HomeMy WebLinkAboutVieth Construction CorporationVieth Construction
Corporation
6419 Nordic Dr.
Cedar Falls, IA 50613
3R 20 2019 pM12:40:21
301330 S 4313 h1I3
OOE831Uti IO h1I3
y
Sea /z , bi`r� -For
x-01 ce, I"
zona ra,,, !/ 7
Vieth Construction
Corporation
Dr.
CedarFlls IA
50613
SI:OVZINci SIOZ 81 Ski
3DI330 SM313
z 01?31ki: 30 MID
bc., o -rot ;
cd^��a�'� 4:,t 9-73
FORM OF BID OR PROPOSAL
F.Y. 2019 LINCOLN PARK IMPROVEMENTS
CONTRACT NO. 973
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
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. 2019 LINCOLN PARK IMPROVEMENTS, Contract No. 973, all in accordance with the
above -listed documents and for the unit prices for work in place for the following items and
quantities:
ITE
DESLRIIiF T
F.Y. 2019 LINCOLN PARK IMPROVEMENTS
CONTRACT NO. 973
AL
RI'(
TRAFFIC CONTROL
MOBILIZATION
SILT FENCE, INSTALLATION, REMOVAL,
CLEANOUT
LS
LS 1.00 $� .e.)'$ 3 %
LF 1,298 $ "� $ 3 /
CONSTRUCTION FENCE
LF 2,998 $ 3 $ 9 9
REMOVALS, EXISTING PAVEMENT SY 1,879 $ /2- $ its
REMOVALS, SUNKEN PLAZA LS 1.00 $ /3 v ' $ /2 cJc) -
REMOVALS, LIGHTING EA 4 $ cSO - $
4-55
-$ 2 $ 91
EXCAVATION, CLASS 10
CY
SITE GRADING
10 IMPORTED CLEAN FILL
LS 1.00 $ / ck,e3- $ /v ck; J
CY
107 $ /1 - $ 2c43
11 IMPORTED TOP SOIL CY 143 $ 2 s - $ S 75 ✓
FORM OF BID -ADD 1
CONTRACT NO. 973 Page 1 of 5
12
Bidder
ELECTRICAL INSTALLATION
LS
1
$ 1/ $,(..e..0
$//J, Jo
13
PLUMBING & DRINKING FOUNTAIN
INSTALLATION
LS
1
$ 35', C - '
$ 3�_ cJ Ji; '
14
MODIFIED SUBBASE, COMPACTED
SY
1,755
$ 9
$ 794.r.
15
PCC PAVEMENT, 6"
SY
—
933
$ 51-3-- -
$ 9-< 9`J' S-
16
CONCRETE CURB FOR BRICK
LF
307
$ 20 SI:
6 293:5-
$
17
BRICK PAVERS WITH CONCRETE BASE
SF
3,321
$ /9 -
$ 4.3, O 99
18
PCC, 6" CONCRETE -
STAMPED/COLORED
SY
1,286
$ 36-- -
$ /y 9,jfc) -
19
BENCHES
EA
54
$ ✓v ?5~
$ 5--Z-3, 6,51
20
WASTE RECEPTACLES
EA
8
r
$ J S -
$ /L, Zed
21
ENTRANCE SIGNS
EA
2
$ /2,LJ
$ ZS ck:.o--
22
FLOWER BASKETS FOR LIGHT POLES
EA
16
$ /2-J
$ 2k-) J
23
SHADE TREES
EA
10
$ -2--,S-. -
$ 9-Z
24
TURFGRASS SEEDING
SF
16,000
$ G- �=
$ 51-6
25
DANCE CHIMES & INSTALLATION
LS
1.00
$ (A)U-$
i4,1 c1CJcJ�
26
POROUS PAVEMENT FOR TREE
SURROUNDS
SF
288
$ /2---
$ 3 9-4--c
27
REMOVALS, MISC
LS
1
$ G.5c,j'
$ es -Dc, J
28
CONSTRUCTION SURVEYING & STAKING
LS
1
$ 3c
$ 3 ck.)c)
TOTAL BID
'—c'
$ 68 9 9/ 3 -'—c--'-
Bidder will complete the Work in accordance with the Contract Documents for the following
prices. Items annotated as an ALTERNATE will be considered for inclusion in the contract at the
discretion of the Owner
BASE BID PROPOSAL: Bidder agrees to perform all the work described in the proposed
Contract Documents and shown on the Drawings for the sum of
,S c jv s Z.4."JV f o %' G• /1;_*1 .t/fr .r ..,te, ',ia v® Al/ .,.1C -
Dollars
($ 9 9 / 3 • ---
and figures. In case of discrepancy, the amount shown in words will govern.
). Amount shall be shown in both words
FORM OF BID -ADD 1
CONTRACT NO. 973 Page 2 of 5
ALTERNATE PROPOSAL(S):
Alternate No. 1: If the Owner elects to proceed with Alternate No. 1, ADD the cost of the
electrical contractor furnishing and installing electrical cabinet #4, and providing all associated
devices, equipment and materials. Refer to the documents for additional information.
Add sum of:
Dollars
($ 2J, odd— ).
Alternate No. 2: If the Owner elects to proceed with Alternate No. 2, ADD the cost of the
electrical contractor furnishing and installing electrical cabinet #5, and providing all associated
devices, equipment and materials. Refer to the documents for additional information. Plumbing
contractor shall locate pedestal type hydrant as indicated in the documents.
Add sum of:
Tek -nJ i 7 4,e 2. Dollars
($ � de)d ).
Alternate No. 3: If the Owner elects to proceed with Alternate No. 3, ADD the cost of the
electrical contractor furnishing and installing fiber handholes and associated conduit as
indicated on the plans. Electrical contractor shall provide conduit from inside electrical cabinet
#1 to power handhole near the center of the park as indicated on the plans. Refer to the
documents for additional information.
Add sum of:
Dollars
($ � c1(*)u ).
Alternate No. 4: If the Owner elects to proceed with Alternate No. 4, DEDUCT the cost of the
dance chimes, installation and 16 LF of concrete curb. ADD the cost of installing 30 SF brick
pavers with concrete base in place of the dance chimes, as shown on the plans.
Deduct sum of:
S./ „kir-7 7;?)5 �/�
($ Gv, c) e.)
Add sum of:
64.)0u s0
FORM OF BID -ADD 1
Dollars
Dollars
CONTRACT NO. 973 Page 3 of 5
Net Alternate Price ADD / DEDUCT (ci cle one) Total:
l 7 ,Lt >/1—/ '[/, Dollars
($ <3 c: .)e) ).
Alternate No. 5: If the Owner elects to proceed with Alternate No.4(DEDUCT the cost stamped
colored concrete and ADD the cost of PCC, 6" Concrete.
Deduct sum of: JJ ,
d A) L k1-' A -01z 4 7 9 cJ Dollars
($ /c)U 400c) ).
Add sum of:
7- l 1.c Sl.
($ 6 C. U (A.) ),
Net Alternate Price ADI / DEDUCT (iircle one) Total:
Dollars
($
'sciUcJ ).
Dollars
Alternate No. 6: If the Owner elects to proceed with Alternate No. 6, ADD the cost of the
electrical contractor furnishing and installing electrical cabinet #3, and providing all associated
devices, equipment and materials. Refer to the documents for additional information.
Add sum of:
Dollars
1. It is understood and agreed by the undersigned that OWNER reserves the unrestricted
privilege to reject any or all of the foregoing prices which it may consider excessive or
unreasonable. It is also understood that OWNER reserves the right to select any
combination of Bid Items that are in the OWNER's best interest.
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 tern (10) days after the agreement is presented to him for
signature, and start work within ten (10) clays after "Notice to Proceed" is issued.
FORM OF BID -ADD 1
CONTRACT NO. 973 Page 4 of 5
4. Security in the sum of 5 6/es 6.1 50(
Dollars ($ ) in the form of 3o
submitted herewith in accordance with the INSTRUCTIONS TO BIDDERS.
5. Attached hereto is a Non -Collusion Affidavit of Prime Contractor.
is
6. Attached hereto is a Resident Bidder Certification ( ), or Non -Resident Bidder
Certification ( ). (Mark one.)
7. The bidder is prepared to submit a financial and experience statement upon request.
8. The Prime Contractor and Subcontractor(s), which have performed an aggregate of
$10,000.00 in work for the City in the current calendar year, are prepared to submit an AAP
or Update and an EOC, within ten (10) days of notification that the bid submitted is lowest
and acceptable.
9. The bidder has received the following Addendum or Addenda: %
Addendum No. 1 Date 31)6/%9
3/6//7
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.
BY:
111'e 114- G6n-5 4 - 0
(Name of Bidder) (Date)
Title
3411 M
Official Address: (Including Zip Code):
6 1//9 i(.lvrP(`C. Oe. e6,116i _T S ri
I.R.S. No. OP- — d 5o 405--7
FORM OF BID -ADD 1
CONTRACT NO. 973 Page 5 of 5
Bidder Status Form
To be completed by all bidders
PartA
Please answer "Yes" or "No" for each of the following:
El_ Yes ❑ No
( Yes D No
Yes ❑ No
Yes No
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 lowa 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: 3 / ( / n 5 to Address:
Dates:
/ /
Vieth Construction
City, State, Zip: Corporation
I I Address: 6419 Nordic Dr.
Cedar Falls, IA 50613
City, State, Zip:
Dates: / / to _ / / Address:
You may attach additional sheet(s) if needed. City, State, Zip:
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
force preferences or any other type of preference to bidders or laborers? ❑ Yes 0 No
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: Vi`. -Ah 6o"
Cdf1./.
L
3/
Signature: Date:
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)
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.
_Yes ❑ No My business is currently registered as a contractor with the Iowa Division of Labor.
❑ Yes --No My business is a sole proprietorship and I am an Iowa resident for Iowa income tax purposes.
❑ Yes KINo 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.
`Yes ❑ No 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.
❑ Yes r8,No 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 filed
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 •],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 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.
❑ 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.
❑ Yes No 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.
❑ Yes [No My business is a limited liability company whose certificate of organization is filed in lowa and has
not filed a statement of termination.
❑ Yes 0,,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)
NONCOLLUSION AFFIDAVIT OF PRIME BIDDER
State of A
County of �' Gk
l r 70-~''9 1"/"t72 , being first duly sworn, deposes and says
)ss
that:
1. He is (Owner Partner, Officer, Representative, or Agent) , of
, the Bidder that has submitted the attached Bid;
2. He is fully informed respecting the preparation and contents of the attached Bid
and of all pertinent circumstances respecting such Bid;
3. Such Bid is genuine and is not a collusive or sham Bid;
4. Neither the said Bidder nor any of its officers, partners, owners, agents,
representatives, employees, or parties in interest, including this affiant, has in any
way colluded, conspired, connived or agreed, directly or indirectly, with any other
Bidder, firm or person to submit a collusive or sham Bid in connection with the
Contract for which the attached Bid has been submitted or to refrain from bidding
in connection with such Contract, or has in any manner, directly or indirectly,
sought by agreement or collusion or communication or conference with any other
Bidder, firm or person to fix the price or prices in the attached Bid or of any other
Bidder, or, to fix any overhead, profit or cost element of the bid price or the bid
price of any other Bidder, or to secure through any collusion, conspiracy,
connivance, or unlawful agreement any advantage against the City of Waterloo,
Iowa, or any person interested in the Proposed Contract; and
5. The price or prices quoted in the attached Bid are fair and proper and are not
tainted by any collusion, conspiracy, connivance or unlawful agreement on the part
of the Bidder or any of its agents, representatives, owners, employees, or parties in
interest, including this affiant.
(Signed)
Title
Subscribed and sworn to before me this day of
-9,4b , 201
Title
My commission expires 3 -aa-
My
,►,,,
`, ,,
♦
r �
r i
I,,,,.PPIRES
H ♦ `,,�
Prime Contractor Name:
MBEIWBE BUSINESS ENTERPRISE
PRE-BID CONTACT INFORMATION FORM
(a S J • l ,, r P Project: ) c /- 1,4
plc- -1‘,-f) Letting Date:
3/ // 9
NO MBEIWBE SUBCONTRACTORS: If you are NOT using any MBENVBE 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: Date:
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 MBENVBE 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 Rudy Jones, Contract Compliance Officer, for
assistance at (319) 291-4429.
In the event it is determined that the fv9BENJBE 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
/S an 4-c-o-ai e- (-0,1-410i
3/ i
IU U
3 I /o
1
,k.)o
6.0r -t!5 (..-on�cc,kCnv,
3/(a
/L))
3/ro
iOC
Th d -g- Uvr r. V
3U co
"fe S
31 i 6
'W3
li
2, 9-- 3 ~
0 ti 4 c� C
3 64J
474S.
3 j-,
/Uv
O
(Form CCO-4) Rev. 06-20-02
BID BOND
KNOW ALL MEN BY THESE PRESENTS, that we, Vieth Construction Corporation
as Principal, and North American Specialty Insurance Company
as Surety are held and firmly bound unto the CITY OF WATERLOO , Iowa, hereinafter called
"OWNER." In the penal sum ---Five Percent of the Bid Submitted ---
Dollars ($ ---5%--- ) lawful money of the United States, for the payment
of which 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 the28th day of March
, 2019 , for FY 2019 Lincoln Park Improvements, Waterloo. IA. Contract No. 973
NOW, THEREFORE,
(a) If said Bid shall be rejected, or in the altemate,
(b) If said Bid shall be accepted and the Principal shall execute and deliver a contract in the form specified
and shall fumish 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 7th day of March , A.D. 2019
Witn s
Witness Anne Crowner
By
Vieth Construction Corporation
(Seal)
Principal
(Title)
North n Specialty I ance CompanrSeat)
rety
By
Attorn y -i rr a Dione R. Young
i OFFICIAL SFAL
M. KENNY
Notary Public -State of Illinois
My Commission Expires
12/0412021
SWISS RE CORPORATE SOLUTIONS
NORTH AMERICAN SPECIALTY INSURANCE COMPANY
WASHINGTON INTERNATIONAL INSURANCE COMPANY
WESTPORT INSURANCE CORPORATION
GENERAL POWER OF ATTORNEY
KNOW ALL MEN BY THESE PRESENTS, THAT North American Specialty Insurance Company, a corporation duly organized and existing under
laws of the State of New Hampshire, and having its principal office in the City of Overland Park, Kansas and Washington International Insurance
Company a corporation organized and existing under the laws of the State of New Hampshire and having its principal office in the City of Overland
Park, Kansas, and Westport Insurance Corporation, organized under the laws of the State of Missouri, and having its principal office in the City of
Overland Park, Kansas each does hereby make, constitute and appoint:
JAY D. FREIERMUTH, CRAIG E. HANSEN, BRIAN M. DEIMERLY, SHIRLEY S. BARTENHAGEN, CINDY BENNETT, ANNE CROWNER,
TIM McCULLOH„ STACY VENN, DIONE R. YOUNG, and WENDY ANN CASEY JOINTLY OR SEVERALLY
Its true and lawful Attomey(s)-in-Fact, to make, execute, seal and deliver, for and on its behalf and as its act and deed, bonds or other writings
obligatory in the nature of a bond on behalf of each of said Companies, as surety, on contracts of suretyship as are or may be required or permitted by
law, regulation, contract or otherwise, provided that no bond or undertaking or contract or suretyship executed under this authority shall exceed the
amount of: ONE HUNDRED TWENTY FIVE MILLION ($125,000,000.00) DOLLARS
This Power of Attorney is granted and is signed by facsimile under and by the authority of the following Resolutions adopted by the Boards of
Directors of North American Specialty Insurance Company and Washington International Insurance Company at meetings duly called and held
on March 24, 2000 and Westport Insurance Corporation by written consent of its Executive Committee dated July 18, 2011.
"RESOLVED, that any two of the President, any Senior Vice President, any Vice President, any Assistant Vice President,
the Secretary or any Assistant Secretary be, and each or any of them hereby is authorized to execute a Power of Attorney qualifying the attorney named
in the given Power of Attorney to execute on behalf of the Company bonds, undertakings and all contracts of surety, and that each or any of them
hereby is authorized to attest to the execution of any such Power of Attorney and to attach therein the seal of the Company; and it is
FURTHER RESOLVED, that the signature of such officers and the seal of the Company may be affixed to any such Power of Attorney or to any
certificate relating thereto by facsimile, and any such Power of Attorney or certificate bearing such facsimile signatures or facsimile seal shall be
binding upon the Company when so affixed and in the future with regard to any bond, undertaking or contract of surety to which it is attached."
J SEAL
Hayti 197a ��u 8
mono
`r`a 5UIlilIlllllll/l/1V
al SEAL SEAL4.
ionitulimio-
By
Stereo P. Anderson, Senior Vice President of Washington International Insurance Company
& Senior Vice President of North American Specialty Insurance Company
& Senior Vice President of Westport Insurance Corporation
By
Mike A. Ito, Senior Vice President of Washington International Insurance Company
& Senior Vice President of North American Specialty Insurance Company
& Senior Vice President of Westport Insurance Corporation
IN WITNESS WHEREOF, North American Specialty Insurance Company, Washington International Insurance Company and Westport
Insurance Corporation have caused their official seals to be hereunto affixed, and these presents to be signed by their authorized officers this
this 3rd day of November , 20 17
State of Illinois
County of Cook
On this 3rd day of
North American Specialty Insurance Company
Washington International Insurance Company
Westport Insurance Corporation
ss:
November , 20 17, before me, a Notary Public personally appeared Steven P. Anderson , Senior Vice President of
Washington International Insurance Company and Senior Vice President of North American Specialty Insurance Company and Senior Vice President of
Westport Insurance Corporation and Michael A. Ito Senior Vice President of Washington International Insurance Company and Senior Vice President
of North American Specialty Insurance Company and Senior Vice President of Westport Insurance Corporation, personally known to me, who
being by me duly swom, acknowledged that they signed the above Power of Attorney as officers of and acknowledged said instrument to be the
voluntary act and deed of their respective companies.
`�1\1•V�;��";�
M. Kenny, Notary Public
I, Jeffrey Goldberg , the duly elected Vice President and Assistant Secretary of North American Specialty Insurance Company, Washington
International Insurance Company and Westport Insurance Corporation do hereby certify that the above and foregoing is a true and correct copy of a
Power of Attorney given by said North American Specialty Insurance Company, Washington International Insurance Company and Westport Insurance
Corporation which is still in full force and effect.
IN WITNESS WHEREOF, I have set my hand and affixed the seals of the Companies this 7th day of March , 2019 .
//.erg
JeFfrey Goldberg, Vice President & Assistant Secretary of Washington International Insurance Company &
North American Specialty Insurance Company & Vice President & Assistant Secretary of Westport Insurance Corporation