HomeMy WebLinkAboutWilson Custom TreeCITY OF WATERLOO, IOWA
WATERLOO LEISURE SERVICES COMMISSION
BIDDER: IS
BID FORM
for
2017 RIGHT-OF-WAY MOWING
-�—
ADDRESS: c9 /EA Shur E 2 -Fre e.t
V1cr n 52-13(4
PHONE: (6E1)5 ) 541 - -a.3 S
1. The undersigned, being a Corporation existing under the laws of the State of
a Partnership consisting of the following partners: A1/49 -
having
/`/. -
having been familiarized with the existing conditions on the project area affecting the
cost of the work, and with all the Contract Documents now on file in the offices of the
City Clerk, City Hall, Waterloo, Iowa, and the Waterloo Leisure Services Commission,
1101 Campbell Ave., Waterloo, Iowa, hereby proposes to furnish all supervision,
technical personnel, labor, materials, machinery, tools, equipment, and services,
including utility and transportation services required to complete the proposed RIGHT-
OF-WAY MOWING, in accordance with the contract documents and for the unit price in
place for the following amount:
OPTION A: provide all mowing services for:
• Broadway St. (22 acres) Parker St. to Airport Blvd.
• Dubuque Road (8.2 acres) Nevada St. to Evansdale city limits
• San Marnan Dr. (36.6 acres) W.4rh St. to Texas St.
• US 218 corridor (68.6 acres) US 63 interchange to San Marnan Dr.
• Highway 20 overpasses 7 acres) Hammond Ave., Kimball Ave.,
Ansborough Ave., W.4" St.
• Martin Luther King Jr. Dr. (23 acres) Franklin St. to Idaho.
• Police Training Center (2.6 acres) Martin Luther King & Elk
Run Rd
Total 168 acres
Price Per Acre:
A/o, eb
OPTION B: provide all specified mowing services for
• University Ave. (13 acres) and
• Greenhill Road (28 acres)
Total 41 acres
Price Per Acre:
dollars ($
2-utUt.0 Glnt-.st M'ii li dollars ($ (06. )
U BID FORM page 1 of 3
OPTION C: provide all specified mowing services for Fairview Cemetery (7 acres)
Price Per Acre:
Atte ry x t am -1-1% dollars ($ c 7. 15 )
OPTION D: provide all specified mowing services for Virden Creek Waterway
(2 acres)
Price Per Acre:
CU12-4-2
A-I'�
11D • .' ollars($ 57
OPTION E: provide all specified mowing services for Logan Ave/Hwy 63
(8.1 acres)
Price Per Acre: aid Lcin:l`ch'-' Cyt t2/na' x'017 ' dollars($
2. It is understood that the quantities set forth are approximate only and subject to
variation and that the unit price for the work done shall govern the actual payment to the
Contractor.
3. In submitting this bid, the Bidder understands that the City reserves the right to reject
any or all bids and to award one or more contracts for a single Option, all Options
together, or any combination of Options. If written notice of acceptance of this Bid is
mailed or delivered to the undersigned within thirty (30) days after Bid Opening, of at
any time thereafter before this bid is withdrawn, the undersigned agrees to execute and
deliver an agreement in the prescribed form and furnish the required certificate of
insurance within ten (10) days after the agreement is presented for signature, and start
work within ten (10) days after "Notice to Proceed" is issued.
(1D
4. Security in the m of Oka_ ,+.1.414.4.46141b dollars ($30()0, )
in the form of ) Anti_, , is submitted herewith in accordance
with NOTICE TO BIDDERS.
5. Attached is a Non -Collusion Affidavit of Prime Contractor.
6. The Bidder is prepared to submit a financial and experience statement upon request.
7. The Prime Contractor and Subcontractor(s), which have performed an aggregate of
$10,000.00 in work for the City in the current calendar year, are prepared to submit an
AAP or Update and an FOC, within ten (10) days of notification that the bid submitted is
lowest and acceptable.
8. The Bidder has received the following Addendum or Addenda:
Addendum No. -19
—
Date: "e9" /._g.,/ . g.
/ /
/ /
1310 FORM page 2 of 3
9. The Bidder shall list the MBE/WBE subcontractors, amount of subcontracts and bid
items listed on the City of Waterloo Minority and /or Women Business Pre-bid Contract
Information Form submitted with this Bid Foran. The apparent low bidder shall submit a
list of all other subcontractor(s) to be used on this project to the City of Waterloo by 5:00
p.m. the business day following the day bids on this project are due along with the Non-
collusion Affidavits of ALL Subcontractor(s).
The subcontractors listed on this proposal and/or submitted to the Contract Compliance
Officer cannot be changed except for the following reasons.
1. The City of Waterloo does not approve the subcontractors,
2. The subcontractors submit in writing that they cannot fulfill their subcontracts
10. The Bidder shall List all equipment available for this project:
4. -Ito" I r iran base? Frank End -L-e.vr, Tan
a-rc)i) diE,fifi Luau-6t4“,ha
I - 4loy `iohn fuze, U9a. Jc &.b im,
i —
(pp' John Deere. ttv»Tu,rn ur' off
std , SPI, laehAnd W beck_
c-S4^r) Trirnine+-
i 1pruXS
dcy, Tri mn-gi s
779 -aa lir 3
'plot up s
11. The Bidder has filled in all blanks on this proposal. Those blanks not applicable are
marked "none" or "NA".
12. The bidder has attached all applicable forms.
13. The owner reserves the right to select alternatives, delete line items, and/or to reduce
quantities prior to the Award of Contract due to budgetary limitations.
SIGNED:
Na
1.r7A)i\.J DATE: 5 //I7
BID FORM page 3 of 3
STATEMENT OF BIDDER'S QUALIFICATIONS
(To be submitted by the Bidder only upon request of the City of Waterloo, Iowa.)
All questions shall be answered and the data given must be clear and comprehensive. This
statementmust be notarized. If necessary, questions may be answered on separate attached
sheets. The Bidder may submit any additional information desired.
1. Name of Bidder. Jell Icaan
2. Permanent main office address, is Short Sine1 G"-esc.cl'rcr 2-13(1
3. When organized. /9 go
4. If a corporation, where ineorpor•atedysj/,q
5. How many years have you been engaged in the contracting business under your present firm
or trade name? AC ,.,,,t4.6
6. Contracts on hand: (Schedule these showing amount of each contract and the appropriate
anticipated dates of completion.) it l i nneetiogit e .1v &sante- t it (.UnJYrtct " "W"'1 - ND ) ,M7
ANA Coo ft,
7. General character of work performed by your company.1? e SuVi c.oj 7 ri mai); ni
8. Have you ever failed to complete any work awarded to you? If so, where and why?
Na
9. Have you ever defaulted on a contract.? If so, where and why?
No
10. List the more important projects recently completed by your company, stating the
approximate cost for each, and to month and ear con feted. �z
clollo watt . €-h- c .n�bp" c -drat -c' c;3; 7sz . =
91ot(o trouts 3 Ince. 12nx4n.. Cirrala:r 9135,9/x'/. e
11. List your major equipment available for the contract..bDe-IA m€ -t '' c,, t
12. Experience in landscape work similar in importance to the project.
Fap`ti 4.2nit--
13. Background and experience of the principal members of your organization, including the
officers. a 5
14. Credit available: $ (6b, D00
15. Give Bank reference: FrIt yx j M F J4 <gait eta -
16.
t -16. Will you, upon request, fill out a detailed financial statement and furnish any other
information that may be required by the City of Waterloo, Iowa? 1.$6
17. The undersigned hereby authorizes and requests any person, firm, or corporation to furnish
any information requested by the City of Waterloo, Iowa, in verification of the recitals
comprising this Statement of Bidder's Qualifications.
STATEMENT OF BIDDERS QUALIFICATIONS PAGE 1 OF 2
Dated this aQc1 AL' day of MQ, 1
State of 10 LOA )
'I ) ss
County of Dtbaral
\\4-1Isirn
Fi)
Name of Bidder
,2011 .
deposes and says that she/he is QC -`i N e r
W I�Son CR51170 Tr'?c
, being duly sworn
Name of Organization
of
and that the answers to the foregoing questions and all statements therein contained are true and
correct. Subscribed and sworn to before me thiscQd day of trim , 20 17
April D. Buis
Commission Number 783136
MY COMM EXP. 08117 Po
QPua .Ado
Notary Public
My commission expires
03//7 ,20OC) .
STATEMENT OF BIDDER'S QUALIFICATIONS PAGE 2 OF 2
NON -COLLUSION AFFIDAVIT OF PRIME BIDDER
State of 10 wet )
County of II wavd ) )
3Qf F \ itstrn , being first duly sworn, deposes and says that:
1. He is (Owner), (Partner), (Officer), (Representative), or (Agent) of tyitSorn Gficir n I Yee_.,
the Bidder that has submitted the attached Bid;
2. He is fully informed respecting the preparation and contents of the attached Bid and of all
pertinent circumstances respecting such Bid;
3. Such Bid is genuine and is not a collusive or sham Bid;
4. Neither the said Bidder nor any of its officers, partners, owners, agents, representatives,
employees, or parties in interest, including this affiant, has in any way colluded, conspired,
connived or agreed, directly or indirectly, with any other Bidder, firm or person to submit a
collusive or sham Bid in connection with the Contract for which the attached Bid has been
submitted or to refrain from bidding in connection with such Contract, or has in any manner,
directly or indirectly, sought by agreement or collusion or communication or conference with
any other Bidder, firm or person to fix the price or prices in the attached Bid or of any other
Bidder, or, to fix any overhead, profit or cost element of the bid price or the bid price of any
other Bidder, or to secure through any collusion, conspiracy, connivance, or unlawful
agreement any advantage against the City of Waterloo, Iowa, or any person interested in the
Proposed Contract; and
5. The price or prices quoted in the attached Bid are fair and proper and are not tainted by any
collusion, conspiracy, connivance or unlawful agreement on the part of the Bidder or any of
its agents, representatives, owners, employees, or parties in interest, including this affiant.
5 Cgnature'
ner
Title
Scrte& ci*t 1. kwon to- before/ moth*
&_^_' day of_ . c -b , 2017.
tie
My coni,(46iari.exptref' 0q17
• e
NON -COLLUSION AFFIDAVIT OF SUBCONTRACTOR
State of ll% )
County of It A )
that.:
, being first duly sworn, deposes and says
1. He is (Owner), (Partner), (Officer), (Representative), or (Agent) of 4\/f}
hereinafter referred to as the "Subcontractor";
2. He is fully informed respecting the preparation and contents of the subcontractor's proposal
submitted by the subcontractor to N/ A , contract
pertaining to the 2017 RIGHT-OF-WAY MOWING CONTRACT in Waterloo, Black
Hawk County, Iowa;
3. Such subcontractor's proposal is genuine and is not a collusive or sham proposal;
4. Neither the subcontractor nor any of its officers, partners, owners, agents, representatives,
employees, or parties in interest, including this affiant, has in any way colluded, conspired,
connived or agreed, directly or indirectly, with any other bidder, firm or person to submit a
collusive or sham proposal in connection with such contract or to refrain from submitting a
proposal in connection with such contract, or has in any manner, directly or indirectly, sought
by unlawful agreement or connivance with any other bidder, firm or person to fix the price or
prices in said subcontractor's proposal, or to fix any overhead, profit or cost element of the
price of prices in said subcontractor's proposal, or to secure through collusion, conspiracy,
connivance or unlawful agreement any advantage against the City of Waterloo, Iowa, or any
person interested in the proposed Contract;
5. The price or prices quoted in the subcontractor's proposal are fair and proper and are not
tainted by any collusion, conspiracy, connivance or unlawful agreement on the part of the
bidder or any of its agents, representatives, owners, employees, or parties in interest,
including this affiant.
N/A
N/A
Signature Tide
Su/Nat:bed' amici. a-worn,to- before' rnerth.“,
NjA_ Bary of _N/A , 2017.
_vie -- 4.,[A
Stonature' T t ei
My cotnm42dawewptrea __ /y/A
EQUAL OPPORTUNITY CLAUSE
(As provided in Executive Order No. 11246)
All contractors, subcontractors, vendors and suppliers of goods and services doing business with
the City and value of said business equals or exceeds ten thousand dollars ($10,000.00) annually
agree as follows:
1. The contractor, subcontractor, vendor and supplier of goods and services will not
discriminate against any employee or applicant for employment because of race, color, creed,
sex, national origin, economic status, age, mental or physical handicap, political opinions or
affiliations. The contractor, subcontractor, vendor and supplier will develop an Affirmative
Action program to ensure that applicants are employed and that employees are treated during
employment without regard to their race, creed, color, sex, national origin, religion, economic
status, age, mental or physical disability, political opinions or affiliations. Such actions shall
include but not be limited to the following:
a. Employment
b. Upgrading
c. Demotion or Transfer
d. Recruitment and Advertising
e. Layoff or Termination
f. Rates of Pay or Other Forms of Compensation
g. Selection for Training Including Apprenticeship.
2. The contractor, subcontractor, vendor and supplier of goods and services will, in all
solicitations or advertisements for employees, state that all qualified applicants will receive
consideration for employment without regard to race, creed, color, sex, national origin,
religion, economic status, age, mental or physical disabilities, political opinion or affiliations.
3, The contractor, subcontractor, vendor and supplier or his/her collective bargaining
representative will send to each labor union or representative of workers which he/she has a
collective bargaining agreement or other contract or understanding, a notice advising said
labor union or workers' representative of the contractor's commitment under this section.
4. The contractor, subcontractor, vendor and supplier of goods and services will comply with all
published rules, regulations, directives, and order of the City of Waterloo Affirmative Action
Program Contract Compliance Provisions.
5, The contractor, subcontractor vendor and supplier of goods and services will furnish and file
compliance reports within such time and upon such forms as provided by the Affirmative
Action Officer. Said forms will elicit information as to the policies, procedures, patterns, and
practices of each subcontractor as well as the contractor himself/herself and said
subcontractor, vendor and supplier will permit access to his/her employment books, records
and accounts to the City's Affirmative Action Officer, for the purpose of investigation to
ascertain compliance with this contract and with rules and regulations of the City's
Affirmative Action Program — Contract Compliance Provisions relative to Resolution No.
24664.
EQUAL OPPORTUNITY CLAUSE PAGE 1 OF 2
6. In the event of the contractor's non-compliance with the non-discrimination clauses of this
contract or with any of such rules, regulations and orders, this contract may be canceled,
terminated or suspended in whole or in part and the contractor may be declared ineligible for
further contracts in accordance with procedures authorized by the City Council.
7. The contractor, subcontractor, vendor and supplier of goods and services will include, or
incorporate by reference, the provisions of the non-discrimination clause in every contract,
subcontract or purchase order unless exempted by the rules, regulations or orders of the
City's Affirmative Action Program, and will provide in every subcontract, or purchase order
that said provisions will be binding upon each contractor, subcontractor, or supplier.
8. We, the undersigned, recognize that we are morally and legally committed to non-
discrimination in employment. Any person who applies for employment with our company
will not be discriminated against because of race, creed, color, sex, national origin, economic
status, age, mental or physical disabilities.
Signed:
U311( -V'
tatiLerN
Appropriate Official
SA9,91 /7
Title
Date
EQUAL OPPORTUNITY CLAUSE PAGE 2 OF 2
Bid Bond
CONTRACTOR:
(Name, legal status and address)
Jeff Wilson dba Wilson Custom Tree
212 Short Avenue
Cresco, IA 52136
Bond Number 41367017
SURETY:
(Name, legal status and principal place of business)
Platte River Insurance Company
P.O. Box 5900
Madison, WI 53705-0900
OWNER:
(Name, legal status and address)
City of Waterloo - Waterloo Leisure Services Commission
1101 Campbell Ave.
Waterloo, IA 50701
BOND AMOUNT: $3,000.00
PROJECT:
(Name, location or address, and Pn ject number if aiy)
2017 Right -of -Way Mowing
Waterloo, IA
This document has important legal
consequences. Consultation with
an attorney is encouraged with
respect to its completion or
modification.
Any singular reference to
Contractor, Surety, Owner or
other party shall be considered
lural where applicable.
The Contractor and Surety are bound to the Owner in the amount set forth above, for the payment of which
the Contractor and Surety bind themselves, their heirs, executors, administrators, successors and assigns,
jointly and severally, as provided herein. The conditions of this Bond are such that if the Owner accepts the
bid of the Contractor within the time specified in the bid documents, or within such time period as may be
agreed to by the Owner and Contractor, and the Contractor either (1) enters into a contract with the Owner
in accordance with the terms of such bid, and gives such bond or bonds as may be specified in the bidding or
Contract Documents, with a surety admitted in the jurisdiction of the Project and otherwise acceptable to the
Owner, for the faithful performance of such Contract and for the prompt payment of labor and material
furnished in the prosecution thereof; or (2) pays to the Owner the difference, not to exceed the amount of this
Bond, between the amount specified in said bid and such larger amount for which the Owner may in good
faith contract with another party to perform the work covered by said bid, then this obligation shall be null
and void, otherwise to remain in full force and effect. The Surety hereby waives any notice of an agreement
between the Owner and Contractor to extend the time in which the Owner may accept the bid. Waiver of
notice by the Surety shall not apply to any extension exceeding sixty (60) days in the aggregate beyond the time
for acceptance of bids specified in the bid documents, and the Owner and Contractor shall obtain the Surety's
consent for an extension beyond sixty (60) days.
If this Bond is issued in connection with a subcontractor's bid to a Contractor, the term Contractor in this
Bond shall be deemed to be Subcontractor and the term Owner shall be deemed to be Contractor.
By arrangement with the American Institute of Architects, the National Association of Surety Bond
Producers (NASBP) (www.nasbp.org) makes this form document available to its members, affiliates, and
associates in Microsoft Word format for use in the regular course of surety business. NASBP vouches that
the original text of this document conforms exactly to the text in AIA Document A310-2010, Bid Bond.
Subsequent modifications may be made to the original text of this document by users, so careful review of its
wording and consultation with an attorney are encouraged before its completion, execution or acceptance.
1
When this Bond has been furnished to comply with a statutory or other legal requirement in the location of the
Project, any provision in this Bond conflicting with said statutory or legal requirement shall be deemed deleted
herefrom and provisions conforming to such statutory or other legal requirement shall be deemed incorporated
herein. When so furnished, the intent is that this Bond shall be construed as a statutory bond and not as a
common law bond.
Signed and sealed this 21st day of March, 2017.
Jeff Wilson dba Wilson Custom Tree
(Priucipa9 (Seal)
Rita Jorgenson (Witness
1,01-6-1‘, ownek-
Platte River Insurance Company
(Snnqy) (Seal)
Ronald Kaiboi, Attorney -in -Fact
By arrangement with the American Institute of Architects, the National Association of Surety Bond
Producers (NASBP) (www.nasbp.org) makes this form document available to its members, affiliates, and
associates in Microsoft Word format for use in the regular course of surety business. NASBP vouches that
the original text of this document conforms exactly to the text in AIA Document A310-2010, Bid Bond.
Subsequent modifications may be made to the original text of this document by users, so careful review of its
wording and consultation with an attorney are encouraged before its completion, execution or acceptance.
2
ACKNOWLEDGMENT OF PRINCIPAL (Individual)
State of 7a, Uta
County of ward
On this c969
}
day of (LCc I-) , in the year 9 -Ci i 7 , before me
personally comes iL1 t W i t,CA-n
to me known and known to me to be the person who is described in and executed the foregoing instrument, and
acknowledges to me that he/sh
s
April D. Buis
Commission Number 783136
MY COMM. EXP. O 1 .9
e 6A-10
Notary Public
ACKNOWLEDGMENT OF PRINCIPAL (Partnership)
State of
County of
On this day of , in the year , before me
personally come(s)
a member of the co -partnership of
to me known and known to me to be t - person who is described in and executed the foregoing instrument, and
acknowledges to me that he/she executed the same as the act and deed of the said co -partnership.
Notary Public
ACKNOWLEDGMENT OF PRINCIPAL (Corporation/LLC)
State of
County of
On this day of
he/she resides in the City of
}
, in the y - , before me personally come(s)
, to own, who being duly sworn, deposes and says that
that he/she is the of the
, the corporation described in and
which executed the foregoing ins i ent, and that he/she signed his/her name thereto by like order.
Notary Public
1 NRt , Iltn i
i► 'l5iil►i
11
Hlfll � IiiNH 7 rllrE 1 i It
Itlut`b',IuHr{ t`p In U"
llllfi�Allllil11�1�1#11 111 hl
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PLATTE RIVER ]INSURANCE COMPANY 41 3 6 7 017
POWER OF ATTORNEY
KNOW ALL MEN BY THESE PRESENTS, That the PLATTE RIVER INSURANCE COMPANY, a corporation of the State of Nebraska, having its
principal offices in the City of Middleton, Wisconsin, does make, constitute and appoint
--JACK ANDERSON; RONALD KATHOT
its true and lawful Attorney(s)-in-fact, to make, execute, seal and deliver for and on its behalf, as surety, and as its act and deed, any and all bonds,
undertakings and contracts of suretyship, provided that no bond or undertaking or contract of suretyship executed under this authority shall exceed in
amount the sum of
ALL WRITTEN INSTRUMENTS IN AN AMOUNT NOT TO EXCEED $20,000,000.00
This Power of Attorney is granted and is signed and sealed by facsimile under and by the authority of the following Resolution adopted by the Board
of Directors of PLATTE RIVER INSURANCE COMPANY at a meeting duly called and held on the 8th day of January, 2002.
"RESOLVED, that the President, and Vice -President, the Secretary or Treasurer, acting individually or otherwise, be and they hereby are granted the
power and authorization to appoint by a Power of Attorney for the purposes only of executing and attesting bonds and undertakings and other writings
obligatory in the nature thereof, one or more vice-presidents, assistant secretaries and attorney(s)-in-fact, each appointee to have the powers and duties
usual to such offices to the business of the company; the signature of such officers and the seal of the Corporation may be affixed to such power of
attorney or to any certificate relating thereto by facsimile, and any such power of attorney or certificate bearing such facsimile signatures or facsimile
seal shall be valid and binding upon the Corporation in the future with respect to any bond or undertaking or other writing obligatory in the nature
thereof to which it is attached. Any such appointment may be revoked, for cause, or without cause, by any of said officers, at any time."
In connection with obligations in favor of the Florida Department of Transportation only, it is agreed that the power and authority hereby given to the
Attorney -in -Fact includes any and all consents for the release of retained percentages and/or final estimates on engineering and construction contracts
required by the State of Florida Department of Transportation. It is fully understood that consenting to the State of' Florida Department of Transportation
making payment of the final estimate to the Contractor and/or its assignee, shall not relieve this surety company of any of its obligations under its bond.
In connection with obligations in favor of the Kentucky Department of Highways only, it is agreed that the power and authority hereby given to the
Attorney -in -Fact cannot be modified or revoked unless prior written personal notice of 'such intent has been given to the Commissioner — Department of
Highways of the Commonwealth of Kentucky at least thirty (30) days prior to the modification or revocation.
IN WITNESS WHEREOF, the PLATTE RIVER INSURANCE COMPANY has caused these presents to be signed by its officer undersigned and
its corporate seal to be hereto affixed duly attested, this 27th day of July, 2015.
Attest:
Gary W. Stumper
President
Surety & Fidelity Operations
`,��y'INISulll�l�c�
/<,< GotAPORA7F Cas .
44
2.
al SEAL {&
PLATTE RIVER INSURANCE COMPANY
Ae---#•4
Stephen J. Sills
CEO & President
:96
COUNTY OF DANE S.S.:
4' • ��NE
804711:\00IIIRIIIA6@\\1\
STATE OF WISCONSIN •
On the 27th day of July, 2015 before me personally came Stephen J. Sills, to me known, who being by me duly sworn, did depose and say: that he
resides in the County of New York, State of New York; that he is President of PLATTE RIVER INSURANCE COMPANY, the corporation described
herein and which executed the above instrument; that he knows the seal of the 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 he signed his name thereto by like order.
STATE OF WISCONSIN l
COUNTY OF DANE J S.S.:
gra
4$9.4‘9.11: aec���
CERIIF'ICATE
David J. Regele
Notary Public, Dane Co., WI
My Commission Is Permanent
I, the undersigned, duly elected to the office stated below, now the incumbent in PLATTE RIVER INSURANCE COMPANY, a Nebraska
Corporation, authorized to make this certificate, DO HEREBY CERTIFY that the foregoing attached Power of Attorney remains in full force and has
not been revoked; and furthermore, that the Resolution of the Board of Directors, set forth in the Power of Attorney is now in force.
Signed and sealed at the City of Middleton, State of Wisconsin this 2 1 S t day of March , 2 017
31 SEAL
Antonio Celii
Secretary
THIS DOCUMENT TS NOT VALID UNLESS PRINTED ON GREEN SHADED BACKGROUND -WITH A RED SERIAL NUMBER IN THE UPPER RIGHT HAND
CORNER. IF YOU HAVE ANY QUESTIONS CONCERNING THE AUTHENTICITY OF THIS DOCUMENT CALL, 800-475-4450. PR -POA (Rev. 12-2016)
,jStr.•r*•.2 "jrfoto �f
747=
t tj v 1 I� tl1 '1x15 !�'�'�!;"'
Inl l..r It3�
r E�w 4•.r_'. cC.,l. E•.••r��-3��/��_��`iiihv r_+z�''.•s/�•+i•:•:
�•.tj �YSi x �.L Yy ..CSCE :.
ACKNOWLEDGEMENT OF SURETY
STATE OF MINNESOTA
COUNTY OF CHIPPEWA —
On this 21st day of March , 2017 , before me, a Notary Public within and for said
County, personally appeared Ronald Kaihoi to me personally known, who being by me duly
sworn he/she did say that he/she is the attorney-in-fact of Platte River Insurance Company ,
the corporation named in the foregoing instrument, and the seal affixed to said instrument is the
corporation seal of said corporation, and sealed on behalf of said corporation by authority of its
Board of Directors and said Ronald Kaihoi acknowledged said instrument to be the free act
and deed of said corporation.
7k17-.&(
NOTARY PUBLIC
My Commission Expires 1131(•
CARA L. ABEL
Notary Public -Minnesota
My Commission Expires Jan 31, 2021
Bid Bond Result Form
Principal: Jeff Wilson dba Wilson Custom Tree
212 Short Avenue
Cresco IA 52136
You have received a bid bond for the project described below. The Surety Company needs the
results of this bid before issuance of further bonds. If you do not know the result, other than your
own bid amount, please indicate this when returning it. Thank you for your cooperation.
Reference #: 55341
Bond Number: 41367017 Estimate: $16,120.20
Obligee: City of Waterino - Waterloo I eisure Services Commission
Description:
2017 Right-of—Way Mowing
Please fill in firm name and their bid price ( also, check off the winning bid )
Lowest Bidder
2nd Lowest Bidder
3rd Lowest Bidder
IF YOUR BID IS NOT LISTED ABOVE, WHAT WAS YOUR PRICE ? $
COMMENTS:
Dated: By: Title:
Please return this form to:
Acora Surety & Insurance Services, LLC.
PO BOX 506 Phone: (320) 269-8546
Montevideo, MN 56265 Fax: (320) 269-6287