Fill - Free fillable Street Storm Drain - New Utility Contractor2 PDF form

To perform construction in the City’s right‐of‐way, contractors must be

licensedandbonded.Thefollowingdocumentsandfeearerequiredbythe

CityofFortWorthforlicensingandbonding:



□Original$25,000StreetandStormDrainContractorsBondwith

Power‐of‐Attorney.

□ApplicationforLicense(fornewcontractorsonly)

□Licensefeeof$500,payabletotheCityofFortWorth

□(ForCommercialWorkonly)CertificateofLiabilityInsuranceinthe

amountof$10milliongeneralcommercialliabilitycoverage.The

certificatemustnametheCityofFortWorthascertificateholder

andadditionalinsured.Italsomustincludea30‐daycancellation

notice.



**Pleasereadattachedinstructions

fordetailedinformation**



Formoreinformation,pleasecontacttheCityofFortWorthTransportation

andPublicWorksDepartment,StreetPermitCenterat817.392.6594,or

visitusat311W.10

St.FortWorth,TX.76102.Wearelocatedonthe

southwestcornerof10

andTaylor.

$25,000 BOND

Instructions for completing the Street and Storm Drain Contractors Bond



Thebondformsprovidedmustbecompletedbythebondingcompany’sinsurance

agencyandsignedbythebondingcompany’sprincipalandAttorney‐in‐Fact.



ThePower‐of‐AttorneyfortheAttorney‐in‐Factmustbethesamenameandhavethe

samedateonthebond.SubmittheoriginalbondwithsealandPower‐of‐Attorneywith

originalsignaturestotheStreetPermitCenter.



Ifyouareanewcontractor,thelicenseapplicationmustbecompletedinfull,signed

anddatedbytheapplicant(principal).



Namesmustbewrittenandprintedinthespaceprovided.(Pleaseattachasheetwith

insuranceandbondingcompany’sname,fulladdress,andphoneandfaxnumbers).



Newcontractors:Apre‐constructionmeetingmayberequiredattheinspector’s

discretion.





Annuallicensefeeforallcontractors



Acheck/creditcard/cash/moneyorder/cashier’scheckintheamountof$500(annual

licensefee),payabletotheCityofFortWorth,mustaccompanytheapplicationwhenit

isreturnedtotheStreetPermitCenteroffice.Thisfeeisforoneyearfromthedateof

thebondandisrenewedannually.



ExistingContractors:Ifyouarecontinuingyourbondfromoneyeartothenext,withno

lapseincoverage,acontinuationcertificateandthelicensefeeof$500isallthatis

required.Thecontinuationcertificatemusthaveacoveragetermof12months.The

licenserenewalwiththeStreetPermitCenterisvalidoneyearfromthebond’seffective

date.

CITY OF FORT WORTH, TEXAS

STREET AND STORM DRAIN CONTRACTORS BOND

THE STATE OF TEXAS )

KNOW ALL MEN BY THESE PRESENTS:

COUNTY OF TARRANT )

That We ______________________________________________________,As,

principal, and _________________________________________________,As

surety, are held and firmly bound unto the City of Fort Worth, Texas, in the penal

sum of twenty-five thousand Dollars ($25,000.00) good and lawful money of the

United States of America, well and truly to be paid for the payment of which we,

and each of us, hereby bind ourselves, our heirs, executors, administrators and

successors, jointly and severally, firmly by these presents

THE CONDITIONS OF THIS OBLIGATION ARE SUCH THAT

WHEREAS, the above principal desires to engage in the business of

laying, constructing, building, repairing, rebuilding, grading, graveling, paving,

surfacing, resurfacing and doing work in and upon the public streets, alley or

thoroughfares within the corporate limits of the City of Fort Worth and has

complied with all the terms and conditions of ordinance No. 3449 of the City of

Fort Worth, Texas, and has applied to the Director of Transportation and Public

Works as provided in said ordinance

NOW, THEREFORE, if said principal shall fully indemnify and save whole

and harmless the said City of Fort Worth, its agents and employees, as well as

indemnify and save harmless any person, firm or corporation with whom the

Principal has contracted, from any and all damages of any character arising from

or caused directly or indirectly by any negligence in the performance of such

work as above set forth under the terms of said ordinance and said license or for

any imperfect or inadequate work done by said principal under the terms of said

ordinance and said license, and shall maintain said work in good and

workmanlike state of repair for a period of two (2) years from and after its

completion and acceptance by the City of Fort Worth, then this obligation shall be

null and void, otherwise to remain in full force and effect: provided, however, this

bond is executed by the surety on the condition that its liability shall be limited by

and subject to the conditions and provisions herein under contained:

Successive actions may be brought on this bond for successive breaches

of its conditions or any of them; provided, however, that the total sum of all

liability of the surety on any one or all of such actions shall not exceed a total

sum of Twenty-five Thousand Dollars ($25,000.00).

The liability of the Surety under this bond, if not canceled as hereinafter

provided, shall cease and terminate of its own force and effect one year from the

date hereon, saving and excepting for the maintenance of the work performed

previous to the date of termination, for which work the liability of the Surety for

maintenance shall continue for two years from and after the date of the

completion and acceptance of said work by the City, but no longer.

The Surety may terminate its liability under this bond at any time by giving

the City Council of the City of Fort Worth, Texas, five (5) days notice in writing of

the Surety’s intention to do so, and from and after said date the Surety will no

longer be liable for any subsequent act, save and except as to maintenance as

herein above provided.

IN WITNESS WHEREOF, the said Principal and the said Surety have set

their hand and seal this the ______ day of ____________ 20_________.

_____________________

Principal

_____________________

Surety

_____________________

Attorney-in-Fact

Street and Storm Drain Contractor’s Bond

Application for License

Type or print the name of the applicant in the blank below:

___________________________hereby makes application for license as

provided for by Ordinance #3449; stating that applicant is fully qualified to

complete properly any work undertaken, and will make available the necessary

labor, materials, and equipment; and furnishes the following in support of this

application:

1. The applicant or owner has been in business____ years as street and storm drain

contractor under the present business name.

2. Has the applicant or owner engaged in business under any other name(s) in the

past ten years? __________If yes, what name(s)?

_____________________________________________________________________

3. Other cities where applicant is licensed?

_____________________________________________________________________

4. Has the applicant or owner ever been licensed as a parkway contractor by the City

of Fort Worth? ______If yes, when? ______________________________________

5. Has the applicant or owner had concrete work he/she started, completed or

reconstructed by a bonding company? ___ If yes, summarize on an attached sheet.

6. Has the applicant or owner failed to complete any contract he entered? _______

If yes, summarize on an attached sheet.

7. Types of construction company usually performs:

____________________________________________________________________

8. Type of organization: Individual, Partnership, Corporation, etc:

____________________________________________________________________

9. Applicant/owner full home address:

___________________ ______________________ __________ ____________

Address City State Zip

10. Applicant/owner full business address:

___________________ ______________________ __________ ____________

Address City State Zip

Owner, partners, or officers and construction experience:

Name Title Years

Applicant is familiar with City of Fort Worth Ordinance #3449; will furnish the

required bond satisfactory to the City of Fort Worth, Texas; and agrees to complete

all work in compliance with the requirements established by the City of Fort Worth

through its City Engineer.

City Engineer Approval: __________________________

AUTHORIZATION TO SIGN FOR PERMITS:

Name of authorized Phone number for

individuals to receive permits

: Emergencies:

_________________________ ________________________

Name

_________________________ ________________________

Name

_________________________ ________________________

Name

_________________________ ________________________

Name

_________________________ ________________________

Name

_________________________ ________________________

Name

_________________________ ________________________

Name

Licensee/Applicant Signature: ______________________ Date: _______

TPW/Traffic Engineering

Street Permit Center

BASIC INSURANCE REQUIREMENTS

UTILITY CONTRACTORS

The following items represent basic insurance requirements. Exceptions to the

insurance requirements may be permitted, depending on the risk exposure in regards to

respective services, products procured or contractual terms, to name a few. The only

non-negotiable item is number 3, Statutory Limits of Workers’ Compensation

, which is

required for all public projects.

1. Commercial General Liability (CGL) Insurance Policy

$10,000,000 Each occurrence, no exception

Please note: to meet the requirement of $10,000,000 coverage, a combination of an

underlying Commercial General Liability policy with an Excess/Umbrella Liability policy is

acceptable as long as the excess policy follows form and provides the required limit of

coverage.

2. Automobile Liability Insurance Policy

$1,000,000 Each accident on a combined single limit basis. A

commercial business policy shall provide coverage on “Any Auto”

3. Workers’ Compensation Insurance Policy

 Statutory Limits

 Employer’s liability

$100,000 Each accident/occurrence

$100,000 Disease-per each employee

$500,000 Disease-policy limit

4. Policy Endorsements as follows:

 The City of Fort Worth, its Officers and Employees named as an

Additional Insured

 Thirty (30) days notice of cancellation or non-renewal. It would be

advantageous to the City to require the following clause:

“This insurance shall not be cancelled, limited in scope or

coverage, cancelled or non-renewed, until after thirty (30) days

prior written notice has been given to the City of Fort Worth”.

 Waiver of rights of recovery (subrogation) in favor of the City

of Fort Worth.

5. The insurers for all policies must be licensed/approved to do business in the

State of Texas and have minimum rating of A: VII in the current A. M. Best Key

Rating Guide or have reasonably equivalent financial strength and solvency to

the satisfaction of the Risk Manager.

6. The deductible or self-insured retention (SIR) affecting required insurance

coverage shall be acceptable to the Risk Manager of the City of Fort Worth in

regards to asset value and stockholders’ equity. In lieu of traditional insurance,

alternative coverage maintained through insurance pools or risk retention groups

must also be approved.

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