Black Hills Energy Grant of Easement at W&RRC Initiate Copyrighted
July 5, 2017
City of Dubuque Items to be set for Public Hearing # 3.
ITEM TITLE: Black Hills Energy Grant of Easement
SUMMARY: City Manager recommending the City Council set a public
hearing for July 17, 2017, to approve a Grant of Easement
to Black Hills Energy to facilitate connection of the gas
system being constructed by BIRD Three, LLC at the Water
& Resource Recovery Center to Black Hills Energy's
Dubuque Gas Distribution System
RESOLUTION Intent to Dispose of an Interest in City Of
Dubuque Real Estate pursuant to an easement granted by
the City Of Dubuque to Black Hills/Iowa Gas Utility
Company, LLC DBA Black Hills Energy to facilitate
connection of the gas system being constructed by BIRD
Three, LLC at the Water Resource and Recovery Center to
Black Hill Energy's Dubuque Gas Distribution System and
fixing the date for a public hearing and providing for the
publication of notice thereof
SUGGESTED DISPOSITION: Suggested Disposition: Receive and File; Adopt
Resolution(s), Set Public Hearing for July 17, 2017
ATTACHMENTS:
Description Type
Black Hills Energy Grant of Easement-MVM Memo City Manager Memo
Staff Memo Staff Memo
Resolution Setting Public Hearing Resolutions
Grant of Easement Supporting Documentation
THE CITY OF Dubuque
fta B E I 11p y
Masterpiece 012 the Mississippi 2007.2012«2013
TO: The Honorable Mayor and City Council Members
FROM: Michael C. Van Milligen, City Manager
SUBJECT: Grant of Easement to Black Hills Energy to Facilitate Connection of the
Gas System Being Constructed by BIRD Three, LLC at the Water &
Resource Recovery Center to Black Hills Energy's Dubuque Gas
Distribution System
DATE: June 29, 2017
Senior Counsel Barry Lindahl recommends the City Council set a public hearing for
July 17, 2017, to approve a Grant of Easement to Black Hills Energy to facilitate
connection of the gas system being constructed by BIRD Three, LLC at the Water &
Resource Recovery Center to Black Hills Energy's Dubuque Gas Distribution System.
I concur with the recommendation and respectfully request Mayor and City Council
approval.
Michael C. Van Milligen `
MCVM:jh
Attachment
cc: Crenna Brumwell, City Attorney
Teri Goodmann, Assistant City Manager
Barry Lindahl, Senior Counsel
HE CITY OF
DUB
E MEMORANDUM
Masterpiece on the Mississippi
BARRY LINDAHL
SENIOR COUNSEL
To: Michael C. Van Milligen
City Manager
DATE: June 29, 2017
RE: Grant of Easement to Black Hills Energy to Facilitate Connection of the Gas
System Being Constructed by BRD Three, LLC at the Water & Resource
Recovery Center to Black Hill Energy's Dubuque Gas Distribution System
The City of Dubuque has entered into a Lease and a Gas System Development and
Operating Agreement with BRD Three, LLC for the construction and operation of a Gas
System at the Dubuque Water Resource & Recovery Center.
BRD Three, LLC and Black Hills/Iowa Gas Utility Company, LLC dba Black Hills Energy
have entered into a Facilities Interconnection and Operating Agreement to connect the
Gas System to Black Hill Energy's Dubuque Gas Distribution System.
Black Hills Energy has requested that the City of Dubuque grant to Black Hills Energy an
easement to facilitate connection of the Gas System to Black Hill Energy's Dubuque Gas
Distribution System. Grant of the necessary easements for the Gas System Project is
required by the Lease and Gas System Development and Operating Agreement with BRD
Three, LLC.
The City and Black Hills Energy have agreed upon the terms of the Grant of Easement
which is attached.
The easement is six(6.0) feet wide and an area 65.7 feet by 35.08 feet wide all as shown
on Exhibit A attached to the Easement. The Easement is for the purpose of surveying,
constructing, operating, patrolling, inspecting, maintaining, altering, repairing, rebuilding
and removing a private natural gas main pipeline, town border station and associated
appurtenances in accordance with applicable City Standards and plans reviewed by the
City Engineer.
Disposal of an interest in City property requires a public hearing.
OFFICE OF THE CITY ATTORNEY DUBUQUE, IOWA
SUITE 330, HARBOR VIEW PLACE, 300 MAIN STREET DUBUQUE, IA 52001-6944
TELEPHONE (563)583-4113/FAX (563)583-1040/EMAIL balesq@cityofdubuque.org
I recommend that the attached resolution setting a public hearing on the Grant of
Easement be submitted to the City Council.
BAL:tls
Attachment
cc: Crenna M. Brumwell, City Attorney
William O'Brien, Water & Resource Recovery Center Manager
Steve Brown, Project Manager
F:\USERS\fsteckle\Lindahl\Black Hills Energy Grant of Easement(WRRC)\MVM_GrantOfEasement_062917.docx
2
RESOLUTION NO. 247-17
INTENT TO DISPOSE OF AN INTEREST IN CITY OF DUBUQUE REAL ESTATE
PURSUANT TO AN EASEMENT GRANTED BY THE CITY OF DUBUQUE TO
BLACK HILLS/IOWA GAS UTILITY COMPANY, LLC DBA BLACK HILLS
ENERGY TO FACILITATE CONNECTION OF THE GAS SYSTEM BEING
CONSTRUCTED BY BRD THREE, LLC AT THE WATER RESOURCE AND
RECOVERY CENTER TO BLACK HILL ENERGY'S DUBUQUE GAS
DISTRIBUTION SYSTEM AND FIXING THE DATE FOR A PUBLIC HEARING
AND PROVIDING FOR THE PUBLICATION OF NOTICE THEREOF
Whereas, the City of Dubuque has entered into a Lease and a Gas System
Development and Operating Agreement with BRD Three, LLC for the construction
and operation of a Gas System at the Dubuque Water & Resource Recovery
Center as described therein; and
Whereas, BRD Three, LLC and Black Hills/Iowa Gas Utility Company, LLC
dba Black Hills Energy have entered into a Facilities Interconnection and Operating
Agreement to connect the Gas System to Black Hill Energy's Dubuque Gas
Distribution System; and
Whereas, Black Hills Energy has requested that the City of Dubuque grant
to Black Hills Energy an easement to facilitate connection of the Gas System to
Black Hill Energy's Dubuque Gas Distribution System; and
Whereas, Black Hills Energy and the City have tentatively agreed to the
terms of an Easement for the easement area shown on Exhibit A attached thereto,
which is located on the following described real property:
Part of Lot 1 of Lot 1 of the NE Fract. 1/4 of the NW 14 of Sec. 6,
T88N, R3E.
; and
062917ba1
Whereas, the City Council has tentatively determined that it would be in the
best interests of the City to approve the Easement; and
Whereas, the Iowa Code requires that the City Clerk publish a notice of the
proposal and of the time and place of the meeting at which the City Council
proposes to take action thereon and at which meeting the City Council shall receive
oral and/or written objections from any resident or property owner of said City to
such proposed action.
NOW THEREFORE, BE IT RESOLVED BY THE CITY COUNCIL OF THE
CITY OF DUBUQUE, IOWA:
Section 1. The City of Dubuque intends to dispose of its interest in the
foregoing -described property by Easement to Black Hills Energy.
Section 2. The City Clerk is hereby authorized and directed to cause this
Resolution and a notice to be published as prescribed by Iowa Code Section 364.7
of a public hearing on the City's intent to dispose of the foregoing -described property,
to be held on the 17th day of July, 2017, at 6:00 p.m. in the City Council Chambers at
the Historic Federal Building, 350 W. 6th Street, Dubuque, Iowa.
Section 3. The City Clerk is hereby directed to cause at least one
publication to be made of a notice of said meeting, in a newspaper, printed wholly
in the English language, published at least once weekly, and having general
circulation in said City, said publication to be not less than four days nor more than
twenty days before the date of said meeting on the disposal of the City's interest
in the property.
Section 4. That the notice of the proposed action shall be in substantially
the form attached hereto.
Passed, approved and adopted this 5th day of July, 2017.
Clq /-t
Roy D. B( I, Mayor
Attest:
Kevin S. Firnstahl, CityClerk
F:\Users\tsteckle\Lindahl\Black Hills Energy Grant of Easement(WRRC)\ResolutionSettingPublicHearing_062917.docx
062917ba1
EXHIBIT A
Reserved for Recorder
Prepared By: Nate Kleffer 50 West 13th St. Duboque,IA 52001 Ph:563-589-4270
2
NOTICE OF A PUBLIC HEARING OF THE CITY COUNCIL OF THE CITY OF
DUBUQUE, IOWA, ON THE INTENT TO DISPOSE OF AN INTEREST IN CITY
OF DUBUQUE REAL ESTATE PURSUANT TO AN EASEMENT GRANTED BY
THE CITY OF DUBUQUE TO BLACK HILLS/IOWA GAS UTILITY COMPANY,
LLC DBA BLACK HILLS ENERGY TO FACILITATE CONNECTION OF THE
GAS SYSTEM BEING CONSTRUCTED BY BIRD THREE, LLC AT THE WATER
RESOURCE AND RECOVERY CENTER TO BLACK HILL ENERGY'S
DUBUQUE GAS DISTRIBUTION SYSTEM
PUBLIC NOTICE is hereby given that the City Council of the City of Dubuque,
Iowa, will hold a public hearing on the 17th day of July, 2017, at 6:00 p.m. in the
City Council Chambers at the Historic Federal Building, 350 W. 6th St., Dubuque,
Iowa, at which meeting the City Council proposes to take action on the intent to
dispose of an interest in City of Dubuque real estate by Easement as shown on
the attached Exhibit A.
The City of Dubuque has entered into a Lease and a Gas System Development
and Operating Agreement with BIRD Three, LLC for the construction and operation
of a Gas System at the Dubuque Water & Resource Recovery Center.
The City of Dubuque will grant the Easement to Black Hills Energy for the purpose
of surveying, constructing, operating, patrolling, inspecting, maintaining, altering,
repairing, rebuilding and removing a private natural gas main pipeline and
associated appurtenances in accordance with applicable City Standards and plans
reviewed by the City Engineer to facilitate connection of the Gas System to Black
Hill Energy's Dubuque Gas Distribution System.
At the meeting, the City Council will receive oral and written objections from any
resident or property owner of said City to the above action. After all objections
have been received and considered, the City Council may at this meeting or at any
adjournment thereof, approve the Grant of Easement to Black Hills Energy.
Dated this day of 2017.
Kevin S. Firnstahl
City Clerk of Dubuque, Iowa
3
Prepared by: Barry A. Lindahl, Esq. 300 Main Street Suite 330 Dubuque IA 52001 (563) 583-4113
Return to: Barry A. Lindahl, Esq. 300 Main Street Suite 330 Dubuque IA 52001
GRANT OF EASEMENT FOR PRIVATE UTILITY
For and in consideration of the sum of one and 00/100 Dollar ($1.00), the receipt
whereof is hereby acknowledged.
Whereas, the City of Dubuque has entered into a Lease and a Gas System
Development and Operating Agreement with BRD Three, LLC for the construction
and operation of a Gas System at the Dubuque Water & Resource Recovery
Center as described therein; and
Whereas, BRD Three, LLC and Black Hills/Iowa Gas Utility Company, LLC
dba Black Hills Energy has entered into a Facilities Interconnection and Operating
Agreement to connect the Gas System to Black Hill Energy's Dubuque Gas
Distribution System; and
Whereas, Black Hills Energy has requested that the City of Dubuque grant
to Black Hills Energy an easement to facilitate connection of the Gas System to
Black Hill Energy's Dubuque Gas Distribution System.
NOW, THEREFORE, THE PARTIES HERETO AGREE AS FOLLOWS:
The City of Dubuque, a Municipal Corporation of Dubuque County, Iowa
(Grantor), 50 West 13th Street, Dubuque, IA 52001-4864 of Dubuque County, State
of Iowa, does hereby grant, sell and convey to Black Hills/Iowa Gas Utility
Company, LLC d/b/a Black Hills Energy (Grantee) its agents, contractors and
assigns, in perpetuity from the date hereof, a permanent easement through, under
and across the following described real estate situated in Dubuque, Iowa:
Dubuque Water & Resource Recovery Center, in the City of
Dubuque, Dubuque County, Iowa
062917baI
Said easement being six (6.0) feet wide and an area 65.7 feet by 35.08 feet wide
all as shown on the attached Exhibit A, for the purpose of surveying, constructing,
operating, patrolling, inspecting, maintaining, altering, repairing, rebuilding and
removing a private natural gas main pipeline, town border station and associated
appurtenances (the Private Utility), in accordance with applicable City Standards
and plans reviewed by the City Engineer.
Grantor shall pay all platting fees and recording.
It is understood and agreed by Grantee that Grantee shall backfill and compact
any disturbed ground to City Standards, returning the disturbed area as near as
possible to the condition and grade it was prior to construction of the Private Utility.
Grantee shall assume any and all liability for damages to persons or property which
may result from Grantee's negligence or the negligence of Grantee's
subcontractors for the installation, construction, design, maintenance, or repair of
the Private Utility.
Grantee shall indemnify, hold harmless, and defend, at its own expense, on behalf
of said City, any claim against the City and pay on behalf of the City all sums which
the City shall become obligated to pay be reason of the liability imposed upon the
City of Dubuque for damages or injury of any kind, unless such damage or injury
is caused by the sole negligence of Grantor, resulting from Grantee's negligence
or the negligence of Grantee's subcontractors for the installation, existence,
construction, or maintenance or repair of the Private Utility and to pay reasonable
attorney fees therefore. The indemnification provided for in this easement is not
intended in any way to affect or diminish any liability of subcontractors of Grantee
under any agreements between Grantor and its subcontractors.
Grantee is given the right to trim, cut and clear away or otherwise control any trees,
limbs, brush and vegetation on or adjacent to the Private Utility whenever, in its
judgment, such will interfere with or endanger the construction, safety, operation
or maintenance of the pipeline.
This easement does not constitute any approval of the design, erection, location,
construction, repair or maintenance of the Private Utility and Grantee agrees not
to assert such claim or defense against the City of Dubuque in event of claim
asserted for death, personal injuries and/or property damage against Grantee
arising out of or in any way connected with the location, installation, construction,
design, maintenance, or repair of the Private Utility.
Grantor reserves unto itself the perpetual right for the purpose of erecting,
installing, constructing, reconstructing, maintaining, owning, operating and repair
of storm and sanitary sewers, watermain, pavement, street lights, gas, telephone,
television, fiber optics cable, and electrical lines above or below the Private Utility
Page 2 of 13
so long as such utilities do not, in the sole judgment of Grantee, interfere with the
existence or safe operation of the Private Utility.
Grantee must register with Iowa One -Call. Upon request, Grantee shall submit
documentation to the City Engineer of Iowa One -Call registration membership.
Grantee shall at all times while the easement is in effect provide insurance as
required by the attached Insurance Schedule.
To have and to hold unto Grantee, forever, and the undersigned do hereby
expressly covenant that Grantor is the owner in fee of said real estate and has
good right to execute this Grant of Easement, and that Grantee, its agents or
contractors, shall at all times have free access to and egress from and over said
real estate to maintain, remodel or repair the Private Utility thereon or therein as
set forth herein.
Attest:
Dated at Dubuque, Iowa, this
Kevin'. Firnsta I, CMC, City Clerk
day of
City of Dub
STATE OF IOWA, DUBUQJ4E COUNTY, ss:
, 2017.
Roy D. Buol, Mayor
On this v day of 'J4 , 2017, before me, the undersigned, a Notary
Public in and for said Coty d State, personally appeared Roy D. Buol and
Kevin S. Firnstahl to me p rsonally known, who, being by my duly sworn, did say
that they are the Mayor and City Clerk respectively, of the City of Dubuque, Iowa;
that said instrument was signed on behalf of said City of Dubuque by authority of
Resolution No. NO -17 and that the said Roy D. Buol and Kevin S. Firnstahl as
such officers, acknowledge the execution of said instrument to be the voluntary act
and deed of said municipal corporation, by it and by them voluntarily executed.
No 0 -I ..
.EFAMELA Je McCARRON
_' ; „ Commission Nurir 772419
ow: My Comm. Exp. Ii -5-2o
aindi Me6
Ndtary Public it nd for State of Iowa
F:\PROJECTS\Water Pollution Control Plant Replacement\Green Technology\Biogas\Black Hills Town Station\Black Hills Town Station.doc
Page 3 of 13
BLACK HILLS ENERGY
By:
'Nick Pribyl
Manager, Eastern Iowa Operations
06 7-d0/
STATE OF IOWA
ss:
DUBUQUE COUNTY
On this Of 1 day of , 2017, before me, a Notary Public in and for the
State of Iowa, in and for said county, personally appeared Nick Pribyl, to me
personally known, who being by me duly sworn did say that he is the Manager,
Eastern Iowa Operations of Black Hills Energy and that said instrument was signed
on behalf of said company and that he acknowledged the execution of this
instrument to b-, . - olu.ntar d deed of said company.
CATHY L LATS
Commission Number 739654
My Com issi Expires 10
Notary Public, State of Iowa
Page 4 of 13
EXHIBIT A
Page 5 of 13
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Page 6 of 13
INSURANCE SCHEDULE
Page 7 of 13
City of Dubuque Insurance Requirements for General.Artisan or Trade Contractors.
Subcontractors or Sub Subcontractors
INSURANCE SCHEDULE B
t. Black HillsiIowa Gas Utility Company, LLC dlbla Black Hills Energy(Contractor)shall furnish a
signed certificate of insurance to the department responsible for the contract for the coverage
required in Exhibit I prior to commencing work and at the end of the project if the term of work is
longer than 60 days. Contractors presenting annual certificates shall present a certificate at the
end of each project with the final billing- Each certificate shall be prepared on the most current
ACORD form approved by the Iowa Department of Insurance or an equivalent approved by the
Finance Director The certificate must clearly indicate the project number.project name.or project
descnpWn for which it is being provided: Project Location at Water Resource and Recovery
Center for construction of private natural gas main pipeline
2. All policies of insurance required hereunder shall be with an Ensurer authorized to do business in
Iowa and atl insurers shall have a rating of A or better in the current A.M.Best's Rating Guide.
3. Each Certificate requ€red shall be furnished to the Department Manager of the'A'ater Resource
and Recovery Center of the City of Dubuque.
4. Failure to provide the coverages descnbed in this Insurance Schedule shall not be deemed a
waiver of these requirements by the City of Dubuque.
S. Contractor shall require all subcontractors and sub-subcontractors to obtain and maintain during
the performance of work insurance for the coverages described in this Insurance Schedule and
shall obtain certificates of insurance from all such subcontractors and sub-subcontractors.
Contractor agrees that it shall be liable for the failure of a subcontractor and sub-subcontractor to
obtain and maintain such coverage The City may request a copy of such certificates from the
Contractor.
6. All required endorsements to various policies shall be attached to the certificate of insurance.
7. Whenever an ISO form is referenced the current edition must be provided.
8. Contractor shall be required to carry the minimum coveragellimrt.or greater if required by law or
other legal agreement,in Exhibit I-Insurance Schedule B.
Page 8 of 13
City of Dubuque Insurance Requirements for General.Artisan or Trade Contractors,
Subcontractors or Sub Subcontractors
INSURANCE SCHEDULE B (continued)
Contractor Insurance
Contractor will use Its corporate insurance program, which might include a level of self-
insurance,or self-insured retention, in fulfillment of the liability obligations arising from
any operations. Any and all deductibles or sett-insured retentions associated shall be
assumed by, for the account of, and at the sole risk of Black Hills Corporation and its
subsidiaries.
LIMBRELLA/EXCESS LIABILITY $10,000,000
The City of Dubuque, its elected and appointed officials, all its employees and
volunteers,all its board members, employees,volunteers are included as Additional
Insured (except for Workers' Compensation), where required by written contract, subject
to policy terms, conditions and exclusions Waiver of Subrogation applies on all policies
including Workers' Compensation,where required by written contract, subject to policy
terms, conditions and exclusions. Excess Liability policy includes general liability,auto
liability, and employers liability coverages and is primary and non-contributory when
required by written contract. Excess Liability polity does not exclude bodily injury to a
co-employee and does not exclude work completed within 50' of a railroad right of way.
Preservation of governmental immunity endorsement included.
Subcontractor Insurance
EXHIBIT I
A) COMMERCIAL GENERAL LIABILITY
General Aggregate Limit $2,000,000
Pro lucts-ComPleted Operations Aggregate Limit $2,000,000
Personal and Advertising Injury Limit $1,000,000
Each Occurrence $1,000,000
Fire Damage Limit(any one occurrence) $50,000
Medical Payments S5,000
1) Coverage shall be written on an occurrence,not claims made,toren.The general
Lability coverage shall be written in accord with ISO farm CG0001 or business
owners form SP0002 All deviations horn me standard ISO commercial general
liability forth CG 0001 or business owners form BP 0002 shall be clearly
identified.
2) Include ISO endorsement form CG 25 04"Designated Locabon(s)General
Aggregate Limit'or CG 2503-Designated Construction Projects)General
Aggregate Limd-as appropriate.
S) Include endorsement indicating that coveroge is primary and non-con rbutory-
4) Include Preservation of Govemmental Immunities Endorsement(Sample
attached).
5) Include an endorsement that deletes any fellow employee exclusion.
Page 9 of 13
City of Dubuque Insurance Requirements for General.Artisan or Trade Contractors.
Subcontractors or Sub Subcontractors
INSURANCE SCHEDULE B (continued)
6) Include additional insured endorsement for:
The City of Dubuque, including all its elected and appointed officials,all its
employees and volunteers,all its boards. commissions andlor authorities and
their board members,employees and volunteers.Use ISO form CG 20 10
(Ongoing operations).
7) The additional insured endorsement shall include completed operations under
ISO form CG 2037 during the project term and for a pened of two years after the
completion of the project.
8l Policy shall include Waiver of Right to Recover from Others endorsement.
B) AUTOMOBILE LIABILITY
Combined Single Limit 51.000,000
C) WORKERS' COMPENSATION & EMPLOYERS LIABILITY
Statutory Benefits covering all employees injured on the fob by accident or disease as
prescribed by Iowa Code Chapter 85.
Coverage A Statutory--State of Iowa
Coverage B Employers Liability
Each Accident $100.000
Each Employee-Disease $100,000
Policy Limit-Disease $500.000
Policy shall include Waiver of Right to Recover from Others endorsement.
Coverage B limits shall be greater if required by the umbrella/excess insurer.
Nonelection of Workers'Compensation or Employers'Liability Coverage under Iowa
Code sec 87.22
yes _x_form attached
D) UMBRELLA?EXCESS LIABILITY $10.000.000
Umbrella liability coverage must be at least following form with the underlying policies,if any.
included herein.
Page 10 of 13
Cloy of Dubuque Insurance Requirements for General,Artisan or Trade Contractors,
Subcontractors of Sub Subcontractors
INSURANCE SCHEDULE B (continued)
E) ENVIRONMENTAL IMPAIRMENT LIABILITY OR POLLUTION LIABILITY
Coverage required. _yes _x_no
Pollubon liability coverage shall be required 0project involves any pollution exposure for
hazardous or contaminated materials including,but not limited to,the removal of lead,
asbestus,or PCB's.Pollution product and complete operations coverage shall also be
covered.
Each Occunmce $2,000,000
Policy Aggregate $4.000,000
1) Policy to include premises and transportation coverage.
2) Include additional insured for.
The City of Dubuque,including all its elected and appointed officials.all Its
employees and volunteers,all its boards,commissions and/or auhomes and
their board members,employees and volunteers. Use ISO form CG 20 10.
(Ongoing operations)as stated in A(6)above.
3) Include Preservation of Governmental Immunities Endorsement
4) Pmvide evidence of coverage for 5 years after completion of project.
F) RAILROAD PROTECTIVE LIABILITY
Coverage required: _yes _x_no
Any contract for construction or demolition work on or wahin filly feet(50')from the edge
of the tracks of a railroad or effecting any railroad bridge or trestle,tracks,roadbeds,
tunnel,underpass,or crossing for which an easement or license or indemnification of the
railroad is required,shall require evidence of Ne following additional coverages.
Railroad Protective Liability:
S each occurrence(per Smith;required by Railroad)
S policy aggregate(Par limits required by Railroad)
OR
An endorsement W Ne Commercial General Liability policy equal to ISO CG 2417
(ConfritWal Liability-Railroads). A copy of Nis endorsement shall be attached to the
certificate of insurance.
Page 11 of 13
City of Dubuque Insurance Requirements for General.Artisan or Trade Contractors.Subcontractors or Sub
Subcontractors
ASSOCIATED ELECTRIC 8 GAS INSURANCE SERVICES LIMITED
Endorsement No TBD Effective Data or Endonsiment TBD
Attached to and forming part of POLICY No. Renevralof Polkye
NAMED INSURED BlaeM Ndk CoWation
It Is understood ant agreed that the POLICY is hereby amended as indicated AN other dams and conditions of
the POLICY remain uncharged.
IOWA GOVERNMENTAL IMMUNITY ENDORSEMENT
This POLICY shall nod appy and me COMPANY shall vnt W liable to make auy papnent IN INDEMNITY vih
reseed to any CLAIM(S)made agarnd airy INSURED for lubrlyy a suds for damages A m,d by the doctme of
gcNernmental fort Immunity,nm or hereafter eitsu g at common ImY or by statute In the Slate of IOMT.including
lova Code Ann.,Section 6704,orelseMere-
L1011l"J
Sgnawre of Authanzed Repesenutive
Page 12 of 13
City of Dubuque Insurance Requirements for General.Artisan or Trade Contractors,Subcontractors or Sub
Subcontractors
AAEGIS
ASSOCIATED ELECTRIC & GAS INSURANCE SERVICES LIMITED
Endorsement No.21 ES*c*e date of Endorsement JdV 1.201
Attached to and forming port of POLICY No. XL5'2g7p5P
NAMEDINSURED BlackHftCorooratlon
It is understood and agreed that this POLICY is hereby amended as indreated Al otter terms and conditions d
Itis POLICY remain unchanged
ADDITIONAL INSUREDS•BLANKET BASIS
(CERTIFICATE HOLDERS)
Any person or organization to whom a Certificate of Insurance has been issued with respect to this POLICY is
Indudod as an additional INSURED under the POLICY, but cnty if and to the cslrnt the P&kMLD INSURED has
agreed in wffng prior to an OCCURRENCE to provide insurance to such parser or crgan¢ation The coverage
afforded the adddxrral INSURED is subiect to the lerms,exclusions and condibcns of Ibis POLICY.including lie
Limits of Liability.WC is IUrther limilad to the amount required try the prbr wnten agreement with ate NAMED
INSURED.
NoWthstandng the foregoing.the following shall rtot be an addit3mal INSURED under this POLICY
{a) ary orgarizabon acqurad or formed by the NAMED INSURED after the inc000n of the POLICY
PERIOD.
Ib) where such ottlsr person or organization has assumed the Ilatility of any other INSURED under
cvlwact,or
ic) rrh[:re such other parson or organization Is dngogod In a JOINT VENTURE wro the NAMED INSURED
in which the NAMED INSURED is not the operator or managing p"er.
Slgnalure of Authonzea Representative
104E8933(112011) Pais 1 oft
Prinl Dare 0t?VjM6 991114
Page 13 of 13