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Contract - Asphalt Inc. LLC dba Lone Star Paving - 3/27/2025 CITY OF ROUND ROCK PUBLIC WORKS DEPARTMENT r l ROUND ROCK TEXAS Project Manual For: 2024 Residential Street Maintenance Program January 2025 tiE of% tis •• 1 ..........................»*.I � MATTHEW BUSHAK � ........91480...... ; Prepared By• C�ENS��G�� O `= Matthew Bushak, P.E. APPROVED BY C ATT®R�EY D � � - o � .� BID BOND THE STATE OF TEXAS § § KNOW ALL BY THESE PRESENTS: COUNTY OF WILLIAMSON § That Asphalt Inc.,LLC dba Lone Star Paving of the City of Round Rock County of Williamson State of Texas as Principal, and westem surety Company and Liberty Mutual Insurance Company authorized under the laws of the State of Texas to act as surety on bonds for principals,are held and firmly bound unto the CITY OF ROUND ROCK,TEXAS("Owner"), in the penal stun of Five Percent(5%)of the total amount of the Bid of the Principal submitted to the Owner, for the Work described below; for the payment whereof, well and truly to be made,and the said Principal and Surety do herby bind themselves and their heirs, administrators, executors, successors and assigns, jointly and severally,as follows: In no case shall the liability of the Surety hereunder exceed the sum of Five Percent of the Total Amount of the Bid Dollars($ 5%TAB ). 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 2024 Residential Street Maintenance Program for which Bids are to be opened at the office of Owner on the 6th day of March , 2025 . 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 6th day of the month of March 20 25. Western Surety Company and Asphalt Inc.,LLC dba Lone Star Paving Libea Mutual Insurance Company Principal Srety A(ex Fl ore s �ell Printed Name Printed Name Loll By: By: Maria D.Zuniga Title: 110 c e Prr6; A11- Title: Attorney-in-Fact Address: 11 11 ✓J1e Rd $fr•��Sv Address: WSC: 151 N.Franklin St.,Chicago,IL 60606 hubt a c —2 87.5-9 LMIC: 175 Berkeley Street,Boston,MA 02116 00200 4-2020 Page I Bid Bond 00443638 Resident Agent of 7 Signature Maria D.Zuniga Printed Name 10100 Katy Freeway,Suite 400 Street Address Houston. TX 77043 City,State,Zip Page 2 00200 4-2020 Bid Bond 00443638 Western Surety Company POWER OF ATTORNEY APPOINTING INDIVIDUAL ATTORNEY-IN-FACT Know All Men By These Presents,That WESTERN SURETY COMPANY,a South Dakota corporation,is a duly organized and existing corporation having its principal office in the City of Sioux Falls,and State of South Dakota,and that it does by virtue of the signature and seal herein affixed hereby make,constitute and appoint Marc W Boots,Vickie Lacy,Richard Covington,Maria D Zuniga,Heather Noles,Stephanie Moore Harold,Ryan Varela, Ashley Koletar,Melanie Salinas,Joseph R Aulbert,Individually of Houston,TX,its true and lawful Attomey(s)-in-Fact with full power and authority hereby conferred to sign,seal and execute for and on its behalf bonds,undertakings and other obligatory instruments of similar nature - In Unlimited Amounts - and to bind it thereby as fully and to the same extent as if such instruments were signed by a duly authorized officer of the corporation and all the acts of said Attorney, pursuant to the authority hereby given,are hereby ratified and confirmed. This Power of Attorney is made and executed pursuant to and by authority of the Authorizing By-Laws and Resolutions printed at the bottom of this page,duly adopted,as indicated,by the shareholders of the corporation. In Witness Whereof,WESTERN SURETY COMPANY has caused these presents to be signed by its Vice President and its corporate seal to be hereto affixed on this I Ith day of April,2024. � ►!!QIQ WESTERN SURETY COMPANY �..•sF Ate:?*� Larry Kasten,Vice President State of South Dakota 1 ss County of Minnehaha I On this I I th day of April,2024,before me personally came Larry Kasten,to me known,who,being by me duly sworn,did depose and say: that he resides in the City of Sioux Falls,State of South Dakota;that he is a Vice President of WESTERN SURETY COMPANY described in and which executed the above instrument;that he knows the seal of said corporation;that the seal affixed to the said instrument is such corporate seal;that it was so affixed pursuant to authority given by the Board of Directors of said corporation and that he signed his name thereto pursuant to like authority,and acknowledges same to be the act and deed of said corporation. My commission expires : M.BENT sena NOTARY PUBLIC March 2,2026 SOUTH DAKOTAM / + M.Bent,Notary Public CERTIFICATE 1,Paula Kolsrud,Assistant Secretary of WESTERN SURETY COMPANY do hereby certify that the Power of Attorney hereinabove set forth is still in force,and further certify that the By-Law and Resolutions of the corporation printed below this certificate are still in force. In testimony whereof I have hereunto subscribed my name and affixed the seal of the said corporation this 6th day of March,2025 � o-.1 WESTERN SURETY COMPANY foe Z ••••' Paula Kolsrud,Assistant Secretary Authorizing By-Laws and Resolutions ADOPTED BY THE SHAREHOLDERS OF WESTERN SURETY COMPANY This Power of Attorney is made and executed pursuant to and by authority of the following By-Law duly adopted by the shareholders of the Company. Section 7. All bonds,policies,undertakings,Powers of Attorney,or other obligations of the corporation shall be executed in the corporate name of the Company by the President,Secretary,and Assistant Secretary,Treasurer,or any Vice President,or by such other officers as the Board of Directors may authorize. The President,any Vice President,Secretary,any Assistant Secretary,or the Treasurer may appoint Attorneys in Fact or agents who shall have authority to issue bonds,policies,or undertakings in the name of the Company. The corporate seal is not necessary for the validity of any bonds,policies,undertakings,Powers of Attorney or other obligations of the corporation. The signature of any such officer and the corporate seal may be printed by facsimile. This Power of Attorney is signed by Lary Kasten,Vice President,who has been authorized pursuant to the above Bylaw to execute power of attorneys on behalf of Westem Surety Company. This Power of Attorney may be signed by digital signature and sealed by a digital or otherwise electronic-formatted corporate seal under and by the authority ofthe following Resolution adopted by the Board of Directors of the Company by unanimous written consent dated the 27'day of April,2022: "RESOLVED:That it is in the best interest of the Company to periodically ratify and confirm any corporate documents signed by digital signatures and to ratify and confirm the use of a digital or otherwise electronic-formatted corporate seal,each to be considered the act and deed of the Company." Go to Nvrw.cnasuretv.corn>Owner/Obligee Services>Validate Bond Coverage,if you want to verify bond authenticity. Form F4280-6-2023 No Text This Power of Attorney limits the acts of those named herein,and they have no authority to bind the Company except in the manner and to the extent herein stated. Liberty Liberty Mutual Insurance Company Mutual, The Ohio Casualty Insurance Company Certificate No: 8212371 -022004 SURETY West American Insurance Company POWER OF ATTORNEY KNOWN ALL PERSONS BY THESE PRESENTS:That The Ohio Casualty Insurance Company is a corporation duly organized under the laws of the State of New Hampshire,that Liberty Mutual Insurance Company is a corporation duly organized under the laws of the State of Massachusetts,and West American Insurance Company is a corporation duly organized under the laws of the State of Indiana(herein collectively called the"Companies"),pursuant to and by authority herein set forth,does hereby name,constitute and appoint, Ashley Koletar,Dylan Young.Heather Noles,Jacob Boots,Joseph R.Aulbert,Marc W.Boots,Maria D.Zuniga,Melanie Salinas,Richard Covington.Ryan Varela,Stephanie Moore Harold,Susan Golla,Vickie Lacy all of the city of Houston state of TR each individually if there be more than one named,its true and lawful attomey-in-fact to make, execute,seal,acknowledge and deliver,for and on its behalf as surety and as its act and deed,any and all undertakings,bonds,recognizances and other surety obligations,in pursuance of these presents and shall be as binding upon the Companies as if they have been duly signed by the president and attested by the secretary of the Companies in their own proper persons. IN WITNESS WHEREOF,this Power of Attorney has been subscribed by an authorized officer or official of the Companies and the corporate seals of the Companies have been affixed thereto this 9th day of September , 2024 Liberty Mutual Insurance Company 11 The hio Casualty Insurance Company JP oa oaq�gL J��ovLP- �9 GPaoaP0 9�gti WestOAmerican Insurance Company C, Lu J 3` Fo m r° Fo y =c Fo m D y .1 1912 0 0 1919 o 1991 // O �_l�tn N 0 d" 144C„U`��da lye, �NDIANt' .aay� R.I7� N U 877 * 1 Hyl * *� ''M . >� By: Z ru Nathan J.Zangede,Assistant Secretary w m State of PENNSYLVANIA — rn County of MONTGOMERY ss o E L On this 9th day of Scptember , 2024 before me personally appeared Nathan J.Zangede,who acknowledged himself to be the Assistant Secretary of Liberty Mutual Insurance M -0'Fa Company,The Ohio Casualty Company,and West American Insurance Company,and that he,as such,being authorized so to do,execute the foregoing instrument for the purposes f at > therein contained by signing on behalf of the corporations by himself as a duly authorized officer. > IN WITNESS WHEREOF,I have hereunto subscribed my name and affixed my notarial seal at Plymouth Meeting,Pennsylvania,on the day and year first above written. N a O ru 5a Fos., _ O P� ONWf F<, Commonwealth of Pennsylvania-Notary Seal >_ [a O 4t„ Teresa Pastella,Notary Public y'fa dt` O = Montgomery County C2 OF My commission expires March 28.2025 By: N r`u v Commission number 1126044 � Member.Pennsylvania Association of Notaries Teresa Pastella,Notary Public Q `o �by.4'SYl.�� m AHY W p O M N -22 This Power of Attorney is made and executed pursuant to and by authority of the following By-laws and Authorizations of The Ohio Casualty Insurance Company, Liberty Mutual 3 00 E-E- Insurance Company,and West American Insurance Company which resolutions are now in full force and effect reading as follows: ti 00 ARTICLE IV—OFFICERS:Section 12.Power of Attorney. o Any officer or other official of the Corporation authorized for that purpose in writing by the Chairman or the President, and subject to such limitation as the Chairman or the C:> President may prescr be,shall appoint such attorneys in-fact,as may be necessary to act in behalf of the Corporation to make,execute,seal,acknowledge and deliver as surety CO any and all undertakings,bonds,recognizances and other surety obligations.Such attorneys-in-fact,subject to the limitations set forth in their respective powers of attorney,shall c u have full power to bind the Corporation by their signature and execution of any such instruments and to attach thereto the seal of the Corporation.When so executed, such o a1 Z instruments shall be as binding as if signed by the President and attested to by the Secretary.Any power or authority granted to any representative or attomey-in-fact under the M provisions of this article may be revoked at any time by the Board,the Chairman,the President or by the officer or officers granting such power or authority. tC) ARTICLE XIII—Execution of Contracts:Section 5.Surety Bonds and Undertakings. Any officer of the Company authorized for that purpose in writing by the chairman or the president,and subject to such limitations as the chairman or the president may prescribe, shall appoint such attomeys-in-fact,as may be necessary to act in behalf of the Company to make,execute,seal,acknowledge and deliver as surety any and all undertakings, bonds,recognizances and other surety obligations.Such attorneys-in-fact subject to the limitations set forth in their respective powers of attorney,shall have full power to bind the Company by their signature and execution of any such instruments and to attach thereto the seal of the Company.When so executed such instruments shall be as binding as if signed by the president and attested by the secretary. Certificate of Designation—The President of the Company, acting pursuant to the Bylaws of the Company, authorizes Nathan J. Zangede, Assistant Secretary to appoint such attomeys-in-fact as may be necessary to act on behalf of the Company to make,execute,seal,acknowledge and deliver as surety any and all undertakings,bonds,recognizances and other surety obligations. Authorization—By unanimous consent of the Company's Board of Directors,the Company consents that facsimile or mechanically reproduced signature of any assistant secretary of the Company,wherever appearing upon a certified copy of any power of attorney issued by the Company in connection with surety bonds,shall be valid and binding upon the Company with the same force and effect as though manually affixed. I,Renee C.Llewellyn,the undersigned,Assistant Secretary,The Ohio Casualty Insurance Company,Liberty Mutual Insurance Company,and West American Insurance Company do hereby certify that the original power of attorney of which the foregoing is a full,true and correct copy of the Power of Attomey executed by said Companies,is in full force and effect and has not been revoked. IN TESTIMONY WHEREOF,I have hereunto set my hand and affixed the seals of said Companies this 6th day of March 2025. 1NSU,p VSV INS( tNSUR jp4opvo�roZ� �JP�oavog4r Pqy� `P`opvok4rg2C+ 1912 0 = 1919 o 1991 0 ��'ss4 c„us��,da y0 h4NF9`l�aai� `�s By. r41DIANP .4 Renee C.Llewellyn,Assistant Secretary LMS-12673 LMIC OCIC WAIC Multi Co 02/24 00300 BID FORM BID FORM PROJECT NAME: 2024 Residential Street Maintenance Program PROJECT LOCATION: Round Rock,Texas OWNER: City of Round Rock,Texas DATE: Pursuant to the foregoing Notice to Bidders and Instructions to Bidders,the undersigned bidder hereby proposes to do all the Work, to famish 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 2024 Residential Street Maintenance Program(SMP) 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.gov/solicitations by the close of business on Monday,March 3,2025 . 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". 11x1 BASE BID Bid Approx. Item Description Item Quantit Unit and Written Unit Price Unit Price Amount 1 5324 TON Pavement Repair, 8" Depth complete in place per TON for One lfaider / &r4x Sev h dollars I)b and Z e/'y cents. N., 2 20825 SF Remove and Replace Sidewalk complete in place per SF for /�,/11 e*w`1 dollars 00 au and z taro cents. -r 00300-9-2015 Page 1 of 7 Bid Form BASE BID Bid Approx. Item Description Item Quantit Unit and Written Unit Price Unit Price Amount — 3 6295 LF Remove and Replace Curb and Gutter complete in place per LF for i9 y N e dollars SO and �r�7y cents. � IZ� 4 21400 SF Remove and Replace Driveway complete in place per SF for dollars s(7 and cents. 00 5 12 EA Remove and Replace Ramps ,/" complete in place per EA � ./vl for � oU witl�x 7W-V(j(�)��dollars and Zero cents. � �`Gb ✓ '/ �� 6 1020 SF Remove and Replace Fillets � complete in place per SF for lwft�"/ dollars zOo and 2 pro cents. ©. Z'of q� 7 196283 SY Surface Mill,2" complete in place per SY 06--afor 67e- dollars 106-- and nd F;ye. cents. . 00300-9-2015 Page 2 of 7 Bid Form BASE BID Bid Approx. Item Description Item Quantit Unit and Written Unit Price Unit Price Amount 8 21591 TON Type D HMAC Surface Course for Ole complete in place per TON dollars and z -fr0 cents. /Z 5-- 00 Z, 00 9 12100 SY Geogrid complete in place per SY for �WO dollars 00 and cents. �Di �� 10 20 EA Valve Can Adjustment complete in place per EA for Fa-47, dollars y (� ©�`' Do and 7 eI G? cents. ` O goo D 11 187 EA Manhole Adjustment complete in place per EA for �0��q dollarso. and 7 1er0 cents. 12 1570 LF REFL PAV MRK TY I(W)6"(SLD)(100 MIL) complete in place per LF for Otic° dollars dU 00 00300-9-2015 Z-e✓'0 cents. �► 0 00300-9-2015 Page 3 of 7 Bid Form BASE BID Bid Approx. Item Description Item Quantit Unit and Written Unit Price Unit Price Amount 13 1000 LF REFL PAV MRK TY I(W) 12"(SLD)(100 MIL) complete in place per LF for tour dollars L/I OD and er'6 cents. I "/ 14 137 LF REFL PAV MRK TY I(W)24"(SLD)(100 MIL) complete in place per LF for J &7 dollars rl -!;7 0 J and 2 eil0 cents. 15 603 LF REFL PAV MRK TY I(W)8"(SLD)(100 MIL) complete in place per LF for �Vf 2 dollarsl 0 s and cents. 16 455 LF REFL PAV MRK TY I(Y) 12"(SLD)(100 MIL) complete in place per LF for Tow dollars � and ICU cents. 17 9845 LF REFL PAV MRK TY I(Y)4"(SLD)(100 MIL) complete in place per LF for eel'0 dollars ,S i13 .� and h ✓°L cents. 00300-9-2015 Page 4 of 7 Bid Form BASE BID Bid Approx. Item Description Item Quantit Unit and Written Unit Price Unit Price Amount 18 7 EA REFL PAV MRK TY I(W)(ONLY)(100 MIL) complete in place per EA for �k2Q Huidry�( dollars //�� and Zero cents. Z©0 0 19 5 EA REFL PAV MRK TY I(W)(ARROW)(100 MIL) complete in placg per EA for d g7e2 6f hC Fyl S>Gt rg- y F;v&- dollars o� 8—K bJ and 7 er U cents. 75 20 284 EA TYPE 1-C RPM r, complete in place per EA for 5o(( dollars w and 5-eo Tt VC, cents. i 21 96 EA TYPE II-B-B RPM(HYDRANTS) complete in place per EA for Pwk, dollars and F,vd- cents. 22 251 EA TYPE II-A-A RPM complete in place per EA for Sx dollars (Q / and �, tocents. 00300-9-2015 Page 5 of 7 Bid Form BASE BID Bid Approx. Item Description Item Quantit Unit and Written Unit Price Unit Price Amount 23 6 MO TRAFFIC CONTROL corn lete in place per MO for Fr w° I Yi�SQ dollars 7 3 and Iry cents. �000-"° 00300-9-2015 Page 6 of 7 Bid Form TOTAL BASE BID (Items I thru 23 ) l / Z(r�Z. a I Materials: All Other Charges: Z 77, 3 * Total: ��/&1,Z- (r9� * 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, 5 # _570 Signature NexTX.mss-1 7�7 / Print Name Address Title Telephone Name of Firm 03 10V 0� Date Secretary, if Bidder is a Corporation 00200-9-2015 Page 7 of 7 Bid Form Solicitation Requirements, Contract Forms & Conditions of Contract Statement of Bidder's Safety Experience Section 00410 Bidder must submit a signed Statement of Bidder's Safety Experience form with his Bid; failure to do so will constitute an incomplete Bid that may be rejected. In order to make a responsive Bid, Bidder must provide evidence that it meets minimum OSHA construction safety program requirements, has not been fined by OSHA for any willful safety violations in the past three years, and has a lost time injury rate that doesn't exceed the limits established below. All questions must be answered and data given must be clear and comprehensive. If necessary, questions may be answered on separate attached sheets. Q Company Name: 14 �qL. (/ dba L° S�r 1��rr►q (-- kn Address:��i A* Rd s� 10 /SO Ak��ni TX � Phone: �/Z— Completed by: �(alpe,J war001- Date: 1. Does the company have a written construction Safety program? [(Yes ❑No 2. Does the company conduct construction safety inspections? [4'Yes ❑No 3. Does the company have an active construction safety-training program? 14Yes ❑No 4. Has the company been fined by OSHA for any willful safety violations in the past []Yes [�No three years? 5. Does the company have a lost time injury rate of 7.8 for SIC 15,or 7.6 for SIC 16, [Yes ❑No or less over the past three years? Attach the company's OSHA 200/300 logs for the past three years. ${C °h 6. Does the company or affected subcontractors have competent persons in the following Areas? A. Scaffolding ❑Yes ❑No LAN/A B. Excavation [ Yes [:]No ❑N/A C. Cranes ❑Yes ❑No [q�N/A D. Electrical El Yes []No [� A E. Fall Protection ❑Yes ❑No %A F. Confined Spaces El Yes ❑No SNIA I hereby certify that th bo ation is true and correct. Signature Title Page 1 00410 8-2014 Statement of Bidder's Safety Experience 00090654 Workers'compensation Experience Modification Rate(EMR)for the last 5 years: YEAR U)Q' EMR 6-9 YEAR EMR X4-1 YEAR EMR ,&O YEAR X2!2 EMR S' YEAR o?4,W EMR Total Recordable Frequency Rate(TRFR)for the last 5 years: YEAR ;�-6o23 TRFR /-7, 3 YEAR ° TRFR YEAR a2 TRFR YEAR 0; TRFR 3 / YEAR t TRFR Total number of man-hours worked for the last 5 Years: YEAR ;2093 TOTAL NUMBER OF MAN-HOURS 40352 YEAR Ae TOTAL NUMBER OF MAN-HOURS JfZ'd'c'o YEAR �,?4,94 TOTAL NUMBER OF MAN-HOURS o�c YEAR TOTAL NUMBER OF MAN-HOURS 3VRa YEAR TOTAL NUMBER OF MAN-HOURS 3f Po Provide Contractor's(and Contractor's proposed Subcontractors and Suppliers furnishing or performing Work having a value in excess of 10 percent of the total amount of the Bid)Days Away From Work, Days of Restricted Work Activity or Job Transfer(DART)incidence rate for the particular industry or type of Work to be performed by Contractor and each of Contractor's proposed Subcontractors and Suppliers)for the last 5 years: YEAR DART if 9Q YEAR DART YEAR Zoe DART /,/0 YEAR ?G:Zy DART /.,,?7 YEAR DART (,,j 13. EQUIPMENT: MAJOR EQUIPMENT: List on Schedule C all pieces of major equipment available for use on Owner's Project. Project No.2024-2 6 Section 00 45 13 STREET MAINTENANCE PROGRAM Qualifications Statement WORKERS COMPENSATION EXPERIENCE RATING NCC/ Risk Name: ASPHALT INC LLC Risk ID: 421452792 Rating Effective Date:01/19/2024 Production Date: 10/27/2023 State: TEXAS StateWt Exp Excess Expected Exp Prim Act Exc Losses Ballast Act Inc Losses Act Prim Losses Losses Losses Losses Tx .381 597,476 892,649 295,173 35,167 117,300 152,837 117,670 Tx-A .38 1,241 1,910 669 0 117,300 0 0 Tx-B .38 71 109 38 0 117,300 0 0 Tx-c .38 16 25 9 0 117,300 01 0 Tx-D .38 151 233 82 0 117,300 0 0 Tx-E .38 5,833 8,333 2,500 01 117,300 0 0 Tx-F .381 25 38 13 01 117,300 0 0 Tx-G .38 170 263 93 0 117,300 0 0 Tx-H .38 38 59 21 0 117,300 0 0 Tx-I .38 68 105 37 0 117,300 0 0 Tx-K .38 161 246 85 0 117,300 0 0 Tx-t .38 21 32 11 0 117,300 0 0 Tx-M .38 4211 648 227 0 117,300 0 0 (A) (B) (C)Exp Excess (D)Expected (E)Exp Prim (F)Act Exc (G)Ballast (H)Act Inc (1)Act Prim Wt Losses(D-E) Losses Losses Losses(H-1) 1 Losses Losses 1.381 1 605,6921 904,6501 298,9581 26,6601 117,3001 115,5861 88,9261 Primary Losses Stabilizing Value Ratable Excess Totals (I) C*(1 -A)+G (A)*(F) (J) Actual 88,926 492,829 10,131 591,886 (E) C*(1 -A)+G (A)*(C) (K) Expected 298,958 492,829 230,163 1,021,950 ARAP FLARAP SARAP MAARAP Exp Mod (J)/(K) Factors 1 •58 RATING REFLECTS A DECREASE OF 70%MEDICAL ONLY PRIMARY AND EXCESS LOSS DOLLARS WHERE ERA IS APPLIED. THIS RATING CONTAINS ALL UNIT REPORT DATA EXPECTED TO BE RECEIVED BY NCCI,NO UNIT REPORT DATA IS EXPECTED TO BE SUBMITTED TO NCCI FOR THE FOLLOWING PERIODS(S): FROM 09/01/2019 TO 05/01/2021 ST:TX AND FIRM C. THIS RATING CONTAINS ALL UNIT REPORT DATA EXPECTED TO BE RECEIVED BY NCCI,NO UNIT REPORT DATA IS EXPECTED TO BE SUBMITTED TO NCCI FOR THE FOLLOWING PERIODS(S): FROM 03/01/2021 TO 03/01/2022 ST:TX AND FIRM L. Carrier: 29939-000 Policy: 0001299829 Eff-Date: 01-19-2023 Exp-Date: 01-19-2024 ®Copyright 1993-2023,All rights reserved.This product is comprised of compilations and information which are the proprietary and exclusive property of the National Council on Compensation Insurance, Inc.(NCCI).No further use,dissemination,sale,transfer,assignment or disposition of this product,in whole or in part,may be made without the prior written consent of NCCI.This product is furnished'As is" As available'With all defects"and includes information available at the time of publication only.NCCI makes no representations or warranties of any kind relating to the product and hereby expressly disclaims any and all express,statutory,or implied warranties,including the implied warranty of merchantability,fitness for a particular purpose,accuracy,completeness,currentness,or correctness of the product or information contained therein.This product and the information contained therein are to be used exclusively for underwriting,premium calculation and other Insurance purposes and may not be used for any other purpose including but not limited to safety scoring for project bidding purposes.All responsibility for the use of and for any and all results derived or obtained through the use of the product and information are the end users and NCCI shall not have any liability thereto. Page 1 of 8 WORKERS COMPENSATION EXPERIENCE RATING omrcl Risk Name: ASPHALT INC LLC Risk ID: 421452792 Rating Effective Date:01/19/2024 Production Date: 10/27/2023 State: TEXAS 42-TEXAS Firm ID: Firm Name: ASPHALT INC LLC Carrier: 29939 Policy No. 0001299829 Eff Date: 01/19/2020 Exp Date: 01/19/2021 Code ELR D- Payroll Expected Exp Prim Claim Data IJ OF Act Inc Act Prim Ratio Losses Losses Losses Losses 1463 2.80 .30 3,295,849 92,284 27,685 0001210590 04 F 26,043 18,500 4000 .73 .35 1,998,633 14,590 5,107 5001232159 05 F 1,771 1,771 5220 .92 .35 11,590,097 106,629 37,320 6001222755 06 F 986 986 5506 11.27 .35 1,468,010 18,644 6,525 5606 .15 .30 1,742,533 2,6141 784 8227 .44 .35 2,583,4311 11,367 3,978 8742 .06 .41 2,104,7921 1,263 518 8809 .04 .41 62,400 25 10 8810 .03 .48 5,610,038', 1,683 808 Subject Total Act Inc (Policy Total: 30,455,78 Premium: 905,435 Losses: 28,800 42-TEXAS Firm ID: Firm Name: ASPHALT INC LLC Carrier: 29939 Policy No. 0001299829 Eff Date: 01/19/2021 Exp Date: 01/19/2022 Code ELR D- Payroll Expected Exp Prim Claim Data IJ OF Act Inc Act Prim Ratio Losses Losses Losses Losses 1463 2.80 .30 4,168,963 116,731 35,019 1001262215 05 F 5,358 5,358 4000 .73 .35 2,434,250 17,770 6,220 5001251122 05 F 6,585 6,585 5220 .92 .35 13,649,103 125,572 43,950 4001277050 05 F 7,392 7,392 5506 1.27 .35 1,670,934 21,221 71427 0001257102 05 F 22,176 18,500 5606 .15 .30 1,780,0641 2,670 801 [NO.4 06 1,279 1,279 8227 .44 .35 2,961,885 13,032 4,561 5001254146 06 F 8,320 8,320 8742 .06 .41 2,125,1101 1,2751 523 4001261462 06 F 30,653 18,500 8809EE .41 62,400 25 10 8810 .48 6,173,198 1,8521 889 Subject Total Act Inc Policy Total: 35,025,90 Premium: 1,010,815 Losses: 81,763 ©Copyright 1993-2023,All rights reserved.This product is comprised of compilations and information which are the proprietary and exclusive property of the National Council on Compensation Insurance, Inc.(NCCI).No further use,dissemination,sale,transfer,assignment or disposition of this product,in whole or in part,may be made without the prior written consent of NCCL This product is furnished"As is" "As available""With all defects"and includes information available at the time of publication only.NCCI makes no representations or warranties of any kind relating to the product and hereby expressly disclaims any and all express,statutory,or implied warranties,including the implied warranty of merchantability,fitness for a particular purpose,accuracy,completeness,currentness,or correctness of the product or information contained therein.This product and the information contained therein are to be used exclusively for underwriting,premium calculation and other Insurance purposes and may not be used for any other purpose including but not limited to safety scoring for project bidding purposes.All responsibility for the use of and for any and all results derived or obtained through the use of the product and information are the end user's and NCCI shall not have any liability thereto. *Total by Policy Year of all cases$2000 or less. D Disease Loss X Ex-Medical Coverage U USL&HW C Catastrophic Loss E Employers Liability Loss #Limited Loss Page 2 of 8 WORKERS COMPENSATION EXPERIENCE RATING 0/vEr, Risk Name: ASPHALT INC LLC Risk ID: 421452792 Rating Effective Date:01/19/2024 Production Date: 10/27/2023 State: TEXAS 42-TEXAS Firm ID: Firm Name: ASPHALT INC LLC Carrier: 29939 Policy No. 0001299829 Eff Date: 01/19/2022 Exp Date: 01/19/2023 Code ELR D- Payroll Expected Exp Prim Claim Data IJ OF Act Inc Act Prim Ratio Losses Losses Losses Losses 1463 2.80 .30 5,212,074 145,938 43,781 5001314275 05 F 30,295 18,500 4000 .73 .35 2,383,435 17,399 6,090 2001304210 06 F 2,530 2,530 5220 1 .92 .35 13,839,262 127,321 44,562 2001326971 06 F 4,576 4,576 5506 1.27 .35 2,648,887 33,641 11,774 NO.7 06 4,873 4,873 5606 .15 .30 2,191,465 3,287 986 8227 .44 .35 2,838,560 12,490 4,372 8742 .06 .41 2,891,2221 1,735 711 8809 .04 .41 62,400 25 10 8810 1 .03 .48 5,219,403 1,566 r 752 Subject Total Act Inc Policy Total: 37,286,70 Premium: 1,043,678 Losses: 42,274 42-TEXAS Firm ID:A Firm Name: ASPHALT INC LLC Carrier: 10863 Policy No. WC651298300 Eff Date: 06/14/2020 Exp Date: 05/01/2021 Code ELR D- Payroll Expected Exp Prim Claim Data IJ OF Act Inc Act Prim Ratio Losses Losses Losses Losses 5220 .92 .35 2,049 19 7 Subject Total Act Inc Policy Total: 2,04 Premium: 75 Losses: 0 42-TEXAS Firm ID:A Firm Name: ASPHALT INC LLC Carrier: 21814 Policy No. WA761DC1622JO21 Eff Date: 05/14/2021 Exp Date: 01/01/2022 Code ELR D- Payroll Expected Exp Prim Claim Data IJ OF Act Inc Act Prim Ratio Losses Losses Losses Losses 5220 .92 .35 205,582 1,891 66211 Subject Total Act Inc Policy Total: 205,58 Premium: 5,633 Losses: 0 42-TEXAS Firm ID:B Firm Name: ASPHALT INC. DBA LONE STAR PAVING Carrier: 21814 Policy No. WA764D445797701 Eff Date: 08/02/2021 Exp Date: 08/02/2022 Code ELR D- Payroll Expected Exp Prim Claim Data IJ 10171 Act Inc Act Prim Ratio Losses Losses Losses Losses 5220 .92 .35 11,817 109 38 Subject Total Act Inc Policy Total: 11,81 Premium: 249 Losses: 0 ®Copyright 1993-2023,All rights reserved.This product is comprised of compilations and information which are the proprietary and exclusive property of the National Council on Compensation Insurance, Inc.(NCCI).No further use,dissemination,sale,transfer,assignment or disposition of this product,in whole or in part,may be made without the prior written consent of NCCI.This product is furnished'As is' 'As available'With all defects'and includes information available at the time of publication only.NCCI makes no representations or warranties of any kind relating to the product and hereby expressly disclaims any and all express,statutory,or implied warranties,including the implied warranty of merchantability,fitness for a particular purpose,accuracy,completeness,currentness,or correctness of the product or information contained therein.This product and the information contained therein are to be used exclusively for underwriting,premium calculation and other Insurance purposes and may not be used for any other purpose including but not limited to safety scoring for project bidding purposes.All responsibility for the use of and for any and all results derived or obtained through the use of the product and information are the end user's and NCCI shall not have any liability thereto. Total by Policy Year of all cases$2000 or less. D Disease Loss X Ex-Medical Coverage U USLBHW C Catastrophic Loss E Employers Liability Loss #Limited Loss Page 3 of 8 WORKERS COMPENSATION EXPERIENCE RATING omf�rr Risk Name: ASPHALT INC LLC Risk ID: 421452792 Rating Effective Date:01/19/2024 Production Date: 10/27/2023 State: TEXAS 42-TEXAS Firm ID:C Firm Name: LONE STAR PAVING LLC Carrier: 21814 Policy No. WA769D466320957 Eff Date: 07/10/2019 Exp Date: 09/01/2019 Code ELR D- Payroll Expected Exp Prim Claim Data IJ OFi Act Inc Act Prim Ratio Losses Losses Losses Losses 5220 .92 .35 1,274 12 4 Subject Total Act Inc Policy Total: 1,27 Premium: 40 Losses: 0 42-TEXAS Firm ID:C Firm Name: LONE STAR PAVING LLC Carrier: 10863 Policy No. WC651298301 Eff Date: 05/01/2021 Exp Date: 05/01/2022 Code ELR D- Payroll Expected Exp Prim Claim Data IJ OF Act Inc Act Prim Ratio Losses Losses Losses Losses 5220 .92 .35 1,382 13 5 Subject Total Act Inc Policy Total: 1,38 Premium: 43 Losses: 0 42-TEXAS Firm ID:D Firm Name: ASPHALT INC.LLC LONE STAR PAVING Carrier: 21814 Policy No. WA766DO67243850 Eff Date: 03/27/2020 Exp Date: 05/31/2020 Code ELR D- Payroll Expected Exp Prim Claim Data IJ OF Act Inc Act Prim Ratio Losses Losses Losses Losses 5220 1 .92 .35 2,524 231 8 Subject Total Act Inc Policy Total: 2,52 Premium: 80 Losses: 0 42-TEXAS Firm ID:D Firm Name: ASPHALT INC.LLC LONE STAR PAVING Carrier: 21814 Policy No. WA7C4D445641730 Eff Date: 06/01/2020 Exp Date: 06/01/2021 Code ELR D- Payroll Expected Exp Prim Claim Data IJ OF Act Inc Act Prim Ratio Losses Losses Losses Losses 5220 .92 .35 19,431 179 63 5220 .92 .35 3,3931 31 1 11 Subject Total Act Inc Policy Total: 22,82 Premium: 7241 Losses: 0 42-TEXAS Firm ID:E Firm Name: ASPHALT INC.LLC.DBA LONE STAR PAVING Carrier: 10863 Policy No. WC122644500 Eff Date: 01/01/2022 Exp Date: 01/01/2023 Code ELR D- Payroll Expected Exp Prim Claim Data IJ OF Act Inc Act Prim Ratio Losses Losses Losses Losses 1463 2.80 .30 297,603 8,333 2,500 Subject Total Act Inc Policy Total: 297,60 Premium: 27,945 Losses: 0 ®Copyright 1993-2023,All rights reserved.This product is comprised of compilations and information which are the proprietary and exclusive property of the National Council on Compensation Insurance, Inc.(NCCI).No further use,dissemination,sale,transfer,assignment or disposition of this product,in whole or in part,may be made without the prior written consent of NCCI.This product is furnished"Asis" "As available"With all defects"and includes information available at the time of publication only.NCCI makes no representations or warranties of any kind relating to the product and hereby expressly disclaims any and all express,statutory,or implied warranties,including the implied warranty of merchantability,fitness for a particular purpose,accuracy,completeness,currentness,or correctness of the product or information contained therein.This product and the information contained therein are to be used exclusively for underwriting,premium calculation and other Insurance purposes and may not be used for any other purpose including but not limited to safety scoring for project bidding purposes.All responsibility for the use of and for any and all results derived or obtained through the use of the product and information are the end users and NCCI shall not have any liability thereto. Total by Policy Year of all cases$2000 or less. D Disease Loss X Ex-Medical Coverage U USL&HW C Catastrophic Loss E Employers Liability Loss #Limited Loss Page 4 of 8 WORKERS COMPENSATION EXPERIENCE RATING OIV----,.f Risk Name: ASPHALT INC LLC Risk ID: 421452792 Rating Effective Date:01/19/2024 Production Date: 10/27/2023 State: TEXAS 42-TEXAS Firm ID:F Firm Name: ASPHALT INC Carrier: 10863 Policy No. WCO25819403 Eff Date: 05/09/2020 Exp Date: 05/09/2021 Code ELR D- Payroll Expected Exp Prim Claim Data IJ OF Act Inc Act Prim Ratio Losses Losses Losses Losses 5220 .92 .35 4,042 37 13 Subject Total Act Inc Policy Total: 4,04 Premium: 147 Losses: 0 42-TEXAS Firm ID:F Firm Name: ASPHALT INC Carrier: 17965 Policy No. WC055890700 Eff Date: 06/10/2021 Exp Date: 05/01/2022 Code ELR D- Payroll Expected Exp Prim Claim Data IJ OF Act Inc Act Prim Ratio Losses Losses Losses Losses 5220 .92 .35 135 1 0 Subject (Total Act Inc Policy Total: 13 Premium: 3 Losses: 0 42-TEXAS Firm ID:G Firm Name: ASPHALT INC Carrier: 17965 Policy No. WC611723801 Eff Date: 09/17/2019 Exp Date: 09/17/2020 Code ELRD❑- Payroll Expected Exp Prim Claim Data IJ 1OF1 Act Inc Act Prim Ratio Losses FLosses Losses Losses 1 5220 1 .921 .351 16,043 148 52 Subject Total Act Inc Policy Total: 16,04 Premium: 409 Losses: 0 42-TEXAS Firm ID:G Firm Name: ASPHALT INC Carrier: 17965 Policy No. WC611723802 Eff Date: 09/17/2020 Exp Date: 09/17/2021 Code ELR D- Payroll Expected Exp Prim Claim Data IJ OF Act Inc Act Prim Ratio Losses Losses Losses Losses 5220 .92 .35 4,203 39 14 Subject Total Act Inc Policy Total: 4,203 Premium: 92 Losses: 0 42-TEXAS Firm ID:G Firm Name: ASPHALT INC Carrier: 17965 Policy No. WC611723803 Eff Date: 09/17/2021 Exp Date: 09/17/2022 Code ELR D- Payroll Expected Exp Prim Claim Data IJ OF Act Inc Act Prim Ratio Losses Losses Losses Losses 5220 .92 .35 8,210 76 27 Subject Total Act Inc Policy Total: 8,21 Premium: 147 Losses: 0 ©Copyright 1993-2023,All rights reserved.This product is comprised of compilations and information which are the proprietary and exclusive property of the National Council on Compensation Insurance, Inc.(NCCI).No further use,dissemination,sale,transfer,assignment or disposition of this product,in whole or in part,may be made without the prior written consent of NCCI.This product is furnished"As is" "As available"With all defects"and includes information available at the time of publication only.NCCI makes no representations or warranties of any kind relating to the product and hereby expressly disclaims any and all express,statutory,or implied warranties,including the implied warranty of merchantability,fitness for a particular purpose,accuracy,completeness,currentness,or correctness of the product or information contained therein.This product and the information contained therein are to be used exclusively for underwriting,premium calculation and other Insurance purposes and may not be used for any other purpose including but not limited to safety scoring for project bidding purposes.All responsibility for the use of and for any and all results derived or obtained through the use of the product and information are the end users and NCCI shall not have any liability thereto. `Total by Policy Year of all cases$2000 or less. D Disease Loss X Ex-Medical Coverage U USL&HW C Catastrophic Loss E Employers Liability Loss #Limited Loss Page 5 of 8 WORKERS COMPENSATION EXPERIENCE RATING ONE" Risk Name: ASPHALT INC LLC Risk ID: 421452792 Rating Effective Date:01/19/2024 Production Date: 10/27/2023 State: TEXAS 42-TEXAS Firm ID:H Firm Name: LONE STAR PAVING ASPHALT INC. LLC DBA Carrier: 16586 Policy No. WA269D470759019 Eff Date: 07/17/2020 Exp Date: 07/17/2021 Code ELR D- Payroll Expected Exp Prim Claim Data IJ OF Act Inc Act Prim Ratio Losses Losses Losses Losses 5220 .92 .35 4,306 40 14 Subject Total Act Inc Policy Total: 4,306 Premium: 148 Losses: 0 42-TEXAS Firm ID:H Firm Name: LONE STAR PAVING ASPHALT INC. LLC DBA Carrier: 16586 Policy No. WA269D470759019 Eff Date: 07/17/2021 Exp Date: 07/01/2022 Code ELR D- Payroll Expected Exp Prim Claim Data IJ OF Act inc Act Prim Ratio Losses Losses Losses Losses 5220 .92 .35 2,017 19 7 Subject Total Act Inc Policy Total: 2,017 Premium: 53 Losses: 0 42-TEXAS Firm ID:I Firm Name: ASPHALT INC LLC DBA LONE STAR PAVING Carrier: 10863 Policy No. WC567886401 Eff Date: 08/01/2019 Exp Date: 08/01/2020 Code ELR D- Payroll Expected Exp Prim Claim Data IJ 101 Act Inc Act Prim Ratio Losses Losses Losses Losses 5220 .92 .35 8,176 75 26 I�� Subject (Total Act Inc Policy Total: 8,17 Premium: 298 Losses: 0 42-TEXAS Firm ID:I Firm Name: ASPHALT INC LLC DBA LONE STAR PAVING Carrier: 10863 Policy No. WC567886402 Eff Date: 08/01/2020 Exp Date: 08/01/2021 Code ELR D- Payroll Expected Exp Prim Claim Data IJ OF Act Inc Act Prim Ratio Losses Losses Losses Losses 5220 .92 .35 3,217 30 11 Policy Total: 3,217 Premium: 10111Los es:Total Inc 0 42-TEXAS Firm ID:K Firm Name: LONE STAR PAVING LLC Carrier: 28355 Policy No. 41 WCI1543200 Eff Date: 06/28/2019 Exp Date: 07/17/2019 Code ELR D- Payroll Expected Exp Prim Claim Data IJ OF Act Inc Act Prim Ratio Losses Losses Losses Losses 5220 .92 .35 883 8 3 Subject Total Act Inc Policy Total: 883 Premium: 43 Losses: 0 ©Copyright 1993-2023,All rights reserved.This product is comprised of compilations and information which are the proprietary and exclusive property of the National Council on Compensation Insurance, Inc.(NCCI).No further use,dissemination,sale,transfer,assignment or disposition of this product,in whole or in part,may be made without the prior written consent of NCCI.This product is furnished"As is" "As available""With all defects'and includes information available at the time of publication only.NCCI makes no representations or warranties of any kind relating to the product and hereby expressly disclaims any and all express,statutory,or implied warranties,including the implied warranty of merchantability,fitness for a particular purpose,accuracy,completeness,currentness,or correctness of the product or information contained therein.This product and the information contained therein are to be used exclusively for underwriting,premium calculation and other Insurance purposes and may not be used for any other purpose including but not limited to safety scoring for project bidding purposes.All responsibility for the use of and for any and all results derived or obtained through the use of the product and information are the end users and NCCI shall not have any liability thereto. Total by Policy Year of all cases$2000 or less. D Disease Loss X Ex-Medical Coverage U USLBHW C Catastrophic Loss E Employers Liability Loss #Limited Loss Page 6 of 8 WORKERS COMPENSATION EXPERIENCE RATING O/V----/ Risk Name: ASPHALT INC LLC Risk ID: 421452792 Rating Effective Date:01/19/2024 Production Date: 10/27/2023 State: TEXAS 42-TEXAS Firm ID:K Firm Name: LONE STAR PAVING LLC Carrier: 28355 Policy No. 41 WC11543201 Eff Date: 07/17/2019 Exp Date: 07/17/2020 Code ELR D- Payroll Expected Exp Prim Claim Data IJ OF Act Inc Act Prim Ratio Losses Losses Losses Losses 5220 .92 .35 447 4 1 5220 .92 .35 4291 4 1 Subject Total Act Inc Policy Total: 87 Premium: 361 Losses: 0 42-TEXAS Firm ID:K Firm Name: LONE STAR PAVING LLC Carrier: 17965 Policy No. WC320439000 Eff Date: 07/17/2020 Exp Date: 05/19/2021 Code ELR D- Payroll Expected Exp Prim Claim Data IJ OF Act Inc Act Prim Ratio Losses Losses Losses Losses 5200 .82 .35 1,804 15 51 I � Subject I IT-tal Act Inc Policy Total: 1,80 Premium: 35 Losses: 0 42-TEXAS Firm ID:K Firm Name: LONE STAR PAVING LLC Carrier: 27243 Policy No. WA566DO67318931 Eff Date: 03/23/2021 Exp Date: 03/23/2022 Code ELR I D- Payroll Expected Exp Prim Claim Data IJ OF Act Inc Act Prim Ratio Losses Losses Losses Losses 5220 1 .92 .35 3,529 32 11 5220 1 .92 .35 19,860 183 64 I I I 1 Subject Total Act Inc Policy Total: 23,38 Premium: 477 Losses: 0 42-TEXAS Firm ID:L Firm Name: ASPHALT INC Carrier: 12491 Policy No. WC039252150 Eff Date: 08/26/2019 Exp Date: 03/01/2020 Code ELR D- Payroll Expected Exp Prim Claim Data IJ OF Act Inc Act Prim Ratio Losses Losses Losses Losses 5220 .92 .35 1,311 12 4 Subject Total Act Inc Policy Total: 1,311 Premium: 49 Losses: 0 42-TEXAS Firm ID:L Firm Name: ASPHALT INC Carrier: 12491 Policy No. WC039252150 Eff Date: 03/01/2020 Exp Date: 03/01/2021 Code ELR D- Payroll Expected Exp Prim Claim Data IJ OF Actinic Act Prim Ratio Losses Losses Losses Losses 1 5220 1 .921 .351 1,410 13 5 I 1 1 Subject Total Act Inc Policy Total: 1,41 Premium: 53 Losses: 0 ©Copyright 1993-2023,All rights reserved.This product is comprised of compilations and information which are the proprietary and exclusive property of the National Council on Compensation Insurance, Inc.(NCCI).No further use,dissemination,sale,transfer,assignment or disposition of this product,in whole or in part,may be made without the prior written consent of NCCI.This product is furnished"As is" As available""With all defects"and includes information available at the time of publication only.NCCI makes no representations or warranties of any kind relating to the product and hereby expressly disclaims any and all express,statutory,or implied warranties,including the implied warranty of merchantability,fitness for a particular purpose,accuracy,completeness,currentness,or correctness of the product or information contained therein.This product and the information contained therein are to be used exclusively for underwriting,premium calculation and other Insurance purposes and may not be used for any other purpose including but not limited to safety scoring for project bidding purposes.All responsibility for the use of and for any and all results derived or obtained through the use of the product and information are the end user's and NCCI shall not have any liability thereto. Total by Policy Year of all cases$2000 or less. D Disease Loss X Ex-Medical Coverage U USL&HW C Catastrophic Loss E Employers Liability Loss #Limited Loss Page 7 of 8 WORKERS COMPENSATION EXPERIENCE RATING 0/vEla, Risk Name: ASPHALT INC LLC Risk ID: 421452792 Rating Effective Date:01/19/2024 Production Date: 10/27/2023 State: TEXAS 42-TEXAS Firm ID:L Firm Name: ASPHALT INC Carrier: 12491 Policy No. WC039252150 Eff Date: 03/01/2022 Exp Date: 03/01/2023 Code ELR D- Payroll Expected Exp Prim Claim Data IJ OF Act Inc Act Prim Ratio Losses Losses Losses Losses 5506 1.27 .35 550 7 2 Subject Total Act Inc Policy Total: 55 Premium: 18 Losses: 0 42-TEXAS Firm ID:M Firm Name: LONE STAR PAVING Carrier: 21814 Policy No. WC7625095488591 Eff Date: 11/17/2021 Exp Date: 11/17/2022 Code ELR D- Payroll Expected Exp Prim Claim Data IJ OF Act Inc Act Prim Ratio Losses Losses Losses Losses 5220 .92 .35 53,476 492 172 5220 .92 .35 17,000 1561 55 Subject Total Act Inc Policy Total: 70,47 Premium: 1,487 Losses: 0 ®Copyright 1993-2023,All rights reserved.This product is comprised of compilaUons and information which are the proprietary and exclusive property of the National Council on Compensation Insurance, Inc.(NCCI).No further use,dissemination,sale,transfer,assignment or disposition of this product,In whole or in pad,may be made without the prior written consent of NCCI.This product is furnished"As Is' "As available"With all defects'and includes information available at the time of publication only.NCCI makes no representations or warranties of any kind relating to the product and hereby expressly disclaims any and all express,statutory,or Implied warranties,including the implied warranty of merchantability,fitness for a particular purpose,accuracy,completeness,currentness,or correctness of the product or information contained therein.This product and the information contained therein are to be used exclusively for underwriting,premium calculation and other Insurance purposes and may not be used for any other purpose including but not limited to safety scoring for project bidding purposes.All responsibility for the use of and for any and all results derived or obtained through the use of the product and information are the end user's and NCCI shall not have any liability thereto. Total by Policy Year of all cases$2000 or less. D Disease Loss X Ex-Medical Coverage U USL&HW C Catastrophic Loss E Employers Liability Loss #Limited Loss Page 8 of 8 OSHA's Form 300 (Rev. 0412004) Note:You can type Input Into this farm and save it Attention:This form contains information relating to Logo f Work-Related 1 a to d Becauthe forms in this recordkeeping package are 7tllable/writable" employee health and must be used in a manner that g PDF docse uments,you can type into the Input form fields and protects the confidentiality of employees to the extent Year 20 23 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. ocrapatlonar sar rrand Hearth AdmrNstrarlon Please Record: Reminders: Fomtapprowd OMB no.1218.0176 •lnformarlonaboureverywork-relareddeath andabouteveryworkrdatedfnjuryar111ness that lnvolveslossof Complete an Injury andflinens InddenrReparr(OSHA Form 301)orequIvalenr consdausness,resfricredworkoctiv7ryaJobtransfer,days away from work,ormedmltreoirnentbeyondfirst dd. form foreachinjury or111ness recorded onthltform.lfyouYenotsurewhethera Asphalt Inc dbaLane StarPaving Company •Slgnillcontwork-relaredlnjvnaandiitnwetrhararedlognosedbyaphys;danorllcensedhealthcareprofesslonal. cast hrecwdablgcallyour local OSHA office for help. •Work-rdated injuries and illnesses that meet anyofthe spedficrecording airedalisted in 29 CFR Parr 79049 -Fed free to use two Iinesfor a single case ifyou need to. TX through 7904.72 •Complete the 5steps foreach case- Step ase ca,,Austin she Stop 3.Classify the case SIMECT 010f Y ONE circle based on the (A) (B) (C) (0) (E) (F) Enter the number of Case - days the 1nAtred or 19 sefect one column: C Employce'snatae Job title Date ofinjury Whcie the event occurred Describe lnjary or Ulnmss,parts orbody worker was: no. (ag.,Welder) or onset of (e.g.,Lw&ng dark nordi end) affected,and object/subslancetbat —._.rte - -_ ------ ------- irtntss directly injured or made person ill(r. Remained at Work — lllota (e.g.,7/10) Sceand degree b....n right core 7t. acotylene torch) Days awe Job transfer othar mmrd- Awry On f b Death immwork or resVicllon able carie from transferor 2 c work raiMatlon E. D (G) (y) (1) (J) (K� (L) S� Reset Jordan Baker Paving Crew 2 (1) (2) (3) (4) (5) (6) /20— Fort Hood JObsite Ring Finger caught In equipment and t p injured lO O 0 3� O O OO OO nnnlnlday _.r. —army, Reset 2 Brian Benivedes Paving Crew 8 122 SH29 Jobsite 0 0 0 0 69 � days 00000 nonan/day d Reset m—nu,iday 0 0 0 0 000000 Reset .0,1 day O O 0 0 _day, _days 000000 0 O 0 0 na�nl�y 11 �ye 000000 Reset monA;day 0 0 0 O _..der _day= 000000 Reset Nldey 0 0 0 0 Jaye _day= 000000 tronn Reset /— O 0 �J O n0/day aya -I.Y. 000000 nw Reset / O O O 0 mon h!day _-__day, days 000000 Reset 0 0 0 0 —dayr _day. 000000 mmn{h I day Publ;c,opmdnyboela,for this mlloaaa ofmfannwaa is atieutcdmasmec is mineto lxrrmpaase,imr<IWir>L dmeto taiew the Pa_qe!orals , 0 2 0 0 99 0 2 O O Q O Q imttnctioar,acamcb and 1?OQ Ne data nrNcd,dad m,opinc ami rcvinr thr ra0mion afarormm0an.Pram me dot ragnircd fo sspoeawwrranerdanarer doaDatea:tduphyzacomedywndOMBmmmlovmba.ifyoohnrcany...un v.bootth— Add a Form Page —— --- e.r,...^,^or myolhcro of this does co➢oction conlact:IlS Dcparte=torfabor.osim 0M=ofssdsdu1 Mnlyds.xoom Besure to transfertheso lotalsto the Summarypage(Form MA)beforeyoupostit. 2 ;R V s `� N-36",200 ComtiftakaAvenae.NW,NVwhierma OC 20210.Do sot scud the complcmd toms to this ofOc� — .9 'a , a" (1) (2) (3) (4) (5) (6) O SHA's Form 300A (Rev.04/2004) Note.You can type Input into this form and save it Because the forms in this recordkeeping package are'fillable1writable" Year 20 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_ Ouupauanat Safrry and Haalrh Admin(straaen Fo app ved OMB oa.1_13-0176 m m All establishments covered by Part 1904 must complete this Summary page,even if no wank-related injuries orillnesses 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 foreach category.Then write the totals below,maldng sure you've added the entries from everypage of the Log.If you had no cases,write 0.' ,Establishment informafian 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 GFR Part 1904.35,in OSHA's recordkeeping rule,for further details on the access provisions for r asnbeshmwtnama Asphalt Inc dba Lone Star Paving Co these forms- sue,, 11824 Harold Green Road i Austin stat TX zip 78725 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(eg.,Marufacriwe afmoror truck trailers) away from work restriction cases Asphalt Paving 0 2 0 0 (G) (H) (I) (J) - North American Industrial Classit3cation(NAICS),iflmown(cg..336212) 237310 11lumberofDays Employment information(Ifyou don't have rhesefigures,see the Total number of days Total number of days of Nor,4heet on die neu page to etamate) away from work job transfer or restriction 231 Annual average number of employees 99 0 Total hours worked by all employees last year 480,480.00 (K) (1) 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 (t''n my kn ledge the tries are true,accurate,and complete. (1)Injuries 2 (4) Poisonings 0 —� GvO (2)Slan disorders 0 (5) Healing loss 0 Co paay executive J Title Fbonc512-799-9145 Dat.1/24/2024 (3)Respiratory conditions Q (5) All other illnesses 0 Post this Summarypage from February 7 to April 30 of the year following the year covered by the form. Reset. Pablie n:portias buMm for this collection of iar n atioa is swim ted to--z-58 miarces peresl ansa hwladiag time to review the imavedom,search mad palter the dam needed,and ...__._ .___..._._._ cornplUs mad n:vie.•the colleetiop of infarpatio¢Pcaons am rat r quircd m rspoad to the collection of ioformtioa uakss it dispisys o erur�tly talid OMti eoatral nvmbd ICyou have my comments about these mti mta or any otheras;=U oftbis data eollcuioo,eonmet:US Department otIabor,OSHA OM"of Statistical Aaulysis,Room N-3641.20D Constitution Aurone,NW, Washington,DC 20_10.Do rot send the completed forms to this otrae OSHA's Form 300A (Rev.0412004) Note:You can type input into this form and save it. Because the forms in this recordkeeping package are'fillable/writable" Year 20 22 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. Oecapsaonsf Ssfery end Hufta Adn.ln7straden FosmapprowdOMa ao.1218-0176 All establishments covered by Part 1904 must complete this Summary page,even if no work-rela(ed injuries orillnesses occurred during the year. Remember to review the Log to verffy that the entries are complete and accurate before completing this summary. Using the Lag,count fire 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 orris equivalent See 29 CFR Part 1904.35,in OSHA's recordkeeping rule,forfurther details on the access provisions for rourests6frshmentnomo Harold Green Plant I Offices these forms. street 11824 Harold Green Road ciryAustin state -(X zip 78725 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 Ceg.,Manufacnire ofmotor truck trailers) away from work restriction cases 0 0 0 0 Asphalt Paving (G) (H) (1) (J) North Asncricaa Industrial Classification(NAICS),ifkmown(e.g.,3352I2) 237311 0 Number of Days Employment information(ffyou don 1 have these figures,see the Total number of days Total number of days of Worhsheer on the nett page to estimate.) away from work job transfer or>estriction 220 Annual average number of employee (K) 0 (L) 0 Total hours worked by all employees last year 440,00 Sign here injury and Illness Types Knowingly falsifying this document may result in a fine. Total number of... (M) I certify that I have examined this document and that to the best of (1)Injuries 2 (4) Poisonin s my knowledge the entries arc true,accurate,and complete. g (2)Skin disorders 0 A Hearing loss 0 company executive Title phoac512-799-9145 Dn1c1/10/2022 (3)Respiratory conditions 0 (6)All othcr illnesses 0 Past this summary page from February i to Apol 30 of the year forlow/ng the year covered by Ne form. .Reset Public rcponingbundea forrhis callccrioa of infartaodr.is.bleated to—p 58 minutes p-rspaaoc,-..lading time to mvi w the iastrardru s,scuch and gstherthc dam needed,sad complete and mvrn the wlkelien of iaCotnn6on Persons nn:aol requited to rapoad to the collection of infosroasioa ud�it displays a crosanlly wGd OMH wmml mmobee.ILyoa haw any eotnmems about tbrae esl'anam or say other aspera of this dab"Ecclion,wmwt:US Department oflabt r,OSHA Office afSta isticst Anslyris,Roam N-3644,200 ConRilafea Avcauu,NW, Washington DC 20210.Do out send the completed forms to this office. OSHA's Form 300A (Rev.0412004) Note,You can type input into this form andsave ir. Year 20 Because the forms In this recordkeeping pad<2ge are"fillabfelwritable" 21 PDF documents,you can type into the input form fields and Summary of Work-Related Injuries and Illnesses then save your inputU.S.Department of Labor s using the free Adobe PDF Reader. oCcapaoonarsaretvaneHamrn Admtnrao-aaon Finaa app—d OMS ao.1218-0176 All establishments covered by Part 1904 must complete this Summarypage,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,quirt 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 infnrmaUon Employees,former employees,and theirrepresentadves have the right to review the OSHA Form 3007n its entirety They also have Grafted access to the OSHA Form 301 or its equivalent See 29 CFR Part 1904.35,in OSHA's recordkeeping rule,for further detads on the access provisions for ray.aceaeew ad,nama Asphalt Inc.LLC dSo Lona Star Pm1n Camwa these forms. saret 11824 Harold Green Road cityAustin stain TX zip 78725 Total number of Total number of Total number of cases Total n=bcr of dead cases c+ith days with job transfer or other recordable Industry description(cg.Manufacture efmofor tuck--trailers) away from work restriction cases 0 Asphalt Paving 0- 0 p (G) M) (1) (.1) Noah Amed=industrial C1:��Mtion(,VAICs),iflmown(e g,33 6212) 237310 Number ofDays Employment ifyformatian(Ifyou don't have these figurer,see the Total niunber of days Total number of days of r3'orkyhect on Me net page m er imawj away from work job transfer or restriction 200 Annual average number of employees 0 P0 Total hours worked byall employeeslast year 476,000.00 Sign here Knowingly fa.1sifying this document may reralt in a fine. Total number of... I ccr fy that have examined this document and that to the best of (M} M1=yo 1l e the entri t ase true,accurate,and complete. (1)Tnjtries 0 (4)Poisonings 0 &C70 (2)Skin disorders 0 (5)Hearing loss 0 Company executive TItIc Pbone5124285778 oa1e1/31/2022 (3)Respiratory conditions 0 (6)All other illnesses 0 Post this Summary page from r-bruary Ito April 30 of the year following the year covered by the form. RESEt Puhlic;epa-tia8 htadm fa-tkes eoDe�iaa oriafomatioa a aara+><d m avmga ss atmaus perxospansa iazLtdmgtime to xwiew 3e:,�•, �,rorch and ssAethe dim—" eatapleto aadteviaar the olkeaoa ofmf nmcoa Pears re natsquked to=pond to the=Me=rto=ofinfotuation vnlocs i[displaysa emxratly�sdid OMBcoatml auaSa.Ifyoa}asc nay comcueat aboe[SFac rstitaates or my other asyeetc ofthis dsa coIlutSoa,maCCC US Depasraeat otT�bpr,OSSA Office of Siati�l Analysis,ltoomN36G4.200 CoesCfiSon Avenue,NW, Washitigtan,DC^_0?I0.Do mtand Ihn eampl�d Iotas=to the o$iri. 00500 AGREEMENT 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 a7 AGREEMENT made as of the tW--)day o rl in the year 20z-!�r 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 Paving; ("Contractor") 11675 Jollyville Rd,St#150 Austin,TX 78759 The Project is described as: 2024 Residential Street Maintenance Program The Engineer is: Matthew Bushak,P.E. City of Round Rock mbushak(a),roundrocktexas.gov 512-341-3318 For and in consideration of the mutual terms, conditions and covenants of this Agreement and all accompanying documents between Owner and Contractor, the receipt and sufficiency of which are hereby acknowledged,Owner and Contractor agree as follows: ARTICLE I THE CONTRACT DOCUMENTS The Contract Documents consist ofthis Agreement,Conditions of the Contract(General,Supplementary and other Conditions),Drawings, Specifications,Addenda issued prior to execution of this Agreement,other documents listed in this Agreement and Modifications issued after execution of this Agreement;these form the Contract,and are as fully a part of the Contract as if attached to this Agreement or repeated herein.The Contract represents the entire and integrated agreement between the parties hereto and supersedes prior negotiations,representations or agreements, either written or oral.An enumeration of the Contract Documents,other than Modifications,appears in Article 7. ARTICLE 2 THE WORK OF THIS CONTRACT Contractor shall fully execute the Work described in the Contract Documents,except to the extent specifically indicated in the Contract Documents to be the responsibility of others. 00500 4-2020 Page 1 Of 5 Standard Form of Agreement 00443647 ARTICLE 3 DATE OF COMMENCEMENT;DATE OF SUBSTANTIAL COMPLETION;DATE OF FINAL COMPLETION 3.1 The date of commencement of the Work shall be the date of this Agreement unless a different date is stated below or provision is made for the date to be fixed in a Notice to Proceed issued by Owner. 3.2 The Contract Time shall be measured from the date delineated in the Notice to Proceed. 3.3 Contractor shall commence Work within ten ( 10 ) calendar days from the date delineated in the Notice to Proceed. 3.4 Contractor shall achieve Substantial Completion of the items of Work listed on Attachment A to this Agreement no later than n/a ( )calendar days from issuance by Owner of Notice to Proceed, and Contractor shall achieve Substantial Completion of the entire Work no later than one-hundred,fifty 150 )calendar days from issuance by Owner of Notice to Proceed,subject to adjustments of this Contract Time as provided in the Contract Documents. 3.5 If Contractor fails to achieve Substantial Completion of the Work(or any portion thereof)on or before the date(s)specified for Substantial Completion in the Agreement,Contractor shall pay to Owner,as liquidated damages, the sum of one-thousand and No/100 Dollars($ 1,000 )for each calendar day that Substantial Completion is delayed after the date(s) specified for Substantial Completion. It is hereby agreed that the liquidated damages to which Owner is entitled hereunder are a reasonable forecast of just compensation for the harm that would be caused by Contractor's failure to achieve Substantial Completion of the Work(or any portion thereof)on or before the date(s)specified for Substantial Completion in the Agreement and is not a penalty. It is agreed that the harm that would be caused by such failure, which includes loss of expected use of the Project areas,provision of alternative storage facilities and rescheduling of moving and occupancy dates,is one that is incapable or very difficult of accurate estimation.It is hereby agreed that if Substantial Completion of the Work(or any portion thereof)is not achieved on or before thirty(30)days after the date(s) specified for Substantial Completion in the Agreement, the Owner shall have the option to either collect liquidated damages as set forth herein or to thereafter rely on its remedies under the Contract Documents and at law and in equity, including without limitation, the recovery of actual damages. The date(s) specified for Substantial Completion of the Work(or any portion thereof)in the Agreement shall be subject to adjustment as provided in the Contract Documents. 3.6 Contractor shall achieve Final Completion of the entire Work no later than one-hundred,eighty ( 180 )calendar days from issuance by Owner of Notice to Proceed. ARTICLE 4 CONTRACT SUM 4.1 Owner shall pay Contractor the Contract Sum in current funds for Contractor's full and complete performance of the Work and all of Contractor's obligations under this Agreement. The Contract Sum shall be Five million one hundred sixty-one thousand two hundred sixty-two dollars and sixty-five cents ($ X5,161,262.65 ),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: 00500 4-2020 Page 2 of 5 Standard Form of Agreement 00443647 ARTICLE 5 PAYMENTS 5.1 PROGRESS PAYMENTS 5.1.1 Based upon Applications for Payment submitted to Engineer and Owner by Contractor,and Certificates for Payment issued by Engineer and not disputed by Owner and/or Owner's lender,Owner shall make progress payments on account of the Contract Sum to Contractor as provided below, in Article 14 of the General Conditions, and elsewhere in the Contract Documents. 5.1.2 The period covered by each Application for Payment shall be one calendar month ending on the last day of the month. 5.1.3 Provided that an Application for Payment is received by Engineer and Owner, and Engineer issues a Certificate of Payment not later than the tenth (10th) day of a month, Owner shall make payment to Contractor of amounts approved by the Owner not later than the tenth(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 4-2020 Page 3 of 5 Standard Form of Agreement 00443647 6.2 The Work may be suspended by Owner as provided in Article 15 of the General Conditions. ARTICLE 7 ENUMERATION OF CONTRACT DOCUMENTS 7.1 The Contract Documents,except for Modifications issued after execution of this Agreement,are enumerated as follows: 7.1.1 The Agreement is this executed version of the City of Round Rock, Texas Standard Form of Agreement between Owner and Contractor,as modified. 7.1.2 The General Conditions are the "City of Round Rock Contract Forms 00700," General Conditions, as modified. 7.1.3 The Supplementary,Special,and other Conditions of the Contract are those contained in the Project Manual dated January 2025 7.1.4 The Specifications are those contained in the Project Manual dated January 2025 7.1.5 The Drawings,if any,are those contained in the Project Manual dated January 2025 7.1.6 The Insurance&Construction Bond Forms of the Contract are those contained in the Project Manual dated January 2025 7.1.7 The Notice to Bidders,Instructions to Bidders,Bid Form,and Addenda,if any,are those contained in the Project Manual dated January 2025 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 ARTICLE 8 MISCELLANEOUS PROVISIONS 8.1 Where reference is made in this Agreement to a provision of any document, the reference refers to that provision as amended or supplemented by other provisions of the Contract Documents. 8.2 Owner's representative is: Reuben Ramirez,PMP City of Round Rock rramirez@roundrocktexas.gov 512-218-7084 8.3 Contractor's representative is: A iC h Q r/ C✓'y m Aspha/; 2nc. . LLLI t,- lome Spar RLY 6`"yrq, Se4 v" . cprrL Slz - `f93 - 079 8.4 Neither Owner's nor Contractor's representative shall be changed without ten(10)days'written notice to the other party. 00500 4-2020 Page 4 of 5 Standard Form of Agreement 00443647 8.5 Waiver of any breach of this Agreement shall not constitute waiver of any subsequent breach. 8.6 Owner agrees to pay Contractor from available funds for satisfactory performance of this Agreement in accordance with the bid or proposal submitted therefor,subject to proper additions and deductions,all as provided in the General Conditions, Supplemental Conditions, and Special Conditions of this Agreement, and Owner agrees to make payments on account thereof as provided therein. Lack of funds shall render this Agreement null and void to the extent funds are not available. This Agreement is a commitment of City of Round Rock's current revenues only. 8.7 Although this Agreement is drawn by Owner,both parties hereto expressly agree and assert that,in the event of any dispute over its meaning or application,this Agreement shall be interpreted reasonably and fairly,and neither more strongly for nor against either party. 8.8 This Agreement shall be enforceable in Round Rock,Texas,and if legal action is necessary by either party with respect to the enforcement of any or all of the terms or conditions herein,exclusive venue for same shall lie in Williamson County, Texas. This Agreement shall be governed by and construed in accordance with the laws and court decisions of the State of Texas. 8.9 Both parties hereby expressly agree that no claims or disputes between the parties arising out of or relating to this Agreement or a breach thereof shall be decided by an arbitration proceeding,including without limitation,any proceeding under the Federal Arbitration Act(9 USC Section 1-14)or any applicable state arbitration statute. 8.10 The parties, by execution of this Agreement, bind themselves, their heirs, successors, assigns, and legal representatives for the full and faithful performance of the terms and provisions hereof. This Agreement is entered into as of the day and year first written above and is executed in at least two(2) original copies,of which one is to be delivered to Owner. OWNER n_ CONTRACTOR CITY OF OUND R CK,TEXAS T1��hC�N Skc• L66 CkA L'IP 5�r � 1A Printed N./e: C Ll ''`© Printed Name:),Abex F Title A r r Title: V'(4i Date Signed: 12-"'t I�2x Date Signed: 0q/DLl/2dZS A ST: Ci erk FOR CIT APPROVED AS TO FORM: u City Attorney ` 00500 4-2020 Page 5 of 5 Standard Form of Agreement 00443647 Bond Nos.: CCC: 30243724 LMIC: 016249876 PERFORMANCE BOND THE STATE OF TEXAS § § KNOW ALL BY THESE PRESENTS: COUNTY OF WILLIAMSON § That Asphalt Inc., LLC dba Lone Star Paving, of the City of Round Rock, County of Williamson and State of Teras as Principal and cody Mi asua y company and , , � I ilw M rt gal Inc irancx Company authorized under the law of the State of Texas to act as surety on bonds for principals, are held and firmly bound unto the CITY OF ROUND ROCK, TEXAS (Owner), in the penal sum of Five million one hundred sixty-one thousand taro hundred sixth-trio dollars and sixty-five cents Dollars ($ 5.161,262.65 ) 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 dayo 1n' 20�o which the Agreement is hereby referred to and made a part hereo as fully and to the same extent as if copied at length herein consisting of: 2024 Residential Street Maintenance Program NOW, THEREFORE, THE CONDITIONS OF THIS OBLIGATION IS SUCH, that if the said Principal shall faithfully perform said Agreement and shall, in all respects, duly and faithfully observe and perform all and singular the covenants, conditions and agreements in and by said Agreement, agreed and covenanted by the Principal to be observed and performed, including but not limited to, the repair of any and all defects in said work occasioned by and resulting from defects in materials furnished by or workmanship of,the Principal in performing the Work covered by said Agreement and occurring within a period of twelve (12) months from the date of Final Completion and all other covenants and conditions, according to the true intent and meaning of said Agreement and the Plans and Specifications hereto annexed,then this obligation shall be void; otherwise to remain in full force and effect; PROVIDED, HOWEVER, that this bond is executed pursuant to the provisions of Chapter 2253, Texas Government Code, as amended, and all liabilities on this bond shall be determined in accordance with the provisions of said Chapter 2253 to the same extent as if it were copied at length herein. Page 1 00610 4-2020 Performance Bond 00443639 PERFORMANCE BOND(continued) Surety, for value received, stipulates and agrees that no change, extension of time, alteration or addition to the terms of the Agreement, or to the Work performed thereunder, or the Plans, Specifications, or drawings accompanying the same, shall in anywise affect its obligation on this bond,and it does hereby waive notice of any such change,extension of time,alteration or addition to the terms of the Agreement,or to the work to be performed thereunder. If Principal fails to faithfully perform said Agreement, Surety, after receipt of written notice of Principal's default,shall perform all of Principal's duties and obligations under the Agreement. If, within ten (10) days after receipt of such notice from Owner, Surety does not commence to complete the obligations of Principal with a contractor acceptable to Owner and diligently complete the performance of the Principal's duties and obligations, Owner shall have the right but not the obligation to have the duties and obligations of Principal performed. In such event, Surety shall pay to Owner,upon demand, all costs,expenses and damages sustained by Owner as a result of Principal's failure to perform its duties and obligations under the Agreement up to the $5,161,262.65 sum of this Performance Bond, plus all costs and expenses, including attorney's fees and expert and consultant fees incurred by Owner to enforce its rights under this Performance Bond. IN WITNESS WHEREOF, the said Principal and Surety have signed and sealed this instrument this day of , 20,?-1- Asphalt Inc.,LLC dba Lone Star Paving Continental Casualty Company and As p 9 Liberty Mutual Insurance Company Principal Surety Mii!jr Flores Michael Garcia Printed Name Printed Name _ By. By: cs ` Title: (/i GAt. Title: Attorney-in-Fact Address: //615 7d4,t/;//e " Sle. #i,5'o Address: CCC: 151 N. Franklin St.. C_hiccagq IL"60606 %X �87s9 I MIC: 175 Berkeley +r -t Boston_iM 02116 Resident Agent of Surety: Signature Michael Garcia-TX License No.2869367 Printed Name 10100 Katy Freeway, Suite 400 Street Address Houston, TX 77043 City, State &Zip Code Page 2 00610 4-2020 Performance Bond 00443639 Bond Nos.: CCC: 30243724 LM IC: 016249876 PAYMENT BOND THE STATE OF TEXAS § § KNOW ALL MEN BY THESE PRESENTS: COUNTY OF WILLIAMSON § That Asphalt Inc., dba Lone Star Paving, of the City of Round Rock, County of Williamson, and State of Texas as Principal and Continental al C y and authorized 1 iha Miifiial Inc�iranr•a Company under the laws of the State of Texas to act as Surety on Bonds for Principals, are held and firmly bound unto the CITY OF ROUND ROCK, TEXAS (OWNER), and all subcontractors, workers, laborers, mechanics and suppliers as their interest may appear, all of whom shall have the right to sue upon this bond, in the penal sum of Five minion one hundred sixty-one thousand two hundred sixty-two dollars and sixty-five cents Dollars ($ 5,161,262.65 ) 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 Prinqal has entered into a certain written Agreement with the Owner, dated the day of , 20Z4i to which Agreement is hereby referred to and made a part hereof as hilly and to the same extent as if copied at length herein consisting of 2024 Residential Street Maintenance Program NOW, THEREFORE, THE CONDITION OF THIS OBLIGATION IS SUCH, that if the said Principal shall well and truly pay all subcontractors, workers, laborers,mechanics, and suppliers, all monies to them owing by said Principals for subcontracts,work,labor,equipment,supplies and materials done and furnished for the construction of the improvements of said Agreement, then this obligation shall be and become null and void; otherwise to remain in full force and effect. PROVIDED, HOWEVER, that this bond is executed pursuant to the provisions of Chapter 2253, Texas Government Code, as amended, and all liabilities on this bond shall be determined in accordance with the provisions of said Chapter 2253 to the same extent as if it were copied at length herein. Page 1 00620 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 f" day of a/ , 20 ZS Continental Casualty Company and Asphalt Inc., LLC dba Lone Star Paving Liberty Mutual Insurance Company Principal Surety l7/e F/o�-es Michael Garcia Printed Name Printed Name - By: BY4i i i�i: Title: V d'u rm syen?t Title: Attorney-in-Fact Address: I1` /TV Address: CCC: 151 N. Franklin St.,CNcaqu, IL 60606 TX 710?fl 1 MIC• 175 Berkeley 02116 Resident Agent of Surety: Signature Michael Garcia-TX License No.2869367 Printed Name 10100 Katy Freeway Suite 400 Street Address Houston, TX 77043 _ City, State&Zip Code Page 2 006201-2020 Payment Bond 00090656 Figure: 28 TAC §1.601(a)(2)(B) Have a complaint or need help? If you have a problem with a claim or your premium, call your insurance company or HMO first. If you can't work out the issue, the Texas Department of Insurance may be able to help. Even if you file a complaint with the Texas Department of Insurance, you should also file a complaint or appeal through your insurance company or HMO. If you don't, you may lose your right to appeal. Continental Casualty Company, National Fire Insurance Company of Hartford, American Casualty Company of Reading, PA and Continental Insurance Company To get information or file a complaint with your insurance company or HMO: Call: Customer Service at 1-312-822-5000 Toll-free: 1-877-672-6115 Email: legclm@cnasurety.com Mail: CNA Surety, 151 North Franklin, 17th Floor, Chicago, IL 60606 The Texas Department of Insurance To get help with an insurance question or file a complaint with the state: Call with a question: 1-800-252-3439 File a complaint: www.tdi.texas.gov Email: ConsumerProtection@tdi.texas.gov Mail: Consumer Protection, MC: CO-CP, Texas Department of Insurance, P.O. Box 12030,Austin, TX 78711-2030 Tiene una queja o necesita ayuda? Si tiene un problema con una reclamacion o con su prima de seguro, (lame primero a su compania de seguros o HMO. Si no puede resolver el problema, es posible que el Departamento de Seguros de Texas (Texas Department of Insurance, por su nombre en ingles) pueda ayudar. Aun si usted presenta una queja ante el Departamento de Seguros de Texas, tambien debe presentar una queja a traves del proceso de quejas o de apelaciones de su compania de seguros o HMO. Si no to hace, podria perder su derecho para apelar. Continental Casualty Company, National Fire Insurance Company of Hartford, American Casualty Company of Reading, PA and Continental Insurance Company Para obtener informacion o para presentar una queja ante su compania de seguros o HMO: Llame a: Servicio al Cliente al 1-312-822-5000 Telefono gratuito: 1-877-672-6115 Correo electronico: legclm@cnasurety.com Direccion postal: CNA Surety, 151 North Franklin, 17th Floor, Chicago, IL 60606 EI Departamento de Seguros de Texas Para obtener ayuda con una pregunta relacionada con los seguros o para presentar una queja ante el estado: Llame con sus preguntas al: 1-800-252-3439 Presente una queja en: www.tdi.texas.gov Correo electronico: ConsumerProtection@tdi.texas.gov Direccion postal: Consumer Protection, MC: CO-CP, Texas Department of Insurance, P.O. Box 12030, Austin, TX 78711-2030 Form F8277-9-2023 Liberty Mutual. SURETY TEXAS TEXAS IMPORTANT NOTICE AVISO IMPORTANTE To obtain information or make a complaint: Para obtener informacion o para someter Una queja: You may call toll-free for information or to Usted puede Ilamar al numero de telefono gratis make a complaint at para informacion o para someter una queja al 1-877-751-2640 1-877-751-2640 You may also write to: Usted tambien puede escribir a: 2200 Renaissance Blvd., Ste.400 2200 Renaissance Blvd., Ste.400 King of Prussia, PA 19406-2755 King of Prussia, PA 19406-2755 You may contact the Texas Department of Puede comunicarse con el Departamento de Insurance to obtain information on companies, Seguros de Texas para obtener informacion coverages,rights or complaints at acerca de companias, coberturas, derechos o 1-800-252-3439 quejas al 1-800-252-3439 You may write the Texas Department of Insurance Puede escribir al Departamento de Seguros Consumer Protection (111-1 A) de Texas Consumer Protection (111-I A) P. O. Box 149091 P. O. Box 149091 Austin,TX 78714-9091 Austin, TX 78714-9091 FAX: (512)490-1007 FAX #(512)490-1007 Web: http://www.tdi.texas.gov Web: http://www.tdi.texas.gov E-mail: ConsumerProtection&tdi.texas.gov E-mail: ConsumerProtection&tdi.texas.goy PREMIUM OR CLAIM DISPUTES: DISPUTAS SOBRE PRIMAS O RECLAMOS: Should you have a dispute concerning your Si tiena una disputa concerniente a su prima o a premium or about a claim you should first un reclamo, debe comunicarse con el agente o contact the agent or call 1-800-843-6446. primero. Si no se resuelve la disputa, puede If the dispute is not resolved,you may contact the entonces comunicarse con el departamento(TDI) Texas Department of Insurance. ATTACH THIS NOTICE TO YOUR UNA ESTE AVISO A SU POLIZA: POLICY: This notice is for information only and does not Este aviso es solo para proposito de informacion become a part or condition of the attached y no se convierte en parte o condicion del document. documento adjunto. NP 70 68 09 01 LMS-15292 10/15 POWER OF ATTORNEY APPOINTING INDIVIDUAL ATTORNEY-IN-FACT Know All Men By These Presents,That Continental Casualty Company,an Illinois insurance company,National Fire Insurance Company of Hartford,an Illinois insurance company,and American Casualty Company of Reading,Pennsylvania,a Pennsylvania insurance company(herein called"the CNA Companies"),are duly organized and existing insurance companies having their principal offices in the City of Chicago,and State of Illinois,and that they do by virtue of the signatures and seals herein affixed hereby make,constitute and appoint Marc W Boots,Maria D Zuniga,Joseph R Aulbert,Richard Covington,Vickie Lacy,Melanie Salinas,Stephanie Moore Harold,Ashley Koletar,Ryan Varela,Michael Garcia,Individually of Houston,TX,their true and lawful Attomey(s)-in-Fact with full power and authority hereby conferred to sign,seal and execute for and on their behalf bonds, undertakings and other obligatory instruments of similar nature -In Unlimited Amounts- and to bind them thereby as fully and to the same extent as if such instruments were signed by a duly authorized officer of their insurance companies and all the acts of said Attorney,pursuant to the authority hereby given is hereby ratified and confirmed. This Power of Attomey is made and executed pursuant to and by authority of the By-Laws and Resolutions,printed below,duly adopted,as indicated,by the Boards of Directors of the insurance companies. In Witness Whereof,the CNA Companies have caused these presents to be signed by their Vice President and their corporate seals to be hereto affixed on this 5th day of March,2025. Continental Casualty Company "r Ck. National Fire Insurance Company of Hartford eo�ronATp ' t o � paeoaa>� American Casualty Company of Readin Pennsylvania H . z 2 4 a 1urr n. �U SEAL Y i 19C2a"a Qc 1897 Larry Kasten Vice President State of South Dakota,County of Minnehaha,ss: On this 5th day of March,2025,before me personally came Larry Kasten to me known,who,being by me duly swom,did depose and say: that he resides in the City of Sioux Falls,State of South Dakota;that he is a Vice President of Continental Casualty Company,an Illinois insurance company,National Fire Insurance Company of Hartford,an Illinois insurance company,and American Casualty Company of Reading,Pennsylvania,a Pennsylvania insurance company described in and which executed the above instrument;that he knows the seals of said insurance companies;that the seals affixed to the said instrument are such corporate seals;that they were so affixed pursuant to authority given by the Boards of Directors of said insurance companies and that he signed his name thereto pursuant to like authority, and acknowledges same to be the act and deed of said insurance companies. My commission expires M.BENT //?1��rromm weuc J1�JEOUTH DAKOTA March 2,2026 ,,,,, ,,,,,,,,,,,,,,,,♦ M.Bent Notary Public CERTIFICATE I,Paula Kolsrud,Assistant Secretary of Continental Casualty Company,an Illinois insurance company,National Fire Insurance Company of Hartford,an Illinois insurance company,and American Casualty Company of Reading,Pennsylvania,a Pennsylvania insurance company do hereby certify that the Power of Attorney herein above set forth is still in force,and further certify that the By-Laws and Resolutions of the Board of Directors of the insurance companies printed below are still in force. In testimony whereof I have hereunto subscribed my name and affixed the seal of the said insurance companies this day of Continental Casualty Company ��G �q<r� tHsuagvar«o.� National Fire Insurance Company of Hartford American Casualty Company of Reading,Pennsylvania x CoNVOAArf i < � 0 6 %4W?aq>to 7 ---yyyr''' ; ,S Z )ULY rl. \JI �J SEAL �k to 1897 Paula Kolsrud Assistant Secretary Authorizing By-Laws and Resolutions ADOPTED BY THE BOARD OF DIRECTORS OF EACH OF CONTINENTAL CASUALTY COMPANY,NATIONAL FIRE INSURANCE COMPANY OF HARTFORD,and AMERICAN CASUALTY COMPANY OF READING,PENNSYLVANIA(as defined above,the"CNA Companies"): This Power of Attorney is made and executed pursuant to and by authority of the following resolution duly adopted by the Board of Directors of each of the above CNA Companies at a meeting held on May 12,1995: "RESOLVED: That any Senior or Group Vice President may authorize an officer to sign specific documents,agreements and instruments on behalf of the Company provided that the name of such authorized officer and a description of the documents,agreements or instruments that such officer may sign will be provided in writing by the Senior or Group Vice President to the Secretary of the Company prior to such execution becoming effective" This Power of Attomey is signed by Larry Kasten,Vice President,who has been authorized pursuant to the above resolution to execute power of attomeys on behalf of each of the CNA Companies. This Power of Attorney is signed and sealed by facsimile under and by the authority of the following Resolution adopted by the Board of Directors of each of the above Companies by unanimous written consent dated the 25"day of April,2012: "Whereas,the bylaws of the Company or specific resolution of the Board of Directors has authorized various officers(the"Authorized Officers")to execute various policies,bonds,undertakings and other obligatory instruments of like nature;and Whereas,from time to time,the signature of the Authorized Officers,in addition to being provided in original,hard copy format,may be provided via facsimile or otherwise in an electronic format(collectively,"Electronic Signatures");Now therefore be it resolved: that the Electronic Signature of any Authorized Officer shall be valid and binding on the Company." This Power of Attorney may be signed by digital signature and sealed by a digital or otherwise electronic-formatted corporate seal under and by the authority of the following Resolution adopted by the Board of Directors of each of the above CNA Companies by unanimous written consent dated the 27th day of April,2022: "RESOLVED:That it is in the best interest of the Company to periodically ratify and confirm any corporate documents signed by digital signatures and to ratify and confirm the use of a digital or otherwise electronic-formatted corporate seal,each to be considered the act and deed of the Company." Go to www.cnasurety.com>Owner/Obligee Services>Validate Bond Coverage,if you want to verify bond authenticity. Forth F6853-6!2023 Lll'1� POWER OF ATTORNEY Mutuil Liberty Mutual Insurance Company Certificate No 8213056 022004 SURETY The Ohio Casualty Insurance Company West American Insurance Company KNOWN ALL PERSONS BY THESE PRESENTS:That The Ohio Casualty Insurance Company Is a corporation duly organized under the laws of the State of New Hampshire,that Liberty Mutual Insurance Company is a corporation duly organized under the laws of the Slate of Massachusetts and West American Insurance Company is a corporation duly organized under the laws of the State of Indiana(herein collectively called the'Companies') pursuant to and by authority herein set forth does hereby name constitute and appoint, Joseph R Aulbert Jacob(loots Marc W Boots Richard(-o%inptun Michael Garcia.Susan(iolla-Stephanie Mcxtm Harold,Ashlcv Koletar-Vickie Laq,Melanie Salinas,Ryan Varela DNIan Young Maria t) 7uniga all of the city of Houston state of I X each individually if there be more than one named.its true and lawful attorney-in-fact to maker execute,seal acknowledge and deliver for and on its behalf as surety and as Its act and deed any and all undertakings:bonds,recognizances and other surety obligations,in pursuance of these presents and shall be as binding upon the Companies as if they have been duly signed by the president and attested by the secretary of the Companies In their own proper persons IN WITNESS WHEREOF,this Power of Attorney has been subscribed by an authorized officer or official of the Companies and the corporate seals of the Companies have been affixed thereto this kith day of January 2025 Liberty Mutual Insurance Company P�tr4suq �SY INS& d tNsuq The Ohio Casualty Insurance Company OR, , West American Insurance Company J + Fo U l Fp T ? o T 1912 0 0 1919 0 s 1991 r ✓j /' 0 p H ~dVy�'�sS�,da Z�s��hA/R�A+at -e 4-0. aD --— d C Nathan J Zangerle:Assistant Secretary a« C M State of PENNSYLVANIA c E c ::3County of MONTGOMERY ss p T Em c) 3 On this loth day of January 'k I_' before me personalty appeared Nathan J.Zangerler who acknowledged himself to be the Assistant Secretary of Liberty Mutual Insurance a Company t�Ohio Casualty Company.and West American Insurance Company and that he as such being authorized so to do,execute the foregoing instrument for the purposes c= therein contained by signing on behalf of the corporations by himself as a duly authonzed officer > cinQ5 � IN WITNESS WHEREOF,I have hereunto subscribed my name and affixed my notarial seal at Plymouth Meeting,Pennsylvania,on the day and year first above written. N c � a0 N ON W /F C°mmmwealm or Pennsyivarua Notary Sea' T— O All J� f<,,�! Teresa P"W-Notary PUW V. Monigkxnery county �� j// E OF My commss�on expaes Abrch 26 1029 By• WLI.�R� �iL 0 C) C rp l �� canmssron nkaneer 11260" �8resa Pastella.Notary Public Q o rLiP -� Menne,Pe.�nsyNa A s hw r d N01—ii O �tT_ This Power of Attorney is made and executed pursuant to and by authority of the following By-laws and Authorizations of The Ohio Casualty Insurance Company. Liberty Mutual 3 e C? E.9 Insurance Company,and West Amencan Insurance Company which resolutions are now in full force and effect reading as follows 0 04� a ARTICLE IV-OFFICERS:Section 12 Power of Attorney `0 0 Any officer or other official of the Corporation authonzed for that purpose in writing by the Chairman or the President, and subject to such limitation as the Chairman a the President may prescribe,shall appoint such attomeys-in-fact,as may be necessary to act in behalf of the Corporabon to make,execute seal.acknowledge and deliver as surety U — M N any and all undertakings,bonds,recognizances and other surety obligations Such attomeys-in-fad.subject to the limitations set forth In their respective powers of attorney,shall- have full power to bind the Corporation by their signature and execution of any such instruments and to attach thereto the seal of the Corporation When so executed.such e0 m 0 0 instruments shall be as finding as d signed by the President and attested to by the Secretary Any power or authority granted to any representative or attomey-In-fad under the m Z 0— provisions of this article may be revoked at any time by the Board,the Chairman,the President or by the officer or officers granting such power or authonty u- a ARTICLE XIII-Execution of Contracts:Sedan 5 Surety Bonds and Undertakings Any officer of the Company authorized for that purpose in writing by the chairman or the president,and subject to such limitations as the chairman or the president may prescribe, shall appoint such attomeys-in-fact,as may be necessary to act In behalf of the Company to make,execute,seal.acknowledge and deliver as surety any and all undertakings. bonds,recognizances and other surety obligations Such attomeys-in-fad subject to the limitations set forth In their respective powers of attomey shall have full power to bind the Company by their signature and execution of any such instruments and to attach thereto the seal of the Company When so executed such instruments shall be as binding as if signed by the president and attested by the secretary Certificate of Designation -The President of the Company. acting pursuant to the Bylaws of the Company. authorizes Nathan J Zangede. Assistant Secretary to appoint such attorneys-in-fact as may be necessary to act on behalf of the Company to make.execute,seal acknowledge and deliver as surety any and all undertakings,bonds.recogmzances and other surety obligations Authorization-By unanimous consent of the Company's Board of Directors,the Company consents that facsimile or mechanically reproduced signature of any assistant secretary of the Company.wherever appearing upon a certified copy of any power of attorney Issued by the Company in connection with surety bonds,shall be valid and binding upon the Company with the same force and effect as though manually affixed. I Renee C Llewellyn the undersigned.Assistant Secretary.The Ohio Casualty insurance Company Liberty Mutual Insurance Company,ate West American Insurance Company do hereby certify that the original power of attorney of which the foregoing is a full true and correct copy of the Power of Attorney execuied br sa d C.Trances.Is in full force and effect and has not been revoked Ar IN TESTIMONY WHEREOF.I have hereunto set my hand and affixed the seals of said Companies this x1day of Ar "'1 1NSUR ytV INSO ey iNSU.9 tiJ jL°0.P0 R+<74 0 yJr`°P.o�<R7,y VP`°PPow+f y� J o t^ u Fo m 1912y o 0 1919 n Q 1991 L7r` _ o By: rd,11�Ss4r S�'A NA 's •',p ^'o:A�� .4si Renee l.lewzllyr.,y'.ssi,tmt Seiretzry -- 9j> � 1•ev ''/11 LMS-12873 LMIC OCIC WAIC Mux.Co 02124 l ® DATE(MM/DD/YYYY) A�o CERTIFICATE OF LIABILITY INSURANCE 04/04/2025 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 Martha Lee Hawkins/Ext 9406 NAME: McGriff,a Marsh&McLennan Agency LLC Company PHONE 1-800 476-2211 FAX 2000 International Park Drive (AIC, Alc No Ex A/C No): Suite 600 EMAIL mhawkins m riff.com Birmingham,AL 35243 ADDRESS: INSURERS AFFORDING COVERAGE NAIC# INSURER A:ArchInsurance Company 11150 INSURED INSURER B:Allied World National Assurance Company 10690 Asphalt Inc.LLC dba Lone Star Paving Company 11675 Jollyville Road INSURER C: Suite 150 Austin,TX 78759 INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:5PMKSBGN 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 TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LIMITS LTR INSD POLICY NUMBER MM/DD/YYYY MMIDD/YYYY A X COMMERCIAL GENERAL LIABILITY ZAGLB9247603 10/01/2024 10/01/2025 EACH OCCURRENCE $ 6,000,000 RENTEDDAMAGE TO 100,000 CLAIMS-MADE X OCCUR PREMISES Ea occurrence $ MED EXP(Any one person) $ 10,000 PERSONAL&ADV INJURY $ 6,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 12,000,000 POLICY�JET LOC PRODUCTS-COMP/OP AGG $ 12,000,000 OTHER: $ A AUTOMOBILE LIABILITY ZACAT9276803 10/01/2024 10/01/2025 (Ea aBINEDtSINGLE LIMIT 6,000,000 X ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY Per accident B UMBRELLA LIAB X OCCUR 03125099 10/01/2024 10/01/2025 EACH OCCURRENCE $ 5,000,000 X EXCESS LIAB CLAIMS-MADE AGGREGATE $ 5,000,000 DED RETENTION$ $ A WORKERS COMPENSATION ZAWC11040600 01/19/2025 10/01/2025 XPER OTH- AND EMPLOYERS'LIABILITY T TUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE YIN N/A E.L.EACH ACCIDENT $ 1,000,000 OFFICERIMEMBER EXCLUDED? (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under 1,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Certificate Holder is Additional Insured on a primary and non-contributory basis with respects to General Liability,Automobile Liability and Excess Liability as required by written contract. Waiver of Subrogation applies in favor of the Certificate Holder with respects to Workers'Compensation,General Liability,Automobile Liability and Excess Liability as required by written contract. In the event of cancellation by the insurance company(ies)the policy(ies)has been endorsed to provide 30 days'Notice of Cancellation(except for non-payment)to the certificate holder shown below. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. City of Round Rock City Manager AUTHORIZED REPRESENTATIVE 221 E Main Round Rock,, TX 78664-5299 Page 1 of 1 ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD