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HomeMy WebLinkAboutDorner Inc 19-04 13,4co$ CONSTRUCTION CONTRACT THIS AGREEMENT, made on the 27th day of March, 2019, by and between the CITY OF OSHKOSH, party of the first part, hereinafter referred to as CITY, and Dorner, Inc.,E506 Luxemburg Road, Luxemburg,WI 54217, 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. 19-04 for Hazel Street (Washington Avenue to East Irving Avenue) Reconstruction in the City of Oshkosh,for the Public Works Department, pursuant to Resolution 19-164 adopted by the Common Council of the City of Oshkosh on the 26th day of March, 2019, all in accordance and in strict compliance with the CONTRACTOR's Proposal and the other Contract Documents referred to in ARTICLE V of this Contract. ARTICLE 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 CONTRACTOR for the performance of the Contract the sum of Three million five hundred thirty-nine thousand seven hundred ninety-three dollars and 35/100 ($3,539,793.35), adjusted by any changes as provided in the Specifications, or any changes hereafter mutually agreed upon in writing by the parties hereto, provided, 1 however, in the event the Proposal and Contract Documents are on a "Unit Price" basis, the above mentioned figure is an estimated figure, and the CITY shall, in such cases, pay to the CONTRACTOR for the performance of the Contract the amounts determined for the total number of each of the units of work as set forth in the CON I RACTOR'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 CONTRACT 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: 2 1. This Instrument 2. The City's Plans and Specifications, including all Addenda's 3. City of Oshkosh Standard Specifications 4. Instructions to Bidders 5. Advertisement for Bids 6. Contractor's Proposal The Contract Documents are complementary;what is required by one is as binding as if required by all. Before undertaking each part of the work, the CONTRACTOR shall carefully study and compare the Contract Documents and check and verify all pertinent figures and measurements required therein. CONTRACTOR shall promptly report in writing to the Engineer any conflict, error, ambiguity or discrepancy which CONTRACTOR may discover and shall obtain written clarification from the Engineer before proceeding with any work affected thereby. 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 Presence of: CONTRACTOR Dorner, Inc. LA--- % \42D601no' By: atsj GX:XikatTakirialAiii Prestd - (Seal of Contractor (Specify Title) if a Corporation.) By: (Specify Title) 3 CITY OF OSHKOSH By: Mark A. Rohloff, City Manager (Witness) And: (Witness) Pamela R. Ubrig, City Jerk APPROVED: I hereby certify that the necessary provisions have been made to pay the liability which will accrue under this contract Lynn A orenson, i Attorney AO( kf)(V \CK-* Trena Larson, City Comptroller 4 Bond No. 9305583 PERFORMANCE BOND CITY OF OSHKOSH Contract Number 19-04 Date Bond Executed(Date of Contract or Later) 3/27/2019 PRINCIPAL/CONTRACTOR(Legal Name and Business Address) Type of Organization Dorner,Inc. E506 Luxemburg Road Individual ---Partnership Luxemburg,WI 54217 _X Corpondian State of Incorporation Wisconsin SURE Y(115)(Legal Names)and Business Address(es)) Penal Sum of Bond Fidelity And Deposit Company Of Maryland $3,539,793.35 1299 Zurich Way,5th Floor Schaumburg,IL 60196 OWNER(Legal Name and Business Address) • C1TY OP 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. • I 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. Dorner, Inc. ama it4 ,v Fidelity And Deposit Company Of Maryland Name of Principal/Contractor . Name of Surety p'eSid,e„-3/4' Title Title Connie Smith,Attorney-in-Fact • • • Bond No,9305583 PAYMENT BOND • CTIY OF OSHKOSH Contract Number 19-04 Data Bond Executed(Date of Contract or Later) 3/27/2019 • PRINCIPAL/CONTRALtOK(Legal Name and Business Address) TlYpe of Organization Darner,Inc. • Individual „Partnership E506 Luxemburg Road Corporation Luxemburg,WI 54217 State of Incorporation Wisconsin SURBTY(IBS)(Legal Name(s)and Business Addresa(es)) Penal Sum of Bond Fidelity And Deposit Company Of Maryland $3,539,793.35 1299 Zurich Way,5th floor Schaumburg,IL 60196 • • OWNER(Legal Name and Business Address) CITY OP OSHKOSH 215 Church Avenue . PO Box 1130 Oshkosh,Wisconsin 54903-1130 • OBLIGATION The Contractor and Surety,jointly and severally,bind themselves,their heirs,execAtors,administrators,successors and assigns to the Owner to pay for labor,materials and equipment furnished for use in the performance of the Contract identified above,which is Incorporated herein by reference,subject to the following terms. If the Contractor promptly makes payment of all sums due to daimants, and defends, indemnifies and holds harmless the Owner from ail claims,demands,liens or suits by any person or entity seeking payment for labor, materials or equipment furnished for use in the performance of the Contract,then the Surety and the Contractor. shall have no obligation under this Bond. If there 1s no Owner Default to pay the Contractor as required under the Contract for work performed or to perform or complete any material term of the Contract,then the Surety(ies)obligation under this Bond shall arise after the Owner her promptly notified the Contractor and the Surety of claims,demands,Hens or suit$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. Dorner, Inc. G � �T'titc,c�i Fidelity And Deposit Company Of Maryland Name of Principal/Contractor Name of Surety PfeS6c rsi" lhe-P 649X4-1-" " Title Title Connie Smith, Attorney-in-Fact ZURICH AMERICAN INSURANCE COMPANY COLONIAL AMERICAN CASUALTY AND SURETY COMPANY FIDELITY AND DEPOSIT COMPANY OF MARYLAND POWER OF ATTORNEY KNOW ALL MEN BY THESE PRESENTS:That the ZURICH AMERICAN INSURANCE COMPANY,a corporation of the State of New York,the COLONIAL AMERICAN CASUALTY AND SURETY COMPANY,a corporation of the State of Maryland,and the FIDELITY AND DEPOSIT COMPANY OF MARYLAND a corporation of the State of Maryland (herein collectively called the "Companies"), by MICHAEL BOND,Vice President,in pursuance of authority granted by Article V, Section 8, of the By-Laws of said Companies, which are set forth on the reverse side hereof and are hereby certified to be in full force and effect on the date hereof, do hereby nominate, constitute,and appoint Michael J.DOUGLAS,Chris STEINAGEL,Christopher M. KEMP,Robert DOWNEY,Kory MORTEL and Connie SMITH,all of Hudson,Wisconsin, EACH its true and lawful agent and Attorney-in-Fact,to make,execute,seal and deliver,for, and on its behalf as surety,and as its act and deed:any and all bonds and undertakings,and the execution of such bonds or undertakings in pursuance of these presents,shall be as binding upon said Companies,as fully and amply,to all intents and purposes,as if they had been duly executed and acknowledged by the regularly elected officers of the ZURICH AMERICAN INSURANCE COMPANY at its office in New York,New York.,the regularly elected officers of the COLONIAL AMERICAN CASUALTY AND SURETY COMPANY at its office in Owings Mills,Maryland.,and the regularly elected officers of the FIDELITY AND DEPOSIT COMPANY OF MARYLAND at its office in Owings Mills, Maryland.,in their own proper persons. The said Vice President does hereby certify that the extract set forth on the reverse side hereof is a true copy of Article V,Section 8,of the By-Laws of said Companies,and is now in force. IN WITNESS WHEREOF, the said Vice-President has hereunto subscribed his/her names and affixed the Corporate Seals of the said ZURICH AMERICAN INSURANCE COMPANY, COLONIAL AMERICAN CASUALTY AND SURETY COMPANY, and FIDELITY AND DEPOSIT COMPANY OF MARYLAND,this 28th day of June,A.D.2018. ATTEST: ZURICH AMERICAN INSURANCE COMPANY COLONIAL AMERICAN CASUALTY AND SURETY COMPANY FIDELITY AND DEPOSIT COMPANY OF MARYLAND DEPo'1.4 Sim `c.!•-•......... I. . 1flG9 41 � 4UJ /2J DY _ Assistant Secretary Vice President Joshua Lecker Michael Bond State of Maryland County of Baltimore On this 28th day of June,A.D.2018,before the subscriber, a Notary Public of the State of Maryland,duly commissioned and qualified,MICHAEL BOND, Vice President, and JOSHUA LECKER, Assistant Secretary, of the Companies, to me personally known to be the individuals and officers described in and who executed the preceding instrument, and acknowledged the execution of same, and being by me duly sworn,deposeth and saith,that he/she is the said officer of the Company aforesaid,and that the seals affixed to the preceding instrument are the Corporate Seals of said Companies,and that the said Corporate Seals and the signature as such officer were duly affixed and subscribed to the said instrument by the authority and direction of the said Corporations. IN TESTIMONY WHEREOF,I have hereunto set my hand and affixed my Official Seal the day and year first above written. u',. 11`4 'la i Constance A.Dunn,Notary Public My Commission Expires:July 9,2019 POA-F 184-0011A / ® DATE(MMlDDIYYYY) A��D CERTIFICATE OF LIABILITY INSURANCE 4/4/2019 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 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: Bri Hauge,CISR Ansay&Associates, LLC. PHONE F800 236-8652 (A/C,No):920�37 4179 1710 Lawrence Drive (A/C. X No,EMI: De Pere WI 54115 ADDRESS: bri.hauge@ansay.com INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:Sentry Insurance a Mutual Company 24988 INSURED DORNINC-01 INSURER B:Middlesex Insurance Company 23434 Dorner Inc& Dorner Stahl Trucking LLC INSURER C: PO Box 129 INSURER D: Luxemburg WI 54217 INSURERE: INSURER F: COVERAGES CERTIFICATE NUMBER: 1603248513 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. IPOLICY EFF POLICY EXP NSR ADDLTYPE OF INSURANCE INSO WVDSUB POLICY NUMBER (MMIDDIIYYYY) (MM/DO!!YYYY) LIMITS LTR INSD WVD B X COMMERCIAL GENERAL LIABILITY Y A0103044004 6/1/2018 6/1/2019 EACH OCCURRENCE $1,000,000 DAMAGE TO RENTED CLAIMS-MADE X OCCUR PREMISES(Ea occurrence) $500,000 MED EXP(Any one person) $10,000 PERSONAL 8 ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $3,000,000 POLICY X JECT _ LOC PRODUCTS-COMP/OP AGG $2,000,000 OTHER: $ B AUTOMOBILE LIABILITY Y A010304-4001 6/1/2018 6/1/2019 COMBINED SINGLE LIMIT $ B A0106391001 6/1/2018 6/1/2019 (Ea accident) 1,000,000 X ANY AUTO BODILY INJURY(Per person) $ — ALL OWNED SCHEDULED BODILY INJURY(Per accident)_$ AUTOS _ AUTOS NON-OWNED PROPERTY DAMAGE $ X HIRED AUTOS X AUTOS (Per accident) $ B X UMBRELLA LIAB X OCCUR Y A0103044001 6/1/2018 6/1/2019 EACH OCCURRENCE $10,000,000 EXCESS LIAB CLAIMS-MADE AGGREGATE $10,000,000 DED X RETENTION$0 , _ $ A WORKERS COMPENSATION A0103044005 6/1/2018 6/1/2019 X AND EMPLOYERS'LIABILITY Y/N STATUTE OTH- ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $100,000 OFFICER/MEMBER EXCLUDED? N N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $100,000 If yes,describe under DESCRIPTION OF OPERATIONS below E-L.DISEASE-POLICY LIMIT $500,000 • B Motor Truck Cargo A0103044003 6/1/2018 6/1/2019 Limit 750,000 Deductible: 5,000 Builders Risk/Installation Float Limit 6,000,000 Deductible: 2,500 Leased/Rented Equipment _---- - -� -' — --- Limit 400,000 --- --- - - Deductible: 2,500 DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) RE: Public Works Contract#19-04 City of Oshkosh,and its officers,council members,agents,employees and authorized volunteers are included as additional insured's on a primary and noncontributory basis for general liability per form CG2010 07/04&CG2037 07/04,auto liability and umbrella liability when required by written contract.City of Oshkosh is included as additional insured on above listed builders risk coverage in regards to project Public Works Contract#19-04. Endorsed policies will include a 30 day notice of cancellation/nonrenewal for any reason other than nonpayment of premium provided to certificate holder. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Oshkosh ACCORDANCE WITH THE POLICY PROVISIONS. Attn: City Clerk PO Box 1130 AUTHORIZED REPRESENTATIVE Oshkosh WI 54903-1130 .�'� ��'�s2•��y.+rs�+tr i ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD AC�® DATE(MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 4/5/2019 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 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 Ansay&Associates, LLC. PHONE Bri Hauge,CISR FAX 1710 Lawrence Drive (A/C,No,Ext►. 800-236-8652 (A/c,No):920-437-4179 De Pere WI 54115 ADDRESS: bri.hauge@ansay.com INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:Sentry Insurance a Mutual Company 24988 INSURED DORNINC-01 INSURER B:Middlesex Insurance Company 23434 Dorner Inc& Dorner Stahl Trucking LLC INSURER C: PO Box 129 INSURER D: Luxemburg WI 54217 INSURERE: INSURER F: COVERAGES CERTIFICATE NUMBER: 1773363207 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 EFF POLICY EXP W LIMITS LTR INSD VD POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY) B X COMMERCIAL GENERAL LIABILITY Y A0103044004 6/1/2018 6/1/2019 EACH OCCURRENCE $1,000,000 DAMAGE TO RENTED CLAIMS-MADE X OCCUR PREMISES(Ea occurrence) $500,000 MED EXP(Any one person) $10,000 PERSONAL 8 ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $3,000,000 POLICY X JECT LOC PRODUCTS-COMP/OP AGG $2,000,000 OTHER: $ B AUTOMOBILE LIABILITY Y A0103044001 6/1/2018 6/1/2019 COMBINED SINGLE LIMIT $ B A0106391001 6/1/2018 6/1/2019 (Ea accident) 1,000,000 X ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS X X NON-OWNED PROPERTY DAMAGE HIRED AUTOS _ AUTOS (Per accident) $ B X UMBRELLA LIAB X OCCUR Y A0103044001 6/1/2018 6/1/2019 EACH OCCURRENCE $10,000,000 EXCESS LIAB CLAIMS-MADE AGGREGATE $10,000,000 DED X RETENTIONS 0 $ A WORKERS COMPENSATION A0103044005 6/1/2018 6/1/2019 X PER OTH- AND EMPLOYERS'LIABILITY Y I N STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $100,000 OFFICER/MEMBER EXCLUDED? N N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $100,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $500,000 B Motor Truck Cargo A0103044003 6/1/2018 6/1/2019 Limit: 750,000 Deductible: 5,000 Builders Risk/Installation Float Limit: 6,000,000 Deductible: 2,500 Leased/Rented Equipment Limit: 400,000 Deductible: 2,500 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) RE: Public Works Contract#19-04 City of Oshkosh,and its officers,council members,agents,employees and authorized volunteers are included as additional insured's on a primary and noncontributory basis for general liability per form CG2010 07/04&CG2037 07/04,auto liability and umbrella liability when required by written contract.City of Oshkosh is included as additional insured on above listed builders risk coverage in regards to project Public Works Contract#19-04. Endorsed policies will include a 30 day notice of cancellation/nonrenewal for any reason other than nonpayment of premium provided to certificate holder. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Oshkosh ACCORDANCE WITH THE POLICY PROVISIONS. Attn: City Clerk PO Box 1130 AUTHORIZED REPRESENTATIVE Oshkosh WI 54903-1130 '��f�-' _ I_ ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD POLICY NUMBER: A0103044001 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: Dorner Inc Endorsement Effective Date: 06/01/2018 SCHEDULE Name Of Person(s) Or Organization(s): Any Additional Insured As Required By Written Contract or Written Agreement Executed Prior To Loss 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 (2) Paragraph D.2. of Section I - Covered Autos writing in a contract or agreement that this Coverages of the Auto Dealers Coverage insurance would be primary and would not 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 A0103044 with its permission. 06/08/2018 Middlesex Insurance Company 1 00001 0000000000 18159 0 N 39753a41-c097-4108-ab5c-d821db1ab186 0027020044345463909454217001212 POLICY NUMBER: A0103044004 COMMERCIAL GENERAL LIABILITY CG 20 10 07 04 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - SCHEDULED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s): Location(s) Of Covered Operations City of Oshkosh RE: Public Works contract#19-04 Attn:City Clerk PO Box 1130 Oshkosh,WI 54903-1130 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", pp y "property damage" or "personal and advertising This insurance does not apply to "bodily injury" or injury" caused, in whole or in part, by: "property damage" occurring after: 1. Your acts or omissions; or 1. All work, including materials, parts or 2. The acts or omissions of those acting on your equipment furnished in connection with such 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 2. That portion of "your work" out of which the injury or damage arises has been put to its intended use by any person or organization other than another contractor or subcontractor engaged in performing operations for a principal as a part of the same project. CG 20 10 07 04 © ISO Properties, Inc., 2004 Page 1 of 1 SPECIMEN COPY POLICY NUMBER: A0103044004 COMMERCIAL GENERAL LIABILITY CG 20 37 07 04 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - COMPLETED OPERATIONS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name of Additional Insured Person(s) Or Organization(s): Location And Description Of Completed Operations City of Oshkosh RE: Public Works Contract#19-04 Attn: City Clerk PO Box 1130 Oshkosh,WI 54903-1130 Information required to complete this Schedule, if not shown above, will be shown in the Declarations. Section II - Who Is An Insured is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for "bodily injury" or "property damage" caused, in whole or in part, by "your work" at the location designated and described in the schedule of this endorsement performed for that additional insured and included in the "products-completed operations hazard". CG 20 37 07 04 ©ISO Properties, Inc., 2004 Page 1 of 1 SPECIMEN COPY