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HomeMy WebLinkAboutAecom Technical Services-5/28/2013Letter of Transmittal TO: Ms. Suzy Schares City Clerk 715 Mulberry Street Waterloo, Iowa 50703 WE ARE SENDING YOU: O Attached ❑ Shop Drawings ❑ Copy of Letter ❑ Prints ❑ Change Order DATE: May 23, 2013 JOB ID NO. 60275974 ATTENTION: RE: Rehabilitate T -Hangar "A " Roofing and Siding Waterloo Regional Airport ❑ Under Separate Cover Via the Following Items: ❑ Plans D Samples ❑ Specifications El Copies Date No. Description 4 Contracts for T -Hangar "A" Roofing and Siding at the Waterloo Regional Airport (Signed by Contractor - Prairie Construction) THESE ARE TRANSMITTED AS CHECKED BELOW: ❑ For Approval ❑ Approved as Submitted ❑ For Your Use ❑ Approved as Noted ❑ As Requested ❑ Returned for Corrections O For Review and Comment 0 For Mayor's Signature ❑ For Bids Due 20 REMARKS: O Resubmit _ Copies for Approval O Submit _ Copies for Distribution O Return Corrected Prints ❑ Prints Returned After Loan to Us COPY TO: DWS:blc 501 Sycamore Street, Suite 222 If enclosures are not as noted, kindly notify us at once. P.O. Box 1497 • Waterloo, Iowa 50704-1497 Douglas W. Schindel, P.E. • (319) 232-6531 • Fax: (319) 232-0271 FORM OF CONTRACT CONTRACT FOR THE CONSTRUCTION OF REHABILITATE T -HANGAR 'A' ROOFING AND SIDING AT THE WATERLOO REGIONAL AIRPORT IN THE CITY OF WATERLOO, IOWA IOWA DOT CSVI PROJECT This contract made and entered into this dX � day of C'1C Li 2013, by and between the City of Waterloo, Iowa, a Municipal Corporation, (hereinafter referred to as City), and Prairie Construction Services, Inc. of Waterloo, Iowa, (hereinafter referred to as Contractor), WITNESSETH: PAR. 1 PAR. 2 PAR. 3 PAR. 4 PAR. 5 PAR. 6 PAR. 7 Contractor agrees to build and construct the REHABILITATE T -HANGAR 'A' ROOFING AND SIDING AT THE WATERLOO REGIONAL AIRPORT and furnish all necessary tools, equipment, materials, and labor necessary to do all the work called for in the plans and specifications in a workmanshiplike manner and for the prices set forth in Contractor's proposal, which was accepted by the City, and which is understood and agreed to be a part of this contract. It is understood and agreed that the resolution adopted by the City Council ordering the construction of the improvement, the Notice to Contractors as published, the Instruction to Bidders, the Form of Proposal, the Construction .and Maintenance Bonds, the Council Proceedings relating to this matter, and the Plans and Specifications shall all be considered as forming a part of the contract the same as though they were each set out in said contract. The Contractor agrees to fumish at its own cost and expense, all necessary materials and labor for said work and to construct said improvements in a thorough, substantial, and workmanlike manner, and in strict accordance with the requirements of this contract, and of the plans and specifications made a part hereof by reference, and to the satisfaction and approval of the City and its engineer. The Contractor agrees to perform said work and install said improvements on the terms set out in bid or proposal to the City which has been accepted by the City and which is by reference made a part of this contract. The Contractor agrees to commence said work within ten (10) working days after receipt of "Notice to Proceed" and complete it on or before August 31, 2013 unless an extension of time is granted in writing by the Council of the City. Should the Contractor fail to complete said improvements in strict accordance with the terms and conditions of this contract, or the plans and specifications therefor promptly by the date herein specified, the City may pay such additional sums as it may be required to pay by reason of the failure of said contractor and deduct any and all such sums from any amount then due the Contractor. The Contractor agrees to comply with and obey all ordinances of the City of Waterloo, Iowa, relating to the obstruction of streets and alleys, keeping open passage ways for water, traffic, and protecting any excavations in any street or alley, and maintaining proper and sufficient FORM OF CONTRACT AECOM 60275974 REHABILITATION T -HANGAR 'A' C-1 of 4 PAR. 8 PAR. 9 PAR. 10 PAR. 11 PAR. 12 PAR. 13 barricades with lights and signals during all hours of darkness, to see that the backfilling is properly done, and agrees to keep the City whole and defend any and all suits that may be brought against the City by reason of any injuries that may be sustained by any person or property allegedly caused by the Contractor, or his agents, while work is done pursuant to this agreement. The Contractor agrees that in the event a law suit is brought against the City for damages allegedly sustained by reason of any act, omission or negligence of the Contractor or its agents, or on account of any injuries allegedly sustained by reason of any obstruction, hole, depression or barrier placed or dug by the defendant or its agents, in the doing of the work herein contracted for, that it will defend said suit and save the City harmless therein, and in case judgment is rendered against the City, the Contractor agrees to pay the same promptly. The Contractor agrees to cavy public liability insurance in a solvent company in a sufficient amount to protect the City and those who use the streets of the City. The City shall have the right to appoint one or more construction reviewers who shall review the progress of the work in detail; also, to make any test or any material to be used in such work. No material shall be used in any work until the same has first been approved by the construction reviewer. Such construction reviewer shall have full authority to pass judgment upon all materials and upon the manner of doing the work, and their judgment on rejecting any materials, substance, or manner of work shall be final unless it is revoked or modified by the City Engineer. Any material, which has been rejected by the construction reviewer, shall be at once removed from the line of work and shall not be again taken thereon or placed with the material proposed to be used without the written consent of the City Engineer. The Contractor shall maintain no cause of action against the City on account of delays and prosecution of work, but if said work is delayed by the City, the Contractor shall have such extra time for completion of the job as was lost by reason of the delay caused by the City. The Contractor agrees to pay punctually all just claims of labor, material, men, or subcontractors who shall perform labor or fumish materials entering into this improvement. It is agreed that the City need not pay the Contractor until all such claims are paid by the Contractor. It is agreed that the City shall not be liable for said labor, material, or men under this contract. The Contractor agrees to fumish the City, simultaneously with this contract, a bond on a form to be provided by the City in the amount provided by law as stated in the Notice to Bidders, which shall be for the benefit of the City, and any and all persons injured by the breach of any of the terms of this contract. Said bond shall be filed with the City Clerk and shall be subject to the approval of the City Council, and is by reference made a part of this contract. FORM OF CONTRACT REHABILITATION T -HANGAR 'A' C-2 of 4 AECOM 60275974 PAR. 14 PAR. 15 PAR. 16 PAR. 17 The Contractor agrees that should it abandon work under this contract or cease the prosecution thereof for a period of thirty (30) consecutive days without reasonable cause, and should it fail to proceed with said work within ten (10) days after a notice to continue or carry it on has been mailed to it at the address given herein by the City, or after such notice has been served on it, then the City may proceed to complete said work, using any material, tools, or machinery found along said line of work, doing the work either by contract or as it may elect, and the Contractor and the sureties on its bond shall be liable to the City for the costs and expenses so paid out. Said costs shall be retained by the City from any compensation due, or to become due the Contractor, and may be recovered by the City in an action upon Contractor's bond. In consideration of the full compliance on the part of the Contractor with all the provisions, stipulations, and conditions hereof, or contained in the various instruments made a part of this contract by reference, and upon completion and acceptance of said work, the City agrees to pay to the Contractor, in the manner set out in the Notice to Contractors, the amount of money due the Contractor for work performed and accepted, at the unit prices set out in the Contractor's proposal, which has been accepted by the City. The total amount of the contract, based on the Engineer's estimates of quantities and the Contractor's unit bid prices, and for which 100% surety bond is required is $ 63,510.00 . After the completion of said work, the Contractor agrees to remove all debris and clean up said streets, and to save the City harmless from any damage allegedly resulting from a failure to clean up and remove the debris or put the street back in a proper condition for travel. PAR. 18 This contract is not divisible, but in the event of a conflict between this contract and the various instruments incorporated by reference, this contract shall govem. PAR. 19 Before the Contractor shall be entitled to receive final payment for work done under this contract, it shall execute and file a bond in the penal sum of not Tess than 100% of the total amount of the contract, same to be known as "Maintenance Bond," and which bond must be approved by the City Council, and which bond is in addition to the bond given by the Contractor to guarantee the completion of the work. PAR. 20 The Contractor shall maintain all work done hereunder in good order for the period of two (2) years from and after the date it is accepted by the Council of the City of Waterloo, Iowa. Said maintenance shall be made without expense to the City or the abutting property. In the event of the failure or default of the Contractor to remedy any or all defects appearing in said work within a period of two (2) years from the date of its acceptance by said Council, and after having been given ten (10) days notice so to do by registered letter deposited in the United States Post Office in said town, addressed to said contractor at the address herein given, then the City may proceed to remedy such defects. The costs and expenses thereof to be recovered from the Contractor and the sureties on its maintenance bond by an action brought in any court of competent jurisdiction. PAR. 21 The Contractor shall give notice to said City by registered letter directed to the Mayor or City Clerk/Auditor thereof not more than four (4) and not less than three (3) months prior to the expiration of the term during which the Contractor is required to maintain said improvements, in good repair by the terms of its Contract. The liability of the Contractor and of the sureties on its bond for maintenance of the said improvements shall continue until three (3) months after such notice has been given to the City, and, in any event, until two (2) years after the acceptance of the work. FORM OF CONTRACT AECOM 60275974 REHABILITATION T -HANGAR 'A' C-3 of 4 CITY WATERLOO, IOWA City erk Prairie Construction Services, Inc. Contractor BY: Charles Seastrand Titre: C.E.O. Approved by the City Council of the City of Waterloo, Iowa, this c .7 day of ATTEST: FORM OF CONTRACT AECOM 60275974 , City Clerk Waterloo, Iowa 2013. REHABILITATION T -HANGAR 'A' C-4 of 4 Bond No. 2171157 PERFORMANCE BOND KNOW ALL MEN BY THESE PRESENTS: That we, Prairie Construction Services, Inc. of Waterloo, Iowa (hereinafter called the Principal), and North American Specialty Insurance Company of Manchester, New Hampshire (hereinafter called the Surety), are held and firmly bound unto the City of Waterloo (hereinafter called the Obligee), in the penal sum of Sixty Three Thousand Five Hundred Ten Dollars {$63151000), lawful money of the United States, to payment of which sum, well and truly to be made, the Principal here firmly bands himself/themselves, his/their heirs, executors, and administrators, and the said Surety binds himself, his successors, assigns, executors, and administrators, jointly and severally, firmly by these presents. THE CONDITION OF THIS OBLIGATION is such that, WHEREAS the above bounden Principal did, on the day of VI \. 2013, enter into a written contract with the City of Waterloo, Iowa, for the construction of" -Rehabilitate T Hanoar'A' Roofing and Sidino at the Waterloo Reolo al Alroort , a copy of which contract, together with ail of its terms, covenants, conditions, and stipulations, is incorporated herein and made a part hereof as full and completely as if said contract were recited at length herein; and WHEREAS, the Principal and Surety on this bond hereby agree to pay to all persons, firms or corporations having contracts directly with the Principal or with subcontractors, all just daims due them for labor performed or materials furnished in the performance of the contract on account of which bond Is given when the same are not satisfied out of the portion of the contract price which the public corporation is required to retain until completion of the public improvement, but the Principal and Surety shall not be liable to said persons, firms, or corporation unless the claims of said claimants against said portion of the contract prig shall have been established as provided by taw. Now, if the Principai shall in all respects fulfill his said contract according to the terms and tenor thereof, and shall satisfy alt claims and demands incurred for the same, and shall fully indemnify and save harmless the Obligee from all costs and damages which it may suffer by reason of failure to do so, and shall fully reimburse and repay the Obligee all outlays and expenses which it may incur in making good any such default, then the obligation is to be void and of no effect, otherwise to remain in full force and effect Every Surety on this bond shalt be deemed and held, any contract to the contrary notwithstanding, to consent without notice: 1. To any extension of time to the Contract In which to perform the Contract. 2. To any change in' he pians, specifications, or Contract when such change does not involve an increase of more than twenty percent (20%) of the total Contract price, and shall then be released only as to such excess increase. 3. That no provision of this bond or of any other contract shall be valid which limits to Less than one (1) year from the time of the acceptance of the work the right to sue on this bond for defect in workmanship or material not discovered or known to the Obligee at the time such work was accepted. PERFORMANCE BOND AECOM 00275974 REHABILUTATiON T -HANGAR 'A' PFB-1 of 2 ZJO z -83d PL65LZ09 MON d, aV9NVH-i NOLL'aillaVITA1 0N09 SONvwao d 'allos swam memo sisuped pe teRsieWed s! 8010%11NO3 dl . pe. }uoo jo amp a3 Jo!ld aq lou ;sew 0N09 JO Ma :310N [AswoyJo JeNtOd goal ped-u!-Aewouv :aill.I. puu seas sa1E :A8 OWN Auedwoo eouemsul Aploeds ueouawy 1-11J0N •oul ` eovues uoi;orulsuo3 Wald maws 1VdIONRld " jo se quos aoueltho;ted slg; pa exe snag Awns gee j d pupil pau6siepun e n 1do383I-SIA SS3N IM NI Bond No. 2171157 PAYMENT BOND KNOW ALL MEN BY THESE PRESENTS:that Prairie Construction Services, Inc. (Name of Contractor) 321 West 18e' Street. Waterloo. Iowa 50702 (Address of C-ontractor) a Corporation hereinafter called Principal, (Corporation, Partnership or Individual) and North American Specialty Insurance Company (Name of Surety) 650 Elm Street, Manchester, New Hampshire 03101 (Address of Surety) hereinafter called Surety, are held and firmly bound unto City of Waterloo, Iowa (Name of Owner) 715 Mulberry Street. Waterloo. Iowa (Address of Owner) hereinafter called OWNER, in the penal sum of Sixty Three Thousand Five hundred Ten Dollars, $( 53,510.00 ) in lawful money of the United States, for the payment of which sum well and truly to be made, we bind ourselves, successors, and assigns, jointly and severally, firmly by these presents. THE CONDITION OF THIS OBLIGATION is such that whereas, the Principal entered into a certain contract with the OWNER, dated the ,4..'- day of , 2013, a copy of which is hereto attached and made a part hereof for the construction>of The extent of the work involved ;is the construction of the removal and replacement of the metal roofintz, the removal and replacement of the metal siding other than the bi-fold doors, and such other work as may be incidental thereto: NOW, THEREFORE, if the Principal shall promptly make payment to all persons, firms, SUBCONTRACTORS, and corporations furnishing materials for or performing labor in the prosecution of the WORK provided for in such contract, and any authorized extension or modification thereof, including all amounts due for materials, lubricants, oil, gasoline, coal and coke, repairs on machinery, equipment and tools, consumed or used in connection with the construction of such WORK, and all insurance premiums on said WORK, and for all labor, performed in such WORK whether by SUBCONTRACTOR or otherwise, then this obligation shall be void; otherwise to remain in full force and effect. PROVIDED, FURTHER, that the said Surety for value received hereby stipulates and agrees that no change, extension of time, alteration or addition to the terms of the contract or to the WORK to be performed thereunder or the SPECIFICATIONS accompanying the same shall in any wise affect its obligation, on this BOND, and it does hereby PAYMENT BOND AECOM 60275974 REHABILITATION T-HANGAR'A' PB -1 oil waive notice of any such change, extension of time, alteration or addition to the terms of the contract or to the WORK or to the: SPECIFICATIONS. PROVIDED, FURTHER, that no final settlement between the OWNER and the CONTRACTOR shall abridge the right of any beneficiary hereunder, whose claim may be unsatisfied. IN WITNESS HEREOF, this instrument is executed in three (3) counterparts, each one of (number) which shall be deemed an original, this the day of 11\.P 2013. ATTEST: (Principal) See,etary (SEAL) X0.0% 321 West 18th Street Prairie Construction Services, Inc. / ar es eas r.nd, .E.O. 321 West 18th Street (Address) Principal Waterloo, Iowa 50702 (Address) Waterloo, Iowa 50702 North. erican Specialty Insurance Company Surety Witness as to Surety (Address) Des Moines, Iowa 50306-9207 By Attorney -in -Fact Anne Crowner Holmes Murphy & Associates, Inc. P. O. Box 9207 (Address) Des Moines, Iowa 50306-9207 NOTE: date of BOND must not be prior to date of Contract. If CONTRACTOR is Partnership, all partners should execute BOND. PAYMENT BOND REHABILITATION T -HANGAR W PB -2 of 2 AECOM 80275974 P - 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 Attomey 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." otimituto gat SEAL 10 Steven P. Anderson, Senior Vice President of Washington International Insurance Company 1971 Qy p & Senior Vice President of North American Specialty Insurance Company VUJNt IIIGIN 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 N"oPF[t1ALSEAL" 1 DONNA D. SKLENS Notary Public, Sudo of Illinois 44, My Commission Elites 10(0612015 � £XelkAz Donna D. Sklens, Notary Public I, 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 Jeffrey Goldberg, Vice President & Assistant Secretary of Washington International Insurance Company & North American Specialty Insurance Company •• a S f ' CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YWI) 5/8/2013 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS N0 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). PROWLER TrueNorth PO Box 1863 500 First Street SE Cedar Rapids IA 52406-1863 CONTACTAME TrueNorth Risk Management PHONE FAX No. EXt1:319-366-2723 (A/C, Not:877-810-6374 E-MAIL aDDREss:cert p s@truenorthcom anies.com INSURER(S)AFFORDING COVERAGE NAIC0 INsuRERA:United Fire & Casualty Co...any 13021 INSURED PRAICON-05 Prairie Construction Services, Inc 321 W 18th Street Waterloo IA 50704 INSURER B : 60407837 INSURER C: 10/4/2013 INSURER D : $1,000,000 INSURER E : $100,000 INSURER F : COVERAGES CERTIFICATE NUMBER: 957702656 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POUCIES 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 POUCIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POUCIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. I LTRR TYPE OF INSURANCE INSRSR L SUBR WVD POUCY NUMBER EFF (MMMIDDIYYYY) EXP (MMMIDD/YYYY) LIMITS A GENERAL X LIABILITY COMMERCIAL GENERAL UABIUTY 60407837 10/4/2012 10/4/2013 EACH OCCURRENCE $1,000,000 DAMAGE TO RENTED PREMISES (Ea occurrence) $100,000 CLAIMS -MADE X OCCUR MED EXP (My one person) $5,000 PERSONAL & ADV INJURY $1,000,000 GENERAL AGGREGATE $2,000,000 GEM_ AGGREGATE UMITAPPUESPER: 7POUCY nJECaT 1-1 LOC PRODUCTS - COMP/OP AGG $2,000,000 $ A AUTOMOBILE X X LIABILITY ANY AUTO CO OWNED HIRED AUTOS - X �OESDULED AUTOSED 60407837 10/4/2012 10/4/2013 COMi31Nt:D SINGLE Lem] (faaccident' MI $1,000,000 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PPeOraEtDAMAGE $ $ A X UMBRELLA UAB EXCESS UAB X OCCUR CLAIMS -MADE 60407837 10/4/2012 10/4/2013 EACH OCCURRENCE $10,000,000 AGGREGATE $10,000,000 DED X RETENTION $None $ A WORKERS COMPENSATION AND EMPLOYERS' UABIUTY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS below N / A 60407837 10/4/2012 10/4/2013 X WC STATU- OTH- TORY LIMITS ER E.L. EACH ACCIDENT $500,000 E.L. DISEASE - EA EMPLOYEE 8500,000 E.L DISEASE - POUCY OMIT $500,000 DESCRIPTION OF OPERATIONS I LOCATIONS 1 VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space is required) If Y 's indicated above for add'I insd Gen Liab forms CG7103 06/11 (ongoing wk/premises) & CG7150 03/06 (completed operations) apply & Primary & Noncontributory conditions included. If Y is indicated above for Auto Liab Additional Insured form CA7109 01/06 applies. If Y is indicated above for waiver of subrogation Gen Liab form CG7103 05/06, Auto Liab form CA7109 01/06 & WC form WC000313/4/84 (IA only) applies. Umbrella is following form per policy provisions and conditions. Coverage is for work performed and terms required under written contract with the above named insured. Project #PCS -13-9009 - City of Waterloo Rehabilitate T -Hanger 'A' Roofing & Siding at the Waterloo Regional Airport, Waterloo, IA CERTIFICATE HOLDER CANCELLATION City of Waterloo 715 Mulberry St Waterloo IA 50703 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 ACORD 25 (2010/05) © 1988-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD