HomeMy WebLinkAboutContract 48737-R1 �tCl 101CITY SECRETARY _
DE oRtK CONTRACT N0..
GS��P�PRc CITY OF FORT WORTH
FIRST RENEWAL OF AGREEMENT
WHEREAS,the City of Fort Worth, ("City"),and William J. Schultz Inc. dba
Circle "C" Construction Company, authorized to do business in Texas, ("Contractor"),
entered into that certain ORIGINAL AGREEMENT(City Secretary#48737,M&C C-
28089)for the PROJECT generally described as: Sewer Main Extensions, Replacements &
Relocations Contract 2016, City Project No. 100434; and
WHEREAS, the ORIGINAL AGREEMENT may be renewed up to two times as
provided by M&C C-28089; and
WHEREAS, The City and Contractor desire to renew the ORIGINAL
AGREEMENT for an additional term at the same price, said FIRST RENEWAL is
available in the Water Capital Projects Fund, as appropriated in Ordinance#22992-11-2017,
M&C C-28471.
NOW, THEREFORE, it is agreed by the City and Contractor as follows:
Article I
The Scope of Services as set forth in the ORIGINAL AGREEMENT has not
changed.
Article II
The Contractor's compensation shall be in the amount up to $1,000,000.00. The
Term of this renewal agreement shall be for one year, effective as of the effective date or the
expenditure of the funding,whichever occurs first.
Article III
There are no other changes to any other terms or conditions of the ORIGINAL
AGREEMENT.
t
L RECORDCRETARYRTH, TX
First Renewal of Agreement Page 1 of 2
Circle C Construction Company MSERR2016
City Project No.100434
EXECUTED by each party's duly authorized representative and EFFECTIVE as of the date
subscribed by the City's designated City Manager.
City of Fort Worth William J. Schultz Inc. dba Circle C
Construction Company.
Jesus J. Chapa
Assistant City Manager President
DATE: DATE: /Z • S""- ZD/7
APPROVAL RECOMMENDED:
6 16'x.
Christopher Harder,P.E.
Assistant Director,Water Department
APPROVED AS TO FORM AND LEGALITY:
M&C: C-28471
Date: November 7, 2017
�a •a-�s:�.o��- a�8a�a
Douglas W. Black
Sr. Assistant City Attorney
7
ATTEST: foRr
May J. Kays I Jr13:
r
City Secretary 'k
�pS
OFFICIAL RECORD
CITY SECRETARY
FT.WORTH, TX
First Renewal of Agreement Page 2 of 2
Circle C Construction Company MSERR2016
City Project No.100434
Contract Compliance Manager
By signing I acknowledge that I am the person
responsible for the monitoring and
administration of this contract, including
ensuring all performance and reporting
requirements.
F
Signature
James A. Deeter
Name of Employee
Senior Professional Engineer
Title
City of Fort Worth, Texas
Mayor and Council Communication
COUNCIL ACTION: Approved on 11/7/2017 - Ordinance No. 22992-11-2017
DATE: Tuesday, November 7, 2017 REFERENCE NO.: C-28471
LOG NAME: 60MMSERR2016R1 - CIRCLEC
SUBJECT:
Adopt Appropriation Ordinance in the Amount of$1,300,000.00 to Fund the First Renewal of City Secretary
Contract No. 48737 with William J. Schultz Inc. d/b/a Circle C Construction Company in the Amount of
$1,000,000.00 for Sewer Main Extensions, Replacements and Relocations Contract 2016, at Various
Locations Throughout the City and Provide for Additional Project Costs (ALL COUNCIL DISTRICTS)
RECOMMENDATION:
It is recommended that the City Council adopt the attached appropriation ordinance increasing
estimated receipts and appropriations in the Water Capital Projects Fund in the amount of
$1,300,000.00 from available funds for sewer main extensions, replacements and relocations
Contract 2016 (City Project No. 100434).
DISCUSSION:
On January 24, 2016, Mayor and Council Communication (M&C C-28089) the City Council authorized the
City Manager to execute a contract in the amount of$1,000,000.00, with the option of two renewals, with
William J. Schultz, Inc. d/b/a Circle C Construction Company for sewer main extensions, replacements
and relocations Contract 2016.
The City and the Contractor desire to exercise the first renewal of the contract in the amount of
$1,000,000.00 and with the same terms and conditions.
The work to be performed under this contract consists of extending, replacing and/or relocating sewer
mains, services, and other pertinent construction required to provide sewer service to individual customers
or developers.
In addition to the contract amount $300,000.00 is required for project management, real property
acquisitions, survey, contingencies, material testing, and inspection.
This project will have no impact on the Water Department's operating budget when completed.
Construction is expected to start December 2017 and be completed by December 2018 or when the
contract amount is exhausted.
This project is located in ALL COUNCIL DISTRICTS.
FISCAL INFORMATION /CERTIFICATION:
The Director of Finance certifies that upon approval of the above recommendations and adoption of the
attached appropriation ordinance, funds will be available in the current capital budget, as appropriated, of
the Water Capital Projects Fund. The Fiscal Year 2018 water Operating Fund budget includes
appropriations of$29,022,689.00 for the purpose of providing Pay-As-You-Go funding for sewer capital
projects. After this transfer for Fiscal Year 2018, the balance will be $27,616,840.00.
Appropriations for the first renewal of the Sewer Main Extensions, Replacements and Relocations
Contract 2016 project by Fund will consist of the following:
http://apps.cfwnet.org/ecouncil/printmc.asp?id=25289&print—true&DocType=Print 12/1/2017
FUND Existing Additional Project
Appropriations Appropriations Total*
Water Capital
Projects Fund $1,430,000.00 $1,300,000.00 $2,730,000.00
56002
Project Total $1,430,000.00 $1,300,000.00=$2,730,000.00
*Numbers rounded for presentation purposes.
FUND IDENTIFIERS (FIDs):
TO
Fund Department Accoun Project Program ctivity Budget Reference # moun
L ID ID Year Chartfield 2
FROM
Fund Department �Accoun Project Program ctivity Budget Reference # moun
l,
ID ID Year Chartfield 2
CERTIFICATIONS:
Submitted for City Manager's Office by: Jay Chapa (5804)
Originating Department Head: Kara Shuror (8819)
Additional Information Contact: Adolfo Lopez (7829)
ATTACHMENTS
1 60MMSERR2016R1 - CIRCLEC 60 AO 18Rey.docx (Public)
2. 60MMSERR2016R1 CIRCLEC FID TableRev.docx (CFW Internal)
3. 60MMSERR2016R1- CIRLEC 1295.pdf (Public)
4. SAM William J. Schultz Inc dba Circle C Construction Company.pdf (CFW Internal)
http://apps.cfwnet.org/ecouncil/printmc.asp?id=25289&print=true&DocType=Print 12/1/2017
Ordinance No.
AN ORDINANCE INCREASING THE ESTIMATED RECEIPTS AND APPROPRIATIONS
IN THE AMOUNT OF$1,300,000.00 IN THE WATER CAPITAL PROJECTS FUND, FROM
AVAILABLE FUNDS, FOR SEWER MAIN EXTENSIONS, REPLACEMENTS, &
RELOCATIONS CONTRACT 2016 PROJECT: PROVIDING FOR A SEVERABILITY
CLAUSE; MAKING THIS ORDINANCE CUMULATIVE OF PRIOR ORDINANCES;
REPEALING ALL ORDINANCES IN CONFLICT HEREWITH; AND PROVIDING AN
EFFECTIVE DATE.
BE IT ORDAINED BY THE CITY COUNCIL OF THE CITY OF FORT WORTH, TEXAS:
SECTION 1
That in addition to those amounts allocated to the various City departments for Fiscal Year 2017-2018 in the
Budget of the City Manager, there shall also be increased estimated receipts and appropriations in the
amount of $1,300,000.00 in the Water Capital Projects Fund, from available funds, for Sewer Main
Extensions, Replacements, & Relocations Contract 2016 project.
SECTION 2.
That should any portion, section or part of a section of this ordinance be declared invalid, inoperative or void
for any reason by a court of competent jurisdiction, such decision, opinion or judgment shall in no way
impair the remaining portions, sections, or parts of sections of this ordinance, which said remaining
provisions shall be and remain in full force and effect.
SECTION 3.
That this ordinance shall be cumulative of Ordinance 22928-09-2017 and all other ordinances and
appropriations amending the same except in those instances where the provisions of this ordinance are in
direct conflict with such other ordinances and appropriations, in which instance said conflicting provisions of
said prior ordinances and appropriations are hereby expressly repealed.
SECTION 4.
This ordinance shall take effect upon adoption.
APPROVED AS TO FORM AND LEGALITY: CITY SECRETARY
Douglas W Black Mary J. Kayser
Sr.Assistant City Attorney
ADOPTED AND EFFECTIVE:
60MMSERR2016R1 CIRCLE FID Table
11 KK Journa-f-Entries)
9 CF POS
Re Fund Dept# Accounit— Project I Activity � Bud etYear Progria Amount Pur Xfe
5600 070043 495600
1 2 0 1 100434 2018 $ 1,300,000.00
5600 070043 511010 00133
1 2 0 1 100434 0 2018 $ 180,000.00
5600 070043 531035 00133
1 2 0 0 100434 0 2018 $ 5,000.00
5600 070043 533050 00133
1 2 0 0 100434 0 2018 $ 5,000.00
5600 070043 571001 00134
1 2 0 0 100434 0 2018 $ 1,000.00
5600 070043 531035 00134
1 2 0 0 100434 0 2018 $ 1,000.00
5600 070043 533050 00134
1 2 0 0 100434 0 2018 $ 500.00
5600 070043 531035 00138
1 2 0 0 100434 0 2018 $ 1,000.00
5600 070043 533050 00138
1 2 0 ', 0 100434 0 2018 $ 11,000.00
5600 070043 554010 00138
1 2 0 1 100434 0 2018 $ 500.00
5600 070043 555010 00138
1 2 0 2 100434 0 2018 $ 500.00
5600 070043 574001 00138
1 2 0 0 100434 0 2018 $1,030,000.00
5600 070043 531035 00138
1 2 0 0 100434 4 2018 $ 5,000.00
5600 070043 533050 00138
1 2 0 0 100434 4 2018 $ 10,000.00
5600 070043 531035 00138
1 2 0 0 100434 5 2018 $ 79,500.00
.. -
�Amortlze Fund Dept# Account Project Activity ..- -
5600 070043 495600
1 2 0 1 100434 9999 $ 1,300,000.00
5600 070043 511010 00133
1 2 0 1 1 100434 0 9999 $ 150,000.00
5600 070043 531035 00133
1 2 0 0 1 100434 0 9999 $ 5,000.00
5600 070043 533050 00133
1 2 0 0 100434 0 9999 $ 5,000.00
5600 070043 571001 00134
1 2 0 0 100434 0 9999 $ 1,000.00
5600 070043 531035 00134
1 2 0 0 100434 0 9999 $ 1,000.00
5600 070043 533050 00134
1 2 0 0 100434 0 9999 $ 500.00
5600 070043 531035 00138
1 2 0 0 100434 0 9999 $ 1,000.00
5600 070043 533050 00138
1 2 0 0 100434 D 9999 $ 11,000.00
5600 070043 554010 00138
1 2 0 1 100434 0 9999 $ 500.00
5600 070043 555010 00138
1 2 0 2 100434 0 9999 $ 500.00
5600 070043 574001 00138
1 2 0 0 100434 0 9999 $ 1,030,000.00
5600 070043 531035 00138
1 2 0 0 100434 4 9999 $ 5,000.00
5600 070043 533050 00138
1 2 0 0 100434 4 9999 $ 10,000.00
5600 070043 531035 00138
1 2 0 0 100434 5 9999 $ 79,500.00
(ExpenseFIDs Only No KK or -•-•
Re Fund Dept# Account Project Activity Budget Year CF Progra Amount Purpos
5600 070043 57400100138
2 2 0 0 100434 0 9999 $ 1,000,000.00
CERTIFICATE OF INTERESTED PARTIES
FORM ,.295
1of1
Complete Nos.1-4 and 6 if there are interested parties. OFFICE USE ONLY
Complete Nos.1,2,3,5,and 6 if there are no interested parties. CERTIFICATION OF FILING
1 Name of business entity filing form,and the city,state and country of the business entity's place certificate Number:
of business. 2017-268242
William 1 Schultz Inc dba Circle C Construction Company
Fort Worth,TX United States pate Filed:
2 Name of governmental entity or state agency that is a party tot the contract for which the form is 1010412017
being filed.
City of Fort Worth pate Acknowledged:
l` l ry
3 Provide the identification number used by the governmental entity or state agency to track or identify the contract,and provide a
description of the services,goods,or other property to be provided under the contract.
100434
Sewer Main Extensions,Replacements&Relocations Contract 2016 Renewal Number 1
Nature of interest
4 Name of Interested Party City,State,Country(place of business) (check applicable)
Controlfing intermediary
Skelly,Teresa Fort Worth,TX United States X
5 Check only if there is NO Interested Party.
6 AFFIDAVIT I swear,or affirm,under penalty of perjury.that the above disclosure is true and correct.
N" °us.;MICHELE S.LANKFORA
Notary Public
STATE OFTEXA*�
=•i o� ru Signature of authorized agent of contract business entity
' otery rp r MW4&Q,
.1y CC— Exp.odobw*.gois
AFFIX N A P
Sworn to and subscribed before me,by the said t>K: L�� ,this the � � day of
20j�,to certify which,witness my hand and seal of office.
Signature of officer administering oath Printed name of officer administering oath Title of officer administering oath
Forms provided by Texas Ethics Commission www.ethics.state.tx.us Version V1.0.3337
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October 05,2017 9:28 AM Page 1 of 1
006113-1
PERFORMANCE BOND
Page 1 of 2
1 BOND NO. TXC608535
2 SECTION 00 6113
3 PERFORMANCE BOND
4
5 THE STATE OF TEXAS §
6 § KNOW ALL BY THESE PRESENTS:
COUNTY OF TARRANT §
8
9 That we,William 3. Schultz, Inc. dba Circle C Construction Company, known as"Principal'
10 herein and Merchants Bonding Company(Mutual), a corporate surety(sureties, if more than one)
11 duly authorized to do business in the State of Texas, known as"Surety"herein (whether one or
12 more), are held and firmly bound unto the City of Fort Worth, a municipal corporation created
13 pursuant to the laws of Texas, known as"City"herein, in the penal sum of, One Million Dollars
14 ($1,000.000.00), lawful money of the United States,to be paid in Fort Worth, Tarrant County,
15 Texas for the payment of which sum well and truly to be made, we bind ourselves, our heirs,
16 executors, administrators successors and assigns,jointly and-severally, firmly by these presents.
17 WHEREAS, the Principal has entered into a certain written contract with the City
18 awarded the day of NOV Q 7+ 201 2017, which Contract is hereby referred to and
19 made a part hereof for all purposes as if fully set forth herein, to furnish all materials, equipment
20 labor and other accessories defined by law, in the prosecution of the Work, including any Change
21 Orders, as provided for in said Contract designated as
22 First Renewal-Sewer Main Extensions,Replacements&Relocations Contract 2016
23 Cit} Profect No. 100434
24 NOW,THEREFORE, the condition of this obligation is such that if the said Principal shall
25 faithfully perform it obligations under the Contract and shall in all respects duly and faithfully
26 perform the Work, including Change Orders, under the Contract, according to the plans,
27 specifications, and contract documents therein referred to, and as well during any period of
28 extension of the Contract that may be granted on the part of the City, then this obligation shah
29 be and become null and void, otherwise to remain in full force and effect.
30 PROVIDED FURTHER, that if any legal action be filed on this Bond,venue shall lie in
31 Tarrant County,Texas or the United States District Court for the Northern District of Texas, Fort
32 Worth Division.
CITY OF FORT WORTH MSERR2016
STANDARD CONSTRUCTION SPECIFICATION DOCUMENTS City Project Number 100434
Revised July 1,2011
006113-2
PERFORMANCE BOND
Page 2 of 2
1 This bond is made and executed in compliance with the provisions of Chapter 2253 of
2 the Texas Government Code, as amended, and all liabilities on this bond shall be determined in
3 accordance with the provisions of said statue.
4 IN WITNESS WHEREOF, the Principal and the Surety have SIGNED and SEALED this
5 instrument by duly authorized agents and officers on this the day of NOV 0 7 2017
6 . 2017.
7 PRINCIPAL:
8 William J. Schultz, Inc.dba
9 Circle C Construction Company
10
11 BY: cf�li
12 Signature
13 ATTEST:
14
15Ll
( Teresa S.Skelly, President
16 (Principal)Secretary, Michele S. Lan rd Name and Title
17
18 Address: P.O. Box 40328
19 500 W.Trammell
20 Fort Worth.TX 76140
21
22 Witness as to Principal
23 SURETY:
24 MerchantsAioging Company Mutual
25
26 BY:
27 Signature
28
29 Sheryl A. Klutts,Attomey-in-Fact
30 Name and Title
31
32 Address: 6700 Westown Parkway
33 r� West Des Moines, IA 50266-7754
34
35 Witness as to Surety,John A. Mi ler Telephone Number: (800)678-8171
36
37
38
39 *Note: If signed by an officer of the Surety Company, there must be on file a certified
40 extract from the by-laws showing that this person has authority to sign such
41 obligation. If Surety's physical address is different from its mailing address,
42 both must be provided. The date of the bond shall not be prior to the date the
43 Contract is awarded.
44
CITY OF FORT WORTH MSERR2016
STANDARD CONSTRUCTION SPECIFICATION DOCUMENTS City Project Number 100434
Revised July 1,2011
006114-1
PAYMENT BOND
Page 1 of 2
1 BOND NO. TXC608535
2 SECTION 00 6114
3 PAYMENT BOND
4
5 THE STATE OF TEXAS §
6 KNOW ALL BY THESE PRESENTS:
COUNTY OF TARRANT §
8
9 That we, William 3. Schultz, Inc. dba Circle C Construction Company,, known as
10 "Principal" herein, and Merchants Bonding Company (Mutual), a corporate surety (sureties), duly
11 authorized to do business in the State of Texas, known as "Surety" herein (whether one or
12 more), are held and firmly bound unto the City of Fort Worth, a municipal corporation created
13 pursuant to the laws of the State of Texas, known as "City" herein, in the penal sum of One
14 Million Dollars ($1,000,000.00), lawful money of the United States, to be paid in Fort Worth,
15 Tarrant County, Texas, for the payment of which sum well and truly be made, we bind ourselves,
16 our heirs, executors, administrators, successors and assigns,jointly and severally, firmly by these
17 presents:
18 WHEREAS, Principal has entered into a certain written Contract with City, awarded the
19 day of NOV 0 7 2017 , 2017, which Contract is hereby referred to and made a
20 part hereof for all purposes as if fully set forth herein, to furnish all materials, equipment, labor
21 and other accessories as defined by law, in the prosecution of the Work as provided for in said
22 Contract and designated as
23 First Renewal-Sewer Main Extensions, Rev/acemeni s&Relocations Contract 2016
24 City Protect No. 100434
25 NOW, THEREFORE, THE CONDITION OF THIS OBLIGATION is such that if Principal
26 shall pay all monies owing to any(and all) payment bond beneficiary(as defined in Chapter 2253
27 of the Texas Government Code, as amended) in the prosecution of the Work under the Contract,
28 then this obligation shall be and become null and void; otherwise to remain in full force and
29 effect.
CITY OF FORT WORTH MSERR2016
STANDARD CONSTRUCTION SPECIFICATION DOCUMENTS City Project Number 100434
Revised July 1,2011
006114-2
PAYMENT BOND
Page 2 of 2
1 This bond is made and executed in compliance with the provisions of Chapter 2253 of
2 the Texas Government Code, as amended, and all liabilities on this bond shall be determined in
3 accordance with the provisions of said statute.
4 IN WITNESS WHEREOF, the Principal and Surety have each SIGNED and SEALED this
5 instrument by duly authorized agents and officers on this the day of
6 Nov 0 7 2017 2017.
7 PRINCIPAL:
8 William J. Schultz, Inc. dba
9 Circle C Construction Company
10
11 BY:_ / f lra�
12 Signature
13 ATTEST:14
G,
15 �(� Teresa S.Skelly, President
16 (Principal)Secretary,Michele S. Lan rd — Name and Title
17
18 Address: P. O. Box 40328
19 500 W.Trammell
20 Fort Worth,TX 76140
21
22 Witness as to Principal
23 SURETY:
24 Merchants in Company Mutual
25
26 BY:
27 SignaturiV
28
29 Sheryl A. Mutts,Attorney-in-Fact
30 Name and Title
31
32 /' Address: 6700 Westown Parkway
33 K West Des Moines,IA 50266-7754
34 '
35 Witness as to Surety,John A. Miller Telephone Number: (800) 678-8171
36
37
38 Note: If signed by an officer of the Surety, there must be on file a certified extract from the
39 bylaws showing that this person has authority to sign such obligation. If Surety's physical
40 address is different from its mailing address, both must be provided.
41
42 The date of the bond shall not be prior to the date the Contract is awarded.
43
44
45 END OF SECTION
46
CITY OF FORT WORTH MSERR2016
STANDARD CONSTRUCTION SPECIFICATION DOCUMENTS City Project Number 100434
Revised July 1,2011
006119-1
MAINTENANCE BOND
Page 1 of 3
1 BOND NO.TXC608535
2 SECTION 00 6119
3 MAINTENANCE BOND
4
5 THE STATE OF TEXAS §
6 § KNOW ALL BY THESE PRESENTS:
7 COUNTY OF TARRANT §
8
9 That we, William J. Schultz. Inc. dba Circle C Construction Companx known as"Principal"
10 herein and Merchants Bonding Company(Mutual), a corporate surety (sureties, if more than one)
11 duly authorized to do business in the State of Texas, known as"Surety"herein (whether one or
12 more), are held and firmly bound unto the City of Fort Worth, a municipal corporation created
13 pursuant to the laws of the State of Texas, known as"City"herein, in the sum of One Million
14 Dollars ($1,000,000.00), lawful money of the United States, to be paid in Fort Worth,Tarrant
15 County,Texas, for payment of which sum well and truly be made unto the City and its
16 successors, we bind ourselves, our heirs, executors, administrators, successors and assigns,
17 jointly and severaAy, firmly by these presents.
18
19 WHEREAS,the Principal has entered into a certain written contract with the City awarded
20 the day of N O V 0 7 H i t , 2017, which Contract is hereby
21 referred to and a made part hereof for all purposes as if fully set forth herein, to furnish all
22 materials, equipment labor and other accessories as defined by law, in the prosecution of the
23 Work, including any Work resulting from a duly authorized Change Order(collectively herein, the
24 "Work'I as provided for in said contract and designated as
25
26 First Renewal-Sewer Main Extensions, Rep/acements&Relocations Contract 2016
27 City Proiect No. 100434
28
29 WHEREAS, Principal binds itself to use such materials and to so construct the Work in
30 accordance with the plans, specifications and Contract Documents that the Work is and will
31 remain free from defects in materials or workmanship for and during the period of two (2)
32 years after the date of Final Acceptance of the Work by the City("Maintenance Period'j; and
33
34 WHEREAS, Principal binds itself to repair or reconstruct the Work in whole or in part upon
35 receiving notice from the City of the need therefore at any time within the Maintenance Period.
CITY OF FORT WORTH MSERR2016
STANDARD CONSTRUCTION SPECIFICATION DOCUMENTS City Project Number 100434
Revised July 1,2011
006119-2
MAINTENANCE BOND
Page 2 of 3
1
2 NOW THEREFORE, the condition of this obligation is such that if Principal shall remedy
3 any defective Work, for which timely notice was provided by City, to a completion satisfactory to
4 the City, then this obligation shall become null and void; otherwise to remain in full force and
5 effect.
6
7 PROVIDED, HOWEVER, if Principal shall fail so to repair or reconstruct any timely
8 noticed defective Work, it is agreed that the City may cause any and all such defective Work to
9 be repaired and/or reconstructed with all associated costs thereof being borne by the Principal
10 and the Surety under this Maintenance bond; and
11
12 PROVIDED FURTHER, that if any legal action be filed on this Bond, venue shall lie in
13 Tarrant County,Texas or the United States District Court for the Northern District of Texas, Fort
14 Worth Division; and
15
16 PROVIDED FURTHER,that this obligation shall be-continuous-in nature and successive
17 recoveries may be had hereon for successive breaches.
18
19
20
CITY OF FORT WORTH MSERR2016
STANDARD CONSTRUCTION SPECIFICATION DOCUMENTS City Project Number 100434
Revised July 1,2011
006119-3
MAINTENANCE BOND
Page 3 of 3
1 IN WITNESS WHEREOF,the Principal and the Surety have each SIGNED and SEALED this instrument by
2 duly authorized agents and officers on this the day of NOV U 7 20117
3 2017.
4
5 PRINCIPAL:
6 William J.Schultz,Inc.dba
7 Ir le C Construction Company
8
9
10 Signature
11 ATTEST:
12
13 ��l�-� ,� �Q4 Teresa S. Skelly President
14 (Principal)Secretary, Michele S. Lan d Name and Title
15
16 Address: P.O. Box 40328
17 500 W.Trammell
18 Fort Worth,TX 76140
19
20 Witness as to Principal
21 SURETY:
22 Merchants Boondno Com an Mutual
23
24 BY:
25 Signature
26
27 SherylA. Mutts,Attorney-in-Fact
28 Name and Title
29 ATTEST:
30 '> Address: 6700 Westown Parkway
31 West Des Moines,IA 50266-7754
32urety(Secy tary)
33 �44 �
34 '
35 Witness as to Surety,John A. Miller Telephone Number: (804)678-8171
36
37 *Note: If signed by an officer of the Surety Company,there must be on file a certified extract from the
38 by-laws showing that this person has authority to sign such obligation. If Surety's physical
39 address is different from its mailing address, both must be provided. The date of the bond shall
40 not be prior to the date the Contract is awarded.
41
42
43
CITY OF FORT WORTH MSERR2016
STANDARD CONSTRUCTION SPECIFICATION DOCUMENTS City Project Number 100434
Revised July 1,2011
MERCHANTS"*,
BONDING COMPANY
POWER OF ATTORNEY
Know All Persons By These Presents,that MERCHANTS BONDING COMPANY(MUTUAL)and MERCHANTS NATIONAL BONDING,INC.,
both being corporations of the State of Iowa(herein collectively called the"Companies")do hereby make,constitute and appoint,individually,
John A Miller;John R Stockton;Sheryl A Klutts
their true and lawful Attorney(s)-in-Fact, to sign its name as surety(ies) and to execute, seal and acknowledge any and all bonds, undertakings,
contracts and other written instruments in the nature thereof, on behalf of the Companies in their business of guaranteeing the fidelity
of persons, guaranteeing the performance of contracts and executing or guaranteeing bonds and undertakings required or permitted in any
actions or proceedings allowed by law.
This Power-of-Attomey is granted and is signed and sealed by facsimile under and by authority of the following By-Laws adopted by the Board
of Directors of Merchants Bonding Company (Mutual) on April 23, 2011 and amended August 14, 2015 and adopted by the Board of Directors
of Merchants National Bonding,Inc.,on October 16,2015.
'The President, Secretary,Treasurer, or any Assistant Treasurer or any Assistant Secretary or any Vice President shall have power and authority
to appoint Attorneys-in-Fact, and to authorize them to execute on behalf of the Company, and attach the seal of the Company thereto, bonds and
undertakings,recognizances,contracts of indemnity and other writings obligatory in the nature thereof.'
"The signature of any authorized officer and the seal of the Company may be affixed by facsimile or electronic transmission to any Power of Attorney
or Certification thereof authorizing the execution and delivery of any bond, undertaking, recognizance, or other suretyship obligations of the
Company,and such signature and seal when soused shall have the same force and effect as though manually fixed."
In connection with obligations in favor of the Florida Department of Transportation only,it is agreed that the power and aut hority hereby given to the
Attomey-in-Fact includes any and all consents for the release of retained percentages and/or final estimates on engineering and construction
contracts required by the State of Florida Department of Transportation. It is fully understood that consenting to the State of Florida Department
of Transportation making payment of the final estimate to the Contractor and/or its assignee, shall not relieve this surety company of any of
its obligations under its bond.
In connection with obligations in favor of the Kentucky Department of Highways only,it is agreed that the power and authority hereby given
to the Attorney-in-Fact cannot be modified or revoked unless prior written personal notice of such intent has been given to the Commissioner-
Department of Highways of the Commonwealth of Kentucky at least thirty(30)days prior to the modification or revocation.
In Witness Whereof,the Companies have caused this instrument to be signed and sealed this 6th day of April 2017
;ma .UaaF����' .°0�,O�QQR . y : MERCHANTS BONDING COMPANY(MUTUAL)
CO
V 4f,.��• MERCHANTS NATIONAL BONDING,INC.
Co
2003 ;`,� y� 1933 c, By74r�
• ... ..•.'•" ••6� .. .•`1t►•. President
STATE OF IOWA ••••*'"" "'`""•" °•°••••°•
COUNTY OF DALLAS ss.
On this this 6th day of April 2017 before me appeared Larry Taylor,to me personally known, who being by me duly sworn
did say that he is President of MERCHANTS BONDING COMPANY (MUTUAL)and MERCHANTS NATIONAL BONDING, INC.; and that the
seals affixed to the foregoing instrument are the Corporate Seals of the Companies;and that the said instrument was signed and sealed in behalf
of the Companies by authority of their respective Boards of Directors.
AUCIA K.GRAM
c� Commission Nutter 767430
My Commission EMM
• April 1,2020 v,
Notary Public
(Expiration of notary's commission
does not invalidate this instrument)
1,William Warner,Jr.,Secretary of MERCHANTS BONDING COMPANY(MUTUAL)and MERCHANTS NATIONAL BONDING,INC.,do hereby
certify that the above and foregoing is a true and correct copy of the POWER-OF-ATTORNEY executed by said Companies,which is still in full
force and effect and has not been amended or revoked.
In Witness Whereof,I have hereunto set my hand and affixed the seal of the Companies on this day of 2017 .
l '� OG co, •
�•'EiPOR gip', qO ORPO'g % �•
2003 ? ;" 1933 secretary
POA 0018 (3/17) "
'4"�
MERCHANTS
BONDING COMPANY.
MERCHANTS BONDING COMPANY(MUTUAL) • MERCHANTS NATIONAL BONDING, INC.
P.O. BOX 14498 • DES MOINES, IOWA 50306-3498 • (800)678-8171 • (515)243-3854 FAX
Please send all notices of claim on this bond to:
Merchants Bonding Company(Mutual)/Merchants National Bonding, Inc.
P.O. Box 14498
Des Moines, Iowa 50306-3498
(515)243-8171
(800)678-8171
Physical Address: 6700 Westown Parkway, West Des Moines, Iowa 50266
SUP 0073 TX(2/15)
�^
CG 72 08 02 15
TEXAS - EXTENDED ULTRA LIABILITY PLUS ENDORSEMENT
COMMERCIAL GENERAL LIABILITY EXTENSION ENDORSEMENT SUMMARY OF COVERAGES
This is a summary of the various additional coverages and coverage modifications provided by this
endorsement. No coverage is provided by this summary.
* Extended Property Damage
* Expanded Fire Legal Liability to include Explosion, Lightning and Sprinkler Leakage
* Coverage for non -owned watercraft is extended to 51 feet in length
* Property Damage - Borrowed Equipment
* Property Damage Liability - Elevators
*Coverage D -Voluntary Property Damage Coverage $5,000 Occurrence with a $10,000 Aggregate
* Coverage E - Care, Custody and Control Property Damage Coverage $25,000 Occurrence with a $100,000
Aggregate -$500 Deductible
* Coverage F - Electronic Data Liability Coverage - $50,000
* Coverage G - Product Recall Expense $25,000 Each Recall Limit with a $50,000 Aggregate - $1,000 Deductible
* Coverage H -Water Damage Legal Liability -$25,000
* Coverage I -Designated Operations Covered by a Consolidated (Wrap-Up) Insurance Program - Limited Coverage
* Increase in Supplementary Payments: Bail Bonds to$1,000
* Increase in Supplementary Payments: Loss of Earnings to $500
* For newly formed or acquired organizations -extend the reporting requirement to 180 days
* Broadened Named Insured
* Automatic Additional Insured - Owners, Lessees or Contractors - Automatic Status When Required in Construction
Agreement With You
* Contractors Blanket Additional Insured - Limited Products -Completed Operations Coverage
* Automatic Additional Insured -Vendors
* Automatic Additional Insured , Lessor of Leased Equipment Automatic Status When Required in Lease Agreement With
You
* Automatic Additional Insured - Managers or Lessor of Premises
* Additional Insured - Engineers, Architects or Surveyors Not Engaged by the Named Insured
* Additional Insured -State or Governmental Agency or Subdivision or Political Subdivision - Permits or Authorizations
* Additional Insured -Consolidated Insurance Program (Wrap-Up) Off-Premises Operations Only - Owners, Lessees or
Contractors Automatic Status When Required in Construction Agreement With You
* Additional Insured - Employee Injury to Another Employee
* Automatically included -Aggregate Limits of Insurance (per location)
* Automatically included -Aggregate Limits of Insurance (per project)
* Knowledge of occurrence - Knowledge of an 'occurrence" "claim or suit' by your agent, servant or employee shall not
in itself constitute knowledge of the named insured unless an officer of the named insured has received such notice
from the agent, servant or employee.
* Blanket Waiver of Subrogation
* Liberalization Condition
* Unintentional failure to disclose all hazards. If you unintentionally fail to disclose any hazards existing at the inception
date of your policy, we will not deny coverage under this Coverage Form because of such failure. However. this
provision does not affect our right to collect additional premium or exercise our right of cancellation or non-renewal.
* "Insured Contract' redefined for Limited Railroad Contractual Liability
* Mobile equipment to include snow removal, road maintenance and street cleaning equipment less than 1,000 lbs GVW
* Bodily Injury Redefined
REFER TO THE ACTUAL ENDORSEMENT FOLLOWING ON PAGES 2 THROUGH 14 FOR CHANGES AFFECTING
YOUR INSURANCE PROTECTION
CG 72 08 02 15 Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 1 of 14
CG 72 08 02 15
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
TEXAS - EXTENDED ULTRA LIABILITY PLUS ENDORSEMENT
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
SECTION I - COVERAGES
A. The following changes are made at COVERAGE A- BODILY INJURY AND PROPERTY DAMAGE LIABILITY
1, Extended Property Damage
At 2. Exclusions exclusion a. Expected or Intended Injury is replaced with the following:
"Bodily injury" or"property damage" expected or intended from the standpoint of the insured. This exclusion does
not apply to "bodily injury" or"property damage" resulting from the use of reasonable force to protect persons or
property.
2. Expanded Fire Legal Liability
At 2. Exclusions the last paragraph is deleted and replaced by the following:
Exclusions c. through n. do not apply to damage by fire, explosion, lightning, smoke resulting from such fire,
explosion, or lightning or sprinkler leakage to premises while rented to you or temporarily occupied by you with
permission of this owner. A separate limit of insurance applies to this coverage as described in SECTION III -
LIMITS OF INSURANCE ,
3. Non-Owned Watercraft
At 2. Exclusions exclusion g. Aircraft, Auto Or Watercraft (2) (a) is deleted and replaced by the following:
(a) Less than 51 feet long;
4. Property Damage —Borrowed Equipment
At 2. Exclusions the following is added to paragraph (4) of exclusion J. Damage To Property
This exclusion does not apply to "property damage" to borrowed equipment while at a jobsite and while not being
used to perform operations. The most we will pay for "property damage" to any one piece of borrowed equipment
under this coverage is $25,000 per occurrence. The insurance afforded under this provision is excess over any
valid and collectible property insurance (including deductible) available to the insured, whether primary, excess,
contingent or on any other basis.
5. Property Damage Liability —Elevators
At 2. Exclusions the following is added to paragraphs (3), (4) and (6) of exclusion J. Damage To Property: This
exclusion does not apply to "property damage" resulting from the use of elevators. However any insurance
provided for such "property damage" is excess over any valid and collectible property insurance (including
deductible) available to the insured, whether primary, excess, contingent or on any other basis.
B. The following coverages are added:
1. COVERAGE D -VOLUNTARY PROPERTY DAMAGE COVERAGE
"Property damage" to property of others caused by the insured:
a. While in your possession; or
b. Arising out of"your work"
Coverage applies at the request of the insured, whether or not the insured is legally obligated to pay.
For the purposes of this Voluntary Property Damage Coverage only:
Exclusion j. Damage to Property is deleted and replaced by the following:
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CG 72 08 02 15
j. Damage to Property
"Property damage" to:
(1) Property held by the insured for servicing, repair, storage or sale at premises you own, rent, lease,
operate or use;
(2) Property transported by or damage caused by any "automobile", "watercraft" or"aircraft" you own, hire or
lease;
(3) Property you own, rent, lease, borrow or use.
The amount we will pay is limited as described below in SECTION III -LIMITS OF INSURANCE
For the purposes of this Voluntary Property Damage Coverage, our right and duty to defend ends when
we have paid the Limit of Liability or the Aggregate Limit for this coverage.
2. COVERAGE E-CARE, CUSTODY AND CONTROL PROPERTY DAMAGE COVERAGE
For the purpose of this Care, Custody and Control Property Damage Coverage only:
a. Item (4) of Exclusion j. does not apply.
The amount we will pay is limited as described below in SECTION III - LIMITS OF INSURANCE
For the purposes of this Care, Custody and Control Property Damage Coverage, our right and duty to
defend ends when we have paid the Limit of Liability or the Aggregate Limit for this coverage.
3. COVERAGE F - ELECTRONIC DATA LIABILITY COVERAGE
For the purposes of this Electronic Data Liability Coverage only:
a. Exclusion p. of Coverage A— Bodily Injury And Property Damage Liability in Section I — Coverages is
replaced by the following:
2. Exclusions
This insurance does not apply to:
p. Electronic Data
Damages arising out of the loss of, loss of use of, damage to, corruption of, inability to access, or
inability to manipulate "electronic data" that does not result from physical injury to tangible property.
However, this exclusion does not apply to liability for damages because of"bodily injury"
b. "Property Damage" means:
(1) Physical injury to tangible property, including all resulting loss of use of that property. All such loss of use
shall be deemed to occur at the time of the physical injury that caused it; or
(2) Loss of use of tangible property that is not physically injured. All such loss of use shall be deemed to
occur at the time of the "occurrence" that caused it; or
(3) Loss of, loss of use of, damage to, corruption of, inability to access or inability to properly manipulate
"electronic data", resulting from physical injury to tangible property. All such loss of"electronic data" shall
be deemed to occur at the time of the "occurrence" that caused it.
For the purposes of this Electronic Data Liability Coverage, "electronic data" is not tangible property.
The amount we will pay is limited as described below in SECTION III - LIMITS OF INSURANCE
4. COVERAGE G - PRODUCT RECALL EXPENSE
a. Insuring Agreement
(1) We will pay 90% of"product recall expense" you incur as a result of a "product recall' you initiate during
the coverage period.
(2) We will only pay for "product recall expense" arising out of "your products" which have been physically
relinquished to others.
The amount we will pay is limited as described below in SECTION III - LIMITS OF INSURANCE
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CG 72 08 02 15
b. Exclusions
This insurance does not apply to "product recall expense" arising out of:
(1) Any fact, circumstance or situation which existed at the inception date of the policy and which you were
aware of, or could reasonably have foreseen that would have resulted in a "product recall'.
(2) Deterioration, decomposition or transformation of a chemical nature, except if caused by an error in the
manufacture, design, processing, storage, or transportation of"your product'.
(3) The withdrawal of similar products or batches that are not defective, when a defect in another product or
batch has been found.
(4) Acts, errors or omissions of any of your employees, done with prior knowledge of any of your officers or
directors.
(5) Inherent vice, meaning a natural condition of property that causes it to deteriorate or become damaged.
(6) "Bodily Injury" or"Property Damage".
(7) Failure of"your product' to accomplish its intended purpose, including any breach of warranty of fitness,
quality, efficacy or efficiency, whether written or implied.
(8) Loss of reputation, customer faith or approval, or any costs incurred to regain customer market, or any
other consequential damages.
(9) Legal fees or expenses.
(10) Damages claimed for any loss, cost or expense incurred by you or others for the loss of use of "your
product"
(11) "Product recall expense" arising from the "product recall" of any of "your products" for which coverage is
excluded by endorsement.
(12) Any "product recall" initiated due to the expiration of the designated shelf life of"your product"
5. COVERAGE H -WATER DAMAGE LEGAL LIABILITY
The Insurance provided under Coverage H (Section 1) applies to "property damage" arising out of water damage
to premises that are both rented to and occupied by you.
The Limit under this coverage shall not be in addition to the Damage To Premises Rented To You Limit,
The amount we will pay is limited as described below in SECTION III - LIMITS OF INSURANCE.
6. COVERAGE I — DESIGNATED OPERATIONS COVERED BY A CONSOLIDATED (WRAP-UP) INSURANCE
PROGRAM
The following exclusion is added to Paragraph 2. Exclusions of SECTION I — COVERAGES COVERAGE A -
BODILY INJURY AND PROPERTY DAMAGE LIABILITY
r. This insurance does not apply to "bodily injury" or "property damage" arising out of either your ongoing
operations or operations included within the "products-completed operations hazard" for any "consolidated
(Wrap-up) insurance program" which has been provided by the prime contractor / project manager or owner
of the construction project in which you are involved.
This exclusion applies whether or not a consolidated (Wrap-up) insurance program:
a. Provides coverage identical to that provided by this Coverage Part; or
b. Has limits adequate to cover all claims.
This exclusion does not apply if a "consolidated (Wrap-up) insurance program" covering your operations has
been cancelled, non-renewed or otherwise no longer applies for reasons other than exhaustion of all
available limits, whether such limits are available on a primary, excess or on any other basis. You must
advise us of such cancellation, nonrenewal or termination as soon as practicable.
For purposes of this exclusion a "consolidated (wrap-up) insurance program" is a program providing
insurance coverage to all parties for exposures involved with a particular (typically major) construction
project.
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CG 72 08 0215
C. SUPPLEMENTARY PAYMENTS -COVERAGES A AND B is amended:
1 To read SUPPLEMENTARY PAYMENTS
2. Bail Bonds
Item 1.b. is amended as follows:
b. Up to $1,000 for cost of bail bonds required because of accidents or traffic law violations arising out of the
use of any vehicle to which the Bodily Injury Liability Coverage applies. We do not have to furnish these
bonds.
3. Loss of Earnings
Item 1.d. is amended as follows:
d. All reasonable expenses incurred by the insured at our request to assist us in the investigation or defense of
the claim or"suit", including actual loss of earnings up to $500 a day because of time off from work.
4. The following language is added to Item 1.
However, we shall have none of the duties set forth above when this insurance applies only for Voluntary
Property Damage Coverage and/or Care, Custody or Control Property Damage Coverage and we have paid
the Limit of Liability or the Aggregate Limit for these coverages.
SECTION II - WHO IS AN INSURED
A. The following change is made:
Extended Reporting Requirements
Item 3.a. is deleted and replaced by the following:
a. Coverage under this provision is afforded only until the 180th day after you acquire or form the organization or
the end of the policy period, whichever is earlier.
B. The following provisions are added:
4. BROAD FORM NAMED INSURED
Item 11 is added as follows:
f. Any legally incorporated entity of which you own more than 50 percent of the voting stock during the policy
period only if there is no other similar insurance available to that entity. However:
(1) Coverage A does not apply to "bodily injury" or "property damage" that occurred before you acquired
more than 50 percent of the voting stock; and
(2) Coverage B does not apply to "personal and advertising injury" arising out of an offense committed
before you acquired more than 50 percent of the voting stock.
5. Additional Insured - Owners, Lessees or Contractors - Automatic Status When Required in Construction
or Service Agreement With You
a. Any person or organization for whom you are performing operations when you and such person or
organization have agreed in writing in a contract or agreement that such person or organization be added as
an additional insured on your policy is an insured. Such person or organization is an additional insured only
with respect to your liability for "bodily injury", "property damage" or "personal and advertising injury" which
may be imputed to that person or organization directly arising out of:
1. Your acts or omissions; or
2. The acts or omissions of those acting on your behalf; in the performance of your ongoing operations for
the additional insured.
However, the insurance afforded to such additional insured:
1. Only applies to the extent permitted by law; and
2. Will not be broader than that which you are required by the contract or agreement to provide for such
additional insured.
b. With respect to the insurance afforded to these additional insureds, the following additional exclusions apply:
This insurance does not apply to:
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CG 72 08 02 15
1. "Bodily injury", "property damage" or "personal and advertising injury" arising out of the rendering of, or
the failure to render, any professional architectural, engineering or surveying services, including:
a. The preparing, approving, or failing to prepare or approve, maps, shop drawings, opinions, reports,
surveys, field orders, change orders or drawings and specifications; or
b. Supervisory, inspection, architectural or engineering activities.
This exclusion applies even if the claims against any insured allege negligence or other wrongdoing in the
supervision, hiring, employment, training or monitoring of others by that insured, if the "occurrence" which
caused the "bodily injury" or "property damage", or the offense which caused the "personal and advertising
injury", involved the rendering of or the failure to render any professional architectural, engineering or
surveying services.
2. "Bodily injury" or"property damage" occurring after:
a. All work, including materials, parts or equipment furnished in connection with such work, on the
project (other than service, maintenance or repairs) to be performed by or on behalf of the additional
insured(s) at the location of the covered operations has been completed; or
b. That portion of"your work" out of which the injury or damage arises has been put to its intended use
by any person or organization other than another contractor or subcontractor engaged in performing
operations for a principal as a part of the same project.
6. Additional Insured —Limited Products Completed Operations Coverage
a. Any person(s) or organization(s), but only with respect to your liability for "bodily injury" or "property
damage" which may be imputed to that person(s) or organization(s) directly arising out of "your work"
performed for that additional insured and included in the "products-completed operations hazard" is an
insured.
However:
(1) The insurance afforded to such additional insureds only applies to the extent permitted by law;
(2) If coverage provided to the additional insured is required by a contract or agreement, the insurance
afforded to such additional insured will not be broader than that which you are required by the contract or
agreement to provide for such additional insured.
(3) Coverage will cease five years from the completion of"your work" if:
(a) a timeframe is not stipulated in the written contract or written agreement; or
(b) a timeframe longer than 5 years is stipulated in the written contract or written agreement.
However if a lesser timeframe is stipulated in the written contract or written agreement then that time frame
will prevail.
b. With respect to the insurance afforded to any additional insured under this endorsement, the following
additional exclusionary language shall apply:
This insurance does not apply to "bodily injury" or "property damage" arising out of the rendering of, or the
failure to render, any professional architecture, engineering or surveying services, including:
(1) The preparing, approving, or failing to prepare or approve, maps, shop drawings, opinions, reports,
surveys, field orders, change orders or drawings and specifications; or
(2) Supervisory, inspection, architectural or engineering activities.
7. Additional Insured -Vendors
a. Any person(s) or organization(s) (referred to throughout this additional coverage as vendor), but only with
respect to "bodily injury" or "property damage", which may be imputed to that person(s) or organization(s)
arising out of "your products" shown with the Schedule which are distributed or sold in the regular course of
the vendor's business is an insured.
However:
(1) The insurance afforded to such vendor only applies to the extent permitted by law; and
(2) If coverage provided to the vendor is required by a contract or agreement, the insurance afforded to such
vendor will not be broader than that which you are required by the contract or agreement to provide for
such vendor.
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CG 72 08 02 15
b. With respect to the insurance afforded to these vendors, the following additional exclusions apply:
(1) This insurance afforded the vendor does not apply to:
(a) "Bodily injury" or "property damage" for which the vendor is obligated to pay damages by reason of
the assumption of liability in a contract or agreement. This exclusion does not apply to liability for
damages that the vendor would have in the absence of the contract or agreement;
(b) Any express warranty unauthorized by you;
(c) Any physical or chemical change in the product made intentionally by the vendor;
(d) Repackaging, except when unpacked solely for the purpose of inspection, demonstration, testing, or
the substitution of parts under instructions from the manufacturer, and then repackaged in the
original container.
(e) Any failure to make such inspections, adjustments, tests or servicing as the vendor has agreed to
make or normally undertakes to make in the usual course of business, in connection with the
distribution or sale of products.
(f) Demonstration, installation, servicing or repair operations, except such operations performed at the
vendor's premises in connection with the sale of the product.
(g) Products which, after distribution or sale by you, have been labeled or relabeled or used as a
container, part or ingredient of any other thing or substance by or for the vendor
(h) "Bodily injury" or "property damage" arising out of the sole negligence of the vendor for its own acts
or omissions or those of its employees or anyone else acting on its behalf. However, this exclusion
does not apply to:
i. The exceptions contained in Sub-paragraphs d. or f.; or
fl. Such inspections, adjustments, tests or servicing as the vendor has agreed to make or normally
undertakes to make in the usual course of business, in connection with the distribution or sale of
the products.
(2) This insurance does not apply to any insured person or organization, from whom you have acquired such
products, or any ingredient, part or container, entering into, accompanying or containing such products.
8. Additional Insured — Lessor of Leased Equipment — Automatic Status When Required in Lease
Agreement With You
a. Any person(s) or organization(s) from whom you lease equipment when you and such person(s) or
organization(s) have agreed in writing in a contract or agreement that such person(s) or organization(s) be
added as an additional insured on your policy. Such person(s) or organization(s) is an insured only with
respect to your liability for "bodily injury", "property damage" or "personal and advertising injury" directly
arising out of the maintenance, operation or use of equipment leased to you, which may be imputed to such
person or organization as the lessor of equipment.
However, the insurance afforded to such additional insured:
(1) Only applies to the extent permitted by law; and
(2) Will not be broader than that which you are required by the contract or agreement to provide for such
additional insured.
A person's or organization's status as an additional insured under this endorsement ends when their contract
or agreement with you for such leased equipment ends.
b. With respect to the insurance afforded to these additional insureds, this insurance does not apply to any
"occurrence" which takes place after the equipment lease expires.
9. Additional Insured —Managers or Lessors of Premises
a. Any person(s) or organization(s), but only with respect to liability arising out of the ownership, maintenance or
use of that part of the premises leased to you and subject to the following additional exclusions:
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CG 72 08 02 15
This insurance does not apply to:
(1) Any "occurrence" which takes place after you cease to be a tenant in that premises.
(2) Structural alterations, new construction or demolition operations performed by or on behalf of the
person(s) or organization(s) afforded coverage by this additional coverage.
However:
(1) The insurance afforded to such additional insured only applies to the extent permitted by law; and
(2) If coverage provided to the additional insured is required by a contract or agreement, the insurance
afforded to such additional insured will not be broader than that which you are required by the contract or
agreement to provide for such additional insured.
10. Additional Insured - Engineers, Architects or Surveyors Not Engaged by the Named Insured
a. Any architects, engineers or surveyors who are not engaged by you are insureds, but only with respect to
liability for "bodily injury" or"property damage" or"personal and advertising injury" which may be imputed to
that architect, engineer or surveyor arising out of:
(1) Your acts or omissions; or
(2) Your acts or omissions of those acting on your behalf; in the performance of your ongoing operations
performed by you or on your behalf.
But only if such architects, engineers or surveyors, while not engaged by you, are contractually required to be
added as an additional insured to your policy.
However, the insurance afforded to such additional insured:
(1) Only applies to the extent permitted by law; and
(2) Will not be broader than that which you are required by the contract or agreement to provide for such
additional insured.
b. With respect to the insurance afforded to these additional insureds, the following additional exclusion applies:
This insurance does not apply to 'bodily injury" "property damage" or "personal and advertising injury"
arising out of the rendering of or failure to render any professional services, including:
(1) The preparing, approving, or failing to prepare or approve, maps, drawings, opinions, reports, surveys,
change orders, designs or specifications; or
(2) Supervisory, inspection or engineering services.
This exclusion applies even if the claims against any insured allege negligence or other wrongdoing in the
supervision, hiring, employment, training or monitoring of others by that insured, if the "occurrence" which
caused the "bodily injury" or "property damage" or the offense which caused the "personal and advertising
injury", involved the rendering of or the failure to render any professional services.
11. Additional Insured - State or Governmental Agency or Subdivision or Political Subdivision - Permits
or Authorizations
Any state or governmental agency or subdivision or political subdivision is an insured, subject to the following
provisions:
a. This insurance applies only with respect to operations performed by you or on your behalf for which the state
or governmental agency or subdivision or political subdivision has issued a permit or authorization.
However:
(1) The insurance afforded to such additional insured only applies to the extent permitted by law; and
(2) If coverage provided to the additional insured is required by a contract or agreement, the insurance
afforded to such additional insured will not be broader than that which you are required by the contract or
agreement to provide for such additional insured.
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CO 72 08 02 15
b. This insurance does not apply to:
(1) "Bodily injury", "property damage" or "personal and advertising injury" arising out of operations
performed for the federal government, state or municipality; or
(2) "Bodily injury" or"property damage" included within the "products-completed operations hazard".
12. Additional Insured Consolidated Insurance Program (Wrap-Up) Off-Premises Operations Only - Owners,
Lessees or Contractors
a. Any persons or organizations for whom you are performing operations, for which you have elected to seek
coverage under a Consolidated Insurance Program, when you and such person or organization have agreed
in writing in a contract or agreement that such person or organization be added as an additional insured on
your policy is an insured. Such person or organization is an additional insured only with respect to your
liability which may be imputed to that person or organization directly arising out of your ongoing operations
performed for that person or organization at a premises other than any project or location that is designated
as covered under a Consolidated Insurance Program. A person's or organization's status as an insured under
this endorsement ends when your operations for that insured are completed.
b. With respect to the insurance afforded to these additional insureds, the following additional exclusion applies.
This insurance does not apply to:
"Bodily injury", "property damage", or "personal and advertising injury" arising out of the rendering of, or
failure to render, any professional architectural, engineering or surveying services, including:
(1) The preparing, approving, or failing to prepare or approve, maps, shop drawings, opinions, reports,
surveys, field orders, change orders or drawings and specifications; and
(2) Supervisory, inspection
13. Additional Insured - Employee Injury to Another Employee
With respect to your"employees" who occupy positions which are supervisory in nature:
Paragraph 2.a.(1) of SECTION II —WHO IS A NAMED INSURED is amended to read:
a. "Bodily injury" or"personal and advertising injury"
(1) To you, to your partners or members (if you are a partnership or joint venture), or to your members (if
you are a limited liability company);
(2) For which there is any obligation to share damages with or repay someone else who must pay damages
because of the injury described in paragraph (1)(a) above; or
(3) Arising out of his or her providing or failing to provide professional healthcare services. Paragraph 3.a. is
deleted.
For the purpose of this Item 13 only, a position is deemed to be supervisory in nature if that person performs
principle work which is substantially different from that of his or her subordinates and has authority to hire,
direct, discipline or discharge.
SECTION III - LIMITS OF INSURANCE
A. The following Items are deleted and replaced by the following:
2. The General Aggregate Limit is the most we will pay for the sum of.
a. Medical expenses under Coverage C;
b. Damages under Coverage A, except damages because of "bodily injury" or "property damage" included in
the "products-completed operations hazard"; and
c. Damages under Coverage B; and
d. Damages under Coverage H.
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3. The Products-Completed Operations Aggregate Limit is the most we will pay under Coverage A for damages
because of "bodily injury" and "property damage" included in the "products-completed operations hazard" and
Coverage G.
6. Subject to 5. above, the Damage to Premises Rented to You Limit is the most we will pay under Coverage A for
damages because of "property damage" to any one premises, while rented to you, or in the case of damage by
fire, explosion, lightning, smoke resulting from such fire, explosion, or lightning or sprinkler leakage while rented
to you or temporarily occupied by you with permission of the owner
B. The following are added:
8. Subject to Paragraph 5. of SECTION III — LIMITS OF INSURANCE $25,000 is the most we will pay under
Coverage H for Water Damage Legal Liability.
9. Coverage G - Product Recall Expense
Aggregate Limit $50,000
Each Product Recall Limit $25,000
a. The Aggregate Limit shown above is the most we will pay for the sum of all "product recall expense" you
incur as a result of all "product recalls" you initiate during the endorsement period.
b. The Each Product Recall Limit shown above is the most we will pay, subject to the Aggregate and $1,000
deductible, for "product recall expense" you incur for any one "product recall" you initiate during the
endorsement period.
We will only pay for the amount of Product Recall Expenses which are in excess of the deductible amount. The
deductible applies separately to each Product Recall. The limits of insurance will not be reduced by the amount
of this deductible.
We may, or will if required by law, pay all or any part of any deductible amount. Upon notice of our payment of a
deductible amount, you shall promptly reimburse us for the part of the deductible amount we paid.
10. Aggregate Limits of Insurance (Per Location)
The General Aggregate Limit applies separately to each of your 'locations" owned by or rented to you or
temporarily occupied by you with the permission of the owner.
"Location" means premises involving the same or connecting lots, or premises whose connection is interrupted
only by a street, roadway, waterway or right-of-way of a railroad.
11. Aggregate Limits of Insurance (Per Project)
The General Aggregate Limit applies separately to each of your projects away from premises owned by or rented
to you.
12. With respects to the insurance afforded to additional insureds afforded coverage by items 5 through 13 of
SECTION II —WHO IS AN INSURED above, the following is added:
The most we will pay on behalf of the additional insured is the amount of insurance:
a. Required by the contract or agreement;
b. Available under the applicable Limits of Insurance shown in the Declarations;
Whichever is less.
This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations.
13. Subject to 5. of SECTION III — LIMITS OF INSURANCE a $5,000 'occurrence" limit and a $10,000 "aggregate"
limit is the most we will pay under Coverage A for damages because of "property damage" covered under
Coverage D-Voluntary Property Damage Coverage
For the purposes of this Voluntary Property Damage Coverage, our right and duty to defend ends when
we have paid the Limit of Liability or the Aggregate Limit for this coverage.
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14. Subject to 5. of SECTION III - LIMITS OF INSURANCE, a $25,000 'occurrence" limit and a $100,000
"aggregate" limit is the most we will pay under Coverage E - Care, Custody and Control Coverage regardless
of the number of:
a. Insureds;
b. Claims made or"suits" brought; or
c. Persons or organizations making claims or bringing "suits".
Deductible - Our obligation to pay damages on your behalf applies only to the amount of damages in excess of
$500.
This deductible applies to all damages because of "property damage" as the result of any one 'occurrence"
regardless of the number of persons or organizations who sustain damages because of that 'occurrence".
We may pay any part or all of the deductible amount to effect settlement of any claim or "suit" and upon
notification of the action taken, you shall promptly reimburse us for such part of the deductible amount as has
been paid by us.
As respects this coverage "Aggregate" is the maximum amount we will pay for all covered 'occurrences" during
one policy period.
For the purposes of this Care, Custody and Control Property Damage Coverage, our right and duty to
defend ends when we have paid the Limit of Liability or the Aggregate Limit for this coverage.
15. Subject to 5. of SECTION III - LIMITS OF INSURANCE, the most we will pay for "property damage" under
Coverage F - Electronic Data Liability Coverage for loss of "electronic data" is $50,000 without regard to the
number of"occurrences"
SECTION IV - COMMERCIAL GENERAL LIABILITY CONDITIONS
A. The following conditions are amended:
1. Knowledge of Occurrence
a. Condition 2., Items a. and b. are deleted and replaced by the following:
(1) Duties In The Event Of Occurrence, Offense, Claim Or Suit
(a) You must see to it that we are notified as soon as practicable of an 'occurrence" or an offense which
may result in a claim. Knowledge of an 'occurrence" by your agent, servant or employee shall not in
itself constitute knowledge of the named insured unless an officer of the named insured has received
such notice from the agent, servant or employee. To the extent possible, notice should include:
I. How, when and where the 'occurrence" took place;
fl. The names and addresses of any injured persons and witnesses, and
iii. The nature and location of any injury or damage arising out of the 'occurrence" or offense .
(b) If a claim is made or"suit' is brought against any insured, you must:
i. Immediately record the specifics of the claim or"suit" and the date received; and
!I. Notify us as soon as practicable.
You must see to it that we receive written notice of the claim or"suit' as soon as practicable. Knowledge
of a claim or "suit' by your agent, servant or employee shall not in itself constitute knowledge of the
named insured unless an officer of the named insured has received such notice from the agent, servant
or employee.
2. Where Broad Form Named Insured is added in SECTION II — WHO IS AN INSURED of this endorsement,
Condition 4. Other Insurance b. Excess Insurance (1).(a) is replaced by the following:
(a) Any of the other insurance, whether primary, excess, contingent or on any other basis, that is available to an
insured solely by reason of ownership by you of more than 50 percent of the voting stock, and not
withstanding any other language in any other policy. This provision does not apply to a policy written to apply
specifically in excess of this policy.
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B. The following are added:
1. Condition (5) of 2.c.
(5) Upon our request, replace or repair the property covered under Voluntary Property Damage Coverage at
your actual cost, excluding profit or overhead.
10. Blanket Waiver Of Subrogation
We waive any right of recovery we may have against any person or organization because of payments we make
for injury or damage arising out of: premises owned or occupied by or rented or loaned to you, ongoing
operations performed by you or on your behalf, done under a contract with that person or organization, "your
work" or "your products" We waive this right where you have agreed to do so as part of a written contract,
executed by you before the "bodily injury" or "property damage" occurs or the "personal injury" or "advertising
injury" offense is committed.
11. Liberalization
If a revision to this Coverage Part, which would provide more coverage with no additional premium becomes
effective during the policy period in the state designated for the first Named Insured shown in the Declarations,
your policy will automatically provide this additional coverage on the effective date of the revision.
12. Unintentional Failure to Disclose All Hazards
Based on our reliance on your representations as to existing hazards, if you unintentionally should fail to disclose
all such hazards at the inception date of your policy, we will not deny coverage under this Coverage Part
because of such failure. However this provision does not affect our right to collect additional premium or
exercise our right of cancellation or non-renewal.
13. The following conditions are added in regard to Coverage G - Product Recall Expense
In event of a "product recall" you must
a. See to it that we are notified as soon as practicable of a "product recall", To the extent possible, notice
should include how, when and where the "product recall' took place and estimated "product recall expense
b. Take all reasonable steps to minimize "product recall expense" This will not increase the limits of insurance.
c. If requested, permit us to question you under oath at such times as may be reasonably required about any
matter relating to this insurance or your claim, including your books and records. Your answers must be
signed.
d. Permit us to inspect and obtain other information proving the loss. You must send us a signed, sworn
statement of loss containing the information we request to investigate the claim. You must do this within 60
days after our request.
e. Cooperate with us in the investigation or settlement of any claim.
f. Assist us upon our request, in the enforcement of any rights against any person or organization which may be
liable to you because of loss to which this insurance applies.
g. Claims Handling
(1) Within 15 days after we receive written notice of claim, we will:
(a) Acknowledge receipt of the claim. If we do not acknowledge receipt of the claim in writing, we will
keep a record of the date, method and content of the acknowledgment;
(b) Begin any investigation of the claim; and
(c) Request a signed, sworn proof of loss, specify the information you must provide and supply you with
the necessary forms. We may request more information at a later date, if during the investigation of
the claim such additional information is necessary.
(2) We will notify you in writing as to whether:
(a) The claim or part of the claim will be paid;
(b) The claim or part of the claim has been denied, and inform you of the reasons for denial;
(c) More information is necessary; or
(d) We need additional time to reach a decision. If we need additional time, we will inform you of the
reasons for such need.
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(3) We will provide notification, as described in (2)(a) through (2)(d) above, within:
(a) 15 business days after we receive the signed, sworn proof of loss and all information we requested;
or
(b) 30 days after we receive the signed, sworn proof of loss and all information we requested, if we have
reason to believe the loss resulted from arson.
If we have notified you that we need additional time to reach a decision, we must then either approve or deny
the claim within 45 days of such notice.
h. We will pay for covered loss or damage within 5 business days after:
(1) We have notified you that payment of the claim or part of the claim will be made and have reached
agreement with you on the amount of loss; or
(2) An appraisal award has been made.
However, if payment of the claim or part of the claim is conditioned on your compliance with any of the terms
of this policy, we will make payment within 5 business days after the date you have complied with such
terms.
i. Catastrophe Claims
If a claim results from a weather related catastrophe or a major natural disaster, the claim handling and claim
payment deadlines described in a. and b. above are extended for an additional 15 days. Catastrophe or
Major Natural Disaster means a weather related event which is:
(1) Declared a disaster under the Texas Disaster Act of 1975; or
(2) Determined to be a catastrophe by the State Board of Insurance.
j. The term "business day", as used in this endorsement, means a day other than Saturday, Sunday or a
holiday recognized by the state of Texas.
k. We will issue loss payment to the first Named Insured shown in the Declarations and any mortgagee or loss
payee as designated.
14. Limited Railroad Contractual Liability
The following conditions are applicable only to coverage afforded by reason of the redefining of an "insured
contract' in the DEFINITIONS section of this endorsement:
a. Railroad Protective Liability coverage provided by ISO form CG 0035 with minimum limits of$2,000,000 per
occurrence and a$6,000,000 general aggregate limit must be in place for the entire duration of any project.
b. Any amendment to the Other Insurance condition of form CG 0035 alters the primacy of the coverage or
which impairs our right to contribution will rescind any coverage afforded by the redefined "insured contract"
language.
c. For the purposes of the Other Insurance condition of form CG 0035 you, the named insured, will be deemed
to be the designated contractor.
SECTION V - DEFINITIONS
A. At item 12. Mobile Equipment the wording at f.(1) is deleted and replaced by the following:
E(1) Equipment designed primarily for:
(a) Snow removal;
(b) Road maintenance, but not construction or resurfacing; or
(c) Street cleaning;
except for such vehicles that have a gross vehicle weight less than 1,000 lbs which are not designed for highway
use.
B. Item 3. "bodily injury" is deleted and replaced with the following:
3. "Bodily injury" means physical injury, sickness or disease sustained by a person. This includes mental anguish,
mental injury, shock, fright or death that results from such physical injury, sickness or disease.
C. Item 9. "Insured Contract' c. is deleted and replaced with the following:
c. Any easement or license agreement;
D. Item 9. "Insured Contract' f.(1) is deleted
E. The following definitions are added for this endorsement only:
23. "Electronic data" means information, facts or programs stored as or on, created or used on, or transmitted to or
from computer software, including systems and applications software, hard or floppy disks, CD-ROMS, tape
drives, cells, data processing devices or any other media which are used with electronically controlled
equipment.
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24. "Product recall" means a withdrawal or removal from the market of"your product" based on the determination
by you or any regulatory or governmental agency that:
a. The use or consumption of "your product" has caused or will cause actual or alleged "bodily injury" or
"property damage"; and
b. Such determination requires you to recover possession or control of "your product" from any distributor,
purchaser or user, to repair or replace "your product", but only if "your product" is unfit for use or
consumption, or is hazardous as a result of:
(1) An error or omission by an insured in the design, manufacturing, processing, labeling, storage, or
transportation of"your product"; or
(2) Actual or alleged intentional, malicious or wrongful alteration or contamination of "your product" by
someone other than you.
25. "Product recall expense" means reasonable and necessary expenses for:
a. Telephone, radio and television communication and printed advertisements, including stationery, envelopes
and postage.
b. Transporting recalled products from any purchaser, distributor or user, to locations designated by you.
c. Remuneration paid to your employees for overtime, as well as remuneration paid to additional employees or
independent contractors you hire.
d. Transportation and accommodation expense incurred by your employees.
e. Rental expense incurred for temporary locations used to store recalled products.
f. Expense incurred to properly dispose of recalled products, including packaging that cannot be reused.
g. Transportation expenses incurred to replace recalled products.
h. Repairing, redistributing or replacing covered recalled products with like products or substitutes, not to
exceed your original cost of manufacturing, processing, acquisition and/or distribution.
These expenses must be incurred as a result of a "product recall".
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COMMERCIAL AUTO
CA 71 09 01 17
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
BUSINESS AUTO ULTRA ENDORSEMENT
This endorsement modifies insurance provided under the following:
BUSINESS AUTO COVERAGE FORM
COMMON POLICY CONDITIONS
COVERAGE INDEX
DESCRIPTION PAGE
Temporary Substitute Auto Physical Damage 2
Broad Form Insured 2
Employee as Insureds 2
Additional Insured Status by Contract, Agreement or Permit 2
Bail Bond Coverage 3
Loss of Earnings Coverage 3
Amended Fellow Employee Coverage 3
Towing and Labor 3
Physical Damage Additional Transportation Expense Coverage 3
Extra Expense - Theft 3
Rental Reimbursement and Additional Transportation Expense 4
Personal Effects Coverage 4
Personal Property of Others 4
Locksmith Coverage 4
Vehicle Wrap Coverage 5
Airbag Accidental Discharge 5
Audio, Visual and Data Electronic Equipment Coverage 5
Auto Loan/Lease Total Loss Protection 5
Glass Repair —Deductible Amendment 5
Amended Duties in the Event of Accident, Claim, Suit or Loss 6
Waiver of Subrogation Required by Contract 6
Unintentional Failure to Disclose 6
Hired, Leased, Rented or Borrowed Auto Physical Damage 6
Mental Anguish 7
Extended Cancellation Condition 7
The COVERAGE INDEX set forth above is informational only and grants no coverage.
Terms set forth in (Bold Italics) are likewise for information only and by themselves shall be deemed to grant no
coverage.
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(Temporary Substitute Auto Physical Damage)
A. TEMPORARY SUBSTITUTE AUTO PHYSICAL DAMAGE
SECTION I — COVERED AUTOS, paragraph C. Certain Trailers, Mobile Equipment and Temporary Substitute
Autos is amended by adding the following at the end of the existing language:
If Physical Damage Coverage is provided under this Coverage form for an "auto" you own, the Physical Damage
coverages provided for that owned "auto" are extended to any "auto" you do not own while used with the permission of its
owner as a temporary substitute for the covered "auto" you own that is out of service because of its breakdown, repair,
servicing, 'loss", or destruction
B. BROADENED LIABILITY COVERAGES
SECTION II — LIABILITY COVERAGE in Paragraph A. Coverage at 1. Who Is An Insured is amended to include the
following:
(Broad Form Insured)
d. Any legally incorporated subsidiary in which you own more than 50% of the voting stock on the effective date
of the Coverage Form. However, the Named Insured does not include any subsidiary that is an "insured"
under any other automobile policy or would be an "insured" under such a policy but for its termination or the
exhaustion of its Limit of Insurance.
e. Any organization that is acquired or formed by you, during the term of this policy and over which you
maintain majority ownership. However, the Named Insured does not include any newly formed or acquired
organization:
(1) That is a joint venture or partnership,
(2) That is an "insured" under any other policy,
(3) That has exhausted its Limits of Insurance under any other policy, or
(4) 180 days or more after its acquisition or formation by you, unless you have given us notice of the
acquisition or formation
Coverage does not apply to "bodily injury" or "property damage" that results from an accident that occurred
before you formed or acquired the organization.
(Employee as Insureds)
f. Any employee of yours while acting in the course of your business or your personal affairs while using a
covered "auto" you do not own, hire or borrow.
(Additional Insured Status by Contract,Agreement or Permit)
g. Any person or organization whom you are required to add as an additional insured on this policy under a
written contract or agreement; but the written contract or agreement must be:
(1) Currently in effect or becoming effective during the term of this policy; and
(2) Executed prior to the "bodily injury" or"property damage."
The additional insured status will apply only with respect to your liability for "bodily injury" or "property
damage" which may be imputed to that person(s) or organization(s) directly arising out of the ownership,
maintenance or use of the covered "autos" at the location(s) designated, if any.
Coverage provided by this endorsement will not exceed the limits of liability required by the written contract
or written agreement even if the limits of liability stated in the policy exceed those limits. This endorsement
shall not increase the limits stated in Section ll. C. Limits of Insurance.
For any covered "auto" you own this Coverage Form provides primary coverage.
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C. BROADENED SUPPLEMENTARY PAYMENTS
SECTION II. LIABILITY A. Coverage 2. Coverage Extensions a. Supplementary Payments (2) and (4) are replaced
by the following:
(Bail Bond Coverage)
(2) Up to $5,000 for cost of bail bonds (including bonds for related traffic violations) required because of an
"accident" we cover We do not have to furnish these bonds.
(Loss of Earnings Coverage)
(4) All reasonable expenses incurred by the "insured" at our request, including actual loss of eaming up to $500 a
day because of time off from work.
(Amended Fellow Employee Exclusion)
D. AMENDED FELLOW EMPLOYEE EXCLUSION
Only with respect to your "employees" who occupy positions which are supervisory in nature, SECTION II. LIABILITY B.
Exclusion 5. Fellow Employee is replaced by:
5. Fellow Employee
"Bodily Injury":
a. To you, or your partners or members (if you are a partnership or joint venture), or to your members (if you
are a limited liability company);
b. To your "executive officers" and directors (if you are an organization other than a partnership, joint venture,
or limited liability company) but only with respect to performance of their duties as your officers or directors;
c. For which there is an obligation to share damages with or repay someone else who must pay damages
because of the injury described in paragraph a and b above; or
d. Arising out of his or her providing or failing to provide professional health care services.
For purposes of this endorsement, a position is deemed to be supervisory in nature if that person performs
principle work which is substantially different from that of his or her subordinates and has authority to hire,
transfer direct, discipline or discharge.
E. BROADENED PHYSICAL DAMAGE COVERAGES
SECTION III —PHYSICAL DAMAGE COVERAGE A.Coverage is amended as follows:
(rowing and Labor)
2. Towing is deleted and replaced with the following:
2. Towing and Labor
We will pay towing and labor costs incurred, up to the limits shown below, each time a covered "auto" is disabled:
a. For private passenger type vehicles we will pay up to $100 per disablement.
b. For all other covered "auto's" we will pay up to$500 per disablement
However the labor must be performed at the place of disablement.
(Physical Damage Additional Transportation Expense Coverage)
4. Coverage Extensions
a. Transportation Expenses is amended to provide the following limits:
We will pay up to $60 per day to a maximum of$1,800. All other terms and provisions of this section remain
applicable.
The following language is added to 4. Coverage Extensions:
(Extra Expense—Theft)
c. Theft Recovery Expense
If you have purchased Comprehensive Coverage on an "auto" that is stolen, we will pay the expense of
returning that stolen auto to you. The limit for this coverage extension is$5,000.
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(Rental Reimbursement and Additional Transportation Expense)
d. Rental Reimbursement
We will provide Rental Reimbursement and Additional Expense coverage only for those Physical Damage
coverages for which a premium is shown in the Declarations or schedule pages. Coverage applies only to a
covered "auto"
(1) We will pay for auto rental expense and the expense incurred by you because of "loss" to remove and
transfer your materials and equipment from a covered "auto" to a covered "auto." Payment applies in
addition to the otherwise applicable coverage you have on a covered "auto." No deductible applies to this
coverage.
(2) We will pay only for expenses incurred during the policy period and beginning 24 hours after the "loss"
and ending, regardless of the policy's expiration, with the lesser of the following number of days:
(a) The number of days reasonably required to repair or replace the covered "auto." If "loss" is caused
by theft, this number of days is added to the number of days it takes to locate the covered "auto" and
return it to you, or
(b) 30 days.
(3) Our payment is limited to the lesser of the following amounts:
(a) Necessary and actual expenses incurred; or
(b) $75 per day.
(c) This coverage does not apply while there are spare or reserve "autos" available to you for your
operations.
(d) If"loss" results from the total theft of a covered "auto" of the private passenger or light truck type, we
will pay under this coverage only that amount of your rental reimbursement expense which is not
already provided for under the SECTION III — PHYSICAL DAMAGE COVERAGE, A. Coverage, 4.
Coverage Extensions, a. Transportation Expenses.
(Personal Effects Coverage)
e. Personal Effects
If you have purchased Comprehensive Coverage on this policy for an "auto" you own and that "auto" is
stolen, we will pay, without application of a deductible, up to $500 for Personal Effects stolen with the "auto"
The insurance provided under this provision is excess over any other collectible insurance. For this coverage
extension, Personal Effects means tangible property that is worn or carried by an "insured"
(Personal Property of Others)
f. Personal Property of Others
We will pay up to $500 for loss to personal property of others in or on your covered "auto." This coverage
applies only in the event of "loss" to your covered "auto" caused by fire, lightning, explosion, theft, mischief
or vandalism, the covered "auto's" collision with another object, or the covered "auto's" overturn. No
deductibles apply to this coverage.
(Locksmith Coverage)
g. Locksmith Coverage
We will pay up to $250 per occurrence for necessary locksmith services for keys locked inside a covered
private passenger "auto" The deductible is waived for these services.
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(Vehicle Wrap Coverage)
h. Vehicle Wrap Coverage
If you have Comprehensive or Collision coverage on an "auto" that is a total loss, in addition to the actual
cash value of the "auto", we will pay up to$1,000 for vinyl vehicle wraps which are displayed on the covered
"auto" at the time of total loss. Regardless of the number of autos deemed a total loss, the most we will pay
under this Vehicle Wrap Coverage for any one 'loss" is $5,000. For purposes of this coverage provision,
signs or other graphics painted or magnetically affixed to the vehicle are not considered vehicle wraps.
(Airbag Accidental Discharge)
F. SECTION III — PHYSICAL DAMAGE COVERAGE, B. Exclusions is amended at 3. to include the following
language:
If you have purchased Comprehensive or Collision Coverage under this policy, this exclusion does not apply to
mechanical breakdown relating to the accidental discharge of an air bag. This coverage applies only to a covered
auto you own and is excess of any other collectible insurance or warranty. No deductible applies to this coverage.
G. BROADENED LIMITS OF INSURANCE
(Audio, Visual and Data Electronic Equipment Coverage)
SECTION III — PHYSICAL DAMAGE COVERAGE — C. Limit of Insurance at 1.b. is amended to provide the following
llmr ts:
b. Limits of $1,000 per "loss" is increased to $5,000 per 'loss" All other terms and provisions of this section
remain applicable.
(Auto Loan/Lease Total Loss Protection)
SECTION III — PHYSICAL DAMAGE COVERAGE — C. Limit of Insurance is amended by adding the following
language:
4. In the event of a total 'loss" to a covered "auto" shown in the Schedule pages, subject at the time of the "loss" to
a loan or lease, we will pay any unpaid amount due including up to a maximum of$500 for early termination fees
or penalties on the lease or loan for a covered"auto" less:
a. The amount paid under the Physical Damage Coverage Section of the policy; and
b. Any:
(1) Overdue lease loan payments at the time of the "loss";
(2) Financial penalties imposed under a lease for excessive use, abnormal wear and tear or high mileage;
(3) Security deposits not returned by the lessor;
(4) Costs for extended warranties, Credit Life Insurance, Health, Accident or Disability Insurance purchased
with the loan or lease; and
(5) Cary-over balances from previous loans or leases.
(Glass Repair—Deductible Amendment)
H. GLASS REPAIR — DEDUCTIBLE
SECTION III —PHYSICAL DAMAGE COVERAGE —D. Deductible is amended by adding the following:
Any deductible shown in the Declarations as applicable to the covered "auto" will not apply to glass breakage if the
damaged glass is repaired, rather than replaced.
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(Amended Duties in the Event of Accident, Claim, Suit or Loss)
I. AMENDED DUTIES IN THE EVENT OF ACCIDENT„ CLAIM, SUIT OR LOSS
Under SECTION IV — BUSINESS AUTO CONDITIONS, A. Loss Conditions , the following is added to paragraph 2.
Duties In The Event of Accident, Suit or Loss:
d. Knowledge of any "accident". "claim", "suit" or "loss" will be deemed knowledge by you when notice of such
"accident", "claim" "suit" or"loss" has been received by:
(1) You, if you are an individual;
(2) Any partner or insurance manager if you are a partnership;
(3) An executive officer or insurance manager, if you are a corporation;
(4) Your members, managers or insurance manager, if you are a limited liability company; or
(5) Your officials, trustees, board members or insurance manager, if you are a not-for-profit organization.
(Waiver of Subrogation by Contract)
J. WAIVER OF SUBROGATION REQUIRED BY CONTRACT
Under SECTION IV BUSINESS AUTO CONDITIONS, A. Loss Conditions 5. Transfer of Rights of Recovery
Against Others to Us the following language is added:
However we waive any rights of recovery we may have against the person or organization with whom you have
agreed in writing in a contract, agreement or permit, to provide insurance such as is afforded under the policy to
which this endorsement is attached. This provision does not apply unless the written contract or written agreement
has been executed, or permit has been issued, prior to the "bodily injury" or"property damage."
(Unintentional Failure to Disclose)
K. UNINTENTIONAL FAILURE TO DISCLOSE
Under SECTION IV — BUSINESS AUTO CONDITIONS, B. General Conditions the following is added to 2.
Concealment, Misrepresentation Or Fraud
Your unintentional error in disclosing, or failing to disclose, any material fact existing at the effective date of this
Coverage Form, or during the policy period in connection with any additional hazards, will not prejudice your rights
under this Coverage Form.
(Hired, Leased, Rented or Borrowed Auto Physical Damage)
L. HIRED, LEASED, RENTED OR BORROWED AUTO PHYSICAL DAMAGE
Under SECTION IV — BUSINESS AUTO CONDITIONS B. General Conditions S. Other Insurance Paragraph 5.b. is
replaced by the following:
b. (1) For "Comprehensive" and "Collision" Auto Physical Damage coverage provided by this endorsement, the
following are deemed to be covered "autos" you own:
(a) Any Covered "auto" you lease, hire, rent or borrow; and
(b) Any Covered "auto" hired or rented by your "employee" under a contract in that individual
"employee's" name, with your permission, while performing duties related to the conduct of your
business.
However any "auto" that is leased, hired, rented or borrowed with a driver is not a covered "auto"
(2) Limit of Insurance For This Section
The most we will pay for any one "loss" is the lesser of the following:
(a) $75,000 per accident, or
(b) actual cash value at the time of loss, or
(c) cost of repair.
Page 6 of 7 Includes copyrighted material of Insurance Services Office, Inc., with its permission. CA 71 09 01 17
Minus a $500 deductible. An adjustment for depreciation and physical condition will be made in
determining actual cash value in the event of a total loss. No deductible applies to "loss" caused by fire
or lightning.
(3) This Hired Auto Physical Damage coverage is excess over any other collectible insurance.
(4) Definitions For This Section
(a) Comprehensive Coverage: from any cause except the covered "auto's" collision with another object
or the covered "auto's" overtum. We will pay glass breakage, "loss" caused by hitting a bird or animal
and, "loss" caused by falling objects or missiles.
(b) Collision Coverage: caused by the covered "auto's" collision with another object or by the covered
"auto's" overturn.
(Mental Anguish)
M. MENTAL ANGUISH
Under SECTION V—DEFINITIONS, C. is replaced by the following:
C. "Bodily injury" means bodily injury, sickness or disease sustained by a person including mental anguish or death
resulting from bodily injury, sickness, or disease.
(Extended Cancellation Condition)
N. EXTENDED CANCELLATION CONDITION
Under CANCELLATION, of the COMMON POLICY CONDITIONS form, item 2.b. is replaced by the following:
b. 60 days before the effective date of cancellation if we cancel for any other reason.
CA 71 09 01 17 Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 7 of 7
Policy #85316434 CA 73 34 09 15
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
PRIMARY AND NON-CONTRIBUTORY - OTHER INSURANCE CONDITION
This endorsement modifies insurance provided under the following:
BUSINESS AUTO COVERAGE FORM
The following language replaces SECTION IV BUSINESS AUTO CONDITIONS Part B. General Conditions
5. Other Insurance c.:
c. Regardless of the provisions of Paragraph a. above, this Coverage Form's Covered Autos Liability
Coverage is primary for any liability assumed under an "insured contract". This coverage will also be
non-contributory if it is required by the terms of the "insured contract",
CA 73 34 09 15 Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 1 of 1
WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 42 03 04 B
(Ed. 6.14)
TEXAS WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT
This endorsement applies only to the insurance provided by the policy because Texas is shown in Item 3.A.
of the Information Page.
We have the right to recover our payments from anyone liable for an injury covered by this policy We will
not enforce our right against the person or organization named in the Schedule, but this waiver applies only
with respect to bodily injury arising out of the operations described in the Schedule where you are required
by a written contract to obtain this waiver from us.
This endorsement shall not operate directly or indirectly to benefit anyone not named in the Schedule.
The premium for this endorsement is shown in the Schedule.
Schedule
1. Blanket Waiver
Any person or organization for whom the Named Insured has agreed by written contract to furnish this
waiver.
2. Operations: All TX Operations
3. Premium:
The premium charge for this endorsement shall be 2 percent of the premium developed on payroll in
connection with work performed for the above,person(s) or organization(s) arising out of the operations
described.
This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated.
Date Prepared: August 10, 2017
Carrier: Bridgefield Casualty Insurance Company
Effective Date of Endorsement: August 12, 2017
Policy Number: 0196-43838 Countersigned by:
Insured: William J. Schultz, Inc. dba Circle C Construction
WC 42 03 04 B (Ed. 6-14)
"Includes copyright material of the National Council on Compensation Insurance,Inc.used with its permission.Copyright 2014 NCCI"