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04604
PROPOSAL FORM
FOR
TERMINAL SECURITY UPGRADES (CCTV)
AT THE
WATERLOO REGIONAL AIRPORT
WATERLOO, IOWA
Waterloo Regional Airport
2790 Livingston Lane
Waterloo, IA 50703
All:
1. The undersigned, being a Corporation existing under the laws of the State of Tau* , a Partnership consisting of
the following partners: K.4tA) EIecfr1G eSasi. _ , 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 Conte' is 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 Terminal Security Upgrades, Contract No. CNTRT-
00005819, all in accordance with the above -listed documents and for the unit prices for work in place for the following
items and quantities:
2. The extent of the work involved is as follows.
This IDOT CSVI Project No. 91240AL0200, Contract No. CNTRT-00005819 project portion consists of an
expansion of the existing surveillance system at the remote exterior gates, at the SIDA doors, baggage belts, and
other unmonitored areas. The existing Salient System will be relocated to a dedicated, secured room as part of this
project.
3. The undersigned, in compliance with your Invitation for Bids dated J / 7 / Z,i , hereby proposes to o the work
called for in said Contract and Specifications and shown on said Plans al d Addendum Nos. (s and
to furnish all materials, tools, labor and all appliances and appurtenances necessary for the said work at t le following
rates and prices:
1DOT CSVI Project No. 91240AL0200 P-t PROPOSAL FORM
CONTRACT NO. 5819 Terminal Security Upgrades (CCTV) AECOM 60734402
ITEMIZED PROPOSAL
WATERLOO REGIONAL AIRPORT
WATERLOO, IOWA
PROJECT: • TERMINAL SECURITY UPGRADES
IDOT CSVI Project, Contract No. CNTRT-00005819
ITEM
NO.
DESCRIPTION
UNIT
ESTIMATED
QUANTITY
UNIT
QUOTE
PRICE
TOTAL
QUOTE
PRICE
BASE QUOTE
1
EXTERIOR CAMERA WORK
LS
1
$ &!
Srjr4
•
$ LI� Se/ q 0 `-
2
INTERIOR CAMERA WORK
LS
I
$ 77197�$
$ a,j3Q'-
-5.-.5-10
7797700
$
QL
3
LS
I
SERVER RELOCATION
TOTAL QUOTE
$ 1 24
1 A
I
4. The Airport reserves the right to award the contract based on the Total Bid.
5. The undersigned understands that the above quantities of work to be done are approximate only and are intended
principally to serve as a guide in evaluating the bids. All quantities are subject to increase or decrease and are to
be performed at the unit prices stipulated herein.
6. It is understood that the schedule of minimum wage rates, as established by the Secretary of Labor and included
in the Specifications, are to govern on this project, and the undersigned certifies that he has examined this schedule
of wage rates and that the prices bid are based on such established wage rates.
7. The undersigned certifies that he does not maintain or provide for his employees any segregated facilities at any
of his establishments, and that he does not permit his employees to perform their services at any location, under
his control, where segregated facilities are maintained. The undersigned certifies further that he will not maintain
or provide for his employees any segregated facilities at any of his establishments, and that he will not permit his
employees to perform their services at any location, under his control, where segregated facilities are maintained.
The undersigned agrees that a breach of this certification is a violation of the equal opportunity clause in this
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 by explicit directive or are in fact segregated on the basis
of race, color, religion, or national origin, because of habit, local custom, of any other reason. The undersigned
agrees that (except where he has obtained identical certifications from proposed subcontractors for specific time
periods) he 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 he will
retain such certifications in his files.
8. The undersigned agrees, upon written notice of the acceptance of this bid, within thirty (30) days after the opening
of the bids, that he will execute the Contract in accordance with the bid as accepted and give Contract (Performance
and Payment) bond on attached forms within five (5) days after the prescribed forms are presented for signature.
9. The undersigned further agrees that if awarded the Contract, he will commence the work within ten (10) calendar
days after the receipt of a "Notice to Proceed" and that he will substantially complete all work according to the
terms of the entire contract within Seventy -Five (75) calendar days from the date established in the Notice to
Proceed. An extension of time may be allowed when extra or additional work is ordered by the Engineer.
10. The contractor, by submission of this offer and/or execution of a contract, certifies that it:
a. is not owned or controlled by one or more citizens or nationals 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).
IDOT CSVI Project No. 91240AL0200
CONTRACT NO. 5819
P-2 PROPOSAL FORM
Terminal Security Upgrades (CCTV) AECOM 60734402
b. has not knowingly entered into any contract or subcontract for this project with a contractor that is a citizen or
national of a foreign county 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.
c. 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.
Unless the restrictions of this clause are waived by the Secretary of Transportation in accordance with
49 CFR 30.17, no contract shall be awarded to a contractor or subcontractor who is unable to certify to the above.
If the contractor knowingly procures or subcontracts for the supply of any product or service of a foreign country
on the said list for use on the project, the Federal Aviation Administration may direct, through the sponsor,
cancellation of the contract at no cost to the Government.
Further, the contractor agrees that, if awarded a contract resulting from this solicitation, it will incorporate this
provision for certification without modification in each contract and in all lower tier subcontracts. The contractor
may rely upon the certification of a prospective subcontractor unless it has knowledge that the certification is
erroneous.
The contractor shall provide immediate written notice to the sponsor if the contractor learns that its certification or
that of a subcontractor was erroneous when submitted or has become erroneous by reason of changed
circumstances. The subcontractor agrees to provide immediate written notice to the contractor, if at any time it
learns that its certification was erroneous by reason of changed circumstances.
This certification is a material representation of fact upon which reliance was placed when making the award. If
it is later determined that the contractor or subcontractor knowingly rendered an erroneous certification, the Federal
Aviation Administration may direct, through the sponsor, cancellation of the contract or subcontract for default at
no cost to the Government.
Nothing contained in the foregoing shall be construed to require establishment of a system of records in order to
render, in good faith, the certification required by this provision. The knowledge and information of a contractor
is not required to exceed that which is normally possessed by a prudent person in the ordinary course of business
dealings.
This certification concerns a matter within the jurisdiction of an agency of the United States of America and the
making of a false, fictitious, or fraudulent certification may render the maker subject to prosecution under Title 18,
United States Code, Section 1001.
11. The bidder/offeror certifies, by submission of this proposal or acceptance of this contract, that neither it nor its
principals are 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/offer/contractor or any lower tier participant is unable to certify this
statement, it shall attach an explanation to this solicitation/proposal.
12. The undersigned hereby declares that the only parties interested in this Proposal are named herein, that this
Proposal is made without collusion with any other person, firm, or corporation, that no member of the Council,
Waterloo Regional Airport or agent of the City of Waterloo, Iowa, is directly or indirectly financially interested in
this bid.
13. In submitting this bid, it is understood that the right to reject any and all bids has been reserved and that this bid
may not be withdrawn for a period of ninety (90) days from the opening thereof.
IDOT CSVI Project No. 91240ALO200
CONTRACT NO. 5819
P-3 PROPOSAL FORM
Terminal Security Upgrades (CCTV) AECOM 60734402
14. Attachment to This Bid. The following documents are attached to and made a part of this Bid:
a. Non -Collusion Affidavit of Prime Bidder.
b. Statement of intent — Non -Discrimination and Equal Opportunity Statement.
c. Targeted Small Business.
15. The Bidder shall indicate whether the bid is submitted by a/an:
❑ Individual, Sole Proprietorship
❑ Partnership
Corporation
❑ Joint -venture: all parties must join -in and execute all documents
❑ Other
Respectfully submitted,
Bidder
By 3r`itv. DeVr i es
Signature
prrstiew7r
Title
s4
Address
Cedar Falls) X-13 4'0443
(Include Zip Code)
31q- :t7'7-o'(1�
Telephone No.
IDOT CS VI Project No. 91240AL0200
CONTRACT NO. 5819
P-4 PROPOSAL FORM
Terminal Security Upgrades (CCTV) AECOM 60734402
NON -COLLUSION AFFIDAVIT Of PRIME BIDDER
State of IO W ek )
)ss
County of d1atK FFawIC )
that:
Bid
Uriixw Dck?r-ieS
(1) He is (Owner, Partner
, being first duly sworn, deposes and says
Representative or Agent) of
K.� In 1 C sect -rim , the Bidder that has submitted the attached
•
(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 li day of reA,0 , 20,25
ftir^—
OEC";VvkGv.os.clei✓
Title
My Commission Expires Fick s rl S, 200
Pres �`d e ct—
IDOT CSVI Project No. 91240AL0200
CONTRACT NO. 5819
Terminal Security Upgrades (CCTV)
P-5 PROPOSAL FORM
AECOM 60734402
STATEMENT OF INTENT
NONDISCRIMINATION
AND
EQUAL OPPORTUNITY STATEMENT
The Contractor does hereby certify to the Waterloo Regional Airport, that no person shall, in any way, be favored or
discriminated against because of his race, political or religious opinions and affiliations, national origins, sex, age, sexual
orientation, gender identity, disability, color, creed, marital status, employee union or association membership or office
herein.
If selected as the successful bidder, this contractor hereby agrees to file either a nondiscrimination and equal opportunity
statement and/or an Affirmative Action Program.
Improvements to the Waterloo Regional Airport consisting of
TERMINAL SECURITY UPGRADES (CCTV)
IDOT CSVI Project, Contract No. CNTRT-000058 19
W EleoC+ri c
COMPANY
Brim. DeVr-ie5'
EXECUTIVE OFFICER
/i eC
AFFIRMATIVE ACTION OFFICER
ADDRESS OF THE AFFIRMATIVE ACTION OFFICER
PHONE NUMBER
/I;2ifcvIR 5#-.
C ecQ�t Fed( s fir+ S eMP
11 2.77 —Dj/i�
IDOT CSVI Project No. 91240AL0200 P-6 PROPOSAL FORM
CONTRACT NO. 5819 Terminal Security Upgrades (CCTV) AECOM 60734402
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(To Be Completed By All Bidders per the Current Contract Provision)
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QUOTATION USED IN BID
DOLLAR AMT. PROPOSED
TO BE SUBCONTRACTED
YES/
NO
QUOTES RECEIVED
DATES
CONTACTED
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UTILIZATION OF TARGETED SMALL BUSINESS (TSB) ENTERPRISES
ON NON-FEDERAL AID PROJECTS
(THIRD -PARTY STATE -ASSISTED PROJECTS)
In accordance with Iowa Code Section 1913.71 it is the policy of the Iowa Department of Transportation (Iowa DOT) that Targeted Small
Business (TSB) enterprises shall have the maximum practicable opportunity to participate in the performance of contracts financed in
whole or part with State funds.
Under this policy the Recipient shall be responsible to make a positive effort to solicit bids or proposals from TSB firms and to utilize
TSB firms as contractors or consultants. The Recipient shall also ensure that the contractors or consultants make positive efforts to
utilize TSB firms as subcontractors, subconsultants, suppliers, or participants in the work covered by this agreement.
The Recipient's "positive efforts" shall include, but not be limited to:
1. Obtaining the names of qualified TSB firms from the Iowa Economic Development Authority (515-725-3132) or from its website
at: https://www.iowa.gov/tsb/index.php/home.
2. Notifying qualified TSB firms of proposed projects involving State funding. Notification should be made in sufficient time to
allow the TSB firms to participate effectively in the bidding or request for proposal (RFP) process.
3. Soliciting bids or proposals from qualified TSB firms on each project, and identifying for TSB firms the availability of
subcontract work.
4. Considering establishment of a percentage goal for TSB participation in each contract that is a part of this project and for
which State funds will be used. Contract goals may vary depending on the type of project, the subcontracting opportunities
available, the type of service or supplies needed for the project, and the availability of qualified TSB firms in the area.
5. For construction contracts:
a) Including in the bid proposals a contract provision titled "TSB Affirmative Action Responsibilities on Non -Federal Aid
Projects (Third -Party State -Assisted Projects)" or a similar document developed by the Recipient. This contract provision
is available on-line at:
http://www. dot. state. i a. us/local_syste ms/publications/tsb_contract_provision. pdf
b) Ensuring that the awarded contractor has and shall follow the contract provisions.
6. For consultant contracts:
a) Identifying the TSB goal in the Request for Proposal (REP), if one has been set.
b) Ensuring that the selected consultant made a positive effort to meet the established TSB goal, if any. This should include
obtaining documentation from the consultant that includes a list of TSB firms contacted; a list of TSB firms that responded
with a subcontract proposal; and, if the consultant does not propose to use a TSB firm that submitted a subcontract
proposal, an explanation why such a TSB firm will not be used.
The Recipient shall provide the Iowa DOT the following documentation:
1. Copies of correspondence and replies, and written notes of personal and/or telephone contacts with any TSB firms. Such
documentation can be used to demonstrate the Recipient's positive efforts and it should be placed in the general project file.
2. Bidding proposals or RFPs noting established TSB goals, if any.
3. The attached "Checklist and Certification." This form shall be filled out upon completion of each project and forwarded to: Iowa
Department of Transportation, Civil Rights Coordinator, Office of Employee Services, 800 Lincoln Way, Ames, IA 50010.
TSB-5
Bidder Status Form
To be completed by all bidders Part A
Please answer "Yes" or "No" for each of the following:
g Yes
1-6XJ Yes
17
■
No
No
Yes ❑ No
® Yes ■ No
®Yes No
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: 3 / a / 1 81 to l Pr-fo ller
Address: 1127 Linoln 5+,
City, State Zip- Cedar F&Ils, D4- SO613
Dates: / / to / / Address -
City, State, Zip -
Dates: / / to / / Address•
You may attach additional sheet(s) if needed. 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?
Yes ■ No
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: K4- k/ 6lrctr-kk rt&c_.
Signature:
Date: 214 /2 S
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)
BF-1
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.
Yes U No My business Is currently registered as a contractor with the Iowa Division of Labor.
❑ Yes [I. No My business is a sole proprietorship and I am an Iowa resident for Iowa income tax purposes.
❑ Yes ►: No My business is a general partnership or joint venture. More than 50 percent of the general
partners or joint venture parties are residents of Iowa for Iowa income tax purposes.
( Yes ❑ 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
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.
Yes fitj No My business is a limited liability partnership which has filed a statement of qualification in this
state and the statement has not been canceled.
❑Yes 5jNo
My business is a limited liability partnership which has filed a statement of qualification in a
state other than Iowa, has filed a statement of foreign qualification in Iowa and a statement of
cancellation has not been filed.
Yes t] No 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.
❑ Yes IN No
My business is a limited partnership or a limited liability limited partnership whose certificate of
limited partnership is filed in a state other than Iowa, the limited partnership or limited liability
limited partnership has received notification from 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.
❑ Yes 1' No My business is a limited liability company whose certificate of organization is filed in Iowa and has
not filed a statement of termination.
■
YesNo
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 (09-1F)
BF-2
BID BOND
KNOW ALL MEN BY THESE PRESENTS, that we, K & W Electric, Inc.
as Principal, and Westfield Insurance Company
as Surety are held nd 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 Pr`ncipal has submitted the accompanying
bid dated the 6th day of February 2025, for
Terminal Security Uporades (CCTV) Waterloo Regional Air
•
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 6th day of February AD 2025.
Contract No. CNTRT-5819
Bid Bond
K & W Electric, Inc.
Principal
By
, /Sriz.. beVr Title) Pre3 i decal'
Westfield Insurance Company (Seal)
Surety
(Seal)
By �- %
Joseph I. Sc�r�lit Attorney-'n-fact
BB-1 of
Terminal Security Upgrades (ACS)
Waterloo Regional Airport-60734402
THIS POWER OF ATTORNEY SUPERCEDES ANY PREVIOUS POWER BEARING THIS SAME
POWER # AND ISSUED PRIOR TO 06/20/22, FOR ANY PERSON OR PERSONS NAMED BELOW.
General
Power
of Attorney
CERTIFIED COPY
POWER NO. 1429172 00
Westfield Insurance Co.
Westfield National Insurance Co.
Ohio Farmers Insurance Co.
Westfield Center, Ohio
Know All 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
JOSEPH I. SCHMIT, JEFFREY R. BAKER, GREG T. LAMAIR, E. A. VONHAR2, BRANDON HORBACH, JOINTLY OR SEVERALLY
of WEST DES MOINES 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, recagnizances, 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 follow ng 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 an 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 20th day of JUNE A.D., 2022 .
Corporate
el I RAti2,}
Affixed •w+o�
(`J s .LT;4
State of Ohio
County of Medina ss.:
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SEAL: m
WESTFIELD INSURANCE COMPANY
WESTFIELD NATIONAL INSURANCE COMPANY
OHIO FARMERS INSURANCE COMPANY
1
By:
Gary W.
tumper, Nations Surety Leader and
Senior Executive
On this 20th day of JUNE A.D., 2022 , 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, WESTF ELD 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 seats; 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.:
E OF o
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 Whe epf, I have hereunto set my hand and affixed the seals of said Companies at Westfield Center, Ohio, this 6th day of
February A•D•, 2025 •
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i"( SEAL Alt 5, SEAL °m
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- A eutAL,
Frank A. Carrino, Secretary
Secretary
BPOAC2 (combined) (03-22)