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HomeMy WebLinkAboutBates Oil & Water Testing Services,LLC & Oshkosh 2016 r CITY OF OSHKOSH DEPARTMENT OF PUBLIC WORKS 215 CHURCH AVENUE,P.O.BOX 1130,OSHKOSH,WI 54903-1130 PHONE: (920)236-5065 FAX(920)236-5068 LETTER OF TRANSMITTAL To: Brian Bates Date: October 14,2016 Bates Soil&Water Testing Services Subject: Executed Agreement N1237 Countr Crest Circle Wetland Determination& Hortonville, WI 54944 Delineation Contract 14-21 Please find: ® Attached ❑ Under Separate Cover ❑ Copy of Letter ® Contracts ❑ Amendment ❑ Report ❑ Agenda ❑ Meeting Notes ❑ Photos ❑ Mylars ❑ Change Order ❑ Plans ❑ Specifications ❑ Estimates ❑ Diskette ❑ Zip Disk ❑ Other Quantity Description 1 Executed Agreement These are being transmitted as indicated below: ❑ For Approval ® For Your Use ❑ As Requested ❑ For Review&Comment Remarks: Enclosed is the executed agreement for the wetland determination&delineation services for 2240 Westowne Avenue. A City of Oshkosh Purchase Order will follow shortly. Please reference this Purchase Order number on all of your invoices. If you have any questions, please contact us. cc: Signed: Tr(y) cy . Taylor L\Engineering\2014 CONTRAC514.21 Washburn St WtrQua[Det Basin\Prefect-fnformationlContract lnfolCansultants'Agmements�Bates LOT-2241)Weslaw Ave Wetland Delin Executed Agreement-10-14-16.docx t . AGREEMENT 2016, by and between the This AGREEMENT, made on the day °f referred to as CITY, and BATES SOIL & CITY OF OSHKOSH, party of the first part, hereinafter WATER TESTING SERVICES,LLC,N1237 Country Crest Circle,Hortonville,WI 54944,party of the second part,hereinafter referred to as the CONSULTANT, WITNESSETH: The CITY and the CONSULTANT, or the consideron hereinafter &DELINEATIONamed, enter into the following AGREEMENT for WETLAND D ARTICLE I. PROTECT MANAGER A. Assignment of Project Manager. The CONSULTANT shall assign the following individual to manage the PROJECT described in this AGREEMENT: Brian D.Bates,P.S.S,C.S.T.—Licensed Professional Soil Scientist B. Changes in Project Manager. The CITY shall have the right to approve or disapprove of any proposed change from the individual named above as Project Manager. The CITY shall be provided with a resume or other information for any proposed substitute and shall be given the opportunity to interview that person prior to any proposed change. ARTICLE II. CITY REPRESENTATIVE The CITY shall assign the following individual to manage the PROJECT described in this AGREEMENT: John Ferris,P.E.,P.H.—Civil Engineering Supervisor ARTICLE III. SCOPE OP WORK The CONSULTANT shall provide the services described in the CONSULTANT's Proposal. CITY may make or approve changes within the general Scope of set-vices in this AGREEMENT. If such changes affect CONSULTANT's cost of or time required for performance of the services, an equitable adjustment will be made through an amendment to this AGREEMENT. nts All reports, drawings, specifications,CONSULTANTe asiles, field da ,mst uments ofoservicedshallr remain and instruments prepared by property of the CITY. Page 1 of 5 1:IEnginee=ing12014 CONTRAC15114-2141',hburn St Wtr Qual Det Basinll°roje Lintomiationl Contract lnfolComuttants'Agreement$%Bate$-2240 Westoivne Ate Wetland Delin 10--t-16.do" ARTICLE IV. 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. ARTICLE V. RECORD DRAWINGS Record drawings,if required,will be prepared,in part,on the basis of information compiled and furnished by others. CONSULTANT is not responsible for any errors or omissions in the information from others the CONSULTANT reasonably relied upon and are incorporated into the record drawings. ARTICLE VL 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. 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. ARTICLE VII. TIME OE COMPLETION The work to be performed undern he CONSULTANT'S Proposal EEMENT shall be commenced and the work completed within the time limits as agreed upon The CONSULTANT shall perform the services under this AGREEMENT with reasonable diligence and expediency consistent with sound professional practices. The CITY agrees 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, failure of performance by the CITY, or discovery of any hazardous substances or differing site conditions. 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. ARTICLE V11I. 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 Page 2 of 5 1:\F rngineering1201A CONI RAC"1�11441 Washburn st W tr Qual pet Basin\project_Infomtalion\Contract Info\Consultants'Agreements\Bates-2240 J*Jestotane Ave Wetland Delia 104-16.docx 2. CONSULTANT's Proposal dated October 2,2016 and attached hereto In the event 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 may be otherwise specifically stated. ARTICLE IX. PAYMENT A. The Agreement Sum. The CITY shall pay to the CONSULTANT for the performance of the AGREEMENT the total sum as set forth below, adjusted by any changes hereafter mutually agreed upon in writing by the parties hereto: • Lump Sum$2,300 (Two Thousand Three Hundred Dollars). B. Method of Payment. The CONSULTANT shall submit itemized monthly statements for services. The CITY shall pay the CONSULTANT within thirty (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. ARTICLE X. HOLD HARMLESS The CONSULTANT covenants and agrees to protect and hold the City of Oshkosh harmless against aII actions, claims, and demands which may be to the proportionate extent caused by or result from the intentional or negligent acts of the CONSULTANT,his/her agents or assigns,his/her employees, or his/her subcontractors related however remotely to the performance of this AGREEMENT or be caused or result from any violation of any law or administrative regulation,and shall indemnify or refund to the CITY all sums including court costs, attorney fees, and punitive damages which the CITY may be obliged or adjudged to pay on any such claims or demands within thirty (30) days of the date of the CITY's written demand for indemnification or refund for those actions, claim,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 CONSULTANT harmless from any and all liability, including claims, demands, losses, costs, damages, and expenses of every kind and description (including death), or damages to person or property arising out of re-use of the documents without consent 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. I:�Engineering12014 CONTMACM\14-21 1Slashbum SL Wtr Qual Det Page 3 of 5 Basin\Project_lnformationlContraet in(o\Comultants'Agmements\Bates-2240 Westowne ANT Wetland Delir 10-4-1&docx ARTICLE XI. INSURANCE The CONSULTANT agrees to obtain General Liability Coverage of$500,000 per occurrence. The following must be named as additional insureds — City of Oshkosh, and its officers, council members,agents,employees, and authorized volunteers. Certificates of insurance acceptable to the CITY shall be submitted to the Engineering Division of the Department of Public Works prior to the commencement of the work. These certificates shall contain a provision that coverage afforded under the policies will not be cancelled or non-renewed until at least 30 days prior written notice has been given to the City Clerk of the City of Oshkosh. ARTICLE XII. TERMINATION A. For Cause. If the CONSULTANT shall fail to fulfill in timely and proper manner any of the obligations under this AGREEMENT, the CITY shall have the right to terminate ONSULTANT. In this event, the CONSULTANT shall b; AGREEMENT by written notice to the C e entitled to compensation for any satisfactory,usable work completed. B. For Convenience, The CITY may terminate this AGREEMENT at any time by giving written notice to the CONSULTANT no later than ten {10} calendar days before the termination date. If the CITY terminates under this paragraph, then the CONSULTANT 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 o be invalid AGREEMENT unless made in writing, signed by both parties and incorporated as an amendment ARTICLE XIII. RE-USE OF PRO ECT DOCUMENTS All reports, drawings, specifications, documents, and other deliverables of CONSULTANT, whether in hard copy or in electronic form,are instruments of service for this PROJECT,whether the PROJECT is completed or not. CITY agrees to indemnify CONSULTANT and CONSULTANT's officers,employees,subcontractors,and affiliated corporations from all claims, damages,losses, and costs,including,but not limited to,litigation expenses and attorney's fees arising out of or related to the unauthorized re-use,change,or alteration of these project documents. ARTICLE XIV. 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. Page 4 of 5 l:\Engineering\2014 CPNTRAM\14-21 Washbum5t Wtr Qual lel BasinSPro°} Wormalion\Contract lnfolConsultarnts''Agrz a1en1slBales-2240 Westawne Aye SVetIand De11n_10-1-16.d0tz 4 ARTICLE XV. NO THIRD-PARTY BENEFICIARIES This AGREEMENT gives no rights or benefits to anyone other than CITY and CONSULTANT and has no third-party beneficiaries. In the Presence of: CONSULTANT By: (Seal of Consultant °V ' if a Corporation) (Specify Title) By: (Specify Title) CITY OF OSHKOSH lam%• � �' f� By. ___..._....- (Witness) atie abe,P.E.,CPESC,Director of Public Works 1:1 Engineering12014 CONTRAC S\14-21 Washburn St Wtr Qual Dzt Page 5 of 5 Basfn\pr*;ct_InfomiaHon`Contract 1nfolCom0ants'Agreements\Bates-2240 Westotrne Ave Wetland Delin_104-16.do x SOIL WATER TESTING SERVICES, LLCM RECEIVED OCT - 3 2016 DEPT OF PUBLIC WORKS OSHKOSH, WISCONSIN Proposal for a Wetland Determination & Delineation 2240 Westowne Avenue City of Oshkosh, Winnebago County To: City of Oshkosh N1237 COUNTRY CREST CIRCLE • HORTONVILLE, WI 54844 820.775-0000 POIL & MATER TESTING SERVICES, LLC, October 2, 2016 John Ferris Civil Engineer Supervisor City of Oshkosh 215 Church Avenue Oshkosh, WI 54903 Re: Proposal for Wetland Determination & Delineation Services 2240 Westowne Aveune City of Oshkosh, Winnebago County, Wisconsin Dear John, Please find enclosed a proposal for a Wetland Determination & Delineation of the 2240 Westtowne Avenue Area of Interest, shown on the enclosed map. Bates Soil &Water Testing Services, LLC. appreciates the opportunity to submit a proposal for a Wetland Determination and Delineation. If the terms and conditions are acceptable, please return one executed copy to my office. If you have any questions concerning this proposal or scope of work, please contact me at 920-779-0000 or 920-470-5313. Yours truly, Bates Soil &Water Testing Services, L.L.C. Brian D. Bates, PSS, CST Licensed Professional Soil Scientist/Hydrogeologist WDNR Professionally Assured Wetland Delineator N1237 COUNTRY CREST CIRCLE HORTONVILLE, WI 54944 920-779-0000 Y 17 3 ' - • _� , ��' +t�" �,���" z x � n � ,-' � � •�tip"" i :r jx A OW O r i 0.4 ac m k_ --'" JJ N � P'l g X T , 0 3 Al i .�- '" METHODOLOGY The initial steps for the Area of interest (AOI) evaluation will include the following reviews: . • Natural Resources Conservation Service Hydric Soil List • Wisconsin Department of Natural Resources Wetland Inventory Map • Preliminary Reconnaissance Survey • National Wetland Inventory Map • County Soil Survey The reviewed resources provide information on whether wetlands have been previously identified within the AOI or have a higher probability of wetlands occurring. Wetland area or areas with wetland potential within the AOI will then be field investigated to make on-site determinations and where necessary, complete delineations of the uppermost wetland boundary. The wetland determinations and delineations will be completed using the criteria and methods outlined in the Regional Supplement to the Corps of Engineers Wetland Delineation Manual: Northeast/Northcentral Region. This supplement three-criterion investigation method which examines for indicators of hydrophyt€c vegetation, hydric soils and wetland hydrology. Soil morphology, the field observable attributes of the soil in various horizons or arrangements, based on vertical exposure at each sampling point to a minimum depth of 24" below grade (unless otherwise noted), will be documented on the Northeast/Northcentral Data Forms. Sol] profiles will be evaluated through the construction of backhoe pits or hand auger borings. Backhoe pits are the preferred method of soil evaluation since they provide a clear picture of the soil profile over a large area, unlike small auger holes, push probes or hand dug holes. The use of a backhoe Is the only option for deeply filled sites or sites that contain large coarse fragments such as concrete, blacktop or bricks. Soil profiles will be compared to the Field Indicators of Hydric Soils in the United States —A guide for Identifying and Delineating Hydric Soils, Version 7, and the July 2011 and March 2013 supplemental revisions. Hydrology is the most variable of all three criteria. It is highly influenced by short and long-term precipitation, soil properties and the drainage Catena of the small watersheds typically evaluated. Hydrology follows three pathways from the time it drops onto the soil surface to the time it becomes stream flow. The first pathway is overland flow, where water flows on the soil surface. The second pathway is through flow, which is lateral flow through the soilscape, generally paralle[ to the soil surface. The final flow path is groundwater flow, which is generally deep (except in most wetland areas), saturated, subsurface flow. Verification of Hydrology for this study will be based on the primary and secondary hydrology indicators listed in the Regional Supplement to the Corps of Engineers Wetland Delineation Manual: Northeast/Northcentral Region. Unlike soils or vegetation, hydrology Indicators are not always associated with a specific sample point or area. If a hydrology indicator is found near a sampling point, in an area that has similar landscape arrangement, vegetation and soils, any evidence of hydrology will be noted on the Northeast/Northcentral Region Wetland Determination Data Forms. The wetland boundaries will be marked with pink flagging tape or pink wire flags. The sampling plots will be field marked with numbered hardwood stakes. Wetland boundary information provided within the Wetland Determination & Delineation Report will be prepared by an engineering/surveying firm chosen by the property owner or authorized agent. Wetland Delineation Services will be provided by Brian Bates and Tom Neitzel, both Licensed Professional Soil Scientists In the State of Wisconsin. Bates Soil & Water Testing Services, LLC. will include within our report a discussion of our findings and site layout maps documenting any wetland boundaries. Upon receiving copies of the wetland boundary survey maps from the client's surveyor of choice, the final report will be completed. Once complete, copies will be provided to the Client, the U.S. Army Corps of Engineers and the Wisconsin Department of Natural Resources. The U.S. Army Corps of Engineers will be asked to provide concurrence on the wetland delineation. Costs associated with surveying the wetland boundaries and sampling plots are not included in this proposal. If the regulatory agencies do not agree with the mapped wetland boundaries, some areas may need to be resurveyed (extremely unlikely). Costs associated with resurveying any wetland boundaries are not included in this proposal. Brian Bates is a WDNR Assured Wetland Delineator. Wetland Determinations and Delineations conducted by Mr. Bates do not require concurrence from the WDNR. Benefits of hiring a WDNR Assured Wetland Delineator for this project include: Elimination of a 60 Day WDNR concurrence review period. No WDNR Review Fees. Client cost savings of$300.00. - High level of confidence of wetland boundary accuracy for planning purposes. PROJECT COST SUMMARY: Wetland Determination & Delineation........ $2,300.00 Lump Sum C- R � DATE(MMleWYYYY) CERTIFICATE OF LIABILITY INSURANCE 09128/2016 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 pollcy(les)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and nonditlons of the policy,certain polloles may require an endorsement. A statement on this cortlflcate does not confer rights to the Certificate holds In lieu of such ondomomont(s). I PRODUCER CONTACT Judy Juwons Fuhrman Insurance Unlimited,Inc. PHONE 10503 Northwestern Avenue (262)866.0600 N,1: (282)$861000 FranksviEle,WE 53126 A e dudy0Afuhrmaninsurancoxom- INSURE 8 AFFORMNG COVERAGE.. NAIL# 1 INaURERA: State Auto Insurance Company INSURED Bates Soil&Water Testing Services,LLCINsuRERB: SOCIETY INSURANCE COMP 6 N1237 County Crest Circle Hodonville,WI 54944 INSURERC: INSURER D: DEPT O1; PUBLIC WC RKS INSURERE: OSHKOSH, WISCONSIN INSURERF: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED A13OVE 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 18 SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS, ISR 11L FOUCYNUMBER �ADDLIWBRYEF IPO LIC YE Llydli9 A 41ENERALLIMUTY S002468912 05/15/2016 05/15/2017 EACH OCCURRENCE g 1,000,000 . i COMWRCUAL GENERAL LU R11.11Y PREMISES 1EQ 0MXMXq1 $ 100,000 CLAUMS4MDE W OCCUR MED EV Airyompersaa) s 5,000 PERSONAL&ADV INJURY $ 1,000,000 GEn'ERALAGGREGATE S 2,000,000 GENTLAGGREGATELtMITAPPLIESPER: PRODUCTS-WRtOPAGO S 2,000,000 POLICYn%ef El LOC A AUTOMOBILE LIABILITY BAP2223686 05/15/2016 05/15/2017100 Eff,MDSIWLE1IMrr1,000,000 ANYAUTO SODILYINJURY(Pgrpwsm) $ A AUTSCHEDULED BODILYINJURY(Par aodder,l) $ AUTOS H:REDAUTOS � EO PROPERTY 440E S - S A UMBRELLA LIAB OCCUR SOC2468912 05/15/2016 0510512017 EACH OCCURRENCE $ 2,000,000 EXCESS LM HCLAfIAS_?'%0E AGGREGATE $ DEO I I RETENTION S $ B WORKERS COMPENSATION 0513017 0726/2016 07/26/2017 1 A STATU- I JOTH- AND EMKOYERS'LIABILITY YIN FQ ANY PROPRIETORIPARTNERIECECUINE ELEACHACCIDENT $ 500,000 OFFICEFIMEMBEREXCLUDED? MIA (Mya9ndalorytoNH) ELDISEASE•EAEMPLOYEE S 500,000 UESs [OPTION OF:Obe PERATIONS fLDISEASI -POLICYLIdJT $ 600,000 llESCRJPMNOFOPERATIONS ILOCATIONS IVEHICLES(Attach ACORO101,AddHtamlRemarksSMadure,9more space[a(4quired) ADDITIONAL INSUREDS PERATTACHED ENDORSEMENTS CERTIFICATE OF INSURANCE ACCEPTABLE TO THE CIN 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 CANCELLED OR NON RENEWED UNTILAT LEAST 30 DAYS'PRIOR WRITTENT NOTICE HAS BEEN GIVEN TO THE CITY CLERK-CITY OF OSHKOSH CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City Of Oshkosh THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 215 Church Avenue ACCORDANCE NTH THE POLICY PROVISIONS. P.O,Box 1130 AUTHORIZED REPRESENTATIVE Oshkosh,WI 54903-1130 4 ' I g 1988.2010 ACOrgCORPORAOION. All rights reserved. ACORD 25(2010108) The ACORD name and logo are registered marks of ACORD POLICY NUMBER,, m4 1.2 COMMERCIAL 0eKRA{-,LjA8IQTY 0Q.20 10 07 04 EN DO RSEM ENT CHAO IES .0T- POLICY,- KeAtt 99AU MtrAREFULLY. ADDITIONAL. INSURED OWN8R$9 ,LE.SSEJE­S OR CONTRA CT01 RS -UHSOULED PERSON, OR ORGANIZATION Th(s-endEsrsemorA.-rnbd16$InsfirmV.0,PtoVided.urtdor th6.fQf14wjn9, CdMWROIALGNEIRALLLMILIT �Y 0 OVLAME'PART SCHEDULE Narno of ANY001 inpurbd Porsop(s) OrOr Anizat­1-1- Lqc4tjo!*Y Of Covered Opera L) .0no Atf required-by QoAfract Any and.alf job ekes RBLIC WOWS GM OF OSHKOSH 215 CHURCH AVEWE OSHKOSH, V9 BW Information reqUI—red to tom o,,o Ibis Schedule,if not sh'oft a boV -.-- � A, teotl6h il - WkQ is A6 Inautod Jo amended to B. With respect to theInsurance afforded to (hese Include,as an 0041(lonal Insured Mo. poroom(s) otadd41661 I'l Wteidt,the f&IloWlh9,additional exc4u- n orqanlzallon(s) shown In the Schedule=,. but :only slons,appl*y. with respect to 1146jilty for--obbdiij Injury', -prbpejrty 0ma,06fr or OPOflonal and a.d.yedis,ing !Nury* Thli frfsvronoe does riot,appi, to'bodlly tnjpry'or- caused,In whole or In part,by. *0ropOy damage ocourriogaIT1.6'r.: 1. YoUrOctsoroMissIcopror 1. All work, including maferials, parts or equip- 2. Tile acts or omjss(Qp-s of fhoft a.Q.firig.on yourIris nt. behalf; f90shedJft-c.oRn0Iloh with such work, On*PY000(01JIlOr than service,maIntonance; or iepalrs)'to be performed by or on bohqjf 0 In the performpiio6 Of your origolng Qporallons-for' 1hei additloneil lnsuiod(g It ftjobatlsof 1ho the additional Insured(o).at,the Io0`atI6n(s)'desIgA-.'- covqrefdopilyagons has boon complletq4,or hated above,- .2.1 That 'PoTtIOW of"your work' out ()f'whlq4 the Ini'lify or daftd&.0008 tics boon put lb Its in- fended 0'0-4yany porsop or n fattftaffud.oi' 'her- -thaft another contractor or subcontractor on- '00900 .1h'150tOtmirig bPetAtidft for a principal as 9.-part_of the same ptofect, 1nsijr4,j?,ca Stmidiijrdlff -SAMPLE C4,01FICATE P)6Afa11ftdUca4415)ndVVW4 on this aarur[aale,the oontraO.Or project# M 20 10.0 1 04L V ISO Prbpot'64,Mo..,2044 Pagel of 1 1 , MOBD50 SOC 2468812 01 04/4612010 U" BATR CPP` RN 48FUIIR0041116 054944 I r Insurance Companies AUT00 SOC 2468912 08 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. i NOTICE OF CANCELLATION SCHEDULED PARTY This endorsement modifies insurance provided under the following: COMMERCIAL AUTOMOBILE COVERAGE PART COMMERCIAL GENERAL LIABILITY COVERAGE PART COMMERCIAL INLAND MARINE POLICY COMMERCIAL PROPERTY COVERAGE PART CRIME AND FIDELITY COVERAGE PART BUSINESSOWNERS SPECIAL PROPERTY COVERAGE" FORM EMPLOYMENT PRACTICES LIABILITY INSURANCE COVERAGE FORM LIQUOR LIABILITY COVERAGE PART OWNERS AND CONTRACTORS PROTECTIVE LIABILITY COVERAGE PART PRODUCT WITHDRAWAL COVERAGE PART PRODUCTSICOMPLETED OPERATIONS LIABILITY COVERAGE PART RAILROAD PROTECTIVE LIABILITY COVERAGE PART SCHEDULE 1. Name: CITY OF OSHKOSH DEPARTMENT OF 2, Address: PUBLIC WORKS 295 CHURCH AVENUE OSHKOSH, WI 54902 -3,jOptlonal Notification: 30ays Information requlfed to complete this Schedule, if not shown above, will be shown in the Declarations. A. We will mail the designated person or organization in the Schedule above at least 30 days' advance notice or the number of days' advance notice shown in the Schedule above if we cancel or nonrenew this policy for any reason other than nonpayment of premium, subject to statutorily permitted reasons. S. We will mail the designated person or organization in the Schedule above at least 10 days' advance notice If we cancel this policy for nonpayment of premium; or C. The person or organization shown in the Schedule above will be mailed confirmation if you cancel this policy for any reason. In no event will 'the action or timing of the named insures election to cancel or modify the terms of this policy serve to extend the policy beyond the expiration dale shown in the Declarations. Failure to mail such notice shall impose no obligation or liability of any kind upon the company, its agents, or representatives. i SI 10 20 06 10 Page i of 1 '!!`911020.241008 Incrudes copyrighted•materlar of Insurance Servioes Office, Inc., with Its permrssion r Issue Date 04/06/2016 01:44:02 PM acme alsu�, MOBDEC SOC 2468912 Q$ 04106/2016 UVN BATE CPP` RN 48FUHR0040115 054944 Companiesjw STATE AU TO Insurance SOC 2468912 08 ADDITIONAL INTERESTS/INSUREDS COMMERCIAL GENERAL LIABILTY j OTHER INTERESTS TYPE LOC/BLDG ANI INCORPORATED Designated Person or Organization 111 S GARFIELD AVENUE= HINSDALE, IL 60521 CITY OF OSHKOSH DEPARTMENT OF Notice of Cancellation-Scheduled Party PUBLIC WORKS 215 CHURC14AVENUE OSHKOSH,WI 54902 i HALLMARK CUSTOM HOMES Owners, Lessees,or Contractors PO BOX 201 HORTONVILLE,WI 54944 f TOWN OF NEENAH Owners, Lessees,or Contractors 1648 S PARK AVE NEENAH,WI 64956 MCMAHON&ASSOCIATES INC Owners,Lessees,or Contractors 1445 MCMAHON DR NEENAH,WI 54956 ANI INCOPOR4TED Owners, Lessees,or Contractors 111 S GARFIE=LD AVEVUE HINSDALE,IL 60521 Issue Date 04/06/2016 01:44:02 PM SL 50 01 (01104) Page 006 of 006 i aaiees Pn:we: i MOIR$ 01x 11