Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Signed Contracts_Bergfeld_Seippel Pond Detention Basin Maintenance
THE CITY OF Dubuque -~. Dui E A6-AmericaCHU Masterpiece on the Mississippi .~ 2007 TO: Michael C. Van Milligen, City Manager FROM: Gus Psihoyos, City Engineer~Q~ DATE: September 23, 2009 SUBJECT: Detention Basin Maintenance -Bergfeld and Seippel Pond Attached is the Short Form Improvement Contract between the City of Dubuque and McDermott Excavating for the detention basin maintenance of the Bergfeld and Seippel Pond. Finance Director Ken TeKippe has reviewed and approved the Certificate of Liability Insurance to ensure compliance with insurance guidelines. Would you please execute the noted documentation and return to the Engineering office. Attachs. THE ~IlT1f OF DUB E 11~Iasterpiece on the 1Vlississippi CITY OF DUBUQUE, IOWA SHORT FORM IMPROVEMENT CONTRACT City of Dubuque Engineering Department 50. W. 13'h Street Dubuque, IA 52001 (563) 589-4270 (563) 589-4205 FAX THIS IMPROVEMENT CONTRACT (the Contract), made in triplicate, between the City of Dubuque, Iowa (City), by its City Manager, through authority conferred upon the City Manager by its City Council (City) and of the City of Dubuque. McDermott Excavating (Contractor) (Contractor Name) 14407 Hwy 20 West, Dubuque IA 52003-9709 (Contractors Address -City and State) PROJECT TITLE: Bergfeld and Seippel Pond For and in consideration of the mutual covenants herein contained, the parties hereto agree as follows: CONTRACTOR AGREES: 1. To furnish all material and equipment and to perform all labor necessary for (the Project): Work to include: Repair rip-rap slope & repair outlet areas. The work described above shall be completed at the following location(s) Bergfeld /Seippel Road Ponds. The Project shall be constructed to the existing grades and to any revised grades as described in this Project contract; in strict accordance with the requirements of the laws of the State of Iowa and ordinances of the City of Dubuque relating to public works, and in accordance with the Contract Documents which provisions and documents are each and all hereby referred to and made a part of this Contract just as much as if the detailed statements thereof were repeated herein. Page 1 of 3 2. Contract Documents shall mean and include the following: This Improvement Contract; all ordinances and resolutions heretofore adopted by the City Council having to do with the Project; the Contractor's Proposal; and the conditions described in the Contract, including any Special Conditions, Plans and Specifications and General Requirements as adopted by the City Council for the Project. 3. All materials used by the Contractor in the Project shall be the best of their several kinds and shall be put in place to the satisfaction of the City Manager. 4. The Contractor shall remove any materials rejected by the City Manager as defective or improper, or any of said work condemned as unsuitable or defective, and the same shall be replaced or done anew to the satisfaction of the City Manager at the cost and expense of the Contractor. 5. Five percent (5%) of the Contract price may be retained by the City for a period of thirty (30) days after final completion and acceptance of the Project by the City Manager to pay any claim that may be filed within said time 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 time, as provided in Iowa Code Chapter 573. The City shall 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 shall be held by the City until such claims have been settled, adjudicated or otherwise disposed of. 6. The Contractor has read and understands the City of Dubuque Standard Specifications including General Requirements and has examined and understands the project description described in Section 1 and any attached Special Conditions herein referred to and agrees not to plead misunderstanding or deception because of estimates of quantity, character, location or other conditions surrounding the same. 7. The Contractor shall guarantee for a period two years and make good any other defect in any part of the Project due to improper construction or material performance notwithstanding the fact that said Project may have been accepted and fully paid for by the City. The guarantee shall commence on the date that the City pays full compensation for the complete performance of this contract. 8. The Contractor shall full complete the Project under this Contract on or before November 30t , 2009 (DATE) 9. To the fullest extent permitted by law, the Contractor shall indemnify and hold harmless the City from and against all claims, damages, losses and expenses, including but not limited to attorneys' fees, arising out of or resulting from performance of the Contract, provided that such claim, damages, loss or expense is attributable to bodily injury, sickness, disease or death, or injury to or destruction of property (other than the Project itself) including loss of use resulting there from, but only to the extent caused in whole or in part by negligent acts or omissions of the Contractor, the Contractor's subcontractor, or anyone directly or indirectly employed by the Contractor or the Contractor's subcontractor or anyone for whose acts the Contractor or the Contractor's subcontractor may be liable, regardless of whether or not such claim, damage, loss or expense is caused in part by a party indemnified hereunder. Page2of3 10. Unless otherwise specified in the Contract Documents, prior'to` t'he'commencement of any work on the Project and at all times during the performance of thisContract, the Contractor shall provide evidence of insurance which meets the requirements of the City's Insurance Schedule for Artisan Contractors or General Contractors. ~ . ~. THE CITY AGREES: Upon the completion of the Contract, and the acceptance of the Project by the City Manager, the City agrees to pay the Contractor as full compensation for the complete performance of this Contract, the amount determined- for the total number of units completed at the unit prices stated in the Contractor's Proposal and less any liquidated damages provided for in the Contract Documents. The number of units stated in the contract, special conditions and contractors proposal is approximate only and the final payment shall be made by the work covered by the Contract. CONTRACT ESTIMATED AMOUNT $ ,4568.00 THE MAXIMUM CONTRACT AMOUNT SHALL BE LIMITED TO AN INCREASE OF 5 % OF THE ABOVE LISTED ESTIMATED AMOUNT. CITY OF DUBUQUE, IOWA By: Michael C. Van Milligen Date City Manager PRINCIPAL: G ~- ~~~~ ~K Contractor By: ~ ~~ Signature Date ~en6 ~~~~K Printed Name .~~Iyl/c Sol- Title Page 3 of 3 CERTIFICATE OF ACORD LIABILITY INSURANCE UATE(MM,°D/YYYY, M 09/22/2009 PRODUCER (563) 583-5775 FAX (563) 583-5779 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Wallis , Kunnert, Pri ce & Smi th ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 890 Main St HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR . ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW P.O. Box 176 . Dubuque, IA 52004-0176 INSURERS AFFORDING COVERAGE NAIC # INSURED McDermott Excavating INSURERA Cincinnati Insurance Co. 10677 14407 Hwy 20 West INSURER 6: Cincinnati Indemnity Company 23280 Dubuque, IA 52003-9709 INSURER C: INSURER D: INSURER E: l~AVCOAf!CO .. vlc~ yr u~a~rwrv~.c ua I cu ntwvv nHVt tsttN IJJUtU i0 THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CER TIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS EXCLUSIONS AN , D CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR DD' LTR NSR TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE MMlDD/YYYY POLICY EXPIRATION DATE MMIDD/YYYY LIMITS GENERAL LIABILITY CAP5328171AWRP 01/01/2009 01/01/2010 EACH OCCURRENCE $ 1, OOp ~ 00 X COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence $ 100, 00 A CLAIMS MADE ~ OCCUR MED EXP (Any one person) $ 5 000 ' PERSONAL & ADV INJURY 1 QQQ $ ~ ~ 000 GENERAL AGGREGATE 2 QQQ 0 $ ~ ~ 00 GEN'L AGGREGATE LIMIT APPLIES PER: PRO- PRODUCTS -COMP/OP AGG $ 2 ~ QQQ ~ ~0 POLICY X JECT LOC AU TOMOBILE LIABILITY CAA5328171AWR 01/01/2009 01/01/2010 ANY AUTO COMBINED SINGLE LIMIT (Ea accident) $ 1' 000, 00 ALL OWNED AUTOS A X SCHEDULED AUTOS BODILY INJURY (Per person) $ X HIRED AUTOS X NON-OWNED AUTOS BODILY INJURY (Per accident) $ PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: qGG $ EXCESS /UMBRELLA LIABILITY X CAP5328171AWR 01/01/2009 01/01/2010 EACH OCCURRENCE $ 3 ~ QQQ, 000 A OCCUR ~ CLAIMS MADE AGGREGATE $ 3 ~ 000 ~ 000 $ DEDUCTIBLE X $ RETENTION $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY WC1846366-02 O1 O1 / /2009 01/01/2010 Y / N TORY LIMITS ER B ?~CUTIVE A R ^ OFFICER/MEM ER E X CLUDED E.L. EACH ACCIDENT $ 100 ~ 00 (Mandatory In NH) If yes, describe under E.L. DISEASE - EA EMPLOYEE $ 100 ~ 00 SPECIAL PROVISIONS below E.L. DISEASE -POLICY LIMIT $ 500 000 OTHER ~ aFCr RIDTInW nc nocDwr~nuc.. ~ ~nw~.~..n ...._...... ~............-.-..- _ ____ ___ -_._ _ _ _ - _ __ _.. _.__ . _ _...____ . -_._-_-.-..-......-.. r. r..vvr~.a~m ~~~ ~ / Jr GIrIML rRV VIJIVIV.1 o Bergfeld and Seippel Ponds he City of Dubuque is an Additional Insured on General Liability per Form GA 4113 11/99 & GA 443 1/95 lso attached are forms GA 4094 10/Ol, WC 00 03 13, CG 25 03 3/97 & Govenmental Immunities Endorsement :ERTIFICATE HOLDER CANCELLATION The City of Dubuque 50 West 13th St. Dubuque, IA 52001-4864 25 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION GATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR AUTHORIZED REPRESENTATIVE 7. Allen Wallis III,CIC,CPI~ rights reserved. The ACORD name and logo are registered marks of ACORD IMPORTANT If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). 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). DISCLAIMER This Certificate of Insurance does not constitute a contract between the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon. ,CO THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL ENSURED -OWNERS, LESSEES OR CONTRACTORS -SCHEDULED PERSON OR ORGANIZATION -YOUR WORK This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name of Person or Organization (Additional Insured): The City of Dubuque, including all its•elected and appointed officials, all its employees and volunteers, all its boards, commissions &/or authorities and their board members, employees and volunteers 50 West 13th St. Dubuque, IA 52001 WHO IS AN INSURED (section ll) is amended to include as an insured the person or organization shown in the Schedule, but only with respect to liability arising out of "your work" for that Additional Insured by you or on your behalf. GA 4113 11 99 Includes copyrighted material ofi Insurance Services Office, Inc., with its permission. THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED -OWNERS, LESSEES OR CONTRACTORS (Form A) This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Location of Covered Operations: Dubuque, IA Name of Person or Organization (Additional Insured): The City of Dubuque, including all its elected and appointed officials, all its employees and volunteers, all its boards, commissions &/or authorities and their board members, employees and volunteers 50 West 13th St. Dubuque, IA 52001 Premium Basis Rates Advance Premium Bodily Injury and Per Property Damage Liability Cost $1D00 of cost) $ INCL. (If no entry appears above, information required to complete this endorsement will be shown in the Declara- tions as applicable to this endorsement.) 1. WHO IS AN INSURED (Section II) is amended to include as an insured the person or organi- zation (called "additional insured") shown in the Schedule but only with respect to liability arising out of: A. Your ongoing operations performed for the additional insureds) at the location designated above; or B, Acts or omissions of the additional in- sureds) in connection with their general supervision of such operations. 2. With respect to the insurance afforded these additional insureds, the following additional provisions apply: A. Exclusions b., c., g., h.(1), j., k., I. and n. under COVERAGE A-BODILY INJURY AND PROPERTY DAMAGE LIABILITY (Section I -Coverages do not apply. B. Additional Exclusions. This insurance does not apply to: (1) "Bodily injury" or "property damage" for which the additional insureds) are obligated to pay damages by reason of the assumption of liability in a contract or agreement. This ex- clusion does not apply to liability for damages that the additional in- sureds) would have in the absence of the contractor agreement. (2) "Bodily injury" or "property damage" occurring after: (a) All work, including materials, parts or equipment furnished in connection with such work, on the project (other than service, maintenance or repairs) to be performed by or on behalf of the additional insureds) at the site of the covered operations has been completed; or (b) That portion of "your work" out of which the injury or damages arises has been put to its in- tended use by any person or or- ganization other than another contractor or subcontractor en- gaged in performing operations for a principal as a part of the same project. (3) "Bodily injury" or "property damage" arising out of any act or omission of the additional insureds) or any of their "employees", other than the general supervision by the additional insureds) of your ongoing opera- tions performed for the additional in- sured(s). (4) "Property damage" to: Contains copyrighted material of Insurance Services Office, Inc., with its permission. GA 443 01 95 Copyright, Insurance Services Office, Inc., 1992 Page 1 of 2 (a) Property owned, used or occu- pied by or rented to the addi- tional insured(s); (b) Property in the care, custody, or control of the additional in- sureds) or over which the addi- tional insureds) are for any pur- pose exercising physical control; or (c) Any work, including materials, parts or equipment furnished in connection with such work, which is performed for the addi- tional insureds) by you. Contains copyrighted material of Insurance Services Office, Inc., with its permission. GA 443 01 95 Copyright, Insurance Services Office, Inc., 1992 Page 2 of 2 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY, PRIMARY /NONCONTRIBUTORY AMENDMENT OF CONDITIONS FOR DESIGNATED ADDITIONAL INSUREDS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name of Person or Organization (Additional Insured): The City of Dubuque, including all its elected and appointed officials, all its employees and volunteers, all its boards, commissions &/or authorities and their board members, employees and volunteers 50 West 13th St. Dubuque, IA 52001 With respect to insurance provided the additional insured shown in the Schedule, SECTION N - GOMMERCIAL GENERAL LIABILITY CONDI- TIONS, 5. Other Insurance is deleted in its en- tirety and replaced by the following: b, Other Insurance If other valid and collectible insurance is available to the additional insured for a loss we cover under Coverages A or B of this Coverage Part, our obligations are limited as follows: a. Primary Insurance Where required by a writ<en contract, this insurance is primary and noncontributory as respects any other insurance policy issued to the additional insured. Other- wise, b. below applies. b, Excess Insurance This insurance is excess over any of the other insurance available to the additional insured whether primary, excess, contin- gent or on any other basis. When this insurance is excess, we will have no duty under Coverages A or 8 to defend any claim or "suit" that any other insurer has a duty to defend. if no other insurer defends, we will undertake to do so, but we will be entitled to the insured's rights against all those other insurers. When this insurance is excess over any other insurance, we will pay only our share of the amount of the loss, if any, that exceeds the sum of: (1) The total amount that all such other insurance would pay for the loss in the absence of this insurance; and (2) The total of all deductible and self- insured amounts under all that other insurance. We will share the remaining loss, if any, with any other insurance that was not bought specifically to apply in excess of the Limits of Insurance shown in the Declarations of this Coverage Part. c. Method of Sharing if all of the other insurance permits con- tribution 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 in- surance 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 #otal applicable limits of insurance of all insurers. GA4D94 1D D1 WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WAIVER OF OUR RIGHT TO RECOVER FROM OTTERS ENDORSEMENT We have the right #o 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 anyone not named in the Schedule. Schedule City of Dubuque 50 West 13th St. Dubuque, IA 52001-4864 This endorsement changes the policy to which it is attached and is effective on the date issued unless oth- erwise stated. (The information below is required only when this endorsement is issued subsequent to preparation of the policy.) Endorsement Effective 9/22/09 Policy No. WC 1846366-02 Endorsement No. Insured McDermott Excavating Premium $ Inc 1 . Insurance Company THE CINCINNATI INDEMNITY CO. Countersigned by ~ WC 00 03 13 ©1983 National Council on Compensation Insurance. THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. DESIGNATED CONSTRUCTION PROJECT(S) GENERAL AGGREGATE LIMIT This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Designated Construction Projects: Bergfeld & Seippel Ponds, Dubuque, IA (If no entry appears above, information required to complete this endorsement will be shown in the Declara- tions as applicable to this endorsement). A. For all sums which the insured becomes legally ignated construction project shown in the obligated to pay as damages caused by "occur- Schedule above. rences under COVERAGE A (SECTION I), and for all medical expenses caused by accidents 4. The limits shown in the Declarations for under COVERAGE C (SECTION I), which can Each Occurrence, Fire Damage and Medi- be attributed only to ongoing operations at a cal Expense continue to apply. However, single designated construction project shown in instead of being subject to the General Ag- the Schedule above: gregate Limit shown in the Declarations, such limits will be subject to the applicable 1. A separate Designated Construction Proj- Designated Construction Project General ect General Aggregate Limit applies to Aggregate Limit. each designated construction project, and that limit is equal to the amount of the Gen- B• For all sums which the insured becomes legally eral Aggregate Limit shown in the Declara- obligated to pay as damages caused by "occur- tions, rences" under COVERAGE A (SECTION I), and for all medical expenses caused by accidents 2. The Designated Construction Project Gen- under COVERAGE C (SECTION I), which can- eral Aggregate Limit is the most we will pay not be attributed only to ongoing operations at a for the sum of all damages under single designated construction project shown in COVERAGE A, except damages because the Schedule above: of "bodily injury" or "properly damage" in- 1. An a ments made under COVERAGE A cluded in the "products-completed opera- for dama es or under COVERAGE C for tions hazard", and for medical expenses medical ex enses shall reduce the amount under COVERAGE C regardless of the available under the General A re ate number of: Limit or the Products-Completed Opera- a. Insureds; tions Aggregate Limit, whichever is applica- b. Claims made or "suits" brought; or b{e; and 2. Such payments shall not reduce any Des- c. Persons or organizations making claims or bringing "suits". ignated Construction Project General Ag- gregate Limit. 3. Any payments made under COVERAGE A C, When coverage for liability arising out of the for damages or under COVERAGE C for °products-completed operations hazard" is pro- medical expenses shall reduce the Desig- vided, any payments for damages because of Hated Construction Project General Aggre- "bodily injury" or "property damage" included in gate Limit for that designated construction the "products-completed operations hazard" will project. Such payments shall not reduce reduce the Products-Completed Operations Ag- the General Aggregate Limit shown in the gregate Limit, and not reduce the General Ag- Declarations nor shall they reduce any gregate Limit nor the Designated Construction other Designated Construction Project Project General Aggregate Limit. General Aggregate Limit for any other des- CG 25 03 03 97 Copyright, Insurance Services Office, Inc., 1996 Page 1 of 2 D. If the applicable designated construction project has been abandoned, delayed, or abandoned and then restarted, or if the authorized con- tracting parties deviate from plans, blueprints, E• designs, specifications or timetables, the project will still be deemed to be the same construction project. The provisions of Limits of Insurance (SECTION III) not otherwise modified by this endorsement shall continue to apply as stipulated. CG 25 03 03 97 Copyright, Insurance Services Office, Inc., 1996 Page 2 of 2 CITY OF DUBUQUE, IOWA GOVEi~NMENTAL IMMUNITIES ENDORSEMENT 1. Nonwaiver of Governmental Immunity. The insurance carrier expressly agrees and states that the purchase of this policy and the including of the City of Dubuque, Iowa as an Additional Insured does not waive any of the defenses of governmental immunity available to the City of Dubuque, Iowa under Code of Iowa Section 670.4 as it is now exists and as it may be amended from time to time. 2. 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 exists and as it may be amended from time to time. Those claims not subject to Code of Iowa Section 670.4 shall be covered by the terms and conditions of this insurance policy. 3. Assertion of Government Immunity. The City of Dubuque, Iowa shall be responsible for asserting any defense of governmental immunity, and may do so at any time and shall do so upon the timely written request of the insurance carrier. 4. Non-Denial of Coverage. The insurance carrier sha11 not deny coverage under this policy and the insurance carrier shall not deny any of the rights and benefits accruing to the City of Dubuque, lows under this policy for reasons of governmental immunity unless and until a court of competent jurisdiction has ruled in favor of the defense(s) of governmental immunity asserted by the City of Dubuque, Iowa. No Other Change in Policy. The above preservation of governmental immunities shall not otherwise change or alter the coverage available under the policy. 41 PROJECT INFORMATION REQUIREMENTS FOR STATE OF IOWA SALES TAX EXEMPTION CERTIFICATES FOR CONTRACTORS ~ SUBCONTRACTORS Submitting Department:l~-1~,u~Fy~Q~ ~a Department Contact: 11~g~,~l 1'~HAu1G Please complete this form in its entirety and submit along with the executed Construction Contracts, Bonds and Certificate of Insurance. Upon receipt, the City Finance Department will work with the Iowa Department of Revenue to issue Sales Tax Exemption Certificates to the approved contractor(s) to allow for the purchase or inventory withdrawal of materials for the specified Construction Project free from State of Iowa Sales Tax. Sales tax exemption certificates are not provided to material suppliers. The general contractor and subcontractors can provide copies of the sales tax exemption certificates issued by the City to individual material suppliers. Construction Project Name: Ber feld & Sei el Pond Project Description: Re air ri -ra sloe & outl et areas Start Date (Bid let date): 09-16-09 Completion Date: 10-16-09 1. General Prime Contractor: McDermott Excavati n Contact Name: Herbert W. Dol hi n Complete Address: (Include PO Box and Street Information) 14407 Hwy 20 West City, State, Zip Code D _ Telephone Number: 563-583-4633 Federal I.D. Number: (or Include Social Security Number) 39-1872711 Work Type to be Completed: General Contractor 2• Subcontractor: Complete Address: (Include PO Box and Street Information) City, State, Zip Code Telephone Number: Federal I.D. Number: (or Include Social Security Number) Work Type to be Completed: 3• Subcontractor: Complete Address: (Include PO Box and Street Information) City, State, Zip Code Telephone Number: Federal I.D. Number: (or Include Social Security Number) Work Type to be Completed: C'1D000ME-1UMCDER-11LOCALS-1\Temp\Sales Tax Exempt Certificate Information Summary 8.22.07-1.doc