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HomeMy WebLinkAboutLaib Restoration August 2017\/?�-C���1 �/ /� AGREEMENT��U��U���I � ����8�����J�. J� THIS AGFlEEMENT, made on the day ofJah/. 2017. by and between the CITY OF OSHKOSH, hereinafter referred to as CITY, and Laib Restoration, Inc., 410 East Murdock Avenue, Oshkosh, Wisconsin, hereinafter referred to as the (CONTRACTOR), That the City and the Contractor, for the consideration hereinafter named, enter into the following Agreement. ARTICLE 1. COMPONENT PARTS OF THE CONTRACT This Agreement consists ofthe following component parts, all ofwhich are as fully apart Of this Agreement as if herein set out verbatim, or if not attached, as if hereto attached: 1� This Instrument 2, Contractor/Consultant's Proposal |nthe event that any provision inany ofthe above component parts of this Agreement conflicts with any provision in any other of the component parto, the provision in the component part first enumerated above shall govern over any other component part which follows itnumerically except asmay beotherwise specifically stated. ARTICLE 11, CONTRACTOR'S REPRESENTATIVE A. Assignment ofContractor's Representative. The Contractor shall assign the fo|k]xvOg individual to perform the services described in this Agreement and be the main point of contact between the City and Contractor: Terry Laib B. Changes inContractor's Representative. The City shall have the right 10approve nr disapprove of any proposed change from the individual named. The City shall be provided with o resume orother information for any proposed substitute and shall begiven the opportunity to interview that person prior to any proposed change. ARTICLE 111. CITY REPRESENTATIVE The City shall assign the following individual tomanage the project deocrbedinthis Bill Sturm, Landscape Operations Manager ARTICLE IV. SCOPE OF WORK The Contractor shall provide the services described iDthe attached Contractor's submittal. Agreement and/or the Contractor's aubrnh±ai Such changes shall be made by written amendment to this Agreement or other written direction to the Contractor which shall be acknowledged and accepted bythe Contractor. |fsuch changes affect Contractor's cost or time required for performance of services, an equitable adjustment will be made through a written amendment t0this Agreement. ARTICLE V. CITYREPONG|B|L0E8 The City shall furnish at Contractor's request such information as is needed by the Contractor to aid in the progress of the project, providing it is reasonably obtainable from City records and shall render such decisions as are necessary to aid in the completion of the work in a timely manner. ARTICLE VI. STANDARD OF CARE The Standard of Care applicable to Contractors Services will be the degree of skill and diligence normally employed by professional Contractor's orconsultants performing the SGnle o[similar services atthe time said services are performed. CQntogctorwi||re-perfomn any services not meeting this standard without additional compensation. ARTICLE V11. RECORDS AND INSTRUMENTS OF SERVICE All reports, drawings, specifications, computer files, email or other correspondence, field data, and other documents and instruments pnaponad by the Contractor as instruments of service shall be retained by Contractor and shall be and remain the property of the City. Contractor acknowledges and understands that City is a governmental entity and subject to Wisconsin's Public Records Law and that Contractors written documents collected and prepared under this Agreement are subject to the Wisconsin Public Records law through Contractor's entry into this agreement. Contractor ag[88S that it will fully and completely cooperate with the City to provide all documents related to this Agreement tothe City to allow the City to evaluate the documents and respond to any records requests. Contractor may provide the City with an explanation of why the Contractor believes any document should not be released tUthe public hQvvGver. City shall make all final determinations regarding the existence or release of any document related to this Agreement according to the Public Records |evv. ARTICLE VIII. TIME OF COMPLETION A. All work to be performed under this Agreement shall be completed on or before October 31.2O17unless the parties agree inwriting toextend this date. The Contractor shall perform the services under this Agreement with reasonable diligence and expediency consistent with sound professional practices. The City agrees that the Contractor is not responsible for damages arising directly or indirectly from any delays for causes beyond the Contractor's control. For the purposes ofthis Agreement, such causes iDC|Ude' but are not limited to, severe weather disruptions Orother natural disasters, or failure Ofperformance bythe City. |fthe delays resulting from any such causes increase the time required by the Contractor to perform its services in an orderly and efficient manner, the Contractor shall be entitled to an equitable adjustment in schedule. B, City may suspend, delay or interrupt the services of Contractor for the convenience of the City. In such event. Contractor's contract price and/or schedule shall be equitably adjusted ifnecessary. ARTICLE IX. TERMINATION Either party to this Agreement may hanniRaƒe this contract at any time by giving written notice to the other party no later than 30 calendar days before the termination date. If the Agreement is {enniDated, then the Contractor shall be entitled to compensation for any satisfactory work performed to the date of termination. Contractor's duties and responsibilities regarding submission of materials, cooperation, and hold harmless shall survive the termination ofthis Agreement. ARTICLE X PAYMENT A. The Contract Sum. The (}ih/ shall pay to the Contractor thirty one thousand four hundred eighteen dollars ($31.41O.00). B. Method of Payment. The Contractor/Consultant shall submit itemized monthly statements for services. The City shall pay the Consultant within 3Ocalendar days after receipt of such statement. |fany statement amount is disputed, the City may withhold payment ofsuch amount and shall provide tOContractor/Consultant a statement astothe reaaon(S)for withholding payment. C. Additional Costs. Costs for additional services shall benegotiated and set forth ina written amendment to this Agreement executed by both parties priorto proceeding with the work subject tUadditional costs covered under the subject amendment. ARTICLE XI. INSURANCE The Contractor shall carry insurance to cover its negligence and other obligations related to this Agreement which includes the City and its 8rnp|Dy0es and agents as additional insureds for work required bythis Agreement. The Contractor's insurance must beprimary insurance. The type of insurance and coverages must conform to the attached City of Oshkosh Insurance Requirements. ARTICLE XII. CONTRACTOR TOHOLD CITY HARMLESS The Contractor/Consultant covenants and agrees to protect and hold the City of Oshkosh harmless against all actions, claims and demands of any hind orcharacter whatsoever which may in any way be caused by or result from the intentional or negligent acts of the Contractor/Consultant, its agents or assigns, employees or subcontractors related however remotely to the performance of this Agreement or be caused or result from any violation of any |ovv or administrative negU|8dOn, and shall iOdBrDOifv 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. 3 ARTICLE XIII. 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 orother representative of the City (collectively, the "City" for purposes of this Article) in connection with (a) any internal or governmental investigation or administrative, negu|atory, arbitral or judicial proceeding (collectively "Litigation") or internal orgovernmental Audit, with respect to matters relating to this Agreement; other than o third pgdv 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 making Contractor's employees available tmthe City (or their respective insurers, attorneys or auditors) upon reasonable notice for: (i) interviews, factual inveati0mtionm, and providing declarations oraffidavits that provide truthful information in connection with any Litigation or Audit; (ii) appearing at the request mfthe City togive testimony without requiring service ofasubpoena 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 0oauditors in oforrn and within otimeframnm 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 ao copying, postage and similar costs; but does not include wages, salaries, benefits and other employee compensation. Contractor shall not be entitled toadditional compensation for employee services provided under this paragraph. ARTICLE XIV. ASSIGNMENT Contractor shall not have the right to assign this Agreement without the prior written consent ofthe City. Failure of either party to insist upon the strict performance of terms and provisions of this Aoreement, or any of thern, 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 tem orprovision shall continue |nfull force and effect. ARTICLE XVI. NOTHIRD PARTY BENEFICIARIES This Agreement gives no rightsorbenefitsb]mnyoneotherthanCbvmndContnactorand ARTICLE XVII. AGREEMENT NOT TOBECONSTRUED AGAINST ANY PARTY This Agreement is the product nfnegotiation between the parties hereto and no term, covenant orprovision or the failure to include abann` covenant orprovisions shall be construed against any party hereto solely onthe basis that one party orthe other drafted this Agreement orany term, covenant orprovision contained herein. ARTICLE XVIII. WHOLE AGREEMENT 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 anamendment 1Othis Agreement. ARTICLE XIX. SEVERABILITY If any tenn, covenant, condition or provision of this Agreement shall be invalid Or uneOfO[Ce8b\8, the remainder of this Agreement shall not be affected th8n8hv and the remainder of the Agreement shall n8mn8iO valid and enforceable to the fullest extent permitted by law. ARTICLE XX. CHOICE OF LAW AND VENUE The laws Ofthe State ofWisconsin shall govern the interpretation and construction ofthis Agreement. Winnebago County shall be the venue for all disputes arising under this Agreement. (Signature Page F0||ovvs) 5 IN WITNESS WHEREOF, the City of Oshkosh, Wisconsin, has caused this Agreement to be sealed with its corporate seal and to be subscribed to by its City Manager and City Clerk and countersigned by the Comptroller, and Contractor hereunto set its hand and seal this date as first written above. In the Presence of: (Seal of Contractor if a Corporation.) LAIR RESTORATION, INC By- name title CITY OF OSHKOSH By: iTria* A. RohloU, City And. Ian �) .. AP OVED:4 I hereby certify that the necessary provisions have been made to pay the liability which will accrue under this contract. ity A JV )n C1 A 4(1 City Comptroller 1.1 LAIR RESTORATION, INC. Historic Building Consultation Bill Sturm City Forester City of Oshkosh 215 Church Avenue P.O. Box 1130 Oshkosh, Wisconsin 54903-1130 Estimate for interior work at Riverside Cemetery Chapel 1901 Algoma Boulevard Ave per attached Badger Scaffold to set scaffold for east and west ends of chapel $7,180.00 Figure 28 days minimum the 29th day is 42.14% day. I expect to finish in 28 days with the exception of the two paintings which can be rehung off ladders. Klinger painting per enclosed complete. See Klinger's break out 10,339.00 Add 140 per register Albert's Plastering per enclosed 5290 subcontractor total 22809 mark up 20% 4561 Laib : remove two paintings before scaffold is set $200 Cover floor and altar with 6 mil poly and packing blankets 320 Move pews as needed 160 Prep walls by scraping all loose paint and plaster 1928 Vacuum all debris 160 Prime areas to be plastered with oil based primer 640 Final clean up of floors 640 4048 Painting conservator has not yet given the cost of assessment No solution proposed for floor crack Total for scaffold, plastering, painting $22,809 Contractor mark up 4561 Laib's direct labor 4048 project total $31,418 submitted by erry Laib 410 East Murdoch Avenue Oshkosh, Wisconsin 54901 Ph. 920-233-7026 B DGER 633 N. Military Avenue Green Bay, W1 54303 COMPANIES (920) 429-0308 BADGER LADDER, LLC & BADGER SCAFFOLD, LLC 1-80D-BG3-9791 Badgerl-adder.com May 2, 2017 Proposal #3441 Laib Restoration Attn: Terry Laib RE: Cemetery Sanctuary Scaffold Oshkosh, WI We propose to furnish on rental, erect and dismantle our system scaffold for the project stated above. Scaffold will be built so contractor can gain access to walls on alter and back wall. In both areas we will build a 4' wide scaffold that is 24' tong and reaches 29' in the peak. There will be working decks every 6'6" elevation that contain all necessary guardrails and are accessible from attached hand over hand ladder. Labor to erect and trucking ------------------------------------------------------- $6,000.00 Rental of Materials for 1st 28 days (28 days Min) ------------------------------$1,180.00 Pro -rated daily at $42.14 per day "All / any applicable taxes are not included in the above pricing.****** Thank you for the opportunity to quote this project for you. Sincerely, Accepted: Brent Thoen Badger Ladder& Scaffold, Inc. Laib Restoration `"► #W.V. OW R WTi" M, lot. MAiN111"a CON"ACTO" K9 1910 Harrison Street _. Oshkosh. ) 1.54/ Phsrxa 1424 231.5320 (/��#!I :41N 1 Fax (924) 231•5321 QUOTATION May 9, 2017 Terry Laib Laib Restoration Inc. 21 W. New York Avenue Oshkosh, Wi. 54901 (920) 233-7026 Re: Riverside Chapel 1901 Algoma Boulevard Chapel (East and West Gable Walls) Klinger will apply 2 coats of Pro Mar 200 Flat to the newly plastered walls, using the erected scaffolding. If the North and South Walls are painted, please add $2,885.00 If the East Wall, 2 heating radiators are pointed the wall color, ,please add $275.00 Klinger will paint the closet walls & ceiling with 2 coats of PM200 Flat BID: 585.00 Storage Room $1,210.00 Bathroom $1,120.00 If the heat registers are painted with the wall cover , please add $140.00 per register. Sincerely, Jay H. Klinger M.V. Klinger Painting Co., Inc. From: Bob@alberisplastering.com B Subject: Plaster proposal Date: April 6, 2017 at 7:46 AM To: Terry Laib tlaib@laibrestoration.com Thank you, Bob Dvorak Alberts Plastering, Inc. IPLAS'rSR1NG INC. Laib Restoration Attn: Terry 410 E Murdock Ave Oshkosh, W154901 t*tti tt*** *t*it tit*t John G. Alberu 1610 ovck d V-ww LanC Pouwt. %I %4_2Ob (920) 921-7373 • FAX: (920) 825-74% al)xrsa2 101'rom April 5. 2017 Worship Building Oshkosh, WI Gluing and plastering surfaces where paint/ miscellaneous plaster is loose, V -out and Patch miscellaneous cracks as per 4/4/17 walk through. Not to exceed: $5.290.00 • Scaffolding by others. • Scraping off loose paint by others. If loose paint/ miscellaneous plaster is scraped off by Alberts Plastering Inc., it will be done on a time and material basis. Wt VrOP"t hereby to furnish material and labor – comNeta to accordartae v M above spoci(icaaw. for ow sum of: Apm•N b b mo0p p aafo.c doews (S 1 At a Is P- a b• n p omw Aa Wft to to CC1VWW w a QUV.. wM�v kQWiAO 00" b tw4vd pamm Ana sumam a *WW— a,= tufts W.W* assa'�+�V I** QM s0 b 4—UW ai'll Wog roto &{tm Ma d WC=W M ft" 0wr tfs tops Qts a UMM Al a jpQeMy a Wary pup. M_MU.. && WWd a00 CTotY 0-M b 0" Ya tmb awl WW -CUW �vwwm Oo .0 bw a .6^ 'a lfla Cppoeal �` � 0-2 OF vfje w l coeoaxatt— t'd✓ .n. w�Q�m.n bva w i not 000eipofe.�m 3aeptante of Propogal — fta abme oma. weak"= and ao�tona •ea ta4tUMNY ane aro Noma =WCSo. ►w am ma MHAW to m Qr wCM p apuMO ftrm No bo ra u a! as nw at" 'At>sorts Plaafartnl) Inc. is W respo SUS for lob site dabft 11ut>psters or rocydiltg casts are not InctuM in the above pr". - D=. m A.00a,awa 4/14/14 CITY OF OSHKOSH INSURANCE REQUIREMENTS III. PROFESSIONAL SERVICES LIABILITY INSURANCE REQUIREMENTS The Contractor shall not commence work on contract until proof of insurance required has been provided to the applicable City department before the contract or purchase order is considered for approval by the City. It is hereby agreed and understood that the insurance required by the City of Oshkosh isrip mare coverage and that any insurance or self insurance maintained by the City of Oshkosh, its officers, council members, agents, employees or authorized volunteers will not contribute to a loss. All insurance shall be in full force prior to commencing work and remain in force until the entire job is completed and the length of time that is specified, if any, in the contract or listed below whichever is longer. 1. PROFESSIONAL LIABILITY A. Limits (1) $1,000,000 each claim (2) $1,000,000 annual aggregate B. Must continue coverage for 2 years after final acceptance for service/job GENERAL LIABILITY COVERAGE A. Commercial General Liability (1) $1,000,000 each occurrence limit (2) $1,000,000 personal liability and advertising injury (3) $2,000,000 general aggregate (4) $2,000,000 products — completed operations aggregate B. Claims made form of coverage is not acceptable. C. Insurance must include: (1) Premises and Operations Liability (2) Contractual Liability (3) Personal Injury (4) Explosion, collapse and underground coverage (5) Products/Completed Operations must be carried for 2 years after acceptance of completed work (6) The general aggregate must apply separately to this project/location 3. BUSINESS AUTOMOBILE COVERAGE— If this exposure shall exist: A. $1,000,000 combined single limit for Bodily Injury and Property Damage each accident B. Must cover liability for Symbol #1 - "Any Auto" — including Owned, Non -Owned and Hired Automobile Liability. 4/14/14 4. WORKERS COMPENSATION AND EMPLOYERS LIABILITY — "If" required by Wisconsin State Statute or any Workers Compensation Statutes of a different state. A. Must carry coverage for Statutory Workers Compensation and an Employers Liability limit of: (1) $100,000 Each Accident (2) $500,000 Disease Policy Limit (3) $100,000 Disease — Each Employee UMBRELLA LIABILITY - If exposure exists, provide coverage at least as broad as the underlying Commercial General Liability, Watercraft Liability (if required), Automobile Liability and Employers Liability, with a minimum limit of $2,000,000 each occurrence and $2,000,000 aggregate, and a maximum self-insured retention of $10,000. 6. ADDITIONAL PROVISIONS A. Acceptability of Insurers - Insurance is to be placed with insurers who have an A.M. Best rating of no less than A- and a Financial Size Category of no less than Class VI, and who are authorized as an admitted insurance company in the state of Wisconsin. B. Additional Insured Requirements — The following must be named as additional insureds on all Liability Policies for liability arising out of project work - City of Oshkosh, and its officers, council members, agents, employees and authorized volunteers. On the Commercial General Liability Policy, the additional insured coverage must be ISO form CG 20 10 07 04 or its equivalent and also include Products — Completed Operations ISO form CG 20 37 07 04 or its equivalent for a minimum of 2 years after acceptance of work. This does not apply to Professional Liability, Workers Compensation and Employers Liability. C. Certificates of Insurance acceptable to the City of Oshkosh shall be submitted prior to commencement of the work to the applicable City department. These certificates shall contain a provision that coverage afforded under the policies will not be canceled or non renewed until at least 30 days' prior written notice has been given to the City Clerk — City of Oshkosh. III - 2 Arm CERTIFICATE OF LIABILITY INSURANCE ATE (MM D/DDYYY) F 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 Insurance Agency contact CONTACT NAME: information, including street PHONEY Insurance Agent's AX— address and PO Box it (A/C No. Ext):_ contact information. AIC. No): applicable. - M- EAIL ....------._ ....._. PRODUCTS–COMP/OP A_GG $2,000,000 ADDRESS: $ INSURER S) AFFORDING COVERAGE NAIC # AUTOMOBILE INSURERA: ABC Insurance Company NAIC # INSURED Insured's contact information, INSURER 8: XYZ Insurance Company # including name, address and .NAIC phone number. INSURER C: LMN Insurance Company NAIC# z1:1 ®ANY INSURER D: Insurer(s) must have a minimum A.M. Best rating of A- Liability Policy Number '! JPolicy effective and expiration date. BODILY INJURY (Per person) $ and a Financial Performance Rating of VI or better. ❑ 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 AMY 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 ADDL SUBR POLICY EFF POLICY EX( LTR TYPE OF INSURANCE INSR WVD POLICY NUMBER MM/DD/YYY MM/DD/YYY I LIMITS GENERAL LIABILITY i : EACH OCCURRENCE _ $ 1,000,000 EACH ®(COMMERCIAL GENERAL LIABILITY '. ® DAMAGE TO RENTED General Liability Policy Number Policy effective and expiration date. 1:1 General (Ea occurrence) $ 50,000 ❑ CLAIMS -MADE ® OCCUR ! I MED EXP (Any one person) $ 5,000 ® ISO FORM CG 20 37 OR EQUIVALENT ....... .. .........- PERSONAL &ADV INJURY $ 1,000,000 ❑ __ ... ? GENERAL AGGREGATE $ 2,000,000 ....... ...... _ .._. - IGEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS–COMP/OP A_GG $2,000,000 ❑POLICY ® JERCOT-'.,❑ LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea accident) $ 1,000,000 z1:1 ®ANY ANY AUTO Liability Policy Number '! JPolicy effective and expiration date. BODILY INJURY (Per person) $ B ❑ ALL OWNEDSCHEDULED ❑ AUTOS AUTOS i,BODILY INJURY (Per accident) $ HIRED AUTOS ❑ NON -OWNED PROPERTY DAMAGE AUTOS (Per accident) $ i$ ® UMBRELLA LIAB ®.00CUR EACH OCCURRENCE $ 2,000,000 ❑EXCESS LIAB❑) CLAIMS -MADE Umbrella Liability Policy Number I Policy effective and expiration date. AGGREGATE $ 2,000,000 ❑ DED ® RETENTION $10,000 $ C WORKERS AND EMPLO ERS' L ABILITY : ❑ STATU OTH ❑ ®, ANY PROPRIETOR/PARTNER/EXECUTIVE ORY LIMITS ER OFFICE/MEMBER EXCLUDED? YIN E.L._ EACH ACCIDENT I $ 100,000 Workers Compensation Policy Policy effective and expiration date .. _.. (Mandatory in NH) N If yes, describe under i Number E.L. DISEASE – EA EMPLOYEE $ 100,000 DESCRIPTION OF OPERATIONS below E.L. DISEASE–POLICY LIMIT $ 500,000 A PROFESSIONAL LIABILITY $1,000,000 EACH CLAIM Professional Liability Policy Policy effective and expiration date. $1,000,000 ANNUAL AGGREGATE Number DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) Additional Insureds per attached endorsements. Certificates of Insurance acceptable to the City of Oshkosh shall be submitted prior to commencement of the work to the applicable City department. These certificates shall contain a provision that coverage afforded under the policies will not be canceled or non renewed until at least 30 days' prior written notice has been given to the City Clerk — City of Oshkosh. CERTIFICATE HOLDER CANCELLATION City of Oshkosh, Attn: City Clerk Insurance Standard Ill SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 215 Church Avenue SAMPLE CERTIFICATE THE EXPIRATION DATE, THEREOF, NOTICE WILL BE DELIVERED IN PO Box 1130 ACCORDANCE WITH THE POLICY PROVISIONS. Oshkosh, WI 54903-1130 Please indicate somewhere on this AUTHORIZED REPRESENTATIVE certificate, the contract or project # this certificate is for. © 1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD POLICY NUMBER: COMMERCIAL GENERAL LIABILITY CG 20 10 07 04 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - SCHEDULED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organ ization(s): Location(s) Of Covered Operations As required by contract Any and all job sites Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. Section II — Who Is An Insured is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury' caused, in whole or in part, by: 1. Your acts or omissions; or 2. The acts or omissions of those acting on your behalf; In the performance of your ongoing operations for the additional insured(s) at the location(s) design- nated above. Insurance Standard III SAMPLE CERTIFICATE Please indicate somewhere on this certificate, the contract or project # this certificate is for. B. With respect to the insurance afforded to these additional insureds, the following additional exclu- sions apply: This insurance does not apply to "bodily injury' or "property damage" occurring after: 1. All work, including materials, parts or equip- ment furnished in connection with such work, on the project (other than service, maintenance or repairs) to be performed by or on behalf of the additional insured(s) at the location of the covered operations has been completed; or 2. That portion of "your work" out of which the injury or damage arises has been put to its in- tended use by any person or organization other than another contractor or subcontractor en- gaged in performing operations for a principal as a part of the same project. CG 20 10 07 04 © 130 Properties, Inc., 2004 Page 1 of 1 ❑ POLICY NUMBER: Policy# COMMERCIAL GENERAL LIABILITY CG 20 37 07 04 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - COMPLETED OPERATIONS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s): Location And Description Of Completed Operations As required by contract Any and all job sites Information required to complete this Schedule, if not shown above, will be shown in the Declarations. Section II — Who Is An Insured is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for "bodily injury", "property dam- age" caused, in whole or in part, by "your work" at the location designated and described in the sched- ule of this endorsement performed for that additional insured and included in the "products -completed operations hazard". Insurance Standard Ill SAMPLE CERTIFICATE Please indicate somewhere on this certificate, the contract or project # this certificate is for. CG 20 37 07 04 © ISO Properties, Inc., 2004 Page 1 of 1 0 ACC>Rf> C E R T I F I GA M OF 1A13 iNN:Z i 'S" 40 MUM UPO�4 "HE !�'MrMrATS 00i.06R. 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Y *Vot2ol 7 olmlrxia 0%"QW X 2 �Mow ANY A010 A Awosawy ;mw" . .. . . .. zowow A txte.ao Y CPPG 12,9144 "10147011 01101MIS AND "Moftalt, t I"nq"f Ov* CtA*0-c001' I -""rM �1'1 sm'(w City d 00*0$b ml bofobjr bddod A&M",w'k-,og'A"tj (;fs*adum saw'4*� lei N"fw',r (w Qfq4m-mww' (00 20 10 (1104) WW City of 00*ooh is lwvbyAdd*ofw ka"W (CA20 44 02 09) on Q* bau?m*s AuW (',ovwa0v fom ,ecoCERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) `...►-'' 08/09/2017 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 Drovisions or be endorsed.