HomeMy WebLinkAboutRES 13-186 RESOLUTION NO.13-186
BE IT RESOLVED BY THE CITY COUNCIL
OF THE CITY OF BEAUMONT:
THAT the City Manager be and he is hereby authorized to execute a one (1) year
Agreement, with an option to renew for two (2) additional terms of one year, with Texas
Industries for the Blind and Handicapped (TIBH)/Beaumont Products & Services (BPS),
of Beaumont, Texas, at a rate of $15.00 per hour per person in the estimated amount of
$149,380 to provide litter removal services on City rights-of-way. The Agreement is
substantially in the form attached hereto as Exhibit "A" and made a part hereof for all
purposes.
PASSED BY THE CITY COUNCIL of the City of Beaumont this the 10th day of
September, 2013. r ;a; N UM ie
AW® � 6T{a1WY
- Mayor ro Tem ethrel Wright -
� w � r
,�/ ='o
STATE OF TEXAS §
COUNTY OF JEFFERSON §
AGREEMENT FOR FURNISHING LITTER REMOVAL SERVICE
FOR CITY RIGHTS-OF-WAY AND SPECIFIED AREAS
TI-IlS AGREEMENT, is made and entered into by and between the CITY of BEAUMONT, Texas, a
municipal corporation, hereinafter referred to as "City," and Texas Industries for Blind and 1-Iandieapped
(:'IBI-1), a State of Texas agency, hereinafter referred to as TIBH, and Beaumont Products & Services,
Inc., hereinafter referred to as"Provider." Therefore, City, 1I13I-1,and Provider agree as follows:
WITNESSETH
1 .0 It is the intent of the City of Beaumont 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 one (1) year beginning September 16, 2013 and
ending September 15, 2014. The City may renew the contract for up to two (2) additional one(1)
year periods. Renewals shall occur by mutual agreement between the City and "1'181-1 at the end
of each yearly contract period. On the anniversary dates of the agreement,the City shall increase
the monthly payments by the lesser of the percentage increase in the Consumer Price Index for all
tJrban Consumers (CPI-U) or 2.5%. The increase will be based on the Houston-Gal veston-
Brazoria Consolidated Metropolitan Statistical Areas for the previous year from July 1 through
June 30.
3 .0 The Provider shall furnish all labor,supervision, equipment, supplies and transportation necessary
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 'iature 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.
5 .0 All litter accum-dated 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 litte3' must be equipped to prevent litter from 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. 1-lowever, the Provider shall notify the designated official of the location of
1
EXHIBIT "A"
these items immediately upon their discovery.
7 .0 The Provider shall furnish a crew consisting of one (I) supervisor and four(4) crew members for
approximately eight (8) hours per day. At the sole discretion of the City, it niay 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 designated official. Additional days may be provided with the written
approval of the Designated Official. Normal working hours shall be 7:30 a.m. to 4:00 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 or conditions, safety, damages, or
operational interests.
8.1 Work days that are voluntarily called as a result of a inclement weather shall not incur a
minimum charge for the day. Payments will not be made for hours not worked due to
inclement weather.
4.0 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 official. The Provider shall contact the designated official
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.
10.0 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
performance of this Agreement.
11.0 City holidays shall be defined as follows:
Labor 1--)ay
Veterans Day
Thanksgiving Day
Day after Thanksgiving
Christmas Day
New Year's Day
Martin Luther King, Jr.'s Birthday
Good Friday
Memorial Day
Independence 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.
2
13.0 "file 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.
14.0 This Agreement shall constitute the entire understanding of the parties hereto with respect to the
subject matter hereof, and no amendment, modification,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.
15.0 The Provider agrees to indenntify and save harmless the City of Beaumont 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 Provider under this Agreement, and including acts or omissions of the City of Beaumont
or its officers, agents or employees in connection with said Agreement.
16.0 The Provider shall at all times during the Agreement maintain in full force and effect insurance as
provided in Attachment"A". A certificate of insurance, or a copy of the insurance policies shall
be furnished to the City prior to the commencement of work by the Provider and shall provide
that the City shall receive thirty days prior written notice before any change or cancellation of any
policy.
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 days, the Agreement shall automatically terminate and the Provider
shall be in breach of this Agreement. Should the City of Beaumont receive notices of insurance
cancellation three (3) or more times within any twelve (12) month period, the City may cancel
this Agreement.
17.0 The City, besides all other rights or remedies it may have, shall have the right to terminate this
Agreement upon thirty (30) days written notice from the City Manager or his designee of its
election to do so. Said termination shall be at the sole discretion of the City Manager or his
designee.
18.0 The City, besides all other rights or remedies it may have, shall have the right to terminate this
Agreement upon five (5) days written notice in writing if 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.
19.0 'File 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. 'File City shall have the right to refuse payment for work not satisfactorily
completed.
19.1 On a weekly basis, the Provider shall provide the following reports:
19.1.1 An accurate record of the streets worked and the amount of litter removed. The
3
unit of measurement for |kior xbuU be the number of bags and tbu number of
cubic yards collected.
19.1.2 An accurate listing detailing the number of crew members, days worked, and
number of hours each worked each day.
20,8 The City shall pay the Provider atu rate of$|5.O0 per hour per person. Payment will hc made for
crew member hours actually worked. No minimum payments for inclement weather(lays will be
allowed. This payment shall be full compensation for all work performed, equipment, materials,
transportation,and iouideo1uia necessary to complete the work aswell as disposal ofthe litter.
21,0 Deductions fl-ozn payments by the City to the Provider may include items specified herein,
including taxes, oou<o for damages by the Provider, or other amounts which may be owed by the
Provider tothe City. Such deductions sbu|| not be cause for the Provider to cease or partially
cease upuru1imnu or activities required by this }\grrunco1.
22J0 The relationship of the Provider 10 the City shall be that of an independent provider, and no
principal-agent or omp}oycpcmpluyue relationship in created by this Ag/000uomL 3v entering
into this Agreement,the Provider acknowledges that it will, in tile performance of its duties under
this Agreement ho acting as all independent provider and that 000fficer, agent o,employee nfthe
Provider will bn for any purpose an employee of the City of Beaumont and that no officer, agent
or employee uf the Provider ia entitled to any of the henofitaand privileges ofu City employee o,
officer under any provision *fthe statutes of the State o[Texas or the Charter and ordinances of
the City ofBeaumont,
23.0 Y40 PERSON has the authority to verbally alter these terms and conditions. Any changes muo<bo
approved in writing 6v both parties.
24,0 Any ouxioe which City or Provider may require or may desire to give to the other shall be in
writing and uhu|| be sent by registered or certified mail 10 the following respective addresses:
City:
City ofBcuumon1
p. O. Box 3827
801 Main Street
Beaumont,TX 77704
State Agency:
Melinda May, Market Representative
Texas Industries for the Blind and Hundicuppcd
l 79Y4urik Skmc1, Suite B
Nacogdoches,Texas 75V6]
4
Provider:
Harold Comstock, President
Beaumont Products&Services, Inc.
1305 Washington Blvd.
Beaumont,Texas 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.
IN WITNESS WHEREOF, City and Provider have executed or caused to be executed by their duly
authorized officers or agents this Agreement as of the day and year written below.
CITY OF BEAUMONT:
BY:
Kyle Hayes, City Manager
bate:
TEXAS INDUSTRIES FOR THE BLIND
AND HANDICAPPED:
By:
Melinda May, Market Representative
Date:
13EAUMONT PRODUCTS AND SERVICES,INC.:
BY:
Harold Comstock, President
ATTACHMENT A
(Revised 4/1/2013)
INSURANCE
SECTION A. Prior tu the approval of this contract by the City,CONTRACTOR shall furnish u completed Insurance Conifi:atetuthe
Purchasing office. The certificate shall be completed by an agent authorized to bind the named underwriter(s)to the coverages,limits,and
termination provisions shown tho/roo, arid ahuU furnish arid contain all required information referenced o, indicated thereon. CITY
SHALL HAVE#0DD7YT0 PAY Olt PERFORM UNDGRTUlSC0NTDACTUNDL SUCH CERTIFICATE iS RECEIVED 8l,
THE CITY OF D6\U&40NTS PURCHASING DlY|O[0N,and no officer or employee of the City x6u||have authority to w6vu this
requirement.
INSURANCE COVERACE REQUIRE
SECTION B. CITY reserves the rightto reviewthe iiisuraticerequii-eineiitsoftliissectiott during the effective period ofthecontract
and to adjust insurance coverages arid theirlimits when deemed necessary and prudentby CITY, based upon changes in statutory law,
court decisions,o,the u|uimx history oythe industry umwell 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 fb|| force and uAeu for the duration of this uoo(rooi, arid any extension hereof, at
CONTRACTOR'S soleexpense,insurance coverage written bycornpaniesapproved bythe StateofTexas and acceptableto CITY,in the
following typo(o)arid umouut(y)
TYPE' AMOUNT
l. Workers' Coin p*nvxdnnarid Statutory
Employer's Liability
NOTE: For building orconstruction projects,and services provided at City-owned facilities,the successful
Contractor shall meet the minimum ccquimcmcutx defined in the Texas Workers' Compensation Commission
Rule 2M3/tC0ll0.11O which follows this insurance attachment.
2, Commercial General(yohOo)Liability
including covet-age for the following:
o. Premises operations Combined single limit for bodily injuryuoJ
h. Independent contractors and property damage o[$5O0`000per
C. Products/completed operations occurrence or its equivalent with an a0g/ngwo:
d, Personal injury limit nf$l.O00'0O0.
C. Advertising in
[ Contractual liability
� Mudicm| palmonv
}�
Professional liability*
i. Underground hazard*
J Explosion and collapse hazard*
L {.iquo,|ivhUi|y*
i Fire legal liability*
IM City's prope,t\ iuCmnt,auor's*
cmm, custody,orcontrol
o. Asbestos specific liability*
*
Not required for this contract
] Comprehensive/knmuoabUo IjuhUity Combined uio&|o !imkfor bodily injury and
inaumuco,including coverage for loading property dmmagu of$500,000 per occurrence
and unloading hazards, k`c or equivalent.
' l '
ATTACHMENT ''A"
a. Owned/leased vehicles
b. Non-owned vehicles
C. [-fired vehicles
4. Errors and Oinissions 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 andmay
make any reasonable request for deletion, revision, or modifration 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 underwiter 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. CON'T'RACTOR.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 yeas which shall begin at the end of
the warranty period.
NOTICES
CONTRACTOR shall notify CI'T'Y in the event of any change in coverage and shall give such notices not less thanthirty(30)days
prior to the change,which notice must be accompanied by a reT acement CERTIFICATE OF INSURANCE. All notices shall be given
to CITY at the following address:
Purchasing Division
City of Beaumont
P.O. Box 3827
Beaumont,Texas 77704
SECTION 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 shdl the
bankruptcy, insolvency, or denial of liability by the insurance companyexonerate CONTRACTOR from liability.
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WORKERS COMPENSATION INSURANCE
for
Building*rConstruction Projects and Services Provided utCixy0v*u*d Facilities
TEXAS WORKEBk0' COMPENSATlON COMMISSION RULE%0,§118.l18
An required 6ythel'euuy YVu/kcm'Cmnpcooadnn Rule 28,§] |0.\|0. the Contractor shall accept the following definitions and comply
with the following provisions:
Workers' Compensation Iumucomoe Coverage
A. Definitions:
| Certificate of coverage("cotifivate')-A copy ofuconif icateof insurance,o certificate vf authority mmo|t-innuraissued
by the commission, ormcoverage agreement[rwcC'8}^ TVVCC82. [VVCC-83, orT\VCC'84). showing statutory
*ockmrx'compcnsozien insurance coverage for the person's mr entity's employees providing services oomproJoot.for the
duration of the project.
2. Duration ofthe project-includes the time frorn the beginning of the work on the project until the Contracta's/person's
work nn the project has been completed and accepted 6y the City u[Beaumont,
3. Persons providing set-vices oo the project("xu6000truotor''io§406.0P6)'indudcuu|\p*munsormniduopu,fonniogu\l
or part of the services the Contractor has undertaken to perform on the project, regardless of whether that person
unotmo1cd directly with the Contractor and regardless nf whether that person has employees. This includes,without
|imitabon'independent Contractors,subcontractors,leasing companies,motor carriers,owoer-opcomoru,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,oi-other
set-vice related to a project."Set-vices"does not include activities unrelated to the project,such as food/beverage vendors,
office supply deliveries,and delivery of pot-table toilets.
B. The Contractor shall provide coverage, based on proper reporting of classification codes and payroll amounts and filing of any
coverage agreements,which ineets the statutory requirements of Texas Labor Code,.Section 401.01](44)for all employees of the
Contractor providing services un the project,for the duration uf the project.
C. The Contractor mug provide u certificate ofcoverage to the City of Beaumont prior m being awarded the contract.
D. If the coverage period shown on the Contractor's current certificate of coverage oodo during the duration of the project, the
Contractor must,pviexoa the end o the coverage period,fi|ou new certificate ufoov*mgevvidh the City ofBouumontuhm*ingtha
coverage has been extended.
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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 showingcoverage for all persons providing services on the
project; and
1 No later than seven (7) days after receipt by the Contractor, a new certificate of coverage showing
extension of coverage,ifthe coverage period shown on the current certificate of coverage ends during
the duration of the project.
P. The Contractor shall retain all required certificates of coverage for the duration of the project and for one(1)
year thereafter.
G. The Contractor shall notify the City of Beaumont in writing by certified mail orpersonal delivery,within ten
{10)days after the Contractor knew or should have known,of any change that materially affects the provision of
coverage of any person providing services on the project.
1-1. fhe Contractor shall post on each project site a notice, in the text, form and manner prescribed 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.
1. The Contractor shall contractually require each person with whom it contracts to provide services on a project,
!o:
I. 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
401.01 1(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.
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.
Retain all required certificates of coverage on file for the duration of the project and for one(1)year
thereafter; . Notify the City of Beaumont in writing by certified mail or personal delivery,within
ten(10'1 days after the person knew or should have known,of any change that maternally affects the
provision of coverage of any person providing services on the project; and
Contractually require each person with whom it contracts,to perform as required by paragraphs(])-
(7), with tile, certificates of coverage to be provided to the person for whom they are providing
services.
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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
be 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 ofthese 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:
Erecting or preparing to erect 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 employmentof a maintenance employee who is not engaging in building or construction as the employer'sprimary
business does not constitute engaging in building or construction.
_ S _
CERTIFICATE OF INSURANCE Form No. C0131
Put! Edition Date: 12/12/2012
A I L Page 1 of 3
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 all 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 e-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:
Project Name:
Project Location:
Phone:
Managing Dept.:
Name and Address of Insured:
Project Mgr.:
Insurers Affording Coverages:
Insurer A:
Phone: /
Insurer B:
Prime or Sub-Contractor?-.—
Insurer C:
Name of Prime Contractor, if different from Insured:
Insurer D:
INSR TYPE OF INSURANCE POLICY POLICY EFF.DATE POLICY EXP. LIMITS OF LIABILITY
LTR NO. (MM/DDIYYYY) DATE
(MMIDDIYYYY)
Commercial General Each Occurrence $
Liability Policy
As defined in the
Policy, does the Policy General Aggregate $
provide:
Completed $
I ❑ Yes ❑ No – Completed Operations/Products Operations/
Products Aggregate
❑Yes ❑ No — Contractual Liability Personal & $
Advertising Injury
Deductible or Self $
El Yes El No — Explosion Insured Retention
- 6 -
.,�.. CERTIFICATE OF INSURANCE Form No, COB1
Edition Date: 12/12/2012
M IL Page 2 of 3
INSR POLICY POLICY EFF.DATE POLICY EXP.
LTR TYPE OF INSURANCE NO. (MM/DDIYYYY) DATE LIMITS OF LIABILITY
(MMIDD[YYYY)
O Yes El No — Collapse
0 Yes 0 No — Underground
*Yes ❑No — Contractors/Subcontractors Work
❑Yes f1 No — Aggregate Limits per Project Form CG 2503
O Yes 0 No — Additional Insured Form—CG 2010
i
Yes 0 No — 30 Day Notice of Cancellation Form-CG 0205
O Yes 0 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 [_i No — Any Auto Bodily Injury $
(Per Person)
0 Yes 11 No - All Owned Autos Property Damage $
Per Accident)
0 Yes 0 No — Non-Owned Autos
❑Yes C7 No — Hired Autos
D Yes Ll No — Waiver of Subrogation •CA0444
O Yes L]No — 30 Day Notice of Cancellation-CA0244
D Yes EI No — Additional Insured-CA2048
D Yes 0 No — MCS 90
r
Excess Liability
n Umbrella Form Occurrence $
P Excess Liability
Follow Form Aggregate $
Workers Compensation 8: 0 Statutory
Employers Liability
As defined in the Policy,
does the Policy provide
Each Accident $
[]Yes �No — Waiver of Subrogation -WC420304 Disease
' $
Folic Limit
O Yes i.:J No — 30 Day Notice of Cancellation -WC420601 Disease- $
Each Employee
Is a Builders Risk or $
Installation Insurance
Policy provided?
0 Yes 0 No
O Yes D No — Is the City shown as loss payee/mortgagee?
Professional Liability
As defined in the Policy, Each Claim $
does the Policy provide:
0 Yes 0 No — 30 Day Notice of Cancellation Deductible or Self
Retroactive Date: Insured Retention
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CERTIFICATE OF INSURANCE Form No. COB1
Edition Date: 12/12/2012
A US w Page 3 of 3
AGENT CERTIFICATION:
THIS IS TO CERTIFYTO THE CITY OF BEAUMONTthatthe 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: DATE ISSUED:
City of Beaumont
P. 0, Box 3827 AUTHORIZED REPRESENTATIVE SIGNATURE
Beaumont, Texas 777043827 Licensed Insurance Agent
Printed Name:
Beaumont Products & Services, Inc.
Street From To Dates
McLean Major Drive Greeves
Phelan Blvd IH-10 W Frontage Road W City Limits
Laurel Office Park Dr. IH-10 N. Frontage Road
Gladys Major Drive IH-10 W Frontage Road
Dowlen Road Concord Road College
Old Dowlen Road Dowlen Road Hwy 105
Plant Road Eastex Helbi
Sherwood Broadoak Piney Point
Maida Helbig Barrett one block
Comstock Garner Helbi
Calder Magnolia 400' W of Arlington
Todd Phelan McLean
West Lucas Calder Eastex E Frontage Road
East Lucas Eastex E Frontage Road Pine
Bigner E Lucas Dead end
Id (wood E Lucas Charles
Pine _ Boat Ram IH-10 N Frontage Road
Delaware Major Drive Pine
Dishman Major Drive City Limits
Tolivar Ma ior Drive Keith Road
Magnolia Laurel E Lucas
Lawrence Drive Eastex Chinn
Chinn Eastex Lawrence
Concord Hwy 105 Liveoak
Gober Concord 1 st Driveway
Pineburr E Lucas Concord
Pinkston Eastex E Frontage Road Concord
CDS/Dollin er/Hoover Concord 11th Street
7th Street Dollin er Laurel
College IH-10 E Frontage Road Neches
Eleventh Street Delaware Fannett Road
Fannett _ Washington Blvd Cardinal N Frontage Road
Walden Road Major Drive Fannett Road
Brooks Major Drive IH-10 W Frontage Road
Tyrrell Park Road Fannett Road Frint/Canal
Buford Pennsylvania Carroll
Irving Buford Highland
Highland Ave. Irving Cardinal N Frontage Road
Highland Drive Highland Ave Kenneth
Florida Cardinal N Frontage Road University
Park MLK Florida
Pennsylvania Washington Blvd MLK
Avenue A Virginia City Limits
Washington Blvd MLK Parkway Reynolds
Pevitot/Burbank Washington Blvd W of LNVA Canal
Lan ham Washington Blvd College
Wendelin Lan ham College
Fourth North Cardinal N Frontage Road
Cedar MLK Parkway Fourth
Delores/Elmira/Fatima Fannett Road Sarah
Sarah Fannett Road Bob
Lavaca Bob University Drive
Liberty& Laurel MLK 11th Street
McFaddin MLK Willow
Fannin MLK Neches
Bowie MLK Neches
First Calder Evalon
ATTACHMENT "B"