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Improvement Contract(s)/Maintenance Bonds_R&W Resoration_429 Rhomberg Copyright 2014 City of Dubuque Consent Items # 17. ITEM TITLE: Improvement Contract(s)/Maintenance Bonds SUMMARY: R&W Restoration, LLC for the 429 Rhomberg Demolition and Building Stabilization Project SUGGESTED DISPOSITION: Suggested Disposition: Receive and File; Approve ATTACHMENTS: Description Type ❑ R&W Restoration Contract/Maintenance Bond Supporting Documentation CITY OF DUBUQUE, IOWA PUBLIC IMPROVEMENT CONTRACT 429 RHOMBERG DEMOLITION AND BUILDING STABILIZATION THIS IMPROVEMENT CONTRACT (Contract), made in triplicate, dated for references purposes the 23rd 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 R &W Restoration LLC. 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 429 Rhomberg Demolition and Building Stabilization (Project). 2. 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. 4. 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. 6. 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. 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 14. ❑ 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 Fx 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, F�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. i A copy of the Consent Decree is included in the Contract Documents and can be viewed at http://www.cityofdubuque.org/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 'j 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 2:1 1-cv-0101 1-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. i �I 3. All documents reports, data, records, or other information (including i 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. i 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. Contractor: R & W Restoration, LLC By: Date: f0 —3U 'lq 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 $ 170,750.00 CITY OF DUBUQUE, IOWA: CONTRACTOR: Pa By: By: Signature Signature Date: �" Date: A0 -20 -140e Bond No. 62201993 CITY OF DUBUQUE, IOWA PERFORMANCE, PAYMENT AND MAINTENANCE BOND KNOWN ALL MEN BY THEME PRESENTS: That R +& W Restoration, LLC (Contractor) as Principal and WESTERN SURETY COMPANY as Surety are held firmly bound unto the City of Dubuque, Iowa (City), in the penal sunt of One Hundred Seventy Thousand severs hundred fifty dollars and no cents ($1701,750.00) 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 panes who, under the provisions of the laws of Iowa, are Intended to be protec ed 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 28th day of October , 2014, and duly attested and sealed. WHEREAS, Contractor by a Contract dated October 23, 2014 incorporated herein by referenda, has agreed with City to perform all labor and furnish all materials required to be performed and furnished for 429 Rhomberg Demolition and Building Stabilization (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 Contractoes default of failure to perform as required. The Contractor shall also be responsible for the default or failure to perform as required under the Contract and Contract Documents by all Its subcontractors, suppliers, agents, or employees furnishing materials or providing labor In the performance of the Centrt. 2. PAYMENT Baba: The Contractor and the Surety shall pay all just claims submitted by persons, films, subcontractors, and corporatlons furnishing materials for or perforating labor In the performance of the Contract on account of which this Band Is given, Including but not iimlthd 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 pride Mich the City Is required to retain until completion of the improvement, but the Contractor and Surety shall not be liable to said persons, farts, or corporations unless the claims of said claimants against said portion of the contract prioe shall have been established as provided by law. The Contractor and Surety hereby hind themselves to the obligations and conditions set forth in Chapter 673, Code of Iowa, which by this reference is made a part hereof as though fully set out herein. 3. MAINTENANCE BOND: The Contractor and the Surety hereby agree, at their own expense., A. To remedy any and all defects that may develop in or result from work to be performed under the Contract within the period of two (2) year(s) from the date of acceptance of the work under the Contract by the City Council of the City of Dubuque, Iowa, by reason of defects In workmanship or materials used in construction of said work; B. To keep all work in continuous goad repair; and C. To pay the City the reasonable costs of monitoring and inspection to assure that any defects are remedied, and to repay the City all outlay and expense incurred as a result of Contractor's and Surety's failure to remedy any defect as required by this section. Contractor's and Surety's agreement herein made extends to defects in workmanship or materials not discovered or known to the City at the time such warp 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 gill maintain in goon repair said Project for the period specified in the Contract where this band Is obligated fear maintenance, and will faithfully comply with all of the provisions of Section 573 of the Coda of Iowa, then this obligation shall be null and void, otherwise it shall remain in full force and effw. All the conditions of this bond must be fully complied with Mare the Contractor or the Surety Will be released. The Contract, Contractor's Proposal, and Construction Documents shall be considered as a part of this Boal just as if their terms were repeated herein. Bated at Dubuque, Iowa this .28111day of October ,2014, CITY OF DU UES IOWA PRINCIPAEICONTRACTOR: �y R&W Restoration, LLC dirty ana er Contractor BY: ,"1""ltle SURETY: WESTERN SURETY COMPANY Surety Company - -� Signs Lure SEAL Attorney-in-Fact ' Title 333 South Wabash Avenue, 41st Floor Chicago, IL 60604 City, State, ,Zip Code (605) 336-0850 Telephone -RICIN M URBAIlN �- - � l�ttomey In-Fact Western Surety Company POWER OF ATTORNEY-CERTIFIED COPY Bond No. 62201993 Know All Men By These Presents,that WESTERN SURETY COMPANY, a corporation duly organized and existing under the laws of the State of South Dakota,and having its principal office in Sioux Falls,South Dakota(the"Company'),does by these presents make,constitute and appoint Rick M Urbain its true and lawful attorney(s)-in-fact,with full power and authority hereby conferred,to execute,acknowledge and deliver for and on its behalf as Surety,bonds for: Principal: R&W Restoration, LLC Obligee: City of City of Dubuque, IA Amount: $500,000.00 and to bind the Company thereby as fully and to the same extent as if such bonds were signed by the Senior Vice President, sealed with the corporate seal of bhe Company and duly attested by its Secretary, hereby ratifying and confirming all that the said attorney(s)-in-fact may do within the above stated limitations. Said appointment is made under and by authority of the following bylaw of Western Surety Company which remains in full force and effect. "Section 7. All bonds,policies, undertakings, Powers of Attorney or other obligations of the corporation shall be executed in the corporate name of the Company by the President, Secretary, any Assistant Secretary, Treasurer, or any Vice President or by such other officers as the Board of Directors may authorize. The President, any Vice President, Secretary, any Assistant Secretary,or the Treasurer may appoint Attorneys in Fact or agents who shall have authority to issue bonds,policies, or undertakings in the name of the Company. The corporate seal is not necessary for the validity of any bonds,policies, undertakings, Powers of Attorney or other obligations of the corporation. The signature of any such officer and the corporate seal may be printed by facsimile." All authority hereby conferred shall expire and tenninate,without notice,unless used before midnight of March 31 s t 2015 ,but until such time shall be irrevocable and in full force and effect. In Witness Whereof,Western Surety Company has caused these presents to be signed by its Vice President,Paul T.Bruflat,and its corporat ttobeaffixed this 28th day of October 2014 " WES SURLAY COMPANY Ch 2-1 Paul T ruflat,Vice President _ .. 4 S.� jW, $OUTj1-' (STA COUN .R -Oft-AHA On this 2 8 th day of October in the year 2014 before me,a notary public,personally appeared Pan] T. Rniflat, who being to me. duly sworn, acknowledged that he signed the above. Power of Attorney as the aforesaid officer of WESTEVySURETY y COMPANY yNand acknowledged said instrument to be the voluntary act and deed o said corp tion. s O PETRIK s NOTARY PUBLI SEAT- C SLL s SSOUTH DAKOTA s Notary Public-South Dakota �'�ahaa'.�ah�ayhdi�ah�ah�ah�ayyh�i GiO+ My Commission Expires August 11,2016 I the undersigned officer of Western Surety Company,a stock corporation of the State of South Dakota,do hereby certify that the attached Power of Attorney is in full force and effect and is irrevocable,and furthermore,that Section 7 of the bylaws of the Company as set forth in the Power of Attorney is now in force. In testimony whereof,I have hereunto set my hand and seal of Western Surety Company this 28th day of October 2014 WES R .S�~U-RE Y COMPANY Form F5306-8-2012 Paul T ruflat,Vice President , ACKNOWLEDGMENT OF SURETY STATE OF Iowa ( ss (Attorney-in-Fact) Bond No. 62201993 COUNTY OF )J On this day ofr. 6 before me,a notary public in and for said County,personally appeared Rick M Urbain to me personally known and being by me duly sworn, did say, that he/she is the Attorney-in-Fact of WESTERN SURETY COMPANY, a corporation of Sioux Falls, South Dakota, created, organized and existing under and by virtue of the laws of tho State of South Dakota, that the said instrument was executed on behalf of the said corporation by authority of its Board of Directors and that the said Rick M Urbain acknowledges said instrument to be the free act and deod of said corporation and that he/she has authority to sign said instrument without affixing the corporate seal of said corporation. IN WITNESS WHEREOF, I have hereunto subscribed m name and affixed my official seal at the day and year last above written. My commission expires L Notary Public Form 106-9-2013 _•+"' `�� FIANpY M. URBAIN Commission Number 778403 My Comm. Exp,Q Phone: (563)589-4205 ACC)/?" CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) few. 10/29/2014 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 CONTACT Christine Breen NAME: FAX Urbain Insurance Group PHONNo 11 E WC. (563)583-7722 (,C No: (866)843-6317 9165 E Tamarack Dr ADDRESS: cbreen@uainsurance.com Dubuque,IA 52003 INSURER(S)AFFORDING COVERAGE NAIC# INSURERA: Midwest Family Mutual INSURED INSURER 8: R&W Restoration LLC Randy Williams INSURER C: 862 Walker St INSURER D: INSURER E: Dubuque,IA 52001 INSURER F COVERAGES CERTIFICATE NUMBER: 00000000-366615 REVISION NUMBER: 2 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 CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS, INSR TYPE OF INSURANCE ADDL SUER POLICY EFF POLICY EXP LIMITS LTR POLICY NUMBER MM/DD/YYYY MMIDD/YYYY A X COMMERCIALS NERALLIABILITY Y Y ACIA0560082252 07/02/2014 07/02/2015 EACH OCCURRENCE $ 11000,000 CLAIMS-MADE Fx_1 OCCUR PREMISES Ea occurrence) $ 50,000 MED EXP Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIE5 PER: GENERAL AGGREGATE $ 2,000,000 POLICY PRO-JECT El LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: $ A AUTOMOBILE LIABILITY CAIA0560094038 07/02/2014 07/02/2015 COMBINED SINGLE OBDSINGLE LIMIT $ 1,060,000 ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED AUTOS X AUTOS BODILY INJURY(Per accident) $ NON-OWNED PROPERTY DAMAGEI' HIRED AUTOS AUTOS Peraccident $ a A X UMBRELLALIAB �( OCCUR CUTA0560095247 07/02/2014 07/02/2015 EACH OCCURRENCE $ 1,000,000 EXCESS LIAB CLAIMS-MADE AGGREGATE $ , DED RETENTION $ A WORKERS COMPENSATION Y WCIA0560089850 07/02/2014 07/02/2015 X STATUTE ER I, AND EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE YIN N N/A E.L.EACH ACCIDENT $ 100,000 OFFICER/MEMBER EXCLUDED? Fy— (Mandatory in NH) - E.L.DISEASE-EA EMPLOYEE $ 500,000If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 100,000 II I i DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,maybe attached if more space is required) The City of Dubuque including all its elected and appointed officials,all its employees and volunteers,all its boards, k commissions and/or authorities and their board members,employees and volunteers are 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 Pimary&Non-contributing form CG 2503 0397,"Designated Projects"General Liability Aggregate Limit shall be incl. Waiver of Subrogation in favor of City of Dubuque on Workers Compensation. All policies shall be endorsed to provide 30 days advance notice of cancellation. Project: "City of Dubuque, Iowa 429 Rhomberg Demolition&Buildings , continued on ACORD 101 Additional Remarks Schedule CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Dubuque THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN City Hall ACCORDANCE WITH THE POLICY PROVISIONS. 50 W 13th St Dubuque,IA 52001 AUTHORIZED RrEPRESENTATIVE (CMB) p ©198 -2Ul 4 ACUD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD Printed by GMB on October 29,2014 at 12:11 PM i i i AGENCY CUSTOMER ID: 00000000 LOC#: ADDITIONAL REMARKS SCHEDULE Page 2 of 2 j AGENCY NAMED INSURED Urbain Insurance Group R&W Restoration LLC POLICY NUMBER Randy Williams ACIA0560082252 CARRIER NAIC CODE Midwest Family Mutual EFFECTIVE DATE:07!0212014 ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: Certificate of Liability Insurance (continued from Description of Operations) Stabilization" SII III U II II !I Ii I Ili I III II it I IiJ It i J 9 II ACORD 101 (2008101) ©2008 ACORD CORPORATION. All rights reserved. i The ACORD name and logo are registered marks of ACORD Printed by GMB on October 29,2014 at 12:11 PM MIDWEST FAMILY MUTUAL PART B DECLARATION PAGE amUy INSURANCE COMPANY Artisan Contractor P.O.BOX 9425 Minneapolis,MN 55440-9425 (dwest utual Insuring es Since 1891 G Renewal Coverage Summary EFFECTIVE 07102114 DB ¢ ROLICY'INUMBER FROM POLICY PERIQ,D„i TD :i AGENT ij _ ACIA0560082252 07/02/14 07/02/15 12 : 01 AM STANDARD TIME 06713 NAMED IN aURE[)!AND:ADDRE$S AGEINT R & W RESTORATION LLC URBAIN & ASSOCIATES LLC 862 WALKER ST 9165 E TAMARACK DR DUBUQUE IA 52001 DUBUQUE , IA 52003 Phone : ( 563) 583-7722 05 I 'X'IF SUPPLEMENTAL DECLARATION ❑X SUPPLEMENTAL DECLARATION Business Description: Form of Business: Masons LLC In return for the payment of the premium and subject to all the terms of this policy, we agree with you to provide the insurance as stated in this policy, DESCRIBED PREMISES Forms Applicable: Special Premises No. Bldg. No. Location Mortgage Holder Name and Address I' SEE ATTACHED SUPPLEMENTAL DECLARATIONS SEE ATTACHED SCHEDULE P PROPERTY PREM.NO. BLDG.NO. PREM.NO. BLDG.NO. PREM.NO. BLDG.NO. SEE ATTACHED SUPPLEMENTAL DECLARATIONS d i. r; Deductible$ SEE ATTACHED SUPPLEMENTAL DECLARATIONS OPTIONAL COVERAGES SEE ATTACHED SUPPLEMENTAL DECLARATIONS 11 LIABILITY AND MEDICAL PAYMENTS Except for Fire Legal Liability, each paid claim for the following coverages reduces the amount of insurance we provide during the applicable annual period. Please refer to paragraph D.4. of the B usinessowners Liability Coverage Form. Limits of Insurance Liability $1 000,000/$2,000,000 Aggregate Products/Completed Operations Liability $1,000,000 Occurrence/$2,000,000 Aggregate Medical Expense $5,000 per person Fire Legal Liability $50,000 any one fire or explosion Deductible(Property Damage Liability) NONE THIS POLICY IS SUBJECT TO AUDIT AND BASED UPON FULL TIME EMPLOYEES AND PART TIME EMPLOYEES. TOTAL PREMIUM FORMS AND ENDORSEMENTS: SEE ATTACHED SCHEDULE During the past three years no insurer has canceled any insurance issued to the name insured, similar to that afforded hereunder, unless otherwise stated herein. THESE DECLARATIONS,TOGETHER WITH THE COVERAGE FORM(S),COMMON POLICY CONDITIONS AND FORMS AND ENDORSEMENTS,IF ANY,ISSUED TO FORM A PART THEREOF,COMPLETE THE ABOVE NUMBERED POLICY. Includes copyright material of Insurance Service Office Inc.,with its permission. Copyright Insurance Service Inc.,1984,1985 PAGE 1 MFM ML1 04-05 MIDWEST FAMILY MUTUAL INSURANCE COMPANY INSURED: R&W RESTORATION POLICY NUMBER: ACIA0560082252 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED IT IS AGREED THE ADDITIONAL INSURED NAMED BELOW IS ADDED FOR LIABILITY AND MEDICAL PAYMENTS COVERAGE. LIABILITY AND MEDICAL PAYMENTS ARE 1 AFFORDED THIS ADDITIONAL INSURED ONLY FOR LIABILITY CAUSED BY THE OPERATIONS OR OTHER NEGLIGENT ACTS OF THE NAMED INSURED. OUR DUTY TO DEFEND AND PROTECT THIS ADDITIONAL INSURED BEGINS AND ENDS ONLY WITH LIABILITY CREATED BY OUR NAMED INSURED. ADDITIONAL INSURED: CITY OF DUBUQUE CITY HALL � 50 W 13TH ST DUBUQUE, IA 52001 PROJECT: 429 Rhomberg Demolition &Stabilization j IT IS FURTHER AGREED THAT SUCH INSURANCE AS IS AFFORDED R&W RESTORATION, ITS AFFILIATES AND SUBSIDIARIES SHALL BE PRIMARY AND NON-CONTRIBUTORY WITH ANY OTHER INSURANCE IN FORCE OR WHICH MAY BE PURCHASED BY CITY OF DUBUQUE ITS AFFILIATES AND SUBSIDIARIES, BUT ONLY WITH RESPECT TO WORK PERFORMED BY OR FOR THE INSURED IN CONNECTION WITH THE ABOVE DESCRIBED PROJECT. l ISII V i h l �I a a ACIA0560082252 '9 PER PROJECT AGGREGATE The endorsement changes the Policy. Please Read it Carefully. It is hereby agreed and understood that the policy aggregate is on a per-project basis when required in a written contract or agreement. 1 i 'I i i a I s 3 MFM ML5 04-05 i MIDWEST FAMILY MUTUAL INSURANCE CO POLICY NUMBER: ACIA0560082252 ISSUED To: R&W Resoration LLC i THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US This endorsement modifies insurance provided under the following: Business owners Common Policy Conditions Schedule Name of Person or Organization: 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.) The TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US Condition is amended by the addition of the following: 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 i included in the "products-completed operations hazard". This waiver applies only to the person or organization shown in the Schedule above. [ i IT IS FURTHER AGREED THAT SUCH INSURANCE AS IS AFFORDED R&W RESTORATION LLC ITS AFFILIATES AND SUBSIDIARIES SHALL BE PRIMARY AND NON-CONTRIBUTORY WITH ANY OTHER INSURANCE IN FORCE OR WHICH MAY BE PURCHASED BY City of Dubuque--Public Works, ITS AFFILIATES AND SUBSIDIARIES, BUT ONLY WITH RESPECT TO WORK PERFORMED BY OR FOR THE INSURED IN CONNECTION WITH THE ABOVE DESCRIBED PROJECT. -- ------------------------------- ---------------------------------- i 6 h ti E Q y yj V 8 J MFM ML10 04-05 MIDWEST FAMILY MUTUAL INSURANCE CO POLICY NUMBER: ACIA0660082262 ISSUED TO: R&W Restoration LLC THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. I CITY OF DUBUQUE, IOWA GOVERNMENTAL IMMUNITIES ENDORSEMENT 1. NONWAIVER OF GOVERNMENTAL IMMUNITY. The insurance carrier expressly agrees and states that the purchase of this policy and the including of the City of Dubuque, 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. II� 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. I 3. ASSERTION OF COVERNMENT 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 . j 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 i' NO OTHER CHANGE IN POLICY. The above preservation of governmental immunities shall not otherwise change or alter the coverage available under the policy. I P 9 MFM ML2 04-05 MIDWEST FAMILY MUTUAL INSURANCE COMPANY INSURED: R&W RESTORATION POLICY NUMBER: ACIA0560082252 I THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. REGARDING FORM NUMBER MFMIL004 0710 CANCELLATION: NUMBER OF DAYS NOTICE:30 WHEN WE DO NOT RENEW (Nonrenewal) NUMBER OF DAYS NOTICE: 63 J NAME AND ADDRESS: CITY OF DUBUQUE CITY HALL 50 W 13TH ST DUBUQUE, IA 52001 i i i i I i d I i I' I i i ji j 9 i x A a NCCI# 33928 MIDWEST FAMILY MUTUAL PART B DECLARATION PAGE LAfldwest INSURANCE COMPANY Workers Compensation P.O.BOX 9425 Minneapolis,MN 55440-9425ual es I' Renewal Coverage Summary J EFFECTIVE 07/02/14 PIJLICY;:NUMf3£R FROM' PC7LICYPERIOD :'sTC7i ACENT3i WCIA0560089850 1 07/02/14 1 07/02/15 12 : 01 AM STANDARD TIME 06713 NAMED INSURED'AND i4DDRE$S AGENT R & W RESTORATION LLC URBAIN & ASSOCIATES LLC 862 WALKER ST 9165 E TAMARACK DR DUBUQUE , IA 52001 DUBUQUE , IA 52003 Phone ; (563) 583-7722 05 FED. EMP. I.D. NO.: 46-4415400 Form of Business: LLC COVERAGE-ITEM 3: A.Workers Compensation Insurance: Part One of the policy applies to the Workers Compensation Law of the states listed here. Iowa B. Employers Liability Insurance: Part Two of the policy applies to work in each state listed in Item 3A. The limits of our liability under Part Two are: Bodily Injury by Accident $100,000 each accident Bodily Injury by Disease $500,000 policy limit Bodily Injury by Disease $100,000 each employee C. Other States Insurance: Part Three of the policy applies to the states, if any, listed here: All States EXCEPT North Dakota, Ohio, Wyoming and Washington. D. This policy includes these endorsements and schedules. SEE SCHEDULE ATTACHED PREMIUM-ITEM 4: The premium for this policy will be determined by our Manuals of Rules, Classifications, Rates and Rating Plans. All information required below is subject to verification and change by audit. Classification Code Premium Basis Rates Per Estimated Annual No. Total Estimated $100 of Premium Annual Remuneration Remuneration i I SEE SCHEDULE ATTACHED i I I I t f i I Total Deposit Premium WC 00 00 OIA(Standard) Copyright 1987 National Council on Compensation Insurance PAGE 1 i I MFM ML2 04-05 MIDWEST FAMILY MUTUAL INSURANCE COMPANY INSURED: RANDY WILLIAMS POLICY NUMBER: WCIA0560089850 { WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS WE HAVE THE RIGHT TO RECOVER OUR PAYMENTS FROM ANYONE LIABLE FOR AN INJURY COVERED BY THIS POLICY. WE WILL NOT ENFORCE OUR RIGHT AGAINST THE PERSON OR ORGANIZATION NAMED IN THE SCHEDULE. (THIS AGREEMENT APPLIES ONLY TO THE EXTENT THAT YOU PERFORM WORK UNDER A WRITTEN CONTRACT THAT REQUIRES YOU TO OBTAIN THIS AGREEMENT FROM US) . THIS AGREEMENT SHALL NOT OPERATE DIRECTLY OR INDIRECTLY TO BENEFIT l ANYONE NOT NAMED IN THE SCHEDULE. ,:III CITY OF DUBUQUE CITY HALL 50 W 13TH ST DUBUQUE, IA 52001 II !qi 4 i i i i i i I I I I i I i