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HomeMy WebLinkAboutDixon Engineering-Tank Inventory Services (2014) • ORIGINAL AGREEMENT THIS AGREEMENT, made on the �q day of Rb , 2014, by and between the CITY OF OSHKOSH, party of the first part, hereinafter referred to as CITY, and DIXON ENGINEERING, INC., 9415 West Forest Home Avenue, Suite 208; Hales Corners, WI 53130, 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 for TANK INVENTORY SERVICES. ARTICLE I. PROJECT MANAGER A. Assignment of Project Manager. The CONSULTANT shall assign the following individual to manage the PROJECT described in this AGREEMENT: Joseph T. Hoban, P.E. 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 M. Brand — Public Works Utility Bureau Manager ARTICLE III. SCOPE OF WORK The CONSULTANT shall provide the services described in the CONSULTANT's Proposal. CITY may make or approve changes within the general Scope of Services in this AGREEMENT. If such changes affect CONSULTANT's cost of or time required for performance of the services, an equitable adjustment will be made through an amendment to this AGREEMENT. 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. I:\Engineenng\Tracy Taylor\Steve Brand Agreements\Dixon Eng Agreemnt-Tank Inventones_2-12-14.docx Page 1 of 5 • ARTICLE IV. STANDARD OF CARE The standard of care applicable to CONSULTANT's services will be the degree of skill and diligence normally employed by professional consultants or consultants performing the same or similar services at the time said services are performed. CONSULTANT will re-perform any services not meeting this standard without additional compensation. ARTICLE V. 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 VI. 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 in the CONSULTANT's Proposal. 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 VII. 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 Proposal dated January 31, 2014 and attached hereto I:\Engineering\Tracy Taylor\Steve Brand Agreements\Dixon Eng Agreemnt-Tank Inventones_2-12-14.docx Page 2 of 5 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. ARTICLE VIII. 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 $11,050 (Eleven Thousand Fifty Dollars). • Attached fee schedules shall be firm for the duration of this AGREEMENT. B. Method of Payment. The CONSULTANT shall submit itemized monthly statements for services. The CITY shall pay the CONSULTANT within thirty (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 IX. HOLD 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/her agents or assigns, his/her employees, or his/her 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. Subject to any limitations contained in Sec. 893.80 and any similar statute, of the Wisconsin Statutes, the CITY further agrees to hold CONSULTANT harmless from any and all liability, including claims, demands, losses, costs, damages, and expenses of every kind and description (including death), or damages to person or property arising out of re-use of the documents without consent where such liability is founded upon or I:1Engineenng1Tracy Taylor%Steve Brand AgreementsODixon Eng Agreemnt-Tank Inventones_2-12-14.docx Page 3 of 5 grows out of the acts or omission of any of the officers, employees or agents of the City of Oshkosh while acting within the scope of their employment. ARTICLE X. INSURANCE The CONSULTANT agrees to abide by the attached City of Oshkosh Insurance Requirements. ARTICLE Xl. 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 ten (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. ARTICLE XII. RE-USE OF PROJECT DOCUMENTS All reports, drawings, specifications, documents, and other deliverables of CONSULTANT, whether in hard copy or in electronic form, are instruments of service for this PROJECT, whether the PROJECT is completed or not. CITY agrees to indemnify CONSULTANT and CONSULTANT's officers, employees, subcontractors, and affiliated corporations from all claims, damages, losses, and costs, including, but not limited to, litigation expenses and attorney's fees arising out of or related to the unauthorized re-use, change, or alteration of these project documents. ARTICLE XIII. SUSPENSION, DELAY, OR INTERRUPTION OF WORK CITY may suspend, delay, or interrupt the services of CONSULTANT for the convenience of CITY. In such event, CONSULTANT's contract price and schedule shall be equitably adjusted. I:1Engineertng%Tracy Taylor\Steve Brand Agreements\Dixon Eng Agreemnt-Tank Inventones_2-12-14.docx Page 4 of 5 ARTICLE XIV. NO THIRD-PARTY BENEFICIARIES This AGREEMENT gives no rights or benefits to anyone other than CITY and CONSULTANT and has no third-party beneficiaries. In the Presence of: CONSULTANT By: 7 621/5//y h�av r12 -finyit, (Seal of Consultant (Specify Title) if a Corporation.) By: (Specify Title) CITY OF OSHKOSH By: (Witness) Ma A. Rohloff, City Manager And: LL10)11 (Witness) Pamela R. Ubrig, City Clerk APPROVED: I hereby certify that the necessary provisions have been made to pay the liability which Q� will accrue under this AGREEMENT. Witatl.,.__ Jiak • City Attorney City Comptr•-r .L}SSidittihf- 1:1Engineering\Tracy TaylortSteve Brand AgreementslDixon Eng Agreemnt-Tank Inventones_2-12-14.docx Page 5 of 5 D IXO 1 9415 West Forest Home Avenue, Suite 208 Hales Corners,WI 53130 ENGINEERING, INC. Telephone(414)529-1859 Fax(414)529-3120 Proposal/Contract Agreement for Antennas Oshkosh, Wisconsin—Tank Inventories(four towers) The agreement is between Dixon Engineering, Inc. (DIXON) and the City of Oshkosh for technical services in connection organizing and inventorying files for four water towers. This agreement inclusive together with any expressly incorporated appendix or Schedule, constitutes the entire agreement between Owner and DIXON and supersedes all prior written or oral understandings. This Agreement may only be amended, supplemented, modified, or canceled by a duly executed written instrument. This agreement includes pages 1 through 4 and Schedules A, B, and C. 1.01 BASIC AGREEMENT DIXON shall provide, or cause to be provided(subcontracting is limited to specialty or laboratory service), services detailed in Scope of Services (see Exhibit A) and OWNER agrees to pay DIXON as compensation for their services the (not to exceed/lump sum) fee of Eleven Thousand Fifty dollars $11,050. Terms of charges and payments per details in Schedule B. (Prices quoted are subject to change 90 days after proposal date, if not contracted.) 2.01 SCOPE OF SERVICES Organizing and Inventorying files for four towers, as further detailed in Exhibit A 3.01 SIGNATURES Joseph T. Hoban 01/31/14 PROPOSED by DIXON(Not a contract until approved by an officer) PROPOSAL DATE CONTRACT APPROVED by OWNER POSITION DATE CO SIGNATURE(if required) POSITION DATE CONTRACT APPROVED by DIXON OFFICER EFFECTIVE CONTRACT DATE 1 4.01 ADDITIONAL SERVICES A. If additional services are Requested and authorized by the OWNER which are not within the proposed Scope of Services or because of changes in the Project, these additional services will be on a time and material basis per fee schedule of attached SCHEDULE C. B. Delay by the Contractor in completing the work,which is the responsibility of the Contractor and which extends the amount of time required for DIXON to complete their work,will be charged as an Additional Service. C. Failure by the Contractor to notify DIXON of the necessity to change inspection dates more than twenty-four(24)hours in advance and which results in unnecessary travel and/or expense to DIXON shall cause this travel and expense to be charged as Additional Service. D. Failure by the Contractor to Meet Specifications and/or to complete work prior to requesting an inspection is considered a failed inspection. Services provided by DIXON as a result of failed inspection include travel, inspector, and project manager time will be charged as an Additional Service. 5.01 Termination A. The obligation to provide further services under this Agreement may be terminated: 1. For cause, a. By either party upon thirty(30) days written notice in the event of substantial failure by the other party to perform in accordance with the Agreement's terms through no fault of the terminating party. Agreement will not terminate as a result of substantial failure under paragraph 5.01.A.1.a if the party receiving such notice begins,within seven(7) days of receipt of such notice, to correct its failure and proceeds diligently to cure such failure within no more than thirty(30) days of receipt of notice;provided,however, that if and to the extent such substantial failure cannot be reasonably cured within such thirty(30) day period, and if such party has diligently attempted to cure the same and thereafter continues diligently to cure the same,then the cure period provided for herein shall extend up to, but in no case more than, sixty(60) days after the date of receipt of the notice. b. By DIXON upon seven days written notice: 1) If Owner fails to pay invoices within 60 days of invoicing. 2) Upon seven(7) days written notice if the DIXON's services for the Project are delayed or suspended for more than ninety(90) days for reasons beyond DIXON's control. 3) If DIXON believes that Engineer is being requested by Owner to furnish or perform services contrary to engineer's responsibilities as a licensed professional. 4) DIXON shall have no liability to Owner on account of such termination. 2. For Convenience, a. By OWNER effective upon the receipt of notice by DIXON. 2 B. The terminating party may set the effective date of termination at a time up to thirty (30) days later to allow Engineer to demobilize personnel and equipment from the Project site, to complete tasks whose value would otherwise be lost,to prepare notes as to the status of completed and uncompleted tasks, and to assemble Project materials in orderly files. 6.01 Controlling Law A. This Agreement is to be governed by the law of the state in which the Project is located. 7.01 Successors,Assigns, and Beneficiaries A. OWNER and DIXON and their successors are hereby bound to successors and legal representatives of the other to the extent permitted by law in respect of all covenants, agreements, and obligations of this Agreement. B. Neither OWNER nor DIXON may assign, sublet, or transfer any rights under or interest(including, but without limitation,moneys that are due or may become due) in this Agreement. 8.01 General Considerations A. The Standard of Care for all professional engineering and related services performed or furnished by DIXON under this Agreement will be the care and skill ordinarily used by members of the subject profession practicing under similar circumstances at the same time and in the same locality. DIXON makes no warranties, expressed or implied,under this Agreement or otherwise, in connection with DIXON's services. DIXON and its consultants may use or rely upon the design services of others, including,but not limited to, contractors,manufacturers, and suppliers. B. DIXON shall Not at any time Supervise, direct, or have control over any of the Contractor's work,nor shall DIXON have authority over or responsibility for the means, methods, techniques, sequences, or procedures of construction selected or used by any contractor, for safety precautions and programs incident to contractor's work progress,nor for any failure of any contractor to comply with laws and regulations applicable to contractor's work. C. Engineer does not guarantee the performance of any contractor and does Not Assume Responsibility for any contractor's failure to furnish and perform its work in accordance with the contract between Owner and such contractor. D. Engineer shall Not be Responsible For the acts or Omissions of any Contractor, subcontractor, or supplier, or of any contractor's agents or employees or any other persons (except Engineer's own employees) at the Project site or otherwise furnishing or performing any of the construction work; or for any decision made on 3 interpretations or clarifications of the construction contract given by Owner without consultation and advice of Engineer. E. The General Conditions for any construction contract documents prepared hereunder are to be the"Standard General Conditions of the Construction Contract" as prepared by the Engineers Joint Contract Documents Committee (No. C-700, 2007 Edition) or equally protective document provided by Owner. F. All Design Documents prepared or furnished by DIXON are instruments of service, and DIXON retains an ownership and property interest(including the copyright and the right of reuse) in such documents,whether or not the Project is completed. G. DIXON agrees to defend, Indemnify, and hold harmless the Owner, its officers, agents, and employees, from and against legal liability for all claims, losses, damages, or expenses to the extent such claims, losses, damages, or expenses are directly caused by Engineer's negligent or intentional acts, errors, or omissions. Limits of liability for negligence is based on the comparative negligence principle. H. The parties acknowledge that DIXON's scope of services does not include any services related to a Hazardous Environmental Condition (the presence of asbestos, PCBs,petroleum,hazardous substances or waste, and radioactive materials). DIXON acknowledges that some hazardous metals may be encountered in coatings. 8.02 Severability A. If any clause or paragraph or sentence is found to be in opposition to any law in the state of the Project, that clause or paragraph or sentence may be severed from the Agreement with no effect on remaining clauses. 8.03 Headings A. Article and paragraph headings are inserted for convenience only and do not constitute parts of these General Conditions. Words in the first sentence are in bold to act as secondary headings and should not be interpreted any different than a numbered heading. 4 • wow SCHEDULE A—Scope of Services Oshkosh, Wisconsin—Tank Inventories(four towers) I. Work to be completed for four elevated water towers: a. Marion Legged Tank b. Washburn Hydropillar Tank c. Southwest Hydropillar Tank d. Fernau Hydropillar Tank II. Work will be completed by Joseph T. Hoban, Registered Professional Engineer in the State of Wisconsin at the Oshkosh Water Filtration Plant(mobilization will be from and back to Menasha, Wisconsin). III. Work to include organizing and inventorying: a. Each tank hard copy file will be thoroughly sorted through and organized. b. During the sorting past work such as original erection, tank maintenance, tank rehabilitation, original antenna installation project, antenna upgrade projects, installation of new components (cathodic projects or a SCADA system for example), etc. documents will be organized. c. When applicable, documents will be scanned,properly named, and put on a computer system or external hard drive(to be provided by the City). d. A summary/history will be logged for each tank. i. Original erection history. ii. Tank maintenance history. iii. Tank rehabilitation history. iv. Original antenna installations/removal history. v. Antenna upgrade projects history. vi. Installation of new components history. e. Findings will be presented to interested City employees at the end of the organizing and inventorying ISM SCHEDULE B Oshkosh, Wisconsin—Tank Inventories(four towers) I PAYMENT In the Water Filtration Plant: Mobilization: Total On site time 8 hrs.@$125/hr.= $1,000 Travel time 1 hrs.@$75/hr. = $ 75 Total Estimated Daily Fee $1,000 Mileage 50 miles @$.60/mile = 30 Total(round trip) $105 Total Estimate Daily Fee $1,000 Total Mobilization Costs 105 Total Daily Fees: $1,105 Total Fee:$1,105 x 10 days=$11,050 II INVOICES A. Invoices will be compiled monthly. B. All DIXON services that are outstanding more than thirty(30) days from date of issue shall be assessed(DIXON's favor) one and a half percent(1.5%)per month interest starting from 30 days after date of issue. SCHEDULE C Engineering Services Fees Labor Class Per Hour *Overtime Rate Principal $175.00 Expert Witness (Office, Travel & Court) $185.00 Project Manager $100.00 Registered Professional Engineer.................. $100.00 Certified NACE Inspector $ 90.00 Assistant Project Manager .. $ 80.00 Staff Engineer—Level III $ 72.00 to $85.00 Staff Engineer—Level II . $ 67.00 to $80.00 Staff Engineer—Level I $ 62.00 to $75.00 CAD Supervisor $ 65.00 to $75.00 CAWI or CWI Welding Inspector $ 67.00 to $85.00 Inspector—Level III $ 63.00 to $80.00 Inspector—Level II $ 60.00 to $75.00 Inspector—Level I $ 55.00 to $70.00 CAD Technician $ 60.00 to $70.00 Secretarial Services . $ 48.00 & expenses Bookkeeping Services . $ 44.00 Project Status Meetings w/Project Engineers and Council or Board Meetings Time and Expenses, Including Preparation Time *All Saturday, Sunday, and holiday inspections are overtime rate. Overtime rate is 1 '/2 time the hourly rate. Overtime rate does not apply to Principal. Expenses: Metropolitan Out—state Mileage $0.70/mile(including tolls)$0.60/mile Meals &Lodging, $135 per diem $125 per diem (may be increased based on location) Without Lodging $35/day $30/day Air Travel Business fare from Grand Rapids Chicago O'Hare or Milwaukee,plus full size car rental Material(gaskets, cathodic protection caps, etc.) Negotiated FEES EFFECTIVE THROUGH JUNE 30,2014 -�..11 DIXONEI OP ID: LB AC(JRQ° DATE(MMIDDIYYYY) I .. ..-- CERTIFICATE OF LIABILITY INSURANCE 02/13/2014 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 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 Phone:231-775-3416 CNOAMNEACT Glick Dillon Insurance Fax:231-775-0817 BONE FAX 123 N Mitchell St P.O.B.389 rMC No.Ext): (A/C,No): Cadillac,MI 49601 ADDRESS: Pete Suminskl INSURER(S)AFFORDING COVERAGE NAIC/ INSURER A:Auto Owners Insurance Company 18988 INSURED Dixon Engineering Inc INSURER B:T ravelers Insurance Company William Dixon INSURER C:US Specialty Insurance Company 11043RD Ave Lake Odessa, MI 48849-1191 INSURER D: INSURER E: INSURER F COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LLTTRR TYPE OF INSURANCE A INSR yvD POLICY NUMBER (MMIDDIYEYYY) EXP LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A X COMMERCIAL GENERAL LIABILITY X 33007656 11/01/2013 11/01/2014 pRE■ISE (Ea«ncuErrencei $ 300,000 CLAIMS-MADE X OCCUR MEDEXP(Anyoneperson) $ 10,000 X XCU PERSONAL&ADV INJURY _ $ 1,000,000 GENERAL AGGREGATE _ $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000 7 POLICY JECT PRO LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 1000 000 (Ea accident) _ $ , , A X ANY AUTO X 9536751602 07/01/2013 07/01/2014 BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY Per accident) $ AUTOS _ AUTOS - X HIRED AUTOS X NON-OWNED PROPERTY DAMAGE - $ _ AUTOS (Per accident) _ $ X UMBRELLALIAB X OCCUR EACH OCCURRENCE _ $ 5,000,000 A EXCESS LIAB CLAIMS-MADE 9536751603 11/01/2013 11/01/2014 AGGREGATE _ $ DED X RETENTION$ WAIVED $ WORKERS COMPENSATION WC()VIN - 0TH AND EMPLOYERS'LIABILITY x TORY LIMITS x °a - AND ANY PROPRIETORIPARTNER/EXECUTIVE Y 1 N I 6JUB5B53814-2-13 10/13/2013 10/13(2014 E.L.EACH ACCIDENT $ 500,000 OFFICER/MEMBER EXCLUDED? NIA (Mandatory in I.4) E L DISEASE-EA EMPLOYEE $ 500,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 C Professional Liab USS1324111 07/01/2013 07/01/2014 Ea Claim 1,000,000 $25,000 DEDUCTIBLE Aggregate 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHCLES(Attach ACORD 101,Additional Remarks Schedule,If more space Is required) When required by contract or written agreement, certificate holder and its officers, council members, agents, employees and authorized volunteers are included as Additional Insured by endorsement. CERTIFICATE HOLDER CANCELLATION CIOS001 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Oskosh THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN dY ACCORDANCE WITH THE POLICY PROVISIONS. 215 Church Ave. P.O.Box 1130 AUTHORIZED REPRESENTATIVE Oshkosh,WI 54903-5100 7e&/ O 1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD