Signed Contract_Teska Associates for 2017 Comp Plan Implementation / Washington Neighborhood Market Analysis Copyrighted
January 7, 2019
City of Dubuque Consent Items # 25.
ITEM TITLE: Signed Contract(s)
SUMMARY: Emmons & Olivier Resources, Inc., for Eagle Point Park
Environmental Restoration; RDG Planning & Designforthe
Central Avenue Corridor Streetscape Master Plan; Teska
Associates for implementation of the 2017 Comprehensive
Plan and the Washington Neighborhood MarketAnalysis.
SUGGESTED DISPOSITION: Suggested Disposition: Receive and File
ATTACHMENTS:
Description Type
EOR Contract Supporting Documentation
RDG Contract Supporting Documentation
TeskaAgreement- Imagine Dubuque Supporting Documentation
TeskaAgreement- Washington Neighborhood Supporting Documentation
Dubuque
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TO: Michael C. Van Milligen, City Manager
FROM: Laura Carstens, Planning Services Manager ,���=
SUBJECT: Implementation of 2017 Comprehensive Plan — Teska Agreement
DATE: December 5, 2018
INTRODUCTION
This memo transmits two (2) originals of the Agreement with Teska Associates for
implementation of the 2017 Comprehensive Plan using a collective impact model. The Legal
and Finance Departments have reviewed and approved the Agreement and insurance.
BACKGROUND
With adoption of the FY 2019 Operating Budget, the City Council approved a budget
improvement level request for implementation of the 2017 Comprehensive Plan. The City is to
retain a consultant to serve as the backbone organization for a collective impact initiative to
coordinate implementation of the Comprehensive Plan for one year at a cost of$25,000.
DISCUSSION
The City saw effectiveness and desired results with investment in Teska Associates for
community engagement and plan development to contact, interview, conduct focus groups, lead
community workshops, collect and analyze data and input, synthesize 12,500+ ideas into 110
community recommendations, and serve as the City's liaison during Imagine Dubuque.
As we discussed and concluded, Teska Associates brought the time, talent, resources, and
capacities of their team that were beyond the capability of the City, making them the best choice
for implementation of the 2017 Comprehensive Plan.
Teska Associates will serve as the backbone organization for a collective impact initiative to
coordinate implementation of the Comprehensive Plan for one year, with City staff then to
assume the role of the backbone organization for community implementation.
Teska Associates will serve as project manager, data manager, facilitator, and promoter. Teska
Associates will make contacts, establish relationships, build more effective partnerships, foster
collaboration, create a strategy to market the process and measure success, etc. based on the
collective impact model. The process will be used to manage implementation outward in the
community and within the City organization.
RECOMMENDATION
Please sign and date the enclosed Agreements, and then return them to me. Thanks.
Enclosures
AGREEMENT BETWEEN
CITY OF DUBUQUE
AND
TESKA ASSOCIATES, INC.
This Agreement, dated for reference purposes the�w�day of December, 2018, is
made and entered into by and between the City of Dubuque, an lowa municipality with
offices at 50 West 13�h Street, Dubuque, IA 52001-4845, hereinafter referred to as
"CLIENT" and Teska Associates, Inc., an Illinois Corporation with primary offices at 627
Grove Street, Evanston, Illinois 60201, hereinafter referred to as "CONSULTANT".
WITNESSETH:
WHEREAS, CLIENT desires to engage the services of CONSULTANT to furnish
professional and technical assistance in connection with Services to Implement the
Imagine Dubuque Comprehensive Plan, hereinafter referred to as "the PROGRAM", and
CONSULTANT has signified its willingness to furnish professional and technical services
to CLIENT:
NOW THEREFORE, the parties hereto do mutually agree as follows:
SECTION 1. SCOPE OF CONSULTANT'S SERVICES. CONSULTANT agrees to
commence work upon execution of this Agreement, and to perform those services
outlined in Attachment A, a copy of which is attached hereto and incorporated into this
Agreement, utilizing the degree of skill and care exercised by practicing professionals
performing similar services under similar conditions. CONSULTANT makes no other
representations and no warranties of any kind, whether express or implied, with respect
to its services rendered hereunder.
SECTION 2. SERVICES TO 6E PROVIDED BY CLIENT. If any information, data,
reports, records and maps are existing and available and are useful for carrying out the
work on this Project, CLIENT shall promptly furnish this material to CONSULTANT.
CONSULTANT shall be entitled to rely upon the accuracy and completeness of all
information provided by CI.IENT and CLIENT shall obtain any information reasonably
necessary for CONSULTANT to perform its work under this Agreement. CLIENT will be
responsible for the organization and conduct of alI meetings necessary to carry out the
services described in Attachment A. CLIENT designates Laura Carstens, Planning
Services Manager to act as its representative with respect to the work to be pertormed
under this Agreement, and such person shall have authority to transmit instructions,
receive information, interpret and define CLIENT's policies and provide decisions in a
timely manner pertinent to the work covered by this Agreement until CONSULTANT has
been advised in writing by CLIENT that such authority has been revoked. CONSULTANT
shall assign Mike Hoffman, AICP, PLA as project manager with respect to the work to be
performed under this Agreement.
110418ba1
SECTION 3. COMPENSATION.
3.1 CONSULTANT shall be compensated for services on the basis of houriy billing
rates for professional and technical staff time devoted to the Project, plus reimbursement
for directly-related expenses such as travel (including use of automobiles at $0.545 per
mile, tolls, reproduction, etc.). The billing rates for professional staff are:
Mike Hoffman $155/hour
Other Principals $150 -- $190/hour
Senior Associates $115 - $125/hour
Associates $100 -- $110/hour
32 Based upon the Scope of Services in Attachment A, the maximum compensation
for this Project will not exceed $25,000. An accurate accounting of the hours and
expenses incurred on the assignment shall be kept by CONSULTANT and provided to
CLIENT. A $1,000 retainer will be required to initiate the Project, followed by monthly
invoices of$2,000 for the following year. Invoices will include a detailing of actual hours,
tasks completed, and expenses. if requested by City, CONSULTANT is available for
additional tasks (meetings, reports, etc.) at the above hourly rates. CONSULTANT will
provide an estimate of time and expenses and receive City written authorization prior to
proceeding with any additional efforts outside of the attached Scope of Services.
SECTION 4. METHOD OF PAYMENT.
4.1 Method of payment shall be as follows: CONSULTANT shall submit monthly
invoices for costs incurred on the Project during the billing period. To the extent permitted
by applicable law, CLIENT agrees to pay all costs and disbursements, including
reasonable attorney's fees, incurred by CONSULTANT in legal proceedings to collect for
invoices which are delinquent and payable. No interest or collection costs shall be
included in the maximum budget of this Agreement.
4.2 If CLIENT fails to make any payment due CONSULTANT within sixty (60) days
from receipt of the invoice, CONSULTANT may, after giving seven days' written notice to
CLIENT, suspend services under this Agreement until it has been paid in full all amounts
due.
SECTION 5. TIME OF PERFORMANCE. Work shall proceed in a timely manner
according to mutually acceptable scheduling adopted between CLIENT and
CONSULTANT. The services of CONSULTANT will begin upon delivery to
CONSULTANT of an executed copy of this Agreement and shall continue through
�;`K`l day of December 2019 (one year from date of agreement).
SECTION 6. EXCUSABLE DELAYS. CONSULTANT shall not be in default by reason
of any failure in performance of this Agreement in accordance with its terms (including
any failure by CONSULTANT to make progress in the prosecution of the work hereunder
which endangers such performance) if such failure arises out of causes beyond the
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reasonable control and without the fault or negligence of CONSULTANT. Such causes
may include, but are not restricted or limited to, acts of God, or of the public enemy, acts
of the government in either its sovereign or contractual capacity, fires, floods, epidemics,
quarantine restrictions, strikes, illness, accidents, and unusually severe weather, but in
every case the failure to perform must be beyond the control and without the fault or
negligence of CONSULTANT.
SECTION 7. TERMINATION. CLIENT and CONSULTANT shall have the right to
terminate this Agreement for any reason, with orwithout cause, bywritten notice delivered
to the other party at least thirty (30) days prior to the specified effective date of such
termination. In such event, all finished and unfinished documents prepared by
CONSULTANT under this Agreement shall become the property of CLIENT upon
payment of all invoices properly submitted and due CONSULTANT under the terms of
this Agreement. CLIENT acknowledges that incomplete documents are not represented
as suitable for any use or purpose, and further agrees to defend, indemnify, and hold
CONSULTANT harmless from and against all claims, costs, suits, damages, Iiabilities,
and expenses, including reasonable attorneys' fees, arising from or relating to any use,
reuse, or modification of any CONSULTANT-authored documents that occurs without
CONSULTANT'S consent and professional involvement. This includes any subsequent
use or completion of any incomplete documents.
SECTION 8. DISPUTE RESOLUTION. The parties agree that aIl claims, disputes, or
other matters in question that arise out of or relate to this Agreement or the breach thereof
shall be submitted to non-binding mediation as a condition precedent to the institution of
legal proceedings. If inediation fails to resolve the matter, either party may initiate
litigation in the lowa District Court for Dubuque County.
SECTION 9. CONFLICT OF INTEREST. CONSULTANT certifies that to the best of
CONSULTANT'S knowledge, no CLIENT employee or agent interested in this Agreement
has any pecuniary interest in the business of CONSULTANT or this Agreement, and that
no person associated with CONSULTANT has any interest that would conflict in any
manner or degree with the performance of this Agreement.
SECTION 10. CHANGES. CLIENT may, from time to time, require or request changes
in the scope or deadline of services of CONSULTANT to be performed hereunder. Such
changes, including any appropriate increase or decrease in the amount of compensation,
which are mutually agreed upon by and between CLIENT and CONSULTANT, shall be
incorporated in written amendments to this Agreement.
SECTION 11. HOLD HARMLESS
11.1 CLIENT shall hold CONSULTANT harmless, protect and defend CONSULTANT
against any claims brought by third parties in connection with the implementation of any
recommendations made or services rendered by CONSULTANT in accordance with this
Agreement that are not the result of CONSULTANT'S negligence.
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11.2 To the fullest extent permitted by law, the total liability in the aggregate, of
CONSULTANT to CLIENT or anyone daiming by, through, or under CLIENT, whether
arising in tort, breach of contract, or by virtue of any other cause of action or legal theory,
shall be limited to the coverage and limits of the insurance required of CONSULTANT by
this Agreement.
11.3 CONSULTANT shall indemnify and hold CLIENT from and against damages,
costs, liabilities, and expenses, to the extent caused by CONSULTANT'S negligence in
the performance of its services under this Agreement.
SECTION 12. INSURANCE. CONSULTANT shall maintain and keep in force during
the term of this Agreement insurance as described in the attached Insurance Schedule J.
CITY OF DUBUQUE, IOWA TESKA A5SOCIATES, INC,
Client Consultant
By ��-.� � � _
By � -....�
Michael C. Van Milligen Michael E. Ho an
City Manager Vice President
F:\Users\tsteckle\Lindahl W greements\TeskaAssoclnc-Imag ineDubuquelmplementation_110418.docx
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ATTACHMENT A
SCOPE OF SERVICES
Teska will serve assist the City of Dubuque in implementation efforts regarding the
Imagine Dubuque Comprehensive Plan. The Teska Team would make contacts,
establish relationships, build more effective partnerships, foster collaboration, create a
strategy to market the process and measure success, etc. based on the five collective
impact model components:
• Common Aqenda — taken from imagine Dubuque, but as refined and prioritized
thru this effort
. 5hared Measurement Svstems — working with existing systems where feasible
(metrics from the STAR Community Rating system, SOCRATA, Inclusive
Dubuque's Community Equity Profile, etc.)
• Mutuallv Reinforcinq Activities — events and shared activities, such as a Mayor's
kick-ofF breakfast, open house, education stations, or perhaps a tactical urbanism
effort
• Continuous Communications— regular meetings, web-based tools, etc.
• Backbone Orqanization — a separate, dedicated staff to plan, manage and support
the initiative (Teska in year one, City Staff in future years)
Specific tasks inciude:
1. Meetings — Communications and coordination will be critical to moving forward
with Imagine Dubuque, and from review of the literature on the Collective impact
Model — regular meetings of key partners are essential. For each meeting, Teska
would be responsible for creating the agenda, facilitating discussions, and
providing a meeting summary complete with action steps. Meetings will be
focused on prioritizing key focus areas for initial plan implementation, identification
of the roles various participants can play in implementation, identifying and
agreeing on common metrics to evaluate progress, establishing clear and open
lines of communications, promoting shared values and mutual benefits of working
cooperatively towards a common goal, etc.
We propose the following meeting structure:
a. Quarterly in-person meetings (total of 4), the first of which would be a kick-
off meeting to coordinate and organize the overall implementation effort.
b. Video conferences (total of 4) meetings, conducted in-between the in-
person meeting dates
2. Partner Coordination — Project management, phone calls and e-mails, data
management, moderating an online forum such as a Google Group, etc. is a key
part of a successful backbone organization. Teska will help fill this role in the first
5
year of implementation. We have budgeted 7 hours per month, for 10 months, for
this effort.
3. Events —As noted in your outline, a kick-off breakfast, outreach at events like the
Farmers Market, and other activities will be critical to plan implementation. Teska's
role would be to develop agenda's and event approach (along with the City and
partner groups), coordinate staffing, create promotional materials, etc. Teska
would attend the kick-off breakfast/lunch but given budget limitations would not
attend other events.
4. Community Promotion — Imagine Dubuque was built from the community and
will need the communities continued support to achieve the plan's vision. In
addition to working with key partner organizations, direct outreach to residents is
also critical. Teska will prepare articles (2 budgeted), Facebook posts (12
budgeted), and other promotional materials to assist in keeping the community
engaged in plan implementation. Note that we do have a person on-staff that can
translate materials into Spanish if appropriate.
5. Annual Report— Near the end of the year-long engagement, Teska will develop
an annual report detailing progress towards implementation of Imagine Dubuque,
including shared goals, comparison to metrics, next steps, and challenges faced
or anticipated in future plan implementation. This report will 6e produced in a short,
easy to read and illustrated format(target of 4 — 8 '/z x 11 pages), with an appendix
if needed for support information.
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i
AGREEMENT BETWEEN
CITY OF DUBUQUE
AND
TESKA ASSOCIATES, INC.
This AGREEMENT made and entered into this �'� day of �'�='?��N���'`,
2018 by and between City of Dubuque, a municipality with offices at 50 W. 1� 3�h Street,
Dubuque, IA 52001 hereinafter referred to as the "CLIENT" and Teska Associates, Inc.,
an Illinois Corporation with offices at 627 Grove Street, Evanston, Illinois 60201 ,
hereinafter referred to as the "CONSULTANT".
WITNESSETH:
WHEREAS, the CLIENT desires to engage the services of the CONSULTANT to
furnish professional and technical assistance in connection with a Market Update for the
Washington Neighborhood for the City of Dubuque, hereinafter referred to as the
"PROGRAM", and the CONSULTANT has signified its willingness to furnish professional
and technical services to the CLIENT:
NOW THEREFORE, the parties hereto do mutually agree as follows:
A. Scope of Consultant's Services
The CONSULTANT agrees to commence work upon execution of this
AGREEMENT, and to perform those services outlined in Attachment "A", a copy
of which is attached hereto and incorporated in this Agreement, utilizing the degree
of skill and care exercised by practicing professionals performing similar services
under similar conditions. CONSULTANT makes no other representations and no
warranties of any kind, whether express or implied, with respect to its services
rendered hereunder.
B. Services to be provided bv the CLIENT
In the event that any information, data, reports, records and maps are existing and
available and are useful for carrying out the work on this PROJECT, the CLIENT
shall promptly furnish this material to the CONSULTANT. CONSULTANT shall be
entitled to rely upon the accuracy and completeness of all information provided by
the CLIENT and the CLIENT shall obtain any information reasonably necessary
for the CONSULTANT to perform its work under this Agreement. The CLIENT will
be responsible for the organization and conduct of all meetings necessary to carry
out the services described in Attachment "A".
The CLIENT designates Laura Carstens to act as its representative with respect
to the work to be performed under this Agreement, and such person shall have
authority to transmit instructions, receive information, interpret and define the
CLIENT's policies and provide decisions in a timely manner pertinent to the work
covered by this Agreement until the CONSULTANT has been advised in writing by
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t
the CLIENT that such authority has been revoked. The CONSULTANT shall
assign Scott Goldstein with respect to the work to be performed under this
agreement.
C. Compensation
The CONSULTANT shall be compensated for services on the basis of hourly billing
rates for professional and technical staff time devoted to the PROJECT, plus
reimbursement for directly-related expenses such as travel (including use of
automobiles at $0.545 per mile, tolls, reproduction, subcontractors, etc.). The
billing rates for professional staff are:
Scott Goldstein, Principal $155/hour
Other Principals $150 -- $190/hour
Senior Associates $115 - $125/hour
Associates $100 -- $110/hour
Clerical/Technical $60/hour
Based upon the Scope of Services in Attachment A, the maximum compensation
for this project will not exceed $10,750. An accurate accounting of the hours and
expenses incurred on the assignment shall be kept by the CONSULTANT and the
CLIENT will be invoiced accordingly.
D. Method of Payment
Method of payment shall be as follows: The CONSULTANT shall submit monthly
invoices for costs incurred on the PROJECT during the billing period. Invoices are
subject to the requirements of the Prompt Payment Act of the State of Illinois. To
the extent permitted by applicable law, the CLIENT agrees to pay all costs and
disbursements, including reasonable attorney's fees, incurred by the
CONSULTANT in legal proceedings to collect for invoices which are delinquent
and payable. No interest or collection costs shall be inciuded in the upset
maximum budget of this Agreement.
If the CLIENT fails to make any payment due the CONSULTANT within sixty (60)
days from receipt of the invoice, the consultant may, after giving seven days'
written notice to the CLIENT, suspend services under this AGREEMENT until it
has been paid in full all amounts due.
E. Time of Performance
Work shall proceed in a timely manner according to mutually acceptable
scheduling adopted between the CLIENT and CONSULTANT. The services of the
CONSULTANT will begin upon delivery to the CONSULTANT of an executed copy
of this Agreement and shall continue through January 30, 2019.
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F. Excusable Delays
The CONSULTANT shall not be in default by reason of any failure in performance
of this Agreement in accordance with its terms (including any failure by the
CONSULTANT to make progress in the prosecution of the work hereunder which
endangers such performance) if such failure arises out of causes beyond the
reasonable control and without the fault or negligence of the CONSULTANT. Such
causes may include, but are not restricted or limited to, acts of God, or of the public
enemy, acts of the government in either its sovereign or contractual capacity, fires,
floods, epidemics, quarantine restrictions, strikes, illness, accidents, and unusually
severe weather, but in every case the failure to perform must be beyond the control
and without the fault or negligence of the CONSULTANT.
G. Termination
The CLIENT and the CONSULTANT shall have the right to terminate the
Agreement by written notice delivered to the other party at least thirty (30) days
prior to the specified effective date of such termination. In such event, all finished
and unfinished documents prepared by the CONSULTANT under the Agreement
shall become the property of the CLIENT upon payment ot all invoices properly
submitted and due the CONSULTANT under the terms of the Agreement. CLIENT
acknowledges that incomplete documents are not represented as suitable for any
use or purpose, and further agrees to defend, indemnify, and hold the
CONSULTANT harmless from and against all claims, costs, suits, damages,
liabilities, and expenses, including reasonable attorneys' fees, arising from or
relating to any use, reuse, or modification of any CONSULTANT-authored
documents that occurs without the CONSULTANT'S consent and professional
involvement. This includes any subsequent use or completion of any incomplete
documents.
H. Dispute Resolution
The parties agree that all claims, disputes, or other matters in question that arise
out of or relate to this AGREEMENT or the breach thereof shall be submitted to
non-binding mediation as a condition precedent to the institution of legal
proceedings. If inediation fails to resolve the matter, either party may initiate
litigation in the State of lowa.
I. Governing LawNenue
Any disputes arising under this Agreement shall be governed by lowa Iaw. The
venue for disputes shall be lowa District Court for Dubuque County.
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f
J. Conflict of Interest
The CONSULTANT certifies that to the best of his knowledge, no CLIENT's
employee or agent interested in the Agreement has any pecuniary interest in the
business of the CONSULTANT or the Agreement, and that no person associated
with the CONSULTANT has any interest that would conflict in any manner or
degree with the performance of the Agreement.
K. Chanqes
The CLIENT may, from time to time, require or request changes in the scope or
deadline of services of the CONSULTANT to be performed hereunder. Such
changes, including any appropriate increase or decrease in the amount of
compensation, which are mutually agreed upon by and between the CLIENT and
the CONSULTANT, shall be incorporated in written amendments to this
Agreement.
L. Hold Harmless
The CLIENT shall hold the CONSULTANT harmless, protect and defend the
CONSULTANT against any claims brought by third parties in connection with the
implementation of any recommendations made or services rendered by the
CONSULTANT in accordance with the Agreement that are not the result of the
CONSULTANT'S negligence.
To the fullest extent permitted by law, Consultant 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 Agreement, including but not
limited to attorneys' fees, arising out of or resulting from performance of this
Agreement, 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 therefrom, but only to the extent caused in whole or
in part by negligent acts or omissions of Consultant, or anyone directly or indirectly
employed by Consultant or anyone for whose acts Consultant may be liable,
regardless of whether or not such claim, damage, loss or expense is caused in
part by a party indemnified hereunder.
To the fullest extent permitted by law, the total liability in the aggregate, of the
CONSULTANT to the CLIENT or anyone claiming by, through, or under the
CLIENT, whether arising in tort, breach of contract, or by virtue of any other cause
of action or legal theory, shall be limited to the coverage and limits of the insurance
required of CONSULTANT by this Agreement.
The CONSULTANT shall indemnify and hold the CLIENT from and against
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damages, costs, liabilities, and expenses, to the extent caused by the
CONSULTANT'S negligence in the performance of its services under this
Agreement.
M. Insurance
The CONSULTANT shall maintain insurance in accordance with City Insurance
Schedule J which is attached.
IN WITNESS WHEREOF, the CLIENT and the CONSULTANT have executed this
Agreement on the date and year first above written.
CONSULTANT: CLIENT:
TESKA ASSOCIATES, INC. CITY OF DUBUQUE
..�__-
BY• BY:
Lee BroWn, FAICP Name: Michael Vatt Milligen
President Title: City Manager
Date: � 31 � S Date: � '�
Page � S
ATTACHMENT A
SCOPE OF SERVICES
1. Review and confirm market trade areas.
We will review with City staff the boundaries of the market trade area that was used in the 2010
Washington Neighborhood Plan and 2013 Washington Neighborhood Market Study.We would
propose using the same boundaries for the Washington Neighborhood and Trade Area and then
compare those results with City of Dubuque (rather than the 2.5 mile radius in the prior study). This
allows an easier format to follow and compare with other indicators.
We will work with City staff to identify investments that have been made in the Washington
Neighborhood and Trade Area based on available documents including the Bee Branch and
programs initiated in the CHANGE initiatives and Central Avenue corridor.
2. Demographic Profile
Once the trade areas are confirmed, a detailed demographic profile for each area will be produced.
Demographics will include household characteristics such as employment, income, housing value,
length of residence, race and ethnicity,age distribution, educational attainment, home ownership
rate, household type, and median income trend, etc. Data for key variables (population,
households, income, etc.) will be compared between 2000, 2010, and 2018 data.
Graphs, charts and maps will be developed for demographic characteristics induding income
diversity, age distribution and education attainment.
3. Retail Development
The study will provide an up-to-date analysis of current retail trade gaps and surpluses to identify
challenges and strengths in the Washington Neighborhood and the overall Trade Area.
Based on this analysis a table of current needs (retail gaps) will be identified as well as strengths
based on retail surpluses. The demand numbers will identify categories which could 6e attracted to
locate in the area based on local demand. Those categories identified as retail surplus includes
goods in which residents from other areas of Dubuque are coming into the Washington
Neighborhood and/or Trade Area and could be the basis for further expansion.
4. Employment,Office and Industrial
An analysis of employment characteristics of households including the fields employees work in,
their educational attainment, and income levels will be conducted.
We will also look at characteristics of empioyers, including characteristics of each field of employer
(e.g. manufacturing, logistics, retail services, education, etc.), and number of employees in each
field.
Finally, we will compare the employment characteristics of residents with that of employers to
determine any gaps or strengths.
Page � 6
This analysis can inform both economic development efforts to attract jobs such as office and
industrial firms and inform education and training programs to build the skills of local residents.
5. Housing
Housing characteristics will be determined for the two trade areas. These will income information
on home ownership versus rental, median housing value, range of housing value, affordability of
housing, length of tenure (for owners and renters).
Based on this analysis,we will compare trends for 2000, 2010, 2013 and 2018 data.
The analysis will also estimate the demand for various housing types including: workforce, senior,
veterans, persons with disabilities. This will include estimates of housing need by type of population
for each market segment. A series of maps of housing needs will also be produced in order to help
the city identify demand for various housing types.
6. Available Space
Based on addresses listed for rent or sale on real estate brokerage sites,we will identify properties
in the Washington Neighborhood and Trade Area and delermine availability of space, type of space,
and prices for:
Commercial Space—for rent and forsale
Industrial Space—for rent and for sale
Residential—single-family and multi-family for rent and for sale
We will compare this data to the results completed in 2013 to identify any trends in the real estate
market.
7. Findings
A summary of key findings will be developed to inform efforts by the City of Dubuque and its
partners in pursuing economic development, retail attraction, housing, education and training
programs.
Key findings will be organized by each set of issues, including:
- Key retail opportunity gaps—types of stores and goods that are in demand in the trade areas
and not met well by current offerings
- Key retail strengths—types of stores and goods that are attracting additional consumers to
come into the trade area and can be built upon as a market niche to anchor retail attraction
strategies.
- Office and Industrial—key areas of strength or needs of employers that can be used to attract
additional economic development
- Housing—for sale and for rent trends and demand for specific housing types
- Education and training—areas in which local employees may need additional training to meet
existing employment opportunities
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8. Draft and Final Market Study
A draft market study will be submitted to the City of Dubuque. A conference call will be held with
City staff to review the study and findings. Based on comments received from the City, a final
Market Study will be prepared and distributed to the City in electronic format.
9. Site Visit and Presentation
Teska will prepare a PowerPoint presentation for use in presenting on-site with staff, elected or
appointed officials. Teska will conduct a site visit to make the presentation to the appropriate staff
and/or officials. The PowerPoint will be completed in draft and final formats and made available to
staff to use in other settings at the completion of the project.
Page � 8
City of Dubuque Insurance Requirements for Professional Services
INSURANCE SCHEDULE J
1. reska associates. incshall fumish a signed certificate of insurance to the City of Dubuque, lowa for the �
coverage required in Exhibit I prior to commencing work and at the end of the project if the term of
work is longer than 60 days. Contractors presenting annual certificates shall present a certificate at �
ihe end of each project with the final billing. Each certificate shall be prepared on the most current
ACORD form approved by the lowa Department of Insurance or an equivalent approved by the
Finance Director. Each certificate shall include a statement under Description of Operations as to
why the certificate was issued. Eg: Project# or Project Location at
Washinqton Neiqhborhootl Market AnaNsis
2. All policies of insurance required hereunder shall be with an insurer authorized to do business in
lowa and all insurers shall have a rating of A or better in the current A.M. Best's Rating Guide.
3. Each certificate shall be furnished to the Pianning servic�epartment of the City of Dubuque.
4. Failure to provide coverage required by this Insurance Schedule shall not be deemed a waiver of
these requirements by the City of Dubuque. Failure to obtain or maintain the required insurance
shall be considered a material breach of this agreement.
5. Contractors shall require all subconsultants and sub-subconsultants to obtain and maintain during
the performance of work insurance for the coverages described in this Insurance Schedule and
shall obtain certificates of insurances from all such subconsultants and sub-subconsultants.
Contractors agree that they shall be liable for the failure of a subconsultant and sub-subconsultant
to obtain and maintain such coverages. The City may request a copy of such certificates from the
Contractor.
6. All required endorsements shall be attached to certificate of insurance.
7. Whenever a specific ISO form is listed, required the current edition of the form must be used, or an
equivalent form may be substituted if approved by the Finance Director and subject to the
contractor identifying and listing in writing all deviations and exclusions from the ISO form.
8. Contractors shall be required to carry the minimum coverage/limits, or greater if required by law or
other legal agreement, in Exhibit I. If the contractor's limits of liability are higher than the required
minimum limits then the provider's limits shall be this agreemenYs required limits.
Page 1 of 4 Schedule J Professional Services November 2017
City of Dubuque Insurance Requirements for Professional Services
INSURANCE SCHEDULE J (continued)
Exhibit I
A) COMMERCIAL GENERAL LIABILITY
General Aggregate Limit $2,000,000
Products-Completed Operations Aggregate Limit $1,000,000
Personal and Advertising Injury Limit $1,000,000
Each Occurrence $1,000,000
Fire Damage Limit(any one occurrence) $50,000
Medical Payments $5,000
1) Coverage shall be written on an occurrence, not claims made, form. The general
liability coverage shall be written in accord with ISO form CG0001 or business
owners form BP0002. All deviations from the standard ISO commercial general
liabilityform CG 0001, or business owners form BP 0002, shall be dearly
identified.
2) Include ISO endorsement form CG 25 04"Designated Location(s) General
Aggregate LimiY' or CG 25 03"Designated Construction Project(s) General
Aggregate Limit" as appropriate.
3) Include endorsement indicating that coverage is primary and non-contributory.
4) Include Preservatlon of Governmental Immunities Endorsement. (Sample
attached).
5) Include additional insured endorsement for:
The City of Dubuque, including al� its elected and appointed officials, all its
employees and volunteers, all its boards, commissions and/or authorities and
their board members, employees and volunteers. Use ISO form CG 2026.
6) Policy shall include Waiver of Right to Recover from Others endorsement.
B) AUTOMOBILE LIABILITY
Combined Single Limit $1,000,000
C) WORKERS' COMPENSATION & EMPLOYERS LIABILITY
Statutory benefits covering all employees injured on the job by accident or disease as
prescribed by lowa Code Chapter 85 as amended.
Coverage A Statutory—State of lowa
Coverage B Employers Liability
Each Accident $100,000
Each Employee-Disease $100,000
Policy Limit-Disease $500,000
Policy shall include Waiver of Right to Recover from Others endorsement.
Nonelection of Workers'Compensation or Employers' Liability Coverage under lowa
Code sec. 87.22
_yes _X_form attached
Page 2 of 4 Schedule J Professional Services November 2017
City of Dubuque Insurance Requirements for Professional Services
INSURANCE SCHEDULE J (continued)
D) UMBRELLA/EXCESS LIABILITY $1,000,000
Umbrella/excess liability coverage must be at least following form with the underlying
policies inciuded herein.
E) PROFESSIONAL LIABILITY $1,000,000
Provide evidence of coverage for 5 years after completion of project.
F) CYBER LIABILITY $1,000,000
_yes _no
Coverage for First and Third Party liability including but not limited to lost data and
restoration, loss of income and cyber breach of information.
Page 3 of 4 Schedule J Professional Services November 2017
City of Dubuque Insurance Requirements for Professional Services
PRESERVATION OF GOVERNMENTAL IMMUNITIES ENDORSEMENT
1. Nonwaiver of Governmental Immunitv. The insurer expressly agrees and states that the purchase
of this policy and the including of the City of Dubuque, lowa as an Additional Insured does not waive any
of the defenses of governmental immunity available to the City of Dubuque, lowa under Code of lowa
Section 670.4 as it is now exists and as it may be amended from time to time.
2. Claims Coveraqe. The insurer further agrees that this policy of insurance shall cover only those
claims not subject to the defense of governmental immunity under the Code of lowa Section 670.4 as it
now exists and as it may be amended from time to time. Those claims not subject to Code of lowa
Section 670.4 shall be covered by the terms and conditions of thls insurance policy.
3. Assertion of Government Immunitv. The City of Dubuque, lowa 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 insurer.
4. Non-Denial of Coveraqe. The insurer shall not deny coverage under this policy and the insurer
shall not deny any of the rights and benefits accruing to the City of Dubuque, lowa 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, lowa.
No Other Chanqe in Policv. The above preservation of governmental immunities shall not otherwise
change or alter the coverage available under the policy.
� _
(DEPARTMENT MANAGER: FILL IN ALL BLANKS AND CHECK BOXES)
Page 4 of 4 Schedule J Professional Services November 2017
,�coRo� CERTIFICATE OF LIABILITY INSURANCE °A�E`M`"'°°�`�""
� 9�1��201g
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFOftMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFOR�ED 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 6e endorsed. If SLIBROGATION IS WAIVED, subject to
the terms and conditions of the policy,cer[ain policies may require an endorsement. A stafement on this certificate does not confer rights to the
certificate holder in lieu of such endorsement(s).
PRO�UCER coNrncr Sma11 Business SBU
NAME:
ASSUT2CLP3YtREiS �f Illinois, LLC. _�q�c�No Ex�i, (847)679-7350 �A� Ho�: (8491619-p361
Four Westbrook Corporate E-Ma�� —
A�DRE55:
CERt2Y Suite SOO MSURER($�AFFORDINGCOVERAGE NAICN
Westchester IL 60154 iNsurtEan:Selective insurance co of Southeast 39926
MSURED INSURERB:TYU[IlbllSl Insurance_Company 27120
TESKA ASSOCIATES, INC. WSUReeC:
627 GROVE ST iNsuaeao� _
INSURER E:
EVANSTON IL 60201-4474 iNSUReRF: �
COVERAGES CERTIFICATE NUMBER:z018-19 REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTR4CT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIRCATE MAY BE ISSUEO OR MAY PERTAIN, THE INSUR4NCE AFFORDED BV THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CON�ITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR - IADDL'�SOBRj �POLICYEFF I POUCVEXP I
LTR I TYPE OF INSURANCE N o�wv �. POLICY NUMBER �. MMI� Opryyyy MMIO�IYVYV � LIMITS
X COMMERQAL GENERAL LIAeILITY EACH OCCURRENCE I$ 2,000,000
4 DAMAGE TO RENTED 500,000
A CLAIMS-MADE � OCCUR � PREMISES Ee occurrencel I$
X XCU included ._ 5 1839604 � B/28/2018 8/28/2019 MEDEXP�Anyoneperson) �$ 10,000
__ I PERSONAL&A�VINJURY IS_ Z,000,000
GEMLAGGREGATELIMITAPPLIESPER: GENERALAGGREGAI'E I 4,000,000
PRO- $
X POLICV� �ECT � ��� PRODUCTS-COMP/OPAGGI$ 4,000,000
I OTNER' NOCR � I$
AUTOMOBILELIABILITY COMBWEDSINGLELIMIT I$ 1,000,000
La accitlenp
A ANV AUTO BO�ILV INJURV(Per person) 3
ALLOWNED SCHEDULED -�- -
AUTOS AUTOS S 1834604 8/20/2018 8/28/2019 BODILVINJURY(Peraccitlent) $
X HIRE�AUTOS X AUTOSWNEo PROPERTY�AMAGE � $ �
(Per accidenl
$
X UMeRELLA LIAB �i pCCl1R EACH OCCURRENCE $ 1,000,000
EXCESSLIAB CLAIMS-MADE
A AGGREGATE � 1,000,000
IOE� I `Y RETENTION$ 0 S 1839609 8/28/2018 8/28/2019 �
WORNERSCOMPENSATION I X PER OTH- I
AN�EMPLOVERS'LIABILITY ��N STATUTE ER
ANYPROPRIETOWPARTNEWE%ECUTNE ELEACHACCIDENT� 1,000�000
OFFICEPoMEMBEREXCWOEO? �N� N�A _
B (MandatoryinNH) I 83WEC859594 8/28/2018 B/28/2019 ELOISEASE-EAEMPLOVEE$ 1,000,000
Ifyes.tlescribeunder EL.DISEASE-POLICYLIMIT�$ 1,000,000
I�ESCRIPTION OF OPERATIONS below
DESCRIPTION OF OPER/TION51 LOCATION51 VEHICLES (ACORD 101,Atlditional Remarks Schedule,may be atlached if more space is required)
RE: Washington Neighborhood Market Analysis
The City of Dubuque, including all its elected and appointed officials, all its employees and volunteers,
a11 its boards, commissions and/or authorities and their board members, employees and volunteers are
named as additional insureds on primary non-contributory basis as it pertains to the general liability
policy per written contract reguired. waiver of Subrogation applies in favor of the additional insureds
as it pertains to the general liability and workers compensation policies as per written contract
required. Subject to policy terms and conditions.
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
TYlE Cit]+ Of Dubugue THE EXPIRATION �ATE THEREOF, NOTICE WILL BE �ELIVERED IN
P1dRRing SeTViCeS ACCORDANCEWI7HTHEPOLICYPROVISIONS.
50 West 13th Street
Dubuque, IA SZOOL AUTHORIZEOREPRESENTATIVE
� f�
Scott Cummings/AKML00 ���'�'` �-�..>'�'"'��r+�ia',�,i'
� OO 1988-2014 ACORD CORPORATION. All rights reserved.
ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD
WS025(zotaoi)
MERCHANTSPRO PLUS
LIABILITY ENHANCEMENT
(INCLUDING BUSWESSOWNERS COMMON POLICY
CONDITIONS AMENDMENTS)
BUSINESSOWNERS
BP 71 94 04 10
SUMMARY OF COVERAGE AND INDEX
This is a summary of the various additional coverages and coverage modifications provided by this endorsement. No
coverage is provided by this summary. Refer to the actual endorsement (Pages 3. through 6. for changes affecting your
insurance protection.
DESCRIPTION PAGE FOUND
Additional Insured - Primary and/or Not Contributory 4
Blanket Additional Insureds - Including Broad Form Vendors -As Required By Contract 4
Damage To Premises Rented To You ($300,000) 3
Incidental Malpractice Amendment (not applicable in Illinois) 4
Knowledge of Occurrence, Offense, Claim or Suit 5
Liberalization Clause 6
Mental Anguish Amendment (not applicable in New York) 5
Mobile Equipment Definition Amended (not applicable in New York or Virginia) 6
Newly Formed orAcquired Organizations 5
Non-Owned Aircraft 3
Non-Owned Watercraft(under 60 feet) 3
Not-for-profit Members
As Additional Insureds 5
Medical Payments Coverage 3
Defined 6
Personal and Advertising Injury
Contractuai Exclusion Amendment (Excludes Advertisement) 6
Discrimination and Humiliation Amendment(not Applicable in New York; 6
Excludes Advertisement)
Supplementary Payments- Bai� Bonds ($3,000) and Loss of Earnings ($1,000) 3
Temporary Workers as Employees 6
Transfer of Rights of Recovery-Waiver of Subrogation 6
Unintentional Failure to Disclose Hazards 6
When Two or More Coverage Parts Apply to a Loss 3
Copyright, 2010 Selective Insurance Company of America. All rights reserved. BP 71 94 04 10
Includes copyrighted materiat of Insurance Services Office, Inc., with its permission. Page 1 of 6
INSUR�D'S COPY
THIS PAGE IS INTEtVTIONALLY LEFT BLANK.
Copyright, 2010 Selective Insurance Company of America. All rights reserved. BP 71 94 04 10
Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 2 of 6
INSURED'S COPY
MERCHANTSPROPLUS
LIABILITY ENHANCEMENT
(INCLUDING BUSINESSOWNERS COMMON POLICY
CONDITIONS AMENDMENTS)
BUSINESSOWNERS
BP 71 94 04 10
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
This endorsement modifies insurance provided under the following:
BUSINESSOWNERS COVERAGE FORM
The sections of the above form identified in this endorsement will be amended as shown below. With respect to coverage
provided by this endorsement, the provisions of the above form applies unless modified by the endorsement. But, when
two or more Coverage Parts of this policy apply to a loss, only the broadest coverage of this policy will apply, unless
specifically stated otherwise within the particular amendment covering that loss.
SECTION II — BUSINESSOWNERS LIABILITY COVER- 3. If the insured has any other valid and collecti-
AGES —Amendments ble insurance for "bodily injury" or "property
A. SUPPLEMENTARY PAYMENTS damage" that would be covered under this
Paragraphs 7.(b) and 1.(d) of Section A. COVER- provision, or on any other basis, this coverage
is then excess and subject to the Other
AGES are replaced by the following: Insurance provisions of this policy for Excess
(b) Up to �3,000 for cost of bail bonds required Insurance.
because of accidents or traffic law violations aris- D. MEDICAL PAYMENTS FOR NON-FOR-PROFIT
ing out of the use of any vehicle to which the Busi- MEMBERS
ness Liability Coverage for "bodily injury" applies.
We do not have to furnish these bonds. Paragraph 2.2. of Section B. Exclusions,
(d) All reasonable expenses incurred by the insured at APplicable to Medical Expenses Coverage is
our request to assist us in the investigation or deleted and replaced by the following:
defense of the claim or "suit," including actual loss We will not pay expenses for"bodily injury"
of earnings up to $1,000 a day because of time off a. To any insured, except "volunteer work-
from work. ers"and "not-for-profit members".
6. NON-OWNED AIRCRAFT E. DAMAGE TO PREMISES RENTED TO YOU
1. Exclusion g. of Section B. EXCLUSIONS does not 1. The last paragraph under Section 1. Applica-
apply to any aircraft, not owned or operated by any ble to Business Liability Coverage of B.
insured that is hlred, chartered or loaned with a EXCLUSIONS is replaced by the following:
paid crew. Exclusions c., d., e., f., g., h., i., k., I., m., n.
2. If the insured has any other valid and coliectible and o. in SECTION II — LIABILITY do not
insurance for "bodily injury" or "property damage" apply to damage by fire, lightning, explosion
that would be covered under this provision, or on or water release to premises rented to you or
any other basis, this coverage is then excess and temporarily occupled by you with permission
subject to the Other Insurance provisions of this of the owner. A separate Damage To Prem-
policy for Excess Insurance. ises Rented To You limit of insurance applies
C. NON-OWNED WATERCRAFT to this coverage as described in Section D.,
1. Exclusion 2 of Section B. EXCLUSIONS is Liability And Medical Expenses Limits Of
9�� ) Insurance.
replaced by the following:
2 A watercraft ou do not own that is: z• Paragraph 3. of Section D., Liability And
( ) Y Medical Expenses Limits Of Insurance is
(a) Less than GO feet long; and replaced by the following:
(b) Not being used to carry persons or prop- The most we will pay under Business Liability
erty for a charge. Coverage for damages because of "property
2. With respect to Paragraph a. above, any person is damage" to a premises while rented to you or
an insured who uses or is responsible for the use temporarily occupied by you with the permis-
of such watercraft with your expressed or implied sion of the owner is $300,000 unless a higher
consent. Damage To Premises Rented To You limit is
shown in the Declarations. For a premises
temporerily occupied by you, the applicable
limit will be the highest Damage To Premises
Rented To You limit shown in the Declara-
tions.
Copyright, 2010 Selective Insurance Company of America. All rights reserved. BP 71 94 04 10
Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 3 of 6
INSURED'S COPY
F. BLANKET ADDITIONAL INSUREDS — INCLUDING b. Any express warranty unauthorized by
BROAD FORM VENDORS - AS REQUIRED BY you;
CONTRACT a Any physical or chemical change in the
WHO IS AN INSURED is amended to include as an product made intentionally by the vendor;
additional insured any person or organization whom d. Repackaging, unless unpacked solely for
you have agreed in a written contract, written agree- the purpose of inspection, demonstration,
ment or written permit that such person or organization testing, or the substitution of parts under
be added as an additional insured on your policy. Such instructions from the manufacturer, and
person or organization is an additional insured only then repackaged in the original container;
with respect to:
1. "Bodily injury", "property damage" or "personal and e. Any failure to make such inspections,
adjustments, tests or servicing as the
advertising injury" caused, in whole or in part by vendor has agreed to make or normally
your ongoing operations performed for that person undertakes to make in the usual course of
or organization, "your producY' or premises owned business in connection with the sale of
or used by you. However, this provision does not the product; or
include any architects, engineers, or surveyors with
respect to any injury or damage caused, in whole f. Products which, after distribution or sale
or in part by rendering or failure to render any pro- by you, have been labeled or re-labeled
fessional services by or for you, including: or used as a container, or part of an ingre-
a. The preparing, approving, or failing to prepare dient of any other thing or substance by or
for the vendor; but this insurance does not
or approve maps, shop drawing, opinions, apply to any insured person or organiza-
reports, surveys, field orders, change orders or tion, from who you have acquired such
drawings and specifications; or products, or any ingredient, part or con-
b. Supervisory, inspection, architectural or engi- tainer, entering into, accompanying or
neering activities. containing such products.
2. "Bodily injury", "property damage" or" personal and This coverage shall be excess with respect to the
advertising injury" caused, in whole or in part by person or organization included as an additional
your maintenance, operation or use of equipment, insured by its provisions; any other insurance that
other than aircraft, "auto" or watercraft rented or person or organization has shall be primary with
leased to you by such person or organization. A respect to this insurance, unless this coverage is
person or organization's status as an additional required to be primary and/or not contributory in
insured under this endorsement ends when their the contract, agreement or permit referred to
written contract or written agreement with you for above.
such rented or leased equipment ends. With The provisions of this coverage extension do not
respect to the insurance afforded to these addi- apply unless the written contract or written agree-
tional insured, this insurance does not apply to any ment has been executed (executed means signed
"occurrence"which takes piace after the equipment by the named insured or written permit issued
lease expires. prior to the:
3. "Bodily injury" or "property damage" caused, in 1. "Bodily injury" or "property damage" with
whole or in part by "your products" which are dis- respect to a vendor as an additional insured,
tributed or sold in the regular course of a vendor's or
business, but the insurance afforded the vendor
does not apply to: 2. "Bodily injury," "property damage," or "per-
sonal and advertising injury" with respect to
a. "Bodily injury" or "property damage" for which other additional insureds.
the vendor is obligated to pay damages by G. INCIDENTAL MALPRACTICE
reason of the assumption of Iiability in a written
contract or written agreement; but this exclu- (This provision does not apply in Illinois). Para-
sion does not apply to liability for damages that graph 2.a.(1)(d) of Who Is An Insured is replaced
the vendor would have in the absence of the by the following:
written contract or written agreement;
Copyright, 2010 Selective Insurance Company of America. All rights reserved. BP 71 94 04 10
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INSURED'S COPY
_ _ _ _
(d) Arising,out of his or her providing or failing to pro- J. KNOWLEDGE OF OCCURRENCE, OFFENSE,
vide professional health care services. However, if CLAIM OR SUIT
you have employees who are nurses, emergency �, Condition 2.a. Duties In The Event Of
medical technicians or paramedics, and you are Occurrence, Offense, Claim Or Suit of
not in the business or occupation of providing any Section E. LIABILITY AND MEDICAL
such professional health care services, those EXPENSES GENERAL CONDITIONS will not
employees are insured with respect to such profes- apply untii after the "occurrence" or offense is
sional services. known to:
H. NOT-FOR-PROFIT ORGANIZATION MEMBERS AS (a) You, if you are an individuai;
ADDITIONAL INSUREDS
(b) A partner, if you are a partnership;
The following is added to Section C. WHO IS AN
INSURED: (c) An executive officer or insurance man-
ager, if you are a corporation;
If you are an organization other than a partnership, d Your members, managers or insurance
joint venture or a limited liability company and you are � �
a not for profit organization, WHO IS AN INSURED is manager, if you are a limited liability com-
amended to include as additional insureds your offi- pany; or
cials, trustees, board members, insurance managers (e) Your elected or appointed officials, trus-
and "not-for-profit members" but only with respect to tees, board members or your insurance
their liability for your activities or activities they perform manager if you are an organization other
on your behalf. than a partnership, joint venture or Ilmited
I. NEWLY FORMED OR ACQUIRED ORGANIZATIONS liability company.
The following is added to Section C. WHO IS AN 2. Condition 2.b. Duties In The Event Of
INSURED: Occurrence, Offense, Claim Or Suit of
Section E. LIABILITY AND MEDICAL
Any organization you newly acquire or form, other than EXPENSES GENERAL CONDITIONS wili not
a partnership, jolnt venture or Ilmited liability company, apply until after the claim or"suiY' is known to:
and over which you maintain ownership or majority
interest, will qualify as a Named Insured if there is no (a) You, if you are an indlvidual;
other similar insurance available to that organization. (b) A partner, if you are a partnership;
However, (c) An executive officer or insurance man-
a. Coverage under this provision is afforded only untll ager, if you are a corporation;
the 180th day after you acquire or form the organi- (d) Your members, managers or insurance
zation or the end of the policy period, whichever is manager, if you are a Ilmited liability com-
earlier; pany; or
b. This coverage does not appiy if the newly formed (e) Your elected or appointed officials, trus-
or acquired organization's coverage is excluded tees, board members or your insurance
either by the provisions of this Policy or by manager if you are an organization other
endorsement; and than a partnership, joint venture or limited
c. This coverage does not apply to "bodily injury" or liability company.
"property damage" that occurred before you K. MENTAL ANGUISH
acquired or formed the organization; and
Definition 3. "bodily injury" of Section F. LIABIL-
d. Thls coverage does not apply to "personal and ITY AND MEDICAL EXPENSES DEFINITIONS is
advertising injury" arising out of an offense commit- replaced by the following:
ted before you acquired or formed the organiza-
tion. (This provision does not apply in New York.)
"Bodily injury" means bodily injury, sickness or
disease sustained by a person, including mental
anguish or death resulting from any of these at
any time. (In New York, mental anguish has been
determined to be"bodily injury.")
Copyright, 2010 Selective Insurance Company of America. All rights reserved. BP 71 94 04 10
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INSURED'S COPY
i
L. TEMPORARY WORKERS AS EMPLOYEES SECTION III — BUSINESSOWNERS COMMON
Definition 5. "employee" of Section F. LIABILITY AND POLICY CONDITIONS—Amendments
MEDICAL EXPENSES DEFINITIONS is replaced by A. UNINTENTIONAL FAILURE TO DISCLOSE
the following: HAZARDS
"Employee" includes a "leased worker" and a "tempo- The following is added to Paragraph C. Conceal-
rary worker". ment, Misrepresentation Or Fraud:
M. MOBILE EQUIPMENT However, if you should unintentionally fail to dis-
(This provision does not apply in the states of New ciose any existing hazards in your representations
York or Virginia.) Paragraph f.(1)(a)(b)(c) of Definition to us at the inception date of the policy or during
12. "mobile equipmenY' of Section F. LIABILITY the policy period in connection with any additional
AND MEDICAL EXPENSES DEFINITIONS does not hazards, we shall not deny coverage under this
apply to seif-propelled vehicles of less than 1,000 policy based upon such failure.
pounds gross vehicle weight. B. Paragraph G. Liberalization is replaced by the
N. PERSONAL AND ADVERTISING INJURY following:
1. Definition 14. "personal and advertising injury" G. LIBERALIZATION
of Section F. LIABILITY AND MEDICAL If we revise this Coverage Form to provide more
EXPENSES DEFINITIONS is amended by the coverage without additional premium charge, sub-
addition of the following: ject to our filed company rules, your policy will
h. Discrimination or humiliation that results in automatically provide the additional coverage as
injury to the feelings or reputatlon of a natural of the day the revision is effective in your state.
person, but only if such discrimination or C. The following is added to Paragraph 2. Applica-
humiliation is: ble to Businessowners Liability Coverage of K.
(1) Not done intentionally by or at the direction Transfer Of Rights Of Recovery Against
of: Others To Us:
(a) The insured; or We will waive any right of recovery we may have
against a person or organization because of pay-
(b) Any executive officer, director, stock- ments we make for injury or damage arising out of
holder, partner or member of the your ongoing operations or "your work" done
insured; and under a contract with that person or organization
(2) Not directly or indirectly related to the and included in the "products-completed opera-
employment, prospective empioyment or tions hazard", if:
termination of employment of any person 1. The waiver of such rights is required in a writ-
or persons by any insured. ten contract or written agreement with that
(3) Not arising out of any advertisement by the person or organization; and
insured. 2. Such person or organization is an additional
2. Exclusion p.(4) of Section B. EXCLUSIONS is insured on your policy; and
amended to apply only to damages arising out of 3. You have assumed the liability of that person
advertisement. or organization in that same contract, and it is
3. Paragraph 1. above does not apply in the State of an "insured contract."
New York. This amendment only applies to that person or
4. Paragraphs 1. and 2. above do not apply if "per- organization identified above, and only if the injury
sonal and advertising injury" coverage is excluded or damage occurs subsequent to the execution of
either by the provisions of this policy or by the written contract or written agreement.
endorsement.
O. FlDDITIONAL DEFINTION
The following definition is added:
"Not for profit members" means a person(s) who is a
member of a not for profit organization, including clubs
and civic organizations who receive no financial or
other compensation.
Copyright, 2010 Selective Insurance Company of America. All rights reserved. BP 71 94 04 10
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INSURED'S COPY
DESIGNATED LOCATION(S)
GENERAL AGGREGATE LIMIT
POLICY NUMBER: s 1634604 BUSINESSOWNERS
BP 14 17 01 10
TI-IiS Et�DORSEMEIVT CHANGES THE POLICY. PL[ASE READ IT CAREFULLY.
This endorsement modifies insurance provided under the following:
BUS W ESSOWNERS COVERAGE FORM
SCHEDULE
Designated Location(s):
EACH LOCATION OWNED BY OR RENTED TO YOU
Information required to complete this Schedule, if not shown above, will be shown in the Declarations.
SECTION II —LIABILITY is amended as follows: 3. Any payments made under Paragraph A.1.
A. For all sums whlch the insured becomes legally obli- Business Liability for damages or under
gated to pay as damages for"bodily injury" or"property Paragraph A.2. Medical Expenses for medi-
damage" caused by "occurrences" covered under caI expenses shall reduce the Designated
Paragraph A.1. Business Liability, and for all medical Location General Aggregate Limit for that
expenses caused by accidents covered under Para- designated "location". Such payments shall
graph A.2. Medical Expenses, which can be attributed not reduce the Other Than Products/Com-
only to ongoing operations at a single designated pleted Operatlons Aggregate Limit shown in
"location" shown in the Schedule above: the Declarations nor shall they reduce any
other Designated Location General Aggregate
1. A separate Designated Locatlon General Aggre- Limit for any other designated "location"
gate Limit applies to each designated "location", shown in the Schedule above.
and that limit is equal to the amount of the Other n„ The Ilmits shown in the Declarations for Each
Than Products/Completed Operations Aggregate Occurrence, Damage To Premises Rented To
Limit shown in the Declarations. You and Medical Expenses continue to apply.
2. The Designated Location General Aggregate Limit However, instead of being subject to the
is the most we will pay for the sum of all damages Other Than Products/Completed Operations
under Paragraph A.1. Business Liability, except Aggregate Limit shown in the Declaratlons,
damages because of "bodily injury" or "property such limits will be subject to the applicable
damage" included in the "products-completed Designated Location General Aggregate Limit.
operations hazard", and for medical expenses g For all sums under Paragraph A.1. Business
under Paragraph A.2. Medical Expenses, Liability which the insured becomes legally obli-
regardless of the number of: gated to pay as damages because of "bodily
a. Insureds; injury" or "property damage" caused by "occur-
b. Claims made or"sults" brought; or rences" and medical expenses caused by acci-
c. Persons or organizations making claims or dents under Paragraph A.2. Medical Expenses,
bringing "suits". which cannot be attributed only to operations at a
single designated "location" shown in the Sched-
ule above:
Copyright, Insurance Services Offlce, Inc., 2009 BP 14 17 01 10
Page 1 of 2
INSURED'S COPY
1. Any payments made under Paragraph A.1. D. For the purposes of this endorsement, the
Business Liability for damages or under Para- Liability And Medical Expenses Definitions
graph A.2. Medical Expenses for medical section is amended by the addition of the follow-
expenses shall reduce the amount available under ing definition:
the Other Than Products/Completed Operations "Location" means premises involving the same or
Aggregate Limit or the Products/Completed Opera- connecting lots, or premises whose connection is
tions Aggregate Limit, whichever is applicable; and interrupted only by a street, roadway, watenvay or
2. Such payments shall not reduce any Designated right-of-way of a railroad.
Location General Aggregate Limit. E. The provisions of Paragraph D. Liability And
C. When coverage for liability arising out of the "products- Medical Expenses Limits Of Insurance, not
completed operations hazard° is provided, any pay- othenvise modified by this endorsement, shall
ments for damages because of"bodily injury" or "prop- continue to apply as stipulated.
erty damage" included in the "products-completed
operations hazard" will reduce the Products/Completed
Operations Aggregate Limit, and not reduce the Other
Than Products/Compieted Operations Aggregate Limit
nor the Designated Location General Aggregate Limit.
Copyright, Insurance Services Office, Inc., 2009 BP 14 17 01 10
Page 2 of 2
INSURED'S COPY
DESIGNATED CONSTRUCTION PROJECT(S)
GENERAL AGGREGATE LiMIT
POLICY NUMBER: s 1834604 BUSINESSOWNERS
BP 14 18 01 10
l'HIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
This endorsement modifies Insurance provided under the following:
BUSINESSOWNERS COVERAGE FORM
SCHEDULE
Designated Construction Project(s):
EACH CONSTRUCTION PROJECT OF YOURS AWAY FROM PREMISES OWNED BY OR RENTED TO YOU
Information required to complete this Schedule, if not shown above,will be shown in the Declarations.
SECTION II — LIABILITY is amended as follows: 3. Any payments made under Paragraph A.1.
A. For all sums which the insured becomes legally obli- Business Liability for damages or under
ated to a as damages for"bodil in ur ' or" ro ert Paragraph A.2. Medical Expenses for medi-
g p y y � y P p Y cal expenses shall reduce the Designated
damage" caused by "occurrences" covered under Construction Project General Aggregate Limit
Paragraph A.1. Business Liability, and for all medical for that designated construction project Such
expenses caused by accidents covered under Para- payments shall not reduce the Other Than
graph A.2. Medical Expenses, which can be attributed Products/Completed Operatiohs Aggregate
only to ongoing operations at a single designated con- Limit shown in the Declarations nor shall they
struction project shown in the Schedule above: reduce any other Designated Construction
1. A separate Designated Constructlon Project Gen- Project General Aggregate Llmit for any other
eral Aggregate Limit applies to each designated designated construction project shown in the
construction project, and that limit is equal to the Schedule above.
amount of the Other Than Products/Completed q. The limits shown in the Declarations for Each
Operations Aggregate Limit shown in the Declara- pccurrence, Damage To Premises Rented To
tions. You and Medical Expenses continue to apply.
2. The Designated Construction Project General However, instead of being subject to the
Aggregate Limit is the most we will pay for the sum Other Than Products/Completed Operations
of all damages under Paragraph A.1. Business Aggregate Limit shown in the Declarations,
Liability, except damages because of "bodily such limits will be subject to the applicable
injury" or "property damage" induded in the Designated Construction Project General
"products-completed operatlons hazard", and for Aggregate Limit.
medical expenses under Paragraph A.2. Medical g, For all sums under Paragraph A.1. Business
Expenses, regardless of the number of: Liability which the insured becomes legally obli-
a. Insureds; gated to pay as damages because of "bodily
b. Claims made or"suits"brought; or injury" or "property damage" caused by "occur-
c. Persons or organizations making claims or rences" and Paragraph A.2. Medical Expenses
bringing "suits". for medical expenses caused by accidents, which
cannot be attributed only to ongoing operations at
a single designated construction project shown in
the Schedule above:
Copyright, Insurance Services Office, Inc., 2009 BP 14 18 01 10
Page 1 of 2
INSURED'S COPY
1. Any payments made under Paragraph A.1. D. For the applicable designated construction project
Business Liability for damages or under has been abandoned, delayed, or abandoned and
Paragraph A.2. Medical Expenses for medical then restarted, or if the authorized contracting par-
expenses shall reduce the amount available under ties deviate from plans, blueprints, designs, speci-
the Other Than Products/Completed Operations fications or timetables, the project will still be
Aggregate Limit or the Products/Completed Opera- deemed to be the same construction project.
tions Aggregate Limit, whichever is applicable; and E. The provisions of Paragraph D. Liability And
2. Such payments shall not reduce any Designated Medical Expenses Limits Of Insurance, not
Construction Project General Aggregate Limit. otherwise modified by this endorsement, shall
C. When coverage for liability arising out of the "products- continue to appiy as stipulated.
completed operations hazard" is provided, any pay-
ments for damages because of"bodily injury" or"prop-
erty damage" included in the "products-completed
operations hazard" will reduce the Products/Completed
Operations Aggregate Limit, and not reduce the Other
Than Products/Completetl Operations Aggregate Limit
nor the Designated Construction Project General
Aggregate Limit.
Copyright, Insurance Services Office, Inc., 2009 BP 14 18 01 10
Page 2 of 2
INSURED'S COPY
��� � CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY)
0 911 1/2 01 8
THIS GER?!FlC.4TE!S 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(5),AUTHORIZED
REPRESENTATIVE OR PRODUCER AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed.If SUBROGATION IS WAIVED,subject to
the terms and conditions of the policy,certain policies may require an endorsement.A statement on this certificate does not confer rights to tlie
ifi h I r'n i f
PRODOCER Karen Bronson
CorRisk Sol.utions 312-637-8755
xo.sn
225 W. Washington St. SuiCe 1560 kbronson@cortisksolutioos.com
Chi.ca9o, IL 60606
INSURER�S�AFFORDINGCOVERAGE NAICp
INSURERA: New Hampshire Insurance Company 23891
INSlIREO INSl1RER B:
TeSkd ASSOCidt25� TnC. INSURERC:
627 Grpve Street
Ev�nStOR� IL C�201 WSURERD:
INSURER E:
INSURER R
COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BEI.OW HAVE BEEN ISSUED TO THE WSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED.NOTWITHSTANDING ANV REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAV PERTAIN,THE INSUftANCE AFFORDED BY THE POLIGES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIN7ITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
���� TYPEOFINSl1RANCE A��� y�nk POLICYNUMBER POUCYEFF POUCYEXP LIMITS
LTR INSRD WVO IMMI�O/TTYTI IMMID�ITTYTI
GENERAL LIABILITY EACH OCCURANCE
UAMHGE TO HEN I H]
COMWERCIAL GENERAL LIABILITY PREMISES(Ea ocwrancel
CLAIWSMAOE �OCCUR MEDEXP(Anyoneperson)
DOES NOT APPLY
PERSONAL&ANDINJURY
GENERALAGGREGATE
GEML AGGREGATE LIMIT APPLIES PER� PRODUCTS-COMP.�OP AGG
POLICV PROJECT LOC
I:UMdINEU JINIiLt LIMI I�tT
AUTOMOBILE LIABILITV �cciaen0
ANY AUTO sooaV wNav�aer no�so�p
n��owNeo scHeuu�eo p0E5NOTAPPLY aooaviNeuRv�ae,a«me�p
AUTOS At1TOS reovercivvmm�ee(ver
HIREDAUTOS NON-OWNED acciaenu
m i.ne
UMBREILALIAB OCCUR
EACH OCCURANCE
EXCESS LIAB CLAIMS MADE DOES NOT APPLY AGGREGATE
DED RETENTIONS
WORHERSCOMPENSATION W�y�AT� OTHER
AND EMPLOYERS'LIABILITY TORV LIMITS
ANV PROPRIETO WPARTNE(LEXECUTNE EL EACH ACQ�ENT
oFFic�MEMeER Exc�uoEo? y�N NrA DOES NOT APPLY
tL UI6GJHt-tP
(Mandatory in NH) ❑ EMPLOVEE
It yes,OescnOe untler UtSGHIFI IUN OF E L DISEASE-POLICY LIMIT
OPERATIONS below
OE9991993- PerOccurrence: $z�000,000
A Professional Liabili.ty pZ 03/25/lII 03/25/19 qnnuaiAggregate: $p�p00,000
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACCORD 101,Additional Remarks Schedule, if more space is required)
CERTIFICATE HOLDER CANCELLATION
ShIOULD ANY OF l FIE ABOVE�[SCRIBED POLIQES BE CANCELLE�BEPoRE THE EXPIRATION DATE
C1C}� OP DUbUCjll2 TH[REOF,NOTIC[WILLBE�ELIVEREDINACCORDANCEWITHTHEPOLICYPROVISIONS.
50 w 13th St AUTHORIZED REPRESENTATIVE
Dubuque, IA 52001 �.�c�'{�_
ACORD 25(2070105) OO 1988-2010 ACORD CORPORATION.Allrights reservetl.
The ACORD name and logo are registered marks of ACORD
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
WORKERS' COMPENSATION BROAD FORM ENDORSEMEPIT
EXTENDED OPTIONS
Policy Number: 83 WEC BS7594 Endorsement Number:
Effective Date: 08/28/18 Effective hour is the same as stated on the Information Page of the policy.
Named Insured and Address: TESKAASSOCIATES, INC.
627 GROVE ST
EVANSTON IL 60201
Section I of this endorsement expands coverage provided under WC 00 00 00.
Section II of this endorsement provides additional coverage usually only provided by endorsement.
Secfion III of this endorsement is a Schedule of Covered States.
You may use the index to locate these coverage features quickly:
INDEX
SUBJECT PAGE SUBJECT PAGE
SECTION I 2 B. Part One Does Not Appiy 3
PARTS ONE and TWO 2 C. Application of Coverage 3
01 We Will Also Pay 2 D. Additional Exclusions 3
PART-THREE 2 EXTENDED OPTIONS 4
02 How This Insurance Works 2 01 Employers' Liability Insurance 4
PART-SIX 2 02 Unintentional Failure to Disclose 4
03 Transfer of Your Rights and Duties 2 Hazards
04 Liberalization 2 03 Waiver of Our Right to Recover from 4
SECTION II 2 Others
VOLUNTARY COMPENSATION INSURANCE 2 04 Foreign Voluntary Compensation 4
05 Voluntary Compensation Insurance 2 A. How This Reimbursement Applies 4
A. How This Insurance Applies 2 B. We Will Reimburse 4
B. We Wiil Pay 3 C. Exclusions 4
C. Exclusions 3 D. Before We Pay 5
D. Before We Pay 3 E. Recovery From Others 5
E. Recovery From Others 3 F. Reimbursement For Actual Loss 5
F. Employers' Liability Insurance 3 Sustained
EMPLOYERS' LIABILITY STOP GAP 3 G. Repatriation 5
[NDORSEMENT H. Endemic Disease 5
06 Employers' Liability Stop Gap 3 05 Longshore and Harbor Workers' 5
Coverage Compensation Act Coverage
A. Stop Gap Coverage Limited to 3 Endorsement
North Dakota, Ohio, Washington, SECTION III 6
and Wyoming 01 Schedule of Covered States 6
Form WC 99 03 81 Printed in U.S.A. Page 1 of 6
Process Date: 07/19/18 Policy Expiration Date: 08/28/19
O 2000, The Hartford
_
SEi,7lviv i
PARTS ONE and TWO PART THREE
1. WE WILL ALSO PAY 2. How This Insurance Applies
D. We Will Also Pay of Part One (WORKERS' Paragraph 4. of A. How This Insurance Applies of
COMPENSATION INSURANCE); and Part 3 (Other States Insurance) is replaced by the
following:
E. We Will Also Pay of Part Two (EMPLOYERS'
LIABILITY INSURANCE) is replaced by the 4. If you have work on the effective date of this
following: policy in any state not listed In Item 3.A. of the
Information Page, coverage will not be aiforded
We Will Also Pay for that state unless we are notified within sixty
We will also pay these costs, in addition to other days.
amounts payable under this insurance, as part
of any claim, proceeding, or suit we defend: PART SIX
1. reasonable expenses incurred at our 3. Transfer Of Your Rights and Duties
request, INCLUDING loss of eamings; C. Transfer Of Your Rights and Duties of Part 6
2. premiums for bonds to release attachments (Conditions) is replaced by the following:
and for appeal bonds in bond amounts up to Your rights or duties under this policy may not be
the limit of our liability under this insurance; transferred without our written consent.
3. litigation costs taxed against you; If you die and we receive notice within sixty days
4. interest on a judgment as required by law after your death, we will cover your legal
untll we offer the amount due under this law; representative as insured.
and 4. Liberalization
5. expenses we Incur. If we adopt a change in this form that would broaden
the coverage of this form without extra charge, the
broader coverage will apply to this policy. It will apply
when the change becomes effective in your state.
SECTION II
VOLUNTARY COMPENSATION AND to work in a state shown in Item 3.A. of the
EMPLOYERS' LIABILITY COVERAGE Information Page.
3. The bodily injury must occur in the United
5. Voluntary Compensation Insurance States of America, its territories or
A. How This Insurance Applies possessions, or Canada, and may occur
This insurance applies to bodily injury by elsewhere if the employee is a United States
accident or bodily injury by disease. Bodily or Canadlan citizen, or otherwise legal
injury includes resulting death. resident, and legally employed, in the United
States or Canada and temporarily away from
1. The bodily injury must be sustained by any those places.
officer or employee not subject to the
workers' compensation law of any state 4. Bodily injury by accident must occur during
shown in Item 3.A. of the Information Page. the policy period.
2. The bodily injury must arise out of and in the 5. Bodily injury by disease must be caused or
course of employment or incidental aggravated by the conditions of the
Form WC 99 03 81 Printed in U.S.A. Page 2 of 6
officer's or employee's employment. The recovery and the benefits we paid. We will pay
officer's or employee's last day of last the balance to the persons entitled to it. If the
exposure to the conditions causing or persons entitled to the benefits of this insurance
aggravating such bodily injury by disease make a recovery from others, they must
must occur during the policy period. reimburse us for the benefits we paid them.
B. We Will Pay F. Employers' Liability Insurance
We will pay an amount equal to the benefits that Part Two (Employers' Liability Insurance) applies
would be required of you as if you and your to bodily injury covered by this endorsement as
employees were subject to the workers' though the State of Employment was shown in
compensation law of any state shown in Item Item 3.A. of the Information Page.
3.A. of the Informatlon Page. We will pay those This provision 5. does not apply in New Jersey or
amounts to the persons who would be entitled to Wisconsin.
them under the law. EMPLOYERS' LIABILITY STOP GAP COVERAGE
C. Exclusion
6. Employers' Liability Stop Gap Coverage
This insurance does not cover:
A. This coverage only applies in North Dakota, Ohio,
1. any obligation imposed by wori<ers' Washington, and Wyoming.
compensation or occupational disease law
or any similar law. B. Part One (Workers' Compensation Insurance)
does not apply to work in states shown in
2. bodily injury intentionaily caused or Paragraph A above.
aggravated by you.
C. Part Two (Employers' Liability Insurance) applies
3. officers or employees who have elected not in the states, shown in Paragraph A., as though
to be subject to the state workers' they were shown in Item 3.A. of the Information
compensation law. Page.
4. partners or sole proprietors not covered D. Part Two, Section C. Exclusions is changed by
under the Standard Sole Proprietors, adding these exclusions.
Partners, Officers and Others Coverage
Endorsement. This insurance does not cover;
D. Before We Pay 5. bodily injury intentionally caused or
Before we pay benefits to the persons entitled to aggravated by you or in Ohio bodily injury
resulting irom an act which is determined by
them,they must: an Ohio court of law to have been committed
1. Release you and us, in writing, of all by you with the belief that an injury is
responsibility for the injury or death. substantially certain to occur. However, the
2. Transfer to us their right to recover from cost of defending such claims or suits in Ohio
others who may be responsible for the injury is covered.
or death. 13. bodily injury sustained by any member of the
3. Cooperate with us and do everything flying crew of any aircraft.
necessary to enabte us to enforce the right 14. any claim for bodily injury with respect to
to recover from others. which you are deprived of any defense or
If the persons entitled to the benefits of this defenses or are othenvise subject to penalty
insurance fail to do those things, our duty to pay because of default in premium under the
ends at once. If they claim damages from you provisions of the workers' compensation law
or from us for the injury or death, our duty to pay or laws of a state shown in Paragraph A.
ends at once.
E. Recovery From Others
If we make a recovery from others, we will keep
an amount equal to our expenses of
Form WC 99 03 81 Printed in U.S.A. Page 3 of 6
_ _ _ _ ,
EXTER�DE� C�PTInNs
1. Employers' Liability Insurance 4. Foreign Voluntary Compensation and Employers'
Item 3.6. of the Information Page is replaced by Liability Reimbursement
the following: A. How This Reimbursement Applies
B. Employers' Liability Insurance: This reimbursement provision applies to bodily
1. Part Two of the policy applies to work in injury by accident or bodily injury by disease.
each state listed in Item 3.A. Bodily injury includes resulting death.
The Limits of Liabllity under Part Two are 1. The bodily injury must be sustained by an
the higher of: officer or emplayee.
Bodily Injury 2. The bodily injury must occur in the course of
by Accident $500,000 Each Accident employment necessary or incidental to work
in a country not listed in Exclusion C.1. of
Bodily Injury this provision.
by Disease $500,000 Policy Limit 3. Bodily injury by accident must occur during
the policy period.
Bodily Injury 4. Bodily injury by disease must be caused or
by Disease $500,000 Each Employee aggravated by the conditions of your
employment. The officer or employee's last
OR exposure to those conditions of your
2. The amount shown in the Information Page. employment must occur during the policy
This provision 1 of EXTENDED OPTIONS does not period.
apply in New York because the Limits Oi Our B. We Will Reimburse
Liability are unlimited. We will reimburse you for all amounts paid by
In this provision the limlts are changed from you whether such amounts are:
$500,000 to $1,000,000 in California. 1. voluntary payments for the benefits that
2. Uninten4ional Failure to Disclose Hazards would be required of you if you and your
If you unintentionally should fail to disclose all officers or empioyees were subject to any
existing hazards at the inception date of your policy, workers' compensation law of the state of
we shall not deny coverage under this policy hire of the individual employee.
because of such failure. 2. sums to which Part Two (Employers' Liability
3. Waiver of Our Right To Recover From Others Insurance) would apply if the Country of
Employment were shown in Item 3.A. of the
A. We have the right to recover our payments from Information Page.
anyone liable for an injury covered by this C. Exclusions
policy. We will not enforce our right against any
person or organization for whom you perform This insurance does not cover:
work under a written contract that requires you 1. any occurrences in the United States,
to obtain this agreement from us. Canada, and any country or jurisdiction
This agreement shall not operate directly or which is the subject of trade or economic
indirectly to benefit anyone not named in the sanctions imposed by the laws or regulations
agreement. of the United States of America in effect as
B. This provision 3. does not apply in the states of of the inception date of this policy.
Pennsylvania and Utah. 2. any obligation imposed by a workers'
compensation or occupational disease law,
or similar law.
3. bodily injury intentionally caused or
aggravated by you.
Form WC 99 03 81 Printed in U.S.A. Page 4 of 6
4. liability for any consequence, whether direct of America necessarily incurred as a direct resuit
or indirect, of war, invasion, act of Foreign of bodi�y injury.
enemy, hostilitles (whether war be declared Our reimbursement shall be limited as follows:
or not), civil war, rebellion, revolution, �, to the amount by which such expenses
insurrection or military or usurped power.
No endorsement now or subsequently exceed the normai cost of returning the officer
attached to this policy shall be construed as or employee if in good health, or
overriding or waiving this limitation unless 2. in the event of death, to the amount by which
specific reference is made thereto. such expenses exceed the normal cost of
D. Before We Pay returning the officer or employee if alive and
in good health.
Before we reimburse you for the benefits to the In no event shall our reimbursement exceed the
persons entitled to them, you must have them:
bodily injury by accident limit shown in Item 3.B.
1. release you and us, in writing, of all of the Information Page as respects any one such
responsibility for the injury or death, officer or empioyee whether dead or alive.
2. transfer to us their right to recover from F{, Endemic Disease
others who may be responsible for their
injury or death, The word "disease" includes any endemic
d iseases.
3. cooperate with us and do everything
necessary to enable us to enforce the right The coverage applies as if endemic diseases
to recover from others. were included in the provisions of the workers'
compensation law.
If the persons entitled to the benefits paid fail to
do these things, our duty to reimburse ends at 5. Longshore and Harbor Workers' Compensation
once. If they claim damages from us for the Act Coverage
injury or death, our duty to reimburse ends at General Section C. Workers' Compensation Law
once. is replaced by the following:
E. �iecovery From Others C. Workers' Compensation Law
If we make a recovery from others, we wi�l keep Workers' Compensation Law means the workers
an amount equal to our expenses of recovery or workers' compensation law and occupational
and the benefits we reimbursed. We will pay disease law of each state or territory named in
the balance to the persons entitled to it. If Item 3.A. of the Information Page and the
persons entitled to the benefits make a recovery Longshore and Harbor Workers' Compensation
from others, they must repay us for the amounts Act (33 USC Sections 901-950). It inciudes any
that we have reimbursed you. amendments to those laws that are in effect
F. Reimbursement for Rctual Loss Sustained during the policy period. It does not include any
other federal workers or workers' compensation
This endorsement provides only for law, other federal occupational disease law or the
reimbursement for the loss you actually sustain. provisions of any law that provide
In order for you to recover loss or expenses nonoccupational disability benefits.
under this reimbursement you must: Part Two (Employers' Liability Insurance), C.
1. actually sustain and pay the loss or expense Exclusions, exdusion 8, does not apply to work
in money after trial, or subject to the Longshore and Harbor Workers'
2. secure our consent for the payment of the Compensation Act.
loss or expense. This coverage does not apply to work subject to
G. Repatriation the Defense Base Act, the Outer Continental
Our reimbursement includes the additional Shelf Lands Act, or the Nonappropriated Fund
expenses of repatriation to the United States Instrumentalities Act.
Form WC 99 03 81 Printed in U.S.A. Page 5 of 6
,___
SECTl�N 111
1. SCHEDULE OF COVERED STATES B. If a state, shown in Item 3.A. of the Informatlon
A. This endorsement only applies in the states Page, approves this endorsement after the
listed in this Schedule of Covered States. effective date of this policy, this endorsement will
apply to thls policy. The coverage will apply in the
new state on the effective date of the state
approval.
C. Schedule of Covered States:
IL
Form WC 99 03 81 Printed in U.S.A. Page 6 of 6