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Accu-Com/Fire Alarm Replacement Safety Building 2014
CONTRACTOR AGREEMENT:: SAFETY BUILDING FIRE ALARM REPLACEMENT DESIGN AND INSTALLATION THIS AGREEMENT, made on the 9TH day of July, 2014, by and between the CITY OF OSHKOSH, party of the first part, hereinafter referred to as CITY, and ACCU-COM, 90 Riverway Drive, Oshkosh, WI 54901 , hereinafter referred to as the CONTRACTOR, WITNESSETH: That the City and the Contractor, for the consideration hereinafter named, enter into the following agreement. The Contractor's proposal is attached hereto and reflects the agreement of the parties except where it conflicts with this agreement, in which case this agreement shall prevail. ARTICLE I. PROJECT MANAGER A. Assignment of Project Manager. The Contractor shall assign the following individual to manage the project described in this contract: (Matt Moore — President, Accu-Com B. Changes in Project Manager. The City shall have the right to approve or disapprove of any proposed change from the individual named above as Project Manager. The City shall be provided with a resume or other information for any proposed substitute and shall be given the opportunity to interview that person prior to any proposed change. ARTICLE II. CITY REPRESENTATIVE The City shall assign the following individual to manage the project described in this contract: (Jon Urben — General Services Manager) ARTICLE III. SCOPE OF WORK The Contractor shall provide the services described in the City's "Fire Alarm Replacement Oshkosh Safety Building" RFP dated May 28, 2014 attached as Exhibit A and the Cost Proposal Form of the Contractor for said project dated June 17, 2014 attached as Exhibit B. If anything in the Cost Proposal Form conflicts with the RFP, the provisions in the RFP shall govern. 1 The Contractor may provide additional products and/or services if such products/services are requested in writing by the Authorized Representative of the City. ARTICLE IV. CITY RESPONSIBLITIES The City shall furnish, at the Contractor's request, such information as is needed by the Contractor to aid in the progress of the project, providing it is reasonably obtainable from City records. To prevent any unreasonable delay in the Contractor's work the City will examine all reports and other documents and will make any authorizations necessary to proceed with work within a reasonable time period. ARTICLE V. TIME OF COMPLETION The work to be performed under this contract shall be commenced and the work completed within the time limits specified in the RFP. ARTICLE III. PAYMENT A. The Contract Sum. The City shall pay to the Contractor for the performance of the contract the sum of $39,950, adjusted by any changes hereafter mutually agreed upon in writing by the parties hereto. Fee schedules shall be firm for the duration of this Agreement. B. Method of Payment. The Contractor shall submit itemized monthly statements for services. The City shall pay the Contractor within 30 calendar days after receipt of such statement. If any statement amount is disputed, the City may withhold payment of such amount and shall provide to Contractor a statement as to the reason(s) for withholding payment. C. Additional Costs. Costs for additional services (e.g. Contractor Costs for Unit Price Items as listed in the Bid Form) 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 IV. CONTRACTOR TO HOLD CITY HARMLESS The Contractor covenants and agrees to protect and hold the City of Oshkosh harmless against all actions, claims and demands of any kind or character whatsoever which may in any way be caused by or result from the intentional or negligent acts of the Contractor, his agents or assigns, his employees or his subcontractors related however remotely to the performance of this Contract or be caused or result from any 2 . r violation of any law or administrative regulation, and shall indemnify or refund to the City all sums including court costs, attorney fees and punitive damages which the City may be obliged or adjudged to pay on any such claims or demands within thirty (30) days of the date of the City's written demand for indemnification or refund. ARTICLE V. INSURANCE The Contractor agrees to abide by the City of Oshkosh Insurance Requirements as specified in the RFP. ARTICLE VI. TERMINATION A. For Cause. If the Contractor shall fail to fulfill in timely and proper manner any of the obligations under this Agreement, the City shall have the right to terminate this Agreement by written notice to the Contractor. In this event, the Contractor shall be entitled to compensation for any satisfactory, usable work completed. B. For Convenience. The City may terminate this contract at any time by giving written notice to the Contractor no later than 10 calendar days before the termination date. If the City terminates under this paragraph, then the Contractor shall be entitled to compensation for any satisfactory work performed to the date of termination. This document and any specified attachments contain all terms and conditions of the Agreement and any alteration thereto shall be invalid unless made in writing, signed by both parties and incorporated as an amendment to this Agreement. 3 In the Presence of: CONTRACTOR /CONSULTANT By: AilarI r 7t-e-i 1 ti,-4- (Seal of Contractor (Specify Title) if a Corporation.) By: (Specify Title) CITY OF OSHKOSH � ,dt � � BY: Q- �1 !/Gc2�/f-s/ zed Mark A. ohloff, City Manage (Witless) - 44 t= _ //t/t- And. 1 )` id Oiliness) Pamela R. Ubrig, City Clerk 0 APPROVED: I hereby certify that the necess- ■ ary provisions have been made to r' ■ pay the liability which will accrue .►ilk _ _ under this contract. I ity At I ` ArK.n0 , ct.:u< i" City Comptroller 4 -X/// 7 f City of Oshkosh, Wisconsin Request for Proposals For Fire Alarm System Replacement Oshkosh Safety Building May 28, 2014 City of Oshkosh P.O. Box 1130 Oshkosh, Wisconsin 54903-1130 www.ci.oshkosh.wi.us 1 CITY OF OSHKOSH STANDARD TERMS AND CONDITIONS (Request For Bids/Proposal) 1) SPECIFICATIONS: The specifications in this request are the minimum acceptable. When specific manufacturer and model numbers are used, they are to establish a design, type of construction, quality, functional capability and/or performance level desired. When alternates are bid/proposed, they must be identified by manufacturer, stock number, and such other information necessary to establish equivalency. The City of Oshkosh shall be the sole judge of equivalency. Bidders/proposers are cautioned to avoid bidding alternates to the specifications which may result in rejection of their bid/proposal. 2) DEVIATIONS AND EXCEPTIONS: The bid/proposal shall be accepted as in strict compliance with all terms, conditions, and specifications and the bidders/proposers shall be held liable. Specific product types or manufacturers identified in specifications shall be interpreted to require bidding of those exact types and manufacturers. Specifications which allow for bids/quotes with"equal"materials must be fully supported with technical data, test results, or other pertinent information as evidence that the substitute offered is a sufficient alternate to the specification requirement. Failure to provide product infolination will result in disqualification of such requests. 3) QUANTITIES: The quantities shown on this request are based on estimated needs. The city reserves the right to increase or decrease quantities to meet actual needs. 4) DELIVERY: Deliveries shall be F.O.B. destination freight prepaid and included unless otherwise specified. 5) ACCEPTANCE-REJECTION: The City of Oshkosh reserves the right to accept or reject any or all bids/proposals, to waive any technicality in any bid/proposal submitted, and to accept any part of a bid/proposal as deemed to be in the best interests of the city. Only proposals which are made out on the bid/proposal form attached hereto will be considered. All bid/proposals forms must be completed in full compliance as specified. Failure to complete bid/proposals forms may result in disqualification and considered non-responsive. 6) ORDERING: Purchase orders or releases via purchasing cards shall be placed directly to the contractor by an authorized agency. No other purchase orders are authorized. 7) GUARANTEED DELIVERY: The contractor shall strictly adhere to delivery schedules as specified by the City and to promptly replace rejected or defective materials. The City retains the right to procure materials on its own when the Contractor's materials 2 are not delivered, or replaced if necessary, according to the City's schedule. Contractor's failure to deliver, or replace when applicable, materials as required shall result in the contractor's liability for all costs in excess of the contract price when the City is required to procure materials necessary due to Contractor's failure to act. The City's excess costs shall also include the administrative costs. 8) ENTIRE AGREEMENT: These Standard Terms and Conditions shall apply to any contract or order awarded as a result of this request except where special requirements are stated elsewhere in the request; in such cases, the special requirements shall apply. Further, the written contract and/or order with referenced parts and attachments shall constitute the entire agreement and no other terms and conditions in any document, acceptance, or acknowledgment shall be effective or binding unless expressly agreed to in writing by the contracting authority. 9) APPLICABLE LAW: This Contract shall be governed under the laws of the State of Wisconsin, and all disputes shall be resolved in the state or federal court jurisdiction within which Oshkosh, Wisconsin is located. The contractor shall at all times comply with and observe all federal and state laws, local laws, ordinances, and regulations which are in effect during the period of this contract and which in any manner affect the work or its conduct. The City of Oshkosh reserves the right to cancel any contract with a federally debarred contractor or a contractor which is presently identified on the list of parties excluded from federal procurement and non-procurement contracts. 10) SAFETY REQUIREMENTS: Contractor must follow all applicable federal, state and local standards. 11) SAFETY DATA SHEET: If any item(s) on an order(s) resulting from this award(s) is a hazardous chemical, as defined under 29CFR 1910.1200, provide one (1) copy of a Material Safety Data Sheet for each item with the shipped container(s). 12) PUBLIC RECORDS ACCESS: It is the intention of the City of Oshkosh to maintain an open and public process in the solicitation, submission, review and approval of procurement activities. Bid/proposal documents and openings are public records and therefore subject to release unless excluded from release by Wisconsin Statutes. Those submitting information to the City that believe that their information is not subject to release must identify the applicable statute(s) and describe in detail how the information being submitted applies to the statute cited. The City's lack of response to assertions related to public records does not indicate any agreement with those assertions. Public records may not be available for public inspection prior to the opening of bids/quotes and/or the issuance of the notice of intent to award or the award of the contract. 13) PRICING: Unit prices shown on the bid/proposal or contract shall be the price per unit of sale (e.g., gal., cs., doz., ea.) as stated on the request or contract. For any given item, the quantity multiplied by the unit price shall establish the extended price; the unit price shall govern in the bid/proposal evaluation and contract administration. If the bid/quote clearly involves the City's desire to purchase a product or products, then all 3 prices shall exclude any Federal Excise Tax or State of Wisconsin Sales Tax as the City of Oshkosh is exempt from such taxes and will furnish an exemption certificate, if requested by the successful bidder. If the bid/quote is for the purpose of completing a project involving both labor and materials, then the Contractor/Consultant, and not the City, will be purchasing the material directly and the bid/quote must include all material costs, including without limitation, taxes. 14) WARRANTY: Unless otherwise specifically stated by the bidder/proposer, equipment purchased as a result of this request shall be warranted against defects by the bidder/proposer for one (1) year from date of receipt, or the manufacturer's warranty, whichever is longer. The equipment manufacturer's standard warranty shall apply as a minimum and must be honored by the contractor. 3/13 4 REQUEST FOR PROPOSALS FIRE ALARM SYSTEM REPLACEMENT OSHKOSH SAFETY BUILDING I. Introduction The City of Oshkosh, Wisconsin, (herein referred to as the City) is seeking proposals from qualified firms to replace the fire alarm system and components at the Oshkosh Safety Building. It is the responsibility of the Proposer to carefully read the entire Request for Proposals (hereinafter referred to as the RFP) which contains all provisions applicable to successful completion and submission of a proposal. All proposals, sealed and marked "Fire Alarm System Replacement", must be received by the City of Oshkosh, City Clerk's Office, 215 Church Avenue, PO Box 1130, Oshkosh, WI 54901 by 10:00 a.m. CST on Tuesday, June 17, 2014. Any proposal received after this time will not be considered. It is neither the City's responsibility nor practice to acknowledge receipt of any proposal. Proposals may be withdrawn by notice to the party receiving proposals of the place designated for the receipt of proposals any time prior to the opening. Such notice shall be in writing over signature of the proposer, or by e- mail. If by e-mail, written confirmation over the signature of the proposer shall be mailed and postmarked on or before the date and time set for receipt of proposals, and it shall be so worded as not to reveal the amount listed in the original proposal. The City will not be liable for any costs incurred by the proposer in responding to this RFP or participating in the RFP process. Such costs are the sole responsibility of the proposer. The City of Oshkosh reserves the right to reject any or all proposals, to waive any informalities in the process, or to accept any proposal deemed in the best interests of the City of Oshkosh. The City is a governmental entity which is subject to the Wisconsin Open Records laws. Therefore, all proposals and other materials submitted to the City may be considered a public record accessible to anyone who may request such information. If you believe that any information or document that you may submit to the City is not, or should not be, a public record, then you must contact the City before it comes into the possession of the City. The City will be glad to answer questions about the applicability of open record laws and to come to some type of resolution, if possible, regarding particular circumstances. Any 5 ongoing discussions regarding open records will not extend the deadline for submitting proposals. II. Background & Purpose The Oshkosh Safety Building has two fire alarm panels that are tied to various fire alarm/activation components throughout the building including heat detectors, wall horns, wall strobes, ceiling strobes, smoke detectors, pull stations and sub panels. All four levels of the building (basement, first floor, second floor and penthouse) have various degrees of fire alarm components. Currently the building has two main fire alarm panels in the basement level. Panel 1 is circa 1980 and original to the building construction. Panel 1 is beyond its expected life cycle and replacement parts are almost non-existent. Panel 2 was added in the 2006-07 building renovation/modification project when areas changed with the Winnebago County Sheriff's Department vacating the building. Currently both panels and all components are proprietary. The purpose of this project is to solicit proposals from qualified fire alarm system designers/installers/contractors for the replacement of the two fire alarm panels and fire alarm components with one, non-proprietary, "open protocol" unified fire alarm system and non-proprietary components to be monitored by a U.L. listed monitoring company. A non-proprietary "open" protocol design will allow the City to also compare monitoring and maintenance costs from multiple life safety monitoring and maintenance vendors. The City has confirmed that this project will require submittal to the State of Wisconsin Department of Safety and Professional Services (DSPS) for plan review. It is the responsibility of the proposer to ensure that their proposal includes all costs to meet all DSPS plan review requirements, including the costs for the plan review submittal. Upon successful completion of the installation of the system components it is the City's intent to select a vendor to enter into a three-year agreement contract with the City to provide monitoring, maintenance and/or parts and labor service agreements for the system with the option for two (2) additional one year renewable terms. This contract is expected to commence as soon as the system is operational. If the City decides to opt for any of these alternate agreements they will select the same vendor for any or all of the agreements. Proposers are reminded that the City reserves the right to consider and/or select different vendors for the installation and the alternate monitoring, maintenance and/or parts and labor service agreements. III. Objectives The objectives anticipated for this project include, but are not limited to: 6 1. A fire alarm system that specifies City, State of Wisconsin Department of Safety & Professional Services (DSPS) and NFPA-72 code compliant, U.L. listed fire alarm system replacements that will specifically exclude proprietary equipment manufacturers so as to provide the City the maximum flexibility in selecting monitoring/maintenance proposals that best serve the City's needs; 2. A fire alarm panel manufacturer that allows for multiple vendors to service the system; 3. A fire alarm system that allows for any U.L. listed monitoring company to monitor the system; 4. An alternate proposal for a three-year monitoring/maintenance agreement (with optional two one-year renewal terms) for the fire alarm system. IV. Scope of Services Using best practices, field data collection and input from City staff, proposers shall review all requirements of the fire alarm system replacement project. The proposer's project requirements will include, but not limited to: 1. All drawings and/or plans required for the submittal, conditional approvals, installation and completion of the fire alarm system replacements; 2. All fire alarm system components, installation and/or material; 3. All testing of the fire alarm system and/or any of the fire alarm system components; 4. Any submittals of the fire alarm system and/or any of the fire alarm system components including but not limited to, State of Wisconsin and local submittal requirements; 5. Obtaining any conditional approvals of the fire alarm system and/or any of the fire alarm system components. Available Resources to the Bidder 1. The City will provide proposers will all required access to the buildings and will provide staff to assist in any site reviews; 2. The City will provide proposers with print copies of existing plans/drawings of all floors of the Safety Building at the mandatory walkthrough; 3. City staff will present an overview of the project at the mandatory walkthrough; 4. Any required inspections or witnessing of the acceptance tests for the systems will be done by the Oshkosh Fire Department and/or the Inspections Services Division. 7 New Components It is the City's intent to not reuse any current existing fire alarm system components within the building. Proposers should propose only new, non- proprietary components within their proposal. Operation of System during Conversion/Install The City has confirmed that during the installation of the new system the current system does not need to remain operational, provided the Safety Building/Police Department institutes a fire watch program/schedule during the installation period. It would be the City's intent to minimize the down time during the conversion/installation of the old system to the new system. Smoke, Heat & Duct Detection The City has confirmed it would like to provide smoke detection, heat detection and duct detection devices within the building per the minimum requirements of NFPA-72 and the State of Wisconsin DSPS. Document Deliverables By conclusion of the project the proposer shall provide the City with the following document deliverables: 1. Two (2) high resolution PDF copies of the final approved plan designs; 2. Two (2) larger format blueprints of the final approved designs; 3. All warranty, monitoring/maintenance agreement documents; 4. Any other documents as specified within their proposal. Permits The Contractor shall be fully responsible for obtaining (and paying for) all required State of Wisconsin Department of Safety & Professional Safety (DSPS) plan review, approvals, permits, licenses, inspections and certificates for this installation. As this is a City of Oshkosh project there will be no fees for any City of Oshkosh permits. Safety and Hazardous Materials Contractor shall be solely responsible for initiating, maintaining and supervising all safety programs and precautions and shall comply with all applicable safety laws, good industry standards or practices, and take all reasonable precautions for the safety of their workers, City property, the Public and City of Oshkosh employees, guests and/or vendors. Product Delivery, Installation, Site Organization and Clean Up 1. Work shall be done during regular working hours until complete. The work must be specifically authorized by City of Oshkosh representatives. 8 2. All work schedules shall be submitted and coordinated in advance to the designated authorized City of Oshkosh representatives. 3. Contractor shall keep work areas orderly and free from debris during the course of installation and clean up on a daily basis. If areas are not kept clean the City of Oshkosh may demand immediate clean up or clean those areas and deduct such costs from the contract. 4. Contractor shall regularly remove trash, materials, cartons, etc. generated by their work from the premises. 5. Protect all materials stored on site as well as work in progress from damage by others. Damage resulting from improper storage, handling or during installation shall be the sole responsibility of the Contractor. Warranty The installed equipment shall be warranted by the manufacturer for one (1) year on the workings of the equipment. The contractor shall warrant their installation work for one (1) year from defects in workmanship. The warranty date shall start on the date of the final acceptance of the system by the City of Oshkosh. Insurance The successful proposer shall not commence work under this agreement until it has obtained all necessary insurance requirements as listed within the attached City of Oshkosh Insurance Requirements. Bid and Performance Bond See the attached City of Oshkosh Insurance Requirements for any bid and/or performance bond requirements for this project. Background Check Policy The City will conduct background checks on employees working for the Contractor that will be involved in the physical installation of this project. In addition, the City may provide security/supervision for the project areas to maintain the confidentiality of the work environment. Contractor Agreement Template Regardless of the bid, or proposal, or part of the project the proposer is interested in, the successful proposer will be expected to enter into a contract substantially similar to the sample contract agreement attached to this RFP. The successful proposer may propose additional contract language. However, proposers who submit and/or require contractual terms and conditions that are not acceptable to the City, but are considered by the contractor as a condition of their undertaking the City's project, will not be considered a responsible proposer by the City and their proposal may be rejected for that reason. Bidders do not need to sign or complete the sample contract agreement attached to this RFP as part of their bid submittal. 9 Time of Completion The contractor shall have all systems installed, tested and operational no later than 9/1/14, provided they can work around the City's schedule. Project Schedule The following schedule provides events and deadlines for this project: RFP Issued 5/28/14 Mandatory Pre-Proposal Walkthrough 6/4/14- Noon Deadline to Receive Questions from Bidders 6/11/14 Contractor Pre-Qualifications Deadline 6/12/14 Posting of Answers to Proposer's Questions 6/13/14 Proposals Due 6/17/14- 10:00 a.m. Proposals Review/Contractor Selection 6/17/14-6/30/14 Anticipated Bid Award 7/8/14 Anticipated Notice to Proceed 7/9/14 Testing/Acceptance/Project Completion By 9/1/14 V. Monitoring, Maintenance, and Parts & Labor Service Agreement Proposals Proposers are also asked to provide costs for three (3) year monitoring, maintenance and parts and labor service agreement proposals for the fire alarm system specified in this RFP. Proposals should also specify the monitoring, maintenance, and parts and labor service agreement rates for optional two (2) one-year renewal terms. Proposal should also include any adjustments or increases to costs for the initial three year contract term and the subsequent two (2), one-year renewal terms. Proposal 1: Monitoring Agreement This proposal should specify all of the monitoring costs and provisions for the fire alarm system for the contract terms listed above. All monitoring provisions must meet all applicable local, state or NFPA-72 codes. Proposal 2: Maintenance Agreement This proposal should specify costs to provide any applicable scheduled testing and/or maintenance required to meet all local, state or NFPA-72 code for the fire alarm system for the contract term lengths listed above. Testing and maintenance provisions may include but are not limited to: testing of power supplies and battery chargers, proper alarm and trouble reporting of all zone and output circuits, testing for correct battery voltage, system diagnostics, testing of all pull stations, testing for proper audibility levels from indicating appliances, cleaning of total system smoke detectors, testing of all door holders and testing of water flow and tamper switches. Proposal should list all scheduled testing and maintenance provisions included in the proposal. Proposals should also include 10 standard service call response procedures, any rates for labor, mileage, travel and attach a fee schedule for hourly or other unit rates of cost for standard service. Proposal 3: Parts & Labor Service Agreement This proposal should also specify costs to provide parts and labor service agreement to diagnose, repair or replace any failed system parts or components for the term lengths listed above that would not be covered within the maintenance agreement. This proposal should indicate what the service plan(s) coverage include, all cost differences, service times/rates, any exclusion to the coverage, other features of the plan(s) and attach a fee schedule for hourly or other unit rates of cost for the plan(s). VI. Elements of Proposal Elaborate proposals beyond that which is sufficient to present a complete and effective proposal are not necessary or desired. Each proposer shall print their submission on single-sided paper. Each proposal shall include the following: 1. A statement of your work plan including the anticipated time schedule for completing this project. 2. A plan and/or drawing indicating all recommended counts and locations to provide smoke detection, heat detection and duct detection devices within the building per the minimum requirements of NFPA-72 and the State of Wisconsin DSPS. 3. Submittal of the City of Oshkosh Contractor Pre-Qualification Form showing at least (3) examples of previous experience with similar projects, including contacts for each of the projects. Project experience should emphasize public-sector projects. The same contact person may be used for more than one project. 4. Submittal of any required bid and/or performance bond as noted in the attached City of Oshkosh insurance requirements. 5. Submittal of the Cost Proposal Form (in a separate sealed envelope within their proposal) in a not-to-exceed amount for all labor and materials required to perform the work identified within this RFP. VII. Evaluation of Proposals The proposals will be initially reviewed to determine if proposal requirements are met. Failure to meet mandatory requirements may result in the proposal being rejected. Based on the evaluation of the written proposal, additional information may be required to clarify or confirm proposal information. Additional information obtained may be of any or all of the following: proposer interviews, reference reviews, and proposer presentation/demonstration. The following criteria are listed in priority order and will be followed to evaluate the information submitted in each proposal: 11 1. Responsiveness & Solution- The extent to which the firm's proposal responds to the scope and requirements outlined in this RFP. 2. Professional Competence- The extent to which the firm has demonstrated competence in performing similar work and/or the extent of former client/customer satisfaction. 3. Proposal- The extent to which the firm's proposal is organized, complete and demonstrates a thorough understanding of the services described in this RFP. 4. Cost- The proposals will be evaluated for all costs necessary to fulfill the requirements of this RFP. VIII. Proposal Selection and Agreement The City will notify all proposers upon completion of the evaluation process. The City will begin negotiating with the most qualified (highest scoring responsive and responsible) consultant. If an agreement on price fails, negotiations with the next most qualified consultant will be conducted until a contract award can be made to the most qualified consultant whose price is fair and reasonable to the City. The scope of services defined in this RFP, the cost schedule supplied by the proposer, along with any subsequent scope addenda/amendments, will become the scope of the work for the proposer. Once awarded, the successful proposer will be expected to enter into an agreement similar to the sample attached and to provide proof of required City of Oshkosh insurance coverage, naming the City as an additional insured. Upon signature by designated City officials, the agreement will become binding and the consultant may begin to execute its scope of work. IX. Addenda / Questions All requests for interpretations, corrections or questions to this RFP must be emailed to General Services Manager Jon Urben (jurben©ci.oshkosh.wi.us) by Wednesday, June 11, 2014. Only interpretations or corrections of the RFP made in writing by the General Services Manager are binding. Proposers interested in receiving proposal addenda based on these interpretations or corrections shall provide an email address to the General Services Manager. Any addenda with corrections or questions will be emailed to proposers by Friday, June 13, 2014. X. Protest Procedure Any proposer who wishes to protest the proposed award of a contract must submit a detailed statement in writing of the grounds for protest and any supporting documentation to the General Services Manager prior to the contract award. The appealing party must be an actual or prospective proposer whose direct economic interest would be affected by the award, or failure to aware the 12 contract. Award of the contract will be suspended temporarily unless this action will cause undue harm to the City of Oshkosh. The General Services Manager shall issue a determination upon the protest and notify the protesting party. Minor errors in proposal procedures shall not be grounds for delaying or prohibiting approval of the contract. 13 City of Oshkosh Contractor Agreement Pre-Qualification Form 14 ****MUST BE ON FILE 5 DAYS PRIOR TO SOLICIATION DUE DATE**** Vendor is responsible to update annually CITY OF OSHKOSH CONTRACTOR QUALIFICATION FORM Company Information Company Name: Complete Address: Phone: Fax: State Contractor's License #: State Public Works Contractor's License#: Other Applicable Licenses: Union Affiliation: Work Trades Perfonned: Type of Company: [] Corporation [] Partnership [] Sole Proprietorship Federal Tax ID#: Company Contact: Email Address: Date Formed: Number of Employees: Salaried: Hourly: Bank Reference Lenders Name and Address Lending Officers Name and Phone Number Completed Projects List four(4)representative projects completed in the last five(5)years Project Name Contracting Company Contact Name/Phone# Contract Amount Current Projects List four(4)representative projects currently under construction Project Name Contracting Company Contact Name/Phone# Contract Amount Trade References List three(3)of your subcontractors or suppliers Company Name Address Phone# Contact Name Client References List three(3) clients Company Name Address Phone# Contact Name Other Information In the past five years has your company failed to complete a contract or had a contract terminated? [] Yes []No In the past five years,has your company had any liens filed against it by any subcontractors or suppliers? [] Yes []No Has your company ever had liquidated damages assessed against it? []Yes []No Has your company or any of its employees been involved in a lawsuit related to a project? [] Yes [] No Has your company been investigated for any violations of local, state, or federal laws? []Yes []No Has your company or any of its employee's been investigated for violation of any labor laws? [] Yes []No Provide a detailed description of the circumstances behind any"yes"answers given above below: Sample City of Oshkosh Contractor Agreement 15 CONTRACTOR AGREEMENT- SAMPLE THIS AGREEMENT, made on the day of , 2012 by and between the CITY OF OSHKOSH, party of the first part, hereinafter referred to as CITY, and , hereinafter referred to as the CONTRACTOR, WITNESSETH: That the City and the Contractor, for the consideration hereinafter named, enter into the following agreement. The Contractor's proposal is attached hereto and reflects the agreement of the parties except where it conflicts with this agreement, in which case this agreement shall prevail. ARTICLE I. PROJECT MANAGER A. Assignment of Project Manager. The Contractor shall assign the following individual to manage the project described in this contract: (Name, Title) B. Changes in Project Manager. The City shall have the right to approve or disapprove of any proposed change from the individual named above as Project Manager. The City shall be provided with a resume or other information for any proposed substitute and shall be given the opportunity to interview that person prior to any proposed change. ARTICLE II. CITY REPRESENTATIVE The City shall assign the following individual to manage the project described in this contract: (Name, Title) ARTICLE III. SCOPE OF WORK The Contractor shall provide the services described in the Contractor's Proposal dated . If anything in the Contractor's proposal conflicts with this agreement, the provisions in this agreement shall govern. The Contractor may provide additional products and/or services if such products/services are requested in writing by the Authorized Representative of the City. 1 ARTICLE IV. CITY RESPONSIBLITIES The City shall furnish, at the Contractor's request, such information as is needed by the Contractor to aid in the progress of the project, providing it is reasonably obtainable from City records. To prevent any unreasonable delay in the Contractor's work the City will examine all reports and other documents and will make any authorizations necessary to proceed with work within a reasonable time period. ARTICLE V. TIME OF COMPLETION The work to be performed under this contract shall be commenced and the work completed by ARTICLE III. PAYMENT A. The Contract Sum. The City shall pay to the Contractor for the performance of the contract the sum of $ , adjusted by any changes hereafter mutually agreed upon in writing by the parties hereto. Fee schedules shall be firm for the duration of this Agreement. B. Method of Payment. The Contractor shall submit itemized monthly statements for services. The City shall pay the Contractor within 30 calendar days after receipt of such statement. If any statement amount is disputed, the City may withhold payment of such amount and shall provide to Contractor a statement as to the reason(s) for withholding payment. C. Additional Costs. Costs for additional services to be negotiated and set forth in a written amendment to this agreement executed by both parties prior to proceeding with the work covered under the subject amendment. ARTICLE IV. CONTRACTOR TO HOLD CITY HARMLESS The Contractor covenants and agrees to protect and hold the City of Oshkosh harmless against all actions, claims and demands of any kind or character whatsoever which may in any way be caused by or result from the intentional or negligent acts of the Contractor, his agents or assigns, his employees or his subcontractors related however remotely to the performance of this Contract or be caused or result from any violation of any law or administrative regulation, and shall indemnify or refund to the City all sums including court costs, attorney fees and punitive damages which the City may be obliged or adjudged to pay on any such claims or demands within thirty (30) days of the date of the City's written demand for indemnification or refund. 2 ARTICLE V. INSURANCE The Contractor shall provide insurance for this project that includes the City of Oshkosh as an additional insured. The specific coverage required for this project are identified on a separate document. ARTICLE VI. TERMINATION A. For Cause. If the Contractor shall fail to fulfill in timely and proper manner any of the obligations under this Agreement, the City shall have the right to terminate this Agreement by written notice to the Contractor. In this event, the Contractor shall be entitled to compensation for any satisfactory, usable work completed. B. For Convenience. The City may terminate this contract at any time by giving written notice to the Contractor no later than 10 calendar days before the termination date. If the City terminates under this paragraph, then the Contractor shall be entitled to compensation for any satisfactory work performed to the date of termination. This document and any specified attachments contain all terms and conditions of the Agreement and any alteration thereto shall be invalid unless made in writing, signed by both parties and incorporated as an amendment to this Agreement. In the Presence of: CONTRACTOR /CONSULTANT By: (Seal of Contractor (Specify Title) if a Corporation.) By: (Specify Title) CITY OF OSHKOSH By: 3 Mark A. Rohloff, City Manager (Witness) And: (Witness) Pamela R. Ubrig, City Clerk APPROVED: I hereby certify that the necess- ary provisions have been made to pay the liability which will accrue under this contract. City Attorney City Comptroller 4 City of Oshkosh Insurance Requirements 16 4/14/14 CITY OF OSHKOSH INSURANCE REQUIREMENTS II. CONTRACTOR'S INSURANCE WITHOUT PROPERTY INSURANCE REQUIREMENTS The Contractor shall not commence work on contract until proof of insurance required has been provided to the applicable City department before the contract or purchase order is considered for approval by the City. It is hereby agreed and understood that the insurance required by the City of Oshkosh is primary coverage and that any insurance or self insurance maintained by the City of Oshkosh, its officers, council members, agents, employees or authorized volunteers will not contribute to a loss. All insurance shall be in full force prior to commencing work and remain in force until the entire job is completed and the length of time that is specified, if any, in the contract or listed below whichever is longer. 1. INSURANCE REQUIREMENTS FOR CONTRACTOR—LIABILITY& BONDS A. Commercial General Liability coverage at least as broad as Insurance Services Office Commercial General Liability Form, including coverage for Products Liability, Completed Operations, Contractual Liability, and Explosion, Collapse, Underground coverage with the following minimum limits and coverage: 1. Each Occurrence limit $1,000,000 2. Personal and Advertising Injury limit $1,000,000 3. General aggregate limit (other than Products–Completed Operations) per project $2,000,000 4. Products–Completed Operations aggregate $2,000,000 5. Fire Damage limit—any one fire $50,000 6. Medical Expense limit—any one person $5,000 7. Watercraft Liability, (Protection & Indemnity coverage)"if" the project work includes the use of, or operation of any watercraft, then Watercraft Liability insurance must be in force with a limit of$1,000,000 per occurrence for Bodily Injury and Property Damage. 8. Products –Completed Operations coverage must be carried for two years after acceptance of completed work. B. Automobile Liability coverage at least as broad as Insurance Services Office Business Automobile Form, with minimum limits of $1,000,000 combined single limit per accident for Bodily Injury and Property Damage, provided on a Symbol#1–"Any Auto" basis. C. Workers' Compensation as required by the State of Wisconsin, and Employers Liability insurance with sufficient limits to meet underlying Umbrella Liability insurance requirements. If applicable for the work coverage must include Maritime (Jones Act) or Longshoremen's and Harbor Workers Act coverage. D. Umbrella Liability providing coverage at least as broad as the underlying Commercial General Liability, Watercraft Liability (if required), Automobile Liability and Employers Liability, with a minimum limit of $2,000,000 each occurrence and $2,000,000 aggregate, and a maximum self-insured retention of$10,000. II - 1 4/14/14 E. Aircraft Liability, "if" the project work includes the use of, or operation of any aircraft or helicopter, then Aircraft Liability insurance must be in force with a limit of $3,000,000 per occurrence for Bodily Injury and Property Damage including Passenger liability and including liability for any slung cargo. F. Builder's Risk / Installation Floater / Contractor's Equipment or Property - The contractor is responsible for loss and coverage for these exposures. City of Oshkosh will not assume responsibility for loss, including loss of use, for damage to property, materials, tools, equipment, and items of a similar nature which are being either used in the work being performed by the contractor or its subcontractors or are to be built, installed, or erected by the contractor or its subcontractors. G. Also, see requirements under Section 3. H. Bond Requirements 1. Bid Bond. Bids that are $25,000 or greater will require the contractor to provide to the owner a Bid Bond, which will accompany the bid for the project. The Bid Bond shall be equal to 5 percent of the contract bid. The City may, at its discretion, require bonds for certain contracts with amounts less than $25,000. 2. Payment and Performance Bond. If awarded the contract, bids that are $25,000 or greater will require the contractor to provide to the owner a Payment and Performance Bond in the amount of the contract price, covering faithful performance of the contract and payment of obligations arising thereunder, as stipulated in bidding requirements, or specifically required in the contract documents on the date of the contract's execution. The City may, at its discretion, require bonds for certain contracts with amounts less than $25,000. 3. Acceptability of Bonding Company. The Bid, Payment and Performance Bonds shall be placed with a bonding company with an A.M. Best rating of no less than A- and a Financial Size Category of no less than Class VI. 2. INSURANCE REQUIREMENTS FOR SUBCONTRACTOR All subcontractors shall be required to obtain Commercial General Liability (if applicable Watercraft liability), Automobile Liability, Workers' Compensation and Employers Liability, (if applicable Aircraft liability) insurance. This insurance shall be as broad and with the same limits as those required per Contractor requirements, excluding Umbrella Liability, contained in Section 1 above. 11 - 2 4/14/14 3. APPLICABLE TO CONTRACTORS /SUBCONTRACTORS /SUB-SUB CONTRACTORS A. Acceptability of Insurers - Insurance is to be placed with insurers who have an A.M. Best rating of no less than A- and a Financial Size Category of no less than Class VI, and who are authorized as an admitted insurance company in the state of Wisconsin. B. Additional Insured Requirements — The following must be named as additional insureds on all Liability Policies for liability arising out of project work - City of Oshkosh, and its officers, council members, agents, employees and authorized volunteers. On the Commercial General Liability Policy, the additional insured coverage must be ISO form CG 20 10 07 04 or its equivalent and also include Products — Completed Operations ISO form CG 20 37 07 04 or its equivalent for a minimum of 2 years after acceptance of work. This does not apply to Workers Compensation Policies. C. Certificates of Insurance acceptable to the City of Oshkosh shall be submitted prior to commencement of the work to the applicable City department. These certificates shall contain a provision that coverage afforded under the policies will not be canceled or non renewed until at least 30 days' prior written notice has been given to the City Clerk — City of Oshkosh. II - 3 A�z CERTIFICATE OF LIABILITY INSURANCE I DATE(MM/DD/YW) THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THI 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 0 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 th terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificat holder in lieu of such endorsement(s). PRODUCER Insurance Agency contact CONTACT information,including street NAME: address and PO Box if PHONE Insurance Agent's contact information. I FAX applicable. (A/C.No.Est): jA/C.No): E-MAIL ADDRESS: INSURER(S)AFFORDING COVERAGE - I NAIC# INSURED INSURER A: ABC Insurance Company I NAIC# Insured's contact information, including name,address and I INSURER B: XYZ Insurance Company ! NAIC# phone number. INSURER c: LMN Insurance Company I NAIC# INSURER D: I Insurer(s)must have a minimum A.M.Best rating of A- and a Financial Performance Rating of V/or better. INSURER E: I INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE AMY BE ISSUED OR MAY PERTAIN. THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR! ADDL SUER LTR TYPE OF INSURANCE I INSRI WVD I POLICY NUMBER I (MM/DD EFF POLICY EXP !GENERAL LIABILITY /YYY) I (MM/DD/Yl'1') I LIMITS EACH OCCURRENCE $ 1,000,000 I®!COMMERCIAL GENERAL LIABILITY ® I I (General liability Policy Number! !Policy effective and expiration date.! DAMAGE TO RENTED A I II CLAIMS-MADE i®(OCCUR PREMISES(Ea occurrence) $50,000 ! MED EXP(Any one person) $5,000 ISO FORM CG 20 37 OR EQUIVALENT II if PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 nIPOLICY I®(PRO!I IILOC !PRODUCTS—COMP/OP AGG $2,000,000 l JECT I 1 !AUTOMOBILE LIABILITY I $ (COMBINED SINGLE LIMIT 'MANY AUTO ® fI� I(Ea accident) $ 1,000,000 I ! Auto Liability Policy Number I 'Policy effective and expiration date.! B! HLL OWNED !! I SCHEDULED BODILY INJURY(Per person) $ 11 ',ALL AUTOS NON-OWNED BODILY INJURY PROPERTY DAMAGE(Per accident) $ il I'HIRED AUTOS n AUTOS I II H I (Per accident) $ (®(UMBRELLA LIAR ®OCCUR ® n ! A n I EACH OCCURRENCE $2,000,000 II ('EXCESSLIAB I I CLAIMS-MADE !UmbrellaLiabilityPolicyNumber) !Policy effective and expiration date.) �DED I®! (AGGREGATE $2,000,000 RETENTION$10,000 ! ENSATION I I $ C' (AND WORKERS EMPLOYERSCOMP'LIABILITY I I ® I / ITORY LIMITSIuI ER /ANY PROPRIETOR/PARTNER/EXECUTIVE (OFFICE/MEMBEREXCLUDED? Y/N I (Mandatory in NH) N Workers Compensation Policy I !Policy effective and expiration date.) fE.L.EACH ACCIDENT $ 100,000 If yes,describe under Number I DESCRIPTION OF OPERATIONS below E.L.DISEASE—EA EMPLOYEE $ 100,000 IY ' H / E.L.DISEASE—POLICY LIMIT $500,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach ACORD 101 I I . I Additional Remarks Schedule,if more space is required) Additional Insureds per attached endorsements. Certificates of Insurance acceptable to the City of Oshkosh shall be submitted prior to commencement of the work to the applicable City department. These certificates shall contain a provision that coverage afforded under the policies will not be canceled or non renewed until at least 30 days'prior written notice has been given to the City Clerk—City of Oshkosh. CERTIFICATE HOLDER CANCELLATION City of Oshkosh,Attn:City Clerk Insurance Standard II SAMPLE CERTIFICATE SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 215 Church Avenue THE EXPIRATION DATE,THEREOF,NOTICE WILL BE DELIVERED IN PO Box 1130 ACCORDANCE WITH THE POLICY PROVISIONS. Oshkosh,WI 54903-1130 Please indicate somewhere on this certificate,the contract or project# AUTHORIZED REPRESENTATIVE this certificate is for. ©1988-2010 ACORD CORPORATION. All rights reservec ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD POLICY NUMBER: COMMERCIAL GENERAL LIABILITY 0 ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ 0 ® ❑ IIIIOLG 20 10 07 04 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - SCHEDULED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s): Location(s) Of Covered Operations As required by contract Any and all job sites Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. Section II — Who Is An Insured is amended to B. With respect to the insurance afforded to these include as an additional insured the person(s) or additional insureds, the following additional exclu- organization(s) shown in the Schedule, but only sions apply: with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" This insurance does not apply to "bodily injury" or caused, in whole or in part, by: "property damage"occurring after: 1. Your acts or omissions; or 1. All work, including materials, parts or equip- 2. The acts or omissions of those acting on your ment furnished in connection with such work, behalf; on the project(other than service, maintenance or repairs) to be performed by or on behalf of In the performance of your ongoing operations for the additional insured(s) at the location of the the additional insured(s) at the location(s) design- covered operations has been completed; or nated above. 2. That portion of "your work" out of which the injury or damage arises has been put to its in- tended use by any person or organization other than another contractor or subcontractor en- gaged in performing operations for a principal as a part of the same project. Insurance Standard Il SAMPLE CERTIFICATE Please indicate somewhere on this certificate,the contract or project# this certificate is for. CG 20 10 07 04 ©ISO Properties, Inc., 2004 Page 1 of 1 ❑ POLICY NUMBER: I Policy# I COMMERCIAL GENERAL LIABILITY 0 0 0 0 0 0 0 0 0 0 ® 0 =ECG 20 37 07 04 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - COMPLETED OPERATIONS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s): Location And Description Of Completed Operations As required by contract Any and all job sites Information required to complete this Schedule, if not shown above, will be shown in the Declarations. Section II — Who Is An Insured is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for "bodily injury", "property dam- age" caused, in whole or in part, by "your work" at the location designated and described in the sched- ule of this endorsement performed for that additional insured and included in the "products-completed operations hazard". Insurance Standard II SAMPLE CERTIFICATE Please indicate somewhere on this certificate,the contract or project# this certificate is for. CG 20 37 07 04 ©ISO Properties, Inc., 2004 Page 1 of 1 ❑ COST PROPOSAL FORM Fire Alarm Replacement: Oshkosh Safety Building From: (bidder's company name) PROPOSAL DEADLINE: Tuesday,June 17, 2014 at 10:00 a.m. CST. Addenda: Receipt of Addenda numbered of are hereby understood, acknowledged and included in bidder's proposal form. If no addenda were issued for this project please write"N/A"above. We, the undersigned, propose to furnish all labor and materials per the project specifications or noted deviations for the following amount: Fire Alarm System Replacement Proposal $ Monitoring, Maintenance and Parts/Labor Service Agreement Proposals: Alternate Proposal 1: 3 year fire alarm alarm monitoring $ Optional two (2) one-year renewal terms $ yearly Alternate Proposal 2: 3 year fire alarm maintenance $ Optional two (2) one-year renewal terms $ yearly Alternate Proposal 3: 3 year parts/labor service agreement $ Optional two (2) one-year renewal terms $ yearly Date: Name of Company: Submitted by: (name/title) Email: Address of Company: Phone: That I have examined and carefully prepared this Proposal from the RFP soliciation and have checked the same in detail before submitting this Proposal; that I have full authority to make such statements and submit this Proposal in (its) (their) behalf, and that said statements are true and correct. Signature Title 17 . x/1i4 r1 COST PROPOSAL FORM Fire Alarm Replacement: Oshkosh Safety Building From: A LI ` c;�-�^• (bidder's company name) PROPOSAL DEADLINE: Tuesday,June 17, 2014 at 10:00 a.m. CST. Addenda: Receipt of Addenda numbered k of \ are hereby understood, acknowledged and included in bidder's proposal form. If no addenda were issued for this project please write"N/A"above. We, the undersigned, propose to furnish all labor and materials per the project specifications or noted deviations for the following amount: Fire Alarm System Replacement Proposal $ 39,950. � Monitoring, Maintenance and Parts/Labor Service Agreement Proposals: Alternate Proposal 1: 3 year fire alarm alarm monitoring $ a0.- Optional two (2) one-year renewal terms $ yearly Alternate Proposal 2: 3 year fire alarm maintenance $ 13O GO Optional two (2) one-year renewal terms $ O yearly Alternate Proposal 3: 3 year parts/labor service agreement $ S COO.CO Optional two (2) one-year renewal terms $ 400,°" yearly Date: ti j4 Name of Company: to e,C L! 60.-n I Submitted by: (name/title) Plat/ 171 corn I• ee_., 'Email: i7?477�72CC�OQ�,ecr- ,-r�, z�X. Address of Company: /o i�lc r;,r � e (D. Phone: Ci •Zc - `[z-4 That I have examined and carefully prepared this Proposal from the RFP soliciation and have checked the same in detail before submitting this Proposal; that I have full authority to make such statements and submit this P oposal in (its) (their) behalf, and that said statements are true and correct. Signature Title P2 t-K, 17 WEST BEND A MUTUAL INSURANCE COMPANY r" Bond Number 2152948 Bid Bond KNOW ALL BY THESE PRESENTS, That We, Accu Corn, [me- as Principal, and WEST BEND MUTUAL INSURANCE COMPANY, a corporation organized under the laws of the State of Wisconsin and having its principal office in Middleton, Wisconsin, in said State, as Surety, are held and firmly bound unto City of Oshkosh as Owner, in the full and just sum of Five Percent ( 5 %)of amount bid for the payment whereof said Principal binds its heirs, administrators, and executors and said Surety binds itself, its successors and assigns firmly by these presents WHEREAS, said Principal has submitted to said Owner a bid or proposal for Oshkosh Safety Building Fire Alarm Replacement NOW THEREFORE, THE CONDITION OF THIS OBLIGATION IS SUCH that if within Sixty days hereof and in accordance with said proposal a contract shall be awarded to said Principal and the said Principal shall enter into a contract for said work and shall furnish bond with surety as required for its faithful performance then this obligation shall be void, otherwise remain in full force and virtue. Signed and Sealed this 16 day of June 20 14 Principal: AO Acc. Com,lue / B I �� (SEAL) Witness fl](��;,r. (!t (1' 2 - Name Typ-d: Matthew Moore President (� Title Surety: West Bend j 1)Jtual Insurance Comppan BY: L)/ZYX—&-f /7) l (SEAL) Witness: / CL ( :(, V ,j')2 f2r Name Typed:SHEL ffLARK Attorney-In-Fact U (1 Title Agency Name: RICHARDS INS OF OSHKOSH LLC Address: 48 N. OAKWOOD RD OSHKOSH , WI 54904 Phone Number: (920)235-1980 MICHIGAN ONLY: This policy is exempt from the filing requirements of Section 2236 of the Insurance Code of 1956, 1956 PA 218 and MCL 500.2236. NB 0192 02 08 Page 1 of 1 8401 Greenway Blvd.Suite 1100 I Middleton,WI 53562 I Phone:(608)410-3410 I Fax: (877)674-2663 I www.wbmi.com