HomeMy WebLinkAbout2007-2945 - Ordinance - 01/11/2007
ORDINANCE NO. 2945
AN ORDINANCE GRANTING TEJAS MEDICAL WASTE, ITS SUCCESSORS AND
ASSIGNS, A NONEXCLUSIVE FRANCHISE FOR THE PRIVILEGE AND USE OF PUBLIC
STREETS, ALLEYS, AND PUBLIC WAYS WITHIN THE CORPORATE LIMITS OF THE
CITY OF COLLEGE STATION FOR THE PURPOSE OF ENGAGING IN THE BUSINESS
OF COLLECTION AND DISPOSAL OF TREATED AND UNTREATED MEDICAL WASTE
FROM VARIOUS HEALTH CARE-RELATED FACILITIES WITHIN THE CITY LIMITS;
PRESCRIBING THE TERMS, CONDITIONS, OBLIGATIONS, AND LIMITATIONS UNDER
WHICH SAID FRANCHISE SHALL BE EXERCISED; PROVIDING FOR THE
CONSIDERATION; FOR PERIOD OF GRANT; FOR ASSIGNMENT; FOR METHOD OF
ACCEPTANCE; FOR REPEAL OF CONFLICTING ORDINANCES AND FOR PARTIAL
INVALIDITY.
WHEREAS, the City of College Station regulates, the collection and disposal of all solid
waste generated from within the corporate limits of the City of College Station; and
WHEREAS, the City of College Station may, pursuant to Article XI of its Charter, grant
franchises to other entities for the use of public streets, alleys and thoroughfares within the
corporate limits of CITY and for the collection and disposal of treated and untreated medical
wastes generated from within the corporate limits of the City of College Station; and
WHEREAS, Tejas Medical Waste, is engaged in the business of collection and disposal
of treated and untreated medical waste from health care-related facilities and is requesting a
franchise to operate its business within the City limits of the City of College Station; and
WHEREAS, the City of College Station (hereinafter referred to as "CITY"), believes it is
in the best interest of College Station to offer Tejas Medical Waste, a franchise on such terms
and conditions as will provide College Station with control and options necessary to provide for
the public good; now, therefore,
BE IT ORDAINED BY THE CITY COUNCIL OF THE CITY OF COLLEGE
STATION, TEXAS, THAT:
I.
DEFINITIONS
1.1 For the purposes of this Ordinance, when not inconsistent with the context, words used in
the present tense include the future tense, words in the plural include the singular, and words in
the singular include the plural, and the use of any gender shall be applicable to all genders
whenever the sense requires. The words "shall" and "will" are mandatory and the word "may" is
permissive. Words not defined in this Ordinance shall be given their common and ordinary
meamng.
Page 1
Contract No. 07-/:l.. t.z
10/12/06
Ordinance No. 2Cj4~
1.2 For the purposes of this Ordinance, the following words, terms, phrases and their
derivations shall have the meaning given in Section. 1.1
Franchise means this ordinance and all rights and obligations established herein or as it
may be amended.
CITY means the City of College Station, a home rule municipal corporation in the State
of Texas.
City Council or "Council" means the governing body of the City of College Station.
City Manager means the City official appointed by the City Council who is responsible
for the daily operation of the City of College Station.
Brazos Valley Solid Waste Management Agency or BVSWMA means a permitted
municipal solid waste facility jointly owned by the Cities of Bryan and College Station and
operated by the City of College Station on behalf of the cities as authorized by an interlocal
agreement.
Customers. Those health care-related facilities located within the CITY that generate
treated and untreated medical waste.
Medical Wastes means medical wastes as that term is defined in 30 T.A.C. 330.2(74),
(93), (141), and (14l)(C) as it now exists or as is hereafter amended.
Treated or Processed Medical Waste is medical waste that has been treated as provided
in 25 T.A.C. 1.133 and 1.136 as it now exists or as it is hereafter amended.
COMPANY means Tejas Medical Waste, a privately held corporation incorporated in
the State of Texas which provides medical waste management services for the healthcare
industry as well as providing destruction services to major pharmaceutical manufacturers and
which operates in the State of Texas as well as other states.
T.A.C. means the Texas Administrative Code as it now exists or as it is hereinafter
amended.
Force Majeure means, without limitation, by the following enumeration, acts of God and
the public enemy, the elements, fire, or accidents.
TCEQ means Texas Commission on Environmental Quality.
Page 2
Contract No.
10/12/06
Ordinance No. 2945
II.
GRANT OF NONEXCLUSIVE FRANCHISE
2.1 CITY hereby grants to COMPANY a nonexclusive franchise to operate and establish in
College Station, as constituted as of the effective date of this Franchise, or as may hereafter be
constituted to collect and dispose of treated and untreated medical waste from various health
care-related facilities within the jurisdictional limits of CITY, and COMPANY is hereby
granted passage and right-of-way on, along and across the streets, avenues, rights-of-way, alleys,
and highways within the corporate limits of College Station, for any such service and lawful
purpose as herein mentioned; provided that all such work, activity and undertakings by
COMPANY shall be subject to the terms and provisions of this Franchise and the continuing
exercise by College Station of its governmental and police powers, and provided further that
nothing herein shall be construed to require or authorize COMPANY to exceed any rights
granted herein or by the TCEQ.
2.2 Nothing in this Franchise shall be construed as granting any exclusive franchise or right.
III.
FRANCHISE AND RENTAL FEES
3.1. For and in consideration of the use of the CITY's rights-of-way, streets, alleys, highways,
avenues and thoroughfares as well as in consideration of the covenants and agreements contained
herein, COMPANY agrees to and shall pay to CITY upon acceptance of this Agreement and
thereafter during the term hereof, a sum equivalent to five percent (5%) of COMPANY's
monthly gross delivery and hauling revenues generated from COMPANY's provision of
collection and disposal of treated and untreated medical waste services within the CITY. Said
payment shall be paid quarterly to the CITY's Finance Department and shall be due by the
twentieth of the month following the end of the previous quarter.
3.2 The franchise fee shall be in lieu of any and all other College Station imposed rentals or
compensation or franchise, license, privilege, instrument, occupation, excise or revenue taxes or
fees and all other exaction's or charges (except ad valorem property taxes, special assessments
for local improvements, city sales tax, and such other charges for utility services imposed
uniformly upon persons, firms or corporations then engaged in business within College Station)
or permits upon or relating to the business, revenue, franchise, equipment, and other facilities of
COMPANY and all other property of COMPANY and its activities, or any part thereof, in
College Station which relate to the operation of COMPANY's medical waste collection
business.
3.3 Payment after that date shall incur a ten percent (10%) penalty on the outstanding amount
owed under this article, and after written notice by CITY, may constitute a basis for forfeiture or
termination under this Franchise pursuant to Article VIII herein.
Page 3
Contract No.
10/12/06
Ordinance No. 2945
IV.
TERM OF FRANCHISE
4.1 The term of this franchise shall be for a period of five (5) years beginning on the 15th day
of February, 2007.
V.
SERVICE TO BE PROVIDED BY COMPANY
5.1 COMPANY shall furnish service consistent with the requirements and intent of this
Franchise, and specified in this ordinance as now or hereafter approved by the Councilor other
regulatory authority having jurisdiction, without unreasonable discrimination, to all areas of
College Station.
5.2 COMPANY shall maintain its property and equipment in good order and working
condition, consistent with the needs of the services rendered therefrom and in accordance with 30
T.A.C. 330.1 005(g) through (i).
5.3 COMPANY agrees that a standby vehicle shall always be available.
5.4 COMPANY's vehicles shall at all times be clearly marked with COMPANY's name and
TCEQ registration number in letters not less than three (3) inches in height.
5.5 COMPANY's operations shall be conducted in a manner that minimizes nOise,
disturbance, and commotion.
5.6 COMPANY shall use all proper skill and care, and exercise all due and proper
precautions that meet or exceed industry standards and TCEQ regulatory requirements to prevent
injury to any person or person(s) and damage to any property.
5.7 COMPANY shall register their operations with the TCEQ prior to commencing
operations under this Franchise and shall provide proof of such registration and renewal thereof
annually to CITY.
5.8 AD VALOREM TAXES
COMPANY agrees to render a list annually of all personal property utilized in its treated and
untreated medical waste operation services to Brazos County Appraisal District so that said
personal property will be subject to ad valorem taxation by the applicable taxing entities.
Page 4
Contract No.
10/13/06
Ordinance No. 2945
5.9 DISPOSAL SITE FOR TREATED MEDICAL WASTE
Unless approved otherwise in writing by CITY, COMPANY shall utilize the BVSWMA landfill
located on Rock Prairie Road, College Station or any other municipal landfill site designated by
CITY for its municipal solid waste disposal for disposal of all treated medical waste collected by
COMPANY from within the corporate limits of the City of College Station. Untreated medical
waste collected by COMPANY within the corporate limits of the City of College Station will be
treated and disposed of at any site of COMPANY's selection, provided however, that any site
used shall be permitted to accept this classification of waste by the appropriate regulatory
authority.
5.10 CITY shall have access to all books of accounts and records of its business operations
from which Gross Receipts may be determined.
5.11 COMPANY further agrees CITY may review its books and records, during normal
business hours and on a non-disruptive basis, as reasonably necessary to monitor compliance
with the terms hereof, or as otherwise required by law
(a) COMPANY shall keep complete and accurate books of accounts and records of
its business and operations from which Gross Receipts may be determined.
(b) The following records and reports shall be filed monthly with the City Manager or
his delegate:
1. Reports of all complaints and investigations received from any
customer or regulatory authority and remedial action taken by
COMPANY in response to said complaints.
11. A listing of all COMPANY's customer accounts and monthly revenue
derived from collections made in the CITY under the terms of this
Agreement. The reports shall include customer's name, address,
frequency of pick-up, number of containers, pounds of waste collected
by customer separated by treated and untreated, and monthly charges.
5.12 COMPLAINTS
COMPANY shall respond to any customer complaints. Any customer complaints
received by CITY shall be forwarded to COMPANY within twenty-four (24) hours of their
receipt. COMPANY shall notify CITY of action taken within twenty-four (24) hours following
receipt of complaint. Failure to timely respond to Customer complaints by COMPANY may
result in the imposition of a Twenty-five Dollar ($25.00) per incident charge from CITY payable
with the next payment due to CITY under Article III of this Agreement.
Page 5
Contract No.
10/12/06
Ordinance No. 2945
5.13 COMPANY agrees to provide free service to CITY during periodic CITY clean-up
campaigns and following natural disasters or Acts of God.
5.14 TERMINATION OF SERVICE
COMPANY must notifY CITY in writing oftermination of any customer's service for cause via
registered mail within forty-eight (48) hours of said termination and the basis therefor.
VI.
TITLE TO WASTE
6.1 Sole and exclusive title to all treated and untreated medical waste collected by
COMPANY under this Agreement shall pass to COMPANY when said waste is placed on
COMPANY's truck.
VII.
RATES, RULES AND REGULATIONS
7.1 The COMPANY shall charge for the aforementioned services according to the rates set
out in the Schedule of Rates attached hereto as Exhibit "A" and incorporated herein by
reference. The Schedule of Rates may be revised periodically and must be submitted to the City
Manager or his delegate upon each revision and will be attached to the original franchise
agreement.
VIII.
FORFEITURE AND TERMINATION OF FRANCHISE
8.1 In addition to all other rights and powers retained by CITY under this Franchise or
otherwise, CITY reserves the right to declare this Franchise forfeited and to terminate the
Franchise and all rights and privileges of COMPANY hereunder in the event of a material
breach of the terms, covenants, or conditions herein set forth. A material breach by COMPANY
shall include, but not be limited to, the following:
1. Failure to pay the fee prescribed by Article III;
2. Failure to materially provide the services provided for in this Franchise;
3. Material misrepresentation of fact in the application for or negotiation of this
Franchise;
Page 6
Contract No.
10/12/06
Ordinance No. 2945
4. Conviction of any director, officer, employee, or agent of COMPANY of the
offense of bribery or fraud connected with or resulting from the awarding of this
Franchise;
5. Material misrepresentations of fact knowingly made to CITY with respect to or
regarding COMPANY's operations, management, revenues, services or reports
required pursuant to this Franchise;
6. Revocation or denial of registration or renewal of registration by TCEQ;
7. Excessive interruption in service for a period of seventy-two (72) hours or more
due to causes other than force majeure.
8.2 COMPANY shall not be excused by mere economic hardship nor by misfeasance or
malfeasance of its directors, officers or employees.
8.3 CITY may after a hearing as described herein, revoke and cancel the Franchise by and
between the parties and said Franchise shall be null and void. CITY shall mail notice to
COMPANY, at the address designated herein or at such address as may be designated from time
to time, by registered mail. The notice shall specify the time and place of the hearing and shall
include the allegations being asserted for the revocation of this Agreement. The hearing shall be
conducted in public before the City Council and COMPANY shall be allowed to present
evidence and be given an opportunity to answer all reasons for the termination set forth in the
notice. In the event that the Council determines that the allegations set forth are true as set forth
in the notice, it may by majority vote cancel this Agreement between the parties at no penalty to
the CITY.
IX.
RECEIVERSHIP AND BANKRUPTCY
9.1 The Council shall have the right to cancel this Franchise one hundred twenty (120) days
after the appointment of a receiver or trustee to take over and conduct the business of
COMPANY, whether in receivership, reorganization, bankruptcy, other action or proceeding,
whether voluntary or involuntary, unless such receivership or trusteeship shall have been vacated
prior to the expiration of said one hundred twenty (120) days, unless:
9.2 Within one hundred twenty (120) days after his election or appointment, such receiver or
trustee shall have fully complied with all the provisions of this franchise and remedied all
defaults thereunder; or
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Contract No.
10/12/06
r
I
I
Ordinance No. 2945
9.3 Such receiver or trustee, within one hundred twenty (120) days, shall have executed an
agreement, duly approved by the court having jurisdiction, whereby the receiver or trustee
assumes and agrees to be bound by each and every provision of this Franchise.
X.
INDEMNIFICATION
10.1 COMPANY shall not dispose of any untreated medical waste, special waste or other
hazardous waste or any waste that the landfill is not permitted to accept by TCEQ in the
BVSMA landfill. COMPANY hereby agrees to indemnify, defend and hold CITY
harmless for disposal of any snch waste in the BVSMA landfill whether intentional or
inadvertent.
10.2 COMPANY shall indemnify and hold CITY harmless from any and all injuries to
persons or claims of damage to property caused by COMPANY, its agents, employees, and
representatives.
10.3 COMPANY agrees to and shall indemnify and hold harmless CITY, its officers,
agents and employees, from and against any and all claims, losses, damages, causes of
action, suits, and liability of every kind, including all expenses of litigation, court costs, and
attorney's fees, for injury to or death of any person, or for damage to any property, arising
out of or in connection with the services provided or medical waste collected, treated, or
disposed of by COMPANY under this contract, regardless of whether such injnries, death
or damages are caused in whole or in part by the negligence, including but not limited to
the contractual comparative negligence, concurrent negligence or gross negligence, of
CITY.
10.4 COMPANY assnmes responsibility and liability and hereby agrees to indemnify the
City of College Station from any liability caused by COMPANY's failure to comply with
applicable federal, state or local laws and regulations, touching upon the maintenance of a
safe and protected working environment, and the safe use and operation of machinery and
equipment in that working environment.
XI.
INSURANCE
11.1 COMPANY shall procure and maintain at its sole cost and expense for the duration of
the Agreement insurance against claims for injuries to persons or damages to property which may
arise from or in connection with the performance of the work hereunder by COMPANY, its
agents, representatives, volunteers, employees or subcontractors.
Page 8
Contract No.
10/12/06
Ordinance No. 2945
11.2 COMPANY's insurance coverage shall be primary insurance with respect to the CITY,
its officials, employees and volunteers. Any insurance or self-insurance maintained by the
CITY, its officials, employees or volunteers shall be considered in excess of the COMPANY's
insurance and shall not contribute to it.
11.3 COMPANY shall include all subcontractors as additional insured under its policies or
shall furnish separate certificates and endorsements for each subcontractor. All coverages for
subcontractors shall be subject to all of the requirements stated herein.
11.4 Ail Certificates of Insurance and endorsements shall be furnished to the CITY's
Representative at the time of execution of this Agreement, attached hereto as Exhibit B, and
approved by the CITY before work commences.
A. Standard Insurance Policies Required:
1. Commercial General Liability Policy
2. Automobile Liability Policy
3. Workers' Compensation Policy
4. Pollution Liability Policy
5. Excess Liability Policy
B. General Requirements Applicable to all Policies:
1. Only Insurance Carriers licensed and admitted to do business in the State of
Texas will be accepted.
2. Deductibles shall be listed on the Certificate of Insurance and are acceptable
only on a per occurrence basis for property damage only.
3. "Claims Made" policies will not be accepted.
4. Each insurance policy shall be endorsed to state that coverage shall not be
suspended, voided, canceled, reduced in coverage or in limits except after
thirty (30) days prior written notice by certified mail, return receipt requested,
has been given to the City of College Station.
5. Upon request, certified copies of all insurance policies shall be furnished to
the City of College Station.
6. The City of College Station, its officials, employees and volunteers, are to be
added as "Additional Insured" to all applicable Liability policies. The
coverage shall contain no special limitations on the scope of protection
afforded to the CITY, its officials, employees or volunteers.
C. Commercial General Liability
1. General Liability insurance shall be written by a carrier with a B+:VII or better
rating in accordance with the current Best Key Rating Guide.
Page 9
Contract No.
10/12/06
Ordinance No. 2945
2. Minimum Limit of$I,OOO,OOO.OO per and $2,000,000.00 annual aggregate.
3. Coverage shall be at least as broad as Insurance Service's Office Number CG
0001.
4. No coverage shall be deleted from the standard policy without notification of
individual exclusions being attached for review and acceptance.
5. The coverage shall include but not be limited to the following:
premises/operations; independent contracts; products/completed operations;
contractual liability (insuring the indemnity provided herein); and where
exposures exist, "Explosion, Collapse, and Underground" coverage.
D. Automobile Liability
1. Business Automobile Liability insurance shall be written by a carrier with a
B+:VII or better rating in accordance with the current Best Key Rating Guide.
2. Minimum Combined Single Limit of $2,000,000.00 per occurrence for bodily
injury and property damage.
3. The Business Auto Policy must show Symbol 1 in the Covered Autos portion
of the liability section in Item 2 of the declarations page.
4. The coverage shall include owned or leased autos, non-owned autos, and hired
cars. Where applicable endorsement MCS-90, (Motor Carrier Policies for
Insurance for Public Liability) is required.
5. COMPANY is responsible for any liability and/or costs that exceed the dollar
limits set forth in this section.
E. Workers' Compensation
1. Employer's Liability limits of $500,000/$500,000/$500,000 are required.
2. City of College Station shall be named as Alternate Employer on endorsement
WC 99 0301 unless written through TWCARP.
3. Texas Waiver of Our Right to Recover from Others Endorsement, WC 42 03
04 shall be included in this policy.
4. Texas must appear in Item 3A of the Workers' Compensation coverage or Item
3C must contain the following: All States except those listed in Item 3A and
the States ofNV, ND, OH, WA, WV, WY.
F. Pollution Liability
1. Minimum acceptable limit $2,000,000 aggregate and $1,000,000 per
occurrence.
Page 10
Contract No.
10/12/06
1---
Ordinance No. 2945
2. Pollution coverage endorsement CG 04 22 required.
G. Excess Liability
1. Minimum acceptable limit $5,000,000 aggregate and $1,000,000 per
occurrence.
H. Certificates of Insurance
Certificates of Insurance shall be prepared and executed by the insurance
company or it's authorized agent, and shall contain the following provisions and
warranties:
1. The company is licensed and admitted to do business in the State of Texas.
2. The insurance policies provided by the insurance company are underwritten on
forms that have been provided by the Texas State Board of Insurance or ISO.
3. All endorsements and insurance coverages according to requirements and
instructions contained herein.
4. The form of the notice of cancellation, termination, or change in coverage
provisions to the City of College Station.
5. Original endorsements affecting coverage required by this section shall be
furnished with the certificates of insurance.
11.5 The coverage requirements set forth in this Article are in addition to those required under
30 T.A.C. 330. I 005(j). COMPANY shall provide proof that it has met the requirements of 30
T.A.C. 330.1005(j) to CITY upon the execution ofthis Franchise by COMPANY.
11.6 COMPANY shall notifY CITY by certified mail of the commencement of voluntary
proceedings under Title 11 (Bankruptcy), United States Code, naming the COMPANY as
debtor, within ten (10) business days after the commencement of the proceeding.
11.7 If COMPANY is deemed to be without financial assurance pursuant to 30 T.A.C.
330.l005(j), COMPANY's operations shall be suspended until COMPANY establishes other
acceptable financial assurance with the TCEQ and provides proof of same to CITY.
XII.
GOVERNING LAW; LIMITATIONS; COMPLIANCE
12.1 This ordinance shall be construed in accordance with the CITY's Charter and Code in
effect on the Effective Date of this ordinance to the extent that such Charter and Code are not in
conflict with or in violation of the constitution and laws of the United States or the State of
Texas.
12.2 This ordinance shall be governed in accordance with the laws of the State of Texas.
Page 11
Contract No.
10/12/06
Ordinance No. 2945
12.3 Notwithstanding any other provIsIOn in this franchise to the contrary, CITY and
COMPANY shall at all times comply with all laws, rules and regulations of the state and federal
government and any administrative agencies thereof, with respect to the subject matter of this
ordinance.
XVIII.
ASSIGNMENT
13.1 This Agreement and the rights and obligations contained herein may not be assigned by
COMPANY without the specific prior written approval of the City Council.
XIV.
NOTICES
14.1 All notices required under the terms of this Contract to be given by either party to the
other shall be in writing, and unless otherwise specified in writing shall be sent to the parties at
the addresses following:
CITY:
Glenn Brown, City Manager
City of College Station
P.O. Box 9960
College Station, Texas 77842
COMPANY:
Janet K. McClain
Tejas Medical Waste
P.O. Box 1547
Copperas Cove, Texas 76522
14.2 All notices shall be deemed to have been properly served only if sent by Registered or
Certified Mail, to the person( s) at the address designated as above provided, or to any other
person at the address which either party may hereinafter designate by written notice to the other
party.
XV.
AMENDMENTS
15.1 It is understood and agreed by the parties to this Franchise that no alteration or variation
to the terms of this Franchise shall be effective unless made in writing, approved by both parties,
and attached to this Agreement to become a part hereof.
Page 12
Contract No.
10/12/06
Ordinance No. 2945
XVI.
SEVERABILITY
16.1 If any section, sentence, clause or paragraph of this Ordinance is for any reason held to be
invalid or illegal, or unenforceable, such invalidity, illegality or unenforceability shall not affect
the remaining portions of the Ordinance other than the part or parts held invalid or
unconstitutional.
XVII.
AUTHORIZATION TO EXECUTE
17.1 The parties signing the Franchise shall provide adequate proof of their authority to
execute this Agreement. The Franchise shall inure to the benefit of and be binding upon the
parties hereto and their respective successors or assigns, but shall not be assignable by either
party without the written consent of the other party.
XVIII.
ACCEPTANCE OF FRANCHISE BY COMPANY
18.1 In accordance with CITY OF COLLEGE STATION CITY CHARTER, SECTION 103, this
Ordinance shall be effective sixty (60) days after its adoption. COMPANY shall file its written
acceptance of the terms and conditions of the Ordinance with the City Secretary within thirty (30)
days from the final adoption of this Ordinance. Such acceptance shall be typed or printed on the
letterhead of COMPANY and, with the blank spaces appropriately completed, shall be as
follows:
Attn: City Manager
Tejas Medical Waste acting by and through the undersigned
who is acting within his/her official capacity and authority, hereby accepts the franchise
to operate a medical waste collection service within the City of College Station, Texas
("College Station") as said franchise is set forth and provided in Ordinance No.
(the "Ordinance"). Tejas Medical Waste agrees to be bound and governed by each
term, provision and condition of the Ordinance, to accept and to give the benefits
provided for in the Ordinance in a business like and reasonable manner and in
compliance with the Ordinance.
Tejas Medical Waste
By:
Name:
Page 13
Contract No.
10/12/06
Ordinance No. 2945
Title:
XIX.
PUBLIC HEARING
19.1 It is hereby found and determined that the meetings at which this ordinance was passed
were open to the pubic, as required by TEXAS GOVERNMENT CODE S 551 (Vernon 1994, Vernon
Supp. 2003), as amended, and that advance public notice of time, place, and purpose of said
meetings was given.
PASSED, ADOPTED and APPROVED by a majority vote of the City Council of the City of
College Station on this the I J#" day of -:r-c...'1 u...~ ~ ,2001.7
TEJAS MEDICAL WASTE
CITY OF COLLEGE STATION
BY:~1(JJ .~~
Tit ~~
Date: 10 - 01 D rtJ It
BY:C:~} JL~
RON S v: ,Mayor
Date: /-~:L -02007
ATT~ t&{2
CONNIE HOqKS, City Secretary
Date: Ir~~v Mo1
AP~y~Y
Oo--v--. ~
City
Page 14
Contract No.
10/12/06
Ordinance No. 2945
First Consideration and Approval:
Second Consideration and Approval:
Third Consideration and Approval:
Contract No.
10/12/06
Date: OJ I ( 9/ D,
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Page 15
Ordinance No. 2945
Exhibit "A"
SCHEDULE OF RATES
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Page 16
Contract No.
10/12/06
Ordinance No. 2945
Contract No.
10112/06
Exhibit "8"
CERTIFICATES OF INSURANCE
Page 17
Ordinance No. 2945
ACORD CERTIFICA TE OF LIABILITY INSURANCE I DATE (MMIDOIYY)
'" 11109/05
PRODUCER Tom Stewart Insurance THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
1001 S. Dairy Ashford, Suite 225 ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
Houston, TX 77077 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
(281 )589-0004 INSURERS AFFORDING COVERAGE NAIC#
INSURER A: Arch Insurance CO.
INSURED Tejas Medical Waste
INSURER B:
PO BOX 1547 INSURER c:
Copperas Cove. TX 76522 INSURER 0:
I INSURER E:
COVERAGES INSURER F'
THE POLICIES OF INSURANCE LISTED 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 VVHICH 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. AGGREGATE LIMITS SHOV\1l\l MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR AOO'L TYPE OF INSURANCE POLICY NUMBER ~i{~~~:8~E PJl~r,i~~ON LIMITS
LlR INSRO
GENERAL LIABILITY EACH OCCURRENCE 1.000.000
~ COMMERCIAL GENERAL LIABILITY FBCAT0044201 OS/21/06 OS/21/07 ~~~~~~J9E~~~~~ncei 100,000
DO CLAIMS MADE ~ OCCUR MED EXP (Anyone person) 5,000
A ~ 0 PERSONAL & ADV INJURY 1,000,000
0 GENERAL AGGREGATE 2.000,000
GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMPfOP AGG Included
o POLICY 0 PROJECT o LOC
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 1.000.000
0 ANY AUTO FBCAT0044201 OS/21/06 OS/21/07 (Ea accident)
0 ALL OVVNED AUTOS BODILY INJURY
A ~ ~ SCHEDULED AUTOS (Per person)
~ HIRED AUTOS BODILY INJURY
~ NON OIJl.t.lED AUTOS (Per accident)
~ Broad Pollution PROPERTY DAMAGE
(Per accident)
GARAGE LIABILITY AUTO ONLY - EA ACCIDENT
0 0 ANY AUTO OTHER THAN EA ACC
0 AUTO ONLY: AGG
EXCESS LIABILITY EACH OCCURRENCE
0 OCCUR o CLAIMS MADE AGGREGATE
0
0 DEDUCTiBLE
0 RETENTION
WORKERS COMPENSATION AND OT~ STAT~o o ~bH.
EMPLOYERS' LIABILITY RYLlMIT
ANY PROPRIETOR f PARTNER f EXECUTIVE E.L EACH ACCIDENT
OFFICER f MEMBER EXCLUDED? E.L DISEASE - EA EMPLOYEE
If yes, describe under
SPECIAL PROVISIONS below E.L DISEASE. POLICY LIMIT
OTHER
DESCRIPTION OF OPERATIONS f LOCATIONS I VEHICLES f EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS
Medical Waste Transporter
Certificate holder is named as additional insured as respects to general liability and auto liability.
CERTIFICATE HOLDER
CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBEO POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL
City of College Station 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO
Alln: Risk Management THE L.EFT, BUT FAILURE TO DO SO SHALL. IMPOSE NO OBLIGATION OR LIABILITY
OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES.
PO box 9960 AUTHORIZED REPRESENTATIVE ~d
I College Station. TX 77842 ~
ACORD 25 (2001108)
@ACORDCORPORATlON1988
r ---~~-~-
Ordinance No. 2945
U')/~<J/UIf
.1,): 44 t'hA ~n~ '/tl4 311Y!:'
cues PURCHASING
IiIl002
TEXAS WOltXERs' COMPBNSATION COMMISSION
SOIllhfield Buildiol. 4000 South IH-3S
Awtio, Toxu 78704
I f you are Dot certain whether aU parties meet the requiraDICQtI for eaterina: iceo this qJ'1llC':meat, you may wisb to COlilsult an aUo~cy.
I
T cu.. Worbn' CompcnuLion Acl, To.... Laor C4dc, s.ocio4 ~.11J (1) dcr.... .iad.,...."l cOnLrular- .. loUo....: (I) "lnckpendelU CONnCtot"- mc:aQ.J .. p~~
~o ~ODtn.CUl &D pcdormwort or p~vld.. IICrvicc for &b. buli!GLo(ualtusraM wbo~rilr: (A) 1Cl1I...Ih. empla)'CrOf &a)' cmployGCl o(lhe; canlnclor by p~YiAc
.....'e., dit.cUa, acLivilie.a, and pcrfonala.c ocher 1ll1bUt., fu~ cblrKlerta1c o( an lqdoyct....lllpla,... ~i (II) it: eRO ~ c1ee.crtDl.,lhc fnar\nl:( in w.9deb
Ihe ....art DC" _rvtn Ia p.rf'ol'lllM, Jacbldiot lb. .OUI'I' or &aboIf.r or tMdIod orPl,.tnfN 10 MY -.Iayec; (C) M ....u...... lit flImbb Of' b.ve hi. .mpI4y..... iC.~ft)'1
fumi.&h nc.c.....ry 1001.. 1UppUa. IN" ftWl..rill.1O pcd'ann 11M ~ or _rvia.: .... CD) ,...... CIur.kIIIa ftllIulrM: tor the ~lr&4 won: Dr Kl'YicllI. I
AGREEMENT BETWEEN GBN1lRAL CONTRAcrOR AND SUBCONTRAcrOR
TO BSTA$LISH INDEPENDENT RELATIONSHIP
Notio& of A.fteenJ8tt
The Yndersi,ncd acn-I CoalnlcCor IIlId the ImdcniJncd Suboon_r ~y doctore !hot:
(A) the Subconltal:lDr mcclJ the quallliaatio.. of...ladopcndcnl ContnclorunderT"".. Work...' CompcllSlUon Act, Texa. LAbor
CodA:, Secl.ton 406.121; I
(8) the SuboontroCIDr" a_lin, u IlIlndcpond<iat _lar u IhoJ t.cnn iI dclincd undor Scallon 406.121 of the .Act;
(c) the Subco_r unm..1hc rcoponslbllillal>f In IItlplayer (or lI1e pcrfOIJllll>DO o( work; IIld
(0) the Subcontrw.c:tor and lhe Subooncn.c:cor', emplDycea 13 not cmployou af the General ContnOCor (or purposCI'''Of the Act.
TERM (DATIlS) OF AGREBMBNT:
PROM:
Nlm~~ofmcC://~
TO:
~J
Na_ of S..bcoalll.ctor
LOCATION OF EACH AFFi1CI'EI> JOB SITB t::; Sf".... WHIlT'HER
THIS IS A BLAHlCET "GIlEEMEH1'): .('{ " ~4!!'"
Estimated aumber of employees affected:
11lIS ACJRaiMliNT IHAU. TAKE EFFWCr I/O SOOtlEll THAN iE
DATE IT IS SIONBD.
I
~I!I"III Contnu:tnr'.I Amnnation
I r Lbt: GeauaJ Coat.ncwr'. wirkus' c..,......tl.. caniIr .....
dwiar: the en'cti..........1 co'YV1llt, It II ad.....,... ~
GMen! CoIlc.nc1or 10 Gl4I1.b11 fOnD vWa die: alW ........icatrier.
C..L J ('DII~f' ~ 5/1rQ./o"-l //01 -re.rac A"eJ1l.(.e.
SltCWDJI"C ~enenl Can1nc.lor V... Md.... (S~ II~..
Co _~ ~ ~7;k
~
Pnnl.cd N.~ or G6hC~1 CONNCtOr Addn:a (Ck,y, Su.14. ZIp)
., 1.(- 1~---.S.3c.(
Fcdonal Tn; I.D. Numbcr
.;(- s~O~ofud.-tra4
,--~,,),~ft..- '3-J(/-riV ~ t)'j/.f (I, e
sp.llJt'& or SubcOalftctot Data AcItINM ($t""I)
-r(;~<; mr:bIOli.. WA5rr-~..mK/}1'ti.H~~. ctJ4.
PriRted Nlme or ,ljivbcomr.cUtr /. Addtoa. (Ql)/. SlAta, Zip)
Sub~nntnu::tor~ Affirmation
17 i7~2.....
,
,
74-.;.'1..C;.rqlg~
Federal TalC. I. D. Number
~~ ~lf-
7// ~-.J 9'
j,
!
Three eop1c1 ot Ihi. I'onn mull M compkhMf: nil .'RC!IMIII1nUII b. tUod by.... OClMral Coalnct.ar "idl.... warbn' comge....llonlnauraacc umer of the Occam
ConlracfGr wi&hU1 10 da)'& at di. dale ar uRUlion. The odaiMl tftUtl.. died wtlll lh. l.IIIunnco o.m.. by PER.$ONAL DEl-WERY OR REGISTERED 'OR
CERT1F1ED MAlL. Bath cite Oenera' Contnll:llar Ind Ihc S~clOr mull.lIo rtlIin I cap)' or Ihc. IIIft1C1N!lH.
TWCC~85 (R.v, 5/161
Rule \ 12.101 '
7.00~
~NIJ.NIHd HOHNOH
OOg&L~g~gZ XY& Cg:&Z Hal ~OOZ/&Z/CO
03/08/2004 22:42 2815898889
Ordinance No. 2945
TOM STEWART
PAGE 02
ENDORSEMENT FOR
MOTOR CARRIER POLICIES OF INSURANCE FOR PUBLIC LIABILITY
UNDER SECTIONS 29 AND 30 OF THE MOTOR CARRIER ACT OF 1980
'..uedlo Tei.. MedicaIWaste.lnc. of PO Box 1547. COPPW8sCove, 1)( 76522
Form Approved
OMB No, 2125--0074
Dated Bl Denver CO
Amending Policy No. AT7119538
Nam.. of Inouram:e Company Attantlc lnouranee Co n
111..
2111
doy or
E_e Da.e 0512.1103
MaY . 2003
Telephone Number (~) 497-7200 .. Counlenllgned by
Tha poncy to which 1I11s endo.-emenl is attached pn...ctes primary or ax<:eu.lneurance, Ot lndlc8ted by
o This In""ranee is primary end the company wll not be Rabie for amounts In e_ of $ 1.000 000
o This insurance Is __ and the company ahall not be liable for amounts In excess of $
In ..xcees "'the und8l1ylng limit of $ for each aCCIdent.
VVllenever required by the Fed<nl Highway Administration (FHWA) or lh.. Interatate eonvne"", Commission (ICCl, the compeny
sg_a to furnish lhe FtWVA or the ICC.. dupUcate.of lAid policy end all Its endoraMler1le. The c:ornpeny allD agrees, upon lel.phone
request by en authorlzed repre_. of!he FHWA or the ICe, to .",erify that.thto poIiey Is in force ee of e partlcular date.
Canoellat1on of this endo....ment may be eft'ecled by the company or the Insured by 1IM"9 (1) thlrty-fiIIe (35) days notice In wriling to
the other perty (Mid 35 daY" notice to .commence. from the date \he notice Is mal1<od, "",of of malling ohall be lufflOient proof of
nollce). and (2) 11 tho InIUred Is $Ubject to the lce'e /Ur\ldicliDll, .by P""",,ing thirty (30) daY" nollce to the ICC (said 30 daY" notice to
commonce from the date the notice Is. """"wd bv the Ice etlls oM"" In WilllhinAton. D.C.\,
DEFINmONS AS USED IN THIS ENDORSEMENT
ACCIDENT- Includes contlnuo,", or rep8lIled """"lUre to loa. damage, or deatrUclIon of natural 1'lI0000rcec llI10ing oul of
cond1llons which ....ulls In bodily Injury, "",perty damage, or the eccld.ntaI dlecMrge. <11_1, release or escape Into or
."wlronments! <lamlga which the Insured n_ .8lq>8Cled nor upon tho 1lInd, 8lrnosph..... watercoursa, or body of water, of .ny
irltancled. commodity \m1spo<ted by a motor camero This llhalllnc1uda the
coot of removal .nd the coat of neOll$COry measures taken ~
MOTOR VEHICLE means a land vehlde, machine. lru,*, -, mlnlm..e or mlIlgate damage to human health, tha nstural
t",lIer, or ..",ItnIHer ,propelled or.drawn by mechenlC8I ,p<>w<or environment, .nlh, .0hlllfisl1. end wildlife.
and uled on . highway for 'lnlnsporUng . property. or en)'
combination thereof. PROPERTY . DAMAGE . maens dlmage to or loos of usa of
BODILY INJURY meens Injury to the body, slckn..... or dl........ ta"9lbla property.
to any """,on, Induding death rusullil1ll from IlnY of these.
ENVIRONMENTAL RESTORATION _ matItutlon for thto
The Inaura""" policy 10 which this ~ la attached
provides automobile liability lnaunmce and Is lIlTl8nded 10 a..ure
ocmptiance by 1110 Insured, within thto Iimlts slated herein, .. a
motor eani.r of property, with See1lons 29 end 30 of the Motor
Canier Act of 198Q and 1I1e rul.. and rugulatlono of the Federal
Highwsy Admlnlotrlllion (FHWA) end the Interstete Commerce
CQmmllSion (ICC).
for each accident.
PUBUC LIABILITY means liability for bodily Injury. proporty
cWnell8, .nd envIron"*'t8Il reatorlllion.
..ndol'lemont u.er.on, or viola1lon thereof, lhal relie"" Ihe
company from IlablHly cr from the payment of any final
Judgment. within the limits of liablity herein desCl1bed.
irrespecllve of thto financial eond'dion, Insol.....ncy or bankruptcy of
the insured. Howe\I&r. all tennl, concfrtions and ImltaUons In the
policy to which the endoroament Ie attached shell remeln In full
force and effect as binding between the Insured and Iha
company. The In<IlJI'8d lIl\l""'" to reimburse the compeny for any
-~ In payment m&de by the company on account of any accident.
In consideration of the pnlmium stat... the policy to whIc1llhis dalm, or ouIt Involving a breech of the leons of the poUcy, and
endorsement Is ortlachad, the InsUJ'Il( (the comp&ny) agreet 10 for any payment that the company would not he.. been
pay. within \he IImItl of lIabRIty delcribed herein, eny fnel obligated to make ........ the provisiono of the policy oxcept for the
Judgment nocovered againat the IMUred for pubIlc UabI'rty
resuttlng n."" negligence In Ill.. opel'Mion, melnlllnance or use of egreement contained In thll on<l<nement.
motor vehicles subject to the ftnanclal responslbUIty requ1nm>ents n Ie furthor undentood end agreed that, upon failure of the
of SectiOnll 2g end 30 of the Molor Camar A<:I. of 1980 rsgerdlaa company to pay any final /udgmant recovered agelnst the
of whether or not each motor vahlcle Ie apecItIca1ly deec:ribed In Insured.. provided herein. the Judgment creditor may maintain
the policy and whether or not auch n"llllgonce occurs on any an action In any oourt 0( competaot jurisdiction against the
l'Outo or In any territory aulhorlzed to be _d by the insurod or company to compellUCh payment.
elsewhere. SU<h insurance a" 10 efYorded. lbr publIc IIllblllty.
does not apply to 'r1ury 10 or dNth 0( the lMUled'a IllI'I\pl0yeeo The ImIIs of the company'a liability for the amounts prncribed in
willie engaged in the oou"'" of their ernpfoytTMlnt. or property this endorsement apply aap&nltaiy. to each accident, and any
lran.ported by the NUred. designated .. CIII'\lo. k Ie understood peyment under the poKey beeeUllB of any ene aedelent shall not
and egreed thlt no oondl1lon, provision, stipulation, or Umlt8tlon opel'llte 10 reduce the AobUIIy of the company for the payment of
contained in the pOlley, this endorsement. or anv ether ftnallUdamentl....uttlng "om .nv other aooIdent,
The Motor Carrier PC. of 1980 requI.... ImIW of ftnoncle1 responsibility according to the type of carriage and commodity transported
by !he motor c;errfer. It 1& the MOTOR CARRIER'S alligation 10 obtain tho ...qulred IImItI of ftnenc:lal responslblliiy.
THE SCHEDULE OF LIMITS SHOWN ON THE NEXT PAGE OOES NOT PROVIDE COVERAGE.
The limits shown In thtolchedule are for infonnatlon pu_ only.
Form Mcs...to
(Oller)
UNlfIOlUIlNrotutA'nON '_vu:~e"IMO. Me 1822k (10-99)
Ordinance No. 2945
I AcORD. . COMMERCIAL POLICY CHANGE REQUEST------ -] --DA;~=DtYY) I
AGENCyT~~!~~~~-=~:;;~~::==I~~~-B~NR:~R::,NE ..... ~ :~~RALLl'BILITY ~] ..:~;::~c::::::sEi - -- ~ 1
T S IN -, -" - L---------------------------------------1 n UMBRELLA, --D_TRU~~_~~____ __ _ _ jJ___~~~~E[~S CO~---.lJ_____ -- .1
\ 1: ;~~:~I:SS~f:~~ Suhe 225 CZ:~;s:rance.-~~~-- --- ___~~_~_C~~_E~_____
I Houston, TX 77077
: CODE SUBCODE:
f~~~~i~~u::~-E~--'~
I Tajas Medical Waste
, INSURED'S MAILING ADDRESS IF CHANGED (INC ZIP+4)
,
I Tajas Medical Waste
! PO BOX 1547
! COpperas Cove, TX 76522
ATTENTION:
POLICY NUMBEA-'--'" ~ ~ - I EFFECTIVE DATE OF CHANGE
FBCAT0044201 t 11109/05
POLICY INCEPTION DATE --~ -- --- POLICY EXPIRATtON DATE
05121105 OS/21/06
TH$S IS AA ACKNOWlEOOEMENT OF YOUR REQUEST. UPON APPROVAL, THE COMPANY'S RECORDS
WILL BE ADJUSTED ACCORDINGLY. NfO JF A PREMIUM ADJUSTMENT IS REQUIRED, IT WlllSE DONE
AT PREMIUM AUDIT OR BV ENDORSEMENT.
li-:~f'-""~~,;:,~^U"- RIT;,';: R=~'~ ~~T l~~~:~~
I NATUREOF~UsltiEsSitiESCRIPTiOtiOFOPeRATiONs BVPREMlte(Sj---- ~- U ADO 1 DCHANGETT DELETE
LOC;fBu'*f-- ------
_-.l_1
AUTO-VEHICLE DESCRIPTION/UMITS
r VEH II YEAR MAKE:_
I - ------ ------ MOD~,-,- _ V.I.N.:
~ CI1Y. STATE. .tl'k lERR GVWJO,CW
ZIP WHERE
~;.lE~.l-b.U~E.:=::8 :;':l ~ B~; B ~
Ll.~'M-'~S.J(=j_ ~ARM_.__._ BER\I1CE ~LT l.\\l,If'8R 0 l!'6rl
1Jr.:'if"
L___' _.____.__
'l.. - .._.__J.IABI~____ NO FAULT AOO'L NO FAULT IIIEDlCAL PAYMENTS
.__L. $ $ $
AUTQ.VEHICLE DESCRli>TloNIUMITS GED
!VEH'-I YEAR tMKE
, MODEL:
-nJ
CI1Y, STATE,
ZIP WHERE
GAAAGED
(lJl,'I.U'l:HOOl 1 UBE -.
II < 15 MilES 0 PLEASURE
[J lU~ILES... 0 FARM
.__~1TH~__
UABILI1Y NO FAULT UNINSURED MOTORISTS
L_ $ $
DRIVER INl;OAMATlON UaI .tv.,. who ADD
[~"_NAlIIe.~ud6 oddr.... Wreqoirod) ~RSJ'=~ ~'cTE
DRIVER INFORMATION UII drtvl,. who Ulntt utI OW" vohlCl.. 0 ADO
ErR NAME(lndudeaddr....Wrequlred} SEX"'" DATEO'SI"," "W' ~T~=W "l~E
ffft=rr-~~=-~--_u- .
ACORD 175 (2003108) PlEASE COMPLETE REVERSE SIDE
CLASS
Op
SIC
o
OF
OFT
Ohw
OLSP
OCOMP
OCOll
o~
OFG
DEOUCTIBlES 0 ACV
OM OSTAMT
$
TOTAlPREM
C
DATE
HIRE
_~J
o CHANGE 0 DELETE
~~-i~ OOl~J
-----..1
E~ulfD 1
REMUNERAT.!O~_____j
,
I
i
i I
iCJ ACORD CORPORATION 1991
Ordinance No. 2945
PIlOPERTYANlANO'MARIIlE--PR~_MI~E.s INFClI'l~TlOIl_J~~EMIS~;" _-:J BUILD",.GL~ -_'1- . 0 ADD _.0 CHANGE U DELETE
,~,cr ~~_" ] _ ..,"""- ro~ , "~l." ~~' --r~=~IEQAMS AllOj;ON!;)tT!ONS TO APPLY
. _.- -------~[- ~- -- -- --
ADDITIONAL COVERAGES, OPTIONS, RESTRICTIONS. ENDORSEMENTS AND RATING INFORMATION
CONSTRUCTlONTYPE'-."'. ... ------- ------J-- ~;DRl,SJrANFT~ET~TAT FlAECiisTRICT/COOE NUMBER
ISUILIliNGIMPROVEMENTS-- -- DPLUMBING, YR.-'::d B=DE INSPECTED? !fv'Wl
, ] WIRING, YR 0 HEATING, YR DYES O.""l..___
I U"OOFIN_G~_':~_____._._OOTHER TAX CODE . _____.___
RIGHT EXPOSURE & DISTANCE LEFT EXPOSURE & DIST ANeE
..- PAOT CL eTOAI~~:iJY:BUILTtAL AREA
OTHER OCCUPANCIES
REAR EXPOSURE & DISTANCE
~-"' r,,"~m"~tt I m'~I""t"~"~'~
L WITH KEYS
BURGLAR ALARM IN-STAUEDANDSERViCED-sy ------------ ~-~- II GUAROS/WATCHMEN D CLOCK HOUR~~
r
IpREMISES FIRE PROTECTION ($pnntders Standpipes, C02JChemleal Systems) FIRE ALARM MANUFACTURER----- - - ~ '[J CEN;RAL STATION -
, - ..__.__ I ___.______.. LDbQQ.I\!,<:19N~_
INlAND MARINE - SCHEDULED EQUIPtjlEN " COINSURANCE. 0 ADO 0 CHANGE 0 DE TE
['ti~~~~~-"~--~='i .--. ~"~mro :_:~j
OENEAALUAlIIUTY - UMITS ..IlQ,HANGE
~~~:=~~G~~MJNSAGGREGATE: =:::L~~~':On)--===~:~-"-~'-j
EACH OCCURRENCE' $ _~~._____~____ __ J
GeNERAL LIABIUTY . SCHEDULE OF HAZARDS
_~~~()T'O~
--1==
BURGLAR ALARM TYPE
UMBRELLA
~~:;~ .....:
AODnlONALINTeREST
I-'NTEREST RANK. NAME AND ADDRESS REFERENCE'.
IllI ADDITIONAL INSURED .
I 0 LOSS PAYEE ClIy of College Station
I 0 MORTGAGEE (' --.J Alln: Risk Mariagement PO Box 9960
I 0 MORTGAGEE ('--.J Conege Station, TX n842
lo LIENHOLDER
o EMPLOYEE /lS LESSOR ITEM DESCRIPTION.
Al>OmONAL CHANOESJREMARKS
Please add addlttonallnsured as shOwn above.
I r--------.
CLASSIFICATMJN ClASS PREMIUM TEAR PREMIU
CODe BASIS
--- _.~-- ---
(S) GROSS
-------.---. -- (P) PAYROLL -
(AlAREA.PER
--.- (C) TOTAl.C
(M) ADMISS
-- (U) UNIT - PER
-_.'-----_. -- -- -- rn OTHER
M BASIS COOES
SALES - PER $l,OOOISAl.ES
PER$l;OC1J/PAY
1,OOOlSO FT
OST. PER 51.000ICOST
IONS - PER 1.000IADM
UNIT
J
-.-:.::.::j ~~'l.'BE)
o CHANGE
----.---1
__ __ J
ADD
~ CERTIFICATE REQUIRED
CHANGE DELETE
INTEREST IN ITEM NUMBER
PREMISES. BUILDING
~__._ ,---"-.-.-._._...0-'..
VEHICLE. BOAT.
SCHEDULED ITEM NUMBER
OTHER
Thanks
SIGNATURE (Any dlllation Qr reductlon In
[INSURED'S SIGNATURE
-_.._------_._-------------_._---~--
ACORD 175 (2003108)
. r ulrea theln.u'td'a. . rMltur.
DATE r~t~~ NATIONAl.PRO:~ERNUMBER]