HomeMy WebLinkAboutGMS/Freezer-Convention CenterCONTRACTOR AGREEMENT.•
REFR/GERA T/ON/COOLER ADD/T/ON: OSHKOSH CONVENT/ON CENTER
THIS AGREEMENT, made on the 9th day of September, 2015, by and between
the CITY OF OSHKOSH, party of the first part, hereinafter referred to as CITY, and
GMS, INC. DBA GARTMAN MECHANICAL SERVICES, 520 W. SOUTH PARK
AVENUE, OSHKOSH, WI 54902-00000, hereinafter referred to as the CONTRACTOR,
WITNESSETH:
That the City and the Contractor, for the consideration hereinafter named, enter
into the following agreement. The Contractor's proposal is attached hereto and
reflects the agreement of the parties except where it conflicts with this agreement, in
which case this agreement shall prevail.
ARTICLE I. PROJECT MANAGER
A. Assignment of Project Manager. The Contractor shall assign the following
individual to manage the project described in this contract:
(Scott Olejnik, Vice-President, GMS)
B. Changes in Project Manager. The City shalt have the right to approve or
disapprove of any proposed change from the individual named above as Project
Manager. The City shall be provided with a resume or other information for any
proposed substitute and shall be given the opportunity to interview that person prior to
any proposed change.
TICLE II. CITY REPRESENTATIVE
The City shall assign the following individual to manage the project described in this
contract:
(Jon Urben, General Services Manager)
ARTICLE III. SCOPE OF WORK
The Contractor shall provide the services described in the City's August 8,
2015, Invitation for Bid for the Project titled "Refrigeration/Freezer Addition- Oshkosh
Convention Center" and the contractor's bid form and bid bond for the project dated
8/25/15 and attached as Exhibit A. If anything in the Bid Form conflicts with the Bid
Specifications, the provisions in the Bid Specifications shall govern.
1
The Contractor may provide additional products and/or services if such
products/services are requested in writing by the Authorized Representative of the
City.
ARTICLE IV. CITY RESPONSIBLITIES
The City shall furnish, at the Contractor's request, such information as is needed
by the Contractor to aid in the progress of the project, providing it is reasonably
obtainable from City records.
To prevent any unreasonable delay in the Contractor's work the City will
examine all reports and other documents and will make any authorizations necessary
to proceed with work within a reasonable time period.
ARTICLE V. TIME OF COMPLETION
The work to be performed under this contract shall be completed by no later
than November 15, 2015.
ARTICLE III. PAYMENT
A. The Contract Sum.
The City shall pay to the Contractor for the performance of the contract the sum of
552,260, adjusted by any changes hereafter mutually agreed upon in writing by the
parties hereto.
Fee schedules shall be firm for the duration of this Agreement.
B. Method of Payment. The Contractor shall submit itemized monthly
statements for services. The City shall pay the Contractor within 30 calendar days
after receipt of such statement. If any statement amount is disputed, the City may
withhold payment of such amount and shall provide to Contractor a statement as to
the reason�s) for withholding payment.
C. Additional Costs. Costs for additional services shall be negotiated and set
forth in a written amendment to this agreement executed by both parties prior to
proceeding with the work covered under the subject amendment.
ARTICLE IV. CONTRACTOR TO HOLD CITY HARMLESS
The Contractor covenants and agrees to protect and hold the City of Oshkosh
harmless against all actions, claims and demands of any kind or character whatsoever
which may in any way be caused by or result from the intentional or negligent acts of
the Contractor, his agents or assigns, his employees or his subcontractors related
however remotely to the performance of this Contract or be caused or result from any
violation of any law or administrative regulation, and shall indemnify or refund to the
2
City all sums including court costs, attorney fees and punitive damages which the City
may be obliged or adjudged to pay on any such claims or demands within thirty (30)
days of the date of the City's written demand for indemnification or refund.
ARTICLE V. INSURANCE
The Contractor shall provide insurance for this project that includes the City of
Oshkosh as an additional insured. The contractor's certificate of insurance for this
project is attached as Exhibit B.
ARTICLE VI. TERMINATION
A. For Cause.
If the Contractor shall fail to fulfill in timely and proper manner any of the obligations
under this Agreement, the City shall have the right to terminate this Agreement by
written notice to the Contractor. In this event, the Contractor shall be entitled to
compensation for any satisfactory, usable work completed.
B. For Convenience.
The City may terminate this contract at any time by giving written notice to the
Contractor no later than 10 calendar days before the termination date. If the City
terminates under this paragraph, then the Contractor shall be entitled to compensation
for any satisfactory work performed to the date of termination.
This document and any specified attachments contain all terms and conditions
of the Agreement and any alteration thereto shall be invalid unless made in writing,
signed by both parties and incorporated as an amendment to this Agreement.
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In the Presence of:
(Seal of Contractor
if a Corporation.)
.-
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(Wit ess)
�
(Witness)
CONTRACTOR /CONSULTANT
�y:
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(Specify Title)
:
(Specify Title)
CITY OF OSHKOSH
By: , �-�--��.�-�-�'�
Mark A. Rohloff, City Manager
~�
A n d: l� L�' .X�.��� 1� ��
Pamela R. Ubrig, City Clerk
)VED: /�`II I hereby certify that the necess-
� ary provisions have been made to
pay the liability which will accrue
under this contract.
Cit� At#�rn y
� n�ma r��.,�
City Comptroller
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CITY OF OSHKOSH BID PROPOSAL FORM
Page 1 of 3
REFRIGERATION/COOLER ADDITION: OSHKOSH CONVENTION CENTER
From: �� .5 � nL, �b�� �a��''��.a-. /��1� ��J,�-(bidder's company name)
BID PROPOSAL DEADLINE: THURSDAY, AUGUST 27, 2015 @ 10:00 A.M. CST
Addenda: Receipt of Addenda numbered _L of _� are hereby understood,
acknowledged and included in bidder's bid proposal form. If no addenda were issued for this
project please write "N/A" above.
In compiiance with the advertising �for Bids and having carefully examined the drawings and
specification for the Work and the Site of the proposed work and having determined all of the
conditions of the work, the rules, regulations, laws, codes, ordinances, and other governing
circumstances relating to this project, the undersigned proposes to furnish all Labor, Materials
and Equipment necessary to complete the construction indicated on the drawings and described
in the project manual to include all described work completed to the Owners' satisfaction.
By Submission of this Bid, each Bidder certifies, and in the case of a joint Bid, each party thereto
certifies as to its own organization, that this Bid has been arrived at independently without
consultation, communication, or agreement as to a matter relating to this Bid and with any other
Bidder or with any competitor.
We, the undersigned, propose to furnish all labor and materials per the project specifications or
noted deviations for the following amount(s):
BASE BID: Relocate the existing electric lights and ceiling plugs away from the new
freezer/cooler Iocation. Install one new freezer box and one new cooler box in the kitchen as
shown on the drawings, Install the two condensers on the lower roof and the evaporator inside
the walk-In cooler and freezer. Run new condensate line from the bottom of the evaporator
pans to the new floor drain. Heat tape all condenser piping located in the freezer box and
insulate the whole condensate line from the evaporators to the floor drains. Install one fire
sprinkler head per box. All electrical, plumbing work, fire protection and assembly work must be
completed by the HC. At the end of the project the HC must supply the HVAC engineer with a
report indicating the freezer and cooler's have been tested and are working properly. HC must
train the owner on the workings and required maintenance of the new equipment. HC must
work closely with the Convention Center Head Chef and the Oshkosh City Halls maintenance
department during this installation. �� � ��QQ
TOTAL BASE BID $_ f
�!' i� n i ns� f�e, ��( �5 ix �i � h�na�% � se�� ei9 �� o�-,-�ci.� /� ��''�
(Base Bid Price n rds)
17
CITY OF OSHKOSH BID PROPOSAL FORM
Page 2 of 3
REFRIGERATION/COOLER ADDITION: OSHKOSH CONVENTION CENTER
ALTERNATE BID A-1Z The instaliing contractor is to purchase and install the interior shelving
for both the walk-in freezer and walk-in cooling boxes per shelving specifications. The end goal
is to have a walk in cooler and freezer ready for use.
. TOTAL ALTERNATE BID 1 $ 0`1, .5�a . ��
�
e /r0 /
, l- � /
GW p (� � dt -.--� �p� /C4�`r'
(Altern Bi 1 Price — in Words)
Warranty Details:
Please include one set of shop drawings of equipment for bid review.
PROPOSED SUBCONRACTOR LIST:
ELECT'RICAL• �� � o_c.�°� f � � �
MECHANI
OTHER: �L�iL �//,�l.,z� ?
Submittals will be re�iiewed for general compliance with design concept and contract documents
only. Full compliance with contract documents, Code requirements, dimensions, fit finishes, and
interface with the existing Control System is the Prime contractor's responsibility. Within 7 days
after award of contract, provide required submittals for approval to the HVAC Engineer.
Contractor shall promptly respond to requests for additional information so that delivery and
installation schedules are not delayed.
QUALIIY ASSURANCE — REGUTATORY REQUIREMENTS
A. All work shall comply with the applicable code requirements in effect: Including by
not limited to ASME, Division of Safety & Buildings Administrative Codes and other
applicable Building or local codes in effect as of the contract date.
B. The Contractor shall be fufly responsible for obtaining all required approvals,
permits licenses, inspections �and certificates for this installation.
SAFEfY AND HAZARDOUS MATERIALS
A. Contractor shall be solely responsible for initiating, maintaining, and supervising all
safety programs and precautions and shall comply with applicable safety laws, good
industry standards or practices, and take all reasonable precautions for the safety of
their workers, City property, the Public, or City of Oshkosh employees, guest, or
vendors.
B. The City of Oshkosh retains the authority to approve all chemicals and lubricants
prior to Contractor bringing them on site. The Contractor shall furnish a Material
Safety Data Sheet and proper labeling for each hazardous chemical to be brought
into the premises in compliance with OSHA Hazard Communication Standards, and
track usage for EPA reporting purposes.
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CITY OF OSHKOSH BID PROPOSAL FORM
Page 3 of 3
REFRIGERATION/COOLER ADDITION: OSHKOSH CONVENTION CENTER
SCHEDI�LE '
A. Work shall be pursued during regular working hours until complete. This work must
be specifically authorized by Jon Urben or other authorized representative of the City
of Oshkosh.
B. All work schedules shall be submitted and coordinated in advance to the designated
City of Oshkosh representative and Consultant.
INSTALlA7TON
A. Contractor shali instaii equipment as outiined in specification drawings.
PROQUCT DELIVERY, SITE ORGANIZATION AND CLEANUP
A. Contractor shall keep work areas orderly and free from debris during the course of
installation and clean up on a daily basis. If areas are not kept clean, the City of
Oshkosh may demand immediate cleanup or clean those areas and deduct cost from
contract.
B. Contractor shall regularly remove trash, materials, cartons, etc. generated by their
work from the premises.
C. Clean outside surface of Repaired and new equipment and adjacent areas of grease,
dirt and other construction debris at the time of Substantial Completion.
SIGNATURES .
Date: ����� Name of Company: %��3 ,���..
Submitted by: (name/title)����{Prn � k' V�ca-��Srr�Email: �` 4+ r n�an rn�.ec�ar��� ��G�"�
Address of Company: �0 l.�l� SQ���aC�� �t U, Phone: � t.�3f °� �`.�A
That I have examined and carefuily prepared this Proposal from the Plans and Specifications and
have checked the same in detail before submitting this Proposal; that I have full authority to
make such statements and submit this Proposal in (its) (their) behalf, and that said statements
are true and corr ct.
.
�� .
Signature Title '
�E
THE AMERIGAN 1NSTITUTE QF ARCH{T�CTS
A!A Document A3i0
�i ! s � •
KNOW ALL MEN BY THESE PRESENTS, thai we
G.M.S.,Inc. d/b/a Gartman Mechanicai Services
520 W. South Park Avenue, PO Box 2264, Oshkosh, WI 54903
as Principai, fiereinafter cailed the Principal, and
Merchants Bonding Company (Mutual)
P.O. Box 14498, Des Moines, IA 50306 - 3498
a Corporation duly organized under tf�e laws of the S#ate o€ IA
as Surety, hereinaf#er cailed ths Surety, are held and firmly t}aund unio
City of Oshkosh
215 Church Avenue, Oshkosh, WI 54901
as Obliges, hereinafter called the Obligee, in the sum of Five Percent of Amount Bid
Doliars ($_ 5% ),
for the payment of which sum wei! and truiy to be made, the said PrincipaE and the said Surery bind ourselves, our
heirs, executors, administrators, successors and assigns, jointly and severaily, firmly by these presents.
WHEREAS, #he Psincipal has submitted a bid for Project # OCC-2015-1, Refrigeration/CoolerAddition - Oshkosh
Convention Center
NOW, THEREFORE, if the Obfigee shail accept the bid of the Principal and ihe Principal shall enter inta a Contract
with the Obfigee in accordance with the terms of such bid, and give such bond or bonds as may be specified in the
bidding or Gontract Documents with good and sufficient surety for the faithfu! perforrttance of such Contract and for
the prompt payment of labor and material furnished in the prosecution thereof, or in the event of the failure of the
Principal to enter such Contract and give such bond a� bonds, if the Principai shall pay to the Obtigae ihe difference
not to exceed the penatty hereof between the amount specified in said bid and such larger amaunt for which the
Obligee may in good faiih contract with another pariy to perform the Work covered by said bid, then this obligation
shal! be nul! and void, otherwise ia remair� in fuEl force and effect.
Signed and sealed this
(Witness)
27th day of August
�`'�`�n�t�,yA �.
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hery herman (yyftness) '•.�"�"��;.�
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2015
G.M.S.,Inc. d/b/a Gartman Mechanical Services
{ Principal) (Sea!)
(Tirta)
Merchants Bonding Company (Mutual)
(SUreryj {SB81}
By: ` p� , ��JY� �.
�
(77r1e)
Pamela L. Ronski � Attorncy-in-Fact
CONFORMS WITt{ AIA DOCUMENT A310 • BfiD BDND • AIA '. FEBAUARY 1970 ED • THE AMERICAN
INS7iTUTE OF AACti1TECTS, 1735 N,Y. AVE., N.W., WASHINGTON, D.C. 20006 j
�ERC��ANTS
BONUING COMPANY,M
P4NVER OF ATTORNEY
KnowAll Persons By These Presents, that MERCHANTS BONDING COMPANY (MU7UAL) and MERCHANTS NATIONAL 80NDING,
INC., both being corporations o� the State of lowa (herein collectively called the "Companies� do hereby make, constiiute and appoint,
individually,
Pamela L. Ronski
their true and lawful Attorney-in-Fact, with full power and aufhority hereby conferred to sign, execute and acknowledge, at any
ptace within the United States, the foliowing surety bond:
Surety Sond #: Bid Bond
Principa�: G.M.S.,Inc. d/b/a Gartman Mechanical Services
Obligee: City of Oshkosh
This Power-of-Attomey is granted and is signed and seafed by facsimile under and by authority of fhe following By-Laws adopfed by the
Board of Directors of Merchants Bonding Company (Mutual) on April 23, 2011 and adopted by the Boarcl of Directors of Mer�hants
Nationai Bonding, Inc_, on October24, 201'1.
"i'he President, Secretary, Treasurer, or any Assistant Treasurer or any Assistant Secretary or any Vice P2sident shati have power and
authority to appoint Attomeys-in-Fact, and to authorize them to execufe on behalf of the Company, and attach the seal of the Company
thereto, bonds and undertakings, recognizances, contracts of indemnity and otherwritings obligatory in ths nature fhereof.°
"The signature of any authorized officer and the seal of the Company may be a�xed by facsimile or elecironic transmission to any Power of
Attomey or Certification thereof authorizing the execution and delivery of any bond, undertaking, recognizance, or other suretyship
obfigations of the Company, and such signature and seal when so used shall have the same iorce and effect as though manuaily fixed."
In connecfion with obligations in favar of the Fiorida Department of Transporfation only, it is agreed that the power and autE�ority hereby given
to the Attomey-in-Fact indudes any and ali consents for the release of retained percentages and/or final estimates on engineering and
construction contracts required by the State of Fiorida Department of Transportation. It is fully understood that consenting to the StaEe ofFlorida
Department of Transportation making payment of the final estimate to the Contractor and/or its assignee, shalt not relieve this surety company
of any of its obliga6ons under its bond.
In conneciion with obligations in favor of the Ke�tucky Deparfinent of Highways only, it is agreed that the power and authority hereby given
to the Attomey-in-Fact cannot be modified or revoked unless prior written personal notice of such intent has been given to the Commissioner-
Department of Highways of the Commonweaith of Kentucky at ieast thirty (30} days prior to the mod�cation or revocation.
ln Witness Whereof, the Companies have caused this instrument to be signed and sealed this 1st day of August , 20'(S.
`�„�. �nr.n,,,ry��
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STATE OF IOWA ',����n��n��+����',`,
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MERCHANTS BONDING COMPANY (MU7UAL}
MERC!-iANTS NATIONAI. BQNOING, INC.
BY �
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COUNTY OF DALLAS ss. President
On this 1st day of August , 2015 , before me appeared LarryTaylor, to me personaliy known, who being by me swom did say that
he is President of the MERCHANTS BONDING COMPANY {MUTUAL) and MERCHANTS NA710NAL BONDING, INC.; and that the seais a�xed
to the foregoing insicument are the Corporate seats of the Companies; and that the said instrument was signed and sealed in behaif of the
Companies by authorify of their respective Boards of Directors.
,�P¢'^�s WENDY WOODY
o s Commission Number 784b54
? ° ' My Commission Expires
�ov,,e. � June 20, 2017 tJotary Pub , o Counfy, lowa
(Expiration of notary's commission
does not invalidate this instrument)
I, William Wamer, Jr., Secretary of the MERCHANTS BONQiNG COMPANY (MUTUAL) and MERCHANTS NATIONAL BONDING, INC.,
do hereby certify that the above and foregaing is a true and correct copy af the POWER-OF-ATTORNEY executed by said Companies,
which is still in fuli force and effect and has not been amended ar revoked.
In Witness Whereof, I have hereunto set my hand and a�xed the seai of the Companies on this27th day of August , 2015 ,
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,' Addendum -1
H.C. Installation Changes City Of Oshkosh HVAC
Refrigeration/Freezer Addition
Oshkosh Convention Center
Project No. OCC-2015-1 August 27, 2Q15
The HVAC Heating Contractors shall revise and amend the Contract Documents dated
JuIY 10, 201 S& bids due August 27, 2015 for providing install work and equipment for the
above referenced project as stated in this addendum. Otherwise the original Contract
Documents shall remain in effect.
Make note of the fotlowing clarifcation items for the above bid, after walk through.
All Electricai & Fire Protection Contractors who want to tour this building are to
Terry Smith at 920-379-2262:
Electrical Outlets on the wall:
1) The city electrician will be handling this portion of the project. The HC therefore
will not have to address this electrical work in their bids.
Control Work:
1) The only thing that needs to be address is the new fire protection heads must be
connected to the existing fire control system.
By: Jael Clary PE.
/�'i
. f __ �---
Page 1 of 2
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✓^�, GMSINCG-01 BROWNCM
.acoizv� CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY)
�� 8/25/2015
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
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
IMPORTANT: It the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to
the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the
ceRificate hoider in lieu of such endorsement(s).
PRODUCER NAMEACT W����s Certificate Center
Willis of Wisconsin, IIIC. PHONE g�� 945-7378 FAx
c/o 26 Century Blvd A/C No ex� :( � A/C No :�888� 467-237$
P.O. Box 305191 E-MAIL Certificates willis.com
ADDRESS:
Nashville, TN 37230-5191
INSURER�S) AFPORDING COVERAGE NAIC #
�n,suReRn:Cincinnati Insurance Company 10677
INSURED INSURERB:CI�ICI�1178t1 CaSUBItV COIT1D811V 28665
GMS, Inc. DBA Gartman Mechanical Services INSURER C:
520 W South Park Avenue INSURER D:
OShkOSh, WI rJ49�2-���0 INSURERE:
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.
ILTR TYPE OF INSURANCE INSD WVD POLICY NUMBER MM/�DDY/YYYY MM/DDYIYYYY LIMITS
A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ ��OOO�OO
CLAIMS-MADE � OCCUR X X EBA/EPP 028 93 29 72/06/2�14 12/06/2015 pREMISES Ea occurrence S 5�0,00
MED EXP (Any one person) s 10,000
PERSONALBADVINJURY $ 'I,OOO,OO
GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ Z,OOO,OO
POLICY � jE o- � LOC PRODUCTS - COMP/OP AGG $ Z,OOO�OO
orHeR: PD Per Occ Ded s 2,00
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT g 'I OOO OO
Ea accident > >
A X ANY AUTO X EBA/EPP 028 93 29 � 2/06/2014 72/06/2015 BODILY INJURY (Per person) $
ALL OWNED SCHEDULED BODILY INJURY (Per accident) S �
AUTOS AUTOS
NON-OWNED PROPERTY DAMAGE $
HIREDAUTOS AUTOS Peraccident
$
UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ S�OOO�OO
A X EXCESS LIAB CLAIMS-MADE X EPP 028 93 29 12/06/2014 12/06/2015 AGGREGATE $ 5,0�0,��
DED X RETENTION $ 0 $
WORKERS COMPENSATION X PER OTH-
AND EMPLOYERS' LIABILITY STATUTE ER
B ANYPROPRIETOR/PARTNER/EXECUTIVE Y�N WC1926583-02 12/06/2014 12/06/2015 E.L.EACHACCIDENT $ ��0���
OFFICER/MEMBER EXCLUDED? � N � A
(Mandatory In NH) E.L. DISEASE - EA EMPLOYEE $ 'I OO,OO
If yes, describe under
DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICV LIMIT $ rJOO,OO
p Contractors E80 EBA/EPP 028 93 29 12/06/2014 72/06/2015 Per Claim / Agg: 500,00
DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
RE: Refrigeration/Cooler Addition - Oshkosh Convention Center, Project # OCC-2015-1
City of Oshkosh, and its Officers, Council Members, Agents, Employees and Authorized Volunteers are hereby named as Additional Insureds with respects to
the General Liability, Automobile Liability and Umbrella Liability for work performed by the Insured as required in the written contracUagreement.
Blanket Additional Insured applies on the General Liability when required as per GA233 (02/07� Contractors Commercial General Liability Broadened
Endorsement. Coverage applies for completed operations.
Blanket Waiver of Subrogation applies on the General Liability when required as per GA233 (02/07n Contractors Commercial General Liability Broadened
SEE ATTACHED ACORD 101
CERTIFICATE H
City of Oshkosh
Attn: City Clerk
215 Church Avenue
P O Box 1130
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVE
-- ,
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O 1988-2014 ACORD CORPORATION. Ali rights reserved.
ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD
/"�
ACORO�
��
AGENCY CUSTOMER ID: GMSINCG-01
LOC #: 0
ADDITIONAL REMARKS SCHEDULE
AGENCY NAMEDINSURED
illis of WisCOnsin, InC. GMS, Inc. DBA Gartman Mechanicai Services
520 W South Park Avenue
POLICY NUMBER OShkOSh, UVI 54902-0000
EE PAGE 1
CARRIER NAIC CODE
EE PAGE 1 SEE P 1 EFFECTIVE DATE: SEE PAGE �
ADDITIONAL REMARKS
BROWNCM
Page 1 of 1
ACORD 101 (2008/01) O 2008 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD
THIS ENDORSEMENT CHAIdGES THE POLICY. PlEASE READ IT CAREFULLY.
CC�NTRACTfJRS` C�MMERCIAL GENERAL LIABILITY
BROADENED ENDORSEMENT
This endorsement modifias insurance provided under the followinc�:
GOMMERCIAL, GENERAL IJABILI7Y COVERAGE PART
A. Endorsement - Table of Contents:
Coveraqe:
1. Employee Bene#it Liability Goverage .........................................................................
2, Unintentional Failure to Disclose Hazards .................................................................
3. Damage to Premises Rented to You ..........................................................................
4. Supplementary Payments ..........................................................................................
5. Medical Payments .......................................................................................................
6. Voluntary Property Damage {Goverage a.) and Care, Custody or Control
Liability Coverage (Coverage b,j ................................................................................
7. 180 Day Coverage for Newly Formed or Acquired �rganizations ...........................
8. Waiver of Subrogation ................................................................................................
9. Automatic Additionai Insured - 5pecified Relationships : .........................................
• Managers or Lessors of Premises;
• Lessor of Leased Equipment;
• Vendors;
• State or Political Subdivisions - Permits Relating to Premises;
. State or Politicaf Subdivisions - Permits; and
• Contractors' Operations
10. Broadened Gontractual Liability - Work Within 50' of Railroad Property ..................
11. Property Damage to Borrowed Equipment ................................................................
12. Employess as lnsureds - Specified Health Care Services : .....................................
• Nurses;
• Emergency Medical Technicians; and
• Paramedics
13. Broadened Notice of Qccurrence ...............................................................................
B. Limits of Insurance:
Beqins on Paae:
........................ 2
........................ 7
........................ 8
........................ 9
........................ 9
......................... 9
....................... 70
.......................10
.......................10
....................... 14
....................... 14
....................... � a
................... 14
7he Commercial Generai Liability Limits of Insurance apply to the insurance provided by Fhis endorse-
ment, except as provided below:
1. Employee Benefii Liability Coverage
Each Employee Limif: $ 1,000,000
Aggregate Limit: $ 3,000,000
Deductible: $ 1,000
3. Damage to Premises Rented io You
The lesser of:
a. The Each Occurrence Limit shown in the Declarations; or
b. $500,000 unless otherwise stated $
4. Supplementary Payments
a. Bail bonds: $
b. Loss of earnings: $
5. Medical Payments
1,000
350
Medical Expense Limit: $ 10,000
GA 233 02 07
Includes copyrighted material of Insurance
Services �ffice, Inc., with its permission.
Page 1 of 15
6, Voluntary Property Damage (Coverac�e a.) and Care, Custody or Control Liability Coverage
(Coverage b.}
Limits of Insurance (Each Occurrence)
Coverage a. $1,000
Coverage b. $5,00� unless otherwise stated
Deductibles (Each Occurrencej
Coverage a. $250
Coverage b. $250 unless otherwise stated
$
COVERAGE PREMIUM BASfS RATE ADVANCE PREMIUM
(a) Area {For Limits in Excess of (For Limits in Excess of
(b) Payroll $�,p00) $5,000}
(c} Gross Sales
d) Units
e Qther
b. Care, Gustody �
or Control
i' TA ANNUA PREM UM
11. Property Damage to Borrowed Equipment
Each Occurrence Limit: $ 10,000
Deduciible: $ 250
C. Coverages:
1. �mployee Benefit Liability Coverage
a. The following is added to SECTIOfV I
- COVERAGES: Ernployee Benefit
Liabili#y Goverage.
(1) lnsuring Agreement
(a) We will pay those sums that
tlie insured becomes legally
obligated to pay as dam-
ages caused by any act, er-
ror or omission of the in-
sured, or of any other per-
son for whose acts the in-
sured is legally liable, to
which this insurance ap-
plies. We will have the right
and duty to defend the in-
sured against any "suit"
saeking ti�ose damages.
However, we wilf have no
duty to defend against any
"suit" seeking damages to
whicl� this insurance does
not ap�ly. We may, at our
discretion, investigate any
report of an act, error or
omission and settle any
claim or "suit" ihat may re-
suft. But:
1) The amountwe will �ay
for damages is limited
as described in SEC-
TION III - LIMITS OF
INSURANCE; and
2) Our right and duty to
defend ends when we
have used up the ap-
plicable limit of insur-
ance in the payment of
judgments or settle-
ments.
No oiher obligation or liabil-
ity to pay sums or perform
acts or services is covered
unless explicitly provided for
under Supplemenkary Pay-
me�its.
(b) 7his insurance appfies to
cfamages only if the act, er-
ror or ornission, is negli-
gently committed in the
"administration" of your
"employee benefit pro-
gram"; and
1) Uccurs during the pol-
icy period; or
2} Occurred prior to the
effeciive date of this
endorsement provided:
a} You did ��oE have
knowledge of a
claim or "suit" on
or before the ef-
fective date of this
endorsement.
You will be
deemed to have
knowledge of a
claim or "suit"
when any
"authorized repre-
sentative";
Includes copyrighted material of Insurance
GA 233 02 07 Services Office, (nc., with its permission. Page 2 of i5
i) Reports all, or
any part, of the
act, error or
omissian to us
or any other
in surer;
ii) Receives a
written or ver-
bal demand or
claim for dam-
ages because
of the act, er-
ror or omis-
sivn; and
b) There is no other
applicable insur-
ance.
(2} Exclusions
This insurance does not apply
to:
(a) Bodily Injury, Property
Damage or Personal and
Advertising Injury
"Bodily injury", "property
damage" or "personal and
advertising injury".
(b) Dishonest, Fraudufenf,
Criminai or Malicious Act
Damages arising out of any
intentional, dishonest,
fraudufent, criminal or mali-
cious act, error or omission,
committed by any insured,
including the willful or reck-
iess violation of any statute.
{c) Failure to Perform a Con-
tract
Damages arising out of fail-
ure of perforrrtance af con-
tract by any insurer.
(d) Insufticiency of Funds
Darnages arising out of an
insu#ficiency of iunds to
meet any abligations under
any plan included in the
"employee benefit pro-
gram".
(e) lnadequacy nf Perform-
ance of Investment / Ad-
vice Given Wifh Respeci
to Participation
Any claim based upon:
1) FaiEure of any invest-
ment to perform;
2) Errors in providing in-
formation on past per-
formance of investment
vehicles; or
3) Advice given to any
person with raspect to
that person's decision
to participate or not to
participate in any plan
included in the "em-
ployee bensfit pro-
g ram".
(f} Workers' Compensation
and Similar Laws
Any claim arising out of
your failure to comply with
the mandatory provisions of
any workers' compensation,
unemployment compensa-
tion insurance, social secu-
rity or disability bsnsfits Eaw
or any similar law.
{g) ERISA
Damages for which any in-
surec! is liabie because of
liability imposed on a fiduci-
ary by the Employea Re-
tirement Income Security
Act of 1974, as now or
hereafter amended, or by
any similar federal, state or
local laws.
(h) Available Benefits
Any clafm for benefits to the
extent tliat such benefits
ars available, with reason-
able effort and cooperation
of the insured, from the ap-
plicable funds accrued or
other collectible insurance,
(i) Taxes, Fines or Penalties
Taxes, fines or penalties,
including those imposed
under the Internal Revenus
Code ar any similar state or
local law.
(j) Employment-Related
Practices
Any liability arising out of
any:
(1) Refusal to employ;
t2) Termination of em-
ployment;
(3} Coercion, demotion,
evalttation, reassign-
ment, discipline, defa-
mation, harassment,
humiliation, discrimina-
tion or other employ-
Includes copyrighted material of Insurance
GA 233 U2 07 Services �ffice, Inc., with its permission. Page 3 of 15
ment-related practices,
acts or omissiot3s; or
(4} Consequential liability
as a result of (7), {2) or
(3) above.
This exclusion applies
whether the insured may be
hefd liable as an employer
or i�� any other capacity and
to any obligation Eo share
damages witf� or repay
someone else who must
pay damages 6ecause of
the injury.
(3) Supplementary Payments
SECTION 1 - COVERAGES,
SUPPLEMENTARY PAY-
MENTS - CUVERAGES A AND
B also appEy to tf�is Coverage,
b. Who is an Insured
As respects Employee Bene#it Liabil-
ity Coverage, SECTIDN ll - WH� !S
AN 1NSURED is deleted in its en-
tirety and replaced by the following;
(1) If you are designated in the
Declarations as:
(a) An individual, you and your
spouse are insureds, but
only with respect to the
conduct of a business of
which you are tlze sole
owner.
(b) A partnership or joint ven-
ture, you are an insured.
Your members, your part-
ners, and their spouses are
also insureds but onfy with
respect to the conduct of
yaur busin�ss.
(c) A limited liability company,
you ars an insured. Your
members are afso insureds,
but only with respect to the
conduct of your business.
Your managers are in-
sureds, but only with re-
spect to their duties as your
managers.
(d} An organization other than
a partnership, joint venture
or fimited liabil�ty company,
you are an insured. Your
"executive officers" and di-
rectors are 'tnsureds, but
onfy with respect to iheir
duties as your officers or di-
recto��s. Your stockholders
are also insureds, but only
with respect to their liability
as stookholders.
c.
{e) A trust, you are an insured.
Your trustees are also in-
sureds, but only with re-
spect #o their dutiss as
trustees.
(2) Each of tl�e following is afso an
insured:
(a) Each of your "empioyees"
who is or was authorized to
administer your "employea
benefit program".
(b} Any persons, organizations
or "employees" having
proper temporary autfiori-
zation to administer your
"employee benefit program"
if you die, but only until your
legal representative is ap-
pointed.
(c) Your legal representative if
you die, but only with re-
spect to duties as suc11.
That representative will
have all your rights and du-
ties under this Coverage
Part.
(3) Any organization you newly ac-
quire or form, other than a part-
nership, joint venture or limited
liability company, and over
which yau maintain ownership
or majority interest, will qualify
as a Named Insured if no other
similar insurance applies to that
organization. However, cover-
age under this provision:
(a) Is afforded only until the
180th day after you acquire
or form the organization or
the end of the policy period,
whichever is earlier; and
(b) Does not apply to any act,
error or omission that was
committed before you ac-
guired or formed the or-
ganization.
Limits of Insurance
As respects Employee Benefit Liabil-
ity Coverage, SEC710N III - LIMITS
�F tNSURANCE is cleleted in its en-
tirety and replaced by the following:
(1) ihe Limits of Insurance shown
ir� Section B. Limi#s of Insur-
ance, 1. Employee Benefif Li-
ability Coverage and the rules
below fix the most we will pay
regardless of the number of:
(a) Insureds;
]ncludes copyrighted material of Insurance
GA 233 02 07 Services Office, Inc., with its �ermission. Page 4 of 15
(b) Claims mada or "sui�s"
brought;
(c} persons or organizations
making claims or bringing
"suits' ;
(d) Acts, errors or omissions; or
(e) Benefits included in your
"employee benefit pro-
gram".
(2) The Aggregate Limit shown in
Section B. Limits af Insurance,
1. Employee Benefit Liability
Coverage of this endorsement
is the most we will pay for all
damagas because of acts, er-
rors or omissions negligently
committed in tlie "administra-
tion" of your "employee benefit
program".
(3) Subject to the limit described in
(2) above, the Each Employee
Limit shown in Section B. Limits
of Insurance, 1. Employee
Benefit Liability Coverage of
this endorsement is tha most we
will pay for all damages sus-
#ained by any one "employee",
including damages sustained by
such "employee's" dependents
and beneficiaries, as a result of:
(a) An act, error or omission; or
(b} A series of related acts, er-
rors or omissions, regard-
less of ihe amount of time
that lapses between such
acts, errors or omissions,
negligently committed in the
"administration" of your "em-
ployee benefit program".
However, the amount paid un-
der this endorsement shall not
exceed, and will be subject to
the fimits and restrictions that
apply to the payment of benefits
in a►iy plan included in the "em-
ployes benefit program".
(4) Decluciible Amount
(a) Our obligation to pay dam-
ages on bef�alf of the in-
sured applies onEy to the
amount of damages in ex-
cess of the deductible
amount sta#ed in the Decla-
rations as applicable to
Each Employee. The limits
of insurance shall not be
reduced by tha amount of
this deductible.
(b) The deductible amount
stated in the Declarations
applies to all damages
sustained by any one "em-
ployee", including such
"employee's" dependents
and bene#iciaries, becauss
of all acts, errors or omis-
sions to which this insur-
ance applies.
{c) The terms of this insurance,
including those with respect
to:
1) Our right and duty to
defend the insured
against any "suits"
seaking those dam-
ages;and
2) Your duties, and the
duties of any other in-
volved insured, in the
event of an act, error or
omission, or claim,
apply irrespective of the
appl�catio�� of the deductible
amount.
(d) We may pay ar�y part or all
of the deductible amount to
effect settlement of any
claim or "suit" and, upon
notification of the action
taken, you shafl promp�y
reimburse us for such part
of the deductible amount as
we have paid.
d. Additional Conditions
As respects Employee Benefit Li-
ability Coverage, SECTION IV -
COMMERCIAL GENERAL LIABIL-
!1'Y Cc7NDIT10NS is amended as
follows;
(1) Item 2. Duiies in the Event of
�ccurrence, O#fense, C1aim or
Suifi is deleted in its entirety and
replaced by the following:
2. Duiies in the Event of an Aci, Error or
�mission, or Claim or Suit
a. You must see to it that we are noti-
fied as saon as practicable of an act,
error or omissian which may result in
a claim. To the extent possible, no-
tice should irtclude;
(1) What the act, error or omission
was and when it occurred; and
(2) The names and addresses of
anyone who may suffer dam-
ages as a result of the act, error
or omission,
Includes copyrighted material of Insurance
GA 233 02 07 Services Office, Inc., with its permission. Page 5 of 15
b. !f a claim is made or "suit" is brought
againstany insured, you must:
(1) Immediately record the specifics
of the ciaim or "suit" and the
date received; and
(2} Notify us as soon as practicable.
You must see to it that we receive
written notice of the claim or "suit" as
soon as practicable.
c. You and any other involved insured
must:
(1) Immediately send us copies of
any demands, notices, sum-
monses or legal papers re-
ceived in connection with the
claim or "suit";
(2) Authorize us ta obtain records
and other ii�tformation;
(3) Cooperate with us in the ii�vesti-
gation or settlement of the claim
or defense against the "suit";
and
(4) Assist us, upon our request, in
the enforcement of any right
against any person or organiza-
tion which may be liable to #he
insured because of an act, error
or omission to which this insur-
ance may afso apply.
d. No insured will, except at that in-
sured's own cost, voluntari(y make a
payment, assume any oblic�ation, or
incur any expense without our con-
sent.
{2) Item 5. Ather Insurance is de-
leted in its entirety and replaced
by the following:
5. Other lnsurance
If other valid anc! collectible
insurance is available to the
insured for a loss we cover
under this Coverage Part,
our obligations are iimited
as follows:
a. Primary Insurance
This insurance is pri-
mary except when c.
below applies. I# this
insurance is primary,
aur obligations are not
affected unEess any of
the o#her insurance is
also primary. Then, we
will share with all that
otf}er insurance by the
method described in b.
below.
b.
c.
Method of Sharing
If all of the other insur-
aizce permits contribu-
tion by equal shares,
we will follow this
method also. Under
tliis approach each in-
surer contributes equal
amounts until it has
paid ifs applicabfe limit
of insurance or none of
the ]oss remains,
whichever comes first.
If any of the o#her in-
surance does not per-
mit contribution by
equal shares, we will
contribute by limits.
Under this method,
each insurer's share is
based on the ratio of its
applicable limit of in-
surance to the total ap-
plicable limits of insur-
ance of all insurers.
No Coverage
This insuraiice shall not
cover any loss for
which the insured is
entitled to recovery un-
der any other insur-
ance in force previous
to the effective date of
this Coverage Part.
e. Additional Definitions
As respects Employee Benefit E.i-
abiiity Coverage, SECTION V -
DEFINITI�NS is amended as fol-
lows:
(1) The following definitions are
added:
1. "Administration" means:
a. Providing information to
"employees", inc[uding
their dependents and
beneficiaries, with re-
spect to eligibility for or
scope of "employee
benefit programs';
b. Interpreting the "em-
ployee benefit pro-
grams";
c. Handling records in
connection with the
"employee benefit pro-
grams"; or
d. Effecting, continuing or
terminating any "em-
ployee's" participation
Includes copyrighted material of Insurance
GA 233 02 07 Servicss Office, Inc., with its permission. Page 6 ot'15
in any benefit included
in the "employee bene-
fit program".
However, "administration"
does not include:
a. Handling payroll de-
cluctions; or
b. The failure to effect or
maintain any insurance
or adequate {imits of
coverage of insurance,
inciuding but nofi limited
fo unemployment in-
surance, social security
benefits, workars' com-
pensatian and disability
benefits.
2. "Cafeteria plans" means
plan authorized by applica-
b!e law to allow "employ-
ees" to elect fo pay for cer-
tain benefits with pre-tax
dollars.
3. "Employee benefit pro-
grams" means a program
providing some or all of the
following benefits to "em-
ployees", whether provided
through a "cafeEeria plan" or
atherwise;
a. Croup life insurance;
group accident or
health insurance; den-
tal, vision and hearing
plans; and flexible
spending accounts;
provided that no one
other than an "em-
ployee" may subscribe
to such benefits and
such benefits are made
generally available to
those "employees" who
satisfy #he plan's eligi-
bility requirements;
b. Profit sharing plans,
employee savings
plans, employee stock
ownership plans, pen-
sion plans and stock
subscription pians,
provided that no one
other than an "em-
ployee" may subscribe
to such benefits and
such benefits are made
generally available io
all "employees" who
are eligible under the
plan for suci� benefits;
c. Unemp{oyment insur-
ance, social security
benefits, workers' com-
pensation and disability
benefits; and
d. Vacation plans, includ-
ing buy and sell pro-
grams; leave of ab-
sence programs, in-
cluding military, mater-
nity, family, and civil
leave; fuition assis-
tance plans; transpor-
tation ancf health club
subsidies.
{2) The following definitions are
deleted in their entirety and re-
placed by the following:
21. "Suit" means a civil pro-
ceeding in which money
damages because of an
act, error or omission to
which this insurance applies
are alleged. "Suit" includes:
a. An arbi#ration pro-
ceeding in which such
damages are claimed
and to which the in-
sured must submit or
does submit with our
consent;
b. Any other alternative
dispute rssolution pro-
ceeding in which such
damages are claimed
and to which the in-
sured submits with our
consent; or
c. An appeal of a civil
proceeding,
8. "Employee" means a per-
son actively employed, for-
merly empioyed, on leave
of absence or disabled, or
retired. "Employee" in-
cludes a "leased worker".
"Employee" does not in-
clude a "temporary worker".
2. Uninientional Failure to Disclose Hax-
ards
SECTION IV - COMMERCIAL. GENERAL
LIABILITY CONDITIONS, 7. Represen-
tations is hereby amended by the addi-
tion of the following;
Based on our dependence upon your
representations as to existin� hazards, if
unintentionally you should fail to disclose
a[I such hazards at ths inception date of
your policy, we wilf not reject coverage
under this Coverage Part based sofely on
such failure.
lncludes copyrigl�ted maEerial of Insurance
GA 233 02 07 Serrrices �ffice, Inc,, with its permission. Page 7 of 15
3. Damage to Premises Renled to You
a. �ihe las# Subparagraph of Paragraph
2. SECTION I - COVERAGES,
COVERAGE A. - B�DILY lNJURY
AND PRUPERTY QAMAGE, 2. L!-
ABiLITY Exclusions is hereby de-
leted and replaced by the following:
Exclusions c. #hrough q. do not a�ply
to damage by fire, explosion, fight-
ning, smoke or soot to premises
while rented to you or temporarily
occupied by you with permission of
the owner,
b. The insurance provided ur�der SEC-
TION I - COVERACES, COVERAGE
A. BODILY INJURY AND PROP-
ERTY DAMAGE LIABlLITY applies
#o "property damage" arising out of
water damage to premises tha# are
botli rented to and occupied by you.
(1) As respects Water Damage Le-
gal Liability, as provided in
Paragraph 3.b. above:
The exclusions under SECTION
I - COVERAGES, COVERAGE
A. BUI]ILY INJURY AND
P�iOPERTY DAMAGE LIABIL.-
ITY, 2. Exclusions, other than i.
War and the Nuclear Energy
Liability Exciusion, are deleted
and the foffowing are added:
This insurai�ce does not apply
to:
(a) "Property damage":
1) Assumed in any con-
tract; or
2) Loss caused by or re-
sultin� from any of the
followmg:
a) Wear and tear;
b) Rust, corrosion,
fungus, decay,
deterioration, hid-
den or latent de-
fect or any quality
in property that
causes it ta dam-
age ar destroy it-
self;
c) Smog;
d) Mechanical
breakdown in-
cluding rupture or
bursting caused
by centrifugal
force;
e) Settfing, cracking,
shrinking or ex-
pansion; or
f) Nes�ing or infesta-
tion, or discharge
or release of
waste products or
secretions, by in-
sects, birds, ro-
dents or other
animais.
(b) Loss caused direcTly or indi-
rectly by any of the follow-
ing:
1) Earthquake, volcanic
eruption, landslide or
any other earth move-
ment;
2) Water that backs up or
overflows from a
sewer, drain or sump;
3) Water under the
ground surface press-
ing on, or flowing or
seeping through:
a) Foundations,
walls, floors or
paved surfaces;
b) Basements,
whether pavec! or
not; or
c) Doors, windows or
other openings.
{c) Loss caused by or resulting
from water that ieaks or
flows from plumbing, heat-
ing, air conditioning, or fire
protection systems caused
by or resultmg from freez-
ing, unless:
1) You did your best to
maintain heat in the
building or structure; or
2) You drained the
equipment and shut off
the water supply if the
heat was not main-
tained.
(d) Loss to or damage to;
1� Plumbing, heating, air
condifioning, fire pro-
tection systems, or
other equipment or ap-
pliances; or
2) The interior of any
building or structure, or
to personal property in
the building or struct�ire
Includes copyrighted material of Insurance
GA 233 02 O7 Services Office, Inc., witli its permission. Page 8 of 15
caused by or resulting
from rain, snow, sleet
or ice, whather driven
by wind or nat,
c. Limit of lnsurance
The Damage to Premisss Rented to
You Limit as shown in the Declara-
tians is amended as follows:
{2) Paragraph 6. of SECT[ON 111 -
LIMITS OF INSURANCE is
hereby deleted and replaced by
the following:
6. Subject to 5. above, the
Damage to Premises
Rented to You Limit is the
most we will pay under
COVERAGE A. BODILY
INJURY AND PR�PER7Y
DAMAGE LIABILITY, for
damages because of
"property damage" to
premises while rented #o
you or temporarily occupied
by you with permission of
the owner, arising out of
any one "occurrence" to
which this insurance ap-
plies,
(3) The amount we will pay is lim-
ited as described in Section B.
Limits of Insurance, 3. Dam-
age to Premises Rented to
You of this endorsement.
4. Supplementary Paymenis
l.inder SECTION 1- COVERAGE, SUP-
PLEMENTARY PAYMENTS - COVEFi-
AGES A AND B:
a. Paragraph 2. is repfaced by ths fof-
lowing;
Up to the limit shown in Section �.
Limits nf Insurance, 4.a. Bail Bonds
of this endorsemen# for cost of bail
bonds required because of accidents
or traffic ]aw violations arising out of
the use of any vehicle to which the
Bodily Injury Liability Coverage ap-
plies. We do not have to furnish
these bonds.
b. Paragraph 4. is replaced by the fol-
lowing:
All reasonable expenses incurred by
the insured at our request to assist
us in the investigation or defense of
the ciaim or "suit", including actua!
loss of earnings up to the limit shown
in Section B. Limils of Insurance,
4.b. Loss of Earnings ot this en-
dorsement per day because of time
off from work.
5. Medical Payments
The Medical Expense Limit of Any One
Person as stated in the Dsclarations is
amended to the limit shown in Section B.
Limits of Insurance, 5. Medical Pay-
ments of this endorsement.
6. Voluntary Property Damage and Care,
Custody or Con#rol Liability Coverage
a, Voluniary Property Damage Cov-
erage
We will pay for "property damage" to
property of others arising aut of ap-
erations incidental to the insured's
business when:
{i) Damage is caused by the in-
sured; or
(2) bamage occurs while in the in-
sured`s possession.
With your consent, we will make
these payments regardless of fault.
b. Care, Cusiody or Control Liability
Coverage
SEC710N I - COVERAGES, COV-
ERAGE A. BODILY INJURY AND
PROPERTY DAMAGE LIABILI7Y, 2.
Exclusions, j. Qamage to Pro erfy,
Subparagraphs (3), (4) and �5) do
not apply to "property damage" to
the property of othsrs described
therein.
With respect to the insurance provided by
this section of the endorsement, the fol-
lowing additional provisions apply;
a. The Limits of Insurance shown in ths
Declarations are replaced by the lim-
its designated in Section B. Limits of
Insurance, 6. Voluntary Properiy
Damage and Care, Custody or
Control Liability Coverage of this
endorsement with respect to cover-
age provided by this endorsement.
These limi#s ars inclusive of and not
in addition to the limits being re-
pEaced, `fhe Limits of Insurance
shown in Section B. Limiis of lnsur-
ance, 6. Voluntary Property Dam-
age and Care, Custody or Controk
Liability Cuverage of this endorse-
meni fix the most we wilf pay in any
one "occurrence" regardless of the
number of:
{i) Insureds;
{2) Claims made ar "suits" brought;
or
(3) Persons or organizations mak-
ing claims or bringing "suits".
Includes copyrighted materiaf of Insurance
GA 233 02 07 Services Office, lnc., with its permission, Page 9 of 15
b. Deduciible Ctause
(1) C7ur obligation to pa� damages
on your behalf applies only to
the amount of damages for each
"occurrence" which are in ex-
cess of the decluctible amount
stated in Section B. Limits of
Insarance, 6. Voluntary Prop-
erty Damage and Care, Cus-
tody or Control Liability Cov-
erage of this endorsement. 7he
limits of insura�ice wil( not be re-
duced by the application of such
deductible amount.
{2) Conditioi� 2. Duties in the Event
of bccurrence, Uftense, Claim
or Suit, applies to each claim or
"suit" irrespective of the amount.
(3) We may pay any part or all of
the deductible amount to effect
settlement of any cfaim or "suit"
and, upon notification of the ac-
tion taken, you shall pramptly
reimburse us for such part oi the
deductible amount as has been
paid by us.
7. 180 Day Coverage for Newly Formed or
Acquired �rganizationa
SECTION II - WHC7 IS AN INSURED is
amended as follows:
Subparagraph a. of Paragrapf� 4. is
hereby deleted and replaced by the fol-
lowing:
a. li�surance under this provision is af-
forded only until the 18otli day after
you acq�i�-e or form the o��ganization
or the end of the policy period,
whichever is earlier;
8. Waiver of Subrogation
SECTIaN IV - COMMERCIAL GEHERAL
LlABILITY CONDITIONS, 9. Transfer of
Rights of Recovery Against Others 10
Us is hereby amended by the addition of
the following:
We waive any rigl�t oi recovery we may
have because of payments we make for
injury or damage arising out of your on-
going operations or "your work" done un-
der a writfen conEract requiring such
waiver with tl�at person or organization
and included in the "products-completed
operations hazard". However, our rights
may only be waived prior to the "occur-
rence" giving rise to tlie injury or damage
for which we make payment under this
Coverage Part, Tiie insured must do
notl�ing after a loss to impair our rights.
At our req��est, the insured will bring "suit"
or transfer those rigl�ts to us and i�elp us
enforce thoss rights.
9. Automatic Additional Insurecf - Speci-
fied Relationships
a. The following is hereby added to
SEGTION II - WHO IS AN INSURED:
(1) Any person or organization de-
scribed in Paragraph 9.a.(2)
below (l�ereinafter referred to as
additional insured) whom you
are required to add as an addi-
tional ins�ired under this Cover-
age Part by reason of:
(a) A written contract or
agreement; or
(b) An orai agreement or con-
tract where a certificate of
insurance showing that per-
son or organization as an
additional insured has been
issued,
is an insured, provided:
(a) The written or oral contract
or agreement is:
1) Currently in effect or
becomes effective
during the policy pe-
riod; and
2) Executed prior to an
"occurrence" or offense
to which #his insurance
would apply; and
(b) ihey are not specifically
named as an additional in-
sured under any other pro-
vision of, or endorsement
added to, this Coverage
Part.
(2) Oniy the following persons or
organizations are additional in-
sureds under this endorsement,
and insurance coverage pro-
vided to such additional in-
sureds is limited as provided,
hereii�:
(a) The manager or lessor of a
premises leased to you with
whom you have agreed per
Parac�raph 9.a.(1) above to
provide insurance, but only
with respect to liability aris-
ing out of #he ownership,
maintenance or use of that
part of a premises leased to
you, subject to the following
additiona) exclusions:
Tl�is insurance does not
apply to:
1} Any "occurrence"
which takes place after
Includes copyrighted materiai of Insurance
GA 233 02 07 Services Office, Inc., with its permission. Page 10 of 15
�
you cease to be a ten-
ant in that premises,
2) Structural aiterations,
new construction or
demoiiiion operations
performed by or on be-
half of such adcEitional
insured.
{b} Any person or organization
from which you lease
equipment with whom you
have agread per Paragraph
9.a.(1) above to provide in-
surance. Such person(s} or
organization(s) are insureds
solely with raspect to their
liabifity arising out of the
maintenance, operation or
use by you of equipment
leased to you by such per-
son{s} or organizations(s).
However, this insurancs
does not apply to any "oc-
currence" which takes place
after the equipment lease
expirss.
(c) Any person or organization
(referred to befow as ven-
dor) with whom you have
agreed per Paragraph
9.a.(1} above to provide in-
surance, but only with re-
spect to "bodily injury" or
"property damage" arising
out of "your products" which
are distributed or sold in the
regular course of the ven-
dor's business, subject to
the folfowing additional ex-
cEusions:
1) The insurance afforded
the vendor daes not
apply to:
a} "Bodily injury" or
"properry damage"
for which the ven-
dor is obligated to
pay damages by
reason of the as-
sumption of liabil-
ity in a cvntract or
agreement. This
exclusion does not
apply to liability for
damages that the
vendor would
have in the ab-
sence of the can-
traci or agree-
rnent;
b) Any express war-
ranty unauthorized
by you;
c) Any physical or
chernicaf change
in the product
made intentionally
by the vendor;
d) Repackaging, un-
less unpacked
soleiy for the pur-
pose of inspection,
demonstration,
testing, or the
substitution of
parts under in-
structions from the
manufacturer, and
then repacka�ed
in the original
container;
e) Any failure to
make such in-
spections, adjust-
ments, tests or
servicing as the
vendor has
agreed to make or
normally under-
takes to make in
the usual course
of business, in
connection with
the distribuiion or
sale of the prod-
ucts;
f) Demonstration, in-
stalfation, servic-
ing or repair op-
erations, except
such operations
performed at the
vendor's premises
in connection with
the sale of the
product;
g} Products which,
after distribution or
sals by you, have
been labeled or
refabeled or used
as a container,
part or ingredient
of any other thing
or substance by or
for the vendor.
2) This insurance does
not apply to any in-
sured person or or-
ganization:
a} From whom you
have acquired
such products, or
any ingredien#,
part or container,
entering into, ac-
Includes copyrighted material of Insurance
GA 233 02 07 Services Office, Inc., with its permission. Page 11 of 15
companying or
containing such
products; or
b} Wl1en fiability in-
cluded within the
"prodL�cts-
completed opera-
tions hazard" has
been excluded
�mder this Cover-
age Part with re-
spect to such
products.
(d) Any state or political subdi-
vision with which you have
agreed per Paragra�h
9.a.{1) above to provide in-
surance, subject io the fol-
lowing additional provision:
This insurance applies only
with respect to the following
hazards for whic4i the state
or political subdivision has
issued a permit in connec-
tion with premises you own,
rent or control and to which
this insurance applies:
1) The existence, rnainte-
nance, repair, con-
struction, erection, or
removal of advertising
sigils, awnings, cano-
pies, celiar .entrances,
coal holes, driveways,
manholes, marquees,
hoist away openings,
sidewalk vaults, sireet
banners, or dacora-
tions and similar expo-
sures; or
2) Tiie construction, erec-
tion, or removal of ele-
vators; oE�
3) The ownership, main-
te��ance, or use of any
elevators coversd by
this insurance.
{e) Any state or political subdi-
vision with which you have
agreed per Paragrapli
9.a.(1) above to provide m-
surance, subject to the fol-
lowing provisions:
1) This insurance applies
only witl� respect to op-
erations performed by
you or on your behalf
for wliich tlie state or
political subdivision f�as
issued a permit.
2) This insurance does
not apply to "bodily in-
jury", "property dam-
age" or "personal and
advertising injury" aris-
ing out of operations
performed for Ehe state
or politicai subdivision.
(f) Any person or organization
with which you have agreed
per Paragraph 9.a.(1)
above to provide insurance,
but only with respect to ii-
ability arising out of "your
work" pertormed for that
additionaf insured by you or
on your behalf. A person or
organization's status as an
insured under this provision
of this endorsement contin-
ues for only the period of
time required by the written
contract or agreement, but
in no event beyond the ex-
piration date of tl�is Cover-
age Part. If there is no
written contract or agree-
ment, or if no period of time
is required by #he written
contract or agreement, a
person or orc�anization's
status as an insurecE under
this endorsement ends
when your operations for
that insured are completed.
(3j Any insura��ce provided to an
additionaf iiisured designated
under Paragraph 9.a.(2):
(a) Subparagraphs (e} and (f)
does not apply to "bodily
i��jury" or "property damage"
included within the "prod-
ucts-comgleted operations
hazard";
(b} Subparagraphs (a), (b), (d),
(e) and (f) does not apply to
"bodily injury", "property
damage" or "personal and
advertising injury" arising
out of the sole negligence
or willful misconduct of the
adcfitional insured ar their
agents, "employees" or any
otl�er representative oi the
additional i�isured; or
(c) Subparagraph (f) does not
apply to "bodily injury",
"property damage" or "per-
sonal and advertising injury"
arising out of:
1) Defects in design fur-
nisheck by or on behalf
)ncludes copyrighted material of Insurance
GA 233 02 07 Services Office, Inc., with its permission. Page 12 of 15
u �
of the additional in-
sured; or
2} The rendering of, or
failure to render, any
professional architec-
tural, engineering or
surveying services, in-
cluding:
a) The preparing,
approving or fail-
ing fo prepare or
approve maps,
shop drawings,
opinions, reports,
surveys, field or-
ders, change or-
ders or drawings
and specifications;
and
b) Supervisory, in-
spection, archi-
tectural or engi-
neering activi#ies.
3) "Your work" for which a
consoEidated (wrap-up)
insurance Qrogram has
been provided by the
p ri m ec o n tracto r-p roj e c#
manager or owner of
the constructio�� project
in which you are in-
volved.
b. �nly with regard to insurance pro-
vided fo an addifianal insured desig-
nated under Paragraph 9.a.(2} Sub-
paragraph (f} above, SECTION II( -
LlMITS OF INSURANCE is amended
to include:
The limits applicable to the additional
insured are those specified in the
written contract or agreement or in
the Declarations of this Coverage
Part, whichever are less. If no limits
are specified in the written contract
or agreement, or if there is no written
contract or agreement, the limits ap-
plicable to the additiorial insured are
those specified in the Declarations of
this Coverags Part. The limits of in-
surance ara inclusive of and not in
addition to the limits of insurance
shown in the Declarations.
c. SECTION IV - COMMERCIAL GEN-
ERAL LIABtLITY CONDITIONS is
hereby arnended as follows:
(1) Condition 5. Qther Insurance is
amended to include:
(a) Where required by a written
contract or agreement, this
insurance is primary and /
or noncontrifoutory as re-
spects any other insurance
policy issued to the addi-
tional insured, and such
other insurance policy shall
be excess and / or noncon-
tributing, whichever applies,
with this insurancs.
(b) Any insurance provided by
this endorsement shall be
primary to other insurance
available to the additional
insured except;
1) As otherwise provided
in SECT[ON IV -
COMMERCIAL GEN-
ERAL LIABILITY
CQNDITIONS, 5. Other
Insurance, b. Excess
Insurance; or
2) For any other valid and
collectible insurance
available to the addi-
tional insured as an
additional insured by
attachment of an en-
dorsement to another
insurance poficy that is
written on an excess
basis. In such case,
the coverage provided
under this endorse-
ment shalf also be ex-
cess.
(2) Condition 11. Conformance ta
Specific Written Contracl or
Agreement is hereby added:
11. Conformance to Specific
Written Contract or
Agreement
With respect to additionaf
insureds described in Para-
graph 8.a.{2)(f) above only:
If a written contract or
agreement between you
and the additional insured
specifies that coverage for
the additional insured:
a. Be provided by the In-
surance Services Of-
fice additional insured
form number CG 20 10
or CG 20 37 (where
edition specified); or
b, Include coverage for
completed operations;
or
c. Include coverage for
"your work";
and where the limits or cov-
erage provided to the addi-
Includes copyrighted material of Insurancs
GA 233 02 07 Services (7ffice, Inc., with its permission. Page 13 of 15
tional insured is more re-
strictive tfzan was specifi-
caliy required in that written
contract or agreement, tlie
terms of Paragraphs
9.a.(3}(a), 9,a.(3){b) or 9,6.
above, or any combination
thereof, shall bs interpreted
as providing the limits or
coverage required by the
terms of the written contract
or agreement, but only to
the exteni that such limits or
coverage is included within
the terms of the Coverage
Part to which this endorse-
ment is attached. If, how-
ever, the written contract or
agreement specifies the In-
surance Services Office
additional insured form
number CG 20 10 but does
not specify which edition, or
specifies an edition that
does not exist, Paragraphs
9.a.(3)(a) and 9.a.(3)(b) of
this endorsement shall ��ot
apply and Paragraph 9.b. of
this endorsemeni shall ap-
ply.
i0. Broadened Contracfual Liabiliiy - Work
Within 50' of Railroad Property
It is hereby agreed that Paragraph f.(1) of
Definition 12. "Insured contract" (SEC-
TION V- DEFINITI(JNS} is deleted.
11. Property Damage to Borrowed Equip-
ment
a. The followinc� is hereby added to Ex-
ciusion j. Qamage to Property of
Paragraph 2., Exclusions of SEC-
TfON I - COVERAGES, COVERAGE
A. BQpfLY INJURY AND PR�P-
EFiTY DAMAGE LIABILI7Y:
Paragraphs (3) and {4) of this exclu-
sion c!o not apply to tools or equip-
ment loaned to you, provided they
are not being used to perform opera-
tions at the time of loss.
b. With respect to ti�e insurance pro-
vided by this section of the en-
dorsement, the following additional
provisions apply:
{1) The Limits of insurance shown
in the Declarations are replaced
by the limits designated in Sec-
tion B. Limifs of Insurance, 11.
of this endorsement with respect
to coverage provided by this
endorserr�ent. These limits are
inclusive of and not in addition to
the limits being replaced. The
Limits of Insurance shown in
Section B. Limits of Insurance,
11. of this endorsement fix the
most we will pay in any one "oc-
currence" regardless of the
number of:
{a) Insureds;
(b) Claims made or "suits"
brought; or
(c) Persons or organizations
making claims or bring
"su its",
(2) Deductible Clause
(a) Our obligation to pay dam-
ages on your behalf applies
only to the amount of dam-
ages for each "occurrence"
which are in excess of the
Deductible amount stated in
Section S. limits of Insur-
ance, 11. of this endorse-
ment. The limits af insur-
ance will not be reduced by
the application of such De-
ductible amount.
(b) Condition 2. Duties in the
Event of �ccurrence, �f-
fense, Claim or SLiit, ap-
plies to each claim or "suit"
irrespective of the amount.
(c} We may pay any part or aIl
of the deductible amount to
effect settlement of any
c[airn or "suiY' and, upon
notification of the action
taken, you shall promptly
raimburse us for such part
of the deductible amount as
has been paid by us.
i2. Employees as Insureds - Specified
Heaith Care Services
It is hereby agreed that Paragraph
2.a.(t)(d} of 5ECTI�N II - WHO IS AN
INSURED, does not apply to your "em-
ployees" wlio provide professianal heaith
care services on your behalf as duly li-
censed;
a. Nurses;
b. Emergency Medical Technicians; or
c. Paramedics,
in the jurisdiction wliere an "occurrence"
or ofEense to which this insurance applies
takes place.
13. Broadened Notice of Occurrence
Paragraph a. of Condition 2. Duties in
the Event of Occurrence, �ffense,
Claim or Suit �SECTION fV - COMMER-
CIAL GENERAL LIABILITY CONDI-
Includes copyrighted material of Insurance
GA 233 02 07 Services Office, Inc., wit�� its permission. F'age 14 of 15
TIdNS} is hereby de�eted and replaced
by the following:
a. You musk see to it that we are noti-
fied as soon as practicable of an
"occurrence" or an offense which
may result in a claim. To the extent
possible, notice should include:
(1) How, when and where the "oc-
currence" or offense took place;
(2) The names and addresses of
any injured persons and wit-
nesses; and
(3) The nature and location of any
injury or damage arising ouf of
the "occurrence" or offense.
This requirement applies only when
the "occurrence" or offense is known
to an "authorized representative".
Includes copyrighted material of Insurance
GA 233 02 07 Services Office, Inc., with its permission. Page 15 of '15