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28E Agreement - Key West Fire Department Copyright 2014 City of Dubuque Consent Items # 21. ITEM TITLE: 28E Agreement- Key West Fire Department SUMMARY: City Manager recommending approval of a 28E Agreement with the Key West Fire Department to allow them to use City of Dubuque-owned hydrants that are located in the Key West Fire Department Fire District. SUGGESTED DISPOSITION: Suggested Disposition: Receive and File; Approve ATTACHMENTS: Description Type Hydrant Use Agreement with Key West Fire City Manager Memo Department-MVM Memo Staff Memo Staff Memo Key West Fire Dept. Hydrant Agreement Staff Memo THE CITY OF Dubuque DUB E i" Masterpiece on the Mississippi 2007.2012.2013 TO: The Honorable Mayor and City Council Members FROM: Michael C. Van Milligen, City Manager SUBJECT: Hydrant Use Agreement with Key West Fire Department DATE: October 12, 2016 During the Twin Ridge Water System acquisition process, the question of hydrant use for fire protection in the area came up. Fire Chief Rick Steines recommends City Council approval of a 28E Agreement with the Key West Fire Department to allow them to use City of Dubuque-owned hydrants that are located in the Key West Fire Department fire district. I concur with the recommendation and respectfully request Mayor and City Council approval. Mic ael C. Van Milligen MCVM:jh Attachment cc: Crenna Brumwell, City Attorney Cindy Steinhauser, Assistant City Manager Teri Goodmann, Assistant City Manager Rick Steines, Fire Chief THE CITY OF Dubuque AII11-America CiI.ty UB E1 Masterpiece on the Mississippi 2007.2012.2013 TO: Michael C. Van Milligen, City Manager FROM: Rick Steines, Fire Chief DATE: October 7, 2016 RE: Hydrant Use Agreement with Key West Fire Department INTRODUCTION During the twin ridge water system acquisition process the question of hydrant use for fire protection in the area came up. In a memo dated December 2, 2015 1 recommended establishing an agreement with the Key West Fire Department (KWFD) for use of city-owned hydrants that are located in the KWFD fire district. DISCUSSION Working with Water Department Manager Bob Green, Assistant City Attorney Maureen Quann, and Key West Fire Chief Brian Arnold a 28E agreement has been worked out. This agreement allows KWFD personnel to operate city hydrants to fight fires in their protection area. As part of the agreement Dubuque firefighters are providing hydrant operation training to Key West personnel. RECOMMENDATION The Board of Directors of the Key West Fire Department have signed the agreement and the same has been reviewed by the city legal department. I therefore recommend the agreement be signed by the City of Dubuque to finalize the agreement. ACTION REQUESTED I respectfully request this agreement be placed on the city council agenda for consideration. Cc: Bob Green Water Department Manager Maureen Quann Assistant City Attorney 28E Agreement Paul D. Pate Secretary of State State of Iowa FO R O F F I C E U S E O N L Y : PLEASE READ INSTRUCTIONS ON BACK BEFORE COMPLETING THIS FORM Item 3. The purpose of this agreement is: (please be specific) _________________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________ Item 6. Attach two copies of the agreement to this form if not filing online. Item 7. The primary contact for further information regarding this agreement is: (optional) LAST Name _________________________________ FIRST Name ___________________________ Title ________________________________________ Department ____________________________ Email ______________________________________ Phone_________________________________ Item 4. The duration of this agreement is: (check one) Agreement Expires ____________ Indefinite Duration [mm/dd/yyyy] *Enter “Other” if not in Iowa (Use the filing number of the most recent version filed for this agreement) The filing number of the agreement may be found by searching the 28E database at: http://sos.iowa.gov/28e. Item 5.Does this agreement amend or renew an existing agreement? (check one) NO YES Filing # of the agreement: ____________ Item 1. The full legal name, organization type and county of each participant to this agreement are: Full Legal Name Organization Type *County Party 1 Party 2 Party 3 Party 4 Party 5 Item 2.The type of Public Service included in this agreement is: ________ _______________________________ (Enter only one Service Code and Description)Code Number Service Description 4 4 11/1/2016 3:24:04 PM Key West Fire Department DubuqueCity of Dubuque 210 Fire Response Dubuque M509575 City FILED Fire District Installation and maintenance by city of city owned fire hydrants and water systems within the fire protection coverage area of KWFD. 28E AGREEMENT FOR MUTUAL AID FOR FIRE HYDRANT USE BETWEEN THE CITY OF DUBUQUE, IOWA AND THE KEY WEST FIRE DEPARTMENT This agreement ("Agreement"), dated for reference purpose the 2.0D day of a Preme e- 2016 is made pursuant to Iowa Code Chapter 28E between and among the City of Dubuque ("City") and the Key West Community Fire Department ("KWFD"). WHEREAS, parties of this agreement recognize the installation and maintenance by City of City -owned fire hydrants and water systems within the fire protection coverage area of KWFD, including fire hydrants in the Twin Ridge subdivision, on Key West Drive, and along highways 151 and 61 in route from the City to the airport; WHEREAS, occasions may arise whereby such City fire hydrants and water systems would be beneficial to the protection of life and property from fire; WHEREAS, in such a situation the availability of said City fire hydrants and water system might well avert disastrous results; WHEREAS, Iowa Code Chapter 28E provides that powers, privileges or authority exercised by a public agency of this state may be exercised jointly with any other public agency having such powers, privilege and authority; and WHEREAS, the parties hereto wish to enter into a 28E agreement to allow KWFD use of said City fire hydrants within the fire protection coverage area of KWFD. THEREFORE, the parties mutually agree to allow KWFD use of said City fire hydrants when needed under the following terms and conditions: SECTION 1. AUTHORITY TO USE CITY FIRE HYDRANTS. Authorized KWFD personnel, under the direction of the KWFD fire chief, shall be authorized to operate City fire hydrants within the KWFD fire protection coverage area. Such operation shall only be allowed for responses to fires or other official KWFD operations such as training, and only after the conditions outlined in Section 2 of this Agreement have been met. SECTION 2. TRAINING FOR USE OF CITY FIRE HYDRANTS. KWFD personnel operating City fire hydrants must complete and maintain proper training as to the opening, closing, and flowing of City fire hydrants. Training will be provided by the Dubuque City Fire Department or Dubuque City Water Department personnel at no cost to the KWFD. Training must be completed once immediately following the execution of 06232016MAQ this Agreement in 2016, and every other year moving forward. Usage of the City fire hydrants must be in accordance with the methods taught in these training sessions. SECTION 3. NOTIFICATION AFTER USE. After any authorized use of a City fire hydrant by KWFD personnel, the KWFD fire chief, or his designee must notify the City Water Department of such use. This notification must include the exact location of the City fire hydrant that was used and any problems that may have been encountered. During normal business hours, KWFD must notify the City Water Department at 563- 589-4291. After hours, KWFD must notify City contacting Dubuque County 911 and requesting that the City Water Department be notified of such use. SECTION 4. EQUIPMENT PROVIDED. 4.1 City makes no guarantee as to the serviceability, flow availability, or reliability of City fire hydrants used by KWFD. City is not required to notify KWFD if any City fire hydrant is out of service or if a water shut-off occurs in the area in question. KWFD is responsible for providing all adaptors, wrenches, and other tools needed, and such adaptors, wrenches, and tools must be compatible with City fire hydrants and meet the requirements of the City Water Department. 4.2 If KWFD becomes aware of any City fire hydrant that is out of service, not working properly, or defective in any way, KWFD shall notify the City Water Department at 563-589-4291. After hours notification must be made by calling Dubuque County 911 and requesting that the City Water Department be notified. SECTION 5. REIMBURSEMENT FOR COSTS. 5.1 KWFD is not required to reimburse City for the cost of providing the services set forth in this Agreement. KWFD must pay its own costs, including but not limited to salaries, repairs, materials, compensation incurred during use of any City fire hydrant. KWFD is financially responsible for any costs associated with the repair and/or replacement of City equipment that is part of the City fire hydrant or associated piping system, if the damage is determined to have been caused by any KWFD operation or use of a City fire hydrant. 5.2 The City's Water Department Manager, the City's Fire Chief, and KWFD's Fire Chief will examine any damaged City fire hydrant or associated piping system to determine the cause and extent of damage and the repairs or replacement necessary to correct that damage. If the City and KWFD do not agree on the cause or extent of damage or the repairs or replacement needed, a mutually agreed upon neutral third party will evaluate the equipment and determine the cause and extent of damage, and the necessary repairs. Possible third parties may include but are not limited to water department managers and fire chiefs from nearby cities or fire departments. If the damage is determined to result from KWFD's use of the equipment, KWFD will be financially responsible for any costs associated with the repair and/or replacement of the City equipment. 2 SECTION 6. LIABILITY. 6.1 Employees of the KWFD acting pursuant to this Agreement shall be considered as acting at all times under the lawful orders and instructions of their employer fire department. Under no circumstances are such employees considered employees of any other agency or department. 6.2 KWFD hereby waives all claims against City and any City department for any loss, damage, injury or death occurring as a consequence of the performance of this Agreement. 6.3. KWFD is liable for any damage to its equipment and for the death of or injury to its personnel, whether the death, injury or damage occurred at a fire or incident in KWFD fire protection area, or at any City fire hydrant location. 6.4 KWFD agrees to indemnify, defend and hold harmless City for damages, claims, demands, suits, judgments, costs and expenses arising from loss of or damage to private property, or death of or injury to a private person whether caused by the KWFD, personnel or equipment in the performance of this Agreement, except where such loss, damage, death or injury is the result of wanton and willful misconduct by City. For purposes of this Agreement, "private person" and "private property" means a person not an employee or volunteer of the KWFD and property not belonging to a member of the KWFD. SECTION 7. INSURANCE. During the term of this Agreement and any renewal terms, KWFD will comply with the requirements set forth in the attached Insurance Schedule A. SECTION 8. TERM OF AGREEMENT. This Agreement has an initial term of three (3) years commencing on the date of filing and recording. After the initial term, the Agreement will renew for one (1) year renewal terms, unless written notice of intent not to renew is received at least six (6) months before the end of the current term. SECTION 9. TERMINATION. Either party may terminate by giving thirty (30) days' written notice of termination to the governing body of each of the other party by certified mail. Such notice will only be effective if duly approved by the governing body of the withdrawing party. SECTION 10. AMENDMENTS. This Agreement may be amended at any time by the parties. All amendments must be in writing, signed by both parties, and filed in an electronic format with the Iowa Secretary of State as required by Iowa Code Section 28E.8. SECTION 11. ADMINISTRATION OF AGREEMENT. This Agreement is administered by City of Dubuque and Key West Community Fire Department. City and 3 KWFD will periodically review the Agreement and attempt to resolve any problems which may arise in carrying out the Agreement. SECTION 12. NOTICES. Any written notice required by this Agreement must be sent via certified mail to the following: To KWFD: To City: Key West Fire Department Attention: Chief Brian Arnold 10640 Lake Eleanor Road Dubuque, Iowa 52003 City of Dubuque Fire Department Attention: Chief Rick Steines 11 West gth Street Dubuque, Iowa 52001 City of Dubuque Water Department Attention: Water Department Manager Bob Green 1902 Hawthorne Street Dubuque, Iowa 52001 SECTION 13. PRIOR FIRE MUTUAL AID AGREEMENTS. This Agreement is in addition to, and separate from any current fire mutual aid or fire protection agreements by, between, and among the parties. SECTION 14. FILING AND RECORDING. Upon execution by all of the parties hereto, this Agreement shall be filed with the Secretary of State and the Dubuque County Recorder. Copies of the Agreement shall be supplied to the City of Dubuque Fire Department, the Key West Fire Department, the City of Dubuque Water Department, and the respective governing bodies. SECTION 15. EFFECTIVE DATE. This Agreement takes effect upon execution by the parties as required by law, filing with the Iowa Secretary of State, and recording with the Dubuque County Recorder. SECTION 16. GOVERNING LAW. This Agreement is governed by and interpreted under the laws of the State of Iowa. SECTION 17. DISPUTE RESOLUTION. Any dispute between the parties arising out of or within the scope of the interpretation, construction, or application of this Agreement shall, prior to the commencement of any formal legal proceedings, be submitted to arbitration. Either party may submit to the other a written request for arbitration. Within ten (10) days after the date of such request, City and County will each select one (1) arbitrator and notify the other party of the name and address of such arbitrator. The arbitrators so selected will, within ten (10) days after being notified of their selection, select a third (3rd) arbitrator. After doing so, the arbitrators must notify City and County 4 in writing of the name and address of the third (3rd) arbitrator. The arbitration proceedings will be governed by Iowa Code Chapter 679A. APPROVED BY: KEY WEST FIRE DEPARTMENT BOARD OF DIRECTORS d President Date: — , 2016. On this 2 -Nm day of OEPTEM ber2, , 2016, before me, eRTHE2_INS. R. rei-3.--7Q-ri FIN) a Notary Public, in and for the State of Iowa, personally appeared EA C4 A -Q-0 B 2,14 D and DeaA_ , to me personally known and who, being duly sworn, did say thql hey are the President of the Board of the Key West Fire Department and the Seef4a of the Board of the Key West Fire Department of the County of Dubuque, Iowa; and PA c-FiR B PMDLE )1 and r\ BiecHLER._ acknowledged the execution of the instrument to be their voluntary act and deed and the voluntary act and deed of the corporation, by it voluntarily executed. 7E1.0.E.8111Al4 F,1 ' 184217 CQ,.cur, 6,3 an Exptrips I' la APPROVED : CITY OF DUBUQUE, IOWA Roy D.BuoIf ayor ATTEST: Kevin Ffnitahl, City CI Jikei PI. fOtfl Notary Public Date: /7 , 2016. On this 17 day of OC.4.ace" , 2016, before me, --re L. a Notary Public, in and for the State of Iowa, personally appeared Roy D. Buol and 5 Kevin Firnstahl to me personally known and who, being duly sworn, did say that they are the Mayor and City Clerk, respectively, of the City of Dubuque, Iowa; and Roy D. Buol and Kevin Firnstahl acknowledged the execution of the instrument to be their voluntary act and deed and the voluntary act and deed of the corporation, by it voluntarily executed. TRISH L. GLEASON ommission Number 71 My Commission Expires L3.1 6 Notary Public INSURANCE SCHEDULE A 7 City of Dubuque insurance Requirements for Tenants and Lessees of City Property or Vendors {Suppliers, Service Providers)„ or Illight of 'Way Permit Holders Insurance Schedule A 1. shall furnish a signed Certificate of Insurance (COI) to the City of Dubuque, Iowa for the c.overage required in Exhibit I prior to contract or lease commencement. All lessees of City property and Right of Way Permit 140ders shall submit an updated COI annually, Each Certificate shall be prepared on the most current ACORD 'form approvedby the Department of Insurance or an equivale.nt. Each certificate shall include a statement Under Description a Operations as to why issued. Eg: Project or .Lea.se of premises at or construction of or right of way permitted location and description 2. All policies of insurance required hereunder shall be with a .carrier authorized to do busiriess n Iowa and all carriers shall have a rating of A or better in the current et's Rating Guide. 3. Each Certificate shall be'furnished to the contracting deparbnent of the aty of Dubuque.. 4. Failure to provide MiniIMM coverage sw not be deemed a waiver of these requirements by the City of Dubuque. Failure to obtain or maintain the required insurance shall be .cansidered a :material breach of this. agreement. 5. M reqred endorsements to venoms panicles shall be attached to Certificate of Insurance. 6. Whenever a specific ISO form ia listed, an equivalent form may be VibStibited 54;ibie.et itfli the provider identifying and listing in wiltingall deviations and exclusions that defer from the 60 form. 7. Provider shll be required to carry the .minimum coverage/limits, or rea r if required by law or other legal. agreement, in Exhibit L S. Whenever an OSO form is referenced the current edition of the form must be gssed. If provider's limits of Pability are higher than the required minimum limits then the provider's limits Shall be this agreement's required limits. Page 1 of 3 Schedule A Property Or Vendors March 2016 8 City of Dubuque Insurance Requirements for Tenants and Lessees of City Property or Vendors (Suppliers, Service Providers), or Right of Way Permit Holders Insurance Schedule A (continued) Exhibit 1 A) COMMERCIAL GENERAL LIABILITY General Aggregate Limit $2,000,000 Products -Completed Operations Aggregate Limit $1,000,000 Personal and Advertising injury Limit $1,000,000 Each Occurrence $1,000,000 Fire Damage Limit (any one occurrence) $ 50,000 Medical Payments $ 5,000 a) Coverage shalt be written on an occurrence, not claims made, form. The general liability coverage shall be written in accord with LSO form CG0001 or business owners form BP0002. All deviations from the standard ISO commercial general liability form CG 0001, or Business owners forrn BP 0002, shall be clearly Identified. h) Inc -Jude ISO endorsement form CG 25 04 "Designated Location(s) General Aggregate Limit." c) Include endorsement indicating that coverage is primary and non-contributory. d) Include endorsement to preserve Governmental Immunity. (Sample attached). e) Include an endorsernent that deletes any fellow employee exclusion. f) Include additional insured endorsement for: 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. Use ISO form CG 20 10 (Ongoing operations) or its equivalent. g) If vendor utilizes Trikkes or Segways in the conduct of business, include an endorsement reflecting that these vehicles are not excluded from Commercial General Liability coverage. B) WORKERS' COMPENSATION & EMPLOYERS LIABILITY Statutory benefits covering all employees injured on the job by accident or disease as prescribed by Iowa Code Chapter as as amended. Coverage A Statutory—State of Iowa Coverage B Employers Liability Each Accident $100,000 Each Employee -Disease $100,000 Policy Limit -Disease $500,000 Policy shall include an endorsernent providing a waiver of subrogation to the City of Dubuque. C) Paul:Ion Liability Coverage required: yes no Pollution Liability coverage shall be required If lessee has any pollution exposures including abatement of hazardous or contaminated materials Including, but not limited to, petroleum products, the removal of lead, asbestos, or PCB's. Pollution product and complete operations coverage shall also be covered. $2,000,000 each occurrence $4,000,000 policy aggregate a) Policy to Include premises and transportation coverage. b) Include additional Insured as stated in Af above. c) Include preservation of governmental immunity as stated in Ad above. d) Provide evidence of coverage for 5 years after completion of project. Page 2 of 3 Schedule A Property Or Vendors March 2016 9 City of Dubuque Insurance iRequirements for Tenants and ILessees of Cy Property or Vendors (Suppliers, Service Providers), or Right of Way Permit Holders Preservation of Govern tImrnuiniti.es !Endorsement Nonwaiver of Governmental Immunity. The insurance carrier exprrssy 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 iMMUDity 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, fovea shall be responsible for asserting any defense of governmental immunity, and may do so at anytime 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 governmenta immunities shall not otherwise change or alter the coverage available under the policy. ECIMEN Page 3 of 3 Schedule A Property (Jr Vendors March 2016 10 OP ID: 01 del C.— �I(r— ' �,..,.. DATE (MM/DD/YYYY) 08/03/2016 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(les) 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 Iowa Municipal Insurance PO Box 398 Humboldt, IA 50548 Iowa Municipal Insurance, LTD NAME: Iowa Municipal Ins, Pete Holt (ac,NNo, Ext); 800-320-2953 FAX No): E-MAILDESS: petem@iamunicipalins.com PRODUCER CUSTOMER ID #: KEYWE-1 INSURER(S) AFFORDING COVERAGE NAIC # INSURED Key West Community Fire Depart Fire Chief 10480 Timothy Street Dubuque, IA 52003 INSURER A: Continental Western Group LIABILITY OCCUR INSURER B INSURER C: 11/01/2015 INSURER D : EACH OCCURRENCE INSURER E : 2,000,000 INSURER F : DAMAGES(RENTED PREMISES (Ea occurrence) CERTIFICATE 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 (MMIDD/YYYY) LIMITS A GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY OCCUR X FDK 2373220 11/01/2015 11/01/2016 EACH OCCURRENCE $ 2,000,000 X DAMAGES(RENTED PREMISES (Ea occurrence) $ 500,000 CLAIMS -MADE X MED EXP (Any one person) $ 10,000 PERSONAL & ADV INJURY $ 2,000,000 GENERAL AGGREGATE $ 10,000,000 GEN'LAGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 10,000,000 X POLICY PRO- JFCT LOC $ A AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS FDK2373220 11/01/2015 11/01/2016 COMBINED SINGLE LIMIT (Ea accident) $ 2,000,000 X BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (PER ACCIDENT) $ $ $ UMBRELLA LIAB EXCESS LIAB OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DEDUCTIBLE RETENTION $ $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS Y / N N / A WC STATU- OTH- TORY LIMITS ER E.L. EACH ACCIDENT $ below E.L. DISEASE - EA EMPLOYEE $ E.L. DISEASE - POLICY LIMIT $ A Liquor Liability FDK 2373220 11/01/2015 11/01/2016 Common Ca Aggregate 2,000,000 2,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101 Additional Remarks Schedule, if more space is required) It is agreed that the City of Dubuque will be endorsed as Addiitionai Insured, per their specific Insurance Requirements for Special Events Permits - Insurance Scehdule D, relating to Key West Community Fire Departments Appreciation Days activites. ER CANCELLATION City of Dubuque City Manager 50 West 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 Iowa Municipal Insurance, LTD ACORD 25 (2009/09) © 1988-2009 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD KEY WEST FIRE AND EMS TRAINING LOG DATE: /0-3-/ 6 TIME: Too- /goo TOPIC: 1-110rA4r `T- rainht? CEH NUMBER: — NO. OF CEHS — INSTRUCTOR: clqvck 614,5eA wrri, Dakatic jz Depr INITIAL NAME S)7A4-ruee_ CERTIFICATION NUMBER Arnold, Brian ,,,C 6/ ii r' -22-300-01 Arnold, Kate "Se„, - ., EMT -01-1004-10 Arnold, Nick ;AIX p...,..,, 'MT -08-1004-85 Arnold, Zach-40P---- '''' EMT -08-1005-01 Blasen, Chuck PM -22-016-05 Bradley, Dennis PS -22-004-20 Breitbach, Tyler Burke, Kyle PM -01-305-03 Denlinger, Carl Enke, Craig P-01-306-02 Fetzer, Matt , Ginther, Tony EMT -01-1014-03 Healey, Rhonda PM -01-308-01 Hoffman, Tim VW” _ EMT -01-1001-04 Kafer, Steve ...---Y r (•('' EMR -08-204-34 Latham, Lisa – _.4, ---.1.,--4,,'-22-300-04 Latham,Todd ,-----„ - . , EMT -01 -342 -08 - Lawler, Corey tie'(1/4fr‘ li' EMR -01-202-06 Leonard, Pat 4. EMR -22-202-02 Ness, Sarah ( 'oak" - EMT -01-1018-16 O'Brien, Mark bt...„ PM -01-309-11 Ben, Pancratz !J Reed, Robert P-01-309-04 Small, Mike / I //' 1-01-301-06 Tigges, Christopher Z,( EMT -01-360-07 White, Daniel ---r& , _ — PM -01-1601-04 White, Hans Welu, Chrisee:<---------- PM -01-1602-02