HomeMy WebLinkAboutNorthern Divers USAi `ram/
AGREEMENT
This AGREEMENT, made on the vAay of 2020, by and
between the CITY OF OSHKOSH, party of the first part, hereinafter referred to as CITY,
and NORTHERN DIVERS USA, 10404 Fox Bluff Lane, Spring Grove, IL 60081, party of the
second part, hereinafter referred to as the CONSULTANT,
WITNESSETH:
The CITY and the CONSULTANT, for the consideration hereinafter named, enter
into the following AGREEMENT for REPAIRS OF LEAKING WATER MAIN RIVER
CROSSING.
ARTICLE I. PROTECT MANAGER
A. Assignment of Project Manager. The CONSULTANT shall assign the following
individual to manage the PROJECT described in this AGREEMENT:
Frank Frosolone — President
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 AGREEMENT:
Steven M. Gohde, P.E. — Assistant Director of Public Works /
Utilities General Manager
ARTICLE III. SCOPE OF WORK
The CONSULTANT shall provide the services described in the E-mail dated
February 20, 2020. The CITY may make or approve changes within the general Scope of
Services in this AGREEMENT. If such changes affect CONSULTANT's cost of or time
required for performance of the services, an equitable adjustment will be made through an
amendment to this AGREEMENT.
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RECEIVE 67
MAR 2 3 2020
CITY CLERK'S OFFICE
All reports, drawings, specifications, computer files, field data, notes, and other
documents and instruments prepared by the CONSULTANT as instruments of service shall
become property of the CITY upon payment for those documents by the CITY to the
CONSULTANT, and shall remain the property of the CITY.
ARTICLE IV. STANDARD OF CARE
The standard of care applicable to CONSULTANT's services will be the degree of
skill and diligence normally employed by professional consultants or consultants
performing the same or similar services at the time said services are performed.
CONSULTANT will re -perform any services not meeting this standard without additional
compensation.
ARTICLE V. OPINIONS OF COST FINANCIAL CONSIDERATIONS, AND SCHEDULES
In providing opinions of cost, financial analyses, economic feasibility projections,
and schedules for the PROJECT, CONSULTANT has no control over cost or price of labor
and materials; unknown or latent conditions of existing equipment or structures that may
affect operation or maintenance costs; competitive bidding procedures and market
conditions; time or quality of performance by operating personnel or third parties; and
other economic and operational factors that may materially affect the ultimate project cost
or schedule. Therefore, it is understood between the parties the CONSULTANT makes no
warranty the CITY's actual project costs, financial aspects, economic feasibility, or schedules
will not vary from CONSULTANT's opinions, analyses, projections, or estimates.
ARTICLE VI: RECORD DRAWINGS
Record drawings, if required, will be prepared, in part, on the basis of information
compiled and furnished by others. CONSULTANT is not responsible for any errors or
omissions in the information from others the CONSULTANT reasonably relied upon and
are incorporated into the record drawings.
ARTICLE VH. CITY RESPONSIBILITIES
The Cm shall furnish, at the CONSULTANT's request, such information as is
needed by the CONSULTANT to aid in the progress of the PROJECT, providing it is
reasonably obtainable from City records.
To prevent any unreasonable delay in the CONSULTANT'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.
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ARTICLE VIII. ASBESTOS OR HAZARDOUS SUBSTANCES
If asbestos or hazardous substances in any form are encountered or suspected,
CONSULTANT will stop its own work in the affected portions of the PROJECT to permit
testing and evaluation.
If asbestos is suspected, CONSULTANT will, if requested, manage the asbestos
remediation activities using a qualified subcontractor at an additional fee and contract
terms to be negotiated.
If hazardous substances other than asbestos are suspected, CONSULTANT will, if
requested, conduct tests to determine the extent of the problem and will perform the
necessary studies and recommend the necessary remedial measures at an additional fee and
contract terms to be negotiated.
The CITY recognizes CONSULTANT assumes no risk and/or liability for a waste or
hazardous waste site originated by other than the CONSULTANT.
ARTICLE IX. CITY'S INSURANCE
The CITY will maintain property insurance on all pre-existing physical facilities
associated in any way with the PROJECT.
The CITY will provide (or have the construction contractor(s) provide) a Builders
Risk All Risk insurance policy for the full replacement value of all project work including
the value of all onsite CITY -furnished equipment and/or materials associated with
CONSULTANT's services. Upon request, the CITY will provide CONSULTANT a copy of
such policy.
ARTICLE X. TIME OF COMPLETION
The work to be performed under this AGREEMENT shall be commenced and the
work completed within the time limits as agreed upon in the E-Mail dated February 20,
2020.
The CONSULTANT shall perform the services under this AGREEMENT with
reasonable diligence and expediency consistent with sound professional practices. The
CITY agrees the CONSULTANT is not responsible for damages arising directly or
indirectly from any delays for causes beyond the CONSULTANT's control. For the
purposes of this AGREEMENT, such causes include, but are not limited to, strikes or other
labor disputes, severe weather disruptions or other natural disasters, failure of performance
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by the CITY, or discovery of any hazardous substances or differing site conditions. If the
delays resulting from any such causes increase the time required by the CONSULTANT to
perform its services in an orderly and efficient manner, the CONSULTANT shall be entitled
to an equitable adjustment in schedule.
ARTICLE XI. COMPONENT PARTS OF THE AGREEMENT
This AGREEMENT consists of the following component parts, all of which are as
fully a part of this AGREEMENT as if herein set out verbatim, or if not attached, as if hereto
attached:
1. This Instrument
2. CONSULTANT's E-Mail dated February 20, 2020 and attached hereto
In the event any provision in any of the above component parts of this
AGREEMENT conflicts with any provision in any other of the component parts, the
provision in the component part first enumerated above shall govern over any other
component part which follows it numerically except as may be otherwise specifically
stated.
ARTICLE XII. PAYMENT
A. The Agreement Sum. The CITY shall pay to the CONSULTANT for the
performance of the AGREEMENT the total sum as set forth below, adjusted by any changes
hereafter mutually agreed upon in writing by the parties hereto:
• Unit Price Not to Exceed $17,500 (Seventeen Thousand Five Hundred
Dollars).
• Attached fee schedule shall be firm for the duration of this AGREEMENT.
B. Method of Payment. The CONSULTANT shall submit itemized monthly
statements for services. The CITY shall pay the CONSULTANT within thirty (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 CONSULTANT 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 AGREEMENT executed by both parties prior to
proceeding with the work covered under the subject amendment.
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D. Indirect Costs. Indirect costs such as computer time, printing, copying, cell
phone charges, telephone charges, and equipment rental shall be considered overhead and
shall not be invoiced separately to the PROJECT.
E. Expenses. Expenses may be billed with up to a maximum of 10%D mark-up.
All invoices with expenses shall include supporting documentation of the expense. Failure
to include the supporting documentation will result in the reduction of payments by the
amount of those expense(s) not including documentation.
ARTICLE XIH. STANDARD PROVISIONS
The CONSULTANT agrees that, in all hiring or employment made possible by or
resulting from this AGREEMENT, there will not be any discr*nination against any
employee or applicant for employment because of race, color, religion, sex, sexual
orientation, gender identity, or national origin.
ARTICLE XIV. HOLD HARMLESS
The CONSULTANT covenants and agrees to protect and hold the City of Oshkosh
harmless against all actions, claims, and demands to the proportionate extent caused by or
resulting from the intentionally wrongful or negligent acts of the CONSULTANT, his/her
agents or assigns, his/her employees, or his/her subcontractors related to the performance
of this AGREEMENT or be caused or result from any violation of any law or administrative
regulation, and shall indemnify the CITY for all sums including court costs, attorney fees,
and damages of any kind which the CITY may be obliged or adjudged to pay on any such
claims or demands upon the CITY's written demand for indemnification or refund for those
actions, claim, and demands caused by or resulting from intentional or negligent acts as
specified in this paragraph.
Subject to any limitations contained in Sec. 893.80 and any similar statute of the
Wisconsin Statutes, the CITY further agrees to hold CONSULTANT harmless from any and
all liability, including claims, demands, losses, costs, damages, and expenses of every kind
and description (including death), or damages to person or property arising out of re -use of
the documents without consent where such liability is founded upon or grows out of the
acts or omission of any of the officers, employees or agents of the City of Oshkosh while
acting within the scope of their employment.
ARTICLE XV. INSURANCE
The CONSULTANT agrees to abide by the attached City of Oshkosh Insurance
Requirements.
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ARTICLE XVI. TERMINATION
A. For Cause. If the CONSULTANT shall fail to fulfill in timely and proper
manner any of the obligations under this AGREEMENT, the CITY shall have the right to
terminate this AGREEMENT by written notice to the CONSULTANT. In this event, the
CONSULTANT shall be entitled to compensation for any satisfactory, usable work
completed.
B. For Convenience. The CITY may terminate this AGREEMENT at any time by
giving written notice to the CONSULTANT no later than ten (10) calendar days before the
termination date. If the CITY terminates under this paragraph, then the CONSULTANT
shall be entitled to compensation for any satisfactory work performed to the date of
termination.
This document and any specified attachments contain all terms and conditions of the
AGREEMENT and any alteration thereto shall be invalid unless made in writing, signed by
both parties and incorporated as an amendment to this AGREEMENT.
ARTICLE XVIL RE -USE OF PROTECT DOCUMENTS
All reports, drawings, specifications, documents, and other deliverables of
CONSULTANT, whether in hard copy or in electronic form, are instnunents of service for
this PROJECT, whether the PROJECT is completed or not. The CITY agrees to indemnify
CONSULTANT and CONSULTANT's officers, employees, subcontractors, and affiliated
corporations from all claims, damages, losses, and costs, including, but not limited to,
litigation expenses and attorney's fees arising out of or related to the unauthorized re -use,
change, or alteration of these project documents.
ARTICLE XVIIISUSPENSION. DELAY, OR INTERRUPTION OF WORK
The CITY may suspend, delay, or interrupt the services of CONSULTANT for the
convenience of the CITY. hi such event, CONSULTANT's contract price and schedule shall
be equitably adjusted.
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ARTICLE XIV. NO THIRD -PARTY BENEFICIARIES
This AGREEMENT gives no rights or benefits to anyone other than the CITY and
CONSULTANT and has no third -party beneficiaries.
In the Presence of:
kfilD 1 Q
is So _
(Seal of CONSULTANT
if a Corporation)
c
(Witness)
(Witness)
APPROVED:
i
i Attorney
CONCTU T A urr
O
Un
(Specify Title)
(Specify Title)
CITY OF OSHKOSH
By:�'—��C
Mark A. Rohloff, City Manager
And: /
' er_ k n
I(• J . ��`�.�tca.Q , 1'1'o_I1�,lD1.h
I hereby certify that the necessary provisions
have been made to pay the liability which
will accrue under this AGREEMENT.
ZfL 47�
City Comptroller
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Repairs 2-21.20.docx
Taylor, Tracy L
From: Lemke, Ryan
Sent: Thursday, February 20, 2020 1.46 PM
To: Taylor, Tracy L
Subject: FW: FW. City of Oshkosh water break on a river crossing
Attachments: image001 jpg
Tracy,
Please see Franks response below.
Thanks you,
Ryan C. Lemke
Assistant Water Distribution Manager
City of Oshkosh
Office: 920.232.5332 Cell: 920.379.1724
Follow us: Web I Facebook I Twitter
Citcyif
Oshkosh
From: Frank [mailto:frank@ndiversusa.com]
Sent: Thursday, February 20, 2020 1:41 PM
To: Lemke, Ryan <RLemke@ci.oshkosh.wi.us>
Subject: Re: FW: City of Oshkosh water break on a river crossing
Yes good starting point for sure, hopefully we can get in and out.
Thank You
Frank Frosolone
Northern Divers USA
Www.ndiversusa.com
847-293-8465
On Thu, Feb 20, 2020, 2:34 PM Lemke, Ryan <RLemkeaci.oshkosh.wi.us> wrote:
Frank,
Please see the email below. We need conformation from you that this looks "acceptable" as a starting point for the
river crossing repair in the City of Oshkosh. Please respond to this email and we can get a professional service
agreement started.
Thank you,
Ryan C. Lemke
Assistant Water Distribution Manager
City of Oshkosh
Office: 920.232.5332 Cell: 920.379.1724
Follow us: Web I Facebook I Twitter
E
From: Gohde, Steven M.
Sent: Wednesday, February 19, 20201:20 PM
To: Taylor, Tracy L <TTaVlor@ci.oshkosh.wi.us>
Cc: Rabe, James E. <Irabe@ci.oshkosh.wi.us>; Lemke, Ryan <RLemke_@ci.oshkosh.wi.us>; Brand, Stephan
<sbrandCa)ci.oshkosh.wi.us>; Johnson, Bob <BJohnson@ci.oshkosh.wi.us>
Subject: FW: City of Oshkosh water break on a river crossing
Tracy,
Please put together a professional services agreement for Northern Divers for an amount not to exceed
$17,500, based on the following and attached.
Assume 2 days @$7,1000 per day
Assume 4 overnights @ $225 each
Assume $2,400 for travel mileage
This is an urgent project to fix a leaking water main.
Thanks,
Steve
Steven M. Gohde, P.E.
Asst. Director Public Works/Utihties General Manager, Department of Public Works
City of Oshkosh
920.236.5065
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0
From: Lemke, Ryan
Sent: Monday, February 17, 2020 2:26 PM
To: Gohde, Steven M. <saohdeCdci.oshkosh.wi.us>
Cc: Rabe, James E. <irabeCdci.oshkosh.wi.us>; Johnson, Bob <BJohnsonCdci.oshkosh.wi.us>; Brand, Stephan
<sbrand ci.oshkosh.wi.us>; Gierach, Justin <jgierach(aci.oshkosh.wi.us>
Subject: FW: City of Oshkosh water break on a river crossing
Steve,
I spoke with Frank from Northern Divers USA this afternoon on the phone. He sent along an updated pricing
sheet. They are currently on their way down to Florida this week. Weather depending they would be available next
week or the week after. His best guess is if the pipe is "laying on the bottom" and covered with 1'-2' of dirt/silt they
would like to be in and out in an 8 hour day. If It's deeper or requires additional attention the time frame would
lengthen from there. It is very tough to put a definite time frame on a project like this. On the price sheet he would
keep this to the 1 diver team for the $7100.00 per day, and travel costs. If they would have to stay overnight it would
be an additional $225.00 per person (4 man team). Let me know if there is additional information he needs to provide
us so we can continue moving forward with this project.
Thank you,
Ryan C. Lemke
Assistant Water Distribution Manager
City of Oshkosh
Office: 920.232.5332 Cell: 920.379.1724
Follow us: Web I Facebook I Twitter
From: Frank (mailto7frank2ndiversusa.coml
Sent: Monday, February 17, 202012:01 PM
To: Lemke, Ryan <RLemkeCdci.oshkosh.wi.us>; Inni Frosolone <konrundiversusa.com>
Subject: Re: City of Oshkosh water break on a river crossing
Ryan good to speak with you again today, here is our cost sheet for 2020.
We will be using a 4 man crew for the equipment we will be needing.
Thank You
Frank Frosolone
Northern Divers USA
10404 Fox Bluff Ln.
Spring Grove, IL 60081
Frank( a �.ndiversusa.com
847-293-8465
www.ndiversusa.com
On Mon, Feb 17, 2020 at 11:50 AM Lemke, Ryan <RLemkena ci osbkosh.wi.us> wrote:
Good Morning Frank,
I gave you a call last week about a water main break on one of our river crossing. We are going to proceed
with making repairs on the crossing. Before we can proceed I will need a scope of work, cost breakdown and
your best idea of a time frame we are looking at from start to finish. You can email me this information
directly. If you have any other questions or would like more information on the situation please call me on
my cell phone listed below.
Thank you,
Ryan C. Lemke
Assistant Water Distribution Manager
City of Oshkosh
Office: 920.232.5332 Cell: 920.379.1724
Follow us: Web I Facebook I Twitter
0
tANORTHERN DIVERS
u
COMMERCIAL I MUNICIPAL i INOUSTRIAL
10404 Fox Bluff Ln, Spring Grove, IL. 60081
PHONE: (847) 293.8467/ EMAIL: Frank@ndiversusa.com
WEB: www.ndiversusa.com
DIVE PRICING
As Of 01101/2020
MONDAY - FRIDAY 8 HR DAY
$7100.00 PER DAY —1 DIVER TEAM
$8200.00 PER DAY — 2 DIVER TEAM
SATURDAYS
$10,640.00 PER DAY —1 DIVER TEAM
$11,640.00 PER DAY — 2 DIVER TEAM
REOEnsD
DEPT F 192020
PUBLIC
OSIjKOgyINONS
AFTER 8 IRS
ADDIT. $1330.00 PER HR-1 DIVER TEAM
ADDIT. $2360.00PER HR-2DIVER TEAM
SUNDAYS - DBL TDIE
CALL FOR QUOTE
CONTANIINATION DIVES - CALL FOR QUOTE
• ALL DIVE TEAMS - SINGLE DIVER, 4 MAN CREW, INCLUDING OPERATOR, AND M.O.B.
• IF REQUESTED — TWO DIVER TEAM, 5 MAN CREW INCLUDES M.O.B.
• LARGER CREW — CALL FOR QUOTE
• IVERS CONTROL
ANY DIVE DAY SHORTENED BY WEATHER OR REASONS BEYOND NORTHERN D
WILL BE BILLED AT FULL DAY RATE.
TRAVEL
OUTSIDE OF A 25 MILE RADIUS OF SPRING GROVE ILLINOIS $225 00 PER MILE PER
PER DAY
OVERNIGHT STAY
R.O.V. INSPECTIONS
$6,500.00 PER DAY ADDED TO CREW RATES.
$5,500.00 PER DAY FOR MULTIPLE DAYS (OVER 1 DAY).
UP TO 2500' IN ANY ONE DIRECTION.
MATERIALS AS REQUIRED
WELDING RODS
CUTTING RODS
OXYGEN BOTTLES 300 QF.
DRY GLOVES
PRESSURE WASHER
PUMPS (2" TO 24")
DIVE BOAT
60' CRANE BARGE & TUG
TRUCK CRANE UP TO 4 TON
$3.00 EA
$ 4.50 EA
$165.00 EA
$ 75.00 PR
$175.00 EA, PER DAY
$175.00 - $2,000.00 EA, PER DAY
$550.00 PER DAY
$18,500.00 PER DAY
$1500.00 PER JOB WEEK.
ALL OTHER MATERIALS AND SERVICES REQUIRED WILL BE BILLED ACCORDINGLY. THESE ITEMS AND
SERVICES MAY BE OBTAINED BY CUSTOMER BUT MUST BE APPROVED BY NORTHERN DIVERS FOR
QUALIFICATION AWARENESS
OATE(MMIDOfA'YY)
AC R ® CERTIFICATE OF LIABILITY INSURANCE 03/03/2020
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. 1 1 ns or be endorsed
IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the poll y(les) must nave ADDITIONAL INSURED prov s o -
If SUBROGATION IS WAIVFDsubject to the terms and conditions of the policy, certain policies may require an endorsement A statement on
this certificate does not co�fei_Hghts o e holder idlleu of such endorsement(s).
PRODUCER - - NAME: Jaml Mared
PHONE (781)295-0270 A/C, No: (781)248-7830
International Special Risks — Alc No Ext
50 Salem Street MAR - 4 2020 AnA as: jrnafadl�lsr-Insurance.CDm
eUllding B, 3rd FIDOf INSURERISI AFFORDING COVERAGE NAIDp
Lynntield rtF OF PUBLIC WO 1940 INSURERA: Great American insurance Company
16691
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Northern Divers USA Inc.
10404 Fox Bluff Lane
Spring Grove IL 60081-8052 InSURER F:
oCv1CInM NIIMRE2
COVERAGES
CERTIFICATE
NUMBER:
TO THE INSURED
..__----
NAMED ABOVE
FOR THE POLICY PERIOD
THIS
IS TO CERTIFY THAT THE POLICIES OF it
USTED BELOW HAVE BEEN ISSUED
OR OTHER
DOCUMENT
WITH RESPECT TO WHICH THIS
INDICATED.
NOTWITHSTANDING ANY REQUIREMENT,
TERM
OR CONDITION OF ANY CONTRACT
THE POLICIES
DESCRIBED
HEREIN IS SUBJECT
TO ALL THE TERMS,
CERTIFICATE
MAYBE ISSUED OR MAY PERTAIN,
THE
INSURANCE
AFFORDED BY
EXCLUSIONS
AND CONDITIONS OF SUCH POLICIES.
LIMITS
SHOWN MAY HAVE BEEN REDUCED
BY PAID CLAIMS.
TYPE OF INSURANCE IN6D
WVO
POLICY NUMBER
MNIDUNM
MMIDOIYYYY
LIMITSIL.�
PACHOCE
i 1,000,000
x
COMMERCIALGENERALLIABILITY
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PREMISEESS Ea....
S 100,000
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§ 5,000
CLAIMS -MADE OCCUR
PERSONAL SAW INJURY
E 1,000,000
Y
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OMH 109AI-19
03/26/2019
03126/2020
GENERAL AGGREGATE
2,000,000
i
A
GEML AGGREGATE LIMIT APPLIES PER:
PRODUCTS -COMP/OP AGG
g 1,000.000
$
POLICY � J COT LOC
OTHER:
AUTOMOBREUABIUTY
BIN SI LEUNUT
Ea acddenl
BODILY INJURY (Per parson)
§ 1.000.000
§
ANY AUTO
OWNED x SCHEDULED
Y
Y
CAP265-51-19
04119/2019
03/26@020
BODILY INJURY (Per ecddan0
E
ROPERTY DANA
Perauident
§
A
AUTOSONLY AUTOS
HIRED x NON -OWNED
$
x AUTOS ONLY AUTOS ONLY
UMSRELLAUAB x OCCUR
Y
Y
ML201900001265
0312812019
03/26/2020
EACHOCCURRENCE
E 21000,000
AGGREGATE
S 2,000,000
S
B
x EXCESS LIAR CWM6-MADE
DED RETENTION S
x STAME ER
WORKERS COMPENSATION
E.L. EACH ACCIDENT
$ 1,000,000
AND EMPLOYERS' LIABILITY YIN
ANY FROPRIETOR/PARTNEMEXEOJTIVE ❑
NIA
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VVG425706204
03126/2019
03/28/2020
EA- DISEASE- EA EMPLOYEE
$ 1,000,000
C
OFFICERINEMSER EXCLUDED?
E.L. DISEASE-POUCY LIMIT
E 1,000,000
(Mandatary in NH)
If yes, descree under
DESCRIPTION OF OPERATIONS N.Iow
United Slates Longshore&Harbors Act
Y
ALMA01375-05
03/26/2019
03126/2020
EL Each Accident
EL Disease - Ea Empl
$1,000,000
$1,000,000
E
coverage(USL&H)
EL Disease- Policy LIMA
$1,000,000
DESCRIPTION OF OPERATIONS 1 LOCATIONS VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attacked it users, ... la.Wlmd)
Coverage, Policy #: B180520-035-19. 3/2612019 - 312612020, Llmlt $1,000,000 any one accident)
(D: Maritime Employer§ Liability
except 10 days for nonpayment of premium. Certificele Holder is an Additional Insured on a Primary &
30 day notice of cancellation
Non-Conldbutory basis with Waiver of Subrogation in their favor as respects GL coverage as their Interests may appear Subject to the terms,
by contract At, P&NC & WOS as respects GL included
conditions, exclusions and endorsements set forth in the policy and as required written
Fallow Form. WOS Included on the WC, USL&H & MEL coverage as required by written contract & where
on the Auto coverage. Excess coverage is
allowed by law. '
City of Oshkosh, Attn: City Clerk
215 Church Avenue
PO Box 1130
Oshkosh
WI 549D3-1130
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
rn 401111.211115 ACORD CORPORATION. All rights
ACORD 25 (2016403) The ACORD name and logo are registered marks of ACORD