HomeMy WebLinkAboutRes.2780.09-09-2013BILL NO. 13-129
RESOLUTION NO. CNLI .
A RESOLUTION AUTHORIZING THE CITY MANAGER TO
EXECUTE AN AGREEMENT WITH NIP KELLEY
EQUIPMENT COMPANY, INC., FOR THE EXTENSION
OF THE CAPE LACROIX/SHAWNEE PARK TRAIL
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 extension of the Cape LaCroix/Shawnee Park Trail, 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.
A
PASSED AND ADOPTED THIS DAY OFA J 2013.
ATTEST:
Gayle,,,4- Conrad, City Clerk
Harry .
64-9 Mayor
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CITY OF CAPE GIRARDEAU
CAPE LACROIX TRAIL AND
SHAWNEE PARK CONNECTIONS
STANDARD FORM OF AGREEMENT
� BETWEEN OWNER AND CONTRACTOR
ON THE BASIS OF A STIPULATED PRICE
THIS AGREEMENT is dated as of the �?3rd day of 5����y-,i�_�- in the year
2013 by and between the City of Cape Girardeau, Missouri {hereinafter called OWNER)
8nd Nip Kelley Eq�pment Co. In�reinafter called CONTRACTOR).
OWNER and CONTRACTOR, in consideration of the mutual covenants hereinafter set
forth, agree as follows:
Articte 1. WORK.
CONTRACTOR shall complete all Work as specified or indicated in the Contract
Documents. The Work is generally described as follows:
The Improvement consists of the construction of approximatefy 325 linear feet of an
8 feet wide mixed-use trail from the existing Cape LaCroix Trail to the southem
� softball fields and construction of approximately 1,425 linear feet of an 8 feet wide
mixed-use trail and approximately 475 linear feet of a 6 feet wide sidewalk from the
south end of the Cape LaCroix Trail at Cape LaCroix Creek to the intersection of
West End Boulevard and Linden Street and any other related construction items as
stated in the Specifications or shown on the Project Plans prepared by Bowen
Engineering & Surveying, Inc. and Dated June 24, 2013 for the City of Cape
Girardeau, Missouri.
Article 2. ENGINEER.
The Project Engineer or his 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 shall be di(igently prosecuted at such rate and in such manner as, in the
judgment of the engineer, is necessary for the completion of the work within the time
specified as follows in accordance with Sec 108 of the Missouri Standard Specifications for
Highway Construction, 2011 Edition:
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Calendar Days: 60 calendar days
3.2 Liquidafed 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. 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. Accordingfy,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 Seven
Hundred dollars $700.00 for each day that expires after the time specified in paragraph
3.1 for Completion unfil the Work is complete and ready for final inspection.
Article 4. CONTRACT PRICE.
OWNER shall pay CONTRACTOR for completion of the Work in accordance with the
Contract Documents an amount in current funds equal to the sum of the amounts
determined pursuant to paragraph 4.1 below:
4.1 for all Unit Price Work, an amount equal to the sum of the established unit price for
each separately identified item of Unit Price Work times the estimated quantity of that item
as indicated in the bidding documents.
TOTAL OF ALL UNIT PRICES:
One hundred seventeen thousand two hundred
forty-one dollars and saty-three cents
($ 117,241.63 )
As provided in paragraph 11.9 of the General Conditions estimated quantities are not
guaranteed, and determinations of actual quantities and classification are to be made by
ENGINEER as provided in paragraph 9.10 of the General Conditions. Unit prices have
been camputed as provided in paragraph 11.9.2 of the General Conditions.
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; OWNER shall make progress payments on ac;count 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. 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 Generaf
Requirements. Retainage may be initiated during contract performance in accordance with
Sec 109.9 of the Missouri Standard Specifications for Highway Construction, 2011 Edition.
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5.2 Final Payment. Upon final completion and acceptance�f 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 allawed by taw at the place af the Project.
Article 7. CONTRACTOR'S REPRESENTATIONS.
In order to induce OWNER to enter in#o 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".
72 CONTRACTOR has visited the site and become#amiliar 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 fumishing of the Work.
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 Facifities at or
contiguous to the site. CONTRACTOR has obtained and carefully studied (or assumes
responsibifity 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 inciderrt thereto.
CONTRACTOR does not consider that any additional examinations, investigations,
explorations,tests,studies or data are necessary for the performance and fumishing of the
Work at the Contract Price, within the Contract Times and in accordance with the other
terms and conditions of the Contract Documerrts.
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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 confli�ts,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 pertormance and furnishing of the Work.
Article 8. CONTRACT DOCUMENTS.
The Contract Documents which comprise the entire agreement between OWNER and
CONTRACTOR conceming the Work consist of the following:
8.1 This Agreement(pages A=1 to A=7 inclusive).
8.2 Exhibits to this Agreement(pages_to_, inclusive).
8.3 Performance, Payment, and other Bonds, identified as exhibits and consisting of
pages.
8.4 Notice to Proceed.
8.5 General Conditions {pages GC-1 to GC-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 Cape LaCroix Trail and Shawnee Park Connections.
8.8 Drawings.
8.9 Addenda numbers�to�, inclusive.
8.10 CONTRACTOR'S Bid (pages P=1 to P-8, inclusive) marked exhibit
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 senrices requested herein by 1) submitting a
completed, notarized copy of AFFIDAVIT OF WORK AUTHORIZATION and 2}providing
documentation affirming the bidders enrollment and participation in a federal work
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authorization program with respect to the employees proposed to work in connection with
the services requested herein.
8.i2 Documentation submitted by CONTRACTOR prior to Notice of Award (pages to
, inclusive).
8.13 The following which may be delivered or issued aiter 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 othervvise 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.fi of the General Conditions.
Article 9. MISCELLANEOUS.
9.1 Terrns used in this Agreement which are defined in Article 1 of the General Conditions
will have the meanings indicated in the General Conditions.
� 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 fimitation, 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
Contra.ct 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 ta provide, and require its_on-site employees to
complete, a ten (10) hour course in construction safety and health approved by the
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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 twenty (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 Subcon�ractors 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 Contract Documents
have been signed, initialed or identified by OWNER and CONTRACTOR or identified by
ENGINEER on their behalf.
This Agreement witl be effective on �����nbEr �3 , 20�(which is the
Effective Date of the Agreement).
OWNER Ci a e Girardeau CONTRACTOR Ni Kelle E � ment o c.
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Scott er i Mana er � _ '
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[CORPO ATE SE L] S A ] 1��v11;�,K��l�'
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Attest Attes ... ,;', ,,.
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Address for giving notices Address for givin�notices
401 Independence Street 41 N.Spri�Q Street
Cape Girardeau, �VI� 63703 Sarp (;irarr�aan NA� (��A
(If OWNER is a public body, attach License No. � ���J
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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NOTICE TO CONTRACTORS
Sealed bids, addressed to the City of Cape Girardeau, Engineering Departrnent, 401 Independence Street, Cape
Girardeau,MO 63703 for the proposed work will be received by the City of Cape Girazdeau until 10:00 a.m (prevailing
local time)on August 14,2013,at the office of the City Engineer,401 Independence Street,Cape Girardeau,MO 63703,
and at that time will be publicly opened. Bids should be delivered to: City of Cape Girardeau,Engineering Department,
401 Independence S�eet,Cape Girardeau,MO 63703.
A pre-bid conference will be held at 10:00 a.m.,local time,July 30,2013,at the Shawnee Pazk Center,835 S.West End
Boulevard, Cape Girardeau, MO 63703. Representatives of the Owner and Engineer will be present to discuss the
project Bidders aze r ' d to attend and participate in the pre-bid conference. The Engineer will transmit to all
prospective Bidders of record such Addenda as Engineer considers necessary in response to questions arising at the
conference. Oral statements may not be relied upon and will not be binding or legally effective.
(1) PROPOSED WORK: The proposed work,hereinafter called the work,includes:
Federal Aid Project No. STP-1500(021)consisting of the construction of approximately 325 linear feet of an 8
feet wide mixed-use trail from the existing Cape LaCroiz Trail to the southern softball fields and construction of
approximately 1,425 linear feet of an 8 feet wide mized-use trail and approximately 475 linear feet of a 6 feet wide
sidewalk fi-om the south end of the Cape LaCroix Trail at Cape LaCroix Creek to the intersection of West End Boulevard
and Linden Street and any other related construction items as stated in the Specifications or shown on the Project Plans
prepared by Bowen Engineering&Surveying,Inc.and Dated June 24,2013.
(2) COMPLIANCE W1TH CONTRACT PROVISIONS: The bidder, having examined and being
familiar with the local conditions affecting the work, and with the contract,conh�act documents,including the Missouri
Highways and Transportation Commission's "Missouri Standard Specifications for Highway Construction, 2011," and
"Missouri Standard Plans for Highway Conshvction,2009",and revisions,and the request for bid,including appendices,
the special provisions and plans, hereby proposes to fumish all labor, materials, equipment, services, etc.,required for
the performance and completion of the work All references are to the Missouri Standatd Specifications for Highway
Const�ruuction,as revised,unless otherwise noted.
The following documents aze available on the Missouri Department of Transportation web page at www.modot.mo.gov
under"Business with MoDOT""Standards and Specifications". The effective version shall be detErmined by the letting
date of the project.
General Provisions&Supplemental Specifications
Supplemental Plans to October 2009 Missouri Std.Plans
For Highway Construction(if applicable)
These supplemental bidding documents contain all current revisions to the bound printed versions and have important
legal consequences. It shall be conclusively presumed that they are in the bidder's possession, and they have been
reviewed and used by the bidder in the preparation of any bid submitted on this project
City of Cape Girardeau Standazd Specifications,dated May 27,2010
City of Cape Girardeau Standard Drawings,dated May 27,2010
Please note that within the above-listed documents, the term "Commission" shall be replaced with the term, "City of
Cape Girardeau", and the teim "Engineer" is a reference to the Engineer of Record from Bowen Fngineering &
Surveyi.ng,P.C_.
(3) PERIOD OF PERFORMANCE: If the bid is accepted, the bidder agrees that work shall be
diligenfly prosecuted at such rate and in such manner as,in the judgment of the engineer,is necessary for the completion
of the work within the rime specified as follows in accordance with Sec 108:
Calendar Days: 60 calendar days
(4) LIOUIDATED DAMAGFS: The bidder agrees that, should the bidder fail to complete the work in
the rime specified or such additional time as may be allowed by the engineer under the contract,the unount of liquidated
damages to be recovered in accordance with Sec 108 shall be as follows:
Liquidated damages per day:$700.00
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(� BID GUARANT'Y: Each Bid must be accompanied by a Bid security made payable to Owner in an
amount of five percent of Bidder's maximum Bid price and in the form of a certified or bank check or a Bid Bond(on
form attached,if a form is prescribed)issued by a surety meeting the requirements of Paragraph 5.1 of t3�e General
Conditions.
The bidder shall mark t6e box below to identify the type of Bid Guaranty.
� Paper Bid Bond
❑ Cashier's Check
The Bid security of Successful Bidder will be retained until such Bidder has executed the Agreement,furnished the
requued contract security and met the other conditions of the Notice of Award,whereupon the Bid security will be .
returned. If the Successful Bidder fails to execute and deliver the Agreement and furnish the required contract security
within fifteen days after the Notice of Award,Owner may annul the Notice of Award and the Bid sec�ity of that Bidder
wil]be forfeited. The Bid security of other Bidders whom Owner believes to have a reasonable chance of receiving the
award may be retained by Owner unti]the earlier of tt►e seventh day after the Effective Date of the Agreement or the
sixty-first day after the Bid opening,whereupon Bid security furnished by such Bidders will be returned. Bid security
with Bids which are not competitive will be retumed within seven business days after the Bid opening.
(� CERTIFICATTONS FOR FEDERAL JOBS: By signing and submitting this bid,the bidder makes
the certifications appearing in Sec. 102.18.1 {regarding affirmative action and equal opportunity), Sec. 102.18.2
(regarding disbarment,eligibility,indictments,convictions,or civil judgments),Sec. 102.183(regarding anti-co)lusion),
and Sec_ 102.18.4{regarding lobbying activities). Any necessary documentation is to accompany the bid submission,as
required by these sections. As provided in Sec. 108.13,the contracting authority may terminate the contract for acts of
R , . misconduct, which include but are not limited to fraud, dishonesty, and material misrepresentation or omission of fact
within the bid submission. _
{'n ANTIDISCRIIVIINATION: The Contracting Authority hereby notifies all bidders that it will
affirmatively insure that in any contract entered into pursuant to this advertisement,businesses owned and controlled by
socially and economically disadvantaged individuals will be afforded full opportunity to submit bids in response to this
invitation and will not_be discriminated against on the grounds of race, color, religion, creed, sex, age, ancestry, or
national origin in consideration for an award.
{8) FEDERAI� AND STATE INSPECTION: The Federal Govemment is participating in the cost of
construction of this project. All applicable Fedetal laws, and ti�e regulations made pursuant to such laws, shall be
observed by the contractor,and tfie work will be subject to the inspection of the appropriate State or Federal Agency in
the same manner as provided in Sec 105.10 of the Missouri Standatd Specifications for Highway Construction with all
revisions applicable to this bid and contract_
(9) PREVAII�ING WAGE (STATE ONLI�: This contract requires payment of the prevailing hourly
rate of wages for each craf3 or type of worker requu�ed to execute the contract as determined by the Missouri Deparhnent
of Labor and Industrial Relations. The applicable State Wage Rates for this contract are detailed in"Annual Wage Order
No. 19", that is attached to this bidding document These supplemental bidding documents have important legal
consequences_ It shall be conclusively presumed that they are in the bidder's possession, and they have been reviewed
and used by the bidder in the preparation of any bid submitted on this project.
(10) WORKER ELIGIBILTTY REOUIREMENTS: Execution of the construction conhact for this
project is dependent upon the awarded bidder providing an Affidavit of Compliance AND E-Verify Memorandum�f-
Understanding (MOT� between the bidder and Departrnent of Homeland Security to the Contracting Authority as
required by section 285530 RSMo.
An Affidavit of Work Authorization form(Affidavit of Compliance)is included in the Bid Documents.
All bidders must also be enrolled in the E-Verify Progrdm,and include their MOU prior to contiact�ecution. Bidders
who are not enrolled will need to go to the following website link and select"Enroll in the Program"to get started. After
completing the program,they will receive their E-Verify MOU with Department of Homeland Security. This document
will need to be printed out and kept on file so that a copy can be attached to the Affidavit of Compliance.
httpJ/www dhs gov/files/programs/�c 1 l 85221678150 shtrn
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, , This requirement also applies to subcontractors and conhact labor, but this contract only requires submittal of the
veri5cation documents for the prime contractor. It is the prime contractor's responsibility to verify the worker elig�bility
of their subcontractors in order to protect their own company from liability as required by secUon 285_530 RSMo.
{ll) OSHA TEN HOUR TRAINING REOUIREMENTS: Missouri Law,292.675 RSMO,requires any
awarded contractor and its subcontractor(s) to provide a tea-hour Occupa#ional Safety and Health Administration
(OSHA) Construction Safety Program (or a similaz program approved by the Missouri Department of Labor and
Industrial Relations as a qualified substitute) for their on-site employees (laborers, workmen, drivers, equipment
operators, and craftsmen) who have not previously completed such a program and are directly engaged in actual
construction of the unprovement(or working at a nearby or adjacent facility used for consh-uction of the improvement).
The awarded contractor and its subcontractor(s) shall require all such employees to complete this ten-hour program,
pursuant to 292.675 RSMO,unless they hold documentation on their prior completion of said program. Penalties, for
Non-Compliance include contractor forfeiture to the Contracting Authority in the amount of$2,500, plus $100 per
contractor and subcontractor employee for each calendar day such employee is employed beyond the elapsed tune period
for required program completion under 292.675 RSMO.
An Affidavit of OSHA Training is included in the Bid Documents.
(12) BITY AMERICA REQUIREMENTS: Construction contracts shall assure compliance with Section
165 of the Surface Transportation Assistance Act of 1982, Section 337 of the Surface Transportation and Uniform
Relocation Assistance Act of 1987, and 23 CFR 635.410 regarding Buy America provisions on the procurement of
foreign products and materials. On all contracts involving Federa]-aid, all products of iron, steel, or a coating of steel
which are incorporated into the work must have been manufactured in the United States. The Conh-acting Authority may
allow minimal amounts of these ma#erials fi-om foreign sources, provided the cost does not exceed 0.1 percent of t6e
contract sum or $2,500, whichever is greater. The Conbactor ceitifies that these materials are of domestic origin.
Additional information regazding the`Buy America"requirements can be found at:
httpJ/www.fhwa.do�eov/programadmin/contracts/b-amquck.cfin
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(13) ADDENDUM ACKNOWLEDGEMENT: The undersigned states that all addenda(if applicable)have been
received,aclmowledged and incorporated into their bid,prior to submittal. Staple addenda to the bid in the appropriate
part of the bid.
(14) SIGNATURE AND IDENTITY OF BIDDER: The undersigned states that the following provided
information is correct and that(if not signing with the intention to bind themselves to become the responsible and sole
bidder)t3�ey aze the agent of,and they are signing and executing this,as the bid of
� �l.�, Yk��"`�'� � . {� C ' which is the
correct LEG NAME as stat on th ntra r questionnaire(if appl�cable).
a) The organization submitting this bid is a(n) (1)individual bidder,(2)parh�ership,(3)joint venturer(whether
individuals or corporations,and whether doing business under a fictitious narne),or(4)corporation. Indicate by marking
the appmpriate box below.
❑ sole individua] ❑ partnership ❑ joint venture
�corporation,incorporaied under laws of state of_ _y� I _�Q (�- r!
b) If the bidder is doing business under a fictitious name,indicate below by filling in the 5ctitious name
Executed by bidder this�day of ! 20�.
TI-IE BIDDER CER'IgIES THAT Tf� BIDDER AND ITS OFFICIALS, AGENTS, AND EMPLOYEES HAVE NEITHER
DIRECTLY NOR INDIRECTLY ENTERED INTO ANY AGREEMENT, PARTICIPATED IN ANY COLLUSION, OR
OTI�RWISE TAKEN ANY ACTION IN RESTRAINT OF FREE COMPETITIVE BIDDING IN CONNECTION WITH THIS
BID, AND THAT THE BIDDER INTENDS TO PERFORM THE WORK WITH ITS OWN BONAFIDE EMPLOYEES AND
SUBCONTRACTORS,AND DID NOT BID FOR TF�BENEFIT OF ANOTf�R CONTR.ACTOR.
1T� BIDDER ACKNOWLIDGES THAT THIS IS AN UNSWORN DECLARATION, EXECUTED UNDER PENALTY OF
PERNRY UNDER Tf� LAWS OF TF� iJNITED STATES AND/OR FALSE DECLARATION UNDER TI� LAWS OF
MISSOURI, AND ANY OTT�R APPLICABLE STATE OR FEDERAL LAWS. TF� FAII.URE TO PROVIDE THIS
CERTIFTCATION IN THIS BID MAY MAKE THIS BID NON-RESPONSIVE,AND CAUSE IT TO BE REJECTED.
THE BIDDER CERTg�S THAT Tf� BIDDER'S COMPANY KNOWII�iGLY EMPLOYS ONLY INDNIDUALS WHO ARE
AUT'HORIZED TO WORK IN TT�UNTIED STATES IN ACCORDANCE WITH APPLICABLE FEDERAL AND STATE LAWS
AND ALL PROVISIONS OF MISSOURI EXECUTNE ORDER NO. 07-13 FOR CONTRACTS WITH THE CONTR.ACTING
AUTHORITY.
❑ Ch k this box NLY if the bidder REFUSES to make any or all of tbese certifications. The bidder may provide
explanatio or the refusal(s)with this submittal.
Signature of i r's Own , ffice , artner or Authorized Agent
V/ � ('
Please print or type name an tide of erson signin ere
Attest:
Secretary of Corporation ifBid� '" �o " on
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Affix Corporate Seal�Tf.�i�r.iSra '-�'"',erpQrat��=
'�.� � 4f;' ��, �;w ��� '.
NOTE: If bidder is doin�bei�'ines�s�d�rta�t ous name,the bid shall be executed in the legal name of the individual,
partners,joint ventures,�r tpora� �a`��'Fegis�a{ion of fictitious name filed with the secretary of state,as required by
sections 417200 to 4�.7..�3�� o. If tl�e bidder is a corporation not organized under the laws of Missouri, it shall
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procure a certificate:��tr�ori�-tq;do bys�ss itn Missouri, as required by section 351.572 et seq RSMo. A certified
copy of such registratipn::q��.�h�p�s n�ne o�a�ertificate of authority to do business in Missouri shall be filed with the
l�fissouri Highways and'=�'r�aus�Yt��n�ss�on,as required by the standard specifications.
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(15) TRAINEES: By submitting this bid,the bidder certifies that the bidder is familiar with the Training
Provision in the Missouri Highways and Transportation Commission's "General Provisions and Supplement
Specifications" which are available on the Missouri Department of Transportation web page at www.modot.mo.gov
under 'Business with MoDOT" "Standards and Specifications". The number of trainee hours provided under this
contract will be 0 slots at 1000 hours per slot or 0 hours.
(1� SUBCONTRACTOR DISCLOSURE: Requirements contained within Sec 102.7.12 of the Missouri
Standard Specifications for Highway Construction shall be waived for this contract.
(1'n PRIME CONTRACTOR REOLIIREMENTS: The limitation in Sec 108.1.1 of the Missouri
Standard Specifications for Highway Construction that "the contractor's organization shall perform work amounting to
not less than 40 percent of the total contract cost" is waived for this contract_ Instead,the less restrictive terms of the
Federal Highway Administration's rule at Title 23 Code of Federal Regulations(CFR) § 635.1 lb(a) shall apply, so that
the contractor mnst perform project work with its own organization equal to and not less than 30 percent of the total
original conh-act price. Second-tier subcontracting will not be permitted on this contract. All other provisions in Sec
108.1.1 et seq. of the Missouri Standard Specifications for Highway Construction sha11 remain in full force and effect,
and shal] continue to govem the contractor and its subcontractors, in accordance with the provisions of Title 23 CFR §
635.116.
(18) SALES AND USE TAX EXEMPTION: The City of Cape Girardeau, a tax exempt entity, will
fiunish a Missouri Project Exemption Certificate as described in Section 144.062 RSMo to the awarded contractor who
in tum may use the certificate to purchase materials for a specific project performed for the tax exempt entity. Only the
materials and supplies incorporated or consumed during the construction of the project are exempt. The certificate will
. -• be issued to the contractor for a specific project for a defined period of time.
(19) DIFFERING SITE CONDITIONS: If differing site conditions are encountered during the progress
of the work,the work shall proceed in accordance with Sec 104.2 of the Missouri Standard Specifications for Highway
Construction.
(20) SUSPENSION OF THE WORK DIRECTED BY THE ENGINEER: All suspensions of work
directed by the Engineer which delay the work for an unreasonable period of time shall be addressed in accordance with
Sec 108.15 of the Missouri Standard Specifications for Highway Construction.
(21) CHANGES IN TAE WORK: All changes in work shall be addreSsed in accordance with Sec 104.3
of the Missouri Standard Specifications for Highway Construction.
(22) RETAINAGE: Retainage may be initiated during contract performance in accordance with Sec 109.9
of the Missouri Standard Specifications for Highway Construction.
P-5
(23) HIERARCHY OF DOCiJMENTS: T�te documents included in the contract are intended to be ' ,
complementary and to descnbe a complete work_ If the Engineer determines a conflict exists between the contract
documents, the following hierarchy will be applied and the Contractor shall then complete the work according to the
interpretation made by the Engineer.
Hierarchy of the Contract Documents
Job Special Provisions(JSP) Hold over: Project Plans,
Supplementary Conditions,
General Condirions,
Standard Specifications
Standard Drawin s/Plans
*Project Plans Hold over. Supplementary Conditions,
General Conditions,
Standard Specifications
Standard Drawin /Plans
Supplementary Conditions Hold over: General Conditions,
Standard Specifications
Standard Drawin s/Plans
General Conditions Hold over: Standard Specifications
Standard Drawin s/Plans
*#Standard Specifications Hold over: ***Standard Drawings/Plans
* Calculated dimensions hold over scaled dimensions.
** City of Cape Girardeau Standard Specifications hold over the Missouri Standard Specifications for Highway
Construction
*** City of Cape Girardeau Standard Drawings hold over the Missouri Standard Plans for Highway Construction
P-6
. �
ITEMIZED BID: The bidder should complete the following section in acwrdance with Sec 102.7. The bidder
proposes to furnish al] labor, materials, equipment, services, etc. required for the performance and completion of the
work,as follows:
NO ITEM UNIT EST. UNIT TOTAL
QN. PRICE EST. PRICE
� T'P.C. CONCRETE
PAVEMENT S.Y. 40 $ . `7r� $ Lf�.�
2 4"TYPE 1 AGGREGATE
BASE FOR PAVEMENT S.Y. 44 $ � O $ D�, U
6"GRADE"B"SURFACE
3 DRIVEWAYTE FOR S.Y. 101 $ � � $ �`��� ��j
4 ADJUST WATER VALVE TO
GRADE EACH 2 $ �(�`� $ / .(�
5 ADJUST PULL BOX TO
GRADE EACH 1 $ Q (J� $ O,(Jj�
6 TEMPORARY TRAFFIC
CONTROL SIGN EACH 10 $ �7� � $ 7�O •�
� TEMPORARY TRAFFIC
CONTROLCONES EACH 60 $ 3 .(jZ� $ p7SO.CI�
8 TEMPORARY TRAFFIC
CONTROL FLAGGER EACH 2 $ �aO.� $ l�L��• (Jv
9 EROSION CONTROL-SILT
FENCE L.F. 742 $ , 7 $ �g 8,��
10 CLEARING 8�GRUBBING ACRES 0.5 $ c�/ ,(� $ Q,�
1� EARTHWORK-
EXCAVATION C.Y. 653 $ ,�U $ g_�
12 EARTHWORK-BORROW C.Y. 764 $ $ �,�
�3 ASPHALT REMOVAL&
DISPOSAL S.F. 4,042 $ , �p0 $ 1�a�a(�
14 GRAVEL REMOVAL& �
DISPOSAL S.F. 1,973 $ � �Q $ �,�
15 RIP RAP REMOVAL S.F. 233 $ 0 p $ _ U[J
16 CONCRETE REMOVAL&
DISPOSAL S.F. 120 $ a� $ �/-� U�
�� GRATE INLET REMOVE& �
RE-INSTALL EACH 2 $ � �(�� $ �
�$ SEGMENTAL BLOCK
RETAINING WALL S.F. 105 $ .�(7 $ �J 'O.O�
�9 60"RCP CLASS I11 L.F. 7.5 $ �;� $ �a v
20 60"RCP-8'F.E.S. EACH 1 $ $
2� 24"1YPE II RIP RAP MAT W/
GEO. FABRIC S.Y 110 $ 3 3 3� $ 3 6�ij 3��
22 4"P.C. CONCRETE
SIDEWALK S.Y. 253 $ $ g `���,1
23 4"TYPE 1 AGGREGATE
BASE FOR SIDEWALK S.Y. 295 $ �_ � $ 1 �� �
P-7
. ,
24 6"TYPE 1 BASE FOR
SIDEWALK TRANSITION S.Y. 35 $ �G�� $ �v� �
25 DETECTABLE WARNING
SURFACE S.F. 48 $ D $ f �L�DU
26 FERTILIZE, SEED 8� MULCH ACRES 1.1 $ Q�p . OD $ OD- �7
2� 6'P.C. CONCRETE
PAVEMENT FOR TRAIL S.Y. 1,495 $ �L`� ' $ � ��
28 4'TYPE 1 AGGREGATE
BASE FOR TRAIL S.Y. 1,680 $ ,1�Q $ �g��
29 6°WIDE CROSSWALK
STRIPING L.F. 90 $ a � $ , �
30 PEDESTRIAN CROSSING
SIGN W/"AHEAD"PLAQUE EACH 2 $ �-- �,�� $ �3�_ O�
3� PEDESTRIAN CROSSING
SIGN W/ARROW PLAQUE EACH 2 $ �� $ g�D _ O�
BID TOTAL FOR ALL UNIT PRICES $ / / � (� �I I ��
/ � '7/
_0� � /�1�,-ri-r��-P� ��P�t ���� � o�,,, ���' %�vv �/r�,nc�r�a%�
�
�� r � .� � l/a� c� � � �°� �
(Written figure) �
(Total bid amount is to be shown in both words and figures. In case of discrepancy, the
amount shown in words will govem. In case of error in extension, the unit and lump sum
prices under each Pay Item will be considered correct, and these sums when properly
extended, shall constitute the Bid.)
P-8
ADDENDUM #1
1.1 PROJECT INFORMATION
A. Project Name: Cape LaCroix Trail and Shawnee Park Connections;
Federai Aid No. STP-1500 (021).
B. Owner. The City of Cape Girardeau, Missouri.
C. Owner Project Number: 2092
D. Engineer. Bowen Engineering and Surveying, Inc.
E. Date of Addendum: August 07, 2013
1.2 NOTICE TO BIDDERS
A. This Addendum is issued to all registered plan holders pursuant to the Instructions
to Bidders and Conditions of the Contract. This Addendum serves to clarify,
revise, and supersede information in the Bidding and Contract Documents (Bid
Documents), Drawings, and any previously issued Addenda. Portions of the
Addendum affecting the Contract Documents will be incorporated into the Contract
by enumeration of the Addendum in the Owner/Contractor Agreement.
B. The Bidder shall acknowledge receipt of this Addendum in the appropriate space
on the Bid Form.
C. The date for receipt of bids is unchanged by this Addendum, at same time and
location.
1.3 GENERAL
A. This Addendum provides comments, clarifications, questions and answers as
result of the Pre Bid Meeting held July 30, 2013, and subsequent questions.
1.4 ATTACHMENTS
A. None.
1.5 REVISIONS TO PREVIOUS ADDENDA
A. None.
Page i of 3
ADDENDUM#1: ITB:August 14, 2013
2092 Cape LaCroix TraillShawnee Park Connections
� ,
1.6 REVISIONS TO PROJECT MANUAL
A. CHANGE Notice to Contractors, number (5), paqe P-2, third par.
Change the language reading "..or the sixty-first day after Bid opening..° to
"..or the ninety-first day after Bid opening..°
B. ADD JSP 01-Access and Work Areas:
"Access and work areas shall be limited. Contractor shall access the west side via
Rte 74 and the east side via West End Blvd. At a minimum, the work areas shall be
separated and surrounded by pedestrian barrier fencing, subject to approval by the
City Engineer(Engineer).
The west side pavement within the work area shall be no greater than sixteen
normal parking spaces on the outer parking row(no handicap spaces shall be
blocked). The east side pavement within the work area shall be no greater than
thirty normal parking spaces along the south side (no handicap spaces shall be
blocked). West side driving lanes shall remain open. Grassed areas on each side
may also be available if requested by the contractor, subject to approval by the
Engineer. All pavement and grassed areas disturbed by the contractor shall be
restored to equal or better condition, subject to approval of the Engineer, after trail
construction is completed. Concrete truck wash-out shatl not be allowed within the
Park or other City property.
All cost associated with Wo�lc Areas shall be incidental to other bid items.°
1.7 REVISIONS TO DRAWING SHEETS
A. None
1.8 PRE BID MEETING COMMENTS
A. All work shall be ADA compliant; grades will be checked using 2-foot long digital
level; see checklist required by MoDOT.
B. Numerous forms and pages with blanks to be filled in occur in the Bid Document;
be sure you have all required items filled in; also refer to pages BC-1 and BC-2.
Page 2 of 3
ADDENDUM#1: ITB:August 14,2013
2092 Cape LaCroix Trai{/Shawnee Park Connections
C. Submit questions by noon on August 06 via. Email or fax.
D. Make sure you check DBE requirements and prepare to submit the necessary
paperwork for DBE subs in case your bid is one of the low three; those three will
have to submit the completed DBE information within three days after bid opening.
E. Be familiar with various other MoDOT LPA requirements such as employee
interviews, invoicing etc.
F. Borrow pits and waste or debris disposal shall not be within the Park or other City
property.
G. Construction staking will be by the contractor.
H. Concrete testing will be by the City.
I. Bid Documents do not include structural design of the segmented block retaining
wall. The contractor shall be responsible for providing the sealed and signed
engineered drawings prior to wall construction.
J. Contractor is responsible for protection of the work site and for temporary traffic
control.
1.9 PRE BID MEETING QUESTIONS AND ANSWERS
A. Question; — Is excavation included in the borrow amount?
Answer, — No, the borrow is in addition to the excavation.
1.10 QUESTIONS RECEIVED AFTER THE PRE BID MEETING:
A. Question; — Can excess topsoil be disposed within the Park?
Answer; — Yes as directed by Park Department.
There are no other changes to the contract documents in this addendum.
� — END OF ADDENDUM #1 —
Page 3 of 3
ADDENDUM#1: ITB:August 14, 2013
2092 Cape LaCroix Trail/Shawnee Park Connections
SUBCONTRACTOR CERTIFTCATION REGARDING AFFIRMATIVE ACTION
Project: � T�� �.�� ,Oo2��
Job No.
Route:
ca��y: � a,o� i r'�.r—d e�,�c,
Certification Regarding Affirmative Action and Equal Opportunity: The bidder
(prospective prime contractor)or proposed subcontractor certifies:
1. Affirmative Action ProQram: That it has developed and has on file at each
of its establishments affirmative action programs pursuant to 41 CFR Part
50-2.
2. Equal Opporiunity Clause: That it has participated in a previous contract
or subcontract subject to the equal opporlunity clause set forth in 41 CFR
Part 69-1.4 and executive order no. 11246.
3. Compliance Reports: That it has filed with the Joint Reporting
Committee,the Director of the Office of Federal Contract Compliance
Programs and his designate,or the Equal Employment Opporiunity
Commission, all reports due under the applicable filing requirements
contained in 41 CFR Part 60-1.
If the text of the certification above is incorrect,the bidder or subcontractor making the
certification shall correct it below:
NOTE: This certificabon applies to and must be executed by each bidder(prospective prime
contractor)or proposed subcontractor if its proposed contract or subcontract on this project will
equal or ezceed$10,000 or that contractor or subcon�actor has contracts or subcontracts on
federally assisted projects in any 12-month period which have or can reasonably be ezpected to
have,an aggregate total value exceedi.ng$10,000 41 CFR Part 60-1.5(a)(1). It is a duty and
contract obligation of the prime contractor to insure that each of its subcontractors,which meet
this criterion,ezecutes and submits to the commission this certification aLso.
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Company ITJ Number.211168
THE E-VERIFY PROGF3AM FOR EMPLOI�'MENT VERIFICATION
MEMORANDUM OF UNDERSTANDING
ARTICLE !
RUR�O�E AND AtiTHORtlY
Thi� Memorandum of Undersfarrding (MOU) sets fartfi the po'rnts of �reemEnt between the
Department 4f Homeland Security (DHS) and Nip IfeHev Ecauipment Companv, tnc.
(Errtpio}fer} regarding the Employer's participation in the Employment Eligibility Verification
, Program (E-Verify). This MOU explains certain features of the E-Verify program and
enumerates specific responsibilities of DHS, the Social Security Administrafian (SSA), and the
Employer. E-Verify is a program that electronically confirms an employee's eligibility to work in
the United States after completion of the Employment Eligibility Verificatiort Form (Form I-9).
For covered government contractors, E-Verify is used to verify the employment eligibility of all
newly hired employees and all existing employees assigned to Federal contracts.
,4u�hority for the E-Verify program is found in Title fV, Subtitle A, ofi the Ulegal itnmigraffon
Reform and Immigrant Responsibility Act of 1996 (IIRIRA), Pub. L. 104-208, 110 Stat 3009, as
amended (8 U.S.C. § 1324a note). Authority for use of the E-'Jerify progr�am by Federal
contractors and subcontractors covered by the terms of Subpart 22.18, "Employment Eligibiiity
Verification", of the Federal Acquisition Regulation (FAR) (hereinafter referred to in this MOU as
a "Fed�ral cortracto�') to verify the employment eligibility•of certain employees working on
Federal contracfs is also found in Subpart 22.18 and in Execuiive CGrde� 12989, as amended.
ARTlCLE !I
�UNCTIONS TO BE PERFORMED
A. RESPONSIBILITIES OF SSA
1. SSA agrees to provide th� Empioyer with avaitable in#ormation that allovus the Employer
to confirm the accuracy of Social Security Numbers provided by all er�ployees verified under
#his MOU and the employment authorization of U.S. citizens.
2. SSA agrees to provide tfl the Emplo� appropriate assis�ance with operational
problems that may arise during the Employer'� partieipation in the E=Verify program: SSA
agr�es to pr�vide the Employer �nrith names, titles, addresses, and telephone numbers of SSA
representatives to be contacted during the E-Veri#y proc�ss.
3. SSA agre�s.to safeguard the inforr�natian provided by the Emplvyer through the E-Verifiy
program procedur�s, ar►d to limit access to such information, as is appropriate by faw, to
individuals responsibie f�r the verificatis�n of Social Security Numbers and for evafuation of the
E-Verdy program ar such other persons ar entities who may t�e aufhorized by SSA as gc�vemed
by the Privacy Act (5 U.S.C. § 552a), #he Social Security Act (42 U.S.C. 1306(a)), and SSA
regulations(2D CFR Part 401).
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�. �SA agrees to provide a means of autom�ted verfieation that is designed (in
Conjuncti�n with DHS's automated spstem if necessary) to provide confirmation or terrta#ive
noncorrfirmation of U.S. citizen�' employment eligibility within 3 Federal Govemmerrt work days
of the initial inquiry.
b. SSA �g�es tt� pr�pv#� a means pf secondary verification (ineluding updating SSA
recards �s maq L�e nece5sary) for employees wrho contest SSA tentative nonconfiirmations that
is designed to provide finat con#irmatiQn ar nonconfirmation af U.S. citizens' employment
eligibility and accuracy of SSA records for both citizens and aliens within 10 Federal
Government work days of the date ofi referral to SSA, unless SSA determines that more than 1�
days may be necessary. In such cases, SSA will provide additional verification instructions.
B, RESPOI�ISIBILITIES OF DHS
1. �tft�r SSA verifies the accurac�o#SSA records fo� afie�s throug#� E-Verrfy, DHS agrees
to provide the Employer access to selected data from DHS's database to enable ths Employer
to conduct, to the extent authorized by this MOU:
• Automated verification checks on alien employees by eleCtronic means, and
• Pt7oto verification checks (when avaifable) on employees.
�. DHS agrees to provide to the Employer appropriate assistance with operatiarral
problems that may arise during the Employer's participation in the E-Verifjr program. DHS .
agrees to provide the Employer names, titles, addresses, and telephon� �numbers of DHS
representatives to be contacted during the E-Verify process.
3. DHS agrees to provide to the Employer a manual (the E-Ver'rfy User Manual) containing
instru�ctions on E-Verify policies, procedures and requirements for both SSA and DHS, incfuding
restrictions on the use of E-Verify. DHS agrees to provide training materials on E-Verify.
4. DHS agrees to provide #+o the Employer a notice, which indicates the Employer's
participation in the E-Verify program. DHS also agrees to provide to the Employer anti-
discrimination notices issued by the Office flf Special Counsel for Immigration-Related Unfair
Employment Practices (OSC), Civil Rights Division, U.S. Department of Justice.
5. DHS a�grees to �ssue the Employer a u�er identific�tion �umber and passworii tFrat
permi#s the Emplayer to verify information provided by alien emplflyees with DHS's database.
6. DH5 agrees to s�afieguard the informafion provided #o DHS �y the Employer, ar�d #o lami�t
access to such irTformation to indnriduals responsible for the ve�ifie�tion af alien empbyment
�iigibiiity and for eval.uatwn of the E-Veri#y �rogram, or to such other persons or entities as ma�
be authorized �y applica�ile law. Informatic�n will be used oniy to verify the accuracy of So�iat
Security Numbers a+�d employment eligibil�ty, to enforce the lmmigration and Nationality Act
(INA) and Federal criminal laws, and to administer Federal contracting requirements.
7. DHS agr�es to provide a means of automated verif'rcation that is designed (in
conjunction with S,SA verification procedures) to provide confirmation or tentative
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nor�confim�atifln of emplayees' empCoymerrt eiig�itity within 3 Federal Caa�remment work days of
the initial inquiry.
8. DtiS agrees to provide a means o# se�ondaryr verificatian (includ'mg wp�ting DHS
records as may be necessary) for emplaye�s r:vvho contest DHS tentative nonconfirmafions and
photo non-match tentative nonconfirmatior�s tliat is designed to Pravide final confirmation or
noncon�rmation of the employees' emplvymeni. eligibiAty within 10 Federal Government wQrk
days of fihe date of referra) tt� DHS, ur�f�5s DHS determines that more than 10 days may b�
necessary. In such cases, DHS will pror�ide�dditional verification instructions.
C. RESPONSIBItITtES OF THE EMPLflYER
1. The Empfoyer agrees to display the notices supplied by DH5 in a prominent piace that is
cfearly visible to prospective employees and all employees who are to be verified through the
sys#em.
� 2. The Employer agrees to provi�e tn th�e SSA and DHS the rrames, ti�les, adrlresses, and
#�lephane numbers of the Employer representatives to be cantacted regarding E-Veri#y.
3. The Emplayer agrees to becflme familiar with and comply with the most recent version
� of the E-Verify User Manual.
4,. The Employer agrees that any Employer Representative who will perform emplopment
v�rifrcation queries will complete the E-Verify Tutorial be#ore that individual initia#cs a;�y
., queries.
� A. The Employer �rees that �!# Employer representat�ves witl t�ke the re#resher
tutorials initiated by the E-Ver'rfy program as a condition of cantiriued use of E-
Ver'rfy, including any tutorials for Federal contractors if the Employer is a Federal
contractor.
B. F�ilure to complete a refres#�er tutorial will prevent the Employer from continued
use of the program. .
5. The Employer agrees to c.�mpfy with current Form I-9 procedures, with two exceptions
• lf an emptayee presents a "List B� identi#� daclimen#, the Employer agrees to on�y
accept "List B" documents that contain a photo. (List B documen#s identified in 8 C.F.R.
�274a.2{b)(1)(B)) can be presented dur'mg the Forrri I-9 process to establish identity.) If
an emplpyee objects to the pho#o reequirement ��r religious reasons, the Employer
shou�d contact E-Verify at 888-464-4218.
• If �n empioyee pr�sertts a DHS Form I-551 (Perman�nt Resident Gard) or Form 1-766
(Emplc�yment Autharization Document)to comple#e the Form 1-9, the Empinyer agrees to
make a photocopy a# the documet�t and to retain the photocopy v�irth the employee's
Farm 1-9. The employer r�vi11 use the photocopy to verify the photo and to assist [3HS
witF� its review of photo non-matches that are contested by employees. Note that
emplayees �etain the right to present any List A, or List B and List C, documentation to
camptete�he Form I-9. D.HS may in tF�e future designate other documents that activate
the photo screening tool.
Page 3 uf 93�E-t�erliy MOU far Fm�lcrye'IRevision O�le 70'�:�9 ,.-i};.'.:<€s:.;..<;=s'��;�-': .
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6. The �npioyer und�rstarnds that participation in E-Verifj+ does not exempt the Empfoyer
#ran fhe responsibility to comple#e, re#ain, and make available for inspection Forms I-9 that
relate #o its emp{oyees, or from other r�quirements of appiicable regulations or taws, ineluding
th� obligation to compiy with the antidiscrimination requirements of section 2746 0#the INA with
respect to Form I-9 procedures, except fipr the following modified requiremerrts �pplicable by
reason of the Empioyer's participation in E-Verify: (1) identity doeuments m�,rst have pt�otos, as
described in paragraph 5 a#�ove; j2) a rebuttable presump6�n is estabfished that the Empioyer
has not vro{ated section 274A(a){1)(�j of the Immigrafion and Nationality Act (INA) with respect
to the hiring of any individu�l i#it obt�ains�onfirmation of the identi#y and employment eligibilify of
the individuaf in compliance vuith the terms and conditions of E-Verify; (3) the Employer must
notify DHS if it eontinues to employ any employee after receiving a final nonconfirmation, and is
subject to a �ivil money penalty between $550 and $1,100 for each failure to notify DHS of
co'ntinu�d employment following a #inal nonconfirmation; (4) the Employer is subject to a
rebuttable pres�mption that it h�s knowingly employed an unauthorized alien in violation of
section 274A(a)(1)(A) rf th8 Employer c�ntinues to employ an employee after reCeiving a final
nonconfirmation; and (5) no person or entity participating in E-Verify is civilly or criminally I'rable
under any law for any action taken in good faith based on information provided through the
confirmation system. DHS reserves the right to conduct 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-Verity verification procedures for new employ�es
within 3 Employer business days after ea�h employAe has been hired (but after both sections 1 .
a�d 2 of the Form f-9 have been completed), and to complete as many(but only as marry) steps .
of the E-Verifiy process as are necessary according t�the E-Verify User Manual. The Employer. . .
is prohibited from initiating verification procedures before the employee has been hired and the � .
Form I-9 completed. tf the automated system to.be querisd is temporarily unavailable,the 3-+�ay _ .
�me period �is extended until it i� again operational in order to accommodate the Employer's �
attempting, in good faith, to make inquiries during the period of unavailabiliiy. In all cases, the
Employer must use the SSA verification procedures first, and use DHS verification procedures
and photo screening tool only after the SSA verification response has been given. Employers
may initiate verification by notating the Form I-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 Etnployer performs an E-Verify employment verification query using the
employee's SSN as soon as the SSN becomes available.
8. The Emplo}�er agree5 not to use E-uer'ify procedures for pre-emptoymenf screen�ng af
job applicants, in support of any unlawful employment p�actice, or for any other use not
authorized by this I�OU. Employers musi use E-Verify fflr a!1 new employees, unles� an
Emptoyer is a Federal contractor that qua�`res for the exceptions des�ribed in Article II.D.1.c.
Except as p�vid�d in Article II.D, the Empiayer wi{I not verify se(e�#ively and will not v�ri#y
employees hired bef�re the effiecfive date af #tiis [b!C)U. The Empfoyer urx9erstands that if the
Em{�ipyer �ses E-�l�rif� praeedures for any purpQse other than as authori�ed by this MOU, the
Empfoyer may be su#�je�# to appropriate legal acfion and t�mination caf its a�ess to SSA and
pHS information purs�ant to this MOU.
9. Th� Emp�oyer agrees to follow apprapr�ate procedures (see Aiti�lE (11. below) r�garding
terrtative noncanfirmat�ons, includiRg ncr�#ying �mptoyees ofi the finding, pra�ri�ing wri�n
referral irtstrtrctions #o employees, allowing smployees to �r�test the finding, and nat taking
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atl�erse ac�on against emplo�rees if they choose to contest the firt�iing. Further, when
empioyees cante�t a terrtative nonconfirmafion based upon a photo non-match, the Employer is
r.equired to take affirmative steps (see Arfici� III.B. below) to contact DHS with information
necessary t� resoive the challenge.
10. The Em{�Ioyer agrees not to take any adverse action against an emplayee based upon
the employee's pefceived employment �ligibil'�y status while SSA or DHS is processing th�
verification request unless the Employer ob#air�s krrawledge (as defined in 8 C.F.R_ § 274a.1(1))
ftiat the emptoyee is not work �uthorized. The Employer understands that an initial inability of
the SSA or DHS �utomated verification sys#em #o verify work authorization, a tentative
nonconfirmation, a case in continuance (indicating the need for additional time for the
gavemment to r�solve a case), or the finding of a photo non-match, 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 #�ir 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 �on the employee's perceived employment eligibility status
(including denying, reducing, or extending work hours, delaying or preventing training, requiring
an employee to work in poorer conditions, refusing to assign the employee to a Federal contract
or other assignment; or otherwise subjecting an employee to any assumption that he or she is
r�nauthorized to work) until and unless secondary verification by SSA or DHS has been
completed and a final nonconfirmation has been issued. If the employee does not chaose to
contest a tentative nDnconfirmation ar a photo non-match ar 'rf a secondary verificatioR is
complsted and a final nonconfirmation is issued,then the Employer can find the employee is not
work author,zed and terminate the employe�'s employment. : Employers or employees with ...
questions about a final nonconfirma�iorr may�a�l E-Veri#�� at 1-888-464-4218 or OSC at�1-800-
255-8155 or 1�800-237-2515 (TDD).
11. The Employer agrees to comply with Title VIi of the Civil Rights Act of 1964 and section
274B of the INA by not discriminating unlawfully against any individual in hiring, firing, �r
�ecruitment or referral practices because of his or her national origin or, in the case of a
protected individual as defined in section 274B(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 employess because they appear or sound "foreign" or have received tentative
nonconfirmations. The Employer further understands that any violation of the unfair
immigration-related emplo�rment practices provisions in section 274B of the INQ could subject
the Employer to civil penalties, back pay aw�rds, and other sanctions, and violations of Title VII
could subject the Em�loyer to back pay awards, compensatory and punitive damages.
Violations of either section 274B of tf�e INA or Ti�e VII may also lead to the termination of its
participation in E-Verify. If the Employer has �ny questions r�lating to the anti-discrimination
pravision, it should contact OSC at 1-800-255-875� or 1-800-237-2515 (TL3{�).
12. The Employer agrees to record the case verificafion number on the empinyee�s Form I-9
or to print the screen cortt�aimng the case verificatian number and attach it to �he employee's
Form I-9.
13. The Employer agrees that i# v�rill use the tn#ormation it receives frorfl SSA or DHS
pursuant to E-Verify and this NfOU only tr� confirm the employment eligibifity o# employees as
Page 5 af i3)E-Vsrify 1��0lJ for Em�toyer�Renisivn Date 1C cz�^�It�'s '�R',^�s-,'-.'�-r-:�'a';'`-. . .
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�utho�ized h�r#his 1V10U. The Employer a�fiees that it will safeguarti this informa�ipn, and means
of aceess to it(such as PINS and passwords)fo ensure that it is not used for any other purpose
and as necessary to protect its confidentiality, including ensuring that it is n�t disseminated to
any person other than employees of the Employer vyho are authorized to perform the
Employer's responsibilities under this MOU, except fnr such cfissemination as may be
�uthorized in advance by SSA or DHS for legitimate purposes,
14. The Employer acknowledges that tlis i�tformafion rNhich it receives f��rm SSA is
gov�mect by fiJie Priva�y Act (5 U.S.C. § 5�2a(i)(1) and (3)) and the Social Security Act (42
U.S.�. 13t)6�a)�, and tfiat any person who abtains this information under f�lse pretenses or uses
i#for ar�y putpose other than as provided for in this MOU may be subject ta criminal penalties.
'1b. ThE Employer agrees to cooperate with DHS and SSA in tM�ir cc�mpli���•monitoring
and evaft�ation of E-Verify, including by permitting DHS and SSA, upon reasor�able notice, to
re�iew Forms l-9 and other employment records and to interview it and its employees regarding
the Emplo�rer's use c>f E-Verify, and to respand in a time#y �nd ac�urate manner to DHS
requests for information relating to their participation in E-Verify. .
D. RESPONSIBILITIES OF FEDERAL CONTRA�TORS
, 1. The Ernplayer undersfands thai if it. is a F�deral cpntractcx subj�ct to the
e�rtpioyment verification terms in Subpart 22.i8 of the FAR it must verify the employment
. �#igibility of any "employee assigned to the contract� (as defined in FAR 22.1801) in addition to
venfyi�g the.employment eligibility of all other employees required ta be vErifed under the FAR. .
Once an employee has been verified through E-Verify by the Empioyer, the Employer may not �
reverify the employee through E-Verifiy.
�. �Federal contractors not enrolled at the time of coritract award: An Employer that
is not enrolled in E-Verify as a Federal cont�actor at the time of a contract award must enroll as
a Federal eontrae#flr in the E-Verify p�ogram within 30 calendar days of contract award and,
within 90 days of enrollment, t�gin to use E-Verify to initiate rrerification of employment eligibility
of new hires of the Employer who are working in the United �tates, whether or not assigned to
the contract Once the Emp)oyer begins verifying new hires, such verification of new hires must
be initiated within 3 business days after the date of hire. Once enrolled in E-Verify as a Federal
con#�Cactor, the Empioyer must initiate verification of employees assigned to the contract within
30 cal�ndar days after the date of enrollment or within 30 days of an employee's assignment to
the contract, whichever date is later.
b. Fetlerai con#ra�iors already enrolled at ths time ofi a corrtract aw�rtl: Emplayers
enral�ed In E-Verify as a Federal contractor fi�r'�0 days ar more �t the time vf a coritraEt award
must use E-Verify fo initiate verificafion af employmerrt e�igibit'rty far new hir�� o#�Chs Em{�iayer
wha are working ir�the tJni��d States, whether Qr na#assigned to the contract, within 3 b�siness
days a#ter the dats ofi hire. (fi the Employ�r is enrolled in E-Ve�ify as a Fede�al contract�r��r 90
c�lendar days or less at the time of contract award, the Emplo�er musf, within 90 days c�f
enrol�ment, begin t�p t.r�e E-Verify to initiate verification of new hires of the contra�tor who are
vworking in the United 5tates, whether or not assigned to the contrac#. �uch verification of new
hires must be initiated within 3 business days after the date of hi��e. An Employer enrolled as �
Federa! contractor in E-Verify must ini�iate verification of each employee assigned to the
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contract wiifim-9D calenciar days after date of corrtract award or within 30 days after assignment
#�trt�contract, whichever is latet.
�. Ins#itutions of high;er education, S#�te, iocal and tribal governments and sureties:
F�der�d cnntractors that are institutions of higher educatian (as defined at 20 U.S.C. 1001(a)),
State or local gr�vemments, govemments of �ederall� recognized Indian tribes, or sureties
pertorm�ng under a tak�over agreement entered into wi#h a Federal at�ency pursuant to a
perfarmance bond ma� chaose to anly verifiy new and existing employe�es assigned to the
Federal contract. Such Federal contractors may, however, elect to �erify all new hires, aFld/or
all existing employees hired after November 6, 1986. The provisions of Article II.D, paragraphs
1:a�nd 1.b of this MOU providing timeframes for initiating employment verification of employees
assigned to a contrac# apply to such institutions of higher education, 5tate, local a�d tribal
governments, and sureties.
d. Verification of �I1 employees: UpQn entoflm�itt, Employers who are ��de�ai
contractors may ele�t tfl verify employment eligib1i#y o# a8 e�is#it�g emp.loyees working in #he
United States who were hired after November 6, 198fi, inst��d of verifying on�y those
employees assigned to a covered Federal con#ract. After enrollment, Employers must elect to
do so only in the manner designated by DHS and initiate E-Verify verification of all existing .
employees within 180 days after the election.
e. Form I-9 prt�cedures for Federal contra�tors: The Employer may use a
previously completed Fqrm I-J as the basis for initiating E-Verity verification o# an emptoy�e
. assigned to a contract as long as thaf Form I-9 is complete (including the SSN), corr;pliss with
Article II.C.5, the errTployee's work authorization has not expired, and the Em�loyer has
r�viewed the information reflectsd 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 to, a lawfu4 permanent resident alien
having become a rktturafized U.S. citizen). If the Employer is unable to determine that the Form
I-9 complies with Article II.C.5, � the employee's basis for work authorization as attested in
section 1 has expired or changed, or ifi the Form I-9 contains no SSN or is otherwise incomplete,
the Employer st�all complete a new I-9 consisten# with Article 11.C.5, or updat� the previous I-9
to provide the necessary information. If section 1 pf the Form I-9 is otherwise valid and up-to-
date and the forrn othervvise complies with Article II.C.5, but reflects documentation (such as a
U.S. passport or Form I-551j that expired subsequent to completion of the Form I-9, ttTe
Employer shaN not require the production of additional documentation, nr use the ph�to
screening tool described in Article II.C.S, subject to any additional or superseding irYstructions
that may be provided on this subject in the E-Verify User Manual. Nothing in this sec�ion shall
be construed to require a second ver'rfication using E-Verify of any assigned employee wh� has
previously been veri'Fied as a newfy hireti empbyee ut�der this MOU, or to a.uthorize verification
of atiy existing erim#�loyee by any Employer that is no#a Federal contractor.
2. ThE Employer unders#ant3s th�t i�ff is a Federal contractor, its com�liance with this MOU
is a performance requirement under the terms of th� Federal contract or subcontract, �nd the
Empto�er consents to the release of information relati�g to compliance with its verifica�ion
responsibi�ities under this MUU to cQntracting officers ar o�her officials authorized to rev�ew tC�►e
Employe�'s campliance v►ri�h F�lera�corrtracting requirements.
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A�RTI�1..E III
R�FERRAL OF I1�1D1V1DUALS TO SSA AND DHS
A F�EFERRAL TO S3A
1. If #he Empioyer receives a tentative ��n�onfrrmati�n issued by SSA, the Empioy�r must
print the tentative nonConfirmation notice as directed by the automated system �nd provide it to
the employe� so that the empioyee may determine whether he or she wn11 contes#the tentative
noncor�firmation.
2, The Employer v�li re�etr empioyees to SSA fi�id offices only as directed by the �
automated system based r�n a t�ntative nonconfirmation, and only aiter the Employer records
#he case verificati�n number, reviews the input to detect any transaction errors, and determines
that the employee con#ests the#entative nonconfirmation. The Employer will transmit the Social
Security Number to SSA for verification again if this review indicates a need to do so. The
Employer wi�l deterrrrine whether the employee contests the tentative nonconfirmation as soon
as possible after the Employer receives it.
3. If the empioy�e�contests an SSA tentative nonconfirmation, the Employer w�1 prQvide
the employee with a system-generated referral letter and instruct the employee to visit ar�SS�
office_within 8 Federal Govemment work days. SSA tinrill electronically transmit the resul#of the
referral to the Employer within 10 Federal Govemment work days of the referr�f unless it. -
determines that more than 10 days is necessary.The Employer agrees to checic the E-Ver'rfy • �
system regularly for case updates.
�. The �mployer agrees not to ask the employee to obtain a printout from the Social
Security Number database (the Numident) or other written verification of the Se�ccial Security
Number from the SSA.
B. REFERRAL Tf,S DHS
1. lf the Etnployer receives a ten#,ative r►crnconfirmafion issued by DHS, the Employe� must
prnrt the tentative nonconfirmation notice as directed by the au#omated system and provide it to
the employee sb that the em�lr�yee may determine whether ne or she wit� contest the terrtative
nonconfirmation.
2. If the Employer fin�s a photo non-match for an em�lc�yee who prav�ides a document fdr
which the autorr�ated sys#em has transmitt�d a photo, the em{�Ic�yer mus# print the photo non-
match tentativ.e npnconfirmation notice �s directed by the aut�mat�d sy.stem and pravide i�tQ
the employ�e so#hat the empi�y��; may cfe#ermine whether he ar she �nn�l contest the firmdir�g.
3. The Em�ivyer agrees �o re#e� individuals to DHS or�ly v+Ft►en the err�ployee ch�oses to
ccantest a tentative nonconfirma#ian r�ceived from DHS automafied verification process ar when
the Employer issues a tentati�e noncarlfi�mation based upon a photo non-match. The Employer
w�}I determine whether the empl�ree con�:sts the tentative nonconfirmation as soon as possible
Page 8 ut 13jE-�ler"(v MUU i6�ERtR'tVyEs.'���VISiJn Date 10:�08 •s,��-n€.t:'!.;-;=-''�;`�-`_�:�:��
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4. �� the employee cc�ntes�s a fenta#ive noncor�f'�rrriati�n �ued b�r DHS, the EmpiD�er wiil
pravide the employee w�th a referral letter and irrstrucC the empioyee to con#act DH5 thraugh its
toA-free hotiine(as found on the referral letter)withi� 8 Federal Govemmeni work days.
5. If the employee conte�ts a tent�tive noncon�rmation based w�or� a phato non-rnatc�, th�
Employer wili provide th� emptoyee v.�i�fi a r�fierral letter to aHS. DHS will electronicaqy transmit
the resuit of tt�e re#erral to the Employer within 1Q F�deral Govemmen#wori�days of the referrat
u�iess it determines tt�at mare than 10 day� is necessary. The Empfoyer a�rees to check�he E-
1fer�#y system regu�arly far�ase updates.
6. The Employer agrees that 'rf an emplt�yee con#ests a tentafive rior�corrfirmation l�ased
upon a photo non-match, the Employer will send a copy of fhe employee's Form I-551 or Form
I-766 to DHS for review by:
� �Scanning and uploading the document, or .
• Sending a photoco{�y of the document by an e�ress maii account (fumisMed and paid
for by DH�j.
� 7. The Emplayer understands thaf if it. cannot� d�terrni�e whether there i� a pho�
ma#�h�non-match,the Errtployer is required to foiward the employee's documentation to DHS by
scanning and uptoading, or by sending the document as described in the preceding paragraph,
and resolving the ca5e as specified by the Immi�ration Services Verifier at DHS w��o wi� �
determine the photo match or non-match. �
ARTICLE IV
SERVlCE PROVISIONS
SSA and DHS wiil not eharge th� Employer for verificatian services performed untlex ttiis MOU.
The Employer is respansibis for providing equipment needed to make inquiries. Ta acc�ss the
E-�/erify System, an Employer will need a personal computer with Intemet access.
ARTICLE V
PARTiES
A. TMis MOU is efiective upon the signature of all parties, and shall continue in e#fect for as
{ang as the 5SA and DNS conduct the E-Veri�y program unless mod�ied in wri#ing by the mutual
consefli ofi all parties, or terminated by any pariy upon 30 days prior written ru3tice to the �thers.
Any and afi system enhancements to fihe E-Verifiy progf�m by DHS or SSA, incl��iing but not
[imited to the E-Verify checking agairzs# adclitional data sourcEs and ins#ituting new verifieation
proceiiutes, v�rill be covered under this MC�U and v►ii�l nat cause the ne�d for a suppl�;mental
IwtOU that outlines these changes_ DHS agrees to tra�n employers on aH changes made #o E-
Verify through the use o# manda#ory refresher tutorials and updates to the E-Verify User
Manual. Even without changes to E-Verify, DHS reserves tf�e right to require emplay�rs to take
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mandatory r�e#r•�sh�r tutorials. An .Emp#�er that is a Federal cflntrac�or may terminate this
MOU wh�n �he. Fed�ral contract that req�rires its participation in E-Verify is terminated or
�ompt�ted. ln st�s� a circumstance, ttr�e Federal�ontractor must provide w►ritten notice to DHS.
If an Employer that is a Federal contractor fai�s to provide such notice,that Employer witl remain
a ¢articipant in #he E-lterify program, will remain bound by the terms nf this MOU that apply to
non-Federal c�ntractar p�rticipants, and wi�l be re�quired to use#he E-Verify procedures to verify
the employment alig�bil'iiy�all newly hired employees.
B. I�tc�twrithstanding Articte V, paY# A cc�f tkti� Mt�U, DHS may tertninate this MOU if �deemed
necessary becau�e t�f the requirements of law t�r �olicy, or upun a determination by 5SA or
DHS #hat there has t�een a breach of system integriry or secur'rty by the Employer, or a failure
on tt�e part o#the Emplo�er to comply with established procedures or legal requirements. The
Employer uriderstands that if it is a Federal contractor, #ermination o#thi� MOU by any party fior
any reason may negatively affect its performance of its contractual responsibilities.
C. Same ar aiJ SSA and DHS responsibilitie� under this ME)U may �re performed by
cQntraotor(s), and SSA and DHS may adjust verification responsibilities be#ween each other as
they rnay determine necessary. By separate agreement with DHS, SSA has agreed to perform
tts respc�nsibilities as described in this MOU.
D. No#hing in this �IIOU is intended, or shouid be construed, #o cre.aie a�ny right or benefit,
substantive or procedutal, enforceable at law by any third party aga�n�t the United States, its
agencies, officers, or employees, or against the Empfoyer, its agents, officers, or employees.
E. Each pariy st��l be solely responsibfe far d�e#ending any cla'rm vr ac'kion against it arising •
out o# or related fo E-Verify or this MOU, whether civil Qr criminat, and for any liablity
wheref�om, including (but not limited to) any dispute between the Emptoyer and any other
person or entity regarding the applicability af Section 403(d) of IIRIRA ta any action taken or
allegedly taken by the Employer.
F. The Employer understands that the fact of its participation in E-Verify is not confidential.
inf��rrtaation and may be disclosed as authorized or required by layr and DHS or SSA policy,
including but not fimited to, Congressional oversight, E-Verify pubJicity and media inquiries,
determinatfons of compliance with Federal cantractual requirements, and responses to inquiries
under the Freedom nf In#ormation Act (FOIA).
G. The �oregoing c�nstitu�s the fun agreemen# on this suDjeGt be#v,ieert DH3 �nd ths
Employer.
H. The in�vidu�ls who�e signatures �ppear t�elow represent that thEy are authorized ta
enter into ti�is MOU can behalf o#the Employer and DHS respecti�tely.
Page 10 e�13jE•�Te��y MC>U for�anaioyer�Rewision Da�e 1 fk'2gK�6 . .--�-. .;'i=_.'=�y�.'-�.�:°�: .
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TQ be ac�epted as a participant irt E-Verify, you sftoufd only sigfi trie Employer's Section
of`fhe signature page. if you have any t�uestions; �aitact E-Verify at 888-464-4218.
E�m�lsyer t�tip Kelley Equipment Company,lnc.
Vlr�c�Keiley
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De�sartment of Homeland Security-Verifieation Divlsion �
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Company ID Nuinber.211168
information Required for the E-Verify Program
h�rm�ation relating t�your Company:
�Ott��an}�hd�me: ldip KelEey Equipment Company,lnc.
�ornpam¢Facttity Address: �1 North Spri9g
Cape Girarc�eau;M�fi370'1
Gotnpany A�ternafe
A�idress:
�ounty ar Rarish:_CAPE.GiRARDE�U �
Empiayer ldentification
� F�tumber: �.3108624�4
Ntarth American lndusfry
Classlfication Systems
Code: 237
P�rent Corr►pany: �ip Kelley Equipment Company,inc.
hturnber af Emp�ay�es: 2a to 99 �
Muinber of S#t�s Vsrf�€i=c!
#L�l: 1 �
Are you verify�ng for more than 7 site? i#yes,pi�s�prravide trie number o#sites veriffed it�t in
�ch State:
. nn�ssouRi � S�ts�
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'��r ,'�:�`,.e„�'�� '`,IIIIII �
:�YY.:; � �
1Yi7��c
� � L-Vl6IlT 3S A SlINSCC M Dtl5
Gompany 1D Numt�:2i i 1 ss
irt�al�ttation reiatfng to Et�e Program Admf�istrator'(s)for your Comp►any an pnlicy quest�ons or
operatlo�l prait�tems:
Name: 5taci L Pepple
�elephone Number. (573)334-0.553 Fax Numb�r. {�i�3�i-2025
E-mail Address: spepple�nipkeileyco.com
Name: Vince L Kelley
Telephone�Jucnber: (573)334-0553 Fa3c Number. (573)3�4-2D25
E-rtrail Address: vkeliey�nipkelleyco.com
Page'13 of 13�E-Veriiy h1OU fbr Empioy�r1Re;�isia�D�te 1D�'29/�i9 �._�.-`,:.C .,{`�;•'^'-, .
EXHIBIT
AFFIDAVIT OF WORg AUTHORIZATION
COMES NOW (rt��) �I s (offi«x�t� 1�CSl Gt ��
of(CompaayName/Contractor) / 211��itst eing d y SufolYi, � �
mp oath,affiim as follows:
1. (Company Name/Contractoz) / � L( j C�'�("jwI �Q• ��� .
is enrolled and will continue to participate in a federal work au orizati n program in respect to
employees that will work in connection with the contracted services related to(Project Name)
C�0 /�(.r��� �� � S��'�Sr`th�di.a'uanon of t�eKco��ta��at�cordance with RSMo
Chapter 285.530(2).
l/ ` 1 � �
2. I also affitm that(Company Name/Contraaor)N/ � �//�( �� GC/,�f'��does
not and will nbt knowingly employ a person who is an unauthorized alien in connection with the
contract services related to (Project Name) �U C�OJ,� /('t�1I ��hGL(,J/f PP ��/�� for
the duration of the contract. ' ���e��S
3. Attached hereto is documentation affirming Contractor's enrollment and
participation in a federal work authoiization program with respect to the employees working in
connection with the contracted services.
FURTHER AFFIANT SAITH NOT.
IN AFFIRMATION THEREOF, the facts stated above are true and cozrect (the
undersigned understands that false statements made in this Sling are subject to the
penalties provided in Section 575.040,RSMo.)
! �%(�1�1 (�, y� .
�
!
(nlme f co rdtion)
By: �s't�1.
(aame of of cer of cotporatio d tide
AT1�ST:
.y �/�
�r y�' ✓V` -
`Y+..
Secre (or Q���.f�.!:, -:
.f•• �'�'
_-`„L'�• �;�I Q 1?,,��„� �:. �
-�, '�..�: �.w-��...y: - ..:�°::
(SEAL-C�F-Qy��� ����'.�f/,._
� ,. � ��. C3;?'=
,� _ J _.�, .
- ���; ,� ' .. ,-:��"=". .
,�,. _
. �'. ��J a'' �'.� WA-1
:� .. .,_ o,• �,
a.a�� °•�� .-
..r'';. '��11� v �.
. ��/� .�Yf''"',��4►
, •� �f���ii1101�6Lii8
.rr�?�``
STATE OF MISSOURI )
) ss.
COUNTY OF CAPE GIRARDEAU )
On this I�`�hday of �4 U-S� '�, 20 t�3 before me appeared Y��✓tC �����-
to me personally known,who,being b me dulp swom,did say that�/she is the ����l��t,`E-
of i ��.c u:, /1�' C� � Missouri Corporation, and that the seal affized to the
foregouig ins ent is e seal of said Corporation, and that the said instrument was signed and
' sealed in behalf of said Corporation by authority of its Board of Directors, and acknowledged said
instruinent to be the free act and deed of said Corporation.
IN TESTIMONY WHEREOF,I have hereunto set my hand and affixed my official seal, at
my office in Cape Girardeau,Missouri,the day and year first above written.
Notary Public
•`�IYP'
({��,, STAq L PEPPLE
Mp Commission Egpires: :�►�Y�'= ��0"�P"�
''' Februery9,2017
� ' ',� . .��` �#13434217
WA-2
EXHIBIT
AFFIDAVIT OF OSHA TRAINING
COMES NOW(Name) ✓� e ��/ as (Office Helc� r .S/G' e lt-�"
of(Company Name/Contractor) � l �C� t being duly sworn, on
my oath,affizm in connection with the contracted services related to a.�v ,�aC�o�� J�'�'a i l �' s�'1 a��
j� 1l T1�"�jea Name) for the duration of the contract,as follows: '
I
1. Contractor shall provide a ten (10) hour Occupational Safety and Health
Aclministration (OSHA) construction safety program for all emplopees who will be on-site at the
Project. The construction safety program shall indude a course in construction safety and health
that is approved by OSHA or a similar program approved by the Missouri Department of Labor and
Industrial Relations which is ar least as stringent as an approved OSHA progtam as required by
Section 292.675,RSMo.
2. Contractor shall require its on-site employees to complete a construction safety
program within sigty(60) days after the date work on the Project commences, as required by Section
292_675,RSMo.
3. Contractor acknowledges and agrees that any of Contractor's employees found on
the Project site without documentation of the successful completion of a construction safetp
program shall be required to produce such documenta.tion within twenty (20) days,or will be subject
to removal from the Project
4. Contractor shall require all of its Subcontractors to comply with the requirements of
Section 292.675,RSMo.
5. Contractor acknowledges that pursuant to Section 292.675, RSMo., Contractor shall
forfeit to City as a penalty two thousand five hundted dollars ($2,500.000),plus one hundred dollars
($100.00) for each on-site emplopee employed by Contractor or its Subcontractor, for each calendar
day, or portion thereof, such on-site employee is emploped without the construction safety training
required in Section 292.675,RSMo.
6. Conttactor acknowledges that violations of Section 292.675, RSMo, and imposition
of the penalties described therei.n shall be investigated and dete�ined by the Missouri Departtnent
of Labor and Industual Relations.
7. Contractor acknowledges that in the event that the Missouri Department of Labor
and Industrial Relations has determined that a violation of Section 292.675, RSMo., has occuaed
OSHA-1
and that a penalty shall be assessed,the City shall withhold and retai.n all sums and amounts due and
owing when making payments to Contractor under this Contract.
FURTHER AFFIANT SAITH NOT.
IN AFFIRMATION THEREOF, the facts stated above are true and co=rect (the
� undersigned understands that false statements made in this filing are subject to the
penalties provided in Section 575.040, RSMo.)
, � �� ��� �J �„
(name of co ration
By: � �SJ x-�"
(name of fica o cozpora' n utic)
A'I"I'EST:�%� _.----�..,.
�"_. C ..'�� y `�.,
Scczctazy(or other officcr) � .. • "'-
_ v�l-J���, �f /• '` ''._
_ ,y.__�+'_�
,{\`
•,t=�s�' i,_: r. �i (-1 0 _' � ..
. � ��.:: �, �
(SEAI.OF CORPORATIOIV) - �'; '��� _�'}`;
. � ��.�- , ` .�°'��,� _-`
� ,�'
v
�;, .?,��,;�c �� .
""' �''�•,.,,,��.<<,���`''s
STATE OF MISSOURI )
) ss.
COUNTY OF CAPE GIRARDEAU )
On this 1�dap of �('U-S�' , 20�before me appeared �' � �� ,
to me personl lly known,who,b�� b��y me duly swom,did say that�e she is the 4�✓1��
of �" e � � �'1 � -�"�; a Missouri Corporation, and that the seal affiged to the
foregoing ins e�it i the seal of said Corporation, and that the said instrument was signed and
sealed in behalf of said Corporation by authority of its Board of Directors, and acknowledged said
instniment to be the free act and deed of said Corporation.
IN TESTIMONY WHEREOF,I have hereunto set my hand and affiaed my official seal,at
my office in Cape Girardeau,Missouri,the day and ear first above written.
�
Notary Public
����", STAq L PEPPLE
Mp Commission Ezpires: ;o�qAYP '�;
�?��+� �'Feb�17�
� � �� ��'� S�t Cour�tY
' ��� :� Cortni�siot►513434217
, �,
OSHA-2
��1� -I.�o�<�al�
�-o��c N��
,,..:
Certification Regarding
Debarment, Suspension and Other Responsibility Matters
The contractor hereby certifies to the best of its knowledge and belief and that it and its principals
and its subcontractors and their principals:
(a) Are not presently debazred, suspended,proposed for debarment, declared ineligible or
voluntarily excluded from covered transactions by any Federal or State department or agency;
(b) Have not within a three(3) year period preceding this proposal been convicted of or had a
civil judgment rendered against them for commission of fraud or a criminal offense in
connection with obtaining,attempting to obtain or performing a public (Federal,State or
Local)transaction or contract under a public transaction; violation of Federal or State antitrust
statutes or commission of embezzlement, theft,forgery,bribery,falsification or destruction of
records,making false statements or receiving stolen property;
(c) Are not presently indicted for or otherwise criminally or civilly charged by a government
entity{Federal, State or Local)with commission of any of the offenses enumerated in
paragraph(1)(b)of this certification; and
. (d) Have not within a three-year period preceding this subcontract had one or more public
transactions (Federal, State or Local)terminated for cause or defaul�
I understand that a false statement on this certi5cation may be grounds for rejection of this
contractor or termination of the contrac�t. In addition,under 18 USC Sec. 1001,a false
statement may result in a fine of up to$10,000 or imprisonment for up to five(�years or
both.
• � � ,
� � r�s � �
Typed Name Title rized Representative
��-�3
Signature o Authorized Repr tative Date
❑ I am unable to certify to the above statement. My explanation is attached.
. •
DBE Submittal Forms
(6) DBE Submittal Forms: This form must be submitted by 4 p.m.three(3)business days after bid opening.
(A) DBE Contract Goal: By submitting this bid,the bidder certifies that the bidder is familiar
with the DBE Program Requiremerrts in this contract. The contract DBE goal for the amount of work to
be awarded is 6%of the total federal project price. The bidder shall also comptete the DBE Submittal
Form in accordance with the program requirements.
{B) DBE Participation: The bidder certifies that it will utilize DBE's as follows:
�%OF TOTAL FEDERAL CONTRACT
NOTE: Bidder must fill in the above blank. If no percentage is specified, the bidder
certifies that it agrees to,and will comply with the contract goaf. If a percentage below the
contract goal is specified,then the bidder must submit complete documentation ot good faith
efforts to meet the DBE contract goal,immediately below.
(C) Certification of Good Faith Efforts to Obtain DBE Participation: By submitting its
signed bid, the bidder certifies under penalty of perjury and other provisions of law, that the bidder
took each of the following steps to try to obtain sufficient DBE participation to achieve the proposed
DBE Contract Goal: (Attach additional sheets'rf necessary).
DBE-1
a �
DBE Submittal Forms
Identification of Participating DBEs:The information shown on this page must be completed. tf this page is submitied but not signed,it will
not be cause for rejection_ The apparent low and second low bidder must file this form with the
by 4:00 p.m.on the third woricing day after the bid opening. Fax or email
transmittal is permitted. The fax number is and the email address for submittal is . The
original copy must be mailed by ovemight mail to the Local Public Agency the day of the FAX or email transmittal. Contact External Civil
Rights at(573)751-7801 for questions or assistanc:e in completion.{Note:Submittal of this form is not required if the Contract DBE Goal is
0%)
The undersigned submits the following list�f DBEs to be used in accomplishing the work of this conVaci. The work,supplies or services,
applicable value and percent of total federal contract each DBE is to perform or fumish is as follows:
(A) (B) (�) (�) (E) I�
DBE Name 8 Address Bid Item numbers $Value of DBE of Work" °k Of$Value $Amount Applicable to %O(Total Contract
(Or Line numbers) Applicable to DBE DBE Goal for each Amount for each ftem
(Unit Price x Quantity of Goal" item
each item in B,or Lump Sum) (100%,60qa) (F1Total Contract Amount)
CxD
S�ilver Eagle #9 360.00
Construction #21 550.00
Products #25 792.00
P.O. Box 997
O'Fallon, MO
63366
#0040649 TOt� $1 �702.00 60� Tota�$1 �021 .20 Total ,87$
2.
Road Runner
Safety Servi s
P.O. Box 552 #6 1 ,360.00
Jackson, MO #� 1 ,625.00
63755
#0025463
TO�2�985.00 100� 7otal$2�985.00 TO� 2.55$
3.
Road Runner
Safety Servi s
P.O. Box 552 #30 280.90
Jackson, MO #31 280.90
63755
#0025463
T°t�561 .80 60$ Total$337.08 Tota� �29�
a.
Gertis, Leste
' Dameron & Ass c. #11 500.00
1301 N. Kings ighway#12 500.00
Cape Girardea , MO #18 800.00
63701 #27 900.00
#0027883
TO�� $2,700.00 1 00$ TO��$2,700.00 TO� 2.30$
Total DBE Participation $7,9 4 8.8 0 � ' 6.O 1 $
*} Cannot exceed contract amount for given item af work.
DBE-2
� . DBE Submittal
(Aj {8) (C) (D) (E) (F)
DBE Name&Address Bid Item $Value of DBE of Work 'k Of$Value $Amourrt Applicable to %Of Total Corrtract
numbers " Applicable to DBE DBE Goal for each Amount for each item
Goal" ftem
(Unit Price x Quantity oi
each item in B,or Lump (100%,60qa) (C x D) (F1Total Corttract
Sum Amourtt
Trucking Services
100%
Only used ff the DBE owns
the trucks or is leasing from
a DBE firm
Trucking Senrices
Only Include Fees for
Trucking Services
Trucks are leased from non-
DBE source
Brokered Services
Only Indude Fees tor
Brokered Services
Totals(Page 1)
6.01 �
Totals(Page 2)
Totals(additional pages if
neede�
Total DBE Participation
$7,948.80 $7,043.28 6.01 $
** Cannot exceed contract amount tor given item oF work.
i
Company: N p Kell y Equipment Co. , a��.. August 15, 2013
By: Ti�e: President ;
�
DBE-3
' � ��.����
�� B��
SIDDSR(Nm�e�d.l�ars�:
Nip Ke3.lev Eani_nme_n�t Comrrariv, Inc .
41 North Scnc�z S`t.t�eet "' .
t:ape Girarcieau, IrA 63703 ' '
S[IBY1YtNaw�e asd A�dnet:�o�'Ariaa�a�t Plaoe af�s;- . . .
Mere�aats__BoedinQ �anv(�l)
2IQ0 Fl.eur Driv+e "' _ -
Des I'jaines, IA 50321 Tel: 515-243-8171
�$(Na�.s+r�d�lddnss}: •
Ci of Gt=ard�u_
City F�].I, 401 Indep�oe Street
Cape irardeau, 1� 6370I . .
Bl�
B�DUE3?ATE:�st 14� 2013
P�OJECT t'Bri�D�to��a r.aaatio,y; �'—
Cape LaCroi�c Trail an�wnee Park Connee�c�s.
BOL�TD�
BONp AtUA�R; N/A
���������= 14 2013 �
P�Aj.5�3� Five Peree�nt flf t�e-Amo�t Bid o .
tNWrrr�'ssw�oF'�ya�a�c.����r��y.m����
p�ate�!a�►the�evase si��db e�c�e t�B;d.H�na�o.be a�ly e�m��a o�i��f by its
�o�,aSe�a�e�spve. ;' '°
. ,,,,.,�,..����,., ..
BYDpTR SURBTY ;;�,Q.���Y.:� .�'� '�
. .�,,
N7P I�L,I.EY CCJI�.'ANY, tNC MERCE�`t5 B�D I'�''�� ����0 9�
r�� ING (S'�ANY ( >' ;, %,
�'s I�De� N�� �.:�p c��. .�: .�-,�
Nmme and Co�te SEa2 0�' o�� ' .'-' ' '
gl,: � /6� �� '•/i�,..
y.4YaY>5� �t:j�� _ I, � �, .
!�'w /J( •�
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� .�- " 4';: 3ig�s and 1�fAt�ch Ibeuez ot'�Yj •.,,�,: �`+. . �t �
, � . "r••�;�� �- �� �
�� � �•;,� Y�.,��}; d L. Wasaba, �it�oraey in-F'act .
�� ` �' ' .Y; � Witness: n�n .,� Zj l,�@o�.�e-�.0�„
,_ � ., _ ' l ; U d r �` • :� �d't"We
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,,��,'��`�',�'`�:��fu�t,SaEte�►s t3wao[at� a�ajl
.;,,,,.� � o�l�arty 6e c�o�+od pl�at�rba+e
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1. BS�+��et�,.�7��oaad sevas8X.6iad t�t�hrq,� • 8p�y��t ap�,�l�a aF�r�ANfi`+bJa
heus'r���ors�aQ a�ns�A47�p�
of�hii Baud,������snm aet€�tA m�t�cc ���is aot �,t t�vit�shat!
c��ia fiti[tbsx sad c�oct.
:, D�t'sutt ci'Siddcr s�att occur o�a t�F�'turc ot'Bic�d�r ta t 1. 't�E�"b,d"as vsed �
�����4��Y dle B�dia�Dn�t� ��� �ia inch��aid,offet a�pqyp�ai
P�'�uCt��od 6Y tlk Hidd���ap�,
�+a ard�� �������
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3. This obti��a�+atllr�ri1 sn6.wid i C:
3.! a.vaac axeyts aittcka's�id and Eidder dtlerats w;�n
���N►�t►Y tlu Biddiag I7ncua�ns(or aav ..
mctatsiaa c�f�ao ia ar�g bj*pv��
+.xecvba 11����by fhe S�dd"w� •
Qocu�u,d�Y�oe md p�rama ba�b
�Kd�i''�B�t?oc�s�d Coatact
Qacuax��,� �
3.� M bi�aAe rGjected b9 Qwner;or
33 bw��y��,,;�a�ofam�m Bi�a ww�r�a
:!a sie�sD�Gcd i��Biaaiog poe�r;a�(or,py
�x�sioa tbereaf�raod ss ie`�l�9 Bidda a�ul.iC
�eo�eat m by Sure�y�aq�ed by
W�pl�5 heceo�
4. ��Aa'deis 8ond wlif�doa at�p�rbk upm drf�Wt
at8iddu aa6 o'itltia 3t1 csk�dardays attcr cax;p�bY�4dd�r ea�
S�Sy af writa��a ot�a$+o�dwaer,xd+ich notiee wi11
br 8n'tn witL�ess8nahk P�►�.�this 8urtd m8
�7°p`Rl���lu�t�aocmaoe Qf We amouac dae.
S. Sunty waive�ne,cicc oFand mry ssd a8 d�bas�en or
ensi�a.►c otany rime e��i�a�ice ofawa�d a�seed m
im wtiuu�bY pwntr aud&ddr�F�'�dqe d�c time for inu�ir�g
notF�o£aur��B�io�:�nll aot in tl�e�e�
exceeQ I20 dyn from�id t7oc Ds��yj�$��e2aidt
canseot
G l�ie wit as:ceioa���u��s$oad��
3p alen�ar dv0's�Ehc As#ice af dc�ah cr.t�c�d ia px�g,sph 4
a���a bys�a�apoa�m�,�a��►�tv�ra�, �
on�rar atl�x sid Dus II�e.
7. Aay suit orac�eR��;c Boad s1uIt bC cw�eaced va�r is►
�ca�rt of�i)urtsdiartin lceateR i�tE�s4ae ia w�cte dra
�]��s baste�.
B. Noticc rcqims��se,�a�g he i�vv�{qt��d�c�8�
�Sn�acy at eb�t+�ve����va on�tac�o�trhii
8oad.SuGt�aod��be sesc bY P�drlive:y.ooa�x,a�i
oo�rier es b�y fJoifcd Stat'es Bsgictes�y or C�Sod Ufa7.�re-
�Ft�.Past�e��.n�d�tp�!be�w br
�'eeuEQe t�pee rap�p��'��pat�}+000�, ' _
9. �T st�ewet tcbr ame'ka�tv tlns Bm�d t ca[1'tOt me
eflFeaer�e Powa atA[icu�c,r�dra sut�o�r of ttsr�C,
�fi���sttive wi�p�tldi B�d oa�af S�
���wt aed dNiwr sge6 Bvnd�bind tht StQexy�Y
t fl. 7�as Bo�W a�m c��ta att appiiabk smm�y '
�b0°a���dr�pood�he domoed!�t� .
irwtnelod]�a sa i�sat�a�}engfh. �f'�P�e�i�p��
EJCDCI�R t9iCi-E6�(t99d6diqn) B�-2
' ` MERCHA[�TT�
BONDING COMPANY.�
POWER OF ATTORNEY
Know All Persons By These Preserrts,that MERCHANfS BONDING COMPANY(MUTUAL}and MERCHANTS NATIONAL BONDING,
INC.,both being corporations duy orc�anized under the laws of the State of lowa(herein collectivey qlled the`Companies�,
and that the Companies do hereby make,constitr�te and appoirrt,individualfy,
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 rtame,place and stead,to sign,exearte,aclaiowledge and deliver in their behaif as surety
any and aU bonds, undertakings,recognizanoes or other wriiten oWigations in the nature thereof,subjed to the limitation that any
such inshumerrt shall not e�cceed the amount of
TR'O NIILLION(S2,000,000.00)DOLLARS
and to bind the Companies thereby as fuly and to the same extent as ff 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 cortfirtned.
This Power-0f-Attomey is made and exewted pursuarrt to and by authority of the following By-Laws adopted by the Board of
Directors of the Mer�hants Bonding Company(Mutua�on April 23,2011 and adopted by the Board of Directors of Merchants Nationai
Bonding,Inc.,on October24,2011.
"The Presiderrt,Secxetary,Treasurer,or any/�ssistarrt Treasurer or arry Assistant Secretary or arry vce Presiderrt shali have
power and authority to appoirrt Attomeys-in-Fac*,and to authorize them to exearte on behalf of the Company,and attach the
seal of the Company thereto,bonds and undertakings,recognizances,corrtrads of indemnity and other writings obligatory in
the nature ttiereof.
The signature of arry authorized officer and the seal of the Comparry may be affaed by facsimile or eledronic transmission to
any Power of Attomey or Certification thereof author¢ing the execuGon and delivery of any bond,undertaking,recognizance,
or ofher suretyship obligations of tl�e Company,and such signature and seal when so used shall have the same force and
eRect as though manualy foced.'
In Wdness Whereof,the Companies have pused this instrumerrt to be signed and sealed this 2nd day of Ma�Ch � 2�1z.
�,,,,.��►�..,'+� ��,�.���
A
a��''*SIOt1,4� •a,� ��p��...�Dij�A� MERCHANTSBONDINGCOMPANY(MUTUAL)
���'p�dRq��p�_ :y��oRP�99�9y�: MERCHANTS NATIONAL BONDING,INC.
;�; � -b- d'� f �z:• -� �'3:
=xj• 2�03 %n a •� 1933 :•y:
:. . . i76 .a`. gY ��
y • • �
. .`
^���~�' '���:rjh�ej .�.��••�• '1 :
STATE OF IOWA o, �YF •'
COUNTY OF POLK ss. �����»N^� ���"'�� Presdent
On this 2nd day of March 2p�2,before me appeared Larty Taylor,to me personally known,who being by me dufy swom did
say that he is Presiderrt of the MERCHANTS BONDING CAMPANY(MUTUAL)and MERCHANTS NATIONAL BONDING,INC.;and
that the seals afPoced to ihe foregoing instrumerrt is the Corporate Seals of the Companies;and that the said instrumerrt was signed and
sealed in behaff of the Comparoes by authority of their respedive Boards of Diredors.
in Testimony Whereof,I have hereurrto set my hand and affoced my Offiaal Seal at the City of Des Moines,lowa,the day and year
first above written.
�� MARANDA GREENWALT �r� � ��
Commission Number 770312
� My Commission Expirss
Octobx 28,2014
IUotary Public,Polk Cou�;lowa
STATE OF IOWA
COUNTY OF POLK ss.
i, William Wamer,Jr.,Secxetary of the MERCHANTS BONDING COMPAM'(MUTUAL)and MERCHANTS NATIONAL BONDING,INC.,
do hereby certify that the above and foregoing is a true and corred copy of the POWER-0E-ATTORNEY exearted by said Companies,
which is stilt in fuil torce and efied and has not been amended or revolced.
In V�itriess Whereof,I have hereurtto set my hand and affoced the seal of the Companies on
this 14th daY� August � 2013 • �`'`'
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SEP 16 2013
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--------------•---------
� r
THE AlvIERICAN INSTITUTE OF ARCHITECTS
Bond No. MOC 67414
AlA Docurnen[A3 J 2
Performance Bond
Any singular reference bo Contractor,Surety,Owner or other party shall be coruidered plural where applicabie.
CONTRACTOR(Name and Address): SURETY(Name and Principa!Place of Busir�ess):
Nip Kelley Equipment Company,Inc. Merchants Bonding Company(Mutual)
41 North Sprigg Street 2100 Fleur Drive
Cape Girardeau, MO 63701 Des Moines IA 50321
OWNfR tName and Address): Tel:515-243-8171
City of Cape Girardeau
401 Independence Street
Cape Girardeau, MO 637D1
CONTSTRUCTION C�NTRACT
Date: S c?p�-Ern i���^ a 3, a C`_�I�
Amount: $117,241.63
Description(Name and Lo�ation}: Cape Lacroix Trial and Shawnee Park Connections
BOND
Date(Not eariier than Construction Corrtract Uate); S�p�C=��b�r �3, �C�'13
Amoun#: $117,241.63
Modificadons to thi Bond: � None ❑ See Page 3
� C�N.TRAC�OR AS P INCIPAL SURETY ,,, ,,,,;
t<<:y Comp,�(rY� {Corporabe Seal) Company: ( ''� S��I��'-,,
�
` � 1+T�pKr�ley�.�quip t Com ,Inc. Merchants Bonding Company(Mutual) ��. f j
j �� � ,%�� «�� �� Tel:S 15-2�8171 1�� ���� �✓:
� ati �d�[� $f$1'1dtU�: � �,,;S , � i-+ ;
_ � �•r N�i"`ihie�jnd Tifle���ce Kelley Name and Tdle: Donald L.Wasoba �: ���$8 �a �' {';
. �.r y }�', � ., President Attomey-In-Fact : o. ��' " � <�
P ,''�•�� � add��t,ib�ai signatures appear on page 3) BOnd Signed and Sealed this 16th day�o€��,�t�e��`:,�Q�3�,�
: `�;. f:�,�„� but left undated at the r est of the .ti� $' �.�t�7�,.�
. '•,,:� 'f�Ft��;�dA�I�JNlAT10N ONLY—Name,Address and k/ephone) ;' ,y�;���''�s
A��h�c�]�,BROKER; OWNER'SREPRESENTATIVE(Archiaect,fngineeror�tt�ec�
1 4,. n'}� - .
��..
.: );� �,/�' .
Gateway Surety
22 Avocado Tree Circle
St.Peters,MO 63376 �
Tel: 314374-0589
AIA DOCUMENT A312�PfRFORMANCE BOND AND PAYMENT BON�• DECEMBER 198I ED. •AIA �
TiiE AMERICAN lNSTITUTE OF ARCHJTECTS, 1735 NEW YORK AVE., N.W.,WASMIN�.TON, D.C. 1000G A3t2��9H� �
1 The Contractor and the Surety,jofnUy and severally,bind ,1 After investigation, determine the amount for
themselves, their heirs, executors, administrators, �ich it may be liable to the Owner and, as soon
successors and assigns to the Owner for the pertormance
of the Construction Contract, which is incorporated herein � P��icable after the amount is determined,
by reference. tender payment therefore to the Owner,or
.Z Deny liability in whole or in part and notify the
2 If the Contractor perforrns the Construdion Contract,the Owner cifing reasons therefore.
Surety and the Contractor shaN have no obligation under 5 If the surety does not proceed as provided in Para-graph
this Bond,except to participate in conferences as provided 4 with r�easonable promptness, the Surety shall be deemed
in Subparagraph 3.1. to be in defauft on this Bond fifteen days after receipt of
3 If there is no Owner Defautt, the Surety's obligation an additional written notioe from the Owner to tlie Surety
demanding that the Surety perForm its obligations under this
under this Bond shafl arise after. Bond, and the Owner shall be entifled to enforce any
3.1 The Owner 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 Defauit and has r�quested and attempted whole or in part, without further notice the Owner shall be
to arrange a conferenoe with the Contractor and the entitled to enforce any remedy available 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 Construction Contract. ff the Owner, the �mplete the Construction Contract, and if the 5urety
Contrador and the Surety agree,the Contractor shall elects to act under Subparagraph 4.1,4.2, or 4.3 above,
be allowed a reasonable time to perform the then the responsibilities of the Surety to the Owner shall
Construction Contract, but sucM an agreement shall not be greater than those of the Contractor under the
not waive the Owner's right, if any, subsequently to Constn�ctio� Contract, and the responsibilities of the
declare a Contractor Default;and Owner to the Surety shatl not be greater than those of the
3.2 The Owner has declared a Contrador Default and �ner under the Construdion Contract. To the limit of the
formally terminated the Contractors right to complete amount of this Bond, but subject to commitment by the
the contract. Such Contract�r Default shall not be �ner of the Balance of the Contract Price to mitigation of
declared earlier than twenty days after the Contractor �sts and damages on the Construction Contrad, the
and the Surety have received notice as provided in Surety is obligated without duplication for.
Subparagraph 3.1;and 6.1 The r�esponsibiiities of the Contractor for cor-
3.3 The Owner has agreed to pay the Balance of the r���on of defective work and�mpletion of the Con-
Contract Price to the Surety in accordance with the struction Contract;
tertns of the Construction Contract or to a contractor
selected to pertorm the Construction ContraCt in 6.2 Additional legaf, design professional and delay
accoMance with the terms o# the contract with the costs resuiting from tfie Contractors Default, and
Qwner. resulting from fhe actions or failure to act of the
4 When the Owner has satisfied the conditions of Surety under Paragraph 4;and
Paragraph 3,the Surety shall promptly and at the Surety's 6.3 Liquidated damages, or if no liquidated damages
expense take one of the following actions: are speafied in the Construction Contract, actual
damages caused by delayed perFotmance or non-
4.1 Arrange for the Contractor, with consent of the performance of the Contractor.
Owner, to perform and complete the Construction
Contract;or 7 The Surety shall not be liable to the Owner or others for
obligations of the Gontractor that are unrelated to the
4.2 Undertake to perform and complete the Con- Construction Contra�t, and the Balance of the Contract
struction Contrad itself, through its agerrts or through Price shall not be reduced or set off on account of any
independent contractors;or such unrelated obligations. No right of action shall acxrue
4.3 Obtain bids or negotiated proposals from qualified on this Bond to any person or entity other than the Owner
contractors acceptable to the Owner for a contract for or its heirs,executors,administrators or successoPs.
performance and completion of the Construction 8 The Surety hereby waives notice of any change, inclu-
Contract, arrange for a contract to be prepared for ding changes of time, to the Construction Contract or to
execution by the Owner and the contractor selected related subcontracts, purchase orders and other obli-
with the Owner's concurrence, to be secured with gations.
perfoRnance and payment bonds executed by a
qualified surety equivalent to the bonds issued on the 9 Any proceeding, legaf 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 �ocation in which the work or part of the work is located and
excess of the Balance of the Contract Price inaured shaA be instituted within two years after Contractor DefauR
by the Owner resulti�g from the Contractor's default;or or within finro years after the Contractor ceased working -
or within two years after the Surety refuses or fails to
4.4 Waive its right to perform and complete, arrange perform its obligations under this Bond, whichever occurs
for completion, or obtain a new contractor and with first. If the provisions of this Paragraph are void or
reasonable promptness under the circumstances: prohibited by law,the minimum period of iimitation avail-
AIA DOCUMENT A312�PERFORMANCE BOND AND PAYMENT BOND�DECEMBER 1964 ED.�AIA ��_�� 2
THE AMERICAN INSTITUTE OF ARCHITECHT5,1T35 NEW YORK AVE,N.W. WASHINGTON,D.C. 20006
r •
able to sureties as a defense in the jurisdiction of the suit have been made including allowance to the
shall be appiicabie. 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 Contractor 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 Contractor under the
Construdion Contract.
11 When this Bond has been fumished to comply with a 12.2 Construction Contract: The agreement between
statutory or other legal requirement in the location where the Owner and the Contractor identified on #he sig—
the construction was td be perFortned, any provision in nature page, including all Contract Documents and
this Bond conflicting with said statutory or legal changes thereto.
requirement shalf be deemed deleted heieftom and 12.3 Contractor Default: Failure of the Contractor,
provisions conforming to such statutory or other fegal
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 comply with the terms of the
bond and not as a common law bond. Construction Contract
12 DEFINI710NS 12.4 Owner Default: Failure of the Owner, which has
neither been remedied nor waived, to pay the Con-
12.1 Balance of the Contract Price: The total amount tractor as requir�ed by the Construction Contract or to
payable by the Owner to the Corrtractor under the perform and complete or comply with the other terms
Construction Contract after all proper adjustments thereof.
MODIFICATIONS TO THIS BOND ARE AS FOLLOYVS:
NONE.
(Space is provided below for additional signatures of added parties,other�an those appearing on the cover page.)
CONTRACTOR AS PRINCIPAL SURETY
Company: Company:
(Corporate Seal) (Corporate Seal)
Signature: Signature:
Plame a�d Tdte: Name and Title:
Address: Address:
AIA DOCUMENT A312�PERFORMANCE BOND AND PAYINENT BOND�DECEMBER 1984 ED.�AIA� ��_�� 3
THE AMERICAN INSftTUTE OF ARCHITECTS,1735 NEW YDRK AVE.,N.W. WASHINGTON,D.C. 20006
Y I
THE AMERICAN INST(TUTE OF ARCH(TECTS
Bond No. MOC 67414
fu,a r�o��me,�ca3 rz
Payment Bond
Any singular reference�o Contracta.Sur�y,Owner or other party shall be oonsidered ptural where applicable.
CONTRACTOR(Name and Address): SUREIY(Name ar�d Principal Place of Business):
Nip KelleyEq uipment Company,Inc. Merchants Bonding Company(Mutual)
41 N.Spngg Street 2100 Fleur Drive
Cape Girardeau, MO 63701 Des Moines IA 50321
OWNER iName and Address}: Tel:515-243-8171
City of Cape Girardeau
401 Independence Street
Cape Girardea.u, MO 63701
CONT5TRUCTION CONTRACT
Date: S E�?k"�irrl l�L'r ;��, 3(9�3
Amount: $117,241.63
Description(Name and Locdtion):Cape Lacroix Trail and Shawnee Park Connections
$QND
Date iNot eariier than Construction Contract Date1: S E��E►�`1�'-�" �3, a0 i.3
Amount:$117,241,63
Modifications to this nd: p None fSl See Page 6
COW,,,7htACTORASP ClPAL SURETY
��`''�o��y''�. � (Corporate Seaq Company: (Corporate,Seal�,; ,`
� ,�T',i� �Iley�qmpme Company c. Merchants Bonding Company(Mutual) , �',�+'{` ' g+�'�
� `�. �- ' Tel:515-24�17�� � ��F � _� /.,
�r, S►��R •. Signature: � Q�� �, . �r ,y� `
, ` rF <:� N�e�nd Ttt�e V�nce �elley Name and Tide: Donald L.Wasoba �r ; Q_ �• ,,y
i dent v,
'`t,t� 5 : ,` :�presi Attomey-In-Fact ; , �;� '' � � �
�. .
�r' • ��.��}add�por�bs�gnatures appear or�page 6)BOnd Signed and Sealed this 16th day of Sep't�be�,� 2013, ;;� '
�,, "�� •��� �=� � but left undated at the r est of the obli �: ,.,, �"',w
`� ,o
'°' ( •R;tl���,RM�4T10N ONLY—Name.Address and Tetephone) �"'-,` �r(��','� �'F;.��`
� AGEI��,sW'BROKER: OWNER'S REPRFSENTATIVE(ArchiLect, Engineer or otF�et" "'! ",`�� `
' Gateway Surety P�Y)�
22 Avocado Tree Circle
St.Peters,MO 63376
Tel:3143740589
AW OOCUMENT A3lZ•PERfORMANCE 80ND ANO PAYMENT 80ND•DECEMBER 1984 EO. •AIA•
THE AMERICAN INSTI7UTE OF ARCIifTECTS, 1735 NEW YORK AVE., N.W.,WASHlNGTON, D.C. 20D06 I��Z-'I9$� 4
v •
1 The Contractor and the Surety, jointly and severaily, 5 If a notice required by Paragraph 4 is given by the
bind themselves, their heirs, executors, administrator, Owner to the Contractor ar to the Surety, that is suffiaent
successors and assigns to the Owner to pay for tabor, compfiance.
materials and equipment fumished for use in the 6 When the Claimant has satisfied the conditions of
performanoe of the Construction Contract, which is Paragraph 4,the Surety shalf promptly and at the Surety's
incorporated herein by reference. expense take the following actions:
2 WRh respect to the Owner, this obligation shall be null 6.1 Send an answer to the Claimant, with a copy to
and void if the Contractor. the Owner, within 45 days after receipt of the Gaim,
2.1 Promptly makes payment, directly 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.
2.2 Defends, indemnities, and holds harmless the 6.2 Pay or arrange for payment of any undisputed
Owner from all claims,demands, liens or suits by any �mounts.
person or entity who fumished labor, materials or
equipment for use in the perFormance of the 7 The Surety's total obligation shall rtot exceed the
Construction Contract, provided the Owner has amount of this Bond,and the amount of this Bond shall be
promptly notified the Contrador and the Surety (at �dited for any payments made in good faith by the
the address described in Paragraph 12) of any Surety.
claims,demands, liens or suits and tendered defense 8 Amounts owed by the Q+wner to the Contractor under
of such claims, demands, liens or suits to the the Construetion Contract shall be used for the
Contrador and the Surety, and provided there is no performance of the Construction Contrad and to satisfy
Owner Default. claims, if any, under any Construction Performance Bond.
By the Contractor fumishing and the Owner acoepting this
3 With resped to Claimants, this obligation shall be null Bond, they agree that a!I funds earned by the Contractor
and void if the Contrador promptly makes payment, in the perFormance of the Construction Contrad are
directly or indirectly,for all sums due. ded'+cated to satisfy obligations of the Contractw and the
Surety under this Bond, subject to the Owners priority to
4 The Surety shall have no obligation to Ctaimants under use the funds for the comple6on of the worlc.
this Qond until:
4.1 Claimants who are employed by or have a direct 9 The Surety shall not be liable to the Owner, Claimants
contract 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 Contract. The Owner shafl
and sent a copy, or notice thereaf, to the Owner, not be iiable for payment of any costs or expenses of any
stating that a claim is being made under this Bond Claimant under this Bond,and shall have under this Bond
and, with substantial aa.uracy, the amount of the no obligations to make payments to, give notices on
claim. behalf of, or otherwise have obligations to Claimants
4.2 Gaimants 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 including changes of time, to the Construction Contract or
and sent a copy, or notic� thereof, to the to related subcantrads, purchase orders and other
Owner, within 90 days after having last per- obligations.
formed labor or last fumished materials or
equipment included in the daim stating, with 11 No suit or action shall be commenced by a Claimant
substantial accuracy, 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- diction in the location in which fhe worlc or pa�t of the woric
ials were fumished or supplied or for whom is located�r after the expiration of one year from the date
the labor was done or performed; and (1) on which the Claimant gave the nofice 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 fabor or service was pertortned 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 occurs. 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 diredly or indiredly;and available to sureties as a defense in the jurisdiction of the
.3 Not having been paid within the above 30 days, suit shall be applicab{e.
have sent a written notice to the Surety(at the 12 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 ctaim is being made under this Bond and p�er or the Contractor, however acxomplished,shall be
enclosing a copy of the previous written notice sufficient compliance as of the date neceived at the
fumished to the Contrador. address shown on the signature page.
AIA DOCUMENT A312�PERFORMAN(:�60ND AND PAYA7ENT BOND�DECEM6ER 1984 ED.�AIA� ��_�� 5
THE AMERICAN INSTfTUTE OF ARCHITECTS,1735 NEW YORK AVE,N.W.WASHINGTON,D.C. 20006
y f
13 When this Bond has been furnished to comply with a The intent of this Bond shatl 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 rental 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 sMall be deemed incorporated herein. The worlc of the Contractor and the Contractor's
intent is that this Bond shall be construed as a statutory subcontractors, and all other items for whicJ� 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 benefiaary of this Bond, the Corrtractor shall 15.2 Construction Contract:The agreement beiween
promptty fumish a copy of this Bond or shall pertnit a copy the Owner and the Contractor identified on the
to be made. signature page, including all Contract
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 Contractor or with a subwntractor of Contractor as required by the Construction Contract
the Contractor to fumish labor, materials or or to perform and complete or�mply with the other
equipment for use in the performance of the Contract. terms thereof.
MODIFICATIONS TO THfS BOND ARE AS FOLLOWS:
Section 6 is modified by adding section 6.3.
6.3 The Surety's failure to discharge its obligations under this Section 6 sha11 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 sha1�indemnify the Claimant for the reasonable attorney's fees the Claimant
incurs to recover any sums found to be due and owing to the Claiman�
NONE.
(Space is provided below for additional signatures of added parties,other than those appearing on the cover page.)
CONTRACTOR AS PRINCIPAL SURE7Y
Company: Company:
(Corporete Seal) (Corporate Sea�
Signature: Signature: ,
Name and TiUe: Name and Title:
Address: Address:
AIA DOCUMENT A312�PERFORMANCE BOND AND pAYMENT BOND�DECEMBER 1984 Ep.�AtA�
THE AMER�CAN INSTITUTE OF ARCHlTECT5,1�35 NE1N YORK AVE, N.W. WASHINGTON,D.C. 2000fi ��-�� 6
+ � MERCHANT�
BONDING COMPANYTM
POWER OF ATTORNEY
Know All Persons By These PreseMs,that MERCHANTS BONDING COMPANY(MUTUAL)and MERCHANTS NATIONAL BONDING,
INC.,both being corporations duly organized under the laws of the State of lowa(herein coliectively 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 fuli power
and authority hereby conferred in their name,plaoe and stead,to sign,execuie,acknowledge and deliver in their behalf as surety
any and al�bonds,undertakings,recognizances or other written obligations in the nature thereof,subjed to the limitation that any
such instrumerrt shall not exceed the amount of:
TWO MILLION($2,000,000.00)DOLLARS
and to bind the Companies thereby as fully and to the same extent as if such bond or undertaking was signed by the dufy
authorized officers of the Companies,and all the acts of said Attomey-in-Fact, pursuant to the authority herein given,are
hereby ratified and confiRned.
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 April 23,2011 and adopted by the Board of Directors 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 shall have
power and authority to appoint Attomeys-in-Fact,and to authorize them to exearte 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 affuced by facsimile or electronic transmission to
any Power of Attomey or Certification thereof authorizing the execution and delivery of any bond,undeRaking,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 Wrtness Whereof,the Companies have caused this instrument to be signed and sealed this 2nd day of March � 2012.
�.�'"���'[l�0�!1�`'% • �� �0�'•
r • .Nc .
.•` �1�;.••• -• .� • ��� - �A•. MERCHANTS BONDING COMPANY(MUTUAL)
:o�:'pM�Rq'•�p�': ;0�'O P�9q'•y: MERCHANTSNATIONALBONDING,INC.
=�. 4 0�=.�i .y Ga .►:.c.
=��•� —p_ ;C, � .r-•'Z' -o- R'� :
? ,�j� 2�'03 %�c�i c :a�� 1933 �'3.
�•. . . .yJ. :�ti' ay �
•.�
. 6 .� , �
'•••• •:��<•a`� '. �'' •'`'� :
STATE OF IOWA •'I'�� *•• .+`'� `•� � .'
COUNTY OF POLK ss. ��"'����•�•"�"�� ��"'� President
On this 2nd day of MarCh 2012,before me appeared Larry Taylor,to me personally known,who being by me duly swom did
say that he is President 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 � �, ��
�� Commission Number 770312
My Commission Expires
October 28,2014
Notary Public,PoJk County,lowa
STATE OF IOWA
COUNTY OF POLK ss.
I, William Wamer,Jr.,Secretary of the MERCHANTS BONDING COMPANY(MUTUAL)and MERCHANTS NATIONAL BONDING,INC.,
do hereby certify that the above and foregoing is a Vue and correct copy of the POWER-OF-ATTORNEY executed by said Companies,
which is still in full force and effect and has not been amended or revoked.
In Wifiess Whereof,I have hereunto set my hand and affixed the seal of the Companies on
this day of .
Power of Attorney .�..�••"•�. .••••.. ,
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attached to bond .•�`��*�10t�,�C ••'= •o�p` PQ O,�.o,•. �,,.,ta �"�;,,''�-.,
and sealed this :�g.�`p�ORq�;OO'• ;m.�OA i4,9�9y�� h/ ��Q\ ••• ,J�,��;.
16th day of Sept3�. � `,.'y'�' :�:2 -o- o'. . !/��;,;G��zs.-c/ ���'.�' �t,���,••".���_
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2013, but left :z? x��3 :.n- •y' 1933 ;�� � �� � � ;:A
undated at'�.the -�b' :;� :�d. .;�o:' ; �^; � c_
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COMMERCIAL GENERAL LIABILITY `�
CG 71 57 09 10 I
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THIS ENDORSEMENT CHANGES THE POLtCY. PLEASE READ IT CAREFULLY. �
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ADDITtONAL INSURED - OWNERS, LESSEES OR CONTRACTORS :
AUTOMATlC STATUS WHEN REQUiRED iN CONSTRUCTION CONTRACT �
PRIMARY AND NON-CONTRI�UTORY '
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This endorsement modifies insurance provided under the following: '
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COMMERCIAL GENERAL LIA81LfTY COVERAGE PART �
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A. Section II — Who Is An tnsured is amended to a. The preparing, approving, or failing to pre- �
include 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,field 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, architecturai or
organization be added as an additional insured on engineering activities. k
your policy. Such person or organization is an ad- 2 "god�� m'u or " ro e dama e" occurrin �
ditional insured only with respect to liability for"bo- y � �' p p � g g
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 1 � E
vice, maintenance or repairs) to be per� =a
2. The acts ar omissions of those acting on your formed by or on behalf of the additional in- �
behalf; sured(s) at the location of 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 e
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 additional principal as a part of the same project. �
insured for fiability arising out of#he "products- D. With respect to the insurance afforded to these ;
completed operations hazard". additiQnal insureds, Condition 4. Other Insurance �
B.The following is added to SECTiON Ifl— LIMITS of Section IV — Commercial General Liability
OF INSURANCE: Conditions is repiaced by the following: f
The limits of insurance applicable to the additional 4. Other insurance ;
insured are those specified in the written contract a. Primary Insurance [
between you and fhe additional insured, 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: �
These limits are part of and not in addition to the �1� That this insurance be primary. If other �
limits of insurance under this policy. insurance is also primary, we will share �:
C. With respec# to the insurance afforded to these with a!I that other insuranee as de- =
additional insureds, the following additional exclu- scribed in c. below;or �
sions appiy: (2) The coverage afforded by this insur-
This insurance does not apply to: ance is primary and non-contributory ;
1. "Bodily injury", "property damage" ar "personal with the additionaf insured's own insur- _
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and advertising injury" arising out of the ren ance.
dering of, or the failure to render, any profes-
sional architectural, engineering or surveying i
services, including: ;
CG 71 57 09 't0 Includes copyrighted material of lnsurance Services Office, Inc. Page 1 of 2 �
with its permission. f:
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CG 71 57 0910
Paragraphs (1) and (2) do not appiy 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 add+- to defend the additional insured against �
tional insured or to other insurance de- any"suit"if any other insurer has a duty
scribed in paragraph b.below. to defend the additional insured against F
b. Excess Insurance that "suit". if no other insurer defends, �
This insurance is excess over: we wifl undertake to do so, but we will ;
be entitled to the additional insured's ?
(1) Any of the other insurance, whether rights against all those other insurers. p
primary, excess, contingent or on any (3) When this insurance is excess over �
other basis: other insurance, we wiii pay onfy our �
(a} That is Fire, Extended Covera e, E
g share of the amount of the loss, if any, �
Builder's Risk, Insfallation Risk or that exceeds the sum of: `
similar coverage for"your work"; �
(a)The total 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 i
you or temporarily occupied by you (b) The total of all deductible and self- �
with permission of the owner; insured amounts under all 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- �
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 I — Cov-
erage A—Bodily Injury And Property If all of the other insurance available to �
Damage Liability the additional insured permits contribu- �
(e) That is any other insurance availa- tion by equal shares, we will follow this E
ble to an additional insured under method aiso. Under this approach each �
this endorsement covering liability 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 the ioss remains, whichever ;
tions, for which the additional in- comes first. ;
sured has been added as an If any of the other insurance avai(able 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 k
applicabfe limits of insurance of all insur- �
ers. �-
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All terms and canditions of this poticy apply untess modified by this endorsement. �
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P�ge 2 of 2 lncludes copyrighted material of fnsurance Services Office, Inc. CG 71 57 09 10 �
with its permission. �
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�'`��� CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DDlYYY�
9/12/2013
THlS CERTIFlCATE IS ISSUED AS A MATTER OF INFORMATtON 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
REPRESENTATNE OR PRODUCER,AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certificate holder is an ADDiT10NAL INSURED,the policy(ies)must be endorsed. If SUBROGATION IS WAIVED,subject to
the terms and conditions of the policy,certain policies may require an endorsement A statement on this certificate does not confer rights to the
cert�cate holder in lieu of such endorsement(s).
PRODUCER �MEA�T Te=ina DillahSy
Capital Insurance & Associates �+oNE . (573)335-2300 F� �:(573)335-0117
326 South Broadview 'M^�� .terina@capitalinsagency.com
P.O. BOX 1�I7 9 INSU S AFFORDING COVERAGE ►rp���
Cape Girardeau MO 63703 INSURERAAMCO Insurance Co 9100
INSURED INSURERBNatlOI1W1Cl2 Ml1t3I. Ins Co 3'7g�
NIP E�LLY EQUIPMENT CO INC INSURERCAl112d Insurance
PO BOX 33 iNsur�xoi�ti.ssouri E lo ers Mut„a�
INSURER E:T�le Hartford Commercial 3rt
CAPE GIRARDEAU MO 63702-0033 INSURERP:
COVERAGES CERTIFICATE NUMBER3�aster 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. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
�N� TYPE OF INSURANCE POLICY EFF POLICY EXP
�� POLICY NUMBER MM/DD MM/DD LIMITS
GENERAL WIBILITY EACH OCCURRENCE $ 1�OOO�000
X COMMERCIAL GENERAL LIABILITY PREMISE Ea occurtence S 100,000
A CW MS-MADE �OCCUR 7162738259 /23/2013 /23/2014 MED EXP(Arry one person) $ 5,000
PERSONAL 8 ADV INJURY y 1�000�000
GENERAL AGGREGATE S 2,000�O00
GEMLAGGREGATE LIMITAPPLJES PER: PRODUCTS-CAMP/OPAGG S 2�000�000
X POLICY PRa LOC S
AUTOMOBILE W161LITY CA e�IN�EDtSINGLE LIMIT 1 OOO 000
B X ANY AUTO BODILY INJURY(Perperson) E
ALL OWNED SCHEDULED PBA7162738259 /23/2013 /23/2014 gODILY INJURY(Per acciderrt) b
AUTOS AUTOS
NON-0WNED PROPERTY DAMAGE
X HIRED AUTOS X AUTOS Per accident $
X 19 Schedule Mod Fador 1 $
X UMBRELLA W4B pCCUR EACH OCCURRENCE S 4�OOO�OOO
C �C�S�-�'B CLAIMS-MADE AGGREGATE S 4�O00,000
DED X RETENTION 10,00 PCAA7162738259 /23/2013 /23/2014 a
D WORKERS COMPENSATION WC STATU- OTH-
AND EMPLOYERS'1WB11JTY Y/N
ANY PROPRIETORIPARTNEWEXECUTIVE E.L EACH ACCIDENT b S OOO OOO
OFFlCEWMEMBER EXCLUDED7 � N�A
(Mandatory in NH) 0509977-10 /6/2013 /6/2014 EL DISEASE-EA EMPLOYE S 1 000 000
If yes,desaibe under
DESCRIPTION OF OPERATIONS below E.L DISEASE-POLICY LIMR $ 1 000 OOO
E Leaeed/Rented Equipment 4MSiU4365 /29/2013 /29/2014 $300 000
.
DESCRIPTON OF OPERATONS/LOCATONS/VEHICLES (Attach ACORD 101,Addltlonal Remarks Schedule,lf more apace is requfretl)
CERTIFICATE HOLDER CANCELLATION
339-6302 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
City of Cape Girardeau
Project: Cape LaCroix Trail/Shawnee Park
401 Independence Street AUTHOR¢ED REPRESENTATIVE
Cape Girardeau, 2� 63701
Chris Gross/S�:LLY �Yi"'� � ��`y
ACORD 25(2010/05) O 1988-2010 ACORD CORPORATION. All rights reserved.
INS025r�mnr�im Thn Af`(1RI1 n�mo�nrl lnnn aro wnicMrorl m�r4c nf ef_ARII