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HomeMy WebLinkAboutAcord-5/17/2010'.4Ec'fitf CERTIFICATE OF LIABILITY INSURANCE �•- OP ID , LMD ACTIV-2 D/YYYY) 04/26/10 IN ORMATIOIS EXTEND OR BELOW PRODUCER A W Welt Ambrisco Ins., Inc. 24 Westside Drive Iowa City IA 52246 Phone: 319-887-3700 Fax:319-887-3701 THIS CERTIFICATE IS ISSUED AS A MATTER 0 ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, ALTER THE COVERAGE AFFORDED BY THE POLICIES INSURERS AFFORDING COVERAGE NAIC # INSURED Active Thermal Concepts Inc. Dave Reisner 2805 Stonegate Ct Hiawatha IA 52233 1 INSURER k Arch Specialty Insurance Compa LIABILITY COMMERCIAL GENERAL LIABILITY INSURER B: West Bend Insurance Co. 15350 INSURER C: $ 3 , 000 , 000 X INSURER D: $50,000 INSURER E: MED EXP (Any one person) $ 5 000 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. NSR LTR ADO. INSRC TYPE OF INSURANCE POUCY NUMBER POUCY EFFECTIVE DATE (MM/DD/YYYY) POUCY EXPIRATION DATE (MM/DD/YYYY) LIMITS A GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY 12EMP4352905 INCLUDED GL DED $5000 02/18/10 02/18/11 EACH OCCURRENCE $ 3 , 000 , 000 X pREMISEs(Eaocourence) $50,000 CLAIMS MADE X OCCUR MED EXP (Any one person) $ 5 000 X Asbestos Abatemnt PERSONAL &ADV INJURY , $ 3,000,000 $ 3, 000,000 $ 3 0 0 0 0 0 0 X Pollution ded $5k GENERAL AGGREGATE GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG X 1 POLICY n JECT LOC Pollution 3,000,000 B AUTOMOBILE LIABILITY ANY AUTOCPJ0906060 ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS Comp ded $100 02/18/10 02/18/11 COMBINED SINGLE LIMIT (Ea accident) $ 1,000,000 X BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ X PROPERTY DAMAGE (Per accident) $ X Coll ded $500 GARAGE UABILITY ANY AUTO AUTO ONLY - EA ACCIDENT $ OTHER THAN EA ACC $ AUTO ONLY: AGG $ A EXCESS 1 UMBRELLA UABILITY 12EMX7167701 02/18/10 02/18/11 EACH OCCURRENCE $ 2 , 000 , 000 X OCCUR CLAIMSMADE AGGREGATE $ 2, 000, 000 $ DEDUCTIBLE RETENTION $ $ $ A WORKERS AND EMPLOYERS' AOFFICER/MEMBEREXCLUD (Mandatory If yes, describe SPECIAL PROVISIONS COMPENSATION UABIUTY Y / N D7ECUT EBWCC0002001 02/18/10 02/18/11 WC5IM0I X TORY LIMITSER E.LEACHACCIDENT $1,000,000 In NH) under below E.L. DISEASE - EA EMPLOYEE $ 1 , 000,000 E.L DISEASE - POLICY LIMIT $ 1 0 0 0 000 A OTHER Arch Specialties Professional Liab 12EMP435905 02/18/10 02/18/11 Limit Ded , , 1,000,000 5,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS The City of Waterloo and Howard R Green Company, Engineering Consultant, are additional insureds in respects to the General Liability coverage as required by written contract. f FDTICIr'ATC IJA1 r1CCe CANCELLATION City of Waterloo 715 Mulberry St. Waterloo IA 50703 ACORD 25 (2009/01) WATERCI SHOULD ANY OF THE ABOVE DESCRIBED POUCIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBUGATION OR UABIUTY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRES ©1988-2109 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD IMPORTANT If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). 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). DISCLAIMER This Certificate of Insurance does not constitute a contract between the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon. ACORD 25 (2009/01) ti r. 23. 2010 3: 1OPM n • Howard Fi. Green Company Proiect No. 722930J41 No.6927 P. 6 Phase 2 Demolition, Former Chamberlain Mfg. Property Contract No. 762, Waterloo, Iowa SECTION 00520 PERFORMANCE BOND SU 110 6358 B KNOW ALL MEN BY THESE PRESENTS: 2805 Stonesgate Ct- That we,Active Thermal Concepts Inc of Hiawatha, I13 52233 (hereinafter called the Principal), and Arch Insurance Company of 3100 Broadway- Kansas City, MO 64111 (hereinafter catied the Surety), are held and firmly bound unto the City of Waterloo (hereinafter Qalied the Obligee), in the penal sum of Five hundredforty-seven thousand four hundred twenty-seve altars ($547,427.00 ), lawful Money of the United States, to payment of which sum, well and truly to be made, the Principal here firmly binds himself/themselves, his/their heirs, ekecutors, andadministrators, 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 it1'day of �rOri 2OJ .. enter into a written contract with the City of Waterloo, Iowa, for the FY 2010 Phase 2 Demolition at the Former Chamberlain Manufacturing Property, 550 Esther Street, Contract No. 762, Waterloo, lows, a copy of which contract, together with all 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; Now, if the Principal shall in all respects fulfill his said contract according to the original terms and tenor thereof, and any extensions thereof which may be granted by the Owner, with or without notice to Surety, and during the one (1) year guaranty and maintenance period, and shall satisfy all 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 ail 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 shall 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 the plans, specifications, or contract when such change does not Involve an increase Af more than twenty percent (20%) of the total contract price, and shall then be released only as to such excess increase. PERFORMANCE BOND 00520-1 4:IPftOJ1722930J411Demo Specs\Chamberrain Demo specs Phase 2•s-10\00520 Performance Bond 1209,doc 1 Howard R. Green Company Phase 2 Demolition, Former Chamberlain Mfg. Property iProject No. 722930J41 Contract No. 762, Waterloo, Iowa ga. 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. iIN WITNESS WHEREOF, we have hereunto set our hands and seals this 27 thday of April , 2O9 Apr. 23. 2010 3:10PM No. 6927 P. 7 Active Thermal Concepts Inc Principal Arch Insurance Company Surety Att ney-in-Fact 1 PERFORMANCE BOND 00820-2 0:xPli0.11722930J411Demo'S.pecs\Ghamberlain Demo specs Phase 2-8-10\00520 Performance Bond 1209.doc Apr. 23. 2010 3:10PM No. 6927 Howard R. Green Company Phase 2 Demolition, Former Chamberlain Mfg. Property Contract No. 762, Waterloo, Iowa Project No. 722930J41 SECTION 00530 SU 110 6358 B PAYMENT BOND KNOW ALL WIEN BY THESE PRESENTS: that ACTIVE THERMAL CONCEPTS INC (Narne of Contractor) 2805 STONEGATE CT- HIAWATHA, IA 52233 (Address of Contractor) CORPORATION and (Corporation, Partnership or Individual) ARCH INSURANCE COMPANY (Name of Surety) 3100 BROADWAY- KANSAS CITY, MO 64111 , hereinafter called Principal, (Address of Surety) hereinafter called Surety, are held and firmly bound unto CITY OF WATERLOO (Name of Owner) 715 MULBERRY ST- WATERLOO, IA 50703 (Address of Owner) Five hundred orty-seven thousand four hundred twenty-seven hereinafter called OWNER, In the penal sum of and 00/100 Dollars, $( 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 day of 20 , a copy of which is hereto attached and made a part hereof for the construction of: FY2010 Phase 2 Demolition, Former Chamberlain Manufacturing Property Contract No 762 550 Esther St- Waterloo, IA PAYMENT BOND O:1PROJ\722 30J4'I\pemo Specs\Ghamberiain Dem© specs Phase 2-840W0530 PAYMENT BOND.doe 00530-1 Apr. 23. 2010 3:11PM No. 6927 P. 9 Howard R. Green Company . Phase 2 Demolition, Fanner Chamberlain Mfg. Property Project No. 722930J41 Contract No. 762, Waterloo, Iowa 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 authorizedextension 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 tome 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 there -under 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 claim may be unsatisfied. IN WITNESS HEREOF, this instrument is executed in 5 counterparts, each one of (number) whch shall be deemed an original, this the , Zah___ day of Apri 1., 20,1g AFI EST: (SEAL) ACTIVE THERMAL CONCEPTS INC '(Principal) Secretary • By Principal (s) Witness as to Principal (Address) ARCH INSURANCE COMPANY Surety (Address) PAYMENT BOND OAPROJ\722930J411Demo SpeotACharnberla!n Dmo specs fuits02-8,10100530 PAYMENT BONR.doo °ono -2 14, Apr. 23. 2010 3:11PM . Howard R. Green Company Project No. 722930J41 ATTEST: Mess to Surerty 3100 BROADWAY- KANSAS CITY, MO 64111 (Addrss) N0.692.7 P, 10 Phase 2 Demolition, Former Chamberlain Mfg. Property Contract No. 762, Waterloo, Iowa. By NOTE: Date of BOND must not be prior to date of Contract. If CONTRACTOR is Partnership, all partners should execute BOND. IMPORTANT: Surety companies executing BONDS must appear on the Treasury Department's most current IIsi (Circular 570 as amended) and be authorized to transact business in the State where the PROJECT is located. PAYMENT BOND 0D630-3 OAPROA722930J41 I Demo Specs\Chemberfain Demo specs Phase 2-8-10100630 PAYMENT BOND.doc POWER OF ATTORNEY SU 110 6358 B Know NI Men By These Presents: That the Arch Insurance Company, a corporation organized and existing under the laws of the State of Missouri, having its principal office in Kansas City, Missouri (hereinafter referred to as the "Company") does hereby appoint William A. Bailey, Maria A. Gonzalez, Anne M. Barber, Michael J. Friedrich and Dana M. Kuber of Bridgeview, IL (EACH) • AS true' end laiwfal'Atter ey(sjtct, to make, execute, seal, and deliver from the date of issuance of this powsrfOr and ones behalf as eked. and as its act and deed: Any and aU bonds and undertakings .EXCEPTION: 'Nt? AUTHORITY Is granted to rake, execute, :moi end: dieiver bonds:or undertakings that guarantee the payment cr-milletdion of anyprorniissry note, drafter fetter' of eredit> This autthority does,. not permit the sane ligation to be: split into two or.more bonds 1n order to bring each. eutlh bond Wi hi the dollar Solit f autherity'as sat foriltheivint The Company may revoke this appordment*denyidine. . The execution of such: ;bonds and 'undertakings. 'Ih. pu :e..of.: p ts."shai be as binding upon Are Said Goniparet 8$ IUIIY and amply 10 at Intents and pargosattc as if it18 *Oendul)t end and acknowledged Wits ratildarlY sleeted t niters 6.p1in4pal Ace In Kai** ti , M > This.Power of Attorney is executed by authority of resolutioriadopted by tirtaniMeis consent of the Board of DIrattes of the `Company:on. Mardi 8#.. bus and accurate bf which :are hereinafter eafordi and are hereby certified to by the tindecsigned Becretaryy as being loftdIioce and effect NOTNOTEDi That ihtt Of the 'Board, the Proltideritsc or any Vice President -or their allpointoes desigtlete4 In oiling and filed with the Sectary; or the :Semitaly sib have tbe power and'authoryr to mint agents and attorneys -t -fes and to authorize thorn to execute on behalf of the toinpany, and attach the seal of the 'Company thereto,, btutt; s and undertaldngs, recognizance!,' contras of indmrfity and Other *OSA a Hgeto y in the mature the and any smolt alliters ofthou Companymay appgtnt'.agentsfol'accept a O1pry*" This::Pallier of Attorney Is Sighed, wed and :certified rti by facsimile under and by authority of the following resolution adopted :by the unanimous a nsentof the Board of Directors of the Company oar. March 3, 2003: V TE% milkat ihesighattere Of the Chalrinan of # :Board; the President, or any Vice .President, or their apprintiles designated in Writings ttrid tiled with the Ssarstary, arid the signature .of the Secretary, the seal of the Cc penyi end cencations by the Secretary, may be affixed by lacaimue on;.any poor pf attorney Or band executed. putt to the. resolution adopted by the Board .of *Directors. on Manch 3; 20033, and .any such power so executed, sealed and welled with. respect to any bond or undertaking to which it Is attached, shalt cOnlinuelobeiralid and binding upon tare Cerripanir. OOML0G13 00 03 03 Page 1 of 2 Printed in V.S.A.