HomeMy WebLinkAboutPW CNT 14-20/Carl Bowers & Sons CITY OF OSHKOSH
LEGAL DEPARTMENT
215 CHURCH AVENUE, P.O. BOX 1130, OSHKOSH, WI 54903-1130
PHONE: (920) 236-5115 FAX (920) 236-5106
LETTER OF TRANSMITTAL
To: Carl Bowers & Sons Construction Co. Date: September 5, 2014
N1844 Maloney Road Pro'ect: Storm Sewer Laterals
Kaukauna, WI 54130 From: Carol Marchant, Adm. Assistant
Re: Contract No. 14-20
Attn:
Please find: � Attached ❑ Under Separate Cover
❑ Copy of Letter � Contracts ❑ Amendment ❑ Report ❑ Agenda
❑ Meeting Notes ❑ Photos ❑ Mylars ❑ Change Order ❑ Plans
❑ Specifications ❑ Estimates ❑ Diskette ❑ Zip Disk ❑ Other
Quantit Description
1 Ori inal of the full executed Contract 14-20
These are being transmitted as indicated below:
❑ For Approval � For Your Use ❑ As Requested ❑ For Review�Comment
Remarks:
cc: City Clerk (original)
Public Works, Engineering (original)
City Attorney (copy)
CONSTRUCTION CONTRACT
THIS AGREEMENT, made on the 25th day of June, 2014, by and between the CITY
OF OSHKOSH, party of the first part, hereinafter referred to as CITY, and CARL BOWERS
8� SONS CONSTRUCTION COMPANY, INC., N1844 Maloney Road, Kaukauna, WI
54130, party of the second part, hereinafter referred to as the CONTRACTOR,
WITNESSETH:
That the CITY and the CONTRACTOR, for the consideration hereinafter named,
agree as follows:
ARTICLE I. SCOPE OF WORK
The CONTRACTOR hereby agrees to furnish all of the materials and all of the
equipment and labor necessary, and to perform all of the work shown on the plans and
described in the specifications for the project entitled or described as follows:
Public Works Contract No. 14-20
for the Storm Sewer LateralsNarious Locations, for the Public Works Department,
pursuant to Resolution 14-273 adopted by the Common Council of the City of Oshkosh on
the 24th day of June, 2014,
all in accordance and in strict compliance with the CONTRACTOR's Proposal and the other
Contract Documents referred to in ARTICLE V of this Contract.
ARTICLE II. 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 Special Conditions and/or
CONTRACTOR's proposal.
ARTICLE III. PAYMENT
(a) The Contract Sum.
The CITY shall pay to the CONTRACTOR for the performance of the Contract the
sum of $255,028.00, adjusted by any changes as provided in the Specifications, or any
changes hereafter mutually agreed upon in writing by the parties hereto, provided,
however, in the event the Proposal and Contract Documents are on a "Unit Price" basis,
the above mentioned figure is an estimated figure, and the CITY shall, in such cases, pay
to the CONTRACTOR for the performance of the Contract the amounts determined for the
total number of each of the units of work as set forth in the CONTRACTOR's proposal; the
number of units therein contained is approximate only, and the final payment shall be
made for the actual number of units that are incorporated in or made necessary by the
work covered by the Contract.
1
(b) Progress Payments.
In the event the time necessary to complete this Contract is such that progress payments
are required, they shall be made according to the provisions set forth in the Specifications.
ARTICLE IV. CONTRACTOR TO HOLD CITY HARMLESS
The CONTRACTOR covenants and agrees to protect and hold the CITY 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.
ARTICLE V. INSURANCE
The Insurance required by the City of Oshkosh as specified in the CITY's
specifications, including addenda, or plans, or instructions, or advertisements, shall be
primarv coveraqe 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 based upon the occurrence of an event, and
not based on claims made. 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 this Contract, the Specifications, whichever is longer.
ARTICLE VI. COMPONENT PARTS OF THE CONTRACT
This Contract consists of the following component parts, all of which are as fully a
part of this contract as if herein set out verbatim, or if not attached, as if hereto attached:
1. This Instrument
2. The City's Approved Plans
3. Specifications, including any addenda
4. City of Oshkosh Standard Specifications
5. Instructions to Bidders
6. Advertisement for Bids �
7. Contractor's Proposal
The Contract Documents are complementary; what is required by one is as binding
as if required by all. Before undertaking each part of the work, the CONTRACTOR shall
carefully study and compare the Contract Documents and check and verify all pertinent
figures and measurements required therein. CONTRACTOR shall promptly report in
writing to the Engineer any conflict, error, ambiguity or discrepancy which CONTRACTOR
may discover and shall obtain written clarification from the Engineer before proceeding with
any work affected thereby.
2
In the event that any provision in any of the above component parts of this Contract
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.
IT IS HEREBY DECLARED, UNDERSTOOD AND AGREED that the word
"CONTRACTOR" wherever used in this Contract means the party of the second part and
its/his/their legal representatives, successors, and assigns.
IN WITNESS WHEREOF, the City of Oshkosh, Wisconsin, has caused this contract
to be sealed with its corporate seal and to be subscribed to by its City Manager and City
Clerk and countersigned by the Comptroller of said City, and the party of the second part
hereunto set its, his or their hand and seal the day and year first above written.
In the Presence of: CONTRACTOR
CARL BOWERS 8� SONS CONSTRUCTION CO.
e� �
By:
t �.e �rye.f��
(Seal of Contractor (Specify Title)
if a Corporation.)
By:
(Specify Title)
CITY OF OSHKOSH
� . / �
� � By: a—�/-�
2 Z 'L — Mark A. Rohloff, City Manager
Witne �____
�=_
��G L � � And: � , ___-� N � ,
ss) Pamela R. Ubrig, City Clerk
APPROVED: I hereby certify that the necessary
provisions have been made to pay
the liability which will accrue under
this contract
orne
���� a J{I 11 � i
City Comptroller�
3
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FORM OF PERFORMANCE,PAYMENT AND MAINTENANCE BOND
Bond No. WIC 46021
KNOW ALL MEN BY THESE PRESENTS:
That we,Carl Bowers&Sons Construction Co.,Inc.
of Kaukauna,WI
(hereinafter called the Principal)and Merchants Bonding Company(Mutual)
of 2100 Fleur Drive,Des Moines,Iowa 50321-1158 (hereinafter called the Surety)are held firmly
bound unto City of Oshkosh (hereinafter called the
Owner)in the penal sum of Two Hundred Fifty Five Thousand Twenty Eight
Dollars (Dollars) $255,028.00 lawful money of the United
States,to the payment of which sum,well and truly to be made,the Principal herein firmly binds himself
(themselves),their heirs,executors,and administrators,and the said Surety binds themselves,their
successors,assigns,executors and administrators,jointly and severally,firmly by these presents.
THE CONDITION OF THIS OBLIGATION IS SUCH,THAT whereas the above bounden
Principal,did on the gth day of July � 2014 enter into a written
contract with City of Oshkosh to construct the following
improvements,to wit: public Works Contract No. 14-20 Storm Sewer
Laterals/Various Locations for the Public Works Deparhnent
NOW,THEREFORE,if said Principal shall faithfully perform said contract,and if the said Principal
shall warrant all workmanship and materials for a period of� years from improvement
acceptance date,then this obligation shall be void;otherwise,it shall remain in full force and effect. Copy
of which contract,together with all of its terms covenants,conditions and stipulation is incorporated herein
and made a part hereof as fully and completely as if said contract were received at length herein and,
Whereas,the principal and sureties on this bond hereby agree to pay all persons,firms,or corporations
having contracts directly with the principal or with subcontractors,all just claims due them for labor
performed or materials furnished in the performance of the contract on account of which this bond is given,
when the same are not satisfied out of the portion of the contract price which the Owner is required to retain
until completion of the improvements,but the principal and sureties shall not be liable to said persons,firms
or corporations unless the claims of said claimants against said portion of the contract price shall have been
established as provided by law.
Now if the principal shall in all respects fulfill his said contract according to the terms and tenor thereof,
and shall satisfy all claims and demands incurred for the same;and shall fully indemnify and save
harmless the Obligee from all costs and damages which it may suffer by reason of failure to do so and shall
fully reimburse and repay the Obligee all outlays and expenses which it may incur in making good any such
default,then the obligation is to be void and of no effect;otherwise to remain in full force and effect.
CON 0498(6/04)
Every surety on this bond shall be deemed and held,any contract to the contrary notwithstanding,to
consent�vithout notice,
1. To any extension of time to the contractor in which to perform to the conh•act.
2. To any change in the plans,specifications or contract,when such change does not involve an
increase of more than twenty percent(20%)of the total contract price,and shall then be released
only as to such excess increase.
3. That no provision of this bond or of any other contract shall be valid which limits to less than
one year from the time of the acceptance of the work the right to sue on this bond for defects in
warkmanship ar material not discovered or known to the Owner at the time such work is accepted.
IN WITNESS WHEREOF,we have hereunto set our hands and seals this
8th day of July , 2014
Carl Bowers&Sons Construction Co.,Inc.
Principal
BY
Merchants Bonding Company(Mutual)
Surety c-
BY /�•. � .0��___�._�,�.�� �
�
Richard K Carlson Attorney-in-Fact
.ME�C�-�A�TT♦S�,
B 0 I�1 D I N G C(J M PA N Y�M Bond#. WIC 46021
POWER OF ATTORNEY
Know All Persons By These Presents,that MERCHANTS BONDING COMPANY(MUTUAL)and MERCHANTS NATIONAL BONDING,
INC.,both being corporations dulyorganized under the laws of the State of lowa(herein collectively called the"Companies"),
and that the Companies do hereby make,constitute and appoint,individually,
Richard K Carlson
of Eau Claire and State of WI their true and lawful Attorney-in-Fact,with full power
and authority hereby conferred in their name,place and stead,to sign,execute,acknowledge and deliver in their behalf as surety
any and all bonds,undertakings,recognizances or other written obligations in the nature thereof,subject to the limitation that any
such instrument shall not exceed the amount of:
FIFTEEN MILLION($15,000,000.00)DOLLARS
and to bind the Companies thereby as fully and to the same extent as if such bond or undertaking was signed by the duly
authorized officers of the Companies,and all the acts of said Attorney-in-Fact, pursuant to the authority herein given,are
hereby ratified and confirmed.
This Power-of-Attorney is made and executed pursuant to and by authority of the following By-Laws adopted by the Board of
Directors of the Merchants Bonding Company(Mutual)on April 23,2011 and adopted by the Board of Directors of Merchants National
Bonding,Inc.,on October 24,2011.
"The President,Secretary,Treasurer,or any Assistant Treasurer or any Assistant Secretary or any Vice President shall have
power and authority to appoint Attomeys-in-Fact,and to authorize them to execute on behalf of the Company,and attach the
seal of the Company thereto,bonds and undertakings,recognizances,contracts of indemnity and other writings obligatory in
the nature thereof.
The signature of any authorized officer and the seal of the Company may be affixed by facsimile or electronic transmission to
any Power of Attorney or Certification thereof authorizing the execution and delivery of any bond,undertaking,recognizance,
or other suretyship obligations of the Company,and such signature and seai when so used shall have the same force and
effect as though manually fixed."
In Witness Whereof,the Companies have caused this instrument to be signed and sealed this 3rd day of December ,2013 ,
,`,���.nrf1�•ipsMi ���.�.��•
�.`����;�?�t'�:�� ��` •��1��N'��"���J.o'. MERCHANTS BONDING COMPANY(MUTUAL)
:�g�:`q���qj'�,�p�=� ,�04vO�P�Rq�;�y�� MERCHANTSNATIONALBONDING,INC.
_'_' � 'p_ �'L' " �z:= -° o' :
��'= 2�'�?$ ��; �6�' 1933 'c;
__� :• :yJ. ��,,. By ��
�'.�H• .. •:;.;<`,,.•'; '•.d��•• -•`1a;'
STATE OF IOWA •,•.,�• �'t�• �.a•� ••.���.� ••
COUNTY OF POLK ss. ""�«���"'��4 �" � President
On this 3rd day of December , 2013 ,before me appeared Larry Taylor,to me personally known,who being by me duly sworn did
say that he is President of the MERCHANTS BONDING COMPANY(MUTUAL)and MERCHANTS NATIONAL BONDING,INC.;and
that the seals affixed to the foregoing instrument is the Corporate Seals of the Companies;and that the said instrument was signed and
sealed in behalf of the Companies by authority of their respective Boards of Directors.
In Testimony Whereof,i have hereunto set my hand and affixed my Official Seai at the City of Des Moines,lowa,the day and year
first above written.
,��. MARANDA GREENWALT ��,� - �� ����
±°�� Commission Number 770312
My Commission Expires
ow� October 28,2014
Notary Public,Polk County,lowa
STATE OF IOWA
COUNTY OF POLK 5s.
i, William Warner,Jr.,Secretary of the MERCHANTS BONDING COMPANY(MUTUAL)and MERCHANTS NATIONAL BONDING,INC.,
do hereby certify that the above and foregoing is a true and correct copy of the POWER-OF-ATTORNEY executed by said Companies,
which is still in full force and effect and has not been amended or revoked.
In Witness Whereof,I have hereunto set my hand and affixed the seal of the Companies on
this 8th day of July , 2014 .
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acoR°� CERT'IFICATE OF L[ABILITY INSURANCE DATE(MMIDDM'YY)
8/26/2014
THIS CERTIFICATE IS ISSUED AS A MATTER OP INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. TH1S
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFfCATE OF INSURANCE DOES NOT CONSTITUTE A CaNTRACT 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 poticy,certain policies may require an endorsement. A statement on fhis certificate does not confer rights to the
certificate holder in lieu of such endorsement s.
PRODUCER � CONTACT
NAME:
Spectrum Insurance Group GB AHONNo t• - - FAlC No:��� -
303 Packerland Dr. Ste C E-MAII.
PO BOX 12495 nooRess: uza e i ou c
Green Bay WI 54307 INSURER S AFFORDING COVER4GE NAICp
INSURER A: Be
INSURED CARLB-2 INSURER B:
Carl Bowers&Sons iNSUReRC:
Construction Co., II1C. INSURERD:
N 1844 Maloney Rd
Kaukauna W154130 INSURERE:
INSURER F:
COVERAGES CERTIFICATE NUMBER:1831191167 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 WNICH 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 CIAIMS.
INSR ADDL SUBR POLICY EFF POLICY EXP
LTR TYPEOFINSURANCE INSR WVD POLICYNUMBER MM/�DfVYYY MMfD�M'YY LIMITS
A GENERALLIABILITY � US184463501 /1/2074 �/1(2015 Ep,CHOCCURRENCE 51,000,000
X DAMAGE TO RENTED
COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence 5100,000
CLAIMS-MADE �OCCUR MEDEXP Myone erson $5,000
PERSONAL�ADVINJURY 51,000,000
GENERALAGGREGATE 52,000,000
GEN'LAGGREGATELIMITAPPLIESPER: PRODUCTS-COMP/OPAGG �u2,000,000
POLICY X PRa LOC §
A AUTOMOBILE LIABILITY CUS1844635 01 /7/2014 /1/2015 B
Ea accident 1 OOQ 000
X ANYAUTO BODILYINJURY(Perperson) S
ALL OVvNED SCHE�ULED BODILY INJURY Peraccident 5
AUTOS AUTOS � �
NON-0WNED PROPERTY DAMAGE
HIREDAUTOS AUTOS Peraccident �
5
A X UMBRELLA LIAB X pCCUR CUS1844635 01 11l2014 /1/2015 Ep,CH OCCURRENCE $5,000,000
EXCESS LIAB CLAIMS-MADE AGGREGATE S
DED X RETENTION510,000 g �
q WORKERS COMPENSATION CUS1844635 01 /1/2014 /1/2015 X �STATU- OTH-
AND EMPLOYERS'LIABILITY y�N
ANY PROPRIETORlPARTNEWEXECUTIVE E.L.EACHACCIDENT $500,000
OFFICER/MEMBER EXCLUDEDT � N�A
(Mandatory In NH) E.L.DISEASE-EA EMPLOYE 5500 000
If yes,describe under �
DESCRIPTION OF OPERATIONS below E_L DISEASE-POLICY LIMIT $500,000
A Builders Rlsk US1844635 01 /1/2014 /1/2015 Buflders Risk 744,000
Installation Floaler Installation Floater 100,000
Deductible 500
oESCRIPTION OF OPERATIONS!LOCATIONS/VEHICLES (Attach ACORD 101,Additfonal Remarks Schedule,If more space is required)
Additional insured per attached endorsement CG 2037
City of Oshkosh,and its officers,council members,agents,employees and authorized volunteers are listed as addditionai insured on the
general and auto liability policies. There is a 10-day cancellation and 60-day non-renewal notice to the City Clerk-City of Oshkosh.
CERTIFICATE HOLDER CANCELLATION30 Da s
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
City of Oshkosh ACCORDANCE WfTH THE POLICY PROVISIONS.
215 Church Ave
PO Box 1130 AUTHORIZED REPRESENTATIVE
Oshkosh W154903 /
1J a.�.���-�-�—
O 9988-2010 ACORD CORPORATION. All rights reserved.
ACORD 25(2010l05) The ACORD name and logo are registered marks of ACORD
THlS ENDORSEMENT CHANGES TH� POLICY, PLEASE READ IT CAREFULLY.
ADDITIONAL INSURED - OWNERS, LESSEES OR
CO�lTRACT�RS - C�MPLETED OPERATIONS
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
SCNEbULE
NAME OF ADDITIONAL INSURED PERSON(S) OR ORGANIZATION(S):
CITY OF OSHKOSH
215 CHURCH AVE
03HKOSH, WI 54903
LOCATION AND DESCRIPTION OF COMPLETED OPERATIONS:
CITY CONTRACT 14-20 STORM SEWER LATERAI,S/VARIOUS LOCATIONS
IN THE CITY
Inforrnation 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"or"property dam-
age" caused, in whole or in parE, by "your work" at
the location designated and described in the sched-
ule of this endorsement pertormed for thaf additional
insured and included in the "products-compieted
operations hazard".
CG ZO 37 O7 04 O ISO Properties, Inc., 2004 Page 1 of 1
CUSTOMER N0. O1I0147096
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GENERAL LIABILITY DECLARATIDN
POLICY NUMBER CPS 1844533 OI
ENDORSEMENT EFFECTIVE JULY 09, 2014 �
ADDIN� ADDITIONAL INSURED TO AUTO AND FORM WB213 TO GENERAL
LIABILITY
INSUREb NAME: CARL BOWERS & SONS
THE FOLLOWING FORMS HAVE BEEN ADDED TO THE POLICY.
FORMS SCHEDULE
NUMBER DESCRIPTION
WB213 12/10 A EARLIER N�TICE OF CANCELLATION AND/OR NONRENEWAL '
(
� A - INDICATHS FORM HAS SEEN ADDED
�` FORM N0, GLFORMSINV 02/D9 ISSU�b 07/15/2014
AGENT COPY
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CUSTOMER N0� 0110147096
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A MUNAL INNIIMICE Co11TH1• R 335
\\�cst Bcnd A•(um�f Insurancc Company
1900 S.1 Arh Areivu�1Vesr Rend,\Vf 53095
�
POLICY NUMBER CPS 1844633 O1
ENDORSEMENT EFFECTIVE JULY 09, 2014
ADDING ADDITIONAL INSURED TO AUTO AND FORM WB213 TO GENERAL
LIASILITY
INSURED NAME: CARL BOWERS & SONS
ADbTTIONAL INTEREST
EXCEPT FOR 7oWING, ALL PHYSICAL DAMAGE "LOSS" IS PAYABLE TO YOU AND THE LDSS
PAYEE NAMED BELOW AS TNTERESTS MAY APPEAR AT THE TIME OF "LOSS"-
CITY OF OSHKOSH AND ITS
OFFICERS, COUNCIL CSEE EXT�
205 CHURCH AVE
OSHKOSH, WI
549D3
FDRM CA2048 APPLIES
*ADDITIONAL INSURED
HAS BEEN ADDED
FDRM N0. A➢DINT �2/09 PAGE 1 LAST ISSUED 07/15/20I4
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AGENT COPY
� CUSTOMER N0. 0110147096
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1900 S.I St6 Avcnuc�\\�csc Hcnd,V�1 53D95
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- Commercial Lines Policy
POLICY NUMBER: CPS 1844633 O1
ENDORSEMEN7 EFF�CTIVE JULY 09, 2014
ADDIN6 ADDITIOMAL INSURED TO AUTO AND FORM WB213 TO GENERAL
LIABILITY
TNSURED NAME: CARL SOWERS & SDNS
NAMG EXTENSTON — ADDITIONAL INSURED:
PORM CA2098 APPLIES
CTTY OF OSHKOSH AND ITS Ok'FTCERS, COUNCII, MEMBERS, AGENTS, EMPLOYEES, ANp
AUTHORIZED VOLUNTEERS
205 CHURCH AVE
OSHKOSH, WI 54903
(
f
FORM NO. CAAI 02 09 ISSUED 07/15/14 AGENT COPY
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
ADDITIONAL lNTEREST - AMENDMENT OF
CANCELLATlON AND NONRENEWAL CONDITiONS
WISCONSIN
This endorsement modifies insurance provided under the foilowing:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
COMMERCIAL AUTOMOBILE COVERAGE PART
Notice of Cancellation and Nonrenewat to Additional Interest Party
SCHEDULE
Name of Person(s)or Organization(s):
Information re uired to com lete this Schedule, if not shown above,will be shown in the Declarations.
The following is added to Paragraph 2. of the Can- The foilowing paragraph is added to D. 1. Nonre-
ceilation Common Policy Condition or as amend- newal of Wisconsin Ghanges - Cancellation and
ed by an applicable sfate cancellation endorsement Nonrenewal:
thereof: If we decide not to renew this policy, we will maii or
We wiil mail or deliver written notice of canceliation deliver written notice of nonrenewal to the person(s)
to fhe person(s) or organization(s) shown in the or organization(s)shown in the Schedule, at leasf 60
Schedule, at least 10 days before this policy is can- days before the expiration date of this policy.
celled for non-payment of premium. Failure on our part to provide notice to the person(s)
or organization(s) shown in the Schedule shall not
delay the effective date of canceliation of this insur-
ance to the named insured.
West Bend Mutual Insurance Company
West Bend,Wisconsin 53095
Contains material copyrighted by ISO with its permission
WB 213 11 09 O ISO Properties, Inc.,2006 Page 1 of 1
CUSTOMER N0. 0110147096
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BUSINESS AU70 DECLARATION
POI.ICY NUMBER CPS 1844633 O1
ENDORSEMENT EFFECTTVE JULY 09, 20I4
ADDING ADDITIONAL INSURED TO AUTO AND FORM WB213 TO GENERAL
LIABILITY
INSURED NAME; CARL BOWERS & SOMS
THE F�LLOWING FORMS HAVE BEEN AADED 70 THE POLTCY,
FORMS SCHEDULE
NUMBER DESCRIPTION
CA2048 D2/99 A DESI6NATED TNSURED
�
� A - INDICATES FORM HAS BEEN A➢DE➢
FORM ND. CAFORMSINV 02/09 ISSUED 07/15/2014
AGENT COPY
i
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
DESIGNATED INSURED
This endorsement modifies insurance provided under the following:
BUSINESS AUTO COVERAGE FORM
GARAGE COVERAGE FORM
MOTOR CARRIER COVERAGE FORM
TRUCKERS COVERAGE FORM
With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified
by this endorsement.
This endorsement identifies person(s) or organization(s)who are"insureds"under the Who Is An insured Provision
of fhe Coverage Form. This endorsement does not alter coverage provided in the Coverage Form.
This endorsement changes the policy effective on the inception date of the policy unless another date is indicated
below.
Endorsement Effective: Countersigned By:
Named Insured:
Authorized Re resentative
SCNEDULE
Name of Person(s) or Organization(s):
(If no entry appears above, informafion required to complete this endorsement will be shown in the Declarations as
applicable to the endorsemenf.)
Each person or organization shown in the Schedule is an "insured"for Liability Coverage, but only to the extent that
person or organization qualifies as an "insured" under the Who Is An Insured Provision contained in Section II of
the Coverage Form.
CA 20 48 02 99 Copyright, Insurance Services Office, Inc., 1998 Page 1 of 1 ❑
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
` EARLIER NOTICE OF
CANCELLATION AND/OR N�NRENEWAL
This endorsement modifies insurance provided under the fo(lowing:
BUSINESSOWNERS COVERAGE PART
COMMERCIAL GEN�RAL LIABII,ITY COVERAGE PART
COMMERCIAL AUTOMOBILE COVERAGE PART
COMMERCIAL LIABILITY UMBRELLA COVERAGE PART
RAILROAD pROTECTIVE LIABII.ITY COVERAGE PART
COMMERCIAL PROPERTY COVERAGE PART
Notice of Cancellation a�d/or IVonrenewal to other Person{s)or Organization(s)
SCHEDULE
NAME OF P�RSON{S) OR ORGANIZATION(S):
CITY OF OSHKOSH AND ITS OFFICERS� COUNCIL MEt�ERS� AG�NTS, CMPZOYEGS, AND
AUTHORTZED VOLUNT�ERS
�� NOTICE OF CANCELLATION OTHER THAN NONPAYMGNT NUMB�R OF DAXS NOTICE 10
NOTICE OF CANCELZATION NONPRYMENT OF PREMIUM NUMBER OF DAYS NOTICE 10
NOTIC� OP NONRENEWAL NUMB�R OF DAYS NOTIC� 60
information required to complete this Schedule, if not shown above,wifl be shown in the Declarations.
As (ndicated in the Schedule above, we will mail or
deliver writfen Notice of Cancellation for a statutorily
permitfed reason and/or Notice of Nonrenewal to fhe
person(s)or organization(s)shown,
Unless a specified number of Days Notice fs shown
above, the Notice of Cancellation and/or Notice of
Nonrenewal does not apply,
i
West Bend Mutual Insurance Company
West Bend,Wisconsln 53095
Contains maferial copyr(ghted by ISO with its permission
WB 293 92 10 �O ISO Properties, Inc.,2006 Page 1 of 1
TH1S ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
ADDITIONAL INSURED - CONTRACTOR'S BLANKET
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
A. WHO IS AN INSURED (Section II) is amended 3. Except when required by written contract or
to include as an additional insured any person or written agreement, the coverage provided to
organization whom you are required to add as an the additional insured by this endorsement
additional insured on this policy under a written does not apply to:
contract or wriften agreement, a. "Bodily injury"or"property damage"occur-
The written contract or written agreement must ring after:
be: (1) All work on the project (other than
1. Currently in effect or becoming effective dur- service, maintenance or repairs) to be
ing the term of this policy;and performed by or on behalf of the addi-
2. Executed prior to the "bodily injury," "property tional insured af the site of the covered
damage," "personal injury and advertising in- operations has been completed;or
jury." (2) That portion of"your work"out of which
B. The insurance provided to the additional insured the injury or damage arises has been
is limited as follows: put to its intended use by any person or
organization other than another con-
1. That person or organization is only an addi- tractor or subcontractor engaged in
tional insured with respect to liability arising performing operations for a principal as
out of: part of the same project.
a. Your premises; b. "Bodily injury"or"property damage"arising
b. "Your work"for that additional insured;or out of acts or omissions of the additional
c. Acts or omissions of the addifional insured insured ofher than in connection with the
in connection with the general supervision general supervision of"your work."
o your wor . 4-T e insurance provi e o e a i iona m-
2. The Limits of Insurance applicable to the sured does not appiy fo "bodily injury," "prop-
addifional insured are those specified in the erty damage," "personal injury and advertising
written contract or written agreement or in the injury"arising out of an architecf's, engineer's,
Declarations for this policy, whichever is less. or surveyor's rendering of or failure to render
These Limits of Insurance are inclusive and any professional services including;
not in addition to the Limits of Insurance a. The preparing, approving, or failing to
shown in the Declarations. prepare or approve maps, shop drawings,
opinions, reports, surveys, field orders,
change orders or drawings and specifica-
tions;and
b. Supervisory, or inspection activities per-
formed as part of any related architectural
or engineering activities.
I
WB 1482 06 06 West Bend Mutual Insurance Company Page 1 of 2
West Bend, Wisconsin 53095
C. As respects the coverage provided under this
endorsement, Paragraph 4.b. SECTION IV -
COMMERCIAL GENERAL LIABILITY CONDI-
TIONS is amended wifh the addition of the fol-
lowing:
4. Other insurance
b. Excessinsurance
This insurance is excess over:
Any other valid and coilectible insurance
available to the additional insured whether
primary, excess, contingent or on any
other basis unless a written contract spe-
cifically requires that this insurance be ei-
ther primary or primary and noncontribut-
ing. Where required by written contract,
we will consider any other insurance
maintained by the additional insured for
injury or damage covered by this en-
dorsement to be excess and noncontrib-
uting with this insurance.
When this insurance is excess, as a con-
dition of coverage, the additional insured
shall be obligated to tender the defense
and indemnity of every claim or suit to all
other insurers that may provide coverage
to the additional insured, whether on a
contingent, excess or primary basis.
Page 2 of 2 West Bend Mutual Insurance Company WB 1482 06 06
West Bend,Wisconsin 53095