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FORM OF BID OR PROPOSAL
FY 2016 WATER POLLUTION CONTROL FACILITIES
UPGRADE TO INSTRUMENTATION AND CONTROLS SYSTEMS
CITY OF WATERLOO, IOWA
CITY CONTRACT NO. 929
Honorable Mayor and City Council
Waterloo, Iowa
Gentlemen: 11
1. The undersigned, being a Corporation existing under the laws of the State of Ni,441,. °tri , a
Partnership consisting of the following partners: /V1
having familiarized (himself) (themselves) (itself) with the existing conditions on the project area
affecting the cost of the work, and with all the contract documents listed in the Table of Contents and
Addenda (if any), as prepared by the City Engineer of the City of Waterloo now on file in the office of
the City Clerk, City Hall, Waterloo, Iowa, hereby proposes to furnish all supervision, technical
personnel, labor, materials, machinery, tools, appurtenances, equipment, and services, including
utility and transportation services required to construct and complete this FY 2016 WATER
POLLUTION CONTROL FACILITIES, UPGRADE TO INSTRUMENTATION AND CONTROLS
SYSTEMS, CITY CONTRACT NO. 929, all in accordance with the above -listed documents and for
the unit prices for work in place for the following items and quantities:
FY 2016 WATER POLLUTION CONTROL FACILITIES
UPGRADE TO INSTRUMENTATION AND CONTROLS SYSTEMS
CITY OF WATERLOO, IOWA
CITY CONTRACT NO. 929
Item
Description
Unit
Estimated
Quantiles
Unit Price
Total Amount
1
Upgrade to Instrumentation and Controls
LS
1.0
$g73,15-0. 00
$ S 7`3 150,D0
�
TOTAL BID
$ g 73, 15c> ,
2. It is understood that the quantities set forth are approximate only and subject to variation and that the
unit bid price for the work done shall govern in the actual payment to Contractor.
3. In submitting this bid, the bidder understands that the right is reserved by the City of Waterloo, Iowa,
to reject any or all bids. If written notice of the acceptance of this bid is mailed, telegraphed, or
delivered to the undersigned within thirty (30) days after the opening thereof, or 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before this bid is withdrawn, the undersigned agrees to execute and deliver an agreement in the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 bond and certificate of the insurance within ten (10) days
after the agreement is presented to him for signature, and start work within ten (10) days after
"Notice to Proceed" is issued. /J� t /
4. Security in the sum of � tib rr e., n(d Dollars ($ 34 7.57) in the
form of b A j ( , is submitted herewith in accordance with the INSTRUCTIONS
TO BIDDERS.
5. Attached hereto is a Non -Collusion Affidavit of Prime Contractor.
FORM OF BID
AECOM 60438627
CONTRACT NO. 929 BF -1 OF 2
6. Atta9hed hereto is a Resident Bidder Certification ( ) or Non -Resident Bidder Certification
( A ). (Mark one.)
7. The bidder is prepared to submit a financial and experience statement upon request.
8. 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
EOC, within ten (10) days of notification that the bid submitted is lowest and acceptable.
9. The bidder has received the followinggqAddendum or Addenda:
Addendum No, 1- Date e / %
10. The bidder shall list the MBE/WBE subcontractor(s), amount of subcontracts and bid items on the
City of Waterloo Minority and/or Women Business Pre-bid Contact Information Form submitted with
this Form of Bid or Proposal. 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 Contractor shall submit information on subcontractors on "SUBCONTRACTOR REQUEST AND
APPROVAL" Form to be provided by City prior to approval of contract.
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.
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 alternates, delete line items, and/or to reduce quantities
prior to the award of a contract due to budgetary limitations.
BY:
)eCYIe' Cry I� isS o
��i►'��.(-7/- 41/a9// ! l7
(Name idder) at )
Title / /L'S> de, -7
O3fidial Address: (Includingip Code):
236/ .2 c5-. S Ftiejv� N D 5Y-103
I.R.S. No. LI
FORM OF BID
AECOM 60438627
* * * END OF SECTION * * *
CONTRACT NO. 929 BF -2 OF 2
State of
NON -COLLUSION AFFIDAVIT OF PRIME BIDDER
County of
, being first duly sworn, deposes and says that:
1. He is (Owner, Partner, Officer, Representative, or Agent) , of e.1 A,/101,5
, 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 i�restrincluding thi affiant.
(Signed)
f Title
-r4
Subscribed
-
Subscribed and sworn to before me this day of (0‘k -S , 20 t1
My commission expires as a0 $
Title
1
1
ROCK MESSERSCHMIDT
Notary Public
State of North Dakota
My Commission ExpiresAprit•25, 2018
• w - : w - . - A ••••
NON -COLLUSION CONTRACT NO. 929 NCA -1 OF 2
AECOM 60438627
CONTRACT NO.:
NON-RESIDENT BIDDER CERTIFICATION
9-) Gl
PROJECT NAME: FY9-01(; wit r' 4'66/'
DATE OF LETTING: 3//0 17
C,4 114,14.0////'P5 dr9/'t le YO `/ 51ai r4 tr, /a/1 J l o n 4/ Sf/S,lfmys
I hereby certify that I am an Iowa non-resident bidder.
COMPANY NAME: &.Je•er`ry CGS rye )S COr+,/%7iy
CORPORATE OFFICER: T96°_et . St) cC h ems,/
TITLE: �/'�/S, er? /
DATE: 1 ( 17 f/ /
STATE/COUNT Y OF RESIDENCY: Alf., --/4 AL 74
Stated below are the preference(s) to resident bidders in the state/country of /t'c;,/A a L A
(Preference to bidders, labor force, or other preferential treatment to bidders or laborers, etc.
/Vk4-e-
RESIDENT BIDDER
AECOM 60438627
CONTRACT NO. 929 RB -3 OF 3
Mayor
QUENTIN M.
HART
COUNCIL
MEMBERS
TOM
POWERS
Ward /
BRUCE
JACOBS
Gr'ard 2
PATRICK
MORRISSEY
Ward 3
JEROME
AMOS, JR.
Ward 4
RON
WELPER
Ward 5
TOM
LIND
At -Large
STEVEN
SCHMITT
At -Large
SALES TAX EXEMPTION
AECOM 60438627
CITY OF WATERLOO, IOWA
WATERLOO ENGINEERING DEPARTMENT
715 Mulberry St. • Waterloo, IA 50703 • (319) 291-4312 Fax (319) 291-4262
ERIC THORSON, P.E. • City Engineer
INFORMATION NEEDED
FOR
IOWA CONSTRUCTION SALES TAX EXEMPTION CERTIFICATE
CONTRACTOR NAME:
)e erey adro S ro mevy
ADDRESS: 3L( (.8' b (57/• �' . rG rjo ND sVo3
(Check One) PRIME: \ SUBCONTRACTOR:
FEDERAL ID#: � ' C� � f � 2 (r
PROJECT NAME: tY xi&w,l r elluv -;��' „ (nn'ri)I aiC l l l �r��S G,2r e
77>zns i�dn� �c )f),)/ 5y5k'7?5
PROJECT CONTRACT NO.:
DESCRIPTION OF WORK:
O Brickwork 0 Landscaping
O Carpentry 0 Painting
❑ Concrete 0 Paving
O Drywall -Plaster -Insulation 0 Plumbing
J( Electrical 0 Roofing -Siding -Sheet Metal
O Excavation/Grading 0 Windows
O Flooring 0 Wrecking -Demolition
O Heavy Construction 0 Other (Please Specify)
O Heating -Ventilating -Air Cond. 0
WE'RE WORKING FOR YOU!
An Equal Opportunity/Affirmative Action Employer
CONTRACT NO. 929 Page STE-1 OF 1
Attachment 1
SRF Required Front -End Specifications
(This form must be completed and signed by Prime Contractor and
submitted with the bid.)
U.S. Environmental Protection Agency
Certification of Non -Segregated Facilities
(Applicable to contracts, subcontracts, and agreements with applicants who are themselves
performing Federally assisted construction contracts, exceeding $10,000 which are not exempt
from the provisions of the Equal Opportunity clause.)
By the submission of this bid, the bidder, offeror, applicant, or subcontractor certifies that
he does not maintain or provide for his employees any segregated facilities at any of his
establishments, and that he does not permit his employees to perform their services at any
location, under his control, where segregated facilities are maintained. He certifies further that
he will not maintain or provide for his employees any segregated facilities at any of his
establishments, and that he will not permit his employees to perform their services at any
location, under his control, where segregated facilities are maintained. The bidder, offeror,
applicant, or subcontractor agrees that a breach of this certification is a violation of the Equal
Opportunity clause in this contract. As used in this certification, the term "segregated facilities"
means any waiting rooms, work areas, restrooms and washrooms, restaurants and other eating
areas, time clocks, locker rooms and other storage or dressing areas, parking lots, drinking
fountains, recreation or entertainment areas, transportation, and housing facilities provided for
employees which are segregated by explicit directive or are in fact segregated on the basis of
race, creed, color, or national original, because of habit, local custom, or otherwise. He further
agrees that (except where he has obtained identical certifications from proposed subcontractors
for specific time periods) he will obtain identical certifications from proposed subcontractors prior
to the award of subcontracts exceeding $10,000 which are not exempt from the provisions of
the Equal Opportunity clause; that he will retain such certifications in his files; and that he will
forward the following notice to such proposed subcontractors (except where the proposed
subcontractors have submitted identical certifications for specific time periods):
NOTICE TO PROSPECTIVE SUBCONTRACTORS OF REQUIREMENT FOR
CERTIFICATIONS OF NON -SEGREGATED FACILITIES
A Certification of Non -segregated Facilities, as required by the May 9, 1967, order (33
F.R. 7808, May 28, 1968) on Elimination of Segregated Facilities, by the Secretary of Labor,
must be submitted prior to the award of a subcontract exceeding $10,000 which is not exempt
from the provisions of the Equal Opportunity clause. The certification may be submitted either
for each subcontract or for all subcontracts during a period (i.e., quarterly, semiannually, or
annually).
` - l
Signatyx Date
J6seph Sweeney — President
Name and Title of Signer (Please Type)
NOTE: The penalty for making false statements in offers is prescribed in 18 U.S.C. 1001.
EPA -7 5720-4.2
May 2015
Attachment 2
SRF Required Front -End Specifications
(This form must be completed and signed by the Prime Contractor and
submitted with the bid.)
Debarments and Suspensions
Any bidder or equipment supplier whose firm or affiliate is listed in on the U.S. General Services
Administration Excluded Parties List System web site at http://www.epls.gov/ will be prohibited
from the bidding process. Anyone submitting a bid who is listed on this web site will be
determined to be a non-responsive bidder in accordance with 40 CFR Part 31.
United States Environmental Protection Agency Washington, DC 20460
Certification Regarding Debarment, Suspension, and
Other Responsibility Matters
The prospective participant certifies to the best of its knowledge and belief that it and the
principals:
(a) Are not presently debarred, suspended, proposed for debarment, declared ineligible,
or voluntarily excluded from covered transactions by any Federal department or
agency;
(b) Have not within a three year period preceding this proposal been convicted of or had a
civil judgment rendered against them for commission o f fraud or a criminal offense in
connection with obtaining, attempting to obtain, or performing a public (Federal, State,
or local) transaction or contract under a public transaction: violation of Federal or
State antitrust statutes or commission of embezzlement, theft, forgery, bribery,
falsification or destruction of records, making false statements, or receiving stolen
property;
(c) Are not presently indicted for otherwise criminally or civilly charged by a government
entity (Federal, State, or local) with commission of any of the offenses enumerated in
paragraph (1) (b) of this certification; and
(d) Have not within a three-year period preceding this application/proposal had one or
more public transaction s (Federal, State, or local) terminated or cause or default.
understand that a false statement on this certification may be ground for rejection of this
proposal or termination of the award. In addition, under 18 U SC Sec. 10 01, a false statement
ma y result in a fine of up to $10,000 or imprisonment for up to 5 years, or both.
Joseph Sweeney — President
Typed Name & Title of Authorized Representative
Signature + Authorized Representative
Date
❑ I am unable to certify to the above statements. My explanation is attached.
EPA Form 5700-49 (11-88)
May 2015
Attachment 3
SRF Required Front -End Specifications
(This form must be completed and signed by Prime Contractor and
submitted with the bid.)
Disadvantaged Business Enterprise (DBE) Solicitation
It is EPA's policy that recipients of EPA financial assistance through the State Revolving Fund
programs award a "fair share" of subagreements to small, minority and women -owned
businesses, collectively know as Disadvantaged Business Enterprises (DBEs). Iowa's Fair
Share goals are:
Only work performed by certified DBEs can be counted toward the goals. In Iowa, DBEs must
be certified through the Iowa Department of Transportation (IDOT). Information on certification
requirements and a list of certified DBEs is on the IDOT website at
http://www.iowadot.gov/contracts/contracts eeoaa. htm.
Prime contractors' DBE requirements for SRF projects include:
• Taking affirmative steps for DBE participation
• Documenting the efforts and the proposed utilization of certified DBEs
PROJECT INFORMATION
SRF Applicant:
Minority -Owned Business
Enterprise (MBE) Goal
Women -Owned Business
Enterprise (WBE) Goal
Construction
1.7%
2.2%
Supplies
0.6%
5.6%
Services
2.5%
11.3%
Goods/Equipment
2.5%
10.4%
Average
1.8%
7.4%
Only work performed by certified DBEs can be counted toward the goals. In Iowa, DBEs must
be certified through the Iowa Department of Transportation (IDOT). Information on certification
requirements and a list of certified DBEs is on the IDOT website at
http://www.iowadot.gov/contracts/contracts eeoaa. htm.
Prime contractors' DBE requirements for SRF projects include:
• Taking affirmative steps for DBE participation
• Documenting the efforts and the proposed utilization of certified DBEs
PROJECT INFORMATION
SRF Applicant:
City of Waterloo
Bidder:
Sweeney Controls Company
Address:
234 28th Str S Fargo, ND 58103
Contact Person:
Joseph Sweeney
Signature:
Phone Number:
701-232-3644
E -Mail Address:
jsweeney@sweeneycontrols.com
Check if Prime Contractor
is: •
Minority -Owned ❑ Women -Owned
May 2015
MBE/WBE BUSINESS ENTERPRISE
C f / PRE-BID CO TACT,JN ORMATION FORM l •
Prime Contractor Name: Jc. €i-c7Cmi'o/ Lori/ Project: /, /, .4 /�viru.�u CaL.e`ting Date: F(70//7
NO MBE/WBE SUBCONTRACTORS: If you are NOT using any MBE/WBE subcontractors to complete this project, sign below. Attach a brief explanation as to
why subcontracting was not fea ' o - ith this project. If any M/WBE subcontractors will be used, please use the bottom portion of this form.
Contractor Signature:
Title:
pE
5 �.. Date: 1— 17
SUBCONTRACTO - APPLICABLE: You are required, in order for your bid to be considered responsive, to provide the information on this form showing ALL of
your MBE/WBE subcontractor contacts made for your bid submission. This information is subject to verification. Any questions should be directed to Contract
Compliance Office 319-291-4429.
You are required, in order for your bid to be considered responsive, to provide the information on this Form showing your MBE/WBE Business Enterprise contacts
made prior to your bid submission. This information is subject to verifications and confirmation.
If you are unable to identify MBENVBE firms to perform portions of the work, please contact Louis Starks, Contract Compliance Officer, for assistance at (319) 291-
4429.
In the event it is determined that the MBENVBE Business Enterprise goals are not met, then before awarding the contract the City of Waterloo will make a
determination as to whether or not the apparent successful low bidder made good faith efforts to meet the goals.
TABLE OF INFORMATION SHOWING BIDDER'S PRE-BID
MBE/WBE BUSINESS ENTERPRISE CONTACTS
Quotes Received Quotation Used in Bid
MBE/WBE
Subcontractors
Dates
Contacted
Yes
Dates
Contacted
Yes/No
Dollar Amount Proposed to
be Subcontracted
Cr r CG/r,c crj-e
Oh ?
(16)
0/7
it ,. ( -C .e C 0ii
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s&/-4.,44 2k d7, ,- t'N.or"r~ 1_,,.',favcictiecKl-
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' gC r=lectr,.,/r /ixe kr_5
'Y -Con -I- rce ' n— Isen
(Form CCO-4) Rev. 06-20-02
MBE/WBE PARTICIPATION
AECOM 60438627
CONTRACT NO. 929
M-6 OF 6
BID BOND
KNOW ALL MEN BY THESE PRESENTS, that we Sweeney Controls Company, 234 28th St. SW, Fargo, ND
as Principal, and Great American Insurance Company, 301 E 4th St., Cincinnati, OH 45202
as Surety are held and firmly bound unto the CITY OF WATERLOO Iowa,
hereinafter called
"OWNER." In the penal sum Five Percent of the Bid
Dollars ($ 5% ) lawful money of the United States, for the payment of which
sum will and truly be made, we bind ourselves, our heirs, executors, administrators, and successors,
jointly and severally, firmly by these presents. The condition of this obligation is such that whereas the
Principal has submitted the accompanying bid dated the 10th day of August 2017
for FY 2016 Wter Pollution Control Facilities Upgrade to Instrumentation and Control Systems
City Contract No, 929
NOW, THEREFORE,
(a) If said Bid shall be rejected, or in the alternate,
(b) If said Bid shall be accepted and the Principal shall execute and deliver a contract in the form
specified and shall furnish a bond for his faithful performance of said contract, and for the payment of all
persons performing labor or furnishing materials in connection therewith, and shall in all other respects
perform the agreement created by the acceptance of said Bid,
Then this obligation shall be void, otherwise the same shall remain in force and effect; it being expressly
understood and agreed that the liability of the Surety for any and all claims hereunder shall, in no event,
exceed the penal amount of this obligation as herein stated.
By virtue of statutory authority, the full amount of this bid bond shall be forfeited to the Owner in
liquidation of damages sustained in the event that the Principal fails to execute the contract and provide
the bond as provided in the specifications or by law.
The Surety, for value received, hereby stipulates and agrees that the obligations of said Surety and its
bond shall be in no way impaired or affected by any extension of the time within which the Owner may
accept such Bid or execute such contract; and said Surety does hereby waive notice of any such
extension.
IN WITNESS WHEREOF, the Principal and the Surety, have hereunto set their hands and seals, and
such of them as are corporations, have caused their corporate seals to be hereto affixed and these pres-
ents to be signed by their proper officers this 7th day of August A.D. 20 17
BID BOND
AECOM 6;0438627
Sweeney Controls Company
Principal
B
Y
Joseph eeney, President (Title)
(Seal)
Great American Insurance Company
Surety
By
(Seal)
CONTRACT NO. 929
Attorney-in-fact Wayne L. Lauwers
BB -1 OF 1
ACKNOWLEDGMENT OF PRINCIPAL (CORPORATION)
State of North Dakota )
County of Cass
On this day of August 2017, before me personally appeared
Joseph Sweeney known to be the President of the corporation that is
described in and that he or she executed the within instrument, and acknowledged to me that such
corporation executed the same.
JILL GRAVELINE
NotaryPublic
State of North Dakota
My Commission Expires Jan. 28, 2019
igic) elm Ve2/17-a
ACKNOWLEDGMENT OF PRINCIPAL (INDIVIDUAL OR PARTNERSHIP)
State of
County of
On this day of 2017, before me personally
Appeared known to be the person described in and who
executed the within instrument, and acknowledged to me that he/she executed the same.
ACKNOWLEDGMENT OF SURETY
State of North Dakota )
County of Cass )
On this 7th day of August 2017, before me personally
appeared Wayne L. Lauwers known to be the person who is described in
and whose name is subscribed to the within instrument as Attorney in Fact of
Great American Insurance Company and acknowledged to me that he or she
subscribed the name of Great American Insurance Company thereto as surety and
his or her own name as Attorney in Fact.
' 'JILL'GRAVELINE
Notary Public
Slate of North Dakota
Commission Ex Ires Jan. 28, 2019
40.
GREAT AMERICAN INSURANCE COMPANY®
Administrative Office: 301 E 4TH STREET • CINCINNATI, OHIO 45202 • 513-369-5000 • FAX 513-723-2740
The number of persons authorized by
this power of attorney is not more than SIX
No.0 15036
POWER OF ATTORNEY
KNOW ALL MEN BY THESE PRESENTS: That the GREAT AMERICAN INSURANCE COMPANY, a corporation organized and existing under
and by virtue of the laws of the State of Ohio, does hereby nominate, constitute and appoint the person or persons named below, each individually if more than
one is named, its true and lawful attorney-in-fact, for it and in its name, place and stead to execute on behalf of the said Company, as surety, any and all bonds,
undertakings and contracts of suretyship, or other written obligations in the nature thereof; provided that the liability of the said Company on any such bond,
undertaking or contract of suretyship executed under this authority shall not exceed the limit stated below.
Name Address Limit of Power
WAYNE L. LAUWERS REBECCA J. HECKER ALL OF ALL
THOMAS C. DAWSON BRIDGET HELM FARGO, $100,000,000.00
DANIEL M. AMBRUST MATT EDLUND NORTH DAKOTA
This Power of Attorney revokes all previous powers issued on behalf of the attorney(s)-in-fact named above.
IN WITNESS WHEREOF the GREAT AMERICAN INSURANCE COMPANY has caused these presents to be signed and attested by its appropriate
officers and its corporate seal hereunto affixed this 8TH day of JULY 2015 .
Attest - GREAT AMERICAN INSURANCE COMPANY
Assistant Secretary Divisional Senior Vice President
STATE OF OHIO, COUNTY OF HAMILTON - ss: DAVID C. KITCHIN (877-377-2405)
On this 8TH day of JULY , 2015 , before me personally appeared DAVID C. KITCHIN, to me
known, being duly sworn, deposes and says that he resides in Cincinnati, Ohio, that he is a Divisional Senior Vice President of the Bond Division of Great
American Insurance Company, the Company described in and which executed the above instrument; that he knows the seal of the said Company; that the seal
affixed to the said instrument is such corporate seal; that it was so affixed by authority of his office under the By -Laws of said Company, and that he signed his
name thereto by like authority.
Susan k Kohorst
Notary RtiA SbM of Ohio
My Comlllukn Wes 0644020
ci4,94,,y
This Power of Attorney is granted by authority of the following resolutions adopted by the Board of Directors. of Great American Insurance Company
by unanimous written consent dated June 9, 2008.
RESOLVED: That the Divisional President, the several Divisional Senior Vice Presidents, Divisional Vice Presidents and Divisonal Assistant Vice
Presidents, or any one of them, be and hereby is authorized, from lime 10 tine, to appoint one or more Attorneys -in -Fact to execute on behalf of the Company,
as surety, any and all bonds, undertakings and contracts ofsuretyship, or other written obligations in the nature thereof, to prescribe their respective duties and
the respective limits of their authority; and to revoke any such appointment at any time.
RESOLVED FURTHER: That the Company seal and the signature of any of the aforesaid officers and any Secrelai y or Assistant Secretary of the
Company may be affixed by facsimile to any power of attorney or certificate of either given for the execution of any bond, undertaking, contract of suretyship,
or other written obligation in the nature thereof such signature and seal when so used being hereby adopted by the Company as the original signature of such
officer and the original seal of the Company, to be valid and binding upon the Company with the same force and effect as though manually affixed.
CERTIFICATION
I, STEPHEN C. BERAHA, Assistant Secretary of Great American Insurance Company, do hereby certify that the foregoing Power of Attorney and
the Resolutions of the Board of Directors ofJune 9, 2008 have not been revoked and are now in full force and effect.
Signed and sealed this
81029AF (06/15)
day of
2oi7 .
%mac.
Assistant Secrelaiy
3�