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16-150 Brazos Urethane Inc., Library and Community Hall Roof Restoration Project, Project No. 2017-105
RECORDING REQUESTED BY City of Cupertino WHEN RECORDED MAIL TO City Clerk's Office City of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 NO FEE IN ACCORDANCE WITH GOV. CODE 27283 23735592 Regina Alcomendras Santa Clara County -Clerk-Recorder 08/23/2017 12:41 PM Ti lles: 1 Fees: $0.00 Taxes: $0 Total: $0 .00 Pages: 3 1111 w11~-'rftH'.·-1~~«111¥ ~1~'i 1~ r~.1i.\~11,1t'~"11~,~1,111'1'~, 11111 (SPACE ABOVE THIS LINE FOR RECORDER'S USE) NOTICE OF COMPLETION CITY PROJECT NAME: 2016 Library and Community Hall Roof Rehabilitation Project City Project No. 2017-105 p Original D For Fast Endorsement "NO FEE" City of Cupertino NOTICE OF COMPLETION is hereby given in order to comply with the provisions of Section 27283 of the Government Code. This is to certify that the Notice of Completion dated August 23, 2017 for CITY PROJECT NAME: 2016 Library and Community Hall Roof Rehabilitation Project-City Project No. 2017-105 and the City of Cupertino, a governmental agency is hereby accepted by the City of Cupertino on August 23, 2017 and the grantee consents to recordation thereof by its duly authorized officer. I certify under Penalty of Perjury under the laws of the State of California that the foregoing paragraph is true and correct. Dated: By: August 23, 2017 Lauren Sapudar Senior Office Assistant CUPERTINO Recording Requested By : When Recorded Mail To: City of Cupertino 10300 Torre Ave. Cupertino , CA 95014 SPACE ABOVE THIS LINE IS FOR RECORDER 'S USE NOTICE OF COMPLETION Civil Code§§ 8182 , 8184 , 9204 , and 9208 NOTICE IS HEREBY GIVEN THAT: 1. The undersigned is the agent of the owner of the project described below . 2. Owner 's full name is : City of Cupertino , California . 3. Owner's address is : City Hall, 10300 Torre Ave.; Cupertino, CA 95014. 4. The nature of owner's interest in the project is: _X_ Fee Ownership Lessee Other : 5. Construction work on the project performed on the owner's behalf is generally described as follows : City Project Name : 2016 Library and Community Hall Roof Rehabilitation Project City Project No .: 2017-105 6. The name of the original contractor for the project is: Brazos Urethane. 7. The project was completed on: August 15 , 2017 . 8. The project is located at: 10350 & 10800 Torre Ave, Cupertino Verification: In signing this document, I, the undersigned , declare under penalty of perjury under the laws of the State of California that I have read this notice, and I know and understand the contents of this notice , and that the facts stated in this notice are true and correct. g/-z~/r1 ; Santa Clara County D&te and Place ~~ Signature Timm Borden Director of Public Works and City Engineer DOCUMENT 00520 CONTRACT THIS CONTRACT, dated this ifL_ day of /Jv/Dw , 2016, by and between BRAZOS URETHANE, INC.,whose place of business is located at 4331 W. SANTA ANA AVE., FRESNO, CA 93722 ("Contractor"), and the CITY OF CUPERTINO, a Municipal Corporation of the State of California ("City") acting under and by virtue of the authority vested in the City by the laws of the State of California. WHEREAS, City, on the jJ)_____ day of ~ , 2016 awarded to Contractor the following Project: LIBRARY AND COMMUNITY HALL ROOF RESTORATION PROJECT NOW, THEREFORE, in consideration of the mutual covenants hereinafter set forth , Contractor and City agree as follows: Article l. Work 1.1 Contractor shall complete all Work specified in the Contract Documents, in accordance with the Specifications, Drawings, and all other terms and conditions of the Contract Documents . A11icle 2. Agency and Notices to City 2.1 City has designated Roger Lee, Assistant Director of Public Works to act as City's Authorized Representative(s), who will represent City in performing City's duties and responsibilities and exercising City 's rights and authorities in Contract Documents. City may change the individual(s) acting as City's Authorized Representative(s), or delegate one or more specific functions to one or more specific City's Representatives, including without limitation engineering, architectural , inspection and general administrative functions, at any time with notice and without liability to Contractor. Each City 's Representative is the beneficiary of all Contractor obligations to City, including without limitation, all releases and indemnities. 2.2 All notices or demands to City under the Contract Documents shall be to City 's Authorized Representative at: 10555 Mary Avenue, Cupertino , California 95014 or to such other person(s) and address( es) as City shall provide to Contractor. Article 3. Contract Time and Liquidated Damages 3.1 Contract Time. The Contract Time will commence to run on the date indicated in the Notice to Proceed . City may give a Notice to Proceed at any time within 30 Days after the Notice of Award . Contractor shall not do any Work at the Site prior to the date on which the Contract Time commences to run. The City anticipates issuing a Notice to Proceed on March 1, 2017 . However, at Contractors request, the City may consider issuing the Notice to Proceed at an earlier date, provided that the Contractor is confident that weather conditions allow all work to be completed to manufacturer specification with warranty. Contractor shall achieve Final Completion of the entire Work and be ready for Final Payment in accordance with Section 00700 (General Conditions) by June 30, 2017 as provided in Document 00700 (General Conditions) City of Cupertino 00520 -1 Contract Libra,y and Community Hall Roof Restoration Project Addendum I 3 .2 Liquidated Damages. City and Contractor recognize that time is of the essence of this Contract and that City will suffer financial loss in the form of contract administration expenses (such as project management and consultant expenses), if al l or any part of the Work is not completed within the times specified above, plus any extensions thereof allowed in accordance with the Contract Documents. Consistent with Document 00800 (Special Conditions) and Technical Specifications, Contractor and City agree that because of the nature of the Project, it would be impractical or extremely difficult to fix the amount of actual damages incurred by City because of a delay in completion of a ll or any part of the Work. Accordingly, City and Contractor agree that as liquid ated damages for delay Contractor shall pay City: 3 .2.1 $500 for each Calendar Day that expires after the time specified herein for Contractor to achieve Final Completion of the entire Work as specified above . Liquidated damages shall app ly cumulatively and , except as provided be lo w, shall be presumed to be the damages suffered by City resulting from delay in completion of the Work . Contractor should be aware that California Department of Fish and Game , and other State and Federal agencies, may also levy fines and penalties for the harming, harassing or killing of protected wi ldli fe and endangered species . Contractor hereby agrees to become familiar with and adhere to wildlife and endangered species protection requirements. 3.3 Liquidated damages for delay shall only cover administrative, overhead, interest on bonds, and general loss of public use damages suffered by City as a result of delay. Liquidated damages shall not cover the cost of completion of the Work, damages resulting from defective Work, lost revenues or costs of substitute facilities , or damages suffered by others who then seek to recover their damages from City (for examp le, delay claims of other contractors, subcontractors, tenants , or other third-parties), and defense costs thereof. Article 4. Contract Sum 4.1 City shall pay Contractor the Contract Sum for completion of Work in accordance with Contract Documents as set fo1th in Contractor 's Bid Form 00400 . Article 5. Contractor's Representations In order to induce City to enter into this Contract, Contractor makes the following representations and warranties: 5 .1 Contractor has visited the Site and has examined thoroughly and understood the nature and extent of the Contract Documents, Work, Site, locality, actual conditions, as-built conditions, and all local conditions , and federa l, state and local la ws and regulations that in any manner may affect cost, progress, performance or furnishing of Work or which relate to any aspect of the means , methods, techniques, sequences or procedures of construction to be employed by Contractor and safety precautions and programs incident thereto . 5.2 Contractor has examined thoroughly and understood a ll reports of exp loration and tests of subsurface conditions , as-built drawings, drawings, products specifications or reports , available for Bidding purposes, of physical conditions, including Underground Facilities, which are identified in Document 00320 (Geotechnical Data, Hazardous Materia ls Surveys and Existing Conditions), or which may appear in the Drawings. Contractor accepts the determination set forth in these Documents and Document 00700 (General Conditions) of the limited extent of the information contained in such materials upon which Contractor may be entitled to rely . Contractor agrees that except for the in formation so identified, Contractor does not and shall not rely on any other information contained in such reports and drawings. 5.3 Contractor has conducted or obtained and has understood all such examinations, investigations , explorations , tests , reports and studies (in addition to or to supplement those referred to in Section 5.2 of this Document 00520) that pertain to the subsurface conditions , as-built conditions, underground facilities, and all other City ofCupe1tino 00520 -2 Contract Library & Community Hall Roof Restoration Project Addendum I physical conditions at or contiguous to the Site or otherwise that may affect the cost, progress , performance or furnishing of Work, as Contractor considers necessary for the performance or furnishing of Work at the Contract Sum , within the Contract Time and in accordance with the other terms and conditions of the Contract Documents, including specifically the provisions of Document 00700 (General Conditions); and no additional examinations, investigations , explorations, tests , reports , studies or similar information or data are or will be required by Contractor for such purposes. 5.4 Contractor has correlated its knowledge and the results of all such observations , examinations, investigations , explorations, tests , reports and studies with the terms and conditions of the Contract Documents . 5.5 Contractor has given City prompt written notice of all conflicts, errors, ambiguities, or discrepancies that it has discovered in or among the Contract Documents and as-built drawings and actual conditions and the written resolution thereof through Addenda issued by City is acceptable to Contractor. 5.6 Contractor is duly organized, existing and in good standing under applicable state law, and is duly qualified to conduct business in the State of California. 5.7 Contractor has duly authorized the execution, delivery and performance of this Contract, the other Contract Documents and the Work to be performed herein. The Contract Documents do not violate or create a default under any instrument, contract, order or decree binding on Contractor. 5.8 Contractor has listed Subcontractors pursuant to the Subcontractor Listing Law, California Public Contracting Code §4100 et seq. in document 00340 (Subcontractors List) A rticle 6. Contract Documents 6.1 Contract Documents consist of the following documents, including all changes , addenda, and modifications thereto: Document 00400 Bid Form Document 00430 Subcontractors List Document 00450 Statement of Qualifications Document 00460 Schedule of Major Equipment and Materials Suppliers Document 00481 Non-Collusion Affidavit Document 00482 Bidder Certifications Document 00505 Notice ofintent to Award Document 00510 Notice of A ward Document 00520 Contract Document 00530 Insurance Forms Document 00550 Notice to Proceed Document 00610 Construction Performance Bond Document 00620 Construction Labor and Material Payment Bond Document 00630 Guaranty Document 00650 Agreement and Release of Any and All Claims Document 00660 Substitution Request Form Document 00680 Escrow Agreement for Security Deposit in Lieu of Retention Document 00700 General Conditions Document 00800 Special Conditions Document 00821 Insurance Document 00822 Apprenticeship Program Technical Specification Addenda(s) Drawings/Plans City of Cupertino 00520 -3 Library and Community Hall Roof Restoration Project Addendum I Contract 6 .2 There are no Contract Documents other than those listed in this Document 00520, Article 6 . Document 00320 (Geotechnical Data, Hazardous Material Surveys and Existing Conditions), and the information supplied therein , are not Contract Documents. The Contract Documents may only be amended, modified or supplemented as provided in Document 00700 (General Conditions). Article 7. Miscellaneous 7.1 Terms used in this Contract are defined in Document 00700 (General Conditions) and will have the meaning indicated therein. 7.2 It is understood and agreed that in no instance are the persons signing this Contract for or on behalf of City or acting as an emp loyee, agent, or representative of City, li able on th is Contract or any of the Contract Documents, or upon any warranty of authority, or otherwise, and it is further understood and agreed that liability of the City is limited and confined to such liability as authorized or imposed by the Contract Documents or applicable law. 7 .3 Contractor shall not assign any portion of the Contract Documents, and may subcontract portions of the Contract Documents only in compliance with the Subcontractor Listing Law, California Public Contracting Code §4 I 00 et seq. 7.4 The Contract Sum includes all allowances (if any). 7.5 In entering into a public works contract or a subcontract to supply goods, services or materials pursuant to a public works contract, Contractor or Subcontractor offers and agrees to assign to the awarding body all rights , title and interest in and to all causes of action it may have under Section 4 of the Clayton Act (15 U .S .C . § 15) or under the Cartwright Act (Chapter 2 (commencing with Section 16700) of Part 2 of Division 7 of the Business and Professions Code), arising from purchases of goods, services or materials pursuant to the public works contract or the subcontract. This assignment shall be made and become effective at the time City tenders final payment to Contractor, without further acknowledgment by the parties . 7 .6 Copies of the general prevailing rates of per diem wages for each craft, classification, or type of worker needed to execute the Contract, as determined by Director of the State of California Department oflndustrial Relations, are deemed included in the Contract Documents and on file at City 's office, or may be obtained of the State of California web site http://www.dir.ca.gov/DLSR/PWD/Northern.html and shall be made available to any interested party on request. Pursuant to Section 1861 of the Labor Code, Contractor represents that it is aware of the provisions of Section 3700 of the Labor Code which require every employer to be insured against liability for workers' compensation or to undertake self-insurance in accordance with the provisions of that Code , and Contractor shal I comply with such provisions before commencing the performance of the Work of the Contract Documents. 7 .7 Should any part, term or provision of this Contract or any of the Contract Documents, or any document required herein or therein to be executed or delivered , be declared invalid, void or unenforceable, all remaining parts, terms and provisions shall remain in full force and effect and shall in no way be invalidated , impaired or affected thereby. If the provisions of any law causing such invalidity, illegality or unenforceability may be waived , they are hereby waived to the end that this Contract and the Contract Documents may be deemed valid and binding contracts, enforceable in accordance with their terms to the greatest extent permitted by applicable law. In the event any provision not otherwise included in the Contract Documents is required to be included by any applicable law, that provision is deemed included herein by this reference(or, if such provision is required to be included in any particular portion of the Contract Documents, that provision is deemed included in that portion). 7.8 This Contract and the Contract Documents shall be deemed to have been entered into in the County of Santa Clara, State of California, and governed in all respects by California law (excluding choice of law rules). The exclusive venue for all disputes or litigation hereunder shall be in Santa Clara County. Both parties hereby waive their rights under California Code of Civil Procedure Section 394 to file a motion to transfer any action or proceeding arising out of the Contract Documents to another venue. Contractor accepts the Claims City of Cupertino 00520 - 4 Contract Library & Community Hall Roof Restoration Project Addendum I Procedure in Document 00700 , Article 12 , established under the California Government Code, Title I , Division 3 .6 , Part 3, Chapter 5. 7.9 Contractor and all subcontractors shall comply with the Uniform Administrative Requirements for State and Local Governments set forth in the Code of Federal Regu lations (CFR), Title 49, Part 18. In addition, the Contractor agrees to comply with the cost principles and procedures set forth in Office of Management and Budget Circular A-87. The Contractor agrees that a reference to either Office of Management and Budget (0MB) Circular A-87ofthe Code ofFederal Regulations , Title 49, Chapter I , Part 31 , whichever is applicable, and the Code of Federal Regulations, Title 49 , Part 18, will be included in any subcontracts entered into as a result of this contract. City of Cupertino 00520 - 5 Contract Library and Community Hall Roof Restoration Project Addendum I IN WITNESS WHEREOF the paiiies have executed this Contract in quadruplicate the day and year first above written. LIBRARY AND COMMUNITY HALL ROOF RESTORATION PROJECT CITY: CITY OF CUPERTINO, a Municipal Corporation of the State of California A"'Ga .. Ru,5;/11 ·~f/J · JU b City Clerk: Grace Schmidt Approved as to form by City Attorney: City Attorney: Designated Representative: Name: Roger S. Lee Title: Assistant Director of Public Works Address: 10300 Torre Ave., Cupe1iino , CA 95014 Phone: 408-777-3350 Facsimile: 408-777-3333 AMOUNT: $$108 ,771.00 CONTRACTOR: tS(O(._--i{)$ vlV t 'Tu_l{i,,,{') VlC. · [_ Contractor's name_] Howard W. Scoggins, III [Please print name here] [Please print name here] Title: __ S_e_c_re_t_a_ry~------------ [If Corporation: Secretary, Assistant Secretary, Chief Financial Officer, or Assistant Treasurer] 982578 C-39, B, C-2, C-33 State Contractor 's License No. Classification 04/30/2017 Expiration Date Taxpayer ID No. __ 7_4_-2_4_6_6_0_58 _______ _ Name: _H_o_w_a_r_d_W_._S_c_o~g=g_in_s_,_II_I _____ _ Title : President ------------------ Address: __ 43_3_l_W_. S_a_n_t_a_A_n_a_A_v_e_. ____ _ Phone: _(_55_9_)_2_7_5-_4_0_40 ________ _ Facsimile: (559) 275-4020 ACCOUNT NUMBERS: 110-87-828-900-990 ($83 ,468 .00), 100-87-838-900-990 ($25,303.00) FILE NO.: 2017-105 City of Cupertino END OF DOCUMENT 00520 - 6 Library & Community Hall Roof Restoration Project Addendum 1 Contract Project No . 2017-105 DOCUMENT 00630 GUARANTY TO THE CITY OF CUPERTINO , a Municipal Corporation of the State of California ("City"), for construction of LIBRARY AND COMMUNITY HALL ROOF REHABILITATION PROJECT CUPERTINO, CALIFORNIA The undersigned guarantees all construction performed on this Project and also guarantees all material and equipment incorporated therein. Contractor hereby grants to City for a period of one year following the date of Final Acceptance, or such longer period specified in the Contract Documents, its unconditional warranty of the quality and adequacy of all of the Work including, without limitation, all labor, materials and equipment provided by Contractor and its Subcontractors of all tiers in connection with the Work . Neither final payment nor use or occupancy of the Work performed by the Contractor shall constitute an acceptance of Work not done in accordance with this Guaranty or relieve Contractor of liability in respect to any express warranties or responsibilities for faulty materials or workmanship . Contractor shall remedy any defects in the Work and pay for any damage resulting therefrom , which shall appear withjn one year, or longer if specified, from the date of Final Acceptance. If within one year after the date of Final Acceptance, or such longer period of time as may be prescribed by laws or regulations, or by the terms of Contract Documents, any Work is found to be defective , Contractor shall promptly, without cost to City and in accordance with City's written instructions , correct such defective Work. Contractor shall remove any defective Work rejected by City and replace it with Work that is not defective , and satisfactorily correct or remove and replace any damage to other Work or the work of others resulting therefrom. If Contractor fails to promptly comply with the terms of such instructions, or in an emergency where delay would cause serious risk of loss or damage, City may have the defective Work corrected or the rejected Work removed and replaced . Contractor shall pay for all claims, costs, losses and damages caused by or resulting from such removal and replacement. Where Contractor fails to correct defective Work, or defects are discovered outside the correction period , City shall have all rights and remedies granted by law . Inspection of the Work shat I not relieve Contractor of any of its obligations under the Contract Documents. Even though equipment, materials, or Work required to be provided under the Contract Documents have been inspected , accepted, and estimated for payment, Contractor shall , at its own expense, replace or repair any such equipment, material , or Work found to be defective or otherwise not to comply with the requirements of the Contract Documents up to the end of the guaranty period . All abbreviations and definitions of terms used in this Agreement shall have the meanings set forth in the Contract Documents, including, without means oflimitation, Section 00700 (General Conditions). The foregoing Guaranty is in addition to any other warranties of Contractor contained in the Contract Documents, and not in lieu of, any and all other liability imposed on Contractor under the Contract Documents and at law with respect to Contractor's duties, obligations, and performance under the Contract Documents . In the event of any conflict or inconsistency between the terms of this Guaranty and any warranty or obligation of the Contractor under the Contract Documents or at law, such inco istency or conflict sha be resolved in favor of the higher level of obligation of the Contractor. / / / J ' 17i' Brazos Urethane, Inc. 'A_,, f/V· 1 li{, ci~~1cW\~t'fi Ana Ave. Address Fresno, CA 93722 10/19/2016 City/State/Zip Date END OF DOCUMENT City of Cupertino 00630-I Guaranty Library & Community Hall Roof Rehabilitation Project Bond No. PB12142800208 Project No. 2017-105 DOCUMENT 00620 CONSTRUCTION LABOR AND MATERIAL PAYMENT BOND TI-IlS CONSTRUCTION LABOR AND MATERIAL PAYMENT BOND ("Bond") is dated 10 1191 2016 , is in the penal sum One Hundred Eight Thousand Seven Hundr ed Seventy-one And No/lOOTHS Dollars ($108,771.00) [one hundred percent of the Contract Price], and is entered into by and between the parties listed below to ensure the payment of claimants under the Construction Contract listed below. This Bond consists of this page and the Bond Terms and Conditions, paragraphs I through 14, attached to this page. Any singular reference to Brazos Ureth ane, Inc . ("Contractor"), Philadelph ia Indemnity Insurance Company ("Surety"), the City of Cupertino, a Municipal Corporation of the State of California ("City") or other paity shall be considered plural where applicable. CONTRACTOR: Brazos Urethane , Inc. Name 1031 6th St . North Address Texa s City, TX 77 59 0 City/State/Zip CONSTRUCTION CONTRACT: SURETY: Philadelphia Inde mnity Insurance Company Name One Bala Plaza, Suite 100 Principal Place of Business Bala Cynwyd, PA 1 9 004 City/State/Zip LIBRARY AND COMMUNITY HALL ROOF REHABILITATION PROJECT PROJECT NUMBER 2017-105 at Cupertino, California. DATED October 1 9 , 20_1_6 _ in the Amount of$_1_0_8_•_7 _71_·_0_0 ________ (the "Penal Sum") CONTRACTOR AS PRINCIPAL Bra zo s Urethan e , Inc. Compaay ·~~~ ~ Signature : l " ~' J.iL Name and Title: ~~rt&~ Sw~~/v1Sllli' r~, r\ SURETY Ph ilad elph i a Company: (Corp . Seal) Name and Title: ____________ _ Mary Catherine T u rner, Attorney-in -Fac t BOND TERMS AND CONDITIONS I. Contractor and Surety, jointly and severally, bind themselves, their heirs, executors, administrators, successors and assigns to City and to Claimants, to pay for labor, materials and equipment furnished for use in the performance of the Construction Contract, which is incorporated herein by reference . 2. With respect to City, this obligation shall be null and void if Contractor: 2 .1 Promptly makes payment, directly or indirectly, for all sums due Claimants; and 2 .2 Defends, indemnifies and holds harmless City from all claims, demands, liens or suits by any person or entity who furnished labor, materials or equipment for use in the performance of the Construction Contact, provided City has promptly notified Contractor and Surety (at the address set forth on the signature page of this Bond) of any claims, demands, liens or suits and tendered defense of such claims, demands, liens or suits to Contractor and Surety, and provided there is no City Default. 3 . With respect to Claimants, this obligation shall be null and void if Contractor promptly makes payment, directly or indirectly through its Subcontractors, for all sums due Claimants. If Contractor or its Subcontractors, however, fail to pay any of the persons named in Section 3181 of the California Civil Code, or amounts due City of Cupertino Construction L a bor and Material Payment Bond Library & Community Hall Roof Rehabilitation Project 00620 -I Project No. 2017-105 under the Unemployment Insurance Code with respect to Work or labor performed under the Contract, or for any amounts required to be deducted, withheld , and paid over to the Employment Development Department from the wages of employees of Contractor or Subcontractors pursuant to Section 13020 of the Unemployment Insurance Code, with respect to such Work and labor, then Surety shall pay for the same, and also, in case suit is brought upon this Bond, a reasonable attorney 's fee, to be fixed by the court. 4 . Consistent with the California Mechanic 's Lien Law, Civil Code §3082, et seq., Surety shall have no obligation to Claimants under this Bond unless the Claimant has satisfied all applicable notice requirements. 5 . Surety's total obligation shall not exceed the amount of this Bond, and the amount of this Bond shall be credited for any payments made in good faith by Surety under this Bond . 6. Amounts due Contractor under the Construction Contract shall be applied first to satisfy claims, if any , under any Construction Performance Bond and second, to satisfy obligations of Contractor and Surety under this Bond. 7 . City shall not be liable for payment of any costs, expenses, or attorney's fees of any Claimant under this Bond, and shall have under this Bond no obligations to make payments to , give notices on behalf of, or otherwise have obligations to Claimants under this Bond . 8. Surety hereby waives notice of any change, including changes of time, to the Construction Contract or to related subcontracts, purchase orders and other obligations . Surety further hereby stipulates and agrees that no change, extension of time, alteration or addition to the terms of the Construction Contract, or to the Work to be performed thereunder, or materials or equipment to be furnished thereunder or the Specifications accompanying the same, shall in any way affect its obligations under this Bond , and it does hereby waive any requirement of notice or any such change, extension of time, alteration or addition to the terms of the Construction Contract or to the Work or to the Specifications or any other changes . 9 . Suit against Surety on this Bond may be brought by any Claimant, or its assigns , at any time after the Claimant has furnished the last of the labor or materials, or both , but, per Civil Code §3249, must be commenced before the expiration of six months after the period in which stop notices may be filed as provided in Civil Code §3184. 10 . All notices to Surety or Contractor shall be mailed or delivered (at the address set forth on the signature page of this Bond), and all notices to City shall be mailed or delivered as provided in Document 00520 (Contract). Actual receipt of notice by Surety, City or Contractor, however accomplished , shall be sufficient compliance as of the date received at the foregoing addresses. 11. This Bond has been furnished to comply with the California Mechanic's Lien Law including, but not limited to , Civil Code §§3247 , 3248 , et seq . Any provision in this Bond conflicting with said statutory requirements shall be deemed deleted herefrom and provisions conforming to such statutory or other legal requirements shall be deemed incorporated herein. The intent is that this Bond shall be construed as a statutory bond and not as a common law bond . 12. Upon request by any person or entity appearing to be a potential beneficiary of this Bond, Contractor sha ll promptly furnish a copy of this Bond or shall permit a copy to be made . 13. Contractor shall pay to persons performing labor in and about Work provided for in the Contract Documents an amount equal to or more than the general prevailing rate of per diem wages for (I) work of a similar character in the locality in which the Work is performed and (2) legal holiday and overtime work in said locality . The per diem wages shall be an amou nt equal to or more than the stipulated rates contained in a sched ule that has been ascertained and determined by the Director of the State Department of Industrial Relations and City to be the general prevailing rate of per diem wages for each craft or type of workman or mechanic needed to execute this Contract. Contractor shall also cause a copy of this determination of the prevailing rate of per diem wages to be posted at each Site. City of Cupertino Construction Labor and Material Payment Bond Library & Community Hall Roof Rehabilitation Project 00620 -2 Project No. 2017-105 14 . Definitions. 14 .1 Claimant: An individual or entity having a direct contract with Contractor or with a Subcontractor of Contractor to furnish labor, materials or equipment for use in the performance of the Contract, as further defined in California Civil Code §3 I 81. The intent of this Bond shall be to include without limitation in the terms "labor, materials or equipment" that part of water, gas, power, light, heat, oil , gasoline, telephone service or rental equipment used in the Construction Contract, architectural and engineering services required for performance of the Work of Contractor and Contractor's Subcontractors, and all other items for which a stop notice might be asserted . The term Claimant shall also include the Unemployment Development Department as referred to in Civil Code §3248(b). 14.2 Construction Contract: The contract between City and Contractor identified on the signature page of this Bond, including all Contract Documents and changes thereto . 14.3 City Default: Material failure of City, which has neither been remedied nor waived, to pay the Contractor as required by the Construction Contract, provided that failure is the cause of the failure of Contractor to pay the Claimants and is sufficient to justify termination of the Construction Contract. END OF DOCUMENT City of Cupe11ino Construction Labor and Material Payment Bond Library & Community Hall Roof Rehabilitation Project 00620 - 3 1279 PHIL ADELPHI A INDEMNIT Y INSURANCE COMP AN Y One Bala Plaza , Su ite I 00 Ba la Cy nwyd , PA 19004 -0950 Power or Attorn ey KNOW ALL PERSONS BY THESE PRESENTS: That PHILADELPHIA INDEM NITY I NSU RANCE COMPAN Y (t he Company), a co rporat ion orga ni zed and ex istin g und er the laws of the Co mm onwea lth of Penn sy lva ni a, does hereby co nstitut e and ap point Garrett Turner, Marv Catherine Turner, Megh a nn Catherine Turner & Ron a ld T. Turner of Surety Bond Brokers of LA. Inc ., its tru e and lawful At torn ey-in -fac t with fu ll a uth ori ty to exec ut e on it s be ha lf bo nds , unde rt ak in gs , recogn iza nces and oth er co ntrac ts of in de mn ity and writin gs ob li ga tory in th e nat ur e th ereof, issued in the co urse of its bus in ess and to bind th e Co mpa ny th ereby , in an amou nt not to exceed $25 ,000 ,000 .00 . Th is Powe r o f Atto rn ey is gra nted a nd is signed and seale d by facs im ile un der and by th e aut hor ity of th e fo ll owin g Reso lu tion adopted by th e Boa rd of Direc tors of PHILA DELPHI A IN DEMN ITY INSURANCE COM PANY a t a mee t ing dul y ca ll ed the I" day of J uly, 20 11 . RESOLVED: FURTH ER RE SOL VE D: That th e Boa rd of Di recto rs hereby a uth or izes th e Pres ide nt or any Vice Pr es id ent of th e Com pany to: (I) Ap point Atto rn ey(s) in Fact and auth ori ze the Att orn ey(s) in Fac t to exec ut e on beha lf of th e Co mp any bonds and un de rt aki ngs , contrac ts of ind emni ty an d oth er wr it ings ob li gatory in th e natu re thereof and to attac h the sea l of th e Co mp any th ereto; and (2) to re move , at any tim e, any such Att orn ey -in-F ac t and revo ke th e auth ori ty give n. And , be it Th at th e signatures of such office rs and the sea l of th e Co mp any may be affixed to a ny such Power of Att orn ey or ce rti fica te relatin g th ereto by facs im ile, and any such Powe r of Att orn ey so exec uted a nd certified by facs imi le signatu res and facsi mil e sea l shall be va lid and bi nd in g upo n the Co mpan y in the future wit h the re spect to an y bond or un de rt a king to whic h it is at tached . IN TESTIMONY WHEREOF , PHIL ADELPHI A IN DEMN IT Y INSURANCE COMPANY HAS CAUSED THI S INS TR UMENT TO BE SIGNE D AND ITS CORPORA TE SEAL TO BE AFF IXED BY ITS AUTHOR IZED OFF ICE TH IS I om DAY O F JUNE 20 13. (Seal) Robert D. O 'Leary Jr., Pres ide nt & CEO Phil ade lphi a Ind emn ity In s ura nce Comp any On thi s 10th day of Jun e 201 3, befo re me came the indi v id ua l who exec ut ed the preced ing instru ment , to me perso na ll y kn o\\11 , and bei ng by me d uly sworn said that he is the th erei n desc rib ed and au thor ized office r of th e PHIL ADELPHI A INDEM NITY INSURANC E COMP AN Y; th at the sea l affixed to sa id in stru men t is th e Co rpora te seal of sa id Co mp any; that th e sai d Cor porat e Sea l and hi s signatur e were dul y affixed . COMMONWEALTH OF PENNSYLVANIA Notarlli Seol Klnlle1y A. K&!esld, Nota ry Pubnc l.ower""""1 T•l'·,_,....,,cror,y My Coovnl>5100 tqiru Dec. 18. 20 16 (No tary Sea l) No tary Pub! ic : res id in g at : Ba la Cv nwyd. PA My co mmi ss ion ex pir es : Dece mbe r I 8 20 16 I, Edwa rd Sayago , Corpora te Sec retary of PHI LADELP HI A INDEMN ITY INSURANCE COM PANY , do herby certify that th e fo rego ing reso lu tion of the Boa rd of Di recto rs and thi s Powe r of Attorney issued purs uant there to o n th is !Orn day of .Jun e 20 13 tru e and co rr ec t and a re stil l in full fo rce a nd effec t. I do fu rth er ce rti fy th at Robert D. O 'Leaiy Jr., who exec ut ed th e Powe r o f Att orn ey as Pr es id ent , was on th e da te o f exec uti on of th e att ac hed Powe r of Att orn ey th e dul y e lecte d Pr es id en t of PHILA DEL PHIA INDEMN IT Y INSURANCE CO MPANY , In Test im ony Whereof I have subsc rib ed my na me and affi xed the facs imil e sea l of eac h Company thi s Edward Sayago , Co rp orate Secretary PHIL ADELPHI A INDEM NITY INS URA NC E COMP AN Y ALL-PURPOSE CERTIFICATE OF ACKNOWLEDGMENT A notary public or other officer completing this certificate verifies only the identity of the individual who signed the document to which this certificate is attached, and not the truthfulness, accuracy, or validity of that document. State of Louisiana } County of Parish of East Baton Rouge } On \() '\ 0\ )io\ lo before me , _B_ry~a_n_D_. _F_is_h_(~-!r-.-,n.-.r1-n-am-e-an~a-1,u-.0~1~1he-o=t1,c-•r_> ___ _ personally appeared Mary Catherine Turner who proved to me on the basis of satisfactory evidence to be the person(s) whose name(s) is/are subscribed to the within instrument and acknowledged to me that he/she/they executed the same in his/her/their authorized capacity(ies), and that by his/he·r/their signature(s) on the instrument the person(s), or the entity upon behalf of which the person(s) acted, executed the instrument. Notary (Notary Public Seal) ADDITIONAL OPTIONAL INFORMATION INSTRU CTIONS FOR COMPLETING THIS FORM DESCRIPTION OF THE ATTACHED DOCUMENT (Title or des cription of atta ched document) (Title or description of attached document continued} Number of Pages __ Document Date ___ _ CAPACITY CLAIMED BY THE SIGNER D Individual (s) D Corporate Officer (Title) D Partner(s) D Attorney-in-Fact o Trustee(s) 0 Other _________ _ 2015 Version www.NotaryC la sses.com 800-873-9865 Thi s form co mp li es with cu/'/'ent Ca lifo rnia sta tutes regarding nota,y wo rdin g and , if needed, should be comp leted and atta ched to th e doc um elll. Ackno lll'edgentsfrom oth er stat es may be comple!ed fo r doc um ents being se nt to th a t state so long as th e wo rding does not require th e California nota,y to vio late Californi a nota,y law. • Sta te a nd Coun ty informati on must be th e Sta te a nd Coun ty whe re th e d ocu m ent signer(s) persona ll y a p peared before th e notary pu b lic fo r ack nowledgment. • Da te o f notar izati on mu st be th e d ate th a t the signer(s) persona ll y a pp ea red wh ic h mu st a lso be th e same d ate th e ackn owledgme nt is compl eted . • TI1e no tary pub li c mu st p rint h is or he r name as it appears w ithin hi s or he r commi ss ion fo ll owed by a comm a and the n you r ti tle (no tary pu b li c). • Pr int th e n am e(s) of doc um e nt s ig ne r(s) who persona ll y a pp ea r at the tim e of notari zation . • Ind icate th e correct si ng ul a r or plu ra l fo rm s by cross in g off in correc t fo nn s (i .e . he/she/!ftey;-is /are) or c irc ling th e correct for m s. Fai lure to correct ly in di cate th is in fo rmati o n may lead to rejecti on of docum e nt recordi ng . • The notary seal im press ion must be c lear a nd ph otographi ca ll y re produci ble. Im p ress io n mu st not cover tex t o r lin es. If seal im press io n smudges, re-seal if a s u ffic ien t a rea pe rmits, o th erwise com p le te a d iffere nt ackn owledgme nt fo rm . • S ignature of th e notary publi c m ust m atc h th e signatu re on fil e w ith th e office of th e county c lerk . •!• Ad diti o na l in fo rm ati o n is no t re quired but could help to e nsure thi s ac knowledgm e nt is not mi s used or a tt ac hed to a d iffere nt document. •,• Indi cate titl e or ty pe of attac hed d oc um e nt, nu m be r of pages and date . •!• Indi cate th e capac ity c la im ed by th e signer. If th e cl a im ed capacity is a cor pora te officer, indi ca te th e titl e (i.e . CEO, CFO, Secretary). • Sec ure ly a ttac h thi s doc um ent to th e s ig ned d ocum e nt w ith a stap le . DOCUMENT 00610 Bond No . PB12142800208 CONSTRUCTION PERFORMANCE BOND THIS CONSTRUCTION PERFORMANCE BOND ("Bond ") is dated 1011912016 , is in the penal sum of One Hundred Eight Thousand Seven Hundred Seventy-one And No/100THS Dollars ($108,771 .00) _________________________ [which is one hundred percent of the Contract Price], and is entered into by and between the parties listed below to ensure the faithful performance of the Construction Contract listed below. This Bond consists of this page and the Bond Terms and Conditions, paragraphs 1 through 12, attached to this page . Any singular reference to Brazos Urethane, Inc. ("Contractor"), Philadelphia Indemnity Insurance Company ("Surety"), the City of Cupertino, a Municipal Corporation of the State of California ("City") or other party shall be considered plural where applicable . CONTRACTOR: Brazos Urethane, Inc. Name 1031 6th St. North Address Texas City , TX 77590 City/State/Zip CONSTRUCTION CONTRACT : SURETY: Philadelphia Indemnity Insurance Company Name One Bala Plaza, Suite 100 Principal Place of Business Bala Cynwyd, PA 19004 City/State/Zip LIBRARY AND COMMUNITY HALL ROOF RESTORATION PROJECT -PROJECT# 2017-105 at Cupertino, California. DATED __ o_c_t_ob_e_r_1_9 ____ , 20~ in the Amount of$ __ 1_0_8 ,_77_1_.o_o _______ (the "Penal Sum") CONTRACTOR AS PRINCIPAL Company: ( p . Seal) SURETY Company : ~ity Insurance Company Name an itle: Mary Catherine Turner, Attorney-in-Fact BOND TERMS AND CONDITIONS I. Contractor and Surety, jointly and severally, bind themselves, their heirs , executors , administrators, successors and assigns to City for the complete and proper performance of the Construction Contract, which is incorporated herein by reference . 2 . If Contractor completely and properly performs all of its obligations under the Construction Contract, Surety and Contractor shall have no obligation under this Bond. 3 . lfthere is no City Default, Surety 's obligation under this Bond shall arise after: 3 .1 City has declared a Contractor Default under the Construction Contract pursuant to the terms of the Construction Contract; and 3.2 City has agreed to pay the Balance of the Contract Sum : 3 .2.1 To Surety in accordance with the terms of this Bond and the Construction Contract; or 3 .2 .2 To a contractor selected to perform the Construction Contract in accordance with the terms of this Bond and the Construction Contract. City of Cupertino 00610 - I Construction Performance Bond Library & Community Hall Roof Restoration Project 4. When City has satisfied the conditions of paragraph 3, Surety shall promptly (within 30 days) and at Surety's expense elect to take one of the following actions: 4.1 Arrange for Contractor, with consent of City, to perform and complete the Construction Contract (but City may withhold consent, in which case the Surety must elect an option described in paragraphs 4.2, 4.3 or 4.4, below); or 4.2 Undertake to perform and complete the Construction Contract itself, through its agents or through independent contractors; provided, that Surety may not select Contractor as its agent or independent contractor without City's consent; or 4.3 Undertake to perform and complete the Construction Contract by obtaining bids from qualified contractors acceptable to City for a contract for performance and completion of the Construction Contract, and, upon determination by City of the lowest responsible bidder, arrange for a contract to be prepared for execution by City and the contractor selected with City's concurrence, to be secured with perfonnance and payment bonds executed by a qualified surety equivalent to the bonds issued on the Construction Contract; and, if Surety's obligations defined in paragraph 6, below, exceed the Balance of the Contract Sum, then Surety shall pay to City the amount of such excess; or 4.4 Waive its right to perform and complete, arrange for completion, or obtain a new contractor and with reasonable promptness under the circumstances, and, after investigation and consultation with City, determine in good faith its monetary obligation to City under paragraph 6, below, for the performance and completion of the Construction Contract and, as soon as practicable after the amount is determined, tender payment therefor to City with full explanation of the payment's calculation . If City accepts Surety's tender under this paragraph 4.4, City may still hold Surety liable for future damages then unknown or unliquidated resulting from the Contractor Default. If City disputes the amount of Surety's tender under this paragraph 4 .4, City may exercise all remedies available to it at law to enforce Surety 's liability under paragraph 6, below. 5 . If Surety does not proceed as provided in paragraph 4 , above, then Surety shall be deemed to be in default on this Bond ten days after receipt of an additional written notice from City to Surety demanding that Surety perform its obligations under this Bond. At all times City shall be entitled to enforce any remedy available to City at law or under the Construction Contract including, without limitation, and by way of example only, rights to perform work, protect work, mitigate damages, advance critical work to mitigate schedule delay, or coordinate work with other consultants or contractors . 6. Surety's monetary obligation under this Bond is limited by the Amount of this Bond identified herein as the Penal Sum. This monetary obligation shall augment the Balance of the Contract Sum. Subject to these limits, Surety's obligations under this Bond are commensurate with the obligations of Contractor under the Construction Contract. Surety's obligations shall include, but are not limited to : 6.1 The responsibilities of Contractor under the Construction Contract for completion of the Construction Contract and correction of defective work; 6 .2 The responsibilities of Contractor under the Construction Contract to pay liquidated damages, and for damages for which no liquidated damages are specified in the Construction Contract, actual damages caused by non-performance of the Construction Contract including, but not limited to , all valid and proper backcharges, offsets, payments, indemnities, or other damages; 6.3 Additional legal, design professional and delay costs resulting from Contractor Default or resulting from the actions or failure to act of the Surety under paragraph 4, above (but excluding attorney's fees incurred to enforce this Bond). 7 . No right of action shall accrue on this Bond to any person or entity other than City or its successors or assigns . City of Cupertino Service Center Roof Project 00610 - 2 Construction Performance Bond 8. Surety hereby waives notice of any change, alteration or addition to the Construction Contract or to related subcontracts, purchase orders and other obligations, including changes of time . Surety consents to all terms of the Construction Contract, including provisions on changes to the Contract. No extension of time, change, alteration, modification, deletion, or addition to the Contract Documents, or of the work required thereunder, shall release or exonerate Surety on this Bond or in any way affect the obligations of Surety on this Bond . 9 . Any proceeding, legal or equitable, under this Bond shall be instituted in any court of competent jurisdiction where a proceeding is pending between City and Contractor regarding the Construction Contract, or in the courts of the County of Santa Clara, or in a court of competent jurisdiction in the location in which the work is located. Communications from City to Surety under paragraph 3.1 of this Bond shall be deemed to include the necessary contracts under paragraph 3.2 of this Bond unless expressly stated otherwise . 10. All notices to Surety or Contractor shall be mailed or delivered (at the address set forth on the signature page of this Bond), and all notices to City shall be mailed or delivered as provided in Document 00520 (Contract). Actual receipt of notice by Surety, City or Contractor, however accomplished, shall be sufficient compliance as of the date received at the foregoing addresses . 11. Any provision in this Bond conflicting with any statutory or regulatory requirement shall be deemed deleted herefrom and provisions conforming to such statutory requirement shall be deemed incorporated herein . 12. Definitions. 12. l Balance of the Contract Sum: The total amount payable by City to Contractor pursuant to the terms of the Construction Contract after all proper adjustments have been made under the Construction Contract, for example, deductions for progress payments made, and increases/decreases for approved modifications to the Construction Contract. 12 .2 Construction Contract: The contract between City and Contractor identified on the signature page of this Bond, including all Contract Documents and changes thereto . 12.3 Contractor Default: Material failure of Contractor, which has neither been remedied nor waived, to perform or otherwise to comply with the terms of the Construction Contract including, but not limited to, "default" or any other condition allowing a termination for cause as provided in Document 00700 (General Conditions). 12.4 City Default: Material failure of City, which has neither been remedied nor waived, to pay Contractor progress payments due under the Construction Contract or to perform other material terms of the Construction Contract, if such failure is the cause of the asserted Contractor Default and is sufficient to justify Contractor termination of the Construction Contract. END OF DOCUMENT City of Cupertino 00610 -3 Construction Performance Bond Library & Community Hall Roof Restoration Project 1293 PI-IIL A DELPI-II A INDEMNIT Y INSURANCE COMP AN Y One Ba la Pl aza , Sui te I 00 Bala Cy nwyd , PA 19004 -0950 Power of Attorne y KNOW ALL PERSONS BY THESE PRESE NTS: Th at PHILADELPHIA INDEMNITY INSU RA CE COMPAN Y (th e Co m pa ny), a corpora tio n organ ized and ex istin g und er th e laws of th e Co mm onwea lth o f Penn sy lva nia , does hereby co nstitut e and a pp o int Garrett Turner, Mary Catherine Turner, Meghann Cath erine Turner & Ronald T. Turner of S uretv Bond Brokers of LA. Inc., it s tru e and lawful Att orn ey -in-fac t with full auth or ity to execu te on its be ha lf bo nds , und ertak in gs , recog ni za nces and ot her co ntracts of ind emnity a nd wr it in gs ob li gatory in th e nat ur e the reof, issued in the course of its bus in ess and to bin d the Company thereby , in a n a mount no t to exceed $25,000,000.00. Th is Power of Att orn ey is granted a nd is signe d and sea led by facs imil e und er and by the au th or ity of the fo ll owi ng Reso lu t io n ado pted by th e Boa rd of Direc tors of PHI LADE LPHI A INDEMN IT Y fNSURANCE COMP ANY at a meeting d uly ca ll ed the I" day of Jul y, 20 1 1. RE SOLV ED: FURTH ER RESOLVED : Th at th e Boa rd of Di rec tors hereby au th or izes th e Pres ide nt or a ny Vice Pres ident of th e Co mp any to : (I) Ap poi nt Att o rn ey(s ) in Fac t and auth orize the Att orn ey(s) in Fac t to exec ute on be ha lf of th e Co mpa ny bo nds and un derta ki ngs , con tr acts of inde mni ty a nd oth er writin gs ob li ga tory in th e natur e th ereof and to att ac h th e sea l of th e Co mpany th ereto ; a nd (2) to re move , at any tim e, any such Attorn ey -in-F ac t and revoke th e au th ority g ive n. And , be it lliat the signatu res of s uch office rs and th e sea l of th e Co mp any may be affi xed to a ny such Power of Att orn ey or ce rtifi ca te re lat in g th ereto by fa cs imil e, and any such Powe r of Att orne y so exec ut ed a nd ce rti fied by facs imil e s ignature s and facsi mil e sea l sha ll be valid and bin d ing upon the Compa ny in th e fu ture wit h the respect to any bond or undertaki ng to whi ch it is attac hed. IN TEST IMONY WHEREOF , PH ILADELP HI A IN DEMN ITY INSURANCE COMPAN Y HAS CAUSE D THI S INS TRUMEN T TO BE SIGNE D AN D ITS CORPORA TE SEAL TO BE AFF IXED BY ITS AUT HOR IZED O FFICE TH IS I Orn DAY OF JUNE 20 13. (Sea l) Rober t D. O 'Leary Jr., Pres ide nt & CEO Phil ade lphi a Ind emni ty In s ura nce Comp any On thi s !0 th day of Jun e 20 13, befo re me ca me the ind iv idu al who execut ed th e preced in g instru me nt , to me persona ll y kno\\11, and be in g by me dul y swo rn sa id that he is th e th erein desc ribed and auth orized officer of the PHIL ADELPHIA INDEM NITY INS URAN CE COMPAN Y; th at the sea l affixed to sa id in stru me nt is the Co rp ora te sea l of sa id Co mp any; th at th e sa id Co rp orat e Sea l and hi s signature we re dul y affi xed. COM EAi.TH OF PEN NSYLVANIA -•Sul Kinber1y A. K,ss~eslcl. Notary Publk LawerH<11oo T•J>.,-,-YC0ur<\' My Commbo10o E.qires Oec. 18, 2016 M9taER, PfMfSYl.YAHIA ASSOCJAlltrl OF NOTWES (No tary Sea l) No tary Publi c: res idin g at : My co mmi ss ion ex pir es : Bala Cy nwyd. PA Dece mb er 18 20 I 6 I, Edwa rd Sayago , Corporate Secre tary of PHI LA DEL PHI A IN DEMN ITY INSU RANCE COM PANY , do herby ce rti fy th at th e forego ing reso luti on of th e Boa rd of Direc tors and thi s Powe r of Att orn ey iss ued pursua nt th e reto on thi s I om day o f Jun e 20 13 tru e and co rr ec t and are still in fu ll force and effec t. I do furt her ce rt if)' th at Ro bert D. O 'Le a ry Jr., who exec ut ed th e Powe r o f Att orn ey as Pres ide nt , was on the date of exec uti on of th e att ac hed Power of Att orn ey th e dul y e lec ted Pr es id ent of PHIL ADEL PHI A IN DEMN IT Y INSURANCE COMP AN Y, In Tes timo ny Whereof I have s ubscribed my name and affixed th e facsimile seal of eac h Co mp any thi s Edwa rd Sayago, Co rp ora te Secretary PI-IILADELPHI A INDEM NITY INS URANC E COMP AN Y ALL-PURPOSE CERTIFICATE OF ACKNOWLEDGMENT A notary public or other officer completing this certificate verifies only the identity of the individual who signed the document to which this certificate is attached, and not the truthfulness , accuracy , or validity of that document. State of Louisiana } County of Parish of East Baton Rouge } On \o l \"\To\ LP before me, _B_.ryc.-a_n_D_. _F_is_h=(~.~~e-,n~s.~rtn~am~e~an~a1=,t1e-,or=1h~eo=tt,c~e,'"'") ---- personally appeared Mary Catherine Turner who proved to me on the basis of satisfactory evidence to be the person(s) whose name(s) is/are subscribed to the within instrument and acknowledged to me that he/she/they executed the same in his/her/their authorized capacity(ies), and that by his/her/their signature(s) on the instrument the person(s), or the entity upon behalf of which the person(s) acted , executed the instrument. I certify under PENAL TY OF PERJURY under the laws of the State of California that the foregoin , aragraph ·51ru)8 and correct. DESCRIPTION OF THE ATTACHED DOCUMENT (TiUe or description of attached document) (Title or description of attached document con tinued ) Number of Pages __ Document Date ___ _ CAPACITY CLAIMED BY THE SIGNER D Individual (s) D Corporate Officer (Title) D Partner(s) D Attorney-in-Fact o Trustee(s) 0 Other _________ _ 2015 Version www.NotaryClasses.com 800-873-9865 (Notary Public Seal) INSTRU CT IONS FOR COMPLETING THIS FORM Thi s fo rm compli es with current California statutes regarding nolai)' wording and, if needed, should be comp leted and attached to th e dowment. Acknolwedgen tsfi-0111 oth er states may be co mpleted for documents being se nt to that slate so long as th e wording doe s not require th e California notaiy to vio late Ca lifornia no ta1y law. • State and County inform a tion mu st be th e State a nd County where th e document s ig ner(s) personally a ppe ared before the notary publ ic for acknowledgment. • Da te of notarizati on m us t be the date th at th e signer(s) personally appeared whi ch mu st a lso be the same date th e ack nowledgment is com pl eted. • The notary public mu st print his or her name as it appears with in his or her commi ss ion fo llowed by a comma and then yo ur title (notary public). • Print the na m e(s) of document signer(s) who personall y a ppea r at th e tim e of not ari zat ion . • Indi cate th e correct si ngul ar o r plural form s by cross in g off incorrec t fo nn s (i .e . lle/she/tfley;-is /are) or circling th e correct forms . Failure to correctl y indicate thi s in fo rm at ion may lead to rejection of document recording. • The n otary seal impressio n must be c lear a nd ph otographica ll y reproducible. Impressio n mu st not cover text or lines . If seal impression sm ud ges , re -sea l if a sufficient area permits, otherwi se compl e te a different ack nowledgment form . • Signature of th e nota ry public must ma tch th e s ig na ture on fil e w ith th e office of the coun ty clerk. •!• Additional information is not required b ut cou ld help to e nsure this acknowledgment is not mi s used or attac hed to a different document . •!• Indi cate titl e or type of attached docum e nt , number of pages and date . •,• In d icate the capac ity clai med by the s ig ne r. If th e c lai med capac ity is a corporate officer, indi cate th e title (i .e. CEO, CFO, Secre tary). • Sec ure ly attach thi s docum ent to the s ig ned document w ith a stap le . C IT Y O F a CUPERTINO INSURANCE AGREEMENT A. Contractor is aware of the provisions of Section 3700 of the Labor Code, which requires every emp lo yer to be insured against li ability for worker's compensation or unde1take se lf- insurance in accordance with the provis ion s of that Code, and will comply with such provisions before commencing the performance of the work of this Contract. B. Contractor and all subcontractors will carry worker 's compensation insurance for the protection of its emp lo yees during the progress of the work. The insurer shall waive its rights of subrogation against the City, the City 's officers, agents and employees and shall issue an endorsement to the policy evidencing same . C. Contractor shal l carry at all times , on all operations hereunder, commercial general liability insurance, automobile liability insurance and builder 's all risk insurance. All insurance coverage shall be in amounts required by the City and shall be evidenced by the issuance of a certificate in a form prescribed by the City and shall be underwritten by insurance companies satisfactory to the City for all operations , sub-contract work, contractual obligations, product or completed operations , all owned vehicles and non-owned vehicles. Said insurance coverage obtained by the Contractor, excepting worker's compensation coverage , shall name the City, its engineer, and each of its directors, officers, agents and employees, as determined by the City, as additional insureds on said policies . Insurers must be licensed to do business in the State of California. The Insurers must also have an "A " policyholder's rating and a financial rating of at least Class VII in accordance with the current Best's Guide Rating or that is otherwise acceptable to the City. D . Before Contractor performs any work at , or prepares or delivers materials to, the site of construction , Contractor shall furnish certificates of insurance evidencing the foregoing insurance coverages and such certificates shall provide the name and policy number of each carrier and policy and that the insurance is in force and will not be canceled or modified without thirty (30) days written notice to the City. Contractor shall maintain all of the foregoing insurance coverages in force until the work under this Contract is fully completed . The requirement for carrying the foregoing insurance shall not derogate from the provisions for indemnification of the City by Contractor under this Contract and for the duration of the warranty period. Notwithstanding nor diminishing the obligations of Contractor with respect to the foregoing , Contractor shall maintain in full force and effect during the life of this Contract, the following insurance in amounts not less than the amounts specifi ed and having a Best's Guide Rating of A, Class VII or better or that is otherwise acceptable to the City. City of Cupertino 00530 - 2 Insurance Forms Library and Community Hall Roof Restoration Project LIMITS Worker's Compensation & Employers ' Liability General Liability -commercial general liability; including provisions for contractual liability, personal injury, independent contractors and products -completed operations hazard. Automobile Liability -comprehensive covering owned, non-owned and hired automobiles. Brazos Urethane, Inc. In accordance with the Worker 's Compensation Act of the State of California-Worker's comp "statutory" per CA Law; Employers ' Liability $ I ,000 ,000 per occurrence . Combined single limit of $2.0 million per occurrence; $4.0 million in the aggregate Combined single limit of$1.0 million per occurrence. (Contractor 's Name) Dated: October 19 2016 City of Cupertino 005 30 - 3 Insurance Forms Library and Community Hall Roof Restoration Project CITY OF a CUPERTINO CERT I FICATE OF I NSURANCE TO THE CITY OF CUPE RTI NO T his cer tifi es to the C it y of'C upcrtino that th e foll ow in g desc ribed poli c ie s have bee n issued to the in s ur ed named below and are in forc e at this tim e. In su red: Brazos Urethane, Inc. Address: 10 3 1 6th St. North Texas C it y, TX De sc rip t io1/l?6~eratiLlnsi loca ti o ns /proclu cts in s ur ed (show con tra ct name and /or number, if a ny): Library and Co mmunity Hall Roof Re storation WORK ER'S COMPENSATION Argonaut Insurance Co (n a 111e of in s urer) * Statutory Min . * Emp loyer's Liab ilit y $ 1,000,000 E.L. Each Accident $ 1,000 ,000 E.L. Disease Ea . $ 1,000,000 E.L. Disease In s urance Co mp any's S ta te Lice nse No. /c; ~3-0 Employee Policy limit C heck Po li cy Ty pe: COMPREHENSIVE GENERAL LIABILITY r X] Pre111i ses !Operation s Owners & Contrac to rs Prot ec tive [ ] Co ntra ctua l fo r S pec ifi c Co ntra ct s -------- [ x] Produ cts Liabilit y Ix J XCU Ha za rd s L:ach Occurrence Ccneral Agg rega te ( if ap pl ic a bl c) Agg rega te Perso nal Injur y S 1,000 ,000 $ 2,000,000 $ 2 000 000 [ x] Broad Form P.O. Fir e Dam age (a ny o ne fire) S 100 ,000 -~------[ x ] Severabiliry of Intere s t C lause [ x] Perso na l Injur y with Medical Ex pense S 10 000 -~------Em p Io ye e Excl us ion Removed (any o ne perso n ) or Self-In s ured COMMERCIAL GENERAL LIABILITY Rete ntio n $ 5,000 ded . -------- Allied World Assurance (US) Inc. (name of in s ur er) Po l icy No. 0309 -0207 Ex pi ra ti o n Date 5/31/2017 Ci1 y o l'Cupcrt i 1w 00530 -4 I nsurancc Forms Lib rary and Co 1111 nu 11i1 y Ha ll Roof Rc,to rnrion Project AUTOMOT IVE/VE ! !!CLE LIABILITY Co111111ercia l Fo rm BODILY INJ URY Eac h Pe rso n PROP ERTY DAMACE Eac h Acc id en t Liabilit y Cmcrage $ _____ _ $ ______ _ Eac h Acc iden t United States Fire Insurance Co. (name of insurer) $ _____ or Co 111bin ed Single Limit $ 1,000 ,000 Polic y No. 133-739073 -9 Ex piration Date 5/31/2017 --------------------------------------------------------------------- B 'ILDER 'S R ISK ·'ALL RI S K" T h is is to certify rh at th e following po li cy has bee n iss ued by the below -stated co mp any in co nforrnancc w ith the requirements of th e project documents and is in fo rce at this ti111e. N/A (Na111e of in s urer) Polic y No. Expiration Date _______ _ Deductib le: Limit s of Liabi lit y: ________ _ ----------___ F ______________________________________________________ _ ------------------------------------------------------------------- -----1-C----A cop y of a ll Endor seme nts to the polic y(ics) wh ich in an y way (agent 's ini tial) limit th e above-listed tyres of cove rage are attached to this Ce rti ficate of In s ur ance. This Ce rtili ca te of In s uranc e is not an in s uran ce r o licy a nd does no t amend , exten d or alte r th e coverage afTorded by th e poli cies li s ted here in . Notw ith sta ndin g an y req uirem e nt , te rm , or co ndit io n o f an y co ntract o r a ny other document ,with respec t to whic h thi s Cert ifi cate of In s uran ce may be iss ued o r ma y pe11ain , th e in s uran ce affo rd ed by the poli cies descr ibe d here in is s ubj ect to a ll th e te rms , excl us io ns a nd conditions of s uch poli c ie s. IT IS H EREB Y CE RTIFI ED that the above po lic y(ies) provide li abi li ty insu ranc e as requ ired by the Ag ree ment between th e C it y and the in s ur ed. By: ____ H_1_· ld_a_L_op_e_z _____ _ Da tcd: October 19 20 16 Attac h Ce rtifi ca te of Insurance an d Additi o na l In s ur ed End orse ment on com pany fo1111s. C i l \ o !Tupt:rlin u 005 ]0 -5 I nsur,111cc Forms I. ibrary ancl Co mmu n ity Hall Roof Rcs ro rar inn Proj ec t . ·, CITY OF a CUPERTINO ADDIT IO NAL INSURED ENDORSEMENT and ENDORSEMENT OF PRIM ARY I NSURANCE and NOTICE OF POLICY CANCELLATION ENDORSEMENT Library and Community Hall Roof Restoration Project Project Tit le: _________________________ _ In consideration of the policy premium and notwithstanding any inconsistent statement in th e polic y to which this Endorsem e nt is attached or any other Endorseme nt attac hed thereto , it is agreed as follows: The City of Cupertino ("City'') and it s directors , officers, eng ine ers , agents and employee s, and a ll public agencies from whom permit s wi ll be o btain ed and their directors. o fficer s, engineers. age nt s and e mplo yees, a nd the State of Cal iforni a, and it s officers , age nt s and employees , a rc hereby declared to be additional insureds under th e te rm s of this policy, but only with res pect to th e o peration s o r th e Contractor at or upon any of the premi ses of th e C ity in co nne ct ion with the Co ntrac t \Nith th e City , or ac ts o r omissions of the additiona l in s ur eds in connection with. but limited to its ge ne ra l supervision or insp ec tion of said operations. The in s uran ce afford ed by thi s poli cy is primar y in sura nce, and no additional in sura nce held or ow ned by th e des ignnt ed additiona l in s ur ed(s) s hall be called upon to cover a loss under sai d ad ditional po li cy. Cancellation Notice. The in s urance affo rded by this polic y s ha ll not be s u pend ed, voi d ed, cance led. reduced in coverage o r in limits , or materiall y altered , except after thirty (30) da ys' prior written noti ce b y ce rtified mail. return receip t reque s ted, has been g ive n to th e City of Cuperti no ("City"). Such noti ce sha ll be aclclrcs secl to th e City as indi ca ted below. POLICY I NFORMATION I . Insuranc e Co mpan y: Allied World Assurance (US) Inc.; United States Fire Insurance Co. 2. In sura nc e Polic y Numbcr:_0_3_0_9_-0_2_0_7_; _13_3_-_7_3 _90_7_3_-_9 ____________ _ 3. Effective Date of this Endorsem ent: October 19 20 16 ------------------- 4. In su red: Brazos Urethane, Inc. All notic es herei n provid ed to be g ive n by the In sura nce Company to th e City in co nn ect ion with this po li cy ancl th ese Endor se ment s, s hall be mail ed to or deli ve red to the C it y at I 0300 Torre /\ve nu e: C up e rtino. California 95014. 1, Hilda Lopez (print/type name) ,varrant that I ha ve author ity to bind th e below li sted In s urance Company and by my s ign ature he reon do so bind this Co mpany. C i ty o l'Cupcrtinu 00530 -6 I nsurancc Fo rm s Lib rary and C0 mmu11ity Hall Roo f Rcs rorati0 11 Pmjcc t Signature or A uth o ri zed Reprc sc ntati vc :_..L----4-N";,.....<.;_/,cw'd-'--l-----,::'------------- (0rig in a l s ig natur e required on a ll Em oi-s Na me s of Agen t! Age nc y: Bowen , Miclette & Britt Insurance Agency , LLC T itl e: Vice President Address: 1111 North Loop W., Su ite 203, Houston , TX 77008 T e le phon e : ____?___@-880-71 _00 __ . Facs imil e: 713-880-7166 ----------- City o l'Cupcrti110 00530 -7 I nsurancc Form s Library nnd Co mmuni ty Hall Roof Res torat i on Project CITY OF a CUPERTINO COMPREHENSIVE GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY ENDORSEMENT OF AGGREGATE LIMITS OF INSURANCE PER PRO.JECT Library and Community Hall Roof Restoration Project Proj ec t Title: _________________________ _ In consideration o f the poli cy premium and notwith standing any inconsistent statemen t in the poli cy to which thi s Endorsement is attached or any other Endorsement attached thereto, it is as follows: This Endor se ment modifi es the in s urance pro vided und er th e General Liabilit y Coverage part of the below-referenced pol icy of insurance. The ge neral aggregate limit under LIMITS OF INS URAN CE app li es se parately to the projec t desc ribed as Library a nd Commun ity Hall Roof Restoration Project POLICY INFORM/\ TION I . Insurance Co mpan y: Allied World Assurance (US) Inc. 2. Insurance Pol icy Numbcr:_0_3_0_9_-_0_2_07 ____________________ _ 3. Effec ti ve Date ol"this End o rse me nt: October '19 20 16 ------------------- 4. In s ured: Brazos Ure thane, Inc. ' '··. ---------------~-,------------------ 5. Additional Insured: City of Cupertino , its directo rs, officers , age nt s ancl employees. A ll notic es he rein pro vid ed to be give n by the In s ur ance Com pa ny to the Cit y in connection w ith this polic y a nd this Endorsement, sha ll be mailed to or delivered to the City at 10 300 Torre Avenue; Cupertino , Ca liforni a 95014. I , __ H_i_Id_a_L_o-=.p_e_z ________ --+'~----------(p1inti type name) Na mes of /\gen t/ Agency: Bowen , Miclelte & Britt Insurance Agency, LLC Address: 11 11 North Loop W , Su ite 400 , Houston , TX 77008 Cit\ o l"Cupi;rti1w 00.'iJO -X l.ibrn1-y nnd Community Hall Roof Rc sl nrn tion Pro_ic c t e Company a nd by my signature hereon do Tirlc: Vice President Telephone: ~-880-7100 ---- Fac s imile : 713-880-7166 -------- I nsuram:e Forms C I TY OF a \:VA I VE R O F SlJ BROG A T IO N EN OOR SEM ENT WORK E R 'S C O M PENSAT ION I NS URANCE CUPERTINO l'ro.1 ect Titl e: Library and C ommunity Hall Ro o f Res tora tion P ro j ec t In con s idera tion of th e po licy pre m ium a nd no tw ith sta ndin g a ny in co nsis te nt sta te me nt in the pol icy to w h ic h this Endorse m e nt is at tac hed or a ny ot her Endo rse111e n t attac hed th ereto, it is agreed as fo ll ows: It is ag reed th a t w ith res pec t to suc h insura nce as is affo rde d b y th e po li cy , th e In s u ra nce Co m pa ny waives a ny r ig ht of su brogat ion aga ins t the C it y o r C u pert in o, a nd eac h of its d ir ec tors , office rs . agen ts, consultants an d em pl oyees b y reason of any paymen t made on acco ulll of' injury, including dea th res u lti ng there from, sustai ned by any emp loyee of the ins ur ed. aris in g o u t of the pe r formance of the abo\'c-re lc rcnccd Contract. POLI CY fNF ORM A TIO N I. Ins ura nce Com pa ny: Argonaut Insurance Co 2. In s ur a nce Po l icy Nu mb er :_W_C_9_2_7_9_0_8_2_5_4_3_1_4 _________________ _ 3. Effective Da te of this En do rse111en t: October 19 201 6 ------------------- 4 . Jn :;urc d : Brazos Uret h a n e, I nc. All not ices herei n p rov ided to be give n by the Ins urance Com pa ny lo the C it y in connect ion wi th thi s po lic y and this Endorse 111 c nt, s ha ll be 111a ilccl to or delivered lo the City at 10300 Torre Avenue; Cupert ino . California 950 14. wa rr ant that I have a uth or it y t o b ind th e be low so bind th is Com pany. Name s of ;\gen t/ Agency: Bowen , Mic lette & Britt Insurance Agency LLC /\d d rcss :_~ort_h Loop W., Suite 400 , Houston ,TX 77008 Ci1:v u l"Cupcnino 00530 -9 Libra ry and Co mmunit y Hall Roof Rcs rora 1io11 Project Title: Vi ce Pres ident -~~~'--"-'~~~---- Te le ph o ne: ~-880-7 100 ___ _ Facs im ile: 713-880-7166 -------- I 11sur ,111cc Forn 1s ACORD® CERTIFICATE OF LIABILITY INSURANCE I DATE (MM /DD/YYYY) ~ 10/17/2016 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ON LY AND CONFERS NO RIGHTS UPON THE CERTI FICATE HOLDER. THIS CERTIFICATE DOES N OT 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 ADD ITIONAL INSURED, the policy(ies) must be endorsed . If SUBROGATION IS WAIVED , subject to the terms and conditions of the policy, certain policies may r equire an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsementlsl. PRODUCER CONTACT A .J . Adams NAME: Bowen , Miclette & Britt ;tif NJ<> Ext) 71 3-880-71 00 I FAX 713-880-7166 Insurance Agency , LLC IA/C Nol · 1111 North Loop West , #400 ~;.,MnA~~ ••. certificates@bmbinc .com Houston TX 77008 INSURER ISI AFFORDING COVERAGE NAIC # INSURER A ,Allied World Assurance (US ) Inc. 19489 ------------ INSURED BRAZOSURET INSURER B ,United States F ire I nsurance Co . 21113 Brazos Urethane , Inc . INSURER c : Navigators Specialty Insurance Comp 36056 1031 6th Street North INSUR ER D : Texas Mutual Insurance Companv 22945 Texas City T X 77590 INSURER E ,Argonaut Insurance Co 19801 INSURER F : COVERAGES CERTIFICATE NUMBER · 1104124543 REVIS ION NUMBER· THI S IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAV E BEEN ISSUED TO THE INSURED NAM ED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTAN DING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTH ER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN , THE INSURANC E AFFORDED BY THE POLICIES DESCRIBED HERE IN IS SUBJECT TO ALL THE TERMS, E XCLUSIONS AN D CONDITIONS OF SUCH POLICIES . LIMITS SHOWN MAY HA VE BEEN REDUCED BY PAID CLAIMS . INSR :t([)ll'Twc" POLICY EFF POLIC Y EXP LTR TYPE OF INSURANCE INSD WVD POLIC Y NUMBER IMM /DD /YYYYl IMM /DD /YYYYl LIMITS A X COMMERCIAL GEN ERAL LIABILITY y y 0309-0207 5/31/2016 5/31/20 17 EACH OCCURRENCE $1,000 ,000 1--GJ OCCUR DAMAG E TO RENTED ~-- CL AIMS -MADE PREMISES /Ea occurrence \ S100,000 ·---------·-----MED EXP (Any one person ) 510,000 PER SONA L & ADV INJURY S 1,000 ,000 r-·-·-----. . GEN'L AGGREGATE LIMI T APPLIES PER. GENERAL AGGREGA TE $2 ,000 ,000 =-~ POLICY [>] jm: [] LOC PRODUC TS · COMP /OP AGG S2 ,000,000 OTHER : s B AUTOMOBILE LIABILIT Y y y 133-739073-9 5/31 /2016 5/31 /2017 :SIN<il~ LIM I I s 1,000 ,000 (Ea accident ) X ANY AUTO BODIL y INJU RY (P er person ) s -ALL OWNED ~ """""" AU TOS AUTOS BODILY INJU RY (Per acc iden t) s 1--NON-OWNED PROPERTY DAMAGE X HIR ED AUTOS AUTOS /Pe r ac cid en t) s 1-- Deduct ible S1 ,000 C UMBR ELLA LIAB H OCC UR y y H0 16EXC8087051C 5/31 /2016 5/31/2017 EA CH OCCURRENCE $4,000 ,000 i-- X EXC ESS LIAB CLAIMS-MADE AGGR EGATE $4 ,000 .000 --- -~ED I I RE TEN TI ON $ s D WORKERS COMPENSATION y TSF0001 253554 5/31 /20 16 5/31/2017 X I ~ffTuT E I X I ~~H- E AND EMPLOYERS' LIABILITY Y I N WC927908254314 5/31 /2016 5/31 /2017 ANY PROPRIETOR/PARTNER/EXECUTI VE ~ N /A E.L. EACH ACCIDENT s 1,000 ,000 OFFICER /MEMBER EXCLUDED ? (Mandatory In NH ) E.L. DISEAS E· EA EMPLOYEE S1 ,000 ,000 If yes , descnbe under E.L. DISEASE -POLICY LIM IT 5 1,000 ,000 DESC RIPTION OF OPERATIO NS below .-, ., ., DESCRIPTION OF OPERATIONS / LOCAT IONS / VEHICLES (ACORD 101 , Additional Remarks Sch edule , may be attached If more space Is required) Excluded from t he workers compensation policy TS F 0001253 554: John Orsburn The following policy provisions and /or endorsements form part of t he policies of insurance represented by this c ert i ficate of insurance. The terms contained in the policies and/or endorsements supersede the representa tions made herein . Electronic copies of the policy provisions and /or endorsements listed below are a v ailable by emailing : certificates @bmbinc.com See Attached .. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Cupertino THE EXPIRATION DATE THEREOF , NOTICE WILL BE DELIVERED IN 10300 T orre Avenue ACCORDANCE WITH THE POLICY PROV ISIONS . Cupertino CA 95014 AUTHORIZED REPRESENTAT IVE I ~Jat{;IJ:?/~ © 1988-2014 ACORD CORPORATION . All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER I D: BRAZOSURET ---------------------- LO C #: ~ ACORD® ~-ADDITIONA L REMARKS SCHEDULE AG EN CY NAMED IN SURED Bowen, Miclette & Britt Brazos Urethane , Inc. 1031 6th Street North POLICY NUMBER Texas City TX 77590 .. CARRI ER I NA IC CO DE EFFE CTIV E DATE: ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM , FORM NUMBER : 2 5 FORM TITLE : CERT IF I CA TE OF L I ABIL ITY I NSURA NCE General Liability: Blanket additional insured Ongoing Operations per fo r m# CG 20 1 0 04 13 Blanket additional insured Completed Operations per fo r m# CG 20 37 04 13 Blanket waiver of subrogation per form# CG 2 4 04 05 09 Blanket primary/non -con tribu t ory per form# GL 00030 00 (10/09) Automobile : Blanket additional insured per form# FM 114 .0.1378 11 11 Blanket waiver of subrogation per form# FM 114.0.1378 11 11 Worker's Com pensation: Blanket waiver of subrogation per form# WC 42 03 04 A (TX) & WC 00 03 13 (OS) Umbrella : Blanket additional insured per form# NAV-EXC-001 (0 4 /10 ) Blanket waiver of subrogation per form# NAV-EXC-001 (0 4 /10 ) Blanket primary/non-contributory per form# NAV-EXC -348A (01/11) Re : Library and Community Hall Roof Restor ation Proj~ct Page 1 of 1 Certificate Holder to Include : The City of Cupertiho ,and its directors, officers, engineers, agents and employees, and all public agencies from whom permits will be obtained and their direc t ors , officers, engi neers , agents and employees, and the State of California, and its officers, agents and employees . ACORD 101 (2008 /01 ) © 2008 ACORD CORPORATION . All r igh ts reserved. The ACORD name and logo are registered marks of ACORD Effective Dates : 5/31/20 16-5/31/20 17 POLICY NUMBER 0309-0207 COMMERCIAL GENERAL LIABILITY CG 24 04 05 09 WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US T his endorsement modifies ins urance provided under the following : COMMERCIAL GENERAL LIA BILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILIT Y COVERAGE PART SCHEDULE Name Of Person Or Organization: Any person or organ ization against whom you have agreed to waive your right of recovery in a written contract, provided such contract was executed prior to the date of loss. Information requ ir ed to complete th is Schedule , if not shown above, will be shown in t he Dec larations. T he follow ing is added lo Para graph 8. Transfer Of Rights Of Recovery Against Others To Us oF Section IV -conditions : We waive any right of recovery we m ay have aga inst the person or organization shown in the Schedule abo ve because of payments we make for injury o r damage a ris ing out of your ongoing operations or "your work" don e und er a con tract with that person or organi zation and included in the "prod ucts - completed operations hazard". This waive1-app li es only to the pers on or organ irnt ion shown in lhe Schedu le above . CG 24 04 05 09 © Insurance Services Office , Inc , 2008 Page 1 of 1 D Eff ecti ve Dates : 5/31 /2016 -5/31/20 17 Policy Number : 030 9-0207 COMMERCIAL GENERAL LIABILITY TH I S ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED -WHERE REQUIRED UNDER CONTRACT OR AGREEMENT (PRIMARY AND NON-CONTRIBUTORY WHERE REQUIRED UNDER CONTRACT) This endorsement mocifics insurance provided under the fo ll owing . COMMERCIA L GE NERAL LI A BILITY COVERAG E PART Section II -Who Is An Insured is amended to include any person or organization to whom you become obligated to include as an additional insured under t his po licy , as a result of any contract or ag reement you enter into which requ ires you to furnish insurance to that person or organization of the type prov ided by th is po licy . However , t he insurance provided wi ll not exceed the lesser of a The coverage and/or limits of t his policy ; or b. The coverage and/or limi ts requ ired by said contract :::ir agreement Coverage afforded to these additional insured part ie s will be primary to , and non-contributory with , any other insurance available to that pe rson or organi zation w here required of you by written contract or agreement GL 00030 00 (10/09) Policy Number: 133-739073-9 Effecti ve Date: 5/31/2016 -5/31/2017 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFUU. Y. COMMERCIAL AUTOMOBILE BROAD FORM ENDORSEMENT This endorsement modifies insurance provided under the following : BUSINESS AUTO COVERAGE FORM SCHEDULE 1 . Broadened Insured Status 14 . Audio , Visual , And Data Electronic Equipment 2 . Blanket Additional Insured When Required Und er Written Contract 15. Loan/Lease Payoff Coverage 3. Employee Hired Autos Liabi lity Coverage 16 . Airbag Coverage 4. Employees As Insureds 17. Multiple Deductible Protection -Covered "Auto" And Trai ler 5. Coverage Extensions -Supplementary Payments 18. Duties In The Event Of An Accident , Limited Fellow Employee Cove ;~ge Cla im, Suit, O r Loss 6. 19. Non -Owned Aut o Waiver Of Subrogation 7. Limited Hi red Aut o -Phy sical Dam age Coverage -Private Passenger (In c ludes 20 . Blanket Waiver Of Subrogation When Employee Hired Autos Physical Damage Required Under Written Contract Coverage) 21 . Coverage Territory -Short Term Hired 8. Custom Signs And Decoration Commerc ial "Autos" 9 . Extended Towing Coverage 22. Limited Mexic o Coverage 10 . Glass Breakage 23 . Un intentional Fai lure To Disclose Hazards 11 . Reimbursement For Increased Tempo rary Transpo rtation Expense For Private 24 . Mental Anguish Resulting From "Bodily Passenger And Commercia l Vehicles Injury" 25 . Waiver Of Sovereign Immunity 12. Extra Ex pense -Stolen Vehicles 26 . Application Of This Endorsement 13 . Personal Effects Coverage FM 114 .0 .1378 1111 Page 1 of 10 In cludes copyr ighted mate ri al of Insuran ce Ser vice Office , Inc. with it s perm iss ion . 0133-739073 -9 Effective Date: 5/31/2016 -5/31/2017 1. Broadened Insured Status SECTION II -LIABILITY COVERAGE , Paragraph A Coverage , Subparagraph 1 . Who Is An Insured is amended to include as an insured : A. Any subsidiary which is a legally incorporated entity of which you own a financial interest of more than 50% of the voting stock on the effective date of this Coverage Form, While using with your permission a covered "auto." However, the insurance afforded by this provision 1.A does not apply to any subsidiary that is an insured under any other autorn_obiJe liability policy , or would be an insured under such policy but for the termination of such pdlicy or the exhaustion of such policy 's li mits of insurance . B . Any organization you newly acquire or form, and over which you maintain majority interest, while using with your permiss ion a covered "auto". The insurance afforded by this provision 1.B.: 1. Is effective on the acquisition or formation date, and is afforded only until the end of the policy period of this Coverage Form , or the next anniversary of its inception date , whichever is earlier . 2. Does not apply to "bodily inju ry" or "property damage'! resulting from an "accident" th at occurred before yo_u acquired or formed the or ganization . 3. Does not include any newly acquired or formed organ ization that is ; a. A joint venture or partnership ; or b . An insured under any other automobile liability policy , or would be an insured under such policy but for the termination of such poli c y or the exhaustion of su c h policy 's limits of insurance . 2. Blanket Additional Insured When Required Under Written Contract Paragraph A 1. Who ls An Insured under SECTION 11 -LIABLITY CO~GEis amended to add : d . Any person , organization or governmental entity with respect to the operation, maintenance , or use of a covered "auto" if you are required to add such person , organization or governmental entity to -this policy as an additional "insured" in order to comply with the ter ms of a written contract or written agreement . T his Additional Insured status is not conferred when such written contract or written agreement : (1) Involves the owner or anyone else from whom you hire or borrow a covered "auto" unless it is a "trailer" connected to a covered "auto" you own ; or (2) Is executed after the date of "accident" or "loss"; Pa ragraph d .(2) above does not apply if: (a) the te rms and co nditions of the written co ntract or written agreeme nt had been agreed upon prior to the "accident" or "loss"; and (b) you can definitively establ ish that the terms and conditions of the written contract or written agreement ultimately executed are the same as those which had been agreed upon prior to the "accident" or "loss". Paragraph a. of Condition 5. Other Insurance of Part B. General Conditions under Section IV -Business .Auto Conditions is amended by the addition of the following : Regardless of whether other insurance is maintained by an additronal insured on a primary basis, the coverage provided by Provision 2. of the Commercial Auto Broad Form Endorsement will be primary to and noncontrib uting with other insurance maintained by the add itional insured if the written contract or written agreement between you and the additional insured specifically requires that this insurance be primary . FM114.0.13781111 · Page2of10 Includes copy r ighted mate ri al _ of ln,sur;ance S.ervice Office , Inc. with its permission. ' 133-739073-9 Effective Date : 5/31/2016 -5/31/2017 3. Employee Hired Autos Liability Cowrage The following is added to the Who Is An Insured Provision of SECTION II --LIABILITY COVERAGE : An "employee" of yours is an "insured" while operating an "auto" hired or rented under a written contract or written agreement in that "employee 's" name , with your pe r mission , while perfo r ming duties related to the conduct of your business . 4. Employees As Insureds The following is added to the Section II -LIABILITY COVERAGE, Paragraph A 1. Who Is An Insured Provision: Any "employee" of yours while using with your permission a covered "auto" you don 't own, hire o r borrow if such "auto" is being used in your business or your personal affairs. 5. Coverage Extensions · Supplementary Payments Paragraphs a .(2) and a .(4) under SE CTION II -LIABILITY COVERAGE , Paragraph 2.a . Supplementary Payments are revised as follows : 1. In a.(2}, the limit fo r the c ost of bail bonds is increased to $5,000; and 2 In a .(4), the limit for the actual los s of earnings is in c reased to $1 ,000 per day . 6. Limited Fellow Employee Cowrage The fo llowing is added to Subparagraph 5. Fellow Employee under Paragraph B. Exclusions in SECTI O N II -LIABILITY COVERAGE: But thi s exclu sion does not apply if : a . the "b o dily inju r y" results fro m the use of a cove red "auto " you o wn or hire, and b . yo u have Workers Compensation in sura nc e in force co ve rin g all of your "employees ." Su c h c overage as is afforded by this provisi o n is excess over a ny other c ollectible insurance. 7 . Limited Hired Auto -Physical Damage Coverage -Private Passenger (Includes Employee Hired Autos Physical Damage Cowrage) The fo llowing is added to Subparag raph 1. under Paragraph A Coverage under SEC TION Ill -PHYSICAL DAMAGE COVERAG E : " d . Limited Hired Auto -Physical Damage ...c Private Passenger If hired "autos" are covered "autos" for Liability Coverage , and if Physical Damage Coverage of Comprehensive or Collision is provided under th is Coverage Form fo r any "auto" you own, then Comprehensive and Collision Physical Damage Coverages as provided under SECTION Ill -PHYSICAL DAMAGE COVERAGE of this Coverage Part are extended to "auto s" of the private pa ssenger type you or your employee hire s unde r a written contra c t or written agreement without a driver, at your direction , for the purpose of condu cting your bus iness , subject to the following : (1 ) The most we will pay for "loss" to any h ired "auto" is $35 ,000 or the actual cash value or cost to repair or replace , whichever is the least, minus a deductible . (2) The deductible will be equal to the largest dedu c tible applicable to any owned "auto " of the private passen g er type fo r that coverage, or $1,000 , wh icheve r is less . FM 114 .0.13781111 Page 3 of 10 Inc ludes copyr ig h ted mater ial of In s urance Ser vice Office , In c . w ith its permissio n . I';.' t33-739073-9 Effective Date: 5/31/2016 -5/31/2017 (3) Limited Hired Auto -Physical Damage -Private Passenger coverage is excess over any other collectible insurance . (4) Subject to the above limit , deductible, and excess provisions we will provide coverage equal to the broadest coverage applicable to any covered "auto" you own of the private passenger type insured under th .is policy. Coverage includes loss of use of that hired auto, provided it results from an "accident" for which you are legally liable and as a result of which a monetary loss is sustained by the leasing or rental concern . The most we will pay for any one ,;accident" is$20 per day subject to a maximum of$1,000. If a limit for Hired Auto -Physical Damage is shown in the Schedule , then that limit replaces , and is not added to, the $35 ,000 limit indicated above . This extension of coverage does not apply to any "auto" you hire or borrow from any of your "e mployees". partners (if you are a partnership), members (if you are a limited liability company), or members of their households. 8. Custom Signs And Decoration The following is.added to Paragraph A Coverage 1. under SECTION Ill -PHYSICAL DAMAGE COVERAGE : In the event of a total loss to an "auto" insured for auto physical damage coverage on this policy, in addition to the actual cash value of the "auto", we will pay the actual cost to repair or replace signage or custom paint details up to $5,000 . 9 . Extended To'Mng Cowrage If the named insured carries Comprehens ive and Collision Coverage for the damaged cove red co mme rc ial "auto", then th is c overa ge extension 9. applies to that covered "auto ." If the damaged covered "auto" is of the private passenger type, then in addition to Comprehensive and Collision Coverage , the damaged covered "auto" must also carry Towing Coverage in order for this c'overage extension 9. to apply . ·' •;' , The following is added to Paragraph A2. Towing under SECTION Ill -PHYSICAL DAMAGE COVERAGE : We will pay for towing and associated labor costs each time a covered "auto" is disabled . All labor must be performed at the place of disablement . If the "auto" is of the private passenger type , there will be no deductible . If the "auto" is not a private passenger type, a $250 dedu c tible will apply to this coven::1ge but It will not reduce the available lim it of insurance . For all types of "autos", the most we will pay under this coverage is $1,000 per disablement . "Autos" which are disabled do not include stolen vehicles. 10. Glass Breakage If you carry Comprehensive Coverage for the damaged covered "auto", then this coverage extension applies to that covered "auto": The following is added to Paragraph A3. Glass Breakage -Hitting A Bird Or Animal --Falling Objects Or Missiles under SECTI ON Ill -PHYSICAL. DAMAGE COVERAGE : Any de.ductible shown in the Declarat ions will not apply to glass breakage if such glass is repaired, in a manner acceptable to us, rather than replaced. If the glass must be replaced and there is no other damage associated with the "loss", the deductible will be $100 unless a lower deductible is shown on the declarations page for this coverage. FM 114.0 .13781111 Page 4 of 10 Inc ludes copy r ighted materia l of Insu rance Service Office, Inc. w ith its permiss ion . ' 133-739073-9 Effective Date : 5/31/2016 -5/31/2017 11. Reimbursement For Increased Temporary Transportation Expense For Private Passenger And Commercial Vehicles A If The Covered "Auto" Has Comprehensive Or Specified Causes Of Loss Physical Damage Coverage: Paragraph a. Transportation Expenses under SECTION Ill -PHYSICAL. DAMAGE COVERAGE, A Coverage , 4. Coverage Extensions is replaced by the following : If your coveted "auto" is damaged or stolen and the damage or theft is covered by Comprehensive or Specified Causes of Loss coverage provided by this policy, we will pay up to $50 per day subject to a maximum limit of $1 ,500 for the necessary and actual temporary transportation expenses (including rental reimbursement) incurred by you during the period beginning 24 hours after the theft or damage and ending , re.gardless of the policy's expiration, a . when the covered "auto" is returned to use or we pay for its "loss" in the event of a total theft of the covered "auto", or b . when the covered "auto" is repaired or replaced, or we pay for its "lo.ss''; whichever is earlier in the event of a "loss" due to a cause other than the total theft of the covered "auto." Except with respect to losses pertaining to the total theft of covered "autos" of the private passenger type, this coverage does not apply while there are spare or reserve "autos" available to you . No deductible applies to this coverage. B. If The Covered "Auto" Has Collision Physical Damage Coverage: If your covered "auto" is damaged and the damage is covered by Collision coverage provided by this policy, we will pay up to $50 per day subject to a maximum limit of $1 ,500 for necessary and actual temporary transportation expenses (including rental reimbursement) incurred by you during the period beginning 24 hours after the "loss" and ending , regardless of the policy's expiration, when the covered "auto" is repaired or replaced , or we pay for its ''loss", whichever is earlier. This coverage does not apply while there are spare or reserve "autos'' available to you . No deductible applies to this coverage . 12. Extra Expense -Stolen Vehicles The following is added under Paragraph A4.a. Coverage Extensions of SECTION Ill - PHYSICAL DAMAGE COVERAGE : . We will pay for all reasonable and necessary expenses to return a stolen covered "auto" to the named insured if such covered "auto" carries Comprehensive coverage. FM 114 .0.13781111 Page 5of 10 Includes copyrighted material of Insurance Service Office , Inc. with its permission . 133-739073-9 Effective Date: 5/31/2016 -5/31/2017 13. Personal Effects Cowrage Paragraph A Coverage under SECTION Ill -PHYSICAL DAMAGE COVERAGE is amended to add the following coverage: Personal Effects Coverage 1. We will pay for "loss" to personal property or effects which are owned by an insured and in or on your covered "auto" at the time bf "lo.ss" in the event of a total theft of that covered "auto." 2. Subject to Paragraph C. Limit Of Insurance under SECTION Ill -PHYSICAL DAMAGE COVERAGE , we will pay up to $500 for "loss" of personal property or effects in any one "accident" involving total theft of a covered "auto". This insurance will not apply if, at the time of "loss", the covered "auto" is unattended, unless the "loss" is the result of forced entry into the covered "auto" while all doors , windows or other openings are closed and locked and there is evidence of forced entry . Under this extension , we will not pay for "loss'' to the foUowing: accounts, bills, currency, deeds, evidences of debt, money, notes or securities; electronic equipment or tapes, records , discs or other sim ilar a.udio, visual or data electronic devices designed for use with audio, visual or data electronic equipment ; ~welry, watches, necklaces, bracelets, gems , gold , platinum , silver ,furs; animals, birds , or fish or any motorized vehicle . This coverage will be excess over any other collectable insurance . No deductible applies to this coverage. 14. Audio, Visual, And Data Electronic Equipment The sub-limit in Paragraph C .2. of the Limit of Insurance Provision of SECTION Ill- PHYSICAL DAMAGE COVERAGE is increased to $1,500 . 15. Loan/Lease Payoff Cowrage The following is added to Limit of Insurance of SECTION Ill -PHYSICAL DAMAGE COVERAGE : In the event of a total "loss" to a covered "auto" shown in the schedule or declarations for which Collision and Comprehensive Coverage apply, we will pay any unpaid amount due on the lease or loan for that covered "auto," Je·ss ; 1. The amount paid under the Physical Damage Coverage Section of the policy , and 2. Any; a . Overdue lease/loan payments at the time of the "Joss"; b . Financial penalties imposed under a lease for excessive use, abnormal wear and tear or high mileage: c . Security deposits not returned by the lessor; d . Costs for extended warranties , Credit Life Insurance , Health , Accident or Disability Insurance purchased with the loan or lease: and e . Carry -over balances from previous loans or leases . This coverage is limited to a maximum of 1 $1,500 for ea c h covered "au~o". FM 114 .0 .1378 1111 Page 6 of 10 Includes copyr ighted mate ri al of Insu rance Service Office , Inc. with its perm ission . 133-739073-9 Effective Date : 5/31/2016 -5/31/2017 16. Airbag Coverage If the named "insured" carries Comprehensive and Collision Coverage for the damaged covered "auto", then this coverage extension 1.6. applies to that covered "auto". The following is added to Subparagraph 3:a. under Paragraph B. Exclusions in SECTION Ill -PHYSICAL DAMAGE COVERAGE: The accidental discharge of an airbag shall not be considered mechanical or electrical breakdown and therefore shall not be excluded . This provision does not apply to "autos" you hire with a driver and it is excess over any warranty specifically designed to provide this coverage . 17. Multiple Deductible Protection -Covered "Auto" And Trailer If you carry Comprehensive and Collision coverages for the damaged covered "autos", then this coverage extension 17 . applies to those covered "autos": The following is added to Paragraph D. Deductible under SECTION Ill -PHYSICAL DAMAGE COVERAGE : Whenever a covered "auto" and trailer are each damaged in the same "loss" while operating as a combined truck and trailer unit, only one deductible shall apply to the "accident". The larger of the two deductibles shall apply . If another policy o r coverage form issued by us , that is not an automobile policy or coverage form , applies to the same "loss" or "accident", the following applies: 1. If the deductible under this Business Auto Coverage Form is not the largest deductible , it will be waived. 2. If the deduc tible under this Business Auto Coverage Form is the largest deductible , it will be redu ce d by the amount oftne smaller (or smallest) deductible . 18. Duties In The Event Of An Accident, Claim, Suit, Or Loss A. Subparagraph 2.a. under Paragraph A Loss Conditions in SECTION IV -BUSINESS AUTO CONDITIONS is amended so that your obligations relative to notification requirements apply only when the "accident" or "loss" is known to: 1. You , if you are an individual ; 2. A partner, if you are a partnership ; 3 . A member , if you are a joint venture ; 4 . An executive officer, insurance manager or any other person designated by you to send notices of "accidents" or "loss" to insurers, if you are a corporation; or 5. A member , if you are a limited liability company . B . Subparagraph 2.b.(2} under Paragraph A Loss Conditions in SECTION IV -BUSINESS AUTO CONDITIONS is amended so that your obligations relative to providing us with documents concerning a claim or "suit" will not be considered breached unless the breach OGcurs after such claim or "suit" is known to: 1. You, if you are an individual ; 2 . A partner , if you are a partnership ; 3. A member , if you are a joint venture,; 4 . An exec utive officer , insura·nce rri.anage r or any other person designated by you to send notices of claims or "suits" to insurers , if you are a corporation; or 5. A member , if you are a limited liability company. FM 114 .0.1378 1111 Page 7 of 10 Includes copyr ighted mate ri al of In sur ance Ser vice Office , In c. with its permiss io n. 133-739073-9 Effective Date : 5/31/2016 -5/31/2017 19. Non-Owned Auto Waiwr Of Subrogation The following is added to Subparagraph 5: Transfer Of Rights Of Recovery Against Others To Us , under Paragraph A Loss Conditions in SECTION IV-BUSINESS AUTO CONDITIONS: We hereby waive any right of subrogation against any of your officers, directors, or "employees" which might arise by reason ofany payment under the insurance afforded by this policy for the operation , maintenance, use, loading , or unloading of non-owned "autos". This waiver extends only to payments in excess of other valid and collectible insurance available to the officer, director, or "employee". 20. Blanket Waiver Of Subrogation When Required Under Written Contract The following is added to Subparagraph 5. Transfer Of Rights Of Recovery Against Others To Us , under Paragraph A Loss Conditions in SECTION IV -BUSINESS AUTO CONDITIONS : However, we waive any right of recovery we may have against a person, organization or governmental entity when you have waived such right ofrecovery under a w ritten contract or written agreement provided such written contract oragreement is : 1. currently i.n effect or becoming effective during the term of this policy ; and 2. executed prior to the "accident" or "loss"; or 3. executed after the "accident" cir "loss" if: a . the terms and conditions Qf th e writ,tEih contract or written agreement had been agreed upon prior to the "accident'; or "loss"; and b . you can definitively establish that the terms and conditions of the written contract or w ri tten agreement ultimately executed are the same as those which had been agreed upon prior to the "accident" or "loss". 21. Coverage Territory -Short Term Hired Commercial "Autos" Paragraph 7. Policy Period , Coverage Territory under Paragraph B. General Conditions in SECTION IV -BUSINESS AUTO CONDITIONS is amended by the addttioil of the following : The coverage territory is extended to anywhere in the world if: 1. A covered "auto" of the commercial van, pick -up , or truck type is leased, hired, rented or borrowed for a period of 30 days or less ; and 2. The "insured's" responsibility to pay damages is determined in a "suit" on the merits, in the United States of America, the territories and possessions of the United States of America, Puerto Rico, or Canada or in a settlement we agree to . We will also cover "loss" to , or "accidents" involving, a covered "auto" while being transported between any of these places . FM 114.0 .13781111 Page 8 of 10 In cl udes copyr ighted mate r ial of Insurance Service Office , Inc . with its permiss ion . 133-739073-9 Effective Date : 5/31/2016 -5/31/2017 22. Limited Mexico Coverage WARNING AUTO ACCIDENTS IN MEXICO ARE SUBJECT TO THE .LAWS OF MEXICO ONLY -NOT THE LAWS OF THE UNITED STATES OF AMERICA. THE REPUBLIC OF MEXICO CONSIDERS ANY AUTO ACCIDENT A CRIMINAL OFFENSE AS WELL AS A CIVIL MATTER. IN SOME CASES THE COVERAGE PROVIDED UNDER THIS ENDORSEMENT MAY NOT BE RECOGNIZED BY THE MEXICAN AUTHORITIES AND WE MAY NOT BE ALLOWED TO IMPLEMENT THIS COVERAGE AT ALL IN MEXICO. YOU SHOULD CONSIDER PURCHASING AUTO COVERAGE FROM A LICENSED MEXICAN INSURANCE COMPANY BEFORE DRIVING INTO MEXICO. THIS ENDORSEMENT DOES NOT APPLY TO ACCIDENTS OR LOSSES WHICH OCCUR OUTSIDE OF 25 MILES .FROM THE BOUNDARY OF THE UNITED STATES OF AMERICA. A. Coverage 1 . Paragraph 7. Policy Period , Coverage Territory of the General Conditions is amended by the addition of the following : T he coverage territory is extended to include Mexico but only for: a. "Accidents" or "losses" occurring within 25 miles of the United States border ; and b . Trips into Mexico of 10 days or less . 2. Condition 5. Other Insurance of Part B. General Conditions under Section N - Business Auto Conditions is replaced by the following : The insurance provided by this Provision 22 Will be excess over any other collectible insurc:1nce. B. Physical Damage Coverage is amended by the addition of the following: If a "loss" to a covered "auto" occurs in Mexico , we will pay for such "loss" in the United States . lfthe covered "auto" must be repaired in Mexico in o r der to be driven, we will not pay more than the actual cash valu.e of such "loss" at the nearest United States point where the repairs can be made . C. Additional Exclusions The following additional exclusions are added : This insurance does notapply: 1. If the covered "auto" is not principally garaged and principally us.ed in the United States . 2 . To any "insured" who is not a resident of the United States . 23. Unintentional Failure To Disclose Haz~rds . The following is added to Paragraph B. General Conditions in SECTION IV -BUSINESS AUTO CONDITIONS: If you unintentionally fail to disclose any hazards existing on the effective date of this policy , we will not deny coverage under this Coverage Form because of such failure . However, this provision does not affect our right to collect additional premium due to us as a result of.these undisclosed hazards in accordancewith our filed rating plans . FM 114.0 .1378 1111 Page 9 of 10 In c ludes copyr ighted mate r ial of Insurance Service Office, Inc . with its permiss ion . 1'33 -739073 -9 Effective Date : 5/31/2016 -5/31/2017 24. Mental Anguish Resulting From "Bodily Injury" The definition of "bodily injury" in SECTION V -DEFINITIONS is replaced by the following : "Bodily injury" means physical injury , physical sickness or physical disease sustained by any person , including ''mental anguish" or death resulting from any of these . It does not include mental anguish to any person which occurs in the absence of physical in jury, physical sickness or physical d isease to that person . For the purpose of this provision , the term "mental anguish" shall mean any type of mental or emotional illness or distress . 25. Waiver Of Sovereign lrnmunity The following provision applies if you are a "governmental entity " or we have added a "governmental entity" to your policy as an additional insured , and the "governmental entity" requires us to obtain permission prior to asserting a defenseinvolving governmental immunity or the jurisdiction of fhe tr ibunal over the "governmental.entity": We shall not raise any defense involving. in c;Jnyway, the jurisdiction of the tribunal over the "governmental entity", the immunity of the "governmental entity" or its commissioners , offi cers , agents or employees , the governmental nature of such entity . or the provisions of any statutes respecting suits ag·ainst the" governmental entity" without first obtaining express advance pe r mission from th'e designated representative of the "governmental entity ." Appli cation of this provision shall not subject us to liability for a ny portion of a claim or jud gme nt in excess of the applicable limit of insurance . For the pu r poses of this provision . "govern mental entity" means a state , county, district, municipality, town. township, borough, parish, village, or other political subdivision or governmental agency or subdivision . 26. Application Of This Endorsement The coverage enhancements provided by this endorsement apply to the Business Auto Coverag e Form . If your policy in c ludes other endorsements in addition to this Commerc ia l Automobile Broad Form Endorsement , and the re Ls a conflict between any of the terms of such endorsement(s) and this Commercial Automobile Broad Form Endorsement, the terms of the other endorsement(s) shall be given priority and control over the terms set forth in this Commercial Automobile Broad Form Endorsement, even if the terms of such other endorsement(s) have the effect of limiting, excluding or reducing the coverage provided under this Commercial Automobile Broad Form Endorsement . All other terms and conditions remaih unc:~i:111ged. FM 114 .0.1378 1111 Page 10 of 10 Includes copyr ighted material of Insurance Service Office , Inc. with its permiss ion. lexasMutual® Insurance Company WORKERS' COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 42 03 04 A TEXAS WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT This endorsement applies only to the insurance provided by the policy because Texas is shown in Item 3 .A. of the Information Page . We have the right to recover our payments from anyoµe 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'.' : 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 w hich ii 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 5/31/2016 at 12:01 A .M . standard t ime, forms a part of Policy No . TSF0001253554 of the Texas Mutual Insurance Company Issu ed to BRAZOS URETHANE I NC Endorsement No. Prem ium$ Authorized Representative WC420304A (ED. 1..01-2000) WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT WC 00 03 13 (Fd. 4-84) We have the right to recover our payments from anyone liable for an Injury covered by this policy. We will not enforce our righ! against \he person or organization named in the Schedule. (This agreement applies only to the extent that you perform work under a written contract that requires you to obtain this agrooment from us.) This agreement shall not operate direcily or indimctly lo benefit anyone not named in the Schedule. Schedule Blanket Where required by written contract This endorsemen1 changes the pollcy to which il is anached and is e!fective on the date issu ed unlt,s~ utl.,,wise statBd . (The information below is required only when th~ endorsement is issued subsequent to preparation of the policy.) Endorsement Effective Date: 5/31/2016 Policy Effective Date: 5/31/2016 -5/31/2017 Insured : BRAZOS URETHANE INC Pol icy Number: WC927908254314 Endorsement No . Premium$ Carrier Name I Code: Argonaut Insurance Company . ft.:, WC 00 03 1 J Co<Jnler.signed by --~--~-__ fl_ tY_~_. ____ _ (Ed. 4-84) e 1913 National Council on Compensation lmi.a,nc:e. Page 1 of 1 Policy Number: HO 16EXC8087051C Effective Date: 5/31/2016-5/31/2017 Commercial Excess Liability Coverage Part Various provisions of th is policy restrict coverage . Read the entire policy carefully to determine your rights , duties and what is and is not covered . Throughout the po licy the words "you " and "your" refer to the Named I nsured . The words "we ," "us " and "our" refer to the company providing this insuran ce. The word "i nsured " means any other person or organization qualifying as such under SECTION II -WHO IS AN INSURED . OH1er words and phrases that appear in quotations in this policy have specia l meanings . Refer to SECTION V -DEFINITIONS. SECTION I -COVERAGE 1 . Insuring Agreement A. Excess Liability 1 . We will pay on behalf of the insured and in excess of "underlying limits" those sums the insured becomes legally obligated to pay as damages for "loss" to which this insurance applies. This insurance applies only if: a . the "loss" is caused by an "event " that takes place in the cove rage territory ; b . the "loss" occurs during the "policy period;" and c . the "controlling underlying insurance " applies to the "loss ." 2 . If an aggregate limit of "controlling underlying insura nce " is exhausted by the payment of judgments or settlements to which this insurance applies , or would have applied but for the amount of the damages , this insurance w ill apply in place of the "contro lling underlying insura nce " until we have paid our applicable Lim its of Insurance . 3 . When paragraph 2. above applies, ending the "controlling underlying insurance " obligations to investigate and settle cla ims or defend suits against the insured , we have the right and duty to investig ate claims and defend suits which seek damages to which this insurance applies . Our right and duty to defend end when we have paid our applicable Limits of Insurance . 4 . When paragraph 2. above does not apply , we have the right, but not the duty , to participate in the investigation or settlement of any claim or the defense of any suit against any insured . 5. We have the righ t, at our discretion , to settle any claim to which th is insurance appl ies . 6 . As respects paragraphs 3 . and 4 . above, "defense expenses" we incur in the investigation of any claim or defense of any su it will be paid in addition to the Limits of Insurance except when such costs reduce the limi ts of "controlling underlying insurance ," in wh ich case they will reduce our Limits of Ins urance. 7 . The amount we pay is limited. See SECTION Ill -LIMITS OF INSURANCE . 2 . Excl us ions The EXCLUSIONS sect ions of the "control ling underlying insurance " are made part of this policy . If an inconsistency or contradiction exists between an Ex clusion of this policy and an Exclusion of the "con trolling underlying insurance " th e Exclusion of this policy will apply . NA V-EXC-00 I (0 +/10 ) Navigators Specialty Insurance Company Conta ins copyrighted material of the Insurance Services Office , Inc. with its permission . Pa ge I of7 Policy Number: HO 16EXC8087051C Effective Date : 5/31/2016 -5/31/2017 However, in no c ase w ill co ve ra g e be excluded by the "controlling unde rly ing insurance" and not excluded by this policy . This insurance does not apply to any liability : 1 . to which "controlling underly in g insurance " does not apply ; 2 . for which coverage is provided by "controll ing underlying insurance " at limits less than the limits of insurance applicable to other coverage provided by the "controlling underlying insurance" and less than "underlying limits ;" 3 . fo r "lo ss " which commenced prior to this ;'pol icy period ." whethe r or not su ch "loss" continues , progresses , c hanges or resumes during this "pol icy period ;" 4 . fo r damage to property you own , rent or occupy , including any costs or expenses incurred by you or any othe r person , organization or entity , for repair, replacement , enhancement , restoration or ma intenance of such property for any reason , including the prevention of injury t o a person or damage to another's property; 5. fo r damage to personal property in the care , custody or contro l of any insured ; 6 . arising out of any "aircraft products;" 7 . arising out of t he actual , alleged , suspected or threa tene d inhalation of, ingestion of, conta ct with , exposure to , existence of, or presence of "asbestos ;" 8 . arising out of the actual , alleged , suspected or threatened inhalation of, ingestion of, contact with , exposure to , existence of, or presence of "fungi " or bacteria ; 9 . aris ing o ut of the actual , alleged , suspected or threatened i nhalation of, ingestio n of, co nta ct with . exposu re to , existence of, or presence of "silica " or "sili ca related dust ;" 1 O. arising out of any "employment practi ce s " of any insured ; 11. ari si ng out of: a. war, includ ing undec la red or civil war; b . warlike act ion by a military force , including act ion in hindering or defending against an actual or expected attack . by any government , sove reign or other authority using military personnel or other agents ; or c . insurrection , rebel li on , revolution , usurped power, or action taken by governmental authority in hindering or defending against any of these ; 12 . imposed under: a. an uninsured or underinsµred motorist, uninsured or underinsu red boater, Medical Payments , Personal lnju,y Protecti o n , No-Fault or any similar law ; b. a workers compensation ,'disability benefits , unemployment compe nsation or any similar law; c the Employee Retirement Income Securit y Act of 1974 , any amendments thereto or any s imilar law. SECTION II -WHO IS AN INSURED The WHO IS AN INSURED sect ion of the "controlling underlying in surance " is made part of this polic y . Any person or organiza ti on that is an insured in "controll ing underlying insurance " is an insured in this policy to the same extent. NA V-EXC-0 0 I (0 +/10) Navigators Spec ialty Insu rance Company Conta in s copyrighted material of the Insurance Services Office , Inc. with its permission . Page 2 of 7 Policy Number: HO 16EXC8087051C Effective Date : 5/31/2016 -5/31/2017 SECTION Ill -LIMITS OF INSURANCE The Limits of Insurance shown in the Declarations and the rules below fix the most we will pay regardless of the number of insureds, claims made or suits brought , or persons or organizations making claims or bringing suits. 1. The General Aggregate Limit is the most we will pay for the sum of all damages to which this insurance applies , except: a. damages because of bodily injury or property damage included within any applicable products-completed operations hazard ; or b. damages arising out of the ownership , operation , maintenance or use of an automobile ; · 2 . The Products-Completed Operations Aggregate Limit is the most we will pay for the sum of all damages included within any applicable products-completed operations hazard ; 3. Subject to paragraphs 1. and 2. above, the Each Event Limit is the most we will pay for all damages that arise out of any one "event." SECTION IV -CONDITIONS The CONDITIONS sections of the "controlling underlying insurance " are made part of this policy . If an inconsistency or contradiction exists between the Conditions of this policy and the Conditions of the "controlling underlying insurance ," the Conditions of this policy will apply . 1. Appeals At our discretion we may appeal any judgment which would resul t in a payment under this policy . When we do appeal , we will pay all costs associated with the appeal in addition to the Limits of Insurance. Any such appeal will not increase our Limits of Insurance . 2 . Bankruptcy or Insolvency Bankruptcy or insolvency of the insured or the insured 's estate will not relieve us of our obligations under this policy . Bankruptcy or insolvency of any company providing "controlling underlying insurance " will not reduce the "underlying limits" or increase our obligations under this policy. We .will not be required to drop down or replace "controlling underlying insurance." 3. Cancellation a . The first Named lnsureq ,may .cancel this policy at any time by providing us advanced written notice of the cancellation date . b. We may cancel this policy at any time by providing the first Named Insured written notice of cancellation : i. at least 10 days in advance if we cancel for non-payment of premium ; or ii. at least 30 days in advance if we cancel for any other reason : c . If the "controlling underlying insurance " is cancelled for any reason, this policy is also cancelled . Reinstatement of the "controlling underlying insurance " does not reinstate th is policy unless reinstatement is endorsed hereon . Return premium , if any , will be calculated per Condition 11 . Premium. Proof of mailing will be proof of notice . NA V -EX C-00 I (O-i /10 ) Navigators Spe c ialty Insurance Company Contains copyrighted material of the Insurance Services Office , Inc. with its permission . Pa ge J of 7 Policy Number: HO 16EXC8087051C Effective Date: 5/31/2016 -5/31/2017 4 . Non-Renewal a. We are not obligatecl to renew this policy. However, should we decide not to renew , we will provide the first Named Insured written notice of our decision at least 30 days prior to the expiration date shown in the Declarations . b . We will not restrict the terms or increase premium of this policy at renewal unless we have given the first Named Insured at lea st 30 days advanced notice of any such changes. However, no notice will be provided or required if a restriction in this policy results from a restriction applicable to "controlling underlying insurance ." c . The first Named Ins ured may non-renew this policy by : 1. providing advance written notice ,to us ; ii. rejecting our offer to renew ; or iii. failing to reply to our offer to renew . Proof of mailing will be proof of notice . 5 . Changes Th is policy contains all of the agreements between you and us . This policy may only be changed by endorsements we issue. 6 . Duties When There is an "Event," Claim or Suit a . You must see to it that we and any other insurers who could provide coverage are not ifie d as soon as practicable of any "event" which may be reasonably expected to result in a claim under this policy. To the extent possible , notice should include: i . how , when and where the "event " took place ; ii. the names and addresses of any injured persons and witnesses ; and iii. the nature and location of any injury or damage arising out of the "even t." b . If a c laim is made or suit is brought against any insured which may be reasona bly expected to result in a claim under this policy , you must: i. immediately record the specifics of the claim or suit and the date received; and ii. notify us, and any other insurers who could provide coverage, as soon as practicable . c . You and any other involved insured must: i . immediately send us , ·and any other insurers who could provide coverage , copies of any demands , notices, summonses or legal papers received in connection with a claim or suit which may be reasonably expected to result in a claim under this policy ; ii. authorize us to obtain records and other information ; iii. cooperate with us in the investigation or settlement of t he claim, issues relating to coverage under this policy or defense against the suit ; and iv. assist us , upon our request, in the enforcement of any right against any person or organization which may be liable to the insured because of the injury or damage to which th is insurance may apply. d . No insured will , except at that insured's own cost , voluntarily make a payment, assume any obligation or incur any expense , other than first aid , without our consent. Notice to us may be sent to our address shown in the Declarations. 7 . Legal Action Against Us No person or organization has a right under this insurance : a . to join us as a party or otherwise bring us into a suit asking for damages from an insured; or b . to sue us on this insuran ce unless all of its terms have been fully complied with . NA V-EXC-00 I (0+/10) Navigato rs Specialty Insurance Company Contains copyrighted material of the lnsuran~e ~erv/ces Office , Inc. with its permission . Page+ of 7 Policy Number: HO 16EXC8087051C Effective Date 5/31/2016 -5/31/2017 8. Ma intenance of Controlling Underlying Insurance During the "po licy period " you must ma in tain "controlling underlying insurance " with "underlying lim its " at least equal to the amounts shown in the Declarations . The "underlying limits" must be unimpaired at the beginning of this "policy period.'' If you fail to maintain the "control ling unde rlying insurance " this policy will be invalid . If you fail to maintain "underlying limits ," we will on ly be liable to the extent we would have been liable had you maintained the "underlying limits ." Reduction of "underlying limits " by the payment of judgments or settlements for "loss " to which this insurance applies , or would have applied but for the amount of the damages , will not be considered a failure to ma intain "underlying limits." 9. Other Insurance This insurance is excess over any insurance available to the insured except insurance purchased specifically to apply in excess of this policy. 10 . Payment of Damages When the amount of damages payable under this policy has been determined by final judgment or a written se ttlement agreem ent between the claimant and us , we will pay that amount , up to our applicable Limits of Insurance , after the "controlling underlying insuran ce " or the insured has paid the full amount of the "underlying limits." 11. Premium The Premium shown in the Declarations is the premiu m for the coverage we provide for the "policy period ." The first Named Insured is responsible for the payment of all premiums under this policy . If this policy is cancelled prior to its expiration date return premium will be calculated as follows : a . if cancelled by us : , ({(Premium)-(Minimum Earne d Premium)} x (Pro Rata factor)] b. if cancelled by you : ({(Premium) -(Minimum Ea rn ed Prem ium)} x {(Pro Rata facto r) x (.90)}]. 12 . Separation of Insureds Except with respect to the Limits of Insurance and any rights or duties specifically assigned in this po li cy to the first Named Insured , this insurance app lies : a. as if each Named Insured were the only Named Insured : and b . separately to each insured against whom claim is made or suit is brought. 13. Transfer of Rights of Recovery Against Others If an insured has rights to recover all or part of any payment we have made under this insurance , the insured must preseNe those rights and , at our request , pursue or transfer those r ights to us . The insured must do nothing after an "event" to impair them. 14. Reformation of Underlying If the "controlling underlying insurance " is reformed after an "event" to provide coverage fo r a "loss ," the terms of such reformation do not apply to this policy. 15 . When w e Defend When we have a duty to defend an insured , the insured w ill co operate with us in the transfer of the defense to counsel of our choosing . If the law of the governing jurisdiction pe rmits an insured to select thei r own counsel to be paid for by us , we shall only be liable for the reasonab le and necessary defense costs of one law firm per insured at rates customarily paid by us for the defense of similar claims in the jurisdiction where the cla im is pending . 16 . C laims outside the U.S.A. it's Territories , Possessions or Canada When we liave the duty to defend an insured and are prevented by law or otherwise from doing so, we will reimburse the insured for any reasonable and necessary expenses in curred in the defens e of a suit to wh ich this insurance applies. If the insured becomes legally obligated to pay damages to which this insurance applies NA V-EXC -00 I (O..J./10 ) Navigators Specialty Insurance Company Contains co pyrigh ted material of the Insurance Servi ce s Office , Inc. with its permission . P:-ige 5 of 7 Policy N°umber: HO 16EXC8087051C Effective Date : 5/31/2016 -5/31/2017 and we are prevented by law from paying s uch damages on behalf of the insured , we will reimburse the insured , in U .$ currenc;y_ at, the prevailing exchange rate at the time the damages were paid , for such damage~. SECTION V -DEFINITIONS The DEFINITIONS sections of the "co ntrolling underlying insurance " are made part of this pol icy, and apply to words or phrases used in this policy provided always that words or phrases in quotations in this poli cy w ill have the meaning given them in this po licy. "Aircraft products " means : a . an aircraft; b. ground control or support equipment; or c . any article , component or device made, sold , licensed , handled or distributed by any insurnd that is used to achieve , control or maintain fl ight or landing of an aircraft . "Asbestos " means the mineral in any form . "Controlling underlying insurance" means the policy listed in the Schedule of Underlying Insurance shown in the Declarations , or its renewal or replacement , which applies to the "loss ," or would have applied but fo r a . an exclusion in that policy ; or b . the exhaustion or erosion of an aggregate limit of insurance ; If more than one policy is listed in the Schedule. the "controlling underlying insurance" is the policy which applies to the "lo~s " m w'\)uld hc,!ve applied but for the reasons a. or b. listed above. ·· · "Defense expenses " means expenses we incur to invest igate a claim or defend a suit. Defense expenses include interest which accrues on our portion of a judgment , after entry of that judgment and after the insured or any underlying insurer has paid the full amount of the ir portion of the judgment but before we have paid , offered to pay or deposited in the court the part of the judgment that is within our applicable Limits of Insurance . "Employment practices" means: a. dism issal , disc harge or termination of employment , whether actual, constructive or retaliatory ; b . failure or refusal to hire or promote; c. discipline, demotion , coercion or retaliatory treatment; d. failure to grant tenure ; e . negligent employment evaluation ; f. sexual or other workplace harassment, including qu id pro quo and hostile work environment; g . employment discrimination; h. invasion of privacy, violation of employment related civil rights, employment related libel, slander or defamation; i. creating or enforcing or failing to create or enforce employment related policies or procedures ; or j. actual or alleged violatioris of.the Fc:1mily and Medical Leave Act of 1993 or its amendments . 1 "Event" means an accident, incident, occurrence , offense , wrongful act or other "l oss" causing "event" defined by and to which the "controlling underly ing insurance" applies. NAV-EX C-0 0 1 (0-1-/10 ) Navigators Specialty Insurance Company Conta ins copyrighted material of the Insurance Services Office , Inc. with its permission . Page 6 of 7 Policy Number:HO 16EXC8087051C Effective Date: 5/31/2016 -5/31/2017 "Fung i" means any type or form of fungus , including mold or mildew and any mycotoxins , spores, scents or byproducts produced or released by fungi. But "fungi " does not include mushrooms cultivated for human consumption. "Loss " means bodi ly inju ry , property damage , personal and adve11ising injury or other loss defined by and to which the "co ntrolling underlying insurance " applies . "Policy period " means the period of time between the effective date shown in the Declarations and the earlier of the expiration date shown in the De clarations or the expiration date shown in an endorsement to this policy. "Silica " means silicon dioxide , occurring in crystalline , amorphous or impure forms , silica particles , silica dust or silica compounds . "Silica related dust" means a mixture or combination of sil ica and other dust particles. "Underlying limits" means the am.aunts shown in the Declarations as the minimum limits of insurance to be provided by "controlling underlying insurance." In Witness Whereof, the issuing Company has caused this policy to be signed officially below, and countersigned on the Declarations page by a duly authorized representative of said Company. Stanley A . Galanski President NA V -EXC-00 I (O.i /10 ) Jeff L. Saunders Vice President Navigators Specialty Insurance Company Contains copyrighted material of the Insurance Services Office , Inc. with its permission . Page 7 of7 ' ' HO 16EXC8087051C Effective Date : 5/3 1/20 16 -5/31/2017 COMMERCIAL EXCESS LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. AMENDMENT OF CONDITIONS OTHER INSURANCE PRIMARY AND NON-CONTRIBUTING This endorsement modifies insurance provided under the fol lowing : COMMERCIAL EXCESS LIAB.ILITY COVERAGE PART SCHEDULE When required by written contract execute d before the ''Joss " A. Section IV -Conditions , 9. Othe r Insurance is deleted and replaced by the following : 9. This insurance is excess over any other insurance avai lable to the insured except: a. insurance that is purchased specifically to apply in excess of this policy ; or b. insurance available to the person or organization shown in the Schedule of this endorsement as an additional insu red on the "controlling underlying insuran ce ." B . When this insurance applies on a primary and non-contributing basis , the Limits of Insura nce available for the addit ional insured will be the lesser of: 1. the amounts shown in item 3 of the Declarations of this policy; or . ' 2 . the amount of insurance you are required to provide the additional insured in the written contract or agreement . All other terms of the policy remain unchanged. NAV-EXC-348A (01 /11) Navigators Specialty Insurance Company Contains copyrighted material of the In surance Services Office , Inc. with its permission . Page 1 of 1 Effective Dates : 5/31/2016 -5/31/2017 Policy Number: 0309-0207 COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADVICE OF CANCELLATION TO OTHERS (EMAIL) This endorsement modifies insurance provided under the following : COMMERCIAL GENERAL LIABILITY COVERAGE PART Section IV -Commercial General Liability Conditions is amended to include the following additional condition: Advice Of Cancellation To Others In the event that we cancel this policy for any reason, other than nonpayment of premium , and the effective date of cancellation is prior to the expiration date . we will endeavor to provide adv ice of such can cel lat ion to a certificate holder, provided that all of the fo ll owing are met: 1. The first Named Insured is under an existing contractual obligation to notify such certificate holder when this pol icy is canceled ; and 2 . The effective date of cancella ti on is prior to the expiration date ; and 3. The first Named Insured sends an email to us , after receiving written notice of cancellation but prior to th e effective date of cancellation , requesting that we provide advice of cancellation to such certifi cate holder. The email request must include the name and email address of such cedifi,c~ie ho;lder We will send the advice of cancellation through email to the ce rtifi cate holder w ithi n 30 days after the receipt of the email request from the first Named Insu red . We will send an email only when a valid email address is provided . The email we send is intended as a courtesy . Our failure to provide such emai l will not extend the policy cancellation date nor negate the cancellation of the po licy . BU Manu A i 33-739073-9 Effective Date : 5/31/2016-5/31/2017 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY NOTiC£ Oi·' CANCELLATION FOR CERTIFICATE HOLDERS This endorsement modifies insurance provided under this policy . A If we cancel this policy for any reason other than nonpayment of premium , we will endeavor to provide notice of such cancellation by electronic mail to any person or organization set forth in a list provided to us by the First Named Insured , subject to the following conditions: 1. The list shall only contain the names and e-mail addresses of persons or organizations : (a) that have been sent a certificate of insurance ; and (b) that you are required to notify in the event of a cancellation of the policy . 2. You must send us a written request to provide such notice as soon as possible after the First Named Insured shown in the Declarations receives notice from us of the ca ncellation of this policy ; 3. We must re c eive such written request no later than 15 days after the date the notice of cancellation was sent by us to the First Named Insured ; and 4. You must provide us with accurate e-mail addresses for all persons and organizations on the schedule and list. B. We will endeavor to maintain proof of e-mailing the electronic notification described in Paragraph A of this endorsement, but we are not obligated to do so . C. Our delivery of notification of cancellation described in Paragraphs A of this endorsement is intended as a courtesy only . We have no obligation to do so , nor do we have an obligation to provide such notification within the timeframe that you may have agreed upon with the certificate holder . Our failure to provide such notification will not: 1. Exte nd the Policy cancellation date ; 2. Negate the cancellatio _n as t~ any insured or any certificate holder; or 3. Provide any additional insur,mce that would not have been provided in the absence of this endorsement. D. We are not responsible for the accuracy, integrity , timeliness or validity of information contained in the list provided to us described in Paragraphs A. of this endorsement. All other terms and conditions of this policy remain unchanged. FM 303.0.21 04 11 Page 1 of 1 1exasMutual® Insurance Company WORKERS' COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY TEXAS NOTICE OF MATERIAL CHANGE ENDORSEMENT WC 42 06 01 T his endors e ment applies on ly to th e ins urance pro vided by t he po licy be cause T exa s is sh own i n It em 3.A. of t he In format ion Pag e . In th e ev ent of cance llat ion or other material change of the poli cy , we will mail advance notice to the perso n or organ iza tion named in the Sch edul e. Th e number of days advan ce not ice is sho wn in th e Schedule. Th is endo rs ement shall not ope rat e dire ctly or ind i rectly to benefit anyo ne no t nam ed i n the Sc hed ule . Sch edule 1. Numb er of days adv anc e noti ce : 30 2. No ti ce wi ll be ma il ed to: PER L I ST ON F I L E This endorse me nt c hanges the policy t o w ll ich it is attached effectiv e on the incept ion da te of t he policy un less a di ffe rent dat e is indicated be low. (The fo ll ow ing "att achi ng clause" need be completed on ly when this endorsement is issued subsequent to preparation of th e po licy.) This en dorsemen t . effecti ve on 5/31 /20 16 at 12:01 A .M . st andard time , form s a part of Pol icy No . TSF -0001253554 of th e T exa s Mu t u a l Ins u rance Co mpa n y Issu ed to BRAZOS URETHANE I NC Endorsement No. 6 OBA : ROOF MAINTENANCE & LEAK REPAIR Prem ium$ Authorized Representati ve WC420601 (ED . 1-94) I NSURED'S COP Y WAS ENDRS WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 04 03 06 (Ed. 4 -84) WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT-CALIFORNIA W e have the right to recover our paym ents from anyone liable for an injury covered by this policy. We will not enforce our right against the person or organiz:ation named in the Schedule. (Thi s agreement applies only to the extent that you per- form work under a wrillen contract that requires you to obtain this agreement from us.) You must maintain payroll records accurately segregating the remuneration of your employees while engaged in the work described in the Schedule . The additional premium for this endorsement shall be otherwise due on such r emuneration. ____ % of the California workers ' co mpensation premium Person or Organization Blanket -C A Job Description Schedule Whe~e required by written contract . Thi,; endorsement change~ the policy to which ii is attached and i,; effective on the date issued unless otherwise stated. (The infonnation below is required only when this endorsement is issued subsequent to preparation of the policy.) Endorsemen t Eff ective Date: 5/31/2016 Policy No. WC 927908254314 Policy Effective Date: 5/31/2016 -5/31/2017 Insured : BRAZOS UR.:;THANE I NC OBA : ROOF ~AINTENANCE & LEAK REPAIR Carrier Name /Code: Argonaut Ir:s u ran c e Compar.y WC 04 03 06 (Ed. 4-84) Countersigned by Endorsemem No . Premium$ Page 1 of 1 POLICY NUMBER : 0309-0207 COMMERCIAL GENERAL LIABILITY CG 25 03 05 09 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. DESIGNATED CONSTRUCTION PROJECT(S) GENERAL AGGREGATE LIMIT This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Designated Construction Project(s): Subject to a $10,000,000 Policy Aggregate Information required to complete this Schedule , if not shown above , will be shown in the Declarations . A. For all sums which the insured becomes legally obligated to pay as damages caused by "occur- rences" under Section I -Coverage A, and for all medical expenses caused by accidents under Section I -Coverage C, which can be attributed only to ongoing operations at a single designated construction project shown in the Schedu le above : 1. A separate Designated Construction Project General Aggregate Limit applies to each des- ignated construction project. and that limi t is equal to the amount of the General Aggregate Lim it shown in the Declarat ions . 2. The Designated Construction Project General Aggregate Limit is the most we will pay for the sum of all damages unde r Coverage A, ex- cept damages because of "bodily inj ury" or "property damage" included in the "products- completed operations hazard", and for medi- cal expenses un der Coverage C regardless of the number of: a. Insureds ; b. Claims made or "suits" brought; or ,. c. Pe rsons or organizations making c laim s or bringing "suits". 3. Any payments made under Cove rage A for damages or under Coverage C for medical expenses shall reduce the Des ignated Con- struction Project General Aggregate Limit for that designa ted con struction project. Such payments shall not reduce the Gen eral Ag- gregate Limit shown in the Declarat ions nor shall they reduce any other Designated Con- struction Project General Agg regate Limit for any other designated construct ion project shown in the Schedule above . 4. The limits shown in the Declarat ions for Each Occurrence , Dama ge To Pre mises Rented To You and Medical Expense continue to apply . Howeve r , instead of being subject t o th e General Aggregate Limit shown in the Decla- rations, such limits will be subject to the appli- cable Designated Construction Project Gen- eral Aggregate Limit . CG 25 03 05 09 © Insuran ce Services Office , Inc ., 2008 Page 1 of 2 0 B . Fo r all s ums wh ich the ins ured becomes le ga lly obliga ted to pay as damages caused by "o cc ur- ren ces'' under Se ction I -Coverage A, and for all medical expenses caused by accidents under Sect ion I -Covera ge C , which cannot be at - tributed only to ongoing operations at a single des ignated construct ion project shown in the Schedule above : 1. Any payme nts mad e und er Coverag e A for damages or under Coverage C for med ical expenses shall reduce the amount .avai lable under the General Aggregate Liin [t or the Products-completed Operations Aggregate Limit , whichever is applicable ; and 2. Such payments shall not reduce any Desig- nated Construction Project General Aggre- gate Limit. C . When coverage for li ability arisi ng ou t of the "products-completed operations hazard" is pro- vided , any paym ents for damages because of "bodily injury" or "property damage " included in the "products-completed operations hazard" will reduce the Products-completed Operations Ag- gregate Lim it , and not reduce t he Gen eral Ag- g regate Limit nor the Des ignated Construction Project General Aggregate Limit. D. If the applicable designated construction project has been abandoned, delayed, or abandoned and then restarted , or if the author ized contract- ing parties deviate from plans , blueprints , de- signs , specifications or timetables , the project will still be deemed to be the same construction pro- ject. E . The provisions of Section Ill -Limits Of Insu r- ance no t otherwise mod ified by this endors ement shall continue to apply as stipulated . Page 2 of 2 © Insuran ce Servi ce s Offi ce , In c , 2008 CG 25 03 05 09 D Effe ct ive da t es : 5/31/2016 -5/31/2017 POLICY NUMBER 0309 -0207 COMMERCIAL GENERAL LIABILITY CG 2010 0413 THIS ENDORSEMENT CHANGES THE POLICY . PLEASE READ IT CAREFULLY. ADDITIONAL INSURED -OWNERS, LESSEES OR CONTRACTORS -SCHEDULED PERSON OR ORGANIZATION T his endorsement modi fies insurance provided under t he fo llowing : COMMERCIAL GENERAL LI ABILI TY COV ERAG E PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s) Location(s) Of Covered Operations W he re Req uir e d By Written Co nt ract Information required to complete this Schedule , if not shown above , wil l be shown in the Declarations . A. Section II -Who Is An Insured is amended to include as an add itional insured the person(s) or organization(s) shown in the Schedule , bu t only w ith respect to liability for "bodily injury", "property damage" or "personal and advertising injury " ca used , in whole or in part, by : 1 . Your acts or omissions ; o r 2 . T he acts or omissions of t hose acting on your behalf ; in the performance of your ongoing opera tions for the addi t ional insured(s) at the location(s) designated above. However : 1. The insurance afforded to such add itional insured only applies to the extent permitted by law ; and 2. If coverage provided to the additional insured is required by a contract or agre e ment, the insurance afforded to such addit iona l insured will no t be broader than that wh ich you are required by the con tr act or ag reement to provide for such additiona l insu red. B. With respect to t he insurance afforded to these additional insureds , the following additiona l exclus ions apply This insurance does not app ly to "bodily inJury" or "property damage" occurring after 1. All work , including materials , parts or equipment furnished in connection w it h such wo rk , on the project (ot her t han service , ma inte nance or repa ir s) to be pe rfor med by or on behalf of the additio nal insured(s) at the location of t he cov e red operations has been completed ; o r 2. Tha t port ion of ''your work" ou t of which the inju ry or damage arises has been pu t to its intended use by any person o r organization other than another contractor or s u bcontractor engaged in performing operations for a princ ipal as a part of the same project CG 20 10 04 13 © Insuran ce Services Offi c e , Inc , 201 2 Page 1 of 2 0309-0207 C. With respect to the insurance afforded to these additional insureds , the fo l low ing is added to Section Ill -Limits Of Insurance: If coverage provided to the additional insured is requ ired by a contract or agreement , the most we will pay on behalf of the additiona l insured is the amount of insurance · 1. Required by the contract or agreement; or 2. Available under the applicable Limits of Insurance shown in the Declarations ; whichever is less . This endorsement applicabl e Limits of Declarations. sha l l not in crease the In surance shown in the Page 2 of 2 © Insuran ce SeN1ces Office , In c , 201 2 CG 2010 0413 Effecti ve dates : 5/31/2016 -5/31/2017 POLICY NUMBER 03 09-0207 COMMERCIAL GENERAL LIABILITY CG 20 37 0413 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSUR E D -OWNERS, LESSEES OR CONTRACTORS -COMPLETED OPERATIONS T his endorsement modifies insurance provided under the fo llowing COMMERC IAL GENERAL LIABILITY COVERAGE PART PRODUCT S/COMPLETED OPERATI ONS LIABI LI TY COV ERAG E PART SCHEDULE Name Of Additional Insured Person(s) Or O rqanization(s) Locat ion And Descriptio n Of Comp leted Operations Where Requ ired By Writt en Co ntract I !.•. ,, Info r mation required to comple te this Sc hedule if not shown above will be shown in the Declarations. A. Section II -Who Is An Insu red is amended to include as an addit ional insu red the pe rson(s) or organ ization(s) shown in the Schedu le , bu t only w ith res pect to liability for "bod ily injury" or "property damage" caused , in who le o r in part , by "your work " at the location designated and described in the Schedule of this endorsement performed for that additional insured and included in the "products-completed operations hazard". However : 1. The insurance affo rded to such addit ional insured only applies to the ex tent permitted by law ; and 2. If coverage prov ided to the add iti ona l insured is requi red by a con t ract or agreement , the insurance afforded to such additiona l insured will not be broader than t hat which yo u are req u ired by the contra ct or agreement, to provide for such addit ional insured B. Wit h respect to the insurance afforded to these additiona l insureds , the fo ll ow ing is added t o Section Ill -Limits Of Insurance : If coverage provided to the additional insured is required by a contract or agreement , the most we wi ll pay on beha lf of the additional insured is the amount of insu rance : 1. Required by the contract or agreement ; or 2. Available under the app licable Limits of Insurance shown in t he Declarations ; w h ic hever is less . Th is en dors ement shall no t inc rease t he applicab le Limi t s of Insu rance shown in the Decla rat ions . CG 20 37 0413 © Insu rance Serv ices Office , Inc , 20 12 Page 1 of 1