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JB HOLLAND CONSTRUCTION, INC.
2092 State Hwy 9
Decorah, IA 52101-8707
BID ENCLOSED
FY 2022 Hyper Drive RISE
Project No RM-8155(778)-9D-07
9/23/21, 1:00 PM
Waterloo City Clerk
715 Mulberry St, Waterloo, IA
FORM OF BID OR PROPOSAL
FY 2022 HYPER DRIVE R.LS.E. PROJECT NO. RM-8155(778)--9D-07
CONTRACT NO. 1051
CITY OF WATERLOO, IOWA
Honorable Mayor and City Council
Waterloo, Iowa
Gentlemen:
The undersigned, being a Coiporation existing under the laws of the State of
Iowa , a Partnership consisting of the following partners:
JB Holland Construction, Inc. , 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 Engineei 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 2022 HYPER DRIVE R.I.S E.
PROJECT NO. RM-8155(778)--9D-7, Contract No. 1051, all in accordance with the above -listed
documents and for the unit prices for work in place for the indicated items and quantities.
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 1eject any or all bids If written notice of the acceptance of this bid is mailed, telegraphed,
or delivered to the undersigned within thirty (30) days after the opening thereof, or at any time
thereafter before this bid is withdrawn, the undersigned agrees to execute and deliver an agreement
in the prescribed form and furnish the required bond and certificate of the insurance within ten (10)
days after the agreement is presented to him for signature, and start work within ten (10) days after
"Notice to Proceed" is issued.
4. Security in the sum of 5% of Amount Bid Dollars ($
) in the form of Bid Bond , 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 ( X ), 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 pet formed an aggregate of $10,000.00 in
work for the City in the current calendar year, ate 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 — A
CONTRACT NO 1051 Page 1 of 2
RM-8155(778)--9D-07
9. The bidder has received the following Addendum or Addenda:
Addendum No.
1
Date 9/14/2021
10. The bidder shall list the MBE/WBF 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 aie due along with the Non -Collusion Affidavits of All
Subcontractor(s).
The Contractor shall submit information on subcontractors on "SUBCONTRACTOR REQUEST
AND APPROVAL' Form to be provided by City prior to approval of contract.
The subcontractors listed on this proposal and/or submitted to the Contract Compliance Officer
cannot be changed except for the following reasons:
1) The City of Waterloo does not approve the subcontractors.
2) The subcontractors submit in writing that they cannot fulfill their subcontracts.
11. The bidder has filled in all blanks on this proposal. Those blanks not applicable are marked "none"
or "NA'.
12. The bidder has attached all applicable forms.
13. The Owner reserves the right to select alternates, delete line items, and/or to reduce quantities prior
to the award of a contract due to budgetary limitations.
JB Holland Construction, Inc.
(Name of Bidder)
BY:
9/23/2021
(l )ate)
Title President
illiamHolland
Official Address: (Including Zip Code):
2092 State Highway 9
Decorah, IA 52101
I.R.S. No. 42-1237122
FORM OF BID — A
CONTRACT NO 1051 Page 2 of 2
RM-8155(778)--9D-07
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INFORMATION NEEDED
FOR
IOWA CONSTRUCTION SALES TAX EXEMPTION CERTIFICATE
CONTRACTOR NAME JB Holland Construction, Inc
ADDRESS:
(Check One):
FEDERAL ID#:
P ROJECT NAME
2092 State Highway 9, Decorah, IA 52101
PRIME X SUBCONTRACTOR
42-1237122
FY 2022 HYPER DRIVE RISE, PROJECT NO. RM-8155(778)--9D-07
P ROJECT CONTRACT NO.:
DESCRIPTION OF WORK:
-1 Brickwork
R Carpentry
Li Concrete
Drywall -Plaster -Insulation
Electrical
g Excavation/Grading
Flooring
Heavy Construction
Heating -Ventilating -Air Cond
1051
n Landscaping
r� Painting
P aving
P lumbing
Roofing -Siding -Sheet Metal
■
LI Windows
P Wrecking -Demolition
rl Other (Please specify)
NON -COLLUSION AFFIDAVIT OF PRIME BIDDER
State of Iowa
)ss
County of Winneshiek
William F Holland , being first duly sworn, deposes and says that:
1. He is (Owner, Partner r e r Representative, or Agent) of JB Holland Construction, Inc.
, the Bidder at 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)
lam F Holland
President
Title
Subscribed and sworn to before me this 23rd day of September
My commission expires April 5, 2024
WOWIL
Title t.k401/11
, 2021.
F DIANE MARIE KRENTZ
r Commission Number 173755
My Commission Fxpires
Aprils 20
EQUAL OPPORTUNITY CLAUSE
(As provided in Executive Order No. 11246)
All contractors, subcontractors, vendors and suppliers of goods and services doing business with the City and value of said
business equals or exceeds ten thousand dollars ($10,000.00) annually agree as follows:
1. The contractors, subcontractor, vendor and supplier of goods and services will not
discriminate against any employee or applicant for employment because of race, color creed, sex, national origin,
economic status, age, mental or physical handicap political opinions or affiliations. The contractor, subcontractor, vendor
and supplier will develop an Affirmative Action program to ensure that applicants are employed and that employees are
treated during employment without regard to their race, creed, color, sex, national origin, religion economic status, age,
mental or physical disability, political opinions or affiliations. Such actions shall include but not be limited to the following:
a Employment
b. Upgrading
c. Demotion or Transfer
d. Recruitment and Advertising
e. Layoff or Termination
f Rates of Pay or Other Forms of Compensation
g. Selection for Training Including Apprenticeship
2. The contractor, subcontractor vendor and supplier of goods and services will, in all solicitations or advertisements for
employees, state that all qualified applicants will receive consideration for employment without regard to race creed,
color, sex, national origin, religion, economic status, age, mental or physical disabilities, political opinion or affiliations.
3. The contractor, subcontractor, vendor and supplier or his/her collective bargaining representative will send to each
labor union or representative of workers which he/she has a collective bargaining agreement or other contract or
understanding, a notice advising said labor union or workers' representative of the contractor's commitment under this
section.
4. The contractor, subcontractor, vendor and supplier of goods and services will comply with all published rules,
regulations, directives, and order of the City of Waterloo Affirmative Action Program Contract Compliance Provisions.
5. The contractor, subcontractor, vendor and supplier of goods and services will furnish and file compliance reports within
such time and upon such forms as provided by the Affirmative Action Officer. Said forms will elicit information as to
the policies, procedures, patterns, and practices of each subcontractor as well as the contractor himself/herself and
said contractor, subcontractor, vendor and supplier will permit access to his/her employment books, records and
accounts to the City's Affirmative Action Officer, for the purpose of investigation to ascertain compliance with this
contract and with rules and regulations of the City's Affirmative Action Program —Contract Compliance Provisions
relative to Resolution No. 24664.
6. In the event of the contractor's non-compliance with the non-discrimination clauses of this contract or with any of such
rules, regulations and orders, this contract may be canceled, terminated or suspended in whole or in part and the
contractor may be declared ineligible for further contracts in accordance with procedures authorized by the City Council.
7. The contractor subcontractor, vendor and supplier of goods and services will include, or incorporate by
reference, the provisions of the non-discrimination clause in every contract, subcontract or purchase order
unless exempted by the rules, regulations or orders of the City s Affirmative Action Program, and will provide
in every subcontract, or purchase order that said provisions will be binding upon each contractor,
subcontractor, or supplier.
8. We, the undersigned, recognize that we are morally and legally committed to non-discrimination in employment. Any
person who applies for employment with our company will not be discriminated against because of race creed, color,
sex, national origin, economic status, age, mental or physical disabilities.
(Signed)
4'
( pprophate Official) William F Holland
President 9/22/2021
(Title) (Date)
TITLE VI CIVIL RIGHTS
During the performance of this contract, the contractor (for itself), its assignees, and successors
in interest (hereinafter referred to as the `contractor') agrees as follows:
1. Compliance with Regulations: The contractor shall comply with the Regulations relative
to non-discrimination in Federally assisted programs of the DOT Title 49, Code of
Federal Regulations, Part 21, as they may be amended from time to time, (hereinafter
referred to as the Regulations), which are herein incorporated by reference and made a
part of this contract.
2. Nondiscrimination: The contractor, with regard to the work performed by it during the
contract, shall not discriminate on the grounds of race, color, national origin, sex, age, or
disability in the selection and retention of subcontractors, including procurement of
materials and leases of equipment The contractor shall not participate either directly or
indirectly in the discrimination prohibited by section 21.5 of the Regulations, including
employment practices when the contract covers a program set forth in Appendix B of the
Regulations.
3. Solicitations for Subcontracts, Including Procurement of Materials and Equipment: In all
solicitations either by competitive bidding or negotiation made by the contractor for work
to be performed under a subcontract, including procurement of materials or leases of
equipment, each potential subcontractor or supplier shall be notified by the contractor of
the contractor's obligations under this contract and the Regulations relative to non-
discrimination on the grounds of race, color, national origin sex, age, or disability.
4. Information and Reports: The contractor shall provide all information and reports
required by the Regulations or directives issued pursuant there to, and shall allow
access to its books, records, accounts, other sources of information, and its facilities as
may be determined by the Contracting Authority, the Iowa DOT, or FHWA to be pertinent
to ascertain compliance with such Regulations, orders and instructions. Where any
information required of a contractor is in the exclusive possession of another who fails or
refuses to furnish this information the contractor shall so certify to the Contracting
Authority, the Iowa DOT, or the FHWA as appropriate, and shall set forth what efforts it
has made to obtain the information.
5. Sanctions for Noncompliance: In the event of the contractor's noncompliance with the
nondiscrimination provisions of this contract, the Contracting Authority, the Iowa DOT, or
the FHWA shall impose such contract sanctions as they may determine to be
appropriate, including, but not limited to:
a. Withholding of payments to the contractor under the contract until the contractor
complies, and/or
b. Cancellation, termination, or suspension of the contract, in whole or in part.
6. Incorporation of Provisions: The contractor shall include the provisions of paragraphs
(1) through (6) in every subcontract, including procurement of materials and leases of
equipment, unless exempt by the Regulations, or directives issued pursuant thereto.
The contractor shall take such action with respect to any subcontract or procurement as
the Contracting Authority, the Iowa DOT or the FHWA may direct as a means of
enforcing such provisions including sanctions for non-compliance: Provided, however,
TITLE VI CIVIL RIGHTS Page 1 of 2
that, in the event of a contractor becomes involved in, or it threatened with, litigation with
a subcontractor or supplier as a result of such direction the contractor may request the
Contracting Authority or the Iowa DOT to enter into such litigation to protect the interests
of the Contracting Authority or the Iowa DOT; and, in addition, the contractor may
request the United States to enter into such litigation to protect the interest of the United
States.
TITLE VI CIVIL RIGHTS Page 2 of 2
Bidder Status Form
To be completed by all bidders
Part A
Ple.se answer "Yes" or "No" for each of the following:
Yes 0No
Yes 0No
Yes ONo
Yes QNo
Yes ONo
My company is authorized to transact business in Iowa.
(To help you determine if your company is authorized, please review the worksheet on the next page).
My company has an office to transact business in Iowa.
My company's office in Iowa is suitable for more than receiving mail, telephone calls, and e-mail.
My company has been conducting business in Iowa for at least 3 years prior to the first request for
bids on this project.
My company is not a subsidiary of another business entity or my company is a subsidiary of another
business entity that would qualify as a resident bidder in Iowa.
If you answered "Yes' for each question above, your company qualifies as a resident bidder. Please
complete Parts B and D of this form.
If you answered 'No" to one or more questions above, your company is a nonresident bidder. Please
complete Parts C and D of this form.
To be completed by resident bidders
Part B
My company has maintained offices in Iowa during the past 3 years at the following addresses:
Dates: 10
Dates: /
Dates: / / to /
You may attach additional sheet(s) if needed.
1 / 1992 to 9 / 23 / 2021 Address: 2092 State Highway 9
City, State, zip• Decorah, IA 52101
/ to / / Address:
City, State, Zip•
/ Address:
City, State, Zip•
To be completed by non-resident bidders
Part C
1. Name of home state or foreign country reported to the Iowa Secretary of State:
2. Does your company's home state or foreign country offer preferences to resident bidders, resident labor
force preferences or any other type of preference to bidders or laborers?
3. If you answered "Yes' to question 2, identify each preference offered by your company's home state or foreign country
and the appropriate legal citation
You may attach additional sheet(s) if needed.
To be completed by all bidders
Part D
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. JB Holland Construction, Inc.
Signature:
Date: 9/23/2021
William F Holland
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.
XYes
Yes
Yes
XYes
No My business is currently registered as a contractor with the Iowa Division of Labor.
)CNo My business is a sole proprietorship and I am an Iowa resident for Iowa income tax purposes.
XNo 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.
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 XNo
Yes X\Io
Yes XNo
Yes Flo
Yes XNo
Yes XNo
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.
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.
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.
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.
My business is a limited liability company whose certificate of organization is filed in Iowa and has
not filed a statement of termination.
�Jo 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
P rime Contractor Name. JB Holland Construction, Inc.
P roject FY 2022 Hyper Drive R.I.S.E Project No RM-8155(778)--9D-07Letting Date: 9/23/2021
N O MBE/WBE SUBCONTRACTORS: If you are NOT using any MBE/WBE subcontractors to complete this project,
sign below. Attach a brief explanation as to why subcontracting was not feasible with this project. If any MBE/WBE
subcontractors will be used, please us e bottom portion of this form.
Contractor Signature: '`/`' �/� , fs44d
Titlen President
Date: 9/23/2021
S UBCONTRACTORS APPLICABLE: You are required, in order for your bid to be considered responsive, to provide
the information on this form showing ALL of your MBE/WBE subcontractor contacts made for your bid submission.
This information is subject to verification. Any questions may be directed to Contract Compliance Office 319-291-
4429.
You are required, in order for your bid to be considered responsive, to provide the information on this Form showing
your MBE/WBE Business Enterprise contacts made prior to your bid submission. This information is subject to
verifications and confirmation.
If you are unable to identify MBE/WBE firms to perform portions of the work, please contact Rudy Jones, Contract
Compliance Officer, for assistance at (319) 291-4429.
In the event it is determined that the MBE/WBE Business Enterprise goals are not met, then before awarding the
contract the City of Waterloo will make a determination as to whether or not the apparent successful low bidder made
good faith efforts to meet the goals.
TABLE OF INFORMATION SHOWING BIDDER'S PRE -BID
MBE/WBE BUSINESS ENTERPRISE CONTACTS
Quotes
Received
Quotation
used
in
bid
MBE/WBE
Contacted
Dates
YeslNo
Contacted
Dates
YeslNo
Dollar
Amount
be Subcontracted
Proposed
to
Subcontractors
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(Form CCO-4) Rev. 06-20-02
BID BOND
KNOW ALL MEN BY THESE PRESENTS, that we, J. B. Holland Construction, Inc.
as Principal, and United Fire & Casualty Company , as Surety, are held and firmly
bound unto the CITY OF WATERLOO , Iowa, hereinafter called "OWNER." In the penal sum
Five Percent of Amount Bid 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 Prncipal has submitted the accompanying bid dated the 23rd day of
September , 20 21 , for 2022 Hyper Drive RISE Project # RM-8155(778)-9D-07
Contract No. 1051
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 23rd day of September , A.D. 20 21 .
out i a K
Witness
Ve
Witness
BID BOND
J. B. Holland Construction, Inc.
Principal
By
WO.IM(N
fi. Eft, (,u►d (Title)
United Fire & Casualty Company (Seal)
u ety,
r Attorney -in- act
Page 1 of 1
UNITED FIRE & CASUALTY COMPANY, CEDAR RAPIDS, IA
UNITED FIRE & INDEMNITY COMPANY, WEBSTER, TX
FINANCIAL PACIFIC INSURANCE COMPANY, ROCKLIN, CA
CERTIFIED COPY OF POWER OF A 11 ORNEY
(original on file at Home Office of Company — See Certification)
KNOW ALL PERSONS BY THESE PRESENTS, That United Fire & Casualty Company„a corporation duly organized and existing under the laws
of the State of Iowa; United Ftre & Indemnity Company, a'; corporation duly organized and existing under the laws of the State of Texas; and
Financial Pacific Insurance Company, acorporation duly organized and existing under the laws of the State of California (herein collectively called
the Companies) and having their corporate headquarters in Cedar Rapids, State of Iowan does make, constitute and appoint
MATT FAY, ABIGAIL R MOHR, MAT DEGROOTE, SANDY VANOSTEN,,LAURA PEIFFER, EACH INDIVIDUALLY
their true and lawful Attorney(s)-in-Fact with power and authority hereby conferred to sign, seal and execute in its behalf all lawful bonds,
undertakings and other obligatory instruments of similar nature provided that no single obligation shall exceed $100, 000 , 000. 00
and to bind the Companies thereby as fully and to the same extent as if such instruments were signed by the duly authorized'. officers of the Companies
and all of the acts of said Attorney, pursuant to the authority hereby given and hereby ratified and confirmed.
The Authority hereby granted is continuous and shall remain in full force and effect until revoked by United Fire & Casualty Company, United Fire &
Indemnity Company, and Financial Pacific Insurance Company
This Power of Attorney is made and executed pursuant to and by authority of the following bylaw duly adopted on May 15, 2013, by the Boards of
Directors of United Fire & Casualty Company, United Fire & Indemnity Company, and Financial Pacific Insurance Company.
"Article VI — Surety Bonds and Undertakings"
Section Appointment of Attorney -in -Fact. "The President or any Vice President or any other officer of the Companies may from time to time, appoint by written
certificates attorneys -in -fact to act in behalf of the Companies in the execution of policies of insurance bonds, undertakings and other obligatory instruments of like nature..
The signature of any officer authorized hereby, and the Corporate seal, may be affixed by facsimile to any power of attorney or special power of attorney or certification` of
either authorized hereby; such signature and seal, when so used, being adopted by the Companies as tl e orig nal signature of such officer and the original seal of the
Companies, to be valid and binding upon the Companies with the same force and effect as though manually affixed. Such attomeys in fact, subject to the limitations set of
forth in their respective certificates of authority shall have full power to bind the Companies by their ignature and execution of any such instruments and to attach the seal
the Companies thereto. The President or any Vice President the Board of Directors or any other officer of the Companies may at any time revoke all power and authority
previously given to any attomey-in-fact.
++ Y`+a`S CASV�L4'4,,
4 c+��..
57
CORPORATE
•
; SEAL•
1R R1APro"``
GAFG MO
NSUA4
QP; GaRPOl99e 7-1 4▪ 6 0 1.*
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• 1986 ; ate`
•
•.9�/PORN:. • "r•
IN WITNESS WHEREOF, the COMPANIES have each caused these presents: to be signed by its
vice president and its corporate seal to be hereto affixed this 14t h day of February, 2014
UNITED FIRE & CASUALTY COMPANY
UNIT"ED FIRE & INDEMNITY COMPANY
FINANCIAL PACIFIC INSURANCE COMPANY
State of Iowa, County of Linn, ss:
On 14th day of February, 2014, before me personally came Dennis J..Richmann
to me known, who being by me duly sworn, did depose and say; that he resides in Cedar Rapids State of Iowa; that he is a Vice President of United Fire
& Casualty Company, a Vice President of United Fire `& Indemnity Company, and a Vice President of Financial Pacific Insurance Company the
corporations.: described, in and which executed the above instrument that he knows the seal- of .said corporations, that the seal affixed to the said
instrument is such corporate seal; that it was so affixed pursuant to authority given by the Board of Directors of said'; corporations and that he signed his
name thereto pursuant to like authority, and acknowledges same to be the act and deed of said corporations. ^
Inquiries Surety Department
118 Second Ave SE
Cedar Rapids, IA 52401
Vice President
attt W / �����
(zdf6'd� ^'Notary Public
My commission. expires: 10/26/2022
, Mary A. Bertsch, Assistant Secretary of United Fire & Casualty Company and Assistant Secretary of United Fire & Indemnity Company, and Assistant
Secretary of Financial Pacific Insurance Company do hereby certify that I have compared the foregoing copy of the Power of Attorney and affidavit, and
the copy of the Section of the bylaws and resolutions of said Corporations as set forth in said Power of Attorney, with the ORIGINALS ON FILE IN THE
HOME OFFICE OF SAID CORPORATIONS, and that the same are correct transcripts thereof, and of the whole of the said originals, and that the said
Power of Attorney has not been revoked and is now in full force and effect.
In testim whereof I have hereuntosubscribed my name and affixed the corporate seal of the said Corporations
this day of J beA 20
iii
g/conronATE
SEAL
7•1.2
/enrols „A
BPOA0049 1217
Patti Waddell
Iowa Notarial Seal
Commission number 713274
My Commission. Expires;10/26/2022
• &14 1.4,.
,1
CORPORATE
•
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G\F‘O INSUggy
Q . ,OR• PO�frt.0•,.tP.
suLY 22 0_
�., 1966 - ra e
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•.A!/FOR*it:" l+.a
By:
fih
Assistant Secretary
OF&C & OF&I & FPIC
This paper h
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