Discussion and Consideration of Pay Application #9 – Miron Construction – Tiffin Recreation Center – Motion to Approve — K-3

DATE (MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 1/19/2026 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 have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). CONTACT PRODUCER NAME: Certificate Processing Skogman Insurance Agency PHONE FAX 417 1st Ave SE (A/C, No, Ext): 319-366-6288 (A/C, No): 319-364-7157 E-MAIL Cedar Rapids IA 52401 ADDRESS: [email protected] INSURER(S) AFFORDING COVERAGE NAIC # License#: 1001002959 INSURER A : Partners Mut Ins Co 13439 INSURED ILTEINC-01 INSURER B : Ilten's Inc. 919 14th Ave SW INSURER C : Cedar Rapids IA 52404 INSURER D : INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER: 646110015 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 ADDL SUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY) LIMITS A X COMMERCIAL GENERAL LIABILITY Y Y CZ92023197 1/1/2026 1/1/2027 EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED CLAIMS-MADE X OCCUR PREMISES (Ea occurrence) $ 100,000 MED EXP (Any one person) $ 5,000 PERSONAL & ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY X PRO-JECT LOC PRODUCTS - COMP/OP AGG $ 2,000,000 OTHER: $ A Y Y COMBINED SINGLE LIMIT $ 1000000/1000000 AUTOMOBILE LIABILITY AZ92023197 1/1/2026 1/1/2027 (Ea accident) X ANY AUTO BODILY INJURY (Per person) $ OWNED SCHEDULED BODILY INJURY (Per accident) $ AUTOS ONLY AUTOS NON-OWNED X HIRED AUTOS ONLY X AUTOS ONLY PROPERTY DAMAGE (Per accident) $ $ A X UMBRELLA LIAB X OCCUR UZ92023197 1/1/2026 1/1/2027 EACH OCCURRENCE $ 5,000,000 EXCESS LIAB CLAIMS-MADE AGGREGATE $ 5,000,000 DED RETENTION $ $ PER OTH- A WORKERS COMPENSATION Y WZ92023197 1/1/2026 1/1/2027 X STATUTE ER AND EMPLOYERS' LIABILITY Y/N ANYPROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $ 500,000 OFFICER/MEMBER EXCLUDED? N/A (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE $ 500,000 If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 500,000 A Errors & Omissions CZ92023197 1/1/2026 1/1/2027 Limit 1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Project: #250120 – City of Tiffin Community Recreation Center-BP#2 including miscellaneous Supply Work at the same location 105 S. Park Rd, Tiffin, IA 52340 Stored Materials - Trane $22,603.00 & Rist $38,370.00 at 919 14th Ave SW, Cedar Rapids, IA 52404 Stored Materials - Trane $127,471.59 RTU at Coonrod Wrecker & Crane Service, 4000 E. Ave NW CR, IA 52405 If required If required by written contract, Miron Construction Co., Inc., and Sunshine Leasing, LLP, City of Tiffin, Atura Architecture are included as a primary/non-contributory additional insured (including products & completed operations) on the General Liability and primary/non-contributory additional insured See Attached... CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Miron Construction Co., Inc. 335 French Ct SW AUTHORIZED REPRESENTATIVE Cedar Rapids IA 52404 © 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD