HomeMy WebLinkAboutTodd Van Dorn Construction-4/28/2014CITY OF WATERLOO
Council Communication
City Council Meeting: April 28. 2014
Prepared: April 23, 2014
Dept. Head Signature: Eric Thorson, PE., City Engineer
# of Attachments:
SUBJECT: F.Y. 2014 SIDEWALK REPAIR PROGRAM - ZONE 4 AND TRAIL REPAIRS
AWARDING OF CONTRACT
AND
APPROVAL OF CONTRACTS, BONDS, & CERTIFICATE OF INSURANCE
TODD VAN DORN CONSTRUCTION
Contract No. 863
Submitted by: Wayne Castles Associate Engineer
Recommended City Council Action:
After review of the bids, it is being recommended that this contract, in the amount of
$334,447.91, be awarded to TODD VAN DORN CONSTRUCTION, of Cedar Falls, Iowa, and
that the Contract, Bonds, and Certificate of Insurance for this project be approved and signed.
Summary Statement
At the City Council meeting on April 21, 2014, bids were opened for the F.Y. 2014
SIDEWALK REPAIR PROGRAM - ZONE 4 AND TRAIL REPAIRS, Contract No. 863, with
TODD VAN DORN CONSTRUCTION, of Cedar Falls, Iowa, as the apparent low bidder.
The Contracts and Grants Coordinator has reviewed the items relating to the 2014 Contract
Compliance Program requirements and determined that the requirements have been met.
Transmitted herewith are four (4) copies of each of the Contract, Bonds, and Certificate of
Insurance for approval and signatures of City officials.
Expenditure Required $334,447.91
Source of Funds G.O. Bonds
Policy Issue
Alternative
Background Information:
FORM OF CONTRACT
CONTRACT FOR THE CONSTRUCTION OF
F.Y. 2014 SIDEWALK REPAIR PROGRAM — ZONE 4
CITY OF WATERLOO, IOWA
CONTRACT NO. 863
This contract made and entered into this 28th day of April , 2014 , by and
between the City of Waterloo, Iowa, a Municipal Corporation, (hereinafter referred to
as City), and TODD VAN DORN CONSTRUCTION of Cedar Falls, Iowa, (hereinafter
referred to as Contractor), WITNESSETH:
PAR. 1
PAR. 2
PAR. 3
Contractor agrees to build and construct the FY 2014 SIDEWALK
REPAIR PROGRAM — ZONE 4 (BASE BID + ALTERNATE), Contract
863 and fumish all necessary tools, equipment, materials, and labor
necessary to do all the work called for in the plans and specifications in a
workmanshiplike manner and for the prices set forth in Contractor's
proposal, which was accepted by the City, and which is understood and
agreed to be a part of this contract.
It is understood and agreed that the resolution adopted by the City Council
ordering the construction of the improvement, the Notice to Contractors as
published, the Instruction to Bidders, the Form of Proposal, the
Construction and Maintenance Bonds, the Council Proceedings relating to
this matter, and the Plans and Specifications shall all be considered as
forming a part of the contract the same as though they were each set out in
said contract.
The Contractor agrees to furnish at its own cost and expense, all
necessary materials and labor for said work and to construct said
improvements in a thorough, substantial, and workmanlike manner, and in
strict accordance with the requirements of this contract, and of the plans
and specifications made a part hereof by reference, and to the satisfaction
and approval of the City and its engineer.
FORM OF CONTRACT PAGE 1 OF 5 PAGES
PAR. 4
PAR. 5
PAR. 6
PAR. 7
PAR. 8
PAR. 9
The Contractor agrees to perform said work and install said improvements
on the terms set out in bid or proposal to the City which has been accepted
by the City and which is by reference made a part of this contract.
The Contractor agrees to commence said work within ten (10) working
days after receipt of "Notice to Proceed" and complete it on or before
September 12, 2014 unless an extension of time is granted in writing
by the Council of the City.
Should the Contractor fail to complete said improvements in strict
accordance with the terms and conditions of this contract, or the plans and
specifications therefor promptly by the date herein specified, the City may
pay such additional sums as it may be required to pay by reason of the
failure of said contractor and deduct any and all such sums from any
amount then due the Contractor.
The Contractor agrees to comply with and obey all ordinances of the City
of Waterloo, Iowa, relating to the obstruction of streets and alleys, keeping
open passage ways for water, traffic, and protecting any excavations in any
street or alley, and maintaining proper and sufficient barricades with lights
and signals during all hours of darkness, to see that the backfilling is
properly done, and agrees to keep the City whole and defend any and all
suits that may be brought against the City by reason of any injuries that
may be sustained by any person or property allegedly caused by the
Contractor, or his agents, while work is done pursuant to this agreement.
The Contractor agrees that in the event a law suit is brought against the
City for damages allegedly sustained by reason of any act, omission or
negligence of the Contractor or its agents, or on account of any injuries
allegedly sustained by reason of any obstruction, hole, depression or
barrier placed or dug by the defendant or its agents, in the doing of the
work herein contracted for, that it will defend said suit and save the City
harmless therein, and in case judgment is rendered against the City, the
Contractor agrees to pay the same promptly. The Contractor agrees to
carry public liability insurance in a solvent company in a sufficient amount
to protect the City and those who use the streets of the City.
The City shall have the right to appoint one or more construction reviewers
who shall review the progress of the work in detail; also, to make any test
or any material to be used in such work. No material shall be used in any
work until the same has first been approved by the construction reviewer.
Such construction reviewer shall have full authority to pass judgment upon
all materials and upon the manner of doing the work, and their judgment on
rejecting any materials, substance, or manner of work shall be final unless
it is revoked or modified by the City Engineer.
FORM OF CONTRACT PAGE 2 OF 5 PAGES
PAR. 10
PAR. 11
PAR. 12
PAR. 13
PAR. 14
PAR. 15
Any material, which has been rejected by the construction reviewer, shall
be at once removed from the line of work and shall not be again taken
thereon or placed with the material proposed to be used without the written
consent of the City Engineer.
The Contractor shall maintain no cause of action against the City on
account of delays and prosecution of work, but if said work is delayed by
the City, the Contractor shall have such extra time for completion of the job
as was lost by reason of the delay caused by the City.
The Contractor agrees to pay punctually all just claims of labor, material,
men, or subcontractors who shall perform labor or fumish materials
entering into this improvement. It is agreed that the City need not pay the
Contractor until all such claims are paid by the Contractor. It is agreed that
the City shall not be liable for said labor, material, or men under this
contract.
The Contractor agrees to fumish the City, simultaneously with this contract,
a bond on a form to be provided by the City in the amount provided by law
as stated in the Notice to Bidders, which shall be for the benefit of the City,
and any and all persons injured by the breach of any of the terms of this
contract. Said bond shall be filed with the City Clerk and shall be subject to
the approval of the City Council, and is by reference made a part of this
contract.
The Contractor agrees that should it abandon work under this contract or
cease the prosecution thereof for a period of thirty (30) consecutive days
without reasonable cause, and should it fail to proceed with said work
within ten (10) days after a notice to continue or carry it on has been mailed
to it at the address given herein by the City, or after such notice has been
served on it, then the City may proceed to complete said work, using any
material, tools, or machinery found along said line of work, doing the work
either by contract or as it may elect, and the Contractor and the sureties on
its bond shall be liable to the City for the costs and expenses so paid out.
Said costs shall be retained by the City from any compensation due, or to
become due the Contractor, and may be recovered by the City in an action
upon Contractor's bond.
In consideration of the full compliance on the part of the Contractor with all
the provisions, stipulations, and conditions hereof, or contained in the
various instruments made a part of this contract by reference, and upon
completion and acceptance of said work, the City agrees to pay to the
Contractor, in the manner set out in the Notice to Contractors, the amount
of money due the Contractor for work performed and accepted, at the unit
prices set out in the Contractor's proposal, which has been accepted by the
City.
FORM OF CONTRACT PAGE 3 OF 5 PAGES
PAR. 16
PAR. 17
PAR. 18
PAR. 19
PAR. 20
PAR. 21
The total amount of the contract, based on the Engineer's estimates of
quantities and the Contractor's unit bid prices, and for which 100% surety
bond is required is $334,447.91.
After the completion of said work, the Contractor agrees to remove all
debris and clean up said streets, and to save the City harmless from any
damage allegedly resulting from a failure to clean up and remove the
debris or put the street back in a proper condition for travel.
This contract is not divisible, but in the event of a conflict between this
contract and the various instruments incorporated by reference, this
contract shall govern.
Before the Contractor shall be entitled to receive final payment for work
done under this contract, it shall execute and file a bond in the penal sum
of not less than 100% of the total amount of the contract, same to be
known as "Maintenance Bond," and which bond must be approved by the
City Council, and which bond is in addition to the bond given by the
Contractor to guarantee the completion of the work.
The Contractor shall maintain all work done hereunder in good order for
the period of two (2) years from and after the date it is accepted by the
Council of the City of Waterloo, Iowa. Said maintenance shall be made
without expense to the City or the abutting property. In the event of the
failure or default of the Contractor to remedy any or all defects appearing in
said work within a period of two (2) years from the date of its acceptance
by said Council, and after having been given ten (10) days notice so to do
by registered letter deposited in the United States Post Office in said town,
addressed to said contractor at the address herein given, then the City may
proceed to remedy such defects. The costs and expenses thereof to be
recovered from the Contractor and the sureties on its maintenance bond by
an action brought in any court of competent jurisdiction.
The Contractor shall give notice to said City by registered letter directed to
the Mayor or City Clerk/Auditor thereof not more than four (4) and not less
than three (3) months prior to the expiration of the term during which the
Contractor is required to maintain said improvements, in good repair by the
terms of its Contract. The liability of the Contractor and of the sureties on
its bond for maintenance of the said improvements shall continue until
three (3) months after such notice has been given to the City, and, in any
event, until two (2) years after the acceptance of the work.
FORM OF CONTRACT PAGE 4 OF 5 PAGES
CITY OF W ERLOO, IOWA
Ma or
City Clerk
Todd Van Dorn Construction
Contractor
Title: ,a AjA)
Approved by the City Council of the City of Waterloo, Iowa, this epac
day of £qa.Q, , 20.
ATTEST:
> , City Clerk
Waterloo, Iowa
FORM OF CONTRACT PAGE 5 OF 5 PAGES
PAYMENT BOND
KNOW ALL MEN BY THESE PRESENTS: that
Todd Van Dom Construction
(Name of Contractor)
5212 N Union Rd., Cedar Falls, IA 50613
(Address of Contractor)
a Individual
(Corporation, Partnership or Individual)
and, AMCO Insurance Company
, hereinafter called Principal,
(Name of Surety)
1100 Locust St. Des Moines IA 50391
(Address of Surety)
hereinafter called Surety, are held and firmly bound unto
City of Waterloo
(Name of Owner)
715 Mulberry, Waterloo, IA 50703
(Address of Owner)
hereinafter called OWNER. in the penal sum of Three Hundred Thirty four thousand four
hundred forty seven and 91/100 Dollars,($ 334,447.91 )
in lawful money of the United States, for the payment of which sum well and truly to be made,
we bind ourselves, successors, and assigns, jointly and severally, firmly by these presents.
THE CONDITION OF THIS OBLIGATION is such that whereas, the Principal entered into a
certain contract with the OWNER, dated the 28th day of April
2014 , a copy of which is hereto attached and made a part hereof for the construction of:
FY 2014 Sidewalk Re air Pro
ram — Zone 4 Base Bid + Alternate Contract 863
NOW, THEREFORE, if the Principal shall promptly make payment to all persons, firms,
SUBCONTRACTORS, and corporations furnishing materials for or performing labor in the
prosecution of the WORK provided for in such contract, and any authorized extension or
modification thereof, including all amounts due for materials, lubricants, oil, gasoline, coal and
coke, repairs on machinery, equipment and tools, consumed or used in connection with the
construction of such WORK, and all insurance premiums on said WORK, and for all labor,
performed in such WORK whether by SUBCONTRACTOR or otherwise. then this obligation
shall be void; otherwise to remain in full force and effect.
990-8 170A 930-1 6ZPZ11Z61S 00 SNI N3SOYW'813{ f18E-woJd wd17:30 71-77-70
PROVIDED, FURTHER, that the said Surety for value received hereby stipulates and agrees
that no change, extension of time, alteration or addition to the terms of the contract or to the
WORK to be performed thereunder or the SPECIFICATIONS accompanying the same shall
in any wise affect its obligation on this BOND, and it does hereby waive notice of any such
change, extension of time, alteration or addition to the terms of the contract or to the WORK
or to the SPECIFICATIONS.
PROVIDED, FURTHER, that no final settlement between the OWNER and the
CONTRACTOR shall abridge the right of any beneficiary hereunder, whose claim may be
unsatisfied.
IN WITNESS HEREOF, this instrument is executed in 4 counterparts, each one of
(number)
which shall be deemed an original, this the 28th
2014
ATTEST:
(Principal) Secretary
day of April
Todd Van Dorn Construction
(SEAL) By
Witness as to Principal
3)e T? y
(Address)
CV
,
—4-400, Joctie,
ATTEST:
Wi ness to Surety
Principal
5212 N Union Rd
(s)
(Address)
Cedar Falls, IA 50613
AMCO Insurance Company
Surety
By 9), AAJO
Attorney -in -Fact
A/C4'./i'Z > 1100 Locust St
.310g
(Address)
addit
(Address)
Des Moines, IA 50391
NOTE: Date of BOND must not be prior to date of Contract.
If CONTRACTOR is Partnership, all partners should execute BOND.
If this project includes Federal Funds, the following applies to the payment bond:
�9
-IMPORTANT: Surety companies executing bonds must appear on the Treasury
Department's most current list (Circular 570 as amended) and be authorized to transact
business in the State where the project is located.
KNOW ALL MEN BY THESE PRESENTS THAT:
Nationwide Mutual Insurance Company, an Ohio corporation
Farmland Mutual Insurance Company, an Iowa corporation
Nationwide Agribusiness Insurance Company, an Iowa corporation
Power of Attorney
AMCO Insurance Company, an Iowa corporation
Allied Property and Casualty Insurance Company, an lowa corporation
Depositors Insurance Company, an Iowa corporation
hereinafter referred to severally as the "Company" and collectively as the "Companies," each does hereby make, constitute and appoint:
Steven C. Schomaker, Scott Cessna, Brian J. Brumm.el, Rhonda R. Schrage, Joan M. Brown, Katie Wirtjes
each in their individual capacity, its true and lawful attorney-in-fact, with full power and authority to sign, seal, and execute on its behalf any and all bonds and undertakings,
and other obligatory instruments of similar nature, in penalties not exceeding the sum of
Five Hundred Thousand Dollars and No/100 $500,000.00
and to bind the Company thereby, as fully and to the same extent as if such instruments were signed by the duly authorized officers of the Company; and all acts of said
Attorney pursuant to the authority given are hereby ratified and confirmed.
This power of attorney is made and executed pursuant to and by authority of the following resolution duly adopted by the board of directors of the Company:
"RESOLVED, that the president, or any vice president be, and each hereby is, authorized and empowered to appoint attorneys -in -fact of the Company, and to authorize
them to execute and deliver on behalf of the Company any and all bonds, forms, applications, memorandums, undertakings, recognizances, transfers, contracts of
indemnity, policies, contracts guaranteeing the fidelity of persons holding positions of public or private trust, and other writings obligatory in nature that the business of
the Company may require; and to modify or revoke, with or without cause, any such appointment or authority; provided, however, that the authority granted hereby shall
in no way limit the authority of other duly authorized agents to sign and countersign any of said documents on behalf of the Company."
"RESOLVED FURTHER, that such attorneys -in -fact shall have full power and authority to execute and deliver any and all such documents and to bind the Company
subject to the terms and limitations of the power of attorney issued to them, and to affix the seal of the Company thereto; provided, however, that said seal shall not be
necessary for the validity of any such documents."
This power of attorney is signed and sealed under and by the following bylaws duly adopted by the board of directors of the Company.
Execution of Instruments. Any vice president, any assistant secretary or any assistant treasurer shall have the power and authority to sign or attest all approved
documents, instruments, contracts, or other papers in connection with the operation of the business of the company in addition to the chairman of the board, the chief
executive officer, president, treasurer or secretary; provided, however, the signature of any of them may be printed, engraved, or stamped on any approved document,
contract, instrument, or other papers of the Company.
IN WITNESS WHEREOF, the Company has caused this instrument to be sealed and duly attested by the signature of its officer the
13th day of February , 2014 .
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Terrance Williams, President and Chief Operating Officer of Nationwide Agribusiness Insurance Company
and Farmland Mutual Insurance Company; and Vice President of Nationwide Mutual Insurance Company,
AMCO Insurance Company, Allied Property and Casualty Insurance Company, and Depositors Insurance
Company
ACKNOWLEDGMENT
STATE OF IOWA, COUNTY OF POLK: ss
On this 13`h day of February , 2014 , before me came the above-named officer for the Companies aforesaid, to
me personally known to be the officer described in and who executed the preceding instrument, and he
acknowledged the execution of the same, and being by me duly sworn, deposes and says, that he is the officer
of the Companies aforesaid, that the seals affixed hereto are the corporate seals of said Companies, and the
said corporate seals and his signature were duly affixed and subscribed to said instrument by the authority and
direction of said Companies.
Sandy Alitz
Notarial Seal — Iowa
Commission Number 152785
My Commission Expires March, 24, 2017
Notary Public
My Commission Expires
CERTIFICATE March 24, 2017
I, Robert W Horner III, Secretary of the Companies, do hereby certify that the foregoing is a full, true and correct copy of the original power of attorney issued by the
Company; that the resolution included therein is a true and correct transcript from the minutes of the meetings of the boards of directors and the same has not been revoked
or amended in any manner; that said Terrance Williams was on the date of the execution of the foregoing power of attorney the duly elected officer of the Companies, and
the corporate seals and his signature as officer were duly affixed and subscribed to the said instrument by the authority of said board of directors; and the foregoing power of
attorney is still in full force and effect.
IN WITNESS WHEREOF, I have hereunto subscribed my name as Secretary, and affixed the corporate seals of said Companies this 23rd day
of April , 20 14 .
This Power of Attorney Expires March 24, 2017
BDJ 1(03-14) 00
Secretary
PERFORMANCE BOND
KNOW ALL MEN BY THESE PRESENTS:
That we, Todd Van Dom Construction of 5212 N Union Rd., Cedar Falls, IA
50613 (The "Principal"), and AMGO Insurance Company of 1100 Locust St,
Des Moines, IA 50391 (the "Surety"), are held and firmly bound unto the City of
Waterloo, Iowa (the "Obligee"), in the penal sum of Three hundred thirty four thousand four
hundred forty seven and 91/100 Dollars ($ 334,447.91), lawful money of the United
States, for the payment of said sum in connection with a contract (the "Contract") dated on
or about April 28, 2014 for the purpose of FY 2014 Sidewalk
Repair Program —Zone 4 (Base Bid + Alternate), Contract 863. The Contract is
incorporated herein by reference as though fully set forth herein.
Whenever the Principal shall be and is declared by the Obligee to be in default under the
Contract, with the Obligee having performed its obligations in the Contract, then the
Surety, acknowledging that time is of the essence, may promptly remedy the default, or
shall promptly undertake to:
1. Complete the Contract in accordance with its terms and conditions; or
2 Obtain one or more bids for completing the Contract in accordance with its
terms and conditions, and upon determination by the Surety of the lowest
responsible bidder. or negotiated proposal, or, if the Obligee elects, upon
determination by the Obligee and the Surety jointly of the lowest responsible
bidder, or negotiated proposal, arrange for a contract between such party
and the Obligee. The Surety will make available as work progresses
sufficient funds to pay the cost of completion less the balance of the
Contract price. The cost of completion includes responsibilities of the
Principal for correction of defective work and completion of the Contract, the
Obligee's legal and design professional costs resulting directly from the
Principal's default, and liquidated damages or actual damages if no
liquidated damages are specified in the Contract. The term 'balance of the
Contract price" means the total amount payable by the Obligee to the
Principal under the Contract and any amendments thereto, less the amount
properly paid by the Obligee to the Principal; or
3. Determine the amount for which it is liable to the Obligee and pay the
Obligee that amount as soon as practicable.
In the event this bond is enforced. Principal and Surety agree to indemnify Obligee and
hold Obligee harmless from and against any and all costs of enforcement, including but
not limited to reasonable attorneys' fees and expenses.
Every Surety on this bond shall be deemed and held, any contract to the contrary
notwithstanding, to consent to each and all of the following matters, without notice:
Performance Bond Page 1 of 2
990—i 80*d 9Z0-1 6Z7Z11Z618 30 SNI N3SOVW'81311110NEI—woad wdZV:ZO VI—VZ-70
1 To any extension of time to the Contract in which to perform the Contract.
To any change in the plans, specifications, or Contract when such change
does not involve an increase of more than twenty percent (20%) of the total
Contract price, and shall then be released only as to such excess increase.
3. That no provision of this bond or of any other contract shall be valid which
limits to less than one (1) year from the time of the acceptance of the work
the right to sue on this bond for defect in workmanship or material not
discovered or known to the Obligee at the time such work was accepted.
If the Principal performs the Contract, then this bond shall be null and void; otherwise it
shall remain in full force and effect. In no event shall the Surety's total obligation exceed
the penal amount of this bond.
Terms used herein shall include, as appropriate, the singular or plural number, or the
masculine, feminine or neuter gender.
IN WITNESS WHEREOF, the undersigned Principal and Surety have executed this
Performance Bond as of April 28, 2014
PRINCIPAL SURETY
Todd Van Dorn Construction AMCO Insurance Company
Name Name
By: , ! By glahne
Title: Owner Title: Attorney in Fact
[attach Power of Attorney]
NOTE: Date of BOND must not be prior to date of Contract.
If CONTRACTOR is Partnership, all partners should execute BOND.
If this project includes Federal Funds, the following applies to the payment bond:
IMPORTANT: Surety companies executing bonds must appear on the Treasury
Department's most current list (Circular 570 as amended) and be authorized to transact
business in the State where the project is located.
Performance Bond Page 2 of 2
KNOW ALL MEN BY THESE PRESENTS THAT:
Nationwide Mutual Insurance Company, an Ohio corporation
Farmland Mutual Insurance Company, an Iowa corporation
Nationwide Agribusiness Insurance Company, an Iowa corporation
Power of Attorney
AMCO Insurance Company, an Iowa corporation
Allied Property and Casualty Insurance Company, an Iowa corporation
Depositors Insurance Company, an Iowa corporation
hereinafter referred to severally as the "Company" and collectively as the "Companies," each does hereby make, constitute and appoint:
Steven C. Schomaker, Scott Cessna, Brian J. Brummel, Rhonda R. Schrage, Joan M. Brown, Katie Wirtjes
each in their individual capacity, its true and lawful attorney-in-fact, with full power and authority to sign, seal, and execute on its behalf any and all bonds and undertakings,
and other obligatory instruments of similar nature, in penalties not exceeding the sum of
Five Hundred Thousand Dollars and No/100 5500,000.00
and to bind the Company thereby, as fully and to the same extent as if such instruments were signed by the duly authorized officers of the Company; and all acts of said
Attorney pursuant to the authority given are hereby ratified and confirmed.
This power of attorney is made and executed pursuant to and by authority of the following resolution duly adopted by the board of directors of the Company:
"RESOLVED, that the president, or any vice president be, and each hereby is, authorized and empowered to appoint attorneys -in -fact of the Company, and to authorize
them to execute and deliver on behalf of the Company any and all bonds, forms, applications, memorandums, undertakings, recognizances, transfers, contracts of
indemnity, policies, contracts guaranteeing the fidelity of persons holding positions of public or private trust, and other writings obligatory in nature that the business of
the Company may require; and to modify or revoke, with or without cause, any such appointment or authority; provided, however, that the authority granted hereby shall
in no way limit the authority of other duly authorized agents to sign and countersign any of said documents on behalf of the Company."
"RESOLVED FURTHER, that such attorneys -in -fact shall have full power and authority to execute and deliver any and all such documents and to bind the Company
subject to the terms and limitations of the power of attorney issued to them, and to affix the seal of the Company thereto; provided, however, that said seal shall not be
necessary for the validity of any such documents."
This power of attorney is signed and sealed under and by the following bylaws duly adopted by the board of directors of the Company.
Execution of Instruments. Any vice president, any assistant secretary or any assistant treasurer shall have the power and authority to sign or attest all approved
documents, instruments, contracts, or other papers in connection with the operation of the business of the company in addition to the chairman of the board, the chief
executive officer, president, treasurer or secretary; provided, however, the signature of any of them may be printed, engraved, or stamped on any approved document,
contract, instrument, or other papers of the Company.
IN WITNESS WHEREOF, the Company has caused this instrument to be sealed and duly attested by the signature of its officer the
13`h day of February 2014. 1
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IS.. SEAL, * O / :.SEAL;
Terrance Williams, President and Chief Operating Officer of Nationwide Agribusiness Insurance Company
and Farmland Mutual Insurance Company; and Vice President of Nationwide Mutual Insurance Company,
AMCO Insurance Company, Allied Property and Casualty Insurance Company, and Depositors Insurance
Company
ACKNOWLEDGMENT
STATE OF IOWA, COUNTY OF POLK: ss
On this 13`h day of February , 2014 , before me came the above-named officer for the Companies aforesaid, to
me personally known to be the officer described in and who executed the preceding instrument, and he
acknowledged the execution of the same, and being by me duly sworn, deposes and says, that he is the officer
of the Companies aforesaid, that the seals affixed hereto are the corporate seals of said Companies, and the
said corporate seals and his signature were duly affixed and subscribed to said instrument by the authority and
direction of said Companies. _
Sandy Alitz
Notarial Seal — Iowa
Commission Number 152785
My Commission Expires March, 24, 2017
Notary Public
My Commission Expires
CERTIFICATE March 24, 2017
I, Robert W Horner III, Secretary of the Companies, do hereby certify that the foregoing is a full, true and correct copy of the original power of attorney issued by the
Company; that the resolution included therein is a true and correct transcript from the minutes of the meetings of the boards of directors and the same has not been revoked
or amended in any manner; that said Terrance Williams was on the date of the execution of the foregoing power of attorney the duly elected officer of the Companies, and
the corporate seals and his signature as officer were duly affixed and subscribed to the said instrument by the authority of said board of directors; and the foregoing power of
attorney is still in full force and effect.
IN WITNESS WHEREOF, I have hereunto subscribed my name as Secretary, and affixed the corporate seals of said Companies this 23rd day
of April , 20 14 .
This Power of Attorney Expires March 24, 2017
BDJ 1(03-14) 00
P4 --w >l
Secretary
A� ®r CERTIFICATE OF LIABILITY I INSU NC
4/24/2014 1
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 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),
FRODUCEa
Bruttunel Madsen & Associates
ubVEAcr Rhonda Schrage
,A,� N Exit (319)266-2644 (A/G Nv) (319)177-2419
318 MaiU Street
ADDRE33_rhondas@brummelmadeen.com
P.O. Box 399
Cedar Falls IA 50613
INSURER(S) AFFORDIN$ GOVs AGE
MAIC
IusuptAA Integrity Mutual Insurance
14303
INSURED
Todd Van Dorn, DBA: Todd Vail Dorn Conn truction
5212 N. Union Rd
Cedar Falls IA 50613
INSURER B -
4/1/2015
INSUaERC'
$ 1,000,000
INSURED D
$ 100,000
Mst/am E
INSURER F:
MED EXPlAr+rOMDemon)
CERTIFICATE NUMBER:14-15
•
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 OP 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 15 SUBJECT TO ALL THE TERMS.
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR
LTR
TYPE OF INSURANCE
AbDL
INSR
SUeN
'AM
P
POLICY NUMBER
POLICY EFF
(&tM/DD/YYYYI
POLICY EXP
(MM/Ob rwYl
UMTS
A
GENERAL
X
LIABILITY
COMMERCIAL GENERAL LIABILrly
X
X(
071220355
4/1/2014
4/1/2015
EACH OCCURRENCE
$ 1,000,000
DAMAGE TO RENT 0
PREyy ES (FA oortmo c)
$ 100,000
CLAIMS -MADE I S I OCCUR
MED EXPlAr+rOMDemon)
g 5,000
PERSONAL&ADVIN,IURV
$ 1,000, 000
GENERALAGGPEGATE
3 2,000, 000
GEN'L AGGREGATE UAWAP�PLIEjS °ER
A l POLICY 1 I JE7T I IEI LOC
PRODUCTS - COMP/OP AGG
$ 2,000,000
$
A
AUTOMOBILE
X
LLABILITV
ANY AUTO
uTOWNED
SNONLWArNED
HIRED AUTOS
^
-
SSCCHEODULED
AUTOS
CA1220356
4/1/2014
4/1/2013
COMBINED sitTGLc UMrr
(Eaaockdeno
5 11000_, 000
$
BODILY INJURY (Per Dorsa•)
BODILYINJURY (Pm.acc�dar.f)
s
PROPERLY bAMAGE
Me'FlCrIIIP.I
$
Wei or Subropat.on Peterson
A
X
UMBRELLA LIAO
EXCESS UAB
X
OCCUR
CLAIMS-MAOE
CV5,1220353
4/1/2014
4/1/2015
EACH OCCURRENCE
$ 2,000.000
AGGREGATE
$
DED X
RETENTON$ °
5
A
WORXEDS COMPENSATON
AND EMPLOYERS' LIABILITY Y / N
ANY PROPRIETOR/PARTNERIEXECUTIVE
OFGICERmnEMBEREXCLUDED,
(Mandatory In NH)
1f yyea dascnbo undo,
DESCRIPTION OF OPERATIONS below
NIA
�CP1220354
4/1/ 014
4/1/2015
x_ WCS
ER.
E L EACH ACCIDENT
5 500,000
E L D13EASE - EA EMPLOYE6
$ S O 0 000
E L DISEASE - POLICY LIMIT
$ 500 000
DESCRIPTION OF OPERATIO'^I$ r LOCATION$ / VEHICLES (Attach ACORD I101. Additional RonthhA Schedule_ N.none apace l& ropulrod)
City of Waterloo is named as additional insured on the General Liability
CERTIFICATE HOLDER
CANCELLATION
City of Waterloo
715 Mulberry
Waterloo, IA 50703
SHOULD ANY OF THE ABOVE DESCRIBED POUCIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF. NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVE
Scott Cessna/RHON
ACORD 25 (2010105)
INS025 acmes) o+
59O—d O1'd 9ZO-1
p 1988-2010 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD
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