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HomeMy WebLinkAboutOshkosh Convention Center Renovations/Boldt Group - . . : ORIGINAL City of Oshkosh PROFESSIONAL SERVICES AGREEMENT. CONSTRUCTION MANAGEMENT SERVICES: OSHKOSH CONVENTION CENTER RENOVATIONS THIS AGREEMENT, made on the 271h day of September,2016,by and between the CITY of OSHKOSH, hereinafter referred to as CITY, and THE BOLDT GROUP, INC,, 2525 N. ROEMER ROAD, P.O. BOX 373, APPLETON, WI 54912-0419,hereinafter referred to as the CONSULTANT, WITNESSETH: That the CITY and the CONSULTANT, for the consideration hereinafter named, enter into the following Agreement. COMPONENT PARTS OF THE AGREEMENT This Agreement consists of the following component parts, all of which are as fully a part of this Agreement as if herein set out verbatim, or if not attached, as if hereto attached: 1. This Instrument 2. Consultant's Professional Services Proposal dated 9126/16 and attached hereto. In the event that any provision in any of the above component parts of this Agreement 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 maybe otherwise specifically stated, CITY REPRESENTATIVE The CITY shall assign the following individual to manage this Agreement: Jon Urben, General Services Manager SCOPE OF WORK The CONSULTANT shall provide the services described in the CONSULTANT's attached Professional Services Proposal. CITY may make or approve changes within the general Scope of Services contained within the Professional Services Proposal and in this AGREEMENT. If such changes affect CONSULTANT's cost or time required for performance of the services, an equitable adjustment will be made through an amendment to this AGREEMENT. Cily Kali,215 Church Avenue P.O,box 1 130 Oshkosh,WI 5 4903-1 130 tittp://vrvvw.cl.oshkosliNWI.us i. RECORDS AND INSTRUMENTS OF SERVICE All reports, drawings, software, data, computer files, and other materials, documents and instruments prepared by the CONSULTANT as instruments of service shall remain the property of the CITY. Any document related to this agreement, whether in electronic or paper form, is considered a public record and shall be provided to the City upon request. The contractor may provide the City with an explanation of why they believe any document should not be released to the public. The City shall make all final determinations regarding the existence or release of any document related to this agreement. TERM AND TERMINATION A. Term. This Agreement shall commence upon the date indicated above and shall terminate on July 1, 2017, unless terminated earlier by one of the parties as provided below. B. Termination. 1. For Cause. If either party shall fail to fulfill in timely and proper manner any of the obligations under this Agreement, the other party shall have the right to terminate this Agreement by written notice. In this event, the CONSULTANT shall be entitled to compensation to the date of delivery of the Notice. 2. For Convenience. The CITY may terminate this Agreement at any time by giving written notice to the CONSULTANT no later than 30 calendar days before the termination date. TIME OF COMPLETION The CONSULTANT shall perform the services under this Agreement with reasonable diligence and expediency consistent with sound professional practices. The CITY agrees that the CONSULTANT is not responsible for damages arising directly or indirectly from any delays for causes beyond the CONSULTANT's control. For the purposes of this Agreement, such causes include,but are not limited to, strikes or other labor disputes, severe weather disruptions or other natural disasters, or failure of performance by the CITY. If the delays resulting from any such causes increase the time required by the CONSULTANT to perform its services in an orderly and efficient manner, the CONSULTANT shall be entitled to an equitable adjustment in schedule. SUSPENSION,DELAY, OR INTERRUPTION OF WORK CITY may suspend, delay, or interrupt the Services of CONSULTANT for the convenience of CITY. In such event, CONSULTANT's contract price and schedule shall be equitably adjusted. ASSIGNMENT Contractor shall not have the right to assign this Agreement without the written prior consent of the City. INDEPENDENT CONTRACTOR CONSULTANT is an independent contractor and is not an employee of the CITY. COOPERATION IN LITIGATION AND AUDITS Contractor shall fully and completely cooperate with the City, the City's insurer, the City's attorneys, the City's Auditors or other representative of the City (collectively, the "City" for purposes of this Article) in connection with(a) any internal or governmental investigation or administrative, regulatory, arbitral or judicial proceeding (collectively "Litigation") or internal or governmental Audit, with respect to matters relating to this Agreement; other than a third party proceeding in which Contractor is a named party and Contractor and the City have not entered into a mutually acceptable joint defense agreement. Such cooperation may include,but shall not be Iimited to, responding to requests for documents and/or other records, and making Contractor's employees available to the City (or their respective insurers, attorneys or auditors) upon reasonable notice for: (i) interviews, factual investigations, and providing declarations or affidavits that provide truthful information in connection with any Litigation or Audit; (ii) appearing at the request of the City to give testimony without requiring service of a subpoena or other legal process; (iii) volunteering to the City all pertinent information related to any Litigation or Audit; and (iv) providing information and legal representations to auditors in a form and within a timeframe requested. City shall reimburse Contractor for reasonable direct expenses incurred in connection with providing documents and records required under this paragraph and may require, at the City's sole discretion, such expenses to be documented by receipts or other appropriate documentation. Reasonable direct expenses include costs, such as copying, postage and similar costs; but do not include wages, salaries, benefits and other employee compensation. Contractor shall not be entitled to additional compensation for employee services provided under this paragraph. STANDARD OF CARE The standard of care applicable to CONSULTANT's Services will be the degree of skill and diligence normally employed by professional CONSULTANTs or consultants performing the same or similar Services at the time said services are performed. CONSULTANT will re-perform any services not meeting this standard without additional compensation. CITY RESPONSIBILITIES The CITY shall furnish, at the CONSULTANT's request, such information as is needed by the CONSULTANT to aid in the progress of the project, providing it is reasonably obtainable from City records. !\f CONSULTANT may reasonably rely upon the accuracy, timeliness, and completeness of the information provided by CITY. To prevent any unreasonable delay in the CONSULTANT'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, PAYMENT A. The Agreement Sum. The CITY shall pay to the CONSULTANT for the performance of the Agreement the amount as outline in the Cost portion of the Consultant's Professional Services Proposal for a not-to-exceed fixed fee of$26,000.00. B. Method of Payment. The CONSULTANT shall submit itemized monthly statements for services. The CITY shall pay the CONSULTANT 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 CONSULTANT 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. HOLD HARMLESS The CONSULTANT covenants and agrees to protect and hold the City of Oshkosh harmless against all actions, claims, and demands which may be to the proportionate extent caused by or result from the intentional or negligent acts of the CONSULTANT, its agents or assigns, its employees, or its subcontractors related to the performance of this Agreement or be caused or result from any violation of any Iaw 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 for those actions, claire, and demands caused by or resulting from intentional or negligent acts as specified in this paragraph. Subject to any limitations contained in Sec. 893.80 and any similar statute, of the Wisconsin Statutes, the City further agrees to hold CONTRACTOR harmless from any and all liability, including claims, demands, losses, costs, damages, and expenses of every kind and description (including death), which may be to the proportionate extent caused by or result from the intentional or negligent acts of the CITY, its agents or assigns, its employees, or its subcontractors related to the performance of this Agreement or be caused or result from any violation of any law or administrative regulation, where such liability is founded upon or grows out of the acts or omission of any of the officers, employees or agents of the.City of Oshkosh while acting within the scope of their employment. It is the intention of the parties to this Agreement that each party shall be solely responsible for its own actions and activities and the actions and activities of its own officers, employees and agents while acting within the scope of their employment INSURANCE The CONSULTANT agrees to abide by the attached City of Oshkosh Insurance Requirefnents for Professional Services, WHOLE AGREEMENT/AMENDMENT 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. NO THIRD-PARTY BENEFICIARIES This AGREEMENT gives no rights or benefits to anyone other than CITY and CONSULTANT and has no third-party beneficiaries. AGREEMENT NOT TO BE CONSTRUED AGAINST ANY PARTY This Agreement is the product of negotiation between the parties hereto and no term, covenant or provision herein or the failure to include a term, covenant or provision shall be construed against any party hereto solely on the basis that one party or the other drafted this Agreement or any term, covenant or condition contained herein. NO WAIVER Failure of either party to insist upon the strict performance of terms and provisions of this agreement, or any of them, shall not constitute or be construed as a waiver or relinquishment of that party's right to thereafter enforce such term or provision, and that term of the provisions shall continue in full force and effect. NON-DISCRIMINATION The Operator agrees not to discriminate in its operations under this Agreement on the basis of race, color, creed, age, and gender, or as otherwise prohibited by law, A breach of this covenant may be regarded as a material breach of this Agreement SEVERABILITY If any term, covenant, condition or provision of this agreement shall be invalid or enforceable, the remainder of this agreement shall not be affected thereby the remainder of the agreement shall be valid and enforceable to the fullest extent permitted by law, CHOICE OF LAW AND VENUE The laws of the State of Wisconsin shall govern the interpretation and construction of this Agreement. Winnebago County shall be the venue for all disputes arising under this Agreement. 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 CONSULTANT hereunto set its hand and seal the day and year first above written. In the Presence of: CONTRACTOR Name of Company/Firm (deal birtrfii ' e (Specify Title) i a Cvrporktpj ",. ....a.,a.�Y }:: �: CITY OF OSHKOSH ` By, Mark A. Aohloff, City Man er �( fitness) And, ( itn ss) Pamela R. Ubrig, City Clerk APPROVED: I hereby certify that the necessary provisions have been made to pay the liability which will accrue under this contract y Attorney (-'CO( l l a"z r . City Comptroller ' e3 II 5 1 , City of Oshkosh Construction Management Services i� I Oshkosh � t S ' f 1 Mr.Jon Urben City of Oshkosh 7 215 Church Ave Oshkosh,WI 54901 September 26,2016 r i t � ` f } _ KFYONO X 125 YEARS x f BEYOND The Boldt Group,Inc. 920.739-7800 plione "a^?. 2525 N,Roemor Road %wAv.boldt_eom O YEARSPO_Hox373 Appleton,WI 54912-0419 September 26,2016 Mr.Jon Urben Manager,General Services Division City of Oshkosh 215 Church Ave Oshkosh,WI 54901 Re: City of Oshkosh--Construction Management Services Revised Dear Mr.Urben, On behalf of The Boldt Company we would like to thank you for the opportunity to respond to your request for construction management services for The Oshkosh Convention Center remodeling work located in Oshkosh,WI. Attached is a breakdown of hours for a project manager and administrative assistant for the duration of the proposed project along with a lump sum 3.0%construction management fee. It is our understanding our scope would include assisting with bid packages,reviewing bids,and scheduling of the work for carpet,electrical, painting/wallcovering,and AIV bids.The city of Oshkosh would hold all contracts for the various scopes of work and also coordinate on site daily activities. We have also included labor rates for our craft employees in the event those services need to be utilized on a time and material basis. We trust the information presented in our proposal aligns with your vision regarding the request for construction management services.We appreciate and look forward to the opportunity to partner with you on this project. Should you have any questions or require further information,please do not hesitate to contact me at any time. Sincerely, Paul E.Coenen Project Executive 920-225-6255 Paul.coenen@boldt.com CONSULTING SOLUTIONS I TECHNICAL SOLUTIONS I CONSTRUCTION SOLUTIONS General Conditions PFYPNP 125' GENERAL CONDITIONS COST ESTIMATE q YEF5R9 City of Oshkosh - Convention Center Remodel General Conditions General Conditions Reimbursibles (Enter$Amount) Project Executive In Fee - Project Management 150 Hours @25 Hrs/Month $ 13,500.00 - Field Engineer Notincluded - General Superintendent See Rates If Required Administrative Assistant 50 Hours $ 2,500.00 - Scheduling In Fee - Travel-Mileage $ 1,000..00 - Document Reproductions In Fee - Office Supplies,Postage,Mail In Fee Computers,Software in Fee Copier In Fee - Buildi Permits By Owner - -Occupa9cy Pemlit B Owner - Builders Risk Insurance By Owner - General Libabilty Insurance .65%of project cost By Owner - Construction Management Fee $ 9,000.00 - Total Direct Cost $ 26,000.00 BOLIYr GreenStone Farm Credit Services-Construction Management Services I July 26,2016 Oshkosh Convention Center Remodel MiRm. Time & Material Flat Labor Rates oscarJ.voldreonsrruc11on June 1, 2016 to May 31, 2017 uCraft ] Single Trme Over Time ( DBL Time 5505 Carpenter Carp 60% _. __ $50,66 $64.02 .$77 37 Car 65%0 CC $53.15 -_ � $67.62 � $82.07 5505 ]Carpenter p l_ .___.__..___. �_�___...-_ �._-___ _ _.__ ._....___ 5505 Carpenter Carp 70% $55.67 $71.25 $86.83 0 .......... - 5505 Carpenter Carp 75/0 $58.18 $74.88 $91.56 5505 Carpenter. Carp 80% $60.72 $78.53 $96.35 $63 22 $82 14 $901.06 5505 Carpenter .-_ l_Carp 85% . ..._ 5505 Carpenter ]Carp 90% $65.72 $85 74 _ $905 77 5505 Carpenter Carp 95/0 $68.22 $89.37 ] $110.50 5506 (Carpenter w Journeyman $70.74 $93.00 $115.24 5506 Carpenter Foreman $74.49 $98.40. $122.32 - 5506 - Carpenter Superintendent $90 00 $115 00 $135,00 5506 Carpenter SubForeman $72.62 ] $95.71 $918.79 5525 Laborer Journeyman $5633 $73.12 $89.89 5525 (Laborer Foreman $57.82 $75 28 $92.71 5525 Laborer Superintendent $90.00 $115.00 _ { $135.00 5527 Laborer Lab 80% __.$47.73 w -LL�r $61.17 $74.58 5527 Laborer Lab 85% $49.59 $63.86 _ $78.11 5527 ILabarer Lab 90% $51.47 $66.58 $81.68 5527 Laborer Lab 95% $53.33 $69.28 $85.21 5540 Iron Worker ]Journeyman ] $78.22 $101.10 $123.97 5540 Iron Worker Foreman $81.40 $105.61 $129.81 5540 Iron Worker Superintendent $90-00 $1115.00 $135,00 5543 [Iron Worker IW 60% $40 86 $53,14 $65.42 u u_r ___.. 5544 Iron Worker ]IW 65% [ $58.77 $73.35 $87 93 5544 Iron Worker IW 70% $61 -1] f $76 82 $92 41 5544 Iran Worker IW 75%0 $63.68 $80 32 t $96.94 5544 Iron Worker tW 80% $66 i4 $83 80 $101.44 5544 Iron Worker IW 85% $68 59] $87.27 $105.93 5544 IronWorker IW 90% $71.04 __$90.74, $110.42 5550 Teamster _ $60.79 $79.53 $98.27 55 55 ]Operator CR 1A 176'* $85.43 $111-10 $136.78 5555 Operator CR 18 975 .._ ._.I _ _ __ $83.85 $108,87 $133.88 T ,..5555..._ 'Operator ]CR 16 44T...,._... .__ . _ $83,45 = $108 31 $133-14 m_ _ 5555 Operator ]Class IC $81.54 $105 60 $129.64 5555 Operator __._ . , ._..Class 2 _._..,. _�_._ _. . $80.70 _ _$104 40n .-------- $128 10 5555 Opera#or Class 4 ._,.. .___.�__. $76.41 $98.32 5560 Mason ]Journeyman $71.63 $92.89 $114.26 T- 5560 Mason Foreman $75.26 $98.28 Project Superintenden $t $90 00 $115 00 1 $135.00 __..-..5560 Mas._._.,:.. ._ � ] ect Manager __.. .__. _. �.. 90 00 $ _ _ r. 120 00 $120.00 Labor Coordinator $92.00 $197.00 $117.00 __ ---_ _ _---_ - --- Project Coordinator _., _ .___ __$50.00 , _$75,00 $75.00 A 60 00 $60 00 $60,00 _ - Field Support Coordinatorme x $65 OOSN $65 00 rn M $65.00 �Sho $ 4114114 CITY OF OSHKOSH INSURANCE REQUIREMENTS I'll. PROFESSIONAL. SERVICES LIABILITY INSURANCE REQUIREMENTS The Contractor shall not commence work on contract until proof of insurance required has been provided to the applicable City department before the contract or purchase order is considered for approval by the City. It is hereby agreed and understood that the insurance required by the City of Oshkosh isrp unary coverage and that any insurance or self insurance maintained by the City of Oshkosh, its officers, council members, agents, employees or authorized volunteers will not contribute to a loss. All insurance shall be 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 the contract or listed below whichever is longer. 1. PROFESSIONAL LIABILITY A. Limits (1) $1,000,000 each claim (2) $1,000,000 annual aggregate B. Must continue coverage for 2 years after final acceptance for service/job 2. GENERAL LIABILITY COVERAGE A. Commercial General Liability (1) $1,000,000 each occurrence limit (2) $1,000,000 personal liability and advertising injury (3) $2,000,000 general aggregate (4) $2,000,000 products--completed operations aggregate B. Claims made form of coverage is not acceptable. C. Insurance must include: (1) Premises and Operations Liability (2) Contractual Liability (3) Personal Injury (4) Explosion, collapse and underground coverage (5) Products/Completed Operations must be carried for 2 years after acceptance of completed work (6) The general aggregate must apply separately to this pro'ectllocation 3. BUSINESS AUTOMOBILE COVERAGE-- If this exposure shall exist: A. $1,000,000 combined single limit for Bodily Injury and Property Damage each accident B. Must cover liability far Symbol#1 - "Any Auto"— including Owned, Non-Owned and Hired Automobile Liability. [Il - 1 4194114 4. WORKERS COMPENSATION AND EMPLOYERS LIABILITY— "If" required by Wisconsin State Statute or any Workers Compensation Statutes of a different state. A. Must carry coverage for Statutory Workers Compensation and an Employers Liability limit of: (1) $100,000 Each Accident (2) $500,000 Disease Policy Limit (3) $100,000 Disease—Each Employee 5. UMBRELLA LIABILITY - If exposure exists, provide coverage at least as broad as the underlying Commercial General Liability, Watercraft Liability (if required), Automobile Liability and Employers Liability, with a minimum limit of$2,000,000 each occurrence and $2,000,000 aggregate, and a maximum self-insured retention of$10,000. 6. ADDITIONAL PROVISIONS A. Acceptability of Insurers - Insurance is to be placed with insurers who have an A.M. Best rating of no less than A- and a Financial Size Category of no less than Class VI, and who are authorized as an admitted insurance company in the state of Wisconsin. B. Additional Insured Re uirements — The following must be named as additional insureds on all Liability Policies for liability arising out of project work - City of Oshkosh, and its officers, council members, agents, employees and authorized volunteers. On the Commercial General Liability Policy, the additional insured coverage must be ISO form CG 20 10 07 04 or its equivalent and also include Products — Completed Operations ISO form CG 20 37 07 04 or its equivalent for a minimum of 2 years after acceptance of work. This does not apply to Professional Liability, Workers Compensation and Employers Liability. C. Certificates of Insurance acceptable to the City of Oshkosh shall be submitted prior to commencement of the work to the applicable City department. These certificates shall contain a provision that coverage afforded under the policies will not be canceled or non renewed until at least 30 days' prior written notice has been given to the City Clerk —City of Oshkosh. Ill - 2 " p' CERTIFICATE OF LIABILITY INSURANCE DArE(I,ararDDn THIS CERTIFICATE 1S ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER, THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If tho certificate holder is an ADDITIONAL INSURED, the policy(les) must be endorsed. If SUBROGATION 1S 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 certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Insurance Agency contact NAME: tnformadon,Includfngstreet — insurance Agents ---- address and POSax1f PHONE conlactInformation,, FAX ) applicable, {AIC,No.Ext1� _ — E-MAIL ADDRESS: INSURE q AFFORDING COVERAGE _ NAIC# INSURERA: ABC Insurance Com any NAIC# INSURED Insured'sconracefnformaefon, Including name,address and INSURER B: XYZ Insurance Company N phonenumAic#_ ber. INSURER c: LMNInsurance Com_ pany NAIC# INSURER P: lnsurer(s)must have a minfmum A-M.BesfraYfng afA- - '- andaFinancial Performance Rafingofl?orbetter. INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS f5 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 OTHE=R DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE AMY BE ISSUED OR MAY PERTAIN. THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJE=CT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES, LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ELTR TYPE OF INSURANCE NSR WVD POLICY NUTABER h IXU�EPF SOIL/DD/Y LIMITS GENERAL LIABILITY EACH OCCURRENCE_ $1_,000,000_ ®COMMERCIAL GENERAL LIARL-TM ❑ General[as6iRy Police Number PoEcy eBecl'n'e and ezpgalb7n date. [DAFdAGE TO RENTED PREMISES(Ea occurrence) $5{),000 _ A J❑CLAVAS-MADE OCCUR MFD EXP(Any one parson) $5,000 ® ISO FOR61 CG 2037 OR EQUNALENT PERSONAL&ADV INJURY $1,{1_00,000 ❑ _ GENERAL AGGREGATE $2,000,000 GEN'LAGGREGATELIMIT APPLIESPER: PRODUCTS—COMPIOPAGO $2,000,000 _ ❑POLICY��PR T�LOC - AUTOMOBILE LIABILITY ICOMBINED SINGLE LIMIT $ Ea accident) _ $1,OD0,000 _ I ANY AUTO ® ❑ Avlo Uabi,Ay Policy Number Policy effedn•e and expiration date. BODILY INJURY(Per person) $ B ALL O�VNI=O fl I,' SCHEDULEDAUr05 1��HJ111 INON•OWNEO BODILY INJURY(PeraccEdent) $ HIRED AUTOAUTOS {Pe�acddantJPERTY A�1ACE $ ®IUMBRELLALIAB p OCCUR ® ❑ EACH OCCURRENCE $2,000,000 A 01EXCE5S LIAR ❑ CLAIMS-NIADE Umbrella IJab2Ay Policy Number jpotiicy efrectire and eapgation dale. AGGREGATE $2,000,000 ❑iDED �®IRETENTION$%000 i $ CANDIWORKEMPLOY RYPENSATION S'LIABILITY ❑ ❑ I WRY LWI J- OTH- ®TORY L€€,aITS ER _ ANY PROPRIETORlPARTNERlEXEGUTNE � _.... (MandatOFFIOVory In H EXCLUDED? YIN Workers Compensation Policy Pabcy cffacliye and expiation date. E.L.EACH ACCIDENT $100,000 {Mandatory In NH} N Number Ifyas,descriheunder E.L,DISEASE--EAEMPLOYEE 100,ODD DESCRIPTION OF OPERATIONS belo.v >=.L.DISEASE—POLICY LIMIT $500,000 A PROFESSIONAL LIABILITY ❑ j$1,000,000 EACH CLAIM efEectiyeandexpirationdate. 1$1,000,000 ANNUAL AGGREGATE ressionall.bbEty Po'y [Pioii N,mher DESCRIPTION OF OPERATIONS!LOCATIONS!VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more spate€s required) Additional Insureds per attached endorsements. Certificates of Insurance acceptable to the City of Oshkosh shall be submitted prior to commencement of the work to the applicable City department. These certificates shall contaln a provision that coverage afforded under the policies will not be canceled or non renewed until at least 30 days'prior written notice has been given to the City Clerk—City of Oshkosh. CERTIFICATE HOLDER CANCELLATION L0,hkosh,W1 h,Attn:City Clerk Insurance Standard III SHOULD ANYOF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 215 Church enue SAMPLE CERTIFICATE THE EXPIRATION ACCORDANCE WITH THE THB POR CY PROVISIONS, EOF,NOTICE BE DELIVERED IN 4903-1130 Please indicate somewhere on this certlficater the contractor project# AUTHORIZED REPRESENTATIVE this certificate Is for. 09988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2090105) The ACORD name and logo are registered marks of ACORD POLICY NUMBER: COMMERCIAL GENERAL LIABILITY CG 20 10 07 04 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED -- OWNERS, LESSEES OR CONTRACTORS - SCHEDULED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILiTY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization s ; Locations Of Covered Operations As required by contract Any and all job sites Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. Section 11 — Who Is An Insured is amended to B. With respect to the insurance afforded to these include as an additional insured the person(s) or additional insureds, the following additional exciu- organization(s) shown in the Schedule, but only sions apply: with respect to liability for "bodily injury', "property damage" or "personal and advertising injury' This Insurance does not apply to "bodily injury or caused, in whole or in part, by: "property damage"occurring after: 1. Your acts or omissions; or 1. All work, Including materials, parts or equip- 2. The acts or omissions of those acting on your ment furnished in connection with such work, behalf; on the project(other than service, maintenance or repairs) to be performed by or on behalf of in the performance of your ongoing operations for the additional insured(s) at the location of the the additional insured(s) at the locations) design- covered operations has been completed;or nated above. 2. That portion of "your work" out of which the injury or damage arises has been put to its in- tended use by any person or organization other than another contractor or subcontractor en- gaged in performing operations for a principal as a part of the same project. Insurance Standard III SAMPLE CERTIFICATE Please Indicate somewhere on this certificate,the contract or project# this certificate is for. CG 20 10 07 04 ©ISO Properties, Inc., 2004 Page 1 of 1 0 POLICY NUMBER: P°!!ty# COMMERCIAL GENERAL LIABILITY CG 20 37 07 04 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY, ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS -- COMPLETED OPERATIONS This endorsement modifies insurance provided under the following: COMMERCIAL.GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organizations : Location And Description Of Completed Operations As required by contract Any and all job sites information required to complete this Schedule, if not shown above,will be shown in the Declarations. Section 11 -- Who Is An Insured is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for "bodily injury`, "property dam- age" caused, in whole or in part, by "your work" at the location designated and described in the sched- ule of this endorsement performed for that additional insured and included In the "products-completed operations hazard". E Insurance Standard 111 SAMPLE CERTIFICATE Please Indicate somewhere on this certificate,the contract or project# this certificate is for. CG 20 37 07 04 0 ISO Properties, Inc., 2004 Page 1 of 1 ❑ BOLDCOM-01 KATR '4�oszos CERTIFICATE OF LIABILITY INSURANCE VAT E(MYY} s12s,20,Yzols THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(les) 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 certificate holder In Ileu of such endorsement(s). PRODUCER (920)968-5217 HAME: T Trisha Kasper Willis of Minnesota,Inc. ArCoNo Ext:920-968-5217 FAX Nol:920-560-4017 P.O.Box 877 E-MAIL Appleton,WI 54912.0419 ADDRESS:trisha.kaspeL@wlllis.com INSURER(S)AFFORDING COVERAGE MAIC N INSURERA:The Travelers Indemnit Company INSURED The Boidt Company INSURERB:Travelers Indemnity Com an of Connectic 40282 P O Box 419 INSURERC:Travelers Property Casualty Company of A 40282 Appleton,WI 54912-0419 INSURERD: 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 POLICYEFF POL[CYEXP LTR TYPE OF INSURANCE BR POLICY NUMBER MMIDDIYYYY (MM IDD LIMITS GENERAL LIABILITY EACHO TCURRENCE $ 5,000,000 A X COMMERCIAL GENERAL LIABILITY TC2K-CO.3992B816-IND-16 1/112016 111/2017 PREMISES(Ea occu encs $ 500,000 CLAIMS-MADE Fx—]OCCUR MED EXP(Any one person) $ 10,00 PERSONAL&ADV INJURY $ 51000,000 GENERAL AGGREGATE $ 51000,000 GEMLAGGREGATE LIMIT APPLIES PER, PRODUCTS-COMPIOPAGG $ 51000,00 POLICY X PEO LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMF Ea accident 2,000,000 B IX ANYAUTo TK-CAP-3510A098-IND-16 1/112016 1/112017 BODILYINJURY(Perperson) $ ALL OWNED SCHEDULED AUTOS AUTOS (BODILY INJURY Peracaent)d $ HIRED AUTOS X NON-OWNED PROPERTYDAMAGE $ AUTOS PERACCIDENT $ UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 3,000,000 C X EXCESS LIAB CLAIMS-MADE TFSJ-EX-9497L897-TIL-16 1/112016 1/1/2017 AGGREGATE $ 3,000,00 DED X RETENTION$ 10,000 g WORKERS COMPENSATIONX WCSTAlIT OE R AND EMPLOYERS'LIABILITY C ANY PROPRIETORIPARTNERIEXECUTWE YIN TC2JUB-46888552-16 111/2016 11112017 E,L.EACH ACCIDENT $ 11000,00 OFFICERlMEMSER EXCLUDED? N f A (Mandatory In NH) E.L.DISEASE-EA EMPLOYEd$ 1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below I E.L.DISEASE-POLICY LIMIT 1$ 1,000,000 C Excess Worker's Compensation VTWXJ-UB-3512A762-16 11112016 1/112017 Wisconsin $500,000 Retenlio C Excess Worker's Compensation TWXJ-UB-4986B487-16 11112016 11112017 Oklahoma $500,000 Retentlo DESCRIPTION OP OPERATIONS!LOCATIONS 1 VEHICLES(Attach ACORD 101,Additional Remarks Schedule,If more space is required) See attached page. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Oshkosh,Attn: City Clerk THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 215 Church Avenue ACCORDANCE WITH THE POLICY PROVISIONS. PO Box 1130 Oshkosh,WI 54903-1130 AUTHORIZED REPRESENTATIVE 01988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD BOLDCOM-01 KATR PAGE 1 OF 1 DESCRIPTION OF OPERATIONS- The Boldt Company City of Oshkosh,Attn: City Clerk P O Box 419 215 Church Avenue Appleton,WI 54912-0419 PO Box 1130 Oshkosh,WI 54903-1130 Blanket additional insured(as required by written contract or agreement)to the Automobile Liability Policy as per form- Deslgnated Insured#CA2048. $1,000 Deductible for Automobile Comprehensive/Collision Coverage. Excess Workers Compensation: MIIOKIIMIMN(MN is with MN Workers Compensation Rating Association with a Retention of $500,000) Retrospective Workers Compensation#VTRK-UB-8498B305-16;The Travelers Indemnity Company; 1/1/2016 to 11112017, Statutory Benefits; Employers Liability; $1,000,0001$1,000,0001$1,000,000, $300,000 Retention. Michigan Excess Workers Compensation#VTWXJ-UB-9497L732-16;Travelers Property Casualty Company of America; 1/1/2016 to 11112017; Statutory Benefits; Employers Liability. $1,000,0001$1,000,0001$1,000,000; $500,000 Retention. Excess Workers Compensatlon for Wisconsin &Oklahoma: Statutory Benefits and Employers Liability: $1,000,0001$1,000,0001$1,000,000. City of Oshkosh shall be named as additional Insured of the general liability and automobile liability policies as per signed written contract. 30 day notice of cancellation to certificate holder General Liability Additional Insured Forms: CG 2010 07-04&CG 2037 07-04 Coverage provided by Boldt hereon shall be primary and non-contributory to any insurance maintained by the City of Oshkosh.