HomeMy WebLinkAboutRes.2917.09-14-2015BILL NO. 15-165
RESOLUTION NO. /
A RESOLUTION AUTHORIZING THE CITY MANAGER TO
EXECUTE AN AGREEMENT WITH MIDWEST PAINTING AND
WALLCOVERING, INC., FOR THE FLOODWALL GATE
PAINTING PROJECT, IN THE CITY OF CAPE GIRARDEAU,
MISSOURI
BE IT RESOLVED BY THE COUNCIL OF THE CITY OF CAPE
GIRARDEAU, MISSOURI, AS FOLLOWS:
ARTICLE 1. The City Manager, for and on behalf of the City
of Cape Girardeau, Missouri, is hereby authorized to execute an
Agreement with Midwest Painting and Wallcovering, Inc., for the
floodwall gate painting project. The Agreement shall be in
substantially the form attached hereto as Exhibit "A", which
document is hereby approved by the City Council, and
incorporated herein by reference, with such changes therein as
shall be approved by the officers of the City executing the
same.
PASSED AND ADOPTED THIS_ DAY OF , 2015.
ATTEST:
1
Gayl L. Conrad, City Clerk
CITY OF CAPE GIRARDEAU
Floodwall Gate Painting Project
STANDARD FORM OF AGREEMENT
BETWEEN OWNER AND CONTRACTOR
ON THE BASIS OF A STIPULATED PRICE
THIS AGREEMENT is dated as of the 0 5A ' day of 5 a-piember in the year
2015 by and between the City of Cape Girardeau, Missouri (hereinafter called OWNER)
and Midwest Painting and Wallcoverinq, Inc. (hereinafter called CONTRACTOR).
OWNER and CONTRACTOR, in consideration of the mutual covenants hereinafter set
forth, agree as follows:
Article 1. WORK.
Contractor is to furnish all necessary labor, equipment, supervision, and
materials to complete the Floodwall Gate Painting Project. The two gates
are located at Broadway and Water Street, and at Themis and Water Street.
The work is to clean the gates and apply approved coating on both sides of
each gate.
Article 2. ENGINEER.
The City Engineer or his or her designee is to act as OWNER'S representative, assume all
duties and responsibilities and have the rights and authority assigned to ENGINEER in the
Contract Documents in connection with completion of the Work in accordance with the
Contract Documents.
Article 3. CONTRACT TIMES.
3.1 The work will be substantially completed within 60 calendar days after the date when
the Contract Times commence to run as provided in paragraph 2.3 of the General
Conditions, and completed and ready for final payment in accordance with paragraph
14.13 of the General Conditions within 90 calendar days after the date when the Contract
Times commence to run.
- - - 3.2 Liquidated Damages. OWNER and CONTRACTOR recognize that time is of the
essence of this Agreement and that OWNER will suffer financial loss if the Work is not
completed within the times specified in paragraph 3.1 above, plus any extensions thereof
allowed in accordance with Article 12 of the General Conditions. They also recognize the
delays, expense and difficulties involved in proving the actual loss suffered by OWNER if
the Work is not competed on time. Accordingly, instead of requiring any such proof,
A-1
will be no additional retainage on account of Work completed, in which case,
the remaining progress payments prior to Substantial Completion will bean
amount equal to 100% of the Work completed.
95% (with the balance being retainage) of materials and equipment not
incorporated in the Work (but delivered,suitably stored and accompanied by
documentations satisfactory to OWNER as provided in paragraph 14.2 of the
General Conditions).
5.1.2 Upon Substantial Completion, in an amount sufficient to increase total payments to
CONTRACTOR to 98%of the Contract Price (with the balance being retainage), less such
amounts as ENGINEER shall determine, or OWNER may withhold, in accordance with
paragraph 14.7 of the General Conditions.
5.2 Final Payment. Upon final completion and acceptance of the Work in accordance with
paragraph 14.13 of the General Conditions, OWNER shall pay the remainder of the
Contract Price as recommended by ENGINEER as provided in said paragraph 14.13.
Article 6. INTEREST.
All moneys not paid when due as provided in Article 14 of the General Conditions shall
bear interest at the maximum rate allowed by law at the place of the Project.
Article 7. CONTRACTOR'S REPRESENTATIONS.
In order to induce OWNER to enter into the Agreement, CONTRACTOR makes the
following representations:
7.1 CONTRACTOR has examined and carefully studied the Contract Documents
- (including the Addenda listed in paragraph 8) and the other related data identified in the
Bidding Documents, including 'technical data".
7.2 CONTRACTOR has visited the site and become familiar with and is satisfied as to the
general, local and site conditions that may affect cost, progress, performance and
furnishing of the Work.
7.3 CONTRACTOR is familiar with and is satisfied as to all federal, state and local Laws
and Regulations that may affect cost, progress, performance and furnishing of the Work.
7.4 CONTRACTOR has obtained and carefully studied (or assumes responsibility for
having done so) all such additional supplementary examinations, investigations,
explorations, tests, studies and data concerning conditions (surface, subsurface and
Underground Facilities) at or contiguous to the site or otherwise which may affect cost,
progress, performance or furnishing of the Work or which relate to any aspect of the
means, methods, techniques, sequences and procedures of construction to be employed
by CONTRACTOR and safety precautions and programs incident thereto. CONTRACTOR
A-3
participation in a federal work authorization program with respect to the employees
proposed to work in connection with the services requested herein by 1) submitting a
completed, notarized copy of AFFIDAVIT OF WORK AUTHORIZATION and 2) providing
documentation affirming the bidder's enrollment and participation in a federal work
authorization program with respect to the employees proposed to work in connection with
the services requested herein.
8.12 Documentation submitted by CONTRACTOR prior to Notice of Award (pages _to
, inclusive).
8.13 The following which may be delivered or issued after the Effective Date of the
Agreement and are not attached hereto' All Written Amendments and other documents
amending, modifying or supplementing the Contract Documents pursuant to paragraphs
3.5 and 3.6 of the General Conditions.
The documents listed in paragraphs 8.2 et seq above are attached to this Agreement
(except as expressly noted otherwise above).
There are no Contract Documents other than those listed above in the Article 8. The
Contract Documents may only be amended, modified or supplemented as provided in
paragraphs 3 5 and 3.6 of the General Conditions.
Article 9. MISCELLANEOUS.
9 1 Terms used in this Agreement which are defined in Article 1 of the General Conditions
will have the meanings indicated in the General Conditions.
9.2 No assignment by a party hereto of any rights under or interests in the Contract
Documents will be binding on another party hereto without the written consent of the party
sought to be bound; and, specifically but without limitation, moneys that may become due
and moneys that are due may not be assigned without such consent (except to the extent
that the effect of this restriction may be limited by law), and unless specifically stated to the
contrary in any written consent to an assignment no assignment will release or discharge
the assignor from any duty or responsibility under the Contract Documents.
9 3 OWNER and CONTRACTOR each binds itself, its partners, successors, assigns and
legal representatives to the other party hereto, its partners, successors, assigns and legal
representatives in respect to all covenants, agreements and obligations contained in the
Contract Documents.
9.4 Any provision or part of the Contract Documents held to be void or unenforceable
under any Law or Regulation shall be deemed stricken, and all remaining provisions shall
continue to be valid and binding upon OWNER and CONTRACTOR, who agree that the
Contract Documents shall be reformed to replace such stricken provision or part thereof
with a valid and enforceable provision that comes as close as possible to expressing the
intention of the stricken provision.
A-5
IN WITNESS WHEREOF, OWNER and CONTRACTOR have signed the Agreement in
multiple copies, One counterpart each has been delivered to CONTRACTOR and
ENGINEER and two counterparts to the OWNER. All portions of the Contract Documents
have been signed, initialed or identified by OWNER and CONTRACTOR or identified by
ENGINEER on their behalf.
This Agreement will be effective on 5e.-P , 2015 (which is the
Effective Date of the Agreement).
OWNER City of Cape Girardeau CONTRACTOR Midwest Painting&Wallcoverinq, Inc:,
ri PYA-5.ck 1�
,Scott Me e. �er b0►lr rl tu � j ao.�; •�•� ''+y's�,
cra
• • By. ie
t, s cWI [CORPORATE SEAL] 4�%; ,�g?S.. ti'
'' • � �1� Attest 0. 0. I I I Lam. ci 01f��1gqQY
. `hest, .► -
'_ rr 1Gaylq- 41 onrad, City Clerk "T0.Y0. E1 LY1
Address for giving notices Address for giving notices
401 Independence Street PO Box 218
Cape Girardeau, MO 63703 Cape Girardeau MO 63702
(If OWNER is a public body, attach License No. 15530
evidence of authority to sign and
resolution or other documents Agent for service of process:
authorizing execution of Agreement.
(If CONTRACTOR is corporation,
attach evidence of authority to sign.)
A-7
DXHIBif A
CITY OF CAPE GIRARDEAU
FLOODWALL GATE PAINTING PROJECT
BID FORM
PROJECT IDENTIFICATION: The improvement consists of Floodwall Gate Painting
Project as specified in the bid documents for the City of Cape Girardeau, Missouri.
THIS BID IS SUBMITTED TO: CITY OF CAPE GIRARDEAU, MO
401 INDEPENDENCE STREET
CAPE GIRARDEAU, MO 63703
1. The undersigned BIDDER proposes and agrees, if the Bid is accepted, to enter into an
agreement with OWNER in the form included in the Contract Documents to perform and
furnish all Work as specified or indicated in the Contract Documents for the Bid Price and
within the Bid Times indicated in this Bid and in accordance with the other terms and
conditions of the Contract Documents.
2 BIDDER accepts all of the terms and conditions of the Advertisement or Invitation to Bid
and Instructions to Bidders, including without limitation those dealing with the disposition of
Bid security. This Bid will remain subject to acceptance for sixty days after the day of Bid
opening. BIDDER will sign and deliver the required number of counterparts of the
Agreement with the Bonds and other documents required by the Bidding Requirements
within fifteen days after the date of OWNER'S notice of Award.
3. In submitting this Bid, BIDDER represents, as more fully set forth in the Agreement,
that:
(a) BIDDER has examined and carefully studied the Bidding Documents and the
following:
Addenda, receipt of all which is hereby acknowledged: (lis[
Addenda by Addendum Number and Date)
(none)
(b) BIDDER has visited the site and become familiar with and is satisfied as to the
general, local and site conditions that may affect cost, progress, performance and
furnishing of the Work;
(c) BIDDER is familiar with and is satisfied as to all federal, state and local Laws and
Regulations that may affect cost, progress, performance and furnishing of the Work.
BF-1
•
4. BIDDER will complete the Work in accordance with the Contract Documents for the
following price(s)
UNIT PRICE BID
NO ITEM UNI EST. UNIT TOTAL
T QTy. PRICE EST. PRICE
1. Mobilization and Clean Up 1 LS $ I,50 D. $ 1)5D°.
2. Clean &Paint Broadway Gate 1 LS $ Sao. $ 5,$aO
3. Clean &Paint Themis St Gate 1 LS $ 54a o $ 51220
TOTAL BID FOR ALL UNIT PRICES 13, 140. 00
(numbers)
41y-E-ten *',lbusand, ohe hundred, -c-ort-3 and rO/ioo
dell ors
(Written figure)
(Total bid amount is to be shown in both words and figures. In case of discrepancy, the
amount shown in words will govern. In case of error in extension, the unit and lump sum
prices under each Pay Item will be considered correct, and these sums when properly
extended, shall constitute the Bid.)
Unit Prices have been computed in accordance with paragraph 11.9.2 of the General
Conditions.
BIDDER acknowledges that quantities are not guaranteed and final payment will be based
on actual quantities determined as provided in the Contract Documents.
5. BIDDER agrees that the Work will be substantially complete within Sixty days (60)
calendar days after the date when the Contract Times commences to run as provided in
paragraph 2.3 of the General Conditions, and completed and ready for final payment in
accordance with paragraph 14.13 of the General Conditions within Ninety days (90)
calendar days after the date when the Contract Times commences to run.
BIDDER accepts the provisions of the Agreement as to liquidated damages in the event of
failure to complete the Work within the times specified in the Agreement
BF-3
•
Business address:
Phone No.:
A Partnership
By (SEAL)
(Firm Name)
(General Partner)
Business address:
Phone No.: :•s'"��; `' ��kj1
A Corporation
By M td Wes+ Painji v Uici,1 (Covers r� ► l�� (S )..
(Corporation Na e) ' ' 41‘ �
�iS50kri „y tSal ';
Incorporation) :. ” +,+
•••fig.. ?,y .. (Name of Person Authorized to Sign)
�' b�'• rre6 p en+ _.>r.o'4 ' rr.
(Title) : a c
.(( ate Seal)
s : Afi?St ".
r� ,
'1i1 [` (Secretary) :•._.,{:-',
•.Bili i:(Nlll'
.�,;:�. B Business address:
Phone No.:
Date of Qualification to do business is
A Joint Venture
By (SEAL)
(Name)
(Address)
BF-5
Company ID Number: 147331
ARTICLE I
PURPOSE AND AUTHORITY
This Memorandum of Understanding (MOU) sets forth the points of agreement between the
Social Security Administration (SSA), the Department of Homeland Security (DHS) and
Midwest Painting and Walleovering,INC(Employer)regarding the Employer's participation in
the Employment Eligibility Verification Program (E-Verify). E-Verify is a program in which the
employment eligibility of all newly hired employees will be confirmed after the Employment
Eligibility Verification Form(Form 1-9)has been completed
Authority for the E-Verify program is found in Title IV, Subtitle A, of the Illegal Immigration
Reform and Immigrant Responsibility Act of 1996(IIRIRA),Pub. L. 104-208, 110 Stat. 3009, as
amended(8 U.S.C. § 1324a note).
ARTICLE II
FUNCTIONS TO BE PERFORMED
A. RESPONSIBILITIES OF THE SSA
1. Upon completion of the Form I-9 by the employee and the Employer, and provided the
Employer complies with the requirements of this MOU, SSA agrees to provide the Employer
with available information that allows the Employer to confirm the accuracy of Social Security
Numbers provided by all newly hired employees and the employment authorization of U.S.
citizens.
2. The SSA agrees to provide to the Employer appropriate assistance with operational
problems that may arise during the Employer's participation in the E-Verify program_ The SSA
agrees to provide the Employer with names, titles, addresses, and telephone numbers of SSA
representatives to be contacted during the E-Verify process.
3. The SSA agrees to safeguard the information provided by the Employer through the E-
Verify program procedures, and to limit access to such information, as is appropriate by law, to
individuals responsible for the verification of Social Security Numbers and for evaluation of the
E-Verify program or such other persons or entities who may be authorized by the SSA as
governed by the Privacy Act(5 U.S.C. § 552a),the Social Security Act (42 U.S.C. 1306(a)), and
SSA regulations(20 CFR Part 401).
4. SSA agrees to establish a means of automated verification that is designed (in
conjunction with DHS's automated system if necessary) to provide confirmation or tentative
nonconfirmation of U.S. citizens' employment eligibility and accuracy of SSA records for both
citizens and aliens within 3 Federal Government work days of the initial inquiry.
Company ID Number: 147331
INFORMATION REQUIRED
FOR THE E-VERIFY PROGRAM
Information relating to your Company:
Company Name: Midwest Painting and Wal covering,INC
Company Facility Address: 2121 Bessie Street
Cape Girardeau,MO 63701
Company Alternate Address: PO Box 218
Cape Girardeau,MO 63702
County or Parish: CAPE GIRARDEAU
Employer Identification Number. 134249960
North American Industry
Classification Systems Code: 236
Parent Company
Number of Employees: 20 to 99 Number of Sites Verified for. 1
Are you verifying for more than I site? Ryes,please provide the minter of sites verified for in each State.
MISSOURI I site(s)
Information relating to the Program Administrator(s)for your Company on policy questions or operational problems:
Name: Tara A Renner
Telephone Number. (573)335-0057 Fax Number. (573)335-0058
E-mail Address: midwatpaintinginc®msacom
Name: Darryl W Dunn
Telephone Number: (573)335-0057 Fax Number (573)335-0058
E-mail Address: midwestpaintingine®msacom
�IIBIT
AFFIDAVITOF OSHA TRAINING Q(��
COMES NOW Name) CJr 1 Q11 L e:413kas(Om= `,Held) Viet Pres es ld ent
of IA id wes+ Pairrlirt� Walkover�thq being dnly w sworn,Cxr�e.
my oath,afraia in contortion with the ccamarted services=lanai is
(hz*t for the duration of the mmhart,as follows:
1. rrmtrarl„r shall provide a tea (10) hoar Ocoapational Safely and Health
9d smati°n (OSHA) constraction safety pmgtam fat all employees who will be on-site at the
Project The constmction safety pmgnm shall inr1nde a Queue in constmd'iou safety and health
that is eppanal by OSHA ar a simhlas program appawed by the Missouri Department of Labor and
Ind„st ial Relations which is at least as sitingcut as an approved OSHA program as iequitid. by
Section 292675,RSMo.
2 Contnrtnr shall require its on-site employees to complete a consumed= safety
program within sixty(60)days after the date work on the Pxlljed mmmarnc s,as required.by Section
292.675,RSMo.
3. Crminrtnr acknowledges and agrees that Cr of Contradnt's employees found on
the Project site without dour of the successful completion of a construction safety
program.shall be required to produce such docomemation avidin twenty(20) days,or will be subject
to=naval from the Project
4. Contactor shall require all of its Snbmnlradna to cot*with the reheats of
Section 292675,RSMo. •
5. Contactor acknowledges that pvtsaaat to Section 292.675,RSMb, Contract r shall
forfeit to City as a pcaalty two thousand five hundred dollars($7,500.000),plus one hundred dollars
($100.00) for each on-site employee employed by Contractor of its Submlxtraet ar,fat each ea/end=
day, or potfian thereof such on-site employee is employed without the masthnctian safety training
required in Section 292.675,RSMn.
6. Cntrtnrir r acknowledges that violation of Section 292675,RSMn, and imposmcn
of the penalties descaled therein shall be investigated and deemed by the Missouri Department
ofIabor and Industrial Relations.
- 7. Ccantadnr aelmawledges that in the event that the Missouri De ni :am of Labor
and Indust al Relarioas has dnamincd that a vm)atian of Section 292.675, RSMn., has oanared
•
Err
AFFIDAVIT OF WORK AUTHORIZATION
COMES NOW(Nue) ' d0, \ bffichk
le.as (oxeld) Via Presicle
of(Company Nammn `
e/Cectnr) MkCWe5t Prisrlkink and fist being duly sworn, on
my oath,arm as follows: tlbill C pvex l U
$r
1. (CmnpaayName/Coatactor) 14 dWCStPo:wm+ Y\ 4 lOctlleauekin3
is entailed and will continue to participate in a federal work authariration program in respect to
employees� that will work in connection with the contracted:services relatzd to(project Name) R ttd WelWel( ye
fir• PQtYvk\.n for the duration of the contract in accordance with RSMo
Chapter 285530(2). �J L
2. I also affirm that(Company Name/Contractor)) [lidwest Pcarchf does
not and will not knowingly employ a person who is an unauthorized alien in connection with the
contract services related to(Project Name) Ft cod A (note. PatY\kfl3 for
the duration of the contract - J
3. Attached hereto is documentation affirming Contractor's enrollment and
participation in a federal work authorization program with respect to the employees working in
connection with the contracted services.
FURTHER.AFFIANT SATIN NOT.
IN AFFIRMATION THEREOF, the facts stated above ate true and correct (the
undersigned ondentands that false statements made in this filing are subject to the
penalties provided in Section 575.040,RSMo.)
klidweek PcAnkinng41A)al\covek-inq 1
(=to )
Br Pr2Sictot
name of officer of corporation and tide)
ATTEST:
Sectary(or other officer)
(s ion tc i zIoN)
'ti' :;;•_
CITY Q CAPE
GIRARDEAU
Certification Regarding
Debarment, Suspension and Other Responsibility Matters
The contractor hereby certifies to the best of its knowledge and belief and that it and its principals
and its subcontractors and their principals:
(a) Are not pzesently debarred, suspended,proposed for debarment, declared ineligible or
• voluntarily excluded from covered transactions by any Federal or State department or agency; •
(b) Have not within a three(3)year period preceding this proposal been convicted of or had a
civil judgment rendered against them for commission of fraud or a criminal offense in
connection with obtaining,attempting to obtain or performing a public(Federal, State or
Local)transaction or contract under a public transaction;violation of Federal or Std antitrust
statutes or commission of embezzlement,theft, forgery,bribery,falsification or destruction of
records,making false statements or receiving stolen property;
(c) Are not presently indicted for or otherwise criminally or civilly charged by a government
entity(Federal, State or Local)with commission of any of the offenses enumerated in
paragraph(1)(b)of this certification; and
(d) Have not within a three-year period preceding this subcontract had one or more public
transactions (Federal, State or Local)terminated for cause or default
I understand that a false statement on this certification may be grounds for rejection of this
contractor or termination of the contract In addition,under 18 USC Sec. 1001, a false
statement may result in a fine of up to$ 10,000 or imprisonment for up to five(5)years or
both.
e i` &an 4-q-r
Typed Name & itle of Au�C � tafive U
- q4/ (5
Signature of A u i Representative Date
❑ I am unable to certify to the above statement My explanation is attarhed.
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R1.�. RL19025lnsure
N.LincendberghComDr. „ye LABOR AND MATERIAL PAYMENT
eoria,2 61615
PA.Box 3967 Peoria,IL 61612
BOND
Phone:(309)692-1000 Fax:(309)683-1610
Bond No. LSM0628871
NOTE: THIS BOND IS ISSUED SIMULTANEOUSLY WITH ANOTHER BOND IN FAVOR OF THE OWNER CONDITIONED FOR
THE FULL AND FAITHFUL PERFORMANCE OF THE CONTRACT.
KNOW ALL MEN BY THESE PRESENTS:
That Midwest Painting and Wallcoverino Inc
(Here insert the name or legal ttle of the contractor)
2121 Bessie St
Caoe Girardeau MO 63701 as
(Here Insert the address of the contractor)
Principal,hereinafter called Principal,and RLI Insurance Company ,an Illinois
Corporation,as Surety,hereinafter called Surety,are held and firmly bound unto
City of Caoe Girardeau
(Here insert the name or legal 011e o1 the owner)
P.O.Box 617,Cape Girardeau,MO 63702
(Here insert the address of the owner)
as Obligee,hereinafter called Owner,for the use and benefit of claimants as hereinbelow defined, in the amount of
Thirteen thousand one hundred forty and no/100 Dollars( 13 140.00 ),
for the payment whereof Principal and Surety bind themselves,their heirs,executors,administrators,successors and assigns,jointly and
severally,firmly by these presents.
WHEREAS, Principal has by written agreement dated Sep+e410er 95, Q-DIS entered into a Contract with Owner for
Floodwall qate painting project
in accordance with drawings and specifications prepared by
(Full name of architect or engineer)
which contract is by reference made a part hereof,and is hereafter referred to as the Contract.
NOW, THEREFORE, THE CONDITION OF THIS OBLIGATION is that if the Principal shall promptly make payment to all claimants as
hereinafter defined, for all labor and material used or reasonably required for use in the performance of the Contract, then this obligation shall
be void;otherwise it shall remain in full force and effect,subject,however,to the following conditions:
1. A claimant is defined as one having a direct contract with the Principal or with a sub-contractor of the Principal for labor, material, or
both,used or reasonably required for use in the performance of the Contract,labor and material being construed to include that part of
water,gas, power,light,heat,oil,gasoline,telephone service or rental of equipment directly applicable to the Contract
2. The above named Principal, and Surety hereby jointly and severally agree with the Owner that every claimant as herein defined,who
has not been paid in full before the expiration of a period of ninety 90)days after the date on which the last of such claimant's work or
labor was done or performed,or materials were furnished by such claimant, may sue on this bond for the use of such claimant in the
name of the Owner, prosecute the suit to final judgment for such sum or sums as may be justly due claimant, and have execution
thereon, provided,however,that the Owner shall not be liable for the payment of any costs or expenses of any such suit.
3. No suit or action shall be commenced hereunder by any claimant,
(a) Unless claimant shall have given written notice to any two of the following: The Principal,the Owner,or the Surety above named,
within ninety(90)days after such claimant did or performed the last of the work or labor,or furnished the last of the materials for
which said claim is made, stating with substantial accuracy the amount claimed and the name of the party to whom the materials
were furnished, or for whom the work or labor was done or performed. Such notice shall be served by mailing the same by
registered mail, postage prepaid, in an envelope addressed to the Principal, Owner or Surety, at any place where an office is
regularly maintained for the transaction of business,or served in any manner in which legal process may be served in the state in
which the aforesaid project is located,save that such service need not be made by a public officer.
(b) After the expiration of one(1)year following the date on which Claimant ceased work on said Contract.
(c) Other than in a state court of competent jurisdiction in and for the county or other political subdivision of the state in which the
protect,or any part thereof is situated,or in the United States District Court for the district in which the project or any part thereof,
is situated,and not elsewhere.
4. The amount of this bond shall be reduced by and to the extent of any payment of payments made in good faith hereunder, inclusive of
the payment by Surety of mechanics liens which may be filed of record against said improvements, whether or not claim for the
amount of such lien be presented under and against this bond.
Signed this o5-1+1 day of Se-{4 . A.D., 9-015
,t1lyi.'_,1, ,
i RLI I7surance Comp ny
MidwestPaintingandWallcoveang.(r+���-'.'� '��-1!.f �� gr�(
_ 2 „ �(Pnna (Seal) — .:..„.4...,,.....' .•••••,.2 i A4
' .� " ;•;=,:,:c
c" By j , • l�i1Nl
•t - Tara Fischer Attomey in Fact
;i ' T
`"- ;`. „' C0027004-50,0
; J J•
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sura
nee
Rt.�• N. ndheghlh Peo61612ria,H.61616 PERFORMANCE BOND
P. O.Box 3967 Peoria,IL
Phone:(309)692-1000 Far(309)683-1610
Bond No. LSM0628871
KNOW ALL MEN BY THESE PRESENTS:
That Midwest Painting and Wallcovering,Inc.
(Here insert the name or legal title of the contractor)
2121 Bessie St.
Cape Girardeau MO 63701
(Here msert the address of the contractor)
as Principal,hereinafter called Contractor,and Rid insurance Company an Illinois
Corporation,as Surety,hereinafter called Surety,are held and firmly bound unto
City of Cape Girardeau
(Here insert the name of the owner)
P.O.Box 617,Cape Girardeau,MO 63702 as Obligee,hereinafter
(Here insert the address of the owner)
called Owner,in the amount of Thirteen thousand one hundred forty and no/I00--
Dollars( 13,140.00 ),for the payment whereof Contractor and Surety bind themselves,their heirs,executors,administrators,
successors and assigns,jointly and severally,firmly by these presents.
WHEREAS,Contractor has by written agreement dated Sep-Fem bee a5,fente ed into a Contract with Owner for
Floodwall gate painting project
in accordance with drawings and specifications prepared by
(Full name of architect or engineer)
which contract is by reference made a part hereof,and is hereafter referred to as the Contract
NOW,THEREFORE,THE CONDITION OF THIS OBLIGATION is such that,if Contractor shall promptly and
faithfully perform said Contract,then this obligation shall be null and void;otherwise it shall remain in full force and effect.
Whenever Contractor shall be,and declared by Owner to be in default under the Contract,the Owner having performed
Owner's obligation thereunder,the Surety may promptly remedy the default,or shall promptly
1. Complete the Contract in accordance with its terms and conditions,or
2. Obtain a bid or bids for submission to Owner for completing the Contract in accordance with its terms and conditions,and upon
determination by Owner and Surety of the lowest responsible bidder,arrange for a contract between such bidder and Owner and make
available as work progresses(even though there should be a default or a s uccession of defaults under the contract or contracts of
completion arranged under this paragraph)sufficient funds to pay the cost of completion less the balance of the contract price;but not
exceeding,including others costs and damages for which the Surety may be liable hereunder,the amount set forth in the first paragraph
hereof.The term"balance of the contract price,"as used in this paragraph,shall mean the total amount payable by Owner to Contractor
under the Contract and any amendments thereto,less the amount properly paid by Owner to Contractor.
Any suit under this bond must be instituted before the expiration of two(2)years from the date on which Contractor ceases
work on the Contract
No right of action shall accrue on this bond to or for the use of any person or corporation other than the Owner named
herein or the heirs,executors,administrators or successors of Owner.
Signed this O day of SepterYlberA.D. .o15
Midwest Painting and Wallcovering,Inc. REI Insurance Company
(Principal) (Seal)
`�% .4 vrjJ�7�f^,(. By � i-� 1 �VIW
!i ir s Tara Luber "`1}1 Attorney in Fact
-2.. r',..--;.•:„•": 0003100450.0
•
RLI I1I`Insurance Company
POWER OF ATTORNEY
P.O.Box 3967 Peoria IL 61612-3967
Phone:(309)692-1000 Fax:(309)683-1610 RLI Insurance Company
Bond No. LSM0628871
Know All Men by These Presents:
That the RLI Insurance Company a corporation organized and existing under the laws of the State of
Illinois and authorized and licensed to do business in all states and the District of Columbia does hereby make,
constitute and appoint: Tam Fischer in the City of Farmington State of
Missouri as Attorney In Fact with full power and authority hereby conferred upon him/her to sign,
execute,acknowledge and deliver for and on its behalf as Surety, in general,any and all bonds,undertakings,and recognizances in an
amount not to exceed Ten Million and 00/100 Dollars ( S10,000,000.00 ) for any single
obligation,and specifically for the following described bond.
Principal: Midwest Painting and Wallcovering,Inc.
Obligee: City of Cape Girardeau
Bond Amount: S 13.140.00
The RLI Insurance Company further certifies that the following is a true and exact copy of a
Resolution adopted by the Board of Directors of RLI Insurance Company and now in force to-wit:
"All bonds, policies, undertakings, Powers of Attorney or other obligations of the corporation shall be executed in the
corporate name of the Company by the President,Secretary, any Assistant Secretary,Treasurer,or any Vice President,or
by such other officers as the Board of Directors may authorize. The President,any Vice President,Secretary,any Assistant
Secretary, or the Treasurer may appoint Attorneys in Fact or Agents who shall have authority to issue bonds, policies or
undertakings in the name of the Company. The corporate seal is not necessary for the validity of any bonds, policies,
undertakings, Powers of Attorney or other obligations of the corporation. The signature of any such officer and the
corporate seal may be printed by facsimile."
IN WITNESS WHEREOF,the RLI Insurance Company has caused these presents to be executed by
its Vice President with its corporate seal affixed this 23rd day of September 2015 .
ATTESST::r r�aJ,,y//I /yt�� ?yJ
S:•• ,,,:°qq.. RLI Insurance Company
�rWl.(Jt. /(/IllyfB/l/ (¢:• EAL Tf-. �p
I SEAL; �jy A/.
Cherie L.Montgomery �ssistant Secretary •••. ...•'. Barton W.Davis Vice President
On this 23rd day of September 2015 before me,a Notary Public,personally appeared Barton W.Davis
and Cherie L Montgomery who being by me duly sworn,acknowledged that they signed the above Power of Attorney
as _ _ Vice President and Assistant Secretary respectively,of the said
RLI Insurance Company and acknowledged said instrument to be the voluntary act and deed of
said corporation.
\ r •
'OFFICIAL SEAL'
�s JACQUELINE hl aOCKIER
Ja • cline M.Boc.i r Notary Public z Comesson EXPIRES mn.ne
A0006104_SUBS_BID
•
ACO o® CERTIFICATE OF LIABILITY INSURANCE 9E(( zD"�s)
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER AND THE CERTIFICATE HOLDER
IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)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).
CCiNTACT Tara Fischer
NAM
AX
First State Insurance Agency yMycLE E I. (573)334-8100 /A .Nb):(573)334-4877
2001 William Street SNAILtfierhrv(feia.bc
INSURER(S)AFFORDING COVERAGE I NAIC e
Cape Girardeau MO 63703 INSURER A Hawkeye Security 36919
INSURED INSURERS Midwestern Indemnity 23515
Midwest Painting And Wallcovering, Inc. INSURERS Peerless 24198
PO Box 218 HIRER O.
INSURER E.
Cape Girardeau MO 63702-0218 INSURER F.
COVERAGES CERTIFICATE NUMBERSIaster 2015-2016 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 CONDMON 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.�8LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
LTR TYPE OF INSURANCE INSO yryeI POLICY NUMBER fWMIDOIYYYLICY YLp(Nl POLICY
YYRI'l leas
X COMMERCIAL GENERAL LIABO.ITY EACH OCCURRENCE S 1,000,000
DAMAGA CLAWS-MADE X OCCUR PREMISES Me
50,000
PREMISESf R NTtO 1
CCP8770606 5/5/2015 5/5/2016 MED MP(Arty we person) S 5,000
_. PERSONAL ADV INJURY S 1,000,000
GENT AGGREGATE LIMITAPPLES PER GENERAL AGGREGATE S 2,000,000
POLICY X JE LOC PRODUCTS-CCMPCPAGG s 2,000,000
OTHER: I
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $(Es accelent) 1,000,000
B X ANY AUTO BODILY INJURY(Pawl)PaS
ALLOYMED SCHEDULED BA8771306 5/5/2015 5/5/2016 BODILY INJURY(Pee aCffiw I
AUTOS X HIRED AUTOSX NON-OOWNED PROPERTY DAMAGE S
AUTOS (Pa arida()
I
_ Unthawed=tone .ilt.ed $ 100,000
X UMBRELLA UAB X LVY'UR EACH OCCURRENCES 5,000,000
A EXCESS LAB CLAIMS-MADE AGGREGATE S 5,000,000
OED X RETENTIONS 10,000 CO8771506 _ 5/5/2015 5/5/2016 1
YORKERS COMPENSATION X PER 0TH-
AND EMPLOYERS'LIABILITY YIN STATUTE ER
ANY PROPRIETORRARTNERIEI(EGITNEEL EACH ACCIDENT S 1,000,000
CFFICDUYEMBER EXCLUDED? N NIA
C (Maldrmry In NH) TCS771006 5/5/2015 5/5/2016 EL DISEASE-EA EMPLOYE $ 1,000,000
dym. chute axe(
DESCRIPTION OF OPERATIONS tem -EL DISEASE-POLICY OMIT I 1 1,000,000
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Addmmal Remarks Schedule,may be mticed a more space b rte)
Form 022-45: Crimmrrcial General Liability Extension Endorsement attached.
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
City of Cape Girardeau THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
Project: Floodwall Gate Painting Project ACCORDANCE WITH THE POLICY PROVISIONS.
401 Independence St
Cape Girardeau, MO 63701 ALrO4OR�DREPRESEHTATIVE
Tara Fischer/TRF �Lt/LN, v Z eJ.t l
®1988-2014 ACORD CORPORATION. All rights reserved.
ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD
INSO25 oolml)
•
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
COMMERCIAL GENERAL LIABILITY EXTENSION ENDORSEMENT
This endorsement modifies insurance under the
COMMERCIAL GENERAL LIABILITY COVERAGE PART
SCHEDULE
The following endorsement provision does not apply when'X' is shown in the space provided below:
Provision C. PROPERTY DAMAGE—BORROWED EQUIPMENT does not apply
Provision D. PROPERTY DAMAGE—CUSTOMERS' GOODS does not apply
Provision G. MEDICAL PAYMENTS EXTENSION does not apply
Provision I.ADDITIONAL INSUREDS—BY CONTRACT,AGREEMENT OR PERMIT does not
apply
Provision J.ADDITIONAL INSUREDS—VENDORS does not apply
Provision K. BROAD FORM NAMED INSURED does not apply
Provision L.FAILURE TO DISCLOSE HAZARDS AND PRIOR OCCURRENCES does not apply
Provision M. KNOWLEDGE OF OCCURRENCE,OFFENSE,CLAIM OR SUIT does not apply
(If no entry appears above, information required to complete this endorsement will be shown in the
Declarations as applicable to this endorsement)
With respect to coverage afforded by this endorsement, the provisions of the policy apply unless modified
by the endorsement.
A. NON-OWNED AIRCRAFT
Under paragraph 2. Exclusions of COVERAGE A BODILY INJURY AND PROPERTY DAMAGE
UABIUTY(SECTION 9, exclusion g.Aircraft,Auto Or Watercraft does not apply to an aircraft
provided:
1. It is not owned by any insured;
2. It is hired, chartered or loaned with a trained paid crew;
3. The pilot in command holds a currently effective certificate, issued by the duly constituted
authority of the United States of America or Canada,designating her or him a commercial or
airline pilot; and
4. It is not being used to carry persons or property for a charge.
However, the insurance afforded by this provision does not apply if there is available to the insured
other valid and collectible insurance,whether primary, excess(other than insurance written to apply
specifically in excess of this policy), contingent or on any other basis, that would also apply to the loss
covered under this provision.
B. NON-OWNED WATERCRAFT
Includes copyrighted material of Insurance Services Office,Inc.with its permission.
Copyright,Insurance Services Office,Inc.,2000
22-45 (12/02) Page 1 of 7
2. The following is added to SECTION IV-COMMERCIAL GENERAL LIABILITY CONDmONS,
Condition 4.Other Insurance, paragraph b.Excess Insurance:
The insurance afforded by provision E. in the Commercial General Liability Extension
Endorsement is excess over any of the other insurance,whether primary, excess, contingent
or on any other basis,that is property insurance.
F. DAMAGE BY FIRE, LIGHTNING, EXPLOSION, SMOKE OR LEAKAGE
If Damage To Premises Rented To You is not otherwise excluded from this Coverage Part
1. Under subsection 2.Exclusions of COVERAGE A BODILY INJURY AND PROPERTY
DAMAGE LIABILITY(SECTION I):
a. The fourth from the last paragraph of exclusion j.Damage To Property is replaced by the
following:
Paragraphs(1), (3)and(4)of this exclusion do not apply to'property damage(other than
damage by fire, lightning,explosion, smoke, or leakage from automatic fire protection
systems)to premises, including the contents of such premises, rented to you for a period
of 7 or fewer consecutive days. A separate limit of insurance applies to Damage To
Premises Rented To You as described in SECTION III—LIMITS OF INSURANCE.
b. The last paragraph of subsection 2. Exclusions is replaced by the following:
Exclusions c.through n.do not apply to damage by fire, lightning, explosion, smoke, or
leakage from automatic fire protection systems to premises while rented to you or
temporarily occupied by you with permission of the owner.A separate limit of insurance
applies to Damage To Premises Rented To You as described in SECTION III -LIMITS
OF INSURANCE.
2. Paragraph 6. under SECTION III-LIMITS OF INSURANCE is replaced by the following:
6. Subject to 5.above,the Damage To Premises Rented To You Limit is the most we will
pay under Coverage A for damages because of'property damage'to any one premises,
while rented to you,or in the case of damage by fire, lightning, explosion, smoke,or
leakage from automatic protection systems,while rented to you or temporarily occupied
by you with permission of the owner.This limit is the greater of
a. $300,000; or
b. The amount shown in the Declarations for Damage To Premises Rented To You
Limit.
3. The word'fire' is changed to'fire, lightning, explosion, smoke,or leakage from automatic fire
protection systems'where it appears in:
a. SECTION IV—COMMERCIAL GENERAL LIABILITY CONDITIONS, Condition 4.Other
Insurance, paragraph b. Excess Insurance, subparagraph(1)(b); and
b. SECTION V—DEFINITIONS, paragraph 9.a.
Includes copyrighted material of Insurance Services Office,Inc.with its permission.
Copyright.Insurance Services Office,Inc,2000
22-45 (12/02) Page 3 of 7
b. Premises or facilities owned or used by you.
With respect to provision 1.a.above, a person's or organization's status as an insured under this
endorsement ends when your operations for that person or organization are completed.
With respect to provision 1.b.above, a person's or organization's status as an insured under this
endorsement ends when their contract or agreement with you for such premises or facilities ends.
2. This endorsement provision I.does not apply:
a. Unless the written contract or agreement has been executed, or permit has been issued, prior
to the'bodily injury','property damage'or'personal and advertising injury';
b. To'bodily injury'or'property damage'occurring after.
(1) All work, including materials, parts or equipment furnished in connection with such work,
in the project(other than service, maintenance or repairs)to be performed by or on behalf
of the additional insured(s)at the site of the covered operations has been completed;or
(2) That portion of'your work'out of which the injury or damage arises has been put to its
intended use by any person or organization other than another contractor or subcontractor
engaged in performing operations for a principal as a part of the same project;
c. To the rendering of or failure to render any professional services including, but not limited to,
any professional architectural,engineering or surveying services such as:
(1) The preparing, approving, or failing to prepare or approve, maps, shop drawings,
opinions, reports, surveys,field orders,change orders or drawings and specifications;and
(2) Supervisory, inspection, architectural or engineering activities;
d. To'bodily injury', 'property damage'or'personal and advertising injury'arising out of any act,
error or omission that results from the additional insured's sole negligence or wrongdoing;
e. To any person or organization included as an insured under provision J.of this endorsement
f. To any person or organization included as an insured by a separate additional insured
endorsement issued by us and made a part of this policy;or
g. When it is shown in the Schedule as not applicable.
J. ADDITIONAL INSURED—VENDORS
Paragraph 2.under SECTION II -WHO IS AN INSURED is amended to include as an insured any
person or organization (referred to below as'vendor)with whom you agreed, in a written contract or
agreement to provide insurance such as is afforded under this policy, but only with respect to'bodily
injury'or'property damage'arising out of'your products'which are distributed or sold in the regular
course of the vendor's business, subject to the following additional exclusions:
1. The insurance afforded the vendor does not apply to:
a. 'Bodily injury'or'property damage'for which the vendor is obligated to pay damages by
reason of the assumption of liability in a contract or agreement. This exclusion does not apply
Includes mpydghted material of Insurance Services Office,Inc with its permission.
Copyright,Insurance Services Office,Inc.,2000
22-45(12/02) Page 5 of 7
Your failure to disclose all hazards or prior"occurrences'existing as of the inception date of
the policy shall not prejudice the coverage afforded by this policy provided such failure to
disclose all hazards or prior'occurrences' is not intentional.
2. This endorsement provision L.does not apply when it is shown in the Schedule as not applicable.
M. KNOWLEDGE OF OCCURRENCE,OFFENSE, CLAIM OR SUIT
1. Under SECTION IV-COMMERCIAL GENERAL UABIUTY CONDITIONS, the following is added
to Condition 2. Duties in the Event of Occurrence,Offense, Claim Or Suit:
Knowledge of an"occurrence, offense,claim or'suit'by an agent, servant or'employee of
any insured shall not in itself constitute knowledge of the insured unless an insured listed
under paragraph 1.of SECTION II—WHO IS AN INSURED or a person who has been
designated by them to receive reports of occurrences, offenses, claims and"suits'shall have
received such notice from the agent, servant or'employee'
2. This endorsement provision M. does not apply when it is shown in the Schedule as not applicable.
N. LIBERALIZATION CLAUSE
If we revise this Commercial General Liability Extension Endorsement to provide more coverage
without additional premium charge, your policy will automatically provide the coverage as of the day
the revision is effective in your state. This does not apply to provisions that are shown in the Schedule
as not applicable.
O. BODILY INJURY REDEFINED
Under SECTION V-DEFINITIONS, definition 3. is replaced by the following:
3. 'Bodily Injury' means physical injury, sickness or disease sustained by a person. This includes
mental anguish, mental injury, shock, fright or death that results from such physical injury,
sickness or disease.
Includes copyrighted material of Insurance Services Office,Inc.with its permission.
Copyright,Insurance Services Office,Inc..2000
22-45(12/02) Page 7 of 7
ACCPRD CERTIFICATE OF LIABILITY INSURANCE 9�22/�
( l o sY)
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 ADDRIONAL INSURED,the policy(ies)must be endorsed. H 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 N�AMMe CT Tara Fier/Inr
First State Insurance Agency PinEbE (573)334-8100 FAX
NRt(5TS Me en
2001 William Street ADDRESS
tfischer@fsia.bz
INSURER(S)AFFORDING COVERAGE NAM a
Cape Girardeau MD 63703 INSURER A:Liberty Mutual Insurance Company
INSURED INSURER B:
City of Cape Girardeau INSURER C:
c/o Midwest Painting 6 Wallcovering, Inc. DSD,
2121 Bessie Street INSURER E.
Cape Girardeau DID 63701 ISURERF:
COVERAGES CERTIFICATE NUMBERaCP-City of Cape REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POUCIES OF INSURANCE USTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POUCY 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 POUCIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR TYPE OFINSLIRANCE ADOL'U:1- POLICY EFF POLICY EXP
LTRIN50 AND POLICY NUMBER IMWDOIYYTn (MWDOYYYY) LIARS
X COMMERCIAL GENERALLIABanY EACH OCCURRENCES 1,000,000
RENTED
TO
A CLAIMS MADE r1-1 OCCUR
DAMAGE
PREMISES R S
CCF56920160 10/1/2015 10/1/2016 MW Exp(Anyraperm) I
PERSONAL I AW INJURY S
GEM.
AGGREGATE DMR LIES APPPER GENERAL AGGREGATE S 2,000,000
1 I petit,❑k& r I LOC PRODUCTS-COMPCIP AGG S
OTHER S
AUTOMOBILE UAnITY 1EM ASINGLE UNIT S acarlec
ANY AUTO BOOILY INJURY(Pr puma S
ALL OWNED — SCHEDULED BODILY INJURY(Pr amOrd)AUTOS AUTOS
S
HIRED AUTOS _ AUTO ED I SSUPERTY e(;F - S —
S
UMBRELLA LIAR OCCUR EACH OCCURRENCE _ S
EXCESS UAB CLAIMS-MADE AGGREGATE
OW RETENTION $
MIDRICEns COMPENSATION PER 0714.
AND EMPLOYERS' ^Y/N AND ER
S LIABILITY
PRO1ETORIPAR NERID0=gnNE 1 1 M I A El.EACH ACCJDEM
S
OFFICER/AEYBER EXCLUDED?
IIraadamlY M NM EL DISEASE-EA EMPLOYEE S
Dyyeesc dar0a rm
DESI:RIPTON OF OPERATIONS Sow E L DICFAeF-POUCY LIMIT S
DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(ACARD 101.ASsMonal Raalb Schee/de,may be arta)0 more space Is tpWtl)
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
City of Cape Girardeau THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
Project: Floodwall Gate Painting Project ACCORDANCE WITH THE POLICY PROVISIONS.
401 Independence Street
Cape Girardeau, hID 63701 AUTHORIZED REPRESENTATIVE
Tara Fischer/TRF �R/Lo-� Ld nJCt4
01988-2014 ACORD CORPORATION. All rights reserved.
ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD
INS025 rmf mn