Contract - Bennett Paving - 4/13/2023 ,)I IGINAL
CITY OF ROUND ROCK
TRANSPORTATION DEPARTMENT
ROUND ROCK TEXAS
Project MFor:
2022 DOWNTOWN STREET MAINTENANCE PROGRAM
,January 2023
Prepared y. fog0000.
Matthew Bushak, FSE `*
I TTM CW BUSHAK
..a....,..4,401660&a0400s6a*000.0 .9
.r
91480
APPROVED - •. ..
SISC ITY ATTO R N EY
�.
:R a,202 low I Ll
00500 AGREEMENT
City of Round Rock,Texas Contract Forms
Standard Form of Agreement: Section 00 500
City of Round Rock, Texas
Standard Form of.Agreement between
Owner and Contractor
AG REEM ENT made as of the day of 11 in the year 2022
BETWEEN the Owner: City of Round Roel,Texas(hereafter"Owner"or"City"')
221 East Main Street
Round Rock,,Texas 78664
and the Contractor Bennett Paring, Inc.. ("Contractor"
P.O. Bic 2309
Leander,TX 78646
The Project is described as: 2022 DOWNTOWN STREET MAINTENANCE
®
PROGRAM
The Engineer is: Matthew Bushal, PE
Pr ieet Manager
City of Round Roel
512-341-3318
For and in consideration of the mutual terms, conditions and covenants of this Agreement and all
accompanying documents between Owner and Contractor, the receipt and sufficiency of which aro hereby
acknowledged,Owner and Contractor all,ree as follows:
ARTICLE LE 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
s 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 ora1.An enumeration of the Contract Document-,other than Modifications,appears in Article 7.
ARTICLE 2 THE WORK OF THIS CONTRACT
Contractor shall fully execute the Work described in the Contract Documents,except to the extent specifically
indicated in the Contract Documents to be the responsibility of others.
00500 4-2020 Page ] of5 standard Form of Agreement
00443647
ARTICLE 3 DATE OF COMMENCEMENT; DATE OF SUBS'T'ANTIAL 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 ineasured from the date delineated in the Notice to Proceed.
3.3 Contractor shall commen a work within ten (10 calendar days
from the date delineated in the Notice to Proceed.
3.4 Contractor shall achieve Substantial Completion of the items of Work listed on Attachment A to this
Agreement no later than nla nla calendar days from issuance by Owner ofNotice to Proceed,
and Contractor shall achieve Substantial Completion of the entire work no later than
one hundred l 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 Substantia] Completion in the Agreement,Contractor shall pay to Owner,as liquidated damages,
the sum of one thousand and N0/100
Dollars 1,000-00 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 entitled
hereunder are a reasonable forecast of just compensation for the harm that would be caused by Contractor's failure to
achieve Substantial Completion ofthe Work or any portion thereof)on or before the dates specified for Substantial
Completion in the Agreement and is not a penalty. 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 of the work r any portion thereof) is not achieved on or before thirty 3 days after the
date(s) specified for 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 remedies under the Contract Documents and at law
and in equity, including without limitation, the recovery of actual damages. The date(s) specified for Substantial
Completion f 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 twenty
( 12 calendar days from issuance by Owner of Notice to Proceed.
ARTICLE 4 CONTRACT SUNT
4.1 Owner shall pay Contractor the Contract Sura in current funds for Contractor's full and complete performance
of the Work and all of Contractor's obligations under this Agreement. The Contract Sum shall be
three million five hundred forty-three thousand four hundred forty and five cents.
3, 43,44 .
subject to additions and deductions as provided in the Contract Documents.
4.2 Does the Contract Sum include alternates which are described in tete Bid Form?
No X Yes . Ify es,p leas e p rovi ( t a Us below:
NIA NIA
00500 -2020 'age 2 of 5 Standard I.orm of Agreement
00443647
ARTICLE 5 PAYMENTS
.1 PROGRESS ESS 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 male progress payments
n account of the Contract Sum to Conti-actor a� provided below, in Article 14 of the 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 Application for Payment is received by Engineer and Owner, and Engineer issues a
Certificate of Payment not later than the tenth (10th) day of a month, Owner shall male payment to Contractor of
amounts approved by the Owner not later than the tenth 1 oth 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 rnade by Owner not later
than one month after the Engineer issues a Certificate for Payment. The Owner shall not have any obligation to pay
any amount covered by the Engineer's Certificate for Payment that is disputed by the Owner.
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 ofvalues shall allocate the entire Contract Sura 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 ofcompletion of each portion of the Work as ofthe
end of the period covered by the Application for Payment.
5,1.6 Subject to other provisions of the Contract Documents, the amount of each progress payment shall be
computed as provided in Article 14 ofthe General Conditions.
5.1.7 Except with Owner's prior written approval, Contractor shall not mare 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, constituting the entire unpaid balance ofthe Contract Sura, shall be made by Owner t
Contractor when:
,I Contractor has fully perform ed 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 and approved by the Owner.
5.2.2 Owner's final payment to Contractor shall be made no later than thirty days after the issuance of
Engineer's final Certificate for Payment. In no event shall final pa yment be rewired to be made prior to thirty
days after all Work on the Contract has been fully performed. Defects in the Work d iscvered 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
.1 The Contract may be terra inated by Owner or Contractor as provided in Article 15 o f the General Conditions.
00500 4-2020 Page 3 of 5 Standard I orm of Agreement
00443647
.2 The Work may be suspended by Owner as provided in Article 15 of the General Conditions.
ARTICLE 7 ENUMERATION OF CONTRACT DOCUMENTS
7.1 The Contract Documents,except for Modifications issued afier execution ofthis Agreement,are enumerated
as follows-
7.1.1 The Agreement is this executed version of the City of Found lock, Texas Standard Form of Agreement
between Owner and Contractor,as modified.
7,1.2 The General Conditions are the "`City of Found Rock Contract Forms 00700," General Conditions, a
modified.
7,1.3 The Supplementary,Special,and other Conditions of the Contract are those contained in the Project Manual
dated January 2023
7.1.4 The Specifications are those contained in the Project Manual dated January 2023
7.1.5 The Drawings, if any,are those contained in the Project Manual dated January 2023
7,1.6 The Insurance&Construction Bond Forms of the Contract are those contained in the Project Manual dated
January 2023
7.1.7 "rhe Notice to Bidders, Instructions to Bidders, Bid Form, and Addenda, if any,are those contained in the
Project Manual dated-- _ January 2023
7.1.8 If this Agreement covers construction involving federal funds, thereby requiring inclusion of mandated
contract clauses, such federally rewired 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-
n
ARTICLE LF MISCELLANEOUS PROVISIONS
.1 where reference is trade 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.
.2 Owner's representative is: Matthew Bushak, P.
Senior Transportation Engineer
3400 Sunrise Ind
Round lock,TX 78665
.3 Contractor's representative is: Robert Terbay
Project Manager
P.O. Box 2309
.ender,TX 78646
8.4 hither Owner's nor Contractor's representative shall be changed without ten 10 days'written notice to the
other party.
00500 4-2020 Page 4 of 5 Standard I orm of Agr c ont
00443647
8.5 Waiver of any breach of this Agreement shall not constitute wa=ver of any subsequent breach.
8.6 Owner agrees to pay Contractor fi- rn 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
male payments on account thereof ars provided therein. Lack of funds shall render this Agreement null and gold to
the extent funds are not available. This Agreement is a commitment ofCity of Round Rock's's current revenues only.
.7 Although this Agreement is drawn by Owner,both parties hereto express agree and assert that, ire the event
of any dispute over its meaning r 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 Koch, 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 lie 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.
.9 Froth 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 1 r any applicable state arbitration statute.
8.10 The parties, by execution of this Agreement, bind themselves, their heirs, successors, assigns, and legal
representatives for the full and faithful performance of the ten-ns and provisions hereof:
This Agreement is entered into as of the day and year first written above and is executed in at least two 2
original copies,of which one is to be delivered to Dinner.
OWNER CONTRACTOR
CITY OF R Nl R ,TE AS Bennett Paving, Inc.
Printed I1axn Printed dame: Bryan Bennett
Title Title: President
- --- - --
• 41122
Date Signed. Date Signed. 0
ATTEST:
City Clerk
FOR CITY,APPROVED S TO FORM:
it Att Hey
00500 -2020 Page 5 of 5 S(andard Form of Agreemeni.
00443647
y
Bond #:: G TX 39
PERFORMANCE BON
THE STATE OF TEXAS
KNOW ALL BY THESE PRESENTS:
COUN'T'Y OF WILLIAMSON
That Bennett Paving Inc. ofthe Cit} of Leander ,
County ofTravis and State of Texas , as Principal, and
Granite Re, Inc. __.. _. __ authorized under the later of the State ofTexas to actsurety
n bonds for principals, are held and firmly bound unto the CITY OF ROUND ROCK,'TEXAS
(Owner), in the penal SUM of three million five hundred forty-three thousand dour hundred forty and five cents
Dollars $31543,4400 for the payment whereof, well and truly to be made the said
Principal and Surety bind themselves, and their heirs, administrators, executors, successors and
assigns,jointly and severally, by these presents:
WHEREAS, the Pr'nipl has entered into a certain written Agreement with the Owner dated the
day ofA ,2073 to which the Agreement is hereby referred t
and made a part hereof as fully and t th same extent as if copied at length herein a nsi ting of-.
2022 DOWNTOWN STREET MAINTENANCE PF F M_ .
NOW, THEREFORE, THE CONDITIONS OF THIS OBLIGATION IS SUCH, that if the said
Principal shall faithfully perforin said Agreement and shall, in all respects, duly and faithfully
observe and perforin all and singular the covenants, conditions and agreements in and 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 defects in said work occasioned by and resulting from
defects in materials furnished by or workman s hip o f,the Principal in performing the Work covered
by said Agreement and occurring within a period of twelve 12 months from the date of Final
Completion and all other covenants and conditions, according to the true intent 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;
PID , HOWEVER, that this bond is executed pursuant to the provisions ofChapter 2253,
Texas Government Code, as amended, and all liabilities on this bond shall be determined in
accordance with the provisions ofsaid Chapter 2253 to the same extent as if it were copied at
length herein.
Page 1
00610 4-2424 Performance Bond
00443639
PERFORMANCE E BOND (continued)
Surety, for value received, stipulates and agrees that no change, extension of time, alteration or
addition to the terms of the Agreement, or to the work performed 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 time,alteration or addition
to the terms of the Agreement, or to the work to be performed thereunder.
If Principal fails to faithfully perform said Agreement, Surety, after receipt of written notice of
Principal's default,shall perform all of Principal's duties and obligations under the Agreement. If,
within ten 10 days after receipt of such notice from Owner, Surety does not commence to
complete the obligations ofPrincipal with a contractor acceptable to Domer and diligently
complete the performance of the principal's duties and obligations,owner shall have the right but
not the obligation to have the duties and obligations of principal performed. In such event, Surety
shall pay to owner, upon demand, all costs, expenses and damages sustained by Owner as a resuilt
of Principal's failure to perform its duties and obligations under the Agreement up to the
$31,543,440.05 sura of this Performance Bond, plus all costs and expenses, including
attorney's fees and expert and consultant fees incurred by Owner to enforce its rights under this
Performance Bond.
IN WITNESS WHEREOF, the said Principal and Surety have signed and sealed this instrument
this day of ( , 20Z3 .
Bennett Paving Inc. Granite Re, Inc.
Principal Surety ---
,r Kenneth D. Whittington
Printed Name Printed dame
By: ,,,& — -
Title: %bu,Ir Title: Attorney-ire- act
Address; 23004 windy Valley Ind. Address: 14001 Quailbrook Drive
Leander, TX 75641 Oklahoma City, K 73134
Resident iden Agent of Surety*
Zf;a�M,,
Signature
Connor Kempston
Printed Name
9001 Airport Fwy Ste 500
Street Address
Forth l ichlan Hills, TX 76180
City, State & Zip Code
Page
00610 4-2020 Performance Fond
00443639
Bona : G TX 0439
PAYMENT BOND
THE STATE OF TEXAS
KNOW W AIT MEN BY THESE PRESENTS:
COUNTY OF WILLIAMSON
That Bennett Paving Inc of the Cir ofLeander 19
County of Travis , and State of Texas , as Principal, and
Granite Ike, Inc 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,
TEXAS (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 sura of
three million five hundred forty-three thousand four hundred forty and fivc cents
Dollars $ 3,543,440.05 ) for the payment whereof,well and truly be made the said
Principal and Surety hind themselves and their heirs, administrators, 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
day of1920 g3 to which Agreement is hereby referred to
and made part hereof s fully r and t the a extent a if XPi l at length herein a consisting 1�;
2022 DOWNTOWN STREET MAINTENANCE PROGRAM
I
Now, THEREFORE, THE CONDITION 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 Principals for subcontracts,work, labor,equipment,supplies and
materials done and furnished for the construction of the improvements of said Agreement, then
this obligation shall be and become null and void; otherwise to remain in full force and effect.
PROVIDED, HOWEVER,that this bond is executed pursuant to the provisions of Chapter 2253,
Texas Government Code, as amended, and all liabilities on this bond shall be determined in
accordance with the provisions of said Chapter 2253 to the same extent as if it were copied at
length herein.
Page 1
00620 04-2020 Payment Fond
004 7699
PAYMENT BOND (continued)
Surety, for value received, stipulates and agrees that no change, extension of time, alteration or
addition to the terms of the Agreement, or to the Work performed thereunder, or the plans,
specifications or drawings accompanying the same shall in anywise affect its obligation ori this
bond,and it does hereby waive notice of any such change,extension of time, alteration or addition
to the terms of the contract, or to the Work to be performed thereunder.
IN WITNESS WHEREOF, the said Principal and Surto have signed and sealed this Instrument
this day of Aix 20E5.
Bennett Paving Inc. Granite Re, Inc.
Principal Surety
by ia.+ Kenneth D. Whittington
Printed Name Printed Name
: -
Title: 1pyfc,-,,LktnAr Title: Attorney-in- act
Address: 23004 Windy_ Valley Ind. Address: 14001 QDrive
Leander., TX 78641 Oklahoma City, OK 73134
Resident Agent of Surety:
coeo�f�4'
ignature
Connor Kempston
Printed Name
9001 Airport FWy Ste Soo
Street Address
North Richland Hills,TX 76180
Cir, Mate&Zip Code
Page 2
006201-2020 Payment Bond
00090656
GRANITE 1E, INC.
GENERAL POWER OF ATTORNEY
Know all Hien by these Presents:
That GRANITE RE, INC., a corporation organized and existing under the laws of the State of MINNESOTA and having its
principal office at the City of OKLAHOMA CITY in the State of OKLAHOMA does hereby constitute and appoint:
KENNETH D. WHITTINGT N;KYLE MCDONALD its true and lawful Attorney-in-Facts)for the following purposes,to wit:
To sign its name as surety to, and to execute, seal and acknowledge any and all bonds, and to respectively do and perforin any
and all acts and things set forth in the resolution ofthe Board of Directors of the said GRANITE ISE# INC. certified copy of which is
hereto annexed and made a part of this Power ofAttorney; and the said GRANITE RE, INC. through us, its Board of Directors, hereby
ratifies and confirms all and whatsoever the said:
KENNETH D. HITTfN T N; KYLE MCD N LD may lawfully do in the premises by virtue of these presents.
In Witness Whereof,the said GRANI'T'E RF, INC. has caused this instrument to be sealed with its corporate seal, duly attested
by the signatures of its President and Assistant Secretary,this 3d day of January,2020.
— I enxieth D.Whitt ora President
STATE OF OKLAHOMA M FA L
SS;
COUNTTY OF OKLAHOMA Kyl F.McDonald,Assistant Secretary
On this 3d day of January, 2020, before me personally carne Kenneth D. Whittington, President of the GRANITE RE, INC.
Company and Kyle P.McDonald,Assistant Secretary of said Company,with both of whom I am personally acquainted,who being by rite
severally duly sworn, said, that they, the said Kenneth D. Whittington and Kyle P. McDonald were respectively the President and the
Assistant Secretary of GRANITE RE, INC.,the corporation described in and which executed the foregoing Power of Attorney; that they
each knew the seal of said corporation;that the seal affixed to said Power of Attorney was such corporate seal,that it was so fixed by order
of the Board of Directors of said corporation, and that they signed their name thereto by like order as President and Assistant Secretary,
respectively,of the Company.
.L a.'-.
My Commission Expires:
April 21,2027 %_ Notary Public
Cominission : 11003620
GRANITE RE,INC.
Certificate
THE UNDERSIGNED, being the duly elected and acting Assistant Secretary of Granite Re, Inc., a Minnesota Corporation, HEREBY
CER'T'IFIES that the following resolution is a true and correct excerpt from the July 15, 1987, minutes of the meeting of the Board of
Directors of Granite Re,Inc.and that said Power of Attorney has not been revoked and is now in full force and effect.
"RESOLVED, that the President, any Vice President, the Assistant Secretary, and any Assistant slice President shall each have
authority to appoint individuals as attorneys-in-fact or under other appropriate titles with authority to execute on behalf of the
company fidelity and surety bonds and other documents of similar character issued by the Company in the course of its business.
On any instrument making or evidencing such appointment, the signatures may be affixed by facsimile. On any instrument
conferring such authority or on any bond or undertaking of the Company, the seal,or a facsimile thereof, may be impressed or
affixed or in any other manner reproduce provided, however, that the seal shall not be necessary to the validity of any such
instrument or undertaking.
IN WITNESS WHEREOF.,the undersigned has subscribed this Certificate and affixed the corporate seal of the Corporation this
S V.C1.
%1 0A Kyle .McDonald,Assistant Secretary
F-40G Ed.04-23
State of Texas
Claim Notice Endorsement
To be attached to and form a part of Bond No. GRTX60439
In accordance with Section 2253.021(f) of the Texas Government Code and
Section 53.202(6) of the Texas Property Code any notice of claim to the named
surety under this bond(s) should be sent to:
Granite Re, Inc.
Attention: Claims Department
14001 Quailbrook Drive
Oklahoma City, OK 73134
Telephone: (405)752-2600
ATTACH THIS NOTICE T4 YOUR BOND
BID FORM
PROJECT NAME: 2022 DOWNTOWN STREET MAINTENANCE PROGRAM
PROJECT LOCATION: Round Rook, Texas
ONNINER: City of Round Dock, Texas
DATE: January 10, 2023
Pursuant to the foregoing Notice to Bidders and Instructions to Bidders, the undersigned bidder hereby
proposes to do all the Mork, to furnish all necessary superintendence, labor, machinery, equipment, tools,
materials, insurance and miscellaneous items, to complete all the Work on which he bids as provided by the
attached Bid Documents, and as shown on the plans for the construction of
2022 DOWNTOWN STREET MAINTENANCE PR GAM
and hinds himself on acceptance of this fid to execute the Agreement and bond for completing said Work
within the time stated, for the following prices, to it:
Any addenda issued will be posted with the Project Manual and;' r Contract Documents on the
City's website at roundrocktexgL.gov/solicitations by the close of business on
February 2 , 2023 Prior to submitting a bid, the bidder is responsible for determining if any
F
addenda have been issued and for following any instructions in any addenda issued.
Bidder acknowledges receipt of the following Addenda by listing Addendum "number" and "date".
BASE BID
Bid Approx. Item Description
Item Quantit Unit and written Unit Price Unit Price Amount
1 7704 TON Pavement Repair 12" Depth)
complete in place per TOIL
for one hundred sixty one dollars
and zero cents. 161.00 11240,344.00
2 950 LF Remove and Replace Cone Curb
and Gutter
complete in place per LF
fog- sixty five dollars
and zero cents. 65.00 615750.00
00300-9-2015 Page 1 of 6 Bid Form
BASE BID
Bid Approx. Item Description
Item Quantit Unit and Written Unit Price Unit Price Amount
1910 SF Remove and Replace Come
Sidewalk
complete in place per SF
for thirty one collars
and zero cents. $ 31.00 $ 59 210.00
400 SF Remove and Replace Conc
Driveway
r
complete in place per SF
for thirty one dollars
and zero cents. $ 31.00 $ 123400.00
91164 SY Surface Billing 2"
complete in place per SY
for four dollars
and seventy,five cents cents. 4.75 433X9.00
1483 SY Edge hill 0"-2"
complete in place per SY
for four dollars
and seven!X fire cents. $ 4.75 $ 7,044.25
12590 TOIL Type D HMAC Surface Course
complete in place per TON.
four one hundred twenty three dollars
and fifty cents. $ 123.50 1,554, 65.00
00300-9-2015 Page 2 of 6 Bid Form
RASE BID
Bid Approx. Item Description
Item Quandt Unit and Written Unit Price Unit Price Amount
o EA Valve Can Adjustment
complete in place per E
for one hundred dollars
and zero cents. 100.00 $ 800.00
9 .6.0 U-A. Manhole Adjustment
complete in place per EA
for six hundred fifty dollars
and zero cents. $ 650.00 $ 3900.00
10 8893 LF REFL PAV MRK TY I
(W)6"(SLD)(100 MIL)
complete in place per LF
for one dollars
and sixty cents. $ 1.60 $ 14X8.80
11 180 LF REFL PAV MRK TY I
(W)666(BRK)(100 MIL)
complete in place per LF
for zero dollars
and ninety six cents. $ 0.96 172.80
1 90 EA RFL IAV MRKR TY I-C
complete in place per EA
for five dollars
and eighty five cents, 5.85 $ 526.50
00300-9-2015 Page 3 of 6 Bid Form
RASE BID
Id Approx. Item Description
Item Quantit Unit and Written Un it Price Unit Price Amount
13 10070 LF REFL PAV MRK TY f
(Y)6"(SLD)(100MIL)
complete in place per LF
for zero dollars
and ninety one cents. 0.91 $ 9,163.70
14 485 LF REL PAV MRK TY I
(Y)6 11 BRK)(100 MIL)
complete in place per LF
for zero dollars
and ninety six cents. $ 0.96 $ 465.60
15 197 EA RFL PAV MRKR TY II-A-A
complete in place per EA
fog- four dollars
and forty cents. $ 4.40 $ 866.
16 l 1 2 LF RFL PAV MRK TY I
(W)8"(SLD)(100MIL)
complete in place per LF
for two dollars
and eighty fire cents. 2.85 $ 319.20
17 494 LF REF'L PAV MRK TY I
(W)12"(SLD)(100 MIL
complete in place per LF
for four dollars
and fifty cents. $ 4.50 $ 2,X3.00
00300-9-2015 Page 4 of 6 Fid Form
RASE BID
Bid Agro . Item Description
Item Quandt Unit and Written Unit Price Unit Price Amount
18 77 LF REEL PAV MRS. TY I
(Y)12"(SLD)(100 MIL
complete in place per LF
for five dollars
and zero cents. $ 5.00 $ 385.00
19 1116 LF REFL PAS' MRK TY I
(W)24"(SLD)(100MIL
complete in place per LF
for ten dollars
and forty cents. $ 10.40 $ 11 106.40
!- 16 EA RFL PAV MRK TY I
(W)(ARROW)(I 00 MIL
complete in place per EA
for one hundred sixty fire dollars
and zero cents. $ 165.00 $ 2MO.00
.00
21 EA REFL PAW MRK TY I
(')(WORD "O LY'1)(1 001 IL
complete in place per EA
for two hundred dollars
and zero cents. 200.00 $ 400.00
2 EA REFL PAV MRK TY I (ADA
PRS. SYM L)(100 MIL
complete in place per EA
for four hundred dollars
and zero cents. $ 400.00 $ 800.00
4 MO Traffic Control
complete in place per
for twenty one thousand dollars
and zero cents. $ 2100.00 $ 8400-00
00300-9-2015 Page 5 of 6 Bid Form
BASE BID
Bid Approx. Item Description
Item Quandt Unit and written Unit Price Unit Price Amount
TOTAL BASE B1 (Items 1 thru 23 315431440.05
Materials: $ 1, 00,000.00
All other Charges: 119431,440.05
* Total: $ 31543,440.05
Note: This total must be the same amount as shown above for "Total Base Bid"
If this bid is accepted, the undersigned agrees to execute the Agreement and provide necessary bonds and
insurance certification as per the Instructions to Bidders.
The undersigned certifies that the bid prices contained in the bid have been carefully checked and are
submitted as correct and final. The Owner reserves the right to reject any or all hick and may waive any
informalities or technicalities.
Respectfully Submitted,
P.O.707
Box 2309
Signature
Bryan Bennett Leander, TX 78646
Print Name Address
President 51 740-8603
Title Telephone
Bennett Paring, Inc.
Larne of Firm
March 2, 2023 Bryan Bennett
Date Secretary, if Bidder is a
Corporation
00300-9-2015 Page 6 of 6 Bid F ren
z
f
BID BOND
THE STATE OF TEXAS
KNOW ALL BY THESE PRESENTS:
COUNTY OF WILLI MS N
That Bennett Pavina Inc. of the City of Leander _ Counter
of lWilliamson State of T eras as Principal, and
Granite Rel Inc. _ — authorized under the laws ofthe State of Texas to act as surety on
bonds for principals,are held and firmly bound unto the CITY OF ROUND ROCK,TEXAS("Owner"),
,
in the penal sura ofFive Percent % of the total amount ofthe Bid of the Principal submitted to the Owner,
for the Work described below; for the payment whereof, well and truly to he made, and the said Principal
and Surety do herby bind themselves and their heirs, administrators, executors, successors and assigns,
jointly and severally, as follows:
In no case shall the liability of the Surety hereunder exceed the sum of
five percent ofbid amount unt Dollars $ %
THE CONDITIONS OF THIS OBLIGATION ARE SUCH that, whereas, the Principal has submitted
the above-referenced Bid to the Owner, for construction ofthe Work under the "Specifications for
Construction of 2022 D WNT " STREET MAINTENANCE PROGRAM
for which Bids are to be opened at the office of Owner on the 2nd day of
March 1) 2023 .
NOW,THEREFORE,I E,if the Principal is awarded the Contract,and within the time and manner required
under the"`Instructions to Bidders,"after the prescribed forms are presented to her/him for signature,eaters
into a written Agreement substantially in the form contained in the Bid Documents, in accordance with the
Bid, and files les the two bonds with the Owner, one to guarantee faithful performance and the other t
guarantee payment for labor and mated al s,then this obligation shall be null and void;otherwise, it sha11 be
and remain in full force and effect.
If, however, Principal fails to enter into a written Agreement with the Owner in accordance with the
Bid or Principal and Surety fail to timely deliver to Owner the performance and payment bonds rewired
by the Bid Documents, Surety within five business days after receipt of a written demand from Owner
shall pay to Owner the full penal sure of this Bid Bond, subject to the limitation described herein.
In the event that suit is brought upon this Bond by the Owner and judgment is recovered, said Surety
shall pay all costs incurred by the Owner in such suit, including a reasonable attorney's fee to be fixed by
the Court.
IN WITNESS WHEREOF,F, the said Principal and Surety have signed this instrument on this the
2nd day of the month of March 2023 .
Bennett Paving Inc. Granite lie, Inc.
Principal Surety
6 ryom 6enod+ -Kenneth D. Whittington
Printed Name Printed Name
By: By: .�
Title: ! r0 Title: Attorney-ln-Fa
Address; 23004 windy Valley lid. Address: 14001 Quailbrook Drive
Leander, TX 78641 Oklahoma City, Off. 73134
00200 4-2020 1 did Bond
00443638
T
ti
Resident Agent of Surety:
Signature
Connor Kempston
Printed Name
9001 Airport Fwy Ste 500
.qtreet Address
North Richland Hills, TX 76180-7773
City, State,Zip
00200 4-2020 fits Bond
00443638
GRANITE RE, INC.
GENERAL POWER of ATTORNEY
Know all Men by these Presents:
That GRANITE RE, INC., a corporation organized and existing under the laws of the State of MINNESOTA and having its
principal office at the City of OKLAHOMA MA IT in the State of OKLAHOMA.does hereby constitute and appoint:
KENNETH D.WHITTINGT N;KYLE MCD NALD its true and lawful Attorney-in-Facts)for the fol[owing purposes,to wit:
To sign its name as surety to, and to execute, seal and acknowledge any and all bonds, and to respectively do and perform any
and all acts and things set forth in the resolution of the Board of Directors of the said GRANITE RE, INC. a certified copy of which is
hereto annexed and made a part of this Power of Attorney; and the said GRANITE RE, INC. through us, its Burd ofIDirectors, hereby
ratifies and confirms all and whatsoever the said:
KENNETH D. 1 HITTINGT N; KYLE MCD N LD may lawfully do in the premises by virtue ofthese presents.
In Witness Whereof,the said GRANITE RE, INC. has caused this instrument to be sealed with its corporate seal, duly attested
by the signatures of its President and Assistant Secretary,this 3rd day of January,2020.
-00
,It:
ke�n�neth D.Whittinfon,President
STATE P OKLAHOMA � �:A'
SS;
COUNTY OF OKLAHOMA Kyl P.McDonald,Assistant Secretary
On this 3rd day of January, 2020, before me personally carne Kenneth D. Whittington, President of the GRANITE ISE, INC.
Company and Kyle P. McDonald,Assistant Secretary of said Company,with both of whom I am personally acquainted,who being by me
severally duly sworn, said, that they, the said Kenneth D. Whittington and Kyle P. McDonald were respectively the President and the
Assistant Secretary of GRANITE RE, INC., the corporation described in and which executed the foregoing Power of Attorney; that they
each knew the seal of said corporation;that the seal affixed to said Power of Attorney was such corporate seal,that it was so fixed by order
of the Board of Directors of said corporation, and that they signed their name thereto by like order as President and Assistant Secretary,
respectively,of the Company.
r "00
My Commission Expires: #'' k•'
April 2 f,2023 = Notary Public
Co ssion#: 11003620
�#fflaliltiti*��
GRANITE RE,INC.
Certificate
THE UNDERSIGNED, being the duly elected and acting Assistant Secretary of Granite Re, Inc., a Minnesota Corporation, HEREBY
CERTIFIES that the following resolution is a true and correct excerpt from the July 1 , 1987, minutes of the meeting of the Burd of
Directors of Granite Re,Inc.and that said Power of Attorney has not been revoked and is now in full force and effect.
"'RESOLVED, that the President, any Vice President, the Assistant Secretary, and any Assistant Vice President shall each have
authority to appoint individuals as attorneys-in-fact or under other appropriate titles with authority to execute on behalf of the
company fidelity and surety bonds and other documents of similar character issued by the Company in the course of its business.
On any instrument making or evidencing such appointment, the signatures may be affixed by facsimile. On any instrument
conferring such authority or on any bond or undertaking of the Company, the seal, or a facsimile thereof, may be impressed or
affixed or in any other manner reproduced; provided, however, that the seal shall not be necessary to the validity of any such
instrument or undertaking,"
IN WITNESS WHEREOF,the undersigned has subscribed this Certificate and affixed the corporate seal of the Corporation this
March 2 } 2023
sFr.
Kyle P. McDonald,Assistant Secretary
GR-40 Ed.01-22
BENriEmImT PAVING
Cover Page
Bennett Paving, Inc
P.O. Box 2309
Leander, TX 78646
Date of response: 3/2/2023
City of Round Rock: 2022 Downtown Street Maintenance Program
Solicitation Number: 23-401
1�e'7
Bryan Bennett
President
Solicitation Requirements., Contract_Forms & Conditions of Contract
Statement of Bidder's Safety Experience Section 00410
Bidder must submit a signed Statement of Bidder"s Safety Experience form with his Bid; failure
to do so will constitute an incomplete Bid that may be rejected. In order to make a responsive
Bid, Bidder must provide evidence that it meets minimum OSHA construction safety program
requirements, has not been fined by OSHA for any willful safety violations in the past three
years, and has a lost time injury rate that doesn't exceed the limits established below. All
questions must he answered and data given must be clear and comprehensive. If necessary,
questions may be answered on separate attached sheets.
Company Name: Bennett Paving, Inc.
-
Address: P.O. Box 2309, Leander, TX 78646 Phone: 1 740#8603
Completed by: Aryan Sennett Date. -2-2023
l� .A a.
1. Does the company have a written construction Safety program? E]Yes ❑No
. toes the company conduct construction safety inspections? Yes ❑No
. Does the company have an active construction safety-training program? [Z]Yes ❑No
4. Has the company been fined by OSHA for any willful safety violations in the past [:]Yes Q No
three years?
. Lees the company have a lost time injury rate of 7.8 for SIC 15, or 7.6 for SIC 16, ElYes El No
or less over the past three years?
Attach the company's OSHA 200:300 logs for the past three years.
. lees the company or affected subcontract rq have competent persons in the
following Areas'
A. Scaffolding M Yes []No 0NiA
B. Excavation Fz]Yes E]No ❑N,
C. Cranes El Yes E]No El N 5,A
D. Electrical R1 Yes E]No El N
E. Fall Proteetio« R]Yes E]No rIN A
F. Confined Spaces [Z]Yes [-]No ❑N.A
I hereby certify that the above information is true and correct.
Signature Tale President
Page 1
(1041 8-2014 tatem nt of Bidder"s SafetyBidder" L p riew.-c
:10090654
Attention: This form contains information relating
�"� �� Form 300 (Rev. 01/2004) to employee health and must be used in a manner
that protects the confidentia ity of employees to the Year 2022
extent possible while the information is being used
Log oWork�Related Injuries Illnesses for occupational•safety and health purposes_ U.S. Department of Labor
Occupational Safety and Health Administration
You must record informalon about every work-related injury or illness that involves loss of consciousness,resbiaed work activity or job transfer days away from work,--r medical treatrrrrent
beyond porn approved OMB no,121"176
first ad.You must also record significant work-related injuries and illnesses that are diagnosed by a physician or licensed health care professional.You must also record work-related
injuries and
illnesses that nwt any of the specific recording Criteria fisted in 29 CFR 19Q4,8 through 1$04.12.Feel free to use two lines for a single case if you rieed to,You must complete an
injury and E tabl' hment name Bennett Paving,Inc.
illness incident report(OSHA Form 301)or equivalent form far each injury or illness recorded on this form. If you're not sure whether a case is recordable,call your local OSHA offim
for help.
city Leander State Texas
Id l 'r thD arson Describe-the case lass i he,ca e
Enter the number of
(A) (B) { ) (b) (E) (F) C H EC K ONLY ONE box for each case based on days the injured or ill Check the"injury,"column or choose one type of
Case Employees Name Job Title (e,g., Date of Where the event occurred(e.g. Describe injury or illness,parts of body affected, the most serious outcome for that case:
worker was: illness:
No. Welder) injury or Loading dock north end) and objectfsubstance that directly injured or made w- ot
onset of person ill(e.g.Second degree bums on Hght M
illness forearm from acetylene torch) On job '
Death Days saucy Remained at work transfer or .
(mo.1day) from work From restrtiction
,lab transfer �tther reword- o (days)
or restriction gable canes (days) 0 0 0 0
e
_ t' (1) 2 (3 '4'e I ; ) ( )
NO REPORTABLE INJURIES FOR YEAR 2022
I
9 —
I
Page totals o o = 0 1 0 0 a 0 0 6 0 0
Be sure to transfer these totals to the Summary page(Form 00A)before you post it. � 12 � J
LO C
Public reporting burden for oris collection of information is estimated to average 14 minutes per response,Ironing®me ❑
EL
review the instruc0on,search and gather the data needed,and Cornptete and review the collection of inforrnation.Persons o� � (13
are not requred to respond to the collection of information unless it displays a currently valid OMB oontrol number If you o
have any comments about these estimates or any aspects of this data colleC'done contact: US Department of Labor,OSHA d
Office of Statistics,Room N-3044,200 Constitution Ave,NW.1 Washington,DC 20210 Do not send the completed forms to
this office. pyo f if 1 I.�� 11) (5, 0) ) (s)
OSHA's Form 30OA (Rev.011 00 Year 2022 4*
Summary of WorkwRelated Injuries Illnesses T.S.Department of Labor
0=padprrd Safety and Heatth AdrnlnIstraWn
Faen approved OMB no-121M176
All estab&sh eats covered by Part 1904 mast complete this Summarypage.even if no injuries or
ifln7esses occurred during the year Renvmber to mi-ew the Log to verity that the entries are corn ote
Using the Log,count the indivo'dual entries you made for each category. There write the totals below, Establishment information
nmk ng sure you%V added the entries frons every page of the log. It you had no cases write'0.'
Employees former employees.and their representatives have the right to review the OSHA Form 300 in Your establishment name Bennett Paving,Inc.
its enhraety. They also have limited access to the OSHA Form 301 or its Bquivetent See 29 CFR
1904.35.in OSHA's Re=dkeeping rL de,for further details on the access provisions for these forms. Street P.O.Box 2309
Number of Cases City Leander State Texas ZP 78646
Industry description(e.g.,Manufacture of motor truck trailers)
Total number cf Total number of Total number of cases Total number of Seal Coating,Striping,Asphalt Paving
deaths cases with days with job transfer or other recordable
away from work restriction cases Standard Industdal Classification(SIC).d known(e.g..StC 3715)
0 0 0 0 1 6 1 1
(G) (H) (I) W) OR North American Industrial Classificatibn(NAI S),if known(e.g..336212)
2 3 7 3 1 0
Number of Days Employment information
Total number of Total number of days of
days away from job transfer or restriction Annual average number of employees 26
Wnrk
Total hours worsted by all employees last
0 0 year 48,257
( ) (�1
Injury and Illness Types -
Sign here
Total number of. Knowingly falsifying this document may result in a free.
M
til Injury 0 -A Paisonsng 0
(21 Skin Disorder 0 ; ; Heanng Loss 0 1 certify that I have examined this document and that to the best of my knowledge the entries are true,accurate,and
(3) Respiratory
complete.
Condition 0 S:AAI Other Illnesses 0
Bryan Bennett President
omparry executive Title
512-740-103 Wa
Post this Summary page Fpm I-eb ruary+I to April 30 of the year following the year covered by the form Phone Data
Attention: This form contains information relating to
OSHA's Form 301 employee health and must be used in a manner that 4e*7>>
protects the confidentiality of employees to the extent
possible while the information is being used for U.S.Department of Labor
Injuries and Illnesses I Report occu pationasafety and health purposes.
ccupetional S a#ety and 1~{ea[th Adrnirtiatration
Form approved OMB no.1218-0176
Infor ation about the employee Information about the case
Th s Injury and 41ne Incident Report sone of the 1) Full Name 1 U} Case number from the Log (Transfer tete kis@ number from the L:>v after�.;L.record the cdsd.
first forms you must fl'out when a recordable work- 21 Street 11:• rate r:9 injury or illness
re aced n ury or IIness has oocurr d. Together with
the Log of Work Related;Junes and Imesses and city state �Zip 12) Time employee began work AM/PM
tete accompany ng Summary these forms help the
employer and OSHA develop a p cfure of the extent 31 Date of birth 13) Time of event AM/PIUI [3 Check if time cannot be determined
and severity of work-re•ated incidents,
Within 7 calendar days after you receive 4 Date hired 14 What was the employee doing just before the incident occurred? Describe the activity,as well as
information that a recordable work-re ated Injury or the tools,equipment or material the employee was using. Be specific. Exarnples: "climbing a ladder
i Iness has occurred you must fl;I out th s form or an 5)❑Male while carving roofing materials";"spraying chlorine from hand sprayee',"daily computer key-entry."
equivalent. Some state workers'oompensatlon, Female
insurance or other reports may be acceptable
substitutes To be considered an equivalent form; Information about the physician or other health care
any substitute must contain all the information professional
asked for on this form 15•I What happened' Tell us how the injury occurred.Examples:"When ladder slipped on wet floor,
Acmrding to Public Law 91-596 and 29 CFR 6, Name of physician or other health care professional worker fell 20 feet";'Wo rker vera s sprayed with chlorine when gasket broke
during replacement"";
1904.OSHNs recordkeeping rule,you must keep "Worker developed soreness to wast over time'.
th s form on file for 5}ears following the year to
which it pertains
If you need additional copies of this form,you 7) If treatment was giver away from the worksite,where was it given?
may photocopy and use as many as you need
Faci ity 1 ) What was the injury or illness?Tell us the part of the body that was affected and how rt.was
affected.be more specific than"hurt","pain",or"sore"Examples."strained back"."chernical burn,
Street hand","carpal tunnel syndrome."
ty+ State Zip
8' las employee treated in an emergency room?
Completed by lYes 17) What object or substance directly harmed the employee's Examples:"ooncrete floor";"chlorine";
� o "radial arm saw."If this question does not apply to the incident,leave it blank.
Title
9 Was employee hospitalized overnight as an in-patient?
Phone Date [:]Yes
R No 18) If the employee died,when did death occur' Date of death
Public reporting burden for this collection of information is estimated to avenge 22 minutes per response.irduding time for reviewing instructions.searching existing data sources,gathering
and maintaining the data needed,and cpa'npled ng and reviewing the collection of'n rr,---o-i s.-r. :j n-�
required to respond to the Collection of information unless it displays a Current valid 0M control number. If you have any comments about this estimate or any other aspects of This
data Cal lection.including suggestions tar reducing this burden,contact: US Department of labor,OS,--
Room
rRoom N-3644.200 Constitution Ave NW.Washington DC 20210 Do not send the completed forms to this off"
Attention: -I-ii dorm contains Infatuation relating to
employee health and must be used in;a manner that
OSHA's Form 300 (Rev.0112004) protects the Confidentiality of employees to the extant Year 2021
possible wh le the infatuation is being used for
Log WorkmiRelated I Illnesses occupationa.safety and health purposes. U.S. Department of Labor
Occupational Safety and Health Administration
You must record information about every work-elated injury or illness that irwoWs loss of consoiausness,restricted work activity or job transfer.days away from work.or medical tfeatment
beyond first aid.You Form approved OMB no.1 1 M176
must also record sigri ficarit work-related lnjuries and iltrr rws that are diagnosed by a physician or ftcensed health cat's professtonal You must also record work elated injuries
and lkwsses that meet arty of fie
specific recording criteria Isted In 29 CFR 1904.$through 1904.12,Feel free to m two lines for a single case if you need to.You must=nplete an injury and•Mess incident report(OSHA
Fom 301 or Establishment name Bennett Paging Inc
a:N&alent form for eadi injury or mess recorded on this form.if you're not we whether a case is raomkible call your local OSHA office for help.
city Leander State Texas
A@ r# e e� Descdbe-the case bassi the False
1 Enter the number of
(A) ( ) (D} (E) J CHECK ONLY ONE box for each case based on the 'days the injured or ill Check the'Injury"column or choose one type of
Case Employee's(Varve Job Title ie ,, Date of Where the event occurred�e g. Describe injury or illness.pans of body affected,and most serious outcome for that case:
'worker was: illness:
No Vlfelderi injury or Loading dock nWh end) ole ectf ubstance that directly injured or made person ill(e.g.
onset of Second degree burns on right forearm from aoetyl ene torch) M
illness Oawayn job
:ma.lday Death from work ftemalned at work From transfer or 2 c
restriction ,
iJob transfer Other record- Work (days} Lp
.
or restriction able cases (days) �
1'Fabian Ramirez -PTO",mi 07(01(21 H• in Vista,T Fell off roller due to soft��ji shoulder and broke-i.-,hi arm 14' 141 �
l
Page totalis o 141 0 0 141 0 tI o C 0 o
Be sure to transfer these totals to the Summary Pale{Form 00 }before you dost it. ,
i ro
I
Crt
Pubic reporryrrg burden for this collection of information is estimafsd to average 14 minutes per response,including time ds 0
to review the instruction,search and gather tfie data needed,Arid complete and rwMw the cokcbon of information.
Psrsoris are not required to respond to the collection of information unless it displays a oxrently void OMB control o
nurnber,If you have any comments abort these estrri es or any aspects of this data colkic iiM.wntwt U S Depaftem
of Labor.OSHA Office of Statistics,Room N,36",200 ConstibAion Ave.NW,Washington,DC 20210.Do not send the
completed forms to ft office, r-a-.e 1 cr ('I (2) (S) :4; (5) ( )
OSHA's
Year 2021 4�p
Summary of WorkwRelated Injuries n Illnesses I.J.S.Department of Labor
0OGYQ4dkmal Sdety and Health Administratlon
form approved OM B no.121"176
M establishments covered by Part f904 must complete this Summary page,even d no initifies or
Illnesses occunvd duhnq the year Remember to review the Log to verify that the entries are complete
Using the Log.count the+ndrvrduef entries you made for each category Thea whie the totals below, Establishment information
making sore youW added the entries from every page of the log. if you had no cases write'V.'
Employees lowlier empfoyees,and their r'eptesontatives have the right to mview the OSHA Form 300 in Your establishment name Bennett Paving.Inc.
its entirety! They also have fr'rrr0d access to the OSHA Form 301 or Its equivalent. See 29 CFR
1904.35,in HA's Recordkeeping ado.for further detaifs on the access prvvis+ons for these forms. Street P.O.Box 2309
Number of Cases City Leander State Texas zP 78646
Industry description(e.g.,Manufacture of motor truck trailers)
Total number of Total number of Total number of rases Total number of sear Coating,Striping,Asphalt Paving
deaths cases with days with lob transfer or other recordable
away from work restriction cases Standard Industrial Classification(SIC).if known(e.g.,SID 3715)
0 141 0 0 1 6 1 1
R North American Industrial Classification(NM S),it mown(e.g..336212)
7 3 1 0
Bumber of Days Employment information
Total number of Total number of days c f
days away from job transfer or restriction Annual average number of employees 26
nrk
Total hours worked by all employees last
141 _ 0 year 38,084
(�
-injury and Illness Types Sign here
Total number of Knowingly falsifying this document may result in a fine.
M:
(1) njur 1 (4) Poisoning 0
( ) Skin Disorder 0 (5) Hearing Loss 0 r certify that I have examined this document end that to the best of my knowledge the entries are true.accurate,and
(3) Respiratory complete.
Condition (B)All Other Illnesses 0
Baan Bennett _ President
Company executive 'Title
512-740-8603 211022
Post this Summary page from February 1 to April 30 of the year following the year covered by the form Phone Date
Attention: This form contains information relating to 4(e*
OSHA's F 301 employee health and must be used in a manner that
protects the confidentiality of employees to the extent
possible while the information is being used for U.S.Department of LaborInjuries IllnessesI ' 'r � �� occupational safety and health purposes.
OccuP ationaI SafetY and Health Administration
Form approved OMB no.1218-0176
Information about the employee Information about the case
This Injury and Illness Incident Report is one of the 1:, Full fame Fabian C Ramirez 1 p) Case nurnber from the Log 1 (Transfer the case number from the flog after
you record the case.)
fiat forms you must fill out when a recordable work- 2® Street 1804 Courtney cove 11) Date of injury or illness 711/2021
related injury or illness has occurred. Together with -the Log of Work-Related injunes and Illnesses and city Round Flock State . 7866 Zip 12) Time employee began
work 7.00 PM AM/PM
the accompanying Summany,these forams help the
employer and OSHA develop a picture of the extent 3) Date of birth 1120/1957 13) Time of event 5:45 PM AM/PIM E]Dheck it time cannot be determined
and severity of work-related incidents.
With n 7 calendar days after you receive 4: Date hired 312212021 14) What was the 9mployee doing just before the incident occurred? Describe the activity,as well
as
information that a recordable work-related injury or the tools,equipment or material the employee was using. Be specific. Examples: "climbing a ladder
illness has o=rred,you must fill out this form or an 5:�Mare while carrying roofing materials";"spraying chlorine from hand sprayee',"daily computer key-entry."
equivalent. Some state workers"compensation, �Female
insurance,or other reports may be acceptable He was operating a roller
substitutes. To be considered an equivalent form, Information about the physician or other health care
any substitute rnu st contain all the Wormation professional
asked for on this form. 16) What happened?Tel us how the injury occurred.Examples:"When ladder slipped on wet floor,
According to Public Law 1-696 and 29 CFR 6: name of physician or other health care professional worker fel 12 0 feet"';"Worker was sprayed with chlorine when gasket broke during
replacement";
1904. HA's recordkeeping rule.you must Keep "Worker developed soreness in wrist over time."
this fonm on file for 5 years fo]owing the year to Due to a soft shoulder,road gave way and machine laid on its side.
which't pertains
If you treed additional copies of this form,you 7) If treatment was given away from the worksite,where was it given?
may photocopy and use as marry as you need.
Facility St David's Hospita 16) What was the injury or illness?Tell us the part of the body that was affected and how it was
affected;be more specific than"hurt',"pain",or"sore."Examples:"strained back',"chemical burry,
Street band","carpal tunnel syndrome."
Broke right arm and he hit the back of his head,
City State Zip
8; Was employee treated in an emergency room?
Comp eted by Lola Greeson Mlles 17) What object or substance directly harmed the employee? Examples:"concrete flooe';"chlorine";
M No "radial ami saw."If this question does not apply to the incident,leave it blank.
Tine Office Manager Roller
8} las ern ployee hospitalized overnight as an in-patient?
Phone (512)740-8503 Date 2/112022 Mlles
❑No 18) If the employee died,when did dearth occur? Date of death N/A
Public reporting burden far this collection of informsUon is estimated to average 22 minutes per response,including time for revievAng instructions,searching erdsbng data sources
gathering and maintaining the data needed,and oDmpleting and reviewing the cotiecwn of information. Persons;-0-131
required to respond to the oollecwn of information unless it displays a current valid OMB control number, If you have any comments about this estimate or any other aspects of this
data collection.including suggestions for reducing this burden,contact: L.S Department of Labor OSHA Office of u1-iNfi 5
Room N-3&K 200 Constitution Ave NW.Washington,DC 20210 Do not send the completed forms to this office
Attention: This form contains information relating
to employee health and must be used in a manner
OSHA"sForm 300 (Bell.0112004) that protects the confidentiality of employees to the Year 2020 4�1
extent possible hi:e the information is being used
Log Workmilelated Injuries Illnesses for occupational safety and health purposes. U.S. Department of Labor
Occupational Safety and Health Administration
You must record information about every work-mlated.njury or illness that in-.dm loss of oonsaousnm.restricted work activity or job transfer,days away frw world or medical treatment
beyond Form approved OMB no.1218-0176
first aid.Your must also record Sig--FCar work-related irqudes and illnesses that are diagnosed by a physician or licensed health care professional.You rnust also reword work-related
injuries and
illnesses that sheet any of the specific recording criteria listed in 29 OFR 3904.8 through 1904.12.Feel free to use two lines fora single case if you need to.Your must comptte an
injury and Establishment name Bennett Paving,Inc.
illness incident report(OSHA Form 301)ar equivalent form for each injury or illness recorded on this form.If you're not sure whether a case is rewardable,call your local OSHA offaoe
for help. � ..�
city Leander State Texas
ldlereN the arson Describe the case ClassiAf the case-
Enter the number of
(4} {B { ) {D) (E a F
CHECK ONLY ONE box for each case based on days the injured or ill Check the"injury'column or choose one type of
Case r Employee's Name Jab Title (e.g., Date of Where the event occurred(e.g. Describe injury or illr►ess.parts of body affected, the most serious outcome for that case:
worker was, illness;
No. Welder) injurer or Loading dock north end) and objectlsubstence that directly injured or made !
onset of person ill(e.g.Second degree bums on right M
illness forearm from acetylene torch) aw Awa On job
Da
(mo.lday) Beath transfer or from work I Remained at work From a o C 0
restriction
'Job transfer Other record- Work (days o o
:or restriction able cases (days) o o m —
f of ¢
Li
NO REPORTABLE INJURIES FOR YEAR..,
Page totals 0 0 0 0 0 0 0 o 0 0 0 0
Be sure to transfer these totals to the Summary page{Form 300A)before you post it. L � �� 2' � �
ML
Public reporting burden for this collection of infornuation is estimated to average 14 minutes per response.including time to a M 0 o �
review the inaruction.search and gathef the data needed,and complete and review the collection of information.Persons CP w= CL
are not required to respond to the collection of inforination unless it displays a cufrendy valid OMB control number. If you �
have any comments about these estimates or any aspects of this data oNecton,contact US Department of Labor,OSHA
Office of Statistics,Room N-3844,200 Constitution Ave,NW,Washington.DC 20210.Do not send the completed f ms to
this once. Pne 1 0(1 (1) Z 44: ( 1 ( )
OSHA's Form 30OA (Rev.011200 Year 2020 4*
Summary of WorkmiRelatedInjuries and Illnesses U.S.Department of Labor
0=patioW Sadety and Health Administradon
Faire ipProved OMB no_121a-0175
AN esfabishments covered by Part 19N must camplste this Summary page•even if no injuries or
fflnesses occurred during the year Remember to mvrewv the Log to v"that the entries are compfete
Using the Log,count the individual entries you made for each category. Thea write the totals below, Establishment information
rnakfng sure youW added the entfies from every page of the lag. if you had no cases write 10,'
Employees former employees.and their represenlahv+es have the right to rewewr the OSHA Farre 300 in Your establishment name Bennett Paving,Inc.
its entirety They also have firnited mess to the OSHA Form 301 or its equNafeni See 29 CFR
1904.,3,in OSHA Is Recordkeeping rule for further details on the access provisions for these forms. Street. P.O.Box 2309
Number of Cases City Leander State Texas Zip 7W46
Industry description(e.g.,Manufacture of motor truck trailers)
Total number of Total number of Total number of cases Total number of Seal Coating,Striping=AspNlt Paving_
deaths cases with days with)ob transfer or other recordable
away from work restrict on cases Standard Industrial Classification(SIC),if icnonn+n(e.g.,SIC 3715)
0 0 0 0 1 6 1 1
{G) (H) (I W) OR North American Industrial ClassiricatJon(NAI S).if known(e.g.,336212)
7 3 1 0
Number of Days - - Employment information
Total number of Total number of days of
days away from job transfer or restriction Annual average number of employees 23
nrk
Total hours worked by al employees last
0 0 year 31,388
(K) (Ll
injury and Illness Types
Sign here
Total number of... Knowingly falsifying this document may result in a firre.
M
(1) Injury 0 (4) Poisoning 0
( ) Skin Disorder 0 (5) Hearing Loss 0 l certify that I have examined this document and that to the best of my knowledge the entries are true.accurate,and
( ) Respiratory
complete.
Condition 0 (B)All Other Illnesses 0
Bryan Bennett President
Company executive Title
512-744-W03 1
Post this Surnmary►page from February 1 to A pri 13 0 of the year following the year covered by the form sone Date
Attention: This form contains information relating to
OSHA' Form 301 employee health and must be used in a manner that
protects the confidentiality of employees to the extent
ident
Report possible while the information is being used for U.S.Department of Labor
Injuries a IllnessesIncoccupabonal safety and health purposes.
ccupatio rraf safety and Health Adrrrirristration
Form approved DMB no.1218-0178
Information about the employee Information about the case
This injury and Illness Incident Report is one of the 18, Full Dame 10) lase number from the Log (Transfer the case number fmm the Log after you record the case.)
first forms you must fill out when a reoordable work- 2'. Street 11) Date of injury or illness
related injury or i nes has occurred Together with
the Log of Work-Related injunes and Vr'resses and C ty► State Zip 12) Time employee began work AM/PM
the acco rn pan yi ng Summary these forms help the
employer and OSHA deve op a picture of the extent , Date of birth 1 ) Time of event A lP 1E]Check if time cannot be determined
and severity of work related incidents
Vlilth.ri 7 ca e ndar days after you rete ve 4: Date hired 14} What was the employee doiing just before the incideint occurred? Describe the activity,as well
a
information that a reoordable work-related injury or the tools,equipment or material the employee was using. Be specific. Examples: "Climbing a ladder
illness has occurred.you must fill out this form or an :E]Male while carrying roofing materials";"spraying chlorine from hand sprayer":"daily computer key-entry."
equivalent. Some state workers'compensation, Female
insurance,or other reports may be acceptable
substitutes. To be considered an equiva ent form Information about the physician or other health care
any substitute must contain all the information professional
asked for on this form. i } What happened' Tell us how the injury occurred.Examples:"When ladder slipped on wet floor,
According to Publ'C Law 1-596 and 29 CFR B: blame of physician or other health care professional worker fel l 20 feet"';'Worker was sprayed with chlorine when gasket broke
during replacement"';
1904 OSHNs reoordkeeping rule,you must keep "Worker developed soreness in wrist over time."
this form on file for 5 years following the year to
which it pertains
If you need additional Copies of this form,you y} if treatment was given away from the worksite,where was it givens?
may photocopy and use as many as you deed.
Facility 1 ) What was the injury or illness?Tell us the part of the body that was affected and how it was
affected:be more specific than"hurl',"pain",or"sore."Examples."strained back";"chemical burn,
Street hand';"carpal tunnel syndrome."
City State Zip
8J las employee treated in an emergency room?
Completed b [—]yes 17) What object or substance directly harmed the employee? Examples:"concrete floor';"chlorine";
No "radial arm saw"If this question does not apply to the incident,leave it blank.
Tide
9) Was employee hospitalized overnight as an in-patient?
Phone Date ❑Yes
I F�No 18) If the emplo ee died when did death occur? Date of death
Public reporting burden for this oollecbon of information is estimated to average 22 minutes per response,including time for reviewing instructions,searching existing data sources,gathering
and maintaining the data needed,and completing and re ewng the ooliecbon of ins-,r-iehen Ffrr.31`:s -i31
required to respond to the collection of information unless it displays a current valid OMS control number If you have any comments about this astimate or any other aspects of this
data oNleclion including suggestions for reducing this burden.contact: Us Department of Laba, 01;i-A. Do cr
Room N-3644,200 Constitution Ave.NW Washington,Do 20210 Do not send the completed forms to this office.
BENTiETT PAVIIIG
Introduction
Bennett Paving, Inc. has been in business for over 13 years. Bennett Paring, Inc. is one
of the individually owned paging companies in the area that is able to provide a boutique
level of service Keeping clients updated throughout any project. Due to the fact that vire
own our own trucks and equipment, we are not at the mercy of vendors and able to
mobilize at a moments notice. We have performed many similar projects of this scope. If
awarded the project we will provide all services as described in this solicitation.
Our goal at Bennett Paving, Inc. is to exceed all of our client's expectations. II a strive to
complete projects within the required time frame and to minimize disruptions to our
customer's normal business operations. We go into every project prioritizing our client's
specific meds. As a family owned business, we pride ourselves on our agility to be
flexible to satisfy any customer requirements.s.
BEMETT PAVING
Benneft Paring, Inc.
References
nces
City of Latey
Contact: Dale Delong — Director of Public Works, 12 269-5520,
daledelong@lakeway-tx.gov
Project Size: $824,240.00
Scope of Work: Asphalt Paring
Completed Dame: 10/14/2022
City of Largo Nista
Contact: Eric Belaj — Public Works s Director, (972) 971-6444, bolarj@largo-vista.org
Project Size: $1,795,221.25
Scope of fir ; Asphalt Paring
Completed Daae: 03/29/2022
McCoy's Buildinq Supply (Corpus Christi, TX)
Contact: Carlos Garcia — Regional ionarl Operartio s Manager, (512) 753-6358,
garia@os. or
Project size: $1,4111000.00
Scope of Work: Asphalt paring, Seal Coat, Striping, Wheel Stops
Completed Date: 09!3012021
March, 2nd 2023
BERMTT PAVING
El List
A unaf Francisco Foreman
Bennett, Baran P Owner
Bennett, Johnathon VII Driver
Bennett, William L Estimator
Bonilla, Javier Labor
Buteau , Randy Driver
Dingey, Robert Estimator
Eniso, .Javier Labor
Escobar, Roio Clerical
Figueroa, Santiago Labor
Gilmore Jr., Gilbert W Driver
Gonzalez, Robert L Driver
Greeson, Lola Clerical
Gutierrez, Rodolfo Driver
Huff Jr., Randy L. Larbor
Johnson, Samuel Driver
Leiva Martinez, Fermin Labor
Martinez,, Blea ar Labor
Mejia, Jesus Labor
Duda, Adam 1 Cierical
Perez Aviles, Jesus Mechanic
Perez, Carlos Labor
Phelps, Johnathon D Driver
Jamey, Shane E Foreman
Rodriguez, Antonio Labor
Rodriguez, Jess Abel Labor
Salazar Torres., Juan Estimator
Salazar, Javier Labor
Salazar, Jose L Labor
Sandoval, Martin Driver
Servin, lodolfo Labor
Sifuentes, Alberto Labor
Smith, George A Driver
Stansfield, William Driver
Terbay, Robert J. Superintendent
Terry, David Foreman
Terror, Sarajo Clerical
Torres-Aguillon, Javier Driver
ene , Juvenal Driver
FWilkes, zachary Driver
DATE(MMIDDNYYY)
CERTIFICATE OF LIABILITY INSURANCE
51412023
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 ED 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
ME-
Watkins Insurance roup-Austin PH l� Susan Hord FAx
3834 pi eWecd Springs d, 1 E-MAIL � -� -8 77INC.No:512-452-0999
Austin TX D _shord@watkinsinsuraneegroup.com
INSURER S AFFORD IN COVERAGE NAIL#
INSURER A.National Fire Insurance Company of Hartford 20478
INSURED BENNE-1 INSURER B.The Continental Insurance Company 35289
Bennett Paving, Inc. INSURER C.Texas Mutual Insurance Company 22945
P.O. Box 2309
Leander TQC 76646 INSURER D:Continental Casualty Company20443
INSURER E.Columbia Casual Company 31127
INSURER F
COVERAGES CERTIFICATE NUMBER:709543576 REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED. NOTWITHSTANDING ANIS REQUIREMENT, TENNI OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT T 1 ITH RESPECT To WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED 13Y 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 SUBI1 POLICY EFF POLICY EXP
LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER JMM10P= (MMJDDfYYYYILIMITS
A X C OMM ERC IAL CENERAL LIABILITY 7034188441 81412022 8/4/2023 EACH OCCURRENCE $1.000,000
CLAIMS-MADE MOCCUR DAMPRE E TO RENTED
REIu1ISE3 Ea occurrence) 100f004
X Pollution MED EXP(Any one person) $15,000
FI PERSO AL&ADV INJURY $1,000,000
CEN*L AGGREGATE LIMIT APPLIES PER. GENERAL AGGRE ATE $2,000,000
POLICY E LOC PRODUCTS-CO PIOP AGG 2,000,000
[Z] O- F
OTHER: Pollution Limit $500.000
B AUTOMOBILE LIABILITY 7034168024 81412022 81412023 COMBINED SINGLE LIMIT 1,000,000
Ea accident
ANY AUTO BODILY INJURY(Per person)
OWNED SCHEDULED BODILY INJURY(Per accident)
AUTOS ONLY AUTOS
HIRED x NON-OWNED PROPERTY DAMAGE
AUTOS ONLY AUTOS ONLY Per accident
8 UMBRELLA LIAR X OCCUR 7034329584 81412022 81412023 EACH OCCURRENCE 5,000,000
EXCESS LIAR CLAIMS-M DE AGGREGATE $5.000,000
ODED I X I RETENTION
C WORKERS COMPENSATION 0002018278 81412022 81412023 X ER ETH-
AND EMPLOYERS'LIABILITY Y!N
ANYPR PRIET MPARTNERIEXECUTIVEN 1 A E.L.EACH ACCIDENT $1,000,000
OFF ICE F UMEMBER EXCLUDED?
(Mandatory In NH) E.L.DISEASE-EA EMPLOYEE S11000,000
I#yes,describe under
DMRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $1,000,000
D Equipment(Deductible$1,000) 7034293205 81412022 81412023 leased/Scheduled 1 OOK 1$3,217,388
E Professional Liability 703441131 81412022 81412023 Each 1 A99 500. 1$ 00
DESCRIPTION OF OPERATIONS 1 LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space Is required)
*Equipment Floater Policy includes CargofTransportation Coverage of$10,000 limit with$1,000 deductible.
city of Round Rock is additional insured on the general liability and auto liability policies where required by written contract.39 day notice of cancellation
endorsement applies when required by written Contract.
CERTIFICATE HOLDEN CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
City Manager ACCORDANCE WITH THE POLICY PROVISIONS.
City of Round Rock
21 E. Main Street AUTHO RLZE D RE P R ES ENTATIVE
Round Rock TQC 78664 /
1988-2015 ACORD CORPORATION. All rights reserved.
ACORD 25(2016/03) The AC RD name and Togo are registered marks f AC RD
t
1
CNA CNA PARAMOUNT
Charges - Notice of Cancellation or Material
Restriction Endorsement
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
EMPLOYEE BENEFITS LIABILITY COVERAGE PART
LIQUOR LIABILITY COVERAGE PART
ONES AND CONTRACTORS PROTECTIVE LIABILITY COVERAGE PART
PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART
RAILROAD PROTECTIVE LIABILITY COVERAGE PART
STOP GAP LIABILITY COVERAGE PART
TECHNOLOGY ERRORS AND OMISSIONS LIABILITY COVERAGE PART
SPECIAL PR TECTIVE AND HI G HWAY LIABILITY POLICY—NEW YORI DEPARTMENT OF TRANSPORTATION
SCHEDULE
Num be r of days notice(other than for nonpayment of prem 1 u m): 030
N umber of days notice for nonpa yment of prem iuim:
Name of person or organization to whom notice will be sent: PER SCHEDULE ON FILE
Address: PER SCHEDULE ON FILE
EADER
TX 78646-2309
If no entry appears above,the number of days notice for nonpayment of premium will be 10 da ns.
It is understood and agreed that in the event of cancellation or any material restrictions in coverage during the policy
period} the Insurer also agrees to mall prior written notice of cancellation or material restriction to the person or
organization listed in the above Schedule.l such notice will be sent prior to such cancellation in the manner prescribed 111
C3
the above Schedule.
q"
1
N
All other terms and condi#'ons of the Polio remain unchanged.
.`._ This endorsement,which forms a part of and is for attach ment to the Policy issued by the designated Insurers, takes effect
on the effective date of said Policy at the hour stated in said Policy, unless another effective date is shown, below, and
expires concurrently with said Policy.
CNA 1-1 Policy No: 7034168041
Page 1 of t Endorsement No: 23
Nat'l Fire Iris Co of Hartford Effective Date: 08/04/2022
Insured Name: BENNETT PAVING INC
cop nght CNA All Rights Reserved.
F
Business Auto Policy
CNA Policy Endorsement
NOTICE OF CANCELLATION TO * + ~
i
It is understood and agreed that:
If you have agreed under written contract to provide notice of cancellation to a party to whom the Agent o
Record has issued a Certificate of Insurance, and if we cancel a policy tern described on that Certificate of
Insurance for any reason other than nonpayment of premium, then notice of cancellation will be provided to
such Certificateholders at least 30 days in advance of the data cancellation is effective.
If notice is mailed, then proof of mailing to the last known mailing address of the rtificateholder on file with
the Agent of Record will be sufficient to prove notice.
Any failure by us to notify such persons or organizations will not extend or invalidate such cancellation, or
impose any liability or obligation upon us or the Agent of Record.
All other terms and conditions of the policy remain unchanged
This endorsement, which forms a part of and is for attachment to the policy issued by the designated Insurers,
takes effect on the Policy Effective date of said policy at the hour stated in said policy, unless another effective
date (the Endorsement Effective Date) is shown below, and expires concurrently with said policy.
Form. No: CNA68021 X (02-2013) Policy No:R A 7034168024
Endorsement Effective Date: Endorsement Expiration Date: Policy Effective Date: 08/04/2022
Endorsement No: 14; Page: 1 of 1 Policy Page: 74 of 160
Underwriting Company: The Continental Insurance Company, 151 N Franklin Sty Chicago,IL 60606
Copyright CNA All Rights Reserved.
Business Auto Policy
CNA Policy Endorsement
CONTRACTORS * + R • PLUS
THIS ENDORSEMENT T CHAT E THE POLICY. PLEASE READ IT CAREFULLY.
This endorsement modifies insurance provided under the following:
BUSINESS AUTO COVERAGE FORM
I. LIABILITY COVERAGE
A. Who is An insured
The following is added to Section Il, Paragraph A.1., Who Is An Insured:
1. a. Any incorporated entity of which the Named insured owns a majority of the voting stock on the
date of inception of this Coverage Form; provided that,
b. The insurance afforded by this provision A.1. does not apply to any such entity that 's an
insured under any other liability 'policy" providing auto coverage.
. Any organization you newly acquire or form, other than a limited liability company, partnership ip or
joint venture, and over which you maintain majority ownership interest.
The insurance afforded by this provision A. .:
a. Is effective on the acquisition or formation date, and is afforded only until the end of the policy
period of this Coverage Font or the next anniversary of its inception dater whichever is earlier.
la. Does not apply to:
(1) Bodily injury or property damage caused by an accident that occurred before you acquired or
foamed the organization; or
( ) Any such organization that is an insured under any other liability "policy" providing auto
covers ge.
. Any person or organization that you are required by a written contract to name as an additional
insured is an insured but only with respect to their legal liability for acts or omissions of a person,
who qualifies as an insured under SECTION II — WHO IS AN iNSURED and for whom Liability
Coverage is afforded under this policy. if required by written contract, this insurance will be primary
and non-contributory to insurance on which the additional insured is a famed Insured.
. An employee of yours is an insured while operating an auto hired or rented under a contract or
agreement in that employee's name, with your permission, while performing duties related to the
conduct of your bu ',nes .
"Policy", as used in this provision A. Who Is An Insured, includes those policies that were in force on
the inception date of this Coverage Form but:
1. Which are no longer in force; or
. whose limits have been exhausted.
B. Bail Bonds and Loss of Earnings
Section Ii, Paragraphs A. . ( ) and A. . ( ) are revised as follows:
1. in a.( ), the Iim;t for the cost of bail bonds is changed from 2,000 to 5,0 00; and
. In a.( ), the lira-t for the loss of earnings is charged from o to $500 a day.
Form No: CNA63359XX(04 201 2) Policy No-BUA 7034168024
Endorsement Effective Date: Endorsement Expiration Date: Policy Effective Date: 0810 4/2022
Endorsement o: 13; Page: 1 of 4 Policy Page: 70 of 160
Underwriting company: The Continental insurance company, 151 N Franklin St, Chicago,IL 60606
Copyright CNA All Rights Reserved. Includes copyrighted material of the
insurance Services Office, Inc., used with its permission.
1
A
Business Auto Policy
CNA Policy Endorsement
C. Fellow Employee
Section II, Paragraph 8.5 does nr3t apply.
Such coverage as is afforded by this provision C. is oxcess over any other collectible insurance.
II, PHYSICAL DAMAGE COVERAGE
A. Class Breakage - Hitting A Bird or Animal - Palling objects or Missiles
The following is added to Section IiI, Paragraph A.3.:
with respect to any covered aceto, any deductible showrA in the Declarations will not apply to glass
breakage if such glass is repaired, in a manner acceptable to us; rather than replaced.
B. Transportation Expenses
Section III, Paragraph A.4.a, i-s revisLd, with rec;p t to transportation expense incurred by you, to
provide
a. Bo per day, in lieu of ; subject t
b. $1,800 maximum, in lieu of $boo.
C. Loss of Use Expenses
Section fll, Paragraph A. .b. is revisers, with respect to loss of use expenses incurred by you, to
provide:
a. $1,000 maximum, in lieu of $loo.
D. Hired "Autos"
The following is added to Section ill. Paragraph A.:
b. Hired ""Autos"
If Physical Damage coverage is provided under this policy, and such coverage does not extend to Fired
Autos, then Physical Damage coverage is extended t :
a. Any covered auto you lease, hire, rent or borrow without a driver; and
b. Any covered auto hired or rented by your employee without a driver, under a contract in that
individual employee's name, with your permission, while performing duties related to the
conduct of your business.
c. The most we will pay for any one accident or loss is the actual cash value, cost of repair, cost
of replacement or $75,000, whichever is less, minus a $500 deductible for each covered auto.
No deductible applies to loss caused by fire or lightning.
d. The physical damage coverage as is provided by this provision is equal to the physical damage
coverage(s) provided on your owned autos.
e. Such physical damage coverage for hired autos will:
(1) Include loss of use, provided it is the consequence of ars accident for which the Named
Insured is legally liable, and as a result of which a monetary loss is sustained by the leasing
or rental concern.
( ) Such coverage as is provided by this provision will be subject to a limit of 75per
accident.
E. Airbag Coverage
The following is added to Section III, Paragraph 13.3.:
The accidental discharge of an airbag shall not be considered mechanical breakdown.
Form No: CNA63359XX (04-2012) Ptiili y Nr:BUA 70341 024
Endorsement Effective Date: Endorsement Expiration Date: Ru ficy Effeuiive DLtui o 1041'202 2
Endorsement No: 13; Page: 2 of 4 Ped cy Pages 71 e;-J 160
UnderwritingCompany: The Continental Insurance Company, 151 N Franklin St, Chicago, - 60606
o
C,Copyright CIA All Rights Reserved. Includes copyrighted material cif the
Insurance Services Officer Inc., used with its permission.
Business Auto Policy
CNA Policy Endorsement
F. Electronic Equipment
Section III Paragraphs B. .c and 13.4.d. are deleted and replaced by the following:
c. Physical Damage Coverage on a covered auto also applies to loss to any permanently installed
electronic equipment including its antennas and other accessories
d. A 100 per occurrence deductible applies to the coverage provided by this provision.
G. Diminution In Value
The following is added to Section Ill, Paragraph 13.6.:
Subject to the following, the diminution in value exclusion does not apply to:
a. Any covered auto of the private passenger type you lease, hire, rent or borrow, without a driver
for a period of 30 days or less, while performing duties related to the conduct of your business;
and
b. Any covered auto of the private passenger type hired or rented by your employee without a
driver for a period of 30 days or less, under a contract in that individual employee's name, with
your permission, while performing duties related to the conduct of your business.
c. Such coverage as is provided by this provision is limited to a diminution in valine loss arising
directly out of accidental damage and not as a result of the failure to make repairs faulty or
incomplete maintenance or repairs; or the installation of substandard parts.
d. The most we will pay for loss to a covered auto in any one accident is the lesser of:
0) $5,000; or
( ) 0% of the auto's actual cash value (ACV).
III. Drive other car Coverage — Executive officers
The following is added to Sections 11 and Ill:
1. Any auto you don't own, hire or borrow is a covered auto for Liability Coverage while being used by,
and for Physical Damage Coverage while in the care, custody or control of, any of your "executive
officers", except:
a. An auto owned by that "executive officer" or a member of that person's household; or
b. An auto used by that "executive officer" while working in a business of selling, servicing, repairing
or parking autos.
Such Liability and/or Physical Damage Coverage as is afforded by this provision.
(1) Equal to the greatest of those coverages afforded any covered auto; and
( ) Excess over any other collectible insurance.
. For purposes of this provision, "executive officer" means a person holding any of the officer positions
created by your charter, constitution, by-lags or any other similar governing &3cument, and, while a
resident of the same household, includes Haat person's spouse.
Such "executive officers" are insureds chile using a covered auto described in this provi .on.
IV. BUSINESS AUTO CONDITIONS
A. Duties In The Event Of Accident, Claire, Suit or Loss
The following is added to Section IV, Paragraph A. . .:
Form o: CNA X(04-2012; PolicV No:BuA 7034168024
Endorsement Effective Date: Endorsement Expiration Date: Policy Effective Date: 08/04/2022
Endorsement No: 13; Page: 3 of 4 Policy Page: 72 of 160
Underwriting Company: The Continental Insurance company, 151 N Franklin St, Chicago, IL 60 606
'Copyright CNA All Fights Reserved. Includes copyrighted material of the
Insurance Services Office, Inc., used with its permission.
Business Auto Policy
CNA Policy
( ) Your employees may know of an accident or loss. -This will not mean that you have such
knowledge, unless such accident or loss is known to you or if you are not an individual, to any
of your executive officers or partners or your insurance manager.
The following is added to Section III, Paragraph A. .b..
( ) Your employees may know )f documents received concerning a claim or suit. This will not mean
that you have such knowledge, unless receipt of such documents is known to you or if you are
not an individual, to any .of your executive officers or partners or your insurance manager.
B. Transfer Of Rights Of Recovery Against Others To CJs
The following is added to section III, Paragraph A.b. Transfer Of Rights Of Recovery Against Others To
U ;
We waive any right of recovery we may have, becaL.se of payments we make for injury or damage,
against any person or organization for whom or which you are required by written contract or
agreement to obtain this waiver from us.
This injury or damage must arise out of your activities under r1 contract with that person or
or anizat;on.
You must agree to that requirement prier to an accident or loss.
C. Concealment, I iisrepresenta ion or Fraud
The folluing is added to Section Ill, Paragraph B. .:
Your failure to disclose all hazards existing on the date of inception of this Coverage Form shall not
prejudice you with respect to the coverage afforded provided such failure or omission is net intentional.
D. Other Insurance
The following is added to Section IV, Paragraph 13.5.:
Regardless of the provisions of Paragraphs 5.a. and 5.d. above, the coverage provided by this policy
shall be on a primary non-contributory basis. This provision is applicable only when required by a
written contract.
That written contract must have been entered into prior to Accident or Loss.
E. Policy Period, Coverage Territory
Section lilt Paragraph B. 7.(5).(a). is reprised to provide:
a. 45 days of coverage in lieu of 30 days.
V. DEFINITIONS
Section V. paragraph C. is deleted and replaced by the following:
Bodily injury means bodily injury, sickness or disease sustained by a person, including mental anguish,
mental injury or death resulting from any of these.
Form No: CNA63359XX (04-2012) Policy No:BUA 7034168024
Endorsement Effective Date. Endorsement Expiration Date. Policy Effective Date: 08/04/2022
Endorsement No: 13; Page:4 of 4 Policy Page: 73 of 160
Underwriting company: The Continental Insurance company, 151 N Franklin St, Chic-ago, IL 60606
ti
Copyright CNA Ali Rights Reserved. Includes copyrighted material of the
Insurance Services Office, Inc., used with its permission.
CNA CNA PARAMOUNT
Blanket Additional Insured - Owners, Lessees or
contractors - with Products-Completed
Operations Coverage Endorsement
This endorsement modifies insurance provided under the following-
COMMERCIAL MER IAL GE# ERAL LIABILITY COVERAGE PAIN
It is understood and agreed as follows:
I. WHO IS AN INSU RED is amended to include ars an Insured any person or organization whoa you acre required by
written contract to add as an additional insured on this coverage part, but only with respect to liability for bodily
injury, property damage or personal and adverb sin injury caused in whole or in part by your acts or omissions,or
the acts or omissions of those acting on your behalf:
A. in the performance of your ongoing operations subject to such written contract;or
B. in the performance of your work subject to such written contract, but only Wth respect to bodily injury or
property damage included in the products-completed operations hazard, and only if:
I. the written contract requires you to provide the additional insured such coverage; and
. this coverage part provides such coverage.
II. But if the written contract requires:
A. additional insured coverage under the 11-85 edition, 10-93 edition, or 10-01 edition of C 2 1 0,or under the 10-
01 edition of 23 ; or
B. additional insured coverage with"arising out of language; or
C. additional insured coverage to the greatest extent permissible by law;
thea paragraph I.above is deleted in its entirety and replaced by the following:
WH 0 I S AN I N S U RED is amended to include as a n Insured any person or organization whore you are required by
written contract to add as an additional insured on this coverage part, but only with respect to liability for bodily
injury, property damage or personal and advertils in g injury arising out of your work that is subject to such written
contract.
Ill. Subject always to the terms and conditions of this polio, including the limits of insurance,the Insurer will not provide
such additional insured with:
A. coverage broader than required by the written contract;or
B. a higher 1-Mit of insurance than required by the written contract.
I1 . The insurance granted by this endorsem ent to the ardditional insured does not apply to bodily injury, property
damage-or personal and advertising injury arising out of.
A. the rendering of, or the failure to render, any professional architectural, engineering,or surveying services.
including:
1. the preparring,approving,or failing to prepare or a pprove maps, shop drawings, opinions, reports, surveys:
.� field orders, change orders or drawings and specifications and
. supervisory, inspection, architectural or engineering activities- or
' B. any premises of work for which the additional insured is spedficllr Iisted as an additional insured on another
endorsement attached to this coverage part.
V. Ander COMMERCIAL GENERAL LIABILITY CONDITIONS,the Condition entitled Other Insurance is amended to
add the following,which supersedes any provision to the contrary in this Condition or elsewhere in this coverage
part:
0 (10-16) Policy No: 7034168041
Page 1 of 2 Endorsement No:
Nat'l Fire Ins Co of Hartford Effective [date: 0810412022
Insured Name: BENNSTT PAVING IMC
opydght CNA All tights Reserved. hAudc-n copyrighted materia!of Insurance Services Office,Inc.,with its permission
1 +
CNA CNA PARAMOUNT
Blanket Additional Insured w Owners, Lessees or
contractors - with Products-core pleted
Operations Coverage Endorsement
Primary and Noncontributory Insurance
With respect to other insurance available to the additional insured under which the additional insured is a named
insured, this insurance is primary to and will not seek contribution from such other insurance, provided that a written
contract requires the insurance provided by this policy to be:
1. primary and non-contributing with other insurance available to the additional insured;or
. primary and to not seely contribution from any other insurance available to the additional insured.
But except as specified above, this insurance will be excess of all other insurance available to the additional insured.
lI. Solely with respect to the insurance granted by this endorsement,the section entitled COMMERCIAL GENERAL
LIABILITY CONDITIONS is amended as follows-
The
llows:The Condition entitled Duties In The Event of Occurrence,Offense, Claim or Suit is amended with the addition of
the following.
Any additional insured pursuant to this endorsement will as soon as practicable:
1. give the Insurer written notice of any claim. or any occurrence or offense which may result in a claim;
. send the Insurer copies of all legal papers received, and otherwise cooperate with the Insurer in the investigation,
defense, or settlement of the claire; and
. make available any other insurance,and tender the defense and indemnity of any clalrn to any other insurer or
self-insurer,whose policy or program applies to a loss that the Insurer corers under this coverage part. However,
if the written contract requires this insurance to be primary and non-contributory,this paragraph 3.does not
apply to insurance on which the add it,onal insured is a named insured.
The Insurer has no duty to defend or indemnify an additional insured under this endorsement until the Insurer receives
written notice of a claim from the additional insured.
11111. Solely with respect to the insurance granted by this endorsement, the section entitled DEFINITIONS is amended to
add the following definition:
Written contract means a written contract or written agreement that requires you to make a person or organization an
additional insured on this coverage part, provided the contract or agreement
A. is currently in effect or becomes effective during the term of this policy; and
B. was executed prior to:
1. the bodily injury or property damage: or
. the offense that caused the personal and advertising injury;
for which the additional insured seeks coverage.
Any coverage granted by this endorsement shall apply solely to the extent permissible by lava.
All other terms and conditions of the policy remain unchanged.
This endorsement, which forms a part of and is for attachment to the Policy issued by the designated Insurers,takes effect
on the effective date of said Policy at the hour stated in sa.Id Policy. unless another effective date is shown below, and
expires concurrently with said Policy.
CNA75079XX (10-16) Policy No, 7034168041
Page 2 of 2 Endorsement Flo:
Nat'l Fire Iris Co of Hartford Effective Cate 08/04/2022
Insured tale: BENNETT PAVING INC
copy fight CLIA All Rights Reserved. Includes copy dghted material of Insurance Services office,Inc with its perm.-;°d!r,
CNA CNA PARAMOUNT
Contractors' General Liability Extension Endorsement
It is understood and agreed that this endorsement amends the COMMERCIAL GENERAL LIABILITY COVERAGE PART
as follows. If any other endorsement attached to this policy amends any provision also amended by this endorsement
thein that other endorsement controls with respect to such provision, and the changes made by this endorsement with
respect to such provision do not apply.
TABLE OF CONTENTS
1. Additional Insureds
. Additional Insured-Primary And bion-Contributory To Additional Insured's Insurance
3. Bodily Injury—Expanded Definition
4. Broad Knowledge of occurrence/Notice of Occurrence
5. Broad Named Insured
. Broadened Liability Coverage For Damage To Your Product And Your Work
. Contractual Liability-Railroads
. Electronic Data Liability
. Estates, Legal Representatives and Spouses
10. Expected Or Intended Injury—Exception for Reasonable Force
11. General Aggregate Limits of Insurance—Per Project
12. In Reim Actions
13. Incidental Health Dare Malpractice Coverage
14. Joint Ventures/Partnership/Limited Liability Companies
15. Legal Liability — Damage To Premises 1 Alienated Premises I Property In The lased Inurd's Care,
Custody or Control
16. Liquor Liability
17. Medical Payments
18. Non-owned Aircraft Coverage
19. Non-owned Watercraft
o. Personal And Advertising Injury Inu —Discrimination or Humiliation
1. Personal And Advertising Injury -Contractual Liability
. Property Damage»Elevators
3. Supplementary Payments
- - 24. Unintentional Failure To Disclose Hazards
. I aiver of Subrogation—Blanket
. Wrap-Up Extension: OCIP DRIP, or Consolidated (Wrap-Up) Insurance Programs
CNA74705XX 1-1 Policy o: 7034168041
Page 1 of 17 Endorsement No:
Nat'l Fire Iris Co of Hartford Effective Date: 08/04/2022
Insured Marne: BENNETT 2AVING INC
Copyright CNA All Rights Reserved. Includes copyrighted materia!of Insurance Services ice.Irc.wb its permission.
CNA CNA PARAMOUNT
Contractors' General Liability Extension Endorsement
1. ADDITIONAL INSUREDS
a. WHO IS AN INSURED is amended to include as an Insured any person or organization described in paragraphs
A. through H. below whom a Named Insured is required to add as an additional insured on this Coverage Part
ulnder aI written contract or written agreement, provided such contract or agreement:
1) is currently in effect or becomes effective during the terra of this coverage Part}and
2) was executed prior to:
(a) the bodily injury or propertydamage-or
b the offense that caused the personal and advertising injury,
for which such additional insured seeks coverage.
b. However, subject always to the terms and conditions of this policy, including the limits of insurance, the Insurer
will not provide such additional insured with:
1) a higher limit of insurance than required by such contract or agreement; or
(2) coverage broader than required by such contract or agreement, and in no event broader than that described
by the applicable paragraph A.through H. below.
Any overage granted by this endorsement shall apply only to the extent permissible by law.
A. controlling Interest
Any person or organization with a controlling interest in a Named Insured, but only with respect to such person or
organization's liability for bodily injury, property damage or personal and advertising injury arising out of
I. such person or organization's financial control of a Named Insured; or
2, premises such person or organization owns, maintains or controls while a Named Insured leases or
occupies such premises,
provided that the coverage granted by this paragraph does not apply to structural alterations, new construction or
demolition operations performed by,on behalf of, or for such additional insured.
B. Co-owner of Insured Premises
co-owner of a prerm'. es co-owned by aI Named Insured and covered under this insurance but only with respect
to such co-owner's liablity for bodily injury, property damage or personal and advertising injury as co-owner
of such premises.
C. Lessor of Equipment
Any person or organization from whom a Named Insured leases equipment, but only with respect to liability for
bodily injury.. property damage or personal and advertising injury caused, in whole or in part, by the famed
Insured's maintenance, operation or use of such equipment, provided that the occurrence giving rise to such
bodily injury property damage or the offense giving rise to such personal and advertising injury takes place
prior to the termination of such lease.
D. Lessor of Land
Any person or organization from whom a Named Insured leases land but only with respect to liability for bodily
injury, property damage or personal and advertising injury arising out of the ownership. maintenance or use
of such land, provided that the occurrence giving rise to such bodily injurer, property damage or the offense
giving rise to such personal and advertising injury takes place prior to the termination of such lease. The
CNA 4 X 1-1 Policy No: 7034168041
Page 2 of 17 Endorsement No:
Nat'l FixIns Co of Hartford Effective Date: 08/04/2022
Insured Name: BENNETT PAVING INC
Copyright C NA Al Fights Reserved, Includes copyrighted mated al of Insurance Serviws Office.Inc.,with its permission
CNA SNA PARAMOUNT
contractors' General Liability Extension E
coverage granted by this paragraph does not apply to structural alterations, new construction or demolition
operations performed by, on behalf of, or for such additional insured.
E. Lessor of Premise
An owner or lessor of premises leased to the Named Insured, or such owner or lessor's real estate manager, but
only with respect to liability for bodily injury, property damage or personal and advertising injury arising out of
the ownership, maintenance or use of such part of the premises leased to the Named Insured, and provided that
the occulrrence giving rise to such bodily 1njulry or property damage,or the offense giving rise to such personal
and advertising injury, takes place prior to the termination of such lease. The coverage granted by this
paragraph does not apply to structural alterations, new construction or demolition operations performed by, on
behalf of, or for such additional insured.
F. Mortgagee,Assignee or Receiver
mortgagee, assignee or receiver of premises but only with respect to such mortgagee, assignee or receiver's
liability for bodily injury, property damage or personal and advertising injury arising out of the Named
Insured'Insured's ownership, maintenance, or use of a premises by a Warned Insured.
The coverage granted by this paragraph does not apply to structural alterations, new construction or demolition
operations performed by,on behalf of, or for such additional insured.
G. State or Governmental Agency or Subdivision or Political Subdivisions—Permits
state or governmental agency or subdivision or political subdivision that has issued a permit or authorization but
only with respect to such state or governmental agency or subdivision or political subdivision's liability for bodily
injury, property damage or personal and advertising injury arising out of:
'I. the following hazards in connection with premises a Named Insured owns, rents, or controls and to which
this insurance applies:
a. the existence, maintenance, repair, construction} erection, or removal of advertising signs, awnings,
canopies, cellar entrances, coal holes, driveways, manholes, marquees, hoistaway openings, sidewalk
vaults, street banners,or decorations and similar exposures;or
b. the construction, erection, or removal of elevators; or
c. the ownership, maintenance or use of any elevators covered by this insurance; or
. the permitted or authorized operations performed by a Named Insured or on a Named Insured's Insured' behalf.
The coverage granted by this paragraph does not apply to:
a. Bodily injury, property damage or personal and advertising injury arising out of operations performed
for the state or governmental agency or subdivision or political subdivision*or
b. Bodily injury or property damage included within the products-completed operations hazard.
=_ Wth respect to this provision's requirement that additional insured status must be requested under- a written
contract or agreement, the Insurer will treat as a written contract any governmental permit that requires the
lamed Insured to add the governmental entity as an additional insured.
H. Trade Show Event Lessor
1. With respect to a Named Insured's participation in a trade show event as an exhibitor, presenter or displayer:
any person or organization whom the Named Insured is required to include as an additional insured, but only
with respect to such person or organization's liability for bodily injury, property damage or personal and
advertising injury caused bar:
CN 7 70 X 1}1 Policy No: 7034168041--
Page
0 1 0 1Page of 17 Endorsement No
Nat'l l Fire Ins Co of Hartford Effective Date: 0810412022
Insured Name: BENNETT PASTING INC
copyright CNA All Rights Reserved. includes copyrighted material of Insurance services Office,Inc. wkh its permission.
CNA SNA PARAMOUNT
Contractors' General Liability Extension Endorsement
a. the Named Insured's acts or omissions;or
b. the acts or omissions of those acting on the Named Insured's behalf,
in the performance of the Named Insured's ongoing operations at the trade show event premises during the
trade show event.
. The coverage granted by this paragraph does not apply to bodily injury or property damage included within
the products-completed operations hazard.
. ADDITIONAL INSURED-PRIMARY Y AND NON-CONTRIBUTORY To ADDITIONAL INSUI ED'S INSURANCE
The other Insurance Condition in the COMMERCIAL GENERAL LIABILITY CONDITIONS Section is amended to
add the following paragraph-
If the Named Insured has agreed in writing in a contract or agreement than this insurance is primary and non-
contributory relative to ars additional insureds own insurance, then this insurance is primary, and the Insurer will not
seek contribution from that other insurance. For the purpose of this Provision 2., the additional insured's own
insurance means insurance on which the additional insured is a named insured. Otherwise, and notwithstanding
anything to the contrary elsewhere in this Condition, the insurance provided to such person or organization is excess
of any other insurance available to such person or organization.
. BODILY INJURY—EXPANDED DED DEFINITION
Under DEFINITIONS,the definition of bodily injury is deleted and replaced by the following:
Bodily injury means physical injury, sickness or disease sustained by a person, including dearth, humiliation, shook,
mental anguish or mental injury sustained by that person at any time which results as a consequence of the physical
injury, sickness or disease.
. BROAD KNOWLEDGE LEDGE of OCCURRENCE/ NOTICE of OCCURRENCE
Under CONDITIONS, the condition entitled Duties in The Event of Occurrence, Offense,elallm or Suit is amended
to add the following provisions:
A. BROAD KNOWLEDGE E of OCCURRENCE
The Named Insured must give the Insurer or the Insurers authorized representative notice of ars occurrence,
offense or claim only when the occurrence, offense or claim is known to a natural person Named Insured, to a
partner, executive officer. manager or member of a Named Insured, or an employee designated by any of the
above to give such notice.
B. NOTICE OF OCCURRENCE
ENCE
The Named Insured's rights under this Coverage Part will not be prk.udiced if the Named Insured fails to give
the Insurer nonce of an occurrence, offense or claim and that failure is solely due to the Named Insured'
reasonable bel; f that the bodily injury or property damage is not covered under this Coverage Part. However,
the Named Insured shall give written notice of such occurrence, offense or claim to the Insurer as soon as the
Nalmed Insured is aware that this insurance may apply to such occurrence, offense or claim.
. BROAD NAMED INSURED
WHO IS AN INSURED ED is amended to delete its Paragraph 3. in its entirety and replace it with the following.
. Pursuant to the limitations described in Paragraph 4. below, any organization in which a Named Insured has
management control
a. on the effecti
CNA SNA PARAMOUNT
Contractors' General Liability Extension Endorsement-,
b. by reason of a Named Insured creating or acquiring the organization during the policy period,
qualifies as a Named Insured, provided that there is no other similar liability insurance, whether primary,
contributory, excess,contingent or otherwise,which provides coverage to such organization, or which would have
provided coverage but for the exhaustion of its limit, and without regard to whether its coverage is broader or
narrower than that provided by this insurance.
But this BROAD NAMED INSURED provision does not apply to:
(a) any partnership, limited liability company or joint venture; or
any organization for which coverage is excluded by another endorsement attached to this Coverage Part.
For the purpose of this provision, management control means:
A. owning interests representing more than "A of the voting, appointment or designation power for the
selection of a majority of the Board of Directors of a corporation; or
B. Laving the right, pursuant to a written trust agreement, to protect, control the use of, encumber or transfer or
sell property held by a trust,
4. With respect to organizations which qualify as Named Insureds by virtue of Paragraph 3. above, this insurance
does not apply to:
a. bodily injury or property damage that first occurred prior to the date of management control, or that first
occurs after management control ceases; nor
b. personal or advertising injury caused by an offense that first occurred prior to the date of management
control or that first occurs after management control ceases,
. The insurance provided by this coverage Part applies to Named Insureds when trading under their own names
or under such other trading names or doing-business-ars names dba) as any Named Insured should choose to
employ.
. BROADENED LIABILITY COVERAGE FOR DAMAGE TO YOUR PRODUCT AND YOUR WORK
A. Under COVERAGES, coverage A -- Bedlly Injury and Property Damage Liability, the paragraph entitled
Exclusions is amended to delete exclusions k.and 1.and replace therm with the following:
This insurance does not apply to:
. Damage to Your Product
Property damage to your product arising out of it or any part of it except when caused by or resulting from:
(I) fire;
( ) smoke;
collapse;or
explosion.
1. Damage to Your work
Property damage to your work arising out of it, or any part of it and included in the prod ucts-complet d
operations hazard.
This exclusion does not apply:
�.. (1) If the damaged work, or the work out of which the damage anises, was performed on the Named
Insured's behalf by a subcontractor; or
CNA {4 0 XX 1-1 Policy No: 7034168041
Page 5 of 17 Endorsement No
Nat'l Fire Ins Co of Hartford Effective Date: 08/04/2022
Insured Name: BENNE` T PaVING INC
Copyright CNA All Rights Reserved. Includes copyrighted material of insurance Services Offloe,Inc.,with its permission
CNA CNA PARAMOUNT
contractors' General Liability Extension Endorsement
( ) If the cause of loss to the damaged work arises as a result of-
(a) fire;
f:( ) fire;
( ) smoker
(c) collapse; or
(d) explosion.
B. The following paragraph is added to LIMITS of INSURANCE
Subject to 5. above, $100,000 is the most the I nsurer will pay under Coverage A for the sum of da mages arising
out of any one occurrence because of property damage to your product and your work that is caused by fire,
smoke, collapse or explosion and is included within the product-completed operations hazard. This sublinnit
does not apply to property damage to your work if the damaged work, or the work out of which the damage
arises,was performed on the Named Insured's Insured' behalf by a subcontractor.
C. This Broadened Liability coverage For Damage To Your Product And Your Work Provision does not apply if
n endorsement of the same name 1s attached to this policy.
7. CONTRACTUAL LIABILITY—RAILROADS
With respect to operations performed within 50 feet of railroad property, the definition of insured contract is replaced
by the following-
Insured Contract means:
a. A contract for a lease of premises. However, that portion of the contract for a lease of premises that indemnifies
any person or organization for damage by fire to premises while rented to a Named Insured or temporarily
occupied by a Named Insured with permission of the owner is not an insured contract;
b. A sidetrack agreement,
c. Any easement or license agreement;
d. An obligation, as rewired by ordinance, to indemnify a municipality, except in connection with work for
municipality;
e. An elevator maintenance agreement,
f. That part of any other contract or agreement pertaining to the Named Insured's business (including an
indemnification of a municipality in connection with work performed for a municipality) under which the Named
Insured assumes the tort liability of another party to pay for bodily injury or property damage to a third person
or organization. Tort liability means a liability that would be imposed by law in the absence of any contract or
agreement.
Paragraph f.does not include that part of any contract or agreement.
('I) That in demn ifi es an architect, engineer or surveyor for injury or darnage arising out of:
(a) Preparing, approving or failing to prepare or approve reaps, shop drawings, opinions, reports, surveys,
field orders. change orders or drawings and specifications, or
(b) Giving directions or instructions, or failing to give thein if that is the primary cause of the injury or
damage-,
{ } Under which the Insured, if an architect, engineer or surveyor, assumes liability for an injury or damage
arising out of the insured's insured' rendering or failure to reader professional services, including those listed in (1)
above and supervisory, inspection: architectural or engineering activities.
8. ELECTRONIC DATA LIABILITY
C NA775 1-1 5 Policy o: 7034168041
Page 5 of 17 Endorsement No
Nat'l Fire Ins Co of Hartford Effective Date: 08104/2022
Insured Name: BENNETT PAVING INC
copyright CNA All Rights Reserved.rued. Includes oopynghted material of Insurance Services office,Inc.,with ft permission.
i
CNA SNA PARAMOUNT
Contractors' General Liability Extension E
A. Linder COVERAGES,ES, verage A — Bodlly Injury and Property Damage Liability, the paragraph entitled
Exclusions is amended to delete exclusion p. Electronic Data and replace it with the following:
This insurance does not apply to:
p. Access or Disclosure of Confidential or Personal Information And Data-related Liability
Damages arising out of:
1) any access to or disclosure of any person's or organization's confidential or personal information,
including patents, trade secrets, processing methods, customer lists, financial information, credit card
information, health information or any other type of nonpublic information; or
( 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, unless Paragraph 1 above applies, this exclusion does not apply to damages because of bodily
injury.
This exclusion applies even if damages are claimed for notification costs, credit monitoring expenses,
forensic expenses, public relation expenses or any other loss, cost or expense incurred by the Named
Insured or others arising out of that which is described in Paragraph(1)or( )above.
B. The follomfing paragraph is added to LIMITS of INSURANCE
Subject to 5. above, $100,000 is the most the Insurer will pay under Coverage A for all damages arising out of
any one occurrence because of property damage that results from physical injury to tangible property and
arises out of electronic data.
D. The following definition is added to DEFINITIONS:
Electronic data reams information, facts or programs stored as or on, created or used on, or transmitted to or
from computer software (Including systems and applications software), hand or floppy disks, CD-ROM, tapes,
drives, cells, data processing devices or any other media which are used with electronically controlled equipment.
D. For the purpose of the coverage provided by this ELECTRONIC OI IC DATA LIABILITY Provision, the definition of
property damage in DEFINITIONS is replaced by the following:
Property damage means:
-- a. 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;
b. 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
c. 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 b
deemed to occur at the time of the occurrence that caused it.
For the purposes of this insurance,electronic data is not tangible property.
E. If Electronic Data Liability is provided at a higher limit by another endorsement attached to this policy, then the
$100,000 limit provided by this ELECTRONIC DATA LIABILITY Provision is part of, and not in addition to, that
higher limit.
. ESTATES, LEGAL REPRESENTATIVES,ESENTATIVES,AND SPOUSES
The estates, heirs, legal representatives and spouses of any natural person Insured shall also be insured under this
policy; provided, however, coverage is afforded to such estates, heirs, legal representatives, and spouses only for
NA X 1-1 Policy No: 7034168041
Page 7 of 17 Endorsement ent No:
Nat'l Fire Ins Co of Hartford Effective Date: 0810412022
Insured Name: BEN ETT PAVING
cpydght CNA All Rights Reserved. Includes copyrighted material of Insurance Services Office,Inc. with its permission.
CNA 111A PARAMOUNT
contractors' General Liability Extension Endorsement
claims arising solely out of their capacity or status as such and, in the case of a spouse, where such claim seeks
damages from marital community property, jointly held property or property transferred from such natural person
Insured to such spouse. No coverage is provided for any act error or omission of an estate, heir, legal
representative, or spouse outside the scope of such person's capacity or status as such, provided however that the
spouse of a natural person Named Insured and the spouses of members or partners of joint venture or partnership
Named Insureds are Insureds with respect to such spouses' acts, errors or omissions in the conduct of the Named
Insured's business.
10. EXPECTED OR INTENDED INJURY—EXCEPTION F l REASONABLE ABLE F RCE
Under COVERAGES,ES, Coverarge A — Bodily Injury and Property Damage Liability, the paragraph entitled
Exclusions is amended to delete the exclusion entitled Expected or Intended Injury and replace it with the following:
This insurance does not apply to:
Expected or Intended Injury
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.
11. GENERAL AGGREGATE LIMITS OF INSURANCE -PER PROJECT
A. For each construction project away from premises the Named Insured owns or rents, a separate Construction
Project General Aggregate Limit, equal to the amount of the General Aggregate Limit shown in the Declarations,
is the most the Insurer will pay for the sura of.
1. All damages under Coverage A, except damages because of bodily injury or property damage included in
the prod urct -completed operations hazard; and
. All medical expenses under coverage c,
that arise from occurrences or accidents which can be attributed solely to ongoing operations at that construction
project. Such payments shall not reduce the General Aggregate Limit shown in the Declarations, nor the
Construction Project General Aggregate Limit of any other construction project.
B. All.-
1.
ll:1. Damages under coverage B, regardless of the number of locat ors or construction projects involved;
. Damages under Coverage , caused by occurrences which cannot be attributed solely to ongoing
operations at a single construction project, except damages because of bodily injury or property damage
included in the products-completed operations hazard- and
. Medical l expenses under coverage D caused by accidents which cannot be attributed soler to ongoing
operations at a single construction project,
will reduce the General Aggregate Umlt shown in the Decla rat ons.
D. The limits shown in the Declamations for Each Occurrence, for Damage To Premises Rented To You and for
Medical Expense continue to apply, but will be subject to either the Construction Project General Aggregate Limit
or the General Aggregate Limit shown in the Declarations: depending on whether the occurrence can be
attributed solely to ongoing operations at a particular construction project.
D. When coverage for liability arising out of the products-completed operations hazard is provided,, any payments
for damages because of bodily injury or property damage included in the products-completed operations
hazard will reduce the Products-Completed Operations Aggregate Limit shown in the Declarations, regardless of
the number of projects involved.
NAOX t-1 Polio No: '7034168041,
Page 8 of 17 Endorsement No:
Nat'l Fare Iris Co of Harford Effective Date- 08/04/2022
Insured Name: BENNETT PAVING INC
apydght CNA All Rights Reserved. Includes copyrighted material of Insurance Services Office,Inc.,with its permiss-D-
CNA SIVA PARAMOUNT
Contractors' General Liability Extension Endorsement
E. If a single construction project away from premises owned by or rented to the Insured has been abandoned and
then restarted, or if the authorized contracting parties deviate from plans, blueprints, designs, specifications or
timetables,the project v►r+ll still be deemed to be the same construction project.
F. The provisions of LIMITS of INSURANCE not otherwise modified by this endorsement shall continue to apply as
stipulated.
12. IN REM ACTIONS
A quasi in rein action against any Gressel owned or operated by or for the Named Insured, or chartered by or for the
Famed Insured, will be treated in the same manner as though the action were in personaim against the Named
Insured.
13. INCIDENTAL HEALTH DARE MALPRACTICE COVERAGE
Solely With respect to bodily injury that arises out of a health care incident:
A. Under COVERAGES, Coverage A — Bodily Injury and Property Damage Liability, the paragraph entitled
Insuring Agreement is amended to replace Paragraphs 1.b.(1)and 'I.b.( )VAth the following:
b. This insurance applies to bodily injury provided that the professional health care services are incidental to
the Warned Insured's primary business purpose, and only if:
1) such bodily injury is caused by an occurrence that takes place in the coverage territory.
{ } the bodily Injury first occurs during the policy period. All bodily injury arising from an occurrence will
be deemed to have occurred at the time of the first act, error, or omission that is part of the occurrence;
and
B, lender COVERAGES, Coverage A — Bodily Injury and Property Damage Liability, the paragraph entitled
Exclusions is amended to:
i. add the following to the Employer's Lilabxlity exclusion:
This exclusion applies only if the bodily injury arising from a health care incident is covered by other
liability insurance available to the Insured or which would have been available but for exhaustion of its
limits).
QD
ii. delete the exclusion entitled Contractual Liability and replace it with the following:
This insurance does not apply to:
Contractual Liability
the In ur d's actual or alleged liability ander any oral or written contract or agreement, including but not
limited to express w►arranties or guarantees.
iii. add the following additional exclusions:
This insurance does not apply to:
Discrimination
any actual or alleged discrimination, humiliation or harassment, including but not limited to claims based on
an individual's race, creed, color, age, gender, national origin, religion, disability, marital status or sexual
orientation.
Dishonesty or gime
Any actual or alleged dishonest, criminal or malicious act, error or omission.
Medicare/Medicaid Fr cud
CNA ' o5 1-15 Polio No: 7034168041
Page g of 17 Endorsement No:
Nat'l Fire Ins Co of Hartford Effedive Cate: 08104/2022
Insured Name: BEI ETT PAVING INC
Copyright CNA A I Fights Reserved. Includes copyrighted material of Insurance Services once,Inc.,wit# "its permission.
CNA CNA PARAMOUNT
Contractors' General Liability Extension Endorsement
any actual or alleged violation of law with respect to Medicare, Medicaid, Tricare or any similar federal, state
or local governmental program.
Services Excluded by Endorsement
Any health care incident for which coverage is excluded by endorsement.
C. DEFINITIONS is amended to:
i. add the following definitions:
Health care incident means an act, error or omission by the darned Insured's employees or volunteer
workers in the rendering of-
a. professional health care services on behalf of the Named Insured or
b. Good Samaritan services rendered in an emergency and for which no payment is demanded or received.
Professional health care services means any health care services or the related furnishing of food,
beverages, medical supplies or appliances by the following providers in their capacitor as such but solely to
the extent they are duly licensed as required:
ak. Physician;
b. Nurse;
c. Nurse practitioner;
d. Emergency medical technician;
e. Paramedic;
f. Dentist;
. Physical therapist,
h. Psychologist,
i. Speech therapist,
Other allied health professional; or
Professional health care services does not include any services rendered in connection with human clinical
trials or product testing.
ii. delete the definition of occurrence and replace it with the following:
occurrence means a health care incident. All acts, errors or omissions sions that are logically connected by any
common fact circumstance, situation, transaction, event, advice or decision will be considered to constitute a
single occurrence
iii. amend the definition of Insured to:
a. add the following:
the Manned Insured's employees are Insureds with respect to:
(1) bodily injury to a co-employee while in the course of the co-employee's employment by the
Named Insured or while performing duties related to the conduct of the Named Insured'
busi ness; and
CNA7 o x 1-1 Policy No: 7034168041
Page 10 of 17 Endorsement No:
Nat'l Fire Ins Co of Hartford Effective Date: 08/04/2022
Insured Name: BENNETT PAVING INC
Copyright CNA All Fights#deserved. Includes copyrighted material of Insurance Services Office,Inc.,with its permission,
CNA CNA PARAMOUNT
Contractors' General Liability Extension Endorsement
( ) bodily injury to a volunteer worker wh le performing duties related to the conduct of the
Flamed Insured's business;
when such bodily injury arises out of a health care incident.
the Nalmed I ns ured's volunteer workers are Insureds with respect to:
1) bodily injury to ai co-volunteer worker while performing duties related to the conduct of the
Named Insured's business; and
bodily injury to ars employee while in the course of the employee's employment by the Named
Insured or while performing duties related to the conduct of the Named Insured's business;
when such bodily injury arises out of a health care incident.
b. delete Subparagraph a), b), c and (d)of Paragraph .a.(1)of WHO is AN INSURED.
D. The other Insurance condition is amended to delete Paragraph b.(1) in its entirety and replace it with the
following.
Other Insurance
b. Excess Insurance
(1) To the extent this insurance applies, it is excess over any other insurance, self insurance or dsk transfer
instrument, whether primary, excess, contingent or on any other basis} except for insurance purchased
specifically by the Named Insured to be excess of this coverage.
14. JOINT VENTURES/PARTNERSHIP I LlMITE D LIABILITY COMPANIES
WHO IS AN INSPIRED is amended to delete its last paragraph and replace it with the following:
No person or organization is an Insured with respect to the conduct of any current or past partnership,joint venture or
limited liabil*ty company that is not shown as a Named Insured in the Declarations, except that if the Named Insured
was a joint venturer, partner, or member of a limited liab.lity company and such joint venturer partnership or limited
liability company terminated prior to or during the policy period, such Named Insured is an Insured with respect to
its interest in such joint venture, partnership or limited liability company but only to the extent that:
Ln
a. any offense giving rise to personal and advertising injury occurred prior to such termination date, and the
personal and advertising injury arising out of such offense first occurred after such termination date;
b. the bodily injury or property damage first occurred after such termination date; and
c. there is no other valid and collectible insurance purchased specifically to insure the partnership, joint venture or
limited liability company; and
If the joint venture, partnership or limited liability company is or was insured under a consolidated (wrap-rip)
insurance program: then such insurance will always be considered valid and collectible for the purpose of paragraph
c. above. But this provision will not serge to exclude bodily injury, property damage or personal and advertising
injury that would otherwise be covered under the Contractors General Liability Extension Endorsement provision
entitled WRAP-IIP EXTENSION: OCIP, CLIP, OR CONSOLIDATED (WRAP-QIP) INSURANCE PROGRAMS.
Please see that provision for the definition of consolidated(wrap-up) insurance program.
15. LEGAL LIABILITY — DAMAGE To PREMISES / ALIENATED PREMISES I PROPERTY IN THE NAMED
INSURED'S CARE, CUSTODY OR CONTROL
A. Under COVERAGES, Coverage A — Bodily Injury and Property Damage Liability, the paragraph entitled
Exclusions is amended to delete exclusion j. Damage to Property in its entirety and replace it with the following-
Th is
ollowing:This insurance does not apply to:
0 XX 1-1 Policy No: 7034168041
Page 11 of 17 Endorsement No:
Nat'l Fire Ins Co of Hartford Effective Date: 08/04/2022
Insured Marne: BE I ETT PAVING INC
copyright C NA All Rights Res rved. Indud s copyrighted material of insurance Services office,Inc.,with its permission
i
J
CNA CNA PARAMOUNT
contractors' General Liability Extension Endorsement
j. Damage to Property
Property damage to:
(1) Property the Named Insured owns, rents, or occupies, including any costs or expenses incurred by you,
or any other person, organization or entity, for repair, replacement, enhancement, restoration or
maintenance of such property for any reason, including prevention of injury to a person or damage to
another's property;
{ } Premises the Named Insured sells, gives away or abandons, if the property damage arises out of any
part of those premises;
3) Property loaned to the Named Insured;
Personal property in the care, custody or control of the Insured;
5) That particular part of real property on which the Named Insured or any contractors or subcontractors
wording directly or indirectly on the Named Insured's behalf are performing operations, if the property
damage arises out of those operations}or
{ That particular part of any property that must be restored, repaired or replaced because your work was
incorrectly performed on it.
Paragraphs 1), (3) and ( ) of this exclusion do not apply to property damage (other than damage by fire)to
premises rented to the Named Insured or temporarily occupied by the Darned Insured with the permission of
the owner, nor to the contents of premises rented to the Named Insured for a period of 7 or fewer
consecutive days.A separate limit of insurance applies to Damage To Premises Rented To You as described
in LIMITS OF INSURANCE.
Paragraph (2)of this exclusion does not apply if the premises are your work.
Paragraphs 3), ( ), ) and ( ) of this exclusion do not apply to liability assumed under a sidetrack
agreement.
Paragraph ( ) of this exclusion does not apply to property damage included in the prod ucts-compl ted
operations hazard.
Paragraphs(3)and ( )of this exclusion do not apply to property damage to:
i. tools. or equipment the Named Insured borrows from others, nor
ii. other personal property of others in the Named Insured's cage custody or control while being used in the
Nld Insured's operations away from any Named Inured's premises.
However, the coverage granted by this exception to Paragraphs( )and )does not apply to:
. property at a job site awaiting or during such property's installation, fabrication, or erection;
b. property that is mobile ealuipment leased by a n Insured;
c. property that is an auto aircraft or watercraft,
d. property in transit, or
e. any portion of property damage for which the Insured has available other valid and collectible
insurance: or would have suer insurance but for exhaustion of its limits, or but for application of one of its
exclusions,
separate lim!t of insurance and deductible apply to such property of others. See LIMITS of INSURANCE
as amended below.
DNA ' 7" X 1-1 - Policy : 7034168041
Page 12 of 17 Endorsement N :
Nat'l Fire Ins Co of Hartford Effective Date: 08104/2022
Insured Name:: B NNETT PAVING INC
Copyright CNA All Rights Reserved. Includes copyrighted material of Insurance Services Office Inc.,with its permission
i
P
4rNA CNA PARAMOUNT
contractors' General Liability Extension Endorsement
B. Under COVERAGES, Coverage A — Bodily Injury and Property Damage Liability, the paragraph entitled
Exclusions is amended to delete its last paragraph and replace it with the following:
Exclusions c. through n. do not apply to damage by fire to premises while rented to a Named Insured or
temporarily occupied by a Named Insured with permission of the owner, nor to damage to the contents of
premises rented to a Named Insured for a period of 7 or fewer consecutive days.
separate limit of insurance applies to this coverage as described in LIMITS OF INSURANCE.
C. The following paragraph is added to LIMITS of INSURANCE:
Subject to 5. above, $25,000 is the most the Insurer will pay under Coverage A for damages arising out of any
one occurrence because of the sura of all property damage to borrowed tools or equipment, and to other
personal property of ethers in the Named I n ur d's care, custody or control, while being used in the Named
Insured's operations away from any Named In ured's premises. The Insurer's obligation to pay such property
damage does not apply until the amount of such property damage exceeds$1,000. The Insurer has the right but
not the duty to pay any portion of this $1,000 in order to effect settlement. If the Insurer exercises that right, the
Named Insured will promptly reimburse the Insurer for any such amount.
D. Paragraph 6., Damage To Premises Dented To You Limit, of LIMITS OF INSURANCE is deleted and replaced by
the following:
. Subject to Paragraph 5. above, (the Each Occurrence Limit), the Damage To Premises Rented To You Limit
is the most the Insurer will pay under Coverage A for damages because of property damage to any one
premises while rented to the Named Insured or temporarily occupied by the Named Insured with the
permission of the owner, including contents of such premises rented to the Named Insured for a period of
or fewer consecutive days.The Damage To Premises Rented To You Limit is the greater of.
a. 00,000;or
b. The Damage To Premises Rented To You Limit shown in the Declarations.
E. Paragraph 4.b.(1)(a)(1I)of the Other Insurance Condition is deleted and replaced by the following:
(ii) That is property insurance for premises rented to the Named Insured, for premises temporarily occupied by
the Named Insured with the permission of the owner; or for personal property of others in the Named
Insured'Insured's care, custody or control;
16. LIQUOR LIABILITY
Under COVERAGES, Coverage A — Bodily Injurer and Property Damage Liability, the paragraph entitled
Exclusions is amended to delete the exclusion entitled Liquor Liability.
This LIQUOR LIABILITY provision does not apply to any person or organization who otherwise qualifies n
additional insured on this Coverage Part.
17. MEDICAL PAYMENTS
A. LIMITS of INSURANCE is amended to delete Paragraph 7. (the Medical Expense Limit) and replace it with the
following:
7. Subject to Paragraph 5. above (the Each Occurrence Lim-it), the [Medical Expense Limit is the most the
Insurer will pay under Coverage c--Medical Payments for all medical expenses because of bodily injury
sustained by any one person. The iledicl Expense Limit is the greater of:
1 ,000 unless a different amount is shown here: I :IIIN,II1,IlIN; or
the amount shown in the Declarations for Medical Expense Limit.
f A 0 1-1 Policy No: 7034168041
Page 13 of 17 Endorsement No:
Nat'l Fire Ins Co of Hartford Effective Date: 08/04/2022
Insured Mame: BE I ETT PAVING INC
Copyright C NA All Rights Reserve d. Includes copyrighted mated al of Insurance Services Office,Inc. with its permission.
w
CNA SNA PARAMOUNT
Contractors' General LExtension Endorsement
B. Under COVERAGES, the Insuring Agreement of Coverage C — Medical Payments is amended to replace
Paragraph I.a.( ){b)with the following
(b) The expenses are incurred and reported to the Insurer within three years of the date of the accident; and
18. NON-OWNED AIRCRAFT
Under COVERAGES, Coverage A — Bodily Injury and Property Damage Liability, the paragraph entitled
Exclusions is amended as follows:
The exclusion entitled Aircraft,Auto or Watercraft is amended to add the following:
This exclusion does not apply to an aircraft not owned by any Named Insured, provided that:
1. the pilot in command holds aI currently effective certificate issued by the duly constituted authority of the United
States of America or Canada, designating that person as a commercial or airline transport pilot;
. the aircraft is rented with a trained, paid crew to the Named Insured,and
. the aircraft is not being used to carry persons or property for a charge.
19. NON-OWNED WATERCRAFT
Under COVERAGES,, overalge A — Bodily Injury and Property Damage Liability, the paragraph entitled
Exclusions is amended to delete subparagraph ( ) of the exclusion entitled Aircraft, Auto or Watercraft, and
replace it with the following.
This exclusion does not apply to:
a watercraft that is not owned by any Named Insured, provided the watercraft is:
(a) less than 75 feet long; and
(b) not being used to carry persons or property for ar change.
0. PERSONAL AND ADVERTISING INJURY—DISCRIMINATION IMINATION HUMILIATION
A. Under DEFINITIONS. the definition of personal and advertising injury is amended to add the following tort:
Discrimination or humiliation that results in injury to the feelings or reputation of a natural person.
D. Under COVERAGES,, Coverage B — Personal and Advertising Injury Liability, the paragraph entitled
Exclusions is amended to.
I. delete the Exclus on entitled Knowing Violation Of Bights of Another and replace it with the following.
This insurance does not apply to:
Knowing Violation of Rights of Another
Personal and advertising injury caused by or at the direction of the Insured with the l nowrledge that the act
would violate the rights of alnother and wrouId inflict personal and advertising injury. This exclusion shall not
apply to dlscdmination or humiliat.on that results in injury to the feelings or reputation of a natural person, but
only if such discrimination or humiliation is not done intentionally by or at the direction of:
(a) the Named Insured; or
any executive officer director. stockholder. partner, member or manager if the Named Insured is a
limited liability company) of the Named Insured.
. add the following exclusions:
NA 47 1-1 Policy No: 7034168041
Page 14 of 17 Endorsement No:
Nat'l Fire Iris Co of Hartford Effective Date: 08/04/2022
Insured Flame: BENNETT PAVING INC
Copyright CIA All Rights Reserved. Includes copyrighted material of insurance SerAces Office,Inc.,whh its permission
i
CNA CNA PARAMOUNT
Contractors' General Liability Extension Endorsement
This insurance does not apply to-
Employment Belated Discrimination
Discrimination or humiliation directly or ind;rectly related to the employment, prospective employment, past
employment or termination of employment of any person by any Insured.
Premises Related Discrimination
discrimination or humiliation arising out of the sale, rental, lease or sub-lease or prospective sale, rental,
lease or sub-lease of any room, dwelling or premises by or at the direction of any Insured.
Notwithstanding the above, there is no coverage for fines or penalties levied or imposed by a governmental entity
because of discrimination.
The coverage provided by this PERSONAL AND ADVERTISING INJURY —DISCRIMINATION OR HUMILIATION
Provision does not apply to any person or organization whose status a s an Insured derives solely from
Provision 1.ADDITIONAL INSURED of this endorsement; or
attachment of an additional insured endorsement to this Coverage Part.
This PERSONAL AL AND ADVERTISING INJURY—DISCRIMINATION OR HUMILIATION Provision does not apply to
any person or organization who otherwise qualifies as an additional insured on this coverage Part.
1. PERSONAL AND ADVERTISING INJURY-CONTRACTUAL LIABILITY
A. Under COVERAGES, Coverage B —Personal and Advertising Injury Liability, the paragraph entitled
Exclusions is amended to delete the exclusion entitled Contractual Liability.
B. Solely for the purpose of the coverage provided by this PERSONAL AND ADVERTISING 1 INJURY -
COI
CONTRACTUAL TUAL LIABILITY provision, the following changes are made to the section entitled
SUPPLEMENTARY PAYMENTS—COVERAGES E A AND B:
1. Paragraph 2.d. is replaced by the following:
d. The allegations in the suit and the information the Insurer knows about the offense alleged in such suit
are such that no conflict appears to exist between the interests of the Insured and the interests of the
indemnitee;
. The first unnumbered paragraph beneath Paragraph .f.( )(b) is deleted and replaced by the following.
So long as the above conditions are met, aftorneys fees incurred by the Insurer in the defense of that
indemnitee, necessary litigation expenses incurred by the Insurer, and necessary litigation expenses incurred
by the indemnitee at the Insurer's request will be paid as defense costs. Such payments will not be deemed
to be daimages for personal and advertising injury and will not reduce the limits of insurance.
C. This PERSONAL AND ADVERTISING INJURY - CONTRACTUAL LIABILITY Provision does not apply if
Coverage E —Personal and Advertising Injury Liability is excluded by another endorsement attached to this
Coverage Part.
This PERSONAL AND ADVERTISING IN INJURY - CONTRACTUAL LIABILITY Provision does not apply to any
person or organization who otherwise qualifies as an additional insured on this Coverage Part.
. PROPERTY DAMAGE—ELEVATORS
A. Linder COVERAGES, Coverage A — Bodily Injury and Property Damage Liability, the paragraph entitled
Exclusions is amended such that the Damage to Your Product Exclusion and subparagraphs ). ) and { } of
the Damage to Property Exclusion do not apply to property damage that results from the use of elevators.
--^ NA7 70 1-1 Policy No: 7034168041
Page 15 of 17 Endorsement No:
Nat'l Fire Ins o of Hartford Effective Date' 08/04/2022
insured Name: BEN ETT PAVING INC
Copyright CNA Ail Rights Reserved. Includes copyrighted material of Insurance Services Offioe,Inc, wAh its permission.
y
CNA CNA PARAMOUNT
Contractors' General Liability Extension Endorsement
B. Solely for the purpose of the coverage provided by this PROPERTY DAMAGE — ELEVATORS Provision, the
Other Insurance conditions is amended to add the following paragraph-
This insurance is excess over any of the other insurance whether primary, excess, contingent or on any other
basis that is Property insurance covering property of others damaged from the use of elevators.
23. SUPPLEMENTARY PAYMENTS
The section entitled SUPPLEMENTARY PAYMENTS ENTS—COVERAGES A AND B is amended as follows:
A. Paragraph 1.b. is amended to delete the $250 limit shown for the cost of bail bonds and replace it with a $5,000.
limit; and
B. Paragraph 1.d. is amended to delete the limit of $250 shown for dally loss of earnings and replace it with
$1,000. limit.
24. UNINTENTIONAL TIONAL FAILURE To DISCLOSE HAZARDS
If the Named Insured unintentionally fails to disclose all existing hazards at the inception date of the Named
I ns ured's Coverage Part,the Insurer will not deny coverage under this Covera ge Part because of such failure.
5. WAIVER of SUBROGATION -BLANKET
Under CONDITIONS, the condition entitled Transfer of Rights of Recovery Against others To Us is amended to
add the following:
The Insurer waives any right of recovery the Insurer may have against any person or organization because of
payments the Insurer makes for injury or damage arising out of.
1. the Named Insured's ongoing operations;or
. your work included in the products-completed operations hazard.
However, this waiver applies only when the Named Insured has agreed in writing to waive such rights of recovery in
awritten contract or written agreement. and only If such contract or agreement:
1. is in effector becomes effective during the terra of this Coverage Part,and
2. was executed prior to the bodily injury, property damage or personal and advertising injury giving rise to the
claim.
26. WRAP-UP EXTENSION: OCIP,DRIP, OR CONSOLIDATED(WRAP-IJP) INSURANCE PROGRAMS
Note: The following provision does not apply to any public construction project in the state of Oklahoma. nor to any
construction project in the state of Alaska, that is not permitted to be insured under a consolidated (wrap-up)
insurance program by applicable state statute or regulation.
If the endorsement EXCLUSION — CONSTRUCTION WRAP-UP is attached to this policy, or another exclusionary
endorsement pertaining to Owner Controlled Insurance Programs .C.I.P. or Contractor Controlled Insurance
Programs .C.I.P. is attached: thea the following changes appy:
. The following wording is added to the above-referenced endorsement-
lith respect to a consolidated (wrap-up) insurance program project in which the Named Insured is or was
involved. this exclusion does not apply to those suras the Named Insured become legally obligated to pay as
damages because of
1. Bodily injury, property damage, or personal or advertising injury that occurs during the Named Insured's
ongoing operations at the project, or during such operations of anyone acting on the Named Insured's
behalf; nor
N 05XX 1-1 Policy No: 7034168041
Fuge 16 of 17 Endorsement No:
Nat'l l Fire Ins Co of Hartford Effective Date: /04/2022
Insured Name: BENNETT PASTING INC
Copyright CNA All Rights Reserved. Includes copyrighted matenai of Insurance Services Office,Inc.,with its permission.
CNA SNA PARAMOUNT
contractors' General Liability Extension Endorsement
. Bodily injury or property damage included within the products-completed operations hazard that arises
out of those portions of the project that are not residential structures.
B. Condition 4. Other Insurance is amended to add the following subparagraph .b.('1)(c):
This insurance is excess over.
{c} Any of the ether insurance whether primary, excess, contingent or any other basis that is insurance available
to the Named Insured as a result of the Tamed Insured being a participant in a consolidated wrap-up)
insurance program, but only as respects the Named Insured's involvement in that consolidated (wrap-up)
insurance program.
D. DEFINITIONS is amended to add the following definitions'
Consolidated (wrap-up) insurance program means a construction, erection or demolition project for which the
prime contractorlproject manager or owner of the construction project has secured general liability insurance
covering some or all of the contractors or subcontractors involved in the project, such as an Owner Controlled
Insurance Program .C.I.P. or Contractor Controlled Insurance Program C. .I.P. .
Residential structure means any structure where % or more of the square foot area is used or is intended to
be used for human residency, including but not limited to:
'l. single or multifamily housing, apartments, condominiums, townhouses* co-operatives or planned unit
developments; and
. the common areas and structures appurtenant to the structures in paragraph 'I. (including pools, hot tubs,
detached garages,guest houses or any similar structures).
However, when there is no individual ownership of knits, residential structure does not include military housing,
collegeluniv r ity housing or dormitories, long terra care facilities, hotels or motels. Residential identlal structure also
does not include hospitals or prisons.
This WRAP-UP EXTENSION: cIP, CLIP, OR CONSOLIDATED (WRAP-UP) INSURANCE PROGRAMS RAM Provision
does not apply to any person or organization who otherwise qualifies as an additional insured on this Coverage Part.
All other terms and conditions of the Policy remain unchanged.
CD
This endorsel ent, which forms a part of and is for attachment to the Policy issued by the designated Insurers, takes effect
n the effective date of said Policy at the hour stated in said Policy, unless another effective date is shown below, and
expires concurrently with said Policy.
CN0 XX 1-1 Policy No: 7034168041
Page 17 of 17 Endorsement No:
Nat'l l Fire Ins -.'. :,.f Har"_f,'.d Effective Gate. 08/0412022
Insured lame: BEI ETT PAVING - k-.
Copyright CNA All Fights Reserved. Includes copyrighted material of Insurance SeNc-v.4 Office,I w-h its permission,
]Fexasmutu
WORKERS'ERS' COMPENSATION INSURANCE
WORKERS* OMPENSATIO AND WC 42 06 01
EMPLOYERS LIABILITY POLICY Insured copy
TEXAS NOTICE OF MATERIAL CHANGE ENDORSEMENT
This endorsement applies only to the insurance provided by the policy because Texas Is shown in Item 3.A. of the
Information Fuge.
In the event of cancellation or other material change of the policy,we will mail advance not ce to the person or
organization named in the Schedule. The number of days advance notice is shown in the Schedule.
This endorsement shall not operate directly or indirectly to benefit anyone not named in the Schedule.
Schedule
1, Number of days advance notice: 30
. Notice will be mailed to: PER LIST ON FILE
This endorsement changes the policy to which it is attached effective on the inception date of the policy unless a different date is indicated below.
(The following"attaching clause"need be completed only when this endorsement is issued subsequent to preparation of the policy.)
This endorsement,effective on 8/4..'2 2 at 12:01 a.rn.standard time,forms a part of:
Policy no,00 02018278 of Texas Mutual Insurance Company effective on 814!22
Issued to- S NNETT PAYING INC
This is not a bill
Authorized representative
NI Carrier Cede; 29939
819!22
PO Box 12058,Austin,TQC 78711-2058
1 of 1 texasmutual.cum 1 (800)859-5995 1 Fax(800)359-0650 WC 42 06 01