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Improvement Contract_Bond_Selco, Inc, 2015 Pavement Marking Project SECTION 00500 Page 1 of 6 I' PUBLIC IMPROVEMENT CONTRACT SECTION 00500 2015 PAVEMENT MARKING PROJECT �! I THIS IMPROVEMENT CONTRACT (the Contract), made in triplicate, dated for references purposes the 8th day of Tuly , 2015 between the City of Dubuque, Iowa, by its City Manager, through authority conferred upon the City Manager by its City Council (City), and P Contractor Name (Contractor). S E L co, Inc . For and in consideration of the mutual covenants herein contained, the parties hereto I� agree as follows: CONTRACTOR AGREES: j 1. To furnish all material and equipment and to perform all labor necessary for the 2015 PAVEMENT MARKING PROJECT (Project). 2. CONTRACT DOCUMENTS A. The Contract Documents consist of the following: 7. Project Title Page (Section 00100). 1 8. Project Directory Page (Section 00101). I! 9. This Public Improvement Contract (Section 00500). 10.Performance, Payment, and Maintenance Bond (Section 00600). 11.Out-of-State Contractor Bond (Section 00610). 12.Other Bonds: a. (Bond Name) (pages—to_, inclusive). b. (Bond Name) (pages_to , inclusive). V c. (Bond Name) (pages_to inclusive). I� 13.The Iowa Statewide Urban Design And Specifications (SUDAS) 2015 Edition. i 14.CITY OF DUBUQUE Supplemental Specifications 2015 Edition. 15.Other Standard and Supplementary Specifications as listed on the Title Page of the y Contract Document Manual. 16.Special Provisions included in the project Contract Document Manual. 17.Drawings–Sheet No. through No. (00 pages) or drawings consisting of ' sheets bearing the following general title: 18.Addenda (numbers_to_ , inclusive). 19.Insurance Provisions and Requirements (Section 00700). 20.Sales Tax Exemption Certificate (Section 00750). 21.Construction Schedule and Agreed Cost of Delay(Section 00800). 22.Pavement Marking (Section 08020). s ti i I SECTION 00500 Page 2 of 6 23.Exhibits to this Contract (enumerated as follows): a. Contractor's Bid (pages_to_, inclusive). d b. Bidder Status Form (Section 00460). c. Contractor Background Information Form (Section 00471) d. The following documentation that must be submitted by Contractor prior to Notice of Award. it ii. e. None. 24.The following which may be delivered or issued on or after the Effective Date of the Agreement: a. Notice to Proceed (Section 00850). b. Project Certification Page (Section 00102). c. Change Orders (Not attached to this agreement). There are no other Contract Documents. The Contract Documents may only be amended, modified, or supplemented as provided in General Conditions. 3. All materials used by the Contractor in the Project must be of the quality required by the Contract Documents and must be installed in accordance with the Contract Documents. 4. The Contractor must remove any materials rejected by the City as defective or improper, or any of said work condemned as unsuitable or defective, and the same must be replaced or redone to the satisfaction of the City at the sole cost and expense of the Contractor. 5. Five percent (5%) of the Contract price will be retained by the City for a period of thirty (30) days after final completion and acceptance of the Project by the City Council to pay any claim by any party that may be filed for labor and materials done and furnished in connection with the performance of this Contract and for a longer period if such claims are not adjusted within that thirty (30) day period, as provided in Iowa Code Chapter 573 or Iowa Code Chapter 26. The City will also retain additional sums to protect itself against any claim that has been filed against it for damages to persons or property arising through the prosecution of the work and such sums will be held by the City until such claims have been settled, adjudicated or otherwise disposed of. d 6. The Contractor has read and understands the Contract Documents herein referred to and agrees not to plead misunderstanding or deception related to estimates of quantity, character, location or other conditions for the Project. 7. In addition to any warranty provided for in the specifications, the Contractor must also fix any other defect in any part of the Project, even if the Project has been accepted and fully paid for by the City. The Contractor's maintenance bond will be security for a period of two years after the issuance of the Certificate of Substantial Completion. 8. The Contractor must fully complete the Project under this Contract on or before the date indicated in the Construction Schedule and Agreed Cost of Delay Section of the Contract ' Documents. s : f SECTION 00500 Page 3 of 6 9. INDEMNIFICATION FROM THIRD PARTY CLAIMS. To the fullest extent permitted by law, Contractor shall defend, indemnify and hold harmless City, its officers and employees, from and against all claims, damages, losses and expenses claimed by third parties, but not including any claims, damages, losses or expenses of the parties to this Contract, including but not limited to attorneys' fees, arising out of or resulting from performance of this Contract, provided that such claim, damages, loss or expense is attributable to bodily I injury, sickness, disease or death, or injury to or destruction of property, including loss of use resulting there from, but only to the extent caused in whole or in part by negligent acts or omissions of Contractor, or anyone directly or indirectly employed by Contractor or anyone for whose acts Contractor may be liable, regardless of whether or not such claim, I damage, loss or expense is caused in part by a party indemnified hereunder. 10. The Contractor hereby represents and guarantees that it has not, nor has any other person for or in its behalf, directly or indirectly, entered into any arrangement or Contract with any other Bidder, or with any public officer, whereby it has paid or is to pay any other Bidder or public officer any sum of money or anything of value whatever in order to obtain this Contract; and it has not, nor has another person for or in its behalf directly or indirectly, entered into any Contractor arrangement with any other person, firm, corporation or association which tends to or does lessen or destroy free competition in the award of this Contract and agrees that in case it hereafter be established that such representations or guarantees, or any of them are false, it will forfeit and pay not less than ten percent (10%) of the Contract price but in no event less than $2,000.00 (Two Thousand Dollars) to the City. I 11. The surety on the Bond furnished for this Contract must, in addition to all other provisions, be obligated to the extent provided for by Iowa Code 573.6 relating to this Contract, which provisions apply to said Bond. r 12. The Contractor agrees, and its Bond is surety therefore, that after the Certificate of Substantial Completion has been issued by the City, it will keep and maintain the Project in good repair for a period of two (2) years. 13. The Project must be constructed in strict accordance with the requirements of the laws of h United States and ordinances of the Cit of Dubuque, and in the State of Iowa, and the y q , accordance with the Contract Documents. A. All applicable standards, orders, or regulations issued pursuant to the Clean Air Act of 1970 (42 U. S. C. 1958 (H) et. seq.) and the Federal Water Pollution Act (33 U. S. C. 1368 et. seq.) as amended, Executive Order 11738, and Environmental Protection Agency regulations (40 CFR, Part 15). Contractor must comply with Section 103 and 107 of the Contract Work Hours and Safety Standards Act (40 USC 327-330) and a Department of Labor Regulations (29 CFR, Part 5). B. The City and the Contractor agree to comply with all provisions of the Davis-Bacon Federal Prevailing Wage Act, if applicable, and related labor requirements and regulations and the Federal Wage Determination for this Project. C. Equipment or products authorized to be purchased with federal funding awarded for this Contract must be American-made to the maximum extent feasible, in accordance with Public Law 103-121, Sections 606(a) and (b). 9 I SECTION 00500 Page 4of6 i l CONSENT DECREE RELATING TO THE PROJECT I u 14. ❑ THIS CONTRACTOR IS PERFORMING WORK FOR THE CITY OF DUBUQUE RELATED TO THE WATER & RESOURCE RECOVERY CENTER OR THE SANITARY SEWER COLLECTION SYSTEM. THEREFORE, THE CONSENT DECREE AND THIS SECTION ARE j APPLICABLE. i CITY CONTRACTOR THIS CONTRACTOR IS NOT PERFORMING WORK FOR THE CITY OF DUBUQUE RELATED TO THE WATER & RESOURCE RECOVERY CENTER OR THE SANITARY SEWER COLLECTION SYSTEM. THEREFORE THE CONSENT DECREE AND THIS SECTION ARE NOT APPLICABLE. The City has entered into a Consent Decree in the case of The United States of America, and the State of Iowa v. The City of Dubuque,. Iowa, Civil Action Number Case 2:11-cv-01011-EMJ, Civil Action Number 2008V00041, DOJ Case Number 90-5-1-1-09339, United States District Court for the Northern District of Iowa. The provisions of the Consent Decree apply to and are binding upon the City j and its officers, directors, employees, agents, servants, successors, assigns, and all persons, firms I' and corporations under contract with the City to perform the obligations of the Consent Decree. The City is required to provide a copy of the Consent Decree to any contractor or consultant retained to perform work required by the Consent Decree. I' p A copy of the Consent Decree is included in the Contract Documents and can be viewed at II http://www.cityofdubugue.org/DocumentCenter/Home/View/3173. A hard copy is available upon I' request at the City's Engineering Department Office. The City must condition any contract to perform work required under the Consent Decree upon performance of the work in conformity with the provisions of the Consent Decree. The Consent Decree also provides that until five (5) years after the termination of the Consent Decree, the City must retain, and must instruct its contractors and agents to preserve, all non-identical copies u of all documents, reports, data, records, or other information (including documents, records, or other I' information in electronic form) in its or its contractors' or agents' possession or control, or that come I' into its or its contractors' or agents' possession or control, and that relate in any manner to the City's �! performance of its obligations under this Consent Decree, including any underlying research and analytical data. This information-retention period, upon request by the United States or the State, the City must provide copies of any documents, reports, analytical data, or other information required to j be maintained under the Consent Decree. At the conclusion of the information-retention period, the i City must notify the United States and the State at least ninety (90) Days prior to the destruction of any y documents, records, or other information subject to such requirements and, upon request by the n United States or the State, the City must deliver any such documents, records, or other information to the EPA or IDNR. ti i a r. , �I E B SECTION 00500 Page 5 of 6 CERTIFICATION BY CONTRACTOR The undersigned, on behalf of the Contractor, with full authority to act on behalf of the Contractor, certifies to the City of Dubuque as follows: 1. 1 have received a copy of the Consent Decree in the case of The United States of America, and the State of Iowa v. The City of Dubuque, Iowa, Civil Action Number Case 2:11-cv-01011-EMJ, Civil Action Number 2008V00041, DOJ Case Number 90- 5 5-1-1-09339, United States District Court for the Northern District of Iowa. 2. All work performed will be in conformity with the provisions of the Consent Decree. 3. All documents reports, data, records, or other information (including documents, records, or other information in electronic form) that relate in any manner to the performance of obligations under the Consent Decree, including any underlying research and analytical data, will be retained as required by the Consent Decree. 4. The Contractor agrees to defend, indemnify, and hold harmless the City, its officers, agents, or employees from and against any claims, including penalties, costs and fees as provided in the Consent Decree, relating to or arising out of the Contractor's failure to comply with the Consent Decree. CONTRACTOR: 100e Contractor ®®/ Signature l Printed Name j Title Date �i I G, I� E l SECTION 00500 Page 6of6 i THE CITY AGREES: 15. Upon the completion of the Contract, and the acceptance of the Project by the City Council, and subject to the requirements of law, the City agrees to pay the Contractor as full compensation for the complete performance of this Contract, the amount determined for I the total work completed at the price(s) stated in the Contractor's Bid Proposal and less any Agreed Cost of Delay provided for in the Contract Documents. CONTRACT AMOUNT $ 71,887.81 it 'i l CITY OF DUBUQUE, IOWA: City Manager's Office Department By: Signature Michael C. Van Milligen I; Printed Name p. 01y Manager Title bd Date Y! II CONTRACTOR: Contractor By: Signature 'oeJ �d 1 Printed Name Title Date I I END OF SECTION 00500 h IAC583045 SECTION 00600 Page I of 4 PERFORMANCE, PAYMENTSND MAINTENANCE BOND SECTIDN 00600 KNOW ALL BY THESE PRESENTS: That we, sFmcn, Tnr. as Principal (hereinafter' the "Contractor" or "Principal") and Merchants Bondi n Company as Surety are held and firmly bound unto the City of Dubuque, Iowa, as Obligee (hereinafter referred to as "Owner"), and to all persons who may be injured by any breach of any of the conditions of this Bond in the penal sum of Seventy one thousand eight hundred eightyseven dollars and 81 /1 00jollars ($ 71 , 887. 81 _), lawful money of the United States, for the payment of which sum, well and truly to be made, we :bind ourselves, our heirs, legal representatives and assigns, jointly or severally, firmly by these presents. The conditions o''f the above obligations are such that whereas said Contractor entered into a contract with the Owner, bearing date the 17th day of July 2015, (hereinafter the "Contract") wherein said Contractor undertakes and agrees to construct the following project in accordance with the Contract Documents, and to faithfully perform all the terms and requirements of said Contract within the time therein specified, in -a good and workmanlike manner, and in accordance with the Contract Documents, The Contract Documents for 2015 J?aNTMP'nt MPrl-' a Prnirt Project detail the following described improvements: I. Furnish, install, maintain, and remove permanent pavement markings to include Lines and Symbols and Legends on City of Dubuque streets as directed by the City Engineer. It is expressly understood and agreed by the Contractor and Surety in this Bond that the following provisions are a part of this Bond and are binding upon said Contractor and Surety,to-wit: 1 PERFORMANCE: The Contractor shall well and faithfully observe, perform, fulfill, and abide by each and every covenant, condition, and part of said Contract and Contract Documents,:by reference made a part hereof, for the project, and shall indemnify and save harmless the Owner from all outlay and expense incurred by the Owner by reason of the Contractor's default of failure to perform as required. The Contractor shall also be responsible for the default or failure to perform as required under the Contract and Contract Documents by all its subcontractors, suppliers, agents, or employees furnishing materials or providing labor in the performance of the Contract. Z PAYMENT: The Contractor and the Surety on this Bond hereby agreed to pay all just claims submitted by persons, firms, subcontractors, and corporations furnishing materials for or performing labor in the performance of the Contract on account of which this Bond is i SECTION 00600 Page 2 of 4 i given, including but not limited to claims for all amounts due for labor, materials, lubricants, a oil, gasoline, repairs on machinery, equipment, and tools, consumed or used by the { Contractor or any subcontractor, wherein the same are not satisfied out of the portion of the contract price the Owner is required to retain until completion of the improvement, but the Contractor and Surety shall not be liable to said persons, firms, or corporations unless the claims of said claimants against said portion of the contract price shall have been established as provided by law. The Contractor and Surety hereby bind themselves to the j obligations and conditions set forth in Chapter 573 of the Iowa Code, which by this reference is made a part hereof as though fully set out herein. 3. MAINTENANCE: The Contractor and the Surety on this Bond hereby agree, at their own expense: A. To remedy any and all defects that may develop in or result from work to be performed under the Contract Documents within the period of two (2) year(s)from the date of acceptance of the work under the Contract, by reason of defects in workmanship, equipment installed, or materials used in construction of said work; B. To keep all work in continuous good repair; and C. To pay the Owner's reasonable costs of monitoring and inspection to assure that any defects are remedied, and to repay the Owner all outlay and expense incurred as a result of Contractor's and Surety's failure to remedy any defect as required by this section. Contractor's and Surety's Contract herein made extends to defects in workmanship or materials not discovered or known to the Owner at the time such work was accepted. 4. GENERAL: Every Surety on this Bond shall be deemed and held bound, any contract to the contrary notwithstanding, to the following provisions A. To consent without notice to any extension of time authorized in approved change orders to the Contractor in which to perforin the Contract; i B. To consent without notice to any change in the Contract or Contrast Documents, authorized in approved change orders which thereby increases the total contract price and the penal sum of this Bond, provided that all such changes do not, in the aggregate, involve an increase of more than twenty.percent (20%) of the total contract price, and that this Bond shall then be released as to such excess increase; C. To consent without notice that this Bond shall remain in full force and effect until the Contract is completed, whether completed within the specified contract period, within an extension thereof, or within a period of time after the contract period has elapsed and the liquidated damage penalty is being charged against the Contractor. k Ili ii ii II G 4 SECTION 00600 Page 3 of 4 The Contractor and every Surety on the Bond shall be deemed and held bound, any contract to the contrary notwithstanding, to the following provisions: D. That no provision of this Bond or of any other contract shall be valid that limits to less than five (5) years after the acceptance of the work under the Contract the right to sue on this Bond. E. That as used herein, the phrase "all outlay and expense" is not to be limited in any way, but shall include the actual and reasonable costs and expenses incurred by the Owner including interest, benefits, and overhead where applicable. Accordingly, "all outlay and expense" would include but not be limited to all contract or employee expense, all equipment usage or rental, materials, testing, outside experts, attorney's fees (including overhead expenses of the Owner's staff attorneys), and all costs and expenses of litigation as they are incurred by the Owner. It is intended the Contractor and Surety will defend and indemnify the Owner on all claims made against the Owner on account of Contractor's failure to perform as required in the Contract and Contract Documents, that all agreements and promises set forth in the Contract and Contract Documents, in approved change orders, and in this Bond will be fulfilled, and that the Owner will be fully indemnified so that it will be put into the position it would have:been in had the Contract been performed in the first instance as required. In the event the Owner incurs any "outlay and expense" in defending itself against any claim as to which the Contractor or Surety should have provided the defense, or in the enforcement of the promises given by the Contractor in the Contract, Contract Documents, or approved change orders, or in the enforcement of'the promises given by the Contractor and Surety in this Bond, the Contractor and Surety agree that they will make the Owner whole for all such outlay and expense, provided that the Surety's obligation under this Bond shall not exceed one hundred h/venty-five percent (1.25%) of the penal sum of this Bond. In the-event that any actions or proceedings are initiated regarding this Bond, the parties agree that the venue thereof shall be Dubuque County, State of Iowa. If legal action is required by the Owner to-enforce the provisions of this Bond onto collect the monetary obligation incurring to the benefit of the Owner, the Contractor and the Surety agree, jointly, and severally, to pay the Owner all outlay an.d expense incurred therefor by the Owner. All rights, powers, and remedies of the Owner hereunder shall be cumulative and not alternative and shall be in addition to all rights, powers,.and remedies given to the Owner, by law. The Owner may proceed against surety for any amount guaranteed hereunder whether action is brought against the Contractor or whether Contractor is jI joined in any such action(s) or not. NOW THEREFORE, the condition of this obligation is such that if said Principal shall faithfully perform all the promises of the Principal, as set forth and provided in the Contract, in the Contract Documents, and in this Bond, then this obligation shall be null and void, otherwise it shall remain in full force and effect. When a work, term, or phrase is used in this Bond, it shall be interpreted or construed first as defined in this Bond, the Contract, or the Contract Documents; second, if not defined in the Bond, Contract, or Contract Documents, it shall be interpreted or construed as defined in, applicable it SECTION 00600 Page 4 of 4 i' provisions of the Iowa Code; third, if not defined in the Iowa Code, it shall be interpreted or construed according to its generally accepted meaning in the construction industry; and fourth, if it has no generally accepted meaning in the construction industry, it shall be interpreted or construed according to its common or customary usage. li Failure to specify or particularize shall not exclude terms or provisions not mentioned and shall not limit liability hereunder, The Contract and Contract Documents are hereby made a part of this Bond. Project No. 3002245 5 Witness our hands, in triplicate,this 17th day of July 2014, SURETY COUN �/;T�EVRIGNED BY: FORM APPR BY: U Signature of Agey RepresentativeOTor Owner Terrance J. Friedman Printed Name of Agent SURETY: . 880 Locust Street Merchapt-r-Scindinq ComDzny- Company Address Surety ny-' . Dubuque, IA. 52001 By. 4 City,State,Zip Code tt ,�%ign Co">eA Attorney-in-Fact Office7r , 563-556-0272 Scott A. DeSousa Company Telephone Number Printed Name of Attorney-in-Fact Officer PRINCIPAL: Merchants Bonding Company.. Company Name -Tnc 2100 Fleur Drive Contractor Company Address BY: Signature Des Moines, IA. 50321-9937 City, State,Zip Code Mp-rk Wc)I-Ff Printed Name 515-243-8171 Company Telephone Number Vi2e Title NOTE: I All signatures on this performance, payment, and maintenance Bond must be original signatures in ink; copies, facsimile, or electronic signatures will not be accepted. 2. This Bond must be sealed with the Surety's raised, embossing seal. 3. The name and signature of the Surety's Attorney-in-Fact/Officer entered on this Bond must be exactly as listed on the Certificate or Power of Attorney accompanying this .Bond. END OF SECTION 00600 i i� MERCHANT S i� BONDING CO.MPANY,�, POWER OF ATTORNEY Know All Persons By These Presents,that MERCHANTS BONDING COMPANY(MUTUAL)and MERCHANTS NATIONAL BONDING, INC.,both being corporations duly organized under the laws of the State of Iowa (herein collectively called the"Companies"). and that the Companies do hereby make,constitute and appoint, individually, Mark J Phalen; Scott A DeSousa; Terrance J Fredman i of Dubuque and State of Iowa their true and lawful Attorney-in-Fact,with full power j and authority hereby conferred in their name, place and stead,to sign, execute, acknowledge and deliver in their behalf as surety any and all bonds, undertakings, recognizances or other written obligations in the nature thereof, subject to the limitation that any such instrument shall not exceed the amount of: SIA MILLION($6,000,000.00)DOLLARS and to bind the Companies thereby as fully and to the same extent as if such bond or undertaking was signed by the duly pursuant to the authority herein given, are said Attorney-in-Fact, Companies, and all the acts of authorized officers of the Comp , hereby ratified and confirmed. This Power-of-Attorney is made and executed pursuant to and by authority of the following By-Laws adopted by the Board of Directors of the Merchants Bonding Company(Mutual)on April 23,2011 and adopted by the Board of Directors of Merchants National Bonding,Inc.,on October 24,2011. "The President,Secretary,Treasurer,or any Assistant Treasurer or any Assistant Secretary or any Vice President shall have e on behalf of the Company,and attach the i' power and authority to appoint Attorneys-in-Fact,and to authorize them to execute P seal of the Company thereto, bonds and undertakings, recognizances, contracts of indemnity and other writings obligatory in n the nature thereof. The signature of any authorized officer and the seal of the Company may be affixed by facsimile or electronic transmission to any Power of Attorney or Certification thereof authorizing the execution and delivery of any bond, undertaking,recognizance, or other suretyship obligations of the Company, and such signature and seal when so used shall have the same force and effect as though manually fixed." In Witness Whereof,the Companies have caused this instrument to be signed and sealed this 13thday of August , 2014. ',,o.rb.elerinppr41' `.• ' �,;`' •�!� `',, MERCHANTS BONDING COMPANY(MUTUAL) MERCHANTS NATIONAL BONDING,INC. 21 LrL cl &C' L2% O a. By exit STATE OF IOWA ° t1`111e`reeoeesiwllMttr °°.a.,o°° President IIS COUNTY OF POLK ss. On this 13th day of August 2014,before me appeared Larry Taylor,to me personally known,who being by me duly sworn did say that he is President of the MERCHANTS BONDING COMPANY(MUTUAL)and MERCHANTS NATIONAL BONDING, INC.;and that the seals affixed to the foregoing instrument is the Corporate Seals of the Companies;and that the said instrument was signed and sealed in behalf of the Companies by authority of their respective Boards of Directors. Ih have hereunto set m hand and affixed my Official Seal at the City of Des Moines, Iowa, the day and year In Testimony Whereof, Y Y _ first above written. RIAS WENDY WOODY c) �' sD Commission Number 784654 z i My Commission Expires ,o June 20; .2017 Notary Public, Polk County, Iowa t I STATE OF IOWA COUNTY OF POLK ss. ' I, William Warner,Jr.,Secretary of the MERCHANTS BONDING COMPANY(MUTUAL)and MERCHANTS NATIONAL BONDING, INC., do hereby certify that the above and foregoing is a true and correct copy of the POWER-OF-ATTORNEY executed by said Companies, which is still in full force and effect and has not been amended or revoked. In Witness Whereof,I have hereunto set my hand and affixed the seal of the Companies on this 17thdayof JU1Y 2015 .. y,«•'`'��ol�;�,¢,,,,, °,.©`�� c pyo.� �/ � + 1933 Secretary _'��: 2%rO� ,�,� °.tib. •may° ,`fir'''' .. .r.. �'';`' ��i •. `tia°• POA 0014 (7114) '1`rrerrnreotetjirl /`-E4....E�...ORO CERTIFICATE OF LIABILITY INSURANCE 7/17/2015(MM/DDIYYYY) C 7/17/2015 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). CONTACT PRODUCER NAME: Friedman Insurance, Inc. a/a"ri EXt:563-556-0272 FAAc Ne:563-556-4425 j PO Box 759 E-MAIL j Dubuque IA 52004-0759 ADDRESS:friedmancerts Friedman- rou .com p INSURERS AFFORDING COVERAGE MAIC# INSURERA:Westfield DB Post Insurance Coma 24112 INSURED SELC000-01 INSURER B: I Ilj SELCO INSURER C 15 S. Main Street INSURER D Dubuque IA 52001 V INSURER E: I i INSURER F: COVERAGES CERTIFICATE NUMBER:923267456 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 ADDL SUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSR WVD POLICY NUMBERMM/DD/YYYY MM/DD/YYYY LIMITS A GENERAL LIABILITY Y TRA3107184 1/1/2015 1/1/2016 EACH OCCURRENCE $1,000,000 DAMAGE TO RENTED X !, COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence $500,000 CLAIMS-MADE LAOCCUR i MED EXP(Any one person) $5,000 PERSONAL&ADV INJURY $1,000,000 GENERALAGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $2,000,000 ! X7POLICY X PRO-JECT F7 LOC $ _ Ij A AUTOMOBILE LIABILITY 1/1/2015 1/1/2016 CO BI ED SINGLE LIMIT TRA3107184 Ea accident $1,000,000 X ANY AUTO BODILY INJURY(Per person) $ ' ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOSAUTOS NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS Per accident $ A X UMBRELLA LIAB X OCCUR TRA3107184 1/1/2015 1/1/2016 EACH OCCURRENCE $3,000,000 7 F1 EXCESS LIAB CLAIMS-MADE AGGREGATE $3,000,000 DED X RETENTION$0 $ A WORKERS COMPENSATION WCP5361095 1/1/2015 1/1/2016 X WC STATU- 0TH- IIS' AND EMPLOYERS'LIABILITY ORY LIMITS ER ANY PROPRIETOR/PARTNER/EXECUTIVE❑ N/A E.L.EACH ACCIDENT $1,000,000 D? G OFFICER/MEMBER EXCLUDE ` (Mandatory in NH) E.L.DISEASE-EA EMPLOYE $1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT 1$1,000,000 I DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) THE CITY OF DUBUQUE, INCLUDING ALL ITS ELECTED&APPOINTED OFFICIALS,ALL ITS EMPLOYEES&VOLUNTEERS,ALL ITS BOARDS, COMMISSIONS,WOR AUTHORITIES&THEIR BOARD MEMBERS, EMPLOYEES&VOLUNTEERS,ARE LISTED AS ADDITIONAL INSUREDS ON GENERAL LIABILITY POLICIES INCL. ONGOING&COMPLETED OPERATIONS COVERAGE EQUIVILANT TO ISO CG 2010 0704&CG 2037 0704. GENERAL LIABILITY POLICY IS PRIMARY&NON-CONTRIBUTING. FORM CG 2503 0397 "DESIGNATED PROJECTS"GENERAL LIABILITY AGGREGATE LIMIT SHALL BE INCLUDED. GOVERNMENTAL IMMUNITIES j ENDORSEMENT IS INCLUDED.ALL POLICIES SHALL BE ENDORSED TO PROVIDE 30 DAYS ADVANCE NOTICE OF CANCELLATION TO CITY OF DUBUQUE. PROJECT: 2015-16 PAVEMENT MARKING PROJECT. !! 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 HALL 50 W 13TH STREET A ORIZED R RESENTATIVE DUBUQUE IA 52001 ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD I i POLICY NUMBER: TRA 3107184 COMMERCIAL GENERAL LIABILITY I 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 jl PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE �j Name Of Additional Insured Persons) Or Organization(s) Location(s)And Description Of Covered Operations THE CITY OF DUBUQUE, INCLUDING ALL 15 S MAIN, DUBUQUE, fA E20D1 ITS ELECTED AND APPOINTED OFFICIALS ALL ITS EMPLOYEES AND VOLUNTEERS, ALL ITS BOARDS, COMMISSIONS, AND/OR AUTHORITIES AND THEIR BOARD MEMBERS, EMPLOYEES AND VOLUNTEERS Information required to complete this Schedule, if not shown above,will be shown in the Declarations. A. Section 11 - Who Is An Insured is amended to contract or agreement to provide for include as an additional insured the persons) such additional insured. or organizations) shown in the Schedule, but only with respect to liability for"bodily injury' B, With respect to the insurance afforded to j or "property damage" caused, in whole or in these additional insureds, the following is part, by "}roar work' at the location,destg- added to Section#11 ..Liirnits Of Insurance; nated and described in the schedule of this if.coverage provided to the additional insured endorsement performed for that additional is required by :a contract or agreement, the insured and included in the "products- most we will pay.on Behalf of the additional completed operations hazard". insured is the amount of insurance: However: 1. Required by the contract or agreement; 1. The insurance afforded to such additional or insured only applies to the extent per- mitted by law; and .2. Available under the applicable Limits of Insurance.shown in the.Declarations; p 2. If coverage provided to the additional in- sured is required by a contract.or agree- whichever is fess, ment, the insurance afforded to such This endorsement shall not increase the ap- additional insured will not be broader plcable Limits of Insurance shown in the than that which you are required by the Declarations. e Insurance Services office,Inc.,2012 GG 20 37 04 13 i l u 1 i i y COMMERC'IA'L GENERAL LIABILITY �I THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. COMMERCIAL GENERAL LIABILITY EXPANDED ENDORSEMENT This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE FORM SCHEDULE The coverage provided by this endorsement is:summarized below and is intended to provide a general coverage description only. For the details affecting each coverage,please refer to the terms and condi- tions in this endorsement. A. Expected or Intended Injury � • Reasonable force j B. Nom-owned Watercraft • increased to 60 feet G. Non-owned Aircraft D. Property Damage -Elevators E. Damage To Premises Rented To You • Limit increased to$500,000 F, Personal and Advertising Injury + Exclusions G. Medical Payments -Volunteer Workers H. Voluntary Property Damage 1. Care, Custody and Control J. Supplementary Payments + Bail Bonds -$2500 i' • Loss of Earnings-$1000 K. Who Is An insured broadened: �- • Limited Liability Partnership + Joint Ventures/ Partnership/Limited Liability Company • Health Care Professionals (incidental Madical.Malpractice) Newly Formed or Acquired Entities (up to 365 days) individual Owners of Buildings L. Knowledge and Notice Of Occurrence i M. Unintentional Failure To Disclose Hazards N. Liberalization O; Definitions i; • Bodily Injury redefined + Expanded Personal and Advertising Injury definition Unintentional Damage.or.Destruction added � h In addition to the policy amendments contained in A 'through ® IMed above, the endorsements listed below will automatically be attached to your policy to complete the coverage provided by the Commercial General Liability Endorsement: h • Additional insured - Co-Owners of Insured P:remises.-CG 20.27 • Additional Insured-Concessionaire -CG 20 03 p + Additional Insured- Controlling Interest CG 20 05 h Additional Insured - Grantor of Franchise- CG 20 20 Additional Insured-Lessor of Leased.Equiprnent-GG 20 34 Additional Insured- Managers or Lessors of Premises-CG 20 11 + Additional Insured - Mortgagee,Assignee or Receiver-CG 2018 • additional Insured -Owners or Other Interests From Whom Land Has Been Leased-CG 20 24 • Additional Insured -State or Governmental Agency orlSubdivisian or Political Subdivision- Permits or Authorizations - CG 20 12 • Additional Insured-Vendors -CG 20 15 • Waiver of Transfer of Rights of Recovery- CG 24 04 CG 7135 11 12 Page 9 of 5 H A. EXPECTED OR INTENDED INJURY Exclusions c,through n. do not apply to Under SECTION f • COVERAGES,COVERAGE damage by fire or explosion to premises ebntyo temporarily ( � ® . DAMAGE. LIABILITY, Item 2. Exclusions a. is pied youwith permission of the J with the following: owner. A separate limit of insurance applies to this coverage as described in a. Expected Or Intended Injury Section III • LIMITS OF INSURANCE. "Bodily i1 or 'property Y 9njury`' " ert damage" ex- F. PERSONAL AND ADVERTISING INJURY petted or intended from the standpoint Under SECTION l -COVERAGES, COVERAGE of the insured. This exclusion does not B PERSONAL AND ADVERTISING INJURY Li- apply to bodily injury' or 'property ABILITY,the following are added to Item 2. damage" resulting from the use of rea- Exclusions: sonable force for the purpose of protect- j ing persons or property, q. Discrimination Relating To Room, Dwell- - S. NON-OWNED WATERCRAFT Ingor Premises Under SECTION I • COVERAGES,:Ct)VERASaE Caused by discrimination directly or in- A BODILY INJURY AND PROPERTY DAMAGE directly related to thesale, rental, lease or sub-lease or prospective sale, rental, LIABILITY, Item 2, Exclusions g. (2) (a) is re- lease or sub-lease of any room, dwelling placed with the following: or premises by or at the direction of any (a) Less than 60 feet long; and insured. r. Fines or Penalties C, NON-OWNED AIRCRAFT , Under SECTION i - COVERAGES, COVERAGE {roes or penalties levied or imposed by a Dover A BODILY INJURY AND PROPERTY DAgovernmental entity because of dis- Iona Aircraft crminatioci. LIABILITY, Item 2. Exclusions, g , Auto or Watercraft,the following is added: 0. MEDICAL PAYMENTS VOLUNTEER WORK- ERS (6) An aircraft you do not own, provided that: UnderSECTION F-COVER-AGES, COVERAGE C :MEDICAL PAYMENTS, item 2. 'Exclusions (a) The pilot in command holds a b.Hired Person is replaced with the following: currently effective certificate is- sued by the duly constituted au- Ls. Hired Person thority of the United States of To a person hired to do work for or on America or Canada, designating :behalf of any insured or tenant of any in- that person as a commercial or sured; however this exclusion does not airline transport pilot; apply to 'volunteer workers' while en- gaged in maintenance or repair of your (b) It is rented with..a trained, paid premises. crew; and Linder SECTION I-COVERAGES,the following are (c) It does not transport persons or i added: cargo for a charge. H. VOLUNTARY PROPERTY DAMAGE D. PROPERTY DAMAGE - ELEVATORS �! With respect to. Exclusions of SECTION I = 1, Ieuring:Agreement I! COVERAGES, COVERAGE A. BODILY IN- We will pay, at your request, for 'prop- JURY AND PROPERTY DAMAGE LIABILITY, erty damage' to property of others item 2. Exclusions,paragraphs(3),(4)and(6) caused by you, or while in your pos- of Exclusion J. Damage to Property and .Ex- session.arising Out of your business op- a ciusion .k. Damage To Your Product do not orations. apply to the use of elevators, The insurance i 2• Exclusions afforded by this provision is excess over any valid and collectible property insurance (in- Coverage for Voluntary Property Damage cluding any deductible) available to the :in- does not apply to: sured, and the Other Insurance Condition is. changed accordingly. a. "Loss' of property at premises P awned, rented, leased, operated or E, DAMAGE TO PREMISES RENTED TO YOU used.:by you. Under SECTION I -COVERAGES,COVERAGE b. 'Loss"of property while in transit; A (BODILY INJURY AND PROPERTY DAMAGE LIABILITY, Item 2,.Exclusions,the last para- c. 'Loss" of property owned by, rented graph of item 2. Exclusions is replaced with to, leased to, borrowed by or used p, the following: by you; CG 7135 11 12 Page 2 of 5 d. The cost of repairing or replacing: unless the"property damage" is (1) "Your work" defectively or in- caused directly by you after de- correctly done by you; livery of"your product" or com- pletion of "your work" and H (2) "Your product" manufactured, resulting from a subsequent sold or supplied by you;or undertaking. unless the "property damage" is d. "Property damage" to property caused directly by you after delivery caused by or arising out of the u of "your product" or completion of "products-completed operations your work" and resulting from a hazard, subsequent undertaking. 3. Deductible e. "Loss" of property caused by or arising out of the "products- We will not,pay for"property damage" in completed operations hazard." any one "occurrence" until the amount of'property damage' exceeds $250. We 3, Deductible wilfl then pay the amount of "property We will not pay for 'lass" in any one damage'in excess of$250, up to the ap- "occurrence" until the amount of "loss" plicable limit of insurance. exceeds $250. We will then pay the . Actual Cost amount of'loss' in excess of$250, up to the applicable limit of insurance. In .the event of covered "property dam- age', you shall, if requested by. us,.re- 4. Actual Cost place the property or fumish the labor In the event of covered "loss", you shall, and materials necessary for repairs if requested by us, replace the damaged thereto at your actual cost, .excluding property or furnish the labor and materi- profit or overhead charges. als necessary for repairs thereto.at your The most we will pay under Care, Custody or actual cost, excluding profit or overhead Control for 'property damage" is $1,000 for charges. each 'occurrence", The most we wilt pay for The most we will pay under Voluntary Prop- the sum of all damages because of'property erty Damage for"loss" arising out of any one damage" under this coverage is$5,000, "occurrence" is $250. The most we will flay -,l. SUPPLEMENTARY PAYMENTS for the sum of all "losses" Lander this cover- age is$1,000. Under SECTION I ." SUPPLEMENTARY PAY - MENITS COVERAGES A AND S, item I.b, is I. CARE, CUSTODY OR CONTROL replaced.with the following: 1. Insuring Agreement b. Up to $2,500 for cost of bail bonds re- We will pay those sums the insured be- quired because.of accidents or traffic law comes legally obligated to pay as dam- violations arising out of the use of any ages because of "property damage" to vehicle to which the "Bodily Injury" Li- property of others while in your care, ability Coverage applies. We do not have custody or control or property as to to furnish these bands. which you are exercising physical control Linder SECTION I -SUPPLEMENTARY PAYMENTS if the "property damage" arises out of COVERAGES A AND g, item 14, is replaced with your business operations, the following: 2. Exclusions d. All reasonable expenses incurred by the Coverage for Care, Custody or Control insured.at our request to assist us in the does not apply to: investigation or defense of the claim or ry "suit", including actual loss of earnings R a. "Property damage" to property at up to $1,000 a day because of time off any premises owned,rented,leased, from work, operated or used by you; K. IIVFiO IS AN INSURED BROADENED fl b. 'Property damage" to property while Linder SECTION Il - WHO IS AN INSURER N in transit; Iters 1.b. is replaced with the following: c. The cost of repairing or replacing; b. A partnership(.including a limited liability (1) "Your work" defectively or in- partnership) or joint venture, you are an correctly done by you; or insured. Your members, your partners, and their spouses are also insureds, but (2) "Your product" - manufactured, only with respect to the conduct of your h sold or supplied by you; business. CG 71 35 11 12 Page 3 of 5 € - s s i i Under SECTION Ii - WHO IS AN.INSURED the following is added to item 1: This does not apply to nurses, emergency medical technicians f t. Joint Ventures ! Partnership f Limited Li- or paramedics employed by you ability Company Coverage to provide health care services, but only if you are not in the �! You are an insured when you had an in- business or occupation of pro- terest in a.joint venture, partnership or limited liability company which is term_ viding such professional ser- limited or ended vices, prior to or .do ring this G policy period but only to the extent of (2) "Property damage" to property: your interest in such joint venture, part- nership or limited liability company. This (a) Owned,occupied or used by, coverage does not apply: j (b) Rented to, (1) Prior to the termination date of an ithe care, custody :n y or control of, or over which joint venture, partnership or limited physical control is being exer- liability company;.or cised for any purpose by you, any of your "employees" or vol- (2) If there is other valid and collectible unteer workers, any partner or insurance purchased specifically to member (if you are a partner- insure the partnership, joint venture ship or joint venture), or any or legal liability company- member (iif you are a limited li- Under SECTION i1 - WHO IS AN .INSURED,..iter" ability company) 2.a, is replaced with the following: Under SECTION 11 WHO IS AN INSURED, item a. Your "employees" or volunteer workers, 3.a. is replaced with the following: other than either your 'executive offi- cers' (if you are an,organization other -a, Coverage-under this provision is of than a partnership, joint venture or lim- forded only until the end 'of the policy ited liability company) or your managers period orthe next anniversary of this (if you are a limited liability company), policy's effective date -after you ac- but only for acts within the scope of their quire or form the organization, employment by you or while performing whichever is earlier. duties related to the conduct of your business. However, none of these "em- Under SECTION It - WHO IS AN INSURED, the ployees" or volunteer workers are an in- following its.added: eared for: 4, For COVERAGE A and COVERAGE S (1) "Bodily injury" or "personal and ad- only, the .owner of any building leased to vertising injury': you, but only if thebuilding :owner is a shareholder in your corporation or a (a) To you, to your partners or partner in your partnership insured in members (if you are a partner- this policy, and only with respect to li ship or joint venture), to your ability arising out of the ownership, ability company), or to a co members (if you are limited o-- maintenance or use.of that .part of the � employee" or co-volunteer premises leased to you. However, this worker while that is either in the insurance does not apply: . course of his or her employment a, To any „occurrence" or offense or performing duties related to which takes place after you cease to the conduct of your business; be a tenant.in the premises;or Pj (b) To the spouse, child, parent, b, To structural alterations, new con- 4 brother or sister of that co- "employee" or co-volunteer struction or demolition operations worker as a consequence of performed by or on behalf of the paragraph(1)(a)above; building owner. (c) For which there is any obligation Under SECTION II WHO IS AN INSURED the last to share damages with or repay paragraph of this section is replaced with the fol- someone else who must pay lowing: damages because of the injury l described in paragraphs (1)(a) Except as provided in 3. above, no person or or(b)above; or organization is an insured with respect to the conduct of any current or past partnership, (d) Arising out of his or her provid- joint venture or limited liability company that ing or failing to :provide profes- is not shown as'a named insured in the C)ec- sional health care services. laraticans. CG 71 35 11 12 Page 4 of 6 9 L. KNOWLEDGE AND NOTICE OF OCCURRENCE all hazards or prior "occurrences" is not Under SECTION iV-COMMERCIAL GENERAL intentional. LIABILITY CONDITIONS, 2. Duties in the W LIBERALIZATION Event of Occurrence, Offense,Claim Or Suit, Under SECTION I - COVERAGES, SECTION fl the following is added: . WKO IS AN INSURED, SECTION iiI -LIMITS e. The requirement in Condition 2.a.applies OF INSURANCE, SECTION IV-COMMERCIAL SEC- only when the "occurrence"car offense is GENERAL LIABILITY CONDITIONS ANI? SEC- known to: TION V DEFINITIONS, the following is added: (1) You, if you are an individual; Liberalization (2) A partner, if you are a partnership; if we adopt any revision that would broaden the'coverage under this endorsement without (3) An "executive officer" or insurance additional premium within 45 days prior to or manager, if you are a corporation; during,the.policy period, the broadened cov- or erage will immediately apply to this endorse- (4) A manager, if you are a .limited h- merit. ability company. 0. DEFINITIONS t. The requirement in Condition 2. b, will Under SECTION V - DEFINITIONS, item 3. is not be breached unless the breach oc- deleted and replaced with the following: curs after such claim or "suit" is known 3, "Bodily injury" means bodily injury, disa- to; bility, sickness, or disease sustained by (I) You, if you are an individual; a person, including death resulting from any of these ait.any tune. 'Bodily injury" 2 A partner, if you are a partnership; includes mental anguish or other mental ( ) p Y p p' injury resulting from "bodily injury". (3) An "executive officer" or insurance Under SECTION V DEFINITIONS, item 14. manager, if you are a corporation; the following is added to the definition of or "Personal and advertising injury". (4) A manager, if you are a Limited li- b. Discrimination or humiliation that results ability company. In injury to the feelings or reputation of g, Your rights under this Coverage Part will a natural person but only if such dis- crimination or humiliation is: not be prejudiced if you fail to give .us notice of an "occurrence," offense,claim, ('f) not done intentionally by or at the or "suit" and that failure is solely due to direction of: f your reasonable belief that the 'bodily injury" or "property damage" is not coy- 4a) The insured;or eyed underthis Coverage Part: However, you shall give written notice of this "oc- (b) stockholder,executive officer,' director, Y s€acknolder, .partner, member ! currence," offense, claim, or "suit" to .us or manager (if you are a limited as soon as you are aware this insurance liability company)ofthe insured; may apply to such "occurrence",offense, and claim, or"suit', M. UNINTENTIONAL FAILURE TO DISCLOSE (2) No! directly or indirectly related to the employment, prospective em- HAZARDS ployment, past employment or ter- Under SECTION IV-COMMERCIAL GENERAL urination of employment of any LIABILITY CONDITIONS, S. Representations, person or persons by any insured. the following is added: Under SECTION Y-DEFINITIONS, the follow- d. Your failure to disclose all hazards or ing definition is added: prior "occurrences" existing as of the in- 23, "Loss" means unintentional damage or ception date of this policy shall not prej- destruction but does not include disap- udice the coverage afforded by this pearance,theft, or loss of use, j policy, provided such failure to disclose r CG 71 35 11 12 Page 5 of 5 — i g. i WORKERS COMPENSATION AND,EMPLOYERS LIABILITY INSURANCE POLICY WAIVER OF aUR .RIGHT TO RECOVER FROM !. OTHERS ENDORSEMENT y pi This endorsement modifies insurance{provided .Under the following: j POLICY NUMBER: WCP 5369095 EFFECTIVE DATE: 01/01/14 INSURER: AMERICAN SELECT INSURANCE COMPANY CARRIER CODE: 35939 NAMED INSURED: SAFETY EQUIPMENT LEASING CO AGENCY NUMBER: 14-2300 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 PRINCIPAL: ANY DESCRIBED OPERATIONS: ANY OPERATION OF THE INSURED MINIMUM PREM/FLAT CHARGE: 2000 !i I This endorsement changes the policy to which it is attached and i;s:effective on the date issued unless otherwise I, stated. (The information below is required only when this endorsement is Issued.s;ubsequent to.preparafion at the policy.) t Endorsement Effective Policy No, Endorsement No. Insured Premium Insurance Company Countersigned by ® IN3 National Council on compensation Insurance, AJC 40 03 13(4-84) a q I POLICY NUMBER: TRA 3107181 INTERLINE THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. EARLIER NOTICE OF CANCELLATION PROVIDED BY US This endorsement modifies insurance provided under the following: li COMMERCIAL AUTO COVERAGE PART 'I CRIME AND FIDELITY COVERAGE PART I EQUIPMENT BREAKDOWN COVERAGE PART FARM COVERAGE PART COMMERCIAL PROPERTY COVERAGE.PART COMMERCIAL INLAND MARINE COVERAGE PART COMMERCIAL LIABILITY UMBRELLA COVERAGE PART OWNERS AND CONTRACTORS PROTECTIVE LIABILITY COVERAGE PART k COMMERCIAL GENERAL LIABILITY COVERAGE PART LIQUOR LIABILITY COVERAGE PART fi PROFESSIONAL LIABILITY COVERAGE i SCHEDULE Number of Days'Notice 30 Name Of Additional Insured'Person(s} Or Organlzation(s} LDcation(s)Of Covered gperations CITY OF DUBUQUE CITY HALL DUBUQUE IA 52001 I^I (If no entry appears above, information required to complete this Schedule will be shown in the Declarations as applicable to this endorsement,) For any statutorily permitted reason other than-nonpayment of premium,the number of clays required for notice of cancellation, as provided in paragraph 2. of either the CANCELLATION :Common Policy Condi- { tion or as amended by an applicable state cancellation.endorsement, is increased tothe number of days shown in the Schedule above. y Copyright,Insurance services orrice,Inc., 1882 IL 70 35 QJ 12 i !i c 1 is hl i dd 9 1 COMMERCIAL GENERAL LIABILITY POLICY NUMBER: TRA 3107184 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. I+ GOVERNMENTAL IMMUNITY ENDORSEMENT IOWA I'I f This endorsement modifies Insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE FORM i i i SCHEDULE ;I i CITY OF DUBUQUE, IOWA WITH RESPECT TO INSURANCE PROVIDED TO THE MUNICIPALITY SHOWN IN THE SCHEDULE OF THIS ENDORSEMENT, THE FOLLOWING SHALL APPLY: 1. NON-WAIVER OF GOVERNMENT .IIMMUNITY THE INSURANCE CARRIER EXPRESSLY AGREES AND .STATES THAT THE PURCHASE OF THIS POLICY AND THE INCLUDING OF HE -JURISDICTION SHOWN IN THE SCHEDULE AS AN ADDITIONAL INSURED DOES NOT WAIVE ANY OF THE DEFENSES OF GOVERNMENTAL IMMUNITY AVAILABLE TO THE JURISDICTION UNDER CODE OF IOWA SECTION 670.4 AS IT NOW EXISTS AND AS MAY BE AMENDED FROM TIME TO TIME. Z. CLAIMS COVERAGE THE INSURANCE CARRIER FURTHER AGREES THAT THIS POLICY OF INSURANCE SHALL COVER ONLY THOSE CLAIMS NOT SUBJECT TO THE DEFENSE OF GOVERNMENTAL IMMUNITY UNDER THE CODE OF IOWA 'SECTION .670.4 AS IT NOW EXSISTS AND AS IT .MAY BE AMENDED FROM TIME TO TIME:.. THOSE CLAIMS NOT SUBJECT TO CODE OF IOWA SECT- ION 670.4 SHALL BE COVERED BY THE TERMS AND CONDITIONS OF THIS INSURANCE POLICY. 3. ASSERTION OF GOVERNMENT IMMUNITY THE JURISDICTION SHOWN IN THE SCHEDULE SHALL BE RESPONSIBLE FOR ASSERTING ANY DEFENSE OF GOVERNMENTAL -IMMUNITY, AND MAY DO SQ AT ANY TIME AND .SHALL DO SO UPON THE TIMELY WRITTEN REQUEST OF THE INSURANCE CARRIER. 4. NON-DENIAL OF COVERAGE THE INSURANCE CARRIER SHALL NOT DENY COVERAGE DR DENY ANY :OF 'THE FIGHTS AND r BENEFITS ACCRUING TO THE JURISDICTION SHOWN IN THE SCHEDULE UNDER. THIS POLICY FOR REASONS OF GOVERNMENTAL IMMUNITY UNLESS AND UNTIL A COURT OF COMPETENT JURISDICTION HAS RULED IN FAVOR OF THE DEFENSE(S) SOF GOVERNMENTAL IMMUNITY ASSERTED BY THE JUHISTICTION SHOWN IN THE SCHEDULE. j S. NO OTHER CHANGE IN POLICY THE INSURANCE CARRIER .AND THE JURISDICTION AGREE.THAT THE ABOVE PRESERVA- TION OF GOVERNMENTAL IMMUNITIES SHALL NOT OTHERWISE CHANCE OR ALTER THE COVERAGE AVAILABLE UNDER THE POLICY., l; d l U P r. p p7I H Q S ryry f 9 AC-132(1-90)