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Res.3078.05-15-2017
BILL NO. 17-71 RESOLUTION NO. 307$ A RESOLUTION AUTHORIZING THE CITY MANAGER TO EXECUTE AN AGREEMENT WITH APEX PAVING CO. , FOR THE 2017 ASPHALT OVERLAY PROGRAM, 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 Apex Paving Co. , for the 2017 Asphalt Overlay Program, 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 15DAY OF „ 2017 . —7 If Harry E. Rediger, Mayor ATTEST: �', Gayle Conrad, City Clerk SWI a: is • eon cy; ; „Edo a. 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CONTRACTOR shall complete all Work as specified or indicated in the Contract Documents. The Work is generally described as follows: The locations for the work to be performed under these Contract Documents are Marlin Drive from Country Club Drive to the Dead End; Landis Drive from E Cape Rock Drive to the Dead End; Ferguson Drive from Big Bend Road to the Dead End; Oak Lane from Green Acres Drive to Roberts Street; Northwoods Court from Main Street to Main Street; Rand Street from E Cape Rock Drive to the End of the Concrete; Spanish Street from Fifth Street to Fourth Street; Alley between Frederick and Middle from Amethyst Street to Emerald Street; Alley between Sprigg and Ranney from Locust Street to Elm Street; Alley between Benton and Pacific from Linden Street to Locust Street;Alley between Pacific and Ellis from William Street to Good Hope Street; Alley between Pacific and Ellis from Independence Street to Themis Street; North Street from Pacific Street to Sprigg Street; Alley between West End and Park from Harmony Street to Broadway; Thilenius Street from Sunset Boulevard to Keller Avenue; Merriwether Street from Sheridan Drive to the Parking Lot Area; Gardenia Lane from Edgewood Drive to the Dead End; Broadview Street from Kiwanis Drive to the End of the Concrete; Rodney Vista Boulevard from East Rodney Drive to Maria Louise Lane; Sharon Drive from Lear Drive to the Dead End; Kingsway Drive from Kurre Lane to the End of the Concrete; Haddock Street from the Dead End to the End of the Concrete; Illinois Avenue from New Madrid Street to Dunklin Street; Bellevue Street from Pacific Street to Houck Place(to be completed by September 1,2017); LaSalle Water Tank Road from Stone Crest to the Water Tank; the Parking Lot located at the 4H Building in Arena Park (to be completed by September 1, 2017); and the Parking Lots located at the Shawnee Park Center. The improvements consist of resurfacing the existing pavement by milling approximately 2 inches off the existing pavement where needed and placing and compacting new hot mix asphalt to result in a 2 inch overlay on the above mentioned streets and removal and replacement of portions of sidewalk, driveways, curb and gutter, adjustment of existing utilities and manholes, establishing new asphalt alleys and parking lots over existing base, constructing new parking lots, in addition to, tree and stump removal as noted for each location, all as described in the contract documents. The streets are located in various areas within the City of Cape Gliardeau, Missouri. A-1 - i 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 Regardless of when the work is begun on this contract, all work shall be completed and ready for final payment on or before October 2, 2017 i 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 Two thousand five hundred dollars $2500.00 for each calendar day that expires after the time specified in paragraph 3.1 until the Work is complete and the CONTRACTOR is ready 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.- 4.2 elow:4.2 For all Unit Price Work, an amount equal to the sum of the established unit price for each separately identified item of Unit Price Work times the estimated quantity of that item as indicated in the bidding documents. TOTAL OF ALL UNIT PRICES: One million thirty one thousand five hundred two dollars and ninety five cents _ ($1,031,502.95) As provided in paragraph 11.9 of the General Conditions estimated quantities are not guaranteed, and determinations of actual quantities and classification are to be made by ENGINEER as provided in paragraph 9.10 of the General Conditions. Unit prices have been computed as provided in paragraph 11.9.2 of the General Conditions. Article 5. PAYMENT PROCEDURES. CONTRACTOR shall submit Applications for Payment in accordance with Article 14 of the General Conditions. Applications for Payment will be processed by ENGINEER as provided in the General Conditions. A-2 ---------------- i 5.1 Progress payments; Retainage. OWNER shall make progress payments on account of the Contract Price on the basis of CONTRACTOR'S Application for Payment as recommended by ENGINEER, on or about the 10th day of each month during construction as provided in paragraphs 5.1.1 and 5.1.2 below. All such payments will be measured by the schedule of values established in paragraph 2.9 of the General Conditions (and in the case of Unit Price Work based on the number of units completed) or, in the event there is no schedule of values, as provided in the General Requirements. 5.1.1 Prior to Substantial Completion, progress payments will be made in an amount equal to the percentage indicated below, but, in each case, less the aggregate of payments 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 ifthe characterand progress of the Work have been satisfactory to OWNER and ENGINEER, OWNER, on recommendation of ENGINEER, maydetermine 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% (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, as agreed to by the OWNER and CONTRACTOR, 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. A-3 f Article 7. CONTRACTOR'S REPRESENTATIONS. In order to induce OWNER to enter into the Agreement, CONTRACTOR makes the following representations: 7.1 CONTRACTOR has examined and carefully studied the Contract Documents (including the Addenda listed in paragraph 8) and the other related data identified in the Bidding Documents, including "technical data". 7.2 CONTRACTOR has visited the site and become familiar with and is satisfied as to the general, local and site conditions that may affect cost, progress, performance and furnishing of the Work. 7.3 CONTRACTOR is familiar with and is satisfied as to all federal, state and local Laws and Regulations that may affect cost, progress, performance and furnishing of the Work. i 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. A-4 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 ji Documents are generally sufficient to indicate and convey understanding of all terms and conditions for performance and furnishing of the Work. i' Article 8. CONTRACT DOCUMENTS. The Contract Documents which comprise the entire agreement between OWNER and CONTRACTOR concerning the Work consist of the following: I 8.1 This Agreement (pages 1 to 7 inclusive). 8.2 Exhibits to this Agreement (pages BF- 1 to BF- 9 , 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 2017 Asphalt Overlay Program . 8.8 Drawings. 8.9 Addenda numbers 1 to 1 , inclusive. 8.10 CONTRACTOR'S Bid (pages BF- 1 to BF- 9 , 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 A-5 ------------ 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, 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 A-6 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. 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 , 20 (which is the Effective Date of the Agreement). OWNER City of Cape Girardeau CONTRACTOR Apex Paving Co. Scott Me a maser Rick Moody, President B . -- By �./l :/v/act [CORP..i 1 S a L] [CORPORPCrE SEAL] Attest Attest craak WSW° Bruce Taylor, D puty City Clerk Sarah Weadon, Asst. Secretary Address for giving notices Address for giving notices 401 Independence Street P 0 Box 637 Cape Girardeau, MO 63703 Cape Girardeau, MO 63702-0637 (If OWNER is a public body, attach License No. evidence of authority to sign and resolution or other documents - Agent for service of process: authorizing exe tion of Agreement. 4-1 itz,• (If CONTRACTOR is corporation, 8,� attach evidence of authority to sign.) ©4 isett� r ,y � + G. ".o - -atea .. e= aara vino.. v./ ' '� a d77pp a�r4Y>''- } A-7 Exhibit ",V E CITY OF CAPE GiRARDEAU 2017 ASPHALT 0 VERLA Y PROGRAM BID FORM (EJCDC 1910-18) (1990) PROJECT IDENTIFICATION. The locations for the work to be performed under these Contract Documents are Marlin Drive from Country Club Drive to the Dead End; Landis Drive from E Cape Rock Drive to the Dead End,Ferguson Drive from Big Bend Road to the Dead End;Oak Lane from Green Acres Drive to Roberts Street;Northwoods Courtfrom Main Street to Main Street,Rand Streetfrom E Cape Rock Drive to the End of the Concrete;Spanish Street from Fifth Street to Fourth Street, Alley between Frederick and Middle from Amethyst Street to Emerald Street; Alley between Sprigg and Ranney from Locust Street to Elm Street; Alley between-Benton and Pacific from Linden Street to Locust Street;Alley between Pacific and Ellis from William Street to Good Hope Street;Ailey between Pacific and Ellis from Independence Street to Themis Street;North Street from Pacihc Street to Sprigg Street,Alley between West End and Park from Harmony Street to Broadway,Thilenius Streetfrom Sunset Boulevard to Keller Avenue, Merriwether Street from Sheridan Drive to the Parking Lot Area, Gardenia Lane from Edge wood Drive to the Dead End;Broadview Street from Kiwanis Drive to the End of the Concrete, Rodney Vista Boulevard from Last Rodney Drive to Maria Louise Lane;Sharon Drive from Lear Drive to the Dead End; Kingsway Drive from Kurre Lane to the End of the Concrete; Haddock Street from the Dead End to the End of the Concrete,Illinois Avenue from New Madrid Street to Dunklin Street,Bellevue Street from Pack Street to Houck Place(to be completed by September 1,2017);LaSalle Water Tank Road from Stone Crest to the Water Tank;the Parking Lot located atthe 4H Building in Arena Park(to be completedby September 1,2017),and the Parking Lots located at the Shawnee Park Center. The improvements consist ofresurfacing the existing pavement by milling approximately 2 inches off the existing pavement where needed and placing and compacting new hot mix asphalt to result in a 2 inch overlay on the above mentioned streets and removal and replacement of portions of sidewalk, driveways, curb and gutter, adjustment of existing utilities and manholes, establishing n e w asph alt alleys and parking lots over existing base, constructing ne w p arking lots, in addition to, tree and stump removal as noted foreach location, all as described in the contract documents. The streets are located in various areas within the City of Cape Girardeau, Missouri. THIS BID IS SUBMITTED TO. CITY OF CAPE GIRARDEAU, MO 401 INDEPENDENCE STREET CAPE GIRARDEAU, MO 63703 1. The undersigned BiDDER proposes and agrees, if the Bid is accepted, to enter into an agreement with OWNER in the form included in the Contract Documents to perform and fumish all Work as specified or indicated in the Contract Documents for the Bid Price and within the Bid Times indicated in this Bid and in accordance with the other terms and conditions of the Contract Documents. BF-1 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 fully set forth in the Agreement, that.- (a) hat.(a) BIDDER has examined and carefully studied the Bidding Documents and the following: Addenda, receipt of all which is hereby acknowledged: (ListAddenda by Addendum Numberand Date) (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 furnishing 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 furnishing 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 maynot 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 forhaving done so) all such additional or 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 BIDDER and safety precautions and programs incident thereto. BIDDER does not consider that any additional 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 tenns and conditions of the Contract Documents. Bl=2 ....:.. ....... i i (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. (f) 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 Contact 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 3 Any questions, comments, or concerns regarding the design of this project should be addressed to Jake GarrardE.i. Cit of Ca e 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 an agreement orrules � tY Y 9 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 foritselfanyadvantage 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 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. • h_ttp://www.uscis.,goy/porfallsite/uscis Q) 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 BF-3 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. 4. BIDDER will complete the Work in accordance with the Contract Documents for the following price(s): UNIT PRICE BID EST TOTAL EST, NO ITEM UNIT QTY. UNIT PRICE PRICE 1 Butt Joint and Spot Milling SY 5761 $ 2 Street Milling SY 11745 $ AS- 3 s3 Type 5 Aggregate Ton 810 $ 1 C3. $ 12- of 4 Alley Preparation Each 7 $ 5,sw."o 5 Parking Lot Preparation Each 3 $ -1, bob. 00 $ 12.1 CDL`) ,cap 6 Liquid Asphalt(Tack Coat) Gallon 5685 $-22 0 $ 7 Asphaltic Concrete Ton 11697 $ 53; S� $ .bg , (2"or 4"BP-2) --- 8 Remove & Replace LF 1523 Concrete Curb& Gutter $ $?f 9 Remove & Replace SY 1355 $ $ Concrete Sidewalk 10 Remove& Replace SY 378 $ Sl. $ $ 0,40 Concrete Driveway 11 ADA Ramp Each 9 $ 4 ©c�' .LSU $_ C , So l. co 12 Adjust Manhole Each 31 $ 2c ,ba $ LQ,2-00, 13 Adjust Valve Each 11 $ S, $� , 14 Full Depth Repair SY 1540 $- S9. $ U b , o,00 15 French Drain System LS 1 $ -1 ,`��' $ 16 Manhole Construction Each 1 $ ,Z00 d� $ C)o , o0 17 12"RCP Stormwater Pipe LF 90 $ 18 Lighting System LS 1 $ °� $ QC ADDENDUM One BF-4 19 Tree Removal Each 17 i 20 Existing Stump Removal Each 2 $ `� . 00 21 Temporary Traffic Control LS 1 $ t [ ,C`' 22 Temporary Erosion Control LS 1 $ t Ouc). ' $ cob TOTAL BID FOR ALL UNIT PRICES $ , 02)1 , 5 of-, AI's �. (Written figure) (Total bid amount is to be shown in both words and figures. In case of discrepancy, the amount shown in words will govern. In case of error in extension, the unit and lump sum prices under each Pay Item will be considered correct, and these sums when properly extended, shall constitute the Bid.) Unit Prices have been computed in accordance with paragraph 11.9.2 of the General Conditions. BIDDER acknowledges that quantities are not guaranteed and final payment will be based on actual quantities determined as provided in the Contract Documents. 5. BIDDER agrees that the Work wil.) -be complete and ready for final payment by October 2, 2017. BIDDER accepts the provisions of the Agreement as to liquidated damages in the event of failure to complete the Work within the time specified in the Agreement. 6. 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) ADDENDUM One BF-5 i (e) The E Verify Program for Unemployment Verification Memorandum of Understanding http://www.uscis.gov/Fles/natiyedocume_n_ts/MOU.p (t) Exhibit Affidavit of OSHA Training (g) Certification Regarding Debarment, Suspension and Other Responsibility Matters is T 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. 8. Communications concerning this Bid shall be addressed to: Name I Address (A(ILIfq&t,i-JT) S3 IQ (a) Performance and Payment Bonding Company Name Li to ► u duo �r���A � Com. Address ?)ci�?� , AgentlPower ofAttomey Name (if used) Address 9. Terms used in the Bid which are defined in the General conditions or Instructions will have the meanings indicated in the General Conditions or Instructions. SUBMITTED on ' 9 , 20_L7. State Contractor License No. 11 7 15 0-5 BF-6 __ IF BIDDER is: An Individual BY (SEAL) (Individual's Name) doing business as Business address: Phone No.: A Partnership By (SEAL) (Finn Name) (General Partner) Business address: Phone No.: A Corporafion BY V e1 d' (SEAL) (Corporation Name) (St #e lof ncorporafion) By Name f Persor Autho ized to Sign) A , VA -(Corporate Seal) ~ � Attest (Secretary) Business address.- 01 ddress: 0 CA A,4-A Phone No.: ` Z3(- j ,T jo k Date of Qualification to do business is BF-7 i A Joint Venture BY (SEAL) (Name) (Address) BY (SEAL) (Name) (Address) Phone Number and Address for receipt of official communications: (Each jointventurermustsign. 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.) BF-8 BREAKDOWN OF WORK FORCE. (Required): 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 following items of work directly without employment of subcontractors: Edo 1 �'l F It is anticipated that the following subcontractors will be employed for work on this project: *SUBCONTRACTORS: (Name of Company) (Type of Work) t1 cX� All subcontractors shall be registered with the Missouri Secretary of State in order to work on this project BF-9 nrxr Company ID Number: THE E-VERIFY MEMORANDUM OF UNDERSTANDING FOR EMPLOYERS ARTICLE I PURPOSE AND AUTHORITY The parties to this agreement are the Department of Homeland Security (DHS) and the (Employer). The purpose of this agreement is to set forth terms and conditions which t e Employer will follow while participating in E-Verify. E-Verify is a program that electronically confirms an employee's eligibility to work in the United States after completion of Form 1-9, Employment Eligibility Verification (Form 1-9).This Memorandum of Understanding (MOU) explains certain features of the E-Verify program and describes specific responsibilities of the Employer, the Social Security Administration (SSA), and DHS, 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). The Federal Acquisition Regulation (FAR) Subpart 22.18, "Employment Eligibility Verification" and Executive Order 12989, as amended, provide authority for Federal contractors and subcontractors (Federal contractor) to use E-Verify to verify the employment eligibility of certain employees working on Federal contracts. ARTICLE 11 RESPONSIBILITIES A. RESPONSIBILITIES OF THE EMPLOYER 1. The Employer agrees to display the following notices supplied by DHS in a prominent place that is clearly visible to prospective employees and ail employees who are to be verified through the system: a. Notice of E-Verify Participation b. Notice of Right to Work 2. The Employer agrees to provide to the SSA and DHS the names,titles, addresses, and telephone numbers of the Employer representatives to be contacted about E-Verify. The Employer also agrees to keep such information current by providing updated information to SSA and DHS whenever the representatives' contact information changes. 3. The Employer agrees to grant E-Verify access only to current employees who need E-Verify access. Employers must promptly terminate an employee's E-Verify access if the employer is separated from the company or no longer needs access to E-Verify. Page 1 of 17 E-Verify MOU for Employers Revision Date 06/01/13 i '� C> SET WA fli ... E-VEP.IFY IS A SE]yV iGB P:ilY3 fy Company ID Number: 188332 Information Required for the E-Verify Program Information relating-to your,Company: Ec mparty Name:Ape-k Company Facility Address; 114 S. SHVer Springs Rd Cape Girardeau,Ma 63701 Company Alternate Address: County or parish: CAPE'GfRARDEAU .-EM01-oyo IdentificatI90 NitmI,er, 43.117450. I i�?r r I ;. rn ricart Industry :Classification Systems Code: 2,37 lParwit Company:'Dotla Companies fnc number of.Employees: 26 to 99 Number oLf Sites Verified for: 26 Are y°cera veri 'rrrg for inorc than i°site- If yes;ptease provift-A'ho nem.. d-for lit eacFr Sfate. . MISSOURI 26 site(s) Page 12 of I3JE-Verify Mou for EmployerjRevision Date 10/29108 At niw'� L n��t Ve i fy- USA.� •4�479 R'~ ',HRSFY [5 F SHR"✓7C_9F DES Company 0 Number:-188332 Wbrin:Ati:an relating to-the Piograxn Ati:rninistratar:(s.)for your Company an poiigy quwgffons or c�petat"r`aii�1 p.rob`Ierns; i`lattie: L}ebbi Rebihsoh Telephone Number:(fit$)434.52i1 Of;34-5 Fax Num r.: .(573)3+32-0931 E-rnail:Address: Are biris_6h@ idtQ-co trn. Page 13 of 13JE Verify MOU for EmployerlRevlsion Date 10M28108 NisrM -verify. - - s-venin in senvr�oz alta Company ID Number: 188332 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 888-464-4218. "'pfo O Apex. Nali'Ee(#�f�ase7ype oY F'rinf) `rifi[e �- , E1 #tonic lly sc 7et _ 02106/2009 sgrfiatare' --- Date ejxar�#ixent-<�of�4etn.elai4d S� t�rlty_1 izt�ificatiara �iv[s:i n "aiaxe.(�lease:7'yp�DrPrfrit)• •.,.. Ti♦!m - &ggod 02106/2009 igiraure Date Page 11 Df 13�EVerify MQU for EmployerlRevision Dato#0129!08 =r ?�•• . EXHIBIT AFFIDAVIT OF OSHA TRAINING COMES NOW(Name} Aas (office Held) of(Company Name/Contractor) _�l P� V A V u),6 and first being duly sworn, on T my oath affirm in connection with the contracted services related to r' A (Project Name) for the duration of the contract,as follows: 1. Contractor shall provide a ten 10 hour Occupational Safety and Health p � ) Administration (OSHA) construction safety program for all employees who will be on-site at the Project. The construction safety program shall include a course in construction safety and health t` that is approved by OSHA or a si]7?ilat program approved by the Missouri Department of Labor and Industrial Relations which is at least as stringent as an approved OSHA program as required by Section 292.675,RSMo. 2. Contractor shall require its on-site employees to complete a construction safety program within sixty (60) days after the date work on the Project commences, as required by Section 292.675,RSMo. 3. Contractor acknowledges and agrees that any of Contractor's employees found on the Project site without documentation of the successful completion of a construction safety program shall be required to produce such documentation within twenty (20) days, or will be subject to removal from the Project. 4. Conttactot shall require all of its Subcontractors to comply with the requirements of Section 292.675,RSMo. 5. Contractor acknowledges that pursuant to Section 292.675, RSMo., Contractor shall forfeit to City as a penalty two thousand five hundred dollars ($2,500.000);plus one hundred dollars ($100A0) for each on-site employee employed by Contractor or its Subcontractor, for each calendar day, or portion thereof, such on-site employee is employed without the construction safety training requited in Section 292.675,RSMo. 6. Contractor acknowledges that violations of Section 292.675, RSMo, and imposition of the penalties described therein shall be investigated and determined by the Missouri Department of Labor and Industrial Relations. T Contractor acknowledges,that in the event that the Missouri Department of Labor and Industrial. Relations has'determined that a violation of Section 292.675, RSMo., has occurred OSHA- 1 and that a penalty shall be assessed, the City,shall withhold and retain all sums and amounts due and owing when snaking payments to Contractor under this Cozutmct FURTHER AFFIANT SAITH NOT. i i IN AFFIRMATION THEREOF, the facts stated above are true and correct (the undersigned understands that false statements made in this filing are subject to the penalties provided in Section 575.040, RSMo.) (name of corporation) By: (name qf officer of corporation and title)- ATTEST: rD &IMVV Secretary(or other officer) I (SEAL OF CORPORATION) STATE OF MISSOURI } ss. COUNTY OF CAPE GIRARDEAU ) On this 4 dap of 2017, before me appeared to zn perso y known,who,b by ine duly'sworn, did say that he/she is the o£ 1 a Missouri Corporation, and that the seal affixed to the forego instrument is the seal of said Corporation, and that the said instrument was signed and sealed in behalf of said Corporation by authority, of its Board of Directors, and acknowledged said instrument to be the free act and deed of said Corporation. IN TESTIMONY WHEREOF, I have hereunto set my band and affixed my official seal, at my office in Cape Girardeau,Missouri,the day&anear rst abovewritten.lic My Commission Expires: VIRGINIA G.Sh�IryryTH STA7t~OF MISSO JRRI Cape Girardeau county Carnmission#15017525 My Commission E 2ts;2/2802019 OSHA-2 i EXHIBIT AFFIDAVIT OF WO RKAUTHORIZATION COMES NOW(N-me) ILL MAPA h as (office Held) _ f&�-'5[ 'cti- , .. of(CompazsyNaroe/Contractor) L and first being duly sworn, on my oath,affirm as follows- 1. i. (Company Name/Contrattoz) 7'I ' ?a V 1 O �6 a is entolled and will continue to patticipate in a federal work authorization pzogtam in respect to einployees that willl-work in connection with the contracted services related to(Project Name) A-5 ?�f3 7 '+/.t for the datatEon of the contract in accordance with RSMo � Chapter 285.530(2). 2. _::I also affirm that(Company Name/Conizactox) _ A 4�. 1�f I� .A6, does not and will not knowingly employ a person who is an unauthoxtized alien in connection with the contract services related to(Project Name)d 011. 10 1 6 I&AIA ., fox the duration of the contract. 3. Attached hereto is documentation af5xtaing Conttactor's enrollment and participation in a federal work authorization program with respect to the employees working in connection with the contracted services. FURTHER AFFIANT'SArM NOT. i ' IN AFFIRMATION THEREOF, the facts stated above are true and correct (the undersigned understands that false statements made in this filing are subject to the penalties provided in Section 575,040,)RSMo.) (name of covontion) T (name f officer of coxporratbo and title) OALL) Mit ATrEsT: Seca (or other o cer) 1 (SEAL OF CORPORATION I STATE OF bMSOURI ss. COUNTY'OF CAPE GRUMDEAU i OIL this dap of , 2fl before me appeased to exsaawn,wha,bdnjLby me dulp sworn,dial sap that he/she is the of_ f SC +/t 111 a Mtssouti Cotpotation, and that the seal armed to the fozegoing t is the seal of said Cozpotation, and that the said iLstmment was sigt ed amd sealed in behalf of said Cotpotatiom by authority of its Boatel of Dirmtots, and acknowledged said itistn=e>at to be the ffee act and decd of said.Cotpotat ton. IN TF-S`t"IMONY WBEREOF,I have hcmmto.set my hand and affixed my official seal,at my office in Cape Crlta.tdeau,Nhssouti;the dap and7cas fast above written. Notary blic VIRGINIA C.SMITH Notary Public-Notary Seal MCotntnissiOA fifes: STAT OF MISSOURI y � Cape Girardeau Coun Commission.#150175 5 "LAW 6 My Commission Expires;2/2812019 ANNUAL WORKER ELIGIBILITY VERIFICATION AFFIDAVIT (for joint ventures,a separate affidavit is required for each business entity) STATE OF ) ss COUNTY OF Cape Girardeau On the 3rd day of January ,20 17,before me appeared Rick Moody Affiant name personally known to me or proved to me on the basis of satisfactory evidence to be a person whose name is subscribed to this affidavit,who being by me duly sworn,stated as follows: • I, the Affiant, am of sound mind, capable of making this affidavit, and personally certify the facts herein stated,as required by Section 285.530,RSMo,to enter into any contract agreement with the state to perform any job,task, employment, labor,personal services,or any other activity for which compensation is provided, expected,or due,including but not limited to all activities conducted by business entities. • 1, the Affiant, am the President: of Apex Paving Co. and I am duly title business'name authorized,directed,and/or empowered to act officially and properly on behalf of this business entity. • I, the Afflant, hereby affirm and warrant that the aforementioned business entity is enrolled in a federal work authorization program operated by the United States Department of Homeland Security, and the aforementioned business entity shall participate in said program to verify the employment eligibility of newly hired employees working in connection with any services contracted by the Missouri Highways and Transportation Commission (MHTC). I have attached documentation to this affidavit to evidence enrolimenb'participation by the aforementioned business entity in a federal work authorization program,as required by Section 285.530,RSMo. • 1, the Affiant, also hereby affirm and warrant that the aforementioned business entity does not and shall not knowingly employ, in connection with any services contracted by MHTC, any alien who does not have the legal right or authorization under federal law to work in the United States,as defined in 8 U.S.C.§ 1324a(h)(3). • 1, the Affiant, am aware and recognize that, unless certain contract and affidavit conditions are satisfied pursuant to Section 285.530, RSMo, the aforementioned business entity may be held liable under Sections 285.525 though 285.550, RSMo, for subcontractors that knowingly employ or continue to employ any unauthorized alien to work within the state of Missouri. • I, the Affiant, acknowledge that I am signing this affidavit as a free act and deed of the aforementioned business entity and not under duress. Affiant Signatur Subscribed and sworn to before me in Cape Girardeau , M0,the day and year first above-written. city(or county}. state M UaLh t 0 5 C&A) Nota Public My commission expires: February 28, 2019 (documentation of enrollmentlparticipation in a federal work authorization program attached) VIRGINIA G.SMITH Nota Public-Notary Seat STATE OF MISSOURI Cape Girardeau County Commission#1501755 My Commission Expires:212812o19 I i CIT CAPE ! G M R A R D ' E A U Certification Regarding Debarment, ,Suspension. and Other Responsibility Matters i The contractor hereby certifies to the best of its knowledge and belief and that it and its principals and its subcontractors and their principals: (a) Are not presently debarred,suspended,proposed for debarment, declared ineligible or voluntarily excluded from covered transactions by any Federal or State department or agency, ' } r iE (b) Have nof-�vithin a three(3)year period preceding this proposal been convicted of or hada civil judgment rendered against them for commission of fraud or a criminal offense n ' connection with obtaining,attempting to obtain or performing a public(Federal, State or E Local)transaction or contract ander a public transaction;violation of Federal or State antitrust. statutes or commission of embezzlement,theft,forgery,bribery,falsification or destruction of records,making false statements or receiving stolen property; (c) Are not presently indicted for or otherwise criminally or civilly charged by a government _ entity(Federal, State or Local)with commission of any of the offenses enumerated in paragraph(1)(b)of this certification, and _ (d.) Have not within a three-year period preceding this subcontract had one or more public transactions(Federal, State or Local)terminated for cause or default. I understand that a false statement on this certification may be grounds for rejection of this contractor or termination of the contract. In addition,under 18 USC See,1001,a false statement may result in a fine of up to$1.0,000 or imprisonment for up to five(5)years or both. f Typed Namc&Title of Authorized Representative Signature of Authorized Representative Date ❑ 1 am unable to certify to the above statement. My explanation is attached. Dvcument A310 T - 2010 Conforms with The American Institute of Architects AIA Document 310 Bid Bond CONTRACTOR: SURETY: O%Me,legal status and address} (Name,legal status and principal plate r f htcsrnavr} Liberty Mutual Insurance Company Apex Paving Co. 175 Berkeley Street PO Box 637 Boston, MA 02116 This document has important legal consequences.Consu[#anon Cape Girardeau, MO 63702-0637 Mailing Address for Notices with an attorney is encouraged 175 Berkeley Street with respect to its completion or OWNER: y modification. (Name.legalslat tisandaddr=) Boston, MA 02116 Any singular reference to City of Cape Girardeau, MO Contractor,Surety,Owner or 401 Independence other party shall be considered P plural where applicable. Cape Girardeau, MO 63703 BONDAMOUNT' 5% Five Percent of Amount Bid PROJECT: (Name,location oraddmss;andProjectn mrber,ifar{ty City of Cape Asphalt Overlay Program The Contractor and Surety arc bound to the Owner in the amount set forth above,for the payment of which the Contractor and Surety bind themselves,their heirs,executors,administrators,successors and assigns,jointly and severally,as provided herein.The conditions of this Bond are such that if the Owner accepts the bid of the Contractor within the time specified in the bid documents,or%Atliin such time period as may be agreed to by the 0xvner and Contractor,and the Contractor either(1)enters into a contract with the Owner in accordance with the terms of such bid,and gives such bond or bonds as may be specified in the bidding or Contract Documents,with a surety admitted in the jurisdiction of the Project and othemise acceptable to the Otviter,for the faithful perfortnance of such Contract and for the prompt payment of labor and material furnished in the prosecution thereof,or(2)pays to the Owner the difference,not to exceed file amount of this Bond,benveen the amount specified in said bid and such larger amount for which the Owner may in good faith contract with another party to perlorm the work covered by said bid,then this obligation shall be null and void,otherwise to remain in Nil three and ell;ect.The Surety hereby waives any notice ol'an agreement between the Owner and Contractor to extend the lime in which the Ownermay accept(lie bid.Waiver of notice by the Surety shall not apply to any extension exceeding sixty(60)days in the aggregate beyond the lime liar acceptance of bids spectlied in the bid documents;and the Owner and Contractor sliall obtain the Surelys consent for an extension beyond sixty(60)days. If this Bond is issued in connection with a subcontractor's bid to a Contractor,the term Contractor in this Bond shall be dccmed to be Subcontractor and the tern Owner shall be deemed to be Contractor. When this Dond has been furnished to comply with a slalutory or other legal requirement in the location of the Pnijecl anv pniVision`'iii ihis Bond conflicting with said statutory or legal requirement shall be deemed deleted herefrom and provisions confibrnting`o such stalulory or other legal requirement shall be deemed incorporated herein.When so lumished,the intent is lhat4his Mind 11 be c(imtrt ed l,, us a ylatutory bund and not as a common laiv bond. Signed and scaled this 1st day of May, 2017. n . Apex Paving Co. (Prdncipal) SAO:, j l!flnn>ss) Sarah Weado st. SecretaryBy: Rick Moody, President Liberty Mutual Insurance Company nweF) Aiza Lopez (rsle)Aimee R. Perondine Attorney to-Fact S-00541AS$110 J " � '1V� a I THIS POWER OF ATTORNEY IS NOT VALID UNLESS IT IS PRINTED ON RED BACKGROUND. This'Pc wer of Attorney limits the acts of those named herein,and they have no authority to bind the Company except in the manner and to the extent herein stated. Certificate No,7687632 Liberty Mutual Insurance Company The Ohio Casualty Insurance Company West American Insurance Company POWER OF ATTORNEY KNOWN ALL PERSONS BY THESE PRESENTS:That The Ohio Casualty Insurance Company is a corporation duly organized under the laws of the State of New Hampshire,that Liberty Mutual Insurance Company is a corporation duly organized under the laws of the State of Massachusetts, and West American Insurance Company is a corporation duly organized under the laws of the State,of Indiana(herein collectively called the:"Companies"),pursuant to and by authority herein.set forth,does hereby name,constitute and appoint, Aimee R.Perondine•Aiza L.o ez;Rshle SinclairivBrlan Peters;Danfelfe D.Johnson Donna M.Pfaneta•Jenriifer.M iGarton:Joshua Sanford;Keri Ann Smith;Michelle Anne McMahan;-Nicole Ann Clark;Stacy R..fvera;Stephani A_Trudeau - ~' ail of the city of Hartford state Of CT. each 1rldfvldually if[here be mope than one nairied,its true and lawful attorney in:fact.te make,execute,seal,acknowledge and deliver,for and on its behalf as surety and:as its act and.deed any and all undertakings,bonds,r.ecogitizanees and other surety obligations iIn orsuance of these presents and shall be as binding upon the Companies as if they havebeen duly signed by the::president and attested by the secretary of the Corripanies in their own..proper persons, IN WITNESS WHEREOF,this Power of Attorney has;beer)subscribed by..anauthhorized officer or.official of the.Companies_and the corpdfate seals of the Companies have been affixed thereto this 23rd day of March 2077 , J? aPo ?y� a�'caceo2a14 4— The The Ohio Casualty Insurance Company 0 1919 0 19 0 - i 4s1 Liberty Mutual Insurance Company m a e z West American Insurance Company N STATE OF PENNSYLVANIA ss David M.Carey,Assistant Secretary COUNTY OF MONTGOMERY _ tiOn this 23rd day of March 2017 before me personally appeared David M.Carey,who acknowledged himself to be the Assistant Secretary of Liberty Mutual Insurance F v m Company, The Ohio Casualty Company, and West American Insurance Company, and that he, as such, being authorized so to do,execute the foregoing instrument for the purposes >.,N 0 2 therein contained by signing on behalf of the corporations by himself as a duly authorized officer, G UJ tl> > IN WITNESS WHEREOF,I have hereunto subscribed my name and affixed my notarial seal at King of Prussia,Pennsylvania,on the day and year first above written. O CL �A PAST COMMONWEALTH OF PENNSYLVANIA O -p 1,40NWcq�� No€arial5eat a�1 Teresa Pasteita,Notary Public By: O O of Upper MerionTwp.,Montgomery County Teresa Pastella,Notary Public My Commission Expires March 28,2V1 {� ~O�+ Member,Pennsylvania Association of Nalaries - O �/ 0. C This Power of Attorney is made and executed pursuant o and by authority of the following By-faws and Authorizations of The Ohio Casualty Insurance Company, Liberty Mutual A CD. a) insurance Company,and West American Insurance Company which resolutions are now in full force and effect reading as follows: t M d ARTICLE IV—OFFICERS--Section 12.Power of Attorney,Any officer or other official of the Corporation authorized for that purpose in writing by the Chairman or the President,and subject O a? to such limitation as the Chairman or the President may prescribe,shall appoint such attorneys-in-fact,as may be necessary to act in behalf of the Corporation to make,execute,seal, �+m O,G acknowledge and deliver as surety any and all undertakings,bonds,recagnizances and other surety obligations. Such attorneys-in-fact,subject to the limitations set forth in their respect[ve T3 16 powers of attorney,shall have full power to bind the Corporation by their signature and execution of any such instruments and to attach thereto the seal of the Corporation. When so FU m O M executed,such instruments shall be as binding as[f signed by the President and attested to by the Secretary.Any power or authority granted to any representative or attorney-In-fact under >o 17 the provisions of this article may be revoked at any time by the Board,the Chairman,the President or by the officer or officers granting such power or authority. ARTICLE XIII—Execution of Contracts—SECTION 5.Surety Bonds and Undertakings.Any officer of the Company authorized for that purpose in writing by the chairman or the president, C° i and subject to such limitations as the chairman or the president may prescribe,shall appoint such attomeys-in-fact,as may be necessary to actin behalf of the Company to make,execute, L seal,acknowledge and deliver as surety any and all undertakings,bonds,recognizances and other surety ob[igations, Such attorneys-in-fact subject to the limitations set forth in their respective powers of attorney,shall have full power to bind the Company by their signature and execution of any such instruments,and to attach thereto the seal of the Company When so 0 o executed such instruments shall be as binding as if signed by the president and attested by the secretary. G to Certificate of Designation—The Presided€'of the Company,acting pursuant..1 the Bylaws of tha:Oompany authorizes David M.Carey,Assistant Secretary to appoint such atforneys-in- ~r fact as may be necessary to act on behalf of the Company to _make,execute,seal,acknowledge.and deliver as surety any and all undertakings;bonds,recagnizances and other surety obligations, Authorization—By unanimous consent of fhe.Campariy s]Board of Dlreetors,the Company consents that facsimlie or mechanically reproduced signature of any assistant secretaryof the Company,wherever appearing upon a certified.eopy ofany of attorney issued by the Company In conineedon with surety bonds,shall bo vatfd:and binding upon the Company with the same force and effect as though manually affixed, I, Renee C. Llewellyn, the undersigned, Assistant Secretary, The Ohba Casually.Insurance Company, Liberty.Mutual Insurance ComOny,_'ali.d i lest American Insurance Company do hereby certify that the original power of attorney of which the foregoing Is a.full true and correct copy of the Powa_r of Attorney executed,by said-Companies, is in full force and effect and has not been revoked. 1 IN TESTifAONY WHEREOF,I have hereunto set my hand and affixedthe aealciaS2tt4anteslhls � day of 20_..]. •. ��i 1!!SL t,IFY51,rq tt v Z 1 t; trlsu� a . ,\yrs,cSWCIL!>: JY 1�P4r7„i�•l �C?' ,.ynE 11, i `4 21- 1919 1 1919 ey: b Renee C.Llewa l ssislant Secretary i xa;4s4y: -� u•.,yrs �E� � < � e� •. o- g 426 of 600 LMS_12873_422617 .°, Lber LIBERTY MUTUAL INSURANCE COMPANY FINANCIALSTATEMENT—DECEMBER 31,20X6 SURETY Assets -- Liabilities Cash and Bank Deposits......................................... $1,092,914,837 Unearned Premiums................................................ $6,929,723,299 *Bonds—U.S Government..................................... 1,406,763,970 Reserve for Cairns and Claims Expense................ 17,233,877,300 *Other Bonds......................................................_ 11,379,916,523 Funds Held Under Reinsurance Treaties................. 208 362 823 Reserve for Dividends to Policyholders.................. 944,909 *Stocks..................................................................... 10,349,761,988 Additional Statutory Reserve................... 39,649,905 Real Estate.............................................................. 290,265,760 Reserve for Commissions,Taxes and Agents'Balances or Uncollected Premiums........... 4,709,977,463 Other Liabilities................................................ 3,061.117,958 Accrued Interest and Rents.... 112,757,395 Total.......................... $27,473,676,194 Special Surplus Funds................. $95,257,334 Other Admitted Assets.............................................. 14,659.523.751 Capital Stock............................... 10,000,000 Paid in Surplus............................ 9,229,250,104 Unassigned Surplus..................... 7,193,698,055 Total Admitted Assets.....................................844001RR16R7 Surplus to Policyholders............................... 16,528,„ 20�_S 493 Total Liabilities and Surplus................................$44,001,981,68 .���oP�Ttie * Bonds are stated at amortized or investment value; Stocks at Association Market Values. r 1972 The foregoing financial information is taken from Liberty Mutual Insurance Company's fuiancial }�9ssq��a statement filed with the state of Massachusetts Department of Insurance, * I 1, TIM MIKOLA7EWSKI,Assistant Secretary of Liberty Mutual Insurance Company, do hereby certify that the foregoing is a true, and correct statement of the Assets and Liabilities of said Corporation,as of December 31,2016,to the best of my knowledge and belief. IN WITNESS WHEREOF, I have hereunto set my hand and affixed the seal of said Corporation at Seattle, Washington,this 23rd day of March,2017. s Assistant Secretary S-1262LMIUa 3117