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HomeMy WebLinkAboutInsurance & Bonds A ° DATE (MMIDD/YYYY) R°® CERTIFICATE OF LIABILITY INSURANCE 6/16/2011 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 =rms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the Irate holder in lieu of such endorsement s . PRODUCER NAME: Michele Miller, CISR Bearence Management Group A PHOE /CN No. Ext): (651)227-8405 (A/C,No): (651)227 -0507 Post Office Box 64016 nDpR l esS:mmiller @bearence.com PRODUCER 00 001119 CUSTOMER ID #: Saint Paul MN 55164 INSURER(S) AFFORDING COVERAGE _ NAIC# INSURED INSURERA:General Casualty Company of WI 24414 INSURER B :TOrt1S Specialty Insurance 44776 Jorgenson Construction, Inc. INSURERC:General Casualty Insurance 18821 9255 E River Road NW INSURER D : INSURER E : Coon Rapids MN 55433 -5722 INSURER F : COVERAGES CERTIFICATE NUMBER:CL1161610992 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. INSR TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LIMITS LTR INSR WVD POLICY NUMBER (MM /DD /YYYY) (MM /DD/YYYY) GENERAL LIABILITY EACH OCCURRENCE $ 2,000,000 DAMAGE TO RENTED X COMMERCIAL GENERAL LIABILITY PREMISES (Ea occurrence) $ 100 , 000 A CLAIMS -MADE X OCCUR CCI0388300 6/20/2011 6/20/2012 MED EXP (Any one person) $ 5, 000 X Contractual PERSONAL & ADV INJURY $ 2,000,000 X XCU GENERAL AGGREGATE $ 2,000,000 GE 'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP /OP AGG $ 2,000,000 — 1 POLICY X IFS•T LOC $ TOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1, 000, 000 (Ea accident) ANY AUTO BODILY INJURY (Per person) $ A ALL OWNED AUTOS CBA0388300 6/20/2011 6/20/2012 BODILY INJURY (Per accident) $ X SCHEDULED AUTOS PROPERTY DAMAGE $ X HIRED AUTOS (Per accident) X NON -OWNED AUTOS Uninsured motorist BI- single $ Underinsured motorist 81 single $ X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 1,000,000 EXCESS LIAB CLAIMS -MADE AGGREGATE $ 1,000,000 DEDUCTIBLE $ B RETENTION $ 22059A100ALI 6/20/2011 6/20/2012 $ C WORKERS COMPENSATION X T WC ORY 1 I ITS ER AND EMPLOYERS' LIABILITY ANY PROPRIETOR /PARTNER /EXECUTIVE Y/ N E.L. EACH ACCIDENT $ 1,000,000 OFFICER /MEMBER EXCLUDED? y N/A 6/20/2011 6/20/2012 (Mandatory In NH) CWCO388300 E.L. DISEASE - EA EMPLOYE; $ 1,000,000 If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) RE: Contractors License. City of Oak Park Heights is named as Additional Insured in regard to the General Liability Form CG8102 where required by written contract on a primary and non contributory basis including completed operations. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE :6% /� THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Oak Park Heights 4 / , � ACCORDANCE WITH THE POLICY PROVISIONS. 14168 Oak Park Blvd N Z':, 0 Box 2007 44 AUTHORIZED REPRESENTATIVE IIPSak Park Heights, MN 55082 -/7 11 M Miller, CISR /MILLER X 24 e t a �i� ACORD 25 (2009/09) © 1988-2009 ACORD CORPORATION. All rights reserved. INS025 (200909) The ACORD name and logo are registered marks of ACORD Ac o CERTIFICATE OF LIABILITY INSURA DATE /16 / DOIYY 4 .......--- 4.......--- 6 9 PRODUCER (651) 227 -8405 FAX: (651) 227 -0507 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION T. C. Field Company ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 00 Bearence Management Group Co ALTER THE COVERAGE AFFORDED BY THE POUCIES BELOW. North Robert Street St. Paul MN 55101 INSURERS AFFORDING COVERAGE NAIC # INSURED INSURER A: General Casualty Company of 24414 Jorgenson Construction, Inc. INSURER B: General Casualty Insurance 18821 9255 E River Road NW INSURER C: INSURER D: Coon Rapids MN 55433 -5722 INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTVVITHSTAN DING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADD'L POUCY EFFECTIVE POUCY EXPIRATION LTR INSRQ TYPE OF INSURANCE POLICY NUMBER DATE (MM P01YYYY) DATE fMMIDDIYYYYI LIMITS GENERAL LIABILITY EACH OCCURRENCE r $ 2, 000 , 000 X COMMERCIAL GENERAL LIABILITY PREMISES SES (Ea $ 100 , 000 A CLAIMS MADE [ X ] OCCUR 20388300 6/20/2009 6/20/2010 MED EXP (Any one person) $ 5, 000 PERSONAL & ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE UNIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 2,000,000 POLICY X ] PT LOC AUTOMOBILE LIABILITY (Ea aBcdden SINGLE LIMIT $ 1,000,000 X _ ANY AUTO A ALL OWNED AUTOS etc 0388300 6/20/2009 6/20/2010 BODILY INJURY (per person) $ X SCHEDULED AUTOS X HIRED AUTOS BODILY INJURY $ X NON-OWNED AUTOS (Per accident) PROPERTY DAMAGE $ (Per accident) S GARAGE UABIUTY AUTO ONLY - EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ _ AUTO ONLY: AGG $ EXCESS / UMBRELLA LIABILITY EACH OCCURRENCE $ 9,000,000 X OCCUR CLAIMS MADE AGGREGATE $ 9,000,000 A DEDUCTIBLE cUO388300 6/20/2009 6/20/2010 $ X RETENTION $ 10,00' $ B W X WORKERS COMPENSATION TORY LIMIT WC STATU- S . ER I DTI+ AND EMPLOYERS' UABIUTY ANY PROPRIETOR/PARTNER/EXECUTIVE { / N EL EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? (Mandatory In NH) 0388300 6/20/2009 6/20/2010 E.L DISEASE - EA EMPLOYEE $ 1,000, If s. de s cribe u nder SPECIAL PROVISIONS below E.L DISEASE - POLICY LIMIT $ 1, 000 , 000 OTHER DESCRIPTION OF OPERATIONS /LOCATIONS 1 VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS Project: City Hall Facility City of Oak Park Heights and Buetow & Associates is named as Additional Insured in regard to the General Liability Fora CG8102 & CG2032 where required by written contract on a primary and non contributory basis. Completed Operations are included. *10 days for non payment. CERTIFICATE HOLDER CANCELLATION (651) 439-0574 SHOULD ANY OF THE ABOVE DESCRIBED POUCIES OE CANCELLED BEFORE THE EXPIRATION City of Oak Park Heights DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30* DAYS WRITTEN Eric Johnson NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL 14168 Oak Park Blvd N Box 2007 IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR Oak Park Heights, MN 55082 REPRESENTATIVES. AUTHORIZED R Mi /MI LLER Michele j Glad / ;� %/ chele iler /MI 7 / �w�>30 i( ORD 25(2009/01) ©1988 -2009 ACORD CORPORATION. All rights reserved. INS025 (200901) The ACORD name and logo are registered marks of ACORD • IMPORTANT If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). DISCLAIMER This Certificate of Insurance does not constitute a contract between the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon. • •ORD 25 (2009/01) 1NS025 (200901) A CERTIFICATE OF LIABILITY INSURANCE 6/16/2009 PRODUCER ( 651) 227 -8405 FAX: (651) 227 -0507 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION T. C. Field 6 Company ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR North Robert Street ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. St. Paul MN 55101 INSURERS AFFORDING COVERAGE NAIC # INSURED INSURER A: General Casualty Company of 24414 Jorgenson Construction, Inc. INSURER B: General Casualty Insurance 18821 9255 E River Road NW INSURER C: INSURER D: Coon Rapids MN 55433 -5722 INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADM POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS LTR .NERD TYPE (W INSURANCE DATE IMMMOD/YWY) DATE IMMIDD/YYYY) GENERAL( (ABILITY EACH OCCURRENCE $ 2,000,000 TO X COMMERCIAL GENERAL LIABILITY PR MIKES (Ea RENTED $ 100,000 A CLAIMS MADE X OCCUR CC10388300 6/20/2009 6/20/2010 MED EXP (Any one Person) $ 5, 000 PERSONAL & ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 2,000,000 ' POLICY X Sra LOC AUTOMOBILE IJABILITY (Ea accident) SINGLE LIMIT $ 1,000,000 X ANY AUTO ' A ALL OWNED AUTOS CBA0388300 6/20/2009 6/20/2010 BODILY INJURY $ X SCHEDULED AUTOS (Per person) X HIRED AUTOS BODILY INJURY $ X NON -OWNED AUTOS (Per accident) PROPERTY DAMAGE $ (Per eaident) • GARAGE LABILITY AUTO ONLY - EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESS / UMBRELLA LIABILITY EACH OCCURRENCE $ 1,000,000 X OCCUR CLAIMS MADE AGGREGATE $ 1,000,000 A DEDUCTIBLE cCUO388300 6/20/2009 6/20/2010 $ X RETENTION $ 10,000 $ B WORKERS COMPENSATION X TORY LIMITS OT AND EMPLOYERS' LIABILITY - ER ANY PROPRIETOR/PARTNER/EXE f CUTIVE [1 E.L. EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDEDT (Mandatory In NH) CWCO388300 6/20/2009 6/20/2010 E.L. DISEASE - EA EMPLOYEE $ 1,000,000 If yes, describe under SPECIAL PROVISIONS below E.L. DISEASE - POLICY LIMIT $ 1,000,000 OTHER DESCRIPTION OF OPERATIONS 1 LOCATIONS 1 VEHICLES /EXCLUSIONS ADDED BY ENDORSEMENT 1 SPECIAL PROVISIONS RE: Contractors License. City of Oak Park Heights is named as Additional Insured in regard to the General Liability Form CG8102 where required by written contract on a primary and non contributory basis. *10 days for non payment. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION ' City of Oak Park Heights DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAL 30* DAYS WRITTEN 14168 Oak Park Blvd N NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL PO Box 2007 Oak Park Heights, MN 55082 IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE p /� cheliler/ �j_ ge 7A.... - CJtf � Michele Miller /MILLER �/Z� S� ORD 25 (2009/01) © 1988-2009 ACORD CORPORATION. All rights reserved. INS025 (200901) The ACORD name and logo are registered marks of ACORD • IMPORTANT If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). DISCLAIMER This Certificate of Insurance does not constitute a contract between the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon. l i • • ACORD 25 (2009/01) INS025 (200901) , 6 Eric Johnson m: Michele VanReese Miller Emmiller @tcfield.com] t: Monday, November 02, 2009 3:10 PM • Eric Johnson Subject: Jorgenson Construction Certs Attachments: Acord Forms_108.pdf «Acord Forms 108.pdf > • • 1 Page 1 of 1 • Eric Johnson From: Randy Engel [randy engel©buetowarchitects.com] Sent: Tuesday, April 28, 2009 12:56 PM To: Eric Johnson Cc: Michael Lueth Subject: OAK PARK HEIGHTS CITY HALL (BA#0822) Attachments: 20090428123740259.pdf; ATT61346.htm; 20090428124826376.pdf; ATT61347.htm; 20090428125256534. pdf; ATT61348. htm April 28, 2009 Eric: Attached are the following regarding the Contractor's submitted insurance coverage(s): 1) Certificate of Liability Insurance (dated 4/28/09) 2) Questions addressed to and responses received from the General Contractor's Insurance advisor /agent. We recommend to the City of Oak Park Heights that it can now prepare and issue a Notice To Proceed • (dated April 29, 2009) to the General Contractor: Jorgenson Construction, Inc. (A sample such letter is attached). BUETOW AND ASSOCIATES, INC. Randy L. Engel, RA, AS Principal -in- Charge 2345 Rice Street, Suite 210 St. Paul, Minnesota 55123 Tel 651 483 -6701 Fax 651 483 -2574 Cellular 952 237 -5932 • 4/28/2009 '``° DATE (MM/DD/YYYY) ® CERTIFICATE OF LIABILITY INSURANCE 6/16/2009 PRODUCER (651) 227 - 8405 FAX: (651) 227 - 0507 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION T. C. Field &Company ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 530 North Robert Street ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. St.4,1 MN 55101 INSURERS AFFORDING COVERAGE NAIC # INSUR _ INSURER A: General Casualty Company of 24414 Jorgenson Construction, Inc. 6001 9 g Nnr INSURER B: General Casualty Insurance 18821 9255 E River Road NW INSURER C: A 0 INSURER D: Coon Rapids MN 55433 -5722 INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADD'L POLICY EFFECTIVE POLICY EXPIRATION LTR NSRD TYPE OF INSURANCE POLICY NUMBER DATE IMM /DD/YYYYI DATE (11M/DDIYYYYI LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY PREMISES LIT SES Ea occurrence) $ 100,000 A CLAIMS MADE , X I OCCUR CC10388300 6/20/2009 6/20/2010 MED EXP (Any one person) $ 5,000 PERSONAL & ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEM. AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 2,000,000 7 POLICY X ECT r l LOC AUTOMOBILE UABIUTY COMBINED SINGLE LIMIT X ANY AUTO (Ea accident) $ 1,000,000 A ALL OWNEDAUTOS CBA0388300 6/20/2009 6/20/2010 BODILY INJURY $ _ X SCHEDULED AUTOS (Per person) X HIRED AUTOS BODILY INJURY X NON =OWNED AUTOS (Per accident) $ PROPERTY DAMAGE $ (Per accident) GARAGE UABIUTY AUTO ONLY - EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESSI UMBRELLA LIABILITY EACH OCCURRENCE $ 1,000,000 X I OCCUR 7 CLAIMS MADE AGGREGATE $ 1,000,000 $ A 1 DEDUCTIBLE CCM0388300 6/20/2009 6/20/2010 $ X RETENTION $ 10,000 $ B WORKERS COMPENSATION X WC STATU- OTH- AND EMPLOYERS' UABIUTY TORY LIMITS ER l ANY PROPRIETOR /PARTNER /EXECUTIVE E.L. EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? (Mandatory In NH) CWCO388300 6/20/2009 6/20/2010 E.L DISEASE - EA EMPLOYEE $ 1,000,000 If yes, describe under ' SPECIAL PROVISIONS below E.L. DISEASE - POLICY LIMIT $ 1,000,000 OTHER DESCRIPTOR OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT/ SPECIAL PROVISIONS RE: Contractors License. City of Oak Park Heights is named as Additional Insured in regard to the General Liability Form CG8102 where required by written contract on a primary and non contributory basis. *10 days for non payment. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POUCIES BE CANCELLED BEFORE THE EXPIRATION City of Oak Park Heights DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30* DAYS WRITTEN 14168 Oak Park Blvd N NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL PO Box 2007 IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER ITS AGENTS OR �ak Park Heights, MN 55082 REPRESENTATIVES. eau ) . } }J 2 C 0 AUTHORIZED REPRESENTATIVE iO _ ( ` t a / / / /k j If V `u Michele Miller /MILLER ACORD 25 (2009/01) © 1988-2009 ACORD CORPORATION. All rights reserved. INS025 (200901) The ACORD name and logo are registered marks of ACORD A O ® C � CERTIFICATE OF LIABILITY INSURANCE 1 DATE (MMIDD/YYTY) 6/16/2009 PRODUCER (651) 227 - 8405 FAX: (651) 227 - 0507 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION T. C. Field & Company ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR A Bearence Management Group Co ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. 530 North Robert Street IN S aul MN 55101 INSURERS AFFORDING COVERAGE NAIC # INSURER A: General Casualty Company of 24414 Jorg. on Construction, Inc. INSURER B: General Casualty Insurance 18821 9255 E River Road NW INSURER C: INSURER D: Coon Rapids MN 55433 -5722 INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTIMTHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR pA INSRD. TYPE OF INSURANCE POLICY NUMBER POLICY DATE /MM/DDC1 POLICY TE I MM/D //YYYYOYI LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED X COMMERCIAL GENERAL LIABILITY PREMISES (Ea occurrence) $ 100,000 A CLAIMS MADE [ X OCCUR CCI0388300 6/20/2009 6/20/2010 MED EXP (Any one person) $ 5 , 000 PERSONAL & ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 2,000,000 7 POLICY 1 X PRO- 7 LOC JECT AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT X ANY AUTO (Ea accident) $ 1,000,000 A ALLOWNEDAUTOS CBA0388300 6/20/2009 6/20/2010 BODILY INJURY X SCHEDULED AUTOS (Per person) $ X HIRED AUTOS BODILY INJURY $ X NON -OWNED AUTOS (Per accident) PROPERTY DAMAGE $ (Per accident) _40 GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ ANY A U T O OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESS / UMBRELLA LIABILITY EACH OCCURRENCE $ 10,000,000 X OCCUR CLAIMS MADE AGGREGATE $ 10,000,000 $ A DEDUCTIBLE CCUO388300 6/20/2009 6/20/2010 $ X RETENTION $ 10,000 $ B WORKERS COMPENSATION X WC STATU- °E- AND EMPLOYERS' LIABILITY TORY LIMITS ER ANY PROPRIETOR /PARTNER /EXECUTIVE � EL EACH ACCIDENT $ 1,000,000 OFFICER /MEMBER EXCLUDED? (Mandatory in NH) CWCO388300 6/20/2009 6/20/2010 E.L. DISEASE - EA EMPLOYEE $ 1, 000 ,000 If yes, describe under SPECIAL PROVISIONS below E.L. DISEASE - POLICY LIMIT $ 1,000,000 OTHER DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS Project: City Hall Facility City of Oak Park Heights and Buetow & Associates is named as Additional Insured in regard to the General Liability Form CG8102 & CG2032 where required by written contract on a primary and non contributory basis. Completed Operations are included. *10 days for non payment. CERTIFICATE HOLDER CANCELLATION (651) 439 -0574 City of Oak Park Heights Eric Johnson. SHOULD ANY OF THE ABOVE DESCRIBED POLICIESBE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30* DAYS WRITTEN 14168 Oak Park Blvd N NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL BOX 2007 IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER ITS AGENTS OR S Oak Park Heights, MN 55082 REPRESENTATIVES. AUTHORIZED eD Miile r r /MI LLER Michele `A ', . /et— a -, chel Mille/MI Gu.�Et. ACORD 25 (2009!01) ©1988 -2009 ACORD CORPORATION. All rights reserved. INS025 (200901) The ACORD name and logo are registered marks of ACORD ACORD_, CERTIFICATE OF LIABILITY INSURANCE 1 DATE (MNVDDM(YY) 4/28/2009 PRODUCER (651)227 -8405 FAX: (651) 227 -0507 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION T. C. Field & Company ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE P y HOLDER. THIS CERTIFICATE DOES NOT AMEND EXTEND OR 530 North Robert Street ALTER THE COVERAGE AFFORDED BY THE POLICI�S BELOW. St . Paul MN 55101 INSURERS AFFORDING COVERAGE NAIC INSURED INSURERA General Casualty Company 24414 Jorgenson Construction, Inc. INSURER B:General Casualty Company 18821 9255 E River Road NW INSURER C: INSURER D: Coon Rapids MN 55433 -5722 INSURERE COVERAGES 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. A(;GRFGATF LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. C FFDD/YV) DE�Try�pp ILTR pp�EY RQ TYPE OF INSURANCE POLICY NUMBER DA7MIAWAINT LIMITS GENERAL LIABILITY EACH OCCURRENCE S 1,000,000 DAMAGE TO RENTED X COMMERCIAL GENERAL LIABILITY P 100,000 . REMISES (Fa occurrence) S A ICLAIMS MADE 5 OCCUR CCI0388300 6/20/2008 6/20/2009 MED EXP (Any oneperfon) $ 5, 000 X Contractual PERSONAL F. ADV INJURY $ 1,000,000 X XCU GENERAL AGGREGATE $ 2,000,000 GENL AGGREGATE LIMIT APPLIES PER PRODUCTS - COMP /OP AGG $ 2,000,000 — 1 POLICY [ l SIR IT LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT X ANY AUTO (Ea accident) $ 1,000,000 A ALL OWNED AUTOS CBA0388300 6/20/2008 6/20/2009 BODILY INJURY X SCHEDULED AUTOS (Per person) $ X HIRED AUTOS BODILY INJURY X NON -OWNED AUTOS (Per accident) — PROPERTY DAMAGE $ (Per accident) GARAGEUABIUTY AUTO ONLY - EAACGDENT 3 I] ANY AUTO OTHER THAN EA ACC $ • AUTO ONLY: AGG $ ET(CESSfUMBRELLA LIABILITY EACH OCCURRENCE $ _ 11 OCCUR 1 I CLAIMS MADE AGGREGATE 3 10,000,000 10,000,000 A DEDUCTIBLE CC00388300 6/20/2008 6/20/2009 X RETENTION 310,000 WC g 77�� i T� $ B WORKERS COMPENSATION AND X l TORY liM1T3 I I O ER EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE EL EACH ACCIDENT 3 1,000,000 OFFICER/MEMBER ICLUDED? MCO3E18300 6/20/2008 6/20/2009 I yes, describe under If DISEASE - EA EMPLOYEE g 1,000,000 SPECIAL PROVISIONS below E.L DISEASE - POLICY LIMIT 3 1,000,000 OTHER DESCRIPTION OF OPERATIONS A_OCATIONSNEHICLES /EXCLUSIONS ADDED BY ENDORSEMENT /SPECIAL PROVISIONS Project: City Ball Facility City of Oak Park Heights and Buetow & Associates is named as Additional Insured in regard to the General Liability Form CG8102 & CG2032 where required by written contract on a primary and non contributory basis. Completed Operations are included. *10 days for non payment. CERTIFICATE HOLDER CANCELLATION (651) 439 - 0574 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE City of Oak Park Heights D(PIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL Eric Johnson 30* DAYS WRIREN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT 14168 Oak Park Blvd N FAILURE TO DO SO SHALL IMPOSE NO OBIJGATION OR LIABILITY OF ANY KIND UPON THE Box 2007 Oak Park Heights, MN 55082 INSURER, RS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE Michele Miller /MILLER �c�(.Lu,�r�u ACORD 25 (2001/08) a ACORD CORPORATION 1988 INS025 (01O8).08a Page 1 ore • IMPORTANT If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed- A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). DISCLAIMER The Certificate of Insurance on the reverse side of this form does not constitute a contract between the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon. ACORD 25 (2001108) 1NS025 (0108).082 Page 2 a2 411 From: "Michele VanReese Miller" <mmiller @tcfield.com> Subject: RE: Revised Certificate • Date: April 28, 2009 11:57:29 AM CDT To: "Randy Engel" <randy_engel @buetowarchitects.com> Cc: "Steve Gansmoe" < Steve @JorgensonConstruction.com >, "Eric A. Johnson" < eajohnson @cityofoakparkheights.com >, "Michele VanReese Miller" <mmiller @tcfield.com> Randy: 1) The Umbrella does not have the per project aggregate only the General Liability. So you have $2mi1 General Liabilty that applies to each project per contract and then the $10,000,000 Umbrella gives you the additional Liability Limits if needed. The contract required $5mil Umbrella Aggregate limit, so they more than comply. And yes, the Umbrella will give the Auto and GL Personal Injury the additional limits required. 2) Yes, they comply and exceed the state Statutory coverage. 3) Yes, Completed Operations is extended to the additional insured by endorsement CG8102 and follows the period stated in the written contract. In your case, the 2 year coverage period would apply. 4) Yes, you will receive a renewal certificate each year that is required by contract. If it is a 2 year period after completion, this is what will be followed. Let me know if you need anything further. Thanks, Michele ii, From: Randy Engel jmailto:randv engelObuetowarchitects.com) Sent: Tuesday, April 28, 2009 11:35 AM To: Michele VanReese Miller Cc: Steve Gansmoe; Eric A. Johnson Subject: Re: Revised Certificate 1) 1 understand you to have stated in today's telephone conversation that the $10,000,000 Umbrella is exclusively dedicated to this project and will cover the lesser coverage amounts than as specified for General Liability Personal Iniury and the single limit present for Automobile Liability. 2) I also understand you to have stated in today's telephone conversation that the Workers Compensation and Employer's Liability complies with State of Minnesota Statutory Coverage. 3) I also understand you to have stated in today's telephone conversation that the General Liability (Completed Operations) extended 2 -year coverage period is stated in the General Liability Policy. 4) Also, will a new Certificate of Lability Insurance be issued on or before June 20, 2009 to reflect that respective insurance coverages will have been renewed? On Apr 28, 2009, at 10 :36 AM, Michele VanReese Miller wrote: «Acord Forms_70.pdf» Randy, a Y, We increased the Umbrella Limits and now this client meets all requirements. Please call me with any questions. III Thanks, Michele • Michele VanReese Miller, CISR Commercial Account Manager T.C. Field & Company A Bearence Management Group Company 530 North Robert Street St. Paul, MN 55102 651 - 726-5158 - Phone 651- 227-0507 - Fax mmilleretcfeid.com Confidentiality Notice: This e-mail and any files transmitted with it are intended solely for the individual or entity to whom they are addressed. This communication may contain material that is privileged, confidential and protected from disclosure under the law. If you are not the Intended recipient, any disclosure, distribution, copying, or use of this information Is strictly prohibited and may be unlawful. If you have received this e-mail in error, please reply immediately to the sender and delete it. <Acord Forms_70.pdfi BUETOW AND ASSOCIATES Randy L. Engel, RA, AS Principal -in- Charge 2345 Rice Street, Suite 210 St. Paul, Minnesota 55123 Tel 651 483 -6701 Fax 651 483 -2574 Cellular 952 237 -5932 ACORD. EVIDENCE OF PROPERTY INSURANCE OP IDKT DATE `' 02/24/09 THIS IS EVIDENCE THAT INSURANCE AS IDENTIFIED BELOW HAS BEEN ISSUED, IS IN FORCE, AND CONVEYS ALL THE RIGHTS AND PRIVILEGES AFFORDED UNDER THE POLICY. PROWCER PNDNERAI I 651- 464 -3333 /651- 464 -7596 COMPANY (AK:.N0. U Landmark Insurance Services LMCIT- Berkley Risk Services, I 2 Lake Street South 145 University Avenue West eat Lake MN 55025 St. Paul MN 55103 Tipping cOOE: sue CODE CUS B OAKPA-1 INSURED LOAN NUMBER POLICY NUMBER City of Oak Park Heights CMC29841 Eric Johnson, City Admin. EFFECTIVE DATE EXPIRATION DATE CONTINUED UNTIL 14168 Oak Park Blvd 04/01/09 1 07/07/10 TERMINATED IF CHECKED Oak Park Heights MN 55082 -6476 TIps REPLACES PRIOR EVIDENCE DATED: PROPERTY INFORMATION LACMIMRDESCRIPT1ON 001 BUILDERS RISK COVERAGE ON CONSTRUCTION 14168 Oak Park Blvd North OF NEW CITY HALL Oak Park Heights MN 55082 COVERAGE INFORMATION COVERAGEPERES/FORMS AMOUNT OF INSURANCE DEDUCTIBLE Premise 001 Building 002 BLANKET BUILDING AND PERSONAL PROPERTY 7000000 500 INCLUDING BUILDING MATERIALS ON PREMISES BUILDERS RISK FORM • REMARKS (Including Special Conditions) Equipment Breakdown coverage to be added as equipment within the new building becomes operational; Binder may be updated on policy renewal date of 07- 07 -09. CANCELLATION THE POLICY IS SUBJECT TO THE PREMIUMS, FORMS, AND RULES IN EFFECT FOR EACH POLICY PERIOD. SHOULD THE POLICY BE TERMINATED, THE COMPANY WILL GIVE THE ADDITIONAL INTEREST IDENTIFIED BELOW 10 DAYS WRITTEN NOTICE, AND WILL SEND NOTIFICATION OF ANY CHANGES TO THE POLICY THAT WOULD AFFECT THAT INTEREST, IN ACCORDANCE WITH THE POLICY PROVISIONS OR AS REQUIRED BY LAW. ADDITIONAL INTEREST NAME AND ADDRESS MORTGAGEE ADDITIONAL INSURED LOSS PAYEE LOAN F AUTHORIZED REPRESENTATIVE del ACORD 27 (3/93) 7. 4 . 11: 64 z ARATION 1993 411 ACORD, CERTIFICATE OF LIABILITY INSURANCE 1 W78 , PRODUCER (651) 227 -8405 FAX: (651) 227 -0507 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION T . C . Field & Company ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE P y HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 530 North Robert Street ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. IN S aul MN 55101 INSURERS AFFORDING COVERAGE NAIC # INSURER A: General Casualty Company 24414 Jorgenson Construction, Inc. INSURER B: General Casualty Company 18821 9255 E River Road NW INSURER C: INSURER D: Coon Rapids IT 55433 -5722 INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADD'L POLICY EFFECTIVE POLICY EXPIRATION LIMITS LTR JNSRD TYPE OF INSURANCE POLICY NUMBER DATE (MM /DD/YY) DATE (MM/DDIYY) GENERAL LIABIUTY EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY PREMISES (Ea occurrence) $ 100 , 000 A CLAIMS MADE I X I OCCUR CC10388300 6/20/2008 6/20/2009 MEDEXP(Anyoneperson) $ 5,000 X Contractual PERSONAL & ADV INJURY $ 1,000,000 X XCU GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP /OP AGG $ 2,000,000 POLICY I X JECTT1 LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT X ANY AUTO (Ea accident) $ 1, 000, 000 A ALL OWNED AUTOS CBA0388300 6/20/2008 6/20/2009 BODILY INJURY (Per person) $ X SCHEDULED AUTOS X HIRED AUTOS BODILY INJURY $ (Per accident) X NON -OWNED AUTOS PROPERTY DAMAGE $ (Per accident) 0 GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR I 1 CLAIMS MADE AGGREGATE $ 1,000,000 $ 1,000,000 A _ DEDUCTIBLE CCUO388300 6/20/2008 6/20/2009 $ X RETENTION $ 10,000 C MITS I$ B WORKERS COMPENSATION AND X I TORY u I I E EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER /EXECUTIVE E.L. EACH ACCIDENT $ 1,000,000 OFFICER /MEMBER EXCLUDED? CWCO388300 6/20/2008 6/20/2009 E.L. DISEASE - EA EMPLOYEE $ 1,000,000 If yes, describe under 1,000,000 SPECIAL PROVISIONS below E.L. DISEASE - POLICY LIMIT $ OTHER DESCRIPTION OF OPERATIONSILOCATIONSNEHICLES /EXCLUSIONS ADDED BY ENDORSEMENT /SPECIAL PROVISIONS Project: City Hall Facility City of Oak Park Heights and Buetow & Associates are included as additional insureds for general liability as required by written contract or written agreement, in accordance with form CG8102. *10 days notice for non - payment. CERTIFICATE HOLDER CANCELLATION (651) 439 -0574 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE City of Oak Park Heights EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL Eric Johnson 30* DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT 14168 Oak Park Blvd N FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE Box 2007 •Oak Park Heights, MN 55082 INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED / /J chelMill Miller/MIL ` 7, j n`' i•��� �Cx/� Michele Miller /MILLER �/Z[/iwL(�. ACORD 25 (2001/08) © ACORD CORPORATION 1988 INS025 (0108).08a Page 1 of 2 THE AMERICAN INSTITUTE OF ARCHITECTS II II `Il Bond No. 08482445 AIA Document A312 Performance Bond Any singular reference to Contractor, Surety, Owner or other party shall be considered plural where applicable. CONTRACTOR (Name and Address): SURETY (Name and Principal Place of Business): Fidelity and Deposit Company of Maryland Jorgenson Construction, Inc. Tower 1, 19th Floor 9255 East River Road NW 1400 American Lane Coon Rapids, Minnesota 55433 Schaumburg, IL 60196 OWNER (Name and Address): City of Oak Park Heights 14168 Oak Park Boulevard North Oak Park Heights, Minnesota 55082 • CONSTRUCTION CONTRACT Date: April 15th, 2009 Amount: Six Million Three Hundred Fifty -eight Thousand Five Hundred and no /100 Dollars ($6,358,500.00) Description (Name and Location): General Construction Work, Site Work Mechanical Work, and Electrical Work Oak Park Heights City Hall BOND Date (Not earlier than Construction Contract Date): April 21st , 2009 Amount: Six Million Three Hundred Fifty-eight Thousand Five Hundred and no /100 Dollars ($6,358,500.00) Modifications to this Bond: X None ❑ See Page 3 CONTRACTOR AS PRINCIPAL SURETY Company: (Corporate Seal) Company: (Corporate Seal) Jorgenson Co` s ru ion, I Fidelity and Depos Company of Maryland Signature: ∎ ' -a t 1 i ' _ Signature: _ ki C _ _ , Name and Title: ey '•r•� a on, President Name and Title: i le M. Co or ee Coty Att � .1,n act (Any additional signatures appear on page 3) (FOR INFORMATION ONLY —Name, Address and Telephone) AGENT or BROKER: T.C. Field & Company OWNER'S REPRESENTATIVE (Architect, Engineer or P.O. Box 64016 other party): Buetow & Associates, Inc. St. Paul, Minnesota 55164 -0016 2345 N. Rice Street #210 (651) 227 -8405 St. Paul, MN 55113 411 AIA DOCUMENT A312 • PERFORMANCE BOND AND PAYMENT BOND • DECEMBER 1984 ED. • AIA THE AMERICAN INSTITUTE OF ARCHITECTS, 1735 NEW YORK AVE., N.W., WASHINGTON, D.C. 20006 A312 -1984 1 • able to sureties as a defense in the jurisdiction of the suit tractor of any amounts received or to be received by shall be applicable. the Owner in settlement of insurance or other claims 10 Notice to the Surety, the Owner or the Contractor shall for damages to which the Contractor is entitled, re- be mailed or delivered to the address shown on the sig- behalf by all valid and proper r payments Con made to or on nature page. behalf of the Contractor under the Construction Con- tract. 11 When this Bond has been furnished to comply with a 12.2 Construction Contract: The agreement between statutory or other legal requirement in the location where the Owner and the Contractor identified on the sig- the construction was to be performed, any provision in this nature page, including all Contract Documents and Bond conflicting with said statutory or legal requirement changes thereto. shall be deemed deleted herefrom and provisions con- forming to such statutory or other legal requirement shall 12.3 Contractor Default: Failure of the Contractor, be deemed incorporated herein. The intent is that this which has neither been remedied nor waived, to per - Bond shall be construed as a statutory bond and not as a form or otherwise to comply with the terms of the common law bond. Construction Contract. 12 DEFINITIONS 12.4 Owner Default: Failure of the Owner, which has 12.1 Balance of the Contract Price: The total amount neither been remedied nor waived, to pay the Con - payable by the Owner to the Contractor under the tractor as required by the Construction Contract or to Construction Contract after all proper adjustments he rorm and complete or comply with the other terms t have been made, including allowance to the Con- thereof. MODIFICATIONS TO THIS BOND ARE AS FOLLOWS: • (Space is provided below for additional signatures of added parties, other than those appearing on the cover page.) CONTRACTOR AS PRINCIPAL SURETY Company: (Corporate Seal) Company: (Corporate Seal) Signature: Signature: Name and Title: Name and Title: Address: Address: • AIA DOCUMENT A312 • PERFORMANCE BOND AND PAYMENT BOND • DECEMBER 1984 ED. • AIA THE AMERICAN INSTITUTE OF ARCHITECTS, 1735 NEW YORK AVE., N.W., WASHINGTON, D.C. 20006 A312 -1984 3 • THE AMERICAN INSTITUTE OF ARCHITECTS III OM �,�1 Bond No. 08482445 AIA Document A372 Payment Bond Any singular reference to Contractor, Surety, Owner or other party shall be considered plural where applicable. CONTRACTOR (Name and Address): SURETY (Name and Principal Place of Business): Jorgenson Construction, Inc. Fidelity and Deposit Company of Maryland 9255 East River Road NW Tower 1, 19th Floor 1400 American Lane Coon Rapids, Minnesota 55433 Schaumburg, IL 60196 OWNER (Name and Address): City of Oak Park Heights 14168 Oak Park Boulevard North 1st Oak Park Heights, Minnesota 55082 ONSTRUCTION CONTRACT Date: April 15th, 2009 Amount: Six Million Three Hundred Fifty -eight Thousand Five Hundred and no /100 Dollars ($6,358,500.00) Description (Name and Location): General Construction Work, Site Work Mechanical Work, and Electrical Work Oak Park Heights City Hall BOND Date (Not earlier than Construction Contract Date): April 21st ,2009 Amount: Six Million Three Hundred Fifty -eight Thousand Five Hundred and no /100 Dollars ($6,358,500.00) Modifications to this Bond: LI IXlne gJ See Page 6 CONTRACTOR AS PRINCIPAL SURETY Company: (Corporate Seal) Company: (Corporate Seal) Jorgenson \ - II , Fidelity and D osit Company of Maryland Signature: • +�, –` 1 . ' t ° i t s Signature: \-- L(j eG ill • C Name and Title: .tanle f Jo s•: , President Name and Title: Nicole M. Coty A ornej} -In -Fact (Any additional signatures appear on page 6) (FOR INFORMATION ONLY —Name, Address and Telephone) AGENT or BROKER: T.C. Field & Company OWNER'S REPRESENTATIVE (Architect, Engineer or P.O. Box 64016 other party): Buetow & Associates, Inc. St. Paul, Minnesota 55164 -0016 2345 N. Rice Street #210 (651) 227 -8405 St. Paul, MN 55113 Ilk DOCUMENT A312 • PERFORMANCE BOND AND PAYMENT BOND • DECEMBER 1984 ED. • AIA 8 THE AMERICAN INSTITUTE OF ARCHITECTS, 1735 NEW YORK AVE., N.W., WASHINGTON, D.C. 20006 A312-1984 4 Bond shall be construed as a statutory bond and not as a Construction Contract, architectural and engineering common law bond. services required for performance of the work of the 14 Upon request by any person or entity appearing to be a Contractor and the Contractor's subcontractors, and 40 potential beneficiary of this Bond, the Contractor shall all other items for which a mechanic's lien may be promptly furnish a copy of this Bond or shall permit a copy asserted in the jurisdiction where the labor, materials to be made. or equipment were furnished. 15 DEFINITIONS 15.2 Construction Contract: The agreement between the Owner and the Contractor identified on the sig- 15.1 Claimant: An individual or entity having a direct nature page, including all Contract Documents and contract with the Contractor or with a subcontractor of changes thereto. the Contractor to furnish labor, materials or equip- 15.3 Owner Default: Failure of the Owner, which has ment for use in the performance of the Contract. The neither been remedied nor waived, to pay the Con intent of this Bond shall be to include without limita- tion in the terms "labor, materials or equipment" that tractor as required by the Construction Contract or to part of water, gas, power, light, heat, oil, gasoline, perform and complete or comply with the other terms thereof. 'telephone service or rental equipment used in the MODIFICATIONS TO THIS BOND ARE AS FOLLOWS: Paragraph 4 is amended to insert sub - paragraph 4.3, which states: 4.3 Claimants have furnished to Surety proof of claim duly sworn to by Claimants with adequate supporting documentation proving the amount claimed is due and payable. Paragraph 5 shall be amended to delete the word "or" and insert the word "and' in its place. Paragraph 6 and its sub - paragraphs 6.1 and 6.2 shall be deleted in their entirety and replaced with the following: • When the Claimant has satisfied the conditions of Paragraph 4, the Surety shall, within 90 days of the date when claimant finally completed its satisfactions of the conditions of Paragraph 4 notify the Claimant of the amounts that are undisputed and the basis for challenging any amounts that are disputed, including, but not limited to, the lack of substantiating documentation to support the claim as to entitlement or amount, and the Surety shall pay or make arrangements for payment of any undisputed amount; provided, however, that the failure of the Surety to timely discharge its obligations under this paragraph or to dispute or identify any specific defense to all or any part of a claim shall not be deemed to be an admission of liability by the Surety as to such claim or otherwise constitute a waiver of the Contractor's or Surety's defenses to, or right to dispute, such claim. Rather, the Claimant's sole remedy shall be the immediate right, without further notice, to bring suit against the Surety to enforce any remedy available to it under this Bond. Paragraph 12 shall be amended to add the following paragraph: CLAIM NOTICE for the FIDELITY AND DEPOSIT COMPANY OF MARYLAND, ZURICH AMERICAN INSURANCE COMPANY, COLONIAL AMERICAN CASUALTY AND INSURANCE COMPANY and/or AMERICAN GUARANTEE AND LIABILITY INSURANCE COMPANY must be sent to the following address: Zurich Surety Claims, 3910 Keswick Road, Chesapeake Building 4th Floor, Baltimore, Maryland 21211 Attention: Surety Claim Department (Space is provided below for additional signatures of added parties, other than those appearing on the cover page.) CONTRACTOR AS PRINCIPAL SURETY Company: (Corporate Seal) Company: (Corporate Seal) Signature: Signature: Name and Title: Name and Title: Address: Address: AIA DOCUMENT A312 • PERFORMANCE BOND AND PAYMENT BOND • DECEMBER 1984 ED. • AIA THE AMERICAN INSTITUTE OF ARCHITECTS, 1735 NEW YORK AVE., N.W., WASHINGTON, D.C. 20006 A312 -1984 6 CORPORATE ACKNOWLEDGMENT STATE OF MINNESOTA • COUNTY OF ANOKA • On the 21st day of April , 2009 before me personally appeared , Stanley M. Jorgenson to me, who being duly sworn, did depose and say: that s /he resides in Andover, MN that s/he is the President of the Jorgenson Construction, Inc. the corporation described in and which executed the foregoing instrument; that s/he knows the seal of said corporation; that the seal affixed to said instrument is such corporate seal; that it was so affixed by order of the board of directors of said corporation; and that s/he signed her/his na - X e by like order. ( : SANDRA M. FISH 0ta 0: i 1 (. - 4,_4 NOTARY PUBLIC - MINNESOTA Notary Public ' : 7 My Con.nission Expires Jan. 31, 2010 ACKNOWLEDGMENT OF CORPORATE SURETY STATE OF MINNESOTA COUNTY OF Ramsey On the 21st day of April , 2009 _ Before IP me personally appeared, Nicole M. Coty to me known, who being duly sworn, did say: that s/he resides in the City of St. Paul, MN that s/he is the aforesaid officer or attorney in fact of Fidelity and Deposit Company of Maryland a corporation; that the seal affixed to the foregoing instrument is the corporate seal of said corporation; and that said instrument as signed and sealed on behalf of said corporation by the aforesaid officer, by authority of its boars o i directors; and the aforesaid officer acknowledged said instrument to be the free ac ! a . deed of said corporation. (SEAL) Notary P_ MARJORIE A. JONES 'q = Notary Put PT-Minnesota My Commission Expores J:0n 31, 2010 WYij".IVMMMNWVHvvvvvWkW WV • Power of Attorney FIDELITY AND DEPOSIT COMPANY OF MARYLAND • KNOW ALL MEN BY THESE PRESENTS: That the FIDELITY AND DEPOSIT COMPANY OF MARYLAND, a corporation of the State of Maryland, by THEODORE G. MARTINEZ, Vice President, and GREGORY E. MURRAY, Assistant Secretary, in pursuance of authority granted by Article V1, Section 2, of the By -Law . id Company, which are set forth on the reverse side hereof and are hereby certified to be in full force and eff- .t o i tel:. ° reof, does hereby nominate, constitute and appoint Litton E. S. FIELD, JR., M. A. JON ,r* 1■A . 0 ay of St. Paul, Minnesota, EACH its true and lawful agent and Attorney -in- {�4 i ute -a . 1,. , 1. Ior, and on its behalf as surety, and as its act and deed: any and all bon 3+. : i a t gs . = • v o`such bonds or undertakings in e' *m pursuance of these presents, shall be as bi. I. 'om� } 11'] Y d- amply, to all intents and purposes, as if they had been duly executed and ackn.; 0 ii - • / 3t e ie! - ' o i ers of the Company at its office in Baltimore, Md., in their own proper pep. * p _ w - • f at opfe, . . issued on behalf of Litton E. S. FIELD, JR., M. A. JONES, F. E. LAUNSTEIN, N e OTX-\dt 1 _ 1, 2004. The said Assistant 1 qes ie y certify that the extract set forth on the reverse side hereof is a true copy of Article VI, Section 2, of the By -L. • said Company, and is now in force. IN WITNESS WHEREOF, the said Vice - President and Assistant Secretary have hereunto subscribed their names and affixed the Corporate Seal of the said FIDELITY AND DEPOSIT COMPANY OF MARYLAND, this 30th day of January, A.D. 2006. ATTEST: FIDELITY AND DEPOSIT COMPANY OF MARYLAND t o OLP ci i J •••••• E W O a use '4YT, By: Gregory E. Murray Assistant Secretary Theodore G. Martinez • State of Maryland ss: City of Baltimore f On this 30th day of January, A.D. 2006, before the subscriber, a Notary Public of the State of Maryland, duly commissioned and qualified, came THEODORE G. MARTINEZ, Vice President, and GREGORY E. MURRAY, Assistant Secretary of the FIDELITY AND DEPOSIT COMPANY OF MARYLAND, to me personally known to be the individuals and officers described in and who executed the preceding instrument, and they each acknowledged the execution of the same, and being by me duly sworn, severally and each for himself deposeth and saith, that they are the said officers of the Company aforesaid, and that the seal affixed to the preceding instrument is the Corporate Seal of said Company, and that the said Corporate Seal and their signatures as such officers were duly affixed and subscribed to the said instrument by the authority and direction of the said Corporation. IN TESTIMONY WHEREOF, I have hereunto set my hand and affixed my Official Seal the day and year first above written. ni c i ■ D , ,,,i Maria D. Adamski Notary Public My Commission Expires: July 8, 2011 1 POA -F 184 -8843 . EXTRACT FROM BY -LAWS OF FIDELITY AND DEPOSIT COMPANY OF MARYLAND "Article VI, Section 2. The Chairman of the Board, or the President, or any Executive Vice - President, or any of the Senio Vice - Presidents or Vice - Presidents specially authorized so to do by the Board of Directors or by the Executive Committ shall have power, by and with the concurrence of the Secretary or any one of the Assistant Secretaries, to appoint Resident Vice- Presidents, Assistant Vice - Presidents and Attorneys -in -Fact as the business of the Company may require, or to authorize any person or persons to execute on behalf of the Company any bonds, undertaking, recognizances, stipulations, policies, contracts, agreements, deeds, and releases and assignments of judgements, decrees, mortgages and instruments in the nature of mortgages,...and to affix the seal of the Company thereto." CERTIFICATE I, the undersigned, Assistant Secretary of the FIDELITY AND DEPOSIT COMPANY OF MARYLAND, do hereby certify that the foregoing Power of Attorney is still in full force and effect on the date of this certificate; and I do further certify that the Vice - President who executed the said Power of Attorney was one of the additional Vice - Presidents specially authorized by the Board of Directors to appoint any Attorney -in -Fact as provided in Article VI, Section 2, of the By -Laws of the FIDELITY AND DEPOSIT COMPANY OF MARYLAND. This Power of Attorney and Certificate may be signed by facsimile under and by authority of the following resolution of the Board of Directors of the FIDELITY AND DEPOSIT COMPANY OF MARYLAND at a meeting duly called and held on the 10th day of May, 1990. RESOLVED: "That the facsimile or mechanically reproduced seal of the company and facsimile or mechanically reproduced signature of any Vice - President, Secretary, or Assistant Secretary of the Company, whether made heretofore or hereafter, wherever appearing upon a certified copy of any power of attorney issued by the Company, shall be valid and binding upon the Company with the same force and effect as though manually affixed." IN TESTIMONY WHEREOF, I have hereunto subscribed my name and affixed the corporate seal of the said Company, this 21st da of April 2009 • Y Assistant Secretary •