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HomeMy WebLinkAbout2016-2717AGREEMENT BETWEEN OWNER AND CONTRACTOR FOR CONSTRUCTION CONTRACT (STIPULATED PRICE) THIS AGREEMENT is by and between the CITY OF COLUMBIA HEIGHTS, MINNESOTA ( "Owner ") and Create Construction Owner and Contractor hereby agree as follows: ARTICLE 1— WORK ( "Contractor ") 1.01 Contractor shall complete all Work as specified or indicated in the Contract Documents. The Work is generally described as follows: Curb and gutter, sidewalk, step or flatwork removals and concrete replacements or installations at spot locations throughout the City. ARTICLE 2 —THE PROJECT 2.01 The Project, of which the Work under the Contract Documents is a part, is generally described as follows: 2016 MISCELLANEOUS CONCRETE REPAIRS AND INSTALLTIONS — CITY PROJECT NO. 1600 ARTICLE 3 — ENGINEER 3.01 The part of the Project that pertains to the Work has been designed by the CITY OF COLUMBIA HEIGHTS' ENGINEERING DEPARTMENT (ENGINEER). 3.02 The ENGINEER 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 the completion of the Work in accordance with the Contract Documents. ARTICLE 4 — CONTRACT TIMES 4.01 Time of the Essence A. All time limits for Milestones, if any, Substantial Completion, and completion and readiness for final payment as stated in the Contract Documents are of the essence of the Contract. 4.02 Contract Times: Dates A. The Work will be substantially completed on or before June 3, 2016 for Phase 1 and September 2, 2016 for Phase 2, and completed and ready for final payment in accordance with Paragraph 15.06 of the General Conditions on or before September 16, 2016. EJCDC® C -520 (Rev. 1), Agreement Between Owner and Contractor for Construction Contract (Stipulated Price). Copyright © 2013 National Society of Professional Engineers, American Council of Engineering Companies, and American Society of Civil Engineers. All rights reserved. Page 1 of 7 4.03 Liquidated Damages A. Contractor and Owner recognize that time is of the essence as stated in Paragraph 4.01 above and that Owner will suffer financial and other losses if the Work is not completed and Milestones not achieved within the times specified in Paragraph 4.02 above, plus any extensions thereof allowed in accordance with the Contract. The parties also recognize the delays, expense, and difficulties involved in proving in a legal or arbitration proceeding the actual loss suffered by Owner if the Work is not completed on time. Accordingly, instead of requiring any such proof, Owner and Contractor agree that as liquidated damages for delay (but not as a penalty): 1. Substantial Completion: Contractor shall pay Owner $1,000.00 for each day that expires after the time (as duly adjusted pursuant to the Contract) specified in Paragraph 4.02.A above for Substantial Completion until the Work is substantially complete. 2. Completion of Remaining Work: After Substantial Completion, if Contractor shall neglect, refuse, or fail to complete the remaining Work within the Contract Times (as duly adjusted pursuant to the Contract) for completion and readiness for final payment, Contractor shall pay Owner $1,000.00 for each day that expires after such time until the Work is completed and ready for final payment. 1 Liquidated damages for failing to timely attain Substantial Completion and final completion are not additive and will not be imposed concurrently. ARTICLE 5 — CONTRACT PRICE 5.01 Owner shall pay Contractor for completion of the Work in accordance with the Contract Documents, subject to adjustment under the Contract: A. For all Work, at the prices stated in Contractor's Bid, attached hereto as an exhibit. B. The extended prices for Unit Price Work set forth as of the Effective Date of the Contract are based on estimated quantities. As provided in Paragraph 13.03 of the General Conditions, estimated quantities are not guaranteed, and determinations of actual quantities and classifications are to be made by Engineer. ARTICLE 6 — PAYMENT PROCEDURES 6.01 Submittal and Processing of Payments A. Contractor shall submit Applications for Payment in accordance with Article 15 of the General Conditions. Applications for Payment will be processed by Engineer as provided in the General Conditions. 6.02 Progress Payments, Retainage A. Owner shall make progress payments on account of the Contract Price on the basis of Contractor's Applications for Payment on or about the 15th day of each month during performance of the Work as provided in Paragraph 6.02.A.1 below, provided that such Applications for Payment have been submitted in a timely manner and otherwise meet the requirements of the Contract. All such payments will be measured by the Schedule of Values established as provided in the General Conditions (and in the case of Unit Price Work based on the number of units completed) or, in the event there is no Schedule of Values, as provided elsewhere in the Contract. EJCDC® C -520 (Rev. 1), Agreement Between Owner and Contractor for Construction Contract (Stipulated Price). Copyright Q 2013 National Society of Professional Engineers, American Council of Engineering Companies, and American Society of Civil Engineers. All rights reserved. Page 2 of 7 1. Prior to Substantial Completion, progress payments will be made in an amount equal to the percentage indicated below but, in each case, less the aggregate of payments previously made and less such amounts as Owner may withhold, including but not limited to liquidated damages, in accordance with the Contract a. 95 percent of Work completed (with the balance being retainage). If the Work has been 50 percent completed as determined by Engineer, and if the character and progress of the Work have been satisfactory to Owner and Engineer, then as long as the character and progress of the Work remain satisfactory to Owner and Engineer, there will be no additional retainage; and b. 95 percent of cost of materials and equipment not incorporated in the Work (with the balance being retainage). B. Upon Substantial Completion, Owner shall pay an amount sufficient to increase total payments to Contractor to 98 percent of the Work completed, less such amounts set off by Owner pursuant to Paragraph 15.01.E of the General Conditions, and less 200 percent of Engineer's estimate of the value of Work to be completed or corrected as shown on the punch list of items to be completed or corrected prior to final payment. 6.03 Final Payment A. Upon final completion and acceptance of the Work in accordance with Paragraph 15.06 of the General Conditions, Owner shall pay the remainder of the Contract Price as recommended by Engineer as provided in said Paragraph 15.06. ARTICLE 7 — INTEREST 7.01 All amounts not paid when due shall bear interest at the rate stipulated in Minnesota Statute 161.322, ARTICLE 8 — CONTRACTOR'S REPRESENTATIONS 8.01 In order to induce Owner to enter into this Contract, Contractor makes the following representations: A. Contractor has examined and carefully studied the Contract Documents, and any data and reference items identified in the Contract Documents. B. Contractor has visited the Site, conducted a thorough, alert visual examination of the Site and adjacent areas, and become familiar with and is satisfied as to the general, local, and Site conditions that may affect cost, progress, and performance of the Work. C. Contractor is familiar with and is satisfied as to all Laws and Regulations that may affect cost, progress, and performance of the Work. D. Contractor has carefully studied all: (1) reports of explorations and tests of subsurface conditions at or adjacent to the Site and all drawings of physical conditions relating to existing surface or subsurface structures at the Site that have been identified in the Supplementary Conditions, especially with respect to Technical Data in such reports and drawings, and (2) reports and drawings relating to Hazardous Environmental Conditions, if any, at or adjacent to the Site that have been identified in the Supplementary Conditions, especially with respect to Technical Data in such reports and drawings. E1CDC® C -520 (Rev. 1), Agreement Between Owner and Contractor for Construction Contract (Stipulated Price). Copyright © 2013 National Society of Professional Engineers, American Council of Engineering Companies, and American Society of Civil Engineers. All rights reserved. Page 3 of 7 E. Contractor has considered the information known to Contractor itself, information commonly known to contractors doing business in the locality of the Site; information and observations obtained from visits to the Site; the Contract Documents; and the Site- related reports and drawings identified in the Contract Documents, with respect to the effect of such information, observations, and documents on (1) the cost, progress, and performance of the Work; (2) the means, methods, techniques, sequences, and procedures of construction to be employed by Contractor; and (3) Contractor's safety precautions and programs. F. Based on the information and observations referred to in the preceding paragraph, Contractor agrees that no further examinations, investigations, explorations, tests, studies, or data are necessary for the performance of the Work at the Contract Price, within the Contract Times, and in accordance with the other terms and conditions of the Contract. G. Contractor is aware of the general nature of work to be performed by Owner and others at the Site that relates to the Work as indicated in the Contract Documents. H. Contractor has given Engineer written notice of all conflicts, errors, ambiguities, or discrepancies that Contractor has discovered in the Contract Documents, and the written resolution thereof by Engineer is acceptable to Contractor. I. The Contract Documents are generally sufficient to indicate and convey understanding of all terms and conditions for performance and furnishing of the Work. I Contractor's entry into this Contract constitutes an incontrovertible representation by Contractor that without exception all prices in the Agreement are premised upon performing and furnishing the Work required by the Contract Documents. EJCDC® C -520 (Rev. 1), Agreement Between Owner and Contractor for Construction Contract (Stipulated Price). Copyright O 2013 National Society of Professional Engineers, American Council of Engineering Companies, and American Society of Civil Engineers. All rights reserved. Page 4 of 7 ARTICLE 9 — CONTRACT DOCUMENTS 9.01 Contents A. The Contract Documents consist of the following: 1. This Agreement (pages 1 to 7 , inclusive). 2. Performance bond (pages 1 to 3 , inclusive). 3. Payment bond (pages 1 to 3 , inclusive). 4. Other bonds. a. _ (pages _ to _, inclusive). 5. General Conditions (pages 1 to 65 , inclusive). 6. Supplementary Conditions (pages 00700 -66 to 00700-75_, inclusive). 7. Specifications as listed in the table of contents of the Project Manual. 8. Drawings are included with the project manual. 9. Addenda (numbers 1 to 1 , inclusive). 10. Exhibits to this Agreement (enumerated as follows): a. Contractor's Bid (pages 10 to 18 , inclusive). 11. The following which may be delivered or issued on or after the Effective Date of the Contract and are not attached hereto: a. Notice to Proceed. b. Work Change Directives. c. Change Orders. B. The documents listed in Paragraph 9.01.A are attached to this Agreement (except as expressly noted otherwise above). C. There are no Contract Documents other than those listed above in this Article 9. D. The Contract Documents may only be amended, modified, or supplemented as provided in the General Conditions. EJCDC® C -520 (Rev. 1), Agreement Between Owner and Contractor for Construction Contract (Stipulated Price). Copyright © 2013 National Society of Professional Engineers, American Council of Engineering Companies, and American Society of Civil Engineers. All rights reserved. Page 5 of 7 ARTICLE 10 — MISCELLANEOUS 10.01 Terms A. Terms used in this Agreement will have the meanings stated in the General Conditions and the Supplementary Conditions. 10.02 Assignment of Contract A. Unless expressly agreed to elsewhere in the Contract, no assignment by a party hereto of any rights under or interests in the Contract will be binding on another party hereto without the written consent of the party sought to be bound; and, specifically but without limitation, money that may become due and money that is 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. 10.03 Successors and Assigns A. Owner and Contractor each binds itself, its successors, assigns, and legal representatives to the other party hereto, its successors, assigns, and legal representatives in respect to all covenants, agreements, and obligations contained in the Contract Documents. 10.04 Severability A. 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. 10.05 Contractor's Certifications A. Contractor certifies that it has not engaged in corrupt, fraudulent, collusive, or coercive practices in competing for or in executing the Contract. For the purposes of this Paragraph 10.05: 1. "corrupt practice" means the offering, giving, receiving, or soliciting of any thing of value likely to influence the action of a public official in the bidding process or in the Contract execution; 2. "fraudulent practice" means an intentional misrepresentation of facts made (a) to influence the bidding process or the execution of the Contract to the detriment of Owner, (b) to establish Bid or Contract prices at artificial non- competitive levels, or (c) to deprive Owner of the benefits of free and open competition, 3. "collusive practice" means a scheme or arrangement between two or more Bidders, with or without the knowledge of Owner, a purpose of which is to establish Bid prices at artificial, non - competitive levels; and 4. "coercive practice" means harming or threatening to harm, directly or indirectly, persons or their property to influence their participation in the bidding process or affect the execution of the Contract. 10.06 Other Provisions (if applicable). EJCDC° C -520 (Rev. 1), Agreement Between Owner and Contractor for Construction Contract (Stipulated Price). Copyright © 2013 National Society of Professional Engineers, American Council of Engineering Companies, and American Society of Civil Engineers. All rights reserved. Page 6 of 7 IN WITNESS WHEREOF, Owner and Contractor have signed this Agreement. This Agreement will be effective on April 28, 2016 (which is the Effective Date of the Contract). OWNER: City of Columbia Heights CONTRACTOR: By: G „i Attest: att Attest: Title: Address for giving notices: LJVJ 0� cCCWhlc- �c cc/ f la_ ,(�//l f , (If OWNER is a corporation, attach evidence of authority to sign. If OWNER is a public body, attach evidence of authority to sign and resolution or other documents authorizing execution of OWNER- CONTRACTOR Agreement.) Designated Representative: Name: Kevin Hansen Title: City Engineer Address: 637 38th Avenue NE Columbia Heights, MN 55421 Phone: 763 - 706 -3700 [CORPORATE SEAL] Title: r�l ' c '0% V )i Address for giving notices: w J Ni License No.: (Where applicable) Agent for service of process: (If Contractor is a corporation, a partnership, or a joint venture, attach evidence of authority to sign.) Designated Representative: EJCDCO C -520 (Rev. 1), Agreement Between Owner and Contractor for Construction Contract (Stipulated Price). Copyright © 2013 National Society of Professional Engineers, American Council of Engineering Companies, and American Society of Civil Engineers. All rights reserved. Page 7 of 7 k' CONTRACTOR (name and address): Create Construction, LLC 18517 100th Avenue North Maple Grove, MN 55311 OWNER (name and address): City of Columbia Heights 59'0uu4mm0tth�AHvenutesNMEN 542 CONgTRUc TI8iNhCONTRACTf r � . j • l i r SU RETY (name and address of principal place of business): United Fire & Casualty Company 118 2nd Avenue SE, PO Box 73909 Cedar Rapids, IA 52407 -3909 Effective Date of the Agreement: 04/25/2016 Amount: $29,679.50 Description (name and location): 2016 Miscellaneous Concrete Repairs and Installations BOND Bond Number: 54210619 Date (not earlier than the Effective Date of the Agreement of the Construction Contract): Amount: 04/25/2016 Modifications to this Bond Form: X� None See Paragraph 16 Surety and Contractor, intending to be legally bound hereby, subject to the terms set forth below, do each cause this Performance Bond to be duly executed by an authorized officer, agent, or representative. c t CONTRACTOR (name and address): Creaet Construction, LLC 18517 100th Avenue North Maple Grove, MN 55311 W • SURETY (name and address of principal place of business): OWNER (nomeond address): City of Columbia Heights, 590 40th Avenue NE, Columbia Heights, MN 55421 CONSTRUCTION CONTRACT Effective Date of the Agreement: 04/25/2016 Amount: $29,679.50 Description (name and location): 2016 Miscellaneous Concrete Repairs and Installations BOND Bond Number: 54210619 Date (not earlier than the ffective Date of the Agreement of the Construction Contract): 04125/2016 Amount: $29,679.50 Modifications to this Bond Form: F—X1 None ❑ See Paragraph 18 Surety and Contractor, intending to be legally bound hereby, subject to the terms set forth below, do each cause this Payment Bond to be duly executed by an authorized officer, agent, or representative. CONTRACTOR AS PRINCIPAL Create Construction, LLC Contractor's Name anc Corporate Seal By: QI(O tIA, Signat e Jodi Gunderson Print Name President Title Attest: _ Signature (seal) Title Title Patricia Higgins Print Name Power of Attorney Title Attest: Signature Notes: (1) Provide supplemental execution by any additional parties, such as joint venturers. (2) Any singular reference to Contractor, Surety, Owner, or other party shall be considered plural where applicable. EICDC® C -615, Payment Bond Copyright © 2013 National Society of Professional Engineers, American Council of Engineering Companies, and American Society of Civil Engineers. All rights reserved. 1 of 3 INDIVIDUAL STATE OF ) SS: COUNTY OF On this day of before me personally appeared to me known, and known to me to be the individual described in and who executed the foregoing instrument and acknowledged to me that STATE OF ) SS: COUNTY OF On this day of to me known, and known to me to be one of the firm of the same in his/her individual capacity. COPARTNERSHIP before me personally appeared (Notary Public) in and who executed the foregoing instrument and he thereupon acknowledged to me that he executed the same as and for the act and deed of said firm. CORPORATE STATE OF Minnesota ) ) SS: COUNTY OF Hennepin ) (Notary Public) On this 25th day of April , 2016, before me personally appeared Jodi Gunderson to me known, who, being by me first duly sworn, did depose and say that she resides in Maple Grove, MN that she is the President of Create Construction LLC the corporatio u e oing instrument; that he knows the corporate seal of said corporation; that the corporate seal affixe o trume sea that it was so affixed by order and authority of the Board of Directors of said corporation, and that h a r o y e rder an authority. !/ (Notary Public) SURETY STATE OF Minnesota ) SS: COUNTY OF Hennepin j UNITED FIRE &'CASUALTY COMPANY, CEDAR RAPIDS, IA Inquiries: Surety Department UNITED FIRE & INDEMNITY COMPANY, WEBSTER, TX 118 Second Ave SE UNIM FINANCIAL PACIFIC INSURANCE COMPANY, ROCKLIN, CA Cedar Rapids, IA 52401 " CERTIFIED COPY OF POWER OF ATTORNEY (original on file at Home Office of Company — See Certification) KNOW ALL PERSONS BY THESE PRESENTS, That UNITED FIRE & CASUALTY COMPANY, 'a corporation duly organized and existing tmder the lava ofthe State of Iowa; UNITED FIRE &'INDEMNITY COMPANY, a corporation duly organized and existing under the laws of the State of Texas; and FINANCIAL PACIFIC INSURANCE COMPANY, a corporation duly organized and existing under the laws of the State of California (herein collectively called the Comppanies) and having their :corporate headquarters in Cedar Rapids, State of Iowa, does make, constitute and appoint KIMBERLY K. ANDERSON, 0 JANt�DOERFLER, OR PATRICIA HIGGINS ALL'TNDIVIDUALLY of EDEN PRAIRIE 'MN their true and lawful Attomey(s) -in -Fact with power and authority hereby conferred to sign, seal and execute in its behalf all lawful bonds, undertakings and other obligatory instruments of similar nature provided that no single obligation shall exceed $750,000.00 and to bind the Companies thereby as fully and to the same extent as if such instruments were signed by the duly authorized officers of the Companies and all of the acts of said Attorney, pursuant to the authority hereby given and hereby ratified and confirmed. The Authority hereby granted shall expire the 18th day of April, 2017 unless sooner revoked by UNITED FIRE & CASUALTY COMPANY, UNITED FIRE & INDEMNITY COMPANY, AND FINANCIAL PACIFIC INSURANCE COMPANY. This Power of Attorney is made and executed pursuant to and by authority of the following bylaw duly adopted on May 15, 2013, by the Boards of Directors of UNITED FIRE & CASUALTY COMPANY, UNITED FIRE & INDEMNITY COMPANY, and FINANCIAL PACIFIC INSURANCE COMPANY. "Article VI — Surety Bonds and Undertakings" Section 2., Appointment of Attorney -in -Fact. "The President or any Vice President, or any other officer of the Companies may, from time to time, Appoint by written certificates attorneys -in -fact to act in behalf of the Companies in the execution of policies of insurance, bonds, undertakings and other obligatory instruments of like nature. The signature of any officer authorized hereby, and the Corporate seal, may be affixed by facsimile to any power of attorney or special power of attorney or certification of either authorized hereby; such signature and seal, when so used, being adopted by the Companies as the original signature of such officer and the original seal of the Companies, to be valid and binding upon the Companies with the same force and effect as though manually affixed. Such attorneys -in -fact, subject to the limitations set forth in their respective certificates of authority shall have full power to bind the Companies by their signature and execution of any such instruments and to attach the seal of the Companies thereto. The President or any Vice President, the Board of Directors or any other officer of the Companies may at any time revoke all power and authority previously given to any attorney -in -fact. IN WITNESS WHEREOF, the COMPANIES have each caused these presents to be signed by its `,e��`"S °''trFCOg, vice president and its corporate seal to be hereto affixed this 18th day of April , 2015 'N CORPORATE ry Z Fa ° CORPORATE y =Qt= ' o_ UNITED FIRE &CASUALTY COMPANY ,see € UNITED FIRE & INDEMNITY COMPANY SEAL ' SEAL FINANCIAL PACIFIC INSURANCE COMPANY . " .. • UFOR.S '�grynrnnn,OS`������ By: State of Iowa, County of Linn, ss: 41— Vice President On 18th day of April, 2015, before me personally came Dennis J. Richmann to me known, who being by me duly sworn, did depose and say; that he resides in Cedar Rapids, State of Iowa- that he is a Vice President of UNITED FIRE &'CASUALTY COMPANY, a Vice President of UNITED FIRE & INDEMNITY COMPANY, and a Vice President of FINANCIAL PACIFIC INSURANCE COMPANY the corporations described in and which executed the above instrument; that he knows the seal of said corporations; that the seal affixed to the said instrument is such corporate seal; that it was so affixed pursuant to authority given by the Board of Directors of said corporations and that he signed his name thereto pursuant to like authority, and acknowledges same to be the act and deed of said:corporations. plat Judith A. Davis clly�& it Iowa Notarial Seat Commission number 173041 otary Public owR My commission Expires 04/23/2018 My commission expires: 04 /23/2018 1, David A. Lange, Secretary of UNITED FIRE & CASUALTY COMPANY and Assistant Secretary of ITLD FIRE & INDEMNITY COMPANY, and Assistant Secretary of FINANCIAL PACIFIC INSURANCE COMPANY, db hereby certify that I have compared the foregoing copy of the Power of Attorney and affidavit, and the copy of the Section of the bylaws and resolutions of said Corporations as set forth in said Power of Attorney, with the ORIGINALS ON FILE IN THE HOME OFFICE OF SAID CORPORATIONS, and that the same are correct transcripts thereof, and of the whole of the said originals, and that the said Power of Attorney has not been revoked and is now in fail force and .effect. In testimony whereof I have hereunto subscribed my name and affixed the corporate seal of the said Corporations this 2r; 7, i-h day of mw+31 ,20 . su,gp p'' ,,145E G�I NSfUN .t cif `QPGpFPORy'� t ^�^ 4?DitPORATE Opp'y `U 6 Vt Ly Ze. $ _ By. .. x SEAL x` Z C 7886 5P J CA i� Secretary, OF &C Assistant Secretary, OF &I /FPIC BPOA0045 0115 AliC"R6r CERTIFICATE OF INSURANCE Ilk� LIABILITY DATE (MWDD/YYYY) 5/6/2016 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). PRODUCER Phone: (952)944 -2929 Fax: (952)944 -3091 Horizon Agency, Inc. 6500 City West Pkwy #100 CONTACT Rim Anderson, CISR NAME: PHNN (952 }914 -7145 ac No): (952)944 -3091 E-DUESS: kim @horizonagency.com INSURER(S) AFFORDING COVERAGE NAIC # Eden Prairie, Minnesota 55344 INSURER A: Selective Insurance Company Of America 12572 7t22/2015 INSURED INSURER B: $ 1,000,000 Create Construction, LLC 18517 100th Ave N Maple Grove, MN 55311 INSURER C., $ 100,000 INSURER D : MED EXP (Any one person) INSURER E INSURER F: PERSONAL & ADV INJURY $ 1,000,000 CUVtKAGtS CERTIFICATE NUMRFR- 6267 AGIJIQInN tal nucco. 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. - INSR LTR I TYPE OF INSURANCE ADDL IN SD SUBR WVD POLICY NUMBER POLICY EFF MM/DD POLICY EXP MM/DD LIMITS A t% COMMERCIAL GENERAL LIABILITY CLAIMS -MADE ✓� OCCUR Y 52177687 7t22/2015 7/22/2016 EACH OCCURRENCE $ 1,000,000 E PREMISES (Ea occurrence) $ 100,000 MED EXP (Any one person) $ 10,000 PERSONAL & ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY ❑ JPERCO T E] Lee OTHER: GENERAL AGGREGATE $ 3,000,000 PRODUCTS $ 3,000,000 $ A AUTOMOBILE LIABILITY ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS NON -OWNED HIRED AUTOS AUTOS Y 52177687 7/22/2015 7/22/2016 Ea BIKED SINGLE LIMIT $ 1,000,000 ✓ BODILY INJURY (Per person) $ BODILY INJURY Per accident ( ) $ PROPERTY DAMAGE Per accident $ A y+� UMBRELLA LIAB EXCESS LIAB ✓ OCCUR CLAIMS -MADE y 52177687 7/22/2015 7/22/2016 EACH OCCURRENCE $ 1,000,000 AGGREGATE $ 1,000,000 DED ✓ RETENTION $ $ A WORKERS AND EMPLO ERSELIABILITY YIN ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICERIMEMBER EXCLUDED? (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS below NIA Y WC9025085 7/22/2015 7/22/2016 STA UTE ERµ E.L. EACH ACCIDENT $ 500,000 E.L. DISEASE- EA EMPLOYE - $ 500,000 E.L. DISEASE - POLICY LIMIT 1 - $ 500,000 DESCRIPTION OF OPERATIONS I LOCATIONS /VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) ... -..... .vr.. a- a .v. -v._.� t.MP/licLL.A I i VIM Holder's Nature of Interest : Additional Insured City of Columbia Heights 637 38th Avenue NE Columbia Heights, MN 55421 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ©1988 -2014 ACORD CORPORATION. All rights reserved ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD ELITEPAC General Liability Extension Assisted Living Facilities COMMERCIAL GENERAL LIABILITY CG 79 89 12 12 SUMMARY OF COVERAGES (including index) This is a summary of the various additional coverages and coverage modifications provided by this endorsement. No coverage is provided by this summary. DESCRIPTION Additional Insured - Funding Source phmarymndNon-ConthbutnryPnovsion -Additiono||nnured BkanketAdditiuna|}nounedo - AoRequhadByContract Broad Form Vendors Coverage Damage to Premises Rented to You ($1.000.000) (including Fire, Lightning, Explosion, Gmoke, Leakage From Automatic Fire Protection Systems or Water) Functional Additional Insureds Incidental Broadcasting and Publishing Increased Limits for Medical Payments ($2O.QOO) Knowledge pf Occurrence, Claim, Suit orLoss Liberalization Clause Limited Assault Coverage Limited Property Damage To Property Of Others In Your Care, Custody Or Control K8edioo| Payments Exclusion - Your Medical 8en/ioem Medical Payments - Amendment to Injury on Normally Occupied Premises exclusion Mental Anguish Amendment (not applicable in New York) Non-Owned Aircraft, Auto orWatercraft Personal and Advertising Injury Contractual Exclusion Amendment (Excludes Advertisement) Discrimination and Humiliation Amendment (not applicable in New York; Excludes Advertisement) Products Amendment Copyright, 2012 Selective Insurance Company of America. All rights reserved. Includes copyrighted mobeho| of Insurance Services Office, Inc., with its permission. FINRMI Supplementary Payments Amended Bail Bonds ($5,000) and Loss of Earnings ($1,000) Limited Legal Expense for Innocent Insureds Temporary Liquor Liability (not applicable in Virginia) Temporary Workers Employee Definition Amended (including status as an insured) Employer's Liability Exclusion Amended Employees As Insureds Modified (co- employee damages) Unintentional Failure to Disclose Hazards Waiver of Transfer of Rights of Recovery (subrogation) When Two or More Coverage Parts of this Policy Apply to a Loss Copyright, 2012 Selective Insurance Company of America. All rights reserved. Includes copyrighted material of Insurance Services Office, Inc., with its permission.