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Signed Contract_Top Grade Construction_Arrowhead Storm Sewer Improvements Copyright 2014 City of Dubuque Consent Items # 11. ITEM TITLE: Signed Contract(s) SUMMARY: Epic Construction for selective demolition of the Dubuque Furniture and Flooring property; Top Grade Excavating for the Arrowhead Storm Sewer Project. SUGGESTED DISPOSITION: Suggested Disposition: Receive and File ATTACHMENTS: Description Type ❑ Epic Construction Contract Supporting Documentation ❑ Top Grade Excavating Contract Supporting Documentation THE CITY OF I _ � Dubuque DUBUQ E Masterpiece on the Mississippi 2,,7,2012, 01; TO: Michael C. Van Milligen, City Manager FROM: Gus Psihoyos, City Engineer4 SUBJECT: Arrowhead/Wallis Storm Sewer Improvements (CIP#720-1208) DATE: 14 October 2014 INTRODUCTION The purpose of this memo is to seek authorization to award a contract for the Arrowhead Drive Storm Sewer Project (CIP#720-1208). BACKGROUND The City was contacted in 1999 by Ms. Gaa Holdiman of 1095 Arrowhead Drive reporting significant flooding and drainage problems around her home. Since that time the City has made some improvements with the installation of additional inlets to capture the storm water. In more recent years, Ms. Holdiman's concern has grown and she has witnessed, with photographic documentation, that the storm water is `getting worse' as it channels along her basement wall. She has experienced flooding in her home. With the adoption of the Fiscal Year 2014 CIP Budget, funding was established for the Arrowhead Drive Storm Sewer Project (CIP#720-1208). DISCUSSION Originally, the thought was to address the flooding issue by constructing the improvements in two phases. Phase 1 involves the replacement of 15-inch diameter pipe with a 36-inch diameter pipe and adds additional inlets to drain the low spot on Arrowhead Drive directly adjacent to Ms. Holidiman's home. Phase 2 involves the extension of the storm sewer up Arrowhead Drive to Wallis Place with additional inlets. The FY14 funding appropriation provided funds for just the first phase. Even though the budget only provided funding for the first phase of the improvements, the engineering design was produced for both phases. And when the City sought bids for the first phase, it asked for a price for the second phase as well as a potential alternate. The City publically sought bids pursuant to Iowa Code receiving and opening three on October 2, 2014. The bids were as follows: Base Bid Alternate Bid Total Bid Contractor Phase 1 Phase 2 (Phase 1 & Phase.Q Top Grade Excavating $110,420.28 $23,333.92 $133,754.20 McDermott Excavating $121,719.74 $22,518.94 $144,238.68 Dave Fondell $131,979.96 $26,259.39 $158,239.35 The bids for the first phase are all above the engineer's estimate of$85,968.48. Having spoken with contractors, it appears that while the bids might be higher due to the push to get the work done this fall it is also true that the bids reflect the challenges associated with the depth of excavation, as well as, increased labor and material costs. Therefore, I believe it is appropriate to award the bid for Phase 1. The bids for the second phase were very competitive. And based on the relative flood protection the improvements will provide, it makes sense to spend the additional $23,333.92 to construct the second phase now. Therefore, I believe it is appropriate to award the bid for Phase 2 at this time. While the low bid did exceed the engineer's estimate, the City Manager can award the contract pursuant to Iowa Code regarding the bidding requirements associated with public improvement projects. This was verified through the Legal Department via correspondence with the independent legal offices of Whitfield & Eddy, P.L.C. of Des Moines, Iowa. Awarding the contract to the low bidder will allow for the work to commence within the next 14 working days and be functional by the end of November 2014. Final landscaping would be complete in the spring of 2015. If the bids were rejected, the improvements would not be in place for the spring rains of 2015. RECOMMENDATION I recommend awarding a contract for the Arrowhead Storm Sewer Project to Top Grade Excavating in the amount of $133,754.20. BUDGET IMPACT The estimate of probable costs for the Arrowhead Storm Sewer Project is as follows: Estimate Award Construction $ 105,084.36 $ 133,754.20 Contingency 10,508.44 10,508.44 Engineering 11,559.28 11,559.28 Total Project Cost $ 127,152.08 $ 155,821.92 The project will be funded through the Fiscal Year 2014 appropriation in the amount of $85,000.00 for the Arrowhead Storm Sewer Project and savings from the Kane/ Kaufmann Storm Sewer project (CIP 7202133). 2 I ACTION TO BE TAKEN respectfully request that the City Manager authorize the award of the contract for the Arrowhead Storm Sewer Project to Top Grade Excavating in the amount of $133,754.20. Cc: Denise 3 CITY OF DUBUQUE, IOWA PUBLIC IMPROVEMENT CONTRACT ARROWHEAD DRIVE STORM SEWER PROJECT THIS IMPROVEMENT CONTRACT (Contract), made in triplicate, dated for references purposes the 30th day of October , 2014 between the City of Dubuque, Iowa, by its City Manager, through authority conferred upon the City Manager by its City Council (City), and Top Grade Excavating. For and in consideration of the mutual covenants herein contained, the parties hereto agree as follows: CONTRACTOR AGREES: To furnish all material and equipment and to perform all labor necessary for the Arrowhead Drive Storm Sewer Project (Project). Contract Documents means and includes the following: This Public Improvement Contract, the Performance, Payment, and Maintenance Bond, and all ordinances and resolutions heretofore adopted by the City Council having to do with the Project; the Notice to Bidders; the Contractor's Bid Proposal; and the Plans, Specifications, and General Requirements in the Contract Documents for the Project. 3. All materials used by the Contractor in the Project must be of the quality required by the Contract Documents and must be installed in accordance with the Contract Documents. The Contractor must 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 must be replaced or redone to the satisfaction of the City Manager at the sole cost and expense of the Contractor. 5. Five percent (5%) of the Contract price will 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 by any party that may be filed 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 thirty (30) day period, as provided in Iowa Code Chapter 573 or Iowa Code Chapter 26. The City will 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 will be held by the City until such claims have been settled, adjudicated or otherwise disposed of. The Contractor has read and understands the Contract Documents herein referred to and agrees not to plead misunderstanding or deception related to estimates of quantity, character, location or other conditions for the Project. 7. In addition to any warranty provided for in the specifications, the Contractor must also fix any other defect in any part of the Project, even if the Project has been accepted and fully paid for by the City. The Contractor's maintenance bond will be security for a period of two (2) years after the issuance of the Certificate of Substantial Completion. 8. The Contractor must fully complete the Project under this Contract on or before the date indicated in the Construction Schedule and Agreed Damages Section of the Contract Documents. 9. INDEMNIFICATION FROM THIRD PARTYCLAIMS. To the fullest extent permitted by law, City shall defend, indemnify and hold harmless Contractor, its officers and employees, from and against all claims, damages, losses and expenses claimed by third parties, but not including any claims, damages, losses or expenses of the parties to this Agreement, including but not limited to attorneys' fees, arising out of or resulting from performance of this Agreement, provided that such claim, damages, loss or expense is attributable to bodily injury, sickness, disease or death, or injury to or destruction of property, including loss of use resulting there from, but only to the extent caused in whole or in part by negligent acts or omissions of City, or anyone directly or indirectly employed by City or anyone for whose acts City may be liable, regardless of whether or not such claim, damage, loss or expense is caused in part by a party indemnified hereunder. 10. 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 award 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 less than $2,000.00 (Two Thousand Dollars) to the City. 11. The surety on the bond furnished for this Contract must, 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. 12. The Contractor agrees, and its bond is surety therefore, that after the Certificate of Substantial Completion has been issued by the City, it will keep and maintain the Project in good repair for a period of two years. 13. The Project must be constructed in strict accordance with the requirements of the laws of the State of Iowa, and the United States, and ordinances of the City of Dubuque, and in accordance with the Contract Documents. 14. A. 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 must 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), CONSENT DECREE RELATING TO THE PROJECT THIS CONTRACTOR IS PERFORMING WORK FOR THE CITY OF DUBUQUE RELATED TO THE WATER & RESOURCE RECOVERY CENTER OR THE SANITARY SEWER COLLECTION SYSTEM. THEREFORE, THE CONSENT DECREE AND THIS SECTION ARE APPLICABLE. CITY CONTRACTOR THIS CONTRACTOR IS NOT PERFORMING WORK FOR THE CITY OF DUBUQUE RELATED TO THE WATER & RESOURCE RECOVERY CENTER OR THE SANITARY SEWER COLLECTION SYSTEM. THEREFORE THE CONSENT DECREE AND THIS SECTION ARE NOT APPLICABLE. The City has entered into a Consent Decree in the case of The United States of America, and the State of Iowa v. The City of Dubuque, Iowa, Civil Action Number Case 2:11-cv-01011-EMJ, Civil Action Number 2008V00041, DOJ Case Number 90-5-1-1-09339, United States District Court for the Northern District of Iowa. The provisions of the Consent Decree apply to and are binding upon the City and its officers, directors, employees, agents, servants, successors, assigns, and all persons, firms and corporations under contract with the City to perform the obligations of the Consent Decree. The City is required to provide a copy of the Consent Decree to any contractor or consultant retained to perform work required by the Consent Decree. A copy of the Consent Decree is included in the Contract Documents and can be viewed at http://www.cityofdubuque.orq/consentdecree. A hard copy is available upon request at the City's Engineering Department Office. The City must condition any contract to perform work required under the Consent Decree upon performance of the work in conformity with the provisions of the Consent Decree. The Consent Decree also provides that until five years after the termination of the Consent Decree, the City must retain, and must instruct its contractors and agents to preserve, all non -identical copies of all documents, reports, data, records, or other information (including documents, records, or other information in electronic form) in its or its contractors' or agents' possession or control, or that come into its or its contractors' or agents' possession or control, and that relate in any manner to the City's performance of its obligations under this Consent Decree, including any underlying research and analytical data. This information retention period, upon request by the United States or the State, the City must provide copies of any documents, reports, analytical data, or other information required to be maintained under the Consent Decree. At the conclusion of the information -retention period, the City must notify the United States and the State at least ninety (90) Days prior to the destruction of any documents, records, or other information subject to such requirements and, upon request by the United States or the State, the City must deliver any such documents, records, or other information to the EPA or IDNR. CERTIFICATION BY CONTRACTOR The undersigned, on behalf of the Contractor, with full authority to act on behalf of the Contractor, certifies to the City of Dubuque as follows: 1 I have received a copy of the Consent Decree in the case of The United States of America, and the State of Iowa v. The City of Dubuque, Iowa, Civil Action Number Case 2:11-cv-01011-EMJ, Civil Action Number 2008V00041, DOJ Case Number 90-5-1-1- 09339, United States District Court for the Northern District of Iowa. 2. All work performed will be in conformity with the provisions of the Consent Decree. 3. All documents reports, data, records, or other information (including documents, records, or other information in electronic form) that relate in any manner to the performance of obligations under the Consent Decree, including any underlying research and analytical data, will be retained as required by the Consent Decree. 4. The Contractor agrees to defend, indemnify, and hold harmless the City, its officers, agents, or employees from and against any claims, including penalties, costs and fees as provided in the Consent Decree, relating to or arising out of the Contractor's failure to comply with the Consent Decree. THE CITY AGREES: 15. Upon the completion of the Contract, and the acceptance of the Project by the City Council, and subject to the requirements of law, the City agrees to pay the Contractor as full compensation for the complete performance of this Contract, the amount determined for the total work completed at the price(s) stated in the Contractor's Bid Proposal and less any Agreed Damages provided for in the Contract Documents. CONTRACT AMOUNT $ 133,754.20 CITY OF DUBUQUE, IOWA: CONTRACTOR: By: By Signature Date: V3/,//Y Signature Date: 10 - 28-H`i Bond No. 2189497 CITY OF DUBUQUE, IOWA PERFORMANCE, PAYMENT AND MAINTENANCE BOND KNOWN ALL MEN BY THESE PRESENTS: That Top Grade Excavating, Inc. (Contractor) as Principal and North American Specialty Insurance Company as Surety are held firmly bound unto the City of Dubuque, Iowa (City), in the penal sum of one hundred thirty-three thousand, seven hundred fifty-four dollars and twenty cents ($133,754.20) the same being one hundred percent (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 (City), 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 3oth day of October 2014, and duty attested and sealed. WHEREAS, Contractor by a Contract dated October 2014 incorporated herein by reference, has agreed with City to perform all labor and furnish all materials required to be performed and furnished for Arrowhead Drive Storm Sewer Project (Project) according to the Contract and Construction Documents prepared therefore. It is expressly understood and agreed by Contractor and Surety bond that the following provisions are a part of this Bond and are binding upon 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 cefault 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 lowa, 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 arid 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 Contractors and Surety's failure to remedy any defect as required by this section. Contractors 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, lowa this 30th day of October 2014. CITY OF DUBUQUE, J0 A PRINCIPALICONTRACTOR By: Top Grade Excavating, Inc. actor Tit[ SURETY: North American S•ecialty Insurance Company Signature Attorney -in -Fact Title Holmes Murphy & Associates, Inc. P. 0. Box 9207, Des Moines, IA 50306-9207 City, State, Zip Code 515-223-6800 Telephone Dione R. Young Attorney in -Fact NAS SURETY GROUP NORTH AMERICAN SPECIALTY INSURANCE COMPANY WASHINGTON INTERNATIONAL INSURANCE COMPANY GENERAL POWER OF ATTORNEY KNOW ALL MEN BY THESE PRESENTS, THAT North American Specialty Insurance Company, a corporation duly organized and existing under laws of the State of New Hampshire, and having its principal office in the City of Manchester, New Hampshire, and Washington International Insurance Company, a corporation organized and existing under the laws of the State of New Hampshire and having its principal office in the City of Schaumburg, Illinois, each does hereby make, constitute and appoint: JAY D. FREIERMUTH, CRAIG E. HANSEN, BRIAN M. DEIMERLY, SHIRLEY S. BARTENHAGEN, CINDY BENNETT, ANNE CROWNER, TIM McCULLOH, STACY VENN, LACEY CRAMBLIT and DIONE R. YOUNG JOINTLY OR SEVERALLY Its true and lawful Attorney(s)-in-Fact, to make, execute, seal and deliver, for and on its behalf and as its act and deed, bonds or other writings obligatory in the nature of a bond on behalf of each of said Companies, as surety, on contracts of suretyship as are or may be required or permitted by law, regulation, contract or otherwise, provided that no bond or undertaking or contract or suretyship executed under this authority shall exceed the amount of: FIFTY MILLION ($50,000,000.00) DOLLARS This Power of Attorney is granted and is signed by facsimile under and by the authority of the following Resolutions adopted by the Boards of Directors of both North American Specialty Insurance Company and Washington International Insurance Company at meetings duly called and held on the 9th of May, 2012: "RESOLVED, that any two of the Presidents, any Managing Director, any Senior Vice President, any Vice President, any Assistant Vice President, the Secretary or any Assistant Secretary be, and each or any of them hereby is authorized to execute a Power of Attorney qualifying the attorney named in the given Power of Attorney to execute on behalf of the Company bonds, undertakings and all contracts of surety, and that each or any of them hereby is authorized to attest to the execution of any such Power of Attorney and to attach therein the seal of the Company; and it is FURTHER RESOLVED, that the signature of such officers and the seal of the Company may be affixed to any such Power of Attorney or to any certificate relating thereto by facsimile, and any such Power of Attorney or certificate bearing such facsimile signatures or facsimile seal shall be binding upon the Company when so affixed and in the future with regard to any bond, undertaking or contract of surety to which it is attached." By Steven P. Anderson, Senior Vice President of Washington International Insurance Company & Senior Vice President of North American Specialty Insurance Company By David M. Layman, Vice President of Washington International Insurance Company & Vice President of North American Specialty Insurance Company IN WITNESS WHEREOF, North American Specialty Insurance Company and Washington International Insurance Company have caused their official seals to be hereunto affixed, and these presents to be signed by their authorized officers this25th day of January 2013 . State of Illinois County of Cook On this 25th day of January , 2013 , before me, a Notary Public personally appeared Steven P. Anderson , Senior Vice President of Washington International Insurance Company and Senior Vice President of North American Specialty Insurance Company and David M. Layman , Vice President of Washington International Insurance Company and Vice President of North American Specialty Insurance Company, personally known to me, who being by me duly sworn, acknowledged that they signed the above Power of Attorney as officers of and acknowledged said instrument to be the voluntary act and deed of their respective companies. ss: North American Specialty Insurance Company Washington International Insurance Company "OFHC ALS AL`• DONNA D. SKI. Notary I'ublic,SState oF-lllinois MIy Commission Expires 10 1 f n {jy1"v71 .�.g e 10,6 Donna D. Sklens, Notary Public 1, Jeffrey Goldberg , the duly elected Assistant Secretary of North American Specialty Insurance Company and Washington International Insurance Company, do hereby certify that the above and foregoing is a true and correct copy of a Power of Attorney given by said North American Specialty Insurance Company and Washington International Insurance Company, which is still in full force and effect. IN WITNESS WHEREOF, I have set my hand and affixed the seals of the Companies this day of , 20 14 . Jeffrey Goldberg, Vice President & Assistant Secretary of Washington International Insurance Company & North American Specialty Insurance Company ACCa, RE) CERTIFICATE OF LIABILITY INSURANCE L...•/ DATE(MM/DD/YYYY) 10/24/2014 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 Urbain Insurance Group 9165 E Tamarack Dr Dubuque, IA 52003 NAME: CONTACT Urbain, Rick M wc° No Ext) 563-583-7722 FAX (A/C, 866-843-6317 E-MAIL accountmngr@uainsurance.com ADDRESS: g @uainsurance.com INSURER(S) AFFORDING COVERAGE NAIC # INSURERA: Allied 23787 INSURED 563-744-9077 563-876-9811 Top Grade Exc IncwsuRERC: PO Box 181 210 Biermann Rd Suite F-1 Epworth, IA 52045 INSURER B: Allied 19100 Allied 42587 INSURERD: $ 1,000,000 INSURERE: $ 100,000 INSURER F : COVERAGES CERTIFICATE NUMBER: 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 LTR 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 A ACP7101461106 12/23/2013 12/23/2014 EACH OCCURRENCE $ 1,000,000 AMAGE TO RENTED PREMSES(Ea occurrence) $ 100,000 CLAIMS -MADE X OCCUR MED EXP (Any one person) $ 5', 000 PERSONAL&ADVINJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE 7 POLICY X2 LIMIT APPLIES PER: LOC PRODUCTS - COMP/OP AGG $ 2,000,00o $ A AUTOMOBILE X XX LIABILITY ANY AUTO ALL OWNED AUTOS HIRED AUTOS Owned Private Pa... SCHEDULED AUTOS NON AUTOS -OWNED Owned Autos 0/5 P... ACP7101461106 - 12/23/2013 12/23/2014 COMBINED SINGLE LIMIT (Ea accident) 1000 0 0 0 $r r BODILYINJURY(Perperson) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ $ B UMBRELLA LIAB EXCESS LIAB X OCCUR CLAIMS -MADE ACP7101461106 12/23/2013 12/23/2014 EACH OCCURRENCE $ AGGREGATE $ 5,000,000 DED RETENTION $ $ C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY PROPRIETOR/PARTNER/EXECUTIVE (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below YYN N/A ACP7101461106 12/23/2013 12/23/2014 x WC STATU- OTH- E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYEE $ 1,000,000 E.L. DISEASE - POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) The City of Dubuque is an additional insured on General Liability Policies incl. Ongoing & Completed Operations coverage equivilant to ISO CG 2010 0704 & CG 2037 0704. General Liability policy is Primary Non-contributing form CG 2503 0397, "Designated Projects" General Liability Aggregate Limit shall be incl. Governmental Immunities Endorsement is Incl. Waiver of Subrogation in favor of City of Dubuque c Workers Compensation. All policies shall be endorsed to provide 30 days advance notice of cancellation. Project: "Arrowhead Drive Storm Sewer Project" CERTIFICATE HOLDER CANCELLATION City of Dubuque City Hall 50 W 13th Street Dubuque, IA 52001 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 RICK M URBAIN ACORD 25 (2010/05) © 1988-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD AMCO INSURANCE COMPANY 1100 LOCUST ST DEPT 1100 DES MOINES, IA 50391-2000 COMMERCIAL GENERAL LIABILITY DECLARATIONS Policy Number: ACP GLAO 7101461106 20397 RENEWAL Named Insured: TOP GRADE EXCAVATING INC Address: PO BOX 356 FARLEY IA 52046-0356 Agent: URBAIN & ASSOCIATES L L C 14-20397-007 Address: DUBUQUE IA 52003 PRODUCER: RICK M URBAIN Policy Period: From 12/23/13 to 12/23/14 12:01 A.M. standard time at the address of the named insured as stated herein. In return for the payment of the premium, and subject to all the terms of this policy, we agree with you to provide the insurance as stated in this policy. LIMITS OF INSURANCE GENERAL AGGREGATE LIMIT (other than products -completed operations) $ 2,000,000 PRODUCTS -COMPLETED OPERATIONS AGGREGATE LIMIT $ 2,000,000 PERSONAL AND ADVERTISING INJURY LIMIT $ 1,000,000 EACH OCCURRENCE LIMIT $ 1,000,000 DAMAGE TO PREMISES RENTED TO YOU LIMIT (any one premises) $ 100,000 MEDICAL EXPENSE LIMIT (any one person) $ 5,000 Retroactive Date (CG0002 only) The Named Insured is: CORPORATION Business of the Named Insured is: EXCAVATION CONTRACTOR Audit Period: ANNUAL ENDORSEMENTS ATTACHED TO THIS POLICY SEE COMMERCIAL GENERAL LIABILITY FORMS AND ENDORSEMENTS SCHEDULE Replacement or Renewal Number ACP GLA07191461106 A PACKAGE MODIFICATION FACTOR HAS BEEN APPLIED GL -D (10-96) DIRECT BILL LMKQ 13331 Countersigned By Authorized Representative AGENT COPY ACP GLAO 7101461106 916213579 74 0002278 CITY OF DUBUQUE, IOWA GOVERNMENTAL IMMUNITIES ENDORSEMENT WAIVER 1. NONWAIVER OF GOVERNMENT 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 THE GOVERNMENTAL IMMUNITY AVAILABLE TO THE CITY OF DUBUQUE, IOWA UNDER CODE OF IOWA SECTION 670.4 AS IT NOW EXISTS AND AS IT MAY BE AMMENDED FROM TIME TO TIME 2. CLAIMS COVERAGE THE INSURANCE CARRIER FURTHER AGREES THAT THIS POLICY OF ISURANCE SHALL COVER ONLY THOSE CLAIMES 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 THE 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 COVERAGE THE INSURANCE CARRIER SHALL NOT DENY COVERAGE UNDER THIS POLICY AND THE INSUREANCE 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 COUNT 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 28 (01-86) ACP GLA07191461106 L8BV 12331 28 (01-86) AGENT COPY 74 0002256 POLICY NUMBER: COMMERCIAL GENERAL LIABILITY CG 20 26 07 04 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - DESIGNATED 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) CITY OF DUBUQUE INCLUDING ALL ITS ELECTED AND APPOINTED OFFICIALS ALL ITS EMPLOYEES AND VOLUNTEERS ALL ITS BOARDS COMMISSIONS AND/OR AUTHORITIES AND THEIR BOARD MEMBERS, EMPLOYEES AND VOLUNTEERS CITY OF DUBUQUE, IA 50 W 13TH ST DUBUQUE, IA 52001 Information required to complete this Schedule, if not shown above, will be shown in the Declarations. Section II — Who Is An Insured is amended to in- clude as an additional insured the person(s) or or- ganization(s) shown in the Schedule, but only with respect to liability for "bodily injury', "property dam- age" or "personal and advertising injury" caused, in whole or in part, by your acts or omissions or the acts or omissions of those acting on your behalf: A. In the performance of your ongoing operations; or B. In connection with your premises owned by or rented to you. All terms and conditions of this policy apply unless modified by this endorsement. CG 20 26 07 04 Includes copyrighted material of Insurance Services Office, Inc. with permission. O ISO Properties, Inc., 2004 ACP GLA07191461106 LBBV 12331 AGENT COPY Page 1 of 1 74 0005275 POLICY NUMBER: COMMERCIAL GENERAL LIABILITY CG 20 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 SEE BLANK FORM 28 DUBUQUE, IA, 52001 Location And Description Of Completed Operations Arrowhead Drive Storm Sewer Project Information required to complete this Schedule, if not shown above, will be shown in the Declarations. Section II — Who Is An Insured is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for "bodily injury" or "property damage" caused, in whole or in part, by "your work" at the location designated and described in the schedule of this endorsement performed for that additional in- sured and included in the "products -completed opera- tions hazard". All terms and conditions of this policy apply unless modified by this endorsement. CG 20 37 07 04 ACP GLA07191461106 © ISO Properties, Inc., 2004 AGENT COPY Page 1 of 1 74 0005280 POLICY NUMBER: COMMERCIAL GENERAL LIABILITY CG 24 04 05 09 WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIO NS LIABILITY COVERAGE PART SCHEDULE Name Of Person Or Organization: CITY OF DUBUQUE 50 W 13TH ST DUBUQUE, IA 50021 Information required to complete this Schedule, if not shown above, will be shown in the Declarations. The following is added to Paragraph 8. Transfer Of Rights Of Recovery Against Others To Us of Section IV — Conditions: We waive any right of recovery we may have against the person or organization shown in the Schedule above because of payments we make for injury or damage arising out of your ongoing operations or "your work" done under a contract with that person or organization and included in the "products - completed operations hazard". This waiver applies only to the person or organization shown in the Schedule above. All terms and conditions of this policy apply unless modified by this endorsement. CG 24 04 05 09 © Insurance Services Office, Inc., 2008 Page 1 of 1 ACP GLA07191461106 AGENT COPY 74 0005283 POLICY NUMBER: COMMERCIAL GENERAL LIABILITY CG 25 03 05 09 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 Project(s): ALL PROJECTS Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. For all sums which the insured becomes legally obligated to pay as damages caused by "occur- rences" under Section I — Coverage A, and for all medical expenses caused by accidents under Section I — Coverage C, which can be attributed only to ongoing operations at a single designated construction project shown in the Schedule above: 1. A separate Designated Construction Project General Aggregate Limit applies to each des- ignated construction project, and that limit is equal to the amount of the General Aggregate Limit shown in the Declarations. 2, The Designated Construction Project General Aggregate Limit is the most we will pay for the sum of all damages under Coverage A, ex- cept damages because of "bodily injury" or "property damage" included in the "products - completed operations hazard", and for medi- cal 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 Con- struction Project General Aggregate Limit for that designated construction project. Such payments shall not reduce the General Ag- gregate Limit shown in the Declarations nor shall they reduce any other Designated Con- struction Project General Aggregate Limit for any other designated construction project shown in the Schedule above. 4. The limits shown in the Declarations for Each Occurrence, Damage To Premises Rented To You and Medical Expense continue to apply. However, instead of being subject to the General Aggregate Limit shown in the Decla- rations, such limits will be subject to the appli- cable Designated Construction Project Gen- eral Aggregate Limit. CG 25 03 05 09 © Insurance Services Office, Inc., 2008 ACP GLA07191461106 AGENT COPY Page 1 of 2 74 0005290 CG 25 03 05 09 B. For all sums which the insured becomes legally obligated to pay as damages caused by "occur- rences" under Section 1— Coverage A, and for all medical expenses caused by accidents under Section 1 — Coverage C, which cannot be attrib- uted only to ongoing operations at a single des- ignated construction project shown in the Sched- ule above: 1. Any payments made under Coverage A for damages or under Coverage C for medical expenses shall reduce the amount available under the General Aggregate Limit or the Products -completed Operations Aggregate Limit, whichever is applicable; and 2. Such payments shall not reduce any Desig- nated Construction Project General Aggre- gate Limit. 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. D. If the applicable designated construction project has been abandoned, delayed, or abandoned and then restarted, or if the authorized contract- ing parties deviate from plans, blueprints, de- signs, specifications or timetables, the project will still be deemed to be the same construction pro- ject. E. The provisions of Section 111 — Limits Of Insur- ance not otherwise modified by this endorsement shall continue to apply as stipulated. All terms and conditions of this policy apply unless modified by this endorsement. Page 2 of 2 ACP GLA07191461106 © Insurance Services Office, Inc., 2008 CG 25 03 05 09 AGENT COPY 74 0005291 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. EARLIER NOTICE OF CANCELLATION/NON-RENEWAL PROVIDED BY US FOR DESIGNATED PERSON OR ORGANIZATION THIS ENDORSEMENT MODIFIES INSURANCE PROVIDED UNDER THE FOLLOWING: COMMERCIAL AUTOMOBILE COVERAGE PART COMMERCIAL GARAGE COVERAGE PART COMMERCIAL BUSINESSOWNERS LIABILITY AND PROPERTY COVERAGE PARTS COMMERCIAL GENERAL LIABILITY COVERAGE PART LIQUOR LIABILITY COVERAGE PART COMMERCIAL PROPERTY COVERAGE PART COMMERCIAL INLAND MARINE COVERAGE PART CRIME AND FIDELITY COVERAGE PART WORKERS COMPENSATION AND EMPLOYERS LIABILITY COVERAGE PART COMMERCIAL UMBRELLA COVERAGE PART PERSON(S) OR ORGANIZATION(S) CITY OF DUBUQUE ADDRESS DUBUQUE, IA 52001-7035 A. IF WE CANCEL THIS POLICY FOR ANY STATUTORILY PERMITTED REASON OTHER THAN NONPAYMENT OF PREMIUM, THE NUMBER OF DAYS REQUIRED FOR NOTICE OF CANCELLATION, AS PROVIDED IN THE CONDITIONS SECTION OF THIS INSURANCE, OR AS AMENDED BY ANY APPLICABLE STATE CANCELLATION ENDORSEMENT APPLICABLE TO THIS INSURANCE, IS INCREASED TO 30 DAYS. B. IF WE DO NOT RENEW THIS POLICY FOR ANY STATUTORILY PERMITTED REASON OTHER THAN NONPAYMENT OF PREMIUM, THE NUMBER OF DAYS REQUIRED FOR NOTICE OF NONRENEWAL, AS PROVIDED IN THE CONDITIONS SECTION OF THIS INSURANCE, OR AS AMENDED BY ANY APPLICABLE STATE ENDORSEMENT APPLICABLE TO THIS INSURANCE, IS INCREASED TO 30 DAYS. C. WE WILL MAIL NOTICE OF CANCELLATION OR NONRENEWAL TO THE PERSON(S) OR ORGANIZATION(S) SHOWN IN THE SCHEDULE ABOVE 30 DAYS BEFORE THE EFFECTIVE DATE OF THE CANCELLATION OR NONRENEWAL. 28 (01-86) ACP GLA07191461106 L8BV 12331 28 (01-86) AGENT COPY 74 0002257 RE: CG7160 28 (01-86) PROJECT: Arrowhead Drive Storm Sewer Project 28 (01-86) ACP GLA07191461106 L8BV 12331 AGENT COPY 74 0002258 POLICY NUMBER: COMMERCIAL GENERAL LIABILITY CG 71 56 08 04 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED PRIMARY AND NON-CONTRIBUTORY ENDORSEMENT This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name of Person or Organization: CITY OF DUBUQUE, IA 50 W 13TH ST DUBUQUE, IA 52001 (If no entry appears above, information required Declarations as applicable to this endorsement.) A. Section II - Who Is An Insured is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for "bodily injury", "prop- erty damage" or "personal and advertising injury" caused, in whole or in part, by: 1. Your acts or omissions; or 2. The acts or omissions of those acting on your behalf; in the performance of your on- going operations for the additional in- sured(s) at the location(s) designated above. No such person or organization is an addi- tional insured for liability arising out of the "products -completed operations hazard". B. With respect to the insurance afforded to these additional insureds, the following additional ex- clusions apply: This insurance does not apply to "bodily injury" or "property damage" occurring after: 1. All work, including materials, parts or equip- ment furnished in connection with such work, on the project (other than service, maintenance or repairs) to be performed by or on behalf of the additional insured(s) at the location of the covered operations has been completed; or to complete this endorsement will be shown in the 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 subcontrac- tor engaged in performing operations for a principal as a part of the same project. C. The following is added to SECTION III - LIMITS OF INSURANCE: The limits of insurance applicable to the addi- tional insured are those specified in the written contract between you and the additional insured, or the limits available under this policy, which- ever are less. These limits are part of and not in addition to the limits of insurance under this pol- icy. CG 71 56 08 04 Includes copyrighted material of ISO Properties, Inc., with its permission. ACP GLA07191461106 L8BV 13018 AGENT COPY Page 1 of 2 74 0002696 CG 71 56 08 04 D. With respect to the insurance provided to the person or organization shown in the Schedule of the Endorsement, Condition 4. Other Insur- ance is replaced by the following: 4. 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 This insurance is primary except when it is excess as provided under part b., below. When this insurance is pri- mary, we will not seek contribution from other insurance available to the person or organization shown in the Schedule of this endorsement. b. Excess Insurance This insurance is excess over: (1) Any of the other insurance, whether primary, excess, contin- gent or on any other basis: (a) That is Fire, Extended Cover- age, Builder's Risk, Installa- tion Risk or similar coverage for "your work"; (b) That is Fire insurance for premises rented to you or temporarily occupied by you with permission of the owner; (c) That is insurance purchased by you to cover your liability as a tenant for "property damage" to premises rented to you or temporarily occu- pied by you with permission of the owner; or (d) If the loss arises out of the maintenance or use of air- craft, "autos" or watercraft to the extent not subject to Ex- clusion g. of Section I - Cov- erage A - Bodily Injury And Property Damage Liability Page 2 of 2 When this insurance is excess, we will have no duty under Coverages A or B to defend the additional insured against any "suit" if any other insurer has a duty to defend the additional insured against that "suit". If no other insurer defends, we will undertake to do so, but we will be entitled to the additional insured's rights against all those other insurers. When this insurance is excess over 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 insur- ance; 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 is not described in this Excess Insurance provision and 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 available to the additional insured permits con- tribution by equal shares, we will fol- low this method also. Under this ap- proach each insurer contributes equal amounts until it has paid its applicable limit of insurance or none of the loss remains, whichever comes first. If any of the other insurance available to the additional insured 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 in- surance to the total applicable limits of insurance of all insurers. All terms and conditions of this policy apply unless modified by this endorsement. Includes copyrighted material of ISO Properties, Inc., with its permission. CG 71 56 08 04 ACP GLA07191461106 L8BV 13018 AGENT COPY 74 0002697 POLICY NUMBER: COMMERCIAL GENERAL LIABILITY CG 20 10 07 04 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): CITY OF DUBUQUE 50 W 13TH ST DUBUQUE, IA 52001-4805 Location(s) Of Covered Operations ALL LOCATIONS AT WHICH ONGOING OPERATIONS ARE BEING PERFORMED FOR THE ADDITIONAL PERSON(S) OR ORGANIZATION(S Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. Section II — Who Is An Insured is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" caused, in whole or in part, by: 1. Your acts or omissions; or 2. The acts or omissions of those acting on your behalf; CG 20 10 07 04 ACP GLA07191461106 LBBV 12331 AGENT COPY in the performance of your ongoing operations for the additional insured(s) at the location(s) desig- nated above. B. With respect to the insurance afforded to these additional insureds, the following additional exclu- sions apply: This insurance does not apply to "bodily injury" or "property damage" occurring after: Page 1 of 2 74 0002227 1. All work, including materials, parts or equip- ment furnished in connection with such work, on the project (other than service, maintenance or repairs) to be performed by or on behalf of the additional insured(s) at the location of the covered operations has been completed; or Page 2 of 2 2. That portion of "your work" out of which the injury or damage arises has been put to its in- tended use by any person or organization other than another contractor or subcontractor engaged in performing operations for a princi- pal as a part of the same project. All terms and conditions of this policy apply unless modified by this endorsement. 0 ISO Properties, Inc., 2004 CG 20 10 07 04 ACP GLA07191461106 LBBV 12331 AGENT COPY 74 0002228 POLICY NUMBER: COMMERCIAL GENERAL LIABILITY CG 71 60 08 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): Location And Description Of Completed Operations CITY OF DUBUQUE Arrowhead Drive Storm Sewer Project Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. Section II — Who Is An Insured is amended to include as an additional insured the person(s) or organiza- tion(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 endorse- ment performed for that additional insured and included in the "products -completed operations hazard". B. With respect to the insurance provided to the person or organization shown in the Schedule of the Endorse- ment the following provisions apply: 1. We will have the right and duty to defend the additional insured against any "suit" seeking damages to which this endorsement applies. However, aur duty to defend the additional insured is limited to defending only those claims or "suits" specifically pertaining to "bodily injury" or "property damage" caused by "your work" at the location designated and described in the schedule of this endorsement performed for that ad- ditional insured and included in the "products -completed operations hazard". We will have no duty to de- fend any claims or "suit" pertaining to any other liability on the part of the additional insured. 2. This insurance does not apply to liability arising out of the sole negligence or willful misconduct of the addi tional insured. All terms and conditions of this policy apply unless modified by this endorsement. GG71 60 08 04 Includes copyrighted material of Insurance Services Office, Inc. with permission. Page 1 of 1 O ISO Properties, Inc., 2004 AGENT COPY 74 0002249 ACP GLA07191461106 L8BV 12331 STANDARD WORKERS COMPENSATION AND EMPLOYERS LIABILITY POLICY DEPOSITORS INSURANCE COMPANY (24589) Issued by: 1100 LOCUST ST DEPT 1100 DES MOINES, IA 50391-2000 INFORMATION PAGE Policy No: ACP WCD 71 0 1461106 as Renewed On 12/23/13 Printed On 11/27/13 1. Name of Insured: TOP GRADE EXCAVATING INC Mailing Address: PO BOX 356 Intra -State ID: 140084050 FARLEY IA 520460356 Agent: URBAIN & ASSOCIATES L L C 74 14 20397 007 DUBUQUE IA 520039453 Producer: RICK M URBAIN Federal ID 1.) 200514092 2.) 3.) 4.) Other Workplaces: See Schedule of Locations The insured is a(n) Individual: Partnership: Corporation: X Limited Liab Co: Other: 2. The policy period is from 12:01 AM standard time on 12/23/13 to 12/23/14 at the insureds mailing address. 3. Coverage. A. Workers Compensation Insurance: Part One applies to the Workers Compensation Law of the states listed here: IOWA B. Employers Liability Insurance: Part Two applies to work in each state listed in 3A. The limits of our liability under Part Two are: Bodily Injury by Accident 1,000,000 each accident Bodily Injury by Disease 1,000,000 each employee Bodily Injury by Disease 1,000,000 policy limit C. Other States Insurance: Part Three applies to the states listed here: All states except North Dakota, Ohio, Washington, West Virginia, Wyoming. D. This policy includes these endorsements and schedules: SEE ATTACHED SUPPLEMENTAL INFORMATION PAGE. Misc. Policy Information Prior Policy: ACP WCD 7191461106 Adjustment of premium shall be made Date WCD (10-98) (WC000001) direct bill 5122 AGENTS COPY 74 0002362 RE: WC000313 28 (01-86) THE CITY OF DUBUQUE INCLUDING ALL ITS ELECTED AND APPOINTED OFFICIALS, ALL ITS EMPLOYEES AND VOLUNTEERS, ALL ITS BOARDS, COMMISSIONS AND/OR AUTHORITIES AND THEIR BOARD MEMBERS, EMPLOYEES AND VOLUNTEERS. CITY OF DUBUQUE, IA 50 W 13TH ST DUBUQUE, IA 52001 PROJECT: Arrowhead Drive Storm Sewer Project RE: WC000313 28 (01-86) ACP WCD 7191461106 LAVE AGENTS COPY 74 0002317