HomeMy WebLinkAboutContract 49693-R1 CITY SECRETARY C
CONTRACT NO. 1
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., ("Contractor"), entered into that certain ORIGINAL
AGREEMENT (City Secretary #49693, M&C C-28355) for the PROJECT generally
described as: Sewer Main Replacements Contract 2017, City Project Number 100909; and
WHEREAS, the ORIGINAL AGREEMENT may be renewed up to two times as
provided by M&C C-28355;and
WHEREAS, The City and Contractor desire to renew the ORIGINAL
AGREEMENT for a second term at the same price, funding for said FIRST RENEWAL is
available in the 2018 operating budget of the Water and Sewer Fund, as appropriated in
Ordinance#23120-02-2018.
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
The Agreement is hereby amended to include the following language:
Immigration Nationality Act
CONSULTANT shall verify the identity and employment eligibility of its employees who
perform work under this Agreement, including completing the Employment Eligibility
Verification Form (I-9). Upon request by City, CONSULTANT shall provide City with
copies of all I-9 forms and supporting eligibility documentation for each employee who
performs work under this Agreement. CONSULTANT shall adhere to all Federal and
State laws as well as establish appropriate procedures and controls so that no services will
be performed by any CONSULTANT employee who is not legally eligible to perform
such services. CONSULTANT SHALL INDEMNIFY CITY AND HOLD CITY
HARMLESS FROM ANY PENALTIES, LIABILITIES, OR LOSSES DUE TO
First Renewal of Agreement OFFICIAL,RECORD Page 1 of 3
Circle C Construction Co. ��,�,��� RR� Sewer Main Replacements
Contract 2017
,WORM TX City Project No. 100909
VIOLATIONS OF THIS PARAGRAPH BY CONSULTANT, CONSULTANT'S
EMPLOYEES, SUBCONTRACTORS, AGENTS, OR LICENSEES. City, upon
written notice to CONSULTANT, shall have the right to immediately terminate this
Agreement for violations of this provision by CONSULTANT.
Article IV
The Agreement is hereby amended to include the following language:
Prohibition on Contracts with Companies Boycotting Israel
CONSULTANT acknowledges that in accordance with Chapter 2270 of the Texas
Government Code, the City is prohibited from entering into a contract with a company
for goods or services unless the contract contains a written verification from the company
that it: (1) does not boycott Israel; and (2) will not boycott Israel during the term of the
contract. The terms "boycott Israel" and "company" shall have the meanings ascribed to
those terms in Section 808.001 of the Texas Government Code. By signing this contract,
CONSULTANT certifies that CONSULTANT's signature provides written verification
to the City that CONSULTANT. (1) does not boycott Israel; and (2) will not boycott
Israel during the term of the contract.
Article V
All other provisions of the Original Agreement not expressly amended herein, shall remain
in full force and effect.
EXECUTED by each party's duly authorized representative and EFFECTIVE as of the date
subscribed by the City's designated City Manager.
First Renewal of Agreement Page 2 of 3
Circle C Construction Co. Sewer Main Replacements
Contract 2017
City Project No. 100909
City of Fort Worth Circle C Construction Co.
f
Jesus J. Chapa
Assistant City Manager
DATE: �� DATE:
APPROVAL RECOMMENDED:
Christopher Harder,P.E.
Interim Director, Water Department
APPROVED AS TO FORM AND LEGALITY:
M&C: C-28632
N2Ak==� Date: 3/20/2018
Douglas W. Black
Sr. Assistant City Attorney F Q R T
ATT T: A,
*'
ary J. ser GJ
City SecretaryCA
Contract Compliance Manager
By signing I acknowledge that I am the person responsible
for the monitoring and administration of this contract, including
ens 'ng all performance and reporting requirements.
G.ld/ttit
Si ature
_ L�ujr 2wy av�l I Ow
Name of Employee
OFFICIAL RECORD
Sr. pro ti��a 'cNa i�G�r CITY SECRETARY
Title FI".WORTH,TX
First Renewal of Agreement Page 3 of 3
Circle C Construction Co. Sewer Main Replacements
Contract 2017
City Project No. 100909
City of Fort Worth, Texas
Mayor and Council Communication
COUNCIL ACTION: Approved on 3/20/2018 - Ordinance No. 23143-03-2018
DATE: Tuesday, March 20, 2018 REFERENCE NO.: **C-28632
LOG NAME: 60SSMRC2017R1-CIRCLEC
SUBJECT:
Adopt Appropriation Ordinance in the Amount of$1,300,000.00 to Fund the First Renewal of City Secretary
Contract No. 49693 with William J. Schultz Inc. d/b/a Circle C Construction Company in the Amount of
$1,000,000.00 for Sewer Main Replacements Contract 2017, 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 Replacements Contract 2017. (City Project No. 100909)
DISCUSSION:
On August 29, 2017, Mayor and Council Communication (M&C C-28355) 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 Replacements Contract
2017.
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 February 2018 and be completed by February 2019 or when the contract
amount is exhausted.
M/WBE OFFICE - William J. Schultz, Inc. d/b/a Circle C Construction Company is in compliance with the
City's BDE Ordinance by documenting good faith effort on the first renewal. The City's goal on this project
is seven percent.
This project is located in ALL COUNCIL DISTRICTS.
FISCAL INFORMATION/CERTIFICATION:
The Director of Finance certifies that upon approval of the above recommendation 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 $10,219,740.00.
http://apps.cfwnet.org/ecouncil/printme.asp?id=25679&print=true&DoeType=Print 3/27/2018
Appropriations for the first renewal of the Sewer Main Replacements Contract 2017 project by Fund will
consist of the following:
Fund Existing Additional Project
Appropriations Appropriations Total*
Water Capital Projects
Fund 56002 $1,210,000.00 $1,300,000.00 $2,510,000.00
Project Total $1,210,000.00 $1,300,000.00 11$2,510,000.00
*Numbers rounded for presentation purposes.
FUND IDENTIFIERS (FIDs):
TO
Fund Department ccoun Project Program ctivity Budget Reference# moun
ID ID Year (Chartfield 2)
FROM
Fund Department ccoun Project Program ctfivityj Budget Reference # moun
ID ID Year (Chartfield 2)
CERTIFICATIONS:
Submitted for City Manager's Office by: Jay Chapa (5804)
Originating Department Head: Kenneth Morgan (8246)
Additional Information Contact: Adolfo Lopez (7829)
ATTACHMENTS
1. 60SSMRC2017R1-CIRCLEC 1295.pdf (Public)
2. 60SSMRC2017R1-CIRCLEC Compliance Renewal 1.pdf (CFW Internal)
3. 60SSMRC2017R1-CIRCLEC FID Table(Dan).docx (CFW Internal)
4. 60SSMRC2017R1-CIRCLEC 60 AO 18.docx (Public)
5. 60VVMERR2015AR1-CIRCLEC SAM.pdf (CFW Internal)
http://apps.cfwnet.org/ecouncil/printme.asp?id=25679&print=true&DoeType=Print 3/27/2018
&ay�c�
CERTIFICATE OF INTERESTED PARTIES
FORM 7.295
lofl
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
I Name of business entity filing form,and the city,state and country of the business entity's place Certificate Number;
of business. 12017-293428
William J Schultz Inc dba Circle C Construction Company
Fort Worth,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 12/13/2017
being filed.
City of Fort Worth Date Acknowled ed:
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.
100909
Sewer Main Replacement Contract 2017 First Renewal
Nature of interest
4 Name of Interested Pa rtY C"rty,State,Count ry(place of business) (check applicable)
Controlling Intermediary
Skelly,Teresa Fort Worth,TX United States X
5 Check only it there is NO Interested Party. ❑
6 UNSWORN DECLARATION
My name is Z"--le we a ���i,/ and my date of birth is i/ /3•/s - 9s 7
My address is,500 41 Z:0 r»w,//..&e !of!fL✓`I i fi 72e ZZIZO UM4 .
(street) (city) (state) (zip code) (country)
I declare under penalty of perjury that the foregoing is true and correct. '
Executed in TOL e V-OA - Coon State of L1.�J on the a of 201
(month) (Year)
Signature of authorized agent of con trac' business entity
(Declarant)
Forms provided by Texas Ethics Commission www.ethics.state.tx.us Version V1.0.3337
CITY OF FORT WORTH
CONTRACT COMPLIANCE MEMORANDUM
RENEWAL OPTION
THIS FORM MUST BE ATTACHED TO THE ROUTING "M& C"BEFORE LEGAL AND
7
CITY MANAGER APPROVAL.
To: Adolfo Lopez
(underline appropriate one) Project Manager Buyer Department Director
From: Melani Valle 2675
M/WBE Office Staff Extension
Date: February 22, 2018
In the Amount of$ 1,000,000.00 Water-100909
DOE/Project/Bid Nos .
Project/Bid: Sewer Main Replacements, Contract 2017, 1St Renewal
1. Compliance with the City's Business Diversity Enterprise (BDE)Ordinance has been achieved by one
of the following MBE methods:
a) William J. Schultz, Inc. dba Circle "C" Construction Company is in compliance
with the City's BDE Ordinance by documenting good faith effort on the 1st renewal. The City's goal
on this project is 7%.
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/
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 REPLACEMENTS CONTRACT 2017;
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$1,300,000.00 in the Water Capital Projects Fund, from available funds, for Sewer Main Replacements
Contract 2017.
SECTION 2.
That should any portion, section or part of a section of this ordinance be declared invalid, inoperative or void
for any reason by a court of competent jurisdiction, such decision, opinion orjudgment shall in no way impair
the remaining portions, sections, or parts of sections of this ordinance, which said remaining provisions shall
be and remain in full force and effect.
SECTION 3.
That this ordinance shall be cumulative of Ordinance 22928-09-2017 and all other ordinances and
appropriations amending the same except in those instances where the provisions of this ordinance are in
direct conflict with such other ordinances and appropriations, in which instance said conflicting provisions of
said prior ordinances and appropriations are hereby expressly repealed.
SECTION 4.
This ordinance shall take effect upon adoption.
APPROVED AS TO FORM AND LEGALITY: CITY SECRETARY
Douglas W Black Mary J. Kayser
Sr. Assistant City Attorney
ADOPTED AND EFFECTIVE:
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Cohn ion, )n )nl q 4•4 F DNA Dona 4 of 1
006113- 1
PERFORMANCE BOND
Page 1 of 2
1
2 BOND NO.TXC610149
3 SECTION 00 6113
4 PERFORMANCE BOND
5
6 THE STATE OF TEXAS §
7 § KNOW ALL BY THESE PRESENTS:
8 COUNTY OF TARRANT §
9 That we, William J. Schultz, Inca dba Circle C Construction Company, known as"Principal"
to herein and Merchants Bonding Company (Mutual),, a corporate surety(sureties, if more than one)
11 duly authorized to do business in the State of Texas, known as"Surety"herein (whether one or
12 more), are held and firmly bound unto the City of Fort Worth, a municipal corporation created
13 pursuant to the laws of Texas, known as"City" herein, in the penal sum of, One Million
14 Dollars($ 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 to be made, we bind
16 ourselves, our heirs, executors, administrators, successors and assigns,jointly and severally,
17 firmly by these presents.
18 WHEREAS, the Principal has entered into a certain written contract with the City
19 awarded the day of MAR 20, 2018_, which Contract is hereby referred to and made
20 a part hereof for all purposes as if fully set forth herein, to furnish all materials, equipment labor
21 and other accessories defined by law, in the prosecution of the Work, including any Change
22 Orders, as provided for in said Contract designated as
23 e Renewal-Sewer/Main&2/cements 62ntract ZU17.
24 City Protect Number 100909
25 NOW,THEREFORE,the condition of this obligation is such that if the said Principal shall
26 faithfully perform it obligations under the Contract and shall in all respects duly and faithfully
27 perform the Work, including Change Orders, under the Contract, according to the plans,
28 specifications, and contract documents therein referred to, and as well during any period of
29 extension of the Contract that may be granted on the part of the City, then this obligation shall
30 be and become null and void, otherwise to remain in full force and effect.
CITY OF FORT WORTH MSR2017
STANDARD CONSTRUCTION SPECIFICATION DOCUMENTS City Project Number 100909
Revised July 1,2011
006113-2
PERFORMANCE BOND
Page 2 of 2
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
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,day of MAR Z _
9 PRINCIPAL:
10
11 William J. Schultz, Inc. dba
12 Circle C Construction Company
13
14 BY:
15 Signature
16 ATTEST:
17
18 , , + ( Teresa S. Skelly, President
19 (Principal) Secretary, Michele S. La rd Name and Title
20
21 Address: P. O. Box 40328
22 500 W.Trammell
23 Fort Worth,TX 76140
24
25 Witness as to Principal
26 SURETY:
27 Merchants BoAng Company(Mutual)
28
29 BY:
30 Signature
31
32 Sheryl A. Klutts.Attorney-in-Fact
33 Name and Title
34
35 Address: 6700 Westown Parkway
36 �. West Des Moines, IA 50266-7754
37
38 Witness as to Surety,John A. Miller Telephone Number: (800)678-8171
39
40
41
42 *Note: If signed by an officer of the Surety Company, there must be on file a certified extract
43 from the by-laws showing that this person has authority to sign such obligation. If
44 Surety's physical address is different from its mailing address, both must be provided.
45 The date of the bond shall not be prior to the date the Contract is awarded.
46
CITY OF FORT WORTH MSR2017
STANDARD CONSTRUCTION SPECIFICATION DOCUMENTS City Project Number 100909
Revised July 1,2011
MERCHANT
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-Attorney 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 so used 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
Attorney-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 Attomey-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
.••'pt10�A��'••. .••••� C
OCH Dill .
�� '' p0 `�••: MERCHANTS BONDING COMPANY(MUTUAL)
•ay:'(�a� R4�''0y; VOVkpOR4J;9y,�; MERCHANT NATIONAL BONDING,INC.
Z �' •y •
v' 2003 ;;A; :y 1933 c; By
........:�•••• •�`�!v"�µ''\1�• President
STATE OF IOWA �••""""'•'• •• "•.
COUNTY OF DALLAS ss.
On this this 6th day of April 2017 before me appeared Larry Taylor,to me personalty known,who being by me duty 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.
,PR
"'4 s AUCIA K.GRAM
Z Commission Number 767430
.^ . My Commission Expires
,ow P April 1,2020
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 20th day of March , 2018.
$.'......... •.•......
• � GCQ •
••.•Pt10 Nqt '••. .• O N M•
-0- _ o 00
o
4) .y 1933 c. Secretary
2003 :
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POA 0018 (3/17) •••••••.
0061 14- 1
PAYMENT BOND
Page 1 of 2
1 BOND NO.TXC610149
2 SECTION 00 6114
3 PAYMENT BOND
4
5 THE STATE OF TEXAS §
6 § KNOW ALL BY THESE PRESENTS:
7 COUNTY OF TARRANT §
8 That we, William J. Schultz, Inc., dba Circle C Construction Company, known as
9 "Principal" herein, and Merchants Bonding Company (Mutual), a corporate surety (sureties), duly
10 authorized to do business in the State of Texas, known as "Surety" herein (whether one or
11 more), are held and firmly bound unto the City of Fort Worth, a municipal corporation created
12 pursuant to the laws of the State of Texas, known as "City" herein, in the penal sum of One
13 Million Dollars ($ 1,000,000.00 ), lawful money of the United States, to be paid in Fort
14 Worth, Tarrant County, Texas, for the payment of which sum well and truly be made, we bind
15 ourselves, our heirs, executors, administrators, successors and assigns, jointly and severally,
16 firmly by these presents:
17 WHEREAS, Principal has entered into a certain written Contract with City, awarded the
18 day of MAR 20,E 2018 , 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
22 .1st Renewal—Sewer Main Replacements Contract 2017
23 City BLO.Lect lV[cmher 100909
24 NOW, THEREFORE, THE CONDITION OF THIS OBLIGATION is such that if Principal
25 shall pay all monies owing to any (and all) payment bond beneficiary (as defined in Chapter 2253
26 of the Texas Government Code, as amended) in the prosecution of the Work under the Contract,
27 then this obligation shall be and become null and void; otherwise to remain in full force and
28 effect.
29 This bond is made and executed in compliance with the provisions of Chapter 2253 of
30 the Texas Government Code, as amended, and all liabilities on this bond shall be determined in
31 accordance with the provisions of said statute.
32
CITY OF FORT WORTH MSR2017
STANDARD CONSTRUCTION SPECIFICATION DOCUMENTS City Project Number 100909
Revised July 1,2011
006114-2
PAYMENT BOND
Page 2 of 2
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_,day of MAR 20, 2018.
3
4 PRINCIPAL:
5 William J.Schultz,Inc.dba
6 Circle C Construction Company
7
8 BY:_
9 Signature
10 ATTEST:
11
12 (�� Teresa S. Skelly, President
13 (Principal)Secretary, Michele S. Ld rd Name and Title
14
15 Address: P. O. Box 40328
16 500 W.Trammell
17 Fort Worth,TX 76140
18
19 Witness as to Principal
20 SURETY:
21 Merchants Elondirno Company(Mutual)
22
23 BY: lf 11A_
24 Si nature
25
26 Sheryl A. Klutts,Attorney-in-Fact
27 Name and Title
28
29 Address: 6700 Westown Parkway
30 West Des Moines, IA 50266-7754
31
32 Witness as to Surety,John A. Miller Telephone Number: (800)678-8171
33
34 Note: If signed by an officer of the Surety, there must be on file a certified extract from the
35 bylaws showing that this person has authority to sign such obligation. If Surety's physical
36 address is different from its mailing address, both must be provided.
37
38 The date of the bond shall not be prior to the date the Contract is awarded.
39 END OF SECTION
40
CITY OF FORT WORTH MSR2017
STANDARD CONSTRUCTION SPECIFICATION DOCUMENTS City Project Number 100909
Revised July 1,2011
MERCHANT
BONDING COMPANY-V
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-Attorney 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 Attomeys-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 so used 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 consent ng 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 Attomey-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
..........
ION .•---•.
l�`j.•v�KpOR,4� Oy :•00'.D�P0,9�0. �s; (MUTUAL)
MERCHANTS NATIONAL BONDING,INC.
v' 2003 ,1�; :y 1933 c; By
•�% •'•6� \1a 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 duty swom
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.
rAt
. 5, AUCIA K.GRAM
o Commission Number 767430 -
My Commission Expires
April 1,2020
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 20th day of March , 2018.
��.••PZ10 Nq�••.•• 'poG CQM•.•
2003 1933 c' Secretary
', :gib. •;�o.•
POA 00 18 (3/17) "" ••••••••
006119-1
MAINTENANCE BOND
Page 1 of 3
1
2 BOND NO.TXC610149
3 SECTION 00 6119
4 MAINTENANCE BOND
5
6 THE STATE OF TEXAS §
7 § KNOW ALL BY THESE PRESENTS:
8 COUNTY OF TARRANT §
9
10 That we, William J. Schultz, Inc., dba Circle C Construction Companyr known as"Principal"
11 herein and Merchants Bonding Company (Mutual), a corporate surety (sureties, if more than one)
12 duly authorized to do business in the State of Texas, known as"Surety"herein (whether one or
13 more), are held and firmly bound unto the City of Fort Worth, a municipal corporation created
14 pursuant to the laws of the State of Texas, known as"City"herein, in the sum of One Million
15 Dollars (s 1,000,000.00 ), lawful money of the United States, to be paid in Fort Worth,
16 Tarrant County, Texas, for payment of which sum well and truly be made unto the City and its
17 successors, we bind ourselves, our heirs, executors, administrators, successors and assigns,
18 jointly and severally, firmly by these presents.
19
20 WHEREAS, the Principal has entered into a certain written contract with the City awarded
21 the day of MAR 20, 2018 , which Contract is hereby referred to and a
22 made part hereof for all purposes as if fully set forth herein, to furnish all materials, equipment
23 labor and other accessories as defined by law, in the prosecution of the Work, including any
24 Work resulting from a duly authorized Change Order(collectively herein, the"Work'D as provided
25 for in said contract and designated as
26
27 1 Renewal—Sewer Main Replacements Contract 2017
28 City Proiect Number 100909
29
30 WHEREAS, Principal binds itself to use such materials and to so construct the Work in
31 accordance with the plans, specifications and Contract Documents that the Work is and will
32 remain free from defects in materials or workmanship for and during the period of two (2)
33 years after the date of Final Acceptance of the Work by the City ("Maintenance Period'; and
34
CITY OF FORT WORTH MSR2017
STANDARD CONSTRUCTION SPECIFICATION DOCUMENTS City Project Number 100909
Revised July 1,2011
006119-2
MAINTENANCE BOND
Page 2 of 3
1 WHEREAS, Principal binds itself to repair or reconstruct the Work in whole or in part upon
2 receiving notice from the City of the need therefor at any time within the Maintenance Period.
3
4 NOW THEREFORE, the condition of this obligation is such that if Principal shall remedy
5 any defective Work, for which timely notice was provided by City,to a completion satisfactory to
6 the City, then this obligation shall become null and void; otherwise to remain in full force and
7 effect.
8
9 PROVIDED, HOWEVER, if Principal shall fail so to repair or reconstruct any timely
10 noticed defective Work, it is agreed that the City may cause any and all such defective Work to
11 be repaired and/or reconstructed with all associated costs thereof being borne by the Principal
12 and the Surety under this Maintenance bond; and
13
14 PROVIDED FURTHER, that if any legal action be filed on this Bond, venue shall lie in
15 Tarrant County, Texas or the United States District Court for the Northern District of Texas, Fort
16 Worth Division; and
17
18 PROVIDED FURTHER, that this obligation shall be continuous in nature and successive
19 recoveries may be had hereon for successive breaches.
20
21
22
CITY OF FORT WORTH MSR2017
STANDARD CONSTRUCTION SPECIFICATION DOCUMENTS City Project Number 100909
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
2 instrument by duly authorized agents and officers on this the day of
3 MAR 20, 2018.
4
5 PRINCIPAL:
6 William J. Schultz, Inc.dba
7 Circle C Construction Company
8
9 BY:
10 Signature
11 ATTEST:
12
13 (Jar Old Teresa S. Skelly, President
14 (Principal)Secretary, Michele S. Lan rd 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 Soniina Com an Mutual
23
24 BY:
25 Signature
26
27 Sheryl A. Klutts,Attorney-in-Fact
28 Name and Title
29
30 Address: 6700 Westown Parkway
31 West Des Moines, IA 50266-7754
32
33 fitness as to Surety,John A. Miller Telephone Number: (800)678-8171
34
35
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.
CITY OF FORT WORTH MSR2017
STANDARD CONSTRUCTION SPECIFICATION DOCUMENTS City Project Number 100909
Revised July 1,2011
MERCHANT
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 Attomey(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 seat 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 so used 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 consenti ng 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 Attomey-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
•'� ION �'. .•• ••.
�hy.GQ�pQ/P4� oy: :•Op�O�pQA •!�•�•: MERCHANTS BONDING COMPANY(MUTUAL)
V 9 • MERCHANTS NATIONAL BONDING,INC.
2003 1933 "e: By
•........ .•• •••!y '1µ" \ •• 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.
"`4 s AUCIA K.GRAM
o Commission Number 767430
? My Commission Expires
„NApril 1,2020
Notary Public
(Expiration of notary's commission
does riot 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 rat been amended or revoked.
In Witness Whereof, I have hereunto set my hand and affixed the seal of the Companies on this 20th day of March , 2018.
.• p p�N ..CQ.
'PO' 4•: 'Off•''•PO 'p• i'r/ �%✓
v 2003 1933 c; Secretary /
PDA 0018 (3/17) •���...�;..••?•• •'••...••'
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)
A�® DATE(MM/ Y)
CERTIFICATE OF LIABILITY INSURANCE Dano/20182018
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 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 CONTACT Kim Wright
NAME:
K&S Insurance Agency H NNo Ext): (972)771-4071 No: (972)771-4695
2255 Ridge Road,Ste.333 E-MAIL kwright@kandsins.com
ADDRESS:
P.O.Box 277 INSURER(S)AFFORDING COVERAGE NAIC k
Rockwall TX 75087 INsuRERA: United Fire&Casualty Company 13021
INSURED INSURER B: Travelers Prop Cas Cc of Amer 25674
William J Schultz,Inc. INSURER C: Bridgefield Casualty Insurance Cc 10335
dba Circle C Construction Company INSURER D: Federal Insurance Company 20281
500 W.Trammell Ave. INSURER E:
Everman TX 76140 INSURER F:
COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
THIS IS TO CERTIFYTHAT 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 ADDL 5tJBR POLICY EFF POLICY EXP LIMITS
LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER MM/DD/YYYY MM/DD/YYYY
X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000
DAMAGE TO RENTED
CLAIMS-MADE Fx_]OCCUR PREMISES Ea occurrence $ 100,000
MED EXP(Any one person) $ 5,000
A 85316434 08/12/2017 08/12/2018 PERSONAL&ADV INJURY $ 1,000,000
GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000
POLICY ❑X PRO- LOC PRODUCTS-COMP/OPAGG $ 2,000,000
OTHER: Limited Jobsite Pollution $ 100,000
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000
Ea accident
X ANY AUTO BODILY INJURY(Per person) $
A OWNED SCHEDULED 85316434 08/12/2017 08/12/2018 BODILY INJURY(Per accident) $
AUTOS ONLY AUTOS
HIRED NON-OWNED PROPERTY DAMAGE $
X AUTOS ONLY IX
AUTOS ONLY Per accident
X UMBRELLA LIABX OCCUR EACH OCCURRENCE $ 5,000,000
B EXCESS LIAB CLAIMS-MADE ZUP41M1142817NF 08/12/2017 08/12/2018 AGGREGATE $ 5,000,000
DED I X1 RETENTION$ 10,000 $
WORKERS COMPENSATIONX1 STAPERTUTE ERH
AND EMPLOYERS'LIABILITY Y/N 1,0001000
C ANY PROPRIETOR/PARTNER/EXECUTIVE N N/A 0196-43838 08/12/2017 08/12/2018 E.L.EACH ACCIDENT $
OFFICER/MEMBER EXCLUDED. 1,000,000
(Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $
If yes,describe under 1,000,000
DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $
Per Item Limit $500,000
D Leased/Rented Equipment 06706289 08/12/2017 08/12/2018 Maximum Limit $500,000
DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached If more space is required)
Project:Sewer Main Replacements Contract 2017 Renewal One
City Project Number 100909
See attached for additional information.
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN
The City of Fort Worth ACCORDANCE WITH THE POLICY PROVISIONS.
1000 Throckmorton Street
AUTHORIZED REPRESENTATIVE
Fort Worth TX 76102 A '- W/-
1988-2015
1988-2015 ACORD CORPORATION. All rights reserved.
ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD
COMMENTS/REMARKS
Additional Insured - Ongoing Operations Form #CG2010 04/13 and Additional Insured -
Completed Operations Form #CG2037 04/13, Waiver of Subrogation Form #CG7208 02/15 and
Primary & Non-Contributory Form #CG2001 04/13 apply to the General Liability Policy.
Additional Insured & Waiver of Subrogation form #CA7109 01/17 and Primary &
Non-Contributory form #CA7334 09/15 apply to the Business Auto Policy.
Waiver of Subrogation Form #WC420304B 06/14 applies to the Workers Compensation Policy.
*ALWAYS REFER TO THE ATTACHED POLICY FORMS FOR SPECIFIC WORDING OF SUCH COVERAGE, LIMITS,
CONDITIONS & EXCLUSIONS.
OFREMARK COPYRIGHT 2000, AMS SERVICES INC.
POLICY NUMBER: 85316434 COMMERCIAL GENERAL LIABILITY
CG 20 10 04 13
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
ADDITIONAL INSURED - OWNERS, LESSEES OR
CONTRACTORS - SCHEDULED PERSON OR
ORGANIZATION
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
SCHEDULE
Name Of Additional Insured Person(s)
Or Organization(s) Locations Of Covered Operations
ANY PERSON OR ORGANIZATION TO WHOM LOCATIONS DESIGNATED AND
YOU HAVE AGREED TO NAME AS ADDI- DESCRIBED IN THE ABOVE
TIONAL INSURED BY WRITTEN CONTRACT MENTIONED WRITTEN CONTRACT
OR AGREEMENT IF THE CONTRACT OR OR AGREEMENT
AGREEMENT IS EXECUTED PRIOR TO LOSS
Information required to complete this Schedule, if not shown above, will be shown in the Declarations.
A. Section II — Who Is An Insured is amended to B. With respect to the insurance afforded to these
include as an additional insured the person(s) or additional insureds, the following additional
organization(s) shown in the Schedule, but only exclusions apply:
with respect toliability for "bodily injury", "property This insurance does not apply to "bodily injury" or
damage ,or personal and advertising injury "property damage" occurring after:
caused, in whole or in part, by:
1. All work, including materials, parts or
1. Your acts or omissions; or equipment furnished in connection with such
2. The acts or omissions of those acting on your work, on the project (other than service,
behalf; maintenance or repairs) to be performed by or
in the performance of your ongoing operations for on behalf of the additional insured(s) at the
the additional insured(s) at the location(s) location of the covered operations has been
designated above. completed;or
However: 2. That portion of "your work" out of which the
injury or damage arises has been put to its
1. The insurance afforded to such additional intended use by any person or organization
insured only applies to the extent permitted by other than another contractor or subcontractor
law; and engaged in performing operations for a
2. if coverage provided to the additional insured is principal as a part of the same project.
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.
CG 20 10 04 13 0 Insurance Services Office, Inc.,2012 Page 1 of 2
C. With respect to the insurance afforded to these 2. Available under the applicable Limits of
additional insureds, the following is added to Insurance shown in the Declarations;
Section III—Limits Of Insurance: whichever is less.
If coverage provided to the additional insured is This endorsement shall not increase the
required by a contract or agreement, the most we applicable Limits of Insurance shown in the
will pay on behalf of the additional insured is the Declarations.
amount of insurance:
1. Required by the contract or agreement;or
Page 2 of 2 0 Insurance Services Office, Inc., 2012 CG 20 10 04 13
POLICY NUMBER: 85316434 COMMERCIAL GENERAL LIABILITY
CG 20 37 04 13
THIS ENDORSEMENT CHANGES THE POLICY, PLEASE READ IT CAREFULLY.
ADDITIONAL INSURED - OWNERS, LESSEES OR
CONTRACTORS - COMPLETED OPERATIONS
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART
SCHEDULE
Name Of Additional Insured Person(s)
Or Organization(s) Location And Description Of Completed Operations
ANY PERSON OR ORGANIZATION TO WHOM LOCATIONS DESIGNATED AND
YOU HAVE AGREED TO NAME AS ADDI- DESCRIBED IN THE ABOVE
TIONAL INSURED BY WRITTEN CONTRACT MENTIONED WRITTEN CONTRACT
OR AGREEMENT IF THE CONTRACT OR OR AGREEMENT
AGREEMENT IS EXECUTED PRIOR TO LOSS
Information required to complete this Schedule if not shown above, will be shown in the Declarations.
A. Section II — Who Is An Insured is amended to B. With respect to the insurance afforded to these
include as an additional insured the person(s) or additional insureds, the following is added to
organization(s) shown in the Schedule, but only section III—Limits Of Insurance:
with respect to liability for "bodily injury" or If coverage provided to the additional insured is
"property damage"caused, in whole or in part, by required by a contract or agreement, the most we
"your work" at the location designated and will pay on be half of the additional insured is the
described in the Schedule of this endorsement amount of insurance:
performed for that additional insured and 1. Required by the contract or agreement; or
included in the "products -completed operations 2. Available under the applicable Limits of
hazard". Insurance shown in the Declarations;
However:
1. The insurance afforded to such additional whichever is less.
insured only applies to the extent permitted This endorsement shall not increase the applicable
by law; and Limits of Insurance shown in the Declarations.
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.
CG 20 37 04 13 0 Insurance Services Office, Inc., 2012 Page i of i
Policy #85316434
COMMERCIAL GENERAL LIABILITY
CG 20 01 0413
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
PRIMARY AND NONCONTRIBUTORY -
OTHER INSURANCE CONDITION
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART
The following is added to the Other Insurance (2) You have agreed in writing in a contract or
Condition and supersedes any provision to the agreement that this insurance would be
contrary: primary and would not seek contribution
Primary And Noncontributory Insurance from any other insurance available to the
additional insured.
This insurance is primary to and will not seek
contribution from any other insurance available
to an additional insured under your policy
provided that:
(1) The additional insured is a Named Insured
under such other insurance; and
CG 20 01 04 13 0 Insurance Services Office, Inc., 2012 Page 1 of 1
Policy #85316434
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
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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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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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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 1 — 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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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 1.f. 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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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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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
ii. 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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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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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;
ii. 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
ii. 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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CG 72 08 02 15
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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CG 72 08 02 15
(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:
f.(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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CG 72 08 02 15
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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Policy #85316434
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.
CA 71 09 01 17 Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 1 of 7
(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 11 — 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 II. 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 earning 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:
(Towing 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
limits:
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) Carry-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.
CA 71 09 01 17 Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 5 of 7
(Amended Duties in the Event of Accident, Claim, Suit or toss)
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 5. 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.
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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" overturn. 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. 6-141
"Includes copyright material of the National Council on Compensation Insurance, Inc.used with its permission.Copyright 2014 NCCI"