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PROPOSAL FORM
AI P Project: 3-19-0094-043
TO: City of Waterloo
Black Hawk County, Iowa
715 Mulberry Street
Waterloo, Iowa 50703
The undersigned, in compliance with the request for bids for furnishing the following Equipment:
Snow Removal Equipment(SRE)
(Front End Loader)
hereby proposes to furnish all necessary labor, permits, material, machinery, tools, supplies and equipment to
faithfully perform all work required for furnishing the equipment identified below in strict accordance with the project
documents and all issued Addenda within the specified time of performance for the unit prices stated below:
BID SCHEDULE
Bid Specification Reference
Item and Item Description Quantity Unit Unit Price Extension
1 Front End Loader 1 LS $ 243,494.00 $ 243,494.00
TOTAL BASE BID (Numeral Format) S 243,494.00
TOTAL BASE BID (Written Format) two hundred forty-three thousand, four
hundred ninety-four dollars & no cents
ACKNOWLEDGEMENTS BY BIDDER
a. The Waterloo Airport Board will select the lowest responsive proposal based on the lowest total bid submitted.
A bid is required with respect to all items of the bid. Failure to submit a bid with respect to one or more of the
items will cause the bid to be rejected as not responsible.
b. The BIDDER acknowledges and accepts that the Bid Documents are comprised of the documents identified
within the Instructions to Bidders. The BIDDER further acknowledges that each the individual documents that
comprise the Bid Documents are complementary to one another and together establishes the complete terms,
conditions and obligations of the successful BIDDER.
c. As evidence of good faith in submitting this proposal, the undersigned encloses a bid guaranty in the form of a
certified check or bid bond in the amount of 5% of the bid price. The BIDDER acknowledges and accepts that
refusal or failure to accept award and execute a contract within the terms and conditions established herein will
result in forfeiture of the bid guaranty to the owner as a liquidated damage.
d. The BIDDER acknowledges and accepts the OWNER'S right to reject any or all bids and to waive any minor
informality in any Bid or solicitation procedure.
e. The BIDDER acknowledges and accepts the OWNER'S right to hold all Proposals for purposes of review and
evaluation and not issue a notice-of-award for a period not to exceed 60 calendar days from the stated date
for receipt of bids. During this evaluation period, the BIDDER agrees to honor the stated price(s)without any
adjustment.
f. The undersigned agrees that upon written notice of award of contract, he or she will execute the contract
within fifteen (15) days of the notice-of-award and furthermore and provide executed payment and
performance bonds within fifteen (15)days from the date of contract execution. The undersigned accepts that
AECOM PROJECT#60323419 PF-1 Snow Removal Equipment
(Front End Loader)
Waterloo Regional Airport
failure to execute the contract and provide the required bonds within the stated timeframe shall result in
forfeiture of the bid guaranty to the owner as a liquidated damage.
g. Time of Performance: By submittal of this proposal, the undersigned acknowledges and agrees to commence
work within ten (10) calendar days of the date specified in the written "Notice-to-Proceed" as issued by the
OWNER. The undersigned further agrees to complete the Project within 180 calendar days from the
commencement date specified in the Notice-to-Proceed or Purchase Order.
h. The undersigned acknowledges and accepts that for each and every Calendar/Working day the project
remains incomplete beyond the contract time of performance, the Contractor shall pay the non-penal amount
of $100 per Calendar/Working day as a liquidated damage to the OWNER.
i. The BIDDER acknowledges that the OWNER has established a contract Disadvantaged Business Enterprise
goal of 0% for this project. The BIDDER acknowledges and accepts the requirement to apply and document
good faith efforts, as defined in Appendix A,49 CFR Part 26,for subcontracting a portion of the prime contract
to certified Disadvantaged Business Enterprises(DBE), as defined in 49 CFR Part 26 for purposes of meeting
the OWNER'S established goal. The BIDDER, in complying with this requirement, proposes participation by
Disadvantaged Business Enterprises as stated on the attached forms, "Utilization Statement' and "Letter of
Intent"
j. The undersigned acknowledges receipt of the following addenda:
Addendum Number 1 dated 7/3/14 Received 7/3/14
Addendum Number 2 dated 7/3/14 Received 7/3/14
Addendum Number 3 dated 7/8/14 Received 7/8/14
REPRESENTATIONS BY BIDDER
By submittal of a proposal (bid),the BIDDER represents the following:
a. The BIDDER has read and thoroughly examined the bid documents including all authorized addenda.
b. The BIDDER has a complete understanding of the terms and conditions required for the satisfactory
performance of project work.
c. The BIDDER has found no errors, conflicts, ambiguities or omissions in the project documents, except as
previously submitted in writing to the owner that would affect cost, progress or performance of the work.
d. The BIDDER is familiar with all applicable Federal, State and local laws, rules and regulations pertaining to
execution of the contract and the project work.
e. The BIDDER has complied with all requirements of these instructions and the associated project documents.
CERTIFICATIONS BY BIDDER
a. The undersigned hereby declares and certifies that the only parties interested in this proposal are named
herein and that this proposal is made without collusion with any other person, firm or corporation. The
undersigned further certifies that no member, officer or agent of OWNER'S has direct or indirect financial
interest in this proposal.
b. Certification of Non-Segregated Facilities:(41 CFR Part 60-1.8)
The BIDDER, as a potential federally-assisted contractor, certifies that it does not maintain or provide, for its
employees, any segregated facilities at any of its establishments and that it does not permit its employees to
perform their services at any location, under its control, where segregated facilities are maintained. The
BIDDER certifies that it will not maintain or provide, for its employees, segregated facilities at any of its
establishments and that it will not permit its employees to perform their services at any location under its
control where segregated facilities are maintained. The Bidder agrees that a breach of this certification is a
violation of the Equal Opportunity Clause,which the Owner will incorporate into the contract.
As used in this certification, the term "segregated facilities" means any waiting rooms, work areas, restrooms,
and washrooms, restaurants and other eating areas, timeclocks, locker rooms and other storage or dressing
areas, parking lots, drinking fountains, recreation or entertainment areas, transportation, and housing facilities
provided for employees which are segregated on the basis of race,color, religion, or national origin because of
habit, local custom, or any other reason. The Bidder agrees that (except where it has obtained identical
certifications from proposed subcontractors for specific time periods) it will obtain identical certifications from
proposed subcontractors prior to the award of subcontracts exceeding $10,000 which are not exempt from the
provisions of the Equal Opportunity Clause and that it will retain such certifications in its files.
AECOM PROJECT#60323419 PF-2 Snow Removal Equipment
(Front End Loader)
Waterloo Regional Airport
c. Trade Restriction Certification: (49 CFR Part 30)
The Bidder, by submission of an offer certifies that it:
1. is not owned or controlled by one or more citizens of a foreign country included in the list
of countries that discriminate against U.S. firms published by the Office of the United
States Trade Representative(USTR);
2. has not knowingly entered into any contract or subcontract for this project with a person
that is a citizen or national of a foreign country on said list, or is owned or controlled
directly or indirectly by one or more citizens or nationals of a foreign country on said list;
3. has not procured any product nor subcontracted for the supply of any product for use on
the project that is produced in a foreign country on said list.
d. Certification Regarding Debarment, Suspension, Ineligibility and Voluntary Exclusion: (49 CFR Part 29)
The Bidder certifies, by submission of this proposal, that neither it nor its principals is presently debarred,
suspended, proposed for debarment, declared ineligible, or voluntarily excluded from participation in this
transaction by any Federal department or agency. It further agrees by submitting this proposal that it will
include this clause without modification in all lower tier transactions, solicitations, proposals, contracts, and
subcontracts. Where the Bidder or any lower tier participant is unable to certify to this statement, it shall attach
an explanation to this solicitation/proposal.
e. Buy American Certification: (Title 49 U.S.C. Chapter 501)
As a condition of bid responsiveness, the bidder must how it intend to comply with the Buy American
preferences established under Title 49 U.S.C. Section 50101. Bidders must complete the Buy American
certification that is attached to this proposal form. If the bidder requests a permissible waiver to the Buy
America requirements, the Bidder identified as the low bid must submit a formal waiver request and
component cost calculation within the prescribed time identified on the Buy America certification.
ATTACHMENTS TO THIS BID
The following documents are attached to and made a part of this Bid:
1. Bid Guaranty in the form of bid bond •
2. Completed DBE forms"Utilization Statement"and"Letter of Intent".
3. Buy America Certification
4. Evidence of good faith efforts required by 49 CFR Part 26, Appendix A. If proposed DBE goal is met,
submittal of evidence of good faith efforts is not required.
5. Evidence of BIDDER'S qualifications per the requirements of the Instructions-to-Bidders.
AECOM PROJECT#60323419 PF-3 Snow Removal Equipment
(Front End Loader)
Waterloo Regional Airport
SIGNATURE OF BIDDER
IF AN INDIVIDUAL:
Name:
By:
(Signature of Individual)
Doing Business as:
Business Address:
Telephone Number:
IF A CORPORATION:
Corporation Name: yTr of & quipint co, Inc
By: E"
(Authorized Signature)
(Attach Evidence of Authority to sign)
Name and Title: Ken Geoghegan, Branch Manager
Business Address: 3469 W Airline Hwy (CORPORATE SEAL)
Waterloo, Iowa 50703
Telephone Number: (319) 235-7085 1-
ATTEST: ! ' PAT L. BUDKE
By: Pat A �� J t COMMtSStON N0.178968
(Authorized Signature) ', } M'1 SSION EXPIRES
I!Z tip
Name and Title:
IF A JOINT VENTURE: (Attach copy of Joint Venture Agreement)
Joint Venture Name:
By:
(Authorized Signature)
(Attach Evidence of Authority to sign)
Name and Title:
Business Address:
Telephone Number:
Joint Venture Name:
By:
(Authorized Signature)
(Attach Evidence of Authority to sign)
Name and Title:
Business Address:
Telephone Number: '
AECOM PROJECT#60323419 PF-4 Snow Removal Equipment
(Front End Loader)
Waterloo Regional Airport
Buy America Certification
(Title 49 U.S.C. Section 50101)
' PROJECT NAME: Snow Removal Equipment(Carrier Vehicle With Snow Blower)
AIRPORT NAME: Waterloo Regional Airport
AIP NUMBER: 3-19-0094-043
This solicitation and any resulting contract are subject to the Buy America requirements of 49 U.S.C. Section 50101.
The bidder certifies it and all associated subcontractors will comply with the Buy American preferences established
under Title 49 U.S.C.Section 50101 as follows:
U.S.C. Section 50101 • Buying goods produced in the United States
(a) Preference. - The Secretary of Transportation may obligate an amount that may be appropriated to carry out section
106(k), 44502(a)(2), or 44509, subchapter I of chapter 471 (except section 47127), or chapter 481 (except sections
48102(e),48106,48107,and 48110)of this title for a project only if steel and manufactured goods used in the project are
produced in the United States.
(b) Waiver.-The Secretary may waive subsection(a)of this section if the Secretary finds that-
(1) Applying subsection(a)would be inconsistent with the public interest;
(2) The steel and goods produced in the United States are not produced in a sufficient and reasonably available amount
or are not of a satisfactory quality;
(3) When procuring a facility or equipment under section 44502(a)(2) or 44509, subchapter I of chapter 471 (except
section 47127),or chapter 481 (except sections 48102(e),48106,48107, and 48110)of this title A. The cost of components and subcomponents produced in the United States is more than 60 percent of the cost
of all components of the facility or equipment;and
B. Final assembly of the facility or equipment has occurred in the United States;or
(4) Including domestic material will increase the cost of the overall project by more than 25 percent.
(c) Labor Costs. - In this section, labor costs involved in final assembly are not included in calculating the cost of
components.
• * * * *
As a matter of bid responsiveness, the bidder or offeror must complete and submit this certification with their bid
proposal. The bidder must sign and date the certification. The bidder/offeror must indicate how they propose to
comply with the Buy America provision by selecting one of the following certification statements.
❑ The bidder hereby certifies that it will comply with Title 49 U.S.0 Section 50101(a) by
only installing steel and manufactured products produced in the United States of
America. The bidder further agrees that if chosen as the apparent low bid, it will
submit documentation to the owner that demonstrate all steel and manufactured
products are 100% manufactured in the United States.
a The bidder hereby certifies that it cannot fully comply with the Buy America
preferences of Title 49 U.S.0 Section 50101(a); the bidder therefore requests a
waiver per Title 49 U.S.0 Section 50101(b). The bidder further agrees that upon
notification from the Owner, the bidder identified with the apparent low bid agrees to
prepare and submit a waiver request and component calculation information to the
owner within 7 calendar days of the date of the notice of apparent low bid.
Murphy Tractor & Equipment Co, Inc
Bidder's Firm Name ate
Signature ~"�i
AECOM PROJECT#60323419 PF-5 Snow Removal Equipment
(Front End Loader)
Waterloo Regional Airport
Buy America Waiver Request
Title 49 U.S.0 Section 50101 (b)
For Equipment and Vehicles Procured under the
Airport Improvement Program
Type of Waiver Request:
The bidder may request a waiver subject to the provisions of Section 50101(b)(3) or Section 50101(b)(4). The
bidder may not request a waiver under Section 50101(b)(1)or Section 50101(b)(2). Bidder is hereby advised that
the Owner's approval with the bidder's waiver request is contingent upon FAA approval. The bidder must select
one of the following applicable waiver provisions:
Section 50101(b)(3): Bidder hereby requests a waiver to Buy America preferences based upon Section
50101(b)(3). The bidder further certifies that 77 % of the cost of components and
subcomponents comprising the equipment are produced in the United States and that final assembly
occurs with the United States. (Bidder must attach a copy of the component cost calculation table)
❑ Section 50101(b)(4). Bidder hereby requests a waiver to Buy America preferences based upon Section
50101(b)(4). The bidder asserts provision of domestic material increases the cost of the overall project
by more than 25%. (This type of waiver is rare)
Certification Signature
In accordance with Section 50101(b), we request a waiver to the Buy America provisions based on the above
certification and attached documentation.
Murphy Tractor & Equipment Co, Inc 7/S/i
Bidder's Firm Name Date
Signature
Instructions for Section 50101(b)(3)Waiver:
1. "Equipment"in Section 50101 shall mean AIP-funded vehicle or single piece of equipment.
2. The bidder must base the U.S. percentage upon the value that results from completing a component cost calculation
table similar to the attached format.Bidder shall avoid mere pro forma efforts to establish the waiver request percentage.
The Bidder must submit the component cost calculation table as an attachment to the waiver request. The component
breakout shall be along major elements/systems of the equipment.
3. Components are the material and products directly incorporated into the"vehicle"at the place of final assembly.
4. The final assembly of the AIP-funded "equipment"must be within the USA (Section 50101(b)(3)(B)). Final assembly is
the substantial transformation of the components and subcomponents into the end product.
5. All steel used in the"Equipment"must be produced in the USA. FAA will not approve a waiver for products made with
non-domestic steel.
6. The Buy American requirements apply to all tier contractors and subcontractors. All contractors/subcontractors are
required to provide sufficient documentation that indicates origin of manufacturer and percentage of domestic
manufactured product.
7. The bidder is hereby advised there is no implied or expressed guarantee that the Federal Aviation Administration(FAA)
will approve any requested waiver. The FAA CANNOT concur with any waiver request for less than 60%US component
participation.
Instructions for Section 50101(b)(4)Waiver:
1. This waiver is rarely applied.Consult Owner before making this request.
2. Prepare detailed proposal costs using domestic product(s)and the overall project cost. Prepare detailed alternate
proposal costs of the non-domestic product(s) and the overall project cost. If the proposal with domestic
product(s)is more than 25%of the proposal with non-domestic product(s),the bidder may request a waiver under
50101(b)(4).
3. Bidder must attach adequate documentation that supports the use of domestic products results in an increase in
the overall project costs that exceeds 25%. The bidder must certify under signature and date that the submittal
information is correct and accurate.
North America Free Trade Act(NAFTA)
The NAFTA does not apply to the AP. Products and material made in Canada or Mexico must be considered as foreign
made •roducts.
AECOM PROJECT#60323419 PF-6 Snow Removal Equipment
(Front End Loader)
Waterloo Regional Airport
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UTILIZATION STATEMENT
Disadvantage Business Enterprise
The undersigned bidder/offeror has satisfied the requirements of the bid specification in the
following manner. (Please mark the appropriate box)
XC The bidder/offeror is committed to a minimum of 0 % DBE utilization
on this contract.
The bidder/offeror, while unable to meet the DBE goal of %, hereby
commits to a minimum of % DBE utilization on this contract and
also submits documentation, as an attachment demonstrating good faith
efforts (GFE).
The undersigned hereby further assures that the information included herein is true and correct, and
that the DBE firm(s) listed herein have agreed to perform a commercially useful function in the work
items noted for each firm. The undersigned further understands that no changes to this statement may
be made without prior approval from the Civil Right Staff of the Federal Aviation Administration.
Murphy Tractor & Equipnent Co, Inc
Bidder's/Offeror's Firm Name
Signature to
DBE UTILIZATION SUMMARY
Contract Amount DBE Amount Contract
Percentage
DBE Prime Contractor $ x 1.00 = $
DBE Subcontractor $ x 1.00 = $
DBE Supplier $ x 0.60 = $
DBE Manufacturer $ x 1.00 = $
Total Amount DBE $
DBE Goal $ 0 0
If the total proposed DBE participation is less than the established DBE goal, Bidder must provide written documentation of the
good faith efforts as required by 49 CFR Part 26.
AECOM Project#60323419 DBE-1 Snow Removal Equipment
(Front End Loader)
Waterloo Regional Airport
LETTER OF INTENT
Disadvantage Business Enterprise
(This page shall be submitted for each DBE firm)
Bidder/Offer Name: Murphy Tractor & Equipment Co, Inc
Address: 3469 W Airline Hwy
City: Waterloo State: Iowa Zip: 50703
DBE Firm: DBE Firm:
Address:
City: State: Zip:
DBE Contact Person: Name: Phone: ( )
DBE Certifying Agency: Expiration Date:
Each DBE Firm shall submit evidence (such as a photocopy) of their
certification status.
Classification: ❑Prime Contractor ❑Subcontractor ❑Joint Venture
El Manufacturer ❑Supplier
Work item(s)
to be performed Description of Work Item Quantity Total
by DBE
The bidder/offeror is committed to utilizing the above-named DBE firm for the work described
above. The estimated participation is as follows:
DBE contract amount: $ 0 Percent of total contract: 0
AFFIRMATION:
The above-named DBE firm affirms that it will perform the portion of the contract for the estimated dollar
value as stated
above.
By: / -- / �ivv�i►'c ��%'�� -/�
(Signature) (Title)
In the event the bidder/offeror does not receive award of the prime contract, any and all
representations in this Letter of Intent and Affirmation shall be null and void.
AECOM Project#60323419 DBE-2 Snow Removal Equipment
(Front End Loader)
Waterloo Regional Airport
1111 BN 84560
Il
ilBID BOND
KNOW ALL MEN BY THESE PRESENTS, that we, Murphy Tractor & Equipment Co Inc
1111 as Principal,and Sentry Select Insurance Company
as Surety are held and firmly bound unto the CITY QF WAIRLOO , Iowa,
NI hereinafter called"OWNER,"in the penal sum Thirteen Thousand One Hundred Thirty-eight & 00/100
Collars($13 , 13 8 . 0 0 )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,
1111 jointly and severally, firmly by these presents. The condition of this obligation la such that whereas the
Principal has submitted the accompanying hid dated the loth day of July, 2014
m, for Snow Removal Eguipment (front end loader)
NWaterloo Regional Airport FAA AIP Project #3-19-0094-43 ,
NOW,THEREFORE,
II (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
Id specified and shell 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,
N Then this obligation shall be void, otherwise the same shall remain In force and effect; It being expressly
understood end 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.
1111 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,
III The Surety, for value received, hereby stipulates and agrees that the obligations of said Surety and hts
bond shall be In no way impaired or affected by any extension of the time within which the Owner may
accept such Bld or execute such contract; and said Surety does hereby waive notice of any such
1111 extension.
IN WITNESS WHEREOF, the Principal and the Surety, have hereunto set their hands and seals, and
such of them as era corporations, have caused their corporate seals to be hereto affixed and these pres-
I ants to be signed by their proper officers this 3rd day of July ,A,D, g2014
Murphy Tractor & Equipment Co Inc (Seal)
Principaly
ill By
1-2Z--J,74.-- ogo4./P -01 f /2744-,-. efr i• ,
(Title)
11 / // Sentry Select Insurance
,/Corn any (seal)out ir/t
W Itne /eu , Sur ��,""'�I�w(/ "��`�NSU Rq`''��,
B ?ORq •111
itngs ✓ Ri a M. Gi der Attorne in-fac ....
, T�:p
II MECOM Project#80323419 BB-t Snow Removal EQGaplr�'nt .. ' '
(Front End L • v-�
Waterloo Regional ..�`
AIIIIIl1it111�..
SENTRY SELECT INSURANCE COMPANY
POWER OF ATTORNEY
Bond Number: BN 84560
Know all men by these presents, that Sentry Select Insurance Company, a corporation duly organized under the laws of the State of
Wisconsin, and having its principal place of business in the City of Stevens Point, State of Wisconsin, does hereby make, constitute
and appoint JOHN T. BAUMAN, BEVERLY R. BEIGEL, DORENE R. BIALAS, RITA M. GINDER, CHERYL M. JISKO, ANDY M.
KURSZEWSKI,JENNIFER M. MURPHY, TRICIA L. SCHILLING, MICHELLE M. THAUER,AND LYNDA L.WACHOWIAK, as its true
and lawful Attorneys-in-Fact, for it, and in its name, place and stead,with full power and authority to sign, execute, acknowledge and
deliver for and on its behalf as Surety, any and all bonds with an effective date on or after January 13, 2014.
Signed: �eu Attest:
r ,V 0/ 4-Lk; r AL
6i•
'Jr
Daniel L.Revai,President •am: , Kenneth J.Erler,Secretary
Sentry Select Insurance Company Sentry Select Insurance Company
ACKNOWLEDGMENT
State of Wisconsin
)ss.
County of Portage
I, Shelley M. McEachen, Notary Public, do hereby certify that Daniel L. Revai and Kenneth J. Erler, the President and the Secretary,
respectively, of Sentry Select Insurance Company, personally known to me to be the same persons whose names are subscribed to
the foregoing instrument as such President and Secretary, appeared before me this day in person and acknowledged that they
signed,sealed and delivered said instrument as their free and voluntary act for the uses and purposes therein set forth.
Given under my hand and official seal,this 13th day of January,2014.
'.w. PC)B1JC
•+1v, ,, �. Shelley M.McEachen
ti.I�c' My Commission expires 10/17/2017
AUTHORIZATION
I, Kenneth J. Erler, Secretary of Sentry Select Insurance Company, hereby certify that Sentry Select Insurance Company is duly
licensed to transact fidelity and surety business in all States of the United States of America, that the foregoing Power of Attorney is a
correct and true copy of the original Power of Attorney,that said Power of Attorney has not been revoked, and I further certify that the
following is a true and exact copy of two resolutions passed by the Board of Directors of Sentry Select Insurance Company at
meetings held by said Board, a quorum being present and voting on the date specified below,which resolutions are still in effect:
RESOLVED, that the President or any Senior Vice President in conjunction with any Secretary or Assistant Secretary, be and
they are hereby authorized and empowered to appoint Attorneys-in-Fact of the Company, in its name and as its acts, to execute
and acknowledge for and on its behalf as Surety any and all bonds, recognizance, contracts of indemnity,waivers of citation and
all other writings obligatory in the nature thereof, with power to attach thereto the seal of the Company. Any such writings so
executed by such Attorneys-in-Fact shall be as binding upon the Company as if they had been duly executed and
acknowledged by the regularly elected Officers of the Company in their own proper persons. (Adopted 11 September 1969.)
RESOLVED, that the signature of any Officer authorized by the Bylaws and the Company seal may be affixed by facsimile to
any power of attorney or special power of attorney or certification of either for the execution of any bond, undertaking,
recognizance or other written obligation in nature thereof, such signature and seal when so used being hereby adopted by the
Company as the original signature of such Officer and the original seal of the Company, to be valid and binding upon the
Company with the same force and effect as though manually affixed. (Adopted 29 April 1971.)
11
Given under my hand and official seal,this 3rd day of July,2014. G�\�1SVR .,.
Kenneth J.Erler,Secretary _ "�• ((�;
SEAL `" =CC SEAL • =
Sentry Select Insurance Company
=k' • • b
"lir1 1%0%
73-70 01-14
M RPHY
TRACTOR & EQUIPMENT CO.
5087 E BROADWAY AVE ff /+
DES MOINES, IA 50317-4744 Evidence of�iC de_s Qualifications—
515-263-0055
PO BOX 1760
DODGE CITY,KS 67801-1760
620-227-3139
1303 3RD AVE NW Benton's Ready liked Concrete
FORT DODGE,IA 50501-2257 Charles Benton
515-576-3184
PO BOX 460 725 Center Street
GERING, NE 69341-0460 Cedar cEaIts, Iowa 50613
308-436-2177
3204 S ENGLEMAN RD (319)266-2641
GRAND ISLAND,NE 68803-6621
308-381-0741
PO BOX 1206 After Trading Corporation
GREAT BEND,KS 67530-1206 Vince.7Ceuer
620-792-2748
1500 WAirline Owy
8600 NE PARVIN RD
KANSAS CITY, MO 64161-9393 Waterloo, Iowa 50703
816-483-5000
(319)236-9856
6100 ARBOR RD
LINCOLN, NE 68517-3211
402-467-1300
Gehrke Inc
PO BOX 1013
NORTH PLATTE, NE 69103-1013 Steve Gehrke
308-534-7020 1405 215t Avenue
9751 S 148TH ST
OMAHA, NE 68138-3898 Eldora, Iowa 50627
402-894-1899 (641)858-3821
PO BOX 5349
SIOUX CITY, IA 51102-5349
712-252-2753 ZJniversity of Northern Iowa
1401 S STATE HIGHWAY MM Lynn Pa afa
SPRINGFIELD,MO 65802-7726
417-863-1000 2412 W 27t6 Street (warehouse)
1621 NW GAGE BLVD Cedar Falls Iowa 50614
TOPEKA, KS 66618
785-233-0556 (319)273-6917
PO BOX 387
ULYSSES, KS 67880-0387
620-356-1071 Popp Excavating
PO BOX 2520 Kurt Popp
WATERLOO, IA 50704-2520
319-235-7085 2198 350th Street
5255 N DEERE RD Osage, Iowa 50461
PARK CITY, KS 67219-3308
316-942-1457 (641) 732-4324
CORPORATE OFFICE:
5375 N DEERE RD
PARK CITY,KS 67219-3307
316-945-1015