HomeMy WebLinkAboutJeff Foust Excavating (2)D. Has your firm or any officer or partner of your firm asked to be relieved from a bid submitted by it to a
public awarding authority during the past ten (10) years? ❑ Yes O No
If so, state:
Date
Owner's Mailing Address
Owner
(At that time or preferably now if there is a difference.)
Full particulars in each instance (including type of work & amount of contract):
E. Has your firm or any officer or partner of your firm been relieved from a contract awarded to it during
the past ten (10) years? ❑ Yes ❑ No
If so, state:
Date
Owner
Owner's Mailing Address
(At that time or preferably now if there is a difference.)
Full particulars in each instance (including type of work & amount of contract):
Has firm or any officer or partner of your firm ever been charged with or convicted of a violation of any
wage schedule? ❑ Yes ❑ No
If so, state:
Date
Claimant
Claimant's Mailing Address
(At that time or preferably now if there is a difference.)
Full particulars in each instance (including type of work & amount of contract):
(:\Engineering\SNOW SHOVELING FOLDERS\Snow Removal Contmcts\2019\Bi4deis Proof Page 5 of 8
Fomt10.11-19.doex
G. Has your firm; any of its owners; a subsidiary or corporate parent; or any officer, director, or partner
thereof, been convicted in the last three years of violating Section 133.03 Wisconsin Statutes (Unlawful
Contracts: Conspiracies)? ❑ Yes ❑ No
If so, state:
Claimant
Claimant's Mailing Address
(At that time or preferably now if there is a difference.)
Full particulars in each instance (including type of work & amount of contract):
H. Has your firm or anyone employed by your firm been convicted of a felony?
❑ Yes ❑ No
If so, identify and describe each incident (include county, case number, violation, circumstances)
Has your firm or anyone employed by your firm been convicted of a misdemeanor or ordinance violation
including disorderly conduct disturbing the peace, assault, battery, theft, fraud, or similar issues?
❑ Yes ❑ No
If so, identify and describe each incident (include county, case number, violation, circumstances):
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Foem 10-11-19.de x
VI. CONTRACTOR'S FINANCIAL STATEMENT
Condition at close of business of 20
A. ASSETS
Cash.................................................................... $
Accounts Receivable ................................................ $
Real Estate Equity .................................................. $
Materials in Stock ................................................... $
Equipment —Book Value ......................................... $
Less Depreciation
Furniture and Fixtures — Book Value .......................... $
Less Depreciation
OtherAssets......................................................... $
TOTAL ASSETS .......................................... $
B. LIABILITIES
Accounts, Notes & Interest Payable ........................... $
Other Liabilities...................................................... $
TOTAL LIABILITIES ..................................... $
NET WORTH (TOTAL ASSETS — TOTAL LIABILITIES).. $
C. Who prepared this balance sheet?
D. Are any of your assets assigned? If so, which are assigned?
E. For what purpose are they assigned?
L\Englm,armg\SNOW SHOVELING FOLDERS\Snow Removal Oonhac6\2019\13iddees Proof Page 7 of 8
Fom�10-11-19.doa
VII. AFFIDAVIT
STATE OF
COUNTY OF
(Name of Officer/Owner)
is the
of
being duly swom, deposes and says that he/she
(Title) (Name of Firm)
and that the answers to the foregoing questions and all statements therein contained are true and correct, and that
any owner or other agency herein named is hereby authorized to supply the municipality, City of Oshkosh, with
any information deemed necessary to verify this statement.
Subscribed and sworn before me this
APPROVED BY:
Director of Public Works
City Manager
(Signature of Officer/Owner)
day of 20_.
Notary Public
County
My Commission Expires
Date
Date
State
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Form 1U11-19.doa
CONTRACT FOR SNOW AND ICE REMOVAL
THIS CONTRACT, made on the _ day of 2019, by and between
the CITY OF OSHKOSH, party of the first part, hereinafter referred to as CITY, and
(Name and address), party of the second
part, hereinafter referred to as the CONTRACTOR,
WITNESSETH:
That the CITY and the CONTRACTOR, for the consideration hereinafter named, enter
into the following Contract. The CITY's Request for Quotations is attached to this Contract,
along with the CONTRACTOR's Proposal. The terms of this Contract and the CITY's Request for
Quotations will prevail over the CONTRACTOR's Proposal if there are any inconsistencies
between these documents.
ARTICLE I. PROTECT MANAGER
A. Assignment of Project Manager. The CONTRACTOR has assigned the primary
individual identified below to manage the project described in this Contract. The
CONTRACTOR also assigns the second individual identified below as qualified to make all
decisions for the CONTRACTOR if the primary person is not available:
(Insert name of Project Manager/Primary Contact)
(Insert name of Secondary Contact with Authority)
B. Changes in Project Manager. The CITY shall have the right to approve or disapprove
of any proposed change from the individual named above as Project Manager. The CITY shall
be provided with a resume or other information for any proposed substitute and shall be given
the opportunity to interview that person prior to any proposed change.
ARTICLE 11. CITY REPRESENTATIVE
The CITY shall assign the following individual to manage the project described in this
contract:
Jean Broennimann, Secretary
Justin Gierach, P.E., Engineering Division Manager / City Engineer
ARTICLE III. SCOPE OF WORK
The CONTRACTOR shall provide the services described in the CITY's Request for
Quotations. The CONTRACTOR may provide additional products and/or services if such
products/services are requested in writing by the Authorized Representative of the City.
I: \Engineering\SNOW SHOVELING FOLDERS\Snow Removal Conhnaa\WMConhaR_10.11-19.doa Page 1 of 4
All reports, drawings, photographs, electronic data, specifications, computer files, field
data, notes, and other documents and instruments prepared by the CONTRACTOR as
instruments of service shall remain the property of the CITY.
ARTICLE W. CITY REPONSIBILITIES
The CITY shall furnish, at the CONTRACTOR's request, such information as is needed
by the CONTRACTOR to aid in the progress of the project, providing it is reasonably obtainable
from City records.
To prevent any unreasonable delay in the CONTRACTOR's work, the CITY will
examine all reports and other documents and will make any authorizations necessary to
proceed with work within a reasonable time period.
ARTICLE V. TIME OF COMPLETION
TIME IS OF THE ESSENCE IN THIS CONTRACT. ALL TIME LIMITATIONS AND
DEADLINES WILL BE STRICTLY ENFORCED BY THE CITY. The work to be performed
under this Contract shall be commenced and the work completed within the time limits as
described in this Contract, including any attachments.
The CONTRACTOR shall perform the services under this Contract with expediency and
with sound work practices. The nature of the work required by this agreement will occur in or
around inclement weather, namely snow, ice, and other weather events involving precipitation.
The CONTRACTOR therefore shall perform work in, and accommodate situations arising from,
inclement weather. The CONTRACTOR will not be responsible for damages arising directly or
indirectly from any delays for cause such as strikes or other labor disputes by organized labor.
ARTICLE VI. COMPONENT PARTS OF THE AGREEMENT
This Contract consists of the following component parts, all of which are as fully a part
of this Contract as if herein set out verbatim, or if not attached, as if hereto attached:
This Instrument.
2. Request for Quotations.
3. CONTRACTOXs Proposal.
In the event that any provision in any of the above component parts of this Contract is in
conflict with any provision in any other of the component parts, the provision in the component
part first listed above shall govern over any other component part which follows it numerically
except as may be otherwise specifically stated.
h\Engineering\SNOW SHOVELING FOLDERS\Snow Removal Contracca\2019\Contmct_10.11-19.docx Page 2 of 4
ARTICLE VII. PAYMENT
A. Payment Amount. The CITY shall pay to the CONTRACTOR for the performance of
the Contract based upon the prices identified in the CONTRACTOR's Proposal, adjusted by any
changes hereafter mutually agreed upon in writing by the parties hereto.
B. Method of Payment. The CONTRACTOR shall submit itemized statements for
services. The CITY shall pay the CONTRACTOR within 30 calendar days after receipt of such
statement. If any statement amount is disputed, the CITY may withhold payment of such
amount and shall provide to CONTRACTOR a statement as to the reason(s) for withholding
payment.
C. Additional Costs. Costs for additional services shall be negotiated and set forth in a
written amendment to this Contract executed by both parties prior to proceeding with the work
covered under the subject amendment.
ARTICLE VIII. CONTRACTOR TO HOLD CITY HARMLESS AND INDEMNIFY
The CONTRACTOR covenants and agrees to protect and hold the City of Oshkosh
harmless against all actions, claims, and demands of any kind or character whatsoever which
may in any way be caused by or result from the intentional or negligent acts of the
CONTRACTOR, his agents or assigns, his employees, or his subcontractors related however
remotely to the performance of this Contract, or caused or result from any violation of any law
or administrative regulation, and shall indemnify or refund to the CITY all sums including
court costs, attorney fees, and punitive damages which the CITY may be obliged or adjudged to
pay on any such claims or demands within thirty (30) days of the date of the CITY's written
demand for indemnification or refund.
ARTICLE IX. INSURANCE
The CONTRACTOR shall carry insurance which includes the CITY and its employees
and agents as an additional insured's for work required by this Contract. The
CONTRACTOR's insurance must be primary insurance. The type of insurance and coverages
must conform to the attached City of Oshkosh Insurance Requirements.
ARTICLE X. TERMINATION
This Contract may be terminated for any reason by either party. The CITY may
terminate this Contract after giving the CONTRACTOR written notice at least seven (7)
calendar days before termination. The CONTRACTOR may terminate this Contract after giving
the CITY written notice at least forty-five (45) days before termination. The CONTRACTOR's
obligations to hold harmless and indemnify the CITY, and to maintain insurance for actions
related to this Contract shall survive after the Contract has been otherwise terminated. The
CONTRACTOR shall be entitled to compensation for any satisfactory work performed up to the
date of termination.
I:\Engineering\SNOW SHOVELING FOLDERS\Snow Removal ContnaS\20I9\Comoatt 10-11-19.d= Page 3 of 4
This document and any specified attachments contain all terms and conditions of the
Contract and any alteration thereto shall be invalid unless made in writing, signed by both
parties and incorporated as an amendment to this Contract.
In the Presence of:
(Seal of CONTRACTOR
if a Corporation.)
(Witness)
(Witness)
APPROVED:
City Attorney
CONTRACTOR
By:
(Specify Title)
By:
(Specify Title)
CITY OF OSHKOSH
By:
Mark A. Rohloff, City Manager
Us".
Pamela R. Ubrig, City Clerk
I hereby certify that the necessary provisions
have been made to pay the liability which will
accrue under this Contract.
City Comptroller
I:\Engineering\SNOW SHOVELING POLDERS\Snow Removal Commeta\2019\Conhact_1LL11-19.do Page 4 of 4
12/20/18
CITY OF OSHKOSH
INSURANCE REQUIREMENTS
V. RIGHT-OF-WAY OBSTRUCTION /
RIGHT-OF-WAY ANNUAL EXCAVATION I
RIGHT-OF-WAY SINGLE SITE EXCAVATION /
WORK IN RIGHT-OF-WAY LICENSES INSURANCE REQUIREMENTS
The Contractor shall not commence work on contract until proof of insurance required has been
provided to the applicable City department before the contract or purchase order is considered for
approval by the City.
It is hereby agreed and understood that the insurance required by the City of Oshkosh is prima
coverage and that any insurance or self insurance maintained by the City of Oshkosh, its officers,
council members, agents, employees or authorized volunteers will not contribute to a loss. All
insurance shall be in full force prior to commencing work and remain in force until the entire job is
completed and the length of time that is specified, if any, in the contract or listed below whichever is
longer.
1. GENERAL LIABILITY COVERAGE
A. Commercial General Liability
(1) $500,000 each occurrence limit
(2) $500,000 personal liability and advertising injury
(3) $500,000 general aggregate
(4) $500,000 products — completed operations aggregate
B. Claims made form of coverage is not acceptable.
C. Insurance must include:
(1) Premises and Operations Liability
(2) Contractual Liability
(3) Personal Injury
(4) Explosion, collapse and underground coverage
(5) Products/Completed Operations for 2 years after acceptance of completed work
(6) The general aggregate must apply separately to this proiect/location
2. BUSINESS AUTOMOBILE COVERAGE— If this exposure shall exist:
A. $500,000 Combined Single Limit for Bodily Injury and Property Damage each accident.
B. Must cover liability for Symbol #1 - "Any Auto" — including Owned, Non -Owned and
Hired Automobile Liability.
3. WORKERS COMPENSATION AND EMPLOYERS LIABILITY — "If' required by Wisconsin
State Statute or any Workers Compensation Statutes of a different state.
A. Must carry coverage for Statutory Workers Compensation and an Employers Liability
limit of:
(1) $100,000 Each Accident
(2) $500,000 Disease Policy Limit
(3) $100,000 Disease— Each Employee
V - 1
12/,20/1 B
4. BUILDER'S RISK / INSTALLATION FLOATER / CONTRACTOR'S EQUIPMENT OR
PROPERTY
The contractor is responsible for loss and coverage for these exposures. City of Oshkosh
will not assume responsibility for loss, including loss of use, for damage to property,
materials, tools, equipment, and items of a similar nature which are being either used in the
work being performed by the contractor or its subcontractors or are to be built, installed, or
erected by the contractor or its subcontractors.
5. ADDITIONAL PROVISIONS
A. Acceptability of Insurers - Insurance is to be placed with insurers who have an A.M.
Best rating of no less than A- and a Financial Size Category of no less than Class VI,
and who are authorized as an admitted insurance company in the state of Wisconsin.
B. Additional Insured Requirements — The following must be named as additional
insureds on all Liability Policies for liability arising out of project work - City of
Oshkosh, and its officers, council members, agents, employees and authorized
volunteers. On the Commercial General Liability Policy, the additional insured
coverage must be ISO form CG 20 10 07 04 or its equivalent and also include
Products — Completed Operations ISO form CG 20 37 07 04 or its equivalent for
a minimum of 2 years after acceptance of work. This does not apply to Workers
Compensation Policies.
C. Certificates of Insurance acceptable to the City of Oshkosh shall be submitted prior to
commencement of the work to the applicable City department. These certificates shall
contain a provision that coverage afforded under the policies will not be canceled or
non renewed until at least 30 days' prior written notice has been given to the City Clerk
— City of Oshkosh.
1M
non' CERTIFICATE OF LIABILITY INSURANCE DATE(MMDD/YYV)
THIS CERjIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR
PRODUCER, AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy((es) must be endorsed. If SUBROGATION IS WAIVED, subject to the
terms and conditions of the policy, certain policies may require an endorsement A statement on this certificate does not confer rights to the certificate
holder in lieu of such endorsemen s .
'RODUCER CONTACT
Nsuranca ABaney canfacf NAME:
lnlortnatiogil.able gsbasf -- Insurance AganYe —,
addreasand POSOX PHONE cronlaR M/orrnetiar. FAX
aPP/icab/e. IA/C. No_Ez1._._..--.____ _-__—..______ __ ___
EMAIL ---""-'
ADDRESS:
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IncludingnamgaddrasaarM INSURERS XYZlnsuranceCompan—__ ___L N/
phone number. INSURERLMN Insurance Company -__ _ i N/
--
INSURERD: bNurer(aJmuafhawemNlmumAM.Bearratlnga/A-
_._._.__-._._._....___ ands RnancWPar/orma e, Rating of V/orbetler. -
INSURER E:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW 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 WHICH THIS
CERTIFICATE AMY BE ISSUED OR MAY PERTAIN. THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED
HEREIN IS SUBJECT TO
ALL THE TERMS,
EXCLUSIONSAND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR ADUL SUBR POLICY EFF .- POLICY E%P
LTR TYPE OF INSURANCE INSR WVD POLICY NUMBER MM/DD/IM MM/DD/YYY
- - -
LIMITS
GENERAL LIABILITY
COMMERCIAL GENERAL LABILITY ® El lGenemi Liability Pofcy Number j Policy effective and mplre(ion dale
EACH OCCURRENCE
DAMAGE TO RENTED
$500,000
A ❑.CLAIMS -MADE ®'OCCUR
. PR_E_MIS_ES(Ea occurrence)_
MERE (AnY one Person)
$50,000
$ 5,000
'®
_
ISO FORM CG 2037 OR EQUIVALENT
PERSONAL& ADV INJURY
i $600,000
I
... .___ -
GENERAL AGGREGATE
$ 500.000
- GEN' L AGGREGATE LIMITAPPLIES PER: li
iPRODUCTS- COMP/OP AGO
$500,000
,[:]POLICY Z; PRO- ❑FLOC
,
$
AUTOMOBILE LIABILITY
(COMBINED SINGLE LIMIT
IEa amclentj
$ 500,000
ANY AUTO ® ❑ Auto Llabilit Polk Number P d expiration tlate.
" - y y olicy e8ec(ive an
_
BODILY INJURY (Per person)
$
OWNED ❑' SCHEDULED
B
I
-❑ AUTOS AUTOS
I BODILYINJURY(Peramid-t)
$
❑. HIRED AUTOS ,,❑ NON -OWNED AUTOS
IPROPERTY
(Peramitlent)AMAGE
$
❑ UMBRELLA LIAB .❑OCCUR ❑ ❑
EACH OCCURRENCE
! $
-❑ ❑' CLAIMS -MADE
EXCESS LIAB
AGGREGATE
$
.❑ DED ❑',.. RETENTION $
$.
C (AND EMPLO ERRKERS $ L ABIILITY ❑ ' El
® WC STATU- ❑ O
;ANVPROPRIBER/EXECUTNE
TORV LIMITS; ERR
---
---- -----
:OFFICE/MEMBER EREXCLUDED? YIN i I
Workers CompenZfion Policy'. Policy ellecYhre and expiration date.
!(Mandatoryin NH) N
E.L. EACHACCIDENT -
$100,000
Number
It yes. describe under
E.L.DISEASE EA EMPLOYEE
$100,000
DESCRIPTION OF OPERATIONS below
-
E.L. DISEASE -POLICY LIMIT
' $ 500,000
El F-1
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required)
Additional Insureds per attached endorsements.
Certificates of Insurance acceptable to the City of Oshkosh shall be submitted prior to commencement of
the work to the applicable
City
department. These certificates shall contain a provision that coverage afforded under the policies will not
be canceled or non renewed until at
least 30 days' prior written notice has been given to the City Clerk — City of Oshkosh.
City of Oshkosh, Attn: City Clerk
Insurance Standard V
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
215 Church Avenue
SAMPLE CERTIFICATE
THE EXPIRATION DATE, THEREOF, NOTICE WILL BE DELIVERED IN
PO Box 1130
Please indicate somewhere on this
ACCORDANCE WITH THE POLICY PROVISIONS.
Oshkosh, WI 54903.1130
certificate, the contract or project #
AUTHOR¢EO REPRESENTATIVE
this certificate is for.
W IVtHi-ZU1U ACOH.D CORPORATION. All rights reserved.
ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD
POLICY NUMBERT___P_-/_y_#___11 COMMERCIAL GENERAL LIABILITY
CG 20 10 07 04
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
ADDITIONAL INSURED - OWNERS, LESSEES OR
CONTRACTORS - SCHEDULED PERSON OR
ORGANIZATION
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
SCHEDULE
Name Of Additional Insured Person(s)
Or Or anization s : Locations Of Covered Operations
As required by contract Any and all job sites
Information required to complete this Schedule, if not shown above, will be shown in the Declarations.
A. Section 11 — Who Is An Insured is amended to
include as an additional insured the person(s) or
organization(s) shown in the Schedule, but only
with respect to liability for "bodily injury", "property
damage" or "personal and advertising injury"
caused, in whole or in part, by:
1. Your acts or omissions; or
2. The acts or omissions of those acting on your
behalf;
In the performance of your ongoing operations for
the additional insured(s) at the location(s) design-
nated above.
Insurance Standard V
SAMPLE CERTIFICATE
Please indicate somewhere on this
certificate, the contract or project #
this certificate is for.
B. With respect to the insurance afforded to these
additional insureds, the following additional exclu-
sions apply:
This insurance does not apply to "bodily injury" or
"property damage" occurring after:
1. All work, including materials, parts or equip-
ment furnished in connection with such work,
on the project (other than service, maintenance
or repairs) to be performed by or on behalf of
the additional insured(s) at the location of the
covered operations has been completed; or
2. That portion of "your work" out of which the
injury or damage arises has been put to its in-
tended use by any person or organization other
than another contractor or subcontractor en-
gaged in performing operations for a principal
as a part of the same project.
CG 20 10 07 04 0 ISO Properties, Inc., 2004 Page 1 of 1 ❑
POI ICY NUMBER: r° °y# COMMERCIAL GENERAL LIABILITY
CG 20 37 07 04
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
ADDITIONAL INSURED - OWNERS, LESSEES OR
CONTRACTORS - COMPLETED OPERATIONS
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
SCHEDULE
Name Of Additional Insured Person(s)
Or Or anization s : Location And Description Of Completed Operations
As required by contract Any and all job sites
Information required to complete this Schedule, if not shown above, will be shown in the Declarations.
Section II — Who Is An Insured is amended to
include as an additional insured the person(s) or
organization(s) shown in the Schedule, but only with
respect to liability for "bodily injury", "property dam-
age" caused, in whole or in part, by "your work" at
the location designated and described in the sched-
ule of this endorsement performed for that additional
insured and included in the "products -completed
operations hazard".
Insurance Standard V
SAMPLE CERTIFICATE
Please indicate somewhere on this
certificate, the contract or project #
this certificate is for.
CG 20 37 07 04 0 ISO Properties, Inc., 2004 Page 1 of 1 ❑
JEFF FOUST EXCAVATING, INC.
2824 CLAIRVILLE ROAD RECEIVED
OSHKOSH, WISCONSIN 54904
� 9 (926) 426-5808 OCT 2.9 2019
FAX: (920) 426-4000 DEPT OF PUBLIC WORKS
OSHKOSH, WISCONSIN
PROPOSAL
FOR
SIDEWALK SNOW AND ICE REMOVAL CONTRACT
We, the undersigned, propose to carry out the assigned sidewalk snow and ice removal
projects, in accordance with the Specifications, from November 18, 2019 — May 31, 2020 for the
following rates.
Rates shall include all cost of labor, materials (rock salt, sand, internet access, photo
disks, etc.), use of equipment, and any incidentals required to complete the work as specified,
regardless of the number of personnel engaged in shoveling by hand or clearing with
equipment.
1. Remove all snow and/or ice at a single location/lot with
0 to 100 feet of sidewalk (including rock salt/sand s75,00
application, if necessary) Lump Sum
2. Additional footage beyond 100 feet at same location/lot $ • / ,
(including rock salt/sand application if necessary) Per Linear Foot
3. Apply rock salt/sand only to 0 to 100 feet of sidewalk at $ 1.
a single location/lot Lump Sum
4. Apply rock salt/sand only to additional footage beyond $ I U5-
100 feet at same location/lot Per Linear Foot
5. Remove all snow and/or ice from all pavement in the
handicap ramp/crosswalk quadrant (including rock $/ V OV
salt/sand application if necessary) Per Intersection Quadrant
6. Remove and dispose of snow from locations where
unusual conditions have occurred:
a. Mobilization/demobilization from site
b. Load snow
c. Haul snow
$ / 00, 0
Each
$ /00, 06
Equipment(Laborr Rate Per Hour
$ i0o. 0%
Equipment/Labor Rate Per Hour
1\a°gfmmn&XSNOW SHOVE GPOLDERS\Snow R=mo con=m\2019\Requ for
Quouaons_1an-19.aorx Page I of 1
FOUST-1
CERTIFICATE OF LIABILITY INSURANCE
DATE(MMIDDIYYYY)
03/1712016
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed.
If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on
this certificate does not confer rights to the certificate holder In lieu of such endorsement s .
PRODUCER 920-233-4000
McCione- Oshkosh RECEI
505 North Westfield Street
Oshkosh, WI 549024105 1
Brian MOClone NOV 3
1
coNr^CT Brian McCione
FAX 920-725-3233
.N .920-233-4000 uc, xo:
E-MAIL rlan.mee one cc one.com
INSURER S AFFORDING COVERAGE
NAIC•
INS RERA:Wesl Bend Mutual Insurance Co.
15350
INSURED.JeffFoust Excavating Inc. DEPT OF PUBLI
2824 Clairville Rd.
Oshkosh, W154904 OSHKOSH, WI
a `
INSURER
INSURER E:
INSURER F:
ON NUMBER•
COVERAGES CERTIFICATE NUMBER: REVISI
o r=nP THE POI N:Y PFRIOD
THIS
INDICATED.
CERTIFICATE
EXCLUSIONS
INSR
IS TO CERTIFY THAT THE POLICIES
NOTMTHSTANOING ANY REQUIREMENT,
MAY BE ISSUED OR MAY PERTAIN,
AND CONDITIONS OF SUCH POLICIES.
TYPE OF INSURANCE
OF INSURANCE
DOL
THE
LIMITS
USR
LISTED BELOW HAVE BEEN
TERM OR CONDITION OF ANY
INSURANCE AFFORDED BY THE
SHOWN MAY HAVE BEEN REFDUUCLEDFBY
POLICY NUMBER
ISSUEU lu
CONTRACT
POLICIES
PAID
04/0112019
Ime maUrccu'w"�
OR OTHER DOCUMENT
DESCRIBED
CLAIMS
LICY S.
04/01/2020
..,. • - • .- ----
WITH RESPEC T TO WHICH THIS
HEREIN IS SUBJECT TO ALL THE TERMS,
DMRS
1,000,000
EACH OCCURRENEDAMAGE
MERCIALGENERAL LJAaILRY
CIAIMSAIADE OCCUR
X
19383
TO RENTED 300,000
1 S .cm,renr t 5,000MEDEXP An aye elson
7AX
1,000,000
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DESCRIPTION OF OPE nONS I LOCATIONS 1 VEHICLES (ACONG 1a1, AddNlonel Remarks Schadule, may M a 0"d a more space Is requimd)
City of Oshkosh, its officers, council members, agents, employees and
Additional Insured on a Primary and Non
authorized volunteers are
Contributory Basis with respects to General Liability including Ongoing and
Completed Operations when required by written contract and Additional
Insured with respect to Auto Liability on a Primary & Noncontributory (cent)
OSHCI-1
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE NCON DATE THE PO HE OF, NOTICE WILL BE DELIVERED IN
ACCORDANCE
City of Oshkosh
Attn: City Clerk AUTHORIZED REPRESENTATIVE
215 Church Avenue
PO Box 1130
Oshkosh, WI 549034130
(01988-2015 ACORD CORPORATION. All rights reserved.
25 (2016103)
The ACORO name ana logo are reyras.1 �.. U.--..•