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Irrevocable License — 799 Locust StreetCopyrighted May 6, 2024 City of Dubuque Consent Items # 015. City Council Meeting ITEM TITLE: Irrevocable License — 799 Locust Street SUMMARY: City Manager recommending City Council approve the irrevocable license for Cottingham & Butler at 799 Locust Street to encroach in the public right of way as described in the irrevocable license. SUGGESTED Suggested Disposition: Receive and File; Approve DISPOSITION: ATTACHMENTS: Description Type MVM Memo City Manager Memo Staff Memo Staff Memo Irrevocable License CBDC Supporting Documentation THE C DUj!BQTE Masterpiece on the Mississippi TO: The Honorable Mayor and City Council Members FROM: Michael C. Van Milligen, City Manager SUBJECT: Irrevocable License — 799 Locust Street DATE: May 1, 2024 Dubuque WAWca 914 ii 2007-2012.2013 2017*2019 City Engineer Gus Psihoyos is recommending City Council approve the irrevocable license for Cottingham & Butler at 799 Locust Street to encroach in the public right of way as described in the irrevocable license. The property at the southwest quadrant of 8tn and Locust is being redeveloped for a new Cottingham and Butler daycare facility. This is the former site of the KC Hall building and the existing building was recently demolished. The proposed day care facility includes a covered drop off and parking area on 8t" Street and a playground and outdoor space along Locust Street at the south end of the site. Cottingham and Butler have coordinated the redevelopment of this site and the entire block between Locust, Bluff, 7t" and 8t" Street with the Dubuque Museum of Art. The proposed building foundation and roof systems will encroach into the right of way of Locust Street, 8t" Street, and the adjacent 20' wide alley. Through this Irrevocable License process the encroachment is now recognized by the owners who assume all terms and conditions as defined in the license. All documents have been received from Cottingham & Butler including an exhibit, irrevocable license, insurance, license fee. The Engineering Department, Planning Services and Building Services have reviewed and approved the request for the continued operation of this encroachment. I concur with the recommendation and respectfully request Mayor and City Council approval. AAA44 k�4 Mic ael C. Van Milligen MCVM:sv Attachment cc: Crenna Brumwell, City Attorney Cori Burbach, Assistant City Manager Gus Psihoyos, City Engineer Nate Kieffer, PLS/PE THE CITYF DUijB- El Masterpiece on the Mississippi TO: Michael C. Van Milligen, City Manager FROM: Gus Psihoyos, City Engineer DATE: April 29, 2024 SUBJECT: Irrevocable License — 799 Locust Street Dubuque AII•Anedea M 1IIII®r 2007-2012.2013 2017*2019 INTRODUCTION This is in response to a request from Cottingham & Butler to encroach on City property. The encroachments will include concrete footings and portions of the building's roof. BACKGROUND An irrevocable or revocable license is required when property owners request to encroach upon the public right of way. Examples of encroachments upon the public right of way can include planters, benches, fences, steps, awnings, windows, buildings, earthen embankments, ADA ramps, loading docks, private utilities, bollards, and sprinkler systems. DISCUSSION The property at the southwest quadrant of 8t" and Locust is being redeveloped for a new Cottingham and Butler daycare facility. This is the former site of the KC Hall building and the existing building was recently demolished. The proposed day care facility includes a covered drop off and parking area on 8t" Street and a playground and outdoor space along Locust Street at the south end of the site. Cottingham and Butler have coordinated the redevelopment of this site and the entire block between Locust, Bluff, 7t" and 8t" Street with the Dubuque Museum of Art. The proposed building foundation and roof systems will encroach into the right of way of Locust Street, 8t" Street, and the adjacent 20' wide alley. Through this Irrevocable License process the encroachment is now recognized by the owners who assume all terms and conditions as defined in the license. All documents have been received from Cottingham & Butler including an exhibit, irrevocable license, insurance, license fee. The Engineering Department, Planning Services and Building Services have reviewed and approved the request for the continued operation of this encroachment. RECOMMENDATION It is recommended that the request for an irrevocable license for Cottingham & Butler at 799 Locust Street to encroach in the public right of way as described in the irrevocable license be approved. BUDGETIMPACT The application fee of $650 has been received and will be receipted as part of the public license revenue. ACTION TO BE TAKEN It is recommended that the attached irrevocable license for Cottingham & Butler of 799 Locust Street be approved and recorded with the Dubuque County Recorder's Office. Prepared by Kerry Bradley, Eng. Dept. cc: Nate Kieffer, PLS/PE F:\JANE SMITH\ROW\ROWENCR\LICENSE REQUEST\2024/799 Locust Street Page 1 of 2 Benjamin H. Beard, AIA Straka Johnson Architects 3555 Digital Drive Dubuque, Iowa 52003 April 29, 2024 Mike Van Milligen City Manager Second Floor of City Hall 50 W 13TH Street Dubuque, Iowa 52001 Straka Johnson A rc h itect5, P.C. Letter of Application: Irrevocable Encroachment of Public Right -of -Way Dear Mr. Van Milligen: Cottingham & Butler is applying for an Irrevocable License to allow portions of Cottingham & Butler Childcare Building at 799 Locust Street to encroach on city property. This application is for portions of concrete footing approximately 4'-0" below City ROW at sidewalks and City Alley and portions of building roof approximately 12'-0" to 26'-0" above City ROW sidewalks. Cottingham & Butler has received written consent from all utilities in vicinity of project, stating no concerns from relevant utilities, including Alliant Energy, Black Hills, ImOn, CenturyLink/Lumen, Comelec, & Mediacom. Several parties have stated an interest in being on site during implementation of improvements and Conlon is coordinating accordingly. The attached Exhibit and Criteria are provided to help clarify intended encroachments in accordance with request by Engineering Department: 1.) Exhibit a. Survey grade exhibit by Buesing & Associates 2.) Criteria a. Encroachment at Footing: i. 8t" Street ROW 1. Encroachment required to maximize pervious surfacing and green space requirements at playground reviewed and approved by City of Dubuque Zoning Advisory Commission. 2. Encroachment required to provide Parking Canopy to maximize safety and weather protection for building users. "10 RE5IPENTIAL COMMERCIAL • IN5TITUTIONAL' s 10502 Ot. Joseph PrIve Dubuque, Iowa 52003 L Phone (503) 556-5577 Fax (563)556-0367 Straka Johnson Page 2 of 2 A rC h itecte, r7. C. ii. Locust Street ROW 1. Encroachment required to accommodate building foundation system. Specialty foundation system provided by Owner to minimize encroachment. iii. City Alley 1. Encroachment required to accommodate building foundation system. Specialty foundation system provided by Owner to minimize encroachment. b. Encroachment at Roof: i. 8th Street ROW 1. Encroachment required to provide Parking Canopy to maximize safety and weather protection for building users. ii. Locust Street ROW 1. Encroachment required to enhance weather protection, solar heat gain, and shade for building users. iii. City Alley 1. Encroachment required to enhance weather protection, solar heat gain, and shade for building users. If we can provide further clarification or information for your consideration, please don't hesitate to reach out. Thank you for your consideration of this important matter. Sincerely, wl-lld�,� 4-?�, Benjamin H. Beard, AIA RE5IDENTIAL • COMMERCIAL • IN5TITUTIONAL 10502 Ot. Joseph DrIve Dubuque, Iowa 52003 Phone (503) 556-5577 Fax (563)556-0367 EXHIBIT FOR IRREVOCABLE LICENSE: FOOTING FOUNDATION RIGHT OF WAY ENCROACHEMENTS ALONG W 8TH ST & LOCUST ST. ON CITY LOT 625, 626, & 627 AND LOT 1 OF DUBUQUE ART PLAZA IN THE CITY OF DUBUQUE, IOWA � 16\ \ 70.67' / / \ 45.50' 10.00' �/ \ -- 0.92' FOOTING \ 3.00' /� 25.75' ENCROACHMENT 0.20' FOOTING 0.08' / R/ / ENCROACHMENT 0 \ G 62123.66'TO p �� INTERSECTION OF\N� \ BUILDING FOOTING G�-�� \ ENCROACHMENT �0 0.92' FOOTING ENCROACHMENT \ \ 20 ALLEY \ 67.53' \ Vo N�35' FOOTING EN ROACHMENT L ROW 11.41' TO INTERSECTION OF \ENCROACHM FLIT \ BUII STC - 'BUILDING FOUNDATION S / BUILDING FOOTING vo 626 LEGEND SURVEYED BOUNDARY LINE PROPERTY LINE BUILDING STRUCTURE OVERHANG PROPOSED BUILDING FOOTING CENTERLINE PROPOSED BUILDING FOUNDATION RIGHT OF WAY LINE SCALE: 1" = 20' \ 101.64' EXHIBIT FOR IRREVOCABLE LICENSE: OVERHEAD RIGHT OF WAY ENCROACHEVENTS ALONG W 8TH ST & LOCUST ST. ON CITY LOT 625, 626, & 627 AND LOT 1 OF DUBUQUE ART PLAZA IN THE CITY OF DUBUQUE, IOWA 72.21' 1-1 moo` 32.00' 2.08' OVERHANG ENCROACHMENT TO INTERSECTION BUILDING OVERHANG 1.31' OVERHANG �� \ ENCROACHMENT 37.23' 0.25' \ BUILDING FOOTING G�•� \ NI -P\ \1.25' OVERHANG \ENCROACHMENT 31.51' 2.45' OVERHANG U.� \ ENCROACHMENT W ALLEY �\\ 108.50' \ BUILDING FOUNDATION 80.00' OVERHANG ENCROACHMENT TO INTERSECTION ROW LEGEND SURVEYED BOUNDARY LINE PROPERTY LINE BUILDING STRUCTURE OVERHANG PROPOSED BUILDING FOOTING CENTERLINE PROPOSED BUILDING FOUNDATION RIGHT OF WAY LINE SCALE: 1" = 20' Doc ID: 011219350024 Type: GEN Kind: MISCELLANEOUS Recorded: 05/08/2024 at 02:46:07 PM Fee Amt: $122.00 Page 1 of 24 Dubuque County Iowa Karol Kennedy Recorder File2024-00003954 Prepared by: Gus Psihoyos, City Engineer, City of Dubuque, 50 W. 13'" Street, Dubuque, IA 52001 (563 589-4270) Return to: Gus Psihoyos, City Engineer, City of Dubuque, 50 W. 13"' Street, Dubuque, IA 52001 (563 589-4270) IRREVOCABLE LICENSE AUTHORIZING Cottingham & Butler TO CONSTRUC _ Building foundation & roof _ ON PUBLIC RIGHT-OF-WAY Section 1. _ Cottingham & Butler as the owner of the premises, (Licensee), known as Cottingham & Butler Childcare Project in Dubuq je, Iowa, and legally described as . City Lot 625, City Lot 626, City Lot 627, and Lot 1 of Dubuque Art Plaza _ be and is hereby granted an irrevocable License and authority to construct and maintain Buildine foundation & roof (Encroachment) (see attachment for location) under the terms and conditions set forth in this License. Section 2. The permission herein granted is expressly conditioned on Licensee's agreement to: a) Assume any and all liability for damages to persons or property which may result from the existence, location, installation, construction or maintenance of said Encroachment; b) Procure and maintain in force during the term of this License a policy of liability insurance as set forth in the attached Insurance Schedule; c) Pay on behalf of the City of Dubuque, all sums which the City of Dubuque shall become obligated to pay by reason of the liability imposed upon the City of Dubuque for damages of any kind resulting from the location, installation, existence, construction or maintenance of said Encroachment sustained by any person or persons, caused by accident or otherwise to defend at its own expense and on behalf of said City any claim against the City of Dubuque arising out of the location, installation, existence, construction or maintenance of Encroachment and to pay reasonable attorney fees therefor; and 00 >� I ?.Z d) Indemnify, defend and hold the City of Dubuque free and harmless from any and all claims, including but not limited to damages, loss, liability and expense for death and/or injuries to third persons or damages to property of third persons, or for damage to any property of the City of Dubuque which may occur as a result of or in connection with the location, installation, existence, construction, maintenance and repair of Encroachment. e) Any special conditions as set forth for this License as identified: NA Section 3. The Encroachment shall be maintained in accordance with all applicable state and federal laws and regulations, and the Ordinances of the City of Dubuque. Section 4. Licensee covenants and agrees that the Irrevocable License herein granted does not constitute an approval of the design, erection, location, construction, repair or maintenance of said Encroachment and Licensee hereby covenants and agrees not to assert such claim or defense against the City of Dubuque in the event of claim asserted for death, personal injuries and/or property damage against Licensee arising out of or in any way connected with the location, installation, construction, design, repair and maintenance of the Encroachment. Section 5. This Irrevocable License shall become effective and the rights hereunder accrue to Licensee when this License has been approved by the City Council and the terms and conditions thereof accepted by Licensee by acceptance endorsed on this License. This Irrevocable License is not assignable or transferable to another location. This license is for this property only. Section 6. The City Clerk is authorized and directed to file at Licensee's expense a copy of this License in the Office of the Recorder in and for Dubuque County, Iowa. Section 7. Iowa One -Call registration may be required by the Code of Iowa. When applicable Licensee shall submit documentation to the City Engineer of Iowa One - Call registration membership. Signed this day of 20a. M. Cavanagh, Mayor Attest: Adrienne N. Breitfelder, City Clerk State of Iowa ) ) ss: County of Dubuque ) On this g day of OA ab-�4 , before me, the undersigned, a Notary Public in and for the State ot Iowa, personally appeared Brad M. Cavanagh and Adrienne N. Breitfelder, to me personally known, who, being by me duly sworn, did say that they are the Mayor and City Clerk, respectively, of the City of Dubuque, Iowa, a municipal corporation, that the seal affixed to the foregoing instrument, is the corporate seal of the corporation, and that the instrument was signed and sealed on behalf of the corporation, by authority of its City Council on the -- 6— day of o� _ aQay , and Brad M. Cavanagh and Adrienne N. Breitfelder acknowledged the execution of the instrument to be their voluntary act and deed. ►' `y TUSDEE LYNN dW8 Notary Public in and for said State C"Mb" N�b�r MY Cm. EV. ACCEPTANCE OF TERMS AND CONDITIONS OF LICENSE The undersigned, being duly authorized to execute this Acceptance on behalf of Cottineham & Butler , an J having read and being familiar with the terms and conditions of the Irrevocable License, for itself and, its successors, accepts the same and agrees to be bound by the terms and conditions herein contained. LICENSE . k 0"�4- Signature By: Andrew Butler Title: Executive Chairman Dated: April 22, 2024 Signature requires notary ALL PURPOSE ACKNOWLEDGMENT STATE OF IOWA ) COUNTY OF DUBUQUE ) On this _ 22nd _day of _April _, 2C 24, bE;fore me, the undersigned, a Notary Public in and for said State, personally appeared _Andrew Butler (NAME/S) to me personally known, OR proved to me on the basis of satistactory evidence to be the person(s) whose name(s) is/are subscribed to the within instrument and acknowledged to me that he/she/they executed the same in his/her/their authorized capacity(ies), and that by his/her/their signature(s) on the instrument the person(s) acted, executed the instrument. (Notary Seal) O4'^IAt @� NA GIE LONG : Commission Number 839231 My Commission Expires 'T— Notary PuW in and for Statteof Iowa CAPACITY CLAIMED BY SIGNER INDIVIDUAL _ (x CORPORATE OFFICER(S) _ Executive Chairman (CORP SEAL) AFFIXED NO SEAL PROCURED PARTNER(S) LIMITED ATTORNEY -IN -FACT TRUSTEE(S) GUARDIAN/CONSERVATOR OTHER SIGNER IS REPRESENTING: Name of Person(s) or Entity(ies): Andrew Butler Cottingham & Butler GENERAL (Title) (sign in ink) (print/type name) Page 1 of 2 Benjamin H. Beard, AIA Straka Johnson Architects 3555 Digital Drive Dubuque, Iowa 52003 April 29, 2024 Mike Van Milligen City Manager Second Floor of City Hall 50 W 131" Street Dubuque, Iowa 52001 Straka Johnroon Architectro, P.C. Letter of Application: Irrevocable Encroachment of Public Right -of -Way Dear Mr. Van Milligen: Cottingham & Butler is applying for an Irrevocable License to allow portions of Cottingham & Butler Childcare Building at 799 Locust Street to encroach on city property. This application is for portions of concrete footing approximately 4'-0" below City ROW at sidewalks and City Alley and portions of building roof approximately 12'-0" to 26'-0" above City ROW sidewalks. Cottingham & Butler has received written consent from all utilities in vicinity of project, stating no concerns from relevant utilities, including Alliant Energy, Black Hills, ImOn, CenturyLink/Lumen, Comelec, & Mediacom. Several parties have stated an interest in being on site during implementation of improvements and Conlon is coordinating accordingly. The attached Exhibit and Criteria are provided to help clarify intended encroachments in accordance with request by Engineering Department: 1.) Exhibit a. Survey grade exhibit by Buesing & Associates 2.) Criteria a. Encroachment at Footing: i. 8th Street ROW 1. Encroachment required to maximize pervious surfacing and green space requirements at playground reviewed and approved by City of Dubuque Zoning Advisory Commission. 2. Encroachment required to provide Parking Canopy to maximize safety and weather protection for building users. RE5IDENTIAL 9 COMMERCIAL • INSTITUTIONAL 10502 5t. Joeeph Drive Dubuque, Iowa 52003 Phone (563) 556-8877 Fax (563)556-0367 Straka Johnson Page 2 of 2 Architects, P.C. ii. Locust Street ROW 1. Encroachment required to accommodate building foundation system. Specialty foundation system provided by Owner to minimize encroachment. iii. City Alley 1. Encroachment required to accommodate building foundation system. Specialty foundation system provided by Owner to minimize encroachment. b. Encroachment at Roof: i. 8th Street ROW 1. Encroachment required to provide Parking Canopy to maximize safety and weather protection for building users. ii. Locust Street ROW 1. Encroachment required to enhance weather protection, solar heat gain, and shade for building users. iii. City Alley 1. Encroachment required to enhance weather protection, solar heat gain, and shade for building users. If we can provide further clarification or information for your consideration, please don't hesitate to reach out. Thank you for your consideration of this important matter. Sincerely, Benjamin H. Beard, AIA RE5IDENTIAL a COMMERCIAL • IN5TITUTIONAL 10502 5t. Joseph Drive Dubuque. Iowa 52003 Phone (503) 556-8877 Fax (563)556-0367 EXHIBIT FOR IRREVOCABLE LICENSE: FOOTING FOUNDATION RIGHT OF WAY ENCROACHEMENTS ALONG W 8TH ST & LOCUST ST. ON CITY LOT 625, 626. & 627 AND LOT 1 OF DUBUQUE ART PLAZA IN THE CITY OF DUBUQUE, IOWA 70.6-r \ \ 45.50' �10.00' \ �� 0.92' FOOTING 3.00' ENCROACHMENT \ 25.75' / 0.20' FOOTING 0.08' / ENCROACHMENT L 62� 0 Q \ BUILDING FOOTING N vo \ 0.92' FOOTING G €NCROACHMENT \ 20'ALLEY ' 67.53' \.! BUILDING FOUNDATION BUILDING FOOTING ENVRING OACOHTMENT s 10� 626 \\ 11.41•TO- G\ ,INTERSECTION OF \ 0 �\1�G 23.66' TO p\TA INTERSECTION OF -p, N ENCROACHMENT O\:A 101.64' \ �\ FUTURE / \ BUILDING STOOP \ cl\�'==�j \ \\\ �p'C�\P\J'" S LEGEND I SURVEYED BOUNDARY LINE PROPERTY LINE ------------------- BUILDING STRUCTURE OVERHANG ---------------- PROPOSED BUILDING FOOTING ■ CENTERLINE } RQW0' 1020' PROPOSED BUILDING FOUNDATION _ —— — RIGHT OF WAY LINE ' SCALE. 7' 20' EXHIBIT FOR IRREVOCABLE LICENSE: OVERHEAD RIGHT OF WAY ENCROACHEMENTS ALONG W 8TH ST & LOCUST ST. ON CITY LOT 625, 626, do 627 AND LOT 1 OF DUBUQUE ART PLAZA IN THE CITY OF DUBUQUE, IOWA 0.25' 1-1 32.00' 2.08'OVERHANG ENCROACHMENT / / TO INTERSECTION / \ / BUILDING OVERHANG 1.31' OVERHANG ENCROACHMENT BUILDING FOOTING x` vo 621 1.25 OVERHANG G 31.81' l 2 4CV OVERHANG \ T ENCROACHMENT \ 20' ALLEY A - ' .00' OVERHANGENCROACHMENTTO INTERSECTION \ \ FUTURE \ BUILDING \ STOOP \ i \\ 1 LEGEND SURVEYED BOUNDARY LINE PROPERTY LINE ------------------- BUILDING STRUCTURE OVERHANG ---------------- PROPOSED BUILDING FOOTING, - CENTERLINE ll} PROPOSED BUILDING FOUNDATION ROW — — — RIGHT OF WAY LINE — 1 FOUNDATION ILDING FOOTING GO vo 626 6 Uc4 / L R6 P E vo'a 0' 10' 20' SCALE.' 1' _ 20' 0.40'OVERHANG ENCROACHEMNT 40' 30.30' v ACORt�� CERTIFICATE OF LIABILITY INSURANCE DATE (MMID°NYYY) 4/22t2024 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(les) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WANED, 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 endorsements . PRODUCER Cottingham & Butler 800 Main St. tAffil M PHONE 563 587-5000 FAX c No: 563-583 7339 Dubuque IA 52001 INSURER(S) AFFORDING COVERAGE NAIC f INSURER A: Travelers Property Casualty Company of America 25674 INSURED Cottingham &Butler, Inc.; Cottingham &Butler Insurance COTBur1 Services, Inc.; Self Insured Services Co.; Self Funded Services INSURER B : The Travelers IndemnityCompany of Connecticut 25682 INsuRt=Rc: The Phoenix Insurance Com an 25623 INSURERD: Company; C&B Claim Services, Inc; dba Healthcheck 360 P. O. Box 28 INSURER E: INSURER F COVERAGES CERTIFICATE NtIMRFR! IRAAAA"R9 RFVICInN MI IMRFR- 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 LTRPOLICY I TYPE OF INSURANCE NUMBER POLICY EFF M D POLICY EXP M D LIMITS C X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE fill OCCUR Y-630-9J745999-PHX-23 10/1/2023 10/1/2024 EACH OCCURRENCE $1.000,000 DAMAGE TO RENTE PREMISES ocmwrimal $1,000,000 MED EXP (Any one ) $5.000 PERSONAL &ADV INJURY t 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY ❑ PRO JECT � LOC GENERAL AGGREGATE $2 000,000 PRODUCTS - COMP/OP AGG $ 2 000 000 $ OTHER A AUTOMOBILE LIABILITY 810-eN3894BA-23-14-G 10/1/2023 10/1/2024 Ea eoNED SINGLE LIM $ 1,D00,000 ANY AUTO BODILY INJURY (Per person) $ OWNED SCHEDULED AUTOS ONLY AUTOS IX BODILY INJURY Per accident) ( ) $ HIRED X NON -OWNED AUTOS ONLY AUTOS ONLY PROPERTY DAMAGE r S $ A X UMBRELLALIAB X OCCUR EX-BR523831-23-14 10/1/2023 1011/2024 EACH OCCURRENCE s20,000,000 AGGREGATE S 20,OD0 000 EXCESS LIAB CLAIMS -MADE DEO I X I RETENTION $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANYPROPRIETOR/PARTNER/EXECUTIVE OFFICERIMEMBEREXCLUDED? N/A UB-9K4464e0-23-14-E 10/1/2023 10/1/2024 PER OTH- X STATUTE E EL EACH ACCIDENT $1.000,000 EL DISEASE - EA EMPLOYEE $1,000,000 (Mandatory In NH) If yyeess describe under DESG�RIPTION OF OPERATIONS below EL DISEASE - POLICY LIMIT $1.000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101. Addttlonel Remade Scheduls, may be attached N more space Is required)) Re: Cottingham & Butler Childcare Project - Building Encroachments in ROW The City of Dubuque, including all its elected and appointed officials, all its employees and volunteers, all its boards, commissions and/or authorities and their board members, employees and volunteers are additional insured on the general liability policy on a primary, non-contributory basis per written contract between the named insured and the certificate holder that requires such a status subject to the terms and conditions of the endorsement attached to the policy. The governmental immunities endorsement is also included on the general liability Policy. The General Liability, and Workers Compensation policies include a waiver of subrogation in favor of the certificate holder per written contract between the named Insured and the certificate holder that requires such a status subject to the terms and conditions of the endorsement attached to the policy. The Umbrella or Excess policy is follow form subject to all terms and conditions of the policy. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Dubuque ACCORDANCE WITH THE POLICY PROVISIONS. City of Engineering AUTHORIZED REPRESENTATIVE 6L( e�� 50 W 13th St Dubuque IA 52001 01988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD /1 POLICY NUMBER: Y-630-9J745999-PH%-23 COMMERCIAL GENERAL LIABILITY ISSUE DATE: 10-05-23 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. TOTAL AGGREGATE LIMIT AND DESIGNATED PROJECT AND LOCATION AGGREGATE LIMITS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE — LIMITS OF INSURANCE AND DESIGNATED PROJECTS AND LOCATIONS LIMITS OF INSURANCE Total Aggregate Limit $ 10, 000, 000 (Other Than Products -Completed Operations) Designated Project Aggregate Limit $ 2,000,000 (Other Than Products -Completed Operations) Designated Location Aggregate Limit $ 2,000,000 (Other Than Products -Completed Operations) General Aggregate Limit $ 2,000,000 (Other Than Products -Completed Operations) Designated Projects: ALL PROJECTS WITH THE CITY OF DUBUQUE WHERE A SEPARATE GENERAL AGGREGATE LIMIT IS REQUIRED IN A WRITTEN CONTRACT. Designated Locations: PROVISIONS AS PER IL TO 03 04 96 1. The General Aggregate Limit (Other Than Products -Completed Operations) shown in the Declarations is replaced by the Limits of Insurance shown in the Schedule — Limits Of Insurance And Designated Projects And Locations. 3. 2. The following replaces Paragraph 1. of SECTION III — LIMITS OF INSURANCE: 1. The Limits of Insurance shown in the Declarations or the Schedule — Limits Of Insurance And Designated Projects And Locations, whichever apply, and the rules below fix the most we will pay regardless of the number of: a. Insureds: b. Claims made or "suits" brought; c. Persons or organizations making claims or bringing "suits": or d. 'Projects" or "locations". The following replaces Paragraph 2. of SECTION III — LIMITS OF INSURANCE: 2. a. The Total Aggregate Limit shown in the Schedule — Limits Of Insurance And Designated Projects And Locations is the most we will pay for the sum of all amounts under the Designated Project Aggregate Limit, all amounts under the Designated Location Aggregate Limit and all amounts under the General Aggregate Limit This includes: CG D4 68 02 19 O 2017 The Travelers Company. All rights reserved. Page 1 of 3 Includes copyrighted material of Insurance Services Office, Inc. with its permission. COMMERCIAL GENERAL LIABILITY (1) Damages under Coverage A, except damages because of "bodily injury" or "property damage" included in the "products -completed operations hazard": (2) Damages under Coverage B; and (3) Medical expenses under Coverage C. b. Subject to the Total Aggregate Limit described in Paragraph 2.a. above, the Designated Project Aggregate Limit shown in the Schedule — Limits Of Insurance And Designated Projects And Locations applies and is further subject to all of the following provisions: (1) The Designated Project Aggregate Limit is the most we will pay for the sum of: (a) Damages under Coverage A because of "bodily injury" and "property damage" caused by "occurrences"; and (b) Medical expenses under Coverage C for "bodily injury" caused by accidents; that can be attributed only to operations at a single "project". (2) The Designated Project Aggregate Limit applies separately to each "project". (3) The Designated Project Aggregate Limit does not apply to damages because of "bodily injury" or "property damage" included in the "products -completed operations hazard". Instead, the Products - Completed Operations Aggregate Limit described in Paragraph 3. below applies to such damages. (4) The Designated Project Aggregate Limit does not apply to damages under Coverage B. Instead, the General Aggregate Limit described in Paragraph 2.d. below applies to such damages. (b) The Designated Project Aggre- gate Limit for the applicable "project". Such payments will not reduce the General Aggregate Limit described in Paragraph 2.d. below, the Designated Project Aggregate Limit for any other "project" or the Designated Location Aggregate Limit. c. Subject to the Total Aggregate Limit described in Paragraph 2.a. above, the Designated Location Aggregate Limit shown in the Schedule — Limits Of Insurance And Designated Projects And Locations applies and is further subject to all of the following provisions: (1) The Designated Location Aggregate Limit is the most we will pay for the sum of: (a) Damages under Coverage A because of "bodily injury" and "property damage" caused by "occurrences"; and (b) Medical expenses under Coverage C for "bodily injury" caused by accidents; that can be attributed only to operations at a single "location". (2) The Designated Location Aggregate Limit applies separately to each "location". (3) The Designated Location Aggregate Limit does not apply to damages because of "bodily injury" or "property damage" included in the "products -completed operations hazard". Instead, the Products - Completed Operations Aggregate Limit described in Paragraph 3. below applies to such damages. (4) The Designated Location Aggregate Limit does not apply to damages under Coverage B. Instead, the General Aggregate Limit described in Paragraph 2.d. below applies to such damages. (5) Any payments made for damages or (5) Any payments made for damages or medical expenses to which the medical expenses to which the Designated Project Aggregate Limit Designated Location Aggregate Limit applies will reduce: applies will reduce: (a) The Total Aggregate Limit; and (a) The Total Aggregate Limit; and Page 2 of 3 O 2017 The Travelers Company. All rights reserved. CG D4 68 02 19 Includes copyrighted material of Insurance Services Office, Inc. with its permission. COMMERCIAL GENERAL LIABILITY (b) The Designated Location Aggre- 4. The following replaces Paragraph 3. of gate Limit for the applicable SECTION III — LIMITS OF INSURANCE: "location". 3. The Products -Completed Operations Aggre- Such payments will not reduce the gate Limit shown in the Declarations is the General Aggregate Limit described most we will pay under Coverage A for in Paragraph 2.d. below, the damages because of "bodily injury" or Designated Project Aggregate Limit "property damage" included in the "products - or the Designated Location completed operations hazard". Any Aggregate Limit for any other payments made for such damages will not "location". reduce the Total Aggregate Limit, the d. Subject to the Total Aggregate Limit General Aggregate Limit, the Designated described in Paragraph 2.a. above, the Project Aggregate Limit for any "project" or General Aggregate Limit shown in the the Designated Location Aggregate Limit for Schedule — Limits Of Insurance And any "location". Designated Projects And Locations S. The following is added to the DEFINITIONS applies and is further subject to all of the Section, but only for purposes of the Designated following provisions: Location and Designated Project shown in the (1) The General Aggregate Limit is the Schedule — Limits Of Insurance And Designated most we will pay for the sum of: Projects And Locations: (a) Damages under Coverage A "Location" means any designated location shown because of "bodily injury" and in the Schedule — Limits Of. Insurance And "property damage" caused by Designated Projects And Locations that is owned "occurrences", and medical by or rented to you. For the purposes of expenses under Coverage C for determining the applicable aggregate limit of "bodily injury" caused by insurance, each "location" that includes a accidents, that cannot be premises involving the same or connecting lots, attributed only to operations at a or premises whose connection is interrupted only single "project" or a single by a street, roadway or waterway, or by a right - "location": and of -way of a railroad, will be considered a single (b) Damages under Coverage B. "location". (2) The General Aggregate Limit does "Project" means any designated project sh own in not apply to damages for "bodily the Schedule — Limits Of Insurance And injury' or "property damage" Designated Projects And Locations that is away included in the "products -completed from premises owned by or rented to you and at operations hazard". Instead, the which you are performing operations pursuant to Products -Completed Operations a contract or agreement For the purposes of Aggregate Limit described in determining the applicable aggregate limit of Paragraph 3. below applies to such insurance, each "project' that includes a damages. premises involving the same or connecting lots, (3) Any payments made for damages or or premises whose connection is interrupted only medical expenses to which the by a street, roadway or waterway, or by a right - General Aggregate Limit applies will of -way of a railroad, will be considered a single reduce: "project". (a) The Total Aggregate Limit; and (b) The General Aggregate Limit. Such payments will not reduce the Designated Project Aggregate Limit for any "project" or the Designated Location Aggregate Limit for any "location". CG D4 68 02 19 ® 2017 The Travelers Company. All rights reserved. Page 3 of 3 Includes copyrighted material of Insurance Services Office, Inc. with its permission. COMMERCIAL GENERAL LIABILITY POLICY NUMBER: Y-630-9J745999-PHX-23 ISSUE DATE: 10-05-23 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - DESIGNATED 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): THE CITY OF DUBUQUE, INCLUDING ALL ITS ELECTED AND APPOINTED OFFICIALS, ALL ITS EMPLOYEES AND VOLUNTEERS, ALL ITS BOARDS, COMMISSIONS AND/OR AUTHORITIES AND THEIR BOARD MEMBERS, EMPLOYEES AND VOLUNTEERS. 50 W 13TH ST DUBUQUE, IA 52001. Section II — Who Is An Insured is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for "bodily injury", "property damage", "personal injury" or "advertising injury" caused, in whole or in part, by your acts or omissions or the acts or omissions of those acting on your behalf: A. In the performance of your ongoing operations; or B. in connection with your premises owned by or rented to you. CG D4 1104 08 ® 2008 The Travelers Companies, Inc. Page 1 of 1 Includes the copyrighted material of Insurance Services Office. Inc. with its permission. POLICY NUMBER: Y-630-9J745999-PH%-23 COMMERCIAL GENERAL LIABILITY ISSUE DATE: 10-05-23 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. SCHEDULED ADDITIONAL INSURED (Includes Products -Completed Operations If Required By Contract) This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE OF ADDITIONAL INSUREDS AND COVERED OPERATIONS NAME OF PERSON OR ORGANIZATION: CITY OF DUBUQUE PROJECTILOCATION OF COVERED OPERATIONS: "ALL PROJECTS WITH THE CITY OF DUBUQUE WHEN REQUIRED BY WRITTEN CONTRACT OR AGREEMNT" PROVISIONS The following is added to SECTION 11— WHO IS AN INSURED: Any person or organization shown in the Schedule Of Additional Insureds And Covered Operations that you agree in a written contract or agreement to include as an additional insured on this Coverage Part is an insured, but only: a. With respect to liability for "bodily injury" or "property damage" that occurs, or for "personal Injury" caused by an offense that is committed, subsequent to the signing of that contract or agreement and while that part of the contract or agreement is in effect; and b. If, and only to the extent that, such injury or damage is caused by acts or omissions of you or your subcontractor in the performance of "your work" on or for the project, or at the location, shown in the Schedule Of Additional Insureds And Covered Operations, to which the written contract or agreement applies. Such person or organization does not qualify as an additional insured with respect to the independent acts or omissions of such person or organization. The insurance provided to such additional insured is subject to the following provisions: a. If the Limits of Insurance of this Coverage Part shown in the Declarations exceed the minimum limits required by the written contract or agreement, the insurance provided to the additional insured will be limited to such minimum required limits. For the purposes of determining whether this limitation applies, the minimum limits required by the written contract or agreement will be considered to include the minimum limits of any Umbrella or Excess liability coverage required for the additional insured by that written contract or agreement. This provision will not increase the limits of insurance described in Section III — Limits Of Insurance. b. The insurance provided to such additional insured does not apply to: (1) Any "bodily injury", "property damage" or "personal injury" arising out of the providing, or failure to provide, any professional architectural, engineering or surveying services, including: CG D2 47 0419 0 2018 The Travelers Indemnity Company. AN rights reserved. Page 1 of 2 COMMERCIAL GENERAL LIABILITY (a) The preparing, approving, or failing to prepare or approve, maps, shop drawings, opinions, reports, surveys, field orders or change orders, or the preparing, approving, or failing to prepare or approve, drawings and specifications; and (b) Supervisory, inspection, architectural or engineering activities. (2) Any "bodily injury' or "property damage" caused by "your work" and included in the "products -completed operations hazard" unless the written contract or agreement specifically requires you to provide such coverage for that additional insured during the policy period. c. The additional insured must comply with the following duties: (1) Give us written notice as soon as practicable of an "occurrence" or an offense which may result in a claim. To the extent possible, such notice should include: (a) How, when and where the "occurrence" or offense took place; (b) The names and addresses of any injured persons and witnesses; and (c) The nature and location of any injury or damage arising out of the "occurrence" or offense. (2) If a claim is made or "suit" is brought against the additional insured: (a) Immediately record the specks of the claim or "suit" and the date received; and (b) Notify us as soon as practicable and see to it that we receive written notice of the claim or "suit" as soon as practicable. (3) Immediately send us copies of all legal papers received in connection with the claim or "suit", cooperate with us in the investigation or settlement of the claim or defense against the "suit", and otherwise comply with all policy conditions. (4) Tender the defense and indemnity of any claim or "suit" to any provider of other insurance which would cover such additional insured for a loss we cover. However, this condition does not affect whether the insurance provided to such additional insured is primary to other insurance available to such additional insured which covers that person or organization as a named insured as described in Paragraph 4., Other Insurance, of Section IV — Commercial General Liability Conditions. Page 2 of 2 0 2018 The Travelers Indemnity Company. M rights reserved. CG D2 47 04 19 COMMERCIAL GENERAL LIABILITY POLICY NUMBER: Y-630-9J745999-PMC-23 ISSUE DATE: 10-05-23 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. GOVERNMENTAL IMMUNITY ENDORSEMENT - IOWA JURISDICTION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Iowa Jurisdiction: CITY OF DUBUQUE Description Of Project: "ALL PROJECTS WITH THE CITY OF DUBUQUE WHEN REQUIRED BY WRITTEN CONTRACT OR AGREEMMT11 The following is added to SECTION IV — COM- MERCIAL GENERAL LIABILITY CONDITIONS: IOWA GOVERNMENTAL IMMUNITY a. For any claim or "suit" seeking damages from the Iowa jurisdiction scheduled in this endorsement because of "bodily injury", "property damage", "personal injury" or "advertising injury" caused by "your work" on or for any project that is scheduled in this endorsement and located in such Iowa ju- risdiction, this insurance applies only to the extent that such claim or "suit" is not subject to any de- fense of governmental immunity under Iowa Code Section 670.4 and any amendment to that section. b. For any claim or "suit" seeking damages from the Iowa jurisdiction scheduled in this endorsement because of "bodily injury", "property damage", "personal injury" or "advertising injury" to which this insurance applies and caused by "your work" on or for any project that is scheduled in this en- dorsement and located in such Iowa jurisdiction, that Iowa jurisdiction will be responsible for as- serting any defense of governmental immunity and must do so if requested in writing by us. Nothing contained in this endorsement shall pre- vent us from asserting any defense of govern- mental immunity on behalf of that Iowa jurisdic- tion. c. For any claim or "suit" seeking damages from the Iowa jurisdiction scheduled in this endorsement because of "bodily injury", "property damage", "personal injury" or "advertising injury" to which this insurance applies and caused by "your work" on or for any project that is scheduled in this en- dorsement and located in such Iowa jurisdiction, we agree that: (1) The purchase of this policy and including the Iowa jurisdiction as an additional insured un- der this policy does not waive any defense of governmental immunity available to such Iowa jurisdiction under Iowa Code Section 670.4 and any amendment to that section: and (2) We will take the position that this insurance does not apply because of governmental im- munity only after a court of law having juris- diction over such claim or "suit" has ruled in favor of any defense of governmental immu- nity asserted by such Iowa jurisdiction. d. This preservation of governmental immunity does not change the coverage otherwise available un- der this policy. CG F4 22 03 06 0 2006 The St Paul Travelers Companies, Inc. Page 1 of 1 COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. XTEND ENDORSEMENT FOR SERVICE INDUSTRIES This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART GENERAL DESCRIPTION OF COVERAGE — This endorsement broadens coverage. However, coverage for any injury, damage or medical expenses described in any of the provisions of this endorsement may be excluded or limited by another endorsement to this Coverage Part, and these coverage broadening provisions do not apply to the extent that coverage is excluded or limited by such an endorsement. The following listing is a general coverage description only. Read all the provisions of this endorsement and the rest of your policy carefully to determine rights, duties, and what is and is not covered. A. Who Is An Insured — Unnamed Subsidiaries B. Who Is An Insured — Employees And Volunteer Workers — Bodily Injury To Co -Employees And Co -Volunteer Workers C. Who Is An Insured — Newly Acquired Or Formed Limited Liability Companies D. Blanket Additional Insured — Broad Form Vendors E. Blanket Additional Insured — Controlling Interest F. Blanket Additional Insured — Mortgagees, Assignees, Successors Or Receivers PROVISIONS A. WHO IS AN INSURED — UNNAMED SUBSIDIARIES G. Blanket Additional Insured — Governmental Entities — Permits Or Authorizations Relating To Premises H. Blanket Additional Insured — Governmental Entities — Permits Or Authorizations Relating To Operations 1. Blanket Additional Insured — Grantors Of Franchises J. Incidental Medical Malpractice K. Blanket Waiver Of Subrogation The following is added to SECTION II — WHO IS AN INSURED: Any of your subsidiaries, other than a partne rship or joint venture, that is not shown as a Named Insured in the Declarations is a Named Insured if: a. You are the sole owner of, or maintain an ownership interest of more than 50% in. such subsidiary on the first day of the policy B period; and b. Such subsidiary is not an insured under similar other insurance. b. After the date, if any, during the policy period that you no longer maintain an ownership interest of more than 50% in such subsidiary. For purposes of Paragraph 1. of Section If — Who Is An Insured, each such subsidiary will be deemed to be designated in the Declarations as: a. A limited liability company; b. An organization other than a partnership, joint venture or limited liability company; or c. A trust; as indicated in its name or the documents that govern its structure. WHO IS AN INSURED — EMPLOYEES AND VOLUNTEER WORKERS — BODILY INJURY TO CO -EMPLOYEES AND CO -VOLUNTEER WORKERS No such subsidiary is an insured for "bodily The following is added to Paragraph 2.a.(1) of in jury" or "property damage" that occurred, or SECTION 11—WHO IS AN INSURED: personal and advertising injurycaused by an Paragraphs (1)(a), (b) and (c) above do not offense committed: apply to "bodily injury" to a co= employee" while ain the course of the co -"employee's" employment . Before you maintained an ownership interest of more than 50% i n such subsidiary; or by you or performing duties related to the conduct of your business, or to 'bodily injury" to CG D4 67 02 19 ® 2017 The Travelers Indemnity Company. AN rights reserved. Page 1 of 5 Includes copyrighted material of Insurance Services Office, Inc. with its permission. COMMERCIAL GENERAL LIABILITY your other "volunteer workers" while performing duties related to the conduct of your business. C. WHO IS AN INSURED — NEWLY ACQUIRED OR FORMED LIMITED LIABILITY COMPANIES The following replaces Paragraph 3. of SECTION II — WHO IS AN INSURED: 3. Any organization you newly acquire or form, other than a partnership or joint venture, and of which you are the sole owner or in which you maintain an ownership interest of more than 50%, will qualify as a Named Insured if there is no other similar insurance available to that organization. However. a. Coverage under this provision is afforded only: (1) Until the 180th day after you acquire or form the organization or the end of the policy period, whichever is earlier, if you do not report such organization in writing to us within 180 d ays after you acquire or form it; or (2) Until the end of the policy period, when that date is later than 180 da ys after you acquire or form such organization, if you report such organization in writing to us within 180 days after you acquire or form it; b. Coverage A does not apply to 'bodily Injury" or "property damage" that occurred before you acquired or formed the organization; and c. Coverage B does not apply to "personal and advertising injury" arising out of an offense committed before you acquired or formed the organization. For the purposes of Paragraph 1. of Section 11 — Who Is An Insured, each such organization will be deemed to be designated in the Declarations as: a. A limited liability company; b. An organization, other than a partnership, joint venture or limited liability company; or c. A trust; as indicated in its name or the documents that govern its structure. D. BLANKET ADDITIONAL INSURED — BROAD FORM VENDORS The following is added to SECTION II — WHO IS AN INSURED: Any person or organization that is a vendor and that you have agreed in a written contract or agreement to include as an additional insured on this Coverage Part is an insured, but only with respect to liabil ity for "bodly injury" or "property damage" that: a. Occurs subsequent to the signing of that contractor agreement; and b. Arises out of "your products" that are distributed or sold in the regular course of such vendor's business. The insurance provided to such vendor is subject to the following provisions: a. The limits of insurance provided to such vendor will be the minimum limits that you agreed to provide in the written contract or agreement, or the limits shown in the Declarations, whicheverare less. b. The insurance provided to such vendor does not apply to: (1) Any express warranty not authorized by you or any distribution or sale for a purpose not authorized by you; (2) Any change in "your products" made by such vendor, (3) Repackaging, unless unpacked solely for the purpose of inspection, demonstration, testing, or the substitution ofparts under instructions from the manufacturer, and then repackaged in the original container; (4) Any failure to make such inspections, adjustments, tests or servicing as vendors agree to perform or normally undertake to perform in the regular course of business, in connection with the distribution or sale of "your products"; (5) Demonstration, installation, servicing or repair operations, except such operations performed at such vendor's premises in connection with the sale of "your products"; or Page 2 of 5 ® 2017 The Travelers Indemnity Company. A9 rights reserved. CG D4 67 02 19 Includes copyrighted material of Insurance Services Office, Inc. with its permission. (6) "Your products" that, after distribution or sale by you, have been labeled or relabeled or used as a container, part or ingredient of any other thing or substance by or on behalf of such vendor. Coverage under thi s provision does not apply to: a. Any person or organization from whom you have acquired "your products", or any ingredient, part or container entering into, accompanying or containing such products; or b. Any vendor for which coverage as an additional insured specifically is scheduled by endorsement. E. BLANKET ADDITIONAL INSURED — CONTROLLING INTEREST 1. The following is added to SECTION II — WHO IS AN INSURED: Any person or organization that has financial control of you is an insured with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" that arises out of: a. Such financial control; or b. Such person's or organization's ownership, maintenance or use of premises leased to or occupied by you. The insurance provided to such person or organization does not apply to structural alterations, new construction or demolition operations performed by or on behalf of such person or organization. 2. The following is added to Paragraph 4. of SECTION 11— WHO IS AN INSURED: This paragraph does not apply to any premises owner, manager or lessor that has financial control of you. F. BLANKET ADDITIONAL INSURED — MORTGAGEES, ASSIGNEES, SUCCESSORS OR RECEIVERS The following is added to SECTION II — WHO IS AN INSURED: Any person or organization that is a mortgagee, assignee, successor or receiver and that you have agreed in a written contract or agreement to include as an additional insured on this Coverage Part is an insured, but only with respect to its liability as mortgagee, assignee, successor or receiver for "bodily injury", "property damage" or "personal and advertising injury" that: COMMERCIAL GENERAL LIABILITY a. Is "bodily injury" or "property damage" that occurs, or is "personal and advertising injury" caused by an offense that is committed, subsequent to the signing of that contract or agreement: and b. Arises out of the ownership, maintenance or use of the premises for which that mortgagee, assignee, successor or receiver Is required under that contract or agreement to be included as an additional insured on this Coverage Part. The insurance provided to such mortgagee, assignee, successor or receiver is subject to the following provisions: a. The limits of insurance provided to such mortgagee, assignee, successor or receiver will be the minimum limits that you agreed to provide In the written contract or agreement, or the limits shown in the Declarations, whichever are less. b. The insurance provided to such person or organization does not apply to: (1) Any "bodily injury" or "property damage" that occurs, or any "personal and advertising injury" caused by an offense that is committed, after such contract or agreement is no longer in effect; or (2) Any "bodily injury", "property damage" or "personal and advertising injury" arising out of any structural alterations, new construction or demolition operations performed by or on behalf of such mortgagee, assignee, successor or receiver. G. BLANKET ADDITIONAL INSURED — GOVERNMENTAL ENTITIES — PERMITS OR AUTHORIZATIONS RELATING TO PREMISES The following is added to SECTION II — WHO IS AN INSURED: Any governmental entity that has issued a permit or authorization with respect to premises owned or occupied by, or rented or loaned to, you and that you are required by any ordinance, law, building code or written contract or agreement to Include as an additional insured on this Coverage Part is an insured, but only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" arising out of the existence, ownership, use, maintenance, repair, construction, erection or removal of any of the following for which that governmental entity has issued such permit or authorization: advertising signs, awnings, CG D4 67 02 19 O 2017 The Travelers Indemnity Company. AD rights reserved. Page 3 of 5 Includes copyrighted material of Insurance Services Office, Inc. with Its permission. COMMERCIAL GENERAL LIABILITY canopies, cellar entrances, coal holes, driveways, manholes, marquees, hoist away openings, sidewalk vaults, elevators, street banners or decorations. H. BLANKET ADDITIONAL INSURED — GOVERNMENTAL ENTITIES — PERMITS OR AUTHORIZATIONS RELATING TO OPERATIONS The following is added to SECTION II — WHO IS AN INSURED: Any governmental entity that has issued a permit or authorization with respect to operations performed by you or on your behalf and that you are required by any ordinance, law, building code or written contract or agreement to include as an additional insured on this Coverage Part is an insured, but only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" arising out of such operations. The insurance provided to such governmental entity does not apply to: a. Any "bodily injury", "property damage" or "personal and advertising injury" arising out of operations performed for the governmental entity; or b. Any "bodily injury" or "property damage" included in the "products -completed operations hazard". I. BLANKET ADDITIONAL INSURED — GRANTORS OF FRANCHISES The following is added to SECTION II — WHO IS AN INSURED: Any person or organization that grants a franchise to you is an insured, but only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" arising out of your operations in the franchise granted by that person or organization. If a written contract or agreement exists between you and such additional insured, the limits of insurance provided to such insured will be the minimum limits that you agreed to provide in the written contract or agreement, or the limits shown in the Declarations, whichever are less. J. INCIDENTAL MEDICAL MALPRACTICE medical services", first aid or "Good Samaritan services" to a person, unless you are in the business or occupation of providing professional health care services. 2. The following replaces the last paragraph of Paragraph 2.a.(1) of SECTION II — WHO IS AN INSURED: Unless you are in the business or occupation of providing professional health care services, Paragraphs (1)(a), (b), (c) and (d) above do not apply to "bodily injury" arising out of providing or failing to provide: (a) "Incidental medical services" by any of your "employees" who is a nurse, nurse assistant, emergency medical technician, paramedic, athletic trainer, audiologist, dietician, nutritionist, occupational therapist or occupational therapy assistant, physical therapist or speech -language pathologist; or (b) First aid or "Good Samaritan services" by any of your "employees" or "volunteer workers", other than an employed or volunteer doctor. Any such "employees" or "volunteer workers" providing or failing to provide first aid or "Good Samaritan services" during their work hours for you will be deemed to be acting within the scope of their employment by you or performing duties related to the conduct of your business. 3. The following replaces the last sentence of Paragraph S. of SECTION III — LIMITS OF INSURANCE: For the purposes of determining the applicable Each Occurrence Limit, all related acts or omissions committed in providing or failing to provide "incidental medical services", first aid or "Good Samaritan services" to any one person will be deemed to be one "occurrence". 4. The following exclusion is added to Paragraph 2., Exclusions, of SECTION 1 — COVERAGES — COVERAGE A — BODILY INJURY AND PROPERTY DAMAGE LIABILITY: Sale Of Pharmaceuticals 1. The following replaces Paragraph b. of the "Bodily injury" or "property damage" arising definition of "occurrence" in the out of the violation of a penal statute or DEFINITIONS Section: ordinance relating to the sale of pharmaceuticals committed by, or with the b. An act or omission committed in knowledge or consent of, the insured. providing or failing to provide "incidental Page 4 of 5 ® 2017 The Travelers Indemnity Company. AN rights reserved. CG D4 67 02 19 Includes copyrighted material of Insurance Services Office, Inc. with its permission. 5. The following is added to the DEFINITIONS Section: "Incidental medical services" means: a. Medical, surgical, dental, laboratory, x- ray or nursing service or treatment. advice or Instruction, or the related furnishing of food or beverages; or b. The furnishing or dispensing of drugs or medical, dental, or surgical supplies or appliances. 6. The following is added to Paragraph 4.b., Excess Insurance, of SECTION IV — COMMERCIAL GENERAL LIABILITY CONDITIONS: This insurance is excess over any valid and collectible other insurance, whether primary, excess, contingent or on any other basis, that is available to any of your "employees" for "bodily injury" that arises out of providing or failing to provide "Incidental medical services" to any person to the extent not COMMERCIAL GENERAL LIABILITY subject to Paragraph 2.a.(1) of Section II — Who Is An Insured. K. BLANKET WAIVER OF SUBROGATION The following Is added to Paragraph B., Transfer Of Rights Of Recovery Against Others To Us, of SECTION IV — COMMERCIAL GENERAL LIABILITY CONDITIONS: If the insured has agreed in a contract or agreement to waive that insured's right of recovery against any person or organization, we waive our right of recovery against such person or organization, but only for payments we make because of: a. "Bodily injury" or "property damage" that occurs; or b. "Personal and advertising injury" caused by an offense that is committed; subsequent to the execution of the contract or agreement. CG D4 67 02 19 O 2017 The Travelers Indemnity Company. AN rights reserved. Page 5 of 5 Includes copyrighted material of Insurance Services Office, Inc. with Its permission. COMMERCIAL GENERAL LIABILITY c. Method Of Sharing If all of the other insurance permits contribution by equal shares, we will follow this method also. Under this approach each insurer contributes equal amounts until it has paid its applicable limit of insurance or none of the loss remains, whichever comes first. If any of the other insurance does not permit contribution by equal shares, we will contribute by limits. Under this method, each insurer's share is based on the ratio of its applicable limit of insurance to the total applicable limits of insurance of all insurers. d. Primary And Non -Contributory Insurance If Required By Written Contract If you specifically agree in a written contract or agreement that the insurance afforded to an insured under this Coverage Part must apply on a primary basis, or a primary and non- contributory basis, this insurance is primary to other insurance that is available to such insured which covers such insured as a named insured, and we wig not share with that other insurance, provided that: (1) The "bodily injury' or "property damage" for which coverage is sought occurs; and (2) The "personal and advertising injury" for which coverage is sought is caused by an offense that is committed; subsequent to the signing of that contract or agreement by you. S. Premium Audit a. We will compute all premiums for this Coverage Part in accordance with our rules and rates. b. Premium shown in this Coverage Part as advance premium is a deposit premium only. At the close of each audit period we will compute the earned premium for that period and send notice to the first Named Insured. The due date for audit and retrospective premiums is the date shown as the due date on the bill. If the sum of the advance and audit premiums paid for the policy period is greater than the earned premium, we will return the excess to the first Named Insured. c. The first Named Insured must keep records of the information we need for premium computation, and send us copies at such times as we may request. 6. Representations By accepting this policy, you agree: a. The statements in the Declarations are accurate and complete; b. Those statements are based upon representations you made to us; and c. We have issued this policy in reliance upon your representations. The unintentional omission of, or unintentional error in, any information provided by you which we relied upon in issuing this policy will not prejudice your rights under this insurance. However, this provision does not affect our right to collect additional premium or to exercise our rights of cancellation or nonrenewal in accordance with applicable insurance laws or regulations. 7. Separation Of Insureds Except with respect to the Limits of Insurance, and any rights or duties specifically assigned in this Coverage Part to the first Named Insured, this insurance applies: a. As if each Named Insured were the only Named Insured; and b. Separately to each insured against whom claim is made or "suit" is brought. 8. Transfer Of Rights Of Recovery Against Others To Us If the insured has rights to recover all or part of any payment we have made under this Coverage Part, those rights are transferred to us. The insured must do nothing after loss to impair them. At our request, the insured will bring "suit" or transfer those rights to us and help us enforce them. 9. When We Do Not Renew If we decide not to renew this Coverage Part, we will mail or deliver to the first Named Insured shown in the Declarations written notice of the nonrenewal not less than 30 days before the expiration date. if notice is mailed, proof of mailing will be sufficient proof of notice. SECTION V — DEFINITIONS 1. "Advertisement" means a notice that is broadcast or published to the general public or specific market segments about your goods, products or services for the purpose of attracting customers or supporters. For the purposes of this definition: a. Notices that are published include material placed on the Internet or on similar electronic means of communication; and b. Regarding websites, only that part of a website that is about your goods, products or services for the purposes of attracting customers or supporters is considered an advertisement. Page 16 of 21 ® 2017 The Travelers Indemnity Company. All rights reserved. CG T1 00 02 19 Includes copyrighted material of Insurance Services Office, Inc. with its permission. TRAVELERS WORKERS COMPENSATION AND ONE TOWER SQUARE HARTFORD CT 06183 EMPLOYERS LIABILITY POLICY ENDORSEMENT WC 00 03 13 (00) - 001 POLICY NUMBER: UB-9K446460-23-14-E WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce our right against the person or organization named in the Schedule. (This agreement applies only to the extent that you perform work under a written contract that requires you to obtain this agreement from us.) This agreement shall not operate directly or indirectly to benefit any one not named in the Schedule. SCHEDULE DESIGNATED PERSON: DESIGNATED ORGANIZATION: ANY PERSON OR ORGANIZATION FOR WHICH THE INSURED HAS AGREED BY WRITTEN CONTRACT EXECUTED PRIOR TO LOSS TO FURNISH THIS WAIVER. Any person or organization for which the employer has agreed by written contract, executed prior to loss, may execute a waiver of subrogation. However, for purposes of work performed by the employer in Missouri, this waiver of subrogation does not apply to any construction group of classifications as designated by the waiver of right to recover from others (subrogation) rule in our manual. DATE OF ISSUE: 09-28-23 ST ASSIGN: PAGE 1 OF