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HomeMy WebLinkAboutContract 45520-R2 CITY SECRETARY CONTRACT NO. -q- 2251 Q CITY OF FORTWOR-1-11 SECOND RENEWAL OF AGREEMENT WHEREAS, the City of Fort Worth, ("City"). and Westhill Construction. Inc.. authorized to do business in Texas, ("Contractor"), entered into that certain ORIGINAL AGREEMENT (City Secretary 445520, M&C C-26694) for the PROJECT generally described as: Utility Cut Repair Contract 2013, and WHEREAS, the ORIGINAL AGREEMENT may be renewed up to three times as provided by M&C C-26694; and WHEREAS. the City and Contractor renewed the ORIGINAL AGREEMENT on July 21. 2015 for an additional term at the same price. said FIRST RENEWAL authorized by M&C C-27381 to provide funding therefor, and WHEREAS, The City and Contractor desire to renew the ORIGINAL AGREEMENT for an additional term at the same price. said SECOND RENEWAL is available in the 2016 operating budget of the Water and Sewer Fund, as appropriated in Ordinance #2183-09-2015. 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 11 The Contractor's compensation shall be in the amount up to $500.000.00. 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. EXECUTED by each party's duly authorized representative and EFFECTIVE as of the date subscribed by the City's designated City Manager. OFFICIAL RECORD Second Renewal of Agreement CITY SECRETARY Page I of—') Westhill Construction,Inc. IJtility Cut Repair Contract 2013 FT. WORTH, TX City of Fort Worth W i onst tion, Inc. Jesus J. Chapa ed Reynolds Assistant City Manager President DATE: �2-a?3 —A0 DATE: JQMF, 1, 206 AP OVAL COMMENDED: �ri=stoher arder, P.E. Assistant Director, Water Department APPROVED AS TO FORM AND LEGALITY: M&C: G- Z*T 1-3 Date: Douglas W. Black Sr. Assistant City Attorney ®�RT ATTEST: ILA ) ary J. 4 er7 FXAg City Secretary OFFICIAL RECORD CITY SECRETARY FT. WORTH, TX Second Renewal of Agreement Paee 2 of 2 Westhill Construction,inc. Utility Cut Repair Contract 2013 Official site of the City of Fort Worth,Texas CITY COUNCIL AGENDA FORTWORTH COUNCIL ACTION: Approved on 6/7/2016 DATE: 6/7/2016 REFERENCE NO.: **C-27753 LOG NAME: 60UC012013R2-WESTHILL CODE: C TYPE: CONSENT PUBLIC HEARING: NO SUBJECT: Authorize the Second Renewal of City Secretary Contract No. 45520 with Westhill Construction, Inc., in the Amount of$500,000.00 for Utility Cut Repair Contract 2013 UC01- 2013 at Various Locations Throughout the City (ALL COUNCIL DISTRICTS) RECOMMENDATION: It is recommended that the City Council authorize the execution of the second renewal of City Secretary Contract No. 45520 with Westhill Construction, Inc., in the amount of $500,000.00 for Utility Cut Repair Contract 2013 UC01-2013. DISCUSSION: On March 4, 2014 (Mayor and Council Communication (M&C) C-26694), the City Council authorized the award of a contract in the amount of$500,000.00, with the option for three renewals to Westhill Construction, Inc., for Utility Cut Repair Contract 2013 UC01-2013. On July 21, 2015 (M&C C-27381), the City Council authorized the award of the first renewal of the contract in the amount of $500,000.00 with Westhill Construction, Inc., for Utility Cut Repair Contract 2013 U C01-2013. The City and the contractor desire to exercise the second renewal of the contract in the amount of $500,000.00 and with the same terms and conditions for a collective contract amount of$1,500,000.00. The work to be performed under this contract consists of utility cut 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 the street repairs do not adversely impact the life of the remaining street. M/WBE OFFICE: Westhill Construction, Inc., is in compliance with the City's BDE Ordinance by committing to 11 percent MBE participation. The City's MBE goal on this project is 10 percent. This project is located in various locations throughout the City in ALL COUNCIL DISTRICTS. FISCAL INFORMATION/CERTIFICATION: The Director of Finance certifies that funds are available in the Fiscal Year 2016 Water and Sewer Fund Operating Budget. In addition, funds have been requested for appropriation in the City Manager's proposed budget for Fiscal Year 2017 for the Water and Sewer Fund. Upon approval of the above recommendations and adoption of the Fiscal Year 2017 Budget by the City Council, it is anticipated that funds will be available in the Fiscal Year 2017 Water and Sewer Fund Operating Budget, as appropriated. Prior to expenditure being made, the Water and Sewer Fund has the responsibility to validate the availability of funds prior to an expense being incurred. TO Fund Department Account Project Program Activity Budget Reference# Amount ID ID , Year (Chartfield 2) FROM Fund Department Account Project Program Activity Budget Reference# Amount ID ID Year Chartfield 2 560011 0607011 5330201 $250,000.0 560011 0707008 5330201 $250,000.0 Submitted for City Manager's Office b . Jay Chapa (5804) Originating Department Head: John Carman (8246) Additional Information Contact: J Chris Underwood (2629) ATTACHMENTS 1295 Westhill Const UC012013.gdf Bond #5197467 0061 13-1 PERFORMANCE BOND Page 1 of 2 1 SECTION 00 61 13 2 PERFORMANCE BOND 3 4 THE STATE OF TEXAS § 5 § KNOW ALL BY THESE PRESENTS: 6 COUNTY OF TARRANT § 7 8 That we, Westhill Construction, Inc. known as 9 "Principal" herein and SureTec Insurance Company a corporate 10 surety(sureties, if more than one)duly authorized to do business in the State of Texas, known as 11 "Surety" herein(whether one or more), are held and firmly bound unto the City of Fort Worth, a 12 municipal corporation created pursuant to the laws of Texas, known as"City" herein, in the penal 13 sum of, Five Hundred Thousand and 00/100 Dollars($ 500,000.00 ), lawful money 14 of the United States, to be paid in Fort Worth, Tarrant County,Texas for the payment of which 15 sum well and truly to be made, we bind ourselves, our heirs, executors,administrators, successors 16 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 P��1 day of_ ,� q 20 ,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 Utility Cut Repair Contract 2013; 22 Project No. UC-01 2013,2"d Renewal 23 NOW,THEREFORE,the condition of this obligation is such that if the said Principal 24 shall faithfully perform it obligations under the Contract and shall in all respects duly and 25 faithfully 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 be 28 and become null and void, otherwise to remain in full force and effect. 29 PROVIDED FURTHER,that if any legal action be filed on this Bond, venue shall lie in 30 Tarrant County, Texas or the United States District Court for the Northern District of Texas, Fort 31 Worth Division. CITY OF FORT WORT i UTILITY CUT REPAIR STANDARD CONSTRUCTION SPECIFICATION DOCUMENTS CONTRACT 2013,2"RENEWAL Revised July 1,2011 Project No.UC-01 2013 } 0061 13-2 PERFORMANCE BOND Page 2 of 2 I This bond is made and executed in compliance with the provisions of Chapter 2253 of the 2 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 5 this instrument by duly authorized agents and officers on this the day of J LNE 6 20 ItO . 7 PRINCIPAL: 8 Westhill Construction, Inc. 9 10 1 I BY: 12 Signature 13 ATTEST: 14 15 M-k4htmj rltyv-d d.s vP 16 (Principal)Secretary Name and Title 17 18 Address:P.O. Box 2016 19 Cleburne, TX 76033 20 21 22 Witness as to Principli AA 23 SURETY: 24 SureTec Insurance Company 25 26 27 B 28 Signature 29 30 Teresa Godsey, Attorney In Fact 31 Name and Title 32 33 Address: 9737 Great Hills Trail, Ste 320 34 Austin, TX 78759 35 36 37 XCtness as to Sure Telephone Number: (512) 732-0099 38 39 40 41 *Note: If signed by an officer of the Surety Company, there must be on file a certified extract 42 from the by-laws showing that this person has authority to sign such obligation. If 43 Surety's physical address is different from its mailing address, both must be provided. 44 The date of the bond shall not be prior to the date the Contract is awarded. 45 CITY OF FORT WORTH UTILITY CUT REPAIR STANDARD CONSTRUCTION SPECIFICATION DOCUMENTS CONTRACT 2013,2"RENEWAL Revised July I,2011 Project No UC-01 2013 Bond #5197467 0061 14-1 PAYMENT BOND Page 1 of 2 1 SECTION 00 61 14 2 PAYMENT BOND 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 9 "Principal" herein, and SureTec Insurance Company , a 10 corporate surety (sureties), duly authorized to do business in the State of Texas, known as 11 "Surety" herein (whether one or more), are held and firmly bound unto the City of Fort Worth, a 12 municipal corporation created pursuant to the laws of the State of Texas, known as "City" herein, 13 in the penal sum of Five Hundred Thousand and 00/100 Dollars (S 500.000.00), lawful money 14 of the United States, to be paid in Fort Worth, Tarrant County, Texas, for the payment of which 15 sum well and truly be made, we bind ourselves, our heirs, executors, administrators, successors 16 and assigns,jointly and severally, firmly by these presents: 17 WHEREAS, Principal has entered into a certain written Contract with City, awarded the 18 day of 3w4F- , 20 j�-, , 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 as defined by law, in the prosecution of the Work as provided for in 21 said Contract and designated as Utility Cut Repair Contract 2013; Project No. UC-01 2013, 22 2"d Renewal 23 NOW, THEREFORE, THE CONDITION OF THIS OBLIGATION is such that if 24 Principal shall pay all monies owing to any (and all) payment bond beneficiary (as defined in 25 Chapter 2253 of the Texas Government Code, as amended) in the prosecution of the Work under 26 the Contract, then this obligation shall be and become null and void; otherwise to remain in full 27 force and effect. 28 This bond is made and executed in compliance with the provisions of Chapter 2253 of the 29 Texas Government Code, as amended, and all liabilities on this bond shall be determined in 30 accordance with the provisions of said statute. 31 CITY OF FORT WORTH UTILITY CUT REPAIR STANDARD CONSTRUCTION SPECIFICATION DOCUMENTS CONTRACT 2013,2"RENEWAL Revised July 1,2011 Project No.UC-01 2013 0061 14-2 PAYMENT BOND Page 2 of 2 1 IN WITNESS WHEREOF, the Principal and Surety have each SIGNED and SEALED 2 this instrument by duly authorized agents and officers on this the -1141 day of 3 JUN —, 20 1(-- 4 (-4 PRINCIPAL: Westhill Construction, Inc. ATTEST: BY: Signature fkw n (Principal) Secretary Name and Title Address: P.O. Box 2016 Cleburne, TX 76033 Witness as to Pricipal SURETY: SureTec Insurance Company ATTEST: BY: Signature Teresa Godsey, Attorney In Fact (Surety) Secretary Name and Title Address: 9737 Great Hills Trail, Ste 320 )� Austin, TX 78759 Witness as to Sur Telephone Number: (512) 732-0099 5 6 Note: If signed by an officer of the Surety, there must be on file a certified extract from the 7 bylaws showing that this person has authority to sign such obligation. If Surety's physical 8 address is different from its mailing address, both must be provided. 9 l0 The date of the bond shall not be prior to the date the Contract is awarded. I i END OF SECTION 12 CITY OF FORT WORTH UTILITY C UT REPAIR STANDARD CONSTRUCTION SPECIFICATION DOCUMENTS CONTRACT 2013,2"'RENEWAL Revised July I,2011 Project No.UC-01 2013 Bond #5197467 0061 19-1 MAINTENANCE BOND Page i of 3 1 SECTION 00 61 19 2 MAINTENANCE BOND 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 9 "Principal"herein and SureTec Insurance Company a corporate surety 10 (sureties, if more than one)duly authorized to do business in the State of Texas, known as 11 "Surety" herein(whether one or more), are held and firmly bound unto the City of Fort Worth, a 12 municipal corporation created pursuant to the laws of the State of Texas, known as "City" herein, 13 in the sum of Five Hundred Thousand and 00/100 Dollars(S 500,000.00 ), lawful money 14 of the United States, to be paid in Fort Worth, Tarrant County, Texas, for payment of which sum 15 well and truly be made unto the City and its successors, we bind ourselves, our heirs, executors, 16 administrators, 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 rl day of 3 SANE , 20 k 6, which Contract is hereby 20 referred to and a made part hereof for all purposes as if fully set forth herein, to furnish all 21 materials, equipment labor and other accessories as defined by law, in the prosecution of the 22 Work, including any Work resulting from a duly authorized Change Order(collectively herein, 23 the"Work")as provided for in said contract and designated as Utility Cut Repair Contract 24 2013; Project No. UC-01 2013,2nd 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 28 remain free from defects in materials or workmanship for and during the period of two (2)years 29 after the date of Final Acceptance of the Work by the City("Maintenance Period"); and 30 31 WHEREAS, Principal binds itself to repair or reconstruct the Work in whole or in part 32 upon receiving notice from the City of the need therefor at any time within the Maintenance 33 Period. 34 CITY OF FORT'A )RTH UTILITY CUT REPAIR STANDARD CONSTRUCTION SPECIFICATION DOCUMENTS CONTRACT 2013,2nd RENEWAL Revised July I,2011 Project No.UC-01 2013 0061 19-2 MAINTENANCE BOND Page 2 of 3 1 NOW THEREFORE, the condition of this obligation is such that if Principal shall 2 remedy any defective Work, for which timely notice was provided by City, to a completion 3 satisfactory to the City, then this obligation shall become null and void; otherwise to remain in 4 full force and effect. 5 6 PROVIDED, HOWEVER, if Principal shall fail so to repair or reconstruct any timely 7 noticed defective Work, it is agreed that the City may cause any and all such defective Work to 8 be repaired and/or reconstructed with all associated costs thereof being borne by the Principal and 9 the Surety under this Maintenance bond; and 10 1 l PROVIDED FURTHER,that if any legal action be filed on this Bond,venue shall lie in 12 Tarrant County, Texas or the United States District Court for the Northern District of Texas, Fort 13 Worth Division; and 14 15 PROVIDED FURTHER,that this obligation shall be continuous in nature and 16 successive recoveries may be had hereon for successive breaches. 17 18 19 CITY OF FORT WORTH UTILITY CUT REPAIR STANDARD CONSTRUCTION SPECIFICATION DOCUMENTS CONTRACT 2013,2n'RENEWAL Revised July I,2011 Project No.UC-01 2013 0061 19-3 MAINTENANCE BOND Page 3 of 3 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 'JA day of Jms 3 20_Va_. 4 5 PRINCIPAL: 6 Westhill Construction, Inc. 7 8 9 BY: 10 Signature II ATTEST: 121-13 ktyrdd5 14 (Principal)Secretary Name and Title 15 16 Address: P.O. Box 2016 17 Cleburne, TX 76033 18 19 20 Witness as to Princi al 21 SURETY: 22 SureTec Insurance Company 23 24 25 B 26 Signature 27 28 Teresa Godsey, Attorney In Fact 29 ATTEST: Name and Title 30 31 Address: 9737 Great Hills Trail, Ste 320 32 (Sure )Secr�et�ary, Austin,TX 78759 33 34 35 Witness as to Surety Telephone Number: (512) 732-0099 36 37 *Note: If signed by an officer of the Surety Company, there must be on file a certified extract 38 from the by-laws showing that this person has authority to sign such obligation. If 39 Surety's physical address is different from its mailing address, both must be provided. 40 The date of the bond shall not be prior to the date the Contract is awarded. 41 CITY OF FORT WORTH UTILITY CUT REPAIR STANDARD CONSTRUCTION SPECIFICATION DOCUMENTS CONTRACT 2013,2"RENEWAL Revised July 1,2011 Project No.UC-01 2013 POA a: Bons! #5197467 SureTec Insurance Company LIMITED POWER OF ATTORNEY Know AU Men by These Presents, That SURETEC INSURANCE COMPANY (the "Company"), a corporation duly organized and existing under the laws of the State of Texas, and having its principal office in Houston, Harris County, Texas, does by these presents make,constitute and appoint Teresa Godsey its true and lawfid 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 or other instruments or contracts of suretyship to include waivers to the conditions of contracts and consents of surety for: Principal: Westhill Construction, Inc. Obligee: City of Fort Worth Amount: $ 500,000.00 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 resolutions of the Board of Directors of the SureTec Insurance Company: Be it Resolved, that the President, any Vice-President,any Assistant Vice-President,any Secretary or any Assistant Secretary shall be and is hereby vested with full power and authority to appoint any one or more suitable persons as Attomey(s)-in-Fact to represent and act for and 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 of 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 Corporate Secretary. Be it Resolved that the signature of any authorized officer and seal of the Company heretofore or hereafter affixed to any power of 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. (Adopted at a meeting held on 20°i of April, 1999.) In Witness Whereof, SURETEC INSURANCE COMPANY has caused these presents to be signed by its President,and its corporate seal to be hereto affixed this 21 st day of March,A.D.2013. u SURETEC N OMPANY RANC�c 1y! X •9 ;��-, BY: UJ w y& John ox resident State of Texas ss: 7�:.4 d y/t` S County of Hams ••••. On this 21 st day o f March,A.D.2013 before me personally came John Knox Jr.,to me known,who,being by me duly sworn,did depose and say,that he resides in Houston, Texas, that he is President of SURETEC INSURANCE COMPANY, the company described in and which executed the above instrument;that he knows the seal of said Company;that the seal affixed to said instrument is such corporate seal;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. JACQUELYN MALDONADO Nota Public State of Texas 1 ' My Comm.Exp.5/18=17 acquelyn Maldonado,Notary Public My commission expires May 18,2017 I,M.Brent Beaty,Assistant Secretary of SURETEC INSURANCE COMPANY,do hereby certify that the above and foregoing is a true and correct copy of a Power of Attorney,executed by said Company,which is still in full force and effect;and furthermore,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 Houston, Texas this day of _,A.D. Brent Beaty,Assistant S rretary 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 any business day between 8:00 am and 5:00 pm CST. SureTec Insurance Company THIS BOND RIDER CONTAINS 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: SureTec 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: hap: ti\%,.N.tdi.state.tx.us Email: ConsumerProtection@tdi.texas.gov PREMIUM OR CLAIM 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 1 4 WESTCON-05 TGODSEY ACORD DATE(MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 5/27/2016 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(les)must 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). TACT PRODUCER License#4682 NAME: Fort Worth,TX-Hub International Insurance Services PHONE 817 820-8100 ,No 817 870-0310 421 West Third Street,Suite 800 tA/C-No Ext): ) (, h( ) Fort Worth,TX 76102 ADDRESS:ftw•service@hubinternational.com INSURERS)AFFORDING COVERAGE NAIC 9 INSURERA:Amerisure Mutual Insurance Company 23396 INSURED INSURER 13:Amerisure Insurance Company 19488 Westhill Construction,Inc. INSURER C: 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-SUER POLICY EFF POLICY EXP LIMITS LTR IND WVD POLICY NUMBER MMIDDIYYYY (MM MW A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,00 CLAIMS-MADE X OCCUR CPP13240961602 02/28/2016 02/28/2017 DAMAGE-170-RENTED > 100 00 PREMISES(Ea occurrences b MED EXP(Any one person) E 5,00 PERSONAL&ADV INJURY _E 1,000,00 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,00 POLICY X E T LOC PRODUCTS-COMP/OP AGG $ 2,000,00 OTHER: EMPLOYEE BENEFI $ 1,000,00 AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT y 1,000,00 (Ea accident) _ A X ANY AUTO CAI 3240951702 02/28/2016 02/28/2017 BODILY INJURY(Per person) b ALL OVMVED SCHEDULED BODILY INJURY(Per accident) b AUTOS AUTOS _ _ NON-O NED PROPERTY DAMAGE S HIRED AUTOS AUTOS (Per accident) b X UMBRELLA UAB X OCCUR EACH OCCURRENCE $ 1,000,00 B EXCESS UAB CLAIMS-MADE CU13240971601 02/28/2016 02/28/2017 AGGREGATE $ 1,000,00 DED X RETENTIONS 0 $ WORKERS COMPENSATION X PER OTH- AND EMPLOYERS'LIABILITY STATUTE ER _ A ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N WC201872912 02/28/2016 02/28/2017 E.L.EACH ACCIDENT E 1,000,00 OFFICER/MEMBER EXCLUDED? N I A - - (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE E 1,000,00 If as,describe under --_ DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT b 1,000,00 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,Auto Liability and Workers Comp policies includes 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 Liabilityand 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 contract General liability policy has a severability of interest clause.The General Liability,Automobile 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 ATTN:J.CHRIS UNDERWOOD ACCORDANCE WITH THE POLICY PROVISIONS. 1000 THROCKMORTON STREET FORT WORTH,TX 76102 AUTHORIZED REPRESENTATIVE ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID:WESTCON-05 TGODSEY /wol� LOC#: 1 ACRO ADDITIONAL REMARKS SCHEDULE Page 1 of 1 AGENCY License#4682 NAMED IN5URED !� Fort Worth,TX-Hub Intemational Insurance Services Westhill Construction,Inc. POLICY NUNBER 402 N.Border Cleburne,TX 76033 EE PAGE 1 CARRIER NAIC CODE EE PAGE 1 SEE P 1 EFmc-,DATE:SEE PAGE I ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: ACORD 25 FORM TITLE: Certltkab of Llabift Nuurana Description of Operations/Locations/Vehicles: 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: UTILITY CUT REPAIR CONTRACT.FORT WORTH,TEXAS.PROJECT NO.UC-01 2013,2nd Renewal.CERTIFICATE HOLDER: THE CITY OF FORT WORTH,TEXAS,ITS OFFICERS,EMPLOYEES AND SERVANTS. t ACORD 101 (2008/01) ©2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD CERTIFICATE OF INTERESTED PARTIES FORM 1295 10f1 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. 2016-15667 Westhill Construction,lnc Cleburne,TX United States Date Filed: 2 Name of governmental entity or state agency that is a party to the contract for which the form is 02/18/2016 being filed. City of Fort Worth Date Acknowledged: 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 goods or services to be provided under the contract. UC01-2013 Utility cut repair contract 2013. 2nd renewal 4 Nature of interest(check applicable) Name of Interested Party City,State,Country(place of business) Controlling intermediary Reynolds,Ted Cleburne,TX United States X 5 Check only if there is NO Interested Party. 6 AFFIDAVIT I swear,or affirm,underenal p ty of perjury,that the above disclosure is true and correct. ��PRV PG6 f MAR&YN K NEWBY t ,• Not=Y public +ao� STATE OP TE X4S Signature of aut orized agent of cont ting business entity My Comm. 81P-)4Y7.2014 AFFIX NOTARY STAMP f E t t Sworn to and subscribed before me,by the said �hQR.t��3�` ,this the day of 20 � .to certify which,witness my hand and seal of ofilce. Signature of oofcer administering oath Printed name of officer administering oat Title of officer adrMm4ering oath Forms provided by Texas Ethics Commission www.ethics.state.tx.us Version V1.0.34944