HomeMy WebLinkAboutVieth Construction CorpFORM OF BID OR PROPOSAL
F.Y. 2017 LEISURE SERVICES SANITARY SEWER EXTENSION
CONTRACT NO. 925
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
ct, 4 , 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 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 F.Y. 2017 LEISURE SERVICES SANITARY SEWER EXTENSION,
Contract No. 925, all in accordance with the above -listed documents and for the
unit prices for work in place for the following items and quantities:
BID
ITEM
DESCRIPTION
UNIT
EST. QTY.
UNIT BID
PRICE
TOTAL. BID PRICE
1
MOBILIZATION
LS
1.0
$ /-5-04)
$ 7.5--&c. -
2
GRANULAR SURFACING
TON
75.0
$ ,3
$ Z f S G
3
TRACE SANITARY SEWER SERVICE
EACH
1.0
$ /f1-00 `
$ l'¢ c; -
4
DYE TEST INVESTIGATION
EACH
1.0
$ 6 L S "
$ 6 z
5
UNDERGROUND INVESTIGATION -
SANITARY
EACH
3.0
$ /0Uc.:.% -
$ .3 c,,'o
6
TAP AND COLLAR SANITARY
MANHOLE
EACH
1.0
$ Z ?cXj -
$ 2 ? cc
7
SANITARY SEWER, 8" TRUSS PIPE
LF
553.0
$ Z 7 ~
$ 7ft, 9 3 / "
8
SANITARY SEWER SERVICE, PVC, 6
INCH
LF
100.0
$ ' 3
$ fL 3°_
9
STANDARD SANITARY MANHOLE, SW -
301, 48 INCH DIA.
EACH
1.0
$ it- -Cc v .-
$ ¢ i0 --
10
10
SANITARY SEWER ABANDONMENT
LF
175.0
$ 2-Y -
$ SC 7 _- -
11
REMOVE SANITARY SEWER
MANHOLE
EACH
1.0
$ / 94'.
$ /?&.0
12
TRAFFIC CONTROL
LS
1.0
$ .i 75-
$ _y ? _*--
'"TOTAL
TOTALBID
$ c`--5/ 0,5 6.
FORM OF BID
CONTRACT NO. 925
Page 1 of 3
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.
4. Security in the sum of 4
Dollars ($ S io ) in the form of -.3: -:a 3 a -,g
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 ( ✓ ), 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
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:
FORM OF BID CONTRACT NO. 925 Page 2 of 3
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 tq tkie pward ofFa contract due to budgetary limitations.
VIETH CONSCRJL 11,.E . )F\
6419 NORDIC D.
CEDAR FALLS. IA 50613
///, 3 /26
(Name of Bidder) (Date)
BY: Title
Official Address: (Including Zip Code):
VIETH CONSTRUCTION CORP
6419 NORDIC DR.
CEDARt-"f1l_! S, IA 90613
I.R.S. No. Ci d C rc) _c 7
FORM OF BID
CONTRACT NO. 925 Page 3 of 3
BID BOND
KNOW ALL MEN BY THESE PRESENTS, that we,
as Principal, and
as Surety are held and firmly bound unto the CITY OF WATERLOO , Iowa, hereinafter called
"OWNER." In the penal sum
Dollars ($ ) 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 day of
20 , for
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 presents to be
signed by their proper officers this day of , A.D. 201
(Seal)
Principal
By
(Title)
(Seal)
Witness Surety
By
Witness Attorney-in-fact
_NON -COLLUSION AFFIDAVIT OF PRIME BIDDER
State of �4'
County of
)ss
'L7 lir2, being first duly sworn, deposes and says that:
1. He is • wne , ' artner, Officer, Representative, or Agent) , of 1/.CC-
, the Bidder that has submitted the attached Bid;
2. He is fully informed respecting the preparation and contents of the attached Bid and of all
pertinent circumstances respecting such Bid;
3. Such Bid is genuine and is not a collusive or sham Bid;
4. Neither the said Bidder nor any of its officers, partners, owners, agents, representatives,
employees, or parties in interest, including this affiant, has in any way colluded,
conspired, connived or agreed, directly or indirectly, with any other Bidder, firm or person
to submit a collusive or sham Bid in connection with the Contract for which the attached
Bid has been submitted or to refrain from bidding in connection with such Contract, or
has in any manner, directly or indirectly, sought by agreement or collusion or
communication or conference with any other Bidder, firm or person to fix the price or
prices in the attached Bid or of any other Bidder, or, to fix any overhead, profit or cost
element of the bid price or the bid price of any other Bidder, or to secure through any
collusion, conspiracy, connivance, or unlawful agreement any advantage against the City
of Waterloo, Iowa, or any person interested in the Proposed Contract; and
5. The price or prices quoted in the attached Bid are fair and proper and are not tainted by
any collusion, conspiracy, connivance or unlawful agreement on the part of the Bidder or
any of its agents, representatives, owners, employees, or parties in interest, including this
affiant.
(Signed)
Title
,Subscribed and sworn to before me this �5
w1 , 201.
day of
My commission expires 11101.1
G, )D (S.
A"' •+ SHERRY K HORNUNG
a « COMMISSION NO.789387
MY COMMISSION EXPIRES
00.t'' APRIL 6, 2016
NON -COLLUSION AFFIDAVIT OF SUBCONTRACTOR
State of )
County of )
being first duly sworn, deposes and says
that:
1. He is
) ss:
(Owner, Partner, Officer, Representative, or Agent) of
hereinafter referred to as the "Subcontractor;"
2. He is fully informed respecting the preparation and contents of the subcontractor's
proposal submitted by the subcontractor to
contract pertaining to the
project in
(City or County and State)
3. Such subcontractor's proposal is genuine and is not a collusive or sham proposal;
4. Neither the subcontractor nor any of its officers, partners, owners, agents,
representatives, employees, or parties in interest, including this affiant, has in any way
colluded, conspired, connived, or agreed, directly or indirectly, with any other bidder, firm
or person to submit a collusive or sham proposal in connection with such contract or to
refrain from submitting a proposal in connection with such contract, or has in any manner,
directly or indirectly, sought by unlawful agreement or connivance with any other bidder,
firm or person to fix the price or prices in said subcontractor's proposal, or to fix any
overhead, profit or cost element of the price of prices in said subcontractor's proposal, or
to secure through collusion, conspiracy, connivance or unlawful agreement any
advantage against the City of Waterloo, Iowa, or any person interested in the proposed
contract; and
5. The price or prices quoted in the subcontractor's proposal are fair and proper and are not
tainted by any collusion, conspiracy, connivance or unlawful agreement on the part of the
bidder or any of its agents, representatives, owners, employees, or parties in interest,
including this affiant.
(Signed)
Subscribed and sworn to before me this day of
201
Title
Title
My commission expires
RESIDENT/NON-RESIDENT BIDDER
RESIDENT BIDDER:
In accordance with Section 73A.21 of the Iowa Code, all non -federal -aid public
improvement projects, which include road construction, shall be performed by a
qualified resident bidder. The resident bidder has been further defined as follows:
Resident Bidder:
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.
The contractor shall provide the City with a certification that he is a qualified
resident bidder according to the above definition. The Certification shall be
submitted with the contractor's bid. A copy of the form of "Resident Bidder
Certification" is included in the Contract Documents. If it is determined that the
contractor does not meet this qualification after he begins work, a shutdown
notice shall be issued and the voiding of the contract shall begin unless the
contractor becomes qualified.
NON-RESIDENT BIDDER:
The contractor shall provide the City with a certification that he is a non-resident
bidder according to the above definition. The Certification shall be submitted with
the contractor's bid. A copy of the form of "Non -Resident Bidder Certification" is
included in the Contract Documents.
DJG
01/02/12
CONTRACT NO:
PROJECT NAME:
DATE OF LETTING:
RESIDENT BIDDER CERTIFICATION
L�
4—
S4- s, �✓z.
/ 2-11/45-
-
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.
hereby certify that I am a resident bidder as defined above.
VIETH CONSTRUCTION CORP
6419 NORDIC DR.
CEDAR FALLS. IA. 50613
COMPANY NAME
CORPORATE OFFICER
TITLE
DATE
/cam •r VIC —
/ /VA
CONTRACT NO.:
PROJECT NAME:
DATE OF LETTING:
NON-RESIDENT BIDDER CERTIFICATION
I hereby certify that I am an Iowa non-resident bidder.
COMPANY NAME:
CORPORATE OFFICER:
TITLE:
DATE:
STATE/COUNTRY OF RESIDENCY:
Stated below are the preference(s) to resident bidders in the state/country of
(Preference to bidders, labor force, or other preferential treatment to bidders or laborers, etc.
Prime Contractor Name:
r/1
MBE/WBE BUSINESS ENTERPRISE
PRE-BID CONTACT INFORMATION FORM
Project: 2- $ Letting Date: / 2-7/7
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 feasible with this project. If any MBE/WBE subcontractors will be used, please use the bottom
portion of this form. Contractor Signature: ,Zz�Title: AtDate: !��7/,‘
SUBCONTRACTORS 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 MBE/WBE 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 MBE/WBE 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/No
Dates
Contacted
Yes/No
Dollar Amount Proposed to
be Subcontracted
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(Form CCO-4) Rev. 06-20-02
MBE/WBE BUSINESS ENTERPRISE
PRE-BID CONTACT INFORMATION FORM INSTRUCTIONS
Prime Contractor Responsibilities:
Prime Contractors bidding on City of Waterloo contract work are required to ensure that MBE/WBE businesses are provided the opportunity to
participate in the performance of contracts and subcontracts. Prime contractors are required to assist MBE/WBE businesses in overcoming
barriers to participation, and must make good faith efforts to secure bids from, and award subcontracts to, MBE/WBE businesses. For all contract
bids of $50,000 or more, the following is required to demonstrate good faith efforts in accordance with this policy:
1. "MBE/WBE BUSINESS ENTERPRISE PRE-BID CONTACT INFORMATION FORM" submitted with the prime contractor bid, properly
completed and signed on Form CCO-4 (Rev. 06-20-02). Please note that this document must include all subcontractor contacts, bids received,
and awarded - not just those related to disadvantaged business enterprise vendors.
2. A minimum of three (3) MBE/WBE business contacts must be made and documented, if there are at least three (3) MBE/WBE businesses
offering services in the areas to be subcontracted (see City of Waterloo MBE/WBE Certified List). If less than three (3) are offering the services to
be subcontracted, then a contact is required for any that are listed as providing that service. If you have submitted a MBE/WBE contact not on the
City's MBE/WBE list, attach a copy of the certification from another government agency.
3. Contacts to each MBE/WBE businesses are required to be a minimum of seven (7) working days prior to the date the prime contractor submits
the bid to the City of Waterloo.
4. The following documentation must accompany the "MBE/WBE BUSINESS ENTERPRISE PRE-BID CONTACT INFORMATION FORM" for
each MBE/WBE business contacted:
a. A copy of the bid received from the MBE/WBE, OR
b. If no bid was received, a copy of correspondence received from the MBE/WBE with a "no bid" response, OR
c. If no response was received, a copy of the solicitation sent to the MBE/WBE with proof of mailing attached.
5. If any MBE/WBE business submitting bids are not selected for subcontract award, documentation must accompany the "MBE/WBE BUSINESS
ENTERPRISE PRE-BID CONTACT INFORMATION FORM" on why the MBE/WBE was not selected. These reasons could include:
a. Not low bid. Copies of the competing bids may be required for verification.
b. MBE/WBE did not bid, withdrew bid or was non-responsive.
c. Documentation of other business-related reason for not selecting the MBE/WBE business for a subcontract.
d. Prime contractor self performs work.
e. Any other reason relied on by the Prime Contractor.
The Contract Compliance Officer will determine the weight to be given to each item listed above (supported by appropriate documentation) based
on overall program goals.
Subcontractors Responsibilities:
1. Each MBE/WBE firm planning to submit quotes on construction projects with goals, shall submit a Letter of Intent to Bid (Form CCO-5) to
the City Contract Compliance Officer seven (7) working days prior to bid opening, listing specific items which the MBE/WBE firm is
interested in bidding. If the City Contract Compliance Officer does not receive sufficient scope letters seven (7) working days prior to bid
opening, goals on subject project will be reduced accordingly. Agreements between the bidder/proposer and an MBE/WBE in which the
MBE/WBE promises not to provide subcontracting quotations to other bidders/proposers are prohibited.
Form CCO-4A Rev. 07-08-02
131D 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 , lower, hereinafter called
"OWNER." In the penal sum ---Five Percent of the Bid Submitted --
Dollars ($ ---5%--- lawful money of the United States, for the payment
of Which surn 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 1st day of December
2016 ,for
FY 2017 Leisure Services Sanitary Sewer Extension, Waterloo, IA; Contract No. 925
NOW, THEREFOizt=,
(a) If said Bid shall be rejected, or in the alternate.
(b) If said Bid shalt be accepted and the Principal shall execute and deliver a contract in the forret 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 c:onncx;tion 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 shalt 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 heroin stated.
Dy 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 Surely, 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 [31d or execute such contract; and said Surety does hereby waive notice of any such extension.
IN WITNESS WI IFREOF, the Principal and the Surety, have hereunto set their hands and seals, and such
of them as are corporations, have caused their coats role seals to be hereto affixed and these presents to be
signed by their proper officers this 9th day of November , A.D. 2016
Vieth Construction Corporation
pI inCi(1;_If�
(Seal) "Ai S yam`
North American Specialty In ance Comparly;nnl)
fay
Attorne'in-f
to R. Young
NAS SURETY GROUP
NORTH AMERICAN SPECIALTY INSURANCE COMPANY
WASI IING'I'ON INTERNATIONAL INSURANCE COMPANY
GENERAL POWER OF ATTORNEY
KNOW ALL MHN BY THESE PRESENTS, THAT North American Specially Insurance Company, a corporation duly organized and existing under
laws of the State of New I-lampshire, and having its principal office in the City of Manchester, New 1 lampsh ire, and Washington International
Insurance Company, a corporation organized and existing under the laws of the State of New Hampshire and having its principal office in the City of
Schaumburg, Illinois, each does hereby slake, constitute and appoint:
JAY D. FREJERNIIITII. CRAIG E. I IANSE.N. BRIAN M. DEIME.RLY, SHIRLEY S. BARTI1NIIAGEN.
CINDY BI3NNETT, ANNE CROWNER. TINT McCULLOI I. STACY VENN, LACFY CRA M13111 and NONE R. YOUNG
.I OI N'I'Ll' 012 SEVL'ILA LLY
Its true and lawful Allorney(s)-in-Pact, 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 contracts of suretyship as are or may be required or permitted by
law, regulation, contract or otherwise, provided that no bond of undertaking or contract or suretyship executed under this authority shall exceed the
oulollnt of: FIFTY MII.I,ION ($50.000,000.00) DOLLARS
This Powe- of Attorney is granted and is signed by facsimile under and by the authority of the following Resolutions adopted by the Boards of
Directors of both North American Specialty Insurance Company and Washington International Insurance Company in meetings duly called and held
on the 91' of May, 2012:
"RESOLVED, that any two of the Presidents, any Managing Director, any Senior Vice President, any Vice President, any Assistant Vice President,
the Secretary or any Assistant Secrelary 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 Company; and it is
FURTHER RESOLVED, that the signature of such officers and the seal of the Company may be affixed to any such l'o'ver 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 fuln e with regard to any bond, undertaking or contract of surety to which it is attached."
\vyQ�GAu
P.64;1: A
�SG
By
'fTI SEAL im'= sn,;,'.,emer,r: ,,.c.:: :r uric. rrc.,ia:n :,nv:,Iiiiigr::::o:ler,i,:r:::::,n�:..r:,:rr:r<c:i
l 73 m: q g & Senior Vice President of North American Slreci:Jry Lrs:a'ance Ca:naanf-
,b 4AMPNjL
7,;112
Ify / r
Michael A. Ili. Nunn hire I'nsulcnl of \\ns unelau Inler'na:nnannz:u::nae. Cnmpany
.5 Senior Vice Plecident of North American Specially Insurance company
IN WITNESS WHEREOF, North American Specially Insurance Company and Washington International Insurance Company have caused their
, 2015.
official scats to be hereunto affixed, and these presents to be signed by their authorized officers this 8th day of September
Stale of Illinois
County of Cook
55:
North American Specially Insurance Company
Washington International Insurance Company
On this _8t11 day of September , 20 15 , before nue, a Notaty Public personally appeared Steven P. Anderson Senior Vice President of
Washington International Insurance Company and Senior Vice President of North American Specially Insurance Company and Michael A. Ito
Senior Vice President of Washington International Insurance Company and Senior Vice President of North American Specially Insurance
Company, personally known to me, who being by me duly sworn, acknowledged that they signed the above Power of Attorney as officers- of and
acknowledged said instrument to be the voluntary act and deed of their respective cons panics.
OFFICIAL SEL
St KENNY
NOTARY PUBLIC, STATE OF ILLINOIS
MY COMMISSION EXPIRES 12104/2017
Nolan' Public
I, Jeffrey Guldberg 1Iie duly elected Assistant Secretary of North American Specialty Insurance Company and Washington
International Insurance Company, do hereby certify that the above and foregoing is a true and correct copy of a Polder of Attorney given by said North
American Specialty Insurance Company and Washington International Insurance Company, Which is still in full force and effect.
IN WITNESS WI IEREOF, I have set nay band and affixed the seals of die Companies this 9th dap of November , 2016
Jaw
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