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CITY OF WATERLOO, IOWA
WATERLOO LEISURE SERVICES COMMISSION
BIDDER: ► SBrn
CO PANY NAME
BID FORM
for
2016 TREE REMOVAL PROJECT
-P�
ADDRESS: Gla Stno✓L
lA".P.SCo )_TA
PHONE: (510' ) 647- LI (936
1. The undersigned, being a Corporation existing under the laws of the State of 1✓/q ,
a Partnership consisting of the following partners: Nte)
having been familiarized with the existing conditions on the project area affecting the
cost of the work, and with all the Contract Documents now on file in the offices of the
City Clerk, City Hall, Waterloo, Iowa, and the Waterloo Leisure Services Commission,
1101 Campbell Ave., Waterloo, Iowa, hereby proposes to furnish all supervision,
technical personnel, labor, materials, machinery, tools, equipment, and services,
including utility and transportation services required to complete the proposed 2016
TREE REMOVAL PROJECT, in accordance with the contract documents and for the bid
prices for the removal and disposal of trees & associated stumps in city parks (C.A.
Morris Park and Bontrager Park) as described in the attached documents for the
following amount:
OPTION 1: BONTRAGER PARK (42 tree & 42 stump removals)
qY cn,cLten l rnto dnL i,vo `bu.<.ndnzi{v Dollars ($ j�ya€€(D )
BID PRICE (/ 1
OPTION 2: C.A. MORRIS PARK (27 tree & 37 stump removals)
g Gn, ✓ac rwb . ILL/ 44d 4p Dollars ($ )8, Dig )
a� PRICE
OPTION 3: BONTRAGER PARK & C.A. MORRIS PARK
(69 tree & 79 stump removals)
l iu�,,o-B.,-t� rune t i, avit p,i[le. ' Dollars ($ 36)114 )
(PR
BIDC IJ
BID FORM page I of 3
2. In submitting this bid, the Bidder understands that the City reserves the right to reject
any or all bids. If written notice of acceptance of this Bid is mailed or delivered to the
undersigned within thirty (30) days after Bid Opening, of 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this bid is withdrawn, the undersigned agrees to execute and deliver an agreement in the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 insurance within ten (10)
days after the agreement is presented for signature, and start work within ten (10) days
after "Notice to Proceed" is issued.
3. Security in the sum of Ail,I ncsin L G44,) t Ota 401b'ilars ($ L{Q,,°) )
in the form of Pad u , is submitted herewith in accordance
with NOTICE TO BIDDERS.
4. Attached is a Non -Collusion Affidavit of Prime Contractor.
5. The Bidder is prepared to submit a financial and experience statement upon request.
6. 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.
7. The Bidder has received the following Addendum or Addenda:
Addendum No. NA
Date: A*1-/ /
/ /
/ /
8. The Bidder shall list the MBE/WBE subcontractors, amount of subcontracts and bid
items listed on the City of Waterloo Minority and /or Women Business Pre-bid Contract
Information Form submitted with this Bid Form. 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 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
BID FORM page 2 of 3
9. The Bidder shall list all equipment available for this project:
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10. The Bidder has filled in all blanks on this proposal. Those blanks not applicable are
marked "none" or "NA".
11. The bidder has attached all applicable forms.
12. The owner reserves the right to select alternatives, delete line items, and/or to reduce
quantities prior to the Award of Contract due to budgetary limitations.
SIGNED:
DATE: q / 1 / 1(o
BID FORM page 3 of 3
NON -COLLUSION AFFIDAVIT OF PRIME BIDDER
State oft'' oc� )
County of 4ou a d ) )
eJ�1 Y YVtken
, being first duly sworn, deposes and says that:
1. He is (Owner), (Partner), (Officer), (Representative), or (Agent) of W Ago-) ascci Myt
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.
OLon&r
Title
5uthbcrLlred cu d'.-uorwto-before meth '
js-f day of QtpteJy 201
SCruxtu.rer 7ttler
Mycommiimican, e4g3 re4, OAP17./ 17
NON -COLLUSION AFFIDAVIT OF SUBCONTRACTOR
State of Ni )
County of
N/ ,/q
that:
, being first duly sworn, deposes and says
1. He is (Owner), (Partner), (Officer), (Representative), or (Agent) of NA
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 %//A , contract
pertaining to the 2015 STUMP REMOVAL, PROJECT in Waterloo, Black Hawk County,
Iowa;
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;
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.
<ti/A A//A
Signature Title
SUbscrthecLcw�/Lsworn. to -lm vre-meith.is,
N%--- clay of --N-eL-lr , 2015.
W,� NF✓
Slgnatuee. r
My carlimi-44410-14, fret AZ/A
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 contractor, 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:
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 advertisements 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.
5. The contractor, subcontractor vendor 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
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.
EQUAL OPPORTUNITY CLAUSE PAGE 1 OF 2
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 will 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:
�hvniAJ
n
l.r�.—e3`„
Appropriate Official
Title
Date
EQUAL OPPORTUNITY CLAUSE PAGE 2 OF 2
Bond No. 41353891
1311.) BOND
1010W 10W ALL MENl3Y 'THESE PRESENTS, that we,
Jeff Wilson dba Wilson Custom Tree, 212 Short Ave,
Cresco, IA 52136_ iis Principal, €ttati Platte River Insurance Company, PO Box 5900, Madison, WI 53705-0900
as Surety are held and firmly bound unto the t_it\ of Waterloo, Iowa, heleinafier called "OWNER". In thc penal
sum Five Percent (5%) of Amount Bid—_ �___�_ do11ld i
(3; 5% of Amount Bid ) lawful mystic:} of thy: t_Init4d States, for ht. paytilent of which sum will and truly be made.
we bind ourselves, our hairs, executors.. administrators, and successors, jointly aid ;t 'e.rally, firmly by WOW
I,1r4k4,711tS, The condition of this obligation i5 such that whereas the Piiric-ipal has submitted the accompanying
nyring
bid cltttd the lst ilii' orSeptember 20 16 , for 2016 Tree Removal Project
NOW, II-[L>RFFORE,
a) If said Bid shall he r.4jet ted, or in the alternate,
h) If said Bid shall be accepted and the 13rineil.-t,tl shrill execute and deliver a contract in the form s} cified and
shall 111111.111 it bond for his faith:tutl rert lri lance of said turitrttet, land for the paymtni til ail persons performing
labor or furnishing materials in nt ctiot9 tht rcwi111, mid 51iriH m all other respc'ers perform the ;Agreement
created by the aeceptance of said Bine,
Then this obligation shall he void, otherwise the same shall remain in force mid effect: it being cxpre_s: ty
understood and aigried that the liability of lite Surety ti -fir any and all ht tc:tinder hal!, in no event, exceed
the penal amount of this obligation as herein stated,
13y virtue.- of statutory authority, the full amount of this bid bund shall h forfeited to tlic; Ctnner In lijutdatioti of
d:inlaaoes sustained in the event that the Principal tails to execute the contract and proi-ide the bund a4 provided
to the :Tcc:ihc:atiuns or by la -w.
-Fie Safety, for value received, hereby stipulates and age-ees that the oblig=ations of said Surety and its bond =hall
he in nit ciity impaired or affected by any extension of the bait} within which the Owner rnsv aee pt %telt Rid car
execute such contract'arid said Surety does lteleb4 waive notice orally Buell extension
IN W'I'T'NF.SS W11ERCQF. the Principal and the: Surety. have hereunto set their hands and se -al , and •L•luih of
them as are ettrlsc:trtitions, have caused their corporate seals to hr hereto affixed and these pn eiiis to b signed
I,v their proper officers this 30th days of August A:.13- 20 16
whoetz
Jeff Wilson dba Wilson Custom Tree
Frin,zir
B;.
,L)
Platte River Insurance Company
\
(;seat)
otjapeircritic)
itm;ss Rita Jor enson,`ount Specialist Attune -1n-Fa Ronald Kaihoi
(seat)
itt
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PLATTE RIMER INSURANCE COMPANY
POWE : OF ATTORNEY
KNOW ALL MEN BY THESE PRESENTS, That the PLATTE RIVER INSURANCE COMPANY, a corporation of the State of Nebraska, having its
principal offices in the City of Middleton, Wisconsin, does make, constitute and appoint
-------------------------JACK ANDERSON; RONALD KAIHOI--------------- — -- — — — —
41353891
its true and lawful Attorney(s)-in-fact, to make, execute, seal and deliver for and on its behalf, as surety, and as its act and deed, any and all bonds,
undertakings and contracts of suretyship, provided that no bond or undertaking or contract of suretyship executed under this authority shall exceed in
amount the sum of
ALL WRITTEN INSTRUMENTS IN AN AMOUNT NOT TO EXCEED; $20,000,000.00
This :Power of Attorney is.granted and is signed and sealed by facsimile:Under and: by: the authority of the following Resolution adopted. by the Board
of Directors of PLATTE RIVER INSURANCE COMPANY at a meeting duly called and held on the 8th day of January, 2002.
"RESOLVED, that the President, and Vice -President, the Secretary or Treasurer, acting individually or otherwise, be and they hereby are granted the
power and authorization to appoint by a Power of Attorney for the purposes only of executing and attesting bonds and undertakings and other wiiiings
obligatory in the nature thereof, one or more vice-presidents, assistant secretaries and attorneys) -in -fact, each appointee to have the powers and duties
usual to such offices to the Business of the company; the signature of such officers and the seal of the Corporation may be affixed to 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 valid and binding upon the Corporation in the future with respect to any bond or undertaking or other writing obligatory:in the nature
thereof to which it is attached. Any such appointment may be revoked, for cause, or without cause, by any of said officers, at any time."
In connection with obligations in favor of the Florida Department of Transportation only, it is agreed that the power and authority hereby given to the
Attorney -in -Fact includes any and all consents for the release of retained percentages and/or final estimates on engineering and construction contracts
required by the State of Florida Department of Transportation. It is fully understood that consenting to the State of Florida Department of Transportation
making payment of the final estimate to the Contractor and/or its assignee, shall not relieve this surety company of any of its obligations under its bond.
In connection with obligations in favor of the Kentucky Department of Highways only, it is agreed that the power and, authority hereby given to the
Attorney -in -Fact cannot be modified or revoked unless prior written personal notice of such intent has been given to the Commissioner - Department of
Highways of the Commonwealth of Kentucky at least thirty (30) days prior to the modification or revocation.
IN WITNESS WHEREOF, the PLATTE RIVER INSURANCE COMPANY has caused these presents to be signed by its officer undersigned and
its corporate seal to be hereto affixed duly attested, this 27th day of July, 2015.
Attest:
Gary W. Stumper
President
Surety & Fidelity Operations
1
STATE OF WISCONSIN
COUNTY OF DANE j
On the 27th day of July, 2015 before me personally came Stephen J. Stills, to me known, who being by me duly sworn, did depose and say: that he
resides in the County of New York, State of New York; that he is President of PLATTE RIVER INSURANCE COMPANY, the corporation described
herein and which executed the above instrument; that he knows the seal of the said corporation; that the seal affixed to said instrument is such corporate
seal; that it was so affixed by order of the Board of Directors of said corporation and that he signed his name thereto by like order.
S.S.:
se v4suRAive,
'4-4'Q
4 y.4.
SEAL
Cyd �* !ceBRAs, :
PLATTE RIVER INSURANCE COMPANY
Stephen J. Sills
CEO & President
STATE OF WISCONSIN l ss.:
COUNTY OF DANE J
-"9�hbumnm°•
CERTIFICATE
q.
David J. Regele
Notary Public, Dane Co., WI
My Commission Is Permanent
I, the undersigned, duly elected to the office stated below, now the incumbent in PLATTE RIVER INSURANCE COMPANY, a Nebraska
Corporation, authorized to make this certificate, DO HEREBY CERTIFY that the foregoing attached Power of Attorney remains in full force and has
not been revoked; and furthermore, that the Resolution of the Board of Directors, set forth in the Power of Attorney is now in force.
Signed and sealed at the City of Middleton, State of Wisconsin this 30th clay of August , 2 016
Antonio Celii
Secretary
THIS DOCUMENT IS NOT VALiD UNLESS PRINTED ON GREEN SHADED BACKGROUND WITH A RED SERIAL NUMBER IN THE UPPER RIGLLT HAND
CORNER. iF YOU HAVE ANY QUESTIONS CONCERNING THE AUTHENTICITY Oh THIS DOCUMENT CALL, 800-475-4450. PR-PQA (Rev. 07-2015)
r ?alt
55
� er
ACKNOWLEDGEMENT OF SURETY
STATE OF MINNESOTA
COUNTY OF CHIPPEWA —
On this 30th day of August , 2016 , before me, a Notary Public within and for said
County, personally appeared Ronald Kaihoi to me personally known, who being by me duly
sworn he/she did say that he/she is the attorney-in-fact of Platte River Insurance Company ,
the corporation named in the foregoing instrument, and the seal affixed to said instrument is the
corporation seal of said corporation, and sealed on behalf of said corporation by authority of its
Board of Directors and said Ronald Kaihoi acknowledged said instrument to be the free act
and deed of said corporation.
etUa &j -6e0
NOTARY PUBLIC
My Commission Expires r %3(%1
CARR L. ABEL
Notary Public -Minnesota
My Commission Expires Jan 31, 2021
Platte River Insurance Company
1600 Aspen Commons, Middleton, WI 53562
PERFORMANCE BOND
Bond Number 41353901
KNOW ALL PERSONS BY THESE PRESENTS,
That Jeff Wilson dba Wilson Custom Tree as Principal, (hereinafter called the Contractor), and
Platte River Insurance Company as Surety, (hereinafter called Surety), are held and firmly bound unto City of Waterloo,
Iowa as Obligee, (hereinafter called the Owner), in the amount of Thirty Five Thousand Nine Hundred Sixty Four and
No/100 Dollars ($35.964.00), for the payment whereof Contractor and Surety bind themselves, their heirs, executors,
administrators, successors and assigns, jointly and severally, firmly by these presents.
WHEREAS, Contractor has by written agreement dated September 6, 2016 entered into a contract with Owner for 2016
Tree Removal Project in accordance with drawings and specifications prepared by City of Waterloo, Iowa which contract
is by reference made a part hereof, and is hereinafter referred to as the Contract.
NOW, THEREFORE, THE CONDITION OF THIS OBLIGATION is such that if the Contractor shall promptly and faithfully
perform said contract, then this obligation shall be null and void; otherwise it shall remain in full force and effect.
The Surety hereby waives notice of any alteration or extension of time made by the Owner.
Whenever Contractor shall be, and declared by Owner to be in default under the Contract, the Owner having performed
Owner's obligations there under, the Surety may promptly remedy the default, or shall promptly
1) Complete the Contract in accordance with its terms and conditions, or
2) Obtain a bid or bids for completing the Contract in accordance with its terms and conditions, and upon determination
by Surety of the lowest responsible bidder, or, if the Owner elects, upon determination by the Owner and the Surety
jointly of the lowest responsible bidder, arrange for a contract between such bidder and Owner, and make available as
Work progresses (even though there should be a default or a succession of defaults under the contract or contract of
completion arranged under this paragraph) sufficient funds to pay the cost of completion less the balance of the
contract price; but not exceeding, including other costs and damages for which the surety may be liable hereunder,
the amount set forth in the first paragraph hereof. The term "balance of the contract price", as used in this paragraph,
shall mean the total amount payable by Owner to Contractor under the Contract and any amendments thereto, less
the amount properly paid by Owner to Contractor.
Any suit under this bond must be instituted before the expiration of two (2) years from the date on which final payment
under the contract falls due.
No right of action shall accrue on this bond to or for the use of any person or corporation other than the Owner named
herein of the heirs, executors, administrators, or successors of the Owner.
Signed and sealed this 13th day of September, 2016.
MoitAck\AIN,6)
(Witness)
2„ - • >vc _ -
(Witness) Rita J rgens`oAccount Specialist
SBD 013 (12-05)
Jeff Wilson dba Wilson Custom Tree
(Print Name of Principal) (Seal)
(Si
Officer of the Principal)
(Print Name of Officer of the Principal and Title)
Platte River Insurace Company
(Signature of Attorney -in -Fact) (Seal)
Ronald Kaihoi, Attorney -in -Fact
(Print Name of Attorney -in -Fact and title)
Copyright 2006, Capitol Transamerica Corporation Page 1 of 4
Platte River Insurance Company
1600 Aspen Commons, Middleton, WI 53562
LABOR AND MATERIAL PAYMENT BOND
Bond Number 41353901
KNOW ALL PERSONS BY THESE PRESENTS,
That Jeff Wilson dba Wilson Custom Tree as Principal, (hereinafter called the Principal), and
Platte River Insurance Company as Surety, (hereinafter called Surety), are held and firmly bound unto City of
Waterloo, Iowa as Obligee, (hereinafter called the Owner), for the use and benefit of claimants as herein below
defined, in the amount of Thirty Five Thousand Nine Hundred Sixty Four and No/100 Dollars ($35,964.00), for the
payment whereof Principal and Surety bind themselves, their heirs, executors, administrators, successors and
assigns, jointly and severally, firmly by these presents.
WHEREAS, Principal has by written agreement dated September 6, 2016 entered into a contract with Owner for
2016 Tree Removal Project in accordance with drawings and specifications prepared by City of Waterloo, Iowa
which contract is by reference made a part hereof, and is hereinafter referred to as the Contract.
NOW, THEREFORE, THE CONDITION OF THIS OBLIGATION is such that if the Principal shall promptly make
payment to all claimants as hereinafter defined, for all labor and material used or reasonably required for use in
the performance of the Contract, then this obligation shall be void; otherwise it shall remain in full force and effect,
subject, however, to the conditions outlined on the reverse side of this bond:
Signed and sealed this 13th day of September, 2016.
(Mktlit\la
Witness)
(Witness) Rita Jorgenson Account Specialist
SBD 013 (12-05)
Jeff Wilson dba Wilson Custom Tree
(Print Name of Principal) (Seal)
(Sig
icer of the Principal)
(A) ( l 50/i C)()ry e r
(Print Name of Officer of the Principal and Title)
Platte River Insurance Company
1
(Signature of Attorney -in -Fact) (Seal)
Ronald Kaihoi, Attorney -in -Fact
(Print Name of Attorney -in -Fact and title)
SEE CONDITIONS ON PAGE TWO WHICH MUST BE
ATTACHED OR ON THE REVERSE OF THIS DOCUMENT
Copyright 2006, Capitol Transamerica Corporation Page 2 of 4
CONDITIONS
1. A claimant is defined as one having a direct contract with the Principal or with a Subcontractor of the
Principal for labor, material, or both, used or reasonably required for use in the performance of the
Contract, labor and material being construed to include that part of water, gas, power, light, heat, oil,
gasoline, telephone service or rental of equipment directly applicable to the Contract.
2. The Principal named herein and Surety hereby jointly and severally agree with the Owner that every
claimant as herein defined, who has not been paid in full before the expiration of a period of ninety (90)
days after the date on which the last of such claimant's work or labor was done or performed, materials
were furnished by such claimant may sue on this bond for the use of such claimant, prosecute the suit to
final judgment for such sum or sums as may be justly due claimant, and have execution thereon. The
Owner shall not be liable for the payment of any costs or expenses of any such suit.
3, No suit or action shall be commenced hereunder by any claimant.
(a) Unless claimant, other than one having a direct contract with the Principal, shall have given
written notice to any two of the following: The Principal, the Owner, or the Surety herein named,
within ninety (90) days after such claimant did or performed the last of the work or labor, or
furnished the last of the materials for which said claim is made, stating with substantial accuracy
the amount claimed and the name of the party to whom the materials were furnished, or for whom
the work or labor was done or performed. Such notice shall be served by mailing the same by
registered mail or certified mail, postage prepaid, in an envelope addressed to the Principal,
Owner or Surety, at any place where an office is regularly maintained for the transaction of
business, or served in any manner in which legal process may be served in the state in which the
aforesaid project is located, save that such service need not be made by a public officer.
(b) After the expiration of one (1) year following the date on which Principal ceased work on said
Contract, it being understood, however, that if any limitation embodied in t his bond is prohibited
by any law controlling the construction hereof such limitation shall be deemed to be amended so
as to be equal to the minimum period of limitation permitted by such law.
(c) Other than in a state court of competent jurisdiction in and for the county or other political
subdivision of the state in which the project, or any part thereof, is situated, or in the United
States District Court for the district in which the project, or any part thereof, is situated, and not
elsewhere.
4. The amount of this bond shall be reduced by and to the extent of any payment or payments made in good
faith hereunder, inclusive of the payment by Surety of mechanics' hens which may be filed of record
against said improvement, whether or not claim for the amount of such lien be presented under and
against this bond.
SBD 013 (12-05)
Copyright 2006, Capitol Transamerica Corporation Page 3 of 4
Summary Sheet — For Performance and Payment Bond
Bond Number 41353901
Principal Name Jeff Wilson dba Wilson Custom Tree
Obligee City of Waterloo, Iowa
Bond Amount (spelled out — and NO 100/s) Thirty Five Thousand Nine Hundred Sixty Four and
No/100 Dollars
Bond Amount (#s) $35,964.00
Contract Date September 6, 2016
Description of Contract 2016 Tree Removal Project
Architect/Engineer Name N/A
Signature Date September 13, 2016
Name of person signing for Principal Jeffrey Wilson
Title of person signing for Principal Sole Proprietor
Attorney -in -Fact Ronald Kaihoi
SBD 013 (12-05)
Copyright 2006, Capitol Transamerica Corporation Page 4 of 4
ACKNOWLEDGMENT OF PRINCIPAL (Individual)
State of . 10 W
County of 1-itu?(Lrc\
On this 161-t' day of t4�1t try4atvU , in the year r901(o , before me
personally comes LOO' or
to me known and known to me to be the person who is described in and executed the foregoing instrument, and
acknowledges to me that he/she executed the same.
State of
County of
On this day of
personally come(s)
a member of the co -partnership of
to me known and known to me to be the person who ' described in and executed the foregoing instrument, and
acknowledges to me that he/she executed the same as th . ct and deed of the said co -partnership.
Pakto
Notary Public
OWLEDGMENT OF PRINCIPAL (Partnership)
•
OM
April D. Buis
Commission Number 783136
MY COMM EXP.c6)i7/1'7
, in the year , before me
State of
County of
On this day of , in the year , be are me personally come(s)
, to me known, who being duly swo, deposes and says that
he/she resides in the City of that he/she is the of the
, the corporatio ' described in and
Notary Public
ACKNOWLEDGMENT OF PRINCIPA . (Corporation/LLC)
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which executed the foregoing instrument, and that he/she signed his/her name thereto by like • der.
Notary Public
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PLATTE RIVER INSURANCE COMPANY
POWER OF ATTORNEY
KNOW ALL MEN BY THESE PRESENTS, That the PLATTE RIVER INSURANCE COMPANY, a corporation of the State of Nebraska, having its
principal offices in the City of Middleton, Wisconsin, does make, constitute and appoint
41353901
--JACK ANDERSON; RONALD KAIHO
its true and lawful Attorney(s)-in-fact, to make, execute, seal and deliver for and on its behalf, as surety, and as its act and deed,,. any and all bonds,
undertakings and contracts of suretyship, provided that no bond or undertaking or contract of suretyship executed under this authority shall exceed in
amount the sum of •
ALL WRITTEN INSTRUMENTS IN AN AMOUNT NOT TO EXCEED 20,000,000.00
This Power of Attorney isgranted and is signed and sealed by facsimile under: and by the authority of the following Resolution .adopted by the Board
of Directors of PLATTE RIVER INSURANCE COMPANY at a meeting duly called and held on the 8th day of January, 2002,
"RESOLVED, that the President, and Vice -President, the Secretary or Treasurer, acting individually or otherwise, be and they hereby are granted the
power and authorization to appoint by a Power of Attorney for the purposes only of executing and attesting bonds and undertakings and other wnrings
obligatory in the nature thereof, one or more vice-presidents, assistant secretaries and attorney(s)-in-fact, each appointee to have the powers and duties
usual to such offices to the business of the company; the signature of such officers and the seal of the Corporation may be affixed to such powerof
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 valid and binding upon the Corporation in the future with respect to anybond or undertaking or other writing obligatory in the nature
thereof to which it is attached. Any such appointment may be revoked, for cause, or without cause, by any of said officers, at any time."
In connection with obligations in favor of the Florida Department of Transportation only, it is agreed that the power and authority hereby given to the
Attomey-in-Fact includes any and all consents for the release of retained percentages and/or final estimates on engineering and construction contracts
required by the State of Florida Department of Transportation. It is fully understood that consenting to the State of Florida Department of Transportation
making payment of the final estimate to the Contractor and/or its assignee, shall not relieve this surety company of any of its obligations under its bond.
In connection with obligations in favor of the Kentucky Department of Highways only, it agreed that the power and authority hereby given to the
Attorney -in -Fact cannot be modified or revoked unless prior written personal notice of such intent has been given to the Commissioner — Department of
Highways of the Commonwealth of Kentucky at least thirty (30) days prior to the modification or revocation.
IN WITNESS WHEREOF, the PLATTE RIVER INSURANCE COMPANY has caused these presents to be signed by its officer undersigned and
its corporate seal to be hereto affixed duly attested, this 27th day of July, 2015.
Attest:
Gary W. Stamper
President
Surety & Fidelity Operations
1
STATE OF WISCONSIN 1
COUNTY OF DANE } S.S.:
S. a.
01511119UIIMU/4. . .
coaPa/1nrE coli
SEAL {
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PLATTE RIVER.:INSURANCE COMPANY
Stephen J. Sills
CEO & President
On the 27th day of July, 2015 before me personally came Stephen J. Stills, to me known, who being by me duly sworn, did depose and say: that he
resides in the County of New York, State of New York; that he is President of PLATTE RIVER INSURANCE COMPANY, the corporation described
herein and which executed the above instrument; that he knows the seal of the said corporation; that the seal affixed to said instrument is such corporate
seal; that it was so affixed by order of the Board of Directors of said corporation and that he signed his name thereto by like order.
STATE OF WISCONSIN l S.S.:
COUNTY OF DANE
y,yW'w'm'"(ti
CERTIFICATE
David J. Regele
Notary Public, Dane Co., WI
My Commission Is Permanent
I, the undersigned, duly elected to the office stated below, now the incumbent in PLATTE RIVER INSURANCE COMPANY, a Nebraska
Corporation, authorized to Make this certificate, DO HEREBY CERTIFY that the foregoing attached Power of Attorney remains in full force and has
not been revoked; and furthermore, that the Resolution of the Board of Directors, set forth: -in the Power of Attorney is now in force.
Signed and scaled at the City of Middleton, State of Wisconsin this 1 3 th
SEAL
day of
September , 2 01 6
Antonio Celii
Secretary
THIS DOCUMENT IS NOT VALID UNLESS PRINTED ON GREEN SHADED BACKGROUND WITH A RED SERIAL NUMBER IN THE UPPER RIGIIT HAND
CORNER. IF YOU HAVE ANY QUESTIONS CONCERNING THE AUTHENTICITY OF THIS DOCUMENT CALL, 800-475-4450. " PR -POA (Rev. 07-2015)
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ACKNOWLEDGEMENT OF SURETY
STATE OF MINNESOTA
COUNTY OF CHIPPEWA
On this 13th day of September , 2016 , before me, a Notary Public within and for said
County, personally appeared Ronald Kaihoi to me personally known, who being by me duly
sworn he/she did say that he/she is the attorney-in-fact of Platte River Insurance Company ,
the corporation named in the foregoing instrument, and the seal affixed to said instrument is the
corporation seal of said corporation, and sealed on behalf of said corporation by authority of its
Board of Directors and said Ronald Kaihoi acknowledged said instrument to be the free act
and deed of said corporation.
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NOTARY PUBLIC
My Commission Expires IM (/a -I
CARR L. ABEL
Notary Public -Minnesota
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My Commission Expires dell 31, 2021