Signed Contract_Drew Cook & Sons Excavating for the John F. Kennedy Watermain Ext. - Forest Glen Ct. to Daisy Trail ProjectCity of Dubuque
City Council Meeting
Consent Items # 14.
Copyrighted
November 15, 2021
ITEM TITLE: Signed Contract(s)
SUMMARY: Drew Cook & Sons Excavating Co. Inc. for the John F. Kennedy Water
Main Extension - Forest Glen Ct. to Daisy Trail Project; Ferguson
Waterworks for the Water Meter R900 Migration; McDermott Excavating
Company for the South Gate Drive to Simpson Street Water Main
Project.
SUGGESTED Suggested Disposition: Receive and File
DISPOSITION:
ATTACHMENTS:
Description Type
John F. Kennedy Water Main Extension Supporting Documentation
Ferguson MOU Supporting Documentation
South Gate Drive to Simpson Street Water Main Supporting Documentation
Project
SECTION 00500
Page 1 of 6
PUBLIC IMPROVEMENT CONTRACT
SECTION 00500
John F. Kennedy Watermain Extension — Forest Glen Ct. to Daisy Trail Project
THIS IMPROVEMENT CONTRACT (the Contract), made in triplicate, dated for
references purposes the 8.h day of October 2021 between the City of Dubuque, Iowa, by its
City Manager, through authority conferred upon the City Manager by its City Council (City), and
Drew Cook & Sons Excavating Co. Inc. (Contractor).
For and in consideration of the mutual covenants herein contained, the parties hereto agree
as follows:
CONTRACTOR AGREES:
1. To furnish all material and equipment and to perform all labor necessary for the John F.
Kennedy Watermain Extension — Forest Glen Ct. to Daisy Trail Project (Project).
2. CONTRACT DOCUMENTS
A. The Contract Documents consist of the following:
1. Project Title Page (Section 00100).
2. Project Directory Page (Section 00101).
3. This Public Improvement Contract (Section 00500).
4. Performance, Payment, and Maintenance Bond (Section 00600).
5. Out -of -State Contractor Bond (Section 00610).
6. Other Bonds:
a. (Bond Name) (pages _ to — , inclusive).
b. (Bond Name) (pages _ to — , inclusive).
C. (Bond Name) (pages —to—, inclusive).
7. The Iowa Statewide Urban Design And Specifications (SUDAS) 2021 Edition.
8. CITY OF DUBUQUE Supplemental Specifications 2020 Edition.
9. Other Standard and Supplementary Specifications as listed on the Title Page of the
Contract Document Manual.
10. Special Provisions included in the project Contract Document Manual.
11. Drawings —Sheet No. 1 through No. 41
(45 pages) or drawings consisting of
sheets bearing the following general title:
John F. Kennedy Watermain Extension — Forest Glen Ct. to Daisy Trail Project
12. Addenda (numbers 1 to 1 , inclusive).
13. Insurance Provisions and Requirements (Section 00700).
14. Sales Tax Exemption Certificate (Section 00750).
15. Site Condition Information (Section 00775).
16. Construction Schedule and Agreed Cost of Delay (Section 00800).
17. Erosion Control Certificate (Section 00900).
SECTION 00500
Page 2 of 6
18. Consent Decree (Section 01000).
19.Other Project Information and Permits (Sections 01100 - 00000).
20. Exhibits to this Contract (enumerated as follows):
a. Contractor's Bid (pages to inclusive).
b. Bidder Status Form (Section 00460).
c. The following documentation that must be submitted by Contractor prior to Notice
of Award.
i. Contractor Background Information Form (Section 00471)
ii.
21.The following which may be delivered or issued on or after the Effective Date of the
Agreement:
a. Notice to Proceed (Section 00850).
b. Project Certification Page (Section 00102).
c. Change Orders (Not attached to this agreement).
There are no other Contract Documents. The Contract Documents may only be amended,
modified, or supplemented as provided in General Conditions.
3. All materials used by the Contractor in the Project must be of the quality required by the
Contract Documents and must be installed in accordance with the Contract Documents.
4. The Contractor must remove any materials rejected by the City as defective or improper, or
any of said work condemned as unsuitable or defective, and the same must be replaced or
redone to the satisfaction of the City at the sole cost and expense of the Contractor.
5. Five percent (5%) of the Contract price will be retained by the City for a period of thirty (30)
days after final completion and acceptance of the Project by the City Council to pay any claim
by any party that may be filed for labor and materials done and furnished in connection with
the performance of this Contract and for a longer period if such claims are not adjusted within
that thirty (30) day period, as provided in Iowa Code Chapter 573 or Iowa Code Chapter 26.
The City will also retain additional sums to protect itself against any claim that has been filed
against it for damages to persons or property arising through the prosecution of the work and
such sums will be held by the City until such claims have been settled, adjudicated or
otherwise disposed of.
6. The Contractor has read and understands the Contract Documents herein referred to and
agrees not to plead misunderstanding or deception related to estimates of quantity,
character, location or other conditions for the Project.
7. In addition to any warranty provided for in the specifications, the Contractor must also fix any
other defect in any part of the Project, even if the Project has been accepted and fully paid
for by the City. The Contractor's maintenance bond will be security for a period of two years
after the issuance of the Certificate of Substantial Completion.
8. The Contractor must fully complete the Project under this Contract on or before the date
indicated in the Construction Schedule and Agreed Cost of Delay Section of the Contract
Documents.
SECTION 00500
Page 3 of 6
9. INDEMNIFICATION FROM THIRD PARTY CLAIMS. To the fullest extent permitted by law,
Contractor shall defend, indemnify and hold harmless City, its officers and employees, from
and against all claims, damages, losses and expenses claimed by third parties, but not
including any claims, damages, losses or expenses of the parties to this Contract, including
but not limited to attorneys' fees, arising out of or resulting from performance of this Contract,
provided that such claim, damages, loss or expense is attributable to bodily injury, sickness,
disease or death, or injury to or destruction of property, including loss of use resulting there
from, but only to the extent caused in whole or in part by negligent acts or omissions of
Contractor, or anyone directly or indirectly employed by Contractor or anyone for whose acts
Contractor may be liable, regardless of whether or not such claim, damage, loss or expense
is caused in part by a party indemnified hereunder.
10. The Contractor hereby represents and guarantees that it has not, nor has any other person
for or in its behalf, directly or indirectly, entered into any arrangement or Contract with any
other Bidder, or with any public officer, whereby it has paid or is to pay any other Bidder or
public officer any sum of money or anything of value whatever in order to obtain this Contract;
and it has not, nor has another person for or in its behalf directly or indirectly, entered into
any Contractor arrangement with any other person, firm, corporation or association which
tends to or does lessen or destroy free competition in the award of this Contract and agrees
that in case it hereafter be established that such representations or guarantees, or any of
them are false, it will forfeit and pay not less than ten percent (10%) of the Contract price but
in no event less than $2,000.00 (Two Thousand Dollars) to the City.
11. The surety on the Bond furnished for this Contract must, in addition to all other provisions,
be obligated to the extent provided for by Iowa Code 573.6 relating to this Contract, which
provisions apply to said Bond.
12. The Contractor agrees, and its Bond is surety therefore, that after the Certificate of
Substantial Completion has been issued by the City, it will keep and maintain the Project in
good repair for a period of two (2) years.
13. The Project must be constructed in strict accordance with the requirements of the laws of the
State of Iowa, and the United States, and ordinances of the City of Dubuque, and in
accordance with the Contract Documents.
A. All applicable standards, orders, or regulations issued pursuant to the Clean Air Act of
1970 (42 U. S. C. 1958 (H) et. seq.) and the Federal Water Pollution Act (33 U. S. C.
1368 et. seq.) as amended, Executive Order 11738, and Environmental Protection
Agency regulations (40 CFR, Part 15). Contractor must comply with Section 103 and
107 of the Contract Work Hours and Safety Standards Act (40 USC 327-330) and
Department of Labor Regulations (29 CFR, Part 5).
B. The City of Dubuque in accordance with Title VI of the Civil Rights Act of 1964, 78 Stat.
252, 42 U.S.C. 2000d-2000d-4 and Title 49, Code of Federal Regulations, Department
of Transportation, Subtitle A, Office of the Secretary, Part 21, Nondiscrimination in
Federally assisted programs of the Department of Transportation issued pursuant to
such Act, hereby notifies all bidders that it will affirmatively insure that in any contract
entered into pursuant to this advertisement, minority business enterprises will be
afforded full opportunity to submit bids in response to this invitation and will not be
discriminated against on the grounds of race, color, national origin, sex, age, or disability
in consideration for an award.
SECTION 00500
Page 4 of 6
CONSENT DECREE
RELATING TO THE PROJECT
14. THIS CONTRACTOR IS PERFORMING WORK FOR THE CITY OF DUBUQUE RELATED TO
THE WATER & RESOURCE RECOVERY CENTER OR THE SANITARY SEWER
COLLECTION SYSTEM. THEREFORE, THE CONSENT DECREE AND THIS SECTION ARE
APPLICABLE.
CITY CONTRACTOR
1 THIS CONTRACTOR IS NOT PERFORMING WORK FOR THE CITY OF DUBUQUE::
RELATED TO THE WATER & RESOURCE RECOVERY CENTER OR THE SANITARY
SEWER COLLECTION SYSTEM. THEREFORE THE CONSENT DECREE AND THIS
SECTION ARE NOT APPLICABLE.
The City has entered into a Consent Decree in the case of The United States of America, and the State
of Iowa v. The City of Dubuque, Iowa, Civil Action Number Case 2:11-cv-01011--[ M,J, Civil Action
Number 2008V00041, DOJ Case Number 90-5-1-1-09339, United States District Court for the Northern
District of Iowa. The provisions of the Consent Decree apply to and are binding upon the City and its
officers, directors, employees, agents, servants, successors, assigns, and all persons, firms and
corporations under contract with the City to perform the obligations of the Consent Decree.
The City is required to provide a copy of the Consent Decree to any contractor or consultant retained to
perform work required by the Consent Decree.
A copy of the Consent Decree is included in the Contract Documents and can be viewed at
httpalwww.cityofdubugLie.org/DocumentCenter/HomeNiew/3173. A hard copy is available upon
request at the City's Engineering Department Office.
The City must condition any contract to perform work required under the Consent Decree upon
performance of the work in conformity with the provisions of the Consent Decree.
The Consent Decree also provides that until five (5) years after the termination of the Consent Decree,
the City must retain, and must instruct its contractors and agents to preserve, all non -identical copies of
all documents, reports, data, records, or other information (including documents, records, or other
information in electronic form) in its or its contractors' or agents' possession or control, or that come into
its or its contractors' or agents' possession or control, and that relate in any manner to the City's
performance of its obligations under this Consent Decree, including any underlying research and
analytical data. This information -retention period, upon request by the United States or the State, the
City must provide copies of any documents, reports, analytical data, or other information required to be
maintained under the Consent Decree. At the conclusion of the information -retention period, the City
must notify the United States and the State at least ninety (90) Days prior to the destruction of any
documents, records, or other information subject to such requirements and, upon request by the United
States or the State, the City must deliver any ;such documents, records, or other information to the EPA
or IDNR.
SECTION 00500
Page 5 of 6
CERTIFICATION BY CONTRACTOR
The undersigned, on behalf of the Contractor, with full authority to act on behalf of the
Contractor, certifies to the City of Dubuque as follows:
I have received a copy of the Consent Decree in the case of The United States of
America, and the State of Iowa v. The City of Dubuque, Iowa, Civil Action Number
Case 2:1 1-cv-0101 1-EMJ, Civil Action Number 2008V00041, DOJ Case Number 90-
5-1-1-09339, United States District Court for the Northern District of Iowa.
2. All work performed will be in conformity with the provisions of the Consent Decree.
3. All documents reports, data, records, or other information (including documents,
records, or other information in electronic form) that relate in any manner to the
performance of obligations under the Consent Decree, including any underlying
research and analytical data, will be retained as required by the Consent Decree.
4. The Contractor agrees to defend, indemnify, and hold harmless the City, its officers,
agents, or employees from and against any claims, including penalties, costs and
fees as provided in the Consent Decree, relating to or arising out of the Contractor's
failure to comply with the Consent Decree.
CONTRACTOR:
Contractor
By: N/A
Signature
Printed Name
Title
Date
SECTION 00500
Page 6 of 6
THE CITY AGREES:
15. Upon the completion of the Contract, and the acceptance of the Project by the City Council,
and subject to the requirements of law, the City agrees to pay the Contractor as full
compensation for the complete performance of this Contract, the amount determined for
the total work completed at the price(s) stated in the Contractor's Bid Proposal and less
any Agreed Cost of Delay provided for in the Contract Documents.
CONTRACT AMOUNT $ 752,852.00
CITY OF DUBUQUE, IOWA:
City Manager's Office
De ent
By:
ig ture
Michael C. Van Milligen
Printed Name
City Manager
Title
10/28/2021
Date
CONTRACTOR:
Drew Cook & Sons Excavating Co. Inc.
Contractor
By. I
Signature ]
L 0 �6� L -
Printed Name
VILE P=-J?oc
Title
Date
==== END OF SECTION 00500 ====
City of Dubuque Insurance Requirements for General, Artisan or Trade Contractors,
Subcontractors or Sub -Subcontractors
Class A:
Class B:
Class C:
INSURANCE SCHEDULE F
Asbestos Removal
Fiber Optics
Sanitary Sewers
Asphalt Paving
Fire Protection
Sheet Metal
Concrete
Fireproofing
Site Utilities
Construction Managers
General Contractors
Shoring
Cranes
HVAC
Special construction
Culverts
Mechanical
Steel
Decking
Paving & Surfacing
Storm sewers
Demolition
Piles & Caissons
Structural Steel
Deconstruction
Plumbing
Trails
Earthwork
Retaining Walls
Tunneling
Electrical
Reinforcement
Water main
Elevators
Roofing
Chemical Spraying
Landscaping
Rough Carpentry
Doors, Window &
Masonry
Stump Grinding
Glazing
Vehicular Snow Removal
Tank Coating
Drywall Systems
Painting & Wall Covering
Tree Removal
Fertilizer Application
Pest Control
Tree Trimming
Geotech Boring
Scaffolding
Tuckpointing
Insulation
Sidewalks
Waterproofing
Finish Carpentry
Plastering
Well Drilling
Carpet Cleaning
General Cleaning
Power Washing
Carpet & Resilient
Grass Cutting
Tile & Terrazzo Flooring
Flooring
Janitorial
Window Washing
Caulking & Sealants
Non Vehicular Snow &
Acoustical Ceiling
Ice Removal
Filter Cleaning
Office Furnishings
Page 1 of 6 Schedule F, General, Artisan or Trade Contractors, Subcontractors or Sub Subcontractors April 2021
SECTION 00800
Page 1 of 2
CONSTRUCTION SCHEDULE AND AGREED COSTS OF DELAY
SECTION 00800
800.1 SCHEDULE:
MILESTONE DATES:
In addition to the required Substantial and Final Completion Dates, there are
milestones by which certain items of work must be completed. See General
Requirements for milestone requirements.
Milestone 1
Milestone 2
December 15, 2021
April 30, 2022
In general the following contract completion Milestone shall be followed.
a. Milestone 1 Completion: contractor shall have 12" water_main and
associated valves installed, pressure and bacteria tested by 12/15/2021.
Watermain is available for use by residents in Wild flower sub -division.
Temporary erosion control measures are to be in lace. All Permanent
pavement in driveways to be completed.
b. Milestone 2 Completion: Contractor shall by the date listed have
completed all remaining work in contract by April 30, 2022. This includes
hydrant leads and hydrants and all pavement restoration on JFK Road.
800.2 AGREED COSTS OF DELAY:
Time is of the essence of the Contract. As delay in the diligent prosecution of the work may
inconvenience the public, obstruct traffic, interfere with business, and/or increase costs to the
City such as engineering, administration, and inspection, it is important that the work be
prosecuted vigorously to final completion.
An extension of the contract period may be granted by the City for any of the following reasons:
Additional work resulting from a modification of the Contract Documents by approved
change order.
2. Delays caused by the City.
3. Other reasons beyond the control of the Contractor, which in the City's opinion, would
justify such.
Should the Contractor, or in case of default the Surety, fail to complete the work within the
specified Milestone(s), a deduction at the daily rate for agreed costs of delay will be made for
each and every calendar day or working day, whichever is specified, such that the work
remains uncompleted. The Contractor or the Contractor's Surety shall be responsible for all
SECTION 00800
Page 2 of 2
costs incidental to the completion of the work, and shall be required to pay the City the following
daily costs:
A. For each calendar day that any work remains uncompleted beyond the Milestone
date(s) the contractor will be assessed and shall pay, $1000 per calendar day, not
as a penalty but as predetermined and Agreed Cost of Delay until the Milestone
requirements are met.
Permitting the Contractor to continue and finish the Work, or any part of it, after the expiration
of the Milestone Dates or extension thereof shall in no way operate as a waiver on the part of
the City of any of its rights or remedies under the contract, including its right to Agreed Cost
of Delay pursuant to this provision. Furthermore, the assessment of Agreed Cost of Delay
shall not constitute a waiver of the City's right to collect any additional damages which the
City may sustain by failure of the Contractor to carry out the terms of the Contract.
The Agreed Cost of Delay rates specified in the Contract Documents is hereby agreed upon as
the true and actual damages due the City for loss to the City and to the public due to obstruction
of traffic, interference with business, and/or increased costs to the City such as engineering,
administration, construction, and inspection after the expiration of the contract times, or
extension thereof. Such Agreed Cost of Delay will be separately invoiced to the Contractor, and
final payment will be withheld from the Contractor until payment has been made of this invoice
for the agreed cost of delay. The Contractor and its surety shall be liable for any agreed cost of
delay in excess of the amount due the Contractor.
___= END OF SECTION 00800 =___
SECTION 00775
Page 5 of 2
SITE CONDITION INFORMATION
^' SECTION 00775
250.1 SUBSURFACE CONDITION
In the preparation of the Contract Documents, the Engineer relied upon the following report(s)
and drawing(s) of explorations and tests of subsurface conditions at the Site:
1) Geotechnical Engineering Report prepared by
Title:
Date:
Pages: 1 -
The technical data in the above report(s), upon which the Contractor may rely, consists
of boring logs, test results, and boring locations all as of the date made. Engineer
accepts no responsibility for accuracy of the soil data or water level information. Soil
information, included with these Contract Documents, was not obtained for the
purposes of designing excavations and trenches. Soil information was used by
Engineer for design purposes only. Contractor shall assure itself by personal
examination as to subsurface conditions and shall provide its own investigations and
make its own assumptions to comply with OSHA and any other applicable laws and
regulations regarding excavation and trenching requirements.
250.2 PHYSICAL CONDITIONS
In the preparation of the Contract Documents, the Engineer relied upon the following
drawing(s) of physical conditions in or relating to existing surface and subsurface structures
(except underground facilities) which are at or contiguous to the Site:
1) Drawings prepared by
Title:
Date:
Pages: 1 -
2) Sanborn Fire Insurance Map:
NONE OF THE CONTENT OF SUCH DRAWINGS INCLUDE TECHNICAL DATA ON
WHICH THE CONTRACTOR MAY RELY.
SECTION 00775
Page 6 of 2
250.3 HAZARDOUS ENVIRONMENTAL CONDITIONS
In the preparation of the Contract Documents, the Engineer relied upon the following reports(s)
known to the owner of hazardous environmental conditions at the Site:
1) Phase I Environmental Site Assessment Study prepared by
'Title:
Date:
2) Phase II Environmental Site Assessment Study prepared by
Title:
Date:
3) Soil and Groundwater Management Plan prepared by
Title:
Date:
The technical data in the above report(s), upon which the Contractor may rely, consists of test
results all as of the date made. Contractor must not remove, disturb or remediate any
Hazardous Environmental Conditions encountered, uncovered or revealed at the Project Area,
unless such removal or remediation is expressly identified in the Contract Documents to be
within the scope of work.
___= END OF SECTION 00775 =___
EROSION CONTROL CERTIFICATION
SECTION 00900
Dated: P 4-' -1 Z %!/Z I
City:
Address:
fl� Co
Project: John F. Kennedy Watermain Extension — Forest Glen Ct. to Daisy Trail Project
Contract No. 7402836
Description: The project scope includes installation of approximately 4,250 lineal feet of 12-inch
ductile iron pipe (DIP) water main along the north ditch line of John F. Kennedy
Road from Forest Glen Court to Daisy Trail. Additionally, four hydrants will be placed
with 8-inch ductile iron pipe (DIP) leads to the south side of John F. Kennedy Road
to provide fire protection and future connection to the water main.
I certify under penalty of law that I understand the terms and conditions of the National Pollutant
Discharge Elimination System (NPDES) Permit that authorizes the storm water discharges
associated with industrial activities from the construction site and as detailed in the Contract
Documents. Further, by my signature, I understand that I am becoming a co-permittee, along with
the owner(s) and other contractors and subcontractors signing such certifications, to the Iowa
Department of Natural Resources NPDES General Permit No. 2 for "Storm Water Discharge
Associated with Industrial Activity for Construction Activities" at the project site. As a co-
permittee, I understand that 1, and my company, are legally required under the Clean Water Act
and the Code of Iowa, to ensure compliance with the terms and conditions of the storm water
pollution prevention plan developed under this NPDES permit and the terms of this NPDES
permit.
I agree to indemnify and hold the City harmless from any claims, demands, suits, causes of
action, settlements, fines, or judgments and costs of litigation, including, but not limited to,
reasonable attorney's fees and costs of investigation and arising from a condition, obligation, or
requirement assumed or to be performed by the Contractor for storm water pollution and erosion
control.
Fines and other costs incurred against the City for the Contractor's failure to provide the required
erosion control practices will be paid by the Contractor.
Contractor: (Ory `)6
By: �r,3 CCY]l--
(Au orized Signature)
(Title)
SECTION 00600
Page 1 of 4
PERFORMANCE_ PAYMENT AND MAINTENANCE BOND
SECTION 00600
KNOW ALL BY THESE PRESENTS:
That we, Drew Cook & Sons Excavatinq Company, Inc„ as Principal (hereinafter the "Contractor"
or "Principal")
and IMI' Insurance Company as Surety
are held and firmly bound unto the City of Dubuque, Iowa, as Obligee (hereinafter referred to as
"Owner"), and to all persons who may be injured by any breach of any of the conditions of this
Bond in the penal sum of Seven hundred fifty-two thousand, eight hundred fifty-two dollars and
zero cents ($752,852.00), lawful money of the United States, for the payment of which sum, well
and truly to be made, we bind ourselves, our heirs, legal representatives and assigns, jointly or
severally, firmly by these presents.
The conditions of the above obligations are such that whereas said Contractor entered into a
contract with the Owner, bearing date the 8Lrl day of October, 2021, (hereinafter the "Contract")
wherein said Contractor undertakes and agrees to construct the following project in accordance with
the Contract Documents, and to faithfully perform all the terms and requirements of said Contract
within the time therein specified, in a good and workmanlike manner, and in accordance with the
Contract Documents. The Contract Documents for John F. Kennedy Watermain Extension —
Forest Glen Ct. to Daisy Trail Project detail the following described improvements:
The project scope includes installation of approximately 4,250 lineal feet of 12-inch ductile
iron pipe (DIP) water main along the north ditch line of John F. Kennedy Road from Forest
Glen Court to Daisy Trail. Additionally, four hydrants will be placed with 8-inch ductile iron
pipe (DIP) leads to the south side of John F. Kennedy Road to provide fire protection and
future connection to the water main.
It is expressly understood and agreed by the Contractor and Surety in this Bond that the following
provisions are a part of this Bond and are binding upon said Contractor and Surety, to -wit:
PERFORMANCE: The Contractor shall well and faithfully observe, perform, fulfill, and
abide by each and every covenant, condition, and part of said Contract and Contract
Documents, by reference made a part hereof, for the project, and shall indemnify and save
harmless the Owner from all outlay and expense incurred by the Owner by reason of the
Contractor's default of failure to perform as required. The Contractor shall also be
responsible for the default or failure to perform as required under the Contract and Contract
Documents by all its subcontractors, suppliers, agents, or employees furnishing materials
or providing labor in the performance of the Contract.
2. PAYMENT: The Contractor and the Surety on this Bond hereby agreed to pay all just
claims submitted by persons, firms, subcontractors, and corporations furnishing materials
for or performing labor in the performance of the Contract on account of which this Bond is
given, including but not limited to claims for all amounts due for labor, materials, lubricants,
oil, gasoline, repairs on machinery, equipment, and tools, consumed or used by the
Contractor or any subcontractor, wherein the same are not satisfied out of the portion of the
SECTION 00600
Page 2 of 4
contract price the Owner is required to retain until completion of the improvement, but the
Contractor and Surety shall not be liable to said persons, firms, or corporations unless the
claims of said claimants against said portion of the contract price shall have been
established as provided by law. The Contractor and Surety hereby bind themselves to the
obligations and conditions set forth in Chapter 573 of the Iowa Code, which by this
reference is made a part hereof as though fully set out herein.
3. MAINTENANCE: The Contractor and the Surety on this Bond hereby agree, at their own
expense:
A. To remedy any and all defects that may develop in or result from work to be
performed under the Contract Documents within the period of two (2) year(s) from the
date of acceptance of the work under the Contract, by reason of defects in
workmanship, equipment installed, or materials used in construction of said work;
B. To keep all work in continuous good repair; and
C. To pay the Owner's reasonable costs of monitoring and inspection to assure that any
defects are remedied, and to repay the Owner all outlay and expense incurred as a
result of Contractor's and Surety's failure to remedy any defect as required by this
section.
Contractor's and Surety's Contract herein made extends to defects in workmanship or
materials not discovered or known to the Owner at the time such work was accepted.
4. GENERAL: Every Surety on this Bond shall be deemed and held bound, any contract to the
contrary notwithstanding, to the following provisions:
A. To consent without notice to any extension of time authorized in approved change
orders to the Contractor in which to perform the Contract;
B. To consent without notice to any change in the Contract or Contract Documents,
authorized in approved change orders which thereby increases the total contract price
and the penal sum of this Bond, provided that all such changes do not, in the
aggregate, involve an increase of more than twenty percent (20%) of the total contract
price, and that this Bond shall then be released as to such excess increase;
C. To consent without notice that this Bond shall remain in full force and effect until the
Contract is completed, whether completed within the specified contract period, within
an extension thereof, or within a period of time after the contract period has elapsed
and the liquidated damage penalty is being charged against the Contractor.
The Contractor and every Surety on the Bond shall be deemed and held bound, any contract to the
contrary notwithstanding, to the following provisions:
SECTION 00600
Page 3 of 4
D. That no provision of this Bond or of any other contract shall be valid that limits to less
than five (5) years after the acceptance of the work under the Contract the right to sue
on this Bond.
E. That as used herein, the phrase "all outlay and expense" is not to be limited in any
way, but shall include the actual and reasonable costs and expenses incurred by the
Owner including interest, benefits, and overhead where applicable. Accordingly, "all
outlay and expense" would include but not be limited to all contract or employee
expense, all equipment usage or rental, materials, testing, outside experts, attorney's
fees (including overhead expenses of the Owner's staff attorneys), and all costs and
expenses of litigation as they are incurred by the Owner. It is intended the Contractor
and Surety will defend and indemnify the Owner on all claims made against the
Owner on account of Contractor's failure to perform as required in the Contract and
Contract Documents, that all agreements and promises set forth in the Contract and
Contract Documents, in approved change orders, and in this Bond will be fulfilled, and
that the Owner will be fully indemnified so that it will be put into the position it would
have been in had the Contract been performed in the first instance as required.
In the event the Owner incurs any "outlay and expense" in defending itself against any claim as to
which the Contractor or Surety should have provided the defense, or in the enforcement of the
promises given by the Contractor in the Contract, Contract Documents, or approved change
orders, or in the enforcement of the promises given by the Contractor and Surety in this Bond, the
Contractor and Surety agree that they will make the Owner whole for all such outlay and expense,
provided that the Surety's obligation under this Bond shall not exceed one hundred twenty-five
percent (125%) of the penal sum of this Bond.
In the event that any actions or proceedings are initiated regarding this Bond, the parties agree that
the venue thereof shall be Dubuque County, State of Iowa. If legal action is required by the Owner
to enforce the provisions of this Bond or to collect the monetary obligation incurring to the benefit of
the Owner, the Contractor and the Surety agree, jointly, and severally, to pay the Owner all outlay
and expense incurred therefor by the Owner. All rights, powers, and remedies of the Owner
hereunder shall be cumulative and not alternative and shall be in addition to all rights, powers, and
remedies given to the Owner, by law. The Owner may proceed against surety for any amount
guaranteed hereunder whether action is brought against the Contractor or whether Contractor is
joined in any such action(s) or not.
NOW THEREFORE, the condition of this obligation is such that if said Principal shall faithfully
perform all the promises of the Principal, as set forth and provided in the Contract, in the Contract
Documents, and in this Bond, then this obligation shall be null and void, otherwise it shall remain in
full force and effect.
When a work, term, or phrase is used in this Bond, it shall be interpreted or construed first as
defined in this Bond, the Contract, or the Contract Documents; second, if not defined in the Bond,
Contract, or Contract Documents, it shall be interpreted or construed as defined in applicable
provisions of the Iowa Code; third, if not defined in the Iowa Code, it shall be interpreted or
construed according to its generally accepted meaning in the construction industry; and fourth, if it
has no generally accepted meaning in the construction industry, it shall be interpreted or construed
according to its common or customary usage.
SECTION 00600
Page 4 of 4
Failure to specify or particularize shall not exclude terms or provisions not mentioned and shall not
limit liability hereunder. The Contract and Contract Documents are hereby made a part of this
Bond.
Project No. 7402836
Witness our hands,)�i'� riplicate, this 25th day of October 2021.
SURETY O SIGNEDBY: Title
i� FORM APPROVED BY:
r8i"c n �eof-Agent
J h E. . Goodmann Rep esentative for Owner' '
Printed Name of Agent
2774 Qni3Zersity Ave SURETY:
Company Address !
�
Dubuque IA 52001 IMT InsuraC.manSurety Company
City, State, Zip Code <�
563-556-3232 S nat Attorney -in -Fact Officer
Company Telephone Number J Goodmann
Printed Name of Attorney -in -Fact Officer
PRINCIPAL:��/ IMT Insurance Company
tt ; 0�WS 1 Company Name
Contractor P 0 Box 1336
By: Company Address
Signature
Y� 1 Des Moines, IA 50306
[ Printed Name City, State, Zip Code
800-274-3531
Company Telephone Number
NOTE:
1. All signatures on this performance, payment, and maintenance Bond must be original
signatures in ink; copies, facsimile, or electronic signatures will not be accepted.
2. This Bond must be sealed with the Surety's raised, embossing seal.
3. The name and signature of the Surety's Attorney-in-Fact/Officer entered on this Bond
must be exactly as listed on the Certificate or Power of Attorney accompanying this
Bond.
—_-_ END OF SECTION 00600 =-_-
IMT INSURANCE
POWER OF ATTORNEY
No.A0637
Notice: The warning found elsewhere in this Power of Attorney affects the validity thereof. Please review carefully.
Know All Persons By These Presents, that IMT Insurance Company a corporation duly organized under the laws of the State of Iowa, and having
its principal office in the City of West Des Moines, County of Dallas, State of Iowa, hath made, constituted and appointed, and does by these
presents make, constitute and appoint
John E. Goodmann and Barton P. Brown
of r1ahklnkand State of Iowa its true and lawful Attorney -in -Fact, with full power and
authority hereby conferred in its name, place and stead, to sign, execute, acknowledge and deliver in its behalf as surety any and all bonds, under-
takings, recognizances or other written obligations in the nature thereof, subject to the limitation that any such instrument shall not exceed the
amount of:
Three Million and No1100 ($3,000,000.00) f)ollar5
and to bind IMT Insurance Company thereby as fully and to the same extent as if such bond or undertaking was signed by the duly authorized
officers of IMT Insurance Company, and all such acts of said Attorney -in -Fact, pursuant to the authority herein given, are hereby ratified and
confirmed.
This Power -of -Attorney is made and executed pursuant to and by authority of the following By -Laws adopted by the Board of
Directors of IMT Insurance Company on December 18, 1998.
ARTICLE VIII, SECTION 4. - The President or any Vice President or Secretary shall have the authority to appoint Attorneys In Fact and
to authorize them to execute on behalf of the Company, and attach thereto the Corporate Seal, bonds, undertakings, recognizances, con-
tracts of indemnity or other obligatory writings, excluding insurance policies and endorsements.
ARTICLE VIII, SECTION 5. - The signature of any authorized officer and the Corporate Seal may be affixed by facsimile to any Power
of Attorney authorizing the execution and delivery of any of the instruments described in Article VIII, Section 4 of the By -Laws. Such
facsimile signature and seal shall have the same force and effect as though manually affixed.
In Witness Whereof, IMT Insurance Company has caused these presents to be signed by its President and its corporate seal to
be hereto affixed, this ath day of , 2021
IMT I suranc,e� Qompany
Sean Kennedy, President
WARNING: THIS POWER IS INVALID IF NOT PRINTED WITH RED BORDER AND RED LOGO.
STATE OF IOWA l ss:
COUNTY OF DALLAS J
On this 8th day of J1178 2021 , before me appeared Sean Kennedy, to me personally known,
who being by me duly sworn did say that he is President of the IMT Insurance Company, the corporation described in the foregoing instrument,
and that the Seal affixed to the said instrument is the Corporate Seal of the said Corporation and that the said instrument was signed and sealed in
behalf of said Corporation by authority of its Board of Directors.
In Testimony Whereof, I have hereunto set my hand and affixed my Official Seal at the City of West Des Moines, Iowa, the day and year
f;-t �kr ' r4f-
�PR� �s TAM' MI M SODA -GOOD
i Commission Number 816649
My C miss' n Expires
P k 12
Notary Public, Dallas County, Iowa
CERTIFICATE
I, Brad Buchanan, Secretary of the IMT Insurance Company do hereby certify that the above and foregoing is a true and correct copy of
the POWER -OF -ATTORNEY, executed by said the IMT Insurance Company, which is still in force and effect. 25th
In Witness Whereof, I have hereunto set my hand and affixed the Seal of the Company on day of
October , 2021
iIX 10941�
Brad Buchanan, Secretary
SY 06 06 (I1/20)
THE CITY OF
DUrBQTE
Masterpiece on the Mississippi
October 29, 2021
Drew Cook & Son's Excavating
Attn: Drew Cook
10782 Timber Ridge Street
Dubuque, Iowa 52001
Dubuque
Finance Department
50 West 13' Street
WAMM M
Dubuque, Iowa 52001-4845
Office (563) 589-4398
Fax (563) 690-6689
TTY (563) 690-6678
2007-2012.2013
finance@cityofdubuque.org
2 0 1 7* 20 1 9
www.cityofdubque.org
Enclosed is the Iowa Construction Sales Tax Exemption Certificate and project
summary for JFK Watermain Extension — Forest Glen Court to Daisy Trail Project. As
information on subcontractors is received, certificates can be generated.
Thank you for your assistance in gathering the information. If you have any questions,
please feel free to contact me at 589-4133.
Sincerely,
�V� &-b4
Cassie Ross
Assistant Director of Finance
CR/eml
Enclosures
cc: Jon Dienst, Engineering
10/28/21, 4:27 PM
IOWA Designated Exempt Entity
:Department of Revenue Iowa Construction Sales Tax Exemption
.. :. www.iowa.gov/tax Certificate and Authorization Letter
This document may be completed by a designated exempt entity and given to their contractor and/or
subcontractor. Seller: Keep this certificate in your files. Contractor/Exempt Entity: Keep a copy of this certificate
for your records. Do not send this to the Department of Revenue
Designated Exempt Entity
City of Dubuque - Finance Department
Address 1
50 West 13th Street
Address 2
City
State
Zip Code
Dubuque
IIA
152001 4864
Construction Project Name
John F. Kennedy Watermain Extension
Construction Project Number (if used)
7402836
Description of contract/subcontract
General Contractor or Subcontractor Name
Drew Cook tt Sons Excavating
Address 1
10782 Timber Ridge St
Address 2
City
State
Zip Code
Dubuque
IIA
152001
Type of Work
General Contractor
The project scope includes installation of approximately 4,250 lineal feet of 12-inch ductile iron pipe (DIP)
water main along the north ditch line of JFK Road from Forest Glen Court to Daisy Trail. Additionally, four
hydrants will be placed with 8-inch ductile iron pipe (DIP) leads to the south side of JFK road to provide fire
protection and future connection to the water main.
The named contractor/subcontractor may purchase building materials used in the contract, exempt from sales
tax. This exemption does NOT apply to materials, equipment and supplies consumed by the contractor or
subcontractor that are not incorporated into the real propert being constructed.
Designated Exempt Entity Authorized Agent: Date:
Authorization Letter From City of Dubuque - Finance Department
CONTRACTORS/SUBCONTRACTORS: A copy of this document must be presented to your supplier(s)
prior to purchasing your building materials.
Pursuant to Iowa Code Section 423.3(80), you are authorized to purchase building materials tax free for the
contract specified above.
The exemption certificate (or a copy of the certificate) may be provided to the suppliers of your building
materials and will authorize them to sell you the materials exempt from Iowa sales tax and any applicable local
option sales tax. Complete information on qualifying materials can be found at www.iowa.gov/tax, the Iowa
Department of Revenue (IDR) Web site.
It is your responsibility to have records identifying the materials purchased and verifying they were used on this
project. Any materials purchased tax-free and not used on this construction project are subject to sales and
applicable local option tax. Should this occur, the tax must be paid directly by you to IDR in the same calendar
quarter the project is completed. E-mail the department at: idr@lowa.gov if you have questions on this
requirement.
Contractors should be aware that use of the certificate to claim exemption from tax for items not used on this
project or that do not qualify for exemption could result in civil or criminal penalties.
31-013 (12/10/02)
https://www.idr.iowa.gov/taxexemption/certFrame.asp?id=261247 1/1
10/28/21, 4:27 PM
Add Estate/Trust
Iowa Department of
REVENUE
Revenue Home
Search...
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Navigation Menu
PROJECT SUMMARY
View Entity Details
Below are the details for the selected project.
List Existing Projects
DRF Control#: 1076888
Add New Project
Project Name: John F. Kennedy Watermain Extension
Add New Contractor
Logoff
Project Nbr: 7402836
Project Description: The project scope includes installation of
approximately 4,250 lineal feet of 12-inch
ductile iron pipe (DIP) water main along the
north ditch line of JFK Road from Forest
Glen Court to Daisy Trail. Additionally, four
hydrants will be placed with 8-inch ductile
iron pipe (DIP) leads to the south side of
JFK road to provide fire protection and
future connection to the water main.
r---,q
Jvjvly _Cj1i JviJ11
CONTRACTORS ASSIGNMENT
Listed below is a list of all general and sub -contractors involved in this
project. Click on the TaxID to see/edit the details for that general or sub
contractor or to delete the contractor or subcontractor.
Contractor
FedID or Contractor
SSN Name Type
421441076 DREW COOK & General
SONS EXCAVATING
Certificate
State of Iowa l Subscribe to e-mail news I Translate l Privacy Statement I Taxpayer Rights l Links I PDF Reader
https://www.idr.iowa.gov/taxexemption/ProjectSummary.asp?id=l 076888
1/1
SECTION 00750
Page 2 of 2
PROJECT INFORMATION REQUIREMENTS FOR
STATE OF IOWA SALES TAX EXEMPTION CERTIFICATES
FOR CONTRACTORS & SUBCONTRACTORS
Submitting Department: Engineering
Department Contact: Jon Dienst, P.E.
Project CIP Number(s):7402836
Please complete this form in its entirety and submit along with the executed Contract, Bonds and
Certificate of Insurance. Upon receipt, the City Finance Department will work with the Iowa
Department of Revenue to issue Sales Tax Exemption Certificates to the approved contractor(s) to
allow for the purchase or inventory withdrawal of materials for the specified Project free from State
of Iowa Sales Tax.
Sales tax exemption certificates are not provided to material suppliers.
The Contractor and subcontractors can provide copies of the sales tax exemption certificates issued by the
City to individual material suppliers.
Project Name: John F. Kennedy Watermain Extension -- Forest
Glen Ct. to Daisy Trail Project
Project Description: The project scope includes installation of approximately
4,250 lineal feet of 12-inch ductile iron pipe (DIP) water
main along the north ditch line of John F. Kennedy Road
from Forest Glen Court to Daisy Trail. Additionally, four
hydrants will be placed with 8-inch ductile iron pipe (DIP)
leads to the south side of John F. Kennedy Road to provide
fire protection and future connection to the water main.
Start Date Bid Opening Date): September 28, 2021
Final Completion Date: April 30, 2022
1. General Prime Contractor:
(' ' �: E- t, (in
Contact Name:
Complete Address:
(Include PO Box and Street Information)
City, State, Zip Code
t
Telephone Number:
Federal I.D. Number:
(or Include Social Security Number)
.�
ILI I L4 Q I
Work Type to be Completed:
,�
DREWC-2 QP in.
TE
CERTIFICATE OF LIABILITY INSURANCE FD 10125/20Y1
10/25/2021
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed.
If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on
this certificate does not confer rights to the certificate holder in lieu of such endorsements .
PRODUCER 563-556-3232 CONTACT John E Goodmann
Goodmann Insurance Services PHONE 563-556-3232 FAX 563-556-2246
2774 University Ave (A/C, No, EXt): A/C, No):
Dubuque, IA 52001 EMAIL
John E Goodmann ADDgE E
INSURED
Drew Cook and Sons
Excavating Inc
10782 Timber Ridgge
Dubuque, IA 52001
rrIVGAAn=Q
/�C�TIC 1!`ATG \II Ie11�G�.
A: United Fire & Casualty Co*
B:
C:
D:
E:
F:
1302
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR1
TYPE OF INSURANCE
ADDLlush-ISUBIow-j
POLICY NUMBER
POLICY EFF
POLICY EXPLTR
LIMITS
A
X
COMMERCIAL GENERAL LIABILITY
CLAIMS -MADE I= "i OCCUR
Primary &
X
X 60432947
06/10/2021
06/10/2022
ACH CCURRENCE
1,000,000
DAMAGE TO RENTED
EBEdLSEEJEa p�cuJrgncej
MED EXP JAU_on person
PERSONAL ADV INJURY
$ 100,000
$ 5 000
Non-contributing
1000 000
1,000,000
GENT AGGREGATE LIMIT APPLIES PER:
POLICY �� PRO -
OTHER �LOC
2,000,000
GENERAL AGGREGATE
PROD T - COMP/OP AGG
2,000,000
A
AUTOMOBILE
LIABILITY
ANY AUTO
OWNED SCHEDULE)
AUTOS ONLY AUTOS
X
X 160432941
06/10/2021
06/10/2022
COMBINED SINGLE LIMIT
(Ea irdeno
1,000,000
X _
—a
BODILY INJURY Per rson
BODILY INJURY Per accidentAITOS
ONLYAUTO ONLY
P
Peer a cid ntDAMAGE
$
A
X
UMBRELLA LIAB l X
EXCESS LIAB
OCCUR
CLAIMS -MADE
X
'
X U432947 06/10/2021 : 06/10/2022
EACH OCCURRENCE
3,000,000
AGGREGATE
$ 3,000,000
DED RETENTION $
_
A
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY
Y / N
ANYPROPRIETOR/PXCLUDEIEXECUTIVE
OFFICER/MEMBER EXCLUDED L-]
(Mandatory in NH)
If es, describe under
SCRIPT OF OPERATIONS bel
N / A
X
60432947 06/10/2021
06/10/2022
X PER OTH-
= I ES
E.L. EACH ACCIDENT
100,000
E.L. DISEASE - EA EMPLOY
100 000
�
I E.L. DISEASE - POLICY I I"T
500,000
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached it more space is required)
The City of Dubuque, including all its elected and appointed officials, all
its employees and volunteers, all its boards, commissions and/or authorities
and their board members, employees and volunteers included as Addl Insured
Project: #7402836 John F Kennedy Watermain Extension -Forest Glen Ct to Daisy
Trail Project
CITY'DU1
City of Dubuque
50 W 13th Street
Dubuque, IA 52001
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVE
ACORD 25 (2016/03) 01988-2015 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD
ENDORSEMENT SPECEND
60432947 (0000)
THE FOLLOWING IS HOW THE C(3'1131 ADDITIONAL INSURED FOR THE CITY OF
DUBUQUE SHOULD READ:
THE CITY 01' DUBUQUE, INCLUDING ALL ITS FLECTED AND APPOINTED OFFICIALS,
ALL ITS EMJ?LOYEES AND VOLUNTEERS, ALI,, ITS BOARDS, COMMISSIONS AND/OR
AUTHOUTTFS AND THEIR B,.)ARD MEMBERS, EMPLOYEES AND VOLUNTEERS.
All other terms, conditions, lifflitations and agreements of the policy remain Unchanged,
SPEC END
(0000)
IL 71 05 10 14
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
PRIMARY AND NONCONTRIBUTORY - OTHER INSURANCE CONDITION
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART
COMMERCIAL UMBRELLA COVERAGE PART
The following is added to the Other Insurance Condition and supersedes any provision to the contrary:
Primary And Noncontributory Insurance
This insurance is primary to and will not seek contribution from any other insurance available to an additional insured
under your policy provided that:
(1) The additional insured is a Named Insured under such other insurance;
(2) You have agreed in writing in a contract or agreement that this insurance would be primary and would not seek
contribution from any other insurance available to the additional insured;
(3) The additional insured gives us prompt written notice of any 'occurrence" which may result in a claim and prompt
written notice of "suit';
(4) The additional insured immediately forwards all legal papers to us, cooperates in the investigation or settlement of
the claim or defense against the "suit', and otherwise complies with policy conditions.
(5) The additional insured must tender the defense and indemnity of any claim or "suit' to any other insurer which also
insures against a loss we cover under this policy. This includes, but is not limited to, any insurer which has issued a
policy of insurance in which the additional insured qualifies as an insured. For the purpose of this requirement, the
term "insures against' refers to any self-insurance and to any insurer which issued a policy of insurance that may
provide coverage for the loss, regardless of whether the additional insured has actually requested that the insurer
provide the additional insured with a defense and/or indemnity under that policy of insurance.
(6) The additional insured agrees to make available any other insurance that the additional insured has for a loss we
cover under this policy.
IL 71 05 10 14 Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 1 of 1
CG 71 31 02 15
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
ADDITIONAL INSURED -OWNERS, LESSEES OR CONTRACTORS -
COMPLETED OPERATIONS
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART
SCHEDULE
Name of Additional Insured Person(s) or
Location And Description Of Completed Operations
Information required to complete this Schedule, if not shown above, will be shown in the Declarations.
A. Section II — Who Is An Insured is amended to include as an additional insured the person(s) or organization(s)
shown in the Schedule, but only with respect to your liability for "bodily injury" or "property damage"which may be
imputed to that person(s) or organization(s) directly arising out of "your work" at the location designated and
described in the schedule of this endorsement performed for that additional insured and only for that liability included
in the "products -completed operations hazard".
However:
1. The insurance afforded to such additional insured only applies to the extent permitted by law; and
2. If coverage provided to the additional insured is required by a contractor agreement, the insurance afforded to
such additional insured will not be broader than that which you are required By the contract or agreement to
provide for such additional insured.
B. With respect to the insurance afforded to these additional insureds, the following additional exclusions apply:
This insurance does not apply to:
1. "Bodily injury", "property damage" or "personal and advertising injury" arising out of the rendering of, or the failure
to render, any professional architectural, engineering or surveying services including:
a. The preparing, approving, or failing to prepare or approve, maps, shop drawings, opinions, reports, surveys,
field orders, change orders or drawings or specifications; or
b. Supervisory, inspection, architectural or engineering activities.
C. With respect to the insurance afforded to these additional insureds, the following is added to Section III — Limits Of
Insurance:
If coverage provided to the additional insured is required by a contract or agreement, the most we will pay on behalf
of the additional insured is the amount of insurance:
1. Required by the contract or agreement; or
2. Available under the applicable Limits of Insurance shown in the Declarations;
whichever is less.
This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations.
CG 71 31 02 15 Includes copyrighted material of Insurance Services Office, Inc., with its permission Page 1 of 1
0101. 06-10-2021
IPOLICY NUMBER: 60432947
P_- - I
COMMERCIAL GENERAL LIABILITY SUPPLEMENTAL DECLARATIONS - ADDITIONAL INSUREDS
Schedule of Additional Insureds
Premium
WNERS, LESSEES OR CONTRACTORS SCHEDULED PERSON 50
CG7085 --IOWA
Owners, Lessees or Contractors Location of Covered Operation
NORTH ROCK REAL ESTATE
6723 WEAVER RT) STE 108
ROCKFORD 11, 63,114
WNERS, LESSEES OR CONTRACTORS -COMPLETED OPERATIONS 250
CG7137. -IOWA
CITY OF DUBUQUE
50 W 13TIl ST, DUBUQUE IA 5200:1
Location and Description of Completed Operation.,;
VARIOUS LOCATIONS
CG 71 54 01 07
POLICY NUMBER: 60432947 COMMERCIAL MULTIPLE LINE
IL 70 84 06 16
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
IOWA GOVERNMENTAL IMMUNITIES ENDORSEMENT
This endorsement modifies insurance provided tinder the following:
COMMERCIAL GENERAL LIABILITY COVERAGE FORM
BUSINESSOWNERS COVERAGE FORM
BUSINESS AUTO COVERAGE FORM
SCHEDULE
Name of Organization:
CITY OF DUBUQUE
50 W 13TH ST
DUBUQUE IA 52001
I. The insurance carrier expressly agrees and states that the purchase of this
policy and the including of the organization shown in the Schedule as an Additional Insured does not waive any of the
defenses of governmental immunity available to the organization shown in the Schedule under Code of Iowa Section
670.4 as it now exists and as it may be amended from time to time.
2. aim C
-la. , *_Cqyg1qU0. The insurance carrier further agrees that this policy of insurance shall cover only those clairns not
subject to the defense of governmental immunity under the Code of Iowa Section 670.4 as it now exists and as it
may be amended from time to tirne.
3. Assertion of Gove�r mtilal-immunity-. The organization shown in the Schedule shall be responsible for asserting
any defense of governmental immunity, and may do so at any time and shall do so upon the timely written request of
the insurance carrier. Nothing contained in this endorsement, shall prevent the carder from asserting the defense of
governmental immunity on behalf of the organization shown in the Schedule.
4. N-o- n - Qe jI i[al of OQyetage. The insurance carrier shall not deny coverage under this policy and the insurance carrier
shall not deny any of the rights and benefits accruing to the organization shown In the Schedule Linder 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 organization shown in the Schedule.
S. N12 Qlher Change Ili Policy. The insurance carrier and the organization shown in the Schedule agree that the above
preservation of governmental immunities shall not otherwise change or alter the coverage available under the policy.
IL 70 84 0616 Page 1 of 1
CG 71 85 07 17
LAND IMPROVEMENT CONTRACTORS ASSOCIATION (LICA) — ULTRA LIABILITY PLUS ENDORSEMENT
COMMERCIAL GENERAL LIABILITY EXTENSION ENDORSEMENT SUMMARY OF COVERAGES
This is a summary of the various additional coverages and coverage modifications provided by this
endorsement. No coverage is provided by this summary.
• Extended Property Damage
" Expanded Fire Legal Liability to include Explosion, Lightning and Sprinkler Leakage
• Coverage for non -owned watercraft is extended to 51 feet in length
" Property Damage — Borrowed Equipment
" Property Damage Liability — Elevators
• Coverage D — Voluntary Property Damage Coverage
$10,000 Occurrence with a $20,000 Aggregate
" Coverage E — Care, Custody and Control Property Damage Coverage
$10,000 Occurrence with a $20,000 Aggregate — $500 Deductible
• Coverage F — Electronic Data Liability Coverage — $50,000
* Coverage H — Water Damage Legal Liability — $25,000
• For newly formed or acquired organizations — extend the reporting requirement to 180 days
* Broadened Named Insured
" Automatic Additional Insured — Owners, Lessees or Contractors - Automatic Status When Required in Construction
Agreement With You — Including Upstream Parties
• Automatic Additional Insured — Vendors
" Automatic Additional Insured — Lessor of Leased Equipment Automatic Status When Required in Lease Agreement
With You
• Automatic Additional Insured — Managers or Lessor of Premises
" Additional Insured — Engineers, Architects or Surveyors Not Engaged by the Named Insured
" Additional Insured — Employee Injury to Another Employee
• Automatically included — Aggregate Limits of Insurance (per location)
• Automatically included — Aggregate Limits of Insurance (per project)
• Knowledge of occurrence — Knowledge of an `occurrence", "claim or suit' by your agent, servant or employee shall not
in itself constitute knowledge of the named insured unless an officer of the named insured has received such notice
from the agent, servant or employee
" Blanket Waiver of Subrogation
* Liberalization Condition
• Unintentional failure to disclose all hazards. If you unintentionally fail to disclose any hazards existing at the inception
date of your policy, we will not deny coverage under this Coverage Form because of such failure. However, this
provision does not affect our right to collect additional premium or exercise our right of cancellation or non -renewal.
" Mobile equipment to include snow removal, road maintenance and street cleaning equipment less than 1,000 Ibs GVW
• Bodily Injury Redefined
REFER TO THE ACTUAL ENDORSEMENT FOLLOWING ON PAGES 2 THROUGH 9 FOR CHANGES AFFECTING
YOUR INSURANCE PROTECTION
CG 71 85 07 17 Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 1 of 9
CG 71 85 07 17
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
LAND IMPROVEMENT CONTRACTORS ASSOCIATION (LICA)
ULTRA LIABILITY PLUS ENDORSEMENT
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
SECTION I -COVERAGES
A. The following changes are made at COVERAGE A — BODILY INJURY AND PROPERTY DAMAGE LIABILITY
1. Extended Property Damage
At 2. Exclusions exclusion a. Expected or Intended Injury is replaced with the following:
"Bodily injury" or "property damage' expected or intended from the standpoint of the insured. This exclusion does
not apply to "bodily injury" or "property damage' resulting from the use of reasonable force to protect persons or
property.
2. Expanded Fire Legal Liability
At 2. Exclusions the last paragraph is deleted and replaced by the following:
Exclusions c. through n. do not apply to damage by fire, explosion, lightning, smoke resulting from such fire,
explosion, or lightning or sprinkler leakage to premises while rented to you or temporarily occupied by you with
permission of this owner. A separate limit of insurance applies to this coverage as described in SECTION III —
LIMITS OF INSURANCE.
3. Non -Owned Watercraft
At 2. Exclusions exclusion g. Aircraft, Auto Or Watercraft (2) (a) is deleted and replaced by the following:
(a) Less than 51 feet long;
4. Property Damage — Borrowed Equipment
At 2. Exclusions the following is added to paragraph (4) of exclusion j. Damage To Property:
This exclusion does not apply to "property damage' to borrowed equipment while at a jobsite and while not being
used to perform operations. The most we will pay for "property damage' to any one piece of borrowed equipment
under this coverage is $25,000 per occurrence. The insurance afforded under this provision is excess over any
valid and collectible property insurance (including deductible) available to the insured, whether primary, excess,
contingent or on any other basis.
5. Property Damage Liability — Elevators
At 2. Exclusions the following is added to paragraphs (3), (4) and (6) of exclusion j. Damage To Property:
This exclusion does not apply to "property damage' resulting from the use of elevators. However, any insurance
provided for such "property damage" is excess over any valid and collectible property insurance (including
deductible) available to the insured, whether primary, excess, contingent or on any other basis.
B. The following coverages are added:
1. COVERAGE D —VOLUNTARY PROPERTY DAMAGE COVERAGE
"Property damage" to property of others caused by the insured:
a. While in your possession; or
b. Arising out of "your work".
Coverage applies at the request of the insured, whether or not the insured is legally obligated to pay.
For the purposes of this Voluntary Property Damage Coverage only:
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CG 71 85 07 17
Exclusion j. Damage to Property is deleted and replaced by the following:
j. Damage to Property
"Property damage" to:
(1) Property held by the insured for servicing, repair, storage or sale at premises you own, rent, lease,
operate or use;
(2) Property transported by or damage caused by any "automobile", "watercraft" or "aircraft" you own, hire or
lease;
(3) Property you own, rent, lease, borrow or use.
The amount we will pay is limited as described below in SECTION III — LIMITS OF INSURANCE
For the purposes of this Voluntary Property Damage Coverage, our right and duty to defend ends when
we have paid the Limit of Liability or the Aggregate Limit for each coverage, and we are granted sole
discretion in making payments under this coverage.
2. COVERAGE E — CARE, CUSTODY AND CONTROL PROPERTY DAMAGE COVERAGE
For the purpose of this Care, Custody and Control Property Damage Coverage only:
a. Item (4) of Exclusion j. does not apply.
The amount we will pay is limited as described below in SECTION III — LIMITS OF INSURANCE
For the purposes of this Care, Custody and Control Property Damage Coverage, our right and duty to
defend ends when we have paid the Limit of Liability or the Aggregate Limit for each coverage, and we
are granted sole discretion in making payments under this coverage.
3. COVERAGE F — ELECTRONIC DATA LIABILITY COVERAGE
For the purposes of this Electronic Data Liability Coverage only:
a. Exclusion p. of Coverage A — Bodily Injury And Property Damage Liability in Section I — Coverages is
replaced by the following:
2. Exclusions
This insurance does not apply to:
p. Electronic Data
Damages arising out of the loss of, loss of use of, damage to, corruption of, inability to access, or
inability to manipulate "electronic data" that does not result from physical injury to tangible property.
However, this exclusion does not apply to liability for damages because of "bodily injury"
b. "Property Damage" means:
(1) Physical injury to tangible property, including all resulting loss of use of that property. All such loss of use
shall be deemed to occur at the time of the physical injury that caused it; or
(2) Loss of use of tangible property that is not physically injured. All such loss of use shall be deemed to
occur at the time of the 'occurrence" that caused it; or
(3) Loss of, loss of use of, damage to, corruption of, inability to access or inability to properly manipulate
"electronic data", resulting from physical injury to tangible property. All such loss of "electronic data" shall
be deemed to occur at the time of the "occurrence" that caused it.
For the purposes of this Electronic Data Liability Coverage, "electronic data" is not tangible property.
The amount we will pay is limited as described below in SECTION III — LIMITS OF INSURANCE
4. COVERAGE H —WATER DAMAGE LEGAL LIABILITY
The Insurance provided under Coverage W (Section 1) applies to "property damage" arising out of water damage
to premises that are both rented to and occupied by you.
The Limit under this coverage shall not be in addition to the Damage To Premises Rented To You Limit.
The amount we will pay is limited as described below in SECTION III — LIMITS OF INSURANCE
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C. SUPPLEMENTARY PAYMENTS — COVERAGES A AND B is amended:
The following language is added to Item 1.
However, we shall have none of the duties set forth above when this insurance applies only for Voluntary
Property Damage Coverage and/or Care, Custody or Control Property Damage Coverage and we have paid
the Limit of Liability or the Aggregate Limit for these coverages.
SECTION II - WHO IS AN INSURED
A. The following change is made:
Extended Reporting Requirements
Item 3.a. is deleted and replaced by the following
a. Coverage under this provision is afforded only until the 180th day after you acquire or form the organization or
the end of the policy period, whichever is earlier.
B. The following provisions are added:
4. BROAD FORM NAMED INSURED
Item 1.f. is added as follows:
f. Any legally incorporated entity of which you own more than 50 percent of the voting stock during the policy
period only if there is no other similar insurance available to that entity. However:
(1) Coverage A does not apply to "bodily injury" or "property damage" that occurred before you acquired
more than 50 percent of the voting stock; and
(2) Coverage B does not apply to "personal and advertising injury" arising out of an offense committed
before you acquired more than 50 percent of the voting stock.
5. Additional Insured — Owners, Lessees or Contractors -Automatic Status When Required in Construction
or Service Agreement With You — Including Upstream Parties
a. Any person or organization for whom you are performing operations when you and such person or
organization have agreed in writing in a contract or agreement that such person or organization be added as
an additional insured on your policy;
b. Any other person or organization you are required to add as an additional insured under the contract or
agreement described in Paragraph a. above.
Such person(s) or organization(s) is an additional insured only with respect to liability for "bodily injury",
"property damage" or "personal and advertising injury" which may be imputed to that person or organization
directly arising out of:
1. Your acts or omissions; or
2. The acts or omissions of those acting on your behalf;
in the performance of your ongoing operations for the additional insured.
However, the insurance afforded to such additional insured:
1. Only applies to the extent permitted by law; and
2. Will not be broader than that which you are required by the contract or agreement to provide for such
additional insured.
c. With respect to the insurance afforded to these additional insureds, the following additional exclusions apply:
This insurance does not apply to:
1. "Bodily injury", "property damage" or "personal and advertising injury" arising out of the rendering of, or
the failure to render, any professional architectural, engineering or surveying services, including:
a. The preparing, approving, or failing to prepare or approve, maps, shop drawings, opinions, reports,
surveys, field orders, change orders or drawings and specifications; or
b. Supervisory, inspection, architectural or engineering activities.
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This exclusion applies even if the claims against any insured allege negligence or other wrongdoing in the
supervision, hiring, employment, training or monitoring of others by that insured, if the "occurrence" which
caused the "bodily injury" or "property damage", or the offense which caused the "personal and advertising
injury", involved the rendering of or the failure to render any professional architectural, engineering or
surveying services.
2. "Bodily injury" or "property damage" occurring after:
a. All work, including materials, parts or equipment furnished in connection with such work, on the
project (other than service, maintenance or repairs) to be performed by or on behalf of the additional
insured(s) at the location of the covered operations has been completed; or
b. That portion of "your work" out of which the injury or damage arises has been put to its intended use
by any person or organization other than another contractor or subcontractor engaged in performing
operations for a principal as a part of the same project.
6. Additional Insured —Vendors
a. Any person(s) or organization(s) (referred to throughout this additional coverage as vendor), but only with
respect to "bodily injury" or "property damage", which may be imputed to that person(s) or organization(s)
arising out of "your products" shown with the Schedule which are distributed or sold in the regular course of
the vendor's business is an insured.
However:
(1) The insurance afforded to such vendor only applies to the extent permitted by law; and
(2) If coverage provided to the vendor is required by a contract or agreement, the insurance afforded to such
vendor will not be broader than that which you are required by the contract or agreement to provide for
such vendor.
b. With respect to the insurance afforded to these vendors, the following additional exclusions apply:
(1) This insurance afforded the vendor does not apply to:
(a) "Bodily injury" or "property damage" for which the vendor is obligated to pay damages by reason of
the assumption of liability in a contract or agreement. This exclusion does not apply to liability for
damages that the vendor would have in the absence of the contract or agreement;
(b) Any express warranty unauthorized by you;
(c) Any physical or chemical change in the product made intentionally by the vendor;
(d) Repackaging, except when unpacked solely for the purpose of inspection, demonstration, testing, or
the substitution of parts under instructions from the manufacturer, and then repackaged in the
original container.
(e) Any failure to make such inspections, adjustments, tests or servicing as the vendor has agreed to
make or normally undertakes to make in the usual course of business, in connection with the
distribution or sale of products.
(f) Demonstration, installation, servicing or repair operations, except such operations performed at the
vendor's premises in connection with the sale of the product.
(g) Products which, after distribution or sale by you, have been labeled or relabeled or used as a
container, part or ingredient of any other thing or substance by or for the vendor.
(h) "Bodily injury" or "property damage" arising out of the sole negligence of the vendor for its own acts
or omissions or those of its employees or anyone else acting on its behalf. However, this exclusion
does not apply to:
i. The exceptions contained in Sub -paragraphs d. or f.; or
ii. Such inspections, adjustments, tests or servicing as the vendor has agreed to make or normally
undertakes to make in the usual course of business, in connection with the distribution or sale of
the products.
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CG 71 85 07 17
(2) This insurance does not apply to any insured person or organization, from whom you have acquired such
products, or any ingredient, part or container, entering into, accompanying or containing such products.
7. Additional Insured — Lessor of Leased Equipment — Automatic Status When Required in Lease
Agreement With You
a. Any person(s) or organization(s) from whom you lease equipment when you and such person(s) or
organization(s) have agreed in writing in a contract or agreement that such person(s) or organization(s) be
added as an additional insured on your policy. Such person(s) or organization(s) is an insured only with
respect to your liability for "bodily injury", "property damage" or "personal and advertising injury" directly
arising out of the maintenance, operation or use of equipment leased to you, which may be imputed to such
person or organization as the lessor of equipment.
However, the insurance afforded to such additional insured:
(1) Only applies to the extent permitted by law; and
(2) Will not be broader than that which you are required by the contract or agreement to provide for such
additional insured.
A person's or organization's status as an additional insured under this endorsement ends when their contract
or agreement with you for such leased equipment ends.
b. With respect to the insurance afforded to these additional insureds, this insurance does not apply to any
"occurrence" which takes place after the equipment lease expires.
8. Additional Insured — Managers or Lessors of Premises
a. Any person(s) or organization(s), but only with respect to liability arising out of the ownership, maintenance or
use of that part of the premises leased to you and subject to the following additional exclusions:
This insurance does not apply to:
(1) Any "occurrence" which takes place after you cease to be a tenant in that premises.
(2) Structural alterations, new construction or demolition operations performed by or on behalf of the
person(s) or organization(s) shown in the Schedule.
However:
(1) The insurance afforded to such additional insured only applies to the extent permitted by law; and
(2) If coverage provided to the additional insured is required by a contract or agreement, the insurance
afforded to such additional insured will not be broader than that which you are required by the contract or
agreement to provide for such additional insured.
9. Additional Insured — Engineers, Architects or Surveyors Not Engaged by the Named Insured
a. Any architects, engineers or surveyors who are not engaged by you are insureds, but only with respect to
liability for "bodily injury" or "property damage" or "personal and advertising injury" which may be imputed to
that architect, engineer or surveyor arising out of:
(1) Your acts or omissions; or
(2) Your acts or omissions of those acting on your behalf;
in the performance of your ongoing operations performed by you or on your behalf.
But only if such architects, engineers or surveyors, while not engaged by you, are contractually required to be
added as an additional insured to your policy.
However, the insurance afforded to such additional insured:
(1) Only applies to the extent permitted by law; and
(2) Will not be broader than that which you are required by the contract or agreement to provide for such
additional insured.
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b. With respect to the insurance afforded to these additional insureds, the following additional exclusion applies:
This insurance does not apply to "bodily injury", "property damage" or "personal and advertising injury"
arising out of the rendering of or failure to render any professional services, including:
(1) The preparing, approving, or failing to prepare or approve, maps, drawings, opinions, reports, surveys,
change orders, designs or specifications; or
(2) Supervisory, inspection or engineering services.
This exclusion applies even if the claims against any insured allege negligence or other wrongdoing in the
supervision, hiring, employment, training or monitoring of others by that insured, if the 'occurrence" which
caused the "bodily injury" or "property damage", or the offense which caused the "personal and advertising
injury", involved the rendering of or the failure to render any professional services.
10. Additional Insured — Employee Injury to Another Employee
With respect to your "employees" who occupy positions which are supervisory in nature:
Paragraph 2.a.(1) of SECTION II — WHO IS A NAMED INSURED is amended to read:
a. "Bodily injury" or "personal and advertising injury"
(1) To you, to your partners or members (if you are a partnership or joint venture), or to your members (if
you are a limited liability company);
(2) For which there is any obligation to share damages with or repay someone else who must pay damages
because of the injury described in paragraph (1)(a) above; or
(3) Arising out of his or her providing or failing to provide professional healthcare services. Paragraph 3.a. is
deleted.
For the purpose of this Item 10 only, a position is deemed to be supervisory in nature if that person performs
principle work which is substantially different from that of his or her subordinates and has authority to hire,
direct, discipline or discharge.
SECTION III - LIMITS OF INSURANCE
A. The following Items are deleted and replaced by the following:
2. The General Aggregate Limit is the most we will pay for the sum of:
a. Medical expenses under Coverage C;
b. Damages under Coverage A, except damages because of "bodily injury" or "property damage" included in
the "products -completed operations hazard"; and
c. Damages under Coverage B; and
d. Damages under Coverage H.
6. Subject to 5. above, the Damage to Premises Rented to You Limit is the most we will pay under Coverage A for
damages because of "property damage" to any one premises, while rented to you, or in the case of damage by
fire, explosion, lightning, smoke resulting from such fire, explosion, or lightning or sprinkler leakage while rented
to you or temporarily occupied by you with permission of the owner.
B. The following are added:
8. Subject to Paragraph 5. of SECTION III — LIMITS OF INSURANCE $25,000 is the most we will pay under
Coverage H for Water Damage Legal Liability.
9. Aggregate Limits of Insurance (Per Location)
The General Aggregate Limit applies separately to each of your 'locations" owned by or rented to you or
temporarily occupied by you with the permission of the owner.
"Location" means premises involving the same or connecting lots, or premises whose connection is interrupted
only by a street, roadway, waterway or right-of-way of a railroad.
10. Aggregate Limits of Insurance (Per Project)
The General Aggregate Limit applies separately to each of your projects away from premises owned by or rented
to you.
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CG 71 85 07 17
11. With respects to the insurance afforded to additional insureds afforded coverage by items 5 through 10 of
SECTION II — WHO IS AN INSURED above, the following is added:
The most we will pay on behalf of the additional insured is the amount of insurance:
a. Required by the contract or agreement;
b. Available under the applicable Limits of Insurance shown in the Declarations;
Whichever is less.
This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations.
12. Subject to 5. of SECTION III — LIMITS OF INSURANCE, a $10,000 "occurrence" limit and a $20,000
"aggregate" limit is the most we will pay under Coverage A for damages because of "property damage" covered
under Coverage D — Voluntary Property Damage Coverage.
For the purposes of this Voluntary Property Damage Coverage, our right and duty to defend ends when
we have paid the Limit of Liability or the Aggregate Limit for each coverage, and we are granted sole
discretion in making payments under this coverage.
13. Subject to 5. of SECTION III — LIMITS OF INSURANCE, a $10,000 'occurrence" limit and a $20,000
"aggregate" limit is the most we will pay under Coverage E-Care, Custody and Control Coverage regardless of
the number of:
a. Insureds;
b. Claims made or "suits" brought; or
c. Persons or organizations making claims or bringing "suits".
Deductible - Our obligation to pay damages on your behalf applies only to the amount of damages in excess of
$500.
This deductible applies to all damages because of "property damage" as the result of any one 'occurrence"
regardless of the number of persons or organizations who sustain damages because of that 'occurrence".
We may pay any part or all of the deductible amount to effect settlement of any claim or "suit" and upon
notification of the action taken, you shall promptly reimburse us for such part of the deductible amount as has
been paid by us.
As respects this coverage "Aggregate" is the maximum amount we will pay for all covered 'occurrences" during
one policy period.
For the purposes of this Care, Custody and Control Property Damage Coverage, our right and duty to
defend ends when we have paid the Limit of Liability or the Aggregate Limit for each coverage, and we
are granted sole discretion in making payments under this coverage.
15. Subject to 5. of SECTION III — LIMITS OF INSURANCE, the most we will pay for "property damage" under
Coverage F — Electronic Data Liability Coverage for loss of "electronic data" is $50,000 without regard to the
number of `occurrences".
SECTION IV - COMMERCIAL GENERAL LIABILITY CONDITIONS
A. The following conditions are amended:
1. Knowledge of Occurrence
a. Condition 2., Items a. and b. are deleted and replaced by the following:
(1) Duties In The Event Of Occurrence, Offense, Claim Or Suit
(a) You must see to it that we are notified as soon as practicable of an 'occurrence" or an offense which
may result in a claim. Knowledge of an 'occurrence" by your agent, servant or employee shall not in
itself constitute knowledge of the named insured unless an officer of the named insured has received
such notice from the agent, servant or employee. To the extent possible, notice should include:
L How, when and where the 'occurrence" took place;
ii. The names and addresses of any injured persons and witnesses, and
iii. The nature and location of any injury or damage arising out of the 'occurrence" or offense.
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CG 71 85 07 17
(b) If a claim is made or "suit' is brought against any insured, you must:
i. Immediately record the specifics of the claim or "suit' and the date received; and
ii. Notify us as soon as practicable.
You must see to it that we receive written notice of the claim or "suit' as soon as practicable. Knowledge of a
claim or "suit' by your agent, servant or employee shall not in itself constitute knowledge of the named
insured unless an officer of the named insured has received such notice from the agent, servant or
employee.
2. Where Broad Form Named Insured is added in SECTION II — WHO IS AN INSURED of this endorsement,
Condition 4. Other Insurance b. Excess Insurance (1).(a) is replaced by the following:
(a) Any of the other insurance, whether primary, excess, contingent or on any other basis, that is available to an
insured solely by reason of ownership by you of more than 50 percent of the voting stock, and not
withstanding any other language in any other policy. This provision does not apply to a policy written to apply
specifically in excess of this policy.
B. The following are added:
1. Condition (5) of 2.c.
(5) Upon our request, replace or repair the property covered under Voluntary Property Damage Coverage at
your actual cost, excluding profit or overhead.
10. Blanket Waiver Of Subrogation
We waive any right of recovery we may have against any person or organization because of payments we make
for injury or damage arising out of: premises owned or occupied by or rented or loaned to you, ongoing
operations performed by you or on your behalf, done under a contract with that person or organization, "your
work", or "your products". We waive this right where you have agreed to do so as part of a written contract,
executed by you before the "bodily injury" or "property damage" occurs or the "personal injury" or "advertising
injury" offense is committed.
11. Liberalization
If a revision to this Coverage Part, which would provide more coverage with no additional premium becomes
effective during the policy period in the state designated for the first Named Insured shown in the Declarations,
your policy will automatically provide this additional coverage on the effective date of the revision.
12. Unintentional Failure to Disclose All Hazards
Based on our reliance on your representations as to existing hazards, if you unintentionally should fail to disclose
all such hazards at the inception date of your policy, we will not deny coverage under this Coverage Part
because of such failure. However, this provision does not affect our right to collect additional premium or
exercise our right of cancellation or non -renewal.
SECTION V - DEFINITIONS
A. At item 12. Mobile Equipment the wording at f.(1) is deleted and replaced by the following:
f.(1) Equipment designed primarily for:
(a) Snow removal;
(b) Road maintenance, but not construction or resurfacing; or
(c) Street cleaning;
except for such vehicles that have a gross vehicle weight less than 1,000 Ibs which are not designed for highway
use.
B. Item 3. "bodily injury" is deleted and replaced with the following:
3. "bodily injury" means physical injury, sickness or disease sustained by a person. This includes mental anguish,
mental injury, shock, fright or death that results from such physical injury, sickness or disease.
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0101 ---06-J0-2021
POLICY NUMBER- 60432947___.__]
WORKERS COMPENSATION AND EMPLOYERS LIABILITY SUPPLEMENTAL DECLARATIONS,
Premium Basis Rate Per Estimated
Total Estimated $100 of Annual
Annual Remuneration Remuneration Premium
CONTINUED
IS SUBJECT TO VERIFICATION AND CHANGE BY AUDIT.
Form W0000313 appli-es to:
CITY OF DUBUQUE
50 W 13TH ST
DUBUQUE, IA 52001
RIVER CITY PAVING -DIVISION OF
XATHY CONSTRUCTION COMPANY
PO BOX 1430
DUBUQUE, IA 52002-1430
IA LOC# 01
5200 WOLFF RD
DUBUQUE, IA 52002-2505
6217 EXCAVATION & DRIVERS
205,196
4.710
9'F;(35
6306 SEWER CONSTRUCTION -ALL OPERATION8
IF ANY
5.910
0
& DRIVERS
6319 WATER MAIN OR CONNECTION CONSTRUCTION
IF ANY
3.690
0
& DRIVERS
8810 CLERICAL OFFICE EMPLOYEES VOC
73,501
.210
154
IA LOC# 01 DEPT# 01 CITY OF DUBUQUE
5200 WOLFF RD
DUBUQUE, IA 52002-2505
6217 EXCAVATION & DRIVERS IF ANY 4.710 0
0930 ADDITIONAL PREMIUM- WAIVER OF SUBROGATION 100
IA LOC# 01 DEPT# 02 RIVER CITY PABVING/MATHY CONST
5200 WOLFF RD
DUBUQUE, TA 52002-2505
6217 EXCAVATION & DRIVERS IF ANY 4.710 0
0930 ADDITIONAL PREMIUM- WAIVER OF SUBROGATION 100
IA 9898 EXPERIENCE MODIFICATION .890 -1,102
IA 9740 TERRORISM .010 28
CONTINUED ON WC-2S
wc-25 (01 95)
WC 00 03 13
(4-84)
WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT
This endorsement changes the policy to which it is attached effective on the inception date of the policy
unless a different date is indicated below.
(The following "attaching clause" need be completed only when this endorsement is issued subsequent to preparation of the policy.)
This endorsement, effective on at 12:01 A.M. standard time, forms a part of
(DATE)
Policy No. of the
(NAME OF INSURANCE COMPANY)
issued to
Premium $
Authorized Representative
We have the right to recover our payments from anyone liable for an injury covered by this policy. We
will not enforce our right against the person or organization named in the Schedule. This agreement applies
only to the extent that you perform work under a written contract that requires you to obtain this
agreement from us.
This agreement shall not operate directly or indirectly to benefit any one not named in the Schedule.
Schedule
WC 00 03 13
(4-84) Copyright 1982, 1983 National Council on Compensation Insurance.
COMMERCIAL AUTO
CA71410117
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFUL LY.
LAND IMPROVEMENT CONTRACTORS ASSOCIATION
(LICA) BUSINESS AUTO ULTRA ENDORSEMENT
This endorsement modifies insurance provided under the following:
BUSINESS AUTO COVERAGE FORM
COMMON POLICY CONDITIONS
COVERAGEINDEX
DESCRIPTION
PAGE
Tem ora Substitute Auto Physical Damage
2
Drive Other Car Covera e
2
Broad Form Insured
2
Employee as Insureds
3
Additional Insured Status by Contract, Agreement or Permit
3
Bail Bond Coverage
3
Loss of Earnings Coverage
3
Amended Fellow Employee Coverage
3
Towing and Labor
4
Physical Damage Additional Transportation Expense Coverage
4
Extra Expense - Theft
4
Rental Reimbursement and Additional Transportation Expense
4
Personal Effects Covera e
5
Personal Property of Others
5
Locksmith Coverage
5
Vehicle Wrap Coverage
5
Airbag Accidental Discharge
5
Audio, Visual and Data Electronic Equipment Coverage
5
Auto Loan/Lease Total Loss Protection
5
Glass Repair — Deductible Amendment
6
Amended Duties in the Event of Accident, Claim, Suit or Loss
6
Waiver of Subrogation Required by Contract
6
Unintentional Failure to Disclose
6
Hired, Leased, Rented or Borrowed Auto Physical Damage
7
Mental Anguish
7
Extended Cancellation Condition
7
The COVERAGE INDEX set forth above is informational only and grants no coverage.
Terms set forth in (Bold Italics) are likewise for information only and by themselves shall be deemed to grant no
coverage.
CA 71 41 01 17 Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 1 of 7
A. BROADENED COVERED AUTOS COVERAGES
SECTION I — COVERED AUTOS, is amended as follows:
(Temporary Substitute Auto Physical Damage)
Paragraph C. Certain Trailers, Mobile Equipment and Temporary Substitute Autos is amended by adding the
following at the end of the existing language:
If Physical Damage Coverage is provided under this Coverage form for an "auto" you own, the Physical Damage
coverages provided for that owned "auto" are extended to any "auto" you do not own while used with the permission
of its owner as a temporary substitute for the covered "auto" you own that is out of service because of its breakdown,
repair, servicing, "loss", or destruction.
The following language is added to SECTION I — COVERED AUTOS:
(Drive Other Car Coverage)
D. Drive Other Car Coverage
If Liability Coverage is provided by this Coverage Form, any "auto" you don't own, hire or borrow is a covered "auto"
for Liability Coverage while being used by:
1. You, if you are designated in the Declarations as an Individual;
2. Your partners or members, if you are designated in the Declarations as a partnership or joint venture;
3. Your members or managers, if you are designated in the Declarations as a limited liability company;
4. Your "executive officers", if you are designated in the Declarations as an organization other than an individual
partnership, joint venture or limited liability company; and
5. The spouse of any person named in B. 1. through B. 4. while a resident of the same household.
Except:
a. Any "auto" owned by that individual or by any member of his or her household.
b. Any "auto" used by that individual or his or her spouse while working in a business of selling, servicing,
repairing or parking "autos".
"Executive officer" means a person holding any of the officer positions created by your charter, constitution, by-laws
or any other similar governing document.
B. BROADENDED LIABILITY COVERAGES
SECTION II — LIABILITY COVERAGE in Paragraph A. Coverage at 1. Who Is An Insured is amended to include the
following:
(Broad Form Insured)
d. Any legally incorporated subsidiary in which you own more than 50% of the voting stock on the effective date
of the Coverage Form. However, the Named Insured does not include any subsidiary that is an "insured"
under any other automobile policy or would be an "insured" under such a policy but for its termination or the
exhaustion of its Limit of Insurance.
e. Any organization that is acquired or formed by you, during the term of this policy and over which you
maintain majority ownership. However, the Named Insured does not include any newly formed or acquired
organization:
(1) That is a joint venture or partnership,
(2) That is an "insured" under any other policy,
(3) That has exhausted its Limits of Insurance under any other policy, or
(4) 180 days or more after its acquisition or formation by you, unless you have given us notice of the
acquisition or formation.
Coverage does not apply to "bodily injury" or "property damage" that results from an accident that occurred
before you formed or acquired the organization.
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(Employee as Insureds)
f. Any employee of yours while acting in the course of your business or your personal affairs while using a
covered "auto" you do not own, hire or borrow.
(Additional Insured Status by Contract, Agreement or Permit)
g. Any person or organization whom you are required to add as an additional insured on this policy under a
written contract or agreement; but the written contract or agreement must be:
(1) Currently in effect or becoming effective during the term of this policy; and
(2) Executed prior to the "bodily injury" or "property damage".
The additional insured status will apply only with respect to your liability for "bodily injury" or "property
damage" which may be imputed to that person(s) or organization(s) directly arising out of the ownership,
maintenance or use of the covered "autos" at the location(s) designated, if any.
Coverage provided by this endorsement will not exceed the limits of liability required by the written contract
or written agreement even if the limits of liability stated in the policy exceed those limits. This endorsement
shall not increase the limits stated in Section II. C. Limits of Insurance.
For any covered "auto" you own this Coverage Form provides primary coverage.
C. BROADENED SUPPLEMENTARY PAYMENTS
SECTION II. LIABILITY A. Coverage 2. Coverage Extensions a. Supplementary Payments (2) and (4) are replaced
by the following:
(Bail Bond Coverage)
(2) Up to $5,000 for cost of bail bonds (including bonds for related traffic violations) required because of an
"accident" we cover. We do not have to furnish these bonds.
(Loss of Earnings Coverage)
(4) All reasonable expenses incurred by the "insured" at our request, including actual loss of earning up to
$500 a day because of time off from work.
(Amended Fellow Employee Exclusion)
D. AMENDED FELLOW EMPLOYEE EXCLUSION
Only with respect to your "employees" who occupy positions which are supervisory in nature, SECTION II. LIABILITY B.
Exclusion 5. Fellow Employee is replaced by:
5. Fellow Employee
"Bodily Injury":
a. To you, or your partners or members (if you are a partnership or joint venture), or to your members (if you
are a limited liability company);
b. To your "executive officers" and directors (if you are an organization other than a partnership, joint venture,
or limited liability company) but only with respect to performance of their duties as your officers or directors;
c. For which there is an obligation to share damages with or repay someone else who must pay damages
because of the injury described in paragraph a. and b. above; or
d. Arising out of his or her providing or failing to provide professional health care services.
For purposes of this endorsement, a position is deemed to be supervisory in nature if that person performs
principle work which is substantially different from that of his or her subordinates and has authority to hire,
transfer, direct, discipline or discharge.
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E. BROADENED PHYSICAL DAMAGE COVERAGES
SECTION III — PHYSICAL DAMAGE COVERAGE A. Coverage is amended as follows:
(Towing and Labor)
2. Towing is deleted and replaced with the following:
2. Towing and Labor
We will pay towing and labor costs incurred, up to the limits shown below, each time a covered "auto" is disabled:
a. For private passenger type vehicles we will pay up to $100 per disablement.
b. For all other covered "auto's" we will pay up to $500 per disablement.
However, the labor must be performed at the place of disablement.
(Physical Damage Additional Transportation Expense Coverage)
4. Coverage Extensions
a. Transportation Expenses is amended to provide the following limits:
We will pay up to $60 per day to a maximum of $1,800. All other terms and provisions of this section remain
applicable.
The following language is added to 4. Coverage Extensions:
(Extra Expense — Then)
c. Theft Recovery Expense
If you have purchased Comprehensive Coverage on an "auto" that is stolen, we will pay the expense of
returning that stolen auto to you. The limit for this coverage extension is $5,000.
(Rental Reimbursement and Additional Transportation Expense)
d. Rental Reimbursement
We will provide Rental Reimbursement and Additional Expense coverage only for those Physical Damage
coverages for which a premium is shown in the Declarations or schedule pages. Coverage applies only to a
covered "auto".
(1) We will pay for auto rental expense and the expense incurred by you because of "loss" to remove and
transfer your materials and equipment from a covered "auto" to a covered "auto". Payment applies in
addition to the otherwise applicable coverage you have on a covered "auto". No deductible applies to this
coverage.
(2) We will pay only for expenses incurred during the policy period and beginning 24 hours after the "loss"
and ending, regardless of the policy's expiration, with the lesser of the following number of days:
(a) The number of days reasonably required to repair or replace the covered "auto". If "loss" is caused
by theft, this number of days is added to the number of days it takes to locate the covered "auto" and
return it to you, or
(b) 30 days.
(3) Our payment is limited to the lesser of the following amounts:
(a) Necessary and actual expenses incurred; or
(b) $75 per day.
(c) This coverage does not apply while there are spare or reserve "autos" available to you for your
operations.
(d) If "loss" results from the total theft of a covered "auto" of the private passenger or light truck type, we
will pay under this coverage only that amount of your rental reimbursement expense which is not
already provided for under the SECTION III — PHYSICAL DAMAGE COVERAGE, A. Coverage, 4.
Coverage Extensions, a. Transportation Expenses.
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(Personal Effects Coverage)
e. Personal Effects
If you have purchased Comprehensive Coverage on this policy for an "auto" you own and that "auto" is
stolen, we will pay, without application of a deductible, up to $500 for Personal Effects stolen with the "auto".
The insurance provided under this provision is excess over any other collectible insurance. For this coverage
extension, Personal Effects means tangible property that is worn or carried by an "insured".
(Personal Property of Others) -
f. Personal Property of Others
We will pay up to $500 for loss to personal property of others in or on your covered "auto". This coverage
applies only in the event of "loss" to your covered "auto" caused by fire, lightning, explosion, theft, mischief
or vandalism, the covered "auto's" collision with another object, or the covered "auto's" overturn. No
deductibles apply to this coverage.
(Locksmith Coverage)
g. Locksmith Coverage
We will pay up to $250 per occurrence for necessary locksmith services for keys locked inside a covered
private passenger "auto". The deductible is waived for these services.
(Vehicle Wrap Coverage)
h. Vehicle Wrap Coverage
If you have Comprehensive or Collision coverage on an "auto" that is a total loss, in addition to the actual
cash value of the "auto", we will pay up to $1,000 for vinyl vehicle wraps which are displayed on the covered
"auto" at the time of total loss. Regardless of the number of autos deemed a total loss, the most we will pay
under this Vehicle Wrap Coverage for any one "loss" is $5,000. For purposes of this coverage provision,
signs or other graphics painted or magnetically affixed to the vehicle are not considered vehicle wraps.
(Airbag Accidental Discharge)
F. SECTION III — PHYSICAL DAMAGE COVERAGE, B. Exclusions is amended at 3. to include the following
language:
If you have purchased Comprehensive or Collision Coverage under this policy, this exclusion does not apply to
mechanical breakdown relating to the accidental discharge of an air bag. This coverage applies only to a covered
auto you own and is excess of any other collectible insurance or warranty. No deductible applies to this coverage.
G. BROADENED LIMITS OF INSURANCE
(Audio, Visual and Data Electronic Equipment Coverage)
SECTION III — PHYSICAL DAMAGE COVERAGE — C. Limit of Insurance at 1.b. is amended to provide the following
limits:
b. Limits of $1,000 per "loss" is increased to $5,000 per "loss". All other terms and provisions of this section
remain applicable.
(Auto Loan/Lease Total Loss Protection)
SECTION III — PHYSICAL DAMAGE COVERAGE — C. Limit of Insurance is amended by adding the following
language:
4. In the event of a total "loss" to a covered "auto" shown in the Schedule pages, subject at the time of the "loss" to
a loan or lease, we will pay any unpaid amount due including up to a maximum of $500 for early termination fees
or penalties on the lease or loan for a covered "auto" less:
a. The amount paid under the Physical Damage Coverage Section of the policy; and
b. Any:
(1) Overdue lease / loan payments at the time of the "loss";
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(2) Financial penalties imposed under a lease for excessive use, abnormal wear and tear or high mileage;
(3) Security deposits not returned by the lessor;
(4) Costs for extended warranties, Credit Life Insurance, Health, Accident or Disability Insurance purchased
with the loan or lease; and
(5) Carry-over balances from previous loans or leases.
(Glass Repair _ Deductible Amendment)
H. GLASS REPAIR — DEDUCTIBLE
SECTION III — PHYSICAL DAMAGE COVERAGE — D. Deductible is amended by adding the following:
Any deductible shown in the Declarations as applicable to the covered "auto' will not apply to glass breakage if the
damaged glass is repaired, rather than replaced.
(Amended Duties in the Event of Accident, Claim, Suit or Loss)
I. AMENDED DUTIES IN THE EVENT OF ACCIDENT, CLAIM, SUIT OR LOSS
Under SECTION IV — BUSINESS AUTO CONDITIONS, A. Loss Conditions , the following is added to paragraph 2.
Duties In The Event of Accident, Suit or Loss:
d. Knowledge of any "accident', "claim", "suit" or 'loss" will be deemed knowledge by you when notice of such
"accident", "claim", "suit' or 'loss" has been received by:
(1) You, if you are an individual;
(2) Any partner or insurance manager if you are a partnership;
(3) An executive officer or insurance manager, if you are a corporation;
(4) Your members, managers or insurance manager, if you are a limited liability company; or
(5) Your officials, trustees, board members or insurance manager, if you are a not -for -profit organization.
(Waiver of Subrogation by Contract)
J. WAIVER OF SUBROGATION REQUIRED BY CONTRACT
Under SECTION IV, BUSINESS AUTO CONDITIONS, A. Loss Conditions 5. Transfer of Rights of Recovery
Against Others to Us the following language is added:
However, we waive any rights of recovery we may have against the person or organization with whom you have
agreed in writing in a contract, agreement or permit, to provide insurance such as is afforded under the policy to
which this endorsement is attached. This provision does not apply unless the written contract or written agreement
has been executed, or permit has been issued, prior to the "bodily injury" or "property damage".
(Unintentional Failure to Disclose)
K. UNINTENTIONAL FAILURE TO DISCLOSE
Under SECTION IV — BUSINESS AUTO CONDITIONS, B. General Conditions, the following is added to 2.
Concealment, Misrepresentation Or Fraud:
Your unintentional error in disclosing, or failing to disclose, any material fact existing at the effective date of this
Coverage Form, or during the policy period in connection with any additional hazards, will not prejudice your rights
under this Coverage Form.
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(Hired, Leased, Rented or Borrowed Auto Physical Damage)
L. HIRED, LEASED, RENTED OR BORROWED AUTO PHYSICAL DAMAGE
Under SECTION IV — BUSINESS AUTO CONDITIONS B. General Conditions 5. Other Insurance Paragraph 5.1b. is
replaced by the following:
b. (1) For "Comprehensive" and "Collision" Auto Physical Damage coverage provided by this endorsement, the
following are deemed to be covered "autos" you own:
(a) Any Covered "auto" you lease, hire, rent or borrow; and
(b) Any Covered "auto" hired or rented by your "employee" under a contract in that individual
"employee's" name, with your permission, while performing duties related to the conduct of your
business.
However, any "auto" that is leased, hired, rented or borrowed with a driver is not a covered "auto".
(2) Limit of Insurance For This Section
The most we will pay for any one "loss" is the lesser of the following:
(a) $75,000 per accident, or
(b) actual cash value at the time of loss, or
(c) cost of repair.
Minus a $500 deductible. An adjustment for depreciation and physical condition will be made in
determining actual cash value in the event of a total loss. No deductible applies to "loss" caused by fire
or lightning.
(3) This Hired Auto Physical Damage coverage is excess over any other collectible insurance.
(4) Definitions For This Section
(a) Comprehensive Coverage: from any cause except the covered "auto's" collision with another object
or the covered "auto's" overturn. We will pay glass breakage, "loss" caused by hitting a bird or animal
and, "loss" caused by falling objects or missiles.
(b) Collision Coverage: caused by the covered "auto's" collision with another object or by the covered
"auto's" overturn.
(Mental Anguish)
M. MENTAL ANGUISH
Under SECTION V — DEFINITIONS, C. is replaced by the following:
C. "Bodily injury" means bodily injury, sickness or disease sustained by a person including mental anguish or death
resulting from bodily injury, sickness, or disease.
(Extended Cancellation Condition)
N. EXTENDED CANCELLATION CONDITION
Under CANCELLATION, of the COMMON POLICY CONDITIONS form, item 2.b. is replaced by the following:
b. 60 days before the effective date of cancellation if we cancel for any other reason.
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