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Contract - Austin Traffic Signal - 4/25/2019City of Round Rock, Texas Contract Forms Standard Form of Agreement: Section 00500 City of Round Rock, Texas Standard Form of Agreement between Owner and Contractor AGREEMENT made as of the day of in the year 20 14 BETWEEN the Owner: City of Round Rock, Texas (hereafter "Owner" or "City") 221 East Main Street Round Rock, Texas 78664 and the Contractor AAstin TC IC Signal Construction 'U05 1m,: ("Contractor") The Project is described as: Proposed Construction oof Traffic Signal at McNeil Rd at St. Williams St. and Proposed Roadway Imporvements for Various Locations along UPRR Line The Engineer is: BGE, Inc. 7000 North Mopac Suite 330 Austin, Texas 78731 For a nd i n c onsideration of t he in utual terms, con ditions a nd c ovenants of t his Agreement an d al I accompanying doc uments between Owner and C ontractor, the recei pt and s ufficiency of which are he reby acknowledged, Owner and Contractor agree as follows: ARTICLE I THE CONTRACT DOCUMENTS The Contract Documents consist of this Agreement, Conditions of the Contract (General, Supplementary and other Conditions), Drawings, Specifications, Addenda issued prior to execution of this Agreement, other documents listed in this Agreement and Modifications issued after execution of this Agreement; these form the Contract, and are as fully a part of the Contract as if attached to this Agreement or repeated herein. The Contract represents the entire and integrated agreement between the parties hereto and supersedes prior negotiations, representations or agreements, either written or oral. An enumeration of the Contract Documents, other than Modifications, appears in Article 7. ARTICLE 2 THE WORK OF THIS CONTRACT Contractor shall fully execute the Work described in 1he Contract Documents, except to the extent specifically indicated in the Contract Documents to be the responsibility of others. 00500 4-2016 00307791 Page] of 5 Standard Form of Agreement ARTICLE 3 DATE OF COMMENCEMENT; DATE OF SUBSTANTIAL COMPLETION; DATE OF FINAL COMPLETION 3.1 The date of commencement of the Work shall be the date of this Agreement unless a different date is stated below or provision is made for the date to be fixed in a Notice to Proceed issued by Owner. 3.2 The Contract Time shall be measured from the date delineated in the Notice to Proceed. 3.3 Contractor shall commence Work within Ten ( 10 ) calendar days from the date delineated in the Notice to Proceed. 3.4 Contractor sh all ach ieve Substantial Co mpletion of the ite ms o f Work listed on Attachment A to t his Agreement no later than N/A ( N/A ) calendar days from issuance by Owner of Notice to Proceed, and Contractor shall achie ve Substantial Completion of t he a ntire Work no later tha n One -hundred and fifty ( 150 ) calendar days from issuance by Owner of Notice to Proceed, subject to adjustments of this Contract Time as provided in the Contract Documents. 3.5 If Contractor fails to achieve Substantial Completion of the Work (or any portion thereof) on or before the date(s) specified for Substantial Completion in the Agreement, Contractor shall pay to Owner, as liquidated damages, the sum of Five -hundred and No/100 Dollars ($ 500.00 ) for each calendar day that Substantial Completion is delayed after the date(s) specified for Substantial Completion. It is hereby agreed that the liquidated damages to which Owner is en titled hereunder are a reasonable forecast of just compensation for the harm that would be caused by Contractor's failure to achieve Substantial Completion of the Work (or any portion thereof) on or before the date(s) specified for Substantial Completion in the Agreement. It is agreed that the harm that would be caused by such failure, which includes loss of expected use of the Project areas, provision of alternative storage facilities and rescheduling of moving and occupancy dates, is one that is incapable or very difficult of accurate estimation. It is hereby agreed that if Substantial Completion `l of th e Work (or an y portion th ereof) is not ach ieved on or before thirty (3 0) d ays after th e date(s) sp ecified for lJ Substantial Completion in the Agreement, the Owner shall have the option to either collect liquidated damages as set forth herein or to thereafter rely on its rem edies under the Contract Documents and at 1 aw and in equity, including without limitation, the recovery of actual damages. The date(s) specified for Substantial Completion of the Work (or any portion thereof) in the Agreement shall be subject to adjustment as provided in the Contract Documents. 3.6 Contractor shall achieve Final Completion of the entire Work no later than One -hundred and eighty ( 180 ) calendar days from issuance by Owner of Notice to Proceed. ARTICLE 4 CONTRACT SUM 4.1 Owner shall pay Contractor the Contract Sum in current funds for Contractor's performance of the Contract. The Contract Sum shall be E~8ut w�wc _ F,;,� o.,,tid.. -..Ars ($ 415 IT q 5 , O 0 ), subject to additions and deductions as provided in the Contract Documents. 4.2 Does the Contract Sum include alternates which are described in the Bid Form? No f . Yes . If yes, please provide details below: 00500 4-2016 Page 2 of 5 Standard Form of Agreement 00307791 ARTICLE 5 PAYMENTS 5.1 PROGRESS PAYMENTS 5.1.1 Based upon Applications for Payment submitted to Engineer and Owner by Contractor, and Certificates for Payment issued by Engineer and not disputed by Owner and/or Owner's lender, Owner shall make progress payments on account of the Contract Sum to Contractor as provided below, in Article 14 of the City of Round Rock General Conditions, and elsewhere in the Contract Documents. 5.1.2 The period covered by each Application for Payment shall be one calendar month ending on the last day of the month. 5.1.3 Provided that an App lication for Paym ent is receive d by Engineer and Owne r, and Engineer issues a Certificate of Payment not later than the tenth (10th) day of a month, Owner shall make payment to Contractor not later than the tenth (10th) day of the next month. If an Application for Payment is received by Engineer and Owner after the application date fixed above, payment shall be made by Owner not later than one month after the Engineer issues a Certificate for Payment. 5.1.4 Each Application for Payment shall be based on the most recent schedule of values submitted by Contractor in accordance with the Contract Documents. The schedule of values shall allocate the entire Contract Sum among the various portions of the Work. The schedule of values shall be prepared in such form and supported by such data to substantiate its accuracy as Engineer and Owner may require. This schedule, unless objected to by Engineer or Owner, shall be used as a basis for reviewing Contractor's Applications for Payment. 5.1.5 Applications for Payment shall warrant the percentage of completion of each portion of the Work as of the end of the period covered by the Application for Payment. 5.1.6 Subject to other provisions of the Contract Documents, the am ount of each progress paym ent shal 1 be computed as provided in Article 14 of the City of Round Rock General Conditions. 5.1.7 Except with Owner's prior written approval, Contractor shall not make advance payments to suppliers for materials or equipment which have not been delivered and stored at the site. 5.2 FINAL PAYMENT 5.2.1 Final payment, co nstituting t he en tire unpaid balance of t he C ontract Su m, sh all b e made b y Owner to Contractor when: 1 Contractor has fully performed the Contract except for Contractor's responsibility to correct Work, and to satisfy other requirements, if any, which extend beyond final payment; and .2 a final Certificate for Payment has been issued by Engineer. 5.2.2 Owner's fi nal payment t o C ontractor s hall be m ade n o 1 ater t han t hirty (3 0) days after t he i ssuance o f Engineer's final Certificate for Payment. In no event shall final payment be required to be made prior to thirty (30) days after all Work on the Contract has been fully performed. Defects in the Work discovered prior to final payment shall be treated as non -conforming Work and shall be corrected by Contractor prior to final payment, and shall not be treated as warranty items. ARTICLE 6 TERMINATION OR SUSPENSION 6.1 The Contract may be terminated by Owner or Contractor as provided in Article 15 of the City of Round Rock General Conditions. 00500 4-2016 Page 3 of 5 Standard Form of Agreement 00307791 6.2 The W ork in ay be s uspended by O wrier a s pr ovided i n Article 15 of the C ity o f Round R ock G eneral Conditions. ARTICLE 7 ENUMERATION OF CONTRACT DOCUMENTS 7.1 The Contract Documents, except for Modifications issued after execution of this Agreement, are enumerated as follows: 7.1.1 The Agreement is this executed version of the City of Round Rock, Texas Standard Form of Agreement between Owner and Contractor, as modified. 7.1.2 The G eneral Conditions a re the "City o f R ound R ock C ontract F orms 00700, " G eneral C onditions, a s modified. 7.1.3 The Supplementary, Special, and other Conditions of the Contract are those contained in the Project Manual dated July 2018 7.1.4 The Specifications are those contained in the Project Manual dated July 2018 7.1.5 The Drawings, if any, are those contained in the Project Manual dated July 2018 7.1.6 The Insurance & Construction Bond Forms of the Contract are those contained in the Project Manual dated July 2018 7.1.7 The Notice to Bidders, Instructions to Bidders, Bid Form, and Addenda, if any, are those contained in the Project Manual dated July 2018 7.1.8 If this Agreement c overs c onstruction involving federal funds, thereby requiring inclusion of mandated contract clauses, such federally required clauses are those contained in the "City of Round Rock Contract Forms 03000," Federally Required Contract Clauses, as modified. 7.1.9 Other documents, if any, forming part of the Contract Documents are as follows: NIA ARTICLE 8 MISCELLANEOUS PROVISIONS 8.1 Where reference is made in this Agreement to a provision of any document, the reference refers to that provision as amended or supplemented by other provisions of the Contract Documents. 8.2 Owner's representative is: 8.3 Contractor's representative is: Bill Stablein CORR-Transportation Department 512-218-3237 bstableinAroundrocktexas.gov -Sr Log -,L, 8.4 Neither Owner's nor Contractor's representative shall be changed without ten (10) days' written notice to the other party. 8.5 Waiver of any breach of this Agreement shall not constitute waiver of any subsequent breach. �t 00500 4-2016 Page 4 of 5 Standard Form of Agreement t�J 00307791 8.6 Owner agrees to pay Contractor from available funds for satisfactory performance of this Agreement in accordance with the bid or proposal submitted therefor, subject to proper additions and deductions, all as provided in the General Conditions, Supplemental Conditions, and Special Conditions of this Agreement, and Owner agrees to make payments on account thereof as provided therein. Lack of funds shall render this Agreement null and void to the extent funds are not available. This Agreement is a commitment of City of Round Rock's current revenues only. 8.7 Although this Agreement is drawn by Owner, both parties hereto expressly agree and assert that, in the event of any dispute over its meaning or application, this Agreement shall be interpreted reasonably and fairly, and neither more strongly for nor against either party. 8.8 This Agreement shall be enforceable in Round Rock, Texas, and if legal action is necessary by either party with respect to the enforcement of any or all of the terms or conditions herein, exclusive venue for same shall I ie in Williamson County, Texas. This Agreement shall be governed by and construed in accordance with the laws and court decisions of the State of Texas. 8.9 Both parties hereby expressly agree that no claims or disputes between the parties arising out of or relating to this Agreement or a breach thereof shall be decided by an arbitration proceeding, including without limitation, any proceeding under the Federal Arbitration Act (9 USC Section 1-14) or any applicable state arbitration statute. 8.10 The parties, by execution of this Agreement, bind themselves, their heirs, successors, assigns, and 1 egal representatives for the full and faithful performance of the terms and provisions hereof. This Agreement is entered into as of the day and year first written above and is executed in at least three (3) original copies, of which one is to be delivered to Contractor, one to Engineer for use in the administration of the Contract, and the remainder to Owner. OWNER � Date Signed: v - r/ _(q. ATTEST: *yv,-R4U-- City Clerk FOR CITY, APPROVED AS TO FORM: tty Attorney 00500 4-2016 00307791 CONTRACTOR sty Traffic Sign4 Copstruction Co, In Printed Title: v . L Date Signed: 11 — ! —/ Page 5 of 5 Standard Form of Agreement 00600 INSURANCE AND CONSTRUCTION BOND FORMS BONDS AND INSURANCE INSTRUCTIONS Instruction Sheet 1. Insurance Company must be licensed by State of Texas. 2. Agent signing bonds must be licensed in Texas. 3. Agent signing bonds must have Power of Attorney on behalf of insurance company. 4. If Agent signing bonds has Power of Attorn ey, but not licensed in Texas, then the bond must be counter -signed by Texas local recording agent. ALL THE ABOVE INFORMATION CAN BE FOUND AT Texas Department of Insurance website—www.tdi.state.tx.us 5. Make sure the dollar amount on both Pe rformance and Payment Bonds match the amount of the Agreement & Bid Form Sheet. 6. Both Performance and Payment Bonds should be signed by Authorized Person. If the contractor is a corporation, then it should be signed by the President or the Vice -President. If the contractor is not incorporated, then it may be signed by the Owner. Please state the title of the authorized person. rI - PERFORMANCE BOND Bond No. 82521272 THE STATE OF TEXAS § § KNOW ALL BY THESE PRESENTS: COUNTY OF WILLIAMSON 6 That Austin Traffic Signal Construction Company, Incofthe City of Pflugeryille County of Travis , and State of Texas , as P rincipal, and Federal Insurance Company authorized under the law of the State of Texas to act as surety on bonds fo r principals, are held and firmly bound unto THE CITY OF ROUND ROCK, TEXAS, (Owner), in the penal sum of Four Hundred Nineteen Thousand One Hundred Ninetv Five and 8/100 Dollars ($ 419.195.08 ) for the paym ent whereof, well and truly to be m ade the said Principal and Surety bind themselves, and their heirs, adm inistrators, executors, successors and assigns, jointly and severally, by these presents: WHEREAS. the Principal has entered into a certain written Agreement with the Owner dated the Cl �/ day of _ __ _ maw !P20 tj, to which the Agreement is hereby referred to and m ade a part hereof as fully a9d to the sam a extent as if cop ied at Iength herein consisting of: Proposed Traffic Signal Construction at McNeil Rd at St. Williams Street and Proposed Roadway Imporvements at Various Locations along UPRR Line (Name of the Project) NOW, THEREFORE, THE CONDITIONS OF THIS OBLIGATION IS SUCH, that if the said Principal shall faithfully perform said Agreem ent and shall, in all r espects, duly and faithfully observe and perform all and singu lar the covenants, conditions and ag reements in a nd by said Agreement, agreed and covenanted by the Principal to be observed and performed, including but not limited to, the repair of any and all defect s in said work occasione d by and resulting from defects in m aterials furnished by or workm anship of, the Principal in perform ing the W ork covered by said Agreement and occurring within a period of twelve (12) months from the date of Final Com pletion and all oth er co venants and conditions, according to the tru a inten t and meaning of said Agreement and the Plans and Specifications hereto annexed, then this obligation shall be void; otherwise to remain in full force and effect; PROVIDED, HOWEVER, that this bond is executed pursuant to the provisions of Chapter 2253, Texas Governm ent code, as am ended, and all liab ilities on this bond sh all be determ fined in accordance with the pro visions of said Chapter 2253 to the sam a extent as if it were copied at length herein. Page 1 00610 7-2009 Pcrrormancc Bond 00090656 L� i� _ PERFORMANCE BOND (continued) Surety, for value received, stipulates and agrees that no change, extension of tim e, alteration or addition to the term of the Agreem ent, or to the W ork perform ed thereunder, or the Plans, Specifications, or drawings accompanying the same, shall in anywise affect its obligation on this bond, and it does hereby waive notice of any such change, extension of tim e, alteration or addition to the terms of the Agreement, or to the work to be performed thereunder. IN WITNESS WHEREOF, the said Principal and Su rely, have signed and se aled this instrument this I°I� `^ day of by 1( • 20�. Austin Traffic Signal Construction Company, Inc , 5 cz Printed ame int By: Title: Address: 4615 Priem Lane Pflugerville, TX 78660 Resident Agent of Surety: Signature Tonie Petranek Printed Name 2711 N. Haskell Ave., Ste. 800 Street Address Dallas, TX 75204 City, State & Zip Code 00610 7-2009 00090656 Federal Insurance Company Surety Tonie Petranek Name By: JOA, Title: Attorney -in -Fact Address: 2711 N. Haskell Ave.. Ste. 800 Dallas, TX 75204 Page 2 Pcrforrrrancc Bond n - THE STATE OF TEXAS COUNTY OF WILLIAMSON PAYMENT BOND 0 Bond No. 82521272 KNOW ALL MEN BY THESE PRESENTS: That Austin Traffic Signal Construction Company, Inc. , of the City of Pflucierville , County of Travis , and State of Texas as Principal, and Federal Insurance Company authorized under the laws of the State of Texas to act as Surety on Bonds for Principals, are held and firmly bound unto THE CITY OF ROUND ROCK, (OWNER), and all subcontractors, workers, laborers, mechanics and suppliers as their interest may appear, all of whom shall have the right to sue upon this bond, in the penal sum of Four Hundred Nineteen Thousand One Hundred Ninety Five and 8/100 Dollars ($ 419,195.08 ) for the paym ent whereof, well and truly be m ade the said Principal and Surety bind themselves and th eir heirs, administrators, executors, successors, and assigns, jointly and severally, by these presents: WHEREAS, the Principal has ente red into a ce rtain written Agreement with the Owner, date d the .•l- At 'ih. day of _ _ Mil iy- , 20 lam, to which A greement is hereby referred to and m ade a part hereof as fully anto the sam a extent as if cop ied at length herein consisting of: Proposed Traffic Signal Construction at McNeil Rd at St. Williams Street and Proposed Roadway Imporvements at Various Locations along UPRR Line (Name of the Project] NOW, THEREFORE, THE CONDI TION OF THIS OBLIGATION IS SUCH, that if the said Principal shall well and truly pay all subcontractors, workers, laborers, mechanics, and suppliers, all monies to them owing by said Princip als for subcontracts, work, labor, equipment, supplies and materials done and furnished for the construe tion of the im provements of said Agreem ent, then th is ob ligation sh all be and be come null a nd void; o therwise to re main in f ull force and effect. PROVIDED, HOWEVER, that this bond is executed pursuant to the provisions of Chapter 2253, Texas Governm ent code, as am ended, and all liab ilities on this bond sh all be determ ined in accordance with the pro visions of said Chapter 2253 to the sam a extent as if it were copied at length herein. 00620 7-2009 00090656 Page 1 Payment Bond PAYMENT BOND (continued) Surety, for value received, stipulates and agrees that no change, extension of tim e, alteration or addition to the term s of the Agreem ent, or to the W ork perform ed t hereunder, or the plans, specifications or drawings accompanying the same shall in anywise affect it' s obligation on this bond, and it does hereby waive notice of any such change, extension of tim e, alteration or addition to the terms of the contract, or to the work to be performed thereunder. IN WITNESS WHEREOF, the said Principal and Sure ty have signed and sealed this Instrument this h day ofi j , 20J. Austin Traffic Signal Construction Company, Inc. Federal Insurance Company P ' ci al /;jt, Surety �Paloe Tonie Petranek Printe Name P ' to Name By: C' KBy: &Il"� ZU44-� Title: V i ' Title: Attorney -in -Fact Address: 4615 Priem Lane Address: 2711 N. Haskell Ave. Suite 800 Pflugerville, TX 78660 Resident Agent of Surety: A�' -p� Signature Tonie Petranek Printed Name 2711 N. Haskell Ave., Suite 800 Street Address Dallas, TX 75204 00620 7-2009 00090656 Page 2 Dallas, TX 75204 Payment Bond CHUBFEE? ` Power of Attorney Federal Insurance Company I Vigilant Insurance Company I Pacific Indemnity Company Know All by These Presents, That FEDERAL INSURANCE COMPANY, an Indiana corporation, VIGILANT INSURANCE COMPANY, a New York corporation, and PACIFIC INDEMNITY COMPANY, a Wisconsin corporation, do each hereby constitute and appoint Don E. Cornell, Sophinie Hunter, Tina McEwan, Robbi Morales, Tonle Petranek, Ricardo J. Reyna, Joshua Saunders and Kelly A. Westbrook of Dallas, Texas; Steven Dwain Brockinton of Little Rock, Arkansas ---------- each as their true and lawful Attorney -in -Fact to execute under such designation in their names and to affix their corporate seals to and deliver for and on their behalf as surety thereon or otherwise, bonds and undertakings and other writings obligatory in the nature thereof (other than bail bonds) given or executed in the course of business, and any instruments amending or altering the same, and consents to the modification or alteration of any instrument referred to in said bonds or obligations. In Witness Whereof, said FEDERAL INSURANCE COMPANY, VIGILANT INSURANCE COMPANY, and PACIFIC INDEMNITY COMPANY have each executed and attested these presents and affixed their corporate seals on this 20" day of March, 2019. I):rv, n 11 Ch k n t r ..l��la:mt �crrecu'1 Stephen 11 I Laney. Vice ll'osidcm F s STATE OF NEW JERSEY County of Hunterdon ss. On this 201" day of March, 2019, before me, a Notary Public of New Jersey, personally came Dawn M. Chloros, to me known to be Assistant Secretary of FEDERAL INSURANCE COMPANY, VIGILANT INSURANCE COMPANY, and PACIFIC INDEMNITY COMPANY, the companies which executed the foregoing Power of Attorney, and the said Dawn M. Chloros, being by me duly sworn, did depose and say that she is Assistant Secretary of FEDERAL INSURANCE COMPANY, VIGILANT INSURANCE COMPANY, and PACIFIC INDEMNITY COMPANY and knows the corporate seals thereof, that the seals affixed to the foregoing Power of Attorney are such corporate seals and were thereto affixed by authority of said Companies; and that she signed said Power of Attorney as Assistant Secretary of said Companies by like authority; and that she is acquainted with Stephen M. Haney, and knows him to be Vice President of said Companies; and that the signature of Stephen M. Haney, subscribed to said Power of Attorney is in the genuine handwriting of Stephen M. Haney, and was thereto subscribed by authority of said Companies and in deponent's presence. Notarial Seal ` ROSE CURTIS NOTARY PUBLICJERSEY n c No..50072400 050077 2400400 rntmm"*n bQ*= R&Vrb 122.2022 Nowry I'ublii CERTIFICATION Resolutions adopted by the Boards of Directors of FEDERAL INSURANCE COMPANY, VIGILANT INSURANCE COMPANY, and PACIFIC INDEMNITY COMPANY on August 30, 2016: "RESOLVED, that the following authorizations relate to the execution, for and on behalf of the Company, ofbonds, undertakings, recognizances, contracts and other written commitments of the Company entered into in the ordinary course of business (each a "Written Commitment"): (1) Each of the Chairman, the president and the Vice presidents of the Company is hereby authorized to execute any Written Commitment for and on behalf of the Company, under the seal of the Company or otherwise. (2) Each duly appointed attorney-inrfact of the Company is hereby authorized to execute any Written Commitment for and on behalf of the Company, under the seal of the Company or otherwise, to the extent that such action is authorized by the grant of powers provided for in such person's written appointment as such attorney-in-fact. (3) Each of the Chairman. the President and the Vice Presidents of the Company is hereby authorized, for and on behalf of Company, to appoint in writing any person the attorney- in-fact of the Company with full power and authority to execute, for and on behalf of[he Company, under the seal of the Company or otherwise. such Written Commitments of the Company as may be specified in such written appointment, which specification may be by general type or class of Written Commitments or by specification of one or more particular Written Commitments. (4) Each of the Chairman, the president and the Vice Presidents of the Company is hereby authorized, for and on behalf of the Company, to delegate in writing to any other officer of the Company the authority to execute. for and on behalf of the Company, under the Company's seal or otherwise, such Written Commitments of the Company as are specified in such written delegation, which specification may be by general type or class of Written Commitments or by specification of one or more particular Written Commitments. (5) The signature of any officer or other person executing any Written Commitment or appointment or delegation pursuant to this Resolution, and the seal ofthe Company, may be affixed by facsimile on such Written Commitment or written appointment or delegation. FUR'T'HER RESOLVED, that the foregoing Resolution shall not be deemed to be an exclusive statement of [he powers and authority of officers, employees and other persons to act for and on behalf of the Company, and such Resolution shall not limit or otherwise affect the exercise ofany such power or authority otherwise validly granted or vested." I, Dawn M. Chloros, Assistant Secretary of FEDERAL INSURANCE COMPANY, VIGILANT INSURANCE COMPANY, and PACIFIC INDEMNITY COMPANY (the "Companies") do hereby certify that (i) the foregoing Resolutions adopted by the Board of Directors of the Companies are true, correct and in full force and effect. (ii) the foregoing Power of Attorney is true, correct and in full force and effect. Given under my hand and seals ofsaid Companies at Whitehouse Station, NJ, this Dawn tl.Chlcx-txs.A�.tstantSecret:uyt' IN'rHE EVENT' YOU W ISH'I'O VERIFY'I'HE AUI'HEN'I'ICfrY OI''I'HIS BOND OR NO'T'IFY US OF ANY OTHER MA17ER. PLEASE CON'I'AC'I' US A'I': 'fele hone (908)903-3493 Fax(908)903.3656 e-mail: surety@cllubb.com FEC- VIG-PI (rev. 08-18) Policyholder Information Notice IMPORTANT NOTICE To obtain information or make a complaint: You may call Chubb's toll-free telephone number for information or to make a complaint at 1-800-36-CHUBB You may contact the Texas Department of Insurance to obtain information on companies, coverages, rights or complaints at 1-800-252-3439 You may write the Texas Department of Insurance P.O. Box 149104 Austin, TX 78714-9104 FAX # (512) 475-1771 Web: http://www.tdi.state.tx.us E-mail: ConsumerProtection @ tdi. state.tx.us PREMIUM OR CLAIM DISPUTES: Should you have a dispute concerning your premium or about a claim you should contact the agent first. If the dispute is not resolved, you may contact the Texas Department of Insurance. ATTACH THIS NOTICE TO YOUR POLICY' This notice is for information only and does not become a part or condition of the attached document. Form 99-10-0299 (Rev. 1-08) AVISO IMPORTANTE Para obtener informacion o para someter una queja: Usted puede llamar al numero de telefono gratis de Chubb's para informacion o para someter una queja al 1-800-36-CHUBB Puede comunicarse con el Departamento de Seguros de Texas para obtener informacion acerca de compaWas, coberturas, derechos o quejas al 1-800-252-3439 Puede escribir al Departamento de Seguros de Texas P.O. Box 149104 Austin, TX 78714-9104 FAX # (512) 475-1771 Web: http://www.tdi.state.tx.us E-mail: ConsumerProtection@tdi.state.tx.us DISPUTAS SOBRE PRIMAS O RECLAMOS: Si tiene una disputa concerniente a su prima o a un reclamo, debe comunicarse con el agente primero. Si no se resueve la disputa, puede entonces comunicarse con el departamento (TDI). UNA ESTE AVISO A SU POLIZA: Este aviso es solo para proposito de informacion y no se convierte en parte o condicion del documento adjunto. CERTIFICATE OF LIABILITY INSURANCE Instruction Sheet 1. CERTIFICATE OF LIABILITY INSURANCE FORM The City of Round Rock's Certificate of Liability Insurance form provided herein or a standard ACORD form. 2. PRODUCER and INSURED - Please list name, address, phone number and e-mail. 3. COMPANIES AFFORDING COVERAGE — TDI num ber required. The TDI nu mber can b e obtained from the Texas Dept of Insurance Website: http://www.tdi.state.tx.us/. — Company Lookup. Note: Exception to this rule. In certain instances where there is unusual risks involved, Surplus Lines Insurance Carriers can be used. Below are the guidelines: a. Insurance Company does not have to be "licensed in Texas". but they do have to be "eliPible for a Texas license." Please verify with the Texas Dept of Insurance Website: httn://www.tdi.state.tx.us/. — Company Lookup b. Policy has to be written by licensed surplus lines Agent. Also verify with the Texas Dept of Insurance Website: http://www.tdi.state.tx.us/ - Agent Lookup 4. TYPES OF INSURANCE COVERAGE — CONSTRUCTION CONTRACT: Please double check the General Conditions and the Supplemental General Conditions for the ty pes and a mounts of insurance re quired. Th e Supplemental General Conditions usually state the following: a. Business Automobile Liability Insurance b. Workers' Compensation and Employers' Liability Insurance C. Commercial General Liability Insurance d. Builders' Risk Insurance— (Generally required for all "vertical" construction. Check with Project Manager for requirements.) FOR ALL OTHER CONTRACTS, PLEASE REFER TO THE INSURANCE SECTION FOR TYPE OF INSURANCE REQUIRED. (For example Engineering Service Contracts usually require "professional liability insurance".) 5. EFFECTIVE DATE & EXPIRATION DATE Please make sure dates are current. 6. City of Rou nd Rock m ust be listed o n the Certificate of Insu rance as an a dditional insured (excep t Workers Compensation and Builders Risk). 7. Certificate must indicate that the insurance Company must give the City of Rou nd Rock notice of any changes, cancellation , etc. at least thirty (30) days prior to date of change. Make sure Certificate is signed by an Agent Licensed in the State of Texas, this can also be found on the Texas Department of Insurance website —www.tdi.state.tx.us — Agent Lookup. Client#: 148784 AUSTITRA1 ACORDTM CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 05/08/2019 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer any rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Cindy Ellis USI Southwest Austin aCNN Ext: 512 451-7555 a No; 512 467-0113 7600-C N. Capital of TX Hwy #200 ADDRESS: cindy.ellis@usi.com Austin, TX 78731 512 451-7555 INSURER(S) AFFORDING COVERAGE NAIC # INSURER A: Zurich American Insurance Company 16535 INSURED INSURER B • American Guarantee & Liability Ins Co. 26247 Austin Traffic Signal Construction Feaerallnaurancecempany 20281 Co., Inc. & ATS Drilling, Inc. INSURERc: P.O. Box 130 INSURER D: - Round Rock, TX 78680 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NIIMRFR- THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR 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 LTR TYPE OF INSURANCE ADDL INSR SUBR WVD POLICY NUMBER POLICY EFF MM/DD/YYYY POLICY EXP MM/DD/YYYY LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE N OCCUR GL04839723 0310112019 03/01/202 -EACH $1,000,000 �OCCURRENCE PREMISES EaEoccccu'rrence NTED $100 000 MED EXP (Any one person) $10,000 PERSONAL & ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRO - POLICY a ECT D LOC GENERAL AGGREGATE $2,000,000 PRODUCTS -COMP/OPAGG $2,000,000 $ OTHER: � AUTOMOBILE X LIABILITY ANY AUTO BAP4839724 3/01/2019 03/01/202 COMBINED SINGLE LIMIT Ea ecadent 1,000,000 BODILY INJURY (Per person) $ OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY (Per accident) $ X NON -OWNED AUTOS ONLY Ix AUTOS ONLY PROPERTY DAMAGE $ Per accident B X UMBRELLA LIAB X OCCUR AUC549084907 3/01/2019 03/01/202 EACH OCCURRENCE $20000000 AGGREGATE $20 000 000 EXCESS LIAR CLAIMS -MADE DED RETENTION $ $ A AND EMPLOYERS' LIABILITY WORKERS COMPENSATION ANY PROPRIETOR/PARTNER/EXECUTIVE Y 1 N OFFICER/MEMBEREXCLUDED? � NIA WC4839722 3/01/2019 03/01/202 X PER OTH- E.L. EACH ACCIDENT $1,000,000 E.L. DISEASE -EA EMPLOYEE $1,000,000 (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below 3/01/2019 03101/2020 E.L. DISEASE -POLICY LIMIT $1,000,000 $500,000 C Installation 06639633 Floater - Blanket $5,000 dedt, except Coveracie $25,000 Fld/Earth uake DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space Is required) Job #2186: Traffic signal install - McNeil -St. Williams & Road improvement at UPRR The General Liability and Auto policies include a blanket automatic Additional Insured endorsement that provides Additional Insured status to the Certificate Holder (and other entities as required by the Prime Contract), only when there is a written contract that requires such status and only with regard to work performed on behalf of the named insured. The General Liability, Auto and Workers Compensation policies (See Attached Descriptions) City of Round Rock 221 E Main Street Round Rock, TX 78664 ACORD 25 (2016/03) 1 of 2 #S25644493/M25088834 CANGtLLAIIUN SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE T 4. W &.$.veAL " ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD CLEHB DESCRIPTIONS (Continued from Page 1) provide a Blanket Waiver of Subrogation in favor of the same when required by written contract. Coverage js Primary and Non -Contributory, when required by written contract. 30 days notice of cancellation pplies, as required by written contract, with the exception of 10 days notice of cancellation due to nonpayment of premium. The above listed Installation Floater includes a blanket loss payee endorsement that shall apply to the Certificate Holder when required by written contract. SAGITTA 25.3 (2016103) 2 of 2 #S25644493/M25088834