HomeMy WebLinkAboutResolution - 2020-R0183 - Tom's Tree Place, Valencia PID Contract 15250Resolution No. 2020-RO183
Item No. 7.9
,tune 9, 2020
RESOLUTION
BE IT ItFS0LV1.:D 13Y TI-IE CITY COUNCIL OFT -I F CITY 01 1,U13130CK:
THAT the Mayor of the City of Lubbock is hereby authorized and directed to execute for
and on behalf' of the City of Lubbock, Service Contract No. 15250 for Landscape Maintenance
for Valencia Public Improvement District, by and between the City of Lubbock and West "Texas
Services, Inc. dba Tom's 'free Place, of Lubbock, Texas, 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 ofthe City Council.
Passed by the City Council on June 9, 2020
DANIEI. 1i1. POPE', MAYOR
A"CTIST:
-D &��' //,c - ---
Rcbe a- Garza, City Sccrcta
APPROVED AS TO CON" I
Brianna Gerardi, Busincs opmcnt Director
APPROVED AS TO FORM:
Amy I ' s. Deputy City Attorney
vwxcdocs�RES.Conlract 15250 landscape Maintenance far Valencia Public Improvement District
May, 20 2020
Resolution No. 2020-R0183
Contract 15250
City of Lubbock, TX
Landscape Maintenance for the Valencia Public Improvement District
Agreement
This Service Agreement (this "Agreement") is entered into as of the 9th day of June 2020,
("Effective Date') by and between West Texas Services, Inc. dba Tom's Tree Place , (the Contractor),
and the City of Lubbock (the "City").
RECITALS
WHEREAS, the City has issued a Request for Proposals 20-15250-MW, Landscape Maintenance
for the Valencia Public Improvement District.
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 Landscape
Maintenance for the Valencia Public Improvement District, 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 — Best and Final Offer, Proposal Price Sheet
4. Exhibit C — Insurance
Scope of Work
Contractor shall provide the services that are specified in Exhibit A. The Contractor shall comply with all
the applicable requirements set forth in Exhibit B and Exhibit C attached hereto.
Article I
1.1 The contract shall be for a tens of one year, with the option of four, one-year extensions, said
date of term beginning upon formal approval. All stated annual quantities are approximations
of usage during the time period to be covered by pricing established by this bid. Actual usage
may be more or less. Order quantities will be determined by actual need. The City of Lubbock
does not guarantee any specific amount of compensation, volume, minimum, or maximum
amount of services under this bid and resulting contract. The Contractor must maintain the
insurance coverage required during the term of this contract including any extensions. It is
the responsibility of the Contractor to ensure that valid insurance is on file with the
Purchasing and Contract Management Department as required by contract or contract may
be terminated for non-compliance.
1.2 Prices quoted shall be set for a period for one (1) year, said date of term beginning upon City
Council date of formal approval. The rate may be adjusted upward or downward at this time
at a percentage not to exceed the effective change in Consumer Price Index (CPI) or Product
Price Index (PPI), which ever is most appropriate for the specific contract for the previous
12-months at the City's discretion, the effective change rate shall be based on either the local
or national index average rage for all items. If agreement cannot be reached, the contract is
terminated at the end of the current contract period.
1.3 The Contractor shall not assign any interest in this Agreement and shall not transfer any
interest in the Agreement, whatsoever, without prior consent of the City.
1.4 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 non -appropriation 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 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.
1.5 This contract shall remain in effect until the first of the following occurs: (1) the expiration
date, (2) performance of services ordered, or (3) termination of by either party with a 30 day
written notice. The City of Lubbock reserves the right to award the canceled contract to the
next lowest and best bidder as it deems to be in the best interest of the city.
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 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 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 do.
2.11 The contractor shall not assign or sublet the contract, or any portion of the contract, without
written consent from the Director of Purchasing and Contract Management. Should consent
be given, the Contractor shall insure the Subcontractor or shall provide proof of insurance
from the Subcontractor that complies with all contract Insurance requirements document, this
provision shall control.
2.12 Contractor acknowledges by supplying any Goods or Services that the Contractor has read,
fully understands, and will be in full compliance with all terms and conditions and the
descriptive material contained herein and any additional associated documents and
Amendments. The City disclaims any terms and conditions provided by the Contractor
unless agreed upon in writing by the parties. In the event of conflict between these terms
and conditions and any terms and conditions provided by the Contractor, the terms and
conditions provided herein shall prevail. The terms and conditions provided herein are the
final terms agreed upon by the parties, and any prior conflicting terms shall be of no force
or effect.
2.13 TEXAS GOVERNMENT CODE SECTION 2252.15
The Contractor (i) does not engage in business with Iran, Sudan or any foreign terrorist
organization and (ii) it is not listed by the Texas Comptroller under Section 2252.153, Texas
Government Code, as a company known to have contracts with or provide supplies or
services to a foreign terrorist organization. As used in the immediately preceding sentence,
"foreign terrorist organization" shall have the meaning given such term in Section
2252.151, Texas Government Code.
2.14 TEXAS PUBLIC INFORMATION ACT
The requirements of Subchapter J, Chapter 552, Government Code, may apply to this
contract and the contractor or vendor agrees that the contract can be terminated if
the contractor or vendor knowingly or intentionally fails to comply with a
requirement of that subchapter.
To the extent Subchapter J, Chapter 552, Government Code applies to this agreement,
Contractor agrees to: (1) preserve all contracting information related to the contact as
provided by the records retention requirements applicable to the governmental body for the
duration of the contract; (2) promptly provide to the governmental body any contracting
information related to the contract that is in the custody or possession of the entity on request
of the governmental body; and (3) on completion of the contract, either: (A) provide at no
cost to the governmental body all contracting information related to the contract that is in the
custody or possession of the entity; or (B) preserve the contracting information related to the
contract as provided by the records retention requirements applicable to the governmental
body.
2.15 HB 89
The Contractor warrants that it complies with Chapter 2270.001 of the Texas Government
Code by verifying that:
(1) The Contractor does not boycott Israel; and
(2) The Contractor will not boycott Israel during the term of the Agreement.
Pursuant to Section 2270.001, Texas Government Code:
1. "Boycott Israel " means refusing to deal with, terminating business activities with,
or otherwise taking any action that is intended to penalize, inflict economic harm
on, or limit commercial relations specifically with Israel, or with a person or
entity doing business in Israel or in an Israeli -controlled territory, but does not
include an action made for ordinary business purposes; and
2. "Company" means a for profit sole proprietorship, organization, association,
corporation, partnership, joint venture, limited partnership, limited liability
partnership, or any limited liability company, including a wholly owned
subsidiary, majority -owned subsidiary, parent company or affiliate of those
entities or business associations that exist to make a profit.
-----INTENTIONALLY LEFT BLANK-----
IN WITNESS WHEREOF, the parties hereto have caused this Contract to be executed the day and
year first above written. Executed in triplicate.
1
CITY OF LUBBOC CONT CTOR `' S � o'ce
BY:
Daniel M. Pope, Mayor Authorized R e entative
ATTEST: f vD '-*"
-P dxc-e� j'K7
Print Name
Rebe�ca Garza, City Secre
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/, Address
P VED AS TO CON T�
City, State, Zip Code
Brianna Gerardi, Director ��—1
ss
Development
APPROVED AS TO FORM
City of Lubbock, TX Exhibit A
RFP 20-15250-MW
Landscape Maintenance for the Valencia Public Improvement District
I. General Requirements
1.0 DEFINITIONS
1.1 Agent An employee of the City of Lubbock, who is appointed by the City to monitor the work
and actions of the Contractor.
1.2 City - The City of Lubbock, Texas, municipal corporation in Lubbock County, Texas.
1.3 City Council - City Council of the City of Lubbock, Texas.
1.4 Contract -- The contract consists of the following: Notice to bidders; General Provisions;
Specifications; Plans; Addenda; Bid; Agreement; Insurance; Encumbrance; Notice to Proceed; and
Change Orders. These form the agreement whereby the Contractor shall furnish all labor,
equipment, tools, materials, and perform all work necessary to satisfactorily accomplish the
proposed plan, sponsored by the City.
1.5 Contract Time - The number of allowable days to complete the contract.
1.6 Contractor - The individual, firm, partnership, joint venture, or corporation contracting with the
City to perform work.
1.7 Cycle The period in which each service is completed once on the median and once on the park
1.8 Director of Parks and Recreation The individual who shall act on the City's behalf according
to the direction of the Fiscal Policy Designee and appoint an Agent to ensure compliance with the
contract requirements, such as but not limited to, acceptance, inspection and delivery.
1.9 Excluded Damage Damage caused by vandalism, pedestrians, vehicles, animals (except insects
and/or rodents), or other unusual factors. It does not include damage caused by the Contractor's
actions, lack of reasonable care, pest damage (such as insects), diseases or plant loss due to lack of
water caused by an irrigation system programming error, irrigation system breakage or irrigation
malfunction.
1.10 Existing Conditions, Examination of Site - Within fifteen (15) days from the date of Award of
Contract, the Contractor shall make a thorough examination of the current conditions at the site. As
part of the examination, the Contractor shall create an inventory list of the name and quantity of
each plant in each planter and confirm the existing quantities in each planter meet or exceed those
shown on any previous plant inventories. The Contractor shall make a list of all landscape items at
the site that heishe believes are broken, missing, not healthy or otherwise not in compliance with
these specifications. A copy of this list, along with an additional itemized quote for correcting each
item, shall be given to the Agent. Upon confirmation of each item, the Agent will either give the
Contractor written authorization to make the correction or a written release from responsibility for
the item.
1.11 Extra Work - Work over and above that called for in the contract.
1.12 Fiscal Policy Designee - An employee of the City of Lubbock Fiscal Policy Department, who is
appointed by the City to act as liaison to the Quincy Park Public Improvement District (PID)
Advisory Board and to oversee the management of the Quincy Park PID. All payments to the
Contractor must be approved by the Fiscal Policy Designee.
City of Lubbock, TX
RFP 0
Landscape Maintenance or he Valencia Public Improvement Distric
t
1.13 Mayor - The duly appointed official of the City of Lubbock, Texas, who is empowered by the City
Charter to enter into a contract on behalf of the City.
1.14 Notice to Proceed - Written notice stating the date on which the Contracto the Contractor issued and signed by the authorized Agent
tor should proceed with work as stated in the contract.
"IS Review Committee - A committee chosen by the City of Lubbock, to analyze and recommend to
City Council the best Contractor(s) to perform the tasks governed by the contract.
1.16 Specifications - The directions, provisions, and requirements pertaining to the method and manner
of performing the work or to the quality of the materials and equipment to be furnished under the
contract.
1.17 Subcontractor - Any individual, firm, partnership, or corporation licensed or otherwise authorized
by law to do business in Texas, to whom the Contractor, with written consent of the City, sublets a
part of the work.
1.18 Surety - The corporation, partnership or individual, duly authorized and admitted to do business in
Texas and licensed by the State of Texas to issue surety bonds, who is bound with and for the
Contractor to assume legal liability for the faithful performance of the contract.
1.19 Unit Price - Payment to the Contractor based on a unit or portion of the work performed.
1.20 Work - All work, including the furnishing of staff, equipment, materials, and other incidentals
necessary for the performance of the contract. All work will be in the public right-of-way per
attached exhibit.
2.o TERMS AND CONDITIONS
2.1 Work: It is the intent for the Contractor to provide for completion in every detail the work described
herein. The Contractor shall provide all labor, tools, transportation, materials, and equipment
necessary to complete the work in accordance with specifications provided and terms of the contract.
The attached "Valencia Map" indicates the completed landscaped areas. Bidders are to
Provide unit pricing that will be applied to landscaped areas completed and accepted for
maintenance.
2.2 Specification Change: During the term of the Contract, the City may change maintenance
frequencies, thereby increasing or decreasing maintenance frequencies. Unit pricing will be used to
determine cost adjustments. All changes shall be in writing.
2.3 Changed Condition: If the Contractor finds latent conditions which differ from those outlined in
the contract or specifications which differ from custom
ary k, and which the Contractor could
not have discovered during the investigation of the site prior oothe bid, and in which such condition
increased the expense to the Contractor, immediate written notice shall be promptly mailed to the
Director of Parks and Recreation or his Agent. The Contractor shall afford the City the opportunity
to inspect the same. After inspection by the City, the Contractor shall not delay work pending a
decision to be made by the City regarding the claim. Failure of the Contractor to give prompt written
notice and afford the City the opportunity to inspect the condition, before it is disturbed, shall be
deemed a waiver by the Contractor of all claims and extra compensation arising out of the alleged
condition.
If the Agent and the Fiscal Policy Designee determine that the Contractor is entitled to extra
compensation by reason of increased expense to the Contractor and caused by the condition, and
find that the condition requires work not covered in the contract, a change order may be executed
City of Lubbock, TX
RFP 20-15250-MW
Landscape Maintenance for the Valencia Public Improvement District
for additional compensation which shall be agreed upon by all parties involved and approved by the
Agent and the Fiscal Policy Designee. Additional time may be granted if the City deems additional
time is necessary to accomplish the job. No change order or combination of change orders shall
exceed twenty-five percent (25%) of the total contract.
2.4 Clean-up: As specified in the Maintenance Standards Specifications, beginning on page 9, all work
shall be cleaned up and waste materials removed from the site. No equipment shall be left at
maintenance sites and all material removed from the job shall be at the Contractor's expense. If
materials or waste are not removed from the site, written notification from the Agent shall be
delivered to the Contractor. The Contractor shall have forty-eight (48) hours to remove the material
in question. If the material in question is not removed in the forty-eight (48) hour period, the City
shall remove the material and the Contractor shall be charged for the expense. Payment to the City
for said expenses shall be deducted for the Contractor's payment. If such conditions continue, the
contract may be terminated due to breach of contract.
2.5 Preservation and Restoration of Property: The Contractor is responsible for the preservation of
all City owned and adjacent property owner lands expose which the Contractor may come into
contact with. The Contractor shall use every precaution necessary to prevent damage to trees,
shrubs, above and below ground structures, utilities and any other form of property. Should damage
occur, it is the Contractor's responsibility to report the damage to the Director of Parks and
Recreation or his Agent as soon as possible but not exceeding twenty-four (24) hours from the time
damage occurred. If damage occurs as a result of Contractor's actions, the Contractor shall be held
responsible to repair or replace the damaged property at their own expense. Time required to repair
damaged property shall be expedient and to the approval of the Director of Parks and Recreation or
his Agent. If the damage is not repaired in the agreed upon time period, the City may after forty-
eight (48) hours notice from the Director of Parks and Recreation or his Agent, proceed to repair the
damage. The Contractor shall be held financially responsible for the repair work and the cost shall
be deducted from the Contractor's payment.
2.6 Equipment: The Contractor shall provide everything necessary to fulfill the requirements of this
contract. All equipment shall meet all applicable federal, state and local laws and regulations.
Contractors equipment is subject to inspection and approval of the Director of Parks and Recreation
or his Agent. All manufacturers safety features must be operational, in good repair and in proper
positions during operation. All equipment shall be professional grounds maintenance quality and
in good condition throughout the course of the contract. If the Director of Parks and Recreation or
his Agent deems the equipment faulty or if the equipment is damaging the turf or other surfacing
materials in any way, the Contractor shall remove the equipment from the premises. Contractor
shall not impede other grounds maintenance operations during the course of those maintenance
operations. Respective bidders shall submit attached Contractor's Equipment schedule, Index #10,
for their proposed equipment.
2.7 Service Boundaries: The service area may be bounded by hard surfacing materials, sidewalks, or
non -curbed turf areas. The successful bidder shall be responsible for all areas defined by turf or
hard surfacing. However, the successful bidder is not responsible for edging of un-curbed turf.
Although the mowing Contractors are required to operate mowing equipment in a manner that
directs the clippings away from plant beds, the nature of mowing equipment will at times allow
some clipping debris to drop into planting areas.
2.8 Termination of Contract: This contract shall remain in effect until the expiration date for
performance of services ordered. Termination of either party requires a thirty (30) day written notice
prior to any cancellation. Such written notice must state the reason for cancellation. The City of
Lubbock reserves the right to award the canceled contract to the next best bidder as it deems to be
in the best interest of the City.
City of Lubbock, TX
Landscape Maintenance for he Valencia Public Improvement District
3.0 CONTROL OF WORK
3.1 Authority of the Director of Parks and Recreation: It is understood by all parties that the work
is to be done to the satisfaction of the Fiscal Policy Designee and the Director of Parks and
Recreation or his authorized Agent(s). The Director of Parks and Recreation or his Agent shall
interpret all specifications and shall determine the acceptability of all work. The Director of Parks
and Recreation or his Agent shall decide the classification, quality, and amount of all work done
under the contract. The Fiscal Policy Designee shall be the sole administrator of payment(s), and
his or her decision shall be final, conclusive and binding on all parties.
3.2 Authority of the Agent: The Director of Parks and Recreation may appoint an Agent or Agents to
serve as an inspector. The Agent(s) shall be allowed to inspect all work at any time. The Agent
shall not be allowed to alter, revise, add, or delete anything from the contract or specifications. An
Agent's duties shall include keeping the Director of Parks and Recreation notified as to the progress
of the job and the procedures involved in completing the job. The Agent shall call to the attention
of the Director of Parks and Recreation and the Contractor any deviation of contract or
specifications, but failure of the Agent or of the Director of Parks and Recreation to call to the
attention of the Contractor any deviation of the contract or specifications shall not constitute
acceptance of said work. The Agent shall have the authority to suspend any work pending a decision
by the Director of Parks and Recreation.
3.3 Extra Work: Extra work being done by the Contractor without authorization through change
orders, or work which is not shown on the contract or specifications, shall be considered as
unauthorized work; and if performed shall be at the risk of the Contractor. The Director of Parks
and Recreation shall discuss any extra work with the Fiscal Policy Designee and reserves all rights
to refuse payment for such work.
3.4 Unauthorized Work: All work and/or materials which do not conform to the contract and
specifications, and work done contrary to written instructions of the Agent or Director of Parks and
Recreation shall be done at the expense of the Contractor. The Contractor may be ordered to remove
or remedy such work at its own expense. If Contractor damages adj shall remedy such property at its own expense, acent property, the Contractor
3.5 Final Inspection: Final inspection of the site shall take place by the Director of Parks and
Recreation or his appointed Agent as soon as possible after the completion of the project. If the
project is completed in cycles, the project shall be inspected after each cycle by the Agent. The
Contractor shall be allowed to be present at the examination. If the inspection reveals any defective
work, the Director of Parks and Recreation or his Agent may require the work to be remedied before
final acceptance is granted. All said remedies shall be at the expense of the Contractor.
3.6 Laws and Regulations: The Contractor and any Subcontractor(s) shall at all times comply with all
local, county, state and federal laws. The Contractor and his Subcontractor shall abide by all Labor
Laws observed by the State of Texas. The Contractor shall comply with all federal, state and local
Environmental Protection Laws, and regulations. The Contractor shall comply with all applicable
federal, state and local laws and regulations regarding pollution of rivers, lakes, streams and other
waters. The Contractor shall store, handle, use and dispose of chemicals, fuels, oils, greases and
other materials in a manner that prevents them from entering surface or ground waters. Upon receipt
of notice of noncompliance of environmental protection provisions, the Contractor shall take
immediate corrective action at the Contractor's expense. If the Contractor fails or refuses to
immediately take corrective action, the City may issue an order stopping all or part of the work until
satisfactory corrective action has been taken.
3.6.1 Prior to any application of chemicals, the Contractor shall request, in writing, approval
from the Director of Parks and Recreation or his Agent. The request shall include the target
City of Lubbock, TX
RFP 20-15250-MW
Landscape Maintenance for the Valencia Public Improvement District
pest and the type of chemical(s) to be used. If permission is granted, all applications shall
be performed through a Licensed Applicator, licensed by the Texas Structural Pest Control
Board and/or the Texas Department of Agriculture. Upon completion of the operation, the
Contractor shall provide to the Director of Parks and Recreation or his Agent, a copy of
the Pesticide Application Documentation that the Contractor records pursuant to the
requirements of the Structural Pest Control Board.
3.7 Advertising: Contractor shall not advertise or publish, without City's prior consent, the fact that
the City has entered into this contract, except to the extent necessary to comply with proper request
for information from an authorized representative or the federal, state or local government.
3.8 Citizen Contact: The Contractor is granted the privilege of doing work on City owned property,
but does not have exclusive use of the property and must respect the activities of patrons while doing
work on City owned property. The Contractor shall take all precautions necessary to insure that
adjacent property owners are not disturbed.
3.9 Identification and Character: Contractor's vehicles shall be marked with the Contractor's
company name, on both sides and in lettering that is a minimum of two inches tall and of an easily
read typeface. In lieu of lettering, Contractors may submit easily recognizable Company Logos for
approval by the Director of Parks and Recreation. All employees of the Contractor shall have a
name badge for identification, either clip on or incorporated with a uniform. This identification
shall be worn at all times that the employee is at the job site. The Contractor shall provide uniforms
of a different color than City employee uniforms. Uniforms may not be torn or ragged and shall
present a professional appearance. Additionally, the Contractor will at all times require employees
to remain fully dressed and will not allow employees to wear unbuttoned clothing while on City
property.
3.9.1 The Contractor shall prohibit the use of intoxicating substances by its drivers and
crewmembers while on duty or in the course of performing their duties under this Contract.
3.9.2 Employees driving the Contractor's vehicles shall at all times possess and carry a valid
State of Texas Drivers License appropriate for the weight and type of vehicle being driven.
Contractors are specifically required to ensure that a Texas Commercial Drivers License is
obtained where applicable for the type(s) of vehicles in use.
3.9.3 The Contractor's employees, officers, Agents and Subcontractors shall, at no time, be
allowed to identify themselves or in any way represent themselves as being employees of
the City of Lubbock.
3.10 Safety: The Contractor is responsible for maintaining a safety program that insures compliance
with all current requirements of the Federal Occupational Safety and Health Act of 1970. The
Contractor is responsible for safety on the project site and the City shall take no action to interfere
with the Contractor's safety program. Failure to maintain compliant with this act shall be grounds
for termination of the contract.
City of Lubbock, TX
RFP 20-15250-MW
Landscape Maintenance for the Valencia Public Improvement District
4.0 INDEMNITY INSURANCE
4.1 Contractor shall indemnify, hold harmless, and defend the City of Lubbock, its officers and
employees from and against any and all liability or alleged liability without fault and liability by
virtue of the obligations that the City of Lubbock assumes toward its indemnity(s) insofar as
applicable to this Contract or the work to be performed hereunder and including cost of suit,
attorneys' fees, and all other related costs and expenses of whatever kind or character arising directly
or indirectly from any cause whatsoever in connection with or incidental to this Contract or the work
to be performed hereunder, including such injury or harm as may be caused in part by any neglect,
act, or omission of the City, its officers and employees, excepting only such injury or harm as may
be caused solely by an act or omission of the City, its officers and employees. Notwithstanding the
foregoing, the Contractor specifically agrees to so indemnify, hold harmless, and defend the City
from and against any and all such liability, suits, action, legal proceedings, claims, or demands that
may be made or pursued by an employee of Contractor, or of any Subcontractor, or materialsman,
or anyone acting on behalf of Contractor in connection with or incidental to this Contract which are
alleged to be attributable to any condition of or upon the City's property facilities, materials, or
equipment, including where such condition and resulting injury or harm is caused in part by any
negligent act or omission of City, its officers and employee, but excepting only such injury or harm
as may caused solely by an act or omission of City, its officers and employees. Contractor agrees
to waive any and all claims and suits covered by this indemnity agreement and agrees that any
insurance carrier involved shall not be entitled to subrogation under any circumstance against City,
its officers and employees.
4.2 The Contractor shall secure and maintain insurance for the duration of the contract. Proof of the
Contractor's liability insurance shall be provided prior to receipt of a signed contract. The following
insurance is required:
4.2.1 Workman's Compensation Insurance covering all employees whether employed by the
Contractor or any Subcontractor on the job including Employers Liability of at least
$500,000 aggregate.
Commercial General Liability Insurance at minimum combined single limits of $1,000,000
per occurrence and $1,000,000 general aggregate for Bodily Injury and Property Damage,
which coverage shall include Products/Completed Operations, and XCU Hazards
Coverage for Products/Completed Operations must be maintained for at least five (5) years
after the work is completed. Coverage must be written on an Occurrence Form.
Contractual Liability must be obligations contained in the contract.
Commercial Automobile Liability Insurance at minimum combined single limits of
$500,000 per occurrence for owned, non -owned, and hired coverage.
Pollution Liability Insurance at general aggregate of $1,000,000.
4.3 All policies or certificates shall also contain the following endorsements:
4.3.1 Additional named insured wording which includes the Contractor, Subcontractors, and the
City of Lubbock with respect to general liability and automobile liability.
4.3.2 All liability policies shall contain cross liability and severability of interest clauses.
City of Lubbock, TX
RFP 20-15250-MW
Landscape Maintenance for the Valencia Public Improvement District
4.3.3 A waiver of subrogation in favor of the City of Lubbock for all types of insurance
coverages.
4.3.4 The policy shall be endorsed to require the insured to immediately notify the City of
Lubbock of any changes in the insurance coverage.
4.4 All insurance shall be purchased from an insurance company that meets the following requirements.
4.4.1 A Best financial grading of A: V1I or better
4.4.2 Licensed and admitted to do business in the State of Texas and is a subscriber to the Texas
Guaranty Fund.
4.5 All insurance must be written on forms filed with and approved by the Texas State Board of
Insurance. Certificates of insurance shall be prepared and executed by the insurance company or
it's authorized Agent and shall contain provisions representing and warranting the following:
4.5.1 The company is licensed and admitted to do business in the State of Texas.
4.5.2 The company's forces have been approved by the Texas State Board of Insurance.
4.5.3 Sets forth all endorsements as required above.
4.6 The City of Lubbock shall receive at least sixty (60) calendar days notice prior to cancellation or
termination of insurance.
4.7 The Contractor shall understand and agree that they are an independent Contractor and that they are
not an employee of the City, and that the City will not provide Worker's Compensation, health or
accident insurance, general liability insurance, or any other form of insurance coverage of any kind
which would cover the Contractor or their employees, if any, in and under the terms of the Bid.
5.0 CONTRACT TERM
5.1 The contract shall be for a term of one year, with the option of four, one-year extensions, said date
of term beginning upon formal approval. All stated annual quantities are approximations of usage
during the time period to be covered by pricing established by this bid. Actual usage may be more
or less. Order quantities will be determined by actual need. The City of Lubbock does not guarantee
any specific amount of compensation, volume, minimum, or maximum amount of services under
this bid and resulting contract. The Contractor must maintain the insurance coverage required during
the term of this contract including any extensions. It is the responsibility of the Contractor to ensure
that valid insurance is on file with the Purchasing and Contract Management Department as required
by contract or contract may be terminated for non-compliance.
6.0 PROSECUTION AND PROGRESS OF WORK
6.1 Notice to Proceed. Notice to proceed shall be mailed to the Contractor by certified letter. The
Contractor shall have ten (10) working days from the day he receives the letter to actively proceed
with the work.
6.2 Contract Time: All work is schedule driven, therefore, the Contractor's work force and equipment
needs shall vary throughout the contract's time period. The normal work schedule shall fall within
the time frame of Monday through Friday 6:00 a.m. to 6:00 p.m.
City of Lubbock, TX
Landscape Maintenance for he Valencia Public Improvement District
6.3 Weekends, Holidays and Nights: Work on weekends, holidays, and nights shall be at the
discretion of the Contractor. Should the Contractor find it necessary to work during this time, notice
of his intention to do so shall be given to the Director of Parks and Recreation or his Agent at least
seventy-two (72) hours prior to doing so.
6.4 Weather: Weather will affect the progress of grounds maintenance at times and Contractor shall
recognize this and have a plan of action and/or resources available to proceed in an expedient
manner. Should weather conditions alter schedules, the Contractor shall notify the Agent at the
beginning of the next workday. It is the Contractor's responsibility to provide duality workmanship.
If weather conditions prevent such quality, the Contractor shall suspend work and resume work as
soon as weather allows. If the Agent or Director of Parks and Recreation finds that weather
conditions are inappropriate for maintaining high quality work, they may notify the Contractor and
suspend work. The suspension of work by the Agent or Director of Parks and Recreation shall not
in any way allow the Contractor to find grounds for adjustments in contract time or provide for extra
compensation.
6.5 Character of Work: All workers, supervisors, managers, and Subcontractor(s) employed by the
Contractor shall be competent and careful workers skilled in their respective trades. The Director
of Parks and Recreation or his Agent may remove from the work site any person employed by the
Contractor who does not represent the City in a professional manner or does not follow the
instructions given to him. If any person misconducts theirself, is incompetent, or negligent in the
performance of their duties, they may be removed from the work site and shall not return until the
Contractor receives written consent from the City's Representative. Should the Contractor continue
to employ such individual to continue work under this contract, the City reserves the riht to
withhold payment and/or nullify the contract. g
6.6 Assigning or Subletting the Contract: The Contractor shall not assign or sublet the contract, or
any portion of the contract, without written consent from the Director of Parks and Recreation or
his Agent. The City's permission to sublet any contract shall not be construed as making the City a
party of such subcontract. No Subcontractor shall release the Contractor of its surety or its liability
and obligation to fulfill all transactions made under the contract. Should consent be given, the
Contractor shall insure the Subcontractor or shall provide proof of insurance from the Subcontractor
that complies with all Insurance requirements contained in paragraphs, 4.04.7, Indemnity
Insurance.
6.7 Payment: The Contractor shall receive compensation for services provided for in the contract on a
monthly n the end of each month, during the contract period, the contract shall submit an invoice to
the Fiscal Policy Designee for 11121 of the Annual Maintenance Cost. Any Extra Work shall be
shown on the same monthly invoice and identified as "Extra Work." Extra Work billing should
designate hourly labor cost, parts/materials costs and a description of the work performed. Payment
shall be determined by the form included in this package as Exhibit 1 and approved by the Fiscal
Policy Designee.
7X EVALUATION CRITERIA
The following criteria will be used to evaluate and rank submittals:
7.1 Key Personnel and Staff: The offeror's ability to provide quality supervisors and crew members
with proven skills commiserate with these specifications. Also the offeror is to ensure that in
offering such services and staffing that it will in no way over -extend the firm, thereby adversely
affecting the quality and timing of services rendered on this project. (25 pts.)
City of Lubbock, TX
RFP 20-15250-MW
Landscape Maintenance for the Valencia Public Improvement District
7.2 Responsiveness: The degree to which the offeror has responded to the purpose, scope, and requested
submittals, but not limited to, services to be provided as detailed under scope of work, flexibility of
offeror to meet the City of Lubbock needs and conformance in all aspects of this RFP. (15 pts.)
7.3 Responsibility: The offeror who has the capability, in all respects, to perform fully the contract
requirements and the moral and business integrity and reliability that will assure good faith
performance as required by these specifications. (15 pts.)
7.4 Experience and Qualifications: The offeror's experience in providing best management practices for
landscape maintenance services that are similar in size and scope as this project. (15 pts.)
7.5 Equipment Status: The offeror's ability to provide quality and efficient equipment that is maintained
at a high level of readiness, and in case of failure, is able to provide an equivalent substitution or
replace the impaired piece(s) in a timely manner. (10 pts.)
7.6 Originality: Offeror shall not be merely limited to items as shown in scope of work, but rather
encouraged to recommend other services, products, methods, etc. as he/she feels would enhance the
overall quality of the maintenance project both with respect to effectiveness and efficiency. (10 pts.)
7.7 Cost: Offeror's pricing for each tract of the project as outlined. (10 pts.)
8.0 PROPOSAL FORMAT
a) Proposals should provide a straightforward, concise description of the Offeror's capabilities to satisfy
the requirements of the RFP. Emphasis should be on completeness, clarity of content, and conveyance
of the information requested by the City.
b) The proposal should be bound in a single volume where practical. All documentation submitted with
the proposal should be bound in that single volume.
c) If the proposal includes any comment over and above the specific information requested in the RFP, it
is to be included as a separate appendix to the proposal.
d) The proposal must be organized into the following response item sections and submitted in an indexed
binder.
i) Cover letter addressed to the Honorable Mayor and City Council that states the Offeror's
understanding of the services to be provided. Include any additional information believed necessary
that is not requested elsewhere in the RFP.
ii) A description of the methodology to be used to complete the project to include, but not be
limited to, how recommendations will be formulated and commitment of adequate appropriate
resources to the project.
iii) Offeror's specific expertise in areas pertinent to the project to include a listing and brief
description of similar projects completed (with the dates of completion) or in progress and a list of
references by name, address, and telephone number for each project listed. This list of projects in
progress shall include the phase of work that each project is currently in (i.e. design, bid,
construction), and the estimated completion date.
iv) A brochure of past work, with emphasis on comparable projects.
City of Lubbock, TX
Landscape Maintenance for he Valencia Public Improvement District
v) List of principal(s) of the Proposer and amount of time that principal(s) will be involved in
the
project.
vi) List of other professionals to be used, if applicable, with a record of experience in pro
of this nature. Identification of principal(s) and percentage of time the principal(s) will be invojects
ved
in
the
project.
vii) The organizational structure of the employees who will be assigned to this project along
with resumes of those individuals. If a joint venture is expected, then provide the organizational
structure of the sub -contractor and resumes of those persons who will be involved in the project.
viii) The Proposer must assure the City that he/she will to the best of his/her knowledge,
information and belief, be cognizant of, comply with, and enforce, where applicable and to the extent
required, all applicable federal or state statutes and local ordinances.
ix) Describe the Offeror's methodology for handling errors and omissions.
x) Disclosure of any obligations posing a potential conflict of interest, including service on
City boards and/or commissions and any current contracts with the City of Lubbock. This would
apply to the Proposer as well as consultants subcontracted by the Proposer.
xi) Any material which the proponent wishes to submit and which is not specifically requested
in the above categories.
xii) Offerors are strongly encouraged to explore and implement methods for the utilization of local resources,
and to outline how they would address outreach issues in their proposal.
ca'-Vtolirs
TREE PLACE
May 15, 2020
Misty Winter
City of Lubbock
Purchasing Department
1314 Ave. K, 91h Floor
Lubbock, TX 79401
Exhibit B
Landscape Construction • Landscape Architects
6104-34th Street
Lubbock, Texas 79410
Phone: (806) 799-3677
Fax: (806) 799-3680
Subject: Best and Final Offer RFP 20-15250-MW Landscape Maintenance for the Valencia Public
Improvement District
Attached to this letter is Tom's Tree Place Best and Final Offer for the landscape maintenance for the
Valencia Public Improvement District. We appreciate the opportunity to submit this offer.
Alex 5
Tom's
5104-341H STREET • LUBBOCK TEXAS 79410-2313
W6-799.3677 Office B06.799-3990
& Page 2
May 14, 2020
Best and Final
Proposal Price Sheet
VALENCIA PUBLIC IMPROVEMENT DISTRICT
LANDSCAPE MAINTENANCE ANNUAL PRICING
1• Turf Maintenance as per Section 1.0 (based upon 29 cycles per year):
Mowing
Cost Per Thousand Square Feet per Month $ '37. Z�
$ 1 3 Q 5 0 Annual Cost
Per Cycle Cost for Extra Work $ c
I e--' ilixerlPre-Ewer ent
Cost Per Thousand Square Feet Per Application $ _ Annual Cost
Per Application Cost for Extra Work $ 6:S.0
IL Tree Maintenance as per Section 2.0:
Cost Per Tree Per Month $ 2.5 0
$` f, ,10 . Annual Cost
Hourly Labor Cost for Extra Work $ —
III. Irrigation Maintenance as per Section 3.0:
Cost Per Hundred Square Feet Per Month $ . 35
$ , M Annual Cost
Hourly Labor Cost for Extra Work $ -7 5
Materials Cost, Percent Discount From Manufacturer's List Price
$ LIST PRIG. .
IV. Planting Bed Maintenance as per Section 4.0:
Cost per Square Feet Per Month $
$— Annual Cost
Hourly Labor Cost for Extra Work $
• Page 3
May 14, 2020
V. Water Wells and Pump House Maintenance as per Section 5.0:
Hourly Labor Cost for Extra Work $ 2 50 + L,�,��5
VI. Trash Receptacles and Pet Waste Stations Maintenance as per Section 6.0:
Cost per receptacle/station for extra work $ 50
VII. Benches, Hardscape, and Concrete Maintenance as per Section 7.0:
Hourly Labor Cost for Extra Work
VIII. Playground and Playground Equipment Maintenance as per Section 8.0:
Hourly Labor Cost for Extra Work $ '7 S
Exhibit C
City of Lubbock, TX
RFP 20-15250-MW
Landscape Maintenance for the Valencia Public Improvement District
INSURANCE
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.
INSURANCE COVERAGE REQUIRED
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. 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
® Commercial General Liability ❑ Other
❑ Claims Made ® Occurrence
❑ W/Heavy Equipment
❑ To Include Products of Complete Operation Endorsements
PROFESSIONAL LIABILITY
AUTOMOTIVE LIABILITY
®
Any Auto
❑
Scheduled Autos
❑
Non -Owned Autos
EXCESS LIABILITY
❑
Umbrella Form
GARAGE LIABILITY
❑ Any Auto
El
❑ BUILDER'S RISK
❑ INSTALLATION FLOATER
® POLLUTION
❑ CARGO
❑ All Owned Autos
❑ Hired Autos
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 Limit
Each Occurrence $ 500,000
Each Occurrence _.
Aggregate
Auto Only - Each Accident
Each Accident Aggregate
❑ 100% of the Total Contract Price
❑ 100% of the Total Material Costs
$1,000,000
® WORKERS COMPENSATION STATUTORY AMOUNTS OR OCCUPATIONAL MEDICAL AND DISABILITY
® EMPLOYERS' LIABILITY $ 500,000
OTHER: COPIES OF ENDOSEMENTS ARE REQUIRED
® City of Lubbock named as additional insured on Auto/General Liability on a primary and non-contributory basis.
® To include products of completed operations endorsement.
® Waiver ofsubrogation in favor ofthe City of Lubbock on all coverages, except
Exhibit C
The City of Lubbock shall be named as an additional insured on a primary and non-contributory basis and shall include waivers of
subrogation in favor of the City on all coverage's. Copies of the Certificates of Insurance and all applicable endorsements are required.
ADDITIONAL POLICY ENDORSEMENTS
The City shall be entitled, upon request, and without expense, to receive copies of the policies 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.
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 thirty (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.
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 and Contract Management
City of Lubbock
1625 IP 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.
CERTIFICATE OF INTERESTED PARTIES FORM 1295
1of1
Complete Nos. 1- 4 and 6 if there are interested parties.
OFFICE USE ONLY
Complete Nos. 1, 2, 3, 5, and 6 if there are no interested parties.
CERTIFICATION OF FILING
Certificate Number:
1
Name of business entity filing form, and the city, state and country of the business entity's place
of business.
2020-625194
West Texas Services, Inc. DBA Toms Tree Place
Lubbock, TX United States
Date Filed:
05/29/2020
2
Name of government@ entity or state agency that is a party tot the contract for which the form is
being filed.
City of Lubbock
Date Acknowledged:
05/29/2020
3
Provide the identification number used by the governmental entity or state agency to track or identify the contract, and provide a
description of the services, goods, or other property to be provided under the contract.
15250
Landscape Maintenance for the Valencia Public Improvement District
4
Name of Interested Party
City, State, Country (place of business)
Nature of interest
(check applicable)
Controlling
Intermediary
-T
5
Check only if there is NO Interested Party. ❑
X
6
UNSWORN DECLARATION
My name is and my dale of birth is
My address is
(street) (city; (state) (zip code) (country)
I declare under penalty of perjury that the foregoing is true and correct.
Executed in County, State of on the day of , 20
(month) (year)
Signature of authorized agent of contracting business entity
(Declarant)
Forms
Drovided by Texas Ethics Commission www.ethics.state.tx.us Versinn V1.f .gafaaf7d
CERTIFICATE OF INTERESTED PARTIES FORM 1295
1of1
Complete Nos. 1- 4 and 6 if there are interested parties.
Complete Nos. 1, 2, 3, 5, and 6 if there are no interested parties.
OFFICE USE ONLY
CERTIFICATION OF FILING
Certificate Number:
2020-625194
i Name of business entity filing form, and the city. state and country of the business entity's place
of business.
West Texas Services, Inc. DBA Toms Tree Place
Lubbock. TX United States
Date Filed:
05/29/2020
2 Name of governmental entity or state agency that Is a party to the contract for which the forms
being filed.
City of Lubbock
Date Acknowledged:
3 Provide the identification number used by the governmental entity or state agency to track or identify the contract, and provide a
description of the services, goods, or other property to be provided under the contract.
15250
Landscape Maintenance for the Valencia Public Improvement District
4
Name of Interested Party
City, State, Country (place of business)
Nature of Interest
(check applicable)
Controlling
Intermediary
5 Check only N there is NO Interested Party.
X
S UNSWORN DECLARATION
My address is C)7 1 5 t'eS� �� _ V,J6ocl ,� i� VkM 1
�.
(s7eeU (dty) (State) (zip code) (country)
I declare under penalty of perjury that the foregoing is true and correct.
C Executed in /QC- County, State of on the day of� 20
(yew)
Signature of authorized agent of contracting business entity
(Dedwam)
corms proviaea oy i exas ttnics commission www.ethics.state.w.us Version V1.1.3a6aaf?d
ACORUe CERTIFICATE OF LIABILITY INSURANCE
llla.�
DATE(MM10D1YYYY)
1 5/29/2020
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 endorsemen s .
PRODUCER
Aycock & Fowler Insurance Co A Higginbotham Co.
9816 Slide Rd #302
Lubbock TX 79424
NAME: CONTACT Danielle F e, CISR, ACSR
PHONE FAX
-817-347-7084 uc No : 817-870-4993
A -MAIL . dft"Ohigginbotham.net
INSURERS AFFORDING COVERAGE
NAIC 0
INSURER A: West American Insurance Company
44393
INSURED TOMST
Tom' Treelace Services, Inc.
Tom's Tree Place
INSURER B : The Ohio Casualty Insurance Company
24074
INSURER C : Texas Mutual Insurance Company
22045
INSURER D : Lloyds of London
1 8520
Zephyr Tree Farm
5104 34th Street
Lubbock TX 79410
INSURER E :
INSURER F
COVERAGES CERTIFICATE NUMBER: 1846553582 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.
ILTR
TYPE OF INSURANCE
POLICY NUMBER
MMIDD YY EFF
MMAD EXP
LIMITS
A
X
COMMERCIAL GENERAL LIABILITY
BKW56279964
9J2712019
%2712020
EACH OCCURRENCE
$ 1,000,000
CLAIMS -MADE Fx_] OCCUR
PREMISES Ea oocurremal
S 1,000,000
X
MED EXP (Anyone person)
$15,000
XCU Included
X
Contractual
PERSONAL & ADV INJURY
$1.000,000
GENL AGGREGATE LIMIT APPLIES PER:
POLICY 1E JECT LOC
GENERAL AGGREGATE
$2,000.000
PRODUCTS - COMPIOP AGG
$ 2,000,000
$
OTHER
A
AUTOMOBILE LIABILITY
BAW56279964
9127I2019
9127/2020
MBINED IN LE LIMIT
E idn
$1
BODILY INJURY (Per person)
$
ANY AUTO
ALL OWNED SCHEDULED
AUTOS AUTOS
IX
BODILY INJURY(Per accident)
S
NON -OWNED
HIRED AUTOS N AUTOS
PROPERTY DAMAGE
Per accident
$
$
B
X
UMBRELLA LIAR
X
OCCUR
US056279964
8127C2019
9127/2020
EACH OCCURRENCE
$5.000,000
AGGREGATE
$ 5,OM.OW
EXCESS LIAR
CLAIMS -MADE
DED I X RETENTION$ lo.00n
$
C
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY Y 1 N
ANY P OPRIIMBERtPARTNDRD ECUTIVE EN7N
OFFR(Mandatory
1 A
0001184331
92712019
9/272020
X SgTUTE ER
E.L. EACH ACCIDENT
$ 1,000,000
E.L. DISEASE - EA EMPLOYEE
$1,000.000
In NH)
If yes describe under
DESCRIPTION OF OPERATIONS below
E.L. DISEASE - POLICY LIMIT
$1,000,000
D
Professional LiaNlity
AE182539
9272019
9272020
EachreClaim $1.000,000
Each Clasi000,000
m Deductible $0,000
DESCRIPTION OF OPERATIONS f LOCATIONS f VEHICLES (ACORD tilt, Additional Remarks Schedule, may be attached It more space Is required)
Project: City of Lubbock, Valencia Public Improvement District Contract #15250.
The above General Liability, Auto Liability and Umbrella policies include a blanket automatic additional insured endorsement that provides additional insured
status to the certificate holder only when there is a written contract between the named insured and the certificate holder that requires such status. This policy
contains "primary and non-contributory" wording. The above General Liability, Auto Liability, Umbrella and Workers Compensation policies include a blanket
Waiver of Subrogation endorsement in favor of the certificate holders only when there is a written contract between the named insured and the certificate holder
that requires such status. The contractual liability coverage provided by the policies is standard and may not cover all liabilities assumed by the named insured
under its contract with the certificate holder. The above General Liability Auto Liability, Umbrella and Worker's Compensation policies Will provide an
endorsement provided that 30 day notice of cancellation Will be fumished to the Certificate holder. The above Umbrella is "follow farm".
A COPY OF THE ABOVE POLICIES IS AVAILABLE UPON REQUEST FROM THE INSURED,
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
City of Lubbock
PO Box 2000
AUTHORIZED R PRESENTATIVE
Lubbock TX 79457
01988-2014 ACORD CORPORATION. All rights reserved.
ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD
i�
I�
r�
i-
2111111111111-011111111111
COMMERCIAL AUTO
AC 85 01 06 18
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY,
BUSINESS AUTO COVERAGE ENHANCEMENT ENDORSEMENT
This endorsement modifies insurance provided under the following:
BUSINESS AUTO COVERAGE FORM
With respect to coverage afforded by this endorsement, the provisions of the policy apply unless modified
by the endorsement.
If the polrcy to which this endorsement is attached also contains a Business Auto Coverage Enhancement
Endorsement with a specific state named in the title, this endorsement does not apply to vehicles garaged in
that specified state.
COVERAGE INDEX
SUBJECT
PROVISION NUMBER
ACCIDENTAL AIRBAG DEPLOYMENT
13
ADDITIONAL INSURED BY CONTRACT, AGREEMENT OR PERMIT
4
AMENDED DUTIES IN THE EVENT OF ACCIDENT, CLAIM, SUIT OR LOSS
21
SECTION I - COVERED AUTOS is amended as follows:
1. TRAILERS - INCREASED LOAD CAPACITY
The following replaces Paragraph C.I. Certain Trailers, Mobile Equipment And Temporary Substitute
Autos of SECTION I - COVERED AUTOS:
"Trailers" with a load capacity of 3,000 pounds or less designed primarily for travel on public roads.
® 2017Liberty Mutual Insurance
AC 85 01 06 18 Includes copyrighted material of Insurance Services Office Inc., with tts Permission. Page 1 of 7
SECTION II - LIABILITY COVERAGE is amended as follows:
2. NEWLY FORMED OR ACQUIRED SUBSIDIARIES
SECTION 11 - LIABILITY COVERAGE, Paragraph A.I. - Who Is An Insured is amended to include the
following as an "insured":
d. Any legally incorporated subsidiary of which you own more than 50 percent interest during the
policy period. Coverage is afforded only for 90 days from the date of acquisition or formation.
However, "insured" does not include any organization that:
(1) Is a partnership or joint venture; or
(2) Is an "insured" under any other automobile policy except a policy written specificall y to apply
in excess of this policy; or
(3) Has exhausted its Limit of Insurance or had its policy terminated under any other automobile
policy.
Coverage under this provision d. does not apply to "bodily injury" or "property damage" that
occurred before you acquired or formed the organization.
3. EMPLOYEES AS INSUREDS
SECTION II - LIABILITY COVERAGE, Paragraph A-1. Who Is An Insured is amended to include the
following as an "insured":
e. Any "employee" of yours while using a covered "auto" you do not own, hire or borrow but only for
acts within the scope of their employment by you. Insurance provided by this endorsement is
excess over any other insurance available to any "employee".
f. Any "employee" of yours while operating an "auto" hired or borrowed under a written contract or
agreement in that "employee's" name, with your permission, while performing duties related to
the conduct of your business and within the scope of their employment. Insurance provided by this
endorsement is excess over any other insurance available to the "employee".
4. ADDITIONAL INSURED BY CONTRACT, AGREEMENT OR PERMIT
SECTION It - LIABILITY COVERAGE, Paragraph A.I. Who Is An Insured is amended to include the
following as an "insured":
g. Any person or organization with respect to the operation, maintenance or use of a covered "auto",
provided that you and such person or organization have agreed in a written contract, written
agreement, or permit issued to you by governmental or public authority, to add such person, or
organization, or governmental or public authority to this policy as an "insured".
However, such person or organization is an "insured":
(1) Only with respect to the operation_ maintenance or use of a covered "auto";
(2) Only for 'bodily injury" or "property damage" caused by an "accident" which takes place after
you executed the written contract or written agreement, or the permit has been issued to you;
and
(3) Only for the duration of that contract, agreement or permit.
The "insured" is required to submit a claim to any other insurer to which coverage could apply for
defense and indemnity. Unless the "insured" has agreed in writing to primary noncontributory
wording per enhancement number 24, this policy is excess over any other collectible Insurance.
S. SUPPLEMENTARY PAYMENTS
SECTION II - LIABILITY COVERAGE, Coverage Extensions, 2.a. Supplementary Payments, Paragraphs
(2) and (4) are replaced by the following:
(2) Up to $3,000 for cost of ball bonds (including bonds for related traffic violations ) required because
of an "accident" we cover. We do not have to furnish these bonds.
(4) All reasonable expenses incurred by the "insured" at our request, including actual loss of earnings
up to $500 a day because of time off from work.
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�III#7149J[8]Ta4s'17X4]74:84:001][RiNIZl
In those jurisdictions where, by law, fellow "employees" are not entitled to the protection afforded to
the employer by the workers compensation exclusivity rule, or similar protection, the following provi-
sion is added:
SECTION II - LIABILITY, Exclusion 8.5. Fellow Employee does not apply if the "bodily injury" results
from the use of a covered "auto" you own or hire if you have workers compensation insurance in force
for all of your "employees" at the time of "loss".
This coverage is excess over any other collectible insurance -
SECTION III - PHYSICAL DAMAGE COVERAGE is amended as follows:
7. HIRED AUTO PHYSICAL DAMAGE
Paragraph AA. Coverage Extensions of SECTION III - PHYSICAL DAMAGE COVERAGE, is amended by
adding the following:
If hired "autos" are covered "autos" for Liability Coverage, and if Comprehensive, Specified Causes of
Loss or Collision coverage are provided under the Business Auto Coverage Form for any "auto" you
own. then the Physical Damage coverages provided are extended to "autos":
a. You hire, rent or borrow; or
b. Your "employee" hires or rents under a written contract or agreement in that "employee's" name,
but only if the damage occurs while the vehicle is being used in the conduct of your business,
subject to the following limit and deductible:
a. The most we will pay for "loss" in any one "accident" or "loss" is the smallest of:
(1) $50,000; or
(2) The actual cash value of the damaged or stolen property as of the time of the "loss": or
(3) The cost of repairing or replacing the damaged or stolen property with other property of like
kind and quality, minus a deductible.
b. The deductible will be equal to the largest deductible applicable to any owned "auto" for that
coverage.
c. Subject to the limit, deductible and excess provisions described in this provision, we will provide
coverage equal to the broadest coverage applicable to any covered "auto" you own.
d. Subject to a maximum of $1,000 per "accident", we will also cover the actual loss of use of the
hired "auto" if it results from an "accident", you are legally liable and the lessor incurs an actual
financial loss.
e. This coverage extension does not apply to:
(1) Any "auto" that is hired, rented or borrowed with a driver; or
(2) Any "auto" that is hired, rented or borrowed from your "employee" or any member of your
"employee's" household.
Coverage provided under this extension is excess over any other collectible insurance available at the
time of "loss"_
8. TOWING AND LABOR
SECTION III - PHYSICAL DAMAGE COVERAGE, Paragraph A.2. Towing, is amended by the addition of
the following:
We will pay towing and labor costs incurred, up to the limits shown below, each time a covered "auto"
classified and rated as a private passenger type, "light truck" or "medium truck" is disabled:
a. For private passenger type vehicles, we will pay up to $75 per disablement.
b. For "light trucks", we will pay up to $75 per disablement. "Light trucks" are trucks that have a gross
vehicle weight (GVW) of 10,000 pounds or less.
c. For "medium trucks" , we will pay up to $150 per disablement, "Medium trucks" are trucks that
have a gross vehicle weight (GVW) of 10,001 - 20,000 pounds.
However, the labor must be performed at the place of disablement.
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9. PHYSICAL DAMAGE -ADDITIONAL TRANSPORTATION EXPENSE COVERAGE
Paragraph AA.a. Coverage Extensions, Transportation Expenses of SECTION III - PHYSICAL DAMAGE
COVERAGE, is amended to provide a limit of $50 per day and a maximum limit of $1,500.
10. RENTAL REIMBURSEMENT
SECTION III - PHYSICAL DAMAGE COVERAGE, A. Coverage, is amended by adding the following:
a. We will pay up to $75 per day for rental reimbursement expenses incurred by you for the rental of
an "auto" because of "accident" or "loss", to an "auto" for which we also pay a "loss" under
Comprehensive, Specified Causes of Loss or Collision Coverages. We will pay only for those ex-
penses incurred after the first 24 hours following the "accident" or "loss" to the covered "auto."
b. Rental Reimbursement requires the rental of a comparable or lessor vehicle, which in many cases
may be substantially less than $75 per day, and will only be allowed for the period of time it should
take to repair or replace the vehicle with reasonable speed and similar quality, up to a maximum of
30 days.
c. We will also pay up to $500 for reasonable and necessary expenses incurred by you to remove and
replace your tools and equipment from the covered "auto". This limit is excess over any other
collectible insurance.
d. This coverage does not apply unless you have a business necessity that other "autos" available for
your use and operation cannot fill.
e. If "loss" results from the total theft of a covered "auto" of the private passenger type, we will pay
under this coverage only that amount of your rental reimbursement expenses which is not already
provided under Paragraph 4. Coverage Extension.
f. No deductible applies to this coverage.
g. The insurance provided under this extension is excess over any other collectible insurance.
If this policy also provides Rental Reimbursement Coverage you purchased, the coverage provided by
this Enhancement Endorsement is in addition to the coverage you purchased.
For the purposes of this endorsement provision, materials and equipment do not include "personal
effects" as defined in provision 12.B.
11. EXTRA EXPENSE -BROADENED COVERAGE
Under SECTION III - PHYSICAL DAMAGE COVERAGE, A. Coverage, we will pay for the expense of
returning a stolen covered "auto" to you. The maximum amount we will pay is $1,000.
12. PERSONAL EFFECTS COVERAGE
A. SECTION III - PHYSICAL DAMAGE COVERAGE, A. Coverage, is amended by adding the following:
If you have purchased Comprehensive Coverage on this policy for an "auto" you own and that
"auto" is stolen, we will pay, without application of a deductible, up to $600 for "personal effects"
stolen with the "auto."
The insurance provided under this provision is excess over any other collectible insurance.
B. SECTION V - DEFINITIONS is amended by adding the following.
For the purposes of this provision, "personal effects" mean tangible property that is worn or carried
by an "insured." "Personal effects" does not include tools, equipment, jewelry, money or securi-
ties.
13. ACCIDENTAL AIRBAG DEPLOYMENT
SECTION III - PHYSICAL DAMAGE COVERAGE, B. Exclusions is amended by adding the following:
If you have purchased Comprehensive or Collision Coverage under this policy, the exclusion for "loss"
relating to mechanical breakdown does not apply to the accidental discharge of an airbag.
Any insurance we provide shall be excess over any other collectible insurance or reimbursement by
manufacturer's warranty_ However, we agree to pay any deductible applicable to the other coverage or
warranty.
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14. PHYSICAL DAMAGE DEDUCTIBLE -VEHICLE TRACKING SYSTEM
SECTION Ill - PHYSICAL DAMAGE COVERAGE, D. Deductible, Is amended by adding the following:
Any Comprehensive Deductible shown in the Declarations will be reduced by 50% for any "loss"
caused by theft if the vehicle is equipped with a vehicle tracking device such as a radio tracking device
or a global position device and that device was the method of recovery of the vehicle.
15. AUDIO, VISUAL AND DATA ELECTRONIC EQUIPMENT COVERAGE
SECTION III - PHYSICAL DAMAGE COVERAGE, B. Exclusions, Paragraph a. of the exception to exclu-
sions 4.c. and 4.d. is deleted and replaced with the following:
Exclusions 4.c. and 4.d. do not apply to:
a. Electronic equipment that receives or transmits audio, visual or data signals, whether or not de-
s gne solely for the reproduction of sound, if the equipment is:
(1) Permanently installed in the covered "auto" at the time of the "loss" or removable from a
housing unit that is permanently installed in the covered "auto"; and
(2) Designed to be solely operated by use from the power from the "auto's" electrical system; and
(3) Physical damage coverages are provided for the covered "auto".
I�
If the "loss" occurs solely to audio, visual or data electronic equipment or accessories used with
� this equipment, then our obligation to pay for, repair, return or replace damaged or stolen property
x will be reduced by a $100 deductible.
16. LOAN / LEASE GAP COVERAGE (Not Applicable In New York)
A. Paragraph C. Limit Of Insurance of SECTION III - PHYSICAL DAMAGE COVERAGE is amended by
adding the following. -
The most we will pay for a "total loss" to a covered "auto" owned by or leased to you in any one
"accident" is the greater of the:
x 1. Balance due under the terms of the loan or lease to which the damaged covered "auto" is
subject at the time of the "loss" less the amount of:
a. Overdue payments and financial penalties associated with those payments as of the date
of the "loss";
b. Financial penalties imposed under a lease due to high mileage, excessive use or abnormal
wear and tear;
c. Costs for extended warranties, Credit Life Insurance, Health. Accident or Disability Insur-
ance purchased with the loan or lease;
d. Transfer or rollover balances from previous loans or leases;
e. Final payment due under a "Balloon Loan';
f. The dollar amount of any unrepaired damage which occurred prior to the "total loss" of a
covered "auto';
g. Security deposits not refunded by a lessor;
h. All refunds payable or paid to you as a result of the early termination of a lease agreement
or as a result of the early termination of any warranty or extended service agreement on a
covered "auto";
1. Any amount representing taxes;
j. Loan or lease termination fees; or
2. The actual cash value of the damage or stolen property as of the time of the "loss".
An adjustment for depreciation and physical condition will be made in determining the actual
cash value at the time of the "loss". This adjustment is not applicable in Texas.
B. Additional Conditions
This coverage applies only to the original loan for which the covered "auto" that incurred the
"loss" serves as collateral, or lease written on the covered "auto" that incurred the "loss".
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x
C. SECTION V - DEFINITIONS is changed by adding the following:
As used in this endorsement provision, the following definitions apply:
"Total loss" means a "loss" in which the cost of repairs plus the salvage value exceeds the actual
cash value.
A "balloon loan" is one with periodic payments that are insufficient to repay the balance over the
term of the loan, thereby requiring a large final payment.
17. GLASS REPAIR- WAIVER OF DEDUCTIBLE
Paragraph D. Deductible of SECTION III - PHYSICAL DAMAGE COVERAGE is amended by the addition
of the following:
No deductible applies to glass damage if the glass is repaired rather than replaced.
18. PARKED AUTO COLLISION COVERAGE (WAIVER OF DEDUCTIBLE)
Paragraph D. Deductible of SECTION III - PHYSICAL DAMAGE COVERAGE is amended by the addition
of the following:
The deductible does not apply to "loss" caused by collision to such covered "auto" of the private
passenger type or light weight truck with a gross vehicle weight of 10,000 lbs. or less as defined by the
manufacturer as maximum loaded weight the "auto" is designed to carry while it is:
a. In the charge of an "insured";
b. Legally parked; and
c. Unoccupied.
The "loss" must be reported to the police authorities within 24 hours of known damage.
The total amount of the damage to the covered "auto" must exceed the deductible shown in the
Declarations.
This provision does not apply to any "loss" if the covered "auto" is in the charge of any person or
organization engaged in the automobile business.
19. TWO OR MORE DEDUCTIBLES
Under SECTION III - PHYSICAL DAMAGE COVERAGE, if two or more company policies or coverage
forms apply to the same "accident", the following applies to Paragraph D. Deductible;
a. If the applicable Business Auto deductible is the smaller (or smallest) deductible, it will be waived;
or
b. If the applicable Business Auto deductible is not the smaller (or smallest) deductible , it will be
reduced by the amount of the smaller (or smaltest) deductible; or
c. If the "loss" involves two or more Business Auto coverage forms or policies, the smaller (or
smallest) deductible will be waived.
For the purpose of this endorsement, company means any company that is part of the Liberty Mutual
Group.
SECTION IV - BUSINESS AUTO CONDITIONS Ls amended as follows:
20. UNINTENTIONAL FAILURE TO DISCLOSE HAZARDS
SECTION IV. BUSINESS AUTO CONDITIONS, Paragraph B.2. is amended by adding the following:
If you unintentionally fail to disclose any hazards, exposures or material facts existing as of the incep-
tion date or renewal date of the Business Auto Coverage Form, the coverage afforded by this policy will
not be prejudiced.
However, you must report the undisclosed hazard of exposure as soon as practicable after its discovery,
and we have the right to collect additional premium for any such hazard or exposure.
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21, AMENDED DUTIES IN THE EVENT OF ACCIDENT, CLAIM, SUIT, OR LOSS
SECTION IV - BUSINESS AUTO CONDITIONS, Paragraph A.2.a. is replaced in its entirety by the follow-
ing
a. In the event of "accident", claim, "suit" or "loss", you must promptly notify us when it is known to:
(1) You, if you are an individual;
(2) A partner, if you are a partnership;
(3) Member, if you are a limited liability company;
(4) An executive officer or the "employee" designated by the Named Insured to give such notice, if
you are a corporation.
To the extent possible, notice to us should include:
(a) How, when and where the "accident" or "loss" took place;
—� (b) The "insureds" name and address; and
(c) The names and addresses of any injured persons and witnesses.
22. WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US
SECTION IV - BUSINESS AUTO CONDITIONS, Paragraph A.5. Transfer Of Rights Of Recovery Against
r�
Others To Us, is amended by the addition of the following:
If the person or organization has in a written agreement waived those rights before an "accident" or
>_ "loss", our rights are walved also.
23. HIRED AUTO COVERAGE TERRITORY
SECTION IV - BUSINESS AUTO CONDITIONS, Paragraph B.7. Policy Period, Coverage Territory, is
amended by the addition of the following:
f. For "autos" hired 30 days or less, the coverage territory is anywhere in the world. provided that the
"insured's" responsibility to pay for damages is determined in a "suit", on the merits, in the United
States, the territories and possessions of the United States of America, Puerto Rico or Canada or in
a settlement we agree to.
This extension of coverage does not apply to an "auto" hired, leased, rented or borrowed with a
driver.
24. PRIMARY AND NON-CONTRIBUTING IF REQUIRED BY WRITTEN CONTRACT OR WRITTEN AGREE-
MENT
The following is added to SECTION IV - BUSINESS AUTO CONDITIONS, General Conditions, B.S. Other
Insurance and supersedes any provision to the contrary:
This Coverage Form's Covered Autos Liability Coverage is primary to and will not seek contribution
from any other insurance available to an "insured" under your policy provided that:
1. Such "insured" is a flamed Insured under such other insurance; and
2. You have agreed in a written contract or written agreement that this insurance would be primary
and would not seek contribution from any other insurance available to such "insured".
SECTION V - DEFINITIONS is amended as follows:
25. BODILY INJURY REDEFINED
Under SECTION V - DEFINITIONS, Definition C. is replaced by the following:
"Bodily injury" means physical injury, sickness or disease sustained by a person, including mental
anguish, mental injury, shock, fright or death resulting from any of these at any time.
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COMMERCIAL GENERAL LIABILITY
CG 88 10 04 13
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
COMMERCIAL GENERAL LIABILITY EXTENSION
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
INDEX
l�
I�
SUBJECT
PAGNiiiml
NON -OWNED AIRCRAFT
2
NON -OWNED WATERCRAFT
2
PROPERTY DAMAGE LIABILITY - ELEVATORS
2
f t
- EXTENDED DAMAGE TO PROPERTY RENTED TO YOU (Tenant's Property Damage)
2
MEDICAL PAYMENTS EXTENSION
3
EXTENSION OF SUPPLEMENTARY PAYMENTS - COVERAGES A AND B
3
ADDITIONAL INSUREDS -BY CONTRACT, AGREEMENT OR PERMIT
3
PRIMARY AND NON-CONTRIBUTORY- ADDITIONAL INSURED EXTENSION
5
ADDITIONAL INSUREDS - EXTENDED PROTECTION OF YOUR "LIMITS OF INSURANCE"
6
WHO IS AN INSURED -INCIDENTAL MEDICAL ERRORSIMALPRACTICE AND WHO IS AN
INSURED -FELLOW EMPLOYEE EXTENSION -MANAGEMENT EMPLOYEES
6
NEWLY FORMED OR ADDITIONALLY ACQUIRED ENTITIES
7
FAILURE TO DISCLOSE HAZARDS AND PRIOR OCCURRENCES
7
KNOWLEDGE OF OCCURRENCE, OFFENSE, CLAIM OR SUIT
7
LIBERALIZATION CLAUSE
7
BODILY INJURY REDEFINED
7
EXTENDED PROPERTY DAMAGE
8
WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US -
8
WHEN REQUIRED IN A CONTRACT OR AGREEMENT WITH YOU
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With respect to coverage afforded by this endorsement: the provisions of the policy apply unless modified by
the endorsement.
A. NON -OWNED AIRCRAFT
Under Paragraph 2. Exclusions of Section I - Coverage A - Bodily Injury And Property Damage Liability,
exclusion g. Aircraft, Auto Or Watercraft does not apply to an aircraft provided:
1. It is not owned by any insured;
2. It is hired, chartered or loaned with a trained paid crew;
3. The pilot in command holds a currently effective certificate, issued by the duly constituted authority of
the United States of America or Canada, designating her or him a commercial or airline pilot; and
4. It is not being used to carry persons or property for a charge.
However, the insurance afforded by this provisson does not apply if there is available to the insured other
valid and collectible insurance, whether primary, excess (other than insurance written to apply specifically
in excess of this policy), contingent or on any other basis, that would also apply to the loss covered under
this provision.
B. NON -OWNED WATERCRAFT
Under Paragraph 2. Exclusions of Section I - Coverage A - Bodily Injury And Property Damage Liability,
Subparagraph (2) of exclusion g. Aircraft, Auto Or Watercraft is replaced by the following:
This exclusion does not apply to:
(2) A watercraft you do not own that is:
(a) Less than 52 feet long; and
(b) Not being used to carry persons or property for a charge.
C. PROPERTY DAMAGE LIABILITY -ELEVATORS
1. Under Paragraph 2. Exclusions of Section I - Coverage A - Bodily Injury And Property Damage Liabil-
ity, Subparagraphs (3), (4) and (6) of exclusion J. Damage To Property do not apply if such "property
damage" results from the use of elevators. For the purpose of this provision, elevators do not include
vehicle lifts. Vehicle lifts are lifts or hoists used in automobile service or repair operations.
2. The following is added to Section IV - Commercial General Liability Conditions, Condition 4. Other
Insurance, Paragraph b. Excess Insurance:
The insurance afforded by this provision of this endorsement is excess over any property insurance,
whether primary, excess, contingent or on any other basis.
D. EXTENDED DAMAGE TO PROPERTY RENTED TO YOU (Tenant's Property Damage)
If Damage To Premises Rented To You is not otherwise excluded from this Coverage Part:
1. Under Paragraph 2. Exclusions of Section I - Coverage A - Bodily Injury and Property Damage Liability:
s
a. The fourth from the last paragraph of exclusion J. Damage To Property is replaced by the follow-
ing.
Paragraphs (1), (3) and (4) of this exclusion do not apply to "property damage" (other than damage
by fire, lightning, explosion, smoke, or leakage from an automatic fire protection system) to:
(1) Premises rented to you for a period of 7 or fewer consecutive days; or
(11) Contents that you rent or lease as part of a premises rental or lease agreement for a period of
more than 7 days.
Paragraphs (1), (3) and (4) of this exclusion do not apply to "property damage" to contents of
premises rented to you for a period of 7 or fewer consecutive days.
A separate limit of insurance applies to this coverage as described in Section III - Limits of
Insurance.
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b. The last paragraph of subsection 2. Exclusions is replaced by the following:
Exclusions c. through n. do not apply to damage by fire, lightning, explosion, smoke or leakage
from automatic fire protection systems to premises while rented to you or temporarily occupied by
you with permission of the owner. A separate limit of insurance applies to Damage To Premises
Rented To You as described in Section III - Limits Of Insurance.
2. Paragraph 6. under Section III - Limits Of Insurance is replaced by the following:
6. Subject to Paragraph 5. above, the Damage To Premises Rented To You Limit is the most we will
pay under Coverage A for damages because of "property damage" to:
l a. Any one premise:
® (1) While rented to you; or
I (2) While rented to you or temporarily occupied by you with permission of the owner for
damage by fire, lightning, explosion, smoke or leakage from automatic protection sys-
tems: or
i= b. Contents that you rent or lease as part of a premises rental or lease agreement.
3. As regards coverage provided by this provision D. EXTENDED DAMAGE TO PROPERTY RENTED TO
YOU (Tenant's Property Damage) - Paragraph 9.a. of Definitions is replaced with the following:
9.a. A contract for a lease of premises. However, that portion of the contract for a lease of premises
that indemnifies any person or organization for damage by fire, lightning, explosion, smoke, or
leakage from automatic fire protection systems to premises while rented to you or temporarily
occupied by you with the permission of the owner, or for damage to contents of such premises
that are included in your premises rental or lease agreement, is not an "insured contract".
E. MEDICAL PAYMENTS EXTENSION
If Coverage C Medical Payments is not otherwise excluded, the Medical Payments provided by this policy
are amended as follows:
Under Paragraph 1. Insuring Agreement of Section I - Coverage C - Medical Payments, Subparagraph
(b) of Paragraph a. is replaced by the following:
(b) The expenses are incurred and reported within three years of the date of the accident; and
F. EXTENSION OF SUPPLEMENTARY PAYMENTS - COVERAGES A AND B
1. Under Supplementary Payments - Coverages A and B, Paragraph 1.b. is replaced by the following:
b. Up to $3,000 for cost of bail bonds required because of accidents or traffic law violations arising
out of the use of any vehicle to which the Bodily Injury Liability Coverage applies. We do not have
to furnish these bonds.
2. Paragraph 1.d. is replaced by the following:
" d. All reasonable expenses Incurred by the insured at our request to assist us in the Investigation or
defense of the claim or "suit", including actual loss of earnings up to $500 a day because of time
off from work.
G. ADDITIONAL INSUREDS -BY CONTRACT, AGREEMENT OR PERMIT
1. Paragraph 2. under Section If - Who Is An Insured is amended to include as an insured any person or
organization whom you have agreed to add as an additional insured in a written contract, written
agreement or permit. Such person or organization is an additional insured but only with respect to
liability for "bodily injury", "property damage" or "personal and advertising injury" caused in whole
or In part by:
a. Your acts or omissions, or the acts or omissions of those acting on your behalf, in the performance
of your on going operations for the additional insured that are the subject of the written contract or
written agreement provided that the "bodily injury" or "property damage" occurs, or the "per-
sonal and advertising injury" is committed, subsequent to the signing of such written contract or
written agreement; or
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b. Premises or facilities rented by you or used by you; or
c. The maintenance, operation or use by you of equipment rented or leased to you by such person or
organization; or
d. Operations performed by you or on your behalf for which the state or political subdivision has
issued a permit subject to the following additional provisions:
(1) This insurance does not apply to "bodily injury", "property damage", or "personal and ad-
vertising injury" arising out of the operations performed for the state or political subdivision:
(2) This insurance does not apply to "bodily injury" or "property damage" included within the
"completed operations hazard".
(3) Insurance applies to premises you own, rent, or control but only with respect to the following
hazards:
(a) The existence, maintenance, repair, construction, erection, or removal of advertising
signs, awnings, canopies, cellar entrances, coal holes, driveways, manholes, marquees,
hoist away openings, sidewalk vaults, street banners, or decorations and similar expo-
sures; or
(b) The construction, erection, or removal of elevators; or
(c) The ownership, maintenance, or use of any elevators covered by this insurance.
However:
1. The insurance afforded to such additional insured only applies to the extent permitted by law; and
2. If coverage provided to the additional insured is required by a contract or agreement, the insur-
ance afforded to such additional insured will not be broader than that which you are required by
the contract or agreement to provide for such additional insured_
With respect to Paragraph 1.a. above, a person's or organization's status as an additional insured
under this endorsement ends when:
(1) All work, including materials, parts or equipment furnished in connection with such work, on
the project (other than service, maintenance or repairs) to be performed by or on behalf of the
additional insured(s) at the location of the covered operations has been completed; or
(2) That portion of "your work" out of which the injury or damage arises has been put to its
intended use by any person or organization other than another contractor or subcontractor
engaged in performing operations for a principal as a part of the same project.
With respect to Paragraph 1.1b. above, a person's or organization's status as an additional insured
under this endorsement ends when their written contract or written agreement with you for such
premises or facilities ends.
v With respects to Paragraph 1.c. above, this insurance does not apply to any "occurrence" which takes
place after the equipment rental or lease agreement has expired or you have returned such equipment
to the lessor.
The insurance provided by this endorsement applies only if the written contract or written agreement
is signed prior to the "bodily injury" or "property damage".
We have no duty to defend an additional insured under this endorsement until we receive written
notice of a "suit" by the additional insured as required in Paragraph b. of Condition 2. Duties In the
Event Of Occurrence, Offense, Claim Or Suit under Section IV - Commercial General Liability Condi-
tions.
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CG 88 10 04 13 includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 4 of 8
2. With respect to the insurance provided by this endorsement, the following are added to Paragraph 2.
Exclusions under Section I - Coverage A - Bodily Injury And Property Damage Liability:
This insurance does not apply to:
a. "Bodily injury" or "property damage" arising from the sole negligence of the additional insured.
b. "Bodily injury" or "property damage" that occurs prior to you commencing operations at the
location where such "bodily injury" or "property damage" occurs.
c. "Bodily injury", "property damage" or "personal and advertising injury" arising out of the render-
ing of, or the failure to render, any professional architectural, engineering or surveying services,
including:
(1) The preparing, approving, or failing to prepare or approve, maps, shop drawings, opinions,
reports, surveys, field orders, change orders or drawings and specifications; or
(2) Supervisory, inspection, architectural or engineering activities.
This exclusion applies even if the claims against any insured allege negligence or other wrongdoing in
saw the supervision, hiring, employment, training or monitoring of others by that insured, if the "occur-
0
rence" which caused the "bodily injury" or "property damage", or the offense which caused the
o "personal and advertising injury", involved the rendering of, or the failure to render, any professional
architectural, engineering or surveying services.
d. "Bodily injury" or "property damage" occurring after:
l�
(1) All work, including materials, parts or equipment furnished in connection with such work, on
the project (other than service, maintenance or repairs) to be performed by or on behalf of the
additional insured(s) at the location of the covered operations has been completed; or
(2) That portion of "your work" out of which the injury or damage arises has been put to its
intended use by any person or organization other than another contractor or subcontractor
engaged In performing operations for a principal as a part of the same project.
e. Any person or organization specifically designated as an additional insured for ongoing operations
by a separate ADDITIONAL INSURED -OWNERS, LESSEES OR CONTRACTORS endorsement is-
sued by us and made a part of this policy.
3. With respect to the insurance afforded to these additional insureds, the following is added to Section III
- Limits Of Insurance:
If coverage provided to the additional insured is required by a contract or agreement, the most we will
pay on behalf of the additional insured is the amount of insurance:
a. Required by the contract or agreement, or
b. Available under the applicable Limits of Insurance shown in the Declarations;
whichever is less.
This endorsement shall not increase the applicable limits of Insurance shown in the Declaratio ns.
H. PRIMARY AND NON-CONTRIBUTORY ADDITIONAL INSURED EXTENSION
This provision applies to any person or organization who qualifies as an additional insured under any form
or endorsement under this policy.
Condition 4. Other Insurance of SECTION IV - COMMERCIAL GENERAL LIABILITY CONDITIONS is amend-
ed as follows:
a. The following is added to Paragraph a. Primary Insurance:
If an additional insured's policy has an Other Insurance provision making its policy excess, and you
have agreed in a written contract or written agreement to provide the additional insured coverage on a
primary and noncontributory basis, this policy shall be primary and we will not seek contribution from
the additional insured's policy for damages we cover.
® 2013 Liberty Mutual Insurance
CG 88 10 04 13 Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 5 of &
b. The following is added to Paragraph b. Excess Insurance:
When a written contract or written agreement, other than a premises lease, facilities rental contract or
agreement, an equipment rental or lease contract or agreement, or permit issued by a state or political
subdivision between you and an additional insured does not require this insurance to be primary or
primary and non-contributory, this Insurance is excess over any other insurance for which the addi-
tional insured is designated as a Named Insured.
Regardless of the written agreement between you and an additional insured, this insurance is excess
over any other insurance whether primary, excess, contingent or on any other basis for which the
additional insured has been added as an additional insured on other policies.
I. ADDITIONAL INSUREDS - EXTENDED PROTECTION OF YOUR "LIMITS OF INSURANCE"
This provision applies to any person or organization who qualifies as an additional insured under any form
or endorsement under this policy.
1. The following is added to Condition 2. Duties In The Event Of Occurrence, Offense, Claim or Suit:
An additional insured under this endorsement will as soon as practicable:
a. Give written notice of an "occurrence" or an offense that may result in a claim or "suit" under
this insurance to us;
b. Tender the defense and indemnity of any claim or "suit" to all insurers whom also have
insurance available to the additional insured; and
c. Agree to make available any other insurance which the additional insured has for a loss we
cover under this Coverage Part.
d. We have no duty to defend or indemnify an additional insured under this endorsement until
we receive written notice of a "suit" by the additional insured.
2. The limits of insurance applicable to the additional insured are those specified in a written contract
or written agreement or the limits of insurance as stated in the Declarations of this policy and
defined in Section III - Limits of Insurance of this policy, whichever are less These limits are
inclusive of and not in addition to the limits of insurance available under this policy.
J. WHO IS AN INSURED -INCIDENTAL MEDICAL ERRORS/ MALPRACTICE
WHO IS AN INSURED - FELLOW EMPLOYEE EXTENSION - MANAGEMENT EMPLOYEES
Paragraph 2.a.(1) of Section II -Who Is An Insured is replaced with the following:
(1) 'Bodily injury" or "personal and advertising injury". -
(a) To you, to your partners or members (if you are a partnership or joint venture), to your members (if
you are a limited liability company), to a co -"employee" while in the course of his or her employ-
ment or performing duties related to the conduct of your business, or to your other "volunteer
workers" while performing duties related to the conduct of your business;
(b) To the spouse, child, parent, brother or sister of that co -"employee" or "volunteer worker" as a
consequence of Paragraph (1) (a) above;
(c) For which there is any obligation to share damages with or repay someone else who must pay
damages because of the injury described in Paragraphs (1) (a) or (b) above; or
(d) Arising out of his or her providing or failing to provide professional health care services. However,
if you are not in the business of providing professional health care services or providing profes-
sional health care personnel to others, or if coverage for providing professional health care ser-
vices is not otherwise excluded by separate endorsement, this provision (Paragraph (d)) does not
apply.
Paragraphs (a) and (b) above do not apply to "bodily injury" or "personal and advertising injury" caused by
an "employee" who is acting in a supervisory capacity for you. Supervisory capacity as used herein means
the "employee's" job responsibilities assigned by you, includes the direct supervision of other "employ-
ees" of yours. However, none of these "employees" are insureds for "bodily injury" or "personal and
® 2013Liberty Mutual Insurance
CG 88 10 04 13 Includes copyrighted material of Insurance Services Office, Inc., with Its permission. Page 6 Of 8
advertising injury" arising out of their willful conduct, which is defined as the purposeful or willful intent to
cause "bodily injury" or "personal and advertising injury", or caused in whole or in part by their intoxica-
tion by liquor or controlled substances.
The coverage provided by provision J. is excess over any other valid and collectable insurance available to
your "employee".
K. NEWLY FORMED OR ADDITIONALLY ACQUIRED ENTITIES
Paragraph 3. of Section II - Who Is An Insured is replaced by the following:
3. Any organization you newly acquire or form and over which you maintain ownership or majority
interest, will qualify as a Named Insured if there is no other similar insurance available to that
organization. However:
a. Coverage under this provision is afforded only until the expiration of the policy period in
which the entity was acquired or formed by you;
e b. Coverage A does not apply to "bodily injury" or "property damage" that occurred before you
acquired or formed the organization; and
c. Coverage B does not apply to "personal and advertising injury" arising out of an offense
committed before you acquired or formed the organization.
I� d. Records and descriptions of operations must be maintained by the first Named Insured.
No person or organization is an insured with respect to the conduct of any current or past partnership, joint
B venture or limited liability company that is not shown as a Named Insured in the Declarations or qualifies
as an insured under this provision.
L. FAILURE TO DISCLOSE HAZARDS AND PRIOR OCCURRENCES
Under Section IV - Commercial General Liability Conditions, the following is added to Condition 6. Repre-
sentations:
Your failure to disclose all hazards or prior "occurrences" existing as of the inception date of the policy
shall not prejudice the coverage afforded by this policy provided such failure to disclose all hazards or
prior 'occurrences" is not intentional.
M. KNOWLEDGE OF OCCURRENCE, OFFENSE, CLAIM OR SUIT
Under Section IV - Commercial General Liability Conditions, the following is added to Condition 2. Duties
In The Event of Occurrence, Offense, Claim Or Suit:
Knowledge of an 'occurrence", offense, claim or "suit" by an agent, servant or "employee" of any
insured shall not in itself constitute knowledge of the insured unless an insured listed under Paragraph
1. of Section II - Who Is An Insured or a person who has been designated by them to receive reports of
"occurrences", offenses. claims or "suits" shall have received such notice from the agent, servant or
"employee".
z N. LIBERALIZATION CLAUSE
If we revise this Commercial General Liability Extension Endorsement to provide more coverage without
additional premium charge, your policy will automatically provide the coverage as of the day the revision is
effective in your state,
O. BODILY INJURY REDEFINED
Under Section V - Definitions, Definition 3. is replaced by the following:
3. 'Bodily Injury" means physical injury, sickness or disease sustained by a person. This includes
mental anguish, mental injury, shock, fright or death that results from such physical injury, sick-
ness or disease.
2013 Liberty Mutual Insurance
CG 88 10 04 13 Includes copyrighted material of Insurance Services Office, Inc., with Its permission. Page 7 of 8
s
P. EXTENDED PROPERTY DAMAGE
Exclusion a. of COVERAGE A. BODILY INJURY AND PROPERTY DAMAGE LIABILITY is replaced by the
following:
a. Expected Or Intended Injury
"Bodily injury" or "property damage" expected or intended from the standpoint of the insured.
This exclusion does not apply to "bodily injury" or "property damage" resulting from the use of
reasonable force to protect persons or property.
Q. WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US - WHEN REQUIRED IN A
CONTRACT OR AGREEMENT WITH YOU
Under Section IV - Commercial General Liability Conditions, the following is added to Condition 8. Trans-
fer Of Rights Of Recovery Against Others To Us:
We waive any right of recovery we may have against a person or organization because of payments we
make for injury or damage arising out of your ongoing operations or "your work" done under a
contract with that person or organization and included In the "products -completed operations hazard"
provided:
1. You and that person or organization have agreed in writing in a contract or agreement that you
waive such rights against that person or organization; and
2. The injury or damage occurs subsequent to the execution of the written contract or written agree-
ment.
® 2013 Liberty Mutual Insurance
CG 88 10 04 13 Includes copyrighted material of Insurance Services Office, Inc., with Its permission. Page 8 of 8
COMMERCIAL GENERAL LIABILITY
CG 88 70 12 08
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
CONSTRUCTION PROJECT(S) - GENERAL AGGREGATE LIMIT
(PER PROJECT)
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
A. For all sums which the insured becomes legally obligated to pay as damages caused by "occurrences"
under Section I - Coverage A - Bodily Injury And Property Damage Liability, and for all medical ex-
penses caused by accidents under Section I - Coverage C Medical Payments, which can be attributed
only to ongoing operations at a single construction project away from premises owned by or rented to
you:
1. A separate Construction Project General Aggregate Limit applies to each construction project, and
that limit is equal to the amount of the General Aggregate Limit shown in the Declarations .
2. The Construction Project General Aggregate Limit is the most we will pay for the sum of all
damages under Coverage A, except damages because of "bodily injury" or "property damage"
included in the "products -completed operations hazard", and for medical expenses under Cov-
erage C regardless of the number of:
a. Insureds;
b. Claims made or "suits" brought; or
c. Persons or organizations making claims or bringing "suits".
3. Any payments made under Coverage A for damages or under Coverage C for medical expenses
shall reduce the Construction Project General Aggregate Limit for that construction project. Such
payments shall not reduce the General Aggregate Limit shown in the Declarations nor shall they
reduce any other Construction Project General Aggregate Limit for any other construction project.
4. The limits shown in the Declarations for Each Occurrence, Fire Damage and Medical Expense
continue to apply_ However, instead of being subject to the General Aggregate Limit shown in the
Declarations, such limits will be subject to the applicable Construction Project General Aggregate
Limit.
B. For all sums which the insured becomes legally obligated to pay as damages caused by "occurrences"
under Section I - Coverage A - Bodily Injury And Property Damage Liability, and for all medical ex-
penses caused by accidents under Section I - Coverage C Medical Payments, which cannot be attrib-
uted only to ongoing operations at a single construction project away from premises owned by or
rented to you:
1. Any payments made under Coverage A for damages or under Coverage C for medical expenses
shall reduce the amount available under the General Aggregate Limit or the Products -Completed
Operations Aggregate Limit, whichever is applicable; and
2. Such payments shall not reduce any Construction Project General Aggregate Limit.
C. When coverage for liability arising out of the "products -completed operations hazard" is provided, any
payments for damages because of "bodily injury" or "property damage" included in the "products -
completed operations hazard" will reduce the Products -Completed Operations Aggregate Limit, and not
reduce the General Aggregate Limit nor the Construction Project General Aggregate Limit.
D. If the applicable construction project has been abandoned, delayed, or abandoned and then restarted,
or if the authorized contracting parties deviate from plans, blueprints, designs, specifications or
timetables, the project will still be deemed to be the same construction project.
E. The provisions of Section III - Limits Of Insurance not otherwise modified by this endorsement shall
continue to apply.
CG 88 70 12 08 Includes copyrighted material of ISO Properties, Inc., with its permission. Page 1 of 1
Texasmutuar
WORKERS' COMPENSATION INSURANCE
WORKERS' COMPENSATION AND WC 42 03 04 B
EMPLOYERS LIABILITY POLICY Insured copy
TEXAS WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT
This endorsement applies only to the insurance provided by the policy because Texas is shown in item 3.A. of the
Information Page.
We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce our
right against the person or organization named in the Schedule, but this waiver applies only with respect to bodily injury
arising out of the operations described in the schedule where you are required by a written contract to obtain this waiver
from us.
This endorsement shall not operate directly or indirectly to benefit anyone not named in the Schedule.
The premium for this endorsement is shown in the Schedule.
Schedule
1. {) Specific Waiver
Name of person or organization
(X)Blanket Waiver
Any person or organization for whom the Named Insured has agreed by written contract to furnish this waiver.
2. Operations: ALL TEXAS OPERATIONS
3. Premium:
The premium charge for this endorsement shall be 2.00 percent of the premium developed on payroll in connection
with work performed for the above person(s) or organization(s) arising out of the operations described.
4. Advance Premium: Included, see Information Page
This endorsement changes the policy to which It is attached effective on the inception date of the policy unless a different date is ind sated below.
(The fo lowing 'attaching clause" need be completed only when this endorsement is issued subsequent to preparation of the po'icy.)
This endorsement, effective on 9/27/19 at 12:01 a.m. standard time, forms a part of.
Policy no. 0001184331 of Texas Mutual Insurance Company effective on 9/27/19
Issued to: WEST TEXAS SERVICES INC
DBA: TOM'S TREE PLACE
This is not a bits
NCCI Carrier Code: 29939
Authorized representative
9ra' 19
PO Box 12058, Austin, TX 78711-2058
1 of 1 texasmutuat_com 1 (800) 859-5995 1 Fax (800) 359-0650 WC 42 03 04 B
Texasmutuar
WORKERS' COMPENSATION INSURANCE
WORKERS' COMPENSATION AND WC 42 06 01
EMPLOYERS LIABILITY POLICY Insured copy
TEXAS NOTICE OF MATERIAL CHANGE ENDORSEMENT
This endorsement applies only to the insurance provided by the policy because Texas is shown in Item 3.A. of the
Information Page.
In the event of cancellation or other material change of the policy, we will mail advance notice to the person or
organization named in the Schedule. The number of days advance notice is shown in the Schedule.
This endorsement shall not operate directly or indirectly to benefit anyone not named in the Schedule.
1. Number of days advance notice:
2. Notice will be mailed to:
Schedule
30
PER LIST ON FILE
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 9127/19 at 12:01 a.m. standard time, forms a part of:
Policy no. 0001184331 of Texas Mutual Insurance Company effective on 9/27119
Issued to: WEST TEXAS SERVICES INC
DBA: TOM'S TREE PLACE
This is not a bill
NCCI Carrier Code: 29939
PO Box 12058, Austin, TX 78711-2058
1 of 1 texasmutual.com 1 (800) 859-5995 1 Fax (800) 359-0650
Authorized representative
914119
WC 42 06 01