HomeMy WebLinkAboutRes.2779.09-09-2013BILL NO. 13-127
RESOLUTION NO.
A RESOLUTION AUTHORIZING THE CITY MANAGER TO
EXECUTE AN AGREEMENT WITH NIP KELLEY
EQUIPMENT COMPANY, INC., FOR THE MEADOWBROOK
STORAGE TANK
BE IT RESOLVED BY THE COUNCIL OF THE CITY OF CAPE
GIRARDEAU, MISSOURI, AS FOLLOWS:
ARTICLE 1. The City Manager, for and on behalf of the
City of Cape Girardeau, Missouri, is hereby authorized to
execute an Agreement with NIP Kelley Equipment Company, Inc.,
for the Meadowbrook Storage Tank, in the City of Cape Girardeau.
The Agreement shall be in substantially the form attached hereto
as Exhibit A, which document is hereby approved by the City
Council, with such changes therein as shall be approved by the
officers of the City executing the same.
PASSED AND ADOPTED THIS DAY OF`- '4"442013.
Harry E. Rediger, Mayor
ATTEST:
Gayle Conrad, City Clerk
�
,
CITY OF CAPE GIRARDEAU
Meadowbrook Storage Tank
STANDARD FORM OF AGREEMENT
BETWEEN OWNER AND CONTRACTOR
ON THE BASIS OF A STIPULATED PRICE
THIS AGREEMENT is dated as of the �ay of in the year
2013 by and befinreen the City of Cape Girardeau, Missouri (h inafter called OWNER)
and Nip Kelley Equipment Companv, Inc. (hereinafter called CONTRACTOR).
OWNER and CONTRACTOR, in consideration of the mutual covenants hereinafter set
forth, agree as follows:
Article 1. WORK.
The work of this contract comprises supplying labor, materials, equipment, tools and
supervision for the construction of a nominal 1,000,000 gallon ground storage tank
including electrical, instrumentation, and piping modifications. The project is located near
the intersection of Perryville Road and EI Rio Drive in Cape Girardeau, Missouri.
Article 2. ENGINEER.
The City Engineer or his or her designee is to act as OWNER'S representative, assume all
duties and responsibilities and have the rights and authority assigned to ENGINEER in the
Contract Documents in connection with completion of the Work in accordance with the
Contract Documents.
Article 3. CONTRACT TIMES.
3.1 The work will be substantially completed within 240 calendar days after the date when
the Contract Times commence to run as provided in paragraph 2.3 of the General
Conditions, and completed and ready for final payment in accordance with paragraph
14.13 of the General Conditions within 270 calendar days after the date when the Contract
Times commence to run.
3.2 Liquidated Damages. OWNER and CONTRACTOR recognize that time is of the
essence of this Agreement and that OWNER will suffer financial loss if the Work is not
completed within the times specified in paragraph 3.1 above, plus any extensions thereof
allowed in accordance with Article 12 of the General Conditions. They also recognize the
delays, expense and difficulties involved in proving the actual loss suffered by OWNER if
the Work is not competed on time. Accordingly, instead of requiring any such proof,
OWNER and CONTRACTOR agree that as liquidated damages for delay (but not as a
penalty) CONTRACTOR shall pay OWNER 1 100.00 for each day that expires after the
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a
time specified in paragraph 3.1 for Substantial Completion until the Work is substantially
complete. After Substantial Completion, if CONTRACTOR shall neglect, refuse or fail to
complete the remaining Work within the time specified in paragraph 3.1 for completion and
readiness for final payment or any proper extension thereof granted by OWNER,
CONTRACTOR shall pay OWNER 1 100.00 for each day that expires after the time
specified in paragraph 3.1 for completion and readiness for final payment.
Article 4. CONTRACT PRICE.
OWNER shall pay CONTRACTOR for completion of the Work in accordance with the
Contract Documents an amount in current funds equal to the sum of the amounts
determined pursuant to paragraphs 4.1 below:
4.1 for Lump Sum Amount.
LUMP SUM CONTRACT AMOUNT One million finro hundred sixty thousand seven
hundred finrentv-nine dollars and no cents ($ 1,260,729.00).
4.2 The Bidder agrees to complete other additional work that may arise (beyond the
scope of work contemplated under this Contract), and only upon prior authorization by
Owner, for the Supplemental Unit Bid Price stated below for the different types of such
additional work:
Assumed Potential Additional
Work Item Quantity of Work Unit Bid Price
1. Lean Concrete 16 cubic yard $ 100.00
Article 5. PAYMENT PROCEDURES.
CONTRACTOR shall submit Applications for Payment in accordance with Article 14 of the
General Conditions. Applications for Payment will be processed by ENGINEER as
provided in the General Conditions.
5.1 Progress payments; Retainage. OWNER shall make progress payments on account
of the Contract Price on the basis of CONTRACTOR'S Application for Payment as
recommended by ENGINEER, on or about the 10th day of each month during construction
as provided in paragraphs 5.1.1 and 5.1.2 below. All such payments will be measured by
the schedule of values established in paragraph 2.9 of the General Conditions (and in the
case of Unit Price Work based on the number of units completed) or, in the event there is
no schedule of values, as provided in the General Requirements.
5.1.1 Prior to Substantial Completion, progress payments will be made in an amount equal
to the percentage indicated below, but, in each case, less the aggregate of payments
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b
previously made and less such amounts as ENGINEER shall determine, or OWNER may
withhold, in accordance with paragraph 14.7 of the General Conditions.
90% of Work completed (with the balance being retainage). If Work has
been 50% completed as determined by ENGINEER, and if the character and
progress of the Work have been satisfactory to OWNER and ENGINEER,
OWNER, on recommendation of ENGINEER, may determine that as long as
the character and progress of the Work remain satisfactory to them, there
will be no additional retainage on account of Work completed, in which case,
the remaining progress payments prior to Substantial Completion will be an
amount equal to 100% of the Work completed.
90% (with the balance being retainage) of materials and equipment not
incorporated in the Work (but delivered, suitably stored and accompanied by
documentations satisfactory to OWNER as provided in paragraph 14.2 of the
General Conditions).
5.1.2 Upon Substantial Completion, in an amount sufficient to increase total payments to
CONTRACTOR to 95% of the Contract Price (with the balance being retainage), less such
amounts as ENGINEER shall determine, or OWNER may withhold, in accordance with
paragraph 14.7 of the General Conditions.
5.2 Final Payment. Upon final completion and acceptance of the Work in accordance with
paragraph 14.13 of the General Conditions, OWNER shall pay the remainder of the
Contract Price as recommended by ENGINEER as provided in said paragraph 14.13.
Article 6. INTEREST.
All moneys not paid when due as provided in Article 14 of the General Conditions shall
bear interest at the maximum rate allowed by law at the place of the Project.
Article 7. CONTRACTOR'S REPRESENTATIONS.
In order to induce OWNER to enter into the Agreement, CONTRACTOR makes the
following representations:
7.1 CONTRACTOR has examined and carefully studied the Contract Documents
(including the Addenda listed in paragraph 8) and the other related data identified in the
Bidding Documents, including "technical data".
7.2 CONTRACTOR has visited the site and become familiar with and is satisfied as to the
general, local and site conditions that may affect cost, progress, performance and
furnishing of the Work.
7.3 CONTRACTOR is familiar with and is satisfied as to all federal, state and local Laws
and Regulations that may affect cost, progress, performance and furnishing of the Work.
A-3
,
7.4 CONTRACTOR has carefully studied all reports of explorations and tests of
subsurface conditions at or contiguous to the site and all drawings of physical conditions in
or relating to existing surface or subsurface structures at or contiguous to the site (except
Underground Facilities) which have been identified. CONTRACTOR acknowledges that
such reports and drawings are not Contract Documents and may not be complete for
CONTRACTOR'S purposes. CONTRACTOR acknowledges that OWNER and ENGINEER
do not assume responsibility for the accuracy or completeness of information and data
shown or indicated in the Contract Documents with respect to Underground Facilities at or
contiguous to the site. CONTRACTOR has obtained and carefully studied (or assumes
responsibility for having done so) all such additional supplementary examinations,
investigations, explorations, tests, studies and data concerning conditions (surface,
subsurface and Underground Facilities) at or contiguous to the site or otherwise which may
affect cost, progress, performance or furnishing of the Work or which relate to any aspect
of the means, methods, techniques, sequences and procedures of construction to be
employed by CONTRACTOR and safety precautions and programs incident thereto.
CONTRACTOR does not consider that any additional examinations, investigations,
explorations, tests, studies or data are necessary for the perFormance and furnishing of the
Work at the Contract Price, within the Contract Times and in accordance with the other
terms and conditions of the Contract Documents.
7.5 CONTRACTOR is aware of the general nature of work to be performed by OWNER
and others at the site that relates to the Work as indicated in the Contract Documents.
7.6 CONTRACTOR has correlated the information known to CONTRACTOR, information
and observation obtained from visits to the site, reports and drawings identified in the
Contract documents and all additional examinations, investigations, explorations, tests,
studies and data with the Contract Documents.
7.7 CONTRACTOR has given ENGINEER written notice of all conflicts, errors, ambiguities
or discrepancies that CONTRACTOR has discovered in the Contract Documents and the
written resolution thereof by ENGINEER is acceptable to CONTRACTOR, and the Contract
Documents are generally sufficient to indicate and convey understanding of all terms and
conditions for performance and furnishing of the Work.
Article 8. CONTRACT DOCUMENTS.
The Contract Documents which comprise the entire agreement between OWNER and
CONTRACTOR concerning the Work consist of the following:
8.1 This Agreement (pages 1 to 7 inclusive).
8.2 Exhibits to this Agreement (pages BF-1 to BF-7 , inclusive as revised for Addendum
# 1).
8.3 Performance, Payment, and other Bonds, identified as exhibits and consisting of
pages.
A-4
.
8.4 Notice to Proceed.
8.5 General Conditions (pages 1 to 55 , inclusive). (EJCDC No. 1910-8 1990 Edition)
8.6 Supplementary Conditions (pages SC-1 to SC- 5 , inclusive).
8.7 Specifications bearing the title Meadowbrook Storage Tank .
8.8 Drawings.
8.9 Addenda numbers 1 to 2 , inclusive.
8.10 CONTRACTOR'S Bid (pages BF-1 to BF-7 , inclusive as revised in Addendum #
2) marked exhibit "A"
8.11 Pursuant to 285.530 R.S. Mo, the contractor must affirm its enrollment and
participation in a federal work authorization program with respect to the employees
proposed to work in connection with the services requested herein by 1) submitting a
completed, notarized copy of AFFIDAVIT OF WORK AUTHORIZATION and 2) providing
documentation affirming the bidder's enrollment and participation in a federal work
authorization program with respect to the employees proposed to work in connection with
the services requested herein.
8.12 Documentation submitted by CONTRACTOR prior to Notice of Award as listed in
Item 7 on Page BF-4 of the bid form.
8.13 The following which may be delivered or issued after the Effective Date of the
Agreement and are not attached hereto: All Written Amendments and other documents
amending, modifying or supplementing the Contract Documents pursuant to paragraphs
3.5 and 3.6 of the General Conditions.
The documents listed in paragraphs 8.2 et seq. above are attached to this Agreement
(except as expressly noted otherwise above).
There are no Contract Documents other than those listed above in the Article 8. The
Contract Documents may only be amended, modified or supplemented as provided in
paragraphs 3.5 and 3.6 of the General Conditions.
Article 9. MISCELLANEOUS.
9.1 Terms used in this Agreement which are defined in Article 1 of the General Conditions
will have the meanings indicated in the General Conditions.
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9.2 No assignment by a party hereto of any rights under or interests in the Contract
Documents will be binding on another party hereto without the written consent of the party
sought to be bound; and, specifically but without limitation, moneys that may become due
and moneys that are due may not be assigned without such consent(except to the extent
that the effect of this restriction may be limited by law), and unless specifically stated to the
contrary in any written consent to an assignment no assignment will release or discharge
the assignor from any duty or responsibility under the Contract Documents.
9.3 OWNER and CONTRACTOR each binds itself, its partners, successors, assigns and
legal representatives to the other party hereto, its partners, successors, assigns and legal
representatives in respect to all covenants, agreements and obligations contained in the
Contract Documents.
9.4 Any provision or part of the Contract Documents held to be void or unenforceable
under any Law or Regulation shall be deemed stricken, and all remaining provisions shall
continue to be valid and binding upon OWNER and CONTRACTOR, who agree that the
Contract Documents shall be reformed to replace such stricken provision or part thereof
with a valid and enforceable provision that comes as close as possible to expressing the.
intention of the stricken provision.
9.5 Pursuant to 292.675, R.S. Mo, the contractor is informed that all contractors or
subcontractors doing work on this project to provide, and require its on-site employees to
complete, a ten (10) hour course in construction safety and health approved by the
Occupational Safety and Health Administration ("OSHA") or similar program approved by
the Missouri Department of Labor and Industrial Relations which is at least as stringent as
an approved OSHA program. The training must be completed within sixty(60)days of the
date work on the project commences. On-site employees found on the worksite without
documentation of the required training shall have finrenty (20) days to produce such
documentation.
9.6 The General Contractor shall provide to the City of Cape Girardeau City Engineer's
Office weekly certified payrolls from the General Contractor and all Subcontractors during
the course of the project. These must be provided on a weekly basis; if no work was done,
then a payroll stating "No Work Done" must be submitted.
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IN WITNESS WHEREOF, OWNER and CONTRACTOR have signed the Agreement in
multiple copies, One counterpart each has been delivered to CONTRACTOR and
ENGINEER and two counterparts to the OWNER. All portions of the Confract Documents
have been signed, initialed or identified by OWNER and CONTRACTOR or identified by
ENGINEER on their behalf.
�
This Agreement will be effective on '� '' , 2013 (which is the
Effective Date of the Agreement). �
OWNER Citv of Cape Girardeau CONTRACTOR Nip Kelley Equipment
�
Scott Me Ci ana er Com an Inc.
Y� BY� �
ORPO TE S L] CORPORAT L]
`�'�`n� .2, �1-� ,� �.��`ti�e✓1-�–
Attest � � Attest �`—
Gayle Conrad, City Clerk �,�Q�k � � ���ve�,�'�
�
Address for giving notices Address for giving notices
401 Independence Street � � �� `+�'\ � �
Caqe Girardeau, MO 63703 C� �►�ar C(.( � �1, �����
(If OWNER is a public body, attach License No. � �� ��
evidence of authority to sign and
resolution or other documents Agent for service of process:
authorizing execution of Agreement.
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���. , (If CONTRACTOR is corporation,
' � ��' ���".,� attach evidence of authority to sign.)
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� EXBIBIT 'A"
CITY OF CAPE GIRARDEAU
Meadowbrook Storage Tank
. BID FORM
(EJCDC 1910-18) (1990)
PROJECT(DENTIFICATION: The improvement consists of supplying afl labor, materials,
equipment,tools and supervision forthe construction of a nominal 1,000,000 gallon ground
storage tank inciuding electricai, instrumentation, and piping_modfications; and all other
appurtenances as specified in the bid documenfis for the City of Cape Girardeau, Missouri.
THIS BID IS SUBMITTED TO: CITY OF CAPE GIRARDEAU, MO
401 INDEPENDENCE STREET
CAPE GIRARDEAU, MO 63703
1. The undersigned BIDDER proposes and agrees, if the Bid is accepted, to enter into an
agreement with OWNER in the form included in the Contract Documents to perform and
. fumish all Work as specified or indicated in the Contract Documents for the Bid Price and
within the Bid Times indicated in this Bid and in accordance with the other terms and
conditions of the Contract Documents.
2. BIDDER accepts all of the terms and condfions of the Advertisement or Invitation to Bid
and Instructions to Bidders, including without limitation those dealing with the disposfion of
. Bid security. This Bid wilt remain subject to acceptance for sixty days after the day of Bid
opening. B(DDER will sign and deliver the required number of counterparts of the
Agreement with the Bonds and other doauments required by the Bidding Requirements
� within fifteen days after the date of OWNER'S Notice of Award.
3. In submitting this Bid, BIDDER represents, as more fully set forth in the Agreement,
that
; (a) BIDDER has examined and carefully studied the Bidding Documents and the
folfowing: � �
Addenda, receipt of all which is hereby acknowledged: (u�,ada�aa by��,a�m N���a��
#1 - August 9, 2013
#2 - August 15, 2013
(b) BIDDER has visited the si�e and become�familiar with and is satisfied as to the
general, local and site conditions that may affect co$t, progress, perFormance and
fumishing of the Work;
(c) BIDDER is familiar with and is satisfied as to all federal, state and local Laws and
Regulations that may affect cost, progress, performance and fumishing of the Work.
BF-1
(d) BIDDER has carefulty studied aFl reports of explorations and tests of subsurface
conditions at or contiguous to the site and ali drawings of physical conditions in or relating
to e�asting surFace or subsurface structures at or contiguous to the site (except �
Underground Facilities) which have been i�entified. BIDDER acknowledges that such
reports and drawings are not Contract Documents and may not be complete for BtDDER'S
purposes. BtDDER acknowledges that OWNER and Engineer do not assume
responsibility for accuracy or compfeteness of informafion and data shown or indicated in
the Bidding Documents with respect to Underground Facilities at or contiguous to the si�e.
B(DDER has obtained and carefi�lly studied (or assumes responsibility for having done so) �
all such additional or supplementary examinations, investigations, explorations, tests,
studies and data conceming conditions(surface,subsurFace and Underground Faaffies)at
or contiguous to the site or otherwise which may affect cost, progress, perFormanc�or
fumishing of the Wor1c or which relate to any aspect of the means, methods, techniques,
sequences and procedures of construction to be employed by BIDDER and safety
precautions and programs incident thereto. BIDDER does not considertt�at any additiona( .
examinations, investigations, explorations, tests, studies or data are necessary for the
determination of this Bid for performance and fumishing of the Work in accordance with the
times, price and other terms and conditions of the Contract Documents.
(e) BIDDER is aware of the general nature of Work to be performed by Owner and
others at the site that relates to Work for which this Bid is submitted as indicated in the
Contract Documents.
(fl BIDDER has correlated the information known to B(DDER, information and �
observations obtained from visits to the site, reports and drawings ide�tified in the Contract
Documents and all additional examinations, invesfigations,e�lorations,tests,studies and
data with the Contract Documents.
(g) BIDDER has given Engineer written notice of all conflicts, errors, ambiguities or
� discrepancies that BIDDER has discovered in the Contract Documents and the written
resolution thereof by ENGINEER is acceptable to BIDDER, and the Contract Documents
are generally sufficient to indicate and convey understanding of all terms and conditions for
performing and fumishing the Work for which this Bid is submitted.
(h) This Bid is genuine and not made in the interest of or on beha�f of any undisclosed
person, firm or corporation and is not submitted in conformity with any agreement or rules
of any group association, organiza�on or corporation; BIDDER has not directly or indirectty
induced or solicited any other Bidder to submit a false or sham Bid; BIDDER has not
soficited or induced any person, firm or corporation to refrain from bidding; and BIDDER
� has not sought by collusion to obtain for itself any advantage over any other Bidder or over
OWNER. �
(i) Pursuant to 285.530 RSMo;the bidder mustaf�rm its enrollmerrt and participation in
a federal work authorization program with respect to the employees proposed to work in
connection with the services requested herein by
BF-2 �
• submitting a comple#ed, notarized copy of AFF(DAVIT OF WORK
AUTHORIZATION and
• providing documentation affirming the bidde�'s enrollment and participation in a
federai work authorization program with respect to the employees proposed to work
in connection with the services requested herein.
� http://www.uscis.gov/portaUsite/uscis .
(j) Bidders are informed that the Project is subject to the requirements of Section
292.675, .R.S. Mo, which requires all contractors or subcontractors doing work on the
Project to provide, and require its on-si�e employees to complete, a ten (10}hour course in
construction safety and heatth approved by the Occupationaf Safety and Heat�h
Administration (�OSHA°)or similar program approved by the Missouri Departrnent of Labor
and Industrial Relations which is at least as stringent as an approved OSHA program.The
training must be completed within sixty (60) days of the date work on the Project
commences. On-site.employees found on the worksite without documentation of the
required training shal! have twenty (20) days to produce such documentation.
4. BIDDER will complete the Work in acxordance with the Contract Documents for the
following price(s): , -
1,000,000 Gat{on Welded Steel Tank � .
Lump Sum Contract Price
One Million two hundred sixty thousand seven hundred $1 ,260,729.00
{Words) , twenty-nine dollars (Figu�es)
(Total bid amount is to be shown in both words and figures. In case of discrepancy,the
amount shown in words will govem.)
5. The Bidder agrees to complete other additional work that may arise(beyond the scope
of work contempfated under this Contract), and onfy upon prior authorizafion by Owner,for
the Supplemental Unit Bid Price stated below for the different fypes of such additional
work: �
Assumed Potenfial Addfional
. Work ftem . Quantitv of Work Unit Bid Price
1. Lean Concrete 16 cubic yard � � oo.oo/cubic yard
BF-3
6. BIDDER agrees that the Work will be substantially complete within 240 calendar days
after the date when the Contraet Times commences to run as provided in paragraph 2.3 of
the General Conditions, and completed and ready for final payment in accordance with
paragraph 14.13 of the General Conditions within 270 calendar days after the date when
the Contract Times commences to run.
BIDDER accepts the provisions of the Agreement as to liquidated damages in the event of
failure to complete the Work within the times specified in the Agreement.
7. The following documents are attached to and made a condition of this Bid:
(a) Required Bid Security in the form of bid bond or cashiers check.
(b) Exhibit Affidavit of Work Authorization �
(c) Exhibit Affidavit of Excessive Unemploymen# (if applicable)
(d) The E-Verify Program for Unemployment Verification Memorandum of
Understanding http://www.uscis.qov�les/nativedocuments/MOU pdf
(e) Exhibit Affidavit of OSHA Training �
� (fl Certification Regarding Debarment, Suspension and Other Responsibility Matters
8. Bidder agrees to submit the following documents within three (3) business days after
the opening of Bids if requested:
(a} BIDDER'S Qualification Statement with supporting data.
9. Communications conceming this Bid shall be addressed to:
Name Vince Relley
Address 41 North Sprigg st. , Ca e Girardeau, MO 63701
(a) Performance and Payment Bonding Company
Name Merchant's Bonding Company
Address 2100 Fleur Drive, Des Moines, IA 50321
AgentlPower of Attomey Name (if used) Donald L. Wasoba
Address 22 Avacado Circle, St. Peters, MO 63376
BF-4
10. Terms used in the Bid which are defined in the General conditions or instructions will
have fihe meanings indicated in the General Conditions or Instructions.
SUBM(TTED on August 20 , 20 1 3
State Contractor License No. 0 010 5 7 5
IF BIDDER is: �
An Individual
BY (SEAL)
(Individual's Name)
doing business as
Business address: .
Phone No.:
A Partnership
gY (SEAL)
(Firm Name) ,
(General Partner)
Business address:
Phone No.: �
� .. ;�, �..
�''-.;m—....a,''��'t�`'
� ,�,`QE�QF8�� - .
'y.,�, �b�� �T��! Kelle quipment Co. , Inc. (SEAL)
- ����>,, F;�� � � (Corporation Name)
- A�.,;G s �, �i-s�ouri
�E� ;.�� � _ `
'� ( of Incorporation)
-���. -���+' i � � r.
���. __.��' (S�)
� �'�+f �`" -` � a f Person Aufihorized to Sign)
Vince elley, Pr s 'dent
� e)
(Corporate � SealAttest
; G
Fr�nk Myers(SeC!'efi.ary)
BF-5
Business address: 41 N, sprigg st. �
Cape Girardeau, MO 63701
Phone No.: �573) 334-0553
Date of Qualficafion to do business is January 1974
A Joint Venture
By � (SEAL)
, (Name)
(Address)
By (SEAL)
(Name)
. (Address)
Phone Number and Address for receipt of ofificiai communications:
(Each joint venturer must sign. The manner of signing for each individual, partnership and
corporation that is a party to the joint venture shoutd be in #he manner indicated above.)
BREAKDOWN OF W�RK FORCE (Required):
The Contractor sha(I be registered with the Missouri Secretary of State in order to work on
this project.
BIDDER hereby states that he will perform the fotlowing items of work direcdy without
employment of subcontractors:
Everything not listed below �
BF-6
It is anticipated that the foliowing subcontractors wiil be employed for work on this project
*SUBCONTRACTORS:
(Name of Company) (Type of Work)
Welker Fence Fencing
Control System Integration Electrical
Fisher Tank Company Tank Supply/Erection
*AUsubcontractors shal!be registered with tlie Missouri Secretary of State in order
to work on this project .
BF-7
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BIDDFR(Nar,�e a�td Addrassl:
Nip Kel ev Eani�ent Comnanv, Inc . .
41 North Sariaa Street �_...." �
Cape Girarc3eau. 1� 63703 � ..- .
SUSSCS[tNo�ea•d�a�'Pri�a�mi PLmoe af�- . . .
Bo�Y3i (�anv( ,t, )
2I00 Fleur Driv�e ' "' �; -
Des Ybines, IA 50321 Tel: 515-243-8171
�8r11►w�es r�d'�ldditiss}: '
Citp of Cane Girardea.0_
Ci.ty Hall, 401 Indep�deql0e S`t�='eet --.,_
Cape irardeau, 1►� 63701 .
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� FaW sum aet f�th m�� ��d1e p��r'�!�t�te si���sd tie
af tl�Bond. �der o€�B�d�is aot fa oo�t�re��i
��a�teil�aud c�Unct
2, Defsnit offfidda shat!aec�q��F��ufBi�dr,�tti I 1. 7hG 5am"bid`gs u�ed l+oc�ip inc�udes a bid.otfer ac pivpos3t
deIik�v�ti�ciic ti�tequir�ip tbe Bidd"�ppcu�t� �
acenatcd A�raa,����y���a�a� ��.
p�'artnaBCtaad PsY[adu boads�equised byt�e gi�
Doaunaia�d����.
3 71eis cbiega�ion shat;6oat�i aad.Ao;d if
3.l Oamer aCceyt�8idda's hid sad&dder dclerr�az w;m;n
��I1C t�tir�p3'tlu Biddut8 t3ecua�rncr(ar any ..
���sion tD�+eat'�gteed m ia vn�g bj►py�j�
extca6od A�t nq�d b9 d�e 8idd'a� •
d°�u��u'��Y P�ce�ad paye��bo+nd�
*rquic�ed by d�e Bid�nR�owmea�aod Costsa�t
��
3.� A11 bids ast�rjecree3 hy Oorttet;or
33 �ier taiis as'vsue a rotio�af a•�trd m Bidd�sritL�
tic sealc s�er.iGed in�t Eiddip6 Dacbiaes�(oe say
�tl�rm�a�cd�ia'r�6 hY Bidda�I.it
sAAi�bic ca�nalcd�o by S�w�en eeqaasd bp
W�ph 5]uao�
4. �n��da this Bond wiit De Que and A�bk upon det�utt
M'B1�deraaQ v'itTsin 3Q�alesd�nrdays�l1a texipt 6y�c e�
S��'of wziaat tEotict ot8e�+tt�ora Qrveta;wdrid�notiee w71
br�ea a�ith ses;ouahk Pras�.�a this 8a�d a�d
�'°�aad e�t�g a at�mCtnenc��e.�dae.
5. Swrcy waiv�imcice oFadd�y sad alt A�rs�s based es�
ansfn�a.,c of�y��ro issQa noEix afa�aM�tu
ia�v�itiag by Oar�tr ond 8�dde�p�,ided dnc rl,e tirrn for�auing
no�of aar��B�ieas tloit�ot ia�u aggre�
exesed i20 d�ya from�id i?.�Da�e�viiLoex Sa�ry�a��
coeueat
6. t1e wit�attioa�►���dlis 800d�=p
30 aJeridu-d�ys at�r t�nvtice afdcfiwtt rec�Cired�paca�raph 4
°�'P°Q��"�bi'B+�att3 Suretp,and ic no eace 18tec than
BneYq�t a!!er Bid Dne Dn�
7. .�ay suit oracti���;e�shsiE b�c�ctractd v�in
a cant o�con�eni judsdicaon taakd i�t!�s4�u ie wLcl�Wa
F�a��oca�,
B. 1Vdict trguissd herenadaabgii be ia wdtit�m�d urtS�Hidder
nnd Snreay ac�mp�iv���alrowa on�e fa�x nt d�is
800d_S�ch not�s R1�y he uac 6Y 8e�oaa�!ddivay.mramani�l
��or by[TnMed Su�e:B�d ar Cr�tiSed t.fa�f.�re-
��������wbt � :..
R. Suaety eh�A s�nsa bo be anaehc�ia t�it Hond$�Yeceot ind
��cun e Pau�arAeorner p���►of t1�06�,
�or�rstivr wi�mUcvred tlaa 8ond an bdatfa�Su�etp
��,Mwi aaa�liv�such Boad�ud�d the Sittexy�p. .
i a. 77aa�ond it ir�d 1a coaform tu i1i app(icabte t�y . � " - �;' . ,
�-�+Y�►�i�Creqva�at4E'�i'�4 .. ,;�f�,f,� :
,nd�imre�����i dde�aod s�ft he deamed t�� ' , ;;.';-'.�% .
�tOt�effi at kngdt, }ta�P�'o�i�af tiu ... ._ f.'
�r•,
� ... '� J
��.�7��i�i9�{7d�DQ� B.[�L " _ _ _�e't;/.,� - _ ,.::�
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i • ��"t - '
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� MERCHANT�S�
BONDING COMPANYn
POWER OF ATTORNEY
Know All Persons By These Preserrts,that MERCHANTS BONDING COMPANY(MUTUAL)and MERCHANTS NATIONAL BONDING,
INC.,both being corporations duy organized under the laws of the State of lowa(herein colledivey cailed the`Companies�,
and that the Companies do hereby make,constiitute and appoirrt,individually,
Donald L Wasoba
of St Peters and State of MO their true and lawfial Attomey-in-Fad,with Tull power
and authority hereby conferred in their name,place and stead,to sign,exec�te,acknowledge and deliver in iheir behalf as surety
any and all bonds,undertakings,recognizances or other written obiigations in the nature thereof,subjed to the limitation that any
such instrument shall not exceed the amount of:
TR'O MII.LION(52,000,000.00)DOLLAR5
and to bind the Companies thereby as fulty and to the same extent as if such bond or undertaking was signed by the duly
authorized officers of the Companies,and all the acts of said Attomey-in-Fact, pursuant to the authority herein given,are
hereby ratified and confirtned.
This Power-of-Attomey is made and executed pursuant to and by authority of the following By-Laws adopted by Uie Board of
Diredors of the Merchants Bonding Company(Mutual)on April 23,2011 and adopted by the Board of Diredors of Merchants National
Bonding,Inc.,on Odober 24,2011.
"The President,Secretary,Treasurer,or any Assistant Treasurer or any Assistarrt Seaetary or any vce Presiderrt shall have
power and authority to appoirrt Attomeys-in-Fact,and to authorize them to execute on behalf of the Company,and attach the
seal of the Company thereto,bonds and undertakings,recogn¢ances,contracts of indemnity and other writings obligatory in
the nature thereof.
The signature of any authorized officer and the seal of the Company may be affuced by facsimile or eledronic transmission to
any Power of Attomey or Certification thereof authorizing the execution and delivery of any bond,undertaking,recognizance,
or other suretyship obligations of the Company,and such signature and seal when so used shall have the same force and
effed as though manuatiy foced"
In Wdness Whereof,the Companies have pused this insWmerrt to be signed and sealed this 2nd day of Ma� , 2012.
.....a...,,,ti �.•---•.�
,����*��p f�,��"�y,. ��0��1G.Cp�'A� MERCHANTS BONDING COMPANY(MUTUAL)
:�g•�4��p�9�QO; �00�0(iPUq;�9y�� MERCHANTS NATIONAL BONDING,INC.
-.: '.-�. -0_ °�;�? :y.== -o- a� :
.'Q' ix; �Z' �3:
;x.; ' 1933 :e
z V Z�i173 ?.�- SJ. •C1r: BY �
:��y'• •' � � b���" �
.:;�jr�,r, •.�k, ••'i'�'�:
STATE OF IOWA ,I y, .� �• • � •
COUNTY OF POLK ss.
' "a...�.�«.��• • ,•••••• President
On this 2nd day of March ,2012,before me appeared Larty Taylor,to me personaliy known,who being by me duly swom did
say that he is Presiderrt of the MERCHANTS BONDING COMPANY(MUTUAL)and MERCHANTS NATIONAL BONDING,INC.;and
that the seals affixed to the foregoing instrumerrt is the Corporate Seals of ihe Companies;and that the said instrument was signed and
- sealed in behalf of the Companies by authority of their respecHve Boards of Directors.
In Testimony Whereof,I have hereurrto set my hand and affixed my Officiai Seal at the City of Des Moines,lowa,the day and year
first above written.
yMARANDA GREENWALT �� � � -�
�F Commission Number 770312
My Commfssion Expires
October 28,2014
Notary Pub/ic,Polk County,lowa
STATE OF IOWA
COUNTY OF POLK ss.
I, William Wamer,Jr.,Secretary of the MERCHAIYTS BONDING COMPANY(MLRUAL)and MERCHANTS NATIONAL BONDING,INC.,
do hereby certity that the above and foregoing is a true and corred copy of the POWER-0E-ATTORNEY executed by said Companies,
which is still in full force and effed and has not been amended or revoked.
In Witriess Whereof,I have hereurtto set my hand and affaed the seal of the Companies on
this � day of August � 2013 � `�''
.r���H1N.. •�....... � � ---
�•• .� �""�, • �N6 Cp •.
�,�a * tQf� � �.,^ ;�0........qf,o� "-- -.
.• � �; •o;•'AP09•• y . h� n/
:�j .���R4�'._0�- ��-�,4 9r;.Z.�� !/�G,�� ?����-�� " ,� ~
:�;'G �o:�? .ty—:•= -o- o� : .''`_'� :`'',
:�; � :�_ ;a' 1933 ;"C; Secretary ;, 'r�'' +� . �.+.�. '�;-..:.
_+�� 2��3 :��,= :yvd. .�c.• ::� ,,-J�
POA 0014 (11/11) '-,,s►f+' • «':r��'�a' '•;'h�"����1.• ",_ , -� �..�
���•�* ,�a �����N�� . : f � .��'��t �j • !-�,. .
���NIHr�iNl� .. .�. . �- .. :,�� .
��
'!I. . ;riy ;��
-� ��i�f� '�:���, - �.°r�:
. ... �'�'�. ,te�ij::
EX�IIBI'T
AFFIDAVIT OF WOR%AUTHORIZATION
COMES NOW(N�) Vince Kellev as (o�iccHrl� President �
of(CompaapName/Contcactos) Nip Kelley Equipment Co. ,Ir�{�t being dulp stvom, on
my oa.th,affitm as foIlows:
1. (Compaay Name/Con�a.cto=) Nip Rel ley Equipment Co. , Inc.
is enroIled. and w�11 continue to participate in a fedeta]. work authorization program in respect to
emplopees that w�71 work in connecrion with the contracted services=eMl.aeta��w}�rmo�ol���orage Tank '
�r
for the duration of the contract in accordance with RSMo Chaptet 285.530(2).
2. I also affitm that(CompanyName/Coatsacto=) Nip Kelley Equipment C@e� Inc.
not and wi11 not knowinglp emplop a petson who is an una.uthorized alien in connection with the
contract services related to (PZojectName)Meadowbrook Storage Tank fot
the duration of the contraet
� 3. Atta.ched. hereto is documentation affianing Contta.ctoi's eeattollment and
partici�ation in a federal wotk authozization progsam with �espect to the esnplopees wor�ng in
connection with the contracted services.
FURTT�ER AFFlANT SAITH NOT.
� IN AFFTRMA'j'ION TF�RFOF, the facts stated above aze true and correct (the
undetsigned undesstands that faLse statements made in this filing are subject to the
penalties provided in Section 575.040,RSMo.) �
_ Nip K�lley Equipment Co, Inc.
(name of zporation)
By:
. (name f officer of w=po aad tit3e)
Vince Kelley, esident
A�
/"� ,.
��;���`��'� Frank Myers
. ,� :_:'s�'�� d�e;�i
K��.' ra
i' Va�� ��''�� .- _ .•se�'•�- _ .
, � .� �� 1, . .., ..
�-��;cc�o��.
.j �i � `�
_.�e v . �\^ ..> `� .
. _ oGj - - �
1=�� �^,o; t _� '�..
_ �:�," � �,
- -;°;':' _ �-,.
r . .« �
, , . _;. ..
- �.,-<.
STATE OF MISSOURI ) �
. ) ss.
COUN'I'Y OF C.APE GIRARDEAU ) .
On this �3�dap of Au 20�before me appeared V i�l�.Z �.2���
to me pezsonally known,who,b bp me duly swom,did sap that�e she is the i �{--�
of - �� 4 " /1-�� ��Mssouri Corporation� and that the seal aff�ed to the
foregouig ins en is e seal of said Corporation, and that the said �nctri�**�e.at was signed and
sealed in behalf of said Cozporation bp authoritp of its Board of Directors, and acknowledged said
jnctrument to be the free act and deed of said Corporrxion.
IN TE,STIl�IONY��REOF,I have hereu�nto set my hand and affiged mp official seal, at
my office in Cape Girardeau,Mtssour�the dap and peat fi=st above written.
. Q�: �
� Notary Public
� ,,,��,,
o�qRY PU�, STAq L PEPPLE
Mp Commissi.on F.gpires: _�:`N�TARY*_ �'�""�0"�
,�: � - �9��o��
a2 �4�t'1 � �Pf, .'` Corrrr�n n�3a,�a2t7
, • :��: �:.>c���
,�- � i %/'u�"`�l
' ` '' ���Ifl��z
�y 1� r� - �� �
� ��• ���' ;�1siS�
' � i-vuui ss a sexvzci or exs
�::
C.omparry ID Number:211168
THE E-VERIFY PROGRAM �OR EMPLQYMENT VERIFICATION
MEMORANDUM OF UNDEI�TANDING
ARTICLE 1
PURPOSE AND AIJTHORiTY
This Memorandum of Unders#ancfing (MaU� sets forth the points of agreement be#w�e� the
Department s�f Homeland �ecurity (DHS) and Ni� Kellev Eauipment Companv. �nc.
(Employer) regarding the Employers participafion in the Employment Eligibility Verification
Program (E-Verify). This MOU explains certain features of the E-Verify prog�am and
enumerates specific responsibilities of DHS, the Social Security Administration (SSA), and the
Employer. E-Verify is a program that electronicalfy confirms an employee's eligibility to work in
the United States after completion of the Employment Eligibility Verificafiorr Form (Form 1-9).
For covered government contractors, E-Ver'rfy is used to verify the employment eligibility of all
newly hired employees and all existing employees assigned to Federal contracts.
Auth�rity for the E-Verify Rrogr�m is found � Title IV, Subtitle A, of the Ilfegal lmmigration
Reform and Immigrant Responsibility Act of 1996 �t[R1F�A), Pub. L 104-208, 110 Stat. 3009, as
amended (8 U.S.C. § 1324a note). Authority for u�e of the E-`✓erify program by Fe�eral
contractors and subc�ntractors covered by the terms of Subpa�t 22.18, "Employment EligibiAty
Verification", of the Federal Acquisition Regulation (FAR) (hereinafter referred to in this MOU as
a "Fed�ral cortracto�') to verify �the employment el;gibilit�r:of certain employees working on
Federal contracts is also found in Subpart 22,18 and in Exec�tive Grde� 12989, as amended.
ARTICLE I!
FUNC110NS TO BE PERFORM�D
A. RESPONSIBILITIES OF SSA
1. SSA agrees to provide th� Employer with av�ilabl�mft�rmation that allows the Employer
to �flr�#irm the accuracy of Social Security Numbers provided k�y all employess ver'rfied under
this MOU and the employment authorization of U.S. ciflzens.
2 SS� agrees to provide to the Employ�r appropriate assis#ance v+ri�h operatiortal
problems 'that may arise during t�te E,�tplayer's participation in the E-�ferify Rragram. SSA
agrees to provide the Emplayer ►nrith names, titles, addresses, and telephorte numbers of �A
representatives to be contacted during the E-Verify prQCEss.
3. S5A agrees to safeguard the informativn provided by the Emplvyer through th� E-Verifiy
program procedures, and to Gmit ac�ess to suc� rrrf�mration, as is appropriate by Iaw, tu
indivlcfuals responsible for the verifiiea�ion of So�ial SeCurity TVumbe�s and for evaluation of the
E-Verifiy program or such oth�r persons or errti�es who may ae �uthorized by SSA a� govemed
by the Privacy Act (5 U.S.C. § 552a), the Social Security Act (42 U.S.C. 1306(a)), and SSA
regul�ti�ns.(20 CFR Part 401).
Page 1 af��IE-Veri�P�OJ iur Em�yer�Rtvi��ar�l?�!� 1iL�29/A8 t-:.. vi`:? ; ,- ,
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E-VC62Ct 28�StRVSCS O�GtlS
Gbmpany ID Number.211168
4. �S1� agrees to pro�ride � means of automated verification that is designed ('rn
c�nJunction wi�h �HS's aut�mated system if necessary) to ptovide confirmation or t�nt�i�ve
nonconfirmation of U.S. citizens' employment eligibility within 3 Federal Govemment uvor�k-days
of the initial inquiry.
5. SSA �grees to provide. a mearrs of secoRdary ve '�ftcatibn (including updating SSA
records as may be necessary) for employees who contest SSA tentative nonconfirmations that
is designed to provide final confrrmation or nanconfirmation of U.S. citizens' employment
etigibility and accuracy of SSA records for both citizens and aliens within 10 Federal
Govemment work days of the date c� referral to SSA, unless SSA determines that more than 10
days may be necessary. In such cases, SSA will provide additional verification instructions.
B, RESPOI�ISIBtLIT�ES OF DHS
1. �fter SSA verffies the accuracy of SSA records for afiens thfough E-Verify, DHS agrees
�o provide the Employer access �o selected data from DHS's database to enable the Emptoyer
to conduct, to the extent authorized by this MOU:
• �utomated verification checks on alien emptoyees by elecfironic means, and
• Photo verification che�ks (when available}on employees.
2. DHS agrees to pra�idE to the Employer appropriate assistance vvith operatiorral
probiems that may arise during the Empfoyer's participation in the E-Verifjr �rogram. DHS .
agrees to provide the Employer names, titles, addresses, and tele�hone �.numbers c�f DHS
representatives to be contacted during the E-Verrfy process.
3. DHS agrees to provide to the Employer a manual (tF�e E-Ver'rfy User Manual) con�aining
instructions on E-Verify policPes, procedures and requirements for both SSA and DHS, including
restrictions on the use of E-Verify. DHS agrees to provide training materials on E-Verify.
4. DHS agrees to provide to the Employer a notice, wF�ich indicates the Employer's
participation in the E-Verify progrtm. DHS also agrees to provide to tF�e Emptoyer anti-
discrimination notices issued by the Office of Special Counsel for Immigration-Related U►ifiau
Employment Practices (OSC), Civil Rights Division, U.S. D�partment of Justice.
5. DHS a�rees to issue the Empbyer a user iderrtification number and passw�rd that
permits the Empinyer#o verify Fnforrrr�tion provided by alien employees with DHS's database.
6. �HS agrees fo safeguard ttre icrformation provided to DHS by the Empbyer, and to timi�
access to suctt inforrnation to incfividuals responsible for the verr�ieation of afien employrrTerrt
eEigib'rlit�r and fcar evaluation of the E-Veriiy program, ar to such ather persons flr en�ities as may
be authorized by applieable I�w. Infartnatit�n will b� used only to verify the accufacy of SQcial
Security Numbers and emplayment elig�ili�y, to enforce the Immigration arnd Naticrr�al�ty Act
(INA)and F�deral criminal laws, and ta administer Federal contracting requirements.
7. QH5 aqrees to pro�ide a mearrs af autQmated verification that is designed (�n
cbnJunction wi#h SSA ver'�ication procedures) to provide confirmation +or tentatrve
Page 2 ot 13Ec-Ve�iy ir1QU:or Em�lov�r!R�vi�i�r,Date Z13�`29108 +i�- � . .. - . • . . .
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ir s-veaxrr xs x saavxc9 or ous
Companq ID Number:211168
rronconfirrnation of employees' employment eligibil"rty within 3 Federal Govemment work days of
the initial inquiry.
8. DHS agrees to prwide a means of secondary aerific�tion (including up�dat�ng DHS
re�cords as may be necessary) for employees avho �bntest DHS tentative nonconfirmatio�ts and
photo non-rr�atch tentative nonconfirmations that is designed to provide final confirmation or
rtvnconfirmation of the employees' emplayment e�igibi�i#y within 10 Federal Government work
days of the date of referral to DHS, unless DHS determines that more tlian 10 days may be
necessary. In such cases, DHS will provide additional verification instructions.
C. RESPONSIBIL�T►E9 OF THE EMPLOYER
1. The Employer agrees to display the nc�ices supptieri by DHS in a prominent pl�ce#I�t is
cYearly visible to prospective employees and all errTpkoyees who are to be verified through the
system.
2. �he Employer agrees to provic�e to the SSA and DHS the names, tates, addresses, and
tefephone rtumbers of the Employer representafires fo be contacted regarding E-Verify.
3. The Employer agrees to become familiar with and comply with the most recen�t version
� of the E-Verify User Manual. .
4. The Employer agrees that any Empl�yer Rep��sen#afi�re who will perform employm�nt
verification queries will complete the E-Verify Tutorial befare that individual initia#cs a�y
queries.
A. The Emptoyer agrees that alt Empla�rer representatives will take the refresher
tutorials initiated by the E-Verify program as a condition of contiriued use of E-
Verify, including any tuforials for Federal contractors if the Employer is a Federal
contractor.
B. Ftilure to complete a refresher tut�rial v�rill prevent the Employer from continued
use of the program. . .
5. The Employer agrees tn comply with eurrent Fprm I-9 procedures, with two exceptions:
• lf an employes presents a "List B" identitq dacum�nt, the Employer agress tc� only
accept "List B" documents that c�ntain a photu. (List B documents identified in 8 C.F.R.
§274a2(b)(1}(B)) can be presented dur'mg the Form t-9 process to establish identity.) lf
an employee objects to the photo requirement for religious reasons, the Employer
should contact E-Verify at 888-464-�4218.
• If an emplopee presenfs a DHS Form 1-551 �Perm�rteri� Resident Carcl) or Form 1-766
fEmpbymenf Auftwriza�ion Documenfl ta complete the F�rm 1-9, the Emptoyer agrees t�
rrr�ke a photocopy of the documet�t and to retain th� �hotr3copy with the employee's
Fc�rm t-9. The employer w�l us� the pho�cop� to verifiy the photo and ta assist dHS
v3rith its review of photo non-matches that are c�nf�st�d by employees. Note that
�mployee� re#ain the right to present arty List A, of List 8 and List C, docurn�ntation to
complete the Form 1-9. QHS may in the future desigr�ate other documents that activate
the photo s�reening Eool.
Page 3 of 13f E•Verify tutOU for F+�plesy�er�Revhiar+D�te��1�:'�3 ....-...`:�<� :;a:=';:•`?,��'s.
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a-vLRZaY IS w SBE�zCS Ot Otl5
Company ID Number:211168
6: The Employer undersfi�arnfs that particfpatir�ri in �-Verify does not exempt the Employer
�rom the responsibility to eomplete, refiain, and malue avai)able for inspection Forms 1-g that
r�late to its employees, or from other r�quirements Qf�ppfrcable regulations or laws, ineluding
�he obligation to comply tn�ith the antidiscrimination requirements of section 274B of the INA virith
r�spect to Form I-9 procedures, excep# for the fn�owing mvdified requirements applicable by
reason of the Employer's participation in E-Veri#y: (1} identitq documents must have photos, 2s
�escribed in paragraph 5 above; (2) a rebuttable presumption is established that the Employer
has not violated section �74A(a)(1)(A) of the Immigration and Nationality Act (INA) with respect
to the hiring of any individuaf if it obtains conffrmation of the identity and employment eligibility of
t�he individual in compliance with the terrns and conditions of E-Verify; (3) the Employer must
notify DHS if it continues ta employ any employee after receiving a final nonconfirmation, and is
subject to a civil money penalty between $550 and $1,1Q0 for each fiailure to notify DHS of
continued employment following a final nonconfirmation; (4) the Employer is subject to a
rebuttable presumption that it has knowingly employed an unauthorized alien in violation of
section 274A(a)(1)(A) if the Employer cantinues to employ �n employee after receiving a final
nonconfirmation; and (5) no person or entity participating in E-Verify is civilly or criminally liable
under any law for any action taken in good faith based on information provided through the
confirmation system. DHS reserves the right to conc�uct Form I-9 compliance inspections during
the course of E-Verify, as.well as to conduct any other enforcement activity authorized by law.
7. The Employer agrees to initiate E-Verify verification procedures for new employees
within 3 Employer business days after each employee has been hired (but after both sections 1 .
arrd 2 of the Form 1-9 have been completed), and to complete as many(but only as many} steps .
of the E-Verify process as are necessary according.tc the E-Verify User.Manual. The Empl�yer. , _
is prohibited from initiating verification procedures before the emplc�ee has been hired and the � . .
Form I-9 completed. If the automated system to.be queried is temporarify unavailable, the 3-�ay
fime period.is extended until it is again operational in order to accommodate the Employer's �
attempting, in good faith, to make inquiries during the period of unavailability. In all�cases, the
Emplayer must use the SSA verification procedures first, and use DHS verification procedures
and photo screening tool onfy after the SSA verification response has been given. Employers
may initiate verification by notating tfie Form 1-9 in circumstances where the employee has
applied for a Social Security Number (SSN) from the SSA and is waiting to receive the SSN,
provided that the Employer performs an E-Verify employment verification query using the
employee's SSN as soon as the SSN becomes available.
8. The Employer agrees not to use E-Verifiy procedures for pre-emplaymenf �creening of
jab �Rplicants, in support of any unlawful employment practice, or for any other use nvt
�ufhorized by this MQU. Employers must use E-�ferify for all new emptoyees, unless an
Employer is a Federal cantractor that yualifies f�r ftte exceptions described in Article II.D.1.c.
Except as provided in Article II.D, the Employer wi(I not v�rify selecti�ely and will not verify
employees hired b�fore the eflective date of this MOU. The Employer understands that if the
�rrtpioyer uses E-Verify procedures for any �urpose otf�er than as authorized by this MOU, the
Emptoyer may be subject to appropriate legal action and termir�ation of its access to SSA and
DHS information pursuant�o this MOU.
�. The Em�iayer agr�es to folt�nr appropriate procedures (�ee Article III. belrnro) regarding
terrtafirre nonconfrrmatifln�, including notifying employees of the flnding, providirrg written
referral instructions to employees, allowing �mployees to contest the finding, and not taking
Page C a;13EE-4e�y tvlOU(Qr�mpbter�Revisiar Date tOf25tG8 .�.�_,:._.�.:'s;;:;<_r.;;-. 'r�.-. :
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a�iverse action against empt�ayees if they choose �o contest the finding. �urther, when
�r�ployees cont�st a terrtative ntanconfiirmation based upon a photo non-match, the Employer is
r�qUired to take affirmative steps �see Article III.B. below} to contact DHS with information
n�e�sary to resolve the ehaflenge.
10. The �mpi4yer agrees nat t4 take amt adverse accti�on aga�nst an ernp�oyee based upc�n
the emp(oyee's perceiued employment ergibilr�y s#atus vsrhi�e �SA or DHS is processing the
verification request unless tfle Empfc�yer obtains knovrrledg� (as defined in 8 C.F,R. § 274a.1(I))
#hat the employee is not work �Erthorized. The Employei� understands that an initial inability of
the SSA ar DHS automated �erification system to verify work authorization, a fentative
nonconfirmation, a case in continuance (indicating the need for additional time for the
government to re5alve a case), or the finding of a photo non-rrratch, does not establish, and
should not be interpreted as evidence, that the employee is not work authorized. In any of the
cases listed above, the employee must be provided a full and fair opportunity to contest the
finding, and if he or she does so, the employee may not be terminated or suffer any adverse
employment consequences based upon the employee's p,erceived employment eligibility status
(including den�ing, reducing, or ejctending work hours, delaying or preventing training, requiring
an employee to work in poorer conditions, refusing ft�assign the employee to a Federal contract
or other assignment, or otherwise subjecting �n employee to any assumption that he or she is
unauthorized to 4vork) until and unless secondary verification by SSA or DHS has been
completed and a #inal noncor�firmation has been issued. If the employee does not choose to
contest a tentative nonconfirmatian or a photo non-match ar 'rf a secondar� verification is
complsted and a final n�nconfirmation is issued,then the Employer can find the employee is not
work authorzed and terminate the employee's employment. �: Employers or employees with
guestions about a final nonconfirmation may call E-Verffy at 1-888-464-4218 or OSC at 1-800-
�55-8155 or 1�800-237-2515 (TDD).
11. The Employer agrees ti5 ct�rflpiy wittt Title Vtl of the Civil Rights Act of 1964 and section
2746 of the INA by not discriminating unlawfully against any individual in hiring, firing, or
recruitment or referral. practices because of his or her national origin or, in the case of a
protected individual as defined in section 2746(a)(3) of the INA, because of his or her
citizenship status. The Employer understands that such illegal practices can include selective
verification or use of E-Verify except as provided in part D below, or discharging or refusing to
hire employees because they appear ar sound "foreign" or have received tentative
r�onconfirmations. The Employer further understands that any violation of the unfair
immigration-related employment pracdces provisions in section 2746 of the INA could subject
the Employer ta civil penalties, bacl�pay awards, and other sanctions, and violations of Title VII
could subject ttie Ernployer fo b�ck pay awards, compensatory and punitive damages.
1Jiolations of either section 274B of the INA ar Ti�le VII may also lead to the termination of iis
participation in E-�feriijr. If the Employer has any questions relating to the attti-discrimination
provision, it shouic3 corttact OSC at 1-�QO-25�-815� or 1-800-237-2515 (TC3D).
12. Th� EmpJc�yer agrees�.i record the case verification r�mt�er on fhe ernpl+�y�e`s F�rm 1=9
ar ta print the screen cor�taining the case ver�'rcation numbe� and atta�h it tc� the employee's
Form 1-9.
13. The Empfayer agrees that it wiN use tt�e information it recei�res from SSA or DHS
pursuant to E-Verify and this M�U only t� confirr� the employment eligibifity of employees as
Page 5 ot 13(E•VWriiy MOtJ iar Emptoyer�Reyisrc,n bate 1t�2�08 �<:.-...--- ._ ;;': ��: '�
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autl�orized by this INOU. The Employer agrees that i#v�iJt safeguard this information, and means
of access to it (such as RiNS and passwords) to ensure that it is n�t used for any t�ther purpose
and as necessary to protect its confidentiality, incl�ding ensuring that it is not disseminated to
ariy person other than employees of the Employer who are authorized to perform the
Employer's re�ponsibilifies uncter this MOU, except for such disseminatibn as may be
a�thorized in acivance by SSA or DHS for legitimate purposes.
�4. The Employer a�kn4Wledges thaf the information which it rec�ives frc�m SSA is
governecl by the Privacy Act (5 U.S.C. § 552a(i)(1) and (3)) and the Sc�cial �ecurity Act (42
LJ.S.C. 1306(a)�, �nd that any person who obtains this information under false pretenses or uses
i�for any purpose other than as provided for in this MOU may be subject to criminal penalties.
'15. The Employer agrees to cooperate with DHS and SSA in their c6mpliance monitoring
and evaluation of E-Verify, including by permitting DHS and SSA, upon reasonable notice, to
review Forms E-9 and other employment records and to interview it and its employees regarding
the Employer`s use of E-Verify, and to respond in a timety and accurate manner to DHS
requests for information relating to their participation in E-Verify.
D. RESFONSIBILITFES OF FEDERAL CONTRACTORS
�. The Employer understands that 'rf it is a FedEral cor�tractar subj�ct to the
employment rrerification terrns in Subpart 22.18 �of the FAR it must ver'rfy the employment
. �ligibility of any "employee assigned to the contracY' (as defined in FAR 22.1801) in addition to
verifying the,employment eligibility of all other employees required to be verified under the FAR. _
Once an employee has been verified through E-Verify by the Empioyer, the tmployer may not •
reverify tF�e employee throagh E-Verify.
a. �Federal contractors not enrolled at the time of contract award: �4n Employer that
i� not enrolled in E-�/erify as a Federal contractor at the time of a contract award must enroll as
�a Federal contractor in the E-Verify program within 3Q calendar days of contract award and,
tnrithin 90 days of enrollment, begin to use E-Verify to initiate verification of employment eligibilify
of new hires of the Employer who are working in the United States, whether or not assigned to
the contract. Once the Employer begins verifying new hires, such verification ofi new hires must
be initiated within 3 business days after the date of hire. Once enrolled in E-Verify as a Federal
contractor, the Employer must initiate verification of employees assigned to the contr�ct within
90 calendar days after the date of enro(lment or within 30 days of an empbyee's assignment to
the cor�tract, whickrever date is later.
b. Federal contractors alre�dy er�rokled at the time of a contract a�nrard: Empla}f�rs
enrotle�i in E-Verify as a Federal contractor�ar 94 days or more �t ttte time af a contract award
must use E-Verify to initiate uerification of empl�yment �ligibiC�ty for new hires o#the Em�rlayer
wvho are working in the United States, whether or no#assigrxed�o the cc�ntract, anrithin 3 busirte�
days after the date ofi hirQ. If the Employer is enrolfed in �-Verii�r as a Fetie�al contractor for�
calendar days or less at the time of cor�tract award, the Elriptc�y�r rr.rust, within �tl days t�f
enrollment, begin to use E-Ver�y to initiate verifi�ation ofi new hires of the contractor who are
working in the United State�, wtrether or not assigned to the contract. Such verific�tion Qf new
hires must be initiated within 3 business d�ys after the date of hire. An Employer en�oli�d as a
F�deral contractor in E-Veri#y must initiate verification of each employee assigned to the
Ra�s 6 Q#i3�E-Ve<�y MOU fer Emoloyar�Re�r:'sion Date 7N29/JS _ ,.. -��;�,`?=�r+:k-
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contract within 90 calendar days �ft�r date of contract award or within 30 days after assignmer�
to the contract, whichever is later.
c. institutions of higher educafion, State, local and tribal gca��mmerrts and sureti�s:
F�der�i cr�n#�actors tf�at are institutiQns of higher education (as defined at 20 U.S.C. 100�(aj},
Stafe or [ocal government�, govemments of Federafly recognized indian tribes, or sureties
perFormsr�g under a fakeover agreement entered into with a Federal agency pursuant to a
performance bond may choose to Qnly verify new and existing employees assigned to the
Federal contract. Such Federal contractors may, however, elect to verify all new hires, and/or
all existing �mployees hired after November 6, 1986. The provisioris of Article II.D, paragraphs
1.a and i.b of this MOU providing timeframes for initiating employment verification of employees
assigned to a contract apply to such institutions ofi higher education, State, locat and tribal
governments, and sureties.
tJ. Verification of �fl emptoyees: Upon enroflmerrt, Employers v�ho are Federal
contractors may elect to verif}r employment eligibility of all existing employees working 'rn the
United States who were hired after November 6, 1986, instead of verifying only fhose
employees assigned to a cQvered Fed�ral contract. After enroflment, Employers must elect to
do so only in the manner designated by DHS and initiate E-Verify verification of all existing
+�mployees within 180 days after the election.
e. Forrrt I-9 proeedu�-es fc�r Federal contractors: The Employer ma�r tase a
previously comp(eted Form I-9 as the basis for initiating E-Verify verification of an emptoyee
assigned to a contract as long as that Form I-9.is aomplete (including the SSN), ccrplies with
Articfe II_C.5, the employee's work authorization has not expired, and the Employer has
reviewed the information refFected in the Form I-9 either in person or in communications.with the
employee to ensure that the employee's stated basis in section 1 of the Form I-9 for work
authorization has not changed (including, but not limited fo, a lawful permanent resident alien
having become a naturalized U.S. citizen). If the Employer is unable to determine that the Form
I-9 complies with Article II.C.5, if the employee's basis for work authorization as attested in
section 1 has expired or changed, or if the Form I-9 contains no SSN or is otherwise incomplete,
the Employer shall complete a new I-9 consistent with Article II.C.5, or update the previous I-9
to provide the necessary information. If section 1 of the Form I-9 is otherwise valid and up-to-
date and the form otherwise complies with Article II.C.5, but reflects documentation (such as a
U.S. passport or Form I-551) that expired subsequent to completion of the Form I-9, the
Employer shall not require the production of additional documentation, ar use the photo
screening tool described in Article II.C.5, subject to any additional or superseding instructions
that may be provided on this �ubject in the E-Verify User Manual. Nothing in this section shall
be construed to require a secQnd verific�tion using E-Verify of any assigned �mployee who has
previousfy been verified as a newfy hired employee �rnder this MOU, or to au#horize verification
of any existing employee by any Errtptoyer that is not a Federal contractor.
2. Tkxe Emplayer unders#ands that if i#is a �ederal ecantractor, its ComptianEe v�ith thls M!OU
is a perform�nce requirement under th� terms of the Federal contract bt subcotrtract, aFtd the
Emplayer consents to the release af uifiormation relating to compliance with its verification
r�sponsibilities under this MOU to contracting officers or other officials authorized to review the
Ernployer's compliance with Federal contracting requirements.
Page 7 ot 13�E-Y�,�'ry P�U for Em�icyzr�4evi:ion Daie 1C,r2<3/€}8 �:rE in�.��t'�:�;_��;". .- -- ..
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ARTICLE 111
REFERRAL OF 1AtD1VIDUALS TO 5SA AND DHS
A REF�Rf3AL TQ SSA
1. I�th� Empioyer receives a tentafive noneonf"rrmaiic�n is�ued by SSA, the Employ�r mtt5t
print the f�ntative nonconfirmation no�i�c� as directed by the at�omated system and provide it ta
the empl�yee so that th,� errrployee may determine whether he or she will contest the tentative
nonconfirmation.
2. The Employer will refer employees to SSA fielci offices only as direeted b� the •
automated system based on a tentative nonconfirmation, and only after the Employer records
the case verification number, reviews the input to detect any transaction errors, and determines
that the employee contests the tenfative nonconfirmation. The Employer will transmit the Social
Security Number to SSA for verification again 'rf this review indicates a need to do so. The
Employer will determine whether the employee contests the terrtative nonconfirmation as soon
as possib(e after the Employer receives it.
3. tf the employee contests an SSA tentative nonconfirrtration,the Employer w�li provide
the employee with a system-genefated referral letter and instruct the employee to visit an 5SA
Dffice.within 8 Federal Govemment work days. SSA wnll electranically transmit�he resu�ofi the
�efercal to the Employer within 1 a Federal Govemmen#work days of the referrai unless it. - -
determines that more than 10 days is necessary. The Employer agrees to check the E-Verify •
system regularly for case updates.
4. The Employer agrees not ta ask the employee to obtain a printout from the Socaal
Security Number database (the Numident) or other written verification of the Social Security
Number from the SSA.
B. REFERRAL TO DHS
1. lf the Employer recetves a tentative rronconfirmafian issued by�HS, the Erttployer must
p�int the tentative nonconfirmation notice as directed by the automated system and provide it to
the employee so that the empio�ree may c#etermine whether he or sh� will contest the tentative
rrone�nfirmation.
2. If the Emptoye�finds a photo noR-match for at� empl�yee vvho pra�ide�a document fo�
which the automated system has transmitted a ph�ta, the emptoyer mu�# prin# the photo non-
rriatch te�tative npnconfirmation notice �s directed by th� au#Qmated system and provide � to
the employee so that the employee may determine whether he or she wiCl contest the f'rnding.
3. The Employer agrees tca r�fer individuals to DH� only v�n the �mployee chooses to
cantest a tentative nonconfirmation received from DHS autc�mat�ci verificatioh process or vwher�
the Employer issues a tentative nonconfirmation based upon a photo non-match. The EmptQyer
will determine whether the employee contests the tentative nonconfirmation as soon as possible
Page 8 tt 1.�E-Ue�ity MOU for�pioy�;I�e�isi�r:02,�1a�Qfi .-;i! 4 ,.-'�;`� �.
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afiter the Employer receives it.
4. �f �e employee contests a ter�ta#ive nonconfirmation issued by DHS, the Empkayer anriil
�Zrovicfe the �mployee v�rith a referral letter and instr�ct the employee to contact DHS thfaugh its
foll-free hotline (as found on the referral letter)within 8 Federal Govemment work days.
�. tf the employee corrtests a tenfa�ve nonconf#rmation based upor� a photo non-rr�atch,�he
Employ�r wili pr�vide th� empfoyee�cvith � referral letter to DHS. CtHS will electronically transmit
the resutt ofi the�referral to the Employer wifhin 10 Federal Govemment work days of the referral
u�less it determines that more than 10 days is necessary. The Employer agrees to check the E-
V�rify system regutarly for case updates.
6. The Employer agree$ th�.t if an employee contests a terrtative nonconf�rmation based
upon a photo non-match, the EmplQyer will send a copy of the employee's Form I-551 br Form
I-766 to DHS for review by:
� Scanning and uploat�ing the document, or .
+ Sending a pho�ocopy of the document by an -e�ress maii account (fumi�Med and paid
for by DHS).
� 7. The Emplaysr �rnderstands fhat if it cannot deterrnine whether there is a photo
matchlnon-match,the Employer is required to forward the employee's documentation to DHS by
scanning and upfoading, or by sending the document as described in the preceding paragraph,
and resolving the case as specified by the Immigration Services Verifier at DHS w`��o will � --
deterrmine the photo match or non-match. �
ARTICLE !V
SERVICE PROVISIONS
SSA and DHS will n�t charge the Employer for verification services performed under this MOU.
The Employer is responsible fot praviding equipment needed to make inquiries. To access the
E-Verify System, an Employer will need a personal computer with Intemet access.
ART[CLE V
PEkFtT1ES
A. This MUU is effective upon�he�igrrature of a!! parties, and shall �arttinue in effect for as
lartg as t�te 5SA and DHS conduet the E-Verify pr�gram unle�s madified ir►wri�ing by the mufual
consent of a!t partias, or termirTated by any p�upon 30 days prior writt�n notice to the athers.
�1ny and �Ii system �nhartcemertts to t}�e E-Ver�Fy program by DHS or �SA, inckuding but not
fimited ta the E-uer+fy checking against adc#�tiona! data sources and instituting new ver'rfication
procedures, w€II be r.c�ver�d under this MdU and will rrot cause the need for a supplemental
MOU that outlines these change� DH� agree� to train employers on all ehanges made to E-
�fer'rfy throu�gh the use of mandatQry re#resher tutoriats and updates to the E-Verif�r User
RAanual. Even vuithout changes to E-Verify, DHS reserves the right to require employers to take
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mandatpry re#resher tutorials. P�n Empk+p}�er that is a Federal contr�ctor may terminate this
ArtC1U r�en tt�e Federal con#Fact that r�uir�S i�s par�icipation in E-Ver�y i� tetm�rt�ted or
compJete�i. jn sueh a crrcums#a�ae, the Federal contca�ar must prQv�de wei##en notice ta DH�.
If an Emplayer�hat is a Federal contractor fa��o Rrovic�e�such notice,thaf Em�atoyer rnrill remain
a partici�ant in the E-Ve�ify program, will remaan bound by the terms of this NtC)tl that appfy to
non-Federai cc�ntract�r participants, and w�il be required #o us�the E-Verify procedures to verify
the emptoyment eligibifity of all newly hired employees.
B. Nofwiths�ding Artiele V, part A c>f t�ris Mf1U, DHS may t�rtninate tt�i� MOU ifi deemed
necessary because of the requirem�:rrt� of la�nr or potic�, or upon a determination by SSA of
QF+S th�t�there has heen a breach of system iFltegrify ar security by the Employer, or a fail�tre
on the par� of the Employer to comply with established procedures or legal requiremerrts. The
Employ�r t,mderstands that if 'rt is a Federal contractor, termination of this MOU by any party#or
any re�,son may negatively affect its performance of its contractual responsibilities.
C, Same or all SSA and DH5 responsibitities under this MOU may tr� performed by
eontract�r(s), and SSA and DHS may ac�ust uer�'�cation responsbifities be#ween each other as
they may determine necessar�r. By separafe agreement with DHS, SSA has agre�d to perform
its respor}sibilities as described ir�this MOU.
D. Nc�thing in this hl1�U i� intetided, or sfiould b�c�onstruecl, to cre�te any righ# or ber�efit,
substaniive or procedural, enforceable at law by any third party against the Ut�ited Statss, its
�gencies, officers, ar employees,or against the Employer, its agents, officers, or emplc�yees.
E. E�ch party sh�ll be solefy responsible for defending any clairn t�r�ction against it arising �
out o# crr related to E-Verify or this MQU, whether civil or criminal, and for any liab�ifiy
where#rc�rr�, including (but not limiteci to) any dispute between the Emplo�er �nd any other
persan or entity regarding the appticability of Section 403(d) of IIRIRA to any action taken or
allegedly i�en by the Employer.
�. The Employer unders#ands tf�at ffie fac# af its part'rcipation in E-Ve�ify is nat confidential
infiormatwn and may be disclosed �s authorized or required by law and DHS or SSA poficy,
including kwt not limited to, Congre�sional oversight, E-Verify publicity and media inquiries,
determinations of compliance with Federal contractual requirements, and responses to inqui�ies
under the Freedom of Informatxon Ac#(FOIA).
G. The foregoing cQnstitutes the fuil agreement on this st�blect between DHS and the
�mployer.
H. The i�dv�irlual� who�e signatures appear below repres�rtt that �hey are alithorized to
enter into this MOU on behalf of the Empl�ayer and DHS respeet�vely.
Page 10 af 13�E-Ve�T�y M1�3�Eor Empbyer�Ravsion[3ate 1(k2Q:`t�8 --.--,-. ... ,:�'�i=-•: ;,::,�<
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To be a�tFepted as a participa�t in E-Yerify, you shpuld o�ty sign the Emp[oyer's Sectic�n
of the�igna#ul�e page, if you have�ny questions, can#ac#E-Verify a#888-464-421 S.
Empkoyer N�p Kelley Equipment Company,�r}c. .
Vfnce Keiley
Name(Flease Type or Print} � Titie
. E,feclrarrfcally�'rg�ned 4?5It35/2f�09
SFgnature Date — --
Department of Homeland Security-Verif'rcatinn Division �
USCIS Verifiication Division
Mame;Pie2&2 T'f'�39 4!PH:11) Tifie----- —
E�ectr�,�fca//'y,�tqired 0�l45/2Cia9
SignaWre ' Date
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Information Required far the E-Verify Program
Informa#ion relating to your Company:
�omp3tty E+�ame: Idip Keiiey Equipmetrt Company,:na
c:om�an�r Faciiity Address:4-t Korth sprigg
�ape Girar�u,Md 637�1
Gr�mpany Alt�rnate
Address:
Caun#y Qr Parish: CAPc.G1RARDE;�U
Employer l�ent�fication
Numt�r: �.?1085?40 .
IVort(� American indusfry
Classiticat�on Systems �
COtle: 237
P�rent Corrapany: Nip Kslley Equipment Compa�ty,Inc.
Afumber of Ernp3ay�s: 2o ta 99
I��nB�c af�ites Yerifie�3
f�w: 7
Are yau verifying for rnore th�n 1 siie?lf yes,pl�ase provide tfi�e number of�f�es verified far in
each State:
. MISSOURI 1 site(s)
Page 13 of 13jE-t�eriip MC}U(or Etr�oyer�Re�l���Ca=e 1429;'08 r��;+::rr : . .-_ , , 'f`'
. .,::.. ,.�::.
�- � " -�'' �
,— ' — ����k `'3�I�I��
i'" ��' aY 6—VLEIIT IS A SERVICS Of DNS
�
Corrrrtpany 1b Number.211168
Ir�rmation r�atfng ta the Program Adrs�inis#ra��rj�)for yo.ur Company an po#i�ay questinns or
opera#ional problems:
Name: Staci L Peppie
Telephone Numb�r. (573)334-0553 Fa�c Number: (5)3)334-2025
E-mail Address: spepple�nipkelieyco.com
Plame: Yince L Kelley
Teteph�e AFumber. {573)334-0553 Fa�c}+Iumber. (573)334-�025
E-mail AddCess: vkelley�nipkelleyco.com
Page'13 af 19JE-Veiify FRDU`Or Employer�Fevisian Qate iGf29i08 � !�":`i.ri":;.°,, •�;,,'i:,� -� ,
E%��IZ'
AFFIDAVI'T OF OSHA TRAINING �
� COMESNOW(Namc) Vince Kelle� as (OS�ceHeld} Pracir3Pnt ,^
of(CompaapName/Con�or)Nip Kelley Eq�i�ment Co_ , Ia�d,fitst being dulp swom, on
mp oaxh,affitm in connection with the contracted se���gk Storage T�k� Name)
for the duration of the contra.c�as foIlows:
1. Contractor shall provide a ten (10) hout Occupational Safety and Health
Administraxion (OSHA) construction safety program fo= aIl emplopees who w�Il be on-site at the
Project The const=uction safetp progzam shaIl include a course in construction safety and health
that is approved bp OSHA or a similar program approved bp the Missouri Departme�t of Labor and
Industrial Relations which is at least as stringent as an approved OSHA p=ogram as required bp
Section 292.675,RSMo.
2. Contracto=. shall re�Tire its on-site emplopees to complete a construction safetp
program within sigtp(60) days a$ei the date work on the Project commences,as iequited by Section
292.675,RSMo.
3. Contractor acknowledges and agrees that any of Contiacto�'s emptoyees found on
the Project site without docunieatation of #he successful com.pletion of a consttuction safety
progt�n shall be requi.ted to produce such documentation witbin twenty(20) days,or w�11 be subject
to removal from the Project �
4. Contractor shall r��ire aIl of its Subcontra.cto=s to comply with the rern�ireme,nts of �
- Section 292.675,RSMo. �
5. Conttactor acknowledges that p»*��a*�t to Section 292.675, RSMo., Contractor shall
forfeit to City as a penalty two thousand five hundred dollars ($2,500.000),plus one hundted dollats
(�100.00) for each on-site emplopee employed by Contta.ctor or its Subcontractor, for each calendat
day, ot portion thereo� such on-site emplopee is employed without the construction safety ttaining
required in Section 292.675,RSMo.
6. Contractor ackaowledges that vioIations of Section 292675, RSMo, and imposition
� of the penaities descnbed therein shall be iuvestigated and detetmined bp the Mtssou=i Departtnent
- of Labor and Industaal Relations.
7. Contracto= ackaowledges that in the even.t that the I�ssouri Departme.nt of Labor
and Indust�ial Relations has detesmined that a viola.tion of Section 292.675, RSMo., has occu�ed
and that a pena.ttp shall be assessed,t�e City shall withhold and retain all suazs and amotm�s due and
oWing whea making papments to Contracto=under this Con.tta.ct
FURTT3F.R 1?►FFIANI'SATTH NOT.
�j AFFTRMA'rjON THEREOF, the facts stated abave are tcue and corcect (the
undersigned und.erstands that false statemeuts ma.de in this 51ing are snbject to the
penalties provided in Section 575.040,RSMo.)
Nip Kell y Equipment Co, Inc.
' . (name of co xatioa)
Bp: -
(name of fficer of corporarion title)
Vince Kelley, Pr ident
A
���
.�.y{��o�) rank Myers
ti��'` •.��c_:�" `• _
��
, �'�; . . C::_- ` •
a ��. '•- .,':
�7`� t� �. •. ., -
. �+' c '�' �'' �'\ -
"_y(�"���.C�aC���„�ATTOI�
_ :{�_ ��- -=�.��_: .
��` �...,.� `_ .
�� .r�'•� !� , ,
-S�A`T�-4F I�3�SOURI ) � . � �
)ss.
COUNTY OF CAPE GIRARDEAU )
Oz�. this ��h dap of �QI�a�-�, 20 l�before me appeared ���1! �� ���•
to me petsonallp Imow��vho,being bp me duly swoai,did sap that�/she is the ✓.!b�o���'
of�:�J �P l� ,� �q U��J�'x.1/1�' �i ��a Mtssouri Corporation, and that the seal affiged to the
foregou�g i.ns eu is the seal of said Corporation, and that the said instnTmeut was stigned anii
sealed in.behalf of said Corpora.tion by authority of its Board of Directors, and acknowiedged said
instrameax to be the free act and deed of said Corporation.
1N TESTIlvtONY WHEREOF,I have hereunto set mp hand and affiged mp official seal, at
mp office in Cape Girardea�Missouti,the dap , pear fitst above wxitten.
Notary Public
Mp Commission Egpires:
�`,�iY P�'- STAq L PEPPLE �
� 14I�� _:2°•�i: My�p kes
( ��j�,�.��� Soott Courdy
.Qf� Canwr�lon 1'134342i7
Meadowbrook Storage Tank
Project Number
Certification Regarding
Debarment, Snspension and Uther Responsibility Matters
The conlractor hereby certifies to the best of its I�owledge and belief and that it and its principals
and its subcontractors and their pri.ncipals:
(a) Are not presently debaaed, suspended,proposed for debamient, declared ineligible or
voluntarily excluded from covered tran��-t;ons by any Federal or State department or agency;
(b) Ha.ve not within a three(3)year period preceding this proposal been convicted of or had a
civil judgment rendered against them for comTr,;��;on of fraud or a criminal offense in
connection with obtainin�,attempting to obtai.n or performi.ng a public(Federal, Staxe or
Local)transaction or contract under a public han.saction;violation of Federal or Sta�e antitrust
statutes or co�m;ccion of embezzlement,theft,forgery,bribery,f.aLsification or destruction of
records,maldng false statements or receiving stoYen property;
(c) Are not presenfly indicted for or otherwise criminally or civilly charged by a go�ernment �
entity(Federal, State or Local)with cor���on of any of the offenses enumerated in
paragraph(1)(b)of this certification;and
(d) Have not within a three-yeaz period preceding this subcont�act had one or more public
txansactions(Federal, State or Local)termin +a�ci for cause or default
: I understand that a false statement on this certification may be gronnds for rejection of this
contractor or termination of the contract In addition,nnder 18 USC Sec. 1001,a false
statement may resnIt in a fine of np to$ 10,000 or imprisonment for np to five(5�years or
both.
: Vince K�lley, President
Typed N e&Title of Authorized Representati.ve
Dg-�y-�
, Si of Autho ' Representative Date
❑ I am tmable to certi�y to the above statement My explanation is a#tached.
�
THE AMERICAN INSTiTUTE OF ARCH�TECTS
Bond No. MOC 67415
AIA Document A?12
Performance Band
My singular reference to Contractor,Surety,Owner or od�er party shall be considered plural where applicable.
CONTRACTOR(Name and Address): SURETY(Name and Principa!Place of Business):
Nip Kelley Equipment Company,Inc. Merchants Bonding Company(Mutual)
41 North Sprigg Street 2100 Fleur Drive
Cape Girardeau, MO 63701 Des Moines IA 50321
OWNER(Name and Address): Tel:515-243-8171
City of Cape Girardeau
401 Independence Street
Cape Girardeau, MO 63701
CONTSTRUCTiI?N CONTRACT
Date: ,-r��Pr�M/3G(� �3� ����
Amount: $1,260,729.t)0
DeScriQtion(Name and LoCa6on�: Meadowbrook Storage Tank
BOND
Date(Not earlier than Construction Corrtract Date): S�Prc/ri%��;D .�3 2O!"3
Amount: $1,260,729.00 �
Modifications to this Bond: � None � See Pa�e 3
�ONTRACTOR AS P 1NCIPAL SURE7Y
Company: (Corporate Seal) Company: {Corporate Seaq '`:"-
Nip Kelley Equip nt Co y,Ina Merchants Bon ing Company(Mutual)
TeL'S15 3-8171 ' J
5ignaEure• ' Signature: ��'`'b'�� � �-^' � . 1
�' Narne and T Vince Kelley Name and Tdle: Donald L.Wasoba '
'' ' Rresident Attorney-In-Fact - ' - -`
(Any additional signatures appear on page 3)B°nd� Signed and Sealed this 16th day of. SeptecR►►be�, 2013
but left undated at the re.guest of the�obliqee:'
`1�(FOR�IVfORMATlON ONLY—Name,Ad�ress and Telephone)
,AEENT or SROKER: OWNER'S REPRESENTATIVE(Ar�hi�ect,Engine�or other -
. - PartY1:
Gateway Surety
22 Avocado Tree Circle
St.Peters,MO 63376
Tel:3143740589
AIA DOCUINENT I1312•PERFORNII1NCf BOND AND PAYMEhtT BOND•DE�MBER 1484 ED. •AIA i
TME AMERICAN INSTITUTE OF ARCHlTECTS, 1735 NEW YORK AVE.. N.W.,WASHINGTQN, D.C. 20006 A3�Z-�� �
1 The Contractor and the Surety,jointly and severally,bind .1 After investigation, determine the amount for
themseives, their heirs, executors, administrators, ��� �may be liabte to the Owner and,as soon
successors and assigns to the Owner for the performance as practicabie after the amount is determined,
of the Construction Contract, which is incorporated herein tender payment therefore to the Owner,or
by reference.
.2 Deny tiability in whole or in part and notify the
2 If the Contrador performs the Construction Contrad,the Owner citing reasons therefore.
Surety and the Contractor shall have no obligation under 5 If the surety does not prooeed as provided in Para-graph
this Bond, except to participate in conferences as provided 4 with reasonable promptness,the Surety shall be deemed
in Subparagraph 3.1. to be in default on this Bond fifteen days after receipt of
3 If there is no Owner Default, the Surety's obligation an additional written notice from the Owner to the Surety
under this Bond shall arise after. demanding that the Surety perform its obligations under this
Bond, and the Owner shaA be entitled to enforce any
3.1 The �v►+ner has notified the Contractor and the remedy available to the Owner. If the Surety proceeds as
Surety at its address described in Paragraph 10 provided in Subparagraph 4.4, and the Owner refuses the
below that the Owner is considering declaring a payment tendered or the Surety had denied liability, in
Contractor befault and has requested and attempted whole or in part, without further notice the Owner shall be
to arrange a conference with the Contractor and the entiUed to enforce 8ny remedy avaitable to the Owner.
Surety to be held not later than fifteen days after
receipt of such notice to discuss methods of per- 6 After the Owner has terminated the Contractor's right to
forming the Construdion Contrad. If the Owner, the �mplete the Construction Contract, and if ihe Surety
Contrador and the Surety agree,the Contrador shall eleds to act under Subparagraph 4.1,4.2, or 4.3 above,
be allowed a reasonable time to perfortn the then the responsibilities of the Surely to the Owner shall
C�nstruction Contract, but such an agreement shall not be greater than those of the Contractor under the
not waive the Owner's right, if any, subsequently to Construction Contract, and the responsibilities of the
declare a Contrador Default;and Owner to the Surety shall not be greater than those of the
3.2 The Owner has dedared a Contractor Defauft and Owner under the Construction Contrad. To the limft of the
formally terminated the Contractor's rigM to complete amount of this Bond, but subject to commitment by the
the contract. Such Contractor DefauR shall not be �ner of the Balance of the Contrad Price to mitigation of
declared earlier than twenty days after the Contractor �� and damages on the Construction Contract, the
and the Surety have received notice as provided in Surety is obligated without duplication for:
Subparagraph 3.1;and 6.1 The responsibilities of the Contractor for cor-
3.3 The Owner has agreed to pay the BalanCe of the rection of defective work and completion of the Con-
Contrad Price to #he Surety in accordance with the �{ti�ion Contract;
terms of the Construction Contred or to a contractor
selected to perform the Construdion Contract in 6.2 Additional legal, design professional and delay
accordance with the terms of the contract with the oosts resutting fi'om the Cantractors Default, and
Owner. resuiting from the actions or failure to act of the
4 1Nhen the Owner has satisfied the conditions of Surety under Paragraph 4;and
Paragraph 3,the Surety shaU promptty and at the Surety's 6.3 Liquidated damages, or if no liquidated damages
expense take one of the following actions: are specified in the Construction Contract, actual
4.1 Arrange for the Contractor, with consent of the damages caused by delayed performance or non-
Owner, to perform and complete the Constructian Performance of the Contractor.
Contract;or 7 The Surety shall not be liable to the Owner or others for
obligations of the Contractor that are unrelated to the
4.2 Undertake to perform and complete the Con- Construction Contract, and the Balance of the Contract
struction Contrad itself, through its agents or through Price shall not be reduced or set off on account of any
independent contra�tors;or such unrelated obligations. No right of action shalt aaxue
4.3 Obtain bids or negotiated proposats from qualified on this Bond to any person or entity other than the Owner
contractors acoeptable to the 04vner for a contract for or its heirs,executors,administrators or successors.
performance and completion of the Construction 8 The Surety hereby waives notice of any change, inclu-
Corrtract, amange for a contract to be prepared for ding changes of time, to the Construction Contraot or to
execution by the Owner and the contrador selected related subcontracts, purchase orciers and other obli-
with the Owner's concurrence, to be secured with gations.
performance and payment bonds executed by a
qualified surety equivalent to the bonds issued on the 9 Any proceeding, legal or equitable, under this Bond may
Construction Contract, and pay to the Owner the be instituted in any court of competent jurisdiction in the
amount of damages as described in Paragraph 6 in location in which the work or part of the work is located and
excess of the Balance of the Contract Price incurred shall be irtstituted within two years after Contractor Default
by the Owner resulting from the Contracto►'s default;or or within two years after the Contractor ceased working
4.4 Waive its right to perform and complete, arrange or within two years after the Surety refuses or fails to
for completion, or obtain a new contractor and with �rfO� �� obligations under this Bond, whichever occurs
first. If the provisions of this Paragraph are void or
reasonabie promptness under the circumstances: prohibited by law,the minimum period of limitation avail-
AIA DOCUMENT A312�PERFORMANCE BONO AND PAYMENT BOND�DECEMBER 1984 ED.�AIA ��_�� 2
THE AMERICAN INSTfME OF ARCH{TECHT5,1735 NEW YORK AVE,N.W. W0.5HINGTON,D.C. 20006
able to sureties as a defense in the jurisdiction of the suit have been made including ailowance to the
shaA be appiiqble. Contractor of any amounts received or to be
received by the Owner in settlement of insurance or
10 Notice to the Surety,the Owner or the Contrador shall other claims for damages to which the Contractor is
be mailed or delivered to the address shown on the entitled, reduced by all valid and proper payments
signature page. made to or on be- half of the Corrtractor under the
Construdion Contract.
11 When this Bond has been fumished to comply with a 12.2 Constructian Contrad:The agreement between
statutory w other legal requirement in the location where the Owner and the Contractor identified on the sig—
the construction was to be performed, any provision in nature page, inGuding all Contract Documents and
this Bond conflicting with said statutory or legal changes thereto.
requirement shall be deemed deleted herefrom and 12.3 Contractor Default: Failure of the Contractor,
provisions conforming to such statutory or other legal
requirement shall be deemed incorporated herein. The which has neither been remedied nor waived, to
intent is that this Bond shall be construed as a statutory Perform or otherwise to compfy with the terms of the
bond and not as a common law bond. Construction Contrad.
12 DEFINITIONS 12.4 Owner Default: Failure of the Owner, which has
12.1 Balance of the Contract Price: The total amount neither been remedied nor waived, to pay the Cfln-
tractor as required by the Car►struction Contract or to
payable by the Owner to the Contractor under the perform and complete or comply with the other terms
Construction Contract after all proper adjustments thereof.
MODIFICATIONS TO THIS BOND ARE AS FOLLOWS:
NONE.
(Space is provided below for additional signatures of added parties,other than those appearing on ihe cover page.)
CONTRACTOR AS PRINCIPAL SURETY
Company: Company:
(Corporate Seal) (Corporete Seal)
Signature: Signature:
Name and Title: Name and Tdle:
Address: Address:
AIA DOCUMENT A312�PERFORMANCE BOND AND PAYMENT BOND�DECEMBER 1984 ED.�AIA� ��_�� 3
THE AMERICAN INSTRUTE OF ARCHITECT5,1735 NEW YORK AVE,N.W.WASkINCaTON,D.C. 20006
THE AMERlCAN INSTtTUTE OF ARCHITECTS
Bond No. MOC 67415
A!A Document A312
Payment Bond
Any singular reference ro Contracror,Surety,Owner or other party shaq be oonsidered plural where ap�icable.
CONTRACTbR(Name and Address): SUREiY(Name arxt Principai P{ace�Business):
Nip Kelle��uipment Company,Inc. Merchants Bonding Company(Mutual)
41 N.Spngg treet 2100 Fleur Drive
Cape Girardeau, MO b3701 Des Moines IA 50321
OWNER(Name and Address): Tel:515-243-8171
City of Cape Girardeau
401 Independence Street �
Cape Girardeau, MO 63701
CONTSTRUCTION CONTRACt
Date: �i.r�TG/y1 �i�R :����l 3
Amour�t: $1,260,729.00
Description(Name and Location):Meadowbmok Storage Tank
80N0
pate{Not earlier than Constnxtion Contract Date): �EPi�m.S�(L �3� 3� �3
Amouni:$1,260,729.00
Modi�cations to this O None � See,Page 6„_,.,-
CONTRACTOR AS PRI IPAL SiJRETY '�' "
Com" `' (CorparateSeap Company: tCAi'pOrate�D ��
Nip elley uipm om y,Inc. y ,
, Merchants Bonding Company(Mutual) '. ' '� �
� �A _
• Tel:515-24�-j171 , fA- ,
�.�
�` Signature: Signature: '`"�h�� '��"°`"�
` ;;, �larne and,Titfe: Vi ce Ke e Name and Title: Donald L.Wasoba
" ,�;� , -. Presid Attorn�y In-Fact ' � -
� (Any a�dditionat signatures appear on page 6)B°nd Signed and Sealed this 16th day of 5epteml�er, r 2013
,,,, but left undated at the request of the obli,gee.
,� `, f��R fNfORMATION ONLY—Name,Address and Telephone) '
4 ''` AGENT or BROKER: QWNER'S REPRESENTATNE iArchitect,Engineer or ather
�ateway Surety ��}'
" �2 Avocado Tree Circle
St.Peters,MO 63376
Tel:314374-0589
AIA DOCUMENT A312•PERFOR�AANCE BOND AND PAYMENT BOND•DECEMBER 1984 ED. •AIA•
THE AMERICAN INSTITUTE OF ARCHITECTS, I735 NEW YORK AVE., N.W., WASHINGTON, D.C. 20006 A31Z-�9B4 4
1 The Contractor and the Surety, jointly and severally, 5 if a notice required by Paragraph 4 is given by the
bind themselves, their heirs, executors, administrator, Owner to the Contractor or to the Surety,that is sufficient
successors and assigns to the Owner to pay for labor, compliance.
materials and equipment fumished far use in the 6 When the Claimant has satisfied the conditions of
performance of the Construction Contract, which is paragraph 4,the Surety shall promptly and at the Surety's
incorporated herein by reference. expense take the following adions:
2 Wdh respect tq the Owner, this obligation shall be null 6.1 Send an answ�r to the Glaimant, with a copy to
and void if the Co�trddor. the Owner, within 45 days after receipt of the claim,
2.1 Promptly makes payment, directiy or indirectly, stating the amounts that are undisputed and the
for a�l sums due Claimants,and basis for challenging any amounts that are disputed.
22 Defends, indemnities, and holds harmless the 6.2 Pay or arrange for payment of any undisputed
Ovmer from all Gaims,demands, liens or suits by any amounts.
person or entity who fumished labor, materials or
equipment for use in the performance of the 7 The Surety's total obligation shall not exceed the
Construction Contract, provided the Ovmer has amount of this Bond,and the amount of this Bond shall be
promptly notified the Contractor and the Surety (at aedited for any payments made in good faith by the
the address desaibed in Paragraph 12) of any Surety.
claims,demands, liens or suits and tendered defense 8 Amounts owed by the Owner to the Contractor under
of such claims, demands, liens or suits to the the Construction Contract shall be used for the
Contractor and the Surety, and provided there is no perfoimance of the C�nstruction Contrad and to satisfy
Owner Default. claims, if any,under any Construction Perfomtance Sond.
By the Contractor fumishing and the Owner accepting this
3 With respect to Claimants, this obligatian shall be nutl Bond, they agree that al►funds eamed by the Contractor
and void if the Contractor promptly makes payment, �n the performance of the Construction C�ntract are
directly or indirectly,for a{I sums due. dediqted to satisfy obligations of the Contractor and the
Surety under this Bond, subject to the Owner's priority to
4 The Surety shall have no obligation to Ctaimants under use the funds for the completion of the work.
this Bond until:
4.1 Claimants who are employed by or have a direct 9 The Surety shall not be liable to the Owner, Claimants
contrad with the Contrador have given notice to the or others for obligations of the Contractor that are
Surety (at the address described in Paragraph 12) unrelated to the Construction Contrad. The Owner shall
and sent a copy, or notice thereof, to the Owner, not be liable for payment of any costs or expenses of any
stating that a daim is being made under this Bond Claimant under this Bond, and shall have under this Bond
and, with substanfial accuracy, the amount of the no obligations to make payments to, give notices on
claim. behalf of, or othervvise have obligations to Claimants
4.2 Claimants who do not have a direct contract with under this Bond.
the Contractor. 10 The Surety hereby waives notice of any change,
.1 Have fumished written notice to the Contractor induding changes of time,to the Construction Contract or
and sent a copy, or notice thereof, to the to related subcontracts, purchase orders and other
Owner, within 90 days after having last per- obtigations.
formed labor or last fumished materials or
equipment induded in the daim stating, with 11 No suit or action shall be commenced by a Claimant
substantial accurecy, the amount of the claim under this Bond other than in a court of competent juris-
and the name of the party to whom the mater- didion in the I�cation in which the work or part of the work
ials were fumished or supplied or for whom is located or after the expiration of one year from the date
the labor was done or performed; and (1) on which the Claimant gave the notice required by
Subparagraph 4.1 or Clause 4.2.3, or(2) on which the
.2 Have either received a rejection in whole or in last labor or servioe was perfortned by anyone or the last
part from the Contractor,or not received within materials or equipment were fumished by anyone under
30 days of fumishing the above notice any the Construction Contract, whichever of(1) or (2} first
communication from the Contractor by which ��. if the provisions of this Paragraph are void or
the Contrador has indicated the Gaim will be prohibited by law, the minimum period of limitation
paid directly or indirectly;and available to sureties as a deferise in the jurisdiction of the
.3 Not having been paid within the above 30 days, suit shall be applicable.
have sent a written notice to the Surety(at the �2 Notice to the Surety,the Owner or the Contractor shall
address described in Paragraph 12) and sent � mailed or delivered to the address shown on the
a copy, or notice thereof, to the Owner, stating signature page. Actual receipt of notice by Surety, the
that a daim is being made under this Bond and pwner or the Contractor, however acxomplished,shall be
enclosing a copy of the previous written notice su�icient compliance as of the date received at the
fumished to the Contrador, address shown on the signature page.
AIA DOCUMENT A312�PERFORMANCE BOND AND PAYINENT BOND�DECEMBER 1984 ED_�AIA� ��_�� 5
THE AMERICAN INSTRUTE Of ARCHRECT5,1735 NEW YORK AVE,N.W.W0.5HINGTON,D.C. 20006
13 When this Bond has been fumished to comply with a The intent of this Bond shall be to indude without
statutory or other legal requirement in the location where limitation in the terms"labor, materials or equipmenY'
the construction was to be performed, any provision in that part of water, gas, power, light, heat, oil,
this Bond conflicting with said statutory or legal gasoline,telephone service or rerrtal equipment used
requirement shall be deemed deleted herefrom and in the Construction Contract, architectural and
provisions conforming to such statutory or other legal engineering services required for performance of the
requirement shall be deemed incorporated henein. The work of the Contractor and the Contractor's
intent is that this Bond shall be construed as a statutory subcontradors, and all other items for which a
bond and not as a common law bond. mechanic's lien may be asserted in the jurisdiction
where the labor, materials or equipment were
14 Upon request by any person or entity appearing to be fumished.
a potential benefiCiary of this Bond, the Contractor shall 15.2 Construction Contract: The agreement between
promptly furnish a copy of this Bond or shall permit a copy the Owner and the Contractor identified on the
to be made. signature page, including all Contrad
Documents and changes thereto.
15 DEFINITIONS
15.3 Owner Default: Failure of the Owner, which has
15.1 Claimant: An individual or entity having a direct neither been remedied nor waived, to pay the
contract with the Contrador or with a subcontractor of Contractor as required by the Construction Contrad
the Contractor to fumish labor, materials or or to perform and complete or comply with the other
equipment for use in the performance of the Contract. terms thereof.
MODIFICATION5 TO THIS BOND ARE AS FOLLOWS:
Section 6 is modified by adding section 63.
6.3 The Surety's failure to discharge its obligations under this Section 6 shall not be deemed to constitute a waiver of
defenses the Surety or Contractor may have or acquire as to a claim. However, if the Surety fails to discharge its
obligations under this Section 6,the Surety shall indemnify the Claimant for the reasonable attorney's fees the Claimant
incurs to recover any sums found to be due and owing to the Claimant.
NONE.
(Space is provided below for additional signatures of added parties,other than those appearing on the cover page.)
CONTRACTOR AS PRINCIPAL SURETY
Company: Company.
(Corporete Seal) (Corporate Seal)
Signature: Signature:
Plame and Tide: Name and T�tle:
Address: Address:
AIA DOCUMENT A312�PERFORMANCE BOND AND PAYMENT 80N��DECEMBER 1984 ED.�AIA�
THE AMERICAN INSTIME OF ARCHITECT5,1735 NEW YORK AVE, N.W. WASHINGTON,D.C. 20006 ��"�� 6
� . �
MERCHANT�S�
BONDING COMPANYn
POWER OF ATTORNEY
Know All Persons By These Presents,that MERCHANTS BONDING COMPANY(MUTUAL)and MERCFiANTS NATIONAL BONDING,
INC.,both being corporations duly organized under the laws of the State of lowa(herein collectively called the"Companies"),
and that the Companies do hereby make,constitute and appoint,individually,
Donald L Wasoba
of St Peters and State of MO their true and lawful Attomey-in-Fact,with full power
and authority hereby conferred in their name,place and stead,to sign,execute,acknowledge and deliver in their behalf as surety
any and all bonds, undertakings,recognizances or other written obfiga6ons in the nature thereof,subjed to the limitation that any
such instrument shali not exceed the amount of:
TWO MILLION(S2,000,000.00)DOLLARS
and to bind the Companies thereby as fully and to the same extent as if such bond or undertaking was signed by the duly
authorized officers of the Companies,and ali the acts of said Attomey-in-Fact, pursuant to the authority herein given,are
hereby ratified and confirtned.
This Power-of-Attomey is made and executed pursuant to and by authority of the following By-Laws adopted by the Board of
Directors of the Merchants Bonding Company(Mutuai)on Aprii 23,2011 and adopted by the Board of Diredors of Merchants National
Bonding,Inc.,on October 24,2011.
"The President,Secretary,Treasurer,or any Assistant Treasurer or any Assistant Secretary or any vce President shal�have
power and authority to appoint Attomeys-in-Fact,and to authorize them to execute on behalf of the Company,and attach the
seal of the Company thereto,bonds and undertakings,recognizances,contrads of indemnity and other writings obligatory in
the nature thereof.
The signature of any authorized officer and the seal of the Company may be affized by facsimile or electronic transmission to
any Power of Attomey or Certfiqtion thereof authorizing the exeafion and delivery of any bond,undertaking,recognizance,
or other suretyship obligations of the Company,and such signature and seal when so used shall have the same force and
effed as though manually fixed."
In Witness Whereof,the Companies have caused this instrumerrt to be signed and sealed this 2nd day of MarCh , 2�12•
,�„���UNriry�, •�.�.�•
,,���a+�t,'(101�.���'.,, �.�p�N�.Cp,j�A� MERCHANTSBONDINGCOMPANY(MUTUAL)
:g:'p�aRq'•�p=: ;'��•'ORP�'9q'9y: MERCHANTS NATIONALBONDING,INC.
�J�. �r ��';1 �y G J�:.G•
..�:�� �- �:�� •1�'2 -o- v; i
� • :3•
��= 2��3 �.�_ :y: 1933 :y;
. .�Q. By ��
"i�•�`j'y• . •:i-j��,�= •.�6.1�fy-�•''\1 :
STATE OF IOWA '•� .�F•• ��`� ��� •�
COUNTY OF POLK ss. ��"'h���••�"�"�� ��"'�� President
On this 2nd day of March . 2012,before me appeared Larty Taylor,to me personally known,who being by me duly swom did
say that he is Presiderrt of the MERCHANTS BONDING COMPANY(MUTUAL)and MERCHANTS NATIONAL BONDING,INC.;and
that the seals affixed to the foregoing instrument is the Corporate Seals of the Companies;and that the said instrument was signed and
sealed in behalf of the Companies by authority of their respective Boards of Directors.
In Testimony Whereof,I have hereunto set my hand and affixed my Offiaal Seal at the City of Des Moines,lowa,the day and year
first above written.
�MARANDA GREENWALT � � �'
�� Commisslon Number T10312
AAy Commisslon Expires
October 28,2014
Notary Publiq Pofk County,lowa
STATE OF IOWA
COUNTY OF POLK ss.
I, William Wamer,Jr.,Secretary of the MERCHANTS BONDtNG COMPANY(MUTUAL)and MERCHANTS NATIONAL BONDING,INC.,
do hereby certiiy that the above and foregoing is a Vue and correct copy of the POWER-OF-ATTORNEY executed by said Companies,
which is still in Tull force and effed and has not been amended or revoked.
In Wdness Whereof,1 have hereunto set my hand and affixed the seal of the Companies on - -
this �,� day of S�P!��(1 •�O 1�
Power of Attorney attac "�"�•�«,, �••""'••.
..� � 01�� '•1 • p�N� �U,�j•.
to bond and sealed .•��►;, . C . • �.•••.....-.,.o . .
y �` �0 0= :O RPOq q • s�/�G���/ �"
this 16th da of ,'�°�:'yo ���,:07=_ �y 2� '��y,c� l/ ��� .
September, 2013, but�a; � -o- �'�c ;_.— -o- 0.3� :�
left undated at the :xs �z� :�� 1933 .�y� ��'`
2003 ?.�: •y'• :
reque t of the oblig���'• ....;'r s' �'J6�,�'•• . �,�.�: � �
P�A 0014 (11/11) sy,1y�•� %����,� .�lp �' �`�.
••, r• ....•
N�an�.aaN '+ �
J
�C
o DATE(MM/DDlYYYI�
'4��� GERTIFICATE OF LIABILITY INSURANCE g/12/2013
TH!S CERTIFICATE IS 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,fi►e policy(ies)must be endorsed. If SUBROGATION IS WAIVED,subject to
the berms and conditions of the policy,certain policies may require an endorsement A statement on this certificate does not confer righffi to the
certificate holder in lieu of such endorsemerrt(s).
PRODUCER �M�CT T6=iild D7.113t18Is
�3P1t31 Insurance & Associates �oNE , (573)335-2300 F� .(573)335-0117
326 South Broadview ��� .terina@capitalinsaqency.com
P.O. BOX 177 9 INSURE S AFFORDING COVERAGE NAIC i!
Cape Girardeau MO 63703 iNsur�RaAMCO Insurance Co 9100
�^���D iNsur�R e Nationwide Mutal Ins Co 3787
NIP IQ�LI,Y EQUIPMENT CO INC nrsur�e c Allied Insurance
PO BOX 33 INSURERD�"L18801151 E 1 ers Mutual
wsur�e:The Hartford Commercial t
c� cn�D�v rso 63702-0033 INSURERF:
COVERAGES CERTIFICATE NUMBER�8ter 2013/2014 REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED. NOTIMTHSTANDING 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 COND(TIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR 7ypE OF INSURANCE POUCY NUMBER ��pCY EPF M�Y EXP UM�
LTR
GENERAL W181LI1Y EACH OCCURRENCE S 1�000�OOO
X COMMERCIAL GENERAL LIABILITY PREMI ES Ea ocwrtence S 100�000
A CLNMS-MADE �OCCUR PGI.A07162738259 /23/2013 /23/2014 MED EXP(A�one person) $ 5,000
PERSONAL 8 ADV INJURY S 1�OOO�OOO
GENERAL AGGREGATE S 2,OOO�OOO
GEN'L AGGREGATE UMR APPLIES PER: PRODUCTS-COMP/OP AGG E 2,000�OOO
X POLICY PRa LOC $
AUTOMOBILE W4BILITY CA eB�I.Nd�SINGLE UMIT 1 OOO OOO
B X q�.ry q�p - BODILY INJURY(Pet person) E
ALL OWNED SCHEDULED 7162738259 /23/2013 /23/2014 gODILY INJURY(Peraccident) S
X AUTOS X NON-0WNED PROPERTY DAMAGE a
HIREDAUTOS AUTOS Ferecaderrt
X 19 Schedule Mad Fac[or 1 f
X UMBRELIA Wl8 ��R EACH OCCURRENCE y 4�OOO�000
C aC��8 CLPJMS-MADE AGGREGATE E 4�OOO�OOO
DED X RETENTIONS 10,00 7162738259 /23/2013 /23/2014 $
D WORKERS COMPENSATION WC STATU- OTF4-
AND EMPLOYERS'W161lJTY Y/N
ANY PROPRIEfOWPARTNER/F�CUTIVE� N�A EL EACH ACCIDENT S 1 OOO 000
OFFlCER/MEMBER EXCLUDED? 0509977-10 /6/2013 /6/2014
�Mandatory In NH) E.L DISEASE-EA EMPLOYE $ S OOO OOO
If yes,describe under
DESCRIPTION OF OPERATIONS belav E.L DISEASE-POLICY LIMIT S 1 OOO OOO
E Lessed/Rented Eqnip�eat 4MSIU4365 /29/2013 /29/2014 $300,000
DESCPoPTION OF OPERATONS i LOCAl10NS/VEHICLES(A4ach ACORD 101,Addltfoml Remarla Schedule,lf more apace fs requfred)
CERTIFICATE HOLDER CANCELLATiON
339-6302 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
City of Cape GiraZdeau ACCORDANCE WITH THE POLICY PROVISIONS.
Project: Meadowbrook Water Storage Tank
401 Independence Street AUTHOR¢ED REPRESENTAINE
Cape Girardeau, 1�0 63701
Chris Gross/SHELLY �`�'a � ��`���
ACORD 25(2010/OS) �O 1988-2010 ACORD CORPORATION. All rights reserved.
INS025r�mnrtq�m Thc Af_(1RIl n�mc�nrl Innn arc roniaturorl m��lre nf Af:(1RIl
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COMMERCIAE.GENERAL LtABILITY �
CG 71 57 09 10
THIS ENDORSEMENT CHANGES THE POLtCY. PLEASE READ tT CAREFULLY. �
P
i
ADDITIONAL INSURED - 4WNERS, LESSEES OR CONTRACTORS �
AUTOMATIC STATUS WHEN REQUIRED IN CONSTRUCTtON CONTRACT ►
PRtMARY AND NON-CONTRiBUTORY �
This endorsement modifies insurance provided under the foliowing:
COMMERC(AL GENERAL LIABiLfTY COVERAGE PART �
A. Section 11 — Who ts An tnsured is amended to a. The preparing, approving, or faiiing to pre- �
mclude as an additional insured any person or or- pare or approve, maps, shop drawings, opi- �
ganization for whom you are performing operations nions, reports, surveys, fieid orders, change �
when you and such person or .organization have orders or drawings and specifications;or
agreed in a written contract that such person or b. Supervisory, inspection, architectural or �
organization be added as an additiona! insured on engineering activities.
your policy. Such person or organization is an ad- �
ditiona! insured only with respect to liability for"bo- 2• �Bod��Y injury" or "property damage" occurring �
dily injury", "property damage" or "personal and after:
advertising injury"arising out of, in whole or in part, a• All work, including materials, parts or �
by: equipment furnished in connection with
such work on the ro'ect other than ser- �
1. Your acts or omissions;or � P J � {
vice, maintenance or repairs) to be per� ;
2. The acts or omissions of those acting on your formed by or on behalf of the additional in- �
behalf; sured(s) at the location o# the covered
in the performance of your ongoing operations operations has been completed;or �
for the additional insured. b. That portion of "your work" out of which the *
A person's or organization's status as an addi- injury or damage arises has been put to its �
tional insured under this endorsement ends intended use by any person or organization
when your operations for that additional in- other than another contractor or subcontrac-
sured are completed. tor engaged in performing operations for a
No such person or organization is an addi#ional principal as a part of the same projeci. �
insured for fiability arising out of the "products- D. With respect to the insurance afforded to these �
completed operations hazard". additional insureds, Condition 4. Other lnsurance
B.The foflowing is added to SECTION 111— LIMlTS of Section IV — Commerciat General Liability �
OF INSURANCE: Conditions is replaced by the folfowing: �
The limits of insurance applicable to the additional 4. Other tnsurance �
insured are those specified in the written contract a. Primary Insurance
�.:
between you and the additional insuretl, or the lim- This insurance is primary if you have agreed �
its available under this policy, whichever are less. in a written contract or written agreement: t
These fimits are part of and not in addition to the (1) That this insurance be primary. I#other �
limits of insurance under this policy. insurance is also primary, we will share
C. With respect to the insurance afforded to these with all that other insuranee as de- �..
additional insureds, the fol(owing additiona� exclu- scribed in c. below;or E
sions apply: {2) The coverage afforded by this insur- �
This insurance does not app)y to: €
ance is primary and non-contributory ;
1. "Bodily injury", "property damage" or "personal with the additional insured's own insur- i
and advertising injury" arising out of the ren ance. �
dering of, or the failure to render, any profes- �
sional architectural, engineering or surveying
services, including: _,
CG 71 57 09 10 (ncludes copyrighted material of Insurance Services Office, Inc. Page 1 of 2 �
with its permission. '
�:
F:
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�
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S
CG 71 57 09 i 0 `
Paragraphs (1) and (2) do not apply to (2) When this insurance is excess, we will �
other insurance to which the additional have no duty under Coverages A or B F
insured has been added as an addi- to defend the additionai insured against �
tional insured or to other insurance de- any"suit" ifi any other insurer has a duty
scribed in paragraph b.betow, to defend the additional insured against F
b. Excess Insurance tha# "suiY'. If no other insurer defends, �
This insurance is excess over: we will undertake to do so, but we will �
be entitled to the additionat insured's �
(1) Any of the other insurance, whether rights against all those other insurers. �
primary, excess, contingent or on any �3) When this insurance is excess over {
other basis: other insurance, we wili pay only our �
(a) That is Fire, Extended Coverage, share of the amount of the loss, if any, �
Builder's Risk, Installation Risk or that exceeds the sum of:
similar coverage for"your work"; (a)The totai amount that all such other �
(b) That is fire, lightning, or explosion insurance would pay for the loss in
insurance for premises rented to the absence of this insurance; and �
you or temporarily occupied by you (b) The total of all deductible and seif- �
with permission of the owner; insured amounts under aIl that other �
(c} That is insurance purchased by you insurance. �
to cover your liability as a tenant for (4) We will share the remaining loss, if any,
"property damage" to premises with any other insurance that is not de- f
rented to you or temporarily occu- scribed in this Excess Insurance provi-
pied by you with permission of the sion and was not bought specifically to �.
owner;or apply in excess of the Limits of Insur- �
(d) tf the loss arises out of the mainten- ance shown in the Declarations of this
ance or use of aircraft, "autos" or Coverage Part. �
watercraft to the extent not subject c. Method Of Sharing '
to Exclusion g, of Section 1 — Cov- �
erage A—Bodily Injury And Property If all of the other insurance available to
Damage Liability the additionaf insured permits contribu- �
(e) That is any other insurance availa- tion by equa! shares, we will follow this f
ble to an additional insured under method afso. Under this approach each
this endorsement covering liabifity insurer contributes equal amounts until it
arising out of the premises or opera- has paid its applicable limit of insurance
tions, or products completed opera- or none of ihe loss remains, whichever �
tions, for which the additional in- comes first.
sured has been added as an If any of the other insurance avaifable to �
additional insured by that other in- the additianal insured does not permit �
surance. contribution by equal shares,we will con-
tribute by limits. Under this method, each �
insurer's share is based on the ratio of its �
applicable limit of insurance to the total
appticable limits of insurance of all insur-
ers. -
All terms and conditions of this policy apply unless modified by this endorsement. �
i.
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Page 2 of 2 Includes copyrighted material of Insurance Services Office, Inc. CG 71 57 QS 10 €
� with its permission.
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A�� CERTIFICATE OF LIABILtTY INSURANCE 6Ah{MMlDDIYYYY}
9/ie/2ois
THIS CERTIFICATE iS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPQN THE CERTIFICATE HOLDER.THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLIC{E5
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTfTUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZEO
REPRESENTATIVE OR PRODUCER,ANO THE CERTIFlCATE MOLDER.
tMPORTANT: if the certiflpte holder Is an ADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGATION IS WAiVED,subject to
the terms and conditions of the poficy,certain polides may require an endorsemerrt. A statement on this certificate does�ot confer rights to the
certificate holder in lieu of such endorsement(s).
PRODUCER �EA� T6Z'1Iid Dillahay
Capital Insurance 6 Associates �E . (573)335-2300 F^x
p� 0;(573)335-0117
326 South Broadview E�`"^� ,terina@capitalinsaqency.com
P.O. Box 17 7 9 iNsu� n�oRn��rc covertncE N,u��
Cape Girardeau MO 63703 x�suR�nNationwide Mutal Ina Co 3�g�
INSURED INSURER B;
CITY OF CAPE GIRARDEAII INSURERC:
PO BOX 33
INSURER D:
INSURER E:
CAPE GIRARDEAU MO 63702-0033 INSURERF:
COVERAGES CERTIFICATE NUMBER:OCP Master 2�13/2014 REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIE5 OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE ItJSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCt1MENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POIICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCIUSiONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
��R TYPE OF INSURANCE POLICY NUMBER M�Y E� �D EXP L.IMITS
GENERALUABIUTY EACIi pCCURRENCE $ 3�OOO�OOO
X COMMERCIALGENERALL1ABIlITY '�
rr S
A cuir,s-r.v,oE ❑X occuR CPGL07144119085 /14/2013 /lalzoia �o�p� ���� $
Ownar'a 6 Contractors PERSONALEAWINJURY S �
Liability GENEWOLAGGREG4TE S 3,000,000
GEML AGGREG4TE LIMR APPLIES PEf�t PRODUCTS-COMP/0P AGG S
X POLICV PRO- �� s
A������� Es a�ccident �NGLE UMIT s
ANY AUTD BOOILY INJURY(Per persmj $
UTOS � A�HOESDULED 80DILY IWURY(Per accident) $
HiRED AUTOS �N��� PR�PFRT1'DAMAGE
A�� Per accitle $
S
UMBRELLA LIAB p�CUR EACH OCCURRENCE S
EXCESS LIAB CLAIMS-MADE AGGREGATE S
OED RETENTIONS s
WOftKERS COMPENSATION WC STATU- OTH-
AND EMPLOYER5 LIABILITY Y/N
ANY PROPRIETOR/PARTt�WEXEGUTiVE
OfFICER/MEA�BER EXCLUDEO? ❑ N/A E.L EACH ACCIDBJT $
(ManAttory In NH) E.L.DISEASE-EA EMPIOYE $
H yes,desaibe under
DESCRIPTIpN OF OPERATIONS below E.L DISEASE•POLICY LW11T y
DESCRiPTIQV OF OPERATIOH51 LOCATIONS!VEHICLES (Affich ACORO�01,Adtlitlonal Remarks Schedule,If mwe apace h taquhed)
CERTIFiCATE HOLDER CANCELLATION
339-6302 SFiOULD ANY OF THE ABOVE DESCRIBED PO�ICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDAMCE WITH THE POLICY PROVISIONS.
City of Cape Girardeau
Project: Meadowbrook Watar Storage Tank pUTHORiZEOREPRESENTA7IVE
401 Independence Street
Cape Girardeau, MO 63701
Chris Gross/SHELLY �'r""a Q �'jt��
ACORD 25{2010/05) p 1988-2010 ACORD CORPORATION. Ail rights reserved.
IN3025 nmmsi m TV.o Cf'AAI'1 name�n�i Innn�ro ronic*nrcrl marMc nf Af:AGfl