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HomeMy WebLinkAbout23-28 R Ind Agreement-WFP Raw Wtr Diversion Vault Hatch RetrofitI:\Water Filtration\23-28 Emer WFP Intake Cleaning\Administrative\Contract Information\Contractor-Consultant-Supplier Agreements\R Industries\23-28 R Ind Agreement-WFP Raw Wtr Diversion Vault Hatch Retrofit_9-22-23.docx Page 1 of 5 CONTRACTOR AGREEMENT This AGREEMENT, made on the _____ day of __________, 2023, by and between the CITY OF OSHKOSH, party of the first part, hereinafter referred to as CITY, and R INDUSTRIES LLC, W2096 County Road KK, Kaukauna, WI 54130, party of the second part, hereinafter referred to as the CONTRACTOR, WITNESSETH: The CITY and the CONTRACTOR, for the consideration hereinafter named, enter into the following AGREEMENT for CITY OF OSHKOSH WATER FILTRATION PLANT RAW WATER DIVERSION VAULT HATCH RETROFIT (PROJECT). ARTICLE I. 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. City of Oshkosh’s Scope of Services dated September 15, 2023 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 II. PROJECT MANAGER A. Assignment of Project Manager. The CONTRACTOR shall assign the following individual to manage the PROJECT described in this AGREEMENT: Ross Schmidt – Senior Project Manager, President DocuSign Envelope ID: 40F177A3-AFE3-47B0-8E29-20A64FCE7719 25th September I:\Water Filtration\23-28 Emer WFP Intake Cleaning\Administrative\Contract Information\Contractor-Consultant-Supplier Agreements\R Industries\23-28 R Ind Agreement-WFP Raw Wtr Diversion Vault Hatch Retrofit_9-22-23.docx Page 2 of 5 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 III. 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 IV. SCOPE OF WORK The CONTRACTOR shall provide the services described in the CITY’s Scope of Services. CITY may make or approve changes within the general Scope of Services in this AGREEMENT. If such changes affect CONTRACTOR's cost of or time required for performance of the services, an equitable adjustment will be made through an amendment to this AGREEMENT. ARTICLE V. CITY RESPONSIBILITES 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 VI. TIME OF COMPLETION The work to be performed under this AGREEMENT shall be completed by no later than Friday, October 13, 2023. While CONTRACTOR has made reasonable efforts to incorporate into their plan for the PROJECT any known current project impacts of the COVID-19 pandemic, CONTRACTOR has not accounted for, and is not responsible for, unknown future changes DocuSign Envelope ID: 40F177A3-AFE3-47B0-8E29-20A64FCE7719 I:\Water Filtration\23-28 Emer WFP Intake Cleaning\Administrative\Contract Information\Contractor-Consultant-Supplier Agreements\R Industries\23-28 R Ind Agreement-WFP Raw Wtr Diversion Vault Hatch Retrofit_9-22-23.docx Page 3 of 5 due to the COVID-19 pandemic, including, without limitation, additional restrictions by government agencies or others (such as the availability of the site for access or the availability of CITY or CONTRACTOR staff or others) to the extent they delay or otherwise impact the PROJECT. In that event, CONTRACTOR will notify CITY and work in good faith to equitably address any unexpected impacts therefrom. ARTICLE VII. PAYMENT A. The Agreement Sum. The CITY shall pay to the CONTRACTOR 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:  Lump Sum Not to Exceed $30,000 (Thirty Thousand Dollars). B. Method of Payment. The CONTRACTOR shall submit itemized monthly statements for services. The CITY shall pay the CONTRACTOR 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 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 AGREEMENT executed by both parties prior to proceeding with the work covered under the subject amendment. ARTICLE VIII. STANDARD PROVISIONS The CONTRACTOR agrees that, in all hiring or employment made possible by or resulting from this AGREEMENT, there will not be any discrimination against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, or national origin. DocuSign Envelope ID: 40F177A3-AFE3-47B0-8E29-20A64FCE7719 I:\Water Filtration\23-28 Emer WFP Intake Cleaning\Administrative\Contract Information\Contractor-Consultant-Supplier Agreements\R Industries\23-28 R Ind Agreement-WFP Raw Wtr Diversion Vault Hatch Retrofit_9-22-23.docx Page 4 of 5 ARTICLE IX. CONTRACTOR TO HOLD CITY HARMLESS The CONTRACTOR 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 CONTRACTOR, 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. ARTICLE X. INSURANCE The CONTRACTOR agrees to abide by the attached City of Oshkosh Insurance Requirements. ARTICLE XI. TERMINATION A. For Cause. If the CONTRACTOR 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 CONTRACTOR. In this event, the CONTRACTOR 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 CONTRACTOR no later than ten (10) calendar days before the termination date. If the CITY terminates under this paragraph, then the CONTRACTOR 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 XII. SUSPENSION, DELAY, OR INTERRUPTION OF WORK The CITY may suspend, delay, or interrupt the services of CONTRACTOR for the convenience of the CITY. In such event, CONTRACTOR's agreement price and schedule shall be equitably adjusted. DocuSign Envelope ID: 40F177A3-AFE3-47B0-8E29-20A64FCE7719 I:\Water Filtration\23-28 Emer WFP Intake Cleaning\Administrative\Contract Information\Contractor-Consultant-Supplier Agreements\R Industries\23-28 R Ind Agreement-WFP Raw Wtr Diversion Vault Hatch Retrofit_9-22-23.docx Page 5 of 5 ARTICLE XIII. NO THIRD-PARTY BENEFICIARIES This AGREEMENT gives no rights or benefits to anyone other than the CITY and CONTRACTOR and has no third-party beneficiaries. In the Presence of: CONTRACTOR ____________________________ By: _____________________________ ____________________________ Ross Schmidt (Seal of CONTRACTOR Senior Project Manager, President if a Corporation) By: _____________________________ _____________________________ (Specify Title) CITY OF OSHKOSH _____________________________ By: _____________________________ (Witness) Mark A. Rohloff, City Manager _____________________________ And: _____________________________ (Witness) Diane M. Bartlett, City Clerk APPROVED: I hereby certify that the necessary provisions have been made to pay the liability which will accrue under this AGREEMENT. _____________________________ City Attorney ___________________________________ City Comptroller DocuSign Envelope ID: 40F177A3-AFE3-47B0-8E29-20A64FCE7719 9/15/23 SCOPE OF SERVICES City of Oshkosh Water Filtration Plant Raw Water Diversion Vault Hatch Retrofit Introduction The City of Oshkosh (City) Water Filtration Plant (WFP) Raw Water Diversion Vault Retrofit Project (Project) involves modifying the Raw Water Diversion Vault top slab to provide watertight openings that are large enough to permit installation of temporary pipeline flushing connections to clean the 60-inch intake and 60-inch raw water transmission main. The 60-inch pipelines are the City’s only reliable source of drinking water supply. The Project is being completed because lake sediment accumulated in the 60-inch pipelines needs to be removed. Raw Water Diversion Vault Key Features  Located in Lake Winnebago, on north shore of Menominee Park, about 1,800 feet north of the WFP.  Located within, partially below, and partially above Lake Winnebago.  Cast-in-place concrete structure houses interior isolation gates for four 60- inch pipelines. These must remain open at all times. Summary of Work The City will retain R Industries, LLC, to complete the following construction services as shown and described in Attachment A - Drawings:  Remove and dispose of existing top slab precast concrete opening covers.  Modify existing openings to accommodate two new watertight access hatches provided by the City.  Install the hatches and hatch frame drains.  Supply and install opening cover plates.  Provide all labor, materials and tools necessary to complete the work shown in Attachment A.  All debris shall be removed and disposed of properly. Project Coordination R Industries, LLC, shall complete the Project in coordination with the City as follows:  Perform the Project work in a manner which prevents demolition and construction materials from falling into the Diversion Vault and potentially damaging existing assets. Provide immediate notice to Water Filtration Plant at 920- 236-5165 in event of anything falling into vault.  Use materials noted on the Project drawings; proposed substitute materials must be NSF 61 approved for potable water application and require approval, prior to use, by the City and the City’s technical design consultant, Jacobs Engineering Group, Inc. (Jacobs).  Coordinate the Project work directly with the City WFP personnel and direct any questions about the Project to City and Jacobs prior to proceeding with work. Schedule The work shall be performed between September 25, 2023, and October 13, 2023. DocuSign Envelope ID: 40F177A3-AFE3-47B0-8E29-20A64FCE7719 Attachment A - Drawings DocuSign Envelope ID: 40F177A3-AFE3-47B0-8E29-20A64FCE7719 FILENAME:PLOT DATE:PLOT TIME:7/31/2023 10:27:59 AM THIS DOCUMENT, AND THE IDEAS AND DESIGNS INCORPORATED HEREIN, AS AN INSTRUMENT OF PROFESSIONAL SERVICE, IS THE PROPERTY OF REUSE OF DOCUMENTS: 1 2 3 4 5 6 B C D VERIFY SCALE BAR IS ONE INCH ON ORIGINAL DRAWING.1"0 c PROJ DATE DATE NO. DSGN DR REVISION CHK APVD BY APVD SHEET DWG A of \\USLAS0-APP385\ICS_workdir\159233\1713646_1\009-X-001_C9X37803.dgn $PWURL CITY CONTRACT NO. 23-XX CITY OF OSHKOSH, WISCONSIN JACOBS 2023. ALL RIGHTS RESERVED. JACOBS AND IS NOT TO BE USED, IN WHOLE OR IN PART, FOR ANY OTHER PROJECT WITHOUT THE WRITTEN AUTHORIZATION OF JACOBS. JULY 2023 CITY OF OSHKOSH WATER FILTRATION PLANT DIVERSION VAULT HATCH RETROFIT 691019 30% DESIGN DL MICHALEK DR LANGE 009-X-001_C9X37803.dgn PLAN AND SECTION DEMOLITION DIVERSION VAULT PLAN N 3/8"=1'-0" A SECTION 3/8"=1'-0" 3/8"=1'-0" 009-X-001 A A 5'-6" 5'-6" FOR NEW HATCH CONCRETE SLAB SAWCUT 12" FOR NEW HATCH CONCRETE SLAB SAWCUT 12" 5'-6"4'-0" 5'-6"4'-8" 1'-0" 1'-0" GENERAL SHEET NOTE ALL DEMOLISHED MATERIAL. CONTRACTOR SHALL REMOVE AND DISPOSE OF 1. SLAB CONCRETE OF 6" PRECAST REMOVE AND DISPOSE OF NEW BEAM CONNECTION LEDGE FOR INSTALLATION LENGTH OF SUPPORT SAWCUT/ DEMOLISH 1'-0" OF NEW BEAM CONNECTION LEDGE FOR INSTALLATION LENGTH OF SUPPORT SAWCUT/ DEMOLISH 1'-0" SLAB CONCRETE OF 6" PRECAST REMOVE AND DISPOSE DocuSign Envelope ID: 40F177A3-AFE3-47B0-8E29-20A64FCE7719 1'-0" FILENAME:PLOT DATE:PLOT TIME:2023\08\21 8:29:32 AM THIS DOCUMENT, AND THE IDEAS AND DESIGNS INCORPORATED HEREIN, AS AN INSTRUMENT OF PROFESSIONAL SERVICE, IS THE PROPERTY OF REUSE OF DOCUMENTS: 1 2 3 4 5 6 B C D VERIFY SCALE BAR IS ONE INCH ON ORIGINAL DRAWING.1"0 c PROJ DATE DATE NO. DSGN DR REVISION CHK APVD BY APVD SHEET DWG A of pw://ProjectWiseAMER.jacobs.com:DEN001/Documents/691019&space;-&space;OSHKOSH&space;-&space;WFP&space;CLEARWELLS&space;FINAL/DESIGN/C9X37803_Oshkosh_Intake/ST/Dlv/009-S-001_C9X37803.dgn $PWURL CITY CONTRACT NO. 23-XX CITY OF OSHKOSH, WISCONSIN JACOBS 2023. ALL RIGHTS RESERVED. JACOBS AND IS NOT TO BE USED, IN WHOLE OR IN PART, FOR ANY OTHER PROJECT WITHOUT THE WRITTEN AUTHORIZATION OF JACOBS. JULY 2023 CITY OF OSHKOSH WATER FILTRATION PLANT DIVERSION VAULT HATCH RETROFIT 691019 30% DESIGN 3/8"=1'-0" 009-S-001 DL MICHALEK DR LANGE 009-S-001_C9X37803.dgn STRUCTURAL DIVERSION VAULT N 3/8"=1'-0" TOP PLAN A SECTION 3/8"=1'-0" A A 3 1/2" 3" 4" TYP 5" 3 1/2" 1 1/4" TYP 3 1/2" 2 1/2" HIT-HY 200 V3 ADHESIVE HAS-R 316 SS ANCHOR RODS W/ SST L4x3 1/2x3/8x0'-9" W/ (2) 3/4" HILTI AL C12x7.41 HOLES IN BEAM WEB) HORIZONTAL SLOTTED BOLTS (PROVIDE SHORT (2) 3/4"x1 3/4" A193 B8 SST 3 1/2" EMBEDMIN TOP SLAB CONCRETE EXISTING CONC LEDGE EXST 1'-0" 2TO WALL, SEE PLATE, FOR CONNECTION AND EDGE OF CHECKER SUPPORT SIDE OF HATCH ALUMINUM CHANNEL TO TO WALL, SEE PLATE, FOR CONNECTION AND EDGE OF CHECKER SUPPORT SIDE OF HATCH ALUMINUM CHANNEL TO 2 2 TABLE NOTES: TYP2-63/16 L2x1 1/2x1/4 1'-6"2'-6"<L<3'-6" LENGTH 'L'OPENING SPAN SPACING STIFFENERMAX SIZESTIFFENER COVER STIFFENERS PLATE 3/8" TYPE DETAILS VARIES, SEE COVER 12" MAX 6" MAX PL COVER CHECKERED OPENING EDGE OF ABOUT CL SYMMETRICAL AL C12x7.41 SHALL BE SHORT DIMENSION OF OPENING. SPAN DIRECTION OF PLATE TO BE PARALLEL TO STIFFENERS, AND2.STIFFENERS TO BE PLACED LONG LEG VERTICAL.1. EDGE PLATE DETAIL 2 3/4" 1/4" AL C12x7.41 SEE PLAN OPENING SPAN 1/2" MAX 1/2" 2" NEOPRENE GASKET2 1/2" CONT1/8" THICK x 12" CENTERS ALL AROUND W/ 1 1/8" EMBEDMENT AT 1/4" SS HILTI KWIK BOLT 3 1 NTS 2 NTS GUTTER AND DRAIN FDDPA60X60DFL-BI NYSTROM 5FT SQUARE HATCH, BOLT IN, WITH TO WALL, SEE AND EDGE OF CHECKER PLATE, FOR CONNECTION ALUMINUM CHANNEL TO SUPPORT SIDE OF HATCH 1CONCRETE, SEE BOLT TO TOP OF PLATE, GASKETED, ALUMINUM CHECKER OF CONCRETE, SEE GASKETED, BOLT TO TOP ALUMINUM CHECKER PLATE, 1 OF CONCRETE, SEE GASKETED, BOLT TO TOP ALUMINUM CHECKER PLATE, 1 DETAILS PLANS, SECTION AND BEAM/ WALL CONNECTION DETAILCHECKERED PLATE DETAIL AND SUPPORT CHANNEL FRAME, CONCRETE, GROUT BETWEEN CHANNEL FILL VOID WITH NON-SHRINK AND SUPPORT CHANNEL FRAME, CONCRETE, GROUT BETWEEN CHANNEL FILL VOID WITH NON-SHRINK 1'-6" MAX 3/8"COVER PLATE, NEOPRENE GASKET 2 1/2" CONT 1/8" THICK x 1 2 SHEET KEYNOTES CONTRACTOR INSTALLATION. HATCHES WILL BE PROVIDED BY OWNER FOR 2. WITH SST 24MESH SCREEN. ELBOW DOWN 1 1/2" DRAIN AND FIT END OF PIPE 1. TYP OF 2 RECESSED PADLOCK HATCH SHALL HAVE FDDPA60X60DFL-BI GUTTER AND DRAIN HATCH, BOLT IN, WITH NYSTROM 5FT SQUARE TYP OF 2 TO SEAL PENETRATION EXPANDABLE SEALANT WITH WATERPROOF WALL TO PASS PIPE WALL, CORE DRILL CHANNEL TO EXTERIOR PIPE FROM HATCH 1 1/2" 316 SST DRAIN DocuSign Envelope ID: 40F177A3-AFE3-47B0-8E29-20A64FCE7719 ANY PROPRIETOR/PARTNER/EXECUTIVEOFFICER/MEMBER EXCLUDED? INSR ADDL SUBRLTRINSDWVD PRODUCER CONTACTNAME: FAXPHONE(A/C, No):(A/C, No, Ext): E-MAILADDRESS: INSURER A : INSURED INSURER B : INSURER C : INSURER D : INSURER E : INSURER F : POLICY NUMBER POLICY EFF POLICY EXPTYPE OF INSURANCE LIMITS(MM/DD/YYYY)(MM/DD/YYYY) AUTOMOBILE LIABILITY UMBRELLA LIAB EXCESS LIAB WORKERS COMPENSATION AND EMPLOYERS' LIABILITY DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) AUTHORIZED REPRESENTATIVE EACH OCCURRENCE $ DAMAGE TO RENTEDCLAIMS-MADE OCCUR $PREMISES (Ea occurrence) MED EXP (Any one person)$ PERSONAL & ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER:GENERAL AGGREGATE $ PRO-POLICY LOC PRODUCTS - COMP/OP AGGJECT OTHER:$ COMBINED SINGLE LIMIT $(Ea accident) ANY AUTO BODILY INJURY (Per person)$ OWNED SCHEDULED BODILY INJURY (Per accident)$AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $AUTOS ONLY AUTOS ONLY (Per accident) $ OCCUR EACH OCCURRENCE CLAIMS-MADE AGGREGATE $ DED RETENTION $ PER OTH-STATUTE ER E.L. EACH ACCIDENT E.L. DISEASE - EA EMPLOYEE $ If yes, describe under E.L. DISEASE - POLICY LIMITDESCRIPTION OF OPERATIONS below INSURER(S) AFFORDING COVERAGE NAIC # COMMERCIAL GENERAL LIABILITY Y / N N / A (Mandatory in NH) SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 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. 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). COVERAGES CERTIFICATE NUMBER:REVISION NUMBER: CERTIFICATE HOLDER CANCELLATION © 1988-2015 ACORD CORPORATION. All rights reserved.ACORD 25 (2016/03) CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) $ $ $ $ $ The ACORD name and logo are registered marks of ACORD 9/11/2023 (920) 766-1791 (715) 568-5151 22543 R Industries LLC R Industries Contracting LLC W2096 County Road KK Kaukauna, WI 54130 35378 A 1,000,000 X CP3256186 8/1/2023 8/1/2024 100,000 10,000 1,000,000 2,000,000 2,000,000 1,000,000A A3300193 8/1/2023 8/1/2024 5,000,000B XOBW9757023 8/1/2023 8/1/2024 5,000,000 0 A WC3377298 8/1/2023 8/1/2024 1,000,000 Y 1,000,000 1,000,000 The City of Oshkosh, and its officers, council members, agents employees and authorized volunteers are included as additional insureds on the general liability policy, on a primary and noncontributory basis, when required by written contract. A 30-Day Notice of Cancellation applies on the general liability, automobile and umbrella policies when required by written contract. City of Oshkosh, Attn City Clerk 215 Church Ave PO Box 1130 Oshkosh, WI 54903-1130 RINDUST-01 LKLOCEK Apex Insurance Group of WI, LLC 1 Bank Ave, Suite A Kaukauna, WI 54130 Secura Insurance, A Mutual Company Evanston Insurance Company X X X X X X X X X X DocuSign Envelope ID: 40F177A3-AFE3-47B0-8E29-20A64FCE7719 CGE 1037 Includes copyrighted material of Insurance Services Office, with its permission Page 1 of 3 1301 © 2013 SECURA Insurance Company THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY ADDITIONAL INSURED WRAP This Endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART With respect to coverage provided by this Endorsement, the provisions of the Coverage Part apply unless modified by this Endorsement. A. Additional Insured When Required By Written Agreement 1. Operations Performed For An Additional Insured WHO IS AN INSURED is amended to include as an additional insured any person or organization for whom you are performing operations when you and such person or organization have agreed in a written agreement prior to a loss, that such person or organization be added as an additional insured on your policy. Such person or organization is an additional insured only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" caused, in whole or in part, by: a.Your acts or omissions; or b.The acts or omissions of those acting on your behalf; in the performance of your ongoing operations for the additional insured. A person's or organization's status as an additional insured under this provision ends at the earlier of when your operations for that additional insured are completed; or the end of the policy period. 2. Limitations The Operations Performed For An Additional Insured coverage is limited as follows: a.This insurance does not apply to "bodily injury", "property damage" or "personal and advertising injury" arising out of the rendering of, or the failure to render, any professional architectural, engineering or surveying services, including: (1)The preparing, approving, or failing to prepare or approve, maps, shop drawings, opinions, reports, surveys, field orders, change orders or drawings and specifications; or (2)Supervisory, inspection, architectural or engineering activities. b.This insurance does not apply to "bodily injury" or "property damage" occurring after: (1)All work, including materials, parts or equipment 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 intended use by any person or organization other than another contractor or subcontractor engaged in performing operations for a principal as a part of the same project. c.The Limits of Insurance applicable to the additional insured are those specified in the written agreement or in the Declarations for this policy, whichever is less. These Limits of Insurance are inclusive and not in addition to the Limits of Insurance shown in the Declarations. If other insurance available to you and written by us is applicable to this additional insured, the maximum recovery under all coverage forms or policies combined may equal but not exceed the highest applicable limit under any one coverage form or policy providing coverage on either a primary or excess basis. d.This insurance does not apply if the person or organization required to be added as an additional insured is specifically named as an additional insured under any other provision of, or endorsement added to this policy. DocuSign Envelope ID: 40F177A3-AFE3-47B0-8E29-20A64FCE7719 CGE 1037 Includes copyrighted material of Insurance Services Office, with its permission Page 2 of 3 1301 © 2013 SECURA Insurance Company B. Additional Insured When Required By Written Agreement – Completed Operations 1. Additional Insured – Completed Operations WHO IS AN INSURED is amended to include as an additional insured any person or organization, when you and such person or organization have agreed in a written agreement prior to a loss, that such person or organization be added as an additional insured on your policy, but only with respect to “bodily injury” or “property damage” caused, in whole or in part, by "your work" performed for that additional insured and included in the "products-completed operations hazard". 2. Limitations The Additional Insured - Completed Operations coverage is limited as follows: a.This insurance does not apply to "bodily injury" or "property damage" arising out of the rendering of, or the failure to render, any professional architectural, engineering or surveying services, including: (1)The preparing, approving, or failing to prepare or approve, maps, shop drawings, opinions, reports, surveys, field orders, change orders or drawings and specifications; or (2)Supervisory, inspection, architectural or engineering activities. b. A person or organization’s status as an insured under Additional Insured - Completed Operations continues only until the earlier of the end of the policy period; or the period of time required by the written agreement. If no time period is required by the written agreement, a person or organization’s status as an additional insured under this endorsement will not apply beyond the lesser of the end of the policy period; or five years from the completion of “your work” on the project which is the subject of the written agreement. c.The insurance as provided to the additional insured does not apply to “bodily injury”, “property damage” or “personal and advertising injury” arising out of “your work” for which a consolidated (wrap-up) insurance program has been provided by the prime contractor-project manager or owner of the construction project in which you are involved. d.The Limits of Insurance applicable to the additional insured are those specified in the written agreement or in the Declarations for this policy, whichever is less. These Limits of Insurance are inclusive and not in addition to the Limits of Insurance shown in the Declarations. If other insurance available to you and written by us is applicable to this additional insured, the maximum recovery under all coverage forms or policies combined may equal but not exceed the highest applicable limit under any one coverage form or policy providing coverage on either a primary or excess basis. e.The coverage provided to the additional insured by this endorsement and by paragraph f. of the definition of “insured contract” under DEFINITIONS do not apply to “bodily injury” or “property damage” arising out of the “products-completed operations hazard” unless required by the written agreement. f.This insurance does not apply if the person or organization required to be added as an additional insured is specifically named as an additional insured under any other provision of, or endorsement added to this policy. C. Primary And Noncontributory As respects the coverage provided under this endorsement, the Other Insurance Condition is amended as follows: The paragraph regarding Excess Insurance is deleted and replaced with the following: Excess Insurance This insurance is excess over any other insurance available to the additional insured whether primary, excess, contingent or on any other basis unless the written agreement described in A. and B. above specifically requires that this insurance be either primary or primary and noncontributory. Then this insurance is primary and not contributing with any insurance available to the additional insured which covers that person or organization as a named insured. DocuSign Envelope ID: 40F177A3-AFE3-47B0-8E29-20A64FCE7719 CGE 1037 Includes copyrighted material of Insurance Services Office, with its permission Page 3 of 3 1301 © 2013 SECURA Insurance Company D. Waiver Of Transfer Of Rights Of Recovery Against Others To Us As respects the coverage provided under this endorsement, the Transfer Of Rights Of Recovery Against Others To Us Condition is amended by adding the following: We waive any right to recover all or part of any payment we have made under this Coverage Part arising out of your ongoing operations or “your work” done under a written agreement requiring such waiver with that person or organization. However, our rights may only be waived prior to the “occurrence” for which we make payment under this Coverage Part. The insured must do nothing after a loss to impair our rights. At our request, the insured will bring “suit” or transfer those rights to us and help us enforce them. E. Amendment – Aggregate Limits Of Insurance (Per Project) Under LIMITS OF INSURANCE shown on the Declarations, the General Aggregate Limit applies separately to each of your projects away from the premises owned by you or rented to you. This extension does not apply to the “products-completed operations hazard”. F. Additional Condition The following condition is added: Additional Insured Duty To Notify The additional insured described in A. or B. above must give written notice of loss, including a demand for defense and indemnity, to any other insurer having coverage for the loss under its policies. Such notice must demand full coverage available and the additional insured shall not waive or limit such other available coverage. This additional condition does not apply to the insurance available to the additional insured which covers that person or organization as a named insured. All other terms and conditions of this policy not in conflict with the terms and conditions of this Endorsement shall continue to apply. DocuSign Envelope ID: 40F177A3-AFE3-47B0-8E29-20A64FCE7719 ILE 0550 Includes copyrighted materials of Insurance Services Office, Inc., with its permission. Page 1 of 1 1101 © 2011, SECURA Insurance Company THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. NOTICE OF CANCELLATION ENDORSEMENT This Endorsement modifies insurance provided under the following: BUSINESSOWNERS POLICY COMMERCIAL GENERAL LIABILITY COVERAGE PART With respect to coverage provided by this Endorsement, the provisions of the Coverage Part apply unless modified by the Endorsement. SCHEDULE Name and address/contact information of Person(s) or Organization(s): (If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement.) The following Condition is added: Notice Of Cancellation – Scheduled Person(s) or Organization(s) a.If we do not renew or cancel this policy, we will send advance written notice to the person(s) or organization(s) as shown in the SCHEDULE. The notice will be delivered by any method we choose, in the applicable timeframe specified in the policy’s Cancellation Condition, any amendment to that Condition, or any other statutory timeframe requirements. b.Notice provided on this policy shall also apply as notice for any other Commercial Lines insurance policy or coverage part issued to the Named Insured by us. c.The notice is intended only to inform the person(s) or organization(s) named in the SCHEDULE in the event of a pending cancellation or non-renewal of coverage. Our failure to provide such advance notification will not: (1)Change any policy cancellation or non-renewal effective date; (2)Negate any cancellation or non-renewal of the policy; or (e)Grant, alter, or extend any rights or obligations under any policy issued by us. All other terms and conditions of this policy not in conflict with the terms and conditions of this Endorsement shall continue to apply. DocuSign Envelope ID: 40F177A3-AFE3-47B0-8E29-20A64FCE7719 POLICY NUMBER: 20-CP-003256186-13 END: 001 ILD 0002 1204 SUPPLEMENTAL FORM DECLARATION FOR ILE0550 1101 NOTICE OF CANCELLATION ENDORSEMENT ILD 0002 1204 SECURA Insurance Company Page 1 of 1 SCHEDULE Name of Person(s) or Organization(s)Address/contact information of Person(s) or Organization(s) Ahlstrom-Munksjo North America Specialty Solutions PO Box 600, Kaukauna, WI 54130 Appleton Area School District 131 E Washington St, Ste 1A, Appleton, WI 54911 August Winters & Sons 2323 Roemer Rd, Appleton, WI 54911 Bassett Mechanical 1215 Hyland Ave, Kaukauna, WI 54130 Cardinal Construction Company Inc 1183 Industrial Pkwy, Fond Du Lac, WI 54937 Cargill Incorporated or Subsidiaries Attn Appruv, 2485 39th Ave, Columbus, NE 68601 City of Appleton & Its Officers, Council Members, Agents, Employees & Authorized Volunteers 100 N Appleton St, Appleton, WI 54911 City of Green Bay 100 N Jefferson Room 500, Green Bay, WI 54301 Hoffman Planning Design & Construction Inc 122 E College Ave, Ste 1G, Appleton, WI 54911 JF Ahern Co PO Box 1316, Fond Du Lac, WI 54936 Land O'Lakes Inc 4001 Lexington Ave N, Arden Hills, MN 55126 NEXT Electric LLC 1121 Marlin Ct Ste A, Waukesha, WI 53186 RODAC Development & Construction 3346 S Pine Tree Rd, Hobart, WI 54155 Reliable Door and Dock Inc N173 W21130 NW Psge, Jackson, WI 53037 Smet Construction Services Corp 2080 Profit Pl, De Pere, WI 54115 Sunbelt Rentals PO Box 410328, Charlotte, NC 28241 The Boldt Company PO Box 419, Appleton, WI 54912 Tweet/Garot Mechanical Inc 325 Reid St, De Pere, WI 54115 City of Oshkosh, Attn City Clerk 215 Church Ave, Oshkosh, WI 54903-1130 DocuSign Envelope ID: 40F177A3-AFE3-47B0-8E29-20A64FCE7719