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319 EXHIBIT A RFP or Contract # TzDOT Form No. 1560 (Rev. 1291) Previous editions of this form may not be used. NOTE: Copies of the endorsements listed below are not required as attachments to this certificate. TEXAS v% n DEPARTMENT OF TRANSPORTATION CERTIFICATE OF INSURANCE The named contractor shall not commence work until he/she has obtained the minimum insurance specified in Section 11, below, and obtained the following endorsements: the Texas Department of Transportation as an Additional Insured for coverages 3 and 4, and a Waiver of Subrogation in favor of the same department under coverages 2.1 and 4. Only certificates of insurance published by this department are acceptable as proof of insurance. Commercial carriers' certificates are unacceptable. SECTION 1 IDENTIFICATION DATA I.1 Insured Contractor's Name 1.2 Street/Mailing Address 1.3 City 1.4 State 1.5 Zip 1.6 Phone Number Area Code( ) SECTION 11 TYPE OF INSURANCE Type Policy Ef ecdve Expiration Limits of Liability Number: Date: Date: Not Less Than: 2. WORKERS' COMPENSATION 7.1 Name of Authorized Agent 2.1 2.2 2.3 Statutory Texas Endorsed with a Waiver of Subrogadon in favor of the Texas Department of Transportation. 6.4 State 3. COMMERCIAL GENERAL LIABILITY 73 City Bodily Injury/Property 3.1 3.2 3.3 5600,000 combined single limit Damage each occurrence and in the aggregate Endorsed with the Texas Department of Transportation as an Additional Insured and endorsed with a Waiver of Subrogation in favor of the Texas Department of Transportation. 4. TEXAS BUSINESS AUTOMOBILE POLICY A. Bodily Injury 4.1 4.2 4.3 $250,000 ea. Person 5500,000 ea. Occurrence B. Property Damage 4.4 4.5 4.6 S 100,000 ea. occurrence Endorsed with the Texas Department of Transportation as an Additional Insured and endorsed with a Waiver of Subrogation in favor of the Texas Department of Transportation. 5. UMBRELLA POLICY (If Applicable) S.l 5.2 5.3 S SECTION III CERTIFICATION This Certificate of Insurance neither affirmatively or negatively amends, extends, or alters the coverage afforded by the above insurance policies issued by the insurance company named below. Cancellation of the insurance policies shall not be made until THIRTY DAYS AFTER the undersigned agent or his/ber company has sent written notices by certified tail to the contractor and the Texas Department ofTransportation. THIS IS TO CERTIFY to the Texas Department of Transportation, acting on behalf of the State ofTexas, that the insurance policies above meet all the requiremcots stioulated above and such policies are in full force and effect. 6.1 Name of Insurance Company 7.1 Name of Authorized Agent 6.2 Company Address 7.2 Agent's Address 63 City 6.4 State 6.5 Zip 73 City 7.4 State 7.5 Zip 7.6 Authorized Agent's Phone No. Area Code f 1 Original Signature of Authorized Agent Date Resolution No. 2001 -004, approving Addendum Number One to the existing Professional Services Contract between the City of Paris and C. T. Brannon Corporation for the performance of a Master Plan Study for the use of Lake Crook, was presented. A motion was made by Councilman Carter, seconded by Councilman Bell, for approval of the resolution. The motion carried 7 ayes, 0 nays.