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HomeMy WebLinkAboutDavies Services/Ferguson Waterworks-fire hydrant paiting (2012) CONTRACTOR AGREEMENT THIS AGREEMENT, made on the 28th day of March, 2012, by and between the CITY OF OSHKOSH, party of the first part, hereinafter referred to as CITY, and Davies Services/Ferguson Waterworks hereinafter referred to as the CONTRACTOR, WITNESSETH: That the City and the Contractor,for the consideration hereinafter named,enter into the following Agreement. The CITY'S Bid Specifications and Insurance requirements are attached hereto and incorporated into this Agreement. The Contractor's proposal is also attached hereto and reflects the agreement of the parties except where it conflicts with the CITY'S terms within this agreement, in which case the CITY'S Bid Specifications, Insurance requirements, and other terms of this agreement shall prevail. ARTICLE I. PROJECT MANAGER A. Assignment of Project Manager. The Contractor shall assign the following individual to manage the project described in this contract: (John Pealman, Davies Services/Ferguson Waterworks) 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: (Bill Genz, Water Distribution Division Manager) ARTICLE III. SCOPE OF WORK The Contractor shall provide services described in the CITY'S Bid Specifications dated March 20, 2012, attached hereto as Exhibit A, and the Contractor's "Project Bid Proposal Form"dated March15, 2012, attached hereto as Exhibit B. Both Exhibit A and B are incorporated into this Agreement. If anything in the Contractor's proposal conflicts with the CITY'S Bid Specifications or with this agreement,the CITY'S Bid Specifications and the provisions in this agreement shall govern. 1 The Contractor may provide additional products and/or services if such products/services are requested in writing by the Authorized Representative of the City. ARTICLE IV. CITY RESPONSIBLITIES The City shall furnish, at the Contractor's request, such information as is needed by the Contractor to aid in the progress of the project, providing it is reasonably obtainable from City records. To prevent any unreasonable delay in the Contractor'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 by September 30, 2014. ARTICLE VI. PAYMENT A. The Contract Sum. The City shall pay to the Contractor for the performance of the contract the sum of $17,000 per year for 2012, 2013 and 2014 ($51,000 total over contract term), adjusted by any changes hereafter mutually agreed upon in writing by the parties hereto. Fee schedules shall be firm for the duration of this Agreement. B. Method of Payment. The Contractor shall submit itemized monthly statements for services. The City shall pay the Contractor 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 Contractor a statement as to the reason(s) for withholding payment. C. Additional Costs. Costs for additional services to 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 VII. CONTRACTOR TO HOLD CITY HARMLESS The Contractor covenants and agrees to protect and hold the City of Oshkosh harmless against all actions, claims and demands of any kind or character whatsoever which may in any way be caused by or result from the intentional or negligent acts of 2 the Contractor, his agents or assigns, his employees or his subcontractors related however remotely to the performance of this Contract or be caused or result from any violation of any law or administrative regulation, and shall indemnify or refund to the City all sums including court costs, attorney fees and punitive damages which the City may be obliged or adjudged to pay on any such claims or demands within thirty (30) days of the date of the City's written demand for indemnification or refund. ARTICLE VIII. INSURANCE The Contractor shall provide insurance for this project that includes the City of Oshkosh as an additional insured. The specific coverage required for this project is identified in the CITY'S Bid Specifications dated March 20, 2012, attached hereto as Exhibit A and fully incorporated into this Agreement. The Contractor is responsible for meeting all insurance requirements. The CITY does not waive this requirement due to its inaction or delayed action in the event that the Contractor's actual insurance coverage varies from the Insurance required. ARTICLE IX. TERMINATION A. For Cause. If the Contractor 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 Contractor. In this event, the Contractor 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 Contractor no later than 10 calendar days before the termination date. If the City terminates under this paragraph, then the Contractor 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: CONTRACTOR /CONSULTANT 0, (Seal of Contractor (Specify Title) if a Corporation.) 3 By/j//>--7 (Specify Title) CITY OF OSHKOSH � `� % L, �� �'� ( By: i'•-- 744(Y/1-- Mark A. ohloff, City Manager (Witness), -, ) - 11, a' 444`,_ , And: ( �. ��, fitness) Pamela R. Ubrig, City Clerk APPROVED: I hereby certify that the recess- 0 ary provisions have been made to 1 pay the liability which will accrue 11/410 ,►► 1...01 under this contract. ity Attor - 1 �'C,? ___ , ,,,,,,,,City Corr E r er 4 MARCH 27, 2012 12-126 RESOLUTION (CARRIED 6-0 LOST LAID OVER WITHDRAWN ) PURPOSE: AWARD BID FOR FIRE HYDRANT BLASTING AND PAINTING SERVICES (3 YEAR AGREEMENT FOR $51,000.00) FOR WATER UTILITY TO DAVIES SERVICES/FERGUSON WATERWORKS INITIATED BY: PURCHASING WHEREAS, the City of Oshkosh has heretofore advertised for bids for fire hydrant painting services; and WHEREAS, upon the opening and tabulation of bids, it appears that the following is the most advantageous bid: DAVIES SERVICES/FERGUSON WATERWORKS 5350 N. Richmond Street Appleton, WI 54913 Total Bid: $51,000.00/3-year term NOW, THEREFORE, BE IT RESOLVED by the Common Council of the City of Oshkosh that the said bid is hereby accepted and the proper City officials are hereby authorized and directed to enter into an appropriate agreement for the purpose of same, all according to plans, specifications, and bid on file. Money for this purpose is hereby appropriated from: Acct. No. 541-1867-6401-08677 Water Utility— Contractual Services — Maintenance of Hydrants CITY HALL 215 Church Avenue P.O.Box 1130 Oshkosh,Wisconsin City of Oshkosh 410111, OJHKQIH TO: Honorable Mayor and Members of the Common Council FROM: Jon G.Urben,General Services Director DATE: March 20,2012 RE: Bid for Fire Hydrant Painting Services-Water Utility BACKGROUND Each year the Water Utility utilizes a contractor to sandblast,prime and paint an estimated 200 fire hydrants on a rotational cycle throughout the City of Oshkosh. The contractor that received the 2011 award did not meet the quality standards required of these services and as such was not renewed for the 2012 season. Working with Water Utility staff, Purchasing then prepared and solicited contractors to provide these services for a three-year term(2012,2013 and 2014). ANALYSIS The bids were advertised in the local paper and posted online on NovusVendor. Bids were received on March 20, 2012. The bid tab is attached. Purchasing and Water Utility staff reviewed the sole bid received and verified they met the bid specifications. As the sole bidder (Davies Services/Ferguson Waterworks) provided these services prior to 2011 and met all of our quality standards when doing so,Purchasing recommends them for award of this bid. FISCAL IMPACT The fiscal impact of these services for 2012, 2013 and 2014 is $17,000 per year for a total of $51,000 over this three year term. There is $20,000 allocated annually in the Water Utility operating budget for these services. These services will be funded from the Water Utility Operating Budget A/N#: 541-1867-6401-08677. RECOMMENDATION Purchasing recommends the Common Council award this bid to Davies Services/Ferguson Waterworks for$17,000 per year for a total of$51,000 over this three year term. , , (____ ,...,7 Respectfull Submitted, Approved: . 9.._--,1 /0041‘1' Jon G.Urben,General Services Director City Manager " CJ C Cis C co } CO to ' 0 ICI 0 E —N M 0 CO I- t0 o C � 33 0 z N ^ — N ice-- c N O F- 0 c` 0 O qz �y C4 -C>:,11 � O ti =Q N >- O O E} N = N N E d9 La _J cc F— o 0 N re C Co ? 00 {7 W N C 0 0 zaw OO O c3 ~ z } 0 fl¢.. a N E O 0 w N 0 N c CO 0 U) m c o 0 • Ca m N �>, O O p N 0 0 >- E Ta- t., co f ... w e 0 co d 0 065 ELI 2 � O .0alE w a4) CO o 'tk c z N = ZN '> En a. co a) cV) a O LL 10 < xvr6 rrA City of Oshkosh, Wisconsin Invitation for Bids For Fire Hydrant Blasting & Painting March 20, 2012 City of Oshkosh P.O. Box 1130 Oshkosh, Wisconsin 54903-1130 www.ci.oshkosh.wi.us PURCHASING DIVISION Of-KO../H NOTICE TO VENDORS ON THE WATER 1. NOTICE IS HEREBY GIVEN that sealed bids will be received in the City Clerk's office, Room 104, City Hall, Oshkosh,Wisconsin,for: HYDRANT BLASTING AND PAINTING FOR THE CITY OF OSHKOSH,11:00 AM, TUESDAY MARCH 20,2012 at which time all bids will be publicly opened and read. 2. It is the bidder's sole responsibility to insure that the bid is timely and physically received by the City Clerk's office prior to the deadline set forth in this notice. 3. All bids must be submitted in an envelope sealed by the bidder or designated representative. All bids should be addressed to the City Manager,c/o City Clerk's Office,City Hall,215 Church Avenue,P.O. Box 1130,Oshkosh, WI 54903-1130. On the outside of the envelope,the bidder should distinctly indicate the name and address of the bidder and in the lower left corner should clearly indicate the envelope contains a sealed bid for: "HYDRANT PAINTING" Any bids not complying with these instructions will not be considered submitted to the City,and shall be returned to the bidder unopened and unread. 4. Submission of bid documents by facsimile equipment or electronic mail (email)will not be accepted. 5. This notice establishes a time by which sealed bids must be physically received by the City Clerk's office. No bids will be accepted after that deadline. Under no circumstances will bids be accepted and read when submitted at the place of bid opening even if presented before that deadline. 6. The City is not responsible for bids submitted in any other way except those submitted in strict conformance with these instructions. 7. A written request for the withdrawal of a bid or any part thereof may be granted if the request is received by the City prior to the specified time of opening. 8. All formal bids submitted shall be binding for thirty-five(35)calendar days following the bid opening date,unless the bidder(s),upon request of the Director of General Services, agrees to an extension. 9. Although no certified check,cashier's check or bid bond must accompany the proposal,if the bid is accepted,the bidder must execute and file the proper contract within ten (10) days after award by the Common Council and receipt of the contract form for signature. 10. The City reserves the right to reject any and all bids and to waive any informalities in bidding. 11. For specifications and further information concerning this invitation to bid,contact Jon Urben,Director of General Services, Room 401, City Hall, or telephone (920)236-5100. Mark A Rohloff PUBLISH: MARCH 6,2012 City Manager CITY HALL - 215 CHURCH AVENUE - P.O. BOX 1130 - OSHKOSH, WI 54903-1130 CITY OF OSHKOSH STANDARD TERMS AND CONDITIONS (REQUEST FOR BIDS PROPOSALS) 1) SPECIFICATIONS: The specifications in this request are the minimum acceptable . When specific manufacturer and model numbers are used, they are to establish a design, type of construction, quality, functional capability and/or performance level desired. When alternates are bid/proposed, they must be identified by manufacturer, stock number, and such other information necessary to establish equivalency. The City of Oshkosh shall be the sole judge of equivalency. Bidders/proposers are cautioned to avoid bidding alternates to the specifications which may result in rejection of their bid/proposal . All prices shall exclude any Federal Excise Tax or State of Wisconsin Sales Taxes as the City of Oshkosh is exempt from such taxes and will furnish an exemption certificate, if requested by the successful bidder. 2) DEVIATIONS AND EXCEPTIONS: Deviations and exceptions from original text, terms, conditions, or specifications shall be described fully, on the bidder' s/proposer' s letterhead, signed, and attached to the request . In the absence of such statement, the bid/proposal shall be accepted as in strict compliance with all terms, conditions, and specifications and the bidders/proposers shall be held liable. Only proposals which are made out on the regular proposal form attached hereto will be considered. 3) QUANTITIES: The quantities shown on this request are based on estimated needs . The city reserves the right to increase or decrease quantities to meet actual needs . 4) DELIVERY: Deliveries shall be F.O.B. destination freight prepaid and included unless otherwise specified. 5) ACCEPTANCE-REJECTION: The City of Oshkosh reserves the right to accept or reject any or all bids/proposals, to waive any technicality in any bid/proposal submitted, and to accept any part of a bid/proposal as deemed to be in the best interests of the city. 6) ORDERING: Purchase orders or releases via purchasing cards shall be placed directly to the contractor by an authorized agency. No other purchase orders are authorized. 7) GUARANTEED DELIVERY: Failure of the contractor to adhere to delivery schedules as specified or to promptly replace rejected materials shall render the contractor liable for all costs in excess of the contract price when alternate procurement is necessary. Excess costs shall include the administrative costs. 8) ENTIRE AGREEMENT: These Standard Terms and Conditions shall apply to any contract or order awarded as a result of this request except where special requirements are stated elsewhere in the request; in such cases, the special requirements shall apply. Further, the written contract and/or order with referenced parts and attachments shall constitute the entire agreement and no other terms and conditions in any document, acceptance, or acknowledgment shall be effective or binding unless expressly agreed to in writing by the contracting authority. 9) APPLICABLE Law: This Contract shall be governed under the laws of the State of Wisconsin. The contractor shall at all times comply with and observe all federal and state laws, local laws, ordinances, and regulations which are in effect during the period of this contract and which in any manner affect the work or its conduct . The City of Oshkosh reserves the right to cancel any contract with a federally debarred contractor or a contractor which is presently identified on the list of parties excluded from federal procurement and non-procurement contracts . 10) SAFETY REQUIREMENTS: All materials, equipment, and supplies provided to the City of Oshkosh must comply fully with all safety requirements as set forth by the Wisconsin Administrative Code, the Rules of the Industrial Commission of Safety, and all applicable OSHA Standards . 11) MATERIAL SAFETY DATA SHEET: If any item(s) on an order (s) resulting from this award(s) is a hazardous chemical, as defined under 29CFR 1910 . 1200, provide one (1) copy of a Material Safety Data Sheet for each item with the shipped container (s) and one (1) copy with the invoice (s) . 11/10 SPECIFICATIONS FOR FIRE HYDRANT BLASTING & PAINTING Scope: Provide all labor, material, and equipment needed to sandblast, prime and paint approximately 200 hydrants in 2012, 2013, and 2014 . The City will provide a list and location of the hydrants . Hydrants must be painted from May 18t thru Sept 30th. Requirements: All hydrants must have the following included in base pricing: 1 . Prime with Devoe 224 High Build Epoxy Primer 4-8 mils. 2 . Topcoat with Devoe 379UVA Urethane 4 mil Epoxy, Hazard Yellow. 3 . Color code caps, color except caps will be a different color. Materials used will be the same as hydrants. 4 . All hydrants must be fully enclosed during blasting, priming and painting. 5 . All spent material must be cleaned before leaving hydrant sites. 6 . Sandblast to 100% clean white metal from ground level up to top of hydrant . 7 . Air dryer must be used for a minimum of 98% moisture removal in the air supply. 8 . A detailed list of hydrant locations must be provided when billing. 9 . Contractor must follow all guidelines for safety, including traffic marking during work. 10 . Contractor will be responsible for disposal of spent blasting material . 11 . It is the sole responsibility of the bidder to determine the existing conditions and the cost for the work required. 12 . Additional project costs will not be considered for the base project and are the responsibility of the bidder. All other change orders must be submitted in writing and signed by the proper City officials before acceptance. 13 . Inspection: Work not conforming to the requirements of these specifications shall be considered as defective and shall be rejected. All work that has been rejected shall be remedied to plans and specifications at the contractors own expense. 14 . The length of this contract will be from May 1, 2012 through September 30, 2014 , with approximately 200 (more or less) hydrants to be painted each year. Bidder is to 1 indicate on the proposal sheet his/her price for 2012, 2013 , and 2014 . In the event that one or both parties wish to terminate this agreement before the end of the contract period, a 60-day notice shall be given. Please see sample of contract . 15 . The contractor must have a minimum experience of three projects of similar size and complexity painting hydrants . A list of these projects is required upon bid submission. These projects should meet the following criteria: • Completed within the last two years . • Inclusion of customer name, address, telephone number, and contact person. • Brief description of project . 16 . All hydrants shall be warranted for a period of one year from date of billings. 17 . The contractor shall take all necessary precautions to protect passerby, public right-of-way, and neighboring property from damage and injury. The contractor must meet all City of Oshkosh insurance requirements and standard terms and conditions . Please see attachment 2 PROPOSAL FIRE HYDRANT PAINTING The undersigned, having familiarized ourselves with the local conditions affecting the cost of the work and specifications, hereby propose to and furnish all of the labor, materials, tools, necessary to perform and complete all of the work required with the Fire Hydrant Blasting/ Painting in accordance with the specifications, for the following amount : 2012 : 200 (more or less) $ $ Each Total 2013 : 200 (more or less) $ $ Each Total 2014 : 200 (more or less) $ $ Each Total Start Date :May 1st Completion Date :September 30th Please submit certificate of insurance with proposal Terms : Warranty: NAME OF COMPANY 2012 DATE NAME OF PERSON SUBMITTING BID ADDRESS ( ) TELEPHONE NUMBER CITY STATE ZIP 3 REFERENCES Jobs completed within the last two years Inclusion of customer name, address, telephone number, and contact person. Brief description of project . 1 . 2 . 2 . 4 OJHKOJH ON THE WATER Insurance Requirements for the City of Oshkosh Revised: December 21, 2011 Revised: March 31, 2011 Original: January 14, 2011 1/14/11 CITY OF OSHKOSH INSURANCE REQUIREMENTS III. CONTRACTOR'S INSURANCE REQUIREMENTS (excluding Bond and Property Insurance Requirements) The Contractor shall not commence work on contract until proof of insurance required 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 primary coverage and that any insurance or self insurance maintained by the City of Oshkosh, its officers, council members, agents, employees or authorized volunteers will not contribute to a loss. All insurance shall be 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. INSURANCE REQUIREMENTS FOR CONTRACTOR—LIABILITY A. Commercial General Liability coverage at least as broad as Insurance Services Office Commercial General Liability Form, including coverage for Products Liability, Completed Operations, Contractual Liability, and Explosion, Collapse, Underground coverage with the following minimum limits and coverage: 1. Each Occurrence limit $1,000,000 2. Personal and Advertising Injury limit $1,000,000 3. General aggregate limit(other than Products–Completed Operations) per project $2,000,000 4. Products–Completed Operations aggregate $2,000,000 5. Fire Damage limit—any one fire $50,000 6. Medical Expense limit—any one person $5,000 7. Watercraft Liability, (Protection & Indemnity coverage)"if' the project work includes the use of, or operation of any watercraft, then Watercraft Liability insurance must be in force with a limit of$1,000,000 per occurrence for Bodily Injury and Property Damage. 8. Products–Completed Operations coverage must be carried for two years after acceptance of completed work. B. Automobile Liability coverage at least as broad as Insurance Services Office Business Automobile Form, with minimum limits of $1,000,000 combined single limit per accident for Bodily Injury and Property Damage, provided on a Symbol#1–"Any Auto" basis. C. Workers' Compensation as required by the State of Wisconsin, and Employers Liability insurance with sufficient limits to meet underlying Umbrella Liability insurance requirements. If applicable for the work coverage must include Maritime(Jones Act)or Longshoremen's and Harbor Workers Act coverage. D. Umbrella Liability providing coverage at least as broad as the underlying Commercial General Liability, Watercraft Liability (if required), Automobile Liability and Employers Liability, with a minimum limit of $2,000,000 each occurrence and $2,000,000 aggregate, and a maximum self-insured retention of$10,000. III - 1 1/14/11 E. Aircraft Liability, "if"the project work includes the use of, or operation of any aircraft or helicopter, then Aircraft Liability insurance must be in force with a limit of$3,000,000 per occurrence for Bodily Injury and Property Damage including Passenger liability and including liability for any slung cargo. F. Builder's Risk / Installation Floater / Contractor's Equipment or Property - The contractor is responsible for loss and coverage for these exposures. City of Oshkosh will not assume responsibility for loss, including loss of use, for damage to property, materials, tools, equipment, and items of a similar nature which are being either used in the work being performed by the contractor or its subcontractors or are to be built, installed, or erected by the contractor or its subcontractors. G. Also, see requirements under Section 3. 2. INSURANCE REQUIREMENTS FOR SUBCONTRACTOR All subcontractors shall be required to obtain Commercial General Liability (if applicable Watercraft liability), Automobile Liability, Workers' Compensation and Employers Liability, (if applicable Aircraft liability) insurance. This insurance shall be as broad and with the same limits as those required per Contractor requirements, excluding Umbrella Liability, contained in Section 1 above. 3. APPLICABLE TO CONTRACTORS/SUBCONTRACTORS/SUB-SUB CONTRACTORS A. Acceptability 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. Additional Insured Requirements — The following must be named as additional insureds on all Liability Policies for liability 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 work. This does not apply to Workers Compensation Policies. 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. III -2 " _°-R°' CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DO/YYY) THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(Ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT insurance Agency contact NAME: Insurance information,including street Agent's address and PO Box if PHONE contact information. (FAX address and applicable. (A/C.No.Ertl:— (C.No): E-MAIL ADDRESS: • INSURER(S)AFFORDING COVERAGE NAIC X INSURER A: ABC Insurance Company NAIL# INSURED insured's contact information, INSURER B: XYZ Insurance Company n NAIC* including name,address and ------- — phone number. INSURER c: LMN Insurance Company NAIC# INSURER D: InsuM(+)must have a minimum A.N.But rating of A- - and a Financial Performance Rating of N or better. 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 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 BY PAID CLAIMS. INSR ADDL SUBR I POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSR WVD POLICY NUMBER ( (MM/DD/YYY) (MM/DD/YYY) LanTS GENERAL UABUTY EACH OCCURRENCE $1,000,000 ® ® ❑ General Liability Policy Number IPohcY effective and expiration date. DAMAGE EMI S(RENTED COMMERCIAL GENERAL LIABILITY PREMISES(Ea occurrence) $50,000 A ❑j CLAIMS-MADE Ni OCCUR MED EXP(Any one person) $5,000 ® ISO FORM CG 20 37 OR EQUIVALENT PERSONAL ti ADV INJURY $1,000,000 111 I GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS—COMP/OP AGG $2,000,000 El POLICY ®JRE4❑LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Aga accident) --_ $1,000,000_ ®ANY AUTO ® ❑ Auto Liability Policy Number I Policyelredive and expiration date.I BODILY INJURY(Per person) _ $ B ❑ALL OWNED ❑ SCHEDULED AUTOS _ AUTOS BODILY INJURY(Per accident) $ ❑HIRED AUTOS ❑ NON-OWNED PROPERTY DAMAGE AUTOS (Per accident) $ ❑ a _ $ ®UMBRELLA LU18 �j OCCUR ® ❑ EACH OCCURRENCE $2,000,000 A ❑EXCESS LIAB rit CLAIMS-MADE 1 Umbrella Liability Policy Number Policy elIitCtwe and expiration date. AGGREGATE $2,000,000 ❑DED Ei RETENTION$10,000 I ! $ C AND M RP!OYERS'LIABILITY i ❑ ❑ WC STATU- ❑ OTI-f- ANY PROPRIETOR/PARTNER/EXECUTIVE TORY LIMITS ER OFFICE/MEMBER EXCLUDED? Y/N Workers Compensation Policy (Policy effective and expiration date.)Number E.L EACH ACCIDENT $100,000 (Mandatory In NH) N - ._...- -- —...._ .... If yes,describe under E.L DISEASE—EA EMPLOYEE __$100,000 DESCRIPTION OF OPERATIONS below I I i E.L DISEASE—POLICY LIMIT . $500,000 I 111 1 I DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,It more apace Is required) Additional Insureds on all Liability Policies arising out of project work shall be City 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 least 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 III SHOULD ANY OF THE ABOVE DESCRIBED POUCIES BE CANCELLED BEFORE 215 Church Avenue SAMPLE CERTIFICATE ACCORDANCE WITH TH POLICY PROM IONS BE DELIVERED IN PO Box 1130 Please indicate somewhere on this Oshkosh,WI 54903-1130 certificate,the contract or project# AUTHORIZED REPRESENTATIVE this certificate Is for. ©1988-2010 ACORD CORPORATION. All rights reserved. Acord 25(2010/05) The ACORD name and logo are registered marks of ACORD DAVIES WATER A division of PSellAXSanownaden, FERGUSON' Middleton Water Utility Dave Sarbacker 608-827-1086 Paint 100 hydrants per year Oconomowoc Water Utility $� Steve Roush 262-569-3198 Paint 400 hydrants per year Kaukauna Utilities Kevin Obiala 920-462-0233 Paint 100 hydrants per year Jack Reichenberger Superintendent Oshkosh water utility 1-920-232-5330 Paint 200-400 hydrants per year More upon Request 5350 North Richmond Street • Appleton,Wisconsin 54913 • Phone:920-731-3252 • Fax:920-731-2305 PROPOSAL FIRE HYDRANT PAINTING The undersigned, having familiarized ourselves with the local conditions affecting the cost of the work and specifications, hereby propose to and furnish all of the labor, materials, tools, necessary to perform and complete all of the work required with the Fire Hydrant Blasting/ Painting in accordance with the specifications, for the following amount : 2012 : 200 (more or less) $ 85. 00 $ 17, 000. 00 Each Total 2013 : 200 (more or less) $ 85. 00 $ 17, 000. 00 Each Total 2014 : 200 (more or less) $ 85. 00 $ 17, 000. 00 Each Total Start Date:May 1st Completion Date:September 30th Please submit certificate of insurance with proposal Terms : Net 10 Warranty: 1 year • Davies Services/Ferguson Waterworks NAME OF COMPANY March 15th 2012 John Paalman DATE NAME OF PERSON SUBMITTING BID 5350 North Richmond St. ADDRESS ( 920 '.) 740-3131 Appleton, Wisconsin 54913 TELEPHONE NUMBER CITY STATE ZIP 3 A`°R°® CERTIFICATE OF LIABILITY INSURANCE Page 1 of 3 04/021/2012 DATE(MM THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement.A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Willis of Maryland, Inc. -NAMES — — PHONE c/o 26 Century Blvd. _(A/C N0. T):._-877-945-7378 i (Nemo): 888-467-2378_ P. 0. Box 305191 I E-MAIL Nashville, TN 37230-5191 ADLIRFSS certificateS@WiZ118_._com INSURER(S)AFFORDING COVERAGE I NAIC# -- ----- ---- INSURED INSURERA.National Union Fire Ins. Co of Pittsburg119445-002 Ferguson Enterprises, Inc. and Subsidiaries INSURERB:National Union Fire Ins. Co. of Pittsburg419445-000 (See Attached Named Insured Schedule) INSURERC:National Union Fire Ins. Co. of Pittsburg! 19445-001 12500 Jefferson Avenue Newport News, VA 23602 INSURER D:American Guarantee & Liability Ins. Co. . 26247-000 INSURER E:New Hampshire Insurance Company 23841-002 I IINSURERF: Chartis Casualty Company, USA 40258-001 COVERAGES CERTIFICATE NUMBER:17639931 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN. THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR - ---- .-.-- I TR TYPE OF INSURANCE pNsp SUER POLICY EFF POLDD/YYY INSRQ wisp POLICY NUMBER (tWMlppryyy� (MM/DD/VYYY) LIMITS A I GENERAL LIABILITY Y 2449570 8/1/2011 8/1/2012 EACH OCCURRENCE _ $ 2,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED E I I CLAIMS-MAD PREMISES(Ea occurence) i$ 1,000,000 LX J OCCUR MED EXP(Any one person) IS 10,000 - F PERSONAL BADV INJURY $ 2,000,000 -._. ---- --- - I I L GENERAL AGGREGATE .$ 5,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: ,000,000 AUTOMOBILE LIABILITYO I I LOC { PRODUCTS-COMP/OP AGG $ 2 POLICY $ -- -- --- B MA 3506433 8/1/2011 8/1/2012 j j CAIBcdeoj INGLELIMIT is 5,000,000 B X. j ANY AUTO AOS 3506434 8/1/2011 18/1/2012 BODILY INJURY(Per person) Ts r -I ALL OWNED f SCHEDULED 1 AUTOS r AUTOS VA 3506435 8/1/2011 8/1/2012 BODILYINJURY(Per accident) '$ NON-OWNED PROPERTY DAMAGE ----- -- - --- X I HIRED AUTOS X AUTOS `- (Per accident) I Self-Incur X Physical D X ed Iamaae i is.- -. D X UMBRELLALIAB X OCCUR U248379302202 8/1/2011 8/1/2012 ;EACH OCCURRENCE ,$ 5,000,000 EXCESS LIAR 1 I CLAIMS-MADE! I I'AGGREGATE_ _j$ 5 000,000 WORKERS COMPENSATION - i /1/2012 , I WCSIAIU- Io TH- i$ DED RETENTIONS E AOS 015883921 8/1/2011 8 X AND EMPLOYERS'LIABILITY _ TORY_LIMITS __. ER F ANY PROPRIETOR/PARTNER/EXECUTIVE:/NI N/A 11015883924 8/1/2011 8/1/2012 1 E.L.EACH ACCIDENT :Is 2,000,000 OFFICER/MEMBEREXCLUDED9 i - ----- ---..._.. IMandatorylnNH) fE es,describe under F E.L.DISEASE-EA EMPLOYEE 1$ 2,000,000 D SCRIPTION OF OPERATIONS below i E.L.DISEASE-POLICY LIMIT 5 2,000,000 I DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach Acord 101,Additonal Remarks Schedule,If more space Is required) See Attached for Additional Workers' Compensation Policies: CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Oshkosh ACCORDANCE WITH THE POLICY PROVISIONS. Attn: City Clerk AUTHORIZED REPRESENTATIVE 215 Church Avenue PO Box 1130 //)) Oshkosh, WI 54903-1130 Col 1:3684823 Tp1:1304831 Cert:17639931 ©1988-2010 ACORD CORPORATION.All rights reserved. ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: 031419 LOC#: '4`°%°® ADDITIONAL REMARKS SCHEDULE Page_2_of AGENCY NAMED INSURED Ferguson Enterprises, Inc. and Subsidiaries Willis of Maryland, Inc. (See Attached Named Insured Schedule) POLICY NUMBER 12500 Jefferson Avenue Newport News, VA 23602 See First Page CARRIER NAIC CODE See First Page EFFECTIVE DATE: See First Page ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: CERTIFICATE OF LIABILITY INSURANCE WC Policy No. 015883921- AK, AL, AZ, CO, DE, IA, ID, ME, MI, MN, MT, NH, NJ, NV, NY, RI, UT, VA, VT, WV WC Policy No. 015883924 - AR, CT, DC, GA, HI, IL, IN, KS, KY, LA, MD, MO, MS, NC, NE, NM, OK, PA, SC, SD, TN Workers' Compensation - CA Policy No. 015883920 Carrier: Ins. Co. of the State of PA Policy Period: 08/01/2011 - 08/01/2012 Statutory Limits: EL Each Accident $2,000,000 EL Disease - Each Employee $2,000,000 EL Disease - Policy Limit $2,000,000 Workers' Compensation - FL Policy No. 015883923 Carrier: New Hampshire Insurance Company Policy Period: 08/01/2011 - 08/01/2012 Statutory Limits: EL Each Accident $2,000,000 EL Disease - Each Employee $2,000,000 EL Disease - Policy Limit $2,000,000 Workers' Compensation - MA Policy No. 015883922 Carrier: Ins. Co. of the State of PA Policy Period: 08/01/2011 - 08/01/2012 Statutory Limits: EL Each Accident $2,000,000 EL Disease - Each Employee $2,000,000 EL Disease - Policy Limit $2,000,000 Workers' Compensation - WI Policy No. 015883926 Carrier: Illinois National Insurance Company Policy Period: 08/01/2011 - 08/01/2012 Statutory Limits: EL Each Accident $2,000,000 EL Disease - Each Employee $2,000,000 EL Disease - Policy Limit $2,000,000 Workers' Compensation - TX Policy No. 015883919 Carrier: New Hampshire Insurance Company Policy Period: OB/01/2011-2012 Statutory - Limits: EL Each Accident $2,000,000 EL Disease - Each Employee $2,000,000 EL Disease - Policy Limit $2,500 , 00 Workers' Compensation - OR Policy No. 015883925 Carrier: Ins. Co. of the State of PA Policy Period: 08/01/2011 - 08/01/2012 Statutory Limits: EL Each Accident $2,000,000 ACORD101(2008/01) Co11:3631119 Tp1:1304838 Cert:17415777 ©2008ACORDCORPORATION.AIIrightsreserved. The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: 031419 LOC#: ADDITIONAL REMARKS SCHEDULE Paged of�- AGENCY NAMED INSURED Ferguson Enterprises, Inc. and Subsidiaries Willis of Maryland, Inc. (See Attached Named Insured Schedule) POLICY NUMBER 12500 Jefferson Avenue Newport News, VA 23602 See First Page CARRIER NAIC CODE See First Page EFFECTIVE DATE: See First Page ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: CERTIFICATE OF LIABILITY INSURANCE EL Disease - Each Employee $2,000,000 EL Disease - Policy Limit $2,000,000 City of Oshkosh, and its officers, council members, agents, employees and authorized volunteers is included as an Additional Insured under General Liability as required by written contract but only with respect to liability arising out of Named Insured s operations. ACORD 101 (2008/01) Coll:3631119 Tpl:1304838 Cert:17415777 ©2008 ACORD CORPORATION.All rights reserved. The ACORD name and logo are registered marks of ACORD Willis Ferguson Enterprises,Inc. and Subsidiaries. List of Named Insureds Air Cold Supply Ferguson Fire&Fabrication, Inc. (fka Sierra Air Cold Supply/Webb Distributors Craft, Inc.) Alamo Pipe & Supply Ferguson Full Service Supply Alaska Pipe & Supply Ferguson Heating&Cooling Build.com, Inc. Ferguson Holdings, Inc. CAL-STEAM, a Wolseley Company Ferguson Hospitality Sales Camellia Valley Supply Ferguson Industrial Plastics and Pump Castle Supply Company, Inc. Division CastleNorth Ferguson Integrated Systems Division, Inc. CFP Ferguson Intermountain Piping Chadwick Ferguson International Clayton Group, Inc. Ferguson Panama, S.A. Clayton International, LLC Ferguson Process Services Cline Contract Sales Ferguson Valve &Automation Colgan Cabinets Ferguson Waterworks Colgan Distributors Ferguson Waterworks-Midwest Pipe Crow Company Ferguson Waterworks - Municipal Pipe D&C Plumbing&Heating Supply Ferguson Waterworks - Red Hed Davidson Electric Wholesale Supply Ferguson Waterworks EPPCO The Davidson Corporation, a Delaware Ferguson Waterworks International Corporation Frischkorn,Inc. The Davidson Group Companies, Inc Galleria Bath&Kitchen Showplace Davidson Group Leasing Gilmour Supply Company, Inc. Davidson Pipe Company Inc., a New York Ferguson Enterprises,Inc. dba Groeniger& Corporation Company Davidson Pipe Supply Company, Inc. Gulf Refrigeration Supply Davies Water .. High Country Plumbing Supply Decorative Product Source,Inc. Home Equipment Company,Inc. E&J Plumbing&Heating Supply Co. Indiana Plumbing Supply Co.,Inc. Economy Plumbing and Heating Supply Co. Industrial Hub of the Carolinas Endries International of Canada, Inc. J&G Products Endries International, Inc. J.D. Daddario Company Energy&Process Corporation Kandall Fabricating Ferguson Bath Kitchen and Lighting Gallery L&H Supply, Inc. Ferguson CESCO, Inc. Lane Piping Co. Ferguson de Costa Rica Ltd. Lawrence Plumbing Supply Co. Ferguson de Mexico S.A. de CV. Lincoln Products Ferguson Enterprises IV, Inc. Linwood Pipe and Supply Ferguson Enterprises of Montana,Inc. Louisiana Utilities Supply Company Ferguson Enterprises of Puerto Rico,Inc. Louisiana Chemical Pipe,Valve&Fitting, Ferguson Enterprises of Virginia, Inc. Inc. dba Wolseley Industrial Group Ferguson Enterprises V,Inc. LUSCO Ferguson Enterprises, Inc. Lyon Conklin&Co., Inc. Ferguson Enterprises, Inc. of Virginia Mastercraft Cabinets Ferguson Fire & Fabrication, Inc. Monotube Pile Corporation Willis Ferguson Enterprises, Inc. and Subsidiaries. List of Named Insureds Northern Water Works Supply, Inc. Onda-Lay Pipe and Rental, Inc. Page's Appliances Palermo Supply Park Supply Pipe Products Plumbing Decor Plumb Source R Supply Company Record Supply Company SEMSCO Barbados, LLC SEMSCO Trinidad, LLC SEMSCO Venezuela, LLC S.G. Supply Company(except Workers Compensation) S.G. Supply Company dba SG Supply Co., a Ferguson enterprise except Workers Compensation) Sierra Craft, Inc. SOS Sales Specialty Pipe &Tube, Inc. Specialty Pipe &Tube of Texas, Inc. Summer&Dunbar Supply North Central Group Stock Loan Services LLC Tarpon Wholesale Supplies T&A Valve Industries, Inc. The Parnell-Martin Companies LLC The Plumbers Warehouse The Stock Market Tubeco Fabrication, Inc. United Automatic Water Works Supplies Webb Distributors Western Air Systems and Controls, Inc. WIA of California,Inc. Wolseley Industrial Group Wolseley Industrial Plastics Wolseley Investments Acquisitions, Inc. Wolseley Investments,Inc. Wolselely NA Construction Services, LLC Wolseley North America, Inc. Wolseley North American Consulting, LLC Wolseley North American Services, Inc. WPCC Forwarding, LLC Named Insured: Ferguson Enterprises, Inc. and Subsidiaries COMMERCIAL GENERAL LIABILITY (See Attached Named Insured Schedule) POLICY NUMBER: 2449570 CG20 37 07 04 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - COMPLETED OPERATIONS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name of Additional Insured Person(s) Location And Description of Completed Operations Or Organization(s) As per written contract or agreement Information required to complete this Schedule, if not shown above,will be shown in the Declarations. Section II — Who Is An Insured is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for "bodily injury" or "property damage" caused, in whole or in part, by "your work" at the location designated and described in the schedule of this endorsement performed for that additional insured and included in the "products- completed operations hazard". Primary and Non-Contributory: This insurance is primary and non-contributory with other insurance main- tained by the additional insured where required by written contract. CG 20 37 07 04 ©ISO Properties, Inc., 2004 Page 1 of 1 • COMMERCIAL GENERAL LIABILITY CG 2010 07 04 Named Insured: Ferguson Enterprises, Inc. and Subsidiaries (See Attached Named Insured Schedule) Policy Number: 2449570 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - SCHEDULED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s): Location(s)Of Covered Operations As per written contract or agreement Information required to complete this Schedule, if not shown above,will be shown in the Declarations. A.Section II—Who Is An Insured is amended to include as an additional insured the person(s)or organization(s)shown in the Schedule,but only with respect to liability for"bodily injury","property damage"or"personal and advertising injury"caused,in whole or in part,by: 1.Your acts or omissions;or 2.The acts or omissions of those acting on your behalf; in the performance of your ongoing operations for the additional insured(s)at the location(s)designated above. B.With respect to the insurance afforded to these additional insureds,the following additional exclusions apply: This insurance does not apply to"bodily injury"or"property damage"occurring after: 1.All work,including materials,parts or equipment furnished in connection with such work,on the project (other than service,maintenance or repairs)to be performed by or on behalf of the additional insured(s)at the location of the covered operations has been completed;or 2.That portion of"your work"out of which the injury or damage arises has been put to its intended use by any person or organization other than another contractor or subcontractor engaged in performing operations for a principal as a part of the same project. CG 2010 07 04 ©ISO Properties,Inc.,2004 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ENDORSEMENT#6 This endorsement, effective 12:01 A.M. 8/1/2011 forms a part of Policy No. 3506434 issued to WOLSELEY INVESTMENTS, INC. By: National Union Fire Ins. Co. of Pittsburgh ADVICE OF CANCELLATION TO ENTITIES OTHER THAN THE NAMED INSURED LIMITED TO E-MAIL NOTIFICATION This policy is amended as follows: In the event that the Insurer cancels this policy for any reason other than non payment of premium, and 1. The cancellation effective date is prior to this policy's expiration date; 2. The First Named Insured is under an existing contractual obligation to notify a certificate holder when this policy is canceled (hereinafter, the "Certificate Holder(s)"); and has provided to the Insurer, either directly or through its broker of record, the email address of the contact at such entity, and the Insurer received this information after the First Named Insured receives notice of cancellation of this policy and prior to this policy's cancellation effective date, via an electronic spreadsheet that is acceptable to the Insurer, the Insurer will provide advice of cancellation (the "Advice") via e-mail to such Certificate Holders. Proof of the Insurer emailing the Advice, using the information provided by the First Named Insured, will serve as proof that the Insurer has fully satisfied its obligations under this endorsement. This endorsement does not affect, in any way, coverage provided under this policy or the cancellation of this policy or the effective date thereof, nor shall this endorsement invest any rights in any entity not insured under this policy. The following Definitions apply to this endorsement: 1. First Named Insured means the Named Insured shown on the Declarations Page of this policy. 2. Insurer means the insurance company shown in the header on the Declarations Page of this policy. All other terms, conditions and exclusions shall remain the same. dift..,t uthorized Representative 107414(12/10) ENDORSEMENT This endorsement,effective 11'01 A.M. 08/01/2011 forms a part of Policy No. CA 350-64-3i issued to IIOLSELEY INVESTMENTS, 1 NC by NATIONAL UNION FIRE INSURANCE COMPANY OF PITTSBURGH, PA THIS ENDORSEMENT CHANGES THE POUCH.PLEASE READ IT CAREFULLY. EARLY NOTICE OF CANCELLATION PROVIDED BY US This endorsement moddes insurance provided under the following: BUSINESS AUTO COVERAGE FORAt TRUCKERS COVERAGE FORM GARAGE COVERAGE FORM Common Policy Condtfone,A.Cancellation,2 is amended to read: 2. We may cancel this poky by mailing or delivering to the first Named insured written notice of cancel- lation at least a. TEN ( 10 )days before the effective date of cancellation if we cancel for nonpayment of premium;or b. ONE HUNDRED TWENTY (120)days before the effective date of cancellation If we cancel for any other reason. 4OZEDEPRESENTATNE 62198(3/96) THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. MANUSCRIPT# 05 This endorsement, effective 12:01 A.M. OB101f2011 forms a part of Policy No. GL 24495-70 issued to WOLSELEY INVESTMENTS, INC. By: NATIONAL UNION FIRE INSURANCE COMPANY OF PITTSBURGH, PA. ADVICE OF CANCELLATION TO ENTITIES OTHER THAN THE NAMED INSURED LIMITED TO E-MAIL NOTIFICATION This policy is amended as follows: In the event that the Insurer cancels this policy for any reason other than non payment of premium, and 1. The cancellation effective date is prior to this policy's expiration date; 2. The First Named Insured is under an existing contractual obligation to notify a certificate holder when this policy is canceled (hereinafter, the 'Certificate Holder(s) ); and has provided to the Insurer, either directly or through its broker of record,the email address of the contact at such entity, and the insurer received this information after the First Named Insured receives notice of cancellation of this policy and prior to this policy's cancellation effective date,via an electronic spreadsheet that Is acceptable to the Insurer, the Insurer will provide advice of cancellation {the "Advice") via e-mail to such Certificate Holders. Proof of the Insurer emaifing the Advice, using the information provided by the First Named Insured, will serve as proof that the Insurer has fully satisfied its obligations under this endorsement. This endorsement does not affect, in any way, coverage provided under this policy or the cancellation of this policy or the effective date thereof, nor shall this endorsement invest any rights In any entity trot insured under this policy. The following Definitions apply to this endorsement 1. First Named Insured means the Named Insured shown on the Declarations Page of this policy. 2. Insurer means the insurance company shown in the header on the Declarations Page of this policy. Ali other terms, conditions and exclusions shall remain the same. ;• try. A ORIZED REPRESENTATIVE d� POLICY NUMBER: GL 244-95-70 COMMERCIAL GENERAL-UAMUTY CO.02 24 10 93 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. EARLIER NOTICE OF CANCELLATION PROVIDED BY US This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART LIQUOR LIABILITY COVERAGE PART POLLU;TION...LIA9JLIY COVERAGE..PART. PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE Number of Days'Node. 120 lif no entry appears above, Information required to complete this Schedule will be shown in the Declarations as applicable to this endorsement,) For any statutorily permitted reason other then nonpayment of premium, the number of days requlrad for notice of cancellation, as provided h paragraph 2. of either the CANCELLATION Common Pol Condition or as emended by an applicable state cancellation endorsement. is Increased to the number of days shown In the Schedule above. • CG 02 24 10 93 Copyright. Insurance Services Office, Inc.. 1992 Page 1 of 1 ❑