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CITY CLERKS OFFICE
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FORM OF BID OR PROPOSAL
F.Y. 2017 BRIDGE DECK REPAIR AND OVERLAY PROGRAM
CONTRACT NO. 879
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
vxt , 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 BRIDGE DECK REPAIR AND OVERLAY PROGRAM,
Contract No. 879, 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
DIVISION 1 - BASE BID -_ ;
UNIT
EST. QTY.
UNIT BID
PRICE.
TOTAL BID -PRICE-
1
REMOVALS
LS
1.0
$' c, cc` a:
$ 5-0 DOC, c30
2
STRUCTURAL CONCRETE,
MISCELLANEOUS
CY
25.4
$ I100 c'
$ 4,13e / e, o;,
3
REINFORCING STEEL, EPDXY
COATED
LB
750.0$
/,5-o
$ i, iZS'.x
4
DECK REPAIR, CLASS A
SY
729.0
$ 210 c5o
$15-3, 7' :,-'
5
DECK REPAIR, CLASS B
SY
74.0
$ 11o�. °,'
$ 2_`),(, 00 0 -
6
STEEL EXTRUSION JOINT WITH
NEOPRENE
LF
202.0
$ 2 °°• `''.->
$ i{v, `foe . A'
7
NEOPRENE GLAND INSTALLATION
AND TESTING
LF
202.0
$ ya
$ 8 O g° D''
8
CONCRETE REPAIR
SF
600.0
$ tv 3e
$ q g , C°D •'"
9
FURNISH TEMPORARY BARRIER RAIL
LF
1,380.0
$ 12. co
$ i (k, C-40 c--
10
INSTALL TEMPORARY BARRIER RAIL
LF
2,760.0
$ 2 , c.,
$ C—CZO- `"'
11
TEMPORARY CRASH CUSHION,
FURNISH AND INSTALL
EACH
8.0
$ tr3`'" - �0
$ (04 o` . s::
12
BRIDGE APPROACH, BR -201
SY
1,328.2
$ .Z. . 63
$ Z4 c , `l0 . N
FORM OF BID
CONTRACT NO. 879
Page 1 of 5
13
BRIDGE APPROACH, BR -202
SY
850.0
$ Zoo. co
$ ! 76.tea
14
STANDARD NON REINFORCED
PAVING, PCC, 9 INCH, C-4 W/ CD -
JOINTS
SY
796.8
$ S'/ . cap
$ 110‘6.36- , 8,,
15
EXCAVATION EARTHWORK
CY
100.0
$ ZJ•JD
$ Tocst „z,
16
MODIFIED SUBBASE
TON
207.0
$ Z S. a>
$ S'[ "2 C -c
17
LONGITUDINAL GROOVING IN
CONCRETE
SY
5,104.0
$ Z, Cc'
$ F 2;7Lo • .:u
18
REMOVAL OF PAVEMENT
SY
2,939.1
$ J. aj
$ 40°Zr c;o
19
REMOVAL OF EXISTING PAVEMENT
LUG
LF
332.0
$ c-. a'
/
$ 91,o. 60
20
CONCRETE BARRIER, TAPERED END,
BA -108
EACH
4.0
$ ?3`.3`' • w
$ j 3, 2_00- •'"
21
REMOVE AND REPLACE ABUTMENT
BEARING PLATES B,C AND D, CLEAN
AND PAINT PLATE A, RIVER ROAD
EACH
20.0
$ 41"1-1> ' `t'
$ 'o, `"'`' au
22
REMOVE AND REPLACE ABUTMENT
BEARING PLATES, CLEAN AND PAINT
SOLE PLATE, WESTFIELD
EACH
18.0
$ 19 m. w
$ 3`!, 2.0.E
23
FLOOR DRAIN EXTENSION, RIVER
ROAD
EACH
17.0
$ Ii )° `'°
$ J 3 / 0. 0.:,
24
FLOOR DRAIN EXTENSION,
WESTFIELD AVE.
EACH
12.0
$ 4 s'-'3• `'o
$ 7e0 - L:0
25
SIDEWALK/TRAIL REMOVAL
SY
120.0
$ 4.1°,0z)
$ tigoc,a5
26
SIDEWALK/TRAIL, PCC, 6 INCH
SY
120.0
$ , Sb
$ 13 (o ,
27
FLUME, PCC, 6 INCH
SY
8.5
$ 1 'S 0 • `1'
$ Z q 7S• °"
28
SLOPE PROTECTION REMOVAL
SY
181.0
$ Z'1. oo
$ yge'7.
29
SLOPE PROTECTION PAVING, 4 INCH
PCC w/ 6x6 #10 x #10 WW M
SY
181.0
$ r • iP
%
$ / 3 ' s��
30
PAVING NOTCH AND BACKWALL,
WESTFIELD AVE.
LF
90.0
$ 5-00. co
$'1 S, c00 .
31
FLOWABLE MORTAR
CY
2.0
$ c,00. a)
$ 11-oO
32
PAINTED PAVEMENT MARKING,
WATER BORNE OR SOLVENT -BASED
STA
79.91
$ 2-7. `x'
$ Z/ S 7 . 17
33
PAVEMENT MARKINGS REMOVED
STA
78.91
$ Li 5-."-
$ 3 SS -°'1
34
MOBILIZATION
LS
1.0
$ itt mo - LY-)
$ IA c oa=,m
35
DETOUR, WESTFIELD AVENUE
LS
1.0
$ 1 n'. b
$ S/ Ot3. v.�
36
TRAFFIC CONTROL
LS
1.0
$ 0, ea,. a
$ to, ecb,
TOTAL DIVISION 1 — BASE BID$
1 5O9 (91-11,9 Z- `/
FORM OF BID '
CONTRACT NO. 879
Page 2of5
BID
ITEM
DESCRIPTION
ALTERNATE A - OPTION 1
UNIT
EST. QTY.
UNIT BID
PRICE
TOTAL BID PRICE
37.1
DECK OVERLAY (CLASS 0 PCC)
SY
3,305.0
$
$
TOTAL ALTERNATE A - OPTION 1 $ g v t' y4
BID
ITEM
DESCRIPTION
ALTERNATE A - OPTION 2
UNIT
EST. QTY.
UNIT BID -`
PRICE
TOTAL BID. PRICE
37.2
DECK OVERLAY (CLASS HPC -0 PCC)
SY
3,305.0
$ if "s , •
$ / Y E, 7 z.Ss. 0-
/ i
TOTAL ALTERNATE A - OPTION 2 $ 1 y , - "0
BID
ITEM
DESCRIPTION _ `:
DIVISION:2 = WESTFIELD: PAVEMENT
THROUGH LEVEE CLOSURE
UNIT
EST. QTY.
UNIT BID
PRICE
TOTAL BID PRICE
1
REMOVAL OF PAVEMENT,
REINFORCED
SY
296.2
$ % • '''`'
$ 1 4/1/?. a °
2
REINFORCED PAVING, PCC, 8 INCH,
C-4 W/ 8X15 6X6 4X4 GAUGE SHEETS
SY
296.2
,Q. OC
$ S -6.
$ /Y, '< `-"s ,`
3
MANHOLE REPAIR, AS PER DETAIL
EACH
2.0
$ Z 2or o°
$ y`1`0ti
4
FURNISH AND INSTALL BASE PLATE
EACH
2.0
$ i Sa `'G
$ .3, v"
5
FURNISH AND INSTALL MANHOLE
FRAME AND COVER
EACH
2.0
$ g do . cA"
$ iL u a , u
6
PARTIAL DEPTH CONCRETE REPAIR
ON GATE SILL
LS
1.0
$ S a -'@'s' `"-)
$ C-\°-"
TOTAL DIVISION 2 $ .3 U c S" 3 . 00 /16
TOTAL DIVISION 1 BASE BID + ALTERNATE A OPTION 1 + DIVISION 2 /
$ / LI.b t> C
TOTAL DIVISION 1 BASE BID + ALTERNATE A OPTION 2 + DIVISION 2
.
$ 111-1 f:. z s `r
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
FORM OF BID
CONTRACT NO. 879 Page 3 of 5
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 Le - ,c0,...1
Dollars ($ 5u10 ) in the form of �,c1
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 ( X ), 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:
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. 879 Page 4 of 5
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.
(Name of Bidder)
BY: Title
Official Address: (Including Zip Code):
loo Sud ,ve
to ot,j l b
(Date)
-Pres ► /c_!3
Gr�rt•A.T �lll
I.R.S. No. x-12- \\o2..1-koo
FORM OF BID
CONTRACT NO. 879 Page 5 of 5
i
State of bra
County of Polk
NON -COLLUSION AFFIDAVIT OF PRIME BIDDER
)ss
--g..)i2,r� evu,,,.Q..,. , being first duly sworn, deposes and says that:
1. Hen is (Owner, Partner, o fficer, ' epresentative, or Agent) , of i ,ue.- a
h�S'Vy-jS'nc, , the Bidder t -t 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
(Signed)
affiant.
Tres, ,.
Title C
Subscribed and sworn to before me this ) day of
C%cY-e ,
My commission expires /1— /.S--/ L
LISA CROYLE
b Commission Number 781379
tom. =. My Commission Expires
Title
NON -COLLUSION AFFIDAVIT OF SUBCONTRACTOR
State of )
County of )
, being first duly sworn, deposes and says
that:
) ss:
1. He is (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
RESIDENT BIDDER CERTIFICATION
CONTRACT NO: 819
PROJECT NAME: f Y Z 1 2 -;ca p/1„,- ac,‘
DATE OF LETTING: v,547 & Occ1.44,2,f Z6/6,
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 defined above.
COMPANY NAME t ,ra4,-o,, c So i 5
CORPORATE OFFICER
TITLE -Pres ;(C A
DATE kloS7i6
CONTRACT NO.:
PROJECT NAME:
DATE OF LETTING:
NON-RESIDENT BIDDER CERTIFICATION
1 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.
MBEIWBE BUSINESS ENTERPRISE
I PRE-BID CONTACT INFORMATION FORM
Prime Contractor Name: C1a 9+r cod Assc,,,A,:, Project: 2c,i-7 3<zAgQ a,, Letting Date: I0jra6f (b
NO MBEIWBE 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: ?43.; /.yl/c, Date: ioia1„/;b
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
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
7o-n)e_ks :2_ O
tc hio
N 5
I,/4//4
4/o
-DC porn-`
Iuicfi jib
\I "6
lol t_ 1/ (
Y 2S
4 Z' t o'°
C,,Le; s Q S
Ili oto
N 0
Cli-s,cA,- C„,5,1,,k,,
145-100
/-5
,fie / 4 /i 4
(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) MBENVBE 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 MBENVBE 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 MBENVBE 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 MBENVBE 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 MBENVBE business submitting bids are not selected for subcontract award, documentation must accompany the "MBENVBE BUSINESS
ENTERPRISE PRE-BID CONTACT INFORMATION FORM" on why the MBENVBE 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 MBENVBE 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 MBENVBE 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 MBENVBE in which the
MBENVBE promises not to provide subcontracting quotations to other bidders/proposers are prohibited.
Form CCO-4A Rev. 07-08-02
BID BOND
KNOW ALL MEN BY THESE PRESENTS, that we, Cramer and Associates, Inc
as Principal, and Western Surety Company
as Surety are held and firmly bound unto the CITY OF WATERLOO , Iowa, hereinafter called
"OWNER." In the penal sum Five Percent of the Total Amount 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 conditj n of this obligation is such that
whereas the Principal has submitted the accompanying bid dated the day of October
, 20 16 , for F Y 9017 Rridg- Deck Repair and Overlay Program
Contract No. 879
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 6 day of October , A.D. 201 6 .
Cra et d)ssociates, Inc. (Seal)
Pri�"al
Witness LL
C
Witness
By
(Title)
Western Sur: Com . an (Seal)
Surety
By
Attorney- fact
Timothy J. Smith
Western Surety Company
POWER OF ATTORNEY APPOINTING INDIVIDUAL ATTORNEY-IN-FACT
Know All Men By These Presents, That WESTERN SURETY COMPANY, a South Dakota corporation, is a duly organized and existing corporation
having its principal office in the City of Sioux Falls, and State of South Dakota, and that it does by virtue of the signature and seal herein affixed hereby
make, constitute and appoint
Laura A Foust, Scott A Saveraid, Timothy J Smith, Brian C Matlock, Thomas R Schwab,
Debra J Mills, Joyce L Briggs, Michael F Wernsman, Individually
of Davenport, IA, its true and lawful Attorney(s)-in-Fact with full power and authority hereby conferred to sign, seal and execute for and on its behalf bonds,
undertakings and other obligatory instruments of similar nature
- In Unlimited Amounts -
and to hind it thereby as fully and to the same extent as if such instruments were signed by a duly authorized officer of the corporation and all the acts of said
Attorney, pursuant to the authority hereby given, are hereby ratified and confirmed.
This Power of Attorney is made and executed pursuant to and by authority of the By -Law printed on the reverse hereof, duly adopted, as indicated, by
the shareholders of the corporation.
In Witness Whereof, WESTERN SURETY COMPANY has caused these presents to be signed by its Vice President and its corporate seal to be
hereto affixed on this 3rd day of June, 2016.
State of South Dakota
County of Minnehaha
Ss
WESTERN SURETY COMPANY
ul T. Bruflat, Vice President
On this 3rd day of June, 2016, before me personally cane Paul T. Bruflat, to me known, who, being by me duly sworn, did depose and say: that he
resides in the City of Sioux Falls, State of South Dakota; that he is the Vice President of WESTERN SURETY COMPANY described in and which executed
the above instrument; that he knows the seal of said corporation; that the seal affixed to the said instrument is such corporate seal; that it was so affixed
pursuant to authority given by the Board of Directors of said corporation and that he signed his name thereto pursuant to like authority, and acknowledges
same to he the act and deed of said corporation.
My commission expires
June 23, 2021
CERTIFICATE
J. Mohr, Notary Public
I, L. Nelson, Assistant Secretary of WESTERN SURETY COMPANY do hereby certify that the Power of Attorney hereinabove set forth is still in
force, and further certify that the By -Law of the corporation printed on the reversehereofis still in force. In testimony whereof I have hereunto subscribed
my name and affixed the seal of the said corporation this day of C— tOklar
Form F4280-7-2012
WESTERN SURETY COMPANY
L. Nelson, Assistant Secretary
Authorizing By -Law
ADOPTED BY THE SHAREHOLDERS OF WESTERN SURETY COMPANY
This Power of Attorney is made and executed pursuant to and by authority of the following By -Law duly adopted by the shareholders
of the Company.
Section 7. All bonds, policies, undertakings, Powers of Attorney, or other obligations of the corporation shall be executed in the
corporate name of the Company by the President, Secretary, and Assistant Secretary, Treasurer, or any Vice President, or by such other
officers as the Board of Directors may authorize, The President, any Vice President, Secretary, any Assistant Secretary, or the Treasurer
may appoint Attorneys in Fact or agents who shall have authority to issue bonds, policies, or undertakings in the name of the Company.
The coporate seal is not necessary for the validity of any bonds, policies, undertakings, Powers of Attorney or other obligations of the
corporation. The signature of any such officer and the corporate seal may be printed by facsimile.