunteers, or, the
contractor shall procure a bond guaranteeing payment of losses and related investigations,
clmm adrmmstratlon and defense expenses
Liability policies shall be endorsed to provide the following
Name as additional insured the City of Denton, xts Officials, Agents, Employees and
volunteers
That such insurance is primary to any other insurance available to the additional
123
Duncan & Neff S~eet Paving B~d # 2719 CITY OF DENTON
August 02, 2001
insured with respect to claims covered under the pohcy and that th, s ~nsurance
apphes separately to each insured agmnst whom clmm ~s made or suit ,s brought
The Inclusion of more than one insured shall not operate to increase the Insurer's
limit of habfl~ty
· All pollmes shall be endorsed to read:
"SAID POLICY SHALL NOT BE CANCELLED, NONRENEWED OR MATERIALLY
CHANGE WITHOUT $0 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 ~nsurance be provided under a clmms~made form, Contractor
shall mmntatn such coverage continuously throughout the term of this contract and,
w,thout lapse, for a period of three years beyond the contract expiration, such that
occurrences arising dunng the contract term which g,ve 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 hm~ts or obtain Owners and Contractors Protective Liability Insurance
Should any required insurance lapse dunng the contract term, requests for payments
0nglnatang after such lapse shall not be processed until the City receives satisfactory
evidence of reinstated coverage as reqmred by this contract, effective as of the lapse date
If insurance is not reinstated, City may, at Its sole option, terminate this agreement
effecnve on the date of the lapse
SPECIFIC ADDITIONAL INSURANCE REQUIREMENTS
All insurance pohc~es proposed or obtained in satisfaction of this Contract shall additionally
comply with the following marked specifications, and shall be maintained in compliance with
these add~tl0nal specfficatmns throughout the duration of the Contract, or longer, ~f so noted
[X] A General Liability Insurance:
General Llablhty insurance w~th combined single hmlts of not less than $1,000,000 shall
be provided and mmntalned by the Contractor The policy shall be written on an
occurrence basis either in a single policy or in a combination of underlying and umbrella or
excess policies
If the Commercial General Lmbihty form (ISO Form CG 0001 current edition) is used
· Coverage A shall include premises, operations, products, and completed
124
Duncan & NefflStreet Pavmg B~d # 2719 CITY OF DENTON
August 02,2001
operaUons, 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
Iftha 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 hablhty and broad form property damage liability
[3[] Automobile Lmbflity Insurance:
Contractor shall provide Commercial Automobile Llablhty insurance with Combined Single
Limits (CSL) of not less than $500~000 either in a single policy or in a combination of basra
and umbrella or excess policies The policy will include bodily injury and property damage
liability arising out of the operation, mmntenance and use of all automobiles and mobile
equipment used m conjunction wath this contract
SansfacUon of the above reqmrement 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 mmntmn Worker's Compensation insurance which, in addition to
meeting the minimum statutory requirements for issuance of such insurance, has Employer's
Lmblt~ty limits of at least $100,000 for each accident, $100,000 per each employee, and a
$5001000 policy limit for occupational disease The City need not be named as an "Addatlonal
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 bmldlng or construction projects, the Contractor shall comply w~th the provisions
of Attachment I in accordance w~th §406 096 of the Texas Labor Code and rule 28TAC
110 110 of the Texas Worker's Compensation Commission (TWCC)
125
Duncan & Neff Street Paving B~d # 2719 CITY OF DENTON
August 02, 2001
[]
[]
Owner's and Contractor's Protective L~abfl~ty Insurance
The Contractor shall obtain, pay for and maintain at all times during the prosecution of the
work under th~s contract, an Owner's and Contractor's Protective Liability insurance pohcy
naming the C~ty 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" basts, and the policy shall be issued by the same insurance company that carries
the Contractor's habfllty insurance Pohcy hm~ts will be at least combined bodily
lnjmy and property damage per occurrence with a aggregate
Fire Damage Legal L:abfllty Insurance
Coverage is reqmred if Broad form General Lmbfllty is not promded or is unavailable to the
contractor or ff a contractor leases or rents a pomon of a City building Limits of not less than
each occurrence are reqmred
[]
Professional Liabdlty Insurance
Professional habfllty insurance w~th hmlts not less than per claim with respect to
negligent acts, errors or omissions an connection wath professional services as required under
this Agreement
[]
Builders' Pask 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
[]
Additional Insurance
Other insurance may be required on an individual basis for extra hazardous contracts and
specific servme agreements If such addxttonal insurance is required for a specific contract, that
requirement will be described in the "Specific Conditions" of the contract specfficatlons
126
Duncan & NeffStreet Paving Bid # 2719 CITY OF DENTON
August 02,2001
ATTACHMENT 1
IX] Worker's Compensatmn Coverage for Building or Construction Projects for
Gov6rnmental Entrees
A DefinlUons
B
C
D
E
Certaficate of coverage ("cert~ficate")-A copy of a certificate of insurance, a certificate of
authority to self-~nsure ~ssued 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 entaty's employees prowdlng services on a project, for the
duration of the project
Duration of the project - ~neludes the time from the begmmng of the work on the project
until the contractor's/person's work on the project has been completed and accepted by the
governmental enmy
Persons prowdmg services on the project ("subcontractor" ~n §406 096) - includes all
persons or entnles performing all or part of the serwces the contractor has undertaken to
perform on the project, regardless of whether that person contracted d~rectty vath the
contractor and regardless of whether that person has employees Th~s includes, wlthont
limnatton, 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" ~nelude, wnhont hmnaUon,
prov~chng, hauhng, or dehvenng eqmpment or materials, or providing labor, transportation,
or other service related to a project "Services" does not tnclude aCtlwt~es unrelated to the
project, such as food/beverage vendors, office supply dehvenes, and dehvery of portable
toalets
The contractor shall prowde coverage, based on proper reporting of classification codes
and payroll amounts and fihng of any overage agreements, whtch meets the statutory
reqmrements of Texas Labor Code, Section 401 011(44) for all employees of the
Contractor prowchng services on the project, for the duration of the project
The Contractor must provide a certificate of coverage to the governmental entity prior to
being awarded the contract
If the coverage period shown on the contractor's current certificate of coverage ends during
the duratton of the project, the contractor must, prior to the end of the coverage period, file
~ new certxfieate of coverage w~th the governmental entity showing that coverage has been
extended
The contractor shall obtain from each person providing services on a project, and prowde
to the governmental entaty
127
Duncan & Neff IStreet Paving B~d # 2719 CITY OF DENTON
August 02, 2001
F
G
H
(t)
a eertfficate 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 servmes on the project, and
(2)
no later than seven days after receipt by the contractor, a new certificate of coverage
shovang extension of coverage, if the coverage period shown on the current
certificate of coverage ends during the duration of the project
The contractor shall retmn all reqmred certificates of coverage for the duration of the
project and for one year thereafter
The contractor shall not~fy the governmental entity in writing by certified mall or personal
delivery, w~thm 10 days after the contractor knew or should have known, of any change
that materially affects the prowsmn of coverage of any person providing services on the
project
The contractor shall post on each project site a notice, m the text, form and manner
prescribed by the Texas Workers' Compensation Commission, informing all persons
prowdlng services on the project that they are reqmred 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 fihng of any coverage agreements, which meets the statutory
requirements of Texas Labor Code, Section 401 011(44) for all of its employees
prowdmg services on the project, for the duration of the project,
(2)
provide to the contractor, prior to that person beglnmng work on the project, a
certificate of coverage showing that coverage is being provided for all employees of
the person prowdmg serrates 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 extanSlOn of coverage, if the coverage period shown on the current
certificate of coverage ends dunng the duration of the project,
(4) obtain from each other person with whom it contracts, and provide to the contractor
(a) a certfficate of coverage, prior to the other person beginning work on the
project, and
(b)
a new certificate of coverage showing extension of coverage, prior to the end
of the coverage period, if the coverage period shown on the current cemficate
of coverage ends during the duration of the project,
128
Duncan & Neff Street Paving Bid # 2719 CITY OF DENTON
August 02, 2001
(5) retmn all requared cemficates of coverage on file for the durataon of the project and
for one year thereafter,
(6)
notify the governmental entaty in writing by certified mall or personal dehvery,
w~thtn 10 days after the person knew or should have known, of any change that
materially affects the provaslon of coverage of any person providing services on the
project, and
<7)
contractually reqmre each person wlth whom at contracts, to perform as reqmred by
paragraphs (1) - (7), w~th the certificates of coverage to be provided to the person for
whom they are provadmg sen/aces
By sagnang thas contract or provadmg or causing to be provided a certificate of coverage,
the contractor as representing to the governmental entity that all employees of the
contractor who v~ll provide sen/roes on the project wall be covered by workers'
compensataon coverage for the durataon of the project, that the coverage will be based on
proper repo~ng of elassaficatlon codes and payroll amounts, and that all coverage
agreements wall be filed wath the appropraate insurance carrier or, in the case of a self-
insured, with the commassaon's Davlslon of Self-Insurance Regulation Provldang false or
mlsleadang lnfonnataon may subject the contractor to admlmstratave penaltaes, criminal
penalties, cavil penalttes, or other mvfl actions
K
The contractor's faalure to comply with any of these provlstons ts a breach of contract by
the contractor which entitles the governmental entaty to declare the contract void if the
contractor does not remedy the breach within ten days after receapt of notme of breach
from the governmental entity
Bid 2719 - Duncan & Neff Street Pawng
129
W lhs
Document A310
Bid Bond
KNOW ALL MEN BY THESE PRESENTS, that we
~r agoe- P'c~311e Co~panY
~s principal, hereinafter cai~ed the Prlnctpa[, and (He.[nsa~Minameand addressorlegNtttle°f Sum~)
a corporation du~y or~amzed under the laws of the State of
as Surety, ~herem~fter c~lied the Surety~ ~re held ~nd firmly bound unto
~s Obh~ee, hereinafter cslled the ObhSee, m the sum of
FiVe ~e~cen~ o~ ~he ~moun~ Bt~ ...... Dollars ($
for ~he payment of wh~c~ sum we~ ~nd truty to be made, the smd PnnctpaJ and tBe satd Surety, brad
ou~setves, our ~etrs, executors, admmtstrators, successors and assigns, jointly and sever~tty,
these presents
WHEREAS, the principal h~s submitted a bid for (Herelnse~fultname
nd the Pnnmpal shall enter into a Contract w~th
.... L~lI accent the b~d of the Principal a~ L -~- as ma,, be specified in the biddin$ or
NOW THEREFORE !f the u~l,$.e~e_ ~:~s of T~ch b,d, and 8we such bon~ or oon~of suc~ Con.act and for the prompt
~e Obll~ee In accoraanc~ wttn,tn~--~clent sure~ for ~e faithful p~n~rman~. ~f ~e failure of the Prmctpat to ?~er
tract Documen~ w~th ~ooa anu ~-,,, rosecubon thereof, or m ~e e~,~ ~ .- ~ ~erence not to exceed the
C~n~ of labor and ma~naJ furn?he~_ in~e ~the Prmdpat shall pay to the ~t,ge~,~'Ob ,~ee may ,n 8ood fa,th
P~Y~"~ ~ .... , -nd rove such bond or oonu~, .... ,~ ~ J -~ such lar~er amount TOt winch, u,,~. ~' ~-~ void othe~me
such ~nu.~] ~-~.~-n ~e amount specified m sa~ mu,~,_,~._,~ bid then ~Js obligation sn~lt De nu. ....
penaJW nereoi u~ ~ ...... ~orm the Work covered oy ~,~ ,
con[rBct with another par~y ~
to .emaJn in full force and effect. 2 0 0
' day of
Sl~ned and sealed this
E~goe-P~l[c Company
(Wltn~
~~ne¥" in-Face
FIREMAN'S FUND INSURANCE COMPANY
NATIONAL SURETY CORPORATION ASSOCIATED INDEMNITY CORPORATION
THE AMERICAN INSURANCE COMPANY AMERICAN AUTOMOBILE INSURANCE COMPANY
GENERAL POWER OF ATTORNEY
KNOW ALL MEN B¥1THESE PRESENTS That FIREMAN'S FUND INSURANCE COMPANY a Cahfomla corporatton NATIONAL SURETY CORPORATION
an fihnots corporation THE AMERICAN INSURANCE COMPANY a New Jersey corporation redomesncated m Nebraska, ASSOCIATED INDEMNITY
CORPORATION, a Cahfomla corporation, and AMERICAN AUTOMOBILE INSURANCE COMPANY a Missouri corporatton (harem collectively called the
Compames ') does each ~ereby appoint ROS~Y WEAVER AND JOHN R. STOCKTON OF DALLAS TX
COMPANY whtch provj*lons are now in full force and effecl
FIREMAN S FUND INSURANCE COMPANY
NATIONAL SURETY CORPORATION
THE AMERICAN INSURANCE COMPANY
ASSOCIATED INDEMNITY CORPORATION
AMERICAN AUTOMOBILE INSURANCE COMPANY
COUNTY OF MARIN ~
On,is ]-7 }tayof December 1998 , bcfore me personally came M A Mallonee tomeknown who bemgbyme
duly sworn dtd depos~ and say that ho is a Vice President of each company described in and whtch executed the above mstrument that he knows the seals of the sam
Compam~ that the se~ls affixed to the smd instrument are such company seals, that they were so affixed by order of the Board of Dtrectors of smd compames and ~at he
signed his name thereto; by like order
INzl] ~]g~WITNESS ~ .~:~ ~"~ ~-L~WHER~OF'Npfa~yCOmI~IsIIOr~' l hOVeL C~A~pohereunt°# 1163726act my hand~= and affixed my official seal the day and year harem first abo%e wntt~a /.x ~O~
'~ Public- Caflfomla ~,
STATE OF CALIFORniA } SS
COUNTY OF MARIN
I the undersigned, Rea dent Assistant Sacratm'y of anch company, DO HEREBY CERTIFY that the for~gmng and attached POWER OF AJTORNEY remains m full force
IMPORTANT NOTICE
TO OBTAIN INFORMATION OR MAKE A COMPLAINT:
i YOU MAY CONTACT THE TEXAS DEPARTMENT OF
INSURANCE TO OBTAIN INFORMATION ON COMPANIES,
COVERAGES, RIGHTS OR COMPLAINTS AT:
1-800-252-3439
YOUIMAY WRITE THE TEXAS DEPARTMENT OF INSURANCE:
P. O. BOX 149104
AUSTIN, TX 78714-9104
FAX #(512) 475-1771
PREMIUM OF CLAIM DISPUTES:
PR
AG
RE
SHOULD YOU HAVE A DISPUTE CONCERNING YOUR
iMIUM OR ABOUT A CLAIM YOU SHOULD CONTACT THE
ENT OR COMPANY FIRST. IF THE DISPUTE IS NOT
SOLVED, YOU MAY CONTACT THE TEXAS DEPARTMENT
OF INSURANCE.
ATTACH THIS NOTICE TO YOUR POLICY:
THIIS NOTICE
BECOME A
IS FOR INFORMATION ONLY AND DOES NOT
PART OF CONDITION OF THE ATTACHED
DOCUMENT.
FIREMAN'S FUND INSURANCE COMPANY
NATIONAL SURETY CORPORATION ASSOCIATED INDEMNITY CORPORATION
THE AMERICAN INSURANCE COMPANY AMERICAN AUTOMOBILE INSURANCE COMPANY
GENERAL POWER OF ATTORNEY
KNOW ALL MEN BY THESE PRESENTS That FIREMAN S FUND INSURANCE COMPANY a Cahforma corporation NATIONAL SURETY CORPORATION
MERICAN INSURANCE COMPANY a New Jersey co.oratton redomes cared m Nebraska ASSOCIATED INDEMNITY
an Ilhnols co.oratlon THE A ClmA COMPANY a Missouri corporation (berem collectively called the
CORPORATION a Cahfomm corporatmn and AMERICAN AUTOMOBILE IN ..... NCE ..
Compames )d~eseachherebyappoml ROSEMARY WEAVER AND JOHN R. STOCKTON OF DALLAS TX
be~r trl~- and Iqwfu A orney(s m Fact with full power of authority hen.by conferred m their name place and ~tead to execute seal acknowh-dbe and deh~er any and all
and to bind thc Comp intes thereby as fully and to die · uric exknt a~ if such bonds v, ere stbncd by thc President se tied with the corporatt. ~e Ils of th[ Conlp inle· and duly
attested by the Companms Secretary bemby ratifying and conhrmmg all that the sa~d Altomcy(s) m Fact m ~x do m the premises
T ~x pox~e~ ot attorney ~s granted under and by the authomy of Amcle VII of the By laws of FIREMAN S FUND NSURANCE COMPANY NATIONAL SURETY
CORPORATION THE AMERICAN NSURANCE COMPANY ASSOCIATED INDEMNITY CORPORATION and AMERICAN AUTOMOBILF NSURANCE
COMPANY which prow~lonq are now tn full fore and effect
der the author of he following Re~olutton adopted by the Board of D~rec ors of FIREMAN S FUND INSURANCE
Th~ ~wer of attorney is signed and sealed un .-- 3~ ............ .~.~oc ~MPANY ASSOCIATED INDEMNITY CORPORATION and AMERICAN
COMPANY NATIONAL SURETY COR TION TH~ A~tc~t~ ~u~t~ ~
AUTOMOBILE iNSURANCE COMPAN~O~ meeting duly called and held ar by ~mten consent on the 9th day of March 1995 and smd Rem~uuon hax not bccn
amen&d or r~p~alcd
a ute of an Vice Pres dent Assistant Secre cry and Rem&hi Assistant Secretary of the Compames and the seal o~ the
RESOLVED that the sign t Y .... r ..... w*~ of a omev or on any cemfica e relaung thereto by
Compameq may ~ affixed, p Y P . .e ~ ~er nr attorney o~ CCnlfiCa c beqnn~ su;h fac~mde s~gnature or facs~mde seal shall be
vahd and binding upon the Compame~
IN WI~SS WHEREOF the Commn,eq have cau~d tbe~e[p~eoe~s to ~ signed by tbetr Vice ~estdent and their co.orate ~etK to be hereunto alhxed
L / day of Dec&mber
., FIREMAN S FUND INSU~NCE COMPANY
~7~5) ,* _ _%' THE AMERICAN INSURANCE COMPANY
* * ~ ~ s ~ n ~ ~ ASSOCIATED INDEMNITY COR~TION
%'~ ~ ~' ~ ~ --*-- ~ AMERICANAUTOMOBILEINSURANCECOMPANY
360789 11 98
STATE OF CALIFORNIA } ss
COUNTY OF MARIN
Compames that the seals affixed to the said instrument are such company seals mat mey Y
s~gned his name thereto by hke order
IN WITNESS WHERF~OF I have hereunto set my hand and affixed my official seal the day and year hereto first above written
Commission# 63726 !
/v~fn Coun*" ~' / ~" L/~' /
TATE OF CALIFORNIA } ss
COUNTY OF MAR[N
an DO HEREBY CERT FY thc he foregoing and attached pOWER OF A'ITORNEY remains in full force
the undersigned Resident Assistant 8ecre~ary?f e,ac .h,.c?m. pj~ ?n~, I~w~ nf each comnanv and the Resolullon of the Board of Directors set forth In the Power of Attorney
and has not been revoked and fur~bermore hat Attic e vii oi Re .; ........... .
are [lOW Ii1 force
, * ii (-"
IMPORTANT NOTICE
To obtain I information or make a
complaint i
You may call Fireman's Fund's
toll-£ree telephone number for
information or to make a
complaint at
1--800--5~'F--5 7 8'F
You may a~so write to Fireman's
Fund at.
P 01. Box 2519
Dallas, TX 75221
You may contact the Texas
Department of Insurance to obtain
informatl'on on
coveragesj rights or complaints
at '
You muy Write the Texas
Department of Insurance
P. O, BOX 149104
Austin, TX
FAX ~(512) 475-1771
P RIiIM~UM OR CLAIM
D i[S l~Urf Iii ~ ~
Should y~u have a dispute
concerning your premium or about
a claim you should contact the
agent ~s~. If =he dispute Is
not resolved, you may con,ac% the
Texas Department of Insurance.
POLICY: This notice is
for information only and does not
become a~ part or condition o~ the
sttache~ document
AVI SO IMPORTANTE
Para obtener lnformacio~ o para
Usted pusde 1lamer al numero de
telefono gratis de Fireman's
Fund's para lnformacion o para
someter una queJa al
1~800--527--5787
Usted tamb~en puede escribir a
Fireman's Fu~d:
P O. Box 2519
Dallas, TX 75221
Puede comunicarse con el
Departamento de Seguroe de Texas
para obtener ~nformacion acerca
de companias, cober~uras,
derechos o ~uejas al
1--8OO--252--3439
Puede escribtr al Departamento de
Secures de Texas
P 0 BOX 149104
Austin, TX 78714-9104
FAX 9(512) 475-1771
D I ~ ~I-s'--~AS ~OB~
R~Cv.2~/O~5~ : Si =lens una
~puta concerI%~snte a su prima o
a un reclamo, debs comun~¢arse
con el agents primero. ~1 ~o se
resuelve la d~sputa, puede
entonces comunicarse con el
departamento (TDI)
UI~A ~-~TE ~V~aO A
~U
~ste arise es solo para proposito
de informs=ion y no se convierte
en parts o condic~on del
document o adJunto
Page 001-001
ACORD,. CERTIFICATE OF LIABILITY INSURANCE
p~BR (940)38~-9691 PAX (g~-XOSO
My & Ktflg /n~raflce ONLY~DCON~RSNO~HTSU~NTHEGEK~TE
890 ~mJth T-gSE, 5u'lte A
~uam ']~gml Publ'lc Cml~lny, Zn¢
11111 Cheek
P 0 Box ~$0
Den'tM'i, TX 76~0:)
At. TEA THE ¢~VERAGE AFFORDED BY THB PQUCIEe BBkOW
INSUREKE AFFO~DIN(II COVERAGIE
~"~,~R ,', Travelers L1 oydn
Travelers Tnderml~:y of N~e~'lc
~)~IIRAGIBS
K~ORD ~S-~ (7/17)
~te 10/2/01 Tzme 10 39 AM To JAGOE PUBLIC CO ~ 382-9732
Page 005-005
I M PORTANT
If the certificate holder ~s an ADDITIONAL INSURED the pohcy0es) must be endorsed A statement
on th~s certlhcata does not confer r~ghts to the cerbhcate holder m heu of such endorsement(s)
If SUBROGATION IS WAIVED subject to the terms and conditions of the policy certain pohctes may
require an endorsement A statement on this certificate does not confer rights to the certihcate
holder in heu of such endorsement(s)
DISCLAIMER
The Cerbhcate of Insurance on the reverse side of this form does not constitute a contract between
the ~ssulng insurer(s), authonzed representative or producer and the certificate holder nor does it
affirmatively or negatively amend, extend or alter the coverage afforded by the pohcles hsted thereon
ACORD 25-S (7/97)