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FORM OF BID OR PROPOSAL
F.Y. 2017 LEVEE TREE CLEARING
CEDAR RIVER (NORTHEAST)
CONTRACT NO, 908
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
R" - .7 a w 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
t< listed in the Table of Contents and Addenda (if any), as prepared by the City
Engineer of the City of Waterloo row 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 LEVEE TREE CLEANING -- CEDAR RIVER
(NORTHEAST), Contract No. 908, all in accordance with the above -listed
documents and for the unit prices for work in place for the following items and
r • quantities:
z
F.Y. 2016 LEVEE TREE CLEANING — CEDR RIVER (NORTHEAST) ,
CONTRACT NO. 908
BID .
ITEM
DESCRIPTION
-
i.
1
UNIT
LS
.EST. QTY.
1.000
" UNITB(D
PRICE :...
la-
S.25) 000
$ 75 St
TOTAL BID PRICE '
$ 075 000
$/41 15-71-°
1
MOBILIZATION
2
CLEARING AND GRUBBING
UNIT
1,958.10
3
CLEARING AND GRUBBING
ACRE
3.870
$ 334 000 44$
/417 040
4
SEEDING, FERTILIZING AND MULCHING
ACRE
3.870
$ 5- 00o Ca/$
/ % 330 tL'-
5
TRAFFIC CONTROL
LS
1.000
$ ? 000'2
��
$ 8v ov
TOTAL BID
$ 3 1744) a (0 7• CO ply l'IC
Me", haNJrC.d - forty Sij� fti••K,35ki di f a0 Aso ch -cd - s,•11 #y $e//les
FORM OF BID
CONTRACT NO. 908
Page 1 of 3
2. It is understood that the quantities set forth are approximate only and subject to
variation and that the unit bid price :.for the work done shall govern in the actual
payment to Contractor.
3. In submitting this bid, the bidder understands that the right is reserved by the City
of Waterloo, Iowa, to reject any or all bids. If written notice of the acceptance of
this bid is mailed, telegraphed, or delivered to the undersigned within thirty (30)
days after the opening thereof, or at any time thereafter before this bid is
withdrawn, the undersigned agrees; to execute and deliver an agreement in the
prescribed form and furnish the required bond and certificate of the insurance
within ten (10) days after the agreement is presented to him for signature, and
start work within ten (10) days after "Notice to Proceed" is issued.
4. Security in the sum of 10 i'
Dollars ($ N4 ) in the form of Son z
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 $10,000.00 in work for the City in the current calendar year, are prepared to
submit an MP or Update and an EOC, within ten (10) days of notification that the
bid submitted is lowest and acceptable.
9. The bidder has received the following Addendum or Addenda:
Addendum No. Date
10. The bidder shall list the MBENVBEsubcontractor(s), amount of subcontracts and
bid items on the City of Waterloo Minority and/or Women Business Pre-bid
Contact Information Form submitted with this Form of Bid or Proposal. The
apparent low Bidder shall submit a ;,list of all other Subcontractor(s) to be used on
this Project to the City of Waterloo by 5:00 p.m. the business day following the day
Bids on this Project are due alGng with the Non -Collusion Affidavits of All
Subcontractor(s).
The Contractor shall submit information on subcontractors on
"SUBCONTRACTOR REQUEST AND APPROVAL" Form to be provided by City
prior to approval of contract.
FORM OF 810
CONTRACT NO. 908
Page 2 of 3
The subcontractors listed on this proposal and/or submitted to the Contract
Compliance Officer cannot be changed except for the following reasons:
1) The City of Waterloo does not approve the subcontractors.
2) The subcontractors submit in writing that they cannot fulfill their
subcontracts.
11. The bidder has filled in all blanks on this proposal Those blanks not applicable
are marked "none" or "NA".
12. The bidder has attached all applicatle forms.
13. The Owner reserves the right to select alternates, delete line items, and/or to
reduce quantities prior to the award of a contract due to budgetary limitations.
L-4
Con sfraf.3 p
(Name of Bidder)
BY:. --4
Title
OcioI .r G� „26 /G
(Date)
Official Address: (Including Zip Code):
0 /30.x 4'r9
c/cr/c.fv Y/t 76 ,ry t / 7
I.R.S. No. 417- ,$ �j6 ava
t
FORM OF BID
CONTRACT NO. 908
Page 3 of 3
NON -COLLUSION AFFIDAVIT OF PRIME BIDDER
State of )
1'j O1'w ♦ )
County of ablacha..I� )69
we Lockt.
being first duly sworn, deposes and says that:
He is (Owner Partner. Officer. Representative, or Agent) of LOc e. Cnsei a -lisbn
TAc . 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 offi, ers, 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 horn 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 priceiof 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
y�scribg�d anc�.sworn to before me this "c day of
S l'�i11(J�i
201b,..1 -
My commission expires Q
gmAt MELODY KIEWIET
S COMMISSION NUMBER 795107
MY COMMISSION EXPIRES
10W0' March 15, 2019
•:l4•Y3IiRM,4it±!
5. The contractor, subcontractor, vender and supplier of goods and services
will furnish and file compliance reports within such time and upon such
forms as provided by the Affirmative Action Officer. Said forms will elicit
information as to the policies, procedures, patterns, and practices of each
subcontractor as well as the contractor himself/herself and said contractor,
subcontractor, vendor and supplier will permit access to his/her
employment books, records and accounts to the City's Affirmative Action
Officer, for the purpose of investigation to ascertain compliance with this
contract and with rules and regulations of the City's Affirmative Action
Program—Contract Compliance Provisions relative to Resolution No.
24664.
6. In the event of the contractor's non-compliance with the non-discrimination
clauses of this contract or with any of such rules, regulations and orders,
this contract may be canceled, terminated or suspended in whole or in
part and the contractor may be declared ineligible for further contracts in
accordance with procedures authorized by the City Council.
7. The contractor, subcontractor, vendor and supplier of goods and services
will include, or incorporate by reference, the provisions of the non-
discrimination clause in every contract, subcontract or purchase order
unless exempted by the rules, regulations or orders of the City's
Affirmative Action Program, and ill provide in every subcontract, or
purchase order that said provisions will be binding upon each contractor,
subcontractor, or supplier.
8. We, the undersigned, recognize that we are morally and legally committed
to non-discrimination in employment. Any person who applies for
employment with our company will not be discriminated against because
of race, creed, color, sex, national origin, economic status, age, mental or
physical disabilities.
(Signed)
(Appropriate Official)
0 t -i
(Title)
6Gitbtr 6,020/4,
(Date)
EQUAL OPPORTUNITY CLAUSE PAGE 2 OF 2 PAGES
EQUAL OPPORTUNITY CLAUSE
(As provided in Executive Order No. 11246)
All contractors, subcontractors, vendors and suppliers of goods and services
doing business with the City and value of said business equals or exceeds ten
thousand dollars ($10,000.00) annually agree as follows:
1. The contractors, subcontractor, vendor and supplier of goods and services
will not discriminate against any employee or applicant for employment
because of race, color, creed, sex; national origin, economic status, age,
mental or physical handicap, political opinions or affiliations. The
contractor, subcontractor, vendor and supplier will develop an Affirmative
Action program to ensure that applicants are employed and that
employees are treated during employment without regard to their race,
creed, color, sex, national origin, religion, economic status, age, mental or
physical disability, political opinions or affiliations. Such actions shall
include but not be limited to the following:
li
a. Employment
b. Upgrading
c. Demotion or Transfer
d. Recruitment and Advertising
e. Layoff or Termination
f. Rates of Pay or Other Forms of Compensation
g_ Selection for Training Including Apprenticeship
2. The contractor, subcontractor, vendor and supplier of goods and services
will, in all solicitations or advertilsements for employees, state that all
qualified applicants will receive consideration for employment without
regard to race, creed, color, sex, national origin, religion, economic status,
age, mental or physical disabilities) political opinion or affiliations.
3. The contractor, subcontractor, vendor and supplier or his/her collective
bargaining representative will send( to each labor union or representative
of workers which he/she has a collective bargaining agreement or other
contract or understanding, a notice advising said labor union or workers'
representative of the contractor's commitment under this section.
4. The contractor, subcontractor, vendor and supplier of goods and services
will comply with all published rules, regulations, directives, and order of
the City of Waterloo Affirmative Action Program Contract Compliance
Provisions.
EQUAL OPPORTUNITY CLAUSE PAGE 1 OF 2 PAGES
CONTRACT NO.:
PROJECT NAME:
NON-RESIDENT BIDDER CERTIFICATION
903
X Y. 020/7 1. -c - "-c- Tree.
DATE OF LETTING: Oc..3e10 er 6 frit o7o/4
I hereby certify that I am an Iowa non-resident bidder.
COMPANY NAME:
CORPORATE OFFICER:
TITLE: 0 w
lav
C nn..54- c ion
Inc..
S F c' -e. La cite_
DATE J O - [o - /G
STATE/COUNTRY OF RESIDENCY: 4 0 Grq
Stated below are the preference(s) to resident bidders in the state/country of di 0 :
(Preference to bidders, labor force, or other preferential treatment to bidders or laborers, etc.
r
iw prc�crc14-eS.
We hereby certify that we are in compliance with all City and Federal
Affirmative Action Regulations and agree to accept all liability for failure to
comply.
Respectfully submitted,
By:
L4
Company Executive
/0 -is-/4a
By:
Date
Equal Employment
Opportunity Officer
/o -6-/&
City of Waterloo Affirmative Action Officer
Approved
Disapproved Reason:
By:
Date:
Date
-7
CONTRACTOR'S TOTAL WORK FORCE
(WATERLOO)
NAME AND ADDRESS
JOS CATEGORY
RACE
SEX
HOURLY
WAGE
Shcve. Laic It.4..e/I'y 7i
()W.!
kr.e.».%h
P7
Sq/4,75.4e44e.
AcheAsvd/c 7»
Sc.-v*44,7
k vic
7
54 Ary
/3r4..du,. L'e- EA ft.,, ko32*
rore/'.F+.
1414.1e,
in
CilWAO.
it*
Si,....., Sc{s.•o eller hpAigiu n, 79
Orem ►vr
!vA,•ie,
Pi
'Or.
"'Lc Rcns)ow &4nrfinj 74
Pine L4yer
/vA.lc
M
cQJ/AP.
04.401 Dil%k Ivo+.r/o 4.4-
Optresor
1.4 o "r
Mile
»'
11/4.'.
�
I
INDICATE:
DISABLED VETERAN:, DV
VIETNAM ERA VETERAN: W
HANDICAPPED: H
_6
K. In further accordance with rales and guidelines issued pursuant to
Executive Order 11246 as amended, we establish the goals for our
company, based on parity percentages supplied by the City, and we
realize these goals will be reviewed on an annual basis.
L. Loc -• GE75+rt..c.4 pn T,nt , will keep records of
(Name of Company)
specific actions relative to rec uitment, employment, training, upgrading
and promotion and will provide the City of Waterloo with any information
relative to same, including activities of our SUBCONTRACTORS and
suppliers as necessary or when requested_
M. Parity figures for companies located in Waterloo are as folio. s: -
Minority Parity = -08 (8%)
N. to Con ti4-04...c+ t'on Inc. Affirmative Action
(Name of Company)
Employment Goals:
The definition of Affirmative A tion Goals is as follows: "Goals may not
be rigid and inflexible quotas hich must be met, but must be targets
reasonably attainable by means of applying every good faith effort to
make all aspects of the entire Affirmative Action Program work."
For the year 201j, please submit percentage targets for employing
minorities and women. If you already have reached your target for
hiring minorities and women, please submit that percentage.
*Goals for Minorities: %
Goals for Women:
"Your affirmative action goals hould be between 1% and 10% or more
for minorities and 1% and 5% pr more for women.
Please be advised that the goals or targets are purely your estimation
of how many women and minorities your company can reasonably
expect to hire in 201 •. Note, that none of the goals are rigid or
inflexible. They are targets th4t your company calculates as reasonably
attainable. This will help te City in its monitoring procedures as
required by City of Waterloo Resolution No. 1984-142(4).
5
D. I-0 Ghs+^w cion Mne., will seek qualified minority,
(Name of Company)
female, and local group appli ants for all job categories and will make
asserted efforts to increase minority, female and group representation
in occupations at the higher le\ els or skill and responsibility.
E. All sources of employment used shall be aware that we are an Equal
Employment Opportunity Employer. Labor organizations representing
our employees will be notified of our Equal Employment Opportunity
Policy and Affirmative Action Program.
F. Training, upgrading, promotion and transfer activities at all levels will be
monitored to ensure that full consideration has been given to qualified
minority, female, and local group employees.
G. Loi Const•i...c+O'on ty c.. will encourage other
(Name of Company)
companies with whom we are associated and/or do business, to do the
same and we will assist them ii their efforts.
H. LodiL Consrrin'iion jhc, has taken the following
(Name of Company)
Affirmative Action to ensure that minority, female, local contractors
and/or suppliers were provided opportunities to negotiate and/or bid on
this project: (if none, write "NONE")
1. 2 -.i �` /S.
2.
As a result of the above efforts, we have involved minority, female, and
local contractors and/or suppliers in the following areas of
subcontracting: (if none, write "NONE")
2.
Loma -c. Cons*n Znc , will require approved
(Name of Company)
Affirmative Action Programs from all nonexempt contractors who
propose to work on this project and will take whatever steps are
necessary to ensure that non -minority contractors have adequate
representation of minority, female and local persons in their total work
force.
-4 -
realizing that our qualification nd/or merit system should be evaluated
and revised, if necessary.
D. We agree to put forth the ma imum effort to achieve full employment
and utilization of capabilities aid productivity of all our citizens without
regard to race, creed, color, sex, national origin, economic status, age,
and mental or physical handicsp.
E. too Q- Consttc. c# I n% 7rtc , will give training
(Name of Company)
and employment opportunities to local residents of Waterloo, Iowa, to
the greatest extent feasible.
111. AFFIRMATIVE ACTION
A. Go c‘c. Corot tc+,bn Inc. , recognizes that the
(Name of Company)
effective application of a policy of merit employment involves more than
just a policy statement, and L�d„ GonS}pc, c ibrt Inc
(Name of Company)
will, therefore, re-evaluate our affirmative Action Program to ensure that
equal employment opportumtis are available on the basis of individual
merit, and to actively encourae minorities, women and local residents
to seek employment with our company on this basis.
B. Lode, Gons►ru;un /nc.
will undertake the
(Name of Company)
following six (6) steps to improhe our Affirmative Action Program:
1. Minority Recruitment and Employment;
2. Local Recruitment and mployment;
3. Disabled Veteran and Vietnam Era Veteran Recruitment and
Employment;
4. Handicapped Recruitm nt and Employment;
5. Female Recruitment ani Employment; and
6. Training, Upgrading ani Promotional Opportunities.
C. loose,, (0.,S+r»csiorM Ttc., will take
Y(Name of Company)
whatever steps are necessary to ensure that our total work force has
adequate minority, female, and local representation. We will utilize the
following methods in our recruitment attempts:
1. Local advertising media (newspapers, radio, TV);
2. Community organizations (churches, clubs, schools);
3. Public and private institutions in the area (UNI, Hawkeye
Community College);
4. Job Service of Iowa; and
5. Other,
-3 -
C. Remainder of program to be completed by party completing program,
either Prime or Subcontractor.
1. The Owners and/or Principals cf your company:
Ethnic
Name Address Position Sex Origin
S+w� Lv4L 073 30 Avc, /11 k) 41'f er
Vaver?7 24 S01177
2. Other Areas of Interest:
If your company has branches or subsidiaries, or if your company is a
branch or subsidiary of a parent organization, give the following
information:
Name Address
N4
Type of
Affiliation Degree
II. EMPLOYER'S POLICY (Please read larefully.)
A. We, the undersigned, recognize that we are morally and legally
committed to nondiscrimination in employment. Any person who
applies for employment with our company will not be discriminated
against because of race, colcr, creed, sex, national origin, economic
status, age, mental or physical handicap.
B. The employment policies and practices of the undersigned are to recruit
and hire employees without discrimination, and to treat them equally
with respect to compensation and opportunities for advancement,
including training, upgrading, promotion, and transfer. However, we
realize the inequities associa ed with employment training, upgrading,
contracting and subcontractinb for minorities and women and we will
direct our efforts to correcting)) any deficiencies to the maximum extent
possible. The same will be required of our SUBCONTRACTORS and
suppliers.
C. We submit this program to assure compliance with Executive Order
11246, as amender), and other subsequent orders that may pertain to
equal employment opportunity and merit employment policies, fully
-2 -
Revised February 2003
CONTRACTOR'S OR SUBCONTRACTOR'S AFFIRMATIVE ACTION PROGRAM
Check box that applies to party completing program:
( ) General Contractor
( ) Subcontractor
Section A to be completed by GENERAL CONTRACTORS only:
A.
Name of Company Lock c, (0 oruAc4:y„ Tnc.
Address of Company X36 13°t° qv, CArAt vac Zip ,S -°1t / 9
Telephone Number (31 1 ) a3 - 0/98.0
Federal ID Number (if no Federal ID Number, Owner/President's Social
Security Number) 97 - as t/ 8 802
Name of Equal Employment Officer
Name of Project T y..20/7 Leve
Project Contract Number 263
Estimated Construction Work Dates
St c L-0
%r c'i+c/
017a0/ / oy1/410/7
Start Finish
Section B to be completed by SUBCONTRACTORS only:
B.
Name of General or Prime Contractor
Name of Subcontractor
Subcontractor's Address
Subcontractor's Telephone Number (
)
Zip
Subcontractor's Federal ID Number (ik no Federal ID Number
Owner/President's Social Security Number)
Name of Equal Employment Officer
MBEIWBE BUSINESS ENTERPRISE
PRE-BID CONTACT INFORMATION FORM_ Gl 't /
Prime Contractor Name: Lvd c- t!Onstv1-41A» dire, Project: Y a°/7 lace-/eac. Letting Date: /6 - /4'
NO MBE/WEE 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:
Title: d w r`"=r
Date: /0 — 6 /6
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/WEE Business
Enterprise contacts made prior to your bid submission. This information is subject to verifications and confirmation.
If you are unable to identify MBEIWBE 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 swcs ssfullaw_bidder madagaod.faith egnrts tcneet thegoals.
TABLE OF INFORMATION SHOWING BIDDER'S PRE-BID
MBEIWBE 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
/.ech arses
/b-9 /6
94.
YES
1/0� 000 .c--'
(Form CCO-4) Rev. 05-20-02
I Nt)VV ALL MEN BY THESE f' -RESENTS, Met we .......e .Construction, Inc.
t rincipal, and North American Specialty. Insurance Company
Citi Surety ere hc4d and itrmly bound unto the '..'.i i 'i ., ;I: ligci I .I:Lf,1() _, ictva_ 130r4chftEI' celled
l i'�. .i d the penal 5,�ir?
"OW=§Va`?Five Percent of the Amount Bid
Dollar; T _.M.� �%__..•.... _ _..___.,.) ]arra it money or the United Struts, for the payment
of which sum will and truly be mode, we bind ourselves, our hers, executors, administrators, and
successors, jointly and sevorolly, firmly by these presents. The condition of this obligation is such that
whereas the Principal has submitted the cc � �anying bid dated the 6th day of October
.� _��__ _ ..___...m..�_...� 20._16, for FY 17 Levee Tree Clearing Cr KIveC (Northeast), _
Contract No. 9013. Waterloo. A �.,_�....-
NOW, THEREFORE,
(a) if said Bid shall be rejected, or In the alternate,
(b) If said Bid shall bo 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 an herein stated.
By virtue of statutory authority, the full amount of Ibis 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 dons hereby waive notice of any such extension.
IN WITNESS WHEREOF, the Principal and the Surely, have hereunto set their hands and seals, and such
of them as are corporations, have caused their corporate seals to be hereto affixed arid these presents to be
signed by their proper officers this 3rd day of October . , A.B. 2016 �4 Seg
Lodge Construction,
Principal
Witness
Witness Sunn Bartenhagen
North Specialty Insur• : C• pang Seal
)
ety
ifee_..)
Attorney -fac /e is e R. Young
(Tido)
NAS SURETY GROUP
NORTI-I AMERICAN SPECIALTY INSURANCE COMPANY
WASHINGTON INTERNATIONAL INSURANCE COMPANY
GENERAL POWER OF ATTORNEY
KNOW ALL MEN BY THESE PRESENTS, THAT 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 Manchester, New Hampshire, 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 make, constitute and appoint:
JAY D. FREIERMUTH, CRAIG E. HANSEN, BRIAN M. DEIMERLY, SHIRLEY S. BARTENHAGEN,
CINDY BENNETT, ANNE CROWNER, TIM McCULLOH, STACY VENN, LACEY CRAMBLIT and DIONE R. YOUNG
JOINTLY OR 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 contracts of suretyship as are or may be required or permitted by
law, regulation, contract or otherwise, provided that no bond or undertaking or contract or suretyship executed under this authority shall exceed the
amount of: FIFTY MILLION ($50,000,000.00) DOLLARS
This Power of Attorney is granted and is signed by facsimile under and by the authority of the following Resolutions adopted by (he Boards of
Directors of both North American Specialty Insurance Company and Washington International Insurance Company at meetings duly called and held
on (he 911' of May, 2012:
"RESOLVED, that any two of the Presidents, any Managing Director, any Senior Vice President, any Vicc 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 alt 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 Power 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, undertaking or contract of surety to which it is attached."
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=— SEAL o= 6erenr.Avner. 1,eaamrvmnrre:maanna,I,,,mn10ternmmnmmanrnnreCnnapnaa>.
°.? 1973 W '- & Senior Vice President of North American Specialty Laurance Company
QP eC
Michael A. IIllo, Semor Viae President o as Von International Laurance Company
& Senior \'ice President of North Jimerienn Speciality insurance Continay
IN WITNESS WHEREOF, North American Specialty Insurance Company and Washington International Insurance Company have caused their
official seals to be hereunto affixed, and these presents to be signed by their authorized officers this 8th day of September , 20 15 .
State of Illinois
County of Cook
SS:
North American Specialty Insurance Company
Washington International Insurance Company
On this 8th day of September , 20 15 , before me, 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 Michael A. Ito
Senior Vice President of Washington International Insurance Company and Senior Vico President of North American Specialty Insurance
Company, personally known to toe, 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 companies.
OFFICIAL SEAL
M KENNY
NOTARY PUBLIC, STATE OF I W NOIS
MY COMMISSION EXPIRES 1210412017
M. Kenny, Notary Public
I, Jeffrey Goldberg the 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 Power 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 WHEREOF, I have set my hand and affixed the seals of the Companies this 3rd day of October , 2016
Jeffrey Goldberg, Vice President & Assistant Secretary or
Washington International Insurance Cmnpa,y & North American SVccuntY Insurance Company