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HomeMy WebLinkAboutContract 57215-R1 CSC No. 57215-R1 CITY OF FORT WORTH RENEWAL OF AGREEMENT WHEREAS,this Renewal of Agreement is between the City of Fort Worth,("CITY"), and Westhill Construction,Inc. ("CONTRACTOR"); and WHEREAS, CITY and CONTRACTOR desire to renew the Original Agreement (City Secretary#57215); and WHEREAS, M&C 22-0100 (February 8, 2022) authorized the Original Agreement and up to 3 renewals ("Renewal") for the Project generally described as: Utility Cut Street Repair Contract 2022; and WHEREAS,funding for this Renewal is available and appropriated. NOW, THEREFORE, it is agreed by the CITY and CONTRACTOR as follows: Article I The Original Agreement is hereby renewed for another term as described therein. Article II The CONTRACTOR's compensation for this Renewal shall remain $1,000,000, as specified in the Original Agreement. Article III All other provisions of the Original Agreement shall remain in full force and effect. EXECUTED and EFFECTIVE as of the date subscribed by the City's designated City Manager. APPROVED: City of Fort Worth Westhill Construction,Inc. Dana EurandoFF o.�,e�Bna.rt . 1 .saecon Dana Burghdoff Angela Reynolds Assistant City Manager President Aug 26, 2022 0 DATE: DATE: D �� OFFICIAL RECORD First Renewal of Agreement CITY SECRETARY Page 1 of 2 Utility Cut Repair Contract 2022 WestHl Construction,Inc. FT. WORTH, TX APPROVAL RECOMMENDED: Chris Larder,P.E. Director,Water Department APPROVED AS TO FORM AND LEGALITY: M&C: 22-0100 lAuthorizat on) eel Date: February 8, 2022 ogwcklwgayaoaa>xascon ,d4o�nn� Douglas W. Black Aar FOR) pr °°000000 Assistant City Attorney 9,�o° °o0 dA ° ~o �4d ATTEST: ° .7ahhette S Gooa'al6 aan °°°°°°° AVrEX P`-�a4p Annette S.Goodall(Aug 26,202216:34 CDT) ��na00 Jannette Goodall City Secretary Conti-act 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. J. Chris Underwood Senior Engineering Technician OFFICIAL RECORD CITY SECRETARY FT. WORTH, T First Renewal of Agreement Page 2 of 2 Utility Cut Repair Contract 2022 Westhill Construction,Inc. City of Fort Worth, Texas Mayor and Council Communication DATE: Tuesday, February 8, 2022 REFERENCE NO.: **M&C 22-0100 LOG NAME: 60UCRC2022-WESTHILL SUBJECT: (ALL) Authorize Execution of a Contract with Westhill Construction, Inc., in an Amount Up to $1,000,000.00 for the Utility Cut Street Repair Contract 2022 at Various Locations Throughout the City RECOMMENDATION: It is recommended that the City Council authorize execution of a contract with Westhill Construction, Inc. in an amount up to $1,000,000.00 for the Utility Cut Street Repair Contract 2022 at various locations and authorize up to three renewals. DISCUSSION: The work to be performed under this contract consists of utility street street repairs which are necessary after main replacements and repairs are made by the Water Department's Field Operations crews. The Water Department is neither staffed nor equipped to perform some of the larger repairs. This contract is necessary to maintain a reasonable repair schedule, minimize disruption to the public and ensure street repairs do not adversely impact the life of the remaining street. The project was advertised for bid on November 11, 2021 and November 18, 2021 in the Fort Worth Star- Telegram and on December 9, 2021 the following bids were received: Bidder Amount Time of Completion Westhill Construction,Enc.::]$1,769,875.00 365 Calendar Days Staff has reviewed the bid and proposed unit prices and considers them to be fair and reasonable. The bid documents included stipulations that the total quantities listed may not reflect actual quantities and that the amount budgeted for the projects is $1,000,000.00. Payments will be made based on actual measured quantities. The bid documents also included a stipulation giving the City the option to renew (subject to appropriated funding)this contract three times under the same terms, conditions and unit prices. This is budgeted in the Other Contractual Services account, which has approximately $19,672,916.71 available; after this contract the remaining balance will be approximately $18,672,916.71. AGREEMENT TERMS: The agreement may be renewed for three additional renewals at the City's option. The renewal action will not require City Council approval provided that the City Council has appropriated sufficient funds to satisfy the City's obligation during the renewal terms. This amendment will not impact the agreement terms that have already been set in place. M/WBE OFFICE: Westhill Construction, Inc. is in compliance with the City's Business Equity Ordinance by committing to 26 percent Business Equity participation on this project. The City's Business Equity goal on this project is 25 percent. ADMINISTRATIVE CHANGE ORDER: An administrative change order or increase may be made by the City Manager up to the amount allowed by relevant law and the Fort Worth City Code and does not require specific City Council approval as long as sufficient funds have been appropriated. This project is located in ALL COUNCIL DISTRICTS. FISCAL INFORMATION / CERTIFICATION: The Director of Finance certifies funds are available in the current operating budget as appropriated, in the Fiscal year 2022 operating budget of the Water and Sewer Fund. Prior to an expenditure being made, the department has the responsibility to validate the availability of funds. Future year appropriations are subject to Mayor and Council approval. FUND IDENTIFIERS (FIDs),: TO _ Fund Department ccount Project ProgramActivity Budget Reference # Amount ID ID Year (Chartfield 2) FROM FROM Fund Department ccount Project ProgramActivity Budget Reference # Amount ID ID Year (Chartfield 2) CERTIFICATIONS: Submitted for City Manager's Office by_ Dana Burghdoff (8018) Originating Department Head: Chris Harder (5020) Additional Information Contact: J. Chris Underwood (2629) ATTACHMENTS 1. 60UCRC2022-WESTHILL 1295.pdf (CFW Internal) 2. 60UCRC2022-WESTHILL Compliance Memo.pdf (CFW Internal) 3. 60UCRC2022-WESTHILL FID Table (NN 01.05.22).docx (CFW Internal) 4. UCRC2022-WESTHILL SAM.pdf (CFW Internal) 5. WesthillFundsAvailabilitypdf (CFW Internal) 11 CD CD0 111 0 CD 0 -n11'11 1 .F -n -n , c ' a a a • • CD CD CD cDi n; n • • O -n 0 0 , • • :3 Q ,-« y M m vx o D o 0 � (D � CD CD y . CD 0 TI 0 0 0 CA `< Z O N co 00'. co O CL CL 0 cQ o cQ r c CD � CD MC_ � 3 . m0 � _ � a� 0) � v ' = 11 N n N 11"1'1 fV � -n IV v 1 _ '111111' -u Z CD O CCD 0 i� 0 C L CC] (fl 3 Q 31 3 D D', D • 3 3 3 • 0 0 0 • • =3 71 _000 CO cn (D CD CD N CD D 3 0 N• CD i 006113-1 PERFORMANCE BOND Page 1 of 4 1 SECTION 00 6113 2 PERFORMANCE BOND Bond # 5312550-R1 3 4 THE STATE OF TEXAS § 5 § KNOW ALL BY THESE PRESENTS: 6 COUNTY OF TARRANT § 7 8 That we, Westhill Construction Inc. known as "Principal" 9 herein and Markel Insurance Company a corporate surety(sureties, if 10 more than one) duly authorized to do business in the State of Texas, known as "Surety" herein 11 (whether one or more), are held and firmly bound unto the City of Fort Worth, a municipal 12 corporation created pursuant to the laws of Texas, known as "City" herein, in the penal sum of, 13 One Million and 00/100 Dollars ($ 1,000,000.00 ), lawful money of the United States,to be 14 paid in Fort Worth,Tarrant County,Texas for the payment of which sum well and truly to be 15 made,we bind ourselves, our heirs, executors,administrators, successors and assigns,jointly 16 and severally,firmly by these presents. 17 WHEREAS,the Principal has entered into a certain written contract with the City 18 awarded the 8" day of February , 20 22,which Contract is hereby referred to and made a 19 part hereof for all purposes as if fully set forth herein,to furnish all materials, equipment labor 20 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 Utility Cut Repair Contract 2022;City 22 Project No. UC-01 2022—First Renewal 23 NOW,THEREFORE,the condition of this obligation is such that if the said Principal shall 24 faithfully perform it obligations under the Contract and shall in all respects duly and faithfully 25 perform the Work, including Change Orders, under the Contract, according to the plans, 26 specifications, and contract documents therein referred to, and as well during any period of 27 extension of the Contract that may be granted on the part of the City,then this obligation shall 28 be and become null and void, otherwise to remain in full force and effect. CITY OF FORT WORTH UTILITY CUT REPAIR STANDARD CONSTRUCTION SPECIFICATION DOCUMENTSCONTRACT 2022—FIRST RENEWAL Revised July 1,2011 City Project No.UC-01 2022 006113-2 PERFORMANCE BOND Page 2 of 4 1 PROVIDED FURTHER,that if any legal action be filed on this Bond, venue shall lie in 2 Tarrant County,Texas or the United States District Court for the Northern District of Texas, Fort 3 Worth Division. 4 This bond is made and executed in compliance with the provisions of Chapter 2253 of I 5 the Texas Government Code, as amended, and all liabilities on this bond shall be determined in 6 accordance with the provisions of said statue. 7 IN WITNESS WHEREOF,the Principal and the Surety have SIGNED and SEALED this 8 instrument by duly authorized agents and officers on this the 16th day of August 9 20 22 . 10 PRINCIPAL: 11 { 12 Westhill Construction, Inc. 13 14 15 ATTEST: 16 17 18 Signature (Principal)Secretary 19 20 21 22 Witness as to Principal Angela Reynolds, President 23 Name and Title 24 25 Address: 26 P. O. Box 2016 27 lip 28 Cleburne, TX 76031 i I 4 CITY OF FORT WORTH UTILITY CUT REPAIR STANDARD CONSTRUCTION SPECIFICATION DOCUMENTSCONTRACT 2022—FIRST RENEWAL Revised July 1,2011 City Project No.UC-01 2022 li I 006113-3 PERFORMANCE BOND Page 3 of 4 1 2 3 4 5 SURETY: 6 7 Markel Insurance Company 8 9 -- 10 11 BY: 12 13 Signature 14 15 16 Teresa Godsey, Attorney-in-Fact 17 Name and Title Witness as to Surety-Charles Reynolds 18 19 Address: 20 21 22 4521 Highwoods Pkwy 23 Allen, 24 Glen All , VA 23060 25 26 Telephone Number: 27 866-732-0099 28 29 i CITY OF FORT WORTH UTILITY CUT REPAIR STANDARD CONSTRUCTION SPECIFICATION DOCUMENTSCONTRACT 2022—FIRST RENEWAL Revised July 1,2011 City Project No.UC-01 2022 006113-4 PERFORMANCE BOND Page 4 of 4 1 2 *Note: If signed by an officer of the Surety Company,there must be on file a certified extract 3 from the by-laws showing that this person has authority to sign such obligation. If 4 Surety's physical address is different from its mailing address, both must be provided. 5 The date of the bond shall not be prior to the date the Contract is awarded. 6 i i CITY OF FORT WORTH UTILITY CUT REPAIR STANDARD CONSTRUCTION SPECIFICATION DOCUMENTSCONTRACT 2022—FIRST RENEWAL Revised July 1,2011 City Project No.UC-01 2022 006114-1 PAYMENT BOND Page 1 of 4 1 SECTION 00 6114 2 PAYMENT BOND Bond # 5312550-R1 3 4 THE STATE OF TEXAS § 5 § KNOW ALL BY THESE PRESENTS: 6 COUNTY OF TARRANT § 7 8 That we, Westhill Construction Inc. known as "Principal" 9 herein, and Markel Insurance Company , a corporate 10 surety (sureties), duly authorized to do business in the State of Texas, known as "Surety" herein 11 (whether one or more), are held and firmly bound unto the City of Fort Worth, a municipal 12 corporation created pursuant to the laws of the State of Texas, known as "City" herein, in the 13 penal sum of One Million and 00/100 Dollars ($ 1,000,000.00), lawful money of the United 14 States, to be paid in Fort Worth, Tarrant County, Texas, for the payment of which sum well and 15 truly be made, we bind ourselves, our heirs, executors, administrators, successors and assigns, 16 jointly and severally,firmly by these presents: 17 WHEREAS, Principal has entered into a certain written Contract with City, awarded the 18 8th day of February , 20 22,which Contract is hereby referred to and made a part hereof for all 19 purposes as if fully set forth herein, to furnish all materials, equipment, labor and other 20 accessories as defined by law, in the prosecution of the Work as provided for in said Contract i 21 and designated as Utility Cut Repair Contract 2022;City Project No. UC-01 2022—First Renewal 22 NOW, THEREFORE, THE CONDITION OF THIS OBLIGATION is such that if Principal shall 23 pay all monies owing to any (and all) payment bond beneficiary (as defined in Chapter 2253 of 24 the Texas Government Code, as amended) in the prosecution of the Work under the Contract, 25 then this obligation shall be and become null and void; otherwise to remain in full force and 26 effect. i CITY OF FORT WORTH UTILITY CUT REPAIR STANDARD CONSTRUCTION SPECIFICATION DOCUMENTSCONTRACT 2022—FIRST RENEWAL j Revised July 1,2011 City Project No.UC-01 2022 00 61 14-2 PAYMENT BOND Page 2 of 4 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 z i CITY OF FORT WORTH UTILITY CUT REPAIR STANDARD CONSTRUCTION SPECIFICATION DOCUMENTSCONTRACT 2022—FIRST RENEWAL Revised July 1,2011 City Project No.UC-01 2022 006114-3 PAYMENT BOND Page 3 of 4 1 IN WITNESS WHEREOF, the Principal and Surety have each SIGNED and SEALED this 2 instrument by duly authorized agents and officers on this the 16th day of 3 August , 20 22 4 PRINCIPAL: Westhil Construction, Inc. ATTEST: I Signature I j (Principal)Secretary Name and Title Witness as to Principal Address: P.O. Box 2016 Cleburne, TX 76031 I I i I I I I CITY OF FORT WORTH UTILITY CUT REPAIR STANDARD CONSTRUCTION SPECIFICATION DOCUMENTSCONTRACT 2022—FIRST RENEWAL Revised July 1,2011 City Project No.UC-01 2022 006114-4 PAYMENT BOND Page 4 of 4 SURETY: URETY: Markel Insurance Company (Surety)Secretary �terOsa Godsey, Attorney- +11,"� Name and Title Address: 4521 Highwood Pkwy Glen Allen, VA 23060 Witness as to Surety-Charles Reynolds 1 Telephone Number: 866-732-0099 2 3 4 5 6 Note: If signed by an officer of the Surety, there must be on file a certified extract from the bylaws showing that this person has authority to sign such obligation. If Surety's physical 7 address is different from its mailing address, both must be provided. g The date of the bond shall not be prior to the date the Contract is awarded. END OF SECTION CITY OF FORT WORTH UTILITY CUT REPAIR STANDARD CONSTRUCTION SPECIFICATION DOCUMENTSCONTRACT 2022—FIRST RENEWAL Revised July 1,2011 City Project No.UC-01 2022 006119-1 MAINTENANCE BOND Page 1 of 4 1 SECTION 00 6119 2 MAINTENANCE BOND Bond # 5312550-R1 3 4 THE STATE OF TEXAS § 5 § KNOW ALL BY THESE PRESENTS: 6 COUNTY OF TARRANT § 7 8 That we Westhill Construction Inc. known as "Principal" 9 herein and Markel Insurance Company a corporate surety(sureties, if 10 more than one) duly authorized to do business in the State of Texas, known as "Surety" herein 11 (whether one or more), are held and firmly bound unto the City of Fort Worth, a municipal 12 corporation created pursuant to the laws of the State of Texas, known as "City" herein, in the 13 sum of One Million and 00/100 Dollars ($ 1,000,000.00), lawful money of the United States,to 14 be paid in Fort Worth,Tarrant County,Texas,for payment of which sum well and truly be made 15 unto the City and its successors,we bind ourselves, our heirs, executors, administrators, 16 successors and assigns,jointly and severally,firmly by these presents. 17 18 WHEREAS,the Principal has entered into a certain written contract with the City awarded 19 the 8t"day of February , 20 22,which Contract is hereby referred to and a made part hereof 20 for all purposes as if fully set forth herein,to furnish all materials, equipment labor and other 21 accessories as defined by law, in the prosecution of the Work, including any Work resulting from 22 a duly authorized Change Order(collectively herein,the "Work") as provided for in said contract 23 and designated as Utility Cut Repair Contract 2022; City Project No. UC-01 2022—First 24 Renewal; and 25 26 WHEREAS, Principal binds itself to use such materials and to so construct the Work in 27 accordance with the plans, specifications and Contract Documents that the Work is and will CITY OF FORT WORTH UTILITY CUT REPAIR STANDARD CONSTRUCTION SPECIFICATION DOCUMENTSCONTRACT 2022—FIRST RENEWAL Revised July 1,2011 City Project No.UC-01 2022 006119-2 MAINTENANCE BOND Page 2 of 4 1 remain free from defects in materials or workmanship for and during the period of two (2)years 2 after the date of Final Acceptance of the Work by the City("Maintenance Period"); and 3 4 WHEREAS, Principal binds itself to repair or reconstruct the Work in whole or in part upon 5 receiving notice from the City of the need therefor at any time within the Maintenance Period. 6 7 NOW THEREFORE,the condition of this obligation is such that if Principal shall remedy 8 any defective Work,for which timely notice was provided by City,to a completion satisfactory 9 to the City,then this obligation shall become null and void; otherwise to remain in full force and 10 effect. 11 12 PROVIDED, HOWEVER, if Principal shall fail so to repair or reconstruct any timely 13 noticed defective Work, it is agreed that the City may cause any and all such defective Work to 14 be repaired and/or reconstructed with all associated costs thereof being borne by the Principal 15 and the Surety under this Maintenance bond; and 16 17 PROVIDED FURTHER,that if any legal action be filed on this Bond,venue shall lie in 18 Tarrant County,Texas or the United States District Court for the Northern District of Texas, Fort 19 Worth Division; and 20 21 PROVIDED FURTHER,that this obligation shall be continuous in nature and successive 22 recoveries may be had hereon for successive breaches. 23 24 25 CITY OF FORT WORTH UTILITY CUT REPAIR STANDARD CONSTRUCTION SPECIFICATION DOCUMENTSCONTRACT 2022—FIRST RENEWAL Revised July 1,2011 City Project No.UC-01 2022 006119-3 MAINTENANCE BOND Page 3 of 4 1 IN WITNESS WHEREOF,the Principal and the Surety have each SIGNED and SEALED this 2 instrument by duly authorized agents and officers on this the 16th day of August 3 20 22 4 5 PRINCIPAL: 6 7 Westhill Construction, Inc. 8 9 10 11 BY: 12 I 13 Signature 14 ATTEST: 15 16 17 Angela Reynolds, President (Principal)Secretary 18 Name and Title 19 20 % Address: 21 Witness as to Principal 22 23 P. O. Box 2016 24 25 Cleburne, Texas 76031 26 27 28 CITY OF FORT WORTH UTILITY CUT REPAIR STANDARD CONSTRUCTION SPECIFICATION DOCUMENTSCONTRACT 2022—FIRST RENEWAL Revised July 1,2011 City Project No.UC-01 2022 I f i I 006119-4 MAINTENANCE BOND Page 4 of 4 SURETY: 1 2 Markel Insurance Company 3 4 5 6 BY: r r 7 �C 8 Signature 9 10 11 Teresa Godsey, Attorney-in-Fact 12 ATTEST: Name and Title 13 14 Address: 15 (Surety) Secretary 16 / 17 4521 Highwoods Pkwy 18 19 Witness as to Surety-Charles Reynolds Glen Allen, VA 23060 20 21 Telephone Number: 22 866-732-0099 23 24 *Note: If signed by an officer of the Surety Company,there must be on file a certified extract 25 from the by-laws showing that this person has authority to sign such obligation. If 26 Surety's physical address is different from its mailing address, both must be provided. 27 The date of the bond shall not be prior to the date the Contract is awarded. 28 I CITY OF FORT WORTH UTILITY CUT REPAIR STANDARD CONSTRUCTION SPECIFICATION DOCUMENTSCONTRACT 2022—FIRST RENEWAL Revised July 1,2011 City Project No.UC-01 2022 PDA s: 5312550-R1 Markel Insurance Company LIMITED POWER OF ATTORNEY Know All Men by These Presents,That MARKEL INSURANCE COMPANY(the"Company"),a corporation duly organized and existing under the laws of the State of Illinois,and having its principal administrative office in Glen Allen,Virginia,does by these presents make,constitute and appoint Teresa Godsey its true and lawful Attorney-in-fact,with full power and authority hereby conferred in its name,place and stead,to execute,acknowledge and deliver any and all bonds,recognizances,undertakings of other instruments or contracts of suretyship to include waivers to the conditions of contracts and consents of surety for, providing the bond penalty does not exceed Principal: Westhill Construction, Inc. Obligee: City of Fort Worth Amounts:$$1,000,000.00 and to bind the Company thereby as fully and to the same extent as if such bond were signed by the President,sealed with the corporate seal of the Company and duly attested by its Secretary,hereby ratifying and confirming all that the said Attorney-in-Fact may do in the premises. Said appointment is made under and by authority of the following resolution of the Board of Directors of Markel Insurance Company: RESOLVED,that the President,any Senior Vice President,Vice President,Assistant Vice President,Secretary,Assistant Secretary or Assistant Treasurer shall be and is hereby vested with full power and authority to appoint any one or more suitable persons as Attorneys)-in-Fact to represent and act for on behalf of the Company,subject to the following provisions: Attorney-in-fact may be given full power and authority for and in the name of and on behalf of the Company,to execute,acknowledge and deliver,any and all bonds,recognizances,contracts,agreements or indemnity and other conditional or obligatory undertakings and any and all notices and documents canceling or terminating the Company's liability thereunder,and any such instruments so executed by any such Attorney- in-Fact shall be binding upon the Company as if signed by the President and sealed and effected by the Secretary. FURTHER RESOLVED,that the signature of any authorized officer and seal of the Company heretofore or hereafter affixed to any powerof attorney or any certificate relating thereto by facsimile,and any power of attorney or certificate bearing facsimile signature or facsimile seal shall be valid and binding upon the Company with respect to any bond or undertaking to which it is attached. In Witness Whereof,MARKEL INSURANCE COMPANY has caused these presents to be signed by its Senior Vice President,and its corporate seal to be hereto affixed this 9th day of September,2019. ;,\1 R Nql MARKEL INS CE PANY �, d SEAL Commonwealth of Virginia By: Henrico County '���„ *„���` Rob4 Russo,Senior Vice President On this 9th day of September,2019 before me personally came Robin Russo,(Q1peMown,who being by me duly sworn,did depose and say that he resides in Henrico County,Virginia,the he is Senior Vice President of MARKEL INP�RNQ I�C"Q"V� �;;he company described in and which executed the above instrument;that he knows the seal of said Company;that the seal affixed to said inSUN%, tt,i56uctreo fedf e S®al;that it was so affixed by order of the Board of Directors of said Company;and that he signed his name thereto by like order. RY p(ie•,2� Z MY COMMISSION ®BY�. ® n NUMBER Q ® Donna Donavant,Notary Public 7083968 Q)�: My commission expires 1/31/2023 I,Richard R.Grinnan,Vice President and Secretary of MARKEL INSURIJEPM1}tfor>�by certify that the above and foregoing is true and correct copy of a Power of Attorney,executed by said Company,which is still in full force andWdfeutt rthermore,the resolutions of the Board of Directors,set out in the Power of Attorney are in full force and effect. Given under my hand and the seal of said Company at Glen Allen,Virginia this 16th day of August 20 22 By: Richard R.Grinnan, Vice President and Secretary Any instrument issued in excess of the penalty stated above is totally void and without any validity. For verification of the authority of this Power you may call(713)812-0800 on any business day between 8:30 AM and 5:00 PM CST. Markel Insurance Company THIS BOND RIDER CONTAI6IAS IMPORTANT COVERAGE INFORMATION Statutory Complaint Notice/Filing of Claims To obtain information or make a complaint: You may call the Surety's toll free telephone number for information or to make a complaint or file a claim at: 1-866-732-0099. You may also write to the Surety at: Markel Insurance Company 9737 Great Hills Trail, Suite 320 Austin, Tx 78759 You may contact the Texas Department of Insurance to obtain information on companies, coverage, rights or complaints at 1-800-252-3439. You may write the Texas Department of Insurance at: PO Box 149104 Austin, TX 78714-9104 Fax#: 512-490-1007 Web: http://www.tdi.state.tx.us Email: ConsumerProtection@tdi.texas.gov PREMIUM OR CLAIMS DISPUTES: Should you have a dispute concerning your premium or about a claim, you should contact the Surety first. If the dispute is not resolved, you may contact the Texas Department of Insurance. ------------------------------------------------------------------------------------------------------------------------------ Texas Rider 06042015 WESTCON-05 TGODSEY '4Ci�R® CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DDNYYY) ----'' 8/17/2022 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER License#4682 CONTACT NAME: Fort Worth,TX-Hub International Insurance Services PHO 3221 Collinsworth (A/C,No,Ell):(817) 820-8100 (A/C,No):(817)870-0310 NE FAX Fort Worth,TX 76107 ADDRIESS,ftw.service@hubinternational.com INSURERS AFFORDING COVERAGE NAIC# INSURER A:Amerisure Mutual Insurance Company 23396 INSURED INSURER B:Amerisure Insurance Company 19488 Westhill Construction,Inc. INSURERC: 402 N.Border INSURER D: Cleburne,TX 76033 INSURER E INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF POLICY EXP LIMITS LTR IN SD WVD MM/DD/YYYY MM/DDNYYY A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1'000,006 CLAIMS-MADE F_X] OCCUR CPP1324096 2/28/2022 2/28/2023 DAMAGE TO RENTEDurre 1,000,000 PREMISES Ea.Cc nce $ MED EXP(Any oneperson) $ 10,000 PERSONAL&ADV INJURY $ 1,000,000 GENT AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY❑X mw LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: EMPLOYEE BENEFI $ 1,000,000 A AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 1,000,000 Ea accident $ X ANY AUTO CA1324095 2/28/2022 2/28/2023 BODILY INJURY Perperson) $ OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY Per accident $ AUTOS ONLY NON-OWNED ONEY PROPERTY DAMAGE Per accident $ $ B X UMBRELLA LIAB M OCCUR EACH OCCURRENCE $ 1,000,000 EXCESS LIAB CLAIMS-MADE CU1324097 2/28/2022 2/28/2023 AGGREGATE $ 1,000,000 DED I X I RETENTION$ 0 $ B WORKERS COMPENSATION X AND EMPLOYERS'LIABILITY PER EERH YIN WC2018729 2/28/2022 2/28/2023 1,000,000 ANY PROPRIETOR/PARTNER/EXECUTIVE I E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under 1,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) The General Liability and Auto Liability policies includes a blanket automatic additional insured endorsement that provides additional insured status to the certificate holder only when there is a written contract between the named insured and the certificate holder that requires such status subject to policy terms and conditions. The General Liability additional insured endorsements include ongoing and completed operations.The General Liability,Auto Liability and Workers Comp policies include a blanket automatic waiver of subrogation endorsement that provides this feature only when there is a written contract between the named insured and the certificate holder that requires it subject to policy terms and conditions.The General Liability and automobile liability policies contain a special endorsement with"Primary and Noncontributory"wording subject to policy terms and conditions.General liability policy has the additional insured endorsement number CG 20 10 11 85.General liability policy has blanket contractual liability-railroads coverage when required by written SEE ATTACHED ACORD 101 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Fort Worth,Texas THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN tY ACCORDANCE WITH THE POLICY PROVISIONS. ATTN:J.Chris Underwood 1000 Throckmorton Street Fort Worth,TX 76102 AUTHORIZED REPRESENTATIVE ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID:WESTCON-05 TGODSEY LOC#: 1 A "' ADDITIONAL REMARKS SCHEDULE Page 1 of 1 AGENCY License#4682 NAMED INSURED Fort Worth,TX-Hub International Insurance Services 402 N. 11 Construction,Inc. 02 N.Border POLICY NUMBER Cleburne,TX 76033 EE PAGE 1 CARRIER NAIC CODE EE PAGE 1 SEE P 1 EFFECTIVE DATE:SEE PAGE 1 ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: ACORD 25 FORM TITLE: Certificate of Liability Insurance Description of Operations/Locations/Vehicles: contract. General liability policy has a severability of interest clause.The General Liability,Automobile Liability and Workers Compensation policies include a blanket notice of cancellation to certificate holder's endorsement, providing for 30 days'advance notice if the policy is canceled by the company other than for nonpayment of premium, 10 days' notice after the policy is canceled for nonpayment of premium. The Umbrella Policy Follows Form. RE: Project#UC01-2022 Utility Cut Repair Contract 2022 -First Renewal Certificate Holder is The City of Fort Worth,Texas, its Officers, Directors,Agents and Employees. ACORD 101 (2008/01) ©2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD