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HomeMy WebLinkAboutMoss & Associates Kienast and Paulus Quarries 18-01CITY OF OSHKOSH DEPARTMENT OF PUBLIC WORKS 215 CHURCH AVENUE, P.O. BOX 1130, OSHKOSH, WI 54903-1130 PHONE: (920) 236-5065 FAX (920) 236-5068 LETTER OF TRANSMITTAL To: Randy Moss Subject: Moss & Associates, LLC 1556 Apache Avenue Contract 18-01 Date: --September 29, 2017 Subject: Executed Agreement for Kienast and Paulus Quarries Acquisition Services Contract 18-01 Please find: ® Attached ❑ Under Separate Cover ❑ Copy of Letter ® Contracts ❑ Amendment ❑ Report ❑ Agenda ❑ Meeting Notes ❑ Photos ❑ Mylars ❑ Change Order ❑ Plans ❑ Specifications ❑ Estimates ❑ Diskette ❑ Zip Disk ❑ Other Quantity Description 1 Executed Agreement These are being transmitted as indicated below: ❑ For Approval Remarks: ® For Your Use ❑ As Requested ❑ For Review & Comment Enclosed is the executed agreement for the Kienast and Paulus Quarries acquisition services. A City of Oshkosh Purchase Order will follow shortly. If you have any questions, please contact us. City Clerk's Office — Original cc: File — Original Signed: Tr y . Tayl I:\Engineering\2018 CONTRACTS \18-01 Kienast-Paulus LF\Project_Information\Contract Info\Consultant Agreements\ Moss& Assoc\18-01 Moss LOT -Executed Agreement-Acq Sery 9-29-17.docx AGREEMENT SY This AGREEMENT, made on the day of 4LXqtx 2017, by and between the CITY OF OSHKOSH, party of the first part, hereinafter referred to as CITY, and MOSS & ASSOCIATES, LLC, 1556 Apache Avenue, Green Bay, WI 54313, party of the second part, hereinafter referred to as the CONSULTANT, WITNESSETH: The CITY and the CONSULTANT, for the consideration hereinafter named, enter into the following AGREEMENT for KIENAST AND PAULUS QUARRIES ACQUISITION SERVICES. ARTICLE I. PROJECT MANAGER A. Assignment of Project Manager. The CONSULTANT shall assign the following individual to manage the PROJECT described in this AGREEMENT: Randy Moss — Consultant/Negotiator B. Changes in Project Manager. The CITY shall have the right to approve or disapprove of any proposed change from the individual named above as Project Manager. The CITY shall be provided with a resume or other information for any proposed substitute and shall be given the opportunity to interview that person prior to any proposed change. ARTICLE 11. CITY REPRESENTATIVE The CITY shall assign the following individual to manage the PROJECT described in this AGREEMENT: James Rabe, P.E. — Director of Public Works ARTICLE III. SCOPE OF WORK The CONSULTANT shall provide the services described in the CONSULTANT's Proposal. The CITY may make or approve changes within the general Scope of Services in this AGREEMENT. If such changes affect CONSULTANT's cost of or time required for performance of the services, an equitable adjustment will be made through an amendment to this AGREEMENT. 1:\Engineering\2018CONTRACTS\18-01Kienast-Paulus LF\Project Information\Contract Page 1 of Info\Consukant Agreements\Moss & Assoc\1801 Moss Agreement-Acq Serv_-3-17.docx All reports, drawings, specifications, computer files, field data, notes, and other documents and instruments prepared by the CONSULTANT as instruments of service shall remain the property of the CITY. ARTICLE IV. STANDARD OF CARE The standard of care applicable to CONSULTANT's services will be the degree of skill and diligence normally employed by professional consultants or consultants performing the same or similar services at the time said services are performed. CONSULTANT will re -perform any services not meeting this standard without additional compensation. ARTICLE V OPINIONS OF COST FINANCIAL CONSIDERATIONS, AND SCHEDULES In providing opinions of cost, financial analyses, economic feasibility projections, and schedules for the PROJECT, CONSULTANT has no control over cost or price of labor and materials; unknown or latent conditions of existing equipment or structures that may affect operation or maintenance costs; competitive bidding procedures and market conditions; time or quality of performance by operating personnel or third parties; and other economic and operational factors that may materially affect the ultimate project cost or schedule. Therefore, it is understood between the parties the CONSULTANT makes no warranty the CITY's actual project costs, financial aspects, economic feasibility, or schedules will not vary from CONSULTANT's opinions, analyses, projections, or estimates. ARTICLE VI. CITY RESPONSIBILITIES The CITY shall furnish, at the CONSULTANT's request, such information as is needed by the CONSULTANT to aid in the progress of the PROJECT, providing it is reasonably obtainable from City records. To prevent any unreasonable delay in the CONSULTANT's work, the CITY will examine all reports and other documents and will make any authorizations necessary to proceed with work within a reasonable time period. ARTICLE VII. TIME OF COMPLETION The work to be performed under this AGREEMENT shall be commenced and the work completed within the time limits as agreed upon in the CONSULTANT's Proposal. The CONSULTANT shall perform the services under this AGREEMENT with reasonable diligence and expediency consistent with sound professional practices. The I:\Engineering\2018CONTRACfS\18-01 Kienast-PaulusU\Project Information\Contract Page 2 of 6 Info \Consultant Agreements\ Moss & Assoc\18-01 Moss Agreement-Acq Serv_8-3-17.docx CITY agrees the CONSULTANT is not responsible for damages arising directly or indirectly from any delays for causes beyond the CONSULTANT's control. For the purposes of this AGREEMENT, such causes include, but are not limited to, strikes or other labor disputes, severe weather disruptions or other natural disasters, failure of performance by the CITY, or discovery of any hazardous substances or differing site conditions. If the delays resulting from any such causes increase the time required by the CONSULTANT to perform its services in an orderly and efficient manner, the CONSULTANT shall be entitled to an equitable adjustment in schedule. ARTICLE VIII. COMPONENT PARTS OF THE AGREEMENT This AGREEMENT consists of the following component parts, all of which are as fully a part of this AGREEMENT as if herein set out verbatim, or if not attached, as if hereto attached: 1. This Instrument 2. CONSULTANT's Proposal dated July 18, 2017 and attached hereto In the event any provision in any of the above component parts of this AGREEMENT conflicts with any provision in any other of the component parts, the provision in the component part first enumerated above shall govern over any other component part which follows it numerically except as may be otherwise specifically stated. ARTICLE IX. PAYMENT A. The Agreement Sum. The CITY shall pay to the CONSULTANT for the performance of the AGREEMENT the total sum as set forth below, adjusted by any changes hereafter mutually agreed upon in writing by the parties hereto: • Time and Materials Not to Exceed $6,125 (Six Thousand One Hundred Twenty Five Dollars). . B. Method of Payment. The CONSULTANT shall submit itemized monthly statements for services. The CITY shall pay the CONSULTANT within thirty (30) calendar days after receipt of such statement. If any statement amount is disputed, the CITY may withhold payment of such amount and shall provide to CONSULTANT a statement as to the reason(s) for withholding payment. 1:\Engineering\2018CONMCIS\18-01 Kienast-Paulus LF\Project_Gifonnation\Contract Page 3 of 6 Info\Consultant Agreements\Moss & Assoc\18-01 Moss Agreement-Acq Sem_8-3-17.docx C. Additional Costs. Costs for additional services shall be negotiated and set forth in a written amendment to this AGREEMENT executed by both parties prior to proceeding with the work covered under the subject amendment. D. Indirect Costs. Indirect costs such as computer time, printing, copying, cell phone charges, telephone charges, and equipment rental shall be considered overhead and shall not be invoiced separately to the PROJECT. E. Expenses. Expenses may be billed with up to a maximum of 10% mark-up. All invoices with expenses shall include supporting documentation of the expense. Failure to include the supporting documentation will result in the reduction of payments by the amount of those expense(s) not including documentation. ARTICLE X. HOLD HARMLESS The CONSULTANT covenants and agrees to protect and hold the City of Oshkosh harmless against all actions, claims, and demands which may be to the proportionate extent caused by or result from the intentional or negligent acts of the CONSULTANT, his/her agents or assigns, his/her employees, or his/her subcontractors related however remotely to the performance of this AGREEMENT or be caused or result from any violation of any law or administrative regulation, and shall indemnify or refund to the CITY all sums including court costs, attorney fees, and punitive damages which the CITY may be obliged or adjudged to pay on any such claims or demands within thirty (30) days of the date of the CITY's written demand for indemnification or refund for those actions, claim, and demands caused by or resulting from intentional or negligent acts as specified in this paragraph. Subject to any limitations contained in Sec. 893.80 and any similar statute of the Wisconsin Statutes, the CITY further agrees to hold CONSULTANT harmless from any and all liability, including claims, demands, losses, costs, damages, and expenses of every kind and description (including death), or damages to person or property arising out of re -use of the documents without consent where such liability is founded upon or grows out of the acts or omission of any of the officers, employees or agents of the City of Oshkosh while acting within the scope of their employment. ARTICLE XI. INSURANCE The CONSULTANT agrees to obtain General Liability Coverage of $500,000 per occurrence. The following must be named as additional insureds — City of Oshkosh, and its officers, council members, agents, employees, and authorized volunteers. 1:\Engineering\2D18CONTRACIS\18-01 Kienast-Paulus LF\Project Information\Contract Page 4 of 6 Info\Consultant Agreements\Moss k Assoc\18-01 Moss Agreement-AogSm_8-317.docx Certificates of Insurance acceptable to the CITY shall be submitted to the Engineering Division of the Department of Public Works prior to the commencement of the work. These certificates shall contain a provision that coverage afforded under the policies will not be cancelled or non -renewed until at least 30 days prior written notice has been given to the City Clerk of the City of Oshkosh. ARTICLE XII. TERMINATION A. For Cause. If the CONSULTANT shall fail to fulfill in timely and proper manner any of the obligations under this AGREEMENT, the CITY shall have the right to terminate this AGREEMENT by written notice to the CONSULTANT. In this event, the CONSULTANT shall be entitled to compensation for any satisfactory, usable work completed. B. For Convenience. The CITY may terminate this AGREEMENT at any time by giving written notice to the CONSULTANT no later than ten (10) calendar days before the termination date. If the CITY terminates under this paragraph, then the CONSULTANT shall be entitled to compensation for any satisfactory work performed to the date of termination. This document and any specified attachments contain all terms and conditions of the AGREEMENT and any alteration thereto shall be invalid unless made in writing, signed by both parties and incorporated as an amendment to this AGREEMENT. ARTICLE XIII. RE -USE OF PROTECT DOCUMENTS All reports, drawings, specifications, documents, and other deliverables of CONSULTANT, whether in hard copy or in electronic form, are instruments of service for this PROJECT, whether the PROJECT is completed or not. The CITY agrees to indemnify CONSULTANT and CONSULTANT's officers, employees, subcontractors, and affiliated corporations from all claims, damages, losses, and costs, including, but not limited to, litigation expenses and attorney's fees arising out of or related to the unauthorized re -use, change, or alteration of these project documents. ARTICLE XIV. SUSPENSION DELAY OR INTERRUPTION OF WORK The CITY may suspend, delay, or interrupt the services of CONSULTANT for the convenience of the CITY. In such event, CONSULTANT's contract price and schedule shall be equitably adjusted. 1AEngineering\2018 CONTRACTS\18-01 Kienast-Paulus LF\Project_Information\Contmct Page 5 of 6 Info\Consultant Agreements\Moss & Assoc\18-01 Moss Agreement-Acq Serv_8-3.17.do« ARTICLE XV. NO THIRD -PARTY BENEFICIARIES This AGREEMENT gives no rights or benefits to anyone other than the CITY and CONSULTANT and has no third -party beneficiaries. In the Presence of: (Seal of Consultant if a Corporation) (Witness) (Witness) APPROVED: CONSULTANT By: (p, (Specify Title) (Specify Title) CITY OF OSHKOSH Mark A. Rohloff, City Manager t And: f Pamela R. Ubrig, City Clerk I hereby certify that the necessary provisions have been made to pay the liability which will accrue under this AGREEMENT. & vn City Comptroller 1AEngineering\2018CONTRACTS\1"1 Kienast-Paulus LF\Pmject_Information\Contract Page 6 of 6 Info\Consultant Agcements\Moss & Assoc\18-01 Moss Agreement-Aoq Serv_8-3-17.docx Proposal of Services Kienast and Paulus Quarries —_ City of Oshkosh RECEIVED Negotiation Acquisition of parcels: 2 Full Acquisitions $2,025 1 Partial Acquisition $600 Total $2,625 Relocation Small Projects Relocation Plan $1,500 Relocation of Relocatees $2,000 Appraiser 4 Appraisals $8,850 Grand Total $14,975 JUL 18 2017 DEPT OF PUBLIC WORKS OSHKOSH, WISCONSIN RECEIVED ACORl:�r t.,[,017 �. CERTIFICATE OF LIABILITY INSURANCE A H�' DATE (MM/DD/YYYY) 8/21/2017 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 AMORUEDiBY THEP`OLI9IES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSU)yGMSURER(S), A�LTLiQ,R12 PF� 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 CONTACT NAME: Vicki Kamps Peter Baierl Insurance & Investments, Inc. PHONE 9204901022 A/C No Ext): A1C, No): 1345 West Mason Street ADDRESS: vkamps@baierlinsurance.com INSURER(S) AFFORDING COVERAGE NAIC # X COMMERCIAL GENERAL LIABILITY Green Bay WI 54303 INSURER A; SENTINEL INS CO LTD 11000 INSURED INSURER B: Moss & Associates, LLC INSURER C: 2835 Newcastle Ave INSURER D: INSURER E: Green Bay WI 54313 INSURER F: COVERAGES CERTIFICATE NUMBER: RFVICInN NIIMRFR• 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 CONTRACTOR 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. LTR TYPE OF INSURANCEPULICY INSD WVD POLICY NUMBER EFF MM/DDIYYYY POLICY FXP MM/DD/YYYY LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 2000000 CLAIMS -MADE 7 OCCUR PREMISES Ea occurrence $ 1000000 MED EXP (Any one person) $ 10000 PERSONAL & ADV INJURY $ 2000000 A 83SBAIL5288 04/03/2017 04/03/2018 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY ❑ PRO- JECT LOC GENERAL AGGREGATE $ 4000000 PRODUCTS-COMPlOPAGG $ 4000000 OTHER: EPLI $ 10000 AUTOMOBILE LIABILITY UUMBINEU Ea accident) ccident $ ANY AUTO BODILY INJURY (Per person) $ OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY Per accident ( ) $ HIRED NON -OWNED$ AUTOS ONLY AUTOS ONLY Per accident UMBRELLA LIAB HCLAIMS-MADE OCCUR EACH OCCURRENCE $ EXCESS LIAB AGGREGATE $ DED I I RETENTION $ $ WORKERS COMPENSATION ND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE FFICERIMEMBER EXCLUDED?N ❑ / A STATUTE ER E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ Y DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Additional Insureds on Commercial General Liability arising out of project work shall be City of Oshkosh, and its officers, council members, agents, employees and authorized volunteers. Certificates of Insurance acceptable to the Cit of OShkosh shall be submitted prior to commencement of the work to the City Department. These certificates shall rnntnin a nrnvi6r)n that rnvernoe nfforrlerl nndi-r the nnliry xx7ill not he rnnrelerl nr nnn ranewerl until at least Zn dnvc' nrinr written nntirr City of Oshkosh Atm James Rabe 215 Church Ave PO BOX 1130 Oshkosh WI 54903-1130 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE Pe.Jer 13a,,er-b ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD 1zxCEIVEL SEP 1 9V pE�1 O1 P'J BUIC WORKS OSfk1_,OS1-1, WISCONSIN IMPORTANT NOTICE TO OUR POLICYHOLDERS THANK YOU FOR RENEWING YOUR POLICY WITH THE HARTFORD. WITH THIS NOTICE WE ARE PROVIDING YOU ONLY WITH THE DECLARATIONS PAGE, WHICH OUTLINES YOUR COVERAGES, AND WITH THOSE POLICY FORMS, NOTICES, AND BROCHURES WHICH ARE DIFFERENT FROM THOSE WHICH WE PROVIDED WITH YOUR PREVIOUS POLICY. YOU SHOULD RETAIN ALL OF THESE DOCUMENTS AND THOSE PROVIDED WITH YOUR PREVIOUS POLICY INDEFINITELY SO THAT YOU WILL HAVE A COMPLETE SET OF POLICY FORMS AT ALL TIMES FOR YOUR REFERENCE. IF YOU HAVE QUESTIONS, OR IF AT ANY TIME YOU NEED COPIES OF ANY OF THE FORMS LISTED ON YOUR POLICY, PLEASE CALL YOUR HARTFORD AGENT OR BROKER, OR THE OFFICE OF THE HARTFORD IDENTIFIED ON YOUR POLICY, AS APPROPRIATE. 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Form SS 89 93 07 16 Page 1 of 1 © 2016, The Hartford Spectrum Business Owner's Policy THE HARTFORD Form SS 00 01 03 14 Page 1 of 1 POLICY NUMBER: 83 SBA IL5288 PAW THIS ENDORSEMENT IS ATTACHED TO AND MADE PART OF YOUR POLICY IN RESPONSE TO THE DISCLOSURE REQUIREMENTS OF THE TERRORISM RISK INSURANCE ACT. DISCLOSURE PURSUANT TO TERRORISM RISK INSURANCE ACT SCHEDULE Terrorism Premium: $ $7.00 A. Disclosure Of Premium In accordance with the federal Terrorism Risk Insurance Act, as amended (TRIA), we are required to provide you with a notice disclosing the portion of your premium, if any, attributable to coverage for "certified acts of terrorism" under TRIA. The portion of your premium attributable to such coverage is shown in the Schedule of this endorsement. B. The following definition is added with respect to the provisions of this endorsement: 1. A "certified act of terrorism" means an act that is certified by the Secretary of the Treasury, in accordance with the provisions of TRIA, to be an act of terrorism under TRIA. The criteria contained in TRIA for a "certified act of terrorism" include the following: a. The act results in insured losses in excess of $5 million in the aggregate, attributable to all types of insurance subject to TRIA; and b. The act results in damage within the United States, or outside the United States in the case of certain air carriers or vessels or the premises of an United States mission; and c. The act is a violent act or an act that is dangerous to human life, property or infrastructure and is committed by an individual or individuals as part of an effort to coerce the civilian population of the Form SS 83 76 01 15 United States or to influence the policy or affect the conduct of the United States Government by coercion C. Disclosure Of Federal Share Of Terrorism Losses The United States Department of the Treasury will reimburse insurers for a portion of insured losses, as indicated in the table below, attributable to "certified acts of terrorism" under TRIA that exceeds the applicable insurer deductible: Calendar Year Federal Share of Terrorism Losses 2015 85% 2016 84% 2017 83% 2018 82% 2019 81% 2020 or later 80% However, if aggregate industry insured losses under TRIA exceed $100 billion in a calendar year, the Treasury shall not make any payment for any portion of the amount of such losses that exceeds $100 billion. The United States government has not charged any premium for their participation in covering terrorism losses. © 2015 , The Hartford (Includes copyrighted material of the Insurance Services Office, Inc., with its permission.) Page 1 of 2 D. Cap On Insurer Liability for Terrorism Losses If aggregate industry insured losses attributable to "certified acts of terrorism" under TRIA exceed $100 billion in a calendar year and we have met, or will meet, our insurer deductible under TRIA, we shall not be liable for the payment of any portion of the amount of such losses that exceed $100 billion. In such case, your coverage for terrorism losses may be reduced on a pro -rata basis in accordance with procedures established by the Treasury, based on its estimates of aggregate industry losses and our estimate that we will exceed our insurer deductible. In accordance with the Treasury's procedures, amounts paid for losses may be subject to further adjustments based on differences between actual losses and estimates. E. Application of Other Exclusions The terms and limitations of any terrorism exclusion, the inapplicability or omission of a terrorism exclusion, or the inclusion of terrorism coverage, do not serve to create coverage for any loss which would otherwise be excluded under this Coverage Form, Coverage Part or Policy. F. All other terms and conditions remain the same. Form SS 83 76 01 15 Page 2 of 2 IMPORTANT NOTICE TO POLICYHOLDERS To help your insurance keep pace with increasing costs, we have increased your amount of insurance ... giving you better protection in case of either a partial, or total loss to your property. If you feel the new amount is not the proper one, please contact your agent or broker. Form PC -374-0 Printed in U.S.A. 88 This Spectrum Policy consists of the Declarations, Coverage Forms, Common Policy Conditions and any 52 other Forms and Endorsements issued to be a part of the Policy. This insurance is provided by the stock IL insurance company of The Hartford Insurance Group shown below. SBA INSURER: SENTINEL INSURANCE COMPANY, LIMITED ONE HARTFORD PLAZA, HARTFORD, CT 06155 COMPANY CODE: A THE Policy Number: 83 SBA IL5288 SA HARTFORD SPECTRUM POLICY DECLARATIONS Named Insured and Mailing Address: MOSS & ASSOCIATES, LLC (No., Street, Town, State, Zip Code) 2835 NEWCASTLE AVE GREEN BAY WI 54313 Policy Period: From 04/03/17 To 04/03/18 365 DAYS 12:01 a.m., Standard time at your mailing address shown above. Exception: 12 noon in New Hampshire. Name of Agent/Broker: PETER BAIERL INSURANCE & INVEST Code: 411894 Previous Policy Number: 83 SBA IL5288 Named Insured is: LIMITED LIAB CORP Audit Period: NON -AUDITABLE Type of Property Coverage: SPECIAL Insurance Provided: In return for the payment of the premium and subject to all of the terms of this policy, we agree with you to provide insurance as stated in this policy. TOTAL ANNUAL PREMIUM IS: Countersigned by $550 MP di1eZ'1-1 I; .. I Authorized Representative 01/20/17 Date Form SS 00 02 12 06 Page 001 (CONTINUED ON NEXT PAGE) Process Date: 01/20/17 Policy Expiration Date: 04/03/18 SPECTRUM POLICY DECLARATIONS (Continued) POLICY NUMBER: 83 SBA IL5288 Location(s), Building(s), Business of Named Insured and Schedule of Coverages for Premises as designated by Number below. Location: 001 Building: ool 2835 NEWCASTLE AVE GREEN BAY WI 54313 Description of Business: Consultant - Structured Settlement Deductible: $ 500 PER OCCURRENCE BUILDING AND BUSINESS PERSONAL PROPERTY LIMITS OF INSURANCE BUILDING BUSINESS PERSONAL PROPERTY REPLACEMENT COST PERSONAL PROPERTY OF OTHERS REPLACEMENT COST MONEY AND SECURITIES INSIDE THE PREMISES OUTSIDE THE PREMISES Form SS 00 02 12 06 Process Date: 01/20/17 $ 28,500 NO COVERAGE $ 10,000 $ 5,000 Page 002 (CONTINUED ON NEXT PAGE) Policy Expiration Date: 04/03/18 SPECTRUM POLICY DECLARATIONS (Continued) POLICY NUMBER: 83 SBA IL5288 Location(s), Building(s), Business of Named Insured and Schedule of Coverages for Premises as designated by Number below. Location: 001 Building: 001 PROPERTY OPTIONAL COVERAGES APPLICABLE LIMITS OF INSURANCE TO THIS LOCATION SUPER STRETCH FOR BUSINESS SERVICES FORM: SS 40 05 THIS FORM INCLUDES MANY ADDITIONAL COVERAGES AND EXTENSIONS OF COVERAGES. A SUMMARY OF THE COVERAGE LIMITS IS ATTACHED. LIMITED FUNGI, BACTERIA OR VIRUS COVERAGE: FORM SS 40 93 THIS IS THE MAXIMUM AMOUNT OF INSURANCE FOR THIS COVERAGE, SUBJECT TO ALL PROPERTY LIMITS FOUND ELSEWHERE ON THIS DECLARATION. INCLUDING BUSINESS INCOME AND EXTRA EXPENSE COVERAGE FOR: Form SS 00 02 12 06 Process Date: 01/20/17 $ 50,000 30 DAYS Page 003 (CONTINUED ON NEXT PAGE) Policy Expiration Date: 04/03/18 SPECTRUM POLICY DECLARATIONS (Continued) POLICY NUMBER: 83 SBA IL5288 PROPERTY OPTIONAL COVERAGES APPLICABLE LIMITS OF INSURANCE TO ALL LOCATIONS BUSINESS INCOME AND EXTRA EXPENSE COVERAGE 12 MONTHS ACTUAL LOSS SUSTAINED COVERAGE INCLUDES THE FOLLOWING COVERAGE EXTENSIONS: ACTION OF CIVIL AUTHORITY: EXTENDED BUSINESS INCOME: EQUIPMENT BREAKDOWN COVERAGE COVERAGE FOR DIRECT PHYSICAL LOSS DUE TO: MECHANICAL BREAKDOWN, ARTIFICIALLY GENERATED CURRENT AND STEAM EXPLOSION THIS ADDITIONAL COVERAGE INCLUDES THE FOLLOWING EXTENSIONS HAZARDOUS SUBSTANCES EXPEDITING EXPENSES MECHANICAL BREAKDOWN COVERAGE ONLY APPLIES WHEN BUILDING OR BUSINESS PERSONAL PROPERTY IS SELECTED ON THE POLICY IDENTITY RECOVERY COVERAGE FORM SS 41 12 Form SS 00 02 12 06 Process Date: 01 / 2 0 / 17 30 DAYS 30 CONSECUTIVE DAYS $ 50,000 $ 50,000 $ 15,000 Page 004 (CONTINUED ON NEXT PAGE) Policy Expiration Date: 04/03/18 SPECTRUM POLICY DECLARATIONS (Continued) POLICY NUMBER: 83 SBA IL5288 BUSINESS LIABILITY LIMITS OF INSURANCE LIABILITY AND MEDICAL EXPENSES $2,000,000 MEDICAL EXPENSES -ANY ONE PERSON $ 10, 000 PERSONAL AND ADVERTISING INJURY $2,000,000 DAMAGES TO PREMISES RENTED TO YOU $1, 000,000 ANY ONE PREMISES AGGREGATE LIMITS PRODUCTS -COMPLETED OPERATIONS $4,000,000 GENERAL AGGREGATE $4,000,000 EMPLOYMENT PRACTICES LIABILITY COVERAGE: FORM SS 09 01 EACH CLAIM LIMIT $ 10, 000 DEDUCTIBLE - EACH CLAIM LIMIT NOT APPLICABLE AGGREGATE LIMIT $ 10, 000 RETROACTIVE DATE: 04032014 This Employment Practices Liability Coverage contains claims made coverage. Except as may be otherwise provided herein, specified coverages of this insurance are limited generally to liability for injuries for which claims are first made against the insured while the insurance is in force. Please read and review the insurance carefully and discuss the coverage with your Hartford Agent or Broker. The Limits of Insurance stated in this Declarations will be reduced, and may be completely exhausted, by the payment of "defense expense" and, in such event, The Company will not be obligated to pay any further "defense expense" or sums which the insured is or may become legally obligated to pay as "damages". BUSINESS LIABILITY OPTIONAL COVERAGES CYBERFLEX COVERAGE FORM SS 40 26 Form SS 00 02 12 06 Page 005 (CONTINUED ON NEXT PAGE) Process Date: 01/20/17 Policy Expiration Date: 04/03/18 SPECTRUM POLICY DECLARATIONS (Continued) POLICY NUMBER: 83 SBA IL5288 ADDITIONAL INSUREDS: THE FOLLOWING ARE ADDITIONAL INSUREDS FOR BUSINESS LIABILITY COVERAGE IN THIS POLICY. LOCATION 001 BUILDING 001 TYPE PERSON ORGANIZATION NAME SEE FORM IH 12 00 Form SS 00 02 12 06 Page 0 0 6 ( CONTINUED ON NEXT PAGE) Process Date: 01/20/17 Policy Expiration Date: 04/03/18 SPECTRUM POLICY DECLARATIONS (Continued) POLICY NUMBER: 83 SBA IL5288 Form Numbers of Forms and Endorsements that apply: SS 00 01 03 14 SS 00 05 10 08 SS 00 07 07 05 SS 00 08 04 05 SS 00 60 09 15 SS 00 61 09 15 SS 00 64 09 16 SS 84 32 09 07 SS 01 13 10 08 SS 04 15 07 05 SS 04 19 04 09 SS 04 22 07 05 SS 04 30 07 05 SS 04 39 07 05 SS 04 41 04 09 SS 04 42 09 07 SS 04 44 07 05 SS 04 45 07 05 SS 04 46 09 14 SS 04 47 04 09 SS 04 78 07 05 SS 04 80 03 00 SS 04 86 03 00 SS 40 05 09 07 SS 40 18 07 05 SS 40 26 06 11 SS 40 93 07 05 SS 41 12 12 07 SS 41 51 10 09 SS 41 63 06 11 IH 10 01 09 86 SS 05 04 04 05 SS 05 09 07 00 SS 05 47 09 15 SS 05 49 03 00 SS 09 01 12 14 SS 09 67 09 14 SS 09 70 12 14 SS 09 71 12 14 SS 50 19 01 15 IH 99 40 04 09 IH 99 41 04 09 SS 83 76 01 15 SS 89 93 07 16 IH 12 00 11 85 ADDITIONAL INSURED - PERSON -ORGANIZATION Form SS 00 02 12 06 Page 007 Process Date: 01/20/17 Policy Expiration Date: 04/03/18 COMMON POLICY CONDITIONS Form SS 00 05 10 08 © 2008, The Hartford QUICK REFERENCE - SPECTRUM POLICY DECLARATIONS and COMMON POLICY CONDITIONS I. DECLARATIONS Named Insured and Mailing Address Policy Period Description and Business Location Coverages and Limits of Insurance II. COMMON POLICY CONDITIONS Beginning on Page A. Cancellation 1 B. Changes 1 C. Concealment, Misrepresentation Or Fraud 2 D. Examination Of Your Books And Records 2 E. Inspections And Surveys 2 F. Insurance Under Two Or More Coverages 2 G. Liberalization 2 H. Other Insurance - Property Coverage 2 I. Premiums 2 J. Transfer Of Rights Of Recovery Against Others To Us 2 K. Transfer Of Your Rights And Duties Under This Policy 3 L. Premium Audit 3 Form SS 00 05 10 08 PA. COMMON POLICY CONDITIONS All coverages of this policy are subject to the following conditions. A. Cancellation 1. The first Named Insured shown in the Declarations may cancel this policy by mailing or delivering to us advance written notice of cancellation. 2. We may cancel this policy by mailing or delivering to the first Named Insured written notice of cancellation at least: a. 5 days before the effective date of cancellation if any one of the following conditions exists at any building that is Covered Property in this policy: (1) The building has been vacant or unoccupied 60 or more consecutive days. This does not apply to: (a) Seasonal unoccupancy; or (b) Buildings in the course of construction, renovation or addition. Buildings with 65% or more of the rental units or floor area vacant or unoccupied are considered unoccupied under this provision. (2) After damage by a Covered Cause of Loss, permanent repairs to the building: (a) Have not started; and (b) Have not been contracted for, within 30 days of initial payment of loss. (3) The building has: (a) An outstanding order to vacate; (b) An outstanding demolition order; or (c) Been declared unsafe by governmental authority. (4) Fixed and salvageable items have been or are being removed from the building and are not being replaced. This does not apply to such removal that is necessary or incidental to any renovation or remodeling. Form SS 00 05 10 08 (5) Failure to: (a) Furnish necessary heat, water, sewer service or electricity for 30 consecutive days or more, except during a period of seasonal unoccupancy;or (b) Pay property taxes that are owing and have been outstanding for more than one year following the date due, except that this provision will not apply where you are in a bona fide dispute with the taxing authority regarding payment of such taxes. b. 10 days before the effective date of cancellation if we cancel for nonpayment of premium. c. 30 days before the effective date of cancellation if we cancel for any other reason. 3. We will mail or deliver our notice to the first Named Insured's last mailing address known to us. 4. Notice of cancellation will state the effective date of cancellation. The policy period will end on that date. 5. If this policy is canceled, we will send the first Named Insured any premium refund due. Such refund will be pro rata. If the first Named Insured cancels, the refund may be less than pro rata. The cancellation will be effective even if we have not made or offered a refund. 6. If notice is mailed, proof of mailing will be sufficient proof of notice. B. Changes This policy contains all the agreements between you and us concerning the insurance afforded. The first Named Insured shown in the Declarations is authorized to make changes in the terms of this policy with our consent. This policys terms can be amended or waived only by endorsement issued by us and made a part of this policy. © 2008, The Hartford (Includes copyrighted material of Insurance Services Office, Inc. with its permission) Page 1 of 3 COMMON POLICY CONDITIONS C. Concealment, Misrepresentation Or Fraud This policy is void in any case of fraud by you as it relates to this policy at any time. It is also void if you or any other insured, at any time, intentionally conceal or misrepresent a material fact concerning: 1. This policy; 2. The Covered Property; 3. Your interest in the Covered Property; or 4. A claim under this policy. D. Examination Of Your Books And Records We may examine and audit your books and records as they relate to the policy at any time during the policy period and up to three years afterward. E. Inspections And Surveys 1. We have the right but are not obligated to: a. Make inspections and surveys at any time; b. Give you reports on the conditions we find; and c. Recommend changes. 2. Any inspections, surveys, reports or recommendations will relate only to insurability and the premiums to be charged. We do not make safety inspections. We do not undertake to perform the duty of any person or organization to provide for the health or safety of any person. We do not represent or warrant that conditions: a. Are safe or healthful; or b. Comply with laws, regulations, codes or standards. 3. This condition applies not only to us, but also to any rating, advisory, rate service or similar organization which makes insurance inspections, surveys, reports or recommendations on our behalf. F. Insurance Under Two Or More Coverages If two or more of this policy's coverages apply to the same loss or damage, we will not pay more than the actual amount of the loss or damage. G. Liberalization If we adopt any revision that would broaden the coverage under this policy without additional premium within 45 days prior to, or at any time during, the policy period, the broadened coverage will immediately apply to this policy. H. Other Insurance - Property Coverage If there is other insurance covering the same loss or damage, we will pay only for the amount of covered loss or damage in excess of the amount due from that other insurance, whether you can collect on it or not. But we will not pay more than the applicable Limit of Insurance. I. Premiums 1. The first Named Insured shown in the Declarations: a. Is responsible for the payment of all premiums; and b. Will be the payee for any return premiums we pay. 2. The premium shown in the Declarations was computed based on rates in effect at the time the policy was issued. If applicable, on each renewal, continuation or anniversary of the effective date of this policy, we will compute the premium in accordance with our rates and rules then in effect. 3. With our consent, you may continue this policy in force by paying a continuation premium for each successive one-year period. The premium must be: a. Paid to us prior to the anniversary date; and b. Determined in accordance with Paragraph 2. above. Our forms then in effect will apply. If you do not pay the continuation premium, this policy will expire on the first anniversary date that we have not received the premium. 4. Changes in exposures or changes in your business operation, acquisition or use of locations that are not shown in the Declarations may occur during the policy period. If so, we may require an additional premium. That premium will be determined in accordance with our rates and rules then in effect. J. Transfer Of Rights Of Recovery Against Others To Us Applicable to Property Coverage: If any person or organization to or for whom we make payment under this policy has rights to recover damages from another, those rights are transferred to us to the extent of our payment. That person or organization must do everything necessary to secure our rights and must do nothing after loss to impair them. But you may waive your rights against another party in writing: 1. Prior to a loss to your Covered Property; or 2. After a loss to your Covered Property only if, at time of loss, that party is one of the following: Page 2 of 3 Form SS 00 05 10 08 a. Someone insured by this insurance; b. A business firm: (1) Owned or controlled by you; or (2) That owns or controls you; or c. Your tenant. You may also accept the usual bills of lading or shipping receipts limiting the liability of carriers. This will not restrict your insurance. K. Transfer Of Your Rights And Duties Under This Policy Your rights and duties under this policy may not be transferred without our written consent except in the case of death of an individual Named Insured. If you die, your rights and duties will be transferred to your legal representative but only while acting within the scope of duties as your legal representative. Until your legal representative is COMMON POLICY CONDITIONS appointed, anyone having proper temporary custody of your property will have your rights and duties but only with respect to that property. L. Premium Audit a. We will compute all premiums for this policy in accordance with our rules and rates. b. The premium amount shown in the Declarations is a deposit premium only. At the close of each audit period we will compute the earned premium for that period. Any additional premium found to be due as a result of the audit are due and payable on notice to the first Named Insured. If the deposit premium paid for the policy term is greater than the earned premium, we will return the excess to the first Named Insured. c. The first Named Insured must maintain all records related to the coverage provided by this policy and necessary to finalize the premium audit, and send us copies of the same upon our request. Our President and Secretary have signed this policy. Where required by law, the Declarations page has also been countersigned by our duly authorized representative. S!�S� Lisa Levin, Secretary c m1so atot Douglas Elliot, President Form SS 00 05 10 08 Page 3 of 3 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BUSINESS LIABILITY COVERAGE FORM AMENDATORY ENDORSEMENT - SUPPLEMENTARY PAYMENTS This endorsement modifies insurance provided under the following: BUSINESS LIABILITY COVERAGE FORM A. Sub -subparagraph 3.a.(5) of Paragraph 3., Section A. Coverages is deleted and replaced with the following: 3. Coverage Extension - Supplementary Payments: a. (5) All court costs taxed against the insured in the "suit". However, these payments do not include attorneys' fees or attorneys' expenses taxed against the insured. Form SS 00 64 09 16 Page 1 of 1 © 2016, The Hartford POLICY NUMBER: 83 SBA IL5288 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - PERSON -ORGANIZATION LOCATION 001 BUILDING 001 CITY OF OSHKOSH ATTN: CITY CLERK PO BOX 1130 OSHKOSH WI 54903 Form IH 12 00 11 85 T SEQ. NO. 001 Printed in U.S.A. Page 001 Process Date: 01/20/17 Expiration Date: 04/03/18 Named Insured: MOSS & ASSOCIATES, LLC Policy Number: 83 SBA IL5288 Effective Date: 04/03/17 Expiration Date: 04/03/18 Company Name: SENTINEL INSURANCE COMPANY, LIMITED THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. TRADE OR ECONOMIC SANCTIONS ENDORSEMENT This insurance does not apply to the extent that trade or economic sanctions or other laws or regulations prohibit us from providing insurance, including, but not limited to, the payment of claims. All other terms and conditions remain unchanged. Form IH 99 41 04 09 Page 1 of 1