Contracts Signed by Mgr
Dli~~E
~ck~
MEMORANDUM
August 28, 2006
TO: The Honorable Mayor and City Council Members
FROM: Michael C. Van Milligen, City Manager
SUBJECT: Contracts
I have recently signed the following contracts:
1. Roadway Maintenance Agreement
2. Encephalitis Monitoring Memorandum of Understanding with the Iowa
Department of Public Health Amendment
rtJl L(~ ~tJ/
Micj{ael C. Van Milligen
MCVM/jh
Attachment
cc: Barry Lindahl, City Attorney
Cindy Steinhauser, Assistant City Manager
r-
'. )
- --..,
.
~L'
\..,
DU~~E
~~~
MEMORANDUM
August 2, 2006
TO:
Michael C. Van Milligen, City Manager
Don Vogt, Public Works Director ~
SUBJECT: Roadway Maintenance Agreement
FROM:
INTRODUCTION
The purposes of this memorandum are to provide information and recommend your
endorsement of the attached Roadway Maintenance Agreement between the City of
Dubuque and the Iowa Department of Transportation (lOOT).
BACKGROUND
In February, City staff met with lOOT regional and local representatives to discuss the
City's concerns regarding insufficient road cleaning and weed-cutting efforts by lOOT
crews along highways within Dubuque's corporate limits. At the meeting, lOOT
acknowledged its own lack of satisfaction with its efforts, but ascribed the shortcomings
to repeated road maintenance budget cuts in the two noted areas. The lOOT
representatives said the City was free to cut weeds and grass along its urban highways,
but it would/could not compensate us for such work. However, the lOOT
representatives said that they would consider compensating us for any street sweeping
we might do to supplement its twice-per-year schedule. After additional discussions
regarding method of operations and compensation, lOOT's Gretchen Gresslin said that
a supplementary highway cleaning agreement could not be signed until the City and
State signed new five (FY07-FY11) and one year (FY07) highway maintenance
agreements. Those agreements were signed in July.
DISCUSSION
A cover letter from Ms. Gresslin and a Roadway Maintenance Agreement providing for
one sweeping of Dubuque's urban highways is attached. Compensation is for the
agreed amount of $1 ,500.
ACTION STEP
I recommend that you sign the agreement and return it to me. I will then forward it to
Ms. Gresslin.
Attachments
..
11~ Iowa Department of Transportation
.. c8: Cedar Rapids Maintenance Office (319) 365-3558
~ 5455 Kirkwood Blvd. SW, CedarRapids,IA 52404 Fax (319) 365-2317
July 28, 2006
Ref:S32
City of Dubuque
Don V ogt, Manager
Operations and Maintenance Department
City of Dubuque
925 Kerper Blvd.
Dubuque, IA 52001
Deaf Mr Vogt:
Per our conversation, enclosed is the Roadway Maintenance Agreement between the City of
Dubuque and the Department of Transportation. This agreement concerns sweeping Priority
1 highways in Dubuque including the Julien Dubuque Bridge, Wisconsin Bridge and all
ramps one time between August 1,2006 and November 1,2006.
Please review the document and if in agreement, please have the appropriate authority sign
their approval. It will then need to be returned to this office for approval by our district
office. A final copy will be returned to you for your files.
Please call if you have any questions.
Sincerely,
,
retchen Gresslin
District Maintenance Manager
GG/dh
Enclosure
~ " ; " ( ,
L,rr;ri~,""(";":'.., .
F-."~~"; ~'ji.':,I'.. -r::;G;~:~'t,>fJ~:>
fj,.n"~f';' "t,.T
. -
il-J/:~j;-~P';; y'~~r;;.i~',:.;q~o -i'wI: V,j~. f'.V'l::' J1 :(";~'
f:~,r;~:L
~->~:~! !-';-;:,~q u> p~; L,-::~;JL'>'
: ~..: :;::' :)
,"!'~;_., ~V~;{,rJ.t~~
-, ~"', :', ..-.
:"'.'-;n.~,
;'-,
'" ,; ~~,-....,- '~' ': ':,F' [,:>,.....,.
3. PAYMENT
A. It is agreed that payment for the routine maintenance operations will be made after the
work has been completedfo! the fiscal year ending June 30, and payment for
maintenance operations will be made after the work has been completed. It is also
understood and agreed that the right is reserved by both Parties to review, adjust, or
terminate this Agreeinentat any time;:.provided howeverthatwritterrnotice.be given
'either. Party atleast thirty daysprior.to such review,~ adjustm~nt,ol'terminatioJf.~ ~:' - r ,,',
B. Payment for routine inaintenance at the rate of $ mum per lane mile per year.
Total lane miles ==-at $ m__m per lane mile = $ ------------
C. Payment for special maintenance shall be made as follows:
$1500 for one time sweeping of primary highway in the City of Dubuque.
City of Dubuque to invoice Iowa Depaliment of Transportation.
4. AGREEMENT TIME PERIOD
Beginning Date: August L 2006
Ending Date: November L 2006
5. If any section, provision or part of this Agreement shall be found to hi invalid or unconstitutional, such
judgment shall not affect the validity of the Agreement as a whole or any-section; provision, or part
thereof not found to be invalid or unconstitutional:
6. Party of the First Part will follow all federal and state laws and regulations with regard to worker safety
and the handling and disposal of hazardous waste and/or substances in performing any maintenance
task.
7. Any subsequent change or modification to the terms of this Agreement shall be in the form of a duly
executed addendum or amendment to this Agreement.
RECOMMENDED FOR APPROVAL:
(> {f { tJLi ~v-
(CITY)
BY
J/}Jo6
(DATE~
c < ry /l10--t~/-v-
IOWA DEPARTMENT OF TRANSPORTATION
TITLE
BY
District Engineer
(DATE)
Form8]0056wd
3.0]
I;~ Iowa Department of Transportation
~
ROADWAY MAINTENANCE AGREEMENT
AGENCY
COUNTY
CITY Dubuque
BOARD
This written agreement made and entered into by and between the (f,GHJCY) (COUNTY) (CITY) (BO.\RD) ofDubuaue, Party of
the First Part, and the Iowa Department of Transportation, Party of the Second Part.
1. ROUTINE MAINTENANCE
A. It is understood that routine maintenance shall include, but is not limited to snow and ice
control, spot ACC overlays, ACC and PCC crack/joint/spot filling and patching, leveling
of transverse joints, strip sealing, edge sealing, application of granular materials, blading
of granular surfaces, shoulder repair, roadside mowing and herbicide applications,
maintenance of clear channels through and adjoining drainage structures, repair or
replacement of safety appurtenances and traffic control devices, and replacement of
inadequate traffic signs and markings.
B. Party of the First Part will perform the following routine maintenance:
C. Party ofthe Second Part will perform the following routine maintenance:
Routine maintenance not applicable with respect to this agreement.
2. SPECIAL MAINTENANCE
f.. It is lffiderstood that special maintonance shall iHshlde, eat is Hot limited te apjllicatioH
of gI"illlular slH"face materials to whole sections of roadway, crack1joiHt sealing, full or
partial dejltB. patching, eiturnrnOllS seal eoating, stmctuFal paiHtiHg, major structlH"al
rejlaiFs, replaeeffieHt onridges or ealyerts, installatioH of traffic eowol signs, maflBlIgs,
and safety appartenances at Hew locations and apjllieatieR ef ffilst palliati'le.
B. Party of the First Part will perform the following special maintenance:
The City of Dubuque will provide a street sweeper and operator for sweeping Priority 1
highways in Dubuque not limited to but including the Julien Dubuque Bridge,
Wisconsin Bridge and all ramps.
C. Party ofthe Second Part will perform the following special maintenance:
Provide traffic control for the sweeping operation, provide haul truck for sweeper to
dump into and pay landfill fees.
~
5ii~~E
~~~
MEMORANDUM
August 9, 2006
FROM:
Michael C. Van Milligen, City Manager
Mary ~~rigan, RN, Public Health Specialist
TO:
SUBJECT: Encephalitis Monitoring Memorandum of Understanding (MOU) with the
Iowa Department of Public Health (IDPH) Amendment
Attached is an amendment to the annual Arboviral Surveillance (mosquito monitoring)
contract with the Iowa Department of Public Health. You recently signed the original
contract, but because the State made a mistake in the dates, they had to amend that
contract. This amendment allows us to claim an extra $60. Please sign and return to
me.
MRC/cj
.Iowa Department of Public Health
-.J Mary Mincer Hansen, R.N., Ph.D.
Thomas J. Vilsack Director
Governor
Sally J. Pederson
Lt. Governor
PROJECT TITLE: Arboviral Surveillance
CONTRACT #: MOU-2007-ELC04
CONTRACTOR City of Dubuque
AMENDMENT: #1
This contract is amended to increase the budget from $1,180 to $1,240 to allow for a $60 reimbursement for
sentinel chicken bleeding for the week-ending June 3, 2006.
All other conditions and terms of the contract remain in effect.
The parties hereto have executed this contract amendment on the day and year last specified below.
For and on behalf of the Department:
For and on behalf ofthe Contractor:
By
Mary Jones, Director
Division of Acute Disease Prevention and
Emergency Response
By. (21J ~~
Michael C. Van Milligen, Manager
City of Dubuque
Date:
Date:
rr/9(vt;
Promoting and protecting the health of Iowans
Lucas State Office Building, 321 E. 12th Street, Des Moines, IA 50319-0075.515-281-7689. www.idoh.state.ia.us
n~AI= DI=I AV li.lt:I~ri"n nr e.""l:::u:~,..h IMr'\o::r.ir.o.n\ 711 nr 1 s:lntL7~~_?aA?
i5~B~E
~ck~
MEMORANDUM
August 29, 2006
TO:
FROM:
Michael C. Van Milligen, City Ma~n
Gus Psihoyos, City Engineer A\6
Asbury Road Culvert and Garfield/and Street Manhole Repairs
SUBJECT:
INTRODUCTION
The purpose of this memo is to present a contract between the City of Dubuque and
Visu-Sewer Clean & Seal Inc. to perform the repairs to the 60" culvert under Asbury
Road just east of Harvest View Subdivision and a manhole in the area of Garfield and
Ann Street.
DISCUSSION
The repair work involves sealing and patching of eight joints in the 60" diameter culvert
under Asbury Road. Visu-Sewer proposed fee for this work is $13,500.
The second part of the project is to realign a brick manhole using a strong seal system.
The fee proposal for this work is $160 per vertical foot, or $2,400.
RECOMMENDATION
I recommend that the City hire Visu-Sewer Clean & Seal Inc., to repair the culvert under
Asbury Road and the manhole near Garfield and Ann Street.
ACTION
I respectfully request execution of the attached contract for the storm sewer repairs.
DD~~E
~~~
City of Dubuque
Engineering
50. W. 13th Street
Dubuque. fA 52001
(563) 589-4270
(563) 589-4205 FAX
CITY OF DUBUQUE, IOWA
SHORT FORM
IMPROVEMENT CONTRACT
THIS IMPROVEMENT CONTRACT (the Contract), made in triplicate, dated for reference
purposes the 28th day of July, 2006, between the City of Dubuque, Iowa, by its City Manager,
through authority conferred upon the City Manager by its City Council (City) and
Visu-Sewer Clean & Seal, Inc. of the City of
(Contractor Name)
W230 N4855 Betker Drive, Pewaukee, WI 53072
(Contractors Address - City and State)
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
Proiect):
Site#l: Joint sealing and concrete restoration of 60-inch culvert under Asbury Road near Harvest View
Estates Subdivision. This work will eliminate the sink holes around the sidewalk along the north side of
Asbury Road that pose a threat to public safety and the integrity ofthe roadway PER THE PROPOSAL
DATED 5/01/2006.
Site#2: Seal junction chamber and eliminate settlements in the area of Garfield and Aun Streets. PER
THE PROPOSAL DATED 7/24/2006. .
The work described above shall be completed at the following location(s):
Site#l: The north side of Asbury Road near the Harvest View Sub.
Site#2: Garfield and Ann Streets.
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: 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
September 15.2006
(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 provided in the Contract Documents, the Contractor shall provide evidence of
insurance which meets the requirements of the City's Insurance Schedule for General
Contractors or Artisan Contractors.
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 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 $15,900
THE MAXIMUM CONTRACT AMOUNT SHALL BE LIMITED TO AN INCREASE OF 10% OF THE ABOVE LISTED
ESTIMATED AMOUNT.
By:
CITYOF ~A
M' hael C. Van Milligen
City Manager
PRINCIPAL:
0-:/ )/(oG
Date
\/,~....- Se",er Ct..", -t s~J rho.
Contractor
By:
rJ ttA (Jt{~
Signature
ke,-h 4Iex..'~<r
Printed Name
9/1< /"L<A
Date
Qro;t,,+
Title
ACKNOWLEDGEMENT OF ATTACHED
SPECIAL CONDITIONS:
By:
Signature
Date
Printed Name
Title
Page 3 of 4
Visu-Sewer Clean & Seal, Inc.
W230 N4855 Betker Drive
Pewaukee, WI 53072
262-695-2340
Proposal
To: Deron Muehring
City of Dubuque
50 West 13th ST.
Dubuque,IA 52001-4845
563-589-4201
From: John Nelson, Jr.
V isu-Sewer Clean & Seal, Inc.
Date: 05/0112006
Project: 60" Joint Repair and Sealing
Visu-Sewer is pleased to offer the following service:
Sealing and misc. mortar patching of 8 - 60" RCP joints. Project to consist of application of
Strong Seal patching material to exposed rebar areas and installation of 8 Cretex Pipe Joint Seals.
Price - $13,500.00 lump sum
The City of Dubuque is asked to provide access to the pipe inlet and outfall along with water for
our equipment from near by hydrants. Sealing of active leaks, if necessary, will be charged at
T &M rates.
Thank you for the opportunity to quote on this project. If you have any questions please do not
hesitate to contact us at 800-876-8478.
All material guaranteed to be as specified. All work to be completed in a substantia! workmanlike manner according to specifications submitted,
per standard practices. Any alteration or deviation from above specifications involving extra costs will be executed only upon written orders, and
will become an extra charge over and above the estimate. All agreements contingent upon ~trikes, accidents or delays beyond our control.
Owner to carry tire, romado and other necessary insurance. Our workers are fully covered by Workmen's Compensation Insurance. This
proposal may be withdrawn if not accepted within 30 days ofisslle. Tenns - Net 30 days.
Acceptance of Proposal
The above prices, specifications and conditions are satisfactory and are hereby accepted.
VSC&S, Inc. is authorized to do the work as specified.
Date:
Signature:
Please sign and return to sender
07/24/2006 MQN 15~ 1.9 FAX.
1;!]~~1/~~1
Visu-Sewer Clean & Seal, Inc.
W230 N4855 Betker Drive
Pewaukee, WI 53072
262-695-2340
Proposal
To: Bill Meyers
City of Dubuque
50 West 13th Street
Dubuque,IA 52001
563-589-4270
From: John Nelson, Jr.
Visu-Sewer Clean & Seal, Inc.
Date: 7/24/2006
Project: Manhole Lining - Strong Seal
Visu-Sewer is pleased to offer the following service:
Reline one 4' ;<. 5' ;<. 15' brick manhole in the City of Dubuque nsing the Strong Seal System. All
work will be in accordance with manufactures specifications. The price to complete this work is
as follows:
Price - $160.00 per vertical foot
(Based on completion with the pipe joint repair project)
The City of Dubuque is asked to provide access to all manholes and water for our equipment
from near by hydrants. Sealing of active leaks, if necessary, will be charged at T &M rates.
Thank you for the opportunity to quote on this project. Tfyou have any questions please do not
hesitate to contact us at 800-876-8478.
AIl material guaranteed to be as specified. All wotk 10 be completed in a subsltlnUal workmanlike manner according to 5pecificaocDJi 5Ubmittcd.,
pC" :rtcmda.td prnctit:t:S. Any nllCI;1lion or deviation from .above :;pt:CifiCl1tion~ involving extIa co!>ts wilJ be executed only upon wri~ (IrdCr:I,
and will bccoll1e an extra cll~tge OVe1' and above Ute estimate. All agreements COI1LiugertL upon slrike:l', accidents Or delays beyond Our cOnlIol.
OW1l.er lo ctIny fire, tornado and other neC~<Iry insur.ux;e. Our worken> lire fully covcn:c.l by WorkmCl1ls CompCl'lSD.[jon In.''ltmlIlcc.. This
proposal may be: withdrnWll if nor "c~epted wirh.i.u 30 da)'s of issue. TetJ.n:s. Nel 30 dtl)'s.
Acceptance of Proposal
The above prices, specifications and conditions are satisfactory and are hereby accepted.
VSC&S, Inc. is authodzed to do the work as specified.
Date:
Signature:
Please sign and return to sender
i.te: 1';1ZZ/Z00o
Time: 11:Z0 AM
Page: 002
TO: NiCOle wurster M Y,lZoZoY~-Z0~Y
ACORD CERTIFICATE OF LIABILITY INSURANCE I DATE {MM/DDiYYYY}
,. 08/22/2006
PRODUCER (800) 566 7007 FAX (262)574-7080 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
R & R Insurance Services, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
1581 E Racine Avenue ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
PO Box 1610
Waukesha, WI 53187-1610 INSURERS AFFORDING COVERAGE NAIC#
INSURED Visu Sewer Clean & Seal, Inc INSURER A Valley Forge Ins Co 20508
W230N4855 Betker Rd INSURER B Continental Casualty 20443
Pewaukee, WI 53072-1430 INSURER C Transportation Ins Co 20494
INSURER D Fireman's Fund Insu ranee Company
INSURER E
COVERAGES
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 POLJCIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH
POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
I~~ r~~ TYPE OF INSURANCE POL.ICY NUMBER PRk~~,v "~~5greE Pg~ill~X:b~~N LIMITS
GENERAL. L.IABIL.ITY U2055717470 04/01/2006 04/01/2007 EACH OCCURRENCE $ 1 000 000
ex COMMERCIAL. GENERAL LIABILITY DAMAGE TO RENTED $ 300,000
I ClJl..IMS MADE [8] OCCUR MED EXP (Anyone person) $ 5,000
A X $3,000 GL PO Oed PERSONAL & ADV INJURY $ 1 000 000
X Products/Completed GENERAl AGGREGATE $ 2,000,00C
-
GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS - COMP/OP AGG $ 1,000,000
-l ~OLlCY rxl j~8T fXl LOC
AUTOMOBIL.E LIABILITY C2055717498 04/01/2006 04/01/2007 COMBINED SINGLE LIMIT
X (Ee accidenl) $
ANY AUTO 1,000,000
-
AlL OWNED AUTOS BODILY INJURY
- $
SCHEDULeD AUTOS (Per person)
B X
HIRED AUTOS BODll Y II'-JJURY
'x $
NON-OWNED AUTOS (Peraccidenl)
'x $2,000 Comp Oed PROPERTY DAMAGE
'x $2,000 Coll Oed (Peraccidenl) $
GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $
R ANY AUTO OTHER THAN EAACC $
AUTO ONLY AGG $
EXCESSIUMBRELLA LIABiliTY U2055717503 04/01/2006 04/01/2007 EACH OCCURRENCE $ 10 000 000
:8J -OCCUR 0 CLAIMS MADE AGGREGATE $ 10,000,000
B $
~ ~EDUCTlBLE $
X RETENTION $ 10,OOC $
WORKERS COMPENSATION AND WC255717484 04/01/2006 04/01/2007 X I-rCl!~~; I I O~
EMPLOYERS' LIABILITY 100,000
C ANY PROPRIETORtPARTNERlEXECUTIVE E,L. EACH ACCIDENT $
OFFICER/MEMBER EXCLUDED? EL DISEASE - EA EMPLOYE $ 100,000
If YSs, describe under 500,000
SPECiAl PROVISIONS below EL DISEASE - POLICY LIMIT $
OTHER CH05EXC082680NV 04/01/2006 04/01/2007 $10,000,000 Occurrence
Excess Umbrella
0 $10,000,000 Aggregate
$10,000 Retention
JP..ESCRIPTlON OF OPERATIONS I LOCATIONS 1 VEHICLES I EXCLUSIONS AODEO BY ENDORSEMENT I SPECIAL PROVISIONS
roject: Joint Sealing & Structing Rehab
C T CATE OLDE
C NC LLA
N
City of Dubuque
50 West 13th Street
Dubuque, IA 52001-4845
SHOULO ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL
~ DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,
BUT FAILURE TO MAil SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY
OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES.
AUTHORIZEO REPRESENTATIVE /) ~.
~./ --"".A .
Thomas Scheider BM321 c.:::;;n~?2-:'c. -',-",
@ACORDCORPORATION 1988
ACORD 25 (2001/08)
i'te :~'I~~/~OOo
,
Time: 11:~;j AM
Page: 003
'1'0: NiCOle Wurster ~ Y,I~o~oY~-~;j~Y
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).
)f 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.
ACORD 25 (2001/08)