HomeMy WebLinkAboutVieth ConstructionVieth Construction
Corporation
6419 Nordic Dr.
Cedar Falls, IA 50613
5eal-0 (3,-A 6e.)41, .ce)(-
Y 1)-4,v2 wa-k-er 166. 066:4-hc\A,5e__
Vieth Construction
Corporation
6419 Nordic Dr.
Cedar Falb, IA 50613
S�alcc9. g ;`X -re)
`)o►e o(o-A.( loo cocorho:...ce
G o n' {„i4 fro. ? L
FORM OF BID OR PROPOSAL
F.Y. 2018 WATERLOO BOATHOUSE ENHANCEMENTS
CONTRACT NO. 940
CITY OF WATERLOO, IOWA
Honorable Mayor and City Council
Waterloo, Iowa
Gentlemen:
1.The undersigned, being a Corporation existing under the laws of the State of
. 0 w , a Partnership consisting of the following partners:
, 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 Wayne Claassen Engineering &
Surveying, Inc. 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 F.Y. 2018 WATERLOO BOATHOUSE
ENHANCEMENTS, Contract No. 940, all in accordance with the above -listed
documents and for the unit prices for work in place for the following items and quantities:
BASE BID
BID
ITEM
DESCRIPTION
BASE BID
UNIT
EST. QTY.
UNIT BID
PRICE
TOTAL BID PRICE
001
MOBILIZATION
L.S.
1
$ 3t:.(660
$ -3‘,6,
002
TOPSOIL STRIP, SALVAGE, STOCKPILE AND
RESPREAD
C.Y.
587
$ / /�
`7'
(;
$ L 1 -i L7
003
CLASS 10 EXCAVATION
C.Y.
2,797
$ / 7
$ 3'71158
004
TOPSOIL, FURNISH, SPREAD, IN-PLACE
C.Y.
100
$ -) L:
$ 3, 6 Co
005
REVETMENT, CLASS "E" RIP -RAP
TON
950
$ ') 1
$ 3 1 (9 c
006
GEOSYNTHETIC
S.Y.
7,731
$ ` ' ' L,
$ 19/ 3D7.50
007
SEED, FERTILIZE AND MULCH (IDOT RURAL MIX)
ACRES
0.92
$ f iJ i("'
$ -f 5 Ci
008
SILT FENCE (EROSION CONTROL FENCING)
L.F.
530
$ n ' U
$ +, '3')
FORM OF BID
CONTRACT NO. 940
Page 1 of 6
BID • DESCRIPTION=
ITEM BASE SID
•
.UNIT
EST: QTX:
UNIT BID
PRICE
TOTAL•RID PRICE
009 STRAW FILLED WATTLE, ".DI _ L.F.
WOOD EXCELSIOR MAT FOR SLOPE PROTECTION
010 (EC -103} .... SQUARES
011 TRAFFIC CONTROL.
012 SWPPP COMPLIANCE
::013
MAINTENANCE BOND, 2 -YEAR
1.01
L.S.
REMOVALS, STORM SEWER CULVERTS
L.S.
L.F.
7� o
102 REMOVALS, ELECTRIC POLES
103
REMOVALS TREES
.104_ REMOVALS, TREE STUMPS
DOCK NO. 1 (TIMBER WALL AND DOCK NEAR
105 BOAT .HOUSE, .COMPLETE) L.S.
DOCK NO. 2 (STEEL WOOD, AND CONCRETE
106. STRUCTURE;NEAR:BOAT RAMP, COMPLETE) ... •.._L,S...
DOCK NO.3 (WOOD STRUCTURE ADJOINING
1.07 BOAT RAMP,!COMPLETE L.S.
EACH
EACH
EACH
ao
280 $ („
6 45.
108 REMOVALS, P.C.:. CONCRETE SLOPE PROTECTION S.Y,
1.09. REMOVAL$GUARDAIj. AND POSTS L.F.
L.S.
110 REMOVALS MISC.
SUBDRAIN, 6" DIA., IN POROUS BACKFILL,
201 COMPLETE. _
202
30" DIA. INFILTRATION AUGER HOLE, 10' DRILL
DEPTH ...:
L.F.
$ 141 `4C7
$5Sc
1$ `t` c5 0 $ F S v
3
$
ygG� gds
458$ ...,;I.o.. $ �:5[)..,,.
130$
$ 5a
204$ 6
EACH ........ _. 18 $
2Q3...1,5":.:..CLEAN STONE .._ TONS
S.Y.
S.Y.
SUBBASE, MODIFIED, 12" COMPACTED
301 THICKNESS (UNDER HMA PAVING:. -:
PAVEMENT, HMA, 3,000,000 ESAL, BASE COURSE,
302 %": MIX, .3"THICK
._
PAVEMENT, HMA 3,000,000 ESAL, INTERMEDIATE
303:. CQURSEL'/" MIX, 1.5" THICK
PAVEMENT, HMA 3,000,000 ESAL SURFACE
304 COURSE, Y2" MIX, 1.5" THICK
306
306.
S Y..
60 $ 5(4
50
7,731 $ I:
75
7161 $: 1 -?5
7,161
S.Y, :. 716:1$:
CURB AND GUTTER, P.C. CONCRETE, 7" THICK,
24! WIDE, !DOT. CLASS C-4..
SUBBASE, MODIFIED, 4" COMPACTED THICKNESS
(UNDER RECREATIONAL: TRAIL)'
LE,
S,Y..
806
$
1,,007 $
$_1:.6I `76
5. A35
FORM OF BID
Addendum No 1
CONTRACT NO. 940 Page 2 of 6
BID
ITEM
DESCRIPTION
BASE BID
RECREATIONAL TRAIL, PAVEMENT, PC
307. CONCRETE, 5 -INCH THICK, )DOT CLASS 0-4 SY.
UNIT
SUBBASE, MODIFIED, 4" COMPACTED THICKNESS
308 (UNDER SIDEWALKj..... ... S.Y.
SIDEWALK, PAVEMENT, PC CONCRETE, 5 -INCH
309 THICK I00T CLASS C4.....:....
S.Y.
EST. QTY.
8'X3 PC CONCRETE LANDING, COMPLETE AS
310 PER PLAN
401 BOLLARDS COMPj..ETE
402 ELECTRICAL AND LIGHTING, COMPLETE
403. SIO .NAGE,: COMPLETE
L.S.
EACH
L.S,.
915
UNIT BID
PRICE
TOTAL BID PRICE
350 $ 4 $ .l.
290 $
$ ! " $ y900
8
1
LS. 1
404 PAVEMENT MARKINGS, COMPLETE ..... L.S.
STEEL SEAM GUARDRAIL END TERMINAL, BA -205,:
405 COMPLETE.
EACH
406 Guardrall, Steel 'W' Beam, Poets and
406 Gonnectera, Corti la#e L.F.
y
$")-.,7 $ a ...p...
1 $ r U
2 $ 5,' .)
PAVEMENT REMOVAL ON RIVERSIDE OF BOAT
500 HOJSE S.Y.
501.4" CONCRETE PAD FOR .BIKE RACKS
L.6" CONCRETE PATIO WITH INTEGRAL GRADE
502: BEAM
POURED -IN-PLACE INTEGRAL COLORED
503 CONCRETE, GRAY IN:C.OLOR
.,.45 ; 1.4 $ 055.,
S.Y. 7 3
C.Y..
45
S.F.
POURED -IN-PLACE INTEGRAL COLORED
504 CONCRETE, TAN IN COLOR S.F.
505
506
120
4 -SEAT PLEXUS BENCH, AS PER PLAN ... EACH
SCARBOROUGH TRASH RECEPTACLE, AS PER
PLAN • EACH
400
507 BIKE RACK, AS PER PLAN
508 SWAMP WHITE OAK (2" CAL.. B&B);: EACH
509 BALD CYPRESS (2'.' CAL. B&B) __ , EACH
15v t5
$5o
$ )9. $ .31486.
1 $ 46
2$ �•5.0(�
2 $' r): •O.�S
EACH ' ....- $ $ S &
3
...................
510 IARDWOQ0 MULCH FOR TREE PLANTINGS 1_5
.511 TOf SOIL AMENDMENT FOR TREE PLANTINGS C Y g '
TOTAL, BASE BID
X56. ol'g
FORM OF BID
Addendum No 1
CONTRACT NO. 940 Page 3 of 6
ALTERNATE 'A' BID
BID
ITEM
DESCRIPTION
BASE BID
UNIT
EST. QTY.
UNIT BID
PRICE
TOTAL BID PRICE
A-003.
CLASS 10 EXCAVATION-ENTRANCE ROAD
C.Y.
310
$ 15
$ (II i 5v
A-111.
ASPHALTIC CEMENT CONCRETE PAVEMENT
REMOVAL-ENTRANCE ROAD
S.Y.
1,176
$
r
$ I( G ) Ck .
A-301.
SUBBASE, MODIFIED, 6" COMPACTED
THICKNESS, (UNDER HMA)-ENTRANCE ROAD
S.Y.
1,395
$ 4. 5 O
$ cti n4-7. 4 56
A-302.
PAVEMENT, HMA, 3,000,000 ESAL,
% MIX, 3" THICK-ENTRANCE ROAD BASE COURSE,
S.Y,
1,176
$ (LI, 76
$ f if 74i-4
A-303.
PAVEMENT, HMA, 3,000,000 ESAL, INTERMEDIATE
COURSE, 1/2" MIX, 1.5" THICK-ENTRANCE ROAD
S.Y.
1,176
$ ? 7 _)
$ c? (/ 4-
A-304.
PAVEMENT, HMA, 3,000,000 ESAL, SURFACE1
COURSE, 1/2" MIX, 1.5" THICK-ENTRANCE ROAD
S.Y.
1,176
$ ./
$ re), :2 (v
TOTAL ALTERNATE 'A' BID $ > 1 C 11 . 5 v
I
TOTAL BASE BID + ALTERNATE 'A' BID $ 7 (13, 815 , 5 U
ALTERNATE 'B' BID
BID
ITEM
DESCRIPTION
BASE BID
UNIT
EST. QTY.
UNIT BID
PRICE
TOTAL BID PRICE
B-402.
ELECTRICAL AND LIGHTING, COMPLETE
L.S.
1
/
$ r5., G L, L.
$ 9., d t)
TOTAL ALTERNATE `B' BID
$ 951 a6 L)
TOTAL BASE BID + ALTERNATE 'A' BID ÷
ALTERNATE 'B' BID
$ g_.,g'.73 . .;0
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.
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
FORM OF BID
CONTRACT NO. 940 Page 4 of 6
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.
4. Security in the sum of 5 616
Dollars($ )inthe form ofnnC�
is submitted herewith in accordance with the INSTRUCTIONS TO BIDDERS.
5. Attached hereto is a Non -Collusion Affidavit of Prime Contractor.
6. Attached hereto is a Resident Bidder Certification ( 1 ), or Non -Resident
Bidder Certification ( ). (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 following Addendum or Addenda:
Addendum No. Date 94 //i
9//¢/! 7
3 9119/17
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.
FORM OF BID
CONTRACT NO. 940 Page 5 of 6
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.
Vieth Construction
Corporation
6419 Nordic Dr.
Cedar Falls, IA 50613
9/7///7
(Name of Bidder) (Date)
BY: .�i,�G� Title 57:.M.44-0 /
Official Address: (Including Zip Code):
Vieth Construction
Corporation
6419 Nordic Dr.
Cedar Falls, IA 50613
I.R.S. No.
FORM OF BID
CONTRACT NO. 940 Page 6 of 6
KARI LYNN JANSEN!
COMMISSION NO.777490
MY COMMISSION EXPIRES
MARCH 15, 2019
NON -COLLUSION AFFIDAVIT OF PRIME BIDDER
State of rsw )
nn )ss
County of 17; i .. Wow kc )
/c, G,ieb e / being first duly sworn, deposes and says that:
1. He is (Owner, Partner, Officer, Rcol, or Agent) of I) ;e4h
con 5-r . G o ( p the Bidder that has sttfed 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.
(Signed)
Subscribed and sworn to before me this
, 2017.
My commission expires
31151 161
Title
al
day of
o IL)
Title
l!J p
Z
a
0
W Q
W i
�
O
W Z
NCO I—
Z
Wco 0
0
m c
Llj
O
.fid L
V Q Q
co--
= o°�
UZ1.
- Cr) LL
co -0
0
0
`C6 U 03 O
0
0
0)
m
J
U
a)
O
a_
Prime Contractor Name:
o uJ
00
m1
Co
4--
U
C]01
'o
>, F�
Q. (�
C \'
O t
H a),
O �
Z'(7
4c
>,
_> of
coco
ce
O 0
U LP
r O
h U
z.0
O
U -c
m �
O O
wo4-
a] (15
c L
O4
O
co 2
O o 0
a)
H
Contractor Signature:
E
C
U o
LE-
C N
O
c
o o
�Q
E c
O
- U
a)4
>
O b U
O
Lb -
a>
o
a o
C O
Q
0)
OL
O
C
N•
Q u)
C
O o
a) 'U
of
L 'O
O
O
T
Q) O d)
P.
0 -0 .3i.
C
• E rn
-O N
U 0)
5 (�
CCr'
Q) OU O
a)
CZ
`a ° O
O U
>- C c
�• o .0
mhE
U m
a.
QmU
E L O
U 4- 5
Q J 0
fy J a
Z Q a)
O o.0
U •c
mo 0
o
co
a)
C L
4-
m L
W 0
coO
a)
m c
L Q
>> o
0) U
C
O O E
(Cl
(0EUo
E c vi
U- O
(75
C
O C O
C O J
O
U w
E
L L
O >
•C O 0
_cU as
o
> L
c
C
O O 0
E O
(n O u)
c`1- c
o .E 0
0_ •L
N a-
13
c -
2 o
-0a) 'co
0
cEQ-
O f O
0
O U 0)
.0 -O t
O.o4
=m
L
D iWM
> L W
2 N
O fl_
0 0
cc) a) r--
0
.5 u) Orn
U
O (3 a)
n CO
- 0 C (6
CI) o(1)
N U
La -5
a) a
c� L
a) 0
0 C >'
>' W `� (6
O
O
a)
O
U
a)
.0
6
c
0 0)
N
E
Ci
co L 0
O O
,o N
N Z
O - W
C 0 0
W
O CC1 (n
O) r„
E0 V CL
o E Z �1
a) L uJ
-a
OO E--
Tao
4) 5 .- W
Q. Z
0 m (J)
C
u) 0 m
o c U W
.5 Z
CO 0.. LL
me ow
M
m W W
ulO CO
co
'(f) 1-
O L
m
tea)
a) O
E c a
c
mo
-o 0
C
+• a)
C N
>
a) ca
a)
� O
c E
Quotes Received Quotation used in bid
Dollar Amount Proposed to
be Subcontracted
J
Yes/No
Dates
Contacted
Dates
Contacted
n
MBE/WBE
Subcontractors
)
L..\'
U
V.
(Form CCO-4) Rev. 06-20-02
CONTRACT NO:
PROJECT NAME:
DATE OF LETTING:
RESIDENT BIDDER CERTIFICATION
Wale( 163( gl>)9 6oct-l- ho(44•ei.
To be a qualified resident bidder, the bidder shall be a person or
entity authorized to transact business in this state and having a
business for at least three years prior to the date of the first
advertisement for the public improvement. If another state or
foreign country has a more stringent definition of a resident bidder,
the more stringent definition is applicable as to bidders from that
state or foreign country.
This qualification as resident bidder shall be maintained by the contractor and his
subcontractors at the work site until this project is completed.
I hereby certify that I am a resident bidder as d rsiliao
l eevefiStrUCtiOn
Corporation
6419 Nordic Dr.
Cedar Falls, IA 50613
COMPANY NAME
CORPORATE OFFICER
TITLE
DATE
BID BOND
KNOW ALL MEN BY THESE PRESENTS, that we, Vieth Construction Corporation
as Principal, and North American Specialty Insurance Company
as Surety are held and firmly bound unto the CITY OF WATERLOO , Iowa, hereinafter called
"OWNER," in the penal sun-) ---Five Percent of the Bid Submitted --
Dollars ($ _ ---5%--- ) lawful money of the United States, for the payment
of which sunt 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 21st day of September
2017_, for F.Y. 2018 Waterloo Boathouse Enhancements, Waterloo, IA; Contract No. 940
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 anti 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, othervnse 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 (Welted 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 taw,
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 seats, and such
of them as are corporations, have caused their corporate seals to be hereto affixed and these presents to be
signed by their proper officers this llth day of September , A.D. 2017 ,
Vieth Construction Corporation
Principal
,fes
By
North Amepecialty Insurance Company (Seal)
. r:re
,t,
`�Att►
(Seal)
(Title)
SWISS RE CORPORATE SOLUTIONS
NORTH AMERICAN SPECIALTY INSURANCE COMPANY
WASHINGTON INTERNATIONAL INSURANCE COMPANY
WESTPORT INSURANCE CORPORATION
GENERAL POWER OF ATTORNEY
KNOW ALL MEN BY THESE PRESENTS, 'I l -IAT North American Specialty Insurance Company, a corporation duly organized and existing under
laws of the State of New Hampshire, and having its principal office in the City of Overland Park, Kansas and Washington International Insurance
Company a corporation organized and existing under the laws of the State of New Hampshire and having its principal 0fll00 in the City of Overland
Park, Kansas, and Westport Insurance Corporation, organized under the laws of the Slate of Missouri, and having its principal office in the City of
Overland Park, Kansas each does hereby make, constitute and appoint:
JAY D. FREIERMUTII, CRAIG P. HANSEN, BRIAN M. DEIMERLY, SIIIRLEY S. BARI'ENHAGEN, CINDY BENNETT, ANNE CROWNIiR,
TIM McCULLOH„ STACY VENN, DIONE R. YOUNG', and AVENDY ANN CASEY JOINTLY 00 SEVERALLY
Its true and lawful Attorney(s)-in-Fact, to make, execute, seal and deliver, for and on its behalf and as its act and deed, bonds or other writings
obligatory in the nature of a bond on behalf of each of said Companies, as surety, on warmers of suretyship as are or may be required or permitted by
lave, regulation, contraet or otherwise, provided that no bond OF undertaking or contract or suretyship executed under this authority shall exceed the
amount of: ONE HUNDRED TWENTY FIVE MILLION (5125,000,000.00) DOLLARS
This Power of Attorney is granted and is signed by facsimile under and by the authority of the following Resolutions adopted by the Boards of
Directors 0' North American Specially Insurance Company and Washington International Insul:mce Company at meetings duly called and held
on March 24, 2000 and Westport Insurance Corporation by written consent of its Executive Committee dated July 18, 201 I.
"RESOLVED, that any two of the President, any Senior Vice President, any Vice President, any Assistant Vice President,
the Secretary or any Assistant Secretary be, and each or any of them hereby is authorized to execute a Power of Attorney qualifying the attorney named
in the given Power of Attorney to execute on behalf of the Company bonds, undertakings and all contracts of surety, and that each or any of them
hereby is authorized to attest to the execution of any such Power of Attorney and to attach therein the seal of the Go,npany; and it is
FURTHER RESOLVED, that the signature of such officers and the seal of the Company may be affixed to any such I'ower 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
binding upon • the Company when so affixed and in the future with regard to any bond, nldedalong or contract of surety to which it is attached."
131' I if `CZ-- -
Sterol l`rulcesen,Sen u' Vice Presidenlnl wnslnnglnn International Incanm
& Senor Vice Presidcul of North American Specially Insurance Ct
& Senior \'ice President or \\'es11011 insurance Corporation
By / oma/
Mile A. Ile, Senior \'ire President of Washington Inlernetionnl Laurance Con:1101:y
& Senior Vice President or North America, Specialty Insurance Cnnipany
& Senior Vile President orwestport Insurance c011l1)rnln11
• tampon),
IN WITNES5 WHEREOF, North American Specialty Insurance Company, Washington International Insurance Company and Westport
Insurance Corporation have caused their official seals to be hereunto affixed, and these presents to be signed by their authorized officers this
this 17 day of August , 20 17
State of Illinois
County of Cook
On This 17 clay of
SS:
August
North American Specialty Insurance Company
Washington international Insurance Company
Westport Insurance Corporation
20 L7, before 1110, a Notary Public personally appeared Steven P. Anderson , Senior Vice President of
Washington International Insurance Company and Senior Vice President of North American Specialty Insurance Company and Senior Vice President of
Westport Insurance Corporation and Michael A. Ifo Senior Vice President of Washington International Insurance Company and Senior Vice President
of North American Specialty Insurance Company and Senior Vice PresRlenl of Westport Insurance Corporation, personally known to me, who
being by me duly sworn, acknowledged that they signed the above Power of Attorney as officers of and ack1109"ledged said instrument to be the
voluntary act and deed of their respective companies. rstt,KKKKKKK,KttKKKtw.
OFFICIAL SEAL
M KENNY " l
NOTARY PUBLIC, STATE OF ILLINOIS r M Kenn}, Notary Public
MY COMMISSION EXPIRES 1 2104120 1 7
I, Jeffrey Goldberg , the duly elected Vice President and Assistant Secretary of North American Specially Insurance Company, Washington
International Insurance Company and Westport Insurance Corporation do hereby certify that the above and foregoing is 0 true and correct copy of 0
Power of Attorney given by said North American Specialty Insurance Company, Washington International insurance Company and Westport Insurance
Corporation which is still in full force and effect.
IN WITNESS WHEREOF, I have set my hand imd affixed the seals of the Companies this1101 day of September
2017
fry Cotillion, Vice President & Atis6mnt Secreta
Vnericnn Specialty haumnee Cmnpon)' & Vice arc
lc
N
tional Inxnrw¢e Company R
tory of W.:s4an hssurnnm Co