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HomeMy WebLinkAboutCarow_WWTP_Fac_Plan_Survey_Serv_Agreement_2-9-23I:\Wastewater\Facility Plan-WWTP\Survey Work\Carow WWTP Fac Plan Survey Serv Agreement_2-9- 23.docx Page 1 of 7 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 CAROW LAND SURVEYING COMPANY, INC., 615 North Lynndale Drive, Appleton, WI 54912, 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 WASTEWATER TREATMENT PLANT TOPOGRAPHIC SURVEY (PROJECT). ARTICLE I. PROJECT MANAGER A. Assignment of Project Manager. The CONSULTANT shall assign the following individual to manage the PROJECT described in this AGREEMENT: Matthew C. Reider, P.L.S. – Owner 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 II. 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 DocuSign Envelope ID: 10FC554E-D326-4241-9B65-4FA65B40E6BE February10th I:\Wastewater\Facility Plan-WWTP\Survey Work\Carow WWTP Fac Plan Survey Serv Agreement_2-9- 23.docx Page 2 of 7 ARTICLE III. SCOPE OF WORK The CONSULTANT shall provide the services described in the CITY’S Request for Proposal. 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. 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. 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 VI. CITY RESPONSIBILITIES The CITY 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. DocuSign Envelope ID: 10FC554E-D326-4241-9B65-4FA65B40E6BE I:\Wastewater\Facility Plan-WWTP\Survey Work\Carow WWTP Fac Plan Survey Serv Agreement_2-9- 23.docx Page 3 of 7 ARTICLE VII. 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 VIII. 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 CITY’s Request for Proposal. 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 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. While CONSULTANT has made reasonable efforts to incorporate into their plan for the PROJECT any known current project impacts of the COVID-19 pandemic, CONSULTANT has not accounted for, and is not responsible for, unknown future changes 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 CONSULTANT staff or others) to the extent they delay or otherwise impact the PROJECT. In that event, CONSULTANT will notify CITY and work in good faith to equitably address any unexpected impacts therefrom. DocuSign Envelope ID: 10FC554E-D326-4241-9B65-4FA65B40E6BE I:\Wastewater\Facility Plan-WWTP\Survey Work\Carow WWTP Fac Plan Survey Serv Agreement_2-9- 23.docx Page 4 of 7 ARTICLE IX. 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’s Request for Proposal dated November 28, 2022 and attached hereto 3. CONSULTANT’s Proposal dated December 22, 2022 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 X. 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:  Time and Materials Not to Exceed $14,850 (Fourteen Thousand Eight Hundred Fifty 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. 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. DocuSign Envelope ID: 10FC554E-D326-4241-9B65-4FA65B40E6BE I:\Wastewater\Facility Plan-WWTP\Survey Work\Carow WWTP Fac Plan Survey Serv Agreement_2-9- 23.docx Page 5 of 7 E. Expenses. Expenses may be billed with up to a maximum of ten percent (10%) 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 XI. STANDARD PROVISIONS The CONSULTANT 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. ARTICLE XII. 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, their agents or assigns, their employees, or their 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 XIII. INSURANCE The CONSULTANT agrees to abide by the attached City of Oshkosh Insurance Requirements. DocuSign Envelope ID: 10FC554E-D326-4241-9B65-4FA65B40E6BE I:\Wastewater\Facility Plan-WWTP\Survey Work\Carow WWTP Fac Plan Survey Serv Agreement_2-9- 23.docx Page 6 of 7 ARTICLE XIV. 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 XV. RE-USE OF PROJECT DOCUMENTS All reports, drawings, specifications, documents, and other deliverables of CONSULTANT, whether in hard copy or in electronic form, are instruments of service for this PROJECT, whether the PROJECT is completed or not. Subject to individual review, CONSULTANT’S reports, drawings, specifications, documents, or other deliverables will generally be considered public records that are available to the public upon request. Neither the CITY nor the CONSULTANT, therefore, has control of these documents once they are disclosed as a public record. It is understood between these two (2) parties, however, that CONSULTANT does not intend to state or imply that the PROJECT documents it creates have any purpose unrelated to the PROJECT. To the extent the CITY may re-use or reference any part of the CONSULTANT’S documents or information on unrelated projects, the CITY agrees to independently verify their applicability for unrelated projects and further agrees the Standard of Care applicable to the documents for this PROJECT will not apply to their re-use or reference in unrelated projects. ARTICLE XVI. SUSPENSION, DELAY, OR INTERRUPTION OF WORK The CITY may suspend, delay, or interrupt the services of CONSULTANT for the convenience of the CITY. In such event, CONSULTANT's agreement price and schedule shall be equitably adjusted. DocuSign Envelope ID: 10FC554E-D326-4241-9B65-4FA65B40E6BE I:\Wastewater\Facility Plan-WWTP\Survey Work\Carow WWTP Fac Plan Survey Serv Agreement_2-9- 23.docx Page 7 of 7 ARTICLE XVII. 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: CONSULTANT ____________________________ By: _____________________________ ____________________________ Matthew C. Reider, P.L.S. (Seal of CONSULTANT Owner if a Corporation) By: _____________________________ _____________________________ (Specify Title) CITY OF OSHKOSH _____________________________ By: _____________________________ (Witness) Mark A. Rohloff, City Manager _____________________________ And: _____________________________ (Witness) Jessi L. Balcom, 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: 10FC554E-D326-4241-9B65-4FA65B40E6BE I:\Wastewater\Facility Plan-WWTP\Survey RFP\Cover Letters\Carow Cover Ltr_11-28-22.docx Page 1 of 2 City Hall, 215 Church Avenue P.O. Box 1130 Oshkosh, WI 54903-1130 http://www.ci.oshkosh.wi.us November 28, 2022 Matt Reider Carow Land Surveying Co., Inc. 615 North Lynndale Drive Appleton, WI 54912-1297 E-Mail: matt_r@carowlandsurveying.com RE: Request for Proposals for City of Oshkosh Wastewater Treatment Plant Topographic Survey Dear Matt: The City of Oshkosh is hereby requesting proposals be submitted for a topographic survey of the City of Oshkosh’s (City) Wastewater Treatment Plant (WWTP). The purpose of this survey is to define the boundaries of the City-owned parcel and gain a detailed survey of the entire WWTP. The City is interested in getting as detailed as possible survey of the site. The proposal shall include, at a minimum: planned project team and resumes, related project experience of the planned project team, a breakdown of costs, and a fee schedule, as requested in the enclosed Scope of Services. The proposals will be reviewed for completeness and how well it is demonstrated the needs of the City of Oshkosh can be met. Proposals shall be limited to eight (8) pages total, including any resumes, and cost breakdown. The award of this work will not be based solely on cost of the proposal. Questions regarding this Request for Proposals shall be emailed to Tracy Taylor at ttaylor@ci.oshkosh.wi.us (with the subject heading of “WWTP Topographic Survey RFP Questions”) by 12:00 noon on Wednesday, December 14, 2022. The questions and appropriate responses will be distributed to all parties receiving this Request for Proposals by 12:00 noon on Monday, December 19, 2022. Please submit one (1) hard copy and one (1) pdf copy of the proposal to Tracy Taylor no later than noon on Thursday, December 22, 2022. It is anticipated the award of this agreement will be made by Tuesday, January 10, 2023. Please ensure you have the proper insurance paperwork, so the award is not delayed. DocuSign Envelope ID: 10FC554E-D326-4241-9B65-4FA65B40E6BE I:\Wastewater\Facility Plan-WWTP\Survey RFP\Cover Letters\Carow Cover Ltr_11-28-22.docx Page 2 of 2 Enclosed with this letter are copies of the Scope of Services, 1973 WWTP Description of Property, Facility Survey Map, Plant Process Survey Locations figure, Standard Professional Services Agreement, and Professional Services Liability Insurance Requirements. The information contained within these enclosures shall become a part of the agreement with the Consultant selected to perform the Services. If you have any questions, please do not hesitate to contact us. Sincerely, Steven M. Gohde, P.E. Assistant Director of Public Works / Utilities General Manager SMG/tlt Enclosures cc: James Rabe, P.E., CPESC, Director of Public Works Kevin Sorge, Wastewater Treatment Plant Manager Jason Ellis, Utility Operations Manager Linda Mohr, P.E., Jacobs Engineering Group, Inc. File DocuSign Envelope ID: 10FC554E-D326-4241-9B65-4FA65B40E6BE I:\Wastewater\Facility Plan-WWTP\Survey RFP\Scope of Services_11-28-22.docx Page 1 of 3 Scope of Services for City of Oshkosh Wastewater Treatment Plant Topographic Survey General Requirements The City of Oshkosh (City) Wastewater Treatment Plant (WWTP) Topographic Survey Project (Project) involves preparing complete topographic information of the approximately fifteen (15) acre WWTP site and a Plat of Survey of the entire parcel, including the Transportation Department Facility. Based on City records, the entire parcel is approximately thirty (30) acres. All survey work for the Project will be performed under the direct supervision of a Professional Land Surveyor (Surveyor) currently registered in the State of Wisconsin. The survey shall reference Winnebago County Coordinate System (NAD 83) and North American Vertical Datum 1988 (NAVD 88). Surveyor will recover existing and/or set new control to meet the Datum and survey requirements listed herein. If existing control is recovered, the accuracy, coordinate system, and Datum shall be confirmed and documented by the Surveyor. The City will consider any enhancements proposed by the Consultant. Consultant shall outline any proposed enhancement with an explanation of the benefit to the City. Available Information The following information is available from the City to assist in the preparation of proposals:  1973 WWTP Description of Property, enclosed.  Facility Survey Map from City GIS data, enclosed. Please note disclaimer on map.  Full-size WWTP drawings, including buried utilities, from multiple Capital Improvement Projects available for viewing at the WWTP. Plat of Survey Map Surveyor will prepare a Plat of Survey Map of the City property showing the actual location and legal property lines of the City’s parcel of property. Plat of Survey shall be done in accordance with Wisconsin Administrative Code and any other relevant rules and regulations. Property Title Search Surveyor will complete a title search for the City property to confirm the property’s rightful legal owner and any other encumbrances on the land. Topographic Survey Information Requirements Surveyor will prepare the following topographic information for the WWTP site, as indicated on the Facility Survey Map and develop the topographic site plan including the following physical features and information:  Limits of the detailed topographic survey are shown on the enclosed Facility Survey Map. DocuSign Envelope ID: 10FC554E-D326-4241-9B65-4FA65B40E6BE I:\Wastewater\Facility Plan-WWTP\Survey RFP\Scope of Services_11-28-22.docx Page 2 of 3  Field location with elevations of existing visible features of the site (property monuments, walks, roads, corners of buildings and structures, entrances to buildings and structures, trees, non-tree surface vegetation, power poles, manholes, electrical boxes, signs, etc.).  Location of buried utilities; engage Diggers Hotline and WWTP Operations Manager to locate buried utilities, to the extent possible, prior to survey.  Manholes shall be inspected to determine the diameter of structure, diameter of the pipes, flow direction, and invert elevation of structure and all sanitary and storm sewer pipes. The required information shall be obtained to the first (1st) manhole beyond the property line. Location and elevation of submerged outfall pipe ends in creek are not required.  Spot elevation on a fifty-foot (50’) grid maximum or otherwise necessary to generate accurate one-foot (1’) contours, in addition to grade breaks.  Spot elevations of treatment process basins and open water surface elevations in process basins as shown on the enclosed Plant Process Survey Locations figure. Please note date and time of water surface elevation measurements. Topographic Map The Surveyor will provide a topographic map of the WWTP site in AutoCAD file format with a 1” = 20’ horizontal scale and one-foot (1’) contour interval. This mapping will be used for the design process and as base mapping for the preparation of construction plans. Plan locations shall be accurate within one tenth of a foot horizontal (+/-0.10’), and vertical elevations to be accurate within three hundredths of a foot (+/-0.03’) for hard surfaces and within one tenth of a foot (+/- 0.10’) on soft or natural ground surfaces. The drawing will include the following items:  Date, scale, legend, and north arrow.  Recorded property lines; see Plat of Survey Map Section of this Scope of Services.  Easement location/information (if any).  Fence lines and fence gates.  Description of ground surfaces (curb and gutter, edge of pavement, sidewalks, trees with diameter at breast height, landscaped areas, grass, etc.).  Description and location of existing visible improvements (sidewalks, roads, paved areas, structures, etc.).  Spot ground elevations and break lines so as to accurately generate one-foot (1’) contours.  Spot elevations of physical features (drainage grates, curb and gutters, sidewalk edges, driveway edges, manhole covers, hand holes covers, fence posts, etc.).  Benchmarks and control points (locations and descriptions with northing and easting at each point).  Power, telephone poles and lines, above and below ground (locations and descriptions).  Hydrants and valves (locations and descriptions).  One hundred (100) year flood plain elevation contour, if delineated on WWTP site. Field Notes In addition to horizontal and vertical measurements and sketches, the field notes shall also include the name of field crew members, the survey date(s), survey control information, coordinate system and datum used, and daily weather conditions including barometric pressure and temperature. The field notes shall be complete enough to allow for independent retracement of the survey by others. Because there are a number of different field survey software products DocuSign Envelope ID: 10FC554E-D326-4241-9B65-4FA65B40E6BE I:\Wastewater\Facility Plan-WWTP\Survey RFP\Scope of Services_11-28-22.docx Page 3 of 3 with different input formats, the electronic field notes shall be delivered in a generic format readily readable and understandable by a reader not familiar with the specific software used for the field survey. Project Deliverables Surveyor will provide the following deliverables: 1. Two (2) paper hard copies of the site topographic map and Plat of Survey (22-inch by 34-inch) and one (1) PDF copy of each, showing all physical and legal features included in this Scope of Services, signed and sealed by the licensed Professional Surveyor in responsible charge of the work. 2. AutoCAD Civil 3D file containing all cadastral linework. Drawing requirements are as follows: a. Deliver electronic files in AutoCAD Civil 3D. b. Provide electronic copies of all mapping. c. Create all blocks on layer 0 and make color “by layer.” d. Make all colors and linetypes “by layer”, NOT by object. e. Place text on separate layers from objects. Layers shall be named according to the U.S. National CAD Standard (NCS) system or approved substitute. f. Text must read clearly at 1:100 scale (min 0.12 inch high), without overlap. g. Assign all contours with a linetype of “Hidden” or “Hidden 2”. h. Create contours with “plinegen” variable set to 1. i. Use arcs or pline-arcs to draw curves. 3. Site topographic point file containing all the survey controls points if not contained in the CAD file and a tabular list of control points. 4. Shx (shape) files. 5. All field and raw data files and field notes pertaining to the survey. Schedule This scope of services must be completed by Friday, March 3, 2023. Cost Proposal The Cost Proposal shall include anticipated cost of services and estimated hours. Costs shall include all items of labor, material, tools, equipment, and other costs necessary to fully provide the services outlined in this Scope of Services. This item should be stated as a time and materials cost not to exceed, including expenses to be billed at cost, and reference an attached fee schedule for hourly rates or other unit rates of cost. The City will consider enhancements beyond what is outlined in this Scope of Services. The costs for enhancements shall be included in the cost summary and will be evaluated by the City for inclusion in the final agreement. Consultant shall clearly indicate enhancement additional costs and any cost savings from base proposal. Agreement These services will be provided under the City’s Standard Professional Services Agreement and the City’s Professional Services Liability Insurance Requirements (samples of each are enclosed). DocuSign Envelope ID: 10FC554E-D326-4241-9B65-4FA65B40E6BE DocuSign Envelope ID: 10FC554E-D326-4241-9B65-4FA65B40E6BE DocuSign Envelope ID: 10FC554E-D326-4241-9B65-4FA65B40E6BE Property Line based on GIS data Limits of Detailed Topo Survey EASEMENT - SANITARY WWIITTZZEELL AAVV KNAPP ST KNAPP ST DD EE MM PP SS EE YY TT RR NN CC AA MM PP BB EE LL LL RR DD KNAPP ST KNAPP ST IDAHO ST IDAHO ST DURFEE AV DURFEE AV L:\GIS_Maps\Engineering Base Map.mxd User: steveng Fa cility Surv eyFacility Surve yMapMap Water Laterals &A Other Water_Mains Storm Laterals Storm Laterals Laterals Storm Point %U Laterals StormPoint FUNCTION LEAD MAIN PRIVATE LEAD Sanitary Lateral Points %U Sanitary LateralPoints Sanitary Laterals SanitaryLaterals Sanitary Sewer Sanitary Sewer Casing PipeStreet Centerline Class Class 1 LocalRoads Local Roads Road Right ofWay Line Alternate Parcels PARCELTYPE parcel condo condo commonarea EasementEncroachments MISC SANITARY STORM WATER South Side RGB Red: Band_1 Green: Band_2 Blue: Band_3 City of Oshkosh maps and data are intended to be used for general identificationpurposes only, and the City of Oshkosh assumes no liability for the accuracy ofthe information. Those using the information are responsible for verifyingaccuracy. For full disclaimer please go to www.ci.oshkosh.wi.us/GISdisclaimer ¯ 0 125 250ft Printing Date: 10/11/2022Prepared by: City of Oshkosh, WI 1 in = 200 ft 1 in = 0.04 mi DocuSign Envelope ID: 10FC554E-D326-4241-9B65-4FA65B40E6BE E.C. MERRILL WISCONSIN TELEPHONE COMPANY THOMA OILINC. LOUIS A. THOMA SBF CORPORATION WINNEBAGO EXECUTIVE OFFICE DEVELOPMENT SUPER VALUE INC. (CUB FOODS)HUMANE SOCIETY CHEMICAL BLDG SOLIDS HANDLING BLDG PRIMARY CLARIFIER NO. 2 PRIMARY CLARIFIER NO. 4 TRAIL DEMPSEY AERATION TANK NO. 2 GRIT CHAMBER NO. 2 GRIT CHAMBER NO. 1 ADMINISTRATION BLDG. PARKING PRIMARY CLARIFIER NO. 1 PRIMARY CLARIFIER NO. 3 ELECTRICAL CONTROL BUILDING "A" AERATION TANK NO. 1 SECONDARY CLARIFIER NO. 1 SECONDARY CLARIFIER NO. 2 SECONDARY CLARIFIER NO. 4 ELECTRICAL CONTROL BUILDING "B" CHLORINE CONTACT TANK NO. 2 SECONDARY CLARIFIER NO. 3 CHLORINE CONTACT TANK NO. 1 BUS BARN KNAPP STREET WITZEL AVENUE CAMPBELL ROAD CA MPBELL E E E 755 754 753 756757758 753 754 755 756757758 * 752 7 5 2 752 752 M T T T T T T M T ~~ ~ ~ ~ ~ M M STATIONINFLUENT PUMP G G G 4" W W W 4" 6" S AN 18" S TS S T S 1 8 " S T S P E 6 0 " 5 4 " 54" PE PE PE PE 54" PE 18"STS STS STS STS STS SAN15" SAN SAN SAN SAN PE SAN TRAIL BUILDING "B" CONTROLELECTRICAL SECONDARY CLARIFIER NO. 4 NO. 3CLARIFIERSECONDARY TANK NO. 2 DEMPSEY SECONDARY CLARIFIER NO. 2 SECONDARY CLARIFIER NO. 1 AERATION CONTACT TANK NO. 1CHLORINE TANK NO. 1 AERATION BUILDING "A" CONTROLELECTRICAL C A M P B E LL R O AD INFLUENT TRANSFORMERS ELECTRICAL BLDGCHEMICALNO. 2CLARIFIERPRIMARY NO. 1PRIMARY CLARIFIER PRIMARY CLARIFIER NO. 4 CLARIFIERPRIMARY NO. 3 NO. 2 GRIT CHAMBER NO. 1 GRIT CHAMBER STATIONPUMP BLDG. ADMINISTRATION PARKING C A MP BELL TANK NO. 2CHLORINE CONTACT WITZEL AVENUE BARNBUS K N AP P S TR E E T 12" STS STS 10"STS10"STS 6"W W SAN15" BUILDINGGRIT HANDLING BUILDINGHEADWORKS PARKING FUEL PUMP STATION UNDERGROUND FUEL TANKS BUS WASH STATION 10" STS 10" CIP PREVIOUSLY ABANDONED 4" CIP PREVIOUSLY ABANDONED HB (TYP.) HB MOUNTED TO WALL HB (TYP.) HB MOUNTED TO WALL HB MOUNTED TO WALL HB (TYP.) HB (TYP.) SAN SANSTS SAN42" 42"SAN 18" STS PREVIOUSLY ABANDONED 15" SAN. SEWER PREVIOUSLY ABANDONED 42" SAN. SEWER PREVIOUSLY ABANDONED 54" 42" SEE NOTE 4 8" CIP D (TYP.)HB HB (TYP.) 1 1/2" FE TO BE CAPPED AND ABANDONED FOLLOWING HOSE BIB 42" SAN SAN SAN S T S DIGESTER BUILDINGCONTROL DIGESTER NO. 3 DIGESTER NO. 1 NO. 2DIGESTER AND LOADINGSLUDGE DEWATERING BUILDING MOUNTED TO WALL 1" FE 1" NPW FROM EXISTING DIGESTER LOCATION OF FORMER INCINERATOR LAGOON ~ 3/4" FE LOCATION OF FORMER ANAEROBIC DIGESTER COMPLEX ~ 8" CIP D TO BE ABANDONED 6" SLUDGE TO BE 6" SLUDGE SOLIDS BLDGHANDLING 6" SAN.S 60" PE 54" PE 18" STS TO BE CAPPED C EL. 750.83 L12" WAS C EL. 746.00 12" WAS L C EL. 746.00 10" PRS L 8" PRE C EL. 747.66 L W W W W W W W 3" SAN 3" VALVE WITH VALVE BOX LABELED "WATER" PROVIDE TAPPING SADDLE INTO EXIST. 6" WATER MAIN 24" STS 1/2" NG 8" DGD 42" SANITARY SEWER 42" SANITARY SEWER ~ SEE NOTE 1 ~ ~ 6" W ~ P E SAN 12" 4 2 " 5 4" PE ST 39" TO RIVER 8" STS L 12" STS IE. 745.30 AND ABANDONED G G G G G G G G G 4" 4" 4" SAN SAN SAN SAN SAN SAN 15" ~ ~ ~ ~ ~ ~ STS STS ST 24" W W WW SANSAN SS 8" SAN 24" STORM WW W PITCH PITCH SEE NOTE 4 ABANDONED PI T C H T O D R AI N MH-1A H MH-1 MH8B.3 MH7.1 MH-9B MH-8 MH-9 IMH8B.2 MH8B MH8B.1 6 "SAN 8" ~ ~ HYDRANT I I MH-6 I MH-6B I MH-5B MH-5 MH-4 MH-3 PE34" X 53" PE TO RIVER MH-2 1" = 50'SITE PLAN N I.E. 744.21 NEW 27" STS I.E. 744.12 STMH-6 STMH-7 8" STS STMH-1 STMH-2 STMH-3 STMH-4 STMH-5 STMH-4B PROVIDE NEW 12" STS FROM STMH-4B TO STMH-3 PS-1 MH-7 STMH-9 18" STS MH7.2 STMH-12 STMH-11 STMH-10 STMH-4.2 MH-10 ADJUST MANHOLE AND CASTING TO EL. 752.50 STMH-10B STMH-10B.1 STMH-11B STMH-12B MH-11 MH-12 MH-13 MH-14 MH-15 STMH-8 STMH-4.1 C EL. L3" PW 748.25 12" ST 12" ST 24" STS 24" STS 18" STS 24" STSSTATIC W.L. EL. 747.6 100 YR. EL. 750.0 STMH-2C STMH-3C STMH-4C STMH-1C P E SLOPE AT 1/8"/FT ELECTRICAL STORAGE BUILDING P E STMH-2D STMH-1D 10" STS 10" STS10" STS 12" STS 1" FECONNECT TO EXISTING STMH-3D 6" SAN. SEWER IE. 747.00 6" SAN. SEWER IE. 746.10 STORM SEWER OUTFALL LOCATION TO BE DETERMINED IN FIELD O127 ~ STORM SEWER OUTFALL LOCATION TO BE DETERMINED IN FIELD O127 ~ 6" STS IE. 745.05 6" STS IE. 747.31 24" STS 8" STS IE. 747.46 NOTE: STMH-4B IS A CORREGATED METAL PIPE VERTICAL IN THE GROUND S T S S AN 72" SAN 60" SAN 4 2" S A N 12" S TS 60" SAN 12" STS 72" SAN MH-1 SAN42" SAN STMH-2C STMH-1C MH-1A EaCECE CECE T G G G G G G G G G SPD SPD J J EXIT EXIT DB DB Top of weir Water surface in channel (remove grating to access) Bottom of V-notch NORTH SCALE: 1"=60' DocuSign Envelope ID: 10FC554E-D326-4241-9B65-4FA65B40E6BE I:\Wastewater\Facility Plan-WWTP\Survey RFP\Sample Current Agreement Form_11-28-22.docx Page 1 of 7 AGREEMENT This AGREEMENT, made on the _____ day of ________________, 2022, by and between the CITY OF OSHKOSH, party of the first part, hereinafter referred to as CITY, and CONSULTANT’S NAME, address , 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 WASTEWATER TREATMENT PLANT TOPOGRAPHIC SURVEY (PROJECT). ARTICLE I. PROJECT MANAGER A. Assignment of Project Manager. The CONSULTANT shall assign the following individual to manage the PROJECT described in this AGREEMENT: Name – Title 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 II. 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 DocuSign Envelope ID: 10FC554E-D326-4241-9B65-4FA65B40E6BE I:\Wastewater\Facility Plan-WWTP\Survey RFP\Sample Current Agreement Form_11-28-22.docx Page 2 of 7 ARTICLE III. SCOPE OF WORK The CONSULTANT shall provide the services described in the CITY’S Request for Proposal. 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. 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. 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 VI. CITY RESPONSIBILITIES The CITY 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. DocuSign Envelope ID: 10FC554E-D326-4241-9B65-4FA65B40E6BE I:\Wastewater\Facility Plan-WWTP\Survey RFP\Sample Current Agreement Form_11-28-22.docx Page 3 of 7 ARTICLE VII. 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 VIII. 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 CITY’s Request for Proposal. 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 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. While CONSULTANT has made reasonable efforts to incorporate into their plan for the PROJECT any known current project impacts of the COVID-19 pandemic, CONSULTANT has not accounted for, and is not responsible for, unknown future changes 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 CONSULTANT staff or others) to the extent they delay or otherwise impact the PROJECT. In that event, CONSULTANT will notify CITY and work in good faith to equitably address any unexpected impacts therefrom. DocuSign Envelope ID: 10FC554E-D326-4241-9B65-4FA65B40E6BE I:\Wastewater\Facility Plan-WWTP\Survey RFP\Sample Current Agreement Form_11-28-22.docx Page 4 of 7 ARTICLE IX. 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’s Request for Proposal dated November 28, 2022 and attached hereto 3. CONSULTANT’s Proposal dated ____________ 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 X. 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:  Time and Materials Not to Exceed $_________ (__________________________________________ Dollars).  Attached fee schedule(s) 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. 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. DocuSign Envelope ID: 10FC554E-D326-4241-9B65-4FA65B40E6BE I:\Wastewater\Facility Plan-WWTP\Survey RFP\Sample Current Agreement Form_11-28-22.docx Page 5 of 7 E. Expenses. Expenses may be billed with up to a maximum of ten percent (10%) 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 XI. STANDARD PROVISIONS The CONSULTANT 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. ARTICLE XII. 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, their agents or assigns, their employees, or their 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 XIII. INSURANCE The CONSULTANT agrees to abide by the attached City of Oshkosh Insurance Requirements. DocuSign Envelope ID: 10FC554E-D326-4241-9B65-4FA65B40E6BE I:\Wastewater\Facility Plan-WWTP\Survey RFP\Sample Current Agreement Form_11-28-22.docx Page 6 of 7 ARTICLE XIV. 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 XV. RE-USE OF PROJECT DOCUMENTS All reports, drawings, specifications, documents, and other deliverables of CONSULTANT, whether in hard copy or in electronic form, are instruments of service for this PROJECT, whether the PROJECT is completed or not. Subject to individual review, CONSULTANT’S reports, drawings, specifications, documents, or other deliverables will generally be considered public records that are available to the public upon request. Neither the CITY nor the CONSULTANT, therefore, has control of these documents once they are disclosed as a public record. It is understood between these two (2) parties, however, that CONSULTANT does not intend to state or imply that the PROJECT documents it creates have any purpose unrelated to the PROJECT. To the extent the CITY may re-use or reference any part of the CONSULTANT’S documents or information on unrelated projects, the CITY agrees to independently verify their applicability for unrelated projects and further agrees the Standard of Care applicable to the documents for this PROJECT will not apply to their re-use or reference in unrelated projects. ARTICLE XVI. SUSPENSION, DELAY, OR INTERRUPTION OF WORK The CITY may suspend, delay, or interrupt the services of CONSULTANT for the convenience of the CITY. In such event, CONSULTANT's agreement price and schedule shall be equitably adjusted. DocuSign Envelope ID: 10FC554E-D326-4241-9B65-4FA65B40E6BE I:\Wastewater\Facility Plan-WWTP\Survey RFP\Sample Current Agreement Form_11-28-22.docx Page 7 of 7 ARTICLE XVII. 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: CONSULTANT ____________________________ By: _____________________________ ____________________________ (Seal of CONSULTANT _____________________________ if a Corporation) (Specify Title) By: _____________________________ _____________________________ (Specify Title) CITY OF OSHKOSH _____________________________ By: _____________________________ (Witness) Mark A. Rohloff, City Manager _____________________________ And: _____________________________ (Witness) Jessi L. Balcom, 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: 10FC554E-D326-4241-9B65-4FA65B40E6BE 4/14/14 III - 1 CITY OF OSHKOSH INSURANCE REQUIREMENTS III. PROFESSIONAL SERVICES LIABILITY INSURANCE REQUIREMENTS The Contractor shall not commence work on contract until proof of insurance required has been provided to the applicable City department before the contract or purchase order is considered for approval by the City. It is hereby agreed and understood that the insurance required by the City of Oshkosh is primary coverage and that any insurance or self insurance maintained by the City of Oshkosh, its officers, council members, agents, employees or authorized volunteers will not contribute to a loss. All insurance shall be in full force prior to commencing work and remain in force until the entire job is completed and the length of time that is specified, if any, in the contract or listed below whichever is longer. 1. PROFESSIONAL LIABILITY A. Limits (1) $1,000,000 each claim (2) $1,000,000 annual aggregate B. Must continue coverage for 2 years after final acceptance for service/job 2. GENERAL LIABILITY COVERAGE A. Commercial General Liability (1) $1,000,000 each occurrence limit (2) $1,000,000 personal liability and advertising injury (3) $2,000,000 general aggregate (4) $2,000,000 products – completed operations aggregate B. Claims made form of coverage is not acceptable. C. Insurance must include: (1) Premises and Operations Liability (2) Contractual Liability (3) Personal Injury (4) Explosion, collapse and underground coverage (5) Products/Completed Operations must be carried for 2 years after acceptance of completed work (6) The general aggregate must apply separately to this project/location 3. BUSINESS AUTOMOBILE COVERAGE– If this exposure shall exist: A. $1,000,000 combined single limit for Bodily Injury and Property Damage each accident B. Must cover liability for Symbol #1 - “Any Auto” – including Owned, Non-Owned and Hired Automobile Liability. DocuSign Envelope ID: 10FC554E-D326-4241-9B65-4FA65B40E6BE 4/14/14 III - 2 4. WORKERS COMPENSATION AND EMPLOYERS LIABILITY – “If” required by Wisconsin State Statute or any Workers Compensation Statutes of a different state. A. Must carry coverage for Statutory Workers Compensation and an Employers Liability limit of: (1) $100,000 Each Accident (2) $500,000 Disease Policy Limit (3) $100,000 Disease – Each Employee 5. UMBRELLA LIABILITY - If exposure exists, provide coverage at least as broad as the underlying Commercial General Liability, Watercraft Liability (if required), Automobile Liability and Employers Liability, with a minimum limit of $2,000,000 each occurrence and $2,000,000 aggregate, and a maximum self-insured retention of $10,000. 6. ADDITIONAL PROVISIONS A. Acceptability of Insurers - Insurance is to be placed with insurers who have an A.M. Best rating of no less than A- and a Financial Size Category of no less than Class VI, and who are authorized as an admitted insurance company in the state of Wisconsin. B. Additional Insured Requirements – The following must be named as additional insureds on all Liability Policies for liability arising out of project work - City of Oshkosh, and its officers, council members, agents, employees and authorized volunteers. On the Commercial General Liability Policy, the additional insured coverage must be ISO form CG 20 10 07 04 or its equivalent and also include Products – Completed Operations ISO form CG 20 37 07 04 or its equivalent for a minimum of 2 years after acceptance of work. This does not apply to Professional Liability, Workers Compensation and Employers Liability. C. Certificates of Insurance acceptable to the City of Oshkosh shall be submitted prior to commencement of the work to the applicable City department. These certificates shall contain a provision that coverage afforded under the policies will not be canceled or non renewed until at least 30 days’ prior written notice has been given to the City Clerk – City of Oshkosh. DocuSign Envelope ID: 10FC554E-D326-4241-9B65-4FA65B40E6BE CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYY) 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 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 CONTACT NAME: PHONE (A/C. No. Ext): FAX (A/C. No): E-MAIL ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC # INSURER A: ABC Insurance Company NAIC # INSURED INSURER B: XYZ Insurance Company NAIC # INSURER C: LMN Insurance Company NAIC # INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 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 AMY 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 LTR TYPE OF INSURANCE ADDL INSR SUBR WVD POLICY NUMBER POLICY EFF (MM/DD/YYY) POLICY EXP (MM/DD/YYY) LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED PREMISES (Ea occurrence) $ 50,000 A CLAIMS-MADE OCCUR MED EXP (Any one person) $ 5,000 ISO FORM CG 20 37 OR EQUIVALENT PERSONAL & ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN’L AGGREGATE LIMIT APPLIES PER: PRODUCTS – COMP/OP AGG $ 2,000,000 POLICY PRO- JECT LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea accident) $ 1,000,000 ANY AUTO BODILY INJURY (Per person) $ B ALL OWNED AUTOS SCHEDULED AUTOS BODILY INJURY (Per accident) $ HIRED AUTOS NON-OWNED AUTOS PROPERTY DAMAGE (Per accident) $ $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ 2,000,000 A EXCESS LIAB CLAIMS-MADE AGGREGATE $ 2,000,000 DED RETENTION $10,000 $ C WORKERS COMPENSATION AND EMPLOYERS’ LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICE/MEMBER EXCLUDED? Y / N (Mandatory in NH) N If yes, describe under DESCRIPTION OF OPERATIONS below WC STATU- TORY LIMITS OTH- ER E.L. EACH ACCIDENT $ 100,000 E.L. DISEASE – EA EMPLOYEE $ 100,000 E.L. DISEASE – POLICY LIMIT $ 500,000 A PROFESSIONAL LIABILITY $1,000,000 EACH CLAIM $1,000,000 ANNUAL AGGREGATE DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) Additional Insureds per attached endorsements. Certificates of Insurance acceptable to the City of Oshkosh shall be submitted prior to commencement of the work to the applicable City department. These certificates shall contain a provision that coverage afforded under the policies will not be canceled or non renewed until at least 30 days’ prior written notice has been given to the City Clerk – City of Oshkosh. CERTIFICATE HOLDER CANCELLATION City of Oshkosh, Attn: City Clerk 215 Church Avenue PO Box 1130 Oshkosh, WI 54903-1130 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE, THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE © 1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD Insurer(s) must have a minimum A.M. Best rating of A- and a Financial Performance Rating of VI or better. Policy effective and expiration date. Policy effective and expiration date. Policy effective and expiration date. Policy effective and expiration date. General Liability Policy Number Auto Liability Policy Number Professional Liability Policy Number Workers Compensation Policy Number Insurance Agent’s contact information. Insurance Agency contact information, including street address and PO Box if applicable. Insured’s contact information, including name, address and phone number. Insurance Standard III SAMPLE CERTIFICATE Please indicate somewhere on this certificate, the contract or project # this certificate is for. Umbrella Liability Policy Number Policy effective and expiration date. DocuSign Envelope ID: 10FC554E-D326-4241-9B65-4FA65B40E6BE POLICY NUMBER: COMMERCIAL GENERAL LIABILITY CG 20 10 07 04 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED – OWNERS, LESSEES OR CONTRACTORS – SCHEDULED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s): Location(s) Of Covered Operations As required by contract Any and all job sites Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. Section II – Who Is An Insured is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for “bodily injury”, “property damage” or “personal and advertising injury” caused, in whole or in part, by: 1. Your acts or omissions; or 2. The acts or omissions of those acting on your behalf; In the performance of your ongoing operations for the additional insured(s) at the location(s) design- nated above. B. With respect to the insurance afforded to these additional insureds, the following additional exclu- sions apply: This insurance does not apply to “bodily injury” or “property damage” occurring after: 1. All work, including materials, parts or equip- ment furnished in connection with such work, on the project (other than service, maintenance or repairs) to be performed by or on behalf of the additional insured(s) at the location of the covered operations has been completed; or 2. That portion of “your work” out of which the injury or damage arises has been put to its in- tended use by any person or organization other than another contractor or subcontractor en- gaged in performing operations for a principal as a part of the same project. CG 20 10 07 04 © ISO Properties, Inc., 2004 Page 1 of 1 Insurance Standard III SAMPLE CERTIFICATE Please indicate somewhere on this certificate, the contract or project # this certificate is for. Policy # DocuSign Envelope ID: 10FC554E-D326-4241-9B65-4FA65B40E6BE POLICY NUMBER: COMMERCIAL GENERAL LIABILITY CG 20 37 07 04 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED – OWNERS, LESSEES OR CONTRACTORS – COMPLETED OPERATIONS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s): Location And Description Of Completed Operations As required by contract Any and all job sites Information required to complete this Schedule, if not shown above, will be shown in the Declarations. Section II – Who Is An Insured is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for “bodily injury”, “property dam- age” caused, in whole or in part, by “your work” at the location designated and described in the sched- ule of this endorsement performed for that additional insured and included in the “products-completed operations hazard”. CG 20 37 07 04 © ISO Properties, Inc., 2004 Page 1 of 1 Policy # Insurance Standard III SAMPLE CERTIFICATE Please indicate somewhere on this certificate, the contract or project # this certificate is for. DocuSign Envelope ID: 10FC554E-D326-4241-9B65-4FA65B40E6BE DocuSign Envelope ID: 10FC554E-D326-4241-9B65-4FA65B40E6BE DocuSign Envelope ID: 10FC554E-D326-4241-9B65-4FA65B40E6BE DocuSign Envelope ID: 10FC554E-D326-4241-9B65-4FA65B40E6BE DocuSign Envelope ID: 10FC554E-D326-4241-9B65-4FA65B40E6BE DocuSign Envelope ID: 10FC554E-D326-4241-9B65-4FA65B40E6BE DocuSign Envelope ID: 10FC554E-D326-4241-9B65-4FA65B40E6BE DocuSign Envelope ID: 10FC554E-D326-4241-9B65-4FA65B40E6BE DocuSign Envelope ID: 10FC554E-D326-4241-9B65-4FA65B40E6BE DocuSign Envelope ID: 10FC554E-D326-4241-9B65-4FA65B40E6BE DocuSign Envelope ID: 10FC554E-D326-4241-9B65-4FA65B40E6BE