HomeMy WebLinkAboutPW CNT 11-04 LaLonde Contractors, Inc C
CONSTRUCTION CONTRACT
THIS AGREEMENT, made on the 23rd day of March, 2011, by and between the
CITY OF OSHKOSH, party of the first part, hereinafter referred to as CITY, and
LALONDE CONTRACTORS, INC., P.O. Box 070420, Milwaukee, WI 53207 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. 11 -04
for Various Concrete Paving & Utility Projects — Central City Area and appurtenant
work, for the Public Works Department, pursuant to Resolution 11 -118 adopted by the
Common Council of the City of Oshkosh on the 22nd day of March, 2011,
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
$5,851,713.22, 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 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.
1
(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. INSURANCE
The Insurance required by the City of Oshkosh as specified in the City's
specifications, including addenda, or plans, or instructions, or advertisements, shall be
primary coverage and that any insurance or self insurance maintained by the City of
Oshkosh, its officers, council members, agents, employees or authorized volunteers will
not contribute to a loss. All insurance shall be based upon the occurrence of an event,
and not based on claims made. All insurance shall be in full force prior to commencing
work and remain in force until the entire job is completed and the length of time that is
specified, if any, in this contract, the specifications, whichever is longer.
ARTICLE VI. 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
2
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
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
U 11 I n � LALONDECONTRACT INC.
J " , By:
}-' . .Sl ENT
(Seal of Contractor (Spe2 Title)
if a Corporation.)
By:
F-* . , TAR
(Specify Title)
CITY OF OSHKOSH
r By: u___ ,
drii �� t Mar A. Rohloff, City Mana e //0
ess) -
11, i ilk gain&
And: �.
ki2 ness) Pamela R. Ubrig, City Clerk
APPROVED: I hereby certify that the necess-
ary provisions have been made to
pay the liability which will accrue
Iliht.1 A _ PI b id under this contract.
ity Atto
City Compt offer
3
' Interchange Corporate Center
it Liberty 450 Plymouth Road, Suite 400
' '' 11'1 R +i ; � Plymouth Meeting, PA. 19462 -1644
l ll Ph. (610) 832 -8240
PERFORMANCE BOND
Bond Number: 28S100767
KNOW ALL MEN BY THESE PRESENTS, that we LaLonde Contractors, Inc.
PO Box 070420, Milwaukee WI 53207 , as principal (the "Principal "),
and LIBERTY MUTUAL INSURANCE COMPANY, a Massachusetts stock insurance company, as surety (the
"Surety"), are held and firmly bound unto City of Oshkosh
215 Church Ave., Oshkosh WI 54902 , as obligee (the "Obligee"), in
the penal sum of Five Million Eight Hundred Fifty One Thousand Seven Hundred Thirteen dollars & 22/100
Dollars ($5,851,713.22 ),
for the payment of which sum well and truly to be made, the Principal and the Surety, bind ourselves, our heirs,
executors, administrators, successors and assigns, jointly and severally, firmly by these presents.
WHEREAS, the Principal has by written agreement, dated the 23rd day of March , 2011
entered into a contract (the "Contract ") with the Obligee for Various Concrete Paving & Utility Protects- Central City
Area
NOW, THEREFORE, THE CONDITION OF THIS OBLIGATION IS SUCH, that if the Principal shall promptly and
faithfully perform the Contract, then this obligation shall be null and void; otherwise it shall remain in full force and
effect.
PROVIDED AND SUBJECT TO THE CONDITIONS PRECEDENT:
1. Whenever the Principal shall be, and declared by the Obligee to be in default under the Contract, the Obligee
having performed the Obligee's obligations thereunder, the Surety may promptly remedy the default, or shall
promptly:
1.1 Arrange for the Principal, with consent of the Obligee, to perform and complete the Contract; or
1.2 Undertake to perform and complete the Contract itself, through its agents or through independent
contractors; or
1.3 Obtain a bid or bids from alternative contractors to complete the Contract in accordance with its terms and
conditions, and upon determination by the Surety of the lowest responsible bidder, or if the Obligee elects,
upon determination by the Obligee and the Surety jointly of the lowest responsible bidder, arrange for a
contract between such bidder and the Obligee, and make available as work progresses (even though
there should be a default or a succession of defaults under the contract or contracts of completion
arranged under this paragraph) sufficient funds to pay the cost of completion less the balance of the contract
price; but not exceeding the amount set forth in the first paragraph of this bond. The term "balance of the
contract price," as used in this paragraph, shall mean the total amount payable by the Obligee to the
Principal under the Contract and any amendments thereto, less the amount properly paid by the Obligee to
the Principal; or
1.4 Waive its right to perform and complete, arrange for completion, or obtain a new contractor and with
reasonable promptness under the circumstances:
a. After investigation, determine the amount for which it may be liable to the Obligee and, as soon as
practicable after the amount is determined, tender payment therefore to the Obligee; or
b. Deny liability in whole or in part and notify the Obligee citing reasons therefore.
LMIC - 5100 Page 1 of 2 Rev. 03/04
2. Notwithstanding any other provision of this bond or the Contract, or otherwise, the Surety is not responsible for
and shall not be held liable to the Obligee for any hazardous waste removal and the Surety shall not be held
liable to, or in any other respect be responsible to, the Obligee by way of indemnity, claims or otherwise, or to
any public authority or to any other person, firm or corporation, for or on account of any fines or claims by any
public authority or for bodily injuries or property damage to any person or thing, including, but not limited to, injury
or damage due to the release or threat of release of hazardous substances of any kind or damage to real estate
or to the environment or clean -up costs or other damages of whatever kind or nature arising out of any act of
commission or omission by the Principal, the Principal's agents, servants, employees, subcontractors or
suppliers or any other person in connection with the performance of the Contract. This limitation applies
regardless of when any such fine is assessed, claim is made, or injury, damage, release or threat of release
occurs and without regard to any term or condition of the Contract.
3. The Surety hereby waives notice of any alteration or extension of time made by the Obligee.
4. Any suit under this bond must be instituted before the expiration of one (1) year from the date on which the
Principal ceased to work on the Contract or such time period as otherwise permitted by relevant statute. If the
provisions of this paragraph are void or prohibited by law, the minimum period of limitation available to sureties
as a defense in the jurisdiction of the suit shall be applicable.
5. No right of action shall accrue on this bond to or for the use of any person or corporation other than the
Obligee named herein or the heirs, executors, administrators or successors of the Obligee.
6. Any claims must be presented in writing to Liberty Mutual Insurance Company to the attention of the Surety Law
Department at the above address.
DATED as of this 29th day of March , 2011 .
WITNESS / ATTEST LaLonde Contractors, Inc.
(Principal)
a rl r iy 2 UU\ By: (Seal)
Name: p °$'C .ELL @ ONDw R
Title: PRESIDENT
LIBERTY MUTUAL INSURANCE.COMPANY
(Surety)
By: _i) Q24--) (Seal)
Attorney -in -Fact
Debbra A. Hinkes
LMIC -5100 Page 2 of 2 Rev. 03/04
Interchange Corporate Center
Lie 450 Plymouth Road, Suite 400
Mutual /" '' MU Plymouth Meeting, PA. 19462 -1644
JJ L Ph. (610) 832 -8240
PAYMENT BOND
Bond Number: 28S100767
KNOW ALL MEN BY THESE PRESENTS, that we LaLonde Contractors, Inc.
PO Box 070420, Milwaukee WI 53207 , as principal (the "Principal "),
and Liberty Mutual Insurance Company, a Massachusetts stock insurance company, as surety (the "Surety"),
are held and firmly bound unto City of Oshkosh
215 Church Ave., Oshkosh WI 54902 , as obligee (the "Obligee "),
in the penal sum of Five Million Eight Hundred Fifty One Thosuand Seven Hundred Thirteen dollars & 22/100--- -
Dollars ($5,851,713.22 ),
for the payment of which sum well and truly to be made, the Principal and the Surety, bind ourselves, our heirs,
executors, administrators, successors and assigns, jointly and severally, firmly by these presents.
WHEREAS, the Principal has by written agreement dated the 23rd day of March , 2011 ,
entered into a contract (the "Contract ") with the Obligee for Various Concrete Paving & Utility Projects - Central City
Area
NOW, THEREFORE, THE CONDITION OF THIS OBLIGATION IS SUCH, that if the Principal shall promptly
make payment to all Claimants, as hereinafter defined, for all labor and material used or reasonably required for
use in the performance of the Contract, then this obligation shall be null and void; otherwise it shall remain in full
force and effect.
PROVIDED AND SUBJECT TO THE CONDITIONS PRECEDENT:
1. A "Claimant" is defined as one having a direct contract with the Principal or with a subcontractor of the Principal
for labor, material, or both, used or reasonably required for use in the performance of the Contract, labor and
material being construed to include that part of water, gas, power, light, heat, oil, gasoline, telephone service or
rental of equipment directly applicable to the Contract.
2. The Principal and the Surety hereby jointly and severally agree with the Obligee that every Claimant, who
has not been paid in full before the expiration of a period of ninety (90) days (or such lesser or greater
time period as otherwise permitted by relevant law) after the date on which the last of such Claimant's
work or labor was done or performed, or materials were furnished by such Claimant, may sue on this bond
for the use of such Claimant, prosecute the suit to final judgment for such sum or sums as may be justly
due Claimant, and have execution thereon. The Obligee shall not be liable for the payment of any costs or
expenses of any such suit.
3. No suit or action shall be commenced hereunder by any Claimant:
(a) Unless Claimant, other than one having a direct contract with the Principal, shall have given written
notice to the Principal and the Surety within ninety (90) days (or such lesser or greater time period as
otherwise permitted by relevant law) after such Claimant did or performed the last of the work or labor,
or furnished the last of the materials for which said claim is made, stating with substantial accuracy
the amount claimed and the name of the party to whom the materials were furnished, or for whom the
work or labor was done or performed. Such notice shall be served by mailing the same by registered
mail or certified mail, postage prepaid, in separate envelopes addressed to the Principal and Surety.
The Principal may be served at any place where an office is regularly maintained for the transaction of
business, or in any manner in which legal process may be served in the state in which the aforesaid project
is located, save that such service need not be made by a public officer. The Surety may be served to the
attention of The Surety Law Department at the above - listed address.
(b) Other than in a state court of competent jurisdiction in and for the county or other political subdivision of the
state in which the project, or any part thereof, is situated, or in the United States District Court for the
district in which the project, or any part thereof, is situated, and not elsewhere.
LMIC - 5200 Page 1 of 2 Rev. 03/04
(c) After the expiration of one (1) year (or such lesser or greater time period as otherwise permitted by relevant
law) following the date on which the Subcontractor provided the last labor and/or materials to the project. If
the provisions of this paragraph are void or prohibited by law, the minimum period of limitation available to
sureties as a defense in the jurisdiction of the suit shall be applicable.
4. Surety shall have no liability to any Claimant under this Bond for any amount unless it is due and owing to the
Claimant by the Principal pursuant to the express terms of the contract between the Principal and Claimant or, if
the Claimant does not have a direct Contract with Principal, pursuant to the terms and conditions of the
Contract between the Claimant and the Subcontractor to the Principal. The Bond incorporates all of the
Principal's contractual defenses, including but not limited to pay -if -paid provisions, whereby payment to the
Claimant is subject to the condition precedent of the Obligee's payment to the Principal, and other limitations on
amounts due under the contract between Principal and Claimant.
5. The amount of this bond shall be reduced by and to the extent of any payment or payments made in good faith
hereunder, inclusive of the payment by Surety of mechanics' liens, which may be filed of record against
such improvement, whether or not a claim for the amount of such lien be presented under and against this
bond.
DATED as of this 29th day of March , 2011 .
WITNESS / ATTEST LaLonde Contractors, Inc.
(Principal)
\Tik NJ L By � Name: MICHAEL LALONDE
Title: PRESIDENT
LIBERTY MUTUAL INSURANCE COMPANY
(Surety) ^ , / J
By: o6A.i( (/I • Q 1~( P _ (Seal)
Attorney -in -Fact
Debbra A. Hinkes
LMIC - 5200 Page 2 of 2 Rev. 03/04
THIS POWER OF ATTORNEY IS NOT VALID UNLESS IT IS PRINTED ON RED BACKGROUND. 2110953
This Power of Attorney limits the acts of those named herein, and they have no authority to bind the Company except in the manner and to
the extent herein stated.
LIBERTY MUTUAL INSURANCE COMPANY
BOSTON, MASSACHUSETTS
POWER OF ATTORNEY
KNOW ALL PERSONS BY THESE PRESENTS: That Liberty Mutual Insurance Company (the "Company "), a Massachusetts stock insurance
company, pursuant to and by authority of the By -law and Authorization hereinafter set forth, does hereby name, constitute and appoint
CHARLES L. SCHILTZ, DEBBRA A. HINKES, PAMELA M. HINEMAN, ROBERT M. TORTELLI, ALL OF THE CITY OF
NEW BERLIN, STATE OF WISCONSIN
, each individually if there be more than one named, its true and lawful attorney -in -fact to make, execute, seal, acknowledge and deliver, for and on its
behalf as surety and as its act and deed, any and all undertakings, bonds, recognizances and other surety obligations in the penal sum not exceeding
THIRTY MILLION AND 00/100************"****** DOLLARS ($ 30,000,000.00 * * * ** ) each and the
execution of such undertakings, bonds, recognizances and other surety obligations, in pursuance of these presents, shall be as binding upon the
Company as if they had been duly signed by the president and attested by the secretary of the Company in their own proper persons.
That this power is made and executed pursuant to and by authority of the following By -law and Authorization:
ARTICLE XIII - Execution of Contracts: Section 5. Surety Bonds and Undertakings.
Any officer of the Company authorized for that purpose in writing by the chairman or the president, and subject to such limitations as the
chairman or the president may prescribe, shall appoint such attorneys -in -fact, as may be necessary to act in behalf of the Company to make, rd
execute, seal, acknowledge and deliver as surety any and all undertakings, bonds, recognizances and other surety obligations. Such 'a
.. attorneys -in -fact, subject to the limitations set forth in their respective powers of attorney, shall have full power to bind the Company by their N
o signature and execution of any such instruments and to attach thereto the seal of the Company. When so executed such instruments shall be a
'OOH • as binding as if signed by the president and attested by the secretary. C
�c y By the following instrument the chairman or the president has authorized the officer or other official named therein to appoint attorneys -in -fact:
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C Pursuant to Article XIII, Section 5 of the By -Laws, Garnet W. Elliott, Assistant Secretary of Liberty Mutual Insurance Company, is hereby g
el
:.: authorized to appoint such attorneys -in -fact as may be necessary to act in behalf of the Company to make, execute, seal, acknowledge and _
'0 3 deliver as surety any and all undertakings, bonds, recognizances and other surety obligations. s O
0 3 That the By -law and the Authorization set forth above are true copies thereof and are now in full force and effect. d W
I
• > IN WITNESS WHEREOF, this Power of Attorney has been subscribed by an authorized officer or official of the Company and the corporate seal of C g
= Liberty Mutual Insurance Company has been affixed thereto in Plymouth Meeting, Pennsylvania this 21st day of March , = C
d O 2007 . Q cej
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0 y LIBERTY MUTUAL INSURANCE COMPANY I-'C
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( p t „ ' By 6---: `�(/ Al - LG�- -�ri r a w
c RI „ •,� ,'. 7'f Garnet W. Elliott, Assistant Secretary N 0
y"., COMMONWEALTH OF PENNSYLVANIA ss w 2
R w COUNTY OF MONTGOMERY O c
t ▪ c On this 21st day of March , 2007 , before me, a Notary Public, personally came Garnet W. Elliott, to me known, and acknowledged * d
e •- that he is an Assistant Secretary of Liberty Mutual Insurance Company; that he knows the seal of said corporation; and that he executed the above :a Z
£ ar Power of Attorney and affixed the corporate seal of Liberty Mutual Insurance Company thereto with the authority and at the direction of said corporation. To 0
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a IN TESTIMONY WH. a -unto subscribed my name and affixed my notarial seal at Plymouth Meeting, Pennsylvania, on the day and year er
e first above written , 9N€ ' °y' ` oo
To c E o'' �"a COMMONPdEaLT€tOFPP€ NpYLYr E
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CERTIFICATE
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I, the undersigned, Assistan ecretary of Liberty Mutual Insurance Company, do hereby certify that the original power of attorney of which the foregoing
is a full, true and correct copy, is in full force and effect on the date of this certificate; and I do further certify that the officer or official who executed the
said power of attorney is an Assistant Secretary specially authorized by the chairman or the president to appoint attorneys -in -fact as provided in Article
XIII, Section 5 of the By -laws of Liberty Mutual Insurance Company.
This certificate and the above power of attorney may be signed by facsimile or mechanically reproduced signatures under and by authority of the
following vote of the board of directors of Liberty Mutual Insurance Company at a meeting duly called and held on the 12th day of March, 1980.
VOTED that the facsimile or mechanically reproduced signature of any assistant secretary of the company, wherever appearing upon a
certified copy of any power of attorney issued by the company in connection with surety bonds, shall be valid and binding upon the company
with the same force and effect as though manually affixed. (�,—/
IN TES IMONY EREO , I Flame hereunto subscribed my name and affixed the corporate seal of the said company, this % (_/'} day of
f By % " v/
4 David M. Carey, Ass nt Secretary
Client#: 3801 LALOCON
ACORDTM CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY)
3/29/2011
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to
the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the
certificate holder in lieu of such endorsement(s).
PRODUCER CONTACT NAME:
Security Insurance Svcs., Inc. PHONE 262 785 -9490 FAX N 2627859753
P.O. Box 510925 E -MAIL
ADDRESS:
New Berlin, WI 53151 -0925 PRODUCER
CUSTOMER ID #:
262 785 -9490 INSURER(S) AFFORDING COVERAGE NAIC #
INSURED INSURERA: Regent Insurance Company
LaLonde Contractors Inc. INSURER B : General Casualty Company of WI
- P.O. Box 070420
INSURER C :
Milwaukee, WI 53207
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.
INSR ADDL SUBR POLICY EFF POLICY EXP LIMITS
LTR TYPE OF INSURANCE INSR NVD POLICY NUMBER (MMIDDIYYYY) (MM /DD/YYYY)
A GENERAL LIABILITY CCI0421034 04/01/2011 04/01/2012 EACH OCCURRENCE $1,000,000
DAMAGE TO RENTED
X COMMERCIAL GENERAL LIABILITY PREMISES (Ea occurrence) $100,000
CLAIMS -MADE X OCCUR MED EXP (Any one person) $5,000
X PD Ded:1,000 PERSONAL BADVINJURY $1,000,000
GENERAL AGGREGATE $2,000,000
GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP /OP AGG $2,000,000
7 POLICY I ^I 17pRi LOC $
A AUTOMOBILE LIABILITY CBA0421034 04/01/2011 04/01/2012 COMBINED SINGLE LIMIT $
(Ea accident) 1,000,000
X ANY AUTO BODILY INJURY (Per person) $
ALL OWNED AUTOS BODILY INJURY (Per accident) $
SCHEDULED AUTOS PROPERTY DAMAGE $
X HIRED AUTOS (Per accident)
X NON -OWNED AUTOS
$
B UMBRELLA LIAB _ OCCUR CCU0421034 04/01/2011 04/01/201 EACH OCCURRENCE $5 000,000
X EXCESS LIAB CLAIMS -MADE AGGREGATE $5,000,000
_ DEDUCTIBLE $
X RETENTION $ 10000 $
A WORKERS COMPENSATION CWC0421034 04/01/2011 04/01/201 X WCSTATU- OTH-
AND EMPLOYERS' LIABILITY TORY LIMITS ER
Y / N
ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $100,000
OFFICER/MEMBER EXCLUDED? N NIA
(Mandatory in NH) E.L. DISEASE - EA EMPLOYEE $100,000
If yes, describe under
DESCRIPTION OF OPERATIONS below E.L. DISEASE- POLICY LIMIT $500,00
A Rented /Leased Equ CCI0421034 04/01/2011 04/01/201 $250,000
DESCRIPTION OF OPERATIONS 1 LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required)
re: Public Works contract #11 -04.
If required by written contract, the City of Oshkosh, and its officers, council members, agents, employees
(See Attached Descriptions)
CERTIFICATE HOLDER CANCELLATION
City of Oshkosh SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
P.O. Box 1130 ACCORDANCE WITH THE POLICY PROVISIONS.
Oshkosh, WI 54902
AUTHORIZED REPRESENTATIVE
I Cl '
@1988-2009 ACORD CORPORATION. All rights reserved.
ACORD 25 (2009/09) 1 of 2 The ACORD name and logo are registered marks of ACORD
#S219806/M218399 CAC