HomeMy WebLinkAboutVieth Construction CorporationVieth Construction
Corporation
6410 NoCc Dr.
Cedar Fails, IA 50613
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Vieth Construction
Corporation
6419 Nordic Dr.
Cedar Falls, IA 59613
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WATERLfr
CITY CLERK'S OFFICE
p OV 2 20 _1 F1412:36:34
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FORkW OF BID OR PROPOSAL
FY 2020 RIP RAP REPAIRS ALONG LEVEE SYSTEM
CONTRACT N c, . 999
CITY OF WAT2,RLOO, 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 FY 2020 RIP RAP REPAIR ALONG LEVEE
SYSTEM, Contract No. 999, all in accordance with the above -listed documents and for
the unit prices for work in place for the following items and quantities:
FY 2020 RIP RAP REPAIRS ALONG LEVEE SYSTEM
CONTRACT NO. 999
BID
ITEM
DESCRIPTION
UNIT
ES1. QTY.
UNIT BID
PRICE
TOTAL BID PRICE
1
MOBILIZATION
LS
1.0
$ /3, 000 -
$ j3, CO°
2
CLASS D REVETMENT
TN
3329.0
$ 3 J w
al
$ /2 4,, se --6 L..`-
3
RECP TYPE 2 MATTING
SF
2085.0
$ _`
�•- _3cz-
$
4
TRAFFIC CONTROL
LS
1.0
$ s s -G
$ se ---.5--a
TOTAL BID
$ / #v ev
c. --
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withdrawn, the undersigned agrees to execute and deliver an agreement in the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.
FORM OF BID
CONTRACT NO. 999 Page 1 of 3
7
4.
Security in the sum of �v o`� `� 4 -).-Loot "�
Dollars ($ ":2 ) in the form of 7S r -c2 41=''`x, r-)
is submitted herewith in accordance with the INSTRUCTIONS TO BIDDERS.
5. Attached hereto is a Non -Collusion Affidavit of Prime Contractor.
6. Attached hereto is a Resident Bidder Certification ( 2 ), 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. Ail Date
10. The bidder shall list the MBE/WBE subcontractor(s), amount of subcontracts and
bid items on the City of Waterloo Minority and/or Women Business Pre-bid
Contact Information Form submitted with this Form of Bid or Proposal. 1 he
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.
FORM OF BID
CONTRACT NO. 999 Page 2 of 3
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.
Vieth Construction
Corporation
6419 Nordic Di.
Cednr Falls, IA 50613
(Name of Bidder)
BY: Zc€7 C/
gA
(Date)
Title /12/51
Official Address: (Including Zip Code):
Vieth Construction
Corporation
6419 Nordic Dr.
Cedar Falls, IA 50613
I.R.S. No.
FORM OF BID
o ?OS- 7
CONTRACT NO. 999 Page 3 of 3
BID BOND
KNOW ALL MEN BY THESE PRESENTS, that we,
as Principal, and
as Surety are held and firmly bound unto the CITY OF WATERLOO , Iowa, hereinafter called
"OWNER." In the penal sum
Dollars ($
) 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 day of
, 20 , for
•
NOW, THEREFORE,
(a) If said Bid shall be rejected, or in the alternate,
(b) If said Bid shall be accepted and the Principal shall execute and deliver a contract in the form specified
and shall furnish a bond for his faithful performance of said contract, and for the payment of all persons
performing labor or furnishing materials in connection therewith, and shall in all other respects perform the
agreement created by the acceptance of said Bid,
Then this obligation shall be void, otherwise the same shall remain in force and effect; it being expressly
understood and agreed that the liability of the Surety for any and all claims hereunder shall, in no event,
exceed the penal amount of this obligation as herein stated.
By virtue of statutory authority, the full amount of this bid bond shall be forfeited to the Owner in liquidation of
damages sustained in the event that the Principal fails to execute the contract and provide the bond as
provided in the specifications or by law.
The Surety, for value received, hereby stipulates and agrees that the obligations of said Surety and its bond
shall be in no way impaired or affected by any extension of the time within which the Owner may accept
such Bid or execute such contract; and said Surety does hereby waive notice of any such extension.
IN WITNESS WHEREOF, the Principal and the Surety, have hereunto set their hands and seals, and such
of them as are corporations, have caused their corporate seals to be hereto affixed and these presents to be
signed by their proper officers this day of , A.D. 201
(Seal)
Principal
By
(Title)
(Seal)
Witness Surety
By
Witness Attorney-in-fact
State of
County of
NON -COLLUSION AFFIDAVIT OF PRIME BIDDER
)ss
(`�'L)% Ot1, being first duly sworn, deposes and says that:
1 He is (Owne)artner, Officer, Representative, or Agent) of v
clak
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 .2 / s day of
mit 1201_.
My commission expires uuri,•cw.'`1 -z�' Lo 2
PAMELA til SMITH
COMMISSION 110.188085
* MY COMMISSION EXPIRES
JANUARY 2S 2021
udh_ 74/74).
Title
State of
NON -COLLUSION AFFIDAVIT OF SUBCONTRACTOR
County of
that:
) ss:
)
being first duly sworn, deposes and says
1. He is (Owner, Partner, Officer, Representative, or Agent)
hereinafter referred to as the "Subcontractor;"
He is fully informed respecting the preparation and contents of the subcontractor's
proposal submitted by the subcontractor to
, contract pertaining to the
project in
(City or County and State)
3. Such subcontractor's proposal is genuine and is not a collusive or sham proposal;
4. Neither the subcontractor nor any of its officers, partners, owners, agents,
representatives, employees, or parties in interest, including this affiant, has in any way
colluded, conspired, connived, or agreed, directly or indirectly, with any other bidder, firm
or person to submit a collusive or sham proposal in connection with such contract or to
refrain from submitting a proposal in connection with such contract, or has in any manner,
directly or indirectly, sought by unlawful agreement or connivance with any other bidder,
firm or person to fix the price or prices in said subcontractor's proposal, or to fix any
overhead, profit or cost element of the price of prices in said subcontractor's proposal, or
to secure through collusion, conspiracy, connivance or unlawful agreement any
advantage against the City of Waterloo, Iowa, or any person interested in the proposed
contract; and
5. The price or prices quoted in the subcontractor's proposal are fair and proper and are not
tainted by any collusion, conspiracy, connivance or unlawful agreement on the part of the
bidder or any of its agents, representatives, owners, employees, or parties in interest,
including this affiant.
(Signed)
Title
Subscribed and sworn to before me this day of
, 201 _.
Title
My commission expires
1E=43iidd,[c Status Form
To be completed by all bidders
PartA
-71
Please answer "Yes" or "No" for each of the following:
yYes 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).
RYes U No My company has an office to transact business in Iowa.
-',Yes ❑ No My company's office in Iowa is suitable for more than receiving mail, telephone calls, and e-mail.
Yes No My company has been conducting business in Iowa for at least 3 years prior to the first request for
bids on this project.
Yes No 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: Vjeth �o tri tion
Address: corporation
City, State, Zip 6419 Nordlc r,
Cedar Falls, IA 50613
Dates: / / to / / Address:
City, State, Zip:
Address.
You may attach additional sheet(s) if needed. City, State, Zip.
Dates: / / to
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?
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.
Yes ■ No
You may attach additional sheet(s) if needed.
To be completed by all bidders
Part D
I 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:
Vit/71 Cid 4,6-4
0—ciesor,
Date: /1 �4,
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 ■ No 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
■
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 0 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 ❑ No 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 Iowa and has
not filed a statement of termination.
■
Yes ■ 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)
MBE/WBE BUSINESS ENTERPRISE
PRE-BID CONTACT INFORMATION FORM
Prime Contractor Name: V(Cni- Project: 44--/, Letting Date: G.77Z
NO MBE/WBE 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 APPLIICABLE: 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 MBENVBE 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 MBENVBE 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 INEORMATi DON SNOWING BI DER°S PRE-BID
1
E/W - E BUSINESS EGA T E tiPRUSE CONTACTS
Quotes Received Quotation used in bid
MBEIVV37,
Subcontractors
Dates
Contacted
Yes/No
Dates
Contacted
Yes/No
; cffar Amount Proposed to
]e Subcontracted
G `(o Mesa
Lie
/1 ,<
(its
/, / i
pun toi -
h 7ft 7,
Aic.)
l'!(LS 2
i�
(Form CCO-4) Rev. 06-20-02
MBEIWBE BUSINESS ENTERPRISE
PRE-BID CONTACT INFORMATION FORM INSTRUCTIONS
Prime Contractor Responsibilities:
Prime Contractors bidding on City of Waterloo contract work are required to ensure that MBE/WBE businesses are provided the opportunity to
participate in the performance of contracts and subcontracts. Prime contractors are required to assist MBE/WBE businesses in overcoming
barriers to participation, and must make good faith efforts to secure bids from, and award subcontracts to, MBE/WBE businesses. For all contract
bids of $50,000 or more, the following is required to demonstrate good faith efforts in accordance with this policy:
1. "MBE/WBE BUSINESS ENTERPRISE PRE-BID CONTACT INFORMATION FORM" submitted with the prime contractor bid, properly
completed and signed on Form CCO-4 (Rev. 06-20-02). Please note that this document must include all subcontractor contacts, bids received,
and awarded - not just those related to disadvantaged business enterprise vendors.
2. A minimum of three (3) MBE/WBE business contacts must be made and documented, if there are at least three (3) MBENVBE businesses
offering services in the areas to be subcontracted (see City of Waterloo MBE/WBE Certified List). If less than three (3) are offering the services to
be subcontracted, then a contact is required for any that are listed as providing that service. If you have submitted a MBE/WBE contact not on the
City's MBE/WBE list, attach a copy of the certification from another government agency.
3. Contacts to each MBE/WBE businesses are required to be a minimum of seven (7) working days prior to the date the prime contractor submits
the bid to the City of Waterloo.
e �
4. The following documentation must accompany the "MBE/WBE BUSINESS ENTERPRISE PRE-BID CONTACT INFORMATION FORM" for
m c each MBE/WBE business contacted:
a. A copy of the bid received from the MBE/WBE, OR
b. If no bid was received, a copy of correspondence received from the MBENVBE with a "no bid" response, OR
c. If no response was received, a copy of the solicitation sent to the MBE/WBE with proof of mailing attached.
5. If any MBE/WBE business submitting bids are not selected for subcontract award, documentation must accompany the "MBENVBE BUSINESS
ENTERPRISE PRE-BID CONTACT INFORMATION FORM" on why the MBENVBE was not selected. These reasons could include:
a. Not low bid. Copies of the competing bids may be required for verification.
b. MBE/WBE did not bid, withdrew bid or was non-responsive.
c. Documentation of other business-related reason for not selecting the MBE/WBE business for a subcontract.
d. Prime contractor self performs work.
e. Any other reason relied on by the Prime Contractor.
The Contract Compliance Officer will determine the weight to be given to each item listed above (supported by appropriate documentation) based
-444 on overall program goals.
c.,
Subcontractors Responsibilities:
1. Each MBENVBE firm planning to submit quotes on construction projects with goals, shall submit a Letter of Intent to Bid (Form CCO-5) to
the City Contract Compliance Officer seven (7) working days prior to bid opening, listing specific items which the MBENVBE firm is
interested in bidding. If the City Contract Compliance Officer does not receive sufficient scope letters seven (7) working days prior to bid
opening, goals on subject project will be reduced accordingly. Agreements between the bidder/proposer and an MBENVBE in which the
MBE/WBE promises not to provide subcontracting quotations to other bidders/proposers are prohibited.
Form CCO-4A Rev. 07-08-02
BID BOND
KNOW ALL MEN BY THESE PRESENTS, that we, 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 ($ ) 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 21st day of November
2019 , for FY 2020 Rip Rap Repairs Along Levee System, Contract No, 99D
iNaterino,lowa
NOW, Ti-IEREFORE,
(a) If said Bid shall be rejected, or in the alternate,
(b) If said Bid shall be accepted and the Principal shall execute and deliver a contract in the form specified
and shall furnish a bond for his faithful performance of said contract, and for the payment of all persons
performing labor or furnishing materials in connection therewith, and shall in all other respects perform the
agreement created by the acceptance of said Bid,
Then this obligation shall be void, otherwise the same shall remain in force and effect; it being expressly
understood and agreed that the liability of the Surety for any and all claims hereunder shall, in no event,
exceed the penal amount of this obligation as herein stated.
By virtue of statutory authority, the full amount of this bid bond shall be forfeited to the Owner in liquidation of
damages sustained in the event that the Principal fails to execute the contract and provide the bond as
provided in the specifications or by law.
The Surety, for value received, hereby stipulates and agrees that the obligations of said Surety and its bond
shall be in no way impaired or affected by any extension of the time within which the Owner may accept
such Bid or execute such contract; and said Surety does hereby waive notice of any such extension.
IN WITNESS WHEREOF, the Principal and the Surety, have hereunto set their hands and seals, and such
of them as are corporations, have caused their corporate seals to be hereto affixed and these presents to be
signed by their proper officers this 12th day of November
•
Witness
Witness Stacy Ve
By
AD. 2019 ,
A)c) 5'
Vieth Construction Corporation (Seal)
Principal
North Ame"' ap Specialty Insuran64 Compart3eal)
Sdrety
By.
f
iacrprer-.
,.DiR
Attorney-iR. Young
(Title)
4
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 Noith 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 Attorney(s)-in-Fact, to make, execute, seal and deliver, for and on its behalf and as its act and deed, bonds or other writings
obligatory in the nature of a bond on behalf of each of said Companies, as surety, on contracts of suretyship as are or may be required or permitted by
law, regulation, contract or otherwise, provided that no bond or undertaking or contract or suretyship executed under this authority shall exceed the
amount of:
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
m 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 fiiture with regard to any bond, undertaking or contract of surety to which it is attached."
Steven P. Anderson, Senior Vice President of Washington Intentional Insurance Company
& Senior Vice President of North American Specialty insurance Company
& Senior Vice President of Westport Insurance Corporation
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 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 Lnsurance 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 sworn, acknowledged that they signed the above Power of Attorney as officers of and acknowledged said instrument to be the
voluntary act and deed of their respective companies.
ss:
North American Specialty Insurance Company
Washington International Insurance Company
Westport Insurance Corporation
OFFICIAL SEAL
aal
M. KENNY
Notary Public; State of Illinois
My Commission Expires M. Kenny,NotaryPublic \
12/04/1021
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 Noith American Specialty Insurance Company, Washington International Insurance Company and Westport Insurance
Corporation which is still in full force and effect.
1N WITNESS WHEREOF, I have set my hand and affixed the seals of the Companies this 12th day of November 2019 .
Jeffrey Goldberg, Vice President & Assistant Secretary of Washington international Insurance Company &
North American Specialty Insurance Company & Vice President & Assistant Secretary of Westport Insurance Corporation