HomeMy WebLinkAboutPW CNT 14-17/Vinton Construction r
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: Vinton Construction Co. Date: December 1, 2014
PO Box 1987 Pro�ect: Contract 14-17
Manitowoc, WI 54221 From: Carol Marchant, Adm. Assistant
Re: Marion Road Storm Sewer Outfall
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 Descri tion
1 Full executed Contract 14-17 — Marion Road Storm Sewer OutFall
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 12th day of November, 2014, by and between the
CITY OF OSHKOSH, party of the first part, hereinafter referred to as CITY, and VINTON
CONSTRUCTION COMPANY, P.O. Box 1987, Manitowoc, WI 54221, 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. 14-17
for Marion Road Storm Sewer Outfall, for the Public Works Department, pursuant to
Resolution 14-492 adopted by the Common Council of the City of Oshkosh on the 11th day
of November, 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
$198,149.37, 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
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 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 Plans and Specifications, including all Addenda's
3. City of Oshkosh Standard Specifications
4. Instructions to Bidders
5. Advertisement for Bids
6. 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
Cterk 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
VINTON CONSTRUCTION COMPANY
� ' b� a-� � �
� � � By�
� �
President
(Seal of Contractor (Specify Title)
if a Corporation.)
By.
Vice-President
(Specify Title)
CITY OF OSHKOSH
/ ,� ° ` ,.--7%�- � �-��—
� By: G'� o�
� �%' �,L Mark . Rohloff, City Manager
, � �W. S� , l
,
, -
;
,� , � -
� . ;, _ � �� ,
� �l '� � And: ,� �
�-�� ;
� (Witness) Pamela R. Ubrig, City erk
APPROVED: I hereby certify that the necessary
provisions have been made to pay
the liability which will accrue under
this contract
orney �
City omptro ler
3
AC R� DATE(MM/DD/YYYY)
, �..., CERTIFICATE OF LIABILITY INSURANCE ����7�zo,4
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. if SUBROGATION IS WAIVED, subject to �
the terms and conditions of the policy,certain policies may require an endorsement.A statement on this certificate dces not confer rights to the �.
certificate holder in lieu of such endorsement(s). �
CONTACT �
PRODUCER 'C
NAME:
Aon Risk Services Central, Inc. pp,X �
Green Bay WI Offi ce (A/C.No.Exc): C9z0) 437-7123 p,�C.No.: �920) 431-6345 �
111 N. Washington Street, 5uite 300 e�vu� p
P. O. BOX 23004 anDRESS: _
Green Bay wI 54305-3004 u5A
INSURER(S)AFFORDING COVERAGE NAIC#
INSURED INSURER A ZUfICh American If15 CO 16535
Vinton Construction Company INSURER 8: American Guarantee & Liability Ins Co 26247
2705 North Rapids Road
P O BOX 1987 INSURER C:
M3(1l tOWOC WI 54220 USA INSURER D:
INSURER E:
INSURER P:
COVERAGES CERTIFICATE NUMBER:570055875672 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 TYPE OF INSURANCE INSD VWD POLICY NUMBER MM/DD MMIDDlYYYV ��M�TS
X COMMERCIALGENERALLIABILITY G��- - EACHOCCURRENCE 51,000,000
CLAIMS-MADE ❑X OCCUR GENERAL LIABILITY $300,000
PREMISES Ea occurrence
MED EXP(Any one person) �10,000
PERSONAL&ADV INJURY $1,000,000 r
GEN'L AGGREGATE LIMIT APPLIES PER: GENER4L AGGREGATE �2,000,000 �
POLICY �ECT ��OC PRODUCTS-COMP/OPAGG 52,000,000 �
0
OTHER: �
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A AUTOMOBILE LIABILITY BAP-5948753-00 03/Ol/2014 03/Ol/2015 COMBINED SINGLE LIMIT $1,000,000 �
BUSINESS AUTOMOBILE Eaeccident „
BODILY INJURY(Per person) �
X ANY AUTO Z
ALL OWNED SCHEDULED BODILY INJURY(Per accident) �
AUTOS AUTOS to
NON-OW NED PROPERTY DAMAGE
X HIRED AUTOS X Per accident t.v-.
AUTOS
�
Ci
e X UMBRELU►LIAB X OCCUR AUC $948802-00 0 Ol 2014 03 Ol 2015 EACHOCCURRENCE 10,000,000 V
UMBRELLA AGGftEGATE 510,000,000
EXCESS LIAB CLAINIS-MADE
DED RETENTION
A WORKERSCOMPENSATIONAND WC-5948756-00 03 O1 2014 03 O1 2015 X STATUTE ERH
EMPLOYERS'LIABILITY y�N WORKERS GOMPENSATION
ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT �1�OOO�OOO
OFFICER/MEMBER EXCLUDED? � N/A
(Mandatory in NH) E.L.DISEASE-EA EMPLOYEE Sl,000,000
It yes,describe under
DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $1,OOO,000—
�
�
DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Add'Rional Remarks Schedule,may be attached if more space ia required)
RE:PUBLIC WORKS CONTRACT#14-17. ADDITIONAL INSURED ON A PRIMARY BASIS ON THE GENERAL LIABILITY CITY OF OSHKOSH, AND ITS y��
OFFICERS, COUNCIL MEMBERS, AGENTS� EMPLOYEES AND AUTHORIZED VOLUNTEERS AS RESPECTS TO THE PROJECT NAMED ABOVE PER BLANKET �
ADDITIONAL INSURED ENDORSEMENT, AS REQUIRED BY WRITTEN CONTRACT. i_
�
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CERTIFICATE HOLDER CANCELLATION W
G'
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEfORE THE
EXPIRATION DATE THEREOF, NOTICE WILL 8E DELIVERED IN ACCORDANCE WRH THE
POLICY PROVISIONS. �
CITY OF OSHKOSH AUTHORIZEDREPRESENTATIVE
CITY HALL -
215 CHURCH AVENUE r�
Po eoX 1130 (� �(��� �� p 5v
OSHKOSH WZ 5 4903-113 0 USA c�Q'Ofi /1it4Ebd �i c�7$Q.
01988-2014 ACORD CORPORATION.Ali rights reserved.
ACORD 25(Z014/01) The ACORD name and logo are registered marks of ACORD
'`�'c°� EVIDENCE �}F PR{�PERTY °"'�`"�""°°'Y"'�'
�,,._....- 1 NS U RA NCE ��r2a�ao,a
` 7HlS EYIDENCE QF PROPERTY ENSURAHGE 18 ISSUED AS A NIATTER OF lNPORMATI4�N {}NlY AND CONFERS NO RiGN7S UPON THE
ADDITIONAL 1N7EREST NAAAED $ELOW. THIS EVIOENCE t?OES NOT AFFtRMA13VELY C}R NEGAl7YELY AMEN�, EXTENO O}2 ALTER THE
COVERAGE AFPOROED HY THE POLlCIES BELQW. THIS EVIDENCE OF INSURANCE QOES NOT COt�1ST17U7E A CON7'RACT BETWEEN THE
ISSUING IPtSURER{S},AUTHt}R[2ED i2EPRESENTATIVE Oit PRODUCER,ANU THE ADDt7'IONAL iNTEREST.
AGENCY .... "AHdNE +� J2O d37 7'I�3_._ ..... ............ COMPANY ......... _..... ......._ ..._. . .. ___. ......... .. ....... _.....
UVC>P1o.��ctj: _
AON f2ISK SERVICES CENTRAL INC Americar7 Zurich Insurarrce Company
PO E30X 230Q4
GREEN BAY,W!5430�-3004
_
iwC,No�;_+l 920 437 24()i AnDRESS:deni5�.maedkeQaqn,cQm
__
coae: 1635254d i sus cooe:
_....._ __
AGENCY __ __ __ ___._
CUSTOMER IQ#: _ _
_..__
INSURED _ LOAN NUMBER POLiCY MUMBER
ViNTON COlVSTRUC:TitJl�l CO(v1PANY BRtI7230974
P O BQX 1987 _ __ _.: . _ _ _
E�ECTIYE DAT� EXPIRA770N£IATE
270b N RAPIDS ROAL� c;CU,-��ruE.�€t a'�;
MANITOWOG,UV!54221-1987 11i24120'!4 11t2Al2U95 ;e��ntFi�r�o r �;r�t=c'x�:r,
_. . _
;tiEB RE7a'..�CLS Fit10R EbRDEHCE DRTEf.T:
Pi'20PERTY INFt7RMATlON
LOCA TIONtOESCRlPTION
MARlON R�Ap STORM SEWER Ol1TFAl_L
USHKOSH.WI 5A9(13-113t3
.�__�_._— _....._�._.�__....._ _ _..�....__........___ _._.. _��___---......_ ...,..__........_. _ .,_._.__...._....._—_. m_...._..�...�__—.____
THE PaLICl�S pF INSURANC� LiSTEQ BELC3W HAVE BE�N ISSU�D TO TNE lNSURED NAMEp ASOVE Ft�R THE POL{CY PERIOp INCIICATED.
NQ`f"WITHSTANDIIVG ANY REQUIREMENT, T"�RNI OF2 CONCSITION L3F ANY CONTRACT dft O?'NER C?OCUMENT WITH REBPEGT TO WHiCH THIS
EViDENCE O�PRGPEk�'Y iNSUi2fiNC�MAY BE iSSUED OR Mf�Y PER7RIN, THE INSUt2ANCE AFFORL3ED BY THE POLiCiES QESCRiBEt7 NEREIN IS
SUBJECT 701�LL TNE 7ERMS,EXCLt1S10NS AND CONDITIQNS OF SUCH POLICIES. LIM11�5 SNQWN IVIAY HAVE BEEN REt?UCEa BY PAlf3 CLAIMS.
CQVERAGE INFORMAT1t}N
___ _ _ COV£RAGE!PERl43!FORMS _ ', AMOUNF OF INSURANCE ' DEL7UC7161E
$uilders Risk Cav�;rage Form _ � _ • �1>OC30
Any One Building or 8truciute 5198.150
Ail Covered Property ai at11_oca#ions : �1�8�15€l
REMARKS Includin S ecia!Canditians
CANCELLATIQN
SHOULQ ANY OF THE ABDYE DESCt21BED POLfC1ES BE CANCE�LEi3 BEFflRE THE EXPIRATIt3N DA7E TNEREOF, NOl'iCE W1LL BE
DELiVERED IN ACCORDANGE WITH TNE Pt)LlCY PROV153C?NS.
ADDITtONAL 1NTEREST
NAIMIE AND A[}ORE$5 ':t#()RT(yn,.^�EE ' K -At:C9ET;�hSAf,fUS1JF2Ep
CI�1�({)��Sh�}t�ca�-f , _...,LGSS}�i�YEE . .,
215 CHURCN AVENUE:P O BOx t 13q � _ ___ . _:. __ ___ __
L UAN ri
OSHKOSH,Wl 54903-t 13D '
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AllTWORlZEi7 R RE5EN7Ai7YE j .��
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ACORD 27(2009112} @'l993-20Q9 ACORD¢flRPORATION. Ail rights reserved.
The ACORD name and logo are registered rttarks af ACi7Rt3
, BUILDERS RISK COVERAGE DECLARATIt�NS
,The Declara#ions, Supplementa{ DecEaratiorts, Common Arnerican Zurich Insurance Company �
Policy Condi#ions, Comrrrercial Inland Marine Conditions, A 5tock Company �
�Caverage Form(s)And Endorsemenf{s}, if any, issued to Ad�inistrative Office; 140Q American Lane
,and forming a part thereof, cample#e the Gommercial Schaumburg, fL 6fl19S
�Insurance Policy numbered as foilows: �
THIS IS A COINSURANCE CONTRACT
� New Policy BRt172309T4
❑ Renewai of Please read your poiicy.
i� Rewr�te of �
1 In re#urn for the payment of the premiurn, and subject to al(tetms of this palicy,we agree with yau to provide the
{msurance as stated ir�this poliey. (
�1. Nanned Insured and Maili�rg Address: Z. Praducer tnformation: �
1/INTON CC}NSTRUCTiQN COMPANY A ���e= AC3N RISK�ERVICES GENTR�IL iNC �
� P U 80X i 987 PU BOX 23d04
2705 N kAPlQS ROAD GREEN E3AY,Wl 5�i��5-3004
� MANITOWOC,W!54221-1987 B Tel�phone#+� 920 437 7�23 I
C F2x# +t 92Q 437 2dD1
F D Zurich Producer# 16352544 �
�3. Policy Period—From: 11124f2f}34 To:�irzar2os� E Fie�d Office Name �
, 12:01 a.m. �f your maiiing address above. F Fie�d Office Code� l
�
i4. Form of Business: ❑ Individuai ❑ Parfnership Q Corporation ❑Joint Venture ❑ Qther i
15. Limits of fnsurance(either Qna-Shot ar Repr�rting Form as indicafed beJow� �
�------ ,
;
�SUPPL��IENTAL DECLARATIC7IVS �
(If this box is checked, Supplernental0eclaratians is attached tc�and forms a part of this palicy)
��_.�..�_......_....__.----.._.___���__..____�._....__......_.�. - -
❑ Reporting Form (continuous policY} � Une-5hot{nun-reporting formisingle structure policY}
❑ Annu�l Rate ❑ Mnnthly Rate(HBIS—4) Q 1-4 Family Dwelling Q Commercial Structure
P�operry Lacation
A) Any one building vr structure $ ana�zioN�c�aa s'roRnn s�w�R ou�r�,a�.�.
;B) Al(covered property af a11 locatians $ ost�xc�sH,w��4sfl3-��so ;
C} Rate Per Repart �
a} Premium Per ReporY New Gonstruction
E} Total Taxes and Surcharges Per Report A} Any one bui(ding nr structure $ 1 g$,��Q
� {per attached endorsement—NfA in
NY} 8} All covered praperty at a(I lacations $ 198,15p �
F} Tatal FuEly Earned Policy Premium Per Report ; (same as A uniess atherwise noted)
`Remodeling �
[7) Re�avations and improvements �
E} �xi5ting k�ui{dings or structures $ �
;
F) Rate $ 0.15
G) Premium $ 375.00
�j Total Taxes and Surcharges � �•��
(per attached endorsement}
1 i} Tatal Futly Earned Policy Premium $ 375.OQ
minimum remium a licable
6. Deductible: ❑$50C1 �$9,000 [�$2,50�} ❑$5>OOt3 ❑C�ther €
7. Farn,s Applicable To This Coverage Part:
SEE SGHEDUI.E OF FQRMS AND EtV00RSEMENTS ,
f� f �.^�„ �
Countersigned �fjJ�'�,�a'� By: ,��Z�` �`
Dafe - M Authoriz , Representative "
FM-17Q0p1(04-10}
. TNlS ENDORSEMENT CHANGES THE POLtCY. PLEASE REA� IT CAREFULLY.
F'tJL1�Y GHANGES
Psalicy Change
Number
. __ ._ �_.....__�.
� P£}LlCY NUMBER �� POLICY�GHANGES � �OMRANY �������.��_.._.
EFFEGTIVE
� SR4723t�974 From 11/24f2014To 1112�3t2015 �merican Zurich insurance Campany
�
'
� NAMED IN�URED � AUTHURIZED F�EPRESENTATIVE��� _�
�E VINTON CONSTRUCT(ON CC1tuEPANY AC3N RISK SERVIGES CENTRAL INC
P C}8dX 19$7 PQ�iC3X 2300Q
� 27�5 N RAPtC3S ROAD GR�EN�3RY.V'dl�1305-30�4
I MANITOWOC.W(54221-1987
COVERAGE PARTS AFFECTED �
Builders Risk Cavsrac,e
�
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........�._...._...........�.._.._..__ .............'__..._........_ . �.............._. _�_.�_'_"_....�..................._-_..__...__....,,.....�_........,........_...,.. ......._._.._._._.....__,............,.._.»....,...._.._._.._......�__.
E
CHANGES
� Additianai insured:
� CITY QF 05HKC}SH
2t5 CHURCH AVFNUE
P t?BOX 1130
OSHKQSH,WI ad9Q3-1134
Addit'ronai insured�
SUBCQNTRACTORS&SUB-SUIIC(}NTRAGTORS
P O BC3X 1987
MANIT4WOC,WI 5A221-1987
I
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�
�
I
�
�
Authorizeci Representative Sig�ature
Gopyright, Irtsurance Services t7ffice, Inc., 1983
i� 12 01 11 85 Capyright, ISt?Commercial Rtsk Services, fnc., 1983 Page 1 of 1
BUILOERS RISK CC3VERAGE SUPPLEIUfEi�TAL DECL.ARATlC?NS
Poticy Number: BR07230974
.Policy Type: ❑ Reporting Forms(continuous paticy)OR 0 One-Shot(nan-reporting formisi�gle structure policy) �
ADDITIONAL GOVERAGES{COVERAGE FORMj LIMIT UF iNSIJRANCE
a. Collapse
b. Scaffalding, Construction Forms And Temporary Structures � 2p,ppp �
Re-erection �f Scaffoiding , 10,000
c. Debris Removai $ 2�,g�a �
d. Sack-Up Or(?verflaw Of Sewers, Orains ar Sumps $ S,OOo (
e. Fire Department Service GF�arge � 1�,pqp I
f
; #. Vaivable Papers And Records � 2p,ppp i
( g. Poilutant Clean-Up And Remawai $ 15,000 �
� h. Ordinance Or Law—Direct Damag� j
I Loss To The Undamaged Portion Qf The Buiiding
�emoiition Cost � 1,ppa,ppo
� lncreased Cost Of Canstructian a� 1,p��=�pp
Cambined Aggregate For Qemolitian Cask And Increased CnsY C}f Consfrucfion � 1.000,000
; i. Preserva#ion �f Praperty
Ij. Rewards � 10,000
; k. Property A#A Temporary Storage�ocation $ 10.aa0
E
� I. Property In Transit � 2�,pqp
C}PTIQ,1�iAL A�DITiC7NAL COV�RA�GES{ENRORSEMENTS�
�❑ Bus+ness Income(HBIS-9�} �
Anficipated P�oject Gompletion Date
Monthly Limit Qf lndemnity �f�������
� Deductible Period days
Civil Authority Included
(❑ Business Income And Extra Expense{HStS-82} �
Anticipatsd Projeci Canr�pietian C?ate
� Monthly Limit Of lndemnity {fraction}
Deductible Feriad ��ys
� Business Incarne lncluded
Exira Expense lncluded
Civil Authority ���t����
,❑ Development C3r Subdivisian Fences,Walis And Signs{NBIS-S8j �
�❑ Expediting Expense(NB1S-93j �
❑ Extra Expense{HBIS-92j �
❑ Marine Model Home Cantents Goverage{[� NBIS-52—t3R—❑ HBIS-77} $
❑ Soft Costs Coverage(HB15�-88} �
Anticipated Projec#Campletion C}ate
Deductibls Period days
Expense To Mitigate Loss Included
Civii Autharity{couerage extended far 3 additional cc�nsecutive weeks) Included
OPTt{7NAL COVERAGE EXT�NSION��NDC?RSEMENT}
i
�❑ Buiiders Risk Green Bui[ding Coverage ExtensCon {IiBIS-96}
Aggre�ate Limii of Liability �
E "LEED'�Building Rafing,"
H��s-�� faa-os}
_.....__ ._.... _ ..._ _ ... _....... __...... __.._.. _ � . .__ _
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'�an�ed lnsumd: VT3�Tt}� C'C).'�5"[°RUC"I'I()N C'(:1;41f'A�Y I:>fTectivc I)at�;: 11-24r2U14
12:{�t :'�.�49.,Stanc��rd"Cime
;ls:u�t'�aznc: A()'� RI�K�I Ct�"tt F S t[.I�TR�11 1'�C' _ �lgcnt'�c� 1 fi3525a4
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Disclosur� Statement ������
It is our pleasure tc�present the enc(osed policy ta yau
for presentation to your customer.
INSTRUCTIC?N Tt)AGENT OR BR�KER:
WE REQUIRE THAT YOU T}�ANSN!!T THE ATTACNEDIENCLOSEC3 DISCLOSURE Sl'ATEMENT TO THE CUSTOMER
WITN THE F'C?�.l�Y.
Once again, thank you for your interest, and we look fr�rwerd ta meeiing yaur needs and those af your customers.
U-GiJ-873-A CW {06111}
Page 1 of 1
�� � � �
No �ce to W�sconsin Pol�cyhaldersl ZURICH=
�erti�cateholders
KEEP THIS IUOTiCE WITH Y9t1R INSURAIVCE PAPERS
PROEiI.EMS WI7F1 YdUR tNSURANCE? If you are having problems with yaur insurance company or agent,do
not hesiiate io contact the insurance corr�pany or agent to resolve your pr�blems.
Zurich North America
Custc►;ner Inquiry Center
9400 American Lane
Schaumburg, Iliinois 60196-1058
'1-80U-382-2150
Yau can afsa contact the O��ICE CiF THE C{}MMISSIONER C?F tNSURANCE,a skate agency which enforces
Ulisconsin's insurance laws,and file a campEaint, You can contact the OFFICE OF THE CL�MM1SSiOF1ER C?F
INSURANCE by contacting:
Office vF the Cammissioner af Insuranc�
Complainis C}epartment
P.fl. Box 7$73
Madison,WI 537f}7-7873
1-800-236-8�i 7
608-266-(31£�3
U-GU-857-C{Q7f09)
Page 1 a(1
Builders Risk Coverage �'orm ��„����� `
Various pravisions in this policy rastrict coverage. Read the entire policy care#ulJy tc� deterrnine rights, duties and what is
and is not covered.
Throughout this policy, the words "you" and "your" refier tQ the �famed Insured shr�wn in the Declarations. The words
"we", "us"anc!"aur" refer t�the Gompany providing this insurance.
Words and phrases that appear in quotafion marks have special rrreaning. Refer tr�S�ction F. DEFINITitJNS.
Coverage pro�ided by Coverage Form is also subject to al! Con�litierns in the Com�on Policy Conditians and Gammercial
Infand Marine Conditions fcarms.
A. Ct?VERAGE
We r�vill pay frsr direc#physica( loss c�r damage ta Covered Pr�perry from any Covered Cause of Loss described in this
Coverage Form.
1. Covered Praperty, as used in the Coverage Form, means:
Properiy which has been instai(ed, or is t� be installed in any "cammercial structure" or any one ta four family
dwelling, private garage or other structure that uvill �e used to senric� the "commercial structure" or one to four
fiamily dwel�ing�t#he it�cat�on which you hauw repor�erl to!�s. This includev:
a. Your property;
b. Property of others fnr which you�re legally responsible;
c. Paving, curbing,fences and outdoor fi3ctures;
d, Trees, shrubs, plants and lawns insialled by you ar Qn yaur behalf;
e. Compleied single fasnily dweliing which is being used as a Mod�i �lame when reparted to us as such or�
monfhly reports with an amount shvwn; and
f, Foundations af bui#dings and foundations of struciur�s in the course of canstruction.
2. Property Nat�crvered
Covered Prrsperty does nat include:
a. Existing buildings ar structures #o which an additian, alteratian, improverrtsni, or repair is being made, unless
specifically endorsed;
b. Plans, blueprinis, designs or specifications; except as provided in paragraph A.4. Additionai Coverage of
#l�is Co�erage Forrn;
c. Land and water;
d. °Existing invenfory", unless specificaily errdorsed;
e. Contrac#ors toois and equipment.
3. Covered Cause Of Loss
Covered Cause af Loss means risk o€direct physica� loss or damage ta Covered Proper#y, except thase causes
of loss listed in Section B. EXCLUSIONS.
4. Additional Coverages
a. Callapse
4(}471 {a4-09}
Page 1 of 12
Includas capyrighted material af Insurance Services Office,Inc.,wiih its perm#ssion
We w'sli pay for direct physical loss ar damags ta Covered Praperty, caused by collapse af all or part of a
building ar structure insured under this Caverage Form, if the coElapse is caused by one or more of the
fo(lowing:
(9} Fire; lightning, windstorm; hail; explosian; smoke; aircraff; vehicles; riots; civil commotio�; var�clalism;
breakage of glass; falling objec#s; weight of snow, ice ar sleet; or"wa#er damage"; but nniy if the causes
of foss are otherwise covered in tFsis Coverage Form;
{2) Hidden decay;
(3} Hidden insect ar verrnin damage;
{4j Weight of people ar p�rsor�al property,
{5} Wsight ofi rain that collects an a rqof;
�6j Use of defectiue materials or met}�ads in construction, ramodeitng or renovation if the collapse accurs
during the course of the cons#rucfion, remodeling or renovation.
This Additional Cc�verage does not inerease the Limits of Insurance provided in the Gaverage�orrn.
b. Scaff�otding, Construetion Forms And Temporary Structures
(1) We wi11 pay for direct physical Ioss or damage which is caused by or results from a Coversd Cause af
Loss, ta scaffalding. consiruction forms and tempor�ry structures; including fulfy en�lased office snd fully
enclosed too! traifers, but only whiie they are at a constructian site yau have reparted to us. The most we
wili pay uncler this Aciditiana! Coverage is the amaunt shown in ihe Supplemental Declarations for
Scaffofding, Construction Farms And Temporary Structures.
(2) We will also pay f�r the cost c�f re-�rection of the scaffold if ths lass or damage of the scaffolding is
��used F�y or results fram a Cvvered Cause of Loss. The most we wiii pay under this Additional Caverage
is the amount shown in Ehe Supp(ementaf Declarations for Re-erection{�f Scaffolding.
No deductibf�appli�s tc�this Additional C�verage.
c. Debris Remo�val
We will pay your expenses to rert�ove debris ofi Covered Property. This debris must resulf from a Covered
Cause of Loss under this Coverag� Form. The expenses wiEl be paict only if they are repo�ted to us in writing
wiihin 18Ct days of the date of direct physical lass or damage. If the surn of the Jass or damage and debris
r�movai expenses exceetfs the limit of insurance app(icable to the praperty, we will pay an additional arr�ount
of debris remaval expenses you incur in excess of the iimi#ofi insurance appficable to ihe property up ia, but
noi exceeding the amount shown in the Supplementa!Declarations for Debris Rerr�oval.
This Additianal Coverage does nof apply to eosts ta:
{1) Extract"poliutanfs"from land or wafer; or
{2) Rerrtove, restore or repiace poUuted land or water.-
No deductible appiies to fhis Additiana(Coverage.
d. Back-Up Or�verflow C}f Sevvers, Drains t�r Sumps
We will pay far loss or damage io Covered Property caused by water tha# backs up ar overflaws from a
sewer, drain or sump from within th�reported iocation.
The mos#we will pay unde�fhis Add'€tiar�al Coverage is fhe amoun# shawn in the Supplemental Declarations
for Back-Up(3r{7uerflaw�f Sewers, Drains C3r Sumps.
No deductible applies to this Ad�iitianal Coverage.
e. Fire Department Service Cha�ge
When the fire department is called to save or protect Covered Property from a Covered Cause of Lass, we
will pay f�r your liabi[ity for the fire departrr7ent s�rvice charges which are:
(1} Assumed by contract ar egreement prior to loss or damage; ar
aca��(oa-oa}
Page 2 of 12
Includes copyrighted materiaf oi Insurance Services C?ffice,tnc.,with ifs permissian.
�2} Required by Ic�cca!ardinance.
The mast we wiEl pay under this Additional Coverage is the amauni shown in #he Supplementa! Declaraiions
for Fire Department Service Charge.
Na deductible appiies to this Additiana(Coverage,
f. Valuabte Papers And Records
We will pay far direct physicai loss ar damage to`valuable papers and records"caused by�r resulting from a
�overed Cause afi Loss.
The value will be based an the blank rr�aterials far reproducing the records and labor ta transcribe or copy the
recards when there is a duplicate. When there is no dupiicate, ws wil! pay the casts to research, replace,
restore or repraduce the Er�st infarmation on lost or ctamaged"valuable papers and records".
The most we will pay under this Additionai Cc�verage is the amount shown in the Supplemen#a! Declaratians
far Vaivable Papers And Records.
No deductibie applies to this Additiona!Coverage.
g. Pollu#ant Clean-Up And Removal
We wili pay your expense tv ex#ract"pollutants"from Iand ar water at Incafions reported to us ifi fhe discharge,
dispersal, seepage; rrsigrafion, refease or escape of ihe "pc+Eiutants" is caused by or resuits from a Cavered
Cause of Lass fhat occ�rs during the policy periad. The expenses wil!be paid only if they are reported to us in
writing within 180 days of the date fln whic� the Covered Cause of Loss occurs.
This Additional Cc�verage does not apply to casts to test for, monitor, or assess the existence, cancentration
Qt' 8fF@C#S 4f "pollutants". But we wiI( pay for #esting which is performed in the course of extracting the
"pofiutants"fram land or water.
The mast we will pay under this Addi#iona! Coverage is the arnount shown on the Supplemental Oeclarations
for Pollutant Clean-Up And Removal for the sum of all ex�aenses which are incurred as a resuit af aI!Covered
Causes of Loss during each separate 12 monih period from the eff�ckiVe date of the poiicy.
No deductible applies to this Additi�na(Caverage.
h. Urdinance Or Law—Direct C}annage
{1} Coverege For Loss To Undamaged Portiqn Of Th� Building Qr Struc#ure
(a) If a Cavered Cause of Lvss occurs to Govered Property ai the canstruction site reported to us, we will
pay for loss or damage to the undamaged portion af the prt�perty as a consequer�ce of enforcement
af any ordinance ar law that:
{i} Requir�s the demolition of parts of the same property not damaged by a Covered Cause of Lass;
(ii} Regulates the consiruction or repair of p�operty, or estabEishes zoning or land use requi�emen#s
at the constructio�site; and
(iiij Is in force at the time af lass or damage.
{b} Coverage for lass or damage #a the undarnaged portion of the structure is inc(uded within the
applicable limit af insurance far that location a#the constructian site.
This oniy applies�srhen the ordinance or law went into effect after the start of the construc#ion of
the strncture or dwelling.
(Z} Demolitian Gast Coverage
(a) If a Covered Cause of Loss vccurs to Covered Property at the canstruction site reported to us, we will
pay the cost to demolish and clear tl�e construction site of undamaged parts of the property, caused
by enforcemeni ofi building,zoning or land use ordinance or law.
(b� The most we will pay far L�emofitio�Cost is the amount af Ir�ss or damage or the amaunt shown in the
Supplementai Declarations far Demalition Cost Cc�uerage, whichever is l�ss.
4tl471 (Q4-09}
Page 3 of 12
Incfudes copyrighted materiaf of tnsurance Services Of�ce,1nc.,with iks permi5sion.
{3} fncreased Cost�f Constructian Coverage
{a} 1f a Covered Cause of Loss occurs ia Cove�ed Property at ihe cans#ru�tian site reported to us, we will
pay for the increased cost necessary to repair ar reconstruct the darnaged portions of that Cavered
Prope�ty when th� �ncreased cr�st is a consequence of enforcement of building, Zoning ar land use
ordinance or law. If ihe Covered Property is repaired or rebuilt, it must be intended for the same
occupancy as the property prior ta the loss nr damage, un�ess othenn+ise requirad by zoning land use
ardinance or faw.
(b) Ifi the ordinance ar law requires relc�ca#ion ta artotF�er site, we wiii pay the increased cost of
construction ai the new site as set farth below in paragraph {c)below.
{c} 7he most we wifl pay for Increased Cos#of Gonstruction Coverage is the amount of loss or damage
or the amount shown in the Supplemental C}eclarations for lncreased Cost�f Construction Coverage,
which�uer is less.
{4} The most we wil! pay in tota!for Demalition Cvst Coverage and lncreased Cosf of Construction Coverage
for Ioss or damage from any one occurrence is the limit shown in the Suppfemental Declaratians far
Combined Aggrega#e For�emoli#ic�n Cost And Inereased Cost Of Constructior�.
(Sj We will r�at pay under:
{a} Coverage For LQSS To The Undamaged Portion C?f The 8uilding 4r S#ructure;
{b} Demokition Cost Covera�e; or
(c} lncreased Cast�f Canstruction Caverage
for costs associated wiih ihe enfarcemeni afi any ordinance or 1aw which requires any insured or others to
tesi for, monitar, clean up, remove, contain, ireat, de#oxif}� or neutrafize, or in any way respand to or
assess the effects of"pollutants".
{S) )n #he event that fhis po(icy is endarsed to provide cvverage for existing buildings or structures, or the
policy covers renova#ion, remodeling or ather work being done on such buildings ar structures, ihis
Addi#iona�Coverage shall nat apply to such build�r�gs or struefures.
i. Preservat9c�n 3Jf Property
If it is necessary ta mn�e Covere�! Praperty from the lor.ation reported to us or described on the Deciarations,
ta preserve it from loss or damage by a Covered Cause af Loss, we will pay fior any direct physica! loss or
damage ta thai praperty�
{1} VVhile it is being moved or whil�temporarily stored at ar�other location; and
(2} Only if the loss or damage occurs wifhin 30 days after the prope�ty is firsf r�noved.
This Additional Coverage is part of, and not in adcfitior� to, the Limit of Insurance applicable to the Cavered
Property.
j. Rewards
At our option, we may reimburse y�au for rewards you pay, other than to you, yaur partners or o�cers; for
infr�rmaiian which leads to the conviction of any one ar more persans respons'rbie for lass or damage covered
under this Coverage Fo�rn, We will be the soie judge as to the payment and amount of reimbursement.
The masi we wi(I pay for this Additiona! Coverage is the amount shown in the Supplemental Declarations for
Reward5.
Ic, Pruperty At A Temporary Stc�rage Loca#ian
{1) We will pay far direct physical loss ar damage caused by a Gavered Cause ofi Loss tt�Cavered Praperty
while temporarily in s#orage at a (ocation other than a location�vhich you have reparted to us.
{2) We will not pay under this Additianal Coverage fior property in storage if #he prop�rty has nnt been
specifically allocated to or other+lvise ideniified with a covered b�ailding ar structure.
d0471 (Q�t-D$}
Page d of 92
Irzcludes capyrighted material ai Insurance Services C7ifice,Inc.,wifh its permission.
{3} The rnost we wiil pay for this AddiEionai Coverage is the amount shown i�tl�e Suppiemental Declarations
far Property At A Temporary Storage�oca#ior�.
t. P�aperty tn Transit
We wiEl pay for direct physical loss or damage caused by a�overed Cause ofi Loss to Covered Praperty vuhile
in transit.
The most we wi[I pay for ihis Additiona! Coverage is the amouni shown in the Sup�lernental peclarations far
Property In Transit.
B. EXCLUSlONS
1. We wifl not pay for a Eoss or damage caused directly or indirectly by any af the faflawing. Such loss or damage is
exc)uded regardless of any other cause or event thak contributes concurr�:ntiy or in any sequence to the loss or
damage.
a. Governmentat Action
Seizure or d�struc#ion of property by �irder o#' arzy goverr�rr�ental 8UfI3OPi�y. Blt2 we wii! pay for ac#s af
destruction ordered �y gavernmental authariiy and taken ai the #ime of a fire to �arevent its spread, if that fire
wauld be covered under this Caverage Far�m.
b. Nuclear Hazard
Nuclear reactian a�radia#ion, or radioacfive contamination, however caused,
But if nuclear reacfion or radiafion contamination �esu(ts in fre, we wili pay for the loss or damage caused by
that fi�e.
c, tAfar Ar�d Military Action
{1} War, including undedared or civi(war;
(2) Warlike action by a military force, including actian hindering or defending against an actual ar expecfed
attack by any governrrtent sovereign ar o#her auth�rity using miliiary personnei or ofher agents; ar
(3) lnsurrection, rebellian, revolution, usurped power or action #aken by gowernrnent authority in hindering or
defending against any of these.
d. Earth Muvement
(1) Any earth movement (other than sinkhoie col[apse}, such as an earthquake, (andslide, mine subsidenee
ar earth sinking, rising or shifting. But if earth movement resuits in firs or explosian, we will pay far the
lass or damage caused by that fire or explosian.
(2} Vo{canic Actian
Vafcanic erup#ion, explc�sion or effusion. But i€ valcanic eruption, explosion or effusion resuits in fire,
building gfass breakage or volcanic actian, we will pay for the loss or damage caused by that fire, buiiding
glass breakage or volcanic action.
Vaicanic action means direct loss or damage resulting from #he eruption q# a valcano when #he loss ar
damage is caused by:
(a} Airbome vnlcanic blast or airborne shock waves;
(b) Ash, dusi or particufate matter; ar
{c} Lava flow.
Ail vol�anic eruptians that c�ccur within any 168 hour p�rir�d wiEl constiTute a single occurrsnce.
Valcanic ection daes not inc(ude ihe cos# to eempve ash, dust or particulate mat#er that cloes not cause
direct physical lt�ss ar damage ta the described praperfy.
This exclusion does not apply ta Covereri Property whils in transit.
e. Water
46471 (04-09}
Page 5 of 12
tr�cludes copyrighted mafertal af Insurance Services Office.Inc.,w�2h its permission.
(1) Ftaod, surface wafer, waves, #ides, tidal waves, averflow afi any body of water or their spray, atl whether
driven by wind�r not;
(2} The interior of any buiiding or strucfure caused by �r resulting fram rain, snow, sleet, ice, sand or cfust,
whether drivsn by wind or noi, unEess:
{aj The bui[ding or stru�ture #irs# sustains damage by a Covered Cause of Loss to its roof ar walls
through which the rain, snow, sieet< ice, sand or dusi enters; vr
{b) The Ioss or siamage is caused by or resul#s €rorn thawing of snaw, sleet or ice an ths building or
structure.
(3) Mudslide or mudflow;
(4) Water thai backs up or overflows ffom a sewer, drain or sump, except as provided in fl�e Batk-Up C7r
tJverfiow Of Sewers, �rains 4r Sumps Additional Coverage;
{5) Water under the ground surface pressing on, or flowing or seeping fhrough:
{a} Four�datic�ns,walis,flpors or paved surFac�s;
�b} Basements,whe#her paved or no#; or
(c) Daors,windows ar other t�penings.
But if waker, as described in s.(1} through e,{5) ataave, results in fire, explosic�n ar sprinkler Ieakage, we wili
pay for the loss or damage caused by that f re, explasion or sprinkl�r leakage.
2. We will not pay far a Ioss�c?r damage caused by or resulting frarr►any of the foilowing:
a. Delay, lass of use, or loss of market. This does nc�t include "profit" if reported in compliance with #he
Reporting Provisions Addiiional Gondition;
b. Dishonest or criminal acts by you, any af your par�tners, emplc�yees or lea�ed emplayees, directors, trustees,
aufhorized representatives ar anyone to wt�om you entrust the proper#y for any purpose.
This exclusion appfies:
{1� While acting�Ione or in colfusion with othets; ar
(2) Whether or not occucring during ths haurs af employmsnt.
This exclusinn does not apply io acts of destructior� by yout employees or leased empioyees; but #heft by
employees or leased empioyees is not covered.
This exc(usion does not apply ta Covered Property while it is enirusted ta�thers who are carriers for hire.
c. llnexplained ar mysterious disappearance exc�pt far praperty in cusfotly of a carrier far hi�e.
d. Shortage of propert}r fc�und on taking inveniory.
e. Renalties for noneflmpliance with contract canditions.
f, Collapse, except as provided in tf�e Collapse Additianal Coverage.
g. (1} Wear and tear,
(2} Any quaiity in the property iEseif that causes it to damage or destroy itself, or that causes gradual
deterioration;
(3} Insects,vermin, rvden#s;
{4) Carrasion, rust>fungus,�mold, mildew, rot;
{5) Qampness, changes in or extremes of temperatures,freezing;
However,we wili cover freezing lass or damage to property in the building repo�ied to us, if you have shut
aff the water supply anti drained the plumbing syst�ms and appliances or made a reasonable effort to
maintain heat in the building.
(6} Settling,cracking, shrinking, or expansinn of any Covered Property.
aoa7,toa-as>
Page 6 ofi 12
Includes copyrigt7ted materlal o#Insurance Services O�ce,1nc.,wilh its perm(ssian.
h. Rain, snow, sleet, sand or dus#if Covered Rroperty is in the open. This does nat apply to Co�ered Property in
the custody of a car�ier for hire.
i. Artificsal]y generated eleetrical cu�rent; mechanical breakdown; rupturing or bursting caused by centrifugal
. force.
j. Testing, sta�t-up, commissioning, examination or frial of Covered Property such as bQilers, oVens, stoves,
#urbines, pumps, procsss equipment or equipment of a simiiar nature #a prove their abili#y or function. This
includes any form �sf testing making use t�f feedstock, including operational tests, perfarmance tests, or a#her
tests performed in conjunction with such tesfing. This exclusian daes not apply to "electrical tes#ing",
"mechanical testing", "pneumatic iesting" or "hydrostatic testing° used in the start-up and testirtg af building
sysfems that are intended to service a building.
3. We will not pay for bss os damage caused by or resulting from any of the fioliowirtg. But if loss or d�mage by a
Covered Cause o# Loss results, we w�11 pay far #he resulting foss ar damage caused by that Cavered Cause af
Loss.
a. V`Jeather condi#ions which eontribute ir� �ny way to a cause or even"r exciudea in paragraph 1, abave ta
produce the loss ar damage.
b. Acts or decisions, including the #ailure to ac# or decide, of any person; group, or arganization representing a
governmental, regulatory ar contratling body.
c. Faulty, inadequate or de#ective:
(1) Planning,zaning, devetapment,surveying.sitinc�;
{2} C3esign, speci�cations=workrnanship, repair. construction, renovatian, remodeEing, grading, campaction;
(3} Materials usQCi in repair, cc�nstr�.lctioa, renovatirn or rem�dsling;r�r
�4j Maintenance
of all or�art of any Govered Property wherever iocated,
d. The discharge, dispersal, s�epag�, migratior�, release or escape of "pollutants°, except as provided undsr
Follutant Clean-Up And Removal Additional Coverage.
C. �1MITS t3F INSURANCE
The most we wili pay for lass or damage ta any one building or structure is the iesser of the Limit of Insurance shown
in the Declerations for that one building or sfructure or the "total estimated comp(eted value" #hat was reported #a us
far that one building or structure. The mast we wilE pay for loss or damage in any one occurrence is the limit shown in
the Declaratians for all Covered Property at all Iocations.
Q, DE[}UCTIBLE
We will nat pay for loss ar damage until the amount of covered (ass or d�mage exceeds the Deductible shouvn in the
Declaratians. We wii! tl�en pay the amourrt of the cc�vered loss c�r damage which excesds the Deductible, up to the
applicab(e Limit of Insurance.
E. ADDITI4NAL CQNDITIt3NS
The following conditions appEp in addition to the Gommon Paficy Conditions and the Gammercial Iniand Marine
Car�ditions:
1. Cauerage Territory
The coverage territary is United Siates of America�including its territaries and possessions}and Canada.
2. Where Coverage Applies
This coverage applies to Covered Fraperty while within the coverage territory while:
a. At any constructian site you have reported;
b. Temporarily at other premises, if the property has been designated to be installed at a location you have
repo�#ed to us; or
44471{Od-09)
Page 7 of 12
Includes copyrigl�ted material oi Insurance Services Office,Inc„with its permission.
c, In transit sxcept imports or expo�ts white ocean marine eo�erage applies.
3. When Coverage Begins And Ends
We urill co�er risk of(oss or damage frorr� ihe time when you are iegally responsible for the Gover�d Property on
or after the effect3ve da#e af this policy if a!1 vther conditians are met. Coverage will end at the ear(iest of the
folfowing:
a. {}nce your interest in the Cavered Property ceases;
b. Ninetyr days after initial occupancy of the Covered Prapsrty unless�
(1} That building is being used as a madei home;
t2) That building is being rernode(ed and is a single�family dwelling: or
{3} That building is being used as a"madel home leaseback".
c. When the Cavered Prapet�iy is leased to or rented to others�
(1) For a single family dwelling,wher�the bui(ding i�leased or rentect tc�others;
{2} For a two, three ar four famify dweQing, when �fl% or more of the units in the structure are leased to or
rented ta oth�rs: or
{3) Far a "commercial siructure", when 7�°I� or more of the square footage space is Ieased to or renfed to
others.
This does nr�t apply ta pre-I�ases esta�alished priar to cnnstruction.
d. When you abandrn the reported location with no intention tc�cornplete ii;
e. Ar the enci af 12 manths from the month when you first reported the Incation to us unless you report the
location again and pay an addi#ional premium. (f#he loeation is reported again and the addiiional premium is
paid, coverage will end at the end nf i 2 manths from Ehe mc�nth wh�n you re-reported the location to us as
described i� the Reparting Provisinns Additional Condition. You hawe the opfion to report the same loca#ion
a third time at the end of the second 12 montt� pericrd, pravided the required additianaf prsmium is paid.
Cove�age for #his third 12 month term will end at the end of 12 monfl�s from the month you re-reported the
locatian for a third term;
Coverage for existing buildings or struc#ures ff�at are being or have been remodeled�
At the end of 12 mnnihs frarn the mc�nth when yau first reporfed the location fa us unless you report the
laeation again ant� pay an additional premium. If the location is �eported again and the additional premium is
paid, coverage wi(l end at the end of 12 months from the month when you re-reparted the loca#ion ta us as
described in the repa�iing protrision be(orv.Ther�is na optian ta report a third year.
f. When permanent praparty i�surance applies; csr
g. Qnce the Cavered Property is acceptad by the owner crr buyer.
4. Reporting Pruvisio�s
a. Each manth you must report to us the "tota! estimated completed ualues" of aEl Govered Property fnr each
location started during the previous month.This report must ba made on tha form we pravide.
Far the purpose of these reporfs, a [vcation is started wP�en you first put any building materials {including ihe
faundation}on the canstructian site.
!f your policy is endorsed to provide coverage for exi�iing structures thaf you are renovating or adding onto
and for which you seek coverage, a location is started on tha earlier of the follawing.
{1 j When yau first put any building materials, vsrhich inc[udes ar�y new, altered �r expanded foundation, on
the site; or
{2j When you acquire title tfl the existing structure.
b, You must pay premiums based on #he "tatai sstima#ed campleEed valus" of the Cavered Property using the
rate we furnish. Yau must send your premium payrrtent with the report for the reported locations to be
aoa���oa-os>
Page 8 af 12
lncludes capyrighted materfal af Insurance Services Of�ce,Inc.,witYr its permission.
covered. We must recei�e your report and the accampanying premium payments at the address designafed
in our form by the iast business day of th�mcrnth in which the repo�t is due,ar the report is late.
c. If a report is received late, coverage begins on the day t�e repart is receiVed, and there is no coverage for any
loss or damage that occurred before that report was re�eived. C?ur acceptance of a report af values and
premiui-ri payment does noi wai�e or change any part of this poiicy nor sfop us fram asserting any right we
have under the terms af this pvlicy.
d. The premium charged is fu!!y earned and nt�refund is due you when coverage ends.
e. A dwelling being used as a Model Harne must be reportsd and shauld be identified as a Model Hame.
f. Yau will keep accurate construcfivn records regarding property we cover under this po#icy. This includes #he
"total estimated compie#ed �afue" of ihe Covered Praperty and a record of a!i contracts of saie dealing with
the Cavered Properiy.
g. lf ak the end of 12 months from tha #ime yot� first reparted a start to us, yr�u s#iE! have that laca#ion in your
inv�:ntary, yau may report thaf location to us � seeand time. If at th� er�d of fhe seconc! 12 mon#hs frvm th�
time you first reported a s#art to us and you still have fha# lacation in your inventory, you m�y report that
I�catian to us a third time.
Coverage for existi�g buildings or structures that are being or have been rerr�odeled:
If at the end of 12 mQnths from the time you first reporied a start to us, yQU still ha�re fhat Iacatian in yaur
inventory, you may repart that locaiion ta us a second iime. There is no opiion#o report a third time (year}.
h. CancelEa#ion of this policy wi(I no�aff�c#t}�e ir�surance in fiorce on any lacatian which you have reported ta us
or on any 3ocation which started before the effective dafe af ihe cancellatian notice if#hat iocation is reported
on the report due and premium paymeni is made. However, you cannat repo�f any lacation cu�rentfy in yaur
inven#ory a second time a#ter the effective daie of car�cellatian.
However, coverage may bs canceled on any location if noiice is given in wri#ing in accordance with the
canceliation provision in the Common Palicy Cvnditions, or state amsnclatnry endorsements.
5. Mortg�ge Holders Clause
a. The term mortgage holder includes irustees.
b. We w'sll pay#ar couerect lass ar damage to Covered Property to each mortgage holder shown c�n a Gertificate
of Insurance issued by the eurrent Agent af Record.
c. The mortgage hoEder has the right tn receive payment for loss or damage e�en if.#he mortgage halder has
s#arted foreclosure or similar aetion on the Cvvered Properfy.
�i. If we deny your claim because of your acts or because you have failed to comply with the t�rms af this
Coverage Part, fhe mortgage holder wi(1 still have the right to receiue payment for loss or damage ta Covered
Property if the mortgaq�holder�
(1 j Pays any premium due under this Coverage Part af aur request i#you have faiied io do so;
(2} Submits a signed, sworn proofi of loss within 60 days after rsceiving notice from us of your failure to do
so;
{3} Has natified us of any change in awnership, occupancy ar substantiai change in risk knawn ta the
mortgage halder.
All af the terms of this Coverage Part will then appiy directiy to the mortgage holder.
e. !f we pay the mortgage halder for any Ir�ss or damage and deny payment ta yau because af your acts or
because you haue failed fo comply with the terms of this Coverage Part:
{1} The mortgage holder's righ#s under the rnartgage wil! be transferred ta us to the exient af the amoun#we
pay; and
{2j The morigage haider's rights to recover the fuli amount of the martga�e holder's claim will not be
impaired.
40471 (d4-b9}
Page 9 0#12
[ncludes capyrighted material af lnsurance Services Office,inc.,with its permission.
At our c�ption, we may pay to the mortgag� holder the urhole principai on the mortgage plus any accrued
interes#. ln this event, your mortgage and note wifl be transferred ta us and yau wil( pay your remaining
rnortgage debi#o us.
f. If we cancel this poiicy. we wiil gi�e wriften notice to#he m�rrtgage holder at(east:
(1) 10 days befcsre the ef�ective da#�of canceflation if we cancel far non-payment af premium, or
{2) 3U days before the effective date af cancellation if we cancel fiaf any other reason.
g. We will not natify#he mortgage holder if:
{1) You cancel this policy, or
(2� Coverage ends for any reason ather than if we cancei the policy.
6. Wai�er Of Coinsurance
!f there is Ivss or damage tc�Covered PropeRy and the cnst to repair ar replace such praperry is less than or equal
to$25,06t3,we+�vii!adjust th� Icrss�r dam�ge wifhout regard to the�oinsurance Adcii#ianal Condition.
7. Coinsurance
(f the reported value is less than the "total estimaied cornpleted value", you wiCl bear a portion of any loss or
damage. The amaunt we wiil pay is determined by the folEowing steps:
a. Divide ihe reparted value by#he"tatal estimated cnmpleted value"c�f the Covered Property;
b. Muitiply the #ntaf �mount of #he ccrvered loss or damage befiore the appiication af any deductible by the
percentage deiermined in paragra}�h a.;
c. S�,btract th�d�duc#ibl�from the figure�letermfned in para�raph ta.
Example No. 1
(This example assumes there is na penalty for unde�rinsurance.}
�eductible $1,fl00
Reported Value $10�,pp0
.`Total Completed Esiimated Vatue" �10Q.000
Amount of loss ar damage �6�,000
a. Reported value diuided by`�to#al estimated compieted value°
$10�,QD0/$1{?fl,D�Q= 1.(}0
b. Amaunt of lass ar damage multiplied by percentage in paragraph a.
$60,0{}0 x 1.00=�60,000
c. Qeductible amounf subtrac#ed fram resul#of paragraph b.
$60,0�0-a1,{�{}0 = $59,000
Example No. 2
{This examp(e assumes ti�ere is a penafty far underinsurance}
Deductibfe $1,000
Reparted Value $10t?,00{�
`Total estimated corrtpleted value" �120,000
Amount of loss ar damage $60,OOt?
a. Reported valu�divided by"tatal estimated completed va(ue"
a100,000/$12{},000= .833
aoa���oa..os)
Page 10 ofi 12
Inctudes copyrighted materiet of insurance Services Office,Inc..wifh its permissian.
b. Amount of loss or damage multipiied by percentage in paragraph a.
�6Ct,000 x.833=$49,980
c. Deductible amouni 5ubEracted from resuit of paragraph b.
$49,980-$1,40q=$48,980
8. Liberalization Clause
If we adopt any revision which would broaden ihe couerage under this�average Form without additional premium
v+ri#hin 60 days prior to or during the policy period, the broadened coverage wili immediately apply to this policy.
9. lnterest Of Subcontractors,Sub-Subcontractors,Suppliers
We cover th�interest which ynur subcontractors,yo�r sub-subcontractars and your suppliers have in the Co�ered
Property, but only while such property is situated at a canstruction site you have reported ta us. This condition
daes not impair any right of subrogation we would other-wise have.
90. Uninientional Failure Tv Disclose Hazards
Your failur� to disclose aEl hazards existing as of the inception date af the palicy shall not affect #he coverage
afforded by#his policy, pravided such failure ta disclose aEl hazards is nat inientional and the hazard is repor#ed to
us as saan as practicable after you learn abouf it.
F. DE�INITIC)NS
�I. "Cammercia!structure�'means any structure other ihan a one to faur family dwelling.
2. "Electrical testing„ means ihe testing t�f systems that are operated by electricity, excluding service equipment and
service conductars, electrical systems greater than 6U(}vvlts nominal and eEsctrical systems tha#are greater tt�an
sing�e phase.
3. "Existing in�entory" means buildings ar structures in the course of construction fhat are more than 3{?°!o camplete
prior ta the inception date of this policy.
4. "Hydrostatie testing" m�ans testing thraugh the use of water or oth�r fiuids, which are processed #hrough the
machi�ery or system being tested.
5. "Mechanical tesfing° means tesfsng of maving parts of equipment and companents, which are pari o#the buildings
or struc#ures insured, by nperation of such equipment or cr�rnponents.
6. "Model home I�aseback" means a dwetfing purch�sed from the Insured and is then leased back to the insured, by
the purchaser, to be used by the lnsured as a rnodef home untii the purehaser accup3es the dwelling as a
residence.
7. "dvsrhead" me�ns thr�se business expenses, ot�er ihan materials and iabor, incurred either directly ar indirec#fy
due to the constructian of a dwe!ling or structure.
8. "Polfutants" mean any solid. liquid, gasec�us c�r thermal irrifant ar contaminan#, incl�rding smoke, vapor, soot
fumes, acids, a(kalis, chemicals and waste.Waste inciudes materials ta be t�cycled, recanditioned ar reclaimed.
9. "Pneumatic tssting" means testing fhraugh the use of cornpressed air or other gas ta fil( test cavities which is
processed through the ma�hinery or system being teste�l.
10. "Profiit" means the difference be#ween the selling price of the land and compieted structure and your cos# af the
land and t1�e completed structure. If yau do not have a signed contract for the saie of the comp3efed structure and
land, the allowance fior"proft"will nat exeeed 2Q°lo.
11. "To#af estimated completed value" means aIl costs ass�ciated with fhe building and d�signing of the Covered
Prape�ty including labor, °overhead"and ma�erials and if€r�cluded, �prcrfit".
'[2. "Valuabie papers and records" means inscribed, printed or written dacuments, manuscripts or records, including
abstracts, books, deeds, drawings, fiims, maps or mortgages. Ho+�vever, "valuable papers and records" does not
mean�
a. Money or securities;
40471{Qd-09)
f'age 13 0#12
�ncludes copyrighted material of Insurance Services Office,lnc.,witn its permission.
b. Converted dat�;
c. Programs or instructions used in your data processing flpecation, including the materials an which the data is
recorded.
�t 3. "Waier damage" means accidental discharge or le�kage of water or steam as the direct result of the breaking
apart or cracking of any part af a sys#errt or appliance (other than a sump system including its reiated equipment
and parts}containing water or steam.
90471 ((}4-09}
Page 12 of 12
Includes copyrighted material af tnsurance Services tNfice,Inc.,wiih ifs permission.
Non-Reporting Endorsernent Z�I�.I�H
THIS ENDORSEMENT CHANGES 7HE POLICY. PLEASE READ IT CARE�U�LY.
This endorsement madifies insurance presvided under the:
BUILOERB RI�K C�VERAGE Ft3RM
S�ction E.ADDITIONA�C�NC71T1QNS is arr,�nded as foilows:
9. Paragraph e,of Additional Condifion 3.Vflhen Coverage Begins And Ends is replaced by the fol(owing:
e. Upon expirafion of the policy.
2. Additiona! Candition 4.Reporting Pr€tvisians is replaced by the fioiir�wing.
4. Repartirtg Provisions
a. The premium charged is fu11y earned and no refund is due to you when coverage ends.
b. You wiil ke�p accurate construc#ion records regartfing property we cover under#his policy. T�is includes the
`totai estimaied campieted value" of the �araperTy and a record of alf cantracts of sale dealing with the
property.
3. AdditionaE Condition 7.Coinsurance is replaeed by the fol(owing:
7. Gainsurance
If the fir►�it of insurance is less than #he "totaf estimated completed va{ue" af the property insured, you will bear a
portion of any lass.The amount we wili pay is determined by tha following s#eps�
a. Divide ihe limit of insurance by the"tota(estirnated completed value"of the Covered Property;
b. Multipfy the tata( amount ofi ihe co�ered loss, before the applicafion flf any deductible, by #he percentage
determined in paragraph a.;
c, Subtract the derluctible from the figure dsiermir�ed in paragraph b.
Example No 1.
{This exampfe assumes there is no penalty for underinsurance.}
Deductibie $1,000
Reported value $10fl,000
"Total Completed Estimated Value" $100,ppE3
Amount of loss or damage $6C1,OQ4
a. Limit o€lns�arance/Total Estimaked Corripleted Value
$'f00,QOQl$100,000= 1.003
b. Amouni of loss x percentage in A
$60,000 x�.00=$60,000
c. Deductible amount subtracted from results in B
W61S-1 (04•Q9)
Page 1 of 2
Includes eapyr�ghted maieria!ofi Insurance 5ervices C)ffice,Ina.,with i1s permission.
$60,400-$1,00{�=�59,Q(}0
Tata!amount of lass payable=�59,OOd
Example No. 2
{This example assumes there is a penalty for underinsuranc�.}
Deductible $1,000
Limit ofi Insurancs �100,00(3
"Tota}Completed Estimated Va1ue" �120,004
Amount of lass $60,404
a. Limit of Insurance/Total �strm�ted Completed ilalue
��oo,00Qr���o,aao= .ss�
b. Amount of foss x p�r��ntage in A
$60,fl00 x.833=$49,980
c. Deductibie amount subtracted firam results in B
�49.980-$1,000=$48,98C3
Tatal amount of loss payable=$48,980
A!I ather terms, conditions, pr�visions and exclusions of the poiicy remain the same.
1-iB15-1 (Q4-09}
Page 2 of 2
IncEUdes copyrighted rnaierial of lnsurance 5ervices Office,Inc.,vrifh its permissian.
Wisconsin Hydrost�tic VYater Fressure Endorsement �l.�R��H �
THIS ENDORSEMENT CHANGES THE P{JLICY. PLEASE R�AU(7'CAREFUL�Y.
This endarsement modifies insurance provid�;d urtder the:
BUILDERS RISK COVERAGE FORM
Paragraph 1,e.Water in Section B, EXCLUSIONS is rsplaced by the foilowir�g:
e. Water
�1) Flood; surface water, wave�, tides, #idal waves, over€lav�of any k�ody r�f water or tM�ir spray, all whether dri�en by
wind or not;
(2} The interior of any building or structure caused by or resuliing from rain, sno�, sfe�f, ice, sand or dust, whather
driven by wind or not, unless:
{a} The building or structure first sustains damage by a Covared Cause of Loss to its rovf or vva!(s through which
the rain, snow, sJeet, ice, sand or dust en#ers; ar
(bj The foss ar darnage is caused by or resu(ts from thawing of snow, s(set or ice vn th�building or structure.
(3} Mudslide or mudflc�w:
{4} Water that backs up or overf(ows from a sewer, drain ar sump, except as provided in the Back-Up Or t7verflow
Of Sewers,Drains t3r Sumps Additionei Coverage,
But if water, as described in e.{i}through e.{4}above, r�esults ir�fire, expiosion ar sprir�kier leakage,we wil(pay far the
loss ar damage caused by tl�at fire, explosion or sprinkier leakage.
All other terms, canditions, pra�isions an�exclusic�ns of this poiicy remain the same.
HBIS-17{04-49}
Page 1 at t
Incfudes capyrighted materi�f of insuranc�Servic�s Office,Inc.,with its permissian.
Cha�nges In Cancellation �Condi�ion �CIRICH
THlS ENDC?RSEMENT CNANGEB TH� POLiCY. PLEASE READ IT CAREFULLY.
This enriorsement modifies insurance provided under the:
BUILDERB RlSK CQV�F2AGE FC}RM
Par�grapfr 5.ir�i-�e Canc�iEation Commc,n Ro�icy Conctiti�sn is replacect by t�e fc�liowing:
5. The premium for this coverage is fuI(y earned and no refund is due when the policy is canceiled.
All nther terms, conditions, provisions and exclusior�s at the pc�ficy remain the same.
NBIS-83(04-09}
Page 1 of 1
Inctudes cc�pyriyh#ed materiai csf Insurance Services Office,Inc.with its permission.
Changes :In Valuation Cvndition ��,.����H
THiS ENOQRSEMENT CHANGES TH�POLlCY, PLEASE READ ti'CAREFULLY.
This endorsement modifies insurance provided under the:
BUILDERS RISK COVERAGE �C}�tM
T�e Vaivation Gener�l Condition ir� Cflmmereial lnfand Marir��Conaikions is repiaced by the foiiowing:
Valuation
In the event af loss or damage, the value of th�praperty will be determined as of fhe time of the lass or damage.
�E. 7he value of the property will not be more than the arnount necessary ta replace the structure or repair#he structure,
whichever is Iess, ta ihe same paint of completion that had been achieved immediately before the loss or damage.
2. lf the (oss or damage invaives building materials which h��re not been installed, the vaiue of the property wril( not be
mare than fihe amount necessary to replace the materials with liice kind and quality.
AII other terms, canditions, prouisions and exclusions of the policy remain the same.
H81S-84{04-09)
Page 1 af 1
. �
ZURICH
THIS T�;:�'UO�RSE.'4�[I:��T 15 AT'�'ACI��LE.I)Tt) ANF3 iVIAI)�'.� P�I2T€)F Yt�t)it
I'{)LIC:Y.
TN1S Fi�D(J►RSFI��EN'T Dt)ES �V()T t�I2AN'I'A�VY C,'�y'ER�{;F: �K CH�1�Y+(�F T'HE TI:I2�15
AND C'()1V'T)1TI0�'S t3I�AN1�' C()'YERAC,E t7NI)I�;:k'1'IiI1 YULICY.
DISC.I.�C�SUI�E C3F PREMIUM
{RELATII�G Tt3 DTSPtJSITi(�N tJF TRIA)
st:�1��t��'ta�,*
__� � _.....__ ____�..........._...__
(i) t're�niu�i� uttrib�rt<►b!e tca risk c�f las� ti-c�m c�;r�itied a�:ts af terrc�ris�n tlirc����l� t�l�e end c�f khe palicy �eri��c� basccl c�n ?hc
extcnsican c�f'ihe 7`errc�risn� Risf�lnsur�nce:'�ci c�f'_EH�2.�s am�arcied �y�fhe'['errrrcistn Risk [nsur�nce l�;�ten�ion ,�ct ct�'2U0�.
(`'7'Rl rl")far Iin�s s��bje�;t tc�TEZtr�aad tt��"T'errcari5m itisk lnsurance Pr«��ran3 f����uthorir,��tic�n��ct t�C2007(`I�RIPRA}:
t"1t'L,C'U�:[l
It"i�Ri:�terminates,the pc��tio►� c�t'tf�i�; pre�ni�im at�t�ibt�taE�lt tv thc r�mainin�� p�u•t c>f rl�e �lic}� �zrit7�> as tnodified hy a.ny
chan�.e slio��i�in Z� i�f tl�is Scl�eciiale,a � lies t��the risk c3#'lc�ss#�rc�m terroriwm a(ter the te�nunatioi��a�t"I'R1A.
• (2} F'remiur��ch���w���ipt�t�terrnin�ti«n c�t��I'AIr�c�r u�c,n u�s�licability�ofa C'<»lc�itit�na(I:ncic�rse�tre��t:
'�u cTttit��.:e u�t'se,ti u�i���I�tiie ftriii�c�;in�is aant��icted-
EZeri�rn I'reiniu�r�:
�ldtlitic�nal Yrc�niurn;
�I1'we nc�tif'v =o��of an adc{itir�nal ren�i��in�cl�ar��,eh�additit�nal premiurn r�°i(1 be dis�a��specif�ied ir�such nc�ti�e.
*(�iti�rm�itic�n requir�d t�,�oinpleti thi5 Schedi�le, ii'n<�i,l�od��zi ak�t�ve.�vill tre st�a�n in tl�e I7�clar��tians. ___
A. Discic�sure af Freminm i�ec�rnber �I, 2�14 un3ess eklcnded by th� t'cc3t�ra1
�c�veni n�c�_t.
(n accc�r�lance wi�la tt�e "1'K1f�� tive- are rc.yuired to
prc»�icte �o�i u�'stl� � �aotic� di�cic�sing th� porti�an c�f C'. Possibititv t�f.ldditional rtr E2etearc� �'remium
yc�ur �reiaaiuln, if any, attr+t�utah(e tc� il�e risl: c�f toss 'i'I�e prernium .irtrsbutable tc� �th� ri�k a�t' fc>ss from
�froin terrc>rist .3cts ce��titied ttadc�r that Ait t2�r [in�:s certi#ie-c1 z�ct� c�f` terraris�r� cc�ve�age is cal�:t�latc�!
sul3ject �to "I'!tl?t. "i�l�at� poriic�n <>f' yc���c �remium based on ihe coFera�e (if any} its eflect at the
attril�ut�ji�le is shois°n it� tlte Schedule «l` tliis 1�e�inning c�F yc�ur pt�lic;� for certitied acts o('
endvc�en7enE�r in the E3ccl�irati��ns. terrorism. If your �olicy 4ontai�s a £:'c�ndlticzz�al
13. I)isclosura o1'N��tlrral P�rticipati��n in �"s�ymei�i oi' � ��n�4rseinc��t. the �ter�Y�inati�n a�f'i"l2I:'� or e�ctension
7"errarisin C:asses c�f t(�e f�dex�al pre��ruin ��°i2h iertai�� n�adificatic�ns (as
explaine�3 ita that e��dorsement) m�y� �rtc�cli�fy the
Tlse i;niteci St��tes tic�vernm�:r�t, T.)��.zrtin�;t�t oF the �xtent rai'cc��-�r�t�e (i1'aray} yc�ur palicv pro��is�es for
-I'reasury> �viil pay a share Ufterr�cicm fc�sses insured tern�risn�, lf '�["RI.�1 terminates f7r tf�e C'o��dit�ic�nal
und�:a• tl�e t�dcral {�rr��*rtm. T'1�e ���iera] share ec��ials Findorsement bec�zines applicable #a 4�c�r pc�licy, the
SS°�o oi�ihnC partiizF� c�f'the ��rnc�unt of'stich ins�r�d r�:#��n� �r�miu�n {if an�•3 i�r additionat �ren�iva�t (i#'
li�ss�s ti�at cxc:cec�s tlle a��piic7hle ir�s�irer rete��tian. r���y) �hc�wn in {2} of the Sched�le wiil appl}�. If the
.Cl�e�i�t current�ly pro�-ides ft�r i�o ia�surance ii��ustrt Ee:t�ei c�r iirms c�f feder•�! p�t�ici}�atic�n cha»ae, tl�e
c�r l;niteci �tates gc�verninent participation in pret�ii�t�rt sho��n i�7 (1}c�fthe Sch�dule attrihutabEe#t7
terrorism tosse� that exceec� �10{} Gillic�r� i�� a»}� o�e tlz�tl�part o��`tl�e;pc�Iicy�peri�ad e�tctldi�3�bev��7nct such a
c�flendar year. "T�hc fi:c�er�l �ro�ra�n est�►blisl�ed by chan};e m<iy nnt be a�{�rc7priate, and x�e will nc�tiiv
the rlci is Sched��lcd to terrninale at tt�� end ��f yc�u ot any ch;ai�ges in}�c���r premiuin.
I���tude:�cc>�}°riseht�d materia!oPISi)I'ri�prrties.Inc.witi�its permis�ion. t'-Gl.;-b92-C'CFb' (��Liit;j
Cnjn�3i�ln lurich;lmeriean Ins�rrattce C'c�rta}�any'2S)13 i':�gc 1 iff 1
�
Z�.IRI+CH
CAl' t�N L�SSES FR011rI +C:ERTIFIED A�TS t)F
TE�2.RC.IRISM
)nsureds�ame Pzslic�tii�mt5c.�r i;lEective I:)�tir E:riticirsem�-nt
'vu�ntxr
TF[IS F;'tiDC?�t'ti�:;►lE':ti`T'C'F�.�ti(,`H,�1'Ol?R N(31.aCC'Ir". P1,�,151: Itf:t�l?iT C":'1iZI�;�L'l..1..1'.
'1`lais enclarsttnLnt n���difies�c��ir insurance:
CC)'49't1l�TtC"I�lt CJf�`�E:ItAI.I.,tAi31l..i"I'Y C"C3V E::R,�C3I:'.I3;1ii"I`
C'()'�t:41(:RC`I.�L.l�t..�1:�t)1�t:�Rt',vl;L'()ti[:fZ 1ti[;t'.�Et"1.
f'(�.);41;�1[:�1tC"Ir1i.,f�ttOPl':IZ'1`�"C`£7l`��[�:�(i#;-A��K'i�
(.`()'4�'��E:ItC�1r�1.,1;:�9F3}t(wl;l..r� 1..1j1I.3ti.l'1°�' C`t.)�'�:I�,1�a'F: t':�K.t
r1,. (.`a�t nn I.c��ses Frcan� C::ertitieti"Cerrorism I..osses
`.[`crtitied act c�fterrc7rism"nieans an act that is certi�fie�i b��ihe S�eretarv�.�Ptl3e 7're�st�ry. in cc�nsurrence witl�the
5ecretzr}�c�f�Stuie�ncl ti�c=�ttt>rne;�Ciei�eral E�f tl3e t;nitecl States,to b�a��ac;t t�#�€errc�rism}�ursuai�t to th�feder�l
'Tcrrc�ris�n Risk tnsurance tict{"T Itlr1"}. T'17�.'I`errc3risni Risk(��sutance Act�rc}vir�es th�t thc Secretar}�c�Cl�reasury shall
certif-t�ui�act c�fterroric�n:
1. tc�be an act«f t�rrc�ris�n;
2. ic3 be a vialent act ar an aet that is dangen�us tra human iile.praperty c�r infrastre►cture;
:,. t�.1 i�a�;e resulted in d�rnane Fvithin tlie t.>nitcc�StFit�:s,ar autsic�e trf ti�e C:��ited States in t1�s:tase c�f an air ca�rier
(<�s det�inid in sectic�t��tO l0?of"I'i�ile�9,t'��ited Stnte�£�'c�c3�j ar a l;niteti States fi�g vess�l(c�r�f vessel b�tsed
prinei��ally� in t1�e t;nited 4tales,s�ti whis:l� t.�raitc:<9 Stat:es iric«nic ia�is�tiid and�hc�se in4�France caverape is
s��Mjict to reeul�tic�n in t}�e l;nited S�<€tcsa,c�rfl�e premises afa tii�ited StaYes znissi�rr,as�c�
�. tn hauc beera c<�n�n�itted b}�an indi��id��a(c�r indivic�uats as�art nE'a��e�fl�c�rt ti�c�e�•ee the�.ivilian po}�ulatic���af
thc t.:nitec�Statey or tc�inil�►ence thi��c�licy r�r��f��,�t tl�e:conduc2 c�t�Ehe(.;nitcci.�",tat�s Gc�vernn�er7#b�coercion.
?�c��ct maV be c�r�iliet{as�tn act o�'terrt�riszai iftl�e act zs c�n�lnitted as pari c�t'thc caurse ofa��•.�r declare�t by (`ai��*ress
(except fc�r��c�rkers`ci�€npens��tian)orit'I��ssf:�resuitin��iz7�n�he act.ir�tl�� a���r��a���fe3r iu�irr<�iace s«hje;ct to'T'E2[.�,c�c>
ne�t e�ceed$�,(�0{},()t}t). _..
ti'a;gre�ate ii�sured lc��.4es attrib�stable to<�i�e ar tn�rc"cirti#ied act�c�#"terrt�ristn"eYCCed�!(}t�hilliou�n a 1'ro�:ratn Year
(Jan�iar�� 1 throu�li I3ecen�ber 3I}and�e l�ave niet aur€ns�irer dedactible under the 7'�rmrisnt Risk Tnst��•ance Aet,�+;e
shall not�e liable for el��;�a���l�ent c�(�aaz�pcsrlian aFit�e�zna«nt ofsu�h Iosse�t.hat exceeds�l{�Cl billion,and in st�c�r case
insuree�lc�ssrs up ta tl�<�t amcx�nt are��ibject Ya�rc�r�ta al)c>c�tia��in ac:ce�rciai�ce with proced��res estat�li�l�ec�by the
Secret��ry��f�"I"rc�7sury.
13. Apxfii�afion af(J�ther I�:xclusi�as
"I`he Eertns �nd li�nitutic�ns �f a terrc�ri�m exeit�siara ot �n� ather ex�l��si«n, �7r tl�e ii�applic-al�€lity c�r omissic�E� v'f't�
terroE�is�n exc�lusi�n c�r any other exclusi�n.dc�t1c���serz�c ta cr�at�cz>ver���*e which wc�ulci f�thitwise E�e exclucied, liniite�i
or restricted in3der Ciai�;pt�lizy. �
{:'c�pyri�?ht a^�{)t}K:luncl�.1mc�ric����Inst�ra;ic:-C{�mpauy� L€-Cil'-'7{,?-A C'14� (01'�8)
I�icft�cles ce>p}�righteei matcri�i ot'ti���aanec=tie-rcices(1l9ice,ls�c.,witli its permissii�n. Ptire 1 raf 1
IL 00 03 09 Q8
TH1S ENdt3RSEMENT CHANGES THE PCfLICY. PLEASE READ 1T CAREFU�LY.
�ALCULAT��N OF PREMIUIV�
This endorsement modifiies insuranc�pravided und�r the following:
GAPITAL ASSETS PRtaGRAM�OUTPUT POLICY}CC7VERAGE PART
COMMERCIAL AUTOMC}BILE GflVERAGE PAR7
C�MMERCIAL GENERAL LlABILITY CC7VERAGE PART
COMMERCIAL INLAND MARINE COVERAGE PART
CC}MMERCIAL PROFERTY COVERAGE PART
CRIME AND FIDELiTY C{�VERAGE PART
EMPLUYMENT-REl�ATED PRAGTl�ES LlAB1�17Y CQVERAGE PART
EQUIPMENT BREAKD�WN CC?VERAGE t'ART
FARM CQVERAGE PART
LIQlJOR L1ABfLlTY CUVERAGE RI�RT
M�DICAL PR4FESSIt�NAL LfABILITY CflVERAGE PART
OWNERS A�1D CQNTRACTC)�2S PFt{7TECTiV�LIABILITY Cfl1lERAG� PART
RC?LLUTION LIABlLII'Y Ct3VEF2AGE PART
PRfJDUCTSIC4Mf'LETED QP�RATIONS LIAE3lL(1'Y CQVERAGE PAf�T
RAILR�Ia� PROTECiIVE L1ASiLITY COVERA�E PAR7
The fo(lawing is added:
The premium shawn in the l7eciarations was com-
puted based on rates in etfect at the time the policy
was issued. (an each renewal, continuation, or anni-
versary ofi the eff�ctive date nf this poiicy, we wi11
compute the premium in accordance with our rates
ant! rules khen in effect.
1L 00 03 09 Q8 U ISO Praperties, Inc.,2007 Page 1 of 1
Waiters KiEawer Pinanr,ial Services�Unifartn Forms"''
COMMERCIAL 11VLAN0 MARINE
CM 00 Q1 09�4
Ct�MMERCIA� INLAND MARINE CUNDITIC}NS
7he following condi#ions appfy in addition to the 6. As often as may be reasanably required,
Comman Paticy C�nditions and appiicable Aciditic�nal permit us tc� inspect tt�e praperty proving the
Conditions in Commercial Inland Marine Cvverage loss or�famage and examine your books and
Forms: r�cords.
L�SS COMdtTIaNS Also permi# us to take samples of dameged
A. Abandanment and undamaged property for inspectian, test-
ing anr! analysis, and permit us to make cop-
There can b� no�bandonrrient of any prop�rty fo ies#ram yaur books and recards.
us.
7. We may examine any insured under oath,
B. Appraisa! �vhile not in the presence af any other insured
if we and you disagree on the value o#the pr�p- and ai such times as may be reasonably re-
erty or the amount of loss, either may mak� writ- quired,about any matter reiating to this insur-
ten demand for an appraisal of the loss. fn fhis ance t�r the claim, including an insured's
even#, each perty wil# select a competen#and im- books and records. In the e�enf af an exami-
partial appraiser. The two appraisers wil! select nation, an insured's answers must#�e signed.
an umpire. tf they cannoi agree, eittser may re- 8. Send us a signed, sworn proof of Eoss con-
quest that seiection be made by a judge of a couri taining the information we request to setile
having jurisdiction. The appraisers will state sepa- ��� �1���. yq� ���� do this within 6U days
rais(y the value af t�e property and amaunt af after our request. We will supp[Y You with #h�
loss. ifi they faii to agree, thsy will submit their nacessary forms.
differences to ihe umpire.A decision agreec!to by
any two will be binding. Each party will: 9. immsdiateiy send us copies of ar�y demands,
notices, summonses or legal papers received
1. Fay its chosen appraiser;and in cnnnectian with the claim ar suit.
2. 8ear the ather expenses of the appraisal and �{�. �r��p�rate with us in the investigatic�n ar set-
umpire equa)ly. tlement of the clairt�.
!f there is an appraisal, uve will still retain our right �. lnsurance 1Jnder Two tJr More Caverages
#o deny#he claim. If tv�rs or more of this policy's coverages apply to
C. Duties In The E�rent Of Loss the same koss ar damage, we will nat pay more
You must see that the folfo�ving are done in the than t�e actual amounE of the loss or damage.
event of fioss or damage tc��overed Property: E. Lnss Fayrnent
1. Notify the police if a law may have been bra- j. Wa wii{ give ns�tice of our intentions within 30
ken. days after�n+e receive the sworn proof o#loss.
2. Give u� prompt notice of the loss or dama�e. �, We will not pay you more than your financiai
lnelude a descripiion of the property involved. inier�st in the Covered Property.
3. As soon as passible, giue us a descrip#ion of 3. We m�y adjust losses with the owners af lost
how, when and where the loss or damage oc- or damaged property if t�#her ihan yau. If we
cur�-ed. pay the owners; such payments will satisfy
4. Take all reasanable steps io protect the Cov- your cEaim against us for the owners' prop-
ered Property from further damage, and keep erty. Vtle wifl no# pay the owners more than
a record of your expenses necessary #a pro- Yhsir financial interest in the Cavered Prop-
tect the Covered Propsrty, far consideration erty:
in the settlemeni of the claim. This wiil nat in- q. �� �ay el�ct to defend you against suits
crease the Lirr�it +�t lnsuranee. However, we arising frarrr ctaims o#owners of property. We
will not pay for any subsequent loss ar clam- wiil do this at our expense.
ege resuliing from a cause of ioss that is nat
a Covered Cause of Los�. Also, if feasib(e. S, We will pay for�overed loss or darr�age wi#hin
set the demaged property aside and in the 30 days after we receive the swt�rn praaf of
best possible order far examina#ion. ioss if yt�u have complied with aJl the terms of
this Goverage Part and:
5. You wili noi, except at yaur own cost, volun- �. We have reached a reement with au
tariiy make a payment, assume any abiig�- the amoun#of the Eoss; ar Y on
#ion, or incur any expense without our can-
sent. b. An appraisal award has been made.
CM Ot�01 09 04 Gopyright, lSC7 PresperTies, Inc., 2003 Page 1 of 3
UNIFORM
� S. We will not be liabie for any part af a Ioss that must cfo nothing after lass to impair them. But you
has been paid or made good by others. may waive yaur righ#s againsf another party in
F. {Jther Insurance wri#ing.
1. You may have o#her insurance subject to the '1. Prior to a lr�ss to ynur Covered Property.
same plan, terms, conditians and provisions 2. After a loss fo yc�ur Covered Property only if,
as th€; insurance under this Cov�rage Part. If at time o#lvss, that party is one of the follow-
you da, +ue wili pay our share of the covered ing:
lass ar darnage. Qur share is the propcsrtion a. 5omeane insu�-ed by this insurance: or
that the appficable Limit of Insurance under
this Coverage Part bears fo the Limits ofi In- b• A business firm:
surance of ali in�urance covering on the {�t} QwnerJ or controiled by you; or
same basis. {2) 7hat owns vr con#ro(s you.
2. 1f there is other insur�nce cavering the same This wifi not restrici your insurance.
loss ar damag�, other than that des��ibed in
1, abave, we wiil pay anly for the amouni of GENERAL COCdL3lTt4NS
covered ioss or damage in excess of the A, Cflncealment,lUlisrepresentation C3r Fraud
amount due fram tnat other insurance. This Coverage Part i� void in any ease af fraud,
whether you can colEs�f an it ar not. B�t we
will not pay mc�re than the applicable Limit of �����tiona! conceaiment or misrepresenta#ion c�f a
lnsurance. material fact, by you c�r any other insured, at any
#ime, cc�ncerning.
G. Pair,Sets�r Parts 1. This Caverags Part;
1. Fair Or Set 2. The Covered Property;
in case of loss or damage to any part of a p�ir 3. Your interest in the Covered Pr� ert nr
or set we may: P Y�
a. Repair o� r�piace any part ia restore the 4. A ciaim under this Coverage Part.
pair or set tc i:s v�1�e befo,� ih� loss o� S. Contro!C}f Property
darnage; or Any act or neglect af any person other #han yau
b. Pay the difference between the value of beyond yaur dir�:ction or control will not affect this
#he pair or set before and after#he loss vr insurance.
damage. The breach of any cvndition c�f this Coverage Part
2. Parts at any one nr more lacatic�ns wifl not afFect cover-
In case af bss or damage ta any part of Cov- age ai any iocatit�n whe�e, at #he time of (oss c�r
ered Property consis#ing of s�veral parts darr�ag�, the brea�h of conditian does not exisi.
when complete, we wil! only pay for the value C. Legai Action Against Us
of the lost or damaged part. �� ��� ��y�«�� � i�gal action ac�ainst us under
H. Recovered Property this Couerage Part un(ess:
!f eiiher you or we recover any prt�perty after loss '1. There has been full compliance with alf th�
settlernenf, that party must give the other �rc�mpt terms of this Coverage Part;and
notice. At your option, the property will be re- �. The action is broughf within 2 years after yau
turned to you. You must th�n r�tUrrt to u5 the first have knowledge of the direci loss or
amcrunt we paid to yo�� for the prop�rty. We will damage.
pay recovery expenses and#he expenses to re- D. No Ber�efit To Bailee
pair#he recovered proper#y, subject to ihe l.imi#of
Insurance. No person or organizativn, other than you, having
I. Reinstatement Of Limit After Loss custody af Covered Property wiil benefit from this
The Limit of Insurance wifl not be reduced by the insurance.
payment of any claim, except for tatal loss or E. Pgticy Period,Coverage Territary
damage of a scheduled item, EI� WIliCI1 �Y811t W� We cov�r loss or damage commencing:
wiQ refiund fhe unearned premium an that i#em. 1. Quring fhe policy period shown in the Decla-
J. Transfer Of Rights Of Recnvery Agair��t Ctth- rations;and
ers To Us 2. Within the cc�verage#erritory.
If any persan or organization to or for whom w� �, Valuatian
rr►ake payment under this Couerage Part has
rights to recover damages frc,m anott�er, thos� The value of praperty will be the least of th� fol-
rights are iransferred to us to the extent of our I���►�9�����ts:
payment. That persan or organization must do �1. The actua!cash value of that property;
everything necessary to secure our righfs and
Page 2 af 3 Capyright, ISD Properkies. Inc., 20�3 CM 00 01 09 04
' 2. The cost of reasonabiy restoring that property In the event pf Ivss or damage, the value af prop-
#a its condition immediately befors fc�ss ar �rty wil( be tietermined as of the time af lass or
damage;or ���ag�_
3. The cost c�fi replacing that prope�ty with sub-
stanfialiy identicai property.
CM 00�1 09 04 Cc�pyright, I54 Proparties, inc.,2003 Page 3 of 3
COMMERCMAL iNLAND MARlNE
CM 01 05 01 01
THIS ENDQRSEMENT CHANGES THE PC)�ICY. PLEASE READ 1T CAREFU�LY.
WISCt�NS1N �NANGES
This endorsement madifies insurance provided under the fiollowing:
CC}MMERCIAL INLANt3 MARINE GC?VERAGE Pl�RT
A. The following exclusion is adrled. 2. No failure of a condition before a loss and
1, We will not pay far loss Qr damage arising out no breach af a promissory warranty
aF any act commit#ed: affects our abligatian under this Coverage
�a�t ur4fes� such failure or breach exists
a. By or a#the direction af any insured; and at#h�time of loss and either:
b. With the intent ta cause a loss. a, Increases tt�e risk at the time of loss;
2. However, this exclusi�n will nat apply to deny or
coverage to an insured whc� did not coaperate b. Cantributes to the loss.
in or contri�ute t� ihe creatior� af the lc�ss,
provided th� loss is ntherwise covered under �. General Condition C. Legal Action Against Us is
this Gnv�rage Parfi and: replaced by the follcsw[ng:
a. The Eoss aross out o€an act or pattern of C. Legal Action Against Us
abuss ar dornestic abuse; and No one may bring iegai action against us un-
b, The perpetrator of the loss is criminaCly ���" ���s Caveraga Part uniess the a�ti�n is
prosecuted for th�act or acts causing the ��'�W9�t within 2 years after you fiirst have
Eoss. knowledge af the direct loss or damage.
3. [f we pay a c(aim pursuant to Paragraph A.2., D. The fallowing is added to �oss Condition J.
our payment to the innocent insured is limited Trat�sfer t�f Righfis Of Recovery Against Others
to that insured`s ownership interest in the �� �s in the Commercial ln(and Marine Con-
property less any payments we first made to a �titions:
mortgagee or ather parry with a lega! secured J. 1"ransfer Of R�ghfs Of Recavery Against
interest in the property. In na event w11 we pay Others To Us
more than fhe�imit of lnsura�ce. �{ �� p�y an insured for a loss described in
B. General Condition A. Concealment, Mis�epre- Paragraph A,2., the rights of the insured to
sentafiion Or Fraud in the Gommercial Inland recover damages fram the perpeiratar are
Marine Canditians is replaced by the fallawing: transfer�ed to us to#he extent of our payment.
A. Concealrr�ent, Misrepres�n#ation Or Fraud Foliowing khe loss, #he insuretf rrtay not w�ive
such rights to recover against the perpetrator.
i. No misrepresenfation and no breach of
affirmative warranty rr�ade by you or on �� '�'��� �� ����tled to any recoVery only after
your behalf in the negotiation for or pro- you have been fully corr�pensated far dam-
curement af this Covarage Pa�t affects ���s.
our obligafions unless, if a misrepresen- �. The fol(owing are add�d to the Genaral Gondi#ions
tation, the persan knew or shauld have in the Cnmmerciai lnland Marine Conditions:
known khat the representation was false, �. Knouvtedge And Acts Qf Agents
and unlsss:
a. If any of aur agents knaws any facf fhat
a. W� rely an the misrepresentation ar breaches a conditian �f this policy, we wi11
a�rmative warraniy and the misrep- be considered to know it alsa if that fact:
resentation or affirrt�ative warranty is
�ither rriaterial or made with inter�t to {1} is known to the agent at the time the
deceive; or policy is issued or an application
b. The Facts misrepresented or falsely rnade, or
warranted con#ribu#e to ihe loss.
CM Q1 U5 01 01 Gopyright, Insurance Services C?ffice, Inc.,2000 Page 4 of 2
{2} Later beeomes known to the agent in 3. Confarmity To Sfatute Or Rule
the caurs� of his ar her deaEings as Any provisinn a€this Cavsrage Part(including
an ag�:nt with you. endorsements which modify the Coverage
b. Any fact thst breaehes a conditian af this PaR} that is in confil�ct with a Wisconsin
policy and is knrswn ta the agent before statute or rule is hereby amended to canform
thB�C?55 WI�1 11Q�: tQ#�1,��S��IUt6 Of�'Ll��.
�9) Void this poficy;or The terrn rule means a vaiid ruie promulgated
�2j Prevent a recovery in the event of by the Cflrr�missioner of insurance in
iass. accordance with the rule-making authority
confierred under Wis. Stat. An�. Seckion
2. Bankruptcy 227.11(2) and publisheti in the Wiscansin
If you or ya�r estate go bankrupt or becnrne Administrative Code.
insolvent, w� wil( continue to fulfill our duties �
and ob(igations under this Goverage Fart.
Page 2 af 2 CoPY�9�t, Insurance Services Office, Inc..2000 C�I 01 05 01 01
IL tt2 83 09 07
THIS ENDORSEMENT GHANGES THE POL.tCY, PLEASE READ IT CAREFU�LY.
WISCO►NSlN �HANGES -- CANCFLLATIt�tV
ANQ N4NRENEW�►1.
This endorsem�nt modifies insurance pravided under the fallowing:
CAPITAL ASSETS PRQGRAM{OUTPUT POLICY}CQVERAGE PART
C{�MMERCIAL AUT�MOBILE COVERAGE PART
C{?MMERC#AL GENERAL UABILITY COV�RAGE PART
CUMMERCIAL INLANO MARINE Ci�VERAGE PART
COMMERCIAL�IABI�tTY UMBRELLA CflVERAGE PART
C(?MMERCIAL PROPERTY COVERAGE PART
CR1ME ANC3 FIDELITY CQVERAGE PART
EMPLC}YMEN7-RELATE€3 PRACTiCES Lf1�B1L1TY COVERAGE PART
EQUiFMENT BREAKDOWN CUVERAGE PART
FAR(vt CUVERAGE PARI'
FARH�I UMBRE�LA LIABILlTY P�LICY
LIQUtJR LiABILITY�C}VERAGE PART
P4LLUTIC?tJ �IABILI7'Y COVERAGE PART
PRQQUCTSiC�MPLETEC3 QPER�iT1QN5 LIABlL1TY CC7VERAGE PART
A. Paragraph 2, of the Cancellation Cnmmar� Poiicy 7. Anniversary Cancella�ion
Cunciitic�r�is r�placed by the foCiowing: If this policy is wri#Yen fnr a term of mare#han
2. We may cancel this palicy by mailing or deliv- ane year or has no fixed expiraiion date, we
ering to the first Named Insured written notice may cancet this policy for any reason by mail-
of cancellation at least 10 days before the ef- ing or delivering to the first Narned #nsured
fective dafe of cancellaiion. written ngtice of cancellation at least 64 days
If this palicy has been in effect for less than before the anniversary date of the policy.
60 days and is not a renewal policy, we may ����► �ancel]ation wi11 be effeekive on the pal-
cance!for any re�son. icy's anniversary date.
Jf this poiicy has been in effect for 6i7 days or We may cancel this policy because af the
more or is a r�:newaE of a policy we issued, termination of an insurance marketing inter-
except as provided in Paragraph 7. b�low, we mediary's co�tract with us anly if the notice of
may cancel this policy only far one or mare of cancellakion conEains an offer#o continue the
the follawing reasons: policy with us if w� receive a written request
from the first Nameci Insured prior ic� the date
a. The policy was obtained by maferial mis- of Gancella#ion.
repres�ntati�n;
C. The foilowing applies tr�the:
b. There t�as beer� a substantial change in C�pit�f Assets Program {Output Policy} CoverBge
the risk we originally assurned, except to �,a�
the exient that we should have foreseen �Q���rcial Inland Marine Covera s Part
the change c�r cansidered tt�e risk in writ- �
ing the policy; Commercial Property Coverage Park
c. There have been substantial breaches of Grime And Fidefity Coverage Part
co�trecival duties, conditions or warran- Equipment Breakciowr�Coverage P�rt
ties; or Farm Coverage Part
d. Nonpayment of premium. �i. We may rescind this pc�licy because of the fol-
!f this policy has heen in effect for 60 days or lowing:
more or is a renewa( af a policy we issued, a. Misrepresentation made by you or on
the �otice ofi cancellatiQn wiil state the reason yaur behaEfi in the negotiation #ar or pro-
for cancellaiion. curement of this Coverage Par#, if the
B, The �ollowing is added to the Gan�ellation Com- person knew or should have known that
mon Policy Condition: ihe reprssentatian was false;
IL 02 83 09 07 Copyright, 154 Properties,lnc., 2006 Fage 1 of 3
Wolie�Kluwer Financial Services�Uniform Forms'"'
' b, B�each of affirmative warranty made by this policy wi11 termina#e on the policy ex-
yvu or on yaur behatf in the negotiaiian piratian ar anniversary date,if we have:
for or pracuremeni of this Caverage Part; {�ij Given you wriiten notice of the re-
c. Failure of� condition before a lass iF such newaf or continuatio� premium not
faiiure exists at the time of loss;ar more ihan 75 days nor less than 10
d, Breach of a promissc�ry warranty if such days prior to the due date af the pre-
breach exists at ihe time ofi loss. mium;and
2. We may not res�ind this policy: (2} Stated cleariy in the notfce the effect
of nonpayment af premium by the
a. �or#he reast�ns in Paragraphs C.1.a. and due date.
C.1.b,unless:
2. Anniversary AI#eration
{1j We rely on th� misrepr�sentation or
affirmative warranty and the rrrisrep- 1f this pr�licy is written for a term of mora than
resentation or affirmafive warranty is on� year or has no €ix�d exp�ratic�n date, we
either materia) or r,-�ade wiih in#ent to ��Y�1tier the terms or prerr�iums o€thfs poiicy
deceive;or bY mailing or delivering written notice of Eess
favorabie #srms c�r premiums to the first
�2) Tns facts misrepresented or falsely (y���� E��ured's last mailing address known
warranted contribu#e to fhe loss. ta us. We will mail, by first class mai1, or de-
b. For the reasons in Par�graph� G.1.c. and iiver�this notice �t (east 6tl d�ys prior to the
C.1.d.unless such faiiure or breach: anniversary date.
(9) Increases the ris}c at the time of loss; If we notify the !irst Named Ins�red within 60
or days prior to the anniversary da#e, the new
(2} Contributes fa th�Ioss. terms or premiums will not take efiect untii 60
ciays after the notice was maifed or deiivered.
3. If we eiect to rescind this palicy, we will notify The no#Ice wiEi include a staternent of ihe first
the first Named fnsured of our intentinn within Named lnsured's right #o cancel. The first
6G� �ays af:er acquirn� knc���ledge cf suf�i_ i�ameci ir�sureo may eiect to cancei tne po(icy
cient facts to constitute grounds far rescis- ai any time during the 60-day period, in ac-
sion. cordance with Paragraph i. oP the Canceila-
d. The following are added and supersede any vth�r tian Gommon Pc�ficy Condition. lf the first
provisians to the contrary. Namer� insu�ed el�cts to cancel the paficy
1. Nonrenewal during ths 6{�-ctay peric�d, returri premiums or
additiona! premium charges will be caleulated
a. (f we elect not to renew this poiicy we wil! praportic�nately an t�e �asis of t�e ald premi-
mail or deliver written notice of nonre- urr►s.
newa( to the first Named Insured's lasf 3. Renee+val With Altered Terms
mailing address known to us. We cnay
eiect not tc� renew fr�r any reason; the no- If we elecC ka renew#his policy but on less fa-
tice will state tha reasc�n far nanrenewal. vr�rable terrr�s or at higher premiurns, we will
W� will nnail or deliver tt�e notice a# least mail or deliver written notice of'the new terrr�s
60 days before th�; expiration date nf this or pr�rn'tucns to the first Named Insured's last
pol�cy. rnailing address known to us, We will mail, by
We need not mail or deiiver ihe natice if: first class mail, or deliver this nntice at least
60 days priorto the renewa!date.
('1} You have insured eEsewhere; �p�,y� ���ify the frst Named Insured within 60
{2j You have accepied replacement cov- days prior to the renewal date, the new terms
���9�; or premiums wi)! nat take effeet unti! 60 days
(3j You haus requested or agreed ta after the notice was mailed or delivered. The
nanrenewal af this policy, or notice wiit include a statemer�t of the first
Named Insured's right to cancel. The first
{4j This policy is expr�ssly designated as �y���� Ensured may slect to cancel the re-
nonrenewable. ne,i,ra{ policy at any time during the� 60-day
b. We may refuse to renew this policy be- period, in accardance with Paragraph 1, of
caus�e of the terminatian o# an i�surance the Gancellation Common Policy Conditian. if
marketing intermediary's contract with us the firs� Named Insured elects to cancel the
only if the r�atice ofi nonrenewal cantains renewa# policy during the 60-day periorf, re-
an offer to renew the paiicy with us if we turn premiurrrs or at3ditiona} premium charges
receive a written raquest f�om the first wiil be calculated proportionately on the basis
Named lnsured prior to the renewal date. of the oId premiurrrs.
c. )f you fai! to pay the renewa! r�r continua-
iion premium by the premium due date,
Page 2 of 3 Copyright, tSC►Properties;lnc., 2QQfi IL 02 83 09 07
� We need nat mail ar deliver this notice if#he the units of exposure, or increased palicy
only change adverse to yau is a prernium in- coverage.
crease that: E. Special Pro��sion — Canceilation And Nonr�-
a. Is less than 25% and is generaliy appli- newat
cabic to khe class of business #fl which ���� respect ta insurance provided under the
this poiicy belongs; or Cornrr�ercia! Autor�vbile Goverage Part, we wilf
b. Results from a change based an your ac- not cancel ar refuse ta renew Liability Coverage
tion that alters the nature or extent of the wholly ar partiafiy because o#age, sex, residence,
risk insured against, including but not lim- rac�, calor, creed, religion, natianal origin, ances-
ited ta a change in the classification or try, marital status ar occupation of anyone who is
an insured.
IL OZ 83 09 07 Copyright, !SO Properties, inc., 20D6 Page 3 ot 3
con�nnor� Po��cYC�rv��T�aNs
All Coverage Parts inciuded in#his policy are subject to the foilowing conditions.
A. Canceliation D. (nspecfiarts And Surveys
1. The firsi Nam�:d insured shc�wn in the�eciara- 1. W�have th�right to:
tions may cance!this policy by maifir�g c�r deliv- a. Make inspectic�nsand surveysat any fime;
ering to us advance writien notice af cancella-
tion. b. Give you reports on the candiiions we find;
2. We may cancei this policy by mailing or deliv- ���
ering fo the fir�t Named lnsured written notice c. Recammend changes.
of cancella#ion at least: �. We are not abliga"teti to make any inspections,
a. 10 days befare the e�fective date of cancel- surveys,repc�rts or recommendations and any
iation if we cancel fc�r nc�n�ayment af pre- suct� acfic�ns we do €rndertake rela#e only to
mium;or insurabiiity and the premiums to be charged.
b. 30 days before the effecfiue date of cancel- We do not make safety inspectians.We do not
lation if�+e cance!for any other reasan, undertake#o p�rFt�rm the duty�f any person or
organization to provide forthe hea(th c�r safety
3. We wi!! mai! or deliuer our natice to the#irst ofwor4cersorthepublic.Andwedonotwarrant
Name�i ]nsureci's last meiling address known that c�nditions:
to us.
4. Notice of cancellation wil! siate the effective a. Are safe ar healthful;or
dake of cancellation.The policy perit�d wiii end }�. CQmply with {aws, regu(ations, codes or
on that date. standards.
5. !f this palicy is caneefled,we will send the first �. paragraphs'i.and 2.ofthis conditian apply not
Named Insured any prerr�ium refund due.ifwe c�nly to us,but aiso to any rating,advisory,raie
cancel> ihe refund wi11 be pro rata. !f fhe first S���ceorsimilarorganizationwhichrrtakesin-
Nams�lnsured cancets,the refun�m�y be less surance inspec#ivns, surveys, reparts or rec-
than pro rata.The cancellation wif!be effec#ive ammendations.
even if we ha�e not made or offier�d a refund.
6, If notice is rraailed,proof af mailing wil�be suffi- 4. Paragraph 2,afthis conditian does notapply to
any inspectic�ns,sunreys,reportsorrecommen-
cient proaf of notice, d���r���yy�;��y�-,ake relative to certification,
B. Ghanges under stat�e or municipal statutes,ardinances
or regcriations, of bc�ilers, pressure vessels or
This poliey conta'sns atl the agreements betw��n elev�tors.
you and us car�cerning ihe insurance affo�ded.The
first Named Insured shown in the Declaratians is E• �'t��JUrr�s
authorized to make changes in the terms of#E�is Thefirst Namett Insured shown in#he Qeclarations:
policy with our consent.This po(icy's terms can be
amended orwaived only by endorsement 9ssued by 1. Is r�spo�sible for the paymeni of al#premiums;
us anri made a part of this policy. and
C. Examination{�f Yaur Books And Recc�rds 2. VtiTrl1 be the payse for any return premiums we
We may examine and audrt your books anc! pay'
records as#�ey relate to this palicy at any time dur-
ing the policy�eriod and up#o three years afterward.
Page 1 of 2
IL OQ 1711 98 cQaY���x,s ��,_�=�,�s�:�Cpgcn:w�.,�G,,s�,�
F. TransferClfYaurRightsAndE3utiesUnd�rThis ffyoudie,yourrightsanddu#ieswiilbetransferred
policy to your legal representative bui oniy while acfiing
Your righ#s and duties under this policy may no#be within the scope of duties as yo�r legal represen-
transfer�edwithoutaurwrittencansentexceptinthe tative.Untityourlegalrepresentativeisappointed,
case of death of an individuai named insured. anyone hauing proper temparary custody af your
propertywill haveyourrightsanddutiesbutonlywith
respec#ta that property.
Page 2 of 2
IL 001711 98 Ca{;y!i�nt.��szsrasiceSzrv:cusCtfic� ln,:.1�8
� Bond No. 106099382
Executed in Three Copies
PERFORMANCE BOND
KNOW ALL MEN BY THESE PRESENTS, that Vinton Construction Company
, CONTRACTOR, as principal, and
TRAVELERS CASUALTY AND SURETY
COMPANY OF AMERICA ,as surety, are held and firmiy
bound unto the CITY OF OSHKOSH, WISCONSIN, OWNER, in the sum of
One Hundred Ninety-Eight Thousand One Hundred Forty-Nine & 37/100s(D011al'S)
($ 198,149.37 ) to be paid to the OWNER for which
payment well and truly to be made we jointly and severaily bind ourselves, our heirs,
executors, administratars, and assigns firmly to these presents.
THE CONDITIONS OF THE ABOVE OBLIGATIONS are such that
The term of the Performance Bond shall extend for a period of two (2)
years after the project is Completed and Accepted as Final.
WHEREAS, the said Vinton Construction Companydid, Otl the 12th day Of
November , 20 14 , by articles that date, enter into a Contract with the
OWN ER for the
Marion Road Storm Sewer Outfall - Public Works Contract No.
14-17 in Oshkosh, Wisconsin
NOW, THEREFORE, if the said CONTRACTOR shall save and hold harmless the said
OWNER from all public liability and damages of every description in connection
therewith, shall well and faithfully in all things fulfill the said Contract, according to all the
conditions and stipulations therein contained, in all respects, and shall save and hold
harmless the said OWNER from and against all liens and claims of every description in
connection therewith, including payment for all materials, labor and equipment, then this
obligation shall be void and of no effect, but otherwise, it sha{I remain in full force and
virtue, and in the event that the said OWNER shall extend the time for completion of the
work or otherwise modify elements of the Contract in accordance with provisions
thereof, such extensians of time or modifications of the Contract shall not in any way
release the sureties of this bond.
Page 1 of 2
, . ,
WITNESS OUR HANDS AND SEALS this 17t�iay of November 20 14
In the Presence of:
��O�.e..o VINTON CONSTRUCTION COMPANY (SEAL�
�
Principa
� �..�� TRAVELERS CASUALTY AND SURE $� ANY pg AMERICA
� �:,���111111111111111/////
, � , �����/
` . 7/�>i',...i� � � �'�.i.._-''� I�i+t �i..�i'G�iLtlt, (SE�� �O••""•••ly ////�/
�
- �"��. ••.� i
� urety ; %
�
Joseph L. Vigna,. Attorney-In- �HARTFORD,�'�t�
- t
= CONN �`-
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. � ,
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Page 2 of 2
WARNING:THIS POWER OF ATT'ORNEY IS INVALID WITHOUT THE RED BORDER
� ,�, POWER OF ATTORNEY
TRAVELERSJ Farmington Casualty Company St.Paul Mercury Insurance Company
Fidelity and Guaranty Insurance Company TYavelers Casualty and Surety Company
Fidelity and Guaranty Insurance Underwriters,Inc. 1Yavelers Casualty and Surety Company of America
St.Paul Fire and Marine Insurance Company United States Fidelity and Guaranty Company
St.Paul Guardian Insurance Company
Attorney-In Fact No. 219817 �ert�f�ate No. 0 0 6 0 5 3 6 6 7
KNOW ALL MEN BY THESE PRESENTS: That Farmington Casualty Company, St. Paul Fire and Marine Insurance Company, St. Paul Guardian Insurance
Company, St. Paul Mercury Insurance Company,Travelers Casualty and Surety Company,Travelers Casualty and Surety Company of America,and United States
Fideliry and Guaranty Company aze corporations duly organized under the laws of the State of Connecticut, that Fideliry and Guaranty Insurance Company is a
corporatiou duly organized under the laws of the State of Iowa,and that Fidelity and Guaranty Insurance Underwriters,Iuc.,is a corporation duly organized under the
laws of the State of Wisconsin(herein collectively called the"Companies"),and that the Companies do hereby make,constitute and appoint
Elizabeth M.Fedyn,Joseph L.Vigna,Dennis M.Barton,Daniel G.Johnson,and Michael T.Burg
of the Ciry of Bio0�01d ,State of W�SCOnSIn ,their true and lawfal Attorney(s)-in-Fact,
each in their separate capacity if more than one is named above,to sign,execute,seal and acknowledge any and all bonds,recognizances,conditioual undertakings and
other writings obligatory in the nature thereof on behalf of the Companies in their business of guaranteeing the fidelity of persons,guaranteeing the performance of
contracts and executing or guaranteeing bonds and undertakings required or pernutted in any actions or proceedings allowed by law.
9th
IN WITNESS WHEREOF,the Comp��i��have caused this instrument to be signed and their corporate seals to be hereto affixed,this
day of September
Farmington Casualty Company St.Paul Mercury Insurance Company
Fidelity and Guaranty Insurance Company 'Iravelers Casualty and Surety Company
Fidelity and Guaranty Insurance Underwriters,Inc. 1Yavelers Casualty and Surety Company of America
St.Paul Fire and Marine Insurance Company United States Fidelity and Guaranty Company
St.Paul Guardian Insurance Company
C�SU,�� �� ��F 0.E 6� �*��SG ..++�•MSw•A e'k JP�tY ANpm lN6EYqRy �Y�
O?Oi'FOqIr�"4 4o Jr �4 O: .,9 J?'.........,.9,�,.i 9 L C�
.{� y�y�,��� � � e: �s o;' � g�Y '� �4
5 �o f1 � •"^nruV1�Q 4 yT� j CpPPryR�>t;.m �?.��FPORATf.�i�z 9� di ��'�OIN
1 9 8 2 0 '�9T/ �^i : -E; .�e i MAaTFOaD, < H�RTF'OR0.�
g��.S'y � 1951 3.�'� ��.SEAGioI ��'t.SBAL:;'; � COrIN. o �\�\ B ,��n 1896 �
� 11� `GO� i.. " 6�' � b ar "4
y�,y- F�� b4�1.S�Fi�m`,w� � 'ra i �i,o�.��..., a" , �r
�a,�,n,: als.,;.,",� `+:.s. ...ra b1 �„ +�'� �3y AfN�
..,.'
State of Con�ecticut By:
City of Hartford ss. Robert L.Raney, enior Vice President
9th September 2014
On this the day of , ,before me personally appeared Robert L.Raney,who acknowledged himself to
be the Senior Vice President of Farmington Casualty Company, Fidelity and Guaranty Insurance Company,Fidelity and Guaranty Insurance Underwriters,Inc.,St.Paul
Fire and Marine Insurance Company,St.Paul Guardian Insurance Company,St.Paul Mercury Insurance Company,Travelers Casualty and Surety Company,Travelers
Casualty and Surety Company of America,and United States Fideliry and Guazanty Company,and that he,as such,being authorized so to do,executed the foregoing
instrument for the purposes therein contained by signing on behalf of the corporations by himself as a duly authorized officer.
p.TEf �
In Witness Whereof,I hereuoto set my hand and official seal. '� �� �W wr l� • V��n�'�^^��1
My Commission expires the 30th day of June,2016. �p�`�G * Marie C.Tetreault,Notary Pablic
��
58440-8-12 Printed in U.S.A.
WARNING:THIS POWER OF ATTORNEY IS INVALID WITHOUT THE RED BORDER
WARNING:THIS POWER OF ATTORNEY IS INVALID WITHOUTTHE RED BORDER
. , , �,
This Power of Attorney is granted under and by the authoriry of the following resolutions adopted by the Boards of Directors of Farmington Casualty Company,Fidelity w
and Guaranry Insurance Company,Fidelity and Guaranty Insurance Underwriters,Inc., St. Paul Fire and Marine Insurance Company,St.Paul Guardian Insurance
Company,St. Paul Mercury Insurance Company,Travelers Casualry and Surety Company,Travelers Casualty and Surety Company of America,and United States
Fidelity and Guaranty Company,which resolutions are now in full force and effect,readi�g as follows:
RESOLVED,that the Chairman,the President,any Vice Chairman,any Executive Vice President,any Senior Vice President,any Vice President,any Second Vice
President,the Treasurer,any Assistant Treasurer,the Corporate Secretary or any Assistant Secretary may appoint Attorneys-in-Fact and Agents to act for and on behalf
of the Company and may give such appointee such authority as his or her certificate of authoriry may prescribe to sign with the Company's name and seal with the
Company's seal bonds,recognizances,contracts of indemnity,and other writings obligatory in the nature of a bond,recognizance,or conditional undertaking,and any
of said officers or the Board of Directors at any time may remove any such appointee and revoke the power given him or her;and it is
FURTHER RESOLVED,that the Chairman,the President,any Vice Chairman,any Executive Vice President,any Senior Vice President or any Vice President may
delegate all or any part of the foregoing authority to one or more officers or employees of this Company,provided that each such delegatiou is in writing and a copy
thereof is filed in the office of the Secretary;and it is
FURTHER RESOLVED,that any bond,recognizance,contract of indemniry,or writing obligatory in the nature of a bond,recognizance,or conditional undertaking
shall be valid and binding upon the Company when(a)signed by the President,any Vice Chairman,any Executive Vice President,any Senior Vice Preside�t or any Vice
President,any Second Vice President,the Treasurer,any Assistant Treasurer,the Corporate Secretary or any Assistant Secretary and duly attested and sealed with the
Company's seal by a Secretary or Assistant Secretazy;or(b)duly executed(under seal,if required)by one or more Attorneys-in-Fact and Age�ts pursuant to the power
prescribed in his or her certificate or their certificates of authority or by one or more Company officers pursuant ro a written delegation of authority; and it is
FURTHER RESOLVED,that the signature of each of the following officers:President,a�y Executive Vice President,any Senior Vice President,any Vice President,
any Assistant Vice President,any Secretary,any Assistant Secretary,and the seal of the Company may be affixed by facsimile to any Power of Attorney or to any
certificate relating thereto appointing Resident Vice Presidents,Resident Assistant Secretaries or Attomeys-in-Fact for purposes only of executing and attesting bonds
and undertakings and other writings obligatory in the nature thereof,and any such Power of Attorney or certificate bearing such facsimile signature or facsimile seal
shall be valid and binding upon the Company and any such power so executed and certified by such facsimile signature aod facsimile seal shall be valid and binding on
the Company in the future with respect to any bond or understanding to which it is attached.
I,Kevin E.Hughes,the undersigned,Assistant Secretary,of Farmington Casualty Company,Fidelity and Guaranty Insurance Company,Fidelity and Guaranry Insurance
Underwriters,Inc.,St.Paul Fire and Marine Insurance Company,St.Paul Guazdian Insurance Company,St.Paul Mercury Insurance Company,Travelers Casualry and
Surety Company,Travelers Casuaity and Surety Company of America,and United States Fidelity and Guaranty Company do hereby certify that the above and foregoing
is a true and correct copy of the Power of Attomey executed by said Companies,which is in full force and effect and has not been revoked.
�� ^yr �
IN TESTIMONY WHEREOF,I have hereunto set my hand and affixed the seals of said Companies this �� day of 'v�ye��e� ,20 �
G� �
Kevin E.Hughes,Assistaut Sec tary
GI.SU,��T �� yF1&E 4�44 \�N �NS4 :�Y 1'rN�w4 p`tY qN0 SIW Y
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V�82�O � 19� g �1m � m� �� � F:m �WrpOpPORqTt.':.t�s a : j L ��IlD
• t N �. ' , l�. n' J: :pF W I�Af�F�f�. < wi� i '�6
1951 - s E n L.•' j t 1 � cor+N. � �e N �
S��a �y �b� �o �'•. •y°j 's:SEAL.'s
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d•�.........'D_ o.�... .�a +s e `�''
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,,,,,,•
To verify the authe�ticity of this Power of Attorney,call 1-800-421-3880 or co�tact us at www.travelersbond.com.Please refer to the Attomey-In-Fact number,the
above-named individuals and the details of the bond to which the power is attached.
WARNING:THIS POWER OF ATTORNEY IS INVALID WITHOUTTHE RED BORDER