resolution a warding a job order contract to fh paschen, sn

RESOLUTION A WARDING A JOB ORDER CONTRACT TO F. H. PASCHEN,
S. N. NIELSEN & ASSOCIATES, LLC
TO COMPLETE SEWER TELEVISING AND LINING
Resolution (R)2014-03.06
WHEREAS, the Village of Huntley FY2014 Annual Budget includes $225,000 to continue the Sewer
Lining Program; and
WHEREAS, during the 2014 budget approval process the Village Board directed staff to obtain quotes
for completing the sewer televising, jetting and lining project in the identified target area; and
WHEREAS, staff has obtained price quotes through the Cooperative Job Order Contract (JOC) program
for televising, jetting and lining of the sewers in the identified target area; and
WHEREAS, the Sewer Capital Fund has sufficient funds in the FY2014 budget to complete the Sewer
Lining Program.
NOW, THEREFORE, BE IT RESOLVED BY THE PRESIDENT AND BOARD OF TRUSTEES OF
THE VILLAGE OF HUNTLEY as follows:
.
SECTION I: The Village Board approves awarding the attached Job Order Contract to F.H. Paschen,
S.N. Nielsen & Associates, LLC in the amount of $211,170.50 for televising, jetting and lining 4,692lineal feet
of 8" sanitary sewer identified in the target area and televising 1,235 lineal feet of 12" storm sewer from Union
Special to IL Route 4 7.
SECTION II: This Resolution shall be in full force and effect from and after its passage and approval
as provided by law.
SECTION III:
Trustee Goldman
Trustee Hanson
Trustee Kanakaris
Trustee Leopold
Trustee Piwko
All Resolutions and parts of resolutions in conflict herewith are hereby repealed.
~
~
--
~
Nay
Absent
--7
Abstain
Job Order Contract
Proposal Review Summary - CSI
Date:
February 25, 2014
Contract Number:
Job Order Number:
11-082
016828.00
Job Order Title:
Village of Huntley - Sanitary Collection System Lining
Contractor:
F. H. Paschen, S. N. Nielsen & Associates LLC
Proposal Value:
Proposal Name:
Village of Huntley - Sanitay Collection System Lining
Proposal Submitted:
0212512014
$211,170.50
01 ·General Requirements:
$7,302.06
02 - Site Work:
$1,304.29
08 • Openings:
$392.81
22 ·Plumbing:
$1,164.13
23 ·Heating, Ventilating, And Air-Conditioning (HVAC):
$691.84
$200,416.38
33 ·Utilities:
$211,170.50
Proposal Total
This proposal lola! represenls lhe correcl tole! for the proposal. Any discrepancy belween line lotals,
sub-tolals and the orooosallolal is due to rounninn nl lhA linA lolA Is anrl suh-totals
The Percent of NPP on this Proposal:
Proposal Review Summary- CSI
0.00%
Page 1 of 1
2/25/2014
Job Order Contract
Proposal Review Detail - CSI
Date:
February 25, 2014
Contract NumiHu:
Job Order Number:
11-082
016828.00
Job Order Title:
Village of Hunlley- Sanitary Collection System Lining
Contractor:
Proposal Value:
Proposal Name:
$211,170.50
Proposal Submitted:
0212512014
F. H. Paschen. S. N. Nielsen & Associates LLC
Village of Huntley - Sanitay Colleclion System Lining
1.0000-No Adjustment, 1.0300-0plion 2 Phase 2 Normal Working Hours
Adjustment Factor(&) Used:
Recll
CSI
Number
Mod.
UOM
Lin& Total
Description
lo1 -General Requirements
EA
01 22 16 00 0002
$3,145.00
Reimbursable Fees Note: Reimbursab!e Fees will be paid lo !he contractor
for the aclual cost ol all permils. wilhout mark-up, lor which a receipt or bill
is received. The AdjuMmen\ Factor applied lo Reimbursable Fees will be
1.0000. The labor cost involved in obtaining all permits Is in the Adjustment
Factor. The base cost of the Reimbursable Fee is $1.00. The quanlily lJsed
will adjust the base cost to the acluai Reimbursable Fee (e.g. quantity of 125
= $125.00 Reimbursable Fee). It !here are multiple Reimbursable Fees. each
one shall be listed separately wilh a comment in lhe "note" block 1o identify
the Reimbursable Fees (e.g sidewalk closure. road cut, various permits,
extended warrantee, expedited shipping costs, etc). A copy of each
sa
.:;;l.;.
. - - -receipt shall be included with the P"-ro'-'p;..:o"'
Quantity
Unit Price
lnstallaUon
Contractors Note:
Category1:
2
3,145.00
1.00
HR
Installation
Contractors Note:
Faclor
Total
1.0300
$1,097.24
Flag person For TraffJc.:.
c .:
C.:
oc.:.
nl~
ro;,;;l_ __
16.00
$1 ,097.24
Unit Price
x
6S.56
X
Flagger for traffic control for work in manholes on Algonquin Road .
Sewer Lining- All
Highlighted Pipes
01 22 23 00 0579
WK
Contractors Note:
$392.56
16 ,500 GPH. 3" Discharge, 65' Maximum Head, Gas Powered Portable
_ _ __ _ ..:::
Cenlrifugal ,_
Pu::.;m
- "p"-- - - -Quantity
Installation
3.00
X
Category1:
Total
$3.145.00
Reimbursable fee for project performance and payment bond.
Quantity
3
Factor
1.0000
Sewer Lining- All
Highlighted Pipes
01 22 20 00 0050
Category1 :
X
Unit Price
Factor
Total
127.05
1.0300
S392.58
Unit Price
Factor
Total
44 .64
1.0300
$275.88
Bypass pump on site during lining work.
Sewer Lining -All
Highlighted Pipes
01 22 23 00 OB46
_ _WK
:..;__ _ ....:_
a·_· l~n-=sic.:.
de Diameter. 20' Length, Suction Hose With Couplings
Quantity
lnstallallon
Contractors Note:
6.00
X
$275.88
Pump suction hose. 2 hoses on site for 3 weeks
Category1:
5
01 22 23 00 06S2
WK
3" Inside Diameler. 50' Length, Discharge Hose W1th Couplings_ _ _ _ _ __
Unit Price
Quantity
lnstallalion
Contractors Nolo:
Category1:
30.00
x
37.S4
x
Factor
1 0300
$1,1S3.08
Total
$1.163.08
Pump discharge hose, 10 lengths of hose on site for 3 weeks for bypass.
Sewer Lining -All
Highlighted Pipes
Proposal Review Detail - CSI
Page 1 of 5
212512014
Proposal Review Dntail - CSI Continues ..
Job
016828.00
Village of Hunlley · Sanilary Collection System Lining
Order Number:
Job Order Tille:
Roell
CSI Number
Mod.
UOM
Description
DAY
T~pe
Llno Total
lo1 -Gouoral RG<IUiro monts
6
01 55 26 00 0029
Quanlily
225.00
Installation
Contractors Note:
Category1 :
Sewer Lining
~442.64
II Barricade. Up To 3" Wtde Wilh Two Reflective Rails Each Side
Unit Price
1.91
x
x
Total
Factor
1.0300
$442.64
15 figured for 15 da~s
Barricades on site for traffic control
-All
Hlghllg lltod Pipes
01 55 26 00 0108
EA
si_de_ _ __
Place And Remove Up To 250 Barricades B~ Hand From Ro..:.a_d..:.
Quanti!~
Installation
Contractors Note;
Category1:
Sewer Lining
225 00
Unit Price
3.39
X
X
$785.63
Factor
Total
1.0300
$785.63
Place and remove barricades each day.
-All
Highlighted Pipes
$7,J02.05
Subtotal for 01 -General Requirements :
~
lo2 . Site Work
8
02 61
13 00 0007
CY
Quantily
30.00
Installation
Contractors Note:
Catagory1:
_____
S-'
1._3 04.29
Disposal Fees Of Contaminated Soil.'-c-= - : - - - - -Unit Price
42.21
x
Total
$1,304.29
Factor
1.0300
Collection and disposal of material removed from pipes during cleaning and lining process.
All
Highlig hted Pipes
Sewer Lining·
$1,304.29
Subtotal for 02 · Site Work:
los -Oponlngs
9
08 36
13 00 0162
EA
Manual Chain Hois-'
1-
-
Quan~ly
I nslallalion
Contractors Nolo:
Category1 :
Sewer Lining-
1.00
$392 81
- - -- Unit Price
381 .37
X
X
Factor
1.0300
Total
$392.81
Conftned space tripod on site during conslruclion .
All
Highlighted Pipes
Subtotal for 08 - Opening s:
$J92.81
!22 ·Plumbing
10
22 05 76 00 0062
EA
•
a·· Threaded Bronze Plug
f((liHI ,)>
$1.164 13
Quantity
f.'Jicfill
Installation
16.00
18.00
Demo/ilion
Contractors Nolo:
Catogory1 :
X
Unit Pnce
41 .86
20.93
Total
X
Factor
1.0300
$776.08
X
1.0300
$388.04
Cap/Plug sewer line during bypass procedures and remove when finished
Category2:
Category4:
Category3:
$1,164.13
, And Air-Condition In
11
23 05
93 000119
EA
Air TesVCombustion Gas Level
- - -Unit-Price
--
Quanlily
Installation
Contractors Nato:
Catagory1:
Sewer Lining
10.00
X
57.46
$591.84
Factor
1.0300
Total
$591.84
Air tesVmonitoring at each manhole for connned space work.
-All
Highlighted Pipes
Proposal Review Detail . CSI
Page 2 of 5
2125/2014
Proposal Review Detail - CSI Continues ..
Job Order Number:
Job Order Title:
Roell
016828.00
Village of Huntley - Sanitary Collection System Lining
CSI Number
Mod.
UOM
Llno Total
Description
Subtotal for 23 ·Heating, Ventilating, And Air-Conditionir
$591 .84
133 · Utilities
12
33 01
EA
30 16 0003
$1.277.57
Initial Set Up For Video Camera Inspection, Up To 12'' Diameter Pipe Or
-----~
Culvert
Quantity
Installation
Contractors Note:
Catogory1:
13
33 01
2.00
X
Unit Price
620,18
X
Factor
1.0300
Total
$1 ,277.57
Initial set up lor video camera inspection ol pipes. Before and after lining work.
Sewer Lining- All
Highlighted Pipes
EA
30 16 0003
$638.79
Initial Set Up For Video Camera Inspection, Up To 12" Diameter Pipe Or
Culve:o:.ri.:....._- : - - : - - - - -- Quanlity
Installation
Contractors Note:
Category1:
14
1.00
Unit Price
X
620. t6
X
Factor
1.0300
Total
$638.79
Initial set up lor video equipment to televise 12'' storm sewer.
Video 12" Storm Sewer
EA
33 01 30 16 0006
$1.277.57
Re-Set Up/Move For Video Camera Inspection, Up To 12" Diameter Pipe Or
Culvert
Quantity
Ins lallation
Contractors Note:
Catogory1:
15
Mo~e
4.00
X
Unit Price
310.09
X
Factor
1.0300
Total
$1,277.57
and reset ~ideo inspection equipment
VIdeo 12" Storm Sewer
EA
33 01 30 16 0006
Re-Set
Up/Mo~a
S5,749 07
For Video Camera Inspection, Up To 12" Diameter Pipe Or
Culvert
Quantity
Installation
Contractors Note:
Category1:
16
33 01
18 00
X
Mo~e and reset video inspection equipment
Unit Price
310.D9
30 16 0011
LF
Contractors Note:
17
9 limes for pre-rehab work. 9 times for post rehab work
Installation
Factor
1.0300
X
Factor
1.0300
Total
$2,658.58
For Quanuties > 1000 To 5000, Deduct
1,235.00
X
Unit Price
-0.52
S-661 ,47
Total
$-661.47
'Televise 12' storm sewer.'
VIdeo 12" Storm Sew11r
30 16 0020
LF
Contractors Note:
$14,981 .56
>6" To 12" Diameter Pipe Inspection, Pre·Rehabililalion Phase Note: CCTV
inspection of pipe_interio:..:.r:...
· - - - - : - -- : - Quantity
Unit Price
Installation
4,692.00
)(
3 10
Category1 :
X
Televise 12" storm sewer.
Mod _ _ __
Contractors Note:
33 01
$2,658 58
>6" To 12" Diameter Pipe Inspection, Planning/Analysis Phase Note CCTV
Quantity
18
Total
$5,749.07
VIdeo 12" Storm Sewer
330130160011
Category1:
Factor
1.0300
Sewer Lining -All
Highlighted Pipes
_ _ _ _ __:.:;
in::.
•P.:.;e:..:c:.::li.:::.
on, of pip_e in.:..:
le::;ri:::.
or:.:.·--~~-Quantity
Unit Price
Installation
1,235.00
x
2.09
Category1 :
X
X
Factor
1,0300
Total
$14,981.56
Video pipes prior to lining .
Sewer Lining ·All
Highlighted Pipes
Proposal Review Detail - CSI
Page 3 ol5
2/25/2014
Proposal Review Detail- CSI Continues ..
Job Order Number:
Job Order Tille:
Rec#
016628.00
Village of Huntley - Sanitary Colleclion System Lining
C Sf Number
Mod.
UOM
Line Total
Description
b3 -Utllltios
19
Quantity
4,692.00
Installation
Contractors Note:
Category1;
20
$-3,769 55
Mod _ __ __ _F...;...
or Quantities > 1000 To 5000, Deduct
33 01 30 16 0020
Unit Price
Factor
Tole I
-0 78
1.0300
$-3,769.55
x
'Video pipes prior to lining '
Sewer Lining· All
Hlghllghtod Pipes
33 01 30 16 0029
LF
$10,726.73
>6" To 12" Diameter Pipe Inspection, Post-Rehabilitation Phase Note: CCTV
tnspecUon of pipe interior.
Quantity
4,692.00
Installation
Contractors Nota:
Category1:
21
Unit Price
x
Mod
Contractors Note:
4,692.00
X
Total
1.0300
$-2,706.35
'Video pipes after lining.'
EA
Initial Set Up And Final Equipment Removal For Jet Clea_ni_n=g _ _ _ __
Installation
Contractors Note:
Unit Price
1.00
X
1,955.90
X
Factor
-------Total
1.0300
$2,014.58
$2,014.58
Initial set up of jet cleaning equipment.
Sewer Lining- All
Highlighted Pipes
33 01 30 51 0005
EA
9.00
lnMallation
Contractors Note:
$4,532.75
Move And Reset Up At Different Access/location For Jet Cleanin~
g _ _ _ __ _
Quantity
24
-0 .56
X
Factor
Sewer Lining· All
Highlighted Pipes
33 01 30 51 0004
Cotegory1:
---------~S-2~
,70635
Unit Price
Quantity
23
Total
$10,728.73
For QuanUties > 1000 To 5000, Deduct
Installation
Category1:
Factor
1.0300
Video pipes aHer lining.
Quantity
22
X
Sewer Lining -All
Highlighted Pipes
33 01 30 16 0029
Category1:
222
Unit Price
x
488.97
x
Factor
Total
1.0300
$4.532.75
Move and reset jet deaning equipment
Sewer Lining -All
Highlighted Pipes
33 01 30 51 0009
LF
$17,156.30
B" Diameter Pipe line Cleaning, Hydro Jelling Method, Light Cleaning- 3
Passes
Quantity
4,692 00
Installation
Contractors Note:
Category1:
25
1.0300
3.55
Total
$17,156.30
Jet dean sewer pipes prior to lining.
Sewer Lining - All
Highlighted Pipes
33 01 30 51 0009
Mod
$·3,431 .26
For Quantities> 2000 To 5000. Deduct
- - - - -----Installation
Contractors Note:
Category1:
Factor
Unit Price
x
Quantity
4.692.00
U nil Price
x
-0.71
X
Factor
Total
1.0300
S-3,431.26
'Jet clean sewer pipes prior to lining'
Sewor Lining - All
Highlighted Pipos
Proposal Review Detail - CSI
Page 4 of 5
212512014
Proposal Review Detail- CSI Continues ..
Job Order Number:
Job Order Title:
Roc#
016828.00
Village of Huntley - Sanilary Colleclion Syslem Lining
CSI Number
UOM
Mod.
Description
Line Total
133 - Utilities
26
33 01
30 72 0003
EA
$3,741.02
lnilial Set Up And Final Equipment Removal For Relining Underground
Pipelines
Installation
Contractors Note:
Category1 :
27
33 01
Quanlily
1.00
X
30 72 0004
EA
Contractors Note:
33 01
Factor
1.0300
Total
$3,741.02
Sower Lining- All
Highlighted Pi pes
$13.467 .64
Move And Reset Up Al Different Access/Location For Relining Underground
--'P
--"ipelines _ - -- -- - Quantity
Installation
9.00
X
28
X
Equipment inilial set up and removal lor pipe linlnQ.
- --
Calegory1:
Unit Price
3,632.06
-
-
Unit Price
1.452 82
X
Facto r
1.0300
Total
$13,467.64
Move and reset pipe lining equ ipment
Sewer Lining -All
Highlighted Pipes
LF
30 72 0008
Installation
Contractors Note:
6mm Lining 8" Pipe With Cured In-Place Pipe (CIPP)
Quantity
4.692.00
x
Unit Price
25.73
x
_ _ _ __c$_124.346.91
Factor
1.0300
Total
$124,346.91
Lining of 8" sewer pipe. All highlighted pipes on owner supplied map. Th is proposal is based on sewers in
good lin able condition. Grouting or point repairs are not included.
29
33 01
30 72 0008
Mod
For Quantities> 2000 To 5000, Deduct
Quantity
Installa tion
4,692.00
X
Unit Price
-2.09
$·10.10047
X
Factor
1.0300
Total
S-10,100.47
Contractors Noto:
30
33 01
30 73 0033
Contractors Note:
Installation And Maintenance Of Ventilation System, 36" to so·• diameter to
2620' Note: For internal insp_ec\ion and repair of water mains
Quantity
Unit Price
Factor
1 0300
Installation
2.00
x
7,729.64
x
EA
515 ,923.06
Total
$15,923.06
Confined space ventilation system on site for all work inside manholes. Delivery , lnslallalion. set up.
maintain, and relocate as needed to many different locations. Line item is up to 2,600 lin f\, so quantity of 2
used for 4,692 lin nor utility ma in to be lined
Category1 :
31
33 01
Sewer Lining- All
Highlighted Pipes
30 73 0090
EA
$2,590.35
Drill And Chip New Connection In Existing Manhole Note: Includes Grouting
Or New Pipe Inserted Into Manhol-'e_ _ _ _ _ _
Quantity
Installation
Contractors Note:
Calegory1:
5.00
Unit Price
X
502 98
Factor
1.0300
Total
$2,590.35
Cut in •nd re-connect later•ls aNer lining process
Sewer Lining- All
HI hli hted Pipes
Subtotal for 33 -Utilities :
$200,415.38
Proposal Total
$211,170.50
This proposal total represents lhe correct total for the proposal. Any discrepancy between line totals.
sutHnlAI~ Anr:t lhA nrnMsa\ Inial Is dua In rnunnino of thA line totals anrl suh.tntals
The Percent of NPP on this Proposal :
Proposal Review Detail - CSI
0.00%
Page 5 of 5
212512014
Bond# 929587766
Document A312™ - 2010
Performance Bond
CONTRACTOR: .
(Name, legal status and address)
SURETY:
(Name, legal status and principal place
ofbusiness)
F.H. Paschen, S.N. Nielsen & Associates LLC
5515 N. Easl River Road
Chicago, Illinois 60656
Continental Casualty Company
333 S. Wabash Avenue
41st Floor
Chicago, IL 60604
OWNER:
(Name, legal status and address)
Village of Huntley
10987 Main Street
Huntley, Illinois 60142
Any singular reference to
Contractor, Surety, Owner or
other party shall be considered
plural where applicable.
CONSTRUCTION CONTRACT
AlA Document A312-20 10
combines two separate bonds, a
Date: March 21, 201 4
Amount:
This document has important legal
consequences. Consultation with
an attorney is encouraged with
respect to ils completion or
modification.
Performance Bond and a
Payment Bond, Into one form.
This is not a single combined
Performance and Payment Bond.
Two Hundred Eleven Thousand One Hundred Seventy &
50/1 00--------Dollars ($211, 170.50)
Description:
(Name and location)
Sewer Televising & Lining; P.O. Number: 20140299
BOND
Date : March 28, 2014
(Not earlier than Construction Contract Date)
Two Hundred Eleven Thousand One Hundred Seventy &
Amount: 50/1 00--------Dollars ($211, 170.50)
Modifications to
tllis Bond:
D
None
D
See Section
16
CONTRACTOR AS PRINCIPAL
(Corporate Seal)
Company:
Signature:
Name R
and T itle: Authorized
Signature: J:=::f::I~~~~~~-,t.~:L.o~~,qc..-.,_,
Name
and Title:
Attorney-In-Fact
SURETY
(Corporate Seal)
Agent & Sr. V .P.
(Any additional signatures appear 0 11 the last page ofthis Pe1jormance Bond.)
(FOR INFORMA110N ONLY- Name, address and telephone)
AGENT or BROKER:
OWNER'S REPRESENTATIVE:
(A rchitect, E11gineer or other party:)
Marsh USA Inc.
540 W. Madison St.
Suite 1200
Chicago, IL 60661
312.627.6000
Init.
AlA Document A31 2"'- 2010. The American lnsl ijule of Archilecls.
00 11 10
1
§ 1 The Contractor and Surety, jointly and severally, bind themselves, their heirs, executors, administrators, successors
and assigns to the Owner for the perfonnance of the Constmction Contract, which is incorporated herein by reference.
§ 2 If the Contractor pcrfonns the Constmction Contract, the Surety and the Contractor shall have no obligation under
this Bond, except when applicable to participate in a conference as provided in Section 3.
§ 3 If there is no Owner Default under the Constmction Contract, the Surety's obligation under litis Bond shall arise
after
.1
the Owner first provides notice to the Contractor and the Surety that the Owner is considering declaring
a Contmctor Default. Such notice shall indicate whether the Owner is requesting a conference among
the Owner, Contractor ami Surely to discuss the Contractor's performance. If the Owner docs not
request a conference, the Surely may, witltin five (5) business days after receipt of the Owner' s notice,
request such a conference. If the Surety timely requests a conference, Ute Owner shall attend. Unless
the Owner agrees otherwise, any conference requested under tltis Section 3.1 shall be held witltin ten
( 10) business clays of the Surety's receiJJt of the Owner's notice. If the Owner, the Contractor and the
Sutety agree, the Contractor shall be allowed a reasonable time to perfonn the Constmction Contract,
but such an agreement shall not waive the Owner's right, if any, subsequently to declare a Contractor
Default;
.2
the Owner declares a Contractor Default, tenninates the Constmction Contract and notifies the Surety;
illld
.3
the Owner has agreed to pay the Balrutce of tlte Contract Price in accordru1ce with tlte tenns of the
Constmction Contract to the Surety or to a contractor selected to perform the Constmction Contract.
§ 4 Failure on tltc part of the Owner to comply with the notice requirement in Section 3.1 shall ·not constitute a failure
to comply with a condition precedent to the Surety 's obligations, or release the Surety from its obligations, except to
the extent the Surety demonstrates actual prejudice.
§ 5 When the Owner has satisfied the conditions of Section 3, the Surety shall promptly and at the Surety' s expense
take one of UlC following actions:
§ 5.1 Arrange for the Contractor, wiU1thc consent of the Owner, to perfonn and complete the Construction Contract;
§ 5.2 Undertake to perform and complete the Constmction Contract itself, through its agents or independent
contractors;
§ 5.3 Obtain bids or negotiated proposals from qualified contractors acceptable to the Owner for a contract for
performance and completion of the Construction Contract, arrange for a contract to be prepared for execution by tllC
Owner ;md a contractor selected with the Owner's concurrence, to be secured witlt performance and payment bonds
executed by a qualified surely equivalent lo the bonds issued on the Construction Contract, and pay to the Owner tl1e
amount of damages as described in Section 7 in excess of tliC Balance of the Contract Price incurred by tlte Owner as
a result of tliC Contractor Default; or
§ 5.4 Waive its righllo perfonn and complete, arrange for completion, or obtain a new contractor and with reasonable
promptness under tlte circumstru1ces:
.1
After investigation, detennine the amount for which it may be liable to the Owner and, as soon as
·
practicable after Ute amount is determined, make payment to the Owner; or
.2
Deny liability in whole or in part and notify the Owner, citing the reasons for denial.
§ 6 If the Surety does not proceed as provided in Section 5 with reasonable promptness, the Surety shall be deemed to
be in default on this Bond seven days after receipt of an additional written notice from the Owner to the Surety
demrutding that the Surely perform its obligations under this Bond, and the Owner shall be entitled to enforce any
remedy available to the Owner. If the Surety proceeds as provided in Section5.4, and t11e Owner refuses the payment
or the Surety has denied liability, in whole or in part, without further notice the Owner shall be entitled to enforce any
remedy available to the Owner.
Inil.
AlA Document A312Thl- 2010. The American lnsmule of Architects.
2
§ 7 If the Surety elects to act under Section 5.1, 5.2 or 5.3, then the responsibilities of the Surety to the Owner shall not
be greater than those of the Contractor under the Constmction Contrnct, and the responsibilities of the Owner to the
Surety shall not be greater than those of the Owner under the Construction Contrnct. Subject to the conunitment by the
Owner to pay the Balance of the Contract Price, the Surety is obligated, without duplication, for
.1
the responsibilities of UlC Contrnctor for correction of defective work and completion of the
Construction Contract;
.2
additional legal, design professional and delay costs resulting from the Contrnctor's Default, and
resulting from the actions or failure to act of the Surety under Section 5; and
.3
liquidated damages, or if no liquidated damages are specified in the Constmction Contract, actual
damages caused by delayed performance or non-performance of the Contractor.
§ 8 lf the Snrety elects to act under Section 5. 1, 5.3 or 5.4, the Surety's liability is limited to the amount of this Bond.
§ 9 The Surety shall not be liable to the Owner or others for obligations of the Contractor that are unrelated to the
Constmction Contract, and the Balance of the Contract Price shall not be reduced or set off on account of any such
unrelated obligations. No right of action shall accrue on tlus Bond to any person or entity other than the Owner or its
heirs, executors, adnunistrators, successors and assigns.
§ 10 The Surety hereby waives notice of any change, including changes of time, to the Construction Contmct or to
related subcontrncts, purchase orders and other obligations.
§ 11 Any proceeding, legal or equitable, under Utis Bond may be instituted in any court of competent j urisdiction in
the location in which the work or part of the work is located and shall be instituted within two years after a declaration
of Cont ractor Default or within two years after the Contmctor ceased working or within two years after the Surety
refuses or fails to perfonn its obligations under this Bond, whichever occurs first. If Ute provisions of this Paragraph
are void or prohibited by law, Ute mirumum period of limitation available to sureties as a defense in the jurisdiction of
the suit shall be applicable.
§ 12 Notice to the Surety, the Owner or the Contractor shall be mailed or delivered to the address shown on the page
on which their signature appears.
§ 13 When this Bond has been furnished to comply with a statutory or oU1er legal requirement in Ute location where
the constnrction was to be performed, any provision in this Bond conflicting with said statutory or legal requirement
shall be deemed deleted herefrom rutd provisions confomung to such statutory or other legal requirement shall be
deemed incorpomted herein. When so fumished, the intent is that tlus Bond shall be construed as a statutory bond and
not as a common law bond.
§ 14 Definitions
§ 14.1 Balance of the Contract Price. The total amount payable by the Owner to the Contractor under the Constmction
Contract after all proper acljustments have been made, including allowance to the Contractor of any amounts received
or to be received by the Owner in settlement of insurance or other claims for damages to which Ute Contractor is
entitled, reduced by all valid and proper payments made to or on behalf of Ute Contractor under the Constmction
Contmct.
§ 14.2 Construction Contract. The agreement between the Owner rutd Contractor identified on the cover page,
including all Contract Documents and changes made to the agreement and the Contract Documents.
§ 14.3 Contractor Default. Failure of the Contmctor, which has not been remedied or waived, to perfonn or oU1erwise to
comply with a material term of the Constmction Contrnct.
§ 14.4 Owner Default. Failure of the Owner, wlueh has not been remedied or waived, to pay the Contmctor as required
under the Constmction Contract or to perform and complete or comply with the oUter material terms of the
Construction Contract.
§ 14.5 Contract Documents. All the documents that comprise the agreement between the Owner and Contractor.
§ 15 lf Ulis Bond is issued for an agreement between a Contractor and subcontractor, the term Contractor in tlus Bond
shall be deemed to be Subcontmctor and t1te tenn Owner shall be deemed to be Contractor.
In it.
Al A Document A312"'- 2010. The American lnsthute of Architects.
3
§ 16 Modifications to this bond are as follows :
(.';;pace is provided below for additional signatures ofadded parties, other than those appearing on the cover page.)
CONTRACTOR AS PRINCIPAL
SURETY
Company:
(Corporate Seal) Company:
(Corporate Seal)
Signature:
Name and Title:
Address
Signature:
Name and Title:
Address
CAUTION: You should sign an original AlA Contract Document, on which this text appears in RED. An original assures that
changes will not be obscured.
Inil.
AlA Document A312"' -2010. The American lnslilule of Archilecls.
4
Bond # 929587766
Document A312™ - 2010
Payment Bond
CONTRACTOR:
(Name, legal status and address)
SURETY:
(Jilame, legal status and principal place
ofbusines.s)
F.H. Paschen, S.N. Nielsen & Associates LLC
5515 N. East River Road
Chicago, Illinois 60656
Continental Casualty Company
333 S. Wabash Avenue
41st Floor
Chicago, IL 60604
OWNER:
(Name, legal status and address)
Village of Huntley
10987 Main Street
Huntley, Illinois 60142
Any singular reference to
Contractor, Surety, Owner or
other party shall be considered
plural where applicable.
CONSTRUCTION CONTRACT
Date: March 21,2014
A
This document has important legal
consequences. Consultation with
an attorney is encouraged with
respect to its completion or
modification.
t Two Hundred Eleven Thousand One Hundred Seventy &
50/1 00--------Dollars ($211,170.50)
moun :
Description:
(Name and location)
AlA Document A312-2010
combines two separate bonds, a
Performance Bond and a
Payment Bond, Into one form.
This is not a single combined
Performa nce and Payment Bond.
Sewer Televising & Lining; P.O. Number: 20140299
BOND
Date:
March 28, 2014
(Not earlier than Construction Contract Dale)
Amount:
Two Hundred Eleven Thousand One Hundred Seventy &
50/1 00--------Dollars ($211, 170.50)
Modifications to tltis Bond:
0 None
0 See Section 18
CONTRACTOR AS PRINCIPAL
Company:
(Corporate Seal)
SURETY
Company:
F.H. Paschen, S.N. Nielsen & Associates LLC
M~A~
Signature:
Name Robert F. zi~
and Title: Authorized Agent & Sr.
(AI~Y additional signatures appear on
Signature:
Name
V .P. and Title:
1/=.~~!::.!::::!~~-: ;_,U.A..!~'L-t<h-"-..
Attorney-In-Fact
the last page ofthis Payment Bond.)
(FOR INFORMATION ONLY - Name, address and telephone)
AGENT or BROKER:
OWNER'S REPRESENTATIVE:
Marsh USA Inc.
(Arclritec/, Engineer or other party:)
540 W. Madison St.
Suite 1200
Chicago, IL 60661
312.627.6000
Inil.
AlA Document A312N - 2010. The American l nslilule of Archilecls.
0111 10
5
§ 1 The Contractor and Surety, jointly and severally, bind themselves, their heirs, executors, administrators, successors
and assigns to tl1c Owner to pay for labor, materials and equipment fumished for usc in the perfonnance of the
Constmction Conllact, which is incorporated herein by reference, subject to the following terms.
§ 2 If the Cont ractor promptly makes payment of all sums due to Claimants, and defends, indemnifies and holds
hannless the Owner from claims, demands, liens or suits by any person or entity seeking pay ment for labor, materials
or equipment furnished for use in the performance of the Constmction Contract, then the Surety audthe Cont ractor
shall have no obligation under this Bond.
§ 3 If there is no Owner Default under the Constmction Contract, the Surety 's obligation to the Owner under this Bond
shall arise after the Owner has promptly notified the Contractor and the Surety (at the address described in Section 13)
of claims, demm1ds, liens or suits against the Owner or the Owner's property by any person or entity seeking payment
for labor, materials or equipment furnished for use in the perfonnance of the Constmction Contract ami tendered
defense of such claims, demands, liens or suits to the Contractor and the Surety.
§ 4 When the Owner has satisfied the conditions in Section 3, the Surety shall promptly and at the Surety's expense
defend, indenmify and hold hann.less the Owner against a duly tendered claim, demand, lien or suit.
§ 5 The Surety's obligations to a Claimant under this Bond shall arise after the following:
§ 5.1 Claimants, who do not have a direct contract with the Contractor,
.1
.2
have furnished a written notice of non-payment to the Conll<lctor, stating with substantial accuracy the
amount claimed and the name of the pa11y to whom the materials were, or equipment was, furnished or
supplied or for whom the labor was done or pe1fonned, within ninety (90) days after having last
pcrfonned labor or last fu mished materials or equipment included in U1c Claim; and
have sent a Claim to U1e Surety (at the address described in Section 13).
§ 5.2 Claimants, who are employed by or have a direct contract with the Cont ractor, have sent a Clai m to the Surety (at
the address described in Section 13).
§ 6 If a notice of non-payment required by Section 5.1.1 is given by the Owner to the Cont ractor, that is sufficient to
satisfy a Claimant's obligation to fumish a written notice of non-payment under Section 5.1.1.
§ 7 When a Claimant has satisfied tJ1e conditions of Sections 5. 1 or 5.2, whichever is applicable, U1e Surety shall
promptly mtd at the Surety's expense take Ute following actions:
§ 7.1 Send an answer to the Claimant, with a copy to the Owner, within si:..1y (60) days after receipt of the Claim,
stating Ute amounts that are undisputed and t11e basis for challenging any amounts that are disputed; and
§ 7.2 Pay or armngc for payment of any undisputed amounts.
§ 7.3 The Surety's failure to discharge its obligations under Section 7.1 or Section 7.2 shall not be deemed to
constitute a waiver of defenses the Surety or Conll<lctor may have or acquire as to a Claim, except as to undisputed
amounts for which the Surety and Claimant have reached agreement. If, however, the Surety fails to discharge its
obligations under Section 7. 1 or Section 7.2, the Surety shall indemnify the Claimant fo r the reasonable attomcy's
fees the Claimant incurs thereafter to recover any SlllllS found to be due and owing to the Claimant.
§ 8 The Surety's totaJ obligation shall not exceed 1he amount of tllis Bond, plus the amount of reasonable attomcy 's
fees provided under Section 7.3, and U1e amount of this Bond shall be credited for any payments made in good faitlt
by the Surety.
§ 9 Amounts owed by the Owner to U1e Contmctor under the Constmction Contract shall be used for the performance
of the Constmction Conll<lct and to satisfy claims, if any, under any constmction perfonnance bond. By the
Conll<lctor fumishing and the Owner accepti ng this Bond, tliCy agree U1at all funds earned by the Contractor in the
performance of the Constmction Contract arc dedicated to satisfy obligations of the Conll<lctor and Surety under this
Bond, subject to the Owner's priority to use the funds for the completion of the work.
Init.
AlA Document A312"' - 2010. The American l nstilule of Architects.
6
§ 10 The Surety shall not be liable to the Owner, Claimants or others for obligations of the Contractor that are
umclatcd to the Constmction Contract. The Owner shall not be liable for the payment of any costs or expenses of any
Claimant under tltis Bond, and shall have under this Bond no obligation to make payments to, or give notice on behalf
of, Claimants or othemise have any obligations to Claimants under this Bond.
§ 11 The Surety hereby waives notice of any change, including changes of time, to the Constmction Contract or to
related subcontracts, purchase orders and oU1er obligations.
§ 12 No suit or action shall be commenced by a Claimant under tltis Bond other than in a court of competent
jmisdiction in the state in which the project that is the subject of the Constmction ContJact is located or after the
expiration of one year from the elate ( l ) on wltich the Claimant sent a Claim to the Surety pursuant to
Section 5.1.2 or 5.2, or (2) on which the lnst lnbor or se1vice was performed by anyone or the last materials or
equipment were fumished by anyone under the Constmction Contrnct, wltichever of (I) or (2) first occurs. lf the
provisions of this Paragraph arc void or proltibitccl by law, UIC nti1timum period of limitation avnilable to sureties as a
defense in the jurisdiction of the suit shall be applicable.
§ 13 Notice and Claims to the Surety, the Owner or the Contractor shall be mailed or clclivcrcd to the address shown
on the page on wltich their signature appears. Actual receipt of notice or Claims, however accomplished, shall be
sufficient compliance ns of U1c elate received.
§ 14 When tltis Bond has been funtishecl to comply with a statuto!)' or other legal requirement in the location where
t11e constmction was to be performed, any provision intltis Bond conflicting with said statutory or legal requirement
shall be deemed deleted hcrefrom and provisions confornting to such statuto!)' or other legal requirement shall be
deemed incorporated herein. When so furnished, the intent is that tltis Bond shall be constmed as a statutory bond and
not as a common law bond.
§ 15 Upon request by any person or entity appearing to be a potential beneficiary of this Bond, Ute Contractor and
Owner shall promptly funtish a copy of litis Bond or shall penni! a copy to be made.
§ 16 Definitions
§ 16.1 Claim. A written statement by the Claimant including at a minimum:
.1
.2
.3
.4
.5
.6
.7
.8
the name of Ute Claimmtt;
the name of the person for whom the labor was done, or materials or equipment furnished;
a copy of the agreement or purchase order pursuant to which labor, materials or equipment was
funtished for use in the perfom1ance of the Constmction Contmct;
a brief description of the labor, materials or equipment fumished;
the dntc on wltich the Claimant last performed labor or last funtishcd materials or equipment for usc in
the perfonnance of the Constmction Contract;
Ute total amount earned by the Claimant for labor, materials or equipment furnished as of the date of
the Claim;
the total amount of previous payments received by the Claimant; and
the total amount due and unpaid to the Claimant for labor, materials or equipment funtishccl as of the
date of Ute Claim.
§ 16.2 Claimant. An individual or entity having a direct contract with the Contractor or with a subcontractor of Ute
Contractor to furnish labor, materials or equipment for use in the performance of the Constmction Contract. The term
Claimant also includes any individual or entity that has rightfully asserted a claim under an applicable mechanic's lien
or similar statute against the real property upon wltich the Project is located. The intent of this Bond shall be to
include without limitation in the tenns "labor, materials or equipment" that pa1t of water, gas, power, light, heat, oil,
gasoline, telephone service or rental equipment used in the Constmction Contract, arcltitcctural mtd engineering
services required for perfonnance of the work of the Contractor and the Contractor's subcontractors, and all other
items for which a mcchartic's lien may be asserted in the jurisdiction where the labor, materials or equipment were
furnished.
§ 16.3 Construction Contract. The agreement between the Owner mtd Contractor identified on the cover page,
including all Contract Documents and all changes made to the agreement and the Contract Documents.
Init.
AlA Document A312"'- 2010. The American
lnsl~ute
ol Architects.
1
§ 16.4 Owner Default. Failure of the Owner, which has not been remedied or waived, to pay the Contractor as required
under the Constmction Contract or to perform and complete or comply with the oUter material terms of the
Constmction Contract.
§ 16.5 Contract Documents. All the documents that comprise the agreement between the Owner and Contractor.
§ 17 If this Bond is issued for an agreement between a Contractor and subcontractor, the !enn Contractor in this Bond
shall be deemed to be Subcontractor and the term Owner shall be deemed to be Con!mctor.
§ 18 Modifications to this bond arc as follows:
(.S'pace is provided below for additional signatures ofadded parties, other than those appearing on the cover page.)
CONTRACTOR AS PRINCIPAL
SURETY
(Corporate Seal)
(Corporate Seal) Company:
Company:
____________ ___ Signature:
Signatme:
Name and TiUc:
Name and Title:
Address
Address
CAUTION: You should sign an original AlA Contract Document, on which this text appears in RED. An original assures that
changes will not be obscured.
Init.
AlA Document A312"'- 2010. The American lnsi Hute of Architects.
8
STATE OF ILLINOIS
COUNTY OF COOK
I,
Beatriz Polito a notary Public in and for said County, do hereby certify that
Adrienne C. Stevenson
as Attorney-in-Fact, who is personally known to me to
be the same person whose name is subscribed to the foregoing instrument, appeared before me
this day in person, and acknowledged that they signed, sealed, and delivered said instrument
for and on behalf of
CONTINENTAL CASUALTY COMPANY
for the uses and purposed therein set forth.
Given under my hand and notarial seal at my office in the City of Chicago in said County,
this _......:::;.
28.;;;.1._11 - - - - - - day of _ ___:.IV;.:.1:. :.a•::. . ;·c: .:.h;:. ____ A.D. _ __,;;:2=0=14..:....,__
OFFICIAL SEAL
BEATRIZ POLITO
NOTARY PUBLIC, STATE OF ILLINOIS
MYwooooooc;:a
COMMISSION S~f.Ja~
POWER OF ATTOR NEY APPOINTING INDIVIDUAL ATTORN EY- IN- FACT
Know Alll\Ien Oy Th ese Presents, That Continenta l Casuall}' Company. m1 Illinois insurance company; National rire Insurance Company of
Hartford, an Ill inois insurance company, and American Casualty Company of Read ing, Pennsylvania, a Pennsylvania insurance company (herein called
" the CNA Companies"). are duly organ ized and existing insurance compan ies ha\'ing their principal offices in the City of Chicago, and State of Illinois,
and that they do by virtue of the signatures and seals herein affix ed hereby make, constitute and appoi nt
A<.ldcnnc C Stevenson, John K Johnson, Bcatriz Polito, C. R. Hernandez, Katherin e J Foreit, Amy D W icl<ctt, Douglas
M Schmude, Individually
of Chicngo, !L, their tmc amllnwfu! Attorney(s)-in-r act with full power m1d authority hereby confe rred to sign, sen! and execute for and on their behnlf
bonds, undertakings nnd other obligatory instruments of similar nature
- In Unlimited Amounts and to bind them thereby as fully nnd to the same extent as if such instruments were signed by a duly authoriz.:d oflk er of their insuronce compnnies and
all the acts of said Attorney, pursuant to the authority hereby gi\•en is hereby rati lied ilnd confim1ed.
This Power of Attorney is made and executed pursuant to and by authority of the By-Law and Reso lutions, printed on the reverse hereof, duly
adopted, as indicated, by the Boards of Directors of the insurance companies.
In Witness Whereof, the CNA Companies have caused these presents to be signed by their Vice President and their corporate seals to be hereto
affixed on this 20th day of June, 201 3.
Continental Casualty Company
National Fire Insurance Company of Hartford
Am~omp.,,y ofRo.d;ng,
Paul T. Bmflat
P<nnsyl.,.,;,
7.~
~=dent
Stnte of South Dakota, County of Minnehaha, ss:
On this 20th day of June, 2013, before me personally came Paul T. Dru flat to me known, who, being by me duly sworn, did depose <UJd say: that he
resides in the City of Sioux ralls, State of South Dakota; that he is a Vice President of Continental Casualty Company, an Illinois insurance comp:my,
National Fire Insurance Company of Hartford, an Illinoi s insurance company, and American Casualty Company of Reading, Pennsylvania, a
PcnnsylvmJia insurance company described in and which executed the above instru ment; that he knows the seals of said insurance companies; that the
scnls afllxcd to the snid instrument are such corporate seals; that they were so affi xed pursuant to authority given by the Boards of Directors of said
insurance companies and that he signed his name thereto pursuant to like authority, and acknowledges same to be the act and deed of said insurance
companies.
~~~~~~~~~+
J. MOHR
~ NOTARYPUilLIC~
.......................
~SOOTH DAKOTA~
~
.,.
My Commission Expires June 23, 20 15
J. Mohr
Notary Public
CERTIFI CATE
!. D. Bu ll. Assistant Secn:tnry ofContincnta! Casual ty Company, an Ill inois ins urance company, National Fire Insurance Company of I! art ford, an
Illi nois insurance company. and American Casualty Company of Reading. Pennsy lvania, a Pennsy lvania insurance company do hereby certify that the
!'ower of Attorney herein above sd fo rth is still in lim:e, and furt her ccr1ify that the 13y-l.aw and Resolution of the Board of Oir.:ctors of the insurance
companies printed on the reverse hereof is still in force. In testimony whcrcof I have hereunto subscribed my nnme and am xed the seal of the said
insurance companks this 28th
day of _ _ _M_arch
2014
Conti nental Casualty Co mpany
National Fire Insurance Company of Hartford
A merican Casualty Company of Readi ng, Pennsylvania
D
D . Bult
Form F6853-4/20 12
6_.. 4..-Q.;:t--
Assistant Secretary
Authorizing By-Laws and Resolutions
ADOPTED RY THE BOARD OF DIRECTORS OF CONTINENTAL CASUALTY COMPANY:
This Power of Attorney is umde nn.l executed pursuant to and by authority of the foll owing resolution duly adopted by the Board of Drcctors of the
Company at n meeting h:ld on May 12, 1995:
"RESOLVED: That any Senior or Group Vice President may authorize an officer to sign specific documents, agreements and instruments on behalf of
the Company provided that the name of such authorized officer and a descrption of the docllnents, agreements or instnuncnts tlmt such officer may sign
will be provided in writing by tl1e Senior or Group Vice ITcsident to LI-e Secretary of the Cunpany prior to such execution bec.uming effective."
This Power of Attorney is signed by Paul T. Bmflat,
attorneys on behalf of Continental Casualy Company.
Vi~e
President, who has been authorized pursuant to the above resolution to execute power of
This Power of Attorney is signed and sealed by facsimile under and by tl1e authority of the following Resolution adopted by the IJoard of Directors of the
Company by unanimous written consent dated the 21' day of April, 2012:
" Whereas, the bylaws of the Company or specific resolution of the Board of Directors has autht;>rized various oflicers (the "Authorized Ofliccrs") to
execute various policies, bonds, undertakings ami other obligatory instuments of like nature; and
Whereas, from time to time, the signature of the Autl10rized Officers, in addition to being provided in original, hard copy fom1a t, may be provided via
facsimil~ or ot11erwise in an electronic format (collectively, "Electronic Signatures"); Now therefore be it resolved: tlml the Electronic Signature of any
Authorized Officershall be valid and binding on the Company."
ADOPTED BY THE BOARD OF DIRECTORS OF NATIONAL FIRE INSURANCE COMPANY OF HARTFORD:
This Power of Allorney is made and executed pursuant to and by autl10rity of the following resolution duly adopted by the Board of Directors of tl1e
Company by unanimous written consent dated May 10, 1995:
"RESOLVED: That any Senior or Group Vice President may authorize an officer to sign specific documents, agreements and instruments on behalf of
tlte Company provided that the name of such aut110rized officer and a descrjltion of the documents, agreements or instruments that such officer may sign
will be provided in writing by the Senior or Group Vice President to the Secretary of the Ccmpany prior to such execution bccomirg effective."
1l1is Power of Attorney is signed by Paul T. llruflat, Vice President, who has been authorized pursuant to the above resolution to execute power of
attorneys on behalf ofNationallire Insurance Company of Hartford.
This Power of Attorney is signed and scaled by facsimile under and by the autltority of the following Resolution adopted by the Board of Directors of the
Company by unanimous written consent dated the 21' day of April, 2012:
"Whereas, the bylaws of the Company or specific resolution of the Doard of Directors has authorized various officers (the "Authorized Ofllcers") to
execute various policies, bonds, undertakings and other obligatory inshlments of like nature; and
Whereas, ftom time to time, tl1e signature of the Authorized Officers, in addition to being provided in original, hard copy format, may be provided via
facsimile or otherwise in an e lectronic format (collectively, "Electronic Signatures"); Now therefore be it resolved: that the Electronic Signature of any
Authorized Officer shall be valid and binding on the Company."
ADOPTED UY THE BOARD OF DIRECTORS OF AMERICAN CASUALTY C0~1PAN Y OF READING, PENNSYLVANIA:
This Power of Attomey is made ard executed pursuant to and by authocity of the following resolution du~ adopted by the Bonnl of Directors of the
Company by unanimous written consent dated May 10, 1995:
" RESOLVED: That any Senior or Group Vice President may authorize an officer to sign specific documents, agreemC'llts and instruments on behalf of
the Company provided that the name of such autl1orized onicer and a descrplion of the doctments, agreements or instnnncnts tl1at such officer may sign
will be provided in writing by the Senior or Group Vice President to the Secretary of the Ccmpany prior to such execution becomirg effective."
·n1is Power of Attomey is signed by Paul T. Bmflnt, Vice President, who has been authorized pursuant to the above resolution to execute power of
attorneys on behalf of American Ca;ualty Company of Reading, Penn~y l vania .
This Power of Attumey is signed and sealed by facsimile under and by the authority of the following Resolution adopted by the Board of Directors of the
Company by unanimous written consen t dated the 21' day of April, 20 12:
"Whereas, the bylaws of the Company or specifi c resolution of the Board of Directors has autl10rizcd various officers (the "Authorized Officers") to
execute various policies, bonds, undertakings and other obligatory insh1ments of like nature; and
Whcr~as, lrom time to time, the signature of the Authorized Officers, in addition to being provided in original, hard copy fonnat, may he provided via
fa csiulilc (Jr otherwise in an electronic fomwt (collectively, ·' Electronic Signatures''); Now therefore be it resolved: that the Electronic Signature of any
·
Authorized Ofliccr shall be vnlid and binding on the Company."
~RD(/!}
DATE (MM/DDIYYYY)
03/27/2014
I
CERTIFICATE OF LIABILITY INSURANCE
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
CERTIFICATE DOES NOT AFFIRMAnVELY 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 pollcy(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 th is certificate does not confer rights to the
certificate holder in lieu of such endorsement(s).
PRODUCER
~){~r,'"''
MARSH USA INC.
. iAIC NO)!
540 W. MADISON
r~8.~o. Ext!:
E·MAIL
CHICAGO, IL 60661
ADDRESS·
A1tn: [email protected]
NAJCII
INSURERISl AFFORDING COVERAGE
16535
INSURER A : Zurich American lnsuranoe Company
40142
INSURED
INSURER B ! American Zurich lnsuranoe Company
F.H. Paschen
23817
INSURER
c
:
Illinois
Nationallnsuranoe
Company
S.N. Nielsen & Associates, LLC
Attn: Nick Bilski
36940
INSURER D : Indian Harbor Insurance Company
5515 N. East River Road
INSURERE :
Chicago, IL 60656
[FAX
INSURER F :
CH 1-004881708-01
REVISION NUMBER·1
CERTIFICATE NUMBER·
COVERAGES
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
UMITS
TYPE OF INSURANCE
POUCY NUMBER
l c~Wfi~, ~~~LA%~,
LTR
~~~~ ~:;
1,000,000
GLO 58334 76-01
A GENERAL LIABILITY
10/01/2014
10/01/2013
EACH OCCURRENCE
s
-:-:300,000
s
...!:_ =:JMERCIAL GENERAL LIABILITY
~~~~~irrE~~~ncel
_
CLAIMS-MADE
0
OCCUR
1-1--
GEN'L AGGREnE LIMIT APPLIES PER:
lxl POLICY
A
rxrx-
ANY AUTO
1 - ALL OWNED
AUTOS
HIRED AUTOS
1-
c
n
~f'RT
AUTOMOBILE LIABILITY
X
-
MED EXP (Any one person)
$
10,000
PERSONAL & ADV INJURY
$
1,000,000
GENERAL AGGREGATE
$
2,000,000
PRODUCTS- COMP/OP AGG
$
2,000,000
$
LOC
BAP5833474-01
10/01/2013
_fE~~~~(}SI NG LE LIMIT
10/01/2014
BODILY INJURY (Per person)
-
x
-
UMBREUA LIAB
EXCESSLIAB
SCHEDULED
AUTOS
NON-OWNED
AUTOS
M
$
$
BE014929118
OCCUR
CLAIMS-MADE
DED X RETENTION $ 10,000
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY
Y/N
ANY PROPRIETOR/PARTNER/EXECUTIVE
N/A
OFFICER/MEMBER EXCLUDED?
(Mandatory in NH)
0
10/01/2013
10m12014
EACH OCCURRENCE
$
25,000,000
AGGREGATE
$
25,000,000
$
WC 5833475-01 (AOS)
10/0112013
10/01/2014
we 5833477-01 (WI)
10/01/2013
10/01/2014
X J:r~n1INsl
l 0l~-
E.L. EACH ACCIDENT
$
E.L. DISEASE- EA EMPLOYEE $
~~~~~rtir8~ ~J'6PERATIONS below
D Professional/Pollution Uab.
1,000,000
$
BODILY INJURY (Per accident) $
l'P~~~~gAMAGE
I I
8
8
$
E_L DISEASE- POLICY LIMIT
CE07420104
10/01/2013
10/01/2014
'SIR: $50,000'
$
1,000,000
1,000,000
1,000,000
Each Act
5,000,000
Aggregate
5,000,000
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLIES (Attach ACORD 1Ot, Additional Remarks Schedule, If more space is requiredJ
Village of Huntley is/are included as additional insured (except Worllers' Compensation) where required by written contract.
Waiver of subrogation is applicable where required by written contract.
CERTIFICATE HOLDER
Village of Huntley
10967 Main Street
Huntley, IL 60142
CANCELLA TION
SHOULD ANY OF TME ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE TMEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE Willi THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVE
of Marsh USA Inc.
t
Manashi Mukherjee
~-vu>olo..O.
~
© 1988-2010 ACORD CORPORATION. All nghts reserved.
ACORD 25 (2010/05)
The ACORD name and logo are registered marks of ACORD
AGENCYCUSTOMERID: ~0~5~
7~
57~2~---------------------------­
LOC #: Chicago
ADDITIONAL REMARKS SCHEDULE
AGENCY
Page
2
of
2
NAMED INSURED
F.H. Paschen
S.N. Nielsen & Associates, LLC
Attn: Nick Bilski
5515 N. East River Road
Chicago, IL 60656
MARSH USA INC.
POLICY NUMBER
CARRIER
I
NAICCODE
EFFECTIVE DATE:
ADDITIONAL REMARKS
THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM,
FORM NUMBER:
25
FORM TITLE: Certificate of Liability Insurance
Excess Layer Liability
Insurer: Endurance American Insurance Company
Policy Number: EXC1 0004227000
Policy Period: 10/01/2013-10/01/2014
Each Occurrence: $25,000,000
Aggregate: $25,000,000
ACORD 101 (2008/01)
© 2008 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD