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HomeMy WebLinkAbout23-28 R Ind CA #1-WFP Raw Wtr Diversion Vault Hatch Retrofit_11-16-23I:\Water Filtration\23-28 Emer WFP Intake Cleaning\Administrative\Contract Information\Contractor- Consultant-Supplier Agreements\R Industries\23-28 R Ind CA #1-WFP Raw Wtr Diversion Vault Hatch Retrofit_11-16-23.docx Page 1 of 2 AMENDMENT NO. 1 The CITY OF OSHKOSH, hereinafter referred to as CITY, and R INDUSTRIES LLC, W2096 County Road KK, Kaukauna, WI 54130hereinafter referred to as the CONSULTANT, entered into an agreement for CITY OF OSHKOSH WATER FILTRATION PLANT RAW WATER DIVERSION VAULT HATCH RETROFIT on September 25, 2023. Paragraph C in ARTICLE XII. PAYMENT included the provision that 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. THEREFORE, the CITY and the CONSULTANT agree to insert the following paragraph after the first paragraph in ARTICLE IV. SCOPE OF WORK: The CONSULTANT shall provide the services described in the CONSULTANT’s Contract Field Order No. 1 dated November 4, 2023. The CITY and the CONSULTANT further agree to insert the following bullet point after the first bullet point in Paragraph A of ARTICLE VII. PAYMENT:  Payment for Amendment No. 1 shall be a Time and Materials Sum not to exceed $934.79 (Nine Hundred Thirty Four Dollars and Seventy Nine Cents). DocuSign Envelope ID: 75F1D2DB-A0DF-4901-9957-29D0BB7A8617 I:\Water Filtration\23-28 Emer WFP Intake Cleaning\Administrative\Contract Information\Contractor- Consultant-Supplier Agreements\R Industries\23-28 R Ind CA #1-WFP Raw Wtr Diversion Vault Hatch Retrofit_11-16-23.docx Page 2 of 2 All other terms contained within the September 25, 2023 agreement remain unchanged and in effect. In the Presence of: CONSULTANT ____________________________ By: _____________________________ ____________________________ Ross Schmidt (Seal of Consultant 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 which will accrue under this Agreement. __________________________ City Attorney _______________________________ City Comptroller DocuSign Envelope ID: 75F1D2DB-A0DF-4901-9957-29D0BB7A8617 DocuSign Envelope ID: 75F1D2DB-A0DF-4901-9957-29D0BB7A8617 DocuSign Envelope ID: 75F1D2DB-A0DF-4901-9957-29D0BB7A8617 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: 75F1D2DB-A0DF-4901-9957-29D0BB7A8617 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: 75F1D2DB-A0DF-4901-9957-29D0BB7A8617 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: 75F1D2DB-A0DF-4901-9957-29D0BB7A8617 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: 75F1D2DB-A0DF-4901-9957-29D0BB7A8617 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: 75F1D2DB-A0DF-4901-9957-29D0BB7A8617 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: 75F1D2DB-A0DF-4901-9957-29D0BB7A8617