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HomeMy WebLinkAboutAugust Winter & Sons/Wastewater Treatment Plant 2323 N.Roemer Road A tr. Appleton,WI 54911 PO Box 1896 Appleton,WI 54912-1896 WINTER AUGUST WINTER & SONS INC. P: (920)739-8881 "� ww MECHANICAL. CONTRACTOR & -FABRICATO t F: (920)739-2230 'C.r dx•`f}: ds5 t„�M� • � www.augustwinter.com 5613 Schofield Ave. Schofield,WI 54476 P: (715)355-7555 F: (715)355-9048 DATE: 2/12/14 TO: CH2M Hill 135 S. 84th Street Suite 400 Milwaukee, WI 53214 SUBJECT: City of Oshkosh Contract NO. 13-24 Agreement ATTN: Linda Mohr We are sending the following items: QUANTITY DESCRIPTION 3 Performance & Payment Bonds 3 Signed Agreements 1 Certificate of Insurance THESE ARE TRANSMITTED ❑For Your Approval ❑Disapproved As Requested Approved Resubmit EFor Review&Comment Approved As Noted ❑For Your Files EPrints Returned ❑Returned for Corrections For Your Information/Use ECopies After Loaned to us )2 J —2ot;! Sincerely, �O ` _ - „f1)k � Wendy Zeinert ' /lon acv-- j6„ ) Ir-uv""."L AUGUST WINTER& SONS,INC. LL4 sc--ropiat-d,640 Cc lam. a),kr( w c11, Cy1+1," 1-3-24 F c.P y J HVAC"PLUMBING"TAN FABRI ATION*PROCESS PIPING`IND.SHEETMETAL SPECIALTY METAL FAB. ASME PRESSURE VESSELS`ASME CODE WELDING*24 HR.SERVICE ENGINEERING STATE OF WISCONSIN LICENSED MASTER PLUMBERS,LICENSE NUMBER 227170 ' r CONTROL SYSTEM, INFLUENT PUMPING&AERATION BLOWERS UPGRADE CITY OF OSHKOSH WASTEWATER TREATMENT PLANT SECTION 00 52 13 AGREEMENT THIS AGREEMENT is by and between the City of Oshkosh, Wisconsin (Owner) and Contractor. Owner and Contractor, in consideration of the mutual covenants set forth herein, agree as follows: 1. WORK 1.1. Contractor shall complete all Work as specified or indicated in the Contract Documents. The Work is generally described as follows: The completed Work consists of demolition of and providing for the installation of new influent pump motors and adjustable frequency drives, comprehensive control system hardware and software improvements, new centrifuge drives and controls, and new aeration blowers. The Work includes replacement of the existing 4,160-volt electrical service to the influent pump station with 480-volt service by a new electrical substation. The Work includes the installation of Owner-furnished replacement drives and controls for two solids handling centrifuges. Upgrades to the aeration basin blower system include replacement of two blowers and the aeration system instrumentation. With the exception of the installation of a new sixth influent pump and a new electrical substation, the new equipment, controls and instrumentation of the project replaces existing equipment and components, as shown on the Drawings. 2. ENGINEER 2.1. The Project has been designed by CH2M HILL (Engineer), who is to act as Owner's representative, assume all duties and responsibilities, and have the rights and authority assigned to Engineer in the Contract Documents in connection with the completion of the Work in accordance with the Contract Documents. 3. CONTRACT TIMES 3.1. Time of the Essence: All time limits for Milestones, if any, Substantial Completion, and completion and readiness for final payment as stated in the Contract Documents are of the essence of the Contract. 3.2. Days to Achieve Substantial Completion and Final Payment: 3.2.1. The Work shall be substantially completed within 730 days from the date when the Contract Times commence to run as provided in Paragraph 2.03 MKE/469462 AGREEMENT FEBRUARY 4, 2014 00 52 13 - 1 ©COPYRIGHT 2014 CH2M HILL CONTROL SYSTEM, INFLUENT PUMPING& AERATION BLOWERS UPGRADE CITY OF OSHKOSH WASTEWATER TREATMENT PLANT of the General Conditions, and completed and ready for final payment in accordance with Paragraph 14.07 of the General Conditions within 760 days after the date when the Contract Times commence to run. 3.3. Liquidated Damages: 3.3.1. Contractor and Owner recognize that time is of the essence of this Agreement and that Owner will suffer financial loss if the Work is not completed within the times specified in Paragraph Contract Times above, plus any extensions thereof allowed in accordance with Article 12 of the General Conditions. The parties also recognize the delays, expense, and difficulties involved in proving in a legal or arbitration proceeding the actual loss suffered by Owner if the Work is not completed on time. Accordingly, instead of requiring any such proof, Owner and Contractor agree that as liquidated damages for delay (but not as a penalty) Contractor shall pay Owner Five Hundred Dollars ($ 500.00 ) for each day that expires after the time specified herein for Substantial Completion until the Work is substantially complete. 4. CONTRACT PRICE 4.1. Owner will pay Contractor for completion of the Work in accordance with the Contract Documents an amount in current funds equal to the sum of the amounts determined pursuant to the following: 4.1.1. Lump Sum: For all Work a lump sum of: Four million, two hundred ten thousand and five hundred Dollars (Words) and zero Cents $ 4,210,500.00 (Words) (Figures) 4.1.1.1. The above lump sum amount reflects Owner's adoption of the following alternates: 4.1.1.1.1. None. 4.1.1.2. All specific cash and contingency allowances are included in the above lump sum price and have been computed in accordance with Paragraph 11.02 of the General Conditions. AGREEMENT MKE/469462 00 52 13 -2 FEBRUARY 4, 2014 ©COPYRIGHT 2014 CH2M HILL CONTROL SYSTEM, INFLUENT PUMPING&AERATION BLOWERS UPGRADE CITY OF OSHKOSH WASTEWATER TREATMENT PLANT 5. PAYMENT PROCEDURES 5.1. Submittal and Processing of Payments: Contractor shall submit Applications for Payment in accordance with Article 14 of the General Conditions. Applications for Payment will be processed by Engineer as provided in the General Conditions. 5.2. Progress Payments and Retainage: Owner will make progress payments on account of the Contract Price on the basis of Contractor's Application for Payment on the date of each month as established in the preconstruction conference during performance of the Work as provided herein. All such payments will be measured by the Schedule of Values established as provided in Paragraph 2.07.A of the General Conditions (and in the case of Unit Price Work based on the number of units completed) or, in the event there is no Schedule of Values, as provided in the General Requirements. 5.2.1. Prior to Substantial Completion, progress payments will be made in an amount equal to the percentage indicated below but, in each case, less the aggregate of payments previously made and less such amounts as Engineer may determine or Owner may withhold, including but not limited to liquidated damages, in accordance with Paragraph 14.02 of the General Conditions: 5.2.1.1. Ninety five percent of Work completed (with the balance being retainage). If the Work has been 50 percent completed as determined by Engineer, and if the character and progress of the Work have been satisfactory to Owner and Engineer, Owner, on recommendation of Engineer, may determine that as long as the character and progress of the Work remain satisfactory to them,there will be no additional retainage; and 5.2.1.2. Ninety five percent of cost of materials and equipment not incorporated in the Work(with the balance being retainage). 5.2.2. Upon Substantial Completion, Owner will pay an amount sufficient to increase total payments to Contractor to 100 percent of the Work completed, less such amounts as Engineer will determine in accordance with Paragraph 14.02.B.5 of the General Conditions and less 100 percent of Engineer's estimate of the value of Work to be completed or corrected as shown on the tentative list of items to be completed or corrected attached to the certificate of Substantial Completion. 5.3. Final Payment: 5.3.1. Upon final completion and acceptance of the Work in accordance with Paragraph 14.07 of the General Conditions, Owner shall pay the remainder of MKE/469462 AGREEMENT FEBRUARY 4, 2014 00 52 13 - 3 ©COPYRIGHT 2014 CH2M HILL CONTROL SYSTEM, INFLUENT PUMPING&AERATION BLOWERS UPGRADE CITY OF OSHKOSH WASTEWATER TREATMENT PLANT the Contract Price as recommended by Engineer as provided in said Paragraph 14.07. 6. INTEREST 6.1. All monies not paid when due as provided in Article 14 of the General Conditions shall bear interest at the rate of one percent per month. 7. CONTRACTOR'S REPRESENTATIONS 7.1. In order to induce Owner to enter into this Agreement, Contractor makes the following representations: 7.1.1. Contractor has examined and carefully studied the Contract Documents and the other related data identified in the Bidding Documents. 7.1.2. Contractor has visited the Site and become familiar with and is satisfied as to the general, local, and Site conditions that may affect cost, progress, and performance of the Work. 7.1.3. Contractor is familiar with and is satisfied as to all federal, state, and local Laws and Regulations that may affect cost, progress, and performance of the Work. 7.1.4. Contractor has carefully studied all: (1) reports of explorations and tests of subsurface conditions at or contiguous to the Site and all drawings of physical conditions in or relating to existing surface or subsurface structures at or contiguous to the Site (except Underground Facilities) which have been identified in the Supplementary Conditions as provided in Paragraph 4.02 of the General Conditions and (2) reports and drawings of a Hazardous Environmental Condition, if any, at the Site which has been identified in the Supplementary Conditions as provided in Paragraph 4.06 of the General Conditions. 7.1.5. Contractor does not consider that any further examinations, investigations, explorations, tests, studies, or data are necessary for the performance of the Work at the Contract Price, within the Contract Times, and in accordance with the other terms and conditions of the Contract Documents. 7.1.6. Contractor is aware of the general nature of work to be performed by Owner and others at the Site that relates to the Work as indicated in the Contract Documents. AGREEMENT MKE/469462 00 52 13 -4 FEBRUARY 4, 2014 ©COPYRIGHT 2014 CH2M HILL • CONTROL SYSTEM, INFLUENT PUMPING&AERATION BLOWERS UPGRADE CITY OF OSHKOSH WASTEWATER TREATMENT PLANT 7.1.7. Contractor has correlated the information known to Contractor, information and observations obtained from visits to the Site, reports and drawings identified in the Contract Documents, and all additional examinations, investigations, explorations, tests, studies, and data with the Contract Documents. 7.1.8. Contractor has given Engineer written notice of all conflicts, errors, ambiguities, or discrepancies that Contractor has discovered in the Contract Documents, and the written resolution thereof by Engineer is acceptable to Contractor. 7.1.9. The Contract Documents are generally sufficient to indicate and convey understanding of all terms and conditions for performance and furnishing of the Work. 8. CONTRACT DOCUMENTS 8.1. Contents: 8.1.1. The Contract Documents that are associated with this Agreement (except as expressly noted otherwise) consist of the following: 8.1.1.1. This Agreement. 8.1.1.2. Performance bond. 8.1.1.3. Payment bond. 8.1.1.4. General Conditions. 8.1.1.5. Supplementary Conditions. 8.1.1.6. Specifications as listed in the table of contents of the Project Manual. 8.1.1.7. Drawings consisting of 87 sheets with each sheet bearing the following general title: Control System, Influent Pumping & Aeration Blowers Upgrade. 8.1.1.8. Addenda. 8.1.1.9. Davis-Bacon and Related Acts, Appendix F. 8.1.2. Exhibits to this Agreement: 8.1.2.1. Contractor's Bid. MKE/469462 AGREEMENT FEBRUARY 4, 2014 00 52 13 - 5 ©COPYRIGHT 2014 CH2M HILL CONTROL SYSTEM, INFLUENT PUMPING & AERATION BLOWERS UPGRADE CITY OF OSHKOSH WASTEWATER TREATMENT PLANT 8.1.2.2. Documentation submitted by Contractor prior to Notice of Award. 8.1.2.2.1. Disclosure of Ownership. 8.1.3. The following which may be delivered or issued on or after the Effective Date of the Agreement and are not attached hereto: 8.1.3.1. Notice to Proceed. 8.1.3.2. Work Change Directives. 8.1.3.3. Change Order(s). 8.2. There are no Contract Documents other than those listed above in this Article. 8.3. The Contract Documents may only be amended, modified, or supplemented as provided in Paragraph 3.04 of the General Conditions. 9. MISCELLANEOUS 9.1. Terms used in this Agreement will have the meanings stated in the General Conditions and the Supplementary Conditions. 9.2. Successors and Assigns: Owner and Contractor each binds itself, its partners, successors, assigns, and legal representatives to the other party hereto, its partners, successors, assigns, and legal representatives in respect to all covenants, agreements, and obligations contained in the Contract Documents. 9.3. Severability: Any provision or part of the Contract Documents held to be void or unenforceable under any Law or Regulation shall be deemed stricken, and all remaining provisions shall continue to be valid and binding upon Owner and Contractor, who agree the Contract Documents shall be reformed to replace such stricken provision or part thereof with a valid and enforceable provision that comes as close as possible to expressing the intention of the stricken provision. 9.4. Assignment of Contract: 9.4.1. No assignment by a party hereto of any rights under or interests in the Contract shall be binding on another party hereto without the written consent of the party sought to be bound; and, specifically but without limitation, moneys that may become due and moneys that are due may not be assigned without such consent(except to the extent that the effect of this restriction may be limited by law), and unless specifically stated to the contrary in any written consent to an assignment, no assignment shall release or discharge the assignor from any duty or responsibility under the Contract Documents. AGREEMENT MKE/469462 00 52 13 - 6 FEBRUARY 4, 2014 ©COPYRIGHT 2014 CH2M HILL • CONTROL SYSTEM, INFLUENT PUMPING &AERATION BLOWERS UPGRADE CITY OF OSHKOSH WASTEWATER TREATMENT PLANT IN WITNESS WHEREOF, Owner and Contractor have signed this Agreement in triplicate. One counterpoint each has been delivered to Owner, Contractor, and Engineer. All portions of the Contract Documents have been signed or identified by Owner and Contractor or on their behalf. This Agreement will be effective on `E8 2014 (which is the Effective Date of the Agreement). Signed for in behalf of the City of Oshkosh CONTRACTOR: �.i'Gerr'a■lf GU,IiiG L imr,.7-rcc-. Mark A. Rohloff, City Manager � 6�/� C] err By: 4,6--,..44-2> :(dai , City Clerk Title: /�<z - orp` M to J • c C . ( .f- -v1f CORPORA E SEAL _ Art\ Gal orenson, City orn-y Sch& Attest: ird" Title: Ba Onic.5 tk,t) 0 V Address for giving notices: Edward Nokes, Interim Finance Director I hereby certify that the necessary provisions have been made to pay the liability which will accrue under this contract. License No. (Where applicable) Agent for service or process: (If Contractor is a corporation or a partnership, attach evidence of authority to sign.) END OF SECTION MKE/469462 AGREEMENT FEBRUARY 4, 2014 00 52 13 - 7 ©COPYRIGHT 2014 CH2M HILL Appendix F 3. Contract and Subcontract provisions. (a) The Recipient shall insure that the subrecipient(s)shall insert in full in any contract in excess of $2,000 which is entered into for the actual construction, alteration and/or repair, including painting and decorating, of a public building or public work,or building or work financed in whole or in part from Federal funds or in accordance with guarantees of a Federal agency or financed from funds obtained by pledge of any contract of a Federal agency to make a loan,grant or annual contribution (except where a different meaning is expressly indicated),and which is subject to the labor standards provisions of any of the acts listed in §5.1,the following clauses: (1) Minimum wages. (i)All laborers and mechanics employed or working upon the site of the work will be paid unconditionally and not less often than once a week, and without subsequent deduction or rebate on any account(except such payroll deductions as are permitted by regulations issued by the Secretary of Labor under the Copeland Act(29 CFR part 3) ),the full amount of wages and bona fide fringe benefits (or cash equivalents thereof)due at time of payment computed at rates not less than those contained in the wage determination of the Secretary of Labor which is attached hereto and made a part hereof, regardless of any contractual relationship which may be alleged to exist between the contractor and such laborers and mechanics. Contributions made or costs reasonably anticipated for bona fide fringe benefits under section 1(b)(2)of the Davis-Bacon Act on behalf of laborers or mechanics are considered wages paid to such laborers or mechanics, subject to the provisions of paragraph (a)(1)(iv) of this section; also, regular contributions made or costs incurred for more than a weekly period (but not less often than quarterly) under plans, funds, or programs which cover the particular weekly period, are deemed to be constructively made or incurred during such weekly period. Such laborers and mechanics shall be paid the appropriate wage rate and fringe benefits on the wage determination for the classification of work actually performed, without regard to skill, except as provided in§ 5.5(a)(4). Laborers or mechanics performing work in more than one classification may be compensated at the rate specified for each classification for the time actually worked therein: Provided,That the employer's payroll records accurately set forth the time spent in each classification in which work is performed.The wage determination (including any additional classification and wage rates conformed under paragraph (a)(1)(ii) of this section) and the Davis-Bacon poster(WH-1321)shall be posted at all times by the contractor and its subcontractors at the site of the work in a prominent and accessible place where it can be easily seen by the workers. Subrecipient s may obtain wage determinations from the U.S. Department of Labor's web site, www.wdol.gov. (ii)(A)The subrecipient(s), on behalf of EPA, shall require that any class of laborers or mechanics, App F Contract and Subcontract Provisions_ARRA_Handbook_Appendices_pdf including helpers,which is not listed in the wage determination and which is to be employed under the contract shall be classified in conformance with the wage determination.The EPA award official shall approve an additional classification and wage rate and fringe benefits therefore only when the following criteria have been met: (1)The work to be performed by the classification requested is not performed by a classification in the wage determination;and (2)The classification is utilized in the area by the construction industry; and (3)The proposed wage rate, including any bona fide fringe benefits, bears a reasonable relationship to the wage rates contained in the wage determination. (B) If the contractor and the laborers and mechanics to be employed in the classification (if known), or their representatives,and the subrecipient(s)agree on the classification and wage rate (including the amount designated for fringe benefits where appropriate),a report of the action taken shall be sent by the subrecipient (s)to the State award official. The State award official will transmit the report,to the Administrator of the Wage and Hour Division, Employment Standards Administration, U.S. Department of Labor,Washington, DC 20210.The Administrator, or an authorized representative,will approve, modify, or disapprove every additional classification action within 30 days of receipt and so advise the State award official or will notify the State award official within the 30-day period that additional time is necessary. (C) In the event the contractor,the laborers or mechanics to be employed in the classification or their representatives, and the and the subrecipient(s) do not agree on the proposed classification and wage rate (including the amount designated for fringe benefits,where appropriate),the award official shall refer the questions, including the views of all interested parties and the recommendation of the State award official,to the Administrator for determination.The Administrator,or an authorized representative,will issue a determination within 30 days of receipt and so advise the contracting officer or will notify the contracting officer within the 30-day period that additional time is necessary. (D)The wage rate(including fringe benefits where appropriate) determined pursuant to paragraphs (a)(1)(ii)(B)or(C) of this section, shall be paid to all workers performing work in the classification under this contract from the first day on which work is performed in the classification. (iii)Whenever the minimum wage rate prescribed in the contract for a class of laborers or mechanics includes a fringe benefit which is not expressed as an hourly rate,the contractor shall either pay the benefit as stated in the wage determination or shall pay another bona fide fringe benefit or an hourly cash equivalent thereof. (iv) If the contractor does not make payments to a trustee or other third person,the contractor may App F Contract and Subcontract Provisions_ARRA_HandbookAppendices Pdf consider as part of the wages of any laborer or mechanic the amount of any costs reasonably anticipated in providing bona fide fringe benefits under a plan or program, Provided,That the Secretary of Labor has found, upon the written request of the contractor,that the applicable standards of the Davis-Bacon Act have been met.The Secretary of Labor may require the contractor to set aside in a separate account assets for the meeting of obligations under the plan or program. (2)Withholding.The subrecipient(s),shall upon written request of the EPA Award Official or an authorized representative of the Department of Labor, withhold or cause to be withheld from the contractor under this contract or any other Federal contract with the same prime contractor,or any other federally-assisted contract subject to Davis-Bacon prevailing wage requirements,which is held by the same prime contractor,so much of the accrued payments or advances as may be considered necessary to pay laborers and mechanics, including apprentices,trainees, and helpers,employed by the contractor or any subcontractor the full amount of wages required by the contract. In the event of failure to pay any laborer or mechanic, including any apprentice,trainee, or helper,employed or working on the site of the work, all or part of the wages required by the contract,the (Agency) may, after written notice to the contractor,sponsor, applicant, or owner,take such action as may be necessary to cause the suspension of any further payment, advance, or guarantee of funds until such violations have ceased. (3) Payrolls and basic records. (i) Payrolls and basic records relating thereto shall be maintained by the contractor during the course of the work and preserved for a period of three years thereafter for all laborers and mechanics working at the site of the work. Such records shall contain the name, address,and social security number of each such worker, his or her correct classification, hourly rates of wages paid (including rates of contributions • or costs anticipated for bona fide fringe benefits or cash equivalents thereof of the types described in section 1(b)(2)(B) of the Davis-Bacon Act), daily and weekly number of hours worked, deductions made and actual wages paid.Whenever the Secretary of Labor has found under 29 CFR 5.5(a)(1)(iv)that the wages of any laborer or mechanic include the amount of any costs reasonably anticipated in providing benefits under a plan or program described in section 1(b)(2)(B)of the Davis-Bacon Act,the contractor shall maintain records which show that the commitment to provide such benefits is enforceable,that the plan or program is financially responsible, and that the plan or program has been communicated in writing to the laborers or mechanics affected, and records which show the costs anticipated or the actual cost incurred in providing such benefits.Contractors employing apprentices or trainees under approved programs shall maintain written evidence of the registration of apprenticeship programs and certification of trainee programs,the registration of the apprentices and trainees, and the ratios and wage rates prescribed in the applicable programs. (ii)(A) The contractor shall submit weekly,for each week in which any contract work is performed, a copy of all payrolls to the subrecipient,that is,the entity that receives the sub-grant or loan from the State capitalization grant recipient. Such documentation shall be available on request of the State App F Contract and Subcontract Provisions_ARRA_Handbook_AppendiceS Pdf recipient or EPA.As to each payroll copy received,the subrecipient shall provide written confirmation in a form satisfactory to the State indicating whether or not the project is in compliance with the requirements of 29 CFR 5.5(a)(1) based on the most recent payroll copies for the specified week.The payrolls shall set out accurately and completely all of the information required to be maintained under 29 CFR 5.5(a)(3)(i), except that full social security numbers and home addresses shall not be included on the weekly payrolls. Instead the payrolls shall only need to include an individually identifying number for each employee (e.g.,the last four digits of the employee's social security number).The required weekly payroll information may be submitted in any form desired. Optional Form WH-347 is available for this purpose from the Wage and Hour Division Web site at http://www.dol.gov/esa/whd/forms/wh347instr.htm or its successor site.The prime contractor is responsible for the submission of copies of payrolls by all subcontractors.Contractors and subcontractors shall maintain the full social security number and current address of each covered worker, and shall provide them upon request to the subrecipient (s)for transmission to the State or EPA if requested by EPA,the State,the contractor, or the Wage and Hour Division of the Department of Labor for purposes of an investigation or audit of compliance with prevailing wage requirements. It is not a violation of this section for a prime contractor to require a subcontractor to provide addresses and social security numbers to the prime contractor for its own records,without weekly submission to the subrecipient (s). (B) Each payroll submitted shall be accompanied by a "Statement of Compliance," signed by the contractor or subcontractor or his or her agent who pays or supervises the payment of the persons employed under the contract and shall certify the following: (1)That the payroll for the payroll period contains the information required to be provided under§5.5 (a)(3)(ii) of Regulations, 29 CFR part 5,the appropriate information is being maintained under§5.5 (a)(3)(i) of Regulations, 29 CFR part 5, and that such information is correct and complete; (2)That each laborer or mechanic(including each helper,apprentice, and trainee) employed on the contract during the payroll period has been paid the full weekly wages earned,without rebate, either directly or indirectly, and that no deductions have been made either directly or indirectly from the full wages earned, other than permissible deductions as set forth in Regulations, 29 CFR part 3; (3)That each laborer or mechanic has been paid not less than the applicable wage rates and fringe benefits or cash equivalents for the classification of work performed, as specified in the applicable wage determination incorporated into the contract. (C)The weekly submission of a properly executed certification set forth on the reverse side of Optional Form WH-347 shall satisfy the requirement for submission of the "Statement of Compliance" required by paragraph (a)(3)(ii)(B)of this section. (D)The falsification of any of the above certifications may subject the contractor or subcontractor to civil or criminal prosecution under section 1001 of title 18 and section 231 of title 31 of the United App F Contract and Subcontract Provisions_ARRA_Handbook_Appendices pdf States Code. (iii)The contractor or subcontractor shall make the records required under paragraph (a)(3)(i) of this section available for inspection,copying,or transcription by authorized representatives of the State, EPA or the Department of Labor,and shall permit such representatives to interview employees during working hours on the job. If the contractor or subcontractor fails to submit the required records or to make them available,the Federal agency or State may, after written notice to the contractor, sponsor, applicant, or owner,take such action as may be necessary to cause the suspension of any further payment, advance, or guarantee of funds. Furthermore,failure to submit the required records upon request or to make such records available may be grounds for debarment action pursuant to 29 CFR 5.12. (4)Apprentices and trainees-- (i)Apprentices.Apprentices will be permitted to work at less than the predetermined rate for the work they performed when they are employed pursuant to and individually registered in a bona fide apprenticeship program registered with the U.S. Department of Labor, Employment and Training Administration,Office of Apprenticeship Training, Employer and Labor Services, or with a State Apprenticeship Agency recognized by the Office,or if a person is employed in his or her first 90 days of probationary employment as an apprentice in such an apprenticeship program,who is not individually registered in the program, but who has been certified by the Office of Apprenticeship Training, Employer and Labor Services or a State Apprenticeship Agency (where appropriate)to be eligible for probationary employment as an apprentice.The allowable ratio of apprentices to journeymen on the job site in any craft classification shall not be greater than the ratio permitted to the contractor as to the entire work force under the registered program.Any worker listed on a payroll at an apprentice wage rate,who is not registered or otherwise employed as stated above,shall be paid not less than the applicable wage rate on the wage determination for the classification of work actually performed. In addition, any apprentice performing work on the job site in excess of the ratio permitted under the registered program shall be paid not less than the applicable wage rate on the wage determination for the work actually performed.Where a contractor is performing construction on a project in a locality other than that in which its program is registered,the ratios and wage rates(expressed in percentages of the journeyman's hourly rate)specified in the contractor's or subcontractor's registered program shall be observed. Every apprentice must be paid at not less than the rate specified in the registered program for the apprentice's level of progress, expressed as a percentage of the journeymen hourly rate specified in the applicable wage determination.Apprentices shall be paid fringe benefits in accordance with the provisions of the apprenticeship program. If the apprenticeship program does not specify fringe benefits, apprentices must be paid the full amount of fringe benefits listed on the wage determination for the applicable classification. If the Administrator determines that a different practice prevails for the applicable apprentice classification,fringes shall be paid in accordance with that determination. In the event the Office of Apprenticeship Training, Employer and Labor Services,or a State Apprenticeship Agency recognized by the Office,withdraws approval of an apprenticeship program,the contractor will no longer be permitted to utilize apprentices at less than the applicable predetermined rate for the App F Contract and Subcontract Provisions ARRA_Handbook_Appendices_pdf work performed until an acceptable program is approved. (ii)Trainees. Except as provided in 29 CFR 5.16,trainees will not be permitted to work at less than the predetermined rate for the work performed unless they are employed pursuant to and individually registered in a program which has received prior approval, evidenced by formal certification by the U.S. Department of Labor, Employment and Training Administration.The ratio of trainees to journeymen on the job site shall not be greater than permitted under the plan approved by the Employment and Training Administration. Every trainee must be paid at not less than the rate specified in the approved program for the trainee's level of progress,expressed as a percentage of the journeyman hourly rate specified in the applicable wage determination.Trainees shall be paid fringe benefits in accordance with the provisions of the trainee program. If the trainee program does not mention fringe benefits,trainees shall be paid the full amount of fringe benefits listed on the wage determination unless the Administrator of the Wage and Hour Division determines that there is an apprenticeship program associated with the corresponding journeyman wage rate on the wage determination which provides for less than full fringe benefits for apprentices.Any employee listed on the payroll at a trainee rate who is not registered and participating in a training plan approved by the Employment and Training Administration shall be paid not less than the applicable wage rate on the wage determination for the classification of work actually performed. In addition,any trainee performing work on the job site in excess of the ratio permitted under the registered program shall be paid not less than the applicable wage rate on the wage determination for the work actually performed. In the event the Employment and Training Administration withdraws approval of a training program,the contractor will no longer be permitted to utilize trainees at less than the applicable predetermined rate for the work performed until an acceptable program is approved. (iii) Equal employment opportunity.The utilization of apprentices,trainees and journeymen under this part shall be in conformity with the equal employment opportunity requirements of Executive Order 11246, as amended, and 29 CFR part 30. (5)Compliance with Copeland Act requirements.The contractor shall comply with the requirements of 29 CFR part 3,which are incorporated by reference in this contract. (6)Subcontracts.The contractor or subcontractor shall insert in any subcontracts the clauses contained in 29 CFR 5.5(a)(1)through (10) and such other clauses as the EPA determines may by appropriate, and also a clause requiring the subcontractors to include these clauses in any lower tier subcontracts.The prime contractor shall be responsible for the compliance by any subcontractor or lower tier subcontractor with all the contract clauses in 29 CFR 5.5. (7)Contract termination: debarment.A breach of the contract clauses in 29 CFR 5.5 may be grounds for termination of the contract,and for debarment as a contractor and a subcontractor as provided in 29 CFR 5.12. (8)Compliance with Davis-Bacon and Related Act requirements.All rulings and interpretations of the App F Contract and Subcontract Provisions_ARRA_Handbook_Appendices_Pdf Davis-Bacon and Related Acts contained in 29 CFR parts 1, 3, and 5 are herein incorporated by reference in this contract. (9) Disputes concerning labor standards. Disputes arising out of the labor standards provisions of this contract shall not be subject to the general disputes clause of this contract.Such disputes shall be resolved in accordance with the procedures of the Department of Labor set forth in 29 CFR parts 5, 6, and 7. Disputes within the meaning of this clause include disputes between the contractor(or any of its subcontractors)and Subrecipient(s),State, EPA,the U.S. Department of Labor,or the employees or their representatives. (10) Certification of eligibility. (i) By entering into this contract,the contractor certifies that neither it(nor he or she) nor any person or firm who has an interest in the contractor's firm is a person or firm ineligible to be awarded Government contracts by virtue of section 3(a)of the Davis-Bacon Act or 29 CFR 5.12(a)(1). (ii) No part of this contract shall be subcontracted to any person or firm ineligible for award of a Government contract by virtue of section 3(a)of the Davis-Bacon Act or 29 CFR 5.12(a)(1). (iii)The penalty for making false statements is prescribed in the U.S. Criminal Code, 18 U.S.C. 1001. 4. Contract Provision for Contracts in Excess of$100,000. (a)Contract Work Hours and Safety Standards Act.The subrecipient shall insert the following clauses set forth in paragraphs(a)(1), (2), (3), and (4)of this section in full in any contract in an amount in excess of$100,000 and subject to the overtime provisions of the Contract Work Hours and Safety Standards Act.These clauses shall be inserted in addition to the clauses required by Item 3, above or 29 CFF 4.6 . As used in this paragraph,the terms laborers and mechanics include watchmen and guards. (1) Overtime requirements. No contractor or subcontractor contracting for any part of the contract work which may require or involve the employment of laborers or mechanics shall require or permit any such laborer or mechanic in any workweek in which he or she is employed on such work to work in excess of forty hours in such workweek unless such laborer or mechanic receives compensation at a rate not less than one and one-half times the basic rate of pay for all hours worked in excess of forty hours in such workweek. (2)Violation; liability for unpaid wages; liquidated damages. In the event of any violation of the clause set forth in paragraph (a)(1) of this section the contractor and any subcontractor responsible therefor shall be liable for the unpaid wages. In addition, such contractor and subcontractor shall be liable to the United States (in the case of work done under contract for the District of Columbia or a territory,to such District or to such territory),for liquidated damages. Such liquidated damages shall be computed with respect to each individual laborer or mechanic, including watchmen and guards,employed in violation App F Contract and Subcontract Provisions_ARRA_Handbook_Appendices_pdf of the clause set forth in paragraph (a)(1) of this section, in the sum of$10 for each calendar day on which such individual was required or permitted to work in excess of the standard workweek of forty hours without payment of the overtime wages required by the clause set forth in paragraph (a)(1)of this section. (3) Withholding for unpaid wages and liquidated damages.The subrecipient, upon written request of the EPA Award Official or an authorized representative of the Department of Labor, shall withhold or cause to be withheld,from any moneys payable on account of work performed by the contractor or subcontractor under any such contract or any other Federal contract with the same prime contractor, or any other federally-assisted contract subject to the Contract Work Hours and Safety Standards Act, which is held by the same prime contractor,such sums as may be determined to be necessary to satisfy any liabilities of such contractor or subcontractor for unpaid wages and liquidated damages as provided in the clause set forth in paragraph (b)(2) of this section. (4)Subcontracts.The contractor or subcontractor shall insert in any subcontracts the clauses set forth in paragraph (a)(1)through (4)of this section and also a clause requiring the subcontractors to include these clauses in any lower tier subcontracts.The prime contractor shall be responsible for compliance by any subcontractor or lower tier subcontractor with the clauses set forth in paragraphs(a)(1)through (4) of this section. (b) In addition to the clauses contained in Item 3, above, in any contract subject only to the Contract Work Hours and Safety Standards Act and not to any of the other statutes cited in 29 CFR 5.1,the Subrecipient shall insert a clause requiring that the contractor or subcontractor shall maintain payrolls and basic payroll records during the course of the work and shall preserve them for a period of three years from the completion of the contract for all laborers and mechanics, including guards and watchmen,working on the contract. Such records shall contain the name and address of each such employee, social security number, correct classifications, hourly rates of wages paid, daily and weekly number of hours worked, deductions made, and actual wages paid. Further,the Subrecipient shall insert in any such contract a clause providing hat the records to be maintained under this paragraph shall be made available by the contractor or subcontractor for inspection, copying,or transcription by authorized representatives of the (write the name of agency)and the Department of Labor, and the contractor or subcontractor will permit such representatives to interview employees during working hours on the job. App F Contract and Subcontract Provisions_ARRA_Handbook_Appendices pdf CERTIFIED COPY OF RESOLUTION OF BOARD OF DIRECTORS OF AUGUST WINTER & SONS, INC. I, Gerald J. Hietpas, hereby certifying that I am duly elected and qualified Secretary of August Winter& Sons, Inc. and keeper of its records and the Corporate Seal and that the following is a true and correct copy of a Resolution duly adopted at a special meeting of the Board of Directors of said August Winter & Sons, Inc. duly convened in accordance with the By-Laws of said Corporation at its office at Appleton, Wisconsin, on the 3rd day of October, 2013 RESOLVED, that Gerald J. Hietpas, President, Secretary and Treasurer and Mark M. Eimmerman, Vice-President and Thomas A. Winter, Director and Robert H. Winter, Director, and each of them is hereby authorized to execute all contracts and all other papers necessary in the transaction of the Corporation's business and to bind the Corporation by such execution without any other signature of any other Officer. IN WITNESS WHEREOF, I have hereunto affixed my name as Secretary and have caused this Corporate Seal of said Corporation to be hereto affixed this 3rd day of October,2013. Gerald J. Hi tpas, S cretary (CORPORATE SEAL) I, Thomas A. Winter, a Director of said Corporation do hereby certify that the foregoing is a correct copy of a Resolution passed as therein set forth. Thomas A. inter, Director Bond No. 5497900 CONTROL SYSTEM, INFLUENT PUMPING & AERATION BLOWERS UPGRADE CITY OF OSHKOSH WASTEWATER TREATMENT PLANT PERFORMANCE BOND FORM Any singular reference to Contractor,Surety,Owner,or other party shall be considered plural where applicable, CONTRACTOR SURETY (Name and Address):; (Name and Address of Principal Place of Business): August Winter&Sons,Inc. Ohio Farmers Insurance Company 2323 N.Roemer Road,P.O.Box 1896 P.O.Box 5001 Appleton,WI 54912-1896 Westfield Center,OH 44251-5001 OWNER(Name and Address): City of Oshkosh,Wisconsin City Hall,215 Church Avenue Oshkosh,WI 54901 CONTRACT Date:February 4,2014 Amount:$4,210,500.00 Description(Name and Location):Control System,Influent Pumping&Aeration Blowers Upgrade, City of Oshkosh Wastewater Treatment Plant BOND Bond Number:5497900 Date(Not earlier than Contract Date):February 5,2014 Amount:$4,210,500.00 - Modifications to this Bond Form:N/A Surety and Contractor,intending to be legally bound hereby,subject to the terms printed on the reverse side hereof,do each cause this Performance Bond to be duly executed on its behalf by its authorized officer,agent, or representative. CONTRACTOR AS PRINCIPAL- SURETY Company: August Winter&Sons,Inc. Signature: .- - _ - Sal) . Ohio Farmers Insurance Company (Seal) Name and Tided D J//1^ 9S,priers Surety's Name and Corporate Seal By:- z .t�.. �Ci ► L Signatu a d Title Jill N. Swanson,Attorney-in-Fact (Attach Power of Attorney) (Space is provided below for signatures of additional parties,if required.) Attest:___ Signature and Title Wi -ss MKE/469462 PERFORMANCE BOND FORM OCTOBER 22, 2013 00 61 13.13- 1 ©COPYRIGHT 2013 CH2M HILL CONTROL SYSTEM,INFLUENT PUMPING &AERATION BLOWERS UPGRADE CITY OF OSHKOSH WASTEWATER TREATMENT PLANT CONTRACTOR AS PRINCIPAL SURETY Company: Signature. . (Seal) (Seal.). Name and Title = =Surety's Name and Corporate Seal By:. Signature and Title (Attach Power of Attorney) Attest: Signature and Title PERFORMANCE BOND FORM MKE/469462 00 61 13.13 - 2 OCTOBER 22, 2013 ©COPYRIGHT 2013 CH2M HILL CONTROL SYSTEM;INFLUENT PUMPING&AERATION BLOWERS UPGRADE CITY OF OSHKOSH WASTEWATER TREATMENT PLANT I. Contractor and Surety,jointly and severally,bind 4.3. Obtain bids or negotiated proposals from themselves,their heirs,executors;administrators; qualified contractois acceptable to Owner for a successors,and assigns to Owner for the performance contract for performance and completion of the of the Contract,which is incorporated herein by Contract,arrange for a contract to be prepared for reference. execution by Owner and Contractor selected with Owner's concurrence;to be secured with 2. If Contractor performs the Contract,Surety and performance and payment bonds executed by a Contractor have no obligation under this Bond; qualified surety equivalent to the bonds issued on except to participate in conferences as provided in the Contract,and pay to Owner the amount of Paragraph 3.1. damages as described in Paragraph 6 in excess of the Balance of the Contract Price incurred by 3,. If there is no Owner Default,Surety's obligation Owner resulting from Contractor Default;or under this Bond shall arise after: 4,4. Waive its right to perform and complete, 3.1. Owner has notified Contractor and Surety,at. arrange for completion,or obtain a new contractor the addresses described in Paragraph 10 below, and with reasonable promptness under the that Owner is considering declaring a Contractor circumstances- Default and has requested and attempted to arrange a conference with Contractor and Surety 1. After investigation,determine the to be held not later than 15.days after receipt of amount for which it may be liable to Owner such notice to discuss methods of performing the and as soon as practicable after the amount Contract.If Owner,Contractor and Surety agree, is determined, tender payment therefor to Contractor shall be allowed a reasonable time to Owner;or perform the Contract,but such an agreement shall not waive Owner's right,if any subsequently to 2. Deny liability in whole or in part and declare a Contractor Default; and notify Owner citing reasons therefor. 3.2 Owner has declared a Contractor Default 5- If Surety does not proceed as provided in and formally terminated,Contractor's right to Paragraph 4 with reasonable promptness,Surety shall complete the Contract.Such Contractor Default be deemed to be in default on this Bond 15 days after shall not be declared earlier than 20 days after receipt of an additional written notice from Owner to Contractor and Surety have received notice as Surety demanding that Surety perform its obligations provided in Paragraph 3.1;and under this Bond,and Owner shall be entitled to enforce any remedy available to Owner.If Surety 3.3. Owner has agreed to pay the Balance of the proceeds as provided in Paragraph 4.4,and Owner Contract Price to: refuses the payment tendered or Surety has denied liability,in whole or in part,without further notice 1: Surety in accordance with the terms of Owner shall be entitled to enforce any remedy the Contract; available to Owner. 2: Another contractor selected pursuant to 6. After Owner has terminated Contractor's right to Paragraph 4.3 to perform the Contract. complete the Contract,and if Surety elects to act under Paragraph 4.1,4,2, or 4.3 above,then the 4. When Owner has satisfied the conditions of responsibilities of Surety to Owner shall not be Paragraph 3;Surety shall promptly and at Surety's greater than those of Contractor under the Contract, expense take one of the following actions: and the responsibilities of Owner to Surety shall not be greater than those of Owner under the Contract. 4.1. Arrange for Contractor,with consent of To a limit of the amount of this Bond,but subject to Owner.to perform and complete the Contract;or commitment by Owner of the Balance of the Contract Price to mitigation of costs and damages on the 4.2: Undertake to perform and complete the Contract,Surety is obligated without duplication for: Contract itself,through its agents or through independent contractors;or MKEJ469462 PERFORMANCE BOND FORM OCTOBER 22, 2013 00 61 13.13 - 3 ©COPYRIGHT 2013 CH2M HILL CONTROL SYSTEM,INFLUENT PUMPING &AERATION BLOWERS UPGRADE CITY OF OSHKOSH WASTEWATER TREATMENT PLANT 6.1. The responsibilities of Contractor for 10.Notice to Surety,Owner,or Contractor shall be correction of defective Work and completion of mailed or delivered to the address shown on the the Contract;: signature page. 6.2. Additional legal,design professional,and 1 1.When this Bond has been furnished to comply delay costs resulting from Contractor's Default, with a statutory requirement in the location where the and resulting from the actions or failure to act of Contract was to be performed,any provision in this Surety under Paragraph 4;and Bond conflicting with said statutory requirement shall be deemed deleted herefrom and provisions 6.3. Liquidated damages,or if no liquidated conforming to such statutory requirement shall be damages are specified in the Contract,actual deemed incorporated herein.The intent is that this damages caused by delayed performance or non- Bond shall be construed as a statutory bond and not performance of Contractor, as a common law bond: 7. Surety shall not be liable to Owner or others for 12.Definitions. obligations of Contractor that are unrelated to the Contract,and the Balance of the Contract Price shall 12.1.Balance of the Contract Price:The total not be reduced or set off on account of any such amount payable by Owner to Contractor under the unrelated obligations.No right of action shall accrue Contract after all proper adjustments have been on this Bond to any person or entity other than made,including allowance to Contractor of any Owner or its heirs,executors,administrators,or amounts received or to be received by Owner in successors. settlement of insurance or other Claims for damages to which Contractor is entitled,reduced 8. Surety hereby waives notice of any change, by all valid and proper payments made to or on including changes of time,to Contract or to related behalf of Contractor under the Contract subcontracts,purchase orders,and other obligations. 12.2.Contract:The agreement between Owner 9_ Any proceeding,legal or equitable,under this and Contractor identified on the signature page, Bond may be instituted in any court of competent including all Contract Documents and changes jurisdiction in the location in which the Work or part thereto. of the Work is located and shall be instituted within two years after Contractor Default or within two 12.3.Contractor Default:Failure of Contractor, years after Contractor ceased working or within two which has neither been remedied nor waived,to years after Surety refuses or fails to perform its perform or otherwise to comply with the terms of obligations under this Bond,whichever occurs first. the Contract. If the provisions of this paragraph are void or prohibited by law,the minimum period of limitation 12.4.Owner Default:Failure of Owner,which has available to sureties as a defense in the jurisdiction of neither been remedied nor waived,to pay the suit shall be applicable. Contractor as required by the Contract or to perform and complete or comply with the other terms thereof. FOR INFORMATION ONLY—Name,Address and Telephone Willis of Minnesota;Inc. Surety Agency or Broker 1600 Utica Avenue South,Suite 600 Owner's Representative(engineer or other party) Minneapolis,MN 55416 763 307 7100 END OF SECTJON__ PERFORMANCE BOND FORM MKE/469462 00 61 13.13 -4 OCTOBER 22, 2013 @COPYRIGHT 2013 CH2M HILL Bond No. 5497900 • CONTROL SYSTEM, INFLUENT PUMPING &AERATION BLOWERS UPGRADE CITY OF OSHKOSH WASTEWATER TREATMENT PLANT PAYMENT BOND FORM Any singular reference to Contractor,Surety,Owner,or other party shall be considered plural where applicable.. CONTRACTOR SURETY (Name and Address); (Name and Address of Principal Place of Business): August Winter&Sons,Inc. Ohio Farmers Insurance Company 2323 N.Roemer Road,P.O.Box 1896 P.O.Box 5001 Appleton,WI 54912-1896 Westfield Center,OH 44251-5001 OWNER(Name and Address): City of Oshkosh;Wisconsin City Hall,215 Church Avenue Oshkosh,WI 54901 CONTRACT Date: February 4,2014 Amount:$4,210,500.00 Description(NAME AND LOCATION) Control System,Influent Pumping&Aeration Blowers Upgrade, City of Oshkosh Wastewater Treatment Plant BOND Bond Number:;5497900 Date(Not earlier than Contract Date):February 5,2014 Amount:$4,210,500.00 Modifications to this Bond Form:N/A Surety and Contractor,intending to be legally bound hereby,subject to the terms printed on the reverse side hereof,do each cause this Payment Bond to be duly executed on its behalf by its authorized officer,agent,or representative, CONTRACTOR AS PRINCIPAL SURETY Company:. Aug ust Winter&Sons,Inc. Signature: • (Seal) Ohio Farmers Insurance Company (Seal) Name and T:it1 R/¢cd f"ffj /1)‘•pg_E.5 Surety's Name and Corporate Seal By: v \ Signatu ei a d Title Jill N. Swanson,Attorney-in-Fact (Attach Power of Attorney) (Space is provided below for signatures of additional parties,if required.) / Attest.., r,'` 4 Signature and Title Wn ess MKE/469462 PAYMENT BOND FORM OCTOBER 22,2013 00 61 13.16 - 1 ©COPYRIGHT 2012 CH2M HILL CONTROL SYSTEM,INFLUENT PUMPING& AERATION BLOWERS UPGRADE CITY OF OSHKOSH WASTEWATER TREATMENT PLANT CONTRACTOR AS PRINCIPAL SURETY Company: Signature: (Seal) {Seal) Name and Title Surety's Name and Corporate Seal By: Signature and Title (Attach Power of Attorney) Attest: Signature and Title PAYMENT BOND FORM MKE/469462 00 61 13.16-2 OCTOBER 22,2013 ©COPYRIGHT 2013 CH2M HILL CONTROL SYSTEM,INFLUENT PUMPING &AERATION BLOWERS UPGRADE CITY OF OSHKOSH WASTEWATER TREATMENT PLANT I. Contractor and Surety,jointly and severally,bind were furnished or supplied,or for whom the themselves,their heirs,executors,administrators, labor was done or performed;and successors,and assigns to Owner to pay for labor, materials,and equipment furnished by Claimants for 2. Have either received a rejection in use in the performance of the Contract,which is whole or in part from Contractor,or not incorporated herein by reference. received within 30 days of furnishing the above notice any communication from 2. With respect to Owner,this obligation shall be Contractor by which Contractor had null and void if Contractor; indicated the claim will be paid directly or indirectly; and 2.1. Promptly makes payment,directly or indirectly,for all sums due Claimants,and 3: Not having been paid within the above 30 days,have sent a written notice to Surety 2.2. Defends,indemnifies,and holds harmless and sent a copy,or notice thereof,to Owner, Owner from all claims,demands,liens,or suits stating that a claim is being made under this alleging non-payment by Contractor by any - Bond;and enclosing a copy of the previous. person or entity who furnished labor,materials,or written:notice furnished to Contractor. equipment for use in the performance of the Contract;provided Owner has promptly notified 5. If a notice by a Claimant required by Paragraph 4 Contractor and Surety(at the addresses described is provided by Owner to Contractor or to Surety,that in Paragraph 12)of any claims,demands,liens,or is sufficient compliance. suits and tendered defense of such claims, demands,liens,or suits to Contractor and Surety, 6. When a Claimant has satisfied the conditions of and provided there is no Owner Default. Paragraph 4,the Surety shall promptly and at Surety's expense take the following actions: 3.: With respect to Claimants,this obligation shall be null and void if Contractor promptly makes payment, 6.1. Send an answer to that Claimant,with a directly or indirectly,for all sums due.: copy to Owner,within 45 days after receipt of the claim,stating the amounts that are undisputed and 4. Surety shall have no obligation to Claimants the basis for challenging any amounts that are under this Bond until:' disputed. 4.1. Claimants who are employed by or have a 6.2. Pay or arrange for payment of any direct contract with Contractor have given notice undisputed amounts. to Surety(at the addresses described in Paragraph 12 and sent a co ) copy,or notice thereof, 7; Surety's total obligation shall not exceed the to Owner,stating that a claim is being made under amount of this Bond,and the amount of this Bond this Bond and with substantial accuracy,the shall be credited for any payments made in good faith amount of the claim: by Surety: 4.2. Claimants who do not have a direct contract 8. Amounts owed by Owner to Contractor under the with Contractor. Contract shall be used for the performance of the Contract and to satisfy claims,if any under any . Have furnished written notice to performance bond.By Contractor furnishing and Contractor and sent a copy,or notice Owner accepting this Bond,they agree that all funds thereof;to Owner,within'90 days after, earned by Contractor in the performance of the having last performed labor or last furnished Contract are dedicated to satisfy obligations of materials or equipment included in the claim Contractor and Surety under this Bond, subject to stating,with substantial accuracy,the Owner's priority to use the funds for the completion amount of the claim and the name of the of the Work party to whom the,materials or equipment MKE/469462 PAYMENT BOND FORM OCTOBER 22, 2013 00 61 13.16 3 ©COPYRIGHT 2013 CH2M HILL CONTROL SYSTEM, INFLUENT PUMPING &AERATION BLOWERS UPGRADE CITY OF OSHKOSH WASTEWATER TREATMENT PLANT 9. Surety shall not be liable to Owner,Claimants,or conforming to such statutory requirement shall be others for obligations of Contractor that are unrelated deemed incorporated herein.The intent is that this to the Contract.Owner shall not be liable for Bond shall be construed as a statutory Bond and not payment of any costs or expenses of any Claimant as a common law bond. under this Bond,and shall have under this Bond no obligations to make payments to,give notices on 14.Upon request of any person or entity appearing to behalf of,or otherwise have obligations to Claimants be a potential beneficiary of this Bond,Contractor under this Bond. shall promptly furnish a copy of this Bond or shall permit a copy to be made. 10.Surety hereby waives notice of any change, including changes of time,to the Contract or td 15.Definitions• related Subcontracts,purchase orders and other obligations., 15.1.Claimant:An individual or entity having a direct contract with Contractor,or with a first-tier 11.No suit or action shall be commenced by a subcontractor of Contractor,to furnish labor, Claimant under this Bond other than in a court of materials,or equipment for use in the competent jurisdiction in the location in which the performance of the Contract.The intent of this Work or part of the Work is located or after the Bond shall be to include without limitation in the expiration of one year from the date(1)on which the terms'labor,materials or equipment"that part of Claimant gave the notice required by Paragraph 4.] water,gas,power,Iight,heat,oil,gasoline, or Paragraph 42.3,or(2)on which the last labor or telephone service,or rental equipment used in the service was performed by anyone or the last materials. Contract,architectural and engineering services or equipment were furnished by anyone under the required for performance of the Work of Construction Contract,whichever of(I)or(2)first Contractor and Contractor's Subcontractors,and occurs.If the provisions of this paragraph are void or all other items for which a mechanic's lien may be prohibited by law,the minimum period of limitation asserted in the jurisdiction where the labor, available to sureties as a defense in the jurisdiction of materials,or equipment were furnished. the suit shall be applicable. 15.2.Contract:The agreement between Owner 12.Notice to Surety,Owner,or Contractor shall be and Contractor identified on the signature page, mailed or delivered to the addresses shown on the including all Contract Documents and changes signature page.Actual receipt of notice by Surety, thereto_. Owner,or Contractor,however accomplished,shall be sufficient compliance as of the date received at the 15.3.Owner Default:Failure of Owner,which has address shown on the signature page. neither been remedied nor waived,to pay Contractor as required by the Contract or to 13.When this Bond has been furnished to comply perform and complete or comply with the other with a statutory requirement in the location where the terms thereof: Contract was to be performed,any provision in this Bond conflicting with said statutory requirement shall be deemed deleted herefrom and provisions FOR INFORMATION ONLY--Name,Address and Telephone Willis of Minnesota,Inc, Surety Agency or Broker: 1600 Utica Avenue South,Suite 600 Owner's Representative(engineer or other party): Minneapolis,MN 55416 761-307-7100 END OF SECTION PAYMENT BOND FORM MKE/469462 00 61 13.16 4 OCTOBER 22, 2013 ©COPYRIGHT 2013 CH2M HILL Surety Acknowledgment State of MINNESOTA } } ss. County of Hennepin } On this 5th day of February 2014, before me personally came Jill N. Swanson, to me known,who being by me duly sworn, did depose and say that she is the Attorney-in-Fact of Ohio Farmers Insurance Company described in and which executed the above instrument; that she/he knows the seal of said corporation; that the seal affixed to said instruments is such corporate seal, that it was so affixed by order of the Board of Directors of said corporation, and that she/he signed her/she/his name to it by like order. /"\I CAkda S W Notary Public I "`▪ ':- °`'' MICHELLE DIANE SYLVESTER '4'' ";�;U:> i NOTARY PUBLIC-MWNESOTA s // My Commission Expires January 31,2018 • mi THIS POWER OF ATTORNEY SUPERCEDES ANY PREVIOUS POWER BEARING THIS SAME POWER#AND ISSUED PRIOR TO 09127/13,FOR ANY PERSON OR PERSONS NAMED BELOW. • General POWER NO. 2263612 01 Power Westfield Insurance Co. of Attorney Westfield National Insurance Co. CERTIFIED COPY Ohio Farmers Insurance Co. Westfield Center, Ohio Know All Men by These Presents, That WESTFIELD INSURANCE COMPANY, WESTFIELD NATIONAL INSURANCE COMPANY and OHIO FARMERS INSURANCE COMPANY, corporations, hereinafter referred to individually as a "Company" and collectively as "Companies," duly organized and existing under the laws of the State of Ohio, and having its principal office in Westfield Center, Medina County,Ohio,do by these presents make,constitute and appoint DENNIS LOOTS, LAURIE PFLUG, NINA E.WERSTEIN, BRIAN D.CARPENTER, NICOLE LANGER,CRAIG OLMSTEAD, JESSICA HOFF, MICHELLE SYLVESTER, HEATHER R.GOEDTEL,JILL N.SWANSON, JOINTLY OR SEVERALLY of MINNEAPOLIS and State of MN its true and lawful Attorney(s)-in-Fact,with full power and authority hereby conferred in its name, place and stead, to execute, acknowledge and deliver any and all bonds, recognizances, undertakings, or other instruments or contracts of suretyship- , UMITATION: THIS POWER OF ATTORNEY CANNOT BE USED TO EXECUTE NOTE GUARANTEE, MORTGAGE DEFICIENCY, MORTGAGE GUARANTEE,OR BANK DEPOSITORY BONDS. and to bind any of the Companies thereby as fully and to the same extent as If such bonds were signed by the President,sealed with the corporate seal of the applicable Company and duly attested by its Secretary, hereby ratifying and confirming all that the said Attorney(s)-in-Fact may do in the premises. Said appointment is made under and by authority of the following resolution adopted by the Board of Directors of each of the WESTFIELD INSURANCE COMPANY,WESTFIELD NATIONAL INSURANCE COMPANY and OHIO FARMERS INSURANCE COMPANY: "Be It Resolved,that the President,any Senior Executive,any Secretary or any Fidelity&Surety Operations Executive or other Executive shall be and is hereby vested with full power and authority to appoint any one or more suitable persons as Attomey(s)-in-Fact to represent and act for and on behalf of the Company subject to the following provisions: The Attorney-in-Fact. may be given full power and authority for and in the name of and on behalf of the Company,to execute,acknowledge and deliver,any and all bonds, recognizances, contracts,agreements of indemnity and other conditional or obligatory undertakings and any and all notices and documents canceling or terminating the Company's liability thereunder, and any such instruments so executed by any such Attorney-in-Fact shall be as binding upon the Company as if signed by the President and sealed and attested by the Corporate Secretary' "Be it Further Resolved,that the signature of any such designated person and the seal of the Company heretofore or hereafter affixed to any power of attorney or any certificate relating thereto by facsimile,and any power of attorney or certificate bearing facsimile signatures or facsimile seal shall be valid and binding upon the Company with respect to any bond or undertaking to which it is attached" (Each adopted at a meeting held on February 8,2000). In Witness Whereof,WESTFIELD INSURANCE COMPANY, WESTFIELD NATIONAL INSURANCE COMPANY and OHIO FARMERS INSURANCE COMPANY have caused these presents to be signed by their National Surety Leader and Senior Executive and their corporate seals to be hereto affixed this 27th day of SEPTEMBER A.D.,2013 . Corporate �s u.w...y'y. _ ,�,,.w..nn.y - ,,,.uvuq,p, dsYR.(p ��(�NAi j'' ,NS WESTFIELD INSURANCE COMPANY Seals fO`•,..•....,.P� ,.... .,NS•., ?,• y Affixed •�v: eau titm} ;va G�:; Se ...'••.,-ogy WESTFIELD NATIONAL INSURANCE COMPANY C.- =�. 9z 4.•' IJtTFiP �, OHIO FARMERS INSURANCE COMPANY ?ut ED Pal ,,r . 1a :m SEAL m e s.: L' ran `=;T•. 'o:. -a'; 1848.:' . ? Kr‘i. ••%• State of Ohio ""� " "' "'"""'•'".� Dennis P. Baus, National Surety Leader and County of Medina ss.: Senior Executive On this 27th day of SEPTEMBER A.D.,2013 , before me personally came Dennis P. Baus to me known,who, being by me duly sworn,did depose and say, that he resides in Wooster, Ohio;that he is National Surety Leader and Senior Executive of WESTFIELD INSURANCE COMPANY,WESTFIELD NATIONAL INSURANCE COMPANY and OHIO FARMERS INSURANCE COMPANY,the companies described In and which executed the above instrument;that he knows the seals of said Companies;that the seals affixed to said instrument are such corporate seals;that they were so affixed by order of the Boards of Directors of said Companies;and that he signed his name thereto by like order. • Nota ria I „•..•,•••......r Seal Ss\A l •ak Affixed \��;�fJf/�St / ' 1 • William J. Kahelin, A .•rney at Law, Notary Public State of Ohio "'Jo My Commission Does Not Expire(Sec. 147.03 Ohio Revised Code) County of Medina ss.: •;•2' Ai0'N- 9TE• of O r I, Frank A.Carrino, Secretary of WESTFIELD INSURANCE COMPANY,WESTFIELD NATIONAL INSURANCE COMPANY and OHIO FARMERS INSURANCE COMPANY, do hereby certify that the above and foregoing is a true and correct copy of a Power of Attorney, executed by said Companies,which is still in full force and effect;and furthermore,the resolutions of the Boards of Directors,set out in the Power of Attorney are in full force and effect. In Witness Whereof, I have hereunto set my hand and affixed the seals of said Companies at Westfield Center, Ohio, this 5th day of February A,P 2014 • _ • ifs �.;vs '�:. SEAL 2JA -�: :rn= .o• ;Z Secretary �•.,•�•.,ars ,, -*; ;o ` ';.1848.: Frank A.Carrino, Secretary BPOAC2(combined) (06-02) _....---■ AUGUWIN-02 STDE ACC,FZO CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 2/5/2014 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 poiicy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER (920)739-7711 NAME:CT Customer Support Willis of Wisconsin,Inc.-Appleton PHONE FAX 122 E.College Avenue (A/C,No,Eat): (A/C,No): 920-739-1543 E-MAIL City Center East,2nd Floor copy/7 ADDRESS:certrequests.ds @Willis.com Appleton,WI 54911 L'rJJ \1LV1(/ INSURER(S)AFFORDING COVERAGE NAIC# LJ INSURER A:Phoenix Insurance Company 25623 INSURED August Winter&Sons, Inc. INSURER B:Travelers Property Casualty Company of Am25674 Attn: Sharon Bons INSURER C:Cincinnati Insurance Company 10677 P O Box 1896 INSURER D:Travelers Indemnity Company of America 25666 Appleton,WI 54912-1896 INSURER E:Charter Oak Fire Insurance Co 25615 _INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LTR ,INSR WVO POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYYL LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 2,000,000 A X COMMERCIAL GENERAL LIABILITY X DT-CO-6934C377-PHX-13 10/1/2013 10/1/2014 DAMAGE TO RENTED $ 300,000 PREMISES(Ea occurrence) CLAIMS-MADE X OCCUR MED EXP(Any one person) $ 10,000 X Contractual Liability PERSONAL&ADV INJURY $ 2,000,000 GENERAL AGGREGATE $ 4,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 4,000,000 POLICY X P JECRO T LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 1,000,000 (Ea accident) $ B X ANY AUTO X DT810-323D2093-TIL-13 10/1/2013 10/1/2014 BODILY INJURY(Per person) $ - ALL OWNED SCHEDULED BODILY INJURY(Per accident AUTOS AUTOS ( accident) $ NON-OWNED PROPERTY DAMAGE •X AUTOS (Per accident) $ X HIRED AUTOS UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 20,000,000 C X EXCESS LIAB CLAIMS-MADE X EXS0102952 10/1/2013 10/1/2014 AGGREGATE $ ' 20,000,000 DED X RETENTION$ $0 $ WORKERS COMPENSATION X WC STATU- OTH- AND EMPLOYERS'LIABILITY Y/N TORY LIMITS .ER D ANY PROPRIETOR/PARTNER/EXECUTIVE DTDTCHUB-6934C37-7-13 10/1/2013 10/1/2014 E.L.EACH ACCIDENT $ 100,000 OFFICER/MEMBER EXCLUDED? N N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 100,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 E Workers Compensation DTOUB-5580L00-2-13 10/1/2013 10/1/2014 Employers Liability $100/$500/$100,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) See attached page. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Oshkosh, City of ACCORDANCE WITH THE POLICY PROVISIONS. Attn: City Clerk P 0 Box 1130 AUTHORIZED REPRESENTATIVE Oshkosh,WI 54903-1130 __ ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD AUGUWIN-02 SIDE PAGE 1 OF 1 DESCRIPTION OF OPERATIONS - August Winter&Sons, Inc. Oshkosh,City of Attn: Sharon Bons Attn: City Clerk P O Box 1896 P O Box 1130 Appleton,WI 54912-1896 Oshkosh,WI 54903-1130 A 30-day notice of cancellation,except 10 days for non-payment of premium, is provided under the Comm'I General Liability per attached ILT400 1209,Automobile Liability per attached ILT400 1209 and Workers Compensation policies per(2)attached WC990611(A). Re:AWS Job#61114--Oshkosh WWTP (02/2014) The City of Oshkosh and its officers, council members,agents,employees and authorized volunteers, and CH2M Hill and their respective officers, directors, members, partners,employees, consultants,and subcontractors are named as additional insureds to the Comm'l General Liability(primary basis)for acts caused by AWS in the performance of their work to which the written contract requiring insurance applies per attached CGT808,Auto Liability and Excess Liability as required by written contract. POLICY NUMBER: DT—00-6934C377—PBX--13 COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY BLANKET ADDITIONAL INSURED (CONTRACTORS) This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART 1. WHO IS AN INSURED—(Section II) is amended c) The insurance provided to the additional in- to include any person or organization that you sured does not apply to "bodily injury" or agree in a'written contract requiring insurance to "property damage"caused by"your work"and include as an additional insured on this Coverage included in the "products-completed opera- Part, but: tions hazard" unless the "written contract re- a) Only with respect to liability for "bodily injury", quiring insurance" specifically requires you to "property damage"or"personal injury";and provide such coverage for that additional in- sured, and then the insurance provided to the b) If, and only to the extent that, the injury or additional insured applies only to such"bodily damage is caused by acts or omissions of you injury" or "property damage" that occurs be- or your subcontractor in the performance of fore the end of the period of time for which the "your work" to which the "written contract re- "written contract requiring insurance" requires quiring insurance" applies. The person or or- you to provide such coverage or the end of ganization does not qualify as an additional the policy period,whichever is earlier. insured with respect to the independent acts 3. The insurance provided to the additional insured or omissions of such person or organization. p by this endorsement is excess over any valid and 2. The insurance provided to the additional insured collectible other insurance, whether primary, ex- by this endorsement is limited as follows: cess, contingent or on any other basis, that is a) In the event that the Limits of Insurance of this available to the additional insured for a loss we Coverage Part shown in the Declarations ex- cover under this endorsement. However, if the ceed the limits of liability required by the"writ- "written contract requiring insurance" specifically ten contract requiring insurance", the incur- requires that this insurance apply on a primary ance provided to the additional insured shall basis or a primary and non-contributory basis, this be limited to the limits of liability required by insurance is primary to other insurance available that "written contract requiring insurance". to the additional insured which covers that person This endorsement shall not increase the limits or organization as a named insured for such loss, of insurance described in Section III — Limits and we will not share with that other insurance. Of Insurance, But the insurance provided to the additional in- sured by this endorsement still is excess over any b) The Insurance provided to the additional in- valid and collectible other insurance, whether pri- cured does not apply to "bodily injury", "prop- mary, excess, contingent or on any other basis, erty damage" or "personal injury" arising out that is available to the additional insured when of the rendering of, or failure to render, any that person or organization is an additional in- professional architectural, engineering or sur- sured under such other insurance. veying services, including: 4. As a condition of coverage provided to the i. The preparing, approving, or failing to additional insured by this endorsement: prepare or approve, maps, shop draw- ings, opinions, reports, surveys, field or- a) The additional insured must give us written ders or change orders, or the preparing, notice as soon as practicable of an "occur- approving, or failing to prepare or ap- rence" or an offense which may result in a prove,drawings and specifications; and claim. To the extent possible, such notice ii. Supervisory, inspection, architectural or should include: engineering activities. i. How,when and where the"occurrence"or offense took place; CG T8 08 06 13 ©2013 The Travelers Indemnity Company. All rights reserved. Page 1 of 2 COMMERCIAL GENERAL LIABILITY ii. The names and addresses of any injured cover under this endorsement. However, this persons and witnesses; and condition does not affect whether the insur- III. The nature and location of any injury or ance provided to the additional insured by this endorsement is damage arising out of the"occurrence"or available to the additional t insured which co- offense. vers that person or organization as a named b) If a claim is made or"suit" is brought against insured as described in paragraph 3.above. the must:additional insured, the additional insured 5. The following definition is added to SECTION V.— DEFINITIONS: I. Immediately record the specifics of the claim or"suit"and the date received;and "Written contract requiring insurance" means that part of any written contract or agreement Notify us as soon as practicable. under which you are required to include a The additional insured must see to it that we person or organization as an additional in- receive written notice of the claim or"suit"as sured on this Coverage Part, provided that the soon as practicable. "bodily injury" and "property damage" occurs c) The additional insured must immediately send and the "personal injury" is caused by an of- fense committed: us copies of all legal papers received in con- nection with the claim or"suit", cooperate with a. After the execution of the contract or us in the investigation or settlement of the agreement by you; claim or defense against the "suit", and oth- b. While that part of the contract or erwise comply with all policy conditions. agreement is in effect;and d) The additional insured must tender the de- c. Before the end of the policy period. fense and indemnity of any claim or "suit" to any provider of other insurance which would cover the additional insured for a loss we Page 2 of 2 ©2013 The Travelers Indemnity Company. All rights reserved. CG T8 08 06 13 • POLICY NUMBER DT—C0-6934C377—PH%-13 ISSUE DATE: 10/01/13 THIS ENDORSEMENT CHANGES THE POLICY,PLEASE READ IT CAREFULLY. DESIGNATED ENTITY-- NOTICE OF CANCELLATION/NONRENEWAL PROVIDED BY US Thls endorsement modifies Insurance provided under the following: ALL COVERAGE PARTS INCLUDED IN THIS POLICY SCHEDULE CANCELLATION: Number of Days Notice of Cancellation: 30 NONRE■EWAL; Number of Days Notice of Nonrenewal: PERSON OR ORGANIZATION; ANY PERSON OR ORGANIZATION TO WHOM YOU HAVE AGREED IN A WRITTEN CONTRACT 'THAT NOTICE OF CANCELLATION OR MATERIAL LIMITATIONS OF THIS POLICY WILL BE GIVEN, BUT ONLY IF; 1. YOU SEND US A WRITTEN'RRQUEST TO PROVIDE SUCH NOTICE, INCLUDING THE NAME AND ADDRESS OF SUCH PERSON OR ORGANIZATION, AFTER THE FIRST NAMED INSURED RECEIVES NOTICE FROM US OF THE CANCELLATION OR MATERIAL LIMITATION OF THIS POLICY; AND 2. WE RECEIVE SUCH WRITTEN REQUEST AT LEAST 14 DAYS BEFORE THE BEGINNING OF THE APPLICABLE NUMBER OF DAYS SHOWN IN THIS SCHEDULE • ADDRESS; THE ADDRESS FOR THAT PERSON OR ORGANIZATION INCLUDED IN SUCH WRITTEN REQUEST FROM YOU 'TO US. PROVISIONS; A. If we cancel this policy for any statutorily permit- B. If we decide to not renew this policy for any siatu- ted reason other than nonpayment of premium, tartly permitted reason, and a number of days is and a number of days is shown for cancellation In shown for nonrenewal In the schedule above, wo the schedule above,we will mall notice of cancel- will mail notice of the nonrenewal to the person or lation to the person or organization shown In the organization shown In the schedule above, We schedule above. We will mall such notice to the will mall such notice to the address shown in The' address shown In the schedule above at least the schedule above at least.the number of days number of days shown for cancellation In the shown for nonrenewal In the schedule above be- schedule above before the effective date of can- fore the expiration data, cellation. IL T4 00 12 09 ®2009 The Travelers Indemnity Company Page 1 of 1 • POLICY NUMBER: DT-810-323D2093—TIL-13 ISSUE DATE: 10/01/13 THIS ENDORSEMENT CHANGES THE POLICY.PLEASE READ IT CAREFULLY. DESIGNATED ENTITY -- NOTICE OF CANCELLATION/NONRENEWAL. PROVIDED BY US This endorsement modifies Insurance provided under iho following: ALL COVERAGE PARTS INCLUDED IN THIS POLICY SCHEDULE CANCELLATION: Number of bays Notice of Cancellation: 30 NONRENEWAL: Number of Days Notice of Nonrenewal: PERSON OR ORGANIZATION: 'ANY' PERSON OR ORGANIZATION TO WHOM YOU HAVE AGREED IN A WRITTEN CONTRACT THAT NOTICE OF CANCELLATION OR MATERIAL LIMITATIONS OF THIS POLICY WILL BE GIVEN, /MT ONLY IF; 1. YOU SEND US A WRITTEN REQUEST TO PROVIDE SUCH NOTICE, INCLUDING THE NAME AND ADDRESS OF SUCH PERSON OR ORGANIZATION, AFTER THE FIRST NAMED INSURED RECEIVES NOTICE FROM US OF THE CANCELLATION OR MATERIAL LIMITATION OF THIS POLICY] AND 2. WE RECEIVE SUCH WRITTEN REQUEST AT LEAST 14 DAYS BEFORE THE BEGINNING OF THE APPLICABLE NUMBER OF DAYS SHOWN IN THIS SCHEDULE. ADDRESS: THE ADDRESS FOR THAT PERSON OR ORGANIZATION INCLUDED IN SUCH WRITTEN REQUEST FROM YOU TO US." PROVISIONS: A. If we cancel this policy for any statutorily permit- E. If we decide to not renew this policy for any state- ted reason other than nonpayment of premium, torfiy permitted reason, and a number of days Is and a number of days Is shown for cancellation in shown for nonrenewal In the schedule above,we the schedule above,wo will mall notice of cancel- will mail notice of the nonrenewal to the person or lallon to the person or organization shown in the organization shown In the schedule above. We schedule above. We wit mail such notice to the will mall such notice to the address shown in the address shown In the schedule above at least the schedule above at least the number of days number of days shown for cancellation In the shown for nonrenewal In the schedule above be- schedule above before the effective data of can- fore the expiration date. cellatlon. IL T4 0012 09 at 2009 The Travelers Indemnity company Page 1 of 1 TRAVELER J WORKERS COMPENSATION 0O6 TOWER MARE EMPLOYERS LIABILITY POLICY HARTFORD, CT 06183 ENDORSEMENT WC 99 0611(A) POLICY NUMBER: DTDTCHUB-6934C37-7-13 NOTICE OF CANCELLATION Except for non-payment of premium by you,we agree that no cancellation or limitation of this policy shall become effeclive until the number of day's written notice specified in Item 2 of the Schedule has been mailed to you and to the person or organization designated In Item 1 of the Schedule at the address Indicated, SCHEDULE 1. Name: ANY PERSON OR_ORGANIZATION TO WHOM YOU HAVE AGREED IN A WRITTEN CONTRACT THAT NOTICE OF CANCELLATION OR MATERIAL LIMITATIONS OF THIS POLICY WILL SE GIVEN, BUT ONLY IF1 1.YOU SEND US A WRITTEN REQUEST TO PROVIDE SUCH NOTICE, INCLUDING THE NAME AND ADDRESS OF SUCH PERSON OR ORGANIZATION, AFTER THE FIRST NAMED INSURED RECEIVES NOTICE FROM US OF THE CANCELLATION OR MATERIAL LIMITATION Or THIS POLICY; AND 2.WE RECEIVE SUCH WRITTEN REQUEST AT LEAST 14 DAYS BEFORE THE BEGINNING OF THE APPLICABLE NUMBER OF DAYS SHOWN IN THIS SCHEDULE Address: THE ADDRESS FOR THAT PERSON OR ORGANIZATION INCLUDED IN SUCH WRITTEN REQUEST FROM YOU TO 115, 2. Number of Days Written Notice: 30 Additional Days • This endorsement changes the policy to which it Is attached and Is effective on the dale issued unless otherwise stated. (The Information below Is required only when this endorsement Is issued subsequent to preparation of the policy.) Endorsement Effective Policy No, Endorsement No, Insured Premium$ Insurance Company Countersigned by DATE CF ISSUE: 10/01/13 ST ASSIGN: Page 1 of 1 Atatitk WORKERS COMPENSATION TRAVELERS J AND EMPLOYERS LIABILITY POLICY ONE TOWER SQUARE IIART1OAE, er 06183 ENDORSEMENT WC 99 06 11(A) POLICY NUMBER: DTOUB-5580L00-2-13 NOTICE OF CANCELLATION Except for non-payment of premium by you,we agree that no cancellation or limitation of this policy shall become effective until the number of day's written notice specified In Item 2 of the Schedule has beers mailed to you and to the person or organization designated In Item 1 of the Schedule at the address indicated. SCHEDULE 1, Name: ANY PERSON OR ORGANIZATION TO WHOM YOU RAVE AGREED IN A WRITTEN CONTRACT THAT NOTICE OF CANCELLATION OR MATERIAL LIMITATIONS OF THIS POLICY WILL BE GIVEN, BUT ONLY IF: 1. YOU SEND US A WRITTEN REQUEST TO PROVIDE SUCH NOTICE, INCLUDING THE NAME AND ADDRESS OF SUCH PERSON OR ORGANIZATION, AFTER THE FIRST NAMED INSURED RECEIVES NOTICE FROM US OF THE CANCELLATION OR MATERIAL LIMITATION OF THIS POLICY; AND 2. WE RECEIVE SUCH WRITTEN REQUEST AT LEAST 19 DAYS BEFORE THE BEGINNING OF THE APPLICABLE NUMBER OF DAYS SHOWN IN THIS SCHEDULE. • Address: THE ADDRESS FOR THAT PERSON OR ORGANIZATION INCLUDED IN SUCH WRITTEN REQUEST FROM YOU TO US. 2. Number of Days Written Notice: 30 Additional Days This endorsement changes the policy to which It Is attached and is effective on the date Issued unless otherwise stated, (The information below is required only when this endorsement Is Issued subsequent to preparation of the policy.) Endorsement Effective Policy No Endorsement No. Insured Premium insurance Company Countersigned by DATE OF ISSUE: 10/01/13 ST ASSIGN: Page 1 of 1 1