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FORM OF BID OR PROPOSAL
F.Y. 2024 SIDEWALK REPAIR ASSESSMENT PROGRAM - ZONE 3
CONTRACT NO. 1082
CITY OF WATERLOO, IOWA
Honorable Mayor and City Council
Waterloo, Iowa
Gentlemen:
1. The undersigned, being a Corporation existing under the laws of the State of
lows a Partnership consisting of the following partners:
having familiarized (himself) (themselves) (itself) with the existing conditions on
the project area affecting the cost of the work and with all the contract documents
listed in the Table of Contents and Addenda (if any), as prepared by the City
Engineer of the City of Waterloo now on file in the office of the City Clerk, City
Hall, Waterloo, Iowa, hereby proposes to furnish all supervision, technical
personnel, labor, materials, machinery, tools, appurtenances, equipment, and
services, including utility and transportation services required to construct and
complete this F.Y. 2024 SIDEWALK REPAIR ASSESSMENT PROGRAM -
ZONE 3, Contract No. 1082, all in accordance with the above -listed documents
and for the unit prices for work in place for the following items and quantities:
F.Y.
2024
SIDEWALK
REPAIR
ASSESSMENT
PROGRAM
ZONE
3
-
CONTRACT
NO.
1082
ITEM
BID
DESCRIPTION
UNIT
EST.
QTY.
UNIT
PRICE
BID
TOTAL
BID
PRICE
1
4"
PCC
R/R
SIDEWALK
SF
9,550.5
$
V2.B5
$ Ill
(o78,
'AB
2
5"
PCC
R/R
SIDEWALK
SF
1,960.9
$ `A 5
$ 28
,33510
A\,°tg0.73
3
6"
PCC
R/R
SIDEWALK
SF
2,805.4
$ `'al .1°6
$
\5.
20
4 ATI
4
CLASS
A
PCC
R/R
SIDEWALK
SF
295.9
$
$
(08,
5
Class
F Sidewalk
Patch
EACH
29.0
$ 11. 15
$ 2189B.
55
6
CLEAN
WALK
EACH
6.0
$
Ng.95
$ \,VCn.10
7
WATER
VALVE
ADJUSTMENT
EACH
6.0
$ GM IS
$ 5
1R .10
8
WATER
VALVE
CAP
REPLACEMENT
-
EACH
6.0
$ tit' 95
$ 5 l I.1O
9
DETECTABLE
WARNING
SURFACE
s
EACH
1.0
$ Tr
.95
$ I 1 l .9
5
10
JOINT
SEAL
LF
25.3
$ 29 .'15
$ 757
74
TOTAL
BID
$ 2b5,
5D1.73
FORM OF BID
CONTRACT NO. 1082
Page 1 of 3
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withdrawn, the undersigned agrees to execute and deliver an agreement in the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.
4. Security in the sum of
Dollars ($ 1=►v,L. \-)cl(ccnt- T;ti,.A ) in the form of WA '130nu1
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 Bidder Status Form.
7 The bidder is prepared to submit a financial and experience statement upon
request.
8. The Prime Contractor and Subcontractor(s), which have performed an aggregate
of $10,000.00 in work for the City in the current calendar year, are prepared to
submit an AAP or Update and an EOC, within ten (10) days of notification that the
bid submitted is lowest and acceptable.
9. The bidder has received the following Addendum or Addenda:
Addendum No. Date
10. The bidder shall list the MBE/WBE subcontractor(s), amount of subcontracts and
bid items on the City of Waterloo Minority and/or Women Business Pre -bid
Contact Information Form submitted with this Form of Bid or Proposal. The
apparent low Bidder shall submit a list of all other Subcontractor(s) to be used on
this Project to the City of Waterloo by 5:00 p.m. the business day following the day
Bids on this Project are due along with the Non -Collusion Affidavits of All
Subcontractor(s).
The Contractor shall submit information on subcontractors on
"SUBCONTRACTOR REQUEST AND APPROVAL" Form to be provided by City
prior to approval of contract.
FORM OF BID
CONTRACT NO. 1082 Page 2 of 3
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.
:YQ
(111/23
(Name of Bidder) (Date)
BY: 5 ,,.\ n Q u\ ATitle C w ne{
Official Address: (Including Zip Code):
3 1 ) P tee, 3Shk cn , \ 5010 Z
I.R.S. No. 1fV203-3& f1
FORM OF BID
CONTRACT NO. 1082 Page 3 of 3
INFORMATION NEEDED
FOR
IOWA CONSTRUCTION SALES TAX EXEMPTION CERTIFICATE
CONTRACTOR NAME Onb c-ucE \o r\ LLL
ADDRESS:
(Check One):
FEDERAL ID#:
PRIME
S'k. \N a;,V bu s n , \ A `50-10 .
- 2053yri
SUBCONTRACTOR
PROJECT NAME. \^Y ZO7A 'cJIQA»\e,- (\c�eS:a((\ctA Rc0(ArDYrv1 -le
PROJECT CONTRACT NO.:
DESCRIPTION OF WORK:
Brickwork
Carpentry
i<Concrete
Drywall -Plaster -Insulation
Electrical
Excavation/Grading
- Flooring
- Heavy Construction
Heating -Ventilating -Air Cond
Landscaping
Painting
Paving
Plumbing
Roofing -Siding -Sheet Metal
- Windows
Wrecking -Demolition
- Other (Please specify)
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)
ppropriate Official)
Over g 11 f23
(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
State of TOWS
County of BlacY lNaw h
TuSViC Quin*
NON -COLLUSION AFFIDAVIT OF PRIME BIDDER
)ss
, being first duly sworn, deposes and says that:
1 He is (Owner, Partner, Officer, Representative, or Agent) , of TO. Con'\vvc1/2\oA LILL
, the Bidder that has submitted the attached Bid;
2. He is fully -informed respecting the preparation and contents of the attached Bid and of all pertinent
circumstances respecting such Bid;
3. Such Bid is genuine and is not a collusive or sham Bid:
4. Neither the said Bidder nor any of its officers, partners, owners, agents, representatives, employees, or
parties in interest, including this affiant, has in any way colluded, conspired, connived or agreed, directly or
Indirectly, with any other Bidder, firm or person to submit a collusive or sham Bid in connection with the
Contract for which the attached Bid has been submitted or to refrain from bidding in connection with such
Contract, or has in any manner, directly or indirectly, sought by agreement or collusion or communication or
conference with any other Bidder, firm or person to fix the price or prices in the attached Bid or of any other
Bidder, or, to fix any overhead, profit or cost element of the bid price or the bid price of any other Bidder, or
to secure through any collusion, conspiracy, connivance, or unlawful agreement any advantage against the
City of Waterloo, Iowa, or any person interested in the Proposed Contract; and
5. The price or prices quoted in the attached Bid are fair and proper and are not tainted by any collusion,
conspiracy, connivance or unlawful agreement on the part of the Bidder or any of its agents, representatives,
owners, employees, or parties in interest, including this affiant.
(Signed)
Title
Subscribed and sworn to before me this 1' day of epkeisAbe.f" , 20n.
Nok ac t, Pub\c_
Title
My commission expires RUcek 2\ , 202.(0
AUSTIN CUVELIER
COMMISSION NO. 850262
MY COMMISSION EXPIRES
AUGUST 21, 2026
NON -COLLUSION AFFIDAVIT OF SUBCONTRACTOR
State of 'Iowa
) ss:
County of i1 acV 1-\aw13)
i U ,-fi14, -it,L(t_ , being first duly sworn, deposes and says that:
1. He is (Owner, Partner, Officer, Representative, or Agent) , of /,�a, r l ez,
(0,4(refr id ( hereinafter referred to as the "Subcontractor;"
2. He is fully informed respecting the preparation and contents of the subcontractor's proposal submitted by
the subcontractor to 3'G. Cogets scuc'v o n LLL , contract pertaining to the
P1 202M ST►c\ walk eepaif' Pss5e5)r\en* P«raw - 1o11C 3 project in
\A)aku'\W, Iowa ;
(City or County and State)
3. Such subcontractor's proposal is genuine and is not a collusive or sham proposal;
4. Neither the subcontractor nor any of its officers, partners, owners, agents, representatives, employees, or
parties in interest, including this affiant, has in any way colluded, conspired, connived, or agreed, directly or
indirectly, with any other bidder, firm or person to submit a collusive or sham proposal in connection with
such contract or to refrain from submitting a proposal in connection with such contract, or has in any manner,
directly or indirectly, sought by unlawful agreement or connivance with any other bidder, firm or person to
fix the price or prices in said subcontractor's proposal, or to fix any overhead, profit or cost element of the
price of prices in said subcontractor's proposal, or to secure through collusion, conspiracy, connivance or
unlawful agreement any advantage against the City of Waterloo, Iowa, or any person interested in the
proposed contract; and
5. The price or prices quoted in the subcontractor's proposal are fair and proper and are not tainted by any
collusion, conspiracy, connivance or unlawful agreement on the part of the bidder or any of its agents,
representatives, owners, employees, or parties in interest, including this affiant.
(Signed) LWS44�1e.-
2_/i < Ai
Title
Subscribed and sworn to before me this day of
Wok PubVc_
Title
My commission expires RUCtJSS\. Z L, ZO2.
20
Pg1A( S
`4 o`
w.QUi►
ix
mmri, �r
IOWA
AUSTIN CUVELIER
COMMISSION NO. 850262
MY COMMISSION EXPIRES
AUGUST 21, 2026
Bidder Status Form
To be completed by all bidders
Part A
Please answer "Yes" or "No" for each of the following:
Yes QNo
Yes O No
Yes ONo
Yes ONo
Yes Q N o
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:
0 \ / 0 \ / 20\t
Dates: /
Dates: /
You may attach additional sheet(s) if needed.
to C uc e-41 Cutrcnij Cutcexd' Address: 31-3 1';ne
City, State, Zip: W .aShburn ,1(\ 5 S1U2-
to / / Address:
City, State, Zip:
to / / 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 O Yes O 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.
You may attach additional sheet(s) if needed.
To be completed by all bidders Part D
certify that the statements made on this document are true and complete to the best of my knowledge and I know that my
failure to provide accurate and truthful information may be a reason to reject my bid.
Firm Name: )(:Construc'non LLt'-
Signature:
Date: 4 11 f23
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.
O Yes
O ves
O Yes ONo
Yes
Q Yes QNo
0
O Yes No
es
c:) Yes
(3Yes
0
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.
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.
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 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.
My business is a limited liability company whose certificate of organization is filed in a state other
than Iowa, has received a certificate of authority to transact business in Iowa and the certificate
has not been revoked or canceled.
309-6001 (09-15)
MBE/WBE BUSINESS ENTERPRISE
PRE -BID CONTACT INFORMATION FORM
Prime Contractor Name: c( \c uc.l-,o\'\ L .C.
Project: }_-•.? 20M S Iclizcomic Y_t ,j+r - zet,e Letting Date: RI-7 %2,s
NO 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 use the bottom portion of this form.
Contractor Signature:
Title:
Date:
SUBCONTRACTORS APPLICABLE: You are required, in order for your bid to be considered responsive, to provide
the information on this form showing ALL of your MBE/WBE subcontractor contacts made for your bid submission.
This information is subject to verification. Any questions 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
Subcontractors
MBE/WBE
Contacted
Dates
Yes/No
Contacted
Dates
Yes/No
Dollar
Amount
be
Subcontracted
Proposed
to
8 \0\1952.
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(Form CCO-4) Rev. 06-20-02
BID BOND
KNOW ALL MEN BY THESE PRESENTS, that we, JQ Construction, L.L.C.
as Principal, and Westfield 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 Total 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 Principal has submitted the accompanying bid dated the 7th day of
September 20 23 for FY 2024 Sidewalk Repair Assessment Program Zone 3, Contract No. 1082, Waterloo, Iowa
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 5th day of September , A.D. 20 23
JQ Construction, L.L.C.
Principal
By
Wes eld Insurance Company
Witness Surety
% n
Last- POGC.,
Withess
Jamie Paul, Witness to Surety
wner Attorney -in -fact
(Seal)
(Title)
(Seal)
BID BOND Page 1 of 1
THIS POWER OF ATTORNEY SUPERCEDES ANY PREVIOUS POWER BEARING THIS SAME
POWER # AND ISSUED PRIOR TO 07/24/23, FOR ANY PERSON OR PERSONS NAMED BELOW.
CERTIFIED COPY
General POWER NO. 1429262 15
Power Westfield Insurance Co.
of Attorney Westfield National Insurance Co.
Ohio Farmers Insurance Co.
Westfield Center, Ohio
Know AU Men by These Presents, That WESTFIELD INSURANCE COMPANY, WESTFIELD NATIONAL INSURANCE COMPANY and OHIO
FARMERS INSURANCE COMPANY, corporations, hereinafter referred to individually as a "Company" and collectively as "Companies," duly
organized and existing under the laws of the State of Ohio, and having its principal office in Westfield Center, Medina County, Ohio, do by these
presents make, constitute and appoint
CRAIG E. HANSEN, JAY D. FREIERMUTH, BRIAN M. DEIMERLY, CINDY BENNETT, ANNE CROWNER, TIM MCCULLOH, DIONE
R. YOUNG, SETH ROOKER, SARA HUSTON, KATE ZANDERS, JOHN CORD, GRACE RASMUSSEN, JOINTLY OR SEVERALLY
of WAUKEE and State of IA its true and lawful Attorney(s)-in-Fact, with full power and authority hereby conferred in its name,
place and stead, to execute, acknowledge and deliver any and all bonds, recognizances, undertakings, or other instruments or contracts of
suretyship in any penal limit.
LIMITATION: THIS POWER OF ATTORNEY CANNOT BE USED TO EXECUTE NOTE GUARANTEE, MORTGAGE DEFICIENCY, MORTGAGE
GUARANTEE, OR BANK DEPOSITORY BONDS.
and to bind any of the Companies thereby as fully and to the same extent as if such bonds were signed by the President, sealed with the corporate
seal of the applicable Company and duly attested by its Secretary, hereby ratifying and confirming all that the said Attorney(s)-in-Fact may do in
the premises. Said appointment is made under and by authority of the following resolution adopted by the Board of Directors of each of the
WESTFIELD INSURANCE COMPANY, WESTFIELD NATIONAL INSURANCE COMPANY and OHIO FARMERS INSURANCE COMPANY:
"Be it Resolved, that the President, any Senior Executive, any Secretary or any Fidelity & Surety Operations Executive or other Executive shall
be and is hereby vested with full power and authority to appoint any one or more suitable persons as Attorney(s)-in-Fact to represent and act for
and on behalf of the Company subject to the following provisions:
The Attorney -in -Fact. may be given full power and authority for and in the name of and on behalf of the Company, to execute, acknowledge and
deliver, any and all bonds, recognizances, contracts, agreements of indemnity and other conditional or obligatory undertakings and any and all
notices and documents canceling or terminating the Company's liability thereunder, and any such instruments so executed by any such
Attorney -in -Fact shall be as binding upon the Company as if signed by the President and sealed and attested by the Corporate Secretary."
"Be it Further Resolved, that the signature of any such designated person and the seal of the Company heretofore or hereafter affixed to any
power of attorney or any certificate relating thereto by facsimile, and any power of attorney or certificate bearing facsimile signatures or facsimile
seal shall be valid and binding upon the Company with respect to any bond or undertaking to which it is attached." (Each adopted at a meeting
held on February 8, 2000).
In Witness Whereof, WESTFIELD INSURANCE COMPANY, WESTFIELD NATIONAL INSURANCE COMPANY and OHIO FARMERS INSURANCE
COMPANY have caused these presents to be signed by their National Surety Leader and Senior Executive and their corporate seals to be hereto
affixed this 24th day of JULY A.D., 2023 .
Corporate ,,#o`�su1t41v0
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gaNt SEAL
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State of Ohio
County of Medina ss.:
WESTFIELD INSURANCE COMPANY
WESTFIELD NATIONAL INSURANCE COMPANY
OHIO FARMERS INSURANCE COMPANY
By:
Gary W.
tumper, Nationa!"Surety Leader and
Senior Executive
On this 24th day of JULY A.D., 2023 , before me personally came Gary W. Stumper to me known, who, being by me duly sworn,
did depose and say, that he resides in Medina, OH; that he is National Surety Leader and Senior Executive of WESTFIELD INSURANCE
COMPANY, WESTFIELD NATIONAL INSURANCE COMPANY and OHIO FARMERS INSURANCE COMPANY, the companies described in and which
executed the above instrument; that he knows the seals of said Companies; that the seals affixed to said instrument are such corporate seals; that
they were so affixed by order of the Boards of Directors of said Companies; and that he signed his name thereto by like order.
Notarial
Seal
Affixed
State of Ohio
County of Medina ss.:
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,
ciliardirS
David A. Kotnik, Attorney at Law, Notary Public
My Commission Does Not Expire (Sec. 147.03 Ohio Revised Code)
I, Frank A. Carrino, Secretary of WESTFIELD INSURANCE COMPANY, WESTFIELD NATIONAL INSURANCE COMPANY and OHIO FARMERS
INSURANCE COMPANY, do hereby certify that the above and foregoing is a true and correct copy of a Power of Attorney, executed by said
Companies, which is still in full force and effect; and furthermore, the resolutions of the Boards of Directors, set out in the Power of Attorney are
in full force and effect.
In Witness Whereof, I
September A.D., 2023
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have hereunto set my hand and affixed the seals of said Companies at Westfield Center, Ohio, this 5th day of
trL I • SEAL -
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Frank A. Carrino, Secretary
Secretary
BPOAC2 (combined) (03-22)