Loading...
HomeMy WebLinkAboutMETCO/Lang Oil AGREEMENT WHEREAS, the City of Oshkosh has granted to the undersigned a privilege to place an obstruction within the sidewalk right -of -way as follows: Installation of a monitoring well within the right -of -way of North Main Street, at the northeast corner of North Main Street and Vilas Avenue and on Sterling Avenue, east of North Main Street, per attached Exhibit A. WHEREAS, State law provides that by its acceptance of this privilege the undersigned shall become primarily responsible for damages to person or property by reason of the granting of the privilege; NOW, THEREFORE, in consideration of the City of Oshkosh, a Municipal Corporation granting permission to the undersigned to place an obstruction within the sidewalk right -of -way, the undersigned agrees that he is solely responsible for his activities under this agreement. The undersigned hereby releases the City of Oshkosh from all debt, claims, demands, damages, actions and causes of action whatsoever which may result from the placement of an obstruction in the sidewalk right -of -way by the undersigned. Further, the undersigned 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 the activities under this privilege by the undersigned or agents or employees. Further, the undersigned agrees to indemnify and refund to the City all such sums which the City may be obligated or adjudged to pay, including the City's attorney fees and costs, on such actions, claims or demands within 30 days after written request for such indemnification. The undersigned agrees that this paragraph is to be liberally construed in favor of the City of Oshkosh, in consideration of the privilege granted by the City under this agreement. This agreement and the privilege cannot be assigned without the written consent of the City of Oshkosh. The privilege is subject to all terms and conditions contained in any authorizing resolution adopted by the City of Oshkosh Common Council, which is incorporated by reference as if fully recited within this document. By executing this agreement and by using the privilege, the undersigned agrees to fully abide by such terms and conditions, including revocation upon written notice for noncompliance with the authorizing resolution and this agreement. Dated this 31 s A day of 5 , 2011. METCO ENVIRONMENTAL CONSULTING lecv And: Name & Title: ctovv% it &Jel( /fictir-c"i(j Name & Title: Lt 1 l i/' r " ro STATE OF WISCONSIN ) SS. WINNEBAGO COUNTY ) Per onally came before me this ' S i' , , , 2011, the above -named , (Name & Title) and ► (Name & Title) to me known to be the person(s) who executed t e foregoing document and acknowledged the same. DIANA J SYNIITCZEK �= ��i NOTARY PUBLIC STATE OF VVISCONSIN Notary Public, -- Co., Wisconsin ...._ My Commission: --- Attachment: Exhibit A - Resol. #11 -03 and attachments of Oshkosh Common Council Meeting 01/11/11. J AGREEMENT WHEREAS, the City of Oshkosh has granted to the undersigned a privilege to place an obstruction within the sidewalk right -of -way as follows: Installation of a monitoring well within the right -of -way of North Main Street, at the northeast corner of North Main Street and Vilas Avenue and on Sterling Avenue, east of North Main Street, per attached Exhibit A. WHEREAS, State law provides that by its acceptance of this privilege the undersigned shall become primarily responsible for damages to person or property by reason of the granting of the privilege; NOW, THEREFORE, in consideration of the City of Oshkosh, a Municipal Corporation granting permission to the undersigned to place an obstruction within the sidewalk right -of -way, the undersigned agrees that he is solely responsible for his activities under this agreement. The undersigned hereby releases the City of Oshkosh from all debt, claims, demands, damages, actions and causes of action whatsoever which may result from the placement of an obstruction in the sidewalk right -of -way by the undersigned. Further, the undersigned 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 the activities under this privilege by the undersigned or agents or employees. Further, the undersigned agrees to indemnify and refund to the City all such sums which the City may be obligated or adjudged to pay, including the City's attorney fees and costs, on such actions, claims or demands within 30 days after written request for such indemnification. The undersigned agrees that this paragraph is to be liberally construed in favor of the City of Oshkosh, in consideration of the privilege granted by the City under this agreement. This agreement and the privilege cannot be assigned without the written consent of the City of Oshkosh. The privilege is subject to all terms and conditions contained in any authorizing resolution adopted by the City of Oshkosh Common Council, which is incorporated by reference as if fully recited within this document. By executing this agreement and by using the privilege, the undersigned agrees to fully abide by such terms and conditions, including revocation upon written notice for noncompliance with the authorizing resolution and this agreement. Dated this S t day of F f 01 ,, 2011. LANG 00 .0 ic. B f dr. _ j( And: , Name & Title: / La ti P �1t eVrIame & Title: STATE OF WISCONSIN) 411 SS. WINNEBAGO COUNTY) rr �° n�ally came Before me this 1 day of K 6r1� Q , 2011, the above -named �Q � P n -the T. (Name & Title) and ) (Name & Title) to me known to hr� fhe person(s) who executed the fo egoing docu nt and acknowledged the same. SARA J P000LL Notary Public, JJ I K 17 aD Co., Wisconsin Y Notar Public My Commission: (4. --50 ROIO — L TOZQ — o`Z01� State of Wisconsin Attachment: Exhibit A - Resol. #11 -03 and attachments of Oshkosh Common Council Meeting 01/11/11. JANUARY 11, 2011 11 -03 RESOLUTION (CARRIED 7 -0 LOST LAID OVER WITHDRAWN ) PURPOSE: APPROVE GRANTING PRIVILEGE IN STREET TO METCO ENVIRONMENTAL & LANG OIL CO. TO INSTALL MONITORING WELLS IN NORTH MAIN STREET & STERLING AVENUE INITIATED BY: METCO ENVIRONMENTAL & LANG OIL COMPANY PLAN COMMISSION RECOMMENDATION: Approved w /conditions WHEREAS, METCO Environmental, petitioner, and Lang Oil Company, owner of property at 834 North Main Street, requests the Common Council grant a privilege in street to METCO Environmental, general contractor and other subcontractors as may be required to install monitoring wells within the right -of -way of North Main Street, at the northeast corner of North Main Street and Vilas Avenue and on Sterling Avenue, east of North Main Street; and WHEREAS, Section 66.0425, Wis. Stats., provides for the granting of a privilege in a right -of -way; and WHEREAS, the Plan Commission approved of this request with conditions. NOW, THEREFORE, BE IT RESOLVED by the Common Council of the City of Oshkosh that the proper City officials are hereby authorized and directed to grant METCO Environmental, general contractor and other subcontractors as may be required to install monitoring wells within the right -of -way of North Main Street, at the northeast corner of North Main Street and Vilas Avenue and on Sterling Avenue, east of North Main Street, per the attached, and upon completion of said installation, Lang Oil Company, owner, will assume liability for said monitoring wells within the rights -of -way, contingent upon the following: 1) The monitoring wells be installed in a manner that is approved by the Department of Public Works with no modifications or changes in construction procedure without prior approval by the Department of Public Works. 2) If no longer needed, the monitoring wells be properly abandoned and removed in accordance with City standards and under the direction of the Department of Public Works. JANUARY 11, 2011 11 -03 RESOLUTION CONT'D 3) Any problem which may arise as a result of the placement of the monitoring wells be the responsibility of the contractors and owner to correct in coordination with the Department of Public Works. 4) All appropriate permits be obtained prior to the start of placement of the monitoring wells. 5) The monitoring wells be modified or removed immediately upon the request of the City. 6) The monitoring wells be part of and documented with Digger's Hotline system. 7) The petitioner, contractors and owner of the monitoring wells secure and submit to the City Clerk a separate insurance policy which names the City as an additional insured with a minimum coverage of $200,000 per person and $500,000 in general aggregate. 8) It is the responsibility of the petitioner to file in a timely manner a new insurance certificate with the City Clerk upon expiration of an existing certificate. Failure to do so will result in the revocation of the privilege in street upon 10 days notice. 9) The petitioner /contractors and owner execute hold harmless agreements with the City. OJHKOJH ON THE WATER TO: Honorable Mayor and Members of the Common Council FROM: Darryn Buricl Director of Planning Services DATE: January 6, 2011 RE: Approve Granting Privilege in Street to METCO Environmental & Lang Oil Co. to Install Monitoring Wells in North Main Street and Sterling Avenue (Plan Commission Recommends Approval) BACKGROUND As part of an environmental investigation concerning petroleum release at the Lang Oil property (Blue Moose Convenience Store /CITGO Automobile Service Station) located at 834 North Main Street, the petitioner is proposing to install three monitoring wells within public right -of -way. Two proposed monitoring wells are to be located along East Sterling Avenue; one on the north side of the right -of- way in the street and one on the south side of the right -of -way within the sidewalk. The third is proposed to be located on the west side of North Main Street right -of -way near the Vilas Avenue intersection. ANALYSIS The wells will be an 8 -inch diameter bore approximately 12 feet deep. The Wisconsin Department of Natural Resources will require the wells to remain in place for approximately two years or Ionger for water sampling. Once the investigation is complete, the wells will be abandoned per WDNR requirements. The Department of Public Works has reviewed the proposed monitoring well locations and recommends approval of the privilege within the right -of -way with conditions typically required of this type of request. FISCAL IMPACT None anticipated. RECOMMENDATION The Plan Commission approved of this request at its January 4, 2011 meeting. Approved, City Manager ITEM: GRANT PRIVILEGE IN THE RIGHT -OF -WAY FOR PLACEMENT OF THREE MONITORING WELLS AT THE CORNER OF NORTH MAIN STREET & EAST STERLING AVENUE GENERAL INFORMATION Petitioner: METCO (Eric Dahl) Owner: City of Oshkosh Action Requested: The petitioner is requesting a privilege in the right -of -way for the installation of 3 monitoring wells: -2 on East Sterling Avenue east of North Main Street. -1 on North Main Street at the northeast corner of North Main Street and Vilas Avenue Applicable Ordinance Provisions: A privilege in the right -of -way allows placement of non -city related items in the street right -of- way area (i.e. street, terrace, sidewalk). Locating any non -city item or private utility in city right - of -way requires issuance of a privilege in street permit. Property Location and Type /Analysis: As part of an environmental investigation concerning petroleum release at the Lang Oil Property (Blue Moose Convenience Store /CITGO Automobile Service Station) located at 834 North Main Street, the petitioner is proposing to install three monitoring wells within public right -of -way. Two proposed monitoring wells are to be located along East Sterling Avenue; one on the north side of the right -of -way in the street and one on the south side of the right -of -way within the sidewalk. The third is proposed to be located on the west side of North Main Street right -of -way near the Vilas Avenue intersection. The wells will be an 8 -inch diameter bore approximately 12 feet deep. The Wisconsin Department of Natural Resources will require the wells to remain in place for approximately two years or longer for water sampling. Once investigation is complete, the wells will be abandoned per WDNR requirements. The Department of Public Works has reviewed the proposed monitoring well locations and recommends approval of the privilege within the right -of -way with conditions typically required of this type of request. RECOMMENDATION /CONDITIONS Staff recommends approval of the privilege in the right -of -way for the installation of the proposed monitoring wells as requested with the following conditions: 1) The monitoring wells are installed in a manner that is approved by the Department of Public Works with no modifications or changes in construction procedure without prior approval by the Department of Public Works. 2) If no longer needed, the monitoring wells are properly abandoned in accordance with City standards and under the direction of the Department of Public Works. 3) Any problem which may arise as a result of the placement of the monitoring wells be the responsibility of the petitioner, contractors and owner to correct in coordination with the Department of Public Works. 4) All appropriate permits are obtained prior to the start of placement of the monitoring wells. 5) The monitoring wells be modified or removed immediately upon the request of the City. 6) The petitioner and contractors secure and submit to the City Clerk a separate insurance policy which names the City as an additional insured with a minimum coverage of $200,000 per person and $500,000 in general aggregate. 7) It is the responsibility of the petitioner to file in a timely manner a new insurance certificate with the City Clerk upon expiration of an existing certificate. Failure to do so will result in the revocation of the privilege in street upon 10 days notice. 8) The petitioner and contractors execute hold harmless agreements with the City. 9) The facility is part of and documented with Digger's Hotline system. The Plan Commission approved of the privilege in the right -of -way as requested with conditions noted. The following is the Plan Commission's discussion on this item. Mr. Buck presented the item and reviewed the site and surrounding area and explained that the proposed monitoring wells are part of an environmental investigation concerning petroleum release at 834 North Main Street. He also reviewed the conditions recommended for this request which are standard for privilege in street installations. There was no discussion on this item. Motion by Borsuk to approve the consent agenda as requested with the following conditions to be applied to Item I.A.: I) The monitoring wells are installed in a manner that is approved by the Department of Public Works with no modifications or changes in construction procedure without prior approval by the Department of Public Works. 2) If no longer needed, the monitoring wells are properly abandoned in accordance with City standards and under the direction of the Department of Public Works. 3) Any problem which may arise as a result of the placement of the monitoring wells be the responsibility of the petitioner, contractors and owner to correct in coordination with the Department of Public Works. 4) All appropriate permits are obtained prior to the start of placement of the monitoring wells. 5) The monitoring wells be modified or removed immediately upon the request of the City. 6) The petitioner and contractors secure and submit to the City Clerk a separate insurance policy which names the City as an additional insured with a minimum coverage of $200,000 per person and $500,000 in general aggregate. 7) It is the responsibility of the petitioner to file in a timely manner a new insurance certificate with the City Clerk upon expiration of an existing certificate. Failure to do so will result in the revocation of the privilege in street upon 10 days notice. 8) The petitioner and contractors execute hold harmless agreements with the City. 9) The facility is part of and documented with Digger's Hotline system. Seconded by Vajgrt. Motion carried 8 -0. Item: N Main & E Sterling — MWell Priv in ROW 2 ■ . iplot . . City of Oshkosh - SUR.M1 r ro: F.)-4pt.. c-,f Ceir,m7.ani D CLit /1 ''.. G enera I Application 215 Churph CV. :}ik WA/E1 • QshLozh, WI 34901 PlIC' {920) 236-5C 59 ^ IITE OR ?...Ri.:vr Psnstc. ill..A.C.T, APPLICANT INFORMA_TION p NI ETC() - Eric Dahl n 11/23/10 -____ ..._ Potitionc Address! 1421 State Road 16 cit„, La Crosse st WI 7; 54601 — Teleplrnet (608 ) 781-8879 Fix: (603 ) 731-8893 other c.,, -.!: or E ericdianetcohq.com Status of Petitioner (Pi e-ase Check): DOwner Zitenresentative illienzutt DProspective Buyer ..--- ,....:-.. " ) _.,- Petitioner's Sigr.ature (required): t /.:: _. OWNER FATFORISIkTION owner(5): Lang Oil CO - Peter Lang _ D a m : 11/23110 _ - . c Sterling Avenue ci Oshkosh Stu Lu: WI Zip: 54901 Telephone li: ( 505 ) 232-7600 F;( ) Other Contact 4:or Email: - Ownership Status (Please Check): Dtdividttal 0 Trust riPurtitership 151Corporation Pnwerty Owner Cobterit: (requirt..d) ay signature hereon, 1/We acknr_nvictigs that city 0ff c' y ee in the performance of thefr functions. enter upon th:.: property to inspect or gather ether infounation necessary to process thi5 application. f. also uncierstanct that :111 meeting dates are tentative at. 'n :be postponed by the I'lanni. ervicest P " "; '.n t7; incomplete submissions or othcr ac.lin inistrath reasons. Pmperty Owner's Signature: . JP / _ Dale: l_fAL ja — TYPE OF REQUEST: A cos Control Variance Ilasernent i priv4 i st od. Mcnitoring vbell installation in s!met right oi way ki Other (identify) . SITE. INFORMATION Address/Luce of Proposed Project: 83 N'arth Vain Street Proposed _Project Type: tnc.)nitoring well ins4arlatanlenvironiremal inv6utigation Current I:se of Properly: cornme.r621 Zoning: Lnd "Uses Surrounding Your Site: Nurth: CaTurlerc South: Commercial ._ East: Camille wial _ w ts Residontial Application fees are duo 2t time of submin.01. Make check payable tu City cd Oshkosh_ Please refer to the fee schedule for 'Appropriate fee. FEE IS NON-REFUNDABLE For more in l'orniati:.=n please - visit file Ci Ly's vv.. at yvvr.v.ci.osilicosh.wi.iFiCc:mniunity. Del: eklinnent/Pizeini ne.linn Still Ntt Ree' a i 9ea 3 _ __ _ /WITCO i =r } Excellence through experience" 1421 State Road 16♦ La Crosse, WI 54601 • 1- 800 - 552 -2932 • Fax (608) 781 -8893 Email: rona @metcoha.com •www.metcohq.com November 30, 2010 Jeff Nat( City of Oshkosh Department of Community Development 215 Church Avenue, P.O. Box 1130 Oshkosh, WI 54901 Subject: Access permission for monitoring well installation within city right of way. Dear Mr. Nate METCO is conducting an environmental investigation concerning a petroleum release at the Lang Oil property located at 834 North Main Street. Per requirements by the Wisconsin Department of Natural Resources, three monitoring wells are to be installed within city right of way to define the extent of petroleum contamination in groundwater. One monitoring well is to be located along North Main Street to the west of the Lang Oil property and two monitoring wells are to be located along East Sterling Avenue to the north of the Lang Oil property. See attached map for proposed monitoring well locations. Therefore, we are requesting permission from the City of Oshkosh to conduct this work . The monitoring wells will be constructed by advancing an 8 -inch diameter soil boring to the required depth (12 feet) and installing a two inch diameter monitoring well with a slotted screen. Uniform washed sand is installed around the well screen to serve as a filter pack. Bentonite is used above the filter pack to provide an annular space seal. A locking watertight cap along with a steel flush- mounted cover will be installed with the monitoring wells for protection. Soil cuttings generated during the drilling process will be containerized in 55- gallon DOT drums and will be temporarily stored on the Lang Oil property until they can be properly disposed (approximately one month). The monitoring well installation project is expected to be completed in one day. After the monitoring well installation is completed, access to the wells will be necessary on occasion. Events where access to the wells will be required in the next year include development of the wells and quarterly groundwater sampling. These events only require approximately fifteen minutes of work at each monitoring well. It is our experience that the WDNR usually requires that monitoring wells remain in place (for sampling purposes) for a duration of approximately 2 years, and possibly longer, depending on actual site conditions/WDNR requirements. Once the groundwater monitoring is complete, the monitoring wells will be properly abandoned with bentonite clay. This project has not been scheduled, but is expected to be conducted in January 2011. Diggers Hotline Environmental Consulting, Fuel System Design, Installation and Service 4 and local water /sewer utilities will be notified. A City of Oshkosh General Application, application fee, and two Site Layout Maps showing the proposed monitoring well locations have been attached. Should you have any questions, or require additional information, do not hesitate to contact our La Crosse office at 608 - 781 -8879. Sincerely, Eric Dahl Hydrogeologist c: Peter Lang — Lang Oil Environmental Consulting, Fuel System Design, Installation and Service Page 2 5 I • W w< I f tiC7\ A cc\.\\ W \ Z� \ z CD r O • z 151134110WD ° 000'01: V T/ - —I 1' N N LL .1 W o 7Y a O 1 i ® _ \ \.�z • � p 00 v . N ■� wa m F !�?.... . U( ) :: W I— C ..,. ® ii: z O 3 rw » . o La W a z 0^ \ t_ 2 0 )inVM3CIS 1.33 LS NIVW HflION O N °-A z z g W Q > / Q U z o J Z J W Q �Q 0 . me r U' 5W 0 Z H p>. - 0 0 z o Q . a r p qX O P Z • 0 W w N � t<i ~" R • gal U5 ni O g IL< oo E. ID~ I W a. _, J 0 <Q JW "oils Oz c9 y f In gR ° . J E ° w I ii IQ 1 z m N a - W c�z I �� ° > z > o • F- < ' '� � zo o z ° � a J r 1 > i. 11 • 1 zo 1 O ® ®• ! 1 • 6 45. 43 5' 4�., 138.9' 132.0' O O N N O L :- ' - rn 1 4 I '8 1 - 22 132.0' 1 1 F' 110.0' S .... E . R LINQ ........i 9U.U' z , ,„,,_ ; c ',.5';'.10":, t 2 ; I ,r _00 88.0' ' OD I 90:0' 1 elo 0 c •O 840' t _____ IvitiE___ , O co oe 0 c 00. 10.a, 122.0' • 132.0' o b 0 132.0' M d am ' . - - ;e• , 90.0' i _. SUBJECT `'� SITES 110.0' ' • 1 1 a0 \/ / I VTT ' • l _ , t DISCLAIMER PRIVILEGE IN STREET This map is neither a legally recorded map nor MONITORING WELLS V 1�T a survey and It is not intended to be used as one. 1 This drawing is a compilation of records, data N MAIN ST & E STERLING AV OIHKOlH and Information located in various city, county ON THE wnrEn and state offices and other sources affecting the area shown and it is to be used for reference City of Oshkosh purposes only. The City of Oshkosh is not re- Department of sponsible for any inaccuracies herein contained. If discrepencies are found, please contact the 60 , Community Development City of Oshkosh. Scale: 1 = Created by - dff 12116/10 7 __II{Oi BS VE r ° o I', UmZ i 'ON VE. I I[ 'I HU'ON �. II II Z C9 EN AV O ! ' i i I I AVE_ w li s— --- Iii O c4- I I Z E. N E `� l • W 1 w . l to — r �� ID Mr m �^ m ER _'` � 1 I I U i J 11 _N to l AT c z AV � t w 1 0 � � 1 1gs: AV II O ° 0 W . ,�� lL o CL w z i ii , L zlitATOGA I A Ill no= SUBJEC .— co o II ■ IN; t7 AVE. AVE. ES AVE. 2 • . I LE! TE OSPECT 1-: ? ° ' ELVI ' . ' o 'SICK P • i m I SCC�i i AVE/ « 1 Mil I• ER • , 1 TRL. •, `fir — w �"' ,! ( L. 1► a L�{1 e Rar,_, 4 v — rs, _JuJ .. z .. . f 2 w . . In. .� � ' " VE ■ Z Lj Q I J I I..S TONPL. ■ a E. RVI 1♦ AMHERST AVE. UNION E. 1 ' • • - E. • ,:‘,_, . _ O� w. �� , it, F i `r! r� HUDSON 1 lip. A A GS . <9z,,.. • • m • t.. - iii o )kiP � - ? L % _ r7 Lid -1 mil' s - /, ST:�, 4. I w sr T. CT. ! � L� h _ � .� ie. : 1� WASHINGTON W S j: ' s c r 1 r r-----------, - AV DISCLAIMER PRIVILEGE IN STREET 4110 This map Is neither a legally recorded map nor MONITORING WELLS a survey and it is not intended to be used as one. N and in This is a located compilation Invarious c tydc records, N MAIN ST & E STERLING AV O.fHKO /H information lcat in city, QM THE WATER and state offices and other sources affecting the area shown and it is to be used for reference City Of Oshkosh purposes only. The City of Oshkosh is not re- Department of sponsible for any inaccuracies herein contained. +{ If discrepencies are found, please contact the Scale: I " - 1000' Community Development City of Oshkosh. Created by - dff 12/16/10 8 i y w` .P*t. _ - a0. i.. { 1 • s � ' - ate' ' v - �- � '� � .... -:.� . ._ .. s 1. ,u, +- . r � ' +.- . x �' " a *its �. a, w ash'` Y y q, . .� P 8-. � .sue '� r -- , _,I , � � ' a� �:�^. :-+ , � � .+r"�. x�e } 131, t - ^a? * k � s e v. �� x� r Aza t r 7 Y £ } i H x .. x ,Mr- W an. n ' .,' " y �' -' i _:b s'� ma y, at a ! r d _ C ; :. �'` ' -'te fi r` r w ' E . k �` g h s # g • ,ter i f � wain .... _ i " mo w. "�"" - � Ya .. t S ; . w :- '.- '-f- 7 . ".= -, f'. = t -' ' ;',7 - '... ' '..C-' '1.1 ,. ' ;: 4;4' . --' t- 4 ' y , -`te u . - ,� rimer - e £ as - ' $�1 ` E SUBJECT Y _ SITES 44 i t • le yam.,, , R m e t , ? S.', S 4ii This maplsn nor PRIVILEGE IN STREET a survey and it is not intended to b. , uaad 00 . N MAIN A MONITORING WELLS This drawing is a compilation of records, data ST & E STERLING AV N O.IHKOJH and information bated in various city , county and state offices and oth.r sources affecting OM THE WATER the area shown and it b to be used for reference C ity of Oshkosh purposes only. The City of Oshkosh is not re- sponaibls for any inaccuracies herein contained. Department of Itdiscrepencies are found, please contact the 6'+ Community Development City of Oshkosh. Scale. 1 = 60 � Created by - dff 12116/10 9 LANGOIL -01 FIPE ACQRC),,, CERTIFICATE OF LIABILITY INSURANCE DAT 2/1/ 01 Y) PRODUCER (515) 327 -8450 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Management Group ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Bearence Mana S HOLDER, THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 1045 76th St ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Suite 4000 West Des Moines, IA 50266 INSURERS AFFORDING COVERAGE NAJC # INSURED Lang Oil Inc. 1NsuRER k Continental Western Insurance 15 Sterling Avenue INSURER B: . Oshkosh, WI 54901- INSURER C: INSURER D: INSURER E: COVERAGES THE POLICIES OE INSURANCE LISTED BELOW tHAV> 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 13 SUBJECT TO ALL THE TERMS. EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADOi OLIY C EFFECTIVE I POLICY EXPIRATION LIMBS LTR IrS9 TYPE OF IN.AuRANCF,,,,_ FOuch NUMBER P DATE IMMIP 'Y I ouc ( MMIDD/YY1 . --- GENERAL LIABILTY EACH OCCURRENCE b 1,000.000 A X X COMMERCIAL GENERAL LIABIUTY CWP2675839 -24 3/1/2010 3/1/2011 PREM B ° N PREMISES � (Ea oecufence) rEa $ 100,000 CLAIMS MADE I X OCCUR MED EXP (Any one person) $ 5,000 PERSONAL & ADV INJURY s 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER'. PRODUCTS - COMP/OP AGG $ 2,000,000 POLICY PRO X Log Liquor Liability 2,000,000 AUTOMOBILE LIABILTY COMBINED SINGLE uMFT s 1,000,000 A X ANY AUTO BOP2674025 -23 3/1/2010 3/1/2011 (Ea acciocnt) X ALL OW NED AUTOS BODILY INJURY $ X SCHEDULED AUTOS (Per person) X HIRED AUTOS BODILY INJURY $ X NON-OWNED AVMs • (Pe(aocitlent) X $500 Comp Ded PROPERTY DAMAGE $ X $500 Collision Dad. (Per ,cadent) GARAGE UABILITY AUTO ONLY BAACCIOENT _$ ANY AUTO OTHER THAN , EA ACC $ AUTO ONLY: AGG $ EXCESS/ UMBRELLA LIABILITY EACH OCCURRENCE $ 3,000,000 A XC1 OCCUR 1 1 CLAIMS MADE CU2677480 3/1/2010 3/1/2011 AGGREGATE $ 3,000,000 S DEDUCTIBLE $ • ^ S RETENTION $ ' X WC TATU - OTH- WORKERS COMPENSATION AND I Tf1RY S I R M1TS ER A EMPLOYERS' LIABILITY 2674013 -20 3/1/2010 3/1/2011 E.L. EACH ACCIDENT $ 1,000,000 ANY PROFRIEYOR/PARTNERIEXECUTIVE 1,ODO,000 OFFICER/mEMBER EXCLUDED? £.L DISEASE - EA EMPLOYEE 5 If yes, describe under SPECIAL PROVISIONS CRIQW E.L DISEASE - POLICY LIMN 1,000,000 OTHER A Blanket Building & Contents CWP2675839 - 3/1/2010 3/1/2011 51.000 Deductible S6 ,275,133 DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES! EXCI.UBIONSADDED BY ENDORSEMENT 1 SPECIAL PROVISIONS The City of Oshkosh, and its officers, council members, agent, employees and authorized volunteers are named as additional insureds. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION City of Oshkosh DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN 215 Church Ave NOTICE TO THE CERTIFICATE NOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL P.O. Box 1130 Oshkosh, WI 54903 - IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER ITS AGENTS OR REPRESENTATIYES, ALITHoRIZEO REPRESENTATIVE +fir ACORD 25 (2001/08) © ACORD CORPORATION 1988 7 'd 8991' 110 9NV1 Wd9 :Q LIE '8 led • LANGOIL -01 FIPE IMPORTANT If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A statement • on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). 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). • DISCLAIMER The Certificate of Insurance on the reverse side of this form does riot constitute a contract between the issuing insurer(s), authorized representative or producer, and the certificate holder, nor doss it affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon. • • ACORD 25 (2001/08) 8 d 8991' 110 Nd1 Wd9Z:9 110 '8 'qe