HomeMy WebLinkAboutOpening of Bids - St Joseph Street Improvements - Project No 118-008 - Walsh & Kelly•I iilip� I Irf I L .
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Project Name St. Joseph Street Improvements
Project No.
For Bids Due
118-008
August 28, 2018
PART I
(Must be completed for all bids. Please type or print)
Date: August 28, 2018 Bidder (Firm): Walsh & Kelly, Inc.
Address: 24358 SR 23
City/State/Zip: South Bend, IN 46614 Telephone Number: . k 574 ) 288-4811
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:
St. JoseDh -4'Zfr—n-f Improvements - IPro'ect No. 118-008
the City of South Send, Indiana, in accordance with plans and specifications prepared by:
Jones Petrie Rafinski
and dated July 27, 2018 for the sum of (enter the Total Bid as shown on the Proposal)
Four hundred twenty three thousand dollars and zero cents (s 423,000.09)
(Enter sum of Total Base Bid shown on Proposal) (Numerical)
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 addenclums attached will be specifically referenced at the applicable page.
If additional units ofr ,ppitegialjij.j�Iuded in, the contract are needed, the cost of units must be the same as that
shown in the oriqlAc0fdof4apcepted by the City of South Bend, If the bid is to be awarded on a unit
basis, the be shown on rate attachmien�-,
By
(Signature)
svi x
_A (Printed Name of Person Signing) John M. Peisker, VP of
ACCEPTANCE Asphalt Operations
The above bid i;**&6q 410jt-�day of 20
Subject to the following conditions:
BOARD OF PUBLIC WORKS
Gary A. Gilot, President
Elizabeth A. Maradik, Member
Suzanna M. Fritzberg, Member
Therese J. Dorau, Member
James A. Mueller, Member Attest: Linda M. Martin, Clerk
Version 7/20/2,018 Contractor's Bid for Public Works - 2
BID/PROPOSAL
CITY OF SOUTH BEND
�'1'4
Project Name. St. Joseph Street Improvements () 4
Project Number 118-008
For Bids Due: August 28, 2018
Contractor Name: Walsh Kelly, Inc.
BASE BID
Item No.,
Description
Quantity
Unit
Unit Price
Total Amount
1
Construction Engineering
1
LS
6,610.00
$6,610.00
2
Maintaining Traffic
1
LS
15,800,00
$15,800.00
3
Video Record
1
LS
600.00
$600.00
4
Mobilization and Demobilization
1
LS
27,800.00
$27,800.00
5
Clearing of Right of Way
1
LS
34,524.50
$34,524.50
6
Excavation, Common
296
CYS
43.15
$12,772.40
7
Surface Milling, Asphalt, 4 IN
1,582
SYS
8.00
$12,656.00
8
Pavement, Remove
72
SYS
26.00
$1,872.00
9
Curb, Concrete, Remove
140
LFT
13.50
$1,890-00
10
Tree Remove
3
EA
405.00
$1,215.00
11
Structure Remove
1
EA
480.00
$480.00
12
Light Pole & Foundation, Remove
3
EA
410.00
$1,230,00
13
Handhole Remove
2
EA
280.00
$560.00
14
8" VCP Pipe, Remove
51
LFT
18.00
$918-00
15
Sign and Post, Remove & Reset
4
EA
225.010
$1900.00
16
Temporary Erosion Control
1
LS
1,400.00
$1,400.00
17
Temporary Inlet Protection
5
EA
105.00
$525.00
18
Inlet, Type B
2
EA
3,500.00
$7,000.010
19
20
Storm Sewer Pipe, 12 IN
Casting, Adjust to Grade
44
I
LFT
EA
110.00
645.00
$4,840.00
$645,00
21
Water Main,, Ductile Iron, 8 IN
283
LFT
80.00
$22,640.00
22
Water Main, Ductile Iron, 6 IN
15
LFT
140.00
$2,100.00
23
Tapping Valve & Sleeve, 8 IN X 8'IN
1
EA
4,300.00
$4,300-00
24
Gate Valve & Box, 8 IN
I
EA
2,200.00
$2,200.00
25
Fire Hydrant Assembly
1
EA
6,700.00
$6,700.00
26
Water Main Tap
1
EA
7,320.00
$7,320,00
27
28
Compacted Aggregate, No. 53
HMA Patching, FuH Depth, Type B
65
102
TON
TON
68.00
130.00
$4,420.00
$13,260.00
29
HMA Intermediate, Type B
218
TON
99.00
$21,582.00
BID/PROPOSAL
CITY OF SOUTH BEND
Project Name: St. Joseph Street Improvements
Project Number 118-008
For Bids Due: August 28, 2018
Contractor Name: Walsh Kelly, Inc.
1865
30
HMA Surface, Type B
130
TON
130.00
$16,900.00
31
HMA for Wedging, Intermediate Type B
42
TON
119.00
$4,998,00
32
HMA Patching, Type B, Undistributed
80
TON
93.00
$7,440.00
33
Curb and Gutter, Concrete
790
LIFT
30.00
$23,700.00
34
Standard Curb, Concrete
90
LIFT
72.00
$6,480,00
35
Sidewalk, Concrete, 4 IN
515
SYS
30.00
$15,450.00
36
Curb Ramp, Concrete
60
SYS
92.00
$5,520.00
37
38
PCCP for Approach, Reinforced, 6 IN
Light Standard, Type A
62
8
SYS
EA
68.00
6,580.00
$4,216.00
$52,640.00
39
Light Pole Foundation
6
EA
900,00
$5,400.00
40
41
No., 4 Wire
Conduit, PVC, Schedule 80, 2 IN
1000
902
LIFT
LIFT
7.80
6.00
$7,800.00
$5,412.00
42
Conduit, PVC, Schedule 80, 3 IN
18
LIFT
9,00
$162.00
43
Lighting Handhole
1
EACH
11,200.00
$1,200.00
44
Tesco Cabinet w/ Single Service,
Foundation, Etc,
1
EA
7,240.00
$7,240.00
45
Misc. Electrical
1
LS
11,420.00
$1,420.00
46
47
Sawcut for Roadway Loop and Sealer
Roadway Loop Cable
114
675
LIFT
LIFT
9.00
0,60
$1,026.00
$405.00
48
Signal Handhole, Type 1
1
EA
1,100,00
$1,100,00
49
No., 16 Wire
115
LIFT
3.00
$345.00
50
Conduit, HDPE, 2 IN
158
LIFT
14.00
$2,212.00
51
Loop Detector Housing
2
EA
610,00
$1,220.00
52
Traffic Signal Head Improvement
1
LS
3,870.00
$3,870.00
53
54
7C Wire
Thermoplastic Stop Line, White, 24 IN
439
45
LFT
LFT
4.00
0.10
$1,756.00
$4.50
56
Thermoplastic Crosswalk, Solid, White, 12
IN
135
LIFT
0.10
$13.50
56
Thermoplastic Line, Solid, White, 4 IN
150
LIFT
0.10
$15.00
57
58
Thermoplastic Line, Solid, Yellow, 4 IN
Thermoplastic Line, Broken, Yellow, 4 IN
837
120
LIFT
LIFT
0.10
0.10
$83.70
$12.010
59
Pavement Message Marking, Thermoplastic,
Lane Arrow
4
EA
0.10
$0.40
: 0 * 0 1 0 1
L" I WAS] 2;i91111;1;JR9I.1
Project Name: St. Joseph Street Improvements
Project Number 118-008
For Bids Due: August 28, 2018
Contractor Name: Walsh Kelly, Inc.
60
Sheet Sign W/Legend, Reflective, 0.10 IN
8
SIFT
45.00
$360.00
61
Sign Post, Square Type 2, Un,reinforced
Anchor Base
18
LIFT
22.00
$396.00
62
63
Overstory Tree, 2 IN Caliper
Sodding, Nursery and Topsoil
19
560
EA
SYS
465.00
111.00
$8,835.00
$6,160.00
64
Hydro -mulch Seeding, Mix
366
SYS
1100
$4,758,00
6,5
Shredded Hardwood Mulch, 3 IN
2
CYS
60.00
$120.00
66
Tree Watering System
19
EA
30,.00
$570.00
67
Utility Relocation
1
T ALLOW
$5,000.00
$5,000.00
BASE BID TOTAL,: $423,000-00
Bidder (Firm): Walsh & Kelly Inc.
Address: 24358 SIR 23
City/State/Zip: South Bend, IN 46614 Telephone Number: (574)-288-4811
By
(Signature)
John M. P6sker, VP of As, Operations
(Printed Name of Person Signing)
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 Indiana }
) SS:
St. Joseph COUNTY )
The undersigned Contractor, being duly sworn upon his/her/its oath, affirms under the penalties of perjury
that:
1. 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:
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.
Version 7/20/2018 Contractor's laid for Public Works - 4
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 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.
G. 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 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 MBE/WBE Utilization Board shall prohibit that person or entity from
being awarded a City contract for a period of one (1) year fi•om 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
Version 7/20/2018 Contractor's Bid for Public Works - 5
may result in forfeiture of contractual payments.
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 28th day of August , 20 18
®S, %N �tl �d
ze ° �✓
��� covyUR�IF °
BIVD l AM-� ,4�"
d��#1444
Subscribed and sworn to before me this 28th
My Commission Expires
615122
County of Residence
of Contractor/Bidder or Its Agent
Dustin Hilarv. VP of South Bend Area
Printed Name and Title
day of August , 2018
Notary a lic Alish rueger
St. Joseph
ALISHA KRUEGER
?hPH... �a�•., Notary P,0111, State of Miana
D;
�'SEAL;"�
St. j,,FphCounty
Tres
a *'•. ' *'
Ex
My COmrt5i5S'Ign P
June Oa, 2022
Version 712012M Contractor's Bid for Public Works - 6
C., 1-1 LJ � C-3 Surety 0 + 909,903.3485
202B Halls Mill Road, PO Box 1650 F + 908.903.3656
Whitehouse Station, M 08889.1650
Federal Insurance Company
AU Document A31OTM - 2010 Bid Bond
Any singular reference to Contractor, Surety, Owner or other party shall be considered plural where applicable.
CONTRACTOR
(Name Legal status and address):
Walsh & Kelly, Inc.
24358 State Road 23
South Bend, IN 46614
OWNER
(Name, legal status and address).
City of South Bend, Indiana
227 W. Jefferson Blvd.
South Bend, IN 46601
BOND AMOUNT
SURETY
(Name, legal status and principal placeof business):
Federal Insurance Company
202B Halls Mill Rd., PO Box t650
Whitehouse Station, nT 088894650
In an amount not less than five percent (5%) of the base bid plus any alternates.
PROJECT
(Name, location or address, andprojectnumber, if any)
St. Joseph Streetscape Improvements
Project No. 118-008
The Contractor and Surety are bound to the Owner in the amount set forth above, for the payment of which the
Contractor and Surety bind themselves, their heirs, executors, administrators, successors and assigns, jointly and
severally, as provided herein. The conditions of this Bond are such that if the Owner accepts the bid of the Contractor
within the time specified in the bid documents, or within such time period as may be agreed to by the Owner and
Contractor, and the Contractor either (1) enters into a contract with the Owner in accordance with the terms of such
bid, and gives such bond or bonds as may be specified in the bidding or Contract Documents, with a surety admitted
in the jurisdiction of the Project and otherwise acceptable to the Owner, for the faithful performance of such Contract
and for the prompt payment of labor and material furnished in the prosecution thereof, or (2) pays to the Owner the
difference, not to exceed the amount of this Bond, between the amount specified in said bid and such larger amount
for which the Owner 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, The Surety hereby waives any notice of
an agreement between the Owner and Contractor to extend the time in which the Owner may accept the bid. Waiver
of notice by the Surety shall not apply to any extension exceeding sixty (60) days in the aggregate beyond the time for
acceptance of bids specified in the bid documents, and the Owner and Contractor shall obtain the Surety's consent for
an extension beyond sixty (60) days,
If this Bond is issued in connection with a subcontractor's bid to a Contractor, the term Contractor in this Bond shall
be deemed to be Subcontractor and the term Owner shall be deemed to be Contractor.
Printed in cooperation with the American Institute of Architects (AIA) by Chubb. The language in this document conforms to the language used in
ALA DocumentAUO ""» 2010.
Form 15-02-0575-FM (Rev, 3/17)
When this Bond has been furnished to comply with a statutory or other legal requirement in the location of the Project,
any provision in this Bond conflicting with said statutory or legal requirement shall be deemed deleted here
from and provisions conforming to such statutory or other legal requirement shall be deemed incorporated herein.
When so furnished, the intent is that this Bond shall be construed as a statutory bond and not as a common law
bond.
Signed and sealed this 28th
(Witness) Al sha Seger
(witness) Lisa M. Becker
day of August, 2018.
Walsh & K ly, c.
By: / l�
(Pr' �caI) Dustin I Hilary
°.°e•°ye°°
VP of South Bend Area .
o p C R A 7,r
(Title)
g
w
ti
f714111100���
Federal Insurance Company
(Attorney -in -Fact) Terry R. Hurst
Printed in cooperation with the American Institute of Architects (ALA) by Chubb. The language in this document conforms to the language used in
AM Document,A310 "1-2010.
Form 15-02.0575•FE0 (Rev.3117)
CHUBS,
Power of Attorney
Federal Insurance Company I Vigilant Insurance Company I Pacific Indemnity Company
Know All by These Presents, That FEDERAL. INSURANCE COMPANY, an Indiana corporation, VIGILANT INSURANCE COMPANY, a New York corporation, and PACIFIC
INDEMNITY COMPANY, a Wisconsin corporation, do each hereby constitute and appoint Tia A. Boice, Terry R. Hurst, Brian T. Morton, David M. Oliger,
Robert M. Rutigliano, Christina Marie 5chmitter, Tina N, senefeld and Eric M. Wahistrom of Indianapolis, Indiana -------------------------------`------
each as their true and lawful Attorney-in-Facl to execute under such designation in their names and to affix their corporate seals to and deliver for and on their behalfas surety
thereon or otherwise, bonds and undertakings and other writings obligatory In the nature thereof (other than bail bonds) given or executed In the course of business, and any
Insu utnems amendingor altering the same, and eansents to the modification or alteration of any instrument referred to in said bonds or obligations,
in Witness Whereof, said FEDERAL INSURANCE COMPANY, VIGILANT INSURANCE COMPANY, and PACIFIC INDEMNITY COMPANY have each Cxl GitEed at][f attested these
presents and affixed their corporate seals on this i9'"dayofJanuary,2017. / Nit
Dawn M. Chloros, Assistant Secretary — Catherine A. D-6T eVice President
STATE OF NEW JERSEY
County of Hurtrerdon
On this 19't' day of January, 2017 before me, a Notary Public of New]ersey, personally came Dawn M. Chiaros, tome known to be Assistant Secretary of FEDR.RAL INSURANCE
COMPANY, VIGILANT INSURANCE, COMPANY, and PACIFIC INDEMNITY COMPANY, the companies which executed the foregoing Power of Attorney. and the said Dawn M.
Chloros, being by me duly sworn, did depose and say that she is Assistant Secretary of FEDERAL INSURANCE COMPANY, VIGILANT INSURANCE COMPANY, and PACIFIC
INDEMNITY COMPANY and knows the corporate seals thereof. that the seals affixed to the foregoing Power of Attorney are such corporate seals and were thereto affixed by
authority ofsaid Companies; and that she signed said Power of Attorney as Assistant Secretary of said Companies by like authority; and that she is acquainted with Catherine A.
Donahue, and knows him to he Vice President of said Companies; and that the signature of Catherine A. Donahue, subscribed to said Power of Attorney Is in the genuine
handwriting ofCatherin and was tbereLosubsLribed by authority Gfsaid Compatiles and In deporient's presence.
Notarial Seal �`� E' KATHERINE J. ADELAAR
N�TARy NOTARY PUBLIC OF NEW JERSEY
No. 2318886 Votary Public
��••i--lBtlsG Commission EXpfreg Jul
CERTINN18P
Resolutions adopted by ry Dit$ctOrs OFFEDERAL INSURANCE COMPANY, VIGILANIT INSURANCE COMPANY, and PACIFIC INDE:VINITY (X)MPANY on August 30, 2016:
-RESOLVED, that the fo€lomngauthorlratlom relate to the execudon, forand on behalf of theoompany, orbonda undertakings, recognizanm contracts and other wrluen commitments of the Company
entered Intoln the ordinary course aFbusiness teach a "Written Commitment"):
(1) Each of the Chairman, the President and the Vice Presidents of the Company is hereby authorized to execute any Written Commitment for and on bthalfofthe Company. under the
seal of the Company or otherwise.
(a) Each duly appointed auorneyImract of the Company Is hereby authorized to execute any wrinen Commitment for and on behalf of the Cnmpany, under the seal of the Company or
otherwl$e to the extent that such action f$ authorized by the grant of powers provided for In such Persons written appointment m such attorney--ln-fact.
(3) Each of the Chairman, the President and the Vice Presidents of the Company is hereby authorized, for and on behalfofthe company. toaptwlminwriting any person the attorney -
In -fact of the Company with full power and authority to execute, rot and on behalf of the Company, under the seat of the Company or otherwlse, such Written Commitments orthe
Company as may be specifted In such written appointment, which specdllratioa may be by general type or class of Written Commitments or by spertflcahlon of case or more Particular
written Commitments.
(4) Each of the Chairman. the President and the Vice Pmsldents of the Company Is hereby authorized, for and onbehalfofthe company, todelegate Inwriting toany other ofilmofdhe
Company the authority to execute, for and on behalf of the Company, under the Company's seal or otherwise, such Written Commltments of the Company as arc spedfled In such
wtinendeleptim,which specification may he by general typeor elm of Written Commitments or byspedfignlonofoneormoreparticulnrWrittenOommltmencs.
(5) The signature of any officer or other person executing any Written 0ammipuent or alpointment Or delegation pursuant to this Resolution. and the seal of the Company, maybe affixed by
facalm#le on such Written Commitment or written appointment or delegation.
Ft1RTHER RESOLVED, that the Foregoing Resolution $halt not be deemed to be an exclusive statement of the powers and authority ofofllom. employees and other persons to act for and on behalf of
the Company, and such Resolution shall not limit or otherwise alrect the exercise of any such pow" or authority otherwise validly $ranted or vested,"
1, Dawn M, Chloros, Assistant Secretary of FEDERAL INSURANCE COMPANY, VIGILANT INSURANCE COMPANY, and PACIFIC INDEMNITY COMPANY (tile'Oompanies") do hereby
certify that
(1) theforego€ngResolutIonsadoptedbytheBoardofDlrectorsoftheCompaniesaretrue,correctandinfullforceande{t-ect,
(1l) the Companies are duly licensed and authorized to transact surety business in all So of the United States of America and the District of Columbia and are
authorized by the US. Treasury Department; further, Federal and Vlgllant are licensed in the U.S. Virgin islands, and Federal is licensed in Guam, Puerto Rico,
and each of the Provinces of Canada except Prince Edward Island; and
(111) the foregoing Power of Attomey Is true, correct and In full force and effect.
Given under my hand and seals ofsaid Companies at Whitehouse Station, N. this 2$th day of August, 2018.
Dawn M. Chtoros, Assistant Secretary
1� TItEEVEt,'TYOtf WISIiTp ND'r1ErY ttS OC A C1..AIM, YEAIFYTItE AlriYtBN'1'[{7TY OFT1Ii5 6ONOORAtyf1RY IISOF ANY OTlit?R MA'1TER. Pl.t?ASC CbP'rRGT US A'r:
Tete honeEgt7E)`�p3-3493 Fax ('Jp8}gp3.3GSfi ema€1: surer @+chubb.mm
Form 15h0- n225n• U GEN CONSENT (rev. 12-16)
1316 Covm'Y-0,r), BUILDING
227 W. JEFFERSON BOULEVARD
Sour" BERD, INDIANA, 46601-1830
1110M. 574/235-9251
FA X 574/ 235-9171
TDD 574/235-5567
C1'I'YOrSOUTi-j BEND PET E BUTTICIEG, MAYOR
BOARD OF PUBLIC WORKS
Date: August 10, 2018
To: All Planholders
From Linda M. Martin, Clerk, Board of Public Works
Subject Addendum Number: I
Project Name: St. Joseph Streetscape Improvements
Project Number: 118-008
Date Received: August 10, 2018
This addendum is being forwarded to you for the above referenced project.
Please sign below and acknowledge receipt of this Addendum
by faxing this sheet to the Board of Public Works at (574) 235-9171
within 48 hours of receipt. A copy MUST also be included with your
bid package upon submittal.
THIS ADDENDUM MAY AFFECT YOUR BID.
Notes:
�
'The attached documents are hereby added to the Specifications and Contrd&V,,E1-tp,�Mlljgjf f
Documents and become a part of herein, .........
RAT
Company- Walsh & A
Kejly Inc.
Authorized Signature:
INm
Joh pe, Pp�sker, VP of Asphalt Operations
Date: 8/10/18
/'0
1316 0')LJN,ry-Cn,y BUMI)ING IA, PHONF 574/235-9251
7—
227 W. h1B lERSON otjj,[,VARD FAX 574/ 235-9171
SOUTH BEND, INMANA 466(11-1830 IFDD 574/ 235-5507
1865
Crry OF Sou'rii BEND PET E BUTTIGIEG, MAYOR
BOARD OF PUBLIC WORKS
Date:
To:
From
Subject
August 15, 2018
All Bidders
Linda M. Martin, Clerk, Board of Public Works
Addendum Number: 2
Project Name: St. Joseph Streetscape Improvements
Project
Number: 118-008
Date Received: Auaust 15. 2018
This addendum is being forwarded to you for the above referenced project.
Please sign below and acknowledge receipt of this Addendum
by faxing this sheet to the Board of Public Works at (574) 235-9171.
A copy MUST also be included with your bid package upon
submittal.
Note:
The attached documents are hereby added to the Specifications and Contract
Documents and become a part of herein.
Company:
Authorized Signature:
M. Peisker, VP of Asphalt Operations
Date:
1316 COUNTY -(Try BUIUMNG
227 W.JEFITRSON Boul.FVARD
Souris Bl,,ND, I N01 ANA 46601-1830
Cj,i,Yof, Sou,riiBE'1ND
BOARI) OFTUBLIC WORKS
Date: August 24, 2018
To: All Bidders
From Linda M. Martin, Clerk, Board of Public Works
Subject Addendum Number: 3
PI 10NE 574/235-9251
FAX 574/ 235-9171
TDD 574/ 235-5567
Project Name: St. Joseph Streetscape Improvements
Project
Number: 118-008
ACKNOWLEDGEMENT OF RECEIPT OF ADDENDUM
Date Received: August 24, 2018
This addendum is being forwarded to you for the above referenced project.
Please sign below and acknowledge receipt of this Addendum
by faxing this sheet to the Board of Public Works at (574) 235-9171.
A copy MUST also be included with your bid package upon
submittal.
Note:
The attached documents are hereby added to the Specifications and Contract
Documents and become a part of herein.
L �
Company: Walsh & Keliv—Mc. L ....Y0. . IA�,'''.
Authorized Signature:
/�usffi Hilar,,VP of South Bend Area
Date: 8/24/18
Prepared by: Jones Petrie Rahnski
ADDENDUM NO.3
To the Contract Document and Project Specifications for the
St. Joseph Streetscape Improvements
11( 8-0081
CITY OF SOUTH BEND, INDIANA
Date: August 24, 2018
To: All holders of the contract document for the above project.
The items in this addendum are to become a part of the original documents as if included therein. Only
the noted items are affected, and the remainder of the original contract document is to remain in its
entirety.
This Addendum modifies the Contract Documents as follows:
PART I — CLARIFICATIONS
PART 2 — SPECIAL PROVISIONS
PART 3 — CONSTRUCTION DOCUMENTS
PART I - CLARIFICATIONS
1.01 Attached are the meeting minutes from the Pre -bid meeting held on August 21, 2018.
PART 2 — SPECIAL PROVISIONS
2.01 SPECIAL PROVISIONS, Page 13, Section XX1I, Pre -Construction Video of Site Conditions:
1. REVISE Item B, No. 1 to read "The Contractor shall be required to submit a professionally
completed DVD recording of the project area to clearly show driveways, street pavements,
signs, traffic signals, etc. prior to the start of construction to verify before and after
conditions. The DVD shall indicate the date of the recording and also include a method to
identify the street or area being videotaped such as stationing or some other unique
identifier."
2.02 SPECIAL PROVISIONS, Page 19, Section XXXV, Permits:
1. DELETE Item B, No. 1 note.
2.03 SPECIAL PROVISIONS, Page 19, Section XXXV, Permits:
1. DELETE "Part B" callout from Item B, No. 6, a.
2.04 SPECIAL PROVISIONS, Page 21, Section XXXIX, Pavement, Remove:
1. DELETE "Part B" callout from Item B, No. 4, a.
2.05 SPECIAL PROVISIONS, Page 22, Section XL, Structure, Remove:
1. DELETE "Part B and C" callout from Item B, No. 4, a.
2.06 SPECIAL PROVISIONS, Page 24, Section XLIII, Common Excavation:
1. REVISE Item B, No. 12, a, to read "Payment for all costs of "Common Excavation," shall
be only for specific neat line volumes as approved by the Engineer for any common
excavation required during the work which is not included in any established pay item
including the cost of all materials, equipment, tools, labor, transportation, operations, and all
other incidentals, shall be paid for on a cubic yard basis for all parts under the pay item"
2.07 SPECIAL PROVISIONS, Page 28, Section L, Hot Mix Asphalt Pavement:
1. DELETE "Part B and C" callout from Item B, No. 8, a.
St. Joseph Streetscape Improvements Addendum #3
August 24, 2018 Page I
2. REVISE Item B, No. 8 Measure and Payment FROM HMA BASE, TYPE B ..... TON to
read as "HMA Patching, Full Depth, TYPE B ..... TON."
2.08 SPECIAL PROVISIONS, Page 28, Section LV, HMA Patching, Type B, Undistributed:
1. REVISE Item B, No. 2, a. to read "HMA Patching, Type B"
2.09 SPECIAL PROVISIONS, Page 30, Section Llll, PCCP for Approaches:
1. DELETE "Part A" callout from Item B, No. 8, a.
2.10 SPECIAL PROVISIONS, Page 33, Section LIX, Standard Inlets, Manholes, and Catch Basins:
1. REVISE Item B, No. 14, to read "The specified casting assembly shall be R-3010, by
Neenah Foundary, or alternate approved by the Engineer prior to the work, per the City of
South Bend Typical Structure Castings and Adjusting Rings detail."
2.11 SPECIAL PROVISIONS, Page 41, Section LXV, Pavement Traffic Markings:
1. DELETE "Part B and C" callout from Item B, No. 7, a.
2.12 SPECIAL PROVISIONS, Page 45, Section LXII, Traffic Signal Head Improvements:
1. REVISE Item B, No. 11, a. intersection identification note to read "St. Joseph Street/Ireland
Road".
2.13 SPECIAL PROVISIONS, Page 46, Section LXXIV, Sheet Sign w/ Legend, Reflective, 0.10 IN:
1. DELETE Section in its entirety.
2.14 SPECIAL PROVISION, BID/PROPOSAL
1. REPLACE previous Bid/Proposal with the attached Bid/Proposal. Revisions include HMA
pavement and excavation quantities adjustments, and deleting "Pavement Restoration Over Full
Depth" pay item.
PART 3 — CONSTRUCTION DOCUMENTS
3.01 SHEET 3, DEMOLITION PLAN:
I. REPLACE sheet with attached plan sheet. Revisions to plans include revised surface
milling limits and asphalt pavement removal limits.
3.02 SHEET 4, DIMENSIONAL PLAN:
1. REPLACE sheet with attached plan sheet. Revisions to plans include revised HMA
resurfacing limits and HMA patching limits, street light location by station and offset.
3.03 SHEET 9, LANDSCAPE PLAN AND DETAILS:
1. REPLACE sheet with attached plan sheet. Revisions to plans include revised caliper size
of proposed trees.
3.04 SHEET 10, LIGHTING PLAN:
I. REPLACE sheet with attached plan sheet. Revisions to plans include removal of extra
light in Light Pole Foundations Table and switched the mounting heights of the fixtures.
3.05 SHEET 11, LIGHTING DETAILS
I. REPLACE sheet with attached plan sheet. Revisions to plans include removing banner
arm callouts from the light pole and fixture detail.
3.06 SHEET 13, MISC. CONSTRUCTION DETAILS 11
1. REPLACE sheet with attached plan sheet. Revisions to plans include the addition of the
pavement patching and utility cuts detail.
END OF ADDENDUM
St. Joseph Streetscape Improvements Addendum ##3
August 24, 2018 Page 2
JONES PETRIE RAFINSKI
Chris Chockley, , AICP
Landscape Architect
Certified Planner
A sinned coDv of this
Acknowledged by:
figp%' C�H�0C�'/�''
NO.
* = 20500170 T
STATE OF
4�riiO�CRIpE„A�;� ```\`�
bmitted with the
of Bidder Dustin Hilary, VP of So
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8/24118
Date
St. Joseph Streetscape Improvements Addendum #3
August 24, 2018 Page 3
is Wk..
i:
Project Name St. Joseph Street Improvements
Project No. 118-008
Four Bids Due August 28, 20�18
From time to time the South Bend Board of Public WU orks finds Iit 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
X 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 MBENVBE Contacted
X Form [MWBE-2.1].
Acknowledge Receipt of 1, 2, 3Addenidum(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.
X 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.
By Authorized Representative:,
Signature:
Print Name & Title: D
Date:
Hilarv. VP of South Bend Area
Version 7/20/2018 Contractor's Bid for Public Works - 1
PART II
(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/her/its 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 7/20/2018 Contractor's Bid for Public Works - 3
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CITY OF SOUTH BEND
MINORITY AND WOMEN BUSINESS ENTERPRISE DIVERSITY
V!2,
DEVELOPMENT PROGRAM
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 Bond Public
Works Projects requiring Good Faith Efforts to obtain MBENVBE participation. It is the bidder's sole
responsibility to verify whether any listed minority or woman business meats the qualifications of a Minority
or Women's owned business as defined by the Indiana Department of Administration ("IDOA").
Project Number: 118-008
Project Name: - St. Joseph Street Improvements
Bidder: Walsh & Kelly, Inc.
Contact Person: -Ed Pilipow Telephone: 574-288-4811
Address: 24358 SIR 23
City: South Bend state: Indiana zip; 416614
Email: - epilipow_walshkelly.com
To determine whether a bidder has demonstrated good faith efforts to reach the MBENVBE utillization 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
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
Be quires that all perspective bidders complete, no less than 2 of the following:
1. Attend all pre -bid meetings scheduled by the City to inform MBENVBEs of contracting and
subcontracting opportunities.
2. Advertise in general circulation and/or trade association publications concerning subcontracting
opportunities, and allow IMBEIWBEs reasonable time to respond.
t 0.1 Perform any and all necessary steps to provide written notice in a manner reasonably calculated
to inform MBENVBEs of subcontracting opportunities and allowed sufficient time for them to
participate effectively.
4. Utilize pre-existing services of available community organizations, small and/or disadvantaged
business assistance offices and other organizations that provided assistance in the recruitment
and placement of M,BEANBE 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 MBEANBES,
including providing such MBE/WBE's with adequate information about the plans, specifications and other
requirements of the subcontract and did not reject MBEtWBEs 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 MBEANBE goals (including breaking down
contracts into smaller units to facilitate IMBEANBE participation)
CONTRACT' RECORDS: The bidder has maintained the following records for each MBE/WBE that has
bid on the subcontracting opportunity:
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 MBEIWBE was unqualified to perform the job.
*Proper demonstration of Good Faith Effort requires your initials next to all of the above boxes. Any
omissions shall be considered grounds for rejection of the bid by the Board of Public Works.The City of
South Bond reserves the right to request additional information.
Version 7/20/2018 Contractor's Bid for Public Works - 11
CITY OF SOUTH BEND
MINORITY AND WOMEN BUSINESS ENTERPRISE DIVERSITY
DEVELOPMENT PROGRAM
FORM MWBE-2.1
MBENVBE CONTACTED 1865�
This completed forrn should be supplied with Bids that pertain to City of South Bend Public Works Projects
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 I OF 1
Project Number: 11118-008 MBE/VVBE Participation Goal
Project Name: St. Joseph Street Improvements
Ish &,Xplly, Inc.
By: VP of Asphalt Operations
(Sig tore) John M. Peisker (Title) J"
MBENVBE Firm State Barricading,Inc. OR/01:
Owner or Contact at MBIEA/VBE Firm MaMichalski
Telephone: 574-287-2078 Fax: Email: statebarricadel 574-287-1744 p 0 rcgm
TYPE OF WORK SOLICITED FOR THIS PROJECT:
Maintaining of traffic devices
RESULTS OF CONTACT WITH THE MBEMBIE FIRM:
Subcontractor will perform work.
MBEANBE Firm Hawk Enterprises, Inc.
Owner or Contact at MBEANBE Firm JoAnn Plank
Telephone: 219-662-8090 Fax: 219-662-8093 Email: joann@hawk-inccom
TYPE OF WORK SOLICITED FOR THIS PROJECT:
Street lighting and signal work
RESULTS OF CONTACT WITH THE MBEANBE FIRM:
Subcontractor will perform work.
Version 7/20/2018 Contractor's Bid for Public Works - 12
CITY OF SOUTH BEND, INDIANA
CONTRACTOR'S BID FOR PUBLIC WORK
RESPONSIBLE BIDDER CHECKLIST
Project Name St. Joseph Street Improvements
Project No. 118-008
For Bids Due August 28, 2018
Contractor Name: Walsh & Kelly. Inc.
The City seeks to enhance its ability to identify responsive and responsible bidders on all City public works
projects by institution of comprehensive submission requirements in compliance with State law. Quality
workmanship, efficient operation, safety, and timely completion of projects requires that all bidders meet
certain minimum requirements to be responsive and responsible bidders.
THIS FORM MUST BE SUBMITTED WITH YOUR BID.
INSTRUCTIONS:
If you are a pre -qualified bidder, complete Section I only.
If you are not a pre -qualified bidder, complete Section 11 only.
Section II acts as an application for pre -qualification. Submission of Section 11 will allow the bidder to be
considered for pre -qualification for bids with the City of South Bend Department of Public Works. Pre -
qualified bidders will then be exempt from a portion of the submission requirements outlined in Section 6-
63 of The Responsible Bidding Ordinance No. 10594-18 (hereinafter, "Responsible Bidding Ordinance")
for a period of twelve (12) months.
Thereafter, contractors who are pre -qualified must submit a complete application for continuation of "pre -
qualified" standing, on a form provided by the City ("Responsible Bidder Checklist (1) Pre -Qualified
Bidders") by December 3181 for the upcoming calendar year, or within twelve (12) months of obtaining pre -
qualified standing. If the status of any item changes within the twelve (12) months, it is the responsibility of
the contractor to notify the City. Failure by any pre -qualified contractor to submit its complete application
for continuation of "pre -qualified" standing within the time prescribed above shall result in automatic removal
of the designation, effective January 1 of the following year, or immediately following the twelve (12) months
of pre -qualified standing.
However, the "removed" contractor or subcontractor shall still be permitted to bid on City public works
projects, though the contractor must submit all required documents under 6-63 until "pre -qualified" status
is re-established.
Please Note: The City reserves the right to request supplemental information from the Kidder,
additional verification of any information provided by the bidder, and may also conduct random
inquiries of the bidder's current and previous customers regardless of pre -qualified standing.
It is the sole responsibility of the potential bidder to comply with all submission requirements applicable to
the bidder in Section 6-63 of the Responsible Bidding Ordinance no later than the date of the public bid
opening.
Version 7/20/2018 General Conditions - 7
POST BID SUBMISSIONS:
Post -bid submissions must be submitted in accordance with Section 6-64 of the Responsible Bidding
Ordinance. The post -bid submission requirements are as follows:
1. All bidders shall collect, maintain, and provide upon request, a current written list that discloses the
name, address, licensing status, and type of work for any subcontractor from whom the bidder has
accepted a bid and/or intends to hire on any part of the public work project, including individuals
performing work as independent contractors.
2. Each subcontractor, whose portion of the project is estimated to be at least one -hundred fifty
thousand dollars ($150,000.00), shall be required to adhere to the requirements of Section I of the
Responsible Bidder Ordinance as though it were bidding directly to the City, except that the
subcontractor shall submit the required information (including the name, address, and type of work)
to the successful bidder prior to the commencement of work.
3. Failure of a subcontractor to submit the required information shall not disqualify the successful
bidder from performing work on the project and shall not constitute a contractual default and/or
breach by the successful bidder. However, the City may withhold all payment otherwise due for
work performed by a subcontractor, until the subcontractor submits the required information and
the City approves such information.
4. The disclosure of a subcontractor list ("Disclosed Subcontractor(s)") to the City by a bidder shall
not create any rights in the Disclosed Subcontractor(s). Thus, a bidder may substitute another
subcontractor for a Disclosed Subcontractor by giving the City, upon request, written notice of the
name, address, licensing status, and type of work of the substitute subcontractor.
5. The successful bidder and all subcontractors on a public works project are required to submit
certified payroll utilizing the federal form known as WH-347 or a similar form on a bi-weekly basis,
submitted within 10 days after the end of each bi-weekly payroll period, Certified payrolls shall
identify the job title and craft for each employee. Certified payrolls shall be submitted
electronically.
Please Note: Submissions deemed inadequate, incomplete, or untimely by the City may result in
the automatic disqualification of the bid.
The City, after review of complete and timely submissions, shall, in its sole discretion, after taking into
account all information in the submission requirements, determine whether a bidder is responsive and
responsible, and provide a Pre -Qualification Verification Letter. The City specifically reserves the right to
utilize all information provided in the contractor's submission and any information obtained by the City
through its own independent verification of the information provided by the contractor.
Version 7/20/2018 General Conditions - 8
PRE -QUALIFIED BIDDER CHECKLIST
(a) Acknowledgements:
0) X By checking this box, I hereby acknowledge that I am a pre -qualified bidder with
the City of South Bend and that I have met the pre -qualification requirements within
the last twelve (12) months. A copy of my Pre -Qualification verification letter
is attached.
X By checking this box, I hereby acknowledge that the City reserves the right to
request supplemental information, additional verification of any information
provided by me, and may also conduct random inquiries of my current and prior
customers.
(b) Attachments:
W X Indiana Secretary of State's on-line records (ie. Business verification) dated within
sixty (60) days of the submission of said document showing that business is in
existence, current with the Indiana Secretary of State's Business Entity Report,
and eligible for a certificate of good standing. (Not applicable to individuals, sole
proprietors or partnerships).
(ii) X Statement on staffing capabilities, including labor sources. This statement
indicates and ensures I have sufficient employees on staff to complete the work, It
outlines how I intend to meet the staffing needs of the work.
(iii) X Evidence that I am utilizing a surety company which is on the United States
Department of Treasury's Listing of Approved Sureties as required in the bid
specifications or contract.
(iv) X List of projects of similar size and scope of work performed in all areas, including
the State of Indiana, within the last three (3) years.
Version 7/20/2018 General Conditions - 9
PRE -QUALIFICATION CHECKLIST (FOR BIDDERS THAT ARE NOT PRE -QUALIFIED)
(a) Acknowledgements:
(i) _ By checking this box, I hereby acknowledge that I am not a pre -qualified bidder
with the City of South Bend.
(ii) _ By checking this box, I hereby acknowledge that the City reserves the right to
request supplemental information, additional verification of any information
provided, and may also conduct random inquiries of my current and prior
customers. The City reserved the right to utilize all information provided in this
submission and all information obtained in inquiries or requests to determine if a
bidder is responsive and responsible. Additionally, I acknowledge that all
information provided to the City shall be regarded as public records.
(iii) _ By checking this box, I hereby acknowledge that copies of all Applicable
apprenticeship certificates or standards for training programs applicable to the
work performed on the project may be requested at any time and shall be furnished
upon request.
(iv) _ By checking this box, I hereby acknowledge and ensure that I and all sub-
contractors, from whom I have accepted a bid and/or intend to hire to perform work
on the public work project, are properly licensed. Furthermore, I acknowledge my
understanding that it is my responsibility to ensure that all sub -contractors have
the necessary licenses to undertake the work called for in this bid. If a sub-
contractor loses their license at any point, it is the responsibility of that sub-
contractor to notify the City.
(b) Attachments:
(i) _
Indiana Secretary of State's on-line records (ie. Business verification) dated within
sixty (60) days of the submission of said document showing that business is in
existence, current with the Indiana Secretary of State's Business Entity Report,
and eligible for a certificate of good standing. (Not applicable to individuals, sole
proprietors or partnerships).
(ii) _
List identifying all former business names.
(iii) _
Any determinations by a court or governmental agency any violations of federal
state, or local laws including, but not limited to, violations of contracting or antitrust
laws, tax or licensing laws, environmental laws, Occupational Safety and Health
Act (OSHA), or federal Davis -Bacon and related Acts, within the preceding five (5)
years.
(iv)
Statement about staffing capabilities, including labor sources. This statement
indicates and ensures I have sufficient employees on staff to complete the work I
am bidding on OR outlines how I intend to meet the staffing needs of the work.
(v) _
Statement that individuals who will perform work on the public work project on my
behalf will be properly classified as an employee or as an independent contractor
under all applicable state and federal laws and local ordinances,
(vi) _
Evidence of participation in apprenticeship and training programs, applicable to the
work to be performed on the project, which are approved by and registered with
the United States Department of Labor's Office of Apprenticeship, or its successor
organization.
(vii)
Copy of a written plan for employee drug testing that covers all of my employees
who will perform work on the public work project and meets or exceeds the
requirements set forth in IC 4-13-18-5 or IC 4-13-18-6.
(viii) _
Evidence that I am utilizing a surety company which is on the Bureau of Fiscal
Service "Department of Treasury's Listing of Approved Sureties" as required in the
bid specifications or contract.
Version 7/20/2018 General Conditions - 10
(ix) Written statement of any federal, state or local tax liens or tax delinquencies owed
to any federal, state or local taxing body in the preceding three years.
(i) _ List of projects of similar size and scope of work performed in all areas, including
the State of Indiana, within three (3) years prior to the date on which the bid is due.
(Sin re}
®a��i�V LLYilp�°'�®
tin Hilary, VP of South Bend
Area
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Walsh & Kelly. Inc. ---------
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(Name of Company)
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,
24358 SR 23®®®
•°°IID1�����
(Address of Company)
®'41I M10%,�
South Bend
(City)
IN
(State)
574-288-4811
(Telephone Number)
Version 7/20/2018 General Conditions -11
Responsible Bidder Checklist
Pre -Qualified Bidder Checklist
(b) Attachments
(i) Attached
(ii) Staffing Capabilities: Walsh & Kelly, Inc. is signatory with the following unions
which supply our workforce — Laborers International Union, Teamsters, Operating
Engineers and Cement Masons,
(iii) Attached
(iv) See Forms 96 and 96a
CIS
Dated: Aupaust 28, 2018
State of Indiana
Office of the Secretary of State
CERTIFICATE OF EXISTENCE
To Whom These Presents Come, Greeting:
I, CONNIE LAWSON, Secretary of State of Indiana, do hereby certify that I am, by virtue of the laws of
the State of Indiana, the custodian of the corporate records and the proper official to execute this
certificate.
I further certify that records of this office disclose that
WALSH & KELLY INC
duly filed the requisite documents to commence..business activities under the laws 'of the State of
Indiana on March 29, 1966, and was in existence or authorized to transact business in the State of
Indiana on August 03, 2018.
1 further certifiy this Domestic For -Profit Corporation has filed its most recent report required by
Indiana law with the Secretary of State, or is not yet required to file such report, and that no notice of
withdrawal, dissolution, or expiration has been filed or taken place. All fees, taxes, interest, and
penalties owed to Indiana by the domestic or foreign entity and collected by the Secretary of State
have been paid.
In Witness Whereof, I have caused to be affixed my
signature and the seal of the State of Indiana, at the City
of Indianapolis, August 03, 2018
&M44-�o C%3 ""61%
CONNIE LAWSON
SECRETARY OF STATE
194484-057 / 2018687975
All certificates should be validated here: https://bsd.sos.in.gov/ValidateCertificate
Expires on September 02, 2018.
1316 Coi wry-Crry Bi JILDING
227 W-JEFFURSON Boui,r,.vAizD
SOUTH BEND. INDIANA 46601-1830
CITY OF Sourt-i BEND PETE BUTTIGIEG, MAYOR
BOARD OF PUBLIC WORKS
August 17, 2018
Nfr. Dustin Hilary
Walsh & Kelly, Inc.
24358 SR 12
South Bend, IN 46614
RE: Pre -Qualification Verification — 2018 Street Paving
Dear Mr. Hilary:
PHONT,;" 574/ 235-9251
FAX 5�74/ 235-9171
This letter serves as verification of Pre -Qualification status of your company for bidding with the City of South
Bend. This Pre -Qualification status is effective for twelve (12) months from the date of this letter. Thereafter you
are required to re -submit a complete application for continuation of pre -qualification status prior to December 31
for the upcoming calendar year.
A copy of this Verification Letter must be included with every bid exceeding $150,000 submitted to the City of
South Bend Board of Public Works, along with your Pre -Qualified Bidder Checklist and attachments.
If you have any further questions regarding this matter, please call this office at (574) 235-925 1.
Sincerely,
Linda Nl. Martin, Clerk
GARY A. G11,01, DAVIT) R RELOS �LIZABF'11 I A. MARADIK JANIE's A. MU[,.LLE'R T] I1'-,'RES1,J. DORAU
ki I ) Al M � 4 4 11 th
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Department of the Treasury's Listing of Certified
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Footnotes
• Statesjnsuranco Qepgrtnignts
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Download the complete lisflng of!Qjqrrt�iCied Companies (146 KB)
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Updated July 1. 2018
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ACCREDITED SURETY AND CASUALTY COMPANY, INC. (NAIC #26379)
BUSINESS ADDRESS: PO Box 140855, Orlando, FL 32814. PHONE: (407) 629-2131. UNDERWRITING
LIMITATION b/: $5,446,000. SURETY LICENSES G,f/: AL, AK, AZ, AR, CA, CO, CT, DE, DO, FL, GA, HI, ID, IL,
IN, IA, KS, KY, LA, ME, MD, MA, MI, MN, MS, MO, MT, NE, NV, NH', NJ, NM, NY, NO, ND, OH, OK, OR, PA, RI,
SO, SD, TN, TX, UT, VT, VA, WA, WV, Wl, WY. INCORPORATED IN: Florida.
ACE American Insurance Company (NAIC #22667)
BUSINESS ADDRESS: 436 Walnut Street P.O, Box 1000, Philadelphia, PA 19106, PHONE: (215) 640-1000,
UNDERWRITING LIMITATION b/: $478,637,000, SURETY LICENSES c,f/: AL, AK, AZ, AR, CA, CO, CT, DE,
Background
DO, FL, GA, HI, ID, IL, IN, IA, KS, KY, LA, ME, MID, MA, MI, MIN, MS, MO, MT, NE, NV, NH, NJ, NM, NY, NO,
ND, OH, OK, OR, PA, PR, Rl, SC, SD, TIN, TX, LIT, VT, VA, WA, WV, WI, WY. INCORPORATED IN:
Getting Started
Pennsylvania.
ACE Property and Casualty Insurance Company (NAIC #20699)
Certified Companies
BUSINESS ADDRESS: 436 WALNUT STREET, P.O. Box 1000, Philadelphia, PA 19106. PHONE: (215) 640-
1000. UNDERWRITING LIMITATION b/: $296,248,000,, SURETY LICENSES cj1: AL, AK, AZ, AR, CA, CO, CT,
Admitted Reinsurers
DE, DC, FL, GA, Hl, ID, IL, IN, IA, KS, KY, LA, ME, MD, MA, MI, MN, MS, MO, MT, NE, NV, NH, NJ, NM, NY,
NO, ND, OH, OK, OR, PA, PR, RI, SO, SD, TN, TX, UT, VT, VA, WA, WV, WI, WY. INCORPORATED IN:
Sureties Listing
Pennsylvania,
Forms
ACSTAR INSURANCE COMPANY (NAIC #22950)
BUSINESS ADDRESS: 30 SOUTH ROAD, FARMINGTON, CT 06032, PHONE: (860) 415.84K
UNDERWRITING LIMITATION b/:: $2,360,000. SURETY LICENSES c,M AL, AK, AZ, AR, CA, CO, CT, DE, DO,
Regulations & Guidance
FL, GA, HI, ID, IL, IN, ]A, KS, KY, LA, ME, MID, MA, MI, MN, MS, MO, MT, NE, NV, NH, NJ, NM, INY, NO, ND,
OH, OK, OR, PA, PR, RI, SC, SD, TN, TX, LIT, VT, VA, WA, WV, WI, WY. INCORPORATED IN: 1111inois.
Correspondence
Aegis Security Insurance Company (NAIC #33898)
Contacts
BUSINESS ADDRESS: RO. Box 3153, Harrisburg, PA 17105. PHONE: (717) 657-9671. UNDERWRITING
LIMITATION bl: $6,374,000., SURETY LICENSES c,f/:: AL, AK, AZ, AR, CA, CO, CT, DE, DO, FL, GA, HP, ID, IL,
IN, IA, KS, KY, LA, ME, MD, MA, M[, MN, MS, MO, MT, NE, NV, NH, NJ, NM, NY, NO, ND, OH, OK, OR, PA, Rl:,
SO, SD, TN, TX, LIT, VT, VA, WA, WV, Wl, WY, INCORPORATED IN: Pennsylvania,
ALL AMERICA INSURANCE COMPANY (NAIC #20222)
�hmmhw' WM Pidicy
BUSINESS ADDRESS: RO. BOX 351, VAN WERT, OH 45891 - 0351. PHONE: (419) 238-1010.
UNDERWRITING LIMITATION b/: $15,662,000, SURETY LICENSES cjl: AZ, AR, CA, CO, CT, GA, ID, IL, IN,
A, KY, ME, MD, MA, MI, MN, MS, MT, NV, NH, NJ, NM, NY, NO, CH, OK, OR, PA, SC, TN, TX, UT, VT VA,
WA, WI. INCORPORATED IN: Ohio.
Allegheny Casualty Company (NAIL #13285)
ddl, BUSINESS ADDRESS: One Newark Center, 20th Floor, Newark, NJ 07102. PHONE: (800) 333-4167 x-269,
UNDERWRITING LIMITATION b/: $2,264,000. SURETY LICENSES c,fl: AL, AK, AZ, AR, CA, CO, CT, DE, DC,
FL, GA, HI, ID, IL, IN, IA, KS, KY, LA, ME, MD, MA, MI, MN, MS, MO, MT, NE, NV, NH, NJ, NM, NY, NC, ND,
OH, OK, OR, PA, PR, RI, SO, SD, TN, TX, UT, VT, VA, WA, WV, WI, WY. INCORPORATED IN: New Jersey,
ALLEGHENY SURETY COMPANY (NAIL #34541)
BUSINESS ADDRESS: 4217 Steubenville Pike, Pittsburgh, PA 15205, PHONE: (412) 921-3077,
UNDERWRITING LIMITATION b/: $254,000. SURETY LICENSES cj/: PA. INCORPORATED lN: Pennsylvania
ALLIED Property and Casualty Insurance Company (NAIL #42579)
BUSINESS ADDRESS: ONE WEST NATIONWIDE BLVD., 1-04-701, COLUMBUS, OH 43216 - 2220. PHONE:
(515) 508-4211. UNDERWRITING LIMITATION b/: $6,045,000, SURETY LICENSES c,fl: AL, AZ, AR, CA, CO,
CT, DE, DC, FL, GA, ID, IL, IN, [A, KS, KY, ME, MD, Ml, MN, MS, MO, MT, N!E, NV, NH, NM, NY, ND, CH, PA,
RI, SC, SD, TN, TX, UT, VT, VA, WA, WV, WI, WY, INCORPORATED IN: Iowa.
Allied World Insurance Company (NAIL #22730)
BUSINESS ADDRESS: 199 Water Street, New York, NY 10038, PHONE: (646) 794-0500, UNDERWRITING
LIMITATION b/: $59,242,000. SURETY LICENSES c,fl: AL, AK, AZ, AR, CA, CO, CT, DE, DC, FL, GA, HI, lD,
IL, IN, IA, KS, KY, LA, ME, MD, MA, MI, MINI MS, MO, MT, NE, NV, NH, NJ, NM, NY, NO, ND, CHI OK, OR, PA,
PR, RI, SC, SD, TN, TX, UT, VT, VA, WA, WV, WI,. INCORPORATED IN: New Hampshire.
Allied World Specialty Insurance Company (NAIL #16624)
BUSINESS ADDRESS: 199 WATER STREET, NEW YORK, NY 10038. PHONE: (646) 794-0500,
UNDERWRITING LIMITATION b/: $41,919,000. SURETY LICENSES c,f/: AL, AK, AZ, AR, CA, CO, CT, DE,
DC, FL, GA, HI, ID, IL, IN, IA, KS, KY, LA, ME, MID, MA, MI, MN, MS, MO, MT, NE, NV, NH, NJ, NM, NY, NO,
ND, OH, OK, OR, PA, PR, RI, SC, SO, TN, TX, LIT VT, VA, WA, WV, WI, WY. INCORPORATED IN: Delaware.
AMCO Insurance Company (NAIL #19100)
BUSINESS ADDRESS: ONE WEST NATIONWIDE BLVD., 1-04-701, COLUMBUS, OH 43215 - 2220. PHONE
(515) 508-4211. UNDERWRITING LIMITATION bl: $20,982,000, SURETY LICENSES c,f/: AL, AZ, AR, CA,
CO, CT, DE, DC, FL, GA, ID, IL, IN!, IA, KS, KY, ME, MID, MI, MN, MS, MO, MT, NE, NV, NM, NY, NO, ND, OH,
OR, PA, RI, SC, SD, TN, TX, UT, VT, VA, WA, WV, WI, WY, INCORPORATED IN: Iowa.
AMERICAN ALTERNATIVE INSURANCE CORPORATION (NAIL #19720)
BUSINESS ADDRESS: 555 COLLEGE ROAD EAST - P.O. BOX 5241, PRINCETON, NJ 08543. PHONE:
(609) 243-4200. UNDERWRITING LIMITATION bl: $20,167,000, SURETY LICENSES c,f/: AL, AK, AZ, AR, CA
CO, CT, DE, DC, FL, GA, HI, ID, IL, IN, IA, KS, KY, LA, MD, MA, MI, MN, MS, MO, MT, NE, NV, NH, NJ, NM'
NY, NC, ND, OH, OK, OR, PA, RI, SC, SD, TN, TX, UT, VT, VA, WA, WV, WI, WY. INCORPORATED IN:
Delaware.
American Automobile Insurance Company (NAIL #21849)
BUSINESS ADDRESS: 225 W. WASHINGTON STREET, SUITE 1800, CHICAGO, IL 60606 - 3484. PHONE:
(888) 466-7883. UNDERWRITING LIMITATION b/: $7,803,000. SURETY LICENSES e,f/: AL, AK, AZ, AR, CA,
CO, CT, DE, DO, FL, GA, GU, HI, ID, ll-, IN, IA, KS, KY, LA, ME, MID, MA, MI, MN, MS, MO, MT, NE, NV, NH,
NJ, NM, NY, NC, ND, OH, OK, OR, PA, RI, SC, SD, TN, TX, UT, VT, VA, WA, WV, WI, WY, INCORPORATED
IN: Missouri.
AMERICAN BANKERS INSURANCE COMPANY OF FLORIDA (NAIL #10111)
BUSINESS ADDRESS: 111222 QUAIL ROOST DRIVE, MIAMI, FL 33157 - 6596. PHONE: (305) 253-2244.
UNDERWRITING LIMITATION b/: $56,177,000. SURETY LICENSES c,f/: AL, AK, AZ, AR, CA, CO, CT, DIE,
DC, FL, GA, HI, ID, IL, IN, IA, KS, KY, LA, ME, MD, MA, MI, MN, MS, MO, MT, NE, NV, NH, NJ, NM, NY, NC,
ND, OH, OK, OR, PA, FIR, RI, SC, SD, TN, TX, UT, VT, VIA, VI, WA, WV, WI!, WY. INCORPORATED IN: Florida
American Casualty Company of Reading, Pennsylvania (NAIL 920427)
BUSINESS ADDRESS: 151 N. Franklin St., CHICAGO, IL 60606. PHONE: (312) 822-5000. UNDERWRITING
LIMITATION b/: $14,216,000. SURETY LICENSES c,f/: AL, AK, AZ, AR, CA, CO, CT, DE, DC, FL, GA, HI, ID,
IL, IN, ]A, KS, KY, LA, ME, MD, MA, MI, MIN, MS, MO, MT, NE, NV, NH, NJ, NM, NYI, NC, ND, OH, OK, OR, PA
PR, RI, SC, SD, TN, TX, UT, VT, VA, WA, WV, WI, WY, INCORPORATED IN: Pennsylvania.
AMERICAN CONTRACTORS INDEMNITY COMPANY (NAIL #102161)
BUSINESS ADDRESS: 801 South Figueroa Street, Suite 700, Los Angeles, CA 90017. PHONE: (310) 649-
0990. UNDERWRITING LIMITATION b/: $12,855,000. SURETY LICENSES cj/: AL, AK, AZ, AR, CA, Co. CT,
DE, DO, FL, GA, GU, HI, ID, IL, IN, IA, KS, KY, LA, ME, MD, MI, MN, MS, MO, MT, NE, NV, NJ, NM, NY, NO,
OH, OK, OR, PA, RI, SC, SD, TN, TX, UT, VA, WA, WV, WI, WY INCORPORATED IN: California.
American Fire and Casualty Company (NAIL #24066)
BUSINESS ADDRESS: 175 Berkeley Street, Boston, MA 02116. PHONE: (617) 357-9500. UNDERWRITING
LIMITATION b/: $4,070,000, SURETY LICENSES o,f/: AL, AI{, AZ, AR, CA, CO, CT, DE, DO, FL, GA, ID, ll-, IN
1A, KS, KY, LA, ME, MD, MA, MI, MN, MS, MO, MT, NE, NV, NH, NJ, NM, NY, NC, ND, OH, OK, OR, PA, RI,
SC, SD, TN, TX, UT, VT, VA, WA, WV, WI, WY. INCORPORATED IN: New Hampshire.
American Guarantee and Liability Insurance Company (NAIL #26247)
BUSINESS ADDRESS: 1299 ZURICH WAY, 5TH FLOOR, SCHAUMBURG, IL 60196 - 1056. PHONE: (847)
605-6000. UNDERWRITING LIMITATION b/: $18,460,000, SURETY LICENSES 01: AL, AK, AZ, AR, CA, CO,
CT, DE, DC, FL, GA, HI, ID, IL, IN, IA, KS, KY, LA, ME, MD, MA, MI, MN, MS, MO, MT, NE, NV, NIA, NJ, NM,
NY, NO, ND, OH, OK, OR, PA, RI, SC, SD, TN, TX, UT, VT, VA, WA, WV, WI, WY. INCORPORATED IN: New
York.
American Home Assurance Company (NAIC #19380)
BUSINESS ADDRESS: 175 WATER STREET, 18TH FLOOR, NEW YORK, NY 10038. PHONE: (212) 770-
7000. UNDERWRITING LIMITATION bl: $623,782,000. SURETY LICENSES c,fl: AL, AK, AZ, AR, CA, CO, CT,
DE, DC, FL, GA, HI, ID, IL, IN, IA, KS, KY, LA, ME, MD, MA, MI, MN, MS, MO, MT, NE, NV, NH, NJ, NM, NY,
NO, ND, OH, OK, OR, PA, RI, SO, SD, TN, TX, UT, VT, VA, WA, WV, W, WY. INCORPORATED IN: New York.
American Insurance Company (The) (NAIC #21857)
BUSINESS ADDRESS: 225 W. WASHINGTON STREET, SUITE 1800, CHICAGO, IL 60606 - 3484. PHONE:
(888) 466-7883. UNDERWRITING LIMITATION bl: $6,667,000. SURETY LICENSES c,fl: AL, AK, AZ, AR, CA,
CO, CT, DE, DC, FL, GA, GU, HI, ID, IL, IN, IA, KS, KY, LA, ME, MD, MA, MI, MN, MS, MO, MT, NE, NV, NH,
NJ, NM, NY, NC, ND, OH, OK, OR, PA, PR, RI, SC, SD, TN, TX, UT, VT, VA, WA, WV, WI, WY.
INCORPORATED IN: Ohio.
AMERICAN ROAD INSURANCE COMPANY (THE) (NAIC #19631)
BUSINESS ADDRESS: One American Road, MD 7600, Dearborn, MI 48126 - 2701. PHONE: (313) 337-1102.
UNDERWRITING LIMITATION bl: $27,040,000. SURETY LICENSES c,fl: AL, AK, AZ, AR, CA, CO, DE, DO,
FL, GA, HI, ID, IL, IN, IA, KS, KY, LA, ME, MD, MA, MI, MN, MS, MO, MT, NE, NV, NH, NJ, NM, NY, NO, ND,
OH, OK, OR, PA, RI, SO, SD, TN, TX, UT, VT, VA, WA, WV, WI, WY. INCORPORATED IN: Michigan.
American Southern Insurance Company (NAIC #10235)
BUSINESS ADDRESS: P O Box 723030, Atlanta, GA 31139 - 0030. PHONE: (404) 266-9599.
UNDERWRITING LIMITATION bl: $4,335,000. SURETY LICENSES c,fl: AL, AZ, AR, CO, DE, DO, FL, GA, IL,
IN, KS, KY, MD, MI, MN, MS, MO, NF, NJ, NY, NO, OH, PA, SC, TN, UT, VA, WA, WV, WI, WY.
INCORPORATED IN: Kansas.
American Surety Company (NAIC #31380)
BUSINESS ADDRESS: 250 East 96th Street, Suite 202, Indianapolis, IN 46240. PHONE: (317) 875-8700.
UNDERWRITING LIMITATION bl: $1,045,000. SURETY LICENSES c,fl: AL, AK, AZ, AR, CA, CO, CT, DE, DC,
FL, GA, HI, ID, IL, IN, IA, KS, KY, LA, ME, MD, MA, MI, MN, MS, MO, MT, NE, NV, NH, NJ, NM, NY, NO, ND,
OH, OK, OR, PA, RI, SC, SD, TN, TX, UT, VT, VA, WA, WV, WY. INCORPORATED IN: Indiana.
Amerisure Insurance Company (NAIC #19488)
BUSINESS ADDRESS: P. O. Box 2060, Farmington Hills, MI 48331 - 3586. PHONE: (248) 615-9000.
UNDERWRITING LIMITATION bl: $24,179,000. SURETY LICENSES 01: AL, AK, AZ, AR, CO, DE, DC, FL,
GA, HI, ID, IL, IN, IA, KS, KY, LA, MD, MA, MI, MN, MS, MO, MT, NE, NV, NH, NJ, NM, NY, NO, ND, OH, OK,
OR, PA, PR, RI, SC, SD, TN, TX, UT, VT, VA, WA, WV, WI, WY. INCORPORATED IN: Michigan.
Amerisure Mutual Insurance Company (NAIC #23396)
BUSINESS ADDRESS: P. 0. Box 2060, Farmington Hills, MI 48331 - 3586. PHONE: (248) 615-9000.
UNDERWRITING LIMITATION bl: $71,674,000. SURETY LICENSES c,f/: AL, AK, AZ, AR, CA, CO, CT, DE,
DC, FL, GA, HI, ID, IL, IN, IA, KS, KY, LA, ME, MD, MA, MI, MN, MS, MO, MT, NE, NV, NH, NJ, NM, NY, NO,
ND, OH, OK, OR, PA, PR, RI, SC, SD, TN, TX, UT, VT, VA, WA, WV, WI, WY. INCORPORATED IN: Michigan.
Amerisure Partners Insurance Company (NAIC #11050)
BUSINESS ADDRESS: P. 0, Box 2060, Farmington Hills, MI 48331 - 3586. PHONE: (248) 615-9000.
UNDERWRITING LIMITATION b/: $2,398,000. SURETY LICENSES c,fl: AL, AK, AZ, AR, CO, DE, DC, FL, GA,
HI, ID, IL, IN, IA, KS, KY, LA, MD, MA, MI, MN, MS, MO, MT, NE, NV, NM, NO, ND, OH, OK, OR, PA, RI, SC,
SD, TN, TX, UT, VT, VA, WA, WV, WI, WY. INCORPORATED IN: Michigan.
Antilles Insurance Company (NAIC 010308)
BUSINESS ADDRESS: PO Box 9023507, San Juan , PR 00902 - 3507. PHONE: (787) 474-4900.
UNDERWRITING LIMITATION bl: $3,387,000. SURETY LICENSES c,fl: PR. INCORPORATED IN: Puerto
Rico.
Arch Insurance Company (NAIC #11150)
BUSINESS ADDRESS: Harborside 3, 210 Hudson Street, Suite 300, JERSEY CITY, NJ 07311 - 1107. PHONE:
(201) 743-4000. UNDERWRITING LIMITATION bl: $92,978,000. SURETY LICENSES c,fl: AL, AK, AZ, AR, CA,
CO, CT, DE, DO, FL, GA, GU, HI, ID, IL, IN, IA, KS, KY, LA, ME, MD, MA, MI, MN, MS, MO, MP, MT, NE, NV,
NH, NJ, NM, NY, NC, ND, OH, OK, OR, PA, PR, RI, SC, SD, TN, TX, UT, VT, VA, VI, WA, WV, WI, WY.
INCORPORATED IN: Missouri.
Arch Reinsurance Company (NAIC 910348)
BUSINESS ADDRESS: 445 South Street, Suite 220, P.O. Box 1988, Morristown, NJ 07962 - 1988. PHONE:
(973) 898-9575. UNDERWRITING LIMITATION bl: $35,781,000. SURETY LICENSES c,fl: AL, AK, AZ, AR, CA,
CO, CT, DE, DC, FL, GA, GU, HI, ID, IL, IN, IA, KS, KY, LA, MD, MA, MI, MN, MS, MO, MT, NE, NV, NH, NJ,
NM, NY, ND, OH, OK, OR, PA, RI, SC, SD, TN, TX, UT, VT, VA, WA, WV. INCORPORATED IN: Delaware.
Argonaut Insurance Company (NAIC #19801)
BUSINESS ADDRESS: P.O. BOX 469011, SAN ANTONIO, TX 78246. PHONE: (800) 470-7958.
UNDERWRITING LIMITATION bl: $87,278,000. SURETY LICENSES 01: AL, AK, AZ, AR, CA, CO, CT, DE,
DO, FL, GA, GU, HI, ID, IL, IN, IA, KS, KY, LA, ME, MD, MA, MI, MN, MS, MO, MT, NE, NV, NH, NJ, NM, NY,
NO, ND, OH, OK, OR, PA, PR, RI, SC, SD, TN, TX, UT, VT, VA, VI, WA, WV, WI, WY. INCORPORATED IN:
Illinois.
ASPEN AMERICAN INSURANCE COMPANY (NAIC #43460)
BUSINESS ADDRESS: 175 Capital Boulevard, Suite300, Rocky Hill, CT 06067. PHONE: (860) 258-3500.
UNDERWRITING LIMITATION bl: $50,628/000.SURETY LICENSES c,f/: AL, AK, AZ, AR, CA, CO, CT, DE,
DC, FL, GA, H|.ID, IL, IN, IA, KS, KY, LA, ME, MID, MA, MI, MN, MS, MO, MT, NE, NV, NH, NJ, NM, NY, NC,
IND, OH, OK OR, PA, PR, RLGC. S[\ TN, TX, UT, VT, VA, VI, WA, WV, WI, WY. INCORPORATED IN: Texas,
Associated Indemnity Corporation
BUSINESS ADDRESS: 22nW,xYASH|NGnOWSTREET, SUITE 1000.CH/CAGO.|L0U000-3484.PHONE:
(*$8) 466'7$83. UNDERWRITING LIMITATION b/: *9.002.000. SURETY LICENSES c.O:AL, AK, AZ, AR, CA,
CO, CT, DE, DC, FL, GA, GU, HI, ID, IL, IN, IA, KS, KY, LA, ME, MD, MA, MI, MN, MIS, MO, MT, NE, NV, NH,
NJ, NM, NY, NC, ND, OH, OK, OR, PA, RI, SC, 8n'TN, TX, UT, VT, VA, WA, WV, WI, WY. INCORPORATED
IN: California.
Atlantic Specialty Insurance 927154)
BUSINESS ADDRESS: 605M 18gNorth, Suite 8QO.Plymouth, MN55441,PMONE: (952) 852-2431.
UNDERWRITING LIMITATION b/: $01.BO5.00U.SURETY LICENSES o,fl:AL, AK, AZ, AR, CA, CO, CT, DE,
DC, FL, GA, HI, ID, IL, IN, IA, KS, KY, LA, ME, MID, MA, MI, MN, MS, MO, MT, NE, NV, NH, NJ, NM, NY, NC,
ND, OH, OK, OR, PA, PR, RI, SC, BD.TN, TX, UT, VT, VA, VI, WA, WV, Wi'WY. INCORPORATED IN: New
York._
Auto-Owners Insurance CA189B8>
BUSINESS ADDRESS: PO.BOX 3O0O8,LAN8|NG^M114no8n-&160. PHONE: (s17)3z3120O,
UNDERWRITING LIMITATION bt$1,003,474.U0U. SURETY LICENSES xjtAL, AZ, AR, CO, FL, GA, ID, IL,
IN, IA, KS, KY, MI, MN, MS, MO, NE, NV, NM, mC.ND, OH, OR, PA, SC, 8D.TN, UT, VA, WA, WI,
INCORPORATED IN: Michigan.
AXIS Insurance Company (NAIC #37273)
BUSINESS ADDRESS: 1168#Great Oaks Way, Ste, 5gO.Alpharetta, G&30U22.PHONE: (G70)74w-w4uu.
UNDERWRITING LIMITATION b/:$54.4O7.ODO.SURETY LICENSES ojj:AL, AK, AS, AZ, AR, CA, CO, CT,
DE, DC, FL, GA, HI, ID, IL, IN, IA, KS, KY, LA, ME, MID, MA, MI, MN, MS, MO, MT, NE, NV, NH, NJ, NM, NY,
AXIS Reinsurance Company 0NxIC
BUSINESS ADDRESS: 11680Great Oaks Way, GuUo50O. Alpharetta, 8A3882z. PHONE: (678)746-9400.
UNDERWRITING LIMITATION b/:$eO,s81.008.SURETY LICENSES ujl�AL, AKAS, AZ, AR, CA, CO, tT
DE, FL, GA, HI, ID, IL, IN, |A.KS, KY, LA, ME, MID, MA, MI, MN, MS, MO, MT, NE, NV, NH, NJ, NM, NY, NC,
NO, OH, OK' OR, PA, PR, Ri, GO, BD, TN, TX, 0T VT N\ vV4 WV, wN. WY. INCORPORATED IN: New York
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Bankers Insurance Company
BUSINESS AoDwEoSi P.o.BOX 1u7o/.ST,PeTERSBVRG.FL33733.PHONE: <7ar>mzn-4oO0.
UNDERWRITING LIMITATION W: $7.781.000. SURETY LICENSES u'f/:AL, AK, AZ, AR, CA, CO, CT, DE, DC,
FL, GA, H|'ID, IL, IN, IA, KS, KY, LA, ME, MID, MA, MI, MN, MS, MO, MT, NE, NV, NH, NJ, NM, NY, NC, ND,
OH, OK, OR. PA, SC, SO, TN, TX, UT, VT, VA, WA, WV, WI, WY. INCORPORATED IN: Florida.
Bankers Standard Insurance Company (mA|C#`O279)
BUSINESS ADDRESS: 43nWALNUT STREET, PO.Box 1QUQ.Philadelphia, PA1e1n6,PHONE�(215)840'
1000.UNDERWRKT|WGL|M|77TUQNb/:$19.790,000.8URETYL/CEN8Esu'f/:AL.AK.AZ.&R.cA'CO.cT,
DE, DC, FL, GA, H|.ID, IL, |N,IA, KS, KY, LA, ME, MID, MA, MI, MN, MS, MO, MT, NE, NV, NIH.NJ, NM, NY,
NC, ND, OH, OK OR, PA, R|, SC, SID.TN, TX, UT, VT, VA, WA, WV, WI, WY. INCORPORATED IN:
Beazley| Company, Inc.#37540
BUSINESS ADDRESS: xoBuuummnPark Road, Farmington,oTg003a, PHONE:
UNDERWRITING LIMITATION b/: $12.010'000, SURETY LICENSES ^^K:AL, AK, AZ, AR, CA, CO, CT, DE,
DC, FL, GA, HI, ID, IL, IN, IA, KS, KY, LA, ME, MID, MA, MI, MN, MS, MO, MT, NE, NV, NH, NJ, NM, NY, NC,
ND, OH, OK, OR, PA, RI, SC, SD'TN, TX, UT, VT, VA, WA, WV, WI, WY. INCORPORATED IN: Connecticut.
Berkley Insurance Company (NA|C#3200)
BUSINESS ADDRESS: 475STEAMBOAT ROAD, GREEwVYIcV.oTms$3¢.PHONE: (203) 542-3800,
UNDERWRITING LIMITATION b/: $4aa.11r.omo.SURETY LICENSES c.o: AL, AK, AZ, AR, CA, CO, CT, DE,
DC, FL, GA, GU, HI, ID, IL, IN, IA, KS, KY, LA, ME, MD, MA, MI, MN, MS, MO, MT, NE, NV, NH, NJ, NM, NY,
NC, ND, OH, OK, OR, PA, PR, RI, SC, SD.TN, TX, UTVT, VA, VI, WA, WV, WI, WY. INCORPORATED IN:
Berkley Regional Insurance Co
BUSINESS ADDRESS: P0BOX A1V8.DES MV|NE3 i45038G-o19,1PHONE: (51s)47n-3o0O.
UNDERWRITING LIMITATION b/:$72.789.0OO.SURETY LICENSES o,fl:AL, AK, AZ, AR, CA, CO, CT, DE,
DC, FL, GA, HV.ID, IL, IN, IA, KS, KY, LA, ME, MID, MA, MI, MN, MS, MO, MT, NE, NV, NH, NJ, NM, NY, NC,
ND, OH, OK, OR, PA, RI, SC, SD.TN, TX, UT, VT, VA, WA, WV, WI, WY. INCORPORATED IN: Delaware.
Berkshire Hathaway HomevmmInsurance Company (NA|C
BUSINESS ADDRESS: 1314Douglas Street, Suite 13OO.Omaha, NEsa1oo'1o44.PHONE: (402)393'y2*5�
UNDERWRITING LIMITATION b/:$1O6.O73.D0U.SURETY LICENSES c.V:AL, AK, AZ, AR, CA, CO, CT, DE,
DC, FL, GA, HI, ID, IL, IN, IA, KS, KY, LA, ME, MID, MA, MI, MN, MS, MO, MT, NE, NV, NH, NJ, NM, NY, NC,
Berkshire Hathaway Specialty Insurance Company (NAIC #22276)
BUSINESS ADDRESS: 1314 Douglas Street, Suite 1400, Omaha, NE 68102 - 1944, PHONE: (402) 916-3000,
UNDERWRITING LIMITATION b/: $374,964,000. SURETY LICENSES OP AL, AK, AZ, AR, CA, CO, CT, DE,
DC, FL, GA, HI, ID, IL, IN, IA, KS, KY, LA, ME, MD, MA, MI, MN, MS, MO, MT, NE, NV, NH, NJ, NM, NY, NC,
ND, OH, OK, OR, PA, RI, SC, SD, TN, TX, UT, VT, VA, WA, WV, WI, WY, INCORPORATED IN: Nebraska.
BITCO GENERAL INSURANCE CORPORATION (NAIC #20095)
BUSINESS ADDRESS; 3700 MARKET SQUARE CIRCLE, DAVENPORT, IA 52807, PHONE: (800) 475-4477,
UNDERWRITING LIMITATION b/: $29,364,000. SURETY LICENSES c,M AL, AK, AZ, AR, CA, CO, CT, DE,
DC, FL, GA, ID, IL, IN, IA, KS, IKY, LA, ME, MD, MA, Mi, MN, MS, MO, MT, NE, NV, INJ, NM, NY, NC, ND, OH,
OK, OR, PA, RI, SC, SD, TN, TX, UT, VT, VA, WA, WV, WI, WY. INCORPORATED IN. Illinois.
BOND SAFEGUARD INSURANCE COMPANY (NAIC #27081)
BUSINESS ADDRESS: 10002 Shelbyville Road, Suite 100, Louisville, KY 40223 - 2979. PHONE: (615) 553-
9500. UNDERWRITING LIMITATION b/: $3,938,000. SURETY LICENSES c,f/- AL, AK, AZ, AR, CA, CO, CT,
DE, DC, FL, GA, GU, IHI, ID, IL, IN, KS, KY, LA, ME, MD, MA, MN, MS, MO, MP, MT, NV, NIH, NJ, NM, NC, ND,
OH, OK, RI, SC, SD, TIN, TX, UT, VT VA, WA, WV, WI, WY. INCORPORATED IN: South Dakota.
Bondex Insurance Company (NAIC #12965)
BUSINESS ADDRESS: P.O. Box 6, Florham Park, NJ 07932, PHONE: (973) 377-7000. UNDERWRITING
LIMITATION bl: $351,000. SURETY LICENSES c,f/: DE, NJ, NY, PA, INCORPORATED IN: New Jersey,
Boston Indemnity Company, Inc. (NAIC #30279)
BUSINESS ADDRESS: PO Box 6, Florham Park, NJ 07932, PHONE: (973) 377-7000. UNDERWRITING
LIMITATION b/: $451,000, SURETY LICENSES c,Y: AL, AZ, AR, CT, DE, DC, FL, GA, ID, IN, KS, KY, LA, ME,
MA, MN, MS, MT, NE, NV, NC, ND, OK, PA, SD, TN, WV. INCORPORATED IN: South Dakota.
Brierfield Insurance Company (NAIC #10993)
BUSINESS ADDRESS: 6300 University Parkway, Sarasota, FL 34240 - 8424. PHONE: (800) 226-3224 x-2422
UNDERWRITING LIMITATION bf: $913,000. SURETY LICENSES c,f/: AL, AR, FL, GA, MS, TN.
INCORPORATED IN: Mississippi.
BRITISH AMERICAN INSURANCE COMPANY (NAIC #32875)
BUSINESS ADDRESS: P.O. Box 1590, Dallas, TX 75221 - 1590. PHONE: (214) 443-5500. UNDERWRITING
LIMITATION b/: $3,249,000. SURETY LICENSES c,f/: TX, INCORPORATED IN: Texas.
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Capitol Indemnity Corporation (NAIC #10472)
BUSINESS ADDRESS: P.O. Box 5900, Madison, WI 53705 - 0900. PHONE: (6,08),829-4200, UNDERWRITING
LIMITATION bl: $21,699,000. SURETY LICENSES c,f/: AL, AK, AZ, AR, CA, CO, CT, DE, DC, FL, GA, HII, ID,
IL, IN, IA, KS, KY, LA, ME, MID, MA, MI, MN, MS, MO, MT, NE, NV, NIH, NJ, NM, NY, NC, ND, OH, OK, OR, PA,
RI, SC, SD, TIN, TX, UT, VT, VA, WA, WV, WI, WY. INCORPORATED IN: Wisconsin.
Capitol Preferred Insurance Company, Inc, (NAIC #10908)
BUSINESS ADDRESS: 2750 Chanceilorsville Dr, Tallahassee, FL 32312. PHONE: (850) 521-0742.
UNDERWRITING LIMITATION bl: $2,654,000. SURETY LICENSES c,fl: FL, GA, SC, INCORPORATED IN:
Florida.
Carolina Casualty Insurance Company (NAIC #10510)
BUSINESS ADDRESS: PO BOX 9190, DES MOINES, IIA 50306 - 9190. PHONE: (904) 363-0900.
UNDERWRITING LIMITATION b/: $10,338,000. SURETY LICENSES c,f/: AL, AK, AZ, AR, CA, CO, CT, DE,
DC, FL, GA, HI, ID, ll-, IN, IA, KS, KY, LA, ME, MD, MA, MI, MN, MS, MO, MT, NE, NV, NH, NJ, NM, NY, NC,
ND, OH, OK, OR, PA, RI, SC, SD, TN, TX, UT, VT, VA, WA, WV, W11, WY. INCORPORATED IN: Iowa.
Centennial Casualty Company (NAIC #34568)
BUSINESS ADDRESS: 2200 Woodcrest Place, Suite 200, Birmingham, AL 35209. PHONE: (205) 414-2600.
UNDERWRITING LilivIlTATION bl: $8,292,000. SURETY LICENSES cN: AL. INCORPORATED IN: Alabama.
CENTRAL MUTUAL INSURANCE COMPANY (NAIC; #20230)
BUSINESS ADDRESS: P.O. BOX 351, VAN WERT, OH 45891 - 0351. PHONE: (419) 238-1010.
UNDERWRITING LIMITATION b/: $66,541,000, SURETY LICENSES c,f/: AZ, AR, CA, CO, CT, DE, GA, ID, IL,
IN, IA, KY, ME, MID, MA, IMI, MN, MS, MT, NV, NH, NJ, NM, NY, NC, OH, OK, OR, PA, SC, TN, TX, UT VT, VA,
WA, WI. INCORPORATED IN: Ohio.
CENTURY SURETY COMPANY (NAIC #36951)
BUSINESS ADDRESS: 55,0 Polaris Parkway, Westerville, OH 43082. PHONE: (614) 895-2000.
UNDERWRITING LIMITATION bl: $3,931,000. SURETY LICENSES c,f/: AZ, IN, OH, WV, WL
INCORPORATED IN: Ohio.
Charter Oak Fire Insurance Company (The) (NAIC #25615)
BUSINESS ADDRESS: ONE TOWER SQUARE, HARTFORD, CT 06183. PHONE: (860) 277-0111,
UNDERWRITING LIMITATION b/: $22,735,000. SURETY LICENSES c,(/: AL, AK, AZ, AR, CO, CT, DE, DC,
FL, GA, HI, ID, IL, IN, IA, KS, IKY, LA, ME, MD, MA, MI, MN, MS, MO, MT, NE, NV, NH, NJ, NM, NY, NC, ND,
OH, OK, OR, PA, PIR, RI, SC, SID, TN, TX, UT, VT, VA, WA, WV, WI, WY, INCORPORATED IN: Connecticut.
Cherokee Insurance Company (NAIC #10642)
BUSINESS ADDRESS: 34200 Mound Road, Sterling Heights, MI 48310. PHONE: (800) 201-0450 x-3400.
UNDERWRITING LIMITATION b/: $19,781,000. SURETY LICENSES c,fl: AL, AZ, AR, CA, CO, CT, DE, FL,
GA, ID, IL, IN, IA, KS, KY, LA, ME, MD, MA, MI, MN, MS, MO, MT, NE, NV, NJ, NM, NY, NC, ND, OH, OK, OR
PA, RI, SC, SD, TN, TX, UT, VT, VA, WA, WV, WI, WY, INCORPORATED IN: Michigan.
CHUBB INDEMNITY INSURANCE COMPANY (NAIC #12777)
BUSINESS ADDRESS: 202B Hall's Mill Road, Whitehouse Station, NJ 08889. PHONE: (212) 827-4400.
UNDERWRITING LIMITATION bl: $17,505,000, SURETY LICENSES c,f/: AL, AK, AZ, AR, CA, CO, CT, DE,
DC, FL, GA, HI, ID, IL, IN, IA, KS, KY, LA, ME, MD, MA, MI, MN, MS, MO, MT, NE, NV, NH, NJ, NM, NY, NC,
ND, OH, OK, OR, PA, RI, SC, SD, TN, TX, UT, VT, VA, WA, WV, Wl, WY. INCORPORATED IN: New York.
Cincinnati Casualty Company (The) (NAIC 928665)
BUSINESS ADDRESS: P.O. Box 145496, Cincinnati, OH 45250 - 5496. PHONE: (513) 870-2000.
UNDERWRITING LIMITATION b/: $39,229,000. SURETY LICENSES c,f/: AL, AK, AZ, AR, CA, CO, CT, DE,
DC, FL, GA, HI, ID, IL, IN, IA, KS, KY, LA, ME, MD, MA, MI, MN, MS, MO, MT, NE, NV, NH, NJ, NM, NY, NC
ND, OH, OK, OR, PA, RI, SC, SD, TN, TX, UT, VT, VA, WA, WV, WI, WY. INCORPORATED IN: Ohio,
CINCINNATI INDEMNITY COMPANY, THE (NAIC #23280)
BUSINESS ADDRESS: P.O. BOX 145496, CINCINNATI, OH 45250 - 5496. PHONE: (513) 870-2000 x-4414
UNDERWRITING LIMITATION bl: $10,000,000. SURETY LICENSES c,f/: AL, AK, AZ, AR, CA, CO, CT, DE,
DC, FL, GA, HI, ID, IL, IN, IA, KS, KY, LA, ME, MD, MA, MI, MN, MS, MO, MT, NE, NV, NH, NJ, NM, NY, NC
ND, OH, OK, OR, PA, RI, SC, SD, TN, TX, UT, VT, VA, WA, WV, WI, WY. INCORPORATED IN: Ohio,
Cincinnati Insurance Company (The) (NAIC #10677)
BUSINESS ADDRESS: P.O. BOX 145496, CINCINNATI, OH 45250 - 5496. PHONE: (513) 870-2000.
UNDERWRITING LIMITATION b/: $460,128,000. SURETY LICENSES c,fl: AL, AK, AZ, AR, CA, CO, CT, DE,
DC, FL, GA, HI, ID, IL, IN, IA, KS, KY, LA, ME, MD, MA, MI, MN, MS, MO, MT, NE, NV, NH, NJ, NM, NY, NC,
ND, OH, OK, OR, PA, PR, RI, SC, SD, TN, TX, UT, VT, VA, WA, WV, WI, WY. INCORPORATED IN: Ohio,
CITIZENS INSURANCE COMPANY OF AMERICA (NAIC #31534)
BUSINESS ADDRESS: 440 LINCOLN STREET, WORCESTER, MA 01653 - 0002. PHONE: (508) 853-7200,
UNDERWRITING LIMITATION b/: $69,946,000. SURETY LICENSES c,fl: AL, AK, AZ, AR, CO, CT, DE, DC,
GA, HI, IL, IN, IA, KS, ME, MD, MA, MI, MN, MS, MO, MT, NE, NH, NJ, NM, NY, NC, ND, OH, OK, PA, RI, SC,
SD, TN, TX, UT, VT, VA, WA, WV, WI. INCORPORATED IN: Michigan.
COLONIAL AMERICAN CASUALTY AND SURETY COMPANY (NAIC #34347)
BUSINESS ADDRESS: 1299 ZURICH WAY, 5TH FLOOR, SCHAUMBURG, IL 60196 - 1056. PHONE: (847)
605-6000. UNDERWRITING LIMITATION bl: $2,337,000. SURETY LICENSES c,fl: AL, AK, AZ, AR, CA, CO,
CT, DE, DC, FL, GA, HI, ID, IL, IN, IA, KS, KY, LA, ME, MD, MA, Ml, MN, MS, MO, MT, NE, NV, NJ, NM, NY,
INC, ND, OH, OK, OR, PA, RI, SC, SD, TN, TX, UT, VT, VA, WA, WV, WI, WY. INCORPORATED IN: Maryland.
COLONIAL SURETY COMPANY (NAIC #10758)
BUSINESS ADDRESS: 123 Tice Boulevard, Suite 250, Woodcliff Lake, NJ 07677. PHONE: (201) 573-8788.
UNDERWRITING LIMITATION b/: $4,052,000. SURETY LICENSES c,f/: AL, AK, AZ, AR, CA, CO, CT, DE, DC,
FL, GA, GU, HI, ID, IL, IN, IA, KS, KY, LA, ME, MD, MA, MI, MN, MS, MO, MP, MT, NE, NV, NH, NJ, NM, NY,
NC, ND, OH, OK, OR, PA, PR, RI, SC, SD, TN, TX, UT, VT, VA, VI, WA, WV, WI, WY. INCORPORATED IN:
Pennsylvania.
Continental Casualty Company (NAIC #20443)
BUSINESS ADDRESS: 151 N Franklin St., CHICAGO, IL 60606. PHONE: (312) 822-5000, UNDERWRITING
LIMITATION bl: $738,083,000. SURETY LICENSES c,f/: AL, AK, AZ, AR, CA, CO, CT, DE, DC, FL, GA, HI, ID,
IL, IN, IA, KS, KY, LA, ME, MD, MA, MI, MN, MS, MO, MT, NE, NV, NH, NJ, NM, NY, NC, ND, OH, OK, OR, PA,
PR, RI, SC, SD, TN, TX, UT, VT, VA, VI, WA, WV, WI, WY. INCORPORATED IN: Illinois.
CONTINENTAL HERITAGE INSURANCE COMPANY (NAIC #39551)
BUSINESS ADDRESS: 6140 PARKLAND BLVD, STE 321, MAYFIELD HEIGHTS, OH 44124. PHONE: (440)
229-3420. UNDERWRITING LIMITATION bI: $2,514,000. SURETY LICENSES 01: AZ, CA, CO, DC, FL, GA,
ID, IL, IN, IA, KY, LA, ME, MD, MN, MS, NE, NV, NJ, ND, OH, PA, SC, SD, TN, TX, UT, VA, WA, WV, WY.
INCORPORATED IN: Florida.
Continental Insurance Company (The) (NAIC #35289)
BUSINESS ADDRESS: 151 N Franklin St., CHICAGO, IL 60606, PHONE: (312) 822-5000. UNDERWRITING
LIMITATION b/: $155,806,000. SURETY LICENSES c,f/: AL, AK, AZ, AR, CA, CO, CT, DE, DC, FL, GA, GU,
HI, ID, IL, IN, IA, KS, KY, LA, ME, MD, MA, MI, MN, MS, MO, MP, MT, NE, NV, NH, NJ, NM, NY, NC, ND, OH,
OK, OR, PA, PR, RI, SC, SO, TN, TX, UT, VT, VA, VI, WA, WV, WI, WY. INCORPORATED IN: Pennsylvania.
CONTRACTORS BONDING AND INSURANCE COMPANY (NAIC #37206)
BUSINESS ADDRESS: 9025 N. Lindbergh Drive, Peoria, IL 61615. PHONE: (309) 692-1000.
UNDERWRITING LIMITATION b/: $11,490,000. SURETY LICENSES c,f/: AL, AK, AZ, AR, CA, CO, CT, DE,
DC, FL, GA, HI, ID, IL, IN, IA, KS, KY, LA, ME, MD, MA, MI, MN, MS, MO, MT, NE, NV, NH, NJ, NM, NY, NC,
ND, OH, OK, OR, PA, RI, SC, SD, TN, TX, UT, VT, VA, WA, WV, WI, WY. INCORPORATED IN: Illinois.
Cooperativa de Seguros Multiples de Puerto Rico (NAIC #18163)
BUSINESS ADDRESS: PO BOX 363846, SAN JUAN, PR 00936 - 3846. PHONE: (787) 622-3575 x-2512.
UNDERWRITING LIMITATION bl: $15,318,000. SURETY LICENSES c,fl: PR. INCORPORATED IN: Puerto
Rico.
CorePointe Insurance Company (NAIC #10499)
BUSINESS ADDRESS: 401 South Old Woodward Avenue, Suite 300, Birmingham, MI 48009. PHONE: (800)
782-9164. UNDERWRITING LIMITATION lb/: $1,452,000. SURETY LICENSES c,fl: AL, AK, AZ, AR, CA, CO,
CT, DE, DC, FL, GA, HI, ID:, IL, IN, IA, KS, KY, LA, ME, MID, MA, MI, MN, MS, MO, MT, NE, NV, NH, NJ, NM,
NY, NC, ND, OH, OK, OR, PA, RI, SC, SD, TN, TX, UT, VT, VA, VI, WA, WV, WI,'WY. INCORPORATED IN:
Delaware.
CUMIS INSURANCE SOCIETY, INC. (NAIC #10847)
BUSINESS ADDRESS: POST OFFICE BOX 1084, MADISON, W1 53701. PHONE: (608) 238-5851.
UNDERWRITING LIMITATION bl: $85,551,000. SURETY LICENSES c,V: AL, AK, AZ, AR, CA, CO, CT, DE,
IDC, FL, GA, GU, HI, ID, IL, IN, 1A, KS, KY, LA, ME, MD, MA, MI, MN, MS, MO, MT, NE, NV, NH, NJ, NM, NY,
NC, ND, OH, OK, OR, PA, PR, RII, SC, SD, TN, TX, UT, VT, VA, VI, WA, WV, WI, WY. INCORPORATED IN:
Iowa,
CUMIS Specialty Insurance Company, Inc. (NAIC #12768)
BUSINESS ADDRESS: Post Office Box 1084, Madison, W1 53701, PHONE: (608) 238-5851. UNDERWRITING
LIMITATION b/: $5,549,000. SURETY LICENSES c,fl: AL, CA, CT, DC, FL, GA, HI, ID, IL, IN, IA, KS, KY, MD,
MA, MI, MN, MO, NE, NV, NJ, NY, NC, OH, OK, OR, PA, SC, SD, TX, UT, VA, WA, WI, WY INCORPORATED
IN: Iowa.
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Developers Surety and Indemnity Company (NAIC #12718)�
BUSINESS ADDRESS: P.O. BOX 1,9725, IRVINE, CA 92623 - 9725. PHONE: (949) 263-3300.
UNDERWRITING, LIMITATION b/: $9,634,000. SURETY LICENSES c,fl: AL, AK, AZ, AR, CA, CO, CT, DE, DC,
FL, GA, HI, ID, IIL, IN, IA, KS, KY, ILA, ME, MD, MA, MI, MN, MS, MO, MT, NE, NV, NH, NJ, NM, NY, INC, ND,
OH, OK, OR, PA, RII, SC, SD, TN, TX, LIT, VT, VA, VI, WA, WV, Wi, WY. INCORPORATED IN: California.
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Employers Insurance Company of Wausau (NAIC #21458)
BUSINESS ADDRESS: 175 Berkeley Street, Boston, MA 02116. PHONE: (617) 357-9500. UNDERWRITING
LIMITATION bl: $138,602,000. SURETY LICENSES c,f/: AL, At<, AZ, AR, CA, CO, CT, DE, DC, FL, GA, HI, ID,
IL, IN, IA, KS, KY, LA, ME, MID, MA, MI, MN, MS, MO, MT, NE, NV, NH, NJ, NM, NY, NC, ND, OH, OK, OR, PA,
FIR, RI, SC, SD, TN, TX, UT, VT, VA, VI, WA, WV, WI, WY. INCORPORATED IN: Wisconsin.
Employers Mutual Casualty Company (NAIC #21415)
BUSINESS ADDRESS: P. O. BOX 712, DES MOINES, IA 50306 - 0712, PHONE: (515) 280-2511.
UNDERWRITING LIMITATION b/: $143,661,000. SURETY LICENSES c,fl: AL, AK, AZ, AR, CA, CO, CT, DE,
DC, FL, GA, HI, IID, IL, IN, IA, KS, KY, LA, ME, MID, MA, Mi, MN, MS, MO, MT, NE, NV, NH, NJ, NM, NY, NC,
ND, OF, OK, OR, PA, RI, SC, SD, TN, TX, LIT, VT, VA, WA, WV, WI, WY. INCORPORATED IN: Iowa.
Endurance American Insurance Company (NAIC #10641)
BUSINESS ADDRESS: 4 MANHATTANVILLE ROAD, PURCHASE, NY 10577. PHONE: (914) 468-8000.
UNDERWRITING LIMITATION bt: $42,689,000. SURETY LICENSES c,f/: AL, AK, AZ, CO, DIE, DC, GA, HIS, 10,
IL, IN, 1A, KS, KY, LA, MID, MA, MI, MS, MO, MT, NE, NV, NJ, NM, NY, ND, OH, OK, OR, PA, RI, SC, SD, TN,
TX, LIT, VT WA, WV, WY, INCORPORATED IN: Delaware.
Endurance Assurance Corporation (NAIC #11551)
BUSI]NESS ADDRESS: 4 MANHATTANVILLE ROAD, PURCHASE, NY 10577, PHONE: (914) 468-8000,
UNDERWRITING LIMITATION b/: $46,459,000. SURETY LICENSES c,fl: AL, AK, AZ, AR, CA, CO, CT, DE,
DC, FL, GA, GU, HI, ID, 1L, IN, IA, KS, KY, LA, ME, MD, MA, MI, MN, MS, MO, MT, NE, NV, NJ, NM, NY, NC,
ND, OH, OK, OR, PA, PR, RI, SC, SD, TN, TX, UT, VT VA, WA, WV, WY. INCORPORATED IN: Delaware,
Erie Insurance Company (NAIC #26263)
BUSINESS ADDRESS. 100 ERIE INSURANCE PLACE, ERIE, PA 16530, PHONE: (814) 870-2000,
UNDERWRITING LIMITATION b/: $37,432,000. SURETY LICENSES e,f/: DC, IL, IN, KY, MID, MN, NY, NC,
OH, PA, TN, VA, WV, WI. INCORPORATED IN: Pennsylvania.
Eider Hermes North America Insurance Company (NAIC #20516)
BUSINESS ADDRESS: 800 Red Brook Blvd, Owings Mills, MID 21117. PHONE: (410) 753.0753,
UNDERWRITING LIMITATION bl: $15,764,000. SURETY LICENSES c,fl: AL, AK, AZ, CA, CO, CT, DE, DC,
GA, HI, ID, IL, IN, IA, KS, KY, LA, MD, MA, MI, MIN, MS, MO, MT, NE, NV, NH, NJ, NM, NY, INC, ND, OH, OK,
PA, RI, SC, SD, TN, TX, LIT, VT, VA, WI, WY. INCORPORATED IN: Maryland,
Everest Reinsurance Company (NAIC #26921)
BUSINESS ADDRESS: P.O.. Box 830, Liberty Corner, NJ 07938 - 0830. PHONE: (908) 604-3000.
UNDERWRITING LIMITATION bl: $339,185,000. SURETY LICENSES c,fl:: AL, AK, AZ, AR, CA, CO, CT, DE,
DC, FL, GA, HI, ID, IL, IN, IA, KS, KY, LA, ME, MID, MA, MI, MN, MS, MO, MP, MT, NE, NV, NH, NJ', NM, NY,
NC, ND, OH, OK, OR, PA, RI, SC, SD, TN, TX, UT, VT, VA, WA, WV, WI, WY, INCORPORATED IN: Delaware.
Evergreen National Indemnity Company (NAIC #12750)
BUSINESS ADDRESS: 6140 PARKLAND BLVD, STE 321, MAYFIELD HEIGHTS, OH 44124. PHONE: (440)
22o-342o.UNDERWRITING LIMITATION b/: $3,445,oco.SURETY LICENSES n,f/:AL, AK, AZ, AR, CA, CO,
CT, DE, DO, FL, GA, ID, IL, IN, N.KS, KY, LA, ME, MID, MA, MI, MIN, MS, MO, MT, NE, NV, NH, NJ, NM, NY,
ND, OH, OK, OR PA, RI, SO, SO, TN, TX, UT, VT, VA, WA, WI, WY. INCORPORATED IN: Ohio.
Executive Risk Indemnity Inc. (NAIC#35181)
BUSINESS ADDRESS: 2O2BHa|U'uMill Road, Whitehouse Station, NJ0x*88.PHONE: (u1n)e4o-se59.
UNDERWRITING LIMITATION b/: $156.166.000. SURETY LICENSES n.K:AL, AK, AZ, AR, CA, CO, DE, DC
FL, GA, HI, ID, IL, IN, IA, KS, KY, LA, ME, MD, MA, MI, MN, MS, MO, MT, NE, NV, NH, NJ, NM, NY, NO, ND,
OH, OK, OR, PA, RI, SC, SD, TN, TX, UT, VT, VA, WA, WV, WI, WY. INCORPORATED, IN: Delaware,
Explorer Insurance Company U«AUC#4UO2S
BUSINESS ADDRESS: pO.BOX 5U9O3S.SAM0|EGO.CAa21n0.PHONE: (858)o50-24OOx'2550.
UNDERWRITING LIMITATION b/: $14^055.000. SURETY LICENSES c.f/:AZ, CA, CO, CT, DE, HI, ID, IL, IN,
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Fair American Insurance and Reinsurance Company (NA|C#3515q
BUSINESS ADDRESS: One Liberty Plaza, 165 Broadway, New York, NY 10006. PHONE: (212) 365-2200.
UNDERWRITING LIMITATION bf: $19,390,000, SURETY LICENSES c,f/: AL, AK, AZ, AR, CA, CO, CT, DE,
, OH, OK, OR, PA, RI, SO, SD, TN, TX. UT, VT, VA. VI, WA, WV, WI, WY. 'INCORPORATED —: New _York.
Farmers Alliance Mutual Insurance Company (NAIC #19194)
BUSINESS ADDRESS: P/3.Box 14o1.McPherson, KS 67460.PH0NE: (620.UNOERVVR0NG
LIMITATION b/:$17.671.onm.SURETY LICENSES c.CtCO, ID, kA.KS, MN, MO, MT, NE, NM, ND, OK, SID,
INCORPORATED IN: Kansas.
FarmingtonCasualty C
BUSINESS ADDRESS: ONE TOWER SQUARE, HARTFVRD.CTO9183.PHONE: (800)277'0111.
UNDERWRITING LIMITATION b/: $27.447.000. SURETY LICENSES n^0: AL. AK, AZ, AR, CA, CO, CT, DE,
DC, FL, GA, H8. |D. |L' IN, IA, KS, KY, LA, ME, MID, MA, M|, IVIm,WS. MO, MT, NE, NV, NH, NJ, NM�'NY, NO,
ND, OH, OK, OR, PA, R|, SC, SD, TN, T( UT, VT, VA, WA, WV, WI, WY. INCORPORATED IN: Connecticut.
Farmland Mutual Insurance Company Van
BUSINESS ADDRESS: ONE WEST NATIONWIDE BLVD,1-04-7O1.COLUMBUS.0143215 2220. PHONE:
(515) 5na'a000.UNDERWRITING LIMITATION b/:*1o.aV5.ono,SURETY LICENSES u.f/:AL, AZ, AR, CA,
CO, DE, DO, FL, GA, ID, IL, IN, IA, KS, KY, MD, M[MN, MS, MO, MT, NE, NV, NC, ND, OH, OK, OR, PA, SO,
SD.TN, TX, UT, VA, WA, WV, WI, WY. INCORPORATED, IN: Iowa.
FoCiInsurance Company (NxIC#w0178)
BUSINESS ADDRESS: oxmoUniversity Parkway, Sarasota, FL14o4o'x424.PHONE: 800 226-3224x-2720.
UNDERWRITING LIMITATION b/: $54'754.000, SURETY LICENSES cj/�AL, AZ, AR, CO. DO, FL, GA. |L. IN,
Federal Ins:um
BUSINESS ADDRESS: zo2onenmMill Road, Whitehouse Station, NJo8WoV.PHONE:
UNDERWRITING LIMITATION b/:$@9J.7O5.U0O.SURETY LICENSES c.R: AL, AK.AZ, AR, CA, GO, CT, DE,
DO, FL, GA, GU, HI, ID, IL, IN, IA, KS, KY, LA, ME, MID, MA, MI, MN, MS, MO, MP, MT, NE, NV, NH, NJ, NM,
NY, NO, ND, OH, OK, OR, PA, PR, P1. SO, SID.TN, TX, UT, VT, VA, VI, WA, WV, WI, WY. INCORPORATED IN:
Indiana.
FEDERATED MUTUAL INSURANCE COMPANY <NA|C#1
BUSINESS ADDRESS: 121 EAST PARK SQUARE, ovWATVNNA. MN 55080 PHONE: (587)455'5280.
UNDERWRITING LIMITATION b/:*xae^ss1.ono,SURETY LICENSES r.htAL, AK, AZ, AR, CA, CO, CTDE,
DO, FL, GA, ID, IL, IN, A.KS, KY, LA, ME, MID, MA, MI, MN, MS, MO, MT, NE, NV, NH, NJ, NM, NY, NO, ND,
OH, OK, OR, PA, RI, SC, SD, TN, Tx, UT, VT, VA, WA, WV, V0. VYl INCORPORATED IN: Minnesota,
Fidelity and Deposit Company ufMaryland 06)
BUSINESS pmoREes�12oSZVR|CHWAY, oTHFLOOR, 8CHAVMBVRG.|Lww1*o'1nno.PHONE: G47)
6oG'000B.UNDERWRITING LIMITATION W: $14.785.040, SURETY LICENSES o.f/:AL, AK, AZ, AR, CA, CO,
CT, DE, DC, FL, GA, GU, HI, ID, IL, IN, IA, KS, KY, LA, ME, MD, MA, MI, MN, MS, MO, MP, MT, NE, NV, NIA,
NJ, NM, NY, NO, ND, OH, OK, OR, PA, PR, RI, SO, SD.TN, TX, LIT, VT, VA, VI, WA, WV, WI, WY.
INCORPORATED IN: Maryland.
FIDELITY AND GUARANTY INSURANCE COMPANY <NA|C#35S
BUSINESS ADDRESS: One Tower Square, Hartford, CTOS183.PHONE: (8s0)27Fu111.UNDERWRITING
LIMITATION b/:*1.rrs,onn.SURETY LICENSES c.fl:AL, AK, AZ, AR, CA, CO, CT, DE, DC, FL, GA, HI, ID, IL,
IN. IA, KS, KY, LA, ME, MID, MA, MI, MN, MS, MO.MT, NE, NV, NH, NJ, NM, NY, NO, ND, OH, OK, OR, PA, RI,
SO, SD, TN, TX, LIT, VTVA, WA, WV, WI, WY. INCORPORATED IN: iowa.
Fidelity and Guaranty Insurance Underwriters, iuo1mA|O#2
BUSINESS ADDRESS: One Tower Square, Hartford, CTO*1ua,PHONE: (xaV)27T'0111.UNDERWRITING
LIMITATION b/: $8.o89`og0.SURETY LICENSES cjl:AL, AK, AZ, AR, CA. CO, CT. DE. DO, FL, GA, HI, 10. UL.
IN, IA, KS, KY, LA, ME, MD, MA M|, MN, MG, MO, MT NE, NV, MH, NJ, NM, NY, NC, ND, OHI'0K. OR, R4. R|.
SO, GD.TN, TX, LIT, VT, VA, WA, WV, WI, WY. INCORPORATED IN: Wisconsin.
Financial Casualty & Surety, Inc. (NAIC435009)
BUSINESS ADDRESS: 3131 Eastside, Suite 600, Houston, TX 77098. PHONE: (800) 392-1604.
UNDERWRITING LIMITATION b/: $1,651,000, SURETY LICENSES c,f/: AZ, CA, CT, DE, FL, GA, ID, IN, IA,
KS, LA, MID, MI, MN, MS, MO, MT, NV, NJ, NY, NC, ND, OH, PA, SC, SD, TN, TX, UT, VT, VA, WA, WV.
INCORPORATED IN: Texas.
Financial Pacific Insurance Company (NAIC #31453)
BUSINESS ADDRESS: P.O. BOX 73909, CEDAR RAPIDS, IA 52407 - 3909. PHONE: (319) 399-5700.
UNDERWRITING LIMITATION bl: $9,769,000, SURETY LICENSES c,f/: AK, AZ, AR, CA, CO, FL, ID, IL, 11A,
KS, MN, MO, MT, NE, NV, NM, ND, OK, OR, SD, TX, UT, WA, Wi. INCORPORATED IN: California.
Fireman's Fund Insurance Company (NAIL #21873)
BUSINESS ADDRESS: 225 W. WASHINGTON STREET, SUITE 1800, CHICAGO, IL 60606 - 3484. PHONE:
(888) 466-7883. UNDERWRITING LIMITATION b/: $129,737,000. SURETY LICENSES c,f/: AL, AK, AZ, AR,
CA, CO, CT, DE, DC, FL, GA, GU, HI, ID,, IL, IN, IA, KS, KY, LA, ME, I MA, Mil, MN, MS, MO, MT, NE, NV,
NH, NJ, NM, NY, NC, ND, OH, OK, OR, PA, PR, RI, SC, SD, TN, TX, UT, VT VA, VII, WA, WV, WI, WY.
INCORPORATED IN: California,
First Founders Assurance Company (NAIL #12150)
BUSINESS ADDRESS: 6 Mill Ridge Lane, Chester, NJ 07930 - 2486. PHONE: (908) 879-0990,
UNDERWRITING LIMITATION b/: $464,000. SURETY LICENSES c,f/-. NJ, NY. INCORPORATED IN: New
Jersey.
First Insurance Company of Hawaii, Ltd. (NAIL #41742)
BUSINESS ADDRESS: PO Box 2866, Honolulu, Hl 96803, PHONE: (808) 527-7777. UNDERWRITING
LIMITATION b/: $28,154,000. SURETY LICENSES c,f/: GU, I INCORPORATED IN: Hawaii.
First Liberty Insurance Corporation (The) (NAIL #33588)
BUSINESS ADDRESS: 175 Berkeley Street, Boston, 102116. PHONE: (617) 357-9500. UNDERWRITING
LIMITATION bl: $2,229,000. SURETY LICENSES c,f/: AL, AK, AZ, AR, CA, CO, CT, DE, DC, FL, GA, GU, HI,
ID, IL, IN, IA, KS, KY, LA, ME, MD, MA, MI, MN, MS, MO, MT, NE, NV, NH, NJ, NM, NY, II ND, OH, OK, OR,
PA, RI, SC, SD, TN, TX, UT, VT, VA, VI, WA, WV, WI, WY. INCORPORATED IN: Illinois.
First Net Insurance Company (NAIL #10972)
BUSINESS ADDRESS: 424 WEST O'BRIEN DRIVE, STE 202, HAGATNA, GU 96910. PHONE: (671) 477-
8613. UNDERWRITING LIMITATION b/: $1,238,000. SURETY LICENSES cj/: GU, MP. INCORPORATED IN:
Guam.
Frankenmuth Mutual Insurance Company (NAIL #13986)
BUSINESS ADDRESS: One Mutual Avenue, Frankenmuth, MI, 48787 - 0001, PHONE: (989) 652-6121,
UNDERWRITING LIMITATION b/: $60,669,000. SURETY LICENSES c,ff: AL, AZ, AR, CO, CT, DE, FL, GA, ID,
IL, IN, IA, KS, KY, LA, ME, MID, MA, MI, MN, MS, MO, MT, NIE, NV, NH, NJ, NM, NY, NC, ND, OH, OK, OR, PA,
RI, SC, SD, TIN, TX, UT, VT, VA, WA, WV, WI, VVY, INCORPORATED IN: Michigan.
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General Casualty Company Of Wisconsin (NAIL #24414)
BUSINESS ADDRESS: One General Drive, Sun Prairie, WI 53596, PHONE: (608) 825-5160. UNDERWRITING
LIMITATION b/: $17,029,000, SURETY LICENSES c,M AL, AK, AZ, AR, CA, CO„ CT, DE, DC, GA, HI, ID, IL,
IN, A, KS, KY, LA, MID, MA, MI, MN, MS, MO, MT, NE, NV, NH, NJ, NM, NY, NC, ND, OH, OK, OR, PA, RI, SC,
SD, TN, TX, UT, VT, VA, WA, WV, WI, WY, INCORPORATED IN: Wisconsin.
General Reinsurance Corporation (NAIL #22039)
BUSINESS ADDRESS: 120 LONG RIDGE ROAD, STAMFORD, CT 06902 - 1843, PHONE: (203) 328-5000.
UNDERWRITING LIMITATION bl: $1,139,255,000. SURETY LICENSES c,f/: AL, AK, AZ, AR, CA, CO, CT, DE,
DC, FL, GA, ID, IL, IN, 1A, KY, LA, MD, MA, MI, MN, MS:, MO, MT, INE, NV, NJ, NM, NY, NC, ND, OH, OK, OR,
PA, RI, SC, SID, TN, TX, UT, VT, VA, WA, WV, WI, WY. INCORPORATED IN: Delaware,
GRANGE INSURANCE COMPANY OF MICHIGAN (NAIL #11136)
BUSINESS ADDRESS: 671 South High Street, P.O. Box 1218, Columbus, OH 43216 - 1218, PHONE: (614)
445-2900. UNDERWRITING LIMITATION b/: $4,441,000. SURETY LICENSES c,f/: MI, INCORPORATED IN:
Ohio,
GRANGE MUTUAL CASUALTY COMPANY (NAIG #1,4060)
BUSINESS ADDRESS: 671 South High Street, Columbus, OH 43206 - 1014, PHONE: (614) 445-2900,
UNDERWRITING LIMITATION lb/: $118,013,000. SURETY LICENSES c,M AL, GA, IL, IN, IA, KS, KY, MN, MO,
OF, PA, SC, TN, VA, WI. INCORPORATED IN: Ohio.
GRANITE RE, INC. (NAIL #26310)
BUSINESS ADDRESS: 14001 Quailbrook Drive, Oklahoma City, OK 73134. PHONE: (405) 752-2600.
UNDERWRITING LIMITATION b/: $4,157,000, SURETY LICENSES cN: AL, AZ, AR, GO, CT, DE, FL, GA, ID,
IL, IN, IA, KS, KY, LA, ME, MID, MI, MN, MS, MO, MT, NE, NV, NM, NC, ND, OH!, OK, OR, PA, SC, SD, TN, TX,
UT, VT, VA, WA, WV, W1, WY. INCORPORATED IN: Oklahoma.
Granite State Insurance Company (NAIL #23809)
BUSINESS ADDRESS: 175 WATER STREET, 18TH FLOOR, NEW YORK, NY 10038. PHONE: (212) 770-
7QOo.UNDERWRITING LIMITATION 4t$3.3G4.000.SURETY LICENSES nN:AL, AK, AZ, AR, CA, co, CT,
DC, DE, FL, GA, HI, ID, IL, IN, IA, KS, KY, LA, ME, MD, MA, MI, MN, MS, MO, MT, NE, NV, NH.NJ, NM, NY,
NC, NO, OH, OK OR PA, RI, SC, SO, TN, TX, UT, VT, VA, WA, WV, WI, WY. INCORPORATED IN: Illinois.
sm/Y CASKALTY& SURETY COMPANY
nuo|meSS ADDRESS: Po,Box 6202.Mevmiri°.LA7wnO*'62uu.PHONE: (nn4)O88-77oO.UNDERWRITING
LIMITATION W:*1.478.000. SURETY LICENSES n^f/: AL, AZ, AR, CA, DC, GA, IL, KY, LA, MD, MS, MO, NV,
NIVI.NY, NC, OK, PA, SC, TN, TX. INCORPORATED IN: Louisiana.
GRAY INSURANCE COMPANY (rHE)<NAIC#s
BUSINESS ADDRESS: RO. BOX 0202.META|R|E.LA7A0O9-$zo2.PHONE: <mw988o-779o,
UNDERWRITING LIMITATION W: $10.422.O00.SURETY LICENSES o.0:AL, AK, AZ, AR, CA, CO, CT, DE,
DC, FL, GA, HI, ID, IL, IN, IA, KS, KY, LA, ME, MID, MA, MI, MN, MS, MO, MT, NE, NV, NH, NJ, NM, NY, NC,
NO, OH, OK, OR, P\ RI, SC, SD, TN, TX, UT, VT, VA, WA, WV, WI, WY. INCORPORATED IN: Louisiana.
Great American Alliance Insurance Company #26832)
BUSINESS ADDRESS: 301EFourth Street, Cincinnati, DH45202.PHONE:
UNDERWRITING LIMITATION b/:$z.7V1.mno.SURETY LICENSES o'f/:AL, AK, AZ, AR, CA, CO, CT, DE, DC,
FL, GA, H|. |D. |L. IN, |A. KO, KY LA, ME, IVID.MA. M|, MN, M8, IVIO, MT, NE, N\( NH, NJ, NIVI, NY, NC, NO,
OH, OK, OR, P\ RI, SC, SD, TN, TX, UT, VT, WA, WA, WV, WI, WY INCORPORATED IN: Ohio.
Great American Insurance Company (NA|C#ioon1)
BUSINESS ADDRESS: xo1 E P^urlhStr^at C|ncinnoU, OH45202. PHoWE�{*tV3oV-*noo.
UNDERWRITING LIMITATION b/:*io4.u46.V00.SURETY LICENSES c.K: AL, AK, AZ, AR, CA, CO, CT, DE,
DC, FL, GA, GU, HI, ID, IL, IN, IA, KS, KY, LA, ME, MID, MA, MI, MIN, IVIS.MO, MT, NE, NV, NH, NJ, NM, NY,
NC, NO, OH, OK, OR, PA, PR, RI, SC, SO, TN, TX, UT, VT, VA, WA, WV, WI, WY. INCORPORATED IN: Ohio,
GREAT AMER|CANINSURANCE COMPANY OFNEW YORR(MA|C#221t6)
BUSINESS ADDRESS: n$1 EFourth Street, Cincinnati, 0H452u2. PHONE: (s13)D69'50DO.
UNDERWRITING LIMITATION W:$4.»1x'O0O.SURETY LICENSES c'W:AL, AK, AZ, AR, CA, CO, CT, DE, DC,
FL, GA, HI, ID, IL, IN, IA, KS, KY, LA, ME, MD, MA, MI, MN, MS, MO, IVITNE, NV, NH, NJ, NM, NY, NC, NO,
OH, OK, OR, PA, RI, SC, SO, TN, TX, UT, VT, VA, WA, WV, WI, WY. INCORPORATED IN: New York,
Great Northern Insurance Company
BUSINESS ADDRESS: 2028 H*|[vMill Road, Whitehouse Station, NJoe8ee.PHONE:
UNDERWRITING LIMITATION N: $38.17t.0Om.SURETY LICENSES c.f/:AL, AK, AZ, AR, CA, CO, CT, DE,
DC, FL, GA, HI, ID, IL, IN. IA, KS, KY, LA, ME, MD, MA, MK,MN, MS, MO, MT, NE, NV, NH, NJ, NM, NY, NC,
Guarantee Company ofNorth xmwricaWSA
BUSINESS ADDRESS: One Towne Square, Suite 1470. Sounmom, M|48078-3725. PHONE: p48>2*1-0281
x-6002.UNDERWRITING LIMITATION bl:$18.SS5,0OO.SURETY LICENSES o,f/:AL, AK, AZ, AR, CA, CO,
CT, DE, DC, FL, GA, HI, ID, IL, IN, IA, KS, KY, LA, ME, MID, MA, MI, MN, IVIa.IVIo,MT, NE, NV, NH, NJ, NM,
NY, NC, NO, OH, OKOR, PA, PR, RI, SC, SO, TN, TX, UT, VT, VA, VI, WA, mVV,WI, WY. INCORPORATED IN:
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Hanover Insurance Company (The) (NAIC #22292)
UNDERWRITING LIMITATION bl: $129,817,000. SURETY LICENSES c,f/: AL, AK, AZ, AR, CA, CO, CT, DE,
HARCONATIONAL INSURANCE COMPANY �NhAIo
BUSINESS ADDRESS: 7n2OBERLIN ROAD, RALE|8H.NC276n5-oaoo,PHONE: )833-16*0.
UNDERWRITING LIMITATION b/:$20.408.0OO.SURETY LICENSES uj/�AL, AK, AZ, AR, CA, CO, CTDE,
DC, FL, GA, ID, IL, IN, IA, KS, KY, LA, ME, MD, MA, MI, MN, MS, MO, MP, MT, NE, NV, NH, NJ, NM, NY, NC,
NO, OH, OK, OR, PA, RI!'SC, SO, TN, TX, UT, VT, VA, WA, WV, WI, WYINCORPORATED IN: Illinois.
Hartford Accident and Indemnity Company (NA0#22357
BUSINESS ADDRESS: One Hartford Plaza, Hartford, CTos1as'ono1.PHONE: x$Ns47-5go$.
UNDERWRITING LIMITATION b/:$1o4.smr,00n.SURETY LICENSES *N: AL, AK, AZ, AR, CA, CO, CT, DE,
DC, FL, GA, HI, UD.IL, IN, |&. KS, KY, LA, ME, MID, MA, MI, MN, MS, MO, MT, NE, NV, NH, NJ, NM, NY, NC,
NO, OH, 0K OR, P\ PIR, R|, SC, SO, TN, TX, UT, VT, VA, WA, WV, WI, WY. INCORPORATED IN:
Connecticut,
Hartford Casualty C(NA|C
BUSINESS ADDRESS: One Hartford Plaza, Hartford, CTU0i55-UU01.PHONE>547-50oV,
UNDERWRITING LIMITATION b/:$ea.V0.o0O.SURETY LICENSES o.V:AL, AK, AZ, AR, CA, CO, CT, DE,
DC, FL, GA, HI, ID, IL, IN, IA, KS, KY, LA, ME, MD, MA, MI, MN, MS, MO, MT, NE, NV, INK NJ, NM, NY, NC,
NO, OH, OK. OR, P\ R|, SC, GD, TN, TX, UT VT, VA, WA, WV, WI!, WY. INCORPORATED IN: Indiana.
Hartford Fire insurance Company
UNDERWRITING LIMITATION bl: $991,602,000. SURETY LICENSES c,f/- AL, AK, AZ, AR, CA, CO, CT, DE,
DC, FL, GA, GU, HI, ID, IL, IN, IA, KS, KY, LA, ME, MID, MA, MI, MN!, MS, MO, MT, NIE, NV, NH, NJ, NM, NY,
NC, ND, OR OK, OR, PA, PR, RI, SC, SD, TN, TX, UT, VT, VA, WA, WV, W11, WY. INCORPORATED IN:
Connecticut.
Hartford Insurance Company of Illinois (NAIL #38288)
BUSINESS ADDRESS: One Hartford Plaza, Hartford, CT 06155 - 0001. PHONE, (860) 547-5000,
UNDERWRITING LIMITATION b/: $125,353,000. SURETY LICENSES c,fl: CT, HI, IL, MI, NY, PA.
INCORPORATED IN: Illinois,
Hartford Insurance Company of the Midwest (NAIC #37478)
BUSINESS ADDRESS: One Hartford Plaza, Hartford, CT 06155 - 0001. PHONE: (860) 547-6000.
UNDERWRITING LIMITATION b/: $50,777,000, SURETY LICENSES 01: AL, AK, AZ, AR, CA, CO, CT, DE,
DC, FL, GA, HI, 11D, IL, IN,, IA, KS, KY, LA, ME, MID, MA, MI, MIN, MS, MO, MT, NE, NV, NH, NJ, NM, NY, NC,
ND, OH, OK, OR, PA, RI, SC, SO, TN, TX, LIT, VT, VA, WA, WV, WI, WY. INCORPORATED IN: Indiana.
Hartford Insurance Company of the Southeast (NAIL #38261)
BUSINESS ADDRESS: One Hartford Plaza, Hartford, CT 06155 - 0001. PHONE: (86,0) 547-5000.
UNDERWRITING LIMITATION b/: $6,342,000. SURETY LICENSES c,fl: CT, FL, GA, KS, LA, MI, PA,
INCORPORATED IN: Connecticut.
Hudson Insurance Company (NAIL #25054)
BUSINESS ADDRESS: 100 William Street, 5th Floor, New York, NY 10038, PHONE: (212) 978-2800,
UNDERWRITING LIMITATION bl: $42,838,000, SURETY LICENSES c,f/: AL, AK, AZ, AR, CA, CO, CT, DE,
DC, FL, GA, HIS, ID, IL, IIN, A KS, KY, LA, ME, MID, MA, MI, MN, MS, MO, IVIT, NE, NV, NH, NJ, NM, NY, NC,
ND, OH, OK, OR, PA, PR, RI, SC, SD, TN, TX, UT, VT, VA, WA, WV, W1, WY, INCORPORATED IN: Delaware.
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IMIT Insurance Company (NAIL #14257)
BUSINESS AIDDRESS:: P.O. Box 1336, Des Moines, IA 50306 - 1336. PHONE: (515) 327-2777.
UNDERWR11TING LIMITATION V $17,553,000. SURETY LICENSES c,fl: AZ, IL, IA, MN, MO, NE, ND, SD, WI.
INCORPORATED IN: Iowa,
Indemnity Company of California (NAIL #25550)
BUSINESS ADDRESS: P. O. BOX 19725, IRVINE, CA 92623 - 9725. PHONE: (949) 263-3300.
UNDERWRITING LIMITATION b/: $574,000, SURETY LICENSES cj/:AL, AK, AZ, AR, CA, CO, DE, DC, GA,
HI, ID, IN, IKS, KY, LA, MID, MA, MI, MN, MS, MO, MIT, NE, NV, NH, NJ, NM, INC, ND, OK, OR, IPA, RI, SC, SD,
TX, LIT, VT, VA, WA, WV, WY. INCORPORATED IN: California.
Indemnity Insurance Company of North America (NAIL #43575)
BUSINESS ADDRESS: 436 WALNUT STREET, P.O. Box 1000, Philadelphia, PA 19106, PHONE: (2115) 640-
1000. UNDERWRITING LIMITATION bl: $15,341,000. SURETY LICENSES c,fl: AL, AK, AZ, AR, CA, CO, CT
DE, DC, FL, GA, HI, ID, IL, IN, IA, KS, KY, LA, ME, MD, MA, MI, MN, MS, MO, MIT, NE, NV, NH, NJ, NM, NY,
NC, ND, OH, OK, OR, PA, RI, SC, SD, TN, TX, UT, VT, VA, VI, WA, WV, WI, WY. INCORPORATED IN:
Pennsylvania.
Indemnity National Insurance Company (NAIL #18468)
BUSINESS ADDRESS: 725 Cool Springs Blvd., Suite 600, Franklin, TIN 37067. PHONE: (865) 934-4360.
UNDERWRITING LIMITATION bl: $5,005,000. SURETY LICENSES c,f/: AL, AZ, AR, CO, GA, IL, IN, KY, LA,
MD, MS, MT, NV, NM, OH, OK, PA, SC, TN, TX, UT, VA, WV. INCORPORATED IN: Mississippi.
Indiana Lumbermens Mutual Insurance Company (NAIL #142,65)
BUSINESS ADDRESS: 2005 Market Street, Suite 1200, Philadelphia, PA 19103. PHONE: (267) 825-9206.
UNDERWRITING LIMITATION bl: $1,658,000. SURETY LICENSES c,f/: AL, AK, AZ, AR, CA, CO, CT, DE, DC,
FL, GA, HI, ID, IL, IN, IA, KS, KY, LA, ME, MD, MA, MI, MN, MIS, MO, MT, NE, NV, NH, NJ, NM, NY, NC, ND'
OH, OK, OR, PA, RI, SC, SD, TIN, TX, UT, VT, VA, WA, WV, W1, WY, INCORPORATED IN: Indiana.
Inland Insurance Company (NAIL #23264)
BUSINESS ADDRESS: P.O. Box 80468, Lincoln , NE 68501. PHONE: (402) 435-4302, UNDERWRITING
LIMITATION b/: $25:,293,000, SURETY LICENSES c,f/: AZ, CO, IA, KS, MIN, MO, MT, NE, ND, OK, SD, WY.
INCORPORATED IN: Nebraska.
Insurance Company Of North America (NAIL 022713)
BUSINESS ADDRESS: 436 WALNUT STREET, P.O. Box 1000, Philadelphia, PA 19106. PHONE: (215) 640-
1000. UNDERWRITING LIMITATION b/: $34,819,000, SURETY LICENSES c,f/: AL, AK, AZ, AR, CA, CO, CT,
DE, DC, FL, GA, GU, HI, ID, IL, IN, IA, KS, KY, LA, ME, MID, MA, MI, MN, MS, MO, MP, MT, NE, NV, NH, NJ,
NM, NY, NC, ND, OH, OK, OR, PA:, PR, RI, SC, SD, TN, TX, UT, VT, VA, WA, WV, WI, WY. INCORPORATED
IN: Pennsylvania,
Insurance Company of the State of Pennsylvania (The) (NAIL #19429
BUSINESS ADDRESS: 175 WATER STREET, 18TH FLOOR, NEW YORK, NY 10038. PHONE: (212) 770-
7000. UNDERWRITING LIMITATION b/: $14,442,000, SURETY LICENSES c,fl: AIL, AK, AZ, AR, CA, CO, CT,
DE, DC, FL, GA, HI, ID, IL, IN, IA, KS, KY, LA, ME, MID, MA, MI, MN, MS, MO, MT, NE, NV, NH, NJ, NM, NY,
NC, ND, OH, OK, OR, PA, RI, SC, SD, TN, TX, UT, VT, VA, WA, WV, WI, WY. INCORPORATED IN: Illinois.
Insurance Company ofthe West
BUSINESS ADDRESS: P/O. BOX no9039.SAN0Es0,rAeo1oo.PHONE: (858)350-240O»2550.
UNDERWRITING LIMITATION b/:$8V.454.00n.SURETY LICENSES c.V:AL, AK, AZ, AR, CA, CO, CT, DE,
DC, FL, GA, HI, ID, IL, IN, IA, KS, KY, LA, ME, MID, MA, MI, MN, MS, MO, MT, NE, NV, NH!I,NJ, NM, NY, NC,
Insurors Indemnity #43273)
BUSINESS ADDRESS: R0.Box 2Ve3.Waco, TX7o702-2003.PHONE: .UNOERWRUVNG
LIMITATION bl: $2,106,000. SURETY LICENSES cj/: AR, NM, OK, TX, INCORPORATED IN: Texas.
UNTEQRANDASSURANCE CO
BUSINESS ADDRESS: PoBox 70128.San Juan, FIR 00838'81z8. PHONE: (
UNDERWRITING LIMITATION bt$5.072.0OD. SURETY LICENSES c.V:PR, VI. INCORPORATED IN: Puerto
Integrity Mutualhsmrame
BUSINESS ADDRESS: P.O. Bpx539, Appleton, WI 54912'O589PHONE:
LIMITATION b/:*5,374,0oO.SURETY LICENSES c.f/:IL, IA, MN, OH, N@.INCORPORATED IN: Wisconsin,
International Fidelity Insurance Company (NAIC #1159V)
BUSINESS ADDRESS: One Newark Center, Newark, NJO7102 5207.PN0ME�(973)624'7200.
mN0ERWR|T1NGLVM|7ATUoNb/:$7.161.0U0.GURETYL|CEWSESu.f/:AL.AK.AZ.AR.CA.co.cTDE.DC.
FL, GA, GU, HI, ID, IL, IN, IA, KS, KY, LA, ME, MD, MA, MI, MN, MS, MO, MT, NE, NV, NH, NJ, NM, NYNC,
No, OH, OK, OR, PA, PR, R|, SC, GD,TN. TX, UT, VT, VA, VI, WA, WV, WI, WY. INCORPORATED IN: New
uorsoy.
BUSINESS ADDRESS: P.m.BOX a1or.msvvvoRK.NY1U&U8.PHONE: (617)3s7'g5oV.UNDERWRITING
LIMITATION b/:$9.B23.O0O.SURETY LICENSES c.O(AL, AK, AZ, AR, CA, CO, CT DE, DC, FL, GA, GU, HI,
ID, IL, IN, IA, KS, KY, LA, ME, MID, MA, MI, MN, MS, MO, MT, NE, NV, NH, NJ, NM, NY, NC, ND, OH, OK, OR,
PA, PR, RI, SC, SD.TN, TX, UT, VT, VA, WA, WV, WI, WY. INCORPORATED, IN: Wnnexvta.
ISLAND INSURANCE COMPANY, LIMITED #22845)
BUSINESS ADDRESS: PO.Box 152O.Honolulu, H|eG8Os-1o2o.PHONE: (o08)s04'x200.UNDERWRITING
LIMITATION b/: $11,553,000. SURETY LICENSES c,f/: HL INCORPORATED IN: Hawall,
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LEXNGrONNATIONAL INSURANCE CORPORATION yNAIC
BUSINESS ADDRESS: po, BOX 600x.LVTHERV|LLE.MID 21VV4.PHONE �
UNDERWRITING LIMITATION tl: $1.«30.0O0.SURETY LICENSES o.h:AL, AK, AZ, AR, CA, CO, CT, DE, oo
FL, GA, HI, ID, IT, IN, IA, KS, KY, LA, ME, MID, MA, MU, MN, MS, MO, MT, NE, NV, NH, NJ, NM, NY, NC, OH.
LaxooInsurance Company yWx|o#1a3V7>
BUSINESS ADDRESS: 10002 Shelbyville Rd, Suite 100, Lou|miKe, KY48za3. PHONE: <01 553-9500.
UNDERWRITING LIMITATION hh $6^$05.000. SURETY LICENSES o.k:AL, AK, AZ, AR, CA, CO, CT, DE, DC
FL, GA, GU, HI, ID, IL, IN, UA.KS, KY, LA, ME, MD, MA, MI, MN, MS, MO, MP, MT, NE, NV, NJ, NM, NC, ND,
Liberty Insurance Co,vraUon<NAIC
BUSINESS ADDRESS: 175 Berkeley Street, Boston, wmwz11w pnoms n .uwosRVVR[rUWG
LIMITATION b/:*24.5V7.00o.SURETY LICENSES u,flAL, AK, AZ, AR, CA, CO, CT, DE, DC, FL, GA, GU, HI,
ID, IL, IN, IA, KS, KY, LA, ME, MD, MA, MI, MN, MS, MO, MID, MTNE, NV, NFI.NJ, NM, NY, NC, ND, OH, OK,
OR, PA, PR, RI, SC, 8D,TN, TX, UT, VT, VA, WA, WV, WI, WY. INCORPORATED IN: Illinois,
Liberty
BUSINESS ADDRESS: 17n Berkeley Street, Boston,MAo2116, PNVNE�(017) 357-9500. UNDERWRITING
LIMITATION b/:$131.11T,0oO.SURETY LICENSES c,fl: AL, AK, A7.AR, CA, CO, CT, DE, DC, FL, GA, GU,
H|. |D. |L. IN, |A, KS, KY, U\ ME, M�o, MA, MI, MN, MS, MO, MP, MT, NE, NV, NH, NJ, NM, NY, NC, ND, OH,
OK, OR, P\ PR, R|, 3C, SD, TN TX. LIT, VT, VA, VI, WA, WV, WI, WY. INCORPORATED IN: Wisconsin.
Liberty Mutual Insurance Company (NAIC #23043)
BUSINESS ADDRESS: 175BStreet, Boston, MAno11s, PHONE: (o17)357-950w.UNDERWRITING
ID, IL, IN, IA, KS, KY, LA, ME, MID, MA, MI, MN, MS, MO, MP, MiT, NE, NV, NH, NJ, NM, NY, NC, ND, OH, OK,
OR, PA, PR, RI, SC, SD, TN, TX, UT, VT, VA, VI, WA, WV, Wl, WY. INCORPORATED IN: Massachusetts.
LM Insurance Corporation (NAIC #33600)
BUSINESS ADDRESS: 175 Berkeley Street, Boston, MA 02116, PHONE: (617) 357-9500. UNDERWRITING
LiMITATION b/: $11,649,000. SURETY LICENSES 01: AL, AK, AZ, AR, CA, CO, CT, DE, DC, FL, GA, GU, HI,
ID, IL, IN, IA, KS, KY, LA, MIE, MD, MA, MI, MN, MS, MO, MP, MT, NE, NV, NH, NJ, NM, NY, NC, ND, OH, OK,
OR, PA, RI, SC, SD, TN, TX, UT, VT, VA, VI, WA, WV, WI, WY. INCORPORATED IN: Illinois.
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Manufacturers Alliance Insurance Company (NAIC #36897)
BUSINESS ADDRESS: P.O. Box 3031, Blue Bell, PA 19422 - 0754. PHONE: (610) 397-5000,
UNDERWRITING LIMITATION b/: $7,584,000, SURETY LICENSES c,fl: AL, AK, AZ, AR, CO, CT, DE, DC, ID,
IN, KS, KY, LA, ME, MID, MI, MS, MO, MT, NE, NV, NH, NJ, NM, NY, NC, OH, PA, RI, SC, SD, TN, LIT, VT, VA,
WA. INCORPORATED IN: Pennsylvania.
MARKEL INSURANCE COMPANY (NAIC #38970)
BUSINESS ADDRESS: 4521 Highwoods Parkway, Glen Allen, VA 23060, PHIONE: (800) 431-1270 x-3888.
UNDERWRITING LIMITATION b/: $40,924,0100. SURETY LICENSES cjP AL, AIK, AZ, AR, CA, CO, CT, DE,
DC, FL, GA, HI, ID, IL, IN,IA, KS, KY, LA, ME, MID, MA, MI, II MS, MO, MP, MT, NE, NV, NH, NJ, NM, NY,
NC, ND, OH, OK:, OR, PA, PR, RI, SC, SO, TN, TX, UT, VT, VA, WA, WV, WI, WY. INCORPORATED IN: Illinois.
Massachusetts Bay Insurance Company (NAIC #22306)
BUSINESS ADDRESS: 440 LINCOLN STREET, WORCESTER, MA 01663 - 0002, PHONE: (508) 853-7200,
UNDERWRITING LIMITATION b/: $6,516,000, SURETY LICENSES c,f/: AL, AK, AZ, AR, CA, CO, CT, DE, DC,
FL, GA, HI, ID, IL, IN, ]A, KS, KY, LA, ME, MID, MA, MI, MN, MS, MO, MT, NE, NV, NHI, NJ, NM, NY, NC, ND,
OH, OK, OR, PA, RI, SC, SD, TN, TX, VT, VA, WA, WV, WI, WY INCORPORATED IN: New Hampshire,
Merchants Bonding Company (Mutual) (NAIC #1449,4)
BUSINESS ADDRESS: P.O BOX 14498, DES MOINES, IA 50306 - 3498. PHONE: (515) 243-8171.
UNDERWRITING LIMITATION b/: $11,213,000. SURETY LICENSES c,f/: AL, AK, AZ, AR, CA, CO, CT DE,
DC, FL, GA, HI, ID, IL, IN, IA, KS, KY, LA, ME, MD,, MA, MI, MN, MS, MO, MT, NE, NV, NH, NJ, NM, N�, NC,
NO, OH, OK, OR, PA, Ri, SC, SD, TN, TX, UT, VT, VA, WA, WV, WI, WY. INCORPORATED IN: Iowa.
Merchants National Bonding, Inc. (NAIC #11595)
BUSINESS ADDRESS: P.O. Box 14498, DES MOINES, IA 50306 - 3498. PHONE: (515) 243-8171.
UNDERWRITING LIMITATION b/: $1,557,000. SURETY LICENSES c,fl: AL, AK, AZ, AR, CO, CT, DE, DC, FL,
GA, HI, ID, IL, IN, IA, KS, KY, LA, ME, MD, MA, MI, MN, MS, MO, MIT, NE, NV, NJ, NM, NY, NC, NID, OH, OK,
OR, PA, PR, R1, SC, SD, TN, TX, UT, VT, VA, WA, WV, WI, WY, INCORPORATED IN: Iowa.
Michigan Millers Mutual Insurance Company (NAIC #14508)
BUSINESS ADDRESS: P, O. Box 30060, Lansing, MI 48909 - 7560, PHONE: (517) 482-6211 x-5115.
UNDERWRITING LIMITATION bl: $5,999,000. SURETY LICENSES c,fl: AZ, AIR, CA, CO, GA, ID, IL, IN, 1A,
KS, KY, MI, MN, MO, MT, NE, NY, NC, ND, OH, OK, OR, PA, SD, TN, VA, WA, WI, WY INCORPORATED IN:
Michigan.
Mid -Century Insurance Company (NAIC #21687)
BUSINESS ADDRESS: P.O. BOX 4402, WOODLAND HILLS, CA 91365, PHONE: (323) 932-3200,
UNDERWRITING LIMITATION, bf: $107,758,000. SURETY LICENSES c,f/: AL, AZ, AR, CA, CO, FL, GA, HI,
ID, IL, IN, IA, IKS, MA, MI, MN, MS, MO, MT, NE, NV, NJ, NM, NY, NC, ND, OH, OK, OR, PA, SD, TIN, TX, LIT,
VT, VA, WA, WI, WY. INCORPORATED IN: California.
MI,D-CONTINENT CASUALTY COMPANY (NAIC #23418)
BUSINESS ADDRESS: P.O. Box 1409, Tulsa, OK 74101. PHONE: (918) 587-7221, UNDERWRITING
LIMITATION bl: $16,224,000, SURETY LICENSES c,f/: AL, AZ, AR, CO, CT, IL, IN, IA' KS, KY, LA, ME, MN,
MS, MO, MT, NE, NJ, NIM, NC, OH, OK, PA, SC, TN, TX, LIT, VA, WA, WY. INCORPORATED IN: Ohio,
Motorists Commercial Mutual Insurance Company (NAIC #13331)
BUSINESS ADDRESS: 471 East Broad Street, Columbus, OH 43215. PHONE: (614) 225-8211.
UNDERWRITING LIMITATION bl: $14,747,000, SURETY LICENSES c,f/: AZ, CA, CO, CT, DE, DC, GA, ID, IL,
IN, IA, KS, KY, ME, MID, MA, MI, MN, MO, NE, NV, NH, NJ, NM, NY, NC, ND, OH, OK, OR, PA, RI, SC, SD, TN'
TX, LIT, VT, VA, WA, WV, WI, WY, INCORPORATED IN: Ohio,
Motorists Mutual Insurance Company (NAIC #14621)
BUSINESS ADDRESS: 471 East Broad Street, Columbus, OH 43215. PHONE: (614) 226-8211.
UNDERWRITING LIMITATION b/: $46,067,000. SURETY LICENSES c,f/: IN, KY, MI, OH, PA, WV.
INCORPORATED IN: Ohio.
Motors Insurance Corporation (NAIC #22012)
BUSINESS, ADDRESS: 500 WOODWARD AVE, 14TH FLOOR, DIETROIT, W 48226. PHONE: (313) 656-5437.
UNDERWRITING LIMITATION b/: $86,776,000, SURETY LICENSES c,fl: AL, AK, AZ, AR, CA, CO, CT, DE,
DC, FL, GA, HI, ID, IL, IN, IA, KS, KY, LA, ME, MID, MA, MI, MN, MS, MO, MT, NE, NV, NH, NJ, NIM, NY, NC,
ND, OH, OK, OR, PA, RI, SC, SO, TN, TX, UT, VT, VA, WA, WV, WI, WY. INCORPORATED IN: Michigan.
Munich Reinsurance 0227)
BUSINESS ADDRESS: 55GCOLLEGE ROAD EAST 'P.o.BOX 5241.PR{NCETOM.NJ08n43.PHONE:
(8U9)2434zoo.UNDERWRITING LIMITATION W:$3o2.0«7.000. SURETY LICENSES u.V:AL, AK, AZ, AR,
CA, CO, CT, DE, DC, FL, GA, H1.ID, IL, IN, IA, KS, KY, LA, ME, MD, MA, MU.MN, MS, MO, MT, NE, NV, NH,
NJ, NM, NY, NC, ND, mH!'OK, OR, PA, PR, RI, SC, SD.TM.TX, LIT, VT, VA, VVAWV, WI, WY.
INCORPORATED IN: Delaware.
National American Insurance Cum #23663)
BUSINESS ADDRESS: P.0.Box s.Chandler, OK74834.PHONE: (4o5)2sa-o8o4.UNDERWRITING
LIMITATION b/::$6.7g2'0QO.SURETY LICENSES o,f/:AL, AK, Az, AR, CA, CO, CT, DC, FL, GA, H|. 0. |L. IN,
IA, KS, KY, LA, ME, MD, MI, MN, MS, MO, MT, NE, NV, NJ, NM, NY, NC, ND, OH, OK, OR, PA, RI, SC, SD'
TN, TX, UT, VA, WA, WV, WI, WY. INCORPORATED IN: Oklahoma.
National CmltyCom #11991)
BUSINESS ADDRESS: ONE WEST NATIONWIDE BLVD,1-o4-7n1.CVLVMBVS.OH43215-22zV.PHONE:
(480) 365~4O00.UNDERWRITING LIMITATION b/: $14.m77.0ou.SURETY LICENSES r.htAL, AK, AZ, AR, CA,
CO, CT, mE.DC, FL, GA, Ill, ID, IL, IN, |A.KS, KY, LA, ME, MD, MA, MI, MN, MS, MO, MT, NE, NV, NH, NJ,
NM, NY, NC, ND. OH, OK, OR, PA, RI, SC, SD, TN, TX, LIT, VT, VA, WA, WV, WI, WYINCORPORATED IN:
Ohio.
NATIONAL FARMERS UNION PROPERTY AND CASUALTY COMPANY
BUSINESS ADDRESS: One General Drive, Sun Prairie, Wl 53596. PHONE: (608) 825-5160, UNDERWRITING
LIMITATION — $4,213,000. SURETY LICENSES cjf: A_. AK, AZ, AR,_CA, CO, DE, DC, GA, HI, ID, IL, 'IN, 'IA'
KS, KY, LA, ME, MD, MA, MI, MN, MS, MO, MT, NE, NV, NH, NJ, NY, NC, ND, OH, OK, OR, PA, RI, SC, SD,
TN, TX, LIT, VT, VA, WA, VVY WI, WY. INCORPORATED ftYNwwasim.
National Fire & Marine Insurance Co
BUSINESS ADDRESS: 1314 Douglas Street, Suite 1400. Omaha, msm01V2 '1g44 PHONE: 10-3080.
UNDERWRITING LIMITATION b/:$718.72O.0oV,SURETY LICENSES c'/:NE. INCORPORATED IN:
Nebraska.
National Fire Insurance Company nfHartford <NA|C#2D47N
BUSINESS ADDRESS: 1s1N.FRANNUNGT,CG|CAGO,|L8080G,PHONE: (n12)m22'amn0.
UNDERWRITING LIMITATION b/:$11.785.008.SURETY LICENSES *.f/: AL, AK, AZ, AR, CA, CO, CT, DE,
DC, FL, GA,HI, ID, IL, IN, IA, KS, KY, LA, ME, MID, MA, MI, MN, MS, MO, MiT,NE, NV, NH, NJ, NM, NY, NC,
ND, Old, OK, OR, PA, PR, RI, SC, SD, TN, TX, UT, VT, VA, WA, WV, WI, WY. INCORPORATED IN: Illinois.
National Indemnity Com
BUSINESS ADDRESS: 1o1*Douglas Street, Suite 1400.Omaha, NEm9102-1$44,PHONE: (402916-3000,
UNDERWRITING LIMITATION W:$12.315^22o.mn0, SURETY LICENSES c.fpAL, AK, AZ, AR, CA, CO, CT,
DE, DC, FL, GA, ID, IL, UN.IA, KS, KY, LA, ME, MD, MI, MN, MS, MO, MT, NE, NV, Nil, NM, No.ND, OH, OK,
OR, PA, R|, SC, SD,TN, TX, UT VT, VA, WA, WV, WI, WY. INCORPORATED IN: Nebraska.
National Liability & Fire Insurance Company (NA|C#2V052)
BUSINESS ADDRESS: 1o14Douglas Street, Suite 1400^Omaha, NEuO182-1S44,PHONE: (404816-3000.
UNDERWRITING LIMITATION b/: $124.o2r.wuo.SURETY LICENSES o.t(AL, AK, CA, CT, DE, DC, H|.ID, IL,
IA, KS, KY, MID, MA, MI, MS, MO, NE, NH, NJ, NM, NY, ND, OH, OK. RI, SC, SD, TX, UT, VT, VA, WA, WY.
INCORPORATED IN: Connecticut.
National Surety Cuqpvmtivn<N4|C 0218 1
BUSINESS ADDRESS: 22smkVYASHUWGToNSTREET, SUITE 1G0Q.CH|CA6O.|Ls000s'34o4. PHONE:
(888) 466-78*3.UNDERWRITING LIMITATION h/:$7.381.800.SURETY LICENSES o.f/: AL, AK, AZ, AR, CA,
CO, CT, DE, DC, FL, GA, GU, HI, ID, IL, IN, IA, KS, KY, LA, ME, MD, MA, MI, MN, MS, MO, MT, NE, NV, Nil,
NJ. NM. NY, NC, ND, OH, OK, OR, PA, PR, RI, SC, 8D, TN, T( UT, VT, VA, WA, WV, WI, WY,
INCORPORATED IN: Illinois.
NATIONAL TRUST INSURANCE COMPANY (NAIC#2o141)
BUSINESS ADDRESS: 8»00University Parkway, Sarasota, FL8424O-a424,PHONE: (u80)22o-3221�
UNDERVVRhTKMoLUM|T7V0N b/: $3.7D1.8O0.SURETY LICENSES c.n: AZ. DC, FL, GA. UL. IN, |A. KY, LA,
MD, MI, MS, MO, NE, NC, OK, PA, SC, TN, TX, INCORPORATED IN: Indiana.
National Union Fire Insurance Company ofPittsburgh, PA
BUSINESS ADDRESS: 175 WATER STREET, 18TH FLOOR, NEW YORK, NY 10038, PHONE: (214770'
7000.UNDERVYR|T|NGL|M|lAT|ONh/: $043.115,000.SURETY LUCEN8E8uN:AL, AK, AZ, AR, CA, GO, CT,
DE, DC, FL. GA, GU'Ill, |D. |L. IN, IA, KS, KY, LA, ME, MD, MA, MI, MN, MG, MO, MID, MT, NE, N\( NH' NJ.
NM, NY, NC, ND, OH, OK, OR, PA, PR, RI, SC, SD, TN, TX, LIT, VT, VA, WA, WV, WI, WY. INCORPORATED
IN: Pennsylvania.
Nationwide AgribusinessInsurance Company #28223}
BUSINESS ADDRESS: ONE WEST NATIONWIDE 8LVD,1-o4'7o1.CoLuMmUG.OH43215 2228.PHONE:
<s14>24g4s45.UNDERWRITING L|MKTAT|0Nb/:$1n`1e3.o0o. SURETY LICENSES c.V:AL, AZ, AR, CA,
CO, CT, DE, DC, FL, GA, |D. |L. IN, IA, KS, KY, LA, ME, MD, MA, MU, MN, M8, M0, MT, NE, NV, NH, NV. NM,
Nationwide Mutual Insurance Company (NAIC #23787)
BUSINESS ADDRESS: ONE WEST NATIONWIDE BLVD., 1-04-701, COLUMBUS, OH 43215 - 2220. PHONE:
(614) 249-7111. UNDERWRITING LIMITATION bl: $1,142,701,000., SURETY LICENSES c,f/: AL, AK, AZ, AR,
CA, CO, CT, DE, DC, FL, GA, HII, ID, ill-, IIN, IA, KS, KY, LA, ME, MD, MA, MI, MN, MS, MO, MT, NE, NV, NH,
NJ, NM, NY, NC, ND, OH, OK, OR, PA, RI, SC, SO, TN, TX, UT, VT, VA, A WA, WV, WL WY
INCORPORATED IN: Ohio.
NAVIGATORS INSURANCE COMPANY (NAIC #42307)
BUSINESS ADDRESS: 400 Atlantic Street, 8th Floor, Stamford, CT 06901. PHONE: (203) 905-6090.
UNDERWRITING LIMITATION bl: $105,656,000. SURETY LICENSES c,f/: AL, AK, AZ, AR, CA, CO, CT, DE,
DC, FL, GA, GU, HI, ID, IL, IN, IA, KS, KY, LA, ME, MD, MA, MI, MN, MS, MO, MT, NE, NV, NH, NJ, NM, NY,
NC, NO, OH, OK, OR, PA, PR, RI, SC, SD, TN, TX, UT, VT, VA, WA, WV, WI, WY. INCORPORATED IN: New
York.
Now Hampshire Insurance Company (NAIC #23,841)
BUSINESS ADDRESS: 175 WATER STREET, 18TH FLOOR, NEW YORK, NY 10038. PHONE: (212) 770-
7000. UNDERWRITING LIMITATION bl: $18,518,000. SURETY LICENSES cjl: AL, AK, AZ, AR, CA, CO, CT,
DE, DC, FL, GA, HI, ID, IL, IN, lA, KS, KY, LA, ME, MID, MA, MI, MN, MS, MO, MT, INE, NV, NH, NJ, NM, NY,
NC, ND, OH, OR, PA, FIR, RI, SC, SD, TN, TX, UT, VT, VA, WA, WV, Wl, WY. INCORPORATED IN: Illinois.
NGM Insurance Company (NAIC #14788)
BUSINESS ADDRESS: 55 WEST STREET, KEENE, NH 03431. PHONE: (904) 380-7282, UNDERWRITING
LIMITATION bl: $98,934,000, SURETY LICENSES c,fl: AL, AZ, AR, CO, CT, DE, DC, FL, GA, ID, IL, IN, IA,
KS, KY, LA, ME, MID, MA, MI, MS, MO, MT, NE, NV, NH, NJ, NM, NY, NC, ND, 'OH, OK, OR, PA, RI, SC, SD,
TN, TX, UT, VT, VA, WA, WV, Wi, WY. INCORPORATED IN: Florida,
NORTH AMERICAN SPECIALTY INSURANCE COMPANY (NIAIC #29874)
BUSINESS ADDRESS: 5200 METCALF AVENUE, OVERLAND PARK, KS 66202 - 1391. PHONE: (913) 676-
5200. UNDERWRITING LIMITATION b/: $,23,900,000. SURETY LICENSES G,M AL, AK, AZ, AR, CA, CO, CT,
DE, DC, FL, GA, GU, HI, ID, IL, IN, IN KS, KY, LA, ME, MID, MA, MI, MIN, MS, MO, MT, NE, NV, NH, NJ, NM'
NY, NC, IND, OH, OK, OR, PA, FIR, IRI, SC, SD, TN, TX, LIT VT VA, A WA, WV, WI, WY. INCORPORATED IN:
New Hampshire.
NOVA Casualty Company (NAIC #42552)
BUSINESS ADDRESS: 440 LINCOLN STREET, WORCESTER, MA 01653 - 0002. (PHONE: (508) 853-7200.
UNDERWRITING LIMITATION bl: $8,858,000. SURETY LICENSES cjf: AL, AK, AZ, AR, CA, CO, CT, DE, DC,
FL, GA, HI, 11D, IIL, IN, IA, KS, KY, LA, ME, MID, MA, MI, MN, MS, MO, MT, NE, NV, NH, NJ, NM, NY, NC, ND,
OH, OK, OR, PA, RI, SC, SD, TN, TX, UT, VT, VA, WA, WI, WY. INCORPORATED IN: New York.
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Ohio Casualty Insurance Company (The) (NAIC #24074)
BUSINESS ADDRESS: 175 Berkeley Street, Boston, MA 02116. PHONE: (617) 357-9500, UNDERWRITING
LIMITATION bl: $158,673,000. SURETY LICENSES c,f/: AL, AK, AZ, AR, CA, CO, CT, DE, DC, FL, GA, Hi, ID,
IL, IN, lA, KS, KY, LA, ME, MID, MA, Mi, MN, MS, MO, MT, NE, NV, NH, NJ, NM, NY, NC, ND, OH, OK, OR, PA,
RI, SC, SD, TN, TX, UT, VT, VA, WA, WV, WI, WY, INCORPORATED IN: New Hampshire.
Ohio Farmers Insurance Company (NAIC #24104)
BUS11NESS ADDRESS: P.O. Box 5001, Westfield Center, OH 44251 - 5001. PHONE: (330) 887-0101,
UNDERWRITING LIMITATION b/:: $233,551,000. SURETY LICENSES c,f/: AL, AZ, AR, CO, DC, DE, FL, GA,
IL, IN, I& KY, LA, MD, MA, MI, MN, MS, MO, MT, NE, NV, NJ, NM, NY, NC, ND, OH, OK, PA, RI, SC, SD, TN'
TX, LIT, VA, WA, WV, WI, WY. INCORPORATED IN: Ohio,
Ohio Indemnity Company (NAIC #26565)
BUSINESS ADDRESS: 250 E. Broad St., 7th Floor, Columbus, OH 43215 - 0000, PHONE: (614) 228-2800.
UNDERWRITING LIMITATION b/: $4,546,000. SURETY LICENSES c,f/: AL, AK, AZ, AR, C& CO, CT, DE, DC,
FL, GA, HI, ID, IL, IIN, IA, KS, KY, LA, ME, MD, MI, MN, MS, MO, MT, NE, NV, NH, NJ, NM, NY, NC, ND' OH,
OK, OR, PA, RI, SC, SD, TN, TX, UT, VT, VA, WA, WV, WI, WY. INCORPORATED IN: Ohio,
Ohio Security Insurance Company (NAIC #24082)
BUSINESS ADDRESS: 175 Berkeley Street, Boston, MA 021% PHONE: (617) 357-9500. UNDERWRITING
LIMITATION b/: $1,498,000, SURETY LICENSES cj/: AL, AK, AZ, AR, CA, CO, CT, DE, DC, FL, GA, ID, IL, IN,
lA, KS, KY, LA, ME, MD, MA, MI, MN, MS, MO, MT, NE, NV, NH, NJ, NM, NY, NC, ND, OH, OK, OR, PA, RI,
SC, SD, TN, TX, LIT, VT, VA, WA, WV, WI, WY. INCORPORATED IIN: New Hampshire.
Oklahoma Surety Company (NAIC #23426)
BUSINESS ADDRESS: P.O. Box 1409, Tulsa, OK 74101, PHONE: (918) 587-7221. UNDERWRITING
LIMITATION b/: $1,654,000. SURETY LICENSES c,fl: AR, KS, OH, OK, TX. INCORPORATED IN: Ohio.
OLD DOMINION INSURANCE COMPANY (NAIC #40231)
BUSINESS ADDRESS: 55 WEST STREET, KEENE, NH 03431. PHONE!: (904) 380-7282. UNDERWRITING
LIMITATION to/: $3,606,000. SURETY LICENSES c,f/: CT, DE, FL, GA, ME, MD, MA, NH, NY, NC, PA, RI, SC,
TN, VT, VA. INCORPORATED IN: Florida.
Old Republic General Insurance Corporation (NAIC #24139)
BUSINESS ADDRESS: 307 NORTH MICHIGAN AVENUE, CHICAGO, IL 60601, PHONE: (312) 346-8100.
UNDERWRITING LIMITATION b/:g�630,000. SURETY LICENSES �AL, AK, AZ, AR, CA, CO, CT, DE,
DC, FL, GA,|c\ IL. IN, m` K8. Kt LA, ME, MD, MA MI, MN, MS, MO, MT NF.NV, MH, NJ, NM, NY, NC, ND,
om. OK. OR, PA, RI!, GC, SU, TN, TX, UT, VTVA, WA, WV, WI, WY. INCORPORATED IN: Illinois.
Old Republic|
BUSINESS ADDRESS: P.O. Box ros.Greensburg, P*zssn1 nran.PMONE:
UNDERWRITING LIMITATION b/: $114.117.000,8URETY LICENSES 0tAL, AK, AS, AZ, AR, CA, CO, CT,
DE, DC, FL, GA, GU, H|. |D' |L' IN, YA. KS, KY, LA' ME, MID, MA, M|, MN, MS, MO, MP, MT, NE, NV, MH. NJ.
NM, NY, NC, ND, OH, OK, OR, PA, PR, RI, SC, 3ID.TN, TX, UT, VT, VA, VI, WA, WV, WI, WY.
INCORPORATED IN: panmvyhania,
Old'RepubllicSurmty CNA|C
BUSINESS ADDRESS: P.O.BOX 16n5.M|LVVAUKEE.VV|s32O1-1035.PHONE: (262)797-2640.
UNDERWRITING LIMITATION hk$7,048,0Cm.SURETY LICENSES oltAL, AZ, AR, CA, CO, DC, FL, GA, ID,
UL, IN, IA, KS, MD, MN, M8, MO, MIT, NE, NV, NM. NC. ND, OH, OK, OR, PA, 8C, GD'TN. T%. UT, VA, WA,
WV, WI, WY. INCORPORATED IN: Wisconsin.
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Pacific Indemnity Company (NAIC #20340)
BUSINESS ADDRESS: 202B Hall's Mill Road, Whitehouse Station, MUnaaa8. PHONE: (215)$40-1000.
UNDERWRITING LIMITATION b/: $31a.uoo,0oo.SURETY LICENSES c.fl: AL, AK, AZ, AR, CA, CO, CT, DE,
DC, FL, GA, HI, ID, IL, IN, 1A.KS, KY, LA, ME, MID, MA, MU,MN, MS, MO, MT, NE, NV, NH, NJ, NM, NY, NC,
ND, OH, OK, OR, PA, R|, 8O, SD, TN, TX, UT, VT, VA, WA, WV, WI, WY. INCORPORATED IN: Wisconsin.
PACIFIC INDEMNITY INSURANCE COMPANY yNA|C#183GO
BUSINESS ADDRESS: 34VWEST D'BRUENDRIVE, HA8ATNA.GUgVo1V.PHONE: <071 3.
'UNDERWRITING LIMITATION N: $2.o4m.ouo.SURETY LICENSES c.ft:GU, MP. INCORPORATED IN: Guam
PARTNER REINSURANCE COMPANY oFTHE u.S.(mA{C#3OU3Q)
BUSINESS ADDRESS: 2OuFirst Stamford Place, Suite 40O.Stamford, CTO890z,PHONE: (2V3)4x5'42V0,
UNDERWRITING LIMITATION b/: $122.636.000. SURETY LICENSES x.f/:AL, AZ. oA,Co. DC. |L. KS. M|.
MS, NE, NY, TX, UT, WA. INCORPORATED IN: New York,
PAqTNERRGINSURANCE COMPANY 0F
BUSINESS ADDRESS: 2ooFirst QtarnfordPlace, Suite 400.3tamfond.OTo6no2,PHONE:
UNDERWRITING LIMITATION bl$O1.832.8Oo.SURETY LICENSES u,f/: AL, x7.CA, CO, DE, DC, ID, IL, IN,
IA, KS, KY, MD, MI, MN, MS, MT, NE, NJ, NM, NY, ND, OH, OK, OR, PA, RI, SC, SD, TX, UT, VT, VA, WA, YVV
WI. INCORPORATED ft Now York.
Pekin Insurance Company 0NAIC#242u8
BUSINESS AooREoS�25OsCOURT STREET, PEK|N.|L815m8-Doo1.PHONE: (309)346-1101.
UNDERWRITING LIMITATION bt013.231.00V,SURETY LICENSES o.N:AZ, |L, IN, IA, MI, QH'WI,
INCORPORATED IN: Illinois.
Pen(NAIC #41
BUSINESS ADDRESS: P.O. Box 3031.Blue Bell, RA19422 U754.PHONE: (018)3S7-580U.
UNDERWRITING LIMITATION bt$A,662.vnm. SURETY LICENSES o1:AL, AK, AZ, AR, CO, CT, DE, DC, |n
IN, KS, KY, LA, ME, MD, MI, MS, MO, MT, NE, NV, NH, NJ, NM, NY, NC, OH, PA, RI, SC, 8ID.TN, UT, VT, VA,
WA. INCORPORATED IN: Pennsylvania,
Pennsylvania Insurance Company
BUSINESS ADDRESS: P.O. Box 3031,Blue Bell, PA1o422-orn4.PHONE: Vs1#l3975oO0.
UNDERWRITING LIMITATION b/: $34,3a4,0un.SURETY LICENSES c,f/:AL, AK, AR, CO, CT, DE, DC, FL,
GA, HI, ID, U.IA, KS, KY, LA, ME, MID, MA, MI, MS, MO, MT, NE, NV, NH, NJ, NM, NY, NC, OH, OK, PA, RI,
SC, xC\TN, TX, UT, VT, WA, WV. INCORPORATED IN: Pennsylvania,
Pennsylvania NatiCasualty Insurance Company (NAIC #14990)
BUSINESS ADDRESS: P0.Box 2361.Harrisburg, P817105-2301. 2344941,
UNDERWRITING LIMITATION b/: *64.01e.000. SURETY LICENSES u.f/:AL, AS, AZ, AR, CO, CT, DE. DC,
FL, GA, ID, IL, IN, IA, KS, KY�LA, ME, MD, MA, MI, MN, MS, MO, MT, NE, NJ, NM, NY, NC, OH, OK, OR, PA,
RLSC. S[\TN, TX, UT, VT, VA, WA, WV, VNLINCORPORATED IN: Pennsylvania,
PH|LADELPH&AINDEMNITY INSURANCE COMPANY (m4JC#1805V)
BUSINESS ADDRESS: One Bala Plaza East, Suite 1no'Bala Cynwyd, l400.PHONE: (*1o)uos-
7838.UNDERWRITING LIMITATION h/: $231'687.000. SURETY LICENSES o.fi:AL, AK, AZ, AR, CA, CO, CT,
DE, DC, FL, GA, HI, ID, IL, IN, IA, KS, KY, LA, ME, MD, MA, MI, MN, MS, MO, MT, NE, NV, NH, NJ, NM, NY,
NC, NO, OH.OK, OR, PA, RI, SC, SD, TN, TX, UT, VT, VA, WA, WV, WI, WY. INCORPORATED IN:
PLATTE RIVER INSURANCE COMPANY (NAIC #18619)
BUSINESS ADDRESS: P.O. Boxs80o. Madison, YY|53785 0800, PHONE: (608) 823-4200. UNDERWRITING
IN, IA, KS, KY, LA, ME, MID, MA, MI, MN, MS, MO, MT, NE, I NH, NJ', NM„ NY, NC, IND, OH, OK OR, P& RI,
SC, SO, TN, TX, UT, VT, VA, WA, WV, Wi, WY, INCORPORATED IN: Nebraska.
Plaza Insurance Company (NAIC #30945)
BUSINESS ADDRESS: 518 East Broad Street, Columbus, OH 43215. PHONE: (614) 464-5000.
UNDERWRITING LIMITATION' b/: $2,769,000. SURETY LICENSES c,fl: AL, AK, AZ, AR, CA, CO, CT, DE, DC,
FL, GA, HI, ID, IL, IN, A, KS, KY, LA, ME, MD, MA, MI, MN, MS, MO, MT, NE, NV, NH, NJ, NM, NY, NC, ND,
OH, OK, OR, PA, RI, SC, SID, TN, TX, LIT, VT, VA, W& WV, WI, WY. INCORPORATED IN: Iowa,
ProCentury Insurance Company (NAIC #21903)
BUSINESS ADDRESS: 550 Polaris Parkway, Westerville, OH 43082. PHONE: (614) 895-2000.
UNDERWRITING LIMITATION b/: $5,833,000. SURETY LICENSES c,fl: AK, AZ, AR, CA, DE, DC, GA, IL, IN,
1A, KS, LA, MI MA, Mil, I MS, MO, MIT, NE, NV, NJ, NM, NY, ND, OK, OR, PA, SC, SD, TX, UT, WV, WI,
WY. INCORPORATED IN. Michigan.
Progressive Casualty Insurance Company (NAIC #24260)
BUSINESS ADDRESS: P.O. BOX 89490, CLEVELAND, OH 44101 - 6490. PHONE: (440) 461-5000,
UNDERWRITING LIMITATION b/: $212,481,000. SURETY LICENSES cj/: AL, AK, AZ, AR, CA, CO, CT, DE,
DC, FL, GA, HI, ID, IIL, IN, IA, KS, KY, LA, ME, MD, MA, MI:, MN, MS, MO, MT, NE, NV, NH, NJ, NM, NY, NC,
ND, OH:, OK, OR, PA, RI, SC, SD, TN, TX, UT, VT, VA, WA, WV, WI, WY, INCORPORATED IN: Ohio.
Progressive Northwestern Insurance Company (NAIC #42919)
BUSINESS ADDRESS: P.O. BOX 89490, CLEVELAND, OH 441101 - 6490. PHONE: (440) 461-5000.
UNDERWRITING LIMITATION b/: $52,118,000. SURETY LICENSES e,f/: AK, AZ, CA, CO, CT, DE, DC, GA,
HI, 111D, IN, IA, I KY, LA, ME, MID, MIN, MS, MO, MT, NE, NV, NJ, NM, NY, NC, ND, OH, OK, OR, RI, SC, SD,
TN, TX, UT, VA, WA, WV, W11. INCORPORATED IN: Ohio.
Protective Insurance Company (NAIC #12416)
BUSINESS AIDDRII 111 Congressional Blvd., Suite 500, Carmel, IN 46032. PHONE: (317) 636-9800 x-
7433, UNDERWRITING LIMITATION b/: $28,733,000. SURETY LICENSES 01: AL, AK, AZ, AR, CA, CO, CT,
DE, DC, FL, GA, HI, 11D, IL, IN:, IA, KS, KY, LA, ME, MD, MA, MI, MN, MS, MO, MT, NE, INV, NH, NJ, NM, NY,
NC, ND, OH, OK, OR, PA, PR, RI, SC, SD, TN, TX, UT, VT, VA, WA, WV, WI, WY. INCORPORATED IN:
Indiana.
Protective Property & Casualty Insurance Company (NAIC #35769)
BUSINESS ADDRESS: 14755 North Outer Forty Rd., Suite 400, St. Louis, MO 63017. PHONE: (636) 536-
56,00. UNDERWRITING LIMITATION b/: $16,992,000. SURETY LICENSES c,f/: AL, AK, AZ, AR, CA, CO, CT,
DE, DC, FL, GA, HI, ID, IL, IN, IA, KS, KY, ILA, ME, MD, MA, MI, MN, MS, MO, MT, NE, NV, NH, NJ, NM, NC,
ND, OH, OK, OR, PA, PR, RI, SC, SD, TN, TX, UT, VT, VA, WA, WV, WI, WY. INCORPORATED IN: Missouri,
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CUBE Insurance Corporation (NAIC #39217)
BUSINESS ADDRESS: One General Drive, Sun Prairie, WI 53596, PHONE: (608) 825-6160. UNDERWRITING
LIMITATION b/: $67,799,000. SURETY LICENSES c,f/: AL, AK, AZ, AR, CA, CO, CT, DE, DC, FL, GA, Hi, ID,
IL, IN, ]A, I IKY, I ME, MID, MI, MN, I MO, MT, NE, NV, NH, NJ, NM, NY, NC, ND, OH, OK, OR, PA, RI,
SC, SID, TN, TX, UT, VT, VA, WA, WV, WI, WY. INCORPORATED IN: Pennsylvania.
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Regent Insurance Company (NAIC #24449)
BUSINESS ADDRESS: One General Drive, Sun Prairie, W11 53596. PHONE: (608) 825-5160, UNDERWRITING
LIMITATION b/: $3,221,000. SURETY LICENSES c,f/: AL, AK, AZ, AR, CA, CO, DE, DC, FL, GA, HI, ID, IL, IIN,
IA, KS, KY, LA, MD, MA, MI, MN, MS, MO:, MT, NE, NV, NH, NJ, NY, I ND, OH, OK, OR, PA, R1, SC, SD,
TN, TX, UT, VT, VA, WA, WV, WI, WY. INCORPORATED IN: Wisconsin.,
Republic - Franklin Insurance Company (NAIC #12475)
BUSINESS ADDRESS: P. O. Box 530, Utica, NY 13503 - 0530. PHONE: (315) 734-20010, UNDERWRITING
LIMITATION bj: $5,450,000. SURETY LICENSES c,f/: CT, DE, DC, GA, IL, IN, KS, MID, MA, MI, I NJ, NY,
I OH, PA, RI, TN, TX, VA, WI. INCORPORATED IN: Ohio,
RLI Insurance Company (NAIL #13056)
BUSINESS ADDRESS: 9025 N. Lindbergh Drive, Peoria, IL 61615, PHONE: (309) 692-1000,
UNDERWRITING LIMITATION b/: $73,602,000. SURETY LICENSES c,fl: AL, AK, AZ, AR, CA, CO, CT, DE,
DC, FL, GA, GU, HI, ID, IL, IN, IA, KS, KY, LA, ME, MD, IMA, MI, MN, MS, MO, MT, NE, NV, NH, NJ, NM, NY,
NC, ND, OH, OK, OR, PA, PR, RI, SC, SD, TN, TX, UT, VT, VA, VI, WA, WV, WI, WY. INCORPORATED IN:
Illinois.
Roche Surety and Casualty Company, Inc. (NAIC #42706)
BUSINESS ADDRESS: 4107 N HIMES AVE 2ND FLOOR, TAMPA, FL 33607. PHONE: (813) 623-5042.
UNDERWRITING LIMITATION bl: $979,000, SURETY LICENSES cj/; AL, AK, AZ, AR, CT, DE, FL, GA, HI, ID,
IN, IA, KS, LA, MID, MI, MN!, MS, I I NE, I NH, NJ, NM, NY, I I OH, OK, OR, PA, SC, SD, TN,
TX, UT, VT, VA, WA, INCORPORATED IN: Florida,
Rockwood Casualty
BUSINESS ADDRESS: 654 Main Street, Rockwood, PA 15557. PHONE: (814) 926-4661, UNDERWRITING
LIMITATION b/: $112,001,000. SURETY LICENSES cj/i. AK, AZ, AR, CO,DE, DO, FL,—, HI,ID, IL, -IN, IA,
KS, KY, LA, ME, MID, MA, MI, MN, MS, MO. MT, NE, NV, NH, NJ, NM, NY, NO, ND, OH, OK, OR, PA, RI, SO,
SID, TX, UT, VT, VA, WA, WV, WI, WY, INCORPORATED IN: Pennsylvania.
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SAFECO Insurance Company of America(NAIC
BUSINESS ADDRESS: 175 Berkeley Street, Boston, MA 02116. PHONE: (617) 357-9500. UNDERWRITING
Safety National Casualty Corporation 105
BUSINESS ADDRESS: 1832 SchuetzRoad. 3i Louis, MOV3140-354O.PHONE: (314)985-5300.
UNDERWRITING LIMITATION b/:*2V8.192.0UO.SURETY LICENSES oj/: AL, AK, AZ, AR, CA, CO, CT, DE,
DO, FL, GA, GU, HiID, IL, IN, IA, KS, KY, LA, ME, MD, MA, MI, MN, MS, MO, MT, NIE.NV, NH, NJ, NKNY.
NC, ND, OH, OK. OR, PA, PR, RI, SC, Sn.TN, TX, LIT, VT, VA, VI, WA, WV, WI, WY. INCORPORATED IN:
Missouri.
Insurance Company <NAIC#4046N
BUSINESS ADDRESS: 111Congressional Rlvd.0uke5$0.Canme.|N40O32.PHOmE:(317)s3s-9oV0x'
7433.UNDERVVR|T|NGL|M[TAT|ONW:¢13.304^000. SURETY LICENSES u.f/:AL, AK, AZ, CO, CTDE, D,C.
GA, HI, ID, IL, IN, A.KS, KY, ME, MD, MA, MI, MIN, MS, MO, MT, NE, NJ, NM, NY, NC, OH, OR, PA, RI, SO,
SD.Tm. TX' UT, VT, WA, WV, wM. WY. INCORPORATED IN: Indiana.
SEGURA INSURANCE, AMutual
UNDERWRITING LIMITATION ok $43.1/4,0om.SURETY LICENSES o,%AZ, AR, CO, ID, IL, IN, 1A,KS, KY,
MI, MN, MO, MT, NE, NV, NM, ND, OH, OK, OR, PA, SID.TIN, UTWA, WI, WY. INCORPORATED IN:
Wiscons_
Selective Insurance Company of America
BUSINESS ADDRESS: 4uvv*m|AsEAVENUE, BR*mCnv|LLe.mJO789o,PHONE: (er3)o48-3000,
UNDERWRITING LIMITATION b/: $60.9$7.o0o,SURETY LICENSES ojcAL, AK, AZ, CT, DE, DC, GA, IL, IN,
UA.KS, KY, MD, MA, MI, MN, MS, MO, MT, NE, NJ, NY, NO, ND, 0H'OR, PA, RI, SO, go.TN, TX, VA, WA,
WV, WI, WY, INCORPORATED IN: New Jersey.
Seneca Insurance Company, Inc. (NAIC 010e36)
BUSINESS ADDRESS:1O0 Water Street, New York, NY1OQ38 4822.PHONE: 2t2)344'300O.
UNDERWRITING LIMITATION h/:$14,249.00V. SURETY LICENSES u.V:AL, AK, AZ, AR, CA, CO, CT, DIE,
DO, FL, GA, HI, ID, IL, IN, IA. KS, KY, LA, ME, MD, MA, MI, MN, MS, MO, MT, NE, NV, NH, NJ, NM, NY, NC,
ND, OH, OK, OR, PA, PR, RI, SC, SID.TN, TX, UT, VT, VA, WA, WV, WI, WY. INCORPORATED IN: New York.
Sentry Insurance AMutual Company (NA|C#o49V8)
BUSINESS ADDRESS: 18o0NORTH POINT DRIVE, STEVENS POINT, VV|s4481-S028.PHONE: (71n)34s-
Vnon.UNDERWRITING LIMITATION b/: $4$1^451.0u0,SURETY LICENSES o.f/:AL, AK, AZ, AR, CA, GO, CT,
DE, DO, FL, GA, HI, ID, IL, IN, IA, KS, KY, LA, ME, MD, MA, MI, MN, MS, MO, MT, NE, NV, NH, NJ, NM, NY
NO, ND. OH, OK, OR, PA, RI, SC, SD.TN, TX, UT, VT, VA, WA, WV, WI, WY, INCORPORATED IN: Wisconsin.
Sentry Select Insurance Company (NAIC #21180)
BUSINESS ADDRESS: 1uooNORTH POINT DRIVE, STEVENS POINT, YN54481-8Ozm.PHONE: (715)340
0000.UNDERVVRD|NGL|M|TxTmONb/: $22,674.0on.SURETY LICENSES o./:AL, AK, AZ, AR, CA, GO, CT,
DE, DO, FL, GA, HI, ID, IT, IN, IA, KS, KY, LA, ME, MID, MA, MI, MN, MS, MO, MT, NE, NV, NH, NJ, NM, NY,
wC. ND, OH, OK, OR. PA, R|, SC, SD.TN. T%, UT, VT, VA, WA, WV, WI, WY, INCORPORATED IN: Wisconsin.
SERVICE INSURANCE COMPANY (NA|c#3m56V
BUSINESS ADDRESS: 7moOBERLIN ROAD, RALE|GH.MC27onm-oo0o.PHONE: (919)833-1600.
UNDERWRITING LIMITATION b/: $4^733.000. SURETY LICENSES o.8:AL, AK, AZ, AR, CA, GO, CT, DE, DC,
FL, GA. H|. |D' |L, IN, |A. KS, KY, LA, ME, MD, Mx, M|, MN, MS, MO, MP, MT, NE, NV, NH, NJ, NM, NY, NO.
SERVICE INSURANCE COMPANY
BUSINESS ADDRESS: uoMAIN STREET, WEST ORANGE, mJuruoz.PHONE: (a73)731'70so,
UNDERWRITING LIMITATION bf: $82*.000. SURETY LICENSES c.K:CT, DE, DO, FL, MID, MA, NH, NJ, NY
NC, PA, RI, VA. INCORPORATED IN: New Jersey,
S|RmSAMEn|CAINSURANCE COMPANY V«AUC4a877u>
BUSINESS ADDRESS: 14OBROAOVYAY-32NDFLOOR, NEW YORK.NY1oOnS-1lno.PHONE: (213)312'
2500.UNDERyVR|T|M8L|M|lAT|DNb/:*52.181.000.6URETYL]cENSES:.K:AL.AK.AZ.AR,CA.C8.DE'
DC, GA, HI, ID, IL, IN, |A.KS, KY, LA, MD, MA, MI, MS, MO, MT, NE, NV, NH, NJ, NM, NY, NO, ND, OH, OK,
OR, PA, RI, SC, 8D.TN, TX, UT, VT, VA, WA, WV, WI, WY. INCORPORATED, IN: Now York,
SOUTHWEST MARINE AND GENERAL INSURANCE COMPANY (NA;C#122s4)
BUSINESS ADDRESS: 412Mt. Kemb|mAve, Suite 30oc.Morristown, NJoreeo. PHONE: (80n)7r4'z7sa.
UNDERWRITING LIMITATION bl: $6,330,000. SURETY LICENSES c,fl: AL, AK, AZ, AR, CA, CO, CT, DE, DC,
GA, HI, ID, IL, IN, IA, KS, KY, LA, ME, MD, MA, MI, MN, MS, MO, MT, NE, NV, NH, NJ, NM, NC, NO, OH, OK,
OR, PA, RI, SC, SD, TN, TX, UT, VT, VA, WA, WV, WI, WY. INCORPORATED IN: Arizona.
St. Paul Fire and Marine Insurance Company (NAIC #24767)
BUSINESS ADDRESS: ONE TOWER SQUARE, HARTFORD, CT 06183. PHONE: (860) 277-0111,
UNDERWRITING LIMITATION bl: $416,522,000. SURETY LICENSES c,fl: AL, AK, AZ, AR, CA, CO, CT, DE,
DC, FL, GA, GU, HI, ID, IL, IN, IA, KS, KY, LA, ME, MD, MA, MI, MN, MS, MO, MT, NE, NV, NH, NJ, NM, NY,
NO, NO, OH, OK, OR, PA, PR, RI, SC, SD, TN, TX, UT, VT, VA, VI, WA, WV, WI, WY. INCORPORATED IN:
Connecticut.
ST. PAUL GUARDIAN INSURANCE COMPANY (NAIC #24775)
BUSINESS ADDRESS: One Tower Square, Hartford, CT 06183. PHONE: (860) 277-0111. UNDERWRITING
LIMITATION bl: $2,314,000. SURETY LICENSES c,f/: AL, AK, AZ, AR, CA, CO, CT, DE, DC, FL, GA, HI, ID, IL,
IN, IA, KS, KY, LA, ME, MD, MA, MI, MN, MS, MO, MT, NE, NV, NH, NM, NY, NO, NO, OH, OK, OR, PA, RI,
SC, SD, TN, TX, UT, VT, VA, WA, WV, WI, WY. INCORPORATED IN: Connecticut.
St. Paul Mercury Insurance Company (NAIC #24791)
BUSINESS ADDRESS: One Tower Square, Hartford, CT 06183. PHONE: (860) 277-0111. UNDERWRITING
LIMITATION b/: $11,601,000. SURETY LICENSES c,fl: AL, AK, AZ, AR, CA, CO, CT, DE, DC, FL, GA, HI, ID,
IL, IN, IA, KS, KY, LA, ME, MD, MA, MI, MN, MS, MO, MT, NE, NV, NH, NJ, NM, NY, NO, NO, OH, OK, OR, PA,
RI, SC, SO, TN, TX, UT, VT, VA, WA, WV, WI, WY, INCORPORATED IN: Connecticut.
Standard Fire Insurance Company (The) (NAIC #19070)
BUSINESS ADDRESS: ONE TOWER SQUARE, HARTFORD, CT 06183. PHONE: (860) 277-0111.
UNDERWRITING LIMITATION b/: $118,948,000, SURETY LICENSES c,f/: AL, AK, AZ, AR, CA, CO, CT, DE,
DC, FL, GA, HI, ID, IL, IN, IA, KS, KY, LA, ME, MD, MA, MI, MN, MS, MO, MT, NE, NV, NH, NJ, NM, NY, NO,
ND, OH, OK, OR, PA, PR, RI, SC, SD, TN, TX, UT, VT, VA, VI, WA, WV, WI, WY. INCORPORATED IN:
Connecticut.
Star Insurance Company (NAIC #18023)
BUSINESS ADDRESS: 26255 American Drive, Southfield, MI 48034. PHONE, (248) 368-1100.
UNDERWRITING LIMITATION bl: $46,630,000. SURETY LICENSES c,fl: AL, AK, AZ, AR, CA, CO, CT, DE,
DC, FL, GA, HI, ID, IL, IN, IA, KS, KY, LA, ME, MD, MA, MI, MN, MS, MO, MT, NE, NV, NH, NJ, NM, NY, NO,
NO, OH, OK, OR, PA, RI, SC, SD, TN, TX, UT, VT, VA, WA, WV, WI, WY. INCORPORATED IN: Michigan.
StarNet Insurance Company (NAIC #40045)
BUSINESS ADDRESS: PO BOX 9190, DES MOINES, IA 50306 - 9190, PHONE: (515) 473-3000.
UNDERWRITING LIMITATION b/: $11,706,000. SURETY LICENSES c,fl: AL, AK, AZ, AR, CA, CO, CT, DE,
DC, FL, GA, HI, 10, IL, IN, IA, KS, KY, LA, ME, MD, MA, MI, MN, MS, M0, MT, NE, NV, NH, NJ, NM, NY, NO,
NO, OH, OK, OR, PA, RI, SC, SD, TN, TX, UT, VT, VA, WA, WV, WI, WY. INCORPORATED IN: Delaware.
Starr Indemnity & Liability Company (NAIC #38318)
BUSINESS ADDRESS: 399 Park Avenue, 8th Floor, New York, NY 10022. PHONE: (646) 227-6400.
UNDERWRITING LIMITATION bl: $187,529,000. SURETY LICENSES c,fl: AL, AK, AZ, AR, CA, CO, CT, DE,
DC, FL, GA, GU, HI, ID, IL, IN, IA, KS, KY, LA, ME, MD, MA, MI, MN, MS, MO, MT, NE, NV, NH, NJ, NM, NY,
NO, NO, OH, OK, OR, PA, PR, RI, SC, SO, TN, TX, UT, VT, VA, WA, WV, WI, WY. INCORPORATED IN: Texas.
State Auto Property and Casualty Insurance Company (NAIC #25127)
BUSINESS ADDRESS: 518 EAST BROAD STREET, COLUMBUS, OH 43215. PHONE: (614) 464-5000.
UNDERWRITING LIMITATION bl: $68,704,000. SURETY LICENSES c,fl: AL, AK, AZ, AR, CO, CT, DE, DC,
FL, GA, HI, ID, IL, IN, IA, KS, KY, LA, ME, MD, MA, MI, MN, MS, MO, MT, NE, NV, NJ, NY, NO, NO, OH, OK,
OR, PA, RI, SC, SD, TN, TX, UT, VT, VA, WV, WI, WY. INCORPORATED IN: Iowa.
State Automobile Mutual Insurance Company (NAIC #25135)
BUSINESS ADDRESS: 518 EAST BROAD STREET, COLUMBUS, OH 43215. PHONE: (614) 464-5000.
UNDERWRITING LIMITATION bl: $49,057,000. SURETY LICENSES c,fl: AL, AK, AZ, AR, CO, CT, DE, DC,
FL, GA, I'll, ID, IL, IN, IA, KS, KY, LA, ME, MD, MA, MI, MN, MS, MO, MT, NE, NV, NH, NJ, NM, NY, NC, NO,
OH, OK, OR, PA, RI, SC, SD, TN, TX, UT, VT, VA, WA, WV, WI, WY. INCORPORATED IN: Ohio,
State Farm Fire and Casualty Company (NAIC 925143)
BUSINESS ADDRESS: ONE STATE FARM PLAZA, BLOOMINGTON, IL 61710. PHONE: (309) 766-2311.
UNDERWRITING LIMITATION b/: $1,771,019,000. SURETY LICENSES c,f/: AL, AK, AZ, AR, CA, CO, CT, DE,
DC, FL, GA, HI, ID, IL, IN, IA, KS, KY, LA, ME, MD, MA, MI, MN, MS, MO, MT, NE, NV, NH, NJ, NM, NY, NO,
NO, OH, OK, OR, PA, RI, SC, SD, TN, TX, UT, VT, VA, WA, WV, WI, WY. INCORPORATED IN: Illinois.
Stillwater Property and Casualty Insurance Company (NAIC #16578)
BUSINESS ADDRESS: P. O. Box 45126, Jacksonville, FL 32232 - 5126. PHONE: (800) 849-6140.
UNDERWRITING LIMITATION bl: $12,837,000. SURETY LICENSES c,fl: AL, AK, AZ, AR, CO, CT, DC, FL,
GA, HI, ID, IL, IN, IA, KS, KY, LA, ME, MD, MA, MI, MN, MS, MO, MT, NE, NV, NH, NJ, NM, NY, NO, NO, OH,
OK, OR, PA, RI, SC, SO, TN, TX, UT, VT, VA, VI, WA, WV, WI, WY. INCORPORATED IN: New York.
SureTec Insurance Company (NAIC #10916)
BUSINESS ADDRESS: 1330 POST OAK BLVD, SUITE 1100, HOUSTON, TX 77056. PHONE: (713) 812-0800.
UNDERWRITING LIMITATION bl: $10,206,000, SURETY LICENSES c,fl: AL, AK, AZ, AR, CA, CO, CT, DE,
DC, FL, GA, HI, ID, IL, IN, IA, KS, KY, LA, ME, MD, MA, MI, MN, MS, MO, MT, NE, NV, NH, NJ, NM, NY, NO,
NO, OH, OK, OR, PA, RI, SC, SD, TN, TX, UT, VT, VA, WA, WV, WI, WY. INCORPORATED IN: Texas.
SURETY BONDING COMPANY nFAMERICA
BUSINESS ADDRESS: 1s1N.FRAN0LINSl.CHICAG0.|L8osns.PHONE: (312
UNDERWRITING LIMITATION b/:$7x4.omo.SURETY LICENSES "^f/:AL, AZ, AR, CA, GO, DE, DC, GA, ID,
IL, IN, KS, MN, MO, MT, NE, NV, NM, NY, ND.OK, OR, SC, SD.TIN, TX, UT, WV, WY. INCORPORATED IN:
South Dakota.
Swiss Reinsurance America Corporation (NAIC#x5an4)
BUSINESS ADDRESS: 175KING STREET, ARMONK.NY1os04-1000.PHONE:
UNDERWRITING LIMITATION b/: $334.995.000. SURETY LICENSES c.f/:AL, AK, AZ, AR, CA, CO, CT DE.
DC, FL, GA, HI, UD.IL, IN, IA, KS, KY, LA, ME, MID, MA, MI, MN, MS, MO, MT, NE, NV, NH, NJ, NM, NY, NC,
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TRANSATLANTIC REINSURANCE COMPANY(NAIC #19453)
BUSINESS ADDRESS: One LimePlaza, nnBroadway, NEW ronn.NY1mnms.PHONE: (z
UNDERWRITING LIMITATION b/: $47o.8S5.8O0.SURETY LICENSES u,fV:AK, AZ, AR, CA, CO, DE, DC, GA,
ID, IL, IN, IA, KS, KY, LA, MI, MN, MS, NE, NV, NJ, NM, NY, OH, OK, PA, GID^LIT, WA, VYiINCORPORATED
IN: New York,
Travelers Casualty
BUSINESS ADDRESS: ONE TOWER SQUARE, HARTFORD.CT0$183.PHONE: (060)277-0111.
UNDERWRITING LIMITATION W: $42o.498.000.SURETY LICENSES u.K:AL, AK, AZ, AR, CA, CO, CT, DE'
DC, FL, GA, GU, HI, ID, IL, |M'IA, KS, KY, LA, ME, MID, MA, MI, MIN, MS, MO, MT, NE, NV, NH, NJ, NM, NY,
NC. ND, 0H.OK, OR, PA. PR, K|, SC, SID.TN. TX, UT, VT, VA, VI, WA, WV, WI, WY. INCORPORATED IN:
Connecticut.
Travelers Casualty andSurety C of America #31194}
uuu/wEuS ADDRESS: ONE TOWER SQUARE, m*RTFm*o.oT001QB.PHONE: (868) 277-0111.
UNDERWRITING LIMITATION b/:*2O1.$o4'OOV.SURETY LICENSES c.V:AL, AK, AZ, AR, CA, CO, CT, DE,
DC, FL, GA, GU, HI, ID, IL, IN, IA, KS, KY, LA, ME, MID, MA, MI, MN, MS, MO, MT, NE, NV, NH, NJ, NM, NY,
NC, ND, OH, OK, OR, PA, PR, RI, SC, GD.TN, TX, UT, VT, VA, VI, WA, WV, WI, WY. INCORPORATED IN:
Connecticut.
Travelers Casualty Insurance Company nfAmerica (NA|c#t9O40
BUSINESS ADDRESS: ONE TOWER SQUARE, nxnTpowo.cToa1na.PHONE: 77-0111,
UNDERWRITING LIMITATION b/:$53.28S.#0O.SURETY LICENSES 01: AL, AK, AZ, AR, CA, CO, CT, DE.
DC, FL, GA, HI, ID, |L. IN, IA, KS, KY, LA, ME, MD, MA, MI, MN, MS, MO, MT, NE, NV, NH, NJ, NM, NY, NC,
ND, OH, OK, OR, PA, RI, SC, GD.TN, TX, UT, VT, VA, WA, WV, YY|.WY. INCORPORATED IN: Connecticut.
Travelers Indemnity
BUSINESS ADDRESS: ONE TOWER SQUARE, NARTFORD.CTnm1ma.PHONE: (880) 277-8111.
UNDERWRITING LIMITATION b/:x6V2.022.00o.SURETY LICENSES c,fl:AL, AK, AZ, AR, CO, CT, DE, DC,
FL, GA, GU, HI, ID, IL, IN, IA, KS, KY, LA, ME, MD, MA, MI, MN, MS, MO, MT, NE, NV, NH, NJ, NM, NY, NC,
No. OH, OK. OR, PA, PR, R|, SC, SID.TN, TX, UT VT, VA, WA, WV, wN. WY, INCORPORATED IN:
Connecticut.
TRAVELERS INDEMNITY COMPANY VFAMER|CA (MA|c#z566u)
BUSINESS ADDRESS: ONE TOWER SQUARE, HARTFORQ,CT0O183.PHONE: 277'0111,
UNDERWRITING LIMITATION W:$17.Voo,OQO.SURETY LICENSES c.V: AL, AK, AZ, AR, CO, CT. DC, FL,
GA, HI, ID, IL, IN, IA, KS, KY, LA, MD, MA, MI, MN, MS, MO, MT, NE, NV, NH, NJ, NM, NY, NC, ND, OH, OK,
OR. PA, RI, SQ.TN, TX, UT, VT, VA, WA, WV, WI, WY. INCORPORATED IN: Connecticut.
Travelers Indemnity Company ofConnecticut #25082)
BUSINESS ADDRESS: ONE TOWER SQUARE, HAnTFoRo.cT88183.PHONE: (860) 277-0111,
UNDERWRITING LIMITATION h/: $33.251.000. SURETY LICENSES u.f/:AL, AK, AZ, AR, CA, CO, CT, DE,
DC, FL, GA, H|,ID, |L.IN, 1A.KS, KY, LA, ME, MD, MA, MI, MN, MS, MO, MiT,NE, NV, NH, NJ, NM, NY, NC,
ND. OH, OK, OR, PA, PR, R|, Sc. SD.TN, TX, UT, VT, VA, VI, WA, WV, WI, WY. INCORPORATED IN:
Connecticut.
Travelers Property Casualty Company ofAmerica <MAIC
BUSINESS ADDRESS: ONE TOWER SQUARE, HARTFORO.CTu0183,PHONE: 277'0111,
UNDERWRITING LIMITATION b/:$43.5U2.Uno.SURETY LICENSES x.V:AL, AK, AZ, AR, CA, CO. CT, DE,
DC. FL, GA, HI, ID, IL, IN, IA, KS, KY, LA, ME, MD, MA, MU,MN, MS, MO, MP, MT, NE, NV, NH, NJ, NM, NY,
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U.S. Specialty
BUSINESS ADDRESS: 1ovvoNorthwest pmewuy, Houston, Tx77O4U.PHONE: (713)462 1080.
UNDERWRITING LIMITATION bt$Go.rn4.80O.SURETY LICENSES ojl:AL, AK, AS, AZ, AR, CA, CO, CT,
DE, DC, FL, GA, HI, ID, IL, IN, IA, KS, KY, LA, ME, MD, MA, MI, MN, MIS.MO, MT, NE, NV, NH, NJ, NM, NY,
UNITED CASUALTY AND SURETY INSURANCE COMPANY (NAIC #36226)
BUSINESS ADDRESS: 292 Newbury Street, Suite 105. Boston, MA 02115 PHONE: (617) 471-1112,
UNDERWRITING LIMITATION bl: $800,000. SURETY LICENSES c,f/: AK, AZ, AR, CO, CT, DE, DC, FL, GA,
HI, ID, IL, IN, 11A, KS, KY, LA, ME, MID, MA, MI, MS, MO, MT, NIE, NV, NH, NJ, NM, NY, NC, ND, OH, OK, PA,
RI, SC, SD, TN, TX, UT, VT, VA, WA, WV, WI, WY. INCORPORATED IN: Massachusetts.
United Fire & Casualty Company (NAIC #13021)
BUSINESS ADDRESS: P. 0. BOX 73909, CEDAR RAPIDS, IA 52407 - 3909, PHONE: (319) 39,9-5700,
UNDERWRITING LIMITATION b/: $64,150,000, SURETY LICENSES c,f/: AL, AK, AZ, AR, CA, CO, DC, FL,
GA, HI, ID, IL:, IN, IA, KS, KY, LA, ME, MD, MA, MI, MN, MS, MO, MT, NE, NV, NJ:, NM, NY, NC, ND, OH, OK,
OR, PA, SC, SD, TN, TX, UT, VT, VA, WA, WV, WI, WY, INCORPORATED IN: Iowa.
UNITED FIRE & INDEMNITY COMPANY (NAIC #19496)
BUSINESS ADDRESS: P.O. BOX 73,909, CEDAR RAPIDS, IA 52407 - 3909. PHONE: (319) 399-5700.
UNDERWRITING LIMITATION bl: $1,835,000. SURETY LICENSES c,fl: AL, CO, IN, KY, LA, MS, MO, NM, TX.
INCORPORATED IN: Texas.
United States Fidelity and Guaranty Company (NAIC #25887)
BUSINESS ADDRESS: ONE TOWER SQUARE, HARTFORD, CT 06183. PHONE: (860) 277-0111,
UNDERWRITING LIMITATION 11 $98,582,000. SURETY LICENSES c,fl: AL, AK, AZ, AR, CA, CO, CT, DE,
DC, FL, GA, HI, ID, IL, IN, IA, KS, KY, LA, ME, MID, MA, MI, MN, MS, MO, MT, NE, NV, NH, NJ, NM, NY, NIC,
ND, OH, OK, OR, PA, PR, Ri, SC, SD, TIN, TX, LIT, VT, VA, V11, WA, WV, WI, WY, INCORPORATED IN:
Connecticut.
United States Fire insurance Company (NAIC #21113)
BUSINESS ADDRESS: 305 Madison Avenue, Morristown, NJ 07962. PHONE; (973) 490-6600.
UNDERWRITING LIMITATION bl: $130,226,000. SURETY LICENSES c,f/: AL, AK, AZ, AR, CA, CO, CT, DE,
DC, FL, GA, HI, ID, IL, IN, A, KS, KY, LA, ME, MID, MA, MI, MN, MS, MO, MT, NE, NV, NH, NJ, NM, NY, NC,
ND, OH:, OK, OR, PA, PR, RI, SC, SD, TN, TX, UT, VT, VA, VI, WA, WV, WI, WY, INCORPORATED IN:
Delaware.
United States Surety Company (NAIC #10656)
BUSINESS ADDRESS: One Texas Station Court, Suite 230, Timonium, MID 21093, PHONE: (410) 453-9522.
UNDERWRITING LIMITATION b/: $5,126,000, SURETY LICENSES c,f/: CT, DE, DC, FL, GA, ME, MID, MA,
NH, NJ, NY, NC, OH, PA, RI, SC, TN, VT, VA, WV, INCORPORATED IN. Maryland.
UNITED SURETY AND INDEMNITY COMPANY (NAIC #44423)
BUSINESS ADDRESS: P.O. BOX 2111, SAN JUAN, PR 00922 - 2111. PHONE: (787) 625-1105.
UNDERWRITING LIMITATION bk $6,425,000, SURETY LICENSES cj/: PR. INCORPORATED IN: Puerto
Rico.
Universal Surety Company (NAIC #25933)
BUSINESS ADDRESS: P.O. Box 80468, Lincoln, NE 68501. PHONE: (402) 435-4302. UNDERWRITING
LIMITATION b/: $19,154,000. SURETY LICENSES c,f/: AZ, AR, CO, ID, IL, IN, IA, KS, KY, MI, MN, MO, MT,
NE, NM, ND, OH, OK, SC, SD, TX, UT, WA, WI, WY. INCORPORATED IN: Nebraska.
UNIVERSAL UNDERWRITERS INSURANCE COMPANY (NAI,C #41181)
BUSINESS ADDRESS: 1299 ZURICH WAY, 5TH FLOOR, SCHAUMBURG, IL 60196 - 1056. PHONE: (847)
605-6000, UNDERWRITING LIMITATION bl: $32,037,000. SURETY LICENSES c,fl: AL, AK, AZ, AR, CA, CO,
CT, DE, DC, FL, GA, HI, ID, IL, IN, IA, KS, KY, LA, ME, MID, MA, MI, MN, MS, MO, MT, NE, NV, NIFI, NJ, NM,
NY, NC, ND, OH, OK, OR, PA, RI, SC, SD, TIN, TX, UT, VT, VA, WA, WV, WI, WY. INCORPORATED IN: Illinois.
Utica Mutual Insurance Company (NAIC #25976)
BUSINESS ADDRESS: POST OFFICE BOX 530, UTICA, NY 13503 - 0530. PHONE: (315) 734-2000.
UNDERWRITING LIMITATION 11 $87,857,000, SURETY LICENSES c,f/: AL, AK, AZ, AR, CA, CO, CT, DE,
DC, FL, GA, HI, ID, IL, IN, [A, KS, KY, LA, ME, I MA, Mi, MN, MS, MO, MT, NE, INV, NH, NJ, NM, NY, No,
ND, OH, OK, OR, PA, FIR, RI, SC, SD, TN, TX, UT, VT, VA, WA, WV, W1, WY. INCORPORATED IN: Now York.
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VerTerra Insurance Company (NAIC #10024)
BUSINESS ADDRESS: P.O. BOX 509039, SAN DIEGO, CA 92150. PHONE: (858) 350-2400.
UNDERWRITING LIMITATION b/: $5,609,000. SURETY LICENSES 01: TX, INCORPORATED IN: Texas.
Vigilant Insurance Company (NAIC #20397)
BUSINESS ADDRESS: 202E Hall's Mill Road, Whitehouse Station, NJ 08889. PHONE: (215) 640-1000,
UNDERWRITING LIMITATION b/: $33,198,000. SURETY LICENSES c,f/: AL, AK, AZ, AR, CA, CO, CT, DIE,
DC, FL, GA, HI, ID, IL, IN, IA, KS, KY, LA, ME, MID, MA, MI, MN, MS, MO, MT, NE, NV, NH, NJ, NM, NY, NC,
ND, OH, OK, OR, PA, RI, SC, SD, TN, TX, UT, VT, VA, Vi, WA, WV, WI, WY. INCORPORATED IN: New York.
Washington International I
'UNDERWRITING LIMITATION_$8,244,000. SURETY LICENSES -.— AL, AK, AZ, AR,CA, CO, CT, DE, DC,
FL. GA GU, HI, 0. |L. IN, U\ KS, KY, LA, ME, N0, MA M|, MN, MG, MO, M�T, NE. NV, NH, NJ, NM, NY, NC,
ND, OH, OK, OR, PA, PR, RI, SC, SQTN, TX, UT, VT, VA, VI, WA, WV, WLWY, INCORPORATED IN: New
Hampshire.
West American Insurance Company
BUSINESS ADDRESS: 17sBerkeley Street, Boston, MAo21Yo.PHONE: (81n357-8soo.UNDERWRITING
LIMITATION W:$5.122.00O.SURETY LICENSES n.f/:AL, AK, AZ, AR, CO, CT, DE, DC, FL, GA, ID, IL, IN, IA,
KS, KY, LA, MD, MA, MI, MN, MS, MO, NIT, NE, NV, NH, NJ, NM, NY, NC, ND, OH, OK, OR, PA, RI, SC, SD,
TN, TX, LIT, VA, WA, vVY m8. WY. INCORPORATED IN: Indiana,
WEST BEND MUTUAL INSURANCE COMPANY <NA|C#15350U
BUSINESS ADDRESS: 1oomSouth 18thAvenue, West Bend, VV|Soon5.PHONE: 2«2) 334-5571.
UNDERWRITING LIMITATION b/: $1Q4'114.0U8.SURETY LICENSES 01: UL. IN, IIA. KS, KY, M|, MN, M0, NE.
OH, PA, TN, VViINCORPORATED IN: Wisconsin,
Westchester Fire Insurance Company (wxIC#1Oo3U
BUSINESS ADDRESS: 400Walnut Street, PO.Bux1UUO,Philadelphia, PA19100.PHONE: (21s)04$-1V00.
UNDERWRITING LIMITATION h/:$22.x45'VOO, SURETY LICENSES u.V: AL, AK, AZ, AR, CA, CO, CT, DE,
DC, FL, GA, GU, HI, ID, IL, IN, IA, KS, KY, LA, ME, MD, MA, MI, MN, MS, MO, MP, MT, NE, NV, NH, NJ, NM'
NY, NQND, OH, OK, OR, PA, PR, RI, SC, sD,TN, TX, UT, VT, VA, VI, WA, WV, WI, WY. INCORPORATED IN:
Pennsylvania,
Western National Mutual Insurance Company #35374
BUSINESS ADDRESS: PO. BOX 14oa.M|mNE*POLy8.MN5544O.PHONE: (g52)eas's3so.
UNDERWRITING LUMkTAr|ONb/: $48.990.O0O.SURETY LICENSES o.fl: AK, AZ, AR, CA' CO. DE. |D. |L. IN,
IA, KS, KY, MD, Mk MN, MO, MT, NE, NV, NJ, NM, ND, OH, QK, OR, RA, R|^ 8ID.TX. UT, WA, WI, WY.
INCORPORATED IN: Minnesota.
Western Surety Company )
BUSINESS ADDRESS: 1s1N.FRANKLUN3l.CH|CAmO.8La08U8.PHONE: (312)o22'smnO.
UNDERWRITING LIMITATION b/: *151.958`OQ0.SURETY LICENSES c.f/: AL, AK, AZ, AR, CA, CO, CT, DE,
DC, FL, GA, HI, ID, IL. IN, IA, KS, KY, LA, ME, MD, MA, MI, MN, MS, MO, MT, NE, NV, NH, NJ, NM, NY, WC.
ND, OH, OK, OR, PA, PR, RI, SC, 8D.TN, TX, 0TVT, VA, WA, WV, WI, WY. INCORPORATED IN: South
Dakota.
Westfield Insurance Company #24112)
BUSINESS ADDRESS: P.B.Box 5OO1.Westfield Center, OH442s1'soV1,PHONE: (330)&87'01U1,
UNDERWRITING LIMITATION b/: $127.843.000, SURETY LICENSES ",f/:AL, AK, AZ, AR, CO. CT, DE, DC,
FL, GA, H|'ID, IL, IN. IA, KS, KY, LA, ME, MD, MA, MI, MN, MS, MO, MT, ND, NE, NV, NH, NJ, NM,NY, NC,
Old, OK, OR, PA, RI, SC, SD, TN, TX, LIT, VT, VA, WA, WV, WI, WY. INCORPORATED IN: Ohio.
Westfield National Insurance Company #24120}
BUSINESS ADDRESS: p0. Bnx5$01 ^ Westfield Center, OH44251'50U1�PHONE: pno e87-0101,
UNDERWRITING LIMITATION b/:*31J2c,0ou.SURETY LICENSES c�: AL: AZ, AR, CA, CO, DE, FL, GA, IL,
|N,IA, KY, MD, MI, MN, NM, NC, ND, OH, OK, PA, SC, SD, TN, TX, VA, WV, VY|.INCORPORATED IN: PN"�
Westport Insurance Corporation (NAI
BUSINESS ADDRESS: m2VnMETCALF AVENUE, OVERLAND PARK, Ke6O2O2 1391.PHQNE�(913)676
5200.UNQERWR|T|NGL|M|7AT|0Nt/: $121,403.000. SURETY LICENSES o.V:AL, AIK.AZ, AR, CA, CO, CT,
DE, Dc, FL, GA, GU, H|. UD. |L, IN, IA, KS, Kt LA, ME, MID, MA, M|, MN, M8, MO, MP, MT, NE, N\( NH, NJ.
NM, NY, NC.ND, OH, OK, OR, PA, PR, R|,SC, SD, TN, TX, LIT, VT, VA, VI, WA, WV, WI, VVY
INCORPORATED IN: Missouri.
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N-ReinsurancemmerimIn#20583)
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Part of State Form52414 (112 / 2-13) Form 96 (Revised 2013)
Walsh & Kelly, Inc.
(Contractor)
(Address)
South Bend IN 46614
FOR
PUBLIC WORKS PROJECTS
OF
City of South Bend Indiana
St. Joseph Streetscape Improvements_
Project No. 118-008
Filed August 28t" 2018
Action taken
State Form 52414 (R 19-10)
Prescribed by State Board of Accounts Form No. 96 Revised 2013
CONTRACTOR'S BID FOR PUBLIC WORK — FORM 96
PART 1
(To be completed for all bids. Please type or print)
1. Governmental Unit (Owner):
2. County:
3. Bidder (Firm):
Address:
City/State:
4. Telephone Number:
5. Agent of Bidder (If applicable):
Date (month, day, year): August 28`t', 2018
City of South Bend, Indiana
St.. Joseph
Walsh & Kelly, Inc.
24358 SR 23
South Bend, IN 46614
(574) 288-4811
Pursuant to notices given, the undersigned offers to furnish labor and/or material necessary to complete the
public works project of City of South Bend, Indiana (Governmental Unit) in accordance with plans and
specifications prepared by Jones Petrie Rafinski and dated July 27, 2018 for the sum of See Attached
$ See Attached
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
addendunis 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 Governmental Unit. If the bid is to be awarded on a unit basis, the
itemization of the units shall be shown on a separate attachment.
The Contractor and his subcontractors, if any, shall not discriminate against or intimidate any employee, or
applicant for employment, to be employed in the performance of this contract, with respect to any matter directly or
indirectly related to employment because of race, religion, color, sex, national origin or ancestry. Breach of this covenant
may be regarded as a material breach of the contract,
CERTIFICATION OF USE OF UNITED STATES STEEL PRODUCTS
(If applicable)
I, the undersigned bidder or agent as a contractor on a public works project, understand my statutory obligation
to use steel products made in the United States. I.C. 5-16-8-2. I hereby certify I and all subcontractors employed by me
for this project will use U.S. steel products on this project if awarded. I understand that violations hereunder may result in
forfeiture of contractual payments.
ACCEPTANCE
The above bid is accepted this day of . subject to the following conditions:
Contracting Authority Members:
PART II
(For projects of $150,000 or more — IC 36-1-12-4)
Governmental Unit: City of South Bend, Indiana
Bidder (Firm): Walsh & Kelly, Inc.
Date(month, day, year)• Au Est 2_. , 2018
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
What public works projects has your organization completed for the period of one (1) year prior to the date of
the current bid?
Contract Amount
Class of Work
When Completed
Name and Address of Owner
$12,926,200
Reconstruction
October 2017
INDOT
$ 5,970,162
Reconstruction
May 2017
Town of Merrillville
$ 5,521,779
Resurface
December 2017
City of Mishawaka
$ 2,646,574
Reconstruction
September 2017
St. Joseph Cty Hwy Dept
2. What public works projects are now in process of construction by your organization?
Contract Amount
Class of Work
When to be Completed
Name and Address of Owner
$10,695,118
Reconstruction
November 2018
Walsh Construction
$ 8,146,239
Resurface
May 2018
INDOT
$ 4,073,719
Reconstruction
July 2018
City of East Chicago, IN
$ 2,662,813
Reconstruction
October 2018
INDOT
3. Have you ever failed to complete any work awarded to you? No If so, where and why?
4. List references from private firms for which you have performed work.
Gatlin Plumbing & Heating, Inc. 1111 E. Main St., Griffith IN Ms. Clara Murphy
Gough, Inc. 2200 E. 88"' Dr., Merrillville IN 46410 Mr. Raymond Gough
Dyer Construction Co. 1716 Sheffield Avenue Dyer, 1N Janet Furman
Grimmer Construction Co, Inc, 2619 Main Street Highland, IN Mr. Greg Grimmer
SECTION II PLAN AND EQUIPMENT QUESTIONNAIRE
I . Explain your plan or layout for performing proposed work. (Examples could include a narrative of when you could
begin work, completed the project, number of workers, etc. and any other information which you believe would
enable the governmental unit consider your bid.)
As required by owner
2. Please list 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.
See Attached List
3. If you intend to sublet any portion of the work, state 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 governmental unit in the event that you
subsequently determine that you will use a subcontractor on the proposed project.
Will supply upon award of contract
4. What equipment do you have available to use for the proposed project? Any equipment to be used by subcontractors
may also be required to be listed by the governmental unit.
QUANTITY
ITEM
DESCRIPTION,
SIZE, CAPACITY,
ETC.
CONDITION
YEARS
OF
SERVICE
PRESENT LOCATION
5
Asphalt Plants
Various
Good
Griffith, South Bend,
Valparaiso, Lowell, LaPorte
19
Asphalt Pavers
Various
Good
Griffith, South Bend
4
Slipform Cone. Paver
Various
Good
Griffith, South Bend
3
Road Widener
Various
Good
Griffith, South Bend
5
Motor Graders
CAT/J.D.
Good
Griffith, South Bend
54
Rollers
Various
Good
Griffith, South Bend
30
Rubber Tire Loaders
Various
Good
Griffith, South Bend
15
Excavators
Various
Good
Griffith, South Bend
9
Bulldozers
Various
Good
Griffith, South Bend
6
LowBoy Tractors
Various
Good
Griffith, South Bend
8
Flatbed Dumps
Various
Good
Griffith, South Bend
48
%z and 3/ ton Pickups
Various
Good
Griffith, South Bend
65
1 Ton Crew Trucks
Various
Good
Griffith, South Bend
3
Cold Planers
Wirtgen 1900
DC
Good
Griffith, South Bend
3
Tri-Axlc Dunip
Mack
Good
South Bend
5. Have you entered into contracts or received offers for all materials which substantiate the prices used in preparing
your proposal? Otherwise, please explain the rationale used which would corroborate the prices listed.
Yes, we received quotes from potential subcontractors and suppliers
SECTION III CONTRACTOR'S FINANCIAL STATEMENT
4
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 governing body awarding
the contract must be specific enough in detail so that said governing body can make a proper determination of the bidder's
capability for completing the project if awarded.
SECTION IV CONTRACTOR'S NON -COLLUSION AFFIDAVIT
The undersigned bidder or agent, being duly sworn on oath, says that he 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.
He 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
SECTION V OATH AND AFFIRMATION
I HEREBY AFFIRM UNDER THE PENALTIES FOR PERTURY THAT THE FACTS AND INFORMATION
CONTAINED IN THE FOREGOING BID FOR PRBLIC WORKS ARE TRUE AND CORRECT.
Dated at South Bend this 28a' day
`0\®g09III#I6i///
MT[ °
A?
n0a• e ` �
ACKNOWLEDGEMENT
STATE OF Indiana
ss
COUNTY OF St. Joseph_ }
of Organization)
f South Bend Area
(Title of Person Signing)
Before me, a Notary Public, personally appeared the above -named Dustin Hilary -and
swore that the statements contained in the foregoing document are true and correct.
Subscribed and sworn to before me this 28111 day of June, 2018
My Commission Expires: June 5, 2022
J
Alisha Krueger, Notary Public
t NY'un� ALISHA K€�UEGER
Notary k'ublic, State of kndtana
St. JosephCounty
County of Residence: St. Joseph My Commission Expires
June 05, 2022
Form 96 Section II, #2
NuDeontractors urea on Yumic Worm Uontracts ijuring the Fast 5 Years
SUBCONTRACTORS I 1i
COMPANY ADDRESS CITY/STATE/ZIP PHONE FAX
SEWER
B & D Sewer
Deboer Egolf
Delta. 1111
Dyer Construction
Catlin Plumbing & Heating
Gough, Inc.
Grimmer Construction
Hasse Construction
HRP Construction
Rex Construction
Wirtz & Yates, Inc.
Woodruff & Sons
MILLING
C.E. Hughes Milling, Inc.
Javelins Construction, Inc,.
Mid America Milling Co.
McCrite Milling
Specialities Company
ELECTRICAL INSTALLATION
Hawk. Enterprises
Midwestern Electric
SIT Bancroft Electric
Sweney Electric Company
Trans Tech Electric
SIGN INSTALLATION
Hawk Enterprises
Midwestern Electric
RoadSafe Traffic Systems
State Barricading, Inc.
fic Control Specialists, Inc.
PAVEMENT MARKINGS
The Airmarking Company
Blackout Sealcoating
RoadSafe Traffic Systems
State Barricading, Inc.
Traffic Control Specialists, Inc
Traffic Management Company
TRAFFIC CONTROL
RoadSafe Traffic Systems
Traffic Control Specialists, Inc
Traffic Management Compan}
LANDSCAPE
Great American Landscape
Hubinger Landscape
Slusser"s Green Thumb, Inc
T & J Landscape Service
531 Winston Ct
5772 Melton Road
2063 W 1250 S
1716 Sheffield Avenue
1111 E. Main Street
2200 E. 88th Drive
2619 Main Street
10 Lincoln Avenue
5777 Cleveland Rd.
700 Schiller Avenue
P.O. Box 41
P.O. Box 450
Schererville, IN 46375
Portage, IN 46368
Hanna, IN 46340
Dyer, IN 46311
Griffith, IN 46319
Merrillville, IN 46410
Highland, IN 46322
Calumet City, IL 60409
South Bend, IN 46624
Schererville, IN 46375
Kentland„ IN 47961
Michigan City, IN 46361
(219) 322-2300
(219) 763-9700
(219) 797-4004
(219) 865-2961
(219) 924-6972
(219) 756-2200
(219) 924-1623
(219 )932-1611
(574) 2711-7800
(219) 322-8090
(219) 474-6542
(219) 872-8605
(219) 865-0065
(219) 76 3-9 703
(219) 797-3008
(219) 865-2963
(219) 924-1401
(219) 756-2202
(219) 924-0328
(219) 932-6829
(574)271-0524
(219) 322-0031
19) 8795339
3113 Holmans Lane
Jeffersonville, IN 47130
(812) 725-8665
(812) 725-8672
13476 Britton Park Rd.
Fishers, IN 46038
(317) 841-8364
(317) 841-0075
6200 W. Hwy 62, Ste 400
Jeffersonville, IN 47130
(812) 282-2751
(812) 283-9846
209 Quality Ave. Ste 9
New Albany, IN 47150
(812) 941-0252
(812) 941-0852
9350 E. 30th St.
Indianapolis, IN 46229
(317) 594-0291
(317) 594-0271
1860 E. North St
1620 E, Chicago Ave
25020 State Road 2
9111 Louisiana St.
4601 Cleveland Road
1850 E. North St
1620 E. Chicago Ave
3122 Olympia Dr
24963 U.S. Highway 20
1810 W Pacific Avenue
P.O. Box 526
7440 W. 87th Place
3122 Olympia Dr
24963 U.S. Highway 20
1810 W Pacific Avenue
3542 Hiqhwav Avenue
3122 Olympia Dr
1810 W Pacific Avenue
3542 Hiahwav Avenue
P.O. Box 235
210 E. 113th Avenue
125 Montgomery Street
8253 Wicker Avenue
Crown Point, IN 46307
East Chicago, IN 46312
South Bend, IN 46619
Merrillville, IN 46410
South Bend, IN 46619
Crown Point, IN 46307
East Chicago, IN 46312
Lafayette, IN 47909
South Bend, IN 46628
Knox, IN 46534
Rochester, IN, 46975
Bridgview, IL 60455
Lafayette, IN 47909
South Bend, IN 46628
Knox, IN 46534
Highland. IN 46322
IN 47909
Knox, IN 46534
Highland, IN 46322
Dyer, IN 46311
Crown Point, IN 46307
Logansport, IN 46947
St. John, IN 46373
(219) 662-8090
(219) 397-4444
(574) 287-6490
(219) 769-6007
(574) 272-9673
(219) 662-8090
(2119) 397-4444
(317) 780-1825
(574) 287-2078
(574)772-7001
(574) 223-5817
(219) 864-2300
(317) 780-1825
(574) 287-2078
(574) 772-7001
(291) 746-2433
(219) 662-8093
(219) 397-8888
(219) 769-0565
(574) 271-0144
(219) 662-8093
(219) 397-8888
574) 772-7002
(574) 223-7959
(708) 430-6910
(574) 772-7002
(317) 780-18255
(574) 772-7001 (574) 772-7002
(219) 746-2433
(219) 322-7033 (219) 322-4419
(219) 662-9911 (219) 662-6206
(574) 722-3102 (574) 722-1628
(219) 374-9900 (219) 374-990
GUARDRAIL/FENCING
Acorn Fence
2041 164th Street
Hammond, IN 46320
(219) 844-8400
(219) 844-8441
G Tech Corporation
5300 W. 100 North
Boggstown, IN 46110
(317) 835-2746
(317) 835-2781
James H. Drew Company
8701 Zionsville Rd.
Indianapolis, IN 46268
(317) 876-3739
(317) 876-3829
Security Industries
10010 Georgiana. St.
Hobart, IN 46342
(219) 942-9447
(219) 942-9448
Specialties Company
9350 E. 30th St.
Indianapolis, IN 46229
(317) 594-0291
(317) 594-0271
TRUCKING/HAULING
C. Lee Construction Services
1011 S. Lake St
Gary, IN 46403
(219) 888-9564
(219) 888-9564
Condon Trucking, LLC
18245 Amberley Ln
South Bend„ IN 46637
(574) 360-4326
(574) 271-89,84
Fanio Services
28015 SR 23
North Liberty, IN 46554
(574) 233-3236
Gilmer Trucking
20390 New Road
South Bend, IN 46614
(574) 229-3233
Material Transfer Inc.
7811 West 101 st Ave.
Crown Point, IIN 46307
(219) 865-9575
Morris Motor Service, Inc.
10525 W US Hwy 30 Bid
Wanatah, IN 46390
(219) 733-9430
7
P & C Trucking
4410 Ross Road
Gary, IN 46408
(219) 972-0193
Superior Construction Co., Inc.
1455 Louis Sullivan Dr
Portage, IN 46368
(219) 787-0850
V & R Trucking, Inc.
1845 Elmer St.
South (Bend, IN 46628
(574) 329-2102
SRPM'S
K & S Markers, Inc.
2189 N 600 W
Thorntown, IN 46071
(765) 482-6184
(765) 482-6284
UNDERSEAL
Rieth-Riley Construction 'Co.,
2454 West CR 450 North
LaPorte, IN 46350
(219) 362-6178
Inc..
TREE REMOVAL
Dave's Tree Service
1555 Park West Circle
Munster, IN 46321
(219) 922-9829
(219) 922-9843
Homer Tree Service
14000 S. Archer Ave
Lockport, IL 60441
(815) 838-0320
Timber Masters LLC
P.O. Box 245
Dyer, IN 46311
(219) 864-8733
(219) 322-9391
LAME STABILIZATION
Mt. Carmel Sand & Gravel
1611 College Dr.
Mt, Carmel, IL 62.863
(618) 262-5118
(618) 263-4084
Rock Solid Stabilization
5104 Mann Drive
Ringwood, IL 60072
(815) 653-2585
(815) 653-2583
Specialties Company
9350 E. 30th St.
Indianapolis, IN 46229
(317) 594-0291
(317) 594-0271
PIPE LINING
Indiana Reline, Inc.
312 E. Main Street
Sulphur Springs, IN
(765) 766-5040
(765) 533-5831
47388
SAW CUTTING
Diamond Coring Co., Inc.
111800 S Ewing Ave
Chicago„ IL 60617
(773) 978-5000
Quality Saw & Seal, Inc.
7600 W. 79th Street
Bridgeview, IL 60455
(773) 767-9300
SEAL COATING/STRIPING
Site Services, Inc.
10117 Kennedy Ave
Highland, 146322
(219) 924-9944
Blackout Sealcoating
7440W. 87th Place
Bridgview, IL 60455
(219) 864-2300
(708) 430-6910
UINIDERDRAIN
3D Company, Inc.
3200 East CR 350 North
Muncie, IN 47303
(765) 288-3326
(765) 288-3344
General Dorm No. 96-a
Prescribed by the State Board of
Accounts of Indiana. Revised 1949.
Standard Questionnaires and
Financial Statement for Bidders
Prescribed by
THE STATE BOARD OF ACCOUNTS OF INDIANA
For use in investigating and determining the qualifications of bidders on public
construction when the aggregate cost of any such work or improvement will be Five Thousand
Dollars or more,
These statements to be submitted under oath by each bidder with and as a part of his bid, as provided
by Chapter 306, page 1248, Acts of 1947
Submitted to City of South Bend Indiana
By Walsh & Kelly, Inc.
Address 24358 SR 23 South Bend IN 46614
Date submitted AugLast 28 2018
Filed
A.E. BOYCE CO., MUNCIE,
tA Corporation
1
See, 2 of an Act entitled "AN ACT concerning the awarding of contracts for the performance of public work and
authorizing the board of accounts to prescribe certain forms to be used in ascertaining the responsibility of contractors who
submit bids for the performance of such work, providing for plans and specifications, providing for bids repealing certain laws
and declaring an emergency." (Approved March 13, 1947.)
Sec. 2. Whenever the aggregate costs of any work or improvement will be five thousand dollars ($5,000.00) or more, for
the purpose of enabling such board, commission, trustee, officer or agent to ascertain and determine which of the bidders
submitting bids for the performance of any such public work is, in the judgment of such board, commission, trustee, officer or
agent, the lowest and/or best bidder and to exercise intelligently the discretion hereby conferred on such board, commission,
trustee, officer or agent each bidder shall be required to submit under oath with and as a part of his bid a statement of his
experience, his proposed plan for performing such work and the equipment which he has available for the performance of such
work and a financial statement. The statements hereby required shall be submitted on forms which shall be prescribed by the state
board of accounts. The forins so prescribed shall be designated, respectively, as the experience questionnaire, the plan and
equipment questionnaire and the contractor's financial statement, and shall be based, so far as applicable, on the standard
questionnaires and financial statement for bidders as approved and recommended by the joint conference on construction
practices, for use in investigating the qualifications of bidders on public construction work, and the forms so prescribed are
hereby prescribed as the forms which shall hereafter be used by all such boards, commissions, trustees, officers and agents in
obtaining the information which is required in the administration of this act. If the information submitted by any bidder on the
forms herein prescribed is found, on examination, to be unsatisfactory, the bid submitted by such bidder shall not be considered.
(Burns Statutes 1933, Sec. 53-109) See. 2, Chapter 306, Acts of 1947.
TO THE BIDDER —
The following forms of questionnaires and financial statement are prescribed by the State Board of
Accounts in conformity with the statute set out on the preceding page.
These forms, properly filled out and attested, must accompany each bid of five thousand dollars or
more on any public work.
The forms are designed to cover all contracts for all kinds of work and the bidder is required to
answer such questions as are pertinent to the work upon which he is bidding. The purpose of the
questionnaire and financial statement, as set forth in the law, is to enable the awarding body to determine
the qualifications of the bidder to carry out successfully the contract if the same is awarded to him.
The bidder will find it to his advantage to answer fully all questions coming within the range of the
work upon which he is bidding. Particular attention should be given the "Financial Statement" and the
details relative to the assets and liabilities set out. This form is made in extensive detail so that the bidder
may explain his assets and liabilities in proper sequence and in a uniform manner.
T. M. HINDMAN,
State Examiner
Submitted by Walsh & Kelly, Inc. € x A Corporation
Principal Office at 1700 East Main Street Griffith IN 46319
To City of South Bend, Indiana
EXPERIENCE QUESTIONNAIRE
The signatory of this questionnaire guarantees the truth and accuracy of all statements and of all answers
to interrogatories hereinafter made.
I. How many years has your organization been in business as a general contractor under your present
business name? 52 Years
2. How many years' experience in asphalt paving_ construction work has your organization had: (a)
As a general contractor 71 years (b) As a sub -contractor 71 Years
3. What projects has your organization completed?
Contract Amount
Class of Work
When Completed
Name and Address of Owner
$ 12,926,200
Reconstruction
October 2017
INDOT
$ 5,970,162
Reconstruction
May 2017
Town of Merrillville, IN
$ 5,521,799
Resurface
December 2017
City of Mishawaka, IN
$ 2,646,574
Reconstruction
September 2017
St. Joseph County Hwy
Department
3-A. What projects has your organization now in process of construction?
CONTRACT AMT. CLASS OF WORK
WHEN TO BE COMPLETED
NAME AND ADDRESS OF OWNER
$ 10,695,118
Reconstruction
November 2018
Walsh Construction
$ 8,146,239
Resurface
May 2018
INDOT
$ 4,073,719
Reconstruction
July 2018
City of East Chicago, IN
$ 2,662,813
Reconstruction
October 2018
INDOT
4. Have you ever failed to complete any work awarded to you? No If so, where and why?
5. Has any officer or partner of your organization ever been an officer or partner of some other
organization that failed to complete a construction contract? No If so, state name of individual,
other organization and reason therefore
6. Has any officer or partner of your organization ever failed to complete a construction contract
handled in his own name? No If so, state name of individual, name of owner and reason therefor
7. In what other lines of business are you financially interested? None
4
8. For what corporation or individuals have you performed work, and to whom do you refer?_
BP Amoco Whitinj4, Indiana
Tonn & Blank Construction 1623 Greenwood Ave. Michigan City, IN 46360
Grimmer Construction Co. Inc. 2619 Main Street Highland, IN 46322
University of Notre Dame South Bend Indiana
Gough, Inc. 1151 E. Summit Crown Point IN 46307
9. For what cities have you performed work and to whom do you refer?
Town of Griffith
Director of Public Works
Griffith IN
Town of Schererville
Town Manager
Schererville IN
City of Hammond
City Engineer
Hammond IN
City of South Bend
City Engineer
South Bend IN
Town of St. John
Town Manager
St. John IN
10. For what counties have you performed work and to whom do you refer?
Lake Count Highway
Su erintendent
Crown Point IN
Porter County Highway
Su erintendent
Valparaiso, IN
St. Joseph County Highway
Su erintendent
South Bend IN
Elkhart Count HijzhwAy
Su erintendent
ElkhartIN
Laporte County Highway
Superintendent
Laporte, IN
11. For what State bureaus or departments have you performed work and to whom do you refer?
Indiana Department of Transportation INDOT LaPorte District Laporte IN
Department of Natural Resources
Indianapolis, IN
12. Have you ever performed any work for the U.S. Government Yes
If so, when and to whom do you refer?
U.S. Army Corps of Engineers Chicago, IL
Indiana National Guard De t. of Administration Indianapolis, IN
Federal HighwayHighwily Administration Sterling, VA
13. What is the construction experience of the principal individual of your organization?
INDIVIDUAUS NAME
PRESENT POSITION OR
OFFICE
YEARS OF
CONSTUCTION
EXPEREINCE
MAGNITUDE AND
TYPE OF WORK
IN WHAT CAPACITY
Kevin J. Kelly
President
33
All Types
General Manager
Jeffrey L. Swan
Executive Vice President
34
All T es
Supt. Engineering
David J. Misirly
Vice President
33
Bituminous
Pavin
Engineer
Greg A. Hoffman
Vice President
31
Bituminous
Paving
Engineer
John C. Wall
Vice President
41
All types
Engineer
John M. Peisker
Vice President
33
All types
General Manager
J. Michael
Schaum
Secretary/Treasurer
46
Administration
General Manager
Jamie L. Tancos
Controller
14
Administration
General Manager
Lynn J. Bauer
South Bend O s Mgr
23
All types
Engineer
Dustin P. Hilary
South Bend Area Mgr
18
All types
Engineer
Mark E.
Krachenfels
Engineer
28
All types
Engineer
Keith A. Gardina
Engineer
23
All types
Engineer
Nikolas G. Relias
Engineer
16
Bituminous
Engineer
Paving
PLAN AND EQUIPMENT QUESTIONNAIRE
The signatory of this questionnaire guarantees the truth and accuracy of all statements and of all answers
to interrogatories hereinafter made.
1. In what manner have you inspected this proposed work? Explain in detail.
Plans, Specifications, and Site Inspections
2. Explain your plan or layout for performing the proposed work
As directed by owner/engineer
3. The work, if awarded to you, will have the personal supervision of whom?
Kevin J. Kelly, Jeffrey L. Swan David J. Misirly, Gregoa A. Hoffman Dustin P. Hilary, and Lynn J.
4. *Do you intend to do the hauling on the proposed work with your own forces? Yes
If so, give amount and type of equipment to be used As needed
*If you intend to sublet the hauling or perform it through an agent, state amount of sub -contract or
agent's contract, and if known, the name and address of sub -contractor or agent, amount and type of
his equipment and financial responsibility
Items 4,5,6 and 7 may not be applicable in all building contracts; if not, omit.
0
*Do you intend to do the grading on the proposed work with your own forces?
If so, give type of equipment to be used
7. *If you intend to sublet the grading or perform it through an agent, state amount of sub -contract or
agent's contract, and, if known, the name and address of sub -contractor or agent, amount and type of
his equipment and financial responsibility
8. Do you intend to sublet any other portions of the work? If so, state
amount of sub -contract, and, if known, the name and address of the sub -contractor, amount, and type
of this equipment and financial responsibility
9. From which sub -contractors or agents do you expect to require a bond? None
10. What equipment do you own that is available for the proposed work?
QUANTITY
ITEM
DESCRIPTION,
SIZE, CAPACITY,
ETC.
CONDITION
YEARS
OF
SERVICE
PRESENT LOCATION
5
Asphalt Plants
Various
Good
Griffith, South Bend,
Valparaiso, Lowell, LaPorte
19
Asphalt Pavers
Various
Good
Griffith, South Bend
4
Sli form Cone. Paver
Various
Good
Griffith, South Bend
3
Road Widener
Various
Good
Griffith, South Bend
5
Motor Graders
CAT/J.D.
Good
Griffith, South Bend
54
Rollers
Various
Good
Griffith, South Bend
30
Rubber Tire Loaders
Various
Good
Griffith, South Bend
15
Excavators
Various
Good
Griffith, South Bend
9
Bulldozers
Various
Good
Griffith, South Bend
6
LowBoy Tractors
Various
Good
Griffith, South Bend
8
Flatbed Dumps
Various
Good
Griffith, South Bend
48
%z and 3/ ton Pickups
Various
Good
Griffith, South Bend
65
1 Ton Crew Trucks
Various
Good
Griffith, South Bend
3
Cold Planers
Wirtgen 1900
DC
Good
Griffith, South Bend
3
Tri-Axle Dump
Mack
Good
South Bend
11, What equipment do you intend to purchase for use on the proposed work, should the contract be
awarded to you?
QUANTITY
ITEM
DESCRIPTION, SIZE, CAPACITY, ETC.
APPROXIMATE
COST
None
12. How and when will you pay for the equipment to be purchased?
13. Do you propose to rent any equipment for this work?No If so, state type, quantity and reasons for
14. Have you made contracts or received firm offers for all materials within prices used in preparing your
proposal?
Do not give names of dealers or manufacturers
Dated at South Bend this 28"' day of Auggst, 2018
Walsh &fie
co``aa
"" (Name of Org izati n
By i
stin Hilary,VP of South B
'J®� ��1,�� ���y (ztle of Person Signing)
STATE OF Indiana �i,$�9AeagbOW,
{ SS.
COUNTY OF St. Joseph
Dustin Hila1y being duly sworn deposes and says that he is VP of South Bend Area of
the above Walsh & Kelly, Inc.
(Name of Organization)
and that the answers to the questions in the foregoing questionnaires and all statements therein contained
are true and correct.
Subscribed and sworn to before me this 28"' day of August, 2018
Aiisha ge , Notary Public
My Commission expires June 5, 2022
=June
HA KRUEGER$ ublic. Stake of Indiana. Joseph Countymmission Expiresune 06, 2022
WRITTEN CONSENT TO RESOLUTIONS
of the
BOARD OF DIRECTORS
of
WALSH & KELLY, INC.
The undersigned, being all of the Directors of WALSH & KELLY, INC., an Indiana Corporation,
hereby consent to the following actions to be taken by the Corporation without a meeting of the Board of
Directors under the applicable provisions of the Indiana Business Corporation Law, as amended:
RESOLVED that the following be, and hereby are, elected officers of the Corporation, to
hold the office until the next regular meeting of the Board of Directors and until their
successors are duly elected and have qualified:
Kevin J. Kelly, President and Chief Executive Officer
Jeffrey L. Swan, Executive Vice President
Jamie L. Tancos, Controller
John M. Peisker, Vice President of Asphalt Operations
David J. Misirly, Vice President
Gregory A. Hoffman, Vice President
John C. Wall, Vice President and EEO Officer
J. Michael Schaum, Secretary and Treasurer, CFO
RESOLVED FURTHER that the actions of the Officers of the Corporation taken since the
last meeting of the Board of Directors be, and the same hereby are, fully ratified and
approved.
RESOLVED FURTHER that the following be, and they hereby are, authorized to execute
all contracts or similar documents on behalf of the Corporation:
Kevin J. Kelly, President and Chief Executive Officer
Jeffrey L, Swan, Executive Vice President
Jamie L. Tancos, Controller
John M. Peisker, Vice President of Asphalt Operations
David J. Misirly, Vice President
Gregory A. Hoffman, Vice President
Dustin P. Hilary, South Bend Area Manager
Lynn J. Bauer, South Bend Operations Manager
John C. Wall, Vice President and EEO Officer
J. Michael Schaum, Secretary and Treasurer, CFO
RESOLVED FURTHER that this consent shall be in lieu of an annual meeting of the Board
of Directors of the Corporation and shall be filed in the minute book of the Corporation in
place of any such annual minutes.
<<SIGNATURES ON THE NEXT PAGE>>
EXECUTED this 711, day of March, 2017.
Fired Fehsenfeld, Jr.
Thomas P. Bertsch
Kevin J. Kelly
James C. Fehsenfeld
John P. Vercruysse
EXECUTED this 7"' day of March, 2017.
Fred Felisenfeld, Jr,
.. . ..... . . ...
Thomas P. Bertsch
Kevin J. Kelly
JameYC. Felisenfeld
GRIFFITH SOUTH BEND
Walsh & 1700 East Maun Street 24358 State Road 23
Griffith, indiana 46319 South Bend, Indiana 46614
Keflly.., Phone (219) 924-5900 Phone (574) 288-4811
0)v Fax (219) 924-8768 Fax (574) 289-7174
www,walslikelly.com
EQUAL EMPLOYMENT OPPORTUNITY POLICY
It is the policy of this Company to assure that the applicants are employed, and that employees are treated
during employment, without regard to their race, religion, sex, gender identity, sexual orientation, color,
national origin, age, association with the Vietnam era or any other war, disability, genetic information,
citizenship status, military status, veteran status, ancestry, or any other status protected under applicable
law. Such action shall include: employment, upgrading, demotion, or transfer; recruitment or recruitment
advertising; layoff or termination; rates of pay or other forms of compensation; and selection for training,
including apprenticeship, pre -apprenticeship, and/or on the job training.
A. The Contractor will work with the State Highway Agency (SHA) and the Federal Government in carrying
out EEO obligations and in their review of his/her activities under the contract.
11. Vice President of Business Development; John C. Wall, shall be designated as Walsh & Kelly, Inc.'s
Equal Employment Officer. He will be responsible for all activities associated with the implementation of
all policies affecting equal employment opportunity.
111. Walsh & Kelly, Inc. assures nondiscriminatory recruitment by taking appropriate steps such as:
A. Placing employment advertisements in newspapers which serve the largest number of minority group
people in the recruiting area.
B. Recruiting through schools and vocational colleges having substantial proportions of minority
students.
C. Maintaining systematic contacts with minority and human relations organizations leaders referral of
qualified minority applicants.
D. Encourage present employees to refer minority applicants.
E. Make it known to all recruitment sources that qualified minority members are being sought whenever
there is hiring.
IV. This policy is intended to comply with the Civil Rights Act of 1964, as amended, the Federal Highway Act
of 1968, the Executive Order 11246 and 11375, the Rehabilitation Act of 1973, as amended, the Disabled
Veterans and Vietnam Era Veterans Readjustment Act of 1974, as amended, the Indiana Civil Right Act,
and other Federal and State Laws and Regulations pertaining to Equality of Opportunity and Affirmative
Action Policies.
V. Forms for filing any complaints are available in the office located at 1700 E. Main Street, Griffith, IN
46319. In addition, ei , plAtop call (219) 924-5900 to report any workplace concerns under this
policy. 1A/cV0,,,,
WALSH & KELLY, INC.
.Z.
wow c
John C. Wall, lip
Vice President of Business Development/06 Officer
Revised: August 17, 2017
EQUAL OPPORTUNITYEMPLOYER
(aniMmir of Qualifirnfian,
ISSUED BY
�� �.��
Inbithunt�� ��� �������������� �� ar��lo����dijo��
� r
1wDIAN*POLIS,UN April 19,2018
Ire
GRIFFITH, IN
who has filed with the Department a Contractor's Statement of Experience and Financial Condition
required under Indiana Code B-23-10, is hereby qualified to bid at any Department of Transportation
letting in Classes of Work and within the amount and other limitation of each classification as listed
below, for such period as the uncompleted work on hand from all sources does not exceed the Aggregate
amount. Classification references by name or s mbol are In accordance with the definitions in the
Contractor's Statement of Experience and Financl2condition, This certificate supersedes any certificate
previously issued, but is subject to revision or revocation according to the law, If and when changes
in the financial condition of the contracting firm or other facts justify such revision or revocation.
aGGxsmmra............ ... ------........ ....... ----_--_----........... --.... -........... ... .$DmuMIxsm
A(B) CONCRETE PAVE, wswrLIMITED .... --... ....... ....... ........ ...... _.......... ................. .......... � $25,000»0
B(A) ASPHALT PAVEMENT: wnmoozCERTIFIED nMu........... ...... --- ......................... .......... ............. oumuMnEu
C(B) moorGRADING ............... ............... ............... ..... ....... ......... ... ..... ... ........... ......... ............. .... uuNt,Iuo/Eu
E(E) SMALL ozRocTUoFuAND, DRAINAGE ITEMS- ..... ........................ ---- ..... _.......................... - $25,000,00
E(F) SURFACE MASONRY AND mUSoCONCRETE ............ ........ .............. -........ ....... __-...... w50,000,00
w87 TRAFFIC CONTROL: eAvaMmwzumuomovmm--........ ......... _-_--....................... _-_- a25,000,00
E(H) DEEP SEWER AND/OR EXCAVATION ............. ....................... -_-......... ......... ...... .......... -_- $25,000,00
af0 CONCRETE ravaMsmTwEmmua..... .......... ....... .... ............ _-..... -.................... ......... ......... m25,000*0
RE ALINICATION ENGINEER
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COMMISSIONER