HomeMy WebLinkAboutPW CNT 10-20 Four-Way Construction /
CONSTRUCTION CONTRACT
THIS AGREEMENT, made on the 16th day of September, 2010, by and between the
CITY OF OSHKOSH, party of the first part, hereinafter referred to as CITY, and FOUR -
WAY CONSTRUCTON OF WI, PO Box 133, Berlin, WI 54923, party of the second part,
hereinafter referred to as the CONTRACTOR,
WITNESSETH:
That the City and the Contractor, for the consideration hereinafter named, agree as
follows:
ARTICLE I. SCOPE OF WORK
The Contractor hereby agrees to furnish all of the materials and all of the equipment
and labor necessary, and to perform all of the work shown on the plans and described in the
specifications for the project entitled or described as follows:
Public Works Contract No. 10 -20
for mini storm sewer /storm laterals and appurtenant work, for the Public Works Department,
pursuant to Resolution 10 -284 adopted by the Common Council of the City of Oshkosh on
the 15th day of September, 2010,
all in accordance and in strict compliance with the Contractor's proposal and the other
contract documents referred to in ARTICLE V of this contract.
ARTICLE II. TIME OF COMPLETION
The work to be performed under this contract shall be commenced and the work
completed within the time limits specified in the General Conditions and /or Contractor's
proposal.
ARTICLE III. PAYMENT
(a) The Contract Sum.
The City shall pay to the Contractor for the performance of the contract the sum of
$57,030.80, adjusted by any changes as provided in the General Conditions, or any
changes hereafter mutually agreed upon in writing by the parties hereto, provided, however,
in the event the proposal and contract documents are on a "Unit Price" basis, the above
mentioned figure is an estimated figure, and the City shall, in such cases, pay to the
Contractor for the performance of the contract the amounts determined for the total number
of each of the units of work as set forth in the Contractor's proposal; the number of units
1
units therein contained is approximate only, and the final payment shall be made for the
actual number of units that are incorporated in or made necessary by the work covered by
the contract.
(b) Progress Payments.
In the event the time necessary to complete this Contract is such that progress payments
are required, they shall be made according to the provisions set forth in the General
Conditions.
ARTICLE IV. CONTRACTOR TO HOLD CITY HARMLESS
The Contractor covenants and agrees to protect and hold the City of Oshkosh
harmless against all actions, claims and demands of any kind or character whatsoever
which may in any way be caused by or result from the intentional or negligent acts of the
Contractor, his agents or assigns, his employees or his subcontractors related however
remotely to the performance of this Contract or be caused or result from any violation of any
law or administrative regulation, and shall indemnify or refund to the City all sums including
court costs, attorney fees and punitive damages which the City may be obliged or adjudged
to pay on any such claims or demands within thirty (30) days of the date of the City's written
demand for indemnification or refund.
ARTICLE V. COMPONENT PARTS OF THE CONTRACT
This contract consists of the following component parts, all of which are as fully a part
of this contract as if herein set out verbatim, or if not attached, as if hereto attached:
1. This Instrument
2. The City's Approved Plans
3. Specifications, including any addenda
4. City of Oshkosh Standard Specifications
5. Instructions to Bidders
6. Advertisement for Bids
7. Contractor's Proposal
The contract documents are complementary; what is required by one is as binding as
if required by all. Before undertaking each part of the work, the Contractor shall carefully
study and compare the Contract Documents and check and verify all pertinent figures and
measurements required therein. Contractor shall promptly report in writing to the Engineer
any conflict, error, ambiguity or discrepancy which Contractor may discover and shall obtain
written clarification from the Engineer before proceeding with any work affected thereby.
In the event that any provision in any of the above component parts of this contract
conflicts with any provision in any other of the component parts, the provision in the
2
•
component part first enumerated above shall govern over any other component part which
follows it numerically except as may be otherwise specifically stated.
IT IS HEREBY DECLARED, UNDERSTOOD AND AGREED that the word
"Contractor" wherever used in this contract means the party of the second part and
its /his /their legal representatives, successors and assigns.
IN WITNESS WHEREOF, the City of Oshkosh, Wisconsin, has caused this contract
to be sealed with its corporate seal and to be subscribed to by its City Manager and City
Clerk and countersigned by the Comptroller of said City, and the party of the second part
hereunto set its, his or their hand and seal the day and year first above written.
In the Presence of: CONTRACTOR
FOUR -WAY CONSTRUCTION OF WI
By : i -radio
(Seal of Contractor (Spet itle)
if a Corporation.)
� r
By:
(Specify Titl
CITY OF OSHKOSH
By: ■,
Mark A. Rohloff, City Manner
er
�g
„ 'ess)
. �. 8 0 4■47.. And _
Wi ts Pamela R. Ubrig, City ' ler
APPROVED: I hereby certify that the necessary
provisions have been made to
pay the liability which will accrue
W`► _ & ! :pia under his contract.
ity Attorney
Air
...#2:41roLi
City Co It :II f
3
Bond No.
BID BOND
The American Institute of Architects,
AIA Document No. A310 (February, 1970 Edition)
KNOW ALL MEN BY THESE PRESENTS, that we Four -Way Construction of Wisconsin, Inc.
as Principal hereinafter called the Principal, and THE HANOVER INSURANCE COMPANY
a corporation duly organized under the laws of the state of New Hampshire as Surety, hereinafter called the Surety,
are held and firmly bound unto The City of Oshkosh
as Obligee, hereinafter called the Obligee, in the sum of Five Percent of the Amount Bid
Dollars ($ 5% of Bid ), for the payment of which sum well and truly to be made, the said Principal and the
said Surety, bind ourselves, our heirs, executors, administrators, successors and assigns, jointly and severally, firmly
by these presents.
WHEREAS, the Principal has submitted a bid for Contract #10 -22
NOW, THEREFORE, if the Obligee shall accept the bid of the Principal and the Principal shall enter into a Contract
with the Obligee in accordance with the terns of such bid, and give such bond or bonds as may be specified in the
bidding or Contract Documents with good and sufficient surety for the faithful performance of such Contract and for
the prompt payment of labor and material furnished in the prosecution thereof, or in the event of the failure of the
Principal to enter such Contract and give such bond or bonds, if the Principal shall pay to the Obligee the difference
not to exceed the penalty hereof between the amount specified in said bid and such larger amount for which the
Obligee may in good faith contract with another party to perform the Work covered by said bid, then this obligation
shall be null and void, otherwise to remain in full force and effect.
Signed and sealed this 5th day of October 2010
Four -Way Construction of Wisconsin, Inc.
itness - - �Prin sal (Seal)
By: /i '��'' �;� _ .de _
% Name /Title
THE OV / INSURANCE COMPANY
11 i rety (Seal)
\ \IS .1 . -/e---217 I 0, tobe,,
Witness B y:
Dennis M. Barton Attorney -in -Fact
ORSC 21328 (5/97)
THE HANOVER INSURANCE COMPANY
MASSACHUSETTS BAY INSURANCE COMPANY
CITIZENS INSURANCE COMPANY OF AMERICA
POWERS OF ATTORNEY
CERTIFIED COPY
KNOW ALL MEN BY THESE PRESENTS: That THE HANOVER INSURANCE COMPANY and MASSACHUSETTS BAY INSURANCE COMPANY,
both being corporations organized and existing under the laws of the State of New Hampshire, and CITIZENS INSURANCE COMPANY OF
AMERICA, a corporation organized and existing under the laws of the State of Michigan, do hereby constitute and appoint
Joseph L. Vigna, Dennis M. Barton and /or Elizabeth M. Fedyn
of Brookfield, WI and each is a true and lawful Attorney(s) -in -fact to sign, execute, seal, acknowledge and deliver for, and on its behalf,
and as its act and deed any place within the United States, or, if the following line be filled in, only within the area therein designated
any and all bonds, recognizances, undertakings, contracts of indemnity or other writings obligatory in the nature thereof, as follows:
Any such obligations in the United States, not to exceed Twenty Million and No /100 ($20,000,000) in any single instance
and said companies hereby ratify and confirm all and whatsoever said Attorney(s) -in -fact may lawfully do in the premises by virtue of these presents.
These appointments are made under and by authority of the following Resolution passed by the Board of Directors of said Companies which
resolutions are still in effect
"RESOLVED, That the President or any Vice President, in conjunction with any Assistant Vice President, be and they are hereby authorized and
empowered to appoint Attomeys -in -fact of the Company, in its name and as its acts, to execute and acknowledge for and on its behalf as Surety any and
all bonds, recognizances, contracts of indemnity, waivers of citation and all other writings obligatory in the nature thereof, with power to attach thereto the
seal of the Company. Any such writings so executed by such Attomeys -in -fact shall be as binding upon the Company as if they had been duly executed
and acknowledged by the regularly elected officers of the Company in their own proper persons." (Adopted October 7, 1981 - The Hanover Insurance
Company, Adopted April 14, 1982 — Massachusetts Bay Insurance Company; Adopted September 7, 2001 - Citizens Insurance Company of America)
IN WITNESS WHEREOF, THE HANOVER INSURANCE COMPANY, MASSACHUSETTS BAY INSURANCE COMPANY and CITIZENS
INSURANCE COMPANY OF AMERICA have caused these presents to be sealed with their respective corporate seals, duly attested by a Vice
President and an Assistant Vice President, this 18th day of June, 2010.
THE HANOVERINSURANCE COMPANY
" MASSACHUSETTS BAY INSURANCE COMPANY
4Wk� .r"'� D* CtT1ZENS.1t�JSURANCE COMPANY OF AMERICA
tli1/4440.......0„ ''''
`. �� 1.994 t 074 ,> .(-',--'25 ft. I -4
Mary ear,ne ader on, ViCe Preside pt
CZ4 ,-. —1 *%;
Robert K. Grenaan, A.ssistar (.ice President
THE COMMONWEALTH OF MASSACHUSETTS )
COUNTY OF WORCESTER ) ss.
On this 18th day of June 2010., before me came the above named Vice President and Assistant Vice President of The Hanover Insurance
Company, Massachusetts Bay Insurance Company and Citizens Insurance Company of America, to me personally known to be the individuals and
officers described herein, and acknowledged that the seals affixed to the preceding instrument are the corporate seals of The Hanover Insurance
Company Massachusetts Bay Insurance Company and Citizens Insurance Company of America, respectively, and that the said corporate seals and
their signatures as officers were duly affixed and subscribed to said instrument by the authority and direction of said Corporations.
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My commission expires on November 3, 2011
I, the undersigned Assistant Vice President of The Hanover Insurance Company, Massachusetts Bay Insurance Company and Citizens Insurance
Company of America, hereby certify that the above and foregoing is a full, true and correct copy of the Original Power of Attorney issued by said
Companies, and do hereby further certify that the said Powers of Attorney are still in force and effect.
This Certificate may be signed by facsimile under and by authority of the following resolution of the Board of Directors of The Hanover Insurance
Company, Massachusetts Bay Insurance Company and Citizens Insurance Company of America.
".RESOLVED, That any and all Powers of Attorney and Certified Copies of such Powers of Attorney and certification in respect thereto, granted and
executed by the President or any Vice President in conjunction with any Assistant Vice President of the Company, shall be binding on the Company to the
same extent as if all signatures therein were manually affixed, even though one or more of any such signatures thereon may be facsimile." (Adopted
October 7, 1981 - The Hanover Insurance Company; Adopted April 14, 1982 Massachusetts Bay Insurance Company; Adopted September 7, 2001 -
Citizens Insurance Company of America) j
GIVEN under my hand and the seals of said Companies, at Worcester, Massachusetts, this fh day of °C_TD A ,P' , 20 /0
THE HANOVER INSURANCE COMPANY
MASSACHUSETTS BAY INSURANCE COMPANY
CITIZENS INSU ANCE COMPANY OF AMERICA
r. 7/7/ rr / ' "�� / -
F J
j i ! y ,- ''
Sloppto _. Sraufr. Alsis!an! Vice Preshi&nt
Bond No. 1944536
Executed in Four Copies
WISCONSIN SOCIETY OF ARCHITECTS _■!LiA
THE AMERICAN INSTITUTE OF ARCHITECTS
Vino
WIS. AIA DOCUMENT •oglla
6 JULY 1980 ED. WIS. A312
m
PUBLIC IMPROVEMENT
N PERFORMANCEILABOR AND MATERIAL
PAYMENT BOND
O THIS BOND IS TO BE USED ON PUBLIC IMPROVEMENT CONTRACTS PURSUANT
D TO SECTION 779.14 WISCONSIN STATUTES.
vi
KNOW ALL MEN BY THESE PRESENTS: that (Here insert name and address or legal title of the Contractor,
referred to in Sec. 779.14 Wisconsin Statutes as the prime contractor)
Four —Way Construction of Wisconsin, Inc., P.O. Box 133, Berlin, Wisconsin 54923
as Principal, hereinafter called Principal, and, (Here insert the legal title and address of Surety)
THE HANOVER INSURANCE COMPANY, 333 West Pierce Road, Itasca, Illinois 60143
duly authorized and licensed to do business in the State of Wisconsin, as Surety, hereinafter called Surety,
are held and firmly bound unto (Name and address or legal title of Owner)
The City of Oshkosh, 215 Church Street —P.O. Box 1130, Oshkosh, Wisconsin 54902 -1130
as Obligee, hereinafter called Owner, for the use and benefit of claimants as hereinafter provided in the
amount of Fifty — Seven Thousand Thirty and 80 /100s
Dollars ($ 57,030.80)
(Here insert a sum at least equal to the contract price)
for the payment whereof Principal and Surety bind themselves, their heirs, executors, administrators, suc-
cessors and assigns, jointly and severally, firmly by these • presents.
WHEREAS,
Principal has by written agreement dated Sept. 16 02019 entered into a contract with Owner for
Public Works Contract No. 10 -20 — Mini Sewer /Storm Laterals and Appurtenant
Work n Oshkosh, Wisconsin
in accordance with drawings and specifications prepared by (Here insert fell name, title and address)
which contract is by reference made a part hereof and is required by Section 779.14, Wisconsin Statutes,
O
n
The said written agreement, drawings, specifications and amendments
are hereinafter referred to as the Contract. c
c
-.l
PUBLIC IMPROVEMENT -
PERFORMANCE / LABOR - MATERIAL BOND TWO PAGES td
WIS. AIA DOC. WIS. A312AUGUST. 1989ED. PAGE 1 C7
Copr. 1969 Wisconsin Society of Architects/ AIA
321 S. Hamilton St.
Madison, Wis. 53703
NOW, THEREFORE, THE CONDITION OF THIS OBLIGATION, as required by Section 779.14,
Wisconsin Statutes, is such that, if the' Principal shall faithfully perform the said contract and pay every
person entitled thereto for all the claims for labor performed and materials furnished under the Contract,
to be used or consumed in making the public improvement or performing the public work as provided in
the Contract, then this obligation shall be null and void; otherwise it shall remain in full force and effect,
subject, however, to the following conditions:
1) No assignment, modification or change of the Principal and the Surety upon this bond for the
Contract, or change in the work covered thereby, or recovery of any damages he may have sustained by
any extension of time for the completion of the Con- reason of the failure of the Principal to comply with
tract shall release the sureties on the bond. the Contract or with the Contract between the Prin-
cipal and his subcontractors. If the amount realized
2) Not later than one year after the completion of on this bond is insufficient to satisfy all claims of
work under the Contract, any party in interest may the parties in full, it shall be distributed among the
maintain an action in his own name against the parties pro rata.
Signed and sealed this 24th day of September - 2010
IN THE PRESENCE OF:
FOUR —WAY CONSTRUCTION OF WISCONSIN, INC.
Principal
� ' ' 4d / B
�i: ...�., 1 : .�1_
Witness
Tula: / '
THE HAN V INSU CE COMPANY
1 N ty
• / . __. _ �: (Seal)
Witnea Tide: Dennis M. Barton, Attorney —In —Fact
APPROVED BY
IN THE PRESENCE OF:
Owner
By: (Seal)
Witness
Title:
*This bond shall be approved in the case of the state by the state official authorized to enter into such con-
tract, of a county by its district attorney, of a city by its mayor, of a village by its president, of a town by its
chairman, of a school district by the director or president and of any other public board or body by the
presiding officer thereof.
PUBLIC IMPROVEMENT
PERFORMANCE /LABOR- MATERIAL BOND TWO PAGES
WIS. AIA DOC. WIS. A312 AUGUST 1989 ED. PAGE 2
THE HANOVER INSURANCE COMPANY
MASSACHUSETTS BAY INSURANCE COMPANY
• CITIZENS INSURANCE COMPANY OF AMERICA
POWERS OF ATTORNEY
CERTIFIED COPY
KNOW ALL MEN BY THESE PRESENTS: That THE HANOVER INSURANCE COMPANY and MASSACHUSETTS BAY INSURANCE COMPANY,
both being corporations organized and existing under the laws of the State of New Hampshire, and CITIZENS INSURANCE COMPANY OF
AMERICA, a corporation organized and existing under the laws of the State of Michigan, do hereby constitute and appoint
Joseph L. Vigna, Dennis M. Barton and/or Elizabeth M. Fedyn
of Brookfield, WI and each is a true and lawful Attorney(s) -in -fact to sign, execute, seal, acknowledge and deliver for, and on its behalf,
and as its act and deed any place within the United States, or, if the following line be filled in, only within the area therein designated
any and all bonds, recognizances, undertakings, contracts of indemnity or other writings obligatory in the nature thereof, as follows:
Any such obligations in the United States, not to exceed Twenty Million and No /100 ($20,000,000) in any single instance
and said companies hereby ratify and confirm all and whatsoever said Attorney(s) -in -fact may lawfully do in the premises by virtue of these presents.
These appointments are made under and by authority of the following Resolution passed by the Board of Directors of said Companies which
resolutions are still in effect
"RESOLVED, That the President or any Vice President, in conjunction with any Assistant Vice President, be and they are hereby authorized and
empowered to appoint Attorneys -in -fact of the Company, in its name and as its acts, to execute and acknowledge for and on its behalf as Surety any and
all bonds, recognizances, contracts of indemnity, waivers of citation and all other writings obligatory in the nature thereof, with power to attach thereto the
seal of the Company. Any such writings so executed by such Attomeys -in -fact shall be as binding upon the Company as if they had been duly executed
and acknowledged by the regularly elected officers of the Company in their own proper persons." (Adopted October 7, 1981 - The Hanover Insurance
Company, Adopted April 14, 1982 — Massachusetts Bay Insurance Company; Adopted September 7, 2001 - Citizens Insurance Company of America)
IN WITNESS WHEREOF, THE HANOVER INSURANCE COMPANY, MASSACHUSETTS BAY INSURANCE COMPANY and CITIZENS
INSURANCE COMPANY OF AMERICA have caused these presents to be sealed with their respective corporate seals, duly attested by a Vice
President and an Assistant Vice President, this 18th day of June, 2010.
THE HANOVER INSURANCE COMPANY
• MASSACHUSETTS BAY INSURANCE COMPANY
a'' r
( — ret� yf � CITjZENSjt SURANCE COMPAWY OF AMERICA
1 S
Mary Jeanne A;'derson, N.. ice Pres
1.9 ✓y✓, '4f it '--rte
Robert K. Grennan, Assistant' ice President
THE COMMONWEALTH OF MASSACHUSETTS )
COUNTY OF WORCESTER ) ss.
On this 18th day of June 2010., before me came the above named Vice President and Assistant Vice President of The Hanover Insurance
Company, Massachusetts Bay Insurance Company and Citizens Insurance Company of America, to me personally known to be the individuals and
officers described herein, and acknowledged that the seals affixed to the preceding instrument are the corporate seals of The Hanover Insurance
Company Massachusetts Bay Insurance Company and Citizens Insurance Company of America, respectively, and that the said corporate seals and
their signatures as officers were duly affixed and subscribed to said instrument by the authority and direction of said Corporations.
�7
..C.,,, . d r�r..xo.>.»+ rUof>?ry Public
. My commission expires on November 3, 2011
I, the undersigned Assistant Vice President of The Hanover Insurance Company, Massachusetts Bay Insurance Company and Citizens Insurance
Company of America, hereby certify that the above and foregoing is a full, true and correct copy of the Original Power of Attorney issued by said
Companies, and do hereby further certify that the said Powers of Attorney are still in force and effect.
This Certificate may be signed by facsimile under and by authority of the following resolution of the Board of Directors of The Hanover Insurance
Company, Massachusetts Bay Insurance Company and Citizens Insurance Company of America.
"RESOLVED, That any and all Powers of Attomey and Certified Copies of such Powers of Attomey and certification in respect thereto, granted and
executed by the President or any Vice President in conjunction with any Assistant Vice President of the Company, shall be binding on the Company to the
same extent as if all signatures therein were manually affixed, even though one or more of any such signatures thereon may be facsimile" (Adopted
October 7, 1981 - The Hanover Insurance Company; Adopted April 14, 1982 Massachusetts Bay Insurance Company; Adopted September 7, 2001 -
Citizens Insurance Company of America)
GIVEN under my hand and the seals of said Companies, at Worcester, Massachusetts, this 24th day of September , 20 10
THE HANOVER INSURANCE COMPANY
MASSACHUSETTS BAY INSURANCE COMPANY
CITIZENS 1NSU RAN COMPANY OF AMERICA
Siepp6ri L 8rauli; ,rssisraitf '✓ice Preslrithir
09/30/2010 THU 9:05 FAX 1 920 748 5044 The Diedrich Agency 0001 /001
E CERTIFICATE OF LIABILITY INSURANCE OP ID SB DATE (MM /DDMlYY)
09/30/10
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 wN I At.
NAME:
THE DIEDRICH AGENCY, INC.
PHONE , Eat): FAX No):
PO BOX 306 ADDRESS:
RIPON WI 54971 PRODUCER
CUSTOMER ID FOURW -1
Phone: 920 - 748 -2811 Fax: FAX 748 -5044 INSURER(S)AFFORDINGCOVERAGE NAIC#
INSURED INSURER A: Regent Insurance 24414
FOUR —WAY CONSTRUCTION CO INSURER B: Accident Fund 10166
ATTN JEAN
PO BOX 133 INSURER C :
BERLIN WI 54923
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 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,
1NSR AUUL sux
LTR TYPE OF INSURANCE INSR WV POLICY NUMBER t I Eh1 P DD I Y YXP
GENERAL LIABILITY (MMIDD/YYYY} {MM/DDIY1(YY) LIMITS
EACH OCCURRENCE $ 1000000
A X COMMERCIAL GENERAL LIABILITY CCI0104162 03/31/10 03/31/11 PREMISES (Ea occurrence) $ 100000
CLAIMS -MADE I X I OCCUR MED EXP (Any one person) $ 5000
PERSONAL SADVINJURY $ 1000000
X EMPLOYEE BENEFITS GENERAL AGGREGATE $ 2000000
GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 2000000
7 POLICY 5E1 jECOT- n LOC $
AUTOMOBILE LIABILITY
COMBINED SINGLE LIMIT $ 1000000
A X ANY AUTO CBA0104162 03/31/10 03/31/11 (Ea accident)
BODILY INJURY (Per person) $
ALL OWNED AUTOS
BODILY INJURY (Per accident) $
SCHEDULED AUTOS
PROPERTY DAMAGE $
HIRED AUTOS (Per accident)
NON•OW NED AUTOS $
A UMBRELLA LIAB X OCCUR CCU0104162 03/31/10 03/31/11 EACH OCCURRENCE $ 2000000
EXCESS LIAB CLAIMS -MADE AGGREGATE $ 2000000
DEDUCTIBLE
X RETENTION $ 10000 $
B WORKERS COMPENSATION WCV5004770 03/31/10 03/31/11 X WCSTATU- IOTH-
AND EMPLOYERS' LIABILITY Y / N TORY LIMITS ER
ANY PROPRIETOR/PARTNER/EXECUTIVEn EL. EACH ACCIDENT $ 100000
OFFICER/MEMBER EXCLUDED? Y
(Mandatory in NH) E,L. DISEASE - EA EMPLOYEE $ 100 000
If yes, describe under
DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 500000
A EQUIPMENT FLOATER CC10104162 03/31/10 03/31/11 LEASED OR 25,0000
RENTED EQ
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space Is required)
CONTRACT #10 -20 CITY OF OSHKOSH AND ITS OFFICERS COUNCIL MEMBERS, AGENTS,
EMPLOYEES AND AUTHORIZED VOLUNTEERS AS ADDITIONAL INSURED.
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
CITYOSH THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVE
CITY OF OSHKOSH �r
PO BOX 1130 John C . Diedrich
OSHKOSH WI 54903 a
01988-2009A D CORPORATION. All rights reserved.
ACORD 25 (2009109) The ACORD name and Ioao are reaistered marks of ACORQ