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HomeMy WebLinkAboutCH2M Hill/Maron Tower Study CITY OF OSHKOSH DEPARTMENT OF PUBLIC WORKS 215 CHURCH AVENUE, P.O. BOX 1130, OSHKOSH, WI 54903-1130 PHONE: (920) 236-5065 FAX (920)236-5068 LETTER OF TRANSMITTAL To: Ms. Linda Mohr Date: December 7, 2012 CH2M HILL Engineers, Inc. Subject: Executed Agreement 135 South 84th Street Marion Tower Study Milwaukee, WI 53214 Please find: ® Attached ❑ Under Separate Cover ❑ Copy of Letter ® Contracts ❑ Amendment ❑ Report ❑ Agenda ❑ Meeting Notes ❑ Photos ❑ Mylars ❑ Change Order ❑ Plans ❑ Specifications ❑ Estimates ❑ Diskette ❑ Zip Disk ❑ Other Quantity Description 1 Executed Agreement These are being transmitted as indicated below: ❑ For Approval ® For Your Use ❑ As Requested ❑ For Review& Comment Remarks: Enclosed is a copy of the executed agreement for the Marion Tower study. A Purchase Order will be submitted to you shortly. Please reference this Purchase Order number on all of your invoices. If you have any questions, please contact us. Steve Brand — Copy City Attorney's Office — Copy / City Clerk's Office—Original dp . A,. cc: _ File— Original Signed: A Tracy. aylor 1:1Engineering\Tracy Taylor\Requisitions\CH2M Hill1LOTs1LOT-Executed Agreement-Marion Twr Study_12-7-12.docx AGREEMENT THIS AGREEMENT, made on the GT/4 day of , 2012, by and between the CITY OF OSHKOSH, party of the first part, hereinafter referred to as CITY, and CH2M HILL ENGINEERS, INC., 135 South 84th Street, Milwaukee, WI 53214, party of the second part, hereinafter referred to as the CONSULTANT, WITNESSETH: That the CITY and the CONSULTANT, for the consideration hereinafter named, enter into the following Agreement. ARTICLE I. PROJECT MANAGER A. Assignment of Project Manager. The CONSULTANT shall assign the following individual to manage the project described in this Agreement: Linda Mohr— Project 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 Agreement: Stephan Brand — Public Works Utilities Bureau Manager ARTICLE III. SCOPE OF WORK The CONSULTANT shall provide the services described in the CONSULTANT's attached Scope of Services. The CONSULTANT may provide additional products and/or services if such products/services are requested in writing by the Authorized Representative of the CITY. All reports, drawings, specifications, computer files, field data, notes, and other documents and instruments prepared by the CONSULTANT as instruments of service shall remain the property of the CITY. Page 1 of 4 ARTICLE IV. CITY RESPONSIBILITIES 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 Agreement shall be commenced and the work completed within the time limits as agreed upon as projects are identified throughout this Agreement. The CONSULTANT shall perform the services under this Agreement with reasonable diligence and expediency consistent with sound professional practices. The CITY agrees that the CONSULTANT is not responsible for damages arising directly or indirectly from any delays for causes beyond the CONSULTANT's control. For the purposes of this Agreement, such causes include, but are not limited to, strikes or other labor disputes, severe weather disruptions or other natural disasters, failure of performance by the CITY, or discovery of any hazardous substances or differing site conditions. If the delays resulting from any such causes increase the time required by the CONSULTANT to perform its services in an orderly and efficient manner, the CONSULTANT shall be entitled to an equitable adjustment in schedule. ARTICLE VI. COMPONENT PARTS OF THE AGREEMENT This Agreement consists of the following component parts, all of which are as fully a part of this Agreement as if herein set out verbatim, or if not attached, as if hereto attached: 1. This Instrument 2. Consultant's Scope of Services In the event that any provision in any of the above component parts of this Agreement conflicts with any provision in any other of the component parts, the provision in the component part first enumerated above shall govern over any other component part which follows it numerically except as may be otherwise specifically stated. Page 2 of 4 ARTICLE VII. PAYMENT A. The Agreement Sum. The CITY shall pay to the CONSULTANT for the performance of the Agreement the total sum as set forth below, adjusted by any changes hereafter mutually agreed upon in writing by the parties hereto: • Time and Materials Not to Exceed $49,500 (Forty Nine Thousand Five Hundred Dollars). • Attached fee schedule shall be firm for the duration of this Agreement. B. Method of Payment. The CONSULTANT shall submit itemized monthly statements for services. 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 VIII. 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 which may be to the proportionate extent 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 Agreement 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 for those actions, claim, and demands caused by or resulting from intentional or negligent acts as specified in this paragraph. ARTICLE IV. INSURANCE The CONSULTANT agrees to abide by the attached City of Oshkosh Insurance Requirements. Page 3 of 4 ARTICLE X. 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 Agreement 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 By: A A Hellermann, P.E., Vice President (Seal of Consultant if a Corporation.) CITY OF OSHKOSH ...,:d � � By: /lit— I' -*:::--- (Witness) Mark A. Rohloff, City Manager b a.i.„J t"" ,k And: 4L .,«` ,i. , :AIL (Witness) ' - •• - .112":"7. F., 'a ty Jerk A APPROVED: I hereby certify that the necessary provisions have been made to pay the liability which t l which will accrue under this Agreement. A„Lifs-l_ ''' il'q f,(..A f\ -' _w ity Attorney- P_l&21 ��✓ �/ City Comptr er Page 4 of 4 SCOPE OF SERVICES City of Oshkosh Water Utility Marion Tower Study Erected in 1936, the elevated 0.75 million gallon (MG) water storage tank on Marion Road (Marion Tower) is the City of Oshkosh (City)'s oldest water tower. It is located in the downtown Oshkosh between the University of Wisconsin—Oshkosh and the central business district.This area is currently being redeveloped to include commercial and high density residential land uses that better meet the community's needs.While the tank has been maintained and routinely inspected, it is at or near the end of its economic life.The purpose of this study is to evaluate Marion Tower alternatives and develop the information needed to support the City's capital improvement planning process. Task 1 - Analysis of Marion Tower alternatives In recent planning studies,the City investigated replacing or reconditioning the Marion Tower. Conceptual alternatives included structural repair and repainting of the existing tank, erecting a new 0.75-MG tank, or erecting a new 1.5-MG tank. In this study, these options will undergo further hydraulic and engineering analysis to identify impacts to distribution system performance,water age and water quality,operational flexibility and reliability, and fire protection capabilities.Also, in this study CH2M HILL will review the Marion Tower alternatives with the City Department of Community Development to engage City planners early in the design development process. Task 1.1 — Hydraulic and engineering analysis CH2M HILL will use the City's distribution system hydraulic model to simulate water system operation with the three different Marion Tower storage scenarios mentioned above.The model will be used to investigate whether tower design criteria changes(volume, height) should be made to meet the potential future requirements established in the City's 2030 land use plan and riverfront development plans.The model will also be used to evaluate system pressures and the potential for watermain breaks when the Marion Tower is isolated from the system for reconditioning or replacement. CH2M HILL will identify system operational changes (e.g., high lift pumping strategies,valve and hydrant exercising practices,the addition of pressure relief devices)to mitigate watermain breaks associated with tower isolation. CH2M HILL will retain a specialty subconsultant to conduct a detailed structural and coating analysis of the existing elevated tower.The findings from this analysis will be peer reviewed by CH2M HILL structural and corrosion control engineers and used to help determine the practical benefits and costs of reconditioning the existing tower. CH2M HILL will develop preliminary sequence of construction issues associated with reconditioning or replacing Marion Tower. CH2M HILL will prepare cost estimates for the Marion Tower alternatives. CH2M HILL will summarize the technical findings and input from the City in a draft technical memorandum. Deliverables. Draft Task 1.1 technical memorandum and meeting summaries. Task 1.2 — Community Development engagement The Marion Tower is located within, near the Marion Road/Pearl Avenue Redevelopment Area which has been undergoing improvements for the last decade. Revitalization efforts have removed blighted structures, redeveloped brownfields, and introduced new commercial, residential and public land uses. To support these on-going efforts, CH2M HILL will meet with the City Department of Community Development to provide information on the performance of the water distribution system and the role of Marion Tower. CH2M HILL will discuss the Marion Tower alternatives evaluated in Task 1.1 and gather input from City planners to advance the study and future design and construction approaches in ways that are consistent with the City's riverfront plans. Deliverables. Meeting summaries. Task 1.3 — Marion Tower study report CH2M HILL will summarize the Marion Tower analyses,conceptual drawings, cost estimates,and community planning input in a draft study report. CH2M HILL will meet with the City to discuss the draft study report and gather review comments. Review comments will be incorporated in the final study report. Deliverables: Ten paper copies of the study report. Task 2 - Project management, quality assurance/quality control Project management and quality assurance/quality control duties include: Preparation of project instructions.This guidance for the project team includes the detailed scope of services and project deliverables,task assignments and work plan, project schedule, project budget, health and safety considerations, and communication procedures within the team. Communication. Communication will be maintained through regular team meetings,telephone calls, and e-mail. Meetings will be held with City staff to discuss ideas and make decisions at critical points in the work. In addition to project team meetings, brief progress reports will be submitted to the City with the monthly invoice. Quality Control/Quality Assurance(QA/QC).The role of the QA/QC process is to support the project manager and technical staff throughout the project and review completed work at project milestones. Cost Control. CH2M HILL will develop monthly invoices based on labor, expense and percent complete on Tasks. Level of Effort and Compensation The estimated level of effort for professional engineering services and compensation is presented in Table 1. TABLE 1 Level of effort and cost Activity Hours Cost Task 1—Preliminary engineering and design 295 $44,500 Task 2—Project management and quality control 45 $5,000 TOTAL $49,500 ' l © DATE(MMIDDIYYYY) ,a�oR° CERTIFICATE OF LIABILITY INSURANCE 08/2912012 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: MARSH USA.INC. PHONE FAX 1225 17TH STREET,SUITE 2100 (A/C,No.Ext): (A/C,No): DENVER.CO 80202-5534 E-MAIL ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC# 15114-00124-GAWC-12/13 WDC INSURER A: Greenwich Insurance Company 22322 INSURED INSURER B:XL Specially Insurance CO. 37885 CH2M HILL ENGINEERS,INC. 9127 SOUTH JAMAICA STREET INSURER C: ENGLEWOOD,CO 80112 INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: SEA-002343717-06 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. ADDL',SUBR POLICY EFF POLICY EXP INSR LTR TYPE OF INSURANCE INSR WVD POLICY NUMBER (MM!DDIYYYY) (MM/DD/YYYY) LIMITS GENERAL LIABILITY X EACH OCCURRENCE $ 1,500,000 A X COMMERCIAL GENERAL LIABILITY RGE500025501 05/01/2012 05/01/2013 DAMAGE TO RENTED PREMISES(Ea occurrence) $ 1,500,000 CLAIMS-MADE X OCCUR MED EXP(Any one person) $ X 5500,000 SIR PERSONAL&ADV INJURY $ 1,500,000 I GENERAL AGGREGATE $ 5,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: ',.. PRODUCTS-COMP/OP AGG $ 5,000,000 PRO- POLICY ECT LOC $ AUTOMOBILE LIABILITY X COMBINED SINGLE LIMIT 2,000,000 (Ea accident) S A X ANY AUTO RAD500025401(AOS) 05/0112012 05/01/2013 BODILY INJURY(Per person) $ A ALL OWNED SCHEDULED RAD500025601(MA) 05/01/2012 05/01/2013 BODILY INJURY(Per accident) $ AUTOS AUTOS PROPERTY DAMAGE NON-OWNED I (Per accident) $ HIRED AUTOS AUTOS $ i UMBRELLA LIAB OCCUR , EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION X WC STATU- I OTH- AND EMPLOYERS'LIABILITY TORY LIMITS ER B ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N RWD500025201(ADS) 05/01/2012 05/01/2013 E.L.EACH ACCIDENT $ 1,000,000 B OFFICER/MEMBER EXCLUDED? N N/A �'RWR5000253D1(WI) 05/01/2012 05/01/2013 1,000,000 (Mandatory in NH) ( ) E.L.DISEASE-EA EMPLOYEE$ If yes,describe under I 1,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT I$ DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) RE:ALL PROJECTS;PM:LINDA MOHR,PN430702 THE CERTIFICATE HOLDER IS INCLUDED AS AN ADDITIONAL INSURED ON THE GENERAL LIABILITY AND AUTOMOBILE LIABILITY POLICIES AS REQUIRED BY WRITTEN CONTRACT OR AGREEMENT. CERTIFICATE HOLDER CANCELLATION CITY OF OSHKOSH SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE ATTN:SUPERINTENDENT OF UTILITIES- THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN STEPHAN BRAND ACCORDANCE WITH THE POLICY PROVISIONS. 215 CHURCH AVENUE,PO BOX 1130 OSHKOSH,WI 54903-1130 AUTHORIZED REPRESENTATIVE of Marsh USA Inc. Sharon A.Hammer ->°tqu-w.-.. a-Nc 'ry I ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD CH2M HILL 2012 HOURLY CHARGE RATES for PROFESSIONALS AND TECHNICIANS Classification Hourly Rate Senior Consultant $220 Senior Project Manager $200 Senior Designer $175 Project Engineer $130 Associate Engineer $115 Senior CAD Technician $110 Project Accountant $90 CAD Technician $80 Clerical $75 Expenses Expense Type Estimating Method Rate Photo Copies Service Center $0.05 Reprographics Service Center varies Auto mileage Travel $.555/mile Auto Rental Travel Actual Other Travel (FTR Guidelines) Travel Actual Equipment Rental Operating Expense Actual Postage/Freight Operating Expense Actual Note a Assessment applies to all labor hours "°te b Assessment applies to all Health &Safety trained individuals Rates subject to change on January 1,2013 12/21/11 CITY OF OSHKOSH INSURANCE REQUIREMENTS III. PROFESSIONAL SERVICES LIABILITY 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. 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 Injury (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 project/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. III - 1 12/21/11 4. WORKERS COMPENSATION AND EMPLOYERS LIABILITY— "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: (1) $100,000 Each Accident (2) $500,000 Disease Policy Limit (3) $100,000 Disease— Each Employee 5. UMBRELLA LIABILITY - If exposure exists, provide 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. 6. ADDITIONAL PROVISIONS 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 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. III - 2 ---, " -- CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDlYYY) 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: information,including street Insurance Agent's """"FAX PHONE contact information. •address and PO Box if (A/C.No.Ext): (AIC.No): applicable. E-MAIL ADDRESS: INSURER(S)AFFORDING COVERAGE 1 NAIC M INSURER A: ABC Insurance Company . NAIC# INSURED Insured(s contact information, including name,address and INSURER B: XYZ InSUranCe Company _. . NAIC# phone number. INSURER C: LMN Insurance Company I NAIC# INSURER D: Insurer(s)must have a minimum A.M.Best rating of A- - -------- and a Financial Performance Rating of VI 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 POLICY EFF POLICY EXP LTR TYPE OF INSURANCE : INSR i WVD POLICY NUMBER (MMIDDIYYY) (MMIDD/YYY) LIMITS ;GENERAL LIABILITY EACH OCCURRENCE $1,000,000 4® , ® ;; ❑ General Liability Policy Number 'Policy effective and expiration date I DAMAGE TO RENTED COMMERCIAL GENERAL LIABILITY PREMISES(Ea occurrence) $50,000 A ` ❑-CLAIMS-MADE;®f.00CUR MED EXP(Any one person) $5,000 ® ISO FORM CG 20 37 OR EQUIVALENT PERSONAL&ADV INJURY $1,000,000 'El'I GENERAL AGGREGATE $2,000,000 EGEN'L AGGREGATE LIMIT APPLIES PER: ! PRODUCTS—COMP/OP AGG $2,000,,000 ❑POLICY ,PRO-3 :LOC .®1JECT❑ $ AUTOMOBILE LIABILITY € E!COMBINED LIMIT $1 000,000 ( t) f®ANY AUTO ; ® ' ❑ Auto Liability Policy Number -. Policy effective and expiration date. BODILY INJURY(Per person) I $ B -ALL OWNED i SCHEDULED BODILY INJURY(Per accident) $ ❑AUTOS AUTOS , ) HIRED AUTOS' ( PROPERTY DAMAGE ;Li: ;❑ NON-OWNED; AUTOS (Per accident) $ ❑ ❑<` $ 1 OCCUR II®�.:UMBRELLA LIAB;®- ® ❑ EACH OCCURRENCE $2,000,000 A .. 1 EXCESS LIAB ❑ CLAIMS-MADE Umbrella Liability Policy Number I Policy effective and expiration date.) AGGREGATE $2,000,000 ❑DED ®RETENTION E$10,000 $ WORKERS COMPENSATION 1 WC STATU- 0TH- C AND EMPLOYERS'LIABILITY ❑ ❑ ®TORY LIMITS:❑ ER €ANY PROPRIETOR/PARTNER/EXECUTIVE f !OFFICE/MEMBER EXCLUDED? Y/N i Workers Compensation Policy Policy effective and expiration date. E.L.EACH ACCIDENT $100,000 .(Mandatory in NH) N Number If yes,describe under E.L.DISEASE—EA EMPLOYEE $100,000 DESCRIPTION OF OPERATIONS below ! E.L.DISEASE—POLICY LIMIT $500,000 A PROFESSIONAL LIABILITY ; ® - ❑ i$1,000,000 EACH CLAIM I Professional Liability Policy 'Policy effective and expiration date' $1,000,000 ANNUAL AGGREGATE Number DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space Is required) Additional Insureds on the Commercial General Liability and Automobile Liability arising out of project work shall be City of Oshkosh,and its 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 POLICIES BE CANCELLED BEFORE 215 Church Avenue SAMPLE CERTIFICATE THE EXPIRATION DATE,THEREOF,NOTICE WILL BE DELIVERED IN PO Box 1130 ACCORDANCE WITH THE POLICY PROVISIONS. Oshkosh,WI 54903-1130 Please indicate somewhere on this certificate,the contract or project# AUTHORIZED REPRESENTATIVE this certificate Is for. ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD