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ST99-02-CS130816VALENTI -' TROBEC CHANDLER INC. INSURANCE GRCUP GENERAL INSURANCE • SURETY BONDS August 16, 2013 City Coppell 255 Pakway Blvd Coppell, TX 75019 ���5, RE: OCP #GL20879330 Reconstruction for West Sandy Lake Road, Phase 2A & 2B. (North Coppell Road to South Coppell Road) Texas. To Whom It May Concern: With reference to the captioned, we enclose Policy Number GL20879330, original policy evidencing Owner's and Contractor's Protective Liability. If we can be of further assistance, please advise. Thank you. Best regards, VALENTI TROBEC CHANDLER, INC. Jackie Wilson Enclosures cc: Tiseo Paving Company 1175 WEST LONG LAKE RD. ♦ SUITE 200 ♦ TROY, MICHIGAN 48098 ♦ 248 - 828 -3377 ♦ BOND FAX 248 - 828 -4290 ♦ FAX 248- 828 -3741 19 a s1u� POLICY NUMBER: GL 20879330002 Insurance IL DS 71 OS 02 0$ ACCOUNT NUMBER: 11070770 COMMON POLICY DECLARATIONS AMERISURE MUTUAL INSURANCE COMPANY VALENTI TROBEC CHANDLER INC 26777 HALSTED ROAD 1175 W LONG LAKE RD #200 FARMINGTON HILLS, MI 48331 -3586 TROY, MI 48098 0125253 - NAMED INSURED: CITY o f COPPELL MAILING ADDRESS: 255 PARKWAY BLVD COPPELL TX 75019 POLICY PERIOD: FROM _ 06/12/2013 TO 06/12/2014 AT 12:01 A.M. STANDARD r - •� IN RETURN FOR THE PAYMENT OF THE PREMIUM, AND SUBJECT TO ALL THE TERMS OF THIS POLICY, WE AGREE WITH YOU TO PROVIDE THE INSURANCE AS STATED IN THIS POLICY. THIS POLICY CONSISTS OF THE FOLLOWING COVERAGE PARTS FOR WHICH A PREMIUM IS Issue Date: 06/15/2013 IL DS 79 05 02 08 INSURED COPY Page 1 of 2 � PREMIUM CAPITAL ASSETS PROGRAM (OUTPUT POLICY) COVERAGE PART $ COMMERCIAL AUTOMOBILE COVERAGE PART $ COMMERCIAL GENERAL LIABILITY COVERAGE PART $ 4, 498.00 COMMERCIAL INLAND MARINE COVERAGE PART $ COMMERCIAL LIABILITY UMBRELLA $ COMMERCIAL PROPERTY COVERAGE PART $ CRIME AND FIDELITY COVERAGE PART $ EMPLOYMENT - RELATED PRACTICES LIABILITY COVERAGE PART $ EQUIPMENT BREAKDOWN COVERAGE PART $ FARM COVERAGE PART $ LIQUOR LIABILITY COVERAGE PART $ POLLUTION LIABILITY COVERAGE PART $ PROFESSIONAL LIABILITY COVERAGE PART $ TOTAL: $ 4,498.00 Premium shown is payable: $ at inception. $ 4, 498.00 Issue Date: 06/15/2013 IL DS 79 05 02 08 INSURED COPY Page 1 of 2 � "SEE FORMS &ENDORSEMENT SCHEDULE" Countersigned: By: (Date) (Authorized Representative) NOTE OFFICERS' FACSIMILE SIGNATURES MAY BE INSERTED HERE. ON THE POLICY COVER OR ELSEWHERE AT THE COMPANY'S OPTION. Page 2 of 2 IL DS 71 05 02 08 ❑ POLICY NUMBER: GL 20879330002 COMMERCIAL GENERAL LIABILITY CG DS 70 02 09 06 OWNERS AND CONTRACTORS PROTECTIVE LIABILITY DECLARATIONS AMERISURE MUTUAL INSURANCE COMPANY VALENTI TROBEC CHANDLER INC 26777 HALSTED ROAD 1175 W LONG LAKE RD #200 FARMINGTON HILLS, MI 48331 -3586 TROY, MI 48098 NAMED INSURED: CITY OF COPPELL MAILING ADDRESS: 255 PARKWAY BLVD ��LL,_TX75019 _____ __ _ POLICY PERIOD: FROM 06/12/2013 TO 06/12/2014 AT 12:01 A.M. TIME AT YOUR MAILING ADDRESS SHOWN ABOVE LOCATION OF COVERED OPERATIONS: w SANDY LAKE ROAD COPPELL, TX DESIGNATED CONTRACTOR: TISEO PAVING COMPANY MAILING ADDRESS: p,p. BOX 270040 DALLAS, TX 75227 IN RETURN FOR THE PAYMENT OF THE PREMIUM, AND' SUBJECT TO ALL THE TERMS OF THIS POLICY. WE AGREE WITH YOU TO PROVIDE THE INSURANCE AS STATED IN THIS POLICY. LIMITS OF INSURANCE EACH OCCURRENCE LIMIT $ 1, 000, 000 AGGREGATE LIMIT $ 1.000,000 FORM OF BUSINESS: ❑INDIVIDUAL ❑ PARTNERSHIP ❑ JOINT VENTURE ❑LIMITED LIABILITY COMPANY ®ORGANIZATION, INCLUDING A CORPORATION (BUT NOT IN- _ CLUDING A PARTNERSHIP, JOINT VENTURE OR LIMITED LIABILITY COMPANY) ISSUE DATE 06/15/2013 INSURED COPY CG DS 70 02 09 06 Copyright, Insurance Services Office, Inc., 1998 Page 1 of 2 � CLASSIFICATION AND PREMIUM CLASSIFICATION CODE PREMIUM RATE PER ADVANCE PREMIUM NO. BASE 1 000 OF COST SEE SCHEDULE saa sceanvza ssa scaanm.a ssa aexapuaa $4 � 4�� STATE TAX OR OTHER (if applicable) $ es _ 00 TOTAL PREMIUM (SUBJECT TO AUDIT) $ PREMIUM SHOWN IS PAYABLE: AT INCEPTION $ _ _ 4 498.00 AT EACH ANNIVERSARY $ (IF POLICY PERIOD IS MORE THAN ONE YEAR AND PRE- MIUM IS PAID IN ANNUAL INSTALLMENTS) AUDIT PERIOD (IF APPLICABLE) ❑ANNUALLY ❑SEMI- ❑QUARTERLY ❑MONTHLY SEE FORMS IiND ENDORSEMENTS SCHEDULE THESE DECLARATIONS, TOGETHER WITH THE COMMON POLICY CONDITIONS AND COVERAGE FORMS) AND ANY ENDORSEMENT(S), COMPLETE THE ABOVE NUMBERED POLICY. Countersigned: By: (Date) (Authorized Representative) NOTE OFFICERS' FACSIMILE SIGNATURES MAY BE INSERTED HERE. ON THE POLICY COVER OR ELSEWHERE AT THE COMPANY'S OPTION. Page 2 of 2 Copyright, Insurance Services Office, Inc., 1998 CG DS 70 02 09 06 � Named Insured Schedule POLICY NUMBER GL 20879330002 EFFECTIVE DATE o6 /i2 /2oi3 NAMED INSURED CI'T'Y OF COPPELL Named Insured CITY OF COPPELL IL Ds 71 04 09 06 Page i of i � � ,� � J � � _ .? u �� u �� O 3 L •� a� � L 0 0- u � �p C L (a �+ � � r� � V ++ '� � C . 0 Q � � L � ...� cU u M r-I 0 N N 0 w H Q 0 W U W LL LL w a Q w o a, o a r, O ri U rn [� Ga ao O 0 N � C U W Z } U a 0 W N Z 0 W Z � o o O w �. � a �; w � U Z a 0 a H x W o � N A w 0 O W O z 0 H O w w N Q m � � a n. o � � a z � U H w 0 Q a 0 w U w Q W H a a H H r r C1 m a 0 rn 0 O r n D c7 O [x � a m � o � °� ° z O m -- K � w 0 O z O Z N W m � N � O � w u w o � z z a O 0 Z U Q Q Z U � Z O W � o� m � � ,�z a� � a o° O Z U LLL N � N C � ,C U J ...I 0 Q a 0 w U w Q W H a a H H r r C1 m a 0 rn 0 O r n D c7 Forms and Endorsements Schedule Policy Number: GL 20879330002 Effective Date: 06/12/2013 Named Insured: CITY OF COPPELL Form Number Description A 40 10 02 10 TEXAS IMPORTANT NOTICE IL 00 21 09 08 NUCLEAR ENERGY LIABILITY EXCLUSION M 10 85 05 09 AMERISURE MUTUAL INSURANCE COMPANY - SIGNATURE PAGE CG 00 09 04 13 OWNERS & CONTRACTORS PROTECTIVE LIAB COV- OPERATIONS OF DESIGNATED CONTRACTOR CG 21 70 O1 08 CAP ON LOSSES FROM CERTIFIED ACTS OF TERRORISM CG 28 55 03 93 TEXAS CHANGES - CANCELLATION AND NONRENEWAL CG 29 51 12 07 EMPLOYMENT - RELATED PRACTICES EXCLUSION CG 31 07 02 00 TEXAS CHANGES - CONDITIONS REQUIRING NOTICE CG 31 31 12 04 FUNGI OR BACTERIA EXCLUSION CG 70 42 04 03 ASBESTOS EXCLUSION ENDORSEMENT CG 71 30 O1 06 TOTAL POLLUTION EXCL WITH A BLDG HEATING COOL DEHUMID EQUIP EXCEPT HOSTILE FIR: CG 71 95 O1 09 PRIVACY PROTECTION CONDITION IL DS 71 O1 09 06 Page 1 of 1 I L 00 21 09 08 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. NUCLEAR ENERGY LIABILITY EXCLUSION ENDORSEMENT (Broad Form) This endorsement modifies insurance provided under the following: COMMERCIAL AUTOMOBILE COVERAGE PART COMMERCIAL GENERAL LIABILITY COVERAGE PART FARM COVERAGE PART LIQUOR LIABILITY COVERAGE PART MEDICAL PROFESSIONAL LIABILITY COVERAGE PART OWNERS AND CONTRACTORS PROTECTIVE LIABILITY COVERAGE PART POLLUTION LIABILITY CnVFRAGE PART PRODUCTS /COMPLETED OPERATIONS LIABILITY COVERAGE PART RAILROAD PROTECTIVE LIABILITY COVERAGE PART UNDERGROUND STORAGE TANK POLICY 1. The insurance does not apply: A. Under any Liability Coverage, to "bodily injury" or "property damage ": (1) With respect to which an "insured" under the. policy is also an insured under a nu- clear energy liability policy issued by Nu- clear Energy Liability Insurance Associa- tion, Mutual Atomic Energy Liability Underwriters, Nuclear Insurance Associa- tion of Canada or any of their successors, or would be an insured under any such pol- icy but for its termination upon exhaustion of its limit of liability; or (2) Resulting from the "hazardous properties" of "nuclear material" and with respect to which (a) any person or organization is re- quired to maintain financial protection pur- suant to the Atomic Energy Act of 1954, or any law amendatory thereof, or (b) the "in- sured" is, or had this policy not been issued would be, entitled to indemnity from the United States of America, or any agency thereof, under any agreement entered into by the United States of America, or any agency thereof, with any person or organi- zation. B. Under any Medical Payments coverage, to expenses incurred with respect to "bodily in- jury" resulting from the "hazardous properties" of "nuclear material" and arising out of the op- eration of a "nuclear facility" by any person or organization. C. Under any Liability Coverage, to "bodily injury" or "property damage" resulting from "hazard- ous properties" of "nuclear material ", if: (1) The "nuclear material" (a) is at any "nuclear facility" owned by, or operated by or on be- half of, an "insured" or (b) has been dis- charged or dispersed therefrom; (2) The "nuclear material" is contained in "spent fuel" or "waste" at any time pos- sessed, handled, used, processed, stored, transported or disposed of, by or on behalf of an "insured "; or (3) The "bodily injury" or "property damage" arises out of the furnishing by an "insured" of services, materials, parts or equipment in connection with the planning, construction, maintenance, operation or use of any "nu- clear facility ", but if such facility is located within the United States of America, its terri- tories or possessions or Canada, this ex- clusion (3) applies only to "property dam- age" to such "nuclear facility" and any property thereat. 2. As used in this endorsement: "Hazardous properties" includes radioactive, toxic or explosive properties. "Nuclear material" means "source material ", "spe- cial nuclear material" or "by- product material ". IL 00 21 09 08 ©ISO Properties, Inc., 2007 Page 1 of 2 ❑ IL 01 68 03 12 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. TEXAS CHANGES -- DUTIES This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART FARM COVERAGE PART LIQUOR LIABILITY COVERAGE PART MEDICAL PROFESSIONAL LIABILITY COVERAGE PART OWNERS AND CONTRACTORS PROTECTIVE LIABILITY COVERAGE PART POLLUTION LIABILITY COVERAGE PART PRODUCTS /COMPLETED OPERATIONS LIABILITY COVERAGE PART RAILROAD PROTECTIVE LIABILITY COVERAGE PART The following is added to the Duties Condition: We will notify the first Named Insured in writing of: 1. An initial offer to settle a claim made or "suit" brought against any insured ( "insured ") under this coverage. The notice will be given not later than the 10th day after the date on which the offer is made. 2. Any settlement of a claim made or "suit" brought against the insured ( "insured ") under this coverage. The notice will be given not later than the 30th day after the date of the settlement. IL 01 68 03 12 ©Insurance Services Office, Inc.,2011 Page 1of 1 AMERISURE MUTUAL INSURANCE COMPANY 26777 Halsted Road, Farmington Hills, MI 48331 -3586 Phone 1 -800 -257 -1900 ASSIGNMENT Assignment of this policy is valid only with the written consent of this Company. POLICY CONTENT This policy is made and accepted subject to the foregoing provisions and stipulations and those which follow. These provisions, in addition to those added by amendment or endorsement are a part of this policy. This policy consists of the Common Policy Declarations, Coverage Parts and endorsements listed in that Declarations form. In return for the payment of the premium, the Company agrees with the Named Insured to provide the insurance afforded by a Coverage Part forming part of this policy. MUTUAL POLICY CONDITIONS This policy is non - assessable. You may participate in the distribution of dividends to the extent and upon the conditions fixed and determined by the Board of Directors. Dividends cannot be guaranteed. Any distribution will be made in accordance with law. The Company has by its authorized representative executed and attested to these provisions as reflected below. By virtue of this policy, the insured is a member of Amerisure Mutual Holdings, Inc, of Farmington Hills, Michigan. Members are entitled to vote either in person or by proxy at any meetings of members. Annual meetings are held on the second Thursday of May of each year at 10:30 A.M. at the Home Office in Farmington Hills, MI or at such other place in the City of Farmington Hills, to which the members may adjourn such meeting. // I / � i Secretary �����' President M 10 85 05 09 COMMERCIAL GENERAL LIABILITY CG 00 09 04 13 OWNERS AND CONTRACTORS PROTECTIVE LIABILITY COVERAGE FORM -- COVERAGE FOR OPERATIONS OF DESIGNATED CONTRACTOR Various provisions of this policy restrict coverage. Read the entire policy carefully to determine rights, duties and what is and is not covered. Throughout this policy the words "you" and "your" refer to the Named Insured shown in the Declarations. The words "we ", "us" and "our" refer to the company providing this insurance. The word "insured" means any person or organization qualifying as such under Section II —Who Is An Insured. Other words and phrases that- appear in quotation marks have special meaning. Refer to Section V — Definitions. SECTION I — COVERAGES BODILY INJURY AND PROPERTY DAMAGE LIABILITY 1. Insuring Agreement a. We will pay those sums that the insured becomes legally obligated to pay as damages because of "bodily injury" or "property damage" to which this insurance applies. We will have the right and duty to defend the insured against any "suit" seeking those damages. However, we will have no duty to defend the insured against any "suit" seeking damages for "bodily injury" or "property damage" to which this insurance does not apply. We may, at our discretion, investigate any "occurrence" and settle any claim or "suit" that may result. But: (1) The amount we will pay for damages is limited as described in Section III -- Limits Of Insurance; and (2) Our right and duty to defend ends when we have used up the applicable limit of insurance in the payment of judgments or settlements. No other obligation or liability to pay sums or perform acts or services is covered unless explicitly provided for under Supplementary Payments. b. This insurance applies to "bodily injury" and "property damage" only if: (1) The "bodily injury" or "property damage" is caused by an "occurrence" and arises out of: (a) Operations performed for you by the "contractor" at the location specified in the Declarations; or (b) Your acts or omissions in connection with the general supervision of such operations; (2) The "bodily injury" or "property damage" occurs during the policy period; and (3) Prior to the policy period, no insured listed under Paragraph 1, of Section II —Who Is An Insured and no "employee" authorized by you to give or receive notice of an "occurrence" or claim, knew that the "bodily injury" or "property damage" had occurred, in whole or in part. If such a listed insured or authorized "employee" knew, prior to the policy period, that the "bodily injury" or "property damage" occurred, then.. any continuation, change or resumption of such "bodily injury" or "property damage" during or after the policy period will be deemed to have been known prior to the policy period. c. "Bodily injury" or "property damage" which occurs during the policy period and was not, prior to the policy period, known to have occurred by any insured listed under Paragraph 1, of Section II —Who Is An Insured or any "employee" authorized by you to give or receive notice of an "occurrence" or claim, includes any continuation, change or resumption of that "bodily injury" or "property damage" after the end of the policy period. CG 00 09 04 13 ©Insurance Services Office, Inc.,2012 Page 1of 9 g. Damage 1'o Property (ii) "Bodily injury" or "property damage" "Property damage" to: arising out of heat, smoke or fumes from a "hostile fire "; (1) Property you own, rent, or occupy, including any costs or expenses incurred by you, or (b) At or from any premises, site or location any other person, organization or entity, for which is or was at any time used by or repair, replacement, enhancement, for any insured or others for the restoration or maintenance of such property handling, storage, disposal, processing for any reason, including prevention of or treatment of waste; injury to a person or damage to another's (c) Which are or were at any time property; transported, handled, stored, treated, (2) Property loaned to you; disposed of, or processed as waste by or for: (3) Personal property in the care, custody or control of the insured; or (i) Any insured; or (4) "Work" performed for you by the (ii) Any person or organization for whom "contractor ". you may be legally responsible; or h. War (d) At or from any premises, site or location on which any insured or any contractors �� �� � Bodily injury or property damage ,however or subcontractors working directly or caused, arising, directly or indirectly, out of: indirectly on any insured's behalf are (1) War, including undeclared or civil war; performing operations if the "pollutants" (2) Warlike action by a military force, including are brought on or to the premises, site action in hindering or defending against an or location in connection with such actual or expected attack, by any operations by such insured, contractor government, sovereign or other authority or subcontraptor. However, this subparagraph does not apply to: using military personnel or other agents; or (3) Insurrection, rebellion, revolution, usurped (i) "Bodily injury" or "property damage" power, or action taken by governmental arising out of the escape of fuels, lubricants or other operating fluids authority in hindering or defending against which are needed to perform the any of these. normal electrical, hydraulic or i. Mobile Equipment mechanical functions necessary for "Bodily injury" or "property damage" arising out the operation of "mobile equipment" of the use of "mobile equipment" in, or while in or its parts, if such fuels, lubricants practice for, or while .being prepared for, any or other operating fluids escape from prearranged . racing, speed, demolition, or a vehicle part designed to hold, store stunting activity. or receive them. This exception does j. Pollution not apply if the "bodily injury" or � property damage arises out of the (1) "Bodily injury" or "property damage" arising intentional discharge, dispersal or out of the actual, alleged or threatened release of the fuels, lubricants or discharge, dispersal, seepage, migration, other operating fluids, or if such release or escape of "pollutants ": fuels, lubricants o'r' other operating (a) At or from any premises, site or location fluids are brought on or to the which is or was at any time owned or premises, site or location with the occupied by, or rented or loaned to, any intent that they be discharged, insured. However, this subparagraph dispersed or released as part of the does not apply to: operations being performed by such (i) "Bodily injury" if sustained within a insured, contractor or subcontractor; building and caused by smoke, fumes, vapor or soot produced by or originating from equipment that is used to heat, cool or dehumidify the building, or equipment that is used to heat water for personal use, by the building's occupants or their guests; CG 00 09 04 13 ©Insurance Services Office, Inc.,2012 Page 3of 9 h. Expenses incurred by the insured for first aid administered to others at the time of an accident for "bodily injury" to which this insurance applies. These payments will not reduce the limits of insurance. 2. If we defend an insured against a "suit" and an indemnitee of the insured is also named as a party to the "suit ", we will defend that indemnitee if all of the following conditions are met: , a. The "suit" against the indemnitee seeks damages for which the insured has assumed the liability of the indemnitee in a contract or agreement that is an "insured contract "; b. This insurance applies to such liability assumed by the insured; c. The obligation to defend, or the cost of the defense of, that indemnitee, has also been assumed by the insured �n the same "insured contract "; d. The allegations in the "suit" and the information we know about the "occurrence" are such that no conflict appears to exist between the interests of the insured and the interests of the indemnitee; e. The indemnitee and the insured ask us to conduct and control the defense of that indemnitee against such "suit" 'and agree that we can assign the same counsel to defend the insured and the indemnitee; and f. The indemnitee: (1) Agrees in writing to: (a) Cooperate with us in the investigation, settlement or defense of the "suit "; (b) Immediately send us copies of any demands, notices, summonses or legal papers received in connection with the "suit "� (c) Notify any other insurer whose coverage is available to the indemnitee; and (d) Cooperate with us with respect to coordinating other applicable insurance available to the indemnitee; and (2) Provides us with written authorization to: (a) Obtain records and other information related to the "suit "; and (b) Conduct and control the defense of the indemnitee in such "suit ". So long as the above conditions are met, attorneys' fees incurred by us in the defense of that indemnitee, necessary litigation expenses incurred by us and necessary litigation expenses incurred by the indemnitee at our request will be paid as Supplementary Payments. Notwithstanding the provisions of Paragraph 2.b.(2) of Section 1 — Coverages — Bodily Injury And Property Damage Liability, such payments will not be deemed to be damages for "bodily injury" and "property damage" and will not reduce the limits of insurance. Our obligation to defend an insured's indemnitee and to pay for attorneys' fees and necessary litigation expenses as Supplementary Payments ends when we have used up the applicable limit of insurance in the payment of judgments or settlements or the conditions set forth above, or the terms of the agreement described in Paragraph f. above, are no longer met. SECTION II —WHO IS AN INSURED 1. If you are designated in the Declarations as: a. An individual, you and your spouse are insureds. b. A partnership or joint venture, you are an insured. Your members, your partners, and their spouses are also insureds, but only with respect to their duties as partners or members of a joint venture. c. A limited liability company, you are an insured. Your members. are also insureds, but only with respect to their duties as members of a limited liability company. Your managers are insureds, but only with respect to their duties as your managers. d. An organization other than a partnership, joint venture or limited liability company, you are an insured. Your "executive officers" and directors are insureds, but only with respect to their duties as your officers or directors. Your stockholders are also insureds, but only with respect to their liability as stockholders. 2. Each of the following is also an insured: a. Any person (other than your "employee ") or any organization while acting as your real estate manager. CG 00 09 04 13 ©Insurance Services Office, Inc.,2012 Page 5of 9 (3) The nature and location of any injury or damage arising out of the "occurrence ". b. If a claim is made or "suit" is brought against any insured, you must: (1) Immediately record the specifics of the claim or "suit" and the date received; and (2) Notify us as soon as practicable. You must see to it that we receive written notice of the claim or "suit" as soon as practicable. c. You and any other involved insured must: (1) Immediately send us copies of any demands, notices, summonses or legal papers received in connection with the claim or "suit "; (2) Authorize us to obtain records and other information; (3) Cooperate with us in the investigation or settlement of the claim or defense against the "suit "; and (4) Assist us, upon our request, in the enforcement of any right against any person or organization which may be liable to the insured because of injury or damage to which this insurance may also apply. d. No insured will, except at that insured's own cost, voluntarily make a payment, assume any obligation, or incur any expense, other than for first aid, without our consent. 5. Examination Of Yaur Books And Records We may examine and audit your books and records as well as the "contractor's" books and records as they relate to this policy at any time during the policy period and up to three years afterward. 6. Inspections And Surveys a. We have the right to: (1) Make inspections and surveys at any time; (2) Give you reports on the conditions we find; and (3) Recommend changes. b. We are not obligated to make any inspections, surveys, reports or recommendations and any such actions we do undertake relate only to insurability and the premiums to be charged. We do not make safety inspections. We do not undertake to perform the duty of any person or organization to provide for the health or safety of workers or the public. And we do not warrant that conditions: (2) Comply with laws, regulations, codes or standards. c. Paragraphs a. and b. of this condition apply not only to us, but also to any rating, advisory, rate service or similar organization which makes insurance inspections, surveys, reports or recommendations. d. Paragraph b. of this condition does not apply to any inspections, surveys, reports or recommendations we may make relative to certification, under state or municipal statutes, ordinances or regulations, of boilers, pressure vessels or elevators. 7. Legal Action Against Us No person or organization has a right under this Coverage Part: a. To join us as a party or otherwise bring us into a "suit" asking for damages from an insured; or b. To sue us on this Coverage Part unless all of its terms have been fully complied with. A person or organization may sue us to recover on an agreed settlement or on a final judgment against an insured; but we will not be liable for damages that are not payable under the terms of this Coverage Part or that are in excess of the applicable limit of insurance. An agreed settlement means a settlement and release of liability signed by us, the insured and the claimant or the claimant's legal representative. 8. Other Insurance The insurance afforded by this Coverage .Part is primary insurance and we will not seek contribution from any other insurance available to you unless the other insurance is provided by a contractor other than the designated "contractor" for the same operation and job location designated in the Declarations. Then we will share with that other insurance by the method described below. If all of the other insurance permits contribution by equal shares, we will follow this method also. Under this approach, each insurer contributes equal amounts until it has paid its applicable limit of insurance or none of the loss remains, whichever comes first. If any of the other insurance does not permit contribution by equal shares, we will contribute by limits. Under this method, each. insurer's share is based on the ratio of its applicable limit of insurance to the total applicable limits of insurance of all insurers. 9. Premiums The "contractor ": (1) Are safe or healthful; or a. Is responsible for the payment of all premiums; and CG 00 09 04 13 ©Insurance Services Office, Inc.,2012 Page 7of 9 10. "Mobile equipment" means any of the following types of land vehicles, including any attached machinery or equipment: a. Bulldozers, farm machinery, forklifts and other vehicles designed for use principally off public roads; b. Vehicles maintained for use solely on or next to premises you own or rent; c. Vehicles that travel on crawler treads; d. Vehicles, whether self - propelled or not, maintained primarily to provide mobility to permanently mounted: (1) Power cranes, shovels, loaders, diggers or drills; or (2) Road construction or resurfacing equipment such as graders, scrapers or rollers; e. Vehicles not described in Paragraph a., b., c. or d. above that are not self - propelled and are maintained primarily to provide mobility to permanently attached equipment of the following types: (1) Air compressors, pumps and generators, including spraying, welding, building cleaning, geophysical exploration, lighting and well servicing equipment; or (2) Cherry pickers and similar devices used to raise or lower workers; f. Vehicles not described in Paragraph a., b., c. or d. above maintained primarily for purposes other than the transportation of persons or cargo. However,. self - propelled vehicles with the following types of permanently attached equipment are not "mobile equipment" but will be considered "autos ": (1) Equipment designed primarily for: (a) Snow removal; (b) Road maintenance, but not construction or resurfacing; or (c) Street cleaning; (2) Cherry pickers and similar devices mounted on automobile or truck chassis and used to raise or lower workers; and (3) Air compressors, pumps and generators, including spraying, welding, building cleaning, geophysical exploration, lighting and well servicing equipment. However, "mobile equipment" does not include land vehicles that are subject to a compulsory or financial responsibility law or other motor vehicle insurance law where it is licensed or principally garaged. Land vehicles subject to a compulsory or financial responsibility law or other motor vehicle insurance law are considered "autos ". 11. "Occurrence" means an accident, including continuous or repeated exposure to substantially the same general harmful conditions. 12. "Pollutants" mean any solid, liquid, gaseous or thermal irritant or contaminant, including smoke, vapor, soot, fumes, acids, alkalis, chemicals and waste. Waste includes materials to be recycled, reconditioned or reclaimed. 13. "Property damage" means: a. Physical injury to tangible property, including all resulting loss of use of that property. All such loss of use shall be deemed to occur at the time of the physical injury that caused it; or b. Loss of use of tangible property that is not physically injured. All such loss of use shall be deemed to occur at the time of the "occurrence" that caused it. For the purposes of this insurance, electronic data is not tangible property. As used in this definition, electronic data means information, facts or programs stored as or on, created or used on, or transmitted to or from, computer software, including systems and applications software, hard or floppy disks,' CD- ROMs, tapes, drives, cells, data processing devices or any other media which are used with electronically controlled equipment. 14. "Suit" means a civil proceeding, brought in the United States of America (including its territories and possessions), Puerto Rico or Canada, in which damages because of "bodily injury" or "property damage" to which this insurance applies are alleged. "Suit" includes: a. An arbitration proceeding in which such damages are claimed and to which the insured must submit or does submit with our consent; or b. Any other alternative dispute resolution proceeding in which such damages are claimed and to which the insured submits with our consent. 15. "Temporary worker" means a person who is furnished to you to substitute fora permanent "employee" on leave or to meet seasonal or short - term workload conditions. 16. "Work" includes materials, parts or equipment furnished in connection with the operations. CG 00 09 04 13 ©Insurance Services Office, Inc.,2012 Page 9of 9 COMMERCIAL GENERAL LIABILITY CG 21 70 01 08 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. CAP ON LOSSES FROM CERTIFIED ACTS OF TERRORISM This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART LIQUOR LIABILITY COVERAGE PART OWNERS AND CONTRACTORS PROTECTIVE LIABILITY COVERAGE PART POLLUTION LIABILITY COVERAGE PART PRODUCTS /COMPLETED OPERATIONS LIABILITY COVERAGE PART RAILROAD PROTECTIVE LIABILITY COVERAGE PART UNDERGROUND STORAGE TANK POLICY If aggregate insured losses attributable to terrorist acts certified under the federal Terrorism Risk Insur- ance Act exceed $100 billion in a Program Year (January 1 through December 31) and we have met our insurer deductible under the Terrorism Risk Insur- ance Act, we shall not be liable for the payment of any portion of the amount of such losses that exceeds $100 billion, and in such case insured losses up to that amount are subject to pro rata allocation in ac- cordance with procedures established by the Secre- tary of the Treasury. "Certified act of terrorism" means an act that is certi- fied by the Secretary of the Treasury, in concurrence with the Secretary of State and the Attorney General of the United States, to be an act of terrorism pursu- ant to the federal Terrorism Risk Insurance Act. The criteria contained in the Terrorism Risk Insurance Act fora "certified act of terrorism" include the following: �� 1. The act resulted in insured losses in excess of $5 million in the aggregate, attributable to all types of insurance subject to the Terrorism Risk Insurance Act; and ' The act is a violent act or an act that is dangerous to human life, property or infrastructure and is committed by an individual or individuals as part of an effort to coerce the civilian population of the United States or to influence the policy or affect the conduct of the United States Government by coercion. CG 21 70 01 08 ©ISO Properties, Inc., 2007 Page 1 of 1 � COMMERCIAL GENERAL LIABILITY CG 28 55 03 93 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. TEXAS CHANGES - CANCELLATION AND NONRENEWAL This endorsement modifies insurance provided under the following: OWNERS AND CONTRACTORS PROTECTIVE LIABILITY COVERAGE PART A. Paragraph b. of the Cancellation Condition is replaced by the following: b. We may cancel this policy by mailing or delivering to the first Named Insured and the "contractor" written notice of cancella- tion, stating the reason for cancellation, at least 10 days before ine effective date of cancellation. (1) If this policy has been in effect for 60 days or less, we may cancel for any reason except, that under the provisions of the Texas Insurance Code, we may not cancel this policy solely because the policyholder is an elected official. (2) If this policy has been in effect for more than 60 days or if it is a renewal or con- tinuation of a policy issued by us, we may cancel only for one or more of the following reasons: (a) Praud in obtaining coverage; (b) Failure to pay premiums when due; (c) An increase in hazard within the control of the insured which would produce an increase in rate; (d) Loss of our reinsurance covering all or part of the risk covered by the policy; or (e) If we have been placed in supervi- sion, conservatorship or re — ceiver- ship and the cancellation is approved or directed by the supervisor, con- servator or receiver. B. The following Condition is added and supersedes any provision to the contrary: NONRENEWAL 1. We may elect not to renew this policy except, that under the provisions of the Texas Insur- ance Code, we may not refuse to renew this policy solely because the policyholder is an elected official 2. If we elect not to renew this policy, we may do so by mailing or delivering to the first Named Insured and the "contractor ", at the last mailing address known to us, written notice of nonre- newal, stating the reason for, nonrenewal, at least 60 days before the expiration date. If no- tice is mailed or delivered less than 60 days before the expiration date, this policy will re- main in effect until the 61st day after the date on which the notice is mailed or delivered. Earned premium for any period of coverage that extends beyond the expiration, date will be computed pro rata based on the previous year's premium. 3. If notice is mailed, proof of mailing will be suffi- cient proof of notice. 4. The transfer of a policyholder between admit- ted companies within the same insurance group is not considered a refusal to renew. CG 28 55 03 93 Copyright, Insurance Services Office, Inc., 1993 Page 1 of 1 � COMMERCIAL GENERAL LIABILITY CG 29 51 12 07 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. EMPLOYMENT - RELATED PRACTICES EXCLUSION This endorsement modifies insurance provided under the following: OWNERS AND CONTRACTORS PROTECTIVE LIABILITY COVERAGE PART POLLUTION LIABILITY COVERAGE PART The following exclusion is added to Paragraph 2., Exclusions of Coverages — Bodily Injury And Property Damage Liability (Section I -- Cover- ages): This insurance does not apply to: "Bodily injury" to: (1) A person arising out of any: (a) Refusal to employ that person; (b) Termination of that person's employment; or (c) Employment - related practices, policies, acts or omissions, such as coercion, demotion, evaluation, reassignment, discipline, defama- tion, harassment, humiliation, discrimination or malicious. prosecution directed at that person; or (2) The spouse, child, parent, brother or sister of that person as a consequence of "bodily injury" to that person at whom any of the employment - related practices described in Paragraphs (a), (b) or (c) above is directed. This exclusion applies: (1) Whether the injury- causing event described in Paragraphs (a), (b) or (c) above occurs before employment, during employment or after employ- ment of that person; (2) Whether the insured may be liable as an employer or in any other capacity; and (3) To any obligation to share damages with or repay someone else who must pay damages because of the injury. CG 29 51 12 07 ©ISO Properties, Inc., 2006 Page 1 of 1 � COMMERCIAL GENERAL LIABILITY CG 31 07 02 00 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREt =LILLY. TEXAS CHANGES -- CONDITIONS REQUIRING NOTICE This endorsement modifies insurance provided under the following: OWNERS AND CONTRACTORS PROTECTIVE LIABILITY COVERAGE PART PRODUCTS /COMPLETED OPERATIONS LIABILITY COVERAGE PART With regard to liability for Bodily Injury and Property Damage, unless we are prejudiced by the insured's or your failure to comply with the requirement, no provision of this Coverage Part requiring you or any insured to give notice of "occurrence ", claim or "suit ", or forward demands, notices, summonses or legal papers in connection with a claim or "suit" will bar coverage under this Coverage Part. CG 31 07 02 00 Copyright, Insurance Services Office, Inc., 1999 Page 1 of 1 � COMMERCIAL GENERAL LIABILITY CG 31 31 12 04 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. FUNGI OR BACTERIA EXCLUSION This endorsement modifies insurance provided under the following: OWNERS AND CONTRACTORS PROTECTIVE LIABILITY COVERAGE PART PRODUCTS /COMPLETED OPERATIONS LIABILITY COVERAGE PART A. The following exclusion is added to Paragraph 2. Exclusions of Section I — Coverages — Bodily Injury And Property Damage Liability: 2. Exclusions This insurance does not apply to: Fungi Or Bacteria a. "Bodily injury" or "property damage" which would not have occurred, in whole or in part, but for the actual, alleged or threatened in- halation of, ingestion of, contact with, expo- sure to, existence of, or presence of, any "fungi" or bacteria on or within a building or structure, including its contents, regardless of whether any other cause, event, material or product contributed concurrently or in any sequence to such injury or damage. b. Any loss, cost or expenses arising out of the abating, testing for, monitoring, cleaning up, removing, containing, treating, detoxifying, neutralizing, remediating or disposing of, or in any way responding to, or assessing the effects of, "fungi" or bacteria, by any insured or by any other person or entity. This exclusion does not apply to any "fungi" or bacteria that are, are on, or are contained in, a good or product intended for bodily consumption. B. The following definition is added to the Definitions Section: �; "Fungi" means any type or form of fungus, includ- ing mold or mildew and any mycotoxins, spores, scents or byproducts produced or released by fungi. CG 31 31 12 04 ©ISO Properties, Inc., 2003 Page 1 of 1 ❑ THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ASBESTOS EXCLUSION ENDORSEMENT This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS /COMPLETED OPERATIONS LIABILITY COVERAGE PART OWNERS AND CONTRACTORS PROTECTIVE LIABILITY COVERAGE PART All of the terms, provisions, exclusions, and limitations of the coverage form apply except as specifically stated below. This insurance does not apply to: ASBESTOS "Bodily Injury" or "Personal and Advertising injury" or "Property Damage" arising out of: (1) The removal, replacement, repair, enclosure or encapsulation of asbestos from any building or structure; (2) The use, manufacture, transportation, removal, storage or disposal of asbestos or any substance, goods, products or structures containing asbestos; ar (3) The inhalation, ingestion or absorption of asbestos by any person, including any prolonged or repeated exposure to asbestos. Includes copyrighted material of Insurance Services Office, Inc., with its permission. Copyright Insurance Services Office, Inc., 2002 CG 70 42 04 03 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY TOTAL POLLUTION EXCLUSION WITH A BUILDING HEATING, COOLING AND DEHUMIDIFYING EQUIPMENT EXCEPTION, HOSTILE FIRE EXCEPTION, AND CONTRACTOR JOB SITE EXCEPTION This endorsement modifies insurance provided under the fallowing: OWNERS AND CONTRACTORS PROTECTIVE LIABILITY COVERAGE PART All of the terms, provisions, exclusions, and limitations of the coverage form apply except as specifically stated below. Exclusion, j. under Paragraph 2. Exclusions is replaced by the following: This insurance does not apply to: j. Pollution (1) "Bodily injury" or "property damage" which would not have occurred in whole or part but for the actual, alleged or threatened discharge, dispersal, seepage, migration, release or escape of "pollutants" at any time. This exclusion does not apply to: (a) "Bodily injury" if sustained within a building which is or was at any time owned or occupied by, or rented or loaned to, any insured and caused by smoke, fumes, vapor or soot produced by or originating from equipment that is used to heat, cool or dehumidify the building, or equipment that is used to heat water for personal use, by the building's occupants or their guests; (b) "Bodily injury' or "property damage" arising out of heat, smoke or fumes from a "hostile fire" unless that "hostile fire" occurred or originated: (i) At any premises, site or location which is or was at any time used by or for any insured or others for the handling, storage, disposal, processing or treatment or waste; or (ii) At any premises, site or location on which any insured or any contractors or subcontractors working directly or indirectly on any insured's behalf are performing operations to test for, monitor, clean up, remove, contain, treat, detoxify, neutralize or in any way respond to, or assess the effects of, "pollutants ". (c) "Bodily injury" or "property damage" sustained within a building and caused by the release of gases, fumes or vapors from materials brought into that building in connection with operations being performed by you or on your behalf by a contractor or subcontractor. (2) Any loss, cost or expense arising out of any: (a) Request, demand, order or statutory or regulatory requirement that any insured or others test for, monitor, clean up, remove, contain, treat, detoxify or neutralize, or in any way respond to, or assess the effects of "pollutants"; or (b) Claim or suit by or on behalf of a governmental authority for damages because of testing for, monitoring, cleaning up, removing, containing, treating, detoxifying or neutralizing, or in any way responding to, or assessing the effects of "pollutants ". Includes copyrighted material of Insurance Services Office, Inc., with its permission. Copyright Insurance Services Office, Inc. 2004 CG 71 30 01 06 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. PRIVACY PROTECTION CONDITION This endorsement modifies the following: OWNERS AND CONTRACTORS PROTECTIVE LIABILITY COVERAGE FORM — COVERAGE FOR OPERATIONS OF DESIGNATED CONTRACTOR RAILROAD PROTECTIVE LIABILITY COVERAGE FORM The following is added to SECTION IV — CONDITIONS: Privacy Protection a. "Confidential Information ", as used in this endorsement, means non - public personal information. b. This Coverage Form provides that you will report claims to us as soon as practicable and will cooperate with us in the investigation and settlement of claims. To enable you to assist us in the claim handling process, we or our independent agent may share certain information with you. This information may be "Confidential Information ". This information will be shared solely for the purpose of helping to effect, administer or enforce rights and benefits payable or recoverable under this Coverage Form. c. You agree to use such "Confidential Information" solely to perform the services and obligations required under this Coverage Form. You will not use "Confidential Information" for any other purpose. You specifically agree to not use "Confidential Information" to market your products or services or to make personnel or employment - related decisions. You will use information shared to: (1) Work with us to develop settlement or litigation strategies on your behalf. (2) Detect and investigate any suspected fraud. (3) Support our safety, loss prevention, and case management programs. Case management includes utilization review, disability management, return to work, and light duty programs. (4) Check your premium charges and billings for accuracy. (5) Monitor our claim handling practices for quality assurance, quality improvement. and performance evaluation purposes. (6) Report to us any information that may contribute to the fair and final resolution of all claims. d. You agree to protect the privacy of "Confidential Information ". You will not share "Confidential Information" directly or indirectly with any third party, except as may be allowed by law. You will share "Confidential Information" only with your employees who have a need for such information to perform their duties under this Coverage Form. If you need to disclose any "Confidential Information" to a third party in order to perform your duties under this Coverage Form, you will first get our written consent. You will then enter into a confidentiality agreement with such third party. Under that confidentiality agreement such third party must be restricted from disclosing, using or copying "Confidential Information ", except as consistent with this Coverage Form. e. If permitted by law, we may cancel this Coverage Form in the event you use or disclose "Confidential Information" other than as provided in this endorsement or permitted by law. CG 71 9S 01 09 ���� Insurance fhe Ativonfage of Partnership AGENCY NUMBER: 0125253 CITY OF COPPELL 255 PARKWAY BLVD COPPELL, TX 75019 CC: VALENTI TROBEC CHANDLER INC POLICY EFFECTIVE DATE EXPIRATION DATE PREMIUM AMOUNT PAYMENT PLAN GL 20879330002 0611Ziz013 06/12/2014 $4,498.00 BILL IN FULL 06116/2013 CREDIT REP: JULIE BELTZ REP PHONE: 800 - 789 -2969 EMAIL: JBELTZ @AMERISURE.COM INSTALLMENT SCHEDULE FOLLOWING IS THE PAYMENT SCHEDULE FOR YOUR ACCOUNT. SHOULD YOU HAVE ANY QUESTIONS PLEASE CONTACT YOUR CREDIT REPRESENTATIVE. INSTALLMENT NO. BILL MONTH TOTAL AMOUNT DUE DEPOSIT 0612013 $4,498.00 TOTAL PREMIUM $4,498.00 THE INSURED'S PREMIUM IS DUE NO LATER THAN 45 DAYS FOLLOWING CLOSE OF THE BILL MONTH 0125253 ABISINS0609 INSURED COPY PAGE 1 OF 1 IMPORTANT NOTICE To obtain information or make a complaint: You may call company's toll -free telephone number for information or to make a complaint at: 1- 800 - 441 -0293 You may a -mail the company for information or make a complaint at: www.amerisure.com You may contact the Texas Department of Insurance to obtain information on companies, coverages, rights or complaints at: 1 -800- 252 -3439 You may write the Texas Department of Insurance: P.O. Box 149104 Austin, TX 78714 -9104 FAX # (512) 475 -1771 Web: http: / /www.tdi.state.tx.us You may a -mail the Texas Department of Insurance at: C o n s u m e rP ro tecti o n @td i. state. tx. u s PREMIUM OR CLAIM DISPUTES: Should you have a dispute concerning your premium or about a claim you should contact the agent or the company first. If the dispute is not resolved, you may contact the Texas Department of Insurance. ATTACH THIS NOTICE TO YOUR POLICY: This notice is for information only and does not become a part or condition of the attached document. AVISO IMPORTANTE Para obtener information o para someter una queja: Usted puede Ilamar al numeeo de telefono gratis de la compania para information o para someter una queja al: 1- 800 - 441 -0293 Usted puede enviar la compania por correo electronico para la information o quejarse en: www.amerisure.com Puede comunicarse con el Departamento de Seguros de Texas para obtener information acerca de companias, coberturas, derechos o quejas al: 1- 800 - 252 -3439 Puede escribir el Departamento de Seguros de Texas: P.O. Box 149104 Austin, TX 78714 -9104 FAX # (512) 475 -1771 Web: http: / /www.tdi.state.tx.us Usted puede enviar el Departamento deTexas por correo electronico del Seguro en: ConsumerProtection @tdi.state.tx.us DISPUTAS SOBRE PRIMAS O RECLAMOS: Si tiene una disputa concerniente a su prima o a un reclamo, debe comunicarse con el agente o la compania primero. Si no se resuelve la disputa, puede entonces comunicarse con el departamento TDI. UNA ESTE AVISO A SU POLIZA: Este aviso es solo para proposito de information y no - se convierte en parte o condition del documento adjunto. A40100z 10