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Contract - Bennett Paving, Inc. - 4/11/2024 R- 20Z4 -0�7 BID COPY/ORIGINAL CITY OF ROUND ROCK TRANSPORTATION 0 - -- ROUND ROCK TEXA5 Project Manual For: 2023 Residential Street Maintenance Program Feb 2024 Prepared By: Matthew Bushak, P.E. ` 61zoz� *' t�»� MATTHEW BUSHAK %..... .....: S APPROVED BY .9 s �4/CENg�6f., CI ATTRR E iM. IONA. .. '.I BID BOND THE STATE OF TEXAS § § KNOW ALL BY THESE PRESENTS: COUNTY OF WILLIAMSON § That Bennett Paving Inc. of the City of Leander County of Williamson State of Texas as Principal, and Granite Re, 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"), 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 bid amount Dollars(S 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 2023 Residential Street Maintenance Project for which Bids are to be opened at the office of Owner on the 5th day of March , 20 24 . 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 5th day of the month of March 2024 . Bennett Paving Inc. Granite Re, Inc. Principal Surety (3ryrxn &_Anef+ Kenneth D. Whittington Printed N Printed Name B . By: W _ _ Title: rre5; 4- Title: Attorney-in-Fact Address: 23004 Windy Valley Rd. Address: 14M l ua lbrcok Drive Leander, TX 78646 Oklahoma Cqy, OK 73134 00200 4-2020 Pagel Bid Bond 00443638 Resident A�gen"t"oofSurety: Signature Connor Kempston Federated Insurance Printed Name 9001 Airport Fwy Ste 500 Street Address North Richland,Hills,TX 76180 City, State,Zip Page 2 00200 4-2020 Bid 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 CITY in the State of OKLAHOMA does hereby constitute and appoint: KENNETH D.WHITTINGTON;KYLE MCDONALD its true and lawful Attorney-in-Fact(s)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 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 Board of Directors, hereby ratifies and confirms all and whatsoever the said: KENNETH D.WHITTINGTON;KYLE MCDONALD may lawfully do in the premises by virtue of these 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 31 St day of July,2023. Kenneth D.Whittinfion,President sEnt. STATE OF OKLAHOMA ) Uv ) SS: COUNTY OF OKLAHOMA ) Kyl P.McDonald,Assistant Secretary On this 31St day of July, 2023, before me personally came 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 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. A4 My Commission Expires: �"��'""�',%- April 21,2027 i f = Notary Public Commission#: 11003620 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 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 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 5 2024 ;• Kyle P.McDonald,Assistant Secretary GR-40 Ed.08-23 00300 BID FORM BID FORM PROJECT NAME: 2023 Residential Street Maintenance Program PROJECT LOCATION: Round Rock,Texas OWNER: City of Round Rock,Texas DATE: March 5th,2024 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 2023 Residential Street Maintenance Program 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.roundrocktexas.gov/businesses/solicitations/ by the close of business on March 1,2024 . 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". Addendum No. 1 -2/27/2024 BASE BID Bid Approx. Item Description Item Quantity Unit and Written Unit Price Unit Price Amount 1 12,870 TON Pavement Repair, 12"Depth complete in place per TON for One hundred forty dollars and Zero cents. $140.00 $1,801,800.00 2 19890 SF Remove and Replace Sidewalk complete in place per SF for Eighteen dollars and Fifty cents. $18.50 5367,965.00 00300-9-2015 Page 1 of 6 Bid Form BASE BID Bid Approx. Item Description Item Quantity Unit and Written Unit Price Unit Price Amount 3 14775 LF Remove and Replace Curb and Gutter complete in place per LF for Thirty eight dollars and Zero cents. $38.00 $561,450.00 4 69800 SF Remove and Replace Driveway complete in place per SF for Twenty dollars and Seventy five cents. $20.75 $1,448,350.00 5 400 SF Remove and Replace Driveway,Exposed Aggregate complete in place per SF for Twenty two dollars and Zero cents. $22.00 $8,800.00 6 38 EA Remove and Replace Ramps complete in place per EA for One thousand six hundred fifty dollars and Zero cents. $1,650.00 $62,700.00 7 2910 SF Remove and Replace Fillets complete in place per SF for Twenty one dollars and Zero cents. $21.00 $61,110.00 00300-9-2015 Page 2 of 6 Bid Form BASE BID Bid Approx. Item Description Item QuantityUnit and Written Unit Price Unit Price Amount 8 215038 SY Surface Mill,2" complete in place per SY for Three dollars and Twenty five cents. $3.25 $698,873.50 9 23654 TON Type D HMAC Surface Course complete in place per TON f,„- One hundred thirty nine dollars and Zero cents. $139.00 $3,287,906.00 10 �9 EA Valve Can Adjustment complete in place per EA f,„- Twenty five dollars and Zero cents. $25.00 $1,475.00 11 132 EA Manhole Adjustment complete in place per EA f,„- Fifty dollars and Zero cents. $50.00 $6,600.00 12 110 LF REFL PAV MRK TY I(W)6”(SLD)(100 MIL) complete in place per LF for Two dollars and Ten cents. $2.10 $231.00 00300-9-2015 Page 3 of 6 Bid Form BASE BID Bid Approx. Item Description Item Quantity Unit and Written Unit Price Unit Price Amount 13 1465 LF REFL PAV MRK TY I(W) 12"(SLD)(100 MIL) complete in place per LF for Eight dollars and Fifty cents. $8.50 $12,452.50 14 425 LF REFL PAV MRK TY I(W)24"(SLD)(100 MIL) complete in place per LF fo,- Seventeen dollars and Zero cents. $17.00 $7,225.00 15 19018 LF REFL PAV MRK TY I(Y)6"(SLD)(100 MIL) complete in place per LF for Zero dollars and Eighty cents. $0.80 $15,214.40 16 1890 LF REFL PAV MRK TY I(Y)6"(BRK)(l00 MIL) complete in place per LF for One dollars and Thirty cents. $1.30 $2,457.00 17 557 LF REFL PAV MRK TY I(W)8"(SLD)(100 MIL) complete in place per LF for Two dollars and Ten cents. $2.10 $1,169.70 00300-9-2015 Page 4 of 6 Bid Form BASE BID Bid Approx. Item Description Item Quantity Unit and Written Unit Price Unit Price Amount 18 6 EA REFL PAV MRK TY I(W)(WORD ONLY)(100 MIL) complete in place per EA for Three hundred twenty five dollars and Zero cents. $325.00 $1,950.00 19 6 EA REFL PAV MRK TY I(W)(ARROW)(100 MIL) complete in place per EA l„ Three hundred twenty five dollars and Zero cents. $325.00 $1 ,950.00 20 1 EA REFL PAV MRK TY I(W)(RR)(100 MIL) complete in place per for Eight hundred thirty five dollars and Zero cents. $835.00 $835.00 21 90 EA TYPE 11-B-13 RPM(HYDRANTS) complete in place per EA for Eleven dollars and Zerocents. $11.00 $990.00 22 238 EA TYPE II-A-A RPM complete in place per EA for Seven dollars and Eighty cents. $7.80 $1,856.40 00300-9-2015 Page 5 of 6 Bid Form BASE BID Bid Approx. Item Description , Item Quantity Unit and Written Unit Price Unit Price Amount 23 6 MO TRAFFIC CONTROL complete in place per MO for Fifteen thousand dollars and Zero cents. $15,000.00 $90,000.00 24 90 SY Edge Mill(2") complete in place per SY for Three dollars and Twenty five cents. $3.25 $292.50 complete in place per for dollars and cents. complete in place per for dollars and cents. complete in place per for dollars and cents. 00300-9-2015 Page 6 of 6 Bid Form ADD ALTERNATE BID Bid Approx. Item Description Item Quantity Unit and Written Unit Price Unit Price Amount A-1 2592 TON Pavement Repair, 12" Depth complete in place per TON for One hundred forty dollars and Zero cents. $140.00 $ 362,880.00 A-2 100 SF Remove and Replace Sidewalk complete in place per SF for Eighteen dollars and Fifty cents. $18.50 $ 1,850.00 A-3 5580 SY Surface Mill (2" Depth) complete in place per SY for Three dollars and Twenty five cents. $3.25 $ 18,135.00 A-4 570 SY Edge Mill (0"-2") complete in place per SY for Three dollars and Twenty five cents. $3.25 $ $1,852.50 A-5 1155 TON Type D HMAC Surface Course complete in place per TON for One hundred thirty nine dollars and Zero cents. $139.00 $ 160,545.00 A-6 5 EA Valve Can Adjustment complete in place per EA for Twenty five dollars and Zero cents. $25.00 $ 125.00 A-7 5 EA Manhole Adjustment complete in place per EA for Fifty dollars and Zero cents. $50.00 $ 250.00 REFL PAV MRK TY I (W) 12" A-8 13 LF (SLD)(100 MIL) complete in place per LF for Eight dollars and Fifty cents. $8.50 $ 110.50 REFL PAV MRK TY I (W)24" A-9 52 LF (SLD)(100 MIL) complete in place per LF for Seventeen dollars and Zero cents. $17.00 $ 884.00 A-10 8 EA Type II-B-B RPM (Hydrants) complete in place per EA for Eleven dollars and Zero cents. $11.00 $ 88.00 A-1 1 1 MO TRAFFIC CONTROL complete in place per MO for Five thousand dollars and Zero cents. $5,000.00 $ 5,000.00 TOTAL ADD ALTERNATE BID: $ 551,720.00 STATEMENT OF SEPARATE CHARGES: Materials: $275,000.00 All Other Charges: $276,720.00 * Total: $ 551,720.00 * Note: This total must be the same amount as shown above for "Total Add Alternate Bid" BASE BID $8,443,653.00 ADD ALTERNATE BID $ 551,720.00 TOTAL $ 8,995,373.00 TOTAL BASE BID (Items 1 thru 24 ) $8,443,653.00 Materials: $4,100,000.00 All Other Charges: $4,343,653.00 * Total: $8,443,653.00 * 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 bids and may waive any informalities or technicalities. Respectfully Submitted, 4!5= P.O. Box 2309 Signature Bryan Bennett Leander, TX 78646 Print Name Address President (512) 740-8603 Title Telephone Bennett Paving, Inc. Name of Firm 3/5/2024 Date Secretary, if Bidder is a Bryan Bennett Corporation 00200-9-2015 Page 1 of I [aid Form 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: Bennett Paving, Inc. Address: P.O. Box 2309, Leander, TX 78646 Phone: (512) 740-8603 Completed by: Bryan Bennett Date: 3/5/2024 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 ❑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 [I N/A B. Excavation ®Yes []No ❑N/A C. Cranes ®Yes []No ❑N/A D. Electrical ®Yes ❑No ❑N/A E. Fall Protection ®Yes ❑No ❑N/A F. Confined Spaces ®Yes [-]No ❑N/A I hereby certify that the above information is true and correct. Signature Title President Page 1 00410 8-2014 Statement of Bidder's Safety Experience 00090654 Attention: This form contains information relating to employee health and must be used in a manner OSHAr s Form 300 (Rev. 01/2004) that protects the confidentiality of employees to the Year 2023 extent possible while the information is being used Log of Work-Related Injuries and Illnesses for occupational safety and health purposes. U.S. DeyallentOfLabor Occupational Safetafety and Health Administration You must record information about every work-related injury or illness that involves loss of consciousness,restricted work activity orjob transfer,days away from work,or medical treatment Form approved OMB no.1218-0176 beyond first aid. 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 meet any of the specific recording criteria listed in 29 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 Bennett Paving, Inc. injury and illness incident report(OSHA 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 office for help. City Leander State Texas Identify the person Describe the case Classify the case Enter the number of (A) (B) (C) (D) (E) (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 Employee's 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 object/substance that directly injured or made onset of person ill(e.g.Second degree bums on right (M) d illness forearm from acetylene torch) On job H Days away Away 12 c (mo./day) Death from wok Remained at work transfer or 4i Z o From restriction 0 Ao o d c � Job transfer Other record- Work (days) L, .y °w � o or restriction able cases (days) ;e d o o a u, 0 a (G) (H) (1) (J) (K) (L) (1) (2) (3) (4) (5) (6) NO REPORTABLE INJURIES FOR YEAR 2023 Page totals I o 0 0 0 0 0 0 0 0 0 0 1 0 Be sure to transfer these totals to the Summary page(Form 300A)before you post it. a o o M o C `o ip CO J N _C Public reporting burden for this collection of information is estimated to average 14 minutes per response,including time p � 0 ao to review the instruction,search and gather the data needed,and complete and review the collection of information. Y d d Persons are not required to respond to the collection of information unless it displays a currently valid OMB control u7 = c number. If you have any comments about these estimates or any aspects of this data collection,contact: US a 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. Page 1 of 1 (1) (2) (3) (4) (5) (6) OSHA's Form 300A (Rev.01(2004) Year 2023 ``�� Summary of Work-Related Injuries and Illnesses U.S.Department H-1thAofLabor Occupation ieatery and eateand Health Admin lsirvtion 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 Bennett Paving,Inc. its entirety. They also have limited access to the OSHA Form 301 or its equivalent. See 29 CFR 1904.35,in OSHA's Recordkeeping rule,for further details on the access provisions for these forms. Street 23004 Windy Valley Rd Number of Cases City Leander State Texas Zip 78641 Industry description(e.g.,Manufacture of motortruck trailers) Total number of 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 Industrial Classification(SIC),if known(e.g.,SIC 3715) 0 0 0 0 1 6 1 1 (G) (H) (1) (J) OR North American Industrial Classification(NAICS),if known(e.g.,336212) 2 3 7 3 1 0 NN NumbarAf Dayan' t x ` x ' Employment information t. r Total number of Total number of days of days away from job transfer or restriction Annual average number of employees 49 u,nr4 Total hours worked by all employees last 0 0 year 65,337 (K) (L) iMolly,shltdl[Inesi",_ ,_ {i a Sign here Total number of... Knowingly falsifying this document may result in a fine. (M) (1) Injury 0 (4) Poisoning 0 (2) Skin Disorder 0 (5) Hearing 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 Bryan Bennett President Company executive Title 512-740-8603 W7a024 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 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.If you have any comments about these estimates or any aspects of this data collection,contact:US Departmont of Labor.OSHA Office of Statistics.Room N-3644,200 Constitution Ave.NW.Washinaton.DC 20210.Do not send the completed forms to this office. Attention: This form contains information relating I� to employee health and must be used in a manner Year 2022 O S HA S Form 3 OO (Rev. 0112004) that protects the confidentiality of employees to the Log of Work-Related Injuries and Illnesses extent possible while the information is being used for occupational safety and health purposes. U.S. Department Of Labor Occupational Safety and Health Administration You must record information about every work-related injury or illness that involves loss of consciousness,restricted work activity orjob transfer,days away from work,or medical treatment beyond Form approved OMB no.1218-0176 first aid.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 meet any of the specific recording criteria listed in 29 CFR 1904.8 through 1904.12. Feel free to use two lines for a single case if you need to.You must complete an injury and Establishment name Bennett Paving,Inc. illness incident report(OSHA Form 301)or equivalent forth for each injury or illness recorded on this form. If you're not sure whether a case is recordable,call your local OSHA office for help. City Leander State Texas Identify the person Describe the case Classify the case Enter the number of (A) (B) (C) (D) (E) (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 Employee's 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 object/substance that directly injured or made=--- --_=__– ----- -- — =– –-- —�M) onset of person ill(e.g.Second degree bums on right H illness forearm from acetylene torch) Days away On job m Away y m m c (mo./day) Death from work Remained at work From transferor o J o c m restriction vl � O C � Work (days) L Job anfeOther record- o or restriction able cases (days) � c i a°. _ (G) (H) (I) (J) (K) (L) (1) (2) (3) (4) (5) (6) NO REPORTABLE INJURIES FOR YEAR 2022 Page totals o 0 0 0 1 0 1 0 1 0 0 0 0 0 0 Be sure to transfer these totals to the Summary page(Form 300A)before you post it. o c: m o CJ C N C volM c Public reporting burden for this collection of information is estimated to average 14 minutes per response,including time to m .° c c m V a review the instruction,search and gather the data needed,and complete and review the collection of Information. Persons :x of `m= L are not required to respond to the collection of information unless it displays a currently valid OMB control number.If you o 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,Washington,DC 20210.Do not send the completed fortes to this office. Page 1 of 1 (1) (2) (3) (4) (5) (6) OSHA's Form 300A (Rev.0112004) Year 2022 4�1 Summary of Work-Related Injuries and Illnesses U.S.Department of Labor - occupational Safety,and Health Pdminls[ration --- Fonn approved OMB no 121&0178 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 Bennett Paving Inc its entirety. They also have limited access to the OSHA Form 301 or its equivalent. See 29 CFR 1904.35,in OSHA's Recordkeeping rule,for further details on the access provisions for these forms. Street P.O.Box 2309 -- -- --- ---- -- --_- -------------I' City Leander State Texas Zip 78646 ,Number of Cases 'A 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 Asphalt Paving deaths cases with days with job transfer or other recordable away from work restriction cases Standard Industrial Classification(SIC),if known(e.g.,SIC 3715) 0 0 0 0 1 6 1 1 (G) (H) (I) (J) OR North American Industrial Classification(NAICS),if known(e.g.,336212) 2 3 7 3 1 0 Number of Days - i Employment information Total number of Total number of days of days away from job transfer or restriction Annual average number of employees 26 work Total hours worked by all employees last 0 0 year 48,257 (K) (L) 4J Inju�yn Ilse at M - 'i Sign here Total number of... Knowingly falsifying this document may result in a fine. (M) (1) Injury 0 (4) Poisoning 0 (2) Skin Disorder 0 (5) Hearing 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 Bryan Bennett President Company executive Title 512-740-8603 -_ 228/2023 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 employee health and must be used in a manner that OS HA s Form 301 protects the confidentiality of employees to the extent possible while the information is being used for U.S.Department of Labor Injuries and Illnesses Incident Report occupational safety and health purposes. Occupational 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 Name 10) Case number from the Log (Transferthe case numberfrom the Log afteryou record the case.) first forms you must fill out when a recordable work- 2) Street 11) Date of injury or illness related injury or illness has occurred. Together with the Log of Work-Related injuries and Illnesses and City State Zip 12) Time employee began work AM/PM the accompanying Summary,these forms help the employer and OSHA develop a picture of the extent 3) Date of birth 13) Time of event AM/PM ❑Check if time cannot be determined and severity of work-related 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-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 5)❑Male while carrying roofing materials';"spraying chlorine from hand sprayer";"daily computer key-entry." equivalent. Some state workers'compensation, F-1 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) 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 "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 7) If treatment was given away from the worksite,where was it given? may photocopy and use as many as you need. Facility 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 burn, Street hand";"carpal tunnel syndrome." City State Zip 8) Was employee treated in an emergency room? Completed by F]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. Title 9) Was employee hospitalized overnight as an in-patient? Phone Date ❑Yes E]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 `0 employee health and must be used In a manner that ``� OSHA's Form 300 (Rev.0112004) protects the confidentiality of employees to the extent Year 2021 possible while the information is being used for U.S. De attment of Labor Log of Work-Related Injuries and Illnesses occupational safety and health purposes. Occupational Safety and Health Administration - - -- -- - - -- - - - — -- -- - — -- --�-- - -- ---- --- -- OMB 1218-0176 You must record information about every work-related injury or illness that involves loss of consciousness,restricted work activity or job transfer,days away from work,or medical treatment beyond first aid.You Form approved no. 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 meet any of the specific recording criteria listed in 29 CFR 1904.8 through 1904.12.Feel free to use two lines for a single case if you need to.You must complete an injury and illness Incldentreport(OSHA Form 301)or Establishment name Bennett Paving Inc. equivalent form for each injury or illness recorded on this form.If youYe not sure whether a case is recordable,call your local OSHA office for help. City Leander State Texas _Identify•thetperson• "-> _' Descfibe thecase _. – —_--_, _ ..... ------- Enter the number of (A) (B) (C) (D) (E) (F) CHECK ONLY ONE box for each case based on the days the injured or III Check the"injury"column or choose one type of Case Employee's Name Job Title (e.g., Date of Where the event occurred(e.g. Describe Injury or illness,parts of body affected,and most serious outcome for that case: worker was: - _ illness: No. Welder) injury or Loading dock north end) object/substance that directly injured or made person ill(e.g. _-- ---=—==-------- ---- --- -- "M� onset of Second degree bums on right forearm from acetylene torch) illness "Deys:awey= - -� Away On job lu y c mo./da Dmfh 1'Prom works x Remelnedatworka TM From transferor o o c ( Y) `a restriction _ m o orn L —Job transfer••Other record- Work (days) Z• o .�'v h S c c or restriction able cases (days) c � 0 a i a (G) (H) M M (K) (L) 1 (2) (3) 4 (5) (6) 1 Fabian C Ramirez Operator 07/01/21 Highway in Lago Vista,TX Fell off roller due to soft hwy shoulder and broke right arm 1 141 141 1 Page totals o 444 0 0 441 o f o 0 0 0 0 Be sure to transfer these totals to the Summary page(Form 300A)before you post it. oo C J C O 1 O d b w O O m C Pubic reporting burden for this collection of information is estimated to average 14 minutes per response,including time cr d U o- to review the Instruction,search and gather the data needed,and complete and review the collection of Information. N = o Persons are not required to respond to the collection 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 LIS Department < of Labor,OSHA Office of Statistics,Room N-3644,200 Constitution Ave,NW,Washington,DC 20210.Do not send the Page 1 of 1 (1) (2) (3) (4) (5) (6) completed forms to this office. OSHA's Form 300A (Rev.01/2004) Year 2021 4�1 Summary of Work-Related Injuries and Illnesses U.S.Department ofLabor Occupational Safety and Health Administration Form approved OMB no 1216-0176 a ro 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 Bennett Paving Inc. — its entirety. They also have limited access to the OSHA Form 301 or its equivalent. See 29 CFR 1904.35,in OSHA's Recordkeeping rule,for further details on the access provisions for these forms. Street P.O.Box 2309 . '' T'r'r•;r V',.i�,x S .—� City Leander State Texas Zip 78646 Number�of.Cases fill' oar ._...e:.:.y._.�.. .V._ 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 Asphalt Paving deaths cases with days with job transfer or other recordable away from work restriction Cases Standard Industrial Classification(SIC),if known(e.g.,SIC 3715) 0 141 0 0 1 6 1 1 (G) (H) (1) (J) OR North American Industrial Classification(NAICS),if known(e.g.,336212) 2 3 7 3 1 0 iNum�o`f�Da�ts � '( �7• '. � Employment information Total number of Total number of days of days away from job transfer or restriction Annual average number of employees 26 work Total hours worked by all employees last 141 0 year 38,084 (K) (U — --- —: 0 Sign here //' Total number of... Knowingly falsifying this document may result In a fine. (M) (1) Injury 1 (4) Poisoning 0 (2) Skin Disorder 0 (5) Hearing Loss 0 I 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 Bryan Bennett President Company executive Title 512-740-8603 2J12022 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 ``� `_� r employee health and must be used in a manner that OS HA s Form 301 protects the confidentiality of employees to the extent possible while the information is being used for U.S.Department of Labor Injuries and Illnesses Incident Report occupational safety and health purposes. Occupational 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 Name Fabian C Ramirez 10) Case numberfrom the Log 1 (Transfer the case number from the Log afteryou record the case.) first forms you must fill out when a recordable work- 2) Street 1804 Courtney cove 11) Date of injury or illness 7/1/2021 related injury or illness has occurred. Together with the Log of Work-Related injuries and Illnesses and City Round Rock State 'X 7866 Zip 12) Time employee began work 7:00 PM AM/PM the accompanying Summary,these forms help the employer and OSHA develop a picture of the extent 3) Date of birth 1/20/1957 13) Time of event 9:45 PM AM/PM Check if time cannot be determined and severity of work-related incidents. Within 7 calendar days after you receive 4) Date hired 3/22/2021 14) What was the employee 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 occurred,you must fill Out this form or an 5) XD 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 He was operating a roller. 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) 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 workerfell 20 feet";"Worker was sprayed with chlorine when gasket broke during replacement"; 1904,OSHA's recordkeeping rule,you must keep "Worker developed soreness in wrist over time." this form on file for 5 years following the year to Due to a soft shoulder,road gave way and machine laid on its side. 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 St David's Hospital 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 burn, Street hand';"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? Completed by Lola Greeson XQYes 17) What objector 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. Title Office Manager Roller 9) Was employee hospitalized overnight as an in-patient? Phone (512)740-8603 Date 2/1/2022 XQYes F�No 18) If the employee died,when did death occur? Date of death N/A 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 revie Ang 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. BENNETT PAVING Cover Page Bennett Paving, Inc P.O. Box 2309 Leander, TX 78646 Date of response: 3/5/2024 City of Round Rock: 2023 Residential Street Maintenance Program Solicitation Number: 24-403 Bryan Bennett President BENNETT PAVING Introduction Bennett Paving, Inc. has been in business for over 14 years. Bennett Paving, Inc. is one of the individually owned paving 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 we 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. We 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 needs. As a family owned business, we pride ourselves on our ability to be flexible to satisfy any customer requirements. BEl`IIYETT PAVING Bennett Paving, Inc. References City of Burnet — 2023H Street Rehab Overlay Eric Belaj — City Engineer, ebelaj@cityofburnet.com, (512) 715-3217 Project Size: $1,729,403.33 Scope of Work: Asphalt Paving and concrete. Completed Date: January, 2024 City of Round Rock— Downtown Street Maintenance Project Matt Bushak — City Engineer, mbushak@roundrocktexas.gov, (512) 341-3318 Project Size: $3,457,142.10 Scope of Work: Asphalt Paving and concrete. Completed Date: August, 2023 City of Leander— Roadway Rehab FY 2023 Project Roman Poudyal — Project Manager, rpoudyal@leandertx.gov, (512) 259-2640 Project Size: $2,421,313.37 Scope of Work: Asphalt Paving and concrete. Completed Date: July, 2023 McCoy's Building Supply (Dayton, TX) Carlos Garcia — Regional Operations Manager, cgarcia@mccoys.com, (512) 753-6358 Project Size: $4,709,427.86 Scope of Work: Asphalt paving, concrete, striping and wheel stops. Completed Date: September, 2023 BEIM MTT PAVING Bryan Bennett President Experience Contact Bennett Paving,Inc.,Leander,TX—President 2006—Present 23004 Windy Valley Rd. • Successfully managed numerous construction projects Leander,TX 78641 centered on customer satisfaction (512)450-3186 • Managed multiple projects simultaneously bryan@bennettpavingtx.com • Reviewed plans and specs during schematic design of pre- construction Projects • Performed regular job site observations to provide direction for all personnel City of Round Rock • Conducted regular meetings with employees to facilitate . Asphalt Paving strong communication and the ability to resolve critical issues • 2023—Downtown Street Maintenance:$3.5M • Implemented systems to improve process efficiency and reduce project duration McCoy's Building Supply • Oversaw day to day operation of sales, purchasing, payroll, . Various Stores and maintenance of equipment and vehicles • $15M in 2023 • Maintained positive vendor,customer,and sub contractor . Asphalt and Concrete work relations City of Burnet Ramming Paving,Austin,TX—Estimator/Project Manager/ • Asphalt Overlay Superintendent • 2023-$2.2M 2002-2006 . 2022-$1.8M • Prepared bids for various private and government jobs • 2021-$986k • Supervised construction activities at residential and commercial job sites City of Lakeway • Ensured occupational health and safety regulations were . Asphalt Paving being complied with . 2022-$824k • Executed all pre-construction,construction,quality control, and post construction responsibilities City of Leander • Asphalt Paving Wheeler Coatings,Austin,TX-Foreman . 2023-$2.4M 1998-2002 • Direct site supervision of paving crew Expertise • Scheduled sub contractors,trucking needs and personnel required for efficient job progression • Asphalt • Estimated quantities of daily materials needed . Base Work • Managed quality control . Chip Seal • Trained on site crew members • Seal Coat • Striping • Estimating • Project Management • Commercial Construction • Blueprint fluency 0 OSHA 30 certified BENIN ETT PAVING Robert Terbay Sales and Operations Experience Contact Bennett Paving, Inc.,Leander,TX—Sales and Operations 4129 Moss Hollow Dr. 2012—Present Round Rock,TX 78681 • Manage day to day operations (512)987-9737 • Manage job scheduling robert@bennettpavingtx.com • Solicit sales and prepare bids • Manage customer expectations from bid to job completion Projects • Solicit outside sales for trucking company • Negotiate and finalize sales with customers City of Round Rock • Ensure customer satisfaction • Asphalt Paving • 2023—Downtown Street Maintenance:$3.5M APAC Texas,Inc. Ironhorse Concrete, Round Rock,TX—Sales and Operations McCoy's Building Supply 2007-2012 • Various Stores • Solicited outside sales for ready mix concrete company • $15M in 2023 • Prepared bids for various private and government jobs . Asphalt and Concrete work • Ran day to day operations and dispatched ready mix trucks • Managed concrete plant and truck drivers City of Burnet • Coordinated with customers on delivery of materials . Asphalt Overlay • 2023-$2.2M Mid-State Contracting Inc.,Austin,TX-President • 2022-$1.8M 2004-2007 0 2021-$986k • Managed all aspects of trucking company • Purchased company assets City of Lakeway • Maintained company books 0Asphalt Paving • Hired and managed CDL subcontractors • 2022-$824k • Booked jobs,invoiced, and collected payments from contractors City of Leander • Asphalt Paving Wheeler Coatings,Austin,TX-Superintendent • 2023-$2.4M • Coordinated with inspectors, property owners,asphalt plants and trucking companies to ensure completion of each job Expertise according to regulations and job specifications • Managed and evaluated twenty-five employees on asphalt • Asphalt crew • Base Work • Performed minor repairs and maintenance on various • Chip Seal equipment to continue work at job sites • Seal Coat • Striping • Estimating • Project Management • Commercial Construction • Heavy Equipment Operation • Blueprint fluency 0 OSHA 30 certified BENNETT PAVING Contact Melchor Torres Ramirez 104 Lavaca Loop Foreman Hutto,TX 78634 (512)903-0430 melchor@bennettpavingtx.com Experience Projects Bennett Paving,Inc.,Leander,TX—Foreman 2023-Present City of Round Rock • Asphalt Paving • Direct site supervision of all personnel • 2023—Downtown Street Maintenance:$3.5M • Specialized in job layout and scheduling • Supervised construction activities at residential and McCoy's Building Supply commercial job sites • Various Stores • Scheduled sub contractors,trucking needs and personnel $15M in 2023 required for efficient job progression • Asphalt and Concrete work • Managed quality control • Estimated quantities of daily materials needed City of Burnet • Scheduled sub contractors,trucking needs and personnel • Asphalt Overlay required for efficient job progression • 2023-$2.2M JR Schneider Construction, Inc.,Austin,TX—Foreman City of Leander 2010-2023 • Asphalt Paving • Assisted coworkers with establishing job scope and set-up • 2023-$2.4M • Oversaw projects by communicating with key personnel • Ensure project efficiency by managing all project details Expertise including measurement, material requirements,trucking needs and personnel were accounted for • Asphalt • Managed job cost and scheduling • Base Work • Chip Seal Wheeler Coatings,Austin,TX—Foreman • Seal Coat 2000-2010 • Striping • Ensured occupational health and safety regulations were Estimating being complied with • Project Management • Demonstrated team leadership • Commercial Construction • Ensured safety and compliance standards were being met Heavy Equipment Operation • Oversaw new construction and renovation projects . Blueprint fluency • Experience supervising residential and commercial • OSHA 30 certified construction • Trained employees on heavy equipment operation • Performed regular inspection reviews BENNETT PAVING David Terry Project Manager Contact 213 Oakbend Drive Experience Liberty Hill,TX 78642 (512)633-3105 Bennett Paving,Inc.,Leander,TX—Project Manager dave@bennettpavingtx.com 2019—Present • Direct site supervision of all personnel Projects • Specialized in job layout and scheduling • Supervised construction activities at residential and City of Round Rock commercial job sites • Asphalt Paving • Scheduled sub contractors,trucking needs and personnel • 2023—Downtown Street Maintenance:$3.5M required for efficient job progression • Managed quality control McCoy's Building Supply • Estimated quantities of daily materials needed • Various Stores • Scheduled sub contractors,trucking needs and personnel • $15M in 2023 required for efficient job progression • Asphalt and Concrete work Wheeler Coatings/Texas Materials,Austin,TX—Supervisor City of Burnet 1995-2019 • Asphalt Overlay • Ensured occupational health and safety regulations were • 2023-$2.2M being complied with • 2022-$1.8M • Demonstrated team leadership • 2021-$986k • Ensured safety and compliance standards were being met • Oversaw new construction and renovation projects City of Lakeway • Experience supervising residential and commercial • Asphalt Paving construction • 2022-$824k • Trained employees on heavy equipment operation • Performed regular inspection reviews City of Leander • Asphalt Paving • 2023-$2.4M Expertise • Asphalt • Base Work • Chip Seal • Seal Coat • Striping • Estimating • Project Management • Commercial Construction • Heavy Equipment Operation • Blueprint fluency • OSHA 30 certified Resolution of Corporate A-athority Action by unanimous consent of the Board of Directors of Bennett Paving, Inc. {"Corporation"). The Board of Directors have certified that Bennett Paving, Inc. is duly organized and ' existing under the laws of the State of Texas. Resolved,that Bryan Bennett the President of Bennett Paving, Inc., is empowered to sign any and all documents, to take such steps, and to do such other acts and things, on behalf of said Corporation, as in his judgment. may be necessary, appropriate or desirable including but not limited to submitting estimates and bids on services that axe to be performed by the Corporation. Resolved,that a Company Seal is not utilized by the Corporation, and that a signature by Bryan Bennett on behalf of the Corporation shall have the effect of full ratification by the Board of Directors and Corporation, to serve as an official action by the Corporation as though a seal had been affixed to the document. Resolved,that Bryan Bennett has the authority to bind the Corporation on all matters. Resolved, that all transactions entered into by Bryan Bennett, in the Corporation's name and for its account, prior to the adoption of these resolutions, are hereby ratified and approved for all purposes. Date January 3 0 ,2023 Bryan Bwr6ett,President and Secretary Bennett Paving, Inc. Subs crib ed and sworn to before me by the Bryan Bennett,witaess,.on January 3 0 ,2023. 4a � Notary Public, State of Texas .��nY Pur 1.01-AT GREESoN x° n Notary lU#8825122 Y My Commission expires � aF October 23, 7025 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 S ( /� )day of in the year 2(9" BETWEEN the Owner: City of Round Rock,Texas(hereafter"Owner"or"City") t 221 East Main Street Round Rock,Texas 78664 and the Contractor Bennett Paving,Inc. ("Contractor") P.O.Box 2309 Leander,Texas 78646 The Project is described as: 2023 Residential Street Maintenance Program The Engineer is: Matthew Bushak,PE Citv of Round Rock mbushak(@roundrocktexas..gov 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 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 ] 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 One hundred eighty( 180 )calendar days from issuance by Owner of Notice to Proceed, and Contractor shall achieve Substantial Completion of the entire Work no later than One hundred eighty ( 180 )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/]00 Dollars($ 1,000 ) 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 two hundred ten (_110 )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 Eight million nine hundred ninety-five thousand three hundred seventy-three dollars and zero cents ($ 8,995,373.00 ),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 .tf yes,please provide details below: The alternate cost is additional paving 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 (10th) day of a month, Owner shall make payment to Contractor of amounts approved by the Owner not later than the tenth(l 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 Feb 2024 7.1.4 The Specifications are those contained in the Project Manual dated Feb 2024 7.1.5 The Drawings,if any,are those contained in the Project Manual dated Feb 2024 7.1.6 The Insurance&Construction Bond Forms of the Contract are those contained in the Project Manual dated Feb 2024 7.1.7 The Notice to Bidders,Instructions to Bidders,Bid Form,and Addenda,if any,are those contained in the Project Manual dated Feb 2024 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: n/a 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: Reuben Ramirez,PMP City of Round Rock rramirez a roundrocktexas.Qov (512)218-7084 8.3 Contractor's representative is: Robert Terbay Bennett Pavine.Inc. robertnnbennettaavinQtx.com (512)740-8603 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 CONTRACTOR ROUND R K,TEXAS Bennett Paving, Inc. CITY F M /1�1 Printed ame: ,gyp Printed Name: Bryan Bennett Title �YU Title: President Date Signed: Date Signed: 4/19/2024 ATT ST: ty Clerk FOR CITY,APPROVED AS TO FORM: City orney 00500 4-2020 Page 5 of 5 Standard Form of Agreement 00443647 Bond#: GRTX64990 PERFORMANCE BOND THE STATE OF TEXAS § § KNOW ALL BY THESE PRESENTS: COUNTY OF WILLIAMSON § That Bennett Paving, Inc. , of the City of Leander County of Williamson , and State of Texas ,as Principal, and Granite Re, Inc. 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 Eight million nine hundred ninety-five thousand three hundred seventy-three dollars and zero cents Dollars ($ 8,995,373.00 ) 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 e red into a certain written Agreement with the Owner dated the 25! day of , In 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: 2023 Residential Street Maintenance Program 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 $8,995,373.00 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 19+>7 day of 2014. Bennett Paving Inc. Granite Re, Inc. Principal ✓� Surety lir om &10t Kenneth D. Whittington Printed Nam Printed Name By: By: Title: res• en Title: Attorney-in act _ Address: 23004 Windy Valley Rd. Address: 14401 Quailbrook Drive Leander, TX 78641 Oklahoma City, OK 73134 Resident Agent of Surety: CAX"4, Signature Connor Kempston Printed Name 9001 Airport Fwy Ste 500 Street Address North Richlan Hills, TX 76180 City, State&Zip Code Page 2 00610 4-2020 Performance Bond 00443639 Bond 4: GRTX64990 PAYMENT BOND THE STATE OF TEXAS § § KNOW ALL MEN BY THESE PRESENTS: COUNTY OF WILLIAMSON § That Bennett Paving, Inc. , of the City of Leander County of Williamson , and State of Texas , as Principal,and Granite Re, 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 sum of Eight million nine hundred ninety-five thousand three hundred seventy-three dollars and zero cents Dollars($$,995,373.00 )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 Prncipal has ente d into a certain written Agreement with the Owner,dated the 2S day of ' 20;?J to which Agreement is hereby referred to and made a part hereof as fully and fo the same extent as if copied at length herein consisting of: 2023 Residential Street Maintenance Program 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 042020 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 19th day of Bennett Paving Inc. Granite Re, Inc. Principal Surety B r pul &4ne O Kenneth D. Whittington Printed Name Printed Name By: By: =---- Title: Pres;Ain Title: Attorney-in- ct Address: 23004 Windy Valley Rd. Address: 14001 Quailbrook Drivt, Leander, TX 78640 Oklahoma City, OK 73134 Resident Agent of Surety: CBIZfZ6'L /l Qat Ifi Signature Connor Kempston Printed Name 9001 Airport Fwy Ste 500 Street Address North Richlan Hills, TX 76180 City, State & Zip Code Page 2 006201-2020 Payment Bond 00090656 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 CITY in the State of OKLAHOMA does hereby constitute and appoint: KENNETH D.WHITTINGTON;KYLE MCDONALD its true and lawful Attorney-in-Fact(s)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 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 Board of Directors, hereby ratifies and confirms all and whatsoever the said: KENNETH D.WHITTINGTON;KYLE MCDONALD may lawfully do in the premises by virtue of these 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 31 st day of July,2023. Kemieth D. «'hitt tori.President STATE OF OKLAHOMA COUNTY OF OKLAHOMA ) Kyt P.McDonald.Assistant Secretary On this 31St day of July, 2023, before me personally came 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 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. My Commission Expires: ;� +t April 21,2027 ' `_ Notary Public Commission#: 11003620 h 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 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 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 ihis Certificate and affixed the corporate seal of the Corporation this OEA Kyle P.McDonald.Assistant Secretary GR-40 Ed.08-23 State of Texas Claim Notice Endorsement To be attached to and form a part of Bond No. GRTX64990 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 TO YOUR BOND '4� F07/25/22023023 CERTIFICATE OF LIABILITY INSURANCE DATE IMM/ Y) THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terns 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 NAME:CONTACT CLIENT CONTACT CENTER FEDERATED MUTUAL INSURANCE COMPANY PHONE FAX HOME OFFICE: P.O. BOX 328 IA/C,No,Ext):888-333-4949 IA/C,No):507-446-4664 OWATONNA, MN 55060 ADDRESS:CLIENTCONTACTCENTER FEDINS.COM INSURERS AFFORDING COVERAGE NAIC# INSURER A:FEDERATED MUTUAL INSURANCE COMPANY 13935 INSURED 381-867-1 INSURER B: BENNETT PAVING INC. INSURER C: PO BOX 2309 LEANDER,TX 78646-2309 INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:48 REVISION NUMBER:0 THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF POLICY EXP LIMITS LTRX COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $1,000,000 CLAIMS-MADE ❑X OCCUR DAMAGE TO RENTED PREMISES $100,000 MED EXP(Any one person) EXCLUDED A Y N 1867237 08/04/2023 08/04/2024 PERSONAL 8 ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 POLICY X (ECT ❑LOC PRODUCTS 6 COMP/OP AGG $2,000,000 OTHER: D INE COMB AUTOMOBILE LIABILITYINESINGLE LIMIT $1,000,000 Eaaccident X ANY AUTO BODILY INJURY(Per Person) A OWNED AUTOS ONLYSCHEDULED Y N 1867237 08/04/2023 08/04/2024 BODILY INJURY(Per Accident) HIRED AUTOS ONLY NON-OWNED PROPERTY DAMAGE AUTOS ONLY X UMBRELLA LIAR X OCCUR EACH OCCURRENCE $5,000,000 A EXCESS LIAR CLAIMS-MADE N N 1867238 08/04/2023 08/04/2024 AGGREGATE $5,000,000 DED I RETENTION WORKERS COMPENSATION AND EMPLOYERS'LIABILITY YIN PER STATUTE OTHER ANY PROPRIETORIPARTNERI EXECUTIVE OFFICERIMEMBER EXCLUDED? N/A E.L EACH ACCIDENT (Mandatory in NH) E.L DISEASE fA EMPLOYEE If yes,describe under DESCRIPTION OF OPERATIONS below E.L DISEASE-POLICY LIMIT DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) SEE ATTACHED PAGE CERTIFICATE HOLDER CANCELLATION 381-867-1 480 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED ATTN:CITY MANAGER CITY OF ROUND ROCK BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN 221 E MAIN ST ROUND ROCK,TX 78664-5271 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE �— O 1988-2015 ACORD CORPORATION.All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: 381-867-1 ACCO ' LOC#: k.1-1 ADDITIONAL REMARKS SCHEDULE Page 1 of 1 AGENCY NAMEDINSURED FEDERATED MUTUAL INSURANCE COMPANY BENNETT PAVING INC. PO BOX 2309 POLICY NUMBER LEANDER,TX 78646-2309 SEE CERTIFICATE#48.0 CARRIER NAIC CODE EFFECTIVE DATE:SEE CERTIFICATE ##48.0 SEE CERTIFICATE#48.0 ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: CERTIFICATE OF LIABILITY INSURANCE THE CERTIFICATE HOLDER IS AN ADDITIONAL INSURED SUBJECT TO THE CONDITIONS OF THE ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - AUTOMATIC STATUS WHEN REQUIRED IN A WRITTEN CONSTRUCTION AGREEMENT WITH YOU ENDORSEMENT FOR GENERAL LIABILITY. THE CERTIFICATE HOLDER IS AN ADDITIONAL INSURED SUBJECT TO THE CONDITIONS OF THE ADDITIONAL INSURED BY CONTRACT ENDORSEMENT FOR BUSINESS AUTO LIABILITY. GENERAL LIABILITY COVERAGE CONTAINS CG 25 03 DESIGNATED CONSTRUCTION GENERAL AGGREGATE LIMIT ENDORSEMENT APPLICABLE TO EACH CONSTRUCTION PROJECT AS REQUIRED BY WRITTEN CONTRACT OR WRITTEN AGREEMENT. INSTALLATION FLOATER COVERAGE IS PROVIDED WITH A LIMIT OF $4,000,000 FOR PROPERTY THE NAMED INSURED IS CONTRACTED TO INSTALL THAT THEY OWN OR ARE LEGALLY LIABLE FOR. COVERAGE APPLIES WHILE IN TRANSIT, WHILE AT THE PREMISES OF INSTALLATION, OR ELSEWHERE AWAITING AND DURING INSTALLATION. FOR REASONS OTHER THAN NON-PAYMENT OF PREMIUM, 30 DAYS NOTICE WILL BE PROVIDED TO THE CERTIFICATE HOLDER IN THE EVENT THAT THE ISSUING COMPANY CANCELS THE POLICY BEFORE THE EXPIRATION DATE OF THE POLICY. ACORD 101 (2008101) O 2008 ACORD CORPORATION.All rights reserved. The ACORD name and logo are registered marks of ACORD THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED BY CONTRACT ENDORSEMENT This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE PART With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by the endorsement. A. WHO IS AN INSURED for "bodily injury" and "property damage" liability is amended to include: Any person or organization other than a joint venture, for which you have agreed by written contract to procure bodily injury or property damage "auto" liability insurance arising out of operation of a covered "auto" with your permission. However, this additional insurance does not apply to: (1) The owner or anyone else from whom you hire or borrow a covered "auto"_ This exception does not apply if the covered "auto' is a "trailer" connected to a covered "auto' you own. (2) Your "employee" if the covered "auto' is owned by that "employee" or a member of his or her household. (3) Someone using a covered "auto' while he or she is working in a business of selling, servicing, repairing, parking or storing "autos" unless that business is yours. (4) Anyone other than your "employees", partners (if you are a partnership), members (if you are a limited liability company), or a lessee or borrower or any of their "employees", while moving property to or from a covered "auto'. (5) A partner (if you are a partnership), or a member (if you are a limited liability company) for a covered "auto' owned by him or her or a member of his or her household. B. The coverage extended to any additional insured by this endorsement is limited to, and subject to all terms, conditions, and exclusions of the Coverage Part to which this endorsement is attached. In addition, coverage shall not exceed the terms and conditions that are required by the terms of the written agreement to add any insured, or to procure insurance. C. The limits of insurance applicable to such insurance shall be the lesser of the limits required by the agreement between the parties, or the limits provided by this policy. D. Additional exclusions. The insurance afforded to any person or organization as an insured under this endorsement does not apply: 1. To "loss" which occurs prior to the date of your contract with such person or organization; 2. To 'loss" arising out of the sole negligence of any person or organization that would not be an insured except for this endorsement. 3. To 'loss" for any leased or rented "auto' when the lessor or his or her agent takes possession of the leased or rented "auto' or the policy period ends, whichever occurs first. Includes copyrighted material of Insurance Services Office, Inc. with its permission. CA-F-127 (03-03) Policy Number: 1867237 Transaction Effective Date: 08/04/2023 COMMERCIAL GENERAL LIABILITY CG 20 33 12 19 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - AUTOMATIC STATUS WHEN REQUIRED IN A WRITTEN CONSTRUCTION AGREEMENT WITH YOU This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART A. Section 11 - Who Is An Insured is amended to B. With respect to the insurance afforded to these include as an additional insured any person or additional insureds, the following additional organization for whom you are performing exclusions apply: operations when you and such person or This insurance does not apply to: organization have agreed in writing in a contract 1. "Bodily injury", "property damage" or or agreement that such person or organization be added as an additional insured on your policy. "Personal and advertising injury" arising out of Such person or organization is an additional the rendering of, or the failure to render, any insured only with respect to liability for "bodily professional architectural, engineering or injury", "property damage" or "personal and surveying services, including: advertising injury" caused, in whole or in part, by: a. The preparing, approving, or failing to 1. Your acts or omissions; or prepare or approve, maps, shop drawings, opinions, reports, surveys, field orders, 2. The acts or omissions of those acting on your change orders or drawings and behalf; specifications; or in the performance of your ongoing operations for b. Supervisory, the additional insured. p ry, inspection, architectural or engineering activities. However, the insurance afforded to such This exclusion applies even if the claims additional insured: against any insured allege negligence or other 1. Only applies to the extent permitted by law; wrongdoing in the supervision, hiring, and employment, training or monitoring of others 2. Will not be broader than that which you are by that insured, if the "occurrence" which required by the contract or agreement to caused the "bodily injury" or "property provide for such additional insured. damage", or the offense which caused the A person's or organization's status as an "personal and advertising injury", involved the additional insured under this endorsement ends rendering of or the failure to render any when your operations for that additional insured professional architectural, engineering or are completed. surveying services. © Insurance Services Office, Inc., 2018 Page 1 of 2 CG 20 33 12 19 Policy Number: 1867237 Transaction Effective Date: 08/04/2023 2. 'Bodily injury" or "property damage" C. With respect to the insurance afforded to these occurring after: additional insureds, the following is added to a. All work, including materials, parts or Section III - Limits Of Insurance: equipment furnished in connection with The most we will pay on behalf of the additional such work, on the project (other than insured is the amount of insurance: service, maintenance or repairs) to be 1. Required by the contract or agreement you performed by or on behalf of the additional have entered into with the additional insured; insured(s) at the location of the covered or operations has been completed; or 2. Available under the applicable limits of b. That portion of "your work" out of which insurance; the injury or damage arises has been put to its intended use by any person or whichever is less. organization other than another contractor This endorsement shall not increase the or subcontractor engaged in performing applicable limits of insurance. operations for a principal as a part of the same project. Page 2 of 2 © Insurance Services Office, Inc., 2018 CG 20 33 12 19 Policy Number: 1867237 Transaction Effective Date: 08/04/2023 POLICY NUMBER: 1867237 COMMERCIAL GENERAL LIABILITY CG 25 03 05 09 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. DESIGNATED CONSTRUCTION PROJECT(S) GENERAL AGGREGATE LIMIT This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Designated Construction Project(s): Each construction project as required by written contract or written agreement. Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. For all sums which the insured becomes legally 3. Any payments made under Coverage A for obligated to pay as damages caused by damages or under Coverage C for medical "occurrences" under Section I - Coverage A, and expenses shall reduce the Designated for all medical expenses caused by accidents Construction Project General Aggregate Limit under Section I - Coverage C, which can be for that designated construction project. Such attributed only to ongoing operations at a single payments shall not reduce the General designated construction project shown in the Aggregate Limit shown in the Declarations nor Schedule above: shall they reduce any other Designated 1. A separate Designated Construction Project Construction Project General Aggregate Limit General Aggregate Limit applies to each for any other designated construction project designated construction project, and that limit shown in the Schedule above. is equal to the amount of the General 4. The limits shown in the Declarations for Each Aggregate Limit shown in the Declarations. Occurrence, Damage To Premises Rented To 2. The Designated Construction Project General You and Medical Expense continue to apply. Aggregate Limit is the most we will pay for the However, instead of being subject to the sum of all damages under Coverage A, except General Aggregate Limit shown in the damages because of "bodily injury" or Declarations, such limits will be subject to the "property damage" included in the "products- applicable Designated Construction Project completed operations hazard", and for medical General Aggregate Limit. expenses under Coverage C regardless of the number of: a. Insureds; b. Claims made or"suits" brought; or c. Persons or organizations making claims or bringing "suits". CG 25 03 05 09 © Insurance Services Office, Inc., 2008 Page 1 of 2 B. For all sums which the insured becomes legally C. When coverage for liability arising out of the obligated to pay as damages caused by "products-completed operations hazard" is "occurrences" under Section I - Coverage A, and provided, any payments for damages because of for all medical expenses caused by accidents "bodily injury" or "property damage" included in under Section I - Coverage C, which cannot be the "products-completed operations hazard" will attributed only to ongoing operations at a single reduce the Products-completed Operations designated construction project shown in the Aggregate Limit, and not reduce the General Schedule above: Aggregate Limit nor the Designated Construction 1. Any payments made under Coverage A for Project General Aggregate Limit. damages or under Coverage C for medical D. If the applicable designated construction project expenses shall reduce the amount available has been abandoned, delayed, or abandoned and under the General Aggregate Limit or the then restarted, or if the authorized contracting Products-completed Operations Aggregate parties deviate from plans, blueprints, designs, Limit, whichever is applicable; and specifications or timetables, the project will still 2. Such payments shall not reduce any be deemed to be the same construction project. Designated Construction Project General E. The provisions of Section III - Limits Of Insurance Aggregate Limit. not otherwise modified by this endorsement shall continue to apply as stipulated. Page 2 of 2 © Insurance Services Office, Inc., 2008 CG 25 03 05 09 ACo 08/03/22023023 CERTIFICATE OF LIABILITY INSURANCE DATE(MM/ Y) THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Nicole Peterson NAME: Primary Source Insurance Agency Inc AICONNo Ext): (800)760-2809 AX Primary No): (877)446-4631 121 E Park Square ADDRESS: NLPeterson@fedins.com INSURER(S)AFFORDING COVERAGE NAIC# Owatonna MN 55060 INSURERA: Texas Mutual Ins Co INSURED INSURER B: CNA Bennett Paving Inc. INSURER C: PO Box 2309 INSURER D: INSURER E: Leander TX 78646-2309 INSURER F: COVERAGES CERTIFICATE NUMBER: 23-24 WC/PL 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 ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR AUUL bUtSK P LICY EFF POLICY EXP LIMITS LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER MMIDD/YYYY MMIDD/YYYY COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ DAMAGE TO RENTED CLAIMS-MADE D OCCUR PREMISES Ea occurrence $ MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY ElPRO- JECT [7 LOC PRODUCTS-COMP/OPAGG $ OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident ANYAUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY Per accident UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED I I RETENTION$ PER $ WORKERS COMPENSATION X1 STATUTE I EERH AND EMPLOYERS'LIABILITY YIN 1,000,000 A ANY PROPRIETOR/PARTNER/EXECUTIVE ❑ NIA Y 0002018278 08/04/2023 08/04/2024 E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? (Mandatory in NH) E.L.DISEASE-FA EMPLOYEE $ 1,000,000 If yes,describe under 1,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ Aggregate $1,000,000 Professional Liability B Y Y CE07040035596 08104/2023 08/04/2024 Each Condition $1,000,000 Deductible $10,000 DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) BLANKET WAIVER OF SUBROGATION APPLIES TO THE WORK COMP POLICY.Cert holder is an additional insured for Professional Liability for Ongoing and Completed Operations as provided by the Professional Liability Policy.Coverage also includes Mold Coverage. Insurance provided is primary and noncontributory over other insurance.This policy also contains a waiver of subrogation in favor of the certificateholder/additional insureds subject to the conditions of the blanket waiver of transfer of rights of recovery endorsement CERTIFICATE HOLDER 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 AUTHORIZED REPRESENTATIVE 221 E Main St Round Rock TX 78664 �s ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD TeX, SMutuaF WORKERS' COMPENSATION INSURANCE WORKERS' COMPENSATION AND WC 42 03 04 B EMPLOYERS LIABILITY POLICY Insured copy TEXAS WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT This endorsement applies only to the insurance provided by the policy because Texas is shown in item 3.A. of the Information Page. We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce our right against the person or organization named in the Schedule, but this waiver applies only with respect to bodily injury arising out of the operations described in the schedule where you are required by a written contract to obtain this waiver from us. This endorsement shall not operate directly or indirectly to benefit anyone not named in the Schedule. The premium for this endorsement is shown in the Schedule. Schedule 1. ( ) Specific Waiver Name of person or organization (X)Blanket Waiver Any person or organization for whom the Named Insured has agreed by written contract to furnish this waiver. 2. Operations: All Texas operations 3. Premium: The premium charge for this endorsement shall be 2.00 percent of the premium developed on payroll in connection with work performed for the above person(s)or organization(s) arising out of the operations described. 4. Advance Premium: Included, see Information Page 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 8/4123 at 12:01 a.m.standard time,forms a part of: Policy no. 0002018278 of Texas Mutual Insurance Company effective on 8/4/23 Issued to: BENNETT PAVING INC This is not a bill Authorized representative NCCI Carrier Code: 29939 8!2123 PO Box 12058,Austin,TX 78711-2058 1 of 1 texasmutual.com 1 (800)859-5995 1 Fax(800)359-0650 WC 42 03 04 B XX CNA C (Ed. 018 8) ADDITIONAL INSURED WITH PRIMARY/NON CONTRIBUTORY PROVISION ENDORSEMENT It is understood and agreed that, solely with respect to coverage provided under the section entitled COVERAGES the subsection entitled Pollution Incident, the Policy is amended as follows: The Section of the Policy entitled DEFENSE is amended by the addition of the following: Additional Insured with Primary/Non-Contributory Provision A. We also have the right and duty to defend a claim against any person or organization whom you are required to add as an additional insured under this Policy under a written contract or written agreement, provided such contract or agreement: 1. is currently in effect or becomes effective during the term of this policy; 2. was executed prior to the bodily injury or property damage for which such additional insured seeks coverage; and 3. expressly requires making the person or organization an additional insured for pollution coverage such as is provided by this policy. B. The insurance provided to the additional insured is limited as follows: 1. The person or organization is an additional insured only with respect to liability for bodily injury or property damage: a. caused entirely by your negligent acts or omissions or those of others working on your behalf; and b. for which you would be covered under this policy, if the claim had been brought against you. 2. If defense of such a claim results in the additional insured's legal obligation to pay compensatory damages for bodily injury or property damage described in paragraph 2.a. above, then subject to all of the terms and conditions of this policy, we will pay such damages in excess of the self-insured retention up to the applicable Limit of Liability. 3. This insurance is excess of all other insurance available to the additional insured, whether on a primary, excess, contingent or any other basis. But if required by written contract or agreement to be primary and non-contributory, this insurance will be primary and non-contributory relative to insurance on which the additional insured is a Named Insured. 4. Any coverage granted by this provision shall apply only to the extent permissible by law. All other terms and conditions of the Policy remain unchanged. 0 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. CNA88508XX(01-18) Policy No: Page 1 of 1 Endorsement No: Effective Date: Insured Name: Copyright,CNA All Rights Reserved. CNA C (Ed3102 5) SUBROGATION AMENDMENT ENDORSEMENT It is understood and agreed that the Section of the Policy entitled CONDITIONS, the Condition entitled Subrogation, is deleted in its entirety and replaced by the following: Subrogation If any of you have rights to recover amounts from another, those rights are transferred to us to the extent of our payment. You must do everything necessary to secure these rights and must do nothing after a claim is made to jeopardize them. We hereby waive subrogation rights against any person or organization with whom the Named Insured has made a written agreement, prior to a claim or circumstance, to waive such fights, to the extent provided in such agreement. 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 said Policy, unless another effective date is shown below, and expires concurrently with said Policy. 0 a s CNA83662XX(Ed. 10-15) Policy No: Page 1 of 1 Endorsement No: Effective Date: Insured Name: Copyright,CNA All Rights Reserved. TeXI o WORKERS' COMPENSATION INSURANCE WORKERS' COMPENSATION 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 Page. In the event of cancellation or other material change of the policy, we will mail advance notice 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 2. 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 8/4/23 at 12:01 a.m.standard time,forms a part of: Policy no. 0002018278 of Texas Mutual Insurance Company effective on 8/4/23 Issued to: BENNETT PAVING INC "46 This is not a bill Authorized representative NCCI Carrier Code: 29939 8/2123 PO Box 12058,Austin,TX 78711-2058 1 of 1 texasmutual.com 1 (800)859-5995 1 Fax(800)359-0650 WC 42 06 01