HomeMy WebLinkAboutH.J. Martin & Son/Safety Building Flooring � � T � .,
CONTRA CTOR A GREEMENT.•
SAFETY BU/LD/NG FLOOR/NG REPLACEMENT
THIS AGREEMENT, made on the 14T" day of August, 2014, by and between the
CITY OF OSHKOSH, party of the first part, hereinafter referred to as CITY, and H.J.
MARTIN & SON, INC., 320 S. MILITARY AVENUE, GREEN BAY, WI 54303,
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:
(Gary Vandenlangenberg — H.J. Martin & Son, Inc.
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 "Invitation for
Bids for Flooring Replacement Oshkosh Safety Building" dated July 2, 2014 and the
Bid Proposal Form of the Contractor for said project dated July 18, 2014, 2014
attached as Exhibit A. If anything in the Bid Proposal Form conflicts with the Invitation
for Bids, the provisions in the Invitation for Bids 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 Invitation for Bids.
ARTICLE III. PAYMENT
A. The Contract Sum.
The City shall pay to the Contractor for the performance of the contract the sum of
552,493, 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
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. WSURANCE
The Contractor agrees to abide by the City of Oshkosh Insurance Requirements as
specified in the Invitation for Bids.
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
G��y ��������� �su '� _
— � �
ay:
�i2 f G�f v,dC � a..—
(Seal of Contractor (Specify Title)
if a Cor orati "'�����""''ti�
P ,,P`���N �
;��`: •••...». � B
:�. Go� �� y�
:1- � �.,� 4�
= ,�.' .�E,4 T � (Specify Title)
� ,►L .
'=,,�jS'• ... *
., �bN$t�'�
���''�����,�����,.�►��`' CITY OF OSHKOSH
,� � BY, /
Z �� Mark A.�Rohloff, City Manager
itn ss)
� _._�
t _
____
� .
�Z � � � An ,� � � � ,��
(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 A ney
` ���:��
City Comptroller�
4
.... ..... ....... ... ... ..... .. ... ..... ..... .. ...... ... ._ . _... ..
, � , . ��� r� �T �4
BI� P�OPQSAL FOR�
Flooring �ep[acer�e�t. Qshkosh Safety Bui�di�g
From: x.J. MARTIN �� soz� zNC. (bidder's company r�ame)
��E� PROPQSAL �EAI3E.��I�: Tuesda�,7uiy �2, 2tb�.4 at �O.QQ a.�., C�T
Addenda: Receipt ofi Addenda numbered N�A of are hereby
understood, acknowledged and inc[uded in bidder`s bid proposal form. If no
addenda were iss�ed for this project please write "N/�," a�ave.
We, the undersigned, propase to furnish alf �abor and materials per the project
speci ications or noted dev[ations for tfi�e foflowing amo�ant;
B�,�E P�� FE.€�QR�{��`s �EP6.�,�;C+�EC�'�` � 25, 798 . 00 `�°
TUIENTY-FIVE THOUSAND SEV.EN HUNDRED NINETY-EIGHT
Base B�d ���e��� ���a� .
AlEerna�e Bid: Fia[fway VCT " � 6,4 3 S. o 0
A[ternate Bid: Hallway Porcefairt Ti(e � � 2 4, � 9 0. o o '�
Alterr�ate Bid: Bi05A Training Roam & � z ��
B117 Interview Room VCT � 2, 5 0 5 , o o `� ' � ' �
Date: ��� 8 Company: x.J. MARTIN & soN, zNC.
Submitced by: {name/tiEle): GARY VANDENLANGENBERG
Emai[: GARYV@HJMARTIN.COM Phone: 920-490-3150
Add�ess: 320 S. MILITARY AVE, GREEN BAY, WI 54303
That I have examined and carefuEly prepared this Prapasal from the Plans and
Speci�ications and have checked the same in detail before submitting this
Proposal; that I have ful! au�horify to make such statements an� submit this
Proposal in (its} (their} beha�f; and that said s�atements are true and carrect.
Signature; Title: PROJECT MANAGER
Materiafs d " ery date upon bid award notice: APPROX �o DAV�
Insta(lation timeframe; 2-3 wEExs
18
� �
Bid Bond ��fi�� T
����.�.1 C�a��U r�+�r�� ��� �r�" — ��'t�
CONTRACTOR:
�Jame, legal status and address) Bid Bond No. GR01971
H.J. MARTIN&SON, INC.
320 S Military Ave
Green Bay,WI 54307
SURETY:
(Name, legal status and principal This document has�mportant legal
place of business) consequences.Consultation with
an attorney is encouraged wlth
Granite Re,If1C. respect to its completion or
14007 Quailbrook Dr modification.
Oklahoma City, OK 73134
OWNER: Any singular reference to
(Name, legal status and address) Contractor,Surety,owner or
other party shall be considered
Clty Of OShkOSh plural where applicable.
215 Church Ave.
Oshkosh,WI 54903
BOND AMOUNT:Five Percent of the Bid Amount(5.00%of Bid Amount)
PROJECT:
(Name, location or address, and Project number, if any)
Oshkosh Safety Building Flooring Replacement
The Contractor and Surety are bound to the Owner in the amount set forth above,for the payment of which the Contractor
and Surety bind themselves,their heirs,executors, administrators,successors and assigns,jointly and severally,as provided
herein.The conditions of this Bond are such that if the Owner accepts the bid of the Contractor within the time specified in the
bid documents,or within such time period as may be agreed to by the Owner and Contractor,and the Contractor either(I)
enters into a contract with the Owner in accordance with the terms of such bid,and gives such bond or bonds as may be
specified in the bidding or Contract Documents,with a surety admitted in the jurisdiction of the Project and otherwise
acceptable to the Owner,for the faithful performance of such Contract and for the prompt payment of labor and material
furnished in the prosecution thereof; or(2)pays to the Owner the difference,not to exceed the amount of this Bond,between
the amount specified in said bid and such larger amount for which the Owner may in good faith contract with another party to
perform the work covered by said bid,then this obligation shall be null and void,otherwise to remain in full force and effect.
The Surety hereby waives any notice of an agreement between the Owner and Contractor to extend the time in which the Owner
may accept the bid.Waiver of notice by the Surety shall not apply to any extension exceeding si�cly(60)days in the aggregate
beyond the time for acceptance of bids specified in the bid documents,and the Owner and Contractor shail obtain the Surety's
consent for an e�ension beyond sixty(60)days.
If this Bond is issued in connection with a subcontractor's hid to a Contractor,the term Contractor in this Bon��dl��e�S"'��,,,��
deemed to be Subcontractor and the term Owner shall be deemed to be Contractor. `��•���,.�, , .�j� �•,��
When this Bond has been furnished to comply with a statutory or other legal requirement in the location o�Qpao�ect .,•. .•��' � '
�'.• '���t@ ��2:
provision in this Bond conflicting with said statuto ry or legal requirement shall be deemed deleted herefro��lp�'�� s °. (�_
conforming to such statutory or other legal requirement shall be deemed incorporated herein. When so fgrnisl}ed;'th�►i�it n�( ' '
is that this Bond shall be construed as a statutory bond and not as a common law bond. _�?: ���Y '-�[ ;
Signed d sealed this 17th day of July,2014 ':,y y�' :�
'_ ?' � ,''���'T,,�VISI.������\��```•`
(�/ H.J.MARTIN&SON.IN� ^n� i ���` � +„��
S�'t (Principa/) � '�/ / �,���jj
(Witness) � ��
/� � (Title) �
I , Granite Re Inc.
(Surety) � (Seal)
(Wirness)Karla K.Heffron
(Title)Robert Dow ,Attorne in-Fact
AIA Document A310�"—2010.Co ri ht OO 1963,1970 and 2010 b The American Institute of Architects.Ali ri hts res ed.WARNING:This AIA'�
Document is protec[ed by U.S. Copyright Law and Inlernatlonal Treaties. Unauthorized reproduction or distribut on of this AIA�'Document, or.
any portion of it, may result in severe civil and criminal penalties, and will be prosecuted to the maximum extent ossibie under the law.
Purchasers are permitted to reproduce ten(10)copies of this document when completed.To report copyright violations of AIA Contract Documents,e-mail
The American Institute of Architects'legai counsel,copyrightCa�aia.orq, osiiio
GRANITE fZE, If�1C.
GENERAL POWER OF ATTORNEY
Know all Men by these Presents:
That GRANITE RE, INC.,a corporation organized and existing under the laws of the State of OKIAHOMA and having its principal office
at the City of OKLAHOMA CITY in the State of OKLAHOMA does hereby constitute and appoint:
MICHAEL J. DOUGLAS; CHRIS STEINAGEL; CHRISTOPHER M. KEMP; KARIA HEFFRON; ROBERT DOWNEY; CONNIE SMITH its true and
lawful Attorney-in-Fact(s)for the following purposes,to wit:
To sign its name as surety to,and to execute, seal and acknowledge any and all bonds, and to respectively do and perform any and all
acts and things set forth in the resolution of the Board of Directors of the said GRANITE RE, INC. a certified copy of which is hereto annexed
and made a part of this Power of Attorney;and the said GRANITE RE, INC.through us, its Board of Directors, hereby ratifies and confirms all
and whatsoever the said:
MICHAEL J. DOUGLAS; CHRIS STEINAGEL; CHRISTOPHER M. KEMP; KARLA HEFFRON; ROBERT DOWNEY; CONNIE SMITH may lawfully
do in the premises by virtue of these presents.
In Witness Whereaf, the said GRANITE RE, INC. has caused this instrument to be sealed with its corporate seal, duly attested by the
signatures of its President and Secretary/Treasurer,this 3`d day of July, 2013.
��TE NE.� � � ' /_
c>�`�o�.roy��HC 'Vv � --��`�
STATE OF OKLAHOMA ) S �^L
Kenneth D.Whittin on, President
) SS: � �l!/�,.�
COUNTY OF OKLAHOMA ) Kyle .McDonald,Treasurer
On this 3`d day of July, 2013, before me personally came Kenneth D. Whittington, President of the GRANITE RE, INC. Company and
Kyle P. McDonald, Secretary/Treasurer of said Company, with both of whom I am personally acquainted, who being by me severally duly
sworn, said,that they,the said Kenneth D. Whittington and Kyle P. McDonald were respectively the President and the Secretary/7reasurer of
GRANITE RE, INC., the corporation described in and which executed the foregoing Power of Attorney; that they each knew the seal of said
corporation;that the seal affixed to said Power of Attorney was such corporate seal, that it was so fixed by order of the Board of Directors of
said corporation,and that they signed their name thereto by like order as President and Secretary/Treasurer, respectively,of the Company.
��t.Y F C�
A�� ktP
.� % �n6�
My Commission Expires: o,,,,.,,.,,
August 8,2017 Jr„ � Nota Public
y' J�r
Commission#:01013257 f�FONb��
GRANITE RE, INC.
Certificate
THE UNDERSIGNED,being the duly elected and acting Secretary/7reasurer of Granite Re, Inc.,an Oklahoma Corporation, HEREBY CERTIFIES
that the following resolution is a true and correct excerpt from the July 15, 1987, minutes of the meeting of the Board of Directors of Granite
Re, Inc.and that said Power of Attorney has not been revoked and is now in full force and effect.
"RESOLVED,that the President,any Vice President,the Secretary,and any Assistant Vice President shall each have authority to appoint
individuals as attorneys-in-fact or under other appropriate titles with authority to execute on behalf of the company fidelity and surety
bonds and other documents of similar character issued by the Company in the course of its business. On any instrument making or
evidencing such appointment,the signatures may be affixed by facsimile. On any instrument conferring such authority or on any bond
or undertaking of the Company, the seal, or a facsimile thereof, may be impressed or affixed or in any other manner reproduced;
provided,however,that the seal shall not be necessary to the validity of any such instrument or undertaking."
IN W TNESS WHEf�EpF,the undersigned has subscribed this Certificate and affixed the corporate seal of the Corporation this
( �' day of ,2p�,
'NITE qE i
pP'�or.�w�i�NC ��,�, �
SEAL �� /"�G'!/yt/
�n,.� Kyle P.McDonald,Secretary/Treasurer
GR0800-1
r
�
Ma rad , Holl �,/��� ���
,
From: Greeninger, Paul D.
Sent: Monday, July 28, 2014 10:02 AM
To: Magrady, Holly
Subject: RE: Certificate of Insurance
Attachments: National Surety Corporation.pdf; Zurich American Insurance Company.pdf
This certificate is fine.
However, we still would need the other 2 additional insured endorsement certificates, per the requirements.
Paul Greeninger
Safety & Risk Managemei�t Officer
City of Oshkosh
Phone - 920-236-5117
Cell - 920-233-7852
Fax - 920-236-5090
Emp�ovee Self Service
� Please consider the environment before printing this e-mail.
-- ---__.__ .__.___.. _____.
_--- --..._- ----------- _____ _-- - - -----
---_--- _ __________.__.
From: Magrady, Holly
Sent: Friday, July 25, 2014 7:43 AM
To: Greeninger, Paul D.
Subject: FVV: Certificate of Insurance
Hi Paul-please verify
Thank you
��ee� a �v���
Senior Buyer
City of Oshkosh
920-236-5101 ph
920-236-5186 fx
_--- - --- ____ __--- ___-
_--.___�_._.._ _._____.___..__. ._--__.-.------._�____--
_.____. __----._.---
rom: Trish Charlock [mailto:t.charlockCa�h�martin com)
Sent: Friday, July 25, 2014 7:18 AM
To: Gary VandenLangenberg; Urben, Jon
Cc: Magrady, Holly
Subject: RE: Certificate of Insurance
I originally had it sent to the City Clerl<-Oshkosh. Certificate attached.
Thank you,
Trish Charlock
Project Coordinator
320 South Military Avenue � Green Bay,WI 54303 � t.charlockCn�himartin.com
1
(D)920.490.3159 � (C)920.615.4051 � (F)920.494.4177 � himartin.com
�'I �� Our People �
J��� ��x L
� Our Reputation I � '"� I 1� R I��}]
� ,y �
����s'�,?�_- YourSuaess t�."'�_r � 1 ,1�+16
� . . _. _,_. ...,... _._ .. _ _. .,
From: Gary VandenLangenberg
Sent: Friday, July 25, 2014 6:19 AM
To: Urben, Jon; Trish Charlock
Cc: Magrady, Holly
Subject: RE: Certificate of Insurance
No problem Jon.
7"rish, how is that COI coming along?When you get it, please forward to Jon.
Thankyou
Gary VandenLangenberg
. ._._.__.___ � _...__.. ., _.._. _,__ .._ ...__._._ _ _. - - -.. _,. . ___ ___ ._
From: Urben, Jon [mailto:jurbenCa�ci.oshkosh.wi us]
Sent: Thursday, July 24, 2014 7:39 AM
To: Gary VandenLangenberg
Cc: Magrady, Hoily
Subject: Certificate of Insurance
Gary: when you can please provide me a current certificate of insurance meeting all our requirements as listed in the
bid specs. To minimize follow up with your insurance agent I would suggest you simply forward our sample COLI to your
agent to ensure they make sure every box, requirement and additionaliy insured language is verbatim.
You can email me the COLI when you have it.
Thanks,Jon
Jon Urben, CPPO
General Services Manager
Purchasing, Facilities Maintenance &Media Services
City of Oshkosh
215 Church Avenue
PO Box 1130
Oshkosh, WI 54903-1130
(920) 236-5100
Follow the city of Oshkosh on Social Media:
Facebook � YouTube � Twitter � Pinterest
z
'°`�°RO� CERTIFICATE OF LIABILITY INSURANCE DATE�(M 2D�D,/YWY)
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.
IMPOR7ANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed.If SUBROGATION IS WAIVED,subject to �
the terms and conditions of the policy,certain policies may require an endorsement.A statement on this certificate does not confer rights to the w
certificate holder in lieu of such endorsement(s). -
PRODUCER CONTACT N
NAME: 'O
AO11 Risk 5ervices Central, InC. PHONE
Green Bay WI Offi ce (AIC.No.Ext�: �9z0) 437-7123 ac.No.; (920) 431-6345 `y
111 N. washington Street, Suite 300 E-MAIL �—°
P. 0. BOX Z3OO4 ADDRESS: _
Green Bay WI 54305-3004 U5A
INSURER(S)AFFORDING COVERAGE NAIC#
INSURED INSURERA: Zllf'lCh american If15 CO 1(7535
H.J. Mdl'tlfl & SOfI, IfIC. INSURERB: NdtlOnd� Surety Corporation 21881
P.O. Box 11387
Green Bay wI 54307-1387 usa, INSURERC:
INSURER D:
INSURER E:
INSURER F:
COVERAGES CERTIFICATE NUMBER: 570054671745 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. Limits shown are as requested
LTR TYPEOFINSURANCE INSD WVD POLICYNUMBER MM/DD/YYYY MM/DD LIMITS
A X COMMERCIAL GENERAL LIABILITY GLO - EACH OCCURRENCE $1�OOO�OOO
CLAIMS-MADE x❑occuR General Liability $300,000
PREMISES Ea occurrence
X ConVactual Liab. MED EXP(Any one person) �10,���
PERSONAL&A�VINJURY $1�000,000 �
GEN'LAGGREGATE LIMITAPPLIES PER: GENERALAGGREGATE $2,OOO,OOO ^
POLICY X PR� X LOC �
�JECT � PRODUCTS-COMP/OPAGG $?,000�000 v
OTHER: o
0
A �
AUTOMOBILE LIABILITY BAP 3495532-13 10/Ol/2013 10/Ol/2014 COMBINED SINGLE LIMIT $1,000,000
BI151i1255 Automobile Eaaccident
x ANYAUTO BODILY INJURY(Per person) O
2
ALLOWNED SCHEDULED BOD�LYINJURY(Peraccident) y
AUTOS AUTOS
NON-OWNED PROPERTY DAMAGE A
X HIREDAUTOS X V
AUTOS Per accident ;�;,
�
B X UMBRELLALIAB X OCCUR SSE-000-5787-5874 10/Ol/2013 10/Ol/2014 EqCHOCCURRENCE $S,OOO�000 V
UMBRELLA LIABILITY $5,000,000
EXCESS LIAB CLAIMS-MADE AGGREGATE
DED RETENTION
A WORKERSCOMPENSATIONAND wC 3495530-13 10/Ol/2013 10/Ol/2014 PERSTATUTE OTH-
EMPLOYERS'LIABILITY y�ry workers Compensation X ER
ANV PROPRIEfOR/PARTNER/EXECUTIVE N E.L.EACH ACCIDENT
OFFICER/MEMBEREXCLUDED7 ❑N/A SZ�OOO,OOO
(Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $1,OOO,OOO
If yes,descnbe under
DESCRIPTION OF OPER4TION5 below E.L.DISEASE-POIICY LIMIT $1�OOO�OOO�
-
DESCRIPTION OF OPERATIONS I IOCATI0N5/VEHICLES(ACORD 101,Addkional Remarks Sehedule,may be attaehed if more spaee is required) �
RE: OSHKOSH PUBLIC SAFETY BUILDING, OSHKOSH, WI, ADDITIONAL INSURED ON A PRIMARY & NON-CONTRIBUTORY BASIS ON THE GENERAL �
LIABILITY, AUTO & UMBRELLA POLICIES THE CITV OF OSHKOSH AND ITS OFFICERS, COUNCIL MEMBERS, AGENTS, EMPLOYEES AND AUTHORIZED ��
VOLUNTEERS AS RESPECTS THE PROJECT NAMED ABOVE PER ADDITIONAL INSURED ENDORSEMENTS CG 2010 07/04 & CG 2037 07/04, AS REQUIRED Si�
BY WRITTEN CONTRACT, ,4�
�
-�
CERTIFICATE HOLDER CANCELLATION �°j
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE TNEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE
POLICY PROVISIONS.
CI7V OF OSNKOSH AUTHORIZED REPRESENTATIVE
CITY CLERK - PAMELA R UBRIG
215 CHURCH AVE -
PO BOX 1130 �/J `�/�� ����1 ����
OSHKOSH WI 54903-1130 usa �yy,o�y ��yf"
01988-2014 ACORD CORPORATION.All rights reserved.
ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD
Po��CY►vUMBER: GLO 3495531-13 COMMERCIAL GENERAL LIABILITY
CG 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 Or anization s : Location And Descri tion Of Com leted O erations
Any person or organization to whom or to Any location where you have agreed, through
which you are required to provide additional written contract, agreement or permit,
insured status in a written contract or written executed prior to the loss, to provide
agreement executed prior to the loss except additional insured coverage for completed
where such contract or agreement is operations and where that contract demand
prohibited by law, and where that contract specifies ISO 2004 edition forms
demand specifies ISO 2004 edition forms
Information re uired to com lete 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 part, by "your work" at
the location designated and described in the sched-
ule of this endorsement performed for that additionai
insured and included in the "products-completed
operations hazard".
CG 20 37 07 04 O ISO Properties, Inc., 2004 Page 1 of 1 ❑
Po��CY NUMBER: GLO 3495531-13 COMMERCIAL GENERAL LIABILITY
CG 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 Or anization s : Location s Of Covered O erations
Any person or organization to whom or to which Any location where you have agreed,
you are required to provide additional insured through written contract, agreement or
status in a written contract or written agreement permit, executed prior to the loss, to
executed prior to the loss except where such provide additional insured coverage for
contract or agreement is prohibited by law, and completed operations and where that
where that contract demand specifies ISO 2004 contract demand specifies ISO 2004
edition forms edition forms
Information re uired to com lete 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 This insurance does not apply to "bodily injury" or
damage" or "personal and advertising injury" ��property damage"occurring after:
caused, in whole or in part, by:
1. All work, including materials, parts or equip-
1. Your acts or omissions; or ment furnished in connection with such work,
2. The acts or omissions of those acting on your on the project (other than service, maintenance
behalf; 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) desig- 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.
CG 20 10 07 04 O ISO Properties, Inc.,2004 Page 1 of 1 ❑