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Contract - Lone Star Sitework, LLC - 6/27/2024 CITY OF ROUND ROCK BID COPY/ORIGINAL TRANSPORTATION DEPARTMENT ROUND ROCK TEXAS Project Manual For: East Main Street Gaps Sidewalk Project March 2024 r�i�P�F Of T FxQS Prepared By: � 11 Volkert, Inc. / ARNOLD GONZALES, JR. 801 E. Old Settlers Blvd., Suite 120 /............................ . /ii 98234 Round Rock, Texas 78664 Iljox •.IICENSEZ�.•'��a�r� Project No. 1107201.000 APPROVED a �" B'�" 03-18-24 CITY ATTORNEY VOLKERT TBPE Firm Registration No F-12679 00300 BID FORM BID FORM PROJECT NAME: East Main Street Gaps Sidewalk Project PROJECT LOCATION: Round Rock,Texas OWNER: City of Round Rock,Texas DATE: May 1,2024 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 East Main Street Gaps Sidewalk Project-Main Street&Circle Drive 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 roundrocktexas.aov/solicitations by the close of business on Friday,May 3rd,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#I Add#1 -5/2/2024 BASE BID Bid Approx. Item Description Item Quantity Unit and Written Unit Price Unit Price Amount 1 38.4 STA ITEM-R100-6002 PREP ROW complete in place per STATION for Ninety-Five dollars and Zero cents. $ 95.00 $ 3,648.00 2 717.1 SY ITEM-R104-6017 REMOVING CONC (DRIVEWAYS) complete in place per SQUARE YARD for Fourteen dollars and Thirty cents. $ 14.30 $ 10,254.53 3 1037.2 LF ITEM-R104-6021 REMOVING CONC(CURB) complete in place per LINEAR FOOT for Six dollars 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 and Zero cents. $ 6.00 $ 6,223.20 4 374.0 SY ITEM-R105-6008 REMOVING STAB BASE AND ASPH PAV(6") complete in place per SQUARE YARD for Twenty Five dollars and Eighty Five cents. $ 25.85 $ 9,667.90 5 1450.0 CY ITEM-R110-6001 EXCAVATION(ROADWAY) complete in place per CUBIC YARD for Twenty Eight dollars and Ninety cents. $ 28.90 $ 41,905.00 6 725.0 CY ITEM-R132-6003 EMBANKMENT(FINAL)(ORD COMP)(TY B) complete in place per CUBIC YARD for Twenty Four dollars and Zero cents. $ 24.00 $ 17,400.00 7 1945.0 SY ITEM-R162-6002 BLOCK SODDING complete in place per SQUARE YARD for Nine dollars and Eighty cents. $ 9.80 $ 19,061.00 8 556.2 SF ITEM-R423-6004 RETAINING WALL(CONC BLOCK) complete in place per SQUARE FOOT for Forty Two dollars and Zero cents. $ 42.00 $ 23,360.40 00300-9-2015 Page 2 of 6 Bid Form BASE BID Bid Approx. Item Description Item Quantity Unit and Written Unit Price Unit Price Amount 9 13.1 CY ITEM-R432-6001 RIPRAP(CONC)(4 IN) complete in place per CUBIC YARD for Six hundred forty nine dollars and Zero cents. $ 649.00 $ 8,501.90 10 406.7 LF ITEM-R464-6003 RC PIPE(CL I11)(18 IN) complete in place per LINEAR FOOT for One hundred eighty one dollars and Forty cents. $ 181.40 $ 73,775.38 11 32.0 EA ITEM-R467-6357 SET(TY II)(181N)(RCP)(3:1)(P) complete in place per EACH One thousand three hundred for eighty dollars and Zero cents. $ 1,380.00 $ 44,160.00 12 6.0 EA ITEM-R479-6005 ADJUSTING MANHOLES complete in place per EACH for One thousand nine hundred ten dollars and zero cents. $ 1,910.00 $ 11,460.00 13 32.0 EA ITEM-R496-6004 REMOV STR(SET) complete in place per EACH for two hundred eighty dollars and zero cents. $ 280.00 $ 8,960.00 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 14 16.0 EA ITEM -R496-6016 REMOV STR(PIPE) complete in place per EACH for one hundred ninety one dollars and zero cents. $ 191.00 $ 3,056.00 15 3.0 EA ITEM-R496-6030 REMOV STR(BOLLARD) complete in place per EACH for one hundred forty dollars and zero cents. $ 140.00 $ 420.00 16 1.0 LS ITEM -R500-6001 MOBILIZATION complete in place per LUMP SUM Fifteen thousand eight hundred for fifty dollars and zero cents. $ 15,850.00 $ 15,850.00 17 4.0 MO ITEM-R502-6001 BARR, SIGNS,TRAFFIC HANDLING complete in place per MONTH for One thousand one hundred dollars and zero cents. $ 1,100.00 $ 4,400.00 18 3314.0 LF ITEM -R506-6041 BIODEG EROSN CONT LOGS (INSTL)(12") complete in place per LINEAR FOOT for six dollars and thirty cents. $ 6.30 $ 20,878.20 19 3314.0 LF ITEM-R506-6043 BIODEG EROSN CONT LOGS (REMOVE) complete in place per LINEAR FOOT for one dollars and ten cents. $ 1.10 $ 3,645.40 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 20 1130.0 LF ITEM-R529-6015 CONC CURB(TY C 1) complete in place per LINEAR FOOT for Thirty eight dollars and sixty cents. $ 38.60 $ 43,618.00 21 985.2 LF ITEM -R529-6024 CONC CURB(MOUNTABLE) complete in place per LINEAR FOOT for twenty six dollars and twenty cents. $ 26.20 $ 25,812.24 22 1075.5 SY ITEM-R530-6004 DRIVEWAYS(CONCRETE) complete in place per SQUARE YARD for Ninety two dollars and sixty cents. $ 92.60 $ 99,591.30 23 1903.9 SY ITEM-R531-6002 CONC SIDEWALKS(5") complete in place per SQUARE YARD for Eighty three dollars and zero cents. $ 83.00 $ 158,023.70 24 1.0 EA ITEM-R531-6004 CURB RAMPS(TY 1) complete in place per EACH for One thousand eight hundred sixty dollars and zero cents. $ 1,860.00 $ 1,860.00 25 1.0 EA ITEM-R531-6005 CURB RAMPS (TY 2) complete in place per EACH for Two thousand seventy six dollars and zero cents. $ 2,076.00 $ 2,076.00 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 26 5.0 EA ITEM -R531-6013 CURB RAMPS(TY 10) complete in place per EACH for One thousand eight hundres sixty dollars and zero cents. $ 1,860.00 $ 9,300.00 27 60.8 LF ITEM-R550-6007 CHAIN LINK FENCE(REPAIR) complete in place per LINEAR FOOT for Nine dollars and fifty cents. $ 9.50 $ 577.60 28 16.0 EA ITEM -R560-6025 RELOCATE EXISTING MAILBOX complete in place per EACH for One hundred ninety dollars and zero cents. $ 190.00 $ 3,040.00 29 2.0 EA ITEM-R752-6018 STUMP REMOVAL(GREATER THAN 12") complete in place per EACH for Four hundred eighty dollars and zero cents. $ 480.00 $ 960.00 30 1.0 EA ITEM-R1004-6001 TREE PROTECTION complete in place per EACH for Six hundred dollars and zero cents. $ 600.00 $ 600.00 31 $ 10,000.00 LS FORCE ACCOUNT (MISC. IRRIGATION REPAIRS) complete in place per LUMP SUM for Ten thousand dollars and zero cents. $ 10,000.00 $ 10,000.00 00300-9-2015 Page 6 of 6 Bid Form TOTAL BASE BID (Items 1 thru 31 ) $ 682,085.75 Materials: $ 306,938.59 All Other Charges: $ 375,147.16 * Total: $ 682,085.75 * 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, C� Signature Cullen Harrison PO BOX 1867, Wimberley, TX 78676 Print Name Address Managing Member 512-393-1582 Title Telephone Lone Star Sitework, LLC Name of Firm May 8, 2024 Date ecre idd s a Crporatio 00200-9-2015 Page 1 of 1 Bid Form 00410 STATEMENT OF BIDDER'S SAFETY EXPERIENCE Page 1 00410 8-2014 Statement of Bidder's Safety Experience 00090654 Solicitation Requirements, Contract Forms & Conditions of Contract Statement of Bidder's Safety Experience Section 00410 Bidder must submit a signed Statement of Bidder's Safety Experience form with his Bid; failure to do so will constitute an incomplete Bid that may be rejected. In order to make a responsive Bid, Bidder must provide evidence that it meets minimum OSHA construction safety program requirements, has not been fined by OSHA for any willful safety violations in the past three years, and has a lost time injury rate that doesn't exceed the limits established below. All questions must be answered and data given must be clear and comprehensive. If necessary, questions may be answered on separate attached sheets. Company Name: Lone Star Sitework, LLC Address: PO BOX 1867, Wimberley, TX 78676 Phone: 512-393-1582 Completed by: Cullen Harrison Date: 05/07/2024 1. Does the company have a written construction Safety program? ✓❑Yes ❑No 2. Does the company conduct construction safety inspections? OYes ❑No 3. Does the company have an active construction safety-training program? ❑Yes R]No 4. Has the company been fined by OSHA for any willful safety violations in the past ❑Yes E]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 El 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 Q N/A B. Excavation 0 Yes ❑No ❑N/A C. Cranes ❑Yes []No E]N/A D. Electrical ❑Yes ❑No 0 N/A E. Fall Protection ❑Yes []No 0 N/A F. Confined Spaces ❑Yes []No [Z]N/A I hereby certify that the above information is true and correct. Signature Title Managing Member Page 1 00410 8-2014 Statement of Bidder's Safety Experience 00090654 Volkert, Inc. OLKERT 801 East Old Settlers Blvd. Suite 120 Round Rock,TX 78664 Office 737.241.2436 www.volkert.com May 2, 2024 RE: ADDENDUM#1 Project Name: East Main St. Gap Sidewalk Project Project Location: Main Street &Circle Drive, Round Rock,TX To all bidders: This Addendum forms a part of the Contract and clarifies, corrects, or modifies the original Construction Documents—Plans and Project Manual—dated March 18, 2024. Acknowledgement of this Addendum is required. All bidders shall acknowledge receipt of this Addendum on the Proposal Form. Failure to do so may subject the bidder to disqualification. DESCRIPTION OF ADDITIONS,CHANGES,AND/OR CLARIFICATIONS: 1. 00300 BID FORM (pg.6 of 6)—Project Manual pg. 20: • Line Item 31 has been revised to reflect a Lump Sum Force Account estimated quantity of$10,000 for potential irrigation repairs per City of Round Rock. Respectfully submitted, Arnold Gonzales,Jr., PE Q Associate Vice President Volkert, Inc. `v" fat ALABAMA • FLORIDA • GEORGIA • ILLINOIS • LOUISIANA • MISSISSIPPI • MISSOURI • NEW YORK NORTH CAROLINA • OKLAHOMA • PENNSYLVANIA • TENNESSEE • TEXAS • VIRGINIA • WASHINGTON,OC � K �1 OSHA's Form 300A (Rev.0412004) Note:You can type input into this form and save it. Year 2O Because the forms in this recordkeeping package are"fillable/writable" 23 PDF documents,you can type into the input form fields and U.S.Department of Labor Summary of Work-Related Injuries and Illnesses then save your inputs using the free Adobe PDF Reader. oaaup.tranai safety and Health Administration Pommapproved OMB- 1218-0176 All establishments covered by Pail 1904 must complete this Summary page,even if no work-related injuries or illnesses occurred during the year. Remember to review the Log to verify that the entries are complete and accurate before completing this summary. Using the Log,count the individual entries you made for each category. Then write the totals below,making sure you've added the entries from every page of the Log.If you had no cases,write-0." Establishment information Employees,former employees,and their representatives have the right to review the OSHA Form 300 in its entirety. They also have limited access to the OSHA Form 301 or its equivalent.See 29 CFR Part 1904.35,in OSHA's recordkeeping rule,for further details on the access provisions for voaraara6rrsnmamnama LONE STAR SITEWORK, LLC these forms. Street PO BOX 1867 WIMBERLEY 78676 City State TX Zip Total number of Total number of Total number of cases Total number of deaths cases with days with job transfer or other recordable Industry description(e.g.,Manufacture ojmora truck traders) away from work restriction cases HIGHWAY,STREET&BRIDGE CONSTRUCTION 0 0 00 North American Industrial Classification(NAILS),if known(e.g.,336212) (G) (H) (I) (d) 237310 Number of Days Employment Information(If you don't have these figures,.see the Total number of days Total number of days of Worksheet on the next page to estimate.) away from work job transfer or restriction 29 Annual average number of employees 0 0 Total hours worked by all employees last year 72,640.00 Sign here Injury and Illness Types Knowingly falsifying this document may result in a fine. Total number of... I certify that I have examined this document and that to the best of (M) 0 my knowledge the entries are true,accurate,and complete. (t)Injuries 0 (4) Poisonings .-- (2) Skin disorders 0 (5) Hearing loss 0 Company executive Title Phone 512-393-1582 pafeOl/15/2024 (3)Respiratory conditions 0 (6) All other illnesses 0 Post this Summary page from February 1 to April 30 of the year following the year covered by the form. Reset Public reposing burden for this collection of information is estimated to average 58 minutes per response,including time to review the instructions,search and gather the data nuded,and complete and review the collation of information Persons are act required to respond to the collection of information tmless it dispinvs a cumcndt valid OMB wovol number.If y—have am comments about these estimates or any other aspects of this data collection,wotect,US Department of tabor,OSHA Office of Statistical Analysis,Room N-3644,200 Combunion Avenuc,NW, Washington,ux 20210.Do not send the completed forms to this office. OSHA t s Form 300 (Rev 0412004) Note:You can type input into this form and save it. Attention:This form contains information relating to year 20 23 Because the forms In this recordkeeping package are"flllable/writable' employee health and must be used in a manner that Log of Work-Relate PDF documents,you can type into the input form fields and protects the confidentiality of employees to the extent U.S.Department of Labor then save your inputs using the free Adobe PDF Reader.In addition, possible while the information is beingused for Injuries and Illnesses the forms are programmed to auto-calculate as appropriate. occupational safety and health purposes. o..up.d.nat safety and Hearth ndnolm.neala Fomt approved OMB W 12IM176 Reminders: Please Record: •Complete aninjury and illness incident Report(OSHA Form 301)orequivaient LONE STAR SITEWORK,LLC •Information about every work-related death and about every work-related injury or illness that involves loss of form for each injury or illness recorded on this form.if you're not sure whether a Est eDlishment name consciousness,restricted work activity or job transfer,days away from work or medical treatment beyond first aid. case is recordable,call your local OSHA office for help. Significant work-related injuries and illnesses that are diagnosed by a physician or licensed health care professional. Feel free to use two lines for a single case if you need to. ,,W I M BERLEY Staff TX Work-related injuries and illnesses that meet any of the specific recording criteria listed in 29 CFR Part 1904. Complete the 5 steps for each case. , through 1904.72. �MIIIII 11 Step 3.Classify the case e the case Step 1.Identify the person Step 2.Describ I SELECT ONLY ONE circle based on the (F) most serious outcome* Enter the number of Select one colrrrrtn: (A) (e) (C) (0) (E) days the injured or/it parts of bod worker was: Case Employee's name Job title Date of injury Where the event occurred Describe injury or illntys,pe Y no (e.g.,Welder) or onset of (e.g.,Loading dock north end) affected,and objectisubstance that Remained nWork nlrca' illness directly injured or made person 01(e. (M) Second degree Mans on right joreann�inm On job (e b, 2110) Days aw.y Job tr.nsfer Other record- Prat transferor acetylene torch) Death ham work or reatrlctlon able cases from rection _ work (G) (H) (I) (J) (K) (L) (t) (2) (3) (4) (5) (g) 0 0 0 0 _day, _day, 000000 Reset rtonhiaay l 0 0 0 O _day, —day, 000000 RS ] rtronM/day —/— 0 0 0 0 —.days —,.Ya 000000 Reset _ nam/day Reset nro,tbday 0 0 0 0 _day, _days 000000 O 0 0 0 _days _tlays 000000 Reset month day O O 0 O 000000 0 000 0 Refset / _says ---says menm/day 00 0000 Reset 0 0 0 0 _oar, _says Mont.i day _days —,a, 000000 D l— 0 � � month,daY 0 00000 Retset I— 0 0 0 O —day, _oar, north day 000000 —/— Reset 0 0 0 0 _day, —days month i day 1O O O O O 0 0 0 0 0 0 Public reporting Maden for thus collection of inrfunrotiou is esurmled to average 14 minutes per resp a ,including time to miry de Page totals ——— [Add a Form Pae 3 a uatructions.search sod gather ik data ne dad,and wmplete and review the colleeYion of irdomnnan Parsons vc rnt rogwrtd to g 8e sure to fransler Mese totals ro the Summary papa(Form 300A)before you post i[ respatd to I.colhection of inforrution urka it displays a nrnenah valid CMB comml muobcr.It you bare am continents about these nnnnles oc mry other aspera of this data wllecuon wnma t1S llepartmem of Labor.OSHA r mss ro thus office-h Arelysis,Room m e N-1644,200 Constumion Averme,NW,WaAtolttun DC 20210 1M not send the conpkw (t) (2) (3) (4) (5) (g) OSHA's Form 301 (Rev.04/2004) Note:You can type Input Into this form and save it. Attention:This form contains information relating to Because the forms in this recordkeeping package are"fillable/writable" employee health and must be used in a manner that Injury and Illness PDF documents,you can type into the input form fields and protects the confidentiality of employees to the extent Incident Report then save your inputs using the free Adobe PDF Reader.In addition, possible while the information is being used for U.S.Department of Labor the forms are programmed to auto-calculate as appropriate. occupational safety and health purposes. o«aa.uan.f s.t.ty and,t..nh nd.,tni.v.a.n Form apptm�cd(M1B m.121"176This Injury and Illness Incident Report is one of the Information about the employee Information about the case first forms you must fill out when a recordable 1) Full name 10)Case number from the Log (Transfer the care number from the Log ofier you record rhe rose.) work-related injury or illness has occurred.Together 11)Date of injury or illness with the Log of Work-Related Injuries and Illnesses 2) Street Mouth Dav Year and the accompanying Summary,these forms help the employer and OSHA develop a picture of the City State ZIP 11)Time employee began work(HH MM) O AM QPM extent and severity ofwork-related incidents. 13)Time of event(HH.MM) O AM O PM O Check irtime cacraw be detensined Within 7 calendar days after you receive 3)Date of birth "Re fields 14 to 17:Please do not include a personally identifiable information PII Y Y any p Y' ( )Pertaining to worker(s)involved in the incident(e.g.,no names,phone numbers,or Social security numbers>. information that a recordable work-related injury or Month Day Yea illness has occurred,you must fill out this form or an 4) Date hired 14)s What was the employee dohtp fust before the Incident occurred?Describe the activity,as well as the equivalent.Some state workers'compensation, NI-th D,- Year tools,equipment,or material the employee was using.Be specific.Examples."climbing a laddor while carrying roofing materials","spraying chlorine from hand sprayer";"daily computer key-entry." insurance,or other reports may be acceptable 5)OMale OFemale substitutes.To be considered an equivalent form,any substitute must contain all the information asked for Information about the physician or other health care professional on this form. 6)Name of physician or other health care professional 15)•What Happened?Tell us how the injury occurred.Examples:"When ladder dipped on wet floor,worker fell According to Public Law 91-596 and 29 CFR 20 feet","Worker was sprayed with chlorine when gasket broke during replacement";"Wakv developed 1904,OSHA's necordkeeping rule,you must keep 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 the printout or insert additional form Facility pages in the PDF,and then use as many as you need. 16)•What was the lrllury or illness?Tell us the part of the body that was affected and how it was etre ted. Examples:"strained back";"chemical bum,hand';"carpal tunnel syndrome." Street City State ZIP 17)•What object or substance directly harmed the employee?Examples:'concrete floor";"chlorine"; Completed by G�/ji�?� 9)Was employee treated in an emergency roam? "radial arm saw."Iffhis question does not apply to the incident,leave if blank 0 Yes Title Managing Member o No 9)Was employee hospitalized overnight as an in-patient'. 18) N the employee died,when did death occur! Date of death Phone 512-393-1582 Date 01/15/2024 O Yes Month Dav year Mtsmh Day Year © NO I Add a Form Page Reset 1 Public reporting burden for it.,collect of mrorminon is estimated to asenge 22 mlranes per myoma,urJuding nine for reviewing imtrucimr s,searetung etening data sources,gm}cnng and rwrevning dr data welled,and eompkarrg and re—ing the collection of irdorrmtion Persons are int requited to respond to the eellecum of isdonnvu,n unieu n ehWL ys a current valid OMB control nnniber.If you have.try commmats atom this esnmme or am'other mpecrs of ifs data collecuoq including woestiom for redumng this burden,comae.US Depam—i of Labor.OSHA Otice of Stvistical Mislysis,Room N-3644.200 Consaimion Arente,NW,Washington,DC 20210.Do not sed the comphYN toner lo tlas oflK OSHA's Form 300A (fieY.o,)zooa) Year 2022 001 Summary of Work-Related Injuries and Illnesses U.S.Department ofLabor Occupatbna15a1ety and/1eaIM Administration Form ap{xwed OM1IB no 121&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 verily 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 SITEWORK,ew the OSHA Form 300 in Your establishment name LONE STAR SITORK,LLC its entirety. They also have limited access to the OSHA Form 301 or its equivalent See 29 CFR 1904.35,in OSHA's Recoalkeeping rule,for further details on the access provisions for these forms. Street PO BOX 1967 Umbar of Cases Cly WIMBERLEY State TX Zip 79676 Industry description(e.g.,Manufacture of motor truck traders) Total number of Total number of Total number of cases Total number of HIGHWAY,STREET&BRIDGE CONSTRUCTION deaths rases with days with job transfer or other recordable away from work restriction Cases Standard Industrial Classificabon(SIC),i1 known(e.g.,SIC 3715) 0 0 0 0 _ (G) (H) (q (J) OR North Amsncan Industrial Classification(NAICS),d known(e.g.,336212) 2 3 7 3 1 0 Number of DayIF Employment information Total number of Total number of days of days away from job transfer or restriction Annual average number of employees 26 wnrk Total hours worked by all employees last 0 0 year 62,862 (K) (L) Injury and illness Types 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 I certify that 1 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 MANAGINGMEMBE Company executive Title 512-393-1592 1012/1023 Post this Summary page from February t to April 30 of the year following the year covered by the form Phone Date Public reporting burden for this collectbn of information is estimated to average 58 minutes per response,induding live to review the klssudion,search and gather the data needed,and complete and review the colledlon of intonation.Persons are not required to respond to the collection of int—ation unless It displays a currently valid OMB control number.fi you have any comments about these estimates or airy aspects of this data collection,contact:US Department of Labor,OSHA Once of Statistics.Room N-3644,200 Constitution Ave.NW.Washington,DC 20210.Do rol send the most d farms to this offi- 4Y '.�?�s'rird4`�3.d�&:�s�i)1S''SISS"at5r�`i:�©"�i;r'�iiC�."�`�:::9e�:�+-h}r_._,¢:;�^r.d.':Zr.'"«s:."�..,s'..fi5'S"!i:t..:�k�.':."vl°..-.u:�.J.�RS'�'�'vsmrraru-•• ,w' r�. ..3"".a1:7.. .. ..m ,.. _ . :.-ru ... .. Attention: This form contains information relating 40v OS HA's Form 300 (Rev.01/2004) that protectsmployee health and must be used in a manner protects the confidentiality of employees to the Year 22 extent possible while the information is being used Log of Work-Related Injuries and Illnesses for occupational safety arid 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 or job transfer,days away from work,or medical treartment Form approved OMB no 1218-0176 beyond fust aid.You must also record significant work-related injuries and finesses 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 it you need to.You must complete an Establishment name LONE STAR SITEWORK,LLC 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 WIMBERLEY State TX 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"inial'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) h illness forearm from acetylene torch) D On job $ m (mo./day) Death trap work Remained at work ays away Away transfer or c r o From restriction 3.0 Job transfer Other record- Work (days) Z• C o I restriction able cases (days) c pt 0 a° M a (G) (H) (1) (J) (K) (L) (1) (2) (3) (4) (5) (6) Page totals o 0 0 0 1 0 1 0 1 0 0 1 0 0 0 1 0 Be sure to transfer these totals to the Summary page(Form 300A)before you post it. c a o m Public reporting burden for this collection of information is estimated to average 14 minutes per response,including time o n a to review the instruction,search and gather the data needed,and complete and review the collection of information. Y a m Persons are not required to respond to the collection of information unless 0 displays a currently valid OMB control kn = o number. If you have any continents about these estimates or any aspects of this data collection,contact US Q 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) r ,-n Attention: This form contains Information relating to ,�` OSHA's Form 301 employee health and must be used in a manner that `� protects the confidentiality of employees to the extent Injuries and Illnesses Incident Report possible while they and health is being used for U.S.Department of Labor occupational safety and health purposes. Occupational Safety and Health Administration Form approved OMB no.1218-0176 Information about the employee Information about the case 1) Full Name 10) Case number from the Log (7ransfertne case numberfrom the Log altar you record me case.) This Injury and Illness Incident Report is one of the 2) Street 11) Date of injury or illness first forms you must fill out when a recordable work- related injury or illness has occurred. Together with City State Zip 12) Time employee began work AM/PM the Log of Work-Related injuries and Illnesses and the accompanying Summary,these forms help the 3) Date of birth 13) Time of event AM/PM Check if time cannot be determined employer and OSHA develop a picture of the extent 'Pb.se do not include any personally identifiable information(PIU pertaining to workerls)irwowed 1.H.i,"ent(e-g,no mantes,done and severity of work-related incidents. numbers,or ssNs)n the"lowing fields. 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 information that a recordable work-related injury or as the tools,equipment or material the employee was using. Be spec. Examples: "climbing a illness has occurred,you must fill out this form or an 5)❑Male ladder while carrying roofing materials";"spraying chlorine from hand sprayer';"daily computer key- equivalent. Some state workers'compensation, DFemaie entry." 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. Examples:"strained back","chemical burn,hand";"carpal tunnel syndrome." Street City State Zip _ 8) Was employee treated in an emergency room? Completed by / - Yes '17) What object or substance directly harmed the employee? Examples:"concrete floor` �No "chlorine";"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 a (a 12s FiYes F-JNo 18) If the employee died,when did death occur? Date of death Public reporting burden for this wilection 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 14-3844,200 Constitution Ave,NW,Washington,DC 20210. Do not send the completed forms to this office. OSHA's Form 300A (Rev.04/2004) Note:You can type Input into this form and save it. Year 2O Because the forms in this recordkeeping package are"fillable/writable° 21 Summary of Work-Related Injuries and Illnesses PDF documents,you can type into the input form fields and then save your inputs using the free Adobe PDF Reader. U.S.Department of Labor o..uv.tr...i s.ney..d n..tee Adnint.tr.n.. Finn approved OMB ro.121&0176 All establishments covered by Part 1904 must complete this Summary page,even if no work-related injuries or illnesses occurred during the year Remember to review the Log to verify that the entries are complete and accurate before completing this summary. Using the Log,count the individual entries you made for each category. Then write the totals below,making sure you've added the entries from every page of the Log.If you had no cases,write"0." Establishment information Employees,former employees,and their representatives have the right to review the OSHA Form 300 in its entirety. They also have limited access to the OSHA Form 301 or its equivalent.See 29 CFR Part 1904.35,in OSHA's recordkeeping rule,for further details on the access provisions for Your establishment name LONE STAR SITEWORK, LLC these forms. street PO BOX 1867 Number of Cases Cit WIMBERLEY state TX zip lslLot0 Total number of Total number of Total number of cases Total number of deaths cases with days with job transfer or other recordable Industry description(e.g.,Manufacture ofmotor truck trailers) away from work restriction cases HIGHWAY, STREET&BRIDGE CONSTRUCTIOW 0 0 0 0 (G) (H) (I) (J) North American Industrial Classification(NAICS),if known(e.g.,336212) 237310 I Number of Days Employment information(ifyou don't have thesefgures,see the Total number of days Total number of days of Worksheet on the next page to estimate.) away from work job transfer or restriction Annual average number of employees 23 0 0 Total hours worked by all employees last year 58,700,CO (K) (L) Sign here injury ' Illness TypesKnowingly falsifying this document may result in a fine. Total number of... I certify that I have examined this document and that to the best of (M) my knowledge the entries alb,accurate,and complete. (1)Injuries 0 (4) Poisonings 0 (YlCit"eitt tf1A (2) Skin disorders 0 (5) Hearing loss 0 Company executive Title 0 (6) All other illnesses 0 ph.,512-393-1582 Date 01/11/2022 (3)Respiratoryconditions Post this Summary page from February 1 to April 30 o1 the year following the year covered by the form. Reset Public reporting burden for this collection of information is estimated to ar erage 58 minutes per response,including time to review the instructions,search and gather the data needed,and complete and review the collection of information.Persons are not required to respond to the collection of intonation unless it display s a currenth valid OMB control number.If you have any comments about these esti.utes or are,,other aspects of this data collection,contact US Department of Labor,OSHA Ounce of Statistical Amlvsis.Room N-3644,200 Constitution Avenue,NW, Washington,DC 20210_Do mi sent the completed forms to this odic,, Pip OSHA's Form 300 (Rev. 04/2004) Note:You can a in ut into this form and save it tYP P Attention:This form contains information relating to Logo f Work-Related ted Because the forms in this recordkeeping package are"fillable/writable" employee health and must be used in a manner that g PDF documents,you can type into the input form fields and protects the confidentiality of employees to the extent Year 20 21 then save your inputs using the free Adobe PDF Reader.In addition, possible while the information is being used for U.S.Department of Labor Injuries and Illnesses the forms are programmed to auto-calculate as appropriate. occupational safety and health purposes. J P `7 purposes.Y occupational Safety and Health Administration Please Record: Reminders: form approvrd OMB rn.1219-0176 •Information about every work-related death and about every work-related injury or illness that involves loss of Complete on Injury and Illness Incident Report(OSHAFonn 301)orequivalent consciousness,restricted work activity orJob transfer,days away from work or medical treatment beyond first aid form for each injury or illness recorded on this form.Ifyou're not sure whether a esrabl;semen hams LONE STAR SITEWORK, LLL Significant work-related injuries and illnesses that are diagnosed by a physician or licensed health care professional. case is recordable,call your local OSHA office tar help. Work-related injuries and illnesses that meet any of the specific recording criteria Its led in 29 CFR Part 1904.8 Feet free touse two lines for asingle case ifyouneed to. �/t/IIVIBERLEY state TX through I W4.12. Complete the 5 steps for each case. Step 1. .•l7tify the person Step 2.Describe the case ,f 3.Classify the case .� SELECT ONLY ONE chele based on tho (A) (B) (C) (D) (E) (F) Enter the number of days the Injured or Ifl Select one column: Case Fraployee's name Job title Date of injury Where the event occurred Describe injury or Olness,parts or body worker was: no. (e.g,Welder) or onset of (e.g.,Loading dank north end) affected,and object/substance that illness directly injured or made person ill(e. Remained at Work (e.g.,2'/0) Secorul degree burns on nghr jorearm)�iom bines acetylene Iorch) Days away Job transfer other record- Away on job (M) Death from work or restriction able casae from transfer or '� { work restriction (G) (M (1) (J) (K) (L) Sa s s �a Reset / (1) (2) (3) (4) (5) (6) month/day 0 0 0 0 _sera _cars 0 00000 Ref;et / mored/day_ 0 0 0 O _days _days 000000 R®set red day_/_ 0 0 0 0 _stye _day. OOOOOO mo / Reset / red/day_ 0 0 0 0 _deY. _days 000000 mo Reset 0 0 0 0 _eeys _days 000000 morin/day Reset rin/day 0 0 0 0 _car. —car. 000000 mo Reset mnm;day O O 0 0 _aero _ears 000000 Reset month i dry O O O O _aero ,car• 000000 in/aey 0 0 0 0 _days _days 000000 mor Reset _/ in/aey_ 0 0 0 0 _ear. _dare 000000 mor Public repumug burden for this collection of information is emimetcd to ovcmge 14 minutes per response,including cmc to n,i: thePagetotals 0 0 0 0 0 0 0 0 0 0 0 0 imndcdons,search and)rather the data needed,mid compkk and review the collection of idbrmnaon P—m are not required M tespotd to the collection of intonation unless it displays a otnently valid OMB central runtber If you have any comments about these Add a Form Page ga sure to transfer these totals to the Summa! is` a Mor aey other aspecu of thiq data wllection wmsol U S Deptm—e4 of Lbor.OSHA Office of Statislcal Anah.,Room Summary page(Form 300A)before you post it g g�p 5 S N-1644.200 Conuhution Avenue,N W,Watlington,DC 20210 Do int send the completed tomo to this of ic,- .9 a c (1) (2) (3) (4) (5) (6) OSHA'S Form 301 (Rev.04/2004) Note:You can type Input Into this form and save It Attention:This form contains information relating to Injury and Illness Because the forms in this recordkeeping package are'fillable/writable" employee health and must be used in a manner that PDF documents,you can type into the input form fields and protects the confidentiality of employees to the extent Incident Report then save your inputs using the free Adobe PDF Reader.In addition, possible while the information is being used for U.S.Department of Labor the forms are programmed to auto-calculate as appropriate. occupational safety and health purposes. occap.d.n.l s.r.ty and Hcalth Admrni.ha.h n Foos approved OMB no.1218-017( This Injury and Illness Incident Report is one of the Information about the employee Information about the case fust forms you must fill out when a recordable 1)Full name 10)Case number from the Log (Transfer the case nrrmherfrom the Log afrer)rw remrd da care) work-related injury or illness has occurred.Together 11)Date of injury or illness with the Log of Work-Related Injuries and Illnesses 2)street Monte Day Year and the accompanying Summary,these forms help 12)Time employee began work(HH.N" O AM O PM the employer and OSHA develop a picture of the City state ZIP 13)Time of event(HH MM)extent and severity of work-related incidents. OAM ()PM O Check if time cannot be determined Within 7 calendar days after you receive 3) Date of birth • y personally identifiable information(Pli)pertaining to Y Y Re fieltia 14 to 17:Please do not include an information that a recordable work-related injury or Month Day Year worker(s)involved in the incident(e.g.,no names,phone numbers,or Social Security numbers). illness has occurred,you must fill out this form or an 4) Date hired 14)•What was the employee doing Just before the Incident occurred?Describe the activity,as well as the tools,equipment,or material the employee was using.Be specific.Exmnples."climbing a ladder while equivalent.Some state workers compensation, Month Day Yta carrying roofing materials';"spraying chlorine from hand sprayer';"daily computer key-entry." insurance,or other reports may be acceptable 5)O Male O Female substitutes.To be considered an equivalent form,any Information about the physician or other health care substitute must contain all the information asked for professional on this form. 6)Name of physician or other health care professional 15)•What Happened?Tell us how the injury occurred.Examples:"When ladder slipped on wet floor,worker fell According to Public Law 91-596 and 29 CFR 20 feet","Worker was sprayed with chlorine when gasket broke during replacement';"Worker developed 1904,OSHA's recordkeeping rule,you must keep 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 the printout or insert additional form Facility pages in the PDF,and then use as many as you need. 16)•What was the Injury or Illness?Tell us the pari of the body that was affected and how it was affected. Examples:"strained back","chemical bum,hand";"carpal tumid syndrome." Street City State ZIP 17•What object or substance directly harmed the employee?Examples:"concrete floor";"chlorine"; Completed by CULLEN HARRISON 8)Was employee treated in an emergency room? "radial arm saw."Ifthis question does not apply to the incident,leave it blank O Yes Title MANAGING MEMBER O No 9)Was employee hospitaiiied overnight as an in-patient? tg) If the employee died,when did death occur? Date of death Phone 512-393-1582 Date 01-11-2022 O Yes Mord, Day Yea Month Day Year O No [ Add a Form Page Reset Public reporting barrim for this collection of adomation is estimated to enrage 22 m to per response,irschsdiog time for--.g instnrctiom,scatting toasting dao sources,pikong and rmtuaining the does ta..3.d,and—Ti ting and reviewing the colkaion of infornntion Persons are not required to nspoM to the Boll swon of information unless it dispmvs a current valid OMB control number.If you have am comments sbosd this enimace or any other aspeos of tins dam collection toehrding suggestions for reducing this burden,contact US Debarment of Labor.OSHA ice of Smrrsucal Amlyso,Room N-3644,200 Coasfinnion As .NW,W ashiai;im DC 20210.Do not send tie completed forms to this office. BID BOND THE STATE OF TEXAS § § KNOW ALL BY THESE PRESENTS: COUNTY OF WILLIAMSON § That Lone Star Sitework, LLC of the City of Wimberley County of Hays State of Texas as Principal, and Merchants Bonding Company(Mutual)authorized under the laws of the State of Texas to act as surety on bonds for principals,are held and firmly bound unto the CITY OF ROUND ROCK,TEXAS("Owner"), in the penal sum of Five Percent(5%)of the total amount of the Bid of the Principal submitted to the Owner, for the Work described below; for the payment whereof,well and truly to be made,and the said Principal and Surety do herby bind themselves and their heirs, administrators, executors, successors and assigns, jointly and severally,as follows: In no case shall the liability of the Surety hereunder exceed the sum of Five Percent of the Greatest Amount Bid Dollars($ 5%G.A.B. ). 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 E. Main Street Gaps Sidewalk Project for which Bids are to be opened at the office of Owner on the 8th day of May 52024 . 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 8th day of the month of May __2024 . Lone Star Sitework, LLC Merchants Bonding Company(Mutual) Principal Surety ( (lgll �Gfrt56l'� Russ Frenzel Printed Name Printed Name By� By: Title: Title: Attommy-in-Fact Address: P.O. Box 867 Address: P.O. Box 14498 Wimberley, TX 78676 Des Moines, IA 50306-3498 00200 4-2020 Page 1 Bid Band 00443638 R ident Agent of Surety: ""Oh"A KCS S nater Brady K. Cox Printed Name 500 N. Central Expy., Ste 550 Street Address Plano, TX 75074 City, State,Zip Page 2 00200 4-2020 Bid Bond 00443638 MERCHANTS"L*4, BONDING COMPANY,. POWER OF ATTORNEY Know All Persons By These Presents,that MERCHANTS BONDING COMPANY(MUTUAL)and MERCHANTS NATIONAL BONDING, INC., both being corporations of the State of Iowa,d/b/a Merchants National Indemnity Company(in California only)(herein collectively called the "Companies")do hereby make,constitute and appoint,individually, Brady K Cox;Brent Baldwin;Brock Baldwin;Cynthia A Alford;John A Aboumrad;Keith Rogers;Kristi Meek;Michael B Hill;Neira Hernandez;Russ Frenzel;Samuel Freireich;Sylvia Thomas;William D Baldwin;Yamillec Ramos their true and lawful Attorney(s)-in-Fact, to sign its name as surety(ies) and to execute, seal and acknowledge any and all bonds, undertakings, contracts and other written instruments in the nature thereof, on behalf of the Companies in their business of guaranteeing the fidelity of persons, guaranteeing the performance of contracts and executing or guaranteeing bonds and undertakings required or permitted in any actions or proceedings allowed by law. This Power-of-Attorney is granted and is signed and sealed by facsimile under and by authority of the following By-Laws adopted by the Board of Directors of Merchants Bonding Company (Mutual) on April 23, 2011 and amended August 14, 2015 and adopted by the Board of Directors of Merchants National Bonding,Inc.,on October 16,2015. "The President, Secretary, Treasurer, or any Assistant Treasurer or any Assistant Secretary or any Vice President shall have power and authority to appoint Attomeys-in-Fact, and to authorize them to execute on behalf of the Company, and attach the seal of the Company thereto, bonds and undertakings,recognizances,contracts of indemnity and other writings obligatory in the nature thereof." "The signature of any authorized officer and the seal of the Company may be affixed by facsimile or electronic transmission to any Power of Attorney or Certification thereof authorizing the execution and delivery of any bond, undertaking, recognizance, or other suretyship obligations of the Company,and such signature and seal when so used shall have the same force and effect as though manually fixed." In connection with obligations in favor of the Florida Department of Transportation only, it is agreed that the power and aut hority hereby given to the Attorney-in-Fact includes any and all consents for the release of retained percentages and/or final estimates on engineering and construction contracts required by the State of Florida Department of Transportation. It is fully understood that consenting to the State of Florida Department of Transportation making payment of the final estimate to the Contractor and/or its assignee, shall not relieve this surety company of any of its obligations under its bond. In connection with obligations in favor of the Kentucky Department of Highways only,it is agreed that the power and authority hereby given to the Attorney-in-Fact cannot be modified or revoked unless prior written personal notice of such intent has been given to the Commissioner- Department of Highways of the Commonwealth of Kentucky at least thirty(30)days prior to the modification or revocation. In Witness Whereof,the Companies have caused this instrument to be signed and sealed this 23rd day of April 2024 •.•••'��••'••.• .••"'••. MERCHANTS BONDING COMPANY(MUTUAL) P�10Nq� •.,• �o%%G'�R'�A�• MERCHANTS NATIONAL BONDING,INC. �j�oRpoR,q �o'• �p0. P0 .9 d/b/a MERCHANTS NATIONAL INDEMNITY COMPANY o: -o- v 2003 1933 �'c: By .yJ. �,. •'.d.� .......... �` ••.b�i. ..••... \1a•� President STATE OF IOWA '•., f .••• '•.• ..' COUNTY OF DALLAS ss. On this 23rd day of April 2024 , before me appeared Larry Taylor, to me personally known, who being by me duly sworn did say that he is President of MERCHANTS BONDING COMPANY (MUTUAL)and MERCHANTS NATIONAL BONDING, INC.; and that the seals affixed to the foregoing instrument are the Corporate Seals of the Companies;and that the said instrument was signed and sealed in behalf of the Companies by authority of their respective Boards of Directors. �PR'A4s Penni Miller - Z Commission Number 787952 • • My Commission Expires tovvA January 20,2027 Nota b (Expiration of notary's commission does not invalidate this instrument) I,William Warner,Jr.,Secretary of MERCHANTS BONDING COMPANY(MUTUAL)and MERCHANTS NATIONAL BONDING,INC.,do hereby certify that the above and foregoing is a true and correct copy of the POWER-OF-ATTORNEY executed by said Companies,which is still in full force and effect and has not been amended or revoked. In Witness Whereof, I have hereunto set my hand and affixed the seal of the Companies on this 8th day of May 2024 -0- ...00a _ 2003 v 1933 :c• Secretary POA 0018 (1/24) •••••• MERCHANTS BONDING COMPANY., MERCHANTS BONDING COMPANY(MUTUAL) • MERCHANTS NATIONAL BONDING. INC. 2100 FLEUR DRIVE • DES MOINES, IOWA 50321-1158 • (800)678-8171 - (515)243-3854 FAX IMPORTANT NOTICE To obtain information or make a complaint: You may contact your insurance agent at the telephone number provided by your insurance agent. You may call Merchants Bonding Company (Mutual) toll-free telephone number for information or to make a complaint at: 1-800-678-8171 You may contact the Texas Department of Insurance to obtain information on companies, coverages, rights or complaints at: 1-800-252-3439 You may write the Texas Department of Insurance at: P. O. Box 149104 Austin, TX 78714-9104 Fax: (512) 475-1771 Web: http://www.tdi.state.tx.us E-mail: ConsumerProtection@tdi.texas.gov PREMIUM AND CLAIM DISPUTES: Should you have a dispute concerning your premium or about a claim you should contact the agent first. If the dispute is not resolved, you may contact the Texas Department of Insurance. ATTACH THIS NOTICE TO YOUR POLICY: This notice is for information only and does not become a part or condition of the attached document. SUP 0032 TX(12/13) 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 ( )day of ILL in the year 20� BETWEEN the Owner: City of Round Rock,Texas(hereafter"Owner"or"City") 221 East Main Street Round Rock,Texas 78664 and the Contractor Lone Star Sitwork,LLC ("Contractor") PO Box 1867 Wimberley,TX 78676 The Project is described as: East Main Street Gaps Sidewalk Project The Engineer is: Volkert,Inc 801 E.Old Settlers Blvd. Suite 120 Round Rock,TX 78664 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 1 of 5 Standard Form of Agreement 00443647 ARTICLE 3 DATE OF COMMENCEMENT;DATE OF SUBSTANTIAL COMPLETION;DATE OF FINAL COMPLETION 3.1 The date of commencement of the Work shall be the date of this Agreement unless a different date is stated below or provision is made for the date to be fixed in a Notice to Proceed issued by Owner. 3.2 The Contract Time shall be measured from the date delineated in the Notice to Proceed. 33 Contractor shall commence Work within Ten1( 0 ) calendar days from the date delineated in the Notice to Proceed. 3.4 Contractor shall achieve Substantial Completion of the items of Work listed on Attachment A to this Agreement no later than N/A (N/A )calendar days from issuance by Owner of Notice to Proceed, and Contractor shall achieve Substantial Completion of the entire Work no later than N/A ( /A )calendar days from issuance by Owner of Notice to Proceed, subject to adjustments of this Contract Time as provided in the Contract Documents. 3.5 If Contractor fails to achieve Substantial Completion of the Work(or any portion thereof)on or before the date(s)specified for Substantial Completion in the Agreement,Contractor shall pay to Owner,as liquidated damages, the sum of five hundred and No/100 Dollars($ 500.00 )for each calendar day that Substantial Completion is delayed after the date(s) specified for Substantial Completion. It is hereby agreed that the liquidated damages to which Owner is entitled hereunder are a reasonable forecast of just compensation for the harm that would be caused by Contractor's failure to achieve Substantial Completion of the Work(or any portion thereof)on or before the date(s)specified for Substantial Completion in the Agreement and is not a penalty. It is agreed that the harm that would be caused by such failure, which includes loss of expected use of the Project areas,provision of alternative storage facilities and rescheduling of moving and occupancy dates,is one that is incapable or very difficult of accurate estimation.It is hereby agreed that if Substantial Completion of the Work(or any portion thereof)is not achieved on or before thirty(30)days after the date(s) specified for Substantial Completion in the Agreement, the Owner shall have the option to either collect liquidated damages as set forth herein or to thereafter rely on its remedies under the Contract Documents and at law and in equity, including without limitation, the recovery of actual damages. The date(s) specified for Substantial Completion of the Work(or any portion thereof)in the Agreement shall be subject to adjustment as provided in the Contract Documents. 3.6 Contractor shall achieve Final Completion of the entire Work no later than One Hundred Twenty 1( 20 )calendar days from issuance by Owner of Notice to Proceed. ARTICLE 4 CONTRACT SUM 4.1 Owner shall pay Contractor the Contract Sum in current funds for Contractor's full and complete performance of the Work and all of Contractor's obligations under this Agreement. The Contract Sum shall be Six hundred eighty-two thousand eighty-five dollars and seventy-five cents ($682,085.75 ),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 X . Yes .If yes,please provide details below: tJ/A 00500 42020 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(10th)day of the next month.If an Application for Payment is received by Engineer and Owner after the application date fixed above,payment shall be made by Owner not later than one month after the Engineer issues a Certificate for Payment. 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 42020 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 Suel:11 ementary,Special,and other Conditions of the Contract are those contained in the Project Manual dated iv1 0Lu y 7.1.4 The Specifications are those contained in the Project Manual dated lvlal cu wL�1 7.1.5 The Drawings,if any,are those contained in the Project Manual dated A141 Cil LVLT 7.1.6 The Insurance&Construction Bond Forms of the Contract are those contained in the Project Manual dated iviarcu 7.1.7 The Notice to Bidders,Instructions to Bidders,Bid Form,and Addenda,if any,are those contained in the Project Manual dated March 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: A 1 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: Greg Ciaccio,PE gciaccio(&roundrocktexas.gov 512-218-7017 8.3 Contractor's representative is: Cullen Harrison cullen(a,lonestarsitework.c om PO Box 1867 Wimberley,TX 78676 8.4 Neither Owner's nor Contractor's representative shall be changed without ten(10)days'written notice to the other party. 00500 42020 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 fust written above and is executed in at least two(2) original copies,of which one is to be delivered to Owner. OWNER C(O_N-T^R^ACTORR,, CITY OF UN) OCK,TEXAS LSC -Sk--L( :501A. Ir L� Printed Nq LJ 4q IWO PqV'-, Printed Name: Title %JTitle: ff-t" 1 O-0,rYto\ fQkn'b ¢1- Date Signed: 2 2 Date Signed: ATTEST: 1v (09 AZJ7� City Clerk FOR CITY,APPROVED AS TO FORM: tty A orney 00500 42020 Page 5 of 5 Standard Form of Agreement 00443647 Bond No. 101178848 PERFORMANCE BOND THE STATE OF TEXAS § § KNOW ALL BY THESE PRESENTS: COUNTY OF WILLIAMSON § That Lone Star Sitework, LLC , of the City of Wimberley County of Hays , and State of Texas , as Principal,and Merchants Bonding Company(Mutual) authorized under the law of the State of Texas to act as surety on bonds for principals, are held and firmly bound unto the CITY OF ROUND ROCK,TEXAS (Owner), in the penal sum of Six hundred eighty-two thousand eighty-five dollars and 75/100 Dollars ($682,085.75 ) for the payment whereof, well and truly to be made the said Principal and Surety bind themselves, and their heirs, administrators, executors, successors and assigns,jointly and severally,by these presents: WHEREAS, the Principal has entered into a certain written Agreement with the Owner dated the ZS- day of J ,20? to which the Agreement is hereby referred to and made a part hereof as fully and tot the same ext nt as if copied at length herein consisting of: East Main Street Gaps Sidewalk Project 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 $682,085.75 sum of this Performance Bond, plus all costs and expenses, including attorney's fees and expert and consultant fees incurred by Owner to enforce its rights under this Performance Bond. IN WITNESS WHEREOF, the said Principal and Surety have signed and sealed this instrument this qkh day of _ , 201A. Lone Star Sitework, LLC Merchants Bonding Company (Mutual) Principal Surety arC-15 O n Russ Frenzel Printed Name Printed Name By. C �` By: -- Title: f Title: Attorney-in-Fact Address: P.O. dox q67 Address: P.O. Box 14498 _ Wimberley, TX 78676 Des Moines, IA 50306-3498 Resident Agent of Su •ety: Signature Russ Frenzel Printed Name 500 N. Central Expy., Ste 550 Street Address Piano, TX 75074 City, State &Zip Code Page 2 00610 4-2020 Performance Bond 00443639 Bond No. 101178848 PAYMENT BOND THE STATE OF TEXAS § § KNOW ALL MEN BY THESE PRESENTS: COUNTY OF WILLIAMSON § That Lone Star Sitework,LLC , of the City of Wimberley County of Hays , and State of Texas , as Principal, and Merchants Bonding Company(Mutual) authorized under the laws of the State of Texas to act as Surety on Bonds for Principals,are held and firmly bound unto the CITY OF ROUND ROCK, TEXAS (OWNER), and all subcontractors, workers, laborers, mechanics and suppliers as their interest may appear, all of whom shall have the right to sue upon this bond, in the penal sum of Six hundred eighty-two thousand eighty-five dollars and 75/100 Dollars($ 682,085.75 )for the payment whereof,well and truly be made the said Principal and Surety bind themselves and their heirs, administrators, executors, successors, and assigns,jointly and severally,by these presents: WHEREAS,the Principal has entered into a certain written Agreement with the Owner,dated the 25 day of J , 2024 to which Agreement is hereby referred to and made a part hereof as fully and to thb same extent as if copied at length herein consisting of: East Main Street Gaps Sidewalk Project NOW, THEREFORE, THE CONDITION OF THIS OBLIGATION IS SUCH, that if the said Principal shall well and truly pay all subcontractors,workers, laborers, mechanics, and suppliers, all monies to them owing by said Principals for subcontracts,work,labor,equipment, supplies and materials done and furnished for the construction of the improvements of said Agreement, then this obligation shall be and become null and void; otherwise to remain in full force and effect. PROVIDED, HOWEVER, that this bond is executed pursuant to the provisions of Chapter 2253, Texas Government Code, as amended, and all liabilities on this bond shall be determined in accordance with the provisions of said Chapter 2253 to the same extent as if it were copied at length herein. Page 1 00620 04-2020 Payment Bond 00437699 PAYMENT BOND (continued) Surety, for value received, stipulates and agrees that no change, extension of time, alteration or addition to the terms of the Agreement, or to the Work performed thereunder, or the plans, specifications or drawings accompanying the same shall in anywise affect its obligation on this bond, and it does hereby waive notice of any such change, extension of time,alteration or addition to the terms of the contract, or to the work to be performed thereunder. IN WITNESS WHEREOF, the said Principal and Surety have signed and sealed this Instrument this °� h day of (I VUA 20X. Lone Star Sitework, LLC Merchants Bonding Company(Mutual) Principal11 Surety Cwt leen AAD,(-,( Son Russ Frenzel Printed Name Printed Name By: G By: Title: ✓ Title. Attorney-in-Fact Address: P.O. Boy 867 Address: P.O. Box 14498 ___ Wimberley, TX 78676 Des Moines, IA 50306-3498 Resident Agent of S ety- Signature Russ Frenzel Printed Name 500 N. Central Expy., Ste 550 Street Address Plano, TX 75074 City, State&Zip Code Page 2 00620 1-2020 Payment Bond 00090656 MERCHANT BONDING COMPANY,,. POWER OF ATTORNEY Know All Persons By These Presents,that MERCHANTS BONDING COMPANY(MUTUAL)and MERCHANTS NATIONAL BONDING, INC., both being corporations of the State of Iowa,d/b/a Merchants National Indemnity Company(in California only)(herein collectively called the "Companies")do hereby make,constitute and appoint,individually, Brady K Cox;Brent Baldwin;Brock Baldwin;Cynthia A Alford;John A Aboumrad;Keith Rogers;Kristi Meek;Michael B Hill;Neira Hernandez;Russ Frenzel;Samuel Freireich;Sylvia Thomas;William D Baldwin;Yamillec Ramos their true and lawful Attorney(s)-in-Fact, to sign its name as surety(ies) and to execute, seal and acknowledge any and all bonds, undertakings, contracts and other written instruments in the nature thereof, on behalf of the Companies in their business of guaranteeing the fidelity of persons, guaranteeing the performance of contracts and executing or guaranteeing bonds and undertakings required or permitted in any actions or proceedings allowed by law. This Power-of-Attorney is granted and is signed and sealed by facsimile under and by authority of the following By-Laws adopted by the Board of Directors of Merchants Bonding Company (Mutual) on April 23, 2011 and amended August 14, 2015 and adopted by the Board of Directors of Merchants National Bonding,Inc.,on October 16,2015. "The President, Secretary, Treasurer, or any Assistant Treasurer or any Assistant Secretary or any Vice President shall have power and authority to appoint Attorneys-in-Fact, and to authorize them to execute on behalf of the Company, and attach the seal of the Company thereto, bonds and undertakings,recognizances,contracts of indemnity and other writings obligatory in the nature thereof." "The signature of any authorized officer and the seal of the Company may be affixed by facsimile or electronic transmission to any Power of Attorney or Certification thereof authorizing the execution and delivery of any bond, undertaking, recognizance, or other suretyship obligations of the Company,and such signature and seal when so used shall have the same force and effect as though manually fixed." In connection with obligations in favor of the Florida Department of Transportation only, it is agreed that the power and aut hority hereby given to the Attorney-in-Fact includes any and all consents for the release of retained percentages and/or final estimates on engineering and construction contracts required by the State of Florida Department of Transportation. It is fully understood that consenting to the State of Florida Department of Transportation making payment of the final estimate to the Contractor and/or its assignee, shall not relieve this surety company of any of its obligations under its bond. In connection with obligations in favor of the Kentucky Department of Highways only,it is agreed that the power and authority hereby given to the Attorney-in-Fact cannot be modified or revoked unless prior written personal notice of such intent has been given to the Commissioner- Department of Highways of the Commonwealth of Kentucky at least thirty(30)days prior to the modification or revocation. In Witness Whereof,the Companies have caused this instrument to be signed and sealed this 23rd day of April 2024 •'•x(10 N .••• .••. MERCHANTS BONDING COMPANY(MUTUAL) P ... •�Q�.C'..C��A.� MERCHANTS NATIONAL BONDING,INC. y pRPORq�oZ: :•�o�plkP0,0 9 d/b/a MERCHANTS NATIONAL INDEMNITY COMPANY :Qc2 -O- v 2003 Uzi; •y_ 1933 c: By • �•d• :iJ�`•� ••b"�ly'' ' \'fid•• President STATE OF IOWA ••� 1I ••' '• .•• COUNTY OF DALLAS ss. •�•"""o*., •••• • On this 23rd day of April 2024 before me appeared Larry Taylor, to me personally known, who being by me duly sworn did say that he is President of MERCHANTS BONDING COMPANY (MUTUAL)and MERCHANTS NATIONAL BONDING, INC.; and that the seals affixed to the foregoing instrument are the Corporate Seals of the Companies;and that the said instrument was signed and sealed in behalf of the Companies by authority of their respective Boards of Directors. Penni Miller � Z Commission Number 787952 • • My Commission Expires �oWP January 20,2027 Notary,Ja b (Expiration of notary's commission does not invalidate this instrument) 1,William Warner,Jr.,Secretary of MERCHANTS BONDING COMPANY(MUTUAL)and MERCHANTS NATIONAL BONDING,INC.,do hereby certify that the above and foregoing is a true and correct copy of the POWER-OF-ATTORNEY executed by said Companies,which is still in full force and effect and has not been amended or revoked. In Witness Whereof, I have hereunto set my hand and affixed the seal of the Companies on this day of .......... .•...... ••.•`P�IONq�••.,•. �Q��G CQ. �•aRPOR4.�0, �O,•DIiPOg9..0m . COD -0- 2003 `�; y 1933 0:c• Secretary POA 0013 (i;241 •'''••••,,••••••• •••••••• MERG4ANTr BONDING COMPANY, MERCHANTS BONDING COMPANY(MUTUAL) • MERCHANTS NATIONAL BONDING, INC. 2100 FLEUR DRIVE , DES !MOINES. IOWA 50321-1158 (800)678-8171 (515)243-3854 FAX IMPORTANT NOTICE To obtain information or make a complaint: You may contact your insurance agent at the telephone number provided by your insurance agent. You may call Merchants Bonding Company (Mutual) toll-free telephone number for information or to make a complaint at: 1-800-678-8171 You may contact the Texas Department of Insurance to obtain information on companies, coverages, rights or complaints at: 1-800-252-3439 You may write the Texas Department of Insurance at: P. O. Box 149104 Austin, TX 78714-9104 Fax: (512) 475-1771 Web: http://www.tdi.state.tx.us E-mail: ConsumerProtection@tdi.texas.gov PREMIUM AND CLAIM DISPUTES: Should you have a dispute concerning your premium or about a claim you should contact the agent first. If the dispute is not resolved, you may contact the Texas Department of Insurance. ATTACH THIS NOTICE TO YOUR POLICY: This notice is for information only and does not become a part or condition of the attached document. SUP 0032 TX(12/13) AC'ORO� CERTIFICATE OF LIABILITY INSURANCE FD0711612024 ) 0 711 6/2 0 2 4 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 Angie DahlNA D&D Insurance Agency PHONE (512)847-5549 Fsy).(512)847-2107 PO Box 2249 ("� N Wimberley TX 78676- E MAIL s info@dd-ins.net INSURER(S)AFFORDING COVERAGE NAIC 0 INSURER A:Travelers Prop Cas Co 25674 INSURED IN URERB:Travelers Indemnity CO 25674 Lone Star Sitework.LLC INSURERC:GuineOne National Ins 14167 PO Box 1867 INSURER D:Texas Mutual Ins Co 22945 Wimberley TX 78676- INSURER E: INSURER F' COVERAGES CERTIFICATE NUMBER: 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 I TYPE OF INSURANCE ADOL SUBR POLICY EFF POLICY EXP LTR INRIN P LIMITS B X COMMERCIAL GENERAL LIABILITY X X 4T-CO-8W044578-TIA24 7/20/2024 7/20/2025 EACH OCCURRENCE $ 1,000,000 CLAIMSMADE OCCUR DAMAGE TO RENTED = 300,000 MED EXP(Any one on E 5,000 PERSONAL&ADV INJURY E 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE E 2,000,000 X POLICY�JECT LOC PRODUCTS-COMP/OPAGG $ 2,000,000 Rented/Leased Equip s 250,000 A AUTOMOBILE LIABILITY X X BA-8W047359-24-2S-G 7/20/2024 7/20/2025 =)S-INGLE LIMIT $ 1,000,000 X ANY AUTO BODILY INJURY(Per person) b OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE 8 AUTOS ONLY AUTOS ONLY (Per accident) F I I I $ A X UMBRELLA UABX OCCUR X CUP-8W048645-24-2S 7/20/2024 7/20/2025 EACH OCCURRENCE s 5,000,000 EXCESS LIAR CLAIMS-MADE AGGREGATE $ 5,000,000 D WORKERS COMPENSATION 12/04/2023 12/04/2024 XPER OTH- AND EMPLOYERS'LIABILITY Y/N 1,0 011,000 ER ANY PROPRIETOR/PARTNER/EXECUTIVE ❑ N/A E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 It es,descnbnder PT Ne uF OPERATIONS below E.L.DISEASE-POLICY LIMIT 3 1'000,000 B Equipment Breakdown 4T-CO-8W044578-TIA24 07/20/2024 07/20/2025 Rented/Leased Equip $250,000 C ENV562011546-01 08/27/2023 08/27/2024 Per Occurrence $1.000,000 Pollution Liability Aggregate Limit $2.000,000 DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached it more space is required) CERTIFICATE HOLDER CANCELLATION A1008134 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Round Rock ACCORDANCE WITH THE POLICY PROVISIONS. 221 E Main St Round Rock TX 78664- AUTHORIZED REPRESENTATIVE v ®1988-2015 ACORD CORPORATION. All rights reserved. ACORD 26(2016103) The ACORD name and logo are reglotared marks of ACORD COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BLANKET ADDITIONAL INSURED - AUTOMATIC STATUS IF REQUIRED BY WRITTEN CONTRACT (CONTRACTORS) This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART The following is added to SECTION II — WHO IS AN (a) The Additional Insured — Owners, Les- INSURED: sees or Contractors — Scheduled Person Any person or organization that: or Organization endorsement CG 20 10 a. You agree in a written contract or agreement to 07 04 or CG 20 10 04 13, the Additional include as an additional insured on this Coverage Insured — Owners, Lessees or Contrac- Part: and tors — Completed Operations endorse- ment CG 20 37 07 04 or CG 20 3 7 04 13, b. Has not been added as an additional insured for or both of such endorsements with either the same project by attachment of an endorse- of those edition dates; or ment under this Coverage Part which includes such person or organization in the endorsement's (b) Either or both of the following: the Addi- schedule; tional Insured—Owners, Lessees or Con- tractors — Scheduled Person Or Organi- is an insured, but: zation endorsement CG 20 10, or the Ad- a. Only with respect to liability for "bodily injury" or ditional Insured — Owners, Lessees or "property damage" that occurs, or for "personal Contractors — Completed Operations en- injury" caused by an offense that is committed, dorsement CG 20 37, without an edition subsequent to the signing of that contract or date of such endorsement specified: agreement and while that part of the contract or the person or organization is an additional in- agreement is in effect; and sured only if the injury or damage is caused, b. Only as described in Paragraph (1), (2) or (3) be- in whole or in part, by acts or omissions of low,whichever applies: you or your subcontractor in the performance (1) If the written contract or agreement specifical- of "your work" to which the written contract or ly requires you to provide additional insured agreement applies; or coverage to that person or organization by (3) If neither Paragraph (1) nor(2) above applies: the use of: (a) The person or organization is an addi- (a) The Additional Insured — Owners, Les- tional insured only if, and to the extent sees or Contractors — (Form B) endorse- that, the injury or damage is caused by ment CG 20 10 11 85; or acts or omissions of you or your subcon- (b) Either or both of the following: the Addi- tractor in the performance of "your work" tional Insured—Owners, Lessees or Con- to which the written contract or agree- tractors — Scheduled Person Or Organi- ment applies; and zation endorsement CG 20 10 10 01, or (b) Such person or organization does not the Additional Insured —Owners, Lessees qualify as an additional insured with re- or Contractors — Completed Operations spect to the independent acts or omis- endorsement CG 20 37 10 01; sions of such person or organization. the person or organization is an additional in- The insurance provided to such additional insured is sured only if the injury or damage arises out subject to the following provisions: of"your work" to which the written contract or a. If the Limits of Insurance of this Coverage Part agreement applies: shown in the Declarations exceed the minimum (2) If the written contract or agreement specifical- limits required by the written contract or agree- ly requires you to provide additional insured ment, the insurance provided to the additional in- coverage to that person or organization by sured will be limited to such minimum required the use of: limits. For the purposes of determining whether CG D6 04 02 19 ©2017 The Travelers Indemnity Company.All rights reserved. Page 1 of 2 COMMERCIAL GENERAL LIABILITY this limitation applies,the minimum limits required result in a claim. To the extent possible, such by the written contract or agreement will be con- notice should include: sidered to include the minimum limits of any Um- (a) How, when and where the "occurrence" brella or Excess liability coverage required for the or offense took place; additional insured by that written contract or (b) The names and addresses of any injured agreement. This provision will not increase the persons and witnesses; and limits of insurance described in Section M—Limits Of Insurance. (c) The nature and location of any injury or damage arising out of the"occurrence"or b. The insurance provided to such additional insured offense. does not apply to: (2) If a claim is made or "suit" is brought against (1) Any "bodily injury", "property damage" or the additional insured: "personal injury" arising out of the providing, or failure to provide, any professional archi- (a) Immediately record the specifics of the tectural, engineering or surveying services, claim or"suit" and the date received;and including: (b) Notify us as soon as practicable and see (a) The preparing, approving, or failing to to it that we receive written notice of the prepare or approve, maps, shop draw- claim or"suit" as soon as practicable. ings, opinions, reports, surveys, field or- (3) Immediately send us copies of all legal pa- ders or change orders, or the preparing, pers received in connection with the claim or approving, or failing to prepare or ap- "suit", cooperate with us in the investigation prove,drawings and specifications; and or settlement of the claim or defense against (b) Supervisory, inspection, architectural or the"suit", and otherwise comply with all policy engineering activities. conditions. (2) Any "bodily injury" or "property damage" (4) Tender the defense and indemnity of any caused by "your work" and included in the claim or "suit" to any provider of other insur- "products-completed operations hazard" un- ance which would cover such additional fin- less the written contract or agreement specifi- sured for a loss we cover. However, this con- cally requires you to provide such coverage dition does not affect whether the insurance for that additional insured during the policy provided to such additional insured is primary period. to other insurance available to such additional c. The additional insured must comply with the fol- insured which covers that person or organiza- lowing duties: tion as a named insured as described in Par- agraph 4., Other Insurance, of Section IV — (1) Give us written notice as soon as practicable Commercial General Liability Conditions. of an "occurrence" or an offense which may I I i {i {i page 2 of 2 ®2017 Tho Tro.stars Indarnr"y Company.All rights raaGmad. CG D6 04 02 19 I f t 7 COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. XTEND ENDORSEMENT FOR CONTRACTORS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART GENERAL DESCRIPTION OF COVERAGE—This endorsement broadens coverage. However, coverage for any injury, damage or medical expenses described in any of the provisions of this endorsement may be excluded or limited by another endorsement to this Coverage Part, and these coverage broadening provisions do not apply to the extent that coverage is excluded or limited by such an endorsement. The following listing is a general coverage description only. Read all the provisions of this endorsement and the rest of your policy carefully to determine rights, duties, and what is and is not covered. A. Who Is An Insured—Unnamed Subsidiaries C. Incidental Medical Malpractice B. Blanket Additional Insured — Governmental D. Blanket Waiver Of Subrogation Entities — Permits Or Authorizations Relating To E. Contractual Liability—Railroads Operations F. Damage To Premises Rented To You PROVISIONS a. An organization other than a partnership, joint A. WHO IS AN INSURED — UNNAMED venture or limited liability company; or SUBSIDIARIES b. A trust; The following is added to SECTION II — WHO IS as indicated in its name or the documents that AN INSURED: govern its structure. Any of your subsidiaries, other than a partnership, B. BLANKET ADDITIONAL INSURED — joint venture or limited liability company, that is GOVERNMENTAL ENTITIES — PERMITS OR not shown as a Named Insured in the AUTHORIZATIONS RELATING TO OPERATIONS Declarations is a Named Insured if: a. You are the sole owner of, or maintain an The following is added to SECTION If — WHO IS ownership interest of more than 50% in, such AN INSURED: subsidiary on the first day of the policy period; Any governmental entity that has issued a permit and or authorization with respect to operations b. Such subsidiary is not an insured under performed by you or on your behalf and that you similar other insurance. are required by any ordinance, law, building code or written contract or agreement to include as an No such subsidiary is an insured for"bodily injury" additional insured on this Coverage Part is an or "property damage" that occurred, or "personal insured, but only with respect to liability for "bodily and advertising injury" caused by an offense injury", "property damage" or "personal and committed: advertising injury" arising out of such operations. a. Before you maintained an ownership interest The insurance provided to such governmental of more than 50% in such subsidiary; or entity does not apply to: b. After the date, if any, during the policy period a. Any "bodily injury", "property damage" or that you no longer maintain an ownership "personal and advertising injury" arising out of interest of more than 50% in such subsidiary. operations performed for the governmental For purposes of Paragraph 1. of Section II —Who entity; or Is An Insured, each such subsidiary will be b. Any "bodily injury" or "property damage" deemed to be designated in the Declarations as: included in the "products-completed operations hazard". CG D3 16 02 19 O 2017 The Travelers Indemnity Company.All rights reserved. Page 1 of 3 Includes copyrighted material of Insurance Services Office, Inc.,with its permission. COMMERCIAL GENERAL LIABILITY C. INCIDENTAL MEDICAL MALPRACTICE pharmaceuticals committed by, or with the 1. The following replaces Paragraph b. of the knowledge or consent of, the insured. definition of "occurrence" in the 5. The following is added to the DEFINITIONS DEFINITIONS Section: Section: b. An act or omission committed in providing "Incidental medical services" means: or failing to provide "incidental medical services", first aid or "Good Samaritan a. Medical, surgical, dental, laboratory, x-ray services" to a person, unless you are in or nursing service or treatment, advice or the business or occupation of providing instruction, or the related furnishing of professional health care services. food or beverages; or 2. The following replaces the last paragraph of b. The furnishing or dispensing of drugs or Paragraph 2.a.(1) of SECTION 11 — WHO IS medical, dental, or surgical supplies or AN INSURED: appliances. Unless you are in the business or occupation 6. The following is added to Paragraph 4.b., of providing professional health care services, Excess Insurance, of SECTION IV — Paragraphs (1)(a), (b), (c) and (d) above do COMMERCIAL GENERAL LIABILITY not apply to "bodily injury" arising out of CONDITIONS: providing or failing to provide: This insurance is excess over any valid and (a) "Incidental medical services" by any of collectible other insurance, whether primary, your "employees" who is a nurse, nurse excess, contingent or on any other basis, that assistant, emergency medical technician is available to any of your "employees" for or paramedic; or "bodily injury" that arises out of providing or (b) First aid or "Good Samaritan services" by failing to provide "incidental medical services" any of your "employees" or "volunteer to any person to the extent not subject to workers", other than an employed or Paragraph 2.a.(1) of Section II — Who Is An volunteer doctor. Any such "employees" insured. or "volunteer workers" providing or failing D. BLANKET WAIVER OF SUBROGATION to provide first aid or "Good Samaritan services" during their work hours for you The following is added to Paragraph 8., Transfer will be deemed to be acting within the Of Rights Of Recovery Against Others To Us, scope of their employment by you or of SECTION IV — COMMERCIAL GENERAL performing duties related to the conduct LIABILITY CONDITIONS: of your business. If the insured has agreed in a contract or 3. The following replaces the last sentence of agreement to waive that insured's right of Paragraph S. of SECTION III — LIMITS OF recovery against any person or organization, we INSURANCE: waive our right of recovery against such person or For the purposes of determining the organization, but only for payments we make applicable Each Occurrence Limit, all related because of: acts or omissions committed in providing or a. "Bodily injury" or "property damage" that failing to provide "incidental medical occurs;or services", first aid or "Good Samaritan services" to any one person will be deemed to b. "Personal and advertising injury" caused by be one "occurrence". an offense that is committed; 4. The following exclusion is added to subsequent to the execution of the contract or Paragraph 2., Exclusions, of SECTION I — agreement. COVERAGES — COVERAGE A — BODILY E CONTRACTUAL LIABILITY—RAILROADS INJURY AND PROPERTY DAMAGE LIABILITY: 1. The following replaces Paragraph c. of the Sale Of Pharmaceuticals definition of "insured contract" in the "Bodily injury" or "property damage" arising DEFINITIONS Section: out of the violation of a penal statute or c. Any easement or license agreement; Iordinance relating to the sale of i Page 2 of 3 O 2017 The Travelers Indemnity Company.All rights reserved. CG D3 16 02 19 Includes copyrighted material of Insurance Services Office,Inc.,with its permission. COMMERCIAL GENERAL LIABILITY 2. Paragraph f.(1) of the definition of "insured a. Any premises while rented to you or contract' in the DEFINITIONS Section is temporarily occupied by you with permission deleted. of the owner; or F. DAMAGE TO PREMISES RENTED TO YOU b. The contents of any premises while such The following replaces the definition of "premises premises is rented to you, if you rent such damage" in the DEFINITIONS Section: premises for a period of seven or fewer consecutive days. "Premises damage" means "property damage"to: CG D3 16 02 19 ©2017 The Travelers Indemnity Company.All rights reserved. Page 3 of 3 Includes copyrighted material of Insurance Services Office,Inc.,with its permission. POLICY NUMBER: 4T-CO-8W044578-TIA-24 ISSUE DATE: 07-08-24 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. DESIGNATED PERSON OR ORGANIZATION - NOTICE OF CANCELLATION PROVIDED BY US This endorsement modifies insurance provided under the following: ALL COVERAGE PARTS INCLUDED IN THIS POLICY SCHEDULE CANCELLATION: Number of Days Notice: 30 PERSON OR ORGANIZATION: ANY PERSON OR ORGANIZATION CONTINUED ON IL T8 03 ADDRESS: CONTINUED ON IL T8 03 WIMBERLEY TX 78676 PROVISIONS If we cancel this policy for any legally permitted reason other than nonpayment of premium, and a number of days is shown for Cancellation in the Schedule above, we will mail notice of cancellation to the person or organization shown in such Schedule. We will mail such notice to the address shown in the Schedule above at least the j number of days shown for Cancellation in such Schedule before the effective date of cancellation. l t i IL T4 05 05 19 ©2019 The Travelers Indemnity Company.All rights reserved. Page 1 of 1 i COMMERCIAL AUTO THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BLANKET ADDITIONAL INSURED - PRIMARY AND NON-CONTRIBUTORY WITH OTHER INSURANCE - CONTRACTORS This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM PROVISIONS 2. The following is added to Paragraph B.S., Other 1. The following is added to Paragraph c. in A.1., Insurance of SECTION IV — BUSINESS AUTO Who Is An Insured, of SECTION II — COVERED CONDITIONS.- AUTOS ONDITIONS:AUTOS LIABILITY COVERAGE: Regardless of the provisions of paragraph a. and This includes any person or organization who you paragraph d. of this part 5. Other Insurance, this are required under a written contract or insurance is primary to and non-contributory with agreement, that is signed by you before the applicable other insurance under which an "bodily injury" or "property damage" occurs and additional insured person or organization is a that is in effect during the policy period, to name named insured when a written contract or as an additional insured for Covered Autos agreement with you, that is signed by you before Liability Coverage, but only for damages to which the "bodily injury" or "property damage" occurs this insurance applies and only to the extent of and that is in effect during the policy period, that person's or organization's liability for the requires this insurance to be primary and non- conduct of another "insured" contributory. i i i CA T4 99 02 16 ©2016 The Travelers Indemnity Company.All rights reserved. Page 1 of 1 i Includcn capyrightcd mntcriol of Inauranac eorviaoo Offioo, Ino.with ito por iooion. i t t COMMERCIAL AUTO THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BUSINESS AUTO EXTENSION ENDORSEMENT This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM GENERAL DESCRIPTION OF COVERAGE —This endorsement broadens coverage. However, coverage for any injury, damage or medical expenses described in any of the provisions of this endorsement may be excluded or limited by another endorsement to the Coverage Part, and these coverage broadening provisions do not apply to the extent that coverage is excluded or limited by such an endorsement. The following listing is a general cover- age description only. Limitations and exclusions may apply to these coverages. Read all the provisions of this en- dorsement and the rest of your policy carefully to determine rights, duties, and what is and is not covered. A. BROAD FORM NAMED INSURED H. HIRED AUTO PHYSICAL DAMAGE — LOSS OF B. BLANKET ADDITIONAL INSURED USE—INCREASED LIMIT C. EMPLOYEE HIRED AUTO 1. PHYSICAL DAMAGE — TRANSPORTATION EXPENSES—INCREASED LIMIT D. EMPLOYEES AS INSURED J. PERSONAL PROPERTY E. SUPPLEMENTARY PAYMENTS — INCREASED K. AIRBAGS LIMITS L. NOTICE AND KNOWLEDGE OF ACCIDENT OR F. HIRED AUTO — LIMITED WORLDWIDE COV- LOSS ERAGE—INDEMNITY BASIS M. BLANKET WAIVER OF SUBROGATION G. WAIVER OF DEDUCTIBLE — GLASS N. UNINTENTIONAL ERRORS OR OMISSIONS PROVISIONS A. BROAD FORM NAMED INSURED this insurance applies and only to the extent that The following is added to Paragraph A.1., Who Is person or organization qualifies as an "insured" An Insured, of SECTION 11 — COVERED AUTOS under the Who Is An Insured provision contained in Section 11. LIABILITY COVERAGE: Any organization you newly acquire or form dur- C. EMPLOYEE HIRED AUTO ing the policy period over which you maintain 1. The following is added to Paragraph A.1., 50% or more ownership interest and that is not Who Is An Insured, of SECTION II — COV- separately insured for Business Auto Coverage. ERED AUTOS LIABILITY COVERAGE: Coverage under this provision is afforded only un- An "employee" of yours is an "insured" while til the 180th day after you acquire or form the or- operating an "auto" hired or rented under a ganization or the end of the policy period, which- contract or agreement in an "employee's" ever is earlier. name, with your permission, while performing duties related to the conduct of your busi- B. BLANKET ADDITIONAL INSURED ness. The following is added to Paragraph c. in A.1., 2. The following replaces Paragraph b. in B.5., Who Is An Insured, of SECTION II — COVERED Other Insurance, of SECTION IV — BUSI- AUTOS LIABILITY COVERAGE: NESS AUTO CONDITIONS: Any person or organization who is required under b. For Hired Auto Physical Damage Cover- a written contract or agreement between you and age, the following are deemed to be cov- that person or organization, that is signed and ered "autos"you own: executed by you before the "bodily injury" or (1) Any covered "auto" you lease, hire, "property damage" occurs and that is in effect rent or borrow; and during the policy period, to be named as an addi- (2) Any covered "auto" hired or rented by tional insured is an "insured" for Covered Autos your "employee" under a contract in lLiability Coverage, but only for damages to which an "employee's" name, with your CA T3 53 02 15 ©2015 The Travelers Indemnity Company.All rights reserved. Page 1 of 4 Includes copyrighted material of Insurance Services Office,Inc.with its permission. i COMMERCIAL AUTO permission, while performing duties (a) With respect to any claim made or "suit" related to the conduct of your busi- brought outside the United States of ness. America, the territories and possessions of the United States of America, Puerto However, any "auto" that is leased, hired, Rico and Canada: rented or borrowed with a driver is not a covered "auto". (i) You must arrange to defend the "in- D. EMPLOYEES AS INSURED sured" against, and investigate or set- tle any such claim or "suit" and keep The following is added to Paragraph A.1., Who Is us advised of all proceedings and ac- An Insured, of SECTION II — COVERED AUTOS tions. LIABILITY COVERAGE: (ii) Neither you nor any other involved Any "employee" of yours is an "insured" while us- "insured" will make any settlement ing a covered "auto" you don't own, hire or borrow without our consent. in your business or your personal affairs. (iii)We may, at our discretion, participate E. SUPPLEMENTARY PAYMENTS — INCREASED in defending the "insured" against, or LIMITS in the settlement of, any claim or 1, The following replaces Paragraph A.2.a.(2), "suit". of SECTION II — COVERED AUTOS LIABIL- (iv)We will reimburse the "insured" for ITY COVERAGE: sums that the "insured" legally must (2) Up to $3,000 for cost of bail bonds (in- pay as damages because of "bodily cluding bonds for related traffic law viola- injury" or "property damage" to which tions) required because of an "accident" this insurance applies, that the "in- we cover. We do not have to furnish sured" pays with our consent, but these bonds. only up to the limit described in Para- graph C., Limits Of Insurance, of 2. The following replaces Paragraph A.2.a.(4), SECTION II — COVERED AUTOS of SECTION I) — COVERED AUTOS LIABIL- LIABILITY COVERAGE. ITY COVERAGE: (4) All reasonable expenses incurred by the (v) We will reimburse the "insured" for the reasonable expenses incurred "insured" at our request, including actual with our consent for your investiga- loss of earnings up to $500 a day be- tion of such claims and your defense cause of time off from work. of the "insured" against any such F. HIRED AUTO — LIMITED WORLDWIDE COV- "suit", but only up to and included ERAGE—INDEMNITY BASIS within the limit described in Para- The following replaces Subparagraph (5) in Para- graph C., Limits Of Insurance, of graph B.7., Policy Period, Coverage Territory, SECTION 11 — COVERED AUTOS of SECTION IV — BUSINESS AUTO CONDI- LIABILITY COVERAGE, and not in addition to such limit. Our duty to TIONS: make such payments ends when we (5) Anywhere in the world, except any country or have used up the applicable limit of jurisdiction while any trade sanction, em- insurance in payments for damages, bargo, or similar regulation imposed by the settlements or defense expenses. United States of America applies to and pro- hibits the transaction of business with or (b) This insurance is excess over any valid within such country or jurisdiction, for Cov- and collectible other insurance available ered Autos Liability Coverage for any covered to the "insured" whether primary, excess, "auto" that you lease, hire, rent or borrow contingent or on any other basis. without a driver for a period of 30 days or less (c) This insurance is not a substitute for re- and that is not an "auto" you lease, hire, rent quired or compulsory insurance in any or borrow from any of your "employees", country outside the United States, its ter- partners (if you are a partnership), members ritories and possessions, Puerto Rico and (if you are a limited liability company) or Canada, members of their households. Page 2 of 4 ©2015 The Travelers Indemnity Company.All rights reserved. CA T3 53 02 15 Includes copyrighted material of Insurance Services Office,Inc.with its permission. COMMERCIAL AUTO You agree to maintain all required or (2) In or on your covered "auto". compulsory insurance in any such coun- This coverage applies only in the event of a total try up to the minimum limits required by theft of your covered "auto". local law. Your failure to comply with compulsory insurance requirements will No deductibles apply to this Personal Property not invalidate the coverage afforded by coverage. this policy, but we will only be liable to the K. AIRBAGS same extent we would have been liable The following is added to Paragraph B.3., Exclu- had you complied with the compulsory in- sions, of SECTION III — PHYSICAL DAMAGE surance requirements. COVERAGE: (d) It is understood that we are not an admit- Exclusion 3.a. does not apply to "loss" to one or ted or authorized insurer outside the more airbags in a covered "auto" you own that in- United States of America, its territories flate due to a cause other than a cause of "loss" and possessions, Puerto Rico and Can- set forth in Paragraphs A.1.b. and A.1.c., but ada. We assume no responsibility for the only: furnishing of certificates of insurance, or a. If that "auto" is a covered "auto" for Compre- for compliance in any way with the laws hensive Coverage under this policy; of other countries relating to insurance. b. The airbags are not covered under any war- G. WAIVER OF DEDUCTIBLE—GLASS ranty; and The following is added to Paragraph D., Deducti- c. The airbags were not intentionally inflated. ble, of SECTION III — PHYSICAL DAMAGE We will pay up to a maximum of $1,000 for any COVERAGE: one "loss". No deductible for a covered "auto" will apply to L. NOTICE AND KNOWLEDGE OF ACCIDENT OR glass damage if the glass is repaired rather than LOSS replaced. The following is added to Paragraph A.2.a., of H. HIRED AUTO PHYSICAL DAMAGE — LOSS OF SECTION IV—BUSINESS AUTO CONDITIONS: USE —INCREASED LIMIT Your duty to give us or our authorized representa- The following replaces the last sentence of Para- tive prompt notice of the "accident" or "loss" ap- graph A.4.b., Loss Of Use Expenses, of SEC- plies only when the "accident" or "loss" is known TION III—PHYSICAL DAMAGE COVERAGE: to: However, the most we will pay for any expenses (a) You (if you are an individual); for loss of use is $65 per day, to a maximum of (b) A partner (if you are a partnership); $750 for any one "accident". (c) A member (if you are a limited liability com- I. PHYSICAL DAMAGE — TRANSPORTATION pany); EXPENSES— INCREASED LIMIT (d) An executive officer, director or insurance The following replaces the first sentence in Para- manager (if you are a corporation or other or- graph A.4.a., Transportation Expenses, of ganization); or SECTION III — PHYSICAL DAMAGE COVER- (e) Any "employee" authorized by you to give no- AGE: tice of the "accident" or"loss". We will pay up to $50 per day to a maximum of M. BLANKET WAIVER OF SUBROGATION $1,500 for temporary transportation expense in- The following replaces Paragraph A.S., Transfer curred by you because of the total theft of a cov- eOf Rights Of Recovery Against Others To Us, red "auto" of the private passenger type. of SECTION IV — BUSINESS AUTO CONDI- J. PERSONAL PROPERTY TIONS : The following is added to Paragraph A.4., Cover- S. Transfer Of Rights Of Recovery Against age Extensions, of SECTION III — PHYSICAL Others To Us DAMAGE COVERAGE: We waive any right of recovery we may have Personal Property against any person or organization to the ex- tent required of you by a written contract We will pay up to $400 for "loss" to wearing ap- signed and executed prior to any "accident" parel and other personal property which is: or"loss", provided that the "accident" or "loss" (1) Owned by an"insured"; and arises out of operations contemplated by CA T3 53 02 15 Cc.}2015 The Travelers Indemnity Company.All rights reserved. Page 3 of 4 Includes copyrighted material of Insurance Services Office,Inc.with its permission. COMMERCIAL AUTO such contract. The waiver applies only to the The unintentional omission of, or unintentional person or organization designated in such error in, any information given by you shall not contract. prejudice your rights under this insurance. How- N. UNINTENTIONAL ERRORS OR OMISSIONS ever this provision does not affect our right to col- The following is added to Paragraph B.2., Con- lect additional premium or exercise our right of cealment, Misrepresentation, Or Fraud, of cancellation or non-renewal. SECTION IV—BUSINESS AUTO CONDITIONS: i r I Page 4 of 4 02015 The Travelers Indemnity Compa ny,All rights,reserved. CA T3 53 02 15 Includes copyrighted material of Insurance Services Office, Inc.with its permission. f POLICY NUMBER: BA-SW047359-24-2S-G ISSUE DATE: 07-10-24 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. DESIGNATED PERSON OR ORGANIZATION - NOTICE OF CANCELLATION PROVIDED BY US This endorsement modifies insurance provided under the following: ALL COVERAGE PARTS INCLUDED IN THIS POLICY SCHEDULE CANCELLATION: Number of Days Notice: 30 PERSON OR ORGANIZATION: ANY PERSON OR ORGANIZATION TO WHOM YOU HAVE AGREED IN A WRITTEN CONTRACT THAT NOTICE OF CANCELLATION OF THIS POLICY WILL BE GIVEN, BUT ONLY IF: 1. YOU SEND US A WRITTEN REQUEST TO PROVIDE SUCH NOTICE, INCLUDING THE NAME AND ADDRESS OF SUCH PERSON OR ORGANIZATION, AFTER THE FIRST NAMED INSURED RECEIVES NOTICE FROM US OF THE CANCELLATION OF THIS POLICY; AND 2. WE RECEIVE SUCH WRITTEN REQUEST AT LEAST 14 DAYS BEFORE THE BEGINNING OF THE APPLICABLE NUMBER OF DAYS SHOWN IN THIS SCHEDULE. ADDRESS: THE ADDRESS FOR THAT PERSON OR ORGANIZ- ATION INCLUDED IN SUCH WRITTEN REQUEST FROM YOU TO US. PROVISIONS If we cancel this policy for any legally permitted reason other than nonpayment of premium, and a number of days is shown for Cancellation in the Schedule above, we will mail notice of cancellation to the person or organization shown in such Schedule. We will mail such notice to the address shown in the Schedule above at least the number of days shown for Cancellation in such Schedule before the effective date of cancellation. IL T4 05 05 19 O 2019 The Travelers Indemnity Company.All rights reserved. Page 1 Of 1 T eXaSMutuar WORKERS' COMPENSATION INSURANCE WORKERS' COMPENSATION AND WC 42 03 04 B EMPLOYERS LIABILITY POLICY Agent 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 1214123 at 12:01 a.m.standard time,forms a part of: Policy no. 0002006377 of Texas Mutual Insurance Company effective on 1214123 Issued to: LONE STAR SITEWORK LLC This is not a bill Authorized representative NCCI Carrier Code: 29939 11/21/23 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