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Home My WebLink AboutAward Bid - Main Street Improvements between Dean & Sherwood Proj No. 122-04 - Milestone Contractors North, Inc.1316 COUNTY -CITY BUILDING 227 W. JEFFERSON BOULEVARD SOUTH BEND, INDIANA 46601-1830 PHONE 574/235-9251 FAx 574/235-9171 CITY OF SOUTH BEND JAMES MUELLER, MAYOR BOARD OF PUBLIC WORKS January 10, 2023 Mr. Dustin Hilary Milestone Contractors North, Inc. 24358 State Road 23 South Bend, IN 46614 akrueger(kmilestonelp. com RE: Award Bid — Main Street Improvements between Dean St. and Sherwood St. Project No. 122-045 Dear Mr. Hilary: At its January 10, 2023 meeting, the Board of Public Works awarded the above referenced bid to you in the amount of $398,000; Base Bid. Enclosed please find a signed Bid/Proposal form. Please forward the following documents in one submittal by January 24, 2023 to my attention for Board of Public Works approval at lhensleyksouthbendin.gov: 1) One (1) signed original of the Public Works Contract (enclosed) 2) Labor & Material Payment Bond 3) Performance Bond (125% of Bid Amount) 4) Certificate of Insurance naming the City of South Bend as an additional insured 5) Item #4 for all subcontractors that you use If you have any further questions, please call this office at (574) 235-9251. Sincerely, /s/ Theresa Heffner Theresa Heffiier, Clerk Enclosures TH/lh ELIZABETH A. MARADIK JOSEPH R. MOLNAR GARY A. GILOT JORDAN V. GATHERS MURRAY L. MILLER 1316 COUNTY -CITY BUILDING 227 W. JEFFERSON BOULEVARD SOUTH BEND, INDIANA 46601-1830 PHONE 574/235-9251 FAx 574/235-9171 CITY OF SOUTH BEND JAMES MUELLER, MAYOR BOARD OF PUBLIC WORKS January 10, 2023 Mr. Ruben Alvarado Rieth-Riley Construction Co., Inc. 25200 State Road 23 South Bend, IN 46614 ralvarado&rieth-rile,, RE: Bid Award — Main Street Improvements between Dean St. and Sherwood St. Project No. 122-045 Dear Mr. Alvarado: At its January 10, 2023, meeting, the Board of Public Works awarded the above referenced bid to Milestone Contractors North, Inc., Inc. in the amount of $398,000; Base Bid. Thank you for bidding, and we hope you bid with us in the future. If you have any further questions, please call this office at (574) 235-9251. Sincerely, /s/ Theresa Hefner Theresa Heffner, Clerk Enclosures TH/lh ELIZABETH A. MARADIK JOSEPH R. MOLNAR GARY A. GILOT JORDAN V. GATHERS MURRAY L. MILLER �O,,,501ITH *4 INTER -OFFICE MEMORANDUM O r . DEPARTMENT OF PUBLIC WORKS rs DIVISION OF ENGINEERING TO: Theresa Heffner, Clerk Board of Public Works FROM: Charlotte Brach, Senior Engineer SUBJECT: Award Project No. 122-045 Main Street Improvements between Dean and Sherwood DATE: December 23, 2022 On November 8, 2022, the Board of Public Works opened and read bids for the above project, which consisted of a base bid. The bidders ranked as follows: Bidder Amount 1. Milestone Contractors North, Inc. $398,000.00 2. Rieth Riley Construction Co., Inc. $470,953.72 I recommend award of a contract to the lowest responsive / responsible quoter, Milestone Contractors North, Inc.. in the amount of $398,000. Sufficient funds have been appropriated from South Side Development Area TIF 430-10-102-121- 442001-PROJ00000216. Please call with your questions. Enc. Bid Tabulation Page 1 of 1 Main Street Improvements Between Sherwood Street and Dean Street / SB # 122-045 Bid Tab Engineer's Estimate Milestone Contractors North Reith Riley Construction Co. ITEM DESCRIPTION OF ITEM ESTIMATED QUANTITY UNIT Unit Price Extension Unit Price Extension Unit Price Extension 1 Common Excavation 446 CYS $25.00 $11,150.00 $98.00 $43,708.00 $82.87 $36,960.02 2 Concrete, Remove 198 SYS $14.00 $2,772.00 $19.00 $3,762.00 $38.10 $7,543.80 3 Subgrade Treatment Type II 865 SYS $14.00 $12,110.00 $15.00 $12,975.00 $21.03 $18,190.95 4 Compacted No. 53 Subbase 270 TON $29.00 $7,830.00 $44.00 $11,880.00 $61.92 $16,718.40 5 Milling, 1.5 in. 3208 SYS $5.00 $16,040.00 $5.20 $16,681.60 $4.04 $12,960.32 6 HMA Surface, PG64-28P, Type B 321 TON $115.00 $36,915.00 $174.00 $55,854.00 $145.55 $46,721.55 7 HMA Intermediate, Type B 94 TON $115.00 $10,810.00 $187.00 $17,578.00 $309.17 $29,061.98 8 HMA Base, Type B 220 TON $130.00 $28,600.00 $130.00 $28,600.00 $190.28 $41,861.60 9 Tack Coat 2 TON $500.00 $1,000.00 $1.00 $2.00 $339.14 $678.28 10 Joint Adhesive, Surface 1,216 LFT $2.00 $2,432.00 $1.00 $1,216.00 $2.82 $3,429.12 11 PCCP for Approaches, 6 in. 23 SYS $82.00 $1,886.00 $181.00 $4,163.00 $158.83 $3,653.09 12 Sidewalk, Concrete 28 SYS $108.00 $3,024.00 $133.00 $3,724.00 $121.41 $3,399.48 13 Curb, Concrete 766 LFT $48.00 $36,768.00 $41.00 $31,406.00 $98.72 $75,619.52 14 Drywell, 3600 gal. Capacity 2 EA $6,289.00 $12,578.00 $11,000.00 $22,000.00 $11,197.49 $22,394.98 15 Curb Ramp, Concrete 29 SYS $280.00 $8,120.00 $265.00 $7,685.00 $359.79 $10,433.91 16 Sodding, Nursery 434 SYS $9.00 $3,906.00 $34.91 $15,150.94 $19.53 $8,476.02 17 Tree, Remove, 30 in. 2 EA $1,700.00 $3,400.00 $1,250.00 $2,500.00 $7,756.73 $15,513.46 18 Tree Planting 9 EA $1,700.00 $15,300.00 $648.00 $5,832.00 $1,018.72 $9,168.48 19 Adjust Casting to Grade 5 EA $888.00 $4,440.00 $1,520.00 $7,600.00 $723.21 $3,616.05 20 Adjust Water Valve Casting to Grade 2 EA $686.00 $1,372.00 $175.00 $350.00 $301.34 $602.68 21 Curb Box, Adjust to Grade 9 EA $600.00 $5,400.00 $875.00 $7,875.00 $1,638.42 $14,745.78 22 Fire Hydrant Assembly, Relocate 1 EA $1,500.00 $1,500.00 $7,200.00 $7,200.00 $7,186.34 $7,186.34 23 Sheet Sign with Legend 0.080 in. 25 SFT $18.00 $450.00 $63.50 $1,587.50 $24.30 $607.50 24 Sheet Sign, Remove 3 EA $34.00 $102.00 $158.00 $474.00 $386.91 $1,160.73 25 Line, Thermoplastic, Solid, Yellow, 4 in. 1,640 LFT $1.00 $1,640.00 $0.88 $1,443.20 $0.91 $1,492.40 26 Line, Thermoplastic, Solid, White, 4 in. 2,208 LFT $1.00 $2,208.00 $0.88 $1,943.04 $0.91 $2,009.28 27 Line, Thermoplastic, Broken, Yellow, 4 in. 410 LFT $1.00 $410.00 $0.93 $381.30 $0.96 $393.60 28 Line, Thermoplastic, Dotted, Yellow, 4 IN., 2 FT. Line, 4 FT. Gap 30 LFT $2.00 $60.00 $1.66 $49.80 $1.72 $51.60 29 Line, Thermoplastic, Dotted, White, 4 IN., 2 FT. Line, 4 FT. Gap 30 LFT $2.50 $75.00 $1.66 $49.80 $1.72 $51.60 30 Pavement Message Marking, Thermoplastic, Lane Indication Arrow 4 EA $200.00 $800.00 $165.00 $660.00 $170.65 $682.60 31 Grooving for Pavement Markings 3,482 LFT $1.00 $3,482.00 $0.88 $3,064.16 $0.91 $3,168.62 32 Construction Engineering 1 LS $7,000.00 $7,000.00 $4,600.00 $4,600.00 $4,654.04 $4,654.04 33 Mobilization and Demobilization 1 LS $11,600.00 $11,600.00 $22,000.00 $22,000.00 $22,667.92 $22,667.92 34 Clearing Right of Way 1 LS $4,700.00 $4,700.0011 $25,600.00 $25,600.0011 $18,696.65 $18,696.65 35 Maintenance of Traffic 1 LS $16,300.00 $16,300.00 $27,754.66 $27,754.66 $24,233.18 $24,233.18 361 Erosion Control 1 LS $2,400.001 $2,400.00 $650.001 $2,148.191 $2,148.19 TOTAL BID (Items 1 to 36) $278,580.00 $398,000.00 $470,953.72 Certified y 11/9/2022 Nitin V. Timble PE. LS Date CITY OF SOUTH BEND, INDIANA CONTRACTOR'S BID FOR PUBLIC WORK Project Name Main Street Improvements Between Sherwood Street and Main Street Project No. 122-045 For Bids Due November 8, 2022 PART I (Must be completed for all bids. Please type or print) Date: 11 /8/2022 Address: 24358 SR 23 Bidder (Firm): Milestone Contractors North, Inc. City/State/Zip: South Bend, IN 46614 Telephone Number: ( 574 ) 288-4811 Agent of Bidder (if Applicable): Pursuant to notices given, the undersigned offers to furnish labor and/or material necessary to complete the public works project of: Main Street Improvements Between Sherwood Street and Main Street the City of South Bend, Indiana, in accordance with plans and specifications prepared by: and dated 9/23/2022 A & Z Engineering, LLC for the sum of (enter the Total Bid as shown on the Proposal) Three hundred ninety eight thousand dollars and zero cents ($ 398,000.00 (Enter sum of Total Base Bid plus Alternates 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 addendums attached will be specifically referenced at the applicable page. If additional units of material included in the contract are neecd, th cost of units must be the same as th.��l�' shown in the original contract if accepted by the City "of S:th nd. If the bid"is to be awarded o��o h''rf�cror.,sip; basis, the itemization of the units shall be shown on a para� ent: " eL ...•••-.., s2 f` By oar `pRPORgrF0g: (Signature) ustin P. Hilary. Director of Estimating 01-' (Printed Name of Person Signing) �i AL ACCEPTANCE The above bid is accepted this day of 20 • • • . Subject to the following conditions: CITY OF SOUTH BEND, INDIANA BOARD OF PUBLIC WORKS VtLa ,�z 7T� Elizabeth A. Maradik, President Gary A. Gilot, Member P0"^ - 4 7 Murray L. Miller, Member Joseph R. Molnar, Vice President Jordan V. Gathers, Member Attest: Theresa M. Heffner, Clerk Date: January 10, 2023 BOARD OF PUBLIC WORKS CITY OF SOUTH BEND, INDIANA PUBLIC WORKS CONTRACT This Agreement is made and entered into this loth Day of January, 2023, by and between Milestone Contractors North, Inc. (the "Contractor"), and the Board of Public Works (the "Board"). The Contractor covenants and agrees to make the following improvement, as fully set out in the Request for Quotations, Standard Specifications, Special Provisions, Plans, and Bid Proposals, all of which are set forth as a part of this Contract, for: PROJECT NO. 122-045 DESCRIPTION: MAIN STREET IMPROVEMENTS BETWEEN DEAN ST. AND SHERWOOD ST. COMPLETION DATE: SEE SPECIFICATIONS AMOUNT: $398,000; BASE BID FUNDING: PR-00019724 The unit prices for this improvement were those prices as received and accepted by the Board on the 8th Day of November, 2022. The Contractor further agrees to notify the assigned Engineer when this improvement is completed. This notification shall be in the form of a Project Completion Affidavit, signed by the Contractor. Upon final acceptance of the improvement by the Engineer, the Contractor's final estimate will be presented to the Board for final Payment with one (1) copy of the Project Completion Affidavit and one (1) copy of a Waiver of Lien. Each of the Parties, by signing below, represents and warrants to the other Party that he/she/it has the authority to bind the named person or entity to this Agreement. CITY OF SOUTH BEND, INDIANA MILESTONE CONTRATORS BOARD OF PUBLIC WORKS NORTH, INC. Elizabeth A. Maradik, President Gary A. Gilot, Member Murray L. Miller, Member Joseph R. Molnar, Vice President Printed Name Jordan V. Gathers, Member Signature Attest: Theresa M. Heffner, Clerk Date: January 10, 2023 CITY OF SOUTH BEND, INDIANA CONTRACTOR'S BID FOR PUBLIC WORK CHECKLIST FOR BIDDERS Project Name Project No. For Bids Due Main Street Improvements Between Sherwood Street and Dean Street 122-045 November 8, 2022 From time to time the South Bend Board of Public Works finds it necessary to reject a bid because it does not comply with statutory requirements. In preparing your bid, please use the following checklist in order to make sure that your bid is done in the proper manner. Proper bid security included. The bidder has the option of providing either a Certified Check X or Bid Bond. Bid prepared on the City of South Bend Contractor's Bid for Public Work Form, completely X 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 M/WBE Utilization Plans [MBE-1.0 and WBE-1.0]. Also provide Evidence of Good Faith Efforts Forms [MBE-2.0 and WBE-2.0] and M/WBE Contacted Forms [MBE-2.1 and X WBE-2.1]. X Acknowledge Receipt of 1 Addendum(s) included with the bid. X All required additional information is included with the bid. Proposal statements and other affidavits all signed by the proper party with name either X 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. Bidder: Milestone Contractors By Authorized Representa#ve: Signature: Print Name & Title: `1369fin P. Hilarv. Director of Version 09/29/2021 Contractor's Bid for Public Works -1 Date: 11 /8/2022 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. 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 09/29/2021 Contractor's Bid for Public Works - 3 When the prospective Contractor is unable to certify to any of the statements below, it shall attach an explanation to this Affidavit. CONTRACTOR'S NON -COLLUSION AND NON -DEBARMENT AFFIDAVIT, CERTIFICATION REGARDING INVESTMENT WITH IRAN, EMPLOYMENT ELIGIBILITY VERIFICATION, NON- DISCRIMINATION COMMITMENT AND CERTIFICATION OF USE OF UNITED STATES STEEL PRODUCTS OR FOUNDRY PRODUCTS (Must be completed for all quotes and bids. Please type or print) STATE OF 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: i. Contractor, its successor or its affiliate, provides goods or services of twenty million dollars ($20,000,000) or more in value in the energy sector of Iran; or ii. Contractor, its successor or its affiliate, is a financial institution that extends twenty million dollars ($20,000,000) or more in credit to another person for forty-five (45) days or more, if that person will (i) use the credit to provides goods and services in the energy sector in Iran; and (ii) at the time the financial institution extends credit, is a person identified on list published by the Indiana Department of Administration. 4. Contractor does not knowingly employ or contract with an unauthorized alien, nor retain any employee or contract with a person that the Contractor subsequently learns is an unauthorized alien. Version 09/29/2021 Contractor's Bid for Public Works - 4 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. 6. Persons, firms, partnerships, corporations, associations, or joint venturers awarded a contract by the City of South Bend through its agencies, boards, or commissions shall not discriminate against any employee or applicant for employment in the performance of a City contract with respect to hire, tenure, terms, conditions, or privileges of contract or employment, or any matter directly or indirectly related to contracting or employment because of race, sex, religion, color, national origin, ancestry, gender expression, gender identity, sexual orientation, or due to age 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 will consider the Contractor's good faith efforts to obtain participation by those subcontractors 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. Contractors seeking the award of a City contract cannot be required to award a subcontract to an MWBE; however, they may not unlawfully discriminate against said MBE/WBE. On goal -eligible contracts, Contractors are required to either meet both MBE and WBE utilization goals or demonstrate that the Contractor has made good faith efforts to obtain participation from MBE and WBE subcontractors. A finding of noncompliance or a discriminatory practice shall prohibit that Contractor from being awarded a City contract for a period of one (1) year from the date of such determination, and such determination may also be grounds for terminating the contact to 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 09/29/2021 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 8th day of Nov. , 2022 `,l tr alc tor1 ", INN'�ii J s,L ie. • F Jz 0.- `oPPORgTF S y SEAAt hI rail or Its Agent Dustin P. Hilary., Director of Estimating Printed Name and Title Subscribed and sworn to before me this 8th day of N v mber , 2022 My Commission Expires 6/5/2030 In Notary PutifiC Alish rueger County of Residence LaPorte ��gY pVB ;11;7 KRUEGER .�Q� •••. 1, rt,7 14 Mt EiI�$ _* SEAL :*` June 5,2030 Commission Number NP0653544 La Porle couna Version 09/29/2021 Contractor's Bid for Public Works - 6 BID/PROPOSAL CITY OF SOUTH BEND PROJECT NAME: Main Street Improvements between Sherwood & Dean Street PROJECT NO. 122-045 FOR BIDS DUE: November 8, 2022 i CONTRACTOR NAME: Milestone Contractors North, Inc. _. w •r.u:r r, 1 z, ■ 1865 BASE BID — MAIN STREET (FROM SHERWOOD STREET TO DEAN STREET) Item Description Quantity Unit Unit Price Total Amount 1 Common Excavation 446 CYS 98.00 $43,708.00 2 Concrete, Remove 198 SYS 19.00 $3,762.00 3 Subgrade Treatment Type II 865 SYS 15.00 $12,975.00 4 Compacted No. 53 Subbase 270 TON 44.00 $11,880.00 5 Milling, 1.5 in. 3208 SYS 5.20 $16,681.60 6 HMA Surface, PG64-28P, Type B 321 TON 174.00 $55,854.00 7 HMA Intermediate, Type B 94 TON 187.00 $17,578.00 8 HMA Base, Type B 220 TON 130.00 $28,600.00 9 Tack Coat 2 TON 1.00 $2.00 10 Joint Adhesive, Surface 1216 LFT 1.00 $1,216.00 11 PCCP for Approaches, 6 in. 23 SYS 181.00 $4,163.00 12 Sidewalk, Concrete 28 SYS 133.00 $3,724.00 13 Curb, Concrete 766 LFT 41.00 $31,406.00 14 Drywell, 3600 gal. Capacity 2 EA 11,000.00 $22,000.00 15 Curb Ramp, Concrete 29 SYS 265.00 $7,685.00 16 Sodding, Nursery 434 SYS 34.91 $15,150.94 17 Tree, Remove, 30 in. 2 EA 1,250.00 $2,500.00 18 Tree Planting 9 EA 648.00 $5,832.00 19 Adjust Casting to Grade Adjust Water Valve Casting to Grade 5 EA 1,520.00 $7,600.00 20 2 EA 175.00 $350.00 21 Curb Box, Adjust to Grade 9 EA 875.00 $7,875.00 22 Fire Hydrant Assembly, Relocate 1 EA 7,200.00 $7,200.00 23 Sheet Sign with Legend 0.080 in. 25 SFT 63.50 $1,587.50 24 Sheet Sign, Remove 3 EA 158.00 $474.00 25 Line, Thermoplastic, Solid, Yellow, 4 in. 1640 LFT 0.88 $1,443.20 26 Line, Thermoplastic, Solid, White, 4 in. 2208 LFT 0.88 $1,943.04 27 Line, Thermoplastic, Broken, Yellow, 4 in. 410 LFT 0.93 $381.30 28 Line, Thermoplastic, Dotted, Yellow, 4 IN., 2 FT. Line, 4 FT. Gap 30 LFT 1.66 $49.80 Version 09/29/2021 Contractor's Bid for Public Works - 7 PROJECT NAME: Main Street I PROJECT NO. 122-045 BID/PROPOSAL CITY OF SOUTH BEND FOR BIDS DUE: November 8, 2022 nts between Sherwood & Dean Street CONTRACTOR NAME: Milestone Contractors North, Inc. 1865 BASE BID — MAIN STREET (FROM SHERWOOD STREET TO DEAN STREET) 29 Line, Thermoplastic, Dotted, White, 4 IN., 2 FT. Line, 4 FT. Gap 30 LFT 1.66 $49.80 30 Pavement Message Marking, Thermoplastic, Lane Indication Arrow 4 EA 165.00 $660.00 31 Grooving for Pavement Markings 3482 LFT 0.88 $3,064.16 32 Construction Engineering 1 LS 4,600.00 $4,600.00 33 Mobilization and Demobilization 1 LS 22,000.00 $22,000.00 34 Clearing Right of Way 1 LS 25,600.00 $25,600.00 35 Maintenance of Traffic 1 LS 27,754.66 $27,754.66 36 Erosion Control 1 LS 650.00 $650.00 BASE BID - MAIN STREET BASE BID TOTAL $398,000.00 Bidder(Firm): Address: City/State/Zip Telephone Number: Milestone Contractors North, Inc. 24358 SR 23 South Bend,IN 46614 574-288-4811 i (Signature) Dustin Hilary, Director of Estimating (Printed name of Person Signing) Version 09/29/2021 Contractor's Bid for Public Works - 8 CITY OF SOUTH BEND 1 MINORITY AND WOMEN BUSINESS ENTERPRISE INCLUSION PROGRAM PLAN FORM MBE-1.0 MBE UTILIZATION PLAN This completed form should be supplied with Bids that pertain to City of South Bend Public Works Projects involving MBE participation. It is the bidder's sole responsibility to verify whether any listed minority -owned business meets the MBE qualifications. Project Number: Bidder: 122-045 Project Name: Milestone Contractors North, Inc. Main Street Improvements Between Sherwood Street and Dean Street Total Bid Amount: $398,000.00 MBE Goal: 3.21% Page 1 of 1 Name & Address of MBE Primary Contact Person (Name/Telephone) Scope of Work to be Performed (Attach scope/schedule if you need additional space) Dollar Amount of MBE Component Percentage of Total Bid/Proposal 1st Class Logistics, LLC. 24423 IN 23 South Bend, IN 46614 Bernard Coutee 574-993-0071 Hauling $12,800.00 3.216% Submitted by: Dustin P. Hilary, Director of Estimat Print Name Version 09/29/2021 Contractor's Bid for Public Works - 9 11 /8/2022 Date CITY OF SOUTH BEND W MINORITY AND WOMEN BUSINESS ENTERPRISE INCLUSION PROGRAM PLAN r FORM WBE-1.0 = , WBE UTILIZATION PLAN This completed form should be supplied with Bids that pertain to City of South Bend Public Works Projects involving WBE participation. It is the bidder's sole responsibility to verify whether any listed woman -owned business meets the WBE qualifications. Project Number: 122-045 Project Name: Main Street Improvements Between Sherwood Street and Dean Street Bidder: Milestone Contractors North, Inc. Total Bid Amount: $398,000.00 WBE Goal: 5.49% Page 1 of 1 Primary Contact Person Scope of Work to be Performed Dollar Amount of WBE Percentage Name & Address of WBE (Name/Telephone) (Attach scope/schedule if you need additional space) Component of Total Bid/Proposal State Barricading, Inc. James Michalski Traffic Control & Sheet Signs $18,709.50 4.7% 24963 US Hwy 20 W. 574-287-2078 South Bend, IN 46628 V & R Trucking, Inc. Veda Godette 1845 N. Elmer Street 574-234-1268 Hauling $3,200.00 .80% South Bend, IN 46628 Submitted by: Dustin P. Hilary, Director of Estimating Print Name nat Version 09/29/2021 Contractor's Bid for Public Works - 10 11 /8/2022 Date CITY OF SOUTH BEND MINORITY AND WOMEN BUSINESS ENTERPRISE INCLUSION PROGRAM PLAN FORM MBE-2.0 EVIDENCE OF GOOD FAITH EFFORTS This completed form should be included as part of the Bids documents related to City of South Bend Public Works Projects requiring Good Faith Efforts to obtain MBE participation. Project Number: 122-045 Date: 11/8/2022 Project Name: Main Street Improvements between Sherwood St and Dean St Bidder: Milestone Contractors North, Inc. Contact Person: Ed Pili ow Telephone: 574-288-4811 Address: 24358 SR 23 City: South Bend State: Indiana zip: 46614 Email: a ili ow(&,milestonelp.com To determine whether a bidder has demonstrated good faith efforts to reach the MBE utilization goals set forth in the City of South Bend Public Works Project Specifications, the City and its agencies, boards, or commissions, REQUIRE ALL of the following Good Faith Efforts as listed in the table below*: EVIDENCE OF GOOD FAITH EFFORTS MBE LIST(S): The bidder reviewed 1) the City of South Bend's Minority and Women Business Enterprise Inclusion Program Plan; 2) the list of certified MWBEs provided by the City; and 3) the Indiana Department of Administration list of Minority and Women Owned Businesses (both certified and non -certified) found at: hftp://www.in.00v/idoa/. GOOD FAITH EFFORTS TO OBTAIN MBE PARTICIPATION The bidder shall initial each item below, as evidence of its good faith efforts to obtain MBE participation in the awarded contract. I affirm that I reviewed the City of South Bend's Minority and Women Business Enterprise Inclusion Program Plan and the Indiana Department of Administration's certified list of Indiana Minority and Women Business Enterprises, found on their website (http://www.in.gov/idoa). I affirm that I have made good faith efforts to select portions of the contract work to be performed by MWBEs, including, where appropriate, breaking out contract work items into economically feasible units to facilitate MBE participation. I affirm that I have made good faith efforts to solicit through all reasonable and available r' F� means the interest of all MBEs in the scopes of work of the contract. I affirm that I attended all pre -bid meetings scheduled by the City of South Bend to inform MBEs of contracting and subcontracting opportunities. I affirm that I advertised in general circulation and/or trade association publications concerning subcontract opportunities and allowed MBEs reasonable time to respond to such advertisements. I affirm that I performed any and all necessary steps to provide written notices in a manner reasonably calculated to inform MBEs of subcontracting opportunities and allowed sufficient time for MBEs to participate effectively. I affirm that I followed up on initial solicitations with interested MBEs. I affirm that I negotiated with interested MBEs in good faith, including providing such MBEs with adequate information about the plans, specifications and other requirements of the subcontract. I affirm that I have made good faith efforts to assist interested MBEs in obtaining bonding, lines of credit, or insurance as required by the City or the bidder, where appropriate. Version 09/29/2021 Contractor's Bid for Public Works -11 I- L4 CITY OF SOUTH BEND MINORITY AND WOMEN BUSINESS ENTERPRISE INCLUSION PROGRAM PLAN �. FORM MBE-2.0, EVIDENCE OF GOOD FAITH EFFORTS I affirm that I have made good faith efforts to assist interested MBEs in obtaining necessary �� equipment, supplies, materials, or related assistances or services, where appropriate. I affirm that I did not reject any MBEs as unqualified without sound business reasons based } on a thorough investigation of their capabilities. CONTRACT RECORDS: The bidder has maintained the following records for each MBE 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 MBE was unqualified to perform the job. *Proper demonstration of Good Faith Efforts 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 Bend reserves the right to request additional information. Version 09/29/2021 Contractor's Bid for Public Works -12 CITY OF SOUTH BEND _ MINORITY AND WOMEN BUSINESS ENTERPRISE INCLUSION PROGRAM PLAN FORM WBE-2.0 EVIDENCE OF GOOD FAITH EFFORTS This completed form should be included as part of the Bids documents related to City of South Bend Public Works Projects requiring Good Faith Efforts to obtain MWBE participation. Project Number: 122-045 Date: 11/8/2022 Project Name: Main Street Improvements Between Sherwood Street and Dean Street Bidder: Milestone Contractors North, Inc. Contact Person: Ed Pilipow Telephone: 574-288-4811 Address: 24358 SR 23 City: South Bend State: Indiana zip: 46614 Email: epilipow@milestonelp.com To determine whether a bidder has demonstrated good faith efforts to reach the WBE utilization goals set forth in the City of South Bend Public Works Project Specifications, the City and its agencies, boards, or commissions, REQUIRE ALL of the following Good Faith Efforts as listed in the table below": EVIDENCE OF GOOD FAITH EFFORTS WBE LIST(S): The bidder reviewed 1) the City of South Bend's Minority and Women Business Enterprise Inclusion Program Plan; 2) the list of certified MWBEs provided by the City; and 3) the Indiana Department of Administration list of Minority and Women Owned Businesses (both certified and non -certified) found at• httn-//www in nnv/irina/ GOOD FAITH EFFORTS TO OBTAIN WBE PARTICIPATION The bidder shall initial each item below, as evidence of its good faith efforts to obtain WBE participation in the awarded contract. I affirm that I reviewed the City of South Bend's Minority and Women Business Enterprise Inclusion Program Plan and the Indiana Department of Administration's certified list of Indiana Minority and Women Business Enterprises, found on their website (hftp://www.in.gov/idoa). I affirm that I have made good faith efforts to select portions of the contract work to be 7� performed by WBEs, including, where appropriate, breaking out contract work items into economically feasible units to facilitate WBE participation. I affirm that I have made good faith efforts to solicit through all reasonable and available means the interest of all WBEs in the scopes of work of the contract. I affirm that I attended all pre -bid meetings scheduled by the City of South Bend to inform WBEs of contracting and subcontracting opportunities. I affirm that I advertised in general circulation and/or trade association publications concerning subcontract opportunities and allowed WBEs reasonable time to respond to such advertisements. I affirm that I performed any and all necessary steps to provide written notices in a manner reasonably calculated to inform WBEs of subcontracting opportunities and allowed f sufficient time for WBEs to participate effectively. I affirm that I followed up on initial solicitations with interested WBEs. I affirm that I negotiated with interested WBEs in good faith, including providing such WBEs with adequate information about the plans, specifications and other requirements of the subcontract. JW I affirm that I have made good faith efforts to assist interested WBEs in obtaining bonding, lines of credit, or insurance as required by the City or the bidder, where appropriate. Version 09/29/2021 Contractor's Bid for Public Works -13 CITY OF SOUTH BEND MINORITY AND WOMEN BUSINESS ENTERPRISE INCLUSION PROGRAM PLAN FORM WBE-2.0 EVIDENCE OF GOOD FAITH EFFORTS I affirm that I have made good faith efforts to assist interested WBEs in obtaining necessary equipment, supplies, materials, or related assistances or services, where appropriate. I affirm that I did not reject any WBEs as unqualified without sound business reasons based on a thorough investigation of their capabilities. CONTRACT RECORDS: The bidder has maintained the following records for each 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 MWBE was unqualified to perform the job. *Proper demonstration of Good Faith Efforts 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 Bend reserves the right to request additional information. Version 09/29/2021 Contractor's Bid for Public Works -14 CITY OF SOUTH BEND MINORITY AND WOMEN BUSINESS ENTERPRISE INCLUSION PROGRAM PLAN FORM MBE-2.1_ MBE CONTACTED This completed form should be supplied with Bids that pertain to City of South Bend Public Works Projects requiring Good Faith Efforts to contact MBEs. It is the bidder's sole responsibility to verify whether any listed minority -owned business meets the MBE qualifications. Attach additional pages if necessary. PAGE 1 OF 1 Project Number: 122-045 MBE Participation Goal 3.21% Project Name: Mani Weet Improvements Between Sherwood Street and Dean Street Bidder: By 'Idi Itone Contractors North, Inc. Dustin P. Hilary ,Tor o, (Title) NABS_ Firm 1 st Class Logistics, LLC [Owner or Contact at MBE Firm Bernard Coutee Telephone: 574-993-0071 Fax: TYPE OF WORK SOLICITED FOR THIS PROJECT: Hauli RESULTS OF CONTACT WITH THE MBE FIRM: 11 /8/2022 (Date) Email: 1 stclasslogistics2013 c@gmail.com If we are awarded the project, we'll enter into a Hauling Agreement with 1st Class Logistics, LLC, MBE Firm Owner or Contact at MBE Firm Telephone: Fax: TYPE OF WORK SOLICITED FOR THIS PROJECT: RESULTS OF CONTACT WITH THE MBE FIRM: Email: Version 09/29/2021 Contractor's Bid for Public Works -15 This completed form should be supplied with Bids that pertain to City of South Bend Public Works Projects requiring Good Faith Efforts to contact WBEs. It is the bidder's sole responsibility to verify whether any listed woman -owned business meets the WBE qualifications. Attach additional pages if necessary. PAGE OF Project Number: 122-045 WBE Participation Goal 5.49% Project Name: ain Street Improvements Between Sherwood Street and Dean Street Bidder: one Contractors North, Inc. By: _ Director of Estimating 11/8/2022 (Signature) QLaAMi-P. Hilary (Title) (Date) WBF Firm State Barricading, Inc. ?wner or Contact at WBE Firm lamps Mirhalcki Telephone: 574-287-2078 Fax: 574-287-1744 Email: statebarricadel(Maol.com TYPE OF WORK SOLICITED FOR THIS PROJECT: Traffic Control & Sheet Signs RESULTS OF CONTACT WITH THE WBE FIRM: If we are awarded the project, we'll enter into a subcontract with State Barricading, Inc. WBE Firm V & R Trucking, Inc. Owner or Contact at WBE Firm Veda Godette Telephone: 574-234-1268 Fax: 574-234-0748 Email: rfightingirish@aol.com TYPE OF WORK SOLICITED FOR THIS PROJECT: Hauli RESULTS OF CONTACT WITH THE WBE FIRM: IF we are awarded the project, we'll enter into a Hauling Agreement with V & R Trucking, Inc. Version 09/29/2021 Contractor's Bid for Public Works -16 Bid Bond Bond No. Bid Bond CONTRACTOR: SURETY: Continental Casualty Company (Name, legal status and address) (Name, legal status and principal place of business) Milestone Contractors North, Inc. 151 N. Franklin Street 24358 State Road 23 17th Floor South Bend, IN 46614 Chicago, IL 60606 OWNER: (Name, legal status and address) City of South Bend 227 West Jefferson Blvd. South Bend, IN 46601 BOND AMOUNT: 5% Five Percent of the Base Bid Plus any Alternates PROJECT: (Name, location or address, and Project number, if any) This document has important legal consequences. Consultation with an attorney is encouraged with respect to its completion or modification. Any singular reference to Contractor, Surety, Owner or other party shall be considered plural where applicable. Main Street Improvements Between Sherwood Street and Dean Street; Project No. 122-045 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. When this Bond has been furnished to comply with a statutory or other legal requirement in the location of the Prrgg ct, ,f ' any provision in this Bond conflicting with said statutory or legal requirement shall be deemed deleted hert bhi n Ii/� provisions conforming to such statutory or other legal requirement shall be deemed incorporated herein. e,_ �6PA...... . furnished, the intent is that this Bond shall be construed as a statutory bond and not as a_common law1=•� :20 �ORPORgTF s SEA1,3`� al)`� i' o01AP0PAtk ' 'r"Seal) �r f 897.° Signed and sealed this . 8th day of November 2022 (Witness) Hannah Collantes Milestone G6ntract (Princi 1) B (yy e) in P.-Hilary, Continental Casualty (Sur ty , B (Title) Angela R Riley, Attorney -in -Fact Printed in cooperation with the American Institute of Architects (AIA). The language in this document confoans to the language used In AIA Document A310 -Bid Bond - 2010 Edition. y0'UTy e� a a 1316COUNTY-CITY BUILDING t� PHONE 574/235-9251 JL 227 W.JEFFERSON BOULEVARD r _ _ y ',i�?'� FAx 574/235-9171 SOUTH BEND, INDIANA 46601-1830 17tti5 TDD 574/ 235-5567 CITY OF SOUTH BEND TAMES MUELLER, MAYOR BOARD OF PUBLIC WORKS Date: November 3, 2022 To: All Planholders From Theresa Heffner, Clerk, Board of Public Works Subject Addendum Number: 1 Project Name: Main Street Improvements from Sherwood Street to Dean Street Project Number: 122-045 ACKNOWLEDGEMENT OF RECEIPT OF ADDENDUM Date Received: 11/3/2022 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 Contract Documents and become a part of herein. Company: Milestone Authorized Signature: P.,+Hilary, Director of Estimating Date: 11 /3/2022 Version 4/2/2015 POWER OF ATTORNEY APPOINTING INDIVIDUAL ATTORNEY -IN -FACT Know All Men By These Presents, That Continental Casualty Company, an Illinois insurance company, National Fire Insurance Company of Hartford, an Illinois insurance company, and American Casualty Company of Reading, Pennsylvania, a Pennsylvania insurance company (herein called "the CNA Companies"), are duly organized and existing insurance companies having their principal offices in the City of Chicago, and State of Illinois, and that they do by virtue of the signatures and seals herein affixed hereby make, constitute and appoint Angela M. Riley, Individually of,lndianapolis, IN , their true and lawful Attomey(s)-in-Fact with full power and authority hereby conferred to sign, seal and execute for and on their behalf bonds, undertakings and other obligatory instruments of similar nature - In Unlimited Amounts - Surety Bond No.: Bid Bond Principal: Milestone Contractors North, Inc. Obligee: City of South Bend and to bind them thereby as fully and to the same extent as if such instruments were signed by a duly authorized officer of their insurance companies and all the acts of said Attorney, pursuant to the authority hereby given is hereby ratified and confirmed. This Power of Attorney is made and executed pursuant to and by authority of the By -Law and Resolutions, printed on the reverse hereof, duly adopted, as indicated, by the Boards of Directors of the insurance companies. In Witness Whereof, the CNA Companies have caused these presents to be signed by their Vice President and their corporate seals to be hereto affixed on this 16th day of June, 2021. (f,' LttGryContinental Casualty Company National Fire Insurance Company of Hartford 1°O""Te �r++American C lty Company of Re• Ling, Pennsylvania • IDLY 11. S� Y CF ttaM tst a f m •-- Paul T. Bruflat / ce President State of South Dakota, County of Minnehaha, ss: On this 16th day of June, 2021, before me personally came Paul T. Bruflat to me known, who, being by me duly swom, did depose and say: that he resides in the City of Sioux Falls, State of South Dakota; that he is a Vice President of Continental Casualty Company, an Illinois insurance company, National Fire Insurance Company of Hartford, an Illinois insurance company, and American Casualty Company of Reading, Pennsylvania, a Pennsylvania insurance company described in and which executed the above instrument; that he knows the seals of said insurance companies; that the seals affixed to the said instrument are such corporate seals; that they were so affixed pursuant to authority given by the Boards of Directors of said insurance companies and that he signed his name thereto pursuant to like authority, and acknowledges same to be the act and deed of said insurance companies. ISSOUT" M. BENT "ounrnlrrc muava� My Commission Expires March 2, 2026 M. Bent .. Notary Public CERTIFICATE 1, D. Johnson, Assistant Secretary of Continental Casualty Company, an Illinois insurance company, National Fire Insurance Company of Hartford, an Illinois insurance company, and American Casualty Company of Reading, Pennsylvania, a Pennsylvania insurance company do hereby certify that the Power of Attorney herein above set forth is still in force, and further certify that the By -Law and Resolution of the Board of Directors of the insurance companies printed on the reverse hereof is still in force. In testimony whereof I have hereunto subscribed my name and affixed the seal of the said insurance companies this 8th day of November, 2022. �cssuT` ptg Continental Casualty Company National Fire Insurance Company of Hartford �pP01�*t "6Cut ire American Casualty Company of Reading, Pennsylvania DULY 11. OVA D. Johnson Assistant Secretary Form F6$53-412012- t Go to vuerriwxnas}lrgtjLrnrrt `a QvAet / Obligee Services > Validate Bond Coverage, if you want to verify bond authenticity. .4.• Authorizing By -Laws and Resolutions ADOPTED BY THE BOARD OF DIRECTORS OF CONTINENTAL CASUALTY COMPANY: This Power of Attorney is made and executed pursuant to and by authority ofthe following resolution duly adopted by the Board of Directors ofthe Company at a meeting held on May 12, 1995: "RESOLVED: That any Senior or Group Vice President may authorize an officer to sign specific documents, agreements and instruments on behalf of the Company provided that the name of such authorized officer and a description of the documents, agreements or instruments that such officer may sign will be provided in writing by the Senior or Group Vice President to the Secretary ofthe Company prior to such execution becoming effective." This Power of Attorney is signed by Paul T. Bruflat, Vice President, who has been authorized pursuant to the above resolution to execute power of attorneys on behalf of Continental Casualty Company. This Power of Attomey is signed and sealed by facsimile under and by the authority ofthe following Resolution adopted by the Board of Directors ofthe Company by unanimous written consent dated the 25' day of April, 2012: "Whereas, the bylaws ofthe Company or specific resolution ofthe Board of Directors has authorized various officers (the "Authorized Officers"ho execute various policies, bonds, undertakings and other obligatory instruments of like nature; and Whereas, from time to time, the signature ofthe Authorized Officers, in addition to being provided in original, hard copy format, may be provided via facsimile or otherwise in an electronic format (collectively, "Electronic Signatures"); Now therefore be it resolved: that the Electronic Signature of any Authorized Officer shall be valid and binding on the Company. " ADOPTED BY THE BOARD OF DIRECTORS OF NATIONAL FIRE INSURANCE COMPANY OF HARTFORD: This Power of Attorney is made and executed pursuant to and by authority ofthe following resolution duly adopted by the Board of Directors of the Company by unanimous written consent dated May 10, 1995: "RESOLVED: That any Senior or Group Vice President may authorize an officer to sign specific documents, agreements and instruments on behalf of the Company provided that the name of such authorized officer and a description of the documents, agreements or instruments that such officer may sign will be provided in writing by the Senior or Group Vice President to the Secretary ofthe Company prior to such execution becoming effective." This Power of Attorney is signed by Paul T. Bruflat, Vice President, who has been authorized pursuant to the above resolution to execute power of attorneys on behalf of National Fire Insurance Company of Hartford. This Power of Attorney is signed and sealed by facsimile under and by the authority of the following Resolution adopted by the Board of Directors ofthe Company by unanimous written consent dated the 25' day of April, 2012: "Whereas, the bylaws ofthe Company or specific resolution ofthe Board of Directors has authorized various officers (the "Authorized Officers" )to execute various policies, bonds, undertakings and other obligatory instruments of like nature; and Whereas, from time to time, the signature ofthe Authorized Officers, in addition to being provided in original, hard copy format, may be provided via facsimile or otherwise in an electronic format (collectively, "Electronic Signatures"); Now therefore be it resolved: that the Electronic Signature of any Authorized Officer shall be valid and binding on the Company. " ADOPTED BY THE BOARD OF DIRECTORS OF AMERICAN CASUALTY COMPANY OF READING, PENNSYLVANIA: This Power of Attorney is made and executed pursuant to and by authority ofthe following resolution duly adopted by the Board of Directors of the Company by unanimous written consent dated May 10, 1995: "RESOLVED: That any Senior or Group Vice President may authorize an officer to sign specific documents, agreements and instruments on behalf of the Company provided that the name of such authorized officer and a description of the documents, agreements or instruments that such officer may sign will be provided in writing by the Senior or Group Vice President to the Secretary of the Company prior to such execution becoming effective." This Power of Attorney is signed by Paul T. Bruflat, Vice President, who has been authorized pursuant to the above resolution to execute power of attorneys on behalf of American Casualty Company of Reading, Pennsylvania. This Power of Attomey is signed and sealed by facsimile under and by the authority ofthe following Resolution adopted by the Board of Directors ofthe Company by unanimous written consent dated the 251 day of April, 2012: "Whereas, the bylaws ofthe Company or specific resolution ofthe Board of Directors has authorized various officers (the "Authorized Officers" )to execute various policies, bonds, undertakings and other obligatory instruments of like nature; and Whereas, from time to time, the signature ofthe Authorized Officers, in addition to being provided in original, hard copy format, may be provided via facsimile or otherwise in an electronic format (collectively, "Electronic Signatures"); Now therefore be it resolved: that the Electronic Signature of any Authorized Officer shall be valid and binding on the Company. " CITY OF SOUTH BEND, INDIANA CONTRACTOR'S BID FOR PUBLIC WORK RESPONSIBLE BIDDER CHECKLIST Project Name Main Street Improvements Between Sherwood Street and Dean Street Project No. 122-045 For Bids Due November 8, 2022 Contractor Name: Milestone Contractors North, 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 II only. Section II acts as an application for pre -qualification. Submission of Section II 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 31 st 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 bidder, 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 10/13/2021 General Conditions - 10 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 10/13/2021 General Conditions -11 PRE -QUALIFIED BIDDER CHECKLIST (a) Acknowledgements: (i) _ 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. 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: (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) _ 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) _ 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. (iv) _ For every project, submit 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. Version 10/13/2021 General Conditions -12 PRE -QUALIFICATION CHECKLIST (FOR BIDDERS THAT ARE NOT PRE -QUALIFIED) (a) Acknowledgements: (i) X By checking this box, I hereby acknowledge that I am not a pre -qualified bidder with the City of South Bend. *See Attached 2021 Pre-Qaul (ii) X 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) X 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) X 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) 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 List identifying all former business names. (iii) X 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) X 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) X 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) X For every project, submit 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) X 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) X 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 10/13/2021 General Conditions -13 (ix) X 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) X 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. Date: 1118/2022 Dustin P. Hilary (Print Name Here) Milestone Contractors North, Inc. (Name of Company) 24358 SR 23 (Address of Company) South Bend (City) Indiana (State) 574-288-4811 (Telephone Number) Version 10/13/2021 General Conditions -14 Responsible Bidding Practices and Submission Requirements for Pre -Qualified Bidder Checklist (b) Attachments (i) Attached (ii) Walsh & Kelly, Inc. (iii) None (iv) Staffing Capabilities: Milestone Contractors North, Inc. is signatory with the following unions which supply our workforce — Laborers International Union, Teamsters, Operating Engineers and Cement Masons. (v) All individuals who will perform worn on the public works project on behalf of Milestone Contractors North, Inc. will be properly classified under applicable state and federal laws and local ordinances. (vi) See Attached (vii) See Attached (viii) See Attached (ix) None (x) See Attached 96 & 96a By: �� Dated: November 8t`, 2022 ,byin P. Hilary, Director of Estimating State of Indiana Office of the Secretary of State CERTIFICATE OF EXISTENCE To Whom These Presents Come, Greeting: I, HOLLI SULLIVAN, 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. further certify that records of this office disclose that MILESTONE CONTRACTORS NORTH, 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 October 25, 2022. further certify 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, October 25, 2022 HOLLI SULLIVAN SECRETARY OF STATE 194484-057 / 20222834109 All certificates should be validated here: https://bsd.sos.in.gov/ValidateCertificate Expires on November 24, 2022. 1.16 Annual Training Goal Calculation and Partnership Agreement Step 1: Determine the total number of hours worked in the highway construction trades on INDOT federal -aid contracts (either as a prime contractor or subcontractor) during the past three years. Do not include hours worked on state -funded and private work. HOURS WORKED DURING 1 2019 HOURS 1 2020 HOURS 12021 HOURS TOTAL 194723 161274 112862 Step 2: Add the total number of hours from each year and divide by three (3): 94723 + 61274 + 12862 1 = 168859 Step 3: Multiply the "Average Hours" by five percent (5%): 56286.33 X OS = 2814 Average Hours 2022 Training Goal 3 = 56286.33 Average Hours I hereby agree to all of the terms and conditions contained herein and affirm under penalty and perjury that the information stated above is true and accurate. FOR CONTRACTOR USE FOR INDOT USE Company Name Authorized Signature Date Milestone Contractors North Katie Daniels, OJT Program Lead 2/7/2022 Printed Name and Title J Allie Goodpaster 317-671-1160 1 agoodpaster@milestonelp.com Please detach Section 1.16 and return to INDOT c% Katie Daniels at kdaniels2 aiindot.in. ov. Please submit your approved OJT training program documentation as well. 8 AGREEMENT BY AND BETWEEN FOUR COUNTY HIGHWAY CONTRACTORS GROUP and LABORERS' INTERNATIONAL UNION OF NORTH AMERICA STATE OF INDIANA DISTRICT COUNCIL FOR AND ON BEHALF OF ITS AFFILIATED LOCAL UNIONS #41 & #81 APRIL 1, 2022 thru MARCH 31, 2027 ARTICLE XXXI - WAGES AND FRINGES Section 1. Fringe Benefits. All Locals, all Zones covered by this Agreement. Effective H &W Pension Training Annuity HRA CAF BCRC 4/1/2022 — 3/31/2023 $7.25 $13.28 $0.45 $2.50 $0.15 $0.15 $0.13 4/1/2023 — 3/31/2024 Total Package Increase of $2.10 to be allocated at a later date 4/1/2024 — 3/31/2025 Total Package Increase of $2.00 to be allocated at a later date 4/l/2025 — 3/31/2026 Total Package Increase of $2.00 to be allocated at a later date 4/1/2026 — 3/31/2027 Total Package Increase of $2.00 to be allocated at a later date Section 2. Wages A. Basic wage rates for highway workers shall be as follows: furtive Lake, Newton. Forter and LAP-= Starke & Jasper CgWWes Counties. 4/l/2022 — 3/31/2023 $31.74 $28.97 4/1/2023 — 3/31/2024 TBD TBD 4/1/2024 — 3/31/2025 TBD TBD 4/1/2025 — 3/31/2026 TBD TBD 4/1/2026 — 3/31/2027 TBD TBD B. Basic wage rates for utilities shall be as follows: For the purpose of Utility basic wage rates the State shall be divided into the following Zones: Zone 1. Local 41 and Local 81, consisting of Lake, Newton and Jasper Counties. Zone IA. Local 81, Porter, Starke and LaPorte Counties. 21 Wages for the above listed Zones shall be as follows: Effective Zone 1 Zone 1A 4/I/2022 — 3/31/2023 $32.57 $32.22 4/1/2023 — 3/31/2024 TBD TBD 4/l/2024 — 3/31/2025 TBD T13D 4/1/2025 — 3/31/2026 TBD TBD 4/1/2026 — 3/31/2027 TBD TBD The Union and the Employer agree that all Journeymen will be required to complete a minimum of 20 hours of skills upgrade training every two (2) years. CATEGORY I shall include the following and be paid the basic rate. Construction Laborer Carpenter Tender Dingos Fence Erector Flagman Grade Checker Guard Rail Erector Continuous Steel Rod or Mat Installer Wire Mesh Layer Joint Man (Mortar, Mastic, and all other types) Lighting installer (Permanent or Temporary) Lineman for Automatic Grade Maker on Paving Machine Mortar Man Multi -Gang Drill Multi -Plate Erector Remote -controlled Walk Behind Trench Rollers Rip -Rap Installer (All products and materials) Road Marking and Delineation Laborer Rodman and Chainman Setting and Placing of all Precast Concrete Products Sign Installation, including supporting structure Spraying, Rolling, Brushing of all Surface Sealers, Epoxies, Masonry Coatings, Curing Compounds, Cure and Seal products and other like materials on all surfaces, along with the surface preparation required Survey Crew Man Sod Layer Air Tool, Power Tool, and Power Equipment Operator Asphalt Lute Man Asphalt Raker Man 22 Batch Truck Dumper Bridge Hand Rail Erector Handler (Bulk or Bag Cement) Chain Saw Man Concrete Conveyor Assembly Man Concrete Puddler Concrete Rubber Concrete Saw Operator Eye Level Hand Blade Operator Hydro Seeder Man Laborer Instrument Man Motor Driven Georgia Buggy Operator Power Driven Compactor or Tamper Operator Power Saw Operator Pumperete Assembly Man Rebar Installer Sand Blaster Man Sealer Applicator for asphalt, toxic Setting and Placing Prestressed or Precast Concrete Structural Members Side Rail Setter for Sidewalks, Side Ditches, Radii, and Pavements Spreader Box Tender (Manual or Power Driven) Straw Blower Man Subsurface Drain and Culvert Pipe Layer Horizontal Boring and Jacking Man Jackman and Sheetman Pipe Grade Man Winch and Windlass Operator Conduit Installer Water Pumps CATEGORY II shall include the following and shall be paid thirty cents (300) per hour above the basic rate: Cutting Torch Burner Laser Beam Aligner Manhole Erector Water Line Installer — Temporary or Permanent Welders (Electric or Oxy-Acetylene) Hod Carriers (Tending Bricklayers) TV'ing and Associated Grouting of Utility Lines CATEGORY III shall include the following and shall be paid one dollar ($1.00) per hour above the basic rate: Transverse and Longitudinal Hand Bull Float Man 23 Concrete Saw Joint Control Cutting Core Drill Operator (excluding testing) Air Track and Wagon Drillman Concrete Barrier Rail Form Setter Dynamite and Powder Man General Laborer Leadman Sewer Pipe Layer/Stormwater Pipe Layer Screed Man or Screw Man on Asphalt Paver CATEGORY IV shall include the following and shall be paid fifty (50¢) cents per hour above the basic rate: Laborer Leadman CATEGORY V shall include the following and shall be paid one dollar and fifty cents ($1.50) per hour above the basic rate: Concrete Finisher/Form Setter Paving Transverse and Longitudinal Hand Bull Float Man CATEGORY VI — Combination Man/Laborer Teamster $1.50 over tandem axle truck rate in Teamster Agreement CATEGORY VII — shall include the following classifications in Caisson and Tunnel Work in free air: Bottom Man — Concrete Man Basic Rate + .50 Concrete Headman Basic Rate + .65 Miner or Header Man Basic Rate + 1.00 Mucker and Tunnel Laborer Basic Rate + .50 CATEGORY VIII shall include Watchman whose wage rates will be 65% of base rate. Fringe benefits will be paid on actual hours worked with a maximum of forty (40) hours per week. CATEGORY IX - Railroad Work and Wage Rates Shall include railroad work on public right-of-way or railroad work incidental thereto will be the highway wage rates contained herein. New Railroad Work or Maintenance shall not be covered by this Agreement. 24 ARTICLE XXXIV - APPRENTICES Section 1. New Applicants for employment with a signatory contractor who have fewer than 4,000 hours of experience as a Construction Craft Laborer (or alternatively, cannot demonstrate equivalent skills by achieving a satisfactory score in a placement examination administered by the Joint Apprenticeship and Training, Committee (JATC), shall, whenever practical, enter and be allowed to enter the Apprenticeship program on a non-discriminatory basis in accordance with the terms of the Apprenticeship Program. Any person entering, but failing to maintain and complete his or her apprenticeship, shall not be employed by the Employer as a Journeyworker under this Agreement. The failure of any Apprentice to maintain his or her apprenticeship status shall obligate the Employer to discharge such person upon notice from the Union. Section 2. The Apprenticeship and Training Standards approved by the Federal Bureau of Apprenticeship and Training or State Apprenticeship Committee are hereby incorporated herein by reference and made a part of this Agreement. Section 3. The Apprentice wage rates: Hours of Credit Wage Rate l�period _ _ 0-1000 hours �T 75% of journeyworker rate_ 2nd period_ 1001-2000 hours_-85% of 'ourneyworker rate ---------- 3rd I eriod _ ; 2001-3000 hours ' 90% of iourneyworker rate 4`�'Qeriod _; 3001-400_0_hoursS 5% of�ourne�work_er Section 4. The requirements for entry into the Apprenticeship program shall be controlled by the JATC, which shall employ appropriate testing and screening procedures. An Apprentice advances from one hours -of credit and wage -rate category to another only upon determination of satisfactory performance by the JATC, pursuant to requirements specified in the Apprenticeship Program which shall have the authority to grant accelerated credit where warranted by the performance of an individual Apprentice. Section 5. Except as provided in Section 9, the Employer shall participate in the Apprenticeship Program by considering Apprentices for employment upon referral by the Union. The Employer shall have the sole right to reject, at any time, any Apprentice referred to it, or working for it. The Employer is not obligated to accept more than one (1) Apprentice for every five (5) Journeyworkers commencing with the sixth Laborer needed by the Employer. This ratio shall be measured on a company wide basis, and does not require an Employer to have a sixth Laborer, if only five are needed, as determined by the Employer. Section 6. The Employer may not employ an Apprentice until at least one (1) Joumeyworker is employed and thereafter may not employ more than one (1) Apprentice for every additional three (3) Joumeyworkers. Q Section 7. An Apprentice should, whenever practical, be rotated by the Employer through different types of work so as to become trained in a variety of operations and work skills. Where the Employer is unable to provide an Apprentice with experience in the full range of craft skills, the JATC may request the Local Union to reassign the Apprentice to other employment in order to provide that experience. For so long as the Employer is able to provide the necessary range of employment experience, the Employer may choose to retain the Apprentice from job to job. Upon request the Employer will inform the JATC and Local Union of an Apprentice's job reassignments on a project. Section S.. An Apprentice shall not be penalized for taking off from work to attend offsite training (though time off for training is unpaid). Section 9. Notwithstanding the provisions of Section 5, the Employer may call the Union for an individual by name, provided he or she is not then employed by another Employer. If available, the Union shall refer that individual. Section 10. The Union agrees to hold harmless and to indemnify any Employer in any claim arising out of the Union's referral rules/practices or the Union's or JATC's administration of the Apprenticeship Program. ARTICLE XXXV - BCRC/DRUG TESTING Section 1. The Union recognizes the right of the Employer to establish a drug testing policy for Employees. Section 2. In all situations where an Employer is required to agree to a testing program in order to qualify to be the successful contractor on a project, testing may be required, in accordance with the standards of this program, or, if the owner's requirements for successful contractors are more stringent, in accordance with the owner's requirements. No adverse employment action shall be taken against a worker solely because he/she refused a job assignment that has a substance testing requirement. Section 3. BCRC (a) The Association, the Union, various other Employer Associations, and various other unions are members of the Building and Construction Resource Center, Inc. (hereinafter "BCRC"), a non-profit corporation that was formed to provide services in the construction industry, including, but not limited to, education and referral services concerning alcohol, drug and other substance abuse, which purposes are more fully defined in the Articles of Incorporation and By -Laws of said BCRC. (b) Each Employer under this Agreement shall pay to BCRC the amount as specified in Article XXXI of this Agreement per hour worked by each of its Employees covered by this Agreement. Each Employer is obligated to make 28 L iA80RERS iliRNA'CtAL.; UNio J OF NORtH A iEWCA; ' :�$UslnesslVLnn�ie�'r.. �,..: pfl one: W-135�e[ ' V6fete id(.- er8!i ` ICev(q p4arA, Pnsk=-it'. AvdtWr m STATE OF INDIANA DISTRICT COUNCIL LIUNA Local #41 & Local #81 Highway Agreement Fringe Benefits Effective H &W Pension Training CAf BCRC Annuity HRA 4/1/22to 3/31/23 $7.25 $13.28 $0.45 $0.15 $0.13 $2.50 $0.15 Lake, Newton, Starke & Effective Porter & LaPorte Jasper 4/1/22 to 3/31/23 $31.74 $28.97 Working Dues — 5'% of gross wages vduntwy ILDCPAC - $0.05 per hour Molly WaJres r-or the purpose of utility basic wage rates the State shall be divided into the following Zones: Zone 1. Local 41 and Local 81, consisting of Lake, Newton and Jasper Counties Zone IA. Loral 81, Porter, Starke and LaPorte Counties. Wages for the above listed Zones shall be as follows: Effective Zone 1 Zone 1A 4/V22 to 3/31/23 $32.57 $32.22 4.1 '" 5ecretarl►-n�: "s STATE OF INDIANA DISTRICT COUNCIL Agreement by and between Indiana Constructors, Inc. — Labor Relations Division (ia--,LRD) and Laborers' International Union of North America State of Indiana District Council Local Unions #120, #204, #213, #274, #561, #645, #741, #795, #1112 Highway Agreement Edn-algrieft Effective H &W Pension Training ILDCPF ICIAF SAT 4/1/22 to 3/31/23 $7.25 $8.75 $0.45 $0.77 $0.13 $0.04 Wages 4/1/22 to 3/31123 $27.40 Working Dues — 5% of gross wages Voluntary 1LDCPAC - $0.05 per hour T, *Effective 04/01/2022, "Zones" have been eliminated. Basic wage rates for utilities shall be as follows: Effective 4/1/22 to 3/31/23 $27.90 To All Employers Signatory to the following IUOE Local 150 Agreement: HIGHWAY, HEAVY AND UTILITY DIVISION-INDIANA CONSTRUCTORS, INC.-LABOR RELATIONS DIVISION (ICI-LRD) (10CTY HH) 2022 & 2023 ECONOMICS FRINGE BENEFITS FOR JOURNEYMAN AND THIRD_- & FOURTH -YEAR APPRENTICES 04/01/22 04/01/23 HEALTH AND WELFARE _ .. _ 16.80 _ 17.30 RETIREE MEDICAL SAVINGS PLAN 3.45 _3.65 _ PRNMION T __� 9.65 9.95 1 JT ENHANCEMENT FUND_ VACATION SAVINGS TRAINING 0.35 1.00 - I 1.05 INDUSTRY ADVANCEMENT FUND_ 0.13 CONSTRUCTION INDUSTRY RESEARCH AND SERVICE TRUST FUND 0.25 SUBSTANCE ABUSE TESTING PROGRAM FRINGE BENEFITS FOR FIRST- & SECOND -YEAR APPRENTICES HEALTH AND WELFARE RETIREE MEDICAL SAVINGS PLAN I PENSION RETIREMENT ENHANCEMENT FUND VACATION SAVINGS _ _ _ TRAINING _ - __ INDUSTRY ADVANCEMENT FUND CONSTRUCTION INDUSTRY RESEARCH AND SERVICE TRUST_ FUND SUBSTANCE ABUSE TESTING PROGRAM _ 04/01/22 04/01/23 _ 16.80 33.45 17.30 3.65 - �7.80 8.1_0__ 0.70 _ _0.35 0.50 1.05 0.50 1.15 0.13 0.13 _ 0.25 r0.03 0.30 0.03 FOR JOURNEYMEN 1/22 GROUP I 32.85 _ _ 33.90 GROUP 19 31.25 _ 32.30 GROUP 111 29.95 31.00 L GROUP N _ 28.55 N.60 WAGES FOR APPRENTICES 04/01/22 _ 04/01/23 FIRST YEAR 24.25 _ 25.30 _ SECOND YEAR 25.60 26.65 _ FIRST HALF OF THIRD YEAR 27.05 28.10 SECOND HALF OF THIRD YEAR 28.50 29.55_ FIRST HALF OF FOURTH YEAR 29.95 31.00. _SECOND HALF OF FOURTH YEAR 31.40 32.45 Administrative Dues deduction for all wage classifications shall remain at 3% April 14, 2022 mle To All Employers Signatory to the following IUOE Local 150 Agreement: FOUR COUNTY HIGHWAY CONTRACTORS GROUP 2022 & 2023 RATES FRINGE BENEFITS FOR JOURNEYMAN AND THIltD- &. FOURTH -YEAR APPRENTICES HEALTH AND WELFARE RMSP Reriree Medical Savings P1ani PENSION REF Retirement Enhanccmen_t Fund) BCRC VACATION SAVINGS -JOURNEYMAN VACATION SAVINGS__THIRD- & FOURTH -YEAR APPRENTICES APPRENTICESHIP _ INDUSTRY ADVANCEMENT FUND CONSTRUCTION INDUSTRY RESEARCH AND SERVICE TRUST FUND FRINGE BENEFITS FOR FIRST- & SECOND -YEAR APPRENTICES HEALTH AND WELFARE. RMSP CRetiree Medical Savin s Plan) PENSION REF (Retirement Enhancement Fund) BCRC- _VACATION SAVINGS APPRENTICESHIP - _ - I `INDUSTRY ADVANCEMENT FUND _ CONSTRUCTION INDUSTRY RESEARCH AND SERVICETRUST FUND _ WAGES FOR JOURNEYMEN 05/01/22 � 06/01/22 05/01/23 06/01/23 16.90 16.90 _17.40 17.40 4.75 _ 13.10 _2.10 �0.15 1.00 _ 0.75 _4.50 12.60 4.50 _ 4.75 12.60 _ 13.10 1.95 1.85 2.10 0.10 0.13 0.13 1.00 1.00 1.00 0.75 0.75 0.75 2.00 2.00 2.15 2.15 0.12 0.15 0.15 0,15_ 0.60 0.60 0.60---0.60- 16.90 4.50 16.90 17.40 17.40 , 4.75 4.75 9.30 '+- �9.30 2.10 _ 2.10 0.13 0.15 4.50 8.80 1.85 0.10 8.80 1.85 0.13 0.50 0.50 0.50 0.50__ 2.15 _ 2.00 2.00 2.15 0.12 0.60 0.15 0.15 0.15 0.60 - 0.60 0A0 05/01/22 t 05/01/23 FOREMAN 46.35 _ 47.70 DIN CRANE -CERTIFIED 45.35 46.70 ULIC CRANE -CERTIFIED T 44.35 45.70 { LEAD/GANTRY CRANE -CERTIFIED 43.35 43.35 II �s 42.90 III _ 42.45 IV 41,25 V _ _ 40.20 WAGES FOR APPRENTICES YEAR ND YEAR 'HALF OF THIRD YEAR _ 26.70 29.65 31.65 m 33.50 35.55_ � 39.30 ND HALF OF THIRD YEAR 'HALF OF FOURTH YEAR ND HALF OF FOURTH YEAR_ _ � - 05/ 11 /23 28.05 ! 31.00 _ 33.00 34.85 36.90 40.65 Administrative Dues deduction for all wage classifications shall remain at 3% April 14, 2022 mla HEAVY HIGHWAY CONTRACT NEGOTIATED CHANGES TO BE RATIFIED. THESE ARE ONLY THE CHANGES THE REST OF A6999MENT WILL REMAIN INTACT, 1. A YEAR CONTRACT. A IL 1. 2022 THROUSK MARCH 31, 202Z 2. ARTICLE 9: WAGES AND JOB CLASSIFIMIQNS A. INCREASES FOR EACH CLASSIFICATION PER HOUR -14 • 2- 022 4-1-2023 4-1-2024 +1-2025 $1.01 $.85 $.84 $.83 $.83 S. FOOTNOTE 5 AND FOOTNOTE 6 ARE DELETED 3. ARTICLE 11: SAFETY TRAINING AND EDUM1911AL FUND SECTION 1 SHALL READ AS FOLLOWS: BEGINNING APRIL 1, 2022, EACH EMPLOYER AGREES TO PAY THE INDIANA TEAMSTERS SAFETY TRAINING AND EDUCATIONAL TRUST FUND FIFTY CENTS ($.50), FOR DURATION OF CONTRACT, FOR EACH HOUR WORKED BY EACH EMPLOYEE ( CAPPED AT FIFTY (50) HOURS PER WEEK FOR EACH EMPLOYEE) WORKING UNDER THIS AGREEMENT. THIS BENEFIT IS PAYABLE FOR ALL COMBINATION MEN, INCLUDING THOSE WHO CHOSE LABORERS BENEFITS. SECTION 2 SHALL READ AS FOLLOWS: DRIVERS WHO ARE NEW AND HAVE NO EXPERIENCE DRIVING COMMERCIAL TRUCKS 'ON CONSTRUCTION IOBSITES, SHALL BE PAID A PROBATIONARY RATE OF 80X/HOUR FOR THEIR FIRST CONSTRUCTION SEASON (CALENDAR YEAR) AND DURING, THEIR FIRST THIRTY (30) DAYS THEY SHALL HAVE NO SENIORITY, AND MAY BE SENT BACK TO THE HALL WITHOUT RECOURSE TO THE AGREEMENT'S GRIEVANCE AND ARBITRATION PROVISIONS IF THE EMPLOYER IS DISSATISFIED WITH THE PROBATIONARY EMPLOYEE'S OPERATION OF A COMMERCIAL TRUCK. THIS INITIAL THIRTY (30) DAY PERIOD CAN BE EXTENDED AN ADDITIONAL THIRTY (30) DAYS OF NO SENIORITY, WITH MUTUAL AGREEMENT. 4. ARTICLE 1.2: WORKING HOURS AND OVERTIME SECTION 1 AND NEW SUBSECTION D TO READ AS FOLLOWS AND RENUMBER THE REST OF THE SUBSECTIONS. IF THERE IS ONLY ONE (1) SHIFT AND THAT SHIFT IS WORKING AT NIGHT ( THIS IS NOT A 2 OR 3 SHIFT JOB) THEN A ONE DOLLAR AND FIFTY CENTS ($1.50) PER HOUR PREMIUM SHALL BE ADDED TO THE BASE TRUCK RATE PAID TO EACH EMPLOYEE APPLIED TO EACH HOUR WORKED. S. ARTICLE 22: HEALTH AND WELFARE INDIANA TEAMSTERS BENEFIT FUND SECTION 1: 4-1-22 $510.80 PER WEEK OR $12.25 PER HOUR SECTION 2: 4-1-23 $522.80 PER WEEK OR $12.55 PER HOUR SECTION 3: 4-1-24 $534.80 PER WEEK OR $12.85 PER HOUR SECTION 4: 4-1-25 $546.80 PER WEEK OR $13.15 PER HOUR SECTION 5: 4-1-26 $558.80 PER WEEK OR $13.45 PER HOUR SECTION 7: ADD NEW LANGUAGE AS FOLLOWS EMPLOYER SHALL START PAYING THIS CONTRIBUTION FOR A NEW EMPLOYEE AFTER THIRTY (30) CALENDAR DAYS FROM HIRE DATE (CALENDAR DAYS, NOT WORKING DAYS) SO LONG AS THE NEW EMPLOYEE HAS NOT WORKED UNDER AN AGREEMENT THAT HAS INDIANA TEAMSTERS HEALTH BENEFITS WITHIN THE PRECEDING TWELVE (12) MONTHS. IF THE NEW EMPLOYEE HAS WORKED UNDER AN AGREEMENT THAT HAS INDIANA TEAMSTERS HEALTH BENEFITS IN THE PRECEDING (12) MONTHS, THE EMPLOYER SHALL START PAYING CONTRIBUTIONS FOR SAID EMPLOYEE AFTER SEVEN (7) CALENDAR DAYS. THE COMMITTEE ASKED THE TRUSTEES OF FUND FOR RATES TO ENHANCE THE BANKING. THE RATES ABOVE ARE THE RATES GIVEN TO ENHANCE THE BANKING. THE ATTACHED BANKING CHANGES WILL BE IMPLEMENTED IF CONTRACT IS RATIFIED. 6. ARTICLE 23: PENSION SECTION 2: 4-1-22 $163.90 PER WEEK OR $4.98 PER HOUR NEW SECTIONS 3-6 AND RENUMBER REST OF SECTIONS SECTION 3: 4-1-23 $170.50 PER WEEK OR $5.18 PER HOUR SECTION 4: 4-1-24 $177.30 PER WEEK OR $5.39 PER HOUR SECTION 5: 4-1-25 $184.40 PER WEEK OR $5.61 PER HOUR SECTION 6: 4-1-26 $191.80 PER WEEK OR $5.83 PER HOUR SECTION 7: ADD NEW LANGUAGE EMPLOYER SHALL START PAYING THIS CONTRIBUTION FOR A NEW EMPLOYEE AFTER THIRTY (30) CALENDAR DAYS FROM THE HIRE DATE (CALENDAR DAYS, NOT WORKING DAYS) SO LONG AS THE NEW EMPLOYEE HAS NOT WORKED UNDER AN AGREEMENT THAT HAS CENTRAL STATES, INDIANA TEAMSTERS PENSION FUND, AND/OR 716 PENSION WITHIN THE PRECEDING TWELVE (12) MONTHS. IF THE NEW EMPLOYEE HAS WORKED UNDER AN AGREEMENT THAT HAS CENTRAL STATES, INDIANA TEAMSTERS PENSION FUND, AND/OR 716 PENSION IN THE PRECEDING TWELVE (12) MONTHS, THE EMPLOYER SHALL START PAYING THE CONTRIBUTIONS FOR SAID EMPLOYEE AFTER SEVEN (7) DAYS. SECTION 19: IS DELETED, MEANING THERE IS NO CAP ON HOURLY CONTRIBUTIONS 4-1-2022 $.50 PER HOUR 4-1-2023 $.25 PER HOUR 4-1-2024 $.25 PER HOUR 4-1-2025 $.25 PER HOUR 4-1-2026 $.25 PER HOUR SEE ATTACHED PRORAM DETAILES INDIANA TEAMSTERS HEALTH BENEFITS FUND 6007 S. Hardin-, St. 0 Indi:malxilis. Indiana 46-217 Phone: f 317 t 639-3573 Fax: 43171 A39-3548 0 November 29, 2021 Re: Highway, Heavy. Railroad and Underground Utility Contracting Agreement Benefit Rates for new contract. 4/1/2022. Shawn Strain: Erfective April 1, 2022 the new rates for the Indiana Teamsters Health Senelits Fund for the Highway Agreement will be: 1-Iourly Rate Weekly Ratc Current Rate $11.95 $498.80 Rate ror4/I/7022 $12.25 $510.80 hate for4/1/2023 $12.55 $522.80 Rate for411/7-024 $12.85 $534.80 Rate for 4/1/2025 $13.15 $546.80 Rate for 4/1/2026 $13.45 $558.80 Tic Pension nates will be: Current Rate $4.79 $ 157.60 Rate for 4/1/2022 $4.98 $163.90 Rate for4/1/2023 $5.18 $170.50 fUtte for 4/ 1 /2024 $5.39 $177.30 Ratio for4/1/2025 $5.61 $134.40 Rate for 4/1 /202G $5.83 $191.80 INDIANA TEAMSTERS HEALTH BENEFITS FUND bli(17 S. Il:tnling St. Indianapolix. Indiana -16217 Phone: (317) 639-357: I a�: ("a171639-3S4ti Weekly Banking Current Rules 6 Weeks paid in before Eligible - consecutive Weeks paid in 24 4 Weeks 32 8 Weeks 40 12 Weeks Proposed Weekly Banking Rules 6 Weeks paid in before Eligible - Doesn't need to be consecutive Weeks paid in 24 4 Weeks 28 9 Weeks 32 13 Weeks 35 17 Weeks Hourly Banking Current Rules 400 Hours paid In before eligible Hours banked after 220 hours paid in per month 120 Hours in Bank One Month 240 Hours in Bank Two Months 360 Hours in Bank Three Months * Not allowed to use more than 3 months in a fiscal year, April 1 to March 31 Proposed Hourly Banking Rules 250 Hours paid in before eligible Hours banked after 120 hours paid in per month 120 Hours in Bank One Month 240 Hours in Bank Two Months 360 Hours in Bank Three Months 490 Hours in Bank Four Months * no rule on how many months in a fiscal year used � CEN7RALSTATES (� PENSION FUND I August 26, 2021 GEORGE SHERAW DIRECTOR, LABOR RELATIONS INDIANA CONSTRUCTORS, INC ONE N CAPITOL AVE, STE 1000 INDIANAPOLIS, IN 46204 SHAWN STRAIN TRUSTEE LOCAL UNION NO. 135 849 S MERIDIAN ST INDIANAPOLIS, IN 46225 RE: Pension Fund Contribution Rate Increase Highway, Heavy and Utility Division of Indiana Construction Association Contract Expiration Date: March 31, 2022 Dear George Sheraw, Shawn Strain and Robert Warnock: EMPLOYEE TRUSTEES CHARLESA W,10EREY GEORGE J. YMSTLEY GARYDUNHAM TREVORLAMEMCE (MOVER TRUSTEES GARY F CALDWELL ROEERT V64TAKER MARKF AYGERAMF EXECUTWE MRECTOR THOWAS G NYHAN ROBERT WARNOCK PRESIDENT LOCAL UNION NO.364 2405 EDISON ROAD SOUTH BEND, IN 46615 The collectivve bargaining agreement for the above referenced account will expire on March 31, 2022, In accordance with the Pension Protection Act of 2006. the corresponding Central States Fund's Rehabilitation Plan and the Multiemployer Pension Reform Act ot2014 rMPRX), all renewal agreements are to include the required pension rate increases. MPRA provides for the Pension Fund to implement these rates after the collective bargaining agreement has expired. Pension rate increases for your renewal agreement will be effective on April 1. 2022 and will be reflected on your upcoming billings. The following are the minimum rates for the next five years which are necessary for your agreement: Current April 1, 2022 April 1, 2023 April 1, 2024 Apd11, 2025 April 1. 2020 $157.60 $163.90 14W $170.50 (474 $177.30 (40/4 $184.40 (49W 1191.80 (4-A Please note that although we have listed five years of rates, any agreement term for less than the historical contract duration, but not less than three years, is subject to review and approval by the trustees. As you may be aware, on March 11, 2021, President Biden signed the American Rescue Plan Act into law. The federal Pension Benefit Guaranty Corporation issued an interim final rule and request for comment for implementing this new law on July 9. 2021, including the process necessary for Central States and other funds to receive the authorized financial relief. However, it should be noted, that subject to federal guidance, the Rehabilitation Plan contribution schedules (4% annual increases unless capped) will remain in effect under the law. Please submit all renewal agreements to the address below, attention: Contracts Department, by fax to 847- 518-9768 or by e-mail to contracts@centraistates.org. If there are any questions, you may contact the Contracts Department at extension 3247. Sincerely, Q vJ Karl A. Lewis Division Manager Contracts 8647 West Higgins Road, Chicago IL 60631-2803 1 MyCentralStatesPension.org COLLECTIVE BARGAINING AGREEMENT FOR ROAD, BRIDGES AND AIRPORTS BETWEEN OPERATIVE PLASTERERS AND CEMENT MASONS LOCAL #692 Areas #165, #446, & 4438 and ROAD, BRIDGES, AND AIRPORT CONTRACTORS June 1, 2018 through May 31, 2023 Area 165 - Tim Hudson 219-713-4905 Area 406 - Matt Rhoades 219-771-0766 Area 438 - Tom Graham 219-363-5089 1 thudson@plcmlocal692.org opemia4256@yahoo.com opcmia438Qaol.com 8.7 Apprenticeship. (a) The Employers agree to make the contribution rate for the Apprenticeship Funds shall be the amount set forth in Section 8.1 above, for each hour worked by an Employee. (b) It is agreed that there shall be established a Joint Apprenticeship Training Committee comprised of an equal number of Employee and Employer representatives. This Committee shall be run in compliance with all applicable laws, and the Apprenticeship Training Program shall be administered in accordance with the provisions of the National Labor Relations Act, as amended, and also in accordance with the provision of the trust agreement, which established the Apprenticeship Training Fund. (c) Apprentice Ratio. For every two (2) Journeyman, there may be one apprendee utilized when available. The Joint Apprenticeship & Training Committee shall recruit and indenture a sufficient number of apprentices to meet the demands upon the program. (d``) Apprenticeship Wages pG t 1st Period: 0 to 800 Hrs - 60% of Journeyman Rate 2nd Period 801 to 1600 His - 70% of Journeyman Rate CA S 3rd Period: 1601 to 2400 Ha - 75% of Journeyman Rate 4th Period: 2401 to 3200 His - 80% ofJourneyman Rate Sth Period: 3201 to 4000 His - 85% of Journeyman. Rate 6th Period: 400I to 5600 Firs - 95% of Journeyman Rate 8.8 Contributions to BCRC. (a) Various Employers under this Agreement and the Union are members of Building and Construction Resource Center, Inc. ("BCRCI, a non-profit corporation that was formed to provide services in the construction industry, including, but not limited to, education and referral services concerning alcohol, drug, and other substance abuse, which purposes are more fully defined in the Articles of Incorporation and By -Laws of said BCRC. (b) Each Employer under this Agreement shall pay to BCRC in accordance with Section 8.9(a) below for each hour worked by each of its Employees. Said payments shall be made monthly in the manner and at such times as are established by the BCRC. Each Employer is obligated to snake such contributions, regardless of whether or not such Employer is a member of BCRC. (c) Payments required to be made to BCRC shall be deemed to be governed by the provisions of this Agreement pertaining to the collection of other payments required to be made by Employer. 8.9 Employee Benefit Rates. The Employee benefit rates set fortb in Section 8.1(a) above for each hour worked for Health & Welfare, Pension, Savings, Apprenticeship, Dues Check -Off, BCRC, and CAF shall be combined into one check made payable to the Indiana State Council of Plasterers & Cement Masons H&W and Pension Fund and mailed to P.O. Box 50440, MILESTONE CONTRACTORS NORTH, INC. I, Brad McCall, certify that the attached documentation represents the Milestone Contractors North, Inc. Employee Drug Testing Plan, which meets or exceeds the requirements in any collective bargaining agreements of which Milestone Contractors North, Inc. is signatory to. Brad McCall, Vice President, Estimating July 7 2022 Date Milestone Contractors North, Inc. Alcohol and Drug Free Workplace Policy/Statement Milestone Contractor's maintains a drug -free workplace in keeping with the spirit and intent of the Drug -Free Workplace Act of 1988. We are committed to promoting and maintaining a drug -free working environment for all our employees and promoting and protecting the safety, health, and well- being of our employees. The use of alcohol and controlled substances not prescribed for the associate or illegal drugs is inconsistent with the behavior expected of our associates. The unlawful manufacture, distribution, dispensation, possession, sale, or improper use of a controlled substance in the workplace or while engaged in company business is strictly prohibited. Adherence to the alcohol and drug -free workplace policy is a condition of continued employment. • This policy will be applied in a manner consistent with all applicable federal, state and local law. • This policy covers all non -DOT -covered employees of the named employers (DOT -covered employees are subject to the applicable regulations and procedures) and all new employees post -offer, pre -hire. • Confidentiality: All records pursuant to the alcohol and drug -free workplace policy will be maintained in a separate confidential file, in accordance with applicable statutory or regulatory requirements. • Employees' Duty to Report Convictions: Any employee who is convicted of violating any criminal drug statute regarding a violation occurring in the workplace must notify Human Resources Department within five (5) days of the conviction. Substance Abuse Testing All substance abuse testing administered by Milestone Contractor's, and Champaign Asphalt Company will include drug and/or alcohol screening. All entities also participate in random drug and alcohol screening administered by outside sources, such as CCS (Coalition for Construction Safety), ICI (Indiana Constructors Inc.) and BCRC (Building and Construction Resource Center, Inc.) All positive drug or alcohol screens may result in termination. Substance Abuse Testing Procedures for Company Benefitted (non -bargained) Employees Initial Testing (Pre -Employment Post -Offer) All new employees who are made a conditional offer of employment will be required to successfully complete a drug test prior to commencing employment. Random Testing Milestone employees selected for random testing will be contacted and advised when to report to the screening location. Reasonable Suspicion Testing Employees may be required to submit to alcohol and/or drug testing whenever their supervisor/manager has a reasonable suspicion that the employee is under the influence of alcohol or drugs based on the employee's behavior or physical symptoms or reactions upon the supervisor's/manager's request. Examples of reasonable suspicion may include but is not limited to: physical symptoms consistent with substance abuse (e.g., staggered gait, slurred speech, smell of alcohol on breath, inability to focus, etc.); or evidence of illegal substance use, possession, sale or delivery. Refusal to consent will be construed as an independent violation of this policy and the employee may be subject to discipline up to and including immediate dismissal, after an evaluation of the particular facts and circumstances. Post -Accident / Incident Testing Any employee involved in an on-the-job incident or accident (i.e., causing the accident (and not being injured) or being injured as a result of the accident) which results In personal Injury requiring medical treatment or damage to property (otherthan minimal) may be required to tested for the presence of drugs or alcohol, unless the employer determines that the testing would not be appropriate under the circumstances. The employer would not require testing where the accident was very unlikely to have been caused by employee drug use (e.g., repetitive strain injury or bee sting). The employer will make the determination for testing at its sole discretion depending on the facts and circumstances of the case. The employee involved should abstain from using alcohol until after the determination is made. Refusal to consent will be construed as an independent violation of this policy and the employee may be subject to discipline up to and including immediate dismissal. In instances of post-accident/incident or reasonable suspicion testing, the employee will be transported to the testing facility by the employer. At the option of the employer, the employee may be suspended pending the test result. In the event a negative test result Is reported, the employee shall be compensated for all lost time at the employee's base rate, or as determined by a collective bargaining agreement, if applicable. Annual Testing All employees must be tested at least once per year. If an employee is not tested In one of the above scenarios, they will be scheduled for testing. Positive Drug Test Results • individuals with a positive drug test result will be terminated. Eligibility for re -hire may be considered after a minimum of one year has elapsed. Positive Alcohol Results • Employees who have a Blood Alcohol Content (BAC) between.02-.039 will be suspended from work for a minimum of 24 hours. • Employees who have a Blood Alcohol Content (BAC) measuring .04 or more will be suspended from work for a minimum of 30 days. Additional consequences, up to an including, termination of employment may also result, depending on the nature and severity of the infraction. Diluted Results • Employees will be contacted to retest per requirements established by testing authority. • A second diluted test without medical reasoning will be considered positive. Refusal To Test A refusal to take a drug/alcohol screen will be treated as a positive result, and result in immediate termination. Drug Group The drug -testing program will test for the following drugs at these levels: Initial Test Ana lyte Initial Test Cutoff Confirmatory Test Marijuana metabolites 50 ng/mL 15 ng/mL Cocaine metabolite (Benzoylec onine) 150 ng/mL 100 ng/mL Codeine/Morphine 2000 ng/mL 2000 ng/mL Hydrocodone & Hydromorphone 300 ng/mL 100 ng/mL Oxycodone & Oxymorphone 100 ng/mL 100 ng/mL 6-Acetylmorphine 10 ng/mL 10 ng/mL Phencyclidine (PCP) 25 ng/mL 25 ng/mL Amphetamines 500 ng/mL 250 ng/mL Methamphetamine 500 ng/mL 250 ng/mL MDMA (Ecstasy) 500 ng/mL 250 ng/mL Barbiturates 300 ng/mL 200 ng/mL 300 ng/mL 300 ng/mL _Benzodiazepines Methadone Propoxyphene 300 ng/mL 300 ng/mL 300 ng/mL 300 ng/mL Ethanol (Alcohol) .04% w/vol .04% w/vol Union Employees (aka Bargained Employees) Milestone Contractor's will adhere to collective bargaining agreements when administering drug testing. All entities also participate in random drug and alcohol screening administered by outside sources, such as CCS (Coalition for Construction Safety), ICI (Indiana Constructors Inc.) and BCRC (Building and Construction Resource Center, Inc.), as written in their respective bargaining agreements. All positive drug or alcohol screens may result in termination, even on the first offense. Per the following: • ICISAT—this testing program is applicable to those employees working in the following areas: Indianapolis, Lafayette, Richmond, Columbus, Bloomington and Terre Haute areas. Contact Human Resources for further information regarding ICISAT testing. BCRC—this testing program is applicable to those employees working in the Griffith and South Bend Indiana areas. Contact Human Resources for further information regarding BCRC testing. Applicable To Both Union And Non -Union Employees Requirements For Submitting Results To CCS — Coalition For Construction Safety • A copy of the chain of custody initiated at the time of collection must be submitted. • Test results documentation must include panel cutoff levels — both screening and confirmation. (Exception — if documentation clearly indicates that the test was conducted according to DOT guideline). • Date the specimen was collected and reported. Must be within the last 12 months. • The MRO (Medical Review Officer) name and signature. • The employee's first name, middle initial, last name, at least the last 6 digits of the employee's SSN. And their date of birth. • Test result and date the result was verified by the M RO. • The name of the SAMHSA certified lab that conducted the testing. WRITTEN CONSENT TO RESOLUTIONS of the BOARD OF DIRECTORS of MILESTONE CONTRACTORS NORTH, INC. The undersigned, being all of the Directors of MILESTONE CONTRACTORS NORTH, 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: Todd A. Fawver President Charles Potts Jr. Chief Operating Officer, Construction John P. Vercruysse Executive Vice President Mark Andrews Executive Vice President David L. Franz Vice President John M. Peisker Vice President, Production Patrick J, Walters Vice President, Finance Brad McCall Vice President, Estimating Derek Merida Vice President, Bridge Operations David M. Kozyra Vice President/Area Manager Griffith Lynn J. Bauer Vice President/Area Manager South Bend Danielle Payne Assistant Controller, Secretary and Treasurer RESOLVED FURTHER that the above officers be, and they hereby are, authorized to execute all contracts or similar documents on behalf of the Corporation. In addition to the above officers the following are hereby appointed as authorized signers on behalf of the Corporation: David J. Misirly Senior Estimator Gregory A. Hoffman Director of Estimating, Griffith Dustin P. Hilary Director of Estimating, South Bend Mark E. Krachenfels Construction Manager 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 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>> In Conclusion Milestone Contractor's and will adhere to an Alcohol and Drug -Free Workplace Policy. Any employee who is forthcoming and admits to a Substance abuse problem prior to being identified through any form of substance abuse testing will be offered help; however, any employee who uses an EAP because of a positive drug or alcohol test will be subject to the conditions outlined in the testing portion of this policy and as set forth by the EAP counselor. All Information received by the employer because of drug or alcohol testing, including EAP counseling are to remain confidential, only those with a need to know should have access to those communications. A refusal to submit to a drug and alcohol screen may result in dismissal and be considered a positive result. In addition, the following situations may also result in disciplinary action up to and including termination of employment: • Failure to take drug or alcohol test In a timely manner. • Failure to Appear for testing. • Failure to accept the EAP recommendations when required to use the EAP due to a positive test or violation of a company rule pertaining to drugs or alcohol. • Failure to report a work -related injury in a timely manner solely for the purpose of circumventing post -accident testing. 4 EXECUTED this 260'day of August, 2021. Z,�A ,.A� 1 L Fred Fehsenfeld, Jr. Geoffrey C. Dillon Q, �7 /'-.. James dAchsetifetcl y2n� P QA�� Jc4di P. Vercruysse ISMSESEADDRESS: 3USOVTHROAD, MMNGTON.CTOW32 Allegheny Casualty Company List of Certified Companies NN+.9P2a ACCREDITED SURETY AND CASUALTY COMPANY. INC. NAc P2631n BUSINESS ADDRESS. PO Box 14085SOrMMo.R32814 MONE1407)62A213t UNDERVMTINGUMRATION M SR1M.W0 SURETYUCENSES 4(l.ALAKAL WCOCT,DE,DLELWHI.ID.ILIN,µK5.W..VMEMD.MAMLMN,M5,MO. MT, NE W,HK RR. xM. NY W, ND, OH, OK OK PA RLSC SD.IN, M UT. VL VA WA W WL WY I(CORPOMTEDIN:w- ACE American Insurance Company (MAC-7) BUSINESSADDRESS:436W l.n t51netRO.Da1W0.PhIMOMphM.PA191% PNORI.Q11)R4D1WD UNDERWRITING UMRATION M UaSSE,W0 SURETY UCENSES 4f/: AL AKA A0. CA CO.R. DE DC R-W HIE, ID. IL IN. K KS. W. M ME. MD, MA ME MN. W. MO. W,, NL W, NK NJ, NM. W, NC, NO, OK OR OR PA PK RE SCSD, Tx, TK UT, V L VA A W0.WV. W L wY INCORPORATEDIN: P-r.y—E,, ACE Property and Casualty Insurance Company INAC.2 BLISIm55 ADDRESS. 436—UT STREET, P.O. Box t000, 14,1b.,hM, PA I S1W RRONERtsl E4bt000 UNDERWMTING LIMITATION W. 1314e55,0 W SURETY UCSNSES LIT: AL AC aA0. CA CO, 0,, DE, DC, R GA HI. ED. IL IN. K M. W. EA ME. MD. MA ME MN. MS, M0, MT, NL W. NN, NJ, NM W, NC, NO, OK ON OR PA PK RE X, SD, Tµ TK UT,S%VA WA W,, IL WE INCOISMMTEDIN:Penru — ACSTAR INSURANCE COMPANY INAC—SE, WREN UCENSES Lf/:AL AKAE AR M CO, C, DE DC R W HI, ID.IL IN, K M KY. MME MD, MA ML MN, MR MO m,NE W,NKNLNµ WNCND,OH,OKORPAPKRLX,5D,12LTKUr,VLVAKWAW ,,WkM INCORPORATEDIN:Debxare AMCO Insurance Company INMC NI9IW) PRO-(SISI—I UNDERIMSTNG UMITATION M f20,13ROW SURETY UCENSES Lfl.I ARUCO,C.DEDLGAD,R,N.KMW.ME.MD.MLMN,MSMO,MT,NEW,W,NC, ND,OH, IN, P0. RL SCSD, TI4,TK UT, w, vA WgWV, WLYIY NCORP.—IN: Nwa AMERICAN ALTERNATIVE INSURANCE CORPORATION INACS19720 BUSNESSADDRF5S: 5SE COU.NE ROAD BAST-RO. B0X 5241, PMNCETON, NJ005f3 PHONE:(60n1-- UND—TING IMITATION N: 09377.OW SURETYUCENSES Cfl: ALAK AE AR W CO, C,DE DC R W HLID.IL IN,K 1L5, W. U,. ME MD, TM ML MN, MS MO, r,lE W,NX,NJ, NM,W, xC ND,CK DKORPA PRRL SC,SD,TN,TX, W,W,,VA, Wk M, WLM INCORPORATED IN: DRL I American Casualty Company of Reading, Pennsylvania INNCRM n BUSINESS— 151 N.Fra .SS,CHICAGO.IL6WW PHONE:01n8 -sWD UNDERwgnNG UMITATION M M0.W.OW suR UCENSESLf/:ALAK/ AkUCO.C.DE,DCr4WHLID.ILIKN1.W.UME,MD,MgMLMN,M5,MO, MT, NE W, NH, NI, NM, W, NL ND,OH, OK OR PA PK RL SCSD, TN, n4 M,, VEVq WN M, W LVIY INCORPORATED IN: PenruyNanM AMERICAN CONTRACTORS INDEMNITY COMPANY INACtl101..) BUSINESSADDRE55: $0150Mh Fauerva5v4elivhe ]W, Los Angeks, G 90NT Amerisure Insurance Company INAC«194g31 MISINE95A➢ORE55: P.O.IE-so9R, FARMINGTON HRl5,—.33-9098 PHDRr:Q")6ts9 SURETY UCENSES cg/:ALAK AZ. AR CO. DE DL PL W HL V.IL N. M, KE KY, MMD.MA ML MK M5. MO. MT NE NV NRNJ,NRKW,NC, NDOH,ORORP0. PRRLSCSD,Mx m,VT,vAwAwV W INCORPORATED IN: MIFNIgan Amerisure Mutual Insurance Company NAIL♦z33961 PIE—Q.) II—E) UND—KIT NG UM—CRE I I. — SURELY UCENSES cft. AL AK A AN LA CO, IT, FL WTEN It, IL IN, KRS. RY. N MD. NV, MI. MN. M5. MO, MT. NE. W, NH, NJ, Rµ W, NC, ND, OH, ON RA PR RL SC ED, m, TX UT, W,,v0. w0. M, M,M INCO—FNR DIN:MI[Mgan Amerisure Partners Insurance Company NAIL«Ita50) PNONER4016159 SURELY UCENSES 4M ALAKAE AR CO. DE DC R W HL D.IL IN. K M W.. to MD. MA MI. MN, MS,MO. W.. NE W, NM, W, NC ND, ICµ OK OR PARL SCSD, TN, TK m, W, VA WN WV, WL wY INCORPOMTEDIN:MILnlpn Antilles Insurance Company iNAC w-) RUMNSS1—RE; MIEox9023Wr,sanJuan,PRDOso2- PHONE:mna]u9W UNDERwRmNG UREWON a S-1,WD SUREW UCENSES 1. PR PXONeleW3Nsam0 UNDER W WDNG IMBrR1DN nl: S;23g00o SURELYUCENSESKr/:ALAK ARWCO.C,DEDCFLGAHLID.ILW KMKKLAMEMD.MAMLMN.Ms,MO MT,NEW,NH,NJ.NM,NY,NLNMOH,OKORPAPRRLXSD,TN,T UEVLVAWAWv,WLW ACUITY, A Mutual Insurance Company NM<«1MM7 BUSINPSSADDRESS: 28WSWth Taybl D,'rve.RO.DUSB,Sh,Wo In,WI5300 -MO PXDxen2W.5B9n, UND—EEGUMITKnOR W:SW1p85,WD SURELYUCENSESI(P..ALA; CO.DE,GAID,ILIN,KO.W.MEMLMN,MSMO,MT,NEW,NH,NM.ND.OH,OK OR RASD,TN,TKUT,w, VA WANK. WL WY INCORPOMTEDIN: Wn4NWn Aegis Security Insurance Company MAC r33NM BUSINESSADDRESS: MEEM315BNUINSBURS MMDS PHO-TIMI T-9DI MTgElk UCENH.NJ.NM.W. C % H.OKC,DEDCCGA HLID IL.N VXS NY.LAMEMD. MA Ml MN. M5. MO. rvE W,xx. NJ, rvM, m. NL ND.OH, OK OK PA AL sCSn, m,iX ur,W, vAwAwv,wL WY INCOMDRATED IN. Pams,— ALLAMERICAINSURANCE COMPANY INAC tl2021n BUSINESSADDRESS: KO.BOXESI,—MR7,01445891-0351 PRONE:M19)—ID10 UND—STING LIMITATION W. 517p94.D00 SURETY UCENSES Kfl: AE AR W Co, U. DE, W D. 14IN, K RY, ME, MD, MA ME MN. MS. MO. MT, NE. W. NH. M. NM W. NC, ND, ON OK OR PA RLSC TN. TX UT. W, VA WA WV, M. WY INCORPOMTEOIN: . RHONEC3102 SURETYUR NSEScN:ALMA2,AR WCO,CT,Mo,R,WGU,M,10,ILIKKKSm,UMEMD,MLMN.MS.MO Mr. MT, NE.W, K Nµ NY. ND.OH.OK OR PA RLSC SD. TN, M U ..VAWAWV m.WY IrvcoxroRATED IN: UIR—EI American Fire and Casualty Company (NMCtlN066) INEIRE SADDRESS: t]s BerkekyweK eurtorL AK Or is MONEIEsM 51A5W E WENSES LfI:AL AKKARW[O.C, DE OS x.WIO, IL ILA,K Ks, RY.IAMC ND, NA ML MN, MS, MO, MT. NE W. NH. NI.NKW. NC ND.OH.OKOR PA RL SC, SD. TN.TA N. VE VA WA WV, M M INCDRPOMTEDIN,N.M.;NInlT4 American Guarantee and Liability Insurance Company (NUCF'2624]1 BUSINESS ADDRESS: l2 9 MWH WAY, STH FLOOR SMAUMBUM ILM196-1056 PHONF:(M>) WSfiWD 1ICERN- I:AL NCA.CO.(.Go LF4WHI,ID,ILIN,µ15,WMMEMD,MAMLMN.MSMO, MT.NE, W. AR NIIENJ. NM. NY. NC NO.OH.OK O0. PA Rl SL W.TN.11C UT, w, VA WA WV, WL WY INCORPORATED IN. New Ynk American Home Assurance Company —CB193R01 BUSINESSADDRE55: IDI AVENUE OFTHEMAERRAS 3TTH FWOK NEW YORK W 10020-1304 PHONE:UInT1— .NOERwPOING LIMETATION bl:1-JE3.W0 S Rli: AL AKAZ A0. W CO. C, DEDC K. W HI.1O, 141u, K v1, W,1A ME MO, MA ML Mu, N5, MO, NE NE.WNRNJ,NM,W.NCND,OH,OKORPARLSCSD.m,TKUT.W..VAWAWVMM INCORPORATED IN. NM, — AMERICAN ROAD INSURANCE COMPANY (THE) INCORPORATED IN: WXOO Rice Arch Insurance Company ISTEII ADDRESS. xxnn,Ree3, 21DXnesan sl eecsMm3W.JERSErem. NJ DT3I1-uDT PHONE:01)1a3J000 UNDERWRITING LIMITATION b/: f162311,W SUREttUCENSESI.fl.AL A,ARCACO,CT,DEDCFLWGU,HI,D,ILIN,KM,MkMEMD,MAMLMx.Ms, MO,MTNE, W.NH,NyNµ W,NCNDOX,OKDRPAPRRLX.W.TN.MM.W.VAAWAW,MM INCORPORATED IN: Mi1-1 Arch Reinsurance Company ENAlCs103XB2 BUSNESS ADDRESS, 4A56DDTII STREET, SUDS 22D, PO. ROX I RUN MORrySTOWN, NJ MR62-1x0 1HO1E:19T3)898AS/5 UNDERW ITING LIMITATION bh, f55,209A011 SURM UCENSES Kf-l. AN AR CA CO, ET. M.DC, FLWIL GU, HI, IO, K K 0, W. M NO, MA ML IN, IS, MO, MT, NE, WN H, NL Nµ NY, NC, ND, OK OR OR PA NSC SD. Tn', TX UT. VC VA WA YVV INNCORMSATEDIN: CII— Argonaut Insurance Company (MAC—n) PHONE:IBWI4TDT95B UNDERWRITING UMRATDN bl:$t 116,OM SURM UCENSESLf—AKE AR CO. CT.DEDC. FLWGU, E1L ID, IL IN, K RE, m,IA ME, MD MA Mk MM MS MO, W. NE, W, NH, NA NM, W, NC ND. OR ON OR M PR RLSC SD,T ,TN UT, W. VA VL WAWJ. mWY INCORPORATED IN: IDIIII Ascot Surety and Casualty Company MAC tlW2191 BUSINESS ADORFs5: 55 W 4Nh SITeeL New vork, W t W36 PHONE1(W s6e101 UN—ITER. LIMITATION bl: f11,631,W0 (MICtl132Bn STSIRM ADDRESS: One Newak CE 20N Fbnr, Newark, NJ 01N E41—:0W13334161 UNDERWMING UMDATION b1: 53,018,0 W SURETY UCENSES 40. AL. AK A AR CA CO, CT, DE. DLRW HL ID, D, IN,K RE, U,, M ME MD, MA ME MN. MS NO, MT, NE W. NH, NI, NM, NY, NC ND, ON ON OR PA PR M. SC SD. TN, TX W. W. VA W0. M. M. M INCORP—DIN:New Jersey ALLIED Property and Casualty Insurance Company (MIC.-w BUSINESS ADDRESS. ONE WEST NATDI-RE ME.— FMP SOLUTIONS, COLUMBUS OH 402IS-5220 PHONE:IS151508J21t UNDERWRTING UMRATDN bh $5.880.0W E.-UCENSES Lfl: AZ.A0. CA CO. C, DEDC. R W ID, IL IK IA I6. RY, ME, MD, NI MN, Ms, MO, MT, NE, RR.K W. NO, ON PA RE SC ED, TN, TX UT. VT, VA wA WV WLW INCORPORATED IN: Iowa Allied World Insurance Company INAK I2r)3n BUMNESSAONUSS: ,93 Water Sven rvew Yort, W t W38 PHONELR461T94L500 UNDERWWTINGUMDATIONMIEEI. A00 SURETYUCENSESLI/:ALAKA MCACO,C.DE,DCFLWHLID,LIN,KKXWMMEMD,NAMLMN,M5,M0, W.HEW.NM,KNM,W.NCND,OKOKORP&M,SCSD.TK.i ..V2.VAM.WAVN,WLWY INCORPORATED IN: New MaminM1lre Allied World Specialty Insurance Company INAK NE624) BUSIRMADDRESS, 1s9 WATERSTREET, NEW YORR W 1 WM PHONE:(M51]94nEW UNDERWRIING UMRATION M S63.3%— INAICST9631) PHONE:(313)33].1102 FNSESLrh,ALAKaZ CACO,DEDCFLWHI.ID,I4W,KM6 .LAMEMD,MAMLMN,MS.MO,W.. NENV,NH,NJ,NM.NY,NC,ND,OH,OKORPAKSCSD,TN,MM, W.VAWAWVmM INCORPORATED IN: Mkhlp, American Select Insurance Company lNA3CP19N21 PHONE:(13g8 ICI UNDERWRITING UMITATION th $161 4,0 W SURETY UCENSES RU: AL CO, M. W IL N. K U. ME MN. NC. ND, OH OK PA TN. VA WV. WE INCORPORATEDIN:Ohm American Southern Insurance Company WNE IT -) ROSINESS ADDRESS. PDBoa]230W,-M GA31139. W?0 PHONE:I40o2E6-9599 UNDERWRIING UM RATION b/: $5.2— SURETYUCENSESLIT:ALA AN CODE, DC FLW ILIN, IS, mMD. ME MN, Ms, MO, NE NJ, mm, NC Ox, PA sCTµ UT,VAWAWV, wI,WY NCORPORATED IN: Kamas American SuretyCompany (NAIL tl31]BD eusNLSsgooREss. zs0 Fa,f 9Mn Weecswaz9z, Ind;anaPN;s IN46zao PNoxeut-ne]5-R]Do U—NNIRTMED UMITATIDN b1: $895.W0 SURETYLICENSESLf/:AL.AKeECACO,C.DE,DCFLWHLID,ILIN.KKSD,IAME,MDMq MLMN,MSMO, MT, HE,W, NH, NJ, NM, m, NL ND, OH, DK D0. PA N, SC, SD,TN, M UT.VT.VAWAWV.WV INCORPORATED IN:Ine— SUREITUCENSES LI/:ALAK AZAR CO. C. DE DC R W HI, IO.IN. KKS D', IA MF, MD, MAML Nx, M5, MD, MT. NE, xM xH, xA xM, xL xD, Or, OK OR vA RL SL 50, m,MVr,Vr,VAWA Wv,wl WY IxcoMORATED W Cubneo ASPEN AMERICAN INSURANCE COMPANY N.MCA434W1 BUSINESS ADDRESS: 4W CAPRAL BOULEVARD,SUITE 2W,ROCKYHsiCTDS- PIfONEP6D2393223D UNDEMMRIRNG UMRATDN M: f IS-. 0o SURETY UCENSES C.N. AL AK aAR CA CO. CT. DE. DC. R. W GU, HE ID, IL N, K EC, D, U ME MD, MA ME MN, ME, NO, MT, NEW, NH, N. NM, NY, NC, ND, OR OK OR rA PR Is SC SD, Tµ TK UEVT, VAA WA WV, K INY INCOMORATEDIN:Teea, Atlantic Specialty Insurance Company IRMC427I541 BUSINFSEADDRESS. INS H;pway 169 NOM, suns RI PMm ^MN5501 PHONE I95n 852-2431 UN D ER W RED NG U MOAYI0— 581.] W A00 SURETY UCENSEScf—AK A2 AR CA CO. IT. DE DC EL W GU, TEL ID, IL W. K XS KY, 1 k ME, MD, MA ML MR. Ms, MO,MT,NEW,NH,NJ.NM,m,NCNO,OH,DKNLPAP0.N,SCSD,TN,MULVLVAVLwA mSW IN ORU-14:11— Auto-Owners Insurance Company /NAIC«IN9n BUSINIESSAD RRONE.(MT) SURETY UCENSES Lf/: ALAL A0. CO. R-W ID IL IN KD, NY, MI, Mµ M5, M0, NE, NR NM NC ND, OK OR M X. SD, 'ER-1—NE INCOR—D IN: MkMpn AXIS Insurance Company (NAIL tl3R>31 BUSINESSADDRESS, t00—OSBOUIEV , Um2E)D—I RETrAGA3WW PHONE IUa TL6-9w0 SURS-LKENSENW:AE, AA. As, K AR CA CO, CT, DE DL FL GA HL ID. IL IN, K M. W. LA ME MO MA ML MN, MS, MO MT NEPP/, NN NJ. NM, W. NC NO, OR OK OR, p ROC, SO, IN, M UT, VE VArI WA WI. WE WY NC—CH—D NA.— A%IS Reinsurance Company INNCRN330) BUSINESS ADDRESS: IDOOOAV,µON BOULEVARD, WRE M0. ALPHARERA Gh 30009 PHONEIE7IR—•P0 UNDEµ ROTING LIMITATION W. VAI.DLA CO SUREW UCENSESKM:AL AK ASAZ Akq CO, C, DE DL FL GA w IO,141N, K A5, Kv, k ME M%MA ML MN. M$, O,MT, NENWxH,M NM,NY, NL ND,OH,OKOK PARLSCSD,TN.M U .VT.VAAWA WV, WL WV INCORPORATED IN: NewvOSM Bankers Insurance Company INMtt3316n BUMPUSADORESS: KO.RO%IST07.ST.PMR5BURG,R33733 PHOHE:921IB23i0W UNO ERW mING UMITATIO N —S,3N, W O SUREW UCENSES KI/: ALAKAZ A0. OS Co, U, M, OC i4 GA HL ID, L lu, N A5. Kr, U ME. MD, MA MI MN, MS MO. MT,NLW,,HH.NJ,NµNKNCND,OKOKO0.PASCSOTKMUF.VCVAWAW,,MWF INCORPORATEDIN:ROaaa Bankers Standard Insurance Company (NAC.—M WSWUSADDRE55: L36-NUT5TREN,RO.Boa1ooE,PNMaeIpMs PR191M PHONEU15—IM UIDERWPo NOLIMITATIONW:E2t3]30W uCEN9f5Cx:ALAKA AkC Co,CT.DEMFLGAHI,ID,ILIN,KRSKY,IAMEMD,MAMLMN,MS,MO, MT NE NV, NH, NL NM, NK NC, N0, OH, OK OR PA RL SLSD, TN, M Uf. VI. VA WAWNWL M INCORPORATED IN: PenlrsyM— BeaTley Insurance Company, Inc. - ALAK AZ A0. CA CO CT. DC DC R W Gu, HE ID, IL IN, MP,MT, NM NHUNl NM, xG xO, OK OK RL54 sD, lx, M ut, VT. VA WANv,v INCOPPORATED IN: Sank D.— Bond" Insurance Company NA R12M5) BUSNESSADORESS, 3w WNUna Rudd,wne12o POeOa6,norhaa Pa NJo PxONF: INCORPORATED IN. N—Ja Brierfield Insurance Company IHACA+09931 BURNESS ADDRESS: 63W un.—.W PALway, Sarasaa, FL 3L2w-&ail PHONE I-)22.- UNDERwMTINGLIMITATION W.$1.01 EOW SURET UCENSES IN. AL A0. EL GA MS IN IN CORPORATED IN: Mlsslsvppl BRITISH AMERICAN INSURANCE COMPANY IN-R32&T51 BUSINESS ADDPE55: P.O. Be&159D.Dabs.M i5211 -t59O PHOnEnlal Aa3-55W RID—TING LIMRANON W: EBmS,00E SURETf UCENSES 42: M NCORPOMTEDft— Capitol Indemnity Corporation IxNcatOwil BuuNEssAGDRESS, EO.Ba.1—AL uNon NR53I05-o9W PHONE f60R BMA2W UNDERWPoTING LIMITATION W: f24413.OW PHONE:(115)— UNDERWRITING LIMITATION M $1 Sr324p00 SURETY UCENSES IM AL AK AZ A0. CA CO. C, DE DC FL GA HI, ID, ILIN, K KS AY, M ME, MD, MA ML NIR MS. MD, MT,NENV NKNJ,NM.W,,NC,ND,OHCKORPARLSCSD,IKMW.tt.VA WA WV, WLMH INCORPORATEDIN: New YaK Cincinnati Casualty Company (The) INNCP2&6651 BUSINESS ADDRESS: P.O.ft. I—M. CIP,11—K ON 45MO-SL96 PHONE. o+31 oD2DW UNDERWRITING LIMITATION EL EW,W%UDE SURETYUCENSES cfPA4AKA;A0.CKCOU,DEDLFLC HLID,ILIN.KMKY.MMEMD.MAMLMN.MS.M0. ME NE NV NH, N, HK NY, NC ND.OH, OK O0. PA RL SC, SD. M nL UL VLVAWAW].M WF CINCINNATI INDEMNITY COMPANY, THE INNCall m BUSINESS ADDRESS: P.O. RO%1LSL9L CINCINNAn OH L525O-1% MONEI513).— UNDERwIOT11 LIMITATION W. E12566DW LICEMES Cf/:AL AK K ARCA CO, U, DE DC, R W HI.ID.IL IN. K M AV, IA ME MD, MA ML MN, M5, M0. MT. nE NV.NH.NLNMNYNLNo,OKDKORPARLSCSD,TN,MLIT,W,VA WAw MM NCORPORATEDIN:Oh'w Cincinnati Insurance Company (The) INAC-1 UNDERWRITING LIMITATION M:—I IRWO SORETYUCENSFs cfI: AL AKAZ A0. GC0.U,DE.DC EL GA MI,IO.IL Iu,K As, Av.µ ME MD, MA ML MS.MO, MT.NE NV, Nµ W, NM.NY,NC, ND,OH,OKORPA PKRL SCSD,TN.M UTVEVA WA WV, WL WY INCORPORATED IN: OhIS CITIZENS INSURANCE COMPANY OF AMER! CA NAC.v— IUINCSS ADDRESS. PHONE:DCII)—I SURETY UCENSES cM AL AK AZ AR CA CO, CT, DE DC, R W M. 10, LIN. W M. MLA. IL M0, MA ML Mn, M5, Mu MT, NE, NN NK N� NM, NY, x W. OR OK OR PA RL SL SO. IN. M UT, VE VA WA WV, MM INCORPORATEDIN: CDnne l Berkley Insurance Company (NMCa32E03) BUSI NESS AOD RESS: 4]5 SrfAMBOAT RwD, GREENW KK CT Os&3O PHO-CLEN liaea0 UNDER N.I.I.—IONE/:ss/OTSKDOO cfl.;AAZAKMCOU.DLDC,FLGAHLIDn.IN.KMO'.MMEMD,MAMLMN,MS,MO MTRNLNVENN NJ,NM,W..HCND,ON.OKCk PARLSCW,M.MUT,VT,VAWAWV,m WY IxCORPOMTED1N. Delrware Berkley National Insurance Company (NACe3N11) REtt LKFMUCfl.ALAC'kCAMCI.DEDCRGAMID,ILIN,KM,AY,MMEMD,MAMLMN.M5.MD. MT, NE W, NH, N}Nµ MY, NC ND, OK OK OK PA RL SC 5D, TN, M UL VL VA W, WA WV, WLWT INCORPORATEDIN: Iowa Berkley Regional Insurance Company (NAIC.— BUSINFSSADDRESS: POBO%91 W. DFS MONES N SO3M-N W PMNEISIS)AT3- C UNDERW . J-10N W:IIkESE W SUR-LICENSES <,fl: Al- AK AZ A0. CA CO, C, DE OC. R. EA HI, ID, IL IN, K AS. AY. IA ME ME, MA ML MR MS. M0. MT. NE NV, NH. N. W. NYNL ND, 01.OK O0. PA RE SC Z. M', M UT, tt, VA wA WN MWY SURETYLICENSES1.M:AL AK AZA0. u CO.C, DE DC r4 W HI, ID, IL IN, K M5 W M ME MO. MAMLMK M5, MO, MT,NE NV, Nx, uJ, NM, xY uG ND, OK OK 00. vA RL sLSO, TN.M UT,YE VA WA WV. WLNry INCORPOPATEDIN: Wscaran Carolina Casualty Insurance Company NAC--) BUSINESS ADDRESS: PO RO%91 W, DES MORIM N 503W -9150 PHONE(9N)363D3W UNDEmmmMGLIM—N E/:sI E29 — SU RETY LICENSEScI/:ALAKA AR4C,CEDEDCFLGAHLID,ILIRA.KASKY.UMEMD.MAMLMN,MS,MO, MT,NEN RNJ.NM,NY,NLND.OMOKOR. PA RLSCSD,TALMLIT,W VAwALW,WLWY INCORPORATED IN: 1. Centennial Casualty Company NNC —I BUSINESSADDRESS: 22W Woaavesl PIR1 , wile 2W, IS1-9MM AL 352W PHONE',UDS1—OECD LNCORPORAROIN:AMb— CENTRAL MUTUAL INSURANCE COMPANY M. AaID01 BUSINESS ADDRESS: P.O. BOA 35LYA1WERT OH As&91-OMI PHONE p1n23e-+o1O UNDERWRmNG LMITATON W. SIDE..mlpoo SUREtt LICENSES 01: AZ A0. CA CO, C, DE DC DA ID, IL IN, K AY, ME MD. MA, MI. MR MS. MD MT, NE W. MN NL NM. W. NC MD. ON, M OR PA RL SCSI M U. W. VA WA WV, M.M CENTURY SURETY COMPANY (NAEC...1) BUSINESS ADORES. 5% Po 1 Panwry, wexemle, DM-2 PHONF:I6H1 g9S30W (NACr31SSCI CIt, AL AIC AZ A0. CO U. M. DC, GA HE IL IN, M. ICE ME. MD. MA MI MN, MS, MO, MT, NE NH, ME rvµ NY. NC MD. OR.1PA RL SC SD, TN M 1, Vr, VA WAwv,wl INCORPORATED IN. µ 1,SE. COLONIAL AMERICA N CASUALTY AND SURETY COMPANY INMC-7) BUSINESS ADDRESS'. 12M NPoCH WAY, STH nOOk SCHAUMBUR4lL Wl%-10% PHDNE:I&LTIw560W UnOERWXmNCSGry aL AKA3,fA0. N CO. R. DE OC. R W H{ ID.IL IN. K A5. RS'.IA ME. M0, MA. Ml Mx. Ms, MO. MT,NE, NVEN}NM, NK u4 MD, OH,OK OR, PA RL 54 SO,Tn.M Ui, tt, VA WA WV,m WV INCORPOMT®IN: ainoil COLONIAL SURETY COMPANY INAC P10ASB1 RMSINESSADDRESS. tz3 •<eauNYara,sMn. aD, wPoaam LaLe.•WCT677 PHONE'40N 5]3d)eB UNDE.-IMNG uMIrATIOx b:11=000 SURETY uCENSEScfI: AL AK AZ AR, CA CO,U,, DE. DC, FL GA GE HE ID, II. IN, K KS, KY, LA LMD KMS. MO.MP,MT, NE NV,NH,NJ,NM,NY, NG ND, OH,OK 00.PA P0. Po. SC,SD. M,MIm VT,VA AW/, V/{VAY INCORPORATED IR Penn,,—U CorMnentel Casualty Company 3� MAC R20L U) BUSINESS ADDRESS: 151 N. FrMIES SL CHICAW, IL 60606 PHONE: UI 2182n5ooD UND—RING—ION EA: f736,W1,WD SURFT'LIUxsES LIn.ALAKA;AK Ch CD. C, OE OL FLWHL ID, IL In,KAS. xY,LA EMD.MAMLMµ MS,MO, MINE H .. Nµ NJ. NM, NY, NCND, OH.OKOR M Pk µ SCSD, TN, M UT, VT, yNC wAwV.wLwY Bershire Hathaway Homestate Insurance Company o1MCR2D-a SUSIMUSADDREM 1314D1gWSlNN,-1300.0maM,NF6rW-1W —NE:Iwa393— UNDERW ETING U.—IO. N: f269,1S5OW SURETY LICENSESc14 AL AS. AZ A, CK Co, CE OE DE. F40A. HE b, LINK AS, KY, U ME MD, MA ML N. MS. MO. MT, NE, W. MH NJ, NM, M, NC NO, OR OK OR PA RL SC SD. W. IIT W. VA, WAW W. M LW Berkshire Hathaway Specialty Insurance Company INA-76) BUANESS ADDRESS: 1314n.uglas SOeet was 1AW,—. NE 6P102-INA NIONE:(wn916a000 UNDERWMTING UMRANKN M faw,96LW0 LENSES Uh, AL AK AZ AR CA C0. CT.OE. DCFL GA HL ID. L IN, K R, AY, k ME MD. N1 MI MN, M5, MO. ME NE NV, Nµ NL MM, W,, MC NO, OR DK O0.vM1 µSC SO, TK M 0. W, VA WA WV WL Wy NCORPORATI:D N: Nebrarie BITCO GENERAL INSURANCE CORPORATION IKAC 12W951 R—ESS ADORESS. 3]IN —SQUARE CIRCLE. DAVENPORT. N 52g0] PHO-DO(Q— UN DEP W IIIII MG UM RATbx EA. f W 16,000 SURETY UCENSEScff. ALAK AZ AR M M, U, DE DC R GA ID.I4 i%IA AS, %Y, M ME MO, MA ML MN. ME MO.MT, lE,NV, N}Nµ NY,NC ND,OH,OKOk PARLSCSD,M.MUT, VC VA WANK, WLm BOND SAFEGUARD INSURANCE COMPANY I—r2]ae1) BUS HESS ADDRESS: 1DWzsE.y„Ior Roaa, wae+W, LuuiwiN, Avwxz3-z9]9 UNDERWMTING LIMITATION El f0.O2] UNDERwµ 1 LIMITATKM W. S516aDW SURM UCENSES CN: AZ GH, WV INCORPORATED IN Ohlo CERITY INSURANCE COMPANY INAK AIp0p61 BUSINESS ADOWSS:ID3T5 PRDFESSIOIULCRCLF. KENO. NV &952t PXDNE:I]2S)3P.2]W UNOERw R.."RATNx Er.sS,2W,WD RFWLICENSESCf/.AL CACO,DE.DCM lI I41N, KK XV,MD,MI.MN,Mi MT,NENJ,NM,NY,NGND,OH.OK ORPA µSC SD.M Ui, tt. VA WAWV. WI Charter Oak Fire Insurance Company (The) DUSINESSADDRESS: ONETOMRSOtAAREHARTPCW CMIB3 I.M: AKAARCO.CI.DEDC,ILGAHt W.ILIN.KK5.AY,MMEMD.MAMLMN.MSMO,Mn, Mfpxv,MKEmSESNM,M,NC,ND,OH,OK O0.11 PR Po, SC,SDTM,T%,LU,tt,V WNNMm INCO(IPORAFED N:Cpnn—. Cherokee Insurance Company INAICR10W4 BU RNESSADDRgS: 3aW0 Mount Roan, -HIT,, ft'K. MI a0310 PHO1E(&WI20+mwa-NW UNDEPWRTING LNRATION El: 533.]3ACW NINKN NCNcl/:ALAZA0.GCO.C,OE. GA.W.mKM,AKlAMEMD. M0.MLuN, MS, MO, MT,xE Hrv. rv} Nµ xv. NL x0, OKOK 00. PA µ SG SD, TN.M K. tt. VAWAWI. Wl. Wv INCORPORATED IN: MI<hlgan CHUBB INDEMNITY INSURANCE COMPANY NAIc.-M BUSINESSADDRESS: 2029 Hah MII-d.3MIIeh.,I SMHI NIWSN CONTINENTAL HERITAGE INSURANCE COMPANY UCENSES IMM, M CO, DC FL CA D. L N, K KY. LA ME MD, MA ML EIR ME NE NV. NJ, N0, OH, PA SC. SD. TN'TX UL VA WA.— Nx INCORPORATED N: .- Continental Insurance Company (The) IMAIcr352091 BUNNESSADORESS: +s1 R N-Al. SL. ENILAGO, IL6DW6 PHONE:01 B -SEND UNDERWRTING UMWON W:-1.21D000 SURETY UCENSEScf—AE AZA0. CA CO U. DE DC FL GA GU, HL ID.IL IN, K KS KY, IA ME MD, MA ML MN, US MO, MP,MT,NEMV NK NJ, NM, m, NC, HD,OH,OK OKPA PRRLSC,SOTN,TK UI.W.VA VL WAM.WLM INCORPORATED N: Pep'..Ia CONTRACTORS BONDING AND INSURANCE COMPANY (NAIC A3T2M) BUSINMS DRE55: W25N.UndNrgh Date Peal.,a6t6+5 PHONE:LIES111-IOW UNDERWRmNG LIMITATION M f 11D.2,D W ET LICEMES cfl: ALAK AZNL M CO, CT, DE DCFL GA HI. U. R, IN.µ M b.. M ME M0. MA ML MN. MS M0. MI, NE AN. NH. NI. NM W. NC MD.OK OK OIL PAµ SC So, W. M I.T. W. VAWk M. WL WY INCORPORATED N:I— CooperatiMa de Seguros Multiples de Puerto Rlco OINK r+r1.) BUSINESS ADDRESS, PO DO%363Ra6, SAN IUAN, PRON36-3BL6 PHONE, M17) —575 v: 2512 SUREW LICENSES <En PA nCORPORATED IN. Puerto RI,. CorePointe Insurance Company NAK xtM99) DUSNESSADDRESS: SMSUPERNIRAVENVEE., 2ISTFLOORCUNEMD,OHa41M PHONE:(ERC)IR-1M UNDEeaRTlwa LIMITATION W: s1,56ZECD ENSES,D: AL AKAZ AR G cO, R, DE, 0G R W HI, D, IL m K KS, In, IA ME MD, MA ML MN. Ms. M0. MT. NE NVNKJ.NM.WNCNDOH,OKCKMRLSCSD.TRMUT,VEYAWAM.K W INCORPDRATEDIN:DeDware Cresthrook Insurance Company (NAIC x1-11 BUSINESSADDRESS: DIE WEST NATIONWIDE BLVD-1-14301. COLUMBUS, OH 43215. 2 0 PHONE: NBD)%uw. VNDERWRTNG UMRATON W. SIS.M 0 I: AK KAR G DE.DC W NL D.IL IN, K xS N, U ME,MD, MA MI.MN,M%MO,MT.NENV. xH. NJ. NY. NC ND, OROK OR PA RL SC 50.TN, M UE VT. VA WAWI, WE WY INCORPORATED IN: CM, CUMIS INSURANCE SOCIETY, INC. (NMCxta84n BUSINESSADDRESS: 5910 MINEPALPOINT ROAD, MADECKW 53705 PHONE.RSOM -SBSI UND—TINGUMnnnoN M MOE329,aW SU—UCENSES,1):ALAKA ARCACO,R,DE,DLP GAGU,HLID,141N,KNS,AY,LAMEMD.MAMLMN.M5. MO, MT. NENMNH, J, xM, NY, NC, ND,OH,OKOR MPRRLSC5D,TRM UT.VEYAYLwh WV, WLM RNCORPORATEDIN:Msra CUMIS Specialty Insurance Company, Inc. NMCxt]]SM BUSINESSADDRESS: 5910 MINERALPOIm ROAD, MAD60KW 5370 PHC.E(wo -5851 U.NDERWRTING UMRATION W. S5,01H,W0 BuswEsshoDREss. tm ERean Way, waReq Corporate [enter, wanes J mos9 PHON MM—E00 SURELY UCENSES,fNµAKAZ U CO, CT, OE DC NL ID,WIS, K Ks, Kt', Vu MD, MA ML Nx, MS,MO, MT, NEW. NM, NI. NM, NY, NC, ND.OH,H.OK ORPA RL SL SD,D,TN,N, M UEVEWA WV, W, Wy INCORPORATEDIN:D,h,A— Everest Reinsurance Company INNCx269211 BD5INESSADDRESS. Im Everest ay, amen rpor [e [e Mer, warte�L NJ olos9 PHONE ")BRABEC0 UNDERMINING UMNATON M S55BUIDEM W NEW,NKNIN:ALAICA. D, GCOCZDEDLC,GAHI.ID,ILIS,LAKEKY, lA ME MD. MA Ml Mn. MS, M0, Mi. NE NV NR NJ, NM NY, Nc, ND, DR oK OR PA Rl sc, m, iN, M ur. vr, vA wAwV, LVL Wv INCORPORATEDIN:D—I, Evergreen National Indemnity Company (-Cx122w) RUSINFSA AOORESS. 6I50 oak Tree BMd sidle 4b, HMepenaenre, off A4131 MONEMAC)—M20 UNDERWITINGUMNATION W: M,2N.W0 SURELY UCENSES,M µAKAZ AR G CO CI, DE.DC FL W ID. LIK K KS, KY. LAME MD, MA ML MN. MS,MO, MT, NE NV, NH, NI. NM, NY, ND, OH.OK OR PA RL SC SD, TK M UT, W, VA WA M M INCORPORATED IN:ONb Executive Risk Indemnity Inc. eu5r2Es5 wDRESs: 3aza Harz Mn Roax. wNllenouse seuon J .—B rNONE:a15)64D100R UNDERMI1NG UMNATDN W. M6E325.ON SURETY UCENSES,H: AL AKAZ AR G CO, G, DE DC FL GA HI,10, IL IN, K KS, D. M ME MD, MA ML MN. MS, MO. MT, HE, Nv NK J, NM, W. NC ND.OH, OK oR PA RI W. M. M. M U ..W,,VA'SLWAM,, wL W V NCORPORATED 1N: Delaware RETY OCENSESC,D: AL AKAZ ARC&CO, CC DE DC, R GA GU. HI.IO, IL IN, K M M M ME MD, Mh ML MN, MS, MO, MP, MT, NF, NV, NH, NL NM NY, NC ND OH.OKORPA PR RI, SC SD m.M M,W, VA VLWAW M M .CORPORATE...: Ca — FIDELITY AND GUARANTY INSURANCE COMPANY INMCx353B61 RUUNEssADDRESs: DaeTo,«. square, Hama,a CTOR1A3 PxO.el%M mn111 UNDEMBRNG UMITATON bI: II,C39,c00 SURETY LICENSES SNr Al. AK AL AB, G CO CT DE DC, RC.A.HI. 1%IL IN, K M, KY, LA ME, MD, NA ML MN, MS, MO, MT, HE W. NH, J, NM W. NC ND. OR OF OR PA RL SC, SO, m, M M. VC VA WA M. WL WY INCORPORATED IN: Iowa Fidelityand Guaranty Insurance Underwriters, Inc. INMCN258)9) BU.—ADDRE55. One iawW Sgwre. HarNndR%lD PHONE1860)2n 11 s,fl:ALARCACO,CTDEOCFL.Gh KS HLID1LIN,K,MMME,MD,MAMLMN,MS,MD. MT. NE NJENNENA A{A NM, NY, NL ND.OH.OK O0. PA RL SC, SD, m,M m, VT. VA WA WV, VA WT INCORPORATED IN: W 1—IN Financial Casualty & Surety, Inc. INNCx35%M BUSINESSADDRE55: 3131 EASTSIKSURCISc IOUSEDR. T]O% PT-C,N]n'AT-IIb UNOERwR11NG LIMITATON W:31,R6ao00 Fs,r/:AZG ME.RGAD,IN,KKS,GMD,MLMKMS,MO.MENV,J.NKHLND,OH,MSL SD. TN, M UT.W VAWAWV R—RPORATEOIN:Teae3 Financial Pacific Insurance Company INNCx31a5n MISINE55 ADDRESS. PO.eO%73909, (EWR RAPIDS, M5140T-3909 x: AL AZ AR G CO, CT, DE DC, I- K 1D, RL IN, K KS, KY, LA ME, MD. MA. ML MN, MS NO NE. m', NH. NJ. NM. NY INC. ND. 0R OK OR PA BE SC SO TN,M UT. VEV& Wh M. WL WY Developers Surety and Indemnity Company INAIIII2Tln OMNESSADDRESS: BOO SUPERD—NUE E. 2- FLOOR CLEVENND.OH-14 PHONE:(216) KPIA16 c,N:µ AKAZAR MTCO, CE DERL C SD, H, ID, IL IS, K KS NY, ME M0. MAML MN, MS, MO , NE, NVEN ENL NM.NT,NC ND.OK OK OR Ph RL SL SD,TN,M m, VT, VAN, WN WV, WL WY INCORPORATEDIN R-1 Employers Insurance Company of Wausau (NNC 12-B) BUSINESS ADDRESS: 175—ky Wee. BOIOr, NACHIB PHONE:I61n35]-9500 UNDIRIMUHNG UIRATDN bl, 39 6REZ%0 SURETY LICEMES If/: Al,, W AEAR. G CO, U. DE DC, P. W HI, ID.IL IS, K M. W. IA ME MD. MA ML MN, MS. MO MT, NE NV, NR NA Nµ NY, NC. ND, OR OK 0%Ph M RL SC. 5O, TN, T/, UT, INC VAA WA, WV M Employers Mutual Casualty Company (NMcx21Ns) BUSINESS ADDRESS: P.O. BOX T1Z DES MOINES, K SON -0]12 PHONF.ISI )-511 SUBM LICENSES,.: Al, AK AZ AR G m, G, DE. M. R. CA HI, ID, IL IN, K Ks, 0, I.A. ME MD. MA. ML MR MS. MO, MT, NE W. NR NA NM, NY, NC NO. OR OK OR PA RL SC SO, TN, M UT, W,IN, Wh WV, WLM Endurance American Insurance Company NNC P—) BUANESSADDRESS: a MAN.—NI'LLU KMOPURCTKSE, NY 105T] Explorer Insurance Company NMC x4a029) BUSINESSADDRE55: P.O. BOKSORCA SAN DEGO UNDPIMMIG UMITATDN b1. 521,34ADOo DIAL AK AZ AK G CO, CT, DE DL F4 GA HL ID, 141N, K AS, W,, a ME, MD, MA ML MN, MS, MO, W. NE NV,N}RM. W,, NC OR, OR PA RL SC ED, TN, M UT. W. VA WA WY,W INCORPORATED IN: o1(orna Fair American Insurance and Reinsurance Company NAIC s3IT sn BUSIN.B.DRESS:ON Uberty PD]a. 165 HIR.ry,Nex Yank—Oxx PHONE:2121365-SSOD UNDERwPnING UMNATDN El: Sz0,929,000 SURM LCENSES,D: AL AK AZ AR G CO, R, DE MFL C HI,ID, 141N, K CS, W,,k ME MD, MA ML MN, MS. NO, MT, NE W. NR W NM W. NC NOOK OK OK PA RL SCSD,TN,TK UT, VE VA WA WV WLWY Farmers Alliance Mutual Insurance Company (N.C.-.) BUSINESSADDRESS: P.O. Box I.I. MRPFNrsan K56T4W VNDNNwJNG LIMRATDN W.323,a4R0% SURnY LSCm5E5,D: CO, 10. K K5. MN. MO. An. NE. NM, ND. OK SD INCORP.RATEDIN:re1W4s Farmington Casualty Company (NNC P<1GB3) RUSINESSAVORESS: ONETOIMER SQUARE HARTFORD, R 061e3 PN0NE(86012> HI UNDERWRJNG UMRATION.. I.SS OW Al AN 1. A0. G CO, OF. .E DC, n. GA I1.1 RIM, A. K5, w, G ME NO, MA ML NN, MK MO, MT. NE NV NR NJ`NM. NT, NC ND. OR OR. OR PA RL SC Sc. TN,M UT, VT. VA WA N V, AL MY PHO.uECF9)399d700 UNDERWRTTINGLMITATDNW:3 M3.000 zURETY LICENSE IN. AK AZ AIL G Co. IC It. R. KKL MN, MO, MT, HE. W. NN, NO, OK OR SD, M UT, WA, WI Fireman's Fund Insurance Company NAIC x21R]3) PH1NE.(RBM466.)BB3 UNDERWRITING LMRATDN bl: SI35091,000 SURAM UCENSES cf2:AL AKAE AR G CO, R DE DC. R, GA M.ID.IL IN, K M, KY, LA ME MD MA ML MN, MS, MO, ML NE, NV, NH, J, NM, NY, NC ND,OH, DK OR Ph PK KSC SD, TN,M UT,W,VAWAWK MM First Founders Assurance Company NAIC...... BUSINESSADDRESS: 6MITIR'4te Lane,Clnl.,JDT93D-2 PHO.NE:(BE8)S 4J9D UNDERwRmNG UMNATDN W: f562.000 SURETY UCENSES,.: J. NY I—P.—DIN. N-j—, First Insurance Company of Hawaii, Ltd. DWC-P421 PHONE:(IOMSn I UNDERWRTING UMNATDN W: SI%330,b0 SURETY LICENSES CM GU, HI INCORPORATED IN. H.fi First Net Insurance Company NAI—Oran BUSINESS ADDRESS: -I WEST O'BREN DRNE STE 204 HAWTNA GU 9010 PHONF.1914)46rE000 SURETY CSOP. µ AK AZ AR G CO CE, DE DE, F4 W HL D. 14IN, µ KS, W. M MD, MA ML MS, MO, Mr, NE. NV NH, NJ, NM, NY NC MD. OR OK OR PA RL SC SO, TN M M. W. VA WAW,, W L WY INCORPOATED 63. D.R.. Endurance Assurance Corporation NAKx1155U BUSINESSADDRESS: 4 N NNHATTANJUE ROA%PURCHA5E NY H— PHONE:n1O468E000 ... ERWR11NG UMRAnD. W: M6EOr,000 SD:µAIL A; ARG CO, R, DE DC III, CA. OU, HL D, IL IN, K KS, I , M ME MD. MA ML MN, MS MO. W. NE NV, NH. NJ. NM. NY. NC No. ON. OK D0. PA MR, SC 50, TN, TIC UT, W. VA VL WA M,, WLM Erie Insurance Company NMK x26-1 BUSINESS ADDRESS: IDO ERE INSURANCE PLACE ERE PA 1G530 P... EVH1)BIC— UNDER.VRnNG UMNATDN W, 3IMNCmO SUREIN LICENSES GD. DO IL IN, w, MD.MN, W,, NC OH. PA TN. VA W2. W INCORPORATED IN: PmnsyN4Na Euler Hermes North America Insurance Company -CAC P... E:VEMBB3.. UNDERWRnNG UM TATION W: U5AAWD SIV. AL. AK AZ AR G CO. CT, DE DE FL Oh W HL ID, IL IN. K KS. N', RA ME, MD. MA ML MN, MS, MD, W. NE W. NH, NJ. HIM, NY, NC. ND. ON, OK PAIL SC SO, TN, TIC U. W. VA M. WE WY INCORPORATED IN: MR,RDO Everest National Insurance Company NADx101201 INCORPORATED N: CO—LI FCCI Insurance Company (NAKx14198) IUMNESSADDI— PH—:)— U..E—N-R.—..S7— SUR ESU GF/:µA2 W CO, DE, DC R Gh ID, IL IN,K M. RY, M MD ML ALS, MO, MENE, NH, NM, NC ND, OH, OK PASC SD, TN, M UT w, VA WV, LYL WV INCORPORATED N'. ibrlea Federal Insurance Company (NAn C—) BUSINESSAODRESS: NC. —1.R Road W VLebOUse Station NJ OBE99 PHONE015)6w1000 UNDERWITINGUMNATDN W:fM5.3]3000 SUat..µµAZA CO,MDEDCF4G MHLD,141N. KMW.MMEMD,Mh MLMN,MS. MO PMT.NEWNKJ,NM,W.NCND,OKOKOk PAPkK SCSD,TH.MUT,W,VAVLWAWS,WLWY INCORPOMTEDN:NNana FEDERATED MUTUAL INSURANCE COMPANY I— x139B5) RUSINFSSADDRFSS. III FASTPARRSQUAREOwATONNAMNI— PHONE:ISM 4555200 UNDERWINRNGUMIUKHO.N W:M%A39.BRO SURETYUCENSFS,r AKAZAAGCO,G,DEDC,FLGAlD,IL,IN,KMKY.LRME,MD,MAMIMKMS,MO.MT, NE,NMNµ NJ,NM,NYNC.ND,OH,OKORPAM,SCSMT ,MW,VCVAWAW,MM INCORPORATED IN: MI —A Fidelity and Deposit Company of Maryland (Tile) (.It x3930) eUNMMADDRESS: l]WRICHWAY,57HRDDRSCMUMBURG,IL6M%.Ip I ... EIB4T60S6b0 UNDEAVREING UMITATD.4IP.—WAOC PHONE:16]n4]SA613 UN D ERW RTNNG LIMRATD N N f I,4RRN0 SURETY UCENSES IP. GU. MP INCORPORATED N: GLM, Franke nmuth Mutual Insurance Company INAIC.I..) BUSINESSADDR— C PHONE(%M652d121 SURE(' LKMSES cfl. AL. AZ AR CO, G. DE, M FL W ID.IL N, K KS, W. Ur ME, MD, MA ML MK Ms, MO, MT, NE NV, NH,J,NM,NY.NCND,DKOKORPARLSC,SD,TN,MUr,N.V WAWVW,M INCORPORATED N: NB Ni,. General Casualty Company Of Wisconsin (NAIL RN41a) BUSINESSADDRE55. One QBF Wry, Sun PraIH<, W 53596 PNONe.(-)S.-544B UNDERMINING LMLTAT ON W:32],W000 SURMUCENSES,ll.k.AKAZ AR G CO, G, DE, DL W NI, ID, IL IN, K M KY, LA. MD, MA ML MN, MS M0, MT, ME N .WH.J.NM, NE NC ND, OR OK OR PAIL SC SD. TR M W. VE IN, WA WV, WLWY INCORPORATED N:Y 11NIID General Reinsurance Corporation (NARC.- n BUSINESSADDRESS, 130LONG1DGE1OAD,STAMFORD.CTBIS -1R43 PHONE:1203) 32 — UNDERWORING LIMRATDN IRA S1.392.]1T,000 SURELY UCENSES crl: µAK AZ G CD,CT, DE, DC R Gh ID, IL IN, K 1,, MIE, MD, MAMLMN, M5. M0, MT, NEW. NH, NM, NY. NC ND.OR OK OR PA RL SC, SD.M M.VEVAWAWVW,WY INCORPORATED HE D—N, GRANGE INSURANCE COMPANY (NMcxla%ol BUSINESS ADDRESS: 671 SOIAh High S1reeLCOUmbU£OH.1_. 106E PxanE1M4)44S39W UNDERWRNINGLIMUNPON MS1ae,]39,WD SCH_ UCENSES"l—GA IL CO. N CO. KY. MCI Mx, MO, OK pA SC Tx, v0.m IxCORPORATEDIN: — GRANGE INSURANCE COMPANY OF MICHIGAN INNC.... N BUSINESS ADDRESS. 01 Saum High StreeC'oUmbuL OH 433m-, PHONE161a1mSD9m UNDEµMNNG LNRATON M: SU)MR ED-.... Cfl: M1 INCORPORATED IN: Ohm GRANITE RE, INC. (NNC.2£TIOI B1wNESS NDDREss: ,LOIN Omibrmk DIW, OkMhea,e LILY. DO T3' UNDEMVMTNG MMITAnON M. VL9CElM N. AL AL OIL ACO. CT, DE. DC, RGA ID. IL OR N M W. U ME MD. MA ML MR MS. MO. W. NE NV, NN CO. NM. NC. ND, CH. OK oR PA RE SC, SO, TN TK W. W. VAWN WV, m,W Granite State Insurance Company INNC.33BN) aIHIMISSADDRESS, III I AVENUE OFTHE AMERICAS.3]M FLOOR NEW YORK NY 1m20-13m PHONP.6121T]0— UNDE TING WARAnON M: S3746DW SURETY MCENSFS Cfl: AL Al A0. CA CO, DC, R GA, HI, ID, IL IK IN KS, NY, IN ME MD, MA ML MN, M5, MO, MT, NE. W. NH M. NM, V. NC NO, OIL OK OR PA RL SC 50, TN, TK TIT. W. VA WA W. OR WY GRAY CASUALTY 6 SURETY COMPANY (THE) (NNc«Im]n L AKAEWR M.R,DE,DCi HI,ID,ILIN,NK51n,MMEMD,MAUIMN,M£MO. MT, NE 1IMENN NI NM,W.NCND,OH,OKORPARksc,SD,TN.MM.vr,VAwA Wl LVY INCORPORATED IN: Mtliana Guarantee Company of North America USA (the) INNC«366W) BUMNESS Poouss: 6DS HIrh..Y 1ED N—,-0 W. P!,—ti,, MN SWI PHONE m2).21.1 UNOEPWMTING UMIPMION M: n.033DDD SURER UCEmESC1h,ALAK-AR CA C., ET, DE DC FL GA GU,.1. ID, IL IN, IN IS, ID.IA ME M0. MA MI N. M5. MO, MT, NE NM NK M, Nµ NY, NC, NO. ON, OK OR PA OR OR SC, SD, TN TK m, W. VA Vt Wq WV, WE WY INCORPOHNOWDIN:Mich%. Hanover Insurance Company (The) (N.C.—I) DUSINESSADCIE aaD 14COLNSTREETYORCESTERMAO1653-0002 PHOnEA-151130D LNOERNTNTrIG UMRATON M fIB9A69.000 I: AL AK NC ACA CO, CC DE DC FL GA HL ID. L IN. N M W. N. ME MO, MA ML MN, Ms, MO, MT. NE W NNH NA NO. W. NC ND, ON, OK OR PA RE X 90, TN TK UT, VE VA wAwv, WEWY DODOPOMTED IN, New Wmpfhpe HARCO NATIONAL INSURANCE COMPANY (NNC.3m33) BUSINEss ADDRESS: 42m5MFORKSROAD.sum l 4m, RALEIGH,NC27609 PHONE OPOIeWMOCI UNDEMNOTING IMITATION M: S6],329Am SURETYUCENSESLIT:ALAKA AREACO.UDEDC,FLGA11,ID,ILIMNES,KY,IAME.MD,MAMLMN,M5,M0, MINE W,,NH,M NM, NY,NCND,OKOKOR PARLSCSD,TN.TKW,W,, VA WAWV, WL WY INCORPORATED IN: It — Hartford Accident and Indemnity Company IRMC «22351) BD.. ADO WSs: One WNoM PUMA H —O r CI m1 zS--1 Indiana Lumhermens Mutual Insurance Company INNC.142.51 BUSINESSADDRESS: 2005Wlke1511ee45u1ell Ph,MdNph,a,PA1910 PHONE:(26TO3S92m S LD. AL AK AL AR CA CO. CT, DE. DC R GA HI.O, L N, N KS. P. IN ME MD, MA ML MN. W. MO. MT, NE IaVExN NJ, NM. NO, NC NOON ON OK ON RL SC SD, TN. TO. IR.W. vA WA Wv, W LWY INCORPORATED IN Indiana Inland Insurance Company INNc«231m1 eUSNESSADDRESS: P.(TBo.8046r,U W.NE68501 PHONE:PNc4,n M3(2 UNOEONNOTINGDMOATON M: f31 13ANT SUµTYUCENSESOI.A CO.LA%SMN.MO.MTNEND.OKSD,WY INCOPPOMTED IN. Nebraska Insurance Company Of North America NNC*MlS) DUSINESSADDPESS: U6PlNN STNEUP.O.Bo.IDDD,PMmd*p PA19Im PHONERTS)6a 1DOD UNOEMMOTNG ..—N AL AK h,,fAK CA CO, CI. DL DC. FL GA W. HI. 1%IL N, IN N5. 0, to ME. MD. MA ME CAR MS, NO, MP. On. NE NV, NN NJ, NM, NT NC NO. OR OK OR PA OR RLX SD,TN, MUT VF, vA wA wv MM NCORPOMTFO IN, Ph- Insurance Company of the State of Pennsylvania (The) (NNc«IMM BUSNE55ADDNE55:11]1AVENUEOFTHEAMERICAS,3TTHFLOORNEWYDM'NY1W .l1 PHONER1a T1P]Om UNDEµvNTING WITATION W: WNW LSky LII:MMC AL AR CA CO. CT. N.CO. FL GA N. EXEC- IN. N KS, KY, k ME MD, IL ML MN. W. MO, MT.NEW..ON. NJ. IN, W.NC,ID, ON OK DR PAµ SC, SO TN. M LH. W. wA WV, WE WI 1USINE55ADORE55: P.O. Ben O02 MCMIrIe. U ]Om9-6202 PNDNEum)E3B-:,9D UNOERWPInNG LMRATON M: itTOn,000 SURMMENSEScf/:ALKA G DEOCGAILIn,UMD,M5,MO,W.NV,NHNM,NY.NCOKPARt SCTN.TIC GRAY INSURANCE COMPANY (THE) NNC.3630n BUSINESS ADDRESS: P.O. BO%63m,.—WEE. UTm09--I PHONEIsmltE3-TNO UNDERwMEING LMRATON M: S30ATUADO $UNETY IOENSES LM: AL AN AR CA CO, R. DE M. rL ON HIL ID. IL IN, N KS AY, IN ME MD, Mq ML MR M%MO, OCT. NE NV, NK NA ON, NY, NC NOON OK DR ON OIL SC W. M. M UT. 11, YA WAWv WL WY INCORPOMTED IN: LI.N.ha Great American Alliance Insurance Company .SH1 sAODREss..1 E-TET 1umlman ox4s2oz PHONE:IS13)3693000 UNDEMETING LMRATION M: 53,025,OW SURETY LICENSES C,1/:AL AK AS AZ AR CA CO, R, DE DC FL GA xl D.IL IN, IN KS. KY, IA ME, MD. MA MI, MR M£ MO, ME NF. NV OR NA Nµ xY NC No.OH, OK OR PA M, 11111, 11111 WA WJ,wL W! INCORPOMTEDIR hl. Great American Insurance Company (NNC.166911 DULNESSADDP2sS:.1 E FPuwn S 1Unc1-1 DN4O02 PHO1e(113)S69-5000 UNDERWNmNG IMITATION M: s3M.09EA00 SURETYUCENSES LV:ALAK ALAR U CO. Ci. DE M, R W GU, HEIO.IL IK N KS hY. U ME MD, MA ML NM M5, MO. MLNExV.NH.NANµ NY.NCND,OHDKORPAPRRLXM.TN,TKIR,n,V&'LwA&' , RWY NCDIPORATED IN: Ohm P... E. WME) s4T— UNDERWRmNG LMRATION M f3m,43Rw0 SURETY UMSES LV: AL AK A],a0. LA LO. R, DE DL 0. W HL ID.IL IN, N MS. NY. U ME MD. Mh MLMN. M5. MO. MT,NE,WNNM.NMNY,NCNOOH.OKORPAµs Z.TNTKM,W,,VAWAVN,M.VN UNCOLED—DON I. —DO. Hartford Casualty Insurance Company NNc.2942u1 BUSINESSADORESS: One HIlf dPMLa,xaNTNI, %155-0W1 PHONE: IOW) m]-SD00 UNDERwRRING LMRAipP M. 1.—ADD AL AR AL AA CN CO. ET. DE DC RGAM.ID,0, N. IN NY, IN ME MO.MA ML MN, MS, MO, MIT, NE NV ENR NJ NM, NY, NC NO, ON OK DR ON COL SC w. TO. M NE, W, VA ON, wv. vR WY INEOHWoRATEDN:n Hartford Fire Insurance Company INNC.196B31 BUSIN11ADDRE55. One HaMRM rMCa. HaNwtl.Rmt55.OWt PxONEIOW)5M]iWO UNDENLYWITI LMITATIONM:M."AMSAOn SUREry LICENSES cll: AL AK A2, A0. CA CO. R, DE.00. R, GA OU, M, ID.IL 1w, N K5. %Y, k ME MD. MA ML MN, M£ MO, Mp, MINE xv, xH, M, nM, NY. NG ND.OH.OK D0. PA P0. M. SC SD.TN, iX uT, VT, VA Vt WA WV, wELV. INCORPORATED IN: C...M . Hartford Insurance Company of the Midwest LNAIC.3T ) BUSINESSADDRESS: One Ha dPlus,Ha d,CT0EISS-m01 ... NO, (Bb01 m]3W0 TING U RETYLI ENSES SIfh WKAFL CA CO, ET. DE DC R. GC HL ID, P. IN KS. W. M ME, MO, MA ML MN, MS. MO. W. NE. NV. NIT. NJ, NM, W. NC NO, OR OK OR PAµ XMLTN,TKNT VIVA WA WV,m WY Hudson Insurance Company INCOP➢OMTED IN: al—k Insurance Company of the Welt (NNC.ne4n BUSINESS ADDRESS'. P.O. BOO 50 %SAN DWI PHONEOPMO 24m SURETY LICENSES IN, AL WA AR CA CO, CT DE K. R W HEID, IL IN.IA 16. A ME MD. MA ML MN, MS, NO, MT. NE Nv NH rvJ. Nµ NY. NC,.1C R OK OR PA U SC SO, TN, TIt UT, w, VA WA wV,WL wY NCDRPDINTEDIN. Can Insure rs Indemnity Company INNC.H.S1 BUSINEss ADDRESS: RO.BOL325n,Wa<1T%26TD5 PHONE:CL541]59a13] UNDERWIINNG LMRATION ll: f3274,OW SURETY LKPNSES CM: AZ OR KS LN xv, NM, OK TK UT INCORPOMTEDIN:T. Integrity Insurance Company NNC.1M30a N151NH5 ADDRESS. 6715 HIch SIM CDMmbI OH OW-106E PHONEP511, -29m UNOEANamNG LIMITATION bl: 57-00D SURETY LICENSES Ch.IL N MR OR WI International Fidelity Insurance Company owe r110") BUSINESS ADDµ55: Ona NewaM1 Cen,er. xew.N ,M01IN-5207 PHONEDDS)62 . UNDENVRIIING LMRNNEN M: f1kA - SCARETY AIL a AR CN ED.R. DE DC R GA GU. HA IN. IL IN, IN V,,LA ME ND, MA ML MN, ME MO. h3T, NE W. NH, NA NM, NY NC NO, DH Or. OR PA OR SC SO, TN. M TIT, W. VA VL WA WV YA WY GREAT AMERICAN INSURANCE COMPANY OF NEW YORK NAIC PD21361 BUSINESS ADDRESS: 301 E Ica Oh SMN' CIWNNAI, OHn53D2 P... E1513)369-50W UNDERMRRINGIIMITATIONM:f24,56Rm0 SURETY LICENSES CIF. AL AK NE OR ON CO, CT, DE DCR GA HR 0. R, rK N %£ KY, M ME MD, MA MI, MN, M£ MO, MT, HE. NV, NN W. HIM, NY. NE NO. ON ON 0%PA M. X SOTN.M V. W. VA WAWV, WLWI Great American Security Insurance Company (NAIC.311351 BUSINESS ADDRESS:.1 E P Ns Smccs, CMdn ON MOOD vxom:Dl3)x9sab0 MIDERWRRO4G UMITATION M:$1.609,400 SAWPO LKENSESC0 AL AN a A0. CA CO. CT, DE DC N GA HL ID. IL N, N OS. O', 1ti ME MD, MA MI. MN, MS. MO, W. NE, W. NH, N, NM, W,, NO, ND, DR OK OR PN M. SC. 50. W,TKIR, W. vA NA NY, WRWY INCORPORATED N:ON. Great Midwest Insurance Company INNK.ta69O BU CH.SADORESS: 1000e 1—SLON60D, HOlrsmn.l%T2034 PHONEI213)935A226 UNDEaNRRNG UMRATION M 4DO9350W SURETY LICENSES D. AL AK aAR CN CO. CP DE. DE FL GA HL 0, IL N. N R, KY, M ME MD. Mq W, MN, M5, MO, , NEN OR NA Nµ NY, ME, ND, OR OR OR PA M. SC. SO, TO, TK m, W,, VA WA WV, WI. NY INCORPOMTEO N:T Great Northern Insurance Company I—.2D303) BUSINESS ADDRESS: D(AB HIPS MIO NO., WION.1, se SMtlon, M OMID PHONE:1215)6e0-1000 UN. —WRING -RATION IM 1.1—AEW (NAK.asps4) f_vx[s5 ADDRESS. Im W INm SUca, Sin Roar, Ncwro,K NY I.T. PHONE:Illa9]819W UNIN DERW BITG URATro MN bl: fS%W.000 LICENSES CM: AA AZ AR CA CO,R, OE DC FL GA HL ID,IL N. NICS. KY.IA ME MO. MA W. MN MS, MO W. HE W. NH NJ, NM, NY, Nc, ND, ON OKOR PA M CO. X. SO. TRM ITT, W VA NOLWWLWV INCORPORATED IN: Deaware IMT Insurance Company (NA T—IT J:UI:LH'11D= SUIT ICENSESCrF IL N NIR MO. NE. ND.SD.m Indemnity Insurance Company of North America (NAIC«435TM BUSINESS ADDRESS: 436 WAUILn9TRER P.O. Boa IM Philad*MA PA 1910E PHONE1215)W4M UNDERwRRNG LIMITKTIOI M, S1633£Cm SR S cfi.ALAKA AREA CO,CLDE,DCRGAHLID,ILN.KM.KY,MMF. MD.NAMI.MN,MS.MO, MTNE W. NHENJ NM, NY, NC, ND, OH NE OR ON NO, OR SC, SO. TN, T9. UT VT, Vq VL WA W V, WL W! NEORPDMTED IN: Pen Whr, Indemnity National Insurance Company INNS 1-1 MKNESSYODPESS: 23B..NJY l,, R h.0 ,TN3IOG4 PHONE:015I5 I—Ci UN.W—T NG LMITATION bl: SRm2A00 SLID ETV LICENSES Lfk AL AK AL AR CO DE DC R. GA Ht IL OK 9K M.O, IN ME MD, MA M%MO, W, NE ON, NH, Nµ NE, NO. OH. OK OR PAµ SC TN. TK UT, W. W WA W V M. WY INfORPOMTFD N: MHnssippi INCONOD DN: NEw J_ IRONSHORE INDEMNITY INC PNONEIN]135]x6W UNDPPV9M1RING LIMITATION bl: f1R3BTW0 s 1KEu5E5 C11 AL AK u,AR,CA,CO,CT, OE OCRWGU, HE D. IL N. IN K5, KY,lA ME MD, MA MI, MR MS MO,M NE. W.NNM,NM.ON. NC Po NO, OR OK OR M M.—C. TN. TK W. W. VA WA WV, M WC ISLAND INSURANCE COMPANY, LIMITED (HAIC.229a51 BUSINESSADDRESS: P.O. IPMl1IA.H hMM,H1S6006-1520 PHONE:(IIA1E 2OO DNDEnNWITNG1IFAITATIONM:513,5m,DED SIAEtt LICENSES CM. HI IN'ORPOMTED N: Hawaii LEXINGTON NATIONAL INSURANCE CORPORATION PHONE:(410)6 MO UNDEI VBRINGLNRATDNhh,fTMOND µlY LICENSESLfr ALAK KENR CA CO, CT, DE DC R GA HL ID, IL N. N Ks, KY, M ME MD, MA MI, MN,MS, MD, MTNE NV, NH, NA NM,NY, NC ND, OH, oK OR PA M, SC 5D, Tµ M m,W.. VAWAWV, WLWY INCORPORATED N: FMnm Leaon Insurance Company 0111 COT) UNDERNR... LIN--M, IS,— SURETY UCENSES cll: ALAK AK AR I CO, CT, of OC N, GA GU, HAD. IL N, D, x5, KY,IA ME MD, NA, ML WR S. NO, MP, Mr, NE, NV, W.NM. NC, ND. OILOKOR PA RL SC, SD,TM TK UT, VE VA WA WWI WY INCORPORATED IN: Tons liberty Mutual Fire Insurance Company NNC az3o%) NISI NES S ADONESS: I )5 BCrkeNy SI- BOMon, MA 02116 PHONE:(61TI35]-%OD UNDERWMTNG LIMRANION W -1,104 W SURETY LICENSES N:AI. AK Ar AR CA. Co, CT, DE DC F4 G0. M. ID, IL IN, M, K KY, LAME MD, M. ML MNME M0, ML NEW, NH, NL NM. W, NE ND, On OK OR PA PR RL 545D, TN. TK LA, VT, VA WA W/. WL WY INCORPOMTED IN: Wocmvn Liberty Mutual Insurance Company INNCa230Rn BUSINESS ADDRESS: 1>S BeNaky Svett BeM4n. M402116 PHONE:I61n35T-950o UNOERW 14O 11.1-0x w; N,TTz,Te],pw SURELY UCENSES RN: ALAKAZ AR G CO, R, OE, DC, FL GA W.ID. L IN, M K5. KY.IA ME MD. MA ML MN. MS. M0. MP,MT,NEW.NHN.NM,NY,NGND.OH,OKOKPAPRD,SCSD,m,TKUTVEVAM,WA ,,WLWY IN CORPORATED IN: Msssaa - LM Insurance Corporation IMNC:P o" IUSINESSADDRES5: 1]S Belkeky SveN. Bofun.fM 03116 PHCHLBHn35)-%w UNDE-NG LIMITATION w: f11.Tr3.D00 SUBEn UCENSEScf/:ALAKA ARCACO.R.DE.DC.FLGAGU.HI.ID,ILIN,IAMKY.IAMEMD.MAMLMHMS, M ,MS,NE W,NH,N),NM,NYNCND,ONOKOKPARLS"D.T ,1AUT.N.VkAWAW..Wt WY INCORPORATEDIN:IRImb Manufacturers Alliance Insurance Company INNE:136B97! BUSINESS ADDRESS: K O. BOX 3031, BLUEBELL M 1942]-0]54 Motorists Mutual Insurance Company MNCa14621I BDSINE55 ADDRESS, ATt East Bruatl MreeC [GLmbuS.OX 43ns PHONE1614)2 -11 UNDEIWfRNING LIMITATION W. uHA21AC0 SUNEIV UCENSES IM IN V. ML OR PA WV INCORPORATEDIN:O- Motors Insurance Corporation INNC-H. BUSINESS ADDRESS: 500 WOODWARD AVE 14TH FLOOR DETROR. MI48126 .-E P13)611- UNDERW1ITING UMRATON w: f%.6B9.00I SURETY UCENSEScf/: AL AIL AZ AR CA Co. R DE. DC rL Ck H. ID. L IN, M KS.IW, IA ME. MD. MA MI MN. MS NO. IT. NEW, NH, W, NM, W, NC, NO, OIL OR OR PA RL SC SO, HN, nL UT. VI, VA WAWV, WL WY INCORPORATED IN: Mkblgan Munich Reinsurance America, Inc. INMCA-Z, BUSINESS ADDRESS: S55 COLLEGE GOAD EAST -RO. BOA 5241, PMMCETON. T 085A3 PHONE BRIM) 2A3n20O UNDERVIRmNG LI-011 W: N13.523.000 SUREC/ UCENSEScf/: AL AK AZ Ak CA CO. R DE DC. R GA W.ID. L IN. M KS. KY, M ME. MD.MA ML ML M5, MO. Mr, NEW, NH, W, NM,W, NC, ND, OW OKOR PA P0. RL SC SD.TN, TA ULW,VA WA MWLWY INCORPORATEDIN:DeNwae National Amarlcan Insurance Company INNC.E BUSINESSADDRFSS: P.O,BO19.CHN.dN ,OK]4834 PHONE:NS5)25aoe0a UNDERWRTNG ULUTAT1ON W: f9.361,000 SURELYUCENSEScf/:ALAKA ARCAN.RDEDC.ELGAW.ID,LIN,IAM.KV.IAMEMD.IMMLMN.MSMO. MT NEW, NH, W. NM.W, NC, NO, OW OKOK PA RL SC, SO, fN, TM, UT. VEYA WA WV, VA WY MONe PIZ77PTB00 UNDERWmNG LIMITATION W: $565,631.000 SURETY UCENSES CH. AL AK AZ AR CA CO R, DE, DC, FL GA W. Mi. ID.IL IN, IA C%C/, MME MD, MA ML MR MS MO, M, MT, NE W, NH. W. NM. W, NC ND OH, OK OR PA PR RL SC SD IN. TX, UT.YT, VA WA WV. WLM INCORPORATEDIN:PennW-W Nationwide Agribusiness Insurance Company (NNC-CM NISI1- ADDPESS: ONE WEST NATIONWDE BLVD.. 1.14-3 1. COLUMBUS. OH INI5-2ZO 1HONE:I51511-00 UNDEMBrrnG LIMITA¶ON w: {21,2TAW0 IN. AZ AR C& CO, CT, DEC R OCA IA ID, IL IN, Ks, M µ ME, MD, MA ML MN. MS ML MO. NE, NV.NH W.W,S NC. MD. OIL OL OR PA RL SC, ED, TN. TA W. W, VA W0. WV, WL WY Nationwide Mutual Insurance Company INNC XT m SURETY MENSESe,I/: AL AK AZ AR CA CO, Cr DE. DC FL C& W. HI, ID, IL. IN, IA R, W,, IA ME, MD, MA ML MN MS, NO, MT, ME W. NH, W. MM, NY, MC, ND, OH, OR OR M RL SC SD, TN. TA Ur, W, VA AWA wWWL WY INCORPORATEDIN: - NAVIGATORS INSURANCE COMPANY NNCXAV WRINFSSADOPE53: 400 Nknp<51r4e4 MHOROSNm/of0, R069O1 PHONE:Cm3190s6090 UNDE- NG UMDAnON N: {t]3,056,000 SURETYUCENSESKN:AL, KA ARCACO, R. DEDCFLG0.HI.ID.I4IN,MKKY.kMEMD,MAMN,MEW.NE, NW NN NM W. NC ND.OK OR PA PK RL SC5D. TW 1K UT. VI. VAM.WASW, WL WY INCORPOMTEDIRNew Yah New Hampshire Insurance Company PHONE:(61%) SUREIYUCENSES sfP..A4 AKAZAR C0. LT, DE DC ID IN, K5, HY IA ME MD, ML MS, M0, MT, NE W, NH. N7, NM, NY, NC OK PA M SC So,TN, HH'-AWA INCORPORATED IN: Penney- MARKELINSURANCE COMPANY NAK 1.110) BUSINESS ADDRESS: -I HIBMvootlz Partway, GNO APem VA 23N0 PHONE (ND)431nxT0a-36BB UNOEM MNG IWRATION b/: S193340,OOD ETYLICENSESr.ry:ALAK.A0.CACO,CEDEDC.FLGAGU,HLID,ILIN,MH5,RY.LAME.MD,MAMLMN.M5. No, MT,NEW,NN FNM.W..NCNq OH,OICORPARLKSO,TN.T MW,VAWAWWWLWY INCONNUATED IN:111- Massachusetts Bay Insurance Company N.C.-) 9USINESSADDIC- MO LINCOLN STREET, WORCESTER MA01653-0002 PHONE:MOna53-noO UNDERWRRTNG UM -ION SURLT'UCENSES RB.. Al, AN. AE Ak CA CO, CT, DE DC, R4 GA HI, 1%14IN. lA M KY, LA ME MD, MA ML MR MS, NO, MT, ME W, NK NJ, Nµ W, NC ND, ON, OK OR PA RL SC NO,1N.TK IT, VA WA W W1W INCORPORATED IN: Nm Hamp- Merchants Bonding Company (Mutual) MCI`-) BUSINESSADDRESS ROBOK1449KDESMONES,M50306-MN PHONE(515)]4MI71 UNDE-MNG LIMITATION b/: f]I,W6 o SURMUCENSESlM.A AK ARCAN,Cr,DEDC,RWHI.ID,ILIN.Mr IW.IAMEMD.MAMLMN,MS.MO MT, NE W, NH, W, NM, NY, NC IND, OH, OK OR P0. RL SC M.TN, M m, VT, VA WA 1VWAVL W+ Merchants National Bonding, Inc National Casualty Company (NAKXtt%N BUNNESSADDRCSS: ONEWESTNATDNWDEBLVD,1-tr 1, OLUMBUs.OHui15-] 20 PHONE:(4BDIMS-S9 UNDERWRITING UMITATDN N: 520D66.000 SURM UCENSES 01. AC.a ARC& CO, R. DE. DC FL Ck OR HL ID. L IN, IA 0. W. IA ME MD. MA ML MR MS. MO Mr. NE NM NH, W. NM, NY, NC MD. OR OK OR PA RL SC SD IN. TK UT, VI, W, WA WV, wL IVY INCORPORATEDIROND NATIONAL FARMERS UNION PROPERTY AND CASUALTY COMPANY o C.1621n PHONE:(3T6)43S2000 SURETY UCENSES 0A AL AN. A2. AR CA CO. DE. M. GA B.ID. L W. M M. NY. LA ME MD. MA ML MN. MS. MO. ML NE, W,NH. W.NM, NY, NC. HID, OR OR OR PA RL SC SD, IN, TA W, tt, VA WA w WI.m INCORPORATED IN N-C-N. National Fire & Marine Insurance Company (NNC-9) BUSINESS ADDRESS: 1314 DOVtbf Slnx5ullr 1400, OmMd NE6B103-t9a4 PHO-N04916300D UND-ITING HMITATION N. S 1.151.)920 W SURETY LICENSES CO. NE INCORPOWED IN: NMI - National Fire Insurance Company of Hartford MNcr2o4]BI BUSINESSAODRESS: 151NHanI.n SI,.ICNCO.IL6O606 PHONE: PIN NL5000 UNDERWRITINGUMffarIO N:SRr5)p0D INNCr230a 1 BUSINESS ADDRESS: 127I AVENUE OF THE AMERCAS 3ml R000. NEW YORK W 10020.1301 PHONE:RI2)]1P"1000 UNDERW NDING u1-1 M s6156,- Ett UCENSES r fl. AL AR A], AR CA CO, R, DE DC, R, GA HL In, IL IN, M Ps, N, LA ME MD, MA ML MN M5, MO, W. NE. W. NN NJ. Nµ NY NC ND, OR OR PA PK RL Sc, SD. TN, TIC W. W. VA WA W. WL W/ NEW YORK MARINE AND GENERAL INSURANCE COMPANY MMC116WSI BUSINESS ADDRESS: 412 ML Kembk Ave. Sul. 30OC. M-- PHONE:MOn7 IES UNOENWRMNG LIMnATDx M: SStM,M SURMQCNNSES�n: ALAKAZARCACO,R,DEDCRC&HL ID,ILINMKSW..M MEMDM0.MLMNMS.MO. MT, AN. NR NJ, NM, W. NC, ND, ON ON OR PA SC SD, TN, TA UT. W. VA, WA W,, M. WY INCCNPONLAT- NGM Insurance Company MNC-.' BUSINESS ADDRESS: 1.1 Te-- Rpatl DU, Sulce 34W, JazMenMlle. 11S- PHONEM09)38PT283 ff. AL A2, AR CO, R, DE, OC FL GA ID, IL IN, IA RS RW, LA MC MD,MA, ML MN, M5, MO, MT, NE W, NN N).NM, W. NCND.OH, OKOR PA RL SC SD, m,TA ULW.VA WA Wl, W, WY IVCORPORATEDIN:noritla NOVA Casualty Company MNC KIWI BUSINESSADDRESS: WUNCOWSTMET.WORCESTE0.MA01653.0002 PHONE:(SN)053R00 .MDEP--LIMITATION W: f101p3,Wp SURM W,N�=f/:ALAKAZAR C&N. R. DE, o<. RGA HI.ID,14 w, µla, W,IA MB, MD. M0. ML Mu, MS. MO. MT, NE W. NH, Ny NM, W, NCND, OW OK OK PA RLSC SD, TN, M UT. VE VA WA WI, WY (RAKX115%) BUSINESE ADDRE55: RO BOX I -%DES MOINES, M50306.3a9e PHONE(515)-11 UNDERWRITING UMRATION M1302I.000 SMMUCENSES,fP. L KAZARCO,R.DLDC,FLGANLID,ILIN,IAX5,ICY,LAME,MD,MAMEMN,MS,M0,MT, NEW,W.Nµ NYNC,ND.OH.OKORPARLSCSD,W.TK ,,W,,VAWAWV,WLWY INCORPOMnD IN: kwa Michigan Millers Mutual Insurance Company (NA-HISOB) BUSINESS ADDRESS: K O. BON 30O6R Lan M MI4B9O9-]5M) MINE(517)4Bz 1 UNDERWRInNGUWATONM39.780 0 SURMUCENSESOP.A ARCACO.GAD.LN.1AKSKY.MLMN,MD.W,NENY,NCNDOH,OKORPASD,m, VA WA WL- INCORPORATED IN: MkNgan Mid -Century Insurance Company ( IC-ABn BUSINESS ADDRESS: MI OWENSMOIIIII AVE WOODLAND HIIRS, C& 9136] moxEHIHA) o433 UNDERWMINGLIMBATDNMH 0S.- SUBM UCENSES cG. AL A2 MCA CO, FL GA HL ID, ILIN A. K5. MA MI, MN M5, MO, Mr, NE, W. NJ, NM, W, NC, NO, On oIc o k vA S o, TN, TK UT. vr, vA wA Yn v2v INCORPORATEDIN:C1-IM MID-CONTINENT CASUALTY COMPANY (NACr2341B) BUSINESS ADDRESS: RO. Boa 14%, NIUL OK]4W1 PHONEPHII ]- 1 UNDERWRTING UMBATDN M126.551A00 SMMUCENSESCfl.AL ARCACO.R.DEDCELGAHI,ILIN,V. .W,LAMEMAMLMN,MS,MO,MT,NEW, NH.WNM,NCND.OH,OKPARLSCTN,1 M,W,,VAWAWV,WLLW INCORMRATEDM:ON. CNM.W AND, KOVR,DEMrLSAD.TN, IN.16,&to MEMDMAMt Mx, M5, MO, MT,NE.W, NH Nl, rvM. W, n4 ND, OK OK O0. PA PR µ sG sD,Tx,TK m, ur,vA wA wK WL W+ INCORMNATEDINIILnmz National Indemnity Company BNAK rzmB>f BUSINE%ADDRESS: 131A DOurUi SVNL $1111e 1400,OmaN, NE 6BI02-1949 PHONE:( -III 3000 UNDERwWRNGLIMnATDM M E23,)E6,901,OD0 cNCKOKOk PRR4 O5D., , W2 ID.L M,W,.D'. V. ME, MO, ML MN, MS. MO. Mi. NE W, NH.NM.NC N0. ON OK ORPA RL SC sO.TN, iX UK VT,vA w0. Wv, W, WY National Liability & Fire Insurance Company NNCXm Z BUNNESSADDRESS: 1314 Dou61az Svttt Sulle 1400,OmslM. NE 6B102-19H PHONE L40Z -30W UNDEeMWTING MMITATDN W:{16B3)z.000 cf/:A4 AK rA R. DE, 0[. H410, IL K K5, KY,M0. MAML MS. MO, NE, Nx, NJ, xµ xr, nD, oH.OK RI, SC SD,TK IIT,SVT,VAWAW! NATIONAL TRUST INSURANCE COMPANY (NAIC120141) BUPNESSADDRESS: 6300-,,ky-1oW,,SMazoy H-31210-MM PHONE:(B00)226-3224 INOERWRmNGLA.-CN 1S4,0i0,0W RETv UCENSESCO:ALAEARCO,DEDCF4O KIN,MK5.".IAMD,WM5,MO,MT,NEWMENMGKOK PA SC SD.TKTKUr,W, VA WY, WL WY INCORPORATED IN:InUrana National Union Fire Insurance Company of Pittsburgh, PA INAK X19445) BUNNFSSADDRESS: 12)1 Avenueol UleAmerkaz, 3Mikor, New York NY 10020-13DA OBI National Insurance Company INMCat41%) BUSINESSADDRESSGOSx91-m 169NwUASuke RORPlymwrtb,MNSSmt PNONE11MES-A31 UNDERWRITING IIAITATDNb/: 51.3)2DO0 SUMMUCENSE541/:AL,NM. W.ND,PATRW Ohio Casualty Insurance Company (The) I- AS-) BUSINESSADDRESS: 175 Berkeky Sve<C Beslert MAn116 PHONE:I6TT135]ASN UNDERxRmNG UMDATION N: r2 87B000 SURMUCE Cf/:AL AKKA0. CA CO.R DE OGRGA GV.HLD.14 N.10. YS, KY,IA ME MO, M0. ML MN, MS, M0, IW ,NE, W,NH, N. NM,NY,NCND,OROKOKPAM,sCSD,TN,M1 .W.VA WA WV,1VL WY NCORPORATEO N. Ne.Hamp56ire Ohio Farmers Insurance Company INAIC A-) BUSINESSADDRESS: P.O. Rex 5001. W-MW -, OH- -5001 PHONeQ1 )83>LI01 UNDERWRNING LIMITATION M {287.1HZIM SUREN LICENSES 11r ALA; AR CO. DE DC R. CA L IN, M KY IA MD, MA ML MR NO, MO, MT, ME W, N, NM, Mr, NC MD. OH, OK PA RL SC, SO. TN TA UT, VA WAWV, WT INCOFPOMTEDIN:ONIo Ohio Indemnity Company (NAICX26565) BUSINESSADDRESS: 250E.Brent SLTIh Foot.CONm 0H43215.0- PHONe(614)22 ZXO UNDERWRNNGUMITATDNbh,SSp09000 cfF.AL A; aCO.R,DEDCF4G HL1U.141KKM.ILY,w MEMD,M ww MO.M4 NE NV. NN W. NM NY NC, ND,OH, OK OK PA W SCSD,m,TK UT,W. VA W&M..WLWY Oklahoma Surety Company NNcv2u2N SUARY-NSES 01AA. AC on -CM INCCAPIUMDIN:Obb OLD DOMINION INSURANCE COMPANY INMv6m311 ausNESswoREu. sswEsrsTUEr. KEENErvxwA31 PHOxE:rym)BaDT2Bz UNDEFwNt.... .ON M 32A6Mo0 SUAETY IKENEU41A, DE R. GA MD. NY. SL W. VA INCORPORATElft Mnea Old Republic General Insurance Corporation pUl-lAn BUSINE PIADDRESS: 30] NORnf MKHIWN AVENUEM_U B EA Al PHONE:012131B810D UNDERWRRNG UMRAl1014 M 3] -Clo SUBJETY FScP; Al -.AR CA CO. ET, DE DC, PL GA ID. IL IN, K KS, 0. LA ME. MD. MA ML MN. MS. ME, MT, NE W. NHL ENSAKK NM. W, NC, ND. OH, OK OR PA AL 5C, 5D, 1N,M UE W. VA WA WV, MYYY INCORPORATED IN: 11-4 Old Republic Insurance Company DIAL-1An BUvxESS ADDRFss. 631 EXCEL DRNE. SURE 300, MT. -HT. PA ISSM PHONemNBPLSOED UNDERMRIING LIMRATlON M 11A2A393T00 PHONE(61n 39)-SOW UNDE_W ,LN_.. N. NABLI SMAITY UCENSES IN: AL AK K AR CO. CT.OE DC, e. N. KS. W. M ME MD, MI. MS MO, W,, NE, W. NH, NI. NM, NY, NI ON, P& RI, SC. SD. Tx, m, I vA wA INCOMWED IN: PrPP,,Wnb Pennsylvania National Mutual Casualty Insurance Company NN[KM9901 BUSNESS ADORESP P. O. Boa 236E Haxb 19 PA 17105.2MI PHONCNM23aH9A1 U.VDEAWNfING LIMITATION W: Sn,359,DOO l: AL K K AR CO. R. DE, DG FL GA I0.141x. K Ns. KY. IA ME MD, MA Ml MN. M5, MO. Mi. NE. M_ NMMA NC OK10K OR PA AL SL SD.TN. M IR.IT.VA wA WV,m INCORPOMTEOIN.PenvnyNanU PHILADELPHIA INDEMNITY INSURANCE COMPANY (Ul-AOSn BUSINESSADDRE55. One BaM PMaa Suae tm, BaMC3+..ye, PA t9OOa-0950 SU PHONE 14101206)836 UxOE1m 0 E ESCIrtALAKKnRCMCORDEDCGA ELHI.ID,ILIN.KN5.KY.L MEMD.MAMEMN,M5,MO. MT, xC, WFINH, NJ, HM, W. MC, ND, OH OK OR PA AL SC, SO M. M UT, W, V& wA W/, VA M INCDRPOMTEDIN:PPNmyNAOM PLATTE RIVER INSURANCE COMPANY INNCn8619) PHONE:(we182-DA UIDERWANNG UMITAnON M s5,792000 SU LITYLICENSES crl: ALAKKM CA CO, R. DE, DL R GA XI, IO.IL lu, K x5, KY. LA ME. Mo, MA ML MN, MS, M0. ML NEW, NH, NJ. Nµ W, NC. NO, ON, OK OR PA AL SC. SD, TN. M W. W. VA YIAWV, M M Plaza Insurance Company SU REn UCENSES1.D: AL AK ARCACO. CT, DE, DC, FL GA HI- IL N, K KS, W.. L MD, MA ML MN xEW, NH. NJ. NM, W, 11, xo. 01.OK OK PA RL SC SD. TN, M In. VT, V0. WA M. K M INCOMPORADED IN -- Republic - Franklin Insurance Company INMCI11217s) SURNESSADDRESS: P.O,8OX53RUNCANY13S03-053A UNDEAA'RNNG wITAn0x W: 3ESw,000 SURETY UCENSES cN: U. DE, BE, W IL N. Ks, MD. NA ML NH, p, NY NC. ON. PA M. SC IN. IK YA W1 INCORPORATED IN:ONIP RLI Insurance Company NNCa130x1 AUSPIES1 ADDRESS. BIDS N, unebHV Dora P.I. IL41615 PHYAU, 9169z-100A UNDERwRmHG UMIr MPBN W: I— - SURELY UCENSES 0. AL AK K AR. CA CO. ET. DE. DC. FL GA GU, HL A IL IN, K Ns, N. M ME, MD, MA. MC MM ME, NO, MT, xE W. xK NJ, NM, W, NC, NC,, OH, OK OR PA PK AL SC, SD, TN. M UT, W, VA A wA W, W . M INCORPOMTED at - Roche Surety and Casualty Company, Inc. INNCAA2TO61 BUMNESS ADDRESS: 110 N NNCS AVC 21D FLOOR. TAMP& R3MD] PH.-AD51623-So62 UNDEAW'nnNG UMITANON W: SLOB7,E00 SURETY UCENSES Ot.. AL AK AK CO, n, DE. N. G& HI,10. N, M, M LA MD, ML MN. MS MO, MT. W, W, NA NM. W. . ND, onOKPASE.m,IN, MUT. 1.- INC-PATEDN:FMeda Rockwood Casualty Insurance Company INNCY355as1 W-ESSADDRESS: 659 Main SIrMRan}wUOa PA tsars PHONE Ir1e9M4W1 WREtt LKFNSES ufl: AL AK A5. K M CACO, R. DE Of. FL GA GV, NL ID, II, IN, K R. RY U ME MD, MA ML MN, MS,MMMP. MT, NEW, NH, M, NM, NY, NL ND, W.OK OR PA PR n. sC SD.m,M m. VT. V&VLWAWV.WLWY INCORPOMTFD IN: PARnn,#lnM Old Republic Surety Company INM_I 61511ESSADDREss. POBOXIWs,MLVIAUKEEw153201-1635 PHONPR62)-6AD UNDERwPmNG LIMITATION M f9,5T1,000 SURETYMENSEScfl:ALA ARCACO,DCFLG D.A,DI,KXs,MD,Mx,MS,MOMT,NE.W,NM,NLND,UH,OK OR PASLSD, m, Mm, V0.5VAWV.WLWY INCORPORATED IN. W... Pacific Indemnity Company INNC A2034) BUSINESS ADDRESS: 202E Halls MITI RwdLVNrtero�ue s,MV.n, ra oOBw PHONE(215)6W10E0 UnOEAwxIDnG LIMRhinX W:33]036].00D W AETY UCENSES KU, AL NLKAL CI CO. CT. DE DC R W HI, ID IL R K M. 0, LA ME MD, MA IL MN, Ms, MO, W. NE. W. NN NJ. NM, NV, NC ND, ON, MOIL M AL SL W. TN. M Ur, W, V& WA WV, VIL WY PACIFIC INDEMNITY INSURANCE COMPANY (NNC SIBBB01 BUSINESS ADDRE55, 3AA WEST 0 eRFry DPW, HAWTN& GU A6910 PHONE:Orn) TT-0901 UNOEAWRNN.L.I. DNM,s29-D4 SV9M UCENSES cf/: GU, MP INCOAPOMTEDIN: Guam PARTNER REINSURANCE COMPANY OF THE U.S. NNC n863M BUSYNESS ADORES s: l DD FlOL SramlUrtl P lxa sue ADO, sumlore. R 069ID PHONE: R. aA5<2E0 INNC A30 11 BUSINESS AODACESS: SIB M116NMd SAeec C9 l,U, OH cI215 PHaNElA33)3z63sTT UNDEIPMADDNG LIMITATION W: f2596,0E0 SURETY MENSES r,M AL NC K AR M CO. U. M DC, P. W, M, ID, IL IN, K AS, KY. LA, ME S. MA ML MN. M5. MO. MT, NE W. NH, N. NM, W, NL ND. ON. OK OIL PA RI, SC W. TN,M UT, W,, VA WA MI MwY INCORPOMIED IN: lava Proeentury Insurance Company INNCAn9051 BUSINESSADDRESS: SSUPU I1Pa M. estervllk.Oxa30B2 PKONe.(610)89S200D UNDERWRTING LIMITATION W: 33.955.000 SURM LICENSES cfl: AK AZ AA W DE. DC GA L N K KS, LA MD. MA ML MN, MS, MO, MT, Ne. W, N. NM, W, ND, OK 00. PA SC SD, M UT, W, m. wv INCORPOMTEDIN:MICNIdan Progressive Casualty Insurance Company INNCA2AIw1 AU.NESS A..AE55. P.O. BOX B9A90. DLEVEW9D.ON 4101-6090 PHONE:(-).,-soOE UNOERwRmNG LIMITATION M 6330,920,00E WAM UCENSES cPl AL NC KAK C0. CO, CT, BE DC, FL GA W. ID. IL IN, K KS, KY, M ME MD, MA ML MM W. MO, MT, W. W, NH, NJ. NM, NV, NC. NO. ON. OK OL PA AL Sc So. MM UT. VT VA WA M. mvn INCORPORATED IN: Ohl. Progressive Northwestern Insurance Company (NMC-B1% OUSINESS ADDRESS: P.O. BOX 0WO,, CLEVELANO. ON 4101-49E vxoNE(4o141-swo UNDEAD ALONG LIMITATION M Sw,9TeDW LICEW ES r.U:AKK M G CO. R. DE OC W HL ID.IN, K KS. XY. LA MEMO. MN. M5. MD. MT, NE. W, M. NM. NY. NC.ND.OR OK OK RL SC, SD.TN, M UT, VA WA VCV w INCOAPOMiED 1..1hO UNDERwRIIING LNIT.ION b1. 3,0.6NA00 ENSES KN: AL AK N, AR M0. M. DC. FL GA HI, ID, IL IN, IA KS, KY, IA ME, MD. MA ML MN, MMO ML NEW, NK NJ. NM, W, NC. MD.OH, OK OR PA AL SC. W, 11, M M W. VA WA WV, wL WY INCORPORATED IN: Pe ,Wnx SAFECO Insurance Company of America INNC A i-I 1 rt15TDDREs6 I]s aerkeky Weec DPRON. MA o2I,6 .,,1.Ne1Mn35T-9 WRENLIEENSESH.M. M, A2,ARCMOH,tO DE DC R WGU,TN.K . . A M',ti ME MD. MA ML Mrv. Ms. MUM NE NV, NN, ND. NM, W, NL nD.OH.OK O0. PA RLSC SD. TN.M UT,Vr,VA WA WV, wLSVt INODRPOMTLD IN. Nry H-Pa SafePart Insurance Company IMNC SAMPi DUSINESf ADDRESS: QW aN MA1a ROAD, sum 1A00, MLBGK NC TAUS PHOxeuln.-MSS, UNC SUREYLICE S IfMR �� CO,CI.DEDCH,G/.HI,ID,ILIN.KKS,MLAMEMD.MAMLMN,MS,MO, MP.MT,xEEWFNH.NJ.NM.NYNC.ND,OKMMPAM,W..SD,TT m,W,VAwAWV, W, wY INCORPOMTED IN:-W. Safety National Casualty Corporation INAI-E 51 BUNNMADDRESS: 1BUSrb Man SLL.11MD631A6-3W PHONE(3M)9955300 UNOERWRNNG LIAI TATIOx bns326329,00D SIAMENSESIN.AAL M KM U CO CT. DE DC, R W CV, HLID,141N, K KS W, LA ME MD MA ML MN, MS, MO, W,, NE W, AN,W NM, W,NC NO, OK OK OK M PR RL SC SO, TN M UT, W, VA YL WA LW, m WY NEORPOMTEDN:wneDn Sagamore Insurance Company (NNC4gW01 UN.A LINGUMRATMNM.1IB6aT],0W SURETY LICENSES LK. AL Ai M EA CO. CT, DE DC W IL M, IS. LL MD, MA MI, M5. NE, NV, NA Nµ W. OK OK PA SC M N. V0.WAWV. WI Pekin Insurance Company (--A, BUSINESSADDRESS: 2505 COUaTMEEr,FEAN,A6I5% MI PHONLOXY3161161 UnOERwaDNG LIMITATION M.31 K85R000 SURETY LICENSES KfAK IL IN, K OH,m INCORPOATED N: 1-1, Pennsylvania Insurance Company (NNC a2196n BUSINESSADDRESS: P.O.B9XB6 Om .NE66103.PAM P-:1-Bin-a92A UNDERWRnINGLAII WNtV.HSULCUL0 RFTY UCENSESCN:ALK M M CO, R, DE DC FL W,1L IN, KM. KV.IA ME MD. MA ML MN. MS MO MENE W, NH, yNAK W. NC. MD.ON. OK M M AL SC in, m. M W, W, VA WA WV, WL WY Pennsylvania Manufacturers' Association Insurance Company PMK P12262) A.. LKINIES cM AL ALCM CO, CT. DE DC. R W Mi.ID, L M X5. KY. LA ME. MB. MA ML MS. MO, Mr, HE, W, NH, N.NM.MY,- DN OK PA RLKSD. IN, M m, 1, w0. SYV NCORMA-D IN: Prnm WPIP, Pennsylvania Manufacturers Indemnity Company INAK AAlnm) BU51NESIADDAM: P.0BOX3031,MMEBELLPAt9A22-OTSA Protective Insurance Company BUSINESSADDRESS, nl Cano-.MNd,SUltr SUU1. eL IN- P.... x-]A33 cfl:AKA2CACO,CT,DE,oCFLWHI.IOLIx.KKS,KY,v MEMO,M MT,NEWEALNRR,NM,NY,NC,NDONOKORPAMM,SC.M.TN,MUT.N,VAWAW ,,KM IN .-DIN.Ind- Protective Property & Casualty Insurance Company DAMCx35T691 BUNNEss ADDRESS: I.Tss x0nn OUar Fnm Ae.. WXr 900. sL EAM.. MD"" PHONE:(636)53656M MNDErA-NG UMRAITON M, 320 ..- SESOAALAKAZ GMR,DIE.DC.FLWxLID,ILIN,KI,KY.MMEMD,M W. NE W. MI, NI. NM, NY, NC, ND OH, OK OR PA PR. M. SL SO.TKM OT, VI. VA WA WV, WL WY INCOA-,D N:-1- QBE Insurance Corporation 0MK A392IT1 AOSINESSADOAEss. One OBE Wry, Sun PrNre,m s3596 PHONP.(M)362-SMB SURELYLCENSEScf/:ALAKKMCACO,R,DE,DC,RGAHLID,ILN,KK5,KY1AMEMDM MLMN,Mi M0. MT, NEW. NH, W NK NV,NC ND, ON.OK OK M n. SL SO.MM �.W.VAWAWV, WL IVY INCORPORATED -_-- Regent Regent Insurance Company INAKAI449) BUSINESSADDPESS. Ore OBE Wry, SUn Praiea WI53s96 PHONE(A001362-s6r8 UNDERxRInNG LIMBAnON M: 33,522E W BUSINESS ADDRESS. 111 [DngrnslOnal BNE-SUIT 500, CamrtL IN A6033 PHONP(3M 6A6-98o0a 11 UNDERWRITING LNTATION W:315.710,AOD SURETY LICENSES ID: AL AK K Co, CT, DE DC. W, HI, 111E IK K KS KY, ME. NO. MA ML MN, MS MO. Mi. NE LIT, PM, NY, NC, ON, OR PA AL SC, SD, TN. TX. UT. W. W0. WV, WLM INCOAPOMRD IN: P.- SECURA Insurance Company (NAK A225931 BUSIMESSADDREss: PU.&M819.APPkm W156912 Il PHONE: DUM -3161 UNDERYPT SURMCENSUcVK, C0.0,,SINK LIKY ,M..MI.MN,MO,W,,KEW,NM,ND,OKOKORPASD.TN.UT,WA mMu Selective Insurance Company of America INAKr1TSTa) BUSINESS ADDRESS: m WNITAGE AwxVE, BAAMCHVILLE. xl0'M PHONE: 07]1) - DE LA._N W: SBMSB_ LICENSES Ut.A AK KAP. CO.R.DE,DC. GA IL IN. K0. kY. MD, MI ML MN. M5. MO. W. NE W. AN, M. NM. NY, NC, OHL OIL PA RI, SC, SO, m.M W, W. vA WA Wv, wEM INC.AADMTED N: N-J.- Seneca Insurance Company, Inc. NAICP10 U. B NESSALP1E -.,w WATEASTREET,NEWYORKWI003B-3521 PHONe1212)3.630w UNPcRNN .LwTATNN El 315.M15,000 SUAM LICn1SCS c0: AL AK AEM CA CO, U. DE, DC FL G& HL ID, IL N. K PC KY, M ME MD. MA ML Al MS, MO, MT, NE W. NM NOW ND. OIL OK OR PA PR N. SC, 50. TN. M W. W. VA WA WV, M PY INCORPORATED IN Niw York Sentry Insurance Company OUSINESSAODRFSS: I- NORTH POINTDIEW SOPIENS POINT. WE Sg481 PHONE:015)3 SSSE UNDERWRITING LIMITATION W: S 4,219,000 SURETYLICENSESKfl:AL AK ARCAC0,CT,DE,DC,F4G0.HI,ID,141N,AK5,KY,MMEMD.M0.MLMN.M£MO, W..NENWNµ NJ,NM.m,NC,ND.OH.OKORPARLSCSD,TN,MW..W..VA WA WW WLWY NCORPORATFD IN: wS .. Sentry Select Insurance Company NNC A-.) 6USINESSADDRFSS: I800NORENUMINTDOME,STEEFENSPOIW-54491 PHONE:015)3A66WD UNDERwMnNG UMTIAnuN W: P23,125,ON a c,M: AKAZARCACO,ODEDCFLGAHI,ID,ILIN,KKs,KY,1AME,MD,MAMLMN,M5,MO. W.NE. W. NHFM, NM. m. NC. ND.CH.OK OR PA RL SC.SD, TN,M W. W, VA Wk WV, WL WY SERVICE INSURANCE COMPANY INC. (THE) INNCxu240) BUSNESSAODRE55: W MAN STREET, WEST ORANGE NI OME PHONE:(2 )T31-T65o SURETY UCFNSESC0,. AL a.. DE DC, R. GA KK NO, MA, M£ MT PER E, W. NC, PA Py SC W. VA WV NCORPO WED IN. NewJercey SIRIUSPOINT AMERICA INSURANCE COMPANY IHNC A38n6) SUSINESSADDRESS: I WORLDTRAOE Uk U5 WLTON ST 4Tm RSTE4TL NEW YORK NY 1000T PHONE:(212)312-35D0 UNDERWRTING LmITATION M uR15VOD SU PFY UCFNSESKfl:ALAKAZARC0.COR,DE,DCELGAHLID,ILIµ1AK5,Kv,U MD,MAMLM5,MO,MTrvE rvll, NN, NJ, NM, NW NC ND, Oµ OK OR PA RL SC,Tµ TK UT, VTV& WA WV, W),WY PHONef6W1,I EA00 UNDERWRITING LIMRATION W. KOSS NO SURETY UCEN56 c,M A4 AKA , A .Ak CA CO CT DE DC GA GU, HL ID, IL IN.K K£ KV, H MO. MA ML MS, MO NENV,NH,N,Nµ NY,NC,ND,OH.OKORPARISCSD,TN,TXV,,VAWAW,,MWY INCORPORATED IN: - State Auto Property and Casualty Insurance Company NNce25,m PHONe(R33)T3A-35n UNDERWRITING LMnATION EA Sn.1s9AMID SURETYUC NSUCf/.ALAKA ARCO,t,DEOCRG HI.O,ILIN,KK£KY,MMEMD,MAMLMN,M£MO.MT. NE NWNL NY, NC ND, Oµ OK OR PA RLSG SDTMTKW.W.VAWJ.M.W INCORPORATED IN: Iowa State Automobile Mutual Insurance Company (MC4ZI35) PHONf(E331T2A-35n UNDERWR RANG EW NATION W:IS.,'.- SURETYI3CEN56 ,f/.ALAKI ARCO,R,DE,DC.FLG0.HI,I%lI N.KK£Kv,IAMEMD,MAMLMN,M£MO,MT. NEW,, NH, NJ, Nµ NY, NC, ND, OH.OK OR M RE SC, SD, TN, TIC M, VT, VA WA WW M1 WY INCORPORATED IN:ObII State Farm Fire and Casualty Company INNC82g143) BUSINESS ADDAPSs: ONE STALE FARM PW BLOOMNOmN, IL 61110 PHOUEC3091Tsc2311 UNDERWMTING LlMnanON W. $1312N£Nv SUREfY LICENSES 19. AL AK AZ AR CA CO CT. DE. DC FL W HE, D. IL IN, K K£ W.IA ME, NO, MA MI MN, NO, MO, MT NE, W. NH, NJ, NM, W. NC, ND, OH OK OR PA RL SC SD, TN, TK UT, W. VA WAWV, WL WY Stillwater Property and Casually Insurance Company I. /:AL AKAZARCACO,CTDEDC,PL W GU,XI, ID, IL Iµ KK; KY, Lq MEMD,M0. ME MN, MS, M0, MTNE NV.NKNJ.NM,NY,NC.ND,Oµ OKORPAPRRESCSD.TN.T,,u,,W,VAW WAWV,WLWY Travelers Casualty and Surety Company of America (ECAU-S 1N) DUSINESSADDRESS: ONE TOWEASQUARE HARTFORD.CTOOSS ANONClROP,-D II UNDF RfT1NGLIMDAUONN:EEITMEOOR RFTYL SFSc,N:ALAKrS Ak CA .ROEDC,R.G GU,HI,IDILIN,AKs,KY,V.MEMD,MAMLMN, MS.MO.Art,NENWNH.M.NM.NWNCNMOH,OKORPAP0.PLSCSD,Tµr UT.W.VAVLWAWY,WLWY INCORPORATED IN: CPnnnvcuc Travelers Casualty Insurance Company of America (NMCrI9M5) BUSINESSADDRESS: ONE TOWER SQUARE HARTFORD, CT 06183 PH0NC(8 PI-DI11 UNDERWRITING LDAITAT ON EL s56,180,DDD M�Ir: AL AKAZ AR CAcO,R,OE. UC FL GA O HI,.EIN,A K£KY, LA ME, MD, EIA ML MN, MS, MO, MT.E ME. -..NH,. N, N.. NY. NG ND Dµ OKOR PA RE S1, SD. m. TIC uf. W, W, W0.WV, WE WY Travelers Indemnity Company (The) INMCA—SE) BUSINESSADDRESS: ONETOWER SQUARE HARTFORD,Cr06163 PHONEREFO12nE111 UNDFRWRmNGLNANATIox N,&7IZ 3,Do0 SU V: A4AKK AR c0,cr, DF, DC FL GA Gu, HL ID, IL In, N Ks. KY, µ MF, MD, MA ML MN, M5, MO, MT,NE, NVENH.M[NM.NY.NCNDOH,OKORPAPRRL5C5D,TN,TKU..VTVk WA WLWY TRAVELE IRS INDEMNITY COMPANY OF AM ERICA (THE) INAK I1356661 BUSINESSAODPE55: ONETOWERSQUAREHARTFORD.R06103 INCORPORATEDI1:11-1, SOUTHWEST MARINE AND GENERAL INSURANCE COMPANY NNCrIn9y RUSINESSADDRESS: 412Mt. Kembk Ave, SUlte 300C, MEET 0wn,W.- SUR sES Kthµw, nz,a0.4 co, R. DE,Oc,GA HI, ID, 141µK KS, Kr, MS ME, MD, MA, ML MN, MS. MO.MT NE.NV. NKNANM.NCND.OH,OKORPARLSGSU.TN.T W,,W,VAWAW.WEWY INCORPORATFDIN: Admna St. Paul Fire and Marine Insurance Company (NaCI-64 BUSINESS ADDRESS: ONETOWER SQUARE, HARTmRA CTOUIn PHONE: (860)n7E111 UNDERWRITING LNMATION W: SSN,84R000 SURIM FS KN: A4NCAZ aRUCo, n, DED4 EL W H1, lD, 141x,AK£Kv,10. ME, MD, MA ML MN, M£MO, MT, NE, NWENµ NJ, NM. NW NC NO, OH. OK OR. PA PR RL SC SO, M. TK UT. W, VA VL WA W. WE INCORPOINA111 :CI—PN R ST. PAUL GUARDIAN INSURANCE COMPANY NMC AD—S) BUSINESS ADDRESS: One Tower Square, H ,E. Cr061 E3 PHONE:uERE)MA1111 UNDERWRITING LNTATMN W:S2 78,000 SUFMMENSESKARC CO,R,DEOCR,GAHLID,141N,KK£KY,LAMEMD,MAMLMN.M£MO, MT.NE W..NHM. NM. W. NC MD. OH. OK O0. PA n. SC SO, U. TIC UT, W. VA WA WW m WY INCORPORATED IN Qn— St. Paul Mercury Insurance Company NNC.—H ELSE NESS ADDRESS: One Tower Square, HarUord, CT 06183 PHONNEEDI)3T/4111 UNDERWRITING LNIIATON M I11,383,000 INNCt169n BUSINESS ADDRESS. P. O. BOX 4512A Plb.n ,FL 3235E-5126 PHONE(800)F,r I UNDERWRNNG LNHATIN W: 511360A00 FS ci/:AL NC 2Z ARE CO, R. DC, FL W HI, ID, IL IN, A AS, KY, M ME M0, MA ME MN, MS, MO, MT, NE, NVpNN NJ, NM, NY, NC. ND, ON, OK OR A RL SC. SD. TN. M UT W. VA, M. W0. WW WE WY INCORPORATED IN: New York SureTec Insurance Company (NNCt1091N BUSINESS ADDRESS:nm[Iyxm eoukvarB,sWe 1—, HOU 1rXn PHONE:a13)8120800 UNDERWRITING LNWCEN M 114.156a00 SURETY UCENSES IV. ALA AZ AR CA CO, CT, DE, DC, K C HE. ID, IL IN, A KK 0. LA ME MD, MA ME MN MS, NO, MT, NE, NW Nµ NJ, IN, NY, NC ND, OH, OK OR. PA A. SC So. TN. TX UT, VT VA WA WV, WL WY INCORPORATEDIN: S SURETY BONDING COMPANY OF AM ERICA RAJ-2—A NUSHEISSAcE P 011:(31D'. SURETY LICENSES c,l/:0.L ALAR cA CO. DE DC, G0.1D. 141x, KS, Mx, MO, Mi, xE xv, xM, Nv, xD, OK OIL 5G SD,TN, TKUr,Wv,WY INCORPORATED IN: SOYA Dak9M Swiss Re Corporate Solutions America Insurance Corporation (NNca29OA1 BUSNF55ADDRFS; Iroo MANST UPBOD—SAICITY,MDM105 1 PHONE(01n 2353T00 UNDERNRIII4G LMNATION M SIS,1MA011 SURFN UCENSESIN: AL AX. AZ A0. CA CO. U. OIL DC, K GA HE, ID, IL IN. 1 M. NY, IA ME M D, MA MI, Mx, IS, MO, MT. NE, NW Nµ NJ, NM, MY, NC MD, OH, OK OR PA PR RI, SC Sc, TN, TX UT. W, VA WA WV, WE WY INCORPORATED IN: Missouri PHONE(86D)2710111 UNDERWRnNG LNHATION W: s1R39S00R SFS UP AL AKK CT KS LA A%CO, DC, R. W HI, ID, IL IN, K IN. MD. MA ME MN. MS. M0. I. NE NJ. NHpM."'W NC ND. OH, OK OR PA RE 50, TO, M M. VT VA WA WW WE. Wv INCORPORATED IN. U.— Travelers Indemnity Company of Connecticut (The) (NAICa 11 BUSINESS ADDRESS ONE TOWER SQUARE HARIPoRO CT WE 1HON1;u60)II1,EI11 UNDERWRTING LNHATIUN M 13315— SURFN LICENSES cll: AL AK AZ ARE CA CO, CT, DIE, DC, FL W HI, ID, IL IN, N K5, W. A, ME, MD, MA ML MN. MS MO. MT, NE, NW NE N. NM, NY NC MD. OH, OK OR PA PK RE SC SD, IN, TA UT W, VA VL WA WV, WE WY INCORPORATED IN: CunrN UE Travelers Property Casualty Company of America NMC.—AI BUSINESS ADDRESS: ONE TOWER SQUARE. HARTFORD. 0%183 PHONE: (860)3TTEI11 E:ALAKKA0.00.CO,Cr,DE,UCFLGAHLIDILIN,KS.NN,IAMEMD.MAMLMN. M5. MO. MP. MT, NE. WNv. NH.M.NJ. NM, NY. NC ND, OR OK OR PA Po, SD, iN, IK ui, vT,v0. WA wW 5YE wv INCORPORATED DI—1 U.S. Specialty Insurance Company (.AEC ED—, II-1-ADDRESS: 13a03NONwMLnEew Hqungn I1MEE PHONE: 913)462-INO UNDEKWPHINGUNIMICN EU,11 1— tE[FNSESKMA4AKM,AZA CACO,R,DEDCR, HLID.ILIN,KN,KY,U MEMD,MAMLMN.MS, NO. MT, rvE rvv, Nx, "K NY. NG ND, OH.OK oR P0. RLSG sD, irv.iK Ur, w, vA WA wW wlwv Union Insurance Company SUFMLKMSFS1D.AL.MCA;AR CA CD, U DE, DC R. GA HL AL HE N KS. KY, Dy MF,MD. Mk MI, Mµ M5, NO MT NE NW NH. NA NK NY.NC, ND, OIL OK 00. P0. Po, SG Sp,TN,TK UTvr, V0. W0.WWWI,WI Standard Fire Insurance Company (The) (NMCx .) BUSINESSADDRESS: ONETOWERSQUAREHARTFORD,C Uss PHONE.HQ)2n 11 IxDERWRIrNE UMDANON MSI33,AE S,O00 S URETYW.NH.M.N:ALAK ,ND. CACO,CTDE,DCFLGAHEID,L,W, K£KY,& ME M0, AlA MI, MN,M; MO, MT NE NV. NH, N.NM. NY, NC, ND.Oµ OK OR P0. Po, 5G SD,TH,Ie{, UT, YE V0. VL WAwV. WLW1 Star Insurance Company (MICAIBOESE BUSINESS ADDRESS: 26255 Amennn D .Squ Md, MI Aa1EA PHONE:12035&110D UNDERWRITING LIMHATNN W: 15kFS6,D00 SURETY LKENSES OU. AE, AK AZ AR CA CO, CT, DE, DC. FL GA HE ID, IL N, K K5, KY, LA ME MD. MA Na MH, NS, MO, MT, NEW. NH NJ, NM. NY. NC, NO. OK OK, OR P& RL SC, 5D, Tµ TIC UT w, V0. WA W. WL WY 1rv[ORPORAIFo N. MNlB Starflet Insurance Company (MSC _IE BUSINESSADDRESS: PO B0X919D DCS MOINES. K50306-9I95 UNDERWRITING UMHAnDO1 M:11Z30TWD SVNEIV LKENSFSKfI: µ. AK AZ AK CA CO, CT, DE. DC. FL W HLIO.IL N, K KS. KY, a ME MD. MA ML MN, MS, MO, MT. NE NV, NH, NJ, NM. NY, NC ND.OK OK OR PA M,SC, SD.W.TX, W,, W, VA WAWV, WEWY INCORPDRATED N: W..a Starr Specialty Insurance Company (ARK NMOn MUNNESSADDRE55: 393 Pak Avenue.3rtl fl00r,NewvoHR Nv loon Swiss Re Corporate Solutions Premier Insurance Corporation BUSINESS ADDRESS: I200 MAN SLSUNE aO MNSAE Cm, MO MI(ES-3418 I.CNER EIM235-3T00 UNDERWRmNG UMITATION MM.591,ODO SURETY LKmEE.W.I:M.AK AZA0. CA CO, R. DE, DC, RLGA HL TH 0. UL KS,KY, k ME MD,MA MI, MN,M£M0, Mi, NE NV, NH, W. NM, NY, NC NO, Oµ OK DK PA PR Po. SC So. TNTKLn.VT.V0.WAWJ.WLWV Swiss Reinsurance America Corporation (MICIOSSIA BUSINESS ADDRESS: ITS ONGSTPEFT.ARMONK NY foSOA-1606 PHONE:INA)82e— UNDERWmNGUMITATIONEA1410,6OU)ISE SURETYLKMESOII:µ,NKTZARCACO.R.DE,DCFLG0.6U,HI,M,1LN,KM; .LAMEMO, M0.MEAµ MS, MOMT, NE,NV,NH,NJ,NM,NY NCND,OH,OKORPAP0.W.SCSD.TFLMMW..vAWAWv,MWY TRANSATLANTIC REINSURANCE COMPANY IMIt A1M$3) RUSINESSADDREZ: one UPEOPNTA.166emadw NEWYORKNY1OOAE PNDNE:Ul2)36Sn0o . MNDERwRITING UMITATION M tAes,r18.O O ETYLKFNSES �(I:AK KCA CO,DED<.G0.0.IL Ix,NKC KY,LA uI Mx, MS, xE Nv, M.xMMKOµ OK Aso TK Ui, WA m Travelers Casualty and Surety Company (MICI ) BUSINESSADURESS, ONEMWERSQUARE.MRTFORDR06183 PHONCHME)2na111 UNDERWRITING UMITATION M STB2,997,000 (MK AE E BUSINESS ADDRESS: PO BOX 91 N. DES MOINES, ARMA-91SEE PHONF:(972111934Oo UNDERWRITNG UMEWPON 4.. EA.91EOM SURETY IKENSES sll:AL, AK AZ AR U CO. R, OF, UCFL W HE IO, IL N, N K£ Kv, LA MEMD, Pµ MI. MN, M£ MO. MT,NE,NV, NH,KNM, NY,NC,ND, OKOKORPANSCSD.TI9.TK UT. W.VA WA WMVR,VN INCORPORATED N:lowa UNITED CASUALTY AND SURETY INSURANCE COMPANY (ARK O362M) BUSINESS ADDRESS: 233 NeetlFaN SUeet SURE M0, Nmwon,MA03AM PHONE(613)4711112 UNDERWRITING LIMITATION W. 5;386.D00 SURETY LICENSES IM AL AK AZ AR CA CO. CT, DL DC R W HL ID, K, IN, K KS, KW LA ME, MD, MA MI, MN, M; MO. MT, IF, NV, NH, NJ, NM, NY, NC NO, ONE, OK, OR PN, R. SC, SD. TN, TK UT VI. VA WA WV, M M INCORPORATED IN: Nebraska United Fire & Casualty Company (HA-13020 BUSINESSADORE55:POENSIBSO9,CEDAREEPID;R -39D9 PH.HR CE1TI3N3/oO UNDERWREriNG Iw.nATION W: s65.42,M SUREtt LCENSES CV: Al, AK AZ AR CA CO. CT, DE, DC, F4 GA HE ID, R N, K KS, Kv, µ ME, MD, MA MI, MN, MS. MO, NET, NE W. NH, N. NM, NY, NC NO, OK OK OR PA RL SC SD, TN, M UT VT VA SAX M. WE M INCORPORATED IN: 1. UNITED FIRE & INDEMNITY COMPANY NAEC". 61 BUANFSSADDRESS: P.O.B0X1390.CEDARRAPIDS.LA52AD9-3909 PHONE:1319)389 UNDERWRITING UMDATION bl: s1,291.000 SURMLICENSES CV: µco, N, KY, K MS, Mu,NM,TX United States Fidelity and Guaranty Company u,K KAR CA co, R, DE, UCR W NL ID, IL W.K K9, KYN ME MD, MA ML MN, M5, M0. Mi.NE LNYENH NJLNM,m.NGND.ONOKOk PAPRM.SCSD.TN.TXL ,,VC,VAWAW..' WC INUC<rsse07) BUSINESS ADDRE65. OxE IDENER SOUMRE-.A, C1061N PHONE IRE 41-111 UNDERWIOTWG JAAIUTON Rh 05.0 SURETY LICENSES cM AL AK AZ A0. CA CO. R. DE K R W ER, ID, K IN, K AS, KY.IA ME MD, MA ML MN. ME. MO. MT NE NV, NH, H, NM, NY, NC, ND, OH, OK OR PA PR RL EC ER TN, TE. Ur. VC. VA A WA W. WL WC INCORPORATEDIN:Cmn«000I United States Fire Insurance Company INN[111t13) Ou51NE5S ADDRESS: 305 MQ60N AVENUE MORRISTOWN, NJ 0T960 PHON W3)<905600 UNOERWaTwG --.N 11169,6SOAD0 SUREn LICENSES cl/: ALAK KM0. W CO. R. DE, OC, FL W HI,10, ILIN, K K5. RY.IA MF. MD. MA ML MN. M5. M0. MT,NENMNH,H,NM.NYNCND.OH.OKORPAPk ALSCSD.m,T U..VI.VAVI,WAW/,wlwC United States Surety Company WN-ONES) BUSINESS ADDRESS: On<Tevs Sonars Cwrt SUI1.e r30, nmoni um. M D 31 C93 PHONL/AIIAAS19511 UNDEASYMTING 1J.-N b: FSA.- SUREn LXHNSES 01.. R, DE OC R W ME MR MA HE, rvA Hit NC, OH, PA AL SC TN, W. VE, NEDRPDAATED IN: Mz11I UNITED SURETY AND INDEMNITY COMPANY (NAJC-.1 BUSINESS ADDRESS: PO BPR 3111. An1YM. PROD9Y! -1111 PHOxE:nan1T3.1111 UNDERWRmNG UMITATON W: FT,MI,ODD WREN UCENSES cN: PR UNDERnMTING LIMITATION b: SA.7RZR00 SUPEry UCENSES cM: AL AK K AR CA <O, R, DE. DC FL W HI.ID, IL lµ K 1G. Kv, k ME MD, MA Ml MH. M5. MO. MT,NEWNH,Ny NM,m,NCNDOH,OKORPARISC.SMT ,1Km,W.VAwAM^/,MM INCORPORATED IN. Wrxa.HlA Westchester Fire Insurance Company I.-ID0NT BUM—ADDRE55: A]6w1M15DP<K POB9, Iwo, PniM wI4,, PA I91o6 PHONERI516Aa-IDOD UNDEAAAmNG LRA YA ON M $ISxT SURETYUCENSEScN:N,MK m.WcRRDEOLFLWGU.HI.ID.LIN.Ka.KY.LAMEMD.MAMLMN, MS MR MP. MT. NE NV, NH. NJ. NM. W. NC PAX OR OK. OR PA PR PC SC SD, T1, TK UT,W, vAvt wAwV,wL WY WC.RP.-. W. Penns IR Western National Mutual Insurance Company INNC 1153M WIREJESSADDRESS: POAOKIA6RMWrvEAAOLn,MN55AA0 Pxoxe 19sn 03ss3s0 U.VDERmUTING UMITATON W. ST2A9AD0 /: Al. AK AL A0. W OR DE DC. RWID,ILIN. KM$, 0, M MR ML MN, MS. MD, W NE W Ice. NM. NC HD. 01L OK OR PA AL SC SO, IN, TIC UT VAwA wV. W. M INCORP EDIN,MMnes0o Western Surety Company (NAKr131Rn eU5NE55 ADDRESS: 111 N.-.1. StC RIL60606 PHOHE:n11)aT1-SOOD UNDERNNTING UERIATON b: 1152,157,OW SURETY LICENSES C D. AL AK Al AR CA CO, CT, DE, DC R. W HI, 1%IL IN K K5, KY. M ME MR MA ML MN, ME. MO. MT, xE xv, NH, 4 NM. NY. NC RD, OH, OK OR PA P0. Rl SC ED. TH. TK In, V ,, VA WAWV, cal svv WCORPORATED IN: S-I 3a Westfield Insurance Company INNCYlAtln Universal Fire & Casualty Insurance Company (NAIC ml) BUSINESS ADDRESS: 1111 AIRPORT ROAD, WATEAFOAR MIABTY/ PHDxE16111661-390D UNOE-NGUMnAmN b: SS G1.Om WAEN LICENSES Cn. AL AE AR U OR CT, DE FL W HI, ID, A. W. NC MD. OH, PA SC SD TN, TK W. VC VA WA W, m INWAPORAT DIN: Mu. Universal Surety Company (HNC01593SI A ... E(o )A35-0 W AEN MENSES s Y. M AIR TO, u, E. W. K K5, W. ML MN, MO. MT. NE NM ND. ON.OK. D0. SC SD.YE. W. WA m UNIVERSAL UNDERWRITERS INSURANCE COMPANY (.AR--) BUSIxESSADDRE55: tin WRKHWAY,STHKWRSC MWRGILOi96-1056 PHONE(M7)6DS60W UNDERWRITING W1ITATgM V. SN,DI5AW FS LIT: AL AK AL Al CA OR R. DE DC R W HUR IL IN, KKS KY, IA ME, MD. MA W. Mu, MS NO, MT NE W. NH, NJ, NM, NY, HC NO, OH, OK OR PA RL SC SR TN, TK UT, W, VA WA VN.cat M INCORP _. RE IA Utica Mutual Insurance Company INAK Y259)6) DUSINESSADDRE55: POSIOFFKE8OA5M.UTKANY13503-053O A ... E(ROD)59R-RAzl UNDERwRMNG UMD ION b: S1 75ZOOU BU11.E55 ADOREss: P. o. Bor so01, w<Sxm c<M<., Uxmzs -soot PHONE(33018RIL101 U111:-TING UMFLATION b 5151611,Uoo SURESUREU[ENSESCII:ALAK KA0. CO. R.DE DC R W H.ID.IL Iu,K KS kV, 4 ME. MD, MA Ml MN, MS MO. MT, NENMNH,NINM,W,,NC,N0,OH,OKORPARLSC5D,TN,TKU W,VAWAMV,m WY INCORPORATED IN:OM1ID Westfield National Insurance Company (NAlt-lu PHOSIE:C330IM-0101 N.DERWR URMATgN Oh. 130A10.00D xv WREN LCENSES CA: AL AZ AR CA CO. DER W IL IK K KY, MD, MI, IN, NK NC, NO, OK DE. PA SC SO TN. TX Vh IH.-AATED IM OM1b Westport Insurance Corporation 0<NC Y39M5) BUSINESS ADDRESS: Imo Man Sneer, WEP W. Kama1 CM, MOM -R 1HONE(R16)13S _ UNDERVIAIIING UMITATION b: 1103.10— :A0.CACRR, DEM,N.W GU,HI,ID.ILIN,KKS.W..k MEM0MAMLMN.MS. MO.MPLMT,NEc,1/ALAKKNV.NH.NJ,NM.NY.NCND.OH.OKOXPAMM,5C,SD.TN,MUCWVAVL W/.SVLm XL Reinsurance America Inc. (NNC rlOSR31 WgNE55ADDREM TOSEANEw AVENUESTMMFORD,RD6so1 PHDNERO]19Ea5m0 UnOERMiRINGUMITAInN b: f195.535A00 SCA.AL NCKARCACO.CT,DEDCR W HI,ID.ILIN.KKS.M,IAMD,MAMLMN,MEMO,MT, HE NM NHEHS Nu, xv, Nc, ND, oH, oK oR Ph P0. RL s<. SD.Tx, TK Ur,vT, vA wA wv, wlwY IHCORPORATEDI E.Yeh VerTerra Insurance Company INAKA10 ) BMNESEADDRES:: P.O. BON ED9039.SW DECO, CA 9n50 PHONE:uEA) 0-b00 UNDERWRRNIG LIMUATION W. S7,141A00 WEEw UCENSESTJA.TN INCOAPORATEDIN:T<xas Vigilant Insurance Company (NAK P3039)) WN.ESS AO DRESS: 203E wo-f MIRwd. Yfinellouse SWRO. NI OReW Y:r.I:IatiH: SURETY UCENSEScn: u,AK K AR G,CO. R. DE, UCR W xL IO, IL Irv, K Ks, KY, M MT, nE W.NH,NJ,Nµ NY,NCND,OKO OKMa,s SD.M.MW..v..V&M.WA .-HION,TEOIN:xewvon West American Insurance Company (NAK XM39n BUSOIESSADORE55: 17E9e ky WmftH9n,MA01116 1H11E1617)35 AI.ARAZARCACRR,DEDCFLWIO.ILIN,KM,MY MEM0MAMIMN.MS,W..'. NE Nv, NH, NJ, NM, W. NC. ND OH. OK OR PA AL SC SO W. TICK VC VA wA M. KWV IWOEADRATEO'N WEST REND MUTUAL INSURANCE COMPANY PUICP1s350) BUSINESS AD DRESS: 19D0 SmM1teUl Avenue.wescBwgm53095 PHONF:116n33<-5511 XL Specialty Insurance Company PHONE: IYD319M5M UNDERWMTING UM_. A, f533A,000 SM MENSES CM.AL AK KAR CA. CO, R. DE DC R GA GU. HL ID, IL IN. K KS W, k ME MR MA MA MN, NLS, MO, M ,MT, NE xµ xµ NJ, xM, Nv, x4 ND,OH, OK D0. PA P0. RL SC SD,Tµ TA. Ur, VT, vI,v4 WA wV, WI wY INCOAPUMIED IN: DPMware Zurich American Insurance Company (NAK-SE) RUSINESEADORESS. 1MMWHVA ErHFLOOR.SCHAUMBURG.IL60196-1056 P...PoA'06OSsw0 NN DERNAmWUMnATIOND/:1T1DS6A W SURETY U[FNSES cO:A4 AKK AR ti CO, R, DE DE FL W GU, xL lo, IL Irv, K Ks, KY, LA ME MD MA ML MN, M5, MO MP, MT, NE W,NH, NJ, NM, W, NC HOOH, OK OR PA Pk RL SC SD.TN TK DYNE NA VL wAWV,MlM INCORPORATE. Ix: N-1. CONTRACTOR'S BID FOR PUBLIC WORK - FORM 96 �•. :j State Form 52414 (R2 / 2-13) / Form 96 (Revised 2013) Prescribed by State Board of Accounts PART I (To be completed for all bids. Please type or print) 1. Governmental Unit (Owner): 2. County: St. Date (month, day, year): November 8th, 2022 of South Bend, Indiana 3. Bidder (Firm): Milestone Contractors North, Inc. Address: 24358 SR 23 City/State/ZlPcode: South Bend, IN 46614 4. Telephone Number: (574) 288-4811 5. 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 Main Street Improvements from Sherwood Street to Dean Street Project No. 122-045 (Governmental Unit) in accordance_wLth plans and specifications prepared by A & Z Engineering and dated 9/23/2022 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 addendums attached will be specifically referenced at the applicable page. If additional units of material included in the contract are needed, the cost of units must be the same as that shown in the original contract if accepted by the 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). 1 hereby certify that 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. The above bid is accepted this following conditions: Contracting Authority Members: ACCEPTANCE day of PART II (For projects of $150,000 or more — IC 36-1-12-4) Governmental Unit: Bidder (Firm) City of South Bend, Indiana Milestone Contractors North, Inc. , subject to the Date (month, day, year): November 8th, 2022 _ These statements to be submitted under oath by each bidder with and as a part of his bid. Attach additional pages for each section as needed. SECTION I EXPERIENCE QUESTIONNAIRE 1. 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 Completion Date Name and Address of Owner 10,422,417.00 Resurface November 2021 INDOT 6,800,827.00 Resurface November 2021 Lake County Hwy Dept 2,083,392.00 Resurface November 2021 City of Hammond INDOT 3,891,896.00 Resurface November2021 2. What public works projects are now in process of construction by your organization? Contract Amount Class of Work 24,572,623.00 Sidewalk Replacement Expected Completion Date September 2023 Name and Address of Owner Town of Griffith 13,847,877.00 Resurface Summer 2022 St. Joseph Airport Authorit 9,568,000.00 Resurface 2,838,234.00 Reconstruction October 2022 INDOT June 2023 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. Patti Centrowski Gough, Inc. 2200 E. 88th Dr., Merrillville, IN Mr. Raymond Gough Dyer Construction Co., 1716 Sheffield Avenue, Dyer, IN Ms. Janet Furman Grimmer Construction Co., Inc. 2619 Main St., Highland, IN Mr. Greg Grimmer SECTION II PLAN AND EQUIPMENT QUESTIONNAIRE 1. Explain 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 governmental unit to 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 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. See attached list 5. Have you entered into contracts or received offers for all materials which substantiate the prices used in preparing your proposal? If not, 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 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 include 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 PERJURY THAT THE FACTS AND INFORMATION CONTAINED IN THE FOREGOING BID FOR PUBLIC WORKS ARE TRUE AND CORRECT. Dated at South Bend this Milestone.( 01111111111 , Nt r a clto 1��i 4 a.' ��FPORgJF •�� •. SEAL Vic 111111��, By day of November 2022 North, Incr- of Organization) ,,ksfin P. Hilary, Director of Estimating (Title of Person Signing) STATE OF Indiana COUNTY OF St. Joseph j ss ACKNOWLEDGEMENT Before me, a Notary Public, personally appeared the above -named Dustin P. Hilary and swore that the statements contained in the foregoing document are true and correct. Subscribed and sworn to before me this 8th day of November 2022 Notary Public My Commission Expires: June 5, 2030 1pAY PV County of Residence: LaPorte =r°' '�" ALISHA KRUEGER m'�0n Expires *: SEAL *� Commission Number NPOSS3544 ' OFi ii14�r La Porte ODU 4/ Part of State Form 52414 (R2 / 2-13) / Form 96 (Revised 2013) BID OF Milestone Contractors North, Inc. (Contractor) 24358 SR 23 (HOOrBSSJ South Bend, IN 46614 FOR PUBLIC WORKS PROJECTS OF City of South Bend, Indiana Main Street Improvements from Sherwood Street to Dean Street Project No. 122-045 Filed November 8th 2022 Action taken General Form 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 Milestone Contractors North, Inc. Address 24358 SR 23, South Bend, IN 46614 Date submitted November 81, 2022 Filed A.E. BOYCE CO., MUNCIE, IND. IA Corporation 1 Sec. 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 forms 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) Sec. 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 State of Indiana Office of the Secretary of State Certificate of Amendment of WALSH & KELLY INC CONNIE tAWSON, Secretary of State, hereby certify that Articles of Amendment of the above Domestic For -Profit Corporation have been presented to me at my office, accompanied by the fees prescribed by law and that the documentation presented conforms to law ,<< prescribed by the provisions of the Indiana Code. The name following said transaction will be: MILESTONE CONTRACTORS NORTH, INC. NOW, THEREFORE, with this document I certify that said transaction will become effective Monday, February 01, 2021. W-t In Witness Whereof. I have caused to be affixed my signature and the seal of the State of Indiana, at the City of Indianapolis, February 01, 2021 ti •rare ensure the. State of Indiana Office of the Secretary of State Certificate of Assumed Business Name of MILESTONE CONTRACTORS NORTH, INC. I, CONNIE LAWSON, Secretary of State, hereby certify that a Certificate of Assumed Business Name of the above Domestic For -Profit Corporation has been presented to me at my office, accompanied by the fees prescribed by law and that the documentation presented conforms to law a,, prescribed by the provisions of the Indiana Code. Following said transaction, the above named entity will transact business under the assumed business namets) of: WALSH & KELLY NOW, THEREFORE, with this document I certify that said transaction will become effective Monday, February 01, 2021. In Witness Whereof, I have caused to be affixed my signature and the seal of the State of Indiana, at the City of Indianapolis, February 01, 2021, r-PFlir ., CONNIE LAVVSON I i.1 1 11 I.1 'I t 887823A T the i I J,r'.r1', rc: to'titr ch WRITTEN CONSENT TO RESOLUTIONS of the BOARD OF DIRECTORS of MILESTONE CONTRACTORS NORTH, INC. The undersigned, being all of the Directors of MILESTONE CONTRACTORS NORTH, 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: Todd A. Fawver President Charles Potts Jr. Chief Operating Officer, Construction John P. Vercruysse Executive Vice President Mark Andrews Executive Vice President David L. Franz Vice President John M. Peisker Vice President, Production Patrick J. Walters Vice President, Finance Brad McCall Vice President, Estimating Derek Merida Vice President, Bridge Operations David M. Kozyra Vice President/Area Manager Griffith Lynn J. Bauer Vice President/Area Manager South Bend Danielle Payne Assistant Controller, Secretary and Treasurer RESOLVED FURTHER that the above officers be, and they hereby are, authorized to execute all contracts or similar documents on behalf of the Corporation. In addition to the above officers the following are hereby appointed as authorized signers on behalf of the Corporation: David J. Misirly Senior Estimator Gregory A. Hoffman Director of Estimating, Griffith Dustin P. Hilary Director of Estimating, South Bend Mark E. Krachenfels Construction Manager 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 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 26`h day of August, 2021. Zt----A rn , 7�( Fred Fehsenfeld, Jr. Geoffrey C. Dillon James VFehsenfeld �P. J P. Vercruysse CERTIFICATE OF QUALIFICATION to provide CONSTRUCTION SERVICES for PUBLIC WORKS PROJECTS to the STATE OF INDIANA This Certification Board, having duly considered application for qualification in terms of apparent experience and financial resources; and under the applicable Indiana Code 4-13.6-4 and adopted rules of this Board, hereby issues a Certificate of Qualification to provide construction services to the State of Indiana for Public Works Projects to: WALSH - KELLY INC 1700 E MAIN ST GRIFFITH IN 46319 Phone 219-924-5900 Fax 219-924-8768 Company Official JOHN PEISKER for the twcnty-seven month period stated herein, unless revoked by this Board for cause, and in the classifications of services stated below. This certificate supercedes any previous certificate. 1611.01 Concrete Construction of Roads & Curbing 1611.02 Asphalt Construction of Roads and Parking Lots CERTIFICATION DATE 11/4/2020 EXPIRATION DATE 2/4/2023 THIS CERTIFICATE ISSUED BY THE STATE OF INDIANA, PUBLIC WORKS DIVISION CERTIFICATION BOARD, 402 WEST WASHINGTON STREET, ROOM W467, INDIANAPOLIS, INDIANA 46204, ALSO ACTS AS THE OFFICIAL NOTICE OF EXPIRATION. Ck.UA� Tracy L. Cross, Exeeutive Secretary Certification Board DAPW PQ2 State Forth 3983R Rev. 07/06 Milestone DATE: February 26, 2021 TO: All Employees RE: EEO Officer Appointment Margaret Garner has been appointed Equal Employment Opportunity Officer for Milestone Contractors. It is her responsibility to coordinate, advise and assist management and supervisors in their responsibilities of assuring all applicants and employees' equal opportunities in all aspects of their employment. She will review complaints that allege discrimination because of race, religion, color, sex, sexual orientation, gender identity, age, national origin, disability, housing status or veteran status. Employees of Milestone Contractors are to submit any issues or concerns to Margaret. We are committed to comply with the provisions of the Civil Rights Act of 1964 and 1991, plus all Executive Orders issued relating to Equal Employment. Margaret's contact information is listed below. Milestone Contractors 7661 N Perimeter Rd, Suite 200 Indianapolis, IN 46241 mgarner@milestonelp.com (317)616-4937 2,j� - CJ Potts, Chief Operating Officer Milestone EQUAL EMPLOYMENT OPPORTUNITY/ AFFIRMATIVE ACTION POLICY STATEMENT It is the policy of Milestone Contractors to afford equal opportunity for employment to all individuals regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, housing status, or veterans' status. The corporation is committed to this policy by our status as a federally assisted government contractor. We are far more strongly bound to the policy by the fact that adherence to the principles involved is the only acceptable American way of life. Therefore, it is the policy of this corporation to assure that applicants are employed, and that employees are treated during employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, housing status, or veterans' status. 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. The successful achievement of a nondiscriminatory employment program requires a maximum of cooperation between management and employees. In fulfilling its' part in this cooperative effort, management is obliged to lead the way by establishing and implementing affirmative procedures and practices which will ensure our objective, namely equitable employment opportunity for all. (Minority and female employees are encouraged to participate in all company activities and refer applicants.) I have designated Margaret Garner to direct the establishment of and to monitor the implementation of personnel procedures to guide our affirmative action program. This official is charged with designing and implementing audit and reporting systems that will keep management informed on a regular basis of the status of equal employment opportunity and affirmative action. She can be reached at (317)616-4937. Supervision has been made to understand that their work performance is being evaluated based on their equal employment opportunity efforts and results, as well as other criteria. It shall be a responsibility of the supervision to take actions to prevent harassment of employees placed through affirmative action efforts. We shall comply with the Civic 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 Vietnam Era Veterans Readjustment Assistance Act of 1974, as amended, the Indiana Civil Rights Act and other applicable Federal and State Laws and regulations pertaining to equality of Opportunities and Affirmative Action policies. We have developed an Affirmative Action Program for Veterans and Individuals with Disabilities. CJ Potts, Chief Operating Officer Margaret Garner, HR Area Partner/EEO Officer January 2022 EOE M/FNets[Disabled rAwak of Qualifkdtan HUED BY INDIANAPOLIS, IN October 20, 2022 TO MILESTONE CONTRACTORS NORTH, INC. GRIFFITH, IN who has filed with the Department a Co rtrs to s Statermert of Experience and Financial Condition as required under Indiana Code &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 notexceed the Aggregate amount Classification references by name or symbol are in accordance with the definitions in the Cortractor'sStatement ofExperienceandRnancialCondition. This certificaliesupersedes any certificate previously issued, but is subject to revision or revocation according to the law, ti and when changes in the financial condition of the contracting firm or other facts justly such revision or .revocatiop Valid October 20, 2022 Thru September 30, 2023 Aggregate Bidding Capacity: 327,748,000.00 A(B) CONCRETE PAVEMENT: LIMITED................................................................................... $25,000,000.00 B(A) ASPHALT PAVEMENT: W/INDOT CERTIFIED HMA PLANT ............................................. $99,999,999.00 C(B) LIGHT GRADING............................................................................................................... $99,999,999.00 E(E) SMALL STRUCTURES AND DRAINAGE ITEMS.............................................................. $25,000,000.00 E(F) SURFACE MASONRY AND MISCELLANEOUS CONCRETE ........................................... $50,000,000.00 E(G) TRAFFIC CONTROL: PAVEMENT MARKINGS................................................................ $25,000,000.00 E(H) DEEP SEWER AND/OR EXCAVATION.............................................................................. $25,000,000.00 E(Q) CONCRETE PAVEMENT: REPAIRS.................................................................................. $25,000,000.00 E(R) ASPHALT PAVEMENT MILLING....................................................................................... $50,000,000.00 PREQUALIIFICATtON ENGINEER Stft Form 2060E (M i 6-04) J. fv--4sm� COIytM SWONER BOARD OF PUBLIC WORKS AGENDA ITEM REVIEW REQUEST FORM Date: 10/31 /2022 Name: Charlie Brach Department of Public Works — Engineering Division BPW Date: 11/8/2022 Phone Extension: 9246 Required Prior to Submittal to Board BPW Attorney X Attorney Name Dept. Attorney ❑ Attorney Name Purchasing ❑ Check the Appropriate Item Type — Required. for All Submissions ❑ Professional Services Agreement ❑ Contract ❑ Proposal ❑ Open Market Contract ❑ Amendment/Addendum ❑ Special Purchase, QPA ® Bid Opening ❑ Bid Award ❑ Req. to Advertise ❑ Title Sheet ❑ Quote Opening ❑ Quote Award ❑ Reject Bids/Quotes ❑ Proposal Opening ❑ C/O & PCA No. ❑ PCA ❑ Chg. Order, No. ❑ Traffic Control ❑ Resolution I-1 Other: I -I Ease./Encroach Company or Vendor Name New Vendor MBE/WBE Contractor Project Name Project Number Funding Source Account No. Amount Terms of Contract Special Contract Provisions Purpose/Description Information 100 ❑ Yes ❑ If Yes, Approved by Purchasing ❑ No F] MBE ❑ WBE Completed E-Verify Form Attached ❑❑ Nos 122-045 Main Street Improvements between Dean and Sherwood PROJ216 SSDA TIF PR # 19724 N/A Base Bid N/A Opening of Bids for Main Street Improvements between Dean and Sherwood. For Change Orders Only Amount of ❑ Increase $ ❑ Decrease ($ ) Previous Amount Increase Current Percent of Change: Decrease New Amount $ Increase Total Percent of Change: Decrease Time Extension Amount: New Completion Date: BOARD OF PUBLIC WORKS AGENDA ITEM REVIEW REQUEST FORM Date: 12/23/2022 Name: Charlie Brach Department of Public Works — Engineering Division BPW Date: 1/10/2023 Phone Extension: 9246 Required Prior to Submittal to Board BPW Attorney X Attorney Name Dept. Attorney ❑ Attorney Name Purchasing ❑ Check the Appropriate Item Type — Required. for All Submissions ❑ Professional Services Agreement ❑ Contract ❑ Proposal ❑ Open Market Contract ❑ Amendment/Addendum ❑ Special Purchase, QPA ❑ Bid Opening ® Bid Award ❑ Req. to Advertise ❑ Title Sheet ❑ Quote Opening ❑ Quote Award ❑ Reject Bids/Quotes ❑ Proposal Opening ❑ C/O & PCA No. ❑ PCA ❑ Chg. Order, No. ❑ Traffic Control ❑ Resolution I-1 Other: I -I Ease./Encroach Company or Vendor Name New Vendor MBE/WBE Contractor Project Name Project Number Funding Source Account No. Amount Terms of Contract Special Contract Provisions Purpose/Description Information Milestone Contractors North, Inc. ❑ Yes ❑ If Yes, Approved by Purchasing ❑ No F1 MBE ❑ WBE Completed E-Verify Form Attached ❑❑ Nos 122-045 Main Street Improvements between Dean and Sherwood PROJ216 SSDA TIF PR # 19724 $398,000 Base Bid N/A Award Bid for Main Street Improvements between Dean and Sherwood. For Change Orders Only Amount of ❑ Increase $ ❑ Decrease ($ ) Previous Amount Increase Current Percent of Change: Decrease New Amount $ Increase Total Percent of Change: Decrease Time Extension Amount: New Completion Date: