HomeMy WebLinkAboutRES 02-245 RESOLUTION NO. 02-245
WHEREAS, bids were received for the furnishing of all materials, labor, equipment
and supplies necessary to retrofit structural steel and repair the foundation at the
Beaumont Health Clinic located at 950 Washington Blvd.; and,
WHEREAS, Eagle-Pro Engineering, Inc., Beaumont, Texas, submitted a bid in the
amount of$63,098; and,
WHEREAS, City Council is of the opinion that the bid submitted by Eagle-Pro
Engineering, Inc., Beaumont, Texas, should be accepted;
NOW, THEREFORE, BE IT RESOLVED BY THE
CITY COUNCIL OF THE CITY OF BEAUMONT:
THAT the bid submitted by Eagle-Pro Engineering, Inc., Beaumont, Texas, for the
furnishing of all materials, labor, equipment and supplies necessary to retrofit structural
steel and repair the foundation at the Beaumont Health Clinic located at 950 Washington
Blvd. be accepted by the City of Beaumont.
PASSED BY THE CITY COUNCIL of the City of Beaumont this the 22nd day of
October, 2002.
- Mayor Pro Tern Dr. Lulu Smith -
BEAUMONT COMMUNITY HEALTH CLINIC
PROJECT# 00-951
PERFORMANCE BOND
STATE OF TEXAS
COUNTY OF JEFFERSON
BOND NO, 54-124391
KNOW ALL BY THESE PRESENTS:
That EAGLE-PRO ENGINEERING, INC. as Contractor,
and UNITED FIRE & CASUALTY COMPANY as Surety, are held firmly
bound unto the City of Beaumont, Texas, hereinafter called Owner, in the penal sum of SIXTY THREE
THOUSAND NINETY EIGHT & NO/100dollars, for the payment of which sum well and truly to be
made, we bind ourselves, our heirs, executors, administrators, successors, and assigns, jointly
and severally, firmly by these presents.
WHEREAS said Contractor has been awarded and is about to enter into the Agreement with
said Owner to perform the Work as specified or indicated in the Contract Documents entitled:
BEAUMONT COMMUNITY HEALTH CLINIC
STRUCTURAL RETROFIT AND REPAIR
NOW THEREFORE, if said Contractor shall perform all the requirements of said Contract
Documents required to be performed on its part, at the times and in the manner specified
herein, then this obligation shall be null and void, otherwise it shall remain in full force and
effect. If said Contractor fails in any contract requirement, Surety will, upon demand of Owner,
proceed to complete the Contractor's obligations, at Surety's expense.
PROVIDED, that any alterations in the Work to be done or the materials to be furnished, or
changes in the time of completion, which may be made pursuant to the terms of said Contract
Documents, shall not in any way release said Contractor or said Surety thereunder, nor shall
any extensions of time granted under the provisions of said Contract Documents, release either
said Contractor or said Surety, and notice of such alterations or extensions of the Agreement is
hereby waived by said Surety.
PROVIDED, HOWEVER, that this bond is executed pursuant to the provisions of Article 5160
of the Revised Civil Statutes of Texas as amended and all liabilities on this bond shall be
determined in accordance with the provisions of said article to the same extent as if it were
copied at length herein.
PWIE Form 0700.0203-95
City of Beaumont
Performance Bond
Page 1 of 2
BEAUMONT COMMUNITY HEALTH CLINIC
PROJECT# 00-961
SIGNED AND SEALED,this 29th day of OCTOBER Aft 2002
=-F160 EERIN , INC. UNITED FIRE & CASUALTY COMPANY
r) (Surety)
< Bv:
(SA: tore) (Siena ure) Mark Thurmond
Title: /Address:le: Attorney-in-Fact
9323 Long Point
Houston, Texas 77055
(SEAL) (SEAL)
PW/E For- 0700.0203-95
Ciry of Beaumont
Performance Bond
Pace 2 of 2
BEAUMONT COMMUNITY HEALTH CLINIC
PROJECT# 00-964
PAYMENT BOND
STATE OF TEXAS
COUNTY OF: JEFFERSON
BOND NO. 54-124391
KNOW ALL BY THESE PRESENTS:
That EAGLE-PRO ENGINEERING, INC. as Contractor,
and UNITED FIRE & CASUALTY COMPANY as Surety,
are held firmly bound unto the City of Beaumont, Texas, hereinafter called Owner, in the
penal sum of SIXTY THREE THOUSAND NINETY EIGHT DOLLARS & N01100-------- dollars,
for the payment of which sum well and truly to be made, we bind ourselves, our heirs,
executors, administrators, successors, and.assigns, jointly and severally, firmly by these
presents.
WHEREAS, said Contractor has been awarded and is about to enter into the Agreement with
said Owner to perform the Work as specified or indicated in the Contract Documents entitled:
BEAUMONT COMMUNITY HEALTH CLINIC
STRUCTURAL RETROFIT AND REPAIR
NOW THEREFORE, if said Contractor, or subcontractor, fails to pay for any materials,
equipment, or other supplies, or for rental of same, used in connection with the performance of
the work contracted to be done, or for amounts due under applicable State law for any work or
labor thereon, said Surety will pay the same in an amount not exceeding the sum specified
above, and, in the event suit is brought upon this Bond, a reasonable attorney's fee to be fixed
by the Court. This Bond shall inure to the benefit of any and all persons, companies, or
corporations entitled to file claims under applicable State law.
PROVIDED, that any alterations in the work to be done or the materials to be furnished, or
changes in the time of completion, which may be made pursuant to the terms of said Contract
Documents, shall not in any way release said Contractor or said Surety thereunder, nor shall
any extensions of time granted under the provisions of said Contract Documents, release either
said Contractor or said Surety, and notice of said alterations or extensions of the Agreement is
hereby waived by said Surety.
PROVIDED, HOWEVER, that this bond is executed pursuant to the provisions of Article 5160
of the Revised Civil Statutes of Texas as amended and all liabilities on this bond shall be
City of Beaumont
Payment Bond
Page 1 of Page 2
BEAUMONT COMMUNITY HEALTH CLINIC
PROJECT# 00-961
determined in accordance with the provisions of said article to the same extent as if it were
copied at length herein.
SIGNED AND SEALED, this 29th day of OCTOBER -, 20 ox
EAGLE-P 0 ENGINEERING, C. UNITED FIRE & CASUALTY COMPANY
(Contractor) (Surety)
B By:
(Signature) (Signature) MARK T URMOND
Titl . Attorney-in-Fact
Address: 9323 Long Point
Houston, Texas 77055
City of Beaumont
Payment Bond
Page 2 of Page 2
UNI T & CASUALTY COMPANY
HOME OFFICE - CEDAR RAPIDS, IOWA
CERTIFIED COPY OFF POWER OF ATTORNEY
(Original on file at Home Office of Cimpany - See Certification?
KNOW ALl :MEN BY.THESE PRESENTS, That the UNITED FIRE &...
.CASUALTY COMPANY, a corporation duly ;organized and ;existing
under the laws of the State of Iowa, and having its principal officer Cedar Rapids, State of io+iva does malts;' eonstltute artd
appoint &T THURMOIID II, OR MA R K: THURMO? TS,, $0'TH INAIVT.: )UALLY
of 9323 LO J 1?bIi HOU8T0 TX 7US
its true and: lawful; Attvrneyts?—in-Fat# wlth pourer and authority hereby conferred;to sigrt,. seal and ex ecute in its behalf all
lawful bonds,undertakings and otlh:er obligatory irtstrumertts of 'similar raature as foiloVvs: ANY AtdD A.IzIa $t3NDS
and to bind UNITED FIRE & CASUALTY COMPANY thereby as fully and to the same extent as if such instruments were signed by
the duly authorized officers of UNITED FIRE & CASUALTY COMPANY and all the acts of said Attorney, pursuant to the authority;
hereby given' are hereby ratified arid confirmed.
The Authority hereby granted shall expire JtTI�iE ;;.28th, 2004 mess sooner revolted.
This power of A#torney is made and executed pursuant to; and by authority of the following By—Law. :truly ad pted by the -
Board of Directors of the Campaf y on AprH 18 1973.,
"Article V — Surety Bonds and Undertakings."
Section 2, Appointment of Attorney-in-Fat#. "The President or any Vice President,or any other officer of the Company, tray;from time to time,
appoint by written certificates attorneys-in-lact to art in behalf of the Company in the execution of policies of insurance,bonds,undertakings and
other obligatory instruments of like nature.The Signature of any officer eutho0f ad hereby,and thiCorpprate seal,may be affixed by facsimile to any
power of attorney or special power of attorney or certification of either autborized hereby;such stgitature and seal,when so;i sed,being adopied,by
tip$Company as the orEgmal signature of sucft officer and the original seal of the Company,to bevelid and!binding upon ttse company with t-a same
fosse and effect as tfitiigh manually affixed.Such attorneys-in-fact,subject to the limitations set forth in their respecilsze eettifiea#es of autftorlty sisa6
boos foil pourer to bmd the Company:=by their signature and exeouflon of any such instruments and to attach the seal of the mpany'thereta.the
Prasident or any Vice P>esident,Elie 8bard of pirectors or any,6ther officer gf-theCompanp mayat any time revoke afi power aittl author-Ry prevr;ousiy
given to any attorney=ln-fact.
IN VIIITNES;5 WHEREOF..
the UNITED FIRE & CASUALTY COMPANY has: caused these presents
�larngr. tv be sighed by its vice president and `its corporate seal to be hereto affixed this
NNk k��k 28th day of JUNE 'A.D. 2002
` copoute
• UNITED FIRE & CASUALTY WMOP Y
.ISiL
i►aaM*ice;.
V.
+'t�+►u>'tt''
By
State
a# Iowan County of Linn, ss:
\lice President
On this 2 8th day of J U2�E 2 00:9, before me personally came' RANDY.:..� RAM O
to me known, why being;by me ::duly sworn, did depose and say: that he resides in Cedar`Rapids, State of iowra that ;tie Is a
Vice President of 'the UNITED FIRE & CASUALTY. COMPANY, the .corporation :de:scribed.: it and which': executed the'. above
instrument, that he knows the seat:: of said corporation, that the.seal affixed t6i the said instrument Is such corporate seat± that it
was so affixed pureuan# to authority given by the Board .of Directors.of salt! corporation and that he sighed his name (hereto::
pursuant to like author#y and acknowledges same t6:6 the act and deed of said corporation
*�''`s P t^Rif A.JANSEN #
_° fi �4it 10.^.t NUMBER 7#3273" Notary Pu
MY i�ir !: Sip �p I My commission expires OCTOBER, 26 .2004
owl.. _�' 1;L., "
CERTIEICATIOIV
Xv
I. the undersigned officer of the UNITED FIRE $t CASUALTY COMPANY, do hereby ;certify that I have compared the foregoing
copy'of the Power of Attorney and affidavit, and the copy of the Section of!the bylaws of said?Company as set forth in said
Power- of Attorney, with ;the 60IG1NALS ON FILE IN [HE f lL3ME OFFICE OF' SAlla ;COMPANY and that She same. are correct
transcripts thereof, ant! of:':the whole of ttte s ,cl originals anel that tits Said`:Power: of Attorney t3as not been revoked'!and is
now in full force and effect.
nnrryfr In testimony whereof' I have hereunto subscribed my name and affixed the corporate seal of the said
Company this 2 rkt day!of OCTOBER, 20 02
Cabot W.Secretary
STATE OF TEXAS BOND NO. 55-187307
COUNTY OF JEFFERSON PRINCIPALS ADDRESS & PHONE
510 PARK STREET
SUITE 100
BEAUMONT, TEXAS 77705
_(409) 835-3636
BUILDING CONTRACTORS BOND
KNOW ALL MEN BY THESE PRESENT: That we, EAGLE—PRO ENGINEERING,
INC_ as Principal, and__UNITED FIRE & CASUALTY COMPANY as
Sureties,are held and firmly bound unto die City of Beaumont,Texas in the sum of Fifteen Thousand($15,000.00)
Dollars to the payment of which well and truly to be made we hereby bind ourselves, our heirs, executors,
administrators-assigns, and legal representatives, firmly by these presents:
WHEREAS, The above named EAGLE—PRO ENGINEERING, INC.
Is engaged in the business of erecting. constructing. enlarging, altering, repairing, moving,
improving, removing,converting, and demolishing buildings and structures within the City of Beaumont, Texas
and '
WHEREAS, Section 6-4 of the Code of Ordinances of Beaumont,Texas requires a bond in the sum
of Fifteen Thousand ($15,000.00) Dollars of persons or businesses pursuing contracting within the City of
Beaumont.
NOW THEREFORE, if the said EAGLE—PRO ENGINEERING, INC.
shall sufficiently indemnify and protect the City of Beaumont against all costs, expenses, or damages which may
in anywise accrue against, the City of Beaumont on account of his failure to conform to the regulations of the
aforesaid Building Code and other Ordinances of the City in reference to building and shall pay all loss and damage
for injuries to persons and property which may lawfully be claimed against him on account of such failure, then
this obligation shall be null and void, otherwise to remain in full force and effect.
This bond shall cover all erecting,constructing, enlarging, altering, repairing, moving, improving,
removing, converting, or demolishing of buildings and structures, by the said EAGLE—PRO ENGINEERING,
INC_ within the City of Beaumont, for the period of one(1)year from the date of approval and filing
hereof.
This bond shall also insure to the benefit of any and all persons who sustain any loss or damage on
account of any failure by the said EAGLE—PRO ENGINEERING, INC.
to conform to the regulations of the aforementioned Building Code, the regulations of the Code of Ordinances and
other ordinances of the City of Beaumont, in reference to buildings, and any such person sustaining any such loss
or damage may bring suit on this bond against the principal and surety or sureties hereon in any court of competent '
jurisdiction to recover same.
All remedies upon or under this bond shall be in addition to and cumulative of all other remedies
the parties may have at law or In equity for recovery of any such losses or damages. Cumulative recoveries may
be had on this Bond but total recoveries hereunder by all clamiants shall not exceed Fifteen Thousand ($15,000.00)
Dollars. Principal will maintain this bond at Fifteen Thousand ($15,000.00) Dollars by providing the City of
Beaumont with additional bond principal within fifteen (15) days after any recovery is made on this bond.
IN TESTIMONY WI.IEREOF,witness our hands on this 29th day of OCT. , 20 02
TO REMAIN IN EFFECT UNTIL 29th day of OCT. , 20--=
Insurance Co. UNITED FIRE & CASUALTY COMPANY 49 / �) W
Address:_ 9323 Lone Point, Houston, Tx. ( t orT pc Owners e)
Phone; 713-467-8600
AGENT: PLEASE ATTACIi FO OF
ORNE OND
ar urm n — ttorney—in— act
(Siggature To Be Notarized
ORN TO AND SUBSCRIBED BEFORE ME ON THIS THE DAY OF�, 2002—.
Approved.tlsis day of 20
% CATHERINE PUBLIC SIGNATURE
iirf *t NOTARY P tssi Expires:
State of Texas
BUILDING OFFICIAL ' 'k`oF 'jComm.Exp, 09-22-2004
UNITED FIRE & CASUALTY'COMPANY
HOME OFFICE CEDAR RAPIDS, IOWA
CERTIFIED COPT OF.<POWER QF ATTORNEY
(Original on file at Home Office: of Company - See Cert#.ficat ion,
}
KNOW ALL MEN BY 'THESE PRESENTS, That the UNITED`.. FIRE &, CASUALTY COMPANY, a torpor ion duly organized and ex1-stinq
under the laves of the State of Iowa, anal having its principal.;pffice in Cellar Rapids, State of Iowa, does make,<constitute an
appoint AL THUFtMONJ7 II ," OR MARK, THUF2ION]]°, BOIH INDIVTBIIALLY
of 9323 LONG POINT HOUSTQN TX 77055 ;
its true and,lawful. A t
torneyts�—in-Fac# with power and authority hereby conferred to sign, seal and execute in its behalf a#l:
lawful bonds; undertakings :and other obligatory instruments of similar nature as follows: A'NY AND ALL 8.t7NDS
and to bind UNITED FIRE & CASUALTY COMPANY thereby as fully and to the same extent as if such instruments were signed by
the duly authorized 'officers of UNITED FIRE & CASUALTY COMPANY and all the acts. of said Attorney, pursuant to the authority.::
hereby given are hereby ratified and confirmed. ;
The Authority hereby granted,:shall expire JUKE >2 8 t h!
2004 finless. sooner revoked.
This D vver of;Attorney is made and executed pursuant to and b}r: authority of the following Bj!—Law duly adopted by #he:
Board of Directors of the Cornparty on 1prlf
"Article V — Surety Bonds and Undertakings."
Section 2,Appointment o€Attorney-in-Fact:."The President or any Vice President,or any other officer of the Company, may,€nom time to time,
appoint by written certificates attorneys-in-fact to act in behalf of the Company in the execution of policies of insurance,bonds,undertakings and
other obligatory instruments of like nature.The signature of any officer authorized hereby,and the Corporate seal,may be affixed by facsimile to any
power of attorney or special power of attorney or cer#fication of either authorized hereby,such signature and seal,when so used,being adopted by
the company as 4.e origmai signaWite;of such officer and the original seal of the Company,to be valid ant]binding upon the Company+with the same
force and effect as though maxi"lly affixed.Such attorneys-in-fact,subject to the limitations set forth in their respective certificates of authority shall
have full power to bind the Company by their signature and execution of any such instruments and to attach the seat of the Company thereto,The
President or any Vice President,the Board of Directors or any other officer of the Company may at any time revoke all power and authority previously
given to any attorney-fn-fact.
IN WITNESS WHEREOF, the UNITED FIRE & CASUALTY COMPANY has caused these;presents
arn'�ry to be signed by its vice president and its corporate seal to be hereto a ffixed this
• su` t�jti,, 28th day of JUKE
A.D. 2002
UNITED FIRE & CASUALTY COMlOANY
Ai
By
State of Iowa, County of Linn, ss
Vice President
On this 2 8th day,of f ;:J U IQ E:` 2 0 d 2 before me personally came RANDY ,& RAMLO
to me known, who being by me duly sworn, did depose and say: that he resides in Cedar Rapids, State: of Iowa that fta is a
/ice' President of the UNITED FIRE & CASUALTY COMPANY, the earporat:gn described;>-irt and .:w 10 executed the!aboue
instrument; that ha knows :the seai<of said corporation; that the seal"a#fixed tti3 the sa+d instrument;is such corporate seat;`that i t'
was: so affixed pursuant to authority given by #Me Board of Directors:of said corporation and that he signed his name ,thereto;
pursuant to #T€e authority, Intl ackncswdedgs same, to.be the act and Creed of :said corporation.
NUMBER 71327 ` Notary Pu
" MY M r My commssion expires
OCTOBER 26 20 04
RTtF#CATION
ix
1, the undersigned officer 'of the !i:UNITED FIRE $t CASUALTY COMPAI'I do hereby certify that I Nava coittpared the foregoing:
copy of the;Power of Attorney acid affidavit, and the copy of the Section of:the by- laws of said 'Company as set forth in said
Power of Attorney, with the ORIGINALS' Old F#LE IN THE HC?1VlE OFFICE OF SAID COMPANY, and that the same era 'eorrec#
transcripts thereof, ''and of ;:the whole of`the said originals, Inc! that lire said`Power;of Attorney has not'been revoked<and is
now in full force and effect.
,1.nM,7, in testimony whereof I have hereunto subscribed my name and affixed the corporate seal of the said
•1.�' '�ttyyr, Company this 29th day of OCTQBEI : 200:2
``t0tlOUSE
a�`a� Secretary
.�� INTER-OFFICE MEMORANDUM
AN.
' City of Beaumont, Texas
IL
Purchasing Division
Date: December 12, 2002
To: Susan Henderson, City Clerk
From: Brenda Beadle-Purchasing Manager
Subject: Resolution 02-245
COMMENTS
Please find attached certificate of insurance for your files. This should be filed with contract and insurance
documents relating to Resolution 02-245.
If you have any questions, please call.
TE MM D:::<:>::>:::>:::::s...................................
ID
( NY
a�.
. . ::.::.:..:.::::: ::::::::::::::.:::.::::::.:::::::.::.:::.::.:.:::.
1209/20
2
.........:................:.:.:...:...........
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND
AL THURMOND AGENCY, INC CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE
DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE
9323 LONG POINT POLICIES BELOW.
....................................................................................................................................................................
....
HOUSTON, TX 77055 COMPANIES AFFORDING COVERAGE
(713) 467-8600 F: (713-461-0731 ..........................................................................__..._._._........_._..._._............._.............._...._._._..
COMPANY TR A LEXINGTON INSURANCE COMPANY
......... ....... ............................................._................................................................._._..........
...._..
COMPANY B UNION STANDARD INS. COMPANY
...........................................................................................................................
INSURED .......
LETTER
:......................................................................................................................................................................
.
EAGLE—PRO ENGINEERING, INC. LEMPA Y C AMERICAN INTIL SPECIALITY INS.
P.O. BOX 21237
.............._................................................................................_.............................................
BEAUMONT, TEXAS 77720 LETERY D TEXAS MUTUAL INS. COMPANY
COMPANY E
LETTER
:::CQ........cn.............::.: ::::::..:.:::::::::::.:::::::::::::::.:::::::::::::.:::::::::::::::::::::::::::::::::::::::::.:.:::::::.
Vi.�lA.Qtl"i. ::s::::::i::::: ::::: : :::i;:::::;:::;:::::i::;:::a>;;;::;::;::i::;:::::;::i:;:::2:::;:::;:i::;;::;::;::i::;:::;;::>:;::::::::;::i:;:::::::::;•:;:;:.::;:.>:.::.>:.;;:.;:-:.:
;;:.;:.::.>:.;:.>:.:;.;;;:<.;:.>:.::.>:.>:.;;;:.;::.;;:.>:.::.:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT-WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
_......._.._.__............................................_..................._........................._.............:..................._............:................................._.._...
..............._.........................................._.................
.
CO : TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION
LTR: DATE (MM/DDNY) DATE(MM/DDNY) LIMITS
A GENERAL LIABILITY ;. ..................................
GENERAL AGGREGATE $ 2, 000, 000
...............................................
X COMMERCIAL GENERAL LIABILITY 2495035 : PRODUCTS-COMP/OP AGG. $ 2, O O 0, 0 O O
>[ CLAIMS MADE ; X ;OCCUR..: / / / PERSONAL&ADV.INJURY :$ 1, 000, 000
.......... 12 09/02 12 09 03......................................
..................
OWNER'S&CONTRACTOR'S PROT. EACH OCCURRENCE S 11000, 000
X $25, 0 0 0 SIR FIRE DAMAGE(Any one fire)......$ 50, 000
......... .....................I.................
..........................................................
MED.EXPENSE(Any one person):$ —0—
>...... ......................... ... _....._.. ............._. ._................._......_........_..;... _...:.... ........... ... _...__...._. ....... 0....
AUTOMOBILE LIABILITY COMBINED SINGLE
B€ ANY AUTO TA-9069743 LIMIT $ 1, 000, 000
_...
ALL OWNED AUTOS
:12/0 9/02 12/O 9/O 3 BODILY INJURY ___._ _..................
SCHEDULED AUTOS ;(Per person) $
...........................:.....
X..°HIRED AUTOS BODILY INJURY
X NON-OWNED AUTOS (Per accident) $
GARAGELLAE31LITY :...............................................<.....................................
:PROPERTY DAMAGE S
._.._:..................................._.........__.._................................._.............................................<............._...._............<................._._.__....
...i................................................i..._............................._..
:EXCESS LIABILITY EACH OCCURRENCE $ 5, 00'6
EXCESS 1000
................................................................
C X :UMBRELLA FORM BE-7410150 12/0 9/O 2 12/O 9/O 3 AGGREGATE $ 5, 000, 000
OTHER THAN UMBRELLA FORM
............................:..................................................................:..:.....,......................:... .
WORKER'S COMPENSATION
X STATUTORY LIMITS
..;. ....................
D TSF-p000537523 / / / / EACH ACCIDENT $ 1, 000, 000
AND 12 09 02 . 12 09 03.................................................
.:.......................................
DISEASE-POLICY LIMIT :$ 1 00 01 Q 00
EMPLOYERS'LIABILITY :. .............................................:...........!...........................
.......; ...............................................................:................................................................... DISEASE-EACH EMPLOYEE S
1, 000, 000
.........................................................................................................................
OTHER
..........................................................................:........................................................................................................................
..............:........................................................................................
DESCRIPTION OF OPERATIONS ILOCATIONSIVENICLESISPECUIL ITEMS
AS LONG AS IT IS AGREED BY WRITTEN CONTRACT, BLANKET ADDITIONAL
INSURED APPLIES TO THE GENERAL LIABILITY AND BLANKET WAIVER OF
SUBROGATION APPLIES TO THE GENERAL LIABILITY AND WORKERS COMPENSATION
E
H
z' SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
' EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO
MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE
CITY OF BEAUMONT '? LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR
ATTN: PURCHASING DIVISION LIABILITY OF ANY KIND UPON THE COMPANY, ITS AGENTS OR REPRESENTATIVES.
801 MAIN, SUITE 315 >AUTHORIZED REPRESENTATnY
BEAUMONT TX 77704
. ...............................................:...::.::::.�:::::::.:::::.:::..:�.�:::::.�:.:.::::::::..�:::::::.:.>:.;:.::.::.;;:::: ..�:.�:::::::::::::::::::::::::::::::::::::.::.�:.:.::
::.:.;:.>:.;:::.:.::..:.��Fi#7!.:.O�J!�F�I�A'i'#Qtsf.:.i.990::::•-