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OPD/Better Dash Faster Consulting PSA 2016
City f Oshkosh PROFESSIONAL SERVICES AGREEMENT THIS AGREEMENT,made on the 16th day of December, 2016,by and between the CITY of OSHKOSH, hereinafter referred to as CITY, and BETTER DASH FASTER CONSULTING, 613 ENGELHART DRIVE,MADISON,WI 53713,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 1.1/17/16 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 may be otherwise specifically stated, CITY REPRESENTATIVE The CITY shall assign the following individual to manage this Agreement: Dean M.Smith,Chief of Police 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, City Holl,215 Church Avenue P.O.Rox 1130 Oshkosh,WI 54903-1130 hftp://vAvw.cl.oshkosh.wi.us RECORDS AND INSTRUMENTS OF SERVICE t All reports, drawings, software, data, computer files, and other materials, documents and instruments prepared by the CONSULTANT as instruments of service shall reXnain the property of the CITY. Any document related to tlus 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 December 31, 2017, unless terminated earlier by one of the parties as provided below,except that CITY may extend this Agreement for m-L additional year, until December 31, 2018, upon written notice to CONSULTANT given on or before December 31,2017. 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. Tin this event,the CONSULTANT shall be entitled to compensation to the date of delivery of the I 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 CONSULTANTS 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 limited to,responding to requests for documents and/or other records, and malting 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 CART; The standard of care applicable to CONSULTANT's Services will be the degree of skill and diligence t 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. i 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. i 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 snake any authorizations necessary to proceed with work within a reasonable time period. 7 PAYMENT A. The Agreement Sum, The CITY shall pay to the CONSULTANT for the performance of the Agreement the amount as outlined in the Cost portion of the Consultant's Professional Services Proposal for$4,920.00. B. Method of Payment, The CONSULTANT shalll 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 HARMTESS The CONSULTANT covenants and agrees to protect and hold the City of Oshkosh harmless against all I actions, claims, and demands which may be to the proportionate extent caused by or result from the j 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 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 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 1 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 j acting within the scope of their employment f INSURANCE The CONSULTANT agrees to abide by the attached City of Oshkosh Insurance Requirenxents 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 BW%MFICIARrES l 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 1 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 t 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, WiruZebago 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 L Nam�eo ACn }ny i� - t By: - CI 7- AC✓CSI I a r/ l&I s v L-!Ar14 I (Seal of Contractor (Specify Title) if a Corporation.) CITY OF OSHKOSH By: Mark A, ohloff, City Manager Ofne s) /1 1 Sj,4 1 And: LJ f ( fitness) 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 City Attorney City Comptroller I s a WIN r y sL 't � ,t '� � 's fj6• ., PO s • �� ��>. - _ �� tri '�- ��t�' _ �- _- ��?3h--��f-� E y-�'�+�y• � Yea UA MINI WOMEN. _ z � _ 'fir �Yy"A �s u IN 01 zc 4 3 . M M.-A17 M" Tableof Contents. ................................ ........,..,...,,...........,1 Executive Summary.........................................................................................................................1 Cityof Oshkosh Police Department Needs............................................................................................1 Proposed Nigh-level Approach..............................................................................................................1 2017-18 City of Oshkosh Strategic Plan That Impacts Police Department..........................................3 Proposed Department Planning Approach and Work Plan...................................................................4 DetailedCost Proposal ....................................................................................................................5 APPENDIXA-Planning Background.................................................................................................6 StrategicPlanning Overview.............................................„.......................................,...........................6 Building the City of City of Oshkosh Police Department's Center of Excellence...................................6 APPENDIXB--Batter Dash t=aster Background and Resume..............................................................7 APPENDIX C-Sample Deilverables by Phase..................................................................................11 Dean M,Smith Chief of Police Oshkosh Police Department 420 Jackson Street Oshkosh,Wisconsin 54901 Office-(920)236-5720 Dear Chief Smith, Better Dash Faster Consulting,LLC respectfully submit to you this proposal for Oshkosh Police Department stakeholder analysis and strategic planning facilitation, City of Oshkosh police department Needs The City of Oshkosh Police Department is looking for a consultant that: 1. Gathers feedback from various stakeholder groups(key business,residents,and community groups). 2. Will help the Department develop a plan and read map to drive our service needs as outlined In the city plan. Complete with a subset of work tasks that are department specific. 3. Is independent,who is not currently,nor was ever,employed in the poflcing profession,and who has never pubilcally shared a bias either for or against the police. Proposed High-level Approach We have designed our process to gather key external community stakeholders and Internal Department leaders Input while minimizing the time and Department resources spent, Developing a successful plan can be relatively easy,but executing the plan may be hard. To ensure you create a plan you can accomplish,Setter Dash Faster Kelps your organization develop the plan quickly,assigns ownership,builds accountability,and establishes practical measures to track your progress. Here Is the high-level proposed approach: BETTER - IQorU' DHASI Page i 1 Oshkosh Police Department 1 CONSUL71NO Stakeholder Analysis and Strategic Planning Proposal *aaaaal* Libert), Liberty Mutual Office _ MtttuaL 708 Heartland TrI Ste 1800 INSURANCE Madison WI 53717 Walter Jankowski 613 Engelhart Dr Madison WI 53713-4745 CONTACT US Questions About Your Policy Thank you for renewing1- Phone 1-608- - 1-866-751751-2x3203 9 with Liberty Mutual. Mon-Fri 8AMEST EST Sat 8AM-8PM EST Sun 11AM-5PM EST Liberty Mutual Office This package contains your renewal Personal Liability Protection 70B Heartland Tr€Ste 1800 insurance policy. The declarations page summarizes your selected Madison WI 53717 coverages and lists any discounts and savings that have been applied. visit us online LibartyMutual.com We are pleased to offer you a Personal Liability Protection policy To report a claire through your affiliation with University of Wisconsin - Milwaukee Alumni By phone Association. 1-800.2CLAIMS Please take a moment to look over the enclosed documents: (1.800-225.2467) Online 0 • REVIEW your renewal declarations page carefully to ensure that LibertyMutual,comlclaims o your limits, exposure information, underlying policies information, and discounts are correct. 0 o • KEEP these materials with your important documents Co If you have any questions about your coverage please call us at Y 1-608-442-919111-866-751-2039. oSincerely, 0 0 Scott J Hinrichs 0 0 Sales Representative 1-608-442-9191 1-866-751-2039 THIS IS NOT YOUR PERSONAL LIABILITY PROTECTION INSURANCE BILL, .3 LiberLz Policy Declarations N�tttu iNSll HAIdCECE A summary of your Personal Liability Protection coverage Thank you for insuring with us. Here is your.renewal Personal Liability Protection policy summary, which is effective as of 11/13/2016. INSURANCE INFORMATION QUESTIONS ABOUT Named Insured Policy Number YOUR POLICY? Walter Jankowski LJK-248-973004.12 By phone Mailing Address Policy Effective Gate 1-608-442.91911.666-751.2039 613 Engelhart Dr 1111312016-1111312017 12:01AM Madison WI 53713.4745Liberty Mutual Office standard time at the address of the 708 Heartland Tri Ste Named Insured as stated in policy. 1800 Madison WI 53717 Total 12 Month Policy Premium $342 00 Sales Representative THIS l5 LVOT YOUR K.!z-§ AL`LfABILiTY Pi (�bTEON IEUSUf2ANC€'13fLL Scott J Hinrichs We are pleased to offer you a Personal Liability Protection policy through your affiliation with Visit us online University of Wisconsin - Milwaukee Alumni Association, LibertyMutuaLcom Coverage Information MANAGE YOUR LIMITS ACCOUNT ONLINE Personal Liability $1,000,000 Each Occurrence Sign up for eService LibertyMutual,com/eService Your Underlying Policies To report a claim TYPES OF INSURANCE INSURER POLICY NUMBER By phone Auto LIBERTY MUTUAL AOS-248-150367.40 1.800-2CLAIMS Auto PROGRESSIVE 11111111111 (1-800.225-2467) Home LIBERTY MUTUAL H47.248.360844-40 If any changes have been made to your underlying policies, please contact us to ensure proper coverage. Required Minimum Liability Limits for Underlying Policies Auto and Other Vehicles $ 250,000 Each Person $ 500,000 Each Accident $ 50,000 Property Damage Or $ 500,000 Combined Single Limit Home $ 100,000 Each Occurrence Watercraft $ 100,000 Each Occurrence Your underlying policies for auto, home and watercraft must have a minimum of the above limits throughout the policy period. Exeosure Information Vehicles (automobiles/ 1 Total residences (including primary, 1 motorcycles) rental, seasonal, etc) Recreational vehicles licensed for road use None Watercraft None Miscellaneous vehicles (not registered/licensed for road use) None Operators under ago 25 None Liability limits are subject to a retention of$250 on exposures not covered by underlying Insurance. PCE 155 03 12 y Pagel of 2 MIAMI �Y. -.4 ._ r -n..si r,.t' 'r.• ' 7 "ah'':,� A4 linea _; ,� + 3 _ _ - Liberty A"lirtual. INSURANCE Endorsements — Changes to your policy • LibertyGuard PLP Policy 12/04 (PC-41) • Membership in Liberty Mutual Holding Company • Amendatory Mold Endorsement (PCE-103) Inc. (2340e) • Amendment of Policy Definition (PCE-134) • Communicable Disease Exclusion 11/91 (PCE-51) • Exclusion For Lead Liability 3/94 (PCE-2) • Explanatory Endorsement-Home Day Care 11191 (PGE-50) • Sexual Molestation Exclusion 3/94 (PCE-75) • Amendment of Policy Conditions-W! 7105 (PCE-23) LibertyGuard Personal Liability Protection Policy Declarations This policy, including endorsements Coverage provided and underwritten by Wausau Business Insurance Company Boston, listed above, is signed by: MA. Mark G.Touhey J. Paul Condrin Ty Harris Secretary President Authorized Representative PCE 155 03 12 Page 2 of 2 AN I 0 �.3i]CY'hr �'�Utti�i)(. INSURANCE Wisconsin Underwriting Company Change The Liberty Mutual underwriting company issuing your insurance has changed to Wausau Business Insurance Company. This new underwriting company remains a Liberty Mutual company with the same quality coverage and service, and the change does not impact your coverage or your rate. As a result of the underwriting company change, your former policy will not be renewed with Liberty Mutual Insurance Corporation, instead, we are offering you coverage with Wausau Business Insurance Company. If you choose to accept our offer of insurance with Wausau Business Insurance Company, please pay the premium by the due date that will be shown on the bill that you will receive in a separate communication from Liberty Mutual, PMKT 1227 12 15 Page 1 of 1 a r. du �,f�MIT Libe;;•ty mlttuaI. INSURANCE Notice of Privacy Policy Liberty Mutual* values you as a customer and takes your personal privacy seriously. When you request a rate quotation, apply for insurance, request changes to your insurance policy or submit a claim, you disclose information about yourself or members of your family. This notice tells you how we treat the information we collect about you, 1. INFORMATION WE MAY COLLECT We collect information about you from: • Applications or other forms you complete, and information you provide to us over the telephone; • Your business dealings with us and other companies; • Your employer or association for Liberty Mutual Group products; Consumer reporting agencies, Motor Vehicle Departments, inspection services and medical providers; and • Visits to our Liberty Mutual website 2. TYPES OF INFORMATION WE MAY DISCLOSE We may disclose the following about you: • Information from your application or other forms, such as your name, date of birth, address, social security number, vehicle and driver information; • Information about your transactions with us, our affiliates or others, such as your insurance coverages, payment history, and certain claims information; and • Information we receive from third parties, such as your motor vehicle records and claims history. 3. TO WHOM INFORMATION MAY BE DISCLOSED We do not disclose personal information about you to anyone unless allowed by law. We are allowed by law to provide information to: • A third party that performs services for us, such as claims investigations, medical examinations, inspections, and appraisals or for roadside assistance or the repair of your vehicle if you have a claim; • Our affiliated companies and reinsurers; • insurance regulators and reporting agencies; • Consumer reporting agencies to obtain loss history information, motor vehicle reports, or credit report information where permitted by law; • State Motor Vehicle Departments to obtain a report of any accidents or convictions or to confirm your compliance with compulsory motor vehicle liability insurance laws; • Law enforcement agencies or other government authorities to report suspected illegal activities; • A person or organization conducting insurance actuarial, or research studies; • Companies that provide marketing services on our behalf, or as part of a joint marketing agreement with banks, credit unions, and affinity partners, or providers of annuity and financial products and services offered through us to our customers; and • As otherwise permitted by law, 4. HOW WE PROTECT INFORMATION We maintain physical, electronic, and procedural safeguards to protect your nonpublic personal information. These safeguards comply with applicable laws. We retain your information for as long as required by law or regulation. The only employees or agents who have access to your information are those who must have it to provide products or services to you, We do not sell your information to mass marketing or telemarketing companies. Any information we share with third parties, such as those organizations which perform a service for us or market our products, is subject to appropriate confidentiality protections and may be used only for the purposes intended. *This privacy notice is provided on behalf of the following Liberty Mutual companies and affiliates that provide personal automobile,homeowners, life insurance and annuities:Liberty Mutual Insurance Company, Liberty Mutual Lire Insurance Company, Liberty Insurance Corporation, LM Insurance Corporation,The First Liberty Insurance Corporation, Liberty insurance Company of America, Liberty Northwest Insurance Corporation, Liberty Life Assurance Company of Boston, Liberty County Mutual Insurance Company(Texas only), Liberty Lloyds of Texas Insurance Company, LM Property and Casualty Insurance Company, Liberty Mutual Personal Insurance Company, Liberty Personal Insurance Company, Liberty Mutual Mid-Atlantic Insurance Company, LM General Insurance Company,American States Preferred Insurance Company, Consolidated Insurance Company,Wausau General Insurance Company, Wausau Underwriters Insurance Company and Wausau Business Insurance Company. 234812 15 Page 1 of 1 7.7 $�{f `a. - ..q ' YzSya�' s `'r F � rte: •, a "tltubert7r aL INSURANCE Billing Information Your premium notice will be mailed to you in a few days. When it arrives, you may choose a method of payment to suit your budget. THE CHOICE/S YOURS You may pay the entire premium in full without additional charge. Your payment must be received by the due date shown on the premium notice. OR You may pay the premium in installments after a down payment and the valance in 10 monthly installments (minimum $30). Should you elect to pay by the month, your next bill and all subsequent bills, whether or not there is a minimum amount due, will include a $4.00 Billing Expense Fee (shown under "Finance Charge") reflected in your monthly payment. PREMIUM PA YMENT PLAN EXAMPL ES (Minimum of$30 a month) The The Monthly And The If The Total Number Installment The Total Total Total The Balance of Monthly Before Adding Billing Fee Deferred Policy Subject To Installments The For All Payment Premium And You Billing Fee ($30 Minimum) Billing Fee Installments Price Is: Put down: Will Be: Will Be: Will Be: Will Be: Will Be $ 100 $ 30.00 $ 70,00 3 $ 30,00 $ 12,00 $ 112.00 $ 200 $ 50.00 $150,00 5 $ 30.00 $20.00 $ 220.00 $ 300 $ 75.00 $225.00 8 $ 30.00 $32.00 $ 332.00 $ 400 $100.00 $300.00 10 $ 30.00 $40.00 $ 440.00 $ 500 $150.00 $350.00 10 $ 35.00 $40.00 $ 540.00 $ 600 $200.00 $400.00 10 $ 40.00 $40.00 $ 640.00 $ 800 $200.00 $600.00 10 $ 60,00 $40.00 $ 840.00 $1000 $250,00 $750.00 10 $ 75.00 $40.00 $1040.00 AUTO 2957 R1 Page 1 of 1 Libe��tj= R'ttrttial INSURANCr Premium Refund Policy In most states and in most situations, any refund owed will automatically be refunded in the same method your last payment was received. For example, if the last payment you made was by personal check, we will send you a refund via check. PMKT 994 08 12 Information about Personal Liability Protection Rate Determination When determining your premium, we may consider many factors, such as your credit history, claims history, and household risk characteristics, You may request that Liberty Mutual Insurance re-evaluate your current personal liability protection insurance rate with up-to-date information using the same factors prior to your policy's expiration. Policy rate re-evaluation is limited to one request per policy period, and may result in a quoted premium either higher or lower. If you would like your policy re-evaluated, please call us at 1-608-442-9191/1-866-751-2039 and a representative will be happy to assist you. PMKT 861 10 11 Page 1 of 1 Keep This Notice With Your Insurance Papers PROBLEMS WITH YOUR INSURANCE? - if you are having problems with your insurance company or agent, do not hesitate to contact the insurance company or agent to resolve your problem. Liberty Mutual Insurance Company P.O. Box 9099 Dover= NH 03821-9099 (603) 431-7545 You can also contact the OFFICE OF THE COMMISSIONER OF INSURANCE, a state agency which enforces Wisconsin's insurance laws, and file a complaint. You can contact the OFFICE OF THE COMMISSIONER OF INSURANCE by writing to; Office of the Commissioner of Insurance Complaints Department P.O. Box 7873 Madison, Wl 53707-7873 or you can call 1-800-236-8517 outside of Madison or 266-0103 in Madison, and request a complaint form. PMKT 578 01 08 Liberty Mutual Insurance Group Page 1 of 1 5�����'rf*'�'�y �_- � ���;tom�i4"=�� qY F �_ .{" '�} �4 �,°�' '£_ PR90RE.L, YE' Progressive OIRECTAuto PO Box 31260 Tampa,FL 33631 Policy Number: 907860284 Underwritten by: Progressive Universal Insurance Co Policyholder Walter Jankowski December 28,2016 Page 1 of 1 Customer Service 1.800-776.4737 24 hours a day,7 days a week Mailing Address: Progressive PD Box 31260 Tampa,FL 33631-3260 Requested policy documents .................................................................. ............................... ❑ Verification of Insurance Progressive PRMPREWYE' PO Box 31260 D/RFCTAufo Tampa,FL 33631 NAIC Company Code; 21727 Policy!Number: 907860284 Underwritten by: Progressive Universal Insurance Co Policyholder; Walter Jankowsld Page 1 of 1 December 28,2016 Customer Service 1-800-776-4737 24 hours a day,7 days a week Verification of Insurance for Walter Jankowski This verification of insurance is not an insurance policy and does not amend,extend or alter the coverage afforded by the policies listed herein. Notwithstanding any requirement,term or condition of any contract or other document with respect to which this verification of insurance may be issued or may pertain,the insurance afforded by the policies described herein is subject to all the terms, exclusions and conditions of the policies. Please accept this letter as verification of insurance for this policy, Policy and driver information ............................................................................................. Policy number. 907860284 ............................................................................................................ Policy state: Wisconsin .............................. .................,._.,,,. ,...........,,,..... Policy period: Nov 22,2016 May 22,2017 ...................................................................................................................................................... There was no lapse to coverage during this policy period. Effective date: Nov 22,2016 Drivers: Walter Jankowski Insured Driver ........................................................................................................................................... Address: 613 Englehart Drive Madison,Wi 53703 Vehicle information ...............................................................2.007.......S.. . .. .......................... .................................... Vehide: aab.. 9-3 ......................................4........... ....................... ...............................""...................... .. Vehide identification number: Y53FD49Y87i 148196 Coverage information ...... ................................. ............................ ................ ....................... Bodily Injury Liability: $250,000 each person/$500,000 each accident Property Damage Liability: $100,000 each acddent .. ....., .................................................. ............................................................................ Collision: Deductible: $500 deductible ...... ... .. .......... ........ ........... Comprehensive: Deductible: $500 deductible Form Vol{07113} BETTDAS-01 BROJEMANN CERTIFICATE OF LIABILITY INSURANCE DATE 1Y, THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(fes)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder In lieu of such endorsement(s). PRODUCER CONTACT NAME: Select Business Unit TRICOR,Inc.-DeForest PHONE Eft; FAX No 5008 Linde Lane a-MAIL : 60$)723-6440 Suite 100 ADDREss:select@tricorinsurance.com De Forest,WI 53532 INSURER 5 AFFORDING COVERAGE NAIC# INSURER A.Acuity 14184 INSURED INSURER B Better Dash Faster INSURER C t 613 Englehart Dr. INSURER o; Madison,WI 53713 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICES 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 TYPEOFINSURANCE D POLICY EFF POLICY EXP LTR INSD WVD POLICY NUMBER Mh1IDD MMIDD LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE 5 1,000,000 CLAIMS-MADE 0 OCCUR 241007 03/1512016 03/15/2017 PREMISES Fa occarrrence S 100,000 MED EXP(Anyone person) S 5,000 PERSONAL&ADV INJURY S 1,000,000 GEN'LAGGREGATE LIMIT APPLIF'SPER: GENERAL AGGREGATE $ 2,000,000 X POLICY L JECT M LOC PRODUCTS-C MP10PAGG $ 2,000,000 OTHER: S AUTOMOBILE LIABILITY COMBINED SINGLE LIrMIT S Ea accldeM ANY AUTO BODILY INJURY(Per person) $ ALLOWNED SCHEDULED AUTOS AUTOS BODILY (Per accident) $ HIRED AUTOS NON-OWNED PROPERTYDWAGE S AUTOS Per accident b UMBRELLA LIADOCCUR EACH OCCURRENCE $ EXCESS LIAR HOLARAS-MADE - AGGREGATE $ DED RETENTION$ $ !YORKERS COMPENSATION PER OTH- YIN STA ANDEMPLOYERS'LIABILITY TU ER ANY PROPRIETORIPARTNEWEXECUTIVE ❑ N 1 A E.L EACH ACCIDENT 5 OFFICERIMEMBER EXCLUDEDI (h#andatoryinNH) E.LDISEASE-EAEMPLOYE S If yes,eoscribe under DESCRIPTION OF OPERATIONS be',ow E.C.OISEASE-POLICY LIMIT S DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,maybe attached It more space Is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE SAMPLE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 693 Englehart Dr, ACCORDANCE WITH THE POLICY PROVISIONS. 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