Signed Contract_Short Form Improvement Contract_Indiana Court Detention BasinTHE CITY OF
Dui
Masterpiece on the Mississippi
TO: Michael C. Van Milligen, City Manager
FROM: Gus Psihoyos, City EngineerW
SUBJECT: Indiana Court Detention Basin Landscape Maintenance
DATE: June 13, 2011
Attachs.
Dubuque
krittld
All- America City
2007
Attached is the Short Form Improvement Contract between the City of Dubuque and
Mickey Bahr to provide landscape maintenance for the Indiana Court Detention
Basin.
The Certificate of Liability Insurance has been reviewed and approved by Finance
Director Ken TeKippe.
Upon execution of the noted documents, please return to the Engineering office for
further processing.
THE CITY OF
DUB
(Contractors Address - City and State)
CITY OF DUBUQUE, IOWA
SHORT FORM
IMPROVEMENT CONTRACT
THIS IMPROVEMENT CONTRACT (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 (City) and
Mickey Bahr (Contractor) of the City of
(Contractor Name)
3050 Indiana Court, Dubuque, Iowa 52001
PROJECT TITLE: Indiana Court Detention Basin Landscape Maintenance - 2011
City of Dubuque
Engineering Department
50. W. 13 Street
Dubuque, IA 52001
(563) 589 -4270
(563) 589 -4205 FAX
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
Project):
Lawn mower, gas, oil, labor, and any other materials and equipment necessary to maintain
The landscaping at the Indiana Court Detention Basin for the calendar year 2011.
The work described above shall be completed at the following location(s):
Indiana Court Detention Basin
The Project shall be constructed to the existing grades and to any revised grades as described
in this Project contract; in strict accordance with the requirements of the laws of the State of
Iowa and ordinances of the City of Dubuque relating to public works, and in accordance with the
Contract Documents which provisions and documents are each and all hereby referred to and
made a part of this Contract just as much as if the detailed statements thereof were repeated
herein.
Page 1 of 4
2. Contract Documents shall mean and include the following: This Improvement Contract; all
ordinances and resolutions heretofore adopted by the City Council having to do with the
Project; the Contractor's Proposal; and the conditions described in the Contract, including 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 the best of their several kinds and
shall be put in place to the satisfaction of the City Manager.
4. The Contractor shall remove any materials rejected by the City Manager as defective or
improper, or any of said work condemned as unsuitable or defective, and the same shall be
replaced or done anew to the satisfaction of the City Manager at the cost and expense of the
Contractor.
5. Five percent (5 %) of the Contract price may 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 City of Dubuque Standard Specifications
including General Requirements 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 guarantee for a period two years and make good any other defect in any
part of the Project due to improper construction or material performance notwithstanding the
fact that said Project may have been accepted and fully paid for by the City. The guarantee
shall commence on the date that the City pays full compensation for the complete performance
of this contract.
8. The Contractor shall fully complete the Project under this Contract on or before
October 31, 2011
(DATE)
9. To the fullest extent permitted by law, the Contractor shall indemnify and hold harmless the City
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.
Page 2 of 4
10. 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.
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 number of units completed at the unit prices
stated in the Contractor's Proposal and less any liquidated damages provided for in the Contract
Documents. The number of units stated in the contract, special conditions and contractors
proposal is approximate only and the final payment shall be made by the work covered by the
Contract.
THE MAXIMUM CONTRACT AMOUNT SHALL BE LIMITED TO AN INCREASE OF _5 % OF THE ABOVE
LISTED ESTIMATED AMOUNT.
By:
CITY OF DUBUQUE, IOWA
Michael C. Van Milligen Dat
City Manager
CONTRACT ESTIMATED AMOUNT $ 2,000
Page '3 of 4
By:
PRINCIPAL:
Contractor
Sibnature
Printed N
0
Title
i'1')b 0,.,,e S
j v V
ACKNOWLEDGEMENT OF ATTACHED
SPECIAL CONDITIONS:
Printed N
Title
Date
k0-4•v
The following special conditions shall apply to this Project:
CONTRACTOR SHALL MAINTAIN ATTACHED INSURANCE REQUIREMENTS•DURING
THE DURATION OF THE CONTRACT PERIOD.
Depending on conditions, the Contractor will mow the detention basin on average once per week.
The City will inspect the detention basin and compensate the Contractor $240 for each month that
The detention basin is maintained. ($60 per cutting)
The City may terminate the contract for reasons of non - performance or poor workmanship.
Page 4 of 4
REV. 12.1/06
THE CITY OF
Dus u'�
CITY OF DUBUQUE, IOWA
SHORT FORM
IMPROVEMENT CONTRACT
THIS IMPROVEMENT CONTRACT (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 (City) and
Mickey Bahr (Contractor) of the City of
(Contractor Name)
3050 Indiana Court, Dubuque, Iowa 52001
(Contractors Address - City and State)
PROJECT TITLE: Indiana Court Detention Basin Landscape Maintenance - 2011
City of Dubuque
Engineering Department
50. W. 13 Street
Dubuque, IA 52001
(563) 589 -4270
(563) 589 -4205 FAX
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
Project):
Lawn mower, gas, oil, labor, and any other materials and equipment necessary to maintain
The landscaping at the Indiana Court Detention Basin for the calendar year 2011.
The work described above shall be completed at the following location(s):
Indiana Court Detention Basin
The Project shall be constructed to the existing grades and to any revised grades as described
in this Project contract; in strict accordance with the requirements of the laws of the State of
Iowa and ordinances of the City of Dubuque relating to public works, and in accordance with the
Contract Documents which provisions and documents are each and all hereby referred to and
made a part of this Contract just as much as if the detailed statements thereof were repeated
herein.
Page 1 of 4
2. Contract Documents shall mean and include the following: This Improvement Contract; all
ordinances and resolutions heretofore adopted by the City Council having to do with the
Project; the Contractor's Proposal; and the conditions described in the Contract, including 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 the best of their several kinds and
shall be put in place to the satisfaction of the City Manager.
4. The Contractor shall remove any materials rejected by the City Manager as defective or
improper, or any of said work condemned as unsuitable or defective, and the same shall be
replaced or done anew to the satisfaction of the City Manager at the cost and expense of the
Contractor.
5. Five percent (5 %) of the Contract price may 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 City of Dubuque Standard Specifications
including General Requirements 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 guarantee for a period two years and make good any other defect in any
part of the Project due to improper construction or material performance notwithstanding the
fact that said Project may have been accepted and fully paid for by the City. The guarantee
shall commence on the date that the City pays full compensation for the complete performance
of this contract.
8. The Contractor shall fully complete the Project under this Contract on or before
October 31. 2011
(DATE)
9. To the fullest extent permitted by law, the Contractor shall indemnify and hold harmless the City
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.
Page 2 of 4
10. 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.
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 number of units completed at the unit prices
stated in the Contractor's Proposal and less any liquidated damages provided for in the Contract
Documents. The number of units stated in the contract, special conditions and contractors
proposal is approximate only and the final payment shall be made by the work covered by the
Contract.
By:
CITY OF DUBUQUE, IOWA
Michael C. Van Milligen
City Manager
CONTRACT ESTIMATED AMOUNT $ 2,000
THE MAXIMUM CONTRACT AMOUNT SHALL BE LIMITED TO AN INCREASE OF 5 % OF THE ABOVE
LISTED ESTIMATED AMOUNT.
Dat- Contractor
Page 3 of 4
Bv:
By:
PRINCIPAL:
gnature
t Vie
Printed Narr(e
1 / ° r a
Title
ACKNOWLEDGEMENT OF ATTACHED
SPECIAL CONDITIONS:
Title
a'YI (S A. S
4r 610 1
Dale
[ A
Printed Noble
1/
The following special conditions shall apply to this Project:
CONTRACTOR SHALL MAINTAIN ATTACHED INSURANCE REQUIREMENTS DURING
THE DURATION OF THE CONTRACT PERIOD.
Depending on conditions, the Contractor will mow the detention basin on average once per week.
The City will inspect the detention basin and compensate the Contractor $240 for each month that
The detention basin is maintained. ($60 per cutting)
The City may terminate the contract for reasons of non - performance or poor workmanship.
Page 4 of 4
REV. 12.1/06
THE CITY OF
DUB
5 /t , ,ke, G��lfittei
CITY OF DUBUQUE, IOWA
SHORT FORM
IMPROVEMENT CONTRACT
City of Dubuque
Engineering Department
50. W. 13 Street
Dubuque, IA 52001
(563) 589 -4270
(563) 589 -4205 FAX
THIS IMPROVEMENT CONTRACT (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 (City) and
Mickey Bahr (Contractor) of the City of
(Contractor Name)
3050 Indiana Court, Dubuque, Iowa 52001
(Contractors Address - City and State)
PROJECT TITLE: Indiana Court Detention Basin Landscape Maintenance - 2011
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
Project):
Lawn mower, gas, oil, labor, and any other materials and equipment necessary to maintain
The landscaping at the Indiana Court Detention Basin for the calendar year 2011.
The work described above shall be completed at the following location(s):
Indiana Court Detention Basin
The Project shall be constructed to the existing grades and to any revised grades as described
in this Project contract; in strict accordance with the requirements of the laws of the State of
Iowa and ordinances of the City of Dubuque relating to public works, and in accordance with the
Contract Documents which provisions and documents are each and all hereby referred to and
made a part of this Contract just as much as if the detailed statements thereof were repeated
herein.
Page 1 of 4
2. Contract Documents shall mean and include the following: This Improvement Contract; all
ordinances and resolutions heretofore adopted by the City Council having to do with the
Project; the Contractor's Proposal; and the conditions described in the Contract, including 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 the best of their several kinds and
shall be put in place to the satisfaction of the City Manager.
4. The Contractor shall remove any materials rejected by the City Manager as defective or
improper, or any of said work condemned as unsuitable or defective, and the same shall be
replaced or done anew to the satisfaction of the City Manager at the cost and expense of the
Contractor.
5. Five percent (5 %) of the Contract price may 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 City of Dubuque Standard Specifications
including General Requirements 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 guarantee for a period two years and make good any other defect in any
part of the Project due to improper construction or material performance notwithstanding the
fact that said Project may have been accepted and fully paid for by the City. The guarantee
shall commence on the date that the City pays full compensation for the complete performance
of this contract.
8. The Contractor shall fully complete the Project under this Contract on or before
October 31, 2011
(DATE)
9. To the fullest extent permitted by law, the Contractor shall indemnify and hold harmless the City
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.
Page 2 of 4
10. 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.
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 number of units completed at the unit prices
stated in the Contractor's Proposal and less any liquidated damages provided for in the Contract
Documents. The number of units stated in the contract, special conditions and contractors
proposal is approximate only and the final payment shall be made by the work covered by the
Contract.
CONTRACT ESTIMATED AMOUNT $ 2,000
THE MAXIMUM CONTRACT AMOUNT SHALL BE LIMITED TO AN INCREASE OF 5 % OF THE ABOVE
LISTED ESTIMATED AMOUNT.
CITY OF DUBU E, IOWA PRINCIPAL:
By:
Michael C. Van Milligen
City Manager
Page 3 of 4
Contractor
By:
S'a nature Da e
By:
Printed Na
Title
b I C 5 0 Ch r- ,r
Title
ACKNOWLEDGEMENT OF ATTACHED
SPECIAL CONDITIONS:
421. id 6/
gnature Dat
UV! . ai
Printed Narr
The following special conditions shall apply to this Project:
CONTRACTOR SHALL MAINTAIN ATTACHED INSURANCE REQUIREMENTS DURING
THE DURATION OF THE CONTRACT PERIOD.
Depending on conditions, the Contractor will mow the detention basin on average once per week.
The City will inspect the detention basin and compensate the Contractor $240 for each month that
The detention basin is maintained. ($60 per cutting)
The City may terminate the contract for reasons of non - performance or poor workmanship.
Page 4 of 4
REV. 12.1/06
r *rsTME S
MUTUAL I N S U R A N C E
www.partnersmutual.com
QC06784 MICKEY 0 BAHR
I. NAMED INSURED and GENERAL INFORMATION
Named Insured/ MICKEY 0 BAHR
Mailing Address: 3050 INDIANA CT
DUBUQUE IA 52001 -5481
Phone: - -
Individual:
Named Insured
Year Business
Policy Period:
Coverage is:
E -Mail:
Website:
D.O.B. 03/24/1950
is: Individual
was started: 2011
06/10/2011
BOUND
PRODUCER'S STATEMENT:
How long have you known the Applicant? JUST MET
Transfer business within the agency? NO
Direct business? YES
Information obtained via: PERSONAL INTERVIEW
CONTRACTOR BOP INSURANCE APPLICATION
Partners Mutual Insurance Company
20935 Swenson Drive
Waukesha, WI 53186 -2057
TEL: 262 - 798 -5050 FAX: 262- 798 -5040
to 06/10/2012
Date:
Account #:
Policy #:
I understand that as part of Partners Mutual's usual procedure for processing applications and periodic review thereafter, a routine inquiry, Including an investigative
consumer report, may be Initiated. If such Inquiry Is made, further information on the nature and scope of this inquiry Is avail able upon request.
Any person who knowingly and with Intent to defraud any Insurance company or another person files an application for insurance containing any materially false
Information, or conceals for the purpose of misleading Information concerning any fact material thereto, commits a fraudulent Insurance act, which is a crime and
subjects the person to criminal and civil penalties.
06/10/2011
1232343
BZ22737
Agency: 2298
DUBUQUE INSURANCE SERVICES
563 - 585 -0663
Deposit submitted with application:
$58.34
Billing Option: MONTHLY
Payment Option: CHECK
Applicant's statement: I have read this application and declare that to the best of my knowledge and belief all of the foregoing and following statements are true; and
that these statements are offered as an Inducement to the company to Issue the policy for which I am applying .
CAUTION: READ ALL ITEMS PRIOR TO SIGNING THE APPLICATION
Date: Time: Applicant's Signature:
Agent Signature Agent Name _ Number
7 Me er
AGENT: If this application is being submitted electronically, retain the signed copy of this document in your office.
2774 07 07
ART14•RS
MUTUAL I N S U R A N C E
www.partnersmutuaicom
QC06784 MICKEY 0 BAHR
II. GENERAL UNDERWRITING INFORMATION
2774 07 07
CONTRACTOR BOP INSURANCE APPLICATION
Partners Mutual Insurance Company
20935 Swenson Drive
Waukesha, WI 53186 -2057
TEL: 262- 798 -5050 FAX: 262- 798 -5040
Date:
Account #:
Policy #:
06/10/2011
1232343
BZ22737
Ever experienced bankruptcy, foreclosure or been refused bonding? NO
Has any company canceled property, liability or crime insurance for the applicant
within the past 5 years? NO
List all claims presented in the last 5 years: NONE
Has Applicant applied for or had other insurance with PMIC? NO
Name of Previous Insurer: NONE
MUTUAL aRMR INSURANCE
www.partnersmutual.com
QC06784 MICKEY 0 BAHR
II. GENERAL UNDERWRITING INFORMATION
LIABILITY
Describe ALL business operations: MOWS A SMALL STRIP OF LAND THAT IS ADJACEN
T TO HIS PROPERTY THAT IS OWNED BY THE CITY. THE CITY DOES NOT MAINTAIN
THE STRIP AND IT LOOKS BAD WHEN OVERGROWN. HE HAS COME TO AN AGREEMENT WI
TH THE CITY WHERE THEY WILL ALLOW HIM TO MAINTAIN IT AS LONG AS HE HAS A
LIABILITY POLICY FOR LAWN MAINTAINANCE.
How long in business ?: 0 Years experience in the trade: 20
# of employees? 1 Full -time 0 Part -time
Please estimate: annual Payroll $1000 annual Receipts $0
annual cost of Subcontracted Work $0
Number of jobs done each year: 1 Value of largest job: $0
Average value of all jobs: $0
Any property of others in Applicant's Custody? NO
Does Applicant's work include any of the following: (Explain in Comments Section)
NO Asbestos Material NO Waterproofing NO High Pressure Boilers
NO Fire Alarms NO Work over 2 stories NO Use of Scaffolding
NO Tree Trimming NO Bridges or Dams NO Sprinkler Systems
NO EIFS (exterior stucco) I•O Liquid Propane Gas NO Demolition or Wrecking
NO Burglar Alarms NO Use of Cranes
Have a Hold Harmless or Indemnity Agreement with anyone? NO
Ever sold or worked with or on hazardous material, including
asbestos, radioactive materials, fumes, acids, wastes or lead? NO
Participate in trade shows, exhibits, conventions? NO
Sponsor any sporting or social events? NO
Hire, own or lease watercraft or docks? NO
Have or anticipate any other business or liability exposure? NO
Are storage yards fenced in with good lighting? NO
Contact Digger's Hotline prior to doing any underground work? NO
INLAND MARINE
2774 04 07
CONTRACTOR BOP INSURANCE APPLICATION
Partners Mutual Insurance Company
20935 Swenson Drive
Waukesha, WI 53186 -2057
TEL: 262 - 798-5050 FAX: 262- 798 -5040
Date:
Account #:
Policy #:
06/10/2011
1232343
BZ22737
Installation Floater
Total value of equipment installed last 12 months $0
Average equipment value at any one site $0
Average time (in days) for installation 0
Maximum possible loss at any one time at any one installation $0
Contractor Equipment
Where is equipment stored when not in use?
Is equipment ever kept on job site overnight? NO
If yes, how is it protected?
2774 07 07
PARTNERS
MUTUAL I N S U R A N C E
www.partnersmutual.com
III. SigClik UNDE H G M oRMArnON
Landscaping /Lawn Care Service
What type of work is performed? LAWN MOWING
CONTRACTOR BOP INSURANCE APPLICATION
Partners Mutual Insurance Company
20935 Swenson Drive
Waukesha, WI 53186 -2057
TEL: 262- 798 -5050 FAX: 262- 798 -5040
Landscaping 0 % Excavating
Grading of land 0 % Lawn Care
Building of Fences, walkways, etc. 0 %
Tree Trimming and Removal 0 % Tree Height?
Blasting? NO
Other? NO
(if Yes, describe above)
Any Installation of underground sprinkler systems? NO
Any Installation of retaining walls? NO
Are lawn fertilizers /weed control products used? NO
Describe:
Date:
Account #:
Policy #:
0
10 %
0 ft
06/10/2011
1232343
BZ22737
MUTUAL RTNtR!
cE
www.partnersmutual.com
IV. ioVE ►GES, i2a�, & OPTIONAL COVERAGES
CLIENT: BAHR MICKEY 0
3050 INDIANA CT
DUBUQUE IA 52001 -5481
Liability Limit: $1,000,000 Each Occurrence Named Insured is: Individual
Medical Expense: $5,000 per Person
Deductibles: $1,000 Property Damage Liability
LIABILITY CLASS CODE AND DESCRIPTION
Class: 91583 Contractors - subcontracted work - 1 or 2 family dwellings $1
Liability Premium: $0
Class: 97050
Lawn Maintenance $20,000
Liability Premium: $115
PREMISES DESCRIPTION AND LIMITS OF INSURANCE
Premises #: 1 Business Description: LAWN MOWING
CONTRACTOR 130P INSURANCE APPLICATION
Partners Mutual Insurance Company
20935 Swenson Drive
Waukesha, WI 53186 -2057
TEL: 262 - 798 -5050 FAX: 262 -798 -5040
Date:
Account #:
Policy #:
AGENCY:
Code:
Phone:
Equipment Floater:
Unscheduled Tools & Equip: $1000 maximum per Item: $50
Deductible: $100
Catastrophe Limit for Unscheduled Equipment Floater:
PLEASE REFER TO THE INSURANCE FORMS FOR EXACT CONTRACT CONDITIONS.
TOTAL AMOUNT OF QUOTE: $350
QUOTE VALID FOR 30 DAYS FROM DATE OF QUOTE.
06/10/2011
1232343
BZ22737
Dubuque Insurance Servi
2298
563 - 585 -0663
Balance to minimum: $233
PAYROLL
Additional Coverages:
Tenants Fire Legal Liability: $50,000 Included
Business Income: Actual Loss Sustained Included
Outdoor Personal Property: $1,000 Included
Debris Removal Additional Limit: $5,000 Included
$50
277 1tMliN2740 (12 -95) Issued: 6/10/2011
$2
P A R T M N PI
MUTUAL I NSU RANG
www.partnersmutual.com
CLIENT:
MICKEY 0 BAHR
3050 INDIANA CT
DUBUQUE IA 52001 -5481
n......,,, nnnn
BUSINESSOWNERS QUOTATION - CONTRACTORS FORM
Liability Limit: $1,000,000 Each Occurrence Named Insured is: Individual
Medical Expense: $5,00 per Person
Deductibles: $1,000 Property Damage Liability
LIABILITY CLASS CODE AND DESCRIPTION
Class: 91583 Contractors - subcontracted work - 1 or 2 family dwellings
Liability Premium:
Class: 97050 Lawn Maintenance
PREMISES DESCRIPTION AND LIMITS OF INSURANCE
Premises #: 1 Business Description: LAWN MOWING
QUOTE VALID FOR 30 DAYS FROM DATE OF QUOTE.
Account Number: 1232343
Quote Number: QC06784
Policy Period: 5/19/2011 To: 5/19/2012
AGENCY: Dubuque Insurance Services
(563) 585 -0663 Code: 2298 -000
Equipment_ Floater:
Unscheduled Tools & Equip: $1000 maximum per Item: $50
Deductible: $100
Catastrophe Limit for Unscheduled Equipment Floater:
TOTAL AMOUNT OF QUOTE: $350
Liability Premium:
Balance to minimum:
PAYROLL
$1
$0
$20,000
$115
$233
Additional Coverages:
Tenants Fire Legal Liability: $50,000 Included
Business Income: Actual Loss Sustained Included
Outdoor Personal Property: $1,000 Included
Debris Removal Additional Limit: $5,000 Included
PLEASE REFER TO THE INSURANCE FORMS FOR EXACT CONTRACT CONDITIONS.
$50
/1, nr\ T.. .. ,. _ c /fln /nni 1
$2