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Improvement Contract_Green Alley Permeable Pavers Project, 17th-18th, Jackson_WashingtonCITY OF DUBUQUE, IOWA IMPROVEMENT CONTRACT THIS IMPROVEMENT ONTRACT Abe Contract), made in triplicate, dated for reference purposes the day of P , 2012, between the City of Dubuque, Iowa, by its City Manager, through authority onferred upon the City Manager by its City Council (City) and McDermott Excavating of the City of Dubuque, Iowa. 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 Green Alley Permeable Pavers Project — 17tH — 18th between Jackson & Washington Streets (the Project). The Project shall be made to the established grade and to the grades as shown on the profiles and cross - sections on file in the City Engineer's office for this Project, 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 Document shall of which provisions and documents are each and all hereby referred to and made a part of this Contract just as much as if the detail statements thereof were repeated herein. 2. Contract Documents shall mean and include the following: All ordinances and resolutions heretofore adopted by the City Council having to do with the Project; the Notice to Bidders; the Contractor's Proposal; and the Plans, Specifications, and General Requirements as adopted by the City Council for the Project. 3. All materials used by the Contractor in the Project shall be the best of their several kinds and shall be put in place to the satisfaction of the City Manager. 4. The Contractor shall remove any materials rejected by the City Manager as defective or improper, or any of said work condemned as unsuitable or defective, and the same shall be replaced or done anew to the satisfaction of the City Manager at the cost and expense of the Contractor. 5. Five percent (5 %) of the Contract price shall be retained by the City for a period of thirty (30) days after final completion and acceptance of the Project by the City Council to pay any claim that may be filed within said time for labor and materials done and furnished in connection with the performance of this Contract and for a longer period if such claims are not adjusted within that time, as provided in 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 specifications including General Requirements and has examined and understands the plans herein referred to and agrees not to plead misunderstanding or deception because of estimates of quantity, character, location or other conditions surrounding the same. 7. In addition to the guarantee provided for in the specifications, the Contractor shall also make good any other defect in any part of the Project due to improper construction notwithstanding the fact that said Project may have been accepted and fully paid for by the City, and the Contractor's bond shall be security therefore. 8. The Contractor shall fully complete the Project under this Contract on or before June 30, 2012. 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 attorney 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. THE CITY AGREES: Upon the completion of the Contract, and the acceptance of the Project by the City Council, the City agrees to pay the Contractor as full compensation for the complete performance of this Contract, 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 plans and specifications is approximate only and the final payment shall be made by the work covered by the Contract. CONTRACT AMOUNT $148,847.05 FURTHER CONDITIONS The Contractor hereby represents and guarantees that it has not, nor has any other person for or in its behalf, directly or indirectly, entered into any arrangement or agreement with any other bidder, or with any public officer, whereby it has paid or is to pay any other bidder or public officer any sum of money or anything of value whatever in order to obtain this Contract; and it has not, nor has another person for or in its behalf directly or indirectly, entered into any agreement or arrangement with any other person, firm, corporation or association which tends to or does lessen or destroy free competition in the letting of this Contract and agrees that in case it hereafter be established that such representations or guarantees, or any of them are false, it will forfeit and pay not less than ten percent (10 %) of the Contract price but in no event be Tess than $400.00 (Four Hundred and 00/100 Dollars) as liquidated damages to the City. The surety on the bond furnished for this Contract, shall in addition to all other provisions, be obligated to the extent provided for by Iowa Code § 573.6, relating to this Contract, which provisions apply to said bond. The Contractor agrees, and its bond shall be surety therefore, that it will keep and maintain the Project in good repair for a period of two years after acceptance of the same by the City Council and its bond shall be security therefore. The Contractor agrees, and its bond shall be surety therefore, that it will keep and maintain the Project in good repair for a period of two years after acceptance of the same by the City Council and its bond shall be security therefore. The City of Dubuque and the Contractor agree to comply with 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 shall 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). CITY OF DUBUQUE, WA PRINCIPAL �� ,� By �iCL�i"Ind - Excara i5g City Manage Contractor By: 14/4#-D Signature s��- erVi's or Title CERTIFICATE OF CITY CLERK This is to certify that a ce i -d copy of the above Contract has been filed in my office on the 1,561 day of , 2012. K-vin S. Firnsta`'', City Clerk CITY OF DUBUQUE, IOWA PERFORMANCE, PAYMENT AND MAINTENANCE BOND KNOWN ALL MEN BY THESE PRESENTS: That McDermott Excavating as Principal (Contractor) and Merchants Bonding Company (Mutual) as Surety are held firmly bound unto the City of Dubuque, Iowa (City), in the penal sum of $148,847.05 the same being 100% of the total price of the Contract for the Project herein referred to, lawful money of the United States of America, well and truly to be paid to said City of Dubuque, and to all other parties who, under the provisions of the laws of Iowa, are intended to be protected and secured hereby for which payment we bind ourselves, our heirs, executors, successors and assigns, jointly and severally by these presents. Dated at Dubuque, Iowa, this 10th day of February , 2012, and duly attested and sealed. WHEREAS, the said Contractor by a Contract dated February , 2012, incorporated herein by reference, has agreed with said City of Dubuque to perform all labor and furnish all materials required to be performed and furnished for the Green Alley Permeable Paver Project — 17th — 18th between Jackson & Washington Streets (the Project) according to the Contract and Construction Documents prepared therefore. It is expressly understood and agreed by the Contractor and Surety bond that the following provisions are a part of this Bond and are binding upon said Contractor and Surety, to -wit: 1. PERFORMANCE BOND: 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 City from all outlay and expense incurred by the City 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 BOND: The Contractor and the Surety shall 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 contract price which the City 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, Code of Iowa, which by this reference is made a part hereof as though fully set out herein. 3. MAINTENANCE BOND: The Contractor and the Surety 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 within the period of two (2) year(s) from the date of acceptance of the work under the Contract by the City Council of the City of Dubuque, Iowa, by reason of defects in workmanship or materials used in construction of said work; B. To keep all work in continuous good repair; and C. To pay the City the reasonable costs of monitoring and inspection to assure that any defects are remedied, and to repay the City all outlay and expense incurred as a result of Contractor's and Surety's failure to remedy any defect as required by this section. Contractor's and Surety's agreement herein made extends to defects in workmanship or materials not discovered or known to the City at the time such work was accepted. NOW, THEREFORE, the condition of this obligation is such that if the said Contractor shall perform all of the work contemplated by the Contract in a workmanlike manner and in strict compliance with the plans and specifications, and will pay all claims for labor and materials used in connection with said Project, to indemnify the said City for all damages, costs and expense incurred by reason of damages to persons or property arising through the performance of said Contract, and will reimburse the City for any outlay of money which it may be required to make in order to complete said Contract according to the Construction Documents and will maintain in good repair said Project for the period specified in the Contract where this bond is obligated for maintenance, and will faithfully comply with all of the provisions of Section 573 of the Code of Iowa, then this obligation shall be null and void, otherwise it shall remain in full force and effect. All the conditions of this bond must be fully complied with before the Contractor or the Surety will be released. The Contract, Contractor's Proposal, and Construction Documents shall be considered as a part of this Bond just as if their terms were repeated herein. Dated at Dubuque, Iowa this 10th day of February , 2012. CITY OF DUBUQUE, IOWA By: City Manag PRINCIPAL By: McDermott Excavating Contractor Signature S /2e rV isSol- Title SURETY Merchants Bonding Company (Mutual) Sur ompany By: atez gnature Attorney -In -Fact Title Dubuque, IA 52001 City, State, Zip Code 563 - 583 -5775 Telephone Attorney In Fact MERCHANTS BONDING COMPANY POWER OF ATTORNEY Know All Persons By These Presents, that the MERCHANTS BONDING COMPANY (MUTUAL), a corporation duly organized under the laws of the State of Iowa, and having its principal office in the City of Des Moines, County of Polk, State of Iowa, hath made, constituted and appointed, and does by these presents make, constitute and appoint J. Allen Wallis III, Fred J. Kunnert, Robert S. Vohl of Dubuque and 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, undertakings, 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 ($3,000,000.00) DOLLARS and to bind the MERCHANTS BONDING COMPANY (MUTUAL) thereby as fully and to the same extent as if such bond or undertaking was signed by the duly authorized officers of the MERCHANTS BONDING COMPANY (MUTUAL), and all the 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 Amended Substituted and Restated By- Laws adopted by the Board of Directors of the MERCHANTS BONDING COMPANY (MUTUAL) on November 16, 2002. ARTICLE II, SECTION 8 - The Chairman of the Board or President or any Vice President or Secretary shall have power and authority to appoint Attorneys -in -Fact, and to authorize them to execute on behalf of the Company, and attach the Seal of the Company thereto, bonds and undertakings, recognizances, contracts of indemnity and other writings obligatory in the nature thereof. ARTICLE II, SECTION 9 - The signature of any authorized officer and the Seal of the Company may be affixed by facsimile to any Power of Attorney or Certification thereof authorizing the execution and delivery of any bond, undertaking, recognizance, or other suretyship obligations of the Company, and such signature and seal when so used shall have the same force and effect as though manually fixed. In Witness Whereof, MERCHANTS BONDING COMPANY (MUTUAL) has caused these presents to be signed by its President and its corporate seal to be hereto affixed, this 13th day of October , 2010. • • \NG C04••. ;6o�oRPOq .09• •-o- 7. • ry—: f1 'Z • r3• J . �f1 aLr 1 •• 1933 :c. gy • • •Y. . STATE OF IOWA COUNTY OF POLK ss. MERCHANTS BONDING COMPANY (MUTUAL) President On this 13th day of October , 2010 , before me appeared Larry Taylor, to me personally known, who being by me duly sworn did say that he is President of the MERCHANTS BONDING COMPANY (MUTUAL), 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 Des Moines, Iowa, the day and year first above written. CINDY SMYTH Commission Number 173504 lk w� My Commission Expires March 16, 2012 STATE OF IOWA COUNTY OF POLK ss. Notary Public, Polk County, Iowa I, William Warner, Jr., Secretary of the MERCHANTS BONDING COMPANY (MUTUAL), do hereby certify that the above and foregoing is a true and correct copy of the POWER -OF- ATTORNEY executed by said MERCHANTS BONDING COMPANY (MUTUAL), which is still in full force and effect and has not been amended or revoked. In Witness Whereof, I have hereunto set my hand and affixed the seal of the Company on this 1 Ot bay of Feb. 20,12 POA 0001 (1/09) Secretary ACdRO® �� CERTIFICATE OF LIABILITY INSURANCE DATE (MfNDD/YYY1) 2/10/2012 '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 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 endorsement(s). PRODUCER Wallis Kunnert Price & Smith Inc. 890 Main St. P.O. Box 176 Dubuque IA 52004 -0176 CONTACT Linda Caspersen INCNN Exu: (563) 583 -5775 (A/c .No): (563) 583 -5779 RIOhSS :lindac @wkpsins.com INSURER(S) AFFORDING COVERAGE NAIC # INsuRERA:Cincinnati Insurance Co. 10677 INSURED McDermott Excavating 14407 Hwy 20 West Dubuque IA 52003 -9709 INsuRERB:Cincinnati Indemnity Company 23280 INSURER C: 1/1/2013 INSURER D: $ 1,000,000 INSURER E : 100 000 $ r INSURERF: $ 5,000 COVERAGES CERTIFICATE NUMBER:CL1221001650 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY 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. INSR TYPE OF INSURANCE ADDL INSR SUBR WVD POLICY NUMBER POLICY EFF (MM /DD/YYYY) POLICY EXP (MM /DD/YYYY) LIMITS A GENERAL X LIABILITY COMMERCIAL GENERAL LIABILITY ENP0060480 1/1/2012 1/1/2013 EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED PREMISES (Ea occurrence) 100 000 $ r MEDEXP(Anyoneperson) $ 5,000 CLAIMS -MADE X OCCUR PERSONAL &ADVINJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 PRODUCTS - COMP/OP AGG $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: 7 POLICY n IFS,: n LOC $ A AUTOMOBILE X LIABILITY ANY AUTO ALL OWNED HIJR ED AUTOS X x _ SCHEDULED AUTOS NON -OWNED AUTOS EBA0060480 1/1/2012 1/1/2013 COMBINED SINGLE LIMIT (Ea accident) $ 1,000,000 BODILY INJURY (Per person) $ BODILYINJURY(Peraccident) $ PROPERTY DAMAGE (Per accident) $ BFDOC $ 0 A X UMBRELLA LIAB EXCESS LIAB X OCCUR CLAIMS -MADE ENP0060481 1/1/2012 1/1/2013 EACH OCCURRENCE $ 10, 000, 000 AGGREGATE $ 10, 000, 000 $ DED X RETENTON$ 0 B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER /EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below Y/ N N / A WC1896366 -05 1/1/2012 1/1/2013 x WC STATU- TORY LIMITS OTH- ER E.L. EACH ACCIDENT $ 100,000 E.L. DISEASE - EA EMPLOYEE $ 100 , 000 E.L. DISEASE - POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) Job: Green Alley Permeable Paver Project - 17th -18th between Jackson & Washington Streets. Additional Insured for this job ONLY: City of Dubuque per GA 4113 11/99 & GA 443 1/95. Also attached are Forms GA 4094 10 /01, WC 00 03 13, Govenmental Immunities Endorsement and CG 25 03 3/97. A 30 day notice of cancellation will be given to the Cert. Holder if any of these policies cancels. Except for non - payment, which is 10 days. CERTIFICATE HOLDER CANCELLATION The City of Dubuque 50 West 13th St. Dubuque, IA 52001 -4864 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 J Allen Wallis III,CI ACORD 25 (2010/05) IN S025 (201005).01 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - SCHEDULED PERSON OR ORGANIZATION - YOUR WORK This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name of Person or Organization (Additional Insured): The City of Dubuque, including all its elected and appointed officials, all its employees and volunteers, all its boards, commissions & /or authorities and their board members, employees and volunteers. 50 West 13th Dubuque, IA 52001 WHO IS AN INSURED (Section II) is amended to include as an insured the person or organization shown in the Schedule, but only with respect to liability arising out of "your work" for that Additional Insured by you or on your behalf. GA 4113 11 99 Includes copyrighted material of Insurance Services Office, Inc.,with its permission. THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS (Form A) This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Location of Covered Operations: Dubuque, IA Name of Person or Organization (Additional Insured): The City of Dubuque, including all its elected and appointed officials, all employees and volunteers, all its boards, commissions & %or.authorities and their board :members, employees and volunteers. ' 50 West 13th St. Dubuque, IA 52001 Premium Basis Bodily Injury and Property Damage Liability Cost Rates (Per $1000 of cost) Advance Premium $ INCL. its (If no entry appears above, information required to complete this endorsement will be shown in the Declara- tions as applicable to this endorsement.) 1. WHO IS AN INSURED (Section II) is amended to include as an insured the person or organi- zation (called "additional insured ") shown in the Schedule but only with respect to liability arising out of: A. Your ongoing operations performed for the additional insured(s) at the location designated above; or B. Acts or omissions of the additional in- sured(s) in connection with their general supervision of such operations. 2. With respect to the insurance afforded these additional insureds, the following additional provisions apply: A. Exclusions b., c., g., h.(1), j., k., I. and n. under COVERAGE A- BODILY INJURY AND PROPERTY DAMAGE LIABILITY (Section I - Coverages do not apply. B. Additional Exclusions. This insurance does not apply to: (1) "Bodily injury" or "property damage" for which the additional insured(s) are obligated to pay damages by reason of the assumption of liability in a contract or agreement. This ex- clusion does not apply to liability for damages that the additional in- sured(s) would have in the absence of the contract or agreement. Contains copyrighted material of Insurance Services Office, Inc., with its permission. Copyright, Insurance Services Office, Inc., 1992 GA 443 01 95 (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 site of the covered operations has been completed; or (b) That portion of "your work" out of which the injury or damages arises has been put to its in- tended use by any person or or- ganization other than another contractor or subcontractor en- gaged in performing operations for a principal as a part of the same project. "Bodily injury" or "property damage" arising out of any act or omission of the additional insured(s) or any of their "employees ", other than the general supervision by the additional insured(s) of your ongoing opera- tions performed for the additional in- sured(s). (4) "Property damage" to: (3) Page 1 of 2 (a) Property owned, used or occu- pied by or rented to the addi- tional insured(s); (b) Property in the care, custody, or control of the additional in- sured(s) or over which the addi- tional insured(s) are for any pur- GA 443 01 95 pose exercising physical control; or (c) Any work, including materials, parts or equipment furnished in connection with such work, which is performed for the addi- tional insured(s) by you. Contains copyrighted material of Insurance Services Office, Inc., with its permission. Copyright, Insurance Services Office, Inc., 1992 Page 2 of 2 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. PRIMARY / NONCONTRIBUTORY AMENDMENT OF CONDITIONS FOR DESIGNATED ADDITIONAL INSUREDS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name of Person or Organization (Additional Insured): The City of Dubuque, including all its elected and appointed officials, all its employees and volunteers, all its boards, commissions & /or authorities and their board members, employees and volunteers 50 West 13th Dubuque, IA 52001 With respect to insurance provided the additional insured shown in the Schedule, SECTION IV - COMMERCIAL GENERAL LIABILITY CONDI- TIONS, 5. Other Insurance is deleted in its en- tirety and replaced by the following: 5. Other Insurance If other valid and collectible insurance is available to the additional insured for a loss we cover under Coverages A or B of this Coverage Part, our obligations are limited as follows: a. Primary Insurance Where required by a written contract, this insurance is primary and noncontributory as respects any other insurance policy issued to the additional insured. Other- wise, b. below applies. b. Excess Insurance This insurance is excess over any of the other insurance available to the additional insured whether primary, excess, contin- gent or on any other basis. When this insurance is excess, we will have no duty under Coverages A or B to defend any claim or "suit" that any other insurer has a duty to defend. If no other insurer defends, we will undertake to do so, but we will be entitled to the insured's rights against all those other insurers. GA 4094 10 01 When this insurance is excess over any other insurance, we will pay only our share of the amount of the loss, if any, that exceeds the sum of: (1) The total amount that all such other insurance would pay for the loss in the absence of this insurance; and (2) The total of all deductible and self - insured amounts under all that other insurance. We will share the remaining loss, if any, with any other insurance that was not bought specifically to apply in excess of the Limits of Insurance shown in the Declarations of this Coverage Part. c. Method of Sharing If all of the other insurance permits con- tribution by equal shares, we will follow this method also. Under this approach each insurer contributes equal amounts until it has paid its applicable limit of in- surance or none of the loss remains, whichever comes first. If any of the other insurance does not permit contribution by equal shares, we will contribute by limits. Under this method, each insurer's share is based on the ratio of its applicable limit of insurance to the total applicable limits of insurance of all insurers. WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT 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 anyone not named in the Schedule. Schedule The City of Dubuque 50 West 13th St. -- Dubuque, IA 52001 This endorsement changes the policy to which it is attached and is effective on the date issued unless other- wise stated. (The information below is required only when this endorsement is issued subsequent to preparation of the policy.) Endorsement Effective 2/10/12 Policy No. WC1846366 -05. Endorsement No. Insured McDermott Excavating Premium $ Iricl . 1rsurance_Company CinGinriati Insurance —Co. Countersigned WC 00 03 13 © 1983 National Council on Compensation Insurance. 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, IA 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 670.04 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 for 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, IA 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, IA. 5. No Other Change in Policy. The insurance carrier and the City of Dubuque, Iowa agree that the above preservation of governmental immunities shall not otherwise change or alter coverage available under the policy 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: Green Alley Permeable PaverrProject - 17th - 18th between Jackson & Washington Streets Dubuque, IA: (If no entry appears above, information required to complete this endorsement will be shown in the Declara- tions as applicable to this endorsement). A. For all sums which the insured becomes legally ignated construction project shown in the obligated to pay as damages caused by "occur- Schedule above. rences" under COVERAGE A (SECTION I), and for all medical expenses caused by accidents 4. The limits shown in the Declarations for under COVERAGE C (SECTION I), which can Each Occurrence, Fire Damage and Medi- be attributed only to ongoing operations at a cal Expense continue to apply. However, single designated construction project shown in instead of being subject to the General Ag- the Schedule above: gregate Limit shown in the Declarations, such limits will be subject to the applicable 1. A separate Designated Construction Proj- Designated Construction Project General ect General Aggregate Limit applies to Aggregate Limit. each designated construction project, and that limit is equal to the amount of the Gen- B. For all sums which the insured becomes legally eral Aggregate Limit shown in the Declare- obligated to pay as damages caused by "occur - tions. rences" under COVERAGE A (SECTION 1), and for all medical expenses caused by accidents 2. The Designated Construction Project Gen- under COVERAGE C (SECTION I), which can - eral Aggregate Limit is the most we will pay not be attributed only to ongoing operations at a for the sum of all damages under single designated construction project shown in COVERAGE A, except damages because the Schedule above: of "bodily injury" or "property damage" in- cluded in the "products- completed opera- 1. Any payments made under COVERAGE A tions hazard ", and for medical expenses for damages or under COVERAGE C . for under COVERAGE C regardless of the medical expenses shall reduce the amount number of: available under the General Aggregate Limit or the Products - Completed Opera - a. Insureds; tions Aggregate Limit, whichever is applica- ble b. Claims made or "suits" brought; or ,and 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 Declarations nor shall they reduce any other Designated Construction Project General Aggregate Limit for any other des- CG 25 03 03 97 2. Such payments shall not reduce any Des- ignated Construction Project General Ag- gregate Limit. 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 Page 1 of 2 D. If the applicable designated construction project has been abandoned, delayed, or abandoned and then restarted, or if the authorized con- tracting parties deviate from plans, blueprints, designs, specifications or timetables, the project CG 25 03 03 97 E. will still be deemed to be the same construction project. The provisions of Limits of Insurance (SECTION III) not otherwise modified by this endorsement shall continue to apply as stipulated. Copyright, Insurance Services Office, Inc., 1996 Page 2 of 2 PROJECT INFORMATION REQUIREMENTS FOR STATE OF IOWA SALES TAX EXEMPTION CERTIFICATES FOR CONTRACTORS & SUBCONTRACTORS Submitting Department: Engineering Department Department Contact: Jon Dienst Please complete this form in its entirety and submit along with the executed Construction Contracts, Bonds and Certificate of Insurance. Upon receipt, the City Finance Department will work with the Iowa Department of Revenue to issue Sales Tax Exemption Certificate(s) to the approved Contractor(s) to allow for the purchase or inventory withdrawal of materials for the specified Construction Project free from State of Iowa Sales Tax. Construction Project Name: I Green Alley Peremable Paver Project -17th - 18th between Jackson & Washington Streets Project Description: Reconstruction of the alley between Jackson & Washington Streets, from 17th Street to 18th Street. - Reconstruction of the pavement surface with interlocking concrete pavers. - Watermain reconstruction. - Sanitary Sewer repair - Replacement of four (4) lead water services that will be replaced with copper services. - Replacement of the brick sanitary manholes in the alley and on 17th and 18th Streets with new concrete manholes. Start Date (Bid let date): January 19, 2012 Completion Date: June 30, 2012 1. General Prime Contractor: McDermott Excavating Contact Name: 4101 Pennsylvania Ave. Complete Address: (Include PO Box and Street Information) 14407 Route 20 City, State, Zip Code Dubuque, IA 52003 Telephone Number: 563 - 583 -4633 Federal I.D. Number: (or Include Social Security Number) 39- 1872711 Work Type to be Completed: - Excavating 2. Subcontractor: Nauman Nursery Complete Address: (Include PO Box and Street Information) 4101 Pennsylvania Ave. City, State, Zip Code Dubuque, TA 52002 Telephone Number: 563- 599 -7708 Federal I.D. Number: (or Include Social Security Number) 42- 1057939 Work Type to be Completed: Permeable Pavers, Sodding PROJECT INFORMATION PAGE 2 3. Subcontractor: Pat 0' Dowd Concrete 15 South Main Street Complete Address: (Include PO Box and Street Information) 1930 Alta Vista Street Telephone Number: City, State, Zip Code Dubuque, IA 52001 42- 1020126 Telephone Number: 563 - 590 -4114 Federal I.D. Number: (or Include Social Security Number) 42- 1041483 Work Type to be Completed: Cast in Place Concrete Paving 4. Subcontractor: River City Paving Complete Address: (Include PO Box and Street Information) P.O. Box 1430 City, State, Zip Code Dubuque, IA 52004 -1430 Telephone Number: 608 -568 -3433 Federal I.D. Number: (or Include Social Security Number) 39- 0752519 Work Type to be Completed: Hot Mix Asphalt Paving 5. Subcontractor: Sel co Complete Address: (Include PO Box and Street Information) 15 South Main Street City, State, Zip Code Dubuque, IA 52003 Telephone Number: 563 - 556 -2434 Federal I.D. Number: (or Include Social Security Number) 42- 1020126 Work Type to be Completed: Traffic Control 6. Subcontractor: Complete Address: (Include PO Box and Street Information) City, State, Zip Code Telephone Number: Federal I.D. Number: (or Include Social Security Number) Work Type to be Completed: .Masterpiece on the Mississippi February 14, 2012 Mr. Herb Dolphin McDermott Excavating 14407 Route 20 Dubuque, IA 52003 Dear Herb: Dubuque All- America City 11111.1 2007 Finance Department 50 West 13th Street Dubuque, Iowa 52001 -4805 Office (563) 589 -4133 Fax (563) 690 -6689 TTY (563) 690 -6678 finance@cityofdubuque.org www.cityofdubuque.org Enclosed are the Iowa Construction Sales Tax Exemption Certificates for the Green Alley Permeable Paver Project. An extra copy of the certificates is enclosed for your files, as well as the project summary from the State of Iowa. As information on additional 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 563- 589 -4133. Sincerely, Ken TeKippe Finance Director KT /em I Enclosures cc: Engineering Department Service People, Integrity Responsibility Innovation Teamwork PROJECT INFORMATION REQUIREMENTS FOR STATE OF IOWA SALES TAX EXEMPTION CERTIFICATES FOR CONTRACTORS & SUBCONTRACTORS Submitting Department: Engineering Department Department Contact: Jon Dienst Please complete this form in its entirety and submit along with the executed Construction Contracts, Bonds and Certificate of Insurance. Upon receipt, the City Finance Department will work with the Iowa Department of Revenue to issue Sales Tax Exemption Certificate(s) to the approved Contractor(s) to allow for the purchase or inventory withdrawal of materials for the specified Construction Project free from State of Iowa Sales Tax. Construction Project Name: Green Alley Peremable Paver Project -17'n -18'" between Jackson & Washington Streets Project Description: Reconstruction of the alley between Jackson & Washington Streets, from 171h Street to 18th Street. - Reconstruction of the pavement surface with interlocking concrete pavers. - Watermain reconstruction. - Sanitary Sewer repair - Replacement of four (4) lead water services that will be replaced with copper services. - Replacement of the brick sanitary manholes in the alley and o_ n 17th and 18th Streets with new concrete manholes. Start Date (Bid let date): January 19, 2012 Completion Date: June 30, 2012 1. General Prime Contractor: McDermott Excavating Contact Name: Oe rb V\ptN∎n Complete Address: (Include PO Box and Street Information) 14407 Route 20 City, State, Zip Code Dubuque, IA 52003 Telephone Number: 563-581-463 Federal I.D. Number: (or Include Social Security Number) 39- 1872711 Work Type to be Completed: , Excavating 2. Subcontractor: Nauman Nursery Complete Address: (Include PO Box and Street Information) . 4101 Pennsylvania Ave City, State, Zip Code Dubuque, IA 52002 Telephone Number: 563 -599 -7708 Federal I.D. Number: (or Include Social Security Number) 42- 1057939 . Work Type to be Completed: Permeable Pavers, Sodding Add Estate /Trust Revenue Home Navigation Menu View Entity Details I ;List Existing Projects ! !Add New Contractor Page 1 of 1 REVE PROJECT SUMMARY EiM Below are the details for the selected project. DRF Control #: Project Name: Project Nbr: Project Description: 1030566 Green Alley Peremable Paver Project • Reconstruction of the alley between Jackson & Washington Streets, from 17th Street to 18th Street. Reconstruction of the pavement surface with interlocking concrete pavers. Watermain reconstruction. Sanitary Sewer repair. Replacement of four (4) lead water services that will be replaced with copper services. Replacement of the brick sanitary manholes in the alley and on 17th and 18th Streets with new concrete manholes. 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. FedID or Contractor SSN Name 391872711 MCDERMOTT _ EXCAVATING 421057939 NAUMAN NURSERY, INC. 421041483 • 390752519 PATRICK O' DOWD_ CONCRETE RIVER CITY PAVING 421020126 SAFETY EQUIPMENT LEASING CO. D /B /A SELCO, INC. Contractor Type General Subcontractor Subcontractor Subcontractor Certificate Certificate Certificate Certificate Subcontractor Certificate State of Iowa 1 Subscribe to e-mail news 1 Translate 1 Privacy Statement 1 Taxpayer Rights 1 Links 1 PDF Reader https : / /www. idr. iowa. gov /taxexemption/Proj ectSummary. asp ?id =103 05 66 2/14/2012 IOWA Department of Revenue www.state.ia.us /tax Page 1 of 1 Designated Exempt Entity Iowa Construction Sales Tax Exemption 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 Dubuque State IA Zip Code 52001 4864 Construction Project Name Green Alley Peremable Paver Project Construction Project Number (if used) General Contractor or Subcontractor Name MCDERMOTT EXCAVATING Address 1 _ 14407 ROUTE 20 Address 2 City DUBUQUE State IA Zip Code 52003 Type of Work Excavation /Grading . Description of contract/subcontract Reconstruction of the alley between Jackson Et Washington Streets, from 17th Street to 18th Street. Reconstruction of the pavement surface with interlocking concrete pavers. Watermain reconstruction. Sanitary Sewer repair. Replacement of four (4) lead water services that will be replaced with copper services. Replacement of the brick sanitary manholes in the alley and on 17th and 18th Streets with new concrete manholes. 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 property bein o structed,. �1 Designated Exempt Entity Authorized Agent: �Q— / Date: )- (r7 ,/ / 2-- 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 gdalifying materials can be found at www.state.ia.us /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/certificate .asp ?id = 111152 2/14/2012 IOWA Department of Revenue www.state.ia.us /tax Page 1 of 1 Designated Exempt Entity Iowa Construction Sales Tax Exemption 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 4101 Pennsylvania Ave. Address 1 50 West 13th Street City Dubuque Address 2 Zip Code 52002 Dubuque ICity State IA Zip Code 52001 4864 Construction Project Name Green Alley Peremable Paver Project, Construction Project Number (if used) Description of contract/subcontract General Contractor or Subcontractor Name Nauman Nursery, Inc. Address 1 4101 Pennsylvania Ave. Address 2 — City Dubuque State IA Zip Code 52002 Type of Work Paving Reconstruction of the alley between Jackson Et Washington Streets, from 17th Street to 18th Street. Reconstruction of the pavement surface with interlocking concrete pavers. Watermain reconstruction. Sanitary Sewer repair. Replacement of four (4) lead water services that will be replaced with copper services. Replacement of the brick sanitary manholes in the alley and on 17th and 18th Streets.with new concrete manholes. 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 property being coonstructe Designated Exempt Entity Authorized Agent: Date: 2 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.state.ia.us /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/certificate.asp ?id= 111153 2/14/2012 IOWA Department of Revenue www.state. ia. us /tax Page 1 of 1 Designated Exempt Entity Iowa Construction Sales Tax Exemption 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 Dubuque 'State IA _ Project Zip Code 1520014864 Construction Project Name Green Alley Peremable Paver Construction Project Number (if used) General Contractor or Subcontractor Name Patrick 0' Dowd Concrete Address 1 1930 Alta Vista Street Address 2 Dubuque 'IA State IA Zip Code 520014336 • Type of Work Concrete Description of contract/subcontract Reconstruction of the alley between Jackson a Washington Streets, from 17th Street to 18th Street. Reconstruction of the pavement surface with interlocking concrete pavers. Watermain reconstruction. Sanitary Sewer repair. Replacement of four (4) lead water services that will be replaced with copper services. Replacement of the brick sanitary manholes in the alley and on 17th and 18th Streets with new concrete manholes. 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 property being nstructed. Date: Designated Exempt Entity Authorized Agent: 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.state.ia.us /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/certificate .asp ?id = 111154 2/14/2012 IOWA Department of Revenue www.state.ia.us /tax Page l of l Designated Exempt Entity Iowa Construction Sales Tax Exemption 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 Dubuque State IA Zip Code 52001 4864 Construction Project Name Green Alley Peremable Paver Project Construction Project Number (if used) General Contractor or Subcontractor Name River City Paving Address 1 PO Box 1430 . Address 2 ' City Dubuque State IA Zip Code 52004 1430 Type of Work Hot Mix Asphalt Paving Description of contract/subcontract Reconstruction of the alley between Jackson it Washington Streets, from 17th Street to 18th Street. Reconstruction of the pavement surface with interlocking concrete pavers. Watermain reconstruction. Sanitary Sewer repair. Replacement of four (4) lead water services that will be replaced with copper services. Replacement of the brick sanitary manholes in the alley and on 17th and 18th Streets with new concrete manholes. 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 property being onstructed. Designated Exempt Entity Authorized Agent: " -°1411-/4; Date: / Y/ 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.state.ia.us /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 /certificate.asp ?id= 111155 2/14/2012 Page 1 of 1 IOWA Designated Exempt Entity Department of Revenue Iowa Construction Sales Tax Exemption Certificate www.state.ia.us /tax 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 Dubuque State IA Zip Code 52001 4864 Construction Project Name Green Alley Peremable Paver Project Construction Project Number (if used) General Contractor or Subcontractor Name SAFETY EQUIPMENT LEASING CO. D /B /A SELCO, INC. Address 1 15 SOUTH MAIN ST Address 2 City DUBUQUE • 'State State Zip Code 152003 Type of Work • Traffic Control - Description of contract/subcontract. Reconstruction of the alley between Jackson Et Washington Streets, from 17th Street to 18th Street. Reconstruction of the pavement surface with interlocking concrete pavers. Watermain reconstruction. Sanitary Sewer repair. Replacement of four (4) lead water services that will be replaced with copper services. Replacement of the brick sanitary manholes in the alley and on 17th and 18th Streets with new concrete manholes. 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 property being constructed. Designated Exempt Entity Authorized Agent: Date: //V// 2 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.state.ia.us /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/certificate.asp ?id= 111156. 2/14/2012