HomeMy WebLinkAboutOpening of Bids - One or More 2017 or Newer, 3-4 Ton Extended Cab Four Wheel Drive Pick Up Truck - Spec L - Jordan FordCITY OF SOUTH BEND INDIANA �.
SELLER'S BID FOR SALE OR LEASE OF MATERIALS ,
AND NON -COLLUSION AND NON DEBARMENT AFFIDAVIT AND sus
NON-DISCRIMINATION COMMITMENT FOR SELLERS
Spec L - One (1) or More 2017 or Newer % Ton Extended Cab Four Wheel Drive Pick Up
BID NAME Truck
FOR BIDS DUE May 9, 2017 at 9:30 a.m.
Bidder
Date: MAY 9, 2017 (Firm): JORDAN FORD
Address: 609 E. JEFFERSON BLVD. , MISHAWAKA IN 46545
City/State/Zip: MISHAWAKA, IN 46545Telephone Number: ( 574 ) 259-1981 EXT. 317
Agent of Bidder (if Applicable): NIA
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 TNpTANA }
) SS:
SY JOSEPH COUNTY }
The undersigned Contractor, being duly sworn upon his/her/its oath, affirms under the penalties of perjury
that:
l . 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
bid 412
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Contractor/Bidder (Firm)
o
Signature of Contractor/Bidder or Its Agent
DEBRA STARKWEATHER
COMMERCIAL FLEET SALES MANAGER
Printed Name and Title
Subscribed and sworn to before me this 9TH day of MAY , 20 17
My Commission Expires 1 19 1U2-1
County of Residence
7
I- AAI.iof 16AL4=� W /(J-
Notary Public
S{. 7bh
WHITNEY R. PYLE, Notary Public
County of St. Joseph, State of Indiana
My Commission Expires 01/09/2021
(To be completed only by CoutractorslRidders clahning to be a "local liidiaua business"pursuant to LC. 36-1-12-22)
INDIANA LOCAL BUSINESS PREFERENCE CLAIM
A "local Indiana business " refers 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 majorioJ 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 purchasedfrom rom a local Indiana business:
• 5% for a purchase expected by the purchasing agency to be less than $50, 000
• 3% far a purchase expected by the purchasing agency to beat least $50, 000 but less than $100, 000.
• 1 %for apurchase expected by the purchasing agency to beat least $100,000.
Date: MAY 9. 2017
Pursuant to I.C. 36-1-12-22, JORDAN FORD claims a local Indiana business
preference for Project SPEC L EXTENDED CAB 3/4 TON (Project # ) located within the City of
South Bend, St. Joseph County, Indiana.
❑X The location of the principal place of business is 609 E. JEFFERSON, MISHAWAKA, IN 46545
(Address)
® St. Joseph County, Indiana
❑ The following county located adjacent to St. Joseph County, Indiana:
® 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.
WHENSUPPLYING SUPPORTING PAYROLL RECORDS, BIDDER SHALL REDACTALL
SOCIAL SECURITYNUMBERS.
Dated this 9TH day of XAy , 2017
JORDAN FORD
Contractor/Bidder Firm)
Si nature of Contractor/Bidder or Its Agent
DEBRA STARKWEATHER
COMMERCIAL FLEET SATES MANAGER
Printed Name and Title
SPECIFICATIONS
CITY OF SOUTH BEND
Spec L — One (1) or More 2017 or Newer % Ton Extended Cab Four
BID NAME Wheel Drive Pick Up Truck
FOR BIDS DUE May 9, 2017 at 9:30 a.m.
Pursuant to notices given, the undersigned offers bid(s) to the City of South Bend in accordance
with the following attachments) which specify the class or item number or description, quantity,
unit, unit price.
SPEC L — ONE 1 OR MORE 2017 OR NEWER % TON EXTENDED CAB FOUR
WHEEL DRIVE PICK UP TRUCK
It is the intent of these specifications to describe a vehicle or piece of equipment for the City of
South Bend. The unit shall be bid as a fully equipped complete unit as set out in the attached
specifications. No partial or split bids will be accepted. Unit to be bid with and without trade-in
if applicable. Vendor to complete bid proposal contained in this bid specification and attach to
the submitted bid.
These are minimum specifications. Any variation from the specifications must be spelled out on
a separate deviation list in order for the bid to be valid. Any items not listed on the deviation
sheet will be assumed to be part of the unit.
Proprietary products or specific manufacturers may be referenced herein. Such references are
only made to demonstrate minimum scope, quality, and style of the equipment desired.
Equipment that is bid pursuant to these specifications shall be of equal quality and size, or
greater, to those referenced, and are subject to approval by the South Bend Board of Public
Works.
Vendor shall provide all information requested in specifications to qualify for bid. If information
on brochure submitted does not completely cover specifications requested, it shall be typed and
attached to brochure.
If an alternate is included within these specifications, please be advised that, alternate items
placed in the specifications are to determine the best configuration of the item within a budgeted
amount and may be included in the award criteria. If the Board elects to award one or more (s),
the base bid price and the alternate bid price(s) will be totaled and compared for all bidders
offering the final configuration. Award will be made based on the lowest responsible/responsive
bid prices submitted for the base bid with selected (s), if applicable. Failure to submit a bid on
an alternate may result in the entire bid being non -responsive, depending on the final
configuration of the product.
Payment will be processed once the unit is inspected and accepted as to meeting the
specifications by the Division of Central Services. This will include all manuals and warranty
documentation.
Bidder must state as accurately as possible an intended delivery date from the date of the
bid award. Due to the age of the City's existing fleet, it is imperative that the unit's be
delivered as quickly as possible. Stated delivery lead time may be included as an integral
part of our bid selection process. FOB Central Services. The unit and all related paperwork is
to be delivered to:
Central Services Division
1045 West Sample Street
South Bend, Indiana 46619
All Certificates of Origin/Title Work shall list the owner as:
The City of South Bend
1045 West Sample Street
South Bend, Indiana 46619
The Board will award the bid to the lowest responsible and responsive bidder. If the bid is not
awarded to the lowest bidder, the factors used to justify the awards will be stated in writing at the
request of any bidder.
The Board reserves the right to reject any and/or all bids or portions thereof and to waive any
irregularities or informalities.
Chassis: Heavy duty extended cab, GVWR 8600# minimum. O fleet side short
bed.
Wheelbase: 142" minimum
Engine: 8 cylinder, 5.4 liter minimum, gasoline powered
Transmission: Automatic with overdrive and HD cooler, push button transfer case.
Front
Suspension: 4400# minimum capacity with HD shocks
Rear
Suspension: 6000# minimum capacity with HD shocks
Brakes: 4-wheel anti -lock, front disc, rear drum type. 4 wheel disc preferred.
Steering: Power assist
10
Tires: LT235/85RI6 all terrain radials, minimum. Dealer shall equip truck with
a full size tire as a spare. The spare tire will be wheel mounted. Space
saver tires WILL NOT be accepted as the fifth tire and wheel.
Electrical: 125 amp alternator HD, 600 CCA battery HD
Cooling: Heavy duty radiator
Miscellaneous:
Tow Package: Complete with electric brake controller and trailer towing mirrors.
Spray In Liner: Sprayed in bed liner.
Cab & Accessories: AM/FM radio, power outlet, tinted windshield and clearly visible
calibrated dash mounted gauges. Exterior mirrors on both left and right
sides of vehicle. Dealer to include HD rear step bumper capable of
handling potentially heavy towing. Cloth covered 60/40 split bench seat.
Heavy duty rubber floor covering. Air conditioning. Electric windows,
locks, and mirrors. Full Iength assist steps. All weather premium floor
liners Husky or equal.
Rust Proofing: 5 year unlimited mileage factory warranty
Color: White
Warranty: Minimum 3/36 bumper to bumper, 5 year 50,000 power train.
Quantity: One (1) or more
Alternates:
Alternate 1: Front mounted western S' pro -plus power angling left and right. Plow to
come equipped with safety approved lights and markers, and snow
deflector.
Alternate 2: Front mounted Western MVP Plus. Plow to come equipped with safety
approved lights, markers, and snow deflector and shoes.
Alternate 3: CNG — Bi-fucl conversion with tanks mounted under bed.
Alternate 4: Roof mounted strobe light with controller, Federal Signal 53" Legend
LPX or equal.
II
General Product Type: Complete turnkey bi-fuel compressed natural gas/gasoline vehicle
conversion which is Department of Transportation, Environmental
Protection Agency, and National Fire Protection Agency 52
compliant.
Certification: Installation facility shall have a certified gaseous fuel system
inspector on staff. Installer to be factory trained and certified by
conversion kit manufacturer. Copies of certifications shall be
included. Minimum 3 references available upon request.
Cylinder enclosures: Any cylinders mounted outside of vehicle shall be enclosed.
Cylinder enclosures to be made of a minimum 14 gauge steel or
equivalent strength material. Any cylinders mounted inside of
vehicle shall be enclosed also to keep tanks, valves, plumbing, etc.
protected from damage. The material may be wood, aluminum, or
plastic finished to match vehicle interior.
Cylinder cradles: Cylinder cradles to be made of A36 low carbon steel with a tensile
strength of 58,000 PSI. Tank brackets and hangers to meet or
exceed NFPA52 standards.
Plumbing: A minimum of 3/8" seamless stainless steel tubing with a .049 wall
thickness with a 4800 P.S.I. working rating and a 20,000 P.S.I.
burst pressure is to be used. All high pressure tubing is constructed
of stainless steel. All lines are supported with either split block
high pressure retaining devices or rubber insulated steel clamps.
Wherever movement may be present high pressure hoses that
comply with ANSIIIAS, NGV4.2-1999, CSA 12.52 shall be used.
Safety check valves to be installed downstream from the fill
receptacle and before the cylinders. Manual 1/4 turn shut-off valve
and mechanical high pressure gauge must be used. Unit shall also
have an electrically operated valve at tank.
Wiling: All wiring, internal and external, shall be loomed, and properly
secured and routed in a professional manner. Any necessary wire
splices and or connections shall be soldered and shrink-wrapped,
or finished using crimped connectors and shrink-wrapped. Loom to
be securely fastened and supported to the inside of compartment
walls using properly sized cushion clamps, metal clips, or other
industry accepted supporting hardware. Tie -wraps shall only be
used in between primary wiring supports as necessary to aid in
securing wire bundles. Tie -wraps SHALL NOT be used for the
primary supporting or securing of wiring.
General Provisions: All cylinder mounting fasteners are constructed with Grade 8
material and installed in a manner that is compliant with NFPA-52
regulations and are tightened to S.A.E. specifications. All attaching
hardware to be corrosion resistant and incorporate self-locking
12
nuts, or either a lock washer or star washer at the minimum. Where
the attaching hardware passes thru the body, bed or cargo area of
the vehicle, a substantial plate or large fender washer shall be used
to properly distribute the load. Plain washers to be incorporated
under the head of hex -head bolts.
Storage Tank; Tanks to be type IV 20 GGE nominal. Vendor shall provide
pricing for tank size options. All tanks to be certified for 20 years
and manufactured in the same year as bid. Vendor to consult with
Fleet Manager for exact size and placement.
Fuel Gauge: Unit to include a dash mounted fuel gauge to allow for metering
of CNG usage. Shall also include way to monitor CNG fuel versus
gasoline usage.
Methane Detector: Must include self-contained methane detector to be powered by
vehicle electrical system.
Controls: Main on off controls shall be dash mounted.
Training: Vendor to provide all necessary training to operators, and
maintenance technicians. General service training.
Transportation: All transportation to and from bidders facility shall be the
responsibility of the successful bidder. Must specify location of
installation and nearest repair facility.
Warranty: Parts and labor warranty to match original OEM drive train and
cover any consequential damages caused by CNG system. Bidder
shall supply proof of warranty. Successful bidder is responsible
for all warranty repairs. Vendor to state nearest warranty dealer.
If travel outside the City of South Bend is required for warranty
repairs, transportation of the unit is the responsibility of the
successful bidder. All warranty repairs to take place within 48
hours or vendor to pay $100 a day penalty.
13
BIDIPROPOSAL�,
CITY OF SOUTH BEND
Spec L -- One (1) or More 2017 or Newer % Ton Extended Cab Four Wheel
BID NAME Drive Pick Up Truck
FOR BIDS DUE May 9, 2017 at 9:30 a.m.
Description
Year/Make/Model
Unit Price
3/4 TON EXTENDED CAB
2017 FORD F250 SUPERCAB 4X4 PICK UP
$29,509.00 EAC
Alternate#
Description
Cost
Total
1
Front mounted western 8' pro -plus
$ 5584.00 EACH
$ 5584.00 EACH
power angling left and right. Plow to
come equipped with safety approved
li hts and markers, and snow deflector.
2
Front mounted Western MVP Plus.
$ 6089.00 EACH
$ 6089.00 EACH
Plow to come equipped with safety
approved lights, markers, and snow
deflector and shoes.
3
CNG .... Bi-fuel conversion with tanks
$ 9840.00 EACH
$ 9840.00 EACH
mounted under bed.
4
Roof mounted strobe light with
$ 2431.00 EACH
$ 2431.00 EACH
controller, Federal Signal 53" Legend
LPX orequal.
Estimated number of days for delivery from award
date. 85 -- 1001t o
E
I ��
Bidder (Firm): TORDAN FORD
Address: 609 E. JEFFERSON BLVD.
City/State/Zip: MISHAWAKA, IN 46545
Telephone Number: 574/259--1981 X317 Fax Number: 574/254-2777
By
(Signature)
DEBDEBRA STARKWEATHER
(Printed Name)
COMMERCIAL FLEET SALES MANAGER
(Title)
14
BOARD OF PUBLIC WORKS
Gary A. Gilot, President
Suzanna M. Fritzberg, Member
James A. Mueller, Member
15
Elizabeth A. Maradik, Member
Therese J. Dorau, Member
Attest: Linda M. Martin, Clerk
QUOTATION FOR
Description
Plows For City Of South Bend Bid Spec M Regualr Cab Cab 5-9-17
Western 8' Pro Plus Plow With Following Specifications
Ultra- Mount Hitch Design
Blade Width: 8 Foot
Balde Height: 31"
Blade Gauge: 12
Trip Springs: 4
Shock Absorbers: 2
Verticle Ribs: 8
Angling Rams: 1 112" X 12"
Plowing Width Full Angle: 7'4"
Approx Weight Complete: 821#
Disc Shoes: Cast Iron
Cutting Edge: 112" X 6"
Low Profile Dual Beam Halogen Headlamps With Combination Park/turn
Blade Guides
Rubber Snow Deflector & Plow Shoes
Hand Held Controller
Delivery Back To Dealer Ship Inlcuded
Plows For City Of South Bend Bid Spec M Regualr Cab Cab 5-9-17
Western Model Mvp 8.6' Pro Plow Folding V With Following Specifications
Multi Directional V Blade
Ultra- Mount Hitch Design
Blade Width: 8 Foot 6 Inches
Balde Height: 29"
Blade Gauge: 14
Trip Springs: 4
Verticle Ribs: 8
Angling Rams: 1 112" X 11"
Plowing Width Full Angle: 7' '5"
Approx Weight Complete: 880#
Cutting Edge: 318" X 6"
Low Profile Dual Beam Halogen Headlamps With Combination Park/turn
Blade Guides
Rubber Snow Deflector & Plow Shoes
Hand Held Controller
Deliver Back To Dealer Inlcuded
Ultra Line Cargo Area Of Pick Up Bed r nG( Ik €`I) Q (A-0k
Roof Mounted Strobe Federal Signal Legend Model Lpx53z-ambi2h6
Hook Mount
6 Button Controller Inlcuded
Columbia City Office
1171 S W€I#iams `�4feet
Columbia City, IN 46725
Phone: 883-660-7661
Fax: 260.244, 7662
Indianapolis Office
2102 Clay Street.
IrxlOpoli3, IN 46205
Rhone: 317.3TT0407
Fax: 31 r-377-0427
MACQ4105
4/17/2017
Denny McIntyre
Qty Unit Price Ext. Price
$5,584.00
$5,584.00
$6,089.00
$6,089.00
$450.00
$450.00
$2,431.00
$2,431.00
Now Haven Office Page
P 0 Box 558 1
New Hiven, IN 4677.1
Phone: 260-748.41 DC)
Fax 260-148.4121
1 of 2
rj
Alternative
Tue(Systems
Fresno, CA * Elkhart, IN
Will Gutilla 559-28"522 r,rf:ri.rrri:o
will@aialtfuels.com+iiiiiirierr
DATE QUOTE
4/18/2017
170418WG
NAME ADDRESS
Deb Starkweather
Jordan Automotive Group
Mishawaka, IN
P.O. NO.
FORD DROP SHIP
I TERMS
REP
END USER
FOB
88MNZ4
I Due on Com lotion
WG
South Bend
Elkhart, IN
ITEM
DESCRIPTION
QTY
PRICE EA.
EPA Certified Bi-Fuel CNG System
F250-W10A-UB-BF
10.4 GGE 2017 Ford F-2506.2L Pickup
1
$9,400.00
CNG Tanks Mounted Underbody Aft -Axle; OEM Midship Gasoline
Per Unit
Tank Must Be Ordered
All CNG related items in South Bend bid sent by D Starkweather on
04-17-17 are included, EXCEPT:
• Tanks to be installed are Type 1, not Type 4, which is industry
standard for this vehicle type.
• Tanks will amount to 10.4 GGE, not the required 20 GGE. Because
this is a bi-fuel unit with a gasoline tank underbody, the most
underbody CNG capacity is 10.4 GGE. More GGE can be achieved
with tanks not mounted underbody, such as in -bed tanks.
• No methane detector is provided. It is not recommended on this
vehicle t e.
Note: Quote is contingent on 2017 EPA certification.
Note: Quote is good 60 days and is FOB Elkhart, IN.
Note: CNG tanks will have approximately 1000psi upon completion.
Note: After receipt of purchase order, vehicle will be put into production schedule.
Note: After parts and vehicle arrive please allow 25 working days for delivery of first vehicle, and approximately 5
days for each additional vehicle. ,>�r
Note: Vehicle must be ordered with Ford's Gaseous Fuel Prep Engine option.
BUYER AUTHORIZATION : Buyer's signature below is acceptance to purchase the product identified above.
Signature Date-----------------------------------
(U.S `tr00rPICA AC'./ -\a yne
K,� - )r - (- /1) G
9 y�-o
CITY OF SOUTH BEND
BID FOR SPEC L - SEVEN MORE OR LESS 2017 OR NEWER,
TON EXTENDED CAB FOUR WHEEL DRIVE PICKUP TRUCK
BID DUE DATE: MAY 9, 2017
NOTES & EXCEPTION PAGE
IN LIEU OF SERVICE MANUALS, FREE ACCESS TO FORD'S TECHNICAL
RESOURCE CENTER
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THE HANOVER INSURANCE COMPANY
MASSACHUSETTS BAY INSURANCE COMPANY
CITIZENS INSURANCE COMPANY OF AMERICA
POWER OF ATTORNEY
THIS Power of Attorney limits the acts of those named herein, and they have no authority to bind the Company except in .
the manner and to the extent herein stated.
KNOW ALL PERSONS BY THESE PRESENTS:
That THE HANOVER INSURANCE COMPANY and MASSACHUSETTS BAY INSURANCE COMPANY, both being corporations
organized and existing under the laws of the State of New Hampshire, and CITIZENS INSURANCE COMPANY OF AMERICA, a
corporation organized and existing under the laws of the State of Michigan, (hereinafter individually and collectively the "Company") does
hereby constitute and appoint,
Jeffrey C. Carey, Mary T. Flanigan, Christy M, Braila, Patrick T. Pribyl, Debra J. Scarborough, Laura M. Buhrmester, Charles R. Teter, III,
Charissa D. Lecuyer, Evan D. Sizemore, Larissa Smith, Rebecca S. Leal, C. Stephens Griggs, Tahitia M. Fry and/or Megan L. Burns -Hasty
Of Lockton Companies of Kansas City, MO each individually, if there be more than one named, as its true and lawful attorney(s)-in-
fact to sign, execute, seal, acknowledge and deliver for, and on its behalf, and as its act and deed any place within the United States,
any and all surety bonds, recognizances, undertakings, or other surety obligations. The execution of such surety bonds, recognizances,
undertakings or surety obligations, in pursuance of these presents, shall be as binding upon the Company as if they had been duly
signed by the president and attested by the secretary of the Company, in their own proper persons. Provided however, that this power of
attorney limits the acts of those named herein; and they have no authority to bind the Company except in the manner stated and to the
extent of any limitation stated below;
Any such obligations in the United States, not to exceed Fifty Million and No/100 ($50,000,000) in any single instance
That this power is made and executed pursuant to the authority of the fallowing Resolutions passed by the Board of Directors of said
Company, and said Resolutions remain in full force and effect:
RESOLVED: That the President or any Vice President, in conjunction with any Vice President, be and they hereby are authorized and
empowered to appoint Attorneys -in -fact of the Company, in its name and as it acts, to execute and acknowledge for and on its behalf as surety,
any and all bonds, recognizances, contracts of indemnity, waivers of citation and all other writings obligatory in the nature thereof, with power to
attach thereto the seal of the Company. Any such writings so executed by such Attorneys -in -fact shall be binding upon the Company as if they
had been duly executed and acknowledged by the regularly elected officers of the Company in their own proper persons.
RESOLVED: That any and all Powers of Attorney and Certified Copies of such Powers of Attorney and certification in respect thereto, granted
and executed by the President or Vice President in conjunction with any Vice President of the Company, shall be binding on the Company to the
same extent as if all signatures therein were manually affixed, even though one or more of any such signatures thereon may be facsimile.
(Adopted October 7, 1981 — The Hanover Insurance Company; Adopted April 14, 1982 — Massachusetts Bay Insurance Company; Adopted
September 7, 2001 — Citizens Insurance Company of America)
IN WITNESS WHEREOF, THE HANOVER INSURANCE COMPANY, MASSACHUSETTS BAY INSURANCE COMPANY and CITIZENS
INSURANCE COMPANY OF AMERICA have caused these presents to be sealed with their respective corporate seals, duly attested by
two Vice Presidents, this 15th day of November, 2016.
THE HANOVER INSURANCE COMPANY
MASSACHUSETTS DAY INSURANCE COMPANY
CITIZENS SURANCE OMPANY OF AMERICA
Robvrr'Momns, Vicc President
THE HANOVER INSURANCE COMPANY
MA BA HUSETT fiAY I RA CE COMPANY
MA EN , ISUR ICE E AMERICA
THE COMMONWEALTH OF MASSACHUSETTS ) q
COUNTY OF WORCESTER ) ss.
On this 15`h day of November 2016 before me came the above named Vice Presidents The Hanover Insurance Company,
Massachusetts Bay Insurance Company and Citizens Insurance Company of America, to me pe sonally known to bethe individuals and
officers described herein, and acknowledged that the seals affixed to the preceding instrument are the corporate seals of The Hanover
Insurance Company, Massachusetts Bay Insurance Company and Citizens Insurance Company of America, respectively, and that the
said corporate seals and their signatures as officers were duly affixed and subscribed to said instrument by the authority and direction of
said Corporations.
f1IANE J. MARINO
Nary PnhHo
OOMMOM1yrMtw OF WSMC" Mari tJ(/
Gbavr��ilnll irp4w niftw J. , a w, (v�P�l,11C
* +' My Commission L.cpins March 4, 202?
I, the undersigned Vice President of The Hanover Insurance Company, Massachusetts Bay Insurance Company and Citizens Insurance
Company of America, hereby certify that the above and foregoing is a full, true and correct copy of the Original Power of Attorney issued
by said Companies, and do hereby further certify that the said Powers of Attorney are still in force and effect.
GIVEN under my hand and the seals of said Companies, at Worcester, Massachusetts, this day of
CERTIFIED COPY
^
nlwdorc G. mQdincx, vice president
C�