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HomeMy WebLinkAboutOpening of Applications - 2024 Water Works Utility Service Line Repair Program - Niezgodski PlumbingNiezgodski Plumbing, Inc. Plumbing and Heating Contractor PO Box 3096 South Bend, fN 46619 Phone: (574) 233-9774 e-mail: Niezplumgcomcast.net Indiana State License 4 PC88701935 Established 1922 February 5th, 2024 City Of South Bend Board of Public Works, 131h Floor County City Building, Room 1316 South Bend, Indiana. 46601 Attached please find the required documents as requested for the Water Works Utility Service Line Repair Program. Niezgodski Plumbing Inc. has been providing reliable plumbing service in South Bend for over 100 years. In addition, we have been performing water service leak repairs and stop box repairs for the City of South Bend since 1972. Our 4"' Generation family owned business employs qualified and dedicated employees. From day one, instilled in all of our employees is the ethics of hard work. It is stressed that an attitude of honesty and integrity shall always be prevalent. As representatives of the City of South Bend, during the course of performing Water Works Repairs we realize that our performance serves as a front line view of how South Bend residents judge the delivery of one of the City's most essential services. Safe drinking water available to all city residents with minimal interruption is of the utmost essence for any city's administrative and departmental success. Niezgodski Plumbing Inc. will continue to deliver these services to the City of South Bend and view them as our highest priority. We are fully equipped to handle all Water Works repairs, including every manner of emergency service required. We have all the necessary tools and equipment and they are kept fully maintained. We meet all of the requirements called for in the specifications of the Board of Public Works Request for Proposals regarding the Water Works Utility Service Line Repair Program. In addition, we acknowledge that these repairs must be performed in any and all adverse weather conditions. In addition, Niezgodski Plumbing Inc. shall also be responsible for the preparing and pouring or subcontracting of all sidewalk, driveway, and street cuts, according to City specifications. Included, please find all required Commercial General Liability insurance information, Workers Compensation Insurance, required performance bond information, and a copy of our Plumbing Contractors License and Corporate Plumbing License. Also included is the signed and notarized Non -Collusion Affidavit, Non -Debarment Affidavit, Employment Eligibility Verification, and Non -Discrimination Commitment Form. We sincerely hope to have the opportunity to continue representing the needs of the South Bend City Water Works in every manner necessary for many future years to come. Please do not hesitate to contact me if there is anything further that you require. N , i- zgodski LV President — Niezgodski Plumbing Inc. 574-233-9774 niezpiumncomcast. net _sr�►r: Indiana Professional Licensing Agency Indiana Plumbing Commission 402 W. Washington Street, W072 w Indianapolis, IN 46204 Plumbing Corporation License Number Expire Date C089200225 12131 /2025 Niezgodski Plumbing, Inc. Eric J. Holcomb Lindsay M. Hyer Governor Executive Director State of Indiana Indiana Professional Licensing Agency QWIndiana Professional Licensing Agency - Indianapolis,402 W. Washington Street, W072 IN 46204 Plumbing Corporation License Number Expire Date C0892 1 12131/2025 Niezgodski Plumbing, Inc. .:sr�r.ae Indiana Professional Licensing Agency Indiana Plumbing Commission 402 W. Washington Street, W072 Indianapolis, IN 46204 .... I$r8 Plumber Contractor License Number Expire Date PC88701935 12/31/2025 David L Niezgodski Eric J. Holcomb Lindsay M. Hyer Governor Executive Director State of Indiana Indiana Professional Licensing Agency Indiana Professional Licensing Agency f 402 W. Washington Street, W072 Indianapolis, IN 46204 Plumber Contractor License Number Expire Date PC88701935 1 12131 /2025 David L Niezgodski Signature u! •"''^' V / INDIANA FARM P&M BUREAU INSURANCE,@ Worker's Compensation and Employer's Liability Insurance Policy Policyp No. Transaction AMENDED DECLARATIONS Effective: 0 8 / 21 / 2 0 2 3 WC ii341646 01 CHANGE COVERAGE Policy Period From 0 8 / 21 / 2 0 2 3 to 0 8 / 21 / 2 0 2 4 12:01 A.M. Standard Time at the address of the insured as stated herein Agent: Name and Phone Address JACOB KELLEY 2410 EDISON RD, SUITE 400 574-400-4389 SOUTH SEND IN 46615-3518 7601102 762 1. Named Insured and Address NIEZCODSKI PLUMBING, INC 232 N MAYFLOWER RD SOUTH BEND IN 46619-1534 Carrie r# FEIN # Risk ID # Entity of Insured 16454 199105098 CORPORATION Additional Locations: See Attached schedule 2. The Policy Period is from 0 8 / 21 / 2 0 2 3 to 0 8 / 21 / 2 0 2 4 12:01 a. m. Standard Time at the I nsured's mailing address. 3. A_ Workers Compensation Insurance: Part ONE of the policy applies to the Workers Compensation Law of the states listed here: Indiana B. Employers Liability Insurance: Part TWO of the policy applies to work in each state listed in Item 3A. The limits of our liability under Part TWO are: Bodily Injury by Accident $ 1,000,000 each accident Bodily Injury by Disease $ 1, 000, 000 policy limit Bodily Injury by Disease $ 1,000,000 each employee C. Other States Insurance: Part THREE of the policy applies to the states, if any, listed here: ALL STATES EXCEPT states designated in item 3.A., North Dakota, Ohio, Washington, Wyoming D. This policy includes these endorsements and schedules: See attached schedule. 4. The premium for this policy will be determined by our Manuals of Rules, Classifications, Rates, and Rating Plans. All information required below is subject to verification and change by audit. SEE EXTENSION OF INFORMATION PAGE Minimum Premium $ 538 Total Estimated Annual Premium $ Expense Constant $ Premium Discount $ Premium Audit Period: ® Annual; ❑ Semiannual; ❑ Quarterly; ❑ Monthly Countersigned: NOVEMBER 13, 2023 Issued Date: 11./14/2023 Issuing Office: P.O, Box 1250; Indianapolis, IN 46206-1250 10,779 160 -31 D,:F� 7 /W,44, Autl onze epresentative WCPDEC 04s4 INSURED 00267-00003 Page 1 of 4 INDIANA FARM r&Z BUREAU INSURANCE) WORKERS COMP & EMPLOYERS LIABILITY Policy No. WC 8341646 01 Policy Period From 0 8 / 21 / 2 0 2 3 to 0 8 / 21 / 2 0 2 4 at 12:01 a.m. Standard Time at the described location EXTENSION OF INFORMATION PAGE CLASSIFICATION OF OPERATIONS Code No. Classification Description Premium Basis Total Est. Annual Remuneration Rate Per $100 of Remuneration Estimated Annual Premium Indiana Rating Period 08/21 /2023 through 08/21 /2024 Site 00001 5183 PLUMBING NOC & DRIVERS 933,825 1.540000 14,381.00 8610 CLERICAL OFFICE EMPLOYEES - NOC 233,160 0.100000 233.00 Site 00001 Total $ 14,614.00 Total of Sites for Rating Period $ 14,614.00 Rating Period Total $ 14,614.00 Rating Period 08/21 /2023 through 08/21 /2024 9812 EMPLOYER'S LIABILITY INCREASED LIMITS 14,614 0.028000 409.00 9898 EXPERIENCE MODIFICATION 0.86 15,023 -0.140000 -2,103.00 9887 SCHEDULE RATING CREDIT 12,920 -0.200000 -2,584.00 0064 PREMIUM DISCOUNT 10,336 -0.003000 -31.00 0900 EXPENSE CONSTANT 160.00 0935 STATE ASSESSMENT/SECOND INJURY FUND 10,699 0.00750C 80.00 9740 TERRORISM 1,167,005 0.010000 117.00 9741 CATASTROPHE -OTHER THAN CERTIFIED ACTS OF TERRORISM 1,167,005 0.010000 117.00 Rating Period Total $ -3,835.00 Total of all NON -SPLIT Classes $ -3, 835.00 Total of all SPLIT Classes $ 14, 614.00 State Total $ 10, 779.00 Policy Total $ 10, 779.00 Issued Date: 11/14/2023 WCPDEC 0101 INSURED 00267-00004 Page 2 of 4 ME►NDIANA FARM BUREAU INSURANCE® Worker's Compensation and Employer's Liability Insurance Policy Policy No. WC 8341646 01 Policy Period From 0 8 / 21 / 2 0 2 3 to 0 8 / 21 / 2 0 2 4 at 12:01 a.m. Standard Time at the described location ENDORSEMENT SCHEDULE State Number Ed. Date Description 13 WC000000C 01/15 WORKERS COMP/EMPLOYER'S LIAR 13 WC000414A 01/19 NOTIFICATION OF CHG IN OWNER 13 WC000421F 01/22 CATASTROPHE (OTHER THAN CERTF) 13 WC000422C 01/21 TERRORISM RISK PROGRAM REAUTH 13 06--825 12/88 MUTUAL CONDITIONS 13 21-201WC 04/05 NOTICE TO POLICYHOLDERS Issued Date: 11/14/2023 WCPEs 0494 INSURED 00267- 00005 Page 3 01, 4 COMMERCIAL UMBRELLA DECLARATION INDIANA FARM fflow"M BUREAU INSURANCE(D Zi'-yNO. Transaction R=E TAL BUSINESS B 8609087 01 From 0 8 / 21 / 2 0 2 3 to 0 8 / 2 2 -_2 ' at I2:01 a.m. Standard Time at the described location Agent: Name and Phone Address JACOB KELLEY 2410 EDISON RD, SUITE 400 574-400-4389 SOUTH BEND IN 46615-3518 7601102 762 Named Insured NIEZGODSKI P-_��3-:;^, - 2 3 2 N 1M1AYE=O a SOUTH BE _:C--. __ Business Description Type of Business PIrt MRIL:C v `,=_K C-="- CORPORATION LIMIT OF INSURANCE Policy Aggregate Limit 2, c, c o 0 Self -Insured Retention s, -; , 000 SCHEDULE OF UNDERLYING INSURANCE REQUIREMENTS If policies providing the required "underlying insurance' indicated by "X" in Column A are either reduced, cancelled, discontinued or non-existant, the named insured's minimum "retained limit" is equal to the following: Type of A Liability Insurance Limits of Insurance x General Liability General Aggregate $2, 000, 000 Products - Completed Operations Aggregate 2 000 Personal and Advertising Injury Each Occurrence $1, floor coo_ _x. Auto Liability Each Accident or Bodily Injury Each Person Bodily Injury Each Accident Property Damage Each Accident or Combined Single Limit BI Liability/PD Liability Uninsured/ Bodily Injury Each Person: Underinsured Bodily Injury Each Accident: Motorist Liability x Employer's Liability Bodily Injury Each Accident $500, 000 Bodily Injury By Disease Policy Limit $500 , 000 Bodily Injury By Disease Each Employee 5500, 000 Forms and Endorsements Applicable to this policy: See Attached Schedule TOTAL PREMIUM: $2, 65C . 00 Issued Date: 07/04/2022 Authorized Representative 22-27212-93 INSURED 00154-00003 Page 1 of 1 A�� CERTIFICATE OF LIABILITY INSURANCE 02101120244118: 8 ` THIS CERTIFICATE 1S ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME.• Kelley, Jacob PHONE (574) 40p-4389 FAX 2410 Edison Rd, Suite 400 E MANa Ext : AIE Nat ADDRL Jacob.Kelley@infarmbureau.com South Bend, IN 46615 ` INSURED NIEZGODSKI PLUMBING, INC 232 N MAYFLOWER RD SOUTH BEND, IN 46619-1534 INSURER B : INSURER C : INSURER(S) AFFORDING COVERAGE NAICA United Farm Family Mutual Insurance Company 15288� COVERAGES CFRTIFIr ATF NI IIUIFtFR• oC71I0InKi Rn IRAaco. THIS IS TO CERTIFY THAT THE POLIGIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADDL'SUBR i POLICY EFF POLICY EXP LTR TYPE OF INSURANCE POLICY NUMBER MMIDD I MMIDDNYYYI LIMITS X COMMERCIAL GENERAL LIABILITY � OCCUR I EACH OCCURRENCE $1,000,000 —OAMCLAIMS-MADF E O R TE PREMISES Ea occurrence $ 50 000 ME❑ EXP (Anyyne person) `. $10 000 �... PERSONAL&ACV INJURY $1,000, 00 A BOP8236911 08/21/2023 08/21/2024 GEN'L X AGGREGATE LIMIT APPLIES PER: POLICY j a C� LOC I ? GENERAL AGGREGATE PRODUCTS- COMPfOPAGG I $2000 00 1 $ OTHER: AUTOMOBILE - LIABILITY j COMBINED SINGLE LIMIT Ea accident $ 1,OD0,00D BODILY INJURY (Per person) r $ [ ANY AUTO 1 AFOWNED { X SCHEDULED AUTOS ONLY � AUTOS CAPS524976 08121 /2023 08121 /2024 i BODILY INJURY Per accident) ( $ HIRED ? NON -OWNED AUTOS ONLY XAUTOS ONLYPROPERTYDAMAGE i Per accident $ i $ A X UMBRELLALIAB EXCESSLIM OCCUR i_CLAIMS_-M_A_D_1= UMB8609087 08/21/2023 I 08/21/2024 EACH OCCURRENCE $ AGGREGATE $2,000,000 DED RETENTION$10.000 $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANYPROPRIETORIPARTNERfEXECUTIVE OFFICERfMEMBEREXCLUDEO? N!A WC 834164b .08/2112D23 08/21/2024 X STATLITE ERH `—'— $1 000 000 -- E.L. EACH ACCIDENT E.L. DISEASE -EA EMPLOYER - -- -- -- --- --- F.L. $1,000,000 (Mandatory in NH) l yes, descdde under DESCRIPTION OF OPERATIONS below DISEASE -POLICYLI�$ 1,non nri0 i II DESCRIPTION OF OPERATIONS 1 LOCATIONS 1 VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space Is required) CFRTIFIrATF i4ni ITFR relurr-1 I ATInKi City of South Bend Board of Pubiic Works 227 W Jefferson BLVD SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS, South Bend 46601- AUTHORIZED REPRESENTATIVE Kelley, Jacob C71988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD 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 N ) ) SS: s: 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, not 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 -Miele. b. As provided by Ind. Code § 5-22-16.5-5, 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 Non -Collusion Non-D&a mmt Affidavit Non Iran Form the energy sector in Iran; and (ii) at the time the financial institution extends credit, is a person identified on list published by the Indiana Department of Administration. 4. Contractor does not knowingly employ or contract with an unauthorized alien, nor retain any employee or contract with a person that the Contractor subsequently learns is an unauthorized alien. Contractor agrees that he/she/it shall enroll in and verify the work eligibility status of all of Contractor's newly hired employees through the E-Verify Program as defined by I.C. 22-5-1.7-3. Contractor's documentation of enrollment and participation in the E-Verify Program is included and attached as part of this bid/quote; and 5. Contractor shall require his/her/its subcontractors performing work under this public contract to certify that the subcontractors do not knowingly employ or contract with an unauthorized alien, nor retain any employee or contract with a person that the subcontractor subsequently learns is an unauthorized alien, and that the subcontractor has enrolled in and is participating in the E-Verify Program. The Contractor agrees to maintain this certification throughout the term of the contract with the City of South Bend, and understands that the City may terminate the contract for default if the Contractor fails to cure a breach of this provision no later than thirty (30) days after being notified by the City. 6. Persons, partnerships, corporations, associations, or joint venturers awarded a contract by the City of South Bend through its agencies, boards, or commissions shall not discriminate against any employee or applicant for employment in the performance of a City contract with respect to hire, tenure, terms, conditions, or privileges of employment, or any matter directly or indirectly related to employment because of race, sex, religion, color, national origin, ancestry, age, gender expression, gender identity, sexual orientation or disability that does not affect that person's ability to perform the work. In awarding contracts for the purchase of work, labor, services, supplies, equipment, materials, or any combination of the foregoing including, but not limited to, public works contracts awarded under public bidding laws or other contracts in which public bids are not required by law, the City, its agencies, boards, or commissions may consider the Contractor's good faith efforts to obtain participation by those Contractors certified by the State of Indiana as a Minority Business ("MBE") or as a Women's Business Enterprise ("WBE") as a factor in determining the lowest, responsible, responsive bidder. In no event shall persons or entities seeking the award of a City contract be required to award a subcontract to an MBE/WBE; however, it may not unlawfully discriminate against said WBE/MBE_ A finding of a discriminatory practice by the City's MBE/WBE Utilization Board shall prohibit that person or entity from being awarded a City contract for a period of one (1) year from the date of such determination, and such determination may also be grounds for terminating the contact for which the discriminatory practice or noncompliance pertains. 7. The undersigned contractor agrees that the following nondiscrimination commitment shall be made a part of any contract which it may henceforth enter into with the City of South Bend, Indiana or any of its agencies, boards or commissions. Non -Collusion Non -Debarment Affidavit Non hw Form Contractor agrees not to discriminate against or intimidate any employee or applicant for employment in the performance of this contract with privileges of employment, or any matter directly or indirectly related to employment, because of race, religion, color, sex, gender expression, gender identity, sexual orientation, handicap, national origin or ancestry. Breach of this provision may be regarded as material breach of contract. I, the undersigned bidder or agent as contractor on a public works project, understand my statutory obligations to the use of steel products or foundry products made in the United States (I.C. 5-16-8-1). I hereby certify that I and all subcontractors employed by me for this project will use steel products or foundry products made in the United States on this project if awarded. I understand I have an affirmative duty to notify the City in my bid that my proposal does not include the use of steel products or foundry products made in the United States. I understand it is my sole obligation and responsibility to provide a justification to the City, subject to review and approval, why the cost of United States made steel or foundry products is unreasonable. Prior to award and upon submission of bid which does not use steel products or foundry products made in the United States, the City, through its director of public works, shall make a determination if the price of United States made steel or foundry is unreasonable. I understand that violations hereunder may result in forfeiture of contractual payments. 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 T7 -tk day of , 202A N t2 --,als Contr t r rider (F Signature )of Conteacto /dd/er or Its Agent (;Vn,Y�L Printed Nance and le Subscribed and sworn to before me this 101 day of Fe-rv� �t-y 261:1:1 My Commission Expires �� ��✓ ��' Wit' �%�} CRYSTAL D OSLER, Notary Public _ Nctary Fubi:c 01 f . SEAL A Resident of St, Joseph County, IN County of Residence �1 p ar zap Ccmmiss�ori No. N=0744298 R9y Ccr.- ss on Exp4es 10-13/203© Non-Coliusion Non -Debarment Affidavit Nan lima Form Effective Date•,January 9tht 2023 Western Surety Company LICENSE AND FERMIT BOND KNOW ALL PERSONS BY THESE PRESENTS: That we. Niezgadsici_ Plumbing, Inc Bond No_ 66467699 of Soutb Bend , State of Indiana , as Principal, and WESTERN SURETY COMPANY, a corporation. duly licensed to do surety business in the State of Indiana , as Surety, are held and firmly boned unto the C±ty of South Bend and saint Joseph Count -,State of Indian , as Obligee, in the penal SUM of Twenty Five Thousand and 00/100 DOLLARS ( 25 00. 00 ), lawful many of the United States, to be paid to the Obligee, for which payment well and truly to be made, we bind ourselves and our legal representatives, firmly by these presents. THE CONDITION OF THE ABOVE OBLIGATION IS SUCH, That whereas, the Principal has been licensed Performance by the Obligee. NOW THEREFORE, if the Principal shall faithfully perform the duties and in all things comply with the: laws and ordinances, including all amendments thereto, pertaining to the license or permit applied for, then this obligation to he void, otherwise to remain in full force and effect until January 4th 2024 , unless renewed by Continuation Certificate. This band may be terminated at any time by the Surety upon sending notice in writing, by First Class U.S. Mail, to the Obligee and to the Principal at the address last known to the Surety, and at the expiration of thirty-'five135 days from the mailing of said notice, this bond shall ipso facto terminate and the Surety sha"I�'elalelieved fran any liability for any acts or omissions of the Principal subsequent to said d;kte._;. ggs�s..otthe number of years this bond shall continue in: force, the number of claims made � a �us tMat,-an-the number of premiums which shall be payable of paid, the Surety's total limit of l 10ity shall not bd emulative from year to year or period to period, and in no event shall the Surety's total Batty Tor all'claims exceed the amount set forth above. Any revision of the bond amount shall nut be cui�i�iye � 1„,a55�,•` € . lFdltlk4i� Dated lus 5th day of January-2023 Niez odski Plum%in rnc- -_- _- Principal - Principal WESTE SURET COMPANY Jel By P�T.at,resident Form 532-5-2021 STATE OF SOUTH DAKOTA COUNTY OF N1 TNEliA A i ss ACKNOWLEDGMENT OF SURETY (Corporate Officer) On this bth day of January..2023 , before xne, the undersigned officer, personally appeared Paul T . Bruf lat ; who acknowledged himself to be the aforesaid officer of WESTERN SURETY COMPANY, a corporation, and that he as such officer, being authorized so to do, executed the foregoing instrument for the purposes therein contained, by signing the name of the corporation by himself as such officer. IN WITNESS WHEREOF, I have hereunto set my hand and official seal_ �tRM�rc�F+� S. GREEN $ NOTAW PUBUC S A SOUTH DAKOTA No ry Public — South Dakota My Commission Expires: February 12, 2027 ACKNOWLEDGMENT OF PRINCIPAL STATE OF � ss (Individual or Partners) COUNTY OF On this clay of , before nee personally appeared known to me to be the individual _ described in and who executed the foregoing instrument and acknowledged to me that —__he — executed the same_ My commission expires Notary Public ACIWOWLDDGMENT OF PRINCIPAL STATE OF (Corporate Officer') COUNTY OF ss On this day of _ _, before me personally appeared who acknowledged himselfiherself to be the Of __ , a corporation, and that hefshe as such officer being authorized so to do, executed the foregoing instrument for the purposes therein contained by signing the name of the corporation by himselEherself as such officer. My commission expires C_ CL irf d ri A gZz� tsfj a U W ` y i%7 a a Notary Public a r. o Hm 4 0 Q -1Z Western Surety Company POWER OF ATTORNEY KNOW ALL MEN BY THESE PRESENTS: That WESTERN SURETY COMPANY, a corporation organized and existing under the laws of the State of South Dakota, and authorized and licensed to do business in the States of Alabama, Alaska, Arizona, Arkansas, California, Colorado, Connecticut, Delaware, District of Columbia, Florida, Georgia, Hawaii, Idaho,Illinois, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maine, Maryland, Massachusetts, Michigan, Minnesota, Mississippi, Missouri, Montana, Nebraska, Nevada, New Hampshire, New .Jersey, New Mexico, New York, North Carolina, North Dakota, Ohio, Oklahoma, Oregon, Pennsylvania, Rhode island, South Carolina, South Dakota, Tennessee, Texas, Utah, Vermont, Virginia, Washington, West Virginia, Wisconsin, Wyoming, and the United States of America, does hereby make, constitute and appoint Paul T. Bruflat Of Sioux .Falls State of sot -D kota its regularly elected Vi ce Preside as Attorne)�-in-l=act, with full power and authority hereby conferred upon hire to sign, execute, acknowledge and deliver for and on its behalf as Surety and as its act and deed, the following band: One bond with bond number for Niezgadsici. P1umb'nIna as Principal in the penalty amount not to exceed: $ 25, n 0 0 , oo Western Surety company further certifies that the following is a true and exact copy of Section 7 of the by-laws of Western Surety Company duly adopted and now in force, to -wit Section 7. All bonds, policies, undertakings, Powers of Attorney, or other obligations of the corporation shall be executed in the corporate name of the Company by the President, Secretary, any Assistant Secretary, Treasurer, or any Vice President, or by such Other officers as the Board of Directors may authorize. The President, any Vice President, Secretary, any Assistant Secretary, or the Treasurer may appoint Attomeys-in-Fact or agents who shall have authority to issue bonds, policies, or undertakings in the name of the Company. The corporate sea] is not necessary for the validity of any fronds, policies, undertakings, Powers of Attorney or other obligations of the corporation. The signature of any such officer and the corporate seal may be printed by Facsimile. in Witness Whereof, the said WESTERN SURETY COMPANY has caused these presents to be executed by its Slice President with the corporate seal affixed this 5th day of __ January 2023 ATTEST �& L Bauder, Assistant Secretary WESTEyN URET COMPANY BY Paul T nrflat Vice President .a44�t&�Y:eslOfr9a- STATE OF SOUTH DAKOTA41 COUNTY OF MINNEHAHA "t��sa�aEa' On this 5th day of January 2023 before me, a Notary Public, personally appeared Paul T. Bruilat and L=Bauder who, being by me duly sworn, acknowledged that they signed the above Power of Attorney as vice President and Assistant Secretary, respectively, of the said WESTERN SURETY COMPANY, and acknowledged said instrument to be the voluntary act and deed of said Corporation. ��ayhd.Tuua°iq'15'S"a°,?iayai�a�s o°aTaS�f + s M. BENT s sAl<cs �v Pt�ral.Ic S L s 5 SOUTH DA KOTA x Public y commission Expires March 2, 2026 Notary th,�as�eyy5�yyhhha��',�,4�+ To validate bond authenticity, go to xn > Owner/Obligee Services > Validate Bond Coverage. Farm F1975-11-2022 f� Western Surety Company CONTINUATION CERTIFICATE Western Surety Company hereby continues in force Bond No., — 65 9 6 briefly described as ERFORM CE CITY OF SOUTH BEND AND B T for MTEZGODSKI-PLUMBING, I C , as Principal, in the sum of $ THOUSAND AND N041 Dollars, for the term beginning January 04 2024 , and ending Ja3mary 04 , 2025 , subject to all the covenants and conditions of the original bond referred to above. This continuation is issued upon the express condition that the liability of Western Surety Company under said Bond and this and all continuations thereof shall not be cumulative and shall in no event exceed the total sum above written. Dated this _ day of —November , 2023 WESTERN SURETY COMPANY By �d :any Kasten, Vice President THIS "Continuation Certificate" MUST BE FILED WITH THE ABOVE BOND. Form 90-A 6-2023 Western Surety Company FLOWER OF ATTORNEY KNOW .ALL MEN BY THESE PRESENTS: That WESTERN SURETY COMPANY, a corporation organized and existing under the laws of the State of South Dakota, and authorized and licensed to do business in the States of Alabama, Alaska, Arizona, Arkansas, California, Colorado, Connecticut, Delaware, District of Columbia, Florida, Georgia, Hawaii, Idaho, Illinois, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maine, Maryland, Massachusetts, Michigan, Minnesota, Mississippi, Missouri, Montana, Nebraska, Nevada, New Hampshire, New Jersey, New Mexico, New York, North Carolina, North Dakota, Ohio, Oklahoma, Oregon, Pennsylvania, Rhode Island, South Carolina, South Dakota, Tennessee, Texas, Utah, Vermont, Virginia, Washington, West Virginia, Wisconsin, Wyoming, and the United States of America, does hereby make, constitute and appoint Paul T. Bruflat of Sioux Falls State of South Dakota , its regularly elected V' ce P-r as Attorney -in -Fact, with full power and authority hereby conferred upon him to sign, execute, acknowledge and deliver for and on ifs behalf as Surety and as its act and deed, the following bond: One bond with bond number 66497699 for IN Lo-dski P1umf�anc�,. Inc as Principal in the penalty amount not to exceed: $ 25, 000.00 Western Surety Company further certifies that the following is a true and exact copy of Section 7 of the by-laws of WesteM Surety Company duly adopted and now in force, to -wit Section T. All bonds, policies, undertakings, Powers of Attomey, or other obligations of the corporation shall be executed in the corporate name of the Company by the President, Secretary, any Assistant Secretary, Treasurer, or any Vice President, or by such other officers as the Board of Directors may authorize. The President, any Vice President, Secretary, any Assistant Secretary, or the Treasurer may appoint Attorneys -in -Fact or agents who shall have authority to issue bonds, policies, or undertakings in the name of the Company. The corporate seal is not necessary for the validity of any bonds, policies, undertakings, Powers of Attorney or other obligations of the corporation_ The signature of any such officer and the corporate seal may be printed by Facsimile. In Witness Whereof, the said WESTERN SURETY COMPANY has caused these presents to be executed by its Vice President with the corporate seal affixed this 5th day of Januar 2023 ATTEST WESTE N URET COMPANY BY - L. Bauder, Assistant Secretary Paul T ruflat Vice President a4a$i'!5�!sh Yi sltPl�y. STATE OF SOUTH DAKOTA COUNTY OF MINNEHAHA On this 5th day of January 2023 before me, a Notary Public, personally appeared _ Paul T _ Bxuflat and L. Bauder who, being by me duly sworn, acknowledged that they signed the above Power of Attorney as Vice i? res ideal and Assistant Secretary, respectively, of the said WESTERN SURETY COMPANY, and acknowledged said instrument to be the voluntary act and deed of said Corporation. '4S-i��yg5'1'i�ir+a4yssh�ar+a�r�+�'vh9 + s M. PUBLIC s NT s s NNOTARYY Blrtt. S $ s SOUTH DAKOTA r Notary Public * my commission Expires march 2, 2026 To validate bond authenticity, go to m > Owner/Obligee- Services > Validate Bond Coverage. C' Form Fi975-11-2022