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Improvement Contracts/Bonds_Floor Show Companies for GRC Carpet Replacements Projects Copyrighted August 5, 2019 City of Dubuque Consent Items # 37. ITEM TITLE: ImprovementContracts / Performance, Paymentand Maintenance Bonds SUM MARY: Floor Show Companies for the Grand River Center First- Floor Concourse Carpet Replacement Project. SUGGESTED DISPOSITION: Suggested Disposition: Receiveand File;Approve ATTACHMENTS: Description Type ContracVBond - Floor Show Companies Supporting Documentation i BID FORM 3 City of Dubuque, lowa d Improvement Contract � �i � THIS IMPROVEMENT CONTRACT (the Contract), made in triplicate, dated for reference � purposes the 25 day of June 2019, between the City of Dubuque, lowa, by its � City Manager, through authority conferred upon fihe City Manager by its City Council and '� Floor Show Companies of the City of Dubuque, lowa. 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 Grand River � Center 1St Floor Concourse Carpet Replacement Project (the Project). The Project shall be made completed in stricfiaccordance with the requirements of the laws of the State of lowa and ordinances of the City of Dubuque relating to infrastructure improvements, and � in accordance with the Contract Document shall of which provisions and documents are each and II all hereby referred to and made a part of this Contract just as much as if the detail statements �i thereof were repeated herein. � 2. Contract Documents shall mean and include the following: All ordinances and resolutions li heretofore adopted by the City Council having to do with theProject; the Notice to Bidders; il the Contractor's Proposal; and the Plans, Specifications, and General Requirements as � adopted by the City Council for the Project. �i � 3. All materials used by the Contractor in the Project shall be the best of their several kinds and shall be put in place to the satisfaction of the City Manager. 4. The Contractor shall remove any materials rejected by the City Manager as defective or improper, or any of said work condemned as unsuitable or defective, and the same shall be replaced or done anew to the satisfaction of the City Manager at the cost and expense of the Contractor. � 5. Five percent (5%) of the Contract price shall 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 that may be filed within said time for labor and materials done and furnished in connection with the performance of this Contract and for a longer period if such claims are not adjusted within that time, as provided in lowa Code Chapter 573. The City shall also retain additional sums to protect itself against any claim that has been filed against it for damages to persons or property arising through the prosecution of the work and such sums shall be held by the City until such claims have been settled, adjudicated or otherwise disposed of. 6. The Contractor has read and understands the specifications including General Requirements and has examined and understands the plans herein referred to and agrees not to plead misunderstanding or deception because of estimates of quantity, character, location or other conditions surrounding the same. 7. In addition to the guarantee provided for in the specifications, the Contractor shall also make good any other defect in any part of the Project due to improper construction notwithstanding the fact that said Project may have been accepted and fully paid for by the City, and the Contractor's bond shall be security therefore. 1 8. The Contractor shall fully complete the Project under this Contract on or before September 18, � 2019. � � 9. To the fullest extent permitted by law, the Contractor shall indemnify and hold harmless the City � and the Designer from and against all ciaims, damages, losses and expenses, including but not � limited to attorneys'fees, arising out of or resulting from performance of the Contract, provided � � that such claim, damages, loss or expense is attributable to bodily injury, sickness, disease or � death, or injury to or destruction of property(other than the Project itself) including loss of use li resulting there from, but only to the extent caused in whole or in part by negligent acts or omissions of the Contractor, the Contractor's subcontractor, or anyone directly or indirectly employed by the Contractor or the Contractor's subcontractor or anyone for whose acts the Contractor or the Contractor's subcontractor may be liable, regardless of whether or not such claim, damage, loss or expense is caused in part by a party indemnified hereunder. 1 10. The Project must be constructed in strict accordance with the requirements of the laws of the y State of lowa, and the United States, and ordinances of the City of Dubuque, and in accordance ;i with the Contract Documents. 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 i� Contract Work Hours and Safety Standards Act(40 USC 327-330)and Department of Labor �i Regulations (29 CFR, �art 5). i� � i! THE CITY AGREES: I'� Upon the completion of the Contract, and the acceptance of the Project by the City ;� Council, the City agrees to pay the Contractor as full compensation for the complete performance �� of this Contract and less any liquidated damages provided for in the Contract bocuments. The ;i, number of units stated in the plans and specifications is approximate only and the final payment ' shall be made by the work covered by the Contract. � CONTRACT AMOUNT- BID $ 23,447.00 � 2 Fl1RTHER CONDITIONS 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 agreement 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 � agreement or arrangement with any other person, firm, corporation or association which tends to � or does lessen or destroy free competition in the letting 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 be less than � $100.00 (One hundred Dollars) (Refer to Liquidated Damages Table)as liquidated damages to the City. � The surety on the bond furnished for this Contract, shall in addition to all other provisions, � be obligated to the extent provided for by lowa Code § 573.6, relating to this Contract, which provisions apply to said bond. The Contractor agrees, and its bond shall be surety therefore, that it will keep and � maintain the Project in good repair for a period of two years after acceptance of the same by the I� City Council and its bond shall be security therefore. � CITY OF DUB QUE, IOWA PRINCIPAL: � � I By: ��r�,� � Ci Manager tract , � By. � Signatur i ���� ��� Title ` i CER�"IFICATE OF CITY CLERK This i ertify that a c ifie copy of the above Contract has been filed in my office on the �� y of , 2019. ._"� , �, �� Kevy� Firnstahl, ity Clerk L 0 3 CONTRACT FORM 4 ', �, CITY OF DUBUQUE, IOWA �RFORMANCE, PAYMENT AND MAINTENANCE BOND o A� b KNOWN ALL MEN BY TH�SwE PRESENTS: That Floor Show Companies as Pri ipal (Contractor)and g �,, as Surety are held firmly bound unto e City of Dubuque, lowa ' (City), in the penal sum of$ 23,��;7.00 the same being 100% of the total price f the Contract for the Project herein referred to, lawful m`c�ney of the United States of America, wel and truly to be paid to said City of Dubuque, and to all other parti�es who, under the provisions of the I s of lowa, are intended to be protected and secured hereby for whi�h payment we bind ourselves, our�eirs, executors, successors � and assigns,jointly and severally by the`�e presents. � Dated at Dubuque, lowa, this day f , 019, and duly attested and � sealed. � ! a WHEREAS, the said Contractor by a Contract Ju.,ne 2.5, 2019, i orporated herein by reference, has p; agreed with said City of Dubuque to perform all la or and furn� h all materials required to be perFormed 9 and furnished for the Grand River Center 1St Floo Concou se Carpet Replacement Project (the � Project) according to the Contract and Construction cu�nts prepared therefore. ; It is expressly understood and agreed by the Co tractor and Surety bond that the following � � provisions are a part of this Bond and are binding upon a��d Contractor and Surety, to-wit: ; a 1. PERFORMANCE BOND: The Contractor sh.II well a� d faithfully observe, perform,fulfill and i' abide by each and every covenant, conditi and part f said Contract and Contract Documents, � by reference made a part hereof, for the P��oject, and sh I indemnify and save harmless the City from all outlay and expense incurred by��ie City by reaso of the Contractor's default of failure to I perform as required. The Contractor sh�ll also be responsib for the default or failure to perform as required under the Contract and C�htract Documents by a its subcontractors, suppliers, agents, or employees furnishing m��rials or providing labor in e performance of the Contract. 2. PAYMENT BOND: The Contractor�°and the Surety shall pay all just laims submitted by persons, firms, subcontractors, and corpor�tions furnishing materials for or pe orming labor in the performance of the Contract on �ccount ofwhich this Bond is given, in uding but not limited to claims for all amounts due for I bor, materials, lubricants, oil, gasoline, r airs on machinery, � equipment and tools, consum d or used by the Contractor or any subcont ctor,wherein the same are not satisfied out of he portion of the contract price which the City required to retain until completion of the impr�vement, but the Contractor and Surety shall not b liable to said persons, firms, or corpora�'ons unless the claims of said claimants against said ortion of the contract price shall have�een established as provided by law. The Contractor an �Surety hereby bind themselves to the o' ligations and conditions set forth in Chapter 573, Code of I�a, which by this reference is ma�e a part hereof as though fully set out herein. r" 3. MAINTENANCE BOf�D: The Contractor and the Surety hereby agree, at their own expense: a. To remedy any a'nd all defects that may develop in or result from work to be performed under the Contract withi�i the period of two (2) year(s)from the date of acceptance of the work under the Contra�t by the City Council of the City of Dubuque, lowa, by reason of defects in workmanship o�`materials used in construction of said work; b. To keep al.l`work in continuous good repair; and c. To pay the City the reasonable costs of monitoring and inspection to assure that any defects are remedied, and to repay the City all outlay and expense incurred as a result of Contractor's and Surety's failure to remedy any defect as required by this section. 4 � � BID FORM 3 � City of Dubuque, lowa ; Improvement Contract � q THIS IMPROVEMENT CONTRACT (the Contract), made in triplicate, dated for reference purposes the 25 day of June 2019, between the City of Dubuque, lowa, by its � City Manager, through authority conferred upon the City Manager by its City Council and � Floor Show Companies of the City of Dubuque, lowa. � For and in consideration of the mutual covenants herein contained, the parties hereto � agree as follows: � CONTRACTOR AGREES ; � P 1. To furnish all material and equipment and to perform all labor necessary for the Grand River � Center 15t Floor Concourse Carpet Replacement Project (the Project). ' The Project shall be made completed in strict accordance with the requirements of the laws of the ` State of lowa and ordinances of the City of Dubuque relating to infrastructure improvements, and � in accordance with the Contract Document shall of which provisions and documents are each and � all hereby referred to and made a part of this Contract just as much as if the detail statements thereof were repeated herein. 2. Contract Documents shall mean and include the following: All ordinances and resolutions I heretofore adopted by the City Council having to do with the Project; the Notice to Bidders; '� the Contractor's Proposal; and the Plans, Specifications, and General Requirements as i adopted by the City Council for the Project. ; 3. All materials used by the Contractor in the Project shall be the best of their several kinds and � shall be put in place to the satisfaction of the City Manager. � 4. The Contractor shall remove any materials rejected by the City Manager as defective or improper, or any of said work condemned as unsuitable or defective, and the same shall be replaced or done anew to the satisfaction of the City Manager at the cost and expense of the � Contractor. � � 5. Five percent(5%)of the Contract price shall 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 that may be filed within said time for labor and materials done and furnished in connection with the performance of this Contract and for a longer period if such claims are not adjusted within that time, as provided in lowa Code Chapter 573. The City shall also retain additional sums to protect itself against any claim that has been filed against it for damages to persons or property arising through the prosecution of the work and such sums shall be held by the City until such claims have been settled, adjudicated or otherwise disposed of. 6. The Contractor has read and understands the specifications including General Requirements , and has examined and understands the plans herein referred to and agrees not to plead misunderstanding or deception because of estimates of quantity, character, location or other conditions surrounding the same. 7. In addition to the guarantee provided for in the specifications, the Contractor shall also make good any other defect in any part of the Project due to improper construction notwithstanding the fact that said Project may have been accepted and fully paid for by the City, and the Contractor's bond shall be security therefore. 1 8. The Contractor shall fully complete the Project under this Contract on or before September 18, � 2019. ti 9. To the fullest extent permitted by law, the Contractor shall indemnify and hold harmless the City � and the Designer from and against all claims, damages, losses and expenses, including but not limited to attorneys'fees, arising out of or resulting from performance of the Contract, provided ;� that such claim, damages, loss or expense is attributable to bodily injury, sickness, disease or � death, or injury to or destruction of property(other than the Project itself) including loss of use �; resulting there from, but only to the extent caused in whole or in part by negligent acts or � omissions of the Contractor, the Contractor's subcontractor, or anyone directly or indirectly t employed by the Contractor or the Contractor's subcontractor or anyone for whose acts the Contractor or the Contractor's subcontractor may be liable, regardless of whether or not such � claim, damage, loss or expense is caused in part by a party indemnified hereunder. �, 10. The Project must be constructed in strict accordance with the requirements of the laws of the I� State of lowa, and the United States, and ordinances of the City of Dubuque, and in accordance � with the Contract Documents. 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 u Contract Work Hours and Safety Standards Act(40 USC 327-330) and Department of Labor �I Regulations (29 CFR, Part 5). �� �; ___ ,, y THE CITY AGREES: � Upon the completion of the Contract, and the acceptance of the Project by the City � Council, the City agrees to pay the Contractor as full compensation for the complete performance � of this Contract and less any liquidated damages provided for in the Contract Documents. The � number of units stated in the plans and specifications is approximate only and the final payment shall be made by the work covered by the Contract. � � CONTRACT AMOUNT- BID $ 23,447.00 � �' 5 � R � 2 FURTHER CONDITIONS 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 agreement 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 � agreement or arrangement with any other person, firm, corporation or association which tends to 7 or does lessen or destroy free competition in the letting 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°/o)of the Contract price but in no event be less than � $100.00 (One hundred Dollars) (Refer to Liquidated Damages Table) as liquidated damages to � the City. a The surety on the bond furnished for this Contract, shall in addition to all other provisions, �� be obligated to the extent provided for by lowa Code § 573.6, relating to this Contract, which ;� provisions apply to said bond. d The Contractor agrees, and its bond shall be surety therefore, that it will keep and �!, maintain the Project in good repair for a period of two years after acceptance of the same by the li City Council and its bond shall be security therefore. � I�' CITY OF DUB E, IOWA PRINCIPAL: ,� P � Bv: �'/�� �/,��/�,j I � Ci Manager ontr By, i �ignat re � ,����G� �r�� Title � CERTIFICATE OF CIl'Y CLERK This i ��o, ,ertify that a c ifie copy of the above Contract has been filed in my office on I the s�T'o day of �� , 2019. � � � s � Ke •r�'Firnstahl, City Clerk 3 CONTRACT FORM 4 CITY OF DUBUQUE, IOWA � �?ERFORMANCE, PAYMENT AND MAINTENANCE BOND �. � KNOWN ALL MEN BY THESE PRESENTS: That Floor Show Companies as Princi al (Contractor) and as Surety are held firmly bound unto th City of Dubuque, lowa (City), in the penal sum of$ 23,447.00 the same being 100% of the total price o the Contract for the Project herein referred to, lawful money of the United States of America, well d truly to be paid to said City of Dubuque, and to all other parties who, under the provisions of the law of lowa, are intended to be protected and secured hereby for which payment we bind ourselves, our he' s, executors, successors and assigns,jointly and severally by these presents. Dated at Dubuque, lowa, this `;c day of , 20 9, and duly attested and �4' sealed. � ,� WHEREAS, the said Contractor by a Co tract June 25, 2019, incor� rated herein by reference, has � agreed with said City of Dubuque to perfo all labor and furnish a4f materials required to be performed � and furnished for the Grand River Center t Floor Concourse�arpet Replacement Project (the � Project) according to the Contract and Const ction Documents repared therefore. � � It is expressly understood and agreed b the Contrac r and Surety bond that the following w provisions are a part of this Bond and are bindin upon said�ontractor and Surety, to-wit: ; � I 1. PERFORMANCE BOND: The Contractor s all w II and faithfully observe, perform, fulfill and i; abide by each and every covenant, condition an�part of said Contract and Contract Documents, � by reference made a part hereof, for the Pro�e and shall indemnify and save harmless the City � frorri all outlay and expense incurred by the Ci by reason of the Contractor's default of failure to � perform as required. The Contractor shall als°�b responsible for the default or failure to perform a as required under the Contract and Contrac Docu ents by all its subcontractors, suppliers, agents, or employees furnishing materials r providi g labor in the perFormance of the Contract. 2. PAYMENT BOND: The Contractor and t�e Surety sha pay all just ciaims submitted by persons, firms, subcontractors, and corporations�urnishing mate �als for or performing labor in the performance of the Contract on accou,rSt of which this Bo is given, including but not limited to � claims for all amounts due for labor, rnaterials, lubricants, �I, gasoline, repairs on machinery, � equipment and tools, consumed or used by the Contractor any subcontractor, wherein the same are not satisfi.ed out of the pdrtion of the contract price hich the City is required to retain . until completion of the improvem �it, but the Contractor and Su ety shall not be liable fo said � persons, firms, or corporations u less the claims of said claiman against said portion of the contract price shall have been :stablished as provided by law. Th Contractor and Surety hereby bind themselves to the obligatj�ons and conditions set forth in Chapt r 573, Code of lowa, which by this reference is made a p��rt hereof as though fully set out herein. 3. MAINTENANCE BOND: T�� Contractor and the Surety hereby agree, their own expense: a. To remedy any and al�defects that may develop in or result from work t be performed under the Contract within the eriod of two (2) year(s)from the date of acceptance of the work under the Contract by,Y e City Council of the City of Dubuque, lowa, by reaso of defects in workmanship or mat�fials used in construction of said work; / b. To keep all workoin continuous good repair; and �� r c. To pay the City the reasonable costs of monitoring and inspection to assure that any defects are remedied, and to repay the City all outlay and expense incurred as a result of Contractor's and Surety's failure to remedy any defect as required by this section. 4 , .. � CQNTRACT FaRM 4 � � � , Bond #34181 _ �17Y OF QU�U.4UE, IQWA ::, ; . � PERFQRMANC�; PAY'IUIE�lTAND�MaiNTEIVANCE,B�ND � ,{ : , . � . . a - . • : � : � - � � � KNOWN ALL fNEN BY TH�S� PR�SENTS That Flaor Shaw_Compan�es as �'rinctpal(Contracto.r)and � Western Nati onal Mutual Inc Co. �s Su'rety are held firrnly bound unta the,CEty of�C�upuque, fov�a (City}, �n th� pena{sum of�$23,447 OO athe same being�10�b/o of the total pnce'of the Gontract far the � Project herein referred to,�lawful money�af,the United States ofi Americ�,�vell and.trufy to be paEd�to said �i City af Dubuque,�arid t�a!I other p�rti�s who, under�the provisions of#I�e laws c�f loi�a are intended t�be � pro#ected ar�d seeured hereby for which payirient we bind ours�lves;�our heirs, executors,;'suc�essars :`':` � and assigns;�aintly::and sewerally.by!th.e"se'presents .:-z' - � _ r Dated at Dubuque, iawa, th�s 2�th day of June , 20�9, and dufy attested and { seafed, � x f I 'u, F, WM�REAS, the said Gontra�tor by a Cantract June 25,,2419 incorporated herein:�y{refer.�r�ce,�phas : agreed with said City of I�ubuque ta perForm al1 labor ar�d furnish ail rnateriafs required ta be performed : and furnished for#he Grand Rtver Center 1���loor Cpncourse�Carpet R��l�a�fri��#Praject�#lie Project}accor,ding to the Cpt�tra�t=and.Construcfion Do:cuments prepared ther�f�re; � m _ C, It is expressly understaod and.agreed py the ContraGkor and Surety bond that the^folluwing � F ' pravisions are a parf of this �4nd and are`bindirig upbn said Contracfor artci-Sureky;tc�.vvii` � -„ ; u. : . • - �- t� , '� - .� �:. ; , , : p 1. P�RFORMANCE Bt7Np;The Gontra�tor shall well an�_faithfully obs�rve, perForm;fulfili and ;; abide by e,ach and,every�ca�en,ant,�conci�tGon,and�part�#satd:;Contract anct.Contr��t Do�timer�t5, !,; by reference made a part hereof�'far fhe'Project, and"sha�l ir�der�nify an� save��h��rmless;#he City from a!I outlay and expense rn�ur_r�d by#he Ciky bY re�son af the Coi�tractor's d�faul#af failure to I r perform as regu�tad The Cot��ractor�h�t!afso`be respon�ih(e for the default or failure#o perform � as required,under th�CantCact_a:nd Contract Documents 1�y all its sub�ontractors, suppliets, '� agerifs, ar�rriplayees furri4shing t�aterials or providing fabar in the per�armance of the Contract. ;� � 2. PAYMENT BQIVD:Ttie;Cantractor and th�Surety shafl pay al�just claims submikted by persons, firms, subeor�tractars, ai�d�.corporatibns furr��shi�g ma#�r�a�s fQr or��tFormin�fabor in the perfarm�nce o�the Contract on�accourit of whieh thi� Rarid is given;=including but`riat limited fo ` � claims#or ail amaunts due for labor, mafer�als, lubricantsr aif,gasoline, repairs an machinery, � equipment and tools, cQnsumed ar used by the Contractor or�ny subaonfra�tar,wher�in the � same are not sakasfied out of the port�on 4#`the contracf prFce wh�c.,h the�ity;is required to re#ain '� until compl�tio�of the�mprovement, but the�Contractor and �urety shalf not'be liabie tc�s�id � persans, firms, ar corporations urtless th�claims of said claimants agaEnst saEd portior� of the '� b�drthemselves#o� theVoblig t►o'n"s�n�d�a�1�'tiaris set forth in Ghapter 573, Code of lowa, which � avided by law. The Contraetor and;5u�ety;her.eby � by this reference is made a part hereof,as thoiagh fully sef out herein. 3. MAINTENANG� BOND:The Contractan'and the Sucety 1�er.eby ag�ee, at their own exper�se; a.To remedy an,y and a11 defects th�t m;�y deuelop in or result from wark to he perforrr�ed under the Confraet wikhin fhe period af two(2)ysai;(s)from ti�e c#ate af acceptance of the.wark under the Contract by the C�ty°Council of the City ofpuk�uque, lowa, by reason of defects in � workmanship or materials used in'construcfian of said work; � b.Tv keep all wark in eontinuaus good repair; and c.To pay the Gity the reasanabie cosfis of manitarEng and inspectian ta assure thaf any defects are remedied, and to repa,y#he City aA auf[ay an�eXpense incurred as a resuft of Contractor's � and Surety's failure to reme�y any defeet.as required b.y this sectinn, � 4 ' �� � � a � 9 ; - > � Contractar's and Surety's agreement herein made ext�nds ta defecks in workmanship or materi�is not I� discovered or known to the:Gity at#he time such work w�s aocepted. _ � � � � � NOW,;THERE�ORE,the candition of this,ubligatian is.such#hat if the,said,�pntrac.tor sk�aii , '; perform a!i of the work contemplated„by the Corttraot in�a vuoricrnantike manrier and:in stricf compl�iance �i with the plans�nd:spc�.�if€cations, and,wi)i;pay�II.claim�:for fabor and,tna#erials used in conr�eckipn with �,I said I'r4jec#, to in�emnify the said ��ty for all.damage�; casts:antl expense iricurred�y re,ason of �, dama:�es to p:ersbns"ar property a�is�ng tfirough,#i�� perfarrnartce af said Contra�t a�d will reimburse#h;� i C�ty for any outlay of rrioney which it may �e requiretf to make in orrler ta cariiplete s�id Confract � accordirtg ta�he Construction C7ocuments and will maintain in goad repair said �'rojea#for the period � specified in the Contract where this bond;as obiigated for rr►aintsnance, anci�ill faitfifuiiy cprnply with al[af �! the provisi4ns of Sec�ion 57.3 of the Code of lowa,the.n:th�s„�bi�gation shai�l b� �uli,andavaid;other;wise it ii; sY�ail r.emain in�ull for.ce arid effect: .- ,. i � . All the cond,ittons of�this�ond�rtust be fully compl�ed wifh before the Gontrac.kar or the 5urety wi�i 7 , be refeased.: - 3= 'i 4 S.� The Cantraet, Contractor's Pr�pasal, a�nd Canstruct��� bocum�rnts sE�a�l be,,�ons�d,ered�as,a parf ; af#his Bon�just as if their terms were repeated herein. ' � � 26th dayof June'; - �d�9, �.L �� Dated at Dub,uque, l;q.wa this � '; , � CITY 0� DU. , U.�,fO,WA, . = :: �, ;=PRINCIP�4�, ... ` -�z .- :'_ I� ,:> . _ , .. ;� gy; : "`.�-�•.e._. F1oor Sh Comp nies " it�+Manager contrac � '; - gy �;. .: .. ,i . - � S,�nat�r�_�" R�ch ;rd� Gregor ' '; President �;i ; Title` �I r : � . _ � SURETI(: ` (� : Western National Mutual Ins. Co. ;; Suret�t Company '� ; ; By: �� ' !� il . _ _ _ _.._ � ` �Sic�nature � Rt�ornev-in-fiact Title � Dubuque; Iowa 52001 City, State, Zip,Gode � 563-556-0272 Telephone Terrance J Friedman Attorney [n�Fact _ � c . '� � � . � — � _ - — _�hlesreRa N�rioM�� —_ : —— . . .. �.INiURANC6.�� � . . � .. . . . . . . � . . . � . .. � . � - . . . . :�.7fie retadonshe�r emnDuny . . .. .. � � . . . .. . � . . .. ' � . .� . � . � .� . . POWER OF ATTORNEY � Il iii� ,; � � � j II I Il uul��p ii � �i���� il 'f�ll�l�illll�ui I , ���� � I�tESENTS: Th �1�Vester � I , ���al s Company, a � �esot t q ' la � oq��} I does � il�)j�� �718k�� � � t� � ' �����rrance J Friedman ���u pe I iil�� ���I�!����IP„�Il�t��i���ll� �Ilik,�Shirley�M:Sh���� �� �� � �� �� I�� ���������Ih�� Illluo ll��ll��l���� � � � � I����'�'�`��� �� � . � � ��� �� ������������ ������ ��� � �� � � ����i�i i�� � ill IIII hr Fnedman Insurance,Inc.�l����9� , ' I�III�II� Its true and lawful Attorney(s)-in-Fact, with full power and authority for and on behalf of the Company as surety,to execute and deliver and affix the seal of the Company;thereto'(if a seal is required) bond, undertakings recognizances or other written obligations in the nature thereof; (other than bail bonds, bank',depository bonds, mortgage,deficiency bonds, mortgage guaranty'bonds, guarantees of installment paper and note guaranty bonds, self-�nsurance workers compensation bonds �uarar�ing payment of benefits, hazardous waste te�diation bonds�r��c�l��n��follows: — - — = _ -- = _ �i�IOfil�on Dollars -(�5,0�0,�00) �II wrr ten instruments in an amount not to exceetl�aggr�g�te of - for any � single obligation; regardless of the number of instruments issued for the obligation. and to bind Western National Mutual Insurance Company thereby, and all of the acts of said Attorneys-in-Fact, pursuant to these presents; are ratified and confirmed. Thi ointment is rnade under and by authority of the . of directors at a meeting held on September 2 '� This ; , ������� Pow f' �i r � � I ' n � �?��I�Isealed by fac ii 'I I,I'e und i , e I�'� I�rit � �t�I� following res �'��t',ons a �� � ' ����� o (��j����Ip{�ors of � �QI j ��es�� I��1��t' � ���� �IU�I� p Y I� � ��II ��� � �I � li �� �� �� � � ��I��IIII ���IIIIIII�� , liu�l�n ce Com an o i �� ��; �m��Ili uuu����� I�III�IIIII �il�� � � �� I� , ' �� � �IIIIII���iF�'�S��il � . .�� � i�i��m����ii ��I I ��� . �� . �, . IIIIII� I � I �� ���� � !IIIII� �� u� ��mm � II IIII li L D that the president,any vice p���iden, sis an vice p�esitlent in con�unction witi�lll�re s t or any assistant secretary, may appoint attorneys-in-fact or'agents wli�authority as defined or limited in the instrument evi encing the appointrnenf in each case,for � antl on behalf of the company#o execute and deliver and affix the seal of the Company to bonds, undertakings, recognizances; and ; suretyship obligations of all kinds, and said officers may remove any such attorney-in-fact or'agent and revoke any Power of Attorney previously granted to such person. ; . F�S�L.VF�F�JR�hat any'bond undertaki� re�o�ru�a��r s�� r�ip obligation sf�1L be valid anc�b�c��c�th���any � _ ��e���president an�e�re�i�s-���i��s��rdent, and attes�aod s��f��e����by any � - �c�tary or assistant secrefary, o�' - ' = - ' - (ii) when signed by the president, any vi��resident or assistant vice president;secretary or�sfistant secretary, and countersigned and i sealed(if a seal be"required)by a duly authorized attorney-in-fact or agent;or (iii) when duly executed and sealed (if a seal be required) by one or more attorneys-in-fact or agents pursuant#o and within the limits of the authority evidenced by the Power of Attorney issuetl by,the Company to'such person or;persons; g y zed fF�' r d� I of the compan may be affixed ,f i `'le powe� RES LV � R�� ���hat the si natur�e of an ;authoiriJIIIi ii�F ill�i li Ir �i�,'�� I °I� ���� �, ii i ��� �, ��f� � ulj�II� , � II�I���� ���� om an thereof au���ii��it�re H i '� i u�i lill I���e���S'I��I��U�e���auS���all have hensame�l��I�and � �����fho ml I'I,,IM�i�n�l����tyship � III ����li' I �i io� P Y; and�such . "i�� J� _ � ��� m� �affixetl.�� d l Ilo I� 1N WITNESS WHEREOF,Western Nation IIIVMutual Insurance Com pan y has caused these pre�I�H'ts to b'e si gned b y its pro per officer and its corporate seal to be affixed this 16th day of December ,2015. ' - `QNpL Mitp - - - ������ - - � - _ :�- -- � "�"�Mv�so���: = .� . ` .,a',�i'�..�••` Jon R. Hebeisen, Secretary Larry'A. Byers, Sr.Vice President , IIII STATE OF MINNESOTAi COUN I IIPAKOTA I Ilillll I i I Ip� � I �I II I I I ( ��� iii�, �li�� iii� i��I I�!I I �i���� I���II � il� I I I ��,�i��Ip .; �����Illu� , � �i I�� ��� j � � � 'u�, III � uJl n t ��i���1 ��, � ���,��liiiu�� ���cember. � 201 �,��qllll� ,son, � ���f ����Viu�wJ�� ��I Hebeisen and�� I� , � -. B �I �� I���;��������the � � I,���� � � �� ��� ��� �l ��� 'I��� �'�� y �I� ������ ��' �I� g dl I Iil"div I n o icers ofthe Western National I�u�I�I Ins c Com an who executed the above inst �ent, e each acknowled ed the execution of the same, antl being by me duly swor �, d�id severally dispose antl say;that they are the said�,�fficers of the corporation aforesaid, and' that the seal affixed to the above'instrument is the seal of the corporation; and that said corporate seal and their signatures as such officers were ` duly affixed and subscribed to the said instrumentby the authority of the board of-directors of said'corporation. _ r�..�rr.rrr.r..,�+wrr.r -— - —- _ - JEEIt��R�+1�G- - - _ ��,x.R��,, � _ _ - t�7`+4F3�''P�lG.N�St�T�- — - ���������j�1 JenniferA.Young, Notary Public My commission expires January 31,2021 CERTIFICATE I, the undersigned, assistant secretary of the Western National Mutual Insurance C��p mpany, a Minnesota corporation, CERTIFY that the oregoing and attac P �r iI�P�I' tt �I i mains in full f,;,, e and has n rI�"� ' d;� � °����i hermore,#ha , Resolutior� t � �:�Iofl���i� ��� rs set iiii �� � ill�III' orth� ���� r � '� I ,,��now m force. l �illl�llli � � ��I �� (I ll ��(I�lu �)���� ill��(�� J � �� u� ii����iillll l�l III�� I ' ��� I�� i llllll""iuiu "ll �I���I�li�l(I� i �II�II� ��'I�� , I� I,IIII�� '�IIII �ill�uii'�IIIII6�l iuiu l IIIII ����II II� I �II�I��III� II��I III�91111 M,,,,,,� < ���p�l��� � ��� �il o�� . �i� I�I��u�� . . � . 2�'0����i"G9%? � . -. �:SEAL:A: . . . . . �. � . . . �"� �.����� r�.'���r i4 a � . � d 'h�sa ��'. f ��.,'Zt •.:��.. Signesi�n�s�a�d�t�C��f�dina, MN this�t�iay.of �ge -�0� JenniferA.Y�r�g,Assi�ta�t��r�a � ---- �'- = f ,. '' . . o . o 0 0 . o . > . e .�� . . . . .. . .. . . . . . . ` . . � D Z-1�C C rn-I�➢Y(l S � � ➢ -� -1�C'. �_I v ,!l S u �a .. -�� <G ti �T n 3 ^ C a f� �. _ � N (c �. G o_ `p ��, o '..a ^ . . , �p a Cl�a'lSD N O:� O W �� a� . 1 f 1 � � p n_O �� J U-� . � O`G - O D � � ^�� m O�O p o�i,h n�, �'� � � N `7 ti � o � n 3 .] . . O n � T 3� � �N . (` _' � � o ) r . . � � p " �2„ - � n' <a � o - ' �u �. , � ��G tu -� ri �^ c,v � � O O �J`' O ... � .. : , � . � a . , . o . e e < . o �i ac . . . . . . . . . . . . . .�_n �, m n..:�O w<G n _ � 3 D O d fl '�' . y�4� ..-_�G:- '-1 vi D . �T C .., . T� !C � 'a�'t N `» n O d S, . . -. ., " p T5 . '� •� - . . �-o C�m-o � m o� o o, - � ��.� '. v G� �.� c �' c S�� ~s ro ` n z' v n -o C ti b h. . r y � �. tl .�i L ro �C Q 3 T�`G G t��i � � �. .�-�-O r � . �. � O �� O o =`� n 3 � ° m s� ea�n> . - , � � ; te �.. O -� .+�. � � (qi � C - A� ^i fU n 3 lJ p. __p U F � .v � � PROJECT INFORMATION REQUIREMENTS FOR STATE OF IOWA SALES TAX EXEMPTION CERTIFICATES FOR CONTRACTORS & SUBCONTRACTORS Submitting Department: Leisure Services Department Contact: Marie Ware a Please complete this form in its entiretyand submit along with the executed Construction Contracts, Bonds � and Certificate of Insurance. Upon receipt, the City Finance Department will work with the lowa Department � of Revenue to issue Sales Tax Exemption Certificates to the approved contractor(s) to allow for the � purchase or inventory withdrawal of materials for the specified Construction Project free from State of lowa � Sales Tax. Sales tax exemption certificates are not provided to material suppliers. The general contractor and � subcontractors can provide copies of the sales tax exemption certificates issued by the City to individual � material suppliers. Construction Project Name: Grand River Center First Floor Concourse Carpet Replacement P � Project Descriptian: _ h a i Stal't Date (Bld 18t date�: April 4,2019 �� COYYlpletlOfl Date: September 18,2019 �; 1. General Prime Contractor: c�c-�,�aa-�- � \y ec���,., { � a."'r.! �G�°FY,q S•��.s � ��. � � Contact Name: �° c�'��.��.,�-- >' i CompleteAddress: f�'r'�,`?..�� ,��'cJ�� ``� �`� �- � (Include PO Box and Street Information) � Cit State, Zi Code � ��' � Y� P �c �i �.r � ...� ..�� o�. � Telephone Number: ,,,��",��-� �;�',��- � ��� �, Federal I.D. Number: (or Include Social Security Number) p� ""'� ,������ Work Type to be Completed: ����^�,. � ���li.�,���..- �'���� � E 2. Subcontractor: Complete Address: (Include PO Box and Street Information) City, State, Zip Code Telephone Number: Federal I.D. Number: (or Include Social Security Number) Work Type to be Completed: 7 � SPECIAL PROVISIONS � s � An out-of-State contractor, before commencing a contract in excess of$5,000.00, shall, pursuant to lowa ,� Code 91 C.7(2), file a bond with the Division of Labor Services of the Department of Employment � Services. The Surety Bond shall be executed by a Surety Company authorized to do business in the State of lowa, and the bond shall be continuous in nature until canceled by the Surety with not less than � 30 days written notice to the contractor and to the Division of Labor Services of the Department of � Employment Services indicating the Surety's desire to cancel the bond. The bond shall be in the sum of �� the greater of the following amounts: I� a. $1,000.00 �� ,� b. 5% of the contract price � Release of the bond shall be conditioned upon the payment of all taxes, including contributions due under '� the unemployment compensation insurance system, penalties, interest, and related fees,which may i� accrue to the State of lowa or its subdivision on account of the execution and performance of the , contract. If any time during the term of the bond the Department of Revenue and Finance determines that the amount of the bond is not sufficient to cover the tax liabilities accruing to the State of lowa or its subdivision, the Department will require the bond to be increased by an amount the Department deems a sufficient to cover the tax liabilities accrued and to accrue under the contract, as provided under lowa � Code 91 C.7(2). i • If it is determined that this subsection may cause denial of Federal Funds which would otherwise be �I available, or would otherwise be inconsistent with requirements of Federal law, this section shall be 1�7 suspended, but only the extent necessary to prevent denial of the funds or to eliminate the inconsistency i with Federal requirements. �? � � �� u � � � � I� 8 � � DATE(MMIDDIYYYY) '`�CO� CERTIFICATE OF LIABILITY INSURANCE 6,26,2019 � �� � THIS GERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. TNIS � 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 ADDI710NAL INSURED,the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. � If SUBROGATION IS WAIVED, subject to the terms and conditions nf the policy, certain policies may require an endorsement. A statement on ,I� this certificate does not confer rights to the certificate holder irs lieu of such endorsement(s). PRODUCER CONTAC7 NaME: Pamela Buchholtz � Friedman Insurance, IC1C. PHONE Fa�c I, PO Box 759 plc No Ext:563-556-0272 Alc No:563-556-4425 � Dubuque IA 52004-0759 ADOR�Ess: buchholtz friedman- rou .com INSURER(S)AFFORDING COVERAGE NAIC# Il iNsuReRa.:West Bend Mutual Insurance Com an 15350 � INSURED FLOOCOR-01 j� INSURER B: The Floorshow Corp �, American Carpet Outlet aNsuReRc: � 1475 Associates Dr. iNsuReR�: � DUI�UqU@ IA�JZOOZ � . INSURERE: - �f INSURER F: i� COVERAGES CERTIFICATE NUMBER:1886934690 REVISION NUMBER: �! THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAME�ABOVE FOR THE POLICY PERIOD 1 INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WI-IICH THIS �� li CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, I! EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. �i lNSR ADDL SUBR POLICY EFF POLICY EXP ��, LTR TYPE OF BNSURANCE IN D WV6 POLICY NUMBER MM/DDIYYYY MM/DD/YYYY LIMITS 'I�,,, A )( COMMERCIALGENEfdALLIABILITY Y Y 2303168 6/1/2019 6/1/2020 EACHOCCURRENCE $1,000,000 �'I DAMAGE TO RENTED � CLAIMS-MADE � OCCUR PREMISES Ea occurrence $300,000 MED EXP(Any one person) $10,000 PERSONAL&ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 I�� POLICY�jE� � LOC PRODUCTS-COMP/OP AGG $2,000,000 `ry OTHER: � $ $ A AUTOMOBILE LIABILITY 2303168 6/1/2019 6!1/2020 COMBINED SINGLE LIMIT $1,000,000 ' I Ea accident it )( ANY AUTO BODILY INJURY(Per person) $ ? OWNED SCHEDULED BODILY INJURY(Per accident) $ � AUTOS ONLY AUTOS X HIRED X NpN-OWNED PROPERTYDAMAGE $ i; AUTOS ONLY AUTOS ONLY Per accident � $ f A X UMBRELLALIAB X OCCUR 2303168 6/1/2019 6/1/2020 EACH OCCURRENCE $5,000,000 � EXCESS LIAB CLAIMS-MADE AGGREGATE $5,000,000 �I `i DED RETENTION$ $ p WORKERscoMPENSATioN Y 1768641 6/1/2019 6/1/2020 X PER oTH- ` AND EMPLOYERS'LIABILBTY Y�N STATUTE ER '� ANYPROPRIETOR/PARTNER/EXECUTIVE � N�A E.L.EACH ACCIDENT $500,000 j� OFFICER/MEMBEREXCLUDED? r (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $500,000 � If yes,describe under � DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $500,000 � i !i i i� DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 901,Additional Re'marks Schedule,may be attached if more space is required) Project#360 2113 Project name: Grand River Center First Floor Concourse Carpet Project location at Grand River Center � The City of Dubuque, including all its elected&appointed officials,all its employees&volunteers,all its boards,commissions&/or authorities&their board members,employees&volunteers are Additional Insureds for ongoing and completed operations on a primary and non-contributory basis as provided by endorsement WB1482Z.Waiver of Subrogation in favor of Certificate Holder as provided on the general liability by CG2404 and Works Compensation by j WC000313. Umbrella is form following with primary and non-contributory provided by W61787. Governmental Immunities Included.. CERTIFICATE HOLDER CANCELLATION � � SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE � THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN The City of Dubuque accoRDANce werH rHe Poucv PRovisioNs. City Hall `j0�/. 13th 5t. AUYHORI2ED REPRESENT TIVE Dubuque IA 52001 � O 1988-2015 ACORD CORPORATION. All rights reserved. � ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD � � I � THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. � ADDIT'IONAL INSURED - CONTRACTOR'S BLANKET � (BROAD FORM) �� � This endorsement rnodifies insurance provided under the fol6owing: � N � COMMERCIAL GENERAL LIABILITY COVERAGE PART �� A. WHO IS AN INSURED (Section II) is amended 3. Except when required by written contract or � to include as an additional insured any person or written agreernent, the caverage provided to W organization whom you are required to add as an the additional insured by this endorsement j additionaB insured on this policy under a written does not apply to: I� contract or written agreement. a. "Badily injury'° or "property d�mage" oc- I The written contract or written agreement must curring after: il be: h (1) All work on the project (other than 1. Currently in effect or becoming effective dur- service, maintenance or repairs) to be �i; ing the term of this policy; and performed by or on behalf of the addi- �'�, 2. Executed prior to the "bodily injury," "property tional insured at the site of the covered j� damage," "personal injury and advertising in- operations has been completed; or a jury." (2) That portion of "your work" out of � B. The insurance provided to the additional insured which the injury or damage arises has � is limited as follows: been put to its intended use by any ;� person ar organization other than an- '�,; 1. That person or organization is only arr addi- other contractoc or subcontractor en- 'j tionai insured with respect to liability arising gaged in perForming operations for a �'; out of: principal as part of the same project. a. Your premises; b. '°Bodfl in'u '° or " ro ert dama e" aris- � Y 1 rY P p Y J �, b. "Your work"for that additiona! insured; or ing ou# af acts or omissions of the addi- � tional insured other than in connection 'H� c. Act�or amissions of the additional insured with the generaf supervision of "yaur a in connection with the general supervision „ ;� of"yaur work." °"°°rk' � 4. The insurance provided to the additional � 2. The Limits of Insurance applicable to the „ „ additianal insured are those specified in the insured does not appiy to bodily injury, "property damage," "personal injury and ad- written contract or written agreement or in the vertising injury°' arising out of an architect°s, � Declarations for this policy, whichever is less. ��g�ne�r's, or surveyor's rendering of or fail- '� These Limits of Insurance are inclusive and ure to render any professional services in- not in addition to the Limits of Insurance � shown in the Declarations. cluding; , a. The preparing, appraving, or failing to � prepare or approve m�ps, shop drawings, opinions, reports, surveys, field orders, change orders or drawings and specifica- tians; and b. Supervisory, or inspection activities per- formed as part of any related architectural or engineering activities. WB 1482 Z 06 06 West Bend Mutual Insurance Company Page 1 of 2 W�st Bend, Wisconsin 53095 � C. As respects the coverage provided under this � endorsement, Paragraph 4.b. SECTION IV - � COMMERCIAL GENERAL LIABILITY CONDI- � TIONS is amended with the addition af the fol- lowing: ,� 4. Other insurance �� b. Excess insurance { This insurance is excess aver: � Any other valid and collectible insurance � available to the additional insured whether " primary, excess, cantingent or on any � other basis unless a written cantraat spe- � cifically requires that this insurance be ei- � ther primary ar primary and noncontrib- ;� uting. Where required by written contract, � we will consider any other insurance ;, maintained by the additional insured for h injury or damage covered by this en- '' dorsement to be excess and noncontrib- i uting with this insurance. When this insurance is excess, as a con- dition of cover�ge, the additional insured li shall be obligated to tender the defense ��; and inderrrnity of every claim or suit ta all �' other insurers that may provide coverage 'i to the additional insured, whether on a 'I� contingent, excess or primary basis. u! � �� �; � � u � � � � V � � � � Page 2 of 2 West Bend Mutual Insurance Company WB 'l482 Z 06 06 West Bend, Wisconsin 53095 ' � WORK�RS COMPENSATION AND EMPL.O1(ERS LIABILIT`Y INSURANC� POLICY � ; �n�r nn n� �s �F�� n�Re� � �,.� .. � ; WAIVER OF OUR RIGHT TO RECOUER FRIOM t?7HERS ENDtORSEM�NT. � ��, We have the right to recover our payments fr�m..anyohe iiable for an.injury covered by this policy. We will not �'�,I enforce our right against tfie person or organization named in#he Schedule:(Ti��s agreement applies onfy to ti�e ; extent that you perform wor:k under a w�itten�ontracf that re.quires you to obfain this agreerr�ent frorn us,) � This agreement shaJl not operate directly.or indirectly to bene�f anyone not named irr #he 5chedule. � � � � � . � � . � � � Schedule � � ,i IA-ANY PARTY WITH WHtIM THE INSURED AGREES �'0 WA;I.VE I SUBROGATION TN A WRITTEN CONTRA�T ' � '� a 'J � � li II � � �� il � �. � � 1 � � � � � � I�i �� _ II �... ii a u i9 ... � , - .� � ��j � � � II i � 7¢ - . . � .. , � . 'il � This endorsement changes the policy to whiCh it is�ttacfied and is effective on th�date issued unless otherwise stated. (The information below is required only when this endotsement is,issued subsequenf fa preparation of the poticy.) 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