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HomeMy WebLinkAboutPTS Contractors PW Contract 19-05 (313c\ CONSTRUCTION CONTRACT THIS AGREEMENT, made on the 27th day of February, 2019, by and between the CITY OF OSHKOSH, party of the first part, hereinafter referred to as CITY, and PTS Contractors, Inc., 4075 Eaton Road, Green Bay, WI 54311, 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 I. 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. 19-05 for Oregon Street Reconstruction in the City of Oshkosh,for the Public Works Department, pursuant to Resolution 19-105 adopted by the Common Council of the City of Oshkosh on the 26th day of February, 2019, all in accordance and in strict compliance with the CON IRACTOR's Proposal and the other Contract Documents referred to in ARTICLE V of this Contract. ARTICLE II. 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 III. PAYMENT (a) The Contract Sum. The CITY shall pay to the CON TRACTOR for the performance of the Contract the sum of Seven million two hundred fifty-eight thousand five hundred twenty-three dollars and 29/100 ($7,258,523.29), 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 1 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. (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 CON TRACT This Contract consists of the following component parts, all of which are as 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 2 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. 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. 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 resence of: CONTRACTOR PTS Contractors, Inc. Casey Ashman, Corp SPC`, Mark C. Schleis President (Seal of Contractor (Specify Title) if a Corporation.) By: (Specify Title) 3 CITY OF OSHKOSH By: - , '/%Td)-Cj Mark A. Rohloff, City Manager itness) And: ")/r1/1—e( fitness) Pamela R.Ubrig, City lerk APPROVED: I hereby certify that the necessary provisions have been made to pay the liability which will accrue under this contract ynn . Loren n, ity Attorney WrrN Trena Larson, City Comptroller 4 • PERFORMANCE BOND CITY OF OSHKOSH Bond No. 354223071 Contract Number 19-05 Date Bond Executed (Date of Contract or Later) 3/4/2019 PRINCIPAL/CONTRACTOR(Legal Name and Business Address) Type of Organization PTS CONTRACTORS,INC. _Individual _Partnership 4075 Eaton Road X Corporation Green Bay,WI 54311 State of Incorporation Wisconsin SURETY(IES)(Legal Name(s) and Business Address(es)) Penal Sum of Bond $7,258,523.29 LIBERTY MUTUAL INSURANCE COMPANY 175 Berkeley Street Boston, MA 02116 OWNER(Legal Name and Business Address) CITY OF OSHKOSH 215 Church Avenue PO Box 1130 Oshkosh, Wisconsin 54903-1130 OBLIGATION The Contractor and Surety,jointly and severally,bind themselves, their heirs,executors, administrators,successors and assigns to the Owner for payment of the sum shown above or the performance of the Contract identified above, which is incorporated herein by reference. This Bond shall cover any work performed during initial construction and any warranty period required by the Contract. If there is no Owner Default to pay the Contractor as required under the Contract for work performed or to perform or complete any material term of the Contract, then the Surety(ies) obligation under this Bond shall arise after: 1. The Owner provides notice to the Contractor and Surety that the Owner is considering declaring the Contractor in default of the Contract. Within five (5) business days of the Owner's notice, either the Contractor or the Surety may request a conference with the Owner to discuss such default and the remedy therefor. If a conference is requested, the conference shall be scheduled to take place at Owner's principal place of business or another agreed upon location within five (5) business days of the request for conference. If the Owner, Contractor and Surety agree, the Contractor may be allowed a reasonable time to perform the Contract, but such agreement shall not waive the Owner's right, if any, to subsequently declare the Contractor in default; 2. The Owner declares the Contractor in default and notifies the Surety of the declaration of default;and 3. The Owner agrees to pay the balance of the Contract price in accordance with the terms of the Contract to the Surety or to a qualified Contractor selected to perform the Contract. Failure of the Owner to comply with the notice requirement specified above shall not release the Surety from its obligations. Upon notice from the Owner as provided above, the Surety shall promptly and at Surety's expense take one of the following actions: 1. Arrange for the Contractor, with consent of the Owner, to perform and complete the Contract; 2. Undertake to perform and complete the Contract itself, through qualified agents or independent contractors; 3. Obtain bids or negotiated proposals from qualified contractors acceptable to the Owner to enter into a contract with the Owner for performance and completion of the Contract, to be secured with performance and payment bonds, and to pay to the Owner as damages any amount in excess of the original contract amount for the completion of the Contract; any additional legal, design professional, architect, or consultant fees resulting from any delay in the completion of the Contract; and any applicable liquidated damages specified within the Contract resulting from any delay in the completion of the Contract. 4. Make payment to the Owner, as soon as practicable after an amount is determined for completion of the Contract;or 5. Deny liability in whole or in part and notify the Owner, citing with specificity the reasons for such denial. If the Surety does not proceed with reasonable promptness, Owner may give notice to the Surety and the Surety shall be deemed in default on this Bond five (5) business days after notice by the Owner demanding the Surety perform its obligations under this Bond. Owner shall be entitled to enforce any remedy available to Owner upon default. Except for default of the Surety and Surety's election to perform or complete the Contract itself under Paragraph 2 above,Surety's liability shall be limited to the amount of this Bond. Notice to the Contractor or Surety shall be deemed to have been given: (i) upon delivery to an officer or person entitled to such notice, if hand delivered; or (ii) two (2) business days following deposit in the United States mail, postage prepaid; (iii) upon delivery by a commercial carrier that will certify the date and time of delivery; or (iv) upon transmission if by facsimile, email or other form of electronic transmission. Notices shall be provided to the Owner, Surety and/or Contractor at their address as specified on this Bond or to a facsimile, email or other electronic address that has been provided in writing to the other party to be used for this purpose. The laws of the State of Wisconsin shall govern the interpretation and construction of this Bond. Winnebago County shall be the venue for all disputes arising under this Bond. Any provision in this Bond that may conflict with statutory or other legal requirement shall be deemed deleted herefrom and provisions conforming to the statutory or other legal requirement shall be deemed incorporated herein. The above obligation is void if the Contractor performs and fulfills all the terms, conditions and agreements of the Contract and any authorized modifications during the term of the original Contract and any extensions thereof. Notice to the Surety is waived for any modifications agreed upon by Owner and Contractor. PTS Contractors,Inc. Liberty Mutual Insurance Company Name of Principal/Contractor Name of Surety Title Mark C. Schleis, President Title Roxanne Jensen,Attorney-in-Fact PAYMENT BOND CITY OF OSHKOSH Bond No. 354223071 Contract Number 19-05 Date Bond Executed (Date of Contract or Later) 3/4/2019 PRINCIPAL/CONTRACTOR(Legal Name and Business Address) Type of Organization PTS CONTRACTORS, INC. _Individual Partnership 4075 Eaton Road X Corporation Green Bay,WI 54311 State of Incorporation Wisconsin SURETY(IES)(Legal Name(s)and Business Address(es)) Penal Sum of Bond $7,258,523.29 LIBERTY MUTUAL INSURANCE COMPANY 175 Berkeley Street Boston,MA 02116 OWNER(Legal Name and Business Address) CITY OF OSHKOSH 215 Church Avenue PO Box 1130 Oshkosh, Wisconsin 54903-1130 OBLIGATION The Contractor and Surety,jointly and severally, bind themselves, their heirs,executors, administrators,successors and assigns to the Owner to pay for labor, materials and equipment furnished for use in the performance of the Contract identified above, which is incorporated herein by reference,subject to the following terms. If the Contractor promptly makes payment of all sums due to claimants, and defends, indemnifies and holds harmless the Owner from all claims, demands, liens or suits by any person or entity seeking payment for labor, materials or equipment furnished for use in the performance of the Contract, then the Surety and the Contractor shall have no obligation under this Bond. If there is no Owner Default to pay the Contractor as required under the Contract for work performed or to perform or complete any material term of the Contract, then the Surety(ies) obligation under this Bond shall arise after the Owner has promptly notified the Contractor and the Surety of claims, demands, liens or suits against the Owner or the Owner's property by any person or entity seeking payment for labor, materials or equipment furnished for use in the performance of the Contract and tendered defense of such claims, demands, liens or suits to the Contractor and the Surety. Amounts owed by the Owner to Contractor under the Contract shall be used for performance of the Contract and to satisfy claims, if any, under any Performance Bond. By the Contractor furnishing and the Owner accepting this Bond,they agree that all funds earned by the Contractor in the performance of the Contract are dedicated to satisfy obligations of the Contractor and Surety under this Bond, subject to the Owner's priority to use the funds for the completion of the work. Upon notice and tendering of claims as specified above, the Surety shall promptly and at Surety's expense defend, indemnify and hold harmless the Owner against such claim,demand,lien or suit. Surety shall answer claimants, with a copy to Owner, within sixty (60) days of the date of the claim, stating the amount that are disputed and the specific basis for challenging any amount that is disputed or pay or arrange for payment of any undisputed amount claimed. Surety shall not be obligated to the Owner, claimants or others for obligations of the Contractor under this Bond that are unrelated to the Contract. The Owner shall not be liable for the payment of any costs or expenses of any claimant under this Bond and shall have no obligation to make payments to, or give notice on behalf of claimants, or otherwise have any obligation to claimants under this Bond. Notice to the Contractor or Surety shall be deemed to have been given: (i) upon delivery to an officer or person entitled to such notice, if hand delivered; or (ii) two (2) business days following deposit in the United States mail, postage prepaid; (iii) upon delivery by a commercial carrier that will certify the date and time of delivery; or (iv) upon transmission if by facsimile, email or other form of electronic transmission. Notices shall be provided to the Owner, Surety and/or Contractor at their address as specified on this Bond or to a facsimile, email or other electronic address that has been provided in writing to the other party to be used for this purpose. The laws of the State of Wisconsin shall govern the interpretation and construction of this Bond. Winnebago County shall be the venue for all disputes arising under this Bond. Any provision in this Bond that may conflict with statutory or other legal requirement shall be deemed deleted herefrom and provisions conforming to the statutory or other legal requirement shall be deemed incorporated herein. PTS Contractors,Inc. Liberty Mutual Insurance Company Name of Principal/Contractor Name of Surety Ltt —1Qncce.4".At--e_ Title Mark C. Schleis, President Title Roxanne Jensen,Attorney-in-Fac • This Power of Attorney limits the acts of those named herein,and they have no authority to re. bind the Company except in the manner and to the extent herein stated. 1.+11QC Liberty Liberty Mutual Insurance Company r ' Mutual: The Ohio Casualty Insurance Company Certificate No:8196827-354019 West American Insurance Company SURETY POWER OF ATTORNEY KNOWN ALL PERSONS BY THESE PRESENTS:That The Ohio Casualty Insurance Company is a corporation duly organized under the laws of the State of New Hampshire,that Liberty Mutual Insurance Company is a corporation duly organized under the laws of the State of Massachusetts,and West American Insurance Company is a corporation duly organized under the laws of the State of Indiana(herein collectively called the'Companies"),pursuant to and by authority herein set forth,does hereby name,constitute and appoint Kelly Cody: Christopher Hoyden:Roxanne Jensen;Christopher H.Kondrick:Brian I. Krause:Trudy A.Szalewski all of the city of Green Bay state of WI each individually if there be more than one named,its true and lawful attorney-in-fact to make, execute,seal,acknowledge and deliver,for and on its behalf as surety and as its act and deed,any and all undertakings,bonds,recognizances and other surety obligations,in pursuance of these presents and shall be as binding upon the Companies as if they have been duly signed by the president and attested by the secretary of the Companies in their own proper persons. IN WITNESS WHEREOF,this Power of Attorney has been subscribed by an authorized officer or official of the Companies and the corporate seals of the Companies have been affixed thereto this 12th day of September , 2018 . Liberty Mutual Insurance Company V 1NSU ," l INs& a 1HSLJ The Ohio Casualty Insurance Company aa'.opPOs4,74.n �JP`000k,r'%syn (yroaPOR,r 4. West American Insurance Companyca s F 3 F rt10 a 1912 0 1919 1991 /� co rs : 4, o Q o < co (A Yd .4cHus -dD y� HAMPS�e a 'l\°IANP S B - . C �" David M.Carey,Assistant Secretary c >, -2 State of PENNSYLVANIA c = County of MONTGOMERY 88 co c o 0 On this 12th day of September , 2018 before me personally appeared David M.Carey,who acknowledged himself to be the Assistant Secretary of Liberty Mutual Insurance 0 o 2 Company,The Ohio Casualty Company,and West American Insurance Company,and that he,as such,being authorized so to do,execute the foregoing instrument for the purposes ca=r j a) > therein contained by signing on behalf of the corporations by himself as a duly authorized officer. LLI 5r's IN WITNESS WHEREOF,I have hereunto subscribed my name and affixed my notarial seal at King of Prussia,Pennsylvania,on the day and year first above written. c n �p Pn`� o Cn 0 N et;•'( 7) COMMONWEALTH OF PENNSYLVANIAy '�2�/f!' +-UpperMcnonTwpMontgoeryCouty By: eresa Pastella,Notary Public o ca Q� • l^if6 r,, rn � Member,Pennsylvania Association of Notaries CL p co . �W � This Power of Attorney is made and executed pursuant to and by authority of the following By-laws and Authorizations of The Ohio Casualty Insurance Company, Liberty Mutual�°' o•0 Insurance Company,and West American Insurance Company which resolutions are now in full force and effect reading as follows: o o E as ARTICLE IV—OFFICERS:Section 12.Power of Attorney. o m Any officer or other official of the Corporation authorized for that purpose in writing by the Chairman or the President, and subject to such limitation as the Chairman or the c.0 7 c> President may prescribe,shall appoint such attorneys-in-fact,as may be necessary to act in behalf of the Corporation to make,execute,seal,acknowledge and deliver as surety >p� Ws c any and all undertakings,bonds,recognizances and other surety obligations.Such attorneys-in-fact,subject to the limitations set forth in their respective powers of attorney,shall L N > 22 have full power to bind the Corporation by their signature and execution of any such instruments and to attach thereto the seal of the Corporation. When so executed, such '"oO Z instruments shall be as binding as if signed by the President and attested to by the Secretary.Any power or authority granted to any representative or attorney-in-fact under the co provisions of this article may be revoked at any time by the Board,the Chairman,the President or by the officer or officers granting such power or authority. c ARTICLE XIII—Execution of Contracts:Section 5.Surety Bonds and Undertakings. U Any officer of the Company authorized for that purpose in writing by the chairman or the president,and subject to such limitations as the chairman or the president may prescribe,I-- shall appoint such attorneys-in-fact,as may be necessary to act in behalf of the Company to make,execute,seal,acknowledge and deliver as surety any and all undertakings, bonds,recognizances and other surety obligations.Such attorneys-in-fact subject to the limitations set forth in their respective powers of attorney,shall have full power to bind the Company by their signature and execution of any such instruments and to attach thereto the seal of the Company.When so executed such instruments shall be as binding as if signed by the president and attested by the secretary. Certificate of Designation—The President of the Company,acting pursuant to the Bylaws of the Company,authorizes David M.Carey,Assistant Secretary to appoint such attorneys-in- fact as may be necessary to act on behalf of the Company to make,execute,seal,acknowledge and deliver as surety any and all undertakings,bonds,recognizances and other surety obligations. Authorization—By unanimous consent of the Company's Board of Directors,the Company consents that facsimile or mechanically reproduced signature of any assistant secretary of the Company,wherever appearing upon a certified copy of any power of attorney issued by the Company in connection with surety bonds,shall be valid and binding upon the Company with the same force and effect as though manually affixed. I,Renee C.Llewellyn,the undersigned,Assistant Secretary,The Ohio Casualty Insurance Company,Liberty Mutual Insurance Company,and West American Insurance Company do hereby certify that the original power of attorney of which the foregoing is a full,true and correct copy of the Power of Attorney executed by said Companies,is in full force and effect and has not been revoked. f�W�q IN TESTIMONY WHEREOF,I have hereunto set my hand and affixed the seals of said Companies this day o t10/ - P�VMS 44 JP01 1Ns, PN'%N S W?qj ...▪ =°oa i R� ir coo Rt r.0 it, ii z. Ran%n� • 1912 0 1919 f 1991 0 c,`+f - �cp-, o s o s B .,• �gsAcHu`�".La y0 hAt��da '�s ,"D1A"" as y•Renee C.Llewellyn,Assistant Secretary &?y * y,3- .% * 0 'tM * t`ev LMS-12873 LMIC OCIC WAIC Multi Co_062018 • PTSCO-1 OP ID: MH •ACORO CERTIFICATE OF LIABILITY INSURANCE DATE(MM/D D/YYYY) 02/28/2019 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 920-725-3232 NAME: Mallory Scott McGlone PHONE 920-725-3232 I FAX 920-725-3233 150 Main Street,Ste 300 (NC,No,Ext): (A/C,No): Menasha,WI 54952-0389 E-MAIL mallory.scott©mcclone.com Troy Carlson INSURER(S)AFFORDING COVERAGE NAIC 0 INSURER A:Sentry Insurance a Mutual Co 24988 INSURED PTS Contractors Inc INSURER B:Middlesex Insurance Co 23434 4075 Eaton Road Green Bay,WI 54311 INSURER C: 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 SUBR POLICY NUMBER POUCY EFF POUCY EXP LIMITS LTR INSO WVDIMM/DD/YYYYI IMM/DD/YYYYI B X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE X OCCUR A0083395005 07/10/2018 07/10/2019 DAMAGE TO RENTED 500,000 X PREMISES(Ea occurrence) $ _MED EXP(Any one person) $ 10,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 3,000,000 POLICY X JEI X LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: $ B AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 1,000,000 Ea accident) X ANY AUTO X A0083395001-2 07/10/2018 07/10/2019 BODILY INJURY(Per person) $ OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY(Per accident) $ X AUTOS ONLY X AUUTOS W ONLYY (Perr aPcEcidentDAMAGE B X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 15,000,000 EXCESS UAB CLAIMS-MADE X A0083395007 07/10/2018 07/10/2019 AGGREGATE $ 15,000,000 DED X RETENTION$ 0 $ A WORKERS COMPENSATION X PER OTH- AND EMPLOYERS'LIABILITY Y/N STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE N N/A A0083395006 07/10/2018 07/10/2019 E.L.EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes describe under 1,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS 1 LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space Is required) PAGE 1 OF 2: Re: City Contract 19-05-Paving,Sidewalk, Driveway, and Utilities/ Southside Local Street Concrete Paving Program CERTIFICATE HOLDER CANCELLATION OSHCITI SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. CITY OF OSHKOSH 215 CHURCH AVENUE OSHKOSH,WI 54903-1130 AUTHORIZED REPRESENTATIVE Troy Carlson ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD • NOTEPAD. HOLDER CODE OSHCITI PTSCO-1 PAGE 2 INSURED'S NAME PTS Contractors Inc OP ID: MH Date 02/28/2019 In regards to work performed by the insured, the City of Oshkosh, and it's officers council members, agents, employees and authorized volunteers are additional insureds under the Commercial General Liability, Automobile Liability and Umbrella per policy langua e. Coverage provided is primary and non-contributory if required by written contract. A 30 Day Notice of Cancellation applies. Builders Risk Policy Policy No. : A0125295001 Effective Dates: 3/1/19 - 3/1/20 Carrier: Middlesex Insurance Company Limit: $7,258,524 • SENTRY® INSURANCE POLICY NUMBER: A0083395005 • ADDITIONAL INSURED - SUPPLEMENTAL DECLARATIONS The following persons or organizations are included as Additional Insureds, but only to the extent provided in the listed endorsement: Any Additional Insured where required by written contract executed prior to a loss Endorsement CG 24 04 05 09,Waiver Of Transfer Of Rights Of Recovery Against Others To Us, applies to this additional insured. The person or organization indicated above is included as an additional insured under the following endorsement(s): CG 20 37 04 13 Additional Insured-Owners, Lessees Or Contractors- Completed Operations Location and Description of Completed Operations: All Jobsites- Work Performed by Named Insured CG 20 10 04 13 Additional Insured-Owners, Lessees Or Contractors - Scheduled Person Or Organization Location of Covered Operations: All Jobsites- Work Performed by Named Insured Job Description: All Jobsites-Work Performed by Named Insured CG 89 05 10 14 Page 1 of 1 A0083395 Sentry Insurance a Mutual Company 9 00000 0000000000 17192 0 N FEE29979-1071-47A8-MF6-713804FECB54 0027020044341304338254962038988 POLICY NUMBER: COMMERCIAL GENERAL LIABILITY CG20370413 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 PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Location And Description Of Completed Or Organization(s) Operations 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 B. With respect to the insurance afforded to these include as an additional insured the person(s) or additional insureds, the following is added to organization(s) shown in the Schedule, but only Section III - Limits Of Insurance: with respect to liability for "bodily injury" or If coverage provided to the additional insured is "property damage" caused,in whole or in part, by required by a contract or agreement, the most we "your work" at the location designated and will pay on behalf of the additional insured is the described in the Schedule of this endorsement amount of insurance: performed for that additional insured and included Required by the contract or agreement;or in the "products-completed operations hazard". 1. However: 2. Available under the applicable Limits of Insurance shown in the Declarations; 1. The insurance afforded to such additional whichever is less. insured only applies to the extent permitted by law;and This endorsement shall not increase the 2. If coverage provided to the additional insured applicable limits of Insurance shown in the is required by a contract or agreement, the Declarations. insurance afforded to such additional insured will not be broader than that which you are required by the contract, or agreement to provide for such additional insured. CO 20 37 04 13 OO Insurance Services Office, Inc.,2012 Page 1 of 1 A0083395 Sentry Insurance a Mutual Company 35 00000 0000000000 17192 0 N FEE29979-11:171-47A6-A0FD-773604F0C054 0027020044341304338254952038960 COMMERCIAL GENERAL LIABILITY CG70210413 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. SPECIAL BROAD FORM GENERAL LIABILITY ENDORSEMENT This endorsement modifies the insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART 1. Coverage D. Employee Benefits Liability 2. Exclusions A. The following is added to Section I - This insurance does not apply to: Coverages a. "Bodily injury" or mental injury to any 1. Insuring Agreement person, "property damage" or"personal a. We will pay those sums that the insured and advertising injury". becomes legally obligated to pay as b. Liability assumed by the insured under "damages" because of an "occurrence" any contract or agreement. to which this insurance applies.We will c. Any claim for: have the right and duty to defend the insured against any "suit" seeking (1) Failure of performance of a contract those °damages". However, we will by any insurer or other fiduciary • have no duty to defend the insured entrusted with monies intended to against any "suit" seeking "damages" fund "employee benefits"; to which this insurance does not apply. (2) Insufficiency of funds to meet any We may, at our discretion, investigate obligations under any "employee any "occurrence" and settle any claim benefits"; or"suit" that may result. But: (3) Inadequacy of performance of (1) The amount we will pay for investments, errors in providing "damages" is limited as described in information on past performance of paragraph B.of this coverage;and investment vehicles or advice given (2) Our right and duty to defend ends with respect to participation; when we have used up the applica- (4) Your failure to establish any "em- ble limit of insurance in the pay- ployee benefits" in compliance with ment of judgments or settlements the mandatory provisions of any law under Coverage D. governing workers' compensation, No other obligation or liability to pay unemployment insurance, social se- sums or perform acts or services is curity or disability benefits or any covered unless explicitly provided for similar state or federal law; under Supplementary Payments. (5) Advice given to any person to par- ticipate or not to participate in any b. This insurance applies only to "employee benefits"; "damages" caused by an "occurrence" during the policy period. The (6) Taxes, fines or penalties, including "occurrence" must take place in the those imposed under the Internal "coverage territory". Revenue Code or any similar state "employee", 11 or local law; C. "Damages" sustained by any one employee , including "damages" (7) "Damages" arising out of wrongful sustained by such "employee's" termination of employment, discrimi- dependents and beneficiaries, as a nation, or other employment-related result of a series of related errors or practices. omissions shall be considered one "occurrence". CG 70 21 04 13 Page 1 of 9 A0083395 Sentry Insurance a Mutual Company 53 00000 0000000000 17192 0 N FEE29979-1 D71-47A6-A9FD-7F30D4FBC1354 0027020044341304318254952038999 d. Liability based on: b. Your duties in the event of an (1) Medical malpractice of any occurrence,claim or"suit" physician or surgeon; apply regardless of the application of the (2) Dishonest, fraudulent, criminal or deductible amount. malicious acts or omissions 4. We may pay any part of all of the committed by any insured; deductible amount to effect settlement of (3) The Employee Retirement Income any claim or "suit" and, upon notification of Security Act of 1974 or any the action taken, you should promptly amendment thereof; or reimburse us for each part of the deductible amount as has been paid by us. (4) Circumstances of which you were aware, or should have been aware, D. Coverage D Definitions at the inception of this insurance. 1. For Coverage D, only, the following 3. The Supplementary Payments provisions definitions replace the corresponding are extended to Coverage D. definitions found in the Commercial General Liability Coverage Part: B. Limit Of Insurance a. "Employee" means a person actively For this additional coverage, Section employed or formerly employed by or III - Limits Of Insurance is amended as on leave of absence, disabled or retired follows: from the named insured. Employee 1. Paragraph 2. is replaced by the following: does not include a "leased worker" or a 2. The General Aggregate Limit is the "temporary worker". most we will pay for the sum of: b. "Occurrence" means an error or omission in the "administration" of a. Medical Expenses under Coverage "employee benefits'. C; c. "Suit" means a civil proceeding in which b. Damages under Coverage A., "damages" because of an "occurrence" except damages because of "bodily injury" or "property damage" to which Coverage D. applies are included in the "products- alleged_ "Suit" includes: completed operations hazard"; (1) An arbitration proceeding in which c. Damages under Coverage B;and such "damages" are claimed and to which the insured must submit or d. Damages under Coverage D. does submit with our consent;or 2. Subject to the General Aggregate Lirnit (2) Any other alternative dispute described in paragraph B.1. above, the resolution proceeding in which Each Employee Limit is the most we will damages are claimed and to which pay under Coverage D. for all "damages" the insured submits with our sustained by any one "employee", consent. including "damages" sustained by such 2. The following definitions are added for "employee's" dependents andCoverage D only: beneficiaries, because of any one "occurrence". a. "Administration" means: C. Deductible (1) Providing information to employees, 1. Our obligation under Coverage D. to pay including their dependents and "damages" on behalf of the insured applies beneficiaries, with respect to only to the amount of "damages" in excess eligibility for or scope of "employee of any Each Employee Deductible amount benefits"; shown in the Declarations. (2) Interpreting "employee benefits"; 2. The deductible amount applies to all (3) Handling of records in connection "damages" sustained by any one with the "employee benefits";or "employee", including such "employee's" dependents and beneficiaries, because of (4) anya p co ntinuing uparticipationr in any any one occurrence. benefit included in "employee 3. The terms of this insurance, including benefits" those with respect to: by you or a person or organization a. Our right and duty to defend the authorized by you to perform such acts. insured against "suits" seeking those However, "administration" does not "damages";and include handling payroll deductions. Page 2 of 9 CG 70 21 04 13 A0083395 Sentry Insurance a Mutual Company b. "Damage" means" b. Paragraph 1.d. is amended to pay for loss of (1) Those sums that the insured is earnings up to $750 a day because of time off legally obligated to pay as a result of from work. negligent errors or omissions to 3. Fellow Employee Bodily Injury which this insurance applies. For the Paragraph 2.a. of Section II -Who Is An Insured purpose of this coverage, "darn- is replaced by the following: ages" does not include punitive or 2. Each of the following is also an insured: exemplary damages, requests for restitution, requests for injunctive or a. Your "volunteer workers' only while declarative relief, including associ- performing duties related to the conduct of ated requests for costs or fees or your business, or your "employees", other any other costs, fees or penalties than either your "executive officers" (if you that are not insurable by law; or are an organization other than a partnership, joint venture or limited liability (2) Other costs, fees or penalties company) or your managers (if you are a required to be paid by order of limited liability company), but only for acts enforcement of any federal, state, or within the scope of their employment by local statutes to the extent they are you or while performing duties related to insurable by law. the conduct of your business. However, c. "Employee benefits" means: none of these "employees" or "volunteer workers" are insureds for: (1) insurance programs for: (1) "Personal and advertising injury": (a) Group Life; (a) To you,to your partners or members (b) Group accident and health; (if you are a partnership or joint (c) Dental,vision and hearing plans; venture), to your members (if you (d) Flexible spending accounts; are limited liability company), to a co-"employee" while in the course (e) Workers'compensation; of his or her employment or (f) Unemployment; and performing duties related to the (g) Social security and disability conduct of your business or to your benefits. other "volunteer workers" while performing duties related to the (2) Group Plans for: conduct of your business; (a) Profit Sharing; (b) To the spouse, child, parent, brother (b) Pensions; or sister of that co-"employee" or "volunteer worker" as a (c) Employee stock subscription; consequence of paragraph (1)(a) (d) Employee savings plans;and above or (e) Employee stock ownership (c) For which there is any obligation to plans; share damages with or repay (3) Vacation plans, including buy and someone else who must pay sell programs; leave of absence damages because of the injury programs, including military, described in paragraphs (1)(a) or (b) maternity, family, and civil leave; above. tuition assistance plans; (2) "Bodily injury or "personal and transportation and health club advertising injury" arising out of his or subsidies; and her providing or failing to provide (4) Other similar employee benefits, professional health care services. identified by separate endorsement But this does not apply to "bodily The aboveplans must beprovided byinjury" arising out of nurses, emergency medical technicians or paramedics pro- you and are applicable to you and your viding or failing to provide professional employees. health care services. 2. Broadened Supplementary Payments (3) "Property damage"to property: Under Section I - Coverages, Supplementary (a) Owned,occupied or used by; Payments -Coverages A And B: a. Paragraph 1.b. is amended topay up to (b) Rented to, in the care, custody or 9 P control of, or over which physical $3,000 for cost of bail bonds;and control is being exercised for any purpose by; CG70210413 • Page 3of9 A0083395 Sentry Insurance a Mutual Company 55 00000 0000000000 17192 0 N 1EE29979-1D71-47A6-ABFD-7F36174FBCB54 0027020044341304330254952030989 I you, any of your "employees", (3) Any of the other insurance, whether "volunteer workers", any partner or primary, excess, contingent or on member(if you are a partnership or joint any other basis: venture), or any member (if you are a (a) If the insured's liability to pay limited liability company). damages is determined in a 4. World Wide Coverage Territory "suit" brought outside the United a. Under Section V- Definitions,paragraph 4. is States of America (including its replaced by the following: territories and possessions), 4. "Coverage territory" means anywhere in Puerto Rico or Canada;or the world. (b) That is coverage required by law, b. The following is added to Section IV - regulation or other governmental authority in a part of the Conditions: "coverage territory" that is Expanded Coverage Territory outside of the United States of (1) If a "suit" to which this insurance applies is America (including its territories brought outside the United States of and possessions), Puerto Rico or America (including its territories and Canada. possessions), Puerto Rico or Canada, we 5. Engine Rebuilding And Overhaul Operations will have the right but not the duty to defend the insured against such "suit". If this insurance applies to "property damage" included within the "products-completed In any such case in which we elect not to operations hazard", the following exception is defend, the insured will at our option and added to exclusion I. under Paragraph 2., under our supervision: Exclusions of Section I - Coverage A - Bodily (a) Make or cause to be made such Injury And Property Damage Liability: investigation and defense as are reasonably necessary;and This exclusion does not apply if "property To the extentpossible, effect such damage" arises from "engine rebuilding or (b) overhaul operations" conducted by you or on settlement or settlements as we shall your behalf. deem proper. We will reimburse the insured, under "Engine rebuilding or overhaul operations" means Payments, for the repair of internal combustion engines or Supplementary reasnable cost of such investigation and component parts of such engines owned by others if the repair involves the complete defense and, within the limits of liability,for the amounts of such authorized disassembly and reassembly of the engine or component part of the engine. settlement. This insurance does not apply to "property (2) All payments or reimbursements we make damage" to engines or component parts of for damages because of judgments or engines which are used in, or while in practice or settlements will be made in U_S. currency preparation for, any prearranged racing, speed, at the prevailing exchange rate at the time the insured became legally obligated to demolition or stunting activity. pay such sums. All payments or 6. Incidental Medial Malpractice reimbursements we make for expenses a. Under Section V - Definitions, the definition under Supplementary Payments will be of "bodily injury" is amended to include injury made in U.S, currency at the prevailing arising out of the rendering or failure to render exchange rate at the time the expenses medical services to persons by any physician, were incurred. dentist, nurse, emergency medical technician (3) Any disputes between you and us as to or paramedic who is employed by you to whether there is coverage under this policy provide such services. must be filed in the courts of the United b.This insurance does not apply: States of America (including its territories (1) If you are engaged in the business or and possessions), Puerto Rico or Canada. occupation of providing medical services; c. The following is added to Paragraph 4.b. or under the Conditions section: (2) To liability assumed in a contract or 4. Other Insurance agreement. b. Excess Insurance This insurance is excess over: Page 4 of 9 CG 70 21 04 13 A0083395 Sentry Insurance a Mutual Company • 7. Damage To Premises Rented To You We waive the right of recovery we may have a. The final paragraph under Paragraph 2., because of payments we make for "bodily injury" Exclusions of Section I - Coverage under Section I - Coverage C - Medical A - Bodily Injury And Property Damage Payments. Liability is replaced by the following: 11. Aircraft Chartered With A Crew Exclusions c., d., e. and g. through n. do not The following is added to Exclusion g. under apply to damage to premises while rented to Paragraph 2. Exclusions of Section I - you or temporarily occupied by you with Coverage A - Bodily Injury And Property permission of the owner. A separate limit of Damage Liability: insurance applies to this coverage as This exclusion does not apply to an aircraft, not described in Section III - Limits Of - owned by any insured, charted with a crew by or Insurance. on behalf of the insured. This insurance does not apply to "property This insurance is excess over any other valid and damage" (other than damage by fire) to collectible aircraft insurance available to the premises rented to you for a period of 7 or insured, whether such insurance is primary, fewer consecutive days. excess,contingent or on any other basis. b. Except for damage arising out of fire, 12. Extended Property Damage explosion or water discharge, our obligation Exclusion a. under Paragraph 2., Exclusions of under this coverage to pay for premises"property damage" on your behalf applies Section l - Coverage A - Bodily Injury And only to the amount of damages in excess of Property Damage Liability is replaced by the a $5,000 per claim deductible. The following: deductible applies to all damages sustained a. "Bodily injury" or "property damage" expected by any one person or organization because or intended from the standpoint of the of premises "property damage". insured. This exclusion does not apply to The terms of this insurance, including those "bodily injury' or "property damage" resulting with respect to: from the use of reasonable force to protect persons or property. (1) Our right and duty to defend the insured against any "suit" seeking damages to 13. Hostile Fire -Pollution Clean Up which this insurance applies; and The following is added to Paragraph (2) of (2) Your duties in the event of an exclusion f. under Paragraph 2., Exclusions of "occurrence", claim or"suit" Section I - Coverage A - Bodily Injury And Property Damage Liability: Apply irrespective of the application of the (2)(a) do not apply to deductible amount. Subparagraphs andb( ) pp y loss, cost or expense arising out of heat, smoke We may pay any part of or all of the or fumes from a "hostile fire" covered under deductible amount to effect settlement of paragraph f.(1). above.A separate aggregate limit any claim or "suit" and, upon notification of of $25,000 is the most we will pay under this the action taken, you shall promptly coverage for losses during the policy period. reimburse us for such part of the deductible amount as has been paid by us. The above provision does not apply if a Total Pollution Exclusion endorsement is part of this 8. Extended Medical Payments Coverage Part. Section I - Coverage C - Medical Payments is 14. Newly Acquired Organizations extended to apply to medical expenses incurred and reported to us within three years of the date Paragraph 3.a. of Section II - Who Is An Insured of the accident. Is amended,substituting 180th day for 90th day. 9. Extended Non-Owned Watercraft 15. Broad Knowledge Of Occurrence, Claim Or Suit Paragraph (2)(a) of exclusion g. under Paragraph 2., Exclusions of Section I - Coverage A - Under Section IV - Commercial General Bodily Injury And Property Damage Liability is Liability Conditions, Condition 2. Duties In The amended,substituting 51 feet for 26 feet. Event Of Occurrence, Offense,Claim Or Suit is amended by the addition of the following: 10. Medical Payments - Waiver Of Transfer Of Rights Of Recovery Under Section IV - Commercial General Liability Conditions, Condition 8. Transfer Of Rights Of Recovery Against Others To Us is amended by the addition of the following: CG 70 21 0413 Paae 5 of 9 A0083395 Sentry Insurance a Mutual Company 57 00000 0000000000 17192 0 N FEE29979-1071-47A6-ABFD-7F30D4FecE54 0027020044341304338254952038989 Knowledge of an "occurrence", offense, claim or 19.Additional Insureds "suit" by an agent or "employee" of any insured a. The following is added to Section II - Who Is or receipt of any demand, notice, summons or An Insured. other legal paper in connection with a claim or "suit" by any agent or "employee" of any insured The following are included as Additional shall not in itself constitute knowledge of the Insureds when you have agreed to add the named insured or receipt of the named insured, person or organization as an Additional unless a partner, member, manager, "executive Insured on your policy in a written contract, officer" or director shall have such knowledge or written agreement or because of a permit shall have received such demand, notice, issued by a state or political subdivision; summons or legal paper. provided the injury or damage occurs 16. Sold Premises Property Damage subsequent to the execution of the contract or agreement or issuance of the permit: Exclusion j.(2) under Paragraph 2., Exclusions of (1) Any Person or Organization you are Section I - Coverage A - Bodily Injury And Performing Work For Property Damage Liability does not apply. 17. Unintentional Failure To Disclose Hazards Any person(s) or organization(s) not an insured under paragraphs 2. through 6. Under Section IV - Commercial General below,but only with respect to liability for Liability Conditions, the following is added to "bodily injury", "property damage" or Condition 6. Representations: "personal and advertising injury" caused, If in your representations to us you in whole or in part, by your acts or unintentionally failed to disclose all hazards and omissions or the acts or omissions of exposures subject to this insurance, we shall not those acting on your behalf; in the deny all coverage under this policy because of performance of your ongoing operations such oversight. for the Additional Insured. 18. Stop Gap Liability A person's or organization's status as an Additional Insured under this The following exception is added to exclusion e. endorsement ends when your operations under Paragraph 2., Exclusions of Section I - for that Additional Insured are completed. Coverage A - Bodily Injury And Property Damage Liability; (2) Lessor of Leased Equipment This exclusion does not apply to "bodily injury" to Any person(s) or organization(s), but only an employee of the insured arising out of the with respect to liability for "bodily injury", course of: "property damage" or "personal and a. Employment the insured;or advertising injury" caused, in whole or in bypart, by your maintenance, operations or b. Performing duties related to the conduct of use of equipment leased to you by such the insured's business provided such person(s) or organization(s). employee is reported and declared under the With respect to the insurance afforded to Workers Compensation Fund of the states of these Additional Insureds, this insurance North Dakota, Ohio,Washington or Wyoming, does not apply to any "occurrence' whichever is applicable as respects such which takes place after the equipment injured employee. lease expires. As used herein, employee includes a "leased (3) Lessor of Leased Land worker" or "temporary worker". Any person(s) or organization(s), but only The insurance provided by this coverage with respect to liability arising out of the extension does not apply to: ownership, maintenance or use of that a. Punitive or exemplary damage because of part of the land leased to you by that "bodily injury" to an employee employed in person(s) or organization(s), subject to violation of law; the following additional exclusions: b. "Bodily injury" to an employee while This insurance does not apply to: employed in violation of law with your actual (a) Any "occurrence" which takes place knowledge or the knowledge of any of your after you cease to lease the land; "executive officers";or (b) Structural alterations, new c. Damages arising out of the discharge of, construction or demolition operations coercion of, or discrimination against any performed by or on behalf of the employee in violation of law. person(s) or organization(s) that are Additional Insureds under this provision. Page 6 of 9 CG 70 21 04 13 A0083395 Sentry Insurance a Mutual Company - (4) Managers or Lessors of Premises This exclusion applies even if the claims Any person(s) or organization(s); but only against any insured allege negligence or with respect to liability arising out of the other wrongdoing in the supervision, ownership, maintenance or use of that part hiring, employment, training or of the premises leased to you by that monitoring of others by that insured if person(s) or organization(s); subject to the the "occurrence" which caused the following additional exclusions: "bodily injury" or "property damage" or the offense which causes the personal This insurance does not apply to: and advertising injury" involved the (a) Any "occurrence" which takes place rendering of or the failure to render any after you cease to be a tenant in that professional architectural, engineering premises. or surveying services. (b) Structural alterations, new construction (b) Bodily injury" or "property damage" or demolition operations performed by occurring after: or on behalf of the person(s) or (i) All work, including materials, parts or organizations) that are Additional equipment furnished in connection Insureds under this provision. with such work, on the project(other (5) Owners, Lessees or Contractors than service, maintenance or Any person(s) or organization(s), but only repairs) to be performed by or on with respect to liability for "bodily injury", behalf of the Additional Insured(s) at the location of the covered "property damage" or "personal and advertising injury" caused, in whole or in operations has been completed;or part, by: (ii) That portion of "your work" out of which the injury or damage arises (a) Your acts or omissions;or has been put to its intended use by (b) The acts of omissions of those acting any person or organization other on your behalf; than another contractor or In the performance of your ongoing subcontractor engaged in the operations for the Additional Insured(s). performing operations for a principal With respect to the insurance afforded to as a part of the same project these Additional Insureds, the following (6) State or Political Subdivisions - Permits additional exclusions apply: Or Authorizations Related To Premises This insurance does not apply to: Any state or governmental agency or subdivision or political subdivision; but only (a) "Bodily injury", "property damage" or with respect to the following hazards for "personal and advertising injury" arising which the state or governmental agency or out of the rendering of, or the failure to subdivision has issued a permit or render any professional, architectural, authorization in connection with premises engineering or surveying services, you own, rent or control and to which this including: insurance applies: (i) The preparing, approving, or failing (a)The existence, maintenance, repair, to prepare or approve, maps, shop construction, erection or removal of drawings, opinions, reports, advertising signs, awnings, canopies, surveys, field orders, change orders cellar entrances, coal holes, driveways, or drawings and specifications;or manholes, marquees, hoist away (ii) Supervisory, inspection, openings, sidewalk vaults, street architectural or engineering banners or decorations and similar activities. exposures; or (b)The construction, erection or removal of elevators;or • (c) The ownership, maintenance or use of any elevators covered by this insurance. However; (1) The insurance afforded to such Additional Insureds only applies to the extent permitted by law;and CG 70 21 04 13 Page 7 of 9 A0083395 Sentry Insurance a Mutual Company 59 00000 000000000D 17192 0 N FEE29979-1071-47A6-ABFD-7F3604F9C1354 0027020044341304336254952038989 (2) The insurance afforded to such (I) This insurance is primary if you have Additional Insured will not be broader agreed in a written contract or written than that which you are required by the agreement that this insurance be contract or agreement to provide for primary. If other insurance is also such Additional Insureds. primary, we will share with that other A person or organization is an Additional insurance by the method described in Insured under this provision only for the Method of Sharing section below. period of time required by the contract or (ii) If you have agreed in a written contract, agreement. written agreement or permit that this However, no such person or organization is insurance is primary and an insured under this Additional Insured non-contributory with the Additional coverage if included as an insured by an Insured's own insurance, this insurance endorsement issued by us and made a part is primary and we will not seek of this coverage part. contribution from that other insurance_ b. The following is added to Section III - Limits Paragraphs (i) and (ii) do not apply to other of Insurance insurance to which the Additional Insured has been specifically named as an If you have agreed in a written contract or Additional Insured under a separate written agreement that another person or endorsement. organization be added as an Additional Insured on your policy, the most we will pay 20. Mental Anguish on behalf of that Additional Insured is the The definition of "bodily injury" under Section lessor of: V- Definitions is replaced by the following: 1. The Limits of Insurance specified in the "Bodily injury" means bodily injury, sickness or written contract or written agreement;or disease sustained by a person, including "mental 2. Available under the applicable Limits of anguish" or death resulting from any of these at Insurance shown in the Declarations. any lime. This amount shall be a part of and not in The following definition is added to Section addition to Limits of Insurance shown in the V-Definitions: Declarations and described in Section III. "Mental anguish"means extreme pain or distress c. The following is added to Section inflicted upon an individual's emotional and IV - Commercial General Liability intellectual condition with regard to the Conditions: individual's response to the environment. If we cover a claim or "suit" under this 21. Non-Employment Related Discrimination Coverage Part that may also be covered by The following is added to the definition of other insurance available to an Additional "personal and advertising injury" under Section Insured, such Additional Insured must V-Definitions: submit such claim or "suit" to the other Discrimination against or harassment of a person insurer for defense and indemnity. if: However,this provision does not apply to the a. Coverage for such discrimination or extent that you have agreed in a written harassment is permitted by law;and contract or written agreement that this insurance is primary and non-contributory b. The discrimination or harassment is not with the Additional Insured's own insurance. committed by or at the direction of: d. The following is added to Section (1) You; IV - Commercial General Liability (2) If you are an individual,your spouse; Conditions 4.b.(1)of Excess Insurance: (3) If you are a partnership, a partner or his • (c) Any other insurance available to an or her spouse; Additional Insured covered by this policy. (4) If you are a joint venture, a member of However, the following provisions apply the joint venture or his or her spouse; to other insurance available to any (5) If you are a limited liability company, any person or organization who is an of your members or managers;or Additional Insured under this coverage part. (6) If you are an organization other than a partnership, joint venture, or limited liability company, any of your "executive officers",directors or stockholders. Page 8 of 9 CG 70 21 04 13 A0083395 Sentry Insurance a Mutual Company This insurance does not apply to "personal and advertising injury" arising out of any insured's failure to comply with any responsibilities or duties required by the Americans With Disabilities Act, any amendments or additions or any similar state or local law. All other terms and provisions of this policy remain unchanged. • • • CG 70 21 0413 Page 9 of 9 A0083395 Sentry Insurance a Mutual Company 61 00000 0000000000 17102 0 N FEE29979-1071-47A0-A8F1)-7F30D4FBC1354 00270200443413043382349520369139 • • SENTRY. INSURANCE POLICY NUMBER: A0083395001 ADDITIONAL INTEREST SUPPLEMENTAL DECLARATIONS The following additional interests apply to this policy. Any Additional Insured where required by written contract executed prior to a loss 4075 Eaton Rd • Green Bay,WI 54311-9340 Endorsement CA 04 44 10 13,Waiver Of Transfer Of Rights Of Recovery Against Others To Us (Waiver Of Subrogation), applies to this additional insured. CA 76 01 06 15 Designated Insured - Primary and Noncontributory.- Covered Autos Liability Coverage CA 89 0410 14 Page 1 A0083395 Sentry Insurance a Mutual Company 37 00000 0000000000 17192 0 N E07BA4F7-10AF-4e87-A0FE-DF4A6233461F 00270200440410043086549520099BB � -- SENTRY. INSURANCE POLICY NUMBER: A0083395005 ADDITIONAL INSURED - SUPPLEMENTAL DECLARATIONS The following persons or organizations are included as Additional Insureds, but only to the extent provided in the listed endorsement: Any Additional Insured where required by written contract executed prior to a loss Endorsement CG 24 04 05 09,Waiver Of Transfer Of Rights Of Recovery Against Others To Us, applies to this additional insured. The person or organization indicated above is included as an additional insured under the following endorsement(s): CG 20 37 04 13 Additional Insured-Owners, Lessees Or Contractors - Completed Operations Location and Description of Completed Operations: All Jobsites-Work Performed by Named Insured CG 20 10 04 13 Additional Insured- Owners, Lessees Or Contractors- Scheduled Person Or Organization Location of Covered Operations: All Jobsites-Work Performed by Named Insured Job Description: All Jobsites -Work Performed by Named Insured CG 89 05 10 14 Page 1 of 1 A0083395 Sentry Insurance a Mutual Company 9 00000 0000000000 17192 0 N FEE29079-1 D71-47A8-A6F 0-7F3604F13C854 0027020044341304338254952039909 1 POLICY NUMBER: COMMERCIAL GENERAL LIABILITY CG 20 10 0413 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 Organization(s) Location(s)Of Covered Operations 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 B. With respect to the insurance afforded to these include as an additional insured the person(s) or additional insureds, the following additional organization(s) shown in the Schedule, but only exclusions apply: with respect to liability for "bodily injury", This insurance does not apply to 'bodily injury" or "property damage" or "personal and advertising "property damage" occurring after: injury" caused,in whole or in part, by: 1. All work, including materials, parts or 1. Your acts or omissions; or equipment furnished in connection with such 2. The acts or omissions of those acting on your work, on the project (other than service, behalf; maintenance or repairs) to be performed by or in the performance of your ongoing operations for on behalf of the additional insured(s) at the the additional insured(s) at the location(s) location of the covered operations has been designated above. completed;or However: 2. That- portion of "your work" out of which the injury or damage arises has been put to its 1. The insurance afforded to such additional intended use by any person or organization insured only applies to the extent permitted by other than another contractor or law; and subcontractor engaged in performing 2. If coverage provided to the additional insured operations for a principal as a part of the same is required by a contract or agreement, the project. insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured. CG 2010 04 13 © Insurance Services Office, Inc.,2012 Page 1 of 2 A0083395 Sentry Insurance a Mutual Company 33 00000 0000000000 17192 0 N FEE29979-1071-47A0-A8F0-7F3004FBC854 0027020044341304338254952038989 C. With respect to the insurance afforded to these 2. Available under the applicable Limits of additional insureds, the following is added to Insurance shown in the Declarations; Section III - Limits Of insurance: whichever is less. If coverage provided to the additional insured is This endorsement shall not increase the required by a contract or agreement,the most we applicable Limits of Insurance shown in the will pay on behalf of the additional insured is the Declarations. amount of insurance: 1. Required by the contract or agreement;or Page 2 of 2 © Insurance Services Office, Inc.,2012 CG 20 10 0413 AOO83395 Sentry Insurance a Mutual Company POLICY NUMBER: COMMERCIAL AUTO CA76010615 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. DESIGNATED INSURED - PRIMARY AND NONCONTRIBUTORY - COVERED AUTOS LIABILITY COVERAGE This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM MOTOR CARRIER COVERAGE FORM AUTO DEALERS COVERAGE FORM • With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by this endorsement. This endorsement identifies person(s)or organization(s) who are "Insureds" for Covered Autos Liability Coverage under the Who Is An Insured provision of the Coverage Form. This endorsement changes the policy effective on the inception date of the policy unless another date is indicated. Named Insured: Endorsement Effective Date: SCHEDULE Name Of Person(s) Or Organization(s): Information required to complete this Schedule,if not shown above, will be shown in the Declarations. • A. Each person or organization shown in the B. Primary And Noncontributory Insurance Schedule is an "insured" for Covered Autos This insurance is primary to and will not seek Liability Coverage, but only to the extent that contribution from any other auto insurance issued person or organization qualifies as an Insured" to the person or organization in the schedule under the Who Is An Insured provision contained under your policy provided that: in: (1) The person or organization is a Named Insured (1) Paragraph A.1. of Section II - Covered Autos under such other insurance;and Liability Coverage in the Business Auto and Motor Carrier Coverage Forms;or (2) Prior to the "accident" you have agreed in writing in a contract or agreement that this (2) Paragraph D.2. of Section I - Covered Autos insurance would be primary and would not Coverages of the Auto Dealers Coverage seek contribution from any other insurance Form. available to the person or organization. • CA 76 01 06 15 Includes copyrighted material of Insurance Services Office, Inc., Page 1 of 1 A0083395 with its permission. Sentry Insurance a Mutual Company 75 00000 0000000000 17192 0 N E070A4F7-10AF-41387-A0FE-OF4Pp233451F 0027020044341304338954952039999 � .- SENTRY. INSURANCE POLICY NUMBER: A0083395001 ADDITIONAL INTEREST SUPPLEMENTAL DECLARATIONS The following additional interests apply to this policy: Any Additional Insured where required by written contract executed prior to a loss 4075 Eaton Rd Green Bay,WI 54311-9340 Endorsement CA 04 44 10 13,Waiver Of Transfer Of Rights Of Recovery Against Others To Us (Waiver Of Subrogation), applies to this additional insured. CA 76 01 06 15 Designated Insured - Primary and Noncontributory - Covered Autos Liability Coverage • CA 89 04 10 14 Page 1 A0083395 Sentry Insurance a Mutual Company 31 00000 0000000000 17192 0 N E678A4F7-10AF-4887-A0FE-DF4A6233451F 002/020044341304338654952038999 POLICY NUMBER:A0083395007 COMMERCIAL EXCESS/UMBRELLA EU 70 91 05 15 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. AMENDMENT OF OTHER INSURANCE CONDITION This endorsement modifies the coverage provided under the following: COMMERCIAL EXCESS /UMBRELLA COVERAGE PART With respect to the coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by the endorsement. SCHEDULE Name Of Person Or Organization: Any Additional Insured as required by written contract or written agreement executed prior to loss (If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement.) The following is added to Paragraph H. Other (4) Affords indemnification and/or defense of Insurance of Section IV- Conditions: the designated person or organization to 1. This insurance is primary to and will not seek the extent permitted by law. contribution from any other insurance available 2. This condition does not apply to: to the person or organization shown in the a. Other insurance, not included in Paragraph 1. Schedule above, provided that such designated above, that may be available to the person or organization: designated person or organization outside of a. Is identified as an additional insured in the your written contract or agreement; or "underlying insurance"; b. Liability which: b. Is a Named Insured under such other (1) May attach to the designated person or insurance;and organization and is not assumed by your c. Has agreed with you in a written contract or written contract or agreement;or agreement that: (2) Is assumed by the designated person or (1) Is signed and effective prior to an organization under any other written "occurrence" to which this insurance contract assuming the obligations of applies; another. (2) This insurance would be primary and would not seek contribution from such other insurance identified in Paragraphs 1.a. and 1.b. above; (3) Agrees to indemnify or defend the designated person or organization for liability and damages covered by the "underlying insurance";and EU 70 91 05 15 Includes copyrighted material of Insurance Services Office, Inc., Page 1 of 1 A0083395 with its permission. Middlesex Insurance Company 11 00007 0000001389 18190 0 N 510791A4-E157-40A5-9637-G5D0070A5496 0027020044348816895954952038989