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HomeMy WebLinkAboutLodge Construction - Contract No. 952 - 9/4/2018 CI irks FORM OF CONTRACT CONTRACT FOR THE CONSTRUCTION OF F.Y.2019 WATERLOO YARD WASTE WATER AND SANITARY SEWER EXTENSION CITY OF WATERLOO,IOWA CONTRACT NO.952 This contract made and entered into this day of 20by and between the City of Waterloo,Iowa,a Municipal Corporation, (hereinafter referred to as City), and Lodge Construction Inc. of Clarksville, lA, (hereinafter referred to as Contractor), WITNESSETH: PAR. 1 Contractor agrees to build and construct the F.Y. 2019 WATERLOO YARD WASTE WATER AND SANITARY SEWER EXTENSION, CITY OF WATERLOO, IOWA, CONTRACT NO. 952 and furnish all necessary tools, equipment,materials,and labor necessary to do all the work called for in the plans and specifications in a workmanlike 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 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. PAR. 3 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 accepted by the City and which is by reference made a part of this contract. FORM OF CONTRACT PAGE 1 OF 5 PAGES PAR. 5 The Contractor shall commence construction within ten(10) calendar days of the issuance of a Notice to Proceed by the Engineer and shall be substantially complete with all work necessary to provide a complete, fully functioning and satisfactorily tested sanitary sewer for its full length by November 13,2018 and shall alsoravework completed by June 10, 2019, unless an extension of time is granriting by the Council of the City. PAR. 6 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. PAR.7 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. PAR. 8 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. PAR. 9 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. PAR. 10 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. FORM OF CONTRACT PAGE 2 OF 5 PAGES I PAR. 11 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. PAR.. 12 The Contractor agrees to pay punctually all just claims of labor,material, men,or subcontractors who shall perform labor or furnish 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 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. PAR. 15 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. PAR. 16 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 $242,253.00. PAR. 17 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. FORM OF CONTRACT PAGE 3 OF 5 PAGES 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 govern. 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 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. 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 PAGE 4 OF 5 PAGES f I CITY OF WATERLOO,IOWA Mayor City Clerk Lodge traction Inc.,Contractor BY: r �,�► ' �Ji l � ��C� r> Title: Approved by the City Council of the City of Waterloo,Iowa,this day of ��Se 20(L%, ATTEST: City Clerk Waterloo,Iowa I FORM OF CONTRACT PAGE 5 OF 5 PAGES NOTICE TO BIDDERS For the Taking of Construction Bids for the F.Y. 2019 WATERLOO YARD WASTE WATER AND SANITARY SEWER EXTENSION In the City of Waterloo, Iowa CONTRACT NO. 952 ' RECEIVING OF BIDS Sealed proposals will be received by the City Clerk of the City of Waterloo, Iowa, at her office in the City Hall of the said City on the 23th day of Ayg ist, 2018 until 1:00 p.m.for the construction of the F.Y. 2019 WATERLOO YARD WASTE WATER AND SANITARY SEWER EXTENSION "`�V Ax >ratrkt;lErlo:;952, City of Waterloo, Iowa, as described in detail in the plans and specifications now on file In the Office of the City Clerk. OPENING OF BIDS the City of Waterloo, Iowa, on the 23a' day of Au ust, 2018, at 1:00 p.m., and the proposals will be acted upon at such later time and place as may then be fixed by the City Council. PUBLIC HEARING The Council of said City will conduct a public hearing on the proposed plans, specifications, foram of contract, and estimate of cost for the construction of the above- described improvement project at 5:30 p.m. on , 2018 , said hearing to be held in the Harold E. Getty Council Chambers in City Hall in said City. SCOPE OF WORK The extent of the work involved is the construction of approximately 2,765 linear feet of 8-inch dia. ductile iron water main, 760 linear feet of 2" dia., HDPE force main, a 1 hp grinder pump station and appurtenant items thereto at the Waterloo Yard Waste Facility, located North of the 2700 block of Independence Avenue, in Waterloo, Iowa. f3EE 1� AND COMPLETION DATE ' The Contractor shall commence construction within ten(10)calendar days of the issuance of a Notice to Proceed by the Engineer and shall be substantially complete with all work necessary to provide a complete,fully fumctioning and satisfactorily tested sanitary w=Wmaimfor itkrful1 length by November 13,2018 and shall also have all work completed by June 40 26i§. METHOD OF PAYMENT TO CONTRACTOR The Contractor will be paid against bi-monthly estimates in cash on the basis of ninety- five percent (95%) of the work as it is completed and materials delivered and work approved. Final payment will be made thirty-one(31)days after completion of the work and acceptance by the Council. Before final payment is made, vouchers showing that all subcontractors and workmen and all persons furnishing materials have been fully paid for such materials and labor will be required unless the City is satisfied that material, men and laborers have been paid. NOTICE TO BIDDERS CONTRACT NO.952 Page i of 5 Bond No. 2276162 PERFORMANCE BOND KNOW ALL MEN BY THESE PRESENTS: That we, Lodge Construction Inc. of Clarksville, IA(the "Principal"), and North American Specialty Insurance Company of overland Park, KS (the "Surety"), are held and firmly bound unto the City of Waterloo, Iowa (the "Obligee"), in the penal sum of Two Hundred Forty-two Thousand Two Hundred Fifty-three and no cents Dollars($242.253.00), lawful money of the United States,for the payment of said sum in connection with a contract (the "Contract") dated on or about `i , 2-o I e) for the purpose of_F.Y. 2019 Waterloo Yard Waste Water and-SanitaN Sewer Extension, City of Waterloo, Iowa, Contract No. 952. The Contract is incorporated herein by reference as though fully set forth herein. Whenever the Principal shall be and is declared by the Obligee to be in default under the Contract,with the Obligee having performed Its obligations In the Contract, then the Surety, acknowledging that time is of the essence, may promptly remedy the default, or shall promptly undertake to: 1. Complete the Contract in accordance with its terms and conditions; or 2. Obtain one or more bids for completing the Contract 1n accordance with its terms and conditions, and upon determination by the Surety of the lowest responsible bidder, or negotiated proposal, or, if the Obligee elects, upon determination by the Obligee and the Surety jointly of the lowest responsible bidder,or negotiated proposal, arrange for a contract between such party and the Obligee. The Surety will' make available as work progresses sufficient funds to pay the cost of completion less the balance of the Contract price. The cost of completion includes responsibilities of the Principal for correction of defective work and completion of the Contract,the Obligee's legal and design professional costs resulting directly from the Principal's default, and liquidated damages or actual damages if no liquidated damages are specified In the Contract, The term "balance of the Contract price" means the total amount payable by the Obligee to the Principal under the Contract and any amendments thereto, less the amount properly paid by the Obligee to the Principal; or 3. Determine the amount for which it is liable to the Obligee and pay the Obligee that amount as soon as practicable. In the event this bond is enforced, Principal and Surety agree to indemnify Obligee and hold Obligee harmless from and against any and all costs of enforcement, including but not limited to reasonable attomeys' fees and expenses. Every Surety on this bond shall be deemed and held, any contract to the contrary notwithstanding, to consent to each and all of the following matters, without notice: Performance Bond Page 1 of 2 I. 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 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(2)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. If the Principal performs the Contract,then this bond shall be null and void;otherwise it shall remain in full force and effect. In no event shall the Surety's total obligation exceed the penal amount of this bond. Terms used herein shall include, as appropriate, the singular or plural number, or the masculine,feminine or neuter gender. IN WITNESS WHEREOF, the undersigned Principal and Surety have 'executed this Performance Bond as of "A PRINCIPAL. SURETY Lodge Construction, Inc. North American Specialty Insurance Company Name Name By: By: Title: Title: Dione R.Young,Attorney-in-fact [attach Power of Attorney] NOTE: Date of BOND must not be prior to date of Contract. If CONTRACTOR is Partnership, all partners should execute BOND, ' Ycy .s:. ,°'ry• ..it}' 'F.,. .2i - ti<S'• r.Y::-.h li>�y.+, .;x;xa.:..y.....:.:lu4,Li"-..::•. - �f`��ljl;�.p a ,p,.tnclu ONd N�Ud ,. .ri ;a lfes fo tfle;.p ymenf bpntl IMPORTANT: Surety companies executing bonds must appear on the Treasury Department's most current list (Circular 570 as amended) and be authorized to transact business in the State where the project is located. Performance Bond Page 2 of 2 Bond No. 2276162 PAYMENT BOND KNOW ALL MEN BY THESE PRESENTS: that LodgeCEonstruction,Inc. _ (Name of Contractor) AO Box 459, Clarksville, IA 50619 (Address of Contractor) an Iowa Corporation , hereinafter called Principal, (Corporation,Partnership or Individual) and, North American Specialty Insurance Company (Name of Surety) 5200 Metcalf OPN111, Overland Park, KS 66202-1391 (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) hereinafter called OWNER, in the penal sum of Two Hundred Forty-Two Thousand Two Hundred Fifty-three and no cents Dollars,($242,253.00) 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"V'-V day of 20 1 t, a copy of which is hereto attached and made a part hereof for the construction of- F.Y. 2019 Waterloo Yard Waste Water and Sanitary Sewer Extension Contract No. 052, City of 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 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 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 3 counterparts, each one of which shall be deemed an original, this the � (number) day of-- 20 lb ATTEST: Lodge Construction, Inc. Principal (Princlpat)Secretary (SEAL) Yto C�4 By (s} (Address) Witness as to Principal Avg (Address) { CA North American Specialty Insurance Company Sur ATTEST: By Attorney-In-Pact J abighe R.Young Holmes, Murphy and Associates, LLC witness as to Suiw Cindy Bennett (Address) Holmes,Murphy and Associates, LLC P.O. Box 9207, Des Moines, IA 50306-9207 (Address) P.O. Box 9207, Des Moines, IA 50306-9207 NOTE: Date of BOND must not be prior to date of Contract. If CONTRACTOR is Partnership, all partners should execute BOND. fir` ,Fray= ? i„so� reyi IMPORTANT: Surety companies executing bonds must appear on the Treasury Department's most current list (Circular 570 as amended) and be authorized to transact business In the State where the project is located. • SWISS RE CORPORATE SOLUTIONS NORTH AMERICAN SPECIALTY INSURANCE COMPANY WASHINGTON INTERNATIONAL INSURANCE COMPANY WESTPORT INSURANCE CORPORATION 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 Overland Park,Kansas 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 Overland Park,Kansas,and Westport Insurance Corporation,organized under the laws of the State of Missouri,and having its principal office in the City of Overland Park,Kansas each does hereby make,constitute and appoint: JAY D.FREIERMUTH,CRAIG E.HANSEN,BRIAN M.DEIMERLY,SHIRLEY S.BARTENHAGEN,CINDY BENNETT,ANNE CROWNER, TIM MCCULLOR,STACY VENN,DIONE R.YOUNG,and WENDY ANN CASEY JOINTLY OR SEVERALLY Its true and lawful Attomey(s)-in-Fact,to make,execute,sea]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: ONE HUNDRED TWENTY FIVE MILLION($125,000,000.00)DOLLARS This Power of Attorney is granted and is signed by facsimile under and by the authority of the following Resolutions adopted by the Boards of Directors of North American Specialty Insurance Company and Washington International Insurance Company at meetings duly called and held on March 24,2000 and Westport Insurance Corporation by written consent of its Executive Committee dated July 18,2011. "RESOLVED,that any two of the President,any Senior Vice President,any Vice President,any Assistant Vice President, the Secretary or any Assistant Secretary be,and each or any of them hereby is authorized to execute a Power of Attorney qualifying the attorney named in the given Power of Attorney to execute on behalf of the Company bonds,undertakings and all contracts of surety,and that each or any of them hereby is authorized to attest to the execution of any such Power of Attorney and to attach therein the seal of the Company; and it is FURTHER RESOLVED,that the signature of such officers and the seal of the Company may be affixed to any such Power of Attorney or to any certificate relating thereto by facsimile,and any such Power of Attorney or certificate bearing such facsimile signatures or facsimile seal shall be binding upon the Company when so affixed and in the future with regard to any bond,undertaking or contract of surety to which it is attached." �1A11UIIg1/J, Uauo H60a+"'rrrbq 1 � �wrv,, ��,y 0 i6 ........... G�� c IQ;GpRPO% ' SGpp By .N••••4 G4 �F:.��_ �':• S+�LTt :•y Steveu Anderson,senior icePresidentoWashington international nsursuceCompany ~S'Clrc��jrt: S =Z' 2 -`Z &Senior Vice President of North American Specialty Insurance Company SEAL :n=_ o: ;m pee ty ..t ,.. W;Z 1973 tp;m= a t~J? n &Senior Vice President of Westport Insurance Corporation A'AMPSboNY� Q , ,$`�e •.......•* /,J/J/'llllil�"t+��� Mike A.Ito,Senior Vice President of Washington International insurance Company &Senior Vice President of North American Specialty Insurance Company &Senior Vice President of Westport Insurance Corporation IN WITNESS WHEREOF,North American Specialty Insurance Company,Washington International Insurance Company and Westport Insurance Corporation have caused their official seals to be hereunto affixed,and these presents to be signed by their authorized officers this this 3rd day of November 20 17 . North American Specialty Insurance Company Washington International Insurance Company State of Illinois Westport Insurance Corporation County of Cook ss: On this 3rd day of November ,2017,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 Senior Vice President of Westport Insurance Corporation and Michael A.Ito Senior Vice President of Washington International Insurance Company and Senior Vice President of North American Specialty Insurance Company and Senior Vice President of Westport Insurance Corporation,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. OFFICIAL SEAL M.KENNY Notary Public-State at ffli�mis "y`12u`41z021 M.Kenny,Notary Public .` I, Jeffrey Goldberg , the duly elected Vice President and Assistant Secretary of North American Specialty Insurance Company,Washington International Insurance Company and Westport Insurance Corporation 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,Washington International Insurance Company and Westport Insurance Corporation 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&Vice President&Assistant Secretary of Westport Insurance Corporation AC R LODGCON-01 JBONEWITZ �..� CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) [REPRES HIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATI2018 ON ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS ERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES ELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED ENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. MPORTANT: If the certificateholder is an ADDITIONAL INSURED,the policy(ies)must have ADDITIONAL INSURED provisions or be endorsed. 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 CONT CT Joan Bonewitz The Accel Group LLC PHONE PO Box 269 :t- A/C,No,Ext):(319)352-6116 FAXC Waverly,IA 50677 E-MAI (a/c,No): DD jbonewitz acceladvantage.com INSURERS AFFORDING COVERAGE NAIC# INSURED INSURER A:United Fire&Casualty Ins CID 13021 INSURER B: Lodge Construction,Inc. INSURER C PO Box 459 Clarksville,IA 50619 INSURER D: INSURER E: 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. _NSR TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP J= wVD POLICY NUMBER A X COMMERCIAL GENERAL LIABILITY LIMITS EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE OCCUR 60488193 03/16/2018 03/16/2019 DRAMAGE TO REMISES(EaENTED rairrencel $ 100,000 MED EXP(Any one rson 5+000 PERSONAL&ADV INJURY $ 1,000+000 GEN'LAGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY❑JECT E�LOC OTHER: PRODUCTS-COMP/OP AGG $ 2,000,000 A AUTOMOBILE LIABILITY CO AE.aBIN e $ D SINGLE LIMIT 1,000,000 X ANY AUTO 60488193 03!16/2018 03!16/2019 e OWNED SCHEDULED BODILY INJURY Per person) $ AUTOS ONLY AUTOS 4AUTOS N BODILY INJURY Per acc dent $ NLY ,eOaocdentAMAGE $AUREACH OCCURRENCE $ 5+000+000 IMS-MADE +60488193 8193 03/16/2018 03/16/20195,000,000 AGGREGATE $ A WORKERS COMPENSATION $ AND EMPLOYERS'LIABILITY PERLITE OTH- ANY PROPRIETOR/PARTNER/EXECUTIVE YIN 03/16/2018 03!16/2019 500,000 TAT OFFICER/MEMBER EXCLUDED? ❑N N/A E.L.EACH ACCIDENT $ (Mandatory in NH) If yes,describe under E.L.DISEASE-EA EMPLOYE $ 500,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500+000 DESCRIPTION OF OPERATIONS 1 LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City Of Waterloo THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 715 Mulberry ACCORDANCE WITH THE POLICY PROVISIONS. Waterloo,IA 50703 AUTHORIZED REPRESENTATIVE ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD Form W=9 Request for Taxpayer Give Form to the (Rev.December Treasury Identification Number and Certification requester. Do not Internal to venue Service send to the IRS. Internal Revenue Service 1 Name(as shown on your income tax return).Name is required on this line;do not leave this line blank. Lodge Construction, Inc. N 2 Business name/disregarded entity name,if different from above rn cis 0 3 Check appropriate box for federal tax classification;check only one of the following seven boxes: 4 Exemptions(codes apply only to C 0 El U) Individual/sole proprietor or E-1C Corporation 2S Corporation ❑ Partnership ❑Trust/estate certain entities,not individuals;see C C single-member LLC instructions on page 3): ❑Limited liability company.Enter the tax classification(C=C corporation,S=S corporation,P=partnership)to, Exempt payee code(if any) v o` Note.For a single-member LLC that is disregarded,do not check LLC;check the appropriate box in the line above for Exemption from FATCA reporting = CO the tax classification of the single-member owner. code(if any) a ❑Other(see instructions)► (Applies to accounts maintained outside the U.S.) 0 5 Address(number,street,and apt.or suite no.) Requester's name and address(optional) 2330 Ivy Ave. y 6 City,state,and ZIP code Waverly,IA 50677 7 List account number(s)here(optional) Taxpayer Identification Number(TIN) Enter your TIN in the appropriate box.The TIN provided must match the name given on line 1 to avoid Social security number backup withholding.For individuals,this is generally your social security number(SSN).However,for a resident alien,sole proprietor,or disregarded entity,see the Part I instructions on page 3.For other entities,it is your employer identification number(EIN).If you do not have a number,see How to get a TIN on page 3. or Note.If the account is in more than one name,see the instructions for line 1 and the chart on page 4 for Employer identification number guidelines on whose number to enter. M47 - 2 8 4 6 8 8 2 Certification Under penalties of perjury,I certify that: 1. The number shown on this form is my correct taxpayer identification number(or I am waiting for a number to be issued to me);and 2. 1 am not subject to backup withholding because:(a)I am exempt from backup withholding,or(b)I have not been notified by the Internal Revenue Service(IRS)that I am subject to backup withholding as a result of a failure to report all interest or dividends,or(c)the IRS has notified me that I am no longer subject to backup withholding;and 3. 1 am a U.S.citizen or other U.S.person(defined below);and 4.The FATCA code(s)entered on this form(if any)indicating that I am exempt from FATCA reporting is correct. Certification instructions.You must cross out item 2 above if you have been notified by the IRS that you are currently subject to backup withholding because you have failed to report all interest and dividends on your tax return.For real estate transactions,item 2 does not apply.For mortgage interest paid,acquisition or abandonment of secured property,cancellation of debt,contributions to an individual retirement arrangement(IRA),and generally,payments other than interest and dividends,you are not required to sign the certification,but you must provide your correct TIN.See the instructions on page 3. Sign FSi�gnatureof fereUn► Date► General Instructions •Form 1098(home mortgage interest),1098-E(student loan interest),1098-T (tuition) Section references are to the Internal Revenue Code unless otherwise noted. Future developments.Information about developments affecting Form W-9(such :Form 1099-C(canceled debt) as legislation enacted after we release it)is at www.irs.gov/fw9. Form 1099-A(acquisition or abandonment of secured property) Purpose of Form Use Form W-9 only if you are a U.S.person(including a resident alien),to provide your correct TIN. An individual or entity(Form W-9 requester)who is required to file an information If you do not return Form W-9 to the requester with a TIN,you might be subject return with the IRS must obtain your correct taxpayer identification number(TIN) to backup withholding.See What is backup withholding?on page 2. which may be your social security number(SSN),individual taxpayer identification By signing the filled-out form,you: number([TIN),adoption taxpayer identification number(ATIN),or employer identification number(EIN),to report on an information return the amount paid to 1.Certify that the TIN you are giving is correct(or you are waiting for a number you,or other amount reportable on an information return.Examples of information to be issued), returns include,but are not limited to,the following: 2.Certify that you are not subject to backup withholding,or •Form 1099-INT(interest earned or paid) 3.Claim exemption from backup withholding if you are a U.S.exempt payee.If •Form 1099-DIV(dividends,including those from stocks or mutual funds) applicable,you are also certifying that as a U.S.person,your allocable share of •Form 1099-MISC various any partnership income from a U.S.trade or business is not subject to the ( types of income,prizes,awards,or gross proceeds) withholding tax on foreign partners'share of effectively connected income,and •Form 1099-B(stock or mutual fund sales and certin other transactions by 4.Certify that FATCA code(s)entered on this form if an brokers) exempt from the FATCA reporting ( Y)indicating that y?ou are a •Form 1099-S(proceeds from real estate transactions P g,is correct.See what is FATCA reporting. on page 2 for further information. •Form 1099-K(merchant card and third party network transactions) Cat.No.10231X Form W-9(Rev.12-2014)