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Contract-Bond_Drew Cook & Sons_ Dubuque Skate Park at Flora Park Copyrighted July 16, 2018 City of Dubuque Consent Items # 21. ITEM TITLE: Improvement Contracts / Performance, Payment and Maintenance Bonds SUMMARY: Colonial Painting & Decorating for the Washington Park Gazebo Painting Project; Drew Cook& Sons Excavating Co., Inc. for the John F. Kennedy Rd. Concrete Panel Replacement Project and the Dubuque Skate Park; Game Time/Cunningham Recreation for the Creek Wood Park Playground. SUGGESTED DISPOSITION: Suggested Disposition: Receive and File; Approve ATTACHMENTS: Description Type Colonial Painting and Decorating Contract and Bond Supporting Documentation Drew Cook& Sons Contract-Bond for Skate Park Supporting Documentation Drew Cook& Sons Contract-Bond for JFK Rd. Panel Supporting Documentation Replacement Game Tme/Cunningham Recreation Contract-Bond for Supporting Documentation Creek Wood Park Play Ground PUBLIC IMPROVEMENT CONTRACT DUBUQUE SKATE PARK FLORA PARK THIS IMPROVEMENT CONTRACT (the Contract), made in triplicate, dated for references purposes the day of --1-0'u,' 2018 between the City of Dubuque, Iowa, by its City Manager, through authority conferred upon the City Manager by its City Council (City), and Drew Cook and Sons Excavating Co., Inc. (Contractor). 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 Dubuque Skate Park; Flora Park (Project). 2. CONTRACT DOCUMENTS A. The Contract Documents consist of the following: 1. Project Title Page (Section 00100). 2. Project Directory Page (Section 00101). 3. This Public Improvement Contract (Section 00500). 4. Performance and Payment Bond (Section 00600). 5. Out -of -State Contractor Bond (Section 00610). 6. Other Bonds: a. (Bond Name) (pages — to inclusive). b. (Bond Name) (pages _ to inclusive). c. (Bond Name) (pages _ to , inclusive). 7. Iowa Department of Transportation standard specifications for highway and bridge construction, series 2018, plus current supplemental specifications and special provisions shall apply to construction work on this project. 8. The Iowa Statewide Urban Design and Specifications (SUDAS) 2017 Edition. 9. CITY OF DUBUQUE water distribution division standards and specifications 2011 edition for water mains and appurtenances, shall apply to this project. 10.Other Standard and Supplementary Specifications as listed on the Title Page of the Contract Document Manual. 11. Special Provisions included in the project Contract Document Manual. 12. Drawings: Sheet No. AS.00 through Sheet No.C6.20 (30 pages) or drawings consisting of sheets bearing the following general title: Dubuque Skate Park - Flora Park. 13. Addenda (numbers 01, inclusive). 14. Insurance Provisions and Requirements (Section 00700). 15. Sales Tax Exemption Certificate (Section 00750). 16. Site Condition Information (Section 00775). 17. Construction Schedule and Agreed Cost of Delay (Section 00800). 18. Erosion Control Certificate (Section 00900). 19. Consent Decree (Section 01000). NOT APPLICABLE 20. Exhibits to this Contract (enumerated as follows): a. Contractor's Bid (pages 1 to 10 , inclusive). 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. ii. e. None. 21. 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. 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. 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 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, 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. 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. 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 the State of Iowa, and the United States, and ordinances of the City of Dubuque, and in 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 Department of Labor Regulations (29 CFR, Part 5). Federal Prevailing Wage Act, if applicable, and related labor requirements and D. The City of Dubuque in accordance with Title VI of the Civil Rights Act of 1964, 78 Stat. 252, 42 U.S.C. 2000d -2000d-4 and Title 49, Code of Federal Regulations, Department of Transportation, Subtitle A, Office of the Secretary, Part 21, Nondiscrimination in Federally assisted programs of the Department of Transportation issued pursuant to such Act, hereby notifies all bidders that it will affirmatively insure that in any contract entered into pursuant to this advertisement, minority business enterprises will be afforded full opportunity to submit bids in response to this invitation and will not be discriminated against on the grounds of race, color, national origin, sex, age, or disability in consideration for an award. CONSENT DECREE RELATING TO THE PROJECT 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 APPLICABLE. CITY CONTRACTOR X 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 and its officers, directors, employees, agents, servants, successors, assigns, and all persons, firms 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. A copy of the Consent Decree is included in the Contract Documents and can be viewed at http://www.cityofdubuque.orq/DocumentCenter/HomeNiew/3173. A hard copy is available upon 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 of all documents, reports, data, records, or other information (including documents, records, or other information in electronic form) in its or its contractors' or agents' possession or control, or that come 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 be maintained under the Consent Decree. At the conclusion of the information -retention period, the City must notify the United States and the State at least ninety (90) Days prior to the destruction of any documents, records, or other information subject to such requirements and, upon request by the United States or the State, the City must deliver any such documents, records, or other information to the EPA or IDNR. 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. I 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- 5-1-1-09339, 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: Drew Cook and Sons Excavating Co., Inc. Contractor By:�C'ec&) (00 Signature 1�. fru) ( 00 )C Printed Name \(lcr Presid-Pnb Title (P12-11.% Date 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 the total work completed at the price(s) stated in the Contractor's Bid Proposal and Tess any Agreed Cost of Delay provided for in the Contract Documents. CONTRACT AMOUNT $712,835.95 CITY OF DUBUQUE, IOWA: City Manager By: Department Signature Michael C. Van Milligen Printed Name City Manager Title Date f?, CONTRACTOR: Drew Cook and Sons Excavating Co., Inc. Contractor By: LAD Lod , Si a ure Printed Name Tit e Date lc.r PsdA&- PERFORMANCE AND PAYMENT BOND KNOW ALL BY THESE PRESENTS: That we, Drew Cook and Sons Excavating Co., Inc, as Principal (hereinafter the "Contractor" or "Principal") and IMT Insurance 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 Seven hundred twelve thousand, eight hundred thirty-five dollars and ninety-five cents ($712,835.95) 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 of the above obligations are such that whereas said Contractor entered into a contract with the Owner, bearing date the day of 2018, (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 Dubuque Skate Park, Flora Park detail the following described improvements: Construction of a poured in place concrete skate park in Flora Park. Construction includes all related services for the construction of an approximate 13,000 SF skate park and additional amenities. 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. 2. 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 given, including but not limited to claims for all amounts due for labor, materials, lubricants, 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 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 perform the Contract; B. To consent without notice to any change in the Contract or Contract 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. 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 twenty-five percent (125%) 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 or to 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 and 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 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 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. 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. Witness our hands, in triplicate, this- 28th day of June , 2018. SU'r RETY:9 401GNED BY: n- ure o gent -�elrr'E Goodmann Printed Name of Agent 2774 University Ave Company Address Dubuque IA 52001 City, State, Zip Code 563-556-3232 Company Telephone Number PRINCIPAL: Contractor By:D COO )(--- Signature Signature L) Coo K._ Printed Name \hoe Pr es e n. Title FORM APPROVED BY: Representative for Owner SURETY: IMT Insu Sur ty Comp Company ignature Attorney -in -Fact Officer John E Goodmann Printed Name of Attorney -in -Fact Officer IMT Insurance Company Company Name P 0 Box 1306 Company Address Des Moines, IA 50306 City, State, Zip Code 800-274-3531 Company Telephone Number NOTE: 1. 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. EI nrJPL.PriJOPEPLcPrJR7rPrJ�rJ�r�rJ7rPrJ LEPEE PrJ�rJE.PLOPrJ�rJPrJLE-00.00rJ�r�rJL7rJ�rJP � rJ�r�rJ7rJEOPLrJM LEM 5 5 5 0 au uKnow 5 5 rj 50 5 5 5 rj 5 0 5 5 5 5 5 S 5 5 �j 5 rj 5 5 S 5 au u 5 5 S 5 5 5 5 SSY • POWER Notice: The warning found elsewhere in this Power All Persons By These Presents, that IMT Insurance Company its principal office in the City of West Des Moines, County of Polk, make, constitute and appoint John E. Goodmann of Dubuque and State of Iowa 5 INSURANCE OF ATTORNEY No. 94534 5 of Attorney affects the validity thereof. Please review carefully. 5 a corporation duly organized under the laws of the State of Iowa, and having 7c State of Iowa, hath made, constituted and appointed, and does by these presents 5 5 and Barton P. Brown 5 ad its true and lawful Attorney -in -Fact, with full power and 5 authority hereby conferred in its name, place and stead, to sign, execute, acknowledge and deliver in its behalf as surety any and all bonds, under-5 takings,recognizances or other written obligations in the nature thereof, subject to the limitation that any such instrument shall not exceed the 5 amount of: One Million Five Hundred Thousand and No/100 ($1,500,000.00) Dollars CS to bind IMT Insurance Company thereby as fully and to the same extent as if such bond or undertaking was signed by the duly authorized u officers of IMT Insurance Company, and all such acts of said Attorney -in -Fact, pursuant to the authority herein given, are hereby ratified and 5 confirmed. c5 This Power -of -Attorney is made and executed pursuant to and by authority of the following By Laws adopted by the Board of 5 Directors of IMT Insurance Company on December 18, 1998. 5 ARTICLE VIII, SECTION 4. - The President or any Vice President or Secretary shall have the authority to appoint Attorneys In Fact and 5 . to authorize them to execute on behalf of the Company, and attach thereto the Corporate Seal, bonds, undertakings, recognzances, con- tracts of indemnity or other obligatory writings, excluding insurance policies and endorsements. 5 ARTICLE VIII, SECTION 5. - The signature of any authorized officer and the Corporate Seal may be affixed by facsimile to any Power of Attorney authorizing the execution and delivery of any of the instruments described in Article VIII, Section 4 of the By -Laws. Such facsimile signature and seal shall have the same force and effect as though manually affixed. 5 In Witness Whereof, IMT Insurance Company has caused these presents to be signed by its President and its corporate seal to 5 be hereto affixed, this 5th day of February , 2018 E IMT Ins ranee Co parry rj Sean Kennedy, Pres'i�` M WARNING: THIS POWER IS INVALID IF NOT PRINTED WITH Rlb `BORDER AND RED LOGO. 5 STATE OF IOWA ss: S COUNTY OF POLK Cd On this 5th day of February 2018 , before me appeared Richard Keith, to me personally known, .3 who being by me duly sworn and that the Seal affixed behalf of said Corporation In Testimony first above written. I, Dalene Holland, the POWER-OF-ATTORNEY, In Witness Whereof, June did say that he is President of the to the said instrument is the Corporate by authority of its Board of Directors. Whereof, I have hereunto set my hand and IMT Insurance Company, the corporation described in the foregoing instrument, 5 Seal of the said Corporation and that the said instrument was signed and sealed in rCj affixed my Official Seal at the City of West Des Moines, Iowa, the day and year 5 4 , 5 5 "t . OW, IOWA : SETH CARY COMMISSION N0. 783929 SSIOH ASS Notary Public, Polk I aunty, Iowa 5 CERTIFICATE 5 do hereby certify that the above and foregoing is a true and correct copy of 5 Company, which is still in force and effect. 5 and affixed the Seal of the Company on 28th day of Secretary of the IMT Insurance Company executed by said the IMT Insurance I have hereunto set my hand 9018 � �C Qo Asz. it et�oi Dalene Holland, Secretary, 06 06 (01/07) 0 M�rJ�r�JMOfrJ�r OPc_ rPLE PL P PJnn.rrPrPLEPLEMnr EMILrJEPCPrJErPLrJOMME-0210rJ _013rJLI-2-.10_ PLPLE PL PL P� OMPLrJOPCnrLE- PL PL PLEf CI SALES AND USE TAX EXEMPTION CERTIFICATE The City of Dubuque, as a designated exempt entity awarding construction contracts, will issue special exemption certificates to contractors and subcontractors, allowing them to purchase, or withdraw from inventory, materials for the Contract free from sales tax pursuant to Iowa Code Sections: 422.42 (15) & (16), and 422.47 (5). The special exemption certificate will also allow a manufacturer of building materials to consume materials in the performance of a construction contract without owing tax on the fabricated cost of those materials. 1. These tax exemption certificates and authorization letters are applicable only for the work under the contract. The Contractor and each subcontractor shall comply with said Iowa Code Sales Tax requirements, shall keep records identifying the materials and supplies purchased and verify that they were used on the contract, and shall pay tax on any materials purchased tax-free and not used on the contract. 2. Upon award of Contract the City will register the Contract, Contractor, and each subcontractor with the Iowa Department of Revenue and Finance; and distribute tax exemption certificates and authorization letters to the Contractor and each subcontractor. PROJECT INFORMATION REQUIREMENTS FOR STATE OF IOWA SALES TAX EXEMPTION CERTIFICATES FOR CONTRACTORS & SUBCONTRACTORS Submitting Department: Leisure Services Department Contact: Steve Fehsal, Park Division Manager Project CIP Number(s): 350-2461 Please complete this form in its entirety and submit along with the executed Contract, 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 Project free from State of Iowa Sales Tax. Sales tax exemption certificates are not provided to material suppliers. The Contractor and subcontractors can provide copies of the sales tax exemption certificates issued by the City to individual material suppliers. Project Name: Dubuque Skate Park, Flora Park Project Description: Construction of a poured in place concrete skate park in Flora Park. Construction includes all related services for the construction of an approximate 13,000 SF skate park and additional amenities. Start Date (Bid Opening Date): June 8, 2018 Completion Date: December 8, 2018 1. General Prime Contractor: Contact Name: Drew Cook and Sons Excavating Co., Inc. Complete Address: (Include PO Box and Street Information) 10782 Timber Ridge Street City, State, Zip Code Dubuque, IA 52001 Telephone Number: 563-582-9292 Federal I.D. Number: (or Include Social Security Number) Li g , 1 L/ `"i 1 U7 6 Work Type to be Completed: Site work 2. Subcontractor: Artisan Skateparks Complete Address: (Include PO Box and Street Information) P.O. Box 598 City, State, Zip Code Kittyhawk, NC 27949 Telephone Number: 252-202-1333 Federal I.D. Number: (or Include Social Security Number) 45-3273959 Work Type to be Completed: All Concrete Work 3. Subcontractor: Jaeger Plumbing Complete Address: (Include PO Box and Street Information) 17500 John Deere Road City, State, Zip Code Dubuque, IA 52001 Telephone Number: 563-583-6677 Federal I.D. Number: (or Include Social Security Number) 42-1059151 Work Type to be Completed: Water Line 4. Subcontractor: Paulson Electric Complete Address: (Include PO Box and Street Information) Complete Address: (Include PO Box and Street Information) 685 Century Drive Ou rbu u f , rc Sacoy -I y3 Q City, State, Zip Code Dubuque, IA 52001 Federal I.D. Number: (or Include Social Security Number) Telephone Number: 563-588-2373 Pi U 1 NG Federal I.D. Number: (or Include Social Security Number) 4 D, — OCI3 .0 y 2 2 Work Type to be Completed: Electrical 5. Subcontractor: gtU,Q i Oil -Li +6W1 ft Complete Address: (Include PO Box and Street Information) 0 c)sei ,eox ) 46 U City, State, Zip Code Ou rbu u f , rc Sacoy -I y3 Q Telephone Number: le03— 5(.E3-3433 Federal I.D. Number: (or Include Social Security Number) 39 -015 P. 519 Work Type to be Completed: Pi U 1 NG CONSTRUCTION SCHEDULE AND AGREED COSTS OF DELAY SCHEDULE: CALENDAR DAY SCHEDULE: Work required by the Contract Documents shall commence within ten (10) calendar days after Notice to Proceed has been issued and shall be Completed within 180 consecutive calendar days. AGREED COSTS OF DELAY: Time is of the essence of the Contract. As delay in the diligent prosecution of the work may inconvenience the public, obstruct traffic, interfere with business, and/or increase costs to the City such as engineering, administration, and inspection, it is important that the work be prosecuted vigorously to final completion. An extension of the contract period may be granted by the City for any of the following reasons: 1. Additional work resulting from a modification of the Contract Documents by approved change order. 2. Delays caused by the City. 3. Other reasons beyond the control of the Contractor, which in the City's opinion, would justify such. Should the Contractor, or in case of default the Surety, fail to complete the work within the specified Substantial and Final Completion Dates, a deduction at the daily rate for agreed costs of delay will be made for each and every calendar day or working day, whichever is specified, such that the work remains uncompleted. The Contractor or the Contractor's Surety shall be responsible for all costs incidental to the completion of the work, and shall be required to pay the City the following daily costs: A. For each calendar day that any work remains uncompleted beyond the Final Completion date the contractor will be assessed and shall pay, $500.00 per calendar day, not as a penalty but as predetermined and Agreed Cost of Delay until Final Completion requirements are met. Permitting the Contractor to continue and finish the Work, or any part of it, after the expiration of the Final Completion dates or Milestone Dates or extension thereof shall in no way operate as a waiver on the part of the City of any of its rights or remedies under the contract, including its right to Agreed Cost of Delay pursuant to this provision. Furthermore, the assessment of Agreed Cost of Delay shall not constitute a waiver of the City's right to collect any additional damages which the City may sustain by failure of the Contractor to carry out the terms of the Contract. The Agreed Cost of Delay rates specified in the Contract Documents is hereby agreed upon as the true and actual damages due the City for loss to the City and to the public due to obstruction of traffic, interference with business, and/or increased costs to the City such as engineering, administration, construction, and inspection after the expiration of the contract times, or extension thereof. Such Agreed Cost of Delay will be separately invoiced to the Contractor, and final payment will be withheld from the Contractor until payment has been made of this invoice for the agreed cost of delay. The Contractor and its surety shall be liable for any agreed cost of delay in excess of the amount due the Contractor. DREWC-2 OP ID: ACC►Ri� n `,.._- CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 06/28/2018 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 have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER 563-556-3232 Goodmann Insurance Services 2774 University Ave Dubuque, IA 52001 John E Goodmann CONTACT John E Goodmann PHONE 563-556-3232 FAX 563-556-2246 (A/C, No, Ext): (A/C, No): ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC # INSURER A : United Fire & Casualty Co* 13021 INSURED Drew Cook and Sons Excavating Inc 10782 Timber Ridge Dubuque, IA 52001 INSURER B : 60432947 INSURER C: 06/10/2019 INSURER D : $ 1,000,000 INSURER E : INSURER F : X COVE • 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 LTR TYPE OF INSURANCE ADDL INSD SUBR WVD POLICY NUMBER POLICY EFF IMM/DD/YYYY) POLICY EXP (MM/DD/YYYY) LIMITS A X COMMERCIAL GENERAL LIABILITY Y Y 60432947 06/10/2018 06/10/2019 EACH OCCURRENCE $ 1,000,000 CLAIMS -MADE X OCCUR DAMAGE RESES(aoccu RENTED Eoccurrence) $ 100,000 $ 5,000 Primary & MED EXP (Any one person) Non-contributing PERSONAL & ADV INJURY $ 1,000,000 GEN'L AGGREGATE POLICY OTHER: X LIMIT APPLIES JECT PER: LOC GENERAL AGGREGATE $ 2,000,000 PRODUCTS - COMP/OP AGG $ 2,000,000 $ A AUTOMOBILE X LIABILITY ANY AUTO OWNED AUTOS ONLY HIRED AUTOS ONLY SCHEDULED AUTOS NON -OWNED AUTOS ONLY Y Y 60432947 06/10/2018 06/10/2019 COMBINED SINGLE LIMIT (Ea accident) $ 1,000,000 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ $ PROPERTY DAMAGE (Per accident) $ A X UMBRELLA LIAB EXCESS LIAB X OCCUR CLAIMS -MADE Y Y 60432947 06/10/2018 06/10/2019 EACH OCCURRENCE $ 3,000,000 AGGREGATE $ 3,000,000 DED RETENTION $ $ A WORKERSCOMPENSATIONX EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBEEXCLUDED? (Mandatory in NH)E.L. If yes, describe under DESCRIPTION OF OPERATIONS below Y / N N / A Y 60432947 06/10/2018 06/10/2019 ATUTE ER HA E.L. EACH ACCIDENT $ 100,000 DISEASE - EA EMPLOYEE $ 100,000 E.L. DISEASE - POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) The City of Dubuque, including all its elected and appointed officials, all its employees and volunteers, all its boards, commissions and/or authorities and their board members, employees and volunteers included as Addl Insured Project: Dubuque Skate Park, Flora Park ICATE HOLDER CANCELLATION CITYDUI City of Dubuque 50 W 13th Street Dubuque, IA 52001 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS, AUTHORIZED REPRESENTATIVE ACORD 25 (2016/03) © 1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD ENDORSEMENT 60432947 THE EOLLOWINO IS HOW THE C7171 ADDITIONAL INSURED FOR THE CITY OF DUBUQUE SHOULD READ: SPEC END (0000) TEE CITY OF DUBUQUE, INCLUDING ALL ITS ELECTED AND APPOINTED OFFICIALS, ALL ITS EMPLOYEES AND VOLUNTEERS, ALL ITS BOARDS, COMMISSIONS AND/OR AUTHORITIES AND THEIR BOARD MEMBERS, EMPLOYEES AND VOLUNTEERS. All ether tentis„loonditions, limitations and agreements of the policy retrain unONangecL SPEC END (0000) IL 71 05 10 14 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. PRIMARY AND NONCONTRIBUTORY - OTHER INSURANCE CONDITION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART COMMERCIAL UMBRELLA COVERAGE PART The following is added to the Other Insurance Condition and supersedes any provision to the contrary: Primary And Noncontributory Insurance This insurance is primary to and will not seek contribution from any other insurance available to an additional insured under your policy provided that: (1) The additional insured is a Named Insured under such other insurance; (2) You have agreed in writing in a contract or agreement that this insurance would be primary and would not seek contribution from any other insurance available to the additional insured; The additional insured gives us prompt written notice of any "occurrence" which may result in a claim and prompt written notice of "suit"; (4) The additional insured immediately forwards all legal papers to us, cooperates in the investigation or settlement of the claim or defense against the "suit", and otherwise complies with policy conditions. The additional insured must tender the defense and indemnity of any claim or "suit" to any other insurer which also insures against a loss we cover under this policy. This includes, but is not limited to, any insurer which has issued a policy of insurance in which the additional insured qualifies as an insured. For the purpose of this requirement, the term "insures against" refers to any self-insurance and to any insurer which issued a policy of insurance that may provide coverage for the loss, regardless of whether the additional insured has actually requested that the insurer provide the additional insured with a defense and/or indemnity under that policy of insurance. (6) The additional insured agrees to make available any other insurance that the additional insured has for a loss we cover under this policy. (3) (5) IL 71 05 10 14 Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 1 of 1 CG 71 31 02 15 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 PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE Name of Additional Insured Person(s) or Organization(s) Location And Description Of Completed Operations Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. Section II — Who Is An Insured is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to your liability for "bodily injury" or "property damage"which may be imputed to that person(s) or organization(s) directly arising out of "your work" at the location designated and described in the schedule of this endorsement performed for that additional insured and only for that liability included in the "products -completed operations hazard". However: 1. The insurance afforded to such additional insured only applies to the extent permitted by law; and 2. If coverage provided to the additional insured is required by a contractor agreement, the insurance afforded to such additional insured will not be broader than that which you are required By the contract or agreement to provide for such additional insured. B. With respect to the insurance afforded to these additional insureds, the following additional exclusions apply: This insurance does not apply to: 1. "Bodily injury", "property damage" or "personal and advertising injury" arising out of the rendering of, or the failure to render, any professional architectural, engineering or surveying services including: a. The preparing, approving, or failing to prepare or approve, maps, shop drawings, opinions, reports, surveys, field orders, change orders or drawings or specifications; or b. Supervisory, inspection, architectural or engineering activities. C. With respect to the insurance afforded to these additional insureds, the following is added to Section III — Limits Of Insurance: If coverage provided to the additional insured is required by a contract or agreement, the most we will pay on behalf of the additional insured is the amount of insurance: 1. Required by the contract or agreement; or 2. Available under the applicable Limits of Insurance shown in the Declarations; whichever is less. This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations. CG 71 31 02 15 Includes copyrighted material of Insurance Services Office, Inc., with its permission Page 1 of 1 0101 06-10-2018 POLICY NUMBER: 6 0 43 2 947 COMMERCIAL GENERAL LIABILITY SUPPLEMENTAL DECLARATIONS - ADDITIONAL INSUREDS Schedule of Additional Insureds Premium WNER3, LESSEES OR CONTRACTORS SCHEDULED PERSON 087085 -IOWA Owners, LeSsees or Contractors Location of Covered Operation NORTH ROCK REAL ESTATE 6723 WEAVER RD STEL 108 ROCKFORD IL 51114 0wNER8, LESSEES OR CONTRACTORS -COMR1ZTED OPERATIONS 087131 -IOWA CITY OF DUBUQUE 50 14 13TH ST DUBUQUE IA 52001 Location and Description of Completed Operations VARIOUS LOCATIONS HE SAMULS GIOUP INC 311 FINANCIAI 00 STE 300 WAUSAU 141 b4401• RIVER CITY PAVING - DIVISION OF' KATHY CONSTRUCTION COMPANY PO BOX 1430 DUBUQUE IA 52004 0G71 540107 50 750 POLICY NUMBER: 60432947 COMMERCIAL MULTIPLE LINE IL 70 84 06 16 Tilts ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. IOWA GOVERNMENTAL IMMUNITIES ENDORSEMENT This endorsement, modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY1COVERAE FORM BUSINESSOVVNERS COVERAGE FORM BUSINESS AUTO COVERAGE FORM Name cloll Organizaticin: CITY OF 0tIBUQt1S 50 W 13T5 ST Dtr131.1c2IJE IA 52001 1. Nionwalver Qf Governmental Ilmmunity. The insurance carrier expressly agrees and states that the purchase of this PollaY and the including of the organization shown in the Schedule as an Additional insured does not waive any of the defenses of governmental immunity available to the organization shown in the Schedule under Code of Iowa Section 670,4 as It 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, 3. /1;M i0 o Go • I me t. rnmoility. The organization shown in the Schedule 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. Nothing contained in this endorsement, shall prevent the carrier from asserting the defense of governmental immunity on behalf of the organization shown in the Schedule. 4. Non -Denial of Coverage, The insurance carrier shall not deny coverage under this policy and the insurance carrier shall not deny any of the rights and benefits accruing to the organization shown in the Schedule under this policy for reasons of governmental imniunity unless and until a court of competent jurisdiction has ruled in favor of the defense(s) of governmental immunity asserted by the organization shown in the Schedule. 5. No Other ,Chzi.nge Polley. The insurance carrier and the organization shown in the Schedule agree -that the above preservation of governmental immunities shall not otherwise change or alter the coverage availabte under the policy. IL 70 84 06 16 Page 1 of 1 CG 71 85 07 17 LAND IMPROVEMENT CONTRACTORS ASSOCIATION (LICA) — ULTRA LIABILITY PLUS ENDORSEMENT COMMERCIAL GENERAL LIABILITY EXTENSION ENDORSEMENT SUMMARY OF COVERAGES This is a summary of the various additional coverages and coverage modifications provided by this endorsement. No coverage is provided by this summary. * Extended Property Damage * Expanded Fire Legal Liability to include Explosion, Lightning and Sprinkler Leakage * Coverage for non -owned watercraft is extended to 51 feet in length * Property Damage — Borrowed Equipment * Property Damage Liability — Elevators * Coverage D — Voluntary Property Damage Coverage $10,000 Occurrence with a $20,000 Aggregate * Coverage E — Care, Custody and Control Property Damage Coverage $10,000 Occurrence with a $20,000 Aggregate — $500 Deductible * Coverage F — Electronic Data Liability Coverage — $50,000 * Coverage H — Water Damage Legal Liability — $25,000 * For newly formed or acquired organizations — extend the reporting requirement to 180 days * Broadened Named Insured * Automatic Additional Insured — Owners, Lessees or Contractors - Automatic Status When Required in Construction Agreement With You — Including Upstream Parties * Automatic Additional Insured — Vendors * Automatic Additional Insured — Lessor of Leased Equipment Automatic Status When Required in Lease Agreement With You * Automatic Additional Insured — Managers or Lessor of Premises * Additional Insured — Engineers, Architects or Surveyors Not Engaged by the Named Insured * Additional Insured — Employee Injury to Another Employee * Automatically included — Aggregate Limits of Insurance (per location) * Automatically included — Aggregate Limits of Insurance (per project) * Knowledge of occurrence — Knowledge of an "occurrence", "claim or suit" by your agent, servant or employee shall not in itself constitute knowledge of the named insured unless an officer of the named insured has received such notice from the agent, servant or employee * Blanket Waiver of Subrogation * Liberalization Condition * Unintentional failure to disclose all hazards. If you unintentionally fail to disclose any hazards existing at the inception date of your policy, we will not deny coverage under this Coverage Form because of such failure. However, this provision does not affect our right to collect additional premium or exercise our right of cancellation or non -renewal. * Mobile equipment to include snow removal, road maintenance and street cleaning equipment less than 1,000 lbs GVW * Bodily Injury Redefined REFER TO THE ACTUAL ENDORSEMENT FOLLOWING ON PAGES 2 THROUGH 9 FOR CHANGES AFFECTING YOUR INSURANCE PROTECTION CG 71 85 07 17 Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 1 of 9 CG 71 85 07 17 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. LAND IMPROVEMENT CONTRACTORS ASSOCIATION (LICA) ULTRA LIABILITY PLUS ENDORSEMENT This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SECTION I - COVERAGES A. The following changes are made at COVERAGE A — BODILY INJURY AND PROPERTY DAMAGE LIABILITY 1. Extended Property Damage At 2. Exclusions exclusion a. Expected or Intended Injury is replaced with the following: "Bodily injury" or "property damage" expected or intended from the standpoint of the insured. This exclusion does not apply to "bodily injury" or "property damage" resulting from the use of reasonable force to protect persons or property. 2. Expanded Fire Legal Liability At 2. Exclusions the last paragraph is deleted and replaced by the following: Exclusions c. through n. do not apply to damage by fire, explosion, lightning, smoke resulting from such fire, explosion, or lightning or sprinkler leakage to premises while rented to you or temporarily occupied by you with permission of this owner. A separate limit of insurance applies to this coverage as described in SECTION III — LIMITS OF INSURANCE . 3. Non -Owned Watercraft At 2. Exclusions exclusion g. Aircraft, Auto Or Watercraft (2) (a) is deleted and replaced by the following: (a) Less than 51 feet long; 4. Property Damage — Borrowed Equipment At 2. Exclusions the following is added to paragraph (4) of exclusion j. Damage To Property : This exclusion does not apply to "property damage" to borrowed equipment while at a jobsite and while not being used to perform operations. The most we will pay for "property damage" to any one piece of borrowed equipment under this coverage is $25,000 per occurrence. The insurance afforded under this provision is excess over any valid and collectible property insurance (including deductible) available to the insured, whether primary, excess, contingent or on any other basis. 5. Property Damage Liability — Elevators At 2. Exclusions the following is added to paragraphs (3), (4) and (6) of exclusion j. Damage To Property : This exclusion does not apply to "property damage" resulting from the use of elevators. However, any insurance provided for such "property damage" is excess over any valid and collectible property insurance (including deductible) available to the insured, whether primary, excess, contingent or on any other basis. B. The following coverages are added: 1. COVERAGE D — VOLUNTARY PROPERTY DAMAGE COVERAGE "Property damage" to property of others caused by the insured: a. While in your possession; or b. Arising out of "your work". Coverage applies at the request of the insured, whether or not the insured is legally obligated to pay. For the purposes of this Voluntary Property Damage Coverage only: CG 71 85 07 17 Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 2 of 9 CG 71 85 07 17 Exclusion j. Damage to Property is deleted and replaced by the following: j. Damage to Property "Property damage" to: (1) Property held by the insured for servicing, repair, storage or sale at premises you own, rent, lease, operate or use; (2) Property transported by or damage caused by any "automobile", "watercraft" or "aircraft" you own, hire or lease; (3) Property you own, rent, lease, borrow or use. The amount we will pay is limited as described below in SECTION III — LIMITS OF INSURANCE For the purposes of this Voluntary Property Damage Coverage, our right and duty to defend ends when we have paid the Limit of Liability or the Aggregate Limit for each coverage, and we are granted sole discretion in making payments under this coverage. 2. COVERAGE E — CARE, CUSTODY AND CONTROL PROPERTY DAMAGE COVERAGE For the purpose of this Care, Custody and Control Property Damage Coverage only: a. Item (4) of Exclusion j. does not apply. The amount we will pay is limited as described below in SECTION III — LIMITS OF INSURANCE For the purposes of this Care, Custody and Control Property Damage Coverage, our right and duty to defend ends when we have paid the Limit of Liability or the Aggregate Limit for each coverage, and we are granted sole discretion in making payments under this coverage. 3. COVERAGE F — ELECTRONIC DATA LIABILITY COVERAGE For the purposes of this Electronic Data Liability Coverage only: a. Exclusion p. of Coverage A — Bodily Injury And Property Damage Liability in Section I — Coverages is replaced by the following: 2. Exclusions This insurance does not apply to: p. Electronic Data Damages arising out of the loss of, loss of use of, damage to, corruption of, inability to access, or inability to manipulate "electronic data" that does not result from physical injury to tangible property. However, this exclusion does not apply to liability for damages because of "bodily injury" b. "Property Damage" means: (1) Physical injury to tangible property, including all resulting loss of use of that property. All such loss of use shall be deemed to occur at the time of the physical injury that caused it; or (2) Loss of use of tangible property that is not physically injured. All such loss of use shall be deemed to occur at the time of the "occurrence" that caused it; or (3) Loss of, loss of use of, damage to, corruption of, inability to access or inability to properly manipulate "electronic data", resulting from physical injury to tangible property. All such loss of "electronic data" shall be deemed to occur at the time of the "occurrence" that caused it. For the purposes of this Electronic Data Liability Coverage , "electronic data" is not tangible property. The amount we will pay is limited as described below in SECTION III — LIMITS OF INSURANCE 4. COVERAGE H — WATER DAMAGE LEGAL LIABILITY The Insurance provided under Coverage W (Section I) applies to "property damage" arising out of water damage to premises that are both rented to and occupied by you. The Limit under this coverage shall not be in addition to the Damage To Premises Rented To You Limit. The amount we will pay is limited as described below in SECTION III — LIMITS OF INSURANCE CG 71 85 07 17 Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 3 of 9 fl CG 71 85 07 17 C. SUPPLEMENTARY PAYMENTS — COVERAGES A AND B is amended: The following language is added to Item 1. However, we shall have none of the duties set forth above when this insurance applies only for Voluntary Property Damage Coverage and/or Care, Custody or Control Property Damage Coverage and we have paid the Limit of Liability or the Aggregate Limit for these coverages. SECTION II - WHO IS AN INSURED A. The following change is made: Extended Reporting Requirements Item 3.a. is deleted and replaced by the following : a. Coverage under this provision is afforded only until the 180th day after you acquire or form the organization or the end of the policy period, whichever is earlier. B. The following provisions are added: 4. BROAD FORM NAMED INSURED Item 1.f. is added as follows: f. Any legally incorporated entity of which you own more than 50 percent of the voting stock during the policy period only if there is no other similar insurance available to that entity. However: (1) Coverage A does not apply to "bodily injury" or "property damage" that occurred before you acquired more than 50 percent of the voting stock; and (2) Coverage B does not apply to "personal and advertising injury" arising out of an offense committed before you acquired more than 50 percent of the voting stock. 5. Additional Insured — Owners, Lessees or Contractors -Automatic Status When Required in Construction or Service Agreement With You — Including Upstream Parties a. Any person or organization for whom you are performing operations when you and such person or organization have agreed in writing in a contract or agreement that such person or organization be added as an additional insured on your policy; b. Any other person or organization you are required to add as an additional insured under the contract or agreement described in Paragraph a. above. Such person(s) or organization(s) is an additional insured only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" which may be imputed to that person or organization directly arising out of: 1. Your acts or omissions; or 2. The acts or omissions of those acting on your behalf; in the performance of your ongoing operations for the additional insured. However, the insurance afforded to such additional insured: 1. Only applies to the extent permitted by law; and 2. Will not be broader than that which you are required by the contract or agreement to provide for such additional insured. c. With respect to the insurance afforded to these additional insureds, the following additional exclusions apply: This insurance does not apply to: 1. "Bodily injury", "property damage" or "personal and advertising injury" arising out of the rendering of, or the failure to render, any professional architectural, engineering or surveying services, including: a. The preparing, approving, or failing to prepare or approve, maps, shop drawings, opinions, reports, surveys, field orders, change orders or drawings and specifications; or b. Supervisory, inspection, architectural or engineering activities. CG 71 85 07 17 Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 4 of 9 CG 71 85 07 17 This exclusion applies even if the claims against any insured allege negligence or other wrongdoing in the supervision, hiring, employment, training or monitoring of others by that insured, if the "occurrence" which caused the "bodily injury" or "property damage", or the offense which caused the "personal and advertising injury", involved the rendering of or the failure to render any professional architectural, engineering or surveying services. 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 insured(s) at the location of the covered operations has been completed; or b. That portion of "your work" out of which the injury or damage arises has been put to its intended use by any person or organization other than another contractor or subcontractor engaged in performing operations for a principal as a part of the same project. 6. Additional Insured — Vendors a. Any person(s) or organization(s) (referred to throughout this additional coverage as vendor), but only with respect to "bodily injury" or "property damage", which may be imputed to that person(s) or organization(s) arising out of "your products" shown with the Schedule which are distributed or sold in the regular course of the vendor's business is an insured. However: (1) The insurance afforded to such vendor only applies to the extent permitted by law; and (2) If coverage provided to the vendor is required by a contract or agreement, the insurance afforded to such vendor will not be broader than that which you are required by the contract or agreement to provide for such vendor. b. With respect to the insurance afforded to these vendors, the following additional exclusions apply: (1) This insurance afforded the vendor does not apply to: (a) "Bodily injury" or "property damage" for which the vendor is obligated to pay damages by reason of the assumption of liability in a contract or agreement. This exclusion does not apply to liability for damages that the vendor would have in the absence of the contract or agreement; (b) Any express warranty unauthorized by you; (c) Any physical or chemical change in the product made intentionally by the vendor; (d) Repackaging, except when unpacked solely for the purpose of inspection, demonstration, testing, or the substitution of parts under instructions from the manufacturer, and then repackaged in the original container. (e) Any failure to make such inspections, adjustments, tests or servicing as the vendor has agreed to make or normally undertakes to make in the usual course of business, in connection with the distribution or sale of products. Demonstration, installation, servicing or repair operations, except such operations performed at the vendor's premises in connection with the sale of the product. Products which, after distribution or sale by you, have been labeled or relabeled or used as a container, part or ingredient of any other thing or substance by or for the vendor. (h) "Bodily injury" or "property damage" arising out of the sole negligence of the vendor for its own acts or omissions or those of its employees or anyone else acting on its behalf. However, this exclusion does not apply to: i. The exceptions contained in Sub -paragraphs d. or f.; or ii. Such inspections, adjustments, tests or servicing as the vendor has agreed to make or normally undertakes to make in the usual course of business, in connection with the distribution or sale of the products. (f) (g) CG 71 85 07 17 Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 5 of 9 CG 71 85 07 17 (2) This insurance does not apply to any insured person or organization, from whom you have acquired such products, or any ingredient, part or container, entering into, accompanying or containing such products. 7. Additional Insured — Lessor of Leased Equipment — Automatic Status When Required in Lease Agreement With You a. Any person(s) or organization(s) from whom you lease equipment when you and such person(s) or organization(s) have agreed in writing in a contract or agreement that such person(s) or organization(s) be added as an additional insured on your policy. Such person(s) or organization(s) is an insured only with respect to your liability for "bodily injury", "property damage" or "personal and advertising injury" directly arising out of the maintenance, operation or use of equipment leased to you, which may be imputed to such person or organization as the lessor of equipment. However, the insurance afforded to such additional insured: (1) Only applies to the extent permitted by law; and (2) Will not be broader than that which you are required by the contract or agreement to provide for such additional insured. A person's or organization's status as an additional insured under this endorsement ends when their contract or agreement with you for such leased equipment ends. b. With respect to the insurance afforded to these additional insureds, this insurance does not apply to any "occurrence" which takes place after the equipment lease expires. 8. Additional Insured — Managers or Lessors of Premises a. Any person(s)-or organization(s), but only with respect to liability arising out of the ownership, maintenance use of that part of the premises leased to you and subject to the following additional exclusions: This insurance does not apply to: (1) Any "occurrence" which takes place after you cease to be a tenant in that premises. (2) Structural alterations, new construction or demolition operations performed by or on behalf of the person(s) or organization(s) shown in the Schedule. However: (1) The insurance afforded to such additional insured only applies to the extent permitted by law; and (2) If coverage provided to the additional insured is required by a contract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured. 9. Additional Insured — Engineers, Architects or Surveyors Not Engaged by the Named Insured a. Any architects, engineers or surveyors who are not engaged by you are insureds, but only with respect to liability for "bodily injury" or "property damage" or "personal and advertising injury" which may be imputed to that architect, engineer or surveyor arising out of: (1) Your acts or omissions; or (2) Your acts or omissions of those acting on your behalf; in the performance of your ongoing operations performed by you or on your behalf. But only if such architects, engineers or surveyors, whilenot engaged by you, are contractually required to be added as an additional insured to your policy. However, the insurance afforded to such additional insured: (1) Only applies to the extent permitted by law; and (2) Will not be broader than that which you are required by the contract or agreement to provide for such additional insured. or CG 71 85 07 17 Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 6 of 9 CG 71 85 07 17 b. With respect to the insurance afforded to these additional insureds, the following additional exclusion applies: This insurance does not apply to "bodily injury", "property damage" or "personal and advertising injury" arising out of the rendering of or failure to render any professional services, including: (1) The preparing, approving, or failing to prepare or approve, maps, drawings, opinions, reports, surveys, change orders, designs or specifications; or (2) Supervisory, inspection or engineering services. This exclusion applies even if the claims against any insured allege negligence or other wrongdoing in the supervision, hiring, employment, training or monitoring of others by that insured, if the "occurrence" which caused the "bodily injury" or "property damage", or the offense which caused the "personal and advertising injury", involved the rendering of or the failure to render any professional services. 10. Additional Insured — Employee Injury to Another Employee With respect to your "employees" who occupy positions which are supervisory in nature: Paragraph 2.a.(1) of SECTION II — WHO IS A NAMED INSURED is amended to read: a. "Bodily injury" or "personal and advertising injury" (1) To you, to your partners or members (if you are a partnership or joint venture), or to your members (if you are a limited liability company); (2) For which there is any obligation to share damages with or repay someone else who must pay damages because of the injury described in paragraph (1)(a) above; or (3) Arising out of his or her providing or failing to provide professional healthcare services. Paragraph 3.a. is deleted. For the purpose of this Item 10 only, a position is deemed to be supervisory in nature if that person performs principle work which is substantially different from that of his or her subordinates and has authority to hire, direct, discipline or discharge. SECTION III - LIMITS OF INSURANCE A. The following Items are deleted and replaced by the following: 2. The General Aggregate Limit is the most we will pay for the sum of: a. Medical expenses under Coverage C; b. Damages under Coverage A, except damages because of "bodily injury" or "property damage" included in the "products -completed operations hazard"; and c. Damages under Coverage 8; and d. Damages under Coverage H. 6. Subject to 5. above, the Damage to Premises Rented to You Limit is the most we will pay under Coverage A for damages because of "property damage" to any one premises, while rented to you, or in the case of damage by fire, explosion, lightning, smoke resulting from such fire, explosion, or lightning or sprinkler leakage while rented to you or temporarily occupied by you with permission of the owner. B. The following are added: 8. Subject to Paragraph 5. of SECTION III — LIMITS OF INSURANCE $25,000 is the most we will pay under Coverage H for Water Damage Legal Liability . 9. Aggregate Limits of Insurance (Per Location) The General Aggregate Limit applies separately to each of your "locations" owned by or rented to you or temporarily occupied by you with the permission of the owner. "Location" means premises involving the same or connecting lots, or premises whose connection is interrupted only by a street, roadway, waterway or right-of-way of a railroad. 10. Aggregate Limits of Insurance (Per Project) The General Aggregate Limit applies separately to each of your projects away from premises owned by or rented to you. CG 71 85 07 17 Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 7 of 9 CG 71 85 07 17 11. With respects to the insurance afforded to additional insureds afforded coverage by items 5 through 10 of SECTION II — WHO IS AN INSURED above, the following is added: The most we will pay on behalf of the additional insured is the amount of insurance: a. Required by the contract or agreement; b. Available under the applicable Limits of Insurance shown in the Declarations; Whichever is less. This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations. 12. Subject to 5. of SECTION III — LIMITS OF INSURANCE , a $10,000 "occurrence" limit and a $20,000 "aggregate" limit is the most we will pay under Coverage A for damages because of "property damage" covered under Coverage D — Voluntary Property Damage Coverage . For the purposes of this Voluntary Property Damage Coverage, our right and duty to defend ends when we have paid the Limit of Liability or the Aggregate Limit for each coverage, and we are granted sole discretion in making payments under this coverage. 13. Subject to 5. of SECTION III — LIMITS OF INSURANCE , a $10,000 "occurrence" limit and a $20,000 "aggregate" limit is the most we will pay under Coverage E -Care, Custody and Control Coverage regardless of the number of: a. Insureds; b. Claims made or "suits" brought; or c. Persons or organizations making claims or bringing "suits". Deductible - Our obligation to pay damages on your behalf applies only to the amount of damages in excess of $500. This deductible applies to all damages because of "property damage" as the result of any one 'occurrence" regardless of the number of persons or organizations who sustain damages because of that "occurrence". We may pay any part or all of the deductible amount to effect settlement of any claim or "suit" and upon notification of the action taken, you shall promptly reimburse us for such part of the deductible amount as has been paid by us. As respects this coverage "Aggregate" is the maximum amount we will pay for all covered "occurrences" during one policy period. For the purposes of this Care, Custody and Control Property Damage Coverage, our right and duty to defend ends when we have paid the Limit of Liability or the Aggregate Limit for each coverage, and we are granted sole discretion in making payments under this coverage. 15. Subject to 5. of SECTION III — LIMITS OF INSURANCE , the most we will pay for "property damage" under Coverage F — Electronic Data Liability Coverage for loss of "electronic data" is $50,000 without regard to the number of "occurrences". SECTION IV - COMMERCIAL GENERAL LIABILITY CONDITIONS A. The following conditions are amended: 1. Knowledge of Occurrence a. Condition 2., Items a. and b. are deleted and replaced by the following: (1) Duties In The Event Of Occurrence, Offense, Claim Or Suit (a) You must see to it that we are notified as soon as practicable of an "occurrence" or an offense which may result in a claim. Knowledge of an "occurrence" by your agent, servant or employee shall not in itself constitute knowledge of the named insured unless an officer of the named insured has received such notice from the agent, servant or employee. To the extent possible, notice should include: i. How, when and where the "occurrence" took place; ii. The names and addresses of any injured persons and witnesses, and iii. The nature and location of any injury or damage arising out of the "occurrence" or offense. CG 71 85 07 17 Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 8 of 9 CG 71 85 07 17 (b) If a claim is made or "suit" is brought against any insured, you must: i. Immediately record the specifics of the claim or "suit" and the date received; and ii. Notify us as soon as practicable. You must see to it that we receive written notice of the claim or "suit" as soon as practicable. Knowledge of a claim or "suit" by your agent, servant or employee shall not in itself constitute knowledge of the named insured unless an officer of the named insured has received such notice from the agent, servant or employee. 2. Where Broad Form Named Insured is added in SECTION II — WHO IS AN INSURED of this endorsement, Condition 4. Other Insurance b. Excess Insurance (1).(a) is replaced by the following: (a) Any of the other insurance, whether primary, excess, contingent or on any other basis, that is available to an insured solely by reason of ownership by you of more than 50 percent of the voting stock, and not withstanding any other language in any other policy. This provision does not apply to a policy written to apply specifically in excess of this policy. B. The following are added: 1. Condition (5) of 2.c. (5) Upon our request, replace or repair the property covered under Voluntary Property Damage Coverage at your actual cost, excluding profit or overhead. 10. Blanket Waiver Of Subrogation We waive any right of recovery we may have against any person or organization because of payments we make for injury or -damage arising -out -of -premises owned or occupied by or rented or -loaned to you, ongoing operations performed by you or on your behalf, done under a contract with that person or organization, "your work", or "your products". We waive this right where you have agreed to do so as part of a written contract, executed by you before the "bodily injury" or "property damage" occurs or the "personal injury" or "advertising injury" offense is committed. 11. Liberalization If a revision to this Coverage Part, which would provide more coverage with no additional premium becomes effective during the policy period in the state designated for the first Named Insured shown in the Declarations, your policy will automatically provide this additional coverage on the effective date of the revision. 12. Unintentional Failure to Disclose All Hazards Based on our reliance on your representations as to existing hazards, if you unintentionally should fail to disclose all such hazards at the inception date of your policy, we will not deny coverage under this Coverage Part because of such failure. However, this provision does not affect our right to collect additional premium or exercise our right of cancellation or non -renewal. SECTION V - DEFINITIONS A. At item 12. Mobile Equipment the wording at f.(1) is deleted and replaced by the following: f.(1) Equipment designed primarily for: (a) Snow removal; (b) Road maintenance, but not construction or resurfacing; or (c) Street cleaning; except for such vehicles that have a gross vehicle weight less than 1,000 lbs which are not designed for highway use. B. Item 3. "bodily injury" is deleted and replaced with the following: 3. "bodily injury" means physical injury, sickness or disease sustained by a person. This includes mental anguish, mental injury, shock, fright or death that results from such physical injury, sickness or disease. CG 71 85 07 17 Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 9 of 9 0101 06-10-2018 POLICY NUMBER: 60432947 WORKERS COMPENSATION AND EMPLOYERS LIABILITY SUPPLEMENTAL DECLARATIONS Premium Basis Total, Estimated Annual Remuneration Rate Per $100 of Remuneration Estimated ArumM Premium CONTINUED 4. THE PREMIUM FOR THIS POLICY WILL BE DETERMINED BY OUR MANUALS OF RULES, CLASSIFICATIONS, RATES AND RATING PLANS. ALL INFORMATION REQUIRED BELOW IS SUBJECT TO VERIFICATION AND CHANGE BY AUDIT. Form W0000313 applies to: THE SAMUELS GROUP INC RON SMITH & SONS CONSTRUCTION 1640 3.11STIN LN DUBUQUE IA CITY .0F DUBUQUE 50 W 13T8 ST DUBUQUE IA 52001 RIVER CITY PAVING— DIVISION OF KATHY CONSTRUCTION COMPANY PO BOX 1430 DUBUQUE IA 52002-1430 IA LQC# 01 5200 WOLFF RD DUBUQUE, IA 52002-2505 IA 5217 EXCAVATION & DRIVERS 6306 SEWER CoNETRucTION —ADD OPERATIONS & DRIVERS 6310 WATER MAIN OR CONNECTION CONSTRUCTION' DRIVERs 8810 CLERICAL OFFICE EMPLOYEES MCC LOC# 01 DEPT4t 04 CITY OF DUBUQUE 5200 WOLFF RD DUBUQUE( IA 52002-2505 300,000 5.550 16,680 IF ANY 5.840 0 IF ANY 3.510 0 80,577 .250 201 6217 EXCAVATION & DRIVERS IF ANY 5.5 0 0 0930 ADDITIONAL PREMIUM— WAIVER OF SUBROGATION 100 IA EOC# 01 DEPT# 05 RIVER CITY PAVING/ MATHY CONST 5200 WOLFF RD DUBUQUE( IA 52002-2505 6217 EXCAVATION E4 DRIVERS 1? ANY 5.560 0 0930 ADDITIONAL PREMIUM— WAIVER OF SUBROGATION 100 CONTINUED ON WC -28 WC -28 (01 96) WC 00 03 13 (4-84) WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT This endorsement changes the policy to which it is attached effective on the inception date of the policy unless a different date is indicated below. (The following "attaching clause" need be completed only when this endorsement is issued subsequent to preparation of the policy.) This endorsement, effective on Policy No. issued to Premium $ of the at 12:01 A.M. standard time, forms a part of (DATE) (NAME OF INSURANCE COMPANY) Authorized Representative 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 WC 00 03 13 (4-84) Copyright 1982, 1983 National Council on Compensation Insurance.