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Signed Contract_WPC Plant Updgrade, EMSI Asbestos RemovalMasterpiece on the Mississippi TO: Michael C. Van Milligen, City Manager FROM: Steve Sampson Brown, Project Manager Se SUBJECT: Water Pollution Control Plant — Asbestos Removal DATE: October 13, 2010 Dubuque Leal All- America City 2007 Attached is the Short Form Vendor Service Agreement between the City of Dubuque and Environmental Management Services of Iowa, Inc. (EMSI) for asbestos removal services at the Water Pollution Control Plant. Review and approval of the Certificate of Liability Insurance is currently being processed by the Finance Department. Upon execution of the noted documents, please return to the Engineering office for further processing. Attachs. Masterpiece on the Mississippi (Vendor Address - City and State) CONTRACTOR AGREES: CITY OF DUBUQUE, IOWA SHORT FORM VENDOR SERVICE AGREEMENT PROJECT TITLE: Water Pollution Control Plant - Asbestos Removal Water Pollution Control Plant - 795 Julien Dubuque Drive Page 1 of 4 City of Dubuque Engineering Dept. 50. W. 13` Street Dubuque, IA 52001 (563) 589 -4270 (563) 589 -4205 FAX The work described above shall be completed at the following location(s): FILE L'I THIS VENDOR SERVICE AGREEMENT (the Contract), made in triplicate, between the City of Dubuque, Iowa (City), by its City Manager, through authority conferred upon the City Manager by its City Council and Environmental Management Services of Iowa, Inc. (EMSI) (Vendor) of the City of (Vendor Name) 5170 Wolff Road, #2, Dubuque, IA 52002 -2563 For and in consideration of the mutual covenants herein contained, the parties hereto agree as follows: 1. To furnish all material and equipment and to perform all labor necessary for (the Project): Asbestos removal for the Water Pollution Control Plant - 795 Julien Dubuque Drive. The Project shall be completed in strict accordance with the terms as described in this Contract; in strict accordance with the requirements of the laws of the State of Iowa and ordinances of the City of Dubuque, • - - - - - - - = _ - • - - - - e _al (RFP) Documents which provisions just as much ac if the detailed- statem . 2. Contract Documents shall mean and include the following: This Contract; all ordinances and resolutions heretofore adopted by the City Council having to do with the Project; the Vendor's Proposal; and any Special Conditions, Plans and Specifications and General Requirements as adopted by the City Council for the Project. 3. All materials used by the Contractor in the Project shall be of the quality required by the Contract Documents and shall be put in place in accordance with the Contract Documents. 4. The Vendor shall remove any materials rejected by the City Manager as defective or improper, or any of said work condemned as unsuitable or defective, and the same shall be replaced or done anew to the satisfaction of the City Manager at the cost and expense of the Vendor. 5. Five percent (5 %) of the Contract price shall be retained by the City for a period of thirty (30) days after final completion and acceptance of the Project by the City Manager to pay any claim that may be filed within said time for labor and materials done and furnished in connection with the performance of this Contract and for a longer period if such claims are not adjusted within that time, as provided in Iowa Code Chapter 573. The City shall also retain additional sums to protect itself against any claim that has been filed against it for damages to persons or property arising through the prosecution of the work and such sums shall be held by the City until such claims have been settled, adjudicated or otherwise disposed of. 6. The Contractor has read and understands the Contract Documents and has examined and understands the project description described in Section 1 and any attached Special Conditions herein referred to and agrees not to plead misunderstanding or deception because of estimates of quantity, character, location or other conditions surrounding the same. 7. The Contractor shall fully complete the Project under this Contract on or before May 1,2013 (DATE) 8. To the fullest extent permitted by law, the Contractor shall indemnify and hold harmless the City, its officers and employees, from and against all claims, damages, losses and expenses, including but not limited to attorneys' fees, arising out of or resulting from performance of the Contract, provided that such claim, damages, loss or expense is attributable to bodily injury, sickness, disease or death, or injury to or destruction of property (other than the Project itself) including loss of use resulting there from, but only to the extent caused in whole or in part by negligent acts or omissions of the Contractor, the Contractor's subcontractor, or anyone directly or indirectly employed by the Contractor or the Contractor's subcontractor or anyone for whose acts the Contractor or the Contractor's subcontractor may be liable, regardless of whether or not such claim, damage, loss or expense is caused in part by a party indemnified hereunder. 9. Unless otherwise specified in the Contract Documents, prior to the commencement of any work on the Project and at all times during the performance of this Contract, the Contractor shall provide evidence of insurance which meets the requirements of the City's Insurance Schedule for Artisan Contractors or General Contractors. Page 2 of 4 10. The Vendor agrees that no work under this Contract shall commence on the Project until the City has issued a written "Notice to Proceed" to the Vendor. Any work started by the Vendor prior the issuance of the Notice to Proceed shall be considered unauthorized and done at the sole risk to the Vendor. THE CITY AGREES: Upon the completion of the Contract, and the acceptance of the Project by the City Manager, the City agrees to pay the Contractor as full compensation for the complete performance of this Contract, the amount determined for the total work completed at the prices stated in the Vendor's Proposal and less any liquidated damages provided for in the Contract Documents. The work as stated in the Contract Documents is approximate only, and the final payment shall be made for the actual work completed as covered by the Contract. CONTRACT ESTIMATED AMOUNT $ $1 5,000.00 THE MAXIMUM CONTRACT AMOUNT SHALL BE LIMITED TO AN INCREASE OF LISTED ESTIMATED AMOUNT. CITY OF DUB UE, IOWA By: Michael C. an Milligen City Manager Date VENDOR: EMSI By: By: Title Page 3 of 4 Company � 7i� u Signature Printed Name ClItt Title Signature Date 5 % OF THE ABOVE VENDOR ACKNOWLEDGEMENT OF ATTACHED SPECIAL CONDITIONS: Printed Name The following special conditions shall apply to this Project: Note October 5, 2010 Proposal. Page 4 of 4 REV. 02/08 PROPOSAL ENVIRONMENTAL MANAGEMENT SERVICES OF IOWA, INC. 5170 WOLFfi' ROAD, #2 DUBUQUE, IOWA 52002 -2563 PHONE; (563) 583 -0808 FAX: (563) 583 -2206 PROPOSAL TO: City of Dubuque Engineering Department Attn: Mr. Steve Brown STREET: City Hall, 50 West 13 Street • CITY, STATE, ZIP: Dubuque, IA. 52001 NOTE: This proposal may he withdrawn it not accepted within 30 ys, Acceptance of Proposal The above prices, specifications, and enndltlotrs are satisfactory nod are hereby accepted. You are authorized to do the work as specified. Payment will ha mode as stated above. Date Accepted: rnoivi: " (563) 589-4270 FAX: (563) 589 -4205 DATE: October 5, 2010 Jon: Asbestos Removal JOB LOCATION: Waste Water Treatment Plant, 795 Julien Dubuque Drive Dubuque, Iowa We hereby submit specifications and estimates for: Removal and disposal of asbestos materials on a time and material basis at the following labor rates: Iowa Licensed Supervisor /Workers $68.00 per hour (straight time — per supervisor /worker) Iowa Licensed Supervisor/Workers $80.00 per hour (overtime — per supervisor /worker) (Labor rates based on current Davis Bacon wage rates for Heavy Sewer/Water Treating Plant) EMSI will provide asbestos abatement supplies at 25% over the invoice amount. RENTAL EQUIPMENT: Truck $25.00 /day Cube Vans $35.00 /day Air Monitor $15.00 /day Negative Air Machine $25.00 /day Air Sample Analysis $25.00 /each Shower with filter system $15.00 /day HEPA Vacuum $25.00 /day Generator $40.00 /day Airless Sprayer $60.00 /day *All personal respirators, water hoses, power chords, ground fault panels, and small .band tools will be provided by Environmental Management Services of Iowa as part of the hourly labor charge. NOTE: Rates effective as of September 1, 2010. *W1 JOBS ONLY: Ifawarded.this project, there will be an additional notification fee added to the price quoted as this fee Is required by the Wl DNR., The fees range from $75.00 to $335.00 depending on the type of project. *IL JOBS ONLY: If awarded this project, there will be an additional $150.00 notification fee added to the price quoted as this fee is required by the IL EPA. Price does not include the cost of re uired air clearance sam les. *SCHOOL PROJECTS ONLY: Prices do not include the cost of air clearance samples that are required to be taken by an Independent Air Sampling Professional at the end of a school project, Schools will be billed directly by the Air Sampling Professional. All work will be performed In accordance with OSHA asbestos standard for construction industry, 29 CFR 1926.1101 and USEPA National Emissions Standard for Hazardous Air Pollutants (NESHAPS), Asbestos Regulations, 40 CFR 61 Subpart A & M. All work will be performed by AHERA licensed individuals regularly engaged in asbestos removal, We propose Hereby to furnish materials, equipment and labor, complete in accordance with the above specifications, for the sum of Prices Stated Above Payment to be made as follows: Net 30 days from receipt of invoice / 1.5% Past Due Any alteration or deviation from the above specifications 'Involving extra cotta, will be executed only upon written orders, and will become no extra charge over and above the estimate. All agreements contingent upon strikes, accident, nr delays beyond our control. town Contractors Liccnse 1990 IL Asbestos Contractor Permit Na, 500 -0482 Wi Contractor Permit No. CAP -13150 Authorized signature: Mark Hogan, President Signature: Signature: INSURANCE SCHEDULE B INSURANCE REQUIREMENTS FOR ARTISAN CONTRACTORS OR GENERAL CONTRACTORS TO THE CITY OF DUBUQUE 1. All policies of insurance required hereunder shall be with an insurer authorized to do business in Iowa. All insurers shall have a rating of A or better in the current A.M. Best Rating Guide. 2. All Certificates of Insurance required hereunder shall provide a thirty (30) day notice of cancellation to the City of Dubuque, except for a ten (10) day notice for non- payment, if cancellation is prior to the expiration date. 3. Contractor shall furnish a signed Certificate of Insurance to the City of Dubuque, Iowa for the coverage required in Exhibit I. Such Certificates shall include copies of the following endorsements: a) Commercial General Liability policy is primary and non - contributing b) Commercial General Liability additional insured endorsement -See Exhibit I c) Governmental Immunities Endorsement Contractor shall require Certificates of Insurance from all subcontractors and sub - sub contractors who perform work or services pursuant to the provisions of this contract prior to the commencement of any work by such subcontractors or sub - subcontractors. Said certificates shall meet the insurance requirements as required of Contractor. 4. Each certificate from all subcontractors and sub - subcontractors shall be submitted to the general contractor. The general contractor shall submit a certificate to City of Dubuque. 5. Failure to provide minimum coverage shall not be deemed a waiver of these requirements by the City of Dubuque. Failure to obtain or maintain the required insurance shall be considered a material breach of this agreement. 6. Contractor shall be required to carry the following minimum coverage /limits or greater if required by law or other legal agreement; as per Exhibit I. This coverage shall be written on an occurrence, not claims made form. Form CG 25 03 03 97 "Designated Construction Project (s) General Aggregate Limit" shall be included. All deviations or exclusions from the standard ISO commercial general liability form CG 001 shall be clearly identified. 'Governmental Immunity endorsement identical or equivalent to form attached. 1 of 3 January 2008 Completion Checklist Class A Contractors, Class B Contractors and Class C Contractors n Certificate of Liability Insurance (2 pages) Designated Construction Project(s) General Aggregate Limit CG 25 03 03 97 (2 pages) ❑ Additional Insured CG 20 10 07 04 Additional Insured CG 20 37 07 04 U Governmental Immunities Endorsement II II INSURANCE SCHEDULE B (Continued) INSURANCE REQUIREMENTS FOR ARTISAN CONTRACTORS OR GENERAL CONTRACTORS TO THE CITY OF DUBUQUE Additional Insured Requirement — See Exhibit I. 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 shall be named as an additional insured on General Liability Policies for all classes of contractors. Class A, B, and C Contractors shall include coverage for The City of Dubuque as an additional insured including ongoing and completed operations coverage equivalent to:ISO CG 20 10 07 04 *and CG 20 37 07 04. ** *ISO CG 20 10 0704 "Additional Insured - Owners, Lessees or Contractors — Scheduled Person or Organization" * *ISO CG 20 37 0704 "Additional Insured — Owners, Lessees or Contractors — Completed Operations" 2 of 3 January 2008 INSURANCE SCHEDULE B (Continued) EXHIBIT I - Contractors Insurance Requirements CLASS B: General Contractors, Contractors, Trade Contractors, Subcontractors, who perform the following work: Chemical Spraying Doors, Window & Glazing Drywall Systems Fertilizer Application Finish Carpentry Landscaping Motorized Vehicular Snow & Ice Removal General Liability (Occurrence Form Only) Commercial General Liability General Aggregate Products- Completed Operations Aggregate Limit Personal and Advertising Injury Limit Each Occurrence Limit Fire Damage Limit (any one occurrence) Medical Payments Additional Insured - 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 shall be named as additional insured, including ongoing operations CG 2010 07 04 or equivalent, and completed operations CG 2037 07 04 or equivalent. See Specimens Automobile $1,000,000 (Combined Single Limit) Standard Workers Compensation — with waiver of subrogation to the City of Dubuque Statutory for Coverage A Employers Liability: Each Accident Each Employee — Disease Policy Limit — Disease Umbrella Painting & Wall Covering Pest Control Plastering Systems Rough Carpentry Stump Grinding Tree Trimming Waterproofing $2,000,000 $1,000,000 $1,000,000 $1,000,000 $ 50,000 $ 5,000 $ 100,000 $ 100,000 $ 500,000 $1,000,000 3 of 3 January 2008 ACORD CERTIFICATE OF LIABILITY INSURANCE DATE(MM /DDIYYYY) 12/7/2007 TYPE OF INSURANCE PRODUCER (563) 123 -4567 Insurance Agency 9 y Street Address City ST FAX (563) 987 -6543 Zip Code THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. INSURERS AFFORDING COVERAGE NAIC # INSURED Company Street City St Zip Code INSURER A Insurance Company INSURER B: $ 1, 000, 000 INSURER C: COMMERCIAL GENERAL LIABILITY INSURER D: $ 50 000 r INSURER E: I CLAIMS MADE I X I OCCUR 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR ADD'L INSRD TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE (MM /DD/YY) POLICY EXPIRATION DATE (MM /DD/YY) LIMITS A X GENERAL LIABILITY EACH OCCURRENCE $ 1, 000, 000 X COMMERCIAL GENERAL LIABILITY PREMISES PREMISES RENTED occurrence) $ 50 000 r I CLAIMS MADE I X I OCCUR MED EXP (Any one person) • $ 5, 000 PERSONAL & ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L — I AGGREGATE LIMIT APPLIES PER: POLICY I X I JECT P1 LOC PRODUCTS - COMP /OP AGG $ 1, 000 , 000 A AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS COMBINED SINGLE LIMIT (Ea accident) 1, 000,000 X BODILY INJURY (Per person) BODILY INJURY (Per accident) PROPERTY DAMAGE (Per accident) $ GARAGE LIABILITY ANY AUTO AUTO ONLY - EA ACCIDENT $ OTHER THAN EA ACC 3 AUTO ONLY: qGG $ A EXCESS /UMBRELLA LIABILITY X OCCUR I CLAIMS MADE /� e 1 EACH OCCURRENCE $ 1,000;000 _ AGGREGATE $ 1,000,000 DEDUCTIBLE RETENTION $ 0 $ $ X $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER /MEMBER EXCLUDED? If yes, describe under SPECIAL PROVISIONS below /7 (� 1 (� 4! X I TORY LIMITS I OER E.L. EACH ACCIDENT $ 100 , 000 E.L DISEASE - EA EMPLOYEE 5 100, 000 E.L. DISEASE - POLICY LIMIT $ 500, 000 OTHER DESCRIPTION OF OPERATIONS /LOCATIONSNEHICLES /EXCLUSIONS ADDED BY ENDORSEMENT /SPECIAL PROVISIONS The City of Dubuque is an additional insured on general liability policies including ongoing & completed operations coverage equivalent to ISO CG 2010 0704 & CG 2037 0704. General Liability policy is primary & non - contributing. Form CG 2503 0397 "Designated Projects' general liability aggregate limit is included. Governmental immunities endorsement is included. Waiver of subrogation in favor of City of Dubuque on workers compensation is included. COVERAGES CERTIFICATE HOLDER SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE City of Dubuque 50 West 13th Street Dubuque, IA 52001 CORD 25 (2001/08) VS025 (0108).06 AMS CANCELLATION VMP Mortgage Solutions, Inc. (800)327 - 0545 ©ACORD CORPORATION 1988 Page 1 o12 ACORD 25 (2001/08) NS025(oios).o6 AMS IMPORTANT If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). DISCLAIMER The Certificate of Insurance on the reverse side of this form does not constitute a contract between the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does It affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon. Page 2 of 2 CG 25 03 03 97 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. DESIGNATED CONSTRUCTION PROJECT(S) GENERAL AGGREGATE LIMIT This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Designated Construction Projects: (If no entry appears above, information required to complete this endorsement will be shown in as applicable to this endorsement.) A. For all sums which the insured becomes legally obligated to pay as damages caused by "occur- rences" under COVERAGE A (SECTION I), and for all medical expenses caused by accidents under COVERAGE C (SECTION I), which can be attributed only to ongoing operations at a single designated construction project shown in the Schedule above: 1. separate Designated Construction Project General Aggregate Limit applies to each des- ignated construction project, and that limit is equal to the amount of the General Aggregate Limit shown in the Declarations. 2. The Designated Construction Project General Aggregate Limit is the most we will pay for the sum of all damages under COVERAGE A, except damages because of "bodily injury" or "property damage" included in the "products - completed operations hazard ", and for medi- cal expenses under COVERAGE C regard- less of the number of: a. Insureds; b. Claims made or "sults" brought; or c. Persons or organizations making claims or bringing "suits ". 3. Any payments made under COVERAGE A for damages or under COVERAGE C for medical expenses shall reduce the Desig- nated Construction Project General Aggre- gate Limit for that designated construction project. Such payments shall not reduce the General Aggregate Limit shown in the Decla- rations nor shall they reduce any other CG 25 03 03 97 B. the Declarations Designated Construction Project General Aggregate Limit for any other designated construction project shown in the Schedule above. 4. The limits shown in the Declarations for Each Occurrence, Fire Damage and Medical Ex- pense continue to apply. However, instead of being subject to the General Aggregate Limit shown in the Declarations, such limits will be subject to the applicable Designated Con- struction Project General Aggregate Limit. For all sums which the insured becomes legally obligated to pay as damages caused by "occur- rences" under COVERAGE A (SECTION I), and for all medical expenses caused by accidents under COVERAGE C (SECTION I), which cannot be attributed only to ongoing operations at a sin- gle designated construction project shown in the Schedule above: 1. Any payments made under COVERAGE A for damages or under COVERAGE C for medical expenses shall reduce the amount available under the General Aggregate Limit or the Products - Completed Operations Aggregate Limit, whichever Is applicable; and 2. Such payments shall not reduce any Desig- nated Construction Project General Aggre- gate Limit. Page 1 of 2 CG 25 03 03 97 C. When coverage for liability arising out of the "products- completed operations hazard" is pro- vided, any payments for damages because of "bodily injury" or "property damage" included In the "products- completed operations hazard" will reduce the Products - Completed Operations Ag- gregate Limit, and not reduce the General Ag- gregate Limit nor the Designated Construction Project General Aggregate Limit. Copyright, Insurance Services Office, Inc., 1996 D. If the applicable designated construction project has been abandoned, delayed, or abandoned and then restarted, or if the authorized contract- ing parties deviate from plans, blueprints, de- signs, specifications or timetables, the project will still be deemed to be the same construction pro- ject. E. The provisions of Limits Of Insurance (SECTION III) not otherwise modified by this endorsement shall continue to apply as stipulated. Page2of2 CG25030397 Name Of Additional Insured Person(s) Or Organization(s): 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. Location(s) Of Covered Operations Information required to complete this Schedule, if not shown above, will be shown in the Declarations. POLICY NUMBER: THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS -- SCHEDULED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE 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 liability for "bodily Injury", "property damage" or "personal and advertising injury" caused, in whole or in part, by: 1. Your acts or omissions; or 2. The acts or omissions of those acting on your behalf; CG 20 10 07 04 COMMERCIAL GENERAL LIABILITY CG 20 10 07 04 in the performance of your ongoing operations for the additional insured(s) at the location(s) desig- nated above. B. With respect to the Insurance afforded to these additional insureds, the following additional exclu- sions apply: This insurance does not apply to "bodily injury" or "property damage" occurring after: Page 1 of 2 1. All work, including materials, parts or equip- ment 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 Page 2of2 2. That portion of "your work" out of which the injury or damage arises has been put to its in- tended use by any person or organization other than another contractor or subcontractor engaged in performing operations for a princi- pal as a part of the same project. All terms and conditions of this policy apply unless modified by this endorsement. © ISO Properties, Inc., 2004 CG 20 10 07 04 Name Of Additional Insured Person(s) Or Organization(s): 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. Location And Description Of Completed Operations Information required to complete this Schedule, If not shown above, will be shown in the Declarations. POLICY NUMBER: 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 SCHEDULE 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 liability for "bodily injury" or "property damage" caused, in whole or in part, by "your work" at CG 20 37 07 04 COMMERCIAL GENERAL LIABILITY CG 20 37 07 04 the location designated and described In the schedule of this endorsement performed for that additional in- sured and included in the "products- completed opera- tions hazard ". All terms and conditions of this policy apply unless modified by this endorsement. © ISO Properties, Inc., 2004 Page 1 of 1 CITY OF DUBUQUE, IOWA GOVERNMENTAL IMMUNITIES ENDORSEMENT 1. Nonwaiver of Governmental Immunity. The insurance carrier expressly agrees and states that the purchase of this policy and the including of the City of Dubuque, Iowa as an Additional Insured does not waive any of the defenses of governmental immunity available to the City of Dubuque, Iowa under Code of Iowa Section 670.4 as it is now exists and as it may be amended from time to time. 2. Claims Coverage. The insurance carrier further agrees that this policy of insurance shall cover only those claims not subject to the defense of governmental immunity under the Code of Iowa Section 670.4 as it now exists and as it may be amended from time to time. Those claims not subject to Code of Iowa Section 670.4 shall be covered by the terms and conditions of this insurance policy. 3. Assertion of Government Immunity. The City of Dubuque, Iowa shall be responsible for asserting any defense of governmental immunity, and may do so at any time and shall do so upon the timely written request of the insurance carrier. 4. Non - Denial of Coverage. The insurance carrier shall not deny coverage under this policy and the insurance carrier shall not deny any of the rights and benefits accruing to the City of Dubuque, Iowa under this policy for reasons of governmental immunity unless and until a court of competent jurisdiction has ruled in favor of the defense(s) of governmental immunity asserted by the City of Dubuque, Iowa. No Other Change in Policy. The above preservation of governmental immunities shall not otherwise change or alter the coverage available under the policy. SPECIMEN 1 of 1 January 2008