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FORM OF BID OR PROPOSAL
F.Y. 2014 ORANGE SCHOOL SANITARY SEWER EXTENSIONS
CONTRACT NO. 816
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
10Wa , 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. 2014 ORANGE SCHOOL SANITARY SEWER EXTENSIONS,
Contract No. 816, 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. 2014 ORANGE SCHOOL SANITARY SEWER EXTENSIONS
CONTRACT NO. 816
BID DESCRIPTION UNIT EST.QTY. UNIT BID TOTAL BID PRICE
ITEM BASE BID PRICE
101 ADJUST MANHOLE TOP EACH 1 $ aaSO, vv $ a,a50• c4
SANITARY SEWER MANHOLE, STANDARD WATER-
102 TIGHT 48-INCH DIA. EACH 16 $ 2,r795. aU $ ?XL °°
`
103 TAP AND COLLAR EXISTING SANITARY SEWER EACH r 1 $ ay 85. w $
104 SANITARY SEWER, 8" DIA., PVC TRUSS PIPE L.F. 1,155 $ Z,8 /00 $ 32, 340.00
105 SANITARY SEWER, 10" DIA., PVC TRUSS PIPE L.F. 331 $ 3 t- 00 $ (b ,26( -OQ
106 SANITARY SEWER, 15" DIA., PVC TRUSS PIPE L.F. 2,379 $ '4 I . bO $ 97,531 •00
107 SANITARY SEWER, 18" DIA., PVC A-2000 PIPE L.S. 1,038 $ 55(, 0 0 $ 52, 938 • OO
WELDED STEEL CASED CROSSING, HWY 21,
108 COMPLETE L.S. 1 $ 85,(BUD,00 $ gs, 0ce,oo
109 HAMMOND AVE. CROSSING, COMPLETE L.S. 1 $ I$;$00. tv $ $,500, CO
FORM OF BID CONTRACT NO. 816 Page 1 of 4
•
201 TRAFFIC CONTROL L.S. 1 $ 2,5C0.00 $ 2,SSOW t€
202 MAINTENANCE BOND,TWO(2)YEAR L.S. 1 $ /800_C $ jl BOO,
203 EROSION CONTROL SILT FENCE L.F. 4,500 $ /.45 $ 6S a5,
204 SEED, FERTILIZE AND MULCH (IDOT RURAL MIX) ACRES 6.5 $ )8Oo.c4) $ 11,9co,
CONSTRUCTION ACCESS, HAMMOND AVENUE,
205 ONE EACH L.S. 1 $ 4,50D.U0 $ 4,5wt .oO
CONSTRUCTION ACCESS, HIGHWAY 21,TWO
206 EACH L.S. l $ I-1,50D.OD $ t7,500. DO
TOTAL BASE BID $ qua! 55g . 00 OK--Zisk
BID DESCRIPTION UNIT EST.QTY. UNIT BID PRICE TOTAL BID PRICE
ITEM ALTERNATE A
Al FOUNDATION MATERIAL TONS UNKNOWN $ o� l.QS $ a5, �y
REPLACE EXISTING FIELD DRAIN TILE CROSSING, $ 756.00 $ 75o. 00
A2 3" DIA.THRU 8" DIA. EACH UNKNOWN
REPLACE EXISTING FIELD DRAIN TILE CROSSING, $ 39s oo $ 3�5 co
A3 10" DIA.THRU 15" DIA. EASH UNKNOWN •
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 ,� Flo
Dollars ($ ) in the form of i310 '3o0d ,
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 ( ), or Non-Resident
Bidder Certification ( ). (Mark one.)
FORM OF BID CONTRACT NO. 816 Page 2 of 4
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. 1 Date ►io '. a6 r)013
10. The bidder shall list the MBEANBE 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.
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.
FORM OF BID CONTRACT NO. 816 Page 3 of 4
P ;r c - a btu &nsipucTIOAi J�L l�c-c 02CU
(Name of Bidder) (Date)
BY: -- Title I tc-s cif
Official Address: (Including Zip Code):
P.O. ► o,y /' CC
ibutrne1-± T, 5 aa0a
I.R.S. No. JO- /5a55y8
FORM OF BID CONTRACT NO. 816 Page 4 of 4
NON-COLLUSION AFFIDAVIT OF PRIME BIDDER
State of -T-0Li,q
)ss
County of L.;n ii )
i n , being first duly sworn, deposes and says that:
1. He is (Owner, Partner, De, Representative, or Agent) of P;rc -/c,b in
Coror/Y•<<TaJn _rlc• , 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)
Pres oc-711"fill
Title
Subscribed and sworn to before me this a day of
NC-Q.6110er , 2013 .
a6C42,LXL- et....c* aita":" C110&±
Title
My commission expires .3 f 17/)4
ELIZABETH SAUER
r Notarial Ssal•1OWA
'°w" Commission No.751770
My Commission Solna Msr 17,
RESIDENT/NON-RESIDENT BIDDER
RESIDENT BIDDER:
In accordance with Section 73A.21 of the Iowa Code, all non-federal-aid public
improvement projects, which include road construction, shall be performed by a
qualified resident bidder. The resident bidder has been further defined as follows:
Resident Bidder:
A person or entity authorized to transact business in this state and
having a business for at least three years prior to the date of the
first advertisement for the public improvement. If another state or
foreign country has a more stringent definition of a resident bidder,
the more stringent definition is applicable as to bidders from that
state or foreign country.
The contractor shall provide the City with a certification that he is a qualified
resident bidder according to the above definition. The Certification shall be
submitted with the contractor's bid. A copy of the form of "Resident Bidder
Certification" is included in the Contract Documents. If it is determined that the
contractor does not meet this qualification after he begins work, a shutdown
notice shall be issued and the voiding of the contract shall begin unless the
contractor becomes qualified.
NON-RESIDENT BIDDER:
The contractor shall provide the City with a certification that he is a non-resident
bidder according to the above definition. The Certification shall be submitted with
the contractor's bid. A copy of the form of "Non-Resident Bidder Certification" is
included in the Contract Documents.
DJG
01/02/12
RESIDENT BIDDER CERTIFICATION
CONTRACT NO: g (,
PROJECT NAME: F. v. aOry Dr,A ,5(1,001 .5„,70,ry SE'1..et Sr eAYow.
DATE OF LETTING: O . / Omt3
To be a qualified resident bidder, the bidder shall be a person or
entity authorized to transact business in this state and having a
business for at least three years prior to the date of the first
advertisement for the public improvement. If another state or
foreign country has a more stringent definition of a resident bidder,
the more stringent definition is applicable as to bidders from that
state or foreign country.
This qualification as resident bidder shall be maintained by the contractor and his
subcontractors at the work site until this project is completed.
I hereby certify that I am a resident bidder as defined above.
COMPANY NAME Pit( -7 b,;, C_.EJm rcAci/Uv1 „Tic.
CORPORATE OFFICER n"011) ,I . %0bt:1
TITLE 1C)/Ls it)rill-
DATE 1)e-c a aO/
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NEE 11/27/2013 13:34 3193520400 TIEDT NURSERY
■� PAGE 01/01
I.
•
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A K TIEDT NURSERY, LTD.
' DI 2419 E. BREMER AVENUE
WAVE RLY, IOWA 50677
HONE (319) 352-0418 FAX (319) 352-0400
DATE: 11/27/2013
PROJECT 2014 Orange School Sanitary Sewer Extension, Contract No. 816
Waterloo, Iowa
100%will apply to DBE/TSB goal
ITEM NO. QTY DESCRIPTION UNIT UNIT PRICE TOTAL
203 4500 Efosion Control Silt Fence LF $2.65 $11,925.00 135a)
(Includes Install & Removal only)
204 6.5 Seed, Fert.,&Mulch (TOOT Rural) AC $1,800.00 $11,700.00
Total $23,625.00
(----
The initial Install &final removal of the Silt Fence',
Includes mobilization any additional
mobilizations please add $350.00 per trip,
I+ F i_ w
5 tic w ( �e i�stKll.. Ina/tip f,Me� 'r„' l0 �rt 35U` _ 3sua
Act, 13,j 5i14 &N« / s'LF Pia nuNk aOO
• 11/27/2013 12:01 3198335303 SERVICE SIGNING LC PAGE 01/01
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N P.O. BOX 158• CEDAR FALLS, IOWA 50613• 319-235-9356- FAX 319-235-0960
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3533 W AIRLINE HIGHWAY. WATERLOO, IOWA 507-03 - •s: •-e•---•.,„vt. .,4„7.•
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-Ar. Equal Opportunity Employer' !LT UR!:k°In urn
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From:John Toomer To: Estimating Dept Date: 12/2/2013 Time:9:57:38 AM Page 2 of 2
Page 1 of 1 Bid Number: DMH 12 13 7249
Proposal Date: 12/2/2013
Phone: (515) 986-3527
Fax: (515)986-3960 P.O.Box 738
Grimes, IA 50111
Project Name Project Location
Waterloo 2014 Orange School Sanitary Sewer
Extensions
Proposal Submitted To Phone Fax Number
Estimating Department ( ) - ( ) -
Company Name Company Address
Email Address Bid Date City State and Zip Code
12/2/2013
Bid Package Addendums Viewed
Base Bid #1
We hereby submit specifications and estimates for the following:
Item Description Quantity Unit Price Sub Total
203 Erosion Control Silt Fence 4,500.00 LF $2.250 $10,125.000
204 Seed,Fertilize and Mulch(IDOT Rural Mix) 6.50 AC $1,750.000 $11,375.000
SWPPP Management and Inspections 0.00 MO $500.000
We Propose hereby to furnish material and labor complete in accordance with the above specifications, for the sum of:
Twenty-One Thousand Five Hundred Dollars and Zero Cents Bid Total: $21,500.000
Payment to be If no subcontract agreement is issued to convey or pass down the terms&conditions of the prime/2nd tier agreement;vendor payment terms of NET
made as follows: 30 days will apply to any&all work performed by Soil-Tek&no retainage shall be withheld from any payments.
Terms and Conditions:
Above seeding price(s)include:Seedbed prep,seeding,fertilizing,mulching,application .,
and cleanup.Price(s)do not include any soil amendments,top soil import,top soil ,''---1
inspection and/or top soil certification prior to seeding activities,soil testing/analysis, Authorized `_
watering,maintenance or final/finish grading.Soil-tek must approve the final grade before
seedbed prep begins.All items contained within this proposal do not reflect any railroad Signature
protective liability policies or coverages.Traffic control is excluded unless otherwise noted
above. If additional insurance endorsements or bonds are required for this project,please
contact me for additional pricing. THIS PROJECT IS TAX EXEMPT. Soil-tek reserves the Brian Denham (515)208-5169
right to revoke this proposal at any time before acceptance/submission of the prime/2nd tier Note:If this proposal is not accepted and a subcontract
proposal to the owner/contracting authority. Any alteration or deviation from above agreement or purchase order issued within 30 days from
specifications involving extra costs will be executed only upon written orders, and will the date listed above,this proposal is subject to revisions
become an extra charge over and above the estimate.All agreements contingent upon and/or withdrawal at the discretion of Soil-Tek.
strikes, accidents or delays beyond our control.
Acceptance of Proposal - The above prices, Signature:
specifications and conditions are satisfactory and are hereby accepted.You are
authorized to do the work as specified.Payment will be made as outlined above.
Date of Acceptance: _!_I
Des Moines, IA— Iowa City, IA -Omaha, NE - Kansas City, MO
Erosion Control —Seeding—Stormwater Compliance
www.soil-tek.com 1-888-SOILTEK
Proposal
Page 1 of 1
ASPRO , INC .
3613 Texas Street
PO Box 2620 * Waterloo, Iowa 50704
Phone 319 232-6537 Fax 319 232-6539
Proposal Submitted To Phone Date
26-Nov-13
Job Name
Orange School Sanitary Sewer Ext.
Street Job Location
Waterloo, IA
City, State and Zip Fax Number
We hereby submit , specifications and estimates For:
Approx. 15' x 30' - 2" Asphalt Patch on Hammond Avenue... 1 ,350.00
*** Does not include any sawcut, removal , grading or rock base .
We propose hereby to furnish material and labor for the sum of: $ 1 ,350. 00
Payment is to be made as follows : UPON COMPLETION
All material is guaranteed to be as specified. All work to be completed 1 )
in a Workmanlike manner according to standard practices. Any alteration Authorized /.;//
' 2
or deviation from above specifications involving extra costs will be
executed only upon written orders and will become an extra charge over Signature
and above this estimate. All agreements contingent upon strikes, Brad Blo a gh
accidents or delays beyond our control. Owner to carry fire, tornado
and other necessary insurance. Our workers are fully covered by This proposal may be
Workmens' Compensation Insurance. withdrawn if not accepted 30 days
.
Acceptance of Proposal- The above prices, specifications
and conditions are satisfactory and are hereby accepted. You are
authorized to do the work as specified. Payment will be made upon Signature
completion.
Date of Acceptance: Signature
0V-26-2013 TUE 02: 46 PM NIGKQ_BORING INC FAX No, 563-875-7177 P. 001
NICKOL BORING INC.
Awp�6 A��/ sown
�� -▪- Horizontal Earth Boring/ Pipe Ramming
J Avv,
F LICA
%relikt 30798 Pin Oak• Dyersville, Iowa 52040 (563) 875-2602 (office) • (563) 875-7177 (fax)
E-mail: nickol@iowatelecom.net
PROPOSAL SUBMITTED TO: DATE: 11/26/2013
JOB NAME: Orange School San. Sewer
LOCATION: Waterloo, Iowa
BID DATE: 12/2/2013
We hereby submit proposal for:
15" Sanitary Sewer
170' of 24"x .281 Steel Casing $48.00 Per Foot
170' of 24"Auger Boring $134.00 Per Foot
$182.00 Per Foot
Pit Size: By Customer
- 12' wide x 34' long with 8"of 1"washed stone
• Pits prepared per OSHA specs
RR Protective Insurance (if required) is not included in our quote.
Check out our website at www,nickolboring,com
Payment to be made as follows: Net 30 days. 1 1/2%per month interest on unpaid accounts.
Item 1 NICKOL Boring will provide customer with standard Item 5 LABOR...Our regular crew to perform all necessary work
certificate of insurance.Any additional insurance connected with the drilling operation.Additional help as
shall be at contractors/owners expense, required by local unions will be paid by the customer.
Item 2 PITS...We will furnish instructions on your pit preparation. Item 6 EXTRAS,..Cost over runs not attributable to our negligence
BID BOND
KNOW ALL MEN BY THESE PRESENTS,that we, Pirc-Tobin Construction, Inc.
as Principal, and Capitol Indemnity Corporation
as Surety are held and firmly bound unto the CITY OF WATERLOO ;Iowa, hereinafter called
"OWNER," In the penal sum ---Five Percent of Amount of Bid---
Dollars($---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 2nd day of December
,2013 ;for
F.Y. 2014 Orange School Sanitary Sewer Extensions, Waterloo, IA Contract No. 616
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 ail 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 penalamount 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 2nd day of December ,A.D.201 3
Fire-Tobin Construction, Inc. ,(Seal)
Principal
By
��� (Title)
Capitol Indemnity Co oration (Seal)
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Surety
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iq CAPITOL INDEMNITY9 1
,;;;_,�; CORPORATION 6 00 8 6 a ,,�
iai�'' POWER OF ATTORNEY .'
30'=== KNOW ALL MEN BY THESE PRESENTS,That the CAPITOL INDEMNITY CORPORATION,a corporation of the State of Wisconsin,having its S'it.ei,"(pia principal offices in the City of Middleton.Wisconsin,does make,constitute and appoint
I, :✓� ------------JAY D FREIERMUTH;SHIRLEY S BARTENHAGEN;CINDY BENNETT;LACEY CRAMBLIT;ANNE CROWNER
�,:p — BRIAN M DEIMERLY;CRAIG E HANSEN;TIM McCULLOH;STACY VENN;DIONE R YOUNG— — _�.'S/
ro«r` eI
a its true and lawful Attorney(s)in fact, to make execute, seal and deliver for and on its behalf; as surety, and as its act and deed,any and all bonds, �'',r,I'N,
��(',,�.; undertakings and contracts of suretyship, provided that no bond or undertaking or contract of suretyship executed under this authority shall exceed in =� r�:�g'a. a+101�)
y-,: amount the sum of ���
{{1:,•, +'i11�
�Ily- -01 7i 1•> — ALL WRITTEN INSTRUMENTS IN AN AMOUNT NOT TO EXCEED$20,000,000 ,I
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I . This Power of Attorney is granted and is signed and sealed by facsimile under and by the authority of the following Resolution adopted by the Board
i6•� of Directors of CAPITOL INDEMNITY CORPORATION at a meeting dulycalled and held on the 15th dayof May,2002. � ,:
Ise.--,, -. b Y
/lf:•� „ "RESOLVED,that the President Executive Vice President,Vice President,Secretary or Treasurer;acting individually or otherwise,be and they,hereby a+.�;P'i At.„2 are granted the power and authorization to appoint by a Power of Attorney for the purposes only of executing and attesting bonds and undertakings ^tom'''1i1�
iti vim and other writings obligatory in the nature thereof,one or more resident vice-presidents,assistant secretaries and attorney(s)-in-fact,each appointee to •tiw
�,1 have the powers and duties usual to such offices to the business of this company:the signature of such officers and seal of the Company may be affixed _=,y'Y
/(;r»,� to any such power of attorney or to any certificate relating thereto by facsimile,and any such power of attorney or certificate bearing such facsimile
my4:1 signatures or facsimile seal'shall be valid and binding upon the Company,and any such power so executed and certified by facsimile signatures'and • _ 10
Slro� facsimile seal shall be valid and binding upon the Company in the future with respect to any bond or undertaking or other writing obligatory in the '1
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��ti nature thereof to which it is attached. Any such appointment may be revoked,for cause,or without cause,by any of said officers,at any tune." •• :�i.:4)
At , IN WITNESS WHEREOF,the CAPITOL INDEMNITY CORPORATION has caused these presents to be signed by its officer undersigned and its `�."IVe
\4s corporate seal to be hereto affixed duly attested,this 2nd day of May,2011. �'+ri�
�1114�i ♦� Attest:
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'•�t-- CAPITOL INDEM NI f�'CORPORATION ,. I1 OS::
'Y 4 r/, 4 0 o,��MI1Niry Igo Piibg4i _ '�{.
Iy T ,t QV CORPOFRTF �— ,(1 / I�J.�1)
_ i
Oiws Richard W.Allen III _ Kure e�� �' / a ti'1
• SEAL
\� President David F.Pauly �+ ,
//'Ir Surety&Fidelity Operations CEO&President �!a y l
y o. �� ray
/, %� STATE OF WISCONSIN S S `�iiigi��i wis o�su ,I
�11 eilio IA11111111ttwvPOlyV '
11 COUNTY OF DANE • ` + °
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�,1 i On the 2nd day of May,2011 before me personally came David F.Pauly,to me known,who being by me duly sworn,did depose and say:that he residesS,.-1----;-.----i-c--:---.4..;:f17:1:1:;:'"Vii),
i : in the County of Dane;State of Wisconsin;that he is President of CAPITOL INDEMNITY CORPORATION,the corporation described herein and 3
IJoI - which executed the above instrument;that he knows the seal of the said corporation;that the seal affixed to said instrument is such corporate seal;that ,r-_��.
`r11 S � • • A'?I}
�Vp : it was so affixed by order of the Board of Directors of said corporation and that he signed his name thereto by like order.' �.1.y�7�
t DAB w
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1 �NIEL L ��'1
/1 ✓� y KRUEGER I.
(�1 Daniel W. Krueger a i',
STATE OF WISCONSIN g .a
S.S.: Notary Public, Dane Co.,WI r,�
:i1r.� COUNTY OF DANE CERTIFICATE My Commission Is Permanent +V
,I; I, the undersigned, duly elected to the office stated below, now the incumbent in CAPITOL INDEMNITY CORPORATION, a Wisconsin _
/ IZOW
l�;li r r.:�� a'::1
l . Corporation,authorized to make this certificate.DO HEREBY CERTIFY that the foregoing attached Power of Attorney remains in full force and has _s.'��i�
not been revoked;and furthermore,that the Resolution of the Board of Directors,set forth in the Power of Attorney is now in force. 4
.-.-.,ft.41'
Signed and sealed at the City of Middleton,State of Wisconsin this 2nd day of December ,2 013
♦�.•� h „pavoA4 �+
I�I , �� J ctit��
0.-7,f : `
silly.+`F Alan S.Ogilvie �. tial
_ Secretary ;,11�
II,p of„v, R. Vtil
`" l THIS DOCUMENT IS NOT VALID UNLESS PRINTED ON GRAY SHADED BACKGROUND WITH A RED SERIAL NUMBER IN THE UPPER -��el
((, r RIGHT BAND CORNER.IF YOU HAVE ANY QUESTIONS COt.CERNI�VG THE AUTHENTICITY OF THIS DOCUMENT CALL 800-475-4450. ' I,
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