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HomeMy WebLinkAboutRES.2441.04-06-2009BILL NO. 09-61 RESOLUTION NO. A RESOLUTION AUTHORIZING THE INTERIM CITY MANAGER TO EXECUTE A CONTRACT WITH OLIPHANT GOLF, INC., FOR IMPROVEMENTS TO THE JAYCEE MUNICIPAL GOLF COURSE, 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 Interim City Manager, for and on behalf of the City of Cape Girardeau, Missouri, is hereby authorized to execute a Contract with Oliphant Golf, Inc., for improvements to the Jaycee Municipal Golf Course, in the City of Cape Girardeau, Missouri. A copy of said Contract is attached to this Resolution and made a part hereof. PASSED AND ADOPTED THIS DAY OF T� 20. C <..' Jay Knudtson, Mayor FORM OF CONTRACT lk , This agreement is hereby made and entered into this day of %Qt1. , 2009, by and between the City of Cape Girardeau, Missouri, a municipal corporation (hereinafter referred to as "CITY") and OVi P 1 *&M CrZrL—F T.4C— , a (hereinafter referred to as "CON CTOR' . WITNESSETH: For and in consideration of the mutual promises and covenants contained herein, the which is hereby mutually acknowledged, the parties hereto hereby agree as follows: ARTICLE I: The CONTRACTOR shall furnish all labor, materials, plants and other facilities and shall perform all work necessary or proper for, or incidental to, the renovation of the Cape Jaycee Municipal Golf Course as outlined in the plans and specifications prepared by Arthur Schaupeter Golf Course Architects for the CITY complete in strict accordance with the plans and specifications and any future changes made therein as hereinafter provided, to the satisfaction and approval of the CITY, and shall perform all other obligations and assume all liabilities imposed upon him by the Contract. ARTICLE II: It is understood and agreed by and between the parties hereto that the work included in this contract is to be done under the direction of the CITY and that its decision as to the true construction and meaning of the plans and specifications be final. Such additional explanations as may be necessary to detail and illustrate the work to be done are to be furnished by the CITY and they shall be consistent with the purpose and intent of the original plans and specifications referred to in Article I. ARTICLE III: No alteration shall be made in the work except upon the written order of the CITY. The amount to be paid by the CITY or allowed by the CONTRACTOR by virtue of such alterations shall be stated in said written order. ARTICLE IV: The CONTRACTOR shall provide sufficient and proper facilities at all times for the inspection of his work by the CITY or its authorized representative; CONTRACTOR shall within twenty-four (24) hours after receipt of written notice from the CITY to that effect, proceed to remove from the grounds or buildings all material rejected, whether worked or unworked, and take down all portions of the work which are, by like written notice, condemned as unsound or improper or are in any way failing to conform to the plans and specifications and shall make good all work damaged or destroyed hereby. M-1 Form of Contract (cont'd) ARTICLE V: Should the CONTRACTOR at any time refuse or neglect to supply a sufficiency of properly skilled workmen or material or the proper quality, or fail in any respect to execute the work with promptness or diligence, or fail in the performance of any of the agreements herein contained, such refusal, neglect or failure being certified by the CITY or their authorized representatives, the CITY shall be at liberty, after twenty-four (24) hours written notice to the CONTRACTOR, to provide any such labor or materials, to deduct the cost thereof from any money then due or thereafter becoming due to the CONTRACTOR under this contract; and if such refusal, neglect or failure is certified by the GOLF COURSE ARCHITECT, the CITY shall be at liberty to terminate the employment of the CONTRACTOR for such work and to enter upon the premises and take possession, for the purpose of completing the work included under this contract, of all materials, tools and appliances, thereon, and to employ any other persons to finish the work, and to provide the materials therefor; and in case of such discontinuance of the employment of the CONTRACTOR, he shall not be entitled to receive any further payment under this contract until said work shall be wholly finished, at which time, the CITY shall pay the CONTRACTOR the difference between all amounts which were owed the CONTRACTOR prior to such termination of the Contract less the amount of any additional costs or expenses incurred by the CITY in connection ,with completion of said work, and if such expense shall exceed the unpaid balance, the CONTRACTOR shall promptly pay the difference to the CITY. The expense incurred by the CITY as herein provided, either for furnishing materials or for furnishing work, and/or any damage incurred through such default shall be audited and certified by the CITY. ARTICLE VI: As part of the bid package submitted, the CONTRACTOR shall include a schedule of work that provides for finishing construction of the golf course in the shortest time possible, taking into consideration the preferable time frame for grassing operations. Upon completion of the grassing of the golf course, another thirty (30) days are provided to the CONTRACTOR to complete the punch list items for final payment. The time for completion of the work is of the essence in this contract; should the CONTRACTOR neglect, refuse or fail to complete the work to be done under the contract within the time herein agreed upon as stated above, after adding all extensions of time granted by the CITY, then in that event, the CITY shall have, and is hereby given the right to deduct and retain out of such monies then due or which may become due and payable to the CONTRACTOR for the work to be done under this contract, the sum of five hundred dollars (I 500.00) per day for each and every working day that the work is delayed in its completion beyond the specified time. Said sum shall be deemed, taken and treated as extra expense which the CITY will be subject to by reason of such default (including but not limited to extra cost of supervision and inspection) and not by way of penalty. B-10 Form of Contract (cont'd) ARTICLE VII: Should CONTRACTOR be delayed in the prosecution of completion of Work for any reason beyond CONTRACTOR'S reasonable and foreseeable control as determined by CITY in CITY'S sole discretion, then and in such event the time herein fixed for the completion of the Work shall be extended for a period equivalent to the time lost by reason of any and all aforesaid causes, which extended period shall be determined and fixed by CITY in CITY'S sole discretion; provided, however, that no such allowance shall be made unless a claim therefore is presented in writing to the GOLF COURSE ARCHITECT within forty-eight (48) hours of the event giving rise to the occurrence of such delay. Further, in the event of such delay, CONTRACTOR shall receive no further compensation based upon such delay. ARTICLE VIII: It is hereby mutually agreed that the sum to be paid by the CITY to the CONTRACTOR for said work and materials shall be: QAe WIL6O's SAM, War- TMwtAlla se" IUAI ep SsAr_ JTy DOLLARS ($ 0040k,Ti ® ), subject to additions and deductions as herein provided and that such a sum shall be paid by the CITY to the CONTRACTOR in current funds. The CITY shall make monthly payments to the CONTRACTOR, based on the schedule of values, of ninety percent (90%) of the value of the labor and materials incorporated in the work and of ninety percent (90%) of all staple materials stored at the site up to the twentieth (20`'') day of that month as estimated by the GOLF COURSE ARCHITECT, less the aggregate of all previous payments provided that the aggregate of all monthly payments shall not exceed ninety percent (90%) of the contract price. All estimates shall be delivered to the CITY by the twentieth (20") day of each month. The amount of payment approved by the CITY shall be made on the tenth (10`h) day of the following month. The final payment shall be made thirty (30) calendar days after completion and acceptance of the work included in this contract and all payments shall be due when the certificate for same is issued. Notwithstanding the foregoing however, final payment hereunder shall not be due until the CITY has received and approved the required Maintenance Bond, Contractor Warranty, 'Contractor's Affidavit Regarding Settlement of Claims, Bills Paid Affidavits and the consent to final payment of any surety on any Performance Bond or Payment Bond connected with the project. ARTICLE IX: The CONTRACTOR shall make prompt and full payments to all persons furnishing labor and/or material under this contract; and shall save the CITY harmless from all costs resulting from his failure to do so. It is further mutually agreed between the parties hereto that no certificates given or payment made under this contract, except for final certificate or final payment, shall be conclusive evidence of the performance of this contract, either wholly or in part, and that no payment shall be construed to be an acceptance of defective work or improper materials. B-11 Form of Contract (cont'd) ARTICLE X: 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 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. Successful Bidder must submit copies of Form I-9 (Employment Eligibility Verification) of any and all employees that will be working on this project, including subcontractors, before a Notice to Proceed will be issued. Failure to produce such paperwork can be a justification for withholding payment. ARTICLE XI: Waiver of Public Act. CONTRACTOR represents he has made a reasonable inspection of the construction site and hereby voluntarily waives the incorporation of the provisions of Public Act 91- 0647 and represents that the negotiated contract price is the sole consideration for the construction of the improvement described in this contract. Further, the CITY OF CAPE GIRARDEAU shall not be liable to the CONTRACTOR for any amount of money over the negotiated contract price except by written amendment or Change Order to the contract signed by a duly authorized agent of the CITY OF CAPE GIRARDEAU. ARTICLE XII: Indemnification: To the fullest extent permitted by law, CONTRACTOR agrees to indemnify, defend and hold harmless the CITY, its officers, employees, boards and commissions from and against any and all claims, suits, judgments, costs, attorney's fees, damages or other relief arising out of any reckless or negligent acts or omissions of CONTRACTOR'S officers, employees or agents in the performance of this agreement. In the event of any action against the CITY, its officers, employees, agents, boards or commissions covered by the foregoing duty to indemnify, defend and hold harmless, such action shall be defended by legal counsel of the CITY'S choosing. The provisions of this paragraph shall survive any termination/expiration of this agreement. ARTICLE XIII: Seve_ rabUit . The terms of this agreement shall be severable. In the event any of the terms or provisions of this agreement are deemed to be void or otherwise unenforceable for any reason, the remainder of this agreement shall remain in full force and effect. ARTICLE XIV: Independent Contractor Status: This agreement shall not be construed so as to create a partnership, joint venture, employment or other agency relationship between the parties. ARTICLE XV: Choice of Law: This agreement shall be subject to and governed by the laws of the State of Missouri. Venue for the resolution of any disputes or the enforcement of any rights pursuant to this agreement shall be in the Circuit Court of Cape Girardeau County, Missouri. B-12 Form of Contract (cont'd) ARTICLE XVI: Breach of Contract: If either party breaches any of the terms of this agreement, and fails within fifteen (15) days after written notice thereof by the non -breaching party to comply with the terms of this agreement, the non -breaching parry may terminate this agreement. ARTICLE XVII: No Personal Liability: No official, director, officer, agent or employee of the CITY shall be charged personally or held contractually liable under any term or provision of this agreement or because of their execution, approval or attempted execution of this agreement. ARTICLE XVIII: Nondiscrimination: In all hiring or employment made possible or resulting from this agreement, there shall be no discrimination against any employee or applicant for employment because of sex, age, race, color, creed, national origin, marital status, or the presence of any disability, unless based upon a bona fide occupational qualification. This requirement shall apply, but not be limited to: Employment advertising, layoff or termination, rates of pay or other forms of compensation and selection for training, including apprenticeship. No person shall be denied or subjected to discrimination in receipt of the benefit of any services or activities made possible by or resulting from this agreement on the grounds of sex, race color, creed, national origin, age except minimum age and retirement provisions, marital status or the presence of any disability. Any violation of this provision shall be considered a violation of a material provision of this agreement and shall be grounds for cancellation, termination or suspension, in whole or in part, of the agreement by the CITY. ARTICLE XIX: Assignment and Successors: This agreement and each and every portion thereof shall be binding upon the successors and the assigns of the parties hereto; provided, however, that no assignment shall be made without the prior written consent of the CITY. ARTICLE XX: Headings: The headings of the several paragraphs of this agreement are inserted only as a matter of convenience and for reference, and are in no way intended to define, limit or describe the scope or intent of any provision of this agreement; nor shall they be construed to affect in any manner the terms and provisions hereof or the interpretation or construction thereof. 13-13 Form of Contract (cont'd) ARTICLE XXI: Modification or Amendment: This agreement, the documents it incorporates and its attachments including, but not limited to, drawings, diagrams, specifications or requests for proposals, or bid documents constitutes the entire agreement of the parties on the subject matter hereof and may not be changed, modified, discharged or extended except by written amendment or Change Order duly executed by the parties. Each party agrees that no representations or warranties shall be binding upon the other parry unless expressed in writing herein or in a duly executed amendment hereof, or Change Order as herein provided. This Agreement entered into as of the day and year first written above. City of Cape Girardeau V Ken Eftink, Interim City Manager AA 0 OL4 l YM A OACY Gavle Conrad, City Clerk (Affiant) til RIMM CONTRACTOR: 01.i P"IaT cmd-F f Twit - Company Name C� M., Signature Sksay+ 44'.-' � ic-E. Res' -OP -4T - Name written and position 9161 F, Address SJR �t ??tS Bond No. 08939367 Performance Bond Any singular reference to Contractor, Surety, Owner or other party shall be considered plural where applicable. CONTRACTOR (Name and Address): Oliphant Golf, Inc. 8687 E. Via De Ventura Scottsdale, AZ 85258 OWNER (Nasse and Address): City of Cape Girardeau Cape Girardeau, MO CONSTRUCTION CONTRACT Date: 4/24/09 Amount: S 1,049,770.00 SURETY: Fidelity & Deposit Company of Maryland 3910 Kewick Baltimore, MD Description (Name and Location): Renovation of the Cape Jaycee Municipal Golf Course DOLLARS BOND Date (Not earlier than Construction Contract Date): 4/24/09 Amount: S 1,049,770.00 DOLLARS Modifications to this Bond: X None ❑ See Page 3 CONTRACTOR AS PRINCIPAL SURETY Company: Oli n olf, Inc. Company: F'delityDeposit ny of Maryland om Corporate Seal Corporate Seat Signature: Signature: Name and Title: 04WIC""OT Name and ' (Any additional signatures appear on page 3) (FOR INFORMATION ONLY—Name, Addrws and Telephone) AGENTorBROKER: OWNER'S REPRESENTATIVE (Architect, Engineer or Hausmann -Johnson Insurance other party): Arthur Schaupeter Golf Course Architects 700 Regent Street Madison, WI 53715 608-257-3795 Printed in cooperation with the American institute of Architects (AIA) by vouches that the language in the document conforms exactly to the language used in AIA Document A-312, December 1984 Edition. 1 PRF70002ZZ0601f Without Modifications I The Contractor and the Surety, jointly and severally, bind themselves, their heirs, executors, administrators, successors and assigns to the Owner for the performance of the Construction Contract, which is incorporated herein by reference. 2 If the Contractor performs the Construction Contract, the Surety and the Contractor shall have no obligation under this Bond, except to participate in conferences as provided in Sub- paragrdph 3.1. 3 If there is no Owner Default, the Surety's obligation under this Bond shall arise after: 3.1 The Owner has notified the Contractor and the Surety at its address described in Paragraph 10 below that the Owner is considering declaring a Contractor Default and has requested and attempted to arrange a conference with the Contractor and the Surety to be held not later than fifteen days after receipt of such notice to discuss methods of performing the Construction Contract. If the Owner, the Contractor and the Surety agree, the Contractor shall be allowed a reasonable titrtc to perform the Construction Contract, but such an agreement shall not waive the Owner's right, if any, subsequently to declare a Contractor Default; and 3.2 The Owner has declared a Contractor Default and for- mally terminated the Contractor's right to complete the con- tract. Such Contractor Default shall not be declared earlier than twenty days after the Contractor and the Surety have received notice as provided in Sub -paragraph 3.1; and 3.3 The Owner has agreed to pay the Balance of the Contract Price to the Surety in accordance with the terms of the Construction Contract or to a contractor selected to perform the Construction Contract in accordance with the terms of the contract with the Owner. 4 When the Owner has satisfied the conditions of Paragraph 3, the Surety shalt promptly and at the Surety's expense take one of the following actions: 4.1 Arrange for the Contractor, with consent of the Owner, to perform and complete the Construction Contract; or 4.2 Undertake to perform and complete the Construction Contract itself, through its agents or through independent contractors; or 4.3 Obtain bids or negotiated proposals from qualified con- tractors acceptable to the Owner for a contract for perfor- mance and completion of the Construction Contract, arrange for a contract to be prepared for execution by the Owner and the contractor selected with the Owner's concurrence, to be secured with performance and payment bonds executed by a qualified surety equivalent to the bonds issued on the Construction Contract, and pay to the Owner the amount of damages as described in Paragraph 6 in excess of the Balance of the Contract Price incurred by the Owner resulting from the Contractor's default; or 4.4 Waive its right to perform and complete, arrange for completion, or obtain a new contractor and with reasonable promptness under the circumstances: 1 After investigation, determine the amount for which it Printed in cooperation with the American Institute of Architects (AIA) by language used in AIA Document A-312, December 1984 Edition. may be liable to the Owner and, as soon as prac- ticable after the amount is determined, tender pay- ment therefor to the Owner; or .2 Deny liability in whole or in part and notify the Owner citing reasons therefor. 5 If the Surety does not proceed as provided in Paragraph 4 with reasonable promptness, the Surety shall be deemed to be in default on this Bond fifteen days after receipt of an additional written notice from the Owner to the Surety demanding that the. Surety perform its obligations under this Bond, and the Owner shall be entitled to enforce any remedy available to the Owner. If the Surety proceeds as provided in Subparagraph 4.4, and the Owner refuses the payment tendered or the Surety has denied liability, in whole or in part, without further notice the Owner shall be entitled to enforce any remedy available to the Owner. 6 After the Owner has terminated the Contractos's right to com- plete the Construction Contract, and if the Surety elects to act under Subparagtaph 4.1, 4.2, or 4.3 above, then the responsibilities of the Surety to the Owner shall not be greater than those of the Contractor under the Construction Contract, and the responsibilities of the Owner to the Surety shall not be greater than those of the Owner under the Construction Contract. To the limit of the amount of this Bond, but subject to commitment by the Owner' of the Balance of the Contract Price to mitigation of costs and damages on the Construction Contract, the Surety is obligated without duplication for: 6.1 The responsibilities of the Contractor for correction of defective work and completion ofthe Construction Contract; 6.2 Additional legal, design professional and delay costs resulting from the Contractor's Default, and resulting from the actions or failure to act of the Surety under Paragraph 4; and 6.3 Liquidated damages, or if no liquidated damages are specified in the Construction Contract, actual damages caused by delayed performance or non-performance of the Contractor. 7 The Surety shall not be liable to the Owner or others for obliga- tions of the Contractor that are unrelated to the Construction Contract, and the Balance of the Contract Price shall not be reduced or set off on account of any such unrelated obligations. No right of action shall accrue on this Bond to any person or entity other than the Owner or its heirs, executors, administrators or successors. 8 The Surety hereby waives notice of any change, including changes of time, to the Construction Contract or to related sub- contractors, purchase orders and other obligations. 4 Any proceeding, legal or equitable, under this Bond may be instituted in any court of competent jurisdiction in the location in which the work or part of the work is located and shall be instituted within two years after Contractor Default or within two years after the Contractor ceased working or within two years after the Surety refuses or fails to perform its obligations under this Bond, whichever occurs first. if the provisions of this Paragraph are void or prohibited by law, the minimum period of limitation available to sureties as a defense in the jurisdiction 2 vouches that the language in the document conforms exactly to the shall be applicable. 10 Notice to the Surety, the Owner or the Contractor shall be mailed or delivered to the address shown on the signature page. 11 When this Bond has been furnished to comply with a statutory or other legal requirement in the location where the construction was to be performed, any provision in this Bond conflicting with said statutory or legal requirement shall be deemed deleted herefrom and provisions conforming to such statutory or other legal requirement shall be deemed incorporated herein. The intent is that this Bond shall be construed as a statutory bond and not as a common law bond. 12 DEFINITIONS 12,1 Balance of the Contract Price: The total amount payable by the Owner to the Contractor under the Construction Contract after all proper adjustments have been made, including allowance to the Contractor of any amounts received or to be received by the MODIFICATIONS TO THIS BOND ARE AS FOLLOWS: Owner in settlement of insurance or other claims for damages to which the Contractor is entitled, reduced by all valid and proper payments made to or on behalf of the Contractor under the Construction Contract. 12.2 Construction Contract: The agreement between the Owner and the Contractor identified on the signature page, including all Contract Documents and changes thereto. 12.3 Contractor Default: Failure of the Contractor, which has neither been remedied nor waived, to perform or otherwise to comply with the terms of the Construction Contract. 12.4 Owner Default: Failure of the Owner, which has neither been remedied nor waived, to pay the Contractor as required by the Construction Contract or to perform and complete or comply with the other terms thereof. (Space is provided below for additional signatures of added parties, other than those appearing on the cover page). CONTRACTOR AS PRINCIPAL SURETY: Company: (Corporate Scat) Company: (Corporate Seal) Signature: _ Name and Title: Address: Printed in cooperation with the American Institute of Architects (AIA) by the language used in AIA Document A-312, December 1984 Edition. Signature: Name and Title: Address: vouches that the language in the document conforms exactly to 3 Power of Attorney FIDELITY AND DEPOSIT COMPANY OF MARYLAND KNOW ALL MEN BY THESE PRESENTS: That the FIDELITY AND DEPOSIT COMPANY OF MARYLAND, a corporation of the State of Maryland, by WILLIAM J. MILLS, Vice President, and ERIC D. BARNES, Assistant Secretary, in pursuance of authority granted by Article VI, Section 2, of the By -Laws of said Company, are set forth on the reverse side hereof and are hereby certified to be in full force and effect on the date h e (Os by nominate, constitute and appoint Judith A. WALKER, Sheila M. DICKEY, Steven L. S r7bonds A NN, Timothy HAUSMANN, Mary F. GLAUNER, Patrick A. MCKEN ison, Wisconsin, EACH its true and lawful agent and Attorney -in -Fa e, s and on its behalf as surety, and as its act and deed: any and all bonds , an c ti ' corundertakings in pursuance of these presents, shall be as bindiVe �pa �'��,�y, to all intents and purposes, as if they had been r u rs of the Com an at its office in Baltimore, Md. in their duly executed and edCompany own proper personer ,rthat issued on behalf of Judith A. WALKER, Sheila M. DICKEY, Jacqueline A. MCC evUIRES, Jeffrey P. HAUSMANN, Timothy HAUSMANN, Mary F. GLAUNER, Patrick A. MCKEN my 26, 2007. The said Assistant Secretary does hereby certify that the extract set forth on the reverse side hereof is a true copy of Article VI, Section 2, of the By -Laws of said Company, and is now in force. IN WITNESS WHEREOF, the said Vice -President and Assistant Secretary have hereunto subscribed their names and affixed the Corporate Seal of the said FIDELITY AND DEPOSIT COMPANY OF MARYLAND, this 24th day of January, A.D. 2008. ATTEST: FIDELITY AND DEPOSIT COMPANY OF MARYLAND EPO, 1` � 1•���aF o 0 By: Eric D. Barnes Assistant Secretary William J. Mills _ Rice Presiclent State of Maryland t ss: ' - City of Baltimore f On this 24th day of January, A.D. 2008, before the subscriber, a Notary Public of the State of-Marylantl;, duly commissioned and qualified, came WILLIAM J. MILLS, Vice President, and ERIC D. BARNES, Assistant Secretary of the FIDELITY AND DEPOSIT COMPANY OF MARYLAND, to me personally known to be the individuals and officers described in and who executed the preceding instrument, and they each acknowledged the execution of the same, and being by me duly sworn, severally and each for himself deposeth and saith, that they are the said officers of the Company aforesaid, and that the seal affixed to the preceding instrument is the Corporate Seal of said Company, and that the said Corporate Seal and their signatures as such officers were duly affixed and subscribed to the said instrument by the authority and direction of the said Corporation. IN TESTIMONY WHEREOF, I have hereunto set my hand and affixed my Official Seal the day and year first above written. Constance A. Dunn Notary Public My Commission Expires: July 14, 2011 POA -F 184-0007 •�f/f lfl l5,41�` Constance A. Dunn Notary Public My Commission Expires: July 14, 2011 POA -F 184-0007 EXTRACT FROM BY-LAWS OF FIDELITY AND DEPOSIT COMPANY OF MARYLAND "Article VI, Section 2. The Chairman of the Board, or the President, or any Executive Vice -President, or any of the Senior Vice -Presidents or Vice -Presidents specially authorized so to do by the Board of Directors or by the Executive Committee, shall have power, by and with the concurrence of the Secretary or any one of the Assistant Secretaries, to appoint Resident Vice -Presidents, Assistant Vice -Presidents and Attorneys -in -Fact as the business of the Company may require, or to authorize any person or persons to execute on behalf of the Company any bonds, undertaking, recognizances, stipulations, policies, contracts, agreements, deeds, and releases and assignments of judgements, decrees, mortgages and instruments in the nature of mortgages,... and to affix the seal of the Company thereto." CERTIFICATE I, the undersigned, Assistant Secretary of the FIDELITY AND DEPOSIT COMPANY OF MARYLAND, do hereby certify that the foregoing Power of Attorney is still in full force and effect on the date of this certificate; and I do further certify that the Vice -President who executed the said Power of Attorney was one of the additional Vice -Presidents specially authorized by the Board of Directors to appoint any Attorney -in -Fact as provided in Article VI, Section 2, of the By -Laws of the FIDELITY AND DEPOSIT COMPANY OF MARYLAND. This Power of Attorney and Certificate may be signed by facsimile under and by authority of the following resolution of the Board of Directors of the FIDELITY AND DEPOSIT COMPANY OF MARYLAND at a meeting duly called and held on the 10th day of May, 1990. RESOLVED: "That the facsimile or mechanically reproduced seal of the company and facsimile or mechanically reproduced signature of any Vice -President, Secretary, or Assistant Secretary of the Company, whether made heretofore or hereafter, wherever appearing upon a certified copy of any power of attorney issued by the Company, shall be valid and binding upon the Company with the same force and effect as though manually affixed." IN TESTIMONY WHEREOF, I have hereunto subscribed my name and affixed the corporate seal of the said Company, ,this day of Assistant Secretary Bond No. 08939367 Payment Bond Any singular reference to Contractor, Surety, Owner or other party shall be considered plural where applicable. CONTRACTOR (Name and Address): Oliphant Golf, Inc. 8687 E. Via De Ventura Scottsdale, AZ 85258 OWNER (Name and Address): City of Cape Girardeau Cape Girardeau, MO CONSTRUCTION CONTRACT Date: 4/24/09 Amount: $ 1,049,770.00 Description (Name and Location): SURETY (Name and Principal Place of Business): Fidelity & Deposit Company of Maryland 3910 Keswick Baltimore, MD 21211 renovation of Cape Jaycee Municipal Golf Course DOLLARS BOND Date (Not earlier than Construction Contract Date): 4/24/09 Amount: $ 1,049,770.00 DOLLARS Modifications to this Bond: F� None © See Page 3 CONTRACTOR A PRINCIPAL SURETY Comnanv: olf, In Company: Fidelity et C m f Maryland Corporate Seal Corporate real Signature: Signature: Name and Title: P ,f7Plw)VT— Name an e: (Any additional signatures appear on page 3) (FOR INFORMATION ONLY—Name, Address and Telephone) AGENT or BROKER: OWNER'S REPRESENTATIVE (Architect, Engineer or Hausmann -Johnson Insurance 700 Regent Street Madison, WI 53715 608-257-3795 Printed in cooperation with The American Institute of Architects (AIA) by the language used in AIA Document A-312, December 1984 EDITION. PAY76001 ZZ 1107f With Modifications other party): Arthur Schaupeter Golf Course Architects vouches that the language in the document conforms exacth to I The Contractor and the Surety, jointly and severally, bind themselves, their heirs, executors, administrators, successors and assigns to the Owner to pay for labor, materials and equipment furnished for use in the performance of the Construction Con- tract, which is incorporated herein by reference. 2 With respect to the Owner, this obligation shall be null and void if the Contractor: 2.1 Promptly makes payment, directly or indirectly, for all sums due Claimants, and 2.2 Defends, indemnifies and holds harmless the Owner from claims, demands, liens or suits by any person or entity whose claim, demand, lien or suit is for payment for labor, materials or equipment furnished for use in the performance of the Construction Contract, provided the Owner has promptly notified the Contractor and the Surety (at the address described in paragraph 12) of any claims, demands, liens or suits and tendered defense of such claims, demands, liens or suits to the Contractor and the Surety, provided there is no Owner Default. 3 With respect to Claimants, this obligation shall be null and void if the Contractor promptly makes payment, directly or in- directly, for all sums due. 4 The Surety shall have no obligation to Claimants under this Bond until: 4.1 Claimants who are employed by or have a direct contract with the Contractor have given notice to the Surety (at the address described in Paragraph 12) and sent a copy, or notice thereof, to the Owner, stating that a claim is being made under this Bond and, with substantial accuracy, the amount of the claim. 4.2 Claimants who do not have a direct contract with the Contractor: 1 Have furnished written notice to the Contractor and sent a copy, or notice thereof, to the Owner, within 90 days after having last performed labor or last furnished materials or equipment included in the claim stating, with substantial accuracy, the amount of the claim and the name of the party to whom the materials were furnished or supplied or for whom the labor was done or performed; and .2 Have either received a rejection in whole or in part from from the Contractor, or not received within 30 days of furnishing the above notice any communication from the Contractor by which the Contractor has indicated the claim will be paid directly or indirectly; and .3 Not having been paid within the above 30 days, have sent a written notice to the Surety (at the address described in Paragraph 12) and sent a copy, or notice thereof, to the Owner, stating that a claim is being made under this Bond and enclosing a copy of the previous written notice furnished to the Contractor. 5 If a notice required by Paragraph 4 is given by the Owner to the Contractor or to the Surety, that is sufficient compliance. Printed in cooperation with The American Institute of Architects (AIA) by to the language used in AIA Document A-12, December 1984 Edition. 6 When the Claimant has satisfied the conditions of Paragraph 4. the Surety shall promptly and at the Surety's expense take the following actions: 6.1 Send an answer to the Claimant, with a copy to the Owner, within 45 days after receipt of the claim, stating the amounts that are undisputed and the basis for challenging any amounts that are disputed. 6.2 Pay or arrange for payment of any undisputed amounts. 7 The Surety's total obligation shall not exceed the amount of this Bond, and the amount of this Bond shall be credited for any payments made in good faith by the Surety. 8 Amounts owed by the Owner to the Contractor under the Con- struction Contract shall be used for the performance of the Con- struction Contract and to satisfy claims, if any, under any Con- struction Performance Bond. By the Contractor furnishing and the Owner accepting this Bond, they agree that all funds earned by the Contractor in the performance of the Construction Contract are dedicated to satisfy obligations of the Contractor and the Surety under this Bond, subject to the Owner's priority to use the funds for the completion of the work. 9 The Surety shall not be liable to the Owner, Claimants or others for obligations of the Contractor that are unrelated to the Construction Contract. The Owner shall not be liable for pay- ment of any costs or expenses of any Claimant under this Bond, and shall have under this Bond no obligations to make payments to, give notices on behalf of, or otherwise have obligations to Claimants under this Bond. 10 The Surety hereby waives notice of any change, including changes of time, to the Construction Contract or to related sub- contracts, purchase orders and other obligations. 11 No suit or action shall be commenced by a Claimant under this Bond other than in a court of competent jurisdiction in the location in which the work or part of the work is located or after the expiration of one year from the date (1) on which the Claim- ant gave the notice required by Subparagraph 4.1 or Clause 4.2.3, or (2) on which the last labor or service was performed by anyone or the last materials or equipment were furnished by anyone under the Construction Contract, whichever of (1) or (2) first occurs. If the provisions of this Paragraph are void or prohibited by law, the minimum period of limitation available to sureties as a defense in the jurisdiction of the suit shall be applicable. 12 Notice to the Surety, the Owner or the Contractor shall be mailed or delivered to the address shown on the signature page. Actual receipt of notice by Surety, the Owner or the Contractor, however accomplished, shall be sufficient compliance as of the date received at the address shown on the signature page. 13 When this Bond has been furnished to comply with a statutory or other legal requirement in the location where the construction was to be performed, any provision in this Bond conflicting with said statutory or legal requirement shall be deemed deleted herefrom and provisions conforming to such statutory or other legal requirement shall be deemed incorporated herein. The intent is that this Bond shall be construed as a statutory bond and not as a common law bond. vouches that the language in the document conforms exactly 14 Upon request by any person or entity appearing to be a poten- tial beneficiary of this Bond, the Contractor shall promptly fur- nish a copy of this Bond or shall permit a copy to be made. 15 DEFINITIONS 15.1 Claimant: An individual or entity having a direct con- tract with the Contractor or with a subcontractor of the Con- tractor to furnish labor, materials or equipment for use in the performance of the Contract. The intent of this Bond shall be to include without limitation in the terms "labor, materials or equipment" that part of water, gas, power, light, heat, oil, gasoline, telephone service or rental equipment used in the Construction Contract, architectural and engineering services MODIFICATIONS TO THIS BOND ARE AS FOLLOWS: Paragraph 4 is amended to insert sub -paragraph 4.3, which states: required for performance of the work of the Contractor and the Contractor's subcontractors, and all other items for which a mechanic's lien may be asserted in the jurisdiction where the labor, materials or equipment were furnished. 1.5.2 Construction Contract: The agreement between the Owner and the Contractor identified on the signature page, including all Contract Documents and changes thereto. 15.3 Owner Default: Failure of the Owner, which has neither been remedied nor waived, to pay the Contractor as required by the Construction Contract or to perform and complete or comply with the other terms thereof. 4.3 Claimants have furnished to Surety proof of claim duly sworn to by Claimants with adequate supporting documentation proving the amount claimed is due and payable. Paragraph 5 shall be amended to delete the word "or" and insert the word "and' in its place. Paragraph 6 and its sub -paragraphs 6.1 and 6.2 shall be deleted in their entirety and replaced with the following: When the Claimant has satisfied the conditions of Paragraph 4, the Surety shall, within 90 days of the date when claimant finally completed its satisfactions of the conditions of Paragraph 4 notify the Claimant of the amounts that are undisputed and the basis for challenging any amounts that are disputed, including, but not limited to, the lack of substantiating documentation to support the claim as to entitlement or amount, and the Surety shall pay or make arrangements for payment of any undisputed amount; provided, however, that the failure of the Surety to timely discharge its obligations under this paragraph or to dispute or identify any specific defense to all or any part of a claim shall not be deemed to be an admission of liability by the Surety as to such claim or otherwise constitute a waiver of the Contractor's or Surety's defenses to, or right to dispute, such claim. Rather, the Claimant's sole remedy shall be the immediate right, without further notice, to bring suit against the Surety to enforce any remedy available to it under this Bond. Paragraph 12 shall be amended to add the following paragraph: CLAIM NOTICE for the FIDELITY AND DEPOSIT COMPANY OF MARYLAND, ZURICH AMERICAN INSURANCE COMPANY, COLONIAL AMERICAN CASUALTY AND INSURANCE COMPANY and/or AMERICAN GUARANTEE AND LIABILITY INSURANCE COMPANY must be sent to the following address: Zurich Surety Claims, 3910 Keswick Road, Chesapeake Building 4th Floor, Baltimore, Maryland 21211 Attention: Surety Claim Department (Space is provided below for additional signatures of added parties, other than those appearing on the cover page.) CONTRACTOR AS PRINCIPAL Company: (Corporate Sea]) Signature: Name and Title: Address: Printed in cooperation with The American Institute of Architects (AIA) by SURETY: Company: Signature: Name and Title: Address: (Corporate Seal) vouches that the language in the document conforms exactly to the language used in AIA Document A-312, December 1984 EDITION. Power of Attorney FIDELITY AND DEPOSIT COMPANY. OF MARYLAND KNOW ALL MEN BY THESE PRESENTS: That the FIDELITY AND DEPOSIT COMPANY OF MARYLAND, a corporation of the State of Maryland, by WILLIAM J. MILLS, Vice President, and ERIC D. BARNES, Assistant Secretary, in pursuance of authority granted by Article VI, Section 2, of the By -Laws of said Company*A=NN, re set forth on the reverse side hereof and are hereby certified to be in full force and effect on the date h e by nominate, constitute and appoint Judith A. WALKER Sheila M. DICKEY, Steven L. S r TimothPP y HAUSMANN, Mary F. GLAUNER, Patrick A. MCKEN ison, Wisconsin, EACH its true and lawful agent and Attorney -in -Fa l e, s Vand on its behalf as surety, and as its act and deed: any and all bonds , and I ti c bonds or undertakings in pursuance of these presents, shall be as bindi Ppa y, to all intents and purposes, as if they had been duly executed and a ed r u cers of the Company at its office in Baltimore, Md., in their own proper persons. wer r s that issued on behalf of Judith A. WALKER, Sheila M. DICKEY, Jacqueline A. MCC ev UIRES, Jeffrey P. HAUSMANN, Timothy HAUSMANN, Mary F. GLAUNER, Patrick A. MCKEN my 26, 2007. The said Assistant Secretary does hereby certify that the extract set forth on the reverse side hereof is a true copy of Article VI, Section 2, of the By -Laws of said Company, and is now in force. IN WITNESS WHEREOF, the said Vice -President and Assistant Secretary have hereunto subscribed their names and affixed the Corporate Seal of the said FIDELITY AND DEPOSIT COMPANY OF MARYLAND, this 24th day of January, A.D. 2008. ATTEST: �p Ofvps.r lE9a ? State of Maryland i ss: City of Baltimore f FIDELITY AND DEPOSIT COMPANY OF MARYLAND Eric D. Barnes Assistant Secretary By: - William J. Mills Vice President On this 24th day of January, A.D. 2008, before the subscriber, a Notary Public of the -Slate_ of ' 1Vlaryland, duly commissioned and qualified, came WILLIAM J. MILLS, Vice President, and ERIC D. BARNES, Assistant Secretary of the FIDELITY AND DEPOSIT COMPANY OF MARYLAND, to me personally known to be the individuals and officers described in and who executed the preceding instrument, and they each acknowledged the execution of the same, and being by me duly sworn, severally and each for himself deposeth and saith, that they are the said officers of the Company aforesaid, and that the seal affixed to the preceding instrument is the Corporate Seal of said Company, and that the said Corporate Seal and their signatures as such officers were duly affixed and subscribed to the said instrument by the authority and direction of the said Corporation. IN TESTIMONY WHEREOF, I have hereunto set my hand and affixed my Official Seal the day and year first above written. Constance A. Dunn Notary Public My Commission Expires: July 14, 2011 POAT 184-0007 EXTRACT FROM BY-LAWS OF FIDELITY AND DEPOSIT COMPANY OF MARYLAND "Article VI, Section 2. The Chairman of the Board, or the President, or any Executive Vice -President, or any of the Senior Vice -Presidents or Vice -Presidents specially authorized so to do by the Board of Directors or by the Executive Committee, shall have power, by and with the concurrence of the Secretary or any one of the Assistant Secretaries, to appoint Resident Vice -Presidents, Assistant Vice -Presidents and Attorneys -in -Fact as the business of the Company may require, or to authorize any person or persons to execute on behalf of the Company any bonds, undertaking, recognizances, stipulations, policies, contracts, agreements, deeds, and releases and assignments of judgements, decrees, mortgages and instruments in the nature of mortgages,... and to affix the seal of the Company thereto." CERTIFICATE I, the undersigned, Assistant Secretary of the FIDELITY AND DEPOSIT COMPANY OF MARYLAND, do hereby certify that the foregoing Power of Attorney is still in full force and effect on the date of this certificate; and I do further certify that the Vice -President who executed the said Power of Attorney was one of the additional Vice -Presidents specially authorized by the Board of Directors to appoint any Attorney -in -Fact as provided in Article VI, Section 2, of the By -Laws of the FIDELITY AND DEPOSIT COMPANY OF MARYLAND. This Power of Attorney and Certificate may be signed by facsimile under and by authority of the following resolution of the Board of Directors of the FIDELITY AND DEPOSIT COMPANY OF MARYLAND at a meeting duly called and held on the 10th day of May, 1990. RESOLVED: "That the facsimile or mechanically reproduced seal of the company and facsimile or mechanically reproduced signature of any Vice -President, Secretary, or Assistant Secretary of the Company, whether made heretofore or hereafter, wherever appearing upon a certified copy of any power of attorney issued by the Company, shall be valid and binding upon the Company with the same force and effect as though manually affixed." IN'I'ESTINIONY WHEREOF, I have hereunto subscribed my name and affixed the corporate seal of the said Company, this day of �J Assistant Secretary AFFIDAVIT COMPLIANCE WITH THE PREVAILING WAGE LAW Before me, the undersigned Notary Public, in and for the County of IAA�ir.OPA , State of Aili 7D & A personally came and appeared (name and title) ISI 10 f4 A r L (L) 1 P j4A N r of the (name of company) 01-1 PIiANT- 601 F —I N(- (a corporation) (a partnership) (a proprietorship) and after being duly sworn did depose and say that all provisions and requirements set out in Chapter 290, Sections 290.210 through and including 290.340, Missouri Revised Statutes, pertaining to the payment of wages to workmen employed on public works projects have been fully satisfied and there has been no exception to the full and complete compliance with said provisions and requirements and with Wage Determination NO. or Annual Wage Order No. 15 Section 01(a issued by the Division of Labor Standards (Name of Project) 0APE h\4 GE- NIU 10-t PA -L U()LF COMSE REND 1AMOW located at (name of institution) OAP17 G I RAI9, DFA(1 in CA PE 61M DUUCounty, Missouri, and completed on the Z4-�`day of A PIZJ L 200� . Signature and Title of Signer (Corporate Seal) 5"'r Subscribed and sworn to me this 1 day of 20-0-�. Notary Public (Seal) BRENDA L KNOTT 100— Notary Public.State of Arizona Maricopa County My commission expires 120 My Commission Expires March 04, 2012 B-16 EmployerWizard Page 1 of 1 Online Resources I Tutorial I Home I Contact Us I Exit Ver lfy_ Employment Eligibility Verification Case Administration Company Information Initial Verification Company Name: Oliphant Golf, Inc @, View Cases Company ID Number: 196699 User Administration Change Password Physical Location: Mailing Address: Pwd Challenge Q&A Address 1: 8687 E Via de Ventura Address 1: Change Profile Address 2: Suite 318 Address 2: City: Scottsdale City: Site Administration State: AZ State: Add User Zip Code: 85258 Zip Code: View Users County: MARICOPA Maintain Company Terminate Company Employer Identification Number: 47080295 Participation Total Number of Employees: 100 to 499 Reports Corporate / Parent Company: The Oliphant Companies View Reports Organization Designation: Employer Category: None of these categories apply NAICS Code: 238 - SPECIALTY TRADE CONTRACTORS 5� „IT ff Total Hiring Sites: 2 IFf, y Total Points of Contact: 1 U.S.Department of Homeland Security I U.S._Cit_iz_enship and Immigration Servi.c_.e5. D wnlo d Vi w _ P __S ers httDs://www.vis-dhs.com/WebBD/Em-oloverWizard.asnx S/1 i?nnq r-� �` sr •v 1'—Verily. ( r a -E Veru ENERIFY 15. SERVICE OF ORB �rvD 85A Company ID Number: 19 � (A "I 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 GLI (24A1�1T G -)OLP 1I\4 L (Employer) regarding the Employer's participation in the Employment Eligibility Verification Program (E - Verify). This MOU explains certain features of the E -Verify program and enumerates specific responsibilities of DHS, the Social Security 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 1-9). For covered government contractors, E -Verify is used to verify the employment eligibility of all newly hired employees and all existing employees assigned to Federal contracts. 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). Authority for use of the E -Verify program by Federal contractors and subcontractors covered by the terms of Subpart 22.18, "Employment Eligibility Verification", of the Federal Acquisition Regulation (FAR) (hereinafter referred to in this MOU as a "Federal contractor") to verify the employment eligibility of certain employees working on Federal contracts is also found in Subpart 22.18 and in Executive Order 12989, as amended. ARTICLE 11 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 -Verify 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 401). Page 1 of 121E -Verify MOU for EmployerlRevision Date 10/29/081 www.dhs.gov/E-Verify Z-Verifysl EVEHFY SA EHVLEO. O ANOSSA Company ID Number: loW 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 -Verify, 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 -Verify program. DHS agrees to provide the Employer names, titles, addresses, and telephone numbers of DHS representatives to be contacted during the E -Verify 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 nonconfirmation of employees' employment eligibility within 3 Federal Government work days of the initial inquiry. Page 2 of 12JE-Verify MOU for EmpbyerlRevision Date 10;291081 vvww.dhs.gov/E-Verify N4 xi :c. 3 P= X - Verify E ERIFY 5 SEFVILF. OF DH$AND SSA Company ID Number: � � � �q - 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 provide 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 become 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 employment verification queries will complete the E -Verify Tutorial before that individual initiates any queries. A. The Employer agrees that all Employer representatives will take the refresher tutorials initiated by the E -Verify program as a condition of continued use of E - Verify, including any tutorials for Federal contractors if 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 "List B" identity document, the Employer agrees to only accept "List B" documents that contain a photo. (List B documents identified in 8 C.F.R. § 274a.2(b)(1)(B)) can be presented during the Form 1-9 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 1-551 (Permanent Resident Card) or Form 1-766 (Employment Authorization Document) to complete the Form 1-9, the Employer agrees to make a photocopy of the document and to retain the photocopy with the employee's Form 1-9. 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 1-9. DHS may in the future designate other documents that activate the photo screening tool. 6. The Employer understands that participation in E -Verify does not exempt the Employer from the responsibility to complete, retain, and make available for inspection Forms 1-9 that relate to its employees, or from other requirements of applicable regulations or laws, including Page 3 of 12JE-Verify MOU for EmployeriRevision Date t0129/08i tfvwwAhs, gov/i:E-Verify E. VERIFY IS A SERVICE Of OHS AND SSA Company ID Number: N (I M the obligation to comply with the antidiscrimination requirements of section 274B of the INA with respect to Form 1-9 procedures, except for the following modified 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 -Verify; (3) the Employer must notify 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 1-9 compliance inspections during the course of E -Verify, as well as to conduct any other enforcement activity authorized by law. 7. The Employer agrees to initiate E -Verify verification procedures for new employees within 3 Employer business days after each employee has been hired (but after both sections 1 and 2 of the Form 1-9 have been completed), and to complete as many (but only as many) steps of the E -Verify process as are necessary according to the E -Verify User Manual. The Employer is prohibited from initiating verification procedures before the employee has been hired and the Form 1-9 completed. If the automated system to be queried is temporarily unavailable, the 3 -day time 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 1-9 in circumstances where the employee has applied for a Social Security Number (SSN) from the SSA and is waiting to receive the SSN, provided that the Employer performs an E -Verify employment verification query using the employee's SSN as soon as the SSN becomes available. 8. The Employer agrees not to use E -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 ILD, the Employer will not 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 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 resolve the challenge. Page 4 of 12JE-Verify MOU for Employerl Revision Date 1 0/2 910 81 V%1XVW.dhs.gov/E-Verify ;M-VerifyE 1E11FY 15 1 { rA EnViCE D- D I'D 55� Company ID Number: 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 knowledge (as defined in 8 C.F.R. § 274a.1(1)) 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 government to resolve 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 if 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 otherwise subjecting an employee to any assumption that he or she is unauthorized to work) until and unless secondary verification by SSA or DHS has been completed and a final nonconfirmation has been issued. If the employee does not choose to contest a tentative nonconfirmation or a photo non -match or if a secondary verification is completed and a final nonconfirmation is issued, then the Employer can find the employee is not work authorized and terminate the employee's employment. Employers or employees with questions about a final nonconfirmation may call E -Verify at 1-888-464-4218 or OSC at 1-800- 255-8155 or 1-800-237-2515 (TDD). 11. The Employer agrees to comply with Title VII of the Civil Rights Act of 1964 and section 274B of the INA by not discriminating unlawfully against any individual in hiring, firing, or recruitment or referral practices because of his or her national origin or, in the case of a protected individual as defined in section 27413(a)(3) of the INA, because of his or her citizenship status. The Employer understands that such illegal practices can include selective verification or use of E -Verify except as provided in part D below, or discharging or refusing to hire employees because they appear or sound "foreign" or have received tentative nonconfirmations. The Employer further understands that any violation of the unfair immigration -related employment practices provisions in section 2748 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. Violations of either section 274B 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 1-9 or to print the screen containing the case verification number and attach it to the employee's Form 1-9. 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 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 Page 5 of 12JE-Verify MOU for Ernployerl Revision Date 10/29/081 v'vv"i.dhs.gov/E-Verify Verify. Y 5. SERV CE OF OR8.nU 95� Company ID Number: ' " � (M 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 1-9 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 if 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 eligibility of all other employees required to be verified under the FAR. Once an employee has been verified through E -Verify by the Employer, 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 -Verify 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 -Verify 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 verification 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 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 governments and sureties: Federal contractors that are institutions of higher education (as defined at 20 U.S.C. 1001(a)), State or local governments, governments of Federally recognized Indian tribes, or sureties Page 6 of 121E -Verify MOU for EmployerlRevision Date 1 0/2 910 81 WWWA Y 4F 'L - F . -Y, S A"SERV'.CE O: CIN AND SSA Company ID Number: performing 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 1.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 governments, and sureties. d. Verification of all employees: Upon enrollment, Employers who are Federal contractors may elect to 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 1-9 procedures for Federal contractors: The Employer may use a previously completed Form 1-9 as the basis for initiating E -Verify verification of an employee assigned to a contract as long as that Form 1-9 is complete (including the SSN), complies with Article II.C.5, the employee's work authorization has not expired, and the Employer has reviewed the information reflected in the Form 1-9 either in person or in communications with the employee to ensure that the employee's stated basis in section 1 of the Form I-9 for work authorization has not changed (including, but not limited to, a lawful permanent resident alien having become a naturalized U.S. citizen). If the Employer is unable to determine that the Form 1-9 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 1-9 contains no SSN or is otherwise incomplete, the Employer shall complete a new 1-9 consistent with Article II.C.5, or update the previous 1-9 to provide the necessary information. If section 1 of the Form 1-9 is otherwise valid and up-to- date and the form otherwise complies with Article II.C.5, but reflects documentation (such as a U.S. passport or Form 1-551) that expired subsequent to completion of the Form 1-9, 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 -Verify of any assigned employee who has previously been verified as a newly 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. ARTICLE III REFERRAL OF INDIVIDUALS TO SSA AND DHS A. REFERRAL TO SSA Page 7 of 121E -Verify MOU for EmoloyerlRevision Date 10/29/081 w,-vw.dhs.gov/E-Verify � � r Vir�f yJ rr�. c t rr s A SERVICE ocDIS arvo.s-n Company ID Number: N (p 4" 1� 1. If the Employer receives a tentative nonconfirmation issued by SSA, 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 tentative nonconfirmation. 2. The Employer will refer employees to SSA field offices only as directed by the automated system based on a tentative nonconfirmation, and only after the Employer records the case verification number, reviews the input to detect any transaction errors, and determines that the employee contests the tentative nonconfirmation. The Employer will transmit the Social Security Number to SSA for verification again if this review indicates a need to do so. The Employer will determine whether the employee contests the tentative nonconfirmation as soon as possible after the Employer 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 employee to visit an SSA office within 8 Federal Government work days. SSA will electronically 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. 4. The Employer agrees not to ask the employee to obtain a printout from the Social Security Number database (the Numident) or other written verification of the Social Security Number from the SSA. B. REFERRAL 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 tentative nonconfirmation. 2. If the Employer finds a photo non -match for an employee who provides a document for which the automated system has transmitted a photo, the employer must print the photo non - 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 after the Employer receives it. 4. If the employee contests a tentative nonconfirmation issued by DHS, the Employer will provide the employee with a referral letter and instruct the employee to contact DHS through its toll-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 electronically transmit Page 8 of 12JE-Verify MOU for EmployerlRevision Date 10/29/081 wv"v.dhs.gov/E-Verify v4 W J Vu ers Y EvERIFY iS A SERVICE OF CHS Axp SSA y. Company ID Number: t 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 1-551 or Form 1-766 to DHS for review by: • Scanning and uploading the document, or • Sending a photocopy of the document by an express mail account (furnished 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 resolving the case as specified by the Immigration Services Verifier at DHS who will determine the photo match or non -match. ARTICLE IV SERVICE PROVISIONS SSA and DHS will not charge the Employer for verification 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 -Verify program by DHS or SSA, including but not limited to the E -Verify 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 mandatory refresher tutorials. An Employer 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 -Verify 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 determination by SSA or Page 9 of 12JE-Verify MOU for Employe rlRevision Date 10/29/081 www.dhs.gov/E-Verify (-, 0-n-10 E -Verify E VERIFY IS A SERVILE OF OHS ANG S6A Company ID Number: I � � ( " q 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 comply 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 MOU is intended, or should be construed, to create any right or benefit, substantive or procedural, 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 respectively. 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. Employer JAS 0K1 N Name (Please Type or Print) Signature — -- Departmen f Homeland Security — Verification Division Name (Please Type or Print) Signature Vop--- 12- E S (() F Irl T Title Date -� / I 109 — Title Date Page 10 of 12JE-Verify MOU for Employerl Revision Date 10/29/081 \wNw.dhs.gov/E-\ieri4 1 W"11 1 -Verify E -EREVS A SERVCE OS ONSAND SSA Company ID Number: Information Required for the E -Verify Program Information relating to your Company: Company Name: U W P IIA- N Company Facility Address: b (cal E VIN 7T- V Wr V- A S1)1TF- 31 P) S C DTT -S DA- L- E. A -7_ ?)5z — Company Alternate Address: County or Parish: f" i Q- l C op 'A' Employer Identification Number: 4-7- North -7— North American Industry Classification Systems 23 Q G Code: J V I Parent Company: ��}} OU P WA NT L)I 0 W1 lR A- W i F—S Number of Employees: Number of Sites Verified for: Are you verifying for more than 1 site? If yes, please provide the number of sites verified for In each State - State Number of sites Site(s) t21 C- V I E 5 5 1 I' Page 11 of 12JE-Verify MOU for EmployerlRevis!on Date 10/29/081 www.dhs.gov/E-Verify -AZ EAU 40 Ve r, y► \` AS y'4j E -VERIFY ISA SERVICE OF DHS AND S 66A Company ID Number: ( q � � "l Information relating to the Program Administrator(s) for your Company on policy questions or operational problems: Name: gN G "- Telephone Number: 4SU --34E-gcj9 [) Fax Number: E-mail Address: Name: Telephone Number: Fax Number: E-mail Address: Page 12 of 12JE-Verify MOU for Employerl Revision Date 10/29/081 www.dhs.gov/E-Verify ACORD CERTIFICATE OF LIABILITY INSURANCE OP ID RH DATE(MM/DD/YYYY) OLIPH-2 05/01/09 Pf;" —0—JCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Hausmann -Johnson Insurance Inc HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 700 Regent St., PO Box 259408 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Madison WI 53725-9408 Phone:608-257-3795 Fax:608-257-4324 INSURERS AFFORDING COVERAGE NAIC# INSURED INSURER A: Travelers Casualty 6 Surety 19038 INSURER B: The OlipKant Companies, Inc INSURER C: 8687 E Via De Ventura, Ste 318 INSURER D: Scottsdale AZ 85258 INSURER E: rnvrr�wnrn THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INbK LTR NSR TYPE OF INSURANCE POLICY NUMBER P I Y FE V DATE MM/DD/YY P U EXP DATE MM/DD/YY UMITS GENERAL UABILITY EACH OCCURRENCE $ 11000,000 A X COMMERCIAL GENERAL LIABILITY DTC09043L421COF-09 02/03/09 02/03/10 PREMISES(Eaoccurence) $ 300,000 CLAIMS MADE OCCUR MED EXP (Any one person) $ 10,000 PERSONAL &ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS -COMP/OP AGG $2,000,000 POLICY PRO - JECT LOC AUTOMOBILE LIABILITY A X ANY AUTO DT8109043L421TIL-09 02/03/09 02/03/10 COMBINED SINGLE LIMIT (Ea accident) $ 1,000,000 ALL OWNED AUTOS SCHEDULED AUTOS BODILY INJURY (Per (Per person) X HIREDAUTOS NON -OWNED AUTOS BODILX (Perac INJURY (Par accident) $ PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC E AUTO ONLY- EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE5 51000,000 A X OCCUR O CLAIMSMADE DTSMCUP9043L421IND-0902/03/09 02/03/10 AGGREGATE $ 5, 000, 000 S HDEDUCTIBLE $ X RETENTION $10,000 $ WORKERS COMPENSATION AND A EMPLOYERS' LIABILITY TORY LIMITS ER E.L. EACH ACCIDENT $1,000,000 ANY PROPRIETOR/PARTNER/EXECUTIVE DTEUB9043L421-09 02/03/09 02/03/10 OFFICER/MEMBER EXCLUDED? E.L. DISEASE - EA EMPLOYEE $1,000,000 If yes, describe under E.L. DISEASE - POLICY LIMIT $ 1, 0 0 0 , 0 0 0 SPECIAL PROVISIONS below OTHER DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS CERTIFICATE HOLDER CAPEJAY SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATIOI Cape Jaycee Municipal Golf DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN Course c//ooEC Design Group Ltd NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL PO Box 65036 IMPOSE NO OBUGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR West Des Moines IA 50265 REPRESENTATIVES. ACORD 25 (2001/08) © ACORD CORPORATION 1988 IMPORTANT If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). DISCLAIMER The Certificate of Insurance on the reverse side of this form does not constitute a contract between the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon. ACORD 25 !20011081 002987 TRAVELERS INSURING COMPANY: THE TRAVELERS INDEMNITY COMPANY One Tower Square, Hartford, Connecticut 06183 TRAVELERS CORP. TEL: 1-800-328-2189 CONTRACTORS COMMON POLICY DECLARATIONS ISSUE DATE: 04/23/09 POLICY NUMBER: OT -PRS -1532M395 -IND -09 1. NAMED INSURED AND MAILING ADDRESS: CAPE JAYCEE MUNICIPAL GOLF COURSE 3280 PERRYVILLE ROAD CAPE GIRARDEAU, MO 63701 2. POLICY PERIOD: From 06/01/09 to 06/01/10 12:01 A.M. Standard Time at 3. LOCATIONS your mailing address. Premises Bldg. Loc. No. No. Occupancy Address ON FILE WITH COMPANY 4. COVERAGE PARTS FORMING PART OF THIS POLICY AND INSURING COMPANIES: OWNER CONTRACTORS PROTECTIVE COV PART DECLARATIONS CG TO 03 03 95 IND 5. NUMBERS OF FORMS AND ENDORSEMENTS FORMING A PART OF THIS POLICY: SEE IL T8 01 10 93 6. SUPPLEMENTAL POLICIES: Each of the following is a separate policy containing its complete provisions: Policy Policy No. Insuring Company 7. PREMIUM SUMMARY: Provisional Premium $ 2,500 Due at Inception $ 2,500 Due at Each $ NAME AND ADDRESS OF AGENT OR BROKER HAUSMANN-JOHNSON INS (FU144) PO BOX 259408 MADISON, WI 537259408 IL TO 02 11 89(REV. 09-07) PAGE 1 OF i OFFICE: EDISON COUNTERSIGNED BY: Authorized Representative DATE: 002968 TRAVELERS POLICY NUMBER: DT -PRS -1532M395 -IND -09 EFFECTIVE DATE: 06-01 -09 ISSUE DATE: 04-23-09 LISTING OF FORMS, ENDORSEMENTS AND SCHEDULE NUMBERS THIS LISTING SHOWS THE NUMBER OF FORMS, SCHEDULES AND ENDORSEMENTS BY LINE OF BUSINESS. IL TO 02 11 89 COMMON POLICY DECLARATIONS IL T8 01 10 93 FORMS, ENDORSEMENTS AND SCHEDULE NUMBERS IL T3 83 09 06 EXECUTION CLAUSE OWNERS/CONTRACTORS PROTECTIVE LIABILITY CG TO 03 03 95 CG TO 07 03 95 CG TO 08 11 03 CG TO 36 11 03 CG 00 09 10 01 CG D3 17 11 03 CG 20 31 07 04 CG 21 70 01 08 CG 00 63 12 02 CG 31 31 04 02 CG DO 76 06 93 CG T4 78 02 90 CG F2 50 09 08 CG 29 29 09 87 CG 31 12 05 00 CG 29 51 01 96 CG 26 25 04 05 OWNERS AND CONTRACTORS PROT LIAB DEC DECLARATIONS PREMIUM SCHEDULE KEY TO DECLARATIONS PREMIUM SCHEDULE TABLE OF CONTENTS OWNERS/CONTRACTORS PROTECTIVE LIABILITY AMENDMENT OF COVERAGE-POLLUTIDN ADD'L INS -ENGINEERS, ARCHITECTS, SURVEY CAP ON LOSSES -CERTIFIED ACTS -TERRORISM WAR LIABILITY EXCLUSION FUNGI OR BACTERIA EXCLUSION EXCLUSION -LEAD EXCLUSION -ASBESTOS MISSOURI CHCS - DEFINITION OF POLLUTANTS MO CHANGES -CANCELLATION & NON RENEWAL MO CHANGES - POLLUTION EXCLUSION EMPLOYMENT-RELATED PRACTICES EXCLUSION MO CHANGES -GUARANTY ASSOCIATION INTERLINE ENDORSEMENTS IL T3 68 01 08 FEDERAL TERRORISM RISK INSURANCE ACT IL 00 21 09 08 NUCLEAR ENERGY LIAB EXCL END -BROAD FORM IL T8 01 10 93 PAGE : 1 OF 1 OWNERS/CONTRACTORS PROTECTIVE LIABILITY 002900 TRAVELERS J� One Tower Square, Hartford, Connecticut 06183 OWNERS AND CONTRACTORS POLICY NUMBER: DT -PRS -1 532M395 -IND -09 PROTECTIVE LIABILITY ISSUE DATE: 04-23-09 COVERAGE PART DECLARATIONS INSURING COMPANY: THE TRAVELERS INDEMNITY COMPANY Declarations Period: From o6-oi -o9 to 06-01 -10 12:01 A.M. Standard Time at your mailing address shown in the Common Policy Declarations. The Owners and Contractors Protective Liability Coverage Part consists of these Declarations and the Coverage Form shown below. The Common Policy Conditions do not apply to this Coverage Part. 1. COVERAGE AND LIMITS OF INSURANCE: OWNERS AND CONTRACTORS PROTECTIVE LIABILITY COVERAGE FORM LIMITS OF INSURANCE Aggregate Limit $ 3,000,000 Each Occurrence Limit $ 3,000,000 2. AUDIT PERIOD: NONE 3. FORM OF BUSINESS: CORPORATION 4. DESIGNATED CONTRACTOR: Name The Oliphant Companies, Inc. m= m= Malling Address 8687 E. Via De Ventura �— Scottsdale, -AZ 85258 o 5. LOCATION OF COVERED OPERATIONS: Golf course renovations, i nvl oves primarily irrigation renovation, grassing and minimal shaping. o 6. NUMBERS OF FORMS, SCHEDULES AND ENDORSEMENTS FORMING PART OF THIS COVERAGE PART ARE LISTED BELOW OR ATTACHED AS A SEPARATE LISTING. o o o— u� CG TO 03 03 95 PRODUCER: HAUSMANN-OOHNSON INS 002991 FU144 OFFICE: EDISON 06H . DtCLARATiONS PREMIUM SCHEDULE POLICY NUMBER: DT -PRS -1 532M395 -IND -09 This Schedule applies to the Declarations for the period of 06-01-09 to OG -01 -10 It shows all of your known rating classes as of the effective date. Any exceptions will be so noted. This Includes all locations you own, rent or occupy. CLASS PREMIUM DESCRIPT/ BASE/ ADVANCE LOC/BLDG NO. CODE NO. SUBLINE EXPOSURE RATES PREMIUM ST. OF MO CONSTRUCTION 335 C-1,050,000 FLAT $2,500 OPERATIONS - OWNERS CHARGE (NOT RAILROAD) EXCLUDING OPERATIONS ON BOARD SHIP/16292 *This class is subject to the prem/ops transition program. If an "X" Is entered In this box, these Declarations are completed on the Premium Schedule Extension CG TO 12. CG TO 07 03 95 Page 1 of 1 002902