HomeMy WebLinkAboutRes.2910.08-03-2015BILL NO 15-142
RESOLUTION NO ,�gJQ
A RESOLUTION AUTHORIZING THE CITY MANAGER TO
EXECUTE AN AGREEMENT WITH NIP KELLEY
EQUIPMENT COMPANY, INC FOR THE CAPE ROCK
DRIVE/PERRYVILLE ROAD BOOSTER PUMP STATION,
IN THE CITY OF CAPE GIRARDEAU, MISSOURI
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 Cape
Rock Drive/Perryville Road Booster Pump Station, in the City of
Cape Girardeau, Missouri The Agreement shall be in
substantially the form attached hereto as Exhibit "A", which
document is hereby approved by the City Council, and
incorporated herein by reference, with such changes therein as
shall be approved by the officers of' the City executing the
same
PASSED AND ADOPTED THIS -3%^(; DAY OF 2015
ATTEST
Gayle Conrad, City Clerk
Ha ry E R diger, Mayor
r r r
BID OPENING SUMMARY OF PROPOSALS RECEIVED FOR:
DATE: JULY 28, 2015
TIME: 10:00 AM
PLACE. CITY HALL, DEVELOPMENT SERVICES
CAPE ROCK/PERRYVILLE ROAD BOOSTER PUMP STATION
Compiled by Mary Boos
Page 1 of 1
Nip Kelley Equipment Co., Inc.
Zoellner Construction Co., Inc.
ENGINEER'S FSTIMATE
41 North Sprlgg
876 PCR 500
Cape Girardeau, MO 63701
Perryville, MO 63775
ITEM
DESCRIPTION
UNIT
1UANTTr
UNIT
TOTAL
UNIT
TOTAL
UNIT
TOTAL
NO.
I
PRICE
PRICE
PRICE
A
Booster Pump Station with Diesel
LS
1.00
$ 670,280.00
$ 670,280.00
$ 576,630.00
$ 576,630.00
$ 609,000.00
$ 609,000.00
Powered Emergency Generator
Altemate:
"Low Bidder"
E-1
Natural Gas -Powered Generator & Gas
LS
1.00
$ 35,320.00
$ 35,320.00
$ 42,525.00
$ 42,525.00
$ 40,000.00
$ 40,000.00
Service from Meter to Generator
AMOUNT OF PROPOSAL GUARANTEE
5% OF BID
5% OF BID
Fidelity and Deposit Company of
SURETY
Merchants Bonding Company
Maryland
I hereby certify that the above is a true and correct summary of proposals received.
PROJECT MANAGER
Page 1 of 1
. t
� �
CITY OF CAPE GIRARDEAU
CAPE ROCWPERRYVILLE ROAD
BOOSTER PUMP STATION
Project No. 6177
STANDARDFORM OFAGREEMENT
BETWEEN OWNER AND CONTRACTOR
ON THE BASIS OF A STIPULATED PRICE
THIS AGREEMENT is dated as of the _�day of A`�U�J�� in the year
2015 by and between the City of Cape Girardeau, Missouri (hereinafter called OWNER)
and Nip Kellev Equipment Co., Inc. (hereinafter called CONTRACTOR).
OWNER and CONTRACTOR, in consideration of the mutual covenants hereinafter set
forth, agree as follows:
Article 1. WORK.
CONTRACTOR shall complete all Work as specified or indicated in the Contract
Documents. The Work is generally described as follows:
The Contractor shall furnish and install a new pre-fabricated booster pump station at
1800 Perryville Road including water main connections, a concrete driveway, drain pipe,
electrical senrice, emergency generator, telemetry, controls, site restoration and all
appurtenances as indicated in the Project Plans and Specifications prepared by Horner&
Shifrin, Inc. and dated July 2, 2015 for the City of Cape Girardeau, Missouri.
Article 2. ENGINEER.
The City 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 will be substantially completed within 240 calendar days after the date
when the Contract Times commence to run as provided in paragraph 2.3 of the General
Conditions, and completed and ready for final payment in accordance with paragraph
A-1
, 4
1.
14.13 of the General Conditions within 270 days after the date when the Contract Times
commence to run.
3.2 Liquidated Damages. OWNER and CONTRACTOR recognize that time is of the
essence of this Agreement and that OWNER will suffer financial loss if the Work is not
completed within the times specified in paragraph 3.1 above, plus any extensions thereof
allowed in accordance with Article 12 of the General Conditions. They also recognize the
delays, expense and difficulties involved in proving the actual loss suffered by OWNER if
the Work is not competed on time. Accordingly, instead of requiring any such proof,
OWNER and CONTRACTOR agree that as liquidated damages for delay (but not as a
penalty) CONTRACTOR shall pay OWNER Nine Hundred Fifty dollars 950.00 for each
day that expires after the time specified in paragraph 3.1 for Substantial Completion until
the Work is substantially complete. After Substantial Completion, if CONTRACTOR shall
neglect, refuse or fail to complete the remaining Work within the time specified in
paragraph 3.1 for completion and readiness for final payment or any proper extension
thereof granted by OWNER, CONTRACTOR shall pay OWNER Nine Hundred Fifty dollars
950.00 for each day that expires after the time specified in paragraph 3.1 for completion
and readiness for final payment.
Article 4. CONTRACT PRICE.
OWNER shall pay CONTRACTOR for completion of the Work in accordance with the
Contract Documents an amount in current funds equal to the sum of the amounts
determined pursuant to paragraphs 4.1 and 4.2 below:
4.1 for Lump Sum Amount.
LUMP SUM CONTRACT AMOUNT Five Hundred Seventv-six Thousand Six
Hundred Thirty Dollars and Zero Cents ( $ 576,630.00 )
Article 5. PAYMENT PROCEDURES.
CONTRACTOR shall submit Applications for Payment in accordance with Article 14 of the
General Conditions. Applications for Payment will be processed by ENGINEER as
provided in the General Conditions.
5.1 Progress payments;Retainage. OWNER shall make progress payments on account
of the Contract Price on the basis of CONTRACTOR'S Application for Payment as
recommended by ENGINEER, on or about the 10th day of each month during construction
as provided in paragraphs 5.1.1 and 5.1.2 below. All such payments will be measured by
the schedule of values established in paragraph 2.9 of the General Conditions (and in the
case of Unit Price Work based on the number of units completed) or, in the event there is
no schedule of values, as provided in the General Requirements.
A-2
.
�
5.1.1 Prior to Substantial Completion, progress payments will be made in an amount equal
to the percentage indicated below, but, in each case, less the aggregate of payments
previously made and less such amounts as ENGINEER shall determine, or OWNER may
withhold, in accordance with paragraph 14.7 of the General Conditions.
95% of Work completed (with the balance being retainage). If Work has
been 50% completed as determined by ENGINEER, and if the character and
progress of the Work have been satisfactory to OWNER and ENGINEER,
OWNER, on recommendation of ENGINEER, may determine that as long as
the character and progress of the Work remain satisfactory to them, there
will be no additional retainage on account of Work completed, in which case,
the remaining progress payments prior to Substantial Completion will be an
amount equal to 100% of the Work completed.
95°/4 (with the balance being retainage) of materials and equipment not
incorporated in the Work (but delivered, suitably stored and accompanied by
documentations satisfactory to OWNER as provided in paragraph 14.2 of the
General Conditions).
5.1.2 Upon Substantial Completion, in an amount sufficient to increase total payments to
CONTRACTOR to 98% of the Contract Price(with the balance being retainage), less such
amounts as ENGINEER shall determine, or OWNER may withhold, in accordance with
paragraph 14.7 of the General Conditions.
5.2 Final Payment. Upon final completion and acceptance of the Work in accordance with
paragraph 14.13 of the General Conditions, OWNER shall pay the remainder of the
Contract Price as recommended by ENGINEER as provided in said paragraph 14.13.
Article 6. INTEREST.
All moneys not paid when due as provided in Article 14 of the General Conditions shall
bear interest at the maximum rate allowed by law at the place of the Project.
Article 7. CONTRACTOR'S REPRESENTATIONS.
In order to induce OWNER to enter into the Agreement, CONTRACTOR makes the
following representations:
7.1 CONTRACTOR has examined and carefully studied the Contract Documents
(including the Addenda listed in paragraph 8) and the other related data identified in the
Bidding Documents, including "technical data".
7.2 CONTRACTOR has visited the site and become familiar with and is satisfied as to the
general, local and site conditions that may affect cost, progress, performance and
furnishing of the Work.
A-3
�
7.3 CONTRACTOR is familiar with and is satisfied as to all federal, state and local Laws
and Regulations that may affect cost, progress, performance and furnishing of the Work.
7.4 CONTRACTOR has carefully studied all reports of explorations and tests of
subsurface conditions at or contiguous to the site and all drawings of physical conditions in
or relating to existing surface or subsurface structures at or contiguous to the site (except
Underground Facilities) which have been identified. CONTRACTOR acknowledges that
such reports and drawings are not Contract Documents and may not be complete for
CONTRACTOR'S purposes. CONTRACTOR acknowledges that OWNER and ENGINEER
do not assume responsibility for the accuracy or completeness of information and data
shown or indicated in the Contract Documents with respect to Underground Facilities at or
contiguous to the site. CONTRACTOR has obtained and carefully studied (or assumes
responsibility for having done so) all such additional supplementary examinations,
investigations, explorations, tests, studies and data concerning conditions (surFace,
subsurface and Underground Facilities)at or contiguous to the site or otherwise which may
affect cost, progress, performance or furnishing of the Work or which relate to any aspect
of the means, methods, techniques, sequences and procedures of construction to be
employed by CONTRACTOR and safety precautions and programs incident thereto.
CONTRACTOR does not consider that any additional examinations, investigations,
explorations,tests, studies or data are necessary for the performance and furnishing of the
Work at the Contract Price, within the Contract Times and in accordance with the other
terms and conditions of the Contract Documents.
7.5 CONTRACTOR is aware of the general nature of work to be performed by OWNER
and others at the site that relates to the Work as indicated in the Contract Documents.
7.6 CONTRACTOR has correlated the information known to CONTRACTOR, information
and observation obtained from visits to the site, reports and drawings identified in the
Contract documents and all additional examinations, investigations, explorations, tests,
studies and data with the Contract Documents.
7.7 CONTRACTOR has given ENGINEER written notice of all conflicts,errors, ambiguities
or discrepancies that CONTRACTOR has discovered in the Contract Documents and the
written resolution thereof by ENGINEER is acceptable to CONTRACTOR, and the Contract
Documents are generally sufficient to indicate and convey understanding of all terms and
conditions for perFormance and furnishing of the Work.
Article 8. CONTRACT DOCUMENTS.
The Contract Documents which comprise the entire agreement befinreen OWNER and
CONTRACTOR concerning the Work consist of the following:
8.1 This Agreement (pages A-1 to A-7 inclusive).
A-4
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 1 to 55 , inclusive). (EJCDC No. 1910-8 1990 Edition)
8.6 Supplementary Conditions (pages SC-1 to SC- 5 , inclusive).
8.7 Specifications bearing the title Cape Rock/ Perrwille Road Booster Pump Station.
8.8 Drawings. .
8.9 Addenda numbers 1 to 1 , inclusive.
8.10 CONTRACTOR'S Bid (pages BF-1 to BF-8 , inclusive) marked exhibit "A" .
8.11 Pursuant to 285.530 R.S. Mo, the contractor must affirm its enrollment and
participation in a federal work authorization program with respect to the employees
proposed to work in connection with the services requested herein by 1) submitting a
completed, notarized copy of AFFIDAVIT OF WORK AUTHORIZATION and 2) providing
documentation affirming the bidder's enrollment and participation in a federal work
authorization program with respect to the employees proposed to work in connection with
the services requested herein.
8.12 Documentation submitted by CONTRACTOR prior to Notice of Award (pages to
, inclusive).
8.13 The following which may be delivered or issued after the Effective Date of the
Agreement and are not attached hereto: All Written Amendments and other documents
amending, modifying or supplementing the Contract Documents pursuant to paragraphs
3.5 and 3.6 of the General Conditions.
The documents listed in paragraphs 8.2 et seq. above are attached to this Agreement
(except as expressly noted otherwise above).
There are no Contract Documents other than those listed above in the Article 8. The
Contract Documents may only be amended, modified or supplemented as provided in
paragraphs 3.5 and 3.6 of the General Conditions.
Article 9. MISCELLANEOUS.
9.1 Terms used in this Agreement which are defined in Article 1 of the General Conditions
will have the meanings indicated in the General Conditions.
A-5
.
9.2 No assignment by a party hereto of any rights under or interests in the Contract
Documents will be binding on another party hereto without the written consent of the party
sought to be bound; and, specifically but without limitation, moneys that may become due
and moneys that are due may not be assigned without such consent(except to the extent
that the effect of this restriction may be limited by law), and unless specifically stated to the
contrary in any written consent to an assignment no assignment will release or discharge
the assignor from any duty or responsibility under the Contract Documents.
9.3 OWNER and CONTRACTOR each binds itself, its partners, successors, assigns and
legal representatives to the other party hereto, its partners, successors, assigns and legal
representatives in respect to all covenants, agreements and obligations contained in the
Contract Documents.
9.4 Any provision or part of the Contract Documents held to be void or unenforceable
under any Law or Regulation shall be deemed stricken, and all remaining provisions shall
continue to be valid and binding upon OWNER and CONTRACTOR, who agree that the
Contract Documents shall be reformed to replace such stricken provision or part thereof
with a valid and enforceable provision that comes as close as possible to expressing the
intention of the stricken provision.
9.5 Pursuant to 292.675, R.S. Mo, the contractor is informed that all contractors or
subcontractors doing work on this project to provide, and require its on-site employees to
complete, a ten (10) hour course in construction safety and health approved by the
Occupational Safety and Health Administration ("OSHA") or similar program approved by
the Missouri Department of Labor and Industrial Relations which is at least as stringent as
an approved OSHA program. The training must be completed within sixty(60)days of the
date work on the project commences. On-site employees found on the worksite without
documentation of the required training shall have 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 Subcontractors during
the course of the project. These must be provided on a weekly basis; if no work was done,
then a payroll stating "No Work Done" must be submitted.
A-6
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 will be effective on � U C�? �T' / � , 2015 (which is the
Effective Date of the Agreerrient).
OWNER Ci of Ca irardeau CONTRACTOR NiP Kelley Equipment co. , znc.
Scott Me Ci Mana er vince xell y, President
By:
[COR TE L [CORPORAT L]
,�1 �
Attest Ol�1C Attest "
Gay e . Conrad, City Clerk Frank Myers
Address for giving notices Address for giving notices
401 Independence Street 41 North Sprigg st.
Cape Girardeau, MO 63703 cape Girardeau, Mo 63701
(If OWNER is a public body, attach License No. � ssoo
evidence of authority to sign and
resolution or other documents Agent for service of process:
authorizing execution of Agreement.
(If CONTRACTOR is corporation,
� G��q� attach evidence of authority to sign.)
G4,4 d��,
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A-7
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- -... . . . ... . _ .. . .
.
EXHIBIT "A"
CITY OF CAPE GIRARDEAU .
CAPE ROCK/PERRYVILLE ROAD
BOOSTER PUMP STATION
Project No. 6177
� BID FORM
(EJCDC 1910-18) ('!990)
PROJECT IDENTIFICATION: The improvements consist of:
The construction/installation of a new pre-fabricated booster pump station, water main _
connections, concrete driveway, drain pipe, electrical service, emergency generator,
telemetry, controls,site restoration and all appurtenances as indicated in the Project Plans
and Specifications prepared by Homer 8�Shifrin, Inc. and Dated July 2,2015 forthe City of
Cape Girardeau, Missouri.
THIS BID IS SUBMITTED TO: CITY OF CAPE GIRARDEAU, MO .
401 INDEPENDENCE STREET
CAPE GIRARDEAU, MO 63703
1. The undersigned BIDDER proposes and agrees, if the Bid is accepted, to enter into an
agreement with OWNER in the form included in the Contract Documents to perform and
furnish atl Work as specified or indicated in the Cont�act Documents for the Bid Price and
within the Bid Times indicated in this Bid and in accordance with the other terms ancf
conditions of the Contract Documents.
2. BIDDER accepts all of the terms and conditions of the Advertisement or Invitation to Bid
and Instructions to Bidders, including without limitation those dealing with the disposition of
Bid security. This Bid will remain subject to acceptance for sixty days after the day of Bid.
opening. BIDDER will sign and deliver the required number of counterparts of the
Agreement with the Bonds and other documents required by the Bidding Requirements
within fifteen days after the date of OWNER'S notice of Award. .
3. In submitting this Bid, BIDDER represents, as more fuNy set forth in �the Agreement,
that:
(a) BIDDER has examined and carefully studied the Bidding Documents and the
following: �
BF-1
. ,
.
Addenda, receipt of all which is hereby acknowledged: �ListAddenda byAddendum Numberand Date)
a�Aon�_�1 - 7�2Cf15
(b) BIDDER has visited the site and become familiar with and is satisfied as to the
general, local and site conditions that may affect cost, progress, performance and
fumishing of the Work; �
(c) BIDDER is familiar with and is satisfied as to all federal, state and local Laws and
Regulations that may affect cost, progress, performance and fumishing of the Work.
(d) BIDDER 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. BIDDER acknowledges that such
. reports and drawings are not Contract Documents and may not be complete for BIDDER'S
purposes. BIDDER acknowledges that OWNER and Engineer do not assume
responsibility for accuracy or completeness of information and data shown or indicated in
the Bidding Documents with respect to Underground Facilities at or contiguous to the site.
BIDDER has obtained and carefully studied(or assumes responsibility for having done so)
all such additional or supplementary examinations, investigations, explorations, tests,
studies and data conceming conditions(surface,subsurface and Underground Facilities)at
� or contiguous to the�site or othervvise which may affect cost progress, performance or
fumishing of the Work or which relate to any aspect of the means, methods, techniques,
sequences and procedures of construction to be employed by BIDDER and safety
precautions and programs incident thereto. BIDDER does not consider that any addfional
examinations, investigations, explorations, tests, studies or data are necessary for the
determination of this Bid for performance and furnishing of the Work in accordance with the
times, price and other terms and conditions of fhe Contract Documents.
(e) BIDDER is aware of the general nature of Work to be performed by Owner and
others at the site that relates to Work for which this Bid is submitted as indicated in the
Contract Documents. �
(fl BIDDER has correlated the information known to BIDDER, information and
observations 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.
(g) BIDDER has given Engineer written notice of all conflicts, errors, ambiguities or
discrepancies that BIDDER has discovered in the Contract Documents and the written
resolution thereof by ENGINEER is acceptable to BIDDER, and the Contract
Documents are generally sufficient to indicate and convey understanding of all terms
and conditions for performing and fumishing the Work for which this Bid is submitted. �
BF-2
- � .
�- - -- - - -- --. . .. . ._ .
Any questions, comments, or concems regarding the design of this project should be
addressed to Tim Richmond Proiect ManaQer. City of Cape Girardeau at 573-339-
6327.
(h) This Bid is genuine and not made in the interest of or on behalf of any undisclosed
person, firm or corporation and is not submitted in conformity with any agreement or rules
of any group association, organization or corporation; BIDDER has not directly or indirectly
induced or solicited any other Bidder to submit a false or sham Bid; BIDDER has not
solicited or induced any person, firm or corporation to refrain from bidding; and BIDDER
has not sought by collusion to obtain for itself any advantage over any other Bidder or over
OWNER. .
(i) Pursuant to 285.530 RSMo,the bidder must affirm its enrollment and participation in
a federal work authorization program with respect to the employees proposed to work in
connection with the services requested herein by
• submitting a completed, notarized copy of AFFIDAVIT OF WORK
AUTHORIZATION and
• providing documentation affirming the bidders enrollment and participation in a
federal work authorization program with respect to the employees proposed to work
in connection with the services requested herein.
(j) Bidders are informed that the Project is subject to the requirements of Section
292.675, R.S. Mo, which requires all contractors or subcontractors doing work on the
Project to provide, and require its on-site employees to complete, a ten(10) hour course in
construction safety and health approved by the Occupational Safety and Health �
Administration("OSHA")or similar program approved by the Missouri Department of Labor
and Industrial Relations which is at least as stringent as an approved OSHA program.The
training must be completed within sixty (60) days of the date work on the Project
commences. On-site employees found on tk�e worksite without documentation of the
required training shall have twenty(20) days to produce such documentation.
4. BIDDER will complete the Work in accordance with the Contract Documents for the
following price(s): �
BF-3
Booster Pump Station with Diesel Powered Emergency Generator
Lump Sum Contract Base Bid Price
$ 576,630.00
(Total in numeric figures}
Five hundred seventy-six thousand six hundred thirty dollars
(Total in Written Words)
(Total bid amount is to be shown in both words and figures. In case of discrepancy,
the amount shown in words will govern.)
5. BIDDER agrees to substitute the upgrade Altemate described below in place of the
Diesel Powered Emergency Generator included in the above Contract Bid Price if
requested by the Owner. The BIDDER will fumish/ install the upgrade Altemate for the
following additional price:
Upgrade Alternate Unit Upgrade Bid.Price
(Additional Amount)
Alternate E-1:
Natural Gas-Powered Generator�
Gas Service from Meter to Generator Lump Sum $4 2,5 2 5.o 0
6. BIDDER agrees that the Work will be substantially complete within 240 calendar days
after the date when the Contract Times commences to run as provided in paragraph 2.3 of
the General Conditions, and completed and ready for final payment in accordance with
paragraph 14.13 of the General Conditions within 270 calendar days after the date when
the Contract Times commences to run.
BIDDER accepts the provisions of the Agreement as to liquidated damages in the event of
failure to complete the Work within the times specified in the Agreement.
7. The following documents are attached to and made a condition of this Bid:.
� � (a) Required Bid Security in the form of bid bond or cashiers check.
(b) Acknowledgement of any addenda issued. . �
(c) Exhibit Affidavit of Work Authorization _
(d) Exhibit Affidavit of Excessive Unemployment (if applicable)
BF-4 �
(e) The E-Verify Program for Unemployment Verification Memorandum of
Understanding http://www.uscis.qov/e-verifv
(fl Exhibit Affidavit of OSHA Training
(g) Certification Regarding Debarment, Suspension and Other Responsibility Matters
8. Bidder agrees to submit the following documents within three (3) business days after
the opening of Bids if requested:
(a) BIDDER'S Qualification Statement with supporting data.
BF-5 �
8. Communications concerning this Bid shall be addressed to:
Name v�T�o �o, , o�r
Address 41 N. Sprigg St. , Cape Girardeau, MO 63701
(a) PerFormance and Payment Bonding Company
Name MPrrhanf c Rondi nc� ompa�,y
. Address 2100 _Fleur Drive, Des Moines, IA 50321
Agent�Power of Attomey Name (if used) Donald Wasoba
Address 2Z Avocado Tree Circle, St. Peters, MO 63376
9. Terms used in the Bid which are defined in the General conditions or Instructions wiil
have the meanings indicated in the General Conditions or Instructions.
SUBMITTED on July 28 , 20 15 � �
, State Contractor License No. o o� 0 5�5
IF BIDDER is:
An Individual
� BY (SEAL)
(Individual's Name)
doing business as �
Business address:
Phone No.:
A Partnership
BY (SEAL)
(Firm Name)
(General Partner)
Business address: �
Phone No.: �
BF-6
A Corporation
gy (SEAL)
(Corporation Name) �
corporation)
gy (SEAL)
vince xelle ( ame f erson Authorized to Sign)
,Eraciriant
� - ' (Title)
, .
'`(�p�por�,te Seal�
` ' 4-. �,�
�- A�test '� � `''��
; " �;"�, Frank,. ..ers (Secretary)
�- =Busm'ess add�ess: 41 rt. Spriqq st.
- _-� ._ . .' .
�� " Cape Girardeau, MO 63701
Phone No.: (573) 334-0553
Date of Qualification to do business is January � 9�4
A Joint Venture
gy . � (SEAL)
(Name)
(Address)
gy (SEAL)
(Name) �
(Address)
Phone Number and Address for receipt of official communications:
(Each joint venturer must sign. The manner of signing for each individual, partnership and
� corporation that is a party to the joint venture should be in the manner indicated above.)
B F-7
BREAKDOWN OF WORK FORCE (Req�ired): .
. . . . , .
The Contractor shall be registered with the Missouri Secretary of State in order to work on
this project. • � � �
• , � . .. .
BIDDER hereby states that he will perform the foliowing items of work directly without
employment of subcontractors:
• All work not listed below.
It is anticipated that the following subcontractors will be employed for work on this project'
*SUBCONTRACTORS: .
(Name of Company) (Type of Work)
KT Power Systems Electrical
Municipal Equipment Company Booster Pump Station
*All subcontractors shall be registered with the Missouri Secretary of State in order to work
on this project.
BF-8
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BONDING COMPANYw
POWER OF ATTORNEY
Know/40 Peisa�s By These Pr�nis.if�at M�HANTS BONDING COMPANY(MUNAL)�d MERCHANTS NATIONAL BONDING,
fNC.,bofit be's�B�ons dWY organ�ed tmder ihe taws of ihe Sha�e aif Iwra(heren�vely cared tlie��.
and that the Companies do hereby make,con�fie and appotrt,in�ndt�(y,
Donald L Wasoba
of St Petets and State of M�ssouri their true and lawful Attomey-in-Fad,with fuli power
and authority hereby c�nfemed in tF►eir name,pFace a�d stead,tc sig�4 py=^��,acknowledge a�d deGver in tt�6eha�aa surety
any and aY bonds, undertakings,recognaanoes ar otlier wrdien abiga6a�s in�e�re 1h�eof,sibjed to the�iort that a�r
such instrumerrt shall not exceed the amotsrt ofi
TWO 11VIII.LI01�1(52,099,g90.90)DOLLARS
and to bind the Companies thereby as iWly aa�d to the same extent as ff such bond or undertaking was signed by tt►e duly
autfior¢ed officers of the Companies,and aH the acts of said Attomey-in-Fact, pursuarrt to the authority herein given,are
bereby ratified and confirmed.
This Power�is rt�ade�d exew�ed pursuant to and by authority of tlie following By�aws adopted by the Board of
Diedws afffie�ds Sondrg Car�ry(iluhiaQ on Hpra 23,2011 and adopted by the Board of Diredors of Mercharrts Nationai
Bonding.Inc..on Oc6ober 24,2011.
"'fhe PresideM,Secretary,Trsasurer,or any Assistsnt Treasurer or any Assistard Secretary or arry Vce Presiderd shaA have
power and authority to appoirR AGomeys-irrFad,and to authorize them to exearte on behalf of the Company,and attach Bie .
seal of the Company thereto,bonds and undertaldngs,recogn¢ances,contrads of indemnity and other writings obligatory in
ffie na�hxe fiereat
The s�ahae�ary autl�or¢�d o(6oer and tlie seal of the Company may be affoced by facsimilee or electronic transmission to
arry Power af Affiomey or Cer6�on thereof auttwrizing the execution and defivery of any bond,undertaking,recognizance,
�a�her auely�p obigaUons af�e Comparry,and such signature and seal when so used•shail have}he same foroe and
effed as 8�ough mar�y�.•
ln 1fl��ess N�ea�iLe Co�hare raised fhis'v�strurnent tn be signed ar�d sealed this 13th day of q�yust .2014_
�.•---�•.
�r�'� ���►�,�'C�'�'A: Ma2CHA!(TS BONDING COMPANY(MfJTUAI� .
'�g��Q�tr���:_ :��iORP�q;��'� �rs w►T�otr�eoNowG,trrc_
-d- '�-G" 'f--- -o- v:,,�.
d' :�_ :Z' :�'
:�� 2003 :.�_ �y t933 ;c�: By �
• � a � �
:d.�•••-...-r:�r�.-'` • �;' •-1;�
STATE OF IOWA ''4.,� �ft r� �••������•'
COUNTY OF POLK ss. �•�"'� ��f
On this 13th day of AugUst 2014,before me appe�ed Larty Taylor,to me persortaBy bawn,who being by me duly swom d'�d
say that he is Presiderrt of the MERCHA�fTS BONDING COMPANY(MUTUAL)and MERCHANTS NATIONAL BONDING,INC.;and
that tl�e seals afficed to the foregang instrument�the Corporate Seals of fhe Companies;and that the said instrumerrt was signed and
sealed in behalf of the Companies by auttwrfly of their respec�ive Boards of Directors.
In Tesmmoryr YN�!haue i�r�o se!nry hand and affixed my Official Seal at the Ciry of Des Moines,lowa,the day and year
�rst abw�e wr�
,��8 I��l1�DY WOODY
Z�> Cwrx�ror�Number 784b54-
I�fy Commission Expires
%wP June 20 20i 7
n�►r��co�ty,r�
STATE OF IOWA
COUNTY OF POLK ss.
1, V�Nlamer,.lr.,Seae�ary of the M�NTS BONDING COMPAM'(MUTUAL)and MERCHAhfTS NATIONAL BDNDtNG,INC.,
ao ne�y ca sry 1haR�e�ove�d roreyortg is e�ue a�!e�se�-t cx�py ot fk,e Pc>v�ER-0E-aTroRNEY ex�a�by saict c.o�an►e�,
vrFs�#�is s�l m i�To�e�d e1Fed and Fws r�d beeee a�ended ar ee�ialae�
fn 1Af�ess IIIA�reofi 1 have here�arto set t�h�d ad a(fooed B+e seel afifhe Carnparres on
� � �� � �...�5 �.•••••.�
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• •CY� a
POA 0014{7/14) : b,yy�,.. ��,;ri�ytrri �b�i � `:�a� , �}Q��
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E%�i�IT
AFFIDAYIT OF WOR%AUTHORI7.ATION
COMES NOW(N�) v;r,�P xPi �A� as (Offic�H� president
-_of(Comp�ayNzme/C.o�os) Nip Kellev EcTuipment Co. , �ndcfitst being duly swom, on
my oath,affiun as follvws:
' 1. (Com�rmyName/Coatrictor) Nip Kel l eX�qy i nment ��_ f TNr_
is earoIled and w�l continue to patric:ipate in a federal work author���+;,,T, p��m ;�� �
.employees that wt�l work ia connection with the contra.cted setvices related to(Pmject N�a pe Ro c k/
Perryville Road Booster Pump for the dutation of the contract in accordance.with RSMo
a ion
Chaptet 285.530(2).
2. ;��I also aff�rn that(Co�paapNamc/Coatcactior�Vip Kelley EQuinment � Inc.
not and w�11 not kao�ving�y anploy a petson who is a.a unauthorized alien m conne.ction with the
conttact setvices 2elate�tiD(P�ajectNzme) Cap Roe f rr�vi l l e Road Rnc�Gt�Pr for
�e dutation of the contract P�P Station
3_ Attached hctebo is doc�imenta.rion affimiing Contcacto�'s enroIlment and
participation iu a fedetat work authorization pmg�tu with respect to the cmployees worl�ng in
connection with the cont�'a.cted services. .
FURT�iIIt AFFIANT SATI�i NOT. �
IN AFFiRMATION TNFRFOF, the tacts stated above ate true and cos�ect (the
uadersigned undetstaads that false srateme�ts made ia this filing are subject to the
peualties provided.�n Section 575.040,RSMo.) � ,
Nip Ke ley Equipment Co. , Inc. .
(aame of ' )
� • B� , President
(name o ffi�t of coxpo�.i 1x�e) V i n c e Ke 11 e y
/
ATTEST: Y� .
�'�`: � ��-�.
:.✓, 4 i�
�-�°10��°���:F"rank Myers
,�_;; � .s...=- -
_- �,Y�� �/.�. �,'�, �' �j.r - .
. '�'i . - K��`.'/� �
(�.�S�R`.A�.;�F G�1t��RA'T��oI� .
- v>n� � f. iJ -
;>, -
. . ,j:... _ .
. z.:
STATE OF MISSOURI )
' ) ss.
COUNTY OF CAPE GIRARDEAU )
On this o'��f��'day of u� � 20�, before me appeated I�.'�'1! fi
to me personaIly kaaavn,who,b bp me cinlp swom,did sap that he/she is the ��.t t R�
of ' � f- a Mtssonri Cozporation, and that the seal a$�ed to the
fo ' ' t the seal of said Corporation, and t3�at the said instnunent was sig�ed and
sealed in behalf of said Corporation by authoritp of its Boatd of Di�ectors, and ac�nowledged said
instr�e�t to be the free act and deed of said Corporation.
IN��'TT1�(ONY WHEREOF,I have hereunto set mp hand and affiged my official seal,at
. my offtce in Cape Gstardea�Missouri,the dap and yeat fitst above�arit#e�.
. . . . �: .
✓
� Notary Public
,,,,�,,
- �0.`�iY P�'. STACI L PtFPLE
Mp Commission F.gpires: ==`NOTARY-:;_ �'�1��
''r.� � ` Corrx�t��17
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s-veaztr�c a traa�:¢or uu
Company ID Number.211168
THE E-VERIFY PROGRAM FOR EMPLOYMENT VERIFICATION
MEMORANDUM OF UNDERSTANDING
ARTICLE I
PURPOSE AND AUTHORITY
This Memorandum of Understanding (MOU) sets forth the points of agreement between the
Department of Homeland Security (DHS) and Nip Kellev Equipment Companv. Inc.
(Employer) regarding the Employer's participation in the Employment Eligibility Verification
Program (E-Verify). This MOU explains certain features of the E-Ver'rfy program and
enumerates specrfic responsibilities of DHS, the Social Security Administration (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 Verification Form (Form I-9).
For covered govemment contractors, E-Verify is used to verify the employment eligibility of all
newly hired employees and all existing employees assigned to Federal contracts.
Authority for the E-Verify program is found in Title IV, Subtitle A, of the Illegal Immigration
Reform and Immigrant Responsibility Act of 1996 (IIRIRA), Pub. L. 104-208, 110 Stat. 3009, as
amended (8 U.S.C. § 1324a note). Authoriiy for use of the E-'Jerify program by Fe�eral
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 "Federal cor�tracto�') to verify the employment eligibiliiy:of certain employees working on
Federal contracts is also found in Subpart 22.18 and in Executive Grder 12989, as amended.
AR7ICLE tl
FUNCTIONS TO BE PERFORMED
A. RESPONSIBILITIES OF SSA
1. SSA agrees to provide the Employer with available information that allows the Employer
to confirm the accuracy of Social Security Numbers provided by all.employees verified under
this MOU and the employment authorization of U.S. citizens.
2. SSA agrees to provide to the Employer appropriate assistance with operational
problems that may arise during the Employer's participation in the E-Verify program. SSA
agrees to provide the Employer with names, titles, addresses, and telephone numbers of SSA
representatives to be contacted during the E-Verify process.
3. SSA agrees to safeguard the information provided by the Employer through the E-Verify
program procedures, and to limit access to such information, as is appropriate by law, to
individuals responsible for the verification of Social Security Numbers and for evaluation of the
E-Ver'rfy program or such other persons or entities who may be authorized by SSA as governed
by the Privacy Act (5 U.S.C. § 552a), the Social Security Act (42 U.S.C. 1306(a)), and SSA
regulations (20 CFR Part 4D1).
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Company ID Number:211168
4. SSA agrees to provide a means of automated verification that is designed (in
conjunction with DHS's automated system if necessary) to provide confirmation or tentative
nonconfirmation of U.S. citizens' employment eligibility within 3 Federal Government work days
of the initial inquiry.
5. SSA agrees to provide a means of secondary verification (including updating SSA
records as may be necessary) for employees who contest SSA tentative nonconfirmations that
is designed to provide final confirmation or nonconfirmation of U.S. citizens' employment
eligibility and accuracy of SSA records for both citizens and aliens within 10 Federal
Government work days of the date of referral to SSA, unless SSA determines that more than 10
days may be necessary. In such cases, SSA will provide additional verification instructions.
B. RESPONSIBILITIES OF DHS
1. After SSA verifies the accuracy of SSA records for aliens through E-Ver'rfy, DHS agrees
to provide the Employer access to selected data from DHS's database to enable the Employer
to conduct, to the extent authorized by this MOU:
� Automated verification checks on alien employees by electronic means, and
• Photo verification checks (when available) on employees.
2. DHS agrees to provide to the Employer appropriate assistance with operational
� problems that may arise during the Employer's participation in the E-Ver'rfy �rogram. DHS
agrees to provide the Employer names, titles, addresses, and tele�hone numbers of DHS
representatives to be contacted during the E-Ver'rfy process.
3. DHS agrees to provide to the Employer a manual (the E-Verify User Manual) containing
instructions on E-Verify policies, procedures and requirements for both SSA and DHS, including
restrictions on the use of E-Verify. DHS agrees to provide training materials on E-Verify.
4. DHS agrees to provide to the Employer a notice, 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 of Special Counsel for Immigration-Related Unfair
Employment Practices (OSC), Civil Rights Division, U.S. Department of Justice. .
5. DHS agrees to issue the Employer a user identification number and password that
permits the Employer to verify information provided by alien employees with DHS's database.
6. DHS agrees to safeguard the information provided to DHS by the Employer, and to limit
access to such information to individuals responsible for the verification of alien employment
eligibility and for evaluation of the E-Verify program, or to such other persons or entities as may
be authorized by applicable law. Information will be used only to verify the accuracy of Social
Security Numbers and employment eligibility, to enforce the Immigration and Nationality Act
(INA) and Federal criminal laws, and to administer Federal contracting requirements.
7. DHS agrees to provide a means of automated verification that is designed (in
conjunction with SSA verification procedures) to provide confirmation or tentative
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Company ID Number.211168
nonconfirmation of employees' employment eligibility within 3 Federal Govemment work days of
the initial inquiry.
8. DHS agrees to provide a means of secondary verification (including updating DHS
records as may be necessary) for employees who contest DHS tentative nonconfirmations and
photo non-match tentative nonconfirmations that is designed to provide final confirmation or
nonconfirmation of the employees' employment eligibility within 10 Federal Government work
days of the date of referral to DHS, unless DHS determines that more than 10 days may be
necessary. In such cases, DHS will provide additional verification instructions.
C. RESPONSIBILITIES OF THE EMPLOYER
1. The Employer agrees to display the notices supplied by DHS in a prominent place that is
clearly visible to prospective employees and all employees who are to be verified through the
system.
2. The Employer agrees to provic+e to the SSA and DHS the names, titles, addresses, and
telephone numbers of the Employer representatives to be contacted regarding E-Verify.
3. The Employer agrees to becomF 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 employmPnt
verification queries will complete the E-Verify Tutorial before that individuai initiates a�y
queries.
A. The Employer agrees that all Employer representatives will take tne refresher
tutorials initiated by the E-Ver'rfy program as a condition of continued use of E-
Verify, including any tutorials for �ederal contractors 'rf the Employer is a Federal
contractor.
B. Failure to complete a refresher tutorial will prevent the Employer from continued
use of the program. .
5. The Employer agrees to comply with current Form 1-9 procedures, with two exceptions:
• If an employee presents a "Vst B° identity document, the Employer agrees to only
accept "List B° documents that contain a photo. (List B documents ident'rfied in 8 C.F.R.
§ 274a.2(b)(1)(B)) can be presented during the Form I-9 process to establish identity.) If
an employee objects to the photo requirement for religious reasons, the Employer
should contact E-Verify at 888-464-4218.
• If an employee presents a DHS Form I-551 (Permanent Resident Card) or Form I-766
(Employment Authorization Document) to complete the Form I-9,the Employer agrees to
make a photocopy of the document and to retain the photocopy with the employee's
Form I-9. The employer will use the photocopy to verify the photo and to assist DHS
with its review of photo non-matches that are contested by employees. Note that
employees retain the right to present any List A, or List B and List C, documentation to
complete the Form I-9. DHS may in the future designate other documents that activate
the photo screening tool.
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Company ID Number.211168
6. The Employer understands that participation in E-Verify does not exempt the Employer
from the resp�nsibility to complete, retain, and make available for inspection Forms I-9 that
relate to its employees, or from other requirements of applicable regulations or laws, including
the obligation to comply with the antidiscrimination requirements of section 2748 of the INA with
respect to Form I-9 procedures, except for the following mod'rfied requirements applicable by
reason of the Employer's participation in E-Verify: (1) identity documents must have photos, as
described in paragraph 5 above; (2) a rebuttable presumption is established that the Employer
has not violated section 274A(a)(1)(A) of the Immigration and Nationality Act �INA) with respect
to the hiring of any individual if it obtains confirmation of the identity and employment eligibility of
the individual in compliance with the terms and conditions of E-Ver'rfy; (3) the Employer must
not'rfy DHS if it continues to employ any employee after receiving a final nonconfirmation, and is
subject to a civil money penalty between $550 and $1,100 for each failure to notify DHS of
continued employment following a final nonconfirmation; (4) the Employer is subject to a
rebuttable presumption that it has knowingly employed an unauthorized alien in violation of
section 274A(a){1)(A) if the Employer continues to employ an employee after receiving a final
nonconfirmation; and (5) no person or entity participating in E-Verify is civilly or criminally liable
under any law for any action taken in good faith based on information provided through the
confirmation system. DHS reserves the right to 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-Verify verification procedures for new employees
within 3 Employer business days after each emptoyne has been hired (but after both sections 1 .
and 2 of the Form I-9 have been completed), and to complete as many(but only as many) steps
of the E-Verify process as are necessary according tc the E-Ver'rfy User Manual. The Employer �. .
is prohibited from initiating verification proceciures befQre the employee has been hired ana the � . •
Farm I-9 completed. If the automated system to.be queripd is temporarily unavailable, the 3-day �
�ime period .is extended until it is again operational in order to accommodate the Employer's �
attempting, in good faith, to make inquiries during the period of unavailability. In all cases, the
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 Employer performs an E-Verify employment verification query using the
employee's SSN as soon as the SSN becomes available.
8. The Employer agrees not to use E-Verify procedures for pre-employment screening of
job applicants, in support of any unlawful employment practice, or for any other use not
authorized by this MOU. Employers must use E-Verify for all new employees, unless an
Employer is a Federal contractor that qualifies for the exceptions described in Article II.D.1.c.
Except as provided in Article II.D, the Employer will nat verify selectively and will not verify
employees hired before the effective date of this MOU. The Employer understands that if the
Employer uses E-Verify procedures for any purpose other than as authorized by this MOU, the
Employer may be subject to appropriate legal action and termination of its access to SSA and
DHS information pursuant to this MOU.
9. The Employer agrees to follow appropriate procedures (see Article III. below) regarding
tentative nonconfirmations, including notifying employees of the finding, providing written
referral instructions to employees, allowing employees to contest the finding, and not taking
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Company ID Number:211168
adverse action against employees if they choose to contest the finding. Further, when
employees contest a tentative nonconfirmation based upon a photo non-match, the Employer is
required to take affirmative steps (see Article III.B. below) to contact DHS with information
necessary to resofve the challenge.
10. The Employer agrees not to take any adverse action against an employee based upon
the employee's perceived employment eligibility status while SSA or DHS is processing the
verification request unless the Employer obtains know(edge (as defined in 8 C.F.R. §274a.1(I))
that the employee is not work authorized. The Employer understands that an initial inability of
the SSA or DHS automated verification system to verify work authorization, a tentative
nonconfirmation, a case in continuance (indicating the need for additional time for the
govemment 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 fair opportunity to contest the
finding, and 'rf he or she does so, the employee may not be terminated or suffer any adverse
employment consequences based upon 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 othervvise subjecting an employee to any assumption that he or she is
unauthorized to �vork) until and unless secondary verification by SSA or DHS has been
completed and a final nonconfirmation has been issued. If the employee does not choose to
contest a tentative nonconfirmation or a photo non-match nr if a secondary ver'rfication is
completed and a final nonconfirmation is issued,then the Employer can find the employee is not
work author'zed ar�d terminate the employee's employment. Empioyers or employees w�th
questions ai�out a final nonconfirmation may call E-Veri#y at 1-888-464-4218 or OSC at 1-80�-
255-8155 or y.800-237-2515(TDD).
11. The Employer agrees to comply with Title VII of the Civil Rights Act of 1964 and section
2748 of the INA by not discriminating unlawfully against any individual in hiring, firing, or
recruitment or referral practices because of his or her national origin or, in the case of a
protected individual as defined in section 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-Veriiy except as provided in part D below, or discharging or refusing to
hire employees because they appear or sound "foreign" or have received tentative
nonconfirmations. The Employer further understands that any violation of the unfair
immigration-related empl�yment practices provisions in section 274B of the INA could subject
the Employer to civil penalties, back pay awards, and other sanctions, and violations of Title VII
could subject the Employer to back pay awards, compensatory and punitive damages.
Volations of either section 2746 of the INA or Title VII may also lead to the termination of its
participation in E-Verify. If the Employer has any questions relating to the anti-discrimination
provision, it should contact OSC at 1-800-255-8155 or 1-800-237-2515 (TDD).
12. The Employer agrees to record the case verification number on the employee's Form I-9
or to print the screen containing the case verification number and attach it to the employee's
Form I-9.
13. The Employer agrees that it will use the information it receives from SSA or DHS
pursuant to E-Verify and this MOU only to confirm the employment eligibility of employees as
P2g8 S Oi 13�E•Veri�•h4�U ior F�;i�k7y2�,R2EiS�Gr Dctc 1QI .2�.08 _.."_ ,. _._ .. . . � . :
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authorized by this MOU. The Employer agrees that it will safeguard this information, and means
of access to it(such as PINS and passwords) to ensure that it is not used for any other purpose
and as necessary to protect its confidentiality, including ensuring that it is not disseminated to
any person other than employees of the Employer who are authorized to perform the
Employer's responsibilities under this MOU, except for such dissemination as may be
authorized in advance by SSA or DHS for legitimate purposes.
14. The Employer acknowledges that the information which it receives from SSA is
governed by the Privacy Act (5 U.S.C. § 552a(i)(1) and (3)) and the Social Security Act (42
U.S.C. 1306(a)), and that any person who obtains this information under false pretenses or uses
it for any purpose other than as provided for in this MOU may be subject to criminal penalties.
15. The Employer agrees to cooperate with DHS and SSA in their compliance�monitoring
and evaluation of E-Verify, including by permitting DHS and SSA, upon reasonable notice, to
review Forms I-9 and other employment records and to interview it and its employees regarding
the Employer's use of E-Verify, and to respond in a timely and accurate manner to DHS
requests for information relating to their participation in E-Verify.
D. RESPONSIBILITIES OF FEDERAL CONTRACTORS
1. The Employer understands that 'rf it is a Federal contractor subject to the
employment verification terms in Subpart 22.18 of the FAR it must verify the employment
eligibility of any "employee assigned to the contract" (as defined in FAR 22.1801) in addition to
verifying the.employment eligihility of all other employees required to be verified under the FAR.
Once an employee nas been verified through E-Verify by the Empioyer, the Employer may not �
reverify the employee through E-Verify.
a. �Federal contractors not enrolled at the time of contract award: An Employer that
is not enrolled in E-Ver'rfy as a Federal contractor at the time of a contract award must enroll as
a Federal contractor in the E-Verify program within 30 calendar days of contract award and,
within 90 days of enrollment, begin to use E-Verify to initiate verification of employment eligibility
of new hires of the Employer who are working in the United States, whether or not assigned to
the contract. Once the Employer begins verifying new hires, such verification of new hires must
be initiated within 3 business days after the date of hire. Once enrolled in E-Verify as a Federal
contractor, the Employer must initiate verification of employees assigned to the contract within
90 calendar days after the date of enrollment or within 30 days of an employee's assignment to
the contract, whichever date is later.
b. Federal contractors already enrolled at the time of a contract award: Employers
enrolled in E-Verify as a Federal contractor for 90 days or more at the time of a contract award
must use E-Verify to initiate verification of employment eligibility for new hires of the Employer
who are working in the United States, whether or not assigned to the contract, within 3 business
days after the date of hire. If the Employer is enrolled in E-Ver'rfy as a Federal contractor for 90
calendar days or less at the time of contract award, the Employer must, within 90 days of
enrollment, begin to use E-Verify to initiate verffication of new hires of the contractor who are
working in the United States, whether or not assigned to the contract. Such verification of new
hires must be initiated within 3 business days after the date of hire. An Employer enrolled as a
Federal contractor in E-Verify must initiate verification of each employee assigned to the
Fnge 6 of 13�E-�Jerry t�fi�U Eor Em�4erJ�zvisior,bake 1�'2�:�� . � : .. � -- .
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B-VERZIY IS F S61C:Q or m�s
Company ID Number. 211168
contract within 90 calendar days after date of contract award or within 30 days after assignment
to the contract, whichever is later.
c. Institutions of higher education, State, local and tribal govemments and sureties:
Federal contractors that are institutions of higher education (as defined at 20 U.S.C. 1001(a)),
State or local govemments, govemments of Federally recognized Indian tribes, or sureties
perforrning under a takeover agreement entered into with a Federal agency pursuant to a
performance bond may choose to only verify new and existing employees assigned to the
Federal contract. Such Federal contractors may, however, elect to verify all new hires, and/or
all existing employees hired after November 6, 1986. The provisions of Article II.D, paragraphs
1.a and i.b of this MOU providing timeframes for initiating employment verification of employees
.assigned to a contract apply to such institutions of higher education, State, local and tribal
govemments, and sureties.
d. Verification of all employees: Upon enrollment, Employers who are Federal
contractors may elect fo verify employment eligibility of all existing employees working in the
United States who were hired after November 6, 1986, instead of verifying only those
employees assigned to a covered Federal contract. 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 procedures for Federal contractors: The Employer may use a
previously completed Form I-9 as the basis for initiating E-Verify verification of an employee
assigned to a contract as long as that Forr.m I-9 is complete (including the SSN), cerrpliss with
Article II.C.5, the employee's work authorization has not expired, and the Employer has
reviewed the information reflected in the Form I-9 either in person or in communications.with the
emptoyee 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 lawful permanent resident alien
having become a naturalized U.S. citizen). If the Employer is unable to determine that the Form
I-9 complies with Article II.C.5, if the employee's basis for work authorization as attested in
section 1 has expired or changed, or if the Form I-9 contains no SSN or is otherwise incomplete,
the Employer shall complete a new I-9 consistent with Article II.C.5, or update the previous I-9
to.provide the necessary information. If section 1 of the Form I-9 is othervvise valid and up-to-
date and the form otherwise complies with Article II.C.5, but reflects documentation (such as a
U.S. passport or Form I-551) that expired subsequent to completion of the Form I-9, the
Employer shall not require the production of additional documentation, or use the photo
screening tool described in Article II.C.5, subject to any additional or superseding instructions
that may be provided on this subject in the E-Verify User Manual. Nothing in this section shall
be construed to require a second verification using E-Ver'rfy of any assigned employee who has
previousty been verified as a newty hired employee under this MOU, or to authorize verification
of any existing employee by any Employer that is not a Federal contractor.
2. The Employer understands that if it is a Federal contractor, its compliance with this MOU
is a performance requirement under the terms of the Federal contract or subcontract, and the
Employer consents to the release of information relating to compliance with its verification
responsibilities under this MOU to contracting officers or other officials authorized to review the
Employer's compliance with Federal contracting requirements.
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REFERRAL OF INDtViDUALS TO SSA AND DHS
q, REFERRAL TO SSA
1. If the Employer receives a tentative d���ted by the automa ed system and prov de t to
print the tentative nonconfirmation notice as
the employee so that the empioyee may determine whether he or she v+nil contest the tentative
nonconfirmation.
2, The Employer will refer ta p�eyno confi mSa o 1eland olnly afterythe Employer ecords �
automated system based on a te �
the case verification number, reviews the input to detect any transaction errors, and determines i
that the employee contests the tentative nonconfirmation. The Employer will transmit the Social
Security Number to SSA for verification again 'rf this review indicates a need to do so. The ;
Employer will determine whether the employee contests the tentative nonconfirmation as soon �
as possible after the Emp�oyer receives it.
3. If the employee contests an SSA tentative nonconfirmation, the Employer will provide ;
the employee with a system-generated referral letter and instruct the empioyee to visit an 5SA �
office.within 8 Federal Govemment worlc days. SSA w�ll electronically transmit the result of the
referral to the Employer within 1 a Federal Govemment work days of the refeRat unless it
deterrnines that more than 10 days is necessary•The Employer agrees to check the E-Verify
system regularly for case updates.
4. The Employer agrees not to ask the employee to obtain a printout from the Social
Security Number database (the Numiderrt) or other written verification of the Social Security
Number from the SSA.
B. R
EFERRAL TO DHS
�
1. If the Employer receives a tentative nonconfirmation issued by DHS, the Employer must
print the tentative nonconfirmation notice as directed by the automated system and provide it to
the employee so that the employee may determine whether he or she will contest the tentativve
nonconfirmation. i
2. If the Employer finds a photo non-match for an employee who provides a document for
which the automated s stem has transmitted a photo, the employer must pririt the photo non- �
Y
match tentative nonconfirmation notice as directed by the automated system and provide it to
the employee so that the employee may determine whether he or she will contest the finding.
3. The Employer agrees to refer individuals to DHS only when the employee chooses to
contest a tentative nonconfirmation received from DHS automated verification process or when
the Employer issues a tentative nonconfirmation based upon a photo non-match. The Employer �
will determine whether the employee contests the tentative nonconfirmation as soon as possible
Fage 8 ot 13'E-l�eri�y MOU far Err:�toye!i3evis�or?2te iu�� •• k � - . � �
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Company ID Number.211166
after the Empioyer receives it.
4. If the ernployee contests a tentative nonconfirmation issued by DHS, the Employer will
provide the employee with a referrai letter and instruct.the employee to contact DHS through its
toil-free hotline (as found on the referral letter)within 8 Federal Government work days.
5. If the employee contests a tentative nonconfirmation based upon a photo non-match, the
Employer will provide the employee with a referral letter to DHS. DHS will electronicaliy transmit
the result of the referral to the Employer within 10 Federal Government work days of the referral
unless it determines that more than 10 days is necessary. The Employer agrees to check the E-
Verify system regularly for case updates.
6. The Employer agrees that if an employee contests a tentative nonconfirmation based
upon a photo non-match, the Employer will send a copy of the employee's Form I-551 or Form
I-766 to DHS for review by:
� Scanning and uploading the document, or
• Sending a photocopy of the document by an express mail account (fumished and paid
for by DHS).
7. The Employer understands that if it cannot determine whether there is a photo
match/non-match, the Employer is required to forward.the employee's documentation to DHS by
scanning and uploading, or by sending the document as described in the preceding paragraph,
and rEsolvin� thE case as spec'rfied by #he Immigration Services Verifier at DHS wi�o will
determine the photo match or non-match.
ARTICLE IV
SERVICE PROVISIONS
SSA and DHS will not charge the Employer for ver'rfication services performed under this MOU.
The Employer is responsible for providing equipment needed to make inquiries. To access the
E-Verify System, an Employer will need a personal computer with Internet access.
ARTICLE V
PARTIES
A. This MOU is effective upon the signature of all parties, and shall continue in effect for as
long as the SSA and DHS conduct the E-Verify program unless modified in writing by the mutual
consent of all parties, or terminated by any party upon 30 days prior written notice to the others.
Any and all system enhancements to the E-Verrfy program by DHS or SSA, including but not
limited to the E-Ver'rfy checking against additional data sources and instituting new verification
procedures, will be covered under this MOU and will not cause the need for a supplemental
MOU that outlines these changes. DHS agrees to train employers on all changes made to E-
Verify through the use of mandatory refresher tutorials and updates to the E-Verify User
Manual. Even without changes to E-Verify, DHS reserves the right to require employers to take
Page 9 a`.13!E-Veri,y!1�U for Er^�lo°,e��Revision�a�e i��2S.'Oa - _ .
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Company ID Number:211168
mandatory refresher tutorials. An Empioyer that is a Federal contractor may terminate this
MOU when the Federal contract that requires its participation in E-Verify is terminated or
completed. In such a circumstance, the Federal contractor must provide written notice to DHS.
If an Employer that is a Federal contractor fails to provide such notice,that Employer will remain
a participant in the E-Verify program, will remain bound by the terms of this MOU that apply to
non-Federal contractor participants, and will be required to use the E-Verif�r procedures to verify
the employment eligibility of all newly hired employees.
B. Notwithstanding Article V, part A of this MOU, DHS may terminate this MOU if deemed
necessary because of the requirements of law or policy, or upon a determinatian by SSA or
DHS that there has been a breach of system integrity or security by the Employer, or a failure
on the part of the Employer to compty with established procedures or legal requirements. The
Employer understands that if it is a Federal contractor, termination of this MOU by any party for
any reason may negatively affect its performance of its contractual responsibilities.
C. Some or all SSA and DHS responsibilities under this MOU may be performed by
contractor(s), and SSA and DHS may adjust verification responsibilities between each other as
they may determine necessary. By separate agreement with DHS, SSA has agreed to perform
its responsibilities as described in this MOU.
D. Nothing in this WIOU is intended, or should be construed, to create any right or benefit,
substantive or proce�ural, enforceable at law by any third party against the United States, its
agencies, officers, or employees, or against the Employer, its agents, officers, or employees.
E. Each party shall be solely responsible for defending any claim or action against it arising
out of or related to E-Verify or this MOU, whether civil or criminal, and for any liability
wherefrom, including (but not limited to) any dispute between the Employer and any other
� person or entity regarding the applicability of Section 403(d) of IIRIRA to 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
information and may be disclosed as authorized or required by law and DHS or SSA policy,
including but not limited to, Congressional oversight, E-Verify publicity and media inquiries,
determinations of compliance with Federal contractual requirements, and responses to inquiries
under the Freedom of Information Act(FOIA).
G. The foregoing constitutes the full agreement on this subject between DHS and the
Employer.
H. The individuals whose signatures appear below represent that they are authorized to
enter into this MOU on behalf of the Employer and DHS respectivefy.
Pa�e 10 af 1"s;E-'Je:i±�hiOU tor�mpbyer�Ravision�sEe 9C!t2�r�3 - " . _ . .
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Company ID Number:211168
To be accepted as a participant in E-Verify, you should only sign the Employer's Section
of the signature page. If you have any questions, contact E-Verify at 88&464-4218.
Employer Nip Kelley Equipment Company,Inc.
Vince Kelley
Mama(Piease Type or Print) rtte
. E.�eclron.ica//y Signed 45l45/2t3Q9 _
Signature Dafe
Department ot Homeland Security—Verffication Division
USCIS Verfication Division
fsame(Please T�+pe ar FrEni) Trt{e
E/ecfionrca/!y Signed 051�5120�9
signature pate
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Company ID Number.211168 �
Information Required for the E-Verify Program
Ir�formation relating to your Company:
Com�any F1�ame: Nip Kelley Equipmerrt Cocn�any,lnc.
I
Carr.pan�r Faci{E�y Address: 41 Norch Sprigg
Cape Girardeau;MO 637Q1 I
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Cornpany,0.ltern�ie � �
�ddress- I
• CAP�Gi4ARDE�t1
Crsun or F'arish.
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Empiayer I�ent�ficatiore i
hlu�n3�r: �31asB2oo
iNorth America�tndustry i
Classi€ication Systems ,
Ci3tle: 237
Far�nt Catnp�ny:_N+€s Kelley E�uipment Compahy,Inc. '
Plumf3er of Emplayees: �a���
i
f��rr�ber of�ifes i(er��ec! �
f�Y: 1
. ._. ..... . _ .
Are you verifying for more than 1 site?tf yes, please provide the number of sites verffied for in �
each State:
. MISSOURI 1 site s
� ) �
Page 12 a�i's;�`Je�iiy h�fGU fo�Err;�;! •er�Rev's+��^,Date 1�'29;'U8 -. -, - - . . _ ,
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Company ID Number:211168
Information relating to the Program Administrator(s)for your Company on policy questions or
operational problems:
Name: Staci L Pepple
Telephone Number. (573)334-0553 Fax Number. (573)334-2025
E-mail Address: spepple(�3nipkelleyco.com
Name: �nce L Kelley
Telephone Number. (573)334-0553 Fax Number. (573)334-2025
E-mail Address: vkelley�nipkelleyco.com
Paga 13 af i3�E-Verrr rAJU`or Grployer�nevision D2ie I�L9,'O8 - :f'a`'= '
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�IIBIT
� AFF'IDAYIT OF OSHA TRAINING
COMESNOW(N�) Vince� Kelley � as (O�H� President �
of(Co�mpanyN�JCo�) Nip Kelley Equipment Co. , ������ �
mp oath,affitm�cann�with the contractEd setvi�ces n�a�ed toCape Rock/Perrvvil le Road
Booster Pump St�������of the connac�as foIlows: .
1. GoIIriac�6or shaIl pmvid� a tea (1� hont Occ�a�onal Safety anci Health
�jd�ir�i�+r�t�� (OSHA) conslYvc.tion safety pmg�m far aIl emplapecs who w�be on-site at the .
PIO�CCt �1C �II S2fdp� S�.l�G S COiIiSG ifl rrmettnrfirm y�{�t �h� .
that is app�oved by OSHA or a s�tm']ar pmgxam appm�ved bp the 1ldissouri Depat�t of Labor and
�di�+*;�1 Rclativns�which is at least as sttingcnt as an appraved OSH11�pmgram as ra�u�ted bY .
Sectioa 292675,R�SMo.
2. Contr.ac6or shaIl reqmt�e 1ts on-s�e ctnployees tio com�ilete a constrac.-i1oII safetp
PrOS����Y(� �aftct the aa�e Work on rhe Pmject commences,as x�vi�by se�tion
292675,R�SMo. ,
. 3. Contrach�r aclnoovledges and a�ees that azip of Contmcto�t's employees found cu
the Project sme without doc.vmentati:on of the sncccssfal complerion of a const�ctian saf�tp
Pmg�am shaIl be r�quited t�pmdnce sach dna.uneutatiou within tweatp("LO)days,or w�be subject
1��ctnoval ft�om the Prvject '
4. Contc�c6�=shaIl reqmte aIl of its Subcoat�actois to comply wi�t�e reqniranmts of
Section 292675,R�SMo.
5. Coai�tor ackn�cledges that putsuant tio Secti�on 292675,R.SMo.,Contcactor shaIl
for�t to Citp as a peaaltp tc�o thonsand five huadt�ed do�4aa (�2,500.00�,pins one htmdt�ed dolla�s
�ioo.a� ��������c.�ar�s�����a�
aap, ���,�� ����ya� ��a����� �y�
reqnited in Section 292675,R.SMo.
6. Co�tracto=ac�aoWledges t3sat violations of Sectioa 292675,RSMo,and imposiiioa
of the pcnalties descnbed thetaa shaIl be mvestigated and dc6etmm�d by the Mlssouri Department
of Labar and Ifldnstrial R�l�ri�,t,� .
7. C'cm�i_�-+r+*.ackaoavledges t3iat ia the ev�eat ti�t the 1VrissoIIsi Depatla�mt of Labar
and Tndus+*+al Re�atinns I�as de6crmmed that a vio}atian of Sxtion 292675, RSMo., has ocaared '
. ,. • . ' '
and tbat a penaltp shaIl be assessad,the Cify shaIl withhold.and retain aIl sums and amou�ts due and.
���p���c�.�rar��c�.�
FURT�1t A��IANT SATi�i NOT. �
]N ARFrirMAZ'ION THEREOF, the f�cts srated. above are trae and co=cect (the
uade�tands that false s�neats made ia ttus filing are subject �o th,e . . .
P�P��m Sectioa 575.040,RSMo.) . -
Nip Ke ley Equipment Co. , Inc.
• (name of
By- President
� (n�meof fficerofco aadti�e)Vince Kelley
. A7TFSrG/ , .
_�'�---
,..�iy(ofo#i�ero.ffic�) r nk Myers
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. : ,:.S'�1�:OF MtSSOURI �
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COUN7'Y OF CAPE GIRARDEAU� )
On ti�is��day of�•�l _ _2pIS bcfvre me appeared V�✓Jt �� .
to me known,wlw, ' `�Lp me d�y swoin,did sap t3iat hc/she is thc � � /!� .
of �� 0�'�'1 a Mtssomi Co�tinn, aud $zat the seal affised to the
£o�cgomg ' is the seal of said Co2pomti�o� aud th�.t the said +n�t�nm,Mt W� and -
sealed im b�half of said �
C.atpor�ion by authrnitp of its Boud of Dincto=s, and ac�aoW],edge,d said
;t,�+r,,,,,P.,t m bc the fre�act and deed of said Corporati�on.
7N TFS'�'TMONY WHEREOF,I have beteantio set mp haad and aff�ed mp offYcial sea�at
mp o$tce im Ca}�e G�td�,M�ssouri,the day and yr�fiist above w�.
✓
• Notazy Pnblic
My C.ommiissioa E�
" :,�YP(j'� STA�P�EPPLE�
� � !I ��°•��_ � �
-* •*- Febtuary 9,2017
:�;� Scott County
� ` Comrtessiotl#13434217
,QF �M�
? t
`1
• .
CITY Q� CAPE
G 1 RA R D EAU
Certif cation Regarding
Debarment, Suspension and Other Responsibility Matters
The contractor hereby certifies to the best of its lrnowledge and helief and tbat it and its principals
� and its subcontra�ors and their pri.ncipals: . �
(a) Are not presenfly debaaed,suspended,proposed for debarment,declared ineligible or
. voluntarily excluded from covered transactions by any Federal or State department or agency; �
:::r.
_ (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 cri.minal offense in
connection with obtaining,attempting to obtain or performing a public(Federal, State or
Local)transaction or contract under a public tcansaction;violation of Federal or State antitrust
statutes or commission of embezzlement,theft,forgery,bn'bery,falsificahon 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 govemment
entity(Federal, State or Local)with comm;�cion of any of the o�enses enumerated in
pazagraph(1)(b)of this certification; and �
(d) Have not within a three-year period preceding this subcontract had one or mQre public
transactions(Federal, State or Local)terminated for cause or default �
I�derstand that a false statement on this cerlification may be gronnds for rejection of this
contractor or termination of the contrack In addition,nnder 18 USC 5ec. 1001,a false
statement may resnit in a fine of up to$ 10,000 or imprisonment for np to five(S7 years or
both.
Vince elle President
Typed Nam Title Authorized Representative
� 07-28-15
Si f A ��Ve D�
❑ I am unable to certil�ta the above statement My explanation is a.ttached,
, ,
9
♦
THE AMERICAN INSTITUTE OF ARCHffE{,TS
B�arro_ aaoc�c�
NA Documerrt A312
Performance Bond
Mr s�,lar re�r�oe�cama�s�x ow�ac�apmys�6eaor�d�p�al,�i�eapp�.�6�
c+o�rrrr�t�v��da�r. su�nrcN��,a����s��:
����,� M�so�g��y(M�) ,
a�rto�s�sa�c Zioo���
c�c�-�, �+to��oi nes� in so�i
Tel:573-334-0553
��(N����: Tel:515-243-8171
City of Cape Gira�eau _
401 In�ce Sh+eet
C�pe.� A�[(} f37Ek1
t�]I+t[I�ll[_T
� A U G U�T l''� at�/�
M�oor� 5576,630.00 "
Qestription Mame and Location}: �RockdPeiryville Road .
Boostea Pump Sla�ion a�d Gene�tar _ ' . :
BOND Project Na_6177 _ _
Da1e(IVot�rlier fhan C.or�sUnXtion Ga�trad Dade): f�L?G u5T /'� ,;ZOlS�
Amourr� 5576,630.00 = " "
;•f-
AAoci�ica�0or�s tio�his eord: � t�or�e '.;O see PaBe 3 ; '.
CONTRAC70R AS PRI SURETY - :.
compa�y: �c-:«pora�e sean c�►- cc;orp�ra�e s`e�n�e,.
r��r.�r EQ' , co ,�t�t,nJc M�rs so�a�c�y(M�
':, . . ,. TeL-5�24��1 �/�o�-.�r— ;
_� �
= z'�I�tarnea�id�7ii� mceKeIleq Narneae�Fitll�D�1dL Wasobe
' -. . . Pt�deot 1�act
;��pi;y�����;� Bond signed and Sealed this 5th day of August, 2015, but
left undated �t the resniest of the Owner. _____ __
(FO�R 1lVFORM�TION OsNLY--Name,Add►�ss ard Telephone)
AGEIV'f or SROI�R: OVI/NER'S REPR�ffATIVE(Anct�Oe�.Er�neer oralher
R�h►1=
Ga�waY S�udY
22 Avocado Tree Circle
St,Pet�s, MO 63376 �
Tel:314374-0589 �
MA DOCU1Y�If A3t2•PfItFO�IANKE 90ND AND HdMEIVT 80N0•U�1954�.-AIA•
���w ws�mnE oF�er�c�s. �ns r�w Yowc w�. N_w.�.o.c Zaooe A31219d� 1
�
1 The Cor�racbr�d fhe Surety,jointly aM seu�ra�y.b�d .1 Alier �nre�Gon, deie�mine U�e amour�t for
�, �eir heus, ezearbrs. adme�ors. ��may be 6able to 1he Owner and,as soa�
��oo�as and assigt�to the Owr�er�nr the periom�anae as prac�Cable afb� the amount is de�ertnined,
of U�e Construcbon CoMrad,vrhich is inoorpora�ed her�ein tet�der payrnerrt therefone to the Owr�er,or
�Y►�-
2 � fabi�ty a� whole or in parE and �y the
2 tf ihe Contrac�or perfiom�s the Consh�ution Co�drad.the Ow��abg�ons�
Surely and the Contracbr sha�hav�e no obfigation� 5 If 8�e sucly does r+ot piaoeed as povicled "ei Par�graph
this Bond.exoept to particQatie in oonierenoes as provided 4 wifh reasonable pranptr�ess.the Sur+�y shall be deemed
in Subparagraph 3_1. io be a� delauR on 1i�"s Bord f�en days aiier reoeipt of
3 If there is no Owner Defautt, the Suret�fs abigaGon �� �� ����������
unaer this so�a snai arise ai�er ���s�ae�r perrorm�obfga�o«s uder this
Bond. and �e Owner sf�2i be � �o enio�ne ar�y
S_� The own�nas r�o�fi� me co�tractor arsa�e �nea�r�e fu�e owr�er IF�e�jr aoa�s as
Sure�y at its address de,scnbed in Paragraph 10 prwided � Subparagraph 4_4, and the Owner refiues tt�e
belaw that the Owner is aor�sidering dedarirg a payment Uer�dered or the Suretyy had denied fiabifily, in
Ca►�ac�or De€a��t and f�s e�e�and albernp�ed v�Fiole or in part,wifhout further notioe ihe Owner shai be
io ararge a aor�wih fie Car&ac�r�d fhe er�ed�r e�oEae amr�r�1 araia6(e b�e Owner_
S�eijt b 6e 6ekf ent Lafer ihan � datys aRer
reoeQt of s�xh na6c� to d�sass me�9�otis af Pg` 6 MeF fie t��as i�aiad�e Cn[t-adds E+gl� in
iorraeg ihe Cor��x,�on CanUad_ If ihe Owner,U�e � g�e Cor�s6uc6on Cariac� and � �e Suely
Contrador and the SuretY agree.the Contrac�or st�a1 elecls b ad under S�agr-aph 4_1,42, �4 3 aba�e,
be a�b�ed a re�nable time �o per�rm U,e �n the re,spor�b�ties of the s�uety to the owr�er shal�
C,ons6vction ConUact, but such an agreerr�e�rt shaN not be grea� than fhose of ihe Contrac�or under the
not waive the Owners right, if anY. ��Y m C.onstruction ConLad, and 1he r�spor�s�es of fhe
dedare a Contrador Defaufk and Owner to the Surety shall not be greafier U�an tlwse aF the
32 The Owner has deda�ed a Ca�Nac�or Defi�� Owner uMer the Co�on Conhad To the 6mit af the
iom�y�nircd�ied tffe CorfiacEor's ri�t b aampleie amoent o��'s Band, Ex�t std�ject b aoareNment try �e
U�e aorrtrad Sud� C.o�racEor Default sha� nat tie Owner af fie�anoe af ihe Co�-act Prioe io m"Cga�on ofi
dedared�Than iw�ertily days ai�er the Co�nfira�to� ao� �d damages on U�e C�r�vdion Con6act, �e
and the Surety have reaeived notioe as prDvided in ��Y�����rt����
Subparagraph 3_1;and
3.3 The Owner has agreed bo pay the Balanoe of the sredion of de�ec�ve work andthe Contrador for oor-
Contrad Prioe fio U�e Surety in a000rdanoe wilh tl�e ��� O0�afi ihe Con-
terms of the Co�irucbon Contrad or to a�Gontrador ��
selec�eed tu perform the Construction Conh�awt in 6-2 Add'�onal legal, desi9� P� � �Y
a000rdance wilh U�e temis of ihe oontract wilh fhe � restdtirg from the Contrac�ors Default, and
Owner_ res�d6ng irom ihe adions or faiure t� act of ihe
4 VVlten 1he Owner has sa6sfied the corrdifions of �under Paragra�h 4;and
Paraqraph 3,ihe Surely shai pranpUy and at the Suret�s 6.3 LiquidaUed darnages.or if no 6quida�ed damages
e�se take one of the iollowing ac�ons_ are spedfied in the Consfn�tion ConUact, ac�ial
4_1 Mange for the ConUador. with oonserrt of U�e � caused by delayed perfoirrranoe or rwn-
Owner, to perform and oompl�e the Construction �ofthe Conlrac�or .
��� 7 The Sur�ety shall not be liable to the Owner or otFiers for
obliga6or�,s of fhe Contractior that are unrela�ed b the
42 Undertake fio perform �d a�e the C.or� Cor�Gruction Contrad, and U�e Balarwe of the Contract
strudion ConUad ilsetF,through ds agerds or through Prioe shaR rat be reduoed or s� off on aocourd af arry
ind�nde�rt oontracbors;or such unrelaled obfigations. No rigtrt of action shaG acaue
4.3 Obtain bids or negotiated proposals irwn qua6fied on Uus Bond bo any person or er�dy other than the Owner
oontracbors aooep�able�o tbe Owner�nr a contract for °r��8s.ezea�ors.admirtistra�Ors or suooessars
peitonnanae and oornple4on of the Cor�s6rtx�on 8 The Sixety t�ereby vraives notioe of any d�ange, indo-
CuoUact. arr'ange ior a corrtrac� to be prppared for ding changes of tcne, to the Conslnx�on Contract or to
exeattion by fhe Owner and the oonfractor selec�ed rela�ed suboontracLs, purchase orders and other oblF
with the Owr�s oor�urrenoe. to be seaired wifh g�r�-
perfonnanoe and payrr�ent bonds execw�ed by a
qualified sur�y eq�irvalent to the bonds iss��ed on the 9�P���9, �or equiFable, under Utis Bond may
Construction Contrad, and pay bo ihe Owner the be ir�d��ed m arry oourt of oompetierrt jurisdidion in the
amou[rt of damage.s as desc�bed in Pa�agraph 6 in locafion ei which ihe work or part of U�e work is loca�ed and
�Qf�e�atanoe a�F�e Cantr-act Prioe�cuRed sha0 be�within ri�o years af6er Contrac�or Default
by tl�e Owner resu6g#om ffie Ca�-ac�ors de�fatik or or�it �o y�s �er ihe Co�r ae+ased wextag
4_41Maive ifs rigM to perform and comple�+e,aRar�ge or w�n �wo y�rs a�ier 1he Suely re�iises ar fais b
for an�npie�ioEt, or obFai� a naer aoe�acinc and wilh �°�obiga�ions under�s 8ord,wl�id�ev�oa:ws
r�sona6le pampbt�uderlhe�oes: fest If fhe pravisions of this Paragraph are void or
proh�ed by law.the minm�un period of hmdaion avail-
�at noa�r�3u.�ean iuo r��r�.oe��ea�..aa n332�is84 2
THE AM6tlGM ai5i1111iE OF�i7351ffY1►Yolilc JqIE.lLrC Yl�i ,�2oo0G
�
able to sureties as a defense in the jurisdiction af ihe� have been made i�dudix� a�ow�oe to �e
shaU be�pHc�le. C.ontradnr of any amour�.s EeoeiMed � b be
reoeived by tt�e Owner�se�r�ent of insuranoe or
10 No6oe io ine su�y,the owner or the cor�rac�or shae �dazns ior aamages t��the conitar.�or's
be maled or deivered �o the addeess sha+Mn an U�e �. red��oed b�r a� vaid ar�d P�P�P��
���� tnade b or ort 6e-[�f�46e Ca�acbor ta�der tf�e
Corutruction Contrad
11 Wf�en ihis BaK!t�as been fu�sf�ed�u aanply with a 122 Conshtx�ion Corrtract The ag�errient betvveen
sFa�ory or a�(egat r�►t in the bcation where the Owner and the Corfiacbr iderfi6ed on Uie sig—
�e oonshv�fion was fio be P�. �Y P�� � rrabure page, induding a1 Contrad Documerds and
fhis Borxi oonflicUng wifh said slatt�ory or legal ��.
requirernent straY be deemed deleied herefrom and
P�� ���9 �o sud� slaWbry or a�her I�a! 123 Cor�rac�or Defa�t Fa�ae af the Co�racUor,
�r�t shai be deemed inoorporaied herem_ The wt�id� F�as r�her been remedied nor Yraived, fio
in6eErt"s it�at�is BoExf sha!be onr�true�as a stalutory P��or olh�w"se b oanp(y with the ferms of ihe
ba�d and not as a canrrion law bond_ Cor�x�on Corfi-act
12 DEFlNI710NS 724 Owner Ddault Failure of fhe Owner;whid�has
i2i Balanoe�the Contrad Prio�The t�otai anar�t r�bea�reme�cd nor waired,b pa�►the Can-
P�ll'� dY U�e Owr�er�o the Cor�rac�or �aider�e �'aclor as requied by�e Ca�lnidon taoniract or b
Cons�io�t Co�'ac�a�er � ptoper �ustrnenls ��d con�or contpfy we��e other ierrns
thereof.
i10DIPx'.A710NS'�71lS H01iD J1RE Je1S Fa1L011�
NONE
(Space is prorided belaw tor add�ional sig�res oF added parties,dher 8�an ttase appearirg an me oouer Page-)
CONiRACTOR AS PR�IC.IPAL SURE7Y
�Pa�Y �P��Y
(�P�'��l (CaPa'ate Seall
�= �=
N�ne ard 7 rtle: Narne and l�le:
Add� Address:
aa ooanr�rr ass2.��ar�w►rr�xr eorr�.oesa�s9sa�_.�u►s �32�i9�4 3
n�n�o�smureoFu�arec�s.ir�s�rraa�wvE,.Kw.vr�wm�croN.a�a000�
THE AMERlCAN INSTITUTE QF ARCHCfECTS
a��. ��
AfA Dnc�u�tA3�2
Payment Bond
����c�s�n,o�aoa���,�t��a���r,�.
CDN�RAC70R�+lanre and/1ddr�sJ: SURETY(Name and Plnnapal Place af B�sr
N�Ke�eY F�m�t Co�Y,Inc- Menchao�s Bond"mg ComP�Y�M�)
41 Na�th Spngg Sireet 2100 Flc�er Drive
Cape C�rard�u, MO 63701 Des I►�toi� Ip Sp321
Tel:573-334-0553
Q'WN�t(Name ard Ad�e�_ Te�L 515-243-8I7t
(Sty of Cape G�
401 Indep�de�oe Street -
Cape G�n, MO 63701
COIYTRA�C.T
Date: /-}UC-r U ST l� �C�/�'
/trnoiu� 5576,630_00 �
D�son�pban(Na�r�e�d Lo[a�on)_Cape Roc�rtPeacyville Ro�d .
Bom�er Pamp Stdtion�d Ge�aRor ,�, .-
$ONQ P[ojei.�tNo_6tT7 - ^'�
o�ate{Notea�tlwn c�ar�structioo ca�raa E�a�ek /� Z�Gr vY, �`�� �t.G J�` �
M�axrt:5576,630.00 .'- �
Mod�tior�s b this : O None �t_See PaBe 6 -
-- ;
� �
CON(RK.IUR J�S SElREIY � :��,�;f.. ;''
(cor�o��se� CamPa��r '<�S�D.��"
::.
�� co nr�r,nac. ���y tM�) :�
Te1:sl 3--8171� �� ,rs:;�t���
,'f �E e�+�'�" / � J
� '. ���: � o�or�---
� � ,� u T� �e [�e�Ti�D�idLW�
;:( � . �� Ai�om�.y��act
�...�
� � `` � `" Bond Si ed and Sealed this 5th da of Au t, 2015
, ,U�ny addibonai sigra-a(ures , on pa�e 6) 9n Y 9�
' but left undated at the rec�uest of the Owner.
��'�+�iOI�f�S ��UAtt�Y—lyau�Ad3ess andTe�ept+o�ef
11�G0�ifrpi�'B� iOWt�'S #Aarbie�6�aeaiore�i�er
! ;, P�Yk
��g
22 Avocado Ttee Cude
St,Pe�s, MO 63375
TeL-314374-0589
�►ooawiarr�-re�a�r+��n�uo een�,e�rr q�o•oem��ea iess�•�ea•
��u�aecnw camurf oF�nsns. �r3s�r�ec wrE,rir+c.�o_c moob �1�19i4 4
i The Ca�a�aex# 1F�e �. �r and severally, 5 If a ratice requir+ed by Paragra�h 4 is given by the
bid �efres� � heis. �a�ors, adminis�rator, Owner�o the Contractor or to the Surety,that is su�iCient
suoo�sws and �is b 9�e Ormer io pray for labor, �mP�-
rnaie�als and ecpipment fisrrstied ior t�e o fhe 6 1Nt�en ihe C�a�nard l�as sa�ed ihe oo�or�s c�F
p�in��no� af �,e c;a�ir� cai�ac� whid� is p�,a,�e suei�►s�pomptly and a��,e Sti.eiys
�P�'��b7l�- ��se taiae fie foiuw"s�g ac6o«
2 Vl�h�to the Owner,this ab6ga6on s�ra9 be ra� 6_1 Se�d an��o fhe qa�nank w�h a oopy�
and void�the ConUactor ihe Orvner,w�hin 45 days af�er reoeipf of tt�e da�n,
21 Promp�► makes payrt�. �► or Er�y. �9 the arrrounls that are und'�spu�ed �d 1he
tor at suns�,e c�.and basis for d�anenging any amour�s that are a�sputed-
2.2 Defends. indemnities. and holds harrnless the 6.2 Pay or arrange fw payment of any undi�ed
Owner from all daons,dernands,6ens or st9its bY�Y amo�r�
person or erHity who fumished habor, ma� or 7 The Suely's �oFal obig�m sha� �wt �eed the
equiprr�ent ior use i� the � of B�e amoiurt of this Borid,and U�e amourrt of�tis Bond sha1F be
Cor�nicfion Cantract. P�ovided ihe O+�rner F�as
pramptl�► nol�ed�e Cantr"acior and U�e Sureiy (at aedfied f�r any paymenFs made in c�ood failh by U�e
U�e add�ess desa�bed � Paragraph 12) of a�ry �Y-
dams,d�.i�s or su�and�erde�ed dei�se 8�ared by fl�e Oama Eo fhe Cor�tracior�
of such dams, demands. liens or suiLs b �e !fe �o Cr�tad si� be �ed far fie
Ca�arior and!�e S�aod po+iided�x�e s ro perfoe�woe aF f�e CanslndQ�Cani-arf ad io sai�si�
Oaier DeEa� des�ka�y,nr�des as�Q�rac�rr P�Ibr�nce BonEi
By ihe Contractior fum'shing and the Owner aooep�ng tltis
3 Wdh resped to Claunards,this obligation shall be null �,�Y�tt�at all funds eamed by 1he Contractor
and vad if the CoMractor prompty makes �rnerrt, io !he perfiom�ar�oe of �e Cor�ucbor� Cor�rad ar+e
diredl�r or�diredty,for ad sums due_ ded�ed�o s�►abigatior�s af�e Conh-ac�or aod�e
S�t u�der tlrs Bond.subject�o tl�e Owne�s prioriE�l�o
4 The Surety shal have no obGgation to qa�nards u�der ise 8�e i�nds for�e aompl�on of�e wak
this Bond urr61_
4.1 ClainaMs who are employed by or hav�e a dired 9 The S�ety shad not be liable fio 1he Owner, CNaimarrls
oonUact with the Con6-ac�or have given natioe�the or alhers for ob�igations of the Contr-acbr that are
Surety(at the address descnbed in Parag�ph 12) unre�a�ed to fhe Construdion Confirad The Owr�er shall
and sent a c�py, or no6oe thereof, � the Owner. rwt be tiable for paymeM of arry aosls or e�er�es of arry
stating that a daim is being made under #his Bond Claimarrt urxier this Bond,and shaN have under this Bond
and, wifh su�tial aawraq, U�e amourrt of Uie no ob6gations bo rtiake paymenls to, giv�e no�tioes on
�� behalF of, or ofherrvise ha+re obGgations tio Clairnarris
42(�who do not hare a dsect oo�a�wdh u�eier this Ba�d
ihe Ca�trac�or. 10 The Slaely he�r� wai�es nolioe of an�/ d�g�
.1 Have fumished Mrtit�en natio�to 1he Cocdracior �rg d�ages af�ne.to the Construe5on Co�rad ar
and sent a cop�r, or rw6oe tt�eneof, b the � �ai�d s�boa�rads, pud�e a�ders and alher
Owner, wilhin 90 days afier having last per- ��
fom�ed labor or last fumished ma�1s ar
equ��t"s�ckded 's��e daien sf-aTing. w�lh 11 No s�vr ac�on shaA be carrnr+enced by a�rit
s��star�a!aocuag,the amou�t of ffie dain uoder�is Bad c�iE��a�t i�►a caxt of c�np���isr
and�e narne aF ihe party!o whorn i�e nraiFx- tic�'s��e for.a�on�vrhidti fhe wwi�or pa�t a�tl�e wak
ia1.s vrere furri�shed or suppTied or for whom is localed ar a�er�e�d�on af a�oe year iom�e dale
the labor was done or perfortned; and {1)on which 8�e Claimant gave 8�e tw5oe re4�'��'Y
� S�agraph 4_1 or qause 4_23. a(2)on which ihe
2 Ha�re etlher�eoeived a[eje�on�whole or in last labor or servioe was per6amed�►anyone or the last
patf f[aet S�te E�acbr,or�tait�eoeived witl�in ma�or equQmerrt were fumished by anyone under
30 days oF iunshe�g 8�e abvYe notioe anY ihe Constniction CoMract. Mfiid�ever of(1)or(2)first
oomrm�r�a6on irom the Contrac�r by vfiich oc�a� ��e p�ioas �€�ris Pa[agraph ate �ooii3 or
the Conlracxor ha�s u�dicated the daum w�be p�� � iar, �e miiinun period aF fnia6on
paid diredly or s�dredly;and avaiabie b s�e6es as a de�s�fie p�is�an vF�e
_3 Nd Md�viEg been p�d wU�in�e aboYe 30 days. suit st�be�ble-
hare sent a wrifen na5oe io�e�ety(at the 12 Notioe to the Surety,tt�e ONrtier or the C.ontrac�or shaH
ad�ess desa�ed i�P�agraph 12) and sent be ma�led or deiv�ered to the address shown on the
a c�op�r.or no6oe tlie�b�e Or��x,�atin9 signature page_ Aahial reoeipt � naAioe by Suretp, the
ifr�a c�ain"s beig made snda�s Bond and Owner or the Contracbr.however a000rr�,strall be
endosi�g a c�ap�r of fie previ�ous wr�.ten no6oe � �p6anoe as of the date reoeived at the
fimshed b fie CanU-ac�or_ address sfw�wn on fhe signature page-
�►oocaar�t2.re�o�ea�No r,��r�rr eo�.oec�eet�sa ea.nw• 1�i2-i984 5
'Ii�A�ilI�lfY6ifliREOFARt1�E�l5.17351BIY70RKA11�IlW W/IS�IGi011,D.G 20006
.
13 Vllhen this Bond has bcen fumisF�ed to cor��ply w�a The i�ient af tl�is Baw! st� be t� id�d� wiho�#
staWbry a other legal requirernerrt in the bcatio�t�ri�e iciafiort�fie iesms'tai�ac,a�aieria[s ar equQma�C
fhe aor�on was t� be P�. �Y Pravis+on in 1ha# part of � gas, Power, ig� he� oi,
�is Bond oonfficUrg vwtl� s�aid shadtbory ar legd! �of��pl�one seEErice ar�a�at equi�rt�r.�eet
�ent sMaY be deemed deleted f� a�d o f�e � Cad� a�diadQal aod
P� �9 � � �ory or afier tegal �gr�rig senioes rsq�i�d for Pai�a�c�e t�Ffie
req�e�r�ent st� be deemed i�oorporaied he�ein_ The work of the Corrlrac�or and the Contrac�or's
i�lent"s th�Urs Bad�6e aor�slniad as a�► suboor�a�ors. and ai ather �tems for whid� a
bond and not as a oomet�ort iaw bond_ med�arrids ien rnay be assertied in 1he jte�on
wtrere Y�e fabor; rnaie�rials ar eqiipment weie
14 Upon request by any person or e�►appea�ig b be fun"shed
a pofenUal beneficiary of this Bond, the Contr-a�io�r stra� 152 Cor�s6uc�on Cantract The a�t beiween
promplly fimish a aopy af ttas Bw�d or st�perm�a oopy 4�e Owner and fhe Corttracbor idenh7ed on ihe
b be r�de_
signah�►e page, indudng all Contract
Doam�ts and d�ange.s�,
15 DEFlNITIONS
15_1 Claimant M irxl"nridual or a dred 15_3 Owner Default Faise af fie Owner,vrfiidi f�as
���9 neitl�er been rgneded nor Yrai�ed, b psy �e
oo�sad vr�!he Ca�or or wifh a suboo�ntrac:br af �-������the Canslnic�on Cadrad
U�e Cm�trac#or �o fimesh lat�or, ma� nf �b,������y��e cAf�er
eq[i�far e��fie perfo�anoe oE�e Cor�-act ��therea�
MODIF1CAl10NS TO TI�S BOf�D A�AS FOLLOVYS:
Sectioa 6 is mocfified by sddmg section 63.
63 Ihe S�elp's far'teae to d�.vc�ge i1s obtiga�ns�da this Seaion 6 shall not be�ed to oons�tube a waiver of
defenses the S�e#y or C�tract+�r may have or aoc�re as b a c�im Howe�►er,if 16e S�uety fm�ts tn�its
obligations�md�this Sedion 6,the S�uely shafl md�ify t6e C��or 1Le�asaoablc�ey"s fe�s thc C7a�
inpus to recova any s�s fo�md to be�e and owiog�the C�
NONE
. (S�►aoe"s pro�itl��ow far ad�ral sig��f added par6es,a�er�an tha5e appea�:y on B�e c�a�er�age)
�c€a�ws e� su�rY
� ��
�c«��s�9 (��s�
S5� S'i9nature:
N�e ad Ti� Narie�d Fi�
Addres� Add�s
wu oo�rxtz2.�eaQ�Par�reao.n�ees9esm.�ws
Sl�AI�Ob�1[ttiEOfABp4i�f5k3.T�1�Al1fON1[IiV�1L11L MR4■6701�DC 20006 A31�1984 6
Y
� MERC�-�ANTS��
BONDING COMPANY.�
PE)1lItER OF ATTORNEY
�c�o.n.e��r n�e�a�r��eo�oar�nr���a�r�€����ecx��,
�.,,ia�I�o�r�i'i6i�sa�i a�Jerthe ta�rs af ffie sfare af�o.ia pae:�aafe�rely�afed u�e-co�a�ies�,
ad t�at�e C�do lae6j�����ai a�i�iir��
Donald L VlFasoba
of st Pe�s ana sta�e or M�o�i n�m,e ana I�r6W n�mme�e�Fa�wiu,t�pow�
and auNwrdyr he�eby conferred'e�tf�marne,pface�d s�ead,to sign,�e.adv�owledge and defnrer rt�fheQ be�halF as s�ae�y
arry and a1 bmds,iaMerha��8s.reoogr�ar�s or ofher wr�en abigations in ffie natiae tl�ereof,subjed to tlie fnni�lion it�arry
such nsfiar�nt s#�not e��e art�ard afi
TWO MILLION(S?.�80�,000.00)DOLLARS
and to bind ihe Campanies the�eby as Tu�►and m ihe same e��erR as iF sud�bond ar undertaldng was signed by Uie duly
aulhor¢ed oificers oF the Comp-anie.s,and aN the xts of said Atlomeyln-Fad, pwsuant tio the authority herein given,are
hereby raiified and�_
Tt+a Pawef-o�/4�oraey's made and e�a�d pias�a�t�a�d b�i a�hai�af ihe fdor�i9 B]F�-�s ado� bY f�e Boer+d oF
D"iecins af t�e Yer�hais Bandn9 Compar7(Mu�d)ate Apri 23,2011 and adopl�d by fie Board�D"rectns of M�i�ariai
BaMi�9.t'�c.an Oc�i24,2011_
9Le P�dat,S�ry,Tie�aa,ar aey�t T�or�ry/4�t SeFsefaY ar ae�Vioe P�eadeet sEra!E�e
P���a�Y����and to a�me�n b e�aeaie m 6ei�af 9�e CanQay,ad aead�t�e
s�l of tt�e Cortipany tl�e�e6o,borMs and urda�lu�gs,�r�s,aor�Yads d�mi�►ad aiheriwifgs ahi�ry i�
ffie naihre thereaf.
The signahre of�y��ltwraed oif��d ihe s�i aF�e Caapary rrray be a�d by f�nie u eie�aric�a�o�n b
ary Porier af Aflome�►ar Caii�an f�e�eof a�a�aig ihe�afan ard d�ar af a'16ad.u�d�1��9.�i¢-a�oe,
ar oC�svetystip a6ig��s af ffi Campany.ad sud�sigrt�e anQ seat r�hen su�sed s�i have i�e same forae and
edfed as ihoegh ma��r fu�d_•
In VYR�r�ss�AR�f,ifie Com�panies ftave causad fhis ir�trtnr�n[to be signed and sealed this 1�daY of August .2014.
.rrw.,,,_ ��•••_••••.
gt�.�_�y�' ���►0��'� A: YERC�IANiS BONDING(�MP/WY(MUiUA�
���do"•_ :0°;oRPo9'�y: �arrrs w►T�BONoiNc,�Nc.
•`� .^:y° .c�. C� .+:<�
��=� -i►- iD=G; •�—:_ -o- o'3
z�jz 2(2�3 :.�= yJ. 1933 _�y; �
�.�,�-�....�;,`a� '� :d'�j�,• •-�'�'�' ��
STATE OF IOWA �� �r •
COl1NTY OF POLK ss. •�•••••�• p��y�
On tles 13�da�/oF August 2014,befae me appeared LaRy Taylor,to me persar�y lu�own.who bei�g by me dt�y sxran dd
say n,art r���or me M�xci-u�rrrs eoNoa�c co�a�nr�rrun���a n�exca-inrrrs w►noww�r�.wc.:�a
that nie seaLs affo�d m tl�e faegocg nsfi,nerR is tt�e corpora�e sea�oFo�e ca�;and 1ha�n�e said ir�rnenrt was�and
sealed ii behalF oF ffie Comparres by�Y of 1Mea r�ve Boetds d OQectors_
6i Tesbmorry Vllhereo�I have I�eunb set my Mand and afl'oaed my Olbdal S�I art tl�e Gtily of Des Moines,�or►a,tl�e day�d y�r
first aboye r�Len.
�8 WEND�f WOODY
Z�� Commission Nurr�x 784fi54
My CoQunission Ex�es
June 2(! 2t)37
�����
STATE OF IOWA
COUWTY OF POL.K ss.
1, V11�am VVarner..Ir_,Seae4a�y of tl�e M�iq-IAMTS BONDIIJ�COMPANY(MUTUAL)�d I�R(�iANTS NAIIONAL BONDING,INC.,
do hereby oertify U�aR the abwe a�d Toregoig is a true and aorted copy�Vie POYYE72#-ATTORNEY eze�a�d by said Comparies,
w�idi is sti n fi�foroe and e�fed ard t�as naR been amended ar�evol�d
In V11f�ness VllF�ereof,l have f�ere�a�set my har�d and a�ced the seal af the Ca�ies on
� lq,��►� �v����' �0�5. .,.......
Pawer of Attorney attach *t10N{� � ;�p�_�1�rA: _
to Bond and Sealed this;,�:�oR4�mp� :�o�p�tPO�p;�_�• h��G�� _/
5th day of August, 201�,�.� �?�_ ;�:r _o_ .*: ; �'� ����''��. �_
but left undated at th�a' 'a =�' '`: �r'3• seaerary - _
:�s • 1933 :c•
request of the Owner. ��i� ZQ+�3 =•`�, =y�- -v=
�0��4�r���? �.��y,~---..N�.�,� r+ �'-6��"��"�'`�c �.
� • : .. - .
......
�►co� CERTIFICATE OF LIABILITY INSURANCE �TE�MNUDD/YYYY)
`.� 8/5/2015
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
CER7IFICATE DOES NOT AFFIRMATiVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BEI.OW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGATION IS WANED,subject to
the terms and conditions of the policy,certafn policies may require an endorsement. A statement on this certiflcate does not confer rights to the
certiflcate holder in Ileu of such endorsement(s).
PRODUCER �M ACT T@S1A8 Dillahay
CBj�it81 IASII=dI1C@ 6 Associates PHONE , (573)335-2300 � No:(573)335-0117
326 South Broadvie�v ADp��s.terina@capitalinsagency.com
P.O. BOx 1779 INSURE S AFFORDINGCOVERAGE NAICN
Cape Girardeau MO 63703 INSURERAAMCO Iasurance Com aa 19100
INSURED iNsu�R e 3dissouri lo ers Mutual Insurance 1�M
NIP KELLY EQIIIP2�NT CO INC INsurtErtcNationwide Mutal Ias Co 23787
PO BO% 33 INSURER D:
INSURER E:
CAPE GIRARDEAII MO 63702-0033 INSURERF:
COVERAGES CERTIFICATE NUMBER�ev Master 2015/2016 REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED. NOTIMTHSTANDING ,4NY 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 POLICtES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
��� TYPE OF INSURANCE A OL BR ppUCY NUMBER M�p��F M�LICY EXP UMITS
R COMMERCUIL GENERAL LIABILITY EACH OCCURRENCE S 1,000,000
A CLAIMS-MADE �OCCUR PR MISE Ea ocwrtance S 100,000
ACPGLD07182738259 7/23/2015 7/23/2016 MED EXP(Any one person) $ 5,000
PERSONALBADVINJURY $ 1,000,000
GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000
R POLICY❑jE a �LOC PRODUCTS-COMP/OP AGG S 2,000,000
OTHER: Schedule Mod Factor 1 S
AUTOMO&LE LIA91L1TY MBINED SINGLE LIMI g 1,000,000
Ea acddent
A x ANY AUTO BODILY INJURY(Per p�son) $
ALLOWNED SCHEDULED p�pgy�p,�182738259 7/23/2015 7/23/2016 BODILYINJURY Peraccident 5
AUTOS AUTOS � �
NON-0WNED PROPERTY DAMAGE
HIREDAUTOS AIITOS PeraccideM $
Underirxured motorist $ 100,000
R UMBRELLA IIAB pCCUR EACH OCCURRENCE $ 4 000 000
A EXCESS LIAB CLAIMS-MADE AGGREGATE $
DED x RETENTIONS 10 000 �7162738259 7/23/2015 7/23/2016 y
WORKERS COMPENSATION x PER OTH-
AND EMPLOYERS'LIABILITY Y�N STATUTE ER
ANY PROPRIETORlPARTNER/IXECUTIVE ❑ N�A E.L EACH ACCIDENT $ 1 000 000
OFFICER/MEMBER EXCLUDED9
B (Mandatory in NH) MEM 0509977-12 6/6/2015 6/6/2016 E.l.DISEASE-EA EMPLOYE S 1 000 000
If yes,descnbe under
DESCRtPT10N OF OPERATIONS below E.L.DISEASE-POLICY L1M�T S 1 000 000
C Inatallation Floater ACPCIl17182736259 7/23/2015 7/23/2016 Limit 393,000
DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES �ACORD 101,Addkfonal Remarks Schedule,may be attacAed H more apace is requlred)
CERTIFICATE HOLDER CANCELLATION
(573)339-6303
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
City Of Cape Girardeau THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
Job� Cape Rock/Perryville Road ACCORDANCE WITH THE POLICY PROVISIONS.
Booster Pump Station
401 Independence Street AUTHOR¢EDREPRESENTAl1VE
Cape Girardeau, MO 63701
Chris Gross/TERINA �-"a � ��''�`�
OO 1988-2014 ACORD CORPORATION. Ail rights reserved.
ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD
INS025 r�oimi i
COMMERCtAL GENERAL LIABILITY �
CG 71 57 0910
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ',
ADDfTIONA! INSURED - OWNERS, LESSEES OR CONTRACTORS '
AUTOMATIC STATUS WHEN REQUIRED IN CONSTRUCTION CONTRACT
PRIMARY AND NON-CONTRfBUTORY
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART `
A. Section H - Who is An Insured 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 perfarming 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, architectural or
organization be added as an additional insured on engineering activities.
your policy. Such person or organization is an ad- 2, "godily injury" or "property damage" occurring
ditional insured only with respect to liability for"bo- after:
dily injury", "property damage" or "personal and
advertising injury"arising out of, in whole or in part, a. All work, including materials, parts or
►�y: equipment furnished in connection with
1. Your acts or omissions; or such work, on the project (other than ser-
vice, maintenance or repairs) to be per-
2. The acts or omissions of those acting on your formed by or on behalf of the additional in-
behalf; sured(s) at the location 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
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 liability arising out of the "products- D. With respect to the insurance afforded to these '
completed operations hazard". additional insureds, Condition 4. Other Insurance ,
B. The fo{lowing is added to SECTION III— LIMITS of Section IV — Commerciai General Liability
OF INSURANCE: Conditions is replaced by the foliowing:
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 the 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 respect to the insurance afforded to these with all that other insurance as de-
additional insureds, the following additional exclu- scribed in c. below;or ,
sions apply: (2) The coverage afforded by this insur-
This insurance does not apply to: ance is primary and non-contributory
1. "Bodily injury", "property damage" or "personal with the additional insured's own insur-
and advertising injury" arising out of the ren ance.
dering of, or the failure to render, any profes-
sianal architectural, engineering or surveying
services, including:
CG 71 57 09 10 Includes copyrighted material of Insurance Services Office, Inc. Page 1 of 2
with its permission.
CG 71 57 09 10
Paragraphs (1) and (2) do not apply to (2) When this insurance is excess, we will
other insurance to which the additional have no duty under Coverages A or B
insured has been added as an addi- 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
b. Excess Insurance that "suiY'. If no other insurer defends,
This insurance is excess over: We W��� undertake to do so, but we will
(1) Any of the other insurance, whether be entitled to the additionai insured's
rights against ali those other insurers.
primary, excess, contingent or on any (3) When this insurance is excess over
other basis: other insurance, we will pay only our
{a) That is Fire, Extended Coverage, share of the amount of the loss, if any,
Builder's Risk, Installation Risk or that exceeds the sum of:
similar coverage for"your work"; (a)The total amount ihat all such other
(b) That is fire, lightning, or explosion insurance would pay for the loss in
insurance for premises rented to the absence of this insurance; and
you or temporarily occupied by you (b) The total of all deductible and self-
with permission of fhe owner; insured amounts under all that other
(c) That is insurance purchased by you insurance.
to cover your liability as a tenant for
"property damage" to premises �4� We will share the remaining loss, if any,
rented to you or temporarily occu- with any other insurance that is not de-
pied by you with permission of the scribed in this Excess insurance provi-
sion and was not bou ht s ecificall to
owner;or apply in excess of the Lim s of insur- '
(d) If 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 Properry If all of the other insurance availabie to
Damage Liability the additional insured permits contribu-
(ej That is any other insurance availa- tion by equal shares, we will follow this
ble to an additional insured under method also. Under this approach each
this endorsement covering liabiliry 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 loss remains, whichever ;.
tions, for which the additional in- comes first.
sured has been added as an If any of the other insurance availabie to
additional insured by that other in- the additional 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
applicabfe limit of insurance to the total
applicabie limits of insurance of all insur-
ers.
All terms and conditions of this policy apply unless modified by this endorsement.
i
Page 2 Of 2 Inc(udes copyrighted material of Insurance Services Office, Inc. CG 71 57 09 10
with its permission.
� �
�
I
POLICY NUMBER: COMMERCIAL GENERAL LIABIU'FY �
CG 71 58 08 04
�
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
WAIVER OF SUBROGAT(ON
AS REQUIRED BY WRITTEN CONTRACT
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
�
Item 8. TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US of SECTION IV—COMMERCIAL �
GENERAL LIABILITY CONDITIONS is replaced by the following:
8. TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US
OR WAIVER OF SUBROGATION AS REQUIRED BY CONTRACT '
a. If the insured has rights to recover a!I or part of any payment we f�ave made under this Coverage Part,
those rights are transferred to us. The insured must do nothing after loss to impair them.At our request,the
insured witl bring "suit"or transfer those rights to us and help us enforce them.
b. If required by a writfen contract executed prior to loss, we waive any right of subrogation we may have
against the contracting person or organization because of payments we make for injury or damage arising
out of your ongoing operations or"your work" done under a contract with that person or organization and
included in the"products-comPleted operations hazard".
All terms and conditfons of this policy apply unfess modified by this endorsement.
i
�
CG 71 58 08 04 Incfudes copyrighted material of Insurance Services Office, Inc.with permission. Page 1 of 1
O ISO Properties, Inc.,2004
. . �
'`��R�� CERTIFICATE OF LIABILITY INSURANCE �T�(MNUDDlYYYY)
e�i��2oi5
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies) must be endorsed. If SUBROGATION IS WAIVED,subject to
the terms and conditlons of the policy,certain policies may require an endorsement. A statement on this certiftwte does�ot confer rights to the
certificate holder in Ileu of such endorsement(s).
PRODUCER �ME T Terina D1118hH]r
Capital Znsurance 6 Associates PHONE . (573)335-2300 F� No:�573)335-0117
326 South Broadview AppR��:teriaa@capitalinsaqency.com
P.O. BOx 1779 INSURE S AFFORqNGCOVERAGE NAIC!!
Cape Girardeau MO 63703 INSURERA:Alli6d Insuraace
INSURED INSURER B:
City of Cape Girardeau iNsuRERC:
401 Independence Street INSURERD:
INSURER E:
Cape Girardeau Mo 63701 INSURERF:
COVERAGES CERTIFICATE NUMBER:OCP - City of Cape REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED. NOTIMTHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR 7YPE OF INSURANCE AD L R POLICY EFF POLICY DCP
L1R POUCY NUMBER MMID MMlDD UMITS
]C COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE a 1,000,000
MAG R N D
CLAIMS-MADE 7[ OCCUR PREMISE Ea accurrance $
THD 8/15/2015 8/15/2016 MED EXP(Any one person) S
PERSONAL 8 ADV INJURY $
GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000
A POLICY❑�C7 �LOC PRODUCTS-CAMP/OP AGG S
OTHER: $
AUTOMOBILE LIABIUTY COMBINED IN LE LIMIT $
Ea acdtlent
ANY AUTO BODILY INJURY(Per person) $
ALL OWNED SCHEDULED BODILY INJURY Peraccident $
AUTOS AUTOS � )
NON-0WNED PROPERTY DAMAGE
H�RED AUTOS q�pg Per aaitlent $
S
UMBRELLA LIAB pCCUR FACH OCCURRENCE $
EXCESS LIAB CLAIMS-MADE AGGREGATE $
DED RETENTION$ $
WORKERS COMPENSATION PER OTH-
AND EMPLOYERS'UABILITY Y f N STATUTE ER
ANY PROPRIETOR/PARTNER/EXECUTIVE ❑ N/A E.L EACH ACCIDENT $
OFFICER/MEMBER EXCLUDED?
(Mandatory in NH) E.L.DISEASE-EA EMPLOYE S
H yes,describe under
DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY UMIT $ �
DESCRIPTION OF OPERATIONS!LOCATIONS!VEHICLES(ACORD 101,Addklonal Remarks Schedulq may be attacAed if more space Is required)
CERTIFICATE HOLDER CANCELLATION
(573)339-6303
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
City of Cape Girardeau THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
Job: Cape Rock/Perryville Road
ACCORDANCE WITH THE POLICY PROVISIONS.
Booster Pump Station
401 Independence Street AUTHORIZEDREPRESENTATIVE
Cape Girardeau, MO 63701
Chris Gross/TERINA �'h''-"'a Q ��
O 1988-2014 ACORD CORPORATION. All rights reserved.
ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD
INS025 r�o�mn