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River Valley Testing Corporation
AGREEMENT THIS AGREEMENT, made on the 30 day of March, 2011, by and between the CITY OF OSHKOSH, party of the first part, hereinafter referred to as CITY, and RIVER VALLEY TESTING CORPORATION, 1060 Breezewood Lane, Suite 102, Neenah, Wisconsin, hereinafterreferred to as the CONSULTANT, WITNESSETH: • That the CITY and the CONSULTANT, for the consideration hereinafter named, agree as follows: ARTICLE I. PROJECT MANAGER A. Assignment of Project Manager. The CONSULTANT shall assign the following individual to manage the project described in this contract: Jeremy A. McConnell, P.E., Construction Services Manager B. Changes in Project Manager. The CITY shall have the right to approve or disapprove of any proposed change from the individual named above as Project Manager. The CITY shall be provided with a resume or other information for any proposed substitute and shall be given the opportunity to interview that person prior to any proposed change. ARTICLE II. CITY REPRESENTATIVE The CITY shall assign the following individual to manage the project described in this contract: Joseph R. Sargent, Civil Engineer I (Senior) ARTICLE III. SCOPE OF WORK The CONSULTANT shall provide the services described in the CITY's Request for Proposals and Proposal of the CONSULTANT. If anything in the Proposal conflicts with the Request for Proposals, the provisions in the Request for Proposals shall govern. Both the Request for Proposal and the Proposal are attached to this agreement. The CONSULTANT may provide additional products and/or services if such products /services are requested in writing by the Authorized Representative of the City. E:1Engineering\Density Testing120111RVT Contract12011 Agreement Form- Page 1 of 4 RVT.doc ARTICLE IV. CITY RESPONSIBLITIES The CITY shall furnish, at the CONSULTANT's request, such information as is needed by the CONSULTANT to aid in the progress of the project, providing it is reasonably obtainable from CITY records. To prevent any unreasonable delay in the CONSULTANT's work the CITY will examine all reports and other documents and will make any authorizations necessary to proceed with work within a reasonable time period. ARTICLE V. TIME OF COMPLETION The work to be performed under this contract shall be commenced and the work completed within the time frames listed in Scope of Services attached to the CITY's Request for Proposal. ARTICLE III. PAYMENT A. The Contract Sum. The CITY shall pay to the CONSULTANT for the performance of the contract on a time and materials basis not to exceed the total of $75,618.00, adjusted by any changes hereafter muhially agreed upon in writing by the parties hereto. Fee schedules shall be firm for the duration of this Agreement. B. Method of Payment. The CONSULTANT shall submit itemized monthly statements for services. The invoice shall be broken down per city contract and contain the requested back -up documents as described in the RFP. The CITY shall pay the CONSULTANT within 30 calendar days after receipt of such statement. If any statement amount is disputed, the CITY may withhold payment of such amount and shall provide to CONSULTANT a statement as to the reason(s) for withholding payment. C. Additional Costs. Costs for additional services shall be negotiated and set forth in a written amendment to this agreement executed by both parties prior to proceeding with the work covered under the subject amendment. ARTICLE IV. CONSULTANT TO HOLD CITY HARMLESS The CONSULTANT 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 CONSULTANT, 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 1: 1Engineering\Density Testing120111RVT Contract1201 1 Agreement Form- Page 2 of 4 RVT.doc 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 CONSULTANT agrees to abide by the attached City of Oshkosh Insurance Requirements. ARTICLE VI. TERMINATION A. For Cause. If the CONSULTANT shall fail to fulfill in timely and proper manner any of the obligations under this Agreement, the CITY shall have the right to terminate this Agreement by written notice to the CONSULTANT. In this event, the CONSULTANT shall be entitled to compensation for any • satisfactory, usable work completed. B. For Convenience. The CITY may terminate this contract at any time by giving written notice to the CONSULTANT no later than 10 calendar days before the termination date. If the CITY terminates under this paragraph, then the CONSULTANT shall be entitled to compensation for any satisfactory work performed to the date of termination. This document and any specified attachments contain all terms and conditions of the Agreement and any alteration thereto shall be invalid unless made in writing, signed by both parties and incorporated as an amendment to this Agreement. In the Presence of: CONSULTANT L h kf6C. t - Detjr (Title) Seal if Corporation By: (Title) I;\Engineering\Density Testing\2011\RVT Contract12011 Agreement Form- Page 3 of 4 RVT.doc CITY OF OSHKOSH By: / / / i/A4 , �� 1A _,,, Jo . Fitzpatrick, gl./nt •'ty • anager (Witness) � / , _ -. , ., And r - Cam.. '_) tit .I Pamela R. Ubrig, City Clerk ; (Wi ess) l APPROVED: ' I hereby certify that the necessary provisions have been made to pay the liability which will accrue under this contract. I tki._.' a f 11 Lynn Lorenso13, ttorney (224,----# ,....„ y - - _,,,,, Peggy A. etgn of Finance I: \Attorney\FORMS - Office forms\2011 Agreement Form - RVT.doc Page 4 of 4 RV ": IOW RIVER VALLEY TESTING CORP. 1060 Breezewood Lane, Suite 102 Neenah, WI 54956 Telephone: 920/886 -1406 FAX: 920/886 -1409 March 18, 2011 Mr. Joseph R. Sargent Department of Public Works Engineering Division l s ~F c City of Oshkosh 215 Church Avenue, Room 301 Oshkosh, WI 54903 MAR .i, IU 11 DERL OF PUBLIC ‘AIORI<S OS! SH. \ /i: ScorN sfr Subj: Construction Materials Testing 2011 Capital Improvement Program City of Oshkosh, Wisconsin Mr. Sargent: In accordance with your Request for Proposals (RFP) dated March 3, 2011, River Valley Testing Corp (RVT) is pleased to submit the following proposal to provide services for your 2011 Construction Materials Testing contract. This proposal is intended to formalize an outline of our general scope of services and to provide cost information for our services. The proposal has been organized as follows: o Project Information o Scope of Services o Project Approach o Applicable Projects o Schedule o Conditions o Insurance o Why River Valley Testing o Remarks As indicated above, we organized our response in alignment with your request; however, we felt it would be valuable to highlight key considerations of RVT that we feel support an extremely good fit for your project: • Our plan will be to assign a primary engineering technician to this project. This technician has the diverse capability and experience to tackle the testing needs of the City. Construction Materials Testing 2011 Capital Improvement Program Department of Public Works City of Oshkosh March 18, 2011 Page 2 • Our focus on project management will provide the highest chance for a successful project completed in a timely fashion. Our project management methodology has proven to limit delays, dead ends, hazards and surprises for the majority of our clients. As a result, your resources can be focused on other areas of the project thus reducing the common hassle factor related to testing services. You do not have to carry the burden of testing management. For instance, we anticipate most of our daily coordination will occur directly between the contractors and our engineering technician. • With RVT you receive the depth and quality of service typically found in larger firms, but with the personal touch of a smaller firm. This brings the best of both worlds to your firm and the project by combining certified technical skills and flexibility, responsiveness to changes in project timing and requirements and accessibility for problem resolution. All of this translates into a more efficient project for your firm. • Based on feedback from our clients, we understand that our approach to service delivery has improved construction schedules, avoided callbacks and improved ROI on their projects. PROJECT INFORMATION Based on information outlined in the RFP, RVT understands the proposed contract for construction materials testing will extend from award date of March 28, 2011 through December 31, 2011, or upon completion of any testing projects started in 2011, whichever occurs last. Further, this year's season is anticipated to commence in the beginning of April and continue through November. We understand proposed projects requiring our support will include asphalt and concrete street reconstruction, utility upgrades, sanitary sewer relays, culvert reconstructions, and detention basins. Since the City's projected workload appears heavier then past years, we anticipate nearly full time support will be required of the testing consultant. SCOPE OF SERVICES Since our inception in 1990, RVT has made it a corporate commitment to provide the most responsive service possible. The three founding brothers believed there had to be a better way to service clients; this starts with the belief that we should be providing services for the best benefit for the project, not for the best interest of RVT. This continues with being responsive to the needs of your office and field staff. Being the most responsive starts with decreasing the time required to provide our field services and recommendations. Being the most responsive continues with providing recommendations which balance geotechnical and materials concerns with practical construction concerns. Therefore, we have always been willing to work with owners, architects, and design engineers to develop cost effective alternatives and recommendations for potentially difficult sites conditions. Construction Materials Testing 2011 Capital Improvement Program Department of Public Works City of Oshkosh March 18, 2011 Page 3 Based on RVT's understanding of the requested testing services, as outlined in the RFP, our scope of services will include: • Conducting laboratory testing for clay liner and associated laboratory materials testing, • Onsite nuclear density testing of utility trench backfill, • Documentation of soil density test locations by project station, offset, elevation, and utility trench type, • Conducting nuclear density testing on asphalt binder and surface courses, and associated laboratory testing, • Documentation of asphalt density locations project station, offset, and layer type, • Reporting laboratory and field results in PDF fortnat via email to the City Engineer within 48 hours unless test requires longer to perform, • Submitting bi- weekly suuunary reports which include a written summary, material tests results, compaction results log, and the technicians field reports, and • Submitting a final summary report for each individual contract. We understand the testing will include approximately one hundred sixty -five (165)roundtrip visits to the City of Oshkosh for various testing, one thousand, four hundred and three (1,403) hours of field /laboratory time, one thousand, three hundred and twenty (1,320) hours of equipment rental and vehicle rental, fifty (50) trench backfill testing bi- weekly summary reports, six (6) bi- weekly summary asphalt testing reports, fifteen (15) hours of engineer consultation, eighty (80) hours of project management, twelve (12) sieve analysis of aggregate, twelve (12) standard proctor density tests of aggregate, two (2) modified proctor density tests of aggregate, two (2) standard proctor density tests of clay, six (6) modified proctor density tests of clay, four (4) atterberg limits, four (4) grain size analysis of clay, ten (10) flexible wall permeability tests, and four (4) asphalt extraction/gradations. Failing nuclear density tests will be recompacted and retested until passing results are achieved. All tests will be documented. Construction Materials Testing 2011 Capital Improvement Program Department of Public Works City of Oshkosh March 18, 2011 Page 4 All tests and reports will conform to the latest ASTM Standards and be compared to the 2011 City of Oshkosh Standard Specifications. As requested, samples will be kept until the end of each contract. These contracts include: Contract 11 -01 — Tipler Conveyance Upgrades Contract 11 -02 — Westhaven Clubhouse Area Detention Basin Contract 11 -04 - Concrete Paving & Utilities Central Osceola Street (the Fox River to Algoma) Algoma Boulevard (Osceola to Elmwood) Elmwood Avenue (Algoma to Vine) John Avenue (Elmwood to McKinley) Church Avenue (Franklin to Main) Packer Avenue (Algoma to 115' west of Clover) Contract 11 -05 - Concrete Paving & Utilities South Knapp Street (10 to Campbell Creek) 5 Avenue (Knapp to Idaho) 5 Avenue (Ohio to Michigan) 4 111 Avenue (Knapp to Idaho) Michigan Street (5' to the Fox River) Contract 11 -07 — Concrete Paving & Utilities North New York Avenue (Main to Jefferson) Tennessee Avenue (Jefferson to Broad) Custer Avenue (Mt Vernon to Broad) Eastman Street New York to Custer) Broad Street (New York to Nevada) Monroe Street (Irving to Melvin) Lincoln Avenue (RR tracks to Monroe) Contract 11 -08 - Hughes Street Glatz Creek Culvert Replacement Contract 11 -09 - 9 Avenue Water Main Relay Contract 11 -10 - Planeview Road Sanitary & Water Extension Contract 1 1 -13 - High Avenue Asphalt Mill & Overlay Contract 11 -14 - Sanitary Sewer Relay Hazel Street (Baldwin to Melvin) Alley West of Main Street (14 to 15'h) Construction Materials Testing 2011 Capital Improvement Program Department of Public Works City of Oshkosh March 18, 2011 Page 5 ALTERNATE SCOPE OF SERVICES Observations of Subgrade Soils - An engineer can review the subgrade soils exposed in excavations for foundations and utilities by hand -auger borings, manual cone penetrometer and penetrometer testing. The engineer can also document the suitability of the subgrade soils for support of foundations and subsequent engineered fill system. Plastic Concrete Testing - During placement of concrete, tests can be performed in accordance with project specifications or in accordance with your requirements. Six -inch diameter concrete cylinders will be cast for compression testing at the frequency outlined by the project specifications. We understand the City Personnel will handle this testing; therefore, we offer this service only if another option is needed. Hardened Concrete Testing - Four cylinders can be tested for compressive strength; one at 7, two at 28 days, and one held as a backup for additional testing. You will be notified if 7 day strengths indicate a potential failure at 28 days. Unless specifically requested by you, any "Backup" cylinders can be disposed of if the 28 day cylinders meet project specifications. We understand, the City submits these cylinders to a local lab; therefore, we offer this service only if another option is needed, PROJECT APPROACH RVT understands that timeliness is a key aspect for the City of Oshkosh. With this in mind, RVT proposes to utilize the following approach to the project: • RVT would utilize a limited version of its proprietary G.A.M.E. (Geotechnical And Materials Engineering) Management system for this project. The emphasis for our G.A.M.E. Management system would be to develop an understanding of the critical timeframes for the contract in the early stages through discussions with your team. • Based on our understanding of the critical timeframes for the project, we would develop a work plan to manage the contract to the identified concerns, ■ Coordinate with state and county regulatory agencies and city staff as required to accomplish the tasks required by the contract. Construction Materials Testing 2011 Capital I►nprovement Program Department of Public Works City of Oshkosh March 18, 2011 Page 6 PROJECT APPROACH (continued) • RVT believes the project management team is critical to the success of the project. To assure project success, RVT will assign an owner of the company for oversight of the entire process. Please reference the attached professional profiles for the relevant skills and training of each person. We propose the following for the contract team: o Principal Manager: Alex E. Barker, P.E., Owner /Geotechnical Manager o Project Manager: Jeremy A. McConnell, P.E., Construction Services Manager o Staff Engineer: Marcus C. Rue, Coordinator, Reports o Senior Technician: Robert E. Cross or Keith J. Doyle, Field Services o Senior Technician Bradley M. Coleman, Standard and Specialty Laboratory Services • Please note, we believe we have more than one (1) qualified technician for the project. Although Robert Cross would likely be our field engineering technician, Keith Doyle would substitute in event of vacations or personal emergencies. • Our main point of contact will be Jeremy McConnell while our day -to -day coordination will be handled by Marcus Rue. In practice, we also anticipate Robert Cross will handle the vast majority of day -to -day scheduling of field services. However, Marcus will arrange the appropriate response to all other requests. • RVT will draw from a pool of five additional staff engineers with geotechnical and construction material report generating experience for preparation of the reports in the agreed upon time frame. RVT will also draw upon an experienced and diverse pool of talented technicians to support the City's required operations. • RVT believes in a team approach to overcoming project challenges. Therefore, in the spirit of teamwork, we request the City provide answers to requests for information and authorizations for any additional services on a timely basis. We request that our sample tags be completely filled out to facilitate an accurate reporting process. Though we will make the conunitment to provide quick response to short notice calls, we would appreciate if, for typical construction- related services, we are given 24 hours notice prior to needing said services. We understand the City will provide a map of the 2011 construction projects. • Our material testing services will be provided by RVT personnel. • Under normal circumstances, materials tests such as proctors, gradations, and other basic tests will take between three (3) and (5) business days to run. In many cases, the tests typically required to support density testing can be accelerated to as little as one (I) day. However, tests such as consolidation tests or hydraulic conductivity tests can take over three (3) weeks to complete and should not be accelerated. Construction Materials Testing 2011 Capital Improvement Program Department of Public Works City of Oshkosh March 18, 2011 Page 7 • RVT will provide the necessary labels and forms for uniquely identifying samples. • Reports, sample tags, and invoicing will contain the information requested in the RFP. RVT strives to meet and exceed the expectations of our clients. We also understand the City needs to know that RVT can perform the requested services. Therefore, as requested in the RFP, we provide the following four (4) references that can verify RVT's ability to complete the requested services: • Mr. Mark Lenz, Director of Public Works for the City of Fond du Lac • Mr. Mark Spielbauer, Engineering Manager of Hoffman, LLC. • Mr. Larry Wettering, Director of Public Works for the City of Neenah. • Mr. Geoff Farr, Village Engineer, Village of Howard. APPLICABLE PROJECTS In addition, our familiarity with the requirements of municipalities is evident in the fact that we have provided geotechnical and material testing and consultation services for the City of Green Bay, Green Bay Water Utility, the City of DePere, the Village of Howard, the Village of Ashwaubenon, the City of Marinette, the City of Menominee, Michigan, the City of Neenah, Neenah Water Utility, Menasha Utilities, the City of Fond du Lac, Sheboygan County Highway Department, Waupaca County Highway Department, and Dodge County Highway Department. We have also provided testing for contractors on utility projects in Sherwood, Hilbert, Kimberly, Little Chute, Town of Menasha, New London, Weyauwega, Manawa, Kaukauna, New Holstein, Kiel, and North Fond du Lac. Further, we are currently under contract with the City of Oshkosh for their 2011 Geotechnical Engineering Services. SCHEDULE We request a minimum of 24 hours notice prior to needing materials testing services onsite although shorter notice can be acconunodated. Because we understand time to be critical on your projects, we can expedite material laboratory results as required. CONDITIONS Should unanticipated conditions develop necessitating changes in the scope of services, our cost will be based on the actual job work completed in accordance with the attached Proposal Cost Breakdown and Fee Schedule. However, before proceeding with extra services, RVT and the City of Oshkosh will negotiate and execute a change order to the original contract. TFte -eked Construction Materials Testing 2011 Capital Improvement Program Department of Public Works City of Oshkosh March 18, 2011 Page 8 INSURANCE RVT carries all insurance required by The State of Wisconsin. On your project sites, RVT employees are covered by Workman's Compensation and General Liability Insurance. In addition, the opinions of RVT licensed engineers are covered by Errors and Omissions Insurance. Certificates showing proof of insurance will be submitted upon request, hi addition, RVT has reviewed the insurance requirements outlined in the example "City of Oshkosh Insurance Requirements" of the RFP. Based on our understanding of the requirements, RVT maintains insurance limits meeting or exceeding the required amounts. Fu4lierrunrinsttrafiee .7 7(3 1 I WHY RIVER VALLEY TESTING? In examining the key decision criteria to select a Construction Materials Testing firm for this project, we feel that RVT meets those criteria with extremely high marks. Decision Criteria RVT Other Timely Reporting Yes ? Technical qualifications and skills Yes Personal service delivery model- flexible, responsive, accessible Yes Sound and proven project management methodology Yes ? Experience on similar projects Yes Partnership mindset Yes Construction Materials Testing 2011 Capital Improvement Program Department of Public Works City of Oshkosh March 18, 2011 Page 9 REMARKS RVT appreciates the opportunity to submit our technical proposal and fees for your project. We understand that for the highest chance for success during the 2011 construction season to occur, it will be extremely important to manage the timeliness of fieldwork and reporting, as well as provide consistent personnel to support your various needs. As we stated earlier, we believe RVT will meet these goals through management which has a focus on critical concerns and by personal oversight by a RVT owner who had vested interest in the successful execution of our contract. Based on these factors, we believe RVT to be the right partner for City of Oshkosh. Should you decide to accept this proposal, we would appreciate the opportunity to develop our relationship by meeting with you to further refine the project scope. We look forward to working with you on your project. If you have any questions or need additional information, please contact Jeremy McConnell at 920/886 -1406 or myself at 920/886 -1406. Again, thank you for considering RVT for your construction materials testing services. Sincerely, RIVER VALLEY TEST i CORP. 1111 0 71C— Alex E. B. rker, P.E. Jett y . McConnell, P.E. President/Geotechnical Engineer Construction Services Manager AEB /JAM /jarn Attachments PROPOSAL COST BREAKDOWN CONSTRUCTION MATERIALS TESTING 2011 CAPITAL IMPROVEMENT PROGRAM ITEM DESCRIPTION UNIT EST. BID UNIT PRICE PRICE BID TOTAL QTY. 1. Roundtrip Charge Each 165 S 15 $ 2,475.00 49,105.00 3 2. Field Time Hour 1,403 $ 35.00 $ 2.00 2,640.00 3. Equipment Rental Hour 1,320 S S 3.00 3,960.00 4. Vehicle Rental Hour 1,320 S $ 5. Trench Backfill Testing Reports Each 50 $ 50 $ 2,500.00 50.00 300.00 6. Asphalt Testing Reports Each 6 S $ 88.00 1,320.00 7. Engineer Consultation Hour 15 $ $ 8. Project Manager Hour 80 S 74.00 $ 5,920.00 9. Sieve Analysis of Aggregate Each 12 S 67.50 S 810.00 10. Standard Proctor Density Test 112.00 1,344.00 (aggregate) Each 12 S S 11. Modified Proctor Density Test 140.00 280.00 (aggregate) Each 2 $ S 12. Standard Proctor Density Test (clay) Each 2 S 147.00 $ 294.00 13. Modified Proctor Density Test 175.00 1, 050.00 (clay) Each 6 $ S 48.00 192.00 14. Atterbcrg Limits Each 4 S S 15. Grain Size Analysis Each 4 $ 88 S 352.00 16. Flexible Wall Permeability Tests Each 10 5 250 S 2,500.00 17. Asphalt Extraction /Gradation Each 4 S 144 .0 $ 576.00 TOTAL $ 75, 618.00 RESPONSE TIME TO SITE 0 . 5 hours I RVT CMT FEE SCHEDULE LABORATORY: Fees 1. Laboratory Moisture - Density Relationship a. Standard Proctor (ASTM D698) $112.00 /each b. Modified Proctor (ASTM D1557) $140.00 /each c. One -Point Proctor Check (ASTM D698 or D1557) $60.00 /point d. Clay Sample Preparation $35.00 /each 2. Mechanical Analysis on Submitted Samples a. Through the #200 Sieve (ASTM C117 or C136) $67.50 /each b. Through the #200 Sieve Only (ASTM C117) $36.00 /each c. #10 Through 0.001mm by Hydrometer Method (ASTM D422) $88.00 /each 3. Atterberg Limits Including Plasticity Index (ASTM D4318) $48.00 /each 4. Unconfined Compression Tests (ASTM D2166) $40.00 /each 5. Compression Test of 6" x 12" Concrete Cylinders a. Cast by RVT $11.00 /each b. Cast by Others $15.00 /each 6. Handling of Backup Cylinders $9.00 /each 7. Compressive Strength of 2" Mortar Cubes $11.50 /cube 8. Bituminous Extraction & Mechanical Analysis of Aggregate (ASTM D2172, C136 & C117) $144.00 /each EQUIPMENT: 6. Penetrometer Rental a. Half Day $20.00/Y2day b. Daily $29.00 /day 7. Concrete Equipment Rental $12.00 /day 8. Cylinder Cure Box $30.00 /project 9. Cylinder Molds (case of 20) $24.00/case 10. Vehicle Rental $6.00 /hour TECHNICAL STAFF: 11. Level A Engineering Technician $30.00 /hour 12. Level B Engineering Technician $35.00 /hour 13. Level C Engineering Technician $39.00 /hour 14. Level D Engineering Technician $44.00 /hour 15. Clerical $34.00 /hour PROFESSIONAL SERVICES: 16. Principal Registered Engineer $120.00 /hour 17. Registered Engineer $88.00 /hour 18. Project Engineer $74.00 /hour REMARKS: The above rates are valid for calendar year 2011, or the duration of the project, whichever is longer. Services not listed on this schedule will be quoted on request. The minimum Invoice for services provided during any month is $50.00. An overtime rate of 1.5 times the standard rate will apply for services performed over 8 hours per day or outside of 7:00 am to 6:00 pm on Monday through Friday, or anytime on Saturday. Personnel rates are portal to portal. A premium rate of 2.0 times the standard rate will apply for services performed on Sundays and holidays. One day advance scheduling is requested for all field testing services; same day scheduling may be subject to additional charges, River Valley Testing Corp Neenah Madison Green Bay www.rvtcorp.com 920.886.1406 608.222.9406 920.347 -9040 MEMBER City of Oshkosh Contractor Safety Program Acknowledgement Form The City of Oshkosh (City) Is required by law to carry Workers Compensation Insurance (WCI) on our permanent employees. As an independent contractor /vendor, your firm is required by law to carry WCI on your employees. As an independent contractor /vendor, you are not under the direct supervision of the City and are not covered by the WCI or Liability Insurance maintained by the City for their employees. Please attach a copy of your current Workers Compensation Certificate and a copy of your certificate of liability insurance. It is required that you notify the City immediately if any of the required insurance or bonding should be cancelled or notify the City within 30 days of a change in bond status or insurance carriers. Please complete and return to Paul Greeninger, City of Oshkosh, Safety & Risk Management Coordinator. Dale, 3/15/2011 Contractor /Vendor Name: River Valley Testing Corp. Address: 1060 Breezewood Lane, Suite 102 City, State, Zip: Neenah, WI 54956 Telephone Number: 920.886.1406 jmcconnell@rvtcorp.com E -mail Address: Contractor /VendorRepresentative; Jeremy A. McConnell, P.E. Title: Construction Services Manager Individual Responsible for: Safety Coordination: Alex E. Barker, P.E. Phone: 920.886.1406 Environmental Issues: Jeremy A. McConnell, P.E. Phone: 920.886.1406 I understand that it is my obligation to notify my employees of their responsibilities for health and safety. I further understand that if any unsafe work act s are found, the City has the right to immediately contact the Contractor' Sa ety Coor " tor I this ur safe practice is not corrected, the work may be stopped until :::: tiv actin s bee to an reed u on. / d: �, // ''� Date: 3/15/2011 x Certificate of Insurance Attached N Workers Compensation Insurance Certificate attached 9 City of Oshkosh Contractor Safety Program Qualification Questionnaire Date: 3/15/2011 ContractorNendor Name: River Valley Testing Corp. Person completing form: Terri Scriven Title: Sales Coordinator In keeping with the City of Oshkosh commitment to provide a safe and healthful workplace while protecting and preserving the environment, we require the following safety questionnaire be completed and returned to Paul Greeninger, City of Oshkosh Safety & Risk Management Coordinator, 215 Church Ave., Oshkosh, WI 54903. Completion of this questionnaire does not in any way relieve the contractor of their obligations to comply with all applicable legal requirements (federal, state, and local). This questionnaire has been designed to help the City to better understand your safety program and in no way does it represent a complete fist of the Contractor's applicable safety obligations. Your response to some of the following questions may require that you provide documents, however, PLESE DO NOT SEND CONFIDENTIAL, PROPRIETARY OR TRADE SECRET INFORMATION. 1. Provide a brief description of the primary service your company provides the City. RVT provides Consulting Services within the Geosciences and Construction Materials Fields. We offer a full range of services from pre - design Environmental Assessments and Design Phase Geotechnical to Construction Quality Assurance Services. We also provide post construction Forensic services. 2. Do you require the following safety training programs? A. Right to Know /Hazard Communication Yes x No B. Fire Prevention and Protection Yes x No C. Hot Work Permits Yes x No D. Environmental Compliance Yes x No E. Excavation /Trenching Yes x No F. Working at Elevations > 4 feet Yes x No G. Confined Space Entry Yes No 10 H. Control of Hazardous Energy (lockout) Yes x No I. Operation of Powered Equipment /vehicles Yes x No J. Working with hazardous voltages Yes x No K. Personal Protective Equipment Yes x No L. Process Safety Yes x No 3. If you answered NO to any of the above, please comment: 4. Are the training records available upon request? Yes x No 5. Please provide your Total OSHA Incident Rate and Lost Workday Rate for each of the last three years by completing the table below. A. Year 2010 2009 2008 58,582 59,450 78,076 B. Number of employee hours worked C. Number of lost workday cases 2 1 2 D. Number of cases due to injury or 0 1 3 Illness defined as recordable E. Total number of recordable cases 2 2 5 (Add C and D above) F. Calculate your incident rate by using the following formula: Total cases on line E x 200,000 hours Employee hours on line B 6.8 6.7 12.8 6. Management C - rt . : ion 1 4111► • Signature: y ....1L Date: 3/15/2011 Print Name and Title: Alex E. Barker, P.E. - President 11 rill eV ... g PROFESSIONAL PROFILE ALEX E. BARKER P. E PRESIDENT /PRINCIPAL GEOTECHNICAL ENGINEER EDUCATION EXPERIENCE • Slope remediation, including slope stability analysis, monitoring with inclinometers, and overseeing of M.S.C.E., Michigan Technological Engineering consultation for implementation of University geotechnical explorations, construction recommendations. materials testing, and environmental B.S.C.E., Michigan Technological concerns. Below is a partial list of Responsibilities included many aspects University representative project experiences: of work requiring knowledge of field and laboratory services, analysis, and CONTINUING EDUCATION • Quality assurance report reviews reporting. for majority of reports prepared by RVT, including both shallow and RIVER VALLEY TESTING CORP. Geo Florida 2010 Conference — West deep foundations, retaining walls, Palm Beach, FL (2010) slope stability issues, and stormwater management devices, MICROBIAL SCIENCES BUILDING, 54 Geotechnical Engineering to mention just a few. Univ. of Wisc., Madison, WI. Provided Conference — University of Minn. (2006) geotechnical exploration, including th • Provided oversight for the pressuremeter testing, caissons, and 13 Annual Great Lakes Geotechnical development of RVT's Load and special consultation for high bearing and Geoenvironmental Conference — Resistance Factor Design (LRFD) pressure (up to 45 kst). UW Milwaukee (2005) internal process. in Geotechnical and • ROSIERE WIND TURBINE FARM, CPT Testing Design and evaluate sheetpile Door County, WI. Provided Environmental Practice — Argonne walls to provide excavation geotechnical exploration, including 15' Nation Laboratory (2004) bracing for industrial and deep rock cores, and construction commercial projects. materials testing services for 18 turbine REGISTRATION farm. • Subsurface exploration and evaluation for commercial, CELL 7 DEMONSTRATION PROJECT, Professional Engineer: industrial, governmental and Brown County Port Authority. Provided Wisconsin residential structures. piezometer Installation and data - acquisition, and slope stability analysis. - Michigan • Coordinate specialty geotechnical - Iowa field testing, including PERFORMING ARTS CENTER, - Illinois pressuremeter testing, Appleton, WI. Provided geotechnical vibrating -wire piezometer exploration, including pressuremeter CERTIFICATION installation, inclinometer testing, testing and special consultation for . and double - packer in -situ heavily loaded foundation system. Soil Moisture /Density Operator — Troxler hydraulic conductivity. RICHMOND TERRACE CENTER, Electronics Labs, Inc. • Coordinate materials testing and Appleton, WI. Provided geotechnical document caisson installations. exploration, including pressuremeter PROFESSIONAL ACTIVITIES testing and special consultation for • Provide Quality Assurance heavily loaded foundation system. American Society of Civil Engineers documentation for land TURBO GENERATOR BUILDING, geomembrane installatioo f n. Wisconsin Rapids, WI. Project included ASFE: The Association of Firms • Develop procedures and perform excavation bracing designs. Practicing in the Geosciences testing for research projects, Deep Foundation Institute including bedrock modulus of I TWIN CITY TESTING CORP. elasticity and rainfall run -off International Society of Soil Mechanics characteristics of paver blocks. AIR WISCONSIN REGIONAL & Foundation Engineers • Evaluate and characterize MAINTENANCE FACILITY, Outagamie proposed clay borrow sources, County Airport, Appleton, WI. Project PUBLICATIONS including directing subsurface management of construction materials exploration. testing services and caisson inspections. Haas and Barker, "Frozen Gravel: A • Conduct static pile load tests, Study of Compaction and Thaw- analyze and monitor production Settlement Behavior". Proc. of ASCE pile driving. Cold Regions Specialty Conference in Minneapolis, MN, Feb 6 -8, 1989. • Subsurface exploration and evaluation for several auger cast -in -place foundation systems. ev il , " Vow 11 PROFESSIONAL PROFILE JEREMY A. MCCONNELL, P.E. CONSTRUCTION SERVICES MANGER EDUCATION • Manage personnel • Tensile and shear testing of granite and limestone facade • Maintain project backlog, sales fasteners. B.S.C.E., Michigan Technological pipeline, and annual budgets. University • Test dimensioned building stone. • Coordinate and review REGISTRATION construction materials testing Representative projects that require a services performed in working knowledge of field, laboratory Professional Engineer: Northeastern Wisconsin. Below is and engineering services Include: g a partial list of representative project experiences: - Wisconsin RIVER VALLEY TESTING CORP. - Indiana • Construction monitoring of power generation plants and wireless WIND FARM FOUNDATION QUALITY CERTIFICATION communication sites. CONTROL MANAGEMENT, Wisconsin, Indiana, and Oklahoma. Personnel • Forensic engineering to judge management, engineering oversight, Soil Moisture /Density Operator — Troxler causes of distress and failures in and material troubleshooting services Electronics Labs, Inc. concrete structures, bituminous for 410 wind turbines. Wisconsin DOT Certified Aggregate pavements, and low perm floor covering systems. CHILTON ELEMENTARY, MIDDLE, & Technician — Level IPP HiGH SCHOOLS, Chilton, WI. • Vibration monitoring for pile Documented and reviewed soil stability Wisconsin DOT Certified Portland driving operations and for for footings and pavements, and Cement Concrete Technician - Level II vibration- sensitive printing monitored quality control testing of Wisconsin DOT Certified Hot Mix - equipment. construction materials. Asphalt Technician — Level MD Provide deep foundation US HIGHWAY 10, Winnebago County, monitoring of caisson installations WI. Coordinate and supervise PROFESSIONAL ACTIVITIES bearing on low ROD bedrock. Wisconsin DOT QMP testing for plastic and hardened concrete. • of Civil Engineers Provide deep foundation American Society g monitoring of end- bearing and CLOVIS GROVE SCHOOL, Menasha, friction pile installation, and of WI. Monitored installation of caissons. American Concrete Institute PDA services. Performed tests of plastic and hardened concrete and documented soil stability Wisconsin Ready Mixed Concrete Document and evaluate structural for support of floor slabs. Association • stability of soils for pavement systems, isolated foundations and SCHEELS SUPERSTORE, FOX RIVER SEMINARS continuous footings. MALL, Appleton, WI. Coordinate and oversee quality control technicians for • Evaluate concrete, mortar, and testing of soils, concrete, and steel. ASCE 14 Conference on Cold Regions Documented soil stability. Documented Engineering — Duluth, MN, Sept. 2009 grout mixes of various proportions that reinforcing steel complied with and strengths for commercial, specifications. ACI Seminars — Troubleshooting industrial and highway Concrete Floor Problems, Nov. 2003 construction. FOX ENERGY CENTER, Kaukauna, Train, monitor WI. Monitored installation of driven EXPERIENCE • Train, , s uperupervivi se, technician and mo for nitor piles. Documented and reviewed soil projects, including commercial stability oc m y nted completed r Reviewed and office buildings, banks, retail documented completed pre placement Manage testing services and concrete construction, Supervised engineering in Neenah and Madison, developments, hospitals, and concrete, soil, and grout quality control Wisconsin offices, public schools. testing personnel. • Develop and implement strategic • Monitor construction activities and WIRELESS COMMUNICATION SITES, business plans. perform quality control testing, Wisconsin and Michigan. Monitored including field torque testing of foundation construction. Observed and • Develop and maintain business high strength bolted connections documented ground field installation. relationships. for multi- storied facilities and anchor pull -out testing of Corp of • Author proposals. Engineers dam rehabilitation projects. /~� +•® ■ PROFESSIONAL PROFILE MARCUS C. RUE STAFF ENGINEER EDUCATION • Determine laboratory density by 2010 SANITARY AND WATER MAIN standard and modified proctor IMPROVEMENTS, Black Creek, WI. procedures. Trench backfill density testing of native B.S.C.E., University of Wisconsin- • Conduct floor flatness and floor backfill materials. Platteville levelness using FACE dipstick floor profile machine. KIMBERLY AVENUE WATER MAIN REGISTRATION INSTALLATION, Kimberly, WI. Trench • Evaluate concrete distress by use backfill density testing of granular and of Windsor probes and rebound native backfill materials. Engineer In Training: hammer. - Wisconsin (License 111511459 -500) • Perform caisson installations. CERTIFICATION Representative projects that require a working knowledge of field, laboratory and engineering services include: Soil Moisture /Density Operator — Troxler Electronics Labs, Inc. RIVER VALLEY TESTING CORP. Wisconsin DOT Certified Aggregate Technician — Level IPP PLEXUS HEADQUARTERS, Neenah, WI. Performed pile monitoring and Wisconsin DOT Certified Hot Mix- density tests of soil. Asphalt Technician — Level IPT SUNSET PARK DETENTION POND, ACI Concrete Field Technician -- Level I Kimberly, WI. Performed liner installation monitoring and observed Hazardous Materials Safety Training pond repair. per 28 CFR1910.120 — Level A NEW FIRE STATION, Elkhart Lake, WI. EXPERIENCE Observed placement of mass fill and monitored stability of soils. Coordinate and review construction KRAFT FOODS PIZZA LINE materials testing services performed in EXPANSION, Little Chute, WI. Neenah, Wisconsin office. Performed subgrade observations, plastic concrete tests, and density tests • Administrate and monitor of soil. construction materials field staff. NEW THEDACARE CLINIC, Appteton, • Document and evaluate structural WI. Performed subgrade observations stability of soils for pavement and observed pond repair. systems, isolated foundations and continuous footings. WATER FILTRATION PLANT, Oshkosh, WI. Performed plastic • Perform subsurface exploration for concrete tests, mortar and grout tests, site feasibility and foundation and density tests of soil. Confirmed design, compliance with project specifications. • Perform construction materials NEW CBRF FACILITY, Appteton, WI. testing, including subgrade Performed subgrade observations and observations and proofrolling density tests of soil. operations. GRAND CHUTE /MENASHA WWTF, • Concrete testing, including slump, Town of Menasha, WI. Plastic air content, yield tests, and casting concrete, anchor testing, soil density cylinders. testing. Confirmed compliance with project specifications. • Soil moisture /density testing by SNELL ROAD / FOUNTAIN AVENUE nuclear density gauge method. OVERPASS, Oshkosh, WI. Oversight of Wisconsin Technical Standard 1001 — required pond liner testing services. • gni bar a TECHNICAL PROFILE ROBERT E. CROSS SENIOR ENGINEERING TECHNICIAN CERTIFICATION • Soil moisture /density testing by KEENAN WIND FARM, Woodward, OK. nuclear gauge method. Provided preconstruction coordination of laboratory set -up and initial Wisconsin DOT Certified Portland • Determine laboratory density by development of preliminary daily activity Cement Concrete Technician - Level standard and modified proctor plan. I /IA procedures. KRAFT FOODS, Little Chute, WI. Wisconsin DOT Certified Asphalt • Mechanical analysis of soils and Services provided included verifying soil Technician - Hot Mix Asphalt concrete aggregate. bearing capacity, compaction testing, Technician IPT concrete testing, and concrete • Laboratory analysis of clay quality temperature data logging. Wisconsin DOT Certified PCC Strength to document NR 500 Tester characteristics. BUILDING #30, STURM FOODS, Manawa, WI. Performed concrete Wisconsin DOT Certified Aggregate Flow, casting and compressive testing. Technician - Level I - AGGTEC IP strength testing of grout cylinders and cubes. FOX ENERGY CENTER, Kaukauna, Wisconsin DOT Certified Nuclear WI. Performed concrete testing, density Density Gauge Operator -- Level I Caisson installation monitoring testing of soils, verified soil bearing • and testing. capacity, epoxy grout testing, and Soil Moisture /Density Operator - RVT construction monitoring. Nuclear Gauge Operation Program • Pile installation monitoring. ACI Concrete Field Technician - Level I Reinforcing bar inspection. USH 10 CONCRETE PAVING, • Winnebago County, WI. QMP concrete EXPERIENCE • Drill Rig helper for paving operations. KIMBERLY SCHOOLS, Kimberly WI. Conduct field and laboratory testing for Plastic concrete, compressive strength construction projects in Central, The following is a partial list of projects of concrete, soil density testing, Southern and Northern Wisconsin. A requiring application of diverse field and subgrade observations, masonry representative list of these experiences laboratory testing: testing. is compiled below: RIVER VALLEY TESTING CORP. BREEZEWOOD LANE • Coordination of technician INTERCHANGE, Neenah, WI. MSE activities. BLUE SKY WIND FARM, Fond du Lac, wall backfill, laboratory and field density WI. Senior technician supervisor and testing. • Determine bearing capacity of performed plastic concrete testing. native soils. 2010 SANITARY AND WATER MAIN CEDAR RIDGE WIND FARM, Eden, IMPROVEMENTS, Black Creek, WI. • Cast concrete beams to determine Trench backlit' density testing of native flexural strength. WI. Senior technician supervisor and backfill materials. performed plastic concrete testing. • Water vapor transmission testing KIMBERLY AVENUE WATER MAIN of concrete floors. FOWLER RIDGE WIND FARM INSTALLATION, Kimberly, WI. Trench PHASE I, Fowler, IN. Provided backfill density testing of granular and preconstruction coordination of native backfill materials. • Asphalt services, including QMP laboratory set -up and initial nuclear density, bituminous development of preliminary daily activity extractions and gradations, and plan. other WDOT QA/QC Testing. • Concrete testing, including slump, air content, yield tests and casting LAWRENCE UNIVERSITY, Appleton, cylinders. WI. Services performed included caisson inspections, subgrade • Core concrete structures. observations, and concrete temperature • Use Windsor Probe to document data logging. concrete strengths. Rv w / TECHNICAL PROFILE KEITH J. DOYLE ENGINEERING TECHNICIAN CERTIFICATIONS 1 The following is a partial list of projects GRAND CHUTEJMENASHA WWTF, requiring application of diverse field and Town of Menasha, WI. Plastic laboratory testing: concrete, mortar testing, grout testing, Wisconsin DOT Certified Portland soil density testing, and compressive Cement Concrete Technician — PCC strength testing of concrete. Tech I RIVER VALLEY TESTING CORP. Wisconsin DOT Certified Aggregate BLUE SKY WIND FARM, Fond du Lac, M OLD SPRING ROAD, Town of Menasha, WI. Pond liner testing, collect Technician — AGGTEC IPP WI. Senior technician and performed thin - walled tube soil samples for grout testing and anchor tensioning laboratory extrusion and material Wisconsin DOT Certified Nuclear observations. property testing per Wisconsin Density Technician Technical Standard 101. Soil Moisture /Density Operator — RVT CEDAR RIDGE WIND FARM, Eden, Nuclear Gauge Operation Program WI. Performed plastic concrete testing, 2010 SANITARY AND WATER MAIN grout testing, and anchor tensioning IMPROVEMENTS, Black Creek, WI. observations. Trench backfill density testing of native EXPERIENCE backfill materials. • LAWRENCE UNIVERSITY, Appleton, WI. Services performed included Conduct field and laboratory testing for subgrade observations, and concrete KIMBERLY AVENUE WATER MAIN construction projects in Central, INSTALLATION, Kimberly, WI. Trench temperature data logging, plastic Northern, and Southern Wisconsin. A backfill density testing of granular and representative list of these experiences concrete, soil density testing. native backfill materials. is compiled below: • Concrete testing, including slump, BERGSTROM TOYOTA, Oshkosh, WI. BONNIE DRIVE / SANDYS LANE air content, and casting cylinders. Performed subgrade observations, soil Town E of Menasha, WI. T backfill density testing, and concrete testing. density testing of granular and native • Concrete testing, including slump, backfill materials. air content, and casting cylinders KRAFT FOODS, Little Chute, WI. on WDOT projects. Services provided included verifying soil APPLETON - SHERWOOD WATER bearing capacity, compaction testing, MAIN, Sherwood, WI. Trench backfill • Soil SoiI moisture/density gauge istur ure /method. density testing by concrete testing, and concrete density testing of native backfill temperature data logging. materials. • Soil moisture /density testing by nuclear gauge method on WDOT BUILDING #30, STURM FOODS, retaining walls. Manawa, WI. Performed concrete testing. • Determine laboratory density by standard and modified proctor procedures. VALLEY FAIR COPPS STORE, Appleton, WI. Performed subgrade and • Mechanical analysis of soils and proofrolling observations, frost probes, y soil density testing, and plastic concrete concrete aggregate. testing. • Subgrade observations. COLLEGE AVENUE BRIDGE, • P200 & Moisture content of soils. Appleton, WI. QMP concrete testing and observation services. • Determine the Plastic & Liquid Limit & Percent Organic of soils. RETAINING WALL INSTALLATION, Lake Delton, WI. QMP nuclear density • Density testing of asphalt with testing and recording on retaining wall nuclear gauge. backfill. • Water Vapor Emission testing. HMA PAVING PROJECTS, throughout • Conduct frost probes. Northeast Wisconsin. QMP HMA nuclear density testing. Rv , if IV ® TECHNICAL PROFILE BRAD M. COLEMAN LABORATORY SERVICES COORDINATOR SENIOR ENGINEERING TECHNICIAN CERTIFICATION • Field and laboratory testing of soil NEW HIGH SCHOOL, Shawano, Wt. resistivity using Miller box and Project included 32 soil borings for a Werner 4 probe equipment. geotechnical exploration. Soil Moisture /Density Operator — Troxler Electronics Labs, Inc. Laboratory analysis of clay quality 2011 GEOTECHNICIAL DRILLING • to document NR 500 Compliance. FOR THE CITY OF OSHKOSH, Wisconsin DOT Certified HMA Asphalt Oshkosh, WI. Moderate depth Technician — Level IIIS • Verification of field soil geotechnical borings, sample classifications using ASTM D2487 acquisition, and PID Screening. Wisconsin DOT Certified Aggregate procedures. Technician — Level IP • Specialty Laboratory testing, TWIN CITY TESTING CORP. Wisconsin DOT Certified Portland including consolidation and Cement Concrete Compressive hydraulic conductivity tests. Strength Testing WASTE WATER TREATMENT • Coordinate drilling and FACILITY, Appleton, WI. Project maintenance schedules for two included density testing and concrete EXPERIENCE drill rigs. testing. Conduct field and laboratory testing for • Data acquisition of force - balanced PROPOSED SENIOR CITIZENS construction projects in Northern accelerometers based CENTER, Oshkosh, WI. Project Wisconsin. Below is a partial list of inclinometers for slope stability included environmental exploration, representative project experiences: analysis and remediation. monitoring well installation and water sampling. • Crew Chief on drill rig. Representative projects that require a OGDENSBURG LANDFILL CLOSURE, Responsibilities included visual- Ogdensburg, WI. Services provided manual classification of soil working knowledge of field and g 9. P samples and preparation of field laboratory testing Include: include field density testing. borehole logs. NAVARINO LANDFILL CLOSURE, RIVER VALLEY TESTING CORP. Navarino, WI. Services provided • Drilling methods included hollow- include field density testing. stem auger, tri -cone rotary, and USH 45, New London to Clintonville, conventional NX -size rock coring. WI. Superpave HMA Mix Design and PHAR -MOR PLAZA, Eau Claire, WI. Installation of monitoring wells mix testing services. Project included field density tests, • 9 per concrete, asphalt and bolt torque NR141 Codes. VARIOUS DETENTION POND testing. Superpave and Marshall asphalt LINERS, Throughout, WI. Laboratory ave • P P P analysis including maximum density, services, including mix design, hydrometer, plasticity index, and extraction /gradations, and field hydraulic conductivity testing. inspection of asphalt pavement. PERFORMING ARTS CENTER, • Concrete testing, including slump, Appleton, WI. Conducted PID air content, yield tests and casting screening, water and soil sampling, and cylinders. well installation. • Aggregate testing for organic ZWLCKER DEVELOPMENT, Appleton, impurities, deleterious substances, WI. Conducted PID screening, water and lightweight particles in heavy and soil sampling, and well installation. solution. FORCE MAIN INSTALLATION, Orihula, WI. Project included 27 soil borings for a geotechnical exploration. OP ID: PA A` C'ORO CERTIFICATE OF LIABILITY INSURANCE DATE/1 033 1144!11 111 YYYi 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 pollcy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the teens and conditions of the policy, certain policies may require an endorsement A statement on this certificate does not center rights to the certificate holder in lieu of such endorsement(s). PRODUCER 820.235 -2764 CONTACT Pam Krue er CIC Servant Insurance P HONE FAX 920.235.2694 (A(c��J ea0. 920- 235.2764 lac, Not 920- 235 -2694 430 N Koeller Street E-MAIL Oshkosh, WI 54902 AOOaUSS: pkrueger @servantinsurance.com PER R Mary Murken CUSTOMER ID 0: ,�- �_.____. —.� —� INSURER(S) AFFORDING COVERAGE _ NAIC 3 INSURE° RVT Quality Systems Inc. INSURER A: Cincinnati Insurance Company _ Quality Mgmt Services Inc. INSURER B: TRI STATE INSURANCE CO OF MN AKA -River Valley Testing Corp INSURER C: Alex Barker — -- — - -- — 1060 Breezewood Ln Ste 102 INSURER D: Neenah, WI 64956 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. IL R TYPE OF INSURANCE I R LWVD M - POLICY NUMBER ILIWDDIWYY) IMM,D LIMITS GENERAL IIABIUTY EACH OCCURRENCE $ 1,000,000 A X COMMERCIAL GENERAL LIABILITY X EPP0065218 02/16111 02/16/12 OAMAOE TORENTED PREMISES (Ea oc s 100,000 CLAIMS-MADE ( X 1 OCCUR MEDEXP {Any one person) S 10,000 PERSONAL B AOV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GENT AGGREGATE LIMIT APPLIES PER PRODUCTS - COMP/OP AGO $ 2,000,000 V l POLICY n .PIFCT n LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 A X ANY AUTO EBA0065218 02116/11 02/16112 (Ea accident) BODILY INJURY (Per person) S ALL OWNED AUTOS BODILY INJURY (Per accdent) S SCHEDULED AUTOS PROPERTY DAMAGE X HIRED AUTOS (Per accident) X NON -OWNED AUTOS $ ` X UMBRELLA UAB X OCCUR EACH OCCURRENCE $ 6,000,000 EXCESS UAB CLAIMS -MADE AGGREGATE $ 6,000,000 A EPP0065218 02/16/11 02/16/12 - -- OEOUCTIBLE $ X RETENTION $ 10,000 I $ WORKERS COMPENSATION X I WOSTA - 1 IOER AND EMPLOYERS' LIABILITY B ANY PROPRIETOR/PARTNER/EXECUTIVE YIN WC- 48.02- 013146 -00 02/16111 02/16/12 E.L_ EACH ACCIDENr $ 1,000,000 OFFICER/MEMBER EXCLUDED? 1 N 1 NIA (Ma ndatory In NH) EL. DISEASE • EA EMPLOYEE S 1,000,000 If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 1,000,000 OESCRIPTION OF OPERATIONS I LOCATIONS !VEHICLES (Attach ACORD 101, AddlUona l Remark* Schedule, If more space Is required) Pre-Qualifying: If the named insured enters Into contract with Certificate Holder, City of Oshkosh, and its officers council members agents, employees and authorized volunteers will he provided additional status, including products & completed operations on the general liability. Polley will be endorsed to provide 30 day notice: exec ot 10 days for non - payment CERTIFICATE HOLDER _ CANCELLATION CIOS113 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE CITY OF OSHKOSH THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. PO BOX 1130 OSHKOSH, WI 54903 -1130 AUTHORIZED REPRESENTATIVE Mary Murken ©1988.2009 ACORD CORPORATION. All rights reserved. ACORD 26 (2009109) The ACORD name and logo are registered marks of ACORD a C o e'I 1 #`: 3 3 i CERTIFICATE OF LIABILITY INSURANCE OP ID RN M/ DATE(MDDJYYYY) 03/14/11 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 certMcale holder Is an ADDITIONAL INSURED, the policypes) 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 thls certificate does not confer rights to the certificate hotder In !feu of such endorsement(s). PRODUCER Writ I NAME: P O NE Johnson Insurance - Madison P No, Ext): (NC, No): 525 Junction Road ADDRESS: Madison WI 53717 PRODUCER CUST061ERIO RIVVA -1 Phone:608- 203 -3880 Fax:877 -254 -8586 IF INSURERIS) AFFORDING COVERAGE WIC f INSURED INSURER A: CNA Insurance 20427C River Valley Testing Corp. INSURER B : George Barker 1060 Breezewood Lane, Ste. 102 INSURER C: Neenah WI 54956 INSURER D INSURER 5 : INSURER F COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURINCE LISTED 8rLOWAAVE 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 AUUL SUbR POLICY EFF POLIOyy EXP LTR TYPE OF INSURANCE INSR WVD POLICY NUMBER (MWDDrYYYY) (MM1D0(WtY) LIMITS GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GEI713tP1 LIAB'.LITY UAMAI.t I V rttNItu PREMISES (Ea occurrence) $ CLAIMS - },LADE I OCCUR ?/ED ExP {Any one person) $ PERSONALS ADV INJURY 1 GENERAL AGGREGATE GEM_ AGGREGATE LIMIT APPLIES PER PRODUCTS - COMP /OP AGG $ — 1 POLICY n JET I LOC $ • AUTOMOBILE LIABILITY COMBiNED SINGLE LIMB ANY AUTO (Pa accident) BODILY INJURY (Per person) $ ALL OWNED AUTOS BODILY INJURY (per accident) ; SCHEDULED AUTOS - __ FIRED AUTOS PROPERTY DAMAGE (Per a:cl WI) RCN-OWNED AUTOS _ 1 UMBRELLA LIAR OCCUR EACH OCCURRENCE $ —_ EXCESS LIAB CLAIMS -MACE AGGREGATE $ DEDUCTIBLE RETENTION $ $ WORKERS COMPENSATION T AND EMPLOYERS' LIABILITY Y /N _ TORY UI /.ITS ER _ ANY PROPRIETOR/PARTNER/EXECUTIVE / L EACH ACCIDENT 1 OFFICER/MEMBER EXCLUDED? I 4/A (Mandatory In NH) E L DISEASE - EA EMPLOYEE 11 Yes dn under DESCRIPTIO N OF OPERATIONS beke, E L DISEASE • POLICY LIMIT 1 A Professional Liab MCH114051875 03/01/11 03/01/12 Ea Occ 2000000 Aggregate 2000000 DESCRIPTION OF OPERATIONS / LOCATIONS/ VEHICLES (Attach ACORO 101, Additional Remarks Schedule, B more space le required) Environtental Professional Liability & Contractor's Pollution Incident CERTIFICATE HOLDER CANCELLATION CITYOSl SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLEO BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. City of Oshkosh City Clerk AUTHORIZED REPRESENTATIVE 215 Church Ave Oshkosh WI 54901 Q1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25 (2009/09) The ACORD name and Togo are registered marks of ACORO cub ceoboic 4 --z,1 RIVER VALLEY TESTING CORP. GENERAL CONDITIONS 1 COPE OF WORK: River Valley Testing Corp (hereafter referred to as RVT) shall perform the work defined in this Agreement. "Client" refers to e person or b• mess entity for whom the work is performed. "Work" refers to the specific geotechnical, analytical testing or other services to be performed by R ' as set forth In the • oposal or written quotation. Unless otherwise stated in writing, the Client assumes sole responsibility for determining whether the quantity an the nature of the work o • ered by the Client is adequate and sufficient for the Client's intended purpose. RVT will no be liable for any work, advice, judgment or decision based on any inaccurate or incomplete Information furnished by the Cr - nt or other contractors engaged by o or the Client, and the Client will indemnify RVT against liability resulting from such information. 2 ACCESS /UTIL(TI .: The Client will arrange access to the site as is necessary for RVT to complete the work. RVT will take reas• able precautions to minimize damage to the site • • - to its operation, but the fee for repairing damaged has not been included. By furnishing right -of- access, the lient recognizes that the risk of damage to the site ca .e minimized, but not eliminated. if the Client desires or requires RVT to restore the site to its former .ndition, upon written request. RVT will perform such addition. work as is necessary to do so and the Client agrees to pay RVT the cost thereof plus 15 %. RVT Is responsible for cleara e of public utilities and will be responsible for repair of any damages to public utllili:- caused by RVT activities, The Client is responsible for locating all non -. blic utilities and other subterranean or latent conditions and agrees to indemni -nd save RVT harmless from all claims, suits. losses, cost and expenses includi • reasonable attorney's fees as a result of personal injury, death or proper damage occurring from damage to subterranean structures and which are not called to :VT's attention in writing prior to commencement of work. 3. RESPONSIBILITY: RVT's work shall not I Jude determining or implementing the means, methods, tec ques, sequences or procedures of construction. RVT shall not be responsible for evaluating, reporting • affecting job conditions concerning health, safety or v - fare- RVT's work or failure to perform same shall not in any way excuse any contractor, subcontractor or s :.lier from performance of Its work in accordance • ' contract documents. The services of RVT field personnel do not includ- esponsibility for superintendence oft = construction process or direction of the actual work of the contractor, subcontractor or other tradesmen. 11 is further agreed at RVT is not responsible for, nor RVT to review the adequacy of lob safety on the project 4. SAMPLES: Unless otherwise agreed or consumed in test • •, test specimens will be stained for a maximum of thirty (30) days following submission of RVT's report to the Client. 5 INSURANCE RVT will carry workman's compensation insuranc: and public ability in conformance with state law. The Client agrees to limil liability of RVT to the limits of RVT's Insurance The Client is responsible for requesting s: ecific i• Iusions that are not covered in RVT's insurance 8. PAYMENT: RVT will submit monthly invoices for services performed h ing the preceding period Payment is due upon receipt of invoice and shall be considered past due thirty (30) days after receipt of invoice The Client shall provide RVT a written statement of any items in . - estion with' fteen (15) days of receipt of invoice. The Client agrees to pay a finance charge of one and one -half .ercent (1 1/2 %) per onih (18% annually) or the maximum allowed by law on past due accounts. 7 OWNERSHIP OF DOCUMENTS: Reports, plans and oth: work prepared by RVT will r• ain the property of RVT until all fees for RVT's services have been paid in full. The Client agrees that all reports and other work fu 'shed to the Client and its agent , not paid for in full, will be returned upon demand and will not be used for licensing, permits, design and /or construction Further he Client and its agents agree not to :lain copies, photocopies, facsimile, or electronically duplicated copies of reports for which the payment for services is in cis le. 8. Client agrees to limit all liability of RVT and its e• pioyees to the total amount of the fee paid to R with respect to this Agreement It Is expressly agreed that the remedy contained in this Section 8 Is agreed to .0 the exclusive, sole remedy for any breach of this Ag • emeni 9 INDEMNITY: The Client, and it the Client - ting as an agent for a principal In ordering work from RVT the .Iso said principal, agrees to indemnify defend and hold RVT, its officers, employees, and agents • . rmtess from any and all claims, suits, losses, costs and expenses, eluding. but not limited to court costs and reasonable attorney's fees arising, or alleged to ha : arisen, out of or resulting or alleged to have resulted from the eerier - nce of RVT's work on or about the subject project and caused in whole or in part by an negligent, willful or wanton act or omission of the Client or the Client's print •al or any party directly or indirectly employed by the Client or the Client's principal o • nyone for whose acts the Client or the Client's principal may be liable except t• he extent, and only to such a degree, as such claim, suit. toss or damage is ca • ed by the negligent willful or wanton act of RVT, its officers, agents, employees or • • one for whose acts RVT may be liable. In the event the Client or the Cli- • 's principal shall bring any suit, cause of action, claim or counterclaim against RVT to t' - exteni that RVT shall prevail upon such suit, cause of action, claim o ounterctaim the person initiating such action shall pay to RVT the costs expended by RVT to : swer and /or defend against such suit, cause of action, claim or c• • nterclaim including reasonable attorney fees, witness fees and other related expenses. 10 TERMINATION: This : greemeni may be terminated by either party upon seven (7) days prior written notice. In the event of termin. on, RVT shall be compensated by the Client for all • - Prices performed up to, and including, the termination date, including reimbursable expenses, and for the co • •tetlon of such services and records as are net ssary to place RVT's files in order andfor to protect its professional reputation, 11 ASSIGNS: Ne er the Client or RVT may delegate, assign, sublet or transfer its duties, interests or responsibilities in this Agreement withou ritten consent of the other party. w crab kle-dtme- am 3 /a9 /►) A -& 1 7 - 41 - Sti 122 7/04 ( ) SCOPE OF SERVICES CONSTRUCTION MATERIALS TESTING 2011 CAPITAL IMPROVEMENT PROGRAM This contract is to provide nuclear density testing services of trench backfill and asphalt along with laboratory testing of these materials. Responsibilities include providing qualified timely response, daily coordination and communication with contractors and city staff, and prompt professional reporting of test results. 1. Background A. The following City of Oshkosh projects are planned to be covered under this contract: i. Contract 11 -01 — Tipler Conveyance Upgrades ii. Contract 11 -02 — Westhaven Clubhouse Area Detention Basin iii. Contract 11 -04 — Concrete Paving & Utilities Central a. Osceola Street (the Fox River to Algoma) b. Algoma Boulevard (Osceola to Elmwood) c. Elmwood Avenue (Algoma to Vine) d. John Avenue (Elmwood to McKinley) e. Church Avenue (Franklin to Main) f. Packer Avenue (Algoma to 115' west of Clover) iv. Contract 11 -05 — Concrete Paving & Utilities South a. Knapp Street (10 to Campbell Creek) b. 5 Avenue (Knapp to Idaho) c. 5th Avenue (Ohio to Michigan) d. 4th Avenue (Knapp to Idaho) e. Michigan Street (5 to the Fox River) v. Contract 11 - 07 — Concrete Paving & Utilities North a. New York Avenue (Main to Jefferson) b. Tennessee Avenue (Jefferson to Broad) c. Custer Avenue (Mt Vernon to Broad) d. Eastman Street (New York to Custer) e. Broad Street (New York to Nevada) f. Monroe Street (Irving to Melvin) g. Lincoln Avenue (RR tracks to Monroe) vi. Contract 11 -08 — Hughes Street Glatz Creek Culvert Replacement vii. Contract 11 -09 — 9 Avenue Water Main Relay viii. Contract 11 -10 — Planeview Road Sanitary & Water Extension Page 1 of 7 ix. Contract 11 -13 — High Avenue Asphalt Mill & Overlay x. Contract 11 -14 — Sanitary Sewer Relay a. Hazel Street (Baldwin to Melvin) b. Alley West of Main Street (14 to 15 B. The 2011 Capital Improvements Program is subject to change. Projects may be added or deleted based on the needs of the City of Oshkosh. Work listed throughout this RFP is not guaranteed. The City reserves the right to send out separate RFP's for other projects and testing services not listed in this document. 2. Testing and Reporting A. All tests and reports shalt be in conformance with the latest ASTM Standards. The selected consultant will be responsible for providing all necessary forms for labeling of samples and documentation of test results. Test results shall include the location, sample number, and be separated per City Contract number. B. Soils and Aggregate Testing Provide the necessary labor and equipment for clay liner testing, onsite nuclear density testing of utility trench backfill and associated laboratory material testing. Specifications will be based on the City of Oshkosh 2011 Standard Specifications and each contract's special conditions. The testing firm shall obtain all test samples from construction sites throughout the city and may be required to obtain samples from various source sites. At a minimum, keep all lab samples until the end of each contract. Nuclear density testing will be performed on an as- needed basis dependent on the contractor(s) schedule. As a reference, based on years past, a field density testing technician was required almost daily throughout the construction season. It is the testing firm's responsibility to verify the contractor's schedule and to coordinate with the City of Oshkosh Inspectors/Engineers daily. This year's season is anticipated to commence in the beginning of April and continue through November. Nuclear density tests shall be located by project station, offset, elevation, and utility trench type. The density testing technician shall notify the City Inspector and appropriate contractor of all failing tests. Failing areas shall be re- compacted and re- tested until passing results are achieved. All tests shall be documented. C. Asphalt Testing Provide the necessary labor and equipment for nuclear density tests on asphalt binder and surface courses and associated laboratory material testing. Specifications will be based on the City of Oshkosh 2011 Standard Specifications and each contract's special conditions. The testing firm shall obtain all test samples from construction sites throughout the City. At a minimum, keep all lab samples until the end of the project. Nuclear density testing will be performed on an as- needed basis dependent on the contractor(s) schedule. It is the testing firm's responsibility to know the contractor's schedule and to coordinate with the City of Page2of7 Oshkosh Inspectors /Engineers daily. There are approximately 7000 linear feet of asphalt street reconstruction/overlay scheduled for this year. Nuclear density tests shall be located by project station, offset, and layer type. The density testing technician shall notify the City Inspector and appropriate contractor of all failing tests. Failing areas shall be re- compacted and re- tested until passing results are achieved. All tests shall be documented. D. Reporting i. Technician Daily Reports a. Technicians will be required to document their activities through a daily report. These reports shall include the date, a summary of the activities taking place for which they are testing, the technician's arrival and departure times, and other pertinent information as standard with this type of reporting. There shall be a daily report for each city contract worked on that day. Daily reports can be hand written, but must be legible. ii. Material Test Reports a. Material test results shall be emailed in .pdf format to the City Project Engineer within 48 hours of notification of sample pick -up unless lengths of the test dictate otherwise. iii. Summary Reports a. Biweekly density testing reports during utility construction shall include a written summary, any material test results from that time frame, an updated typed compaction results log, and the technician's daily field reports. All reports shall be signed by the appropriate signing authority of the selected firm and the project manager. Separate reports shall be generated for each city contract should multiple projects occur during the same time interval. A final summary report shall be prepared upon the completion of each individual city contract. One summary report is required for each asphalt repaving project (street) and shall include the same information as required for utility trench backfill reporting. b. All reports shall be typed in a professional manner according to the latest ASTM standards and can be emailed to the City Project Engineer in .pdf format. 3. Proposal Cost Breakdown A. The Proposal Cost Breakdown sheet shall be filled out and included in the proposal. B. A description of each item is as follows: i. Roundtrip Charge — includes the technician's travel time and mileage to and from the City of Oshkosh each day services are required. ii. Field Time — includes all necessary labor costs while testing in the City of Oshkosh including travel time between projects. Travel time shall be split equally between projects and documented in their respective daily report. The City Inspector shall be notified upon arrival and departure of the project site. Up to a %2 hour of technician Page 3 of 7 office preparatory time will be allowed per day that field work occurs. Document this time on the daily field report. The field time hourly rate will apply even if overtime is worked by the technician. Long hours are expected due to the tight construction windows placed upon the contractors. • iii. Equipment Rental — includes all necessary rental charges for equipment and materials that will be used in the performance of the testing requirements. Rental time shall match the technician's onsite field time only, iv. Vehicle Rental — includes vehicle rental charges while in the City of Oshkosh. Mileage traveling between projects throughout the day will not be considered. Vehicle costs incurred while traveling to and from the City shall be covered under the Roundtrip Charge. Rental time shall match the technician's onsite field time only. v. Trench Backfill Testing Reports — includes all necessary labor and material costs to provide biweekly summary reports. Reports to include a written engineering summary, material test results, an updated running log of the compaction results, and the technician's daily field reports for the respective period. vi. Asphalt Testing Reports -- includes all necessary labor and material costs to provide a summary report of each asphalt testing project. Projects will more than likely be broken up by street. Reports to include a written engineering summary, material test results, the compaction results log, and the technician's daily field reports. vii. Engineer Consultation — professional engineer's labor rate with a geotechnical and materials background should services be requested for consultation or to attend any meetings. Engineer consultation time should only be used upon approval from City of Oshkosh Project Engineer. viii. Project Manager — City approved project manager's (geotechnical and materials background required) labor rate. Contract will allow up to 2 hours per week without prior approval from the City of Oshkosh for project coordination, scheduling, and other duties as necessary. This person will be asked to attend the contractor's Pre - construction Meetings and will be paid for according to this hourly rate. Additional time per week for normal project management shall be considered incidental to the contract. ix. Sieve Analysis of Aggregate — includes all necessary labor and equipment to provide a sieve analysis per the latest ASTM standards and to compare with the contract's material specifications. Cost to also include report generation and distribution to City and contractor personnel. x. Standard Proctor Density Test (aggregate) — includes all necessary labor and equipment to provide a standard proctor density test of aggregate per the latest ASTM standards. Cost to also include report generation and distribution to the City. xi. Modified Proctor Density Test (aggregate) — includes all necessary labor and equipment to provide a modified proctor density test of aggregate per the latest ASTM standards. Cost to also include report generation and distribution to the City. Page 4 of 7 xii. Standard Proctor Density Test (clay) — includes all necessary labor and equipment to provide a standard proctor density test of a clay material per the latest ASTM standards. Cost to also include report generation and distribution to the City. xiii. Modified Proctor Density Test (clay) — includes all ,necessary labor and equipment to provide a modified proctor density test of a clay material per the latest ASTM standards. Cost to also include report generation and distribution to the City. xiv. Atterberg Limits — includes all necessary labor and equipment to provide Atterberg Limits of clay linear material per the latest ASTM standards. Cost to also include report generation and distribution to the City. xv. Grain Size Analysis — includes all necessary labor and equipment to provide Grain Size Analysis of clay linear material per the latest ASTM standards. Cost to also include report generation and distribution to the City. xvi. Flexible Wall Permeability Tests — includes all necessary labor and equipment to provide Flexible Wall Permeability tests of clay linear material per the latest ASTM standards. Cost to also include plugging holes and report generation and distribution to the City. xvii. Asphalt Extraction/Gradation — includes all necessary labor and equipment to provide an extraction and gradation of an asphaltic paving mixture per the latest ASTM standards. Cost to also include report generation and distribution to City and contractor personnel. xviii.Response Time — time it will take the consultant to mobilize a technician from the home office to a particular construction site in the City of Oshkosh if notified by the City or contractor that their presence is required. An important factor in the selection of the consultant is their ability to be responsive should their services become necessary on short notice, 4. Additional Proposal Requirements A. In addition to the requirements listed throughout this Request for Proposals, each respondent shall include the following: i. Prepare a summary of the firm's understanding of this proposal. A brief description of the respondent's organization is also requested. ii. List the planned project team and their respective resumes including relevant experience and training. Specifically provide the names /titles of personnel assigned to each task including the Project Manger. Due to this year's increased work load and accelerated schedule, it is required that the proposed technician have previous experience with utility trench construction. Should the need arise for a replacement technician during the season; the City of Oshkosh Project Engineer shall be notified for prior approval. Page 5 of 7 iii. Provide a list of recent projects of a similar nature and capacity the respondent has been involved. iv. Furnish a list of at least three (3) references that will be able to verify information supplied in the proposal. B. The proposal shall also include the fee schedules for laboratory testing including additional testing required for clay liners per the WDNR Technical Standard 1001, various levels of engineering rates, and construction testing services should additional work not covered specifically in this proposal be required. 5. Invoices A. The consultant shall submit itemized monthly statements for services. The invoice shall be broken down per city contract. Required back -up information is as follows: i. A copy of each daily report from the time period of the requested payment. ii. A copy of any laboratory tests from the time period of the requested payment. iii. For approved consultation or additional project management time, include the date, a description of the discussion and /or activity and the name of the city staff person and the consultant's staff involved in the discussion. B. Additional invoicing and payment requirements are stated in the Agreement Form. 6, Contract Award A. The contract will be awarded on a time and materials basis with a not to exceed total. Changes to the contract will be completed per the requirements set forth in the City of Oshkosh Agreement document. Indicated quantities in this RFP are only an estimate and are not guaranteed. B. By providing a signed proposal, the respondent is acknowledging they will work solely under the terms and conditions of the City of Oshkosh and if selected, will provide insurance documents according to the attached requirements with the signed contracts within a week after receiving the official contract paperwork from the City of Oshkosh. Besides prior negotiated agreements between the consultant and the City of Oshkosh, a consultant's terms and conditions will not be accepted as part of the contract. C. The information contained within the signed agreement form, the RFP with its attached documents, and the consultant's proposal shall become a part of the Contract with the Consultant selected to perform the Services. D. The proposals will be reviewed for completeness and how well it is demonstrated that the needs of the City of Oshkosh can be meet. The award of this work will not be based solely on cost of the proposal, but will place high value on the ability to provide timely responses and experience with this type of work. Page 6 of 7 7. Project Schedule A. It is anticipated that the City will make the selection by March 28, 2011 with construction scheduled to begin April 4, 2011. The contract will terminate December 31, 2011 or upon the completion of any testing project started in 2011. The City of Oshkosh maintains the right to terminate the contract if the consultant does not respond as stated in the accepted proposal. 8. Method of Response A. As stated in the accompanying letter questions regarding this RFP shall be emailed to isargent@ci,oshkosh.wi.us by 4:00 p.m. on Friday, March 11, 2011. The subject heading of the email shall be "2011 CIP Construction Materials Testing RFP Questions ". The questions and appropriate responses will be distributed to all parties receiving this Request for Proposal by 12:00 p.m. on Wednesday, March 16, 2011. B. Please submit four (4) hard copies with original signatures of the proposal to Joe Sargent no later than 4:00 p.m. on Friday, March 18, 2011. Proposals may be delivered or mailed to: Joseph R. Sargent Engineering Division City of Oshkosh 215 Church Avenue, Rm 301 Oshkosh, WI 54903 Page 7 of 7 i O JH KOJH ON THE WATER CIT O F OSHKOSH CONTRACTOR SAFETY PROGRAM r t o rf al 1 € - *ribe -,:11V c �'' ` $1■—i 4re j 11 �' F 1 1 • ,.., - 1 1 , i ,, , .,_ , 2;:=1.1. ''',, i i*Pillir, ri 'til P '''' 0 1 K Origin Septe 2006 Revised: March 2010 City of Oshkosh Contractor Safety Program TABLE OF CONTENTS Introduction 1 General 1 Project Safety Coordinator Responsibility 2 City of Oshkosh 2 Contractor 2 Fire Prevention and Protection 2 Hot Work 2 Smoking Policy 3 Chemical Safety 3 Material Safety Data Sheets 3 Chemical Management 3 Container Labeling 3 Environmental Compliance 4 Waste Disposal 4 Hazardous Waste 4 Chemical Spills 4 Personal Protective Equipment 5 Elevated /Overhead Work 5 Excavation/Trenching 5 Summary 6 City of Oshkosh Project Manager Contractor Notes and Check List 7 Contractor Qualifications 7 Information Exchange Check List 8 Contractor Project Manager Contractor Safety Program Acknowledgement Form 9 Contractor Safety Program Qualification Questionnaire 10 INTRODUCTION Work - related accidents damage property, cause serious injury and may even result in death. Most accidents are preventable with good planning, up -to -date training, good communication and most of all ... commitment. It is the intent of the City of Oshkosh, that all work conducted, is done in a safe, healthful and environmentally responsible manner. Employers have the duty and responsibility to provide a safe work place for their employees as well as contractor and vendor employees. Contractors, likewise, have a responsibility to keep their workers safe, and to work in a manner that does not compromise the safety of City of Oshkosh employees, while protecting, preserving and enhancing the environment. Therefore, the City expects contractors to meet all safety and health performance requirements and to comply with all applicable laws, regulations, ordinances and codes. For purposes of this program, a "Contractor" may be defined as: a) Construction contractor — project oriented work such as new construction or remodeling b) Service Contractor — a contractor that installs, services or performs maintenance of equipment, tools, systems or processes c) Vendor — a provider of definable services for a facility d) Task Oriented Contractor — performs a specific work task e) Sub - contractor — assumes some of the obligations of a primary Contractor f) Temporary Labor Contractor — provides workers on a temporary, as needed basis with on -site supervision by an employee of the Contractor On- the -job safety is especially important for contract workers. You are called upon to perform highly specialized and potentially hazardous tasks. Working conditions and safety procedures may change each day. Good communication between the contract employer, the City project manager and the contract crew is essential so that proper hazard control measures are followed. The following rules and guidelines promote safety and are an effort to highlight major safety and environmental concerns. THEY ARE NOT INTENDED OR DESIGNED TO BE COMPREHENSIVE, TO SUPPLEMENT OR LIMIT APPLICABLE LEGAL REQUIREMENTS OR TO RELIEVE THE CONTRACTOR OF ANY SAFETY, HEALTH AND ENVIRONMENTAL RESPONSIBILITIES. The Contractor should always refer to the specific requirements of applicable laws, regulations, codes and /or specific standards to assure safety and compliance. GENERAL. The following information is provided to the Contractor by the City of Oshkosh, understanding that these guidelines are not intended in any way to be all - inclusive or to relieve the Contractor of any part of the responsibility for the safe performance of the work outlined in the Introduction of this document. The objective of this policy is to prevent the failures that cause injuries, illnesses, fatalities, property damage, or environmental pollution. 1 No portion of this document is to be construed as establishing a master - servant relationship between the Contractor and the City of Oshkosh. In all cases, the Contractor shall be deemed to be an independent contractor and the sole employer. As a minimum, Contractor safety rules, work practices, and procedures must be compatible with existing City of Oshkosh policies and procedures. PROJECT SAFETY COORDINATOR RESPONSIBILITY City of Oshkosh The City of Oshkosh project coordinator shall be your primary contact. The Safety & Risk Management Coordinator for the City of Oshkosh is Paul Greeninger. He has the overall responsibility for safety and health issues. If you have a concern regarding our safety policies, you may contact him at (920) 236 -5117 or (920) 233 -7852. Contractor Each Contractor shall designate a responsible member of its management team as the Safety Coordinator for the project. The designee's duty shall be prevention of accidents and other job losses. This person shall have control of and be familiar with day -to -day activities of the Contractor. This person will be responsible for initiating, maintaining, and supervising all safety and loss prevention programs and procedures. FIRE PREVENTION AND PROTECTION' The Contractor shall take all necessary precautions to prevent fire and injuries or property damage relative to welding, cutting or other spark or flame producing processes and procedures. It is the responsibility of the Contractor to follow City of Oshkosh Hot Work permitting policies and procedures. Contractors shall also establish procedures for storage, handling and use of flammable or combustible materials, which comply with City of Oshkosh policies and procedures, as well as all applicable laws, regulations and fire codes. The Contractor shall ensure that employees and all Third Parties under their direction are familiar with fire protection and alarm systems in their work area. The Contractor shall also be responsible for supplying and maintaining a sufficient number of appropriate types of fire extinguishers to support the work. HOT WORK At any time during the work, where spark or flame producing operations are conducted (such as welding, cutting, grinding or open flame), the Contractor shall establish a fire watch during and after (for at least 60 minutes) such operations to ensure that fires do not ignite. The Contractor shall insure that fire watch personnel are trained in fire fighting and are aware of procedures for sounding alarms and making notifications in the event of fire. "Hot Work Permits" are required when working within buildings or within 35 ft. of combustible materials, including flammable liquids, vapors or dusts. 2 SMOKING Smoking is prohibited in all City of Oshkosh buildings. The Contractor based on the hazards present shall control smoking at outdoor job sites. CHEMICAL SAFETY Chemicals are important tools in a wide variety of work activities, but many chemicals can cause serious health and environmental issues. The Contractor shall obtain all information necessary to be fully aware of all potential exposures to hazardous materials in the performance of the work. The Contractor shall provide, to their employees, all information and training on the nature and scope of potential hazards as required by all laws, regulations, ordinances and codes, regardless of the source of such hazards. The Contractor is also responsible for communicating to the City of Oshkosh any hazards created by the work being performed. The City of Oshkosh also has the right to restrict the type and amount of chemicals being brought on to the job site. Products containing Methylene Chloride (CAS #75 -09 -2) and paints containing Isocyanates such as (CAS #91 -08 -7 or #584 -84 -9) are two examples of restricted chemicals. Certain other chemical and physical agents (asbestos, PCB's, lead -based paints, radiation sources, etc.) are specifically regulated by Federal, State and /or local agencies. When the work involves a potential exposure to any such hazards, the Contractor shall maintain compliance with all applicable regulations. MATERIAL SAFETY DATA SHEETS Material Safety Data Sheets (MSDS) must be provided to your City of Oshkosh contact for ALL chemicals prior to being brought on site. This requirement includes all liquids, pastes, powders and gas products. CHEMICAL MANAGEMENT Chemicals brought onto City of Oshkosh property must be removed when work has been completed. Any changes must have approval of the project manager and the Safety Coordinator. All waste materials must be managed as identified in the Environmental Compliance and Waste Disposal sections of this booklet. LABELING All containers shall be labeled in accordance with the OSHA Hazard Communication Standard. Waste containers shall be labeled according to all applicable federal, state and/or local laws, regulations, ordinances, codes and/or standards. 3 ENVIRONMENTAL COMPLIANCE The City of Oshkosh is committed to the responsibility to protect, preserve and enhance the environment wherever it conducts business. The Contractor shall be fully and solely responsible for compliance with all environmental laws and regulations applicable to the transportation, packing, labeling, handling, use, storage, or disposal of materials, including liquid and solid wastes and hazardous substances, brought onto City of Oshkosh property or used in the performance of work, or generated as a result of the work. WASTE DISPOSAL Waste and the disposal of many chemicals and products may result in damage to the environment. Environmental laws and regulations closely monitor waste handling and disposal. The City of Oshkosh, therefore, closely manages what happens to waste products, recycled chemicals and abandoned materials. Many chemicals and products are not to be disposed of into sanitary waste containers or into drains. Nothing may be discarded onto facility grounds, parking Tots, or waterways. Some of the waste products that are controlled may include, but not limited to: used or waste oil and grease; paints, paint thinners, solvents and cleaning fluids; strong acids or caustics; sorbents, rags and materials used to cleanup wastes; electronic components, fluorescent light bulbs and ballast's; pesticides, herbicides and related chemicals. Because of the complexity and extensive lists of waste streams, prior approval must be obtained for disposal, and the method of disposal. HAZARDOUS WASTE The Contractor must receive approval from the City of Oshkosh to transport or dispose of hazardous waste from the work site. The Contractor shall provide the City of Oshkosh with copies of all records relating to waste management activities associated with the work including copies of hazardous waste manifests, waste disposal locations and waste transportation and disposal agreements. CHEMICAL SPILLS If spills or unauthorized releases of any product occur, the Contractor shall notify the City of Oshkosh Project Manager or Safety & Risk Management Coordinator immediately of the nature of the incident. If the contact or Safety & Risk Management Coordinator is not available, contact the Oshkosh Fire Department at 236 -5700. The Contractor shall provide all required information necessary for reporting of the incident and to notify the appropriate agency(s) in a timely manner. A copy of the written notification to the agency(s) shall be provided to the City of Oshkosh Safety & Risk Management Coordinator. 4 PERSONAL PROTECTIVE EQUIPMENT All employees of the Contractor, and other persons entering City of Oshkosh property in connection with the work, shall wear appropriate personal protective equipment (PPE) such as, but not limited to, safety glasses, steel toe shoes, hard hats, and proper work clothing. Special personal protective devices and/or equipment must be used where needed based on the hazards of the work. This equipment shall include, but not limited to: • Hearing protection devices • Respiratory protection devices • Fall protection devices • Hand protection • Lifelines and body harnesses • Any other special equipment/devices necessary to provide appropriate protection ELEVATED /OVERHEAD WORK Whenever work is to be done above walking or working areas at a height greater than four feet, which may present a hazard to personnel or property below, all necessary safety precautions shall be taken by the Contractor. This action shall include, without limitations, roping off the area and posting warning signs to caution personnel below from falling materials. If necessary, a flagman shall be stationed below to warn persons in the area. All such barriers and signs shall be removed as soon as the work is completed. All personnel under Contractor supervision or control working at elevations greater than four feet shall be protected by guardrails, ANSI approved body harnesses and lanyards or lifelines, or other effective means that comply with applicable federal, state, and local regulations. The use of safety belts is prohibited as a fall protection device. The use of ladders, scaffolding or work platforms must comply with all federal, state, and local regulations. EXCAVATION /TRENCHING Contractors performing excavation /trenching must meet the qualifications set forth during the bid process. The Contractor shall comply with all OSHA /D -COMM regulations. The Contractor shall have a competent person or persons on the site to inspect the work and to supervise the conformance of Contractor's operations with the regulations. The Contractor shall take all necessary precautions for the safety of employees on the job site. 5 SUMMARY Contractor safety takes teamwork. The City of Oshkosh is committed to providing a safe and healthful workplace while protecting and preserving the environment. We will work with you to help ensure that no injuries occur and that the environment is not harmed. Contractors are responsible for their employee's safety through training, ensuring that the information regarding hazards and safe work practices is communicated to them and making sure that they follow all safety and environmental rules. 6 City of Oshkosh Project Manager Contractor Notes and Checklist Contractors are not only responsible for their tools and equipment and the safety of their employees, but also to our property and the safety and health of our employees. In addition, damage to the environment or failure to properly manage waste disposal may cause long term and costly issues to the City of Oshkosh. These issues pertain in different degrees to all vendors and contractors, anyone who performs a service for the City. A "Contractor" may be defined as: A) Construction Contractor - project oriented work such as new construction or remodeling, B) Service Contractor - a contractor that installs, services or performs maintenance of equipment, tools, systems, or processes C) Vendor - a provider of definable services for a facility D) Task - Oriented Contractor - performs a specific work task E) Sub - contractor - assumes some of the obligations of a primary contractor F) Temporary Labor Contractor - provides workers on a temporary, as needed, basis with onsite supervision by an employee of the Contractor G) The City expects its contractors to meet its safety and health performance requirements and to comply with all applicable laws, regulations, ordinances and codes. When selecting contractors, safety performance must be included in the selection process. Unsafe acts of contract employees can put our workers' safety in jeopardy. In addition, there are always potential legal and liability issues, including citations from EPA, DNR, or D -Comm. Contractor Qualification The Contractor Qualification process (and the qualification questionnaire), may not be required for contractors servicing their own equipment or contractors who have been designated by the manufacturer as the manufacturer's representative or distributor, when the contractor employee is performing a low risk activity. This exception does not apply to Construction Contractors or Service Contractors performing high risk work activities including hot work, use of hazardous chemicals, working with hazardous voltages, control of hazardous energy (lockout /tagout), operation of powered equipment, work at hazardous elevations, excavation work, or confined space entry. Contractors exempted from the qualification process are still required to meet all other requirements of the Contractor Safety Program, including the attached Acknowledgement Form. 7 Information Exchange Checklist for City Project Coordinators The following is a checklist to assist you, the City Project Coordinator, with contractor communication. Yes No N/A Do you have a list of the chemicals that may be found at the City project site and their potential hazards? Have you reviewed these chemicals and their hazards with the Contractor? Have you notified the Contractor of the MSDS file location? _ Have you reviewed our policy of bringing chemicals on -site, including the approval process? See Chemical Safety section of guidebook. Does the Contractor understand this policy? Do they know that chemicals may not be left on premises without approval? Do you have a list of fire and /or physical hazards for the Contractor? Have you discussed these potential hazards with the Contractor? _ Have the City emergency procedures been provided to the Contractor? _ If Hot Work is to be performed, have you provided Hot Work Permit forms and reviewed the policy? Will the Contractor enter Confined Spaces? Have the areas been identified and procedures reviewed? Have you instructed the Contractor about our policy on chemical spills? The City of Oshkosh is committed to protecting the environment. Chemicals may not be disposed of into sanitary waste containers, into drains or onto grounds. Review the materials that the Contractor may be using and how they are to be handled and the waste disposed. Is the Contractor's Safety Acknowledgement Form on file? Workers Compensation Certificate? Liability Insurance? Have you received and reviewed the Qualification Questionnaire? Are there any safety concerns? _ Have you scheduled weekly safety meetings if the project requires more than one week to complete? Was the Contractor given the opportunity to ask questions regarding the safety and environmental requirements for the project? City Project Manager Date 8 .................... . City of Oshkosh Contractor Safety Program Acknowledgement Form The City of Oshkosh (City) is required by law to carry Workers Compensation Insurance (WCI) on our permanent employees. As an independent contractor /vendor, your firm is required by law to carry WCI on your employees. As an independent contractor /vendor, you are not under the direct supervision of the City and are not covered by the WCI or Liability Insurance maintained by the City for their employees. Please attach a copy of your current Workers Compensation Certificate and a copy of your certificate of liability insurance. It is required that you notify the City immediately if any of the required insurance or bonding should be cancelled or notify the City within 30 days of a change in bond status or insurance carriers. Please complete and return to Paul Greeninger, City of Oshkosh, Safety & Risk Management Coordinator. Date: ContractorNendor Name: Address: City, State, Zip: Telephone Number: E -mail Address: ContractorNendor Representative: Title: Individual Responsible for: Safety Coordination: Phone: Environmental Issues: Phone: I understand that it is my obligation to notify my employees of their responsibilities for health and safety. I further understand that if any unsafe work activities are found, the City has the right to immediately contact the Contractor's Safety Coordinator. If this unsafe practice is not corrected, the work may be stopped until corrective action has been taken and agreed upon. Signed: Date: ❑ Certificate of Insurance Attached o Workers Compensation Insurance Certificate attached 9 City of Oshkosh Contractor Safety Program Qualification Questionnaire Date: ContractorNendor Name: Person completing form: Title: In keeping with the City of Oshkosh commitment to provide a safe and healthful workplace while protecting and preserving the environment, we require the following safety questionnaire be completed and returned to Paul Greeninger, City of Oshkosh Safety & Risk Management Coordinator, 215 Church Ave., Oshkosh, WI 54903. Completion of this questionnaire does not in any way relieve the contractor of their obligations to comply with all applicable legal requirements (federal, state, and local). This questionnaire has been designed to help the City to better understand your safety program and in no way does it represent a complete list of the Contractor's applicable safety obligations. Your response to some of the following questions may require that you provide documents, however, PLESE DO NOT SEND CONFIDENTIAL, PROPRIETARY OR TRADE SECRET INFORMATION. 1. Provide a brief description of the primary service your company provides the City. 2. Do you require the following safety training programs? A. Right to Know /Hazard Communication Yes No B. Fire Prevention and Protection Yes No C. Hot Work Permits Yes No D. Environmental Compliance Yes No E. Excavation/Trenching Yes No F. Working at Elevations > 4 feet Yes No G. Confined Space Entry Yes No 10 H. Control of Hazardous Energy (lockout) Yes No I. Operation of Powered Equipment/vehicles Yes No J. Working with hazardous voltages Yes No K. Personal Protective Equipment Yes No L. Process Safety Yes No 3. If you answered NO to any of the above, please comment: 4. Are the training records available upon request? Yes No 5. Please provide your Total OSHA Incident Rate and Lost Workday Rate for each of the last three years by completing the table below. A. Year B. Number of employee hours worked C. Number of lost workday cases D. Number of cases due to injury or Illness defined as recordable E. Total number of recordable cases (Add C and D above) F. Calculate your incident rate by using the following formula: Total cases on line E x 200,000 hours Employee hours on line B 6. Management Certification Signature: Date: Print Name and Title: 11 1/14/11 CITY OF OSHKOSH INSURANCE REQUIREMENTS 1V. PROFESSIONAL SERVICES LIABILITY INSURANCE REQUIR The Contractor shall not commence work on subcontract until proof of insurance required of the Subcontractor has been provided to the applicable City department before the contract or purchase order is considered for approval by the City. It is hereby agreed and understood that the Insurance required by the City of Oshkosh is rims coveracie'and that any insurance or self insurance maintained by the City of Oshkosh, its officers, council members, agents, employees or authorized volunteers will not contribute to a loss. All insurance shall be in full force prior to commencing work and remain in force until the entire job is completed and the length of time that is specified, if any, In the contract or listed below whichever is longer. 1. PROFESSIONAL LIABILITY A. Limits (1) $1,000,000 each claim (2) $1,000,000 annual aggregate B. Must continue coverage for 2 years after final acceptance for service /job 2. GENERAL LIABILITY COVERAGE A. Commercial General Liability (1) $1,000,000 each occurrence limit (2) $1,000,000 personal liability and advertising Injury (3) $2,000,000 general aggregate (4) $2,000,000 products — completed operations aggregate B. Claims made form of coverage is not acceptable. C. Insurance must include: (1) Premises and Operations Liability (2) Contractual Liability (3) Personal lnjury (4) Explosion, collapse and underground coverage (5) Products /Completed Operations must be carried for 2 years after acceptance of completed work (6) The general aggregate must apply separately to this prolect /location 3. BUSINESS AUTOMOBILE COVERAGE A. $1,000,000 combined single limit for Bodily Injury and Property Damage each accident B. Must cover liability for Symbol #1 - "Any Auto" -- including Owned, Non -Owned and Hired Automobile Liability, IV- 1 1/14/11 4. WORKERS COMPENSATION AND EMPLOYERS LIABILIT — "If" required by Wisconsin State Statute or any Workers Compensation Statutes of a different state. A. Must carry coverage for Statutory Workers Compensation and an Employers Liability limit of: ( $100,000 Each Accident (2) $500,000 Disease Policy Limit (3) $100,000 Disease -- Each Employee 6. ADD TIONAL PROVISIONS A. . c e tability of Insurers - insurance is to be placed with insurers who have an A.M. Best rating of no less than A- and a Financial Size Category of no less than Class VI, • and who are authorized as an admitted insurance company in the state of Wisconsin. B. ddit'o ai Insur d Re utrements — The following must be named as additional Insureds on the General Liability and Business Automobile Liability coverage arising out of project work...City of Oshkosh, and its officers, council members, agents, employees and authorized volunteers. On the Commercial General Liability Policy, the additional insured coverage must Include Products — Completed Operations equivalent to ISO form CG 20 37 for a minimum of 2 years after acceptance of the work. This does not apply to Professional Liability, Workers Compensation and Employers Liability. C. Certificates of Insurance acceptable to the City of Oshkosh shall be submitted prior to commencement of the work to the applicable City department, These certificates shall contain a provision that coverage afforded under the policies will not be canceled or non renewed until at least 30 days' prior written notice has been given to the City Clerk — City of Oshkosh. IV -2 '`-'� ' CERTIFICATE OF LIABILITY INSURANCE DATE This CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIG UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOVy, THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER AND THE CERTIFICATE HOLDER. IMPORTANT;-11 IMPORTANA the certificate h oidor Is a n ADDITIONAL t SURED, the poltcy(les) must be endorsed. if SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain pollcios may require an endorsement, A statement on thls certificate does not confer rights to the certificate holder In lieu of such endorsement s PRODUCER insurance Agency contact CONTACT (nlormallon, Including street NAME: address and PO Rex U PHONE lnsuron is I applicable. ADDR contact r,(A/C. o); EMAIL IL w — INSURERIS) AFFORDING COVERAGE NAIL qq 1NSUREO INSURER A^ ABC Insurance Company NAIC # y tnserads contact Information, — — including name, address and INSURERS: XYZ Insurance Colnpany MAIO phone number. INSURER C: LMW InSurance Company NAIC if _ _ INSURER D: � t n s uf er( s) musthaveamin imum and a Financial Performance Rating of Vi or better, ----- INSURER E: - � • INSURER Ft ----- COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE AMY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BYVAID CLAIMS. INSR I ADDS. SUBR I I POLICY EFF POLICYEXP LTD. TYPE OP INSURANCE INSR WVO POLICY NUMBER i (MM/DDIYYY) 1MMIDDIYYy). LIMITS - GENERAL LIABILITY EACH OCCURRENCE E $ 1 000 000 ®C0r.1uERCIAC GENERALLIABILITY El El IGeneret 1po!cyef/echYo date. i P ETORENTED A � I�_J , CLA111S•h1ADEf ®;OCCUR PREMISES(Eaoaunance) — $ 50,000 MEDEXP CAT one person) $ 5,000 , ISO FORM CO 2037 OR EQUIVALENT ((---�� PERSONAL 6 ADV INJURY $ 1,000,000 0 GENERAL AGGREGATE $ 2,040,000 GEM. MORE AE Pr oucTS- COMPIOPAGG $ 2 ,000,000 Eli f�Cj QLOC AUTOMOBILE LAITY $ {{�� COMBINED TINGLE LIMI r�J ❑ ga seddent) $ Sp00,000 ;ANY AUTO _ ( Avto Uab!I• L (i jALLOWNED -' { lyPohcyNumbar I �M !cyel/ec2YeandaxJS'raltondato.� BODICY $ t— rAUTOS ❑ SCHEDULEo AUTOS SoDILYINJURY(P $ NON•O ❑' HIRED AUTOS El � ' AUTOS PROPERTY DAMAGE Li D (PeracddenQ $ ❑iUMORELLA OCCUR ❑ El $ ��}}, EACH OCCURRENCE $ l._f' Ma ❑ y LAIMS - ' "- `..`-' AGGREGATE $ D;DED ❑RETENTIONS {('^ - ..- C AND EM PL OYERS' LIABILIT L J Y ❑ $ 4VC 8TATU• - AN1 PF20PRIpTORIPARTNERIEXECUTNE TORYLI!AnS a OTH ER OFFICE/MEMBER EXCLUDED? YIN (Mandatory In NR) N Workers Compensakbn Po:oy + rPo.* effective andexplratan dale. E_G NCH ACCIDENT $ 100,000 U yes, describe under Number 1 1 DESCRIPTION of OPERATIONS befo v E.S. DISEASE• - EA EMPLOYEE $ 100,000 A PR0FESSIONAL LIABILITY I N 0 •1 $1i DISEASE - POLICY LIMIT $ 500,000 $1,000,000 EACH CLAIM 1 Protess'onartlaoirfy JPoxyefacllve and exaltation date.' $1,000,000 ANNUAL AGGREGATE DESCRIPTION OF OPERATIONS I LOCATIONS 1 VEHICLES (Attach ACORD 101, AddlUonaI Remarks 8C educe, K Mors space s raqulrad) Additional Insureds on the Commercial General Liability and Automobile Liability arising out of project work shall be Cfty of Oshkosh, and It's officers, council members, agents, employees and authorized volunteers. Certificates of Insurance acceptable to the City of Oshkosh shall be submitted prior to commencement of the work to the applicable City department. These certificates shall contain a provision that coverage afforded under the policies will not be canceled or non renewed until at toast 30 days' prior written notice has been given to the City Clerk - CIty of Oshkosh, CERTIFICATE HOLDER CANCELLATION City of Oshkosh, Attn: CIty Clerk Insurance Standard IV SHOULD ANY OP THE ABOVE DESCRIBED POLICIES 13E CANCELLED BEFORE 215 Church Avenue SAMPLE CERTIFICATE THE EXPIRATION DATE, THEREOF, NOTICE WILL BE DELIVERED IN PO Box 1130 Please indicate somewhere on this ACCORDANCE WITH THE POLICY PROVISIONS. Oshkosh, WI 84903.1134 certificate, the contract or project!! AUTHORIZED REPRESENTATIVE this certificate is for. ©1988.2010 ACORD CORPORATION. All rights reserved. Acord 25 (20•0!05) The ACORD name and logo are registered marks of ACORD . 4.....---- ‘.►C1[ 1 II"Rom 1 C %Jr LI1Aa1L1 1 i 11VJUMIA1VL+C I 03/31/11 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 920 - 235 -2764 CONTACT Pam Krueger, CIC Servant Insurance 920- 235 -2694 PHONE FAX 430 N Koeller Street (A/C, No. Ext): 235 -2764 (A/C, No): 920- 235 -2694 E -MAIL Oshkosh, WI 54902 ADDRESS: pkrueger @servantinsurance.com PRODUCER Mary Murken CUSTOMER ID #: RVTQU'1 INSURER(S) AFFORDING COVERAGE NAIC # INSURED RVT Quality Systems Inc. INSURER A: Cincinnati Insurance Company Quality Mgmt Services Inc. INSURER B : TRI STATE INSURANCE CO OF MN AKA -River Valley Testing Corp Alex Barker INSURER C 1060 Breezewood Ln Ste 102 INSURER D : Neenah, WI 54956 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. a. INSR ADDL SUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSR WVD POLICY NUMBER (MM /DD/YYYY) (MMIDD/YYYY) LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,00( A X COMMERCIAL GENERAL LIABILITY X EPP0065218 02/16/11 02/16/12 DAMAGE TO RENTED PREMISES (Ea occurrence) $ 100,00( CLAIMS -MADE X OCCUR MED EXP (Any one person) $ 10,00( PERSONAL & ADV INJURY $ 1,000,00( GENERAL AGGREGATE $ 2,000,00C GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP /OP AGG $ 2,000,00( 7 POLICY X PRO - .IFCT LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,00( A X ANY AUTO EBA0065218 02/16/11 02/16/12 (Ea accident) ALL OWNED AUTOS BODILY INJURY (Per person) $ SCHEDULED AUTOS BODILY INJURY (Per accident) $ PROPERTY DAMAGE $ X HIRED AUTOS (Per accident) X NON -OWNED AUTOS $ $ X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 5,000,00( EXCESS LIAB CLAIMS -MADE AGGREGATE $ 5,000,00( A` EPP0065218 02/16/11 02/16/12 DEDUCTIBLE $ X RETENTION $ 10,000 $ WORKERS COMPENSATION WC STATU- OTH- AND EMPLOYERS' LIABILITY X TORY LIMITS ER B ANY PROPRIETOR/PARTNER /EXECUTIVE Y N N / A WC- 48 -02- 013146 -00 02/16/11 02/16/12 E.L. EACH ACCIDENT $ 1,000,00( OFFICER /MEMBER EXCLUDED? (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE, $ 1,000,00( If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 1,000,00( DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space Is required) City of Oshkosh, and its officers, council members, agents, employees and authorized volunteers are provided additional status, including products & completed operations on the general liability. Policy has be endorsed to provide 30 day notice for cancellation; except 10 days for non - payment. CERTIFICATE HOLDER CANCELLATION CIOS113 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE CITY OF OSHKOSH THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. PO BOX 1130 OSHKOSH, WI 54903 -1130 AUTHORIZED REPRESENTATIVE Mary Murken i © 1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25 (2009/09) The ACORD name and logo are registered marks of ACORD