Well - Monitoring, Tetra Tech, S. Grandview
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MEMORANDUM
November 14, 2006
TO:
The Honorable Mayor and City Council Members
FROM:
Michael C. Van Milligen, City Manager
SUBJECT: Tetra Tech, Inc. - Monitoring Well Installation
City Engineer Gus Psihoyos recommends City Council approval of a License
Agreement with Tetra Tech, Inc., who has been retained on behalf of the Ludwig Estate,
to install a monitoring well, soil gas point and soil boring within City right-of-way at the
property at 1545 South Grandview Avenue.
I concur with the recommendation and respectfully request Mayor and City Council
approval.
f1~1~/1IvtL
Michael C. Van Milligen
MCVM/jh
Attachment
cc: Barry Lindahl, City Attorney
Cindy Steinhauser, Assistant City Manager
Gus Psihoyos, City Engineer
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MEMORANDUM
November 13, 2006
Michael C. Van Milligen, City Manager
Gus Psihoyos, City Engineer ./9/Q
SUBJECT: Tetra Tech, Inc. - Monitoring Well Installation
TO:
FROM:
INTRODUCTION
This is in response to a request from Tetra Tech, Inc. (formerly Maxim Technologies) on
behalf of the Ludwig Estate to install a monitoring well, soil gas point and soil boring
within City right-of-way at the property of 1545 South Grandview Avenue.
BACKGROUND
Tetra Tech, Inc. has been retained by the Ludwig Estate, in cooperation with the Iowa
Department of Natural Resources (Iowa DNR) and the Iowa Underground Storage Tank
(UST) Fund, for closure of this Licensed Underground Storage Tank (LUST) facility.
Placement of well, soil gas point and soil boring is required by Iowa DNR.
DISCUSSION
In July, 2004, sample excavations identified the areas for the well, soil gas point and soil
boring installations. The monitoring well and soil gas point location is the City right-of-
way adjacent to 1545 South Grandview Avenue (the southwest corner of South
Grandview Avenue and Rockdale Road). One soil boring will be performed in the Iowa
DOT right-of-way at the northeast corner of South Grandview and the off-ramp of
Highway 61/151/51. The Iowa Department of Transportation (Iowa DOT) has given
verbal approval to Tetra Tech, Inc. for performing work on the Iowa DOT right-of-way,
with the condition of obtaining City approval due to the location of the proposed work.
No written agreement will be processed from the State; however, the Iowa DOT has
given its approval. Attached is a map indicating the identified locations.
The monitoring well will consist of a 2-inch diameter, Schedule 40 PVC pipe finished at
ground level, with a steel-flush mount box to a proposed depth of less than 20 feet. The
soil gas point will be 5 feet from this well, 1-inch diameter, Schedule 40 PVC pipe with
flush mount to a proposed depth of less than 10 feet. The encroachments will remain
until the site gains closure from the Iowa DNR.
The City Council's approval would be in the form of a License Agreement between Tetra
Tech, Inc. and the City that outlines the responsibility of Tetra Tech, Inc., provides
indemnity to the City, and requires proof of liability insurance for placement of the
monitoring system on City property.
The attached license agreement provides that the City shall have no liability for any
environmental contamination occurring on the project's property, on City property, or on
adjacent private property as a result of contamination from the property owner's site.
RECOMMENDATION
All the appropriate documents, including the license agreement, a map of the well, soil
gas point and soil boring locations, and proof of liability insurance have been submitted
by Tetra Tech, Inc. and have been approved by the appropriate City staff. I would,
therefore, recommend that the request to install the monitoring system on the City
property at 1545 South Grandview Avenue be approved.
I would further recommend that the City Council adopt the attached resolution
authorizing the Mayor to execute the attached License Agreement for Site Assessment.
If, and when, ownership transfers to the owner, there is a separate site assessment
agreement that would be completed and approved by the City Manager.
BUDGET IMPACT
This request will have no budget impact.
ACTION TO BE TAKEN
The City Council is requested to adopt the attached resolution authorizing the Mayor to
execute the License Agreement with Tetra Tech, Inc.
Prepared by Jane Smith, Engineering Assistant
cc: Jon Dienst, Civil Engineer
RESOLUTION NO.
RESOLUTION AUTHORIZING LICENSE AGREEMENT BETWEEN THE CITY OF
DUBUQUE AND TETRA TECH, INC. TO INSTALL MONITORING WELL, SOIL GAS
POINT AND SOIL BORING ON PUBLIC RIGHT-OF-WAY IN THE AREA OF 1545
SOUTH GRANDVIEW AVENUE
Whereas, Tetra Tech, Inc., on behalf of the Ludwig Estates, has requested
permission from the City of Dubuque to install monitoring well, soil gas point and soil
boring on City right-of-way at 1545 South Grandview Avenue in Dubuque, Iowa, for
the purpose of continuing the process of closing out the Licensed Underground
Storage Tank (LUST) site, all in cooperation with the Iowa Department of Natural
Resources (Iowa DNR) and the Iowa Underground Storage Tank (UST) Fund; and,
Whereas, the License Agreement for Site Assessment has been prepared
outlining the responsibilities of Tetra Tech, Inc. in the installation of the monitoring
well, soil gas point and soil boring on public right-of-way; and,
Whereas, the performance of the activities of Tetra Tech, Inc. will be at no cost
or expense to the City, and all work will be performed by the licensee, or its
employees, agents or subcontractors; and,
Whereas, it is the desire of the City Council to enter into said License
Agreement for the installation of monitoring well, soil gas point and soil boring in the
public right-of-way as requested.
NOW, THEREFORE, BE IT RESOLVED BY THE CITY COUNCIL OF THE
CITY OF DUBUQUE, IOWA:
Section 1. The License Agreement for Site Assessment be and the same is
hereby approved.
Section 2. That the Mayor be and is hereby authorized to execute said
License Agreement for and on behalf of the City Council.
Passed, approved and adopted this
day of
2006.
Roy D. Buol, Mayor
Attest:
Jeanne F. Schneider, CMC, City Clerk
[ 11: ] TETRA TECH,INC.
September 28, 2006
City of Dubuque
50 W.13th Street
Dubuque, IA 5200 I
RE: Access Request
Ludwig Porperty
1545 South Grandview Ave
Dubuque, IA, 5200 I
Project # II 56370 116
Dear City Council Members:
Tetra Tech, Inc. (formerly Maxim Technologies) on behalf of the Ludwig Estate, respectively requests
approval from the City to allow Maxim access to City ROW. The Ludwig Estate and Tetra Tech are
working in cooperation with the Iowa DNR and Iowa UST Fund to move this LUST facility to closure. In
order to reach closure additional monitoring wells are to be installed as required by the Iowa DNR. The
purpose of this letter is to outline our request and detail the scope of work to be performed.
Installation of monitoring well, and soil gas point -One monitoring well and one soil gas point will
be installed in the city ROW near a sidewall sample from the excavation activities in July 2004 in the
northeast corner of the property. A soil gas point will also be installed within five feet of the monitoring
well.
One soil boring in the Iowa DOT right of way - One soil boring will be completed adjacent to the
northeast corner of the intersection of Rockdale Road and South Grandview Avenue.
Care will be given when working around utilities and structures. Upon completion of the drilling, work
will be completed to restore the area (street, utilities, and green space) to the condition prior to starting
Tetra Tech will notify the Iowa One-Call utility locating service 48-hours prior to any field activities. The
Ludwig Estate is insured through the Iowa UST Financial Responsibility Program (the Fund), and is subject
to all Fund guidelines, on this project. Currently the site will receive 100% reimbursement up the $1
million dollar cap.
Tetra Tech and the Ludwig Estate greatly appreciate the City's help in the past to complete the site
assessment activities and look forward to working with the City on future remedial action. Tetra Tech
would like a letter outlining the City's response to this request. Thank you for your time and prompt
attention concerning this matter.
2213 La Porte Road, Waterloo, IA 50702
1", 319.232.6591 F.>x 319.232.0373
WWV\I.tetratech.com
Tetra Tech, Inc.
Project #1 1563701 16
If you have any further questions regarding this request, please contact me at (319) 232-6591.
Sincerely.
TETRA TECH. INC.
Gaylen D. Hiesterman
Project Manager
CGP #1619
GDH/mho
cc: Scott Nelson. attorney for the Ludwig Estate
Page 2
LICENSE AGREEMENT FOR SITE ASSESSMENT
THIS AGREEMENT is entered by and between
the City of Dubuque, Iowa (City), this day of
20
(Licensee) and
WHEREAS, Licensee has entered into a contract with the Ludwig Estate, 1545 S.
Grandview, (the Site) to investigate petroleum contamination at the site; and
WHEREAS, pursuant to said contract, Licensee will assess and investigate said
Site to determine the presence of petroleum contamination by taking soil samples and
installing groundwater monitoring wells (the Activities), all in contemplation of the
preparation and submission of a Site Monitoring Report (SMR) to the Iowa Department
of Natural Resources by the Licensee; and
WHEREAS, the investigation of said Site, will involve the investigation of
adjacent City-owned property, or City-owned street or alley right-of-way, (City Property
or the City Properties); and
WHEREAS, the Licensee's performance of the Activities herein provided will be
at no cost or expense to City and it is recognized that all work will be performed by
Licensee or its employees, agents, or subcontractors; and
WHEREAS, it is the desire and intention of Licensee and City to make this
mutual agreement with respect to access to City Properties and with respect to the
Activities to be conducted upon the said City Properties.
NOW, THEREFORE, for and in consideration of the mutual covenants and
undertakings hereinafter made by City and Licensee, the said parties do hereby agree as
follows:
I. City hereby grants to Licensee, its contractors, subcontractors, and their
employees and agents, a temporary license to enter upon City Properties
adjacent to Project Properties for the performance of the assessment and
investigation activities described hereinbelow (the Activities), and the
right to enter shall continue in effect until Site gains IDNR Closure. If at
that time Licensee has not completed all Activities required of it under its
contract with the Board, City may, through its City Council, extend this
License Agreement for such additional period or periods of time to
reasonably complete the Activities. The expiration of this License
notwithstanding, Licensee shall retain its obligations with respect to the
maintenance and removal of monitoring wells until such time as those
obligations are satisfied, all as provided in Paragraph 5 hereof.
2. City represents and warrants that it owns and is lawfully possessed of all
streets and alley rights-of-way adjacent to the Property Properties and that
it has full authority to grant and enter into this License Agreement,
provided, however, that Licensee shall be obligated to obtain permission
from the Iowa Department of Transportation before conducting any of the
Activities hereafter enumerated upon State highway right-of-way within
the City of Dubuque.
3. The assessment and investigation actIVIties (the Activities) to be
undertaken by Licensee may include the following:
Licensee agrees that its entry upon the City Properties shall be
limited to the performance of said Activities. Licensee further
agrees to undertake and complete the said Activities upon the City
Properties in a prudent and responsible manner, and in accordance
with all applicable laws and regulations of City, the state of Iowa,
and the United States, and in accordance with all applicable orders,
directives and regulations of IDNR or other governmental agencies
having jurisdiction of the Activities.
4. Licensee agrees to notify City, at the time it picks up Excavation Permits
for particular Project Properties, of its intent to commence the Activities
upon specific City Properties. Licensee agrees not to conduct soil borings
or to install groundwater monitoring wells upon the paved portion of any
street or in any street or highway median, without special written
authorization from City's Public Works Director.
As to privately owned "underground facilities" located upon City
Property, Licensee agrees to follow the procedures provided in Chapter
480 of the Iowa Code regarding obtaining locator service prior to the
commencement of excavation or drilling activities, and that its
responsibility and liability for damage to such facilities shall be
determined in accordance with the provisions of that Chapter.
As to City owned or operated "underground facilities", (including but not
limited to sewer, water, electric, electronic communications, and traffic
control), City agrees that appropriate City departments or agencies will
provide locator services for its underground facilities as required by
Chapter 480 of the Iowa Code. Licensee, its agents, employees,
contractors or subcontractors, agrees that its responsibility and liability for
damage to underground facilities owned or operated by City, shall be
determined in accordance with the provisions of Chapter 480 of the Iowa
Code.
5. Within a reasonable time after completion of each step of any of the
Activities on City Properties, Licensee shall cause any tools, equipment,
materials except for any groundwater monitoring wells placed hereon to
be removed, and shall restore said Properties to the condition they were in
prior to commencement of said Activities.
The obligation to remove and properly abandon each particular
groundwater monitoring well upon City Properties shall remain the
responsibility of Licensee W1til each such monitoring well is properly
removed and abandoned as required by applicable state or federal law or
regulation, as evidenced by a well closure report issued by a certified well
driller. Alternatively, the obligation of Licensee with regard to particular
monitoring wells shall be deemed discharged upon City's Public Works
Director's receipt, acceptance, and execution of an agreement, in form
acceptable to City's Legal Department, executed by the owner of the
adjacent Project Property, pursuant to which the said property owner
agrees to accept responsibility for the operation and maintenance of said
monitoring well and for its removal and abandonment as above provided.
Licensee agrees that City may retain its License Agreement for Site
Assessment, hold harmless, and maintain on file certificates of liability
insurance until its obligation to remove monitoring wells is deemed
discharged as herein provided.
Licensee agrees that W1less deemed discharged it will promptly remove
and properly abandon any monitoring well located upon City Property
when it is notified by City that the City Property upon which the well is
located is required for mW1icipal purposes, including but not limited to
street, sewer, traffic control, or water utility construction or repair. City
agrees to review the proposed location of monitoring wells, if provided in
advance of their installation, and to advise Licensee if a proposed
monitoring well location will conflict with planned construction activities.
City's failure to advise of such conflicts shall not excuse Licensee of its
obligation to remove monitoring wells to accommodate such construction
activities by City.
The parties further agree that unless Licensee is deemed discharged, then
in the event Licensee fails to properly maintain any monitoring well or the
area immediately adjacent thereto, or fails to remove a monitoring well
after being advised that the City Property upon which it is located is
required for municipal purposes, City may either (a) deny Licensee access
thereto, or (b) declare the said monitoring well a nuisance, cause same to
be removed, and assess the costs of abatement against the Licensee, or
against the Project Property or Properties for whose benefit the well was
installed, all as provided in Iowa Code Section 364.12.
6. This Agreement is intended and shall be construed only as a temporary
license to enter and conduct the Activities upon City Properties and not as
a grant of easement or any other interest therein.
7. This Agreement shall be binding upon the parties hereto and upon their
respective successors, representatives, heirs, and assigns. This agreement
shall also be binding upon all current and future invitees on City
Properties, if any.
8. Licensee agrees to the extent Licensee is negligent to defend, indemnify,
and hold harmless City, its officers, agents, and employees from and
against all manner of actions, liabilities, claims, causes of action, suits,
debts, accounts, losses, damages, and attorneys' fees including but not
limited to property damage or bodily injury, including death at anytime
resulting therefrom, incurred by City, its officers, agents, or employees,
caused by Licensee or its officers, agents, employees, contractors, or
subcontractors, or by any third party, arising out of the performance of the
Activities upon City Property by Licensee, or arising out of the existence,
operation, maintenance, or removal of monitoring wells on City Property
by Licensee, or arising out of or occasioned by Licensee's failure to
perform any act as herein required.
9. Licensee shall purchase and maintain insurance as set forth in the attached
Insurance Schedule through the duration of this Agreement.
10. Upon request by the City, Licensee agrees to provide to the City, within
10 days of request, copies of:
(a) all reports, including raw sampling data, which it has therefore
made or shall thereafter make to the .BellM, IDNR, or any other
governmental agency; and
(b) all correspondence, including further orders or directives, which it
received from the Boai'd., IDNR, or any other governmental
agency; relating to assessment or remediation of any particular
Project Property or to adjacent City Properties.
11. Notices, reports, or correspondence required to be given or sent by this
Agreement shall be directed to the following:
If to the City:
Engineering Department
City of Dubuque
50 W. 13th Street
Dubuque, IA 52001-4864
(563) 589-4270
Fax: (563) 589-4205
If to the Licensee:
Such notices shall be delivered or sent by mail. Notices shall be deemed
given when placed in the mail, postage paid.
I. The undersigned warrant that they have full power and authority to
execute and deliver this Agreement. City further warrants that it has full
power and authority to bind the current and future invitees on City
Properties.
IN WI1NESS HEREOF,
executed two (2) original copies of this Agreement
immediately adjacent to their respective signatures.
, and City have
on the dates specified
--r; t.rd le..J'\ ::b.<..
LICENSEE /
1.
By:
CITY OF DUBUQUE, IOWA
LICENSOR
By:
Roy D. Buol, Mayor
Date:
J () /-<.3 k (,
, ,
Date:
ATTEST:
Jeanne Schneider, City Clerk
Rev. BL 5/06
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TEMPORARY BORING LOCATION
SOIL BORING LOCATION
- MONITORING WELL LOCATION
FORMER TANK LOCATION
FIELD SCREENING MAP
KARL LUDWIG
1545 SOUTH GRANDVIEW AVENUE
DUBUQUE, IOWA
PROJECT # 2004677
DRAVN BY. TJP
DATE' 9/11/00
FIGURE.
REVIEVED BY.
SCALE, 1"-30'
ACORO,.
CERTIFICATE OF LIABILITY INSURANCE Page 1 of 3
DATE
11/06/2006
THIS CERTI.FICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
PRODUCER.
877-945-7378
willis North America, Inc.
26 Contury Blvd.
P. O. Box 305191
Nashville, TN 372305191
INSURERS AFFORDING COVERAGE
NAIC#
INSURED
Tetra Tech, Iuc.
6178 B. Stratler St.
Salt Lake City, UT 84107
INSURER A: ACE Ame.~ican Ins.~r_~nCle Company_
INSURERB: American Internation~l Spec~alty Lines
INSURERC:
INSURERD:
INSURER E:
22667~012
In 26883~OOl
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 POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH
POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
l~r: ~~~ -~-- P8ktl:~,jfJJ6gl.,!~E Pgk~cJ{~~J,'h~!RN -
TYPE OF INSURANCE POLICY NUMBeR LIMITS
A X ~ENERAL LIABILITY HDOG2059214A 10/1/2006 10/1/2007 EACH OCCURRENCE . 1.non 000
eX pMMERCJAL GENERN. LIABILITY ~~~@;~~OE~E!cJ~~nc!l) . 1.000....Q.Q.L
~ CLAIMS MADE [iJ OCCUR MEQ EXP {~on!l ~!Irsonl . 10n.nnn
Contract:. Liab-,-"... ___ PERSONAL &ADV INJURY . 1 000 000
~ X.C.U Coveracre GENERAL AGGREGATE . 2 000 000
~N'l AGG~~E~L1MlT APr.;-'lS PER: .!:.~DUI:::TS. COMP/OP AGG . 2 000 ono
POLICY I X ~~8.;: X LaC
A ~TOMOBILE LIABILITY ISAH08222629 10/1/2006 10/1/2007 COMBINED SINGLE LIMIT 1,000,000
(Eaaccldent) $
-1t ANY AUTO
-1t ALLOWNEDAUTOS BODilY INJURY
(ptlfperson) ,
SCHEDULED AUTOS
:i: HIRED AUTOS BODILY INJURY
(Peraccldenl) .
X NON-OWNED AUTOS ..
~ PROPERTY DAMAGE .
(Peruccldent)
,"AGE "ABILITY AUTO ONLY. EA ACCIDENT $
_ __ ANY AUTO OTHER THAN EAACC $
AUTO ONLY: AGG $
A EXCESS LIABILITY XOOG23714966 '10/1/2006 10/1/2007 EACH OCCURRE~~_ '- __!;i-,--OOO.OOO
~.OCCUR D CLAIMS MADE AGGREGATE . 5 000 000
r:l ,DEDUCTIBLE .
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X RETENTION $ 50 00 I
A ,WORKERS COMPENSATION AND 'AOS WLRC44465279 10/1/2006 10/1/2007 x--.L~~nf1JH-s I IOJ~'1
I EMPLOYERS' UABU..ITY
A ANY PROPRIETOR/PARTNER/EXECUTIVE WI SCFC44465280 10/1/2006 10/1/2007 ~!:: EACH ACCIDENT . 1. 000.000
i OFFICER/MEMBER EXCLUDED? E.l.. DISEASE - E^ EMPLOYEE . 1 000.000
gpEb~e(~~~VI~bNS below E.L. DISEASE - POLICY LIMIT . 1 000 ono
B I OTHER 1'952583 10/1/2006 10/1/20u7 $5,000,000. Each Claim
! Prof. Pollution Legal Liab $5.000,000. Aggregate
I Contractors Pollu.Liab $ 250,000. Retention Claim
M Clai";'-n;:~~nl'r nli e
DESCRIPTION OF OPERA TIONSILOCA TlONSNEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS
All States Covered, except Only "Stop Gapff in OH, ND, WA, WV, WY, PR, USVI
CERTIFICATE HOLDER
CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
DATE THEREOF, THE ISSUING INSURER WILL ~KXiX:MAIL ~ DAYS WRITTEN
NOTICE TO THE CERTIFICATE HOLDER NAMED TQ THE LEF~Dluawor~ltL
IlDClHXlHXiKilWAlfiXiJ(1!iKXiX~J6Xi{WJOXlIlKiH~.>>-KXD&D::aox
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AUTH ESENTp'TIVE
City of Dubuque
Attn: City Hall
50 W 13th Street
Dubuque, IA 52001
ACORD 25 (2001/08)
Coll:1796947 Tpl:562809
WillIs
PRODUCER
CERTIFICATE OF LIABILITY INSURANCE Page 2 of 3
877-945-7378
DATE
11/06/2006
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Willis No~th America, Inc.
26 Century Blvd.
P. O. Box 305191
Nashville, TN 372305191
INSURERS AFFORDING COVERAGE
NAIC#
INSURED
Tetra Tech, Inc.
6178 S. Stratler St.
Salt Lake City, UT 84107
n667~O~
Linea In 26883~OOl
INsunE~A; ACE American Insurance Com any
tNSURER~: Alner!can_ InterI1~tional S ecialt
INSURERC;
.INSURER D:
INSURER E:
DESCRI~IION OF OPERA TIONSILOCA TlONSNEH1CLESIEXCLUSlONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS
Commercial Property Policy No. YU2L9L435456016
Issuing Carrier: Liberty Mutual Fire Insurance Company
Business Personal Property Including Valuable Papers, Special Form
$5,000,000. Limit
10/1/06 - 10/1/07
THE CITY OF DUBUQUE IS LISTED AS AN ADDITIONAL INSURED ON GENERAL LIABILITY POLICIES USING ISO
ENDORSEMENT FORM CG 20 26 07 04 'ADDITIONAL INSURED~DESIGNATED PERSON OR ORGANIZATION" OR ITS
EQUIVALENT. GENERAL LIABILITY POLITY IS PRIMARY AND NON-CONTRIBUTING. FORM CG 25 04 03 97
"DESIGNATED LOCATIONS" GENERAL LIABILITY AGGREGATE LIMIT SHALL BE INCLUDED. GOVERNMENTAL IMMUNITIES
ENDORSEMENT ID INCLUDED. ALL POLICIES SHALL BE ENDORSED TO PROVIDE 30 DAY ADVANCE NOTICE OF
CANCELLATION TO CITY OF DUBUQUE. LANGUAGE ON GOVERNMENTAL IMMUNITIES ENDORSEMENT NEEDS TO BE
INCLUDED ON THE CERTIFICATE OF INSURANCE, NOT JUST REFERENCED.
CITY OF DUBUQUE, IOWA
GOVERNMENTAL IMMUN~TIES ENDORSEMENT
1. Nonwaiver of Governmental Immunity. The insurance carrier expressly agrees and states that the
purchase of this policy and the including of the City of Dubuque, Iowa as an Additional Insured
does not waive any of the defenses of governmental immunity available to the City of Dubuque, Iowa
under Code of Iowa Section 670.4 as it is now exists and as it may be amended from time to time.
2. Claims Coverage. The insurance carrier further agrees that this policy of insurance shall Cover
only those claims not subject to the defense of governmental immunity under the Code of Iowa
Section 670.4 as it now exists and as it may be amended from time to time. Those claims not subject
to Code of Iowa Section 670.4 shall be covered by the terms and conditions of this insurance policy
3. Assertion of Government Immunity. The City of Dubuque, Iowa shall be responsible for asserting
any defense of governmental immunity, and may do so at any time and shall do so upon the timely
written request of the insurance carrier.
4. Non~Denial of Coverage. The insurance carrier shall not deny coverage under this policy and the
insurance carrier shall not deny any of the rights and benefits accruing to the City of Dubuque,
Iowa under this policy for reasons of governmental immunity unless and until a court of competent
jurisdiction has ruled in favor of the defense(s) of governmental immunity asserted by the City of
Dubuque, Iowa.
No Other Change in Policy. The above preservation of governmental immunities shall not otherwise
change or alter the coverage available under the policy.
Coll:1796947 Tpl:562809 Cert:8056134
Page 3 of 3
IMPORTANT
If the certificate holder Is an ADDITIONAL INSURED, the pOlicy(ies) must be endorsed. A statement
on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s).
If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may
require an endorsement. A statement on this certificate does not confer rights to the certificate
holder in lieu of such endorsement{s).
DISCLAIMER
The Certificate of Insurance on the reverse side of this form does not constitute a contract between
the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it
affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon.
ACORD 25 (2001/08)
Coll:1796947 Tpl:562809 Cert:8056134
COMMERCIAL GENERAL LIABILITY
CG 20 26 0704
INSURED: Tetra Tech, IlIc.
POLICY NUMBER: HDOG20592I4A
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
ADDITIONAL INSURED ~ DESIGNATED
PERSON OR ORGANIZATION
This endorsement modifles insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
SCHEDULE
Name of Additional Insured Pcrson(s) or Organization (s)
CITY OF DUBUQUE
Jnformation re uired to com Jete this Schedule, if not shown above, will be shown in the Declarations.
Section II - Who is An Insured is amended to in-
clued as an additional insured the person(s) or organi-
zation(s) shown in the Schedule, but only with respect
to liability for "bodily iI~iury", "property damage" or
"personal and advertising injury" caused, in whole or
in part, by your acts or omissions or the acts or omis-
sions of those acting on your behalf:
A. In the performance ofyotll' ongoing operations; or
B. In connection with your premises owned by or
rented to you.
CG 20 26 07 04
ISO Properties, Inc., 2004
Page 1 of 1
POLICY NUMBER:
HDOG2059214A
COMMERCIAL GENERAL
LIABILITY
CG 25 0403 97
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY
DESIGNATED LOCATION(S)
GENERAL AGGREGATE LIMIT
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
SCHEDULE
Designated Location:
CITY OF DUBUQUE
(If no entry appears above, information required to complete this endorsement will be shown in the
Declarations as applicable to this endorsement.)
A. For all sums which the insured becomes legally obligated to pay as damages caused by "occurrences"
under COVERAGE A (SECTION I ), and for all medical expenses caused by accidents under COVERAGE
C (SECTION I ), which can be attributed only to operations at a single designated "location" shown in the
Schedule above:
1. A separate Designated Location General Aggregate Limit applies to each designated "location", and
that limit is equal to the amount of the General Aggregate Limit shown in the Declarations.
2. The Designated Location General Aggregate Limit is the most we will pay for the sum of all damages
under COVERAGE A, except damages because of "bodily injury" or "property damage" included in the
"productsRcompleted operations hazard", and for medica) expenses under COVERAGE C regardless of
the number of:
a. Insureds;
b. Claims made or "suits" brought; or
c. Persons or organizations making claims or bringing "suits".
3. Any payments made under COVERAGE A for damages or under COVERAGE C for medical
expenses shall reduce the Designated Location General Aggregate Limit for that designated "Iocation~.
Such payments shall not reduce the General Aggregate Limit shown in the Declarations nor shall they
reduce any other Designated Location General Aggregate Limit for any other designated "location"
shown in the Schedule above.
4. The limits shown in the Declarations for Each Occurrence, Fire Damage and Medical Expense
continue to apply. However, instead of being subject to the General Aggregate Limit shown in the
Declarations, such limits will be subject to the applicable Designated Location General Aggregate Limit.
B. For all sums which the insured becomes legally obligated to pay as damages caused by "occurrences"
under COVERAGE A (SECTION I ), and for all medical expenses caused by accidents under COVERAGE
C (SECTION [ ), which cannot be attributed only to operations at a single designated "location" shown in the
Schedule above:
1. Any payments made under COVERAGE A far damages or under COVERAGE C for medical
expenses shall reduce the amount available under the Genera! Aggregate Limit or the Products-
Completed Operations Aggregate Limit, whichever is applicable; and
2. Such payments shall not reduce any Designated Location General Aggregate Limit.
C. When coverage for liability arising out of the "products-completed operations hazard" is provided, any
payments for damages because of "bodily injury" or "property damage" included in the "products-completed
operations hazard" will reduce the Products-Completed Operations Aggregate Limit, and not reduce the
General Aggregate Limit nor the Designated Location General Aggregate Limit.
D. For the purposes of this endorsement, the Definitions Section is amended by the addition of the following
definition:
"Location" means premises involving the same or connecting lots, or premises whose connection is
interrupted only by a street, roadway, waterway or right-af-way of a railroad.
E. The provisions of Limits Of Insurance (SECTION III ) not otherwise modified by this endorsement shall
continue to apply as stipulated,
CG 25 04 03 97
@ Insurance Services Office, Inc., 1996
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY,
ADDITIONAL INSURED - OWNERS, LESSEES OR
CONTRACTORS - SCHEDULED PERSON OR
ORGANIZATION
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
SCHEDULE
Name Of Additional Insured Person(s)
Or Organization{s):
Location(s) Of Covered Operations
CITY OF DUBUQUE
Information required to complete this Schedule, if not shown above, will be shown in the Declarations.
A Section II - Who Is An [nsured is amended to include as an additional insured the person(s) or
organization(s) shown 'in the Schedule, but only with respect to litlbility for "bodily injury", "property
damage" or l'pcrsonul and advertising iqjury" caused, in whole or in part, by:
1. Yom acts or omissions; or
2. The acts or omissions ofthase acting on your behalf;
in the performance of your ongoing operations for the additional insured(s) at the location(s) designated
above.
B. With respect to the insurance afforded to these additional insureds, the following additional exclusions
apply:
This insurance does not apply to "bodily injury" or "property damage" occurring after:
1. All work, including materials, parts or equipment furnished in connection with such work, on the project
(other than servicc, maintenance 01' repairs) to be performed byor on behalf of the additional insured(s) at
the location of the covered operations has been completed; or
2. That portion of "your work" out of which the injury or damage arises has been put to its intended use by
any person or organization other than another contractor or subcontractor engaged in performing operations
for a principal as a pm1 of the same project.
CO 201007 04
@ ISO Properties, Inc., 2004
POLICY NUMBER: HDOG2059214A
COMMERCIAL GENERAL LIABILITY
CG20 37 07 04
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
ADDITIONAL INSURED - OWNERS, LESSEES OR
CONTRACTORS - COMPLETED OPERATIONS
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
SCHEDULE
Name of Additional Insured Person(s)
Or Organization(s)
CITY OF DUBUQUE
Location And Description of Completed Operations
Information required to complete this Schedule, if not shown above, will be shown in the Deciarations.
Section II - Who Is An Insured is amended to
include as an additional insured the person(s) or
organlzation(s) shown in the Schedule, but only with
respect to liability for "bodily injury" or "property
damage" caused, in whole or in part, by "your work"
at the location designated and described in the
schedule of this endorsement performed for tllat
additional insured and included in the "products-
completed operations hazard".
CG 20 37 07 04
@ iSO Properties, Inc., 2004
Page 1 of 1
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