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HomeMy WebLinkAboutOpening of Bids - 2017 Trucking of Belt Pressed Biosolids for Land Application - Trucks R UsINTER -OFFICE MEMORANDUM DEPARTMENT OF PUBLIC WORKS DIVISION OF UTILITIES TO: Members of the Board of Public Works Eric Horvath, Director of Public Works Michael Schmidt, Assistant City Attorney Linda M. Martin, Clerk FROM: AI Greek, Director of Utilities Jacob M. Klosinski, P.E. SUBJECT: 2017 Contract for Trucking of Belt Pressed Biosolids for Land Application Award Recommendation DATE: February 14, 2017 On February 14, 2017, the Board of Public Works opened and read quotations for the above project. The Division of Environmental Services reviewed the documents and finds the information correct and complete. The quotations ranked as follows: Bidder Unit Price Bid "Per Truck Per Hour" 1. -revc s R US, tntc. $ 95, 00 2. 3. 4. 5. The Division of Utilities recommends Award of the contract for the 2017 Trucking of Belt Pressed Biosolids for Land Application to the lowest responsive / responsible bidder, avcu S 0z us, iwC_, at the unit price bid 9g 5 00 per truck per hour, subject to vehicle inspection. The total contract amount shall be issued as a not to exceed contract based on the 2017 Budget for land application. The Division of Utilities will appropriate sufficient funds from the Organic Resources, Contractual Services Other Account (641-0630-793-63-35). For questions regarding the above recommendation or the subject project, contact Al Greek (Ext. 4210) or Jacob M. Klosinski (Ext. 9496) at the Division of Utilities. 1`oTc,. 133ip'Ew4P SwRMXTTEp AT to7o IWST14IP 0)::� -O5,o00, 00 u7_1L,1n6.5 somas 7y1s As Aec6r I-�1-r--. ?aegm, 9 � BID/PROPOSAL CITY OF SOUTH BEND BID NAME 2017 Trucking of Bio-Solids for Land Application FOR BIDS DUE February 14, 2017 BID PRICING FOR CONTRACT Item Est. Qty. Item Unit Unit Price No. TBD Trucking of Belt Pressed Per Truck 1 on call,, Biosolids for Land Application Per Hour $ Bidder (Firm): Address: City/State/Zip: Telephone Number: TRUCKS R US INC 23942 STATE ROAD 2 SOUTH BEND, IN 46619 574-340-8470 a BOARD OF PU BLIC WORKS ✓ U -- Gary A. Gilot, President Suza na M. Fritzberg, Member Jam s A. Mueller, Member Fax mbar: 574-232-3810 (Signature) JAMES BURGER (Printed Name) PRESIDENT (Title) Therese J. Dor2u, M mber Eliz�t�a�k, Member Attest: Linda M. Martin, Clerk Yer.13-610111S .Out 11 CITY OF SOUTH BEND. INDIANA SELLER'S BID FOR SALE OR LEASE OF MATERIALS BID NAME 2017 Trucking of Belt -Pressed Biosolids for Land Application FOR BIDS DUE February 14, 2017_ W5 " Bidder Date: 02/13/17 (Firm): TRUCKS R US INC Address: 23942 STATE ROAD 2 City/State/Zip: SOUTH BEND, IN 46619 Telephone Number: ( 574 ) 340-8470 Agent of Bidder (if Applicable): JAMES BURGER - PRESIDENT 174ren the prospective Contractor is unable to certl(j, to mpg aj'the statements beloiv, it shall attach an explanation to this Affndrnuf. CONTRACTOR'S NON -COLLUSION AND NON -DEBARMENT AFFIDAVIT, CERTIFICATION REGARDING INVESTMENT WITII IRAN, EMPLOYMENT ELIGIBILITY VERIFICATION, NON-DISCRIMINATION COMMITMENT AND CERTIFICATION OF USE OF UNITED STATES STEEL PRODUCTS OR FOUNDRY PRODUCTS (Must be completed for all quotes and bids. Please type or print) STATE OF INDIANA ) ) SS: SLJOSEPH COUNTY ) The undersigned Contractor, being duly sworn upon his/her/its oath, affirms under the penalties of perjury that: I . Contractor has not, nor has any other member, representative, or agent of the firm, company, corporation or partnership represented by him, entered into any combination, collusion or agreement with any person relative to the price to be bid by anyone at such letting nor to prevent any person from bidding nor to induce anyone to refrain from bidding, and that this bid is made without reference to any other bid and without any agreement, understanding or combination with any other person in reference to such bidding. Contractor further says that no person or persons, firms, or corporation has, have or will receive directly or indirectly, any rebate, fee, gift, commission or thing of value on account of such sale; and 2. Contractor certifies by submission of this proposal that neither contractor nor any of 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; and 3. Contractor has not, nor has any successor to, nor an affiliate of, Contractor, engaged in investment activities in Iran. a. For parposes ofthis Certification, `Iran" means the government of fi an and any agency or instrumentality of Iran, or as otherwise defined at Ind. Code § 5-22-16.5-5, as amended from time -to -time. Yer. 13 — 6161115 b. As provided by Ind. Code § 5-22-16.5-8, as amended from time -to -time, a Contractor is engaged in investment activities in tan if either: i. Contractor, its successor or its affiliate, provides goods or services of twenty million dollars ($20,000,000) or more in value in the energy sector of trail; or ii. Contractor, its successor or its affiliate, is a financial institution that extends twenty million dollars ($20,000,000) or more in credit to another person for forty-five (45) days or more, if that person will (i) use the credit to provides goods and services in the energy sector in [ran; and (ii) at the time the financial institution extends credit, is a person identified on list published by the Indiana Department of Administration. 4. Contractor does not knowingly employ or contract with an unauthorized alien, nor retain any employee or contract with a person that the Contractor subsequently learns is an unauthorized alien. Contractor agrees that he/she/it shall enroll in and verify the work eligibility status of all of Contractor's newly hired employees through the E-Verify Program as defined by I.C. 22-5-1.7-3. Contractor's documentation of enrollment and participation in the E-Verify Program is included and attached as part of this bid/quote; and 5. Contractor shall require his/her/its subcontractors performing work under this public contract to certify that the subcontractors do not knowingly employ or contract with au unauthorized alien, nor retain any employee or contact with a person that the subcontractor subsequently learns is an unauthorized alien, and that the subcontractor has enrolled in and is participating in the E-Verify Program. The Contractor agrees to maintain this certification throughout the term of the contract with the City of South Bend, and understands that the City may terminate the contract for default if the Contractor fails to cure a breach of this provision no later than thirty (30) days after being notified by the City. 6. Persons, partnerships, corporations, associations, or joint venturers awarded a contract by the City of South Bend through its agencies, boards, or commissions shall not discriminate against any employee or applicant for employment in the performance of a City contact with respect to hire, tenure, terms, conditions, or privileges of employment, or any matter directly or indirectly related to employment because of race, sex, religion, color, national origin, ancestry, age, gender expression, gender identity, sexual orientation or disability that does not affect that person's ability to perform the work. In awarding contracts for the purchase of work, labor, services, supplies, equipment, materials, or any combination of the foregoing including, but not limited to, public works contracts awarded under public bidding laws or other contracts in which public bids are not required by law, the City, its agencies, boards, or commissions may consider the Contractor's good faith efforts to obtain participation by those Contractors certified by the State of Indiana as a Minority Business ("MBE") or as a Women's Business Enterprise ("WBE") as a factor in determining the lowest, responsible, responsive bidder. In no event shall persons or entities seeking the award of a City contract be required to award a subcontract to an MBE/WBE; however, it may not unlawfully discriminate against said WBE/MBE. A finding of a discriminatory practice by the City's MBE/WBF. Ver. 13 — 6101115 Utilization Board shall prohibit that person or entity from being awarded a City contract for a period of one (1) year from the date of such determination, and such determination may also be grounds for terminating the contact for which the discriminatory practice or noncompliance pertains. 7. The undersigned contractor agrees that the following nondiscrimination commitment shall be made a part of any contract which it may henceforth enter into with the City of South Bend, Indiana or any of its agencies, boards or commissions. Contractor agrees not to discriminate against or intimidate any employee or applicant for employment in the performance of this contract with privileges of employment, or any matter directly or indirectly related to employment, because of race, religion, color, sex, gender expression, gender identity, sexual orientation, handicap, national origin or ancestry. Breach of this provision may be regarded as material breach of contract. I, the undersigned bidder or agent as contractor on a public works project, understand my statutory obligations to the use of steel products or foundry products made in the United States (I.C. 5-16-8-1). I hereby certify that I and all subcontractors employed by me for this project will use steel products or foundry products made in the United States on this project if awarded. I understand I have an affirmative duty to notify the City in my bid that my proposal does not include the use of steel products or foundry products made in the United States. I understand it is my sole obligation and responsibility to provide a justification to the City, subject to review and approval, why the cost of United States made steel or foundry products is unreasonable. Prior to award and upon submission of bid which does not use steel products or foundry products made in the United States, the City, through its director of public works, shall make a determination if the price of United States made steel or foundry is unreasonable. I understand that violations hereunder may result in forfeiture of contractual payments. xM� leer. 13 — 6101115 I hereby affirm under the penalties of perjury that the facts and information contained in the foregoing bid for public works are true and correct. Dated this 13th day of February, 2017 TRUCKS R US INC C tr ctor/Biddet�(Finn) ---� ' nature of Contractor/Bidder or [ts Agent JAMES BURGER - PRESIDENT Printed Name and Title Subscribed and sworn to before me this. 13th day of February_, 20 117 My Commission Expires 10/15/24 Notat'y Public -Kimberley R. Johnson County of Residence LaPorte ;;:y.>;'�"'•. }•wo„A„1?"•- KIMBERLEY R JOHNSON La Porte Cooary ' ; �r My Coremisslon Explres October 15, 2024 Ver. 13 — 6101115 (To be completed only by Contractors/Bidders claiming to be a "local Indiana business" pursuant to I,C. 36-1-12-22) INDIANA LOCAL BUSINESS PREFERENCE CLAIM A "local Indiana business" raters to any of the following: (1) A business whose principal place of business is located in an affected county. (2) A business that pays a majority of its payroll (in dollar volume) to residents of affected counties. (3) A business that employs residents of affected counties as a majority of its employees. (4) A business that makes significant capital investments in the affected counties as defined in rules adopted by the political subdivision. (5) A business that has a substantial positive economic impact on the affected counties as defined by criteria in rules adopted by the political subdivision. An "affected county" refers to St. Joseph County, Indiana, or the following counties located adjacent to St. Joseph County: Elkhart County, Marshall County, Starke County and LaPorte County There are the following price preferences for supplies purchased from a local Indiana business: 5% fora purchase expected by the purchasing agency to be less than $50,000 3% for a purchase expected by the purchasing agency to beat least $50,000 but less than $100,000. 1 % for a purchase expected by the purchasing agency to beat least $100,000. Date: 02/13/17 Pursuant to I.C. 36-1-12-22, 7rat4- g IAS — claims a local Indiana business preference for Project Belt Pressed Biosolids for land application (Project # ) located within the City of South Bend, St. Joseph County, Indiana. The location of the principal place of business is 23942 State Road 2, South Bend, IN 46619 (Address) N St. Joseph County, Indiana ❑ The following county located adjacent to St. Joseph County, Indiana: X The majority of the business's payroll for the 12 months prior to the date of this Bid is to residents of St. Joseph County, Indiana or the adjacent county noted above. The majority of the business's employees for the 12 months prior to the date of this Bid are residents of St. Joseph County, Indiana, or the adjacent county noted above. If the business is deemed to be the apparent lowest, responsible, responsive bidder, then it shall provide supporting documentation for the 12 month period prior to the date of the Bid of (i) the total payroll amount paid to all employees of the business, and (ii) the total payroll amount paid to employees who are residents of St. Joseph County and the adjacent county noted above. WHEN SUPPLYING SUPPORTING PAYROLL RECORDS, BIDDER SHALL REDACT ALL SOCIAL SECURITY NUMBERS. Dated this 13th day of February , 2017 TRUCKS R US INC _ Co ra for/Bidder (F m) Si lure of Contractor/ idder or Its Agent JAMES BURGER - PRESIDENT Printed Name and Title Ver. 13 — 6101115 OP ID: CH ,A11*. a CERTIFICATE OF LIABILITY INSURANCE DATE 11012017 02110/2017 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsements . PRODUCER R.S. Miller & Sons, Inc. P.O. BOX 229 109 W. Plymouth Street Bremen, IN 46506 Gregory S. Miller, CPCU,CIC CONTACT Gregory S Miller, CPCU, CIC NAME: PHONE 574-546-3341 ac Ne :574-546-2687 A/c No at,: EMAIL ADDRESS:PRODUCER CUSTOMS to a: TRUCK-1 INSURERS AFFORDING COVERAGE NAIC N INSURED Trucks R Us, Inc. INSURER A: West Bend Mutual insurance 15350 _ Lake Effect Excavating, Inc Lake Effect Snow Removal INSURER B: Lake Effect Auto Sales INSURER C 23943 State Road 2 INSURER D: South Bend, IN 46619 INSURER E: INSURER F COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR OF INSURANCE ADDLITYPE INgR BUB POLICY NUMBER MMIDO/YYEYYV MM/DD/VYVY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,00 A X COMMERCIAL GENERAL LIABILITY A040137 0710512016 07105/2017 PREMISES Eaoccurence $ 200,000 MED EXP (Any one person) $ 5,00 CLAIMS -MADE a OCCUR PERSONAL &ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 BERL AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGO $ 2,000,000 $ -- POLICY X PRO LOG A AUTOMOBILE LIABILITY ANY AUTO A040137 0710612016 0710512017 COMBINED SINGLE LIMIT (Ea accident) $ 1,000,000 X BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ ALLOWNEDAUTOS PROPERTY DAMAGE (PER ACCIDENT) $ SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS $ A UMBRELLA LIAR EXCESS LIAB I X OCCUR CLAIMS -MADE A040137 0710512016 0710512017 EACH OCCURRENCE $ 2,000,00 AGGREGATE $ 2,000,000 DEDUCTIBLE $ TH X WOR LIMITS ER - $ A A X I RETENTION S 10,000 WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETOR/PARTNERIEXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, RdeIPsTIcribONe untlerOFOPERATIONS below DESC Motor Truck Cargo I A040149 040137 0710512016 0710512016 0710512017 0710512017 E.L. EACH ACCIDENT $ 500,000 E. L. DISEASE -EA EMPLOYEE $ 500,000 E. L. DISEASE - POLICY LIMIT $ 500,00 MTCargo 100,000 ded 1,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 401, Additional Remarks Schedule, if more space Is required) City Of South Bend 125 S. Lafayette Blvd. Suite 100 South Bend, IN 46601 ACORD 26 (2009109) CITYOFS SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE Gregory S. Miller, CPCU,CII ©1988J4609 ACOR The ACORD name and logo are registered marks of ACORD CORPORATION. All rights reserved. Bond No.: B 1182790 Selective Insurance Company of America 40 Wantage Avenue Branchville, New Jersey 07890 973-948-3000 AIA Document A310 BID BOND KNOW ALL MEN BY THESE PRESENTS, that we Trucks R Us, Inc. 23942 State Road 2 South BEnd, IN 46619 (Here insert full name and address or legal title of eoatrarmr) as Principal, hereinafter called the Principal, and Selective Insurance Company of America a corporation duly organized under the laws of the State of New Jersey as Surety, hereinafter called the Surety, are held and firmly bound unto City of South Bend - Board of Public Works County City Buiding South Bend, IN 46601 (Here insert full name and address or legal title of owner) as Obligee, hereinafter called the Obligee, in the sum of 10 % Percent of the Total Bid ($ 10 % Percent) for the payment of which sum well and truly to be made, the said Principal and the said Surety, bind ourselves, our heirs, executors, administrators, successors and assigns, jointly and severally, firmly by these presents. WHEREAS, the Principal has submitted a bid for Trucking of Belt Pressed Biosotids for Land Application (Here insert full name and address and description of project) NOW, THEREFORE, if the Obligee shall accept the bid of the Principal and the Principal shall enter into a Contract with the Obligee in accordance with the terms of such bid, and give such bond or bonds as may be specified in the bidding or Contract Documents with good and sufficient surety for the faithful performance of such Contract and for the prompt payment of labor and material furnished ni )hc prosecution thereof, or in the event of the failure of the Principal to enter such Contract and give such bond or bonds, if the Principal steal I pay to the Obligee the difference not to exceed the penalty hereof between the amount specified in said bid and such larger amount for which the Obligee may in good faith contract with another party to perform the work covered by said bid, then this obligation shall be null and void, otherwise to remain in full force and effect. Signed and Sealed this loth day of February 2017 (Witness) Trucks R Us, SELECTIVE INSURANCE COMPANY OF AMERICA 116 (Surety) (Seal) (Title) Attomey-in-Fact Gregory S. Miller "Printed in cooperation with the American Institute of Architects (AIA) by the Selective Insurance Company of America. The language in this document conforms exactly to the language used in AIA Document A310, February 1970 edition." AIA DOCUMENT A310•BID BOND•AIA ® • FEBRUARY 1970 ED•THE AMERICAN INSTITUTE OF ARCHITECTS,1735 N.Y. AVE., N.W., WASHINGTON, D.C. 20006 B-203 (12/92) SELECTIVE Selective Insurance Company of America 40 Wantage Avenue Branchville, New Jersey 07890 BondNo.B 1182790 973-948-3000 POWER OF ATTORNEY Public Bid SELECTIVE INSURANCE COMPANY OF AMERICA, a New Jersey corporation having its principal office at 40 Wantage Avenue, in Branchville, State of New Jersey ("SICA"), pursuant to Article VII, Section 1 of its By -Laws, which state in pertinent part: The Chairman of the Board, President, Chief Executive Officer, any Executive Vice President, any Senior Vice President or any Corporate Secretary may, from time to time, appoint attorneys in fact, and agents to act for and on behalf of the Corporation and they may give such appointee such authority, as his/her certificate of authority may prescribe, to sign with the Corporation's name and seal with the Corporation's seal, bonds, recognizances, contracts of indemnity and other writings obligatory in the nature of a bond, recognizance or conditional undertaking, and any of said Officers may, at any time, remove any such appointee and revoke the power and authority given him/her. does hereby appoint Gregory S. Miller , its true and lawful attorney(s)-in-fact, full authority to execute on SICA's behalf fidelity and surety bonds or undertakings and other documents of a similar character issued by SICA in the course of its business, and to bind SICA thereby as fully as if such instruments had been duly executed by SICA's regularly elected officers at its principal office, in amounts or penalties not exceeding the sum of: Fifty Thousand Dollars Signed this loth day of February , 2017 SELECTIVE INSURANCE COMPANY OF Brian C. Sarisky Its SVP, Strategic Business Units, STATE OF NEW JERSEY : :ss. Branchville COUNTY OF SUSSEX SEAL On this loth day of February 2017 before me, 11 the undersigned officer, personally appeared B'r�,lello, Cu,$,4risky, who acknowledged himself to be the Sr. Vice President of SICA, and that he, as such Sr. Vice President, beiv' ..e11 do, executed the foregoing instrument for the purposes therein contained, by signing the name of the cQ%Ntion by kiWi as Sr. Vice President and that the same was his free act and deed In the free act and deed of SICA. Chadiene 011ie Notary Public of New Jersey °Ue1 N My Commission Expires 8P1t2021 Notary Public N, , , The power of attorney is signed and sealed by facsimile under and by the authority of the following Resolutr6 U itti;d by the Board of Directors of SICA at a meeting duly called and held on the 6th of February 1987, to wit: "RESOLVED, the Board of Directors of Selective Insurance Company of America authorizes and approves the use of a facsimile corporate seal, facsimile signatures of corporate officers and notarial acknowledgements thereof on powers of attorney for the execution of bonds, recognizances, contracts of indemnity and other writing obligatory in the nature of a bond, recognizance or conditional undertaking." CERTIFICATION Al . to,, I do hereby certify as SICA's Corporate Secretary that the foregoing extract of SICA's By -Laws and Reso force and effect and this Power of Attorney issued pursuant to and in accordance with the By -Laws is val' gal Signed this loth day of February 2017 chael H. Lanza, SICA Corporat ecretary\ Important Notice: If the bond number embedded within the Notary Seal does not match the number in the upper rjy t to 14) right-hand comer of this Power of Attorney, contact us at 973-948-3000. Selective Insurance Company of America SELECTIVE® 40 Wantage Avenue BondNo.B 1182790 Branchville, New Jersey 07890 973-948-3000 STATEMENT OF FINANCIAL CONDITION Public Bid I hereby certify that the following information is contained in the Annual Statement of Selective Insurance Company of America ("SICA") to the New Jersey Department of Banking and Insurance as of December 31, 2015: ADMITTED A$ Tye do thousan&) LIABILITIES AND SURPLUS (in thousands); Bonds $1,393,180 Reserve for losses and loss expenses $944,610 Preferred stocks at convention value 0 Reserve for unearned premiums 329,223 Provision for unauthorized Common stocks at convention values 150,204 reinsurance 945 Subsidiary common stock at Commissions payable and convention values 0 contingent commissions 28,717 Short-term investments 73,117 Other accrued expenses 24,235 Mortgage loans on real estate (including collateral loans) Other invested assets Interest and dividends due or accrued Premiums receivable Other admitted assets Total admitted assets 35,163 Other liabilities 292.165 58,548 Total liabilities 1,619,895 13,287 318,478 Surplus as regards policyholders 520,777 98,695 Total liabilities and surplus as 140.67 regards policyholders L 2 I further certify that the following is a true and exact excerpt from Article VII, Section I of the By -Laws of SICA, which is still valid and existing. The Chairman of the Board, President, Chief Executive Officer, any Executive Vice President, any Senior Vice President or any Corporate Secretary may, from time to time, appoint attorneys in fact, and agents to act for and on behalf of the Corporation and they may give such appointee such authority, as his/her certificate of authority may prescribe, to sign with the Corporation's name and seal with the Corporation's seal, bonds, recognizances, contracts of indemnity and other writings obligatory in the nature of a bond, recognizance or conditional undertaking, and any of said Officers may, at any time, remove any such appointee and revoke the power and authority given him/her. IN WITNESS WHEREOF, I hereunto subscribe my name and STATE OF NEW JERSEY : :ss. Branchville COUNTY OFSUSSEX acknowledged himself to be the Corporate Secretary of to do, executed the foregoing instrument for the purpose himself as Corporate Secretary. RE as si I by My Commission ExpWai' 41wn9nYNiflym Iee !dvj Iw 1iiiSuDuAllnhffldW.termV-'rii,��, SELECTIVE ALL NOTICES REGARDING CLAIMS AGAINST THIS BOND MUST BE MAILED OR FAXED TO: SELECTIVE INSURANCE COMPANY OF AMERICA Attention: BOND CLAIMS P.O. Box 7265 London, KY 40742 Email address: CSVCenter@selective.com Telefax: 866-324-3471 Phone: 866-455-9969