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00524 -1
Agreement
Page I of 4
1 SECTION 00 52 43
2 T' S AG NT, authorized Can JuIv 9 2013 is made her and between the City of Forth
rth.
Worth, a Texas home rule municipality, acting by and through its duly authorized C ty Manager,
4 ("City"), and JET UNDERGROUND UTILITIES, authorized to do business in Texas,
5 acting by and through its duly authon*zed representative, ("Contractor").
r)..
City and Contractor, in consideration of the mutual covenants hereinafter set forth, agree as
7 follows
I,
8 Article 1.WORK
Contractor shall complete all, Work as specified or indicated in the Contract Documents for the
1 10 project Identified herein.
12 The project for which the Work under the Contract Documents,may he the whole or only a part is
13 generally described as follows.-
14 RECONSTRUCTION �F PRENIATUREFAILED STREETS, ACT NO. 5
15 CITY PROJECT NO. 02097
16 Arti"cle 3. CONTRACT TEME,
17 11 Time is -the essence.
18 All time limits for Milestones, if any, and Final Acceptance as stated in the Contract
19 Documents are of the essence to this Contract.
POP
0 3.2 Final Acceptance.
21 The Work will be complete for Final Acceptance within 210 days after t: e date when the
2 Contract Time commences to run as provided in paragraph 2.03 of the General Conditions.
tions.
23 3.3 Liquidated damages
lm! 24 Contractor recognizes that time is, of the essence of this
Agreement and thatC City will
25 suffer financial loss if the Work is not completed within the tunes spcei ffied gin.Paragraph
26 3.2 above, plus any extension thereof allowed in accordance with Article 12 of the
27 General Conditions. The Contractor also recognizes the delays, expense and difficulties,
28 involved in proving in a legal proceeding,the actual loss suffered by the City if the Wort
29 is not completed on tine. Accordingly, instead of requiring any such proof, Contractor
1�
30 agrees that as liquidated damages for delay (but not as a penalty Contractor shall pad'
31 City Six Hundred i Dollars $65 . 0) for each day that expires after the time
32 specified in Paragraph 3.2 for Final Acceptance until the City issues the Final Letter of
33 Acceptance.
r :
CITY OF FORT WORTn RECONSTRUCTION RUCTIO OF PREMATURE FAILED STREET'
STANDARD CONSTRUCTION UCTION SPECIF CATIO DOCUMENT'S CONTRACT NO.
Revised November 09,20 11 CITY Y:PROJECT NO 02097
00 52 4: -2
recment
PRO Fags 2 of
4 Article 4.CONTACT PRICE
35 City agrees to pay C:ontrac or por perf .ance o he r �n accordance with he Contract
3 'Documents arnunt in current undo ONMILLION EIGHTY TWO THOUSAND
37 FOB HUNDRED ONE DOLLARS AND SEVENTY SEVEN C i S (j.1j0822401.77
OR 38 Article 5 CONTRACT DOC S
391 51 CONTENTS.
"111,.<
40 A. The Contract Documents which comprise the entire agreement between City and
1 Contractor concerning the Work consist of the following:
42 1. This Agreement.
43 2. Attachments to this Agreement.
44 a. :did Form
45 1 Proposal Form
46 2 Vendor Compliance to State Law on old nt Bidder
47 3 Prequalification Statement
4 State and Federal documents(project specific)
49 {b. Current Prevailing Wage Rate'Table
510 e. Insurance ACRD Form(s)
t d. "Payment Bond
52 e... Performance fond.
53 f Maintenance Bond.
4 go Power of Attorney for the Bonds
55 lo. Worker's Compensation Affidavit
56 1. E Commitment Form
557 31. General Conditions.
4. Supplementary Conditions.
5. Spec if cations spec f Bally made a. part of the Contract Documents by attachment
car, if not a aBl ed as incorporated by reference and described in the Table of
61. Contents ofthe Projects Contract Documents.
62 61. Drawings.
'. addenda.
4 8. 'Documentation submitted by Contractor prier to Notice of Award.
5 9. The following which may be delivered or 'Issued after the Effective Date of the
66 Agreement,and, if issued, become an incorporated part of the Contract Documents.
67 a.. Notice to Proceed.
b. Field Orders.
c. Change Orders.
d.. Letter of Feral Acceptance.
M
00
CITY OF FORT WORTH RECONSTRUCTIDN OF PREMATURE FAILED STREM'S
STANDARD CONSTRUCTION SPECIFICATION DOCUMENTS CONTRACT NO.5
Revised November 09,2011 t~,l TY PROJECT NO 02097
005243-3
Agreement
Page 3 of 4
72 Article 6.WDEMNIEFICATION
73 6.1, Contractor covenants and agrees to indemnify, hold harmless and defend, at its own
74 expense, the city, its officers, servants and employees, from and against any and all
75 claims arising out o�f, or alleged to arise out of,the work and services to be performed
ed.
76 by the contractor., its officers., agents, employees, subcontractors, licenses or invitees
77 under this contract. This indemnification nification ro° sion is s ecifi+cali intended to operate
78 and he effective even if it is ale ed or proven that all or some of the damages bein
79 sought were caused in whole or in oart, by all act omission or ne li ence of the ci
If This 'indemnity provision is intended to include, without limitation,, indemnity for
costs,expenses and legal fees incurred by the city in,defending against snuh claims and
2 causes of actions.
84 6.2 Contractor covenants and agrees to indemnify and hold harmless, at its own expense,
5 the city,its officers,servants and employees,from and,against any and all ion,damage
or destruction of property of the city, r"sing„out of,o r alleged to arise out of,the work
7 and services to be performed by the contractor, its officers, agents, employees,
subcontractors., licensees or invitees render, this contract. "his indemnification
1, provision is s ecificali %rrtended to operate seed be effective even i it isalleged or
proven that all or some of the damages being sought were cause d in whole or in p curt
1 bj aly act omission or,ne ii ence of the cl
'O,, 2
Article 7. :MISCELLANEOUS
4 7.1 Tereus.
95 Terr�.s used i.n this Agreement which are defined in Article 1. of the General Conditions wl 1
have the meanings indicated in the general Conditions.
I -
7 7.2 Assignment of Contract.
98 his Agreement, including all of the Contract Documents may not be assigned by the
"IM 99 Contractor without the advanced express written consent of the City.
oo 7.3 Successors and assigns.
'101 City and Contractor each binds itself, its partners, successors, assigns ana, legal
102 representatives to the other party, hereto, in respect to all covenants, agreements and
013 obligations contained ire the Contract Documents.
104 SeverabI I ity.
05 Any provision or part of the Contract Documents held to be unconstitutional, void or
106 unenforceable by a court of competent jurisdiction shall be deemed stricken, and all
107 remaining provisions shall continue to be valid and binding upon CITY and
108 CONTRACTOR.
109 7.5 Governing.haw and Venue.
1,10 This Agreement, including all. of the Contract Documents is performable in the State of
Texas. Venue shall be Tarrant County, Texas, or the United States District Court: for the
112 Northern District of Texas,Fort Worth Division.
CITY OF FORT WORTH RECONSTRUCTI.N of PREMNIURE FAILED STREETS
STANDARD co;NsTRucrION SPE IFICATioN DOCUMENTS CONTRACT NO,
Revised November,095 2011 CITY PROJECT NO 02097
00 2 43-4
Agreement
Page 4 of 4
113 7.6 Other Provisions.
MI 114 The Contractor agrees to pay at least minimum wage per hour for all labor as the same is
115 classified, promulgated and set out by the City, a copy of which is attached hereto and
116 made a part hereof the same as if it were copied verbatim herein.,
117 7.7 Authority to Sign.
118 Contractor shall attach evidence of authority to sigri Agreement, if other than duly
119 authorized signatory of the Contractor.
r.
120
121 IN WITNESS OF City and Contractor have executed this Agreement in multiple
122 counterparts.
123
124 This Agreement is effective as of the last date signed by the Parties("Effective Date").
125
ontraeto
*City off Worth
all
B
Fernando Costa
Assistant City Manager
l ture)
iV�„
Date "
Attest.-
f
P"rinted Nat e �� S e��'
(Se�al) A
T tle
0
address:
P0
M&C, C- �
N,„ Date
C1 'Mate' - Approved as to Forte and Legality:
nAA
Date � 6�'. k M,+ C
Assistant City Attorney
126
17
12 .OVAL RECOMMENDED:
°PIR 1.2
130
131
132 Douglas . Wiersi , P.E.
133 DIRECT
134 Transportation and'Public W Vks
13
IM
/F OFFICIAL, CORD
CITY 3ECRETARY
no WORT"f YX
0117 OF FORT WORTH ,. T ,FA C :�' �
STANDARD CONSTRtJCTfON SPECIFICATION DOCUMENTS CONTRACT NO,5
Revised November 09,,2011 CITY I ROKCT"NO 02097
00 61 3-1
Bond NCB-, 769957P PERFORMANCE BOND
Page 1 of 2
lea;
SECTION 00 6113
PERFORMANCE
3
STATE OF TEXAS
5 § KNOW ALL BY PRESENTS.
COUNTY OF T
7 That ' ,Jet-Underground Vtilikm Inc T ' ei a herein and
Developers Inden � sureties more than
one)duly authonized to do husiess in the State of Texas,known as"Surety"here (whether one
'»
10 or are),are held and firmly mound unto the City of Fort Worth, a municipal corporati
006113
PERFORMANCE BOND
pop 2 of
,1
"'I's bond is made and executed compliance with the provisions of Chapter 2253 of the
_- 2 Texas Goverment Code,as amended,and all liabilities on this bond shall be determined e' M
MONO 3 accordance with the provisions of said statue.
IN VVITNES,S VdNREOF,the Principal and the Surety have SIGNED and SEALED
5 this instrument by duly author ze agents and officers can this the 29th daffy of� July .
6 20131
7' PRINCIPAU
8 Jet Underground Utilities,Inc.
9 11 A
to
1 BAY:
13 ATTEST.-
J
16 (Principal):�� � :dame and Title
17
Address:PO Box 800669
wow
19 Balch Springs,TX 7518
o
2
2 Wit*s as to Principal
23 S T:
�P Developers Surety and Indemnity
5 Company
f
� ru rF
2118
..
,de�tr� �n�I McIntosh,Attorney- n act
a� °
Name and Title
. 3, Address:PO Box 19725
34 Irvine,CA 92623
36 071, ro v"Q �Coni Kra el" Witness to Surety (9 '' 2 3
319
4,O
4 *Note: If signed by an officer of the Surety Company,there must be e-n file a certified extract
from the by-laws showing that this person has ority to Sig such obligation. If
3 Surety s,physical address pis different from its mailing address, both mint be provided.,
4 The date of the bond shall not be prior to the date the Contract is award.
5
CITY OF FORT WORT14 RECONSTRUCTION OF PREMATURE,FAILED STREETS
CONTRACT NO.5
STANDARD CONSTRUE
Revisled.duly 1,2011 CITY PROJECT NO 02097
1
61 14-I
P k MENT BOND
Bond No: 769957P Page I oT'2
5,
SECTION 00 6114
J 2 PAYMENTBOND
3
4 THE STATE OF TEXAS
5 § KNOW ALL BY THESE PRESENTS.
6 COUNTY OF T
herein,7 That we, Jet UndeMround Utilities. known as "Principal" d
8 Pevel2pers $ure!3Land I + e n Company._ a corporate surety
(sureties), duly authorized to do busies 'in the State of Texas, known " " herein
(whether one e or more), are held and firmly bound unto the City of Fort Worth, a municipal,
corporation created pursuant to a laws of to ,State of Texas, o "'City" herein, in the
IMP
2 penal sum of ONE MILLION' EIGHTY O THOUSAND FOUR HUNDRED ONE
13 DOLLARS AND SEVENTY SEVEN CE � a money of the United.
14 States, to be paid *in Fort Worth, Tarrant County, Texas, for the payment of which sum well and
5 y he made, we bind nd ourselves, our heir, executors, administrators, successors and assigns,
6 jointly and severally,firmly by these presents.
.. WHEREAS,AS, 'r inc peal has entered into a ce rtain w° tten Contract with City, awarded the
IS 9,day of ""..013 which Contract is hereby referred to and made a part hereof for all purposes
Mom
19 as if filly, set Barth here*in to furnish all matenials, equipment, labs and ether accessories as
20 defined by law, in the p►re gut on of the Work as provided for m said Contract and designated as
21 RECONSTRUCTION OF PREMATURE FAILED STREETS, CONTRACT NO. 5, CITY
22 PROJECT NO 02097.
23 NOW, THEREFORE, THE CONDITION OIF THIS OBLIGATION s such mat if
r iei in Principal all monies a t+ any (and a net rd benef
- 25 Chapter 2253 of the Texas Government Cede, as amended) in the prosecution of the Work under,
26 the Contract, ra this obligation shall d once null d voids otherwise t rema in fu
2 force and effect.
28 This bond is made and executed 'in compliance with the provisions of Chapter 2253 of the
29 Texas Government Cie, as amended, and all liabilities on this bored shall be det iced in
accordance with:the provisions of said statute.
CITY OF FORT WORTH RECONSTRUCTION OF PREMATURE FA LED STREETS
Revised STANDARD CONSTRUCTION SPECIFICATION DOCUMENTS CONT7ZACT NO.5
July 1,2011 CITY PROJECT NO 02097
J
0061 14-2
PAYMENT BOND
Page 2 of 2
1
1 M WITNESS VMREOF, the Principal and Surety have each SIGNED and SEALED
2 this instrument by duly authorized agents and officers on this the day of
3 Juu 2013
4
PRINCIPAL:
r Jet Underground Utilities, Inc.
ATTEST.- BY �.
Si
0 W jr
rmct a Secretes Name and Title
� Address: PO,Box 8010669.
Balch Springs,TX 75180
Y
Wi Ss as to "rincipal
IMP � � SURETY.-
ev+ l r ers Surety and Indemnity
Company
n � n
.. ATTEST. BYhWyp'`" I
„e
See Power ofAttorney ,Jeffrey Todd McIntosh,Attorney-in-Fact
(Surety),Secretary Name and Title
f Address. Pew Box 19725
Irvine,CA 92623
avuL ISI-V
N, Witness as to Surety nn n le Kregel
Tele° hone No r � �+ .�-33d
5
Note: if signed by an officer of the Su"ety, there must be on file a certified a ct from the
bylaws showing that this person has authority to sign such obligation. If Surety's physical
address is different from its mail ing address,both must be provided.
The date of the bond shall not be Pn or to the date the Con t is awarded.
1 END OF SECTION
12
CrFY OF FORT WORTH RECONSTRUCnON OF PREMATURE FAILED STREETS
STANDARD CONSTRUCTION SPECIFICATION DOCUMENTS CONTRACT NO.5
Rvised July 1 2011 CITY PROJECT NO 02097
OF,d
i
00 1
MAINTENANCE BOND'
Bond N . 769957P Page I of 3
,.
2 SECTION 00 6119
3 MAR4TENANCE BOND
4
5 THE STATE OF TEXAS
6 § KNOW ALL BY THESE PRESENTS:
NMI 7 COUNTY OF TARRANT §
8
That we Jet Underaround U 1 ti Inc. known as"Principal"here and
10 Devel ►
pers and I dl C m an a corporate s ty(sureties, fmore e than
one)duly authorized to do business ss*in the State of Texas,known as"Surety herein(whether one
I .2 or more), are held and firmly bound unto the City of Fort Worth, ,a municipal corporation, created
, "City" � O
13 pursuant to�e lames of'the State Texas, as +�i e�m, �the sun of
14 MMLION EIGHTY TWO THOUSAND FOUR HUNDRED ONE DOLLARS AND
15 NE SEVEN CENTS($13082J§1.77), lawful money of the United States,to be paid in
16 Fort Wurth Tarrant County, Texas,for payment of which sum well and truly be made unto th e
17 City and 'Its successors we hind ourselves,our 1eis,executors,administrators, successors and
18 assigns,jointly and severally, firmly by these presents.
1
�,,
2 AS e Principal has entered t a certain written contract with the City awarded
21 the 9 day of which Contract is nereoy,referred to d a made part hereof for all
purposes as f full ►set forth here'4 to furnish all.materials,equipment labor and other accessories
23 as,deed by law, 'in the prosecution of the Work, including any Work resulting from a duly
24 authorized Change Order(collectively herein,the'' nrl" provided for in said contract and
1 designated as RECONSTRUCTION OF PREMATURE FAILED STREETS,,CONTRACT NO.
26 5,CITY PROJECT NO 02097; and
27
S,Principal blinds itself to use such materials,and to so construct the Work in
,I 29 accordance with the plans,,specifications and Contract Documents that the Wow is and will
rem a' fr def t *n materials er wor sh p�for d durMg the per of tin(2 ears
t after the date of Final Acceptance of the Work by the City "Maitenance Period"); and
2
CTS OF FORT WORTH RECONSTRUCTION OF PREMATURE FILED STREETS
STANDARD NS ION SPECIFICATION DOCUMENTS CONTRACT NO.5
Revised W1y 1,,2011 CITY PROJECT .02097
006] 19-2
MAINTENANCE BOND
W2 of3
Y
WHEREAS,Principal binds itself to repair or reconstruct the work in whole or in part
2 upon receloving notice from the City of the need therefor at any time within the Maintenance
3 Pen"od.
5 NOW THEREFORE,the condition of this obligation is such that if Principal shall.
remedy any defective W rK for which timely notice pfovided by City,to a completion
1
7 satisfactory to the City,then this obligation �shall become null and void,otherwise remain in
8 ffill force and effect.
91
to PROVIUDED,HOWEVER, 'if Principal shall fall so to repair or reconstruct any tinely
noticed defective e Work it is agreed that the City may cause any and all such defective work to
2 be repaired and/or reconstructed with all associated costs,thereof being borne by the Principal,and
3 the Surety under this Maintenance bond;
,r, and
t
5 PROVUDED FURTHEK that if any legal action be filed on this Bond,venue shall lie In
6 Tarrant County,Texas or the United States District Court for the Northern District of Texas,Fort
7 Worth Division; and,
9 PROVIDE t this obligation shall he continuous In nature and
IMP 2 successive recoveries may be had hereon for successive breaches.
2.
Ff OF FORT WORTH RECONSTRUCTION ION OF PREMATURE FAILED STREETS
STANDARD CONSTRUCTION SPECIFICATION DOCUMENTS CONTRACT NO.5
Revised July 1,2011 CITY PROJECT NO.02097
l
0061 19-x,
MAINTENANCE BO I
p 3 Of
/009
I IN WnWESS WHEREOF.,the Principal and the Surma have each SIGNED SEALED this
2 meat by duly authorized agents and officers on this the 29th day of' duly
3 ,20 ,
4
5 PRINCIPAL:Jet n �er r+ n LJtities,Inc.
7
9 Y
1
f ATTEST:
12 Av
...............
�- 13
4 tKin-cipal) ►..
1 .PO Box 800669
7 Balch Springs,TX 75180
19
20 Witness a Principal
21 SURETY:
I'M 22 evelo rs Surety and Indemnity
"�
��
Company
�1
25 BY0.
�Ty
26
7
Jeffrey To l d McIntoshl,Attorney-in-;Fact
ATTEST. Name and Tilde
30*11
1 See Power of Attorney Address.-PO Box 19725
32 (Surety)Secretes Irvine,CA 92623
3
3
35 Witness as to Surety cownlie Kregel Telephone Numben- (949)263-3300
ass 3
37' *Note. If signed by an officer of the Surety Company,there must be on file a certified extract
38 from the by-laws sh+ w g that this person has, authority to sign such obligation. If
39 Surety's physical address is different ftom. *its mailing address, both must be provided.
w The date of the bond shall not be p n*or to the date the Contract s awarded.
1
,;
u CITY OF FORT WORTH RECONSTRUCTION OF PREMATURE FAILED STREETS
STANDARD CONSTRUCTION SPECEFICATION DOCUMENTS CONTRACT NO.5
Revised July 13,2011 C,rf'1 PROJECT N .02097
POWER OF ATTORNEY FOR
DEVELOPERS SURETY AND INDEMNITY COMPANY
PC Box 19725,IRVINE,CA 9262 (949)263.3300
KNOW ALL BY THESE PRESENTS that except as expressly limited,DEVELOPERS SURETY AND INDEMNITY COMPANY,does hereby make,constitute and appoint:
***Jeffreys Todd McIntosh,Connie Assn Kregel,jointly or severally***
+� as its true and lawful Attorneys)-in-Fact,to male,execute,deliver and acknowledge,for and on behalf of said corporation,as surety,bonds,undertakings,and contracts of suretyship
giving and granting unto said Attorney(s)-in-Fact full power and authority to do and to perform every act necessary,requisite or proper to be done in connection there v With as each of said
corporation could do,but reserving to each of said corporation full power of substitution and revocation,and all of the acts of said Attorney(s)-in-Fact,pursuant to these presents,are
hereby;~ratified and confirmed.
I MR
This Power of Attorneys is granted and is signed by facsimile under and by authority of the fallowing resolution adopted l by the Board of Directors of DEVELOPERS SURETY AND
INDEMNITY COMPANY,effective as of January 1st,2008.
RESOLVED,that a combination of any two of the Chairman of the Board,the President,any Executive Vice-President,Senior Vice-President or "ice-President of the
N.,
corporation be,and that each of them hereby is,authorized to,execute this Power of Attorney,qualifying the adorney(s)named in the Power of Attorney to e�xe�cute,on behalf of the
corporation,bonds,undertakings and contracts of suretyship;and that the Secretary or any Assistant Secretary of the corporation be,and each of them hereby is,authorized to attest the
execution of any such Power of Attorney;
RESOLVED,ED,FURTHER,that the signatures of such officers may be affixed to any such Power of Attorney or to any certificate relating thereto by facsimile,and any such
Power of Att orney or certificate bearing such facsimile signatures shall be valid and binding upon the corporation when so affixed and in the future with respect to any bond„undertaking
or contract of suretyship to which it is attached
IN WITNESS WH EI EOF,DEVELOPERS SURETY AND INDEMNITY COMPANY has caused these presents to be signed by its officers and attested by its Secretary or Assistant
Secretary this November 10th,,2012,
By° woze ANA
J
Daniell Young,Senior Vice-President , "w
`
CT
AO
1
By. ........... '"
Gregg IN.C? ice-President
State of California
County of Orange
`
On November 1 ':0� , before me:
Antonio Alvarado,Notary Public
_ _.... �...o._.......�_........_.. m
Date Here Insert Name and Title of the Officer
PIP personally appeared Daniel Young and Gregg N.Ckura
...........
Name(s)of Signers)
who proved to me on the basis of satisfactory evidence to be the person(s)whose names isl'are subscribe to
, the within instrument and acknowledged to me that he/she/they executed the sere in his/he�r/their authori
All 611
capacity(ies),and that by hislherltheir,signature(s)on the instrument the persons,or the entity upon behalf of
�'� �� �'
which the person(s)acted,
executed the instrument.
co m 1860W .
I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph is
true and correct.
WTNESS my hand and official seal,
Place Notary Seal Above Signature
Antonio Alvarado,Notary Public
CERTIFICATE
The undersigned,as Secretary or Assistant Secretary of DEVELOPERS SURETY AND INDEMNITY Cf MPANY does hereby certify that the foregoing Power of Attorney
remains in full force and has not been revoked and,furthermore,that the provisions of the resolution of the Board of Directors of said corporation set forth in the Power of Attomey are in
force as of the date of this Certificate.
a This Certificate is executed in the City of Irvine,California,this 29,thday of J7UILY 2013.
,
.,
Mark J.Lansdoin,Assistant,secretary
ID-1143 (Rev,11�/12)
Vii)
IMPORTANT NOTICE AV'ISO IMPORTANCE
To obtain information or make a complaint: Para oibtener infhrmacion oi para someterl una queja:
IM
You may call the Surety's toll free telephone number Usted puede llamar al numero de telefono gratis de
folr information or to male a complaint at: pars informacion o pare soimeter un.a queja al:
�f
1-800-782-154+ 1-800-72-1546
You may also write,to the Surety at: Usted tanbien puede escribir a Surety at.
P.O.Box 19725 P.O.Box 19,72
Irvine,+ A 92623-9725 Irvine,CA 912623-9725
You may contact the Texas(Department of Insurance Puede comunicarse eon el.I1eplartamentol de Seguros
to, obtain information on companies, de Texas para obtener information ac+erca die compa-
coverage,rights or complaints at: Was,coberturas,derechos o quejas al:
1-8001-252-3439 1-800-252-34391
You may write the Texas Department of Insurance at: P'uede eserib r al lDepartmento de Seguros de Texas
P.O.Box 149104 P.O.Box 149104
Austin,Tx 78714-9104 Austin,Tx 78714-9104
Fax#51.2-475-1771 Fax#512-475-1771
web. http://www.tdi.state.tx.us web, http://'Www.tdi.state.tx.us
E-maill ConsumerProtection@tdi.s,tate.tx.us E-mail: ConsumerProltection@tdi.state.tx.us
PREMIUM OR CLAIM DISPUTES- Should you DISPUTAS SOBRE PRIMAS 0 RECLAI O,S:
have a dispute concerning,your premium or about a Si tiene una.disputa concerniente a su prima o a un
claim you should contact the Surety first. If the reclamo,debe comun,icarse con el Surety primero.Si
dispute is not resolved, you may contact the Texas no se resuelve la disputa, puede entonces comuni-
IDepartment of Insurance. carrse con ell departamento(T'IDI).
ATTACK( THIS NOTICE, TO YOUR POLICY: UNA E TE AVISO.AF U POLIZA:Este aviso es solo
This notice is for information only and does not pars proposito de information y no se conviert-0e en
become a part or condition of the attached document. paste o condition del documento adjunto.
insc jr
Ilnsco Insurance Services,, Inc.
Underwriting Manager tor:
Developers Surety and Indemnity Company. Indemnity Comilpany of California
17780 Fi!tch, Suite 2010
Irvine, CA 92614
v 1-800-782-1546
www.IInseeDico.etam
IUD-1404(TX)(Rev.7107)
...........
DATE(MMIDDfyyyy)l
A
..AMML 71/29/2013
4
THIS CERTIFICATE IS ISSUED AS A MATTER OF IN FORMATION ONLY AND CONFERS NO RIGHTS UPON THE GERT'IfICATE HOLDER. THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTERTHE COVERAGE AFFORDEU SY THE POLICIES
BELOW. THIS CERTIFICATE, OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER.
...............
.. ...... .....
IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(les)must be endorsed. If SUBROGATION IS WAIVED,subJect to
i the terms and conditions,of the piolicy,,certai In,policies may require an endorsement. A,statement on this certificate does not confer rights to the
certificate holder In liou of such endorsement(s).
lPRODUCER TACT
E; Sandy Fugitt
(9
FAX
j4kC.
IMullis Newby Hurst LIP 1: 72)201-012,17 =I-WC.,Noi(972)201-0123
F.
I E-MAJIL
I
5057 Keller Springs Road, Suite 400 AD sfugitt@mnhins.com
ORESS;
Liberty Plaza
li INS�REEJS)AFFORDING COVERAGE
IAddison, TX 75001 j,
........ INSURERA-Bituminous Casualty or rat'
--- po ion
INSURED
INSUR Ft s-,St. Paul Fire Marine Ins Co
Jet Underground Utilities,, Inc. INSURER C:
..........
P. 0. Box, 8 01016 6 9 IIIUEMZM�IIIII
Balch Springs, TX 75180 INSURER E:
Lill,
10 #.,L
IL POLICY NUMBER
GENERAL LIABILITY EACH OCCURRENCE 1 000 006
COM M E R CIAL G E N E RAL LIABI LITY $ 3010,000'
]I IML-
CLAIMS-MADE L X J OCCUR, =P358 l r(Any one person"I
L&ADV INJURY $ 1,000,0001
a 2f000f000
a $
GEN'L AGGREGATE LIMIT APPLIES PER. PRODUCTS-COMP/0P AGiG 2RP I X I T F-1 LOC
JECL
AUTOMIOENLE LIABILM
000 00�
MI,
X ANY AUTO, BODILY INJ U RY(Per pem iii)
I ALL OWNED SCHEDULED 3151831223 =--/13/2013
IAUTOS AUTOS
X NONi-OWN'ED PROPERTY DAMAGE
HIRED AUTOS AUTOS (Per aicdidentl
............-
UMBRELLA LIAS RRENCE 2 0100 006
ZAN,OCCUR H OCCU
EXCESS UAS CLAIMS.MADE� XP12S31584 AGGREGATE $ 2,000,rOOO,
MME RETENTION$
WORKERS COMPENSA71ON
AND EMPLOYERSO UABILM
ANY PROPRIETOR/PARTNER/EXECU11VE YIN� E.L.EACH ACCIDENT
OFFICER/MEMBER EXCLUDiED?
(Mandatory In NH) E.L.DISEASE-I EA EMPLOYE� $1
L 1A00F000
If yes,desicAbe under
DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LI�Miidl $ 11000-1000:
WATI-q-111t
10
L
. ............
I,-] MA OEM I
7—
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRAInOIN DATE THEREOIF,i NOTICE WILL, BE DELIVERED IN
City
• Fort Worth ACCORDANCE WITH THE POLICY PROVISIONS.,
'Transportation and Public Works Dept
I AUTHORIZED REPRESENTATIVE
311 W. 10th, Street
Fort Worth, TX 76102
A
iScott Stagner/SANDYF
J
ilk