Loading...
HomeMy WebLinkAboutAgreement: Installation of ground monitoring wells at East Cluster and Grand Street 2016 AGREEMENT This agreement is between The Sigma Group, Inc., 1300 W. Canal Street, Milwaukee, Wisconsin, 53233, Housing Authority of the City of Oshkosh, 600 Merritt Avenue, Oshkosh, Wisconsin 54901, and the City of Oshkosh, 215 Church Avenue, Oshkosh, Wisconsin 54901. Each party agrees that good and sufficient consideration as described or referenced in this document has been given to, and received from the other as part of this agreement. The City of Oshkosh, through Common Council Resolution 17-475, which was passed on September 26, 2017, has granted to The Sigma Group, Inc. and Housing Authority of the City of Oshkosh a privilege within the City's right-of-way for the following purpose: Installation of ground monitoring wells at East Custer Avenue and Grand Street. Wisconsin state law provides that by its acceptance of this privilege the undersigned shall become primarily responsible for damages to person or property by reason of the granting of the privilege, The Sigma Group, Inc. and Housing Authority of the City of Oshkosh, by virtue of its signature below, specifically affirms that it understands the extent of its responsibility and liabilities and accepts all such legal obligations. Subject to Section 66.0425 of the Wisconsin Statutes and the terms and conditions listed below, the City grants permission to The Sigma Group, Inc. and Housing Authority of the City of Oshkosh ("Grantee") to place an obstruction within the public right-of-way consisting of soil vapor monitoring wells ("the facilities") as generally described in Exhibit A (Application for Privilege). Other terms and conditions are identified in Exhibit B (Resolution 17-475 approved September 26, 2017) to this Agreement. Exhibits A and B are attached hereto and are incorporated into this Agreement by reference as if fully set forth herein. 1. The City's grant of the privilege in street is contingent upon the initial, and continuing, compliance with all applicable local, state, and federal codes and rules. 2. Grantee's facilities shall be installed in a manner that is approved by the Department of Public Works. Any modifications or changes to the installation or construction procedures shall not be permitted without prior approval of the Department of Public Works. 3. Grantee's facilities shall be properly abandoned and removed in a manner approved by the Department of Public Works when no longer needed. 4. Grantee shall notify and properly document its facilities with the Digger's Hotline System. 5. Grantee's facilities shall be removed upon 10 days written notice from the City requiring removal. 6. Grantee agrees that it is solely responsible for all of its activities under this agreement, including but not limited to, the installation and maintenance of its facilities and any action or inaction of Grantee, its employees, contractors, and agents pertaining thereto, and that it is solely responsible for any and all personal or property damage caused by any of its activities done under the terms of this agreement and grant of privilege. 7. Grantee acknowledges and agrees that public utilities and facilities, and the street and sidewalk, in the right-of-way are subject to maintenance, repair or replacement. In the event that maintenance, repair, or replacement of public utilities or facilities in the right-of-way will need to occur, the City agrees to make reasonable efforts to notify Grantee of these activities so that Owner may remove or otherwise protect its facilities if affected. Grantee shall be responsible for all costs pertaining to the protection or removal of its facilities, including any costs incurred by the City of Oshkosh to protect or remove its facilities and Grantee shall reimburse City of Oshkosh for any such costs within 30 days after written request for such reimbursement. 8. Grantee releases the City of Oshkosh, its employees, agents, elected officials, and authorized volunteers from all debt, claims, demands, damages, actions and causes of action whatsoever which may result from Grantee's actions or inactions related to the granting of this privilege. Owner shall protect and hold the City of Oshkosh harmless against all actions, claims and demands of any kind or character whatsoever which are related to the granting or use of this privilege. 9. Both parties understand and agree that accidents and incidents occurring on City rights-of-way may result in lawsuits or threats of lawsuits against the City. Therefore, Grantee agrees to indemnify and pay to the City all amounts that the City may be required, obligated, or adjudged as responsible to pay, for any dispute or action related to Grantee's installation of facilities within the City rights-of-way under this privilege. This indemnification is broad, and shall include damages, attorney's fees and costs, and defense costs, The payments required of Owner by this paragraph are due no later than 30 days after written request for such indemnification. Owner agrees that this paragraph shall be liberally construed in favor of the City of Oshkosh, in consideration of the privilege granted by the City under this Agreement. 10. At all times during which Grantee is performing work or has facilities within the right-of-way under this privilege, Grantee shall provide liability insurance which shall cover all potential liabilities related to the privilege granted hereunder. Grantee's insurance shall provide reasonable coverage for potential damages to persons and property cause wholly, or in part, by Grantee's actions or inaction or related in any way to the installation of Grantee's facilities within the right-of way under this privilege. Minimum insurance coverage shall be $200,000 for each occurrence for bodily injury and property damage liability and $500,000 general aggregate. Grantee shall include the City of Oshkosh as an additional insured on its policy for claims, liabilities, and damages pertaining to this privilege. Grantee shall annually provide the City with proof of continued insurance as required under this Agreement. 11, The City's permission is personal to Grantee and cannot be transferred or assigned to any other person or entity, whether voluntarily or involuntarily except as may be identified or described in this Agreement. 12. Grantee's responsibilities pursuant to this Agreement extend to its employee, contractors, agents and any other persons performing work on Grantee's behalf. 13. The election to enforce or not enforce any term of this Agreement, or any statute, code, or rule, as well as the timing of such enforcement, shall be at the City's sole discretion and shall not act as a waiver of any rights to exercise any right in the future. 14. This Agreement shall incorporate all immunities and limitations provided to municipalities within the Wisconsin Statutes, regardless of whether a claim is based upon contract, tort, or other theory. 15. This Agreement may be recorded in the Office of the Registrar of Deeds for Winnebago County, Wisconsin solely at the City's discretion. [SIGNATURE PAGE FOLLOWS] Dated this day of 2018. THE SIGMA GROUP INC. By: v e XX i e, STATE OF WISCONSIN ) ) SS WINNEBAGO COUNTY ) Personally came before me this day of M&q 2018,the above-named _Krisfin-Kuf-zk-a of The Sigma Group Inc. to me known to bnuch person(s) and officers who t'!t"ZI executed the foregoing document and acknowledged that they executed the same 4111 officers by its authority, for the purpose therein contained. 1/z f DAVID L. Notary'Public, St e of Wisc nsin CZERNICKI 0. My Commission Axpires: %I-ooff l h OF WIS HOUSING AUTHORITY OF THE CITY OF OSHKOSH By. &NAXA_,AA Susan van Houwelingen, rxecutive Director STATE OF WISCONSIN ) ) SS WINNEBAGO COUNTY ) Personally came before me this day of TQ",e_ 2018,the above-named Susan van Houwelingen of Housing Authority of the City of Oshkosh to me known to be such person(s) and officers who executed the foregoing document and acknowledged that they executed the same as such officers by its authority, for the purpose therein contained. 01A L O/V 1,0,0" 011 N. N 0 w. _Notary%Public, State of Wisconsin O*T A My Commission Expires: 13 OF\N\-" ""#so its I I it CITY OF OSHKOSH By: And: Mark A. Rohloff, City Manager Pamela R. Ubrig, City Clerk STATE OF WISCONSIN ) ) SS. WINNEBAGO COUNTY ) Personally came before me this d(day of 2018,the above-named Mark Rohloff and Pamela Ubrig of the CITY OF O.3HK69H to me known to be such person(s) and officers who executed the foregoing document and acknowledged that they executed the same as such officers by its authority, for the purpose therein contained. Notary Public, State of Wisconsin My Commission Expires: 12-113 26 2,2 L Lorens6n,,"'CitV Attorney I Attachment: Exhibit A: Map of Location Exhibit B: Resolution 17-475 SEPTEMBER 26,2017 17-475 RESOLUTION (CARRIED 7-0 LOST LAID OVER WITHDRAWN PURPOSE: APPROVE GRANTING PRIVILEGE IN STREET FOR GROUNDWATER MONITORING WELLS AT EAST CUSTER AVENUE AND GRAND STREET INITIATED BY: THE SIGMA GROUP,INC./OSHKOSH HOUSING AUTHORITY PLAN COMMISSION RECOMMENDATION: Approved w/conditions WHEREAS, Section 66.0425, Wis. Stats.,provides for the granting of a privilege in a right-of-way; and WHEREAS, the Plan Commission has approved of this request with conditions. NOW, THEREFORE, BE IT RESOLVED by the Common Council of the City of Oshkosh that the proper City officials are hereby authorized and directed to grant The Sigma Group Inc. and its contractors, a privilege in street for installation of monitoring wells at East Custer Avenue and Grand Street, per the attached, with the following conditions: 1. The groundwater monitoring wells be installed in a manner that is approved by the Department of Public Works with no modifications or changes in construction procedure without prior approval by the Department of Public Works. 2. If no longer needed, the groundwater monitoring wells be properly abandoned and removed in accordance with City standards and under the direction of the Department of Public Works. 3. Any problem that may arise as a result of the placement of the groundwater monitoring wells be the responsibility of the petitioner/owner to correct in coordination with the Department of Public Works. 4. All appropriate permits are obtained prior to the start of placement of the groundwater monitoring wells. SEPTEMBER 26, 2017 17-475 RESOLUTION CONT'D 5. The groundwater monitoring wells be modified or removed immediately upon the request of the City. 6. The petitioner/owner secures and submits to the City Clerk a separate insurance policy which names the City of Oshkosh, and its officers, Council members, agents, employees and authorized volunteers as additional insured's with a minimum commercial general liability coverage of $500,000 per occurrence and $500,000 in general aggregate. 7. It is the responsibility of the petitioner/owner to file in a timely manner a new insurance certificate with the City Clerk upon expiration of an existing certificate. Failure to do so will result in the revocation of the privilege in street within ten(10) days of notice. 8. The petitioner/owner execute a hold harmless agreement with the City. 9. The facility is part of and documented with Digger's Hotline system. . . nUBMnTO: ����comrm"�o�emp / (�it� O� [)S���S� m Development ^ uucxmc»me'ro.aou11m � ~of ����A������K ������U^����f^��k� wm��.°x owo/ � /—�h�()�h General Application^^ pxoms �uMo��oa `~~. .-__' . � ! "PLEASE TYPE on PRINT USING BLACK INx° . APPLICANT INFORMATION � Petitioner: Doke: Petitioner's Address: City: ` State:1�/i Zip: 3 3 Telephone#: (914f) Fax: Other Conhzct#or Email: Status uf Petitioner (P| h � 1�� Tenant Px�p��Uv Buyer ~~'~Check): Pah�on�r'�3�no|un� (mqo�a6)�/ Dofc:________ � OWNER INFORMATION l Ownor(s): no/e:________ Owner(s) Address: City: 5kte:____Zip: _____ Telephone#: ( ) Fox ( ) Other Contact # cvEmuU Ownership Status (Please Check): u1ndividual o7mst OPoMneoh!p oCoqpomUun Property Owner Consent:(nequ|ed) + gy signature hereon,VYYm acknowledge that City officials and/or employees may,in the performance of their functions,enter upon the property to inspect or gather other information necessary to process this application. |also understand that all meeting dates are tentative and may be postponed by the Planning Services Division for incomplete Submissions or other administrative reasons. Properly Owner's Signature: _ -_____'Dote:TYPE OF REQUEST: _________ � O Access Control Variance � El Easement � Wrivilege in Street � E]O1hmr8denU4� SITE INFORMATION � Address/Location of Proposed Proposed Project Type: Current Use m[Property: ninQ: LondVsosSunnundingYou/She: North: South: � End: West: � � > Application fees are due at time of submittal.Make check payable hCity of Oshkosh. � r Please refer ho the fee schedule for appropriate fee, FEE|SNON-REFUNDABLE For more information please visit the City'swebui|aot www.ci.oshknsh.wius/Commmniiy_Deve|opmmn|/Monnkng.htm � —~ stoM Date Rec'd - M®SIG Sinrgle Source.Sound Solutions. August 11, 2017 Project Reference #17069 Department of Community Development 215 Church Ave. P.O. Box 1130 Oshkosh, WI 54901 RE: Privilege in Street Application Three Groundwater Monitoring Wells Right of Way — Grand Street and East Custer Avenue Oshkosh, Wisconsin The Sigma, Group, Inc., (Sigma) has prepared this application on behalf of Oshkosh Housing Authority to obtain a Privilege in Street permit to install three groundwater monitoring wells within the right of way near the intersection of Grand Street and East Custer Avenue in Oshkosh, Wisconsin. Sigma has identified subsurface impacts at the former Waite Grass Rug site located at 1402 Mt Vernon Street in Oshkosh, Wisconsin. Further assessment of the degree and extent of these impacts is required by State statute ch. NR 716. Therefore, three groundwater monitoring wells are proposed to the south and southeast of the former Waite Grass Rug site to evaluate off-site groundwater quality. The proposed monitoring well locations are shown on Figure 1. The final locations of the wells will be dependent upon underground utility corridors, accessibility, etc. A summary of the proposed monitoring well locations is as follows: a t a • One monitoring well is proposed within the terrace on the western side of the Grand Street right of way near the northwestern quadrant of the intersection of Grand Street and East Custer Avenue • One monitoring well is proposed within the terrace on the northern side of the East Custer Avenue right of way near the northwestern quadrant of the intersection of Grand Street and East Custer Avenue • One monitoring well is proposed within the terrace on the southern side of the East Custer Avenue right of way near the southwestern quadrant of the intersection of III Grand Street and East Custer Avenue The proposed wells will be installed in accordance with Wisconsin Administrative Code ch. NR 141. Each of the three monitoring wells will be installed using hollow stern auger drilling techniques to an anticipated depth of approximately 15 feet below ground surface (bgs). The monitoring wells will each consist of a 10-foot length of 2-inch diameter PVC well screen connected to approximately 5 feet of 2-inch diameter PVC riser. The wells will each be completed just below ground surface and protected with flush mount covers level with ground surface. When it is determined that the monitoring wells are no longer needed, the wells will be abandoned in accordance with eh. NR 141 and the ground surface restored to the extent practical. s 13i70N/esl Canal StrPv>t I Miiwaul<ae,W153Lr33I 414-643-4200 414-643 4210 1 www.thasi9magroup.com V k Privilege in Street Application August 11, 2017 Page 2 Should you have any questions regarding this application, please feel free to contact us at 414-643-4200, Sincerely, THE SIGMA GROUP, INC. lie Sarah Fernholz, E.I.T. Kristin Kur-ka, P.E. Staff Engineer Senior Engineer cc: Susan van Houwelingen, Oshkosh Housing Authority is\Oshkosh Housing Authority\17069-Waite Crass Rug Site\080 Outgoing Correspondence\ROW Permit Application\17069_Privilege in Street Application Letter.docx lam— _ w 4 _ -._•+ 7r7 5C� e 11��1 e s^y ,�'i L - '�' $•� �>. Y`1' �Imo.. '� t^�"" *'...L'..^ �����'k CP • . x r... E ' -. �'f r=x }'..`' �,"AC i ,; .J ' y''_ y-{ e ,r' sx + ar+'•1 t!L• sz��v-�'-M y. �`'`�' �trc r-... t ��, S i ti -s• .t r�i A. f xz Jil Z 1 [ �s3: # sr•"� � s.'z�� a��'-fir," � �.., �5''r �4 A S �{ 5 x ng 11-01 r 71 i.+jw.+9Y'.-v�S�F .=s. L :'"4y x"' � L "fi'S # 3 � 5� w tL �i3 �,,,'c• .�.i 1� l Y • ' s '} - r+ $„t 3 ,, :.r 3p x ..„�*•-`-._,v_ ;"-x*, a�4.e.� _.ate.�.. r�..`s-.��.::tr.� it. .s:x:,.�a`u -�'- .rl zt:,. 1 IL 320 k h 330 �o 340 0 h. © f.r 1 3 'S- EVADA,AU ' g,i.s, ,t', - .�y r Vim`&. 'r^r .t" .# C F4 4�'�M' S .` 1,is.' "'e+" '__.—''�a�, k s s K s 6 t-4r C, IN_ fifi � e�� 5 FS; !�Y !8- 30.00• aoAo 5 sia wf k 7t zt �r 'ram a` fig.:2C4. ''u4F ew+-e'CC s. ,""fic"7= "' c3 .4' ,aT+ siix y"'iE-tyx"�'- ^F"�+x.•'""`.r. s a p .sr�#. .et�s35yx -c'-`�.'a .2 �y ut n: 4y7 ;' x�.,�a33"��?��.s--•r�,'� Y�^ x.�rsp{s�'e -1'3 .�x.a''",�"v°��'`°t, ,} ��.'�v.„��i.��-'� €ra..� " r/� '. 'x,�y' •{v�''S'k' ��} ro��'#r. �te x ��ya�i�a. �,�.X.a ';� �*`��=�a z+�.�;.�` _r tOi.aS' LI ..DUST.ER AV Ia20' 142 S3 tOSA2'205 ( i s Cl)r L n � 201 ..,� 203 207 tnaAo �s2A' t� s,: � taz.o' - 142 8T-�a— 020b N CV MA f 9 b t.'t FM 71 xx? x fr ta2.7 t 3 � 3 1 in=0.02 mf ~._4 {�JtI ! �Ywl� ?: � 1 in=100 ff ' :..� ."u City of Oshkosh maps and data are intended to be used for general identification purposes only,and city the City of Oshkosh assumes no liability for the accuracy of the information. Those using the Printing Date:$123/2017 information are responsible for verifying accuracy. For full disclaimer please go to Oshkosh ervnv.ci.oshkosh,vri.us/Gisdisclaimer Prepared by:City of Oshkosh,WI JAGIS1PIanninglPlan Commission Site Plan hlap TemplateWlan Commission Site Plan Map Temp ate.mxd User.deborah( I r I-PD SMU-PD _ I .tvtw �ot�xau UMU__ NMU ___.. UMU-PD o EL SRI.9 - __,_w--- UMU UMU-PD 7R=16 UI-PD UMU-PGE:n D _ U C 4....�.. MR-12 LL LD A) _ - _.- _ I - m —SR-5— � F FITi j !.� �'✓��.`:J�J1 : :+ �na��' 4 ��f111� �i� N 1 in=0.08 mi �y t� J 1 in=400 ftME City of Oshkosh maps and data are intended to be used for general Identification purposes only,and City the City of Oshkosh assumes no liability for the accuracy of the information. Those using the of Information are responsible for verifying accuracy. For hill disclaimer please go to Printing Date;8/2 31201 7 www Oshkosh.ct.oshkosh,arl.us/GfSdisciaimer Prepared by;City of Oshkosh,WI J:IGISIPlanning0on Commission Site Plan Map Ternplale0an Comm"scion Site Plan Map remplate.wd User,debar(ahtt b . ?'° �.1 cp �{�-�.fi'�Y�v` 1,s..."K.u4r�`kk. �re? "���Qd' � 3;"�^, ,.,'..rF�f✓Cri��s Y'o.rns#.,�v'.��`"''"�`���n.�`�A,*-., �'Y��r�fi}.�t"°s�;�� � '� ��i` �� p ­ a ' ,m� f Y ,.s,�i��}�-{.i�.v"�5 �'`V+ r K �,�r - 3�✓ IR sa ,�L r^, Y1k�r-hit ,' '+� ""` �`r5. r'• y '� er', J'��fi.sa1�- �mer '� t .. F yr 'I� #r .r,i xt+e.a srs,{L rF�.++a 'X�r�Lxf b3•.}Ly .f� w.a•' {.$st' e a .1t`y✓{ +{ - ia�jSSYxfiy ..�xrlslirl' Ess+HI�J`�miisn"'a7amt� ,f r i=• &1 , +t+ f i ° �awPt(SLLs lkl�✓�i nGdwr s , v7 j i sx 34 "%�1-1 {�J. ..P` n"s. # •:. xrfCr si•..;1a %F ,:ir .a f� �xnxi^a ft�,t.rpn 1 cit �F7SiE~ a�... ' c7fr k. 4„sr3rrs `..x• 4? jrw-t1' I- "E't � 1.� k�ix���LL4tig 'Fr 1.'rr,r.t TC J Y` s.wx�@ t,s ''k � �a�`L.. 5 f#.V.:rf + r''�W1 y'✓" sa W;r a+ $ rrW I, £:.,- ru".i�•r„45'••� r'£'s�,�Gst,..r 7f' �' 1�r �'" r r reaz'� d'.. T 7°ta-r' " i.�r.....�' {,� T s fr r �•s J t f-k 4. f...,z.# *. '7 t r ;�,-�1 sY �.rw.:a. f r^ ,,— Sr rTr 14 e ,�y y .. ar sd. ,. . p i ;:. aA 4�•S.'o- e" .- r. rva i T° r 1"�. ru C-ji� t Y w'� cju "t - yA �,raA[. 1. r 7 ajry' ..s 't",r' s� �+ rr w 4 r 7 ' 'R�'1 +srr` skt .Fo-*S*Us,.ssr'q 4f, G .�>,.,.e t, r: w,.� ;��,r ".ti ^". '` . w w.zaaar , "3sSerr"ra'r 'S s3131 -�� la r -r; '?j-tr N..r'r Tr. - El' `11r Cr1Cira+f4t::e r'Y1- e ,•_ , ,+ � # ti=a ar ' g 't xriySiTi�p(S H`; tt ?:.7; tk�,tfl � 3 � fyzat� { . .'` �ssts �frm,r .:, pkw,� ash rr'I�Kigh.rbs�-,5. 1,�'(-y�. '+t�rrkf t r ,%.."y . �4 e f i. .Jia'-i .; .:.,✓ra;,� 'iy } �q1/!-n .7 4`a -!F. 7„'Tr�.i6ryrl�'tlr " { ,^ 1 .�,I -5pix: asp..s% C++ $ :kS•,t �'' htFv„-w cL -* :4w ac E, •. ., �tr11h f}�.'" ..i nza„�'sa6F7Aa.�.3..xr•: 4<'VYr3s*qs'f�' �M ! y 9 „' rF J �' �..���� a✓ �tr jit?`� �1�" 1 4��11 ds �'px (iui T ser :..rz-'��{'r~„(," r+r.?r (_ t r�j � lr aaEYt �'� . UkJF4 1611 �a�. tr 41}, "jr x C f x sk t �' �y dib4t p b E P (IA 1 $�eIiAEe ,�� a t s sii. " �,� .:.,: ^,reip5y� � c s x �r € c., A,rA4-. Fla '.< 1 nr ' # r r t ' r z ,s ;r ' r A x;r= ,s,,, ":.•§rti ua Ggj 1911 fm i i 'r ° fir �ag � r 71 M A ;-� M. 7 " F k7 � Paµ 0H 5 Y j ` '��-'-'e.•�, �r;� ? k f� �vA:*s,ri'f� � tar F � -�a�` it x�r�e;a..�4� i A,N�,1 "�;t p �45 rsS 9 d c r .ak47�i�' �' it*kWJrr x sir c a 6 sePfi+P� 'n 1 `kr mf } 1", ..' .<°� � d G p i'+C riIK�S.r�' •'mom,,,. a .•� C RSA -...;;�_.,"'g€ '�M4�f%r�+- "�r v h fig"' a��r ,�<r" � i ,k°j'�'k'x',ti•r,,.+`p 1 � N t� r ✓:_ ": r #1 t ITg fa#ihPL i ` agL ggAAV " krj.","' 5'yll � r" cs:nk.4.9r� �t� �' t��9..:�� +sue'!• o� ar✓...: Rwr.�1V H^ - ` x'�^�✓U�� ¢+��9l s rt awS3 s.4{ r.�,«ppu a �.r t vr w ��� .s-•"fw t �,,, 1� qa r �* � T ha A�# aj'aFSaTf��k -GQr.r J � 9 �41t 1 ;,'�a ,� _ 'r` i-;,"" r •r` a t, xy" a r r as dr. 3 v a; .r- ,.r , '. ' I in 0.02 ;0 ft City of Oshkosh maps and data are intended to be used kx general identification purposes only,and city Hie City of 0shkosh assumes no liability for the accuracy of the information. Those using ft Printing Date-,8/23/2017 ` Preparedinformation are responsible for verifying accuracy. For V1 disclaimer �ease go to L11-1 Oshkosh, �+rF DATE(MMIDDIYYYY) CERTIFICATE OF LIABILITY INSURANCE 10/11/2017 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER,THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER($), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER, IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(les)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 1-414-443-0000 CONTACT Hays Companies of Wisconsin, Inc. PHONE FAX j . INC,Nv..EsO _,_._..__ ------__.<......... _.,,... J.iA!C,:!?41 ..�� __._......_. E-MAIL 1200 North Mayfair Road, Suite 100 _Al2_bREBS__------- .... . _.._,__,.._..„.._.,.._.....,.._._...._..,___ INSURE R(s))AFFORDING COVERAGE ..__._,_,..., ....---..,�NAIC# Milwaukee, WI 53226 tNSuREnA:NAUTILUS INS CO 17370 INSURED INSURERS__VALLEY FORGE INS„CO 20508 The Sigma Group, Inc. 204 INSURER-, TRANSPORTATION INS CO 0494 2300 West Canal Street INSURERD: _INSURER E; Milwaukee, WI 53233 1NSURERF; _ COVERAGES CERTIFICATE NUMBER:51115463 REVISION NUMBER: 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 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.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR _. ..... .. ............. ..._.ADD SUBr '_____._.....__ .__ ...__P041CY-EF'F POLICY EXP -'--",� _.._.._.... ...._....._._..__.. LTR TYPE OF INSURANCE INSD INVO POLICY NUMBER M DIYYYY ,)Mj Lqq YY LIMITS A X COMMERCIAL GENERAL LIABILITY X ECP2024210-10 10/01/17 10/01/18 EACH OCCURRENCE $ 2,000,000 OA.L1AGr 1O fiNTi:I's �_....._I CLAIMS-MADE OCCUR PR[MI$66(0n gccurrq $ 300,000 MED EXP(Any one parson), S 25,000 .__..,,. ..... ....- ------- PERSONALSADVINJURY $ 2,000,000 _ ._... . ..--------------- .....__._ — ...... __... GEN'I.AGGREGATE LIMIT APPLIES PER: GENERALAGGREGATE $ 2,000 000 POLICY'. T LOC PRO DUCTS-COMPlOPAGG $ 2 .......000 000 OTHER; Me B AUTOMOBILE LIABILITY X 6042795128 08/01/17 48/01/18 COMBtNEUSiNGLEUMiT $ 1,000,000 X ANYAUTO BODILY INJURY(Per person) $ " OWNED ._...... SCHEDULED .................__. _.__..._.._........._-_------....._.,..............__ . __,.. AUTOS ONLY _— AUTOS BODILY INJURY(Par accident) $ HIRED NON•OWNED Pf2C1PCRT!' nAMAGC ....".,. _X AUTOS ONLY X AUTOS ONLY PrILLagt4sfell), ,,. $ $ A UMBRELLALIAB I X OCCUR FFX2024211-10 10/01/17 10/01/18 EACHOCCURRENCE $ 5 000 000 X EXCESS UAB CLAIMS•MAOE AGGREGATE g 5 000 000 DED X RETENTION$ 0 C WORKERS COMPENSATION 6042795145 08/01/17 08/01/18 ..X.,.STATUTE ORH. AND EMPLOYERS'LIABILITY - ANYPROPRIETOR/PARTNER)EXECL)TIVE ( N/A E.L.EACH ACCIDENT $ 1,000,000 OFFICERiMEMBER EXCLUpEO7 __f -.- _._.. .__.......-. (Mandatory In NH) E,L.DISEASE•_E_._A_EMPLOYEE S 1,000,000 U ss,describe under �.._.. ......_...........___............. SCRIP"PION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 A Pollution - Occur. ECP2024210-10 10/OS/17 10/01/18 IIILimit 2,000,000 A Professional-C.M. ECP2024210-10 10/01/17 10/01/18 �Occ./Agg. Limit 2,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule„may be attached If more space Is required) Professional Liability Retroactive Date 8/01/87. Excess policy also applies to Pollution and Professional. The City of Oshkosh and its officers, council members, agents, employees and authorized volunteers are included as additional insured on the general and automobile liability policies when required by written contract, A 30 day notice of cancellation, except 10 days for non-payment will be provided to those parties indicated in the written contract. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE.ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Oshkosh THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Attnt City Clark P.O. Box 1130 AUTHORIZED REPRESENTATIVE Oshkosh, WI 54903 USA O 1988-2015 ACORD CORPORATION. All rights reserved, ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD diannewandal 51115463 CNA03359XX (Ed.04/12) THIS ENDORSEMENT CHANGES THE POLiICY. PLEASE READ IT CAREFULLY. CONTRACTORS EXTENDED COVERAGE ENDORSEMENT - BUSINESS AUTO PLUS . This endorsement modifies insurance provided under the following., BUSINESS AUTO COVERAGE FORM 1. LIABILITY COVERAGE 4. An"employee"of yours Is an"insurad,'while A. WWf>t�0h0M_" operating an "auto"hired or rented under e contract or slgresmertt In than"employee,811 The following Is added to Seatlon 11,Paragraph name, with your permlselon, white A.1,,Who Is An Insured; performing duties related to the conduct of 1. a. Any Incorporated entty of which the your business. Named Insured owns a majority of the "Poky,"as used In this provision A.Who Is An voting stock on the date of Inception of Insured, Includes those policies that were In this Coverage Form;provided that, force on the Inception date of this Coverage b. The Insurance afforded by this provision Form but A.I. does not apply to any such entity 1. Which are no longer In force;or that Is an "Insured" under any other liability "policy" providing "auto" 2• Whose limits have been exhausted. coverage. e. Ball Bonds and Loses of Earnings 2. Any organization you newty acquire or form, Section 11, paragraphs A.2, (2) and A.2. (4) other than a limited liability company, are revised as follows; partnership or joint ventpre, and over which 1. In a.(2),the Ilmit for the oost of ball bonds is you maintain majority ownership Interest. chongead from$2,000 to$5,000;and The Insurance afforded by this prrwis[an A.2.± 2. in a.(4), the limit for the Joss of earnings Is changed from$250to$500 a day. a. Is effective on the acquisitlon or C. Follow Employee formation date,and Is afforded only until the end of the policy period of this Section II,Paragraph 0.6 does not apply. Coverage Form,or the next anniversaryof Its 5ur.itcoverage as is afforded b this pro vision earlier, inception date, whichever is C, Is excs over any other c ctible Insurance. b.' Dori not apply to: 11. PHYSICAL DAMAGE COVERAGE (1) "Busily Injury" or"property nt' that A Glass Breeaka e-Hielin A Bird Or Animal-» caused by an "accident' than Falling Objects Dr Missiles before you acquired or g formed the organization;or The following . Is added to Section ill, (2) Any such organlxatlon that Is an Paragraph A.3.: "lnsured" under any other liability With respect to any covered "auto," any "policy"providing"auto"coverage. deductible shown In the Deciaradons will not 3 y Apy. emo n ors �r S tIo1"a tt4at 'yoCd cis, apply to glass" breakage if such glass Is rr i z u wt(t# irlffrepaired, in a manner acceptable to us, rather ahra+"t)o is ;I d","lift I sn ref sad. ': go, B. Transportation Expen"s UK" runt 0 0bon i .4 +���W��'!'A Section III, Paragraph AA.a, is revised, with IirtiCpdsand`ffr.!Nhrrnjrility't;�4nYt ?i?p is respect to transportation expense Incurred by pf fg i�d urjd r�ills potin r'If fe lire 5 i you,to provide: y>rfll 'Ck otx}�tr t, tins 1rXaaran '±NIIi, t a. $80 per day, in ileu of$20;subject to rtif1ht�ua: tttl IgCrajl ihd b. $1,800 maximum,In Ileu of$e00. 'dltisClrsd ` '_'s ONA633SOXX Coippight,CraA Corpondlon,2000, Page 1 of 3 (Ed.04/12) Includes eopydghted material of the Insurance Servicrw orinee used with Its peembWon, CNAe3369XX (Ed.04112) C. Lose of Use Expenses Ssctlon IIi► Paragraphs IR.4.0 and BA.d. are Section iII, Paragraph A.4.h Is revised, with deleted and replaced by the foilowing: aspect to loss of use expenses Incurred by you, e. Physical Damage Covonago 0n a covered to provide: "auto" also applies IC 109s" to any a. $1,000 maximum,in lieu of$600. petmanenily instatted electronic equipment D. Hired"Auto:" Inciudina its antennae and other accessories. The f0HOWIng is added to Section 111. d. A$100 par occurrence deductible applies to Paragraph A.: the coverage provided by this proviulon, 5. Hired"Autos" 0. Diminution In Value if Physical Damage coverage Is.provided under The fbilowing Is added to Section Ill, this policy, and such coverage does not extend. Paragraph B.B.: to Hind Autos,then Physical Damage coverage Is extended to: Subject to the following, the "dlminution in Value"oxclueion does not apply to: a. Any covered"auto"you leaser,hire, rent or borrow without a driver;and a. Any covered "Auld' of the private ,� psasseenger type you lease, hire, rent or b. Any covered auto hired or rented by bormw, without a driver for a period of your employed without a driver, under 30 drays or less,while performing duties a contract in that individual related bD the conduct of your business, `employee`s" name, with your and permisslon, while performing duties b, ,c covered "auto" of. the related to the conduct of your business. pdvate passenger type hired or rented by your c. The most we will pay for any one '#on* eI'without a driver for a period ",accident" or "Joss" is the actual cash of 30 ya or leas, under ai contract In value, cost of repair, ,cost of that Individual "employee'W' name, with replacement or '$76,000, whichever Is your permission, while park6ln lose, minas a$600 deductible for each duties related to the conduct of your covered auto, No deductible applies to business. "lass"caused by fire or lightning, a. ,Such coverage as Is provided b this d. The physical damage Coverage as is provision Is united to a Viminuyon in provided by this provision Is equal to the value"' loss arising directly out of physical damage coverage(&) provided accidental damage and not as a rasult on your owned"autos." of the failure to make repairs, faulty or e. Such physical damage coverage for Incornpiote maintenance or repairs, or hired"autos"will: the Installation of substandard parts, (1) include loss of use, provided it Is d. The most we will pay for "loss" to a the consequance of art "accldettr Covered "auto" in any one accident is for which the Named insured is the tosser of: legally liable, and as a result of (1) $5,000;or which a monetary lost is sustained (2) 20% of the "auto'&" actual cash by the leasing or rental concern. value ( ) Such his provision will be su Is b ect toided ba Ili. Drive Other Car Coverage—Executive ofte n limit of$750 per"accident." The folkwdrhg is added to Sections If and iII: E. Alrbag Coverage 1. A *auto,," you don't own, hire or barrow is e The following is added to Sootion III covered"autd'for Liability Coverage while being Paragraph 8.3.: used by, and for Physical Damage Coverage while In the care. custody or control of, any of The accidental discharge of an alrbag shall not your"executive officers,"except: be considered mechanical breakdown, a. An "auto"owned by that"executive offices" F. Electronic Equipment or a member of that person's household,or CNA5336UX Cupyripht.CNA C arpomtlon.2000. Page 2 of 3 (Ed.04/12) rn&dos copyrighted m+W01 of the lnurance 8ervie9s ofnoe used with iu permispton. , CNA63359XX (Ed,04112) b, An "auto" used by that "executive officer" The following Is added to Section IV, white working in a business of $aping, Paragraph A,6, Trtnsfer Rights IV servicing,repairing or parking"autos" of Recovery Against Others To Us: Such Liability and/or Physical Damage We waive any right of recovoy we may have, Coverage as Is afforded by this provision, because of payments we make for Injury or (1) Equal to the greatest of those, damage, against any person or organlxailon for ctrvOrages afforded any covered"auto'; whom or which you are raquired b written and contract or agreement to obtain this waver from US. (2) Insurance, This any other collectible .This Injury or damage must arise out of your � For purposes of this provision, "executire activities under a contract with that person or. . cofft er" means a person holding any of the orgartization. officer positions creatsd by your charter, You must.agree to that requirement prior to an constitution, by4aws or any other similar accident"or"loss." governing document, and, while a resident of C. Concealment,Milarapressntation or Fraud the same household, Includes that person's spouse. The ibltowing Is added to Section IV, Such "executive officers" are '`tnsurada" white Paragraph B.2,: using a covered "auto" described in this Your fallure to disclose ail hazards existing On the provision. date of Inception of this Coverage Form shall hot IV. BUSINESS AUTO CONDITIONS prejudice you with respect to the coverage afforded provided such failure or omission Is not intentional, A. I1301ies in The went Of Accident,Claim, suit D. Other Insurance Or Loss The 1'0110wing Is added to gucq,n IV, The fbilowing Is added to $0000 IV, Paragraph B.S.: Paragraph A. .a.: Regardless of the provisions of paragra t►e a a. (4) Your ""employees" may know of an and 6.cl. above, the coverage providsd by this "accident or"'loss,"This will not mean policy shall be on a primary non-contributory that you have such knowledge, unless basis, This provision is p appllcsbla only when such "accidaant" or "loss" Is known to requiread by a written contract. That written you or If you are not an individual, to contract must have been'antraed Into prior to any of your executive officers or "Accldenf'car"Loss." partners or your Insurance manager. E. Policy period.Coverage Territory The following Is added to Section IV, Paragraph A.2.b.: Stnstfon IV,Paragraph B.r.(tf),(a). is revised b (6) Your "employees" may know of provide;s. •t5 days ys, documents received concerning a claim y of coverage in lieu of 30 da or "vault" This will not mean that you V. DEFINITIONS have such knowledge, unless recalpt of such documents Is known to yoLl or v 80411101h V. iParagraph C. Is deleted and replaced you are not an Individual, to any Of your by the following: executive officers or parb)ers or your "sodliy Injury" meads bodliy Injury, sickness or insurance manager, disease sustained by a person, including mental B. Transfer Of Rights Of Rmsovery Agai sinulshnst g , mental Injury or death resulting from any of Cthars To Us these. CNM3359XX Copyright,CNA Corponnlron,2m,(Ed,04112) Indud"copyrPage 3 of 3 tphtwd matertet of the tnsuranCe 6av16le Oft $used with its PUMI$110n. ENDORSEMENT This endorsement forms a part of the policy to which it is attached. Please read It carefully. ADDITIONAL; INSURED BLANKET This endorsement modifies insurance provided under the following: ENVIRONMENTAL COMBINED POLICY In consideration of the premium charged and notwithstanding anything contained in this policy to the contrary, it is hereby agreed and understood that this endorsement shall apply only to the Coverage Part(s) corresponding with the box or boxes marked below, COVERAGES PARTS A AND B—GENERAL LIABILITY COVERAGE D—CONTRACTORS POLLUTION LIABILITY SECTION III —WHO IS AN INSURED is amended to include as an insured, with respect to Coverage A, B and D, any person(s) or organization(s) when you and such person(s) or organization(s) have agreed in a written contract or written agreement that such person(s)or organization(s)be added as an additional insured on your policy, Such written contract or written agreement must be in effect prior to the performance of your work which is the subject of such written contract or written agreement. Such additional insured status applies only: 1. Under COVERAGE A BODILY INJURY AND PROPERTY DAMAGE LIABILITY and COVERAGE B PERSONAL AND ADVERTISING INJURY LIABILITY for claims or suits resulting from: a. Your work performed for such person(s) or organization(s) in the performance of your ongoing operations for the additional insured;or b. Your work performed for such person(s) or organizabons(s) and Included in the products-completed operations hazard. 2. Under COVERAGE D CONTRACTORS POLLUTION LIABILITY for claims or suits arising out of pollution conditions that are the result of: a. Your work performed for such person(s) or organization(s) in the performance of your ongoing operations for the additional insured; or b. Your work performed for such person(s) or organizabons(s) and included in the products-completed operations hazard. With respect to damages caused by your work,as described above,the coverage provided hereunder shall be primary and not contributing with any other insurance available to those person(s) or organizations) with which you have so agreed in a written contract or written agreement. ALL OTHER TERMS AND CONDITIONS OF THE POLICY SHALL APPLY AND REMAIN UNCHANGED. ECP 1004 08 16 Page 1 of 7