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Resolution - 2013-R0114 - Contract - Massey Irrigation Inc.- Wireless Irrigation Management System - 04/11/2013
Resolution No. 2013-RO114 April 11, 2013 Item No. 5.7 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. 11127 for a wireless irrigation management system, by and between the City of Lubbock and Massey Irrigation, 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 April 11, 2013 ATTEST: P '0, de _'&_ Reb cca Garza, Ci Secret t) APPROVED AS TO CONTENT: /'? r R. Keith Smith, P.E.. Chief Operating Officer APPROVED AS TO FORM: Chad Weaver, Assistant City Attorney vwxcdocsiRES. Contract -Massey Irrigation, Inc. March 19, 2013 Resolution No. 2013—R0114 City of Lubbock, TX Wireless Irrigation Management System Service Agreement CONTRACT 11127 This Service Agreement (this "Agreement") is entered into as of the 11th day of April, 2013, ("Effective Date") by and between Massey Irrigation, Inc., (the Consultant),and the City of Lubbock (the "City"). RECITALS WHEREAS, the City has issued a Request for Proposals 13 -11127 -TL — Wireless Irrigation Management System. WHEREAS, the proposal submitted by the Contractor has been selected as the proposal which best meets the needs of the City for this service; and WHEREAS, Contractor desires to perform as an independent contractor to provide Wireless Irrigation Management System, upon terms and conditions maintained in this Agreement; and NOW THEREFORE, for and in consideration of the mutual promises contained herein, the City and Contractor agree as follows: City and Contractor acknowledge the Agreement consists of the following exhibits which are attached hereto and incorporated herein by reference, listed in their order of priority in the event of inconsistent or contradictory provisions: 1. This Agreement 2. Exhibit A — General Requirements 3. Exhibit B — Proposal and Price Sheet 4. Exhibit C — Insurance Requirements Scope of Work Contractor shall provide the services that are specified in Exhibit A. The Consultant shall comply with all the applicable requirements set forth in Exhibit B and C attached hereto. Article 1 Services 1.1 Contractor agrees to perform services for the City that are specified under the General Requirements set forth in Exhibit A. The City agrees to pay the amounts stated in Exhibit B, to Contractor for performing services. 1.2 Contractor shall use its commercially reasonable efforts to render Services under this Agreement in a professional and business -like manner and in accordance with the standards and practices recognized in the industry. Nonappropriation clause. All funds for payment by the City under this Agreement are subject to the availability of an annual appropriation for this purpose by the City. In the event of nonappropriation of funds by the City Council of the City of Lubbock for the goods or services provided under the Agreement, the City will terminate the Agreement, without termination charge or other liability, on the last day of the then -current fiscal year or when the appropriation made for the then -current year for the goods or services covered by this Agreement is spent, whichever event occurs first. If at any time funds are not appropriated for the continuance of this Agreement, cancellation shall be accepted by the Contractor on thirty (30) days prior written notice, but failure to give such notice shall be of no effect and the City shall not be obligated under this Agreement beyond the date of termination. Article 2 Miscellaneous. 2.1 This Agreement is made in the State of Texas and shall for all purposes be construed in accordance with the laws of said State, without reference to choice of law provisions. 2.2 This Agreement is performable in, and venue of any action related or pertaining to this Agreement shall lie in, Lubbock, Texas. 2.3 This Agreement and its Exhibits contains the entire agreement between the City and Contractor and supersedes any and all previous agreements, written or oral, between the parties relating to the subject matter hereof. No amendment or modification of the terms of this Agreement shall be binding upon the parties unless reduced to writing and signed by both parties. 2.4 This Agreement may be executed in counterparts, each of which shall be deemed an original. 2.5 In the event any provision of this Agreement is held illegal or invalid, the remaining provisions of this Agreement shall not be affected thereby. 2.6 The waiver of a breach of any provision of this Agreement by any parties or the failure of any parties otherwise to insist upon strict performance of any provision hereof shall not constitute a waiver of any subsequent breach or of any subsequent failure to perform. 2.7 This Agreement shall be binding upon and inure to the benefit of the parties and their respective heirs, representatives and successors and may be assigned by Contractor or the City to any successor only on the written approval of the other party. 2.8 All claims, disputes, and other matters in question between the Parties arising out of or relating to this Agreement or the breach thereof, shall be formally discussed and negotiated between the Parties for resolution. In the event that the Parties are unable to resolve the claims, disputes, or other matters in question within thirty (30) days of written notification from the aggrieved Party to the other Party, the aggrieved Party shall be free to pursue all remedies available at law or in equity. 2.9 At any time during the term of the contract, or thereafter, the City, or a duly authorized audit representative of the City or the State of Texas, at its expense and at reasonable times, reserves the right to audit Contractor's records and books relevant to all services provided to the City under this Contract. In the event such an audit by the City reveals any errors or overpayments by the City, Contractor shall refund the City the full amount of such overpayments within thirty (30) days of such audit findings, or the City, at its option, reserves the right to deduct such amounts owing the City from any payments due Contractor. 2.10 The City reserves the right to exercise any right or remedy to it by law, contract, equity, or otherwise, including without limitation, the right to seek any and all forms of relief in a court of competent jurisdiction. Further, the City shall not be subject to any arbitration process prior to exercising its unrestricted right to seek judicial remedy. The remedies set forth herein are cumulative and not exclusive, and may be exercised concurrently. To the extent of any conflict between this provision and another provision in, or related to, this document, this provision shall control. IN WITNESS WHEREOF, this Agreement is executed as of the Effective Date. CITY OF LUBBOCK, TX: GlefKC Robertson, Mayor ST• Lee -le -C I -!�c eb ca Garza, City Secretary APPROVED AS O CONTENT: k. R. Keith Smith P.E., Chief Operating Officer APP TO FORM: Chad Weaver, Assistant City Attorney Massey Irrigation, Inc. Ronnie Dubois Address L ua aDc -7 k 7%'/0-3 GENERAL REQUIREMENTS 1 INTENT Exhibit A The City of Lubbock (hereinafter called "City") is issuing this Request for Proposals (this "RFP") under the guidelines of a High -Technology RFP. This means that failure to successfully meet all functional requirements may not necessarily disqualify the vendor. Vendors should take exception to functional specifications that they cannot meet and may offer alternative solutions and/or additional features in their proposals. The City of Lubbock is seeking proposals from interested firms and individuals to provide a Wireless Irrigation Management System. a) Offerors are invited to submit demonstrated competence and qualifications of their firm for providing this equipment. b) The information contained within this document is intended to provide interested firms with the requirements and criteria that will be used to make the selection. 2 SCOPE OF WORK The City of Lubbock requires a Wireless Irrigation Management System, which is internet based, and is capable of controlling, monitoring, alerting, and reporting various functions of electric center pivot irrigation systems. 2.1 The purpose of the Wireless Irrigation Management System is to provide an encompassing view to enable quick, effective decision making. Text message alerts further speed the process, making operational changes and notifications of potential problems quick and easy to handle. Employees must be able to access the system from anywhere, precisely track and graph water usage, and communicate with others from one easy, secure site. 2.2 The Wireless Irrigation Management System, when fully equipped, will serve to allow operators to monitor and control center pivot functions from any location that has internet availability, and is intended be equipped with and perform the following functions: a) The wireless system must be user friendly. Operators must be able to monitor and control center pivot functions from any location that has internet availability. b) Functions to include the following as a minimum: 1. Pivot Start/Stop 2. Pivot Direction 3. Pivot Speed 4. Water On/Off (actuator) 5. Schedule Programming 6. Chemigation System On/Off 7. Pump/Valve Control at Pivot Map View of Pivots c) System will provide field remote access from a smartphone, tablet, or laptop. d) Alert System 1. The system must be event driven and must alert operators of system failure caused by mechanical failure, power outage, etc. Alert system must have the capability of text message and voice mail. System must respond within 3 minutes of event. e) Telemetry System 1. Telemetry system must be capable of tracking and reporting effluent flows by use of electronic meters: history of hours run, system failures, date and times, GPC locations, etc. f) System must be expandable to pump/pump station controls. Exhibit B Massey Irrigation & Liquidation, Inc. 4611 Idalou Road Lubbock, Texas 79403 (806) 763-5193 Fax (806) 763-0263 Massey Irrigation has been in business for 32 years in Lubbock. We have been designing and installing irrigation systems throughout that time. We have 10 employees, 7 of them service technicians. We are a Lindsay Dealer which provides Zimmatic Irrigations Systems, Greenfield, Fieldnet, Growsmart and Watertronics. This will be top a priority project, upon bid award. We will start the project immediately. I estimate finishing the project within 3 to 4 weeks. Fieldnet is manufactured by Lindsay and designed to go hand and hand with Zimmatic computer panels. A. Delivery time estimate is 2 weeks. We will start installation immediately, and training is included at that time. We will perform hands on training at the City of Lubbock Site. B. There is a 2 year warranty on all parts and labor. C. Upgrades are plug_and_play. D. Maintenance is a visual inspection of the equipment. E. We have 7 service technicians available in Lubbock. Massey Irrigation - Ronnie or Kyle DuBois 806-763-5193 F. All service calls will be handled within 4 hours. Massey Irrigation's service rate is $85.00 per hour, with no mileage charge. City of Lubbock FieIdNET Upgrade Item Number Item Bridge & Repeaters 13-9071-0 Internet Bridge 13-9072-0 Repeater, SX -R3000 12-0428-0 Omni Directional Antenna 12-1546-0 8.5 dB gain Directional Antenna Pivot Equipment 13-6908-0 AIMS Advance Interface Board 12-1547-0 6 dB gain Directional Antenna 12-1546-0 8.5 dB gain Directional Antenna 13-9073-0 FieIdNET Radio RTU 11-7897-9 12v Power Supply 2,130.00 Installation Labor Units Price Extended Price $ Net 1 $ 2,130.00 $ 2,130.00 $ 2,130.00 1 $1,480.00 $ 1,480.00 $ 1,480.00 1 $ 190.00 $ 190.00 $ 190.00 1 $ 102.00 $ 102.00 $ 102.00 $ 5,750.00 Subtotal $ 3,902.00 $ 3,902.00 31 $ 116.00 $ 3,596.00 $ 3,596.00 6 $ 81.00 $ 486.00 $ 486.00 44 $ 102.00 $ 4,488.00 $ 4,488.00 50 $ 870.00 $ 43,500.00 $ 43,500.00 31 $ 106.00 $ 3,286.00 $ 3,286.00 50 $ 115.00 $ 5,750.00 $ 5,750.00 Subtotal $ 61,106.00 $ 61,106.00 Total $ 65,008.00 Premier 12 Month Contract 50 $ 200.00 $ 10,000.00 $10,000.00 Premier 36 Month Contract 50 $ 500.00 $ 25,000.00 $ 25,000.00 15% discount on service contract for 50 or more pivots 10% discount on service contract for 25 to 49 pivots 5% discount on service contract for 15 to 24 pivots Massey Irrigation 4611 Idalou Rd. Lubbock, TX 79403 806-763-5193 Exhibit C City of Lubbock, TX Purchasing & Contract Management RFP 13 -11127 -TL, Wireless Irrigation Management System II — INSURANCE COVERAGE REQUIRED SECTION A. Prior to the approval of this contract by the City, the Contractor shall furnish a completed Insurance Certificate to the City, which shall be completed by an agent authorized to bind the named underwriter(s) to the coverages, limits, and termination provisions shown thereon, and which shall furnish and contain all required information referenced or indicated thereon. THE CITY SHALL HAVE NO DUTY TO PAY OR PERFORM UNDER THIS CONTRACT UNTIL SUCH CERTIFICATE SHALL HAVE BEEN DELIVERED TO THE CITY. SECTION B. The City reserves the right to review the insurance requirements of this section during the effective period of the contract and to require adjustment of insurance coverages and their limits when deemed necessary and prudent by the City based upon changes in statutory law, court decisions, or the claims history of the industry as well as the Contractor. SECTION C. Subject to the Contractor's right to maintain reasonable deductibles in such amounts as are approved by the City, the Contractor shall obtain and maintain in full force and effect for the duration of this contract, and any extension hereof, at Contractor's sole expense, insurance coverage written by companies approved by the State of Texas and acceptable to the City, in the following type(s) and amount(s): TYPE OF INSURANCE GENERAL LIABILITY X Commercial General Liability ❑ Claims Made ❑ Occurrence W/Heavy Equipment ❑ To Include Products of Complete Operation Endorsements PROFESSIONAL LIABILITY AUTOMOTIVE LIABILITY X Any Auto ❑ Scheduled Autos ❑ Non -Owned Autos EXCESS LIABILITY ❑ Umbrella Form GARAGE LIABILITY ❑ Any Auto ❑ All Owned Autos ❑ Hired Autos Other than Auto Only: Each Accident ❑ BUILDER'S RISK ❑ INSTALLATION FLOATER ❑ CARGO X WORKERS COMPENSATION — STATUTORY AMOUNTS OCCUPATIONAL MEDICAL AND DISABILITY COMBINED SINGLE LIMIT General Aggregate 1,000,000 Products-Comp/Op AGG X Personal & Adv. Injury X Contractual Liability X Fire Damage (Any one Fire) Med Exp (Any one Person) General Aggregate Combined Single Limitl,000,000 Aggregate Each Occurrence Aggregate Auto Only - Each Accident Aggregate ❑ 100% of the Total Contract Price ❑ 100% of the Total Material Costs X EMPLOYERS' LIABILITY OTHER: COPIES OF ENDOSEMENTS ARE REQUIRED X City of Lubbock named as additional insured on Auto/General Liability on a primary and non-contributory basis. X To include products of completed operations endorsement. IMPORTANT: POLICY ENDORSEMENTS The Contractor will provide copies of the policies without expense, to the City and all endorsements thereto and may make any reasonable request for deletion, revision, or modification of particular policy terms, conditions, limitations, or exclusions (except where policy provisions are established by law or regulation binding upon either of the parties hereto or the underwriter of any of such policies). Upon such request by the City, the Contractor shall exercise reasonable efforts to accomplish such changes in policy coverages, and shall pay the cost thereof. Any costs will be paid by the Contractor. REQUIRED PROVISIONS The Contractor agrees that with respect to the above required insurance, all insurance contracts and certificate(s) of insurance will contain and state, in writing, on the certificate or its attachment, the following required provisions: a. Name the City of Lubbock and its officers, employees, and elected representatives as additional insureds, (as the interest of each insured may appear) as to all applicable coverage; b. Provide for 30 days notice to the City for cancellation, nonrenewal, or material change; c. Provide for notice to the City at the address shown below by registered mail; d. The Contractor agrees to waive subrogation against the City of Lubbock, its officers, employees, and elected representatives for injuries, including death, property damage, or any other loss to the extent same may be covered by the proceeds of insurance; e. Provide that all provisions of this contract concerning liability, duty, and standard of care together with the indemnification provision, shall be underwritten by contractual liability coverage sufficient to include such obligations within applicable policies. L All copies of the Certificates of Insurance shall reference the proiect name or bid number for which the insurance is being supplied. NOTICES The Contractor shall notify the City in the event of any change in coverage and shall give such notices not less than 30 days prior the change, which notice must be accompanied by a replacement CERTIFICATE OF INSURANCE. All notices shall be given to the City at the following address: Marta Alvarez, Director of Purchasing & Contract Management City of Lubbock 1625 13'h Street, Room 204 Lubbock, Texas 79401 SECTION D. Approval, disapproval, or failure to act by the City regarding any insurance supplied by the Contractor shall not relieve the Contractor of full responsibility or liability for damages and accidents as set forth in the contract documents. Neither shall the bankruptcy, insolvency, or denial of liability by the insurance company exonerate the Contractor from liability. ALCOR ®CERTIFICATE OF LIABILITY INSURANCEPO4/0412013 ATE 12DD.+YYYY) �r.- 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(les) 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 ileu of such endorsement(s). PRODUCER CONTN PHONE I FA AIC N Ext' - A1C, No): BARRY HOPKINS 42994 PHONE: 1.800-228-6700 5317 72ND STREET ADDRESS: INSURERS AFFORDING COVERAGE NAIL V LUBBOCK, TX 79424 FARMLAND MUTUAL INS CO INSURER A: 111, IOCUIT IT DES MOINES. A 50391-3000 INSURED 0000124655 - MASS EY IRRIGATION AND LIQUIDATION INC INSURER B: INSURER C: 4611 IDALOU RD INSURER D: INSURER E : LUBBOCK, TX 79403-9532 INSURER F: CLAIMS -MAD= � OCCUR Cf1VFRe1GFg CFRTIFICATF NI IMRER- 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. I TR TYPE OF INSURANCE ADDL SUER POLICY NUMBER 4 , -Y F MMID11' Y LIMITS GENERAL LIABILITY EACH OCCURRENCE S X CONMERCL;L G_NERAL LIABILITY PREMISES Eaoccurren s' 100,000 MED F� (m • one Oersonl S 5,000 A CLAIMS -MAD= � OCCUR Y Y CPP124655A 12/15/2012 12/15/2013 PERSONAL 8 AO'.' INJt1RY S 1,000,000 GENERAL AGGREGATE 5 2,000,000 G=NL AGGREGATE LIM'r APPLIES PER FRODilCTS - COMPIOR AGG 5 5 POLICY P � LOC AUTOMOBILE LIABILITY COMBINE JEa accident)FA T ; 1,000,000 CSL BODILY INJURY (Per person) 5 N/A ANY AUTO BODILY INJURY (Per accident) 5 N/A A�LIO`ANED SCHEDULED AUTOS AUTOS FRED AL70S AUTOS Y Y CPP124655A 12/15/2012 12/15/2013 PROPERTY DAMAGE 5 N/A (P 5 X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $2,000,000 AGGREGATE $2,000,000 A EXCESS LIAO CLAth7&MAD: Y Y OU 124055A 12/15/2012 12/15/2013 BED I RETENTION S 5 WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETCRrPAP,TNERCENECUTIVE I PJC STATT� OTl„ EL. EACH ACCIDE-1 5 E.L WSEASE - EA EMPLOYE $ rFFICERMEMBER E-CLUDEDP ❑ (Mandatory In NH) N r A E L. D:3EASE -POLICY LIMIT 3 If Yes, describe urdsr DESCRIPTION OF O. '- ;R4TICnNS telaw DESCRIPTION OF OPERATIONS? LOCATIONS; VEHICLES (Attach ACORD 101, Additional Remarks Schedule. if more space Is required) A.M. BEST RATED A+ CLASS XV ITB# 12-10661-C1. CERTIFICATE HOLDER IS LISTED AS ADDITIONAL INSURED. INSURANCE IS PRIMARY AND NON-CONTRIBUTORY TO INCLUDE PRODUCTS OF COMPLETED OPERATIONS. WAIVER OF SUBROGATION APPLIES. 2LK-IIIII IP111:u1111,91a.i CITY OF LUBBOCK PO BOX 2000 LUBBOCK, TX 79457 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE �/% /�� # /' 0) 1999-2010 ACORD CORPORATION. All riahts reserved ACORD 25 (2010/06) The ACORD name and logo are registered marks of ACORD ACaRD CERTIFICATE OF LIABILITY INSURANCE SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE (MM/DD/YY) �..�.- 11/10/12 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 INSURERS 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 and endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(sl. PRODUCER CONTACT NAME 42994 BARRY HOPKINS PHONE IA/C. No. Ext:! 1-800-228-6700 1 FAX IA/C. NOI: PHONE 1-800-228-6700 5317 72ND STREET E-MAIL ADDRESS: LUBBOCK TX 79424 INSURERISI AFFORDING COVERAGE NAIC # INSURED INSURLIIA FARMLAND MUTUAL INS CO 0000124655 MASSEY IRRIGATION AND 1100 LOCUST ST DES MOINES IA 50391-3000 INSURLII B LIQUIDATION INC INSURER 4611 IDALOU RD LUBBOCK TX 79403-9532 INSUIR.11 D INSURER L 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 ADDL INSR SUBR WVD POLICY NUMBER POLICY EFF DATE (MM/DD/YY) POLICY EXP DATE IMM/DD/YYI LIMITS A GENERAL LIABILITYCPP124655A FCOMMERCIAL GENERAL LIABILITY ❑Y ❑Y 12/15/12 12/15/13 EACH OCURRENCE $ 1, 000, 000 DAMAGE TO RENTED $ 100,000 II PREMISES (Ea occurrence) ❑❑ CLAIMS MADE Fx1 OCCUR MED EXP /Any one person) $ S,000 ❑ PERSONAL & ADV INJURY $ 1, 000,000 ❑ GENERAL AGGREGATE $ 2,000,000 GENL AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000 ❑ POLICY ❑ PROJECT ❑ LOC A AUTOMOBILE LIABILITY FRIANY AUTO CPP124655A 12/15/12 12/15/13 ❑ ALL OWNED AUTOS COMBINED SINGLE LIMIT $1,000,000 CS ❑ SCHEDULED AUTOS ❑ HIRED AUTOS (Ea accident) BODILY INJURY (Per person) $ N/A ❑ NON OWNED AUTOS BODILY INJURY $ N/A (Per accident) PROPERTY DAMAGE $ N/A ❑ (Per accident) A X UMBRELLA LIAB X OCCUR EXCESS LIABILITY CLAIMS -MADE ❑Y CU 124655A 12/15/12 12/15/13 EACH OCCURRENCE $ 1,000,000 AGGREGATE $ 1,000,000 ❑ DEDUCTIBLE S ❑ RETENTION $ g WORKERS COMPENSATION AND ❑ WC STATU- ❑ OTH- EMPLOYERS' LIABILITY TORY LIMITS ER E.L. EACH ACCIDENT $ ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? YIN [MANDATORY IN NHI1:1NIA It yes, describe under ❑ E.L. DISEASE - EA EMPLOY $ DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ ❑ ❑ S DESCRIPTION OF OPERATIONS/LOCATIONS?VEHICLE [Attach ACORD101, Additional Remarks Schedule, H more space Is required). A.M. BEST RATED A+ CLASS XV ITB# 12 -10661 -Cl. CERTIFICATE HOLDER IS LISTED AS ADDITIONAL INSURED. INSURANCE IS PRIMARY AND NON-CONTRIBUTORY TO INCLUDE PRODUCTS OF COMPLETED OPERATIONS. WAIVER OF SUBROGATION APPLIES. CERTIFICATE HOLDER CANCELLATION ACORD 25 (2010105) The ACORD name and logo are reglastered marks of ACORIA 1988-2010 ACORD CORPORATION. All rights reserved. �e" 1 Of 1 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS, CITY OF LUBBOCK PO BOX 2000 LUBBOCK TX 79457 AUTHORIZED REPRESENTATIVE „A fib*4 ACORD 25 (2010105) The ACORD name and logo are reglastered marks of ACORIA 1988-2010 ACORD CORPORATION. All rights reserved. �e" 1 Of 1 AlCCORD® `�.../ CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DDIYYYY) F — 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 CONTA NAME: Allied General Agency Company 1100 Locust Street, Dept. 2002 PHONE FAX C�No Ext AIC No: E IL ADDRESS: INSURERS AFFORDING COVERAGE NAIL# Des Moines, IA 50391 INSURERA: Texas Mutual Insurance Company INSURED INSURER B: INSURERC: Massey Irrigation and Liquidation 4611 Idalou Road Lubbock, TX 79403 INSURER D: INSURER E: DAMAGE TO RENTED PREMISES Ea occurrence S 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. INSRLTR LTRIM OF INSURANCE ADDLTYPE S POLICY NUMBER EFF MUBR MIDD/YYY MMILICY DD/Y XP LIMITS GENERAL LIABILITY EACH OCCURRENCE S COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED PREMISES Ea occurrence S CLAIMS -MADE EIOCCUR MED EXP (Any one person) S PERSONAL & ADV INJURY S GENERALAGGREGATE S GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS- COMPIOP AGG S POLICY PRO LOC JECT S AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident S BODILY INJURY (Per person) S ANY AUTO ALLOWNED SCHEDULED AUTOS AUTOS BODILY INJURY (Per accident) S PROPERTY DAMAGE S Per accident NON -OWNED HIREDAUTOS. AUTOS S UMBRELLA LIAR OCCUR EACH OCCURRENCE S AGGREGATE S EXCESS LIAB CLAIMS -MADE DED I I RETENTION S S A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNERIEXECUTIVE� TSF0001175218 12/19/2012 2/19/2',13 WCSTATU- OTH. I TORY LIMITs ER EL EACH ACCIDENT 51,000,000 OFFICER/MEM BER EXCLUDED? NIA E L DISEASE- EA EMPLOYEE S1,000,000 (Mandatory In NH) It yes, describe under DESCRIPTION OF OPERATIONS below E L DISEASE- POLICY LIMIT S1,000,000 DESCRIPTION OF OPERATIONS/ LOCATIONS VEHICLES (Attach ACORD 101, Additional Remarks Schedule, H more space Is required) waiver of subrogation PO Box 2000 Lubbock, TX 79457 ACORD 25 (2010/05) DS#10749484 GA SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED ®1988-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD ® 6210 E Highway 290 P.O. Bog 12058 M Anson, Texas 78723-1098 Austin, Texas 787112058 (512) 224-3800 (512) 2243800 T____�.•____� 1,800-859-5995 14004159-5995 November 26, 2012 ALLIED GENERAL AGENCY COMPANY 1100 LOCUST ST DEPT 2002 DES MOINES, IA 50391-2002 Re: MASSEY IRRIGATION & LIQUIDATION INC TSF -0001175218 20121219 Thank you for placing this account with Texas Mutual Insurance Company. For your records we are enclosing: The policyholder's original copy of the policy Claims reporting information and forms • Your agency copy of the policy We offer many online services for agents and policyholders at texasmutual.com. Our website allows you to submit applications online, manage your accounts with us, view your clients' claim information, create customized loss reports, and stay up-to-date with Texas Mutuale news and events. As the state's leading provider of workers' compensation insurance, we strive to set the standard in Texas for service, communication, and ease of doing business. If you have any questions, please email us at underwriting@toxasmutual.com, or call us at 1-800$59-5995. Underwriting Department COVAGENT - 0E/121Q4 Te.,AXaLC11V1U Insur�aaeCamp�ny 6210 E Highway 290 Austin. Texas 78723-1098 AU3L INSURED NAME AND ADDRESS PRODUCEF 42485 D07VIIIIIIIIII rrEM3 rMA4 WORKERS' COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY INFORMATION PAGE MASSEY IRRIGATION & LIDUIDATION INC 4611 I DALOU RD LUBBOCK, TX 79403-9532 POLICY NUMBER TSF -0001175218 20121219 Federal Tax ID 75-1755033 WHEitworttPLACESnaTSHCNMABOVE: Bureau Number 420164483 see attached schedule of operation. Branch HOUSTON ALLIED GENERAL AGENCY COMPANY 1100 LOCUST ST DEPT 2002 Renewalof 0001175218 DES MOINES, IA 50391-2002 Entity CORPORATION Interim Adjustment Group The Policy Period is from: 12-19-2012 To: 12-19-2013 12:01 A.M. standard time at the insunmrs mailing address A. Workers• Compensation Insurance: Part One of the policy applies to the Workers' Compensation Law of the states listed here: TEXAS B. Employers Liability Insurance: Part Two of the policy applies to work in each state listed In item 3A. The Limits of our Liability under Part Two are: Bodily Injury by Accident f 1,000,000 Each Accident Bodily Injury by Disease S 1,000,000 Each Employee Bodily Injury by Disease $ 1,000,000 Policy Limit C. Other States Insurance: Part Three of the policy applies to the states, If any, listed here: NONE D. This policy Includes these endorsements and schedules: See Schedule of Endorsements attached The premium for this policy will be detemdned by our manuals of Rules, Classifications, Rates and Bating Plans. All Information required below is subject to verification and change by audit. TOTAL ESTIMATED STANDARD PREMIUM :$ 11 ,491 .00 WAIVER OF SUBROGATION. . . . . . . . . . . . 230.00 INCREASED EMPLOYERS LIABILITY LIMITS.. . . . . . . . . . 234.00 TOTAL PREMIUM SUBJECT TO MODIFICATIONS ... .. 11,955.00 PREMIUM MODIFIED TO REFLECT EXPERIENCE MOD OF 1.18) 2,152.00 PREMIUM MODIFIED TO REFLECT SCHEDULE RATING OF ( .95 ). ; 705.00— WORKERS' COMP HEALTH CARE NETWORK DISCOUNT ( .12 ). 1,808.00— DEDUCTIBLE ,608.00— DEDUCTIBLE PREMIUM. . . . . . . . . . . . . . . . . . . .00 ADMIRALTY/FELA OR L& HW.00 PREMIUM DISCOUNT, IF APPLICABLE(4.80, ) 566.00 - EXPENSE CONSTANT CHARGE . . . . . . . . . . . . . . . . . 150.00 TOTAL ESTIMATED ANNUAL PREMIUM :S 11,378.00 MINIMUM PREMIUM 250.00 DEPOSIT PREMIUM 11 ,378 .00 Countersigned by Issue Date: 11-26-2012 The Texas Mutual Insurance Company is required by law to provide its policyholders with certain accident prevention services as required by Texas Labor Code, §411.066, at no additional charge and retum4o-work coordination services as required by Texas Labor Code §413.021. If you would like more infomlation, call Texas Mutual Insurance Company's loss control division at 1-800-859-5995 for accident prevention services or 1-800-8595995 for return -to -work coordination services. If you have any questions about this requirement, call the Texas Department of Insurance, Division of Workers' Compensation, Workplace Safety, at 1-800-687-7080. WCOODD01A (ED. 07-11) IMPORTANT NOTICE To obtain information or make a complaint: You may contact your agent. You may call the Texas Mutual Insurance Company toll-free telephone number for information or to make a complaint at: 1-800-859-5995 You may also write to: Texas Mutual Insurance Company 6210 E Highway 290 Attn: Information Services Center Austin, Texas 78723-1098 You may contact the Texas Department of Insurance to obtain information on companies, coverages, rights or complaints at: 1-800-252-3439 You may write the Texas Department of Insurance at: P.O. Box 149104 Austin, TX 78714-9104 Fax # (512) 475-1771 Web: http://www.tdi.state.tx.us E-mail: ConsumerProtection@tdi.state.tx.us PREMIUM OR CLAIM DISPUTES: Should you have a dispute concerning your premium or about a claim you should contact the agent or the company first. If the dispute is not resolved, you may contact the Texas Department of Insurance. ATTACH THIS NOTICE TO YOUR POLICY: This notice is for information only and does not become a part or condition of the attached document AVISO iMPORTANTE Para obtener informacion o para someter una queja: Puede comunicarse con su agents. Usted puede Ilamar al numero de telefono gratis del Texas Mutual Insurance Company para informacion o para someter una queja al: 1-800-859-5995 Usted tambien puede escribir a: Texas Mutual Insurance Company 6210 E Highway 290 Attn: Information Services Center Austin, Texas 78723-1098 Puede comunicarse con el Departamento de Seguros de Texas para obtener informacion acerca de companias, coberturas, derechos o quejas al: 1-800-252-3439 Puede escribir al Departamento de Seguros de Texas a: P.O. Box 149104 Austin, TX 78714-9104 Fax # (512) 475-1771 Web: http://www.tdi.state.tx.us E-mail: ConsumerProtection@tdi.state.tx.us DISPUTAS SOBRE PRIMAS O RECLAMOS: Si tiene una disputa concemiente a su prima o a un reclamo, debe comunicarse con el agente o la compania primero. Si no se resuelve la disputa, puede entonces comunicarse con el departamento (TDI). UNA ESTE AVISO A SU POLIZA: Este aviso es solo para pmposito de informacion y no se convierte on parte o condition del documento adjunto. WORKERS' COMPENSATION AND XI ® EMPLOYERS LIABILITY INSURANCE POLICY M Ift=M1ot:CflmP SCHEDULE OF OPERATIONS EXTENSION OF INFORMATION PAGE PAGE 2 NAME AND ADDRESS OF INSURED POLICY NUMBER MASSEY IRRIGATION & LIQUIDATION INC TSF -0001175218 20121219 4511 IDALOU RD LUBBOCK, TX 79403-9832 ISSUE DATE 11-26-2012 Subj to Experience Mad of 1.18 Total Estimated Standard Premium 11,491.00 This endorsement charges the policy to which It is attached effective on the inception date of the policy unless a di ferent date Is Indicated below. (The fallowing "attaching louse° need be completed only when this endorsement is rued subseWar tto preparation of the policy.) This endorsement, effective on at 12:01 A.M. standard time, tonna a part of Policy No. TSF -0001175218 20121219 of the Texas Mutual Insurance Company Issued to MASSEY I RR I GAT I ON & LIQUIDATION INC Endorsement No. Premium $ 0171, Authorized Reppresentatve WCOD0001A (ED. 7-11) AGENT'S COPY AXFLORES 11-26-2012 ITEM 4 *k SCHEDULE OF OPERATIONS *" LOCATION INFORMATION PREMIUM BASIS: TOTAL ESTFAATED RATE PER $100OF ESTIMATED ANNUAL ST LOC CODES CLASSIFICATION ANNUAL REMUNERATION REMUNERATION PREMIUM 42 00001 8742 SALESPERSONS, COLLECTORS OR 16,524.00 .39 65.00 MESSENGERS—OUTSIDE 42 00001 8809 EXECUTIVE OFFICERS NOC— 62,400.00 .34 212.00 PERFORMING CLERICAL OR OUTSIDE SALESPERSONS DUTIES ONLY 42 00001 8810 CLERICAL OFFICE EMPLOYEES NOC 20,000.00 .25 50.00 42 00001 8107 IRRIGATION SYSTEMS DEALER & 226,956.00 4.29 9,735.00 DRIVERS 42 00001 3724 IRRIGATION SYSTEM INSTALLATION— 30,000.00 4.76 1,428.00 PIVOT TVPE—& DRIVERS Subj to Experience Mad of 1.18 Total Estimated Standard Premium 11,491.00 This endorsement charges the policy to which It is attached effective on the inception date of the policy unless a di ferent date Is Indicated below. (The fallowing "attaching louse° need be completed only when this endorsement is rued subseWar tto preparation of the policy.) This endorsement, effective on at 12:01 A.M. standard time, tonna a part of Policy No. TSF -0001175218 20121219 of the Texas Mutual Insurance Company Issued to MASSEY I RR I GAT I ON & LIQUIDATION INC Endorsement No. Premium $ 0171, Authorized Reppresentatve WCOD0001A (ED. 7-11) AGENT'S COPY AXFLORES 11-26-2012 ® WORKERS' COMPENSATION AND r 1wahEMPLOYERS LIABILITY INSURANCE POLICY Ias�r�noec mpw SCHEDULE OF OPERATIONS - STATE PAGE 3 EXTENSION OF INFORMATION PAGE NAME AND ADDRESS OF INSURED POLICY NUMBER MASSEY IRRIGATION & LIQUIDATION INC TSF -0001175216 20121219 4611 IDALOU RO LUBBOCK, TX 79403-9532 ISSUE DATE 11-26-2012 This endorsement changes the poky to which t is a teched effective on the Inoeption date of the policy unless a different date is Indicated below. (The following "attaching clause" need be completed only when this endorsement Is Issued subsequent to prion of the policy.) This endorsemenE, effective on at 1201 A.M. standard time, k me a part of Policy No. TSF -0001175218 20121219 of the Texas Mutual Insurance Company Issued to MASSEY I RR I GAT I ON 8c LIQUIDATION INC Endorsement No. Premium $ rslt' A Authorized Representative W0000001A(ED.7-11) AGENT'S COPY AXFLORES 11-26-2012 ITEM 4 '" SCHEDULE OF OPERATIONS *` STATE INFORMATION PREMIUM ST CODE S DESCRIP M RATE ADJUSTMENTS 42 9812 INCREASED LIMITS 10001100011000 .02 234.00 42 0063 PREMIUM DISCOUNT .048 566.00- 42 9898 EXPERIENCE MOD 1.18 2,152.00 42 0930 WAIVER OF SUBROGATION .02 230.00 42 9887 SCHEDULE RATE MODIFIER .95 705.00- 42 9674 HEALTH CARE NETWORK DISCOUNT .12 1,608.00- 42 0900 EXPENSE CONSTANT 150.00 Total Premium Adjustments 113.00— Total Estimated Annual Premium 11,378.00 This endorsement changes the poky to which t is a teched effective on the Inoeption date of the policy unless a different date is Indicated below. (The following "attaching clause" need be completed only when this endorsement Is Issued subsequent to prion of the policy.) This endorsemenE, effective on at 1201 A.M. standard time, k me a part of Policy No. TSF -0001175218 20121219 of the Texas Mutual Insurance Company Issued to MASSEY I RR I GAT I ON 8c LIQUIDATION INC Endorsement No. Premium $ rslt' A Authorized Representative W0000001A(ED.7-11) AGENT'S COPY AXFLORES 11-26-2012 ® WORKERS' COMPENSATION AND KmM EMPLOYERS LIABILITY INSURANCE POLICY IaamanoeCompony LOCATIONS EXTENSION OF INFORMATION PAGE PAGE 4 NAME AND ADDRESS OF INSURED POLICY NUMBER MASSEY IRRIGATION a LIQUIDATION INC TSF -0001175218 20121219 4511 I DALOU RD ISSUE DATE LUBBOCK, TX 79403-9532 11-26-2012 LOCATION NUMBER ITEM 1 LOCATIONS ADDRESS 00001 MASSEY IRRIGATION A LIQUIDATION INC 4611 I DALOU RD RONNIE DUBOIS LUBBOCK, TX 79403-9532 FEDERAL ID; 75-1765033 EFFECTIVE: 12-19-2012 EXPIRES: 12-19-2013 This endorsement charges the policy to which it Is attached effective on the inception date of the policy unless a diffarent date Is indicated below. (The following -attaching clause need be completed only when this endorsement Is Issued subm quant to preparation of the policy.) This endorsement, effective on at 12:01 A.M. standard time, forms a part of Policy No. TSF -0001175218 20121219 of the Texas Mutual Insurance Company Issued to MASSEY IRRIGATION & LIQUIDATION INC Endorsertxr>t Na. —P Premium $ 0-14, l Authorized Representative WCtA CWIA (ED. 7-11) AGENT'S COPY AXFLORES 11-25-2012 WORKERS' COMPENSATION AND ® EMPLOYERS LIABILITY INSURANCE POLICY ENDORSEMENT SCHEDULE EXTENSION OF INFORMATION PAGE PAGE 5 NAME AND ADDRESS OF INSURED POLICY NUMBER MASSEY IRRIGATION & LIQUIDATION INC TSF -0001175218 20121219 4611 IDALOU RD LUBBOCK, TX 79403-9532 ISSUE DATE 11-26-2012 This endorsement charges the policy to which it is attached effective on the inoepdon date of the poAcy unless a different date Is Indicated below. (The followinD'attao" clauee° need be completed only when this endorsement Is issued subsequent to preparation of the policy.) This endorsement, ef%cM an at 12:01 A.M. standard time, fomes a part of Policy No. TSF -0001175218 20121218 of the Texas Mutual Insurance Company Issued to MASSEY I RR I GAT I ON & LIQUIDATION INC Endorsement No. Premium $ Authorized Representative WC000001 A (ED. 7-11) AGENT'S COPY AXFLORES 11-28-2012 MM 3D "' ENDORSEMENT SCHEDULE EDITION STATE NUMBER DESCRIPTION DATE 42 TM—LRC-2008 LIMITED REIMBURSEMENT COVERAGE 1-01-2008 42 PC -2003 POLICY CONDITIONS ENDORSEMENT 3-25-2003 42 TM—MV-2011 MUTUAL ENDORSEMENT FORM 1-01-2012 42 TM—TRIPRA-2008 TERRORISM RISK INSURANCE PROG 1-01-2008 42 TM—TPE-2008 TERRORISM PREMIUM ENDORSEMENT 1-01-2008 42 WC00 00 GOB WORKERS COMPENSATION AND EMPLO 7-01-2011 42 WC00 00 01A WORKERS COMP/EMPLOYERS LIAB 42 WC00 04 06 PREMIUM DISCOUNT 1-01-1994 42 WC42 03 01F TEXAS AMENDATORY 1-01-2000 42 WC42 04 07 AUDIT PREMIUM ENDORSEMENT 3-23-2002 42 WC42 04 08 NETWORK DISCOUNT 1-02-2003 42 WC42 03 04A TX WAIVER OF RIGHT TO RECOVER 1-01-2000 This endorsement charges the policy to which it is attached effective on the inoepdon date of the poAcy unless a different date Is Indicated below. (The followinD'attao" clauee° need be completed only when this endorsement Is issued subsequent to preparation of the policy.) This endorsement, ef%cM an at 12:01 A.M. standard time, fomes a part of Policy No. TSF -0001175218 20121218 of the Texas Mutual Insurance Company Issued to MASSEY I RR I GAT I ON & LIQUIDATION INC Endorsement No. Premium $ Authorized Representative WC000001 A (ED. 7-11) AGENT'S COPY AXFLORES 11-28-2012 'kxa a ® TEXAS WORKERS' COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY Inswmmc mpany TM -LRC -2008 LIMITED REIMBURSEMENT FOR TEXAS EMPLOYEES INJURED IN OTHER JURISDICTIONS IMPORTANT NOTICE[ PLEASE READ THIS ENDORSEMENT CAREFULLY This policy does not provide "other states" insurance coverage. This endorsement provides reimbursement coverage to you for those Texas employees who are described in the Texas Labor Code §§406.071-.072. Therefore the coverage is for injuries to your Texas employees that occur in another state if () the injury would have been compensable had it occurred in Texas and a the employee has significant contacts with Texas or the employment is principally located in Texas. An employee has significant contacts with Texas If the employee was hired or recruited in Texas, and () the employee was injured not later than one year after the date of hire; or (ii) has worked in Texas for at least ten working days during the twelve months preceding the date of injury. Employees hired or recruited by you outside Texas to work in another state are specifically excluded from the terms and provisions of this policy. If you conduct business in states other than Texas, you must comply with those state laws. You must promptly notify your agent before you begin work in any jurisdiction other than Texas. We are not authorized to provide workers' compensation insurance in any jurisdiction other than Texas. You are responsible for all of your legal obligations for your failure to comply with requirements of the workers' compensation laws of any jurisdiction other than Texas. Part Three Other States Insurance of the policy is deleted and replaced with the following: 1. Limited Reimbursement Provision A. How this endorsement applies This endorsement will reimburse you after you have made payments for benefits for injuries to your Texas employees required of you in another jurisdiction. This reimbursement provision only applies to bodily injury by accident including death or bodily injury by disease including death incurred by your employee who qualifies for Texas workers' compensation benefits under Sec. 406.071 of the Texas Labor Code. 1. Bodily injury must arise out of and in the course of the injured employee's temporary employment by you in a state other than Texas. 2. Bodily injury by accident must occur during the policy period. 3. Bodily injury by disease must be caused or aggravated by the conditions of your employment. The employee's last day of last injurious exposure to the conditions causing or aggravating such bodily injury by disease must occur during the policy period. 4. The employee incurring bodily Injury must be eligible for Texas workers' compensation benefits and must make a written election of workers' compensation benefits in the state in which the bodily injury occurred in lieu of Texas workers' compensation benefits. You must send us written notice of such election within 10 days of receiving notice yourself. Failure to provide such notice means any reimbursement will be made in accordance with the Texas Labor Code. tic -2= AGENT'S COPY B. Reimbursement 1. We will reimburse you for the amount you have paid as workers' compensation benefits for employees, as defined above, under the workers' compensation law of any state listed in the schedule. 2. We will deduct from the benefits so reimbursed any amounts we have paid as Texas benefits to the employee for the same Injury for which the other jurisdiction's benefits are required. 3. Sections D through G of Part One of the policy will apply to reimbursement provided by this endorsement. Sections A, B, C and H of Part One of the policy will not apply to reimbursement provided by this endorsement. 4. We will reimburse you for reasonable attorney's fees you have paid to defend the injury claim in another jurisdiction. fl. Exclusions, Limitations and Conditions The following conditions apply to the reimbursement afforded by this endorsement: 1. Nothing in this endorsement confers jurisdiction in another state or constitutes our doing business in another state. 2. Reimbursement will be made In Texas. 3. Travis County, Texas is the sole venue for any lawsuit involving reimbursement under this endorsement. 4. This endorsement provides reimbursement only In Texas and fully releases and indemnities us and holds us harmless from any liability arising from your failure to obtain workers' compensation coverage in another jurisdiction. 5. The reimbursement provided by this endorsement excludes: a. bodily injury, including death, to an employee while employed in a jurisdiction where you have secured your obligation under the workers' compensation law by other insurance or by self- insurance; b. bodily injury, Including death, to an employee while employed in a state where you affirmatively rejected the workers' compensation law, or c. fines or penalties arising out of your failure to comply with requirements of the workers' compensation law of any state. III. Premium The premium basis and rates for work by Texas employees in jurisdictions other than Texas are the same as if the work had been done in Texas. IV. Schedule Designated States: All states of the United States of America except North Dakota, Ohio, Washington and Wyoming. V 2006. National Council of Compensation Insuraoe, Inc. Ali rishts reserved. Reprinted with Permission' This endorsement changes the policy to which it is attached effective on the inception date of the policy unless a different date Is indicated below. (The following 'attaching clause" need be completed only when this endorsement is issued subsequent to preparation of the policy.) This endorsement, effective on at 12:01 A.M. standard time, forms a part of Policy No. TSF -0001175218 20121218 of the Texas Mutual Insurance Company Issued to MASSEY I RR I GAT 1 ON & L I QU I DAT 1 ON INC DBA: Endorsement No. Premium: $ Authorized Representative TULRC-2= AGENT'S COPY AXFLORES 11-26-2012 ® TEXAS WORKERS' COMPENSATION AND M'kxa EMPLOYERS LIABILITY POLICY —11"knimm iazipw TNI-PC-2003 The named insured ratifies and accepts the terms and conditions of the policy to which this endorsement is attached as well as the terms listed below. 1. Policies that are on an interim reporting basis may not be financed. Texas Mutual Insurance Company may cancel coverage If it determines that Interim reports have been financed in violation of this prohibition. 2. The named insured certifies that the payroll established by classification codes in the application for coverage is a true and reasonable estimate for the period of coverage requested and will promptly report any material change in payroll exposures to Texas Mutual Insurance Company. Texas Mutual Insurance Company may adjust premium for the policy upon receipt of such information. 3. The named Insured and its affiliates permit Texas Mutual Insurance Company access to all oftheir employment Information and records filed with the Texas Workforce Commission, and hereby waive the confidentiality of such information and records. 4. All obligations of the named insured are performable in Travis County, Texas and said county will bethe legal venue for any suit arising from this contract. Maintenance of an action in Travis County, Texas does not work an injustice to the named insured and is in the Interest of the parties, and transfer of the action would work an Injustice to the parties. Any suits must be filed in Travis County, Texas. 5. If the insured defaults on payment of any premiums due under any policy issued, then all premiums due and unpaid shall become due and payable at Texas Mutual Insurance Company's offices in Austin, Travis County, Texas. 6. All information supplied to Texas Mutual Insurance Company by the named Insured or its agent in the application for insurance or otherwise is true and complete; nothing material regarding its operations has been omitted; and the named insured intended Texas Mutual Insurance Company to rely on such information in issuing this policy. The named ensured assumed the duty of full disclosure of such Information and that Texas Mutual Insurance Company has no duty to inquire further regarding such inibrmation. The named insured Is not violating any provision of the Texas Workers' Compensation Act and Is not subcontracting any work to a subcontractor with the intent to avoid liability as an employer. 7. The named insured will not cause any certificate of insurance to be issued for the purpose of satisfying the workers' compensation Insurance requirements of any third party, including any governmental entity, unless the remuneration paid to the Individual workers performing such work is disclosed toTexas Mutual Insurance Company and Included In the premium calculation of the named insured. If the named insured causes a certificate of insurance to be issued forthe purpose of allowing the employees of a person other than the named insured to perform work at any job site where workers' compensation is required, and such workers are not covered by workers' compensation insurance, such action by the named Insured Is a material breach of this insurance policy and constitutes fraud upon Texas Mutual Insurance Company. 8. The named insured has appointed the agent whose name appears on the application as its agent In fact and agrees that any representations made on its behalf by that agent are the representations of the named insured, unless there is an express written agreement between Texas Mutual Insurance Company and the agent that the agent acts on behalf of Texas Mutual Insurance Company. 9. Acceptance of this policy with all endorsements and tender of the deposit premium constitute the Insured's agreement with all of the terms and conditions thereof, and the Insured's acknowledgement of the obligation to pay all premiums due for the policy. 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 dause need be completed only when this endorsement is issued subsequent to preparation of the policy.) This endorsement, effective on at 12:01 A.M. standard time, forms a part of Policy No. TSF -0001175218 20121219 of the Texas Mutual Insurance Company Issued to MASSEY I RR I GAT 1 ON & L 1 QU 1 DAT 1 ON INC Endorsement No. Premium $ Authorized Representative TM -PC -2003 (ED. 03/25/03) AGENT'S COPY AXFLORES 11-26-2012 ® TEXAS WORKERS' COMPENSATION AND Tl.-� EMPLOYERS LIABILITY POLICY Insnraffinacm4my MUTUALS — MEMBERSHIP AND VOTING NOTICE The insured is notified that by virtue of this policy, he is a member of Texas Mutual Insurance Company, and is entitled to vote either in person or by proxy at any and all meetings of said Company. The Annual Meetings are held in its Home Office, 6210 E Highway 290, Austin, Texas, on the fourth Tuesday of June in each year, at 1:00 o'clock p.m. each year unless the Board of Directors of Texas Mutual Insurance Company specifies otherwise. TM -MV -2011 MUTUALS — PARTICIPATION CLAUSE WITHOUT CONTINGENT LIABILITY No Contingent Liability: This policy is non -assessable. The policyholder is a member of the company and shall participate, to the extent and upon the conditions fixed and determined by the Board of Directors in accordance with the provisions of law, in the distributions of dividends so fixed and determined. This endorsement changes the policy to which it is attached effective on the Inception date of the policy unless a 01larent date Is Indicated below. (The followir g'attaching clause" need be completed only when this endorsement Is Issued subsequent to preparation of the policy.) This endorsement, affective on at 1201 A.M. standard time, forms a part of Policy No. TSF -0001175218 20121219 of the Texas Mutual Insurance Company Issued tD MASSEY I RR I GAT 1 ON & L 1 QU I DAT 1 ON INC Endorsement No. Premium $ Authorized Representative TM -MV -2011 AGENT'S COPY AXFLORES 11-25-2012 TeXasmilu ® TEXAS WORKERS' COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY bey TM-TRIPRA-2008 (Ed. 1-08) TEXAS TERRORISM RISK INSURANCE PROGRAM REAUTHORIZATION ACT ENDORSEMENT This endorsement addresses the requirements of the Terrorism Risk insurance Act of 2002 as amended and extended by the Terrorism Risk Insurance Program Reauthorization Act of 2007. Definitions The definitions provided in this endorsement are based on and have the same meaning as the definitions in the Act. If words or phrases not defined In this endorsement are defined in the Act, the definitions in the Act will apply. "Act" means the Terrorism Risk Insurance Act of 2002, which took effect on November 26, 2002, and any amendments resulting from the Terrorism Risk Insurance Program Reauthorization Act of 2007. °Act of Terrorism" means any act that is certified by the Secretary of the Treasury, in concurrence with the Secretary of State, and the Attorney General of the United States as meeting all of the following requirements: a. The act is an act of terrorism. b. The act Is violent or dangerous to human life, property or infrastructure. c. The act resulted in damage within the United States, or outside of the United States in the case of the premises of United States missions or certain air carriers or vessels. d. The act has been committed by an individual or individuals as part of an effort to coerce the civilian population of the United States or to influence the policy or affect the conduct of the United States Government by coercion. "Insured Loss' means, any loss resulting from an act of terrorism (Including an act of war, in the case of workers' compensation) that Is covered by primary or excess property and casualty insurance issued by an insurer if the loss occurs in the United States or at the premises of United States missions or to certain air carriers or vessels. "Insurer Deductible° means, for the period beginning on January 1, 2008, and ending on December 31, 2014, an amount equal to 20% of our direct earned premiums, over the calendar year immediately preceding the applicable Program Year. "Program Year' refers to each calendar year between January 1, 2008 and December 31, 2014, as applicable. TM-TRIPRA-2008 AGENT'S COPY Limitation of Liability The Act limits our liability to you under this policy. If aggregate Insured Losses exceed $100,000,000,000 in a Program Year and if we have met our Insurer Deductible, we are not liable for the payment of any portion of the amount of Insured Losses that exceeds $100,000,000,000; and for aggregate Insured Losses up to $100,000,000,000, we will pay only a pro rata share of such Insured Losses as determined by the Secretary of the Treasury. Policyholder Disclosure Notice 1. Insured Losses would be partially reimbursed by the United States Government. If the aggregate industry Insured Losses exceeds $100,000,000 in a Program Year, the United States Government would pay 85% of our Insured Losses that exceed our Insurer Deductible. 2. Notwithstanding item 1 above, the United States Government will not make any payment under the Act for any portion of Insured Losses that exceed $100,000,000,000. 3. The premium charged for the coverage for Insured Losses under this policy is included in the amounts shown in Rem 4 of the Information Page or in the Schedule In the Texas Terrorism Premium Endorsement. (TM-TPE-2008), attached to this policy. 'D 2006. National Council of Compensation Insurace, Inc. All rights reserved. Reprinted with Permission' This endorsement changes the policy to which it Is attached effective an the inception date of the policy unless a different date is Indicated below. (The following 'attaching dauW need be completed only when this endorsement Is issued subsequent to preparation of the policy.) This endorsement, effective on at 12:01 A.M. standard time, forms a part of Policy No. TSF -0001175218 20121218 of the Texas Mutual Insurance Company Issuedto MASSEY IRRIGATION $ LIQUIDATION INC DBA: Premium: $ Endorsement No. Authorized Representative TWTRIPP-4-M AGENT'S COPY AXFLORES 11-26-2012 kxasmuta ® TEXAS WORKERS' COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY y,y TM-TPE-2008 (Ed. 1-08) TEXAS TERRORISM PREMIUM ENDORSEMENT This endorsement is notification that your insurance carrier Is charging premium for losses that may occur in the event of an act of terrorism. Your policy provides coverage for workers' compensation losses caused by acts of terrorism, Including workers' compensation benefit obligations dictated by state law. Coverage for such losses is still subject to all terms, definitions, exclusions, and conditions in your policy, and any applicable federal and/or state laws, rules, or regulations. For purposes of this endorsement, an °act of terrorism" Is defined as: a. Any act that is violent or dangerous to human life, property or infrastructure; and b. The act has been committed by an individual or individuals as part of an effort to coerce the civilian population of the United States or to influence the policy or affect the conduct of the United States Government by coercion. The premium charge for the coverage your policy provides for workers' compensation losses caused by an act of terrorism is shown in Item 4 of the Information Page or in the Schedule below. Schedule State Texas Rate per $100 of payroll $0.00 V 20136. National Council of Compensation Insurace, Inc. AN rights reserved. Reprinted with Permission" 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. (rhe following "attaching clause" need be completed only when this endorsement is issued subsequent to preparation of the policy.) This endorsement, effective on at 12:01 A.M. standard time, forms a part of Pollcy No. TSF -0001175218 20121219 of the Texas Mutual Insurance Company issuedto MASSEY IRRIGATION & LIQUIDATION INC DBA: Premium: $ Endorsement No. e 0124, Authorized Representative TM-'rMMM AGENT'S COPY AXFLORES 11-26-2012 WORKERS' COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 00 00 00 B In return to the payment ofthe premium and subjectto all terms ofthis po§M we agree with you as follows: GENERAL SECTION A. The Policy This policy includes at its effective date the Information Page and all endorsements and schedules listed there. It is a contract of insurance between you (the employer named in Item 1 of the Information Page) and us (the Insurer named on the Information Page). The only agreements relating to this Insurance are stated in this policy. The terms of this policy may not be changed or waived except by endorsement issued by us to be part of this policy. B. Who Is Insured C. Workers Compensation Law Workers Compensation Law means the workers or workmen's compensation law and occupational disease law of each state or territory named in Rom 3.k of the Information Page. it includes any amendments to that law which are In effect during the policy period. It does not include any federal workers or workmen's compensation law, any federal occupational disease law or the provisions of any law that provide nonoccupational disability benefits. -7.7 You are insured if you are an employer named in Item 1 State means arty state of the United States of America, of the Information Page. If that employer is a and the District of Columbia. partnership, and If you are one of Its partners, you are E. Locations insured, but only in your capacity as an employer of the partnership's employees. This policy covers all of your workplaces listed in Items 1 or 4 of the Information Page; and it covers all other workplaces in Item 3.A. states unless you have other insurance or are self4nsured for such workplaces. PART ONE —WORKERS COMPENSATION INSURANCE A. How This Insurance Applies This workers compensation insurance applies to bodily Injury by accident or bodily injury by disease. Bodily injury includes resulting death. 1. Bodily Injury by accident must occur during the policy period. 2. Bodily Injury ppyy disease must be caused or 305ps raved by tl a conditions of your employment. eloyee'slast day of last exposure to the causing or aggravating such bodily injuryriod. by disease must occur during the policy pe B. We Will Pay We will pay promptly when due the benefits required of you by the workers compensation law. C. We Will Defend We have the right and duty to defend at our expense any claim, proceeding or suit against you for benefits payable by this insurance. We have the right to Investigate and settle these claims, proceedings or suits. We have no duty to defend a claim, proceeding or suit that is not covered by this insurance. WCOOOOOOB (ED. 07/11) D. we will Also Pay We will also pay these costs, In addition to other amounts payable under this insurance, as part of any claim, proceeding or suit we defend: 1. reasonable expenses incurred at our request, but not loss of earnings; 2. premiums for bonds to release attachments and for appeal bonds In bond amounts up to the amount payable under this insurance; 3. litigation costs taxed against you; 4. interest on a judgment as required by law until we offer the amount due under this insurance; and 5. expenses we incur. E. Otherinsurance •P_eLIT A e PADV We will not pay more than our stare of benefits and costs covered by this Insurance and other insurance or self - Insurance. Subject to any limits of liabi that may apply, all re shas will be equal until the loss is If any insurance or self-insurance is e>dmausted, the shares of all remaining insurance will be equal until the loss is paid. F. G. H. A. Payments You Must Make You are responsible for an payments in excess of the benefits regularly provided 6y the workers compensation law including those required because: 1. of your serious and willful misconduct 2. you knowingly employ an employee in violation of law; 3. you fail to comply with a health or safety law or regulation; or 4. you discharge, coerce or otherwise discriminate against any employee in violation of the workers compensation law. If we make any payments in excess of the benefits regularly provided by the workers compensation law on your behalf, you will reimburse us promptly. Recovery From Others We have your rights, and the rights of persons entitled to the benefits of this insurance, to recover our payments from anyone liable for the injury. You will do everything necessary to protect those rights for us and to help us enforce them. statutory Provisions These statements apply where they are required by law. 1. As between an injured worker and us, we have notice of the Injury when you have notice. 2. Your default or the bankruptcy or Insolvency of you or your estate will not relieve us of our duties under this insurance after an injury occurs. 3. We are directly and primarily liable to any person entitled to the benefits payable by this insurance. Those persons may enforce our duties; so may an agency authorized by law. Enforcement may be against us or against you and us. 4. Jurisdiction over you is jurisdiction over us for purposes of the workers compensation law. We are bound by decisions against you under that law subject to the provisions of this policy that are nod in conflict with that law. 5. This insurance conforms to the parts of the workers compensation law that apply to. a. benefits payable by this Insurance; b, special taxes, payments into security or other special funds, and assessments payable by us under that law. 6. Terms of this insurance that conflict with the workers compensation law are changed by this statement to conform to that law. Nothing in these paragraphs relieves you of your duties under this policy. PART TWO - EMPLOYERS LIABILITY INSURANCE How This Insurance Applies This employers liability insurance applies to bodily injury by accident or bodily injury by disease. Bodily Injury includes resulting death. 1. The bodily injury must arise out of and in the course of the injured employee's employment by you. 2. The employment must be necessary or incidental to yyour work in a state or territory listed In Item 3.A oftha Information Page. 3. Bodily injury by accident must occur during the policy period. 4. Bodily injury by disease must be caused or a gravated by the conditions of your employment The employee's last day of last exposure to the conditions causing or aggravating such bodily in by disease must occur during the policy period. 5. If you are sued, the original suit and any related legal actions for damages for bodily injury by accident or by disease must be brought in the United States of America, its territories or possessions, or Canada. WC000000B (ED. 07/11) B. We Will Pay 2 of 5 AMMIT+C MDV We will pay all sums that you legally must pay as damages because of bodily injury to your employees, [rovided the bodily injury is covered by this employers ability Insurance. The damages we will pay, where recovery is permitted by law, Include damages: 1. For which you are liable to a third paby reason of a claim or suit against you by that 7r7pa to recover the damages claimed against such third party as a result of injury to your employee; 2. For care and loss of services; and 3. For consequential bodily injury to a spouse, child, parent, brother or sister of the injured employyee• provided that these damages are the direo� consequence of bodily in ury that arises out of and in the course of lige injured employee`s employment by you; and 4. Because of bodily injury to your employee that arises out of and in the course of employment, claimed against you In a capacity other than as employer. C. Exclusions This Insurance does not cover. 1. Liability assumed under a contracL This exclusion does not apply to a warranty that your work will be done in a workmanlike manner, 2. Punitive or exemplary damages because of bodily Injury to an employee employed In violation of law, 3. Bodily injury to an employee while employed in violation of law with your actual knowledge or the actual knowledge of any of your executive officers; 4. Any obligation Imposed by a workers compensation, occupational disease, unemployment com- pensation, or disability benefits law, or any similar law, 5. Bodily injury Intentionally caused or aggravated by you; 6. Bodily injury occurring outside the United States of America, its territories or possessions, and Canada. This exclusion does not apply to bodily Injury to a citizen or resident of the United States of America or Canada who is temporarily outside these countries; 7. Damages arising out of coercion, criticism, demotion, evaluation, reassignment discipline, defamation, harassment, humiliation, discrimination against or termination of any employee, or any personnel practices, policies, acts or omissions; 8. Bodily injury to any person in work subject to the Longshore and Harbor Workers' Compensation Act 33 USC Sections 901-950), the Nonappropriated und Instrumentalities Act (5 USC Sections 8171- 8173), the Outer Continental Shelf Lands Act (43 USC Sections 1331-1356a), the Defense Base Act (42 USC Sections 1651-1654), the Federal Coal Rhine Safety and Health Act (30 USC Sections 801- 945), any other federal workers or workmen's compensation law or other federal occupational disease law, or any amendments to these laws; 9. Bodily Injury to an person in work subject to the Federal Employers liability Act (45 USC Sections 51-60), any other federal laws obligating an employer to pay damages to an employee due to bodily Injury arising out of or in the course of employment, or any amendments to those laws; 10. Bodily injury to a master or member or the crew of any vessel; 11. Fines or penalties imposed for violation of federal or state law; and 12. Damages syabie under the Migrant and Seasonal Agricultural Worker Protection Act (29 USC Sections 1801-1872) and under any other federal law awarding damages for violation of those laws or regulations issued thereunder, and any amendments to those laws. D. We Will Defend We have the right and duty to defend, at our expense, any claim, proceeding or suit against you for damages Payable by this insurance. We have the right to nvestigate and settle these claims, proceedings and suits. We have no duty to defend a claim, proceeding or suit that is not covered by this insurance. We have no duty to defend or continue defending after we have paid our applicable limit of liability under this Insurance. E. We Will Also Pay We will also pay these costs, in addition to other amounts payable under this insurance, as part of any claim, proceeding, or suit we defend: 1. Reasonable expenses incurred at our request, but not loss of earnings; 2. Premiums for bonds to release attachments and for appeal bonds in bond amounts up to the limit of our liability under this insurance; 3. Litigation costs taxed against you; 4. Interest on a judgment as required by law until we offer the amount due under this Insurance; and 5. Expenses we incur. F. Other Insurance We will not pay more than our share of damages and costs covered by this insurance and other insurance or self-insurance. Subject to any limits of liability that apply, all shares will be equal until the loss Is paid. If any insurance or self-insurance is exhausted, the shares of all remaining insurance and self4nsumnce will be equal until the loss is paid. G. Limits of Liability WCOBODD013 (ED. 07111) 3 of 5 wncurEe ^rev Our liability to pay for damages Is limited. Our limits of liability are shown in Item 3.B. of the Information Page. They apply as explained below. 1. Bodily Injury by Accident. The limit shown for "bodily Injury by accident each accideW is the most we will pay for all damages covered by this insurance because of bodily injury to one or more employees In any one accident. A disease is not bodily injury by accident unless it results directly from bodily injury by accident. 2. Bodily Injury by Disease. The limit shown for "bodily injury by disease policy limit' is the most we will pay for all damages covered by this insurance and arising out of bodily injury by disease, regardless of the number of employees who sustain bodily Injury by disease. The limit shown for "bodily injury by disease each employee" Is the most we will pay for all damages because of bodily injury by disease to any one employee. Bodily in!"ury by disease does not include disease that results directly from a bodily injury by accident 3. We will not pay any claims for damages after we 1. You have complied with all the terms of this policy; have paid the applicable limit of our liability under and this insurance. 2. The amount you owe has been determined with our H. Recovery From Others consent or by actual trial and final judgment We have your rights to recover our payment from liable for injury covered by this insurance. This insurance does not give anyone the right to add us as a defendant in an action against you to determine anyone an You will do everything necessary to protect those rights your liability. for us and to help us enforce them. The bankruptcy or insolvency of you or your estate will I. Actions Against Us not relieve us of our obligations under this Part There will be no right of action against us under this insurance unless: PART THREE — OTHER STATES INSURANCE A. How This Insurance Applies 4. If you have work on the effective date of this policy in any state not fisted in Item 3.A of the Information 1. This other states insurance applies only If one or Page, coverage will not be afforded for that state more states are shown in Item 3.C. of the unless we are notified within thirty days. Information Page. a. Notice 2. If you begin work in any one of those states after the effective date of this policy and are not insured Tell us at once if you begin work in any state listed in or are not self-insured for such work, all provisions Item 3.C. of the Information Page. of the policy will apply as though that state were listed in Item 3.A of the Information Page. 3. We will reimburse you for the benefits required by the workers compensation law of that state if we are not permitted to pay the benefits directly to persons entitled to them. PART FOUR — YOUR DUTIES IF INJURY OCCURS Tell us at once if injury occurs that may be covered by this policy. Your other duties are listed here. 1. Provide for immediate medical and other services required by the workers compensation law. 2. Give us or our agent the names and addresses of the Injured persons and of witnesses, and other information we may need. 3. Promptly give us all notices, demands and legal papers related to the injury, claim, proceeding or suit A. Our Manuals 4. Cooperate with us and assist us, as we may request, in the investigation, settlement or defense of any claim, proceeding or suit 5. Do nothing after an injury occurs that would Interfere with our right to recover from others. 8. Do not voluntarily make payments, assume obligations or Incur expenses, except at your own cost PART FIVE — PREMIUM All premium for this policy will be determined by our manuals of rules, rates, rating plans and classifications. We may change our manuals and apply the changes to this policy If authorized by law or a governmental agency regulating this Insurance. B. Classlficatlons Item 4 of the Information Page shows the rate and premium basis for certain business or work classifications. These classifications were assigned based on an estimate of the exposures you would have during thepolicy period. If your actual exposures are not properly described by those classifications, we WO assign proper classifications, rates and premium basis by endorsement to this policy. WCOOOOOOB (ED. 07111) C. Remuneration 4of5 wr_euT ■ Q rnDV Premium for each work classification is determined by multiplying a rate times a premium basis. Remuneration is the most common premium basis. This premium basis includes payroll and all other remuneration paid or payable during the policy period for the services of. 1. all your officers and employees engaged in work covered by this policy; and 2. all other persons engaged In work that could make us liable under Part One (Workers Compensation Insurance) of this policy. If you do not have payroll records for these persons, the contract price for their services and materials may be used as the premium basis. This paragraph 2 will not apply if you give us proof that the employers of these persons lawfully secured their workers compensation obligations. D. Premium Payments You will pay all premium when due. You will pay the premium even if part or all of a workers compensation law is not valid. E. Final Premium A. B. C. The premium shown on the Information Page, schedules, and endorsements is an estimate. The final premium will be determined after this policy ends by using the actual, not the estimated, premium basis and the proper classifications and rates that lawfully apply to the business and work covered by this policy. f the final premium Is more than the premium you paid to us, you must pay us the balance. If I is less, we will refund the balance to you. The final premium will not be less then the highest minimum premium for the classifications covered by this policy. If this policy Is cancelled, final premium will be determined in the following way unless our manuals provide otherwise: 1. If we cancel, final premium will be calculated pro rata based on the time this policy was In force. Finalpremium will not be less than the pro rata share of the minimum premium. Inspection 2. If you cancel, final premium will be more than pro rate; it will be based on the time this policy was in force, and increased by our short rate cancellation table and procedure. Final premium will not be less than the minimum premium. F. Records You will keep records of information needed to compute premium. You will provide us with copies of those records when we ask for them. O. Audit You will let us examine and audit all your records that relate to this policy. These records include ledgers, journals, registers, vouchers, contracts, tax reports, payroll and disbursement records, and programs for storing and retrieving data. We may conduct the audits during regular business hours during the policy period and within three years after the policy period ends. Information developed by audit will be used to determine final premium. Insurance rate service organizations have the same rights we have under this provision. PART SIX — CONDITIONS We have the right, but are not obliged to inspect your workplaces at any time. Our inspections are not safety inspections. They relate only to the insurability of the workplaces and the premiums to be charged. We may give you reports on the conditions we find. We may also recommend changes. While they may help reduce losses, we do not undertake to perform the duty of any person to provide for the health or safety of your employees or the public, We do not warrant that your workplaces are safe or healthful or that they comply with laws, regulations: codes or standards. Insurance rate service organizations have the same rights we have under this provision. Long Term Policy If the policy period is longer than one year and sixteen days, all provisions of this policy will apply as though a new policy were Issued on each annual anniversary that this policy is in force. Transfer of Your Rights and Duties Your rights or duties under this policy may not be transferred without our written consent If you die and we receive notice within thirty days after your death, we will cover your legal representative as insured. WCWOWOB (ED. 07/11) D. Cancellation 1. You may cancel this policy. You must mail or deliver advanoe notice to us stating when the cancellation is to take effect 2. We may cancel this policy. We must mail or deliver to you not less than ten days advance written notice stating when the cancellation Is to take effect Mailing that notice to you at your mailing address shown in Item 1 of the Information Page will be sufficient to prove notice. 3. The policy period will end on the day and hour stated in the cancellation notice. 4. Any of these provisions that conflicts with a law that oontrols the cancellation of the insurance in this policy is changed by this statement to comply with the law. E. Sole Representative The insured first named in Item 1 of the Information Page will act on behalf of all Insureds to change this policy, receive return premium, and give or receive notice of cancellation. 5of5 AMP UT P C rnov WORKERS' COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 00 04 06 PREMIUM DISCOUNT ENDORSEMENT The premium for this policy and the policies, If any, listed in Item 3 of the Schedule may be eligible for a discount. This endorsement shows your estimated discount in Item 1 or 2 of the Schedule. The final calculation of premium discount will be determined by our manuals and your premium basis as determined by audit. Premium subject to retrospective rating is not subject to premium discount. First 1. State $5,000 TEXAS 0.00 2. Average percentage discount 3. Other Policies: Schedule Estimated Eligible Premium Next Next Balance $95,000 $400,000 8.40 10.50 11.00 4.80 4. if there are no entries In Items 1, 2, and 3 of the Schedule see the Premium Discount Endorsement attached to your policy number. This endorsement changes the policy to which R is attached effective on the Inception date of the policy unless a different date Is Indicated below. (The %WWng "attaching clause" need be completed only when this endorsement Is Issued subsequent to preparation of the poky.) This endorsement, of acbm on at 1201 AM. standard time, forms a part of PollcyNo. TSF -0001175218 20121219 of the Texas Mutual Insurance Company Issued to MASSEY I RR I GAT I ON & LIQUIDATION INC Premium $ W0000400 (ED. 1.94) AGENT'S COPY Endorsement No. Authorized Representative AXFLORES 11-26-2012 TEXAS WORKERS' COMPENSATION AND EMPLOYERS LABILITY POLICY WC420301 F TEXAS AMENDATORY ENDORSEMENT This endorsement applies only to the insurance provided by the policy because Texas is shown In Item 3.A. of the Information Page. GENERAL SECTION B. Who Is Insured is amended to read: You are insured if you are an employer named in Item 1 of the Information Page. If that employer is a partnership or joint venture, and if you are one of its partners or members, you are insured, but only in your capacity as an employer of the partnership's or joint venture's employees. D. State is amended to read: State means any state or territory of the United States of America, and the District of Columbia. PART ONE - WORKERS' COMPENSATION INSURANCE E. Other Insurance Is amended by adding this sentence: This section only applies if you have other insurance or are self-insured for the same loss. F. Payments You Must Make This section is amended by deleting the words "workers' compensation" from number 4. H. Statutory Provisions This section is amended by deleting the words "after an Injury occurs" from number 2. PART TWO - EMPLOYERS LIABILITY INSURANCE C. Exclusions Sections 2 and 3 are amended to add: This exclusion does not apply unless the violation of law caused or contributed to the bodily injury. Section 6 is amended to read: 6. Bodily injury occurring outside the United States of America, its territories or possessions, and Canada. This exclusion does not apply to bodily injury to a citizen or resident of the United States of America, Mexico or Canada who is temporarily outside these countries. D. We Will Defend This section is amended by deleting the last sentence. VVC4203 M F H -(" _20W) Page 1 of 3 PART FOUR - YOUR DUTIES IF INJURY OCCURS Number 6 of this pari is amended to read: 6. Texas law allows you to make weekly payments to an Injured employee in certain Instances. Unless authorized by law, do not voluntarily make payments, assume obligations or incur expenses, except at your own cost. PART FIVE - PREMIUM A. Our Manuals are amended by adding the sentence: In this part, "our manuals" means manuals approved or prescribed by the State Board of Insurance. C. Remuneration Number 2 is amended to read: 2. A8 other persons engaged in work that would make us liable under Part One (Workers' Compensation Insurance) of this policy. This paragraph 2 will not apply if you give us proof that the employers of these persons lawfully secured workers' compensation insurance. E. Final Premium Number 2 is amended to read: 2. if you cancel, final premium will be calculated pro rata based on the time this policy was in force. Final premium will not be less than the pro rata share of the minimum premium. PART SIX - CONDITIONS A. Inspection is amended by adding this sentence: Your failure to comply with the safety recommendations made as a result of an Inspection may cause the policy to be canceled by us. C. Transfer of Your Rights and Duties is amended to read: Your rights and duties under this policy may not be transferred without our written consent. If you die, coverage will be provided for your surviving spouse or your legal representative. This applies only with respect to their acting in the capacity as an employer and only for the workplaces listed in Items 1 and 4 on the Information Page. D. Cancellation is amended to read: 1. You may cancel this policy. You must mail or deliver advance notice to us stating when the cancellation is to take effect. 2. We may cancel this policy. We may also decline to renew it. We must give you written notice of cancellation or nonrenewal. That notice will be sent certified mail or delivered to you in person. A copy of the written notice will be sent to the Texas Workers' Compensation Commission. 3. Notice of cancellation or nonrenewal must be sent to you not later than the 30th day before the date on which the cancellation or nonrenewal become effective, except that we may send the notice not later than the 90th day before the date on which the cancellation or nonrenewal becomes effective if we cancel or do not renew because of: a. Fraud in obtaining coverage; b. Misrepresentation of the amount of payroll for purposes of premium calculation; c. Failure to pay a premium when payment was due; w0420301 F 0 -CH -MM) Page 2 of 3 d. An Increase in the hazard for which you seek coverage that results from an action or omission and that would produce an Increase in the rate, including an Increase because of failure to comply with reasonable recommendations for loss control or to comply within a reasonable period with recommendations designed to reduce a hazard that is under your control; e. A determination by the Commissioner of Insurance that the continuation of the policy would place us in violation of the law, or would be hazardous to the interests of subscribers, creditors, or the general- public. 4. If another insurance company notifies the Texas Workers' Compensation Commission that it Is insuring you as an employer, such notice shall be a cancellation of this policy effective when the other policy starts. Part Seven has been added as follows: PART SEVEN - OUR DUTY TO YOU FOR CLAIM NOTIFICATION A. Claims Notification We are required to notify you of any claim that is filed against your policy. Thereafter we shall notify you of any proposal to settle a claim or, on receipt of a wr%en request from you, of an administrative or judicial proceeding relating to the resolution of a claim, including a benefit review conference conducted by the Texas Workers' Compensation Commission. You may, in writing, elect to waive this notification requirement. We shall, on the written request from you, provide you with a list of claims charged against your policy, payments made and reserves established on each claim, and a statement explaining the effect of claims on your premium rates. We must furnish the requested information to you in writing no later than the 30th day afterthe date we receive your request. The information is considered to be provided on the date the information is received by the United States Postal Service or is personally delivered. COMPLAINT NOTICE: SHOULD ANY DISPUTE ARISE ABOUT YOUR PREMIUM OR ABOUT A CLAIM THAT YOU HAVE FILED, CONTACT THE AGENT OR WRITE TO THE COMPANY THAT ISSUED THE POLICY. IF THE PROBLEM IS NOT RESOLVED, YOU MAY ALSO WRITE THE TEXAS DEPARTMENT OF INSURANCE, P.O. BOX 149091, AUSTIN, TEXAS 78714-9091, FAX # (512) 475-1771. THIS NOTICE OF COMPLAINT PROCEDURE IS FOR INFORMATION ONLY AND DOES NOT BECOME A PART OR CONDITION OF THIS POLICY. This endorsement changes the policy to which it is attached effective on the ineeptlon date of the poky unless a different date is indicated below. (The following "attaching clause" need be completed only when this endorsement is issued subsequent to preparation of the policy.) This endorsement, effective on at 1201 A.M. standard time, forms a part of Policy No. TSF -0001176219 20121219 of the Texas Mutual Insurance Company Issued to MASSEY I RR I OAT I ON & L I QU I DAT I ON I NC Endorsement No. Premium $ Authorized Representative wc420301 Ft1-01-2M Page 3 of 3 AGENT'S COPY AXFLORES 11-26-2012 TEXAS WORKERS' COMPENSATION AND EMPLOYERS LIABILITY POLICY TEXAS —AUDIT PREMIUM AND RETROSPECTIVE PREMIUM ENDORSEMENT Section D of Part Five of the policy is replaced by the following provision: PART FIVE - PREMIUM D_ Premium Payments WC 42 04 07 You will pay all premium when due. You will pay the premium even if part or all of a workers' compensation law is not valid. The billing statement or invoice for audit additional premiums and/or retrospective additional premiums establishes the date that the premium is due. This endorsement charges the poky to which d is attached effective on the inception date of the policy uNess a different date Is hw6cated below. (The fopowing "attachi g clause" need be campleteed only when this endorsement Is Issued subsequent to prgmrgon of the policy.) This endorsement effective on at 12:01 A.M. standard time, lbrn a part of Policy No. TSF -0001176218 20121219 of the Texas Mutual Insurance Company Issued to MASSEY I RR I GAT I ON & LIQUIDATION INC Endorsement No. Premium $ Authorized Representative WC420407 (Ed. 3-23-2002) AGENT'S COPY AXFLORES 11-26-2012 TEXAS WORKERS' COMPENSATION AND miltz EMPLOYERS LIABILITY POLICY e)(9 kwMimeclup q WC42 04 08 TEXAS HEALTH CARE NETWORK ENDORSEMENT This endorsement indicates that you have elected under this policy to provide workers' compensation health care services to your injured employees through a certified workers' compensation health care network that we have either established or contracted with, as provided In Chapter 1305 of the Texas Insurance Code and in Title 28, Chapter 10 of the Texas Administrative Code. We will provide you with information concerning the use of our certified workers' compensation health care network(s) in our service area(s) and your rights and responsibilities as a participant in our network program. This includes information describing the service area(s) applicable to you and your Injured employees as required in Rule VI K. of the Texas Basic Manual of Rules, Classilrcations and Experience Raring Plan for ftrkers' Compensation and Employers' Liability Insurance. In accordance with Chapter 1305 Texas Insurance Code and Title 28, Chapter 10 of the Texas Administrative Code, we will also provide you with information that is required to be given to your employees, including an employee's notice of network requirements and an employee acknowledgement form. Your premium may have been reduced because you have agreed to participate in our certified workers' compensation health care network. The amount of the premium reduction is shown on the Information Page of this policy. The reduction Is estimated at the policy inception and adjusted at final audit of the policy. The reduction may be pro -rated if you elect to participate in a certified workers' compensation health care network during the policy year or if you terminate your participation In our certified workers' compensation health care network before the policy expires. The premium reduction you received may be forfeited if we determine that you have failed to provide the notice of network requirements and employee acknowledgement form to your employees in accordance with Chapter 1305.005(d) and 1305.451 Texas Insurance Code and Title 28, Chapter 10 of the Texas Administrative Code. Minimum premium policies are not eligible for this premium reduction. This endorsement changes the policy to which It Is attached effective on the Inception date of the policy unless a different date is indicated below. {The following 'attaching clause need be completed only when this endorsement Is issued subsequent to preparation of the policy.) This endorsement, effective on at 12:01 A.M. standard time, forms a part of Policy No. TSF -0001175218 20121219 of the Texas Mutual Insurance Company Issued to MASSEY I RR I GAT I ON 8t LIQUIDATION INC DBA: Endorsement No. Premium: $ oosll, !� Authorized Representative TM-MEONET 2DOM AGENT'S COPY AXFLORES 11-26-2012 WORKERS' COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC420304A TEXAS WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT This endorsement applies only to the insurance provided by the policy because Texas is shown in Item 3.A. of the Information Page. We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce our right against the person or organization named in the Schedule, but this waiver applies only with respect to bodily Injury arising out of the operations described in the Schedule where you are required by a written contract to obtain this waiver from us. This endorsement shall not operate directly or indirectly to benefit anyone not named in the Schedule. The premium for this endorsement is shown in the Schedule. Schedule 1. ( ) Specific Waiver Name of person or organization ( X ) Blanket Waiver Any person or organization for whom the Named Insured has agreed by written contract to furnish this waiver. 2. Operations: ALL TEXAS OPERATIONS 3. Premium The premium charge for this endorsement shall be 2.00 percent of the premium developed on payroll In connection with work performed forthe 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 incepts on date of the policy unless a different date is Indicated below. (The following'dtaching clause' need be completed only when this endorsement Is Issued subsequent to preparation of the poky.) This endorsement, effective on at 12,01 A.M. standard time, loans a part of Policy No. TSF -0001176218 20121219 of the Texas Mutual Insurance Company Issued to MASSEY I RR I GAT I ON & LIQUIDATION INC Endorsement No. Premium $ Authorized Representative WC420304A (EO. 1-01-2000) AGENT'S COPY AXFLORES 11-26-2012 TXaSMU[uaP Dear Valued Customer: Thank you for choosing Texas Mutual Insurance Company. We know you have a choice of workers' compensation carriers, and we are determined to continue to earn your business. Your Tew Mutual' coverage includes a range of services that help you get the most value out of your partnership with us. We work hard to help you control your premium, fight workers' compensation fraud and prevent workplace accidents. Ifyour employees do get injured on the job, our professionals are committed to helping theta get well and return as productive members of the workforce. I encourage you to visit tommutual com for more information about the services that have made us Texas' leading workers' compensation provider. Thank you again for your business. Please let us know if there is anything we can do to improve our service to you. Sincerely, Ron Wright President 6210 East Highway 290, Austin, Teras 78723-1098 512.224.3800 1 800.859.5995 1 wwwterasmutuaLcom Texasmu� S TowntreCompany Thank you for choosing Texas Mutual Insurance Company. We created this brief guide to help you get the most out of your Te w Mxtue coverage. Understand We estimate your annual premium at the beginning of your policy by reviewing your premium your payroll, the type of work your employees perfonn, your loss history, your safety programs and other factors. You must pay the full amount at the beginning of your policy year, unless you arrange for premium financing or your account qualifies for interim payroll reporting - At porting. At the end of your policy period, we will review your account for changes in your payroll or operations during the policy year. We will then adjust your premium, if necessary. You may get money back, or you may be billed accordingly. Reportinjuries • Report injuries the same day they happen, if possible. The fastest way to report injuries is at www.remsmutual.com. If you cannot report online, you may report by phone at (800) 859-5995, or send a completed DWC-I form by fax to (877) 404-7999 or by mail to Twos Mutual Insurance Company, P.O. Box 12029, Austin, Texas 78711-2029. • Give the employee a copy of the injury report and the "Employee's Rights and Responsibilities'° form. • Keep accurate records of the dates when you take any claim -related action, including when you file a supplemental report (DWG6 form) or wage statement (DWC-3 form). To file a DWC-3 form online, go to www texasmunW.com, log into the Employer claim detail tool, look up the claim, and click Complete Online DWC-3 Form. • If you have a network policy, give the employee a copy of the "Notice of Network Requirements." Have him or her sign the acknowledgment form, and keep the form for your records. The notice and acknowledgment form are available in the Health Care Network section at www.t=asmutual.com. Prevent workplace A solid workplace safety program contributes to improved productivity and Iower accidents workers' compensation costs. Visit the free safety resource center at www texasmutU .COM to Iearn how to prevent accidents. 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Box 841843 Dallas, TX 75284-1843 Please take time now to enter this information into your records. NOTE: This address pertains ONLY to remittance payments and is not for use for other general correspondence to the Texas Mutual Insurance Company. NOTE: This address Is not to be used for overnight mail. These should be sent to our physical location. We would like to request all payments be sent in a timely manner so the above address may be utilized. IMPREM (ED.11-15-04) POLICYNUMBER CPP124655A COMMERCIAL GENERAL LIABILITY CG 20 26 07 04 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - DESIGNATED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Persons Or Organization(s) CITY OF LUBBOCK ATTN MARTA ALVAREZ PURCH MGR Information required to complete this Schedule if not shown above will be shown in the Declarations. Section II — Who Is An Insured is amended to include as an additional insured the person(s) or organiza- tions) shown in the Schedule, 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 omis- sions of those acting on your behalf: A. In the performance of your ongoing operations; or B. In connection with your premises owned by or rented to you. CG 20 26 07 04 © ISO Properties, Inc., 2004 Page 1 of 1 ❑ Insured Copy POLICYNUMBER: CPP124655A COMMERCIAL GENERAL LIABILITY CG 24 04 05 09 WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/ COMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE Name Of Person Or Organization: CITY OF LUBBOCK POI BOX 2000 LUBBOCK, TX 79457 The following is added to Paragraph 8. Transfer Of Rights Of Recovery Against Others To Us of Section IV — Conditions: 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 waiver applies only to the person or organization shown in the Schedule above. CG 24 04 05 09 ® Insurance Services Office, Inc., 2008 Page 1 of 1 ❑ Insured Copy COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. PRIMARY COVERAGE FOR DESIGNATED ADDITIONAL INSURED This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by the endorsement. SCHEDULE Name of Additional Insured Person(s) or Organization(s): CITY OF LUBBOCK If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to the endorsement. It is agreed and understood that Section IV. 4. Other Insurance is amended to provide coverage that is primary over any other collectible insurance for the person or organization listed in the Schedule above, for any 'occurrence" to which this insurance applies. It is further agreed and understood that any other collectible insurance available to the person or organization listed in the Schedule shall not contribute to any 'occurrence" to which this insurance applies until after our limits shown in the Declarations are exhausted. However, the coverage provided by this endorsement does not apply to liability arising out of the sole negligence of the person or organization listed in the Schedule. ALL OTHER CONDITIONS AND PROVISIONS OF THE POLICY REMAIN UNCHANGED BY THIS ENDORSEMENT. CGLB312 0110 Insured Copy Page 1 of 1 POLICYNUMBER CPP124655A COMMERCIAL GENERAL LIABILITY CG 20 26 07 04 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - DESIGNATED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Persons Or Or anization s CITY OF LUBBOCK ATTN MARTA ALVAREZ PURCH MGR Information required to complete this Schedule, if not shown above, will be shown in the Declarations. Section II —Who Is An Insured is amended to include as an additional insured the person(s) or organiza- tions) shown in the Schedule, 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 omis- sions of those acting on your behalf: A. In the performance of your ongoing operations; or B. In connection with your premises owned by or rented to you. CG 20 26 07 04 © ISO Properties, Inc., 2004 Page 1 of 1 Insured Copy POLICYNUMBER: CPP124655A COMMERCIAL GENERAL LIABILITY CG 20 26 07 04 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - DESIGNATED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Persons Or Organization(s) CITY OF LUBBOCK ATTN MARTA ALVAREZ PURCH MGR Information required to complete this Schedule, if not shown above, will be shown in the Declarations. Section II —Who Is An Insured is amended to include as an additional insured the person(s) or organiza- tions) shown in the Schedule, but only with respect to liability for 'bodily injury", "property damage" or "personal and advertising injurycaused, in whole or in part, by your acts or omissions or the acts or omis- sions of those acting on your behalf: A. In the performance of your ongoing operations; or B. In connection with your premises owned by or rented to you. CG 20 26 07 04 ® ISO Properties, Inc., 2004 Page 1 of 1 D 4isured Copy POLICY NUMBER: CPP124655A COMMERCIAL GENERAL LIABILITY CG 24 04 05 09 WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/ COMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE Name Of Person Or Organization: CITY OF LUBBOCK POI BOX 2000 LUBBOCK, TX 79457 The following is added to Paragraph 8. Transfer Of Rights Of Recovery Against Others To Us of Section IV —Conditions: 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 waiver applies only to the person or organization shown in the Schedule above. CG 24 04 05 09 ® Insurance Services Office, Inc., 2008 Page 1 of 1 bsured Copy COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. PRIMARY COVERAGE FOR DESIGNATED ADDITIONAL INSURED This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by the endorsement. SCHEDULE Name of Additional Insured Person(s) or Organization(s): CITY OF LUBBOCK If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to the endorsement. It is agreed and understood that Section IV. 4. Other Insurance is amended to provide coverage that is primary over any other collectible insurance for the person or organization listed in the Schedule above, for any "occurrence" to which this insurance applies. It is further agreed and understood that any other collectible insurance available to the person or organization listed in the Schedule shall not contribute to any "occurrence" to which this insurance applies until after our limits shown in the Declarations are exhausted. However, the coverage provided by this endorsement does not apply to liability arising out of the sole negligence of the person or organization listed in the Schedule. ALL OTHER CONDITIONS AND PROVISIONS OF THE POLICY REMAIN UNCHANGED BY THIS ENDORSEMENT. CGLB312 0110 Insurer! COPY Page 1 of 1 COMMERCIAL AUTO THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY BLANKET ADDITIONAL INSURED - REQUIRED BY CONTRACT This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM SECTION 11 — LIABILITY COVERAGE, Who Is An Insured is amended to include as an additional insured any person(s) or organization(s) with whom you have agreed in a valid written contract or agreement, executed prior to any "accident' or "loss", that such person(s) or organization(s) be added as an additional insured on your policy. Such persons or organizations are additional insureds but only with respect to liability for "bodily injury" or "property damage" caused by an "accident' in whole or in part, by your acts or omissions or the acts or omissions of those acting on your behalf and resulting from the ownership, maintenance or use of a covered "auto." ALL OTHER CONDITIONS AND PROVISIONS OF THE POLICY REMAIN UNCHANGED BY THIS ENDORSEMENT. CCAB235 0213 Page 1 of 1