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Boulder Contracting, LLC
25789 N Ave, Grundy Center, IA 50638
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MY OF WATERLOO
ITY CLERK'S OFFICE
Al 14 2019 pm12:51:49
25789 N. Ave.
Grundy Center, IA 50638
CITY OF WATERLOO
TY CLERK'S OFFICE
14 2019 N12:51:56
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Revised Per Addendum No. 1 - 02108/2019
FORM OF BID OR PROPOSAL
CITY OF WATERLOO FY 2019 BRIDGE REPAIRS
DUBUQUE ROAD OVER BLOWERS CREEK AND
GREENHILL ROAD OVER TROLLEY CAR TRAIL
CONTRACT NO. 959
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 1-04,44 , 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 CITY OF WATERLOO FY
2019 BRIDGE REPAIRS, DUBUQUE ROAD OVER BLOWERS CREEK AND GREENHILL ROAD
OVER TROLLEY CAR TRAIL, City Contract No. 959, all in accordance with the above -listed
documents and for the unit prices for work in place for the following items and quantities:
CITY OF WATERLOO FY 2019 BRIDGE REPAIRS
DUBUQUE ROAD OVER BLOWERS CREEK AND
GREENHILL ROAD OVER TROLLEY CAR TRAIL
CITY CONTRACT NO. 959
ITEM
NO.
ITEM
CODE
ITEM
UNIT
SITE 1 -
GREENHILL
RD
SITE 2 -
DUBUQUE
RD
TOTAL
Qom'
UNIT BID
PRICE
TOTAL BID
PRICE
ESTIMATED
QTY.
ESTIMATED
QTY
1
IDOT 2107
COMPACTING BACKFILL
ADJACENT TO
BRIDGES, CULVERTS
OR STRUCTURES
CY
150.0
0.0
150.0
$ 140 . 00
$ 6, at10. oo
2
100T 2121
GRANULAR
SHOULDERS, TYPE "9"
AS PER PLAN
TON
0.0
133.0
133.0
$ 23.00
$ 5,0 59 • 0 0
3
IDOT 2301
TWOD LANEPROACH,
SY
906.0
614.0
1,520.0
$ 47. 00
$ I cr1 olo.00
4
IDOT 2301
MEDIAN, PC
CONCRETE, AS PER
PLAN
SY
36.0
0.0
36.0
$ I15-.60
$ ii,iti0.06
5
IDOT 2304
DETOUR PAVEMENT
SY
0.0
310.0
310.0
$ bil . Db
$ 1 9, No .00
6
!DOT 2413
NEOPRENE GLAND
INSTALLATION AND
TESTING
LF
0.0
289.0
289.0
$ 43.00
$ 1/, 65-2 . oo
7
LOOT 24'14
CONCRETE BARRIER
RAIL, BA -107
EACH
4.0
0.0
4.0
$ 3, 300. o0
$ I 3, 2oa .00
8
!DOT 2507
MACADAM STONE SLOPE PROTECTION
SY
1,050.0
0.0
1,050
$ 2`�• �%0
$ ZS, 100 00
9
IDOT 2508
BLAST CLEAN AND
PAINT BEARING PLATE
EACH
0.0
4.0
4.0
$ 1200. 0 U
t
$ '4t 800 .00
FORM OF BID
AECOM #60581804
FB -1 of 3
City Contract No. 959
City of Waterloo FY 2019 Bridge Repairs
Dubuque Road Over Blowers Creek and
Greenhill Road Over Trolley Car Trail
Revised Per Addendum No. 1 - 02/0812019
ITEM
NO.
ITEM
CODE
ITEM
UNIT
SITE 1 -
GREENHILL
RD
SITE 2 -
DUBUQUE
RD
TOTAL
QTY.
UNIT BID
PRICE
TOTAL BID
PRICE
ESTIMATED
QTY.
ESTIMATED
QTY
10
/DOT 2510
REMOVAL OF
PAVEMENT
SY
942.0
924.0
1,866.0
$ 12 . oo
$ 2Z, 3q2 .00
11
/DOT 2518
SAFETY CLOSURE
EACH
4.0
4.0
8.0
$ 105, oo
$ Stl0• 00
12
/DOT 2529
PRESSURE RELIEF
JOINT, CF
LF
185.0
0.0
185.0
$ 9. m)
$ 11(065. a o
13
SUDAS
8020
PAINTED PAVEMENT
MARKING
STA
7.2
2.0
9.2
$ s • oD
2S
$ 2, 3,4(0.00
14
SUDAS
8030
TRAFFIC CONTROL
LS
1.0
1.0
2.0
$ 1,)-b.oa
r $ 2� 5d0• b0
15
SUDAS
11.010
CONSTRUCTION
SURVEY
LS
1.05-10.00)
1.0
2.0
$
$ I IOW - oU
16
SUDAS
11.020
MOBILIZATION
LS
1.0
1.0
2.0
$ 5,000.x,
$ GO
17
PLAN
REPLACE GUARDRAIL
AND TIMBER POSTS
LF
20.0
30.0
50.0
$ Az. 00
$ 1,:(100. oc
18
PLAN
FURNISH AND INSTALL
EXPANSION JOINT
CURB PLATE
EA
0.0
1.0
1.0
$ b75.00
$ 1875". OU
19
PLAN
REPAIR BARRIER RAIL
LS
0.0
1.0
1.0
$ 7, 200.0Q
$ 7, 20 p .00
TOTAL BID AMOUNT
$ 33,4 , 7,(8. 00
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 J %
Dollars ($ ) in the form of
8/0 /301/Q0 , 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 Bidders Status Form.
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. 1 Date 210 °f y
City of Waterloo FY 2019 Bridge Repairs
FORM OF BID FB -2 of 3 Dubuque Road Over Blowers Creek and
AECOM #60581804 City Contract No. 959 Greenhill Road Over Trolley Car Trail
Revised Per Addendum No. 1 - 02/08/2019
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.
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.
eu(DEve, cabsaz A G/ L C C.
(Name of Bidder)
Z/w/ZEf/9
(Date)
BY: ( Title f%.veiX-s2
Official Address: (Including Zip Code):
157139 N Ave
Get iDy CEnTEtt, 1* 515638
I.R.S. No. 27 -30 1�-Z 4/83
FORM OF BID FB -3 of 3
AECOM 1(60581804 City Contract No. 959
City of Waterloo FY 2019 Bridge Repairs
Dubuque Road Over Blowers Creek and
Greenhill Road Over Trolley Car Trail
NON -COLLUSION AFFIDAVIT OF PRIME BIDDER
State of /A )
)ss
County of 6w0 E! )
j)4vrr{i (,I¢eSCrvQcI .ccs , being first duly sworn, deposes and says that:
1. He is •wner "artner, Officer, Representative, or Agent) , of +tcvf i— 6iv -#t 1r e L. it.G .
, 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.
20_.
(Signed)
Title
Subscribed and sworn to before me this /4/tilf day of t-rrgkvA01
My commission expires /v»47 /6 , ?coo
DAVID CAPSOPOULOS
Notarial Seal — Iowa
Commission Number 804393
My Co • sion pig Ma 16, 2020
Title
��.Ifr T -'4E&
City of Waterloo FY 2019 Bridge Repairs
NON -COLLUSION AFFIDAVITS NCA -1 of 2 Dubuque Road Over Blowers Creek and
AECOM #60581804 City Contract Nol. 959 Greenhill Road Over Trolley Car Trail
INFORMATION NEEDED
FOR
IOWA CONSTRUCTION SALES TAX EXEMPTION CERTIFICATE
CONTRACTOR NAME:
4,0
ADDRESS: .g57$1 /L. /1ve we...
�92ww17y £ 4"n -/rft CO to 3
(Check One)
FEDERAL ID#:
PRIME
7 -34.7 a ve3
SUBCONTRACTOR
PROJECT NAME: 2014 a.4 -C -06/S (1 , t4Z-5
PROJECT CONTRACT NO.:
qs9
DESCRIPTION OF WORK:
❑ Brickwork
❑ Carpentry
❑ Concrete
E Drywall -Plaster -Insulation
❑ Electrical
❑ Excavation/Grading
❑ Flooring
LI Heavy Construction
9 Heating -Ventilating -Air Cond
9 Landscaping
❑ Painting
❑ Paving
9 Plumbing
❑ Roofing -Siding -Sheet Metal
0 Windows
❑ Wrecking -Demolition
❑ Other (Please specify)
SALES TAX EXEMPTION CERT STE-1 of 1
AECOM 960581804 City Contract No. 959
City of Waterloo FY 2019 Bridge Repairs
Dubuque Road Over Blowers Creek and
Greenhill Road Over Trolley Car Trail
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:
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 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,
City of Waledoo FY 2019 Bridge Repairs
EQUAL OPPORTUNITY CLAUSE EOC-1 of 2 Dubuque Road Over Blowers Creek and
AECOM 1160581804 City Contract No. 959 Greenhill Road Over Trolley Car Trail
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)
(Approp"1/15c47
late icial)
City of Waterloo FY 2019 Bridge Repairs
EQUAL OPPORTUNITY CLAUSE EOC-2 of 2 Dubuque Road Over Blowers Creek and
AECOM 1160581804 City Contract No. 959 Greenhill Road Over Trolley Car Trail
Bidder Status Form
To be completed by all bidders Part A
Please answer "Yes" or "No" for each of the following:
Yes No
[4 Yes
Yes
Yes
❑ No
❑ No
❑ No
Eia Yes ❑ No
My company is authorized to transact business in Iowa.
(To help you determine if your company is authorized, please review the worksheet on the next page).
My company has an office to transact business in Iowa.
My company's office in Iowa is suitable for more than receiving mail, telephone calls, and e-mail.
My company has been conducting business in Iowa for at least 3 years prior to the first request for
bids on this project.
My company is not a subsidiary of another business entity or my company is a subsidiary of another
business entity that would qualify as a resident bidder in Iowa.
If you answered "Yes" for each question above, your company qualifies as a resident bidder. Please
complete Parts B and D of this form.
If you answered "No" to one or more questions above, your company is a nonresident bidder. Please
complete Parts C and D of this form.
To be completed by resident bidders Part B
My company has maintained offices in Iowa during the past 3 years at the following addresses:
Dates: l / l / i 0 to /Qrtrv5Arer Address' ;5149 N• I11✓6µ&
City, State, Zip.
Dates: / / to / / Address:
City, State, Zip.
Dates: / / to / / Address.
You may attach additional sheet(s) if needed. City, State, Zip:
am,op
C-�eNTrr.I�
To be completed by non-resident bidders Part C
1. Name of home state or foreign country reported to the Iowa Secretary of State:
2. Does your company's home state or foreign country offer preferences to resident bidders, resident labor ❑ Yes ❑ No
force preferences or any other type of preference to bidders or laborers?
3. If you answered "Yes" to question 2, identify each preference offered by your company's home state or foreign country
and the appropriate legal citation.
You may attach additional sheet(s) if needed.
To be completed by all bidders Part D
certify that the statements made on this document are true and complete to the best of my knowledge and I know that my
failure to provide accurate and truthful information may be a reason to reject my bid.
Firm Name:
Signature:
Oo,.«or i_ovre.4A-t i_L-L.
Date: 02/`119
You must submit the completed form to the governmental body requesting bids per 875 Iowa Administrative Code
Chapter 156. This form has been approved by the Iowa Labor Commissioner.
309-6001 (09-15)
BSF-1
Worksheet: Authorization to Transact Business
This worksheet may be used to help complete Part A of the Resident Bidder Status form. If at least one of the following
describes your business, you are authorized to transact business in Iowa.
b6 Yes No
[n Yes ❑ No
❑ Yes 1:4 No
[zt Yes ❑ No
❑Yes 0No
My business is currently registered as a contractor with the Iowa Division of Labor.
My business is a sole proprietorship and I am an Iowa resident for Iowa income tax purposes.
My business is a general partnership or joint venture. More than 50 percent of the general
partners or joint venture parties are residents of Iowa for Iowa income tax purposes.
My business is an active corporation with the Iowa Secretary of State and has paid all fees
required by the Secretary of State, has filed its most recent biennial report, and has not filed
articles of dissolution.
My business is a corporation whose articles of incorporation are filed in a state other than Iowa,
the corporation has received a certificate of authority from the Iowa secretary of state, has tiled
its most recent biennial report with the secretary of state, and has neither received a certificate of
withdrawal from the secretary of state nor had its authority revoked.
Yes ICeg No My business is a limited liability partnership which has filed a statement of qualification in this
state and the statement has not been canceled.
❑ Yes InNo
My business is a limited liability partnership which has filed a statement of qualification in a
state other than Iowa, has filed a statement of foreign qualification in Iowa and a statement of
cancellation has not been filed.
O Yes ® No My business is a limited partnership or limited liability limited partnership which has filed a
certificate of limited partnership in this state, and has not filed a statement of termination.
O Yes E JNo
My business is a limited partnership or a limited liability limited partnership whose certificate of
limited partnership is filed in a state other than Iowa, the limited partnership or limited liability
limited partnership has received notification from the Iowa secretary of state that the application
for certificate of authority has been approved and no notice of cancellation has been filed by the
limited partnership or the limited liability limited partnership.
[I Yes ❑ No My business is a limited liability company whose certificate of organization is filed in Iowa and has
not filed a statement of termination.
❑ Yes [71, No
My business is a limited liability company whose certificate of organization is filed in a state other
than Iowa, has received a certificate of authority to transact business in Iowa and the certificate
has not been revoked or canceled.
309-6001 (09-15)
BSP -2
MBE/WBE BUSINESS ENTERPRISE
PRE-BID CONTACT INFORMATION FORM
Prime Contractor Name: 3o�r-of4— (ownu��rrnr� LAY-- Project: o2D14 set -r06, -i. efpa-ricS Letting Date:
a/y j 9
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: li•SrcM.+-rc>e--
Date: .2/4-1/q
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
nn
1),44as4,..'s (-(owulf. 1`,t...ervo ,.cr+.n.vr
,/ii -i1 r R
N 0
N /k
OIA.GGIc- (0.41 4rOv-c
314/1
`1 E5
277Y /I %
0
N (ti-
(Form CCO-4) Rev. 06-20-02
MBENVBE PARTICIPATION
AECOM #60581804
M-6 of 6
City Contract No. 959
City of Waterloo FY 2019 Bridge Repairs
Dubuque Road Over Blowers Creek and
Greenhill Road Over Trolley Car Trail
BID BOND
KNOW ALL MEN BY THESE PRESENTS, that we, Boulder Contracting, LLC
as Principal, and
Westfield Insurance Company
as Surety are held and firmly bound unto the CITY OF WATERLOO , Iowa, hereinafter called
"OWNER." In the penal sum
Dollars ($ 5%
Five Percent of Amount Bid
)lawful money of the United States, for the payment
of which sum will and truly be made, we bind ourselves, our heirs, executors, administrators, and
successors, jointly and severally, firmly by these presents. The condition of this obligation is such that
whereas the Principal has submitted the accompanying bid dated the 14th day of
February , 2019, for FY 2019 Bridge REpairs Dubuque Road over Blowers Creek and
Greenhill Road Over Trolley Car Trail
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 pres-
ents to be signed by their proper officers this 14th day of February , A.D. 201
Boulder Contracting, LLC (Seal)
Principal
By
(Title)
Witness
Wj{ness
Westfield Insurance Company (Seal)
Surety
By Nn A4are4 VIM-, riot
Nancy D. Baltutat, Attorney-in-fact
BIO BOND BB -1 OF 1
City Contract No. 959
AECOM #60581804
City of Waterloo FY 2019 Bridge Repairs
Dubuque Road Over Blowers Creek and
Greenhill Road Over Trolley Car Trail
THIS POWER OF ATTORNEY SUPERCEDES ANY PREVIOUS POWER BEARING THIS SAME
POWER # AND ISSUED PRIOR TO 06107/16, FOR ANY PERSON OR PERSONS NAMED BELOW.
General
Power
of Attorney
CERTIFIED COPY
POWER NO. 1429172 00
Westfield Insurance Co.
Westfield National Insurance Co.
Ohio Farmers Insurance Co.
Westfield Center, Ohio
Know All Men by These Presents, That WESTFIELD INSURANCE COMPANY, WESTFIELD NATIONAL INSURANCE COMPANY and OHIO
FARMERS INSURANCE COMPANY, corporations, hereinafter referred to individually as a "Company' and collectively as "Companies," duly
organized and existing under the laws of the State of Ohio, and having its principal office in Westfield Center, Medina County, Ohio, do by these
presents make, constitute and appoint
MARK E. KEAIRNES, JOSEPH I. SCHMIT, JEFFREY R. BAKER, JILL SHAFFER, GREG T. LAMAIR, NANCY D. BALTUTAT,
PATRICK K. DUFF, CHRISTOPHER R. SEIBERLING, JOINTLY OR SEVERALLY
of WEST DES MOINES and State of IA its true and lawful Attorney(s)-In-Fact, with full power and authority hereby conferred in Its name,
place and stead, to execute, acknowledge and deliver any and all bonds, recognizances, undertakings, or other instruments or contracts of
suretyship -' - _ _ .... - - -.. .. ...
LIMITATION: THIS POWER OF ATTORNEY CANNOT BE USED TO EXECUTE NOTE GUARANTEE, MORTGAGE DEFICIENCY, MORTGAGE
GUARANTEE, OR BANK DEPOSITORY BONDS.
and to bind any of the Companies thereby as fully and to the same extent as if such bonds were signed by the President, sealed with the corporate
seal of the applicable Company and duly attested by Its Secretary, hereby ratifying and confirming all that the said Attorney(s)-In-Fact may do In
the premises. Said appointment Is made under and by authority of the following resolution adopted by the Board of Directors of each of the
WESTFIELD INSURANCE COMPANY, WESTFIELD NATIONAL INSURANCE COMPANY and 01-110 FARMERS INSURANCE COMPANY:
"Be It Resolved, that the President, any Senior Executive, any Secretary or any Fidelity & Surety Operations Executive or other Executive shall
be and is hereby vested with full power and authority to appoint any one or more suitable persons as Attorney(s)-in-Fact to represent and act for
and on behalf of the Company subject to the following provisions:
The Attorney -in -Fact. may be given full power and authority for and in the name of and on behalf of the Company, to execute, acknowledge and
deliver, any and all bonds, recognizances, contracts, agreements of Indemnity and other conditional or obligatory undertakings and any and all
notices and documents canceling or terminating the Company's liability thereunder, and any such Instruments so executed by any such
Attorney -in -Fact shall be as binding upon the Company as if signed by the President and sealed and attested by the Corporate Secretary."
"Be it Further Resolved, that the signature of any such designated person and the seal of the Company heretofore or hereafter affixed to any
power of attorney or any certificate relating thereto by facsimile, and any power of attorney or certificate bearing facsimile signatures or facsimile
seal shall be valid and binding upon the Company with respect to any bond or undertaking to which It is attached" (Each adopted at a meeting
held on February 8, 2000).
In Witness Whereof, WESTFIELD INSURANCE COMPANY, WESTFIELD NATIONAL INSURANCE COMPANY and OHIO FARMERS INSURANCE
COMPANY have caused these presents to be signed by their National Surety Leader and Senior Executive and their corporate seals to be hereto
affixed this 07th day of JUNE
Corporate
\a911R4'vt" ' ,t`o` ....•A( On i irk''„ :. lq$tto, ,,. WESTFIELD INSURANCE COMPANY
p,••• ••. i•"t �; ••• s� t?. WESTFIELD NATIONAL INSURANCE COMPANY
Affixed ; .w 1,p O: '•,� ,;r �r OHIO FARMERS INSURANCE COMPANY
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State of Ohio
County of Medina ss.:
By:
Dennis P. Baus, National Surety Leader and
Senior Executive
On this 07th day of JUNE A.D., 2016 , before me personally came Dennis P. Baus to me known, who, being by me duly sworn, did
depose and say, that he resides In Wooster, Ohio; that he is National Surety Leader and Senior Executive of WESTFIELD INSURANCE
COMPANY, WESTFIELD NATIONAL INSURANCE COMPANY and OHIO FARMERS INSURANCE COMPANY, the companies described In and Which
executed the above Instrument; that he knows the seals of said Companies; that the seals affixed to said instrument are such corporate seals; that
they were so affixed by order of the Boards of Directors of said Companies; and that he signed his name thereto by like order.
Notarial
Seal
Affixed
State of Ohio
County of Medina ss.:
David A. Kotnik, Attorney at Law, Notary Public
My Commission Does Not Expire (Sec. 147.03 Ohio Revised Code)
I, Frank A. Carrino, Secretary of WESTFIELD INSURANCE COMPANY, WESTFIELD NATIONAL INSURANCE COMPANY and OHIO FARMERS
INSURANCE COMPANY, do hereby certify that the above and foregoing is a true and correct copy of a Power of Attorney, executed by said
Companies, which Is still In full force and effect; and furthermore, the resolutions of the Boards of Directors, set out In the Power of Attorney are
in full force and effect.
In Witness Whereof, I have hereunto set my hand and affixed the seals of said Companies at Westfield Center, Ohio, this 14th day of
February ,42;w 1g
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SEAL
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Frank A. Carrino, Secretary
Secretary