HomeMy WebLinkAboutPW CNT 15-05/Jossart Brothers Inc 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: Jossart Brothers, Inc. Date: April 17, 2015
1682 Swan Road Pro'ect: Concrete Paving & Utilities
DePere, WI 54115 From: Carol Marchant, Adm. Assistant
Re: Contract 15-05
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 Ori inal si ned cop of Contract 15-05 Concrete Pavin & Utilit Pro'ects
These are being transmitted as indicated below:
❑ For Approval � For Your Use ❑ As Requested ❑ For Review 8� Comment
Remarks:
cc: City Clerk (original)
Public Works, Engineering (original)
City Attorney (copy)
� , .
- CONSTRUCTION CONTRACT
THIS AGREEMENT, made on the 25th day of March, 2015, by and between the
CITY OF OSHKOSH, party of the first part, hereinafter referred to as CITY, and JOSSART
BROTHERS, INC., 1682 Swan Road, DePere, WI 54115, 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. 15-05
for various concrete paving & utility projects, for the Public Works Department,
pursuant to Resolution 15-125 adopted by the Common Council of the City of Oshkosh on
the 24th day of March, 2015,
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
$2,835,617.36, 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
f
� (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 coveraqe and that any insurance or self insurance maintained by the City of
Oshkosh, its officers, council members, agents, employees or authorized volunteers will
not contribute to a loss. All insurance shall be based upon the occurrence of an event, and
not based on claims made. All insurance shall be in full force prior to commencing work
and remain in force until the entire job is completed and the length of time that is specified,
if any, in this Contract, the Specifications, whichever is longer.
ARTICLE VI. COMPONENT PARTS OF THE CONTRACT
This Contract consists of the following component parts, all of which are as fully a
part of this contract as if herein set out verbatim, or if not attached, as if hereto attached:
1. This Instrument
2. The City's 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
Clerk and countersigned by the Comptroller of said City, and the party of the second part
hereunto set its, his or their hand and seal the day and year first above written.
In the Presence of: CONTRACTOR
JOSSART BROTHERS, INC.
� By,
�C��J` - `�
(Seal of Contractor (Specify Title)
if a Corporation.)
By:
�tC� �C��rt�p�,�;�.'�,CU
(Specify Title) .J
CITY OF OSHKOSH
�' ,j • By: a,�.-.� _ ��...
� ' l2 G�--- Ma A. Rohloff, City Manager
(Witne s)
,,.. � ,
` �� � And: ' �:-
� �
(W ess) Pamela R. Ubrig, City Clerk
APPROVED: I hereby certify that the necessary
provisions have been made to pay
the liability which will accrue under
this contract
A orney
��14�'Y) �n a .l�n�
City Comp��011er
3
��� JOSSBRO-02 JTOUSEY
ACOR���� DATE(MAAlDDl1'YYY)
�� CERTIFICATE OF LIABILITY INSURANCE 3/30/2015
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
REPRESENTATNE 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).
PRODUCER NAMEACT Jodi Tousey
Ansay 8 Associates,LLC. GB PHONE g00 236-8652 F"� (9 )
419 South Washington Street ac No �cc:� ) ac No: 20 437�179
PO Box 22368 A DR�ESS:�nf0 ansay.com
Green Bay,WI 54305
INSURER(S)AFFORDING COVERAGE NAIC#
�r,suaERa:Cincinnati Insurance Company 10677
INSURED INSURER B:
Jossart Brothers Inc INSURER C:
1682 Swan Road INSURER D:
De Pere,WI 54115 INSURER E:
INSURER F:
COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR 7ypE OF INSURANCE POLICY EFF POLICY EXP LIMRS
LTR INSD WVD POLICYNUMBER MM/DD MMfDD/YYYY
A X COMMERCUIL GENERAL LIABILITY EACH OCCURRENCE $ ��OOO�OOO
CLAIMS-MADE �OCCUR X CPP 1052365 �7/3�/2�'�4 07/31/2015 DAMAGETO RENTED 500 O�O
PREMISES Ea occurrence $ +
MED EXP(Anyooe person) $ �0����
PERSONAL&ADV INJURY $ ��OOO�OOO
GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 3�000�000
POLICY�JECT � LOC PRODUCTS-COMP/OP AGG $ $�OOO,OOO
OTHER: $
AUTOMOBILE LIA6ILITY COMBINED SINGLE LIMIT $ � OOO OOO
Ea accident � �
A X ANY AUTO X CPA 7052365 07/31/2014 07131/2015 BODILY INJURY(Per person) $
ALL OWNED SCHEDULED BODILY INJURY(Per accident) S
AUTOS AUTOS
NON-OWNED PROPERN DAMAGE $
HIRED AUTOS AUTOS Per accitlent
S
X UMBRELLA LIAB X OCCUR EACN OCCURRENCE $ B�OOO�OOO
A EXCESSLIAB CLAIMS-MADE X CPP 1052365 07/31/2014 07l31/2015 AGGREGATE $ sr�00e00�
DED X RETENTION 5 � $
WORKERS COMPENSATION X PER OTH-
AND EMPLOYERS'LIABILPTY STATUTE ER
Q1 ANY PROPRIETOR/PARTNER/EXECUTIVE Y�N WC 1926352 07/31l2014 07/31l2015 E.L.EACH ACCIDENT $ �00,���
OFFICER/MEMBER EXC�UDED? � N f A
(Mandatory In NH) E.L.DISEASE-EA EMPLOYE $ ��0,�00
If yes,describe under 500 000
DESCRIPTION OF OPERATIONS below E.L_DISEASE-POLICY LIMIT $ ,
A Installation Floater CPP 1052365 07/31/2014 07/31/2015 Limit 1,248,401
q CPP 1052365 07/31/2014 07/31/2015 Deductible 1,000
DESCRIPT70N OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 107,Addltfonal Remarks Schedule,may be attaehed if more space is requlred)
Public Works Contract No.15-05
City of Oshkosh,and its officers,council members,agents,employees and authorized volunteers are included as additional insureds on general liability by
endorsement GA233,auto liability by endorsement AA4171,and umbrella follows form.
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
Ci of Oshkosh THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ry ACCORDANCE WITH THE POLICY PROVISIONS.
Attn: City Clerk
PO Box 1130
Oshkosh,WI 54903-1130 AUTHORIZEO REPRESENTATIVE
��--�°',.�`.�"' "�*`�..�"...�
O 1988-2014 ACORD CORPORATION. All rights reserved.
ACORD 25(2014l01) The ACORD name and logo are registered marks of ACORD
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. '
CONTRACTORS' Ct�MMERCiAL GENERAL LIABILITY
BROADENED ENDORSEMENT
This endorsement modifies insurance provided under the foilowing: '
COMMERCIAL GENERAL LIABILITY COVERAGE PART '
A. Endorsement-Table of Contents:
Coveraqe: Beains on Page:
1. Employee Benefit Liability Coverage... ...............:.......................................................................... 2
2. Unintentional Fai(ure to Disclose Hazards.......................................................................................... 7 '
3. Damage to Premises Rented to You................................................................................................... 8
4. Supplementary Payments...................................................................................................................9
5. Medical Payments........................................................................................................................ ,
........ 9
6. Voluntary Property Damage(Coverage a,)and Care,Cusfody or Control
LiabilityCoverage (Coverage b.).........................................................................................................9
7. 180 Day Coverage for Newly Formed or Acquired Organizations..................................................10
8. Waiver of Subrogation....................................................................................................................... 10 '
9. Automatic AdditionaF insured-Specified Retationships: :. ......:....................................................10
• Manager�or Lessors of Premises;
• Lessor of Leased Equipment;
• Vendors; " '
• State or Politicai Subdivisions-Permits Relating to Premises;
� State or Political Subdivisions-Permits;and
• Cantractors'Operations
10. Broadened Contractual Liability-Work Within 50'of Railroad Property.....:............................:...... 14
11. Property Damage to Borrawed Equipment....................................................................................... 14
12. Employees as Insureds-Specified Health Care Services ............................................................ 14
• Nurses;
• Emergency Medical Technicians;and '
• Paramedics '
13. Broadened Notice of Occurrence.................... ............................................................................ 14
B, Limits of Insurance: '
The Commercial General Liability Limits of Insurance apply to the insurance provided by this endorse- '
ment,except as provided below: '
1. Employee Benefit Liability Coverage
Each Employee Limit: $ 1,000,000
Aggregate Limit: $ 3,000,000
Deductible: $ 1,000
3. Damage ta Premises Rented to You '
The lesse�of:
a. The Each Occurrence Limit shown in the Declarations;or
b, $50Q,000 unless otherwise stated$
4. Supplementary Payments
a. Bail bonds: $ 1,OQ0 '
b. Loss of earnings: $ 350
5. Medical Payments
Medical Expense Limit: $ 10,000
Includes copyrighted material of Insurance
GA 233 02 07 Services Office,Inc.,with its permission. Page 1 of 15
b. Deductible Clause 9, Automatic Additianal insured - Speci- '
(1) Our obligation to pay damages fied Retationships
on your behaif applies only to a. The follQwing is hereby added to
the amount of damages for each SECTION il-WHD IS AN INSURED:
"occurrence" which are in ex-
cess of the deductible amount (1) Any person or organization de-
stated in Section B. �imits of scribed in Paragraph 9.a.(2)
Insurance, 6. Voluntary Prop- below(hereinafter referred to as
erty Damage and Care, Cus• additional insured) uvhpm you
tody or Control Liabilify Cov- are �equired ta add as an addi-
erage of this endorsernent. The tionat insu�ed under this Cover-
limits of insurance will not be re- age Part by reason of: ,
duced by the application of such (a� A written contract or
deductible amount, agreement; or '
(2) Condition 2,Duties in the Event (b) An orai agreement or con- '
of Occurrence, Offense, Ctaim tract where a certificate of
or S�uit, applies to each claim or insurance showing that per- '
suit irrespective of the amount. son or organization as an
(3) We may pay any part or ail of additional insured has been
the deductible amount to effect issued,
settlement of any claim or "suiY' is an insured,provided:
and, upon notification of the ac-
tion taken, you shall promptly (aj The written or oral confract
reimburse us for such part of the or agreement is:
deductible amount as has been
paid by us. 1) Currently in effect or
becomes effective
7, 180 Day Coverage for Newly Formed or during the policy pe-
Acquired Organizations riod;and
SECTION II - WHO IS AN INSURED is 2) Executed prior to an
amended as follows: "occurrence"or offense
Subparagraph a, of Paragraph 4. is to which this insurance
hereby deleted and replaced by the fol- would apply;and
lowing: {b) They are not specifically
a. Insurance under this provision is af- narned as an additional in-
forded onl until the 180th da after sured under any ather pro-
Y Y vision of, or endorsement
you acquire or form the organization added to, this Coverage
or the end of the policy period, pa�
whichever is earlier;
8. Waiver of Subro ation {2) Only the foltowing persons or
g organizations are additional in-
SECTION IV- COMMERCIAL GENERAL sureds under this endorsement,
LIABILITY CONDITIONS, 9. Transfer of and insurance coverage pro-
Rights of Recovery Against Others to vided to such additional in-
Us is hereby amended by the addition of sureds is limited as provided
the following: herein:
We waive any right of recovery we may (a) The manager or lessor of a
have because of payments we make for premises leased to you with
injury or damage arising out of your on- whom you have agreed per
going operations or"your work"done un- Paragraph 9.a.(1) above to
der a written contract requiring such provide insurance, but only
waiver with that person or arganization with respect to liability aris-
and included in the "products-completed ing out of the ownership,
operations hazard". However, our rights maintenance or use of that
may only be waived prior to the "occur- part of a premises leased to
rence"giving rise to the injury or damage you, subject to the following
for which we make payment under this additional exc{usions:
Coverage Part. The insured must da This insuranca does not '
nothing after a loss to impair our rights, a I to:
At our request,the insured will bring "suit" pp y
or transfer those �ights to us and help us 1) Any "occurrence"
enforce those rights. which takes place after
Includes copyrighted ma#erial of Insurance
GA 233 02 07 Services Office,Inc., with its permission. Page 10 of 15
you cease to be a ten- c) Any physical or
ant in that premises. chemicai change
2 Structural alterations, in the product ,
) made intentionaily
new construction or by the vendor; '
demolition operations
performed by or on be- d) Repackaging, un-
half of such additional less unpacked
insured. solely for the pur- ,
b An erson or or anization pose of inspection, '
( ) Y P 9 demonstration,
from which you lease testing, or the
equipment with whom you substitution of '
have agreed per Paragraph parts under in-
9.a.(1) above to provide in- structions from the
surance. Such person(s)or manufacturer, and
organization(s)are insureds then repackaged '
solely with respect to their in the original
liabiliry arising out of the container;
maintenance, operation or
use by you of equipment e) Any failure to
leased to you by such per- make such in-
son(s) or organizations(s), spections, adjust-
However, this insurance ments, tests or ,
does not apply to any "oc- servicing as the
currence"which takes place vendor has
after the equipment lease agreed to make or ',
expires. normally under- ;
c An erson or or anization takes to make in
� ) Y p 9 the usual course
(referred to below as ven- of business, in
dor) with whom you have connection with
agreed per Paragraph the distribution or
9.a.(1) above to provide in- sale of the prod-
surance, but only with re- ucts;
spect to "bodily injury" or
� "property damage" arising � Demonstration, in-
out of"your products"which stallation, servio-
are distributed or sold in the ing or repair op-
regular course of the ven- erations, except
dor's business, subject to such operations
the following additional ex- performed at the
clusions: vendor's premises
1 The insurance afforded in connection with
) the sale of the
the vendor does not product;
apply ta
„ „ g) Products which,
a) Bodily injury or after distribution or
"property damage" sale by you, have
for which the ven- been labeled or
dor is obligated to relabeled or used
pay damages by as a container,
reason of the as- part or ingredient '
sumption of liabil- of any other thing
iry in a contract or or substance by or
agreement. This for the vendor.
exclusion does not
apply to liability for 2) This insurance does ',
damages that the not apply to any in-
vendor would sured person or or-
have in the ab- ganization:
sence of the con-
tract or agree- a) From whom you ,
ment; have acquired
such products, or
b) Any express war- any ingredient,
ranty unauthorized part or container,
by you; entering into, ac-
Includes copyrighted material of Insurance
GA 233 02 07 Services Office, Inc„with its permission. Page 11 of 15
companying or 2� This insurance does
containing such not apply to "bodily in-
products;or jury", "property dam-
b When liabili in- age" ar "personal and
? tY advertising injury" aris-
ciuded within the ing out of operations
products- perfarmed for the state
completed opera- or political subdivisian,
tions hazard" has
been exciuded (fl Any person or organization '
under this Cover- with which yau have agreed
age Part with re- per Paragraph 9.a.{i)
spect to such above to'provide insurance,
products. but only with respect to li-
d An state or olitical subdi- ability arising out of "your ,
� ? Y P work" performed for that
vision with which you have additional insured by you or
agreed per Paragraph on your behalf. A person or '
9,a.{1) above to provide in- organizatian's status as an
surance, subject to the fol- insured under this provision
lowing additional provision: ' ofi this endorsement contin-
This insurance applies only ues for only the period of
with respect to the following time required by the written
hazards for which the state contract or agreement, but
or political subdivision has in no event beyand the ex- ,
issued a permit in conneo- piration date of this Cover-
tion with premises you own, age Part. If there is no
rent or control and to which wrttten contract or agree-
this insurance applies: ment, or if'na period of time
is 'required by the written
1) The existence, mainte- contract or agreement, a
nance, repair, con� person or organization's
struction, erection, or status as an insured under
removal of advertising this endorsement ends '
signs, awnings, cano- when your aperatians for '
pies, cellar entrances, that insured are completed.
coal holes, driveways, (3) Any insurance provided to an
manholes, marquees, additional insured designated '
hoist away openings, under Paragraph 9.a.(2):
sidewalk vaults, street '
banners, or decora- {a) Subparagraphs (e) and (fJ '
tions and similar expo- does not apply to "bodily
sures;or injury"or"property damage" '
2) The consiruction, erec- included within the "prod- '
tion, or remaval of ele- ucts-completed operations
vators;or hazard ,
3) The ownership, main- (b) Subparagraphs (a), (bj, (d),
tenance, or use of any (ej and (fl does not�apply to
elevators covered by bodity mjury , property
damage" or "personal and
this insurance. „
advertising injury arising
(e) Any state or political subdi- out of the sole negligence
vision with which you have or willful misconduct of the
agreed per Paragraph additional insured or their
9.a.(1) above to provide in- agents, "employees" or any
surance, subject to the fol- other representative of the
lowing provisions: additianal insured;ar
1} This insurance app�ies (c} Subparagraph (� does not ,
only with respect to op- apply to "bodily injury",
erations performed by "property damage" or "per-
you or on your behalf sonal and advertising injury"
for which the state or arising out of:
politicat subdivision has 1) Defects in design fur-
issued a permit, nished by or on behalf
Includes copyrighted material of Insurance
GA 233 OZ 07 Services Office, Inc.,with its permission. Page 12 of 15
of the additional in- spects any other insurance
sured;or policy issued to the addi-
2 The renderin of, or tional insured, and such '
) 9 other insurance policy shall
failure to render, any be excess and !or noncon-
professional architec- tributing, whichever applies,
tural, engineering o� with this insurance.
surveying services, in-
cluding: (b) Any insurance provided by
tF�is endorsement shall be
a) The preparing, primary to other insurance
approving or fail- available to the additional
ing to prepare or insured except:
approve maps,
shop drawings, 1) As otherwise provided
opinions, reports, in SECTION IV
surveys, field or- COMMERCIAL GEN-
ders, change or- ERAL LIABILITY '
ders or drawings CONDITlONS, 5. Other ;
and specifications; insurance, b. Excess
and Insurance; or
b) Supervisory, in- 2j For any other valid and
spection, archi- collectibie insurance
tectural or engi- available to the addi-
neering activities. tional insured as an
3 Your work for which a additional insured by
) ° '� attachment of an en-
consolidated (wrap-up) dorsement to another
insurance program has insurance policy that is
been provided by the written on an excess
primecontracfor-project basis, In such case,
manager or owner of the coverage provided
the construction project under this endorse- '
in whicM you are in- ment shall also be ex-
volved. cess.
b. Only with regard to insurance pro- (2) Condition 11. Conformance to
vided to an additional insured desig- Specific Written Contract or
nated under Paragraph 9.a.(2} Sub- Agreement is hereby added:
paragraph (� above, SECTION ill -
LIMITS OF INSURANCE is amended 11. Conformance to Specific
to include: Written Contract or
Agreement '
The limits applicable to the additianal
insured are those specified in the With respect to additional
written contract or agreement or in insureds described in Para- '
the Declarations of this Coverage graph 9.a.(2)(�above only:
Part,whichever are less. If no limits '
are speci�ed in the written contract If a written contract or
or agreement, or if there is no wriften agreement between you
contract or agreement, the limits ap- and the additional insured
plicable to the additional insured are specifies that coverage for
those specified in the Qeclarations of the additional insured:
this Coverage Part. The limits of in- a. Be provided by the In-
surance are inclusive of and not in surance Services Of-
addition to the limits of insurance fice additional insured
shown in the Declarations. form number CG 20 10
c. SECTION 1V - COMMERCIAL GEN- or CG 20 37 (where
ERAL LIABILITY CONDITIONS is edition specifiedj;or
hereby amended as follows: b, Include coverage for
(1) Condition 5. Other Insurance is completed operations;
amended to include: or
(a} Where required by a written c. Include coverage for
contract or agreement, this "your work';
insurance is primary and / and where the limits or cov- '
or noncontributory as re- erage provided to the addi- '
lncludes copyrighted material of Insurance
GA 233 02 07 Services�ffice, Inc.,with its permissian. Page 13 of 15
tional insured is more re- 11, of this endorsement fix the
s#rictive than was speci�- most we will pay in any one "oo-
caliy required in thak written currence" regardless of the
contract or agreement, the number of:
terms of Paragraphs (a) Insureds;
9.a.(3)(a), 9.a.(3)(b) or 9,b:
above, or any combination (b} Claims made or "suits" '
thereof, shall be interpreted brought;or
as providing the limits or
coverage required by the {c) Persons or organizations
terms of the written contract making ciaims or bring
or agreement, but only to "suits". '
the extent that such limits or
coverage is included within (2) Deductibie Clause
the terms of the Coverage (a) Our obligation to pay dam-
Part to which this endorse- ages on your behaif applies
ment is attached. If, how- aniy to the amaunt of dam-
ever, the written contract or ages for each 'bccurrence"
agreement specifiss the (n- which are in excess of the
surance Services Office Deductible amount stated in
additional insured form Section B. Limits of Insur- '
number CG 2Q 10 but does ance, 11. of this endorse-
not specify which edition, or ment. The limits of insur- '
specifies an edition that ance will not be reduced by
does not exist, Paragraphs the application of such De-
9.a.(3)(a) and 9.a.(3}(b} of ductible amount.
this endorsement shall not
apply and Paragraph 9.b, of (b) Candition 2. Duties in the '
this endorsement shall ap- Event of Occurrence, Of-
p�Y- fense, Claim or Suit, ap- '
10, Broadened Contractual Liability-Work plies to each claim or "suit° .
Within 50'of Raiiroad Property irrespective of the amount.
It is hereby agreed that Paragraph f.(1) of (c) We may pay any part or all
„ „ of the deductible amount to
Definition 72. Insured contract (SEC- effect settlement of any '
TION V-DEFINITIONS)is deletsd, claim or "suit" and, upon '
11. Property Damage to Borrowed Equip- notification of the action
ment taken, you shall promptly
reimburse us for such part
a. The following is hereby added to Ex- of the deductible amount as
clusion j. Damage to Property of has been paid by us.
Paragraph 2., Exclusions of SEC-
TION I- COVERAGES, COVERAGE 12. Employees as Insureds - Specified
A. BODILY INJURY AND PROP- Health Care Services
ERTY DAMAGE LIABILITY: It is hereby agreed that Paragraph
Paragraphs (3) and (4) of this exclu- 2.a.(1)(d) of SECTION 11 - WNO IS AN
sion do not apply to toals or equip- INSURED, does not apply to your "em-
ment loaned to you, provided they ptoyees"who provide professional health
are not being used to perform opera- care services on your beha{f as duly li-
tians at the time of lass, censed:
b, With respect to the insurance pro- a. Nurses;
vided by this section of the en- b, Emergency Medical Technicians;or
dorsement, the following additional
provisions apply: c. Paramedics,
(1) The Limits of insurance shown in the jurisdiction where an "occur�ence"
in the DeclaratiQns are replaced or offense to which this insurance applies
by the limits designaied in Sec- takes place.
tion B. Limits of Insurance, 11.
of this endorsement with respect 13. Braadened Notice of Occurrence
to coverage provided by this Paragraph a, of Condition 2. Duties in
endorsement. These limits are the Event of Occurrence, Offense, '
inclusive of and not in additian to Claim or Suit (SECTION lV- COMMER-
the limits being replaced. The GIAL GENEi2AL LIABILITY CONDI-
Limits of Insurance shown in
Section B, Limits af Insurance,
Includes copyrighted material of Insurance
GA 233 OZ 07 Services Office,Inc.,with its permission. Page 14 of 15
� � GINA �
ORI
�s�la�n P7o. :��t3��is9
PERFORMARIC� BC7ND
KNO�/1� ALL �viEt'J BY T�-IES� �'R���NT�, ih�t �,�ss��� ����3�rF:�x�, zz�=c.
, CONTF�ACTc�i�, �s princi�ai, �nd
Gr�•; Hw.�a^,�:��.F. I J�"utzi�ir � �,? . .
� --` 'P us� y�s sur�ty, are h�ld and firmly
��und ur�to tt�e C�TI' t�� f�SH�C>SN, �'t�1��QNSiP�, 01t4'h�ER, in the surn �� �,
. .. ..__.....�r _ :g:�;t ?,�.,�x�,�x x_,iT�..p ."z�.�� I�i._,.��s.zrI 4,�,, riun���!d ��,.�:��'�2.� �.,;_i �� r�`1rr� ��Oi�c�CS�
(� :<, ,.,,_;, :.. j t� !�e �aid ��� tl�� 0!j'�/�I�F? �or ��vhic#��
��ym�nt w�li �?�� truiy tc� b� mad� ��1� j�intly �nd �evera�ly bind c�urselv�s, aur l�,eirs,
�kec;.�tc�rv, ��m�nistra��rs; a�d �ssi�n�firmly tc� th�se }�re�eni�,
T�€E COl�D►T101�5 cJ� T'NE A�3C�L1E �BI.I�AT{C��lS ar� such that
��'J;�����,�, �;�� s��� ,-` � � � �.,` rD _ �i�, �r� ti�a� ��, ���� �x
.�;.:xi.._.. ._�� .��`�_:Y't;� �;�i.^1�� �;��` v�t�, �€�t�r in�� � ��n�r�ci����t� 4.h�
�1�'l'C�:�R ft��t��
. ._✓ ,...r�z't':'Y7('.Y ��:._`-. �.':eT . j,.: f' �>,r.'..^:+^-�? 4;.i�..ri ,-} I;, i't t ry.3..Pt1 Z 1 n"i.z;`#`C !"..y �,r i_�. k.^r^.^�+nci n
Including a 2 year warranty per Article VI. of contract terms and conditions.
i�C��'v, THFR�FC��E, if th� s�i� CC��T�A�Tt�R sh�(I ��v� ��,� hcald ha��3�s� th� s�id
O'��L'C�7�R �ror� ��I �ublic Ii�biPl#y an�i dama��s �f e�r�ry d�scriptio� in cc�nn�ctior,
therev��ith, snaii �vel; arEd o�it����iip- it� �I! thit�gs¢�:�Ifill the said C+�ntrauf, according t� ali the
canciitions an� stipul�tions thereir� cc�ntain�d, in �Il respects, ��td sh��l �ave and hoid
h�rmi��4 th� ��i� ��'J�INFR from �nd ag�inst �11 fiens and cl�irrts of every d�sr,r�ation in
canneetian tf�erewith, lnciuding pa��ment for all mater�a#s, labor and equipment, then this
oblig�tion sha31 be void anci �f no eff�ct, but �tl�erwis�, it st��ll r�main in fuH fcar�ce ar�d '
virtue, and in the event that the said Ot�'NER shal! extend fh� time fc�r ct�mpletion c�f the '
��rork or ath�rwise modiFy eiements c�f the Cc�ntract in acco��anc� with p�ovisic�ns
thereaf, su:h �xtensi�ns of time nr rnr�difications c�f the Contract sh�lk nc�t in �ny v�ay
r�lease the sur�ties of tt�is band.
Pag�1 of 2
t�v��ra�ss t�u� �A��� ,��c� sE��,s tn�s�;���:��y�f x���rr-�-� > �a-�
(n the Presence of:
�?t�:���.;�, �� ��.:�� , �zt;�. {SEAL)
T l (S�A.L,`1
1
F'ri p�l
����.�..�'"�,�,^^' ,� mii:.: Ns'�:�Ck`?i'F t1�d�ii;?RIa.IC'.t?; i.tiY+i�?:=s?�7'f ������
_, �� �� �� � ._ .
� _�SEAL}
`4?����t� ::. , ,.,'', c s �',>,. . i a.:4.
Pc��B�tt��
THE HANOVERINSURANCE COMPANY
MASSACHUSETTS BAY INSURANCE COMPANY
CITIZENS INSURANCE COMPANY OF AMERICA
POWERS OF ATTORNEY
CERTIFIED COPY
KNOW ALL MEN BY THESE PRESENTS: That THE HANOVER INSURANCE COMPANYand MASSACHUSElTS BAY INSURANCE COMPANY,both being
corporations organizecE and e�dsting under the laws of the State of New Hampshire,and CITIZENS INSURANCE COMPANY OF AMERICA,a corporation
organized and e�dsting under the laws of the State of Michlgan,da hereby constitute a�d appotnt
Jeffrey R.Meisinge�, Kelly Cody,Kenton Arps and/or Roxanne Jensen
of Green Bay,WI and each is a true and lawful Attomey(srin-fact to sign,execute,seal,acimowtedge and deliver for,and on its behaif,and as ns act and deed any
place within the Unfted States,or,if the following line be filled In,ontywithin the area therein designated atry and ail bonds,recognizances,undertaldngs,comrads of
indemnity or other writings obligatory in the t�ature thereof,as foUows:
My such obligations in the United States,not to exceed Fifteen Miliion and No/100(a15,000,000)in any single instance
and said companies hereby ratify and confirm all and whatsoever said Attomey(s}in-fact may lawfuily do in the premises by virtue of these presents.
These appointments are rnade under and by authority of the following Resolution passed by the Board of Directors of said Companies which resolutlons
are s6'll in effect: •
'RESOLVED,That the Preside�or aoy vice President,in conjundion with any Vce PresideM,be and they are hereby authorized and empowreredto appoird
P1lort�eys-sn-lacl d the Comparry,in lts name and as its acts,to acecute and acimowiedge for and on its.behalf as Surety arry and aii bonds,recognizances,
contracts d indemndy,waivers of citation and all other wtitings obtigatory&�the nature ihereof,wifh power to adach thereto the seal dihe Company.Any
such writi�gs ao ezeculed by such Attomeys-in-fact shail be as bfnding upon the Company as if they had been duly ezecuted and aclmowledged by ihe
�egufarly elected ofllcers of Uie Compamr In their own properpersons�(qdopted pdober 7,1981-The Flanover Insurance Company;Adaptedqpr�14.198Z
-NFassachusetis Bay insurance Comparry;Adopted September 7.2001-Cttizens Insurance Company of qmericx)
IN WITNESS WHEREOF,TNE HANOVER INSURANCE COMPANY,MASSACHUSETTS BAY INSURANCE COMPANY and CiTIZENS INSURANCE
COMPANY OF AMERICA have caused U�ese presents to be sealed with their respective corporate seais,duly attested by iwo Uice Presidents,
this 30th day of Apri12012.
��i�1+li�Y��q�S###�AlV�E G�#�AllY'
' � • �: • •. NYAS�A�F1U���BAY INSE3l�ANC�Ct?AllPA1�tY
..:::::� .;.....-•:::. .:.,;:r.. .,� G!'E'3��'dS U#�1��t3t�FPA�Y t'�F RM�RICA
::. w
..:�:"s:� � "".�i��: . ..
... � ?os�.�.:.::;,:` �;:��;��::°� . .� .,�
. : . r. �
�:...::.::::::i. ... �
�.::."'s::::`A:s� .::'':'.; Rsurc€t.'�7'iiar.ias.idiee Pc�cident �..,
..._....,.,�.,,,,,...
THE COMMONWEALTH OF MASSACHUSETTS ) ._,.�.�' �';"'� .- �^�....-...�-�"'''"
COUNTY OF WORCESTER )ss, IuC��i:[�,�rAt3�lr�pr�s;dc•�t
. �
On this 30th day oi April 2012 before me came the above named V'�ce Presldents of The Hanover Insurance Comparnr,Massachusetts Bay Insurance Company
and Citizens Insurance Cornpany of America,to me personaliy lmown io be the indlviduals and offlcers de.scribed herein,and acknowledged tt�the seals affooed to
the preceding instrument are fhe corporate s�is of The Hanover Insurance Company,Massachusetts Bay Insurance Company and C�lzens�r�xanoe Ccxr�pany,o�
America,respectively,and that fhe said corporate seals and their signaW�es as officers were duly affaed and subscribed to said instrument by the authority and
drection of said Corporations.
"`� �RBAHAA.til.ki.�fSC
��� t��;eryPubiC
C.�s�e+�Yeit�eWs
it�^r•rzti:pc�B+De.3L2� ,. .
Barbara A.Gatlick,Notary Public
nny comrriisslon Expires september 21,2018
1,the undersig�ed V'ice President of The Hanover Insurance Company,Massachusetts Bay Insurance Company and Cltizens insurarx�Company of America,
hereby certify that the above and foregoing is a full,ln�e a!��c�!*ect cop;�!t�O;�;r,a!P�r.�er�;;,�c,;,�-y�b-y sa�d Companies,and do hereby further certlfy
that the said Powers of AHorney are stitl in force and effect.
This Certificate may be signed by facsimile under and by authocity o!the foilowiog resolution of the Board oi Directors of The Nanover Insurance Company,
Massachusetts Bay Insurance Company and Citiaens lnsurance Company of qme�ra.
"RESOLVED.That anyand all Powers of Attomey and CertiAed Coptes of such Powers of Attomey and certificatlon in resped thereto,praMed and e�mcuted
by the President or any lrice President in conjunction with any Vlca Presiderd dthe Comparry,shall be binding on lhe Company fo the same e�xtent as if ap
__ signatures therein v�rere manua�_affaed,even ihough one or more oteny.such signatures thereon may be tacsimile." (Adopted October-7,.1gg1-7he
ofaAmericasurance Comparry;Adopted Apri114,1982-Massachuseds Bay insurance Compam;Adopted September 7,2001-Citizens h�surance Compary
)
GIVEN under my hand and the seals of said Companies,at Worcester,Massachusetts,thisa7� day of MG�c� 2p/S .
'fH�HAt+FOYFR 1NStlt�EC�G4M�'Af�IY
�A.SBACHI�.SEFTB BAY itdSE�RANC�COMFsAl1Y
C�#i5 INSlJRlO►NL`E CDMPANY O�AM�CA
�.���-� �����tr�..,..
C�t�i�n Marpc►sian,Kcx3 Ptesideni