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Contract - Austin Engineering Co. - 5/22/2025 CITY OF ROUND ROCK TRANSPORTATION DEPARTMENT ROUND ROCK TEXAS Project Manual For: Greenlawn Blvd - From IH35 to SH45 January 2025 APPROVED BY CITY ATTORNEY Prepared By: OF �� KFRIESE - * ......................... + ASSOCIATES .E..S..S..E..R..L..Io ., ��'09: 135510 Q;�Qf LOCHNER COMPANY <<��F�CEN`? '"t;' TBPE Firm Registration No 6535 tis%0 1/21/2025 Greenlawn Blvd - From IH35 to SH45 TABLE OF CONTENTS Section Description No. of Pages 00020 Notice to Bidders 1 00100 Instructions to Bidders 4 Exhibit A 1 00200 Bid Bond 2 00300 Bid Form 37 00410 Statement of Bidder's Safety Experience 1 00500 Agreement 5 00600 Insurance&Construction Bond Forms Performance &Payment Bond Instructions 1 Insurance Instructions 1 00610 Performance Bond 2 00620 Payment Bond 2 00650 Certificate of Liability Insurance 1 00700 General Conditions 41 00800 Supplemental General Conditions 2 00900 Special Conditions 5 01000 Technical Specifications Attachment A 2 02000 Plans,Details and Notes 1 8-2016 Table of Contents 00090665 00300 BID FORM BID FORM PROJECT NAME: Greenlawn Blvd-From IH35 to SH45 PROJECT LOCATION: Round Rock,Texas OWNER: City of Round Rock,Texas DATE: February 20,2025 Gentlemen: Pursuant to the foregoing Notice to Bidders and Instructions to Bidders,the undersigned bidder hereby proposes to Greenlawn Blvd-From HU5 to SH45 and binds himself on acceptance of this bid to execute the Agreement and bond for completing said Work within the Any addenda issued will be posted with the Project Manual and/or Contract Documents on the City's website at https://www.roundrocktexas.gDv/departments/ffmsportation/sohcitations/ by the close of business on Friday,February 14,2025 . 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". Adden# 1 02/13/2025 Greenlawn Blvd - From IH35 to SH45 BASE BID Approx. Item Description Bid Item Quantity Unit and Written Unit Price Unit Price Amount 1 53.26 STA 0100-7002 PREPARING ROW complete in place per STATION for Two Thousand Dollars and Sixty Cents dollars and cents. A 2,000.60 $ 106,548.76 2 1476.00 SY 0104-7011 REMOV CONC (DRIVEWAYS) complete in place per SQUARE YARD for Fifteen Dollars and No Cents dollars and cents. $ 15.00 $ 22,140.00 00300-9-2015 Page 1 of 37 Bid Form BASE BID Approx. Item Description Bid Item Quantity Unit and Written Unit Price Unit Price Amount 3 1135.00 SY 0104-7013 REMOV CONC(SIDEWALK, RAMP OR SUP) complete in place per SQUARE YARD for Fifteen Dollars and No Cents dollars and cents. $ 15.00 $ 17,025.00 4 5219.00 LF 0104-7016 REMOV CONC(CURB) complete in place per LINEAR FEET for Two Dollars and No Cents dollars and cents. $ 2.00 $ 10,438.00 5 27.00 SY 0104-7025 REMOV CONC(RETAINING WALLS) complete in place per SQUARE YARD for Seventy Eight Dollars and No Cents dollars and cents. $ 78.00 $ 2,106.00 6 240.00 LF 0104-7036 REMOV CONC(RAIL) complete in place per LINEAR FEET for Thirty Two Dollars and No Cents dollars and cents. $ 32.00 $ 7,680.00 7 13172.00 SY 0105-7006 RMV(6"-10")TRT/JNTRT BASE&ASPH PAV complete in place per SQUARE YARD for Two Dollars and Fifty Cents dollars and cents. $ 2.50 $ 32,930.00 8 31338.93 CY 0110-7001 EXCAV(ROADWAY) complete in place per CUBIC YARD for Eight Dollars and No Cents dollars and cents. $ 8.00 $ 250,711.48 00300-9-2015 Page 2 of 37 Bid Form BASE BID Approx. Item Description Bid Item Quantity Unit and Written Unit Price Unit Price Amount 9 8800.00 CY 0110-7003 EXCAV(SPECIAL) complete in place per CUBIC YARD for Twelve Dollars and No Cents dollars and cents. $ 12.00 $ 105,600.00 10 8990.00 CY 0132-7001 EMBANK(FNL)(OC)(TY A) complete in place per CUBIC YARD for Five Dollars and No Cents dollars and cents. $ 5.00 $ 44,950.00 11 36890.00 CY 0132-7002 EMBANK(FNL)(DC)(TY A) complete in place per CUBIC YARD for Twenty Eight Dollars and No Cents dollars and cents. $ 28.00 $ 1,032,920.00 12 25944.00 SY 0160-7002 FURN&PLACE TOPSOIL(4") complete in place per SQUARE YARD for Three Dollars and No Cents dollars and cents. $ 3.00 $ 77,832.00 13 25944.00 SY 0164-7004 BROADCAST SEED (PERM—URBAN—CLAY) complete in place per SQUARE YARD for No Dollars and Twenty Cents dollars and cents. $ 0.20 $ 5,188.80 14 12972.00 SY 0164-7005 BROADCAST SEED (TEMP—WARM) complete in place per SQUARE YARD for No Dollars and Twenty Cents dollars and cents. $ 0.20 $ 2,594.40 00300-9-2015 Page 3 of 37 Bid Form BASE BID Approx. Item Description Bid Item Quantity Unit and Written Unit Price Unit Price Amount 15 12972.00 SY 0164-7006 BROADCAST SEED (TEMP—COOL) complete in place per SQUARE YARD for No Dollars and Twenty Cents dollars and cents. $ 0.20 $ 2,594.40 16 3860.00 TGL 0168-7001 VEGETATIVE WATERING complete in place per THOUSAND OF GAL] for Nine Dollars and No Cents dollars and cents. $ 9.00 $ 34,740.00 17 9229.00 CY 0247-7179 FL BS(CMP IN PLC)(TY A GR 5)(FNAL POS) complete in place per CUBIC YARD for Seventy One Dollars and No Cents dollars and cents. $ 71.00 $ 655,259.00 18 E 27677.00 SY 0250-7002 GEOGRID BASE REINFORCEMENT(TYPE 2) complete in place per SQUARE YARD for Three Dollars and No Cents dollars and cents. $ 3.00 $ 83,031.00 19 4337.00 GAL 0310-7013 PRIME COAT(MC-30 OR AE- P) complete in place per GALLON for Four Dollars and No Cents dollars and cents. $ 4.00 $ 17,348.00 20 7351.00 TON 0341-7001 D-GR HMA TY-B PG64-22 complete in place per TON for One Hundred Sixteen Dollars and No Cents dollars and cents. $ 116.00 $ 852,716.00 21 2452.00 TON 0341-7022 D-GR HMA TY-C PG70-22 complete in place per TON for Cents dollars and cents. $ 151.00 $ 370,252.00 00300-9-2015 Page 4 of 37 Bid Form BASE BID Approx. Item Description Bid Item Quantity Unit and Written Unit Price Unit Price Amount 22 2170.00 GAL 0344-7077 TACK COAT complete in place per GALLON for Four Dollars and No Cents dollars and cents. $ 4.00 $ 8,680.00 23 2869.00 SY 0354-7002 PLANE&TEXT ASPH CONC PAV(0"TO 2") complete in place per SQUARE YARD for Four Dollars and No Cents dollars and cents. $ 4.00 $ 1 1,476.00 24 473.00 SY 0400-7006 CUT&RESTORING PAY complete in place per SQUARE YARD for Ninety Seven Dollars and No Cents dollars and cents. $ 97.00 $ 45,881.00 25 280.00 CY 0400-7010 CEM STABIL BKFL complete in place per CUBIC YARD for Cents dollars and cents. $ 237.00 $ 66,360.00 26 2602.00 LF 0402-7001 TRENCH EXCAVATION PROTECTION complete in place per LINEAR FEET for Five Dollars and No Cents dollars and cents. $ 5.00 $ 13,010.00 27 1514.00 LF 0416-7006 DRILL SHAFT(36 IN) complete in place per LINEAR FEET for Cents dollars and cents. $ 375.00 $ 567,750.00 28 392.00 LF 0416-7040 DRILL SHAFT(RDWY ILL POLE)(30 IN) complete in place per LINEAR FEET for Three Hundred Eleven Dollars and No Cents dollars and cents. $ 311.00 $ 121,912.00 00300-9-2015 Page 5 of 37 Bid Form BASE BID Approx. Item Description Bid Item Quantity Unit and Written Unit Price Unit Price Amount 29 13.00 LF 0416-7044 DRILL SHAFT(TRF SIG POLE)(36 IN) complete in place per LINEAR FEET for Cents dollars and cents. $ 145.00 $ 1,885.00 30 44.00 LF 0416-7046 DRILL SHAFT(TRF SIG POLE)(48 IN) complete in place per LINEAR FEET for Cents dollars and cents. $ 694.00 $ 30,536.00 31 1.00 EA 0420-7008 CL A CONC(COLLAR) complete in place per EACH for Cents dollars and cents. $ 632.00 $ 632.00 32 102.90 CY 0420-7012 CL C CONC(ABUT) complete in place per CUBIC YARD for Dollars and No Cents dollars and cents. $ 1,358.00 $ 139,738.20 33 102.10 CY 0420-7022 CL C CONC(CAP) complete in place per CUBIC YARD for No Cents dollars and cents. $ 1,200.00 $ 122,520.00 34 24.10 CY 0420-7038 CL C CONC(COLUMN) complete in place per CUBIC YARD for Dollars and No Cents dollars and cents. $ 1,458.00 $ 35,137.80 35 12961.00 SF 0422-7001 REINF CONC SLAB complete in place per SQUARE FEET for Twenty Six Dollars and No Cents dollars and cents. $ 26.00 $ 336,986.00 36 2652.00 SF 0422-7012 BRIDGE SIDEWALK complete in place per SQUARE FEET for Thirteen Dollars and No Cents dollars and cents. $ 13.00 $ 34,476.00 00300-9-2015 Page 6 of 37 Bid Form BASE BID Approx. Item Description Bid Item Quantity Unit and Written Unit Price Unit Price Amount 37 213.90 CY 0422-7013 APPROACH SLAB complete in place per CUBIC YARD for Cents dollars and cents. $ 893.00 $ 191,012.70 38 1303.08 LF 0425-7035 PRESTR CONC X-BEAM (5XB20) complete in place per LINEAR FEET for Four Hundred Ten Dollars and No Cents dollars and cents. $ 410.00 $ 534,262.80 39 99.00 CY 0432-7003 RIPRAP(CONC)(6 IN) complete in place per CUBIC YARD for and No Cents dollars and cents. $ 1,240.00 $ 122,760.00 40 16.00 CY 0432-7013 RIPRAP(MOW STRIP)(4 IN) complete in place per CUBIC YARD for Cents dollars and cents. $ 870.00 $ 13,920.00 41 828.00 CY 0432-7043 RIPRAP(STONE PROTECTION)(18 IN) complete in place per CUBIC YARD for One Hundred Fifty Dollars and No Cents dollars and cents. $ 150.00 $ 124,200.00 42 397.00 LB 0442-7007 STR STEEL(MISC NON- BRIDGE) complete in place per POUND for Twenty Nine Dollars and No Cents dollars and cents. $ 29.00 $ 11,513.00 43 268.00 LF 0450-7014 RAIL(TY T411) complete in place per LINEAR FEET for Two Hundred One Dollars and No Cents dollars and cents. $ 201.00 $ 53,868.00 44 368.00 LF 0450-7038 RAIL(TY C411) complete in place per LINEAR FEET 00300-9-2015 Page 7 of 37 Bid Form BASE BID Approx. Item Description Bid Item Quantity Unit and Written Unit Price Unit Price Amount for Two Hundred Ten Dollars and No Cents dollars and cents. $ 210.00 $ 77,280.00 45 667.00 LF 0450-7059 RAIL(HANDRAIL)(TY B) complete in place per LINEAR FEET for Cents dollars and cents. $ 118.00 $ 78,706.00 46 191.00 LF 0454-7004 SEALED EXPANSION JOINT (4 IN)(SEJ-M) complete in place per LINEAR FEET for Cents dollars and cents. $ 313.00 $ 59,783.00 47 584.00 LF 0462-7008 CONC BOX CULV(5 FT X 4 FT) complete in place per LINEAR FEET for Cents dollars and cents. $ 472.00 $ 275,648.00 48 636.00 LF 0462-7012 CONC BOX CULV(6 FT X 4 FT) complete in place per LINEAR FEET for Cents dollars and cents. $ 595.00 $ 378,420.00 49 1376.00 LF 0464-7003 RC PIPE(CL III)(18 IN) complete in place per LINEAR FEET for One Hundred Thirteen Dollars and No Cents dollars and cents. $ 113.00 $ 155,488.00 00300-9-2015 Page 8 of 37 Bid Form BASE BID Approx. Item Description Bid Item Quantity Unit and Written Unit Price Unit Price Amount 50 1761.00 LF 0464-7005 RC PIPE(CL III)(24 IN) complete in place per LINEAR FEET for One Hundred Four Dollars and No Cents dollars and cents. $ 104.00 $ 183,144.00 51 71.00 LF 0464-7007 RC PIPE(CL 111)(30 IN) complete in place per LINEAR FEET for Cents dollars and cents. $ 121.00 $ 8,591.00 52 1453.00 LF 0464-7009 RC PIPE(CL III)(36 IN) complete in place per LINEAR FEET for Cents dollars and cents. $ 158.00 $ 229,574.00 53 153.00 LF 0464-7010 RC PIPE(CL III)(42 IN) complete in place per LINEAR FEET for Two Hundred Four Dollars and No Cents dollars and cents. $ 204.00 $ 31,212.00 54 225.00 LF 0464-7021 RC PIPE(CL IV)(24 IN) complete in place per LINEAR FEET for One Hundred Twelve Dollars and No Cents dollars and cents. $ 112.00 $ 25,200.00 55 2.00 EA 0465-7003 MANN(COMPL)(PRM)(6011) complete in place per EACH for No Cents dollars and cents. $ 4,100.00 $ 8,200.00 00300-9-2015 Page 9 of 37 Bid Form BASE BID Approx. Item Description Bid Item Quantity Unit and Written Unit Price Unit Price Amount 56 1.00 EA 0465-7004 MANH(COMPL)(PRM)(72I1) complete in place per EACH for No Cents dollars and cents. $ 4,800.00 $ 4,800.00 57 1.00 EA 0465-7011 JCTBOX(COMPL)(PJB)(6FTX6FT) complete in place per EACH for No Cents dollars and cents. $ 9,500.00 $ 9,500.00 58 2.00 EA 0465-7012 JCTBOX(COMPL)(PJB)(8FTX8FT) complete in place per EACH for Cents dollars and cents. $ 23,000.00 $ 46,000.00 59 22.00 EA 0465-7014 INLET (COMPL)(PCO)(3 FT)(LEFT) complete in place per EACH for Dollars and No Cents dollars and cents. $ 6,320.00 $ 139,040.00 60 8.00 EA 0465-7015 INLET (COMPL)(PCO)(3 FT)(RIGHT) complete in place per EACH for Dollars and No Cents dollars and cents. $ 6,342.00 $ 50,736.00 61 5.00 EA 0465-7016 INLET (COMPL)(PCO)(3FT)(BOTH) complete in place per EACH for Eight Dollars and No Cents dollars and cents. $ 7,428.00 $ 37,140.00 00300-9-2015 Page 10 of 37 Bid Form BASE BID Approx. Item Description Bid Item Quantity Unit and Written Unit Price Unit Price Amount 62 5.00 EA 0465-7018 INLET (COMPL)(PCO)(4FT)(LEFT) complete in place per EACH for Dollars and No Cents dollars and cents. $ 7,470.00 $ 37,350.00 63 1.00 EA 0465-7076 INLET (COMPL)(PSL)(RC)(6FTX6FT) complete in place per EACH for No Cents dollars and cents. $ 8,700.00 $ 8,700.00 64 2.00 EA 0465-7077 INLET (COMPL)(PSL)(RC)(8FTX8FT) complete in place per EACH for Nineteen Thousand Dollars and No Cents dollars and cents. $ 19,000.00 $ 38,000.00 65 7.00 EA 0465-7128 INLET (COMPL)(PSL)(FG)(4FTX4FT-4FTX4FT) complete in place per EACH for Cents dollars and cents. $ 6,400.00 $ 44,800.00 66 1.00 EA 0465-XXXX INLET (COMPL)(PSL)(FG)(5FTX5FT-5FTX5FT) complete in place per EACH for No Cents dollars and cents. $ 7,100.00 $ 7,100.00 67 2.00 EA 0466-7101 HEADWALL(CH-PW-0) (DIA=24 IN) complete in place per EACH for No Cents dollars and cents. $ 8,600.00 $ 17,200.00 00300-9-2015 Page 11 of 37 Bid Form BASE BID Approx. Item Description Bid Item Quantity Unit and Written Unit Price Unit Price Amount 68 1.00 EA 0467-7111 SET(TY I)(S=5 FT)(HW=7 FT)(3:1)(C) complete in place per EACH for Twenty Six Thousand Dollars and No Cents dollars and cents. $ 26,000.00 $ 26,000.00 69 1.00 EA 0467-7132 SET(TY I)(S=6 FT)(HW=5 FT)(3:1)(C) complete in place per EACH for Twenty Thousand Dollars and No Cents dollars and cents. $ 20,000.00 $ 20,000.00 70 6.00 EA 0496-7001 REMOV STR(BOX CULVERT) complete in place per EACH for No Cents dollars and cents. $ 1,100.00 $ 6,600.00 71 10.00 EA 0496-7002 REMOV STR(INLET) complete in place per EACH for One Thousand Dollars and No Cents dollars and cents. $ 1,000.00 $ 10,000.00 72 2.00 EA 0496-7006 REMOV STR(HEADWALL) complete in place per EACH for No Cents dollars and cents. $ 1,300.00 $ 2,600.00 73 2697.00 LF 0496-7007 REMOV STR(PIPE) complete in place per LINEAR FEET for Thirty Seven Dollars and No Cents dollars and cents. $ 37.00 $ 99,789.00 74 2724.00 LF 0496-XXXX REMOV WIRE FENCE complete in place per LINEAR FEET for Three Dollars and No Cents dollars and cents. $ 3.00 $ 8,172.00 75 1.00 LS 0500-7001 MOBILIZATION complete in place per LUMP SUM for No Cents dollars and cents. $ 350,000.00 $ 350,000.00 00300-9-2015 Page 12 of 37 Bid Form BASE BID Approx. Item Description Bid Item Quantity Unit and Written Unit Price Unit Price Amount 76 14.00 MO 0502-7001 BARRICADES, SIGNS AND TRAFFIC HANDLING complete in place per MONTH for No Cents dollars and cents. $ 7,900.00 $ 110,600.00 77 125.00 LF 0506-7002 ROCK FILTER DAMS (INSTALL)(TY 2) complete in place per LINEAR FEET for Fifty Three Dollars and No Cents dollars and cents. $ 53.00 $ 6,625.00 78 125.00 LF 0506-7011 ROCK FILTER DAMS (REMOVE) complete in place per LINEAR FEET for Six Dollars and No Cents dollars and cents. $ 6.00 $ 750.00 79 5912.00 LF 0506-7039 TEMP SEDMT CONT FENCE (INSTALL) complete in place per LINEAR FEET for Four Dollars and No Cents dollars and cents. $ 4.00 $ 23,648.00 80 5912.00 LF 0506-7041 TEMP SEDMT CONT FENCE (REMOVE) complete in place per LINEAR FEET for One Dollar and No Cents dollars and cents. $ 1.00 $ 5,912.00 00300-9-2015 Page 13 of 37 Bid Form BASE BID Approx. Item Description Bid Item Quantity Unit and Written Unit Price Unit Price Amount 81 740.00 LF 0506-7043 BIODEG EROSN CONT LOGS (INSTL)(8") complete in place per LINEAR FEET for Four Dollars and No Cents dollars and cents. $ 4.00 $ 2,960.00 82 400.00 LF 0506-7045 BIODEG EROSN CONT LOGS (INSTL)(18") complete in place per LINEAR FEET for Sixteen Dollars and No Cents dollars and cents. $ 16.00 $ 6,400.00 83 1140.00 LF 0506-7046 BIODEG EROSN CONT LOGS (REMOVE) complete in place per LINEAR FEET for One Dollar and No Cents dollars and cents. $ 1.00 $ 1,140.00 84 1182.00 SY 0508-7003 CONSTRUCTING DETOURS (TY1) complete in place per SQUARE YARD for One Hundred Ten Dollars and No Cents dollars and cents. $ 110.00 $ 130,020.00 85 8000.00 LF 0512-7009 PORT CTB(FUR& INST)(LOW PROF)(TY 1) complete in place per LINEAR FEET for Sixty Two Dollars and No Cents dollars and cents. $ 62.00 $ 496,000.00 86 200.00 LF 0512-7010 PORT CTB(FUR& INST)(LOW PROF)(TY 2) complete in place per LINEAR FEET for Seventy One Dollars and No Cents dollars and cents. $ 71.00 $ 14,200.00 00300-9-2015 Page 14 of 37 Bid Form BASE BID Approx. Item Description Bid Item Quantity Unit and Written Unit Price Unit Price Amount 87 7710.00 LF 0512-7033 PORT CTB(MOVE)(LOW PROF)(TY 1) complete in place per LINEAR FEET for Nine Dollars and No Cents dollars and cents. $ 9.00 $ 69,390.00 88 160.00 LF 0512-7034 PORT CTB(MOVE)(LOW PROF)(TY 2) complete in place per LINEAR FEET for Eight Dollars and No Cents dollars and cents. $ 8.00 $ 1,280.00 89 8000.00 LF 0512-7045 PORT CTB(STKPL)(LOW PROF)(TY 1) complete in place per LINEAR FEET for Eight Dollars and No Cents dollars and cents. $ 8.00 $ 64,000.00 90 160.00 LF 0512-7046 PORT CTB(STKPL)(LOW PROF)(TY 2) complete in place per LINEAR FEET for Eight Dollars and No Cents dollars and cents. $ 8.00 $ 1,280.00 91 8000.00 LF 0512-7057 PORT CTB(REMOVE)(LOW PROF)(TY 1) complete in place per LINEAR FEET for Eight Dollars and No Cents dollars and cents. $ 8.00 $ 64,000.00 92 200.00 LF 0512-7058 PORT CTB(REMOVE)(LOW PROF)(TY 2) complete in place per LINEAR FEET for Eight Dollars and No Cents dollars and cents. $ 8.00 $ 1,600.00 00300-9-2015 Page 15 of 37 Bid Form BASE BID Approx. Item Description Bid Item Quantity Unit and Written Unit Price Unit Price Amount 93 13917.00 LF 0529-7009 CONC CURB&GUTTER(TY II) complete in place per LINEAR FEET for Thirty One Dollars and No Cents dollars and cents. $ 31.00 $ 431,427.00 94 667.00 LF 0529-XXXX CONC CURB(TY F3) complete in place per LINEAR FEET for Cents dollars and cents. $ 259.00 $ 172,753.00 95 2378.00 SY 0530-7006 DRIVEWAYS(CONC) complete in place per SQUARE YARD for Cents dollars and cents. $ 154.00 $ 366,212.00 96 4622.00 SY 0531-7001 CONC SIDEWALKS(4") complete in place per SQUARE YARD for Eighty Five Dollars and No Cents dollars and cents. $ 85.00 $ 392,870.00 97 3.00 EA 0531-7005 CURB RAMPS(TY 1) complete in place per EACH for No Cents dollars and cents. $ 3,100.00 $ 9,300.00 98 17.00 EA 0531-7010 CURB RAMPS(TY 7) complete in place per EACH for No Cents dollars and cents. $ 3,800.00 $ 64,600.00 00300-9-2015 Page 16 of 37 Bid Form BASE BID Approx. Item Description Bid Item Quantity Unit and Written Unit Price Unit Price Amount 99 9.00 EA 0531-7011 CURB RAMPS(TY 10) complete in place per EACH for No Cents dollars and cents. $ 3,400.00 $ 30,600.00 100 2.00 EA 0531-7013 CURB RAMPS(TY 21) complete in place per EACH for No Cents dollars and cents. $ 3,300.00 $ 6,600.00 101 1.00 EA 0531-7014 CURB RAMPS(TY 22) complete in place per EACH for No Cents dollars and cents. $ 5,700.00 $ 5,700.00 102 1102.00 SY 0536-7002 CONC MEDIAN complete in place per SQUARE YARD for One Hundred Four Dollars and No Cents dollars and cents. $ 104.00 $ 114,608.00 103 62.50 LF 0540-7001 MTL W-BEAM GD FEN(TIM POST) complete in place per LINEAR FEET for Thirty Five Dollars and No Cents dollars and cents. $ 35.00 $ 2,187.50 104 5.00 EA 0540-7005 MTL BEAM GD FEN TRANS (THRIE-BEAM) complete in place per EACH for No Cents dollars and cents. $ 1,900.00 $ 9,500.00 00300-9-2015 Page 17 of 37 Bid Form BASE BID Approx. Item Description Bid Item Quantity Unit and Written Unit Price Unit Price Amount 105 3.00 EA 0540-7015 DOWNSTREAM ANCHOR TERMINAL SECTION complete in place per EACH for and No Cents dollars and cents. $ 1,650.00 $ 4,950.00 106 2.00 EA 0544-7001 GUARDRAIL END TREATMENT(INSTALL) complete in place per EACH for Four Thousand Dollars and No Cents dollars and cents. $ 4,000.00 $ 8,000.00 107 8800.00 LF 0550-7001 CHAIN LINK FENCE (INSTALL)(6) complete in place per LINEAR FEET for Five Dollars and No Cents dollars and cents. $ 5.00 $ 44,000.00 108 587.14 LF 0552-7002 WIRE FENCE(TY B) complete in place per LINEAR FEET for Thirty Dollars and No Cents dollars and cents. $ 30.00 $ 17,614.34 109 24.00 EA 0610-7009 REMOVE RD IL ASM(TRANS- BASE) complete in place per EACH for Cents dollars and cents. $ 888.00 $ 21,312.00 110 30.00 EA 0610-7140 IN RD IL(TY AL)40T-8(250W EQ)LED complete in place per EACH for and No Cents dollars and cents. $ 6,516.00 $ 195,480.00 00300-9-2015 Page 18 of 37 Bid Form BASE BID Approx. Item Description Bid Item Quantity Unit and Written Unit Price Unit Price Amount 111 19.00 EA 0610-7141 IN RD IL(TY AL)40T-8-8 (250W EQ)LED complete in place per EACH for and No Cents dollars and cents. $ 7,108.00 $ 135,052.00 112 7238.00 LF 0618-7054 CONDT(PVC)(SCH 80)(2") complete in place per LINEAR FEET for Seventeen Dollars and No Cents dollars and cents. $ 17.00 $ 123,046.00 113 773.00 LF 0618-7055 CONDT(PVC)(SCH 80)(2") (BORE) complete in place per LINEAR FEET for Forty Five Dollars and No Cents dollars and cents. $ 45.00 $ 34,785.00 114 95.00 LF 0618-7060 CONDT(PVC)(SCH 80)(3") complete in place per LINEAR FEET for Twenty Nine Dollars and No Cents dollars and cents. $ 29.00 $ 2,755.00 115 780.00 LF 0618-7061 CONDT(PVC)(SCH 80)(3") (BORE)W/PRESSURE GROUT CONCRETE complete in place per LINEAR FEET for Fifty Nine Dollars and No Cents dollars and cents. $ 59.00 $ 46,020.00 116 1162.00 LF 0618-7068 CONDT(PVC)(SCH 80)(6") (BORE) complete in place per LINEAR FEET for Ninety Two Dollars and No Cents dollars and cents. $ 92.00 $ 106,904.00 00300-9-2015 Page 19 of 37 Bid Form BASE BID Approx. Item Description Bid Item Quantity Unit and Written Unit Price Unit Price Amount 117 4848.00 LF 0618-XXXX CONDT(PVC)(SCH 80)(4") complete in place per LINEAR FEET for Twenty Eight Dollars and No Cents dollars and cents. $ 28.00 $ 135,744.00 118 384.00 LF 0618-XXXX CONDT(PVC)(SCH 80)(4") (BORE) complete in place per LINEAR FEET for Eighty Nine Dollars and No Cents dollars and cents. $ 89.00 $ 34,176.00 119 9276.00 LF 0620-7007 ELEC CONDR(NO.8)BARE complete in place per LINEAR FEET for Two Dollars and No Cents dollars and cents. $ 2.00 $ 18,552.00 120 16192.00 LF 0620-7008 ELEC CONDR(NO.8) INSULATED complete in place per LINEAR FEET for Two Dollars and No Cents dollars and cents. $ 2.00 $ 32,384.00 121 860.00 LF 0621-7002 TRAY CABLE(3 CONDR)(12 AWG) complete in place per LINEAR FEET for Two Dollars and No Cents dollars and cents. $ 2.00 $ 1,720.00 122 30.00 EA 0624-7008 GROUND BOX TY D (162922)W/APRON complete in place per EACH for Cents dollars and cents. $ 2,600.00 $ 78,000.00 00300-9-2015 Page 20 of 37 Bid Form BASE BID Approx. Item Description Bid Item Quantity Unit and Written Unit Price Unit Price Amount 123 3.00 EA 0624-7013 REMOVE GROUND BOX complete in place per EACH for Cents dollars and cents. $ 592.00 $ 1,776.00 124 1.00 EA 0628-7002 REMOVE ELECTRICAL SERVICES complete in place per EACH for Cents dollars and cents. $ 770.00 $ 770.00 125 3.00 EA 0628-7034 ELC SRV TY A 240/480 060(NS)AL(E)PS(U) complete in place per EACH for and No Cents dollars and cents. $ 7,700.00 $ 23,100.00 126 1.00 EA 0628-7222 ELC SRV TY D 120/240 100(NS)AL(E)SP(U) complete in place per EACH for and No Cents dollars and cents. $ 7,700.00 S 7,700.00 127 51.00 EA 0644-7001 IN SM RD SN SUP&AM TY1 OBWG(1)SA(P) complete in place per EACH for Cents dollars and cents. $ 967.00 $ 49,317.00 128 22.00 EA 0644-7073 REMOVE SM RD SN SUP&AM complete in place per EACH for One Hundred Eleven Dollars and No Cents dollars and cents. $ 111.00 $ 2,442.00 00300-9-2015 Page 21 of 37 Bid Form BASE BID Approx. Item Description Bid Item Quantity Unit and Written Unit Price Unit Price Amount 129 502.00 LF 0662-7002 WK ZN PAV MRK NON- REMOV(W)4"(DOT) complete in place per LINEAR FEET for Two Dollars and No Cents dollars and cents. $ 2.00 $ 1,004.00 130 7002.00 LF 0662-7004 WK ZN PAV MRK NON- REMOV(W)4"(SLD) complete in place per LINEAR FEET for Two Dollars and No Cents dollars and cents. $ 2.00 $ 14,004.00 131 5556.00 LF 0662-7035 WK ZN PAV MRK NON- REMOV(Y)4"(SLD) complete in place per LINEAR FEET for Two Dollars and No Cents dollars and cents. $ 2.00 $ 11,112.00 132 13.00 LF 0666-7018 REFL PAV MRK TY I (W)8"(DOT)(100MIL) complete in place per LINEAR FEET for Two Dollars and No Cents dollars and cents. $ 2.00 $ 26.00 133 3085.00 LF 0666-7024 REFL PAV MRK TY I (W)8"(SLD)(100MIL) complete in place per LINEAR FEET for Three Dollars and No Cents dollars and cents. $ 3.00 $ 9,255.00 134 661.00 LF 0666-7036 REFL PAV MRK TY I (W)24"(SLD)(100MIL) complete in place per LINEAR FEET for Twelve Dollars and No Cents dollars and cents. $ 12.00 $ 7,932.00 00300-9-2015 Page 22 of 37 Bid Form BASE BID Approx. Item Description Bid Item Quantity Unit and Written Unit Price Unit Price Amount 135 332.00 LF 0666-7117 REFL PAV MRK TY I (Y)12"(SLD)(l 00MIL) complete in place per LINEAR FEET for Six Dollars and No Cents dollars and cents. $ 6.00 $ 1,992.00 136 30.00 EA 0666-7042 REFL PAV MRK TY I (W)(ARROW)(100MIL) complete in place per EACH for Cents dollars and cents. $ 236.00 $ 7,080.00 137 24.00 EA 0666-7066 REFL PAV MRK TY I (W)(WORD)(100MIL) complete in place per EACH for Cents dollars and cents. $ 266.00 $ 6,384.00 138 3.00 EA 0666-7090 REF PAV MRK TY I(W)36"(YLD TRI)(100MIL) complete in place per EACH for One Hundred Thirty Dollars and No Cents dollars and cents. $ 130.00 $ 390.00 00300-9-2015 Page 23 of 37 Bid Form BASE BID Approx. Item Description Bid Item Quantity Unit and Written Unit Price Unit Price Amount 139 5655.00 LF 0666-7347 PAVEMENT SLER 6" complete in place per LINEAR FEET for No Dollars and Sixty Cents dollars and cents. $ 0.60 $ 3,393.00 140 3085.00 LF 0666-7348 PAVEMENT SLER 8" complete in place per LINEAR FEET for No Dollars and Seventy Cents dollars and cents. $ 0.70 $ 2,159.50 141 332.00 LF 0666-7350 PAVEMENT SLER 12" complete in place per LINEAR FEET for Two Dollars and No Cents dollars and cents. $ 2.00 $ 664.00 142 661.00 LF 0666-7352 PAVEMENT SLER 24" complete in place per LINEAR FEET for Three Dollars and No Cents dollars and cents. $ 3.00 $ 1,983.00 00300-9-2015 Page 24 of 37 Bid Form BASE BID Approx. Item Description Bid Item Quantity Unit and Written Unit Price Unit Price Amount 143 30.00 EA 0666-7353 PAVEMENT SLER(ARROW) complete in place per EACH for Twenty Six Dollars and No Cents dollars and cents. $ 26.00 $ 780.00 144 24.00 EA 0666-7354 PAVEMENT SLER(WORD) complete in place per EACH for Twenty Nine Dollars and No Cents dollars and cents. $ 29.00 $ 696.00 145 4427.00 LF 0666-XXXX REFL PAV MRK TY I(W)6" (BRK)(100MIL) complete in place per LINEAR FEET for Two Dollars and Fifty Cents dollars and cents. $ 2.50 $ 11,067.50 146 1228.00 LF 0666-XXXX REFL PAV MRK TY I(Y)6" (SLD)(100MIL) complete in place per LINEAR FEET for Two Dollars and No Cents dollars and cents. $ 2.00 $ 2,456.00 147 217.00 EA 0672-7005 REFL PAV MRKR TY II-C-C complete in place per EACH for Two Dollars and No Cents dollars and cents. $ 2.00 $ 434.00 00300-9-2015 Page 25 of 37 Bid Form BASE BID Approx. Item Description Bid Item Quantity Unit and Written Unit Price Unit Price Amount 148 57.00 EA 0672-7006 REFL PAV MRKR TY II-C-R complete in place per EACH for Seventeen Dollars and No Cents dollars and cents. $ 17.00 $ 969.00 149 7161.00 LF 0677-7001 ELIM EXT PM&MRKS(4") complete in place per LINEAR FEET for One Dollar and No Cents dollars and cents. $ 1.00 $ 7,161.00 150 5655.00 LF 0678-7002 PAV SURF PREP FOR MRK complete in place per LINEAR FEET for No Dollars and Twelve Cents dollars and cents. $ 0.12 $ 678.60 151 3085.00 LF 0678-7004 PAV SURF PREP FOR MRK complete in place per LINEAR FEET for No Dollars and Eighteen Cents dollars and cents. $ 0.18 $ 555.30 152 332.00 LF 0678-7006 PAV SURF PREP FOR MRK — (12") complete in place per LINEAR FEET for No Dollars and Twenty Five Cents dollars and cents. $ 0.25 $ 83.00 153 661.00 LF 0678-7008 PAV SURF PREP FOR MRK — — (24") complete in place per LINEAR FEET for No Dollars and Thirty Five Cents dollars and cents. $ 0.35 $ 231.35 00300-9-2015 Page 26 of 37 Bid Form BASE BID Approx. Item Description Bid Item Quantity Unit and Written Unit Price Unit Price Amount 154 30.00 EA 0678-7009 PAV SURF PREP FOR MRK (ARROW) complete in place per EACH for One Dollar and No Cents dollars and cents. $ 1.00 $ 30.00 155 24.00 EA 0678-7016 PAV SURF PREP FOR MRK (WORD) complete in place per EACH for One Dollar and No Cents dollars and cents. $ 1.00 $ 24.00 156 1.00 EA 0680-7002 INSTALL HWY TRF SIG (ISOLATED) complete in place per EACH for No Cents dollars and cents. $ 9,500.00 $ 9,500.00 157 1.00 EA 0680-7004 REMOVING TRAFFIC SIGNALS complete in place per EACH for Dollars and No Cents dollars and cents. $ 3,554.00 $ 3,554.00 158 1.00 EA 0681-7001 TEMP TRAF SIGNALS complete in place per EACH for Cents dollars and cents. $ 100,000.00 $ 100,000.00 159 8.00 EA 0682-7001 VEH SIG SEC(12")LED(GRN) complete in place per EACH for Cents dollars and cents. $ 444.00 $ 3,552.00 160 4.00 EA 0682-7002 VEH SIG SEC(12")LED(GRN ARW) complete in place per EACH for Cents dollars and cents. $ 438.00 $ 1,752.00 161 8.00 EA 0682-7003 VEH SIG SEC(12")LED(YEL) complete in place per EACH 00300-9-2015 Page 27 of 37 Bid Form BASE BID Approx. Item Description Bid Item Quantity Unit and Written Unit Price Unit Price Amount for Cents dollars and cents. $ 438.00 $ 3,504.00 162 4.00 EA 0682-7004 VEH SIG SEC(12")LED(YEL ARW) complete in place per EACH for Cents dollars and cents. $ 438.00 $ 1,752.00 163 8.00 EA 0682-7005 VEH SIG SEC(12")LED(RED) complete in place per EACH for Cents dollars and cents. $ 438.00 $ 3,504.00 164 2.00 EA 0682-7006 VEH SIG SEC(12")LED(RED ARW) complete in place per EACH for Cents dollars and cents. $ 438.00 $ 876.00 165 3.00 EA 0682-7018 PED SIG SEC (LED)(COUNTDO WN) complete in place per EACH for Cents dollars and cents. $ 533.00 $ 1,599.00 166 6.00 EA 0682-7052 BACK PLATE(12")(3 SECT) complete in place per EACH for Cents dollars and cents. $ 165.00 $ 990.00 167 4.00 EA 0682-7053 BACK PLATE(12")(4 SECT) complete in place per EACH for Two Hundred Seven Dollars and No Cents dollars and cents. $ 207.00 $ 828.00 168 562.00 LF 0684-7031 TRF SIG CBL(TY A)(14 AWG)(5 CONDR) complete in place per LINEAR FEET for Three Dollars and Fifty Cents dollars and cents. $ 3.50 $ 1,967.00 00300-9-2015 Page 28 of 37 Bid Form BASE BID Approx. Item Description Bid Item Quantity Unit and Written Unit Price Unit Price Amount 169 1370.00 LF 0684-7033 TRF SIG CBL(TY A)(14 AWG)(7 COMDR) complete in place per LINEAR FEET for Four Dollars and No Cents dollars and cents. $ 4.00 $ 5,480.00 170 780.00 LF 0684-7046 TRF SIG CBL(TY A)(14 AWG)(20 CONDR) complete in place per LINEAR FEET for Eight Dollars and No Cents dollars and cents. $ 8.00 $ 6,240.00 171 1180.00 EA 0684-7080 TRF SIG CBL(TY C)(14 AWG)(2 CONDR) complete in place per EACH for Three Dollars and No Cents dollars and cents. $ 3.00 $ 3,540.00 172 1.00 EA 0686-7051 INS TRF SIG PL AM(S)1 ARM(48')LUM complete in place per EACH One Thousand Six Hundred Fifty Dollars for and No Cents dollars and cents. $ 1,650.00 $ 1,650.00 173 1.00 EA 0686-7063 INS TRF SIG PL AM(S)1 ARM(60')LUM complete in place per EACH for Forty Five Thousand Dollars and No Cents dollars and cents. $ 45,000.00 $ 45,000.00 174 1.00 EA 0686-7207 INS TRF SIG PL AM(S)2 ARM(55-28')LUM complete in place per EACH for Fifty Thousand Dollars and No Cents dollars and cents. $ 50,000.00 $ 50,000.00 175 3.00 EA 0687-7001 PED POLE ASSEMBLY complete in place per EACH Three Thousand Five Hundred Forty Five for Dollars and No Cents dollars and cents. $ 3,545.00 $ 10,635.00 00300-9-2015 Page 29 of 37 Bid Form BASE BID Approx. Item Description Bid Item Quantity Unit and Written Unit Price Unit Price Amount 176 1.00 EA 0687-7005 REMOVE PED POLE ASSEMBLY complete in place per EACH Three Hundred Fifty Four Dollars and No for Cents dollars and cents. $ 354.00 $ 354.00 177 3.00 LF 0688-7001 PED DETECT PUSH BUTTON — — (APS) complete in place per LINEAR FEET for One Thousand Four Dollars and No Cents dollars and cents. $ 1,004.00 $ 3,012.00 178 7.00 EA 0690-7006 REMOVAL OF GROUND BOXES complete in place per EACH Four Hundred Thirteen Dollars and No for Cents dollars and cents. $ 413.00 $ 2,891.00 179 6.00 EA 0690-7033 REMOVAL OF TRAFFIC SIGNAL POLE FND complete in place per EACH Two Thousand Sixty Eight Dollars and No for Cents dollars and cents. $ 2,068.00 $ 12,408.00 180 1061.00 LF 6005-7001 ITS COM CBL(ETHERNET) (CAT-5E)DETECTION complete in place per LINEAR FEET for One Dollar and No Cents dollars and cents. $ 1.00 $ 1,061.00 181 305.00 LF 6005-7001 ITS COM CBL(ETHERNET) (CAT-5E)RADIO complete in place per LINEAR FEET for One Dollar and No Cents dollars and cents. $ 1.00 $ 305.00 182 360.00 LF 6005-7001 ITS COM CBL(ETHERNET) (CAT-5E)PTZ complete in place per LINEAR FEET for One Dollar and No Cents dollars 00300-9-2015 Page 30 of 37 Bid Form BASE BID Approx. Item Description Bid Item Quantity Unit and Written Unit Price Unit Price Amount and cents. $ 1.00 $ 360.00 183 1.00 EA 6006-7006 VIVDS TEMPORARY complete in place per EACH One Thousand Five Hundred Dollars and for No Cents dollars and cents. $ 1,500.00 $ 1,500.00 184 1.00 EA 6017-7014 VDS(HVDS)(VIVDS AND RVDS) complete in place per EACH for Seven Dollars and No Cents dollars and cents. $ 4,727.00 $ 4,727.00 185 4.00 EA 6017-7015 VIDEO IMAGING AND RADAR DETECTOR complete in place per EACH Four Thousand One Hundred Thirty Six for Dollars and No Cents dollars and cents. $ 4,136.00 $ 16,544.00 186 1.00 EA 6017-7016 VIDEO IMAGING AND RADAR SET-UP SYS complete in place per EACH One Thousand One Hundred Eighty One for Dollars and No Cents dollars and cents. $ 1,181.00 $ 1,181.00 187 1.00 EA 6017-7018 VID IMAGE AND RADAR DET PROCESSOR SYS complete in place per EACH for Seven Dollars and No Cents dollars and cents. $ 4,727.00 $ 4,727.00 188 1.00 EA XXXX-XXXX AXIS Q6315-LE NETWORK PTZ CAMERA complete in place per EACH Four Thousand Four Hundred Ninety for Dollars and No Cents dollars and cents. $ 4,490.00 $ 4,490.00 189 1.00 EA XXXX-XXXX COMNET ETHERNET SWITCH complete in place per EACH 00300-9-2015 Page 31 of 37 Bid Form BASE BID Approx. Item Description Bid Item Quantity Unit and Written Unit Price Unit Price Amount One Thousand Eight Hundred Ninety for Dollars and No Cents dollars and cents. $ 1,890.00 $ 1,890.00 190 1.00 EA XXXX-XXXX PEGASUS TWISTPORT SERIES RADIO complete in place per EACH One Thousand Eight Hundred Ninety for Dollars and No Cents dollars and cents. $ 1,890.00 $ 1,890.00 191 1.00 EA XXXX-XXXX ULTRADISH TP400 ANTENNA W/TWISTPORT CONNECTOR complete in place per EACH for Seven Hundred Nine Dollars and No Cents dollars and cents. $ 709.00 $ 709.00 192 3.00 EA XXXX-XXXX OPTICOM DETECTOR- GTT MODEL 722 complete in place per EACH One Thousand Seven Hundred Seventy Two for Dollars and No Cents dollars and cents. $ 1,772.00 $ 5,316.00 193 1.00 EA XXXX-XXXX OPTICOM PHASE SELECTOR-GTT MODEL 764 complete in place per EACH Four Thousand Seven Hundred Twenty for Seven Dollars and No Cents dollars and cents. $ 4,727.00 $ 4,727.00 194 1.00 EA XXXX-XXXX OPTICOM CARD RACK- GTT MODEL 760 complete in place per EACH One Thousand Sixty Three Dollars and No for Cents dollars and cents. $ 1,063.00 $ 1,063.00 195 818.00 LF XXXX-XXXX OPTICOM CABLE-GTT MODEL 138 complete in place per LINEAR FEET for Two Dollars and Fifty Cents dollars and cents. $ 2.50 $ 2,045.00 00300-9-2015 Page 32 of 37 Bid Form BASE BID Approx. Item Description Bid Item Quantity Unit and Written Unit Price Unit Price Amount 196 4.00 EA XXXX-XXXX ILSN(LED)(8 S)(CLEAN PROFILE OR BRITELITE EDGE LIT STREET NAME SIGN) complete in place per EACH Five Thousand Three Hundred Eighteen for Dollars and No Cents dollars and cents. $ 5,318.00 $ 21,272.00 197 124.30 CY 401-FLOWABLE FILL complete in place per CUBIC YARD Two Hundred Eighty Seven Dollars and No for Cents dollars and cents. $ 287.00 $ 35,674.10 198 28.20 CY 403 CLASS D,2000 PSI CONCRETE complete in place per CUBIC YARD Three Hundred Eighty Nine Dollars and No for Cents dollars and cents. $ 389.00 $ 10,969.80 199 4.00 EA 504 REMOVE EXISTING FIRE — — HYDRANT complete in place per EACH One Thousand Three Hundred Ninety Four for Dollars and No Cents dollars and cents. $ 1,394.00 $ 5,576.00 200 10.00 EA 504 ADJUST WATER VALVE TO FG complete in place per EACH for dollars Four Thousand Five Hundred Fifty Dollars and and No Cents cents. $ 4,550.00 $ 45,500.00 201 1.00 EA 504 AUTOMATIC COMBINATION AIR RELEASE VALVE ASSEMBLY(2-IN DIA) complete in place per EACH Fifteen Thousand Two Hundred Forty Three for Dollars and No Cents dollars and cents. $ 15,243.00 $ 15,243.00 202 3.00 EA 504 REMOVE WATER VALVE complete in place per EACH 00300-9-2015 Page 33 of 37 Bid Form BASE BID Approx. Item Description Bid Item Quantity Unit and Written Unit Price Unit Price Amount One Thousand Four Hundred Two Dollars for and No Cents dollars and cents. $ 1,402.00 $ 4,206.00 203 8.00 EA 504 ADJUST WATER VALVE BOX TO FG complete in place per EACH One Thousand Three Hundred Ninety Four for Dollars and No Cents dollars and cents. $ 1,394.00 $ 11,152.00 204 330.00 LF 505 ENCASEMENT PIPE,24-IN DIA, STEEL,7/16-IN THCK,OPEN CUT (ALL DEPTHS) complete in place per LINEAR FEET Three Hundred Fifty Five Dollars and No for Cents dollars and cents. $ 355.00 $ 117,150.00 205 90.00 LF 505 ENCASEMENT PIPE, 30-IN DIA, STEEL, 1/2-IN THCK,OPEN CUT(ALL DEPTHS) complete in place per LINEAR FEET Four Hundred Twenty Seven Dollars and No for Cents dollars and cents. $ 427.00 $ 38,430.00 206 1.00 EA 506 MAJOR MANHOLE ADJUSTMENT complete in place per EACH for Forty Thousand Dollars and No Cents dollars and cents. $ 40,000.00 $ 40,000.00 207 1360.00 LF 509 TRENCH SAFETY SYSTEMS(ALL DEPTHS) complete in place per LINEAR FEET for Six Dollars and No Cents dollars and cents. $ 6.00 $ 8,160.00 208 190.00 LF 510 PIPE,PVC C900(6-IN DIA)(ALL DEPTHS),INCL EXC AND BACKFILL complete in place per LINEAR FEET for Eighty Five Dollars and No Cents dollars and cents. $ 85.00 $ 16,150.00 00300-9-2015 Page 34 of 37 Bid Form BASE BID Approx. Item Description Bid Item Quantity Unit and Written Unit Price Unit Price Amount 209 11.00 LF 510 PIPE,CL 250 RESTRAINED JOINT DI(6-IN DIA)(ALL DEPTHS),INCL EXC AND BACKFILL complete in place per LINEAR FEET Five Hundred Sixty Three Dollars and No for Cents dollars and cents. $ 563.00 $ 6,193.00 210 86.00 LF 510 PIPE,CL 250 RESTRAINED JOINT DI(12-IN DIA)(ALL DEPTHS),INCL EXC AND BACKFILL complete in place per LINEAR FEET Two Hundred Fifty Two Dollars and No for Cents dollars and cents. $ 252.00 $ 21,672.00 211 843.00 LF 510 PIPE,CL 250 RESTRAINED JOINT DI(16-IN DIA)(ALL DEPTHS),INCL EXC AND BACKFILL complete in place per LINEAR FEET One Hundred Eighty Five Dollars and No for Cents dollars and cents. $ 185.00 $ 155,955.00 212 330.00 LF 510 PIPE,CL 250 RESTRAINED JOINT DI(12-IN DIA),THROUGH ENCASEMENT complete in place per LINEAR FEET for One Hundred Eleven Dollars and No Cents dollars and cents. $ 111.00 $ 36,630.00 213 90.00 LF 510 PIPE,CL 250 RESTRAINED JOINT DI(16-IN DIA),THROUGH ENCASEMENT complete in place per LINEAR FEET Two Hundred Eighty Five Dollars and No for Cents dollars and cents. $ 285.00 $ 25,650.00 214 581.00 LF 510 PIPE REMOVAL, (12-IN DIA)(ALL DEPTHS),INCL EXC AND BACKFILL 00300-9-2015 Page 35 of 37 Bid Form BASE BID Approx. Item Description Bid Item Quantity Unit and Written Unit Price Unit Price Amount complete in place per LINEAR FEET for Fifty One Dollars and No Cents dollars and cents. $ 51.00 $ 29,631.00 215 920.00 LF 510 PIPE REMOVAL, (16-IN DIA)(ALL DEPTHS),INCL EXC AND BACKFILL complete in place per LINEAR FEET for Forty Seven Dollars and No Cents dollars and cents. $ 47.00 $ 43,240.00 216 2.00 EA 510 WET CONNECTION 6-IN DIA X 6-IN — — DIA complete in place per EACH Two Thousand Three Hundred Dollars and for No Cents dollars and cents. $ 2,300.00 $ 4,600.00 217 3.00 EA 510 WET CONNECTION 12-IN DIA X 12- - — IN DIA complete in place per EACH Two Thousand Eight Hundred Dollars and for No Cents dollars and cents. $ 2,800.00 $ 8,400.00 218 8.00 EA 510 WET CONNECTION 16-IN DIA X 16- IN DIA complete in place per EACH Six Thousand Eight Hundred Dollars and for No Cents dollars and cents. $ 6,800.00 $ 54,400.00 219 7.10 TN 510 DUCTILE IRON FITTINGS complete in place per TON Six Thousand Four Hundred Dollars and No for Cents dollars and cents. $ 6,400.00 $ 45,440.00 220 1.00 LS 510 BYPASS PUMPING complete in place per LUMP SUM for Forty Five Thousand Dollars and No Cents dollars and cents. $ 45,000.00 $ 45,000.00 221 1.00 EA 511 VALVES(GATE TYPE)(6-IN DIA) 00300-9-2015 Page 36 of 37 Bid Form BASE BID Approx. Item Description Bid Item Quantity Unit and Written Unit Price Unit Price Amount complete in place per EACH for Seven Thousand Dollars and No Cents dollars and cents. $ 7,000.00 $ 7,000.00 222 6.00 EA 511 VALVES(GATE TYPE)(12-IN DIA) complete in place per EACH Five Thousand Two Hundred Dollars and for No Cents dollars and cents. $ 5,200.00 $ 31,200.00 223 5.00 EA 511 VALVES(GATE TYPE)(16-IN DIA) complete in place per EACH Twelve Thousand Five Hundred Dollars for and No Cents dollars and cents. $ 12,500.00 $ 62,500.00 224 3.00 EA 511 FIRE HYDRANT ASSEMBLY complete in place per EACH Eight Thousand Three Hundred Eighty for Three Dollars and No Cents dollars and cents. $ 8,383.00 $ 25,149.00 225 2.00 EA 511 AUTOMATIC COMBINATION AIR RELEASE VALVE ASSEMBLY(2-IN DIA) complete in place per EACH for Fifteen Thousand Dollars and No Cents dollars and cents. $ 15,000.00 $ 30,000.00 226 108.00 SY 602 BERMUDA BLOCK SODDING complete in place per SQUARE YARD for Sixteen Dollars and No Cents dollars and cents. $ 16.00 $ 1,728.00 00300-9-2015 Page 37 of 37 Bid Form TOTAL BASE BID (Items 1 thru 226 ) $ 13,953,194.32 Materials: $ 2,606,681.00 All Other Charges: $ 11,346,513.32 * Total: $ 13,953,194.32 * 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. Res S miffed, 7 P.O. Box 342349 Signature Travis W keller Austin, Tx. 78734 Print Name Address Vice President 512-327-1464 Title Telephone Austin Engineering Co., Inc. Name of Firm CO., February 20, 2025 ;�` •.. Allison Cambell X Date = Secretary, if Bidder is a a ' =w: W - ;?•. Corporation 00200-9-2015 Page 1 of 1 Bid Form 00200 BID BOND BID BOND THE STATE OF TEXAS § § KNOW ALL BY THESE PRESENTS: COUNTY OF WILLIAMSON § That Austin Engineering Co., Inc. of the City of Austin County of Travis State of Texas as Principal, and SureTec Insurance Company authorized under the laws of the State of Texas to act as surety on bonds for principals,are held and firmly bound unto the CITY OF ROUND ROCK,TEXAS("Owner"), in the penal sum of Five Percent(5%)of the total amount of the Bid of the Principal submitted to the Owner, for the Work described below; for the payment whereof, well and truly to be made, and the said Principal and Surety do herby bind themselves and their heirs, administrators, executors, successors and assigns, jointly and severally,as follows: In no case shall the liability of the Surety hereunder exceed the sum of( five percent of the total amount bid by Principal Dollars($ 5% ). THE CONDITIONS OF THIS OBLIGATION ARE SUCH that,whereas,the Principal has submitted the above-referenced Bid to the Owner, for construction of the Work under the "Specifications for Construction of Greenlawn Blvd- IH35 to SH45 for which Bids are to be opened at the office of Owner on the 20th day of February ,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 20th day of the month of February 20 25 Austin Engineering Co., Inc. SureTec Insurance Company Principal Surety Brad Ballew — Printed N Printed Name JJ,,4_t,_By: By: J3� Title: Title: Attorney-in-Fact Address: P.O. Box 342349 Address: 2103 CityWest Blvd., Suite 1300 Austin, TX 78734-2349 Houston,TX 77042 00200 4-2020 Page 1 Bid Bond 00443638 Resident Agent of Surety: [?4-- 1 � Signature Brad Ballew Printed Name 3802 Menchaca Road Street Address Austin,TX 78704 City, State,Zip Page 2 00200 4-2020 Bid Bond 00443638 POA# 4221356 JOINT LIMITED POWER OF ATTORNEY KNOW ALL MEN BY THESE PRESENTS:That SureTec Insurance Company,a Corporation duly organized and existing under the laws of the State of Texas and having its principal office in the County of Harris,Texas and Markel Insurance Company(the"Company"),a corporation duly organized and existing under the laws of the state of Illinois,and having its principal administrative office in Glen Allen,Virginia,does by these presents make,constitute and appoint: David S. Ballew, Brad Ballew, Connie Davis, David Fernea Their true and lawful agent(s)and attorney(s)-in-fact,each in their separate capacity if more than one is named above,to make,execute,seal and deliver for and on their own behalf,individually as a surety orjointly,as co-sureties,and as their act and deed any and all bonds and other undertaking in suretyship provided,however, that the penal sum of any one such instrument executed hereunder shall not exceed the sum of: Fifty Million and 00/100 Dollars($50,000,000.00) This Power of Attorney is granted and is signed and sealed under and by the authority of the following Resolutions adopted by the Board of Directors of SureTec Insurance Company and Markel Insurance Company: "RESOLVED,That the President,any Senior Vice President,Vice President,Assistant Vice President,Secretary,Assistant Secretary,Treasurer or Assistant Treasurer and each of them hereby is authorized to execute powers of attorney,and such authority can be executed by use of facsimile signature,which may be attested or acknowledged by any officer or attorney,of the company,qualifying the attorney or attorneys named in the given power of attorney,to execute in behalf of,and acknowledge as the act and deed of the SureTec Insurance Company and Markel Insurance Company,as the case may be,all bond undertakings and contracts of suretyship,and to affix the corporate seal thereto." IN WITNESS WHEREOF,Markel Insurance Company and SureTec Insurance Company have caused their official seal to be hereunto affixed and these presents to be signed by their duly authorized officers on the 25th day of January , 2023 . SureTec Insurance Company SvaaN� `�.s'�j'RgNC�r,, Xde Insurance , mpany O i3' i a w e 1g SEALBAAZA4�< \66 WI Michael C.Keimig,President '�, .� ing, ice President State of Texas County of Harris: On this 25th day of January , 2023 A.D.,before me,a Notary Public of the State of Texas,in and for the County of Harris,duly commissioned and qualified, came THE ABOVE OFFICERS OF THE COMPANIES,to me personally known to be the individuals and officers described in,who executed the preceding instrument,and they acknowledged the execution of same,and being by me duly sworn,disposed and said that they are the officers of the said companies aforesaid,and that the seals affixed to the proceeding instrument are the Corporate Seals of said Companies,and the said Corporate Seals and their signatures as officers were duly affixed and subscribed to the said instrument by the authority and direction of the said companies,and that Resolutions adopted by the Board of Directors of said Companies referred to in the preceding instrument is now in force. IN TESTIMONY WHEREOF,1 have hereunto set my hand,and affixed my Official Seal at the County of Harris,the day and year first above written. JULIE E. MCCLARY / �t Notary Public State of Texas B : V�C T-' Commission#12947680-5y EJglifCS March 29,2{I2t 1 ie E.McCrary,Notary Public t/ Cor rasion 4y commission expires 3/29/2026 �r We,the undersigned Officers of SureTec Insurance Company and Markel Insurance Company do herby certify that the original POWER OF ATTORNEY of which the foregoing is a full,true and correct copy is still in full force and effect and has not been revoked. IN WITNESS WHEREOF,we have hereunto set our hands,and affixed the Seals of said Companies,on the 20th day of February 2025 ur sur Company Markel Insurance Company B By: M.Br nt Beaty,A istant Secretary /And4w Ma quis,As ' nt S(e/ r tary Any instrument Issued in excess of the penalty stated above is totally void and without any validity.4221356 r For verification of the authority of this Power you may call(713)812-0300 on any business day between 830 AM and 5:00 PM CST. �`' r,4 .ear '� •� �' : ht' n 4 r:,.;3 �r +S �t y �,y a` r` v 14414 � �, r� - � �' •u a tt h``^ £ `_. Y i Yrs•.: �` ;,$b �\ e� tb• t � � J ��:n _� - N. ilk 8 s °trF P+r�'= r v3E�, ta.- t '•ti: 4 f•r '� .z`t, .. � �t1 ."S::n i� ,r $r� � ..i 3: u. r�-1 .:Xi.> a' - a wi.•rtix r F 'T `skyi'> .;+.� "F' :vim P .i.. 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A < •s�,, � T "+`s ya.-1•.. `t_ :• .�1w- .�.'•f,:'. .`>F,v.. ," •�f"• t A• �- ;.�:+ �, z•' n ...�: '� �... ,.r: `-:•@.�6=''•: �.^- •,..., r i s x :y :5, .�,f.. a. ^�: 3. :'9�r`rYFkr L ...r;� 1:x1 ::..�:• e,�-. � r.�}.�,P:{�i'"_, S• :..: .r=c af,:: 1, .:..,.:. _ -.:�.. Y":' P b• ,r:'4 .k ..�i"st:.:.-Ne° ,..x. ,� }-, ,,��^'.,::�, .6s .F':Ys,:; <,v 't.v� � �y''Y. -�.: F ,e.'� '�r.. ,r+k.'v :�}r '�r }}��z.'t• `x>- y� �yq k •�`,;' � .y,.. . :; .'w.-e'�M.�.�:�; x4 .. ,.n.R4!dS�✓: .k.Aa5o`i.�k•SRN}��';�f,�'i', 1�M .._�x.fn:�.{'°¢..s..- :'�.,f'::�.'.,�#�Y" i1F"IYT. �i '.r.a!-na��M .. },Ma .h-...I •Pr..S_.:.$'a"�}r.✓,a.I'�'dP ,4s5 cHFr-i:'. i,��t: ,�, w?��i FS,.G� x'Y', �J 2f.�,. SureTec Insurance Company IMPORTANT NOTICE Statutory Complaint Notice/Filing of Claims To obtain information or make a complaint: You may call the Surety's toll free telephone number for information or to make a complaint or file a claim at: 1-866-732-0099. You may also write to the Surety at: SureTec Insurance Company 9500 Arboretum Blvd., Suite 400 Austin, TX 78759 You may contact the Texas Department of Insurance to obtain information on companies, coverage, rights or complaints at 1-800-252- 3439. You may write the Texas Department of Insurance at: PO Box 149104 Austin, TX 78714- 9104 Fax#: 512-490-1007 Web: http://www.tdi.state.tx.us Email: ConsumerProtection@tdi.texas.gov PREMIUM OR CLAIMS DISPUTES: Should you have a dispute concerning your premium or about a claim, you should contact the Surety first. If the dispute is not resolved, you may contact the Texas Department of Insurance. ------------------------------------------------------------------------------------------------------------------------------ SIC TX Rider TDI Required Notices rev 07_2022 Page 1 of 1 Solicitation Requirements, Contract Forms & Conditions of Contract Statement of Bidder's Safety Experience Section 00410 Bidder must submit a signed Statement of Bidder's Safety Experience form with his Bid; failure to do so will constitute an incomplete Bid that may be rejected. In order to make a responsive Bid, Bidder must provide evidence that it meets minimum OSHA construction safety program requirements, has not been fined by OSHA for any willful safety violations in the past three years, and has a lost time injury rate that doesn't exceed the limits established below. All questions must be answered and data given must be clear and comprehensive. If necessary, questions may be answered on separate attached sheets. Company Name: Austin Engineering Company Inc. Address: PO BOX 342349 Austin, TX. 78734 Phone: 512-327-1464 Completed by: Elizabeth Serrato Date: 02/20/2025 1. Does the company have a written construction Safety program? Q'Yes ❑No 2. Does the company conduct construction safety inspections? �7es ❑No 3. Does the company have an active construction safety-training program? Wes ❑No 4. Has the company been fined by OSHA for any willful safety violations in the past ❑Yes VNo 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 VNo or less over the past three years? Attach the company's OSHA 200/300 logs for the past three years. See Attached AECO Documents in Qualification Statement 6. Does the company or affected subcontractors have competent persons in the following Areas? A. Scaffolding Q'Ifes []No ❑N/A B. Excavation QlAVes ❑No ❑N/A C. Cranes ❑Yes []No QN/A D. Electrical VYes ❑No ❑N/A E. Fall Protection k'es []No ❑N/A F. Confined Spaces VYes ❑No ❑N/A I hereby certify that the abo a information is true and correct. Signature Travis W Keller Title Vice President Page 1 00410 8-2014 Statement of Bidder's Safety Experience 00090654 Austin Engineering Company, Inc. 2020 - 2024 OSHA Safety Logs & EMR WORKERS COMPENSATION EXPERIENCE RATING NCC/ Risk Name: AUSTIN ENGINEERING CO INC Risk ID: 420057180 Rating Effective Date: 07/01/2020 Production Date: 03/27/2020 State: TEXAS State Wt Exp Excess Expected Exp Prim Act Exc Losses Ballast Act Inc Losses Act Prim Losses Losses Losses Losses Tx-A .231 213,6811 336,241 122,560 208,537 59,7001 306,8031 98,266 (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 I) Losses Losses 1.231 1 213,6811 336,2411 122,5601 208,5371 59,7001 281,8731 73,3361 Primary Losses Stabilizing Value Ratable Excess Totals (1) C'(1 -A)+G (A).(F) (J) Actual 73,336 224,234 47.964 345,534 (E) C`(1 -A)+G (A)'(C) (K) Expected 122,560 224,234 49.147 395,941 ARAP FLARAP SARAP MAARAP Exp Mod (J)/(K) Factors .87 REVISED RATING RATING REFLECTS A DECREASE OF 70% MEDICAL ONLY PRIMARY AND EXCESS LOSS DOLLARS WHERE ERA IS APPLIED. RATING REVISED TO REFLECT APPROVED RATING VALUES Carrier: 29939-000 Policy: 0002049383 Eff-Date: 07-01-2020 Exp-Date: 07 01-2021 0 Copyright 1993-2020,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 warrantes.including the implied Aarranty 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 underAriting,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. Page 1 of 4 WORKERS COMPENSATION EXPERIENCE RATING NCC/ Risk Name: AUSTIN ENGINEERING CO INC Risk ID: 420057180 Rating Effective Date: 07/01/2020 Production Date: 03/27/2020 State: TEXAS 42-TEXAS Firm ID:A Firm Name: AUSTIN ENGINEERING CO INC Carrier: 21075 Policy No. SDZH3013816 Eff Date: 07/01/2016 Exp Date: 07/01/2017 Code ELR I D- Payroll Expected Exp Prim Claim Data IJ OF Act Inc Act Prim Ratio Losses Losses Losses Losses 0042 1.37 .40 1,157,433 15,857 6,343 9655990 05 F 3,105 3,105 3724 .93 .39 339,7161 3,159 1,232 9656086 06 F 2,253 2,253 5200 1.18 .39 15,7201 185 72 9657903 06 F 2,634 2,634 5213 1.23 .39 9,1631 113 44 9656061 06 F 2,745 2,745 5506 1.57 .36 800,3131 12,565 4,5231 9657266 06 F 3,069 3,069 5606 .22 .38 1,404,099 3,089 1,174 NO.6 06 4,823 4,823 6219 1.29 .34 1,347,999 17,389 5,912 6229 1.02 .42 535,518 5,462 2,294 6233 .61 .36 12,892 79 28 6306 1.57 .35 985,173 15,467 5,413 6319 1.13 .35 1,008,645 11,398 3,989 7602 1.26 .37 1,538,548 19,386 7,173 8227 .67 .37 696,683 4,668 1,727 8810 .03 .36 427,8071 128 46 9015 .66 .40 109,899 725 290 Subject Total Act Inc Policy Total: 10,389,60 Premium: 360,259 Losses: 18,629 a9 Copynght 1993-2020.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 purposeaccuracy,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 purposesand 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 9 Limited Loss Page 2 of 4 WORKERS COMPENSATION EXPERIENCE RATING NCC/ Risk Name: AUSTIN ENGINEERING CO INC Risk ID: 420057180 Rating Effective Date: 07/01/2020 Production Date: 03/27/2020 State: TEXAS 42-TEXAS Firm ID:A Firm Name: AUSTIN ENGINEERING CO INC Carrier: 21075 Policy No. WC00301382017A Eff Date: 07/01/2017 Exp Date: 07/01/2018 Code ELR D- Payroll Expected Exp Prim Claim Data IJ OF Act Inc Act Prim Ratio Losses Losses Losses Losses 0042 1.37 .40 725,183 9,935 3,974 9661036 03 F 44,305 17,500 3724 .93 .39 235,2821 2,188 853 9658958 05 F 4,283 4,283 5200 1.18 .39 16,1361 190 74 9659588 05 F 7,281 7,281 5213 1.23 .39 9,265 114 44 9660559 105 F 7,764 7,764 5506 1 1.57 .36 700,0441 10,991 3,957 9660083 05 O 199,232 17,500 5606 .22 .38 1,288,591 2,835 1,077 9661304 06 F 2,207 2,207 6219 1.29 .34 1,628,455 21,007 7,142 NO. 13 06 11,536 11,536 6229 1.02 .42 788,041 8,038 3,376 6233 .61 .36 11,825 72 26 6306 1 1.57 .35 895,4671 14,059 4,921 6319 1 1.13 .35 963,9841 10,893 3,813 7602 1.26 .37 1,443,9101 18,193 6,731 8227 .67 .37 922,4411 6,180 2,287 8810 .03 .36 446,5581 134 48 9015 .66 .401 136,0171 898 359 Subject Total Act Inc Policy Total: 10,211,19g 0,211,19 Premium: 315,526 Losses: 276,608 Copynght 1993-2020,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 3 of 4 WORKERS COMPENSATION EXPERIENCE RATING CAVECIRisk Name: AUSTIN ENGINEERING CO INC Risk ID: 420057180 Rating Effective Date: 07/01/2020 Production Date: 03/27/2020 State: TEXAS 42-TEXAS Firm ID:A Firm Name: AUSTIN ENGINEERING CO INC Carrier: 21075 Policy No. WC00301382018A Eff Date: 07/01/2018 Exp Date: 07/01/2019 Code ELR DPayroll Expected Exp Prim Claim Data IJ OF Act Inc Act Prim Ratio Losses Losses Losses Losses 0042 1 1.37 .40 632,141 8.6601 3,464 9663008 05 F 1,085 1,085 3724 .93 .391 164,0581 1,526 595 9666317 05 F 4,133 4,133 5200 1.18 .39 141,9641 1,675 653 NO.7 06 6,348 6,348 5213 1.23 .39 56,1101 690 269 5506 1.57 .36 988,1831 15,514 5,585 5606 .22 .38 802,495 1,765 671 6219 1.29 .34 2,552,357 32,925 11,195 6229 1.02 .42 596,869 6,088 2,557 6233 .61 .36 20,562 125 45 Et 6306 1.57 .35 1,025,552 16,101 5,635 6319 1.13 .35 1,382,9521 15,627 5,469 7602 1.26 .37 909,6971 11,462 4,241 8227 .67 .37 1,136,8841 7,617 2,818 8809 1 .041 36 62,3991 25 9 8810 1 .03 .36 455,880 137 49 9015 1 .66 .40 137,360 907 363 Subject I Total Act Inc Policy Total: 11,065,46 Premium: 324,560 Losses: 11,566 0 Copyright 1993-2020,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 poor m-ritten 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 4 of 4 Attention:This loan contests a use rn a relating �� OSHA's Form 300 to employee the and must befemploy manner trial protects the conhdanllabty of employees to the Year 2020 extent possible vinfle the information is being used Log of Work-Related Injuries and Illness for occupational safety and healthpurposes U.S.Department of Labor Occupational Safety and Health Administration You must record oformalnn about every work-mialed injury or illness that involves loss of on—msness.restricted work activity or job transfer,days away from work, Form approved OMB no 12180176 or medical treatment beyond first aid.You must also record significant wod-miated injuries and illnesses that are diagnosed by a physician or Iicinsed health care prefesslonai.You must also record work-related mfunet and illnesses that meet any of the specikc recording criteria Isted in 29 CFR 190/.8 through 1901.12.Fea free to use two Ines fora single case gym need Io.You must complete an injury and Illness modem report(OSHA Form 301)orequhalem form for each injury or illness Establishment name Austin Engineering Co.,Inc. recorded on this form.8 yw're not sure whether a case Is recordable,call your local OSHA offca for help. City Austin State Texas Identify the Describe the case Classify the case Enter the number of days (A) (B) (C) (D) (E) IF) Using these categories check ONLY the most the injured or ill worker Check the"injury"column or choose Case Employee's Job Title(eg.,Welder) Date of Injury or Where the event Describe injury or illness,parts of body serious result for each case wasone type of illness. No Name onset of illness occurred(e.g. affected,and object/substance that Loading dock directly injured or made person dl(e 9 (M) north end) Second degree Durno on right forearm Days awe On)ob Away from (mo/day) from acetylene torch) Death from work Remained at work transfer or work 5 restriction (days) .�_ o it u Job lranslar Other record- (days) o S S H o or r.sfrichon able cases e :5 a a (G) Rii (I) (J) (K) (L) (1) (2) (3) (4) (5) 1 Pipe Crew Foreman 1/18 )obsite Right Leg strain 0 1 62 0 1 2 Polifuser 2/10 jobsite Right Leg injury 1 10 1 3 Laborer 5/5 jobsile COVID-19 Positive 1 9 1 4 Laborer 6/10 jobste Left Leg Injury 1 167 1 5 Laborer 6/26 jobsile Back strain 1 20 1 6 Pipe Layer 7/13 jobsile Left Leg Injury 1 9 1 7 Pipe Layer 8/18 jobste Left hand crush injury 1 24 1 e Mechanic 8/18 jobstte Left elbow injury 1 3 1 9 Mechanic 12/8 jobsite Backs rain 1 10 1 0 5 4 0 95 219 1 9 0 0 0 0 Be sure to transfer these totals to the Summary page(Form 300A)before you post it. ; v € Public reporting burden for the mMctun of information s estimated to average 14 moules per response a U a° _ including time to review the instruction,search and gather the data needed,and complete and anew the C ¢ collection of nformahon.Persons are no required to respond to the collection o1 oformalkn unless a '� o displaysa currently valid OMB conlml number.If you have any comments about these estimates or any Q aepecb d this data collection,contact.US Department of labor,OSHA Office c(Slalistks,Roan N-3644, 200 Costitidkn Ave,NW,Washinglon,DC 20210 Do not sand the completed forms to this office Page 1 of 1 (1) (2) (3) (4) (5) OSHA's Form 300A Year 2020 `>> Summary of Work-Related Injuries and Illnesses U.S.Department of Labor Occupational Safely and Health Administration Form approved OMB no.1218-0176 All establishments covered by Part 1904 must complete this Summary page,even if no injuries or illnesses occurred during the year. Remember to review the Log to verify that the entries are complete and Using the Log,count the individual entries you made for each category Then write the totals below, Establishment information making sure you've added the entries from every page of the log. If you had no cases write"0." Employees former employees,and their representatives have the right to review the OSHA Form 300 in its Your establishment name Austin Engineering Co.,Inc. entirety. They also have limited access to the OSHA Form 301 orits equivalent. See 29 CFR 1904.35.in OSHA's Recordkeeping rule.for further details on the access provisions for these forms. Street 3317 RR 620 North P.O.Box 342349 Number of Cases City Austin State TX Zip 78734 Industry description(e g.Manufacture of motor truck trailers) Total number of Total number of Total number of cases Total number of Underground Utilities deaths cases with days with job transfer or other recordable away from work restriction cases Standard Industrial Classification(SIC),if known(e.g.,SIC 3715) 0 5 4 0 1 6 2 3 (G) (H) (1) (J) Number of Days Employment information Total number of Total number of days days of job transfer away from work Annual average number of employees 175 or restriction 95 219 Total hours worked by all employees last year 631,099 (K) (L) Injurer and Illness Types Sign here Total number of... Knowingly falsifying this document may result in a fine. (M) (1) Injury 9 (4) Poisoning 0 (2) Skin Disorder 0 (5) All other illnesses 0 (3) Respiratory I certify that I have examined this document and that to the best of my knowledge the entries Condition 0 are true,accurate,and complete. Pad fi//, Vice-President Company executive Title 512-327-1464 1/13/2020 Post this Summary page from February 1 to April 30 of the year following the year covered by the form Phone Date Public reporting burden for this collection of information is estimated to average 50 minutes per response,inducting time to review the instruction,search and gather the data needed,and complete and review the collection of information. Persons are not required to respond to the collection of information unless it displays a currently valid OMB control number. If you have any comments about these estimates or any aspects of this data collection,contact: US Department of Labor.OSHA Office of Statistics.Room N-3644.200 Constitution Ave.NW.Washington.DC 20210.Do not send the completed forms to this office. Attention:This fort contains information relating O S H A's Form 300 to employee health end must be used in a manner that protects the confidentialityof employees to Iha Year 2021 Log of Work-Related Injuries and Illness mdentpoation wsafetyae Ile and nfo purposing used lorocoupaM1onel safety and healN purposes. U.S.DQp2lF:RlBITt Of Labor Occupational Safety and Health Administration You must record information about every work-related injury or illness that involves loss of consciousness,restrkbd work aclvily or .job transfer.days away from work,or Form approved OMB no.1218-0176 medical Ireatmenl beyond first aid.You nest also record significant work-relaled injuries and illnesses that are diagnosed by a physician or Icensed health care pmfessicnal.You must also recordmr-k-relaledinjunesandillnessesthatmeelanyofthesp-licrecordirgafterlalistedin29CFR19048through1904.12.Feel free Establishment name Austin Engineering Co.,Inc. to use two liras br a shgle case H you need b.You must complete an injury and illness incident report(OSHA Form 301)or equivalent brm br each injury or Illness recorded on the form.If you're not we whether a case is remrdabe,call your local OSHA office for help. City Austin State Texas Identify the Describe the case Classify the case Enter the number of days (A) (B) (C) (D) (E) (F) Using these calegoriee.check ONLY the most the Injured or III worker Check the"injury"column or choose Case Employee's Job Title(e g.,Welder) Date of Injury o onset Where the event Describe injury or illness,pans of body serious result for each case. was'. one type of illness. No. Name of illness occurred(e.g, affected,and objecUsubstance that Loading dock directly injured or made person III(e g (M) north and) Second degree burns on right forearm Days away On job Away from (mo./day) from acetylene torch) Death from work Remained at Work transfer or work 2• 5 restriction (days) °m Job hamster Otherrecond- (days) Z o o or restriction able cases — — 0 M U a Q !G1 (H) (1) I'll IK) (L) (1) (2) 1 (3) (4) 1 (5) 1 Pipe Layer 1/9 jobsite Right Leg injury 1 10 1 2 Backhoe Operator 1/22 jobsite Back/neck/left shoulder injury 1 8 1 3 Laborer 3/15 jobste COVID-19 Positive 1 0 6 1 4 Laborer 3/20 lobsite Lower back strain 1 9 0 1 5 Pie Layer 6/17 jobsite Left wrist injury 0 0 1 6 Laborer 6/18 jobsite Poison ivy 0 0 1 Laborer 7/13 1 jobsite Left index finger laceration 0 0 1 1 1 2 0 17 16 5 0 1 1 0 Be sure to transfer these totals to the Summary page(Form 300A)before you post it. ; € g a Public reporting burden for this oolection of Information is estinaled to average 14 minutes per response, o n 'S = u U o including time to reNew the instruction,search and gather Ifs data needed,and complete and reriewihe colledbn of inbrmalion.Persons are not required b respond to the collection of Information unless it _ displays a wrrentfy valid OMB mmrol number.If you have arty comments about these estimates or any a aspects of Ibis data cdleclion,contact:US Departri ent of Labor,OSHA Office of Slalelics,Room N-3644, 200 Constiluson Ave,NW.Washington.DC 20210.Do not send the completed fomrs to this office. Page 1 M 1 (1) (2) (3) (4) (5) OSHA's Form 300A Year 2021 <0 Summary of Work-Related Injuries and Illnesses U.S.Department ea Labor Occupational Safety and Fbahh Administration Form approved OMB no.1218.0176 All establishments covered by Part 1904 must complete this Summary page,even if no injuries or illnesses occurred during the year. Remember to review the Log to verify that the entries are complete and Using the Log,count the individual entries you made for each category. Then write the totals below, Establishment information making sure you've added the entries from every page of the log. If you had no cases write"0." Employees former employees.and their representatives have the right to review the OSHA Form 300 in its Your establishment name Austin Engineering Co.,Inc. entirety. They also have limited access to the OSHA Form 301 or its equivalent. See 29 CFR 1904.35.in OSHA's Recordkeeping rule,for further details on the access provisions for these forms. Street 3317 RR 620 North P O.Box 342349 Number of Cases City Austin State Tx zip 78734 Industry description(e g.Manufacture of motor truck trailers) Total number of Total number of Total number of cases Total number of Underground Utilities deaths cases with days with job transfer or other recordable away from work restriction cases Standard Industrial Classification(SIC),if known(e.g.,SIC 3715) 1 1 2 0 1 6 2 3 (G) (H) (1) M Number of Days Employment information Total number of Total number of days days of job transfer away from work Annual average number of employees 171 or restriction 17 16 Total hours worked by all employees last year 631,099 (K) (L) Injury and Illness Types Sign here Total number of... Knowingly falsifying this document may result in a fine. (M) (1) Injury 5 (4) Poisoning 1 (2) Skin Disorder 0 (5) All other illnesses 0 (3) Respiratory I certify that I have examined this document and that to the best of my knowledge the entries Condition 1 are true,accurate, and complete. PadW/, /L e,,- Vice-President Company executive Title 512-327-1464 3/29/2021 Post this Summary page from February 1 to April 30 of the year following the year covered by the form Phone Date Public reporting burden for this collection of information is estimated to average 50 minutes per response,including time to review the instruction,search and gather the data needed,and complete and review the collection of information.Persons are not required to respond to the collection of information unless it displays a currently valid OMB control number. If you have any comments about these estimates or any aspects of this data collection,contact: US Department of Labor.OSHA Office of Statistics.Room N-3644,200 Constitution Ave.NW,Washington.DC 20210.Do not send the comoleted forms to this office. OSHA's Form 300A Year 2021 0 Summary of Work-Related Injuries and Illnesses U.S.Department ea Labor Occupational Safety and Health Administration Form approved OMB no.1218-0176 All establishments covered by Part 1904 must complete this Summary page,even if no injuries or illnesses occurred during the year. Remember to review the Log to verify that the entries are complete and Using the Log,count the individual entries you made for each category. Then write the totals below, Establishment information making sure you've added the entries from every page of the log. If you had no cases write"0" Employees former employees,and their representatives have the right to review the OSHA Form 300 in its Your establishment name Austin Engineering Co.,Inc. entirety. They also have limited access to the OSHA Form 301 or its equivalent. See 29 CFR 1904.35,in OSHA's Recordkeeping rule,for further details on the access provisions for these forms. Street 3317 RR 620 North P.O.Box 342349 Number of Cases City Austin State Tx zip 78734 Industry description(e g..Manufacture of motor truck trailers) Total number of Total number of Total number of cases Total number of Underground Utilities deaths cases with days with job transfer or other recordable away from work restriction cases Standard Industrial Classification(SIC),if known(e.g.,SIC 3715) 1 1 2 0 1 6 2 3 (G) (N) 0) (J) Number of Days Employment information Total number of Total number of days days of job transfer away from work Annual average number of employees 171 or restriction 17 16 Total hours worked by all employees last year 631,099 (K) (L) Injury and Illness Types Sign here Total number of... Knowingly falsifying this document may result in a fine. (M) (1) Injury 5 (4) Poisoning 1 (2) Skin Disorder 0 (5) All other illnesses 0 (3) Respiratory I certify that I have examined this document and that to the best of my knowledge the entries Condition 1 are true,accurate, and complete. rDi7r[G (�fr, /I A., Vice-President Company executive Title 512-327-1464 3/29/2021 Post this Summary page from February 1 to April 30 of the year following the year covered by the form Phone Date Public reporting burden for this collection of information is estimated to average 50 minutes per response,including time to review the instruction,search and gather the data needed,and complete and review the collection of information.Persons are not required to respond to the collection of information unless it displays a currently valid OMB control number.If you have any comments about these estimates or any aspects of this data oallecbon,contact: US Department of Labor.OSHA Office of Statistics.Room N-3644.200 Constitution Ave.NW,Washington.DC 20210. Do not send the comDleted forms to this office. Attention:employ This form contains information in relating OSHA's Form 300 to employee health endmust bafeedina manner mel protects the confidentiality of employees to the Year 2021 extent possible while the information is being used Log of Work-Related Injuries and Illness '°r°"occupational Occupational Safety and Health AdmU.S.Department of Labor inistrabon You must record information about every work-related injury or illness that involves loss of consciousness,restricled work acbvq orjob transfer,days away from work,or Form approved OMB no 1218-0176 medical treatment beyond fest ad.You most also record significant work-related injuries and illnesses that are diagnosed by a physician of keened health rare professional.You"ustalsorecordlwrkaetatedinjuriesandillnessesthatmeetmyofthespecificwordirgarenalistedin29CFR19048through1904.12.Feellree Establishment name Austin Engineering Co.,Inc. to use two lines for a sngle cave ff you need b.You must complete an injury and iPress incident report(OSHA Form 301)or equivalent form breach injuryor Illness — recorded on the fomn.If you're not sure whether a rase is recordable,call your local OSHA office for help. City Austin State Texas Identify the Describe the case Classify the case Enter the number of days (A) (B) (C) (D) (E) (F) Using these categories.check ONLY the most the injured or ill worker Check the"Injury'column a choose Case Employee's Job Title(e g Welder) Date of Injury or onset Where the event Describe injury or illness,parts of body serious result for each case. was: one type of illness. No Name W illness occurred(e.g. affected,and object/substance that Loading dock directly injured or made person ill(e g (M) sfi north and) Second degree burns on right forearm D s esve On job Away from (mo./day) from acetylene torch) Death tray,waM Remained at uvomk transfer or m k = rcelndi (days) w 4 g Job transfer Other record- (days) or restriction ante cases o (G) (H) (1) W1 (K) (L) (1) (2) (3) (4) (5) 1 Pipe Layer 1/9 jobsite Right Leg injury 1 1 10 1 2 Backhoe Operator 1/22 -obsite Back/neck/left shouder injury 1 8 1 3 Laborer 3/15 jobsite COVID-19 Positive 1 1 0 6 1 4 Laborer 3/20 jobsite Lower back strain 1 1 9 0 1 Pipe Layer 6/17 -obsite Left wrist injury 0 0 1 Laborer 6/18 jobsite Poison ivy 0 0 1 Laborer 7/13 -obsite jLeft index finger laceration 0 0 1 1 1 1 2 0 17 16 5 0 1 1 0 Be sure to transfer these totals to the Summary page(Form 300A)before you post it, a o o a 5 Public reporting burden for this colection of information is estimated to average 14 minutes per response, o € including time to review the Instruction,search and gather the data needed,and complete and review the `— O a L collection of information.Persona are rpt required to respond to the collection of Information unless i1 in o displays a currently valid OMB control number.Ilyou have arry comments about these eslmates or any a aspects of this data collection,contact:US Department of Labor,OSHA Office of Statistics,Room N-3644, 200 Constituticn Ave,NW,Washington,DC 20210.Do not send the completed forms to this office. Page 1 of 1 (1) (2) (a) (4) (e) OSHA's Form 300A Year 2021 `'> Summary of Work-Related Injuries and Illnesses U.S.Department ea Labor Occupational Safety and Health Administration Form approved OMB no.1218.0176 All establishments covered by Part 1904 must complete this Summary page,even if no injuries or illnesses occurred during the year. Remember to review the Log to verify that the entries are complete and Using the Log,count the individual entries you made for each category. Then write the totals below, Establishment information making sure you've added the entries from every page of the log. If you had no cases write"0." Employees former employees,and their representatives have the right to review the OSHA Form 300)n its Your establishment name Austin Engineering Co.,Inc entirety. They also have limited access to the OSHA Form 301 or its equivalent. See 29 CFR 1904.35.in OSHA's Recordkeeping rule,for further details on the access provisions for these forms. Street 3317 RR 620 North P.O.Box 342349 Number of Cases City Austin State Tx zip 78734 Industry description(e.g..Manufacture of motor truck trailers) Total number of Total number of Total number of cases Total number of Underground Utilities deaths cases with days with job transfer or other recordable away from work restriction cases Standard Industrial Classification(SIC),if known(e.g.,SIC 3715) 1 1 2 0 1 6 2 3 (G) (H) (I) (J) Number of Days Employment information Total number of Total number of days days of job transfer away from work Annual average number of employees 171 or restriction 17 16 Total hours worked by all employees last year 631,099 (K) (L) Injury and Illness Types Sign here Total number of... Knowingly falsifying this document may result in a fine. (M) (1) Injury 5 (4) Poisoning 1 (2) Skin Disorder 0 (5) All other illnesses 0 (3) Respiratory I certify that I have examined this document and that to the best of my knowledge the entries Condition 1 are true,accurate,and complete. PQueW /ea��er Vice-President Company executive Title 512-327.1464 3/29/2021 Post this Summary page from February 1 to April 30 of the year following the year covered by the form Phone Date Public reporting burden for this collection of information is estimated to average 50 minutes per response,including time to review the instruction,search and gather the data needed,and complete and review the collection of information.Persons are not required to respond to the collection of information unless it displays a currently valid OMB control number. If you have any comments about these estimates or any aspects of this data collection,contact US Department of Labor.OSHA Office of Statistics.Room N-3644.200 Constitution Ave.NW.Washmaton.DC 20210 Do not send the comoleted forms to this office :o employ This lora contains intonation in relating OSHA's Form 300 oempbyee theco and must beuemploy manner that protects IM conlidentialily o1 employees to the Year 2021 extent possible while Me information is being used Log of Work-Related Injuries and Illness f°rocc°�0onalaafetyandneaRnpupoaea U.S.Department d Labor Occupational Safety and Health Administration You must record information about every work-related injury or illness that involves loss of consciousness,restricted work activity orjob transfer,days away from work,or Form approved OMB no.1218-0176 medical treatment beyond int aid.You must also record significant work-related irijunes and Illnesses that are diagnosed by a physician or kensed heath are professional.You must also record mrk-related injuries and illnesses that most my of the specific recording afteria listed in 29 CFR 1904 8 t1vough 1904.12 Feellree Establishment name Austin Engineering Co.,Inc. to use two lines for a sngle case if you need b.You must comhpete an injury and illness incident report(OSHA Form 301)or equivalent form for each injury cr Illness recorded on the torr.If you're not sure whether a rase is recordabe,all your local OSHA office for help. City Austin State Texas Identify the Describe the case Classify the case (A) (B) (C) (D) (E) (p) Enter the number of days Using these categories.check ONLY the most the injured or ill worker Check the"injury"column or choose Case Employee's Job Title(e g.,Welder) Date of injury or onset Where the event Describe injury or Illness,parts of body serious result for each case. was. one type of illness, No. Name of illness occurred(e.g. affected,and object/cubstanoe that Loading dock directly injured or made person III(e g (M) north end) Second degree burns on right forearm Days away On job Away from (mo/day) from acetylene torch) Death Remained at work transferor work �xx 2• _ from work restriction (days) S o $' Jobtranster Otherrecord- (days) Z, o or restriction his cases _ i y . a5 a (G) lN) U) (J) (K) (L) (1) (2) (3) (4) (5) Pipe Layer 1/9 jobsite Right Leg injury 1 10 1 Backhoe Operator 1/22 jobsite Back/neck/left shouder injury 1 8 1 Laborer 3/15 jobsite COVID-19 Positive 1 0 1 6 1 4 Laborer 3/20 jobsite Lower back strain 1 9 0 1 Pipe Layer 6/17 jobsite Left wrist injury 0 0 1 Laborer 6/18 jobsite Poison ivy 0 0 1 Laborer 7/13 jobsite jLeft index finger laceration 0 0 1 1 1 2 0 1 17 1 16 5 0 1 1 0 Be sure to transfer these totals to the Summary page(Form 300A)before you post it a o€ € Public reporting buten for l hm collection of information is telmaled to average 14 minutes par response, o a including time to remw the instrudicn,search and gather Ite data needed,and complete and review the E oc L collection of information.Persons are not required to respond to the collection of information unless h N o displays s currently valid OMB mr0rol number If you have any comments about lhese estimates or any a aspects of this data collection,contact.US Department of Labor,OSHA Office d slalelies,Room N-3644, 200 Constitution Ave,NW,Washington,DC 20210.Do not send the canpleted fomhs to this office Page 1 of 1 (1) (2) (3) (4) (5) I EXHIBIT# 13 WORKERS COMPENSATION EXPERIENCE RATING 011VT Risk Name:AUSTIN ENGINEERING CO INC Risk ID: 420057180 Rating Effective Date:07/01/2021 Production Date: 04/12!2021 State: TEXAS State Wt Exp Excess Expected Exp Prim Act Exc Losses BallastPAct Inc Lasses .A'CPfirn Loss" Losses Losses .0 TX•A 22 203,79' 308,594 104,811 456,833 53, fi24,824 167,991 (A) (8 (C)Exp Exceas (D)Extracted (E)Exp Prim (F)Act Exc (G)BallastH)A1�* (1)Act Prim Wt Losses(D E) lopsea Losses Lasses(H-I) Lbaes --_ Losses 22 203,783 308,594 104,8111 456,8331 53,9001 603,7281 146,8951 Prfpiafy Losses Stabilizing Value Ratable Excess Totals (1) C"(1 •A)+G (A)•(F) (J} Actual 146.895 212,851 100,503 460,249 -- (E) C,(1 _A)+G (A) (C) (K) 1Expected 104,811 212,851 44,832 I 362.494 ARAP FLARAP SARAP MAARAP I E7ip Mod Factors I 1.27 REVISED RATING RATING REFLECTS A DECREASE OF 70%MEDICAL ONLY PRIMARY AND EXCESS LOSS DOLLARS WHERE ERA IS APPLIED, RATING REVISED TO REFLECT APPROVED RATING VALUES Carrier: 29939-000 Policy: 0002049383 Eff-Date: 07-01-2020 Exp-Date: 07-01-2021 9 Copynghf 1993-2021,Alt ryhis resensd.This Pnldua s w,rpnsed rf campdahens aqd iiCumatxn Mnch en Iha p*cpn e4ry antl eauwnn property cf Ne.4alianal CaunrJ un edmpensuan In.Cnnee. Int,(NCCII.No(eMa!tim.Afaerrtn■Wn,sqb,Iranll!!,es UgMenl ar dispdsihan of lou produol,in+Male or h pert,may be mad¢wilnoul In¢poor writ n cdnsenl of NC CL This p :.1=A- At,a—tile'WN ail debet.•dna iawdea infarm.¢nn peri ar ma ume of publredon-1y.14CC1❑fakes no n pm A.ions dr Warranties of any kidd IWebng to me p mii;t and.nenby axpreuy di¢claima arty end as express,.W.toq.at mo'oo wurantiH,in oludln the ynphed"a Ay of r mhrrnleb-Tty,fitness row a pankulb puryose,ecoura<y,wmyennue,—Alnea..ar correomees al lne prdd..'cl M inkmfefrpn Gpnln,rl.d melain.Thi.p—and Qrf inlamtatiJM1 Cpntain Yd menM1 efe b ba Uteri exwLlVely!df ondeMtlluf g.prHuin NCa kY'Jgan antl pins!inWran Ce pprp¢.ea and Mey:f of ba mad for any oiher{repo.•,nnudinq bet not iumced to wi saonng rot pm"b ddmg pwpnses.A¢n.ponsmaiy forme use of and far any and.1 nsun.denrod w obtrinad cvough me use of me product and:n fOnnatbn an the and usefa and NCCI shat not neve an haCiny m¢reto. Page 1 of 4 WORKERS COMPENSATION EXPERIENCE RATING NCC/ Risk Name;AUSTIN ENGINEERING CO INC Risk 10: 420057180 Rating Effective Date:07/01/2021 Production Date: 04/12/2021 State: TEXAS i _ I 42-TEXAS Firm 10:A Firm Name: AUSTIN ENGINEERING CO INC Carrier: 21075 Policy No. WC00301382017A Eff Date: 07101/2017 Exp Date: 07101/2018 Code ELR 1 0- payroll expected Exp PrimClaim Data IJ OF Act Inc Act Prim Rado Losses Losses Lasses__ Losses 0042 1.20 .44 725,183 8,702 3,829 966103603 F 44,305 18,000 3724 -81 .29 235,282 1,906 553 9658958 05 F 4.283 4,283 5200 94 35 16,136 152 53 9659588 05 F 7,281 7,281 5213 1981 .29 9,2651 91 26 9660559 05 F 7,764 7.764 5505 1.35 .35 700.044I 9,451 31306 9660083 05 O 211,232 18,000 5606 1 .18 .29 1,288,591 2,319 673 9661304 106 F 2.207 2,207 6219 1.13 .291 1,628,455 18,402 5,337 N0. 13 O6 11,536 11,536 6229 .82 .39 788,041 6,462 2,520 6233 .51 .30 11,825 60 18 6306 1.49 .35 895,467 13,342 4,670 6319 .98 .29- 963,964 9.447 2,740 1 1 1 7602 1.141 401 1,443.9101 16.461 6,584 8227 .57 .35 922,441 5.258 1,840 8810 .03 .46 446,558 134 62 9015 1 .71 ,44 136,0171 966 425 Subject 1 Total Act Inc lPollcyTotal: 10,211,19 Premium: 315,526 Losses: 288,608 u9Copyn0t 1032021,Ali,rots reservaa This product n cc d or o rrfl'aeens and rtonraeon telae are the peoprivary and exdusr,e pmpny Mule Nat;onel Coundl a:Compeesation insurance; Inc.(NCCIi No.furtirer use,duemmalbn,sale,transfer,asl7ment or dsposleon of N-s pfcouct,-n wilois Orin pert.may[o mace wchom Ju pnor wriltan amnnent of NCCI.This product is fumuhed'A-. As Avebaota'`vYnh as detects'and inctudes,cron,,&Uw svanaote At the time of pt,b,kation odty.NCCI makes no representetlone ar warDnliae or any kind relating to erre prcductand Wrloyepreesry nsCa"s any and so expess,statutory,or implied Warranties,mclu=2 the shed•.vananly of merchaniabiyry,hlness fora partinulaa purpose,accuracy,completeness.currentness.or cenncmess of the Product"Information contained therein.This product and the mformauon cdn!mnae therein Are to be used sxclu-v� for undensr,Gng,pritmum uRNatbn and other Imuran"purpdsas and may not be used for a y"I'll puipese 4lduofng out Poi limited m safety soaring for ProJaa blotting Purposes All respansiWity for the use d and for any and 8e results derived or detained through the use of the product and�n bin 40-are the and uaare and NCcI:halt nal nail arty 1f"Qty tharate. Total ey policy Year of all ca581 S20X Or lose 0 P.seaso loss X Ex-Piled""coverage U USL8Hly C Caraatrdphld Loa! E Empluyers L IaW1,ty Los. y UwAvd Lose Page 2 04 /� Attention: This form contains information relating OS HA's Form 300 to employee health and must be used a manner that protects the confidentiality of employees to the Year 222 extent possible while the information is being used Log of Work-Related Injuries and Illnesses for occupational safety and health purposes. U.S. Department of Labor Occupational Safety and Health Health Administration You must record information about every work-related injury or illness that involves loss of consciousness,restricted work activity or job transfer,days away from work,or medical Form approved OMB no.1218-0176 treatment beyond first aid.You must also record significant work-related injuries and illnesses that are diagnosed by a physician or licensed health care professional.You must also record work-related injuries and illnesses that meet any of the specific recording criteria listed in 29 CFR 1904.8 through 1904.12 Feel free to use two lines for a single case Establishment name Austin Engineering Co., Inc. if you need to. You must complete an injury and illness incident report(OSHA Form 301)or equivalent form for each injury or illness recorded on this form. If you're not sure whether a case is recordable,call your kxzl OSHA office for help. City Austin State Texas Identify the person Describe the case Classify the case Enter the number of days (A) (f3) (C) (D) (E) (F) Using these categories,check ONLY the most the injured or ill worker Check the"injury"column or choose Case Employee's Name Job Title (e g..Welder) Date of injury or onset Where the event Describe injury or illness,parts of body serious result for each case: was: one type of illness: Noof illness occurred(e.g. affected,and object/substance that Loading dock directly injured or made person ill(e g (M) d north end) Second degree bums on right forearma s awa DOn job Away from (mo./day) from acetylene torch) Death from work Remained at work transfer or work 2 restriction (days) .0 Job transfer Other record- (days) Z op C N O or restriction able cases c ) ° a° a (G) M) (1) (J) (K) (L) (1) (2) (3) (4) (5) 1 Backhoe Operator 1/21 Jobsite Head Injury 1 0 1 2 Laborer 4/20 Jobsite Right Leg Injury 1 3 1 3 Welder 5/2 Jobsite Right foot laceration 1 0 1 4 Laborer 9/28 Jobsite Head Injury 1 2 1 5 Driver 10/4 Highway Multiple fractures 1 88 1 6 Laborer 11/11 Jobsite JCrUsh injury of fingers 1 0 1 7 Pipe Layer Helper 12/1 Jobsite Right wrist strain 1 0 1 8 9 0 3 0 4 0 93 7 0 0 0 0 Be sure to transfer these totals to the Summary page(Form 300A)before you post it. o C C C y C Public reporting burden forthis collection of information is estimated to average 14 minutes per response.including O C 'o = time to review the instruction,search and gather the data needed,and complete and review the collection of information. Persons are not required to respond to the collection of information unless it displays a currently valid o OMB control number. If you have any comments about these estimates or any aspects of this data collection,contact: Q US Department of Labor,OSHA Office of Statistics.Room N-3844,200 Constitution Ave,NW,Washington,DC 20210. Do not send the completed forms to this office, Page 1of1 0) (2) (3) (4) (5) OSHA's Form 300A Year 2022 0> Summary of Work-Related Injuries and Illnesses U.S.Department ofLabor Occupational Salary and Health Administration Form approved OMA no.1218 0176 All establishments covered by Part 1904 must complete this Summary page,even if no injuries or illnesses occurred during the year. Remember to review the Log to verify that the entries are complete and Using the Log,count the individual entries you made for each category. Then write the totals below, Establishment information making sum you've added the entries from every page of the log. If you had no cases write"0." Employees former employees,and their representatives have the right to review the OSHA Form 300 in its Your establishment name Austin Engineering Co.,Inc.-NAICS#237110 entirety. They also have limited access to the OSHA Form 301 or its equivalent. See 29 CFR 1904.35,in OSHA's Recordkeeping rule.for further details on the access provisions for these forms. Street 3317 RR 620 North P.O.Box 342349 Number of Cases City Austin Slate Tx zip 78734 Industry description(e.g.,Manufacture of motor truck trailers) Total number of Total number of Total number of cases Total number of Underground Utilities-NAICS#237110 deaths cases with days with job transfer or other recordable away from work restriction cases Standard Industrial Classification(SIC),if known(e.g.,SIC 3715) 0 3 0 4 1 6 2 3 (G) (H) (I) (J) NAICS: 237110 Number of Days Employment information Total number of Total number of days days of job transfer away from work Annual average number of employees 143 or restriction 0 93 Total hours worked by all employees last year 398,189 (K) (L) Injury and Illness Types Sign here Total number of... Knowingly falsifying this document may result in a fine. (M) (1) Injury 7 (4) Poisoning 0 (2) Skin Disorder 0 (5) All other illnesses 0 (3) Respiratory I certify that I have examined this document and that to the best of my knowledge the entries Condition 0 are true,,accurate, and complete. All k/ /I.000G1- Vice-President Company executive Title 512-327.1464 1/1112023 Post this Summary page from February 1 to April 30 of the year following the year covered by the form Phone Date Public reporting burden for this collection of information is estimated to average 50 minutes per response,including time to review the instruction,search and gather the data needed,and complete and review the collection of information. Persons are not required to respond to the collection of information unless it displays a currently valid OMB control number. If you have any comments about these estimates or any aspects of this data collection,contact:US Department of Labor.OSHA Office of Statistics.Room N-3644.200 Constitution Ave.NW.Washington.DC 20210. Do not send the completed forms to this office. WORKERS COMPENSATION EXPERIENCE RATING &1E / Risk Name: AUSTIN ENGINEERING CO INC Risk ID: 420057180 Rating Effective Date: 07/01/2022 Production Date: 02/17/2022 State: TEXAS State Wt Exp Excess Expected Exp Prim Act Exc Losses Ballast Act Inc Losses Act Prim Losses Losses Losses Losses Tx-A 1 .211 185,74 282,3991 96,6591 175,819 54,1751 284,6371 108,818 (A) (B (C)Exp Excess (D)Expected (E)Exp Prim (F)Act Exc (G)Ballast (H)Act Inc (1)Act Prim Wt I I Losses(D-E) Losses Losses I Losses(H-1) 1 Losses Losses 1-211 1 185,7401 282.3991 96,6591 175,8191 54,1751 264.6301 88,8111 Primary Losses Stabilizing Value Ratable Excess Totals (I) C'(1 -A)+G (A)"(F) (J) Actual 88,811 200,910 36.922 326,643 (E) C"(1 -A)+G (A)'(C) (K) Expected 96,659 200,910 39,005 336,574 ARAP FLARAP SARAP MAARAP Exp Mod (J)1(K) Factors .97 RATING REFLECTS A DECREASE OF 70% MEDICAL ONLY PRIMARY AND EXCESS LOSS DOLLARS WHERE ERA IS APPLIED. Q1 Copynght 1993-2022,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 NCO,This product is fumished"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 protluct 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. Page 1 of 4 WORKERS COMPENSATION EXPERIENCE RATING &1EP11 Risk Name: AUSTIN ENGINEERING CO INC Risk ID: 420057180 Rating Effective Date: 07/01/2022 Production Date: 02/17/2022 State: TEXAS 42-TEXAS Firm ID:A Firm Name: AUSTIN ENGINEERING CO INC Carrier: 21075 Policy No. WC00301382018A Eff Date: 07/01/2018 Exp Date: 07/01/2019 Code ELR D- Payroll Expected Exp Prim Claim Data IJ OF Act Inc Act Prim Ratio Losses Losses Losses Losses 0042 1.14 .45 632,1411 7,206 3,243 9663008 05 F 1,085 1,085 3724 .74 .30 164,0581 1,214 364 9666317 05 F 4,133 4,133 5200 .86 .35 141,964 1,221 427 NO.7 06 6,348 6,348 5213 .91 .30 56,110 511 153 5506 1.38 .35 988,1831 13,637 4,773 5606 .17 .30 802,495 1,364 409 6219 1.01 .30 2,552,357 25,779 7,734 6229 .72 .40 596,869 4,297 1,719 6233 .43 .30 20,562 88 26 6306 1.27 .36 1,025,552 13,025 4.689 6319 .937301 1,382,952 12,861 3,858 7602 1.08 .40 909,6971 9,825 3,930 8227 .501 .36 1,136,884 5,684 2,046 8809 .04 .40 62,3991 25 10 8810 .03 .48 455,880 137 6611 9015 .66 .45 137,3601 907 408 Subject Total Act Inc Policy Total: 11,065,46 Premium: 324,560 Losses: 11,566 0 Copyright 1993-2022,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 madewithout 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,completenesscurrentness,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 liabilitv 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 4 WORKERS COMPENSATION EXPERIENCE RATING NCC/ Risk Name: AUSTIN ENGINEERING CO INC Risk ID: 420057180 Rating Effective Date: 07/01/2022 Production Date: 02/17/2022 State: TEXAS 42-TEXAS Firm ID:A Firm Name: AUSTIN ENGINEERING CO INC Carrier: 21075 Policy No. SLICWC0041000 Eff Date: 07/01/2019 Exp Date: 07/01/2020 Code ELR I D- Payroll Expected Exp Prim Claim Data IJ OF Act Inc Act Prim Ratio Losses Losses Losses Losses 0042 1.14 .45 1,205,2171 13,739 6,183 9666670 05 F 5,308 5,308 3724 .74 F.30 227,953 1,687 5061 9668385 05 F 21,264 18,500 5200 .86 .35 207,894 1,788 626 9669615 05 F 52,547 18,500 5213 .91 .301 51,2051 466 140 9668195 05 O 157,5081 18,500 5506 1.38 .35 1,074,494 14,828 5,190 9668549 06 F 2,846 2,846 5606 .17 .30 1,110,826 1,888 566 9668175 06 F 7,096 7,096 6219 1.01 .30 3,730,836 37,681 11,304 NO.7 06 7,200 7,200 6229 .72 .40 183,236 1,319 528 6233 .43 .30 50,229 216 65 6306 1.27 .36 522,805 6,640 2,390 6319 .93 .30 1,248,2821 11,609 3,483 7602 1.08 .40 96,475 1 1,042 417 8227 .50 .36 1,302,6721 6,513 2,345 8809 .04 .40 62,400 25 10 8810 .03 .48 582,8361 175 84 9015 .66 .45 177,513 1,172 527 Subject Total Act Inc Policy Total: 11,834,87 Premium: 299,085 Losses: 253,769 rD Copyright 1993-2022,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 turn shed-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 purposeaccuracy.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 3 of 4 WORKERS COMPENSATION EXPERIENCE RATING &I"?, Risk Name: AUSTIN ENGINEERING CO INC Risk ID: 420057180 Rating Effective Date: 07/01/2022 Production Date: 02/17/2022 State: TEXAS 42-TEXAS Firm ID:A Firm Name: AUSTIN ENGINEERING CO INC Carrier: 29939 Policy No. 0002049383 Eff Date: 07/01/2020 Exp Date: 07/01/2021 Code ELR D Payroll Expected Exp Prim Claim Data IJ OF Act Inc Act Prim JRatiol Losses Losses Losses Losses 0042 1.14 .45 777,624 8,865 3,989 2001225604 05 F 1 1,784 1,784 3724 .74 .30 303,359 2,245 674 8001243394 05 F 2,997 2,997 5200 .86 .35 128,655 1,106 387 4001240177 05 F 3,292 3,292 5506 1.38 .35 817,574 11,283 3,949 6001227435 05 F 6,138 6,138 5606 .17 .30 544,196 925 278 8001262366 06 F 641 641 6219 1.01 .30 3,061,278 30,919 9,276 1\10.4 06 4,450 4,450 6229 .72 .40 272,768 1,964 786 6306 1.27 .36 746,272 9,478 3,412 6319 .93 .30 1,030,255 9,581 2,874 7602 1.08 .40 41,398 447 179 8227 .50 .36 1,168,231 5,841 2,103 8809 .04 .40 156,0001 62 25 8810 .03 .48 768,997 231 111 9015 .66 .451 133,730 883 397 (Subject Total Act Inc Policy Total: 9,950,33 Premium: 198,605 Losses: 19,302 ,r)Copyright 1993-2022.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 turn shed 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 4 of 4 Attention: This form contains information relating to eployee health and must be used in a manner OSHA' Form 300 (Rev. 01/2004) thatpmrotectstheconfidentialityofemployeestothe Year 2023 extent possible while the information is being used Log of Work-Related Injuries and Illnesses for occupational safety and healthpuposes. U.S. DepartmentafetyaHealth Labor Occupational Safety and Health Administration You must record information about every work-related injury or illness that involves loss of consciousness,restricted work activity or job transfer,days away from work,or medical treatment Form approved OMB no.1218-0176 beyond first aid.You must also record significant work-related injuries and illnesses that are diagnosed by a physician or licensed health care professional, You must also record work-related injuries and illnesses that meet any of the specific recording criteria listed in 29 CFR 1904.8 through 1904.12. Feel free to use two lines for a single case if you need to.You must complete an Establishment name Austin Engineering Co., Inc injury and illness incident report(OSHA Form 301)or equivalent form for each injury or illness recorded on this form, If you're not sure whether a case is recordable,call your local OSHA office for help. City Austin State Texas Identify the person Describe the case Classify the case Enter the number of (A) (B) (C) (D) (E) (F) CHECK ONLY ONE box for each case based on days the injured or ill Check the"injury"column or choose one type of Case Employee's Name Job Title leg, Date of Where the event occurred(e,g. Describe injury or illness,parts of body affected, the most serious outcome for that case: worker was: illness: No. Welder) injury or Loading dock north end) and object/substance that directly injured or made onset of person ill(e.g.Second degree burns on right (M) y illness forearm from acetylene torch) Days away On job (mo./clay) Awa Remained at work Death from work Rk y transfer or -2 Z 0 —c From restriction ,°n � `o Job transfer Other record- Work (days) coc— o or restriction able cases (days) y rr U a = (G) (H) (1) (J) (K) (L) (1) (2) (3) (4) (5) (6) 1 Henry Hernandez Laborer 1/27/2023 on jobsite Puncture on left eye 1 2 Cesar Correa Mechanic 2/16/2023 at company workshop Finger fracture 1 43 1 3 Eyker Tem Santizo Pipe Layer 3/1/2023 on jobsite Wrist Strain 1 1 4 David Jimeniz Laborer 7/18/2023 at company workshop Hit in head 1 2 5 Lino Arce Laborer 7/28/2023 on jobsite injured wrist 1 92 1 6 Bryan Lopez Laborer 8/25/2023 on jobsite injured hand 1 1 7 Armando Vences Pipe Layer 9/30/2023 on jobsite hip and leg injury 1 94 1 1 Page totals 0 2 2 3 186 1 45 7 0 0 0 0 0 Be sure to transfer these totals to the Summary page(Form 300A)before you post it. L, `o 0 o N - C 0 Public reporting burden for this collection of information is estimated to average 14 minutes per response,including time i5 U o to review the instruction,search and gather the data needed,and complete and review the collection of information. �, v Persons are not required to respond to the collection of information unless it displays a currently valid OMB control = o number. If you have any comments about these estimates or any aspects of this data collection,contact: US Department of Labor,OSHA Office of Statistics,Room N-3644,200 Constitution Ave.NW,Washington,DC 20210. Do not send the completed forms to this office, Page 1 of 1 (1) (2) (3) (4) (5) (6) OSHA's Form 300A (Rev.01/2004) Year 2023 ``*� Summary of Work-Related Injuries and Illnesses U.S.Department of Labor Occupational Safely and Health Atlmin htralion Form ppro—OMB no 1218-0176 All establishments covered by Part 1904 must complete this Summarypage,even if no injuries or illnesses occurred during the year Remember to review the Log to verify that the entries are complete Using the Log.count the individual entries you made for each category. Then write the totals below Establishment information making sure you've added the entries Imm every page of the log. If you had no cases write"0.' Employees former employees,and their representatives have the right to review the OSHA Form 300 in Your establishment name Austin Engineering Co.,Inc. its entirety, They also have limited access to the OSHA Form 301 or its equivalent. See 29 CFR 1904.35,in OSHA's Recordkeeping rule,for further details on the access provisions for these forms. Street 3595 Ranch Road 620 South,Suim 200 Number of Cases City Austin State Texas zip 76738 Industry description(e.g.,Manufacture of motor truck trailers) Total number of Total number of Total number of cases Total number of Uhlhty Construction deaths cases with days with job transfer or other recordable away from work restriction cases Standard Industrial Classification(SIC),if known(e.g.,SIC 3715) 0 2 2 3 1 6 2 3 (G) (H) (1) (J) OR North Amencan Industrial Classification(NAICS),if known(e.g.,336212) 2 3 7 1 1 0 Number of Days Employment information Total number of Total number of days of days away from job transfer or restriction Annual average number of employees 135 wnrk Total hours worked by all employees last 186 45 year 296211 (K) (L) Injury and Illness Types Sign here Total number of... Knowingly falsifying this document may result in a fine. (M) (1) Injury 7 (4) Poisoning 0 (2) Skin Disorder 0 (5) Hearing Loss 0 certify that I have examined this document and that to the best of rtry knowledge the entries are true,accurate,and (3) Respiratory complete Condition 0 (6)All Other Illnesses 0 President Company executive Title 512-327-1464 1/172024 Post this Summary page from February 1 to April 30 of the year following the year covered by the form Phone Date Public reporting burden for this collection of information is estimated to average 58 minutes per response,including time to review the instruction,search and gather the data needed,and complete and review the collection of information.Persons are not required to respond to the collection of information unless it displays a currently valid 0146 control number.If you have any comments about these estimates or any aspects of this data collection,contact:US Department of Labor.OSHA Office of Statistics.Room N-3644.200 Constitution Ave.NW.Washinolon.DC 20210.Do not sand the completed forms to this office WORKERS COMPENSATION EXPERIENCE RATING NCC/ Risk Name: AUSTIN ENGINEERING CO INC Risk ID: 420057180 Rating Effective Date: 07/01/2023 Production Date: 03/02/2023 State: TEXAS State Wt I Exp Excess Expected Exp Prim Act Exc Losses Ballast Act Inc Losses Act Prim Losses Losses Losses I Losses Tx-A 1 .191 165,36 249,4941 84,1281 154A301 51,0001 296,8901 142,460 (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) Losses Losses 1.191 1 165,3661 249,4941 84,1281 154,4301 51,0001 275,5821 121,1521 Primary Losses Stabilizing Value Ratable Excess Totals (I) C'(1 -A)+G (A)'(F) (J) Actual 121,152 184,946 29,342 335,440 (E) C*(1 -A)+G (A)'(C) (K) Expected 84,128 184,946 31,420 300,494 ARAP FLARAP SARAP MAARAP Exp Mod (J)/(K) Factors 1.12 REVISED RATING RATING REFLECTS A DECREASE OF 70% MEDICAL ONLY PRIMARY AND EXCESS LOSS DOLLARS WHERE ERA IS APPLIED. RATING REVISED TO REFLECT APPROVED RATING VALUES 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 disclwarranty any and all express,statutory,or implied warranties.including the implied arranty of merchantability,fitness for a particular purpose,accuracy,completeness,currentness,or correctness of the protluct or any 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. Page 1 of 3 WORKERS COMPENSATION EXPERIENCE RATING &I"? Risk Name: AUSTIN ENGINEERING CO INC Risk ID: 420057180 Rating Effective Date: 07/01/2023 Production Date: 03/02/2023 State: TEXAS 42-TEXAS Firm ID:A Firm Name: AUSTIN ENGINEERING CO INC Carrier: 21075 Policy No. SLICWC0041000 Eff Date: 07/01/2019 Exp Date: 07/01/2020 Code ELRD� Payroll Expected Exp Prim Claim Data IJ �01 Act Inc Act Prim Ratio Losses Losses Losses Losses 0042 1 1.03 .44 1,205,2171 12,414 5,462 9666670 05 1 F 1 5,308 5,308 3724 .74 .30 227,953 1,687 506 9668385 05 F 21,264 18,500 5200 .82 .35 207,894 1,705 597 9669615 05 F 52,547 18,500 5213 .93 .30 51,205 476 143 9668195 05 O 76,049 18,500 5506 1.27 .35 1,074,494 13,646 4,776 9668549 06 F 2,846 2,846 5606 .15 .30 1,110,826 1,666 500 9668175 06 F 7,096 7,096 6219 .93 .30 3,730,836 34,697 10,409 NO.7 06 7,200 7,200 6229 .69 .41 183,236 1.264 518 6233 .47 .30 50,229 236 71 6306 1.19 .35 522,805 6,221 2,177 6319 .90 .30 1,248,282 11,235 3,371 7602 1.03 .41 96,475 994 408 8227 44T 35 1,302,672 5,732 2,006 8809 .04 .41 62,400 25 10 8810 .03 .48 582,836 175 84 9015 .61 .44 177,513 1,083 477 Subject I Total Act Inc Policy Total: 11,834,87 Premium: 299.085 Losses: 172.310 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 S2000 or less. D Disease Loss X Ex-Medical Coverage U USL&HW C Catastrophic Loss E Employers Liability Loss #Limited Loss Page 2 of 3 WORKERS COMPENSATION EXPERIENCE RATING CAVEr., Risk Name: AUSTIN ENGINEERING CO INC Risk ID: 420057180 Rating Effective Date: 07/01/2023 Production Date: 03/02/2023 State: TEXAS 42-TEXAS Firm ID:A Firm Name: AUSTIN ENGINEERING CO INC Carrier: 29939 Policy No. 0002049383 Eff Date: 07/01/2020 Exp Date: 07/01/2021 Code ELR D- Payroll Expected Exp Prim Claim Data IJ �01 Act Inc �1,784 Ratio Losses Losses Losses 0042 1.03 .44 777,624 8,010 3,524 2001225604 05 F 1,784 3724 .74 .30 303,359 2,245 674 8001243394 05 F 2,997 2,997 5200 1 .82 .35 128,655 1,055 369 4001240177 05 F 3,292 3,292 5506 1.27 .35 817,5741 10,383 3,634 6001227435 05 F 6,138 6,138 5606 .15 .30 544,196 816 245 8001262366 06 F 641 641 6219 .93 .30 3,061,278 28,470 8,541 NO.4 06 4,450 4,450 6229 .69 .41 272,768 1,882 772 6306 1.19 .35 746,272 8,881 3,108 6319 .90 .30 1,030,255 9,272 2,782 7602 1.03 .41 41,398 426 175 8227 .44 .35 1,168,231 5,140 1,799 8809 .04 .41 156,000 62 25 8810 .03 .48 768,997 231 111 9015 .61 .44 133,730 816 359 Subject Total Act Inc Policy Total: 9,950,33 Premium: 198,605 Losses: 19,302 42-TEXAS Firm ID:A Firm Name: AUSTIN ENGINEERING CO INC Carrier: 29939 Policy No. 0002049383 Eff Date: 07/01/2021 Exp Date: 07/01/2022 Code ELR D- Payroll Expected Exp Prim Claim Data IJ OF Act Inc Act Prim Ratio Losses I Losses Losses Losses 0042 1.03 .44 813,510 8,379 3,687 7001286269 05 F 25,310 18,500 3724 .74 .30 227,5561 1,684 505 1001274842 05 O 71,760 18,500 5200 .82 .35 91,3141 749 262 NO.4 06 2,963 2,963 5506 1.27 .35 749,187 9,515 3,330 8001282562 06 F 5,245 5,245 5606 .15 .30 604,957 907 272 6219 .93 .30 3,274,8481 30,456 9,137 6229 .69 .41 510,8211 3,525 1,4451 L+ 6306 1.19 .35 595,663 7,088 2,481 6319 .90 .3011,023,691 9,213 2,764 7602 1.03 .41 51,0281 526 216 8227 .44 .35 1,200,575 5,283 1,849 8809 .04 .41 156,000 62 25 8810 .03 .48 910,549 273 131 9015 .61 .44 145,659 889 391 Subject Total Act Inc Policy Total: 10,355,358Premium: 179,603 Losses: 105,278 (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 protluct or information contained therein.This product and the information contained therein are to be used exclusively for underwritingr 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 S2000 or less. D Disease Loss X Ex-Medical Coverage U USL&HW C Catastrophic Loss E Employers Liability Loss #Limited Loss Page 3 of 3 06 OSHA's Form 300A (Rev.0112004) Year 2024 * SurnmarV of Work-Related In'uries and Illnesses U.S.Department ol_ j Occupalrenal Srrelk ant Hua1M Admblatratbn F—.--—a-121"M Ag establishments covaned by Pad f904 must complete this Summarypage,even Nne bl(uries or tgnesses attuned during the year.Remember le levier,the Log(o verily, that the celdra am compare and accurate beloro Using the Log,count the Individual enures you mode for each o Mgory.Tann rvrrfa the fofeh bales,,making sure Establishment Information youVe added lire eMdes from ovary page ah/he log.H you had no cases tmle'0.' Employees formai employees,and theY mprawntafives have the dghl(o review the OSHA Favm 300 In its entirety. Your establlshmeat name AustinEngtnaerhgCo.,I— They ahD have kln4ed scows to the OSHA Form 301 or it,aquivaknt.Sea 29 CFR 1904,35,fn OSHA's Recordec"ping rule,for Nether defaiis on the access provisions for thaw hams. Street 3595 Reach Road 620 South,Suae 200 ,Number of Cases Clry Austin stale Texas zip 79736_ i - IrMuany desalptlon(e.g.,Manufactwe of motor truck tralfers) Total number of Total number of Total number of cases Total number of other Uma,corotrucam deaths cases with days with job transfer or recordable cases away from work restriction Standard Industrial classification(SIC),Ifknoim(e.g..SIC3716) 0 2 0 0 1 6 2 3 (G) (H) (I) (J) OR North American Industries Classification(NAICS),lf known(a.g.,3382121 2 3 7 1 1 0 iNumbor of Days Employment information Total number of Total number of days of days away from job transfer or restdctlon Annual a terege number of employees 148 work 0 373 Total hours worked by all emptoyees last year 304,850 (t9 (ti Injury and Illness Types, Sign here Total number of... Knowingly falsifying this denument may rosull In a fine. (M) (1)Injury 2 (4) Poisoning p (2)Skin Disorder (5)Hearing Loss 0 0 (3) Respiratory I cmtiry that l here examined this document and that to the best or my knowledge the entries are true,accurate,and complete, Condition 0 (6)All Other Illnesses D A,1,4.All, President Company executive Title 512-327-1484 11172025 Post this Summary pane from February 1 to April 30 of the year following the year covered by the form Phone Date Pubro reporting burden for des cor-ban of L:fosmxtien Is estmaled to average 58 rtuwles per resyome,indufjg lime to renew No Inseucaon,avatrh m4 gather the date needed,end m m!eln ant none.,IAe ceecton of ble—den.Persons we mol reqused t Vord to the cotedon of Ntomat'on uvea ildvlays a enmity to OMB —Wroebor, fyouhareeny comments�he�t0asa oaamaW or anyaspee6 a1 M4 data m0eca'on,mNact US DepaMnra oflabn,OSI-A OK¢e of Sta5slcs,Roore N. 3614,200Cmsth&nAve,IIVJ,44esHNton,DC20210.Donolsmdlhemrp!atedfmmsteda`soffice Attention:This form cunidrs bdoonslnn rd.ry to wp"Mesh and mud be used N.Coen.,rN OSHA's Form 300(Rev.0112004) prolsebthe emildWdyof..Pbr.lothe XWet Year 2024 poeAb whts e1.b(rm.M b bN+e used for Log of Work-Related Injuries and Illnesses a*end hsotloPurposes. U.S.Department of Labor ae.wp.a.ad ashy and Hooth .. ...... : .. .. .. .. . .. C!-.... .. ... .t .. t.. ..., ..:a==iii„�f'.',•i:^�:"+�..:�:�:^..•�• ..:..: ...... .... .. ...,<.:f:..v.......... ... .. ... :. .. .,( 'E: :yA�?:^i'.N'Jj":•,.��:'y,''yVv:�.':::r�Yi.``::;.'!:'t.-�t;:�. 1 ':ii'i�::j:;:.::;.:Y<q':Ct:i::c(it:.c..-,.; Y.ur+udr.lydHaorlrl Wdwrrrr4MddkuFr0wNthrW+slandersebssw4 rMbEdeaAMdA'al�Issdr.b+MaandrMYMMWfIM.dMIt YMIIwM.Y.w.ri.. /(erre MIFw!GM M 1=1N17a .yn'Aadwake.l+bds+sl++red lre+u.IeNwdepwdbyspnydtlrrtYw+N Mite u.PdorbiW Yarntdwrowderi�.h!rd Fjnb+WM11.aMINItryllMlsdlll.eli�MaYMMh1a CFR 12R$baeh 1101.12 FW see burhofwbreu'pb IV.need la Y.-0_wk+mquyrw flow hWai,.w(OSMFm.90Qreeftwens,"66 arWNIUM 4406MV YaA.edo s%b+er..wbrrrdd0q mhwrb dOMM.F.Ieh* Establishment name Austin Ehlglneerblg Co.,Inc Gly Austin Stale Taxes Identify the person n P n W) (e) (Cl (D) (E) (F) Csse No. Emple7esY Ions Job Tba(e.e., Dd.of WOM or Who Us ewNommd N'L t..IrN or nnen.wrb dbody CHECK ONLY ONE bex for.shest.b..donth. EnterOw numbrd drys W.N.r) ..of of teen Lo.dne' n.dh ond) taeeY{W obloM.Wence the drdMy al..dws o!Aeem.for qd area; the wNred r 13—k.,wn'. Ch..k eu'INuy co.ame or ehoo+s one 1Yw of non+' L*Aod M l.edspor..n a(..e.Second -. dyne bunt.rld/d farm tom ac.rybn. (hl) bmh) On Job (—Jd yf ped .N.nWgedNwh :; frembr oor Away From rnbbtlrr doe bond( arrer record. Wolk (days) _ orrnbktlon abl.cosee (days) 'q (o) J ) (1) (2) la 1 (s el tPoe L.yr Dine J.bse Lee t 3e7 1 2 Lebon( 01112 Jdaft M.V, I e 1 Ll Poe-Intek 1 e x 1 d O 1 373 1 e 1 x 1 D e e d e Be sure to transfer these totals to the Summary page(Form 300A)before you post IL § s Ador+prbgb.de,brNaml..rndldon.I brarbibevegeM.s sprrgr.,bbd.alpnbrwleoMlWrdeq+w.brd a+t 6,.,*k rgrdnryW.WrdgYm&Aosell n Pr000wadeepAWfe bMmleAn fl!loeexmuiwi 7d p x dg6q+.mriyvw010 o.redn+rar.xyeumreq.orsab.Mear.s.Oodeor reNr4dabdmo.x..dM oedrY US Drpsaaddl Oaf010MdBYada,nawH-7111,xMfadbamM,MN,WrNgtot OC xn10.Mad oo dthe roodoll—loM o1h. r P.D. ton 2 I WORKERS COMPENSATION EXPERIENCE RATING NCC/ Risk Name: AUSTIN ENGINEERING CO INC Risk ID: 420057180 Rating Effective Date: 07/01/2024 Production Date: 02/28/2024 State: TEXAS StateWt Exp Excess Expected Exp Prim Act Exc Losses Ballast Act Inc Losses Act Prim Losses Losses Losses Losses Tx-A .22 118,50 187.702 69,200 335,637 31,280 416,4341 80,797 (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) Losses Losses 1.221 1 118,5021 187,7021 69,2001 209,8101 31,2801 278,6471 68,8371 Primary Losses Stabilizing Value Ratable Excess Totals (I) C'(1 -A)+G (A)'(F) (J) Actual 68,837 123,712 46.158 238,707 (E) C'(1 -A)+G (A)'(C) (K) Expected 69,200 123,712 26,070 218,982 ARAP FLARAP SARAP MAARAP Exp Mod (J)/(K) Factors 1.09 REVISED RATING RATING REFLECTS A DECREASE OF 70% MEDICAL ONLY PRIMARY AND EXCESS LOSS DOLLARS WHERE ERA IS APPLIED. RATING REVISED TO REFLECT APPROVED RATING VALUES id Copyright 1993-2024.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 protluct or information contained therein.This product and the information contained therein are to be used exclusively for under,vriting,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. Page 1 of 3 WORKERS COMPENSATION EXPERIENCE RATING NCC/ Risk Name: AUSTIN ENGINEERING CO INC Risk ID: 420057180 Rating Effective Date: 07/01/2024 Production Date: 02/28/2024 State: TEXAS 42-TEXAS Firm ID:A Firm Name: AUSTIN ENGINEERING CO INC Carrier: 29939 Policy No. 0002049383 Eff Date: 07/01/2020 Exp Date: 07/01/2021 Code ELR D- Payroll Expected Exp Prim Claim Data IJ OF Act Inc Act Prim Ratio Losses Losses Losses Losses 0042 .93 .46 777,624 7,2321 3,327 2001225604 105 1 F 1 1,784 1,784 3724 58 .331 303,3591 1,7591 580 118001243394 05 1 F 1 2,997 2,997 5200 1 .65 .381 128,655 8361 318 4001240177 05 F 3,292 3,292 5506 .99 .381 817,5741 8,0941 3,0761 6001227435 05 F 6,138 6,138 5606 .12 .33 544,1961 653 2151 8001262366 06 F 641 641 6219 .70 .33 3,061,278 21,429 7,072 N0.4 06 4,450 4,450 6229 .56 .43 272,768 1,528 657 6306 .95 .38 746,272 7,090 2,694 6319 .65 .33 1,030,255 6,697 2,210 7602 .82 .43 41,398 339 1461 1 8227 .35 .38 1,168,231 4,089 1,554 8809 .03 .43 156,000 47 20 8810 .02 .49 768,997 154 75 9015 .51 .46 133,730 6821 314 Subject Total Act Inc Policy Total: 9,950,33 Premium: 198,605 Losses: 19,302 42-TEXAS Firm ID:A Firm Name: AUSTIN ENGINEERING CO INC Carrier: 29939 Policy No. 0002049383 Eff Date: 07/01/2021 Exp Date: 07/01/2022 Code ELR D- Payroll Expected Exp Prim Claim Data IJ �01 Act Inc Act Prim Ratio Losses Losses Losses Losses 0042 .93 .46 813,510 7,566 3,480 1001274842 04 1 O 1 135,914#1 16,500 3724 .58 .33 227,5561 1,320 436 7001286269 05 F 25,310 16,500 5200 .65 .38 91,3141 594 226 NO-4 06 2,963 2,963 5506 .99 .38 749,187 7,417 2,818 8001282562 06 1 F 5,245 5,245 5606 .12 331 604,9571 726 240 6219 .70 .33 3,274,848 22,924 7,565 6229 .56 .43 510,821 2,861 1,230 6306 .95 .38 595,663 5,6591 2,150 6319 .65 .33 1,023,6911 6,6541 2,196 7602 .82 .43 51,0281 4181 180 8227 .35 .38 1,200,575 4,202 1,597 8809 .03 .43 156,000 47 20 8810 .02 .49 910,549 182 89 9015 .51 .46 145,659 743 342 Subject Total Act Inc Policy Total: 10,355,35$remium: 179,603 Losses: 169,432 (D Copyright 1993-2024,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,disseminafion,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 USLBHW C Catastrophic Loss E Employers Liability Loss #Limited Loss Page 2 of 3 WORKERS COMPENSATION EXPERIENCE RATING NCC/ Risk Name: AUSTIN ENGINEERING CO INC Risk ID: 420057180 Rating Effective Date: 07/01/2024 Production Date: 02/28/2024 State: TEXAS 42-TEXAS Firm ID:A Firm Name: AUSTIN ENGINEERING CO INC Carrier: 29939 Policy No. 0002049383 Eff Date: 07/01/2022 Exp Date: 07/01/2023 Code ELR D- Payroll Expected Exp Prim Claim Data IJ OF1 Act Inc Act Prim Ratio Losses Losses I Losses Losses 0042 .93 .46 663,991 6.175 2,841 8001324214 05 O 223,913# 16,500 3724 .58 .33 114,692 665 219 NO.5 06 3,787 3,787 5200 .65 .38 139,184 905 1 344 5506 1 .99 .38 668,969 6,623 2,517 5606 1 .12 .33 1,352,042 1,622 535 6219 .70 .33 3,183,125 22,282 7,353 6229 .56 .43 614,117 3,439 1,479 6306 .95 .38 756,099 7,183 2,730 6319 .65 .33 1,116,072 7,254 2,394 7602 1 .82 .43 552,322 4,529 1,947 8227 .35 .38 1,161,590 41066 1,545 8809 .03 .43 249,600 75 32 8810 .02 .49 584,908 117 57 9015 .51 .46 161,675 825 380 Subject Total Act Inc Policy Total: 11,318,38 Premium: 174,867 Losses: 227,700 OD Copyright 1993-2024,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(NCCl) 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 usedfor 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 3 of 3 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 AGREEMENT made as of the 12-- (N day of :;YU nt in the year 20? BETWEEN the Owner: City of Round Rock,Texas(hereafter"Owner"or"City") 221 East Main Street Round Rock,Texas 78664 and the Contractor Austin Engineering Co ("Contractor") PO Box 342349 Austin,TX 78734 The Project is described as: Greenlawn Blvd-From IH35 to SH45 The Engineer is: K Friese+Associates 710 Hester's Crossing Road Summit II,Suite 120 Round Rock,TX 78681 For and in consideration of the mutual terms, conditions and covenants of this Agreement and all accompanying documents between Owner and Contractor, the receipt and sufficiency of which are hereby acknowledged,Owner and Contractor agree as follows: ARTICLE I THE CONTRACT DOCUMENTS The Contract Documents consist of this Agreement,Conditions of the Contract(General,Supplementary and other Conditions),Drawings,Specifications,Addenda issued prior to execution of this Agreement,other documents listed in this Agreement and Modifications issued after execution of this Agreement;these form the Contract,and are as fully a part of the Contract as if attached to this Agreement or repeated herein. The Contract represents the entire and integrated agreement between the parties hereto and supersedes prior negotiations,representations or agreements, either written or oral.An enumeration of the Contract Documents,other than Modifications,appears in Article 7. ARTICLE 2 THE WORK OF THIS CONTRACT Contractor shall fully execute the Work described in the Contract Documents,except to the extent specifically indicated in the Contract Documents to be the responsibility of others. 00500 4-2020 Page 1 of 5 Standard Form of Agreement 00443647 ARTICLE 3 DATE OF COMMENCEMENT;DATE OF SUBSTANTIAL COMPLETION;DATE OF FINAL COMPLETION 3.1 The date of commencement of the Work shall be the date of this Agreement unless a different date is stated below or provision is made for the date to be fixed in a Notice to Proceed issued by Owner. 3.2 The Contract Time shall be measured from the date delineated in the Notice to Proceed. 3.3 Contractor shall commence Work within ten1( 0 ) calendar days from the date delineated in the Notice to Proceed. 3.4 Contractor shall achieve Substantial Completion of the items of Work listed on Attachment A to this Agreement no later than N/A (N/A )calendar days from issuance by Owner of Notice to Proceed, and Contractor shall achieve Substantial Completion of the entire Work no later than four hunderd twenty six (426 )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 five hunderd dollars and No/100 Dollars($ 1,500.00 ) for each calendar day that Substantial Completion is delayed after the date(s) specified for Substantial Completion. It is hereby agreed that the liquidated damages to which Owner is entitled hereunder are a reasonable forecast of just compensation for the harm that would be caused by Contractor's failure to achieve Substantial Completion of the Work(or any portion thereof)on or before the date(s)specified for Substantial Completion in the Agreement and is not a penalty. It is agreed that the harm that would be caused by such failure, which includes loss of expected use of the Project areas,provision of alternative storage facilities and rescheduling of moving and occupancy dates,is one that is incapable or very difficult of accurate estimation.It is hereby agreed that if Substantial Completion of the Work(or any portion thereof)is not achieved on or before thirty(30)days after the date(s) specified for Substantial Completion in the Agreement, the Owner shall have the option to either collect liquidated damages as set forth herein or to thereafter rely on its remedies under the Contract Documents and at law and in equity, including without limitation, the recovery of actual damages. The date(s) specified for Substantial Completion of the Work(or any portion thereof)in the Agreement shall be subject to adjustment as provided in the Contract Documents. 3.6 Contractor shall achieve Final Completion of the entire Work no later than four hunderd fifty six 4( 56 )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 Thirteen million,nine hundred f if ty-three thousand,one hundred ninety-f our dollars and thirty-two cents ($_$13,953,194.32 ),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. 5.13 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: N/A ARTICLE 8 MISCELLANEOUS PROVISIONS 8.1 Where reference is made in this Agreement to a provision of any document, the reference refers to that provision as amended or supplemented by other provisions of the Contract Documents. 8.2 Owner's representative is: Reuben Ramirez City of Round Rock Transportation Department 512-218-7084 rramirezp,roundrocktexas.gov 8.3 Contractor's representative is: John C. Fenley,Vice President, Sales Austin Engineering Co-, Inc_ (512) 327-1464 ifenleySa�aecoi.net 8.4 Neither Owner's nor Contractor's representative shall be changed without ten(10)days'written notice to the other party. 00500 4-2020 Page 4 of 5 Standard Form of Agreement 00443647 8.5 Waiver of any breach of this Agreement shall not constitute waiver of any subsequent breach. 8.6 Owner agrees to pay Contractor from available funds for satisfactory performance of this Agreement in accordance with the bid or proposal submitted therefor,subject to proper additions and deductions,all as provided in the General Conditions, Supplemental Conditions, and Special Conditions of this Agreement,and Owner agrees to make payments on account thereof as provided therein. Lack of funds shall render this Agreement null and void to the extent funds are not available. This Agreement is a commitment of City of Round Rock's current revenues only. 8.7 Although this Agreement is drawn by Owner,both parties hereto expressly agree and assert that,in the event of any dispute over its meaning or application,this Agreement shall be interpreted reasonably and fairly,and neither more strongly for nor against either party. 8.8 This Agreement shall be enforceable in Round Rock,Texas,and if legal action is necessary by either party with respect to the enforcement of any or all of the terms or conditions herein,exclusive venue for same shall lie in Williamson County, Texas. This Agreement shall be governed by and construed in accordance with the laws and court decisions of the State of Texas. 8.9 Both parties hereby expressly agree that no claims or disputes between the parties arising out of or relating to this Agreement or a breach thereof shall be decided by an arbitration proceeding,including without limitation,any proceeding under the Federal Arbitration Act(9 USC Section 1-14)or any applicable state arbitration statute. 8.10 The parties, by execution of this Agreement, bind themselves, their heirs, successors, assigns, and legal representatives for the full and faithful performance of the terms and provisions hereof. This Agreement is entered into as of the day and year first written above and is executed in at least two(2) original copies,of which one is to be delivered to Owner. OWNER CONTRACTOR CITY OF PIOUND ROC XAS AUSTIN FNG NEERING CO C. L11 Y11A — �1� Printed Nam . t arae: Travis W. Keller Title ff__ 0 Title: Vice President Le Date Signed: Z Date Signed: ST• 1�— k City terk FOR CITY,APPROVED AS TO FORM: i ttorney 00500 4-2020 Page 5 of 5 Standard Form of�greement 00443647 IL 00 17 1198 COMMON POLICY CONDITIONS All Coverage Parts included in this policy are subject to the following conditions. A Cancellation b. Give you reports on the conditions we find; 1. The first Named Insured shown in the Declara- and tions may cancel this policy by mailing or deliv- c. Recommend changes. ering to us advance written notice of cancella- 2. We are not obligated to make any inspections, tion. surveys, reports or recommendations and any 2. We may cancel this policy by mailing or deliver- such actions we do undertake relate only to fin- ing to the first Named Insured written notice of surability and the premiums to be charged. We cancellation at least: do not make safety inspections. We do not un- a. 10 days before the effective date of cancella- dertake to perform the duty of any person or tion if we cancel for nonpayment of pre- organization to provide for the health or safety mium; or of workers or the public. And we do not war- rant that conditions: b. 30 days before the effective date of cancella- tion if we cancel for any other reason. a. Are safe or healthful; or 3. We will mail or deliver our notice to the first b. Comply with laws, regulations, codes or Named Insured's last mailing address known to standards. us. 3. Paragraphs 1. and 2. of this condition apply 4. Notice of cancellation will state the effective not only to us, but also to any rating, advisory, date of cancellation. The policy period will end rate service or similar organization which on that date. makes insurance inspections, surveys, reports or recommendations. 5. If this policy is cancelled, we will send the first Named Insured any premum refund due. If we 4. Paragraph 2. of this condition does not apply cancel, the refund will be pro rata. If the first to any inspections, surveys, reports or recom- Named Insured cancels, the refund may be less mendations we may make relative to certifica- than pro rata. The cancellation will be effective tion, under state or municipal statutes, ordi- even if we have not made or offered a refund. nances or regulations, of boilers, pressure ves- sels or elevators. 6. If notice is mailed, proof of mailing will be suffi- cient proof of notice. E. Premiums B. Changes The first Named Insured shown in the Declara- tions: This policy contains all the agreements between you and us concerning the insurance afforded. 1. Is responsible for the payment of all premiums; The first Named Insured shown in the Declarations and is authorized to make changes in the terms of this 2. Will be the payee for any return premiums we policy with our consent. This policy's terms can be pay. amended or waived only by endorsement issued F. Transfer Of Your Rights And Duties Under This by us and made a part of this policy. Policy C. Examination Of Your Books And Records Your rights and duties under this policy may not We may examine and audit your books and re- be transferred without our written consent except cords as they relate to this policy at any time dur- in the case of death of an individual named fin- ing the policy period and up to three years after- sured. ward. If you die, your rights and duties will be trans- D. Inspections And Surveys ferred to your legal representative but only while 1. We have the right to: acting within the scope of duties as your legal rep- resentative. Until your legal representative is ap- a. Make inspections and surveys at any time; pointed, anyone having proper temporary custody of your property will have your rights and duties but only with respect to that property. IL 00 17 1198 Copyright, Insurance Services Office, Inc., 1998 Page 1 of 1 ❑ PERFORMANCE BOND Bond No. 4477791 THE STATE OF TEXAS § § KNOW ALL BY THESE PRESENTS: COUNTY OF WILLIAMSON § That Austin Engineering Co., Inc. , of the City of Austin , County of Travis , and State of Texas , as Principal, and Suretec Insurance Company authorized under the law of the State of Texas to act as surety on bonds for principals, are held and firmly bound unto the CITY OF ROUND ROCK, TEXAS (Owner), in the penal sum of Thirteen million nine hundred fifty-three thousand one hundred ninety-four&thirty-two cents Dollars ($13,953,194.32 ) 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 1 2fi day of , 20 25 to which the Agreement is hereby referred to and made a part hereof as fully and to the same extent as if copied at length herein consisting of: Greenlawn Blvd- From IH 35 to SH 45 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 Perfonnance 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 perforin 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 $13,953,194.32 sum of this Performance Bond, plus all costs and expenses, including attorney's fees and expert and consultant fees incurred by Owner to enforce its rights under this Performance Bond. IN WITNESS WHEREOF, the said Principal and Surety have signed and sealed this instrument this U,Q day of J 0\t , 2025 Austin Engineering Co.. Inc. Suretec Insurance Company — Principal . Surety _ Brad Ballew PrintA Printed Name By- By:TtleTitle: Attorney-In-Fact Addr49 Address: 2103 CityWest Blvd., Suite 1300 Austin TX 78734-2349 Houston, TX 77042 Resident Agent of Surety: Signature Ballew Surety Agency, Inc.. Brad BaHew Printed Name 38Q9 Manrhar;; Rngrl Street Address Austin, TX 78704 City, State& Zip Code Page 2 00610 42020 Pertonnance Bond 00443639 PAYMENT BOND Bond No. 4477791 THE STATE OF TEXAS § § KNOW ALL MEN BY THESE PRESENTS: COUNTY OF WILLIAMSON § That Austin Engineering Co., Inc. , of the City of Austin County of Travis and State of Texas , as Principal, and Suretec Insurance Company authorized under the laws of the State of Texas to act as Surety on Bonds for Principals, are held and firmly bound unto the CITY OF ROUND ROCK, TEXAS (OWNER), and all subcontractors, workers, laborers, mechanics and suppliers as their interest may appear, all of whom shall have the right to sue upon this bond, in the penal sum of Thirteen million nine hundred fifty-three thousand one hundred ninety-four&thirty-two cents Dollars($ 13,953,194.32 )for the payment whereof, well and truly be made the said Principal and Surety bind themselves and their heirs, administrators, executors, successors, and assigns,jointly and severally, by these presents: WHEREAS,the Principal has entered into a certain written Agreement with the Owner, dated the 12-t, day of Z Lnc , 2025 to which Agreement is hereby referred to and made a part hereof as fully and to the same extent as if copied at length herein consisting of: Greenlawn Blvd-From IH 35 to SH 45 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 u of day of q 12025 . Austin Engineering Co., Inc. Suretac Insurance Company__ to Surety -- - _— Brad Ballew Punted Name Printed Name Bye By. Titled / Title: Attorney-In-Fact Address x 342349Address: 210' City VP%t Blvd_ Suite 1300 49 Houston, TX 77042 Resident Agent of Surety: Signature Ballew Surety Agency, Inc., Brad Ballew Printed Name 3802 Menchaca Road Street Address Austin, TX 78704 City, State& Zip Code Page 2 00620 1-2020 Payment Bond 00090656 POA# 4221356 JOINT LIMITED POWER OF ATTORNEY KNOW ALL MEN BY THESE PRESENTS:That SureTec Insurance Company,a Corporation duly organized and existing under the laws of the State of Texas and having its principal office in the County of Harris,Texas and Markel Insurance Company(the"Company'),a corporation duly organized and existing under the laws of the state of Illinois,and having its principal administrative office in Glen Allen,Virginia,does by these presents make,constitute and appoint: David S. Ballew, Brad Ballew, Connie Davis, David Fernea, Grant Ballew Their true and lawful agent(s)and attorney(s)-in-fact,each in their separate capacity if more than one is named above,to make,execute,seal and deliver for and on their own behalf,individually as a surety or jointly,as co-sureties,and as their act and deed any and all bonds and other undertaking in suretyship provided,however, that the penal sum of any one such instrument executed hereunder shall not exceed the sum of: Fifty Million and 00/100 Dollars($50,000,000.00) This Power of Attorney is granted and is signed and sealed under and by the authority of the following Resolutions adopted by the Board of Directors of SureTec Insurance Company and Markel Insurance Company: "RESOLVED,That the President,any Senior Vice President,Vice President,Assistant Vice President,Secretary,Assistant Secretary,Treasurer or Assistant Treasurer and each of them hereby is authorized to execute powers of attorney,and such authority can be executed by use of facsimile signature,which may be attested or acknowledged by any officer or attorney,of the company,qualifying the attorney or attorneys named in the given power of attorney,to execute in behalf of,and acknowledge as the act and deed of the SureTec Insurance Company and Markel Insurance Company,as the case may be,all bond undertakings and contracts of suretyship,and to affix the corporate seal thereto." IN WITNESS WHEREOF,Markel Insurance Company and SureTec Insurance Company have caused their official seal to be hereunto affixed and these presents to be signed by their duly authorized officers on the Sou, day of April 2025 . SureTec Insurance Company U NC `0\)RANC f,, AindeyJ ance pmpany 4�6„X.. FCO `. .0 F0 i LU y jg SEAL By. Michael C.Keimig,President �� .. �' B ice President .* . runn�us State of Texas County of Harris: On this 30th day of April 2025 A.D.,before me,a Notary Public of the State of Texas,in and for the County of Harris,duly commissioned and qualified, came THE ABOVE OFFICERS OF THE COMPANIES,to me personally known to be the individuals and officers described in,who executed the preceding instrument,and they acknowledged the execution of same,and being by me duly sworn,disposed and said that they are the officers of the said companies aforesaid,and that the seals affixed to the proceeding instrument are the Corporate Seals of said Companies,and the said Corporate Seals and their signatures as officers were duly affixed and subscribed to the said instrument by the authority and direction of the said companies,and that Resolutions adopted by the Board of Directors of said Companies referred to in the preceding instrument is now in force. IN TESTIMONY WHEREOF,I have hereunto set my hand,and affixed my Official Seal at the County of Harris,the day and year first above written. JULIE E. :State CLARY Notary Public of Texase :Commission947680-5 yJ ie E.McClary,Notary Public Commission Expirrch 29,2026 y commission expires 3/29/2026 We,the undersigned Officers of SureTec Insurance Company and Markel Insurance Company do herby certify that the original POWER OF ATTORNEY of which the foregoing is a full,true and correct copy is still in full force and effect and has not been revoked. IN WITNESS WHEREOF,we have hereunto set our hands,and affixed the Seals of said Companies,on the day of 2025 ur sur Company Markel Insurance Company B By: V i( M.Br nt Beaty,A istant Secretary And w Ma quis,As nt Se r Lary Any Instrument Issued in excess of the penalty stated above is totally void and withr.;it any va,01.y.G,t21356 For verification of the authority of this Power you may call(713)812-0800 on any business day between 8:3n Af,l and 5:00 PM CST. r - x.p.,', "' .+ " t't. ::d ..^-'-• .:. >. ':.i; ':'o T ,va, z. ts' i„ a'V ?, s "I ,;j ,:�.. ,':`f« }r,.� �, ,,.,a.y �.�,. 7. .� ,.,._F .:: Y.. 4 �' �ryTC r+,e �a:` 'w 7 b' T4 `ri rta fLr, F'1 ^ :. :��N '"` r ti..Yt v+ ,5T ei�!'d. '�y°'.'.w T:�, '•i „+,yy ,a r. , i 7,, 3 + `� {. ,11N. i y '.>• * ,=t-:ter _ ,,, .�} (, ,. w ¢ .,.vim, .e :5 �. 1' Yw ,;Y. -�x;. G t ',t., `. 3 ,;yt ':f�'`(:'t<+. T.. i {: �.�hn -iAV,A y,5'x,''' .1,H -ry r.. * w.' i.� _ :,.y,+�' •Ai 1 4 '-r,n, •:` F ''Tly ,.y�r{� Sic... °'1' .Y e . _ , '' 5.. .;. 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'• .�'.,.- v.. . .:' ,' ::.,.. .- "S{ Y ,. .a ,. 1F. - , :. t3' .:. .,t_,�' .F:.. ... ter.,..�.s. x5. ,Y�..:r5.'t M" SureTec Insurance Company IMPORTANT NOTICE Statutory Complaint Notice/Filing of Claims To obtain information or make a complaint: You may call the Surety's toll free telephone number for information or to make a complaint or file a claim at: 1-866-732-0099. You may also write to the Surety at: SureTec Insurance Company 9500 Arboretum Blvd., Suite 400 Austin, TX 78759 You may contact the Texas Department of Insurance to obtain information on companies, coverage, rights or complaints at 1-800-252- 3439. You may write the Texas Department of Insurance at: PO Box 149104 Austin, TX 78714- 9104 Fax#: 512-490-1007 Web: http://www.tdi.state.tx.us Email: ConsumerProtection@tdi.texas.gov PREMIUM OR CLAIMS DISPUTES: Should you have a dispute concerning your premium or about a claim, you should contact the Surety first. If the dispute is not resolved, you may contact the Texas Department of Insurance. ------------------------------------------------------------------------------------------------------------------------------ SIC TX Rider TDI Required Notices rev 07_2022 Page 1 of 1 AUSTENG-01 JDELMEREDITH ACORO DATE IMM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 6/2/2026 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 License#OC36861 CONTACT Dylan Gaddy Seattle-Alliant Insurance Services,Inc. PHONE 401 Union Street,31st Floor (A/C,No,Ext):(425)595-6060 FAX No): Seattle,WA 98101 AEi)MpAg'ESS.dylan.gaddy@alliant.com INSURERS AFFORDING COVERAGE NAIC N INSURER A:United States Fire Insurance Company 21113 INSURED INSURER B:North River Insurance Company 21105 Austin Engineering Co.,Inc. INSURERC:Texas Mutual Insurance Company 22945 P.O Box 342349 INSURER D; Austin,TX 78734 INSURER E INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE IADDL NSD SUER WVD POLICY NUMBER POLICY EFF POLICY EXP OMITS A X COMMERCIAL GENERAL UABILITY EACH OCCURRENCE E 1,000,000 CLAIMS-MADE [X]OCCUR X 5069098593 7/1/2024 7/1/2025 DAMAGE TO RENTED 100,000 MED EXP(Any oneperson) 5,000 PERSONAL&ADV INJURY 1'000'000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE 2,000,000 X POLICY� PRO LOC PRODUCTS-COMP/OP AGG 2,000,000 JECT X I OTHER:Leased and Rented Equipment Per Occurrence $ 50,000 A AUTOMOBILE LIABILITYCOMBINED SINGLE LIMIT $ 1,000,000 (Ea accident)Ix ANY AUTO X 5069098593 7/1/2024 7/1/2025 BODILY INJURY Per ersonOWNED SCHEDULEDAURRTEEO��S ONLY ALITOSBOODILY INJURY Per accident S AUT&ONLY X AUTO ONLD Peri ardent AMAGE b $ B UMBRELLA LIAB X OCCUR EACH OCCURRENCE E 10'000'000 X EXCESS LIAB CLAIMS-MADE X 582123680 7/1/2024 7/1/2025 AGGREGATE E 10,000,000 DED I I RETENTIONS C WORKERS COMPENSATION X I PERTUT, OTH- AND EMPLOYERS'LIABILITY Y/N 0002049383 7/1/2024 7/1/2025 1,000,000 ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT �Aan ER/M in NHj EXCLUDED? N/A E.L.DISEASE-EA EMPLOYEE $ 1,000,000 It yes,describe under 1,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT A IPollution Liability 5069098593 7/1/2024 7/1/2025 Deductible 5,000 A Pollution Liability 5069098593 7/1/2024 7/1/2025 Limit 1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space Is required) The City of Round Rock is named as additional insured with respect to all policies per the attached.Should any of the above described policies be canceled or changed before the expiration date thereof,the issuing company will mail thirty(30)days written notice to the certificate holder named below. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Ci Manager THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City 9 ACCORDANCE WITH THE POLICY PROVISIONS. City of Round Rock 221 E.Main Street Round Rock,TX 78664 AUTHORIZED REPRESENTATIVE ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. CONTRACTORS GENERAL LIABILITY ENHANCEMENT ENDORSEMENT This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE 1. Expected Or Intended Injury 16. Additional Insured—Engineers,Architects, Or Surveyors 2. Amended Defense Coverage For Indemnitees 17. Additional Insured—Managers Or Lessors Of Premises Additional Insured—State Or Governmental 3. Non-Owned Watercraft 18. Agency Or Subdivision Or Political Subdivision—Permits Or Authorizations 4. Non-Owned Aircraft 19. Broad Knowledge/Notice Of Occurrence Property Damage Liability—Borrowed Waiver Of Transfer Of Rights Of Recovery 5' Equipment 20' Against Others To Us 6. Property Damage Liability—Elevators 21. Unintentional Failure To Disclose Hazards 7. Damage To Premises Rented To You 22. Mental Anguish, Mental Injury Or Humiliation 8 Contractual Liability For Personal And 23. Mobile Equipment Advertising Injury 9. Medical Payments 24. Waiver Of Sovereign Immunity 10. Supplementary Payments 25. Aggregate Limits Of Insurance Per Project 11. Broad Form Named Insured 26 Contractual Liability—Work Within 50 Feet Of Railroads 12. Fellow Employee Coverage 27 Primary Insurance—Additional Insureds By Written Contract 13. Incidental Medical Malpractice Liability 28. Liberalization Clause 14. Newly Acquired Organizations 29. Loss of Electronic Data Resulting from Physical Injury to Tangible Property Liability Coverage Subject to Cyber Incident Exclusion 15. Additional Insured—Lessors Of Leased 30. Application Of This Endorsement Equipment MG 22 004 04 24 Page 1 of 12 Includes copyrighted material of Insurance Service Office, Inc.with its permission. 1. Expected Or Intended Injury Exclusion a. Expected Or Intended Injury under Section I—Coverage A—Bodily Injury And Property Damage Liability is replaced by the following: "Bodily injury"or"property damage" expected or intended from the standpoint of the insured. This exclusion does not apply to "bodily injury"or"property damage" resulting from the use of reasonable force to protect persons or property. 2. Amended Defense Coverage For Indemnitees Supplementary Payments—Coverages A And B is amended as follows: Paragraph 2.d. under Section I—Supplementary Payments—Coverages A And B is hereby deleted. Paragraph 2.e. under Section I—Supplementary Payments—Coverages A And B is replaced by the following: The indemnitee and the insured ask us to conduct and control the defense of that indemnitee against such "suit". In the event we agree a conflict exists between the interests of the insured and the interests of the indemnitee,we will select and assign separate defense counsel for the indemnitee and pay reasonable attorneys'fees and necessary litigation expenses; and 3. Non-Owned Watercraft Paragraph (2)(a)of Exclusion g.Aircraft,Auto Or Watercraft under Section I—Coverage A—Bodily Injury And Property Damage Liability is replaced by the following: (a) Less than 55 feet in overall length; and 4. Non-Owned Aircraft Exclusion g.Aircraft,Auto Or Watercraft under Section I—Coverage A—Bodily Injury And Property Damage Liability does not apply to an aircraft, in which you have no ownership interest, provided: a. It is: (1) Loaned to; (2) Rented by; or (3) Hired or chartered by the insured with a paid and licensed crew; b. It is not being used to carry persons or property for a charge;and c. The pilot in command holds a currently effective license, issued by the duly constituted authority of the United States of America or Canada, designating him or her as a commercial airline pilot for the particular aircraft being flown. 5. Property Damage Liability—Borrowed Equipment Paragraph (4)of Exclusion j. Damage To Property under Section I—Coverage A—Bodily Injury And MG 22 004 04 24 Page 2 of 12 Includes copyrighted material of Insurance Service Office, Inc. with its permission. Property Damage Liability is amended to include the following: This exclusion does not apply to equipment which you borrow from a person or entity, other than an insured, unless the"property damage"occurs while such equipment is being used by an insured at a job site. Subject to all terms of Section III—Limits Of Insurance, the maximum limit in any one"occurrence" is $25,000 subject to an annual aggregate of$50,000 for all 'occurrences". The insurance provided by this exception to Exclusion j.(4)as set forth in Paragraph 5. of this Contractors General Liability Enhancement Endorsement is excess over any other valid and collectible insurance available to the insured whether primary, excess (other than insurance written to apply specifically in excess of this policy), contingent, or any other basis, that would also apply to the loss covered under this provision. 6. Property Damage Liability—Elevators Exclusion j. Damage To Property under Section I—Coverage A—Bodily Injury And Property Damage Liability is amended to include the following: Paragraphs (3) and (4) of this exclusion do not apply to liability arising out of the use of elevators. The insurance provided by this exception to Exclusions j.(3)and j.(4)as set forth in Paragraph 6. of this Contractors General Liability Enhancement Endorsement is excess over any other valid and collectible insurance available to the insured whether primary, excess (other than insurance written to apply specifically in excess of this policy), contingent, or any other basis, that would also apply to the loss covered under this provision. 7. Damage To Premises Rented To You a. The last paragraph of 2. Exclusions under Section I—Coverage A—Bodily Injury And Property Damage Liability is replaced by the following: (1) With respect to damage by fire to premises while rented to you or temporarily occupied by you with permission of the owner, Exclusions c.through n., do not apply. (2) With respect to damage by other than fire to premises while rented to you or temporarily occupied by you with permission of the owner, Exclusions c.through n., except for Exclusion f., do not apply unless the damage arises out of"yourwork". A separate limit of insurance applies to the coverage set forth in (1) and (2)above as described in Section III—Limits Of Insurance. b. Section III—Limits Of Insurance is amended by replacing Paragraph 6.with the following: 6. Subject to Paragraph 5. above,the Damage To Premises Rented To You Limit is the most we will pay under Coverage A for damages because of"property damage" to any one premises while rented to you or temporarily occupied by you with the permission of the owner. The Damage To Premises Rented To You Limit is the amount set forth in the Declarations or$300,000,whichever is greater. 8. Contractual Liability For Personal And Advertising Injury Exclusion e. Contractual Liability under Section I—Coverage B—Personal And Advertising Injury Liability is amended to add the following after the last sentence: MG 22 004 04 24 Page 3 of 12 Includes copyrighted material of Insurance Service Office, Inc.with its permission. This exclusion also does not apply to that part of any contract or agreement pertaining to your business under which you assume the"tort liability"of another party to pay for"personal and advertising injury"to a third party or organization, provided the"personal and advertising injury"offense occurs subsequent to the execution of the contract or agreement. For the purposes of this provision, "tort liability" means a liability that would be imposed by law in the absence of any contract or agreement. 9. Medical Payments Section I—Coverage C—Medical Payments is amended to include the following only if Coverage C— Medical Payments is not otherwise excluded from this coverage part: The Medical Payments Limit is changed to the greater of: a. $15,000; or b.The Medical Expense Limit shown in the Declarations of this coverage part. Paragraph 1.a.(3)(b) under Section I—Coverage C—Medical Payments is replaced by the following: The expenses are incurred and reported to us within three years of the date of the accident; and 10. Supplementary Payments Supplementary Payments—Coverages A And B under Section I—Coverages is amended as follows: a. The bail bonds limit shown in Paragraph 1.b. is increased from $250 to$2,500. b. The actual loss of earnings limit shown in Paragraph 1.d. is increased from $250 to $1,000. 11. Broad Form Named Insured Paragraph 1.d. under Section II—Who Is An Insured is amended to include the following: If you are an organization other than a partnership, limited liability company or joint venture, any of your subsidiary companies or any company over which you exercise control and actively manage will qualify as an insured only if other valid and collectible insurance does not apply. 12. Fellow Employee Coverage Paragraph 2.a. (1)(a) under Section II—Who Is An Insured is deleted. 13. Incidental Medical Malpractice Liability Paragraph 2.a. (1)(d) under Section II—Who Is An Insured does not apply to"employees"who are employed as nurses or other"employees", excluding physicians and medical doctors, who provide incidental health care services within the scope of their employment by you. 14. Newly Acquired Organizations Paragraph 3.a. under Section II—Who Is An Insured is replaced by the following: MG 22 004 04 24 Page 4 of 12 Includes copyrighted material of Insurance Service Office, Inc.with its permission. a. Coverage under this provision is afforded only until the end of the policy period. 15. Additional Insured—Lessors Of Leased Equipment a. Section II—Who Is An Insured is amended to include as an additional insured any person or organization from whom you lease equipment when you or such person or organization have agreed that such person or organization be added as an additional insured to this policy by written contract or written agreement but only with respect to liability for"bodily injury", "property damage" or"personal and advertising injury"caused, in whole or in part, by your maintenance, operation or use of the equipment leased to you by such person ororganization. However,the insurance afforded to such additional insured: (1) Only applies to the extent permitted by law;and (2) Will not be broader than that which you are required by the written contract or written agreement to provide for such additional insured. b. The limits of insurance applicable to the additional insured are those specified in the written contract or written agreement or in the Declarations of this policy,whichever are less.These limits of insurance are inclusive of, and are not in addition to, the limits of insurance shown in the Declarations of this policy. c. With respect to the insurance afforded to these additional insureds, this insurance does not applyto any"occurrence"which takes place after the equipment lease expires or is terminated. 16. Additional Insured—Engineers,Architects, Or Surveyors a. Section II—Who Is An Insured is amended to include as an additional insured any architect, engineer or surveyor engaged by you and with whom you have agreed by written contract to add as an additional insured to this policy, but only with respect to liability for"bodily injury", "property damage"or"personal and advertising injury"caused, in whole or in part, by your acts or omissions or the acts or omissions of those acting on your behalf: (1) In connection with your premises; or (2) In the performance of your ongoing operations. However, the insurance afforded to such additional insured only applies to the extent permitted by law and will not be broader than that which you are required by the written contract to provide for such additional insured. b. The limits of insurance applicable to the additional insured are those specified in the writtencontract in the Declarations of this policy, whichever are less. These limits of insurance are inclusive of, and are not in addition to,the limits of insurance shown in the Declarations of this policy. c. With respect to the insurance afforded to these additional insureds, the following additional exclusion applies: This insurance does not apply to"bodily injury", "property damage" or"personal and advertising injury" arising out of the rendering of or the failure to render any professional services by or for you, including: (1) The preparing, approving, or failing to prepare or approve, maps, shop drawings,opinions, reports, surveys,field orders, change orders or drawings and specifications;or (2) Supervisory, inspection, architectural or engineering activities. This exclusion applies even if the claims against any insured allege negligence or other wrongdoing in the supervision, hiring, employment, training or monitoring of others by that insured, if the "occurrence"which caused the"bodily injury"or"property damage", or the offense which caused the "personal and advertising injury", involved the rendering of or the failure to render any professional services by or for you. MG 22 004 04 24 Page 5 of 12 Includes copyrighted material of Insurance Service Office, Inc.with its permission. 17. Additional Insured—Managers Or Lessors Of Premises a. Section II—Who Is An Insured is amended to include as an additional insured any manager or lessor of premises leased to you and with whom you have agreed by written contract to add such manager or premises as an additional insured to this policy, but only with respect to liability for "bodily injury", "property damage,"or"personal and advertising injury"caused in whole or in part by you or those acting on your behalf in connection with the ownership, maintenance or use of that part of the premises leased to you and subject to the following additional exclusions: This insurance does not apply to: (1) Any"occurrence"that takes place after you cease to be a tenant in that premises;or (2) Structural alterations, new construction, or demolition operations performed by, or on behalf of,the manager or lessor of the premises. b. However, the insurance afforded to such additional insured: (1) Only applies to the extent permitted by law;and (2) Will not be broader than that which you are required by the written contract to provide forsuch additional insured. c. The limits of insurance applicable to the additional insured are those specified in the written contract or in the Declarations of this policy, whichever are less. These limits of insurance are inclusive of, and are not in addition to,the limits of insurance shown in the Declarations of this policy. 18. Additional Insured—State Or Governmental Agency Or Subdivision Or Political Subdivision— Permits Or Authorizations a. Section II—Who Is An Insured is amended to include as an additional insured any state or governmental agency or subdivision or political subdivision which has issued a permit or authorization to you. (1) This applies only with respect to operations performed by you or on your behalf for whichthe state or governmental agency or subdivision or political subdivision has issued a permit or authorization. However: (a) The insurance afforded to such additional insured applies to the extent permitted by law;and (b) If coverage provided to the additional insured is required by a contract or agreement,the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured. (2) This insurance does not apply to: (a) 'Bodily injury", "property damage"or"personal and advertising injury"arising out of operations performed for the state or governmental agency or subdivision or political subdivision; or (b) "Bodily injury"or"property damage" included within the"products-completed operations hazard". b. The limits of insurance applicable to the additional insured are those specified in the contract or agreement or in the Declarations of this policy,whichever are less. These limits of insurance are inclusive of, and are not in addition to, the limits of insurance shown in the Declarations of this policy. 19. Broad Knowledge/Notice Of Occurrence Section IV—Commercial General Liability Conditions is amended to include the following: MG 22 004 04 24 Page 6 of 12 Includes copyrighted material of Insurance Service Office, Inc. with its permission. a. The requirement in Condition 2.a., which states that you must see to it that we are notified of any"occurrence"or offense, applies only when the"occurrence"or offense is known to: (1) You, if you are an individual; (2) A partner, if you are a partnership; (3) A member, if you are a joint venture; (4) An "executive officer', manager or supervisor if you are a corporation;or (5) A member, if you are a limited liability company. b. The requirement in Condition 2.b.,which states that you must see to it that we receive notice of a claim or"suit",will not be considered breached unless the breach occurs after such claim or"suit" is known to: (1) You, if you are an individual; (2) A partner, if you are a partnership; (3) A member, if you are a joint venture; (4) An "executive officer", manager or supervisor if you are a corporation;or (5) A member, if you are a limited liability company. If you report an accident to your Workers Compensation insurance carrier which later develops into a claim or"suit"for a liability"occurrence"for coverage which is provided by this policy,failure to report such "occurrence"to us at the time of the accident shall not be a violation of the notification of loss condition (Condition 2. Duties In The Event Of Occurrence, Offense, Claim, Or Suit under Section IV—Commercial General Liability Conditions)contained in this policy. It is agreed, however, that you shall give notification of such claim or"suit"to us as soon as you are made aware of the fact that the particular accident has developed into a claim or"suit". 20. Waiver Of Transfer Of Rights Of Recovery Against Others To Us Condition 8. Transfer Of Rights Of Recovery Against Others To Us under Section IV— Commercial General Liability Conditions is amended to include the following: We waive any right of recovery against person(s)or organization(s) because of payments we make under this Coverage Part. Such waiver by us applies only to the extent that the insured has waived its right of recovery against such person(s)or organization(s) prior to loss. 21. Unintentional Failure To Disclose Hazards Section IV—Commercial General Liability Conditions is amended to include the following: Unintentional Failure To Disclose Hazards Your unintentional failure to disclose all hazards or prior"occurrences" existing as of the inception date of this policy shall not prejudice the coverage afforded by this policy. 22. Mental Anguish, Mental Injury Or Humiliation The definition of"bodily injury" in Paragraph 3. under Section V—Definitions is replaced by the following: "Bodily injury" means bodily injury, sickness, or disease sustained by a person, including mental anguish, mental injury, humiliation, or death resulting from any of these at any time. MG 22 004 04 24 Page 7 of 12 Includes copyrighted material of Insurance Service Office, Inc. with its permission. 23. Mobile Equipment Paragraph 12. under Section V—Definitions is amended to include the following: Paragraph f.(1) does not apply to self-propelled vehicles of less than 1,000 pounds gross vehicle weight. 24. Waiver Of Sovereign Immunity The following provision applies if you are a "governmental entity"or we have added a "governmental entity"to your policy as an additional insured, and the"governmental entity" requires us to obtain permission prior to asserting a defense involving governmental immunity or the jurisdiction of the tribunal over the"governmental entity': We shall not raise any defense involving, in any way,the jurisdiction of the tribunal over the "governmental entity", the immunity of the"governmental entity"or its commissioners, officers, agents or employees, the governmental nature of such entity, or the provisions of any statutes respecting suits against the"governmental entity"without first obtaining express advance permission from the designated representative of the"governmental entity". Application of this provision shall not subject us to liability for any portion of a claim or judgment in excess of the applicable limit of insurance. For the purposes of this provision, "governmental entity" means a state, county, district, municipality, town,township, borough, parish, village, or other political subdivision or governmental agency or subdivision. 25. Aggregate Limits Of Insurance Per Project Section III—Limits Of Insurance is amended to include the following: 8. The General Aggregate Limit described in 2. above is subject to the following: a. For all sums which the insured becomes legally obligated to pay as damages caused by "occurrences" under Section I—Coverage A, and for all medical expenses caused by accidents under Section I—Coverage C,which can be attributed only to ongoing operations at a "single construction project"away from premises owned by or rented to the insured: (1) A separate Single Construction Project General Aggregate Limit applies to each construction project, and that limit is equal to the amount of the General Aggregate Limit shown in the Declarations. (2) The Single Construction Project General Aggregate Limit is the most we will payfor the sum of all damages under Coverage A, except damages because of"bodily injury"or"property damage" included in the"products-completed operations hazard", and for medical expenses under Coverage C regardless of the numberof: MG 22 004 04 24 Page 8 of 12 Includes copyrighted material of Insurance Service Office, Inc.with its permission. (a) Insureds; (b) Claims made or"suits" brought;or (c) Persons or organizations making claims or bringing"suits". b. Any payments made under Coverage A for damages or under Coverage C for medical expenses shall reduce the Single Construction Project General Aggregate Limit for that construction project. Such payments shall not reduce the General Aggregate Limit shown in the Declarations nor shall they reduce any other Single Construction Project General Aggregate Limit for any other construction project. c. The limits shown in the Declarations for Each Occurrence, Damage To Premises Rented To You and Medical Expense continue to apply. However, instead of being subject to the General Aggregate Limit shown in the Declarations, such limits will be subject to the applicable Single Construction Project General Aggregate Limit. d. For all sums which the insured becomes legally obligated to pay as damages caused by "occurrences" under Section I—Coverage A, and for all medical expenses caused by accidents under Section I—Coverage C,which cannot be attributed only to ongoing operations at a "single construction project'away from premises owned by or rented to the insured: (1) Any payments made under Coverage A for damages or under Coverage C for medical expenses shall reduce the amount available under the General Aggregate Limit or the Products-Completed Operations Aggregate Limit,whichever is applicable; and (2) Such payments shall not reduce any Single Construction Project General Aggregate Limit. e. When coverage for liability arising out of the"products-completed operations hazard" is provided, any payments for damages because of"bodily injury"or"property damage" included in the"products-completed operations hazard"will reduce the Products- Completed Operations Aggregate Limit, and not reduce the General Aggregate Limit nor the Single Construction Project General Aggregate Limit. f. If a"single construction project'away from premises owned by or rented to the insured has been abandoned or delayed and then restarted, or if the authorized contracting parties deviate from plans, blueprints, designs, specifications or timetables, the project will still be deemed to be the same construction project. g. "Single construction project' means each single designated construction project for which you are obligated by written agreement to maintain general liability insurancewith a separate per project general aggregate limit that applies only to that construction project.The agreement must be executed prior to the'occurrence"of the"bodily injury" or"property damage". The provisions of Section III—Limits Of Insurance, not otherwise modified by this provision, shall continue to apply as stipulated. MG 22 004 04 24 Page 9 of 12 Includes copyrighted material of Insurance Service Office, Inc.with its permission. 26. Contractual Liability—Work Within 50 Feet Of Railroads The definition of"insured contract" in Paragraph 9. under Section V—Definitions is amended as follows: Paragraph 9.c. is replaced by the following: c.Any easement or license agreement; Paragraph 9.f.(1) is hereby deleted. 27. Primary Insurance—Additional Insureds By Written Contract Paragraph a. Primary Insurance of Condition 4. Other Insurance under Section IV— Commercial General Liability Conditions is replaced by the following: a. Primary Insurance (1) This insurance is primary except when Paragraph a.(2) or Paragraph b. below applies. If this insurance is primary, our obligations are not affected unless any of the other insurance is also primary. Then we will share with all that other insurance by the method described in Paragraph c. below. (2) This insurance is excess over and shall not contribute with any other valid and collectible insurance available to any person or entity added as an additional insured to this policy under the terms of the Contractors General Liability Enhancement Endorsement or by attachment of any other endorsement, regardless of whether such other insurance is provided on a primary, excess, contingent or on any other basis, unless the written contract between you and the additional insured requires that this insurance apply on a primary and/or non-contributory basis, in which case this insurance will apply in the manner required by such contract. 28. Liberalization Clause If we adopt a change in the coverage form, CG 00 01, which broadens coverage without an additional premium charge, the broader coverage will apply to this policy on the effective date of approval in the state shown in the Named Insured's address in the Declarations of this policy. 29.Loss of Electronic Data Resulting from Physical Injury to Tangible Property Liability Coverage Subject to Cyber Incident Exclusion A. Exclusion p. under Paragraph 2. Exclusions of Section I—Coverage A—Bodily Injury And Property Damage Liability is replaced by the following: 2. Exclusions This insurance does not apply to: p. Electronic Data Damages arising out of the loss of, loss of use of, damage to, corruption of, inability to access, or inability to manipulate "electronic data". However, this exclusion does not apply to liability for damages because of: (1) "Bodily injury"; or (2) Loss of, loss of use of, damage to, corruption of, inability to access, or inability to manipulate "electronic data"that results from physical injury to tangible property. MG 22 004 04 24 Page 10 of 12 Includes copyrighted material of Insurance Service Office, Inc.with its permission. B. For the purposes of this Loss of Electronic Data Resulting from Physical Injury to Tangible Property Liability Coverage Subject to Cyber Incident Exclusion, the following is added to Paragraph 2. Exclusions of Section I—Coverage A—Bodily Injury And Property Damage Liability: 2. Exclusions This insurance does not apply to: Cyber Incident "Bodily injury"or"property damage"arising out of a "cyber incident". This exclusion applies even if damages are claimed for notification costs, credit or identity monitoring expenses, forensic expenses, public relations expenses, data restoration expenses, extortion expenses or any other similar cost or expense incurred by you or others arising out of a "cyber incident". C. The following paragraph is added to Section III—Limits Of Insurance: Subject to the Each Occurrence Limit in Paragraph 5., the most we will pay under Coverage A for "property damage" because of all loss of "electronic data" arising out of any one "occurrence" is $100,000. D. For the purposes of the coverage provided by this Loss of Electronic Data Resulting from Physical Injury to Tangible Property Liability Coverage Subject to Cyber Incident Exclusion,the following definitions are added to the Definitions Section: 1. "Cyber incident" means any: a. Unauthorized access to or use of any computer system. b. Malicious code, virus or any other harmful code that is directed at, enacted upon or introduced into any computer system and is designed to access, alter, corrupt, damage, delete, destroy, disrupt, encrypt, exploit, use or prevent or restrict access to or the use of any part of any computer system or otherwise disrupt its normal functioning or operation. c. Denial of service attack which disrupts, prevents or restricts access to or use of any computer system, or otherwise disrupts its normal functioning or operation. 2. "Electronic data" means information, facts or programs stored as or on, created or used on, or transmitted to or from computer software, including systems and applications software, hard or floppy disks, CD-ROMs, tapes, drives, cells, data processing devices or any other media which are used with electronically controlled equipment. E. For the purposes of this Loss of Electronic Data Resulting from Physical Injury to Tangible Property Liability Coverage Subject to Cyber Incident Exclusion: 1. The definition of"property damage" in the Definitions Section is replaced by the following: "Property damage" means: a. Physical injury to tangible property, including all resulting loss of use of that property.All such loss of use shall be deemed to occur at the time of the physical injury that caused it; b. Loss of use of tangible property that is not physically injured.All such loss of use shall be deemed to occur at the time of the"occurrence"that caused it; or c. Loss of, loss of use of, damage to, corruption of, inability to access, or inability to properly manipulate"electronic data", resulting from physical injury to tangible property.All such loss of"electronic data" shall be deemed to occur at the time of the"occurrence"that caused it. 2 "Electronic data" is not tangible property. 30. Application Of This Endorsement The coverage enhancements provided by this endorsement apply to the Commercial General Liability Coverage Part. If your policy includes other endorsements in addition to this Contractors General Liability Enhancement Endorsement, and there is a conflict between any of the terms of such endorsement(s)and this Contractors General Liability Enhancement Endorsement, the terms of the other endorsement(s)shall be given priority and control over the terms set forth in this Contractors General MG 22 004 04 24 Page 11 of 12 Includes copyrighted material of Insurance Service Office, Inc.with its permission. Liability Enhancement Endorsement, even if the terms of such other endorsement(s) have the effect of limiting, excluding or reducing the coverage provided under this Contractors General Liability Enhancement Endorsement. All other terms and conditions remain unchanged. MG 22 004 04 24 Page 12 of 12 Includes copyrighted material of Insurance Service Office, Inc.with its permission. THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. CONTRACTORS SCHEDULED AND BLANKET ADDITIONAL INSUREDS ENDORSEMENT This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name of Additional Persons or Organizations: Designated Projects or Locations: A. Section II—Who Is An Insured is amended to include as an additional insured any person or organization that you are required by"written contract"to add as an additional insured on this policy. In addition, if a person or organization is scheduled above, Who Is An Insured is amended to also include that person or organization as an additional insured. B. The insurance provided to the additional insured is limited as follows: 1. The person or organization is an additional insured only with respect to: a. Liability for"bodily injury", "property damage"or"personal and advertising injury" caused in whole or in part by your acts or omissions or the acts or omissions of those acting on your behalf in the performance of your ongoing operations for the additional insured as specified in the"written contract"; or b. "Bodily injury"or"property damage" included within the "products-completed operations hazard"and caused in whole or in part by"your work"specified in the "written contract", but only if: (1) The"written contract" requires you to provide the additional insured such coverage; (2) This policy provides such coverage; and (3) The loss occurs within the period of time required by the"written contract"and prior to the expiration date of the policy. 2. This policy will not provide the additional insured with any broader coverage or any higher limit of insurance than the lesser of: a. Coverage afforded under this policy; or b. Coverage required by the"written contract". 3. Coverage provided by this endorsement to an additional insured shall be excess over any other valid and collectible insurance available to the additional insured, whether on a primary, excess, contingent or any other basis, unless the"written contract" requires that MG 20 003 06 18 Page 1 of 3 Includes copyrighted material of Insurance Services Office, Inc.,with its permission. this insurance apply on a primary and non-contributory basis. 4. The insurance provided to the additional insured does not apply to"bodily injury", "property damage"or"personal and advertising injury" arising out of: a. An architect's, engineer's or surveyor's rendering of, or the failure to render any professional services, including: (1) The preparing, approving, or failure to prepare or approve maps, shop drawings, opinions, reports, surveys,field orders, change orders or drawings and specifications; and (2) Supervision or inspection performed as part of any related architectural or engineering activities; or b. Any premises or work for which the additional insured is specifically listed as an additional insured on another endorsement attached to this policy. C. Section IV—Commercial General Liability Conditions is amended as follows: 1. Duties In The Event Of Occurrence, Offense, Claim Or Suit is amended to add the following: An additional insured under this endorsement will as soon as practicable: (1) Give us prompt written notice of any"occurrence"or offense which may result in a claim or"suit" under this insurance, and of any actual claim or"suit"; (2) Except as provided in Paragraph B.3. of this endorsement, agree to make available any other insurance the additional insured has for a loss we cover under this policy; (3) Immediately forward all legal papers to us, cooperate with us in the investigation, defense, or settlement of the claim or"suit", and otherwise comply with the policy conditions; and (4) Tender the defense and indemnity of any claim or"suit"to any other insurer whose policy may provide coverage for a loss covered under this endorsement including, but not limited to, any insurer that has issued a policy under which the additional insured qualifies as an insured; however, if the"written contract" requires this insurance to be primary and non-contributory, this provision does not apply to insurance on which the additional insured is a Named Insured. We have no duty to defend or indemnify an additional insured under this endorsement until we receive written notice of a claim or"suit"from the additional insured. D. Only for the purpose of the insurance provided by this endorsement, Section V— Defrnitions is amended to add the following definition: "Written contract" means a written contract or written agreement that requires you to make a person or organization an additional insured under this policy, provided the contract or agreement: a. Is currently in effect or becomes effective during the term of this policy; and b. Was signed and executed prior to the "bodily injury"or"property damage" or"personal MG 20 003 06 18 Page 2 of 3 Includes copyrighted material of Insurance Services Office, Inc., with its permission. and advertising injury"for which coverage under this policy is sought by the additional insured. All other terms and conditions remain unchanged. MG 20 003 06 18 Page 3 of 3 Includes copyrighted material of Insurance Services Office, Inc., with its permission. THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. GENERAL LIABILITY ENHANCEMENT ENDORSEMENT This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE 1. Expected Or Intended Injury 14. Newly Acquired Organizations 2. Amended Defense Coverage For Indemnitees 15. Additional Insureds By Written Contract 3. Non-Owned Watercraft 16. Additional Insured —Lessors of Leased Equipment Additional Insured —State Or Governmental 4. Non-Owned Aircraft 17. Agency Or Subdivision Or Political Subdivision —Permits Or Authorizations 5 Property Damage Liability—Borrowed 18. Additional Insured —Vendors Equipment 6. Property Damage Liability—Elevators 19. Broad Knowledge / Notice Of Occurrence 7. Damage To Premises Rented To You 20 Waiver Of Transfer Of Rights of Recovery Against Others To Us 8 Contractual Liability For Personal And 21. Unintentional Failure To Disclose Hazards Advertising Injury 9. Medical Payments 22. Mental Anguish, Mental Injury Or Humiliation 10. Supplementary Payments 23. Mobile Equipment 11. Broad Form Named Insured 24. Waiver Of Sovereign Immunity 12. Fellow Employee Coverage 25. Liberalization Clause 13. Incidental Medical Malpractice Liability 26. Application Of This Endorsement FM 101.0.1206 01 11 Page 1 of 10 Includes copyrighted material of Insurance Service Office, Inc. with its permission. 1. Expected Or Intended Injury Exclusion a. Expected Or Intended Injury under Section I - Coverage A- Bodily Injury And Property Damage Liability is hereby deleted and replaced by the following: "Bodily injury" or"property damage"expected or intended from the standpoint of the insured. This exclusion does not apply to "bodily injury"or"property damage" resulting from the use of reasonable force to protect persons or property. 2. Amended Defense Coverage For Indemnitees Supplementary Payments - Coverages Aand B is amended as follows: Paragraph 2.d.under Section I- Supplementary Payments -Coverages A and B is hereby deleted. Paragraph 2.e. under Section I - Supplementary Payments - Coverages A and B is hereby deleted and replaced by the following: The indemnitee and the insured ask us to conduct and control the defense of that indemnitee against such "suit". In the event we agree a conflict exists between the interests of the insured and the interests of the indemnitee, we will select and assign separate defense counsel for the indemnitee and pay reasonable attorney fees and necessary litigation expenses; and 3. Non-Owned Watercraft Paragraph (2)(a)of Exclusion g.Aircraft, Auto Or Watercraft under Section I- Coverage A- Bodily Injury And Property Damage Liability is hereby deleted and replaced by the following: (a)Less than 55 feet in overall length; and 4. Non-Owned Aircraft Exclusion g.Aircraft, Auto Or Watercraft under Section I- Coverage A- Bodily Injury And Property Damage Liability does not apply to an aircraft, in which you have no ownership interest, provided: a. It is: (1) Loaned to; (2) Rented by; or (3) Hired or chartered by the insured with a paid and licensed crew; b. It is not being used to carry persons or property for a charge: and FM 101.0.1206 01 11 Page 2 of 10 Includes copyrighted material of Insurance Service Office, Inc. with its permission. c. The pilot in command holds a currently effective license, issued by the duly constituted authority of the United States of America or Canada, designating him or her as a commercial airline pilot for the particular aircraft being flown. 5. Property Damage Liability- Borrowed Equipment Paragraph (4)of Exclusion j. Damage To Property under Section I - Coverage A- Bodily Injury And Property Damage Liability is amended to include the following: This exclusion does not apply to equipment which you borrow from a person or entity, other than an insured, unless the "property damage" occurs while such equipment is being used by an insured at a job site. Subject to all terms of Section III- Limits Of Insurance, the maximum limit in any one "occurrence" is $25,000 subject to an annual aggregate of$50,000 for all "occurrences". The insurance provided by this exception to Exclusion j.(4) as set forth in Paragraph 5.of this General Liability Enhancement Endorsement is excess over any other valid and collectible insurance available to the insured whether primary, excess (other than insurance written to apply specifically in excess of this policy), contingent or any other basis, that would also apply to the loss covered under this provision. 6. Property Damage Liability- Elevators Exclusion j. Damage To Property under Section I - Coverage A- Bodily Injury And Property Damage Liability is amended to include the following: Paragraphs (3) and (4) of this exclusion do not apply to liability arising out of the use of elevators. The insurance provided by this exception to Exclusions j.(3) and j.(4) as set forth in Paragraph 6.of this General Liability Enhancement Endorsement is excess over any other valid and collectible insurance available to the insured whether primary, excess (other than insurance written to apply specifically in excess of this policy), contingent or any other basis, that would also apply to the loss covered under this provision. 7. Damage To Premises Rented To You a. The last paragraph of 2. Exclusions under Section I - Coverage A- Bodily Injury And Property Damage Liability is hereby deleted and replaced by the following: (1) With respect to damage by fire to premises while rented to you or temporarily occupied by you with permission of the owner, Exclusions c. through in., do not apply. (2) With respect to damage by other than fire to premises while rented to you or temporarily occupied by you with permission of the owner, Exclusions c. through n., except for Exclusion f., do not apply unless the damage arises out of"your work". A separate limit of insurance applies to the coverage set forth in (1) and (2) above as FM 101.0.1206 01 11 Page 3 of 10 Includes copyrighted material of Insurance Service Office, Inc. with its permission. described in Section III - Limits Of Insurance. b. Section III- Limits Of Insurance is amended by deleting Paragraph 6.and replacing it with the following: 6. Subject to Paragraph 5. above, the Damage To Premises Rented To You Limit is the most we will pay under Coverage A for damages because of"property damage"to any one premises while rented to you or temporarily occupied by you with the permission of the owner. The Damage To Premises Rented To You Limit is the amount set forth in the Declarations or$300,000, whichever is greater. 8. Contractual Liability For Personal And Advertising Injury Exclusion e.Contractual Liability under Section I- Coverage B - Personal And Advertising Injury Liability is amended to add the following after the last sentence: This exclusion also does not apply to that part of any contract or agreement pertaining to your business under which you assume the "tort liability"of another party to pay for "personal and advertising injury"to a third party or organization, provided the "personal and advertising injury"offense occurs subsequent to the execution of the contractor agreement. For the purposes of this provision, "tort liability" means a liability that would be imposed by law in the absence of any contract or agreement. 9. Medical Payments Section I - Coverage C - Medical Payments is amended to include the following only if Coverage C - Medical Payments is not otherwise excluded from this coverage part: The Medical Payments Limit is changed to the greater of: a. $15,000; or b. The Medical Expense Limit shown in the Declarations of this coverage part. Paragraph 1.a.(3)(b) under Section I - Coverage C - Medical Payments is hereby deleted and replaced by the following: The expenses are incurred and reported to us within three years of the date of the accident; and 10. Supplementary Payments Supplementary Payments - Coverages A and B under Section I - Coverages is amended as follows: a. The bail bonds limit shown in Paragraph 1.b. is increased from $250 to $2,500. b. The actual loss of earnings limit shown in Paragraph 1.d. is increased from $250 to $1,000. FM 101.0.1206 01 11 Page 4 of 10 Includes copyrighted material of Insurance Service Office, Inc. with its permission. 11. Broad Form Named Insured Paragraph 1.d. under Section II—Who Is An Insured is amended to include the following: If you are an organization other than a partnership, limited liability company or joint venture, any of your subsidiary companies or any company over which you exercise control and actively manage will qualify as an insured only if other valid and collectible insurance does not apply. 12. Fellow Employee Coverage Paragraph 2.a. (1)(a) under Section 11—Who Is An Insured is hereby deleted. 13. Incidental Medical Malpractice Liability Paragraph 2.a. (1)(d)under Section II—Who Is An Insured does not apply to "employees" who are employed as nurses or other"employees", excluding physicians and medical doctors, who provide incidental health care services within the scope of their employment by you. 14. Newly Acquired Organizations Paragraph 3.a. under Section II —Who Is An Insured is hereby deleted and replaced by the following: a. Coverage under this provision is afforded only until the end of the policy period. 15. Additional Insureds By Written Contract Section II —Who Is An Insured is amended to include as an additional insured, any person or organization whom you are required to add as an additional insured to this policy by written contract or written agreement that is: a. Currently in effect or becoming effective during the term of this policy; and b. Executed prior to the"bodily injury", "property damage"or"personal and advertising injury". 1.The insurance provided to the additional insured applies as follows: (a) That person or organization is only an additional insured with respect to liability for"bodily injury", "property damage"or"personal and advertising injury"caused by your negligent acts or omissions at or from: (i) Premises you own, rent, lease or occupy; or (ii) Your ongoing operations performed for the additional insured at the jobsite indicated by the written contract or written agreement. (b) The limits of insurance applicable to the additional insured are those specified in the FM 101.0.1206 01 11 Page 5 of 10 Includes copyrighted material of Insurance Service Office, Inc. with its permission. written contract or written agreement or in the Declarations of this policy, whichever are less. These limits of insurance are inclusive of, and not in addition to, the limits of insurance shown in the Declarations of this policy. 2. If the additional insured is an architect, engineer or surveyor, the insurance provided to the additional insured does not apply to "bodily injury", "property damage"or "personal and advertising injury"caused by: (a) The rendering of or failure to render any professional services including preparing, approving or failing to prepare or approve maps, drawings, opinions, reports, surveys, change orders, designs or specifications; or (b) Any supervisory, inspection or engineering services. 3. With respect to the insurance afforded these additional insured(s), the following additional exclusion applies: This insurance does not apply to "bodily injury", "property damage"or"personal and advertising injury": (a) Occurring after all work (including materials, parts or equipment furnished in connection with such work) on the project(other than service, maintenance or repairs)to be performed by or on behalf of the additional insured(s) at the location of the covered operations has been completed; or (b) Occurring after that portion of"your work"out of which the injury or damage arises has been put to its intended use by any person or organization other than another contractor or subcontractor engaged in performing operations for a principal as part of the same project. Paragraph a. Primary Insurance of Condition 4. Other Insurance under Section IV— Commercial General Liability Conditions is amended by the addition of the following: Regardless of whether other insurance is maintained by an additional insured on a primary basis, the coverage provided by Paragraph 15.of the General Liability Enhancement Endorsement will be primary to and noncontributing with other insurance maintained by the additional insured if the written contract between you and the additional insured specifically requires that this insurance be primary. 16. Additional Insured—Lessors Of Leased Equipment Section II —Who Is An Insured is amended to include as an additional insured any person or organization from whom you lease equipment and with whom you have agreed to add as an additional insured to this policy by written contract or written agreement but only with respect to "bodily injury", "property damage"or"personal and advertising injury"caused, in whole or in part, by your maintenance, operation or use of the equipment leased to you by such person or organization. With respect to the insurance afforded to these additional insured(s), this insurance does not apply to any "occurrence"which takes place after the equipment lease expires or is FM 101.0.1206 01 11 Page 6 of 10 Includes copyrighted material of Insurance Service Office, Inc. with its permission. terminated. 17. Additiional Insured - State Or Governmental Agency Or Subdivision Or Political Subdivision - Permits Or Authorizations Section II -Who Is An Insured is amended to include as an additional insured any state or governmental agency or subdivision or political subdivision which has issued a permit or authorization to you. a. This applies only with respect to operations performed by you or on your behalf for which the state or governmental agency or subdivision or political subdivision has issued a permit or authorization. b. This insurance does not apply to: (1) "Bodily injury", "property damage"or"personal and advertising injury"arising out of operations performed for the state or governmental agency or subdivision or political subdivision; or (2) "Bodily injury"or"property damage" included within the"products-completed operations hazard". 18. Additional Insured-Vendors Section II -Who Is An Insured is amended to include as an additional insured any person or organization (referred to below as vendor)whom you have agreed to add as an additional insured to this policy by written contract or written agreement butonlywith respect to"bodily injury"or"property damage"arising out of"your products"which are distributed orsold in the regular course of the vendor's business, subject to the following additional exclusions: The insurance afforded the vendor does not apply to: a. "Bodily injury"or"property damage"for which the vendor is obligated to pay damages by reason of the assumption of liability in a contract or agreement. This exclusion does not apply to liability for damages that the vendor would have in the absence of the contract or agreement; b. Any express warranty unauthorized by you; c. Any physical or chemical change in the product made intentionally by the vendor; d. Repackaging, except when unpacked solely for the purpose of inspection, demonstration, testing or the substitution of parts under instructions from the manufacturer, and then repackaged in the original container; e. Any failure to make such inspections, adjustments, tests or servicing as the vendor has agreed to make or normally undertakes to make in the usual course of business, in connection with the distribution or sale of the products; f. Demonstration, installation, servicing or repair operations, except such operations FM 101.0.1206 01 11 Page 7 of 10 Includes copyrighted material of Insurance Service Office, Inc. with its permission. performed at the vendor's premises in connection with the sale of the product; g. Products which, after distribution or sale by you, have been labeled or relabeled or used as a container, part or ingredient of any other thing or substance by or for the vendor; or h. "Bodily injury"or"property damage"arising out of the sole negligence of the vendor for its own acts or omissions or those of its "employees"or anyone else acting on its behalf. However, this exclusion does not apply to: (1) The exceptions contained in subparagraphs d.or f.; or (2) Such inspections, adjustments, tests or servicing as the vendor has agreed to make or normally undertakes to make in the usual course of business, in connection with the distribution or sale of the products. This insurance does not apply to any insured person or organization, from whom or which you have acquired such products, or any ingredient, part or container, entering into, accompanying or containing such products. The coverage afforded the additional insured under this provision will be excess over any valid and collectible insurance available to the additional insured as an additional insured under a policy issued to a manufacturer or distributor for products manufactured, sold, handled or distributed unless you require that this insurance be primary and non- contributory. 19. Broad Knowledge / Notice Of Occurrence Section IV— Commercial General Liability Conditions is amended to include the following: The requirement in Condition 2.a., which states that you must see to it that we are notified of any"occurrence"or offense, applies only when the"occurrence"or offense is known to: 1. You, if you are an individual; 2. A partner, if you are a partnership; 3. A member, if you are a joint venture; 4. An "executive officer", manager or supervisor if you are a corporation; or 5. A member, if you are a limited liability company. The requirement in Condition 2.b., which states that you must see to it that we receive notice of a claim or"suit",will not be considered breached unless the breach occurs after such claim or"suit" is known to: 1. You, if you are an individual; 2. A partner, if you are a partnership; 3. A member, if you are a joint venture; 4. An "executive officer", manager or supervisor if you are a corporation; or 5. A member, if you are a limited liability company. If you report an accident to your Workers Compensation insurance carrier which later develops into a claim or"suit"for a liability "occurrence"for coverage which is provided by FM 101.0.1206 01 11 Page 8 of 10 Includes copyrighted material of Insurance Service Office, Inc. with its permission. this policy, failure to report such "occurrence"to us at the time of the accident shall not be a violation of the notification of loss condition (Condition 2. Duties In The Event Of Occurrence, Offense, Claim Or Suit under Section IV— Commercial General Liability Conditions) contained in this policy. It is agreed, however, that you shall give notification of such claim or"suit"to us as soon as you are made aware of the fact that the particular accident has developed into a claim or"suit". 20. Waiver Of Transfer Of Rights Of Recovery Against Others To Us Condition 8. Transfer Of Rights Of Recovery Against Others To Us under Section IV— Commercial General Liability Conditions is amended to include the following: We waive any right of recovery we may have against a person or organization because of payments we make for injury or damage arising out of your ongoing operations or"your work"done under a contract with that person or organization and included in the"products- completed operations hazard"when you have waived such right of recovery under a written contract with that person or organization. Such written contract must be: a. Currently in effect or becoming effective during the term of this policy; and b. Executed prior to the"bodily injury", "property damage"or"personal and advertising injury". Alternatively, the written contract may be executed after the"bodily injury", "property damage"or"personal and advertising injury" but only if. (i) The terms and conditions of the written contract or written agreement had been agreed upon prior to the"bodily injury", "property damage"or"personal and advertising injury"; and (iQThe insured can definitively establish that the terms and conditions of the written contract or written agreement ultimately executed are the same as those which had been agreed upon prior to the"bodily injury", "property damage"or"personal and advertising injury". 21. Unintentional Failure To Disclose Hazards Section IV—Commercial General Liability Conditions is amended to include the following: 9. Unintentional Failure To Disclose Hazards Your unintentional failure to disclose all hazards or prior"occurrences"existing as of the inception date of this policy shall not prejudice the coverage afforded by this policy. 22. Mental Anguish, Mental Injury Or Humiliation The definition of"bodily injury" in Paragraph 3.under Section V— Definitions is hereby deleted and replaced by the following: "Bodily injury" means bodily injury, sickness or disease sustained by a person, including FM 101.0.1206 01 11 Page 9 of 10 Includes copyrighted material of Insurance Service Office, Inc. with its permission. mental anguish, mental injury, humiliation or death resulting from any of these at any time. 23. Mobile Equipment Paragraph 12.under Section V- Definitions is amended to include the following: Paragraph f.(1)does not apply to self-propelled vehicles of less than 1,000 pounds gross vehicle weight. 24. Waiver Of Sovereign Immunity The following provision applies if you are a"governmental entity"or we have added a "governmental entity"to your policy as an additional insured, and the"governmental entity" requires us to obtain permission prior to asserting a defense involving governmental immunity or the jurisdiction of the tribunal over the"governmental entity": We shall not raise any defense involving, in any way, the jurisdiction of the tribunal over the"governmental entity",the immunity of the"governmental entity"or its commissioners, officers, agents or employees, the governmental nature of such entity, or the provisions of any statutes respecting suits against the"governmental entity" without first obtaining express advance permission from the designated representative of the"governmental entity". Application of this provision shall not subject us to liability for any portion of a claim or judgment in excess of the applicable limit of insurance. For the purposes of this provision, "governmental entity"means a state, county, district, municipality, town,township, borough, parish, village, or other political subdivision or governmental agency or subdivision. 25. Liberal¢ation Clause If we adopt a change in the coverage form, CG 00 01, which broadens coverage without an additional premium charge, the broader coverage will apply to this policy on the effective date of approval in the state shown in the Named Insured's address in the Declarations of this policy. 26. Application Of This Endorsement The coverage enhancements provided by this endorsement apply to the Commercial General Liability Coverage Part. If your policy includes other endorsements in addition to this General Liability Enhancement Endorsement, and there is a conflict between any of the terms of such endorsement(s) and this General Liability Enhancement Endorsement, the terms of the other endorsement(s) shall be given priority and control over the terms set forth in this General Liability Enhancement Endorsement, even if the terms of such other endorsement(s) have the effect of limiting, excluding or reducing the coverage provided under this General Liability Enhancement Endorsement. All other terms and conditions remain unchanged. FM 101.0.1206 01 11 Page 10 of 10 Includes copyrighted material of Insurance Service Office, Inc. with its permission.