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HomeMy WebLinkAboutMoss & Associates, LLC CITY OF OSHKOSH DEPARTMENT OF PUBLIC WORKS 215 CHURCH AVENUE, P.O. BOX 1130, OSHKOSH, WI 54903-1130 PHONE: (920)236-5065 FAX(920)236-5068 LETTER OF TRANSMITTAL To: Mr. Randy Moss Date: April 10, 2014 Moss &Associates, LLC Subject: Executed Agreement 2835 Newcastle Avenue Right-of-Way Acquisition Services Green Bay, WI 54313 Contract 14-02 Please find: ® Attached ❑ Under Separate Cover ❑ Copy of Letter ® Contracts ❑ Amendment ❑ Report ❑ Agenda El Meeting Notes ❑ Photos ❑ Mylars ❑ Change Order ❑ Plans ❑ Specifications ❑ Estimates ❑ Diskette El Zip Disk ❑ Other Quantity Description 1 Executed Agreement These are being transmitted as indicated below: ❑ For Approval ® For Your Use ❑ As Requested ❑ For Review& Comment Remarks: Enclosed is a copy of the executed agreement for the right-of-way acquisition services for the North Main Street reconstruction project. Please reference Res. #14-147 on all of your invoices. If you have any questions, please contact us. City Attorney's Office—Copy City Clerk's Office—Original Joe Sargent—Copy • r. cc: File —Original Signed: AIM& Ak Trig L. Tayl I:\Engineering12014 CONTRACTS114-02 N Main St Reconst\CONTRACTS\ROW Acquisitions-Moss114-02 Mos • -Executed A_ t24-10-14.docx AGREEMENT THIS AGREEMENT, made on the 971-1 day of 4PR« , 2014, by and between the CITY OF OSHKOSH, party of the first part, hereinafter referred to as CITY, and MOSS & ASSOCIATES, LLC, 2835 Newcastle Avenue, Green Bay, WI 54313, 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 RIGHT-OF-WAY ACQUISITION 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: Randy Moss— Consultant/Negotiator 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: Joseph R. Sargent, P.E. — Civil Engineer Senior ARTICLE III. SCOPE OF WORK The CONSULTANT shall provide the services described in the CITY'S Request for 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:\Engineering\2014 CONTRACTS\14-02 N Main St Reconst\CONTRACTS\ROW Acquisitions-Moss\14-02 Moss Agreemnt_2-21-14.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 CITY's Request for 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. CITY's Request for Proposal dated February 12, 2014 and attached hereto 3. CONSULTANT's Proposal dated February 20, 2014 and attached hereto I:\Engineering12014 CONTRACTS\14-02 N Main St Reconst\CONTRACTS\ROW Acquisitions-Moss114-02 Moss Agreemnt_2-21-14.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 $80,000 (Eighty Thousand Dollars). 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 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. I:\Engineering12014 CONTRACTS\14-02 N Main St Reconst\CONTRACTSROW Acquisitions-Moss114-02 Moss Agreemnt_2-21-14.docx Page 3 of 5 ARTICLE X. INSURANCE The CONSULTANT agrees to abide by the attached City of Oshkosh Insurance Requirements. ARTICLE XI. 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:\Engineering\2014 CONTRACTS\14-02 N Main St Reconst\CONTRACTS\ROW Acquisitions-Moss\14-02 Moss Agreemnt_2-21-14.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 ,E ; A. //Evs By: (7 lwr"GJ 1•20.2 O,c alln1 (Seal of Consultant (Specify Title) if a Corporation.) By: (Specify Title) CITY OF OSHKOSH By: r e/tli (Witness) Mar A. Rohloff, City Manager And: i „ . ._ ',A .i._.• (Witness) _ •• - - bri•w ity I len, , 6, A �(.( / - APPROVED: I hereby certify that the necessary provisions have been made to pay the liability which ,,-\ will accrue under this AGREEMENT. (- ,„ - ' ; k:,- , , . ity Attorn- .3ft 0 ,i } on City Comptroller I:1Engineering\2014 CONTRACTS\14-02 N Main St Reconst\CONTRACTS\ROW Acquisitions-Moss\14-02 Moss Agreemnt_2-21-14.docx Page 5 of 5 Sargent, Joseph R From: Sargent, Joseph R Sent: Monday, February 17, 2014 11:16 AM To: 'Randy Moss' Cc: Mike Simon; Gulbronson, Peter P.; Gohde, Steven M. Subject: RE: Project ID 4994-01-14; City of Oshkosh, N. Main Street- Request for Appraisal Consultant Quotes Attachments: Blank Current Agreement Form_12-2-13.docx; Prof Sery Ins Requirements_10-31-13.pdf Follow Up Flag: Follow Up Due By: Tuesday, February 18, 2014 8:09 AM Flag Status: Completed Randy, Yes, November 1, 2014 is the date when all of the parcels have to be acquired. In addition, I included a copy of both the City of Oshkosh Standard Agreement and Insurance Requirements that will become part of the contract should you be selected as our Appraisal Consultant. If you have any additional questions, please contact me. Respectfully, Joe From: Randy Moss [mailto:mossassociatesllc@gmail.com] Sent: Wednesday, February 12, 2014 11:41 AM To: Sargent, Joseph R Cc: Mike Simon Subject: Re: Project ID 4994-01-14; City of Oshkosh, N. Main Street- Request for Appraisal Consultant Quotes Hi Joe, Thank you for considering Moss &Associates. The only question I have now is what has WisDOT set as the PS&E date? I'm guessing 11/1/14 is the date they want all parcels acquired or offers with appraisals made by. Randy Moss On Wed, Feb 12, 2014 at 9:11 AM, Sargent, Joseph R<JSargent@ci.oshkosh.wi.us>wrote: Estimator, The City of Oshkosh Engineering Division is currently working with McMahon Group on the design of a roadway improvement project for North Main Street located in the City of Oshkosh(Project ID No. 4994-01- 14/15). The project will entail approximately 5' of TLE acquisition along the entire route of N. Main Street (both sides) between Murdock Avenue and New York Avenue. There will also be minor fee acquisition parcels at some intersections in order to accommodate sidewalk at the curb ramps. 1 Your quote should include the cost to provide both the negotiations and appraisals. All acquisitions must be completed by the DOT's bid AD meeting, which is scheduled for January 27, 2015. The selected Appraisal Consultant will be able to immediately begin work on the project data book, but cannot contact any owners until the ER and DSR are approved. Offers cannot be made until approval of the ER, DSR, and Relocation Order; the anticipated approval date for these documents is July 15, 2014. This is a federally funded project and all federal/state requirements must be met. You are being sent this request for quotation because your firm is on the Wisconsin Department of Transportation's statewide list of approved fee negotiation/relocation consultants. There is an estimated 92 properties with the project limits. Based on the preliminary design, the anticipated acquisition includes 92 temporary limited easements and 15 fee acquisitions required for the project. It is anticipated that the preliminary plat will be available by March 31, 2014. Please mail your official quote by 4:30 p.m. February 20, 2014 to the City of Oshkosh—Department of Public Works, Attn: Joe Sargent, 215 Church Avenue, P.O. Box 1130, Oshkosh, Wisconsin 54903-1130 and by e-mail to)SargentC@ci.oshkosh.wi.us and include an estimated timeframe on when you would be able to have the work completed by. Quotes are requested on a per TLE/Fee basis in case the number of TLE's and PLE's change as the design progresses. Thank you in advance for your prompt response. Please feel free to contact me with any questions regarding this request. Respectfully, Joe Joseph R. Sargent, P.E., LEED®AP Civil Engineer Senior City of Oshkosh 215 Church Avenue Oshkosh, WI 54903-1130 Main Office: (920) 236-5065 Cell: (920)410-3569 2 • Fax: (920)236-5068 Email: isargent(a�ci.oshkosh.wi.us 3 Moss & Associates, LLC 2835 Newcastle Ave, Green Bay, WI 54313 (920) 660-7481 February 20, 2014 City of Oshkosh Attn: Joseph R. Sargent, P.E., LEED, AP Subject: Consulting services for reconstruction of Main St. Dear Joe, Thank you for the opportunity to submit this bid proposal for the acquisition right of way for Project ID 4994-01-14, Reconstruction of Main Street, for the City of Oshkosh. Since its formation in 1995, Moss&Associates, LLC has acquired land under Wisconsin Eminent Domain Law for over 30 Local Public Agencies. As is the case with nearly all the projects we have been engaged in, we understand that time is of the essence in completing your project and are prepared to dedicate all the time that is needed to get the project in on time. We are confident in our ability to acquire all the parcels by the nominal process or make offers based on appraisals by November 1, 2014. We have included Steiro Appraisal as the appraiser for this project. Dave Steiro has performed numerous appraisals for the City of Oshkosh, and is on the WisDOT list of Approved Appraisers. If you have any questions or concerns,please feel free to contact me by phone or text message at 1-920-660-7481 or by e-mail at mossassociatesllc @gmail.com. Thank you for your consideration. Sincerely, MOS : ASSOCIATES, LLC Q72.-- Randy Mo s Consultant/Negotiator Proposal: City of Oshkosh Project ID 4994-01-14 Project: Real Estate Services City of Oshkosh,Winnebago County,Wisconsin City of Oshkosh Project ID 4994-01-15 Deadline: February 20,4:30 pm Appraiser:Steiro Appraisal Appraisal Fees Short Format(per parcel): $ 1,500 Appraisal Fees Standard Abbreviated (per parcel): $ 2,000 Project Data Book: $ 5,000 Pretrial conferences and Court Testimony(per hour) $ 125 Negotiator:Moss&Associates LLC Nominal Payment Parcel Report: $ 5,000 Cost for preparation of documents,files,appraisal review, administrative settlements, meetings, updates and project management $4,500 Negotiation fees through award of damages, if necessary(per parcel): $ 400 Cost to acquire utility interests, if necessary(per utility): $ 150 Preparation of Right of Way Certification (LPA form 3028): $7,500 Postage for certified mailings, as required by statute or as requested by the City for other mailings. will be billed to the City at cost. Moss&Associates LLC will serve as project manager for acquisition of real estate. It is understood that all right of way must be acquired,or offers with appraisals delivered,prior to November 1,2014. It is anticipated that the City of Oshkosh will provide all title searches and updates and will pay for recording fees with the Register of Deeds of Winnebago County. Moss&Associates LLC will deliver all necessary documents for recording to the Register of Deeds of Winnebago County. RESUME RANDY J. MOSS Negotiation/Relocation/Project Management EDUCATIONAL BACKGROUND 1977-1982 University of Wisconsin-Stevens Point,Bachelor of Science degree in Forestry with emphases in Urban Forestry and Forest Management. 1976-1977 University of Wisconsin-Milwaukee 1972-1976 Ashwaubenon High School- Graduate 1976 PROFESSIONAL BACKGROUND & TRAINING 1995 to Present Moss & Associates LLC-Partner, Real Estate Acquisition and Relocation Specialist 1/96-12/98 Draheim Company,Inc. -Relocation Specialist December 1995 Member IRWA (International Right of Way Association) October 1995 IRWA(Training Seminar) -Business Moving Payments December 1995 IRWA Course 501 -Relocation March 1996 IRWA Course 201 - Communication May 1996 IRWA Course 205 -Bargaining Negotiations September 1996 NWTC Course -Appraisal 1 September 1996 IRWA Seminar-Pre-trial Preparation for Relocation February 1997 NWTC Course - Code& Ethics March 1997 IRWA Course 401 - Partial Acquisition April 1997 NWTC Course-Licensure II September 1997 WisDOT&IRWA Course - Case Studies in Eminent Domain Appraisal Seminar May 2004 WisDOT Seminar—Update on LPA Manual November 2010 WisDOT Seminar- Update on LPA Manual December 2010 IRWA Course-Advanced Business Relocation CURRENT AND See Attached Listing PAST LPA PROJECTS REFERENCES See Attached Listing of References Randy Moss is listed on the Wisconsin Department of Transportation Register of Approved Negotiators and Relocation Agents Patrick J. Moss RESUME ADDRESS: 1249 Alice Drive Green Bay, WI 54304 TELEPHONE#: (920) 494-5931 Office (920) 680-2635 Mobile PREVIOUS EMPLOYMENT: 1969-1995 - Wisconsin Dept. of Transportation, 26 years Project Manager, Appraiser and Lead Negotiator 1995-2005—Moss&Associates, LLC Partner,Negotiator CURRENT 2005-Present- Moss &Associates, LLC, Consultant OCCUPATION: SERVICES OFFERED: Project Management; Plat review; Relocation Assistance; Negotiation, (specializing in complex negotiations); Administrative settlements; Condemnation consultation; Litigation Coordination; Creation of specialized documents and agreements for complex acquisition; Relocation. CURRENT PROJECTS: See Attached Listing EDUCATION: Bachelor of Business Administration degree, UW-Milwaukee, (1969) majoring in Real Estate, Urban Planning and Geography. REFERENCES: See Attached List of References Patrick Moss is listed on the Wisconsin Department of Transportation Register of Approved Negotiators Moss&Associates, LLC Current&Past LPA Projects Municipalities Project Negotiation Relocation City of Clintonville STH 22 Reconstruction X City of Hartford Rubicon Trail X City of Kaukauna Crooks Avenue Reconstruction X X Crooks Avenue Relocation X Ann Street Reconstruction X City of Niagara US 141 Reconstruction X City of Oshkosh Quarry Park Gas Venting System X National Guard Armory Detention Basin X Abbey Nicolet Detention Basin X Westhaven Detention Basin X James Road Detention Basin X Washburn Detention Basin X Upgrade to City Maintenance Facility X X City of Sheboygan Eisner Avenue Reconstruction X Camelot Blvd Project X X City of Wausau School District Project Town of Freedom Vine Road Project X Geenen Lane Project X Peterson Road Project X Town of Grand Chute Bluemound Drive Project X Lynndale Drive Project X X Capitol Drive Reconstruction X Town of Greenville Greenville Bike/Pedestrian Trail X Town of Harrison Friendship Trail X Town of Menasha East Shady Lane Project X Town of Scott Bay Settlement Road Reconstruction X Village of Bellevue Multiple Projects(1-4 Parcels) X Village of Hobart Golden Pond Park Court Extension X X Nathan Drive&Overland Road Project X Village of Howard Riverview Drive Project X X Memorial Drive Project X Dousman Street Extension X X Belmont Road Reconstruction X Brookfield Road Project X Sewer Interceptor X Glen Kent Subdivision X Glendale/Pinecrest Reconstruction X Velp Avenue Reconstruction X Ullmer Road Extension X Rockwell Sidewalk Project X Village of Luxemburg Haven Lane Reconstruction X Brown County Cardinal Lane Extension X X CTHG X Shawano Avenue Reconstruction X CTH KB X CTH GV X Ashwaubenon Industrial Park Expansion X Winnebago County West Side Arterial X Langlade County CTH B Reconstruction X Green Bay Metro Sewerage District Sanitary Sewer Line Extension X Kaukauna Utilities Easement Project X Moss & Associates, LLC References Municipality Reference Contacts David Patek, PE, Director of Public Works, City of Oshkosh Mark Rohloff, City Manager, City of Oshkosh Geoffrey Farr, PE, Director of Public Works,Village of Howard Mike Kaster,Village Engineer,Village of Howard Mark Rohloff, City Manager, City of Oshkosh Andrew Vickers, Village Administrator,Village of Hobart Elaine Willman, Director of Tribal Affairs,Village of Hobart Jeffrey Sturgell,Town Administrator,Town of Menasha Mark Mommaerts,AICP, Planner,Town of Harrison Bill Balke,Village Engineer,Village of Bellevue Thomas Marquardt, PE, Director of Public Works,Town of Grand Chute Paul Fontecchio, PE, Engineer, Brown County Dept. of Public Works-Highway Dept. Ryan Sazama, PE, Engineer, City of Sheboygan Michael Pierner, Engineering Services Manager, Green Bay Metro Sewerage District Engineering Firms Troy Robillard, PE, Manager,Transportation Services,Ayres Associates Mike Simon, PE, McMahon Group Engineering Dennis Reim, PE, RLS,VP, Director of Surveying&Technical Services, Robert E. Lee&Associates Thad Majkowski, P.E., Engineer, CedarCorp. A,CG �� (MM/DD/YYYY) DATE ,�/ CERTIFICATE OF LIABILITY INSURANCE 04/03/14 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 1 HE 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 13 WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: Peter Baierl Peter Baled Insurance&Investment (A/c.o.�). (920)490-1022 FAX No): (920)490-1024 1345 West Mason St Suite 116 ADDRESS: pbaierl @baierlinsurance.com Green Bay,WI 54303 INSURER(S)AFFORDING COVERAGE NAIC# _ Phone (920)490-1022 Fax (920)490-1024 INSURER A: The Hartford INSURED INSURER B: Moss&Associates,LLC INSURER C: 2835 Newcastle Av INSURER D: Green Bay,WI 54313 920 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. INSR ADDLSUBR POLICY EFF I.POLICY EXP LTR TYPE OF INSURANCE INSR WVD POLICY NUMBER JMM/DD/YYY Y)_,_(MMlDDlYYYY)_ LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 2,000,000.00 DAMAGE TO RENTED Q COMMERCIAL GENERAL LIABILITY PREMISES(Ea occurrence) $ 1,000,000.00 ❑ ❑ CLAIMS-MADE 0 OCCUR 83SBAIL5288 MED EXP(Any one person $ 10,000.00 A ❑ 04/03/2014 04/03/2015 PERSONAL&ADV INJURY $ 2,000,000.00 ❑ GENERAL AGGREGATE $ 4,000,000.00 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 4,000,000.00 ❑ POLICY Lg PRO T ❑ LOC _ $ JEC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea accident) $ ❑ ANY AUTO BODILY INJURY(Per person) $ ❑ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ❑ AUTOS ( ) ❑ HIRED AUTOS ❑ AO-OWNED PROPERTY DAMAGE $ .UT S (Per accident) ❑ ❑ $ ❑ UMBRELLA LIAB ❑OCCUR EACH OCCURRENCE $ ❑ EXCESS LIAB ❑CLAIMS-MADE AGGREGATE $ ❑ DED ❑ RETENTION S $WC WORKERS COMPENSATION ❑TORY LA IM- ❑0TH AND EMPLOYERS'LIABILITY Y/N ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? N/A (Mandatory In NH) E.L.DISEASE-EA EMPLOYE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES (Attach ACORD 101,Additional Remarks Schedule,If more space is required) Additional Insureds on Commercial General Liability arising out of project work shall be City of Oshkosh,and its officers,council members,agents,employees and authorized volunteers. Certificates of Insurance acceptable to the Cit of Oshkosh shall be submitted prior to commencement of the work to the City Department.These certificates shall contain a provision that coverage afforded under the policy will not be canceled or non renewed until at least 30 days'prior written notice has been given to the City Clerk-City of Oshkosh. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Oshkosh THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN Attn City Clerk ACCORDANCE WITH THE POLICY PROVISIONS. 215 Church Ave AUTHORIZED REPRESENTATIVE PO BOX 1130 I Oshkosh WI 54903-1130 Peter Baled ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05)QF • The ACORD name and logo are registered marks of ACORD AC RD® CERTIFICATE OF LIABILITY DATE(MM/DO/YYYY) INSURANCE 04/03/2014 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 poticy(les)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 Polly Bodjanac, State Farm Insurance NAMEA`T Polly Bodjanac 2337-A South Ridge Road (A/C No.Extl;920-494-0111 I E-MAIL !arc,Nol:920-494 6262 Sfalefarm Green Bay, WI 54304 ADDRESS:Polly @pollybodjanac.com 4114%. INSURER(S)AFFORDING COVERAGE I NAIC# INSURER A:State Farm Mutual Automobile Insurance Company • 25173 INSURED Randy Moss y INSURER a;State Farm Fire and Casualty Company 25143 2835 Newcastle Dr INSURER C: Green Bay, WI 54313-6155 INSURER D: INSURER E: INSURER F; II( 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 'ADOL SUBR' LTR TYPE OF INSURANCE POLICY EFF POLICY EXP INSR WVD POLICY NUMBER (ATM/DDlYYYr (MWDD/YYYY) LIMITS GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED CLAIMS-MADE OCCUR 1 PREMISES(Ea occurrence) $ MED EXP(Any one person) S PERSONAL&ADV INJURY $ GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: POLICY PERCOT n LOC PRODUCTS-COMP/OP AGG $ A ,AUTOMOBILE LIABILITY $ n 096 8666-D18-49F 10118/2013 04/18/2014 COMBINED SINGLE LIMIT X ANY AUTO (Ea accident) $ ALL OWNED SCHEDULED BODILY INJURY(Per person) $ 1,000,000 X AUTOS x)AUTOS BODILY INJURY( accident X HIRED AUTOS x NON OWNED ENOL application 03/31/2014 09/3012014 ( ) $ 1,000,000 AUTOS PROPERTY DAMAGE (Per accident) S 1,000,000 UMBRELLA LIAR OCCUR I $ EXCESS LIAR EACH OCCURRENCE $ CLAIMS MADE AGGREGATE I DED I I RETENTIONS $ WORKERS COMPENSATION $ AND EMPLOYERS'UABIL(TY I TORY IMITS I I OElf ANY PROPRIETOR/PARTNER/EXECUTIVE'Y/N OFFICE/MEMBER EXCLUDED? J N/A E.L EACH ACCIDENT $ (Mandatory ln NH) I If Y� describe under E.L.DISEASE-EA EMPLOYEE $ _DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT I S 13 Personal Liebilky Umbrella + L 49-GC•9911-4 10/18/2013 10/18/2014 2,000,000 excess on auto liability only I II l I DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,If more space Is required) Additional Insured on automobile liability arising out of project work shall be City of Oshkosh,and its officers,council members,agent,employees and authorized volunteers. 30 day notice of non renewal/cancellation will be given. CERTIFICATE HOLDER CANCELLATION City of Oshkosh,Attn: City Clerk SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 215 Church Ave THE EXPIRATION DATE THE F, NOTICE WILL BE DELIVERED IN ACCORDANCE'WITH THE POLICY� WI VISIONS. PO Box 1130 Oshkosh,WI 54903-1130 AUTHORIZED REPRESENTATIVE e I ACORD 25 (2010/05) ©198010 ACORD OD PORATION. All rights reserved. ( ) The ACORD name and logo are registered marks f ACORD 1001486 132849.8 01-23-2013