Discussion and Consideration of Pay Application #12 – Miron Construction – Tiffin Recreation Center Project – Motion to Approve — K.2

ADDITIONAL COVERAGES Ref # Description Coverage Code Form No. Edition Date Uninsured motorist combined single limit UMCSL Limit 1 Limit 2 Limit 3 Deductible Amount Deductible Type Premium 1,000,000 Ref # Description Coverage Code Form No. Edition Date Products/Completed Ops Aggregate PRDCO Limit 1 Limit 2 Limit 3 Deductible Amount Deductible Type Premium 8,000,000 8,000,000 Ref # Description Coverage Code Form No. Edition Date Adjst. to reconcile-exp mod. premium AREM Limit 1 Limit 2 Limit 3 Deductible Amount Deductible Type Premium -$7,866.00 Ref # Description Coverage Code Form No. Edition Date Increased employer's liability INEL Limit 1 Limit 2 Limit 3 Deductible Amount Deductible Type Premium $445.00 Ref # Description Coverage Code Form No. Edition Date Blkt Wvr XFR RR Oth to Us BLKWV Limit 1 Limit 2 Limit 3 Deductible Amount Deductible Type Premium $500.00 Ref # Description Coverage Code Form No. Edition Date Expense constant EXCNT Limit 1 Limit 2 Limit 3 Deductible Amount Deductible Type Premium $160.00 Ref # Description Coverage Code Form No. Edition Date Catastrophe CATAS Limit 1 Limit 2 Limit 3 Deductible Amount Deductible Type Premium $206.00 Ref # Description Coverage Code Form No. Edition Date Premium discount PDIS Limit 1 Limit 2 Limit 3 Deductible Amount Deductible Type Premium -$2,146.00 Ref # Description Coverage Code Form No. Edition Date Limit 1 Limit 2 Limit 3 Deductible Amount Deductible Type Premium Ref # Description Coverage Code Form No. Edition Date Limit 1 Limit 2 Limit 3 Deductible Amount Deductible Type Premium Ref # Description Coverage Code Form No. Edition Date Limit 1 Limit 2 Limit 3 Deductible Amount Deductible Type Premium OFADTLCV Copyright 2001, AMS Services, Inc.