HomeMy WebLinkAboutKS Energy Services Inc Fiber Optic Project 011006
996~ NOI1~OdMO~ OMO~V@
(gonom~:) Sl: OMO~V
~ Slf8Ml/~ap~aq~s sewoq1
3AliViN3S3Hd3H 03ZIHOHinV Z0617S 1M 'qsO>lqsO
'S3Ali v iN3S3Hd3H HO SiN3~V Sil 'H3HnSNI 3Hi NOdn ONI)! ANV ~O laa~lS q~~nq) SlZ
AiIlISVIl HO NOliV~IlS0 ON 3S0dWI11VHS 30UON Hons 1lVW Oi 3HnlIV~ inS ~a6euew Al D : lIn\f
'i~31 3Hi Oi 03WVN H3010H 3iVOI~liH30 3Hi Oi 30liON N3illHM SAVO or qso}JqsO JO j~H)
1lVW Oi HOA V3GN3111M H3HnSNI ~NInSSI 3Hi '~03H3Hi 3i VG NOli 'lfHldX3
3Hi 3HO~3S G31130NVO 3S S3101l0d G3SIHOS3G 3AOSV 3Hi ~O ANV mnOHS
_~,~__,_~~\a_\
\ :lOld::!O ,. '{\ ~ \ 'suo~snpxa pue 'suo~sualxa ' SUO H ~puo~ 'sw~oJ. a6e~a^0
\ ri%:~r- ~'\l~'8e.kJ.. s~,~ Ittwa pue 'Olne 'AHHqeH Le~aua6 6U~AL~apun SMOLLOJ a6e~aM~ eLLa~qwn
\ ~r\\ 9~Ql r,,""c\\ 900no pa~O~d ~HdO ~aq~.:1 :3~
\! ; \ l '",SNOISIAOHd lVI03dS I iN3W3SHOGN3 AS G3GGV SNOISnlOX31 S310lH3A I SNOUV001l SNOliVH3dO ~O NOIidlHOS3G
\\\ H --~. ~~
.. \ -- , - )J ~.
.~: '~~ ~~~!; ~\ .
'\~1i. iJ.~~~,"~,,_,~~^~=':~' 1--'
H3HiO
<- 1 AOIlOd - 3Slt3SI0 ,,.3 MOlaq SNOISIAOHd 1\t103dS
Japun aqlJ~sap 'SaA}1
$ 33A01d~3 1t3 - 3Slt3SI0 ,,.3 i.030nlOX3 H3S~3~~30L:I:l0
$ iN301001t HOlt3 ,,.3 3Alin03X3~3NiHltd~0i3IHdOHd ANIt
AiIlISVIl .S1:I3A01dW3
-~tol I ::.:t-Ir~lg~~ I GNV NOli VSN3dWO:J. SH3)!1:I0M
$ 000'01 $ NOliN3i3H '===
$ 31SIiOn03CI
$ \f
000'000'01 $ 3iltE>3H88\t 30ltW S~I\tlO D Hnooo ~
000'000'01 $ 30N31:1HnOOO HO\t3 900Z/ ll/SO SOOZ/Ll/SO ^NH19S0)X3S0H) AiIlISVIl \tl13HSWnlSS3OX3
$ 88V :A 1NO Oinlt Oinlt AN\! C
$ 001t \t3 N\tHi H3HiO
$ iN301001t \t3 - A 1NO Oin\t AiIlISVIl 38'fHV8
$ (luapp~8 Jad) - f--
38mltO AiH3dOl:ld
f--
(luapp~8 Jad) SOinlt 03NMo-NON
$ AHnrNI A 1100S I--
SOiOlt 031:11H
f--
(uosJad Jad) SOinlt 031n03HOS
$ AHnrNI A 1100S -
SOinlt 03NMO llV
-
(luapP~8 83) Oinlt AN't
$ -
ilWIl 318NIS 03N18~00 -- AiIlISVIl 31lS0WOinV
:J01U i03r U AOIlOd L
-OHd
$ 88\t dOld~OO - SiOnOOHd :H3d S3lldd\t il~1l 3ilt831:188\tl,N38
--
$ 3ilt83H88\t1\tl:l3N38
--
$ AHnrNI AOIt ~ 1ltNOS1:I3d
l:In:Joo D 30m S~I\tlO [= -
$ (uosJad auo AUIt) dlG 03~~
-
$ 03iN3H Oi 38mltO Aill18ltll1\tl:l3N38 1\tlOH3~~0:)
-
$ 30N3Hl:1nOOO HO\t3 AiIlISVIl1~13N38
SilWIl NOli VHldX3 AOIlOd 3Ali03~:l3 AOIlOd 1:I3SWnN AOIlOd 30N'lfHnSNI :l0 3dAi W,'tJ~~ :tNI
'S1N11;/18 OIVd A8 a38n03tl N338 3AVH A'o'IN NMOHS Sl11N1l31'o'83tl8!0)1;/ 'S3181l0d
H8nS::I0 SNOlllaN08 aNI;/ SNOISnl8X3 'SINtl313Hl 11'0' 01183r8nS SI NI3tl3H a381tl8S3a S3181l0d 3Hl A8 a3atlO::l::ll;/ 38NVtlnSNI3Hl 'NI'o'ltl3d A'o'IN
tlO a3nSSI38 AVIN 31'o'81::111tl38 SIHl H81HM 01183dS3tl HIIM IN3INn80a tl3HIO tlO 18~lN08 ANV::IO NOlllaN08 ~O INtl31 'lN31N::ltlln03tl AN'o'
8NlaN'o'1SHlIMlON 'a31'o'81aNI aOltl3d A81l0d 3Hl ~O::l3A08'o' a3INVN 03tlnSN13Hl 01 03nSSI N338 3AI;/H M0138 a31SI138NVtlnSNI::IO S3181l0d 3Hl
NOll 'Vl13~NV~
M3010H 31 V~I.:I11M3~
S3~VM3^0:J
:3 H3HnSNI
:0 H3HnSNI OZHS 1M 'AO~.l lse3
:0 H3HnSNI OZ AMH ISHM
:8 1:I31:1nSNI LH X09 Od
Auedwo) a~ue~nsu1 s~Ole6~^eN :\t 1:I3HnSNI ~u1 sa~~^~as A6~au3 S>I O3HnSNI
# ~IVN 3~VM3^0~ ~NIOMO.:l.:lV SM3MnSNI 0191-LS1fS 1M 'eqsa}JneM
01:91 xog Od
"M0138 S31~110d 3H1 A8 030MO.:l.:lV 3~VM3^0~ 3H1 M311V anua^\f aupe}l 3 lSSl
MO ON31X3 'ON3WV 10N S300 31 V~I.:I11M3~ SIH1 'M3010H
31V~I.:I11M3~ 3H1 NOdn SlH~IM ON SM3:1NO:J ONV A1NO '~U1 'sa~~^~as a~ue~nsu1 }I ~ }I
NOl1VWMO:lNI :10 M311VW V SV 03nSSI SI31V:JI:l11M3:J SIH1 OSOL-17lS(Z9Z) XV:l LOOL -99S (OOS) H30nGOl:ld
900Z/0f/m I 3:>NV~nSNI All118Vll :10 3.L V:>I:lI.L~3:> w(JBO~'V
(AAAAlGG1WW) 3iVG
SOin\t 03NMO-NON X
SOlOlt 03lJIH X
SOlO\t 031n03HOS
SOinlt 03NMO -Il\t
Oinlt AN\t X
S&OBl:BL&v~6A}tSV V
001
OOS'Z:paO Od/l8 X
l:Inooo ~ 30\t~ Sl^JI\tlO [
AiIl18\t1l1\t1:l3N381\tI:JH3l^JVlI00 X
SvOBl:BL&V ~6A}tAA AiIlISVIl1'fH3N39 "V
SilWIl 3tfig3~1r; A5NfO~ H3SWnN AOIlOd 3:lN'lfHnSNI :l0 3dAJ, l:ISN l:Ii
'S~11;Il8 Ol'o'd A8 038na3<J N338 3AVH AI;I~ NMOHS Sll~1l31'o'83H88V 'S3181l0d
H8nS.::I0 SNOlllaN08 ON'o' SNOISnl8X3 'S~tl313Hl 11'0' 01183r8nS SI N13<J3H G381<J8S30 S3181l0d 3Hl A8 G30<JO.::l.::l'o' 38NVtlnSNI3H.L 'NI\fl<J3d AI;I~
tlO G3nSS138 A'o'~ 31'o'81.::111<J38 SIHl H81HM 01183dS3tl HIIM lN3INn800 tl3H10 tlO 18'\11JIN08 ANV::IO NOI1ION08 tlO ~<J31 'lN3~3<Jln03tl ANV
8NlaNV1SHlIMlON '031'o'810NI OOltl3d A81l0d 3Hl tlO::l3A08V 03Wv'N 03<JnSNI 3Hl 01 03nSSI N338 3A'o'H M0138 031SIl38NVtlnSNI .::10 S3181l0d 3Hl
S3~VM3^0~
Bll6 ~ NOI! VMOdHO:J OMO::>V @)
&M~
LLBB9&W/UBSOvS#
~(Y? '(t ~~
3^liViN3S3l:1d31:1 03ZI1:I0HinV
'S3^liViN3S31:1d3H
l:IO SiN3~V Sil 'H3l:1nSNI 3Hi NOdn ONI)! ANV :l0 Aill18ltlll:lO NOliV81lS0 ON 3S0dWI
11VHS OS 00 Oi 3HnlIV~ inS 'i~313Hi Oi G3W\tN H3010H 3iVOI:lliH30 3Hi Oi 30liON
N3illHM SAVO ~ 1lVW Oi HOAV30N311IM 1:I3HnSNI ~NmSSI3Hi ':l03H3Hi 3iVG
8V 3Hi :l0 ANV OlnOHS
NOI! V'113:JNV':J
iN3010:l\t HO\'3 '1'3
90/H/SO
SO/H/SO
S ~OBl:BL&v~6AH~M
$
$
$
$
$
$ 881t
$
$
3ilt83H88\t
30N3HHnooo HO\t3
:A 1NO Oinlt
NltHi H3HiO
00\t \t3
iN30100\t 1t3 - A 1NO Oinlt
$
(IUSPP~8 JSd)
38\tl^J\t0 AiH3dOHd
$
(lUSpp~8 JSd)
AHnrNI A 11008
(uOSJsd JSd)
Al:InrNI A 11008
000'000' U
(IUSpp~8 83)
ill^J11 318NIS 03NISl^J00
90/H/SO
SO/H/SO
000 000 Z$
000 000 Z$
000 000 ~$
000 S$
000 00&$
000 000 U
E>8\t dO/dl^JO:J - SlOnOOl:ld
3ilt83H88\t1ltl:l3N38
AHnrNI ^o\t ~ 1\tNOSH3d
(uOSJsd suo AUIt) dX3 03~
90/H/SO
SOIL ~/SO
l:!0 ~ (IlOHOI~~) Sl: aMO::>V'
Z06vS 1M 'HSO}tHS()
lS H~MnH~ S~;~
M3~VNVW A11~ NIDf
HSO}tHSO :10 All:)
H3alOH 3.LV:JI:lIIH3:J
I
H3HiO
MOlsq SNOISI^Ol:ld 1ltl03dS
Jspun eq!J~SSp 'SSA }I
W30nlOX3 H3Sl^J3l^J~301:l~0
3^lin03X3~3NiH\td~OBIHdOHd AN\t
AiIlISltll,SH3A01dW3
ONV NOliVSN3dWClO SH3)!HOM 8
$ NOliN3BH
3181iOno,lO
301t~ S~llt10 D Hno:)O
AiIlISVIl Vl13HSWnlSS3:lX3
Oinlt ANIt
Aill18VIl 3~'lfHV~
:3 H3HnSNI Ol:~&S 1M 'AOMllS'1f3
:0 H3HnSNI L&~ X08 Od
::J H3HnSNI ~OA~~:3N3BSi6~
AN \fdWO~ 3~N~nSNI lVM3N3~ nVSnVM :s H3HnSNI :>NI S3~I^M3S..A~M3N3 ~S}t
AN {dWO~3~NVMnSNISS3NISha nVSnYM :ltH3HnSNI 03HnSt
# :JIV'N 3~VM3^0::> ~NlaMO:l:lV SH3MnSNI v&&l:- LLS V ~'
600&-vl:l:&S 1M '33}tnVM11~
"M0138 S31::>1l0d 3H! AS 03aMO:l:lV' 3~VM3^0:J 3H.L M3.L1V' 3~Vld >IMVd M OOB~
MO aN3.LX3 'aN3WV' .LON S300 3.LV':JI:lI.LH3::> SIHl 'H3alOH
3.LV:JI:lI.LH3:J 3H.L NOdn S.LHmM ON SH3:lNO:J aNV' A1NO A~N3~V 3MnlVI\IElIS nVSnV^
NOI!VWHO:lNI:lO M311V'W V' SV 03nSSI SI 3!V::>I:lI!M3::> SIH! H3:lnOOH
I '.,v:;"'oo
90/0&1&0 3~N~nSNI A11118V'll :10 31 V'~1:l11~3~ . \~~
(AAAA/001WW) 3iVG rll(7HO::J \f
A~M3N3S}t
~ ~ 17l:B :#Jua!1~
B86~ NOI.l~Od~O:l aHO:>" Q)
&~~
.LLSS9&Wt lO.LLot'S#
~!O ~ (80J~OO1:) !iZ O~OOV
~,.)"IIn (Y? "(t ~'r'\
3^11'1l'1N~53~d;!lf lJilZllIOHin'll'
'S3^Ll 'IflN3S3H<l~ij ZOG.,g 1M 'HSO~HSO
~o SJ.N~V s.u 'H;lHnSNI 1ilHJ. NO.t1'l aND! ANV ~o AiI'IlOlVI' ~o Ncu'll'~llg0 ON ilSO.tWI .lS H~1:InH:) 91.Z
11VHS os 00 Oi ;;Il;In'IV.t J.nll '.cllll 3Hi Oi o;lWVN ~arj10H :u ":JI~ILl!I"'::l ilHJ. 0.1. a:JlLoN ~39VNVW illn NllV
N3ill~M SAVO tJr 1lYW OJ. ~0^V:lIjN3111M K;l1lnSNI gNlnSSr;:jH.1 '~O~;;tH.I. :l.1:~Q HSO>lHSO ~O A.l1~
NOli'IfHldX3 3Hi E11:10~~a <;l;lll3'JNVO 38 S31::lI'O<l Oil8111JS:;lG ;!AOS'll" "'HI.;;10 AN\#' lJ1nOHl:
NOI.J.V11a0 N'V'O
H3010H ;U"~I:lIJ.1I30
"ANVdWO:l3H.l W01:l:ll.Sann3~ NOdn 31S'o"IV^~ SIIN3W3$}JOON:) 31dWVX3
N'o' 'a^OSV O:UV:JIONI AOl10d All118VI1 ''\QI3N3~ 3H11:13CNn 99S01~' "ON WMO::l
lN3W3S1:IOCN3 1:I3d C31:1nSNl 1VNOlllaCV NV SV 031$11 SI HSO>lHSO :110 ..1.110 3H.1.
900UO l::J;trOl::Id :JlldO ~3al:l :31:1
SNOISI^O~d 1V1:J:;ldS I iN3WilWOONEl All G3GOY sNOISn,:.X; J S31:JIH3A1 SNOU.V~O' I SNOliYl:l3dO ,10 NOIJ.dll:lOS3lJ
~ilH.10
000'005$ 1110'111 AOllOoj - 35\f3Sld 'i3 MQI~q s~~~~\\'~q~gs1~1~~~
000'009$ 3:lAO'dVj3 \13 . 3SltOlsJIJ '1'3 W30fllOllol <I38VV3l~kI;;l;)I'!,jO
OOO'OOS$ IN:lOl:J:JV,"::lV3 ',.'" 3^IJ.n03X3Il:13Nll:lVd~0i3ll,1dOl:l.l AN..,.
..u.r'I9'111 .s~13A01<lW3
-~fol I "'-r;1vlsA.~'j"J.1 X 90/,H/SO SO/.L~/~O 9 ~09~e.Let'~6AH:)M GNY NQ'J.VSNil.lWO:) SI:I3:>lHOM 8
S $ NO'J.N3.13~ C
$ 3isliOn03Q
$
$ !il 'F-J3~;;l~\t 010\11'\1 Sv.lIItlD 0 l:In::loo_C
$ 3::lN;l)J)Jnooo H::J'13 ..u.l1IB'IfIl Yl1;ll:l1l....OISSil::lX3
$ Otl'v' ~
~A lNO 011"1\1 OJ.nV' AN'lI.t
$ 00'11'113 N\lH1 !:I3HiO
$ J.N;;tClIOO'll\f3 - AINO Olew A.L1'llIVl' 3!!)'9':~v~
$ (lu"PI;>(l8 18d) -
3;;l'lfI'\lVO .uOlil"'O~d
$ (JUOP!~~~ J~d) SOln'i C3NMO'NON X
AlmrNI AllOOIl SOLn\l Q,"~IH X
sOJ.nv lJ'jin03H::Js -
$ (uo9Jed JOd)
AlJlirNI A 11009 SOinv Q3NMO 11\;1 ~
OOO'OOO'H (lU~PP~B 63) oJ."VAN"I X
lIWIl;Jl'DNIS C13NII3V1l00 90/ HfSO sot L ~ISO !lE08~IU,e'~6^}lSV A.L1'ISVI1 a'IBOI\IOinY V
OOOOOO"l;$ ~O'1 dOldv.lO:J - sJ.onOOl:ld OOi U ;-og~ l!J^OI1OdL X
:~3d S:l11ddV 1Iv.l1l3.LVl;I3\;lOO\l ',I~:I~
OOO'OOO'Z$ 3iV;;l3!:1;;l;;l\ll\tH3N3D r--
000'000 1.$ Al:lnrNI N:).'r/ ~ lltNOSl:l3d OOS't:pea CdtlS X
000 !a (ua$J"d "'-10 ^UV) ~;J C13W l,lnO:;lO ~ 30VI'\I SWIVlO C -
ODO'OOt$ a3iN3l:l Oi 3DltlfllVO A.l.lllaVli 1Vl:I3N':i~ lVl:J!:I3t\lI'\IOO ex
-" 000'000 U ;rON3<1l:1n:JOO HO~ 90/ H/SO SOIL~ISO S?OSZSLtV~6~~ .u1'IS"II' 1W31rn> X V
S.l,IIIII' J.va 3ttltg", ~~ol3,. H3QWnN AOI,Oo;l ::ION~nSNI ;;10 ;101M l:ISN 1'l,lJ.'
11I"'.1. 'lfHldX:;! A:JIlOtl
'SWIV1::J OI\>'d A8 a30na3~ N;;J38 3^\>'H AVIN NMOHS S.l.Il"l1l3.lV~3~98V 'S31:lI'O"j
~:)n$ :l0 SNOI.lIONO::J ON\>' SNOISmOX3 'Sl"l~31. 3Hl. 11\1 OJ. J.oarsns 51 NI;:j~::;rH o:lElll:lOS30 S3JOllOd ;;lHJ. AEI <JSOl=lO=l.:l\>' 3:JJW1:InSNI ilHJ. 'NIVH:I3d AV'I'I
l::IO oanssl 38 NI'I'I3.l'o'::>I:!ll~30 SIHl H;;)IHM 0l1::l;JdS3l::1 HIIM J.N3V11nooo ~;jHJ.O)JO J.OV~.LNOt> ANV =lO NOI.l.ICJNOO l=IO l"ll:l31 'lN3W3~~ln03~ AN\>'
8NION'o'.J.SHl.lMJ.ON 'G3.l\>'::JIONI aOll::l;:l~ A0l10d :3Hl.l:lO.:l3^OS:V CJ3VWN C13'!:1nSNI3H.l 0.1.. 03nSSI N33a 3A\>'H MOl3a a:a.l.SI1 :gO~nSNI.:lO S;lI::lI'Od 3Hl
Sl3~Wa.\OO
1------' ""31 "OI.:lI.l~3~ 03SIA3)4" ~3 C:l3HI"ISNI O~~&9 1M 'A01:l11SV3
:OC:l3l:1nSNI Lt~ XOS Od
~() C:l3l:1nSNI 1:10 Am::I::JN3 BB6~
AN !\fdlf1l0:J 3:JN~nSNll~3N3E) nVSnVM :i!!:I3!:1nSNI :JNI S301AlJ3S A~~3N3 S>I
AN IfdWOO 3~NVHnSNI SS3NISnS nVSnVM :VC:l3l:1nSNI (lil~nSNI
r 3E>W3AOO DNIOMO:HV' S~3~nSNI
#~I'1fN tt:t~-l..LS t ~t
1--------" 600f;-vtc:t:S 1M '3:3)1nVM1IW
-M013B S3r~110d 31-1.1. AQ 03C1140::l:lV l;I€l'>AI3AO::' ::lHJ. ~3J.l'" 3:)V1d }f~"d M OOOH
"dO ON3J.X3 'C1N3WV J.ON S30a 3J.V'OI:lI.Ll43:l SIHJ. "M3Ql0H
3J.V'OI:lIJ.l430 3HJ. NOdn S!HE>I"d ON S~3.:lNOO aN" ^'NO A:JN30V 31:1n.lVN~IS mfSn'iM
NOIJ.VWl40:lNI :10 H3llVW "SV 03nSSI SI3J.YOI:lIJ.~30 SIHJ. ijj:J::tnOOlld
~
90/0t/EO I 3:)N~nSNI AIllIS"I' :10 3I"OI:l11~30 'f"
(MMllJClII\IWJ 3iva ~aHQD\f
~0/C:0"d
A~~3N3S}f
1~0C:L.c:mC:616 01
HtZ9 :1AuaIlO
^9~ 3~nl~N9IS n~Sn~M ~~ ~~:91 900C: L.0 ~d~
-^0N3~V31:1nl.'1NmS nVSnVM
1:I3::lnaO~d
-NOINw~o~Nl~~~:Js;.~SSi1r~~~~~~ .T-------.
'^^~oa~2~?~i~2 I 3:lNVHnSNI All118Vll :10 31V:lI:lII~3~
S0/p0'd
AtJ~3N3S)1
lS0C:L.c:mC:616 01
~ ~VZ9 :mue!l~
^9~ 3~nl~N9IS n~Sn~M ~~ SS:91 900C: L.0 ~d~
ruOHlOq'rl
ACORD", CERTIFICATE OF LIABILITY INSURANCE I DATE lMMJDOIYYVY)
03J30/06
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORM~mON
WAU$AU SIGNATURE AGENCY ONLY AND CONFERS NO RIGHTS UPON THE CERTlflCA1'E
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEN[1 OR
11800 W PARK PLACE ALTER THE COVERAGE AFFORDED BY THE POLICIES BE:LOW.
MILWAUKEE, WI 53224-3009
414577-2334 INSURERS AFFORDING COVERAGE NJlIC #
IN::iURIiiD INSUReR A; WAUSAU BUSINESS INSURANCE COMP~ NY -~
KS ENERGY SERVICES INC INSURIOR B: WAUSAU GENERAL INSURANCE COMP,ll NY
1988 ENERGY DR INSUR.EF\ c:
PO BOX 137 JNSURER D;
EAST TROY, WI 53120 INSURER E: --REVISJ;:O CERTIFICATE.. ,.,,-
RPR 07 2006 16:55 FR WRUSRU SIGNRTURE RGY
Client#. 82411
TO 919203272051
KSENERGY
P.04/05
COVERAGES
THi:: POLICIES OF INSURANCE L.rS1ED BELOW HAVlO. aeeN IS5u"D TO THE INSURED NAMED ABOVE FOR THE POLICY Pi~IOD INDICATED. NOTWITHST,il,NDING
AN'( R.!::QUIREMENT, TeRM OR CONDITION OF ANY CONTRACT OR otHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED C'R
MAY PERTAIN, THE INSURANCE A~FORDED BY THE POL.ICIES D~SCRJBE:D HEREIN IS SUBJi::CT TO ALL. THE TERMS, EXCLUSIONS AND CONDITiONS OF SUCH
POLICIES, AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
~- TYPE O~ INSURANce POLICY NUMBER I'Jil;J~1ri~r6~IE Pg~1fJI~S,~~N LIMITS
A X ~NERAI..I.IASIWTY YYKY91437828045 05/17/05 05/17/06 EACH OCCURRENCE $1 O(tO,OOQ...,_~
~ COMMERCIAL GENI;RAL LIABILITY DAMAGE TO RENTED $300.000
f--- :=J CLAIMS MAD!: [iI OCCUR. MEOO EXP (Anyone pemon) $5.000
X SI/PD Ded;2)500 PERSONAL & AJ;lV INJURY $1.0CIO 000
GENERAL AGGReGATE $2.000 000
X n'L AGGRriiEi LIMIT M'nS PER: PRODUCTS-COM~OPAGG $2 OCIO.OOO
FoOLICY X ~~RT LOC
A ~TOMOBII.E LIABILITY ASKY91437828035 05J17/05 05117/06 COMBINEP SINGLE LIMIT
.K.. ANY AUTO (Eia Qccldent) $1,000,000
I-- AI.1. OWNeD AUIOS BODILY INJURY
$
SCHEDULED AUTOS (Per person)
t--
~ HIR5D AUTOS BODILY INJURY
$
~ NON-OWNED AUTOS (Per acCld<)
l-- PROPERTY DAMAGE $
(P~r aeeidont)
RGE LIABILI'I'Y AUTO ONLY. EOAACCIDENi' $
ANY AUTO OTHIOR THAN EA ACC $
AUTO ONLY; AGO $
OE$$/UMBRELLA LIA,SIU'I'Y EAOH OCCURRENCE $
OCCUF! 0 CI.AIMS MADE: AGGREGATE $
$
R DEDIJCTlel.e $
RETENTION $ $
B WORKERS COMPEI'lSATlON AND WCHY91437828015 05J17105 05117106 X I T"/,r;;J!~]'~" I IOJ~'
EMPLOYeRS' LlABILITY $500,000
ANV PROPFlIETCRlPARTNEPJEiXeCU,lVE IH. EACH ACCIDEN't'
OffiCER/MEMBeR EXCLUDED? !ii,l., Ol5EASE - EA EMPLOYE" $500,000
g~~MtS~~~~~?~~s balQW " E.L. DISEASE - POLICY LIMIT $500.000
OTH,"R
DESCRIPTiON OF OPERATIONS I LOCATiONS IVEHIClES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAl. PROVISIONS
RE: FIBER OPTIC PROJECT 011006
THE FOX VALLEY TECHNICAL COLLEGE IS LISTED AS AN ADDITIONAL INSURED PER
ENDORSEMENT FORM NO. GL0566 UNDER THE GENERAL LIABILITY POLICY INDICATeD
ABOVE. AN EXAMPLE ENDORSEMENT IS AVAILABLE UPON REQUEST FROM THE COMPANY.
CE~TIFICATE HOLDER
CANCELLATION
ACORD 25 (2001108) 1 of 2
#S407708/M368877
aHOUU> ANY 01' THe ABOVe DESCRIBED POLICIES BE CANCELLED llf-FOflE THE EXPJRA TJON
DATE T!1l;REOF, THE ISSUING INSURER WIl.l. eNDEAVOR TO MAIl. -3!L DAYS WRITTSN
NOTll;;E TO T~l; CERTIFICATE HOLDER NAMED TO THE LEI'T, BUT FAILURE TCl 00 SO SHALL
IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
REPREGENTAfivES.
A~DFllZED REPRESENTA'ilVE
r"\.~ -2-. W~
CR3 G:I ACORD CORPiOl~ATION 1988
,,~
FOX VALLEY TECHNICAL COLLEGE
150 N CAMPBELL RD
OSI-IKOSH, WI 54902
~ v86~-Z~EV
LS6~ H8tl'o'l"l- 8NIINltld OtllHl
9000i': "8'0 'NOWNIHS'o'M "M'N '"3AV >ltlOA M3N 9€H 'S.L831IH8tl'o' ::10 31nlllSNI N'o'::>ltl3V~'o' 3Hl
@'o'l'o' _ 'a3 VS6~ tl38l"l383a - aNOSIN3INA'o'd ON'o' aNOS 38NVlNtlO::ltl3d. z~tV lN3lfm::>Oa VI'o'
O~9~-L\H€9 1M B4sa)inBM
O~9~ XOS Od
::>UI 'sa::>!AJas a::>uBJnSUI ~~~
:(AlJBd Ja4l0
JO Jaau!5U3 'l::>al!L1::>JV') 3N1V'.l.N3S3~d3~ S,~3NMO :~3>10~S JO .l.N38V'
(auoqdalal pUB SSaJpP'rI 'awBN - ^ 1NO NOH'rIWClOdNI ClOd)
PB.::I-UI-AaUJOlW
_ )j::>pl!aJS o~V\1 :all!.l. pUB aWBN
I ~ l() W :aJnlBU5!s
" . "
e::>p~~VJO f.uBdwo~ AlaJns ~ AlIenSB~ SJalaAeJ.l.
:AUBdwo~
A.l.3~nS
(€ a5ed uo JBaddB SaJnleu5!s lBUO!l!ppe AUV')
AlBlaJ::>as ~ lUaplSaJd a::>!^ JO!UaS
"Jr 'qWnl>l S!UUaa :all!.l. pue aWBN
o :aJnlBU5!s
"::>UI 'Sa::>IAJas A5JaU3 S>l
(leas aleJodJo~) :Auedwo~
lV'dl~NI~d SV' ~O.l.~V'cLLNO~
€ a5Bd aas 0
auoN x :pUOS S!L1l Ol SUO!lB::>!!!POV\l
OO'9€l'99$ :lunoUlV'
900l '9 IPdV' :(alBa PBJlUO~ UO!l::>nJlSUO~ UBLll Ja!pBa lON) alBa
ClNOS
U!SUO::>S!M 4s0)jLlsO '999170~# Od 'alqB~ ::>!ldO Jaq!.::I ale::>ola~ :(UO!lB801 pUB aWBN) UO!ldp::>saa
OO'9€l'99$ :lunoUlV'
900l '9 IpdV' :awa
.l.~V'Cl.l.NO~ NOI.l.~n~.l.SNO~
€9 ~90 In::>!pauuo~ 'PJOj.lJBH
B::>pawV'!o AUBdUlO~ AlaJns ~ Allense~ SJalaAeJ.l.
:(ssau!sns!o a::>eld IBdpuPd pUB aweN) A.l.3~nS
€06179 1M 'L1S0)j4s0
O€~ ~ XOS Od
5u!SeLl::>Jnd 'L1S0)jLlSO !O Al!~
:(ssaJPPV' pUB aweN) ~:]NMO
Ol~€9 M 'AOJ.l.lse3
L€~ XOS Od
aApa A5Jau:3 996 ~
::>ul 'sa::>!AJas A5JElU3 S>l
:(ssaJPPV' pUB aWBN) ~O.l.~'V1:JI.l.NO~
oalqB::>!ldde aJaLlM IBJnld paJaplSUo::> aq lIeLls AlJBd JaLllO JO JaUMO 'AlaJns 'JopeJlUO~ Ol a::>uaJaJaJ JBln5u!s AUV'
PU08 9:>UewJO..J..I9d
Z ~E:'rIluawmoa 'rI1'rI
17€9969170 ~# pUOS
S1831IH8C!'v' ~O 31nlllSNI N'v'81C!3L^J'v' 3Hl
~
1786 ~-~ ~EV
L96~ H8tlVIN. 8NIINltld OtllHl
9000(;'::)'0 'NOWNIHSVM '"M'N '"3AV >ltlOA M3N 9f;L~ 'Sl~31IH~tlV::I0 31nlllSNI NV8Itl3V~V 3Hl
@ '0'1'0' . '03 1796 ~ H3S1N3~30 . ONOS IN31^lA Vd ONV ONOS 3~NVlNtlO::ltl3d . ZH:V iN3wn::>oa VIV
'alqeo!ldde
aq lIells lins alll JO UO!P!pspn[ a4l ul asuaJap e se
sallaJns Ol alqel!eAe uO!lel!W!I JO popad wnw!ulw alll 'Mel
Aq pal!q!40Jd .10 P!OA aJe lldeJ6eJed S!4l JO SUO!SiAOJd alll
JI "lSJ!! sm:):)o JaAa4:)!4M 'pUOS S!lll Japun suoile6!1qo Sl!
WJO:J.lad Ol sl!eJ .10 sasllJaJ !\laJns alll Jaye sJeaA OMl U!llliM
.10 6u!)j.JoM pasea:) JopeJlu08 alll Jaye sJeaA OMl U!llllM .10
llneJao JopeoAlu08 Jaye sJeaA OMl Uilll!M palnmSui aq lIells
pue pale301 S! )fJOM alll JO lJed .10 )j.JOM alllll:)!llM U! UO!lBOOI
alll U! UO!PlPspn[ lualadw03 JO lJno:) Aue U! palnmSU! aq
Aew puoS S!lllJapUn 'alqelinba .10 le6al '6u!paa:JoJd AuV 6
'suo!le6!1qo
JalllO pue SJapJO aSe1l3Jnd 'speJlU03qns palelaJ Ol
.10 peJlU08 UOlpnJlSU08 alll Ol 'aw!l JO sa6ue1l3 6u!pnpu!
'a6ue1l3 Aue JO aO!lOU saAieM AqaJall AlaJns all.l 8
'SJossa33ns .10 SJOleJls!u!wpe 'SJOlnOaxa 'sJ!a4 Sl! .10
JauMO alll uelll JalllO !\l!lUa .10 uosJad Aue ol puoS S!lll 1.10
anJ::>oe lIells uo!pe JO l1l6p oN 'suo!le6ilqo palelaJun lions
Aue JO lun03::>e 1.10 yo las .10 paonpaJ aq lOU lIells aOPd
peoAlu08 a4l JO a::>ueles alll pue 'peJlU08 UO!pnJlSu08
alll Ol palelaJun aJe lelll JOPeJlu08 alll JO suo!le6!lqo
JOJ sJalllO .10 JauMO a4l Ol alqeil aq lOU lIells AlaJns a41. l
"JopeJlU08 a4l JO aouewJo:J.lad
-1.101.1 .10 a::>ueWJo:J.lad paAelap Aq pasne::> sa6ewep
lenpe 'peJIU08 UOiPnJlSU08 a41 U! pa!!pads aJe
sa6ewep palep!nb!llOU Ji .10 'sa6ewep palepinb!l E"9
pue ~v 4deJ6eJed Japun
!\laJns alll JO l:)e Ol aJnl!eJ .10 suo!pe alll WOJJ 6umnsaJ
pue 'llneJao S,.lOpeJlU08 a4I WOJJ 6umnsaJ SlSOO
Aelap pue leUO!SsaJoJd u6iSap 'le6al leuoiliPPV ~"9
~peJlU08
UO!PnJlSU08 a4l JO UO!laldwoo pue )fJOM aA!paJap JO
UO!paJJ03 JOJ JOpeJlU08 a4l JO sa!l!l!q!suodsaJ a4.l ~"9
:JoJ uO!le::>lldnp ln04liM pale6!1qo S! ^laJns
alll 'peJIU08 uoq::>nJlSU08 a4l 1.10 sa6ewep pue SlS03
JO UOile6mw Ol a3Pd peJlU08 alll JO a::>ueles a4I JO JauMQ
aliI ^q lUaWliwwo::> OI pa[qns Inq 'pUOS S!4l JO lunowe
a4l JO llW!1 a4l 0.1 'peJlU08 uO!l::>noAlsu08 alll Japun JauMO
alll JO asolll ue4l JaleaJ6 aq lOu lIells Al8JnS a4l ol JauMO
a41 JO sa!l!l!q!suodsaJ a4l pue 'peJlU08 UOlpnJlSU08
alll Japun JopeJIU08 alll JO aSOlll ue4l JaIeaJ6 aq lOU
lIells JaUMO aliI Ol AlaJns alll JO sa!l!liq!SuodsaJ a4I ua4l
'aAoqe t;"v .10 'l'17 '~'v 4deJ6eJedqns Japun pe OI spala
!\laJns a4l J! pue 'peJlU08 uo!pnJlSu08 alll alaldwo:J
Oll1l6p S,JOpeJIU08 a4l paleulWJal sell JauMO alll Jayv 9
'JauMO a4l Ol alqelieAe ApawaJ Aue a::>JoJua OI pall!lua
aq lIells JaUMO a4l a::>!lOU Ja4lJIlJ lnolll!M 'lJed U! .10 alollM
ui '!\l!l!qe!l pa!uap se4 AlaJns a4I .10 paJapual lUaw^ed
a4l sasnJaJ JauMO a4I pue 'v'v lldeJ6eJedqns U! paP!AoJd
se spaa30Jd !\laJns a4l JI "JauMO a4l Ol alqel!eAe ^pawaJ
Aue aOJoJua ol pall!lua aq lIe4s JaUMO a4I pue 'pUOS S!lll
Japun suo!le6!1qo Sl! WJO:J.lad AlaJns a4l le4I 6u!puewap
!\lams a4l Ol JauMQ aliI WOJJ a::>!lou UamJM (euO!l!ppe
ue JO Idia3aJ Jaye sAep uaay!! puoS si4l 1.10 llneJap U! aq OI
pawaap aq lIells AlaJnS alll 'ssauldwoJd alqeuoseaJ 4IiM 17
lldeJ6eJed U! pap!AoJd se paa::>oJd lOU saop AlaJnS a4l JI S
'JoJaJa4l SUOseaJ 6umo JaUMO
allll\J!lOU pue lJed Ui .10 al04M Ul Al!l!qe!l ^ueO Z"
.10 ~JaUMO
a4l OI JOJaJalll IUew^ed Japuel 'pau!WJalap
sl lun6we alll Jaye alqe:J!peJd se uoos
se 'pue JaUMO a4l Ol alqell aq Aew l! 1l0lllM
"OlaJe4l se6ue40
pue slUawn::>oo peJlU08 lie 6UlpnpU! 'a6ed aJnlBu6lS
alll 1.10 pa!J!luap! JOpeJlU08 a4l pue JaUMO alll
uaMlaq lUaWaaJ6e a4.l :peJIu08 uO!pnJlSu08 Z"Z ~
"peJlU08
uOiPnJlsu08 alll Japun JOPBJlU08 alll JO JIB4aq 1.10
.10 Ol apew slUawAed JadoJd pue P!leA lie ^q pe:JnpaJ
'pall!lUa S! JOPBJlU08 a4l 4::>illM Ol sa6ewep JOJ sw!ep
JalllO .10 aoueJnsu! JO luawamas U! ~auMO alll Aq
JOJ lunowe a4l au!wJalap 'UO!le6lISaAU! Jayv ~.
:sa:JuelswnoJp a4l Japun ssaUldwoJd alqeuoseaJ
4IiM pue JOPBJlUO:J Mau B U!Blqo .10 'uOilaldwoo JOJ
a6ueJJe 'alaldwo::> pUB WJo:J.lad Oll46!J Sl! aAieM 17"v
.10
~llneJap S,JOpeJlU08 a4l WOJJ 6u!l(nsaJ JaUMO a4l Aq
paJJnou! aOPd peJlU08 alll JO a3ueles alll JO ssa::>xa
ul 9 lldeJ6eJed ui paqposap se sa6ewep JO lunoulB
alll JaUMO alll Ol Aed pue 'peJlU08 UO!l3nJlSU08
alll 1.10 panssl spuoq alll ollUaleA!nba !\laJns pa!!!Ienb
B Aq paInoaxa spuoq luawABd pue a::>UBWJO:J.lad
1l1!M paJn:Jas aq ol 'aouaJJn::>uoo s,JauMQ alll 1l11!M
papalas JopeJluo::> alll pue JaUMO a4l Aq uOiln::>axa
JOJ paJedaJd aq 01 PBJIuo::> e JOJ a6ueJJe 'l::>eJIuo8
uo!pnJlSu08 alll JO UOll8ldwo::> pue a3UBWJO:J.lad
JOJ peJlUOO e JOJ JauMO aliI Ol alqeldao::>e SJopeJluo::>
pa!J!lenb WOJJ slesodoJd palelI06au .10 sPiq u!elQO E"17
.10 ~sJopeJlUOO lUapuadapul 116noJlll
.10 slua6e SI! 116noJlll 'JlaSl! peJlu08 uo!pnJlSuo8
elll aIaldwo::> pue WJo:J.lad ol a)felJapUn Z:"V
.10 ~peJlU08
UOil::>nJlsu08 a4l elaldwo::> pue wJo:J.lad Ol 'JaUNIO
alll JO luaSU03 llliM 'JOpeJlU08 alll JOJ a6ueJJV 1:17
:suoipe 6U!MOIIOJ alll JO auo a)fBl asuadxa
s,!\laJns allllB pue A\ldWOJd lIells !\laJns elll 't; lldeJ6eJed
JO SUO!llPUO::> alll pa!jS!IBS SBll JauMO alll u8'llM 17
"JaUlMO
elll lll!M peJluo::> alll JO sWJal alll 4liM a::>uepJo::>::>e
U! peJlu08 UOipnJISU08 aliI WJo:J.lad Ol pal::>'~las
JopeJlUOO e 01 .10 peJlu08 uoq::>nJlsu08 alll JO SUUJal
aliI lll!M aoUepJo::>3e ul !\laJns alll ol aOPd peJlu08
a4l JO a::>ueles alll Aed 01 paaJ6e sell JauMO alll E"E
pue ~ ~ 't; lldBJ6BJedqns
U! papiAOJd se a::>!lOU paA!a::>aJ aAell !\lams alll pue
JOPeJlU08 alll JaYB SABP ^lUaMl UBlll Jal(Jea paJepap
aq lOU IIB4S llneJao JOl3eJlU08 4::>ns .peJlu03 alll
alaldwoo Ol l46p s,.lopeJlU08 alll paleUiWJal AIIBlUJOJ
pue llnBJao JopeJlU08 B paJepap se4 JaUMO all1. ~'E
pue :llneJao
JOPeJlU08 e aJBpap Ol ^\luanbasqns 'Aue J! '146p
S,JaUMO a4l aAieM lOU lIe4s lUaWaaJ6e UB ll::>ns lnq
'peJIU08 uo!pnJlSu08 a4I wJojJad Ol aWlI alqeuoseaJ
B paMolle aq lIells JopeJlu08 alll 'aaJ6e !\laJns aliI pue
J01::>eJlu08 alll 'JauMO all1 JI 'peJ1u08 UOlpnJlSU08
all1 6UiWJO:J.lad JO spolllaw ssnosiP Ol a:)!lOU
43ns JO ld!a::>aJ JaYB SABp uaay!! uelll Jalel lOU Plall
aq OI A1aJnS a4l pUB JopeJlU08 all1 4l!M aouaJaJuoo
e a6ueJJe Ol paldwalle pue palSanbaJ se4 pue lIneJao
JOpeJ1U08 B 6upepap 6upaplsuoo S! JaUMO alll 1e41
MOlaq 0 ~ lldeJ6eJed U! paqp3sap ssaJppe Sl! le ^laJns
all1 pue JopeJlU08 a41 pa!!!lOU SB4 JaUMO all.l ~"E
:Jaye aspe lIe4S pUOS S!4l Japun
uO!le6ilqo s.AlaJns all1 'llneJao JaUMO 01.1 S! aJa4l JI E
, ~"t; 4deJ6eJBdqns U!
papiAOJd se Sa3UaJaJUo::> Ul a1edp!lJed Olldaoxa 'pUOS Sllll
Japun UO!le6!1qo 01.1 aAell lIe4s JopeJlU08 all1 pue Al8JnS
a41 'peJ1U08 uo!pnJ1SU08 a41 sWJO:J.lad JopeJ1U08 a41 JI ~
'aOuaJaJaJ Aq
u!aJa4 paleJodJo:)u! S! 1l0l4M 'peJlU08 uo!pnJlSU08 a4l JO
a3ueWJo:J.lad a41 JOJ JaUMO a41 Ol su6!sse pue SJOssa::>ons
'SJOleJ1SiU!Wpe 'SJOln:)axa 'SJlall J!alll 'saAlaswall1
PU!q 'AlleJaAas pue AllU!O[ '!\laJnS alll pue JOpeJlU08 all:t ~
leql' ,,!U1UQJUl eqI-u!eJeq" paWJOOJ03U! pawaapaq-lleqs
lUaWaJinbaJ le6al Jall10 .10 N01nIe1s 4:Jns 01 6UiWJOJUO::>
SUO!SlAOJd pue wO.lJaJall pa1alap pawaap aq lIe4s
1uawaJ!nbaJ 1e6al .10 N01n1els Pies lll!M 6u!l::>!lIu03 puoS
silll U! UO!SiAOJd Aue 'pawJo:J.lad aq Ol seM uOlPrulSUO::> a4l
aJallM UO!leool a4l ul lUaWaJlnbaJ le6al JalllO .10 NOlnlels
e 4l!M ^Idwoo Ol pa4S!WnJ uaaq sell puoS S!4l ua4M ~ ~
"a6ed aJnleu61s
a4l 1.10 UM04s ssaJppe a4l Ol paJaAllap .10 pal!Bw aq
lIe4s JOpeJlU08 alll .10 JauMO a4l '!\laJns alll ol aO!loN O~
'aIQe::>!ldde aJaLlM leJnld paJap!suo::> aQ lIeLlS Al-Jed JaLllO .10 JaUMO 'AlaJns 'JOpeJlU08 Ol a~uaJaJaJ Jeln6u!s AU';j
PU08 luaW~ed
z t[;'r/ luawn:JOa 'r//'r/
11 When this Bond has been furnished to comply with a
statutory or other legal requirement in the location where
the construction was to be performed, any provision in this
Bond conflicting with said statutory or legal requirement
shall be deemed deleted herefrom and provisions
conforming to such statutory or other legal requirement
shall be deemed incorporated herein. The intent is that
this Bond shall be construed as a statutory bond and not
as a common law bond.
by the Owner in settlement of insurance or other
claims for damages to which the Contractor is entitled,
reduced by all valid and proper payments made to or
on behalf of the Contractor under the Construction
Contract.
1o'Notice to the Surety, the Owner or the Contractor shall
be mailed or delivered to the address shown on the
signature page.
12.2 Construction Contract: The agreement betwen
the Owner and the Contractor identified on the
signature page, including all Contract Documents and
changes thereto.
12 DEFINITIONS
12.3 Contractor Default: Failure of the Contractor,
which has neither been remedied nor waived, to
perform or otherwise to comply with the terms of the
Construction Contract.
12.1 Balance of the Contract Price: The total amount
payable by the Owner to the Contractor under the
Construction Contract after all proper adjustments
have been made, including allowance to the
Contractor of any amounts received or to be received
12.4 Owner Default: Failure of the Owner, which has
neither been remedied nor waived, to pay the
Contractor as required by the Construction Contract or
to perform and complete or comply with the other
terms thereof.
MODIFICATIONS TO THIS BOND ARE AS FOLLOWS:
(Space is provided below for additional signatures of added parties, other than those appearing on the cover page.)
CONTRACTOR AS PRINCIPAL
Company:
(Corporate Seal)
SURETY
Company:
(Corporate Seal)
Signature:
Name and Title:
Address:
Signature:
Name and Title:
Address:
AlA DOCUMENT A312. PERFORMANCE BOND AND PAYMENT BOND. DECEMBER 1984 ED.. AIA@
THE AMERICAN INSTITUTE OF ARCHITECTS, 1735 NEW YORK AVE., N.w., WASHINGTON, D.C. 20006
THIRD PRINTING. MARCH 1987
A312-19184
3
..
THE AMERICAN INSTITUTE OF ARCHITECTS
Bond #104695634
AlA Document A312
Payment Bond
Any singular reference to Contractor, Surety, Owner or other party shall be considered plural where applicable.
CONTRACTOR (Name and Address):
KS Energy Services, Inc.
1988 Energy Drive
PO Box 137
East Troy, VVl53120
OVVNER (Name and Address):
City of Oshkosh, Purchasing
PO Box 1130
Oshkosh VVI 54903
SURETY (Name and Principal Place of Business):
Travelers Casualty & Surety Company of America
Hartford, Connecticut 06183
CONSTRUCTION CONTRACT
Date: March 17, 2006
Amount: $68,238.00
Description (Name and Location): Relocate Fiber Optic Cable, P.O. #104556, Oshkosh, VVisconsin
BOND
Date (Not earlier than Construction Contract Date): April 5, 2006
Amount: $68,238.00
Modifications to this Bond: x None
OSee Pa!;le 6
CONTRACTOR AS PRINCIPAL
Company: (Corporate Seal)
SURETY
Company:
(Corporate Seal) .
Signature:
Name and Title: Dennis lum , r.
Senior Vice President & Secretary
(Any additional signatures appear on page 6)
Travelers Casualty & Surety Company of America
~ Yb ~fl
Signature: ! .~-
Name and Ti e: M~ Breitrick
Attorney-In-Fact
KS Energy Servi
(FOR INFORMA TION ONL Y - Name, Address and Telephone)
AGENT or BROKER: OVVNER'S REPRESENTATIVE (Architect, En~lineer
or other party):
R&R Insurance Services, lnc
PO Box 1610
VVaukesha, VVI 53187-1610
A312-1~184 4
AlA DOCUMENT A312. PERFORMANCE BOND AND PAYMENT BOND. DECEMBER 1984 ED.. AIA@
THE AMERICAN INSTITUTE OF ARCHITECTS, 1735 NEW YORK AVE., N.W., WASHINGTON, D.C. 20006
THIRD PRINTING. MARCH 1987
1 The Contractor and the Surety, jointly and severally, bind
t!temselves, their heirs, executors, administrators,
successors and assigns to the Owner to pay for labor,
materials and equipment furnished for use in the
performance of the Construction Contract, which is
incorporated herein by reference.
2 With respect to the Owner, this obligation shall be null
and void if the Contractor:
2.1 Promptly makes payment, directly or indirectly, for
all sums due Claimants, and
2.2 Defends, indemnifies and holds harmless the
Owner from claims, demands, liens or suits by any
person or entity whose claim, demand, lien or suit is for
the payment for labor, materials or equipment furnished
for use in the performance of the Construction Contract,
provided the Owner has promptly notified the
Contractor and the Surety (at the address described in
Paragraph 12) of any claims, demands, liens or suits
and tendered defense of such claims, demands, liens
or suits to the Contractor and the Surety, and provided
there is no Owner Default.
3 With respect to Claimants, this obligation shall be null
and void if the Contractor promptly makes payment,
directly or indirectly, for all sums due.
4. The Surety shall have no obligation to Claimants under
this Bond until:
4.1 Claimants who are employed by or have a direct
contract with the Contractor have given notice to the
Surety (at the address described in Paragraph 12) and
sent a copy, or notice thereof, to the Owner, stating
that a claim is being made under this Bond and, with
substantial accuracy, the amount of the claim.
4.2 Claimants who do not have a direct contract with
the Contractor:
.1 Have furnished written notice to the Contractor
and sent a copy, or notice thereof, to the
Owner, within 90 days after having last
performed labor or last furnished materials or
equipment included in the claim stating, with
substantial accuracy, the amount of the claim
and the name of the party to whom the
materials were furnished or supplied or for
whom the labor was done or performed; and
.2 Have either received a rejection in whole or in
part from the Contractor, or not received within
30 days of furnishing the above notice any
communication from the Contractor by which
the Contractor has indicated the claim will be
paid directly or indirectly; and
.3 Not having been paid within the above 30
days, have sent a written notice to the Surety
(at the address described in Paragraph 12)
and sent a copy, or notice thereof, to the
Owner, stating that a claim is being made
under this Bond and enclosing a copy of the
previous written notice furnished to the
Contractor.
5 If a notice required by Paragraph 4 is given by the
Owner to the Contractor or to the Surety, that is sufficient
compliance.
6 When the Claimant has satisfied the conditions of
Paragraph 4, the Surety shall promptly and at the Surety's
expense take the following actions:
6.1 Send an answer to the Claimant, with a copy to the
Owner, within 45 days after receipt of the claim, s~ating
the amounts that are undisputed and the baSIS for
challenging any amounts that are disputed.
6.2 Payor arrange for payment of any undisputed
amounts.
7 The Surety's total obligation shall not exceed the amount
of this Bond, and the amount of this Bond shall be cmdited
for any payments made in good faith by the Surety.
8 Amounts owed by the Owner to the Contractor under the
Construction Contract shall be used for the performance of
the Construction Contract and to satisfy claims, if any, under
any Construction Performance Bond. By the Contractor
furnishing and the Owner accepting this Bond, they agree
that all funds earned by the Contractor in the performance of
the Construction Contract are dedicated to satisfy
obligations of the Contractor and the Surety under this
Bond, subject to the Owner's priority to use the funds for the
completion of the work.
9 The Surety shall not be liable to the Owner, Claimants or
others for obligations of the Contractor that are unrelated to
the Construction Contract. The Owner shall not be liable for
payment of any costs or expenses of any Claimant under
this Bond, and shall have under this Bond no obligations to
make payments to, give notices on behalf of, or otherwise
have obligations to Claimants under this Bond.
10 The Surety hereby waives notice of any change,
including changes of time, to the Construction Contract or to
related subcontracts, purchase orders and other obligations.
11 No suit or action shall be commenced by a Claimant
under this Bond other than in a court of competent
jurisdiction in the location in which the work or part of the
work is located or after the expiration of one year from the
date (1) on which the Claimant gave the notice required by
Subparagraph 4.1 or Clause 4.2.3, or (2) on which the last
labor or service was performed by anyone or the last
materials or equipment were furnished by anyone under the
Construction Contract, whichever of (1) or (2) first occurs. If
the provisions of this Paragraph are void or prohibit~d by
law, the minimum period of limitation available to sl~rebes as
a defense in the jurisdiction of the suit shall be applicable.
12 Notice to the Surety, the Owner or the Contractor shall
be mailed or delivered to the address shown on the
signature page. Actual receipt of notice by Surety, the
Owner or the Contractor, however accomplished" shall be
sufficient compliance as of the date received at thl3 address
shown on the signature page.
13 When this Bond has been furnished to comply with a
statutory or other legal requirement in the location where the
construction was to be performed, any provision in this Bond
conflicting with said statutory or legal requirements shall be
deemed deleted herefrom and provisions conforming to
such statutory or other legal requirement shall b,a deemed
incorporated herein. The intent is that this
AlA DOCUMENT A312. PERFORMANCE BOND AND PAYMENT BOND. DECEMBER 1984 ED.. AIA@
THE AMERICAN INSTITUTE OF ARCHITECTS, 1735 NEW YORK AVE.,N.W., WASHINGTON, D.C. 20006
THIRD PRINTING. MARCH 1987
A312-1984
5
14 Upon request by any person or entity appearing to be a
potential beneficiary of this Bond, the Contractor shall
promptly furnish a copy of this Bond or shall permit a copy
to be made.
in the Construction Contract, architectural and
engineering services required for performance of the
work of the Contractor and the Contractor's
subcontractors, and all other items for which a
mechanic's lien may be asserted in the jurisdiGtion
where the labor, materials or equipment were
furnished.
Bond shall be construed as a statutory bond and not as a
common law bond.
15.1 Claimant: An individual or entity having a direct
contract with the Contractor or with a subcontractor of
the Contractor to furnish labor, materials or equipment
for use in the performance of the Contract. The intent
of this Bond shall be to include without limitation in the
terms "labor, materials or equipment" that part of
water, gas, power, light, heat, oil, gasoline, telephone
service or rental equipment used
15.2 Construction Contract: The agreement between
the Owner and the Contractor identified on the
signature page, including all Contract Documents and
changes thereto.
15 DEFINITIONS
15.3 Owner Default: Failure of the Owner, which has
neither been remedied nor waived, to pay the
Contractor as required by the Construction Contract or
to perform and complete or comply with the other
terms thereof.
MODIFICATIONS TO THIS BOND ARE AS FOLLOWS:
(Space is provided below for additional signatures of added parties, other than those appearing on the cover page.)
CONTRACTOR AS PRINCIPAL
Company:
(Corporate Seal)
SURETY
Cornpany:
(Corporate Se:al)
Signature:
Name and Title:
Address:
Signature:
Name and Title:
Address:
AlA DOCUMENT A312. PERFORMANCE BOND AND PAYMENT BOND. DECEMBER 1984 ED.. AIA@
THE AMERICAN INSTITUTE OF ARCHITECTS, 1735 NEW YORK AVE., N.W., WASHINGTON, D.C. 20006
THIRD PRINTING. MARCH 1987
A312-1!e84
6
'l1llll $ P:ll)Ul!1 (~O-ZO)
'P;}lloll:llU s~ l~ 1l:;~A\ Ol ~uqllll;}Pun
10 puoq hUll Ol lO;}dS;}l l{l~ ;}mlllJ ;}l{l ~ hUlldUIO;) ;}l{l uodn lllI!pu~q pUll P~luA ~ lflllls IU;}S ;}l!UI~souJ pUll ;}mlUuJl~S ;}Hlll!souJ lIons hq P;}Y~ll;}O
pUll P;}lno;}X;} os l;}A\od lIons hUll pUll hUlldUIO;) ;}l{l uodn llu~pu~q pUll P~luA ;}q nUlls IU;}S ;}1~~SOUJ 10 ;}11llUuJl~S ;}1~SOUJ lIons llu~llmq a'llloY!ll;}O 10
h;}U10nU JO l;}A\od lIons hUll pUll 'JO;}l;}l{l ;}mlllU ;}l{l u~ A.IOlUll~NO SllUmlA\. 1;}l{l0 pUll Sll~;}pun pUll spuoq lllI!lS;}llll pUll lllI!lnO;}X;} JO AIUO s;}sodmd
10J lOUd-lI!-SA;}U1OlW 10 S;}~.IIll;}10;}S lUlllS~SSV lU;}P~S;}~ 'SlU;}P~S;}1d ;}O~A lu;JP~S;}~ lllI!lu~oddu Ol;}l;}l{l lllI!lUI;}l ;}lUOY!ll;}O AUll Ol10 A;}U10nU JO .r:;lA\od
hUll Ol ;}1~~souJ Aq P;}x!lJll ;}q AUUI AUlldUIO;) ;}l{l JO fll;}S ;}l{l pUll 'Aml;}10;}S lUlllS~ssV AUll 'Aml;}lO;}S AUll 'lu;Jp~S;}ld ;}O~A lUlllS~SSV AUU 'lu;JP~S;}1d
;}O~A AUll 'lu;JP~S;}1d ;}O~A 10~S AUll 'lU;}P~S;}ld ;}O~A ;}Anno~X:3: AUll 'lU;}P~S;}1d :Sl;Y.)!lJO llu~onoJ ;}l{l JO llOU;} JO ~mllluJl~S ;}l{llUll.L :atliOA
:paJJa p1rn a;}.IoJ lInJ U! A\OU S! uOnnIosall q;}!qA\ 'XN:VdW03
Xl.'IVnSV3 NOl.DNIWllV.!I p1rn XNYdW03 Xl.:rnns ([NV Xl.'IVnSV3 SH3:'I:IAVHl. 'V3nI3:WV .!IO XNYdW03
Xl.:rnns ([NY Xl. 'IVnSV3 SH3:TJIA VHl. JO s.lopa.l!([ JO sp.llmg aql Aq paloA uOnnIosall ~U!PUUlS ~U!A\OlIOJ aql JO Al!.Ioqlnu
Aq puu .Iapun (palU!.Id .10 {U;}!uuq;}aw) auw!s;}uJ Aq paIuas puu pau~!s S! Al!.Ioqlnv JO alu;}!J!J.la3 puu AaU.lOnV JO .IaA\od S!ql.
'Al~10l{lnu JO UOnUll;}PP U;}WlA\. U ollUlffismd Sl~O!lJO AUlldUIO;) ~10UI 10 ;}UO Aq
10 Al~ol{lnu JO S;}lUomll;}O 1~;}l{l10 ;}lUOY!ll~O .r:;l1l10 S~ ~ P;}q~OS;}ld l;}A\od ~l{l ollmmsmd Slu;JllV pUll lOUd-lI!-SA;}UIOnV ;}10UI 10 ~UO Aq (p;}~nb;}l
J~ 'IU;}S l~pun) P;}lno;}X;} hlnp (q) 10 'Aml~10~S lUlllS~SSV 10 Aml~10;}S U Aq fll;}S S,AUlldUIO;) ;}l{ll{l~ P~fll;}S pUll p~lS;}nU Alnp pUll Aml;}10;}S lUlllS~SSV
AUll10 Aml;}10;}S ;}llllOdIo;) ~l{l 'l;}1llSU;}l.llUlllS~SSV AUll '.r:;lmSU;}l.l ~l{l 'lu;Jp~S~ld ~O~A PUOO;}S AUll 'lU;}P~S~ld ~O~A AUll 10 lU~P~S;}1d ;}O~A 10~u;JS
AUll 'lu;JP~S;}1d ;}O~A ;}A nno;}x:3: AUll 'UlllIII!lll{;) ~O~A AUll 'lu;JP~S~1d ~l{l Aq P;}uJl~S (u) U~llA\ AUlldUIO;) ;}l{l uodn llUWlI!q pUll pnUA ;}q IfllllS llUqll11;}Pun
flluompuoo 10 '~OUllzwllOO;}l 'puoq U JO ~mlllu ~l{l lI! A.IOlllllnqo llU~l~lA\. 10 'Al~;}PlI! JO lOu.nUOO ';}OUllZ!uJlO:XU 'puoq AUll lmtL :atliOA
'Aml;}10~S ;}l{lJO ;}O!lJO ~l{llI! P;}lY SUO~l~l{l Adoo U pUll llU~l!lh1. u~
S~ UO~lUll;}PP lIons llOU;) lUl{l p;}p~01d 'AUlldUIO;) S~l{l JO S;};}AOldUI;} 10 Sl;}O!lJO ;}10UI 10 ;}UO Ol Al~10l{lnu 1l~01l;}10J ;}l{l JO :j.IUd AUll10 nu :)lllll~PP hUUI
lU;}P~S;}ld ;}O~A AUll10 lU;}P~S;}ld ~O~A 10~;}S AUll 'lU;}P~S;)1d ;}O~A ;}Anno;}X:3: AUll 'UllUIl~Ull;) ;}O~A AUll 'lU~P~S;}ld ;}l{l 'UllUI1~lll{;) ~l{llmu :atliOA
'1;}1l10 ~ U;}A~ll .r:;lA\od ;}l{l ;}~OA;}l pUll ;};}lU~oddu
lIons AUll ;}AOUI;}l AUUI ;}UIH AUlllll S10lO;}1~a JO plllOg: ~l{l10 Sl;}O!lJO p~US JO AUll pUll 'lluPflll1;}Pun Iuuompuoo 10 '~OUllZ~uJlOO;}l 'puoq U JO ;}mlUu ;}l{l
u~ A.IOlUllnqo SlllI!l!1A\ 1;}l{l0 pUll 'Al~~PlI! JO SlOu.nUOO 'S;}OUllZ~llOO;}l 'spuoq IU;}S S ,AUlldUIO;) ;}l{ll{l~ IU;}S pUll ;}UIUU S ,AUlldUIO;) ;}l{ll{l~ uJl~S Ol
;}q~10S~ld AUUI Al~10l{lnu JO ;JlUOY!ll~O 1~1l10 S~ll su Al~Ol{lnu lIons ;};}lU~oddu lIons ;}A~ll AUUI pUll AUlldrnoo ;}l{lJO JIUll;}q uo PUll10J lOU Ol SlU;}llV pUll
lOUd-lI!-SA;}U10nV lU~oddu AUUI Aml;}10;}S lUlllS~SSV AUll10 Aml;}10;}S ;}lU10dIo;) ;}l{l 'l;}mSU;}l.llUlllS~SSV AUll 'l;}1llSU;}l.l ;}l{l 'lu;Jp~S~ld ;}O~A PUO:Y.lS
AUll 'lU~p~S~ld ~O~A AUll 'lU~P~S;}ld ;}O~A 10~S AUll 'lU;}P~S;}1d ~O~A ;}AnnO;}X:3: AUll 'UllUIlflll(;) ~O~A AUll 'lU~P~S;}ld ~l{l 'UlllIII!lll{;) ;}l{l WlU. :atliOA
:l::l::lJJ::l puu ::l::l10J UtlJ U~ MOU
::llU SUOnnIOS::l'tI q::lrqM 'S::l!Wdwo;) p~US JO SUOnnIOS::l'tI gu!pmns gU~OUOJ ::lql JO Alpmllnu Aq puu l::lpun ::lpmu S~ lU::lUIll[J!oddu S!q.L
'p::luuyuO::l pm P::lY1W1 Aq::ll::lq ::llU 'U::lA!g Up1::lq Alpoqlnu ::lql ollUunsllld 'l::lUd-uI-{S)A::lU10nv PIllS JO SpR ::lql UU puu 'S::l!Wdwo;)
::lql JO Sl::l::lYJO p::lzpOqlnu AInp ::lql Aq P::lug!S ::ll::lM ::lWUS ::lql J! SU lU::llX::l ::lWUS ::lql Ol pUU AUtlJ su Aq::l1::lql 'S::l!uudwo;) ::lql pUN Ol pUU
puoq .lad S(JTI770a (00 '000 '000 'ZS) N0I77IfV OM.LJO ums a1Jl 3u!paa:Jxa IOU Ol::ll::lqllU::lPPU! SlU::lSUO::l IIu puu Am puu gUNUl1::lPun
ItmOnWUO::l 10 '::l::lUUZ~O::l::ll 'puoq U JO ::llllWU ::lql U! A.IOWgnqo sgunpM l::lqlO pUU 'Al!llW::lPU! JO SPU1lUO::l 'S::l::luuz!mtO::l::l1 'spuoq
UU puu Am 'l::lU pm ::llnwlili!s ::lIOS l::lqfS!lI Aq :(S)lU::lWllllSU! gU!MOIIOJ ::lql 'S::llUlS p::ll!Un ::lql uNl~ ::l::lUId AUU W '::lgp::lIMompu pm
::llfi:)::lX::l 'lili!s Ol p::lll::lJUO::l Aq::ll::lq Alpoqlnu pm l::lMOd UtlJ ql!M 'l::lUd-uI-{S)A::lUlOllV I1.1JM.uI pUU ::llUll!::lql 'U!SUO;}S!A\ "PU;lS lsaA\
I uqS;l}fnu A\ JO 'O.IUInwu.!l upun '}f;}!.Il!a.lS "W A.lUW '.I;l~U3: ")I AlS!.I)I 'UlnW;lA\Og }f.luI3 03: 'num "W J.laqoll 'WID "d ;l;}AOr
'1rnWV P{U.I;lD 'uasnuq}f;}OlS "W uuv 'A\O.lwn)l "H: qlauu;l)J 'PlSA\u.lnw usn 'l{aqan unnr :lU!oddu pm ::lltllnSUO::l '::l)j[Uw SlU::lS::l1d
::lS::lql Aq op pm 'p::llU!oddu pUU p::llnmSUO::l '::lpmu qluq CS::l!mdwo;)" ::lqll::llJRUPl::lq) 'lfi:)!P::lUUO;) JO ::lWlS 'PloJl1UH JO Aluno;)
'PlOJl.IUH JO Al!;) ::lql U! S::l::lYJo ludpupd IPql gU!Auq pm 'lfi:)!l::l::lUUO;) JO ::lWlS ::lql JO SMuI ::lqll::lpun P::lZ!llUglO Amp SUOnUIOWO::l
'XNYdW03 Xl.WnSV3 NOl.~NIWllV.!I pUU XNYdW03 Xl.:rnns ([NY Xl.WnSV3 SH3:'I3:AVHl.. "V3nI3:WV
.!IO XNYdW03 Al..:rnns ([NY Xl..WnSV3 SH3:'I3:AVHl.. l..VHl.. 'Sl..N3:S:rnd 3:S3:R.L XS SNOSH3:d TIV A\ON)J
1..3V.!I-NI-(S)X3:NlIOl..l..V.!IO Xl.nIOHl..nV .!IO 3:l..V3IJ1Ull3:3 ([NY X3:NlIOl..l..V .!IO 113:A\Od
t906-f8190 lnJ!pauuo;) 'PJoJl-IllH
ANV~03A~~VilSV3NO.l~N.rnrnV~
ANV~03 A.lIDlilS <INV A.l'lVilSV3 SH:I'UIAVH.L
V3nI:lWV ~O ANV~03 A.lIDlilS <INV A.l~VilSV3 SH:lTilAVH.l
C':.
"
BS6~ NOIIV1:l0dMO:J m:lo:Jv @)
EM~
LL889EVII/lOLLOvS#
('; lO ~ (sonooz) sz OMO:JV
~(Y7 "0 ~~
3AliViN3S3Hd3H G3ZIl:IOHinV
'S3^liViN3S3l:1d3l:1
, 1:I0 SiN3~V Sil 'l:I3HnSNI 3Hi NOdn GNI:>l ANV ~O AilllBVlll:lO NOliV~IlBO ON 3S0dl/lJI
11VHS OS 00 Oi 3l:1OlIV~ inS 'i~,313Hi qi 031/1JVN H3alOH 3iVOI:lliH3::J 3Hi Oi 3::JliON
N3illl:lM SAVO ----o-r 1lVW Oi HOAV3GN311lM H3l:1nSNI ~NInSSI 3Hi '~03l:13Hi 3iVO
NOli'IfHldX3 3Hi 3l:10:l3B G31130NVO 3B S3101l0d 03Sll:I::JS30 3^OSV 3Hi ~O AN\t G1nOHS
.
(,;06VS 1M 'HSO)tHSO
lS H~~nH~ SI,Z
M3~VNVVII A.l1~ Nll.V
HSO)tHSO :10 A11~
___ , NOI!V113:JNV:J H3a10H 31V:JI::II!M3:J
\i '-l~:r\O J.j.\. ~ \\ 'ANVdVIIO~ 3Hl VII0~:llS3n03~ NOdn 318Vl1V^V SIIN3V113S~OON3 31dVIIVX3
3')\::1~O S'" 1 ~l'~ \ NV "3^08V 031V~IONI A~110d A!1118VI1 lVM3N3~ 3Hl ~30Nn 99so'm 'ON VII~O:l
, "'" \1.1W ' N3V113SMOON3 M3d 03~nSNI lVNOlllOOV NV SV 03!SI1 SI HSO)tHSO :10 A11~ 3Hl
I \\,1. '4 1. ee ..
! ~~' r\~ \ 900HO 1~3rOMd ~llclO M381:1 :3M
, ~ i " " . " .u I \;NOISI^OHd l\fl::J3dS I iN31/1J3Sl:IOON3 AS 030GV SNOISnl::JX31 S3101H3^ I SNOliV::J01l SNOli'IfH3dO ~O NOlidll:lOS3C
~,f~'~~
ooo'olfS$ il~1l AOIlOd - 3Slt3SI0 '1'3
OOO'OOS$ 33AOld~3 1t3 - 3S\t3S10 '1'3
OOO'OOS$ iN301:J01t HO\t3 '1'3
-~iol I :~W1tg~.L I X
90/H/SO
SO/H/SO
S ~08(,;8LE17 ~6AH~M
l:I3HiO
MOjSq SNOISlflOHd 1\t1:J3dS
Jspun sqjJ~sap 'SSA}I
W300l:)X3 H38l"13l"1~3:)1:l:l0
3^lin03X3~3Nil:lltd~01.3ll:1dOHd ANIt
Ai1l18\trl ,Sl:I3A01d1/lJ3
ONV NOliVSN3dl/lJ00 Sl:I3:>ll:lOM
$ NOliN31.3H L
318Ii::Jnc130 L
8
$
$
$
$
$
$ 88\t
$
$
001t \t3
'A 1NO Oinlt
N\tHi H3HiO
30ltl"l S~llt1:J 0 l:In~)OO C
Aill18VIl Vl13l:1BWnISS3::JX3
01nlt ANIt t=
AiIlISVIl .3~'IfH\t~
31 \t83H88\t
3::JN3HHnooo HO\t3
iN3010:J\t 1t3 - A 1NO Oin\t
$
(IUSP!O~8 JSd)
3f)\t~ltO Ai1:l3dOHd
000'000' ~$
(IUSpp~8 83)
il~1l 31flNIS 03N18~00
90/H/SO
SO/H/SO
SE08(';SLEv ~6A)tSV
-
SOinlt 03NMO-NON X
-
SOinlt O,IHIH X
SOlnlt 031n03HOS ~
e---
SOinlt 03NMO 1llt
I--
01O\t AN\t X
Aill18VIl 311B01/IJ0.tnv
001 TI ~8g~ ~_ AOI10dL
:H3d S31lddlt ill"lI131\t831:18'Ellt 1,N38 X
-
,
$
(luspp~e JSd)
AHnrNI A 11008
$
(uOSJad JSd)
Al:InrNI A 11008
OOS'(';:paO Odl/18 X
HnOOO ~ 30Vl"I Sl"IIlt10 1-
Ai1118lt1l1ltH3N381lt101:l3l"1V'J00 X
SO/H/SO Sv08(,;8LEv~6A)t^^ AlIlISVIT1'IfH3N3i) X ,
iA'Wg~~~~~3tiJld H3SWnN AOIlOd 30N'lfHnSNI ~O 3d),i i~~I}l~
'SVIIIVl8 OIVd A8 038n03Cl N338 3AVH AVVII NMOHS Sl1VII1l31V8::r1:l88V 'S3181l0d
H8nS.:lO SNOIIION08 ONV SNOISnl8X3 'SVlltl313Hl 11'0' Ol183r8nS SI NI3Cl3H 0381Cl8S30 S3181l0d 3Hl A8 030ClO.:l.:lV 38NVtlnSNI3Hl 'NIVICl3d AVVII
tlO mnssl 38 AVVII 31V81::111tl38 SIHl H81HM 01183dS3tl HIIM IN3V11n800 tl3HIO ClO 18VtllN08 AN\f::lO NOIIION08 tlO VIItl31 'lN3V113Clln03tl AN\f
8NIONV1SHIIMION '031V810NI 00lCl3d A:)1l0d 3Hl tlO.:l 3^08V 03V11VN 03tlnSNI3Hl 01 mnssl N338 3AVH M0138 031S1l38NVtlnSNI:lO S3181l0d 3Hl
000'000'(';$
000 OOO'Z$
000'000 ~$
000 S$
OOO'OOE$
000 000 ~$
8fllt dOld~OO - SiOnOOl:ld
3i\t83H8fllt1\tH3N3fl
AHnrNI ^Olt 'il1\tNOS1:I3d
(uOSJsd suo AUV) dX3 03l"1
s~u~~f~~~3bg~~~~g
30N3Hl:In::J:J0 HO\t3
90/H/SO
~^d~I~X~ K5~gd
SilWIl
S3f>V1:I3^O
--31 V~I:lll~3~ 03SI^3~n '3 H3HnSNI O(,;~ES 1M 'AO~11SV3
:0 1:I3HnSNI LE~ X08 Od
:0 H3HnSNI MO A~M3N3 886~
AN \fdVIIO~ 3~NVMnSNI lVM3N3~ nVSnVM :8,H3HnSNI ~NI S3~1^~3S A~M3N3 S)t
AN #dVIIO:J 3~NVMnSNI SS3NISn8 nVSnVM :lt1:l31:1nSNI G3l:105
# :JIVN 3f>V1:I3^O:J f>NIOMO::l:lV SH3MnSNI ,
vEE(';-LLS vi
600E-v(';(';ES 1M '33)tnVM11
'M0138 S31:J110d 3H! A8 030MO:l:lV 3f>V1:I3^O:J 3Hl M3~ 1'1 3~Vld )tMVd M 0081
MO ON3~X3 'ON3WV ~ON S30a 3~V:JI::II~H3:J SIH~ 'H3a10H
31V:JI:lI~H3:J 3H~ NOdn S~Hf>IM ON SH3::1NO:J ONV A1NO A~N3~V 3Mnl'V'NmS nvsnv,
NOI!VWHO::lNI ::10 H3.llVW V SV 03nSSI SI 3~V:JI::II~M3:J SIHl H30noo
90/0E/EO I ",1i'
(AAAAlOG1WW) 3iVG 3~N~nSNI All118Vll .:10 31V~I.:I11~3~ "llaHQP 11'
A~M3N3S)t
Hv(';S :#tua!l~
ACORD CERTIFICATE OF LIABILITY INSURANCE I DATE (MM/DD/YYYY)
TM 05/09/2006
PRODUCER (800) 566-7007 FAX (262)574-7080 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
R & R Insurance Services, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
1581 E Racine Avenue HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
PO Box 1610
Waukesha, WI 53187-1610 , INSURERS AFFORDING COVERAGE NAtC#
INSURED KS Energy Services Inc INSURER A: Navigators Mgt Co Inc
PO Box 137 INSURER B: St. Paul Fire & Marine Ins. Co.
W31S1 Hwy 20 INSURER c:
East Troy, WI 53120 INSURER D:
INSURER E:
COVERAGES
THE POLICIES OF INSURANCE LISTED BELOWHAVEBEENtsSOErYTOTHEINSOREDNAMED 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 SOCH
POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ,
I~~ ~~g~ TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS
GENERAL LIABILITY EACH OCCURRENCE $
- DAMAGE TO RENTED
COMMERCIAL GENERAL LIABILITY ffiEMlSES-lf..anc=,ence,L $
l CLAIMS MADE o OCCUR MED EXP (Anyone person) $
PERSONAL & ADV INJURY $
f--
GENERAL AGGREGATE $
~
GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COM~OPAGG $
~ nPRO- 11
POLICY JECT LOC
AUTOMOBILE LIABILITY ~l 10:",.'1 . '-."".--.-
- l?:i' t(~ ff!! ~I t\v? ~ ~' COMBINED SINGLE LIMIT $
ANY AUTO ~ \'-~ "'~ ii (Ea accident)
'-- ',., ... l! IS; i
ALL OWNED AUTOS -- -"li{" BODILY INJURY
:-- (Per person) $
SCHEDULED AUTOS
- MAY 1 8 2i ~y
HIRED AUTOS BODILY INJURY
- $
NON-OWNED AUTOS (Per accident)
- 1 CITY
CLERK'S ( PROPERTY DAMAGE
- )FF/r:r;: j (Per accident) $
GARAGE LIABILITY ~'...-... ...............-....,..,._...,J AUTO ONLY - EA ACCIDENT $
R ANY AUTO OTHER THAN EA ACC $
AUTO ONLY: AGG $
EXCESS/UMBRELLA LIABILITY CH06UMB086123NV 05/17/2006 05/17/2007 EACH OCCURRENCE $ 10,000,00CJ
]J OCCUR 0 CLAIMS MADE AGGREGATE $ 10,000,00CJ
A $
~ DEDUCTIBLE $
X RETENTION $ 10,00C $
WORKERS COMPENSATION AND I T'X~$T~;,~~T TOJ.t'-
EMPLOYERS' LIABILITY
ANY PROPRIETOR/PARTNER/EXECUTIVE EL EACH ACCIDENT $
OFFICER/MEMBER EXCLUDED? E.L DISEASE - EA EMPLOYEE $
If yes, describe under
SPECIAL PROVISIONS below E.L DISEASE - POLICY LIMIT $
OTHER Umbrella Q104S00202 05/17/2006 05/17/2007 $5,000,000 Ea. Occurrence
Excess
B $5,000,000 Aggregate
DESCRIPTION OF OP,ERATIONS / LOCATIONS iVEI:Uc::LES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS
E: Fiber Optic Project 011006
mbre11 a coverage follows underlying general 1 iabil ity, auto, and employers liability
overage forms, conditions, extensions, and exclusions.
..,
CERTIFICATE HOLDER CANCELLA TlnN
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFOF1E THE
EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL
City of Oshkosh -1L DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,
Attn: City Manager BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY
215 Church Street OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES.
Oshkosh, WI 54902 AUTHORIZED REPRESENTATIVE ~
Thomas Scheider/TWB315
ACORD 25 (2001/08)
@ACORD CORPORATION 1988
ACORDTM CERTIFICATE OF LIABILITY INSURANCE I DATE: (MM/DD/YYYY)
05/17/06
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
WAUSAU SIGNATURE AGENCY ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
11800 W PARK PLACE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
MILWAUKEE, WI 53224,3009
414577-2334 INSURERS AFFORDING COVERAGE NAIC#
INSURED INSURER A: WAUSAU BUSINESS INSURANCE COMPJ NY
KS ENERGY SERVICES INC INSURER B: WAUSAU GENERAL INSURANCE COMPA NY
1988 ENERGY DR INSURER C:
PO BOX 137 INSURER D:
EAST TROY, WI 53120 INSURER E:
Client#: 82411
KSENERGY
COVERAGES
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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
LTR NSR TYPE OF INSURANCE POLICY NUMBER PJ>,N~~9~f68~E Pg~~l(~~~1N!gN LIMITS
A X GENERAL LIABILITY VYKY91437828046 05/17/06 05/17/07 EACH OCCURRENCE $1.000,000
:-- ~~~~~H?E~~~J~ence\
X COMMERCIAL GENERAL LIABILITY $300 000
I CLAIMS MADE [KJ OCCUR MED EXP (Anyone person) $5.000
X BI/PD Ded:2,500 PERSONAL & ADV INJURY $1.000 000
GENERAL AGGREGATE $2,000,000
-
GEN'L AGGREnE LIMIT APnS PER: PRODUCTS-COM~OPAGG $2 000,000
I PRO-
POLICY JECT LOC
A AUTOMOBILE LIABILITY ASKY91437828036 05/17/06 05/17/07 COMBINED SINGLE LIMIT
- $1 ,000,000
X ANY AUTO (Ea accident)
-
- ALL OWNED AUTOS BODILY INJURY
$
SCHEDULED AUTOS (Per person)
r--
~ HIRED AUTOS BODILY INJURY
$
X NON-OWNED AUTOS (Per accident)
r--
PROPERTY DAMAGE $
(Per accident)
~GE LIABILITY AUTO ONLY - EA ACCIDENT $
ANY AUTO OTHER THAN EA ACC $
AUTO ONLY: AGG $
~ESS/UMBRELLA LIABILITY EACH OCCURRENCE $
OCCUR D CLAIMS MADE AGGREGATE $
$
=1 DEDUCTIBLE $
RETENTION $ $
B WORKERS COMPENSATION AND WCHY91437828016 05/17/06 05/17/07 X I T~2;'[~Ws I IOJ!;,-
A EMPLOYERS' LIABILITY WC~91437828026 05/17/06 05/17/07 $500,000
ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT
OFFICER/MEMBER EXCLUDED? E.L. DISEASE - EA EMPLOYEE $500,000
If yes, describe under ;J,. DISEASE - POLICY LIMIT $500,000
SPECIAL PROVISIONS below
OTHER 'fFj Ie (C~ n ~ir fN
'.,_'7 ~ :, ~
.~. "- W , r"\
--- .,
,~ - . .
,,"'.""", 0' o"",no,,, COCAnoN" "'""''''' ,,",WOO", AD""y ""00","'",, ,."C"'- ..0""'0'" L~ - I I ,
RE: FIBER OPTIC PROJECT 011006 . MAY 1 5 2006 ! /.:'
THE CITY OF OSHKOSH IS LISTED AS AN ADDITIONAL INSURED UNDER THE GENERAL C I :':l/
LIABILITY POLICY INDICATED ABOVE, AN EXAMPLE ENDORSEMENT IS AVAILABLE UPON ITV CLERK'S OFFV" ", !
(See Attached Descriptions) -.- _..:.:...::../
CERTIFICATE HOLDER
CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
CITY OF OSHKOSH DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL --...3{L DAYS WRITTEN
A TTN CITY MANAGER NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL
215 CHURCH ST IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
OSHKOSH, WI 54902 REPRESENTATIVES.
AUTHORIZED REPRESENTATIVE
~~ -12..... W~
ACORD 25 (2001108) 1 of 3
#S411640/M411628
CR3
€l ACORD CORPORATION 1988
-~~- I
ACORDTM CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYV)
# 05/17/06
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
WAUSAU SIGNATURE AGENCY ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
11800 W PARK PLACE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
MILWAUKEE, WI 53224-3009
414577-2334 INSURERS AFFORDING COVERAGE NAIIC#
INSURED INSURER A: WAUSAU BUSINESS INSURANCE COMPJ NY
KS ENERGY SERVICES INC INSURER B: WAUSAU GENERAL INSURANCE COMPJ! NY
1988 ENERGY DR INSURER C:
PO BOX 137 INSURER 0:
EAST TROY, WI 53120 INSURER E:
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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
L TR NSRr TYPE OF INSURANCE POLICY NUMBER PJ>}{~~ri~fJ8,w\E p~~fJ (~'g;I~~N
A X ~NERAL LIABILITY VYKY91437828046 05/17/06
X COMMERCIAL GENERAL LIABILITY
I CLAIMS MADE [Xl OCCUR
X BI/PD Ded:2,500
AUTO ONLY - EA ACCIDENT $
EA ACC $
AGG $
$
$
$
$
$
X I T':'{gJ!~~" I IOJ~-
E.L. EACH ACCIDENT $500,000
E.L. DISEASE - EA EMPLOYEE $500,000
E.L. DISEASE - POLICY LIMIT $500,000
Client#. 82411
KSENERGY
COVERAGES
05/17/07
EACH OCCURRENCE
~~~~~H9E~~~ir?ence\
MED EXP (Anyone person)
PERSONAL & ADV INJURY
A
~'L AGGRE~E LIMIT AP~S PER:
· I POLICY I I ~f8T I I LOC
~OMOBILE LIABILITY
2L. ANY AUTO
_ ALL OWNED AUTOS
_ SCHEDULED AUTOS
2L HIRED AUTOS
~ NON-OWNED AUTOS
GENERAL AGGREGATE
PRODUCTS - COM PlOP AGG
ASKY91437828036
05/17/06
05/17/07
COMBINED SINGLE LIMIT
(Ea accident)
BODILY INJURY
(Per person)
BODILY INJURY
(Per accident)
I--
PROPERTY DAMAGE
(Per accident)
nRAGE LIABILITY
M ANY AUTO
OTHER THAN
AUTO ONLY:
OEXCESS/UMBRELLA LIABILITY
OCCUR D CLAIMS MADE
RDEDUCTIBLE
RETENTION $
B WORKERS COMPENSATION AND
EMPLOYERS' LIABILITY
A ANY PROPRIETOR/PARTNER/EXECUTIVE
OFFICER/MEMBER EXCLUDED?
If yes, describe under
SPECIAL PROVISIONS below
OTHER
EACH OCCURRENCE
AGGREGATE
WCHY91437828016
WCKY9143782~026 _
05/17/06
.... 05/17/06
05/17/07
05/17/07
LIMITS
$1.000.000
$300.0100
$5.0001
$1 0001 000
$2 0001.000
$2 000 000
$1,000,000
$
$
$
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS IrRJ' ;;.---- '~.'.
RE: FIBER OPTIC PROJECT 011006 n~' If:?/ li('~ It~--;"----.
., ~'Of r"'"" i \ " i7~ f""\
THE CITY OF OSHKOSH, AND ITS OFFICERS, COUNCIL MEMBERS, AGENTS, EMPLoy~dl{j '~~L.~':J:~If1J
AND AUTHORIZED VOLUNTEERS ARE INCLUDED AS ADDITIONAL INSUREDS UNDER{ '. JUN 1 2 2006 if!.1.1
(See Attached Descriptions) II lj L Iii /l
CERTIFICATE HOLDER CANCELLATION r-,'T"\,,... _ -- . i -'J r
. \oJ. I~"'" > -
SHOULD ANY OF THE ABO p01:Il:lI!SillaG~N~1\'fEP~F-' T~E EXPIRATION
DATE THEREOF, THE ISSUING INSURER WILL ENDEA~IO-MA~~.'fYS WRITTEN
NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL
IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
CITY OF OSHKOSH
ATTN CITY CLERK
215 CHURCH ST
OSHKOSH, WI 54902
REPRESENTATIVES.
AUTHORIZED REPRESENTATIVE
l'\.~ -l2..... w~
ACORD 25 (2001/08) 1 of 3
#S415130/M411628
CR3
@ ACORD CORPORATION 1988