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Ptaschinski Const. & Oshkosh, Contract 17-17
CONSTRUCTION CONTRACT THIS AGREEMENT, made on the 15th day of February, 2017, by and between the CITY OF OSHKOSH, party of the first part, hereinafter referred to as CITY, and Ptaschinski Construction, Inc., W7352 Sth 33, Beaver Dam, WI 53916, party of the second part, hereinafter referred to as the CONTRACTOR, WITNESSETH: That the CITY and the CONTRACTOR, for the consideration hereinafter named, agree as follows: ARTICLE 1. SCOPE OF WORK The CONTRACTOR hereby agrees to furnish all of the materials and all of the equipment and labor necessary, and to perform all of the work shown on the plans and described in the specifications for the project entitled or described as follows: Public Works Contract No. 17-17 for various concrete paving and utility projects for Hemlock Court and Fraser Drive in the City of Oshkosh, for the Public Works Department, pursuant to Resolution 17-50 adopted by the Common Council of the City of Oshkosh on the 14th day of February, 2017, all in accordance and in strict compliance with the CONTRACTOR's Proposal and the other Contract Documents referred to in ARTICLE V of this Contract. ARTICLE 11. TIME OF COMPLETION The work to be performed under this contract shall be commenced and the work completed within the time limits specified in the Special. Conditions and/or CONTRACTOR's proposal. ARTICLE 111. PAYMENT (a) The Contract Sum. The CITY shall pay to the CONTRACTOR for the performance of the Contract the sum of One Hundred Sixty Nine Thousand One Hundred Eighty Dollars and 99/100 ($169,180.99), adjusted by 'any changes as provided in the Specifications, or any changes hereafter mutually agreed upon in writing by the parties hereto, provided, however, in the event the Proposal and Contract Documents are on a "Unit Price" basis, the above mentioned figure is an estimated figure, and the CITY shall, in such cases, pay to the CONTRACTOR for the performance of the Contract the amounts determined for the total number of each of the units of work as set forth in the CONTRACTOR's proposal; the number of units therein contained is approximate only, and the final payment shall be made for the actual number of units that are incorporated in or made necessary by the work covered by the Contract. 1 7 (b) Progress Payments. In the event the time necessary to complete this Contract is such that progress payments are required, they shall be made according to the provisions set forth in the Specifications. ARTICLE IV. CONTRACTOR TO HOLD CITY HARMLESS The CONTRACTOR covenants and agrees to protect and hold the CITY harmless against all actions, claims and demands of any kind or character whatsoever which may in any way be caused by or result from the intentional or negligent acts of the CONTRACTOR, his agents or assigns, his employees or his subcontractors related however remotely to the performance of this Contract or be caused or result from any .violation of any law or administrative regulation, and shall indemnify or refund to the CITY all sums including court costs, attorney fees, and punitive damages which the CITY may be obliged or adjudged to pay on any such claims or demands within thirty (30) days of the date of the CITY's written demand for indemnification or refund. ARTICLE V. INSURANCE The Insurance required by the City of Oshkosh as specified in the CITY's specifications, including addenda, or plans, or instructions, or advertisements, shall be Primary 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 based upon the occurrence of an event, and not based on claims made. All insurance shall be in full force prior to commencing work and remain in force until the entire job is completed and the length of time that is specified, if any, in this Contract, the Specifications, whichever is longer. ARTICLE VI. COMPONENT PARTS OF THE CONTRACT This Contract consists of the following component parts, all of which areas fully a part of this contract as if herein set out verbatim, or if not attached, as if hereto attached: 1. This Instrument 2. The City's Plans and Specifications, including all Addenda's 3. City of Oshkosh Standard Specifications 4. Instructions to Bidders 5. Advertisement for Bids 6. Contractor's Proposal The Contract Documents are complementary; what is required by one is as binding as if required by all. Before undertaking each part of the work, the CONTRACTOR shall carefully study and compare the Contract.Documents and check and verify all pertinent figures and measurements required therein. CONTRACTOR shall promptly report in writing to the Engineer any conflict, error, ambiguity or discrepancy which CONTRACTOR may discover and shall obtain written clarification from the Engineer before proceeding with any work affected thereby. 2 In the event that any provision in any of the above component parts of this Contract conflicts with any provision in any other of the component parts, the provision in the component part first enumerated above shall govern over any other component part which follows it numerically except as may be otherwise specifically stated. IT IS HEREBY DECLARED, UNDERSTOOD AND AGREED that the word "CONTRACTOR" wherever used in this Contract means the party of the second part and its/his/their legal representatives, successors, and assigns. . I IN WITNESS WHEREOF, the City of Oshkosh,Wisconsin, has caused this contract to be sealed with its corporate seal and to be subscribed to by its City Manager and City Clerk and countersigned by the Comptroller of said City, and the party of the second part hereunto set its, his or their hand and seal the day and year first above written. In the Presence of: CONTRACTOR Ptaschinski Construction, Inc. . 4)&,tL, — By:. (Seal of Contractor (Specify Title) if a Corporation.) By: See /7(-ff tsb�p�— (Specify Title) CITY OF OSHKOSH By: Mar lk A. Rohloff, City Manager MitnesS) And: L )Witness) 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 q,iy�n & Lorens\o-n,--19ify-Attorney Trena Larson, City Comptroller PERFORMANCE TRAVELERS CASUALTY AND SURETY COMPANY OF AMERICA BOND Hartford, Connecticut 06183 Bond No.: 106487293 OKV 106 KNOW ALL MEN BY THESE PRESENTS: that Ptaschinski Construction Inc, W7352 STH 33, Beaver Dam, WI 53916 (Here insert full name and address or legal title of Contractor) as Principal, hereinafter called Contractor, and, Traveler's Casualty and Surety Company of America, One Tower Square, Hartford, CT 06183 (Here insert full name and address or legal title of Surety) as Surety, hereinafter called Surety, are held and firmly bound unto City of Oshkosh, 215 Church Avenue, Oshkosh, WI 54903-1130 (Here insert full name and address or legal title of Owner) as Obligee, hereinafter called Owner, in the amount of One Hundred Sixty Nine Thousand One Hundred Eighty dollars and ninety nine cents Dollars ($169,180.99), for the payment whereof Contractor and Surety bind themselves, their heirs, executors, administrators, successors and assigns, jointly and severally, firmly by these presents. WHEREAS, Contractor has by written agreement dated February 15, 2017, entered into a contract with Owner for Public Works Contract No. 17-17, Oshkosh, WI (Here insert full name,address and description of project) in accordance with Drawings and Specifications prepared by (Here insert full name,address and legal title to Architect) which contract is by reference made a part hereof, and is hereinafter referred to as the Contract. The Company executing this bond vouches that this document conforms to American Institute of Architects Document A311, February 1970 edition. 1 PERFORMANCE BOND NOW, THEREFORE, THE CONDITION OF THIS OBLIGATION is such that, if Contractor shall promptly and faithfully perform said Contract, then this obligation shall be null and void; otherwise it shall remain in full force and effect. The Surety hereby waives notice of any contract or contracts of completion arranged alteration or extension of time made by the under this paragraph) sufficient funds to pay the Owner. cost of completion less the balance of the contract price; but not exceeding, including Whenever Contractor shall be, and declared by other costs and damages for which the Surety Owner to be in default under the Contract, the may be liable hereunder, the amount set forth in Owner having performed Owner's obligations the first paragraph hereof. The term "balance of thereunder, the Surety may promptly remedy the the contract price," as used in this paragraph, default, or shall promptly shall mean the total amount payable by Owner to Contractor under the Contract and any 1) Complete the Contract in accordance amendments thereto, less the amount properly with its terms and conditions, or paid by Owner to Contractor. 2) Obtain a bid or bids for completing the Any suit under this bond must be instituted Contract in accordance with its terms and before the expiration of two (2) years from the conditions, and upon determination by Surety of date on which final payment under the Contract the lowest responsible bidder, or, if the Owner falls due. elects, upon determination by the Owner and the Surety jointly of the lowest responsible No right of action shall accrue on this bond to or bidder, arrange for a contract between such for the use of any person or corporation other bidder and Owner, and make available as Work than the Owner named herein or the heirs, progresses (even though there should be a executors, administrators or successors of the default or a succession of defaults under the Owner. Ptaschinski Construction Inc. (Principal) (Witnes ) (Title) 63� Travel rs Casualty and Surety Company of America df (Sur y (Seal) Z Dorothy L. Hackbarth (Witness) Connie J Born Attorne n Fact (Title) The Company executing this bond vouches that this document conforms to American Institute of Architects Document A311, February 1970 edition. 2 LABOR AND TRAVELERS CASUALTY AND SURETY COMPANY OF AMERICA MATERIAL Hartford, Connecticut 06183 PAYMENT BOND Bond No.: 106487293 OKV 106 THIS BOND IS ISSUED SIMULTANEOUSLY WITH PERFORMANCE BOND IN FAVOR OF THE OWNER CONDITIONED ON THE FULL AND FAITHFUL PERFORMANCE OF THE CONTRACT KNOW ALL MEN BY THESE PRESENTS: that Ptaschinski Construction Inc., W7352 STH 33, Beaver Dam WI 53916, (Here insert full name and address or legal title of Contractor) as Principal, hereinafter called Principal, and, Travelers Casualty and Surety Company of America, One Tower Square, Hartford, CT 60183, (Here insert full name and address or legal title of Surety) as Surety, hereinafter called Surety, are held and firmly bound unto City of Oshkosh, 2015 Church Avenue, Oshkosh, WI 54903-1130 (Here insert full name and address or legal title of Owner) as Obligee, hereinafter called Owner, for the use and benefit of claimants as hereinbelow defined, in the amount of One Hundred Sixty Nine Thousand One Hundred Eighty dollars and ninety nine cents Dollars ($169,180.99) (Here insert a sum equal to at least one-half of the contract price) for the payment whereof Principal and Surety bind themselves, their heirs, executors, administrators, successors and assigns,jointly and severally, firmly by these presents. WHEREAS, Principal has by written agreement dated February 15, 2017, entered into a contract with Owner for(here insert full name,address and description of project)Public Works Contract No. 17-17, Oshkosh,WI in accordance with Drawings and Specifications prepared by , which contract is by reference made a part hereof, and is hereinafter referred to as the Contract. The Company executing this bond vouches that this document conforms to American Institute of Architects Document A311, February 1970 edition. 3 LABOR AND MATERIAL PAYMENT BOND NOW, THEREFORE, THE CONDITION OF THIS OBLIGATION is such that, if Principal shall promptly make payment to all claimants as hereinafter defined, for all labor and material used or reasonably required for use in the performance of the Contract, then this obligation shall be void; otherwise it shall remain in full force and effect, subject, however, to the following conditions: 1. A claimant is defined as one having a direct performed. Such notice shall be served by mailing the contract with the Principal or with a Subcontractor of same by registered mail or certified mail, postage the Principal for labor, material, or both, used or prepaid, in an envelope addressed to the Principal, reasonably required for use in the performance of the Owner or Surety, at any place where an office is Contract, labor and material being construed to include regularly maintained for the transaction of business, or served in any manner in which legal process may be that part of water, gas, power, light, heat, oil, gasoline, served in the state in which the aforesaid project is telephone service or rental of equipment directly located, save that such service need not be made by a applicable to the Contract. public officer. 2. The above named Principal and Surety b) After the expiration of one (1) year following hereby jointly and severally agree with the Owner that the date on which Principal ceased Work on said every claimant as herein defined, who has not been Contract, it being understood, however, that if any paid in full before the expiration of a period of ninety limitation embodied in this bond is prohibited by any (90) days after the date on which the last of such law controlling the construction hereof such limitation claimant's work or labor was done or performed, or shall be deemed to be amended so as to be equal to materials were furnished by such claimant, may sue the minimum period of limitation permitted by such on this bond for the use of such claimant, prosecute law. the suit to final judgment for such sum or sums as may be justly due claimant, and have execution thereon. c) Other than in a state court of competent The Owner shall not be liable for the payment of any jurisdiction in and for the county or other political costs or expenses of any such suit. subdivision of the state in which the Project, or any 3. No suit or action shall be commenced part thereof, is situated, or in the United States District hereunder by any claimant: Court for the district in which the Project, or any part thereof, is situated, and not elsewhere. a) Unless claimant, other than one having a 4. The amount of this bond shall be reduced by direct contract with the Principal, shall have given and to the extent of any payment or payments made in written notice to any two of the following: the Principal, good faith hereunder, inclusive of the payment by the Owner, or the Surety above named, within ninety Surety of mechanics' liens which may be filed of record (90) days after such claimant did or performed the last against said improvement, whether or not claim for the of the work or labor, or furnished the last of the amount of such lien be presented under and against materials for which said claim is made, stating with this bond. substantial accuracy the amount claimed and the name of the party to whom the materials were furnished, or for whom the work or labor was done or Signed and sealed this 21St day of February, 2017. Ptaschinski Construction, Inc (Principal) itness) (Title) Traveler Casualty and Surety Company of America ou l (Surety (Seal) ' Dorothy L. Hackbarth (Witness) Connie J Born Attorney' Fact (Title) The Company executing this bond vouches that this document conforms to American Institute of Architects Document A311, February 1970 edition. 4 oiwwwwuuuwwwuwwwmwwwuwumwwwwwwwmwwwwwwwwwwumuuuuwwwuumwuwmmuwwwwwwwwimuuuuuumwmmmimmimwwwuwwwWARNING:THIS mowiPwOmiWEw O ATTORNEY IS INVALID WITHOUT THE RED BORDERiwmuuuuuuuuuuuuuuuuuuuuuuuoiouuuwuwwuoiwwwowuwwuwiwwwwwwwwwwwwwwwwwwwuwwwwmuuwmwwwwiwwwwwwwwwwwwww POWER OF ATTORNEY TRAVELERSJFarmington Casualty Company St.Paul Mercury Insurance Company Fidelity and Guaranty Insurance Company Travelers Casualty and Surety Company Fidelity and Guaranty Insurance Underwriters,Inc. Travelers Casualty and Surety Company of America St.Paul Fire and Marine Insurance Company United States Fidelity and Guaranty Company St.Paul Guardian Insurance Company Attorney-In Fact No. 222283 Certificate No. 006327056 KNOW ALL MEN BY THESE PRESENTS: That Farmington Casualty Company, St. Paul Fire and Marine Insurance Company, St. Paul Guardian Insurance Company,St. Paul Mercury Insurance Company,Travelers Casualty and Surety Company,Travelers Casualty and Surety Company of America,and United States Fidelity and Guaranty Company are corporations duly organized under the laws of the State of Connecticut, that Fidelity and Guaranty Insurance Company is a corporation duly organized under the laws of the State of Iowa,and that Fidelity and Guaranty Insurance Underwriters,Inc.,is a corporation duly organized under the laws of the State of Wisconsin(herein collectively called the"Companies"),and that the Companies do hereby make,constitute and appoint Connie J.Born,David M.Fister,and Dorothy L.Hackbarth of the City of Beaver Dam ,State of Wisconsin their true and lawful Attorney(s)-in-Fact, each in their separate capacity if more than one is named above,to sign,execute,seal and acknowledge any and all bonds,recognizances,conditional undertakings and other writings obligatory in the nature thereof on behalf of the Companies in their business of guaranteeing the fidelity of persons,guaranteeing the performance of contracts and executing or guaranteeing bonds and undertakings required or permitted in any actions or proceedings allowed by law. IN WITNESS WHEREOF,the Companies have caused this instrument to be signed and their corporate seals to be hereto affixed,this 23rd day of March 2015 Farmington Casualty Company St.Paul Mercury Insurance Company Fidelity and Guaranty Insurance Company Travelers Casualty and Surety Company Fidelity and Guaranty Insurance Underwriters,Inc. Travelers Casualty and Surety Company of America St.Paul Fire and Marine Insurance Company United States Fidelity and Guaranty Company St.Paul Guardian Insurances Company ASU F\Rx 4'4, N �// ...,�NS�.• 4tY A/� .yu o����y p'�........qv`• �P o9 $�Yg����/VN°"/�io"saeq� pytYANo O T •y 4 9� rC0RP0R > 4. '.'t'�'; Vp g d'^'J B .y4 L ..Rwae• p 'IY �J; y � � c � �3� CiO WCDttFORATFD ma �! A)F;m Wee pOaPORAYp:,:^? a 5 e �NC016GR11ED � 19 8 22(- 0 � 1977 �' `"� �' �f t f: "•— :n's a HARTFORD, � Y��hNRPFO�� � l`s L 1951 4 S83LL::3 s� Nab 4~ o .: State of Connecticut By: City of Hartford ss. Robert L.Raney, enior Vice President On this the 23rd day of March 2015 before me personally appeared Robert L.Raney,who acknowledged himself to be the Senior Vice President of Farmington Casualty Company, Fidelity and Guaranty Insurance Company,Fidelity and Guaranty Insurance Underwriters,Inc.,St.Paul Fire and Marine Insurance Company,St.Paul Guardian hrsurance Company,St.Paul Mercury Insurance Company,Travelers Casualty and Surety Company,Travelers Casualty and Surety Company of America,and United States Fidelity and Guaranty Company,and that he,as such,being authorized so to do,executed the foregoing instrument for the purposes therein contained by signing on behalf of the corporations by himself as a duly authorized officer. Ci•t� In Witness Whereof,I hereunto set my hand and official seal. My Commission expires the 30th day of June,2016. i0U8L�G * Marie C.Tetreault,Notary Public L58440-8-12 Printed in U.S.A. WARNING:THIS POWER OF ATTORNEY IS INVALID WITHOUT THE RED BORDER WARNING:THIS POWER OF ATTORNEY IS INVALID WITHOUT THE RED BORDER This Power of Attorney is granted under and by the authority of the following resolutions adopted by the Boards of Directors of Farmington Casualty Company,Fidelity and Guaranty Insurance Company,Fidelity and Guaranty Insurance Underwriters, Inc.,St.Paul Fire and Marine Insurance Company,St.Paul Guardian Insurance Company,St.Paul Mercury Insurance Company,Travelers Casualty and Surety Company,Travelers Casualty and Surety Company of America,and United States Fidelity and Guaranty Company,which resolutions are now in full force and effect,reading as follows: RESOLVED,that the Chairman,the President,any Vice Chairman,any Executive Vice President,any Senior Vice President,any Vice President,any Second Vice President,the Treasurer,any Assistant Treasurer,the Corporate Secretary or any Assistant Secretary may appoint Attorneys-in-Fact and Agents to act for and on behalf of the Company and may give such appointee such authority as his or her certificate of authority may prescribe to sign with the Company's name and seal with the Company's seat bonds,recognizances,contracts of indemnity,and other writings obligatory in the nature of a bond,recognizance,or conditional undertaking,and any of said officers or the Board of Directors at any time may remove any such appointee and revoke the power given him or her;and it is FURTHER RESOLVED,that the Chairman,the President,any Vice Chairman,any Executive Vice President,any Senior Vice President or any Vice President may delegate all or any part of the foregoing authority to one or more officers or employees of this Company,provided that each such delegation is in writing and a copy thereof is filed in the office of the Secretary;and it is FURTHER RESOLVED,that any bond,recognizance,contract of indemnity,or writing obligatory in the nature of a bond,recognizance,or conditional undertaking shall be valid and binding upon the Company when(a)signed by the President,any Vice Chairman,any Executive Vice President,any Senior Vice President or any Vice President,any Second Vice President,the Treasurer,any Assistant Treasurer,the Corporate Secretary or any Assistant Secretary and duly attested and sealed with the Company's seal by a Secretary or Assistant Secretary;or(b)duly executed(under seal,if required)by one or more Attorneys-in-Fact and Agents pursuant to the power prescribed in his or her certificate or their certificates of authority or by one or more Company officers pursuant to a written delegation of authority; and it is FURTHER RESOLVED,that the signature of each of the following officers:President,any Executive Vice President,any Senior Vice President,any Vice President, any Assistant Vice President,any Secretary,any Assistant Secretary,and the seal of the Company may be affixed by facsimile to any Power of Attorney or to any certificate relating thereto appointing Resident Vice Presidents,Resident Assistant Secretaries or Attorneys-in-Fact for purposes only of executing and attesting bonds and undertakings and other writings obligatory in the nature thereof,and any such Power of Attorney or certificate bearing such facsimile signature or facsimile seal shall be valid and binding upon the Company and any such power so executed and certified by such facsimile signature and facsimile seal shall be valid and binding on the Company in the future with respect to any bond or understanding to which it is attached. I,Kevin E.Hughes,the undersigned,Assistant Secretary,of Farmington Casualty Company,Fidelity and Guaranty Insurance Company,Fidelity and Guaranty Insurance Underwriters,Inc.,St.Paul Fire and Marine Insurance Company,St.Paul Guardian Insurance Company,St.Paul Mercury Insurance Company,Travelers Casualty and Surety Company,Travelers Casualty and Surety Company of America,and United States Fidelity and Guaranty Company do hereby certify that the above and foregoing is a true and correct copy of the Power of Attorney executed by said Companies,which is in full force and effect and has not been revoked. IN TESTIMONY WHEREOF,I have hereunto set my hand and affixed the seals of said Companies this 21st day of February 247 ill� (,�-/42o4� Kevin E.Hughes,Assistant Sect tary GASU,�� q""�FF.TY y"FIRE 4 \RN I� .•'j\N Sliq`'...., P tY AHO WA ? O ♦ C o y A A �'.ZOR�OpA>'�1 Q`' ,{n: 4p 69 q`• p �t �'1 4 8 2�o '< 1977 �IC0.RPORATED" �,•#,,.,...1 m �r ,,, �:n �W too"vORgrf..r�i cn t s m gI j ,n t a HARTFORD, •c J H4R1FORb, �a ¢ xcaa�tTro a c+q_ ` 1951 s �t•SG llG iO"! 1�1, 'oC6NN. n \ CONtf.�� 0 1896 Sri�.L:3.,{v •nrm+�F To verify the authenticity of this Power of Attorney,call 1-800-421-3880 or contact us at www.travelersbond.coni.Please refer to the Attorney-hn-Fact number,the above-named individuals and the details of the bond to which the power is attached. WARNING:THIS POWER OF ATTORNEY IS INVALID WITHOUT THE RED BORDER PTASC-1 OP D: CB AOR LJ DATE(MMIDD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 02/21/2017 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(ies) must have ADDITIONAL INSURED provisions or 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 920-887-1615 CONT David M. Fister RICHARDS INS OF BEAVER DAM LLC PHONE g20-887-1615 FAX 920-887-2851 123 N SPRING ST (A/C,No,Ext): (A/C,No): P O BOX 277 EMAIL dfister@richardsinsurance.com BEAVER DAM,WI 53916-0277 ADDRESS: David M.Fister INSURERS AFFORDING COVERAGE NAIC# INSURER A:Cincinnati Insurance Company 10677 INSURED PTASCHINSKI CONSTRUCTION INC INSURER B: W7352 STATE ROAD 33 INSURER C: BEAVER DAM,WI 53916-9413 INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR 7ypE OF INSURANCE ADDL SUB POLICY NUMBER POLICY EFF POLICY EXP LIMITS L D WVD MM/DD/YYYY MM/DD/YYYY A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE X OCCUR EPP0310092 03/01/2017 03/01/2018 DAMAGE TO RENTED 500,000 X E a occurrence) $ MED EXP(AnV oneperson) $ 10,000 PERSONAL&ADV INJURY $ 1'000,000 GENT AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY❑ PECOT- 1:1 LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: Emp Ben. $ 1,000,000 A AUTOMOBILE LIABILITY COMBINdEeD SINGLE LIMIT $ 1,000,000 (Ea acci —._. -- X ANY AUTO EPP0310092 03/01/2017 03/01/2018 BODILY INJURY Perperson) $ OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY Per accident $ HIRED NON-OWNED PROPERTY DAMAGE AUTOS ONLY AUTOS ONLY Per accident $ $ A X UMBRELLA LIAR X OCCUR EACH OCCURRENCE $ 2,000,000 EXCESS LIAR CLAIMS-MADE EPP0310092 03/01/2017 03/01/2018 AGGREGATE $ 2,000,000 DED I I RETENTION$ $ A WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITYYIN EWC030161802 03/01/2017 03/01/2018 STA LITE I I ER 100,000 ANY PROPRIETOR/PARTNER/EXECUTIVE ❑ E.L.EACH ACCIDENT $ _ (Mandatory in NH)EXCLUDED? N/4 E.L.DISEASE-EA EMPLOYEE $ 100,000 If yes,describe under 500,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ ESGRIPTI O QP TI NS/ OCATION /V ICL ORD 101,Additional Remarks Schedule,may be attached if more space is required) I�roject: u�llcor s�ontracoo. �- City of Oshkosh it's officers,council members,agents,employees and authorized volunteers are additional insured per the project listed. CERTIFICATE HOLDER CANCELLATION CITYO-3 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN CITY OF OSHKOSH ACCORDANCE WITH THE POLICY PROVISIONS. 215 CHURCH AVE OSHKOSH,WI 54901 AUTHORIZED REPRESENTATIVE ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD PTASC-1 OP ID: CB �CORQ DATE(MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 02/21/2017 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(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTANAME: David M. Fister RICHARDS INS OF BEAVER DAM LLC PHONE FAX 123 N SPRING ST (AIM,Ell::920-887-1615 A/C No): 920-887-2851 P O BOX 277 ADDRESS:BEAVER DAM,Wl 53916-0277 ss:dfister richardsinsurance.com David M.Fister INSURERS AFFORDING COVERAGE NAIC# INSURERA:Cincinnati Insurance Company 10677 INSURED PTASCHINSKI CONSTRUCTION INC INSURER B:Cincinnati Casualty Company W7352 STATE ROAD 33 INSURER C: BEAVER DAM,WI 53916-9413 INSURER D: 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 TYPE OF INSURANCE ADDL SUB POLICY EFF POLICY EXP LIMITS LTR D WVD POLICY NUMBER MM/DD/YYYY MM/DD/YYYY A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,00 CLAIMS-MADE � OCCUR X EPP0310092 03/01/2016 03/01/2017 DAMAGE TO RENTED 500 00 PREMISES Ea occurrence $ MED EXP(Any one person) $ 10,00 PERSONAL&ADV INJURY $ 1,000,00 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,00 POLICYa PE F]LOC PRODUCTS-COMP/OP AGG $ 2,000,00 OTHER: Emp Ben. $ 1,000,00 AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 Ea accident A X ANY AUTO EPP0310092 03/01/2016 03/01/2017 BODILY INJURY(Per person) $ ALL OS SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE X HIRED AUTOS X AUTOS Per accident $ X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 2,000,00 A EXCESS LIAB CLAIMS-MADE EPP0310092 03/01/2016 03/01/2017 AGGREGATE $ 2,000,00 DED I I RETENTION$ $ WORKERS COMPENSATION X PER OTH- AND EMPLOYERS'LIABILITY STATUTE I ER _ B ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N EWC030161802 03/01/2016 03/01/2017 E.L.EACH ACCIDENT $ 100,00 OFFICER/MEMBER EXCLUDED? N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 100,00 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,00 A INLAND MARINE EPP0310092 03/01/2016 03/01/2017 LIMIT 1,657,83 A INSTALLATION FLOAT EPP0310092 03/01/2016 03/01/2017 LIMIT 100,00 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Project: Public Works Contracto No. 17-17 City of Oshkosh it's officers,council members,agents,employees and authorized volunteers are additional insured per the project listed. CERTIFICATE HOLDER CANCELLATION CITYO-3 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN CITY OF OSHKOSH ACCORDANCE WITH THE POLICY PROVISIONS. 215 CHURCH AVE OSHKOSH,WI 54901 AUTHORIZED REPRESENTATIVE ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. CONTRACTORS' COMMERCIAL GENERAL LIABILITY BROADENED ENDORSEMENT This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART A. Endorsement-Table of Contents: Coverage: Begins on Page: 1. Employee Benefit Liability Coverage.................................................................................................2 2. Unintentional Failure to Disclose Hazards.........................................................................................7 3. Damage to Premises Rented to You.................................................................................................8 4. Supplementary Payments..................................................................................................................9 5. Medical Payments..............................................................................................................................9 6. Voluntary Property Damage(Coverage a.) and Care, Custody or Control Liability Coverage(Coverage b.).......................................................................................................9 7. 180 Day Coverage for Newly Formed or Acquired Organizations...................................................10 8. Waiver of Subrogation.....................................................................................................................10 9. Automatic Additional Insured-Specified Relationships: ...............................................................10 • Managers or Lessors of Premises; • Lessor of Leased Equipment; • Vendors; = State or Political Subdivisions-Permits Relating to Premises; State or Political Subdivisions-Permits; and • Contractors'Operations l 10. Broadened Contractual Liability-Work Within 50'of Railroad Property.........................................14 11. Property Damage to Borrowed Equipment................................................................. ........14 12. Employees as Insureds-Specified Health Care Services: ........14 • Nurses; • Emergency Medical Technicians; and • Paramedics 13. Broadened Notice of Occurrence....................................................................................................14 B. Limits of Insurance: € The Commercial General Liability Limits of Insurance apply to the insurance provided by this endorse- ment, except as provided below: 1. Employee Benefit Liability Coverage Each Employee Limit: $ 1,000,000 Aggregate Limit: $ 3,000,000 Deductible: $ 1,000 3. Damage to Premises Rented to You The lesser of: a. The Each Occurrence Limit shown in the Declarations;or b. $500,000 unless otherwise stated$ 4. Supplementary Payments a. Bail bonds: $ 1,000 b. Loss of earnings: $ 350 5. Medical Payments Medical Expense Limit: $ 10,000 Includes copyrighted material of Insurance GA 233 02 07 Services Office, Inc.,with its permission. Page 1 of 15 i 6. Voluntary Property Damage (Coverage a.) and Care,Custody or Control Liability Coverage (Coverage b.) Limits of Insurance (Each Occurrence) Coverage a.$1,000 Coverage b.$5,000 unless otherwise stated $ Deductibles(Each Occurrence) Coverage a.$250 Coverage b.$250 unless otherwise stated $ COVERAGE PREMIUM BASIS RATE ADVANCE PREMIUM a) Area (For Limits in Excess of (For Limits in Excess of b) Payroll $5,000) $5,000) 1 C Gross Sales d Units e Other b. Care, Custody or Control TOTAL ANNUAL PREMIUM 11. Property Damage to Borrowed Equipment Each Occurrence Limit: $ 10,000 Deductible: $ 250 C. Coverages: have used up the appli- cable limit of insurance 1. Employee Benefit Liability Coverage in the payment of a. The following is added to SECTION I judgments or settle- i -COVERAGES: Employee Benefit ments. Liability Coverage. No other obligation or liabil- (1) Insuring Agreement Ity to pay sums or perform j acts or services is covered (a) We will pay those sums that unless explicitly provided for the insured becomes legally under Supplementary Pay- obligated to pay as dam- ments. ages caused by any act, er- ror or omission of the in- (b) This insurance applies to sured, or of any other per- damages only if the act, er- son for whose acts the in- ror or omission, is negli- sured is legally liable, to gently committed in the which this insurance ap- 'administration" of your plies. We will have the right "employee benefit pro- and duty to defend the in- gram"; and i sured against any "suit" 1) Occurs during the pol- I seeking those damages. icy period;or However, we will have no duty to defend against any 2) Occurred prior to the "suit" seeking damages to effective date of this which this insurance does endorsement provided: not apply. We may, at our discretion, investigate any a) You You did e of not have report of an act, error or g I omission and settle any claim or "suit" on claim or "suit" that may re- or before the ef- sult. But: fective date of this endorsement. 1) The amount we will pay for damages is limited You will be as described in SEC- deemed to have TION III - LIMITS OF knowledge of a INSURANCE; and claim or "suit" when any "author- 2) Our right and duty to ized representa- defend ends when we tive"; Includes copyrighted material of Insurance GA 233 02 07 Services Office, Inc.,with its permission. Page 2 of 15 i) Reports all, or formance of investment any part, of the vehicles; or act, error or omission to us 3) Advice given to any or any other person with respect to Insurer; that person's decision to participate or not to ii) Receives a participate In any plan written or ver- included in the "em- bal demand or ployee benefit pro- claim for dam- gram". ages because of the act, er- (f) Workers' Compensation ror or omis- and Similar Laws sion;and Any claim arising out of your b) There is no other failure to comply with the applicable insur- mandatory provisions of any ani workers' compensation, un- employment compensation (2) Exclusions insurance, social security or This insurance does nota I disability benefits law or any I apply similar law. to: I (a) Bodily Injury, Property (g) ERISA Damage or Personal and Damages for which any in- Advertising Injury sured is liable because of li- ability imposed on a fidud- "Bodily injury", property ary by the Employee Re- + damage" or "personal and tirement Income Security advertising injury". Act of 1974, as now or (b) Dishonest, Fraudulent, hereafter amended, or by Criminal or Malicious Act any similar federal, state or local laws. Damages arising out of any (h} Available Benefits intentional, dishonest, fraudulent, criminal or mall- Any claim for benefits to the j clous act, error or omission, extent that such benefits are j committed by any insured, available, with reasonable including the willful or reck- effort and cooperation of the less violation of any statute. insured, from the applicable i (c) Failure to Perform a Con- funds accrued or other col- I tract lectible insurance. I Damages arising out of fail- (i) Taxes, Fines or Penalties ure of performance of con- Taxes, fines or penalties, tract by any insurer. including those imposed (d) Insufficiency of Funds under the Internal Revenue Code or any similar state or Damages arising out of an local law. insufficiency of funds to (j) Employment-Related meet any obligations under Practices any plan included in the "employee benefit pro- Any liability arising out of gram", any: (e) Inadequacy of Perform- (1) Refusal to employ; ante of Investment 1 Ad- vice Given With Respect (2) Termination of em- to Participation ployment; Any claim based upon: (3) Coercion, demotion, 1 Failure of an invest- evaluation, reassign- ) Y ment, discipline, defa- ment to perform; mation, harassment, 2) Errors in providing in- humiliation, discrimina- formation on past per- tion or other employ- Includes copyrighted material of Insurance GA 233 02 07 Services Office, Inc„with its permission. Page 3 of 15 i I ment-related practices, (e) A trust, you are an insured. acts or omissions; or Your trustees are also in- sureds, but only with re- (4) Consequential liabilityspect to their duties as trus- as a result of(1), (2) or tees. (3)above. (2) Each of the following is also an This exclusion applies insured: whether the insured may be held liable as an employer (a) Each of your "employees" or in any other capacity and who Is or was authorized to to any obligation to share administer your "employee damages with or repay benefit program". someone else who must pay damages because of (b) Any persons, organizations the injury. or "employees" having proper temporary authoriza- (3) Supplementary Payments tion to administer your "em- ployee benefit program" if SUPPLEMENTARY PAY- you die, but only until your MENTS -COVERAGES A AND legal representative is ap- B also apply to this Coverage. pointed. b. Who is an Insured (c) Your legal representative if you die, but only with re- As respects Employee Benefit Liabil- spect to duties as such. ity Coverage, SECTION II -WHO IS That representative will AN INSURED is deleted in its en- have all your rights and du- tirety and replaced by the following: ties under this Coverage Part. (1) If you are designated In the Dec- larations as: (3) Any organization you newly ac- quire or form, other than a part- (a) An individual, you and your nership, joint venture or limited spouse are insureds, but liability company, and over only with respect to the con- which you maintain ownership or duct of a business of which majority interest, will qualify as a you are the sole owner. Named Insured if no other simi- lar insurance applies to that or- b) A partnership or joint ven- ganization, However, coverage ture, you are an insured. under this provision: Your members, your part- ners, and their spouses are (a) Is afforded only until the also insureds but only with 180th day after you acquire respect to the conduct of or form the organization or your business. the end of the policy period, whichever is earlier; and (c) A limited liability company, you are an insured. Your (b) Does notapply to any act, members are also insureds, error or omission that was but only with respect to the committed before you ac- conduct of your business. quired or formed the organi- Your managers are insur- zation, eds, but only with respect to their duties as your manag- c. Limits of Insurance ers. As respects Employee Benefit Liabil- (d) An organization other than a ity Coverage, SECTION III - LIMITS partnership, joint venture or OF INSURANCE is deleted in its en- limited liability company, tirety and replaced by the following: you are an Insured. Your (1) The Limits of Insurance shown "executive officers" and di- in Section B. Limits of Insur- rectors are insureds, but ance, 1. Employee Benefit Li- only with respect to their du- ability Coverage and the rules ties as your officers or direc- below fix the most we will pay tors. Your stockholders are regardless of the number of: also Insureds, but only with respect to their liability as (a) Insureds; stockholders. Includes copyrighted material of Insurance GA 233 02 07 Services Office, Ina,with its permission. Page 4 of 15 (b) Claims made or "suits" (b) The deductible amount brought; stated in the Declarations c Persons or organizations applies to all damages sus- ( ) g tained by any one "em- making claims or bringing ployee", including such"em- "suits"; ployee's" dependents and (d) Acts,errors or omissions;or beneficiaries, because of all acts, errors or omissions to (e) Benefits included in your which this insurance ap- "employee benefit pro- plies. gram". (c) The terms of this insurance, (2) The Aggregate Limit shown in including those with respect Section B. Limits of Insurance, to: 1. Empioyee Benefit Liability Coverage of this endorsement 1) Our right and duty to is the most we will pay for all defend the insured damages because of acts, errors against any "suits" or omissions negligently commit- seeking those dam- ted in the "administration" of ages; and your "employee benefit pro- 2) Your duties, and the gram". duties of any other in- (3) Subject to the limit described in volved insured, in the (2) above, the Each Employee event of an act,error oromission,or claim, � Limit shown in Section B.Limits of Insurance, 1. Employee apply irrespective of the ap- Benefit Liability Coverage of plication of the deductible this endorsement is the most we amount. will pay for all damages sus- tained by any one "employee", (d) We may pay any part or all including damages sustained by of the deductible amount to such "employee's" dependents effect settlement of any and beneficiaries, as a result of claim or"suit"and, upon no- tificationa An act, error or omission; or of the action taken, ( ) you shall promptly reim- (b) A series of related acts, er- burse us for such part of the cors or omissions, regard- deductible amount as we less of the amount of time have paid. that lapses between such d. Additional Conditions acts, errors or omissions, � As respects Employee Benefit Ll- { negligently committed in the ability Coverage, SECTION IV - "administration" of your "em- COMMERCIAL GENERAL LIABIL- ployee benefit program". ITY CONDITIONS is amended as fol- However,the amount paid under lows: this endorsement shall not ex- (1) Item 2. Duties in the Event of ceed, and will be subject to the Occurrence, Offense, Claim or limits and restrictions that apply Suit is deleted in its entirety and s to the payment of benefits in any replaced by the following: plan included in the "employee I benefit program". 2. Duties in the Event of an Act, Error or (4) Deductible Amount Omission, or Claim or Suit a Our obligation to a dam- a. You must see to it that we are noti- ( ) 9 pay fied as soon as practicable of an act, ages on behalf of the in- error or omission which may result in sured applies only to the a claim. To the extent possible, no- amount of damages in ex- tice should include: cess of the deductible amount stated in the Decla- (1) What the act, error or omission rations as applicable to was and when it occurred;and Each Employee. The limits of insurance shall not be re- (2) The names and addresses of duced by the amount of this anyone who may suffer dam- deductible. ages as a result of the act, error or omission. Includes copyrighted material of Insurance GA 233 02 07 Services Office, Inc.,with its permission. Page 5 of 15 i i b. If a claim is made or"suit" is brought b. Method of Sharing against any Insured, you must: If all of the other insur- (1) Immediately record the spedfics ance permits contribu- of the claim or "suit" and the tion by equal shares, date received; and we will follow this 2 Notify us as soon as practicable. method also. Under ( ) fY P this approach each in- You must see to it that we receive surer contributes equal written notice of the claim or"suit"as amounts until it has soon as practicable. paid its applicable limit of insurance or none of c. You and any other involved insured the loss remains, must: whichever comes first. (1) Immediately send us copies of If any of the other in- any demands, notices, sum- surance does not per- monses or legal papers received mit contribution by in connection with the claim or equal shares, we will "suit"; contribute by limits. Under this method, (2) Authorize us to obtain records each insurer's share is and other information; based on the ratio of its (3) Cooperate with us in the investi- applicable limit of in- surancegation or settlement of the claim the total ap- or defense against the "suit"; plicabl e limits of insur- and ante of all insurers. (4) Assist us, upon our request, in c. No Coverage the enforcement of any right This insurance shall not against any person or organiza- cover any loss for tion which may be liable to the which the insured is en- insured because of an act, error titled to recovery under ; or omission to which this insur- any other insurance in ante may also apply, force previous to the ef- fective d. No insured will, except at that in- date of this Cover sured's own cost, voluntarily make a Coverage Part. payment, assume any obligation, or e. Additional Definitions incur any expense without our con- sent, As respects Employee Benefit Li- abili Coverage, SECTION V - (2) Item 5. Other Insurance is de- DEFT (TIONS is amended as fol- leted in its entirety and replaced lows: by the following: (1) The following definitions are 5. Other Insurance added If other valid and collectible 1. 'Administration"means: insurance is available to the ' insured for a loss we cover a. Providing information to under this Coverage Part, "employees", including j our obligations are limited their dependents and as follows: beneficiaries, with re- spect to eligibility for or a. Primary Insurance scope of "employee This insurance is pri- benefit programs'; mary except when c. b. Interpreting the "em- below applies. If this ployee benefit pro- insurance is primary, grams"; our obligations are not affected unless any of c. Handling records in the other insurance is connection with the also primary. Then,we "employee benefit pro- will share with all that grams"; or other insurance by the method described in b. d. Effecting, continuing or below terminating any "em- ployee's" participation Includes copyrighted material of Insurance GA 233 02 07 Services Office, Inc., with its permission. Page 6 of 15 in any benefit included benefits, workers' com- in the "employee bene- pensation and disability fit program". benefits; and However, "administration" d. Vacation plans, includ- does not include: ing buy and sell pro- grams; leave of ab- a. Handling payroll sence programs, in- tions; or eluding military, mater- b. The failure to effect or nity, family, and civil maintain any insurance leave; tuition assis- or adequate limits of tance plans; transporta- coverage of insurance, tion and health dub including but not limited subsidies. to unemployment in- (2) The following definitions are de- surance, social security leted in their entirety and re- benefits, workers' com- placed by the following: pensation and disability benefits. 21. "Suit' means a civil pro- ceeding in which money 2. "Cafeteria p damages because of an act, plan authorized by applica- error or omission to which ble law to allow "employ- this insurance applies are ees" to elect to pay for cer- alleged. "Suit" Includes: tain benefits with pre-tax dollars. a. An arbitration proceed- ing in which such dam- 3. "Employee benefit Pro- ages are claimed and grams" means a program to which the Insured providing some or all of the must submit or does following benefits to "em- submit with our con- j ployees", whether provided sent; through a"cafeteria plan"or otherwise: b. Any other alternative 1 dispute resolution pro- f a. Group life insurance; ceeding in which such group accident or damages are claimed health insurance; den- and to which the In- tal, vision and hearing sured submits with our plans; and flexible consent;or spending accounts; provided that no one c. An appeal of a civil pro- other than an "em- ceeding. ployee' may subscribe to such benefits and 8. "Employee" means a per- such benefits are made son actively employed, for- generally available to mercy employed,on leave of those "employees"who absence or disabled, or re- satisfy the plan's eligi- tired. "Employee" includes bility requirements; a "leased worker". "Em- ployee" does not include a b. Profit sharing plans, "temporary worker". employee savings plans, employee stock 2. Unintentional Failure to Disclose Haz- ownership plans, pen- ards sion plans and stock SECTION IV-COMMERCIAL GENERAL subscription plans, pro- LIABILITY CONDITIONS, 7. Represen- vided that no one other tations is hereby amended by the addi- than an "employee" tion of the following: may subscribe to such benefits and such Based on our dependence upon your rep- benefits are made gen- resentations as to existing hazards, if un- erally available to all intentionally you should fail to disdose all "employees" who are such hazards at the inception date of your eligible under the plan policy, we will not reject coverage under for such benefits; this Coverage Part based solely on such c. Unemployment insur- failure. ante, social security Includes copyrighted material of Insurance GA 233 02 07 Services Office, Inc.,with its permission. Page 7 of 15 3. Damage to Premises Rented to You f) Nesting or infesta- or a. The last Subparagraph of Paragraph oion, el alsehar of 2. SECTION I - COVERAGES, waste products or COVERAGE A. - BODILY INJURY secretions, by in- AND PROPERTY DAMAGE, 2. LI- sects, birds, ro- ABILITY Exclusions is hereby de- dents or other leted and replaced by the following: animals. Exclusions c.through q. do not apply (b) Loss caused directly or indi- to damage by fire, explosion, light- rectly by any of the follow- ning, smoke or soot to premises Ing: I while rented to you or temporarily oc- cupied by you with permission of the 1) Earthquake, volcanic owner. eruption, landslide or any other earth move- b. The insurance provided under SEC- ment; TION I -COVERAGES, COVERAGE A. BODILY INJURY AND PROP- 2) Water that backs up or ERTY DAMAGE LIABILITY applies overflows from a sewer, to "property damage" arising out of drain or sump; water damage to premises that are both rented to and occupied by you. 3) Water under the ground surface pressing on, or (1) As respects Water Damage Le- flowing or seeping gal Liability, as provided In through: Paragraph 3.1b.above: a) Foundations, The exclusions under SECTION walls, floors or ' I - COVERAGES, COVERAGE paved surfaces; A. BODILY INJURY AND PROPERTY DAMAGE LIABIL- b) Basements, ITY, 2. Exclusions, other than i, whether paved or War and the Nuclear Energy not; or Liability Exclusion, are deleted c) Doors, windows or and the following are added: other openings. This insurance does not apply (c) Loss caused by or resulting to: from water that leaks or (a) "Property damage": flows from plumbing, heat- ing, air conditioning, or fire 1) Assumed in any con- protection systems caused tract;or by or resulting from freez- 2) Loss caused by or re- ing, unless: sulting from any of the 1) You did your best to following: maintain heat in the a) Wear and tear; building or structure;or 2) You drained the b) Rust, corrosion, equipment and shut off fungus, decay, de- the water supply if the terioration, hidden heat was not main- or latent defect or tained, any quality in property that (d) Loss to or damage to: causes it to dam- age or destroy it- 1) Plumbing, heating, air self-, conditioning, fire pro- ' tection systems, or C) Smog; other equipment or ap- d) Mechanical break piiances; or down including 2) The interior of any rupture or bursting building or structure, or caused by cen- to personal property in trifugal force; the building or structure caused by or resulting e) Settling, cracking, from rain, snow, sleet shrinking or ex- or ice, whether driven pansion;or by wind or not. Includes copyrighted material of Insurance GA 233 02 07 Services Office, Inc.,with its permission. Page 8 of 15 c. Limit of Insurance Limits of Insurance, 5. Medical Pay- The Damage to Premises Rented to ments of this endorsement. You Limit as shown in the Declara- 6. Voluntary Property Damage and Care, tions is amended as follows: Custody or Control Liability Coverage (2) Paragraph 6. of SECTION 111 - a. Voluntary Property Damage Cov- LIMITS OF INSURANCE is erage hereby deleted and replaced by the following: We will pay for "property damage"to property of others arising out of op- 6. Subject to 5, above, the erations incidental to the insured's Damage to Premises business when: Rented to You Limit is the most we will pay under (1) Damage is caused by the in- i COVERAGE A. BODILY sured; or INJURY AND PROPERTY DAMAGE LIABILITY, for (2) Damage occurs while in the in- damages because of "prop- sured s possession. erty damage" to premises With your consent, we will make while rented to you or tem- these payments regardless of fault. porarily occupied by you with permission of the b. Care, Custody or Control Liability owner, arising out of any Coverage one "occurrence" to which SECTION I - COVERAGES, COV- this insurance applies. ERAGE A. BODILY INJURY AND i (3) The amount we will pay is lim- PROPERTY DAMAGE LIABILITY, ited as described in Section B. 2. Exclusions, j. Damage to Prop- I Limits of Insurance, 3. Dam- erty, Subparagraphs (3), (4) and (5) age to Premises Rented to do not apply to"property damage"to You of this endorsement. the property of others described therein. 4. Supplementary Payments With respect to the insurance provided by Under SECTION I - COVERAGE, SUP- this section of the endorsement, the fol- PLEMENTARY PAYMENTS - COVER- lowing additional provisions apply: AGES A AND B: a. The Limits of Insurance shown in the a. Paragraph 2. is replaced by the fol- Declarations are replaced by the lim- lowing: its designated in Section B. Limits of i Up to the limit shown in Section B. Insurance, 6. Voluntary Property Limits of Insurance, 4.a. Bail Bonds Damage and Care, Custody or i of this endorsement for cost of bail Control Liability Coverage of this bonds required because of accidents endorsement with respect to cover- or traffic law violations arising out of age provided by this endorsement. the use of any vehicle to which the These limits are inclusive of and not Bodlly Injury Liability Coverage ap- p laced. The Limits of Insurance addition to the [imus being re- plies. We do not have to furnish pl these bonds. shown in Section B. Limits of Insur- I once, 6. Voluntary Property Dam- i b, Paragraph 4. is replaced by the fol- age and Care, Custody or Control lowing: Liability Coverage of this endorse- ment fix the most we will pay in any All reasonable expenses incurred by one "occurrence" regardless of the the insured at our request to assist number of: us in the investigation or defense of the claim or "suit', including actual (1) Insureds; loss of earnings up to the limit shown (2) Claims made or "suits" brought; in Section B. Limits of Insurance, or 4.b. Loss of Earnings of this en- dorsement per day because of time (3) Persons or organizations making off from work. claims or bringing"suits". 5. Medical Payments b. Deductible Clause The Medical Expense Limit of Any One (1) Our obligation to pay damages Person as stated in the Declarations is on your behalf applies only to amended to the limit shown in Section B. the amount of damages for each "occurrence" which are in ex- Includes copyrighted material of Insurance GA 233 02 07 Services Office, Inc.,with its permission. Page 9 of 15 cess of the deductible amount (1) Any person or organization de- stated in Section B. Limits of scribed in Paragraph 9.a.(2) be- Insurance, 6. Voluntary Prop- low (hereinafter referred to as trtyyDamage and Care, Cus- additional insured) whom you rt or Control Liability Cov- are required to add as an addi- erage of this endorsement. The tional insured under this Cover- limits of insurance will not be re- age Part by reason of: duced by the application of such deductible amount. (a) A written contract or agree- ment; or (2) Condition 2. Duties in the Event of Occurrence, Offense, (b) An oral agreement or con- Claim or Suit, applies to each tract where a certificate of claim or"suit" irrespective of the insurance showing that per- amount. son or organization as an additional insured has been (3) We may pay any part or all of issued, the deductible amount to effect is an insured, provided: settlement of any claim or suit and, upon notification of the ac- (a) The written or oral contract tion taken, you shall promptly re- or agreement is: imburse us for such part of the deductible amount as has been 1) Currently in effect or paid by us. becomes effective dur- ing the policy period; 7. 180 Day Coverage for Newly Formed or and Acquired Organizations 2) Executed prior to an SECTION II - WHO IS AN INSURED is "occurrence" or offense amended as follows: to which this insurance Subparagraph a. of Paragraph 4. is would apply;and hereby deleted and replaced by the fol- (b) They are not specifically lowing: named as an additional in- a. Insurance under this provision is af- sured under any other pro- forded only until the 180th day after vision of, or endorsement you acquire or form the organization added to, this Coverage or the end of the policy period, Part. whichever is earlier; (2) Only the following persons or 8. Waiver of Subrogation organizations are additional in- sureds under this endorsement, SECTION IV-COMMERCIAL GENERAL and insurance coverage pro- LIABILITY CONDITIONS, 9. Transfer of vided to such additional insureds ; Rights of Recovery Against Others to is limited as provided herein: Us is hereby amended by the addition of I( the following: (a) The manager or lessor of a premises leased to you with We waive any right of recovery we may whom you have agreed per have because of payments we make for Paragraph 9.a.(1) above to injury or damage arising out of your ongo- provide insurance, but only ing operations or "your work" done under with respect to liability aris- a written contract requiring such waiver ing out of the ownership, with that person or organization and in- maintenance or use of that eluded in the "products-completed opera- part of a premises leased to tions hazard". However, our rights may you, subject to the following only be waived prior to the "occurrence" additional exclusions: giving rise to the injury or damage for which we make payment under this Cov- This insurance does not ap- erage Part. The insured must do nothing ply to: after a loss to impair our rights. At our 1) Any"occurrence"which request, the insured will bring "suit" or takes place after you transfer those rights to us and help us en- cease to be a tenant in force those rights. that premises. 9. Automatic Additional Insured - Speci- 2) Structural alterations, fied Relationships new construction or a. The following is hereby added to demolition operations SECTION II-WHO IS AN INSURED: performed by or on be- Includes copyrighted material of Insurance GA 233 02 07 Services Office, Inc.,with its permission. Page 10 of 15 i half of such additional solely for the pur- insured. pose of inspection, demonstration, (b) Any person or organization testing, or the from which you lease substitution of equipment with whom you parts under in- have agreed per Paragraph structions from the 9.a.(1) above to provide in- manufacturer, and surancs. Such person(s) or then repackaged organization(s) are insureds in the original con- solely with respect to their tainer; liability arising out of the maintenance, operation or e) Any failure to use by you of equipment make such inspec- leased to you by such per- tions, adjustments, son(s) or organizations(s), tests or servicing However, this insurance as the vendor has does not apply to any "oc- agreed to make or currence"which takes place normally under- after the equipment lease takes to make in expires. the usual course c An person or organization of business, in ( ) Y g connection with (referred to below as ven- the distribution or dor) with whom you have sale of the prod- agreed per Paragraph ucts; 9.a.(1) above to provide in- surance, but only with re- f) Demonstration, in- i spect to "bodily injury" or stallation, servic- "property damage" arising ing or repair op- out of"your products" which erations, except are distributed or sold in the such operations regular course of the ven- performed at the dor's business, subject to vendor's premises i the following additional ex- in connection with clusions: the sale of the product; 1) The insurance afforded I the vendor does not g) Products which, apply to: after distribution or a :'Bodilyinjury" sale by you, have J rY or been labeled or re- "property damage" labeled or used as for which the ven- a container, part or dor is obligated to ingredient of any pay damages by other thing or sub- reason of the as- stance by or for sumption of liabil- the vendor. ity in a contract or agreement. This 2) This insurance does exclusion does not not apply to any in- apply to liability for sured person or organi- damages that the zation: vendor would have in the absence of a) From whom you the contract or have acquired agreement; such products, or any ingredient, b) Any express war- part or container, ranty unauthorized entering into, ac- by you; companying or An physical or containing such c) Y p Y products; or chemical change in the product b) When liability in- made intentionally cluded within the by the vendor; "products- completed opera- d) Repackaging, tions hazard" has unless unpacked Includes copyrighted material of Insurance GA 233 02 07 Services Office, Inc.,with its permission. Page 11 of 15 been excluded (f) Any person or organization under this Cover- with which you have agreed age Part with re- per Paragraph 9.a.(1)above spect to such to provide insurance, but products, only with respect to liability d An state or political subdi- arising out of "your work" ( ) Y performed for that additional vision with which you have insured by you or on your agreed per Paragraph behalf. A person or organi- 9.a.(1) above to provide in- zation's status as an insured surance, subject to the fol- under this provision of this lowing additional provision: endorsement continues for This insurance applies only only the period of time re- with respect to the following quired by the written con- hazards for which the state tract or agreement,but in no or political subdivision has event beyond the expiration issued a permit in connec- date of this Coverage Part. tion with premises you own, If there is no written contract rent or control and to which or agreement, or if no pe- this Insurance applies: riod of time is required by the written contract or 1) The existence, mainte- agreement, a person or or- nance, repair,construc- ganization's status as an in- tion, erection, or re- sured under this endorse- moval of advertising ment ends when your op- signs, awnings, cano- erations for that insured are pies, cellar entrances, completed. coal holes, driveways, (3) Any insurance provided to an manholes, marquees, additional insured designated hoist away openings, under Paragraph 9.a.(2): sidewalk vaults, street banners, or decorations (a) Subparagraphs (e) and (f) and similar exposures; does not apply to "bodily in- or jury" or "property damage" 2) The construction, erec- included within the "prod- tion, or removal of ele- acts-completed operations vators;or hazard"; 3) The ownership, main- (b) Subparagraphs (a), (b), (d), tenance, or use of any (e)and (f)does not apply to elevators covered by 'bodily Injury", property this insurance. damage" or "personal and advertising injury" arising (e) Any state or political subdi- out of the sole negligence or vision with which you have willful misconduct of the ad- agreed per Paragraph ditional insured or their 9.a.(1) above to provide in- agents, "employees" or any surance, subject to the fol- other representative of the lowing provisions: additional insured; or 1) This insurance applies (c) Subparagraph (f) does not only with respect to op- apply to "bodily iNury", erations performed by "property damage" or "per- you or on your behalf sonal and advertising injury" for which the state or arising out of: political subdivision has issued a permit. 1) Defects in design fur- nished by or on behalf 2) This insurance does of the additional in- not apply to "bodily in- sured; or jury", "property dam- 2 The of, or age or personal and ) e rendering failure to render, any advertising injury" aris- ing out of operations professional archit r performed for the state sural, engineering or or In- or political subdivision. surveying services, in- cluding: Includes copyrighted material of Insurance GA 233 02 07 Services Office, Inc.,with Its permission. Page 12 of 15 a) The preparing, primary to other insurance approving or fall- available to the additional Ing to prepare or insured except: approve maps, shop drawings, 1) As otherwise provided opinions, reports, In SECTION IV - surveys, field or- COMMERCIAL GEN- ders, change or- ERAL LIABILITY ders or drawings CONDITIONS, S. and specifications; Other Insurance, b. and Excess Insurance; or b) Supervisory, in- 2) For any other valid and spection, architec- collectible insurance tural or engineer- available to the addi- ing activities. tional insured as an additional insured by 3) "Your work"for which a attachment of an en- consolidated (wrap-up) dorsement to another insurance program has insurance policy that is I been provided by the written on an excess prim econtra cto r-project basis. In such case, manager or owner of the coverage provided the construction project under this endorsement in which you are in- shall also be excess. volved. (2) Condition 11. Confomtance to l b. Only with regard to insurance pro- Specific Written Contract or I vided to an additional insured desig- Agreement is hereby added: nated under Paragraph 9.a.(2) Sub- paragraph (f) above, SECTION 111 - 11. Conformance to Specific LIMITS OF INSURANCE is amended Written Contract or to Include: Agreement The limits applicable to the additional With respect to additional insured are those specified in the insureds described in Para- i written contract or agreement or in graph 9.a.(2)(f)above only: I the Declarations of this Coverage If a written contract or Part,whichever are less. If no limits agreement between you are specified in the written contract or and the additional insured agreement, or if there is no written specifies that coverage for j contract or agreement, the limits ap- the additional insured: placable to the additional insured are those specified in the Declarations of a. Be provided by the In- this Coverage Part. The limits of in- surance Services Office surance are inclusive of and not in additional insured form addition to the limits of insurance number CG 20 10 or shown in the Declarations. CG 20 37 (where edi- c. SECTION IV -COMMERCIAL GEN- tion specified); or ERAL LIABILITY CONDITIONS is b. Include coverage for hereby amended as follows: completed operations; (1) Condition 5. Other Insurance is or amended to include: c. Include coverage for (a) Where required by a written "your work"; contract or agreement, this and where the limits or cov- insurance is primary and / erage provided to the addi- or noncontributory as re- tional insured is more re- spects any other insurance strictive than was specifi- policy issued to the addi- cally required in that written tional insured, and such contract or agreement, the other insurance policy shall terms of Paragraphs be excess and /or noncon- 9.a.(3)(a), 9.a.(3)(b) or 9.b. tributing, whichever applies, above, or any combination with this insurance. thereof, shall be interpreted (b) Any insurance provided by as providing the limits or this endorsement shatl be coverage required by the terms of the written contract Includes copyrighted material of Insurance GA 233 02 07 Services Office, Inc.,with its permission. Page 13 of 15 or agreement, but only to (c) Persons or organizations the extent that such limits or making claims or bring coverage is included within "suits". the terms of the Coverage Part to which this endorse- (2) Deductible Clause ment is attached. If, how- (a) Our obligation to pay dam- ever, the written contract or ages on your behalf applies ` agreement specifies the In- only to the amount of dam- surance Services Office ad- ages for each "occurrence" ditional insured form num- which are in excess of the ber CG 20 10 but does not Deductible amount stated in specify which edltlon, or Section B. Limits of Insur- specifies an edition that ance, 11, of this endorse- does not exist, Paragraphs ment. The limits of insur- 9.a.(3)(a) and 9.a.(3)(b) of ance will not be reduced by this endorsement shall not De- apply and Paragraph 9.b. of the application . such De- ductible amount. this endorsement shall ap- ply. (b) Condition 2. Duties in the 10. Broadened Contractual Liability-Work Event of Occurrence, Of- Within 50'of Railroad Property fense, Claim or Suit, ap- plies to each claim or "suit" It is hereby agreed that Paragraph f.((1 of irrespective of the amount. Definition 12. "Insured contract" (SEC- TION V-DEFINITIONS)is deleted. (c} We may pay any part all of the deductible amount to 11. Property Damage to Borrowed Equip- effect settlement of any ment claim or"suit"and, upon no- I tification of the action taken, a. The following Is hereby added to Ex- you shall promptly reim- elusion j. Damage to Property of burse us for such part of the Paragraph 2., Exclusions of SEC- deductible amount as has TION I -COVERAGES, COVERAGE been paid by us. A. BODILY INJURY AND PROP- i ERTY DAMAGE LIABILITY: 12. Employees as Insureds - Specified Health Care Services I Paragraphs (3) and (4) of this exclu- sion It is hereby agreed a Paragraph do not apply to tools or equip- d that Para ra h ment loaned to you, provided they 2.a,(1)(d) of SECTION 11 - WHO IS AN are not being used to perform opera- INS RED, does not apply to your "em- tions at the time of loss. ployees" who provide professional health care services on your behalf as duly li- b. With respect to the insurance pro- censed: 1 vided by this section of the endorse- ment, the following additional provi- a. Nurses; sions apply: b. Emergency Iviedical Technicians;or (1) The Limits of insurance shown in c. Paramedics, the Declarations are replaced by the limits designated in Section in the jurisdiction where an "occurrence" B. Limits of Insurance, 11. of or offense to which this insurance applies this endorsement with respect to takes place, coverage provided by this en- dorsement. These limits are in- 13. Broadened Notice of Occurrence elusive of and not in addition to Paragraph a. of Condition 2. Duties in the limits being replaced. The the Event of Occurrence, Offense, Limits of Insurance shown in Claim or Suit (SECTION IV-COMMER- Section B. Limits of Insurance, CIAL GENERAL LIABILITY CONDI- 11. of this endorsement fix the TIONS) is hereby deleted and replaced most we will pay in any one"oc- currence" regardless of the by the fallowing: number of: a. You must see to it that we are noti- (a) Insureds; fied as soon as practicable of an"oc- currence" or an offense which may (b) Claims made or "suits" result in a claim. To the extent pos- brought;or sible, notice should include: (1) How, when and where the "oc- currence"or offense took place; Includes copyrighted material of Insurance GA 233 02 07 Services Office, Inc.,with its permission. Page 14 of 15 (2) The names and addresses of This requirement applies only when any injured persons and wit- the 'occurrence" or offense is known nesses; and to an"authorized representative". (3) The nature and location of any injury or damage arising out of I the"occurrence"or offense. I E I 1 1 i i i i I E I f Includes copyrighted material of Insurance GA 233 02 07 Services Office, Inc.,with its permission. Page 15 of 15 �. � 1������w' �� � e��.r�f� r �"� � r , .�, �— a x �. '"r, e..,�, . '.� � d .",,,