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

CERTIFICATE OF LIABILITY INSURANCE THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFFERS 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). PRODUCER TRICOR, LLC - Dubuque 600 Star Brewery Drive Suite 110 Dubuque, IA 52001 CONTACT Lu Anne Wood PHONE (A/C, No. EX): (608) 405-1161 2202 FAX (A/C, No): EMAIL: [email protected] ADDRESS: INSURER(S) AFFORDING COVERAGE INSURER A: Acuity 14184 INSURER B: INSURER C: INSURER D: INSURER E: INSURER F: INSURED Zephyr Aluminum Products 555 Huff Dubuque, IA 52003 COVERAGES CERTIFICATE NUMBER: 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. <table> <tr> <th>INSURER</th> <th>TYPE OF INSURANCE</th> <th>PREMIUM (MM/DD/YYYY)</th> <th>POLICY NUMBER</th> <th>POLICY EFFECTIVE DATE (MM/DD/YYYY)</th> <th>LIMITS</th> </tr> <tr> <td>A</td> <td>X COMMERCIAL GENERAL LIABILITY<br>CLAIMS-MADE X OCCUR</td> <td></td> <td>X X K60864</td> <td>3/1/2025 3/1/2026</td> <td>EACH OCCURRENCE $1,000,000<br>DAMAGE TO RENTED PREMISES (Per occurrence) $250,000<br>MED EXP (Any one person) $10,000<br>PERSONAL & ADV INJURY $1,000,000<br>GENERAL AGGREGATE $3,000,000<br>PRODUCTS - COMMOD AGG $3,000,000</td> </tr> <tr> <td>A</td> <td>X AUTOMOBILE LIABILITY<br>ANY AUTO OWNED<br>NON-OWNED AUTOS ONLY</td> <td></td> <td>X X K60864</td> <td>3/1/2025 3/1/2026</td> <td>COMBINED SINGLE LIMIT (Per accident) $1,000,000<br>BODILY INJURY (Per person) $<br>BODILY INJURY (Per accident) $<br>PROPERTY DAMAGE (Per accident) $</td> </tr> <tr> <td>A</td> <td>X UMBRELLA LIAB<br>X EXCESS LIAB</td> <td></td> <td>K60864</td> <td>3/1/2025 3/1/2026</td> <td>EACH OCCURRENCE $10,000,000<br>AGGREGATE $10,000,000</td> </tr> <tr> <td>A</td> <td>X WORKERS COMPENSATION AND EMPLOYERS' LIABILITY<br>ANY PROPRIETOR/PARTNER/EXECUTIVE<br>DESCRIPTION OF OPERATIONS below</td> <td>N/A</td> <td>X K60864</td> <td>3/1/2025 3/1/2026</td> <td>X PER STATUTE OTHER<br>E.L. EACH ACCIDENT $1,000,000<br>E.L. DISEASE - EA EMPLOYEE $1,000,000<br>E.L. DISEASE - POLICY LIMIT $1,000,000</td> </tr> </table> DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 191, Additional Remarks Schedule, may be attached if more space is required) Project #250120 City of Tiffin Community Recreation Center-BP#4 Including misc supply work Coverage applies only to the extent provided by the policy and subject to all of the policy terms, conditions, exclusions, endorsements and all applicable laws. Miron Construction Co., Inc., and Sunshine Leasing, LLP, City of Tiffin, Atura Architecture are included as Additional Insured in regard to General Liability on a primary noncontributory basis including ongoing and completed operations all per written contract or agreement; as Additional Insured under the Auto Liability on a primary noncontributory basis per written contract or agreement; A Waiver of Subrogation applies on the General Liability and Work Comp per SEE ATTACHED ACORD 101 CERTIFICATE HOLDER Miron Construction Co., Inc. 335 French Court Cedar Rapids, IA 52404 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. AUTHORIZED REPRESENTATIVE