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HomeMy WebLinkAboutLodge Construction IncP.Q. Box 459 I CLARKSVILLE, IA 50619 NN,A-ei RF F)/ aaa Pt) T 13i\g& etscAti> P.O. Box 459 I CLAR SVILLE, IA 506 9 C c\wee(< \Nbcyme, kojTe-0/4— RE= r/ co 5it kt4 ulbay 11=.Y. 1,02,0 G ii-;101fcliA OF R PROPOSAL MILANO ST.,JEF hHRSON ST.AM 1uECONs 4Luc u i RI PR GRAM c G UTY OF W_T -7 6 Honorable Mayor and City Council Waterloo, Iowa Gentlemen: 1(.)1E5 0 Okft „ U L B FJ U ll N IIJ o • 1. The undersigned, being a Corporation existingunder the laws of the State to of a Parinorship consisting of the following partners: having familiarized (himself) (themselves) (itself) with the existing conditions on the J r©'ect area a�i ectin the cost of the p g 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 CityClerk, City Y Hall, Waterloo, Iowa, hereby proposes to furnish all supervision, technicalpersonnel, labor, materials, machinery, tools, appurtenances, equipment, and services, includingutilityand transportationservices �- - - COURTLAND services required to construct and complete this '�oY. 2020 COURTLAND ST., J E FF :� RS «N ST. AND D i i U L I F RY S T .°RECONSTRUCTION PROGRAM,Contract No. 1015, all in accordance with the above -listed documents and for the unitprices for work in lace for the .r, .. p following items and quantities: FY 2020 COU TLAN D S T CJE ±RS V U V ST. AND MULL) F 11RR tl ■ ■ SUDAS SPECIFICATION *SEE SUPPLEMENTAL ::SP. SPCL; _PRQV: ..... f-:.'....y-: 4 . 1 RECONSTRUCTION PROGRAM CONTRACT NO. 1015 _• _ • DIVISION !Hs' STREET REC(NSTRU.CTIQN_ • ESCRIPTION ....• • • • • UNIT BID PRICE • • • • TO r AL BID ‘ . PRICE: DIVISION 2 - EARTHWORK 1 2 3 4 5 • • 2010-108-D * 2010-108-E-0 * 2010-108-H * 2010-108-1 * SP#2 TOPSOIL, 4 INCHES, ON OR OFF SITE EXCAVATION, CLASS 10 SUBGRADE TREATMENT, WOVEN GEOTEXTILE SUBBASE, MODIFIED CLASS 10, SPECIAL SUBGRADE MATERIAL • S BTOTAL' BASE BIP _EARTHWO SY CY SY TON 1,515.00 5,970.00 2,000.00 7,920.00 CY 250.00 $ S� � as rfr $ 4?)p5VO s- $ 63 j 730 i � $JJc $ 1�7611120O DIVISION 4 n SEWERS AND DRAINS - SANITARY 6 7 4010-108-A-1 * 4010-108-A-1 * SANITARY SEWER GRAVITY MAIN, TRENCHED, PVC, 30 INCH SANITARY SEWER GRAVITY MAIN, TRENCHED, PVC, 18 INCH LF LF 360.00 $ riet OW, /60-..."‘j 49.00 $ 1Z 57 $ :421 beite FORM OF BID CONRACT NO. 1015 Page 1 of 7 SPECIFICATION SUDAS *SEE UNIT I STREET RECONSTRUCTION BID TOTAL BID SUPPLEMENTAL DIVISION - UNIT EST QTY PRICE BID PRICE ITEM SP = SPCL PROV DESCRIPTION (CONTINUED) SANITARY SEWER GRAVITY MAIN, TRENCHED, gL 8 4010-108-A-1 * LF 628.00 $ .9Nt $ uilta TRUSS, 12 INCH `'" SANITARY SEWER GRAVITY MAIN, TRENCHED, `` 9 4010-108-A-1 * ��j0 3%� LF 1,043.00 $ J TRUSS, 10 INCH $ . o oS °i SANITARY SEWER GRAVITY MAIN, TRENCHED, 10 4010-108-A-1 * LF 34.00 $ `V $ 3) Va TRUSS, 8 INCH SANITARY SEWER SERVICE STUB/RENEW, < go . , 11 4010-108-E-0 5/ &/ SDR 23.5, 6INCH LF 1,5'13.00 $ $/31 SANITARY SEWER ABANDONMENT, FILL AND 12 4010-108-L-2 PLUG, 30 INCH LF 361.00 ,,J $ $ /�jv SO SANITARY SEWER ABANDONMENT, FILL AND %- 13 4010-108-L-2 )O _ iizen0 LF 183.00 $ $ PLUG, 12 INCH ) 77 8.00 %S-Z) $ La' �k 14 SP # 5 SANITARY SEWER SERVICE, TRACE EACH $ /s DYE TEST SANITARY SEWER SERVICE, 15 P--5--- 13.00 -1254-r $ EACH $ SP It 4 INVESTIGATION ) UNDERGROUND SANITARY SEWER SERVICE, 16A • ' EACH 2.00 $ $ SP ## 3 INVESTIGATION x) DIVISION 6 - STRUCTURES FOR SANITARY SEWERS -e- 3, 4'1 * EACH 1.00 $ lL $ )32/ ~ 1613 6010-108-A-0 MANHOLE, SW-301, 72" -" * C' t` $ 20.5-4 / 17 6010-108-A-0 MANHOLE, SW-301, 60" EACH 2.00 $/q * 1.00 C/ $ i` 18 6010-108-A-0 MANHOLE, SW-301, 48" EACH $ S)%'O 4'" * $ /1.3 SANITARY EACH 2.00 $ 19 6010-108-H-0 REMOVE MANHOLE, ,-;,_6.. FILL ,.�. '- REMOVE MANHOLE, TOP SECTIONS AND 20 “Oot" ilAeld EACH 2.00 SP it 14 BASE SECTION ---9 *--- SEWER $ c, - - - SUBTOTAL BASE BID SANITARY DIVISION 4 SEWERS AND DRAINS - STORM - 21 4020-108-A-1 * 2000D, 27 art STORM SEWER, TRENCHED, RCP LF 73.00 $ 13e) $ 9;1% INCH 22 4020-108-A-1 RCP 2000D, 18 - 0 STORM SEWER, TRENCHED, t= . 6 2a 44 INCH LF 381.00 $ $ 0b� 23 4020-108-A-1 15 v STORM SEWER, TRENCHED,�S30 RCP 2000D, _ LF 1,046.00 $ $ INCH 24 4020-108-A-1 * 12 STORM SEWER, TRENCHED, RCP 2000D, e0 LF 335.00 $% $17ays INCH 25 4020-108-D-0 * REMOVAL OF STORM SEWER, RCP, LESS -`` 0. 0 �, LF 733.00 $ M $ THAN OR EQUAL TO 36 INCH .2)716 26 4040-108-A-0 sr ) LF 5,344,00 $ /6) $ 9Y acid' SUBDRAIN, TYPE SP, 6 INCH 3 `c' 27 4040-108-A-0 SUBDRAIN, TYPE SP, 4 INCH LF 20.00 $ 0 $ , .L)& 28 4040-108-D-0 CONNECTIONS, ''r k SUBDRAIN OUTLETS AND 5.3a ` $ CMP, 6 INCH EACH 35.00 $ STORM SEWER SERVICE STUB, TYPE S, 4 INCH LF 286.00 $ $ 6 1 290 29 4040-108-E-0 DIVISION 6 - STRUCTURES FOR STORM SEWERS it-$ 30 6010-108-A-0 * =)1G C Y•' MANHOLE, SW-401, 48" EACH 2,00 $ c» -'t c 31 6010-108-A-0 EACH 1.00 $ 7poL�a $ ?oO(> MANHOLE, SW-406, SHALLOW RECTANGULAR `z`t 32 SP # 15 f6Ct tt $ Z630 10 FT X 4 FT EACH 2.00 $ MANHOLE, TYPE C, ' u-:- 33 6010-108-B-0 2.00 $ 7) ' $ INTAKE, SW-501, SINGLE GRATE EACH .(cc/ 34 6010-108-B-0 �- INTAKE SW-504, SINGLE GRATE W/ FLUSH `" $�`2 EACH 1.00 $)5'O�J TOP MANHOLE 35 6010-108-B-0 00 $ ri.er CONNECTION TO EXISTING STRUCTURE, PIPE EACH 2 $ fiX 36 6010-108-G-0 (-_:-- CONNECTION TO EXISTING INTAKE, DRAIN o--. 7ro- $/f), TILE EACH 16.00 $ FORM OF BID CONRACT NO. 10'15 ADDENDUM NO. 2 Page 2 of 7 - SUDAS - - :.. ... • :'::.- UNIT ': SPECIFICATION SUPPLEMENTAL BID UNIT BID TOTAL BID 1- STREET RECONSTRUCTION.;-*.:; ITENI SP o SPCL PROV _.i::::DIVISION = =: DESCRIPTION (CONTINUED) .. -..• PRICE PRICE EST QTY 37 * 1.00 $ $ j G6 L` 6010-108-H-0 REMOVE MANHOLE OR INTAKE, STORM EACH 38 SP # 15 1.00 INTAKE, SW-507, REMOVE AND REPLACE ' $) -&C/ $ 57'O SPECIAL SHAPING AND TOP EACH 39 SP # 15 $ J / <� -= ' $ f i INTAKE, SW-501, REMOVE AND REPLACE BOXOUT 7.00 EACH 40 SP # 15 25.00 .- 0 INTAKE, SW-505, REMOVE AND REPLACE BOXOUT $ -())103 '0?jaU EACH 41 SP # 14 2.00 .? $ ) rL,.y $ / 1 000 ail FURNISH AND INSTALL SW-602 TYPE G CASTING EACH 42 3.00 $ ie&u $ �`o �, 0 FURNISH AND INSTALL SW-603 TYPE R SP # 14 CASTING EACH SUBTOTAL BASE BID STORM SEWER._ $ _ DIVISION 5 o WATER MAINS AND APPURTENANCES 43 LF 201.00 $ cc ` $ rc 0 761 `'' 5010-108-E-1 WATER SERVICE PIPE, COPPER, 3/4 INCH 44 10.00 $ ,2•.5 V `- $ ,n )jrC r 5010-108-E-2 WATER SERVICE CORPORATION, 3/4 INCH EACH 45 10.00 $ • -S $ _?» DC' $t'.' * 5010-108-E-3 WATER SERVICE CURB STOP, 3/4 INCH EACH 46 10.00 41 " $ �)5 e; c4' * 5010-108-E-3 WATER SERVICE CURB BOX, 3/4 INCH $ ,-5 U EACH 47 20.00 $ • •' - $ $ 1,0? . =;e' LF 5010-108-E-1 WATER SERVICE PPE, COPPER, 1.5 INCH 48 1.00 $ ?el c=- * 5010-108-E-3 WATER SERVICE CURB STOP, 1.5 INCH EACH 49 1.00 $ lee3cC $ _ WATER SERVICE MASTER CURB BOX, 1.5 5010-108-E-3 * INCH EACH 50 1.00 $ 3�� 6a4"atv $ TAPPING SLEEVE AND CORPORATION FOR 1.5 * 5010-108-E-3 INCH SERVICE EACH 51 SP # 10 3.00 $ 461'�'�� cm $ 3J je OG° CONVERT WATER VALVE MANHOLE TO ROADBOX EACH 52 SP # 8 17.00 $ (CCU -a- $ /1))0200 £i WATER SERVICE KILL EACH 53 SP # 8 1.00 $ , ?9O ' '' $ 1110c) EACH WATER SERVICE KILL, FIRE LINE, 4 INCH 54 SP ## 9 6.00 $ ,}t5-7s� 4'4 $ t f/S"v a5 LOWER WATER SERVICE, 3/4" OR 1" EACH 55 4.00 -tmU $ -> 8"ee ram- $ - )Ci i ) WATER SERVICE, UNDERGROUND SP # 11 EACH INVESTIGATION :: ::: SUBTOTAL: BASE- BI-D WATER APPURTENANCES -=' DIVISION 7 c STREETS AND RELATED WORK PCC PAVEMENT SY 15.00 $ i 7 $ .232o5 44 56 7040-108-A-0 REMOVE AND REPLACE 3" HMA/7" PCC, C-4 SY 90.00 $ / VI $ 13,320 57 7040-108-A-0 REMOVE AND REPLACE 4.5" HMA/7" PCC, C-4 SY 3,420.00 $ _3 y CJ $ //42,67C -` ' 58 7010-108-A-0 PAVEMENT, PCC, 7 INCH, C-SUD SY 8,781.00 $ 19 -- $ 00J 6? 0 59 7010-108-A-0 PAVEMENT, FCC, 9 INCH, C-SUD LF 30.00 i�.-ses $ ' 7 $ 1) L C) C4' M1 • CURB AND GUTTER, 24 IN WIDE, 6 IN THICK, 60 7010-108-E-0 C-4, MISCELLANEOUS LF 27.00 ,� $ �i- $ j) 9j2 /� w CURB AND GUTTER, 24 IN WIDE, 10 IN THICK, 61 7010-108-E-0 C 4, MISCELLANEOUS LS 1.00 $ Cl�cc� .;� $,.C?�� ejle- 62 7010-108-1-0 PCC PAVEMENT SAMPLES AND TESTING SY 693.50 $ 6 `1 $ 3J %e 7 = 63 63 7010-3.04 COLD WEATHER CONCRETE PROTECTION SY 693.50 $ ' ` $ G' VC_ -a 64 * 7010,3.02, J LINSEED OIL TREATMENT HMA PAVEMENT SY 62.00 $ 'G` $ ;WC 65 7020-108-B-0 MISCELLANEOUS HMA, 7.5 INCH SIDEWALKS, SHARED USE PATHS AND DRIVEWAYS SY 1,151.00 $ - $ 6,90t $ -2, 9YC er-/ ' 66 7030-108-A-0 REMOVAL OF SIDEWALK AND DRIVEWAY SY 490.00 $ 67 7030-108-A-0 REMOVAL OF SIDEWALK, MISCELLANEOUS SY 449.30 $ $ r3J176 �� 68 7030-108-E-0 SIDEWALK, PCC C-4, 4 INCH, C-4 SY 201.00 $ SIDEWALK, PCC C-4, 6 INCH PEDESTIAN 69 7030-108-E-0 RAMP, C-4 $ /0) tire2 FORM OF BID CONRACT NO. 1015 Page 3 of 7 SPECIFICATION ..:...:.• : .:: ' ...'• . *SEE. - - . . .... - :. BID SUPPLEMENTAL DIVISION 1 STREET RECONSTRUCTION - .. UNIT BID TOTAL DID : _ : . _ ITEM SP PROV DESCRIPTION INUED) UNIT EST (WY PRICE PRICE e SPCL (CONTINUED) •.. SIDEWALK, PCC C-4, CLASS A THICKENED �d 1- 70 7030-108-E-0 aI 0)i...i7c-- EDGE LF 492.00 $ $ BRICK/PAVER SIDEWALK WITH BASE, AS PER sv 71 7030-108-F-0 717 DETAIL, TYPE 1 PAVER SY 6.50 $.` ?r $) 1 BRICK/PAVER SIDEWALK WITH BASE, AS PER `� 72 7030-108-F-0 DETAIL, TYPE 2 PAVER SY 24.60 $r $6REMOVAL > OF BRICK/PAVER SALVAGE AND y'73 _ 7030-108-F-0 ,REPLACE, 073674 AS PER DETAIL SY 72.80 $ /( $ 7030-108-G-0 i- :III: DETECTABLE WARNING SF 284.00 $ $ (i%?Y- WARNING, UNILOCK A.D.A. 75 7030-108-G-0DETECTABLE c 0DRIVEWAY PAVERS, TYPE 4 PAVER SF 36.00 $+? $/6 AND SIDEWALK, PAVED, PCC, 6 c+, 76 7030-108-H-1 �� r f �v�I/ INCH, C-4 SY 413.00 $ $ , ' 4> DRIVEWAY AND SIDEWALK, PAVED, PCC, 5 t 77 7030-108-H-1 `/75 INCH, C-4 SY 209.50 $ $ /O) `� 78 7030-108-H-2 DRIVEWAY, GRANULAR TON 5.00 $ $ ,a75 PAVEMENT REHABILITATION * `-�` °my =`"1- 79 7040-108-H-0 PAVEMENT REMOVAL, CONCRETE SY 12,499.00 $ .0 $ 79 Sl1BTOT�►L,._S�"REE s AND=.REiaAi ED � i WORK - - .. _ _H:..7:-/6.4 4ear-.. _ .. .. ._ •-i - -- --- --' DIVISION 8 PAVEMENT MARKING AND - TRAFFIC CONTROL PAVEMENT MARKINGS PAINTED PAVEMENT MARKINGS, ea 80 8020-108-B-0 6P ,1t/T3 SOLVENT/WATERBOURNE STA 35.56 $ $ 4-51 81 8020-108-G-0 - PAINTED SYMBOLS AND LEGENDS EACH 16.00 $ VO $ 61jv 82 8020-108-K-0 = PAINTED PAVEMENT MARKINGS, REMOVED STA 9.34 $ 17-- $ ,j 6., 83 8020-108-L-0 e SYMBOLS AND LEGENDS REMOVED EACH 16.00 $ /U& $ 4 c' ". TEMPORARY TRAFFIC CONTROL 84 8030-108-A-0 r4. 45 TEMPORARY TRAFFIC CONTROL LS 1.00 $ O00� $� G %0 • •. :._ : c 1 :-: I- . _.......:: , SUBTOTAL PAVEMENT MARKINGS AND TRAFFIC CON TROI� ..ram-=--: : ... DIVISION 9 - SITE WORK AND LANDSCAPING SEEDING HYDRAULIC SEEDING, SEEDING, FERTILIZING) z 85 9010-108-B-0 = . AND MULCHING SY 3,945.00 $ ( $ Vi-6. * 86 9010-108-E-0 WARRANTY SY 1,183.50 $ / t $'j2 4'c ob EROSION CONTROL AND SEDIMENT 87 9040-108-E-0 TEMPORARY RECP, WOOD EXCELSIOR MAT SY 450.00 $ $ sc?% : 88 9040-108-F-1 WATTLE, STRAW, 6 INCH LF 300.00 $ .5- $ ??.?-re) 89 9040-108-F-2 WATTLE, REMOVAL LF 300.00 $ tGil% ,a_$ EROSION CONTROL MULCHING, 90 9040-108-Q-2 (5 . e _ t 3/ HYDROMULCHING SY 2,324.00 $ $ /MI INLET PROTECTION DEVICE, INTERMEDIATE a; Ca 91 9040-108-T-1 AND DROP IN i 9)400 EACH 23.00 $ -20C $ 92 9040-108-T-2 * i INLET PROTECTION DEVICE, MAINTENANCE EACH 23.00 $ $ j, 177 SUBTOTAL SITE WORK AND LANDSCAPING $ DIVISION 11 - MISCELLANEOUS CONSTRUCTION SURVEY `' 93 11010-108-A *" CONSTRUCTION SURVEY LS 1.0000 $ ?e:#10 $ g 90U 94 11,050-108-A-0 CONCRETE = WASHOUT LS 1.00 $ ricOO' $ � lCGXC 95. 7040-3.02-A SAW CUT LF 799.00 $ ,7 SEE ESTIMATE REMOVE, SALVAGE AND REINSTALL BIKE 96 LS 1.00 ''� �> ` �`��� REFERENCE RACKS $ / UC��' $ =: .. - - . -.: -.• ::.•-•SUDTCTAL MISCELLANEOUS.: 7. {. 674/ _ ....% .:• :. :. :. FORM OF BID CONRACT NO 1015 Page 4 of 7 6TO A� Diva SIGN I BASE RID166) � SUDAS SPECIFICATION UNIT SEE BID TOTAL DIVISION II JEFFERSON STREETSCAPE BID SUPPLEMENTAL - EST QTY PRICE BID PRICE UNIT SP = SPCL PROV DESCRIPTION ITEM v' SUDAS 2010-108-E- EXCAVATION, CLASS 10, WASTE CY 120.00 j�8 1 $ 0it- $ 2 SUDAS 2010-108-1-0 SUBBASE, MODIFIED CY 70.0 j���-� $ qq- $ 108-H- t SUDAS 5020 2.00 ADJUSTMENT EACH 3 FIRE HYDRANT ' 0,0 0 $ Jr $ rcc SUDAS 7010-108-E- CURB LF 15.00 4 RAISED 50 05 $ $ SUDAS 7030-108-A- �� %-i REMOVAL OF SIDEWALK SY 246.0 ))//76 o r $ Y SUDAS 7030-108-E- 246.0 ill 6 SIDEWALK, PCC, 6 IN. SY $%zr�sy $ SUDAS 7030-108-E 1:- 6 IN. SY 365.0 7 SIDEWALK, COLORED PCC, g g ,e, Ale 7030-`108-F- SUDAS SY 180.0 8 BRICK SIDEWALK WITH CONCRETE BASE aer- __?i.,joroa 0 $ $ cd SUDAS 7030-108-F- SY 10.0 AND REPLACE BRICK PAVERS .- REMOVE $ Vise 0 sus SUDAS 7030-108-G- f -, CAST IRON SF 85.0 --i- 5''(� DETECTABLE WARNINGS, $ l a� 0�10 $ SUDAS 7040- i 08-A- oia SY 53.6 11 FULL DEPTH PATCH ,g{ %U $ni9,5-b $ IA 2523- -DOT EACH 8.0 643610 3 gi y80'12 LIGHTING POLES, TYPE 1 70000100-� $��$ IA -DOT 2523 to%. EACH 1 1.0 ��, z LIGHTING POLESt, TYPE 2 13 0000100 $ $ r _ _ IA -DOT 2523- '1,400.0 CIRCUITS LF 1,3 6,260 14 ELECTRICAL $ % 0000200 $ oz G IA -DOT 2523- EACH 3.0 HANDHOLES AND JUNCTION BOXES ;''" %�ds 16 0000310 $�� $ J r IA 2523- -DOT 1.0 CONTROL CABINET EACH Z �jG� 16 0000400 $ 3'� $ `�� . 7080-108 G PCC EDGE RESTRAINT, 1 2 IN. WIDE X 9 IN. SUDAS _ _ LF 160.0 17 oa $�J%vim 0 HIGH 1, SKYLINE �? PLANTS WITH WARRANTY, TYPE SUDAS 9030-108-B- EACH 3 0 1 ��� i %5T 18 $ $ 0 HONEYLOCUST COMMON 6 =, PLANTS WITH WARRANTY, TYPE 1, SUDAS 9030-108-B- 3.° EACH S %C 6 ?X 1 0 HACKBERRY $ $ PLANTS WITH WARRANTY, TYPE 2, SUDAS 9030-108-B- 11.0 7�� 173 4.,3,G.' EACH 20 GINKGO 0 PRINCETON SENTRY $) $ 00 q7 ii6L .se.. $ 0TAL DIVISION 11 BASE BID FORM OF BID CONRACT NO, 1015 ADDENDUM NO. 3 Page5of7 i UNIT TOTAL SUDAS SPECIFICATION ;1 SEE DIVISION III - JEFFERSON STREE T SCAPE UNIT BID BID BID SUPPLEMENTAL (SOUTH SIDE) EST OTY PRICE PRICE ITEM SP = SPCL PROV DESCRIPTION _ 20.00 $ ����`. S $ tr: ��= 60 II SEE DIVISION EACH DETAILS REMOVE EXISTING TREES AND PIT MATERIAL o -. �� TYPE 2, SEE DIVISION II PLANTS WITH WARRANTY, 20.00 $ 6 750 $ o 2 EACH DETAILS THORNLESS HONEY LOCUST, SHADE iis 000 TOTAL SAL DIVISION III BASE BID $ I. 0`3- TOTAL DIVISION I BASE RID 42J�)76) c tv) to; —AL TO DIVISION II BASE BID $ IQ VSer eo a OTAL DIVISION III RASE F3ID $ 9finC 3 9) a i 6 ,�-- $4;7 TOIA��. DIVISION I + DIVISION II t DIVISION III � 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. cc/0 4. Security in the sum of Dollars ( ) in the form of>�= accordance with the INSTRUCTIONS TO BIDDERS. 5. Attached hereto is a Non -Collusion Affidavit of Prime Contractor. 6. Attached hereto is a Bidder Status Form. is submitted herewith in 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. FORM OF BID CONRACT NO. 1015_ADDENDUM NO. 2 Page 6 of 7 9. The bidder has received the following Addendum or Addenda: Addendum No. Date 713-aoa<9 :3 -0/6 cotia 10. The bidder shall list the MIBE/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 "S U 3CON T RAC T OR RF O UES I 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. Cc u .224 •Qio (Name of Bidder) (Date) BY: Title official Address: (Including Zip Code): , ox 751--(7 C /c!( CI le j _t-1 SOS/9 I.R.S. No. / PSY IS) FORM OF BID CONRACT NO 1015 Page 7 of 7 NON -COLLUSION AFFIDAVIT OF PRIME BIDDER State of } County of J?tc t Pc"."--"} au/k , being first duly sworn, deposes and says that: )ss 1. He is (Owner, Partner, Officer, Rep'resentatvei ; or Agent) , of Etur- n— , the Bidder that has subritted 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. Subscribed and sworn to before me this i%J 2040. My commission expires Title 014 #1, • day of , 1LINDAKSENN 0 COMMISSION NO, 803307 MY COMMISSION EXPIRES an : 0 0 0 2 �� O 7� uni IT 7 \,i W E� 7RI Et o �LL z C7j 0 L � n m® 0 7. PO PI rig IL f, Prime Contractor Name: (0 sEj 0 0 co o c W -0 CO aa)) °O L C C On (CS o � OI � C + 4 w C J •- H 0 0 0 O L- o co 41) C sc o C • O •- d a) o. CD L. E /� O 0 n vJ O o n co C Q) co a - 0 U Cie .45 a) •"' o a� U 0 O 0 0 0 CO Eta 0 4 0 u) LU 0 z hi 0 Contractor Signature: E _O v) O O -1z; co 0 O 2 0 0 6 0 Q) 0) T. O 0 0 p 0 0 0 D O 0 >- 0 c 0 U) 0 V C CC 0 U 1 0 a) 0 :-., (0 0 0 E p 0` O (0 O co CO � o >1 0 4o a) Q � en .0 C Z3 0 L O 0 W a) o o) 0 C '§ o O -F, Ri ac o E c0 Lz.� 0 0 cnD C C 0 C > O 0 . O (0 -E•-' L � O L d . c o4-1 o CO a) _On a. w au)o CL o = o (n 0 cn C O .cCis O 0 -c o sa2a) oc w t p O O .O 0 -Oa) co Ecn O fl T3 3 a O in 8 W O, p co O a >, •�Oq a C 5a.-. ` S 0 o E -a . 0 )) O 8 O a) `id _0 �- C - BE Business 0 ,v C CT a) Q) U N C s- . a (O (a o O C >' >-W`4- (a v! c CO CO co 2 a) a) C Qom) D a) a) a� C 0 0 a) O o • Li w C O O 0) U 7.8 EI U) n3 O r O s. V J j aCO CD U C U W = a) 0 (6 O O 0 co 0 CO 0) 13 (0 a) (0 0 PAL TABLE OF 0 L 7 0 co CD w LU O w w .%•3. V \ T Nj]I L ti 0 Tt e STITT 1 %1J ©)--c 0 4,__%0 kV rt *--3- F„ . , ifl n 0 c'' g >•-- (es/IN � pi), U 9 _ st y CIL k_ (Form CCO-4) Rev. 06-20-02 tfif o. f�'� o h ' ` u. ui i�;h ©rtlEn`illi o n ll ra rimac t' f ui u bt oo -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. i Yes IJ Li LI ri 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. Yes dNo 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 p_No Yes Yes Yes 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 aro filed in a state other than Iowa, the corporation has received a certificate of authority from the Iowa secretary of state, has filed its rnost 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 revolted. My business is a limited liability partnership which has filed a statement of qualification in this state and the statement has not been canceled. 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 11 No My business is a limited partnership or limited liability limited partnership which has filed a certificate of limited partner -ship in this state, and has not filed a statement of termirnation. Yes I I 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 tho Iowa secretary of state that the application for certificate of authority has been approved and no notice of cancollation has boon filed by the iimitod partnership or the limited liability limited partnership. Yes i 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 n 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 revolted or canceled. 309-6001 (09-15) [NM `u io For'LfUil ht. coh-VOpk f e d bS9 Ul Ct.)ndci1=' r3 Please answer 'Yes" or "No" for each of the following: -1 Yes Yes Yos Yes r r- No My company is authorized to transact business in lowa. (To help you determine if your company is authorized, please review the worksheet on the next page). No My company has an office to transact business in Iowa. No My company's ° im in Iowa is suitable for more than reGolving mail, telephone calls, and o=rnail. No My company has boon conducting business in Iowa for at least 3 years prior to tho first request for bids on this project. No My company is riot 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 D and 0 of this form. If you answered "No" to one or more questions above, your company is a nonresident bidder. Please complete Parts 0 and © of this form. b) ©o )11(4,®d r .gdd JII i2 llmadob My company has ma Dates: / - - to Dates: / / to / / Dates: / / — to / t You may attach additional shooks) if noeded. To be completed by U- o uriv s l W biloldovo Paii: (n4a(ncd osr`1cos hi Iowa during tho past 3 years at tho following oddPesses: eiet Yst C /G/ sv‘� j / `-Ck)a Address: City, State, Zip: Address: City, State, Zip: Address: City, State, Zip: 1. Name of horne state or foreign country reported to tho Iowa Secretary of State: Part C 2. Does your company's home state or foreign country offer preferences to resident bidders, resident labor 1 9 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. To ha completed by o8D bockl Uo You may attach additional sheet(s) if needed. 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: Z4etrot Ccvs vac in c � � - Signature: Date: You muiM sathmit the complotod `donYi to gii9 EJOVOillitnefritai body vsgLgo titiq befit p v 076 Iowa Administrative Co Chapter 166. tz hl T rr�u hao beau approved by tho Iowa Labor Commi 0ion@ro 309-6001 (09-'15) Revised February 2003 M IL/1UtoR'S Od , GURGON`:,9eINAGI AFFIRMATIVE _ACTION PROGRAM Check box that applies to party completing program: ) General Contractor ) Subcontractor I. Section A to be completed by GENERAL CONTRACTORS only: A. • Narne of Company. to C/i,.� �VI lw�- Company 80/01Zip 506/5 Address ®f p y Telephone Number (_3/ ) (97C `s-S-7tai• Federad g0 Number (if no Federal ID Number, _' wner/President's Social Security Number) 72-e.,221r6/- Marra of Equal Employment Officer N ame of Project �- - Mciwt T moik P roject Contract Number /67-54-- Estimated Construction Work Dates °409° Start Finish S ection 0 to be completed by!_UBCONTRACTORS only: B. N ame of General or Primo Contractor Narne of Subcontractor S ubcontractor's Address - Zip S ubcontractor's telephone Number (_ ) Subcontractor's Federal ID Number (if no Federal ID Number Owner/President's social Security Number) _- -- Narne of Equal krnployr gent Officor C. Remainder of program to be completed by party completing program, either Prime or Subcontractor. '1. The Owners and/or Principals of your company: Ethnic Name Address Position sex origin PO t poy I; Ct— lei r /14 vO 2. Other Areas of Interest: If your company has branches or subsidiaries, or if your company is a branch or subsidiary of a parent organization, give the following information: Type of Name Address Affiliation Degree H. F.MPLOYER'S POLICY (Please read carefully.) A. We, the undersigned, recognize that we are morally and legally committed to nondiscrimination in employment. Any person who applies for employment with our company will not be discriminated against because of race, color, creed, sox, national origin, economic status, age, mental or physical handicap. B. The employment policies and practices of the undersigned are to recruit and hire employees without discrimination, and to treat them equally with respect to compensation and opportunities for advancement, including training, upgrading, promotion, and transfer. However, we realize the inequities associated with employment training, upgrading, contracting and subcontracting for minorities and women and we will direct our efforts to correcting any deficiencies to the maximum extent possible. :I -he same will beroc-piked of our SUBCONTRACTORS and suppliers. C. We submit this program to assure compliance with Executive Order 1124, as amended, and other subsequent orders that may pertain to equal employment opportunity and merit employment policies, fully realizing that our qualification and/or merit system should be evaluated and revised, if nec_-ssa D. We agree to put and utilization o regard and m E. (N MOST OS and employment opport the greatest extent feasi III. AFFIRMATIVE ACTI A. C. (Nam effective ap •itiatiga just a policy statement, and maximum effort to achieve full employment es and productivity of all our citizens without ational origin, economic status, age, will give training LIE, IA 50619 i to local residents of Waterloo, Iowa, to (N will therefore re-evaluate our Affirmative Ac ,- • equal employm ", Al •ortunities are available on the basis o�a `�in�l • ' 'f9 merit, and to a qi, 1Lr? courage minorities, women and local residents S yfr to seek emplo 141 151 iph our company on this basis. will undertake the foil • ���.f� i? e fur Affirmative Action Program: P.O. Box 459 I CLARKSVILLE, IA 50619 1. Minority Recruitment and Employment; 2. Local Recruitment and Employment; 3. Disabled Veteran and Vietnam Era Veteran Recruitment and Employment; 4. Handicapped Rec 5. Female Recruitm 6. Training, Upgradi (Name whatever ste adequate mo `F following methods in t and Employment; mployment; and romotional Opportunities. will take that our total work force has entation. We will utilize the nktiM npts: 1. Local advertising media (newspapers, radio, TV); 2. Community organizations (churches, clubs, schools); 3. Public and private institutions in the area (UNI, Hawkeye Community College); 4. Job Service of Iowa; and 5. Other. D. (N will seek qualified minority, fe;.�►.r.�c _t�..��{� r_l,. , s for all job categories and will make assefgalfiftctORIIMeasisual. ity, female and group representation in occupations at the higher levels or skill and responsibility. E. All sources of employment used shall be aware that we are an Equal Employment Opportunity ,Employer. Labor organizations representing our employees will be notified of our Rc ual Employment Opportunity Policy and AthF natr -(on Program. 6. Training, upgradi monitor minor'� • (Namofem companies wit same and (N Ar t minority, female, local contractors and/o ° MiPo or��unities to negotiate and/or bid on p � this project: (if none, write "NONE") tiori and transfer activities at all Levels will be onsideration has been given to qualified ployees. will encourage other LLB, IA5 6 e are associaied and/or do business, to do the ther-�n in their efforts. Y.::t. .)• has taken the following 2. 1 As result of the above efforts, we have involved minority, female, and local contractors and/or suppliers in the following areas of subcontracting: (if none, write "NONE") Pce 2. 14-tti + tebCA weir 5 (Na r �' 't i. •, . / }:= k- h Affirm: _ .::.4 , ; all nonexempt contractors who ...4.?1,,,f,-, prop ; �� �� - �• }V t.: . anrd will take whatever steps are necesialifeetriati1WMKAtilainority contractors have adequate representation of minority, female and local persons in their total work force. will require approved In further accor Executive 011ie company, bas realiz with rules and guidelines issued pursuant to as amended, we establish the goals for our ity percentages supplied by the City, and we d ©n an annual basis. will keep records of specifiraWg 6tMr1tarffifltDitDnent, employment, training, upgrading and promotion and will provide the City of Waterloo with any information relative to same, including activities of our SUBCONTRACTORS and suppliers as necessary or when requested. M. Parity figures for c• .'�: located in Waterloo are as follows: Affirmative Action ta Employe .CAQEi,0A.KLLE,LA.50619 The definition of Affirmative Action Goals is as follows: "Goals may not be rigid and inflexible quotas which must be met, but rust be targets,. ro(i ;oriabIy attainable by means of applying every [pod _frith t; to make all aspects of the entire Affirmative Action Program work." For the year 201 , please subrnat percentage targets for employing minorities and women. It you already have reached your target for hiring minorities and women, please submit that percentage. *Goals for Minorities: Goals `r o r Women: Ok .;Your affirmative action goals should be between 1 % and 10% or more for minorities and 1% and 5% or more for women. Please be advised that the goals or targets are purely your estimation of how many women and minorities your company can reasonably expect to hire in 201, . Note, that none of the goals are rigid or inflexible. They are targets that your company calculates as reasonably attainable. This will help the City in its monitoring procedures as required b Y Cityof Waterloo Resolution No. 1984 142(4). We hereby certify that we are in compliance with all City and Federal Affirmative Action Regulations and agree to accept an liability for failure to comply. Respectfully submitted, y: of Ovate rloo Affirmative Action Officer Date: Approved Disapproved Reason: • --)-4( 6( locij Company Executive Date Equal Employment pportunity Officer Date 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. EQUAL OPPORTUNITY CLAUSE PAGE 1 OF 2 PAGES 5The 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. 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 nondiscrimination 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) (Appropriate Official) (Titlo) (Date) EQUAL OPPORTUNITY CLAUSE PAGE 2 OF 2 PAGES BID BOND KNOW ALL MEN BY THESE PRESENTS, that we, Lodge Construction, Inc. 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 Pnncipal has submitted the accompanying bid dated the 26th day of March , 2020 , for F.Y. 2020 Courtland St., Jefferson St. and Mulberry St, Reoonstrvcition_ Program, Waterloo, lA , Contract NoA015 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 matenals 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 18th day of March , A.D. 2020 , Lodge Construction, Inc. North American ;� ecialty Insurance ompany (seal) By Attome one R. Young 10 ( eal) F5t)4...z. (Title) 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 Attorneys) -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." `‘,0111111I1!/111arger.) 141:t. ro ,.. L e iz-- r sZ 1973 �L: %lull{1 `�a�a1,tu1uOntwNAL tuu,�,,' , �;aa �., t z SEAL :: • g. TsO: :0 to' • m_ n € • we 4* Steven 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 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. 4 OFFICIAL SEAL M. KENNY Notary Public - State of Illinois My Commission Expires 12/04J2021 --- f e4 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 18th day of March , 2020 . n 17--‘e Jeffrey Goldberg, Vice President & Assistant Secretary of Washington International Insurance Company & North American Specialty Insurance Company & Vice President & Assistant Secretary of Westport Insurance Corporation