HomeMy WebLinkAboutOpening of Bids - Leeper Park Tennis Court Recoloring 2017 - 10-S Court SolutionsCITY OF SOUTH BEND, INDIANA
CONTRACTOR'S BID FOR PUBLIC WORK
CHECKLIST FOR BIDDERS
Project Name
Project No.
For Bids Due
Leeper Park Tennis Court Recoloring 2017
1003-2017
3/14/2017
From time to time the South Bend Board of Public Works finds it necessary to reject a bid because
it does not comply with statutory requirements. In preparing your bid, please use the following
checklist in order to make sure that your bid is done in the proper manner.
/ Proper bid security included. The bidder has the option of providing either a Certified Check
or Bid Bond.
/Bid prepared on the City of South Bend Contractor's Bid for Public Work Form, completely
executed.
Contractor's Non -Collusion and Non -Debarment Affidavit, Certification Regarding Investments
with Iran, Employment Eligibility Verification, Non -Discrimination Commitment, and
_ Certification of use of United States Steel Products or Foundry Products.
Proof of MBE/WBE Participation Goal Form [MWBE-1.0]. If minimum participation goal is not
met, also provide Evidence of Good Faith Efforts Form [MWBE-2.0] and MBE/WBE Contacted
Form [MWBE-2.1].
Acknowledge Receipt of Addendum(s) included with the bid.
All required additional information is included with the bid.
Proposal statements and other affidavits all signed by the proper party with name either
printed or typed underneath signature.
This checklist submitted with the Bid.
This checklist is provided for bidder's use in assuring compliance with required
documentation; however, it does not include all specifications requirements and does not
relieve the bidder of the need to read and comply with the specifications.
Bidder: 1 O- S COURT Sol U n oN S Date: 3• I• 17
By Authorized Representative:
Signature:
4
Print Name & Title: 4 LI.XAAJbP_A NII PE2GA CA - W 8$
Version 7/31/2015 Contractor's Bid for Public Works - 1
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CITY OF SOUTH BEND, INDIANA
CONTRACTOR'S BID FOR PUBLIC WORK ,Kfis.
Project Name Leeper Park Tennis Court Recoloring 2017
Project No. 1003-2017
For Bids Due 3/14117
PART
(Must be completed for all bids. Please type or print)
Date: 3 • 1 • I -7 Bidder (Firm): 10 — S C4C)UllZr SOLLMO N S
Address: %36 N) NNIESI-F-RtJ Qt.t/Eywr 145
City/State/Zip: 1.-AKE F-6RES17 Telephone Number: ( 7-73) 558 -S'180
I (,001ib
Agent of Bidder (if Applicable):
Pursuant to notices given, the undersigned offers to furnish labor and/or material necessary to complete the
public works project of:
LEEPE-'
R PAILK '(uNIS Coup-T QEC.cx.o(ZIkj& 7-col7
the City of South Bend, Indiana, in accordance with plans and specifications prepared by:
C IT/ OF SOUTH 13END
and dated 3 • I • III for the sum of (enter the Total Bid as shown on the Proposal)
51X-rY1V/NL7NVtSAKjb WINE HVNbR-M NING-rl ($ 6q 990 )
(Enter sum of Total Base Bid plus Alternates shown on Proposal) (Nu erical)
The undersigned further agrees to furnish a bond or certified check with this bid for an amount specified in
the notice of the letting. If alternative bids apply, the undersigned submits a proposal for each in accordance
with the notice. Any addendums attached will be specifically referenced at the applicable page.
If additional units of material included in the contract are needed, the cost of units must be the same as that
shown in the original contract if accepted by the City of South Bend. If the bid is to be awarded on a unit
basis, the itemization of the units shall be shown on a separate attachment.
By Glw'�> N / A/
(Signature)
ALEXAMbRA N6 ER&ACA - WZ66
(Printed Name of Person Signing)
ACCEPTANCE
The above bid is accepted this day of
Subject to the following conditions:
BOARD OF PUBLIC WORKS
Gary A. Gilot, President
Elizabeth A. Maradik, Member
Suzanna Fritzberg, Member
Therese J. Dorau,
James A. Mueller, Member Attest: Linda M. Martin, Clerk
Version 7/31/2015 Contractor's Bid for Public Works - 2
O
PART 11
(For projects of $100,000 or more — IC 36-1-12-4)
These statements to be submitted under oath by each bidder with and as part of his bid.
Attach additional pages for each section as needed.
SECTION I EXPERIENCE QUESTIONNAIRE
1. Attach information regarding projects your organization has completed for the period of one
(1) year prior to the date of the current bid.
2. Attach a listing of public works projects currently in process of construction by your
organization.
3. Attach information regarding any failure to complete any work awarded to you and the
location thereof.
4. Attach references from private firms for which you have performed work.
SECTION II PLAN AND EQUIPMENT QUESTIONNAIRE
1. Attach an explanation of your plan or layout for performing proposed work. (Examples could
include a narrative of when you could begin work, complete the project, number of workers,
etc. and any other information which you believe would enable the City of South Bend to
consider your bid.)
2. Attach a listing of the names and addresses of all subcontractors (i.e. persons or firms outside
your own firm who have performed part of the work) that you have used on public works
projects during the past five (5) years along with a brief description of the work done by each
subcontractor.
3. If you intend to sublet any portion of the work, attach the name and address of each
subcontractor, equipment to be used by the subcontractor, and whether you will require a
bond. However, if you are unable to currently provide a listing, please understand a listing
must be provided prior to contract approval. Until the completion of the proposed project, you
are under a continuing obligation to immediately notify the City of South Bend in the event that
you subsequently determine that you will use a subcontractor on the proposed project.
4. Attach a listing of equipment you have available to use for the proposed project.
5. Have you entered into contracts or received offers for all materials which substantiate the
prices used in preparing your proposal? If not, attach an explanation for the rationale used
which would corroborate the prices listed.
SECTION III CONTRACTOR'S FINANCIAL STATEMENT
Attachment of bidder's financial statement is mandatory. Any bid submitted without said
financial statement as required by statute shall thereby be rendered invalid. The financial
statement provided hereunder to the City of South Bend awarding the contract must be specific
enough in detail so that said City of South Bend can make a proper determination of the bidder's
capability for completing the project if awarded.
Version 7/31/2015 Contractor's Bid for Public Works - 3
When the prospective Contractor is unable to certify to any of the statements below, it shall attach an
explanation to this Affidavit.
CONTRACTOR'S NON -COLLUSION AND NON -DEBARMENT AFFIDAVIT, CERTIFICATION
REGARDING INVESTMENT WITH 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 IL ) S(�LVT�UNS
)SS: /� b CVU2�
LAKE COUNTY )
The undersigned Contractor, being duly sworn upon his/her/its oath, affirms under the penalties of perjury
that:
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 purposes of this Certification, "Iran" means the government of Iran 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.
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 Iran 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 Iran; 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 Iran; 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
Version 7/31/2015 Contractor's Bid for Public Works - 4
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 an
unauthorized alien, nor retain any employee or contract 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 contract 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 MBEMBE 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). 1 hereby certify that I and all subcontractors employed by me for this
project will use steel products or foundry products on this project if awarded. I understand
that violations hereunder may result in forfeiture of contractual payments.
Version 7/31 /2015 Contractors Bid for Public Works - 6
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 ( day of t" t A"O_) 1
ID-S coU(t-r SbLLnI0W
Contractor/Bidder (Firm)
FOFFICIAL��!-�lirrSignature of C tractor/Bidder or Its Agent
�L FORMANIC:, STATE OF ILLINOISnExpires08105/2018 .4 )eANbP-A MEPEI2GAr-4- WIEM
Printed Name and Title
Subscribed and sworn to before me this
My Commission Expires 0
County of Residence
day of �� ' , 201/
c
'�—
Notary Public
LA 145
Version 7/31/2015 Contractor's Bid for Public Works - 6
Project Name
Project No.
For Bids Due
necc ran
, . t11T11 yF,
JCti ^J
BID/PROPOSAL
CITY OF SOUTH BEND
INfiS
Leeper Park Tennis Court Recoloring 2017
1003-2017
03/14/17
Item
No.
Description
Quantity
Unit
Unit Price
Total Amount
1
Power wash entire surface
1
j 4
ZG O
Z P-i UO
2
Apply court patch binder & resurfacer to
1
00
20
Zoo U
3 low areas, a rox.. 100 s yds.
3
Clean & fill 20 feet of large cracks with
1
ZU
(0
'L00
latex rubberized crack filler
4
Grind down raised bumps encountered
1
0 A
iJ
A
3W
Apply Laykold Color System:
5
One coat acrylic resurfacers, one coat of
�1 U��U
` t
C�� IVU�
sand, and one top coat. 8,907 sq yads.
Colors Li ht Green/Pro Blue
1
Layout to regulation, tape, and hand
6
paint lines, including quick start lines
O U
S (0OO
r
with two coats of white/blue acrylic line
paint for all 14 courts
1
BASE BID TOTAL ( 9 00
Bidder (Firm): 1 O- S COUrc—, Sow j 1 0 fjs
Address: -] 36 N Wt=sTEP-M AVE vN rr 1q g
City/State/Zip: LAr-e F0fZ*ST Telephone Number: (-173) 598 -50180
IL (vo045 %� By r
(Signature)
aLF-XA1Jb9A NsMELAcA- wE138
(Printed Name of Person Signing)
Version 7/31/2015 Contractor's Bid for Public Works - 7
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CITY OF SOUTH BEND oe'°" "' °jt,
MINORITY AND WOMEN BUSINESS ENTERPRISE DIVERSITY �w ;.
DEVELOPMENT PROGRAM "All
FORM MWBE-2.0
EVIDENCE OF GOOD FAITH EFFORTS "
This completed form should be included as part of the Bids documents related to City of South Bend Public
Works Projects requiring Good Faith Efforts to obtain MBE/WBE participation. It is the bidder's sole
responsibility to verify whether any listed minority or woman business meets the qualifications of a Minority
or Women's owned business as defined by the Indiana Department of Administration ("IDOA" ).
Project Number: 1003-2017 Date: 3 ( 1 1
Project Name: Leeper Park Tennis Court Recoloring 2017
Bidder: 10 -S court SOLVnowS
Contact Person: iEXA►.WbeA NEPERGACA- kX-W Telephone:i73-S98-59$U
�I-
Address: '736 N WES1-_2N AVE
City: L,AILE rOR.l-sr State: ( L- Zip: (,O IFS
Email: AuEX PSPQ2T1%U2FRGEPROS, COM
To determine whether a bidder has demonstrated good faith efforts to reach the MBE/WBE utilization goals set
forth in the City of South Bend Public Works Project Specifications, the City and its agencies, boards, or
commissions, REQUIRE ALL of the following Good Faith Efforts as listed in the table below':
EVIDENCE OF GOOD FAITH EFFORTS
MBE/WBE LIST(S): The bidder reviewed the City of South Bend's Minority and Women Business
Enterprise Diversity Development Program, which uses the IDOA approved list of Minority and Women
Ups•
Owned Business as found on their website (hftp://www.in.gov/idoa).
ACTION (ADVERTISE/CONTACT): In order for your bid to be deemed responsive, the City of South
Bend requires that all perspective bidders complete no less than 2 of the following:
1. Attend all pre -bid meetings scheduled by the City to inform MBEIWBEs of contracting and
subcontracting opportunities.
2. Advertise in general circulation and/or trade association publications concerning subcontracting
opportunities, and allow MBE/WBEs reasonable time to respond.
3. Perform any and all necessary steps to provide written notice in a manner reasonably calculated
to inform MBE/WBEs of subcontracting opportunities and allowed sufficient time for them to
-AN
participate effectively.
4. Utilize pre-existing services of available community organizations, small and/or disadvantaged
(AM.
business assistance offices and other organizations that provided assistance in the recruitment
and placement of MBE/WBE firms.
"*Bidder must circle or otherwise notate which of the two (2) required actions were performed.
GOOD FAITH NEGOTIATIONS: The bidder negotiated in good faith with interested MBEMIBEs,
including providing such MBE/WBE's with adequate information about the plans, specifications and other
requirements of the subcontract and did not reject MBE/WBEs as unqualified without sound business
reasons based on a thorough investigation of their capabilities.
SMALL CONTRACT(S): The bidder selected specific portions of the work to be performed by
MBE/WBEs in order to increase the likelihood of meeting the MBE/WBE goals (including breaking down
contracts into smaller units to facilitate MBE/WBE participation)
CONTRACT RECORDS: The bidder has maintained the following records for each MBE/WBE that has
bid on the subcontracting opportunity:
i{ N
1. Name, address, and telephone number;
2. A description of information provided by the bidder or subcontractor; and
3. A statement of whether an agreement was reached, and if not, why not, including any reasons for
concluding that the MBE/WBE was unqualified to perform the job.
"Proper demonstration of Good Faith Effort requires your initials next to aii or the above boxes. Any
omissions shall be considered grounds for rejection of the bid by the Board of Public Works. The City of
South Bend reserves the right to request additional information.
Version 7/31/2015 Contractor's Bid for Public Works - 10
CITY OF SOUTH BEND Sovrxday1
MINORITY AND WOMEN BUSINESS ENTERPRISE DIVERSITY IK 1
DEVELOPMENT PROGRAM
i
FORM MWBE-2.1 `
MBENVBE CONTACTED aes
I ms oompiecea Torm snoum oe suppneu wn.. o.ao ..... FvI w .... w. ....._""' —_.._ . __.._ _..._ .. _,_ _ __
requiring contacted MBEIWBE to obtain Good Faith Efforts. It is the bidder's sole responsibility to verify
whether any listed minority or woman business meets the qualifications of a Minority or Women's owned
business.
PAGE OF
Project Number: 1003-2017 MBENVBE Participation Goal 166a a
Project Name: Leeper Park Tennis Court Recoloring 2017
Bidder: iD - S COURT T. 0 L-LMO1JS
By: d4 Al Ul vwAJr-R 3 • 1 • I
(Signature) (Title) (Date)
MBENVBEFirm D-S C-byy- 8bt-LMONS
Owner or Contact at MBENVBE Firm t�Lf7CiQ'A1DilA N (Efta6ACA -- W1570
Telephone: -1 7 3 - S9$-$q$o Fax: Email: AIEK P S PoZ SuP-FAa P eoS
TYPE OF WORK SOLICITED FOR THIS PROJECT:
-7,115NN15 COURT C4Lc>j2iu6,
RESULTS OF CONTACT WITH THE MBENVBE FIRM:
7-14Ls is MY F12N
MBENVBE Firm
Owner or Contact at MBENVBE Firm
Telephone: Fax: Email:
TYPE OF WORK SOLICITED FOR THIS PROJECT:
RESULTS OF CONTACT WITH THE MBENVBE FIRM:
cO M
Version 7/31/2015 Contractor's Bid for Public Works - 11
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10S COURT SOLUTIONS/SPORT SURFACE PROS RECENT
CUSTOMERS:
Anna High School, Anna, TX (8) Hellas Constr 512-250-2910
City of Dallas, TX
(36) Bill Salas
Viroqua High School, Viroqua WI (6) Joe Ratliff
Tall Trees Club Naperville, IL
Middlefork Club, Northfield, IL
City of Charleston, SC
City of Lakeland, FL
Collin College, Plano TX
City of Fort Worth, TX
Skokie Park Dist, Skokie IL
Arlington Hts Park Dist, IL
Park Dist of Glenview, IL
City of Hoffman Estates, IL
Naperville Park Dist, IL
Sun City Community, Huntley, IL
Park Dist of Aiken, SC
City of Rock Falls, IL
Waukegan Park Dist, IL
Palatine Park District, IL
(4) Mike Lange
512-740-3105
773-531-0765
630-973-9380
(4) Murray Krugman 847-501-1274
(25) Beth Brownlee 843-577-2173
(11) Dan Lee 305-849-4940
(8) Kenny Lanius 972-881-5691
(14) Nancy Bunton 817-392-7690
(19) Michael Rea 847-674-1500
(4) Scott Elman 847-577-3000
(25) Ken Wexler 224-521-2264
(10) Gary Buczkowski847-310-3606
(6) Mike Piszynski 630-848-5012
(7) Chris Leuck 847-515-7612
(3) Mark vander Linden 803-642-7559
(6) Mike Sterba
(10) Dan Dalziel
(6) Ed Tynczuk
815-622-4344
847-223-1891
847-705-5130
Lake Forest Park nist n /Al nkoa^lL RA%s^rn oA'7 04^ nccc
%My
Western Surety Company
BID BOND
(Percentage)
Bond Number: 71881762
KNOW ALL PERSONS BY THESE PRESENTS, That we Alexandra Webb dba 10-5 Court Solutions
Of
736 N. Western Ave., Lake Forest, IL 60045 , hereinafter
referred to as the Principal, and Western Surety Company
as Surety, are held and firmly bound unto city of South Bend
of 1316 County -City Building, 227 West Jefferson Blvd., South Bend, IN 46601
hereinafter referred to as the Obligee, in the sum of Five
percent of the greatest
amount bid, for the payment of which we bind ourselves, our legal representatives, successors and assigns,
jointly and severally, firmly by these presents.
WHEREAS, Principal has submitted or is about to submit a proposal to Obligee on a contract
Tennis Court Resurfacing 837 N. LafaVette Blvd.
NOW, THEREFORE, if the said contract be awarded to Principal and Principal shall, within such time as may be
specified, enter into the contract in writing and give such bond or bonds as may be specified in the bidding or
contract documents with surety acceptable to Obligee; or if Principal shall fail to do so, pay to Obligee the
damages which Obligee may suffer by reason of such failure not exceeding the penalty of this bond, then this
obligation shall be void; otherwise to remain in full force and effect.
SIGNED, SEALED AND DATED this
Form F5876
14th day of March 2017
Alexandra Webb dba 10-5 Court Solutions
(Principal)
m
(Seal)
Western Surety Company
(Suure^thy),
By (Seal)
ROBERT THOMAS PRICE J 'Attorney -in -Fact
sr�q@q�F -
��9Fp .
l
Western Surety Company
POWER OF ATTORNEY - CERTIFIED COPY
Bond No. 718 817 62
Know All Men By These Presents, that WESTERN SURETY COMPANY, a corporation duly organized and existing under the laws
of the State of South Dakota, and having its principal office in Sioux Falls, South Dakota (the "Company), does by these presents make,
constitute and appoint ROBERT THOMAS PRICE JR
its time and lawful attorney(s)-in-fact, with full power and authority hereby conferred, to execute, acknowledge and deliver for and on its
behalf as Surety, bonds for:
Principal: Alexandra Webb dba 10—S Court Solutions
Obligee: City of South Bend
Amount: $1,000,000.00
and to bind the Company thereby as fully and to the same extent as if such bonds were signed by the Senior Vice President, sealed with
the corporate seal of the Company and duly attested by its Secretary, hereby ratifying and confirming all that the said attorney(s)-in-fact
may do within the above stated limitations. Said appointment is made under and by authority of the following bylaw of Western Surety
Company which remains in full force and effect.
"Section 7. All bonds, policies, undertakings, Powers of Attorney or other obligations of the corporation shall be executed in the
corporate name of the Company by the President, Secretary, any Assistant Secretary, Treasurer, or any Vice President or by such other
officers as the Board of Directors may authorize. The President, any Vice President, Secretary, any Assistant Secretary, or the Treasurer
may appoint Attorneys in Fact or agents who shall have authority to issue bonds, policies, or undertakings in the name of the Company.
The corporate seal is not necessary for the validity of any bonds, policies, undertakings, Powers of Attorney or other obligations of the
corporation. The signature of any such officer and the corporate seal may be printed by facsimile."
All authority hereby conferred shall expire and terminate, without notice, unless used before midnight of June 14
2017 , but until such time shall be irrevocable and in full force and effect.
Iik6` •. �9Ve€sptf Western Surety Company has caused these presents to be signed by its Vice President, Paul T. Bruflat, and its
irps- l
cacy_,Ate" saltri'lse.a ,this 14th day of March 2017
s_ WEST R SURE COMPANY
==
Paul T. ruflat, Vice President
COUNM�-.OIi �P3EfFfHA
Ptdseia�le5leC��'-
On this 14th day of March. ,intheyear 2017 ,before me, anotary public, personally appeared
Paul T. Bruflat, who being to me duly sworn, acknowledged that he signed the above Power of Attorney as the aforesaid officer of
WESTERNUR aCOMPANY
hOPANY and aknoedged said instrument to be the voluntary act and deed of said corporation.
s J. MOHR
s L NOTARY PUBLIC SEAL f Notary Public - South Dakota
��SOUTH DAKOTA / c p
#44444444444444444444444
My Commission Expires June 23, 2021
I the undersigned officer of Western Surety Company, a stock corporation of the State of South Dakota, do hereby certify that the
attached Power of Attorney is in £till force and effect and is irrevocable, and furthermore, that Section 7 of the bylaws of the Company as
set forth in the Power of Attorney is now in force.
In testimony whereof, I have hereunto set my hand and seal of Western Suety Company this r 4 to day of
March _ 2017
WEST R SURE COMPANY
r
Paul T. ruflat, Vice President
To validate bond authenticity, go to www.cnasurety.com > Owner/Obligee Services > Validate Bond Coverage.
Form FWMI-2016