HomeMy WebLinkAboutMike Dolan Concrete & Masonry, Inc-6/18/2012FORM OF CONTRACT
CONTRACT FOR THE CONSTRUCTION OF
F.Y. 2012 LOGAN AVENUE SIDEWALK
CITY OF WATERLOO, IOWA
CONTRACT NO. 782
This contract made and entered into this i qday of 30K. -E-- , 20 L9,'by and
between the City of Waterloo, Iowa, a Municipal Corporation, (hereinafter referred to
as City), and Mike Dolan Concrete & Masonry, Inc. of Waterloo, Iowa, (hereinafter
referred to as Contractor), WITNESSETH:
PAR. 1
PAR. 2
PAR. 3
Contractor agrees to build and construct the FY 2012 LOGAN AVENUE
SIDEWALK PROGRAM, CONTRACT NO. 782 and furnish 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.
PAR. 4 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
FORM OF CONTRACT PAGE 1 OF 5 PAGES
PAR. 5
PAR. 6
PAR. 7
PAR. 8
PAR. 9
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 14, 2012 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
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 furnish 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.
PAR. 13 The Contractor agrees to furnish 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.
PAR. 14
PAR. 15
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 Contractors 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 $53,040.49.
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 Tess
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 WATERLOO, IOWA
Mike Dolan Concrete & Masonry, Inc.
Contractor
BY: 42 9exa
Title: President
Approved by the City Council of the City of Waterloo, Iowa, this
day of t%v_ , 20
ATTEST:
, City Clerk
Waterloo, Iowa
FORM OF CONTRACT PAGE 5 OF 5 PAGES
Bond #0854440
PERFORMANCE BOND
KNOW ALL MEN BY THESE PRESENTS:
That we, Mike Dolan Concrete & Masonry, Inc. of 1140 Fairchild, Waterloo, IA 50703
(the "Principal"), and West Bend Mutual Company of P.O. Box 620976
Middleton,WI 53562 (the "Surety"), are held and firmly bound unto the City of Waterloo, Iowa
(the "Obligee"), in the penal sum of Fifty Three Thousand Forty Dollars and 50/100.
Dollars ($53 , 040.50 ), lawful money of the United States, for the payment of said
sum in connection with a contract (the "Contract") dated on or about June 8, 2012
for the purpose of sidewalk repair
forth herein.
. The Contract is incorporated herein by reference as though fully set
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
1. To any extension of time to the Contract in which to perform the Contract.
2. 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 June 8, 2012
PRINCIPAL SURETY
Mike Dolan Concrete & Masonry, Inc.
Name
West Bend Mutual Company
Name
By:
Mike Dolan
Title: President
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.
Jec'
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
PAYMENT BOND
KNOW ALL MEN BY THESE PRESENTS: that
Mike Dolan Concrete & Masonry, Inc.
Bond #0854440
(Name of Contractor)
1140 Fairchild, Waterloo, IA 50703
(Address of Contractor)
a Corporation
(Corporation, Partnership or Individual)
and West Bend Mutual Company
, hereinafter called Principal,
(Name of Surety)
8401 ogeenway Blvd., Suite 1100, P.O. Box 620976, Middleton, WI 53562
(Address of Surety)
hereinafter called Surety, are held and firmly bound unto
City of Waterloo
(Name of Owner)
715 Mulberry St., Waterloo, IA 50703
(Address of Owner)
hereinafter called OWNER, in the penal sum of Fifty Three ThousaLfllarS, $( 53,040.50 )
Forty Dollars and 50/100.
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 8 day of June
201 � a copy of which is hereto attached and made a part hereof for the construction of:
Sidewalk repairs
NOW, THEREFORE, if the Principal shall promptly make payment to all persons, firms,
SUBCON TRACTORS, 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.
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 one counterparts, each one of
(number)
which shall be deemed an original, this the 8
20 12 .
A I-IEST:
9cA
(Principal) Secretary
(SEAL)
Witness as to Principal
/tea
(Address)
/a/ Th 101
ATTEST:
Wi ess asto Surety Lori Frerichs
300 E. Bremer Ave.
(Address)
Waverly, IA 50677
day of June
Mike Dolan Concrete & Masonry, Inc.
Principal
By 41, (s)
Mike Dolan
1140 Fairchild
(Address)
Waterloo, IA 50703
West Bend Mutual Company
Surety
By .
Atto'-in-Fact D rcy A. Byl
8401 Greenway Blvd., Suite 1100
(Address)
Middleton, WI 53562
NOTE: Date of BOND must not be prior to date of Contract.
If CONTRACTOR is Partnership, all partners should execute BOND.
eseee]
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.
AIA
BEND
A MUTUAL INSURANCE COMPANY®
0854440
Power of Attorney
Know all men by these Presents, That West Bend Mutual Insurance Company, a corporation having its principal office in
the City of West Bend, Wisconsin does make, constitute and appoint:
Darcy Byl
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: Four Hundred Thousand Dollars ($400,000)
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 West Bend Mutual Insurance Company at a meeting duly called and held
on the 21st day of December, 1999.
Appointment of Attorney -In -Fact. The president or any vice president, or any other officer of West Bend Mutual Insurance
Company may appoint by written certificate Attorneys -in -Fact to act on behalf of the company in the execution of and
attesting of bonds and undertakings and other written obligatory instruments of like nature. The signature of any officer
authorized hereby and the corporate seal may be affixed by facsimile to any such power of attorney or to any certificate
relating therefore and any such power of attorney or certificate bearing such facsimile signatures or facsimile seal shall
be valid and binding upon the company, and any such power so executed and certified by facsimile signatures and
facsimile seal shall be valid and binding upon the company in the future with respect to any bond or undertaking or other
writing obligatory in nature to which it is attached. Any such appointment may be revoked, for cause, or without cause,
by any said officer at any time.
In witness whereof, the West Bend Mutual Insurance Company has caused these presents to be signed by its president
undersigned and its corporate al to be hereto duly attested by its secretary this 1st dayarch, 2009.
Attest
Ja J. Pa
Se tary
State of Wisconsin
County of Washington
On the 1st day of March, 2009 before me personally came Kevin A. Steiner, to me known being by duly sworn, did
depose and say that he resides in the County of Washington, State of Wisconsin; that he is the President of West Bend
Mutual Insurance Company, the corporation described in 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 is was so affixed by order
of the board of directors of said corporation and that he signed his name thereto by like order.
* I NOTARY i * JohnnF. D /-
well
moi.• PUBLIC 1-.1 Executive Vice President - Chief Legal Officer
t` ...• .��'o2, Notary Public, Washington Co. WI
••er1,09.•••' My Commission is Permanent
The undersigned, duly elected to the office stated below, now the incumbent in West Bend Mutual Insurance Company, a
Wisconsin corporation authorized to make this certificate, Do Hereby Certify that the foregoing attached Power of -
Attorney remains in full force effect and has not been revoked and that the Resolution of the Board of Directors, set forth -
in the Power of Attorney is now in force.
Signed and sealed at West Bend, Wisconsin this 8
Kevin A. Steiner
Chief Executive Officer / President
Notice:
day of June 2012
Dale J. Kent
Executive Vice President -
Chief Financial Officer
Reproductions are not binding on the company. Any -questions concerning this Power of Attorney may be
directed to the Bond Manager at NSI, a division of West Bend Mutual Insurance Company.
8401 Greenway Blvd. Suite 1100 I P.O. Box 620976 I Middleton, WI 53562 1 ph (608) 410-3410 1 www.thesilverlining.com
6/14/2012 2:20 PM FROM: The The Sinnott Agency TO: 1-319-291-4262 PAGE: 002 OF 002
MIKED-1
OP ID: JT
'`'1:30CERTIFICATE OF LIABILITY INSURANCE
DATE(MMIDDIYWI�
06/14/12
THIS CERI1FICATE 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 pollcy(les) must be endorsed. If SUBROGATION IS WAIVED, subject to
the terms and conditions of the pollcy, certain policies may require an endorsement. A statement on thls certificate does not confer rights to the
certificate holder in lieu of such endorsement(s).
PRODUCER 319-233-6103
The Sinnott Agency, Inc.
622 W 4th St. PO Box 1918 319-234-8133
Waterloo IA 50704
Steven Sinnott
CONTACT Steve Sinnott
NAME:
PHCNNoExt):319-233-6103 ((NC, No): 319-234-8133
MAIL.
ADDRESS: Sieves@sinnottagency.com
LIMITS
INSURER(S) AFFORDING COVERAGE
NAIC #
INSURER A :Allied/Nationwide Insurance Co
42579
INSURED MIKE DOLAN CONCRETE &
MASONRY INC,
1140 FAIRCHILD STREET
WATERLOO, IA 50703-1424
INSURERS:
01/10/12
INSURERC :
EACH OCCURRENCE
INSURER D :
PREM SES EaoccurrrDence)
INSURER E :
INSURER F :
CLAIMS -MADE
RTIFICATE 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.
ILS
TYPE OF INSURANCE
ADDL
INSR
SUBR
WVD
POLICY NUMBER
POLICY EFF
(MMIDDIYYYY)
POLICY EXP
(MMIDDIYYYY)
LIMITS
A
GENERAL
X
LIABILITY
COMMERCIAL GENERAL LIABILITY
X
ACP7110915307
01/10/12
01/10/13
EACH OCCURRENCE
$ 1,000,000
PREM SES EaoccurrrDence)
$ 100,000
CLAIMS -MADE
X
OCCUR
MED EXP (My one person)
$ 5,000
PERSONAL & ADV INJURY
$ 1,000,000
GENERAL AGGREGATE
$ 2,000,000
GEN'L AGGREGATE LIMITAPPLIES PER:
50 POLICY n 7CT n LOC
PRODUCTS - COMP/OP AGG
$ 2,000,000
A
AUTOMOBILE
X
LIABILITY
ANY AUTO
ALL OWNED
AUTOSAUTOS
HIRED AUTOS
-
SCHEDULED
NON -OWNED
AUTOS
ACP7110915307
01/10/12
01/10/13
COMBINED SINGLE LIMIT
(Ea accident)
$ 1,000,000
BODILY INJURY (Per person)
$
BODILY INJURY (Per acddent)
$
PROPERTY DAMAGE
(Per acddent)
$
$
A
X
UMBRELLALIAB
EXCESS LIAB
X
OCCUR
CLAIMS -MADE
ACP7110915307
01/10/12
01/10/13
EACH OCCURRENCE
$ 1,000,000
AGGREGATE
$ 1,000,000
DED RETENT ON $
$
A
WORKERS COMPENSATIONWC
AND EMPLOYERS' LIABILITY
ANY PROPRIETOR/PARTNER/EXECUTIVEY/N
OFFICER/MEMBER EXCLUDED?
(Mandatory In NH)
IF yes, describe under
DESCRIPTION OF OPERATIONS below
N /A
ACP7110915307
01/10/12
01/10/13
X
STATU-
TORY LIMITS
OTH-
ER
E.L.EACHACCIDENT
$ 100000
,
E.L. DISEASE - EA EMPLOYEE
$ 100,000
E.L. DISEASE - POLICY LIMIT
$ 500,000
DESCRIPTION OF OPERATIONSI LOCATIONS !VEHICLES _Mason ACORD 101, Additional Remarks Schedule if more apace is required)
ADDITIONAL INSURED UNDER THE GENERAL LIABILITY POLICY PER CG201b.
PROJECT: 2012 LOGAN AVENUE SIDEWALK
FAX #291-4262
P•Cn•nr.,-aT,- 1 www
CANCELLATION
CITYWLO
CITY OF WATERLOO
715 MULBERRY ST
WATERLOO, IA 50703
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
ACORD 25 (2010/05)
O 1988-2010 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD