Loading...
HomeMy WebLinkAboutAspro Inc-4/16/2012FORM OF CONTRACT CONTRACT FOR THE CONSTRUCTION OF F.Y. 2012 STREET RECONSTRUCTION PROGRAM CITY OF WATERLOO, IOWA CONTRACT NO. 819 This contract made and entered into this 1 Vjcday of . LL , 2012 -by and between the City of Waterloo, Iowa, a Municipal Corporation, (hereinafter referred to as City), and ASPRO, INC. referred to as Contractor), WITNESSETH: of Waterloo, Iowa, (hereinafter PAR. 1 Contractor agrees to build and construct the FY 2012 STREET RECONSTRUCTION PROGRAM, CONTRACT 819 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. PAR. 2 PAR. 3 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 furnish 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. PAR. 4 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 FORM OF CONTRACT PAGE 1 OF 5 PAGES PAR. 5 PAR. 6 PAR. 7 PAR. 8 PAR. 9 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 November 16, 2012 , 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 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 carry 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. FORM OF CONTRACT PAGE 2 OF 5 PAGES PAR. 10 PAR. 11 PAR. 12 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. PAR. 13 The Contractor agrees to furnish 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. PAR. 14 PAR. 15 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. FORM OF CONTRACT PAGE 3 OF 5 PAGES PAR. 16 PAR. 17 PAR. 18 PAR. 19 PAR. 20 PAR. 21 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 $7A49,459.97. 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. 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 govern. 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 less 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. 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. 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 Tess 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 PAGE 4 OF 5 PAGES CITY O WATERLOO, IOWA ayor City Clerk ASPRO, INC. Contractor BY: ir/,� Title: ''RESIDENT Approved by the City Council of the City of Waterloo, Iowa, this 101 day of k , 2019:- ATTEST: 019: ATTEST: , City Clerk Waterloo, Iowa FORM OF CONTRACT PAGE 5 OF 5 PAGES .030Vd Z 40 t 3OVd 0N09 40 6!W04 'Pelle pug eoioj pnl u4 uiewaJ 0 estnuat)a 'tea ou do two pion aq of si uopeOngo et0 uetl} t nejep gone Rue pooh 6uptew ut Jnout i(ew g 4014M sesuadxa pue sR0gno gB ee6iig0 eLl. Rede) pue esJngwlaJ Rllni Balis pue 'os op in sap; 4o Uossal Itq Jam}ns Itew It gottim ea6etuep pus woo pe W04 ae ijgo eta ssajwey OROS pus AlluwePu1 Ritts begs puri 'ewes ay; Joj paunOui spuswap pue supio pe #4sues nets pup ',pump Joual pue swiel el6 of 6uiplcooe 4oeJ;uo0 pies siq 41UmJ sloadseJ pe ui HBO IOdiulJd a4t i4 'MON 'Mgl Rq pepinoid se pegsllgeese ueaq eneq tietis ao!Jd 4oai uoo oq jo uonlod pigs 4suie6e mmo pies jo swim° eyt seem uogelodloo Jo `stwi}'suosied piss 01 eglell e4 2ou.4legs /ping pus Isdioupd eq inq'4uewenoldwi 011gn, e4140 uopaidwoo Rpm UIOIOJ a4 pellnb$J si uoi}eaodloo oiignd et6 yoigM enpd paquoo ate jo uoptod et{) i01110 IOU we ewes etg uet1M uant6 sl puoq tio4gM »a 4un000e uo IOW Uoa a4) jo eoudtwojied et{l ig peplum). siepapwtu 40 pewloped /opt Joj wag} enp swieia )sn! pe 's1000w Uoogns 4llM 10 I0dtoupd et1 411M Riioo.gp sloel4uoo 6aint3q suopiodioo Jo sun 'suosred He 01 Red 04 eaz6e Agway puoq sitg uo Awns pug lediotald 041 `SV3313HM pus Meng 416ue13e wow eJoM iptquoo plasm se Ria aidwao pue tins se palsy ped n pew pus utaiay palwodhooui 0rsuoneindp pue 'sUOi}pwoo 's}UBtlOAOO 'stwei 04410 Its 41tM Je4)e604 'laaquoa goitim Jo Moo e 61.9 'oN 4eJ;uo0 - weJ6oid 40i;oru;suo091:1;baa;S Z 60Z 'A'd uofoM#Suoo etn JO; 'OMo1 '001194VM }o A110 0144 411M 4a0Jluoo uapiJM a owl Jews a 6 02 ` / e/6/6/ jo Asp 7/ aril uo 'pip lodiouiki uepunoq enoge sin SV3l43HM 'PA ions sl NO41V$1190 911-11 dO NOLUONOO SRL -swami 088141 Rq Awn 'Rit +es pus Apttto('slo46Jistuttupe pue 'sio4noexa'su6lsse 'sloss9ans qtrneswiti spu4q R40mg pies 0l pus'aJO4eIsiu4Wpe pus'W04n0axg '41494 J4 iy `seniesInatiltgleswlq spulq Aiwa 01014 iedioupd 014;'epees aq 01 Rlrul pus ppM'wns 4014m 10 3uewlled 04'ssisIS pefun a1J J,0 'Wow NMI 1=67;70 006/LI' Pue eu!N AMA paJpunH Jnod puesnoyl awN Auod paJpunH Jnod uoIMIN uenes JO MS plied etli ul'(oe6 qO 044 ppea Jeljeul la14? aoµs}st1A;o Alto etp ooun punoq *ID Pus PR we '(i oanS et6 poaea aaleuleiatt) HN ' Je;sayouew JO Auedwo0 aoueinsui Apeioeds ueouawy UPON pUe'(Iediotlild e44 pew Ja)Jeulaleg) b'I oopowm j0 ` out 'adsy 'OMjt�tj.L :SIN3S321d 3S3H1 A8 N31A1 T1V MON I QNOS 33NVIR11;1O*t3d 9.178991.Z 'oN Puoe S3011d Z 30 Z BOW 01108 dO PINO4 }oel-ui-Aawo4y 'Jaunna3 auuy -u4 AOWOW Auedwo0 aouemsui AIeioads ueouawy 11-10 i/o' y ' 40 AV—7 / Wasp* pue spurn; Jno les olunelet' emq eM'30M13MM SS3NJJM NI •paldece src IoM tpris eute qua went) X1101 ttnna 01 Jo p010A raslp 10u lalienuu Jo dpjeueuppom uI }oe ep Jo} puoq sltll uo ens o tpti atqi taut st{l 4o eoueldepoe eq jo awe eta woo melt (6) euo uetp sal q swill tpp{M p1 a eq perk lOUquoa Jat110 Atte 4o JO puoq slip 40 uoiWosd ou 18111, •g '9SB9J0t11 seem tons of se Alco pampa eq uetp Ilegs aue'aajid pag000 Idol etli 40 (%OZ) ;timed Alumni uegi ezow jo es euoul ue eAlonul l0U seap 'e8uego tpns uetput lasJluoo J0 'suogeoppeds 'sued etp u! eluetp due o1 Z Immo sql. 'moped 01 tiomm ul peg= aril o; ewp Jo uolsuo N. • 1 :eogou tram luesuaO ol'Sulpue$tl lou Nemo° atp of velum Me 'meg pue peweep eq Begs puoq sit uo dlwwns dten3 a Bond No. 2156846 PANT BOND KNOW ALL MEN BY THESE PRESENTS: that Aspro, Inc. (Name of Contractor) P.O. Box 2620, Waterloo, IA 50704 a and (Address of Contactor) Corporation , hereinafter called Principal, (Corporation, Partnership or Individual) North American Specialty Insurance Company (Name or Surety) 650 Elm Street, Manchester, NH 03101 (Address of Surety) hereinafter called Surety, are held and firmly bound unto City of Waterloo (Name of Owner) 715 Mulberry Street, Waterloo, IA 50703 (Address of Owner) hereinafter called OWNER, in the penal sum of Dollars, $( 7,449,459.47 ) ** Seven Million Four Hundred Forty Nine Thousand Four Hundred Fifty Nine and 47/100 in lawful money of the United States, for the payment of which sum well and truly to be made, we bind ourselves, successors, and assig- s, jointly and severally, firn iy by these presents. THE CONDITION OF THIS OBLIGATION is such that whereas, the Prinoipal entered into a certain contract with the OWNER, dated the 11, day of ,C" f f / 20 12, a copy of which is hereto attached and made a part hereof for the construction of: F.Y. 2012 Street Reconstruction Program - Contract 819 NOW, THEREFORE, if the Principal shall promptly make payment to all persons, firms, SUBCONTRACTORS, and corporations famishing 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 commotion 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 hill 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 contractor 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 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 olahn may be unsatisfied. IN WITNESS HEREOF, this instrument is executed in which shall be deemed an original, this the / 20 12 ATTEST: Witness as to Principal P.O. Box 2620 6 counterparts, each one of (number) Aspro, Inc. day of 6//P' r �" Principal By//'% / /(J ) /. P. Box 2620 (Address) Waterloo, IA 50704 (s) (Address) Waterloo, IA 50704 North American Specialty Insurance Company ATTEST: Witness as to Suret!j Cindy Bennett u moi./ IOW Tiff AV, rety P.O. Box 9207 Anne Crowner, Attomey-in-fact (Address) P.O. Box 9207 Des Moines, IA 50306-9207 (Address) Des Moines, IA 50306-9207 NOTE: Date of BOND roust not be prior to date of Contract. If CONTRACTOR is Partnership, all partners should execute BOND. 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 LAURE GUISINGER JOINTLY OR SEVERALLY Its true and lawful Attomey(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 undertaldng 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 24th of March, 2000: "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 Attomey 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, President & Chief Executive Officer of Washington International Insurance Company & Senior Vice President of North American Specialty Insurance Company By David M. Layman, Senior Vice Presiden 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 this20th day of March 2012 State of Illinois County of Cook ss: North American Specialty Insurance Company Washington International Insurance Company On this 20th day of March , 20 12 , before me, a Notary Public personally appeared Steven P. Anderson , President and CEO of Washington International Insurance Company and Senior Vice President of North American Specialty Insurance Company and David M. Layman , Senior 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. {giSP1WrA—LvSEAL" DONNA D. SKLENS Notary Public, State of Illinois My CAuimission Expires 1Of06i20Is Donna D. Sklens, Notary Public I, James A. Carpenter , 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 1h day of ✓/cA A G , 20 12 . James A. Carpenter, Vice President & Assistant Secretary of Washington International Insurance Company & North American Specialty Insurance Company OP ID: EC ,ACRO CERTIFICATE OF LIABILITY INSURANCE 11/04/11 ) 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 pollcy(les) must be endorsed. If SUBROGATION 15 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 615-309-8200 AHROLD FAY ROSENBERG, INC. 604 Locust St., Ste. 800 516-309-6225 Des Moines, IA 50309-3713 Drew J. Ahrold ONTACT NAME' Pie C No. Ed): FAX No): E-MAIL ADDRESS: CUSTOMER ASPRO-1 CUSTOMER ID d: INSURER(S) AFFORDING COVERAGE NAIL 0 INSURED Aspro, Inc. P.O. Box 2620 Waterloo, IA 50704 INSURER A:EMC Insurance Companies 21415 INSURER B 9D81383 INSURER C : 12/01/12 INSURER D : $ 1,000,000 INSURER E : DAEMISMAGEES(Ea TO RENTED occurrence) PR 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 LTR TYPE OF INSURANCE ISR NSR wv SUBR POLICY NUMBER �D/YEYYYY) FF DIYY Y) LIMITS A A A GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY OCCUR X 9D81383 12/01/11 12/01/12 EACH OCCURRENCE $ 1,000,000 X DAEMISMAGEES(Ea TO RENTED occurrence) PR $ 100,000 CLAIMS-MADE X MED EXP (Any one person) $ 5,000 X Contracutal Liab PERSONAL 8 ADV INJURY $ 1,000,000 X XCU Included GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 1,000,000 7 POUCY X JPERo- LOC Emp Ben. $ 1,000,000 A AUTOMOBILE LABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS 9E81383 12/01/11 12/01/12 COMBINED SINGLE LIMIT (Ea accident) $ 1,000,000 X BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per modern) $ X X $ $ A X UMBRELLA LIAB EXCESS LAB X OCCUR CLAIMS -MADE 9J81383 12/01/11 12/01/12 EACH OCCURRENCE $ 5,000,000 AGGREGATE $ 5,000,000 DEDUCTIBLE RETENTION $ 10000 $ _ X $ A WORKERS COMPENSATION AND EMPLOYERS' UABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS Y 1 N N / A 9M81383 12/01/11 12/01/12 X WC STATU- OTH- TORY LIMITS ER E.L EACH ACCIDENT $ 500,000 E.L. DISEASE - EA EMPLOYEE $ 500,000 below E.L. DISEASE - POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS / LOCATIONS 1 VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) Certificate holder is an additional insured w th respect to any and all work performed by the named insured. CERTIFICATE HOLDER CANCELLATION CITY -11 City of Waterloo 715 Mulberry Street 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 (2009/09) © 1988-2009 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD