Contract - Patin Construction - 3/23/2023 R- 202 3- Ogg.
CITY OF ROUND ROCK
Utilities and Environmental Services Department
ROUND ROCK TEXAS
Project Manual For:
Chandler Branch and Dry Branch Channel Maintenance
Improvements
January 2023
Prepared By:
City of Round Rock
APPROVED BY
CITY ATTORNEY
TBPE Firm Registration No
�l
BID BOND
THE STATE OF TEXAS §
§ KNOW ALL BY THESE PRESENTS:
COUNTY OF WILLIAMSON §
That Patin Construction,LLC of the City of Taylor County
of Williamson State of Texas as Principal, and
Harco National Insurance company authorized under the laws of the State of Texas to act as surety on
bonds for principals,are held and firmly bound unto the CITY OF ROUND ROCK,TEXAS("Owner"),
in the penal sum of Five Percent(5%)of the total amount of the Bid of the Principal submitted to the Owner,
for the Work described below; for the payment whereof,well and truly to be 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 of The Total
Amount Bid Dollars($ 5% ).
THE CONDITIONS OF THIS OBLIGATION ARE SUCH that,whereas,the Principal has submitted
the above-referenced Bid to the Owner, for construction of the Work under the "Specifications for
Construction of Chandler Branch and Dry Branch Channel Maintenance Improvements
for which Bids are to be opened at the office of Owner on the 21 st day of
February , 2023 .
NOW,THEREFORE,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,enters
into a written Agreement substantially in the form contained in the Bid Documents,in accordance with the
Bid, and files the two (2) bonds with the Owner, one to guarantee faithful performance and the other to
guarantee payment for labor and materials,then this obligation shall be null and void;otherwise,it shall 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 required
by the Bid Documents, Surety within five(5)business days after receipt of a written demand from Owner
shall pay to Owner the full penal sum 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, the said Principal and Surety have signed this instrument on this the
21 st day of the month of February 2023 .
Patin Constructio Harco National Insurance Company
P 'nc' I Surety
Kenneth Nitsche
Printed Name Printed Name
y: Z By:
Title: : s Title: Attorney-In-Fact
Address: 3800 W.2nd Street Address: One Newark Center, 90th Or
Taylor,TX 76574 Newark N_I 0710?
00200 4-2020 Page 1 Bid Bond
00443638
Resident Agent of Surety:
Signature
Kenneth Nitsche
Printed Name
143 E.Austin
Street Address
Giddings,TX 78942
City, State,Zip
Page 2
00200 4-2020 Bid Bond
00443638
POWER OF ATTORNEY Bond# N/A
HARCO NATIONAL INSURANCE COMPANY
INTERNATIONAL FIDELITY INSURANCE COMPANY
Member companies of IAT Insurance Group, Headquartered: 702 Oberlin Road, Raleigh,North Carolina 27605
KNOW ALL MEN BY THESE PRESENTS:That HARCO NATIONAL INSURANCE COMPANY,a corporation organized and existing under the laws of
the State of Illinois,and INTERNATIONAL FIDELITY INSURANCE COMPANY,a corporation organized and existing under the laws of the State of New
Jersey,and having their principal offices located respectively in the cities of Rolling Meadows,Illinois and Newark,New Jersey,do hereby constitute and
appoint
GARY A. NITSCHE, VIOLET J. FROSCH, NINA K. SMITH, KENNETH NITSCHE, ROBERT K. NITSCHE, CRAIG T.
PARKER, ROBERT JAMES NITSCHE
Giddings, TX
their true and lawful attorney(s)-in-fact to execute, seal and deliver for and on its behalf as surety, any and all bonds and undertakings, contracts of
indemnity and other writings obligatory in the nature thereof,which are or may be allowed,required or permitted by law,statute,rule, regulation,contract
or otherwise, and the execution of such instrument(s) in pursuance of these presents, shall be as binding upon the said HARCO NATIONAL
INSURANCE COMPANY and INTERNATIONAL FIDELITY INSURANCE COMPANY,as fully and amply,to all intents and purposes,as if the same had
been duly executed and acknowledged by their regularly elected officers at their principal offices.
This Power of Attorney is executed,and may be revoked,pursuant to and by authority of the By-Laws of HARCO NATIONAL INSURANCE COMPANY
and INTERNATIONAL FIDELITY INSURANCE COMPANY and is granted under and by authority of the following resolution adopted by the Board of
Directors of INTERNATIONAL FIDELITY INSURANCE COMPANY at a meeting duly held on the 13th day of December,2018 and by the Board of
Directors of HARCO NATIONAL INSURANCE COMPANY at a meeting held on the 13th day of December,2018.
"RESOLVED, that (1) the Chief Executive Officer, President, Executive Vice President, Senior Vice President, Vice President, or Secretary of the
Corporation shall have the power to appoint,and to revoke the appointments of,Attorneys-in-Fact or agents with power and authority as defined or limited
in their respective powers of attorney, and to execute on behalf of the Corporation and affix the Corporation's seal thereto, bonds, undertakings,
recognizances,contracts of indemnity and other written obligations in the nature thereof or related thereto; and (2)any such Officers of the Corporation
may appoint and revoke the appointments of joint-control custodians, agents for acceptance of process, and Attorneys-in-fact with authority to execute
waivers and consents on behalf of the Corporation;and(3)the signature of any such Officer of the Corporation and the Corporation's seal may be affixed
by facsimile to any power of attorney or certification given for the execution of any bond,undertaking,recognizance,contract of indemnity or other written
obligation in the nature thereof or related thereto,such signature and seals when so used whether heretofore or hereafter, being hereby adopted by the
Corporation as the original signature of such officer and the original seal of the Corporation,to be valid and binding upon the Corporation with the same
force and effect as though manually affixed."
IN WITNESS WHEREOF,HARCO NATIONAL INSURANCE COMPANY and INTERNATIONAL
FIDELITY INSURANCE COMPANY have each executed and attested these presents
on this 31st day of December,2018 ,,,......
STATE OF NEW JERSEY STATE OF ILLINOIS ;�0�rfl00*4
p SEAL AL County of Essex County of Cook ?_`;SEAL F�
'� rnn
,. 1904�a es //� -Oi 1004
JE
Kenneth Chapman
Executive Vice President,Harco National Insurance Company ••••••`'��
and International Fidelity Insurance Company
On this 31st day of December,2018 before me came the individual who executed the preceding instrument,to me personally known,and,
being by me duly sworn,said he is the therein described and authorized officer of HARCO NATIONAL INSURANCE COMPANY and
INTERNATIONAL FIDELITY INSURANCE COMPANY;that the seals affixed to said instrument are the Corporate Seals of said Companies;that the
said Corporate Seals and his signature were duly affixed by order of the Boards of Directors of said Companies.
.`���,E A����'•. IN TESTIMONY WHEREOF,I have hereunto set my hand affixed my Official Seal,at the City of Newark,
New Jersey the day and year first above written.
•`Q; E.P. Y Y Y
OTA �`Ni�.4s
JEFt;?�,.` Shirelle A.Outley a Notary Public of New Jersey
CERTIFICATION My Commission Expires April 4,2023
I,the undersigned officer of HARCO NATIONAL INSURANCE COMPANY and INTERNATIONAL FIDELITY INSURANCE COMPANY do hereby certify
that I have compared the foregoing copy of the Power of Attorney and affidavit,and the copy of the Sections of the By-Laws of said Companies as set
forth in said Power of Attorney,with the originals on file in the home office of said companies,and that the same are correct transcripts thereof,and of the
whole of the said originals,and that the said Power of Attorney has not been revoked and is now in full force and effect.
IN TESTIMONY WHEREOF,I have hereunto set my hand on this day, February 21,2023
A00134
Irene Martins,Assistant Secretary
BID FORM
PROJECT NAME: Chandler Branch and Dry Branch Channel Maintenance Improvements
PROJECT LOCATION: Round Rock, Texas
OWNER: City of Round Rock, Texas
DATE: January 24, 2023
Gentlemen:
Pursuant to the foregoing Notice to Bidders and Instructions to Bidders, the undersigned bidder
hereby proposes to do all the Work, 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
Chandler Branch and Dry Branch Channel Improvements
and binds himself on acceptance of this bid to execute the Agreement and bond for completing said Work
within the time stated, for the following prices, to wit:
Any addenda issued will be posted with the Project Manual and/or Contract Documents on the
City's website at https://www.civcastusa.comL by the close of business on
February 17, 2023 Prior to submitting a bid, the bidder is responsible for determining if any
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 Quantity Unit and Written Unit Price Unit Price Amount
Chandler Branch
1 2.35 AC Clearing and Grubbing
complete in place per CORR 102
for Eighteen Thousand Five Hundred dollars
and zero cents. 18,500.00 43,475.00
2 2500 CY Excavation, Including Haul Off of
Spoil Material
complete in place per TxDOT 110
for Fifty dollars
and zero cents. 50.00 125,000.00
3 318 SY Cutting and Restoring Asphalt
Pavement(Parking Lot)
complete in place per TxDOT 400
for Thirty dollars
00300-9-2015 Page 1 of 9 Bid Form
BASE BID
Bid Approx. Item Description
Item Quantity Unit and Written Unit Price Unit Price Amount
and zero cents. 30.00 9540.00
4 7 CY Flowable Backfill (Non-Excavatable)
complete in place per TxDOT 401
for Five hundred dollars
and zero cents. 500.00 3500.00
5 110 LF Rock Filter Dams (Install and
Remove)Type 3
complete in place per TxDOT 506
for One hundred dollars
and zero cents. 100.00 11,000.00
6 125 CY Dry Rock Riprap (18" Thickness)
complete in place per CORR 591
for One hundred fifty dollars
and zero cents. 150.00 18750.00
7 2527 SY Sodding for Erosion Control
complete in place per CORR 602
for Twelve dollars
and zero cents. 12.00 30324.00
8 6720 SY Native Seeding for Erosion Control,
Hydraulic Planting
complete in place per CORR 604
for One dollars
and zero cents. 1.00 6720.00
9 6720 SY Soil Retention Blanket Il, Type C
complete in place per CORR 605
for Three dollars
and zero cents. 3.00 20160.00
10 1 LS Install and Remove Temporary
Irrigation System
complete in place per SP 608
00300-9-2015 Page 2 of 9 Bid Form
BASE BID
Bid Approx. Item Description
Item Quantity Unit and Written Unit Price Unit Price Amount
for Twenty five thousand dollars
and zero cents. 25000.00 25000.00
11 13 EA Tree Removal(8"-36" DIA)
complete in place per CORR 610
for Two thousand dollars
and zero cents. 2000.00 26000.00
12 2 EA Stabilized Construction Entrance
complete in place per CORR 641
for One thousand eight hundred dollars
and zero cents. 1800.00 3600.00
13 325 LF Retroreflectorized Pavement Markings
(Parking Lot)
complete in place per TxDOT 666
for Twenty dollars
and zero cents. 20.00 6500.00
14 1100 LF Safety Fencing
complete in place per CORR 703
for Ten dollars
and zero cents. 10.00 11000.00
15 1 EA Project Signs
complete in place per CORR 802
for Two thousand dollars
and zero cents. 2000.00 2000.00
Dry Branch
16 0_3 AC Clearing and Grubbing
complete in place per CORR 102
�o
for Eight thousand five hundred dollars Y 5 66. do 2 S 50 '
and zero cents. Too
00300-9-2015 Page 3 of 9 Bid Form
BASE BID
Bid Approx. Item Description
Item Quantity Unit and Written Unit Price Unit Price Amount
17 1 LS Remove Misc. P.C. Concrete
(Reinforced Concrete Pipe and
Headwall)
complete in place per TxDOT 104
for Five thousand dollars
and zero cents. 5000.00 5000.00
18 82 CY Excavation, Including Haul Off of
Spoil Material
complete in place per TxDOT 110
for Two hundred dollars
and zero cents. 200.00 16400.00
19 20 CY Embankment
complete in place per TxDOT 132
for Two hundred dollars
and zero cents. 200.00 4000.00
20 3 CY Reinforced Concrete Trench Cap
(Class A)
complete in place per TxDOT 420
for One thousand dollars
and zero cents. 1000.00 3000.00
21 1 EA Headwall (27 in. RCP)
complete in place per TxDOT 466
for Five thousand dollars
and zero cents. 5000.00 5000.00
22 85 LF Rock Filter Dams (Install and
Remove) Type 3
complete in place per TxDOT 506
for One hundred dollars
and zero cents. 100.00 8500.00
23 1 EA New Manhole Construction, 4' Dia.
complete in place per CORR 506
for Fifteen thousand dollars
00300-9-2015 Page 4 of 9 Bid Form
BASE BID
Bid Approx. Item Description
Item Quantity Unit and Written Unit Price Unit Price Amount
and zero cents. 15000.00 15000.00
24 56 LF Pipe, 27" Dia. (all depths), including
Excavation and Backfill
complete in place per CORR 510
for One hundred fifty dollars
and zero cents. 150.00 8400.00
25 280 CY Dry Rock Riprap (18" Thickness)
complete in place per CORR 591
for One hundred fifty dollars
and zero cents. 150.00 42000.00
26 1200 SY Native Seeding for Erosion Control,
Hydraulic Planting
complete in place per CORR 604
for One dollars
and zero cents. 1.00 1200.00
27 100 SY Soil Retention Blanket Class II, Type
C
complete in place per CORR 605
for Ten dollars
and zero cents. 10.00 1000.00
28 31 EA Tree Removal (8"-36" DIA.)
complete in place per CORR 610
for Two thousand dollars
and zero cents. 2000.00 62000.00
29 2 EA Stabilized Construction Entrance
complete in place per CORR 641
for One thousand eight hundred dollars
and zero cents. 1800.00 3600.00
30 580 LF Erosion Control Log (18" Diameter)
complete in place per SS 642
for Eight dollars
00300-9-2015 Page 5 of 9 Bid Form
BASE BID
Bid Approx. Item Description
Item Quantity Unit and Written Unit Price Unit Price Amount
and zero cents. 8.00 4640.00
31 50 LF Removing and Relocating Existing 4
FT Chain Link Fence
complete in place per CORR 702
for Eighty dollars
and zero cents. 80.00 4000.00
32 50 LF Removing and Relocating Wire Fence
complete in place per CORR 702
for Two hundred dollars
and zero cents. 200.00 10000.00
33 260 LF Safety Fencing
complete in place per CORR 703
for Fifteen dollars
and zero cents. 15.00 3900.00
34 1 EA Project Signs
complete in place per CORR 802
for Two thousand dollars
and zero cents. 2000.00 2000.00
General Items
35 1 LS Prepare, Submit, Implement, and
Update Storm Water Pollution
Prevention Plan, Including Inspections
complete in place per TXR 150000
for Five thousand dollars
and zero cents. 5000.00 5000.00
36 1 LS Total Mobilization
complete in place per CORR 700
for Ten thousand dollars
and Zero cents. 10000.00 10000.00
00300-9-2015 Page 6 of 9 Bid Form
BASE BID
Bid Approx. Item Description
Item Quantity Unit and Written Unit Price Unit Price Amount
37 4 MO Barricades, Signs,and Traffic
Handling
complete in place per TxDOT 502
for Seven thousand five hundred dollars
and zero cents. 7500.00 30000.00
TOTAL BASE BID (Items 1 thru 37 $589,759.00
Materials: $195,143.05
All Other Charges: $394,615.95
* Total: $589,759.00
* Note: This total must be the same amount as shown above for "Total Base Bid"
00300-9-2015 Page 7 of 9 Bid Form
The Owner, in its sole discretion,may select any,all,or none of the following alternate items for the corresponding items in
the Base Bid as indicated.The items below correspond to items 7 thru 9 in the base bid.
ADD ALTERNATE BID I
(Substitute sod in lieu of soil retention blanket for Chandler Branch)
Bid Approx. Item Description
Item Quantity Unit and Written Unit Price Unit Price Amount
AA 1-76720 SY Sodding for Erosion Control
complete in place per CORR 602
for Twelve dollars
and aere cents. 12.00 $ 80,640.00-
Native Seeding for Erosion Control,
AAl-8 -6000 SY Hydraulic Planting
complete in place per CORR 604
for One dollars
and zero cents. 1.00 $ -6,000.00 -
Soil Retention Blanket Class II,Type
AAl-9 -6720 SY C
complete in place per CORR 605
for Three dollars
and zero cents. 3.00 $ 20,160D0
TOTAL ADD ALTERNATE BID(Items AA1-7 thru AAI-9): $ 54,480.00
BASE BID $589,759.00
ADD ALTERNATE BID
TOTAL BASE BID PLUS ADD ALTERNATIVE(Items 1 thru AAl-9) $ $644,239.00
Materials: 155,384.47 cJ
All Other Charges: 488,854.53
* Total: 644,239.00
* Note: This total must be the same amount as shown above for"Total Base Bid Plus Add Alternative"
Page 8 of 9
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 bids and may waive any
informalities or technicalities.
Respectfully ubmitted,
Signature
A, , << 3 8'0 0 W , LO D S7-
Print Name Address Tpr-f 1,0 2� -7 7
Ti Telephone
ame of Firm
Date Secretary, if Bidder is a
Corporation
00200-9-2015 Page 9 of 9 Bid Form
00410 STATEMENT OF BIDDER'S SAFETY
EXPERIENCE
Page 1
00410 8-2014 Statement of Bidder's Safety Experience
00090654
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 be answered and data given must be clear and comprehensive. If necessary,
questions may be answered on separate attached sheets.
Company Name: Patin Construction LLC
Address: 3800 W. 2nd Street, Taylor, TX 76574 Phone: 512-269-1071
Completed by: Tim Patin Date: 2-13-2023
1. Does the company have a written construction Safety program? []Yes ❑No
2. Does the company conduct construction safety inspections? []Yes ❑No
3. Does the company have an active construction safety-training program? []Yes ❑No
4. Has the company been fined by OSHA for any willful safety violations in the past []Yes []No
three years?
5. Does the company have a lost time injury rate of 7.8 for SIC 15, or 7.6 for SIC 16, ❑Yes 11 No
or less over the past three years?
Attach the company's OSHA 200/300 logs for the past three years.
6. Does the company or affected subcontractors have competent persons in the
following Areas?
A. Scaffolding ❑Yes ❑No 0 N/A
B. Excavation []Yes ❑No ❑N/A
C. Cranes ❑Yes ❑No 0 N/A
D. Electrical ❑Yes ❑No E N/A
E. Fall Protection []Yes ❑No ❑N/A
F. Confined Spaces []Yes ❑No ❑N/A
I hereby certify that the a ve informatio s true and correct.
Signature w Title 6�� �
Page 1
00410 8-2014 Statement of Bidder's Safety Experience
00090654
OSHA's Form 300A (Rev.01/2004) Year 2021 <0.,>
Summary of Work-Related Injuries and Illnesses U.S.Department ofLabor
Occupational Sorely and Health Adm lnisrration
�� upuvnU OMB,w �'Ib-o1/e
All establishments covered by Part 1904 must complete this Summary page,even it no in/uries or
illnesses occurred durino the year. Remember to review the Loa to verity that the entries are complete
Using the Log,count the individual entries you made for each category. Then write the totals below, Establishment information
making sure you've added the entries from every page of the log. If you had no cases write T"
Employees former employees,and thew representatives have the right to review the OSHA Form 300 in Your establishment name Patin Construction,LLC.
its entirety. They also have limited access to the OSHA Form 301 or its equivalent. See 29 CFR
1904,35,in OSHA's Recordkeepirg rule,for further details on the access provisions for these forms. Street 3800 W.2nd Street
Number of Cases City Taylor Slate Texas zip 76574_
Industry description(e.g.,Manufacture of motor truck trailers)
Total number of Total number of Total number of cases Total number of Construction
deaths cases with days with job transfer or other recordable
awav from work restriction Cases Standard Irldustrial Glimipificatio S C),if known(e.g.,SIC 3715)
0 1 0 0
(Ci) (H) (1) (.1) OR North American Industrial Classification(VC f known te.g..336212)
v v, m•.,... � �
Employment information
Total number of Total number of days of
days away from job transfer or restriction Annual average number of employees 146
Total hours worked by all employees last
113 0 year 5,279.16
(K) (L)
Sign here t�
Total number of... Knowingly falsifying this document nli result in a fine.
(M)
(1) Iniury 1 (4) Poisoninq 0
(2) Skin Disorder 0 (5) Hearinq 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 (6)All Other Illnesses 0
Tim Patin President
Company executive Title
512-269-1071 1m2022
Post this Summary page from February 1 to April 30 of the year following the year covered by the form Phone Date
FubllC reporting burden for this collection of information is estimated to average 58 minutes per response,including time to renew the instruction,search and
gather the data needed,and complete and review the collection of information.Persons are not required to respond to the collection of information unless it
displays a currently valid OMB control number.It you have any comments about these estimates or any aspects of this data collection.contact US Department
of I ahor OSHA Offi-of Stati.0,Rmm N-16dd 2f10 ConstiliAim Ave NW Washimtm nC x210 no-1 send the rxxmnl«tot Inrms In Ihic ntfir,
OSHA's Form 300A (Rev.01/2004) Year 2020 410>
Summary of Work-Related Injuries and Illnesses U.S ..dmentofLabor
Oocupaaonal eahtyty and Haakh Admin6tratlon
Form approved OMB no.1218-0176
All establishments covered by Part 1904 must complete this Summary page,even If no injuries or
illnesses occurred during the year. Remember to review the Log to verify that the entries are complete
Using the Log,count the Individual entries you made for each category. Then write the totals below, Establishment Information
making sure you've added the entries from every page of the log. If 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 Patin Construction,LLC.
its entirety. They also have limited access to the OSHA Form 301 or its equivalent. See 29 CFR
1904.35,in OSHA's Recordkeepi g rule,for hither details on the access provisions for these forms. Street 3800 W.2nd Street
City Taylor State Texas Zip 76574
Industry description(e.g.,Manufacture of motor truck trailers)
Total number of Total number of Total number of cases Total number of Construction
deaths cases with days with job transfer or other recordable
away from work restriction cases Standard Industrial Classification(SIC),it known(e.g.,SIC 3715)
0 0 1 0
(G) (H) (I) (J) OR North American Industrial Classification(NAICS),If known(e.g.,336212)
1 7 7 1 0 0
Employment information
Total number of Total number of days of
days away from job transfer or restriction Annual average number of employees 45
-A,
Total hours worked by all employees last
0 16 year 43 255.57
(K) (L)
Sign here
Total number of... Knowingly falsifying this document may re ult In a fine.
(M)
(1) Injury 1 (4) Poisoninq 0
(2) Skin Disorder 0 (5) Heahnq Loss 0
(3) Respiratory I certify that I have examined this document and that to the best of my knowledge the entries are true,accurate,and
complete.
Condition
0 (6)All Other Illnesses 0
John P.Cannon,CSHO SSH Safety Director
Company executive Title
214-287-8131 1/812021
Post this Summary page from February 1 to April 30 of the year following the year covered by the form Phone Date
Public reporting burden for this collection of information is estimated to average 58 minutes per response,including time to review the Instruction,search and
gather the data needed,and oomplele and review the collection of Information.Persons are not required to respond to the collecllon of information unless It
displays a currently valid OMB control number.If you have any comments about these estimates or any aspects of this data collection,contact:US Department
of Labor.OSHA Office of Statistics.Room N-3644.200 Constitution Ave.NW.Washinalon.DC 20210.Do not send the oomoleled forms to this office.
l
Attention: Th. Attention: This form contains information relating
to employee he- to employee health and must be used in a manner
r,.m 300 (Rev. ov2oo � That protecVdhe ; ` that protecyttconfidentiality of employees to the Year 2020
�r�ent ossible w' extent possible while the information is being used
irk-Re latee�l n j u ri 16`nd Illnesses for occloa�bnPWety and health purposes. U.S. Departmen
�^ et, Occupational Sat Occupational Safety and He
:n�.:s_21.L.i..-.s''.1.._i.:..��_
it every work-related injury or illness that involves loss of consciousness,restricted work activity or ,job transfer,days away from work,or medical treatment Form approved
;cord significant work-related injuries and illnesses that are diagnosed by a physician or licensed health care professional. You must also record work-related
iy of the specific recording criteria listed in 22 CFR 1904.8 through 1904.12. Feel free to use two lines for a single case if you need to. You must complete an Establishment name Patin Construction, L
JSHA Form 301)or equivalent form for each-injury or illness recorded on this form. If you're not sure whether a case is recordable,-call your local OSHA
City Taylor State
)n Describe the case - Classilfy fhe case
_ .. -... _. .. ..__. - _.•.:b_�.,n _....._.�..__ _, ...._...:..._....�.e
t
Enter the number of
(C) (D) (E) (F) CHECK ONLY ONE box for each case based on days the injured or ill Check the"injury"COIL
me 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: ill
Welder) injury or Loading dock north end) and object/substance that directly injured or made
onset of person ill(e.g.Second degree bums on right (M)
F,
illness forearm from acetylene torch) R Days away Away On job a)
(mo./day) Deathrn Remained at work transfer or
om work
`WfJ From restriction N m .o
Job transfer Other record- Work (days) `d`0
C
or restriction able cases (days)
cY of U
(G) (H) (1) (J) (K) (L) (1) (2) (3)
Labor 5/4 Huto Texas Sprain to left ankle X 0 16 X
Page totals 0 0 1 1 0 0 16 1 0 0
Be sure to transfer these totals to the Summary page (Form 300A) before you post it. o.o
O P O
ection of information is estimated to average 14 minutes per response,including time i5 n 0
d gather the data needed,and complete and review the collection of information. c
Y Of
d to the collection of information unless it displays a currently valid OMB control U)
s about these estimates or any aspects of this data collection,contact: US
of Statistics,Room N-3644,200 Constitution Ave,NW,Washington,DC 20210. Do
is office. Page 1 of 1 (1) (2) (3)
Attention: This form contains information relating to
OSH A's Form 301 employee health and must be used in a manner that
protects the confidentiality of employees to the extent
Injuries and Illnesses Incident Report possible while the information is being used for U.S.Department of Labor
occupational safety and health purposes. Occupational Safety and Health Administration
Form approved OMB no.1218-0176
Information about the employee Information about the case
1) Full Name Juan Garcia 10) Case number from the Log 1 (Transfer the case number from the Log after you record the case.)
This Injury and Illness Incident Report is one of the 2) Street 1815 Navisota St 11) Date of injury or illness 5/4/2020
first forms you must fill out when a recordable work-
related injury or illness has occurred. Together with City Manor State TX Zip 76567 12) Time employee began work 7:00 AM AM
the Log of Work-Related injuries and Illnesses and
the accompanying Summary,these forms help the 3) Date of birth 8/26/1980 13� Time of event 1:30 PM PM pCheck if time cannot be determined
employer and OSHA develop a picture of the extent I"�af.w ti„r; i,,iai wf«mrw„M)WdX;testo.r„k:r(.Irmr;WIr,fi.r w.""rnel a
and severity of work-related incidents. �wnb.rs,ur88flsllntlwtallowkrpflew. ___ _ _ "y "
Within 7 calendar days after you receive 4) Date hired 11/5/2019 '141J'What was the employee doing just before the incident occurred? Describe the activity,as well
information that a recordable work-related injury or as the tools,equipment or material the employee was using. Be specific. Examples: "climbing a
illness has occurred,you must fill out this form or an 5) XQMaIe ladder while carrying roofing materials";"spraying chlorine from hand sprayer";"daily computer key-
equivalent. Some state workers'compensation, Female entry."
insurance,or other reports may be acceptable Walking the jobsite to get pipe
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. L16J'What happened?Tell us how the injury occurred.Examples:"When ladder slipped on wet Floor,
According to Public Law 91-596 and 29 CFR 6) Name of physician or other health care professional worker fell 20 feet";"Worker was sprayed with chlorine when gasket broke during replacement";
1904,OSHA's recordkeeping rule,you must keep Jihyun You,PA "Worker developed soreness in wrist over time."
this form on file for 5 years following the year to Whem employee was walking he stepped on a dirt clos ans rolled his ankle
which it pertains
If you need additional copies of this form,you 7) If treatment was given away from the worksite,where was it given?
may photocopy and use as many as you need.
Facility Fast Mad Urgent Care "�8};What was the injury or Illness?Tell us the part of the body that was affected and how it was
affected. Examples:"strained back";"chemical bum,hand";"carpal tunnel syndrome."
Street 14008 Shadow Glenn
spdn to left ankel
City Manor State TX Zip 76567
8) Was employee treated in an emergency room?
Completed by Eddie Hill Yes •17j What object or substance directly harmed the employee? Examples:"concrete Floor";
X]No chlorine";'radial arm saw."If this question does not apply to the incident,leave it blank.
Title Safety Manager dirt clod
9) Was employee hospitalized ovemight as an in-patient?
Phone 512-269-1071 Date 5/4/2020 ❑Yes
X]No 18) If the employee died,when did death occur? Date of death
Public reporting burden for this collection 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 reviewing the collection of Information. Persons are not
required to respond to the collection 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: US Department of Labor,OSHA Office of
Statistics,Room N-3644,200 Constitution Ave,NW,Washington,DC 20210. Do not send the completed forms to this office.
Attention:This form contains information relating to
OSHA's Form 300 (Rev.Ol!2004) employee health and must be used in a manner that
protects the confidentiality of employees to the extent Year 20
Log of Work-Related Injuries and Illnesses possible while the information is being used for tm
pa ent of Labor
occupational safety and health purposes. De
Occupationalnsi 5 Safety and MaakA Administration
_cold inlermat+Cr abCUr eiary ry reaaiated death ano abct.r every scrR-reiated injury or ii!ness that inveives less c+.,osr "ess,ras•:.,, worn act.!ry crico nanstec r..nx,ppr...d.r?I a I:• 1 t 1..+.1 a;
Car -A,cr medlcai area 2n.beyerV irrsr aid ycl.must asc record srgnificant]vcnt'reiatad wpiles and idrlesses tret are ciagncsed by a physician or;ir.ensec heairh ,/n/
..are 0: szrei'rcu rrust aisc record.vcr -relarea irliwes and illresses that meet ary cl the specific raccrding cntena risfed in 29 CFR Farr 1904.31hrcugh 1904,12.Feei iree rc esrdnr„-,,,e r,Ian•`r /l
se tac tines ar a singe case it ycu need tc.''ou must ecmp/ete an injury oral liiness Incident,Repays!OSHA Fcrm 301;or ecurieient tcrm ict aeon my ry cr iw ess recorded cn th s Qi 4
:crm.I,'you re not sure wnether a case is rexrdable.cal your kcal OSHA office lot neip. /,�,
Identify the person
r: �i�
Classify the case
(A) A (C) (D) (E) CHECK ONLY ONE box for each(F) based Enter the number of
Case F.]nployee s name job titlethe r"ost serious days the injured or Check the"btJ>W cohatat or
J Date of injury Where the event occurred Describe injury or illness,pans of body affected, ill worker was: choose one type of Nlness/
no. I,•.�.IGbL'r r or onset Irk L...ulwq dwk norllr end r and objecuaubatance that directly injured
of illness or made persuo ill 5rr."I..I de•nr.:Iaurn.;II Remalned at Work (M) _
Away On job = 3 s e
r+,l+t�i•r.'unnln.m•r,<ISI.vMl.d,ll! .._
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Death tram work or rasbiadon able awa work restriction A
(a) (H) (1) (J) (K) (L) (1) (2) (3) (4) (5) (6)
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don
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page totals> -2 Q Q A � (� v /)
P.dax rgxrc:ing lum.:6r au...dk.e.n�••i n:D.rnu:n.tw e.:una:ul n cn¢e 1 1 nueu:e.goys naxn:.e,u:J,ulus:une:n reak.• 2a S:.re ru L2rsiel C'E52 FJrdls'J sine S�rryraty;.eCc.F)m:...GG..!cercre yd'FJSi:r C _ _v _
:L.I... xa•x:..aeant:a:d�aoLer:l:e,L:a coed.d.a:d,ungrk:ern:dre.kxac...Ue.:xn:..i irfi.rmaa.n:.Rr.•n:.are tam rapnred _ - - k
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OSHA's Form 300A (Rey 01/20041 Year 20L 9_0
Summary of Work-Related Injuries and Illnesses U.S.Department of Labor
occ�oano..r saber rrrw ff.arrb ad...:..:.r..r:
r„ru a1q......l.mta u•,.1218-017h
All establishments covered by Parr 1904 must complete this Summary page,even it no work related injuries or illnesses or:cuned during the year Remember to review the Log
to verity that the entries are complete and accurate before completing this summary.
Usingthe Log,count the individual entries you made for each category,Then write the totals below,making sure u've added the entries from ere of the I!you Establishment information
w Y gory. rg you every Page Log. Y / - ' lil�`r
had rw cases,write'0.'
Employees,former employees,and their representatives have the right to review the OSHA Form 300 in its entirety.They also have limited access to the OSHA Form 301 or YO ratabn.,hmcu. „roe "I J*I
its equivalent See 29 CFR Part 1904.35.in OSHA recordkeepirg rule,for hirther details an the access provisions for these forms. 3SO p u) ,RL � �/Street
City 7iwlt9lr state TX z)p�T
Number of Cases
Total number of Total number of Total number of Total number of Industry description uuf am o nnrortrurk tmikn)
deaths cases with days cases withjob other recordable (e.gM�
away from work transfer or restriction cases Standard Industrial Classification(SIC),iflmown(eg.,r l5)
(G) (H) (1) O OR
North American Industrial Classification(NAICS),if known(e{t.•336212)
Number of Days
Total number of days away Total number of days of job Employment information(11 Wu&,n't I—dreae f g.-.;ee if.
[I b&ld t-if.re bmk ofilus pag,meaim.ua)
from work transfer or restriction
0
& Annual a—raRr number of cmploym _ _Z _p'
(K) (L) Total hours�orked by au employee last year 8S
Injury and illness Types Sign here
Total number of... Knowingly falsifying this document may result in a fine.
)
(1)Injuries (4)Poisonings
I certify the[I Inument and that to the best o[my
(5)Hearin
g loss es a true,accurate, d complete.
(2)Skin disorders Q (6)All other illnesses �� e Cc�X
(3)Respiratory conditions
vRaYUve
oZ a /-
Post this Summary page from February t to April 30 of the year following the year covered by the form. �<
f.Jdi•rcp..rtniµ In-I.,fi—fi.,-0..nu.of mfurtnan,m..v canuu.cd u.avv raµc iU rmm�re.. uu l hug rlua n.review.he numuran.a,acarvh anA k,,h nc'dare ncc.k<h and
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Waahiuµru.,DI:.:Mr!111.6,n.e acrid.hc nanlJa.nl fbn....n•d�ia nRrc.
City of Round Rock, Texas Contract Forms
Standard Form of Agreement: Section 00500
City of Round Rock, Texas
Standard Form of Agreement between
Owner and Contractor
AGREEMENT made as of the 0 —(` J day of AX=it J LWIE in the year 20 23 .
BETWEEN the Owner: City of Round Rock,Texas(hereafter"Owner"or"City")
221 East Main Street
Round Rock,Texas 78664
and the Contractor Patin Construcion LLC ("Contractor")
3800 W.2nd Street
Taylor,TX 76574
The Project is described as: Chandler Branch and Dry Branch Channel Maintenance
Improvements
The Engineer is: Will Huff,P.E.,CFM
10431 Morado Circle,Building 5,Suite 300
Austin,Texas 78759
For and in consideration of the mutual terns, conditions and covenants of this Agreement and all
accompanying documents between Owner and Contractor, the receipt and sufficiency of which are hereby
acknowledged,Owner and Contractor agree as follows:
ARTICLE I THE CONTRACT DOCUMENTS
The Contract Documents consist of this Agreement,Conditions of the Contract(General,Supplementary and
other Conditions), Drawings, Specifications,Addenda issued prior to execution of this Agreement, other documents
listed in this Agreement and Modifications issued after execution of this Agreement;these form the Contract,and are
as fully a part of the Contract as if attached to this Agreement or repeated herein. The Contract represents the entire
and integrated agreement between the parties hereto and supersedes prior negotiations,representations or agreements,
either written or oral.An enumeration of the Contract Documents,other than Modifications,appears in Article 7.
ARTICLE 2 THE WORK OF THIS CONTRACT
Contractor shall fully execute the Work described in the Contract Documents,except to the extent specifically
indicated in the Contract Documents to be the responsibility of others.
00500 4-2020 Page 1 of 5 Standard Form of Agreement
00443647
ARTICLE 3 DATE OF COMMENCEMENT;DATE OF SUBSTANTIAL COMPLETION; DATE OF
FINAL COMPLETION
3.1 The date of commencement of the Work shall be the date of this Agreement unless a different date is stated
below or provision is made for the date to be fixed in a Notice to Proceed issued by Owner.
3.2 The Contract Time shall be measured from the date delineated in the Notice to Proceed.
3.3 Contractor shall commence Work within ten ( 10 ) calendar days
from the date delineated in the Notice to Proceed.
3.4 Contractor shall achieve Substantial Completion of the items of Work listed on Attachment A to this
Agreement no later than N/A N( /A )calendar days from issuance by Owner of Notice to Proceed,
and Contractor shall achieve Substantial Completion of the entire Work no later than
ninety 90 )calendar days from issuance by Owner of Notice to Proceed, subject to
adjustments of this Contract Time as provided in the Contract Documents.
3.5 If Contractor fails to achieve Substantial Completion of the Work(or any portion thereof)on or before the
date(s)specified for Substantial Completion in the Agreement,Contractor shall pay to Owner,as liquidated damages,
the sum of one thousand and No/100
Dollars($ 1000 ) 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 of the Work(or any portion thereof)on or before the date(s)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(or any portion thereof)is not achieved on or before thirty(30)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 of the Work(or any portion thereof)in the Agreement shall be subject to adjustment as provided in the
Contract Documents.
3.6 Contractor shall achieve Final Completion of the entire Work no later than one hundred twenty
1( 20 )calendar days from issuance by Owner of Notice to Proceed.
ARTICLE 4 CONTRACT SUM
4.1 Owner shall pay Contractor the Contract Sum in current funds for Contractor's full and complete performance
of the Work and all of Contractor's obligations under this Agreement. The Contract Sum shall be
Six hundred forty four thousand two hundred thirty nine dollars and zero cents
($ 644,239.00 ),subject to additions and deductions as provided in the Contract Documents.
4.2 Does the Contract Sum include alternates which are described in the Bid Form?
No . Yes X .If yes,please provide details below:
Soddinc for Erosion Control
00500 4-2020 Page 2 of 5 Standard Form of Agreement
00443647
ARTICLE 5 PAYMENTS
5.1 PROGRESS PAYMENTS
5.1.1 Based upon Applications for Payment submitted to Engineer and Owner by Contractor,and Certificates for
Payment issued by Engineer and not disputed by Owner and/or Owner's lender,Owner shall make progress payments
on account of the Contract Sum to Contractor as provided below, in Article 14 of the 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 (1 Oth) day of a month, Owner shall make 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 made 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 of values shall allocate the entire Contract Sum among the
various portions of the Work. The schedule of values shall be prepared in such form and supported by such data to
substantiate its accuracy as Engineer and Owner may require.This schedule,unless objected to by Engineer or Owner,
shall be used as a basis for reviewing Contractor's Applications for Payment.
5.1.5 Applications for Payment shall warrant the percentage of completion of each portion of the Work as of the
end of the period covered by the Application for Payment.
5.1.6 Subject to other provisions of the Contract Documents, the amount of each progress payment shall be
computed as provided in Article 14 of the General Conditions.
5.1.7 Except with Owner's prior written approval, Contractor shall not make advance payments to suppliers for
materials or equipment which have not been delivered and stored at the site.
5.2 FINAL PAYMENT
5.2.1 Final payment, constituting the entire unpaid balance of the Contract Sum, shall be made by Owner to
Contractor when:
.1 Contractor has fully performed the Contract except for Contractor's responsibility to correct Work,
and to satisfy other requirements,if any,which extend beyond final payment;and
.2 a final Certificate for Payment has been issued by Engineer and approved by the Owner.
5.2.2 Owner's final payment to Contractor shall be made no later than thirty (30) days after the issuance of
Engineer's final Certificate for Payment. In no event shall final payment be required to be made prior to thirty(30)
days after all Work on the Contract has been fully performed. Defects in the Work discovered prior to final payment
shall be treated as non-conforming Work and shall be corrected by Contractor prior to final payment,and shall not be
treated as warranty items.
ARTICLE 6 TERMINATION OR SUSPENSION
6.1 The Contract may be terminated by Owner or Contractor as provided in Article 15 of the General Conditions.
00500 4-2020 Page 3 of 5 Standard Form of Agreement
00443647
6.2 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 after execution of this Agreement,are enumerated
as follows:
7.1.1 The Agreement is this executed version of the City of Round Rock, Texas Standard Form of Agreement
between Owner and Contractor,as modified.
7.1.2 The General Conditions are the "City of Round Rock Contract Forms 00700," General Conditions, as
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 The 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 required clauses are those contained in the "City of Round Rock Contract Forms
03000,"Federally Required Contract Clauses,as modified.
7.1.9 Other documents,if any,forming part of the Contract Documents are as follows:
WA
ARTICLE 8 MISCELLANEOUS PROVISIONS
8.1 Where reference is made in this Agreement to a provision of any document, the reference refers to that
provision as amended or supplemented by other provisions of the Contract Documents.
8.2 Owner's representative is: Noemi Avila
Engineering Associate
3400 Sunrise Rd.
Round Rock,TX 78665
8.3 Contractor's representative is: Johnny Hill
Patin Construction
3800 W.2nd Street
Taylor,TX 76574
8.4 Neither 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 Form of Agreement
00443647
8.5 Waiver of any breach of this Agreement shall not constitute waiver of any subsequent breach.
8.6 Owner agrees to pay Contractor from available funds for satisfactory performance of this Agreement in
accordance with the bid or proposal submitted therefor,subject to proper additions and deductions,all as provided in
the General Conditions, Supplemental Conditions, and Special Conditions of this Agreement, and Owner agrees to
make payments on account thereof as provided therein. Lack of funds shall render this Agreement null and void to
the extent funds are not available. This Agreement is a commitment of City of Round Rock's current revenues only.
8.7 Although this Agreement is drawn by Owner,both parties hereto expressly agree and assert that,in the event
of any dispute over its meaning or application,this Agreement shall be interpreted reasonably and fairly, and neither
more strongly for nor against either party.
8.8 This Agreement shall be enforceable in Round Rock,Texas, and if legal action is necessary by either party
with respect to the enforcement of any or all of the terms or conditions herein, exclusive venue for same shall 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.
8.9 Both parties hereby expressly agree that no claims or disputes between the parties arising out of or relating
to this Agreement or a breach thereof shall be decided by an arbitration proceeding,including without limitation,any
proceeding under the Federal Arbitration Act(9 USC Section 1-14)or any applicable state arbitration statute.
8.10 The parties, by execution of this Agreement, bind themselves, their heirs, successors, assigns, and legal
representatives for the full and faithful performance of the terms and provisions hereof.
This Agreement is entered into as of the day and year first written above and is executed in at least two(2)
original copies,of which one is to be delivered to Owner.
OWNER C CTOR
CITY7 ROUND RO K,TEXAS c2 ( 1 •�
Printed ame: Printed Name: Tim Pati
Title I Y,AYO-9. Title: President
Date Signed: Date Signed: 4-12-2023
ATTEST:
City Clerk
FOR CIITTY,,APPROVED AS TO FORM:
—•mo y-City�tto ey
00500 4-2020 Page 5 of 5 Standard Form of Agreement
00443647
BOND NO.:HSHNSU0836153
PAYMENT BOND
THE STATE OF TEXAS §
§ KNOW ALL MEN BY THESE PRESENTS:
COUNTY OF WILLIAMSON §
That Patin Construction, LLC , of the City of Taylor
County of Williamson , and State of Texas , as Principal, and
Harco National Insurance Company authorized under the laws of the State of Texas to act
as Surety on Bonds for Principals,are held and firmly bound unto the CITY OF ROUND ROCK,
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 sum of
Six Hundred Forty Four Thousand Two Hundred Thirty Nine Dollars and No Cents
Dollars($ 644,239.00 )for the payment whereof,well and truly 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 Principal has entered into a certain written Agreement with the Owner,dated the
$*1& day of J"e , 2023 to which Agreement is hereby referred to
and made a part hereof as fully and to the same extent as if copied at length herein consisting of:
Chandler Branch and Dry Branch Channel Maintenance Improvements
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 Bond
00437699
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 on 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 Surety have signed and sealed this Instrument
this I Ith day of April , 2023 .
Patin Construction, LLC Harco National Insurance Company
Princi Surety
Kenneth Nitsche
Printed Name Printed Name ,
By. By:
Title: Title: Attorney-In-Fact
Address: 3900 West 2nd St. Address: One-Newark Center, 20th Floor
Taylor, TX 76574 Newark,NJ 07102
Resident Agent of Surety:
Signature
Kenneth Nitsche
Printed Name
143 E. Austin
Street Address
Giddings, TX 78942
City, State & Zip Code
Page 2
00620 1-2020 Payment Bond
00090656
BOND NO.:HSHNSU0836153
PERFORMANCE BOND
THE STATE OF TEXAS §
§ KNOW ALL BY THESE PRESENTS:
COUNTY OF WILLIAMSON §
That Patin Construction, LLC , of the City of Taylor ,
County of Williamson , and State of Texas , as Principal, and
Harco National Insurance Company authorized under the law 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), in the penal sum of Six Hundred Forty Four Thousand Two Hundred Thirty Nine Dollars and No Cents
Dollars ($ 644,239.00 ) 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 Principal has entered into a certain written Agreement with the Owner dated the
S day of ,20 to which the Agreement is hereby referred to
and made a part hereof as fully and to the same extent as if copied at length herein consisting of:
Chandler Branch and Dry Branch Channel Maintenance Improvements
NOW, THEREFORE, THE CONDITIONS OF THIS OBLIGATION IS SUCH, that if the said
Principal shall faithfully perform said Agreement and shall, in all respects, duly and faithfully
observe and perform 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 workmanship of,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;
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
00610 4-2020 Performance Bond
00443639
PERFORMANCE 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 of Principal with a contractor acceptable to Owner 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 result
of Principal's failure to perform its duties and obligations under the Agreement up to the
sum 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 I Ith day of April , 20 23.
Patin Construction, LLC Harco National Insurance Company
Princi al � � Surety
%-� �T�.i► Kenneth Nitsche
Printed Name Printed Name `
B 1 A By:
�` ~
Title: Title: Attorney-In-Fact
Address: 3860 West 2nd St., Address: One Newark Center,20th Floor
Taylor, TX 76574 Newark,NJ 07102
Resident Agent of Surety:
Signature
Kenneth Nitsche
Printed Name
143 E. Austin
Street Address
Giddings,TX 78942
City, State & Zip Code
Page 2
00610 4-2020 Performance Bond
00443639
POWER OF ATTORNEY Bond# HSHNSU0836153
HARCO NATIONAL INSURANCE COMPANY
INTERNATIONAL FIDELITY INSURANCE COMPANY
Member companies of IAT Insurance Group, Headquartered: 702 Oberlin Road, Raleigh, North Carolina 27605
KNOW ALL MEN BY THESE PRESENTS:That HARCO NATIONAL INSURANCE COMPANY,a corporation organized and existing under the laws of
the State of Illinois,and INTERNATIONAL FIDELITY INSURANCE COMPANY,a corporation organized and existing under the laws of the State of New
Jersey,and having their principal offices located respectively in the cities of Rolling Meadows, Illinois and Newark,New Jersey,do hereby constitute and
appoint
GARY A. NITSCHE, VIOLET J. FROSCH, NINA K. SMITH, KENNETH NITSCHE, ROBERT K. NITSCHE, CRAIG T.
PARKER, ROBERT JAMES NITSCHE
Giddings, TX
their true and lawful attorney(s)-in-fact to execute, seal and deliver for and on its behalf as surety, any and all bonds and undertakings, contracts of
indemnity and other writings obligatory in the nature thereof,which are or may be allowed, required or permitted by law, statute, rule, regulation, contract
or otherwise, and the execution of such instrument(s) in pursuance of these presents, shall be as binding upon the said HARCO NATIONAL
INSURANCE COMPANY and INTERNATIONAL FIDELITY INSURANCE COMPANY, as fully and amply,to all intents and purposes, as if the same had
been duly executed and acknowledged by their regularly elected officers at their principal offices.
This Power of Attorney is executed,and may be revoked,pursuant to and by authority of the By-Laws of HARCO NATIONAL INSURANCE COMPANY
and INTERNATIONAL FIDELITY INSURANCE COMPANY and is granted under and by authority of the following resolution adopted by the Board of
Directors of INTERNATIONAL FIDELITY INSURANCE COMPANY at a meeting duly held on the 13th day of December,2018 and by the Board of
Directors of HARCO NATIONAL INSURANCE COMPANY at a meeting held on the 13th day of December,2018.
"RESOLVED, that (1) the Chief Executive Officer, President, Executive Vice President, Senior Vice President, Vice President, or Secretary of the
Corporation shall have the power to appoint,and to revoke the appointments of,Attorneys-in-Fact or agents with power and authority as defined or limited
in their respective powers of attorney, and to execute on behalf of the Corporation and affix the Corporation's seal thereto, bonds, undertakings,
recognizances, contracts of indemnity and other written obligations in the nature thereof or related thereto, and (2) any such Officers of the Corporation
may appoint and revoke the appointments of joint-control custodians, agents for acceptance of process, and Attorneys-in-fact with authority to execute
waivers and consents on behalf of the Corporation;and(3)the signature of any such Officer of the Corporation and the Corporation's seal may be affixed
by facsimile to any power of attorney or certification given for the execution of any bond, undertaking, recognizance,contract of indemnity or other written
obligation in the nature thereof or related thereto, such signature and seals when so used whether heretofore or hereafter, being hereby adopted by the
Corporation as the original signature of such officer and the original seal of the Corporation,to be valid and binding upon the Corporation with the same
force and effect as though manually affixed."
IN WITNESS WHEREOF, HARCO NATIONAL INSURANCE COMPANY and INTERNATIONAL
FIDELITY INSURANCE COMPANY have each executed and attested these presents
on this 31 st day of December,2018
rtltTy
4V0 lj�p STATE OF NEW JERSEY STATE OF ILLINOIS ;NQt'4pP044 A 't�,�
�r vpM��gA County of Essex — County of Cook ; Q. SEAL Q a2 SEAL r" Z
0.
JE a� Kenneth Chapman
Executive Vice President, Harco National Insurance Company ...
and International Fidelity Insurance Company
On this 31 st day of December,2018 before me came the individual who executed the preceding instrument,to me personally known,and,
being by me duly sworn,said he is the therein described and authorized officer of HARCO NATIONAL INSURANCE COMPANY and
INTERNATIONAL FIDELITY INSURANCE COMPANY;that the seals affixed to said instrument are the Corporate Seals of said Companies;that the
said Corporate Seals and his signature were duly affixed by order of the Boards of Directors of said Companies.
A �' IN TESTIMONY WHEREOF, I have hereunto set my hand affixed my Official Seal,at the City of Newark,
Q�t...• fYP Gp . New Jersey the day and year first above written.
or
y:u°�OTAgroao
_
tiF soo re`'�
W JERS��.�� Shirelle A.Outley a Notary Public of New Jersey
My Commission Expires April 4,2023
CERTIFICATION
I,the undersigned officer of HARCO NATIONAL INSURANCE COMPANY and INTERNATIONAL FIDELITY INSURANCE COMPANY do hereby certify
that I have compared the foregoing copy of the Power of Attorney and affidavit,and the copy of the Sections of the By-Laws of said Companies as set
forth in said Power of Attorney,with the originals on file in the home office of said companies,and that the same are correct transcripts thereof,and of the
whole of the said originals, and that the said Power of Attorney has not been revoked and is now in full force and effect.
IN TESTIMONY WHEREOF, I have hereunto set my hand on this day, April 11,2023
�4A00134 a —
Irene Martins,Assistant Secretary
IMPORTANT NOTICE AVISO IMPORTANTE
To obtain information or make a complaint: Para obtener informacion o para presentar una queja:
You may contact Harco National Insurance Company Usted puede comunicarse con su Harco National
at: Insurance Company al:
1-800-333-4167 1-800-333-4167
You may also write to: Harco National Insurance Usted tambien puede escribir a Harco National
Company c/o IAT Surety at: Insurance Company c/o IAT Surety at:
Attn: Claims Department Attn: Claims Department
One Newark Center,20te Floor One Newark Center,20te Floor
Newark,NJ 07102 Newark,NJ 07102
You may contact the Texas Department of Insurance Puede comunicarse con el Departamento de Seguros de
to obtain information on companies,coverages,rights Texas para obtener informacion acerca de companias,
or complaints at: coberturas,derechos o quejas al:
1-800-252-3439 1-800-252-3439
You may write the Texas Department of Insurance: Puede escribir al Departamento de Seguros de Texas:
P. O.Box 149104 P.O.Box 149104
Austin,TX 78714-9104 Austin,TX 78714-9104
Fax: (512)490-1007 Fax: (512)490-1007
Web: www.tdi.texas.eov Web: www.tdi.texas.eov
E-mail: ConsumerProtection(aDtdi.texas.tov E-mail: ConsumerProtection(&tdi.texas.2ov
PREMIUM OR CLAIM DISPUTES: DISPUTAS SOBRE PRIMAS O RECLAMOS:
Should you have a dispute concerning your premium Si tiene una disputa concerniente a su prima o a un
or about a claim you should contact the agent or the reclamo,debe comunicarse con el agente o la compania
company first. If the dispute is not resolved,you may primero. Si no se resuelve la disputa,puede entonces
contact the Texas Department of Insurance. comunicarse con el departamento(TDI).
ATTACH THIS NOTICE TO YOUR BOND: UNA ESTE AVISO A SU FIANZA DE GARANTIA:
This notice is for information only and does not Este aviso es solo para proposito de informacion y no
become a part or condition of the attached document. se convierte en parte o condicion del documento
adjunto.
CERTIFICATE OF LIABILITY INSURANCE Date: 4-10-2023
TDI number required.Please refer to the
PRODUCER: Texas Dept of Insurance website: http://www.tdi.state.tx.us/
The Nitsche Group
143 East Austin
Giddings,Texas 78942 COMPANIES AFFORDING COVERAGE TDI
Phone: E-mail:
A LM Insurance Corporation 33600
INSURED: B Liberty Insurance 42404
Patin Construction,LLC
3800 W.2nd St. C Texas Mutual Insurance Company 22945
Taylor,Tx 76574
Phone: E-mail: D First Liberty Insurance Corporation 33588
THIS IS TO CERTIFY THAT the Insured named above is insured by the Companies listed above with respect to the business operations
hereinafter described, for the types of insurance and in accordance with the provisions of the standard policies used by the companies,
and further hereinafter described. Exceptions to the policies are noted below.
CO TYPE OF POLICY EFFECTIVE EXPIRATION LIMITS
LTR INSURANCE NUMBER DATE DATE
GENERAL LIABILITY GENERAL AGGREGATE $ 2,000,000
A
T85Z91475227012 10/25/2022 10/25/2023 PRODUCTS-COMP/OP AGG. $ 2,000,000
PERSONAL&ADV. INJURY $ 1,000,000
EACH OCCURRENCE $ 1,000,000
FIRE DAMAGE(Any one fire) $ 500,000
MED.EXPENSE(Any one person) $ 10,000
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000
D AS6Z91475227032 10/25/2022 10/25/2023 BODILY INJURY(Per person) $
BODILY INJURY(Per accident) $
PROPERTY DAMAGE $
EXCESS LIABILITY EACH OCCURRENCE $ 5,000,000
B TH7Z91475227032 10/25/2022 10/25/2023 AGGREGATE $ 5,000,000
WORKERS'COMPENSATION STATUTORY LIMITS $
AND EMPLOYERS'LIABILITY EACH ACCIDENT $ 1,000,000
C 0001212733 06/03/2022 06/03/2023 DISEASE-POLICY LIMIT $ 1,000,000
DISEASE-EACH EMPLOYEE $ 1,000,000
PROFESSIONAL LIABILITY
BUILDERS' RISK INSURANCE
OR INSTALLATION INSURANCE
DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/SPECIAL ITEMWEXCEPTIONS
The City of Round Rock is named as additional insured with respect to all policies except 'Workers' Compensation and Employers'
Liability' and 'Professional Liability'. Should any of the above described policies be cancelled or changed before the expiration date
thereof,the issuing company will mail thirty(30)days written notice to the certificate holder named below.
CERTIFICATE HOLDER: City Manager SIGNATURE OF AGENT LICENSED IN STATE OF TEXAS
City of Round Rock
221 E.Main Street
Round Rock,Texas 78664
Typed Name: R.J.Nitsche,
License ID: 675985
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