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HomeMy WebLinkAboutResolution - 2014-R0074 - Contract - CS Advantage USAA Inc - Roof Replacement - 02_27_2014 (6)Resolution No. 2014-R0074 February 27, 2014 Item No. 5.24 RESOLUTION BE IT RESOLVED BY THE CITY COUNCIL OF THE CITY OF LUBBOCK: THAT the Mayor of the City of Lubbock is hereby authorized and directed to execute for and on behalf of the City of Lubbock, Contract No. 11732 for roof replacement at Blower Building No. 4 — Southeast Water Reclamation, by and between the City of Lubbock and CS Advantage, USAA, Inc., and related documents. Said Contract is attached hereto and incorporated in this resolution as if fully set forth herein and shall be included in the minutes of the City Council. Passed by the City Council on February 27, 2014 C. ROBERTSON, MAYOR ATTEST: 4Q1 Le le�' - —)�7 Re e a Garza, City Secret t '� APPROVED AS TO CONTENT: R. Keith Smith, P.E., Director of Public Works APPROVED AS TO FORM: Chad Weaver, Assistant City Attorney vwxcdocs/RES.Contract-CS Advantage February 17, 2014 PROPOSAL SUBMITTAL FORM LUMP SUM PROPOSAL CONTRACT DATE: _-�_ _% y PROJECT NUMBER: 14-11732-NIA -Roof Replacement Blower Building No. 4 Southeast Water Reclamation Plant Proposal of C,S N PVD/q-7U Z1F Q S AA J KG (hereinafter called O fferor) To the Honorable Mayor and City Council City of Lubbock, Texas (hereinafter called Owner) Ladies and Gentlemen: The Offeror, in compliance with your Request for Proposals for the construction of a Roof Replacement Blower Building No. 4 Southeast Water Reclamation Plant having carefully examined the plans, specifications, instructions to offerors, notice to offerors and all other related contract documents and the site of the intended work, and being familiar with all of the conditions surrounding the construction of the intended project including the availability of materials and labor, hereby intends to furnish all labor, materials, and supplies; and to construct the project in accordance with the plans, specifications and contract documents, within the time set forth therein and at the price stated below. The price to cover all expenses incurred in performing the work required under the contract documents. ITEM NO. DESCRIPTION UNIT MATERIALS LABOR TO"rAL PRICE Roof Replacement Project — 1 Blower Building No. 4 at the LS - �/ Southeast Water Reclamation Plant, asspecified TOTAL LUMP SUM $ 660. Contractors proposed CONTRUCTION TIME for completion: t 26 Offeror hereby agrees to commence the work on the above project on a date to be specified in a written "Notice to Proceed" of the Owner and to substantially complete the project within 120 ( One Hundred and Twenty) CONSECUTIVE CALENDAR OR WORKING DAYS thereafter as stipulated in the specifications and other contract documents. Offeror hereby further agrees to pay to Owner as liquidated damages the sum of$100(One Hundred) for each consecutive calendar day in excess of the time set forth herein above for completion of this project, all as more fully set forth in the general conditions of the contract documents. Offeror understands and agrees that this proposal submittal shall be completed and submitted in accordance with instruction number 29 of the General Instructions to Offerors. _q��eOfferor's Initials Offeror understands that the Owner reserves the right to reject any or all proposals and to waive any formality in the proposing. The Offeror agrees that this proposal shall be good for a period of sixty (60) calendar days after the scheduled closing time for receiving proposals. The undersigned Offeror hereby declares that he has visited the site of the work and has carefully examined the plans, specifications and contract documents pertaining to the work covered by this proposal, and he further agrees to commence work on the date specified in the written notice to proceed, and to substantially complete the work on which he has proposed; as provided in the contract documents. Offerors are required, whether or not a payment or performance bond is required, to submit a cashier's check or certified check issued by a bank satisfactory to the City of Lubbock, or a proposal bond from a reliable surety company, payable without recourse to the order of the City of Lubbock in an amount not less than five percent (5%) of the total amount of the proposal submitted as a guarantee that offeror will enter into a contract, obtain all. required insurance policies, and execute all necessary bonds (if required) within ten (10) days after notice of award of the contract to him. Offeror's initials Enclosed with this proposal is a Cashier's Check or Certified Check Enclosed with this proposal is a Cashier's Check or Certified Check for Dollars ($ ) or a Proposal Bond in the sum of 15 YZ ro f) � , Dollars ($ 5-1Z 6pJ--3 ), which it is agreed shall be collected and retained by the Owner as liquidated damages in the event the proposal is accepted by the Owner and the undersigned fails to execute the necessary contract documents, insurance certificates, and the required bond (if any) with the Owner within ten (10) business days after the date of receipt of written notification of acceptance of said proposal; otherwise, said check or bond shall be returned to the undersigned upon demand. Offeror understands and agrees that the contract to be executed by Offeror shall be bound and include all contract documents made available to him for his inspection in accordance with the Notice to Offerors. Pursuant to Texas Local Government Code 252.043(g), a competitive sealed proposal that has been opened may not be changed for the purpose of correcting an error in the proposal price. THEREFORE, ANY CORRECTIONS TO THE PROPOSAL PRICE MUST BE MADE ON THE PROPOSAL (Seal if Offeror is a Corporation) ATTEST: 2 Secretary ` Offeror acknowledges receipt of the following addenda Addenda No. Date Addenda No. Date Addenda No. Date Addenda No. Date Date: I 1 q"} ) Y ure (Printed or Typed Name) Company Address 13 City, County 774 -777/8 9 z State Zip Code Telephone: Z)i_ - -T T 1.O T -z jo Fax: '210 - 5-1!! Z1S-1 Email: _ s�—�;� Q 0 / J3CwN? FEDERAL TA ID or SO IAL SECURITY No. 2'1 2 `312 4 � Resolution No. 2014-R0074 February 27, 2014 Item No. 5.24 RESOLUTION BE IT RESOLVED BY THE CITY COUNCIL OF THE CITY OF LUBBOCK: THAT the Mayor of the City of Lubbock is hereby authorized and directed to execute for and on behalf of the City of Lubbock, Contract No. 11732 for roof replacement at Blower Building No. 4 — Southeast Water Reclamation, by and between the City of Lubbock and CS Advantage, USAA, Inc., and related documents. Said Contract is attached hereto and incorporated in this resolution as if fully set forth herein and shall be included in the minutes of the City Council. Passed by the City Council on February 27, 2014 C. ROBERTSON, MAYOR ATTEST: 4Q1 Le le�' - —)�7 Re e a Garza, City Secret t '� APPROVED AS TO CONTENT: R. Keith Smith, P.E., Director of Public Works APPROVED AS TO FORM: Chad Weaver, Assistant City Attorney vwxcdocs/RES.Contract-CS Advantage February 17, 2014 PROPOSAL SUBMITTAL FORM LUMP SUM PROPOSAL CONTRACT DATE: _-�_ _% y PROJECT NUMBER: 14-11732-NIA -Roof Replacement Blower Building No. 4 Southeast Water Reclamation Plant Proposal of C,S N PVD/q-7U Z1F Q S AA J KG (hereinafter called O fferor) To the Honorable Mayor and City Council City of Lubbock, Texas (hereinafter called Owner) Ladies and Gentlemen: The Offeror, in compliance with your Request for Proposals for the construction of a Roof Replacement Blower Building No. 4 Southeast Water Reclamation Plant having carefully examined the plans, specifications, instructions to offerors, notice to offerors and all other related contract documents and the site of the intended work, and being familiar with all of the conditions surrounding the construction of the intended project including the availability of materials and labor, hereby intends to furnish all labor, materials, and supplies; and to construct the project in accordance with the plans, specifications and contract documents, within the time set forth therein and at the price stated below. The price to cover all expenses incurred in performing the work required under the contract documents. ITEM NO. DESCRIPTION UNIT MATERIALS LABOR TO"rAL PRICE Roof Replacement Project — 1 Blower Building No. 4 at the LS - �/ Southeast Water Reclamation Plant, asspecified TOTAL LUMP SUM $ 660. Contractors proposed CONTRUCTION TIME for completion: t 26 Offeror hereby agrees to commence the work on the above project on a date to be specified in a written "Notice to Proceed" of the Owner and to substantially complete the project within 120 ( One Hundred and Twenty) CONSECUTIVE CALENDAR OR WORKING DAYS thereafter as stipulated in the specifications and other contract documents. Offeror hereby further agrees to pay to Owner as liquidated damages the sum of$100(One Hundred) for each consecutive calendar day in excess of the time set forth herein above for completion of this project, all as more fully set forth in the general conditions of the contract documents. Offeror understands and agrees that this proposal submittal shall be completed and submitted in accordance with instruction number 29 of the General Instructions to Offerors. _q��eOfferor's Initials Offeror understands that the Owner reserves the right to reject any or all proposals and to waive any formality in the proposing. The Offeror agrees that this proposal shall be good for a period of sixty (60) calendar days after the scheduled closing time for receiving proposals. The undersigned Offeror hereby declares that he has visited the site of the work and has carefully examined the plans, specifications and contract documents pertaining to the work covered by this proposal, and he further agrees to commence work on the date specified in the written notice to proceed, and to substantially complete the work on which he has proposed; as provided in the contract documents. Offerors are required, whether or not a payment or performance bond is required, to submit a cashier's check or certified check issued by a bank satisfactory to the City of Lubbock, or a proposal bond from a reliable surety company, payable without recourse to the order of the City of Lubbock in an amount not less than five percent (5%) of the total amount of the proposal submitted as a guarantee that offeror will enter into a contract, obtain all. required insurance policies, and execute all necessary bonds (if required) within ten (10) days after notice of award of the contract to him. Offeror's initials Enclosed with this proposal is a Cashier's Check or Certified Check Enclosed with this proposal is a Cashier's Check or Certified Check for Dollars ($ ) or a Proposal Bond in the sum of 15 YZ ro f) � , Dollars ($ 5-1Z 6pJ--3 ), which it is agreed shall be collected and retained by the Owner as liquidated damages in the event the proposal is accepted by the Owner and the undersigned fails to execute the necessary contract documents, insurance certificates, and the required bond (if any) with the Owner within ten (10) business days after the date of receipt of written notification of acceptance of said proposal; otherwise, said check or bond shall be returned to the undersigned upon demand. Offeror understands and agrees that the contract to be executed by Offeror shall be bound and include all contract documents made available to him for his inspection in accordance with the Notice to Offerors. Pursuant to Texas Local Government Code 252.043(g), a competitive sealed proposal that has been opened may not be changed for the purpose of correcting an error in the proposal price. THEREFORE, ANY CORRECTIONS TO THE PROPOSAL PRICE MUST BE MADE ON THE PROPOSAL (Seal if Offeror is a Corporation) ATTEST: 2 Secretary ` Offeror acknowledges receipt of the following addenda Addenda No. Date Addenda No. Date Addenda No. Date Addenda No. Date Date: I 1 q"} ) Y ure (Printed or Typed Name) Company Address 13 City, County 774 -777/8 9 z State Zip Code Telephone: Z)i_ - -T T 1.O T -z jo Fax: '210 - 5-1!! Z1S-1 Email: _ s�—�;� Q 0 / J3CwN? FEDERAL TA ID or SO IAL SECURITY No. 2'1 2 `312 4 � ��o I q - K Do-? 9 Contract #: 11732 Change Order #: Requisition #: BID#: 14-11732-MA CONTRACT COVER SHEET See Step -by -Step Contracting Process on CLIC for Instructions (Type or Print all information with the exception of Signatures and Signature Dates) Forward the complete contract package to Contract Management, Municipal Building Suite 204, for review, approval and contract execution. The complete package includes one (1) copy of the completed Contract Cover Sheet (for internal City use only); minimum of three (3) originals of the contract or amendment; and minimump94hreq (3) originals of all other certifications and contract addenda. Attached Contract must be "Al proved as to tent" by ector and "Approved as to Form" by Legal. The following signatures e required to process Contract Cove Sheet RTAN alperson who signs t Contract Cover Sheet m t carefully review a att ed contract docume ore st m n , ct r. er e . Risk Man ger: ' e ert Reqd: Approved & Attached Date Director of Fiscal Policy Date: �� f City Manager Direct Report: Date: Z Originating Dept and Individua esponsible for Ensuring Contract Terms and Contract Compliance: F Facilities Management Name: Wesley D. Everett er: 1*775-2275 Title: Director of Facilities Management Information for Vendor/Contractor/Agency or Other Entity City of Lubbock is Contracting With: Name of Entity: CS Advantage USAA Inc. Address: P.O. Box 12407 i City: College Station -� State: ;Texas Zip 77842 � Contact Name: Oscar Galvan Contract Signatory: Title: President Phone #: (210) 771-0720 Fax (210) 579-2157 E-mail: o_ggalvan@hotmail.com Contract Information: Brief Description of Goods or Services or arrangements covered by the terms of the contract: remove/reinstall blower building #4 roof at Southeast Water Reclamation Plant Effective Date: Upon Execution by Authorized Signatories OR Other (Specify Date): End Date:Z Notice To Proceed + 330 (Specify # of Days) OR Other (Specify Date): 75 days added to original contract. i Financial Informatiion Cost Center: q'0'/% Account #: Will Contract No Generate If so, amount: $ Revenue: Reviewed by Purchasing Manager: 9242.30000 r Amount: Not To Exceed: 119,000 v Other: Project Number (if applicable): 91042 Will Contract Be Paid From Grant Funds: l"° Notes: ContractCoverSheet.doc (Rev 10/2007) Contract Form and Signatory Contract: General Agreement Signatory: Mayor Contract Checklist (Not applicable to Change Orders or Amendments) 1. Is this individual or owner of this business an officer or employee of the City of Lubbock? lNo [Note: If Yes, City policy may not allow us to write a contract for this individual/vendor.] If unsure, check with Legal. 2. Are all documents in order and submitted at least 5 business days prior to the at least 20 business days prior to start date for services if using a non-standard contract? Yes [Note: If No, and not associated with a building repair, complete a "Justification for Untimely Contract Submittal" form.] 3. Does the contract, Licensing Agreement, insurance or other document requiring signature originate from the vendor? [Note: If Yes, must be reviewed by Legal. Forward to Purchasing Department.]l No — 4. Does the contract involve work by the contractor on City owned property? iYes - SEE NOTE... (Note: If Yes, contact Risk Management at (806) 775-2277.) 5. Does the contract involve the purchase of hardware, software, firmware or computer component acquisition?INo [Note: If Yes, A Purchase Requisition from Information Technology is required. Contact IT at (806) 775-2374.) 6. Does the contract involve a purchase valued at $2,500 or more? INo [Note: If Yes, A Purchase Requisition is required. For assistance, contact your Buyer in the Purchasing Department.) 7. Does the contract involve a purchase valued at $25,000 or more? No [Note: If Yes, Formal Competitive Sealed Bidding is required. For assistance, contact your Buyer in the Purchasing Department.) 8. Does the contract involve Consulting Services valued at $25,000 or more? Yes - Proposals were solicitated by Purchasing [Note: If Yes, requires Request for Qualifications. Contact Director of Purchasing & Contract Management (806) 775-2165.) 9. Does the contract involve purchase of construction valued at $25,000 or more? Yes - SEE NOTE... [Note: If Yes, Requires Payment Bond.] 10. Does the contract involve purchase of construction valued at $100,000 or more? Yes - SEE NOTE... [Note: If Yes, contract requires Performance Bond] 11. Does the contract include language for Insurance Requirements? iYes - SEE NOTE... (Note: If Yes, contact Risk Management at (806) 775-2277.) 12. If state funded, does the contract require language for Child Support certification? iNot Applicable [Note: If Yes, attach Child Support Certification, form OCA-S-99-25 for state funded acquisition.] 13. If federal or state funded, does the contract include all clauses re uired b federal or state statutes and executive orders and their implementing regulations? lNo 14. If the purchase/transaction involves the purchase, lease, acceptance as a gift, etc. of real estate, has an environmental site assessment (ESA) been performed on the property? Not Applicable [Note: If No, contact Environmental Compliance at x2$$r0_rX11' . Contract Award by City Council (enter applicable information) Council Date: Council Agenda Item #: Resolution #: The complete package includes one (1) copy of the completed Contract Cover Sheet (for internal City use only); minimum of three (3) originals of the contract or amendment; and minimum of three (3) originals of all other certifications and contract addenda. Forward the complete contract package to Contract Management, Municipal Building Suite 204, for review, approval and contract execution. ContractCoverSheet.doc (Rev 10/2007) CSADVAN-01 MEDWARDS CERTIFICATE OF LIABILITY INSURANCE DAT3191201YYYY) 3/9/2014 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 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 Hughston Insurance Agency, Inc. P.O. Box 8550 Brownsville, TX 78526-8550 CONTACT NAME: Mary Edwards PHONE (956) 542-4387 FAX No : (956) 542-8335 A/CNo Ext E-MAIL ma hiains.net ADDRESS: ry@ INSURER(S) AFFORDING COVERAGE NAIC # INSURER A: Starr Surplus Lines Ins. CO. INSURED CS Advantage USAA, Inc. PO Box 12407 College Station, TX 77845 INSURER B: Travelers Casualty Ins CO Of America INSURER C: Torus National Insurance Co 25496 INSURER D: Texas Mutual Insurance Company 22945 INSURER E: America First Insurance Co. 12696 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' TYPE OF INSURANCEADDLI R I POLICY EFF POLICY EXP LIMITS LTR POLICY NUMBER MM/DD/YYYY I MM/DD/YYYY j GENERAL LIABILITY I EACH OCCURRENCE $ DAMA E ENTED A X SLPG-GL00789-02 ' 04/28/2013 04/28/2014 1,000,00 100,00 COMMERCIAL GENERAL LIABILITY PREMISES (Ea occurrence) $ CLAIMS Xj OCCUR j MED $ 5,00 -MADE EXP (Any one person) PERSONAL & ADV INJURY $ 1,000,00 i j `GENERAL AGGREGATE _ $ 2,000,00 GEN'L AGGREGATE LIMIT APPLIES PER: j PRODUCTS - COMPIOP AGG $ 2,000,00 PRO �� $ POLICY'I JECT LOC I AUTOMOBILE LIABILITY I f I COMBINED SINGLE LIMIT 1 1,000,000 E$ a accident) B � j ANY AUTO i BA-9A215232-14-SEL 101/13/2014 j 01/13/2015 BODILY INJURY (Per person) I $ ALL OWNED SCHEDULED BODILY INJURY (Per accident) $ ! J AUTOS AUTOS NON -OWNED PROPERTY DAMAGE $ I HIRED AUTOS �— AUTOS PER ACCIDENT N $ I X I UMBRELLA LIAR 1 + OCCUR EACH OCCURRENCE $ 3,000,00 C EXCESS LIAB L CLAIMS -MADE I j07847B132ALI 04/28/2013 i 04/28/2014 AGGREGATE 1 $ 3,000,00 DED i RETENTION $ �_ $ WORKERS COMPENSATION WC STATU- I OTH-1 I X TORY LIMITS I ER I AND EMPLOYERS' LIABILITY I D ANY PROPRIETOR/PARTNERIEXECUTIVE Y I N TSF0001211645 04/28/2013 1 04/28/2014 E.L. EACH ACCIDENT $ - 1,000,00 OFFICER/MEMBER EXCLUDED? "IN/A! - (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE $ 1,000,00 It yes, describe under DESCRIPTION OF OPERATIONS below E. D EASE - POLICY LIMIT { $ 1,000,000 E ,Installation Floater jIM8772404 04/28/2013 104/28/2014 iAny One Jobsite 2,600,00 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) Re: 14-11732-MA Roof Replacement Blower Building No. 4 Southeast Water Reclamation Plant Additional Insured Endorsement is shown on General Liability Policy on a Primary & Non -Contributory basis as per Endorsements CG2010 (10/01) and CG2037 (10/01) & on Business Auto Policy as per CAT420 (07/06). Waiver of Subrogation Endorsement is shown on Workers Compensation policy as per WC420304A (01/00), on General Liability as per CG2404 (10/93) and on Business Auto as per CAT420 (07/06). TE HOLDER City of Lubbock 1625 13th Street Room 204 Lubbock, TX 79401 SHOULD ANY OF THE EXPIRATIC AUTHORIZED ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE IATE/THEREOF, NOTICE WILL BE DELIVERED IN HE PFOLICY PROVISIONS. ACORD 25 (2010/05) ©1988-2010 The ACORD name and logo are registered marks of TION. All rights reserved. CSADVAN-01 MEDWARDS CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 3/9/2014 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 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 CONTANAME: CT Mary Edwards Hughston Insurance Agency, Inc. PHONE (g56 542 4387 FAX A/c, No P.O. Box 8550 A/C No Ext : ) (956) 542-8335 Brownsville, TX 78526-8550 EMAIL annRGcc. marvb-hiains.net INSURED CS Advantage USAA, Inc. PO Box 12407 College Station, TX 77845 INSURER(S) AFFORDING COVERAGE NAIC # INSURER A: Starr Surplus Lines Ins. Co. INSURER B: Travelers Casualty Ins Co of America INSURER C: Torus National Insurance Co 25496 INSURER D: Texas Mutual Insurance Company 22945 INSURER E: America First Insurance Co. 112696 COVERAGES CFRTIFICATF NI IMRFR- RFVI.glnN NIIMRFR- THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR I ADDLE UBR € POLICY EFF POLICY EXP LTR I TYPE OF INSURANCE I POLICY NUMBER MM/DD MMIDD/YYYY LIMITS GENERAL LIABILITY i EACH OCCURRENCE $ A ISLPG-GL00789-02 104/28/2014 - D 'E R NTED 1,000,000 100,00 !_X COMMERCIAL GENERAL LIABILITY 04/28/2013 PREMISES Ea occurrence $ CLAIMS -MADE OCCUR MED EXP (Any one person) $ 5,00 j I PERSONAL & ADV INJURY $ 1,000,00 I GENERAL AGGREGATE $ 2,000,00 GENT AGGREGATE APPLI S PER: G PRODUCTS - COMP/OP AGG $ 2,000,00 PLIMIT POLICY X I LOC i is AUTOMOBILE LIABILITY I I COMBINED SINGLE LIMIT i1,000,000 _ ! (Ea accident $ B X ANY AUTO BA-9A215232-14-SEL 01/13/2014 01/13/2015 i BODILY INJURY (Per person) $ �. ALL OWNED SCHEDULED ;BODILY INJURY (Per accident) $ AUTOS AUTOS j NON -OWNED y PROPERTY DAMAGE $ HIRED AUTOS AUTOS s(PERACCIDENT) $ X s UMBRELLA LIAB ;OCCUR I EACH OCCURRENCE $ 3,000,00 C € I EXCESS LIAB 7 CLAIMS -MADE 07847B132ALI i 04/28/2013 04/28/2014 AGGREGATE Is i— 3,000,00 1 I DED RETENTION $ I I $ WORKERS COMPENSATIONi I X WCTORLIMITS , OR AND EMPLOYERS' LIABILITY i i YIN j € D ANY PROPRIETOR/PARTNER/EXECUTIVE ETSF0001211645 04/28/2013 ' 04/28/2014 E.L. EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? N / A 1,000,000 ; (Mandatory in NH) j E.L. DISEASE - EA EMPLOYEE $ 1,000,000 I If yes, describe under DESCRIPTION OF OPERATIONS below ! E.L. DISEASE - POLICY LIMIT $ 1,000,00 E 'Installation Floater IM8772404 y 04/28/2013 104/28/2014 Any One Jobsite 2,600,00 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) Re: 14-11732-MA Roof Replacement Blower Building No. 4 Southeast Water Reclamation Plant Additional Insured Endorsement is shown on General Liability Policy on a Primary & Non -Contributory basis as per Endorsements CG2010 (10/01) and CG2037 (10/01) & on Business Auto Policy as per CAT420 (07/06). Waiver of Subrogation Endorsement is shown on Workers Compensation policy as per WC420304A (01/00), on General Liabillty as per CG2404 (10193) and on Business Auto as per CAT420 (07/06). CERTIFICATE HOLDER CANCELLATION City of Lubbock 1625 13th Street Room 204 Lubbock, TX 79401 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE T�REOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITA NE POLICY PROVISIONS. AUTHORIZED ACORD 25 (2010/05) 19ft-2010 A ORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of A RD CSADVAN-01 MEDWARDS A�coRo CERTIFICATE OF LIABILITY INSURANCE DATE31912 D/YYYY) /9/2014 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 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 Hughston Insurance Agency, Inc. P.O. Box 8550 Brownsville, TX 78526-8550 — CONTANAME: CT Mary Edwards PHONE (956) 542-4387 aC No : (956) 542-8335 A/C No Ext E-MAIL ma hiains.net ADDRESS: iy@ INSURER(S) AFFORDING COVERAGE NAIC # INSURER A: Starr Surplus Lines Ins. Co. INSURED CS Advantage USAA, Inc. PO Box 12407 College Station, TX 77845 INSURER B: Travelers Casualty Ins Co of America INSURER C: Torus National Insurance Co 125496 INSURER D: Texas Mutual Insurance Company 122945 INSURER E : America First Insurance Co. 112696 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. INSIR A UBR i POLICY EFF POLICY EXP LTR TYPE OF INSURANCE POLICY NUMBER MM/DD/YYY MM/DD/YYYY LIMITS GENERAL LIABILITY I EACH OCCURRENCE $ 1,000,00 DAMAGE TO RENTED A " X j COMMERCIAL GENERAL LIABILITY 04/28/2013 1 04/28/2014 PREMISES Ea occurrence $ 100,00 iSLPG-GL00789-02 CLAIMS -MADE L ,• !OCCUR i ( MED EXP (Any one person) $ 5,00 PERSONAL & ADV INJURY � $ 1,000,00 GENERAL AGGREGATE $ 2,000,00 GEN'L AGGREGATE LIMIT APPLIES PER. 1 PRODUCTS - COMP/OP AGG 1 $ 2,000,00 POLICY ` X i PROFC� 1 I LOC I j AUTOMOBILE LIABILITY l COMBIN01flNGLt LIMIT i $ Ea accident 1 000,00 B X I ANY AUTO BA-9A215232-14-SEL 01/13/2014 01/13/2015 BODILY INJURY (Per person) $ ALL OWNED i SCHEDULED _ BODILY INJURY (Per accident) E $ AUTOS AUTOS �i NON -OWNED PROPERTY DAMAGE $ HIRED AUTOS �a AUTOS i PER ACCIDENT i i I i $ j X j UMBRELLA LIAB j J OCCUR EACH OCCURRENCE $ 3,000,00 _ C EXCESS LIAB IiI--1, CLAIMS-MADEI 07847B132ALI 04/28/2013 04/28/2014 AGGREGATE $ 3,000,00 DED RETENTION $ $ WORKERS COMPENSATION V X OER TWC ORY LIMITS AND EMPLOYERS' LIABILITY E YIN N I E iTSF0001211645 04/28/20131 04/28/2014 E.L. EACH ACCIDENT $ D I ANY PROPRIETOR/PARTNER/EXECUTIVE 1,000,00 OFFICER/MEMBER EXCLUDED? ❑ N ! A (Mandatory in NH) I E.L. DISEASE - EA EMPLOYEE $ 1,000,00 If yes, describe under DESCRIPTION OF OPERATIONS below i E.L. DISEASE - POLICY LIMIT $ 11000,000 E 'installation Floater IM8772404 04/28/2013 04/28/2014 IAny One Jobsite j { k 2,500,00 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) Re: 14-11732-MA Roof Replacement Blower Building No. 4 Southeast Water Reclamation Plant Additional Insured Endorsement is shown on General Liability Policy on a Primary & Non -Contributory basis as per Endorsements CG2010 (10101) and CG2037 (10101) & on Business Auto Policy as per CAT420 (07106). Waiver of Subrogation Endorsement is shown on Workers Compensation policy as per WC420304A (01100), on General Liability as per CG2404 (10193) and on Business Auto as per CAT420 (07106). CER City of Lubbock 1625 13th Street Room 204 Lubbock, TX 79401 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIR#- ION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH,T POLICY PROVISIONS. ACORD 25 (2010/05) JA_/© 1b -2010 CORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of AtORD CSADVAN-01 MEDWARDS CERTIFICATE OF LIABILITY INSURANCE DATE3/9/2 D/YYYY) /9/2014 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 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 Hughston Insurance Agency, Inc. P.O. Box 8550 Brownsville, TX 78526-8550 CONTANAME: Mary Edwards PHONE FAX A/c No Ext : (956) 542-4387 vc No : (956) 542-8335 E-MAIL ma hiains.net ADDRESS: ry@ INSURER(S) AFFORDING COVERAGE NAIC # INSURER A: Starr Surplus Lines Ins. Co. INSURED CS Advantage USAA, Inc. PO Box 12407 College Station, TX 77845 INSURER B:Travelers Casualty Ins Co of America INSURER c : Torus National Insurance Co 25496 INSURER D: Texas Mutual Insurance Company 122945 INSURER E: America First Insurance Co. 112696 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 IADDL,S POLICY EFF POLICY EXP LTR i TYPE OF INSURANCE POLICY NUMBER MM/DD/YYYY MM/DD/YYYY t LIMITS �� GENERAL LIABILITY i - EACH OCCURRENCE $ hX G RENTED 1,000,00 A j COMMERCIAL GENERAL LIABILITY SLPG-GL00789-02 04/28/2013 04/28/2014 PREMISES Ea occur $ 1 ����� CLAIMS -MADE X OCCUR ! MED EXP (Any one person) $ 5,000 �ti I PERSONAL & ADV INJURY $ 1,000,00 GENERALAGGREGATE $ 2,000,00 GEN'LA GGREGATE LIMIT APPLIES PER: PRODUCTS—COMP/OP AGG $ 2,000,00 ii POLICY i X ( PRO i LOC i $ AUTOMOBILE LIABILITY COMBINED INGLE LIMIT Ea accident $ 1 000,00 B X E ANYAUTO BA-9A215232-14-SEL 01/13/2014 01/13/2015 BODILY INJURY (Per person) $ ALL OWNED i SCHEDULED AUTOS i� AUTOS j BODILY INJURY (Per accident) $ NON -OWNED i I PROPERTY DAMAGE $ HIRED AUTOS AUTOS ' PER ACCIDENT UMBRELLA LIAR I OCCUR $ EACH OCCURRENCE 3,���,�0 C EXCESS LIAB 3 CLAIMS -MADE ] 0784713132ALI 04/28/2013 04/28/2014 AGGREGATE !$ 3,000,00 RED RETENTION $ I $ WORKERS COMPENSATION , OER X I ORY IM TS I AND EMPLOYERS' LIABILITY Y / N 4 D PROPRIETOR/PARTNERIEXECUTIVE �TSF0001211645 04/28/2'013 1 04/28/2014 E.L. EACH ACCIDENT Is 1,000,00 NIA 1,000,00 (Mandatory in NH) ! j E.L. DISEASE -EA EMPLOYEES $ If yes, describe under i i DESCRIPTION OF OPERATIONS below E.L_ DISEASE - POLICY LIMIT 1 $ 1,000,00 E linstallation Floater i IM8772404 04/28/2013 04/28/2014 JAny One Jobsite ] i i 2,500,00 DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) Re: 14-11732-MA Roof Replacement Blower Building No. 4 Southeast Water Reclamation Plant Additional Insured Endorsement is shown on General Liability Policy on a Primary & Non -Contributory basis as per Endorsements CG2010 (10/01) and CG2037 (10/01) & on Business Auto Policy as per CAT420 (07/06). Waiver of Subrogation Endorsement is shown on Workers Compensation policy as per WC420304A (01/00), on General Liability as per CG2404 (10/93) and on Business Auto as per CAT420 (07/06). CERTIFICATE HOLDER City of Lubbock 1625 13th Street Room 204 Lubbock, TX 79401 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DprTE THEFEOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH AHED POLICY PROVISIONS. AUTHORIZED ©1 8-200 ACORD 25 (2010/05) The ACORD name and logo are registered ma s of CORPORATION. All rights reserved. WORKERS' COMPENSATION AND EMPLOYERS LIABILITYINSURANCE POLICY TMS FO RR AIVERO U .. RIGH T TOIRE,,(;OVER.FRO,.M,,OT'HERSENDOk ENDORSEMENT' S ., � This endorseliellit applies .only to. th6 IMut9iric' e. ptbviddd by the policy bed6use,,Texas. is.shown in' 116m. 1A. of the Inforynatio'n P06. _f6_drHhj -revered'by this -ptifldy, -Wd..,.w --t-i'"i We haveth -,ftht 110 1:00dVer our Payin 0"At-s'fron! AOY669 liable, . F uirv,Ill.. no enforce our right. ageln'stAh 06046mor I I organization'I named in. the Schedule, but1his W`AWV.e -e -applies only wW respect td-bodily Ahju-'ry arising out ofthb, operations described 1- the Schedule whLife you are required by d written cohUrad'.`f0 6,btain-this waiver -scribe Un from us. This endorsement 'shall not.operate dirddly.6rInditectly.to, benefit aiqydh1Di;rl6t nairnectin the Schedule. The premium for this Oddorsem6nt is 0*4 lathe 00dule. Schedule A. Soildiff-60W.Ver: Name,o. person or orgAnizatlon. X y 81Ank6tWa1v6'r An person "the Named Insured h'd!i ii d a§reby Written cobtrdct to fumish this:w"alver. 6r.di�g,anizatiofi fdt:Whdm 2. Operatidilk ALL TEXAS' OPERATIONS' 3. Ptem,161* The- premium charge for thisendorserne.0t th011 b6 2.00 perd0fit :of the 'premium developed 00 Oaytbll in connection with work performed Wthe ,.above, person(s) or,orgakt6tion(s) arising: Out of the operations described. 4. Advance Premium INCLUDEDj SEE INFORMATION PAGE: TH �e 6�r Witchanges.the policy to'which 4 ' effective an the lon.diil;6. ' 1 4 1 a a, ridhe 10 n d date #flective I cam pol ess ifferent . ..4-10�lndlcalled below. (rbaAA1 4'i#vQw1nq 012U&dhQ0 bWAqM plit44:,QWy when tMa andorsom This endorsement effective on at 12:01,A,M. stand M time, forms arp of Policy No T3IF-0100,12116.45 20130428.1 Issued to C$ AQVANT Of-,. USAA I.N, Premium t WC42030 Al:(Etk' 60 - -1 1 11 4, Encidta0riant No. Authorized Representative, [NSUREIQ"S COPY GUSER 4-26-2013'. COMMERCIAL AUTO THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. AUTO COVERAGE PLUS ENDORSEMENT This endorsement modifiesinsurance provided under the following:' BUSINESS AUTO COVERAGE FORM With respect to coverage provided by this; endorsement, the provisions of the Coverage Form apply unless modi- fied by the endorsement. GENERAL DESCRIPTION OF COVERAGE -.This endorsement broadens coverage. However, coverage for any injury, damage or medical expenses described in any of the, provisions, of this endorsement may be excluded or limited by another endorsement to the Coverage Part, and these coverage broadening provisions do not apply to the extent that coverage is excluded or limited by such an endorsement. The following listing is a general cover- age description only. Limitations and exclusions may apply to these coverages. Read all the provisions.of this en- dorsement and the rest of your policy carefully to determine rights; duties, and what is and is not covered. A. BLANKET ADDITIONAL INSURED H. AUDIO, VISUAL AND DATA ELECTRONIC:. B. EMPLOYEE` HIRED AUTO EQUIPMENT` -INCREASED LIMIT C. EMPLOYEES AS INSURED D. SUPPLEMENTARY PAYMENTS — INCREASED LIMITS E. TRAILERS — INCREASED' LOAD, CAPACITY` F. HIRED AUTO PHYSICAL DAMAGE G: PHYSICAL DAMAGE TRANSPORTATION EXPENSES —INCREASED LIMIT A:; DLAt�KET ADDiT(ONAt� IAISURED�- B. 1. The following is added to Paragraph A.1., Who Is. An Insured, of SECTION 11 — LI- ABILITY COVERAGE: An "employee" of yours is an "insured" while operating a covered "auto" hired or rented under a contract or agreement in- that "em- ployee's" name; with your permission; while I. WAIVER OF DEDUCTIBLE— GLASS J. PERSONAL EFFECTS K. AIRBAGS L. AUTO.LOAN;LEASE GAP M.: BLANKET WAIVER. OF SUSROOAT16N performing ° duties; related to the conduct of your business. 2. The following replaces Paragraph b. in B.5., Other Insurance, of SECTION IV — BUSI- NESS AUTO CONDITIONS: b. For Hired Auto Physical Damage Cover- age, the following are deemed to be cov- ered "autos" you own: (1) Any covered; "auto" you lease, hire, rent or borrow; and (2) Any covered "auto" hired or rented by your "employee" under'a contract in that individual '"employee's" name, with your permission, while perform- ing duties, related to the conduct of your business. However, any "auto"' that is leased, hired, rented or borrowed with a. driver is not a covered "auto C. EMPLOYEES AS INSURED' The following is added to Paragraph A.1., Who Is An Insured, of SECTION IL LIABILITY COV- ERAGE: CA T4 20, 0710 © 2010 The Travelers Indemnity Company. All rights reserved. Page 1 of a Includes copyrighted material of, Insurance Services Office, Inc. with its permission. COMMERCIAL AUTO Any "employee" of yours is an "insured" while us- ing a covered "auto" you don't own, hire or borrow in'your business or your personal affairs. D. SUPPLEMENTARY PAYMENTS — INCREASED LIMITS, 1. The following replaces Paragraph A.2.a.(2) of SECTION 11--1IABILITY COVERAGE: (2) Up to $3,000 for cost of bail bonds (in- cluding; bonds for related traffic law viola- tions) required because of an "accident" we cover. We do not have to furnish these bonds. 2. The following replaces Paragraph A.2.a.(4) of SECTION _11—LIABILITY COVERAGE (4)All reasonable expenses incurred by the "insured" at our request, including actual loss of earnings up to $500 a day be- cause oftime off from work. E. TRAILERS— INCREASED LOAD CAPACITY The following replaces Paragraph C.I. of SEC- TION I COVERED AUTOS: 1. "Trailers with a load capacity of 3000 pounds or less designed primarily for travel on public roads;; F. HIRED AUTO PHYSICAL DAMAGE The following is added to Paragraph A.4.; Cover- age Extensions, of SECTION III ,- PHYSICAL DAMAGE COVERAGE: Hired Auto Physical Damage Coverage If hired "autos" are covered "autos" for Liability Coverage but not covered "autos" for Physical Damage Coverage, and this policy also provides Physical Damage Coverage for an owned "auto", then the Physical Damage Coverage` is extended to "autos" that you hire, rent or borrow subject to the following: (1) The most we will pay for "loss" in any one "accident' to a hired, rented or borrowed "auto" is the lesser of: (a) $50,000; (b) The actual cash value of the damaged or stolen property as of the time of the "loss"; or, (c) The cost of repairing or replacing the damaged or stolen property with other property of like kind and quality. (2) An adjustment for depreciation and physical condition will be made in determining actual cash value in the event of a total "loss". (3) If a repair or replacement results in better than like kind or quality, we will not pay for the amount of betterment. (4) A deductible equal to the highest Physical' Damage deductible applicable to any owned covered "auto (5) This Coverage Extension does not apply to: (a) Any "auto" that is hired, rented or bor- rowed with a driver; or (b) Any "auto" that is hired, rented or bor- rowed from your "employee". G. PHYSICAL DAMAGE —. TRANSPORTATION EXPENSES — INCREASED LIMIT The following replaces the first sentence in Para- graph AA.a., Transportation Expenses; of SECTION III — PHYSICAL DAMAGE COVER- AGE: We will pay up to $50 per day to a maximum of $1,500 for temporary transportation expense in- curred by you because of the total theft of a cov- ered "auto" of the private passenger type.. H. AUDIO, VISUAL AND DATA ELECTRONIC_: EQUIPMENT INCREASED, LIMIT Paragraph C.2.. Limit Of Insurance; of SEC- TION III — PHYSICAL DAMAGE COVERAGE is deleted. 1. WAIVER OF DEDUCTIBLE —GLASS The following is added to Paragraph D., Deducti- ble, of SECTION III — PHYSICAL DAMAGE COVERAGE: No deductible for a covered "auto" will apply to glass damage if the glass is repaired rather than replaced. J. PERSONAL EFFECTS The following is added to Paragraph A.4., Cover- age ,Extensions, of SECTION III — PHYSICAL DAMAGE COVERAGE: Personal Effects Coverage We will pay up to $400 for "loss" to wearing ap- parel and other personal effects which are: (1) Owned by an "insured", and (2) In or on your covered "auto". This coverage only applies in the event of a total theft of your covered "auto". No deductibles apply to Personal Effects cover- age. Page 2 of 3 ©,2010"The Travelers Indemnity Company. All rights reserved. CA T4 20 07 10 Includes copyrighted material of Insurance services Office, Inc. with its permission. K. AIRBAGS The following is added, to Paragraph B.3,, Exclu- sions, of SECTION III — PHYSICAL DAMAGE COVERAGE: Exclusion 3.a. does not apply to "loss" to one or more airbags in a covered"auto" you own thatin- flate due to a cause other than a, cause of "loss' set forth in Paragraphs A.1.b. and A.1.c., but only: a. If that "auto" is a covered"auto" for Compre- hensive Coverage under this policy; b. The airbags are not covered under any war- ranty; and c. The airbags were not intentionally inflated: We will pay up to:a maximum of $1,000 for any one "loss". L. AUTO LOAN LEASE GAP The following is added to Paragraph AA., Cover- age Extensions, of SECTION III — PHYSICAL DAMAGE COVERAGE` Auto Loan Lease Gap Coverage for Private Passenger Type Vehicles In the event of a total 'loss" to a covered "auto" of the privatepassenger type shown in the Schedule or Declarations for which Physical Damage Cov- erage is provided;, we will pay any unpaid amount due on the lease or loan for such covered "auto" less the following: (1) The amount paid under the Physical Damage Coverage Section of the policy for that "auto"; and COMMERCIAL AUTO (2) Any: (a) Overdue lease or loarl payments at the time of the "loss", (b) Financial penalties imposed under a lease for excessive use; abnormal wear and tear or high mileage; (c) Security deposits not returned by the les- sor; (d) Costs for extended warranties, Credit Life Insurance, Health, Accident or Disability Insurance purchased with the loan or lease; and; (e) Carry-over balances from previous loans or leases. CA T4 20 071,0 0 2010 The Travelers Indemnity Company. Al rights reserved. Page 3 of 3 Includes copyrighted material of Insurance Services Office, ,Inc. 'with Its permission. COMMERCIAL GENERAL LIABILITY CG20101001 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY:. ADDITIONAL, INSURED —OWNERS, LESSEES OR CONTRACTORS SCHEDULED PERSON OR ORGANIZATION" This endorsement modMos Insurance provided under the bilowing: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE' game of Person or Organization c 31anket as required by written contract on a primary & non-contributory basis. (If no entry appears above, Information required to complete this endorsement will,be shown In the Declarations as applicable to this endorsement.) A. Section 11— Who Is An Insured 1s amended to Include as an insured the person or organization shown In the Schedule, but only with respect to liability adaing,Out of your ongoing operations performed for that insured. B. V th resped.to the insurance afforded to these additional insureds, the following exclusion Is added: 2. ExcWslons This Insurance does not apply to "bodily injury" or"property damage" occurring after:; (1) All work, inducing materials, parts or equipment fumbled In connection with such work, on the projed (other than service, malntenance<or repairs) to be performed by or on behalf of the additional insured(s) at the site of the covered operations has been completed; or (2) 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 a part of the same project; CG 201Q 10 01 COMMERCIAL GENERAL LIABILITY . dG 20 3710 01 THIS -ENDORSEMENT CHANOWTHE PO. UCY,. ,FLEASE,READ.IT,CARFfULLY. ADDITIONAL INSURED":-- O WN1E.RS,-LESSEES OR CONTRACTORS'-- COMPLETE© QPEROQNS This endorsement modifies insurance provided under the. following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE irrre.of Person or Organization; anket as required by virtue of written contract. (If no. entry appears abovedj formatlon required to complete this endorsement will be shown in the Dedaratlons. as'appNtable to this: endorsement:: Beak n. ii —1Nho Is An insured is amended to include as an insured the person or organization shown lo.the Scliedule, but only with respect to Ilebilityarisinp out of'your'work" atthe location designated and described, in the;schedule of this endorsement performed for that Insured and Includ6d.in the, "Products -completed operations hazard": CG 20 3110.01 COMMERCIAL GENERAL LIABILITY CO 24 0410 98 THE$ ENdORSEM$NT CNANq.E$ THE.POLICY. PLEASE READ IT CAR01FULLX, WAIVER OF TRANSFER- OF; RIGHTS OF RECOVERY ' AGAINST OTHERS TO M This endorsement modlfles Insurance provided under the following; COMMERCIAL GENERAL -LIABILITY COVERAGE PART SCHEDULE Nana: of Person or Organization; Blanket as required by written contract;, (If no entry appears above; nfonnatlon required to complete this -endorsement will be shown in the Declarations as applicable -to this endorsement. ) The TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US'Conditlon{Section IV - COMMERCIAL GENERAL LIABILITY CONDITIONS) Is amended by,the addition of the following: We waive any right of recoverywe may Nava against the person or organization shown in the Schedule; above because of payments we make for Injury or damage aging out;ofyour ongoing operations or "your work" done under s contract with that: person or organization and Included In the, operations hazard This waiver applies only to the person or organization shown In the Schedule above. C6 Z40410 93 01 "lr�duranoe Services Office, ino:,19K COMMERCIAL G ' AAL UABIUTY CG 35 03 03'97 THIS, ENDORSEMENT CHANGES'THE POLICY. PLEASE READ IT CAREFULLY. DESIGNATED CONSTRUCTION PROJECT(S)' GENERAL AGGREGATE LIMIT This endorsement modlifies'insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Construction Projects: operations of the named insured. uecraranons as appnoapie to tnFs enaorsement.) A. For all sums which the Insured becomes legally_ obligated to pay as damages caused by aoccurrences"under COVERAGE A (SECTION I, ) and for:ali.medical expenses caused by accidents under covERAGE'C(SECTION I ), which can be attributed only: toongoing operatlons at single designated construction project shown, in the Schedule above, 1, A separate Designated Construction Project General Aggregate Limit a . plies to each designated construction project, and that limit is equal to the amount of the General Aggregate Limit, shown in the: Declarations 2.-The Designated Construction Project General Aggregate:Limit is the most we will pay for the sum of all damages under COVERAGE A, except damages because of"bodly injury" or °property damage" includedin the °products -completed operations hazard', and for medical expenses under COVERAGE C regardless of the number of; a. Insureds; b. Claims made or °suits" brought Or: c.;Pemons or orgenizetlons maWng dal-w or bringing "suits".. 3. Any payments made under COVERAGE A for damages or under COVERAGE C for medical expenses shall reduce, the Designated Construction Project, General Aggregate Limit for that designated construction project. Such payments shall not reduce the General Aggregate Limit shown In the: Declaratone nor shall they reduce any other Designated Construction Project; General Aggregate: Llmlt for any ether designated construction project shown In the Schedule. above. 4. The limits shown in the Declaratlons.for Each Occurrence,, Fire Damage and Medical Expense continue to apply. HoweVer, Instead of being subject to the General, Aggregate Limit shown In the Declarations, such limits'wili be subject to the applicable Designated Construction Project General Aggregate Limit. B. Foraii sume which the insured becomes legally obligated to pay as damages caused by CSADVAN-01 MEDWARDS ,A�oRo CERTIFICATE OF LIABILITY INSURANCE DATE 3/9/2 1YYYY) /9/2014 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 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 Hughston Insurance Agency, Inc. P.O. Box 8550 Brownsville, TX 78526-8550 CONTANAME: CT Mary Edwards PHONE FAX _ A/i C. No. Ertl: (956) 542-4387 (A/c No►: (956) 542-8335 ADDRESS:EMAIL ma nhiains.net ry@ INSURERS) AFFORDING COVERAGE NAIC_ M INSURER A: Starr Surplus Lines Ins. Co. v __ INSURED CS Advantage USAA, Inc. PO Box 12407 College Station, TX 77845 INSURER B:Travelers Casualty Ins Co of America _ INSURER C: Torus National Insurance Co 25496 INSURERD:Texas Mutual Insurance Company 22945 INSURER E: America First Insurance Co. 12696 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 - -- -- ---- —� xADOC SU�RT LTR TYPE OF INSURANCE I --i -POLICY EFF POLICY EXP POLICY NUMBER POL'C YYYY MMIDDIYYYY LIMITS GENERAL LIABILITY I EACH OCCURRENCE $ 1,000,00 A i X COMMERCIAL GENERAL LIABILITY SLPG-GL00789-02 104/28/2013 ! 04/28/2014 PREMISES Ea occcu rE ce $ 100,00 E— —t-- -I CLAIMS -MADE OCCUR ! F_ MED EXP (Any one person) $ 5,00 { PERSONAL & ADV INJURY $ 000_,00 _ — 1,000,00 _ I 1 1--- GENERAL AGGREGATE $ 2, --- -- -- ----- k I GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 2,000,00 I I POLICY X_1 PRO- LOC $ I AUTOMOBILE LIABILITY I COMBINED SINGLE LIMIT nt) Ea accideIII 1,000 00 _ B € ANY AUTO { A! BA-9A215232-14-SEL ! 01/13/2014 1 01/13/2015 BODILY INJURY (Per person) $ ALL OWNED SCHEDULED I AUTOS AUTOS BODILY INJURY (Per accident) $ N NON -OWNED HIRED AUTOS AUTOS j � E PROPERTY DAMAGE PER ACCIDENT $ � � $ X UMBRELLA LIAR OCCUR I EACH OCCURRENCE $ 3,000,00 C ? EXCESS LIAR I} CLAIMS -MADE' { 07847B132ALI i 04/28/2013 i 04/28/2014 AGGREGATE $ 3,000,00 1 T DIED { RETENTION $ ' $ WORKERS COMPENSATION X OER AND EMPLOYERS' LIABILITY Y / N i OWC RY MITB�_ -- D ANY PROPRIETOR/PARTNER/EXECUTIVE I ;TSF0001211645 •. 04/28/2013 04/28/2014 E.L. EACH ACCIDENT III 1,000,00 OFFICER/MEMBER EXCLUDED? _ N / A O 1,000,00 (Mandatory in NH) It describe E.L. DISEASE - EA EMP — — yes. under DESCRIPTION OF OPERATIONS below I I E.L. DISEASE - POLICY LIMIT 1 $ 1,000,000 E :Installation Floater i { IM8772404 04/28/2013 04/28/2014 lAny One Jobsite 2,500,00 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space Is required) Re: 14-11732-MA Roof Replacement Blower Building No. 4 Southeast Water Reclamation Plant Additional Insured Endorsement is shown on General Liability Policy on a Primary & Non -Contributory basis as per Endorsements CG2010 (10/01) and CG2037 (10/01) & on Business Auto Policy as per CAT420 (07/06). Waiver of Subrogation Endorsement is shown on Workers Compensation policy as per WC420304A (01100), on General Liability as per CG2404 (10193) and on Business Auto as per CAT420107106). CERTIFICATE HOLDER CANCELLATION SHOULD ANY Oq1THE OVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Lubbock 1625 13th Street Room 204 THE EXPIR) ACCORDANC E HEREOF, NOTICE WILL BE DELIVERED IN OLICY PROVISIONS. Lubbock, TX 79401 AUTHORIZED RES E ©1988-2010 CORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD CSADVAN-01 MEDWARDS CERTIFICATE OF LIABILITY INSURANCE DATE3/9/2 D/YYYY) /9/2014 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 be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME; Mary Edwards _ Hughston Insurance Agency, Inc. PHONE 956 d42r387 _ P.O. Box 8550 {A/C. No, Ext): ( ) A/C, No): (956) 542-8335 Brownsville, TX 78526-8550 E-MAILADDRESS: maryhiains.net INSURER(S) AFFORDING COVERAGE NAIC # INSURER_ A: Starr Surplus Lines Ins. Co. _ INSURED INSURER B : Travelers Casualty Ins Co of America CS Advantage USAA, Inc. INSURER C: Torus National Insurance Co 125496 ----- ---- - - --- - - ---- — - -- PO Box 12407 -INSURER D:Texas, Mutual Insurance Company _ _ 122945 _ College Station, TX 77845 -� INSURER E: America First Insurance Co. 112696 COVERAGES CFRTIFICATF PIIIMRFR- RFVLSIr11U NI IMRFR- 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 CONDITION—S OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. IL R i TYPE OF INSURANCE AT)15L!§UB POLICY EFF POLICY EXP POLICY NUMBER MM/DD/YYYY MM/DD/YYYY LIMITS j GENERAL LIABILITY EACH OCCURRENCE $ 1,000,00 A i X COMMERCIAL GENERAL LIABILITY � � SLPG-GL00789-02 � 04/28/2013 ' 04/28/2014 r PREMISESISES E $ 100,00 - _j CLAIMS -MADE !A] OCCUR MED EXP (Any one person) $ 6,00 PERSONAL & ADV INJURY $ 1,000,00 I--3 - GENERAL AGGREGATE $ 2,000,00 LGEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 2,000,00 ' [ PRO - POLICY X LOC $ — AUTOMOBILE LIABILITY `s i COMBINED SINGLE LIMITa accident) $ (E 1,000,00 B X a ANY AUTO j i 'BA-9A215232-14-SEL ; 01/13/2014 01/13/2015 __ BODILY INJURY (Per person) $ ALL OWNED I SCHEDULED AUTOS _ AUTOS NON -OWNED —�-- BODILY INJURY (Per accident) I $ PROPERTY DAMAGE HIRED AUTOS AUTOS i ER ACCIDENT I $ i F X ;UMBRELLA LIAR OCCUR �-i ' E EACH OCCURRENCE _ $ — 3,000,00 C EXCESS LIAB CLAIMS -MADE 107847B132ALI 04/28/2013 04/28/2014 ( ___ AGGREGATE $ 3,000,00 DED ( RETENTION $ $ WORKERS NSATION AND EMPLOYERS' ELIABILITYYIN( N WC STATU- X TORY IM TS ER D ANY PROPRIETOR/PARTNER/EXECUTIVE 104/28/2013 04/28/2014 I OFFICER/MEMBER EXCLUDED? ❑ N / A E.L. EACH ACCIDENT $ -- -$ 1,000,00 �TSF0001211645 (Mandatory in NH) I E-L. DISEASE - EA EMPLOYEE[ 1,000,00 -- -- If yes, describe under I DESCRIPTION OF OPERATIONS below i j E.L. DISEASE - POLICY LIMIT $ 1,000,00 E ;Installation Floater i IM8772404 04/28/2013 1 04/28/2014 Any One Jobsite ICI I I 2,500,00 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) Re: 14-11732-MA Roof Replacement Blower Building No. 4 Southeast Water Reclamation Plant Additional Insured Endorsement Is shown on General Liability Policy on a Primary & Non -Contributory basis as per Endorsements CG2010 (10/01) and CG2037 (10101) & on Business Auto Policy as per CAT420 (07/06). Waiver of Subrogation Endorsement is shown on Workers Compensation policy as per WC420304A (01/00), on General Liability as per CG2404 (10/93) and on Business Auto as per CAT420 (07106). CFRTIFICATF HrN IIFR rArrror r AT/nnf SHOULD ANY OF THE A80VE DESCRIBED POLICIES BE CANCELLED BEFORE City of Lubbock THE EXPIRATION DATE THJEREOF, NOTICE WILL BE DELIVERED IN 1625 13th Street Room 204 ACCORDANCE W E POLY PROVISIONS. Lubbock, TX 79401 AUTHORIZED REP ESENT E 19n-2010�ORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of A RD CSADVAN-01 MEDWARDS ACOROF CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 1 3/9/2014 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 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 Hughston Insurance Agency, Inc. P.O. Box 8550 Brownsville, TX 78526-8550 CONTACT Ma Edwards _______ __ ___ NAME: __ Mary PHONE g56 542 4387 TAx Ext):� ) __AA1X No): (956) 542_8335 EMAIL AODREss: mary@hiains.net— INSURER(S) AFFORDING COVERAGE NAIC N INSURERA:Starr Surplus Lines Ins. Co._ _ INSURED INSURER B:Trayelers Casualty Ins Co of America CS Advantage USAA, Inc. PO Box 12407 INSURER C : Torus National Insurance Co _(25496 , INSURER D: Texas Mutual Insurance Company 22945 College Station, TX 77845 INSURER E: America First Insurance Co. _112696 INSURER F : COVERAGES CERTIFICATE NUMRER- 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 TA iJlot POLICY EFF POLICY EXP LTR I TYPE OF INSURANCE POLICY NUMBER i MM/DD/YYYY .. M�Yy LIMITS GENERAL LIABILITY T I€ EACH OCCURRENCE $ 1,000,00 _���R�EC— A X I COMMERCIAL GENERAL LIABILITY i SLPG-GL00789-02 04/28/2011 ; 04/28/2014 j 100,000 PREMISES (Ea occurrence) I $ + CLAIMS -MADE LV OCCUR ( € MED EXP (Any one person) $ 5,00 I I PERSONAL & ADV INJURY $ 1,000,00 GENERAL AGGREGATE $ 2,000,00 rGEN'L AGGREGATE i COMPIOP AGG $ 2,000,00 LIMIT APPLIES PER: I - L---- PRODUCTS - - — PRO- I j� IIII I POLICY € X 1 LOC $COMBINED AUTOMOBILE LIABILITY ; I Ea accident SINGLE LIMIT II. $- 1,000,00 B I X ANY AUTO j �BA-9A215232-14-SEL 01/13/2014 01/13/2015 ALL OWNED SCHEDULED E BODILY INJURY (Per person) (I $ I AUTOS I AUTOS ( BODILY INJURY (Per accident) $ NON -OWNED E HIRED AUTOS I AUTOS € PROPERTY DAMAGE $ PER ACCIDENT I $ X 1 UMBRELLA LIAB OCCUR i I EACH OCCURRENCE — $ 3,00_0,00 C EXCESS i 04/28/2013 04/28/2014 LILIA�B--- CLAIMS -MADE AGGREGATE 1 $ 3,000,00 �07847121132ALI DED RETENTION $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N WCSTATU- OTH- X TORY LIMITS D ANY PROPRIETORIPARTNERIEXECUTIVE ITSF0001211645 j 04/28/2013 04/28/2014 E.L. EACH ACCIDENT 1,000,00 OFFICERIMEMBER EXCLUDED? ❑ N / A (Mandatory in NH) I --- — E.L. DISEASE - EA EMPLOYEEI $ 1,00_0+00 - If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE -POLICY LIMIT $ 1,000,00 E 'installation Floater j JM8772404 i 04/28/2013 1 04/28/2014 Any One Jobsite 2,600,00 j i I DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space is required) Re: 14-11732-MA Roof Replacement Blower Building No. 4 Southeast Water Reclamation Plant Additional Insured Endorsement is shown on General Liability Policy on a Primary & Non -Contributory basis as per Endorsements CG2010 (10/01) and CG2037 (10/01) & on Business Auto Policy as per CAT420 (07/06). Waiver of Subrogation Endorsement is shown on Workers Compensation policy as per WC420304A (01/00), on General Liability as per CG2404 (10/93) and on Business Auto as per CAT420 (07/06). City of Lubbock 1625 13th Street Room 204 Lubbock, TX 79401 CANCELLA' SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRI�?IION DIE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDA E WITH.T POLICY PROVISIONS. Ik ©16$ -2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ORD m CSADVAN-01 MEDWARDS Ro CERTIFICATE OF LIABILITY INSURANCE DATEDlYYYY) 3/9/2 /9/2014 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 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 NAME: CT Mary Edwards Hughston Insurance Agency, Inc. P.O. Box 8550 PHONE — FAX WC No Ertl: (956) 5424387 IC, No: (956) 542-8335 E-MAILADDRESS_mary@Q hiains.net Brownsville, TX 78526-8550 INSURERS►AFFORDING COVERAGE NAIC 0 INSURER A: Starr Surplus Lines Ins. Co. INSURED _ INSURER B : Travelers Casualty Ins Co of America INSURER C : Torus National Insurance Co 25496 CS Advantage USAA, Inc. INSURER D: Texas Mutual Insurance Company 22945 PO Box 12407 College Station, TX 77845 INSURER E: America First Insurance Co. 112696 INSURER F : COVERAGES CFRTIFICATF NIIMRFR- RFVI.910N Nt1MRFR! 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-------`ADDL�SUgR --- - T- --— LTR : TYPE OF INSURANCEINSR POLICY NUMBER MM/ODl1^!YY MMIDD/YYYY� _ LIMITS GENERAL LIABILITY i EACH OCCURRENCE $ 1,000,00 A X 1 COMMERCIAL GENERAL LIABILITY I SLPG-GL00789-02 04/28/2011 04/28/2014 � pREMISEs�(Ea occurrence) i $ 100,00 � � CLAIMS -MADE I X i OCCUR —� MED EXP (Any one person) $ 5,00 I = PERSONAL 8 ADV INJURY $ 1,000,00 [— GENERAL AGGREGATE $ 2,000,00 2,000,00_ j�GGEEN'L AGGREGATE LIMIT APPLIES PER: PRO- PRODUCTS -COMP/OP AGG $ $ POLICY X 1 LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT1,000,000 Ea accident $ B X II ANY AUTO ;BA-9A215232-14-SEL 01/13/2014 01/13/2015 �—j ALL OWNED 1 BODILY INJURY (Per person) $ SCHEDULED ' !AUTOS AUTOS BODILY INJURY (Per accident) $ NON -OWNED I HIRED AUTOS AUTOS i PROPERTY DAMAGE PER ACCIDENT $ j i $ X f UMBRELLA LIAR !OCCUR I EACH OCCURRENCE $ 3,000,00 (, i EXCESS LIAR ( CLAIMS -MADE �07847B132ALI 04/28/2013 1 04/28/2014 - - ---�I ----1 gGGREGATE ` $ 3,000,00 0 -- DED ;RETENTION $ I $ I WORKERS COMPENSATION ( AND EMPLOYERS' LIABILITY Y! N I D ! ANY PROPRIETOR/PARTNER/EXECUTIVE - TSF0001211645 04/28/2013 04/28/2014 X WC STATU- 1 OTH-' TORY LIMITS ER E L. EACH ACCIDENT $ 1,000,00 OFFICER/MEMBER EXCLUDED? ❑ I N! I A I 1 —---- ----- (Mandatory in NH) € E.L. DISEASE - EA EMPLOYEE $ 1,000,000 If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 1,000,000 E ;Installation Floater ' jIM8772404 04/28/2013. 04/28/2014 Any One Jobsite 2,500,00 I l I I I i � DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space Is required) Re: 14-11732-MA Roof Replacement Blower Building No. 4 Southeast Water Reclamation Plant Additional Insured Endorsement is shown on General Liability Policy on a Primary & Non -Contributory basis as per Endorsements CG2010 (10/01) and CG2037 (10/01) & on Business Auto Policy as per CAT420 (07/06). Waiver of Subrogation Endorsement is shown on Workers Compensation policy as per WC420304A (01/00), on General Liability as per CG2404 (10/93) and on Business Auto as per CAT420 (07/06). LDER City of Lubbock 1625 13th Street Room 204 Lubbock, TX 79401 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THE ,EOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH Tj{EjPOLIC�/ PROVISIONS. AUTHORIZED ©1 8-20% ACORD 25 (2010/05) The ACORD name and logo are registered maKs of A CORPORATION. All rights reserved. WORKERS' COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY Insurance WC 42 03 04 A TEXAS WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT This endorsement applies only to the Insurance provided by the policy because Texas is shown in Item 3.A. of the Information Page, We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce our right; against the person or organization named in the Schedule, but this waiver applies only with respect to bodily injury arising out of the operations described in the Schedule where you are required by a written contract to obtain this Waiver, from us. This endorsementshall not.operate directly or indirectly to benefit anyone not named in the Schedule. The premium for this endorsement is shown In the Schedule. Schedule 1 ( ) Specific Waiver Name of person':or organization' X) Blanket Waiver Any person or organization for whom the Named Insured has agreed by written contract to fumish this waiver. 2 Operations: ALL TEXAS OPERATIONS, 3. Premium The premium charge for this endorsement shall be 2.00 percent of the premium developed on payroll in connection with work performed for the above person(s) or organization(s) arising out of the operations. described. 4. Advance Premium INCLUDED; SEE INFORMATION PAGE This endorsement changes the policy to which it is attached effective on the inception date of the policy unless a different date is indicated below. (The. following "attaching clause" need be completed only when this ondorcoment is issued subsequent to preparation of the policy.) This endorsement, effective on at 1201 AM. standard time, forms a part of Policy No. TSF-0001211645 20130428 of the Texas Mutual Insurance Company Issued to CS ADVANTAGE USAA INC Endorsement No, Premium $ WC420304A (ED. 1-01-2000) /WS-JQ -6-� Authorized Representative INSURED'S COPY OUSER 4-26-2013 COMMERCIAL AUTO THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. AUTO COVERAGE PLUS ENDORSEMENT This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modi- fied by the endorsement. GENERAL DESCRIPTION OF COVERAGE —This endorsement broadens coverage. However; coverage for any injury, damage or medical expenses described in any of the provisions of this endorsement may be excluded or limited by another endorsement to the Coverage Part, and these coverage broadening provisions do not apply to the extent that coverage is excluded or limited by such an endorsement. The following listing is a general cover- age description only. Limitations and exclusions may apply to these coverages. Read all the provisions. of this en- dorsement and the. rest of your policy carefully to determine rights; duties; and what is and is not covered. A. BLANKET ADDITIONAL INSURED H. AUDIO, VISUAL AND. DATA ELECTRONIC B. EMPLOYEE HIRED AUTO EQUIPMENT —INCREASED LIMIT C. EMPLOYEES AS INSURED D. SUPPLEMENTARY PAYMENTS — INCREASED LIMITS E. TRAILERS — INCREASED LOAD CAPACITY` F. HIRED AUTO PHYSICAL DAMAGE G. PHYSICAL DAMAGE TRANSPORTATION EXPENSES — INCREASED LIMIT A. BLANKET ADDITIONAL, INSURED. B. EMPLOYEE HIRED AUTO 1. The following is added to Paragraph A.1., Who Is An Insured, of SECTION II — LI- ABILITY COVERAGE: An "employee" of yours is an "insured" while operating a covered "auto" hired or rented under a contract or agreement in that "em- ployee's" name, with your permission; while 1 WAIVER OF DEDUCTIBLE — GLASS J. PERSONAL EFFECTS K. AIRBAGS L. AUTO LOAN LEASE GAP M. BLANKET WAIVER OF SUBROGATION performing duties related to the conduct of your business. 2. The following replaces Paragraph b. in B.S., Other Insurance, Of SECTION IV — BUSI- NESS AUTO CONDITIONS: b. For Hired Auto Physical Damage Cover- age, the following are deemed to be cov- ered "autos" you own: (1) Any covered. "auto" you lease, hire, rent or borrow; and (2) Any covered "auto" hired or rented by your "employee" under a contract in that individual "employee's" name, with your permission, while perform- ing duties related to the conduct of your business. However, any "auto" that is leased, hired, rented or borrowed with a. driver is not a covered "auto". C. EMPLOYEES AS INSURED The following is added to Paragraph A.1., Who Is An Insured, of SECTION II — LIABILITY COV- ERAGE: CA T4 20 07 10 V 2010 The Travelers Indemnity Company. All rights reserved. Page 1 of 3 Includes copyrighted material of Insurance Services Office, Inc. with Its permission. COMMERCIAL AUTO Any "employee" of yours is an "insured" while us- ing a covered "auto" you don't own, hire or borrow in your business or your personal affairs. D. SUPPLEMENTARY PAYMENTS — INCREASED LIMITS 1. The following replaces Paragraph A.2.a.(2) of SECTION II — LIABILITY COVERAGE: (2) Up to $3,000 for cost of bail bonds (in- cluding bonds for related traffic law viola- tions) required because of an "accident" we cover. We do not have to furnish these bonds. 2. The following replaces Paragraph A.2.a.(4) of SECTION II — LIABILITY COVERAGE: (4) All reasonable expenses incurred by the "insured"' at our request, including actual loss of earnings up to $500 a: day be- cause of time off from work. E. TRAILERS — INCREASED LOAD CAPACITY The following replaces Paragraph C.I. of SEC- TION I — COVERED AUTOS: 1. "Trailers" with a load capacity of 3,000 pounds or less designed primarily for travel on public roads. F. HIRED AUTO PHYSICAL DAMAGE The following is added to Paragraph A.4., Cover- age Extensions, of SECTION III _— PHYSICAL DAMAGE COVERAGE: Hired Auto Physical Damage Coverage If hired "autos" are covered "autos" for Liability Coverage but not covered "autos" for Physical Damage Coverage, and this policy also provides Physical Damage Coverage for an owned "auto", then the Physical Damage Coverage is extended to "autos" that you hire, rent or borrow subject to the following: (1) The most we will pay for "loss" in any one "accident" to a hired, rented or borrowed "auto" is the lesser of: (a) $50,000; (b) The actual cash Value of the damaged or stolen property as of the time. of the "loss"; or (c) The cost of repairing or replacing the damaged or stolen property with other property of like kind and quality. (2) An adjustment for depreciation and physical condition will be made in determining actual cash value in the event of a total "loss". (3) If a repair or replacement results in better than like kind or quality, we will not pay for the amount of betterment. (4) A deductible equal to the. highest Physical Damage deductible applicable to any owned covered "auto". (5) This Coverage Extension does not apply to: (a) Any "auto" that is hired, rented or bor- rowed with a driver; or (b) Any "auto" that is hired, rented or bor- rowed from your "employee". G. PHYSICAL DAMAGE — TRANSPORTATION EXPENSES — INCREASED LIMIT The following replaces the first sentence in Para- graph AA.a., Transportation Expenses, of SECTION III PHYSICAL DAMAGE COVER- AGE: We will pay up to $50 per day to a maximum of $1,500 for temporary transportation expense in- curred by you because of the total theft of a cov- ered "auto" of the private passenger type:. H. AUDIO, VISUAL AND DATA ELECTRONIC; EQUIPMENT— INCREASED LIMIT Paragraph C.2.. Limit Of Insurance, of SEC- TION III — PHYSICAL DAMAGE COVERAGE is deleted. 1. WAIVER OF DEDUCTIBLE — GLASS The following's added to Paragraph D., Deducti- ble, of SECTION III — PHYSICAL DAMAGE COVERAGE: No deductible for a covered "auto" will apply to glass damage if the glass- is repaired rather than replaced. J. PERSONAL EFFECTS The following is added to Paragraph A.4., Cover- age Extensions, of SECTION III — PHYSICAL DAMAGE COVERAGE: Personal Effects Coverage We will pay up to $400 for "loss" to wearing ap- parel and other personal effects which are: (1) Owned by an "insured'; and (2) In or on your covered"auto". This coverage only applies in the event of a total theft of your covered "auto". No deductibles apply to Personal Effects cover- age. Page 2 of 3 (9 2010 The Travelers Indemnity Company. All rights reserved. CA T4 20 07 10 Includes copyrighted material of Insurance Services Office, Inc. with Its permission. K. AIRBAGS The following is added to Paragraph 6.3., Exclu- sions, of SECTION III — PHYSICAL DAMAGE COVERAGE: Exclusion 3.a. does not apply to "loss" to one or more airbags in a covered "auto" you own that in- flate due to a cause other than a cause of "loss" set forth in Paragraphs A.1.b. and A.1.c., but only: a. If that "auto" is a covered "auto" for Compre- hensive Coverage under this policy; b. The airbags are not covered under any war- ranty; and c. The airbags were not intentionally inflated, We will pay up to a maximum of $1,000 for any one "loss". L. AUTO LOAN LEASE GAP The following is added to Paragraph A.4., Cover- age Extensions, of SECTION III PHYSICAL DAMAGE COVERAGE: Auto Loan Lease. Gap Coverage for Private Passenger Type Vehicles In the event of a total "loss" to a covered "auto" of the private passenger type shown in the Schedule or Declarations for which Physical Damage Cov- erage is provided; we will pay any unpaid amount due on the lease or loan for such covered "auto" less the following: (1) The amount paid under the Physical Damage Coverage Section of the policy for that "auto' ; and COMMERCIAL AUTO (2) Any: (a) Overdue lease or loan payments at the time of the "loss"; (b) Financial penalties imposed under a lease for excessive use, abnormal wear and tear or high mileage; (c) Security deposits not returned by the les= sor; (d) Costs for extended warranties, Credit Life Insurance, Health, Accident or Disability Insurance purchased with the loan or lease; and (e) Carry-over balances from previous loans or leases. CA T4 20 0710 t0 2010 The Travelers Indemnity Company. All rights reserved. Page 3 of 3 Includes copyrighted material of Insurance Services Office, Inc. with its permission. COMMERCIAL GENERAL LIABILITY CO 20 10 10 01 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED— OWNERS, LESSEES OR CONTRACTORS SCHEDULED PERSON OR ORGANmAnON This endorsement modifies Insurance provided under the fdlowing: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name of Person or Organization: Blanket as required by written contract on a primary & non-contributory basis. (If no entry appears above, information required to complete this endorsement will be shown In the Declarations as applicable to this endorsement.) A. Section 11— Who Is An Insured is amended to Include as an Insured the person or organization shown In the Schedule, but only with respect to liability arising out of your ongoing operations performed for that insured. B. With respect to the insurance afforded to these additional Insureds, the following exclusion Is added: 2. Exclusions This insurance does not apply to'bodily injury" or"property damage" occurring after. (1) 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 site of the covered operations has been completed; or (2) 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 a part of the some project. CG 20 10 10 01 COMMERCIAL GENERAL LIABILITY CG20371001 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED'— OWNERS, -LESSEES OR CONTRACTORS - COMPLETED OPERATIONS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART rerson or organization: as required by virtue of written contract. And Description of Completed Operations: (if no entry appears above, information required to complete this endorsement will ba shown in the Declarations as applicable to this endorsement) Section II —Who is An Insured Is amended to include as an insured the person or organization shown in the Schedule, but only with respect to liability arising out of'your work" at the location designated and described in the schedule of this endorsement performed for that insured and Included in the "products -completed operations hazard". CG 20 3710 01 COMMERCIAL GENERAL LIABILITY CO 24 6410 93 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WAIVER OF TRANSFER OF; RIGHTS OF RECOVERY AGAINST OTHERS TO US This endorsement modliles Insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name of Person or Organization; Blanket as required by written contract; (if no entry appears above, Information required to complete this endorsement will be shown In the Declarations as applicable to this endorsement. ): The TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US Condition (Section IV — COMMERCIAL GENERAL LIABILITY CONDITIONS) Is amended by the addition of the following: We waive any right of recovery we may have against the person or organization shown In the Schedule above 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". This walver applies only to the person or organization shown in the Schedule above. CO 24 0410 93 Insurance Services Office, Inc., 1992 COMMERCIAL GENERAL LIABILITY CO 25 03 03 97 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. DESIGNATED CONSTRUCTION PROJECT(S) GENERAL AGGREGATE LIMIT This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Projects: operations of the named Insured. (If no entry appears above, Information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement.) A. For all sums which the Insured becomes legally obligated to pay as damages caused by occurrences" under COVERAGE A (SECTION I), and for all medical expenses caused by accidents under COVERAGE C (SECTION I ), which can be attributed only to ongoing operations at a single designated construction project shown in the Schedule above: 1, Aseparate Designated Construction Project General Aggregate Limit appiles to each designated construction project, and that limit Is equal to the amount of the General Aggregate Limit shown In the Declarations. 2. The Designated Construction Project General Aggregate Umlt Is the most we will pay for 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 number of:. a. Insureds; b. Claims made or "suits" brought; or c. Persons or organizations making claims or bringing °suits". 3. Any payments made under COVERAGE A for damages or under COVERAGE C for medical expenses shall reduce the Designated Construction Project General Aggregate Limit for that designated construction project. Such payments shall not reduce the General Aggregate Limit shown In the Declarations nor shall they reduce any other Designated Construction Project General Aggregate Limit for any other designated construction project shown in the Schedule above. 4. The limits shown in the Declarations for Each Occurrence, Fire Damage 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 Designated Construction Project General Aggregate Limit. B. For all sums which the insured becomes legally obligated to pay as damages caused by