HomeMy WebLinkAboutRES 19-075RESOLUTION NO. 19-075
BE IT RESOLVED BY THE CITY COUNCIL OF THE
CITY OF BEAUMONT:
THAT the City Council hereby approves the award of a three (3) year agreement with
WorkQuest for the purpose of litter removal services along City rights -of -way and other
specified areas in the estimated annual amount of $162,574.43; and,
THAT, Beaumont Products and Services (BPS),, of Beaumont, Texas, will be
providing the services to the City on behalf of WorkQuest; and,
THAT the City Manager be and he is hereby authorized to execute an agreement
with WorkQuest for the purposes described herein. The Agreement is substantially in
the form attached hereto as Exhibit "A" and made a part hereof for all purposes.
The meeting at which this resolution was approved was in all things conducted in
strict compliance with the Texas Open Meetings Act, Texas Government Code, Chapter
551.
PASSED BY THE CITY COUNCIL of the City of Beaumont this the 26th day of
March, 2019.
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STATE OF TEXAS §
COUNTY OF JEFFERSON §
AGREEMENT
FOR FURNISHING LITTER REMOVAL
SERVICE FOR CITY RIGHTS -OF WAY AND SPECIFIED AREAS
Reference: TF031947
THIS AGREEMENT is made and entered into by. and between the CITY of BEAUMONT, TEXAS
(City) ., a municipal corporation, hereinafter referred to as "City", and WorkQuest, a State of Texas
agency, and Beaumont Products & Services, Inc., hereinafter referred to as "Provider".
Therefore, City, WorkQuest, and Provider agree as follows:
WITNESSETH
1.0 It is the intent of the City to contract with a private not -for -profit state -certified workshop as
provided by the State of Texas for furnishing litter removal services on City rights -of -way and other
areas as may be determined.
2.0 This Agreement shall be in effect for a period of three (3) years beginning April 1, 2019
and ending March 31, 2022. The pricing shall remain the same for all three (3) years.
3.0 The Provider shall furnish all labor, supervision, materials, -equipment, supplies, and
transportation required to provide. for the pickup and proper disposal of litter or debris discarded
onto City rights -of —way and other areas as may be determined by the City. The rights -of -way
include but are not limited to those listed on attachment "B" attached hereto.
4.0 "Litter ' or "debris" shall be defined as trash, garbage, fragments, remains, ruins, rubble, or loose
materials of any nature which have been discarded or which may detract from the appearance
and' safety of the area. `Litter" shall also include advertisements placed on or against any pole,
post, tree, fireplug, trash receptacle, or other property located on a street right-of-way.
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EXHIBIT "A"
5.0 All litter accumulated by the Provider shall be collected and disposed of by Provider. All supplies
and equipment needed shall be furnished by the. Provider. All vehicles used in transporting litter
must be equipped to prevent litter fi•om being deposited on the street right-of-way during
transport to disposal sites.
6.0 The Provider shall not be required to remove dead animals, tires, or objects weighing.more than
sixty (60) pounds. However, the Provider shall notify the designated City representative of the
location pf these items immediately upon their discovery.
7.0 The Provider shall furnish a crew consisting of one (1) supervisor and four (4) crew members for
approximately eight (8) hours per day. At the sole discretion of the City, it may require
additional crew members to be provided. If the Provider is unable to furnish the required number
of crew members, the City shall be notified in advance and the City may cancel the days
scheduled to be worked by the reduced crew. No payment shall be made for days canceled by the
City. Provider shall also furnish all transportation required.
8.0 Litter removal shall be performed five (5) days per week, Monday through Friday, except rain
days and City Holidays. Rain days can be voluntarily called by the crew performing litter removal
or at the discretion of the City representative. Additional days may be provided with written
approval of the designated City representative. Normal working hours shall be 7:30 a.m. to 4000
p.m. The City shall have full right of inspection of any facilities, areas, or equipment.. Such
inspections may be related to, but not limited to, verification of work conditions; safety, damages,
or operational interests.
8.1 Work days that are voluntarily called as a result of inclement weather shall not incur a
minimum charge for the day. Payments will not be made for hours not worked due to
inclement weather.
9.0 On a weekly basis, the Provider shall meet with the designated official to define program
objectives and schedule litter removal services. The Provider shall follow the litter removal
schedule as defined by the designated City representative. The Provider shall contact the
designated City representative on a daily basis to report work status. Once work has been
assigned, the Provider shall proceed in an expeditious manner until all work is satisfactorily
completed.
10. Each employee shall wear brightly colored safety vests while on City rights -of -way. It shall be
the responsibility of the Provider to ensure the safety of its employees and citizens while in the
performanceof this Agreement.
11.0 Services shall be provided according to schedule requirements specified in the Scope of Work
(SOW), excluding official City holidays which include:
Labor Day
Thanksgiving Day
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- Day after Thanksgiving
Christmas Day
New Year's Day
Martin Luther Ding, Jr. Birthday
Good Friday
Memorial Day
Independence Day
Veterans Day
12.0 The City shall have the right, but not the duty, to inspect, audit, copy and examine all books and
records of the Provider pertaining to its performance of services and obligations to the City under
this Agreement.
11.0 The Provider may not assign any portion of this Agreement to another party or parties without
written approval of the City Manager or his designee of such sale or assignment. The City may
require any records or financial statements necessary in its opinion to ensure such sale or
assignment will be in the best interest of the City.
12.0 This Agreement, including all Attachments and Exhibits, and the City's,Purchase Order, shall
constitute the entire understanding of the parties here to with respect to the subject matter hereof,
and no Amendment, modifications, or alteration of the terms shall be binding unless the same be
in writing, dated subsequent to the date hereof, and duly executed by the parties hereto.
13.0 LIABILITY
THE PROVIDER AGREES TO INDEMNIFY AND HOLD HARMi ESS THE
CITY OF BEA.UMONT AND ITS OFFICERS, AGENTS; AND EMPLOYEES
FROM ANY AND ALL CLAIMS, CAUSES OR. ACTION, AND DAMAGES OF
EVERY KIND., FOR INJURY TO OR DEATH OF ANY PERSON AND DAMAGES
TO PROPERTY ARISING OUT OF OR IN CONNECTION WITH THE WORK
DONE BY THE CONTRACTOR UNDER THIS CONTRACT; AND INCLUDING
ACTS OR OMISSIONS OF THE CITY OF BE, AUMONT OR ITS OFFICERS,
AGENTS OR EMPLOYEES IN CONNECTION WITH SAID CONTRACT.
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Provider waives all rights of recovery; and its insurers also waive all right of
subrogation of damages against the City and its agents, officers, directors and
employees 'for damages covered by the workers' compensation and employers liability
or commercial umbrella or excess liability or business automobile coverage obtained
by Provider required in this Agreement, where permitted by law. This waiver must
be stated on the City's approved Certificate of Insurance.
The fact that insurance is obtained by Provider on behalf of City will not be deemed
to release or diminish the liability of Provider, including, without limitation, liability
under the indemnity provisions of this Agreement. Damages recoverable by City
from Provider or any third party will not be limited by the amount of the required
insurance coverage.
14.0 INSURANCE REQUIREMENTS
14.1 The Provider shall'at all times during the Agreement maintain in full force and effect
insurance naming the City of Beaumont.as additional insured on the policies for
Commercial General Liability and Automobile Coverage as provided in Attachment
An original certificate of insurance shall be furnished to the City by the insurance
company providing the coverage or tis agent prior to the commencement of work by the
Provider and shall provide that the City shall receive thirty (30) days' prior written
notice before any change or cancellation of any policy.
14.2 All of the insurance costs shall be borne by the Provider. Should any insurance required
by the Agreement lapse, the Provider shall immediately cease all operations as of the
time and date of such lapse and shall not resume any operations until authorized in
writing by the City. If the lapse period extends fifteen (15) days, the City may terminate
the Agreement and the Contractor shall be in breach of this Agreement. Should
the City of Beaumont receive notices of insurance cancellation three (3) or more times
within a twelve (12) month period, the City may cancel this Agreement.
15.0 CONTRACT TERMINATION
15.1 Either the City or the Provider may, upon sixty (60) days' written notice, terminate the
contract for reasons of convenience. Said termination on behalf of the City shall be by
the City Manager or his designee.
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15.2 The City, besides all other rights or remedies it may have, shall have the right to
tenninate this Agreement upon five (5) days' written notice of the Provider fails to
perform the Scope of Work as herein provided. The decision to terminate shall be at the
sole discretion of the City Manager or his designee.
15.3 In addition, the City shall have the right to terminate. this Agreement if the Provider
breaches this Agreement by other means, including the following:
15.3.1 By failing to pay insurance premiums, liens, claims or other charges.
15.3.2 By failing to pay any payments, due the City, State or Federal Government
from the successful bidder or its principals, including, but not limited to,
payments identified in this Agreement or any taxes, fees, assessments, or liens.
15.3.3 Upon the institution of voluntary or involuntary bankruptcy proceedings
against the successful bidder or upon dissolution of the firm or business.
15.3.4 By violation of any provision or non-performance of the Agreement.
15.4 Upon termination or expiration of this contract, the Provider shall be permitted five (5)
working days to remove Provider -owned material and equipment from the City's
premises. Materials and equipment not removed within the specified time shall become
the property of the City.
16.0 The relationship of the Provider to the City, shall be that of an independent Provider, and no
principal -agent or employer -employee relationship is created by this Agreement. By entering
into this Agreement, the Provider acknowledges that it will, in the performance of its duties under
this Agreement, be acting as an independent Contractor and that not officer, agent, or employee
of the Provider is entitled to any of the benefits and privileges of a City employee or officer under
any provision of the statues of the State of Texas or the Charter and Ordinances of the City of
Beaumont.
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17.0 The City agrees to pay the Provider upon receipt of monthly invoices for services performed
satisfactorily and reports as required herein. Such payment shall be made within thirty (30) days
of receipt of invoice. The City shall have the right to refuse payment for work not satisfactorily
completed.
17.1 On a weekly basis, the Provider shall provide the following reports:
17.1.1 An accurate record of streets worked and the amount of litter removed. The unit
of measure shall be the number of bags and the number of cubic yards collected.
17.1.2 An accurate listing detailing the number of crew members. Days worked, and
number of hours each worked, each day.
18.0 The City shall pay the Provider at a rate of $17.20 per hour per person. Payment will be made for
crew member hours actually worked. No minimum payments for inclement weather days will be
allowed. This payment shall be full compensation for all work performed, equipment, materials,
transportation, and incidentals necessary to complete the work as well as disposal of the litter.
19.0 Deductions from payments by the City to the Provider may include items specified herein,
including taxes, costs for damages by the Provider, or other amounts which may be owed by the
Provider to the City. Such deductions shall not be cause for the Provider to cease or partially
cease operations or activities required by this Agreement.
20.0 The relationship of the. Provider to the City shall be that of an independent provider, and no
principal —agent or employer -employee relationship is created by this Agreement. By entering
into this Agreement, the Provider acknowledges that it will, in the performance of its duties under
this Agreement be acting as an independent provider and that no officer, agent, or employee of
the Provider will be for any purpose an employee of the City of Beaumont and that no officer,
agent or employee of the Provider is entitled to any of the benefits and privileges of a City
employee or officer under any provisions of the statutes of the State of Texas or the Charter and
ordinances of the City of Beaumont.
21.0 NO PERSON has, the authority to verbally alter these terms and conditions. Any changes must be
approved in writing by both parties.
M
21.0 NOTICES
Any notice which City or Contractor may require or desire to give to the other shall be in writing
and shall be sent by registered or certified mail to the following respective addresses:
CITY: City Manager
City of Beaumont
P. 0._Box 3827
Beaumont, TX 77704
STATE AGENCY: Melinda May, Market Representative
WorkQuest
119 North Street, Suite H
Nacogdoches, TX 85961
PROVIDER: Steve Havard, President
Beaumont Products & Services, Inc.
1305 Washington Blvd.
Beaumont, TX 77705
All notices shall be deemed .given on the date so delivered. Either party hereto may change the
above address by sending written notice of such change to the other in the manner so provided
herein.
22.0 For any information concerning this contact please contact:
Terry Welch, Senior Buyer
Finance Department / Purchasing Division
City of Beaumont
Physical Address:
801 Main St., Suite 315, Beaumont, TX 77701
Mailing Address:
P.O. Box 3827, Beaumont, TX 77704-3827
Phone # (409) 880-3107 + Fax # (409) 880-3747
E-mail terry.welch@beaumonttexas.gov
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4.0 FULFMLMFNT AND PAYMENT
4.1 The City agrees to pay WorkQuest upon receipt of monthly invoices for services
performed satisfactorily. Such payment by City to Vendor shall be made in accordance
with the requirements of Texas Government Code §2251.021. The City shall have the
right to refuse payment for work not satisfactorily completed.
4.2 The Contractor shall submit an accurate invoice within five (5) working days froip the
date of delivery.
4.3 Invoices must reference a Purchase Order number and the Department or Division for
which goods or services are provided.
c
(Department/Division)
City of Beaumont
P. O. Box 3827
Beaumont, TX 77704
4.4 All other invoices shall be mailed to:
ATTN: Accounting Division
City of Beaumont
P. O. Box 3827
Beaumont, TX 77704
SOME
All other invoices may be submitted via email to: inyoices@beaumonttexas. ov
4.5 Faxed invoices wdl.not be accepted.
5.0 FUNDING
Funds for payment are provided by the City of Beaumont budget approved by City Council for
each fiscal year only. The State of Texas statues prohibit the obligation and expenditure. of public
funds beyond the fiscal year for which a budget has. been approved. Obligations beyond the end
of each current City of Beaumont fiscal year will be subject to budget approval.
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IN WITNESS WIEREOF, City and Contractor have oxecutod or caused to be executed by their duly
authorized officers or agents this Agreomont as oftho day and year written below.
CITY OF BE, AUMONT:
By:
(Signature) Kyle Hayes, City Manager
Printed Name: Kyle Hayes
Date Signed:
WOMCQUUST:
By:, AJ14&
( ignature) Melinda May, Market esentative
Printed Nt�me: Md t i'�-ftL
Date Signed: 3 (41___(
BEAUaMONT PRODUCTS .AND SI;Y ICES:
By:
(Signature) Steve I lav xec i hector
Printed Name: _ smvd &As. C .yN P+:tA � c,
Date Signed: ZD • zo) 4)
ATTACFIMENT "A"
(Revised 2/22/2016)
INSURANCE
SECTION A. Prior to the approval of this contract by the City, CONTRACTOR shall furnish a completed Insurance Certificate to
the Purchasing office. The certificate shall be completed by an agent authorized to bind the named und6rwriter(s) to the coverages,
limits (on a form approved and provided by the City), and termination provisions shown thereon, and shall furnish and contain all
required information referenced or indicated thereon. CITY SHALL HAVE NO DUTY TO PAY OR PERFORM UNDER THIS
CONTRACT UNTIL SUCH CERTIFICATE IS RECEIVED BY THE CITY OF BEAUMONT'S PURCI3ASING DIVISION, and no
officer or employee of the City shall have authority to waive this requirement.
INSURANCE COVERAGE REQUIRED
S)CTION B. CITY reserves the right to review the insurance requirements of this. section during the effective period of the
contract and to adjust insurance coverages and their limits when deemed necessary and prudent by CITY, based upon changes in
statutory law, court decisions, or the claims history of the industry as well as the CONTRACTOR.
SECTION C. Subject to CONTRACTOR`S right to maintain reasonable deductibles in such amounts as are approved by CITY,
CONTRACTOR shall obtain and maintain in full force and effect for the duration of this contract, and any extension hereof, at
CONTRACTOR'S sole expense, insurance coverage written by companies approved by the State of Texas and acceptable.to CITY, in
the following type(s) and amount(s):
TYPE AMOUNT
Workers' Compensation and Statutory
Employer's Liability
NOTE: For building or construction projects, and services provided at City -owned facilities, the successful
Contractor shall meet the minimum requirements defined in the Texas Workers' Compensation Commission
Rule 28 TAC 5i10.110 which follows this insurance attachment.
2: Commercial General (public) Liability
including coverage for the following:
a.
Premises operations
b.
Independent contractors
C.
Products/completed operations
d.
Personal injury
C.
Advertising injury
f.
Contractual liability
g.
Medical payments
h.
Professional liability*
i.
Underground hazard*
j.
Explosion and collapse hazard*
k.
Liquor liability*
l:
Fire legal liability*
in.
City's property in Contractor's*
care, custody, or.control
n.
Asbestos specific liability*
* Not required for this contract
Comprehensive Automobile Liability
insurance, including coverage for loading
and unloading hazards, for:
Combined single limit for bodily injury and
and property damage of W0,000 per
occurrence or its equivalent with an aggregate
limit of $1,000,000.
Combined "single limit for bodily injury and
property damage of $500,000 per occurrence
or equivalent.
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a. Owned/leased vehicles
b. Non -owned vehicles
C. Hired vehicles
4. Errors and Omissions Provide a prudent amount of coverage for the
insurance policy willful or negligent acts or omissions of any
(when applicable) officers, employees or agents thereof.
ADDITIONAL POLICY ENDORSEMENTS
CITY shall be entitled, upon request; and without expense; to receive copies -of the policies and all endorsements thereto and may
make any reasonable request for deletion, revision, or modification of particular policy terms, conditions, limitations, or exclusions
(except where policy provisions are established by law or regulation binding upon either of the parties hereto or the underwriter of any
of such policies). Upon such request by CITY, CONTRACTOR shall exercise reasonable efforts to accomplish such changes in
policy coverages, and shall pay the cost thereof.
REQUIRED PROVISIONS
CONTRACTOR agrees with respect to the above required insurance, all insurance contracts and certificate(s) of insurance will
contain and state; in writing, on the certificate or its attachment, the following required provisions.
a. Name, the City of Beaumont and its officers, employees, and elected representatives as additional insured(s), (as the
interest of each insured may appear) to all applicable coverage.
b. Provide for 30 days' notice to City for cancellation, non -renewal, or material change.
c: Provide for notice to City at the address shown below by registered mail.
d. CONTRACTOR agrees to waive subrogation against the City of Beaumont, its officers, employees, and elected
representatives for injuries, including death, property damage, or any other loss to the extent same may be covered
by the proceeds of insurance.
e. Provide that all provisions of this agreement concerning liability, duty, and standard of care together shall be
underwritten by contractual liability coverage sufficient to include such obligations within applicable policies.
f. For coverages that are, only available with claims made policies, the required period of coverage will be determined
by the; following formula: Continuous coverage for the life of the contract, plus one year (to provide coverage for
the warranty period) and an extended discovery period for a minimum of five (5) years which shall begin at the end
of the warranty period.
NOTICES
CONTRACTOR.shall notify CITY in the event of any change in coverage and shall give such notices not less than.thirty (30) days.
prior to the change, which notice -must be accompanied by a replacement CERTIFICATE OF INSURANCE. All notices shall be
given to CITY at the following address:
Purchasing Division
City of Beaumont
P.O. Box 3827
Bcaumont, Texas 77704
SEC')i'ION D. Approval, disapproval, or failure to act by CITY regarding_ any insurance supplied by CONTRACTOR shall not
relieve CONTRACTOR of full responsibility or liability for damages and accidents as set forth in the contract documents. Neither
shall the bankruptcy, insolvency, or denial of liability by the insurance company exonerate CONTRACTOR from liability.
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WORKERS COMPENSATION INSURANCE
for
Building or Construction Projects and Services Provided at City -Owned Facilities
TEXAS WOR10R.S' COMPENSATION COMMISSION RULE 28, §110.110
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As required by the Texas Workers' Compensation Rule 28, § 110.110, the Contractor shall accept the following definitions and comply
with the following provisions: .
Workers' Compensation Insurance Coverage
A. Definitions:
1. Certificate of coverage ("certificate") -A copy of a certificate of insurance, a certificate of authority to self -insure
issued by the commission, or a coverage agreement (TWCC-81, TWCC-82, TWCC-83, or TWCC-84), showing
statutory workers' compensation insurance coverage for the person's or entity's employees providing services on a
project, for the duration of the project.
2. Duration of the project -includes the time from the beginning of the work on the project until the
Contractor's/person's work on the project has been completed and acceptedby the City of Beaumont.
3. Persons providing services on the project ('subcontractor" in §406.096) - includes all persons or entities performing
all or part of the services the Contractor has undertaken to perform on the project, regardless of whether that person
contracted directly with the Contractor and regardless of whether that person has employees. This includes, without
limitation, independent Contractors, subcontractors, leasing companies, motor carriers, owner -operators, employees
of any such entity, or employees of any entity which furnishes persons to provide services on the project. "Services"
include, without limitation, providing, hauling, or delivering equipment or materials, or providing labor,
transportation, or other service related to a project: "Services" does not include activities unrelated to the project,
such as food/beverage vendors, office supply deliveries, and delivery of portable toilets.
B. The Contractor shall provide coverage, based on proper reporting of classification codes and.payroll amounts and filing of
any coverage agreements, which meets the statutory requirements of Texas Labor Code, Section 401.011(44) for all
employees of the Contractor providing services on the project, for the duration of the project.
C. The Contractor must provide a certificate of coverage to the City of Beaumont prior to being awarded the contract.
D. if the coverage period shown on the Contractor's current certificate of coverage ends during the duration of the project, the
Contractor must, prior to the end of the coverage period, file a new certificate of coverage with the City of Beaumont
showing that coverage has been extended.
E. The Contractor shall obtain from each person providing services on a project, and provide to the City of Beaumont:
1. A certificate of coverage; prior to that person beginning work on the project, so the City of Beaumont will have on
-file certificates of coverage showing coverage for all persons providing, services on the project; .and
2. No later than seven. (7) days after receipt by the Contractor, a new certificate of coverage showing extension of
coverage, if the coverage period shown on the current certificate of coverage ends during the duration of the project.
F. The Contractor shall retainall required certificates of coverage for the duration of the project and for one (1) year thereafter.
a The Contractor shall notify the City of Beaumont in writing by certified mail or personal delivery, within ten (10) days after
the Contractor knew or should have known, of any change that majorially affects the provision of coverage of any person
providing services on the project.
H. The Contractor shall post on each project site a notice, in the text, form and manner -proscribed by the Texas Workers'
Compensation Commission; informing all persons providing services on the project that they are required to be covered,. and
stating how a person may verify coverage and report lack of coverage.
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1. The Contractor shall contractually require each person with whom it contracts to provide services on a project, to:
1. Provide coverage, based on proper reporting of classification codes and payroll amounts and filing of any coverage
agreements, which meets the statutory requirements of Texas Labor Code, Section 401.011(44) for all of its
employees providing services on the project, for the duration of the project;
2. Provide to the Contractor, prior to that person beginning work on the project, a certificate of coverage showing that
coverage is being provided for all employees of the person providing services on the project, .for the duration of the
project.
3. Provide the Contractor, prior to the end of the coverage period, a new certificate of coverage showing extension of
coverage, if the coverage period shown on the current certificate of coverage ends during the duration of the project;
4. Obtain from each other person with whom it contracts, and provide to the Contractor:
a. A certificate of coverage, prior to the other person beginning work on the project; and
b. A new certificate of coverage showing extension of coverage, prior to the end of the coverage period; if the
coverage period shown on the current certificate of coverage ends during the duration of the project.
5. Retain all required certificates of coverage on file for the duration of the project and for one (1) year thereafter;
6. Notify the City of Beaumont in writing by certified mail or personal delivery, within ten (1.0) days after the person
knew or should have known, of any change that materially affects the provision of coverage of any person providing_
services on the project; and
7. Contractually require each person with whom it contracts, to perform as required by paragraphs (1) - (7), with the
certificates of coverage to be provided to the person for whom they are providing services.
J. By signing this contract or providing or causing to be provided a certificate of coverage; the Contractor is.representing to the
City of Beaumont that all employees of the Contractor who will provide. services on the project will be covered by workers'
compensation coverage for the duration of the project, that the coverage will be based on proper reporting of classification
codes and payroll amounts, and that all coverage agreements will he filed with the appropriate insurance carrier or, in the
case of a self -insured, with the commission's Division of Self -Insurance ,Regulation. Providing false or misleading
information may subject the Contractor to administrative penalties, criminal penalties, civil penalties, or other civil actions.
K. The Contractor's failure to comply with any of these provisions is a breach of contract by the Contractor which entitles the
City of Beaumont to declare the contract void if the Contractor does not remedy the breach within ten (10) days after receipt
of notice of breach from the City of Beaumont.
As defined by the Texas Labor Code, Chapter 269, Section 406.096(e), building or construction is defined as:
1. Erecting or preparing to'efect a.structure, including a building, bridge, roadway, public utility facility, or related appurtenance;
2. Remodeling, extending, repairing, or demolishing a structure; or
3. Otherwise improving real property or an appurtenance to real property through similar activities.
The employment of a maintenance employee who is not engaging in building or construction as the employer's primary business does
not constitute engaging in building or construction.
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CITY OF BEAUMONT
INSURANCE RE, QUIREMENT AFFIDAVIT
To be Completed By Appropriate Insurance Agent
and submitted with bid proposal.
I, the undersigned Agent/Broker, certify that the insurance requ
have been reviewed by me with t_he below identified Contractc
awarded this contract by the City. of Beaumont, I will be able to,
of such award, Finnish a valid insurance certificate to the City m
this bid.
Agent (Signature)
�4
Name of Agency/Broker:
Address of Agent/Broker:
City/State/Zip:
Agent/Broker Telephone #:
CONTRACTOR'S
v
61At contained ' is bid document
f _ elow i tified Contractor is
in ten after being notified
quirements defined in
v
(Print or Type)
NOTE TO AGENT/BROIKER
If ti 's time requirement is not met, the City has the right to invalidate the bid award and award the
e tract to the next lowest bidder meeting specifications. Should an awarded bid be invalidated the
Contractor may be liable for breach of contract: If you have any questions concerning these
requirements, please contact the Purchasing Manager for the City of Beaumont at (409) 880-3720.
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CERTIFICATE OF INSURANCE Form No. C001
U9 Edition Date: 12112/2012
M c Page 1 of
This form is for informational purposes only and certifies that policies of insurance listed below have been issued to
insured named below and are in force at this time. Notwithstanding any requirements, term or condition of any contract or
other document with respect to which this certificate may be issued or may pertain, insurance afforded by policies
described herein is subject to ail terms, exclusions and conditions of such policies.
Prior to the beginning of work, the vendor shall obtain the minimum insurance and endorsements specified. Agents must
complete the form providing all requested information and submit by fax, U.S. mail or a=mail, as requested by the City of
Beaumont ("COB"). The endorsements listed below are required as attachments to this certificate; copies of the
endorsements are also acceptable. PLEASE ATTACH ALL ENDORSEMENTS TO THIS FORM AND INCLUDE THE
MATCHING POLICY NUMBER ON THE ENDORSEMENT. Only City of Beaumont certificates of insurance are
acceptable; commercial carriers' certificates are not.
This certificate shall be completed by a licensed insurance agent:
Name -and Address of Agency: City of Beaumont Reference:
Phon
Name and Address of Insured:
Project Name:
Project Location:
Managing Dept.:
Project Mgr.:
Phone: / Insurers Affording Coverages:
Prime or Sub -Contractor?
Insurer A:
Name of Prime Contractor, if different from Insured: Insurer B:
Insurer C:
Insurer D:
INS,R
TYPE OF INSURANCE
' P,OLIGY
POLICY EFF.
POLICY EXP.
LIMITS OF LIABILITY
LTR
NO.
DATE
DATE
(MM/DD/YYYY)
(MM1DD/YYY1)
Commercial General
Liability Policy
Each Occurrence
$
As defined in the
Policy, does the Policy
General Aggregate
$
provide:
Completed
$
❑ Yes ❑ No — Completed Operations/Products
Operations/
Products Aggregate
❑ Yes ❑ No — Contractual Liability
Personal &
$
Advertising Injury
❑ Yes ❑ No — Explosion
Deductible or Self
$
Insured Retention
�15-
CERTIFICATE OF INSURANCE Form No. COB1
Edition Date: 12/12%2012
Pane 2 of
ILTR NSR
POLICY
-POLICY EFF.
POLICY EXP.
TYPE OF INSURANCE
DATE
DATE
LIMITS OF LIABILITY
(MM/DD/YYYY)
(MM1DDNYYY)
❑ Yes ❑ No — Collapse
❑ Yes ❑ No — Underground
❑ Yes ❑ No — Contractors / Subcontractors Work
❑ Yes ❑ No — A re ate Limits per Project Form CG 2503
❑ Yes ❑ No — Additional Insured Form — CG 2010
❑ Yes ❑ No — 30 DaV Notice of Cancellation Form - CG 0205
❑ Yes ❑ No — Waiver of Subrogation Form - CG 2404
Pollution / Environmental
Occurrence
$
Impairment Policy
A re ate
$
Auto Liability Policy
CSL
$
As defined in the Policy,
does the Policy provide:
Bodily Injury
$
Per Incident
❑ Yes ❑ No — Any Auto
Bodily Injury
$
(Per Person)
❑ Yes ❑ No — All Owned Autos
Property Damage
$
(Per Accident)
❑ Yes ❑. No — Non -Owned Autos
❑ Yes ❑ No — Hired Autos
❑ Yes ❑ No — Waiver of.Subrogation - CA0444
❑ Yes ❑ No — 30 Day Notice of Cancellation - CA0244
❑ Yes O.No — ,Additional Insured - CA2048
❑ Yes ❑ No — MCS 90
Excess Liability
Occurrence
$
❑ Umbrella Form
❑ Excess Liability
Follow Form
Aggregate
$
Workers Compensation &
❑ Statutory
Employers Liability
As defined In the Policy,
Each Accident
$
does the Policy provide
❑ Yes ❑ No — Waiver of Subrogation - WC420304
Disease -
$
Policy Limit
❑ Yes ❑ No — 30 Day Notice of Cancellation - WC420601
Disease -
$
Each Employee
Is a Sullders Risk or
$
Installation Insurance
Policy provided?
❑ Yes ❑No
❑ Yes ❑ No — Is the City shown as loss payee/mortgagee?
Professional Liability
As defined in the Policy,
Each Claim
$
does the Policy provide:
p Yes ❑ No — 30 Day Notice of Cancellation
Deductible or Self
$
Retroactive Date:
Insured Retention
-16-
-1.
CERTIFICATE OF INSURANCE Form No. COB1
Edition Date: 12/12/2012
a W- Page 3 of 3.
AGENT CERTIFICATION:
THIS IS TO CERTIFY TO THE CITY OF BEAUMONT that the insurance policies above are in full force and
effect.
Name of Insurance Company:
Name of Authorized Agent:
Company Address:
Agent's Address:
City: State: Zip:
City: State: Zip:
Authorized Agent's Phone Number (including Area Code):
Original signature of Authorized Agent:
X
Date:
CERTIFICATE HOLDER:
City of Beaumont
P. O. Box 382-7
Beaumont, Texas 77704-3827
DATE ISSUED:
AUTHORIZED REPRESENTATIVE SIGNATURE
Licensed Insurance Agent
Printed Name:
-17-
AGREEMENT
FOR FURNISIIING LITTER REMOVAL
SERVICE FOR CITY RIGHTS -OF WAY AND SPECIFIED AREAS
Reference: TF0319-14
Texas Ethics. Commission Certificate Number
HB 1295 — Section 2252.098 of the Government Code states "a contract that requires
an action or vote by the governing body of the entity or agency, or the value of the
contract is at least one million dollars ($1,000,000); must provide a Disclosure of
Interested Parties Form on the Texas Ethics Commission website".
Within five (5) working days after the award of contract by Beaumont City Council, the
awarded vendor must complete the information requested on the Texas Ethics
Commission website and provide'the certificate number to the Purchasing Department.
The Texas Ethics Commission website is: www.ethics.state.tx.us
At the home page, click on Form 1295 Filing Application,, and follow the instructions.
Upon completion of the information on the website, provide the completed form and
certificate number to the following Purchasing e-mail addresses:
patrick.bardweliP,beaumonttexas.gov
terry.welch@beaumonttexas.gov
I understand the requirement as stated above and will comply within five (5) working
days after the award of contract by Beaumont City Council.
Signature
Printed Name
Title
Revised 4/29/16 /bd
Company Name
Date Signed
-18-
CERTIFICATE OF INTERESTED PARTIES FORM 1295
1of1
Complete Nos, 1- 4 and 6,If there are interested parties.
OFFICE U5E ONLY
Complete Nos.1, 2, 3, 5, and 6 if there are no interested parties.
CERTIFICATION OF FILING
Certificate Number:
1 Name of business entity filing form, and the city, state and country of the business entity's place
of business.
2018-387568
Beaumont Products & Services, Inc.
Beaumont, TX United States
Date Filed:
06/02/2018
2 Name of governmenta ent_ ty or state agency that is a party to the contract for which the form is
being flied.
Region 5 Southeast Texas Purchasing Coop
Date Acknowledged:
3 Provide the identification number used by the governmental entity or state agency to track or identify -the contract, and provide a
description of the'servlces, goods, or other property to be provided "under the contract.
20180708
Lawn Maintenance: mowing, trimming, edging, hedging, trash and litter pick up.
4
Name of Interested Party
City, State, Country (place of business)
Nature of interest
(check applicable)
Controlling
Intermediary
5 Check only if there is NO Interested Party.
X
Lij
6 UNSWORN DECLARATION
My name is and my date of birth Is 0.4 I JO
My address is (vZ19 woki't%I.>, F4txs, b-..
(street) (city) (stale) (zip code) (country)
1 declare under penalty of periury that the foregoing is true and correct.
Executed in .1L CG1ZSbk County, State of K1� on the ZV'Iday of , 20_(�t_
(morith) (year)
C.
LL —
Si n ture of aut6rizda agent of contracting business entlty
(Declarant)
Forms proviaea oy I exas Ethics commission www.ethics.state.tx.us Version V1.0.6711
AGREEMENT
FOR FURNISHING LITIT11 IMOVIO1/AL
SERVICE FOR CYN ItIGIIT&OF WAY AND SPECIFIED AREAS
Refereaeo: TF0319-Id
House Bill 89 (WB89) Verifieation
I' —� MULCJl , the Lill (lorsigned ropesontative of
(Company or Business Natne)
(Company or Business Nante) (hereafter referred to as "Ctnnpany"), being fill adult over, the age of eighteen (0) yenrslof age,
verify that the company named -above, under, the provisioirs-of Subtitle F3 Titlo 107 GOvOl"Illlelit Corte Chtlpter 2270;
I. Does not boycott Ist•ael currently; acid
2. Will not boycott Tsrnel during the term of the contt•act the above -named CompallY, business or individual with file
City of Beaumont, Texas.
Pzasua171 to S'eclion 2270.001; Texas Govel•ltirre171 Code;
1. "Boycott Israel" means refusing to deal with, terminating business activities with, or otherwise taking any action
that Is intended to penalize, ht lc1 econornle harm on, or 11m11 commercial relations specifically with /srael, or with a pe/son
or enllty doing business b7 Lsrael or In an Israel!-coiwo/led (cr•1.11oly, but does not inch/C/e (1/7 action rrrade for orcllnin))
bush7essptrrposes•; and
2, "Company" means sole pr•oprielorslzlp, organkelflon, assoclellion, corp0rati6n, partneishlp, fobzt venturr,
limitedpartnership, limited liabllily parine/'s17ip; or arry linriled liaGihly contpcu7y, Irzchrclirrg a rnlro/ly- otPirerLrubsldla�y,
!rujol•igl-owned subsiclim); pw,ent comp(i17y ol, c • 11a1e of those emit' or b In > associalions that a�•ist to nlake a proJil.
hf1'I'E NATt1RE OF COMPANY
REPRESE,' TATIZIE ON THIS THE clay of(a6fi , 2Q , personally appeared
Nkel 1.4a, the above -named person, who after by me being duly
s . om, did swear and eonrinn t tat the above is true and con•ect.
JENNY Crtill DJNSEITH HENRY
• ?�'; }U'' 4 1 J �
S�bSF.�I�te of Texas
Cyr m, Ex •irss 05-16-2022 NOT Zy SIGNrtTURE
''Jtri110'' t40tary ID M569676
eunte Bill 2,52 Ch. 2252 Certification
Gb1'e7"II'7ien1 (bode, Chapter 2252, ,Section ) 521-12 and ,Section 2252.153, cerlo' ihai fhe. Ctrrlil%tlti}'il;ilr7d_l.I�:S; �. L
Gl:.. _.i.. _r tilt' Lt'dJJilc' �f the �. ulJlfth"ollel' Fif lit2 sIfIN Of TeXas vallcemfng 117E lis ing (j Co117pvaie_'11H1! Ore-' iliitrl/7 c°CI ItFId Et �is^P2..",'7l'
10,0il Q1..Si'crion 22J2.11 3, l.l7tl'717f/' cerilij, (hat should the above-na/neil Compalir enter ineo CI conlr;ic! ihv: is 6;
C`Ulr)li(77nC3 (UI 1/7e 15'2051I8710 the l �anlllrroll2/' of the Srarr of Terris r.17ic17 clo business tirith Iran, Sudan or air_, foreign
qsp, . %i_•i i;lLc:1r17_:111u11, 11:'ill 1111/17C:ch(1tPl)° I7Utl�,t� the 00, Of Bea71111o711 s i'UI'chuying{ Deparlwenl.
DI z: S:tmed ignanue ofComjitn}' ftcp7c.,cattaiitic
f� e- i n
Nnnte in Printed Form
[ THIS FORM MUST BE RETURNED WITH AGREEMENT, ]
ATTACHMENT "B"
List of Locations
AGREEMENT
FOR FURNISHING LITTER REMOVAL
SERVICE FOR CITY RIGHTS -OF WAY AND SPECIFIED AREAS
Reference: TF0319-17
-20-
ATTACHMENT TWO
END OF AGREEMENT
AGREEMENT
FOR FURNISHING LITTER REMOVAL
SERVICE FOR CITY RIGHTS -OF WAY AND SPECIFIED AREAS
Reference: T70319-17
-22-