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Home My WebLink AboutRES.2707.08-20-2012s BILL NO. 12-112 RESOLUTION NO. c2 0 1 A RESOLUTION AUTHORIZING THE CITY MANAGER TO EXECUTE AN AGREEMENT WITH APEX PAVING COMPANY FOR THE 2012 ASPHALT OVERLAY PROGRAM, IN THE CITY OF CAPE GIRARDEAU, MISSOURI BE IT RESOLVED BY THE COUNCIL OF THE CITY OF CAPE GIRARDEAU, MISSOURI, AS FOLLOWS: ARTICLE 1. The City Manager, for and on behalf of the City of Cape Girardeau, Missouri, is hereby authorized to execute an Agreement with Apex Paving Company, for the 2012 Asphalt Overlay Program, in the City of Cape Girardeau, Missouri. A copy of said Agreement is attached to this Resolution and made a part hereof. PASSED AND ADOPTED THIS(ZS J DAY OF _, 2012. I/ 0442�� Harry E. Aediger, Mayor ATTEST: ,, '� , z CITY OF CAPE GIRARDEAU 2012 ASPHALT OVERLAY PROGRAM STANDARD FORM OF AGREEMENT BETWEEN OWNER AND CONTRACTOR ON THE BASIS OF A STIPULATED PRICE THIS AGREEMENT is dated as of the a.l day of 11�1�� in the year 2012 by and between the City of Cape Girardeau, Missouri (hereinafter called OWNER) and Apex Pavinq Companv (hereinafter called CONTRACTOR). OWNER and CONTRACTOR, in consideration of the mutual covenants hereinafter set forth, agree as follows: Article 1. WORK. CONTRACTOR shall complete all Work as specified or indicated in the Contract Documents. The Work is generally described as follows: The locations for the work to be perFormed under these Contract Documents are William Street from Sprigg Street to Park Street and from Louisiana to Kingshighway; Bernice Street from Lakeshore Drive to Fremont Street; Old Highway 61 from Delta Drive to South Sprigg Street; Koch Street from Good Hope to Brink Street. The improvements consist of resurfacing the existing pavement on the above mentioned City streets; the removal and replacement of portions of curb, gutter, alleys, and driveways; adjustments to existing manholes and utility castings as well as re-striping for streets that have existing striping as noted for each location, all as described in the contract documents. The streets are located in various areas within the City of Cape Girardeau, Missouri. The existing surface of William Street will be overlaid by placing and compacting a 3/4 inch thin lift of new hot mix asphalt. The existing surfaces of Bernice St., Old Highway 61, and Koch Street will be removed by milling approximately 2 inches off the existing pavement and a new surface will be added by placing and compacting 2 inches of new hot mix asphalt. Article 2. ENGINEER. The City Engineer or his designee is to act as OWNER'S representative, assume all duties and responsibilities and have the rights and authority assigned to ENGINEER in the Contract Documents in connection with completion of the Work in accordance with the Contract Documents. A-1 � { ,� _ Article 3. CONTRACT TIMES. 3.1 The work will be substantially completed within Sixty (60� calendar days after the date when the Contract Times commence to run as provided in paragraph 2.3 of the General Conditions, and completed and ready for final payment in accordance with paragraph 14.13 of the General Conditions within Ninety (90) days after the date when the Contract Times commence to run. 3.2 Liquidated Damages. OWNER and CONTRACTOR recognize that time is of the essence of this Agreement and that OWNER will suffer financial loss if the Work is not completed within the times specified in paragraph 3.1 above, plus any extensions thereof allowed in accordance with Article 12 of the General Conditions. They also recognize the delays, expense and difficulties involved in proving the actual loss suffered by OWNER if the Work is not competed on time. Accordingly, instead of requiring any such proof, OWNER and CONTRACTOR agree that as liquidated damages for delay (but not as a penalty) CONTRACTOR shall pay OWNER Seven hundred fifty dollars $750.00 for each day that expires after the time specified in paragraph 3.1 for Substantial Completion until the Work is substantially complete. After Substantial Completion, if CONTRACTOR shall neglect, refuse or fail to complete the remaining Work within the time specified in paragraph 3.1 for completion and readiness for final payment or any proper extension thereof granted by OWNER, CONTRACTOR shall pay OWNER One thousand dollars 1000.00 for each day that expires after the time specified in paragraph 3.1 for completion and readiness for final payment. Article 4. CONTRACT PRICE. OWNER shall pay CONTRACTOR for completion of the Work in accordance with the Contract Documents an amount in current funds equal to the sum of the amounts determined pursuant to paragraphs 4.1 and 4.2 below: 4.2 For all Unit Price Work, an amount equal to the sum of the established unit price for each separately identified item of Unit Price Work times the estimated quantity of that item as indicated in the bidding documents. TOTAL OF ALL UNIT PRICES: Three Hundred Sixteen Thousand Seventv Dollars and Ninetv-two Cents ($ 316,070.92) As provided in paragraph 11.9 of the General Conditions estimated quantities are not guaranteed, and determinations of actual quantities and classification are to be made by ENGINEER as provided in paragraph 9.10 of the General Conditions. Unit prices have been computed as provided in paragraph 11.9.2 of the General Conditions. A-2 • 3 Article 5. PAYMENT PROCEDURES. CONTRACTOR shall submit Applications for Payment in accordance with Article 14 of the General Conditions. Applications for Payment will be processed by ENGINEER as provided in the General Conditions. 5.1 Progress payments; Retainage. OWNER shall make progress payments on account of the Contract Price on the basis of CONTRACTOR'S Application for Payment as recommended by ENGINEER, on or about the 10th day of each month during construction as provided in paragraphs 5.1.1 and 5.1.2 below. All such payments will be measured by the schedule of values established in paragraph 2.9 of the General Conditions (and in the case of Unit Price Work based on the number of units completed) or, in the event there is no schedule of values, as provided in the General Requirements. 5.1.1 Prior to Substantial Completion, progress payments will be made in an amount equal to the percentage indicated below, but, in each case, less the aggregate of payments previously made and less such amounts as ENGINEER shall determine, or OWNER may withhold, in accordance with paragraph 14.7 of the General Conditions. 90% of Work completed (with the balance being retainage). If Work has been 50% completed as determined by ENGINEER, and if the character and progress of the Work have been satisfactory to OWNER and ENGINEER, OWNER, on recommendation of ENGINEER, may determine that as long as the character and progress of the Work remain satisfactory to them, there will be no additional retainage on account of Work completed, in which case, the remaining progress payments prior to Substantial Completion will be an amount equal to 100% of the Work completed. 90% (with the balance being retainage) of materials and equipment not incorporated in the Work (but delivered, suitably stored and accompanied by documentations satisfactory to OWNER as provided in paragraph 14.2 of the General Conditions). 5.1.2 Upon Substantial Completion, in an amount sufficient to increase total payments to CONTRACTOR to 95% of the Contract Price (with the balance being retainage), less such amounts as ENGINEER shall determine, or OWNER may withhold, in accordance with paragraph 14.7 of the General Conditions. 5.2 Final Payment. Upon final completion and acceptance of the Work in accordance with paragraph 14.13 of the General Conditions, OWNER shall pay the remainder of the Contract Price as recommended by ENGINEER as provided in said paragraph 14.13. Article 6. INTEREST. All moneys not paid when due as provided in Article 14 of the General Conditions shall bear interest at the maximum rate allowed by law at the place of the Project. A-3 � � .� Article 7. CONTRACTOR'S REPRESENTATIONS. In order to induce OWNER to enter into the Agreement, CONTRACTOR makes the following representations: 7.1 CONTRACTOR has examined and carefully studied the Contract Documents (including the Addenda listed in paragraph 8) and the other related data identified in the Bidding Documents, including "technical data". 7.2 CONTRACTOR has visited the site and become familiar with and is satisfied as to the general, local and site conditions that may affect cost, progress, performance and furnishing of the Work. 7.3 CONTRACTOR is familiar with and is satisfied as to all federal, state and local Laws and Regulations that may affect cost, progress, performance and furnishing of the Work. 7.4 CONTRACTOR has carefully studied all reports of explorations and tests of subsurface conditions at or contiguous to the site and all drawings of physical conditions in or relating to existing surface or subsurface structures at or contiguous to the site (except Underground Facilities) which have been identified. CONTRACTOR acknowledges that such reports and drawings are not Contract Documents and may not be complete for CONTRACTOR'S purposes. CONTRACTOR acknowledges that OWNER and ENGINEER do not assume responsibility for the accuracy or completeness of information and data shown or indicated in the Contract Documents with respect to Underground Facilities at or contiguous to the site. CONTRACTOR has obtained and carefully studied (or assumes responsibility for having done so) all such additional supplementary examinations, investigations, explorations, tests, studies and data concerning conditions (surface, subsurface and Underground Facilities) at or contiguous to the site or otherwise which may affect cost, progress, performance or furnishing of the Work or which relate to any aspect of the means, methods, techniques, sequences and procedures of construction to be employed by CONTRACTOR and safety precautions and programs incident thereto. CONTRACTOR does not consider that any additional examinations, investigations, explorations,tests, studies or data are necessary for the performance and furnishing of the Work at the Contract Price, within the Contract Times and in accordance with the other terms and conditions of the Contract Documents. 7.5 CONTRACTOR is aware of the general nature of work to be performed by OWNER and others at the site that relates to the Work as indicated in the Contract Documents. 7.6 CONTRACTOR has correlated the information known to CONTRACTOR, information and observation obtained from visits to the site, reports and drawings identified in the Contract documents and all additional examinations, investigations, explorations, tests, studies and data with the Contract Documents. A-4 R { 7.7 CONTRACTOR has given ENGINEER written notice of all conflicts, errors, ambiguities or discrepancies that CONTRACTOR has discovered in the Contract Documents and the written resolution thereof by ENGINEER is acceptable to CONTRACTOR, and the Contract Documents are generally sufficient to indicate and convey understanding of all terms and conditions for performance and furnishing of the Work. Article 8. CONTRACT DOCUMENTS. The Contract Documents which comprise the entire agreement between OWNER and CONTRACTOR concerning the Work consist of the following: 8.1 This Agreement (pages 1 to 7 inclusive). 8.2 Exhibits to this Agreement (pages BF- to BF- , inclusive). 8.3 Performance, Payment, and other Bonds, identified as exhibits and consisting of pages. 8.4 Notice to Proceed. 8.5 General Conditions (pages 1 to 55 , inclusive). (EJCDC No. 1910-8 1990 Edition) 8.6 Supplementary Conditions (pages SC-1 to SC-5 , inclusive). 8.7 Specifications bearing the title 2012 Asphalt Overlav Proqram . 8.8 Drawings. 8.9 Addenda numbers 1 to 1 , inclusive. 8.10 CONTRACTOR'S Bid (pages BF- 1 to BF- 8 , inclusive) marked exhibit "A" . 8.11 Pursuant to 285.530 R.S. Mo, the contractor must a�rm its enrollment and participation in a federal work authorization program with respect to the employees proposed to work in connection with the services requested herein by 1) submitting a completed, notarized copy of AFFIDAVIT OF WORK AUTHORIZATION and 2) providing documentation affirming the bidder's enrollment and participation in a federal work authorization program with respect to the employees proposed to work in connection with the services requested herein. 8.12 Documentation submitted by CONTRACTOR prior to Notice of Award (pages _to , inclusive). 8.13 The following which may be delivered or issued after the Effective Date of the Agreement and are not attached hereto: All Written Amendments and other documents A-5 � , J amending, modifying or supplementing the Contract Documents pursuant to paragraphs 3.5 and 3.6 of the General Conditions. The documents listed in paragraphs 8.2 et seq. above are attached to this Agreement (except as expressly noted otherwise above). There are no Contract Documents other than those listed above in the Article 8. The Contract Documents may only be amended, modified or supplemented as provided in paragraphs 3.5 and 3.6 of the General Conditions. Article 9. MISCELLANEOUS. 9.1 Terms used in this Agreement which are defined in Article 1 of the General Conditions will have the meanings indicated in the General Conditions. 9.2 No assignment by a party hereto of any rights under or interests in the Contract Documents will be binding on another party hereto without the written consent of the party sought to be bound; and, specifically but without limitation, moneys that may become due and moneys that are due may not be assigned without such consent (except to the extent that the effect of this restriction may be limited by law), and unless specifically stated to the contrary in any written consent to an assignment no assignment will release or discharge the assignor from any duty or responsibility under the Contract Documents. 9.3 OWNER and CONTRACTOR each binds itself, its partners, successors, assigns and legal representatives to the other party hereto, its partners, successors, assigns and legal representatives in respect to all covenants, agreements and obligations contained in the Contract Documents. 9.4 Any provision or part of the Contract Documents held to be void or unenforceable under any Law or Regulation shall be deemed stricken, and all remaining provisions shall continue to be valid and binding upon OWNER and CONTRACTOR, who agree that the Contract Documents shall be reformed to replace such stricken provision or part thereof with a valid and enforceable provision that comes as close as possible to expressing the intention of the stricken provision. 9.5 Pursuant to 292.675, R.S. Mo, the contractor is informed that all contractors or subcontractors doing work on this project to provide, and require its on-site employees to complete, a ten (10) hour course in construction safety and health approved by the Occupational Safety and Health Administration ("OSHA") or similar program approved by the Missouri Department of Labor and Industrial Relations which is at least as stringent as an approved OSHA program. The training must be completed within sixty(60)days of the date work on the project commences. On-site employees found on the worksite without documentation of the required training shall have twenty (20) days to produce such documentation. 9.6 The General Contractor shall provide to the City of Cape Girardeau City Engineer's A-6 � { Office weekly certified payrolls from the General Contractor and all Subcontractors during the course of the project. These must be provided on a weekly basis; if no work was done, then a payroll stating "No Work Done" must be submitted. IN WITNESS WHEREOF, OWNER and CONTRACTOR have signed the Agreement in multiple copies, One counterpart each has been delivered to CONTRACTOR and ENGINEER and two counterparts to the OWNER. All portions of the Contract Documents have been signed, initialed or identified by OWNER and CONTRACTOR or identified by ENGINEER on their behalf. This Agreement will be effective on ��('ri�� .� , 2012 (which is the Effective Date of the Agreement). OWNER City of Cape Girardeau CONTRACTOR Apex Paving Company " Scott Me Clt ana er Glen Graham, President ; � B : By: " � [CORPO ATE S AL] [CORPORATE SE/�L].�-. ,:;�ti > ' � �� Attest ' � j ' . �. ' Attest Gayle L. onrad, City Clerk Kelly Schaefer, asst. Secretary Address for giving notices Address for giving notices 401 Independence Street Po soX 637 Cape Girardeau, MO 63703 Cape Girardeau, MO 63702 0637 (If OWNER is a public body, attach License No. evidence of authority to sign and resolution or other documents Agent for service of process: author' ' '��on of Agreement. ��1gAr�.,_ ,�, -� � � �� '�'�.��, (If CONTRACTOR is corporation, v� �� '',�-��_�-:�� attach evidence of authority to sign.) � ;� ,, ��,>>� ,t�;. o \ 'I`�� e''r, :� ,�,�- ,'.� ��7, , v THE IINION� � �yF��. �EAti �.t�._ A-7 • � ' EXHIBIT "A" CITY OF CAPE GIRARDEAU 2092 ASPHALT OVERLAY PROGRAM BID FORM (EJCDC 1910-18) (1990) PROJECT IDENTIFICATION: The improvement consists of resurfacing the existing pavement on portions of Wlliam Street, Bernice Street, Old Highway 61 and Koch Street; the removal and replacement of portions of curb, gutter, alleys, and driveways; adjustments to existing manholes and utility castings as well as re-striping for streets that have existing striping as noted for each locafion, all as described in the contract documents. The streets are located in various areas within the City of Cape Girardeau, Missouri. The exis#ing surface of Wlliam Street will be overlaid by placing and compacting a 3/4 inch thin lift of _---. -- - - new hof mix asphafi. T�ie existing-surfaces of Bernice St�;-Ord-F�ighway 67 j and-Koch Street will be removed by milling approximately 2 inches off the existing pavement and a new surface will be added by placing and compacting 2 inches of new hot mix asphalt. TH1S BID IS SUBMITTED TO CITY OF CAPE GIRARDEAU, MO 401 1NDEPENDENCE STREET CAPE GIRARDEAU, MO 63703 1. The undersigned BIDDER proposes and agrees, if the Bid is accepted, #o er�ter into an agreement with OWNER in the form included in the Contract Doeuments to perform and furnish alf Work as specified or indicated in the Contract Documents for the Bid Price and within the Bid Times indicated in this Bid and in accordance with the other terms and conditions of the Contract Documents. 2. BIDDER accepts all of the terms and conditions of the Advertisement or Invitation to Bid and Instructions to Bidders, including without limitation,those dealing with the disposition of Bid security. This Bid will remain subject to acceptance for sixty days after the day of Bid ____ _ _ _ opening. BIDDER will sign and deliver the required number of counterparts of the Agreement with the Bonds and other documents required by the Bidding Requirements within fifteen days after the date of OWNER'S notice of Award. 3. In submitting this Bid, BIDDER represents, as more fully set forth in the Agreement, that: (a) BIDDER has examined and carefully studied the Bidding Documents and the following: Addenda, f@Celpt Of aII WIIICFI IS Il2f2bY aCICIIOWIeC�g2CJ: �List Addenda by Addendum Number and Date) BF-1 � � � L�c e��1L�r� 1 - �� >� ;, - - (b) BIDDER has visited the site and become familiar with and is satisfied as to the general, locai and site conditions that may affect cost, progress, performance and furnishing of the Work; (c) BIDDER is familiar with and is satisfied as to all federal, state and local Laws and Regulations that may affect cost, progress, performance and furnishing of the Work. (d) BIDDER has carefully studied alt reports of explorations and tests of subsurface conditions at or contiguous to the site and all drawings of physical conditions in or relating to existing surface or subsurface structures at or contiguous to the site (except Underground Facilities) which have been identified. BIDDER acknowledges that such reports and drawings are not Contract Documents and may not be complete for BIDDER'S purposes. BIDDER acknowledges that OWNER and Engineer do not assume responsibility for accuracy or corripleteness of information and data shown or indicated in the Bidding Documents with respect to Underground Facilities.at or contiguous to the site. BJDDER has obtained and car.efufly s#udied (or assumes responsibility for having done so) all such additional or supplementary exarninations, investigations, explorations, tests, studies anc�data concerning c�nditions(surface,subsurface and Underground Facilities)at oc contiguous to the site or atherwise which may affect cost progress, performance or furnishing of the Work or which relate to any aspect of the means, methods, techniques, sequences and procedures of construction to, be employed by BIDDER and safety precautions and programs incident thereto. BIDDER does not consider that any additional � examinations, investigations, explorations, tests, studies or data are necessary for the determination ofithis Bic#.for.per�ormance and furnishing of the Work in accordance with the � times, price.and ottier.terms anc#.conditions of ihe ContracE Documents. (e) BIDDER is aware of the general nafure of Work to be performed by Owner and others at. the site that relates to Work for which this Bid is submitted as indicated in the, Contract Documents. (fl BIDDER has correlated the information known. to BIDDER, information and observations obtained from visits fo the sife, reports and drawings identified in the Contract Documents and all additionat examinations, invesfigafions, explorations,tests, studies and data with the Contraet Documents. (g) BIDDER has given Engineerwritten notice of all conflicts, errors, ambiguities or discrepancies that BIDDER has.discovered in the Contract Qocuments and the written resolution thereof by ENGINEER is aceeptable to BIDDER, and the Contract Documents are generally sufficient to indicate and convey understanding of all terms and conditions for performing. and furnishing the Work for whicfi this Bid is submitted. BF-2. . , Any questions, comments, or concerns regarding the design of this project should be addressed to Jake Garrard, E.I., City of Cape Girardeau at 573-339-6327. (h) This Bid is genuine and not made in the interest of or on behalf of any undisclosed person, firm or corporation and is not submitted in conformity with any agreement or rules of any group association, organization or corporation; BIDDER has not directly or indirectly ind�!ced er solicited anl� other Bidder to submit a false or sham Bid; BIDDER has not solicited or induced any person, firm or corporation to refrain from bidding; and BIDDER has not sought by collusion to obtain for itself any advantage over any other Bidder or over OWNER. (i) Pursuant to 285.530 RSMo, the bidder must affirm its enrollment and participation in a federal work authorization program with respect to the employees proposed to work in connection with the services requested herein by • submitting a completed, notarized copy of AFFIDAVIT OF WORK AUTHORIZATION and • providing documentation affirming the 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. • http:/Iwww.uscis.qov/portal/site/uscis (j) Bidders are informed that the Project is subject to the requirements of Section 292.675, R.S. Mo, which requires all contractors or subcontractors doing work on the Project to provide, and require its on-site employees to complete, a ten (10) hour course in construction safety and health approved by the Occupational Safety and Health Administration ("OSHA") or similar program approved by the Missouri Department of Labor and lndusfrial Relations virhich is at least as stringent as an approved OSHA program. The training must be completed within sixty (60) days of the date work on the Project commences. On-site employees found on the worksite without documentation of the ___ceq.uiced._training sha11.ha�e twenty (20:) days to-produce such-documentation. BF-3 • , 4. BIDDER will complete the Work in accordance with the Contract Documents for the following price(s): UNIT PRICE BID No. ITEM UNIT EST. UNIT PRICE TOTAL EST. QTY. PRICE 1 Hot Mix Asphaltic Concrete Ton 1568 $ � v � $ I V ��v `b� (3/4"Thin Lift) 2 Hot Mix Asphaltic Concrete Ton 1434 $ v��•� $ ��a��•�� (MoDOT BP-2) 3 Liquid Asphalt Tack Coat Gal 5103 $ d, (�� $ a�5. l5 4 Milling SY 7515 $ �-1� $ � � . s �� 5 Replace Concrete Curb LF 10 $ �. �� $ 4J� . 4u and Gutter 6 Replace Concrete A!leys SY 16 $ 2'1 $ `�� and Driveways � ' � Single Curb Ramp with Each 12 $ ��• � $ lX 4 • �� Truncated Domes 8 Double Curb Ramp with Each 24 $ �� $ �� b� Truncated Domes ' 9 Concrete Patch SY 89 $ �� $5��"� 10 Adjust Manhole Each 31 $ W $ �• � 11 Adjust Valve Box Each 35 $ � $ a ��7. � 12 Striping-Double Yellow LF 6890 $ �, A� $ l� �U Line Striping-Dashed Yellow /� �� 3 Line LF 2805 $ Q.`i L. $ 14 Striping-Dashed White LF 13140 $ �. �Z $ � � � Line 15 Striping-Solid White Line LF 534 $ �. 2 $ c� Zg 16 Turn Arrows Each i6 $d.5� ' � � f�1. � 17 Temporary Traffic Control LS 4 $ �i �� $ 2�� •� �t�� r\� Ol7 18 Temporary Erosion Control LS i $ � a c:la> $ u - i9 Base 5 Aggregate Ton 276 $ � � � $ 2�� 20 Butt Joint and Spot SY 798 $ � �� $ � . � MiUing 21 Asphalt Patch SY 80 $ � $ `� �� TOTAL BID FOR ALL UNIT PRICES $ � � � �—� �, qa -7'hr..-� h u� c� �i x�-,�p ►� -�he�u��I �Q�� ,� c�l (C�-�1 S ��,�,� ��U ��-f-S (Written figure) ADDENDUM One BF-4 Bid Form , (Total bid amount is to be shown in both words and figures. In case of discrepancy, the amount shown in words will govern. In case of error in extension, the unit and lump sum prices under each Pay Item will be considered correct, and these sums when properly extended, shall constitute the Bid.) Unit Prices have been computed ir accordance 4^rith paragraph 11.9.2 of the General Conditions. BIDDER acknowledges that quantities are not guaranteed and final payment will be based on actual quantities determined as provided in the Contract Documents. 5. BIDDER agrees that the Work will be - � -� � ' �. - calendar days after the date when the Contract Times commences to run as provided in pa�agraph _ _ .___ __.--------- ----------------- --- ---_----_------------------r------ 2.3 of the General Conditions, and completed and ready for final payment m accoraance with paragraph 14.13 of the General Conditions within Ninet 90 calendar days after the date when the Contract Times commences to run. BIDDER accepts the provisions of the Agreement as to liquidated damages in the event of failure to complete the INork within the times specified in the Agreement. 6. The following documents are attacfled to and made a condition of this Bid: (a) Required Bid Security in the form of bid bond or cashiers check. (b) Acknowledgement of any addenda issued. (c) Exhibit Affidavit of Work Authorization (d) Exhibit Affidavif of Excessive Unemployment (if applicable) (e) The E-Verify Program for Unemployment Verification Memorandum of Understanding http://www.uscis.qov/files/nativedocuments/MOU.pdf {f� Exhibit Affidavit ofOSHA Training (g) Certification Regarding Debarment, Suspension and Other Responsibility Matters 7. Bidder agrees to submit the following documents within three (3) business days after fhe opening of Bids if requested: (a) BIDDER'S Qualification Statement with supporting data. 8. Communications concerning this Bid shall be addressed to: f� ; Name �� .�� -s,1�i �i��rr, BF-5 . , ;1 ,,, , � � � � �! / ,1 , , ,�r ' Address _L /+�(_�X �' � � � �/r �'�� -="[ ' i��:t:i�� '�C.t!,: �> � ' '�� C�/�::: ; .�-- �--- (a) Performance and Payment Bonding Company / 5 Name (��i � �� f ��:�` L ;;1-` � ;� , Address �-,, ''Q �(;� � � . ! Q � L. � �G`�,� Agent\Power of Attorney Name (if used) Address 9. Terms used in the Bid which are defined in the General conditions or Instructions will have the meanings indicated in the General Conditions or Instructions. SUBMITTED on � �, 20�j State Contractor License No. IF BIDDER is: /An Individual gy (SEAL) (Individual's Name) doing business as Business address: Phone No.: - ----....__ A Partnership gx (SEAL) (Firm Name� (General Partner} Business address: Phone No.: , BF-6 , , A Corporation r BY (SEAL) (Corpo tion Name) (State of Incorporation) r r ' gY " (SEAL) (Nam� of P son A th�rize� to Sign) '� s `�'�> ''� � �1 Wi �t(�1'}11 ��.�,11�� (Title) 4.- � (Corporate Seal) ., � p,; � .f' 4 - �"'� 'j� _ � ' J `3 Attest f,, `: � � f - � ,, //,,ry}f� ' '` a.JA" �yv` a �d �, �,�.,Y,- �l.Y�� '� �:&�S'�s-,,.4..', �.� (Secreta , � ' :�� i '� � ,� �. __.__.�_ _ __ _ _ �.��. _ Business address` _ � , � 3� Phone No.: ��J �� '�� Date of Qualification to do business is °,� A Joint Venture BY (SEAL) (Name) � (Address) - BY (SEAL) (Name) {Address) Phone Number and Address for receipt of official communications: (Each joint venturer must sign. The manner of signing for each individual, partnership and corporation that is a party to the joint venture should be in the manner indicated above.) B F-7 , , BREAKDOVIJN OF W�RK F�RCE (R�quired): The Contractor shail be registered with the Missouri Secretary of State in order to work on this project. BIDDER hereby states that he will perform the following items of work directly without employment of subcontractors: It is anticipated that the following subcontractors will be employed for work on this project: *SUBCONTRACTORS: {Name of Gompany) (�fype of Work) *All subconfraefors shall be registered with the Missouri Secretary of State in order to work on this project, BF-8 , � � THE AMERICAN INSTITUTE OF ARCHITECTS AIA Document A310 Bid Bond NOW ALL MEN BY THESE PRESENTS, THAT WE Apex Paving Company '.O. Box 880 , Cape Girardeau, MO 63702 � Principal, hereinafter called the Principal, and Libertv Mutual Insurance Company �044 Montgomery Road , Cincinnati, OH 45236 corporation duly organized under the laws of the State of Massachusetts ;Surety, hereinafter called the Surety, are held and firmly bound unto City of Cape Girardeau, 401 Independence, Cape Girardeau, Missouri Obligee, hereinafter called the Obligee, in the sum of Five Percent of Total Bid Dollat'S($ 5� of Total R;d ), �the payment of which sum well and truly to be made, the said Principal and the said Surety, bind ourselves, our heirs, ecutors, administrators, successors and assigns,jointly and severally, firmly by these presents. -iEREAS,the Principal has submitted a bid for 2012 Asphalt Overlay Program >W, THEREFORE, if the Obligee shall accept the bid of the Principal and the Principal shall enter into a Contract with : Obligee in accordance with the terms of such bid, and give such bond or bonds as may be specified in the bidding or ntract Documents with good and sufficient surety for the faithful performance of such Contract and for the prompt yment of labor and materials fumished in the prosecution thereof, or in the event of the failure of the Principal to enter :h Contract and give such bond or bonds, if the Principal shall pay to the Obligee the difference not to exceed the �alty hereof between the amount specified in said bid and such larger amount for which the Obligee may..in good faith itract with another party to perform the Work covered by said bid, then this obligation shall be null and v�gi�i,�o�heryvise �emain in full force and effect. f�"��#E'� :' ,�'�1Y� ��. ` / p` ,: 14th Au ust � :;�,.'` ��;` '`2{��:h�" - ined and sealed this day of g � .. ,x . , • , s . � f.r{`' K � .� ;k' � � r ��":: s � r . x: �� ,, �M� A exP vin Com an r��' >�:; `�� ;,_;��:`�� r cipal) ;�' (Sealf �fness) .� � ,� � �,``�,f`,-•, irginia Smith, Asst. 3ecretary e : ��'' �/��:'�� t Glen Graham, President y4�'�'F • �de) , �J � , Liberty Mutual Insuran e Company "_' (Sure ' ,�`,..-' js`ea� - ; °°` y ` " • ��:•^RY"t?'E{t'' � eline avidson �tness) �•� � r ,q�.. � � Rttomey-� a e Porrin� • '_-, _ ' �~'��°�: �r>; a 3. 1 " :r' AIA DOCUNtGNT A310�BID BOND• IA�FEB ARl'1970: D.�THE AMERIC "- 'r ;� ,._✓,�o � �� i, INSTITUTE OF ARCHITECTS,1735 . . .,N.W.,WASH GTON,D.C.Z0006 't � - 'r.JFt(�7tt# tr_�,-�,5,,.� � ... t 4�,+�i,. ... ,��'��`t`. -1 \ �-.:-� _�i-- -. -;. � .,-� " �'��. ' ` ::._ : - ,` .� �..� � � �. . -.-� ��_ _ _ � : i IIS`-POWER SJF A�TDRN�Y�S�IOT VAI�D�lNLESS�7'�S�,giI�TED'OCI,R�D�BACKGR6Ul�D : - � . .: � _ .�,.v. .� � �. ;� � _ _ . is`'Powec-of At�orriey lirriits Yhe�ac�s of those named fiere�ri,;and fFiej��iaye=no`aut�o�aty to b�na�`he�ompany exc�pt in,�he mannerand to�he :: _.. _ ,_ . � - - _ _ :_, _ ; . tent herein stated:: � � - - �., ��. .,_. . _ _ - - - L1B�RTY IGIf!'fGAL.��URdN��C(�1111PANY - - BQS�O(�,JNIASSAGHti$E�i'S� POWEROFAAT�ORHEY � � �-.-.: '1`/\ �_\ / , . - _ " _ ,/:.;; "\"i " IOW ALL�.ERSONS BY THESE Pi3ESENTS That Liber�y-Mutual�nsurance�CompanY(the Compa�)a_Wlassac�iuselts stoak insU"rance�company - . � . .- r� ^� > , . �� r�uant to and by authQnty�f f-theBy�av�r and�u��tion,lie��o"�s-�i��tzy�fa�e oor�titute�ar�t�apRoint ,1�1iNt�E7�F.-f�ORRlt�1�- ACYA11/��A�DATIIEL�E M^BE��F�D;_ALL OF�WE�I�(�Of HA��\OR�SlT�(�J,�;,OF�O�„I(��JGU,T�.�.,�� ,��,v..� � , � ,�^� � .% aeh mdrnd�fally af�tiere be-m6re than one tfalnea t�s":�ru��n8`IawT�C.a'fto e �tF>fact3o�na�Ce eYcecufe sQa�ac�irtob�ed e�nd d'elixe,r ibfar�d��r��s l f �i- . ' - • ��.��.... �•_ . -�;_,...�, 9 .. �, ialfas�u�ety and�as�ts act�r�-td deed any iLd al�dertak�ngs tloedsi7�coyi�iz�n�e��lid tt�s��sur�`o.t�li9�at�o9S`,i�ttl,e:g��al�uhi�oY�x�egdir�g d �;HUNARED NAILI�TAN�LL�Q0C19Q�+'�►..+�`�a�"�'�-*"RL�s„�:�"�+"�'��Lk��id�Q,.��'��.�,..;,.�.a.*,�r ,��each;ar�d t� : .�utionoTsuchifnderf`awri�s bon�,s�,{�coZjn�zances�;a 3ofhersu�e�ot�li a��slTi��[sua��e'o�.tJese,p�,esents�a��e-asbindia�.u�onthe��pa� s if=fhsy had::been du'Cy.sigqed��he�-F�esrd�nt;�nd�e t�d� ttte sed��r o.�1��`a�aY in�ei��ow�ptnReGpe[sbns . .� " . _. . � . • - :: ..._. .. �� '. � _�� .... \-'/� � �� / � fti��. ._.. ._": .`. �. J .� �� \ ; ..,, i'�� .' ,\ '-, _ 3f this po,wer�s mai7e and ezecufed{�ursuant Eo and�y authonty of�he fi�lovuing.By�wand�luthonzat�ort : � . _ , ,..� r - -- � ,. ARTIGLE XIII F�cec`ut�on of'�-qn�aqts:�ec6oa=�.�nr or��nc��1n�er�w �� .i _� . � i- �- f-. . �� v�..� -� �^ ✓'�... .r �...�,..-�-� ��.,�..�. �Y��cer af 4h��ory�Ra��►��h�p��E�'�'�cl�m�y�� L��icf�aa4�S��g�=�t9 5��13��,��1�j� , �. � .-� i. -•: c�airr�an or-tfie presi,e t�fnay p?escnb�s�.i�ll;appoir�t�suEFi atfol�eyr�s.�n`act�as�ay"be�nece,�sar�r3o.�dl�et�a�"�#h�o�ri�apx'fd-�rr�ake ei�ecute;seat,�ckna�nr�d,ge and deliv�er�s s�rely�a,�i;and a11,��5de�r��ki��s�ond��eccs.gntzances��b �?�ar.et��i-"''oblic,�a�or��rSu�� a�e..y�s_a�;� �n�#acf �ub��v<kFi��lipyit�,�rv�-setfoftb�n�aei�ytesp`.ee'fiV��!er�st�'f�'#tbr.e��s}�Tl,�tave=fiil�OjareC3o`�d3n��'rn�t�n�Y3ti,ir,ig�n�'��r.��r�c��.y� r `� executioF�df��aq.�u��n3�Jr unlent�s-and.�o�c-}t�h�rEto�e se�l��F�e� a �7V�ienso�execu�e'��ifcfi i entssTia'Ifb"��brnd��a�;�'�`at �,� .. ,�,._ �P��Y �t�- �� -,:..; sign�f�y th�{ir�s�den,�rfd��sf�d-by�fse se��e�-; -� . -� � ✓ � � 9 � � , � ��.,--^. ,-�...-� . ,� � .� ` ,� ' _ . �.. ' :i -Y : ._"''1 .._ .� :� � , � � � � ✓ � i � - 1 -`�� .v..� - �� .�_� : ., r-�.�.3; the�ol{o�nnn�yns"trument tfie_chairm�n or the pres�den�has au'fFionz�tl Xhe officef..ocotheroffi�af n,a'r�ie�'th�rein fo ap��nf�t�or�eys uT� , �� . ,j. �` `= '�;- . - ;�'� �,.."�. ' �� \"f'`.---:� �:- � _/=� i ,j.` � .�,:` \ .��.:��../.�:i� � 1 i� P b T�✓ �ie�Uf ect�o[t5 o#th � ' ,-- � � � � � �-,-�✓ �� ug`ua � PA�ti" ,'$ � �- Y;�}n�s`,�Jz� r�" ��ntSecr QtLyb� -1Qf-d�1�i�an'su�" "Tnp,a , t�.c'e�k'��fhR"nz, .:--� ,t3>a i�i�'�' �7' s a �� Y� �� . �.,.. 3� �.��, ^ .� � ,.:P��. ��,3�� r�a�,.��.Y,_.-�,��-�� ." ��'tPs��+�K��3�y.��^�;��-�.�L,�'� an arl .al��e kir�'; �� Te� aizances a � r'sd b i `a ons^�• �`'�;� `"�._ �.,�• ��,_�-�-��;..�^.� Y�l ��.9�� r ,--� .��, �:�"�� # ..., . .-� -, � ,�. � �,,./',-C�:� ��:, -.�_l�� ti/�'��- �/-\��„�-�\J�1✓�-• �,J �/.�'-. .. .,1 ��-..^.��:��\� �.% �^ ` Ji�� ` �.�'\i � . :�� \ �•_� c :_��.�_\_.-: ' •1L/"'`�..tii ��../1 � � �.=�.�� ^✓ \�" \�:ri'� � � "'� %� -�� i'� � �\.^'%`'• . � '�. �1��`",y�?4v�rrdtlle.Rv�ioaza'-6Qn.-3e`t�or:ktiabo��..fe�nye��le�1[t��n�a��rt��IG�t��et[ec��:`:�'�`.�. --�'�,�r:�,=. � .�.,. ^- /tiC �' .. . '�._.r.:�`l _�`' '%�-� l'�='^.�i--• � �.- _ ` . .�✓r u. ^ . �� .. �, � ./ " �- '. �' � ...' _ - ��`.�`�-` _ ..i/. . �,---��`�.�=.f^:��... . -^ ... J.��=�J V�"�.�57~ �. � .. ��`i L `� � ^� .. � v . . �-:�.-,`.,/� � �\ � s;V1(�t�E�,�J�� tOmgy�a,��4�'��ffic��r,r��a��rd�h..9i��af��-�� iaT�aranc�Co�ni an�'�as'fi�e✓fi'�1fixe�t�i�reto�n-�,�noutf►,ivl"�6e ra�?�ra�s�iRama��d�ofir��,`�a'�j s.� ==��,.-•:��:�^� �0� �l r- _ �,� ✓ � �l^ `' ^. � "� "_��....T� ��-;✓�✓,'=-\....,�'-�:��'- .. � ^�(_-�I�II��i�AL;I S��C��Ul1�IP •-,^'~•^\ � � - _ -�+sa fi�BE.1Z ��,_. ��-�:_;-�\�-��^. - . �,:^ �-. ! ' �' ��•,"�:� - _`:r^.. _. �--✓-�. !�.��<�.:. _ �� ., �� :-.. � .� _� _ . ti, %~-�=:"; .� -� ��..: ` `��'^. � ' �:� - 't' a.�Y .� � . � � y�` f.�. r '� -. .i \�.� �...� ��.i �- - � . A �M��-� +�� MIVt¢f�fUf7E%kC'EF��F-FEL�N�Y-�Vr�h11Pa ss '� a1�i� ce s t- � .� �'-'� �l�'Y'!DE.�VIbI�-T��TuiERY - � , _ '�--��~� � .; . ` ...i � - _ � '. _.�.. `":.., _,-� � � r,.-�.i.-�'�'�. `•f -. ., � . �, �. - .� . . .�` �.� � _ f._ � . . �i)�s�5�� da��f .: �1�' , �d?� be�or� �rey a��lota7y 1'nbhc �e�isa-`a`i��ca�iRe�a�dVl �1r�to�ie fcii�u�rr%.a� ^ . _-_—�.. . , .� ,, � ,. ,,�;, � �owlQ�eci;fMatfie;is�n Assisf�n�.�5e'crefary;of U6ef3y-l�ldtua�-(nsutance�mpany �hatTie knows`ftt�e s��7'said sxi ra't�t�,aa�c`y-thathel�xeccxv�e- � 8tzo5e PoWe�of�ttOCnBy arid affixed the corp6rat@ s$�F b�t�bertsi NJGtUBYln�nfance Compar�'y ff�efe'�o w�tf]�h€�Gt�o��JTd�f#h��dij'�c�i�?1 b��ait �-'� �rat�bR - _ : : , � �� -. .,� _ - , . :: ^` - ^ �� CESTIMONY WHEFt e�j o subscribed my ha�e;ant3�ffiXed rny notanal seal at Plymo�lth M�etir�� P�nns�+lvani� brrthe d��an�l ye�r w,� abovewritEen ' Q� �d+�� -ft, , - � � - ,�4. 5 T� Not3natSeal; � Teresa Pps:gli.�-AfotgryFy��„ �5F P�imO.rtl*'fWp.fdCNB,��°�- �, i F -% � _ , _. .�� i�y. ?��a., .�:�.�t3:; Y�7 �=�� s��=� �-� - :4 b - `�" . " .�e e�msy�a�taa�oct�x>nof �"e7eS�P��t�tla I�of�ry��'�ir�,, - ,v,��- ; : _ 2TIFICATE � �54�: _ `O .. y ?t'S1(4. �4 ' . ' F„r e undersigned Assis er[�_A7lutual Insurance CompaaY do heieby ce_ctiTjr that the_on�naF�ver of�ttom�y of�nthicfir.the foregoing ts ;; .. _ : ,�.. • . _. � Il;,;frue and.correct�copy t ;, ce arrd ei��ct or�_�tJe t�ateo�this cexti_fieafe a�d 1 do fu�th�r ce.rti�yihatth�officet:dr��ficial who ex�cut�d-tFe s�ld- . ier_of attocri�X�s an Assista`rit S�eexe�tary speqally au�tion�e�bX the chairman or_fkte president tQ ap��t attomey�-in f�ct as provic7ed irt�c1e XNl � .,. _. _: _. �ion 5 oitfie By laws of Lib�rty Mufu�t InsuraRce�orti�pan�-. : ': .. - _:- -� _ _ >certificate and the abov�pouver of attomEy rriay be signed by facsimil�:or mecharncally r�produced signatures urrder.and by-2uthonty:ofithe fgflowing :of the board of directors of Liberty Mutual tnsurance Company at aineet�nq duly called�and held oh tfie'f2�h day of:March,,1980. .. �: .�� : . �. .: 1 .,'�!+- : � �_ -:: �. - _ �. . � � �ry�� , . . . VOTED that the facsimile or mechanically reproduced sigi�atur�•o;f.�n�ass�,,ys�ant s,ecretary of ihe company,wfierever appearing upon a cettified capy of any-power of attomey issued by the compan��ri'c6nrtc�t'�d�i 4v�f;�ure�tionds,shall�tre walid and tiinding upon th�compa�ty yvith the same force and effect as though manually affixed ,., j� .,.a �n�i�� .�,''"� � c f�z.�{��.f°�, �!�� ; �-�''� rESTIM�NY HEREOF,� �have hereunto subscnbed rri��name arid`afi�ixec�#he�corporate seal of the said company, this � day of .mL.�.L(Jk''� t,5N8V ✓� N(�" � . � �,�o�� ...� . +Y r � � - ..a q,'917i�':o {'y{, _;r� '...:� .. '- . .. �.��• � 6 Q'i. r^"..a� J � � . �""t�*�� Gregory W�Davenport,Assistant Secretary ta�E ;.,�f4�' , a a �- Liber� LIBERTY MUTUAL 1NSURANCE CAMPA3�IY . �-�1��-�� FINANQAL STATEME�'T—DECEMBLR31,ZOIO Asse[s Liabitifies Cash and Bank Deposits.._......__...__....................$ 795,278,733 Unearned Premiurns.........._....._. ......._..........$3,5�2,53I,059 *Bonds—U.S Government......._..__. ..... 928,476,332 Reserve for Claims and Ciaims E�ense.................15,45U,806,243 ............... ' FundsHeldUnderReinsuranceTreaties..__.._....._ 1,764,193,716 'FOther Bonds_..__..............._..................-•--•.........._. 12,269,586,768 Reserve for Dividends to PolicyboIders.................. 4,776,435 �Stocks.....................__...-•---____-•_-_••--.._..__.--••---• 8,410,330,084 Additianal Statuwry Reserve............._.._.............. 89,44I,297 Real Estate......................_..._..__._.......---............... 28G,897,925 R�serve for Commissions,Taxes and Agents'Balances or Uncollected Premiums..._...... 2,97I,477,549 Other Liabilities_................................__........._.. 2.126.SQ8,564 AccruedInterestandRents...__.:.........._. ..... 156,129,412 ' To�—"—"".""""'.."' -.�-------�--��--$Z2,438,257,3I4 -•••-••_• : Special Surplus Funds........__..._$2,218,426,655 Othrr Admitied Assets.........._......:.............:........... 1�88.871.535 • Capital Stock.__.......�.................. 10,(100,000 • Paid in SutpIus.__.�._................7,731,965,815 Unassigned Surplus_.._..__....._.....4,802,898,554 Tofai Admiited Assets..._._...._....»......»........�f�701.S4R.343 Surplus ta Palicyholders. ...........»......13.763.291.U29 Totat Liab�ifies and Sru-ptus.........._.......»........_�36,�nt.Sas�43 py 1NS(�� J p * Bonds are sixted at amortized or inveslment value;Stocks at Associarion Market Values. �=G�� '� The foregaing 5nancial info�ation is taken&om Liberty Mutual Insurance Company's 5nancial } ,�g,�2 � statement fiIed with the staie of Massacfiusem Depar�ent of Insurance. O ��O�,roN' �Py��a y � I,TIM MII�OLAJEWSKI,Assistant Secretary of L'berty Mutual Insuance Company.do hereby certify that the foregoing is a true,and correct staiement of fhe Assets and Liabilities of said Corporation,as of December 3I,201Q,to the bes't of my knowledge and belie� IN WITNESS WF�REOF,I have hereunto set my hand and affixed the seaI of said Corporation aY Seattle,Washington,this 29th day of Match,2011. . . ' ` . ' . ` ' Assis�ant Secretary S-f2621.Fl11Ga 7J71 . . , - , . ` ,o;,�E�} .��c,, � �� - - f��'�j� ��(USA``< ''' � ��'I�� 'U ti"F�^ . . .... ' =-��:E�.:F2 I�. h S:.i._:.._ ..: J.� Company f D Number: 188332 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 Apex (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 I-9). For covered government contractors, E- Verify is used to verify the employment eligibility of all newly hired employees and all existing employees assigned to Federal contracts. Authority for the E-Verify program is found in Title IV, Subtitfe 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 contracto�") 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 It FUNCTIONS TO BE PERFORMED A. RESPONSIBILITIES OF SSA 1. SSA agrees to provide the Emptoyer 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 i3�E-Veri;f tv10U for cmployer�R�vis�n Date 1o!29/O8 >s;.! ::;f,• i !.i�"'.. `.�sec,, ' • �?�i9 � ,-.�� `USA�I; '`��F ��` ', �Il�ill ^ _ ..4_.sa,:�� %:�s�Ri��. .. =-•:EP.:FI I= .L Si.n\.�^= .^.; �.:� Company ID Number: 188332 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 verificafion checks on alien employees by electronic means, and • Photo verification checks (when available) on empfoyees. 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 felephone 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 indicafes 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 fmployer a user identification number and password that permits the Employer to verify information provided by alien employees with DHS's database. 6. DHS ag�ees to safeguard the information provided to DHS by the Employer, and to limit access to such information to individuals �esponsible 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 Page 2 of 13�E-�lerif}r MOU forEmp�oyer�Revis�cn Date 1G129/0S ,,;��r��,� �#�-�� ,��,��,_�r�-...,��,� , , . ... :o�a�`T.y{F� 1.1FClA. i� _ _ . r.��i£`� �U$��i E�'�1� : s�.�/ ; lNIII� � �,o��,.� ��:4�F.• ..t:SLF�'i: ..., " _-'�:ET:FI' I`.� .4 S�.n+:'= ri 'uY.S Company ID Number: 188332 nonconfirmation of empioyees' empioyment eligibility within 3 Federal Government work days of the initial inquiry. 8. DHS agrees to provide a means of secondary verification (including updating DHS records as may be necessary) for employees who contest DHS tentative nonconfirmations and photo non-match tentative nonconfirmations that is designed to provide final confirmation or nonconfirmation of the employees' employment eligibility within 10 Federal Government work days of the date of referral to DHS, unless DHS determines that more than 10 days may be necessary. In such cases, DHS will provide additional verification instructions. C. RESPONSIBILITIES OF THE EMPLOYER 1. The Employer ag�ees 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 confractors 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 I-9 procedures, with two exceptions: • If an empfoyee 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 I-9 process to establish identity.) If an employee objects to the photo requirement for religious reasons, the Employer should contact E-Verify at 888-464-4218. , • If an employee presents a DHS Form I-551 (Permanent Resident Card) or Form I-766 (Employment Authorization Document) to complete the Fo�m I-9, the Employer agrees to make a photocopy of the document and to retain the photocopy with the employee's Fo�m I-9. The employer will use the photocopy to verify the photo and to assist DHS with its review of photo non-matches that are contested by employees. Note that employees retain the right to present any List A, or List B and List C, documenfation to complete the Form I-9. DHS may in the future designate other documents that activate the photo screening tool. Page 3 of 13�c-Jerinf PF1CU for E!�p?oyer�Revision Date 70129iG& ;_ ;, ;°;�. - ,.��$ �, ..<n rM-,.. n,iF�.� r n . r _ ��t.^� `�� ¢ . � � �`� S ��1.�e �: i .� ', I�I��I �.�" _ . .. Se<.. 'I�YIS:F�I` . . .. _—�:Ee'.:F1' I�� .4 S�r.J:__^.i .....: Company ID Number: 188332 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 I-9 that relate to its employees, or from ofher requirements of applicable regulations or laws, including the obligation to comply with the antidiscrimination requirements of section 274B of the INA with respect to Form I-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 criminafly liable under any law for any action taken in good faith based on information provided through the confirmation system. DHS reserves the right to conduct Form I-9 compliance inspections during the course of E-Verify, as well as to conduct any other enforcement acfivity 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 I-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 I-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 rriake inquiries during the period of unavailability. In all cases, the Employer must use the SSA verification procedures first, and use DHS verification procedures and photo screening tool only after the SSA verification response has been given. Employers may initiate verification by notating the Form I-9 in circumstances where the employee has applied for a Social Security Number (SSN) from the SSA and is waiting to receive the SSN, provided that the Employer performs an E-Verify employment verification query using the employee's SSN as soon as the SSN becomes available. 8. The Employer agrees not to use E-Verify procedures for pre-employment screening of job applicants, in support of any unlawful employment practice, or for any other use not authorized by this MOU_ Employers must use E-Verify for all new employees, unless an , Ernployer is a Federal contractor that qualifies for the exceptions described in Article II.D.1.c. Except as provided in Article II.D, the Employer will 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 emp�oyees of the finding, providing written referral instructions to employees, allowing employees to contest the finding, and not taking Page 4 cf 13�E-Veri�MOU for Emplayer�R�vis:cn Date?,ri;29/G�s � �r� �;. ��-ir; ;;{.�;z�-,:; ' � . , � �artry , 1.1.�CC�� f��E L ; �US�� r �� ' >:t� 'I��"�,�i= �4ti_nc�.�' tr�y�F� . . ..... " =-'.:EP.:FS' I�. k Scn:':'._ ^.- v..., . Company ID Number: 188332 adverse action against employees if they choose to contest the finding. Further, when empioyees contest a tentative nonconfirmation based upon a photo non-match, the Empioyer is required to take affirmative steps (see Article III.B. below) to contact DHS with information necessary to resolve the challenge. 10. The Employer agrees not to take any adverse action against an employee based upon the employee's perceived employment eligibilify status while SSA or DHS is processing the verification request unless the Employer obfains knowledge (as defined in 8 C.F.R. § 274a.1(I)) that the employee is not work authorized. The Employer understands that an initial inability of the SSA or DHS automated verification system to verify work authorization, a tentative nonconfirmation, a case in continuance (indicating fhe 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 veri�cation 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 ve�ification is completed and a final nonconfirmation is issued, then the Employer can find the employee is not work authorized and terminate the empfoyee'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 274B(a)(3) of the INA, because of his or her citizenship status. The Employer understands that such illegal practices can include selective verification or use of E-Verify except as provided in part D below, or discharging or refusing to hire employees because they appear or sound "foreign" or have received tentative nonconfirmations. The Employer further understands that any violation of the unfair immig�ation-related employment practices provisions in section 274B of the INA could subject the Employer to civil penalties, back pay awards, and other sanctions, and violations of Title VII could subject the Employer to back pay awards, compensatory and punitive damages. Violations of either section 274B of the INA or Title VII may also lead to the termination of its participation in E-Verify. )f the Employer has any questions relating to the anti-discrimination provision, it should contact OSC at 1-800-255-8155 or 1-800-237-2515 (TDD). 12. The Employer agrees to record the case verification number on the employee's Form I-9 or to print the screen containing the case verification number and attach it to the employee's Form I-9. 13. The Employer agrees that it will use the information it receives from SSA or DHS pursuant to E-Verify and this MOU only to confirm the employment eligibility of empfoyees as Page 5 of 13�E-Verify f�OU for Employer�Revisicn Daie 1G/29/C8 1: ;" , :-,xc, ,�=•�': p,,.._..%�fi �n SF�� . , "-:T � "Y�� L' . �� { � q �lUIS��. �.'�i. . '�� ': I'll��f ? i �t, . � .4� �.r �iS�R�. . . a =-�'Ei�.ET�[: .4 S�i.'��.�� CF �::, Company ID Number: 188332 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 fo� any other purpose and as necessary to protect its confidentiality, including ensuring that it is not disseminated to any person other than employees of the Employer who are authorized to perform the Employer's responsibilities under this MOU, except for such dissemination as may be authorized in advance by SSA or DHS for legitimate purposes. 14. The Employer acknowledges that the information which it receives from SSA is governed by the Privacy Act (5 U.S.C. § 552a(i)(1) and (3)) and the Social Security Act (42 U.S.C. 1306(a)), and that any person who obtains this information under false pretenses or uses it for any purpose other than as provided for in this MOU may be subject to criminal penalties. 15. The Employer agrees to cooperate with DHS and SSA in thei� compliance monitoring and evaluation of E-Verify, including by permitting DHS and SSA, upon reasonable notice, to review Forms I-9 and other employment records and to interview it and i�s 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 Emp(oyer, the Employer may not reverify the employee through E-Verify. a. Federal contractors not enrolled at the time of cont�act 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 Federa( 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. Federat contraetors 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 �-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 cont�actor for 90 calendar days or less at the time of confract 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 emp�oyee assigned to the Page 6 of 13�E;ieriy P�tOU for cmp!oyer�Revisio,�Date�G/231G8 . . . .�.,��r�,,�t .it_=,?��,_: a • • re�Y�a .L�FCi. rv � f��` �US�e • �'�` _ :2�� >, IIIfID , !4s°�.s�r� ��isiF�� . =-'�:EP.:FY I� A S�i��•��_ ..- �r.= Company ID Number: 188332 contract within 90 calendar days affer date of contract award or within 30 days after assignment to the contract, whichever is later. c. Institutions of higher educafion, State, local and tribal governments and sureties: Federa( 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 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 A�ticle 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 I-9 procedures for Federal contractors: The Employer may use a previously completed Form I-9 as the basis for initiating E-Verify verification of an employee assigned to a contract as long as that Form I-9 is complete (incfuding the SSN), complies with Article II.C.5, the employee's work authorization has not expired, and fhe Employer has reviewed the information reflected in the Form I-9 either in person or in communications with the employee to ensure that the employee's stated basis in section 1 of the Form I-9 for worfc authorization has not changed (including, but not limited to, a lawful permanent resident alien having become a naturalized U.S. citizen). If the Employer is unable to determine that the Form I-9 complies with Atticle II.C.S, if the employee's basis for work authorization as attested in section 1 has expired or changed, or if the Form I-9 contains no SSN or is otherwise incomplete, the Employer shall complete a new I-9 consistent with Article II.C.5, or update the previous I-9 to provide the necessary information. If section 1 of the Form I-9 is otherwise valid and up-to- date and the form otherwise complies with Article II.C.S, but reflects documentation (such as a U.S. passport or Form I-551) that expired subsequent to completion of the Form I-9, the Employer shall not require the production of additional documentation, or use the photo screening tool described in A�ticle II.C.S, subject to any additional or superseding instructions that may be pcovided 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. Page 7 of 13�E-Ven'ry t�OU for Employer�Revision Date 10/29i08 '� �*�� !- ._ �;'.- : ``� ��'r �, � f.�`e ,-b 5[�•.�, � ` �`J: " — ' ��.} �US"`t (�K- � a\�I ',,fifH(i � �_.�=r<,- . ; - �a��r � . . �" �-vee:rr..is .�, sta.v;ce cr �:s Company fD Number: 188332 ARTICLE III REFERRAL OF INDIVIDUALS TO SSA AND DHS A. REFERRAL TO SSA 1. If the Employer receives a tentative nonconfirmation issued by SSA, fhe 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 fiefd offices only as directed by the automated system based on a tentative nonconficmation, 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 instn.ict 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 aufomated 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 Page 8 of 13�E-4eri"ry�tOU for Empioyer�Rzvis;on Date 1Gl29108 ;, _. ,_;�:;� .'r,e�g,� J Y . .F MYM', `,�1..lCC'i�. I4� � � � " US4A�,j � .� ��,��II��:.�1 = i:: _ E.' �t��y�Fi� � =-':EP.:FI I: c.S:.n�.r:'_ �. J::; Company ID Number: 188332 after the Empioyer receives it. 4. If the employee contests a tentative nonconfirmation issued by DHS, the Employer wiil provide the employee with a referral letter and instruct the employee to contact DHS through its toll-free hotline (as found on the referrai letter) within 8 Federal Government work days. 5. If the empioyee contests a tentative nonconfirmation based upon a photo non-match,the Employer wifl provide the employee with a referral letter to DHS. DHS 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 regulariy for case updates. 6. The Employer agrees that if an employee contests a tentative nonconfirmation based upon a photo non-match, the Employer will send a copy of the employee's Form I-551 or Form I-766 to DHS for review by: • Scanning and uploading the document, or • Sending a photocopy of the document by an express mail account (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 Senrices 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 fnternet 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 p�ior 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 procedu�es, will be covered under this MOU and will not cause the need for a supplemental MOU that outlines these changes. DHS agrees to train employers on all changes made to E- Verify through the use of mandatory refresher tutorials and updates to the E-Verify User Manual. Even without changes to E-Verify, DHS reserves the right to require employers to take Page 9 of 13�E-Veriy P�10U fcr Employer�Revis:or�Date 10'29lG8 . -""n`".+ i[ � � ^..i � o°f�t4� G�'1' �✓A• � '� .� P��lj "USA�� , � � �.? , '�i�� :��I�� . =-'�:EP:FY�t� .4 S:'.i�\•:�= C: v,:.; Company ID Number: 188332 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 fo 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 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 confractual 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 o� 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 constifutes 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. Page 10 of 13;E-Verify MOU for EmployerjRe�lision D2t2 i0/29/08 y,� -,;�3,�r��j�,_':,��; . . � ,.><<,. VE �� j�� - a �� j ��5�� l�' � C2 . '�,4�� fY'S��I I1 + _-':E+'�F1'�I� 4 5�:��1:'_ ^.- ✓-� Company ID Number: 188332 To be accepted as a participant in E-Verify, you should only sign the Employer's Section of the signature page. If you have any questions, contact E-Verify at 888-464-4218. Employer Apex Debb�Ro'binson; Name(#�fease Type or Printj Tit(e �lectroflica//y Signerf 02ffl6/200� SignaEure Date Qep.artment of Homeland Security-Verifieation Division USCIS Ve,�if�cation D�vi,sion, I`darrre(Please Type or Prir�t) Title Elecfroi�ic�fly Signed 02/06l2009 S�gn��ure :'' Date . Page 11 of 13�E-Venfy F10U fcr Employer�Revis�on Date 10/29iv8 � "k "�.iLi.� � � i'e 0 �1 =�� — �� U��;. fC.. t ('� � .. . ._ �lr'�S_�.F.'i . . =-':E...FY' I: n $in�.�;�_ n: �-� Company ID Number: 188332 Information Reqwired for the E-Verify Program Information relating-to your Gompany: Company Name: Apex Company Faciiity Adcire�s: 194 S.Silver Sprir�gs R� Cape Girardeau, 14'i0 63701 Gompany Alt�rnate Acfzlress: CQuhty Or Paris'h: Gi4PE GiR'�kRDEAU EmpFoyer leientificatian . Numbe.r: 43117�5Q 1�arfh Ame�ican It�clu�try �1.�5sif�c�tion Sy�t�ms> CO[le: 237 Pare#tt Goet�tpany: Detla Companies!nc Number af Employ�es: 2O.to 99 t�umber of Sites Verifiec4 for: 26 Afe you verifying for more than 1 site? If yes, please pr�vide fhe number of sites verified for in each Sta�te: . MISSOURI 26 site(s) Page 12 of 13;E-V2rfy f:?O!1 fcr Empicy2r�R2vision Date 10i%9iG8 �� - .- _ , .. �P'. �, y;4 � ��.i. . . � f�f �/�l < ' _ �• � �� `�U", "j ll � ;��` — � , llfllli.? .. _ . . 'O:,nF,� . _-';Ei:FiS I. 4 5:�,.��:.._ ,.- �-..: Company ID Number: 188332 Information relating to the Program Administrator(s) for your Company on policy questions or operatio'nal problems: Name: Debbi Robinson Teleplione Number. (573) 334-5261 ext. 345 Fax Number. (573) 332-0931 E-mail Address; drobinson@deltacos.com Page 13 of 13�E-Verify MOU for Employer�R�v!sion Date 10129?OA � � � , EXHIBIT AFFIDAVIT OF OSI�TRAINING �, COMES NOW (Name) � C as (Of6ce Held) �.Q�S�� of(Companp Name/Contractor) and first being duly sworn, on my oath, afFirm in connection with the contracted services related to � 7��) �(� t�,k(a'�p �Q� �, (Project Name) for the dutation of the contract,as follows: � 1. Contractor shall provide a ten {10) hour Occupational Safety and Health Adnunistration (OSHA) constnzction safety program for all employees who �vill be on-site at the Proiect. The construction safety program shall include a course in construction safety and health that is approved by OSHA or a similar program approved by the Missouri Department of Labor and Industrial Relations which is at least as stringent as an approved OSHA program as required by Seerion 292.675, RSMo. 2. Contractor shall require its on-site employees to complete a construcrion safety program within sixry (60) days after the date work on the Project commences, as required by Section 292.675,RSMa 3. Contractor acknowledges and agrees that any of Contractot's employees found on the Project site without documentation of the successful completion of a construction safety pxogram shall be requixed to produce such documentarion within twenty (20) days, or will be subject to xemoval froin the Project. 4. Contractor shaIl xequire all of its Subcontractoxs to comply with the requirements of Secrio.n 292.675,RSMo. 5. Contractor acknowledges that pursuant to Section 292.675, RSMo., Contractot shall forfeit to Citv as a penaltv two thousand five hundred dollats ($2,500.000), plus one hundred dollars (�100.00) for each on-site employee employed by C�ontractor or its Subcontractor, tor each calendar day, or portion thereof, sueh on-site employee is employed without the construction safety training required in Section 292.675, RSMo. 6. Contractor acknowledges that violarions of Secrion 292.675, RSMo, and imposition of the penalties described therein shall be investigated and determined by the Missouri Depattment of Labor and Industrial Relations. 7. Contractor ackno�uledges that in the event that the Missouri Department of Labor and Industriat Relations has determined that a violation of Section 292.675, RSMo., has occurred � . and that a penalty shall}�e assessed, the City shall withhold and retain all sums and amounts due and owing when making payments to Contsactor under this Contract FURTHER AFFIA.NT SAITH NOT. IN AFFIRMATION THEREOF, the faets stated above are true and correct (the u�idcrsigned understands that false statements made in this filing are subject to the penalties ptovided in Section,575.04U,.1ZS1VIo:) : (' , (narne orati By: ` . (name o officez of corporation and tid C�I,� C��.rrn., `��,,�-��d� ATT ST: , ; _ ¢: , . Secre.� �o�. � � ) �"` � -�z�"�,� �.� �.vV �� • S ,�,!'F' A i1 . _ ^'j `�° y y a� '��J�','!".�n x,r'�� '�'�''S "�� . . . . � � . .. . � , . . .. .. . .. � . . . . k ![v �"`�`'� ) . . . t, ��, �� CORP��1�Ix1� . . X{�„�F� ;� •� ,t �,�.,�.�� ,, � ; . �jk*.J s � ,.x^`' -A'� ' y�.� ;��.s �z '' th,P��,�y.�,.��, ,rid .. . �� j F ff� �. � 1 t' �� _ . . . � � e.� s 3t-�e;) �k �.�' . . . � � � � . . . . . . ✓"z c: �. , :�S'�'AT��C��IY�SQ�RI ,, , _�,�I'`.9Tx'.�,c.�i,�r+,dF�E�`�£ °:�i� �'—�`�..° . . , .. . � � ) S3_ - �. . . � . . . c a, r A � ,: ... . . ' � . . �C,�j��:'��-�E1PE GIR.ARDEAU ) , �, � �L'3'�r ��^�� . �� . C�h this �day o� 20L�befote me appeare / � to me rsona known,who,be g by me duly sworn,did say that he/she is the � of � , a 1Vlissouri Corporarion, and that the seal affixed to the foregoin instrument is e seaI of said Corporation, and that the_ said instrument was signed and sealed in behalf of said Corporarion by authority of its Board of Dixectors, and acknowledged said instrument to be the free act and deed of said Corporation. IN TESTIMONY WHEREOF, I have hereunto set my hand and affixed my official seal, at my office in Cape Girardeau, Missouri, the day an year first above written. vwaum►as�n+ � �� 1 �� r,rrcoo,uas ono��a�ry�,�� Nota Public �a+�tr�rrso� MyACoinnussion Expires: r1 � r �� .�,�.,-c��, �b/S . + * E�iHIBIT APFIDAVIT OF �ORK AUTHORIZATION COMES NOW (Name)�--��oan (y�/.f.111X.11'Yl.. as (OEFiceHeld) �/t_.C�e��J of(Company Name/Contractor) l:-(� . and first being duly swotn, on my oath, affirm as follows: � 1. (Company Name/Contractoz) ad�� ' is enrolled and will continue to participate in a federal work authorization program in respect to employees that will work in connecrion with the contracted services telated to (Projecc Name) � Q � for the duration of the contract in accordance with RSMo -__ _ __ _ Chapter 285.530(2). 2. < T also affirm that(Company Name/Contractoi) ' does not and will not knowingly ernploy a person who is an unauthorized alien in connection with the conCract services related to (Project Name) ��Il�j„ � OMU,r,I � ��v� for the duration of tlie contract. 3. Attached hereto is documentation affisming Contractor's enxollment, and patticipation in a fede�a� w�irk authorization ptogram with respect to the employees working in connection with"the contxacted=;services. FURTHER AFFIANT SAITH NOT. IN A.FFIRMATION THEREOF, the facts stated above are true and correct (the undersigned understands that false statements made in this filing are subject to the penalties provided in Section 575.040, RSMo.) _ __ �� .-_ _��{:� �. _ (name o oratio BY: J� (name of officer of corporation and tide) ��,, C�,�C�-�, �,��d�► � ATTEST: Secr ary(or er officer) ' ��l_ne�n, �i.:�-� S�.! � �� k��_:4.1 t C�t�, � "�1 � � - (S�?.L OF CORPORt1TION) p r Y� . � � . . �� . . '�'� �� .. .. . ... . . . ' .:... . .� . ' . .. . . . � . . f/�} ' � V . STATE OF MISSOURI I j �S�� )_ ) ss. C!=��;�."I`Y OF CAPE GIRARDEAU ` ) On this �tda o£ cs(� 20 efore me a eared� � � � �1', � y . , .�-� pp _ to m person y known,�'h!o,bein by me duly sworn, did say that he/she is the - of 1�5� �' a Missouxi Corpoxation, and that the.seal affixed to the foregqing instrumenC s the.seal of said..Corpoxation� and that tlie said instrument was signed and „ sealed in behalf of said Corporarion by authority of its Board of Directoxs; and acknowledged said '� instrument to.be the free act and deed of said Corporation. �,, IN TESTIMONY WHEREOF, I have hereunto set my hand and affixed my official seal, at m�of�iee in Cape G�ardea�,ivlisso�;`�he�ay arid<year first�bove:�.written. '' _ .. . . . . ... <. . . •-�� . �;,. , _� , . Nqfary P blie . _. _ ..., , , , vu�►a� , : , , . ,. , ,. �� . MYfAlAF06$lONF7�1fiF3FEBl�lAFiY!$!�5 - � NI Corrunission Expixes: ��rio�sxs , . � _ � _ - � 5 � � / 6164 0 � � Project Number rC.��:.1��r qr@ u;r�r �r;��.,�, }��&1� �iyig `,�.. � � � Certification Regarding Debarment, Suspension and Other Responsibility Matters The contractor hereby certifies to the best of its knowledge and belief and that it and its principa�� and its subcontractors and tlleir principals: (al Are not presently debarred, suspended, proposed for debarment,declared ineligible or voluntarily excluded from covered transactions by any Federal or State department or-agency;-- (b) Have not within a three (3) year period preceding this proposal been convicted of or had a civil judgment rendered against them for commission of fraud or a criminal offense in connection with obtaining, attempting to obtain or performing a public(Federal, State or Local)transaction or contract under a public transaction; violation of Federal or State antitrust statutes or commission of embezzlement, theft, forgery, bribery, falsi�cation or destruction of records, making false statements or receiving stolen property; (c) Are not presently indicted for or otherwise criminally or civilly. charged by a government. entity (Federal, State or Local) v�ith commission of any of the offenses enumerated in paragraph (1)(b) of this certification; and (d) Have not within a three-year period preceding this subcontract had one or more public transactions (Federal, State or Local) terminated for cause or default. I understanci that a false statement on this certification may be grounds for rejection of this contractor or termination of the contract. In addition, under 18 USC Sec. 1001, a false statement may result in a fine of up to $ 10,000 or imprisonment for up to five(5) years or both. C ��-�n -�-�.�.� Typ Nam Tifle of Authorized Representative � 8 � � Signature of Authorized Representative ate ❑ I am unable to certify to the above state��cnt. My explanation is attached. � ==. ---� -- - ---_----- -- --------- ----- _--- — --- ��"f� J4�� a��..�� s�+,�� i.,,.�J A!A f?ocument A312 Performance �3o�d Bond No. 014063500/9096217 Any singular reference to Contractor, Surety, Owner or other party shafl be considered plural where applicable. CONTRACT�R {Name and Address): SURETY{Name and Pri►�cipal Piace of Business}: Apex Paving Company Liberty Mutual Insurance Company! P.O. Box 637 Fidelity and Deposit Company of Maryland Cape Girardeau, MO 63702-0637 Q�ti'��ER (Nar}e and Address): City uf Cape Girardeau PO Qox 617 Cape Girardeau, MO 63702 CONSTRUCTION CONTRACT Date: August 21, 2012 Amount: ($316,070.92 � Three Hundred Sixteen Thousand Seventy Dollars and 92/100 Description (Name and Location;: 2012 Asphalt Overlay Program Street Overlays �o!�a �ate (Not earlier than Construction Co�ztract Date): August 21, 2012 .An4ount: (� 316,070.92 ) Three Hundred Sixteen Thousand Seveniy Dollars and 92l100 t�lodifications to this Bond: 0 None �� See Page 3 � C:ONTRACTOR AS PRINCIPAL SURETY Company: (CorEn�rafe Sea!) COmpany: (Corporate Seal) Apex Paving Company See Attached Signature Page Signature: Signature: Na�ne and T�tfe: Glen Graham, President Name and Title: Atiomey-in-Fact Address: �Ar:y acid+tio�al signatures appear on page 3) ;FGk;,+VFORA?ATICN ONLY-Name,Addre<s and 7e;ephc�r,e) AGf_i�i or BftOKEK: OWNFRS REPRESENIAT!VE tA�ChiteCt, EnginE:er cr Wiliis of New York, If1C. other�arty): One Worid Financia! Center, 200 Liber'y Street NEw York, NY 10281 212-915-8888 ' A!A C)CCUN�f N i r312 c PERFORN!.4NCE 80ND?,'�D F.�,Y`.;ENT BC;NL�c DFCEMBER 1984 E{��AiA' ------- -- T''E A+�/ickICAN INS7ETUTE OF ARCHITECTS, T735 NE'�'�YOhi:A'��,, N.�N.,Vv'ASHINGTOid, D.C. 2JOu6 A3i2-i9?4 i l'r;IRD PRiNTI��'G�MARCH 1997 1 __,__'! . _____.__I-_—__'_—_ ..�.._._ ._.. _:_.____.– ._.– . __._ _ {. ��":@ C�(?�'.if2::�Ot .�.'I� `.it`. �UFEtj�, )CNf1ii,J 3:`'�:� S2VBCe�.i�}'. J;ilii .7 P.iiB! ir;v�SF1^.il,'011, C{�`l('.t�tlt;-,P_ :�12 ;?[�161•'L i`��.ms.eh�es, i�+��r h�irs, exrcutors, admin�stra�ors, successors and for ,-;h�ch it may be liable �o rhe Cnvner and, ��s�i�r�s io ?he �wr,et for ihe perfor�nance of the Gonstr;;ciion as sorm as practicnnie aiter ?!�e �mo�mt is ::r;r�tract,µ�hict�is incor�raied herein by reierence. determ�ned, tender payment rnereior to che Qwn�r;or 2 it the Contractor per{orms tF�e Construction CnMract, the Surety and '!�e Contractor shall have no obliaation under this Bond, except t� .? Deny liability in whole or in part and notify the ,�articicate in conferences as provided in Subparagra}�h 3.1. Owner ciling reasons therefor. :i �f there (s no Owner Dciauft, the Surety's obfigation under this 5 If the Surety dces not proCeed as provided in Paragraph 4 wiih Bonc shal{arise after: reasonable promptness, the Surety sha11 be deemeci to t�e in default on this E3ond fifteen days after receipt of an additiona! written noti�e 3.1 The Owner has notifieci the Contractor and the Surety at from the Owner to the Surery demanding that the Surety perform its its address describe�3 in Paragraph 10 below that the Owner ot�ligatiqns under this Bond, and the Owner sha(f t}e entitled to �s considerir,g declaring a Contractor Default and has enforce any remedy available to th2 Owner. if the Surety proteeds requesied and attempted to arrange a conference with the as provided in Subparagrapk� 4,4, ancE the Owner refuses the Contrcctor and the 5urety to be held not laier fhai fiiteen paymenF tendered ar the Surety has denied liability, in whole or in da}�s a(ier receipt af such notice to discuss methods ot part, without further notice the O��ner shali be entitled to entorce performing the Construct�on Contract. If tha Owner, the any remedy available to the Owner. , Con:ractor and ti�e Surety agree, the ContracEor shall be �Ilowed a reasonabfe time to periorm ti�e Construction 6 Afier t}��e Qwner has terminated tl�e Contractors right to complete Contract, but such an agreement shal( not waive ihe the Construction Contra�t, arid if the Suraty efects to act under nwner's right, i( any, subsequently to declare a Contr:�ctor Suf>E�aragraph 4.1, 4.2, or 4.3 al,c�ve, then the responsii�ili;ies of the Defauit;and Surety to the Ovrner shail not be greater than those of the Contractor unoer the Construcrion Contracs, and tne responsibilities of the 3.2 The Owner has declared a Contraaor Defauh arid C�vr.er to the 5urety shall not be grater �han those of the Owner iormal�; te.rmina!ed the Centractor's right to compiete. !he under tEze Construction Coniract. To the f�mit of the amount of this c+�ntract. Such Cvntractar I�eiauit shall noi be declared Sond,but subjecl to commitrnent by the Owner of the Balance ai the e.arliei than twer.ty days after the Contractor and the Surefiy Coniract Price to mitigation of costs and darnages on the have receivecf notice as provided in Subparagraph 3.t;and Construction Contract, the Surery is oblioated without dup{ication far: 3.3 The Owner E�as agreecl to pay the Balance of the Contrari Price to the Surery ij� accordance wiih ihe terrr�s of che 6.1 The responsibilities of the Cont�actor for correction ot Cor,struCtion Contract or to a contrxtar selected to perform tl�e defective worK and con�pletion of the Construction t_onstrur_tion Cantract in accordance with the terms of the contracF Contracc; with the Owner. 6.2 Additional fegal, design professioi�al and deiay cosFs y '+�v'hen t7e Owner F�as satisfied the ccnciitions of Paragraph 3, the resultin; from the Contractor's Default, and resu(;ing (rarr �urery sl,all �;omptiy and at the 5urety's expense ta�:e one of tne the actions or failure to act o(the Surety under Para�ra�h 4; (uilu�.vir�g actions_ and 4.1 Arrange for the Contractor, with the consent of ►he 6.3 Liquidated damages, or i£ r�u liquidated damages are Owner, to perform a�yd com�lete the Constructien Contracr speci#ied in the Construction Contratt, actual ciar7iiges �+ caused by delayed perforrnance or non-peiiormance o� the ContraCtor. 4.2 Undertake ro perlorm and camplete the Construcrion Contact ilself, tfi;ougn its agents or ihrough inde�endeni 7 The Sircety shall not liable to tne O;vner or others for obligations of contractars; cr the Contr;ctor that are unrelated to the Construction ContracE,and the f3alance of the Contr�r_t Price si�all not be reduced or set off on �.3 Obtain bids or negotiated proposafs from quaiifiecl account o� a�iy such ur.re!ated obligations. No right oF action shail contractors accepiable to the Owner for a contract for accrue on this Bond to ariy person or entity other than the Otivner or per(ormance and compfetion of the Constructio+� Contract, its f�eirs,executorc,adil�inistrators or successars. arrange for a contract �o be prepared for execucion by [he Owsier an� the contrattor seleUeci with the Oti+•nFr's $ The Surety hereby waives noti<e of any change, including changes concurrence, to be secured with the performance and of time, to the Construction Contract ar to reiaieci subcontrac;s, payment bonds execu[ed by a qualified si+rety equivalent to purchase orders and other obligations. the bonds issued on the Construction Contract, and pay to the Owner ti�e amount uf ciamages as describ� in 9 P,ny proceec?ing, legal or equitable, under this Bond may be Paragraph 5 in excess of the Balance of the Contract Price irs�itutec! in an� court of comneleni juiisdiction �n the focation in inc.urre�i �y the Owner resulting irom the Contractor's wi�ich t+�e work or part o€ ;fze work is located and shalt be insfiiuted �e(au3t; or �vithin two years after Contractor deiaiit or within !wo years�fter the 4.4 1h'a;ve its right ro perform and com��lete, Contractor ceasecf working or within nva years aiter tne Surety refu�s arrar�ge for completion, or obtain a new contractcr ar iails ro perform its oi�iiga�ir,ns under this Bond, whichever accurs and �vit1� reasonable prompir.ess under the first. l;the provisions of the Paragraph are void or prohibited by law, circums:ances: the minimum period o(iitnitation availabfe�a sureties as a �+':� Dt7CU"Ytf:l�iT A:1��PfRFC�Kiti",.=."JC_f_ E;OND AfvD P?YMENT Bi3ND y✓�CFM�ER 198ti FD�Alri.<_ -- -!IiF A.:AF�ZICAN !^:STITU-iE C��ARCHI',ECT�, i;35 ^JF`vV YORK;i�'E., i:.41�., �1fASNi��GTON, D.t:. 2GOti6 .A312-1•38� 2 ;ninJPRI.".i'iFJ�,: !✓�ARCH i�';ii � _�-s._--- .- _.___-- ----- — - __— - ___ ------— -- -----. __.. �te��i��e ii�the juriscfiriio�i�;i:he s.;;t t,;,ail i��e applicsibft. �:�y the i7wr�r:r in set,!emer� oi insu�ante ot t�:'�er c:laims for ca�nages �o wn�ch :he Cuniraclor ic er.titleC�, rEniuCr.:� b� :�14 vdiid .�nU prop2r fE? NoCice to the Surety, the J�+��er or ihe Cor�tractor shalf be rnailed F�ayms��ts macie .o or on i�ehaif of tne Con:ractor u;rder tl�e c;r ciefiv�red to the address show�i orz�he signati=re page. Co�stri,d�er,Contract. t t �r✓hen this Bc>r.d has been furnished �o comply with a statutory vr 32.2 Construction Contract: 1"he �greement between the Owner the oti�er {egal reyuirement in ihe location �vhere the constructio3� was tr, Contractor identifieci on the signature �age, induding all Contract i�=.: periormed, any provision in the Bond conflicting with said Documents and changes thereto. ��arinory or fegal requirement sha!] be ceemed deleted herelrom and ��f�3VlSlOtlS conforming to suc7 statutcry or other legal reyuicements ?2.3 Contractor Defauh: Failure o(the contr�ctor, which has neither :>nall �e deemed ineor�orated herein. 7he ir.tent is that this Bond bc-en remedied nor waived, to �er{orm or otherwise to comply wiih sh,-:{I be construed as a statutory boild and nut as a common law bon�, the terms of the Consiructio�Contract. �"_> DEFthilTlOt�tS t2.4 Owner Default: Falure of the Owner, which has neither been remedied nor waived, to pay the Contracior as required by the 12.1 Salance of tne Cor.tract Price: The roial amount Construciion Contract or to perform and complete or comply with the pa�,able by the Owner to the Contractor under the Construction other terms thereof. Contract afler all proper adju�tmenls have been made, induding r=;;owance to the Contractor of any amounts received or to be received ivlOE31F1CATtONS TO ThilS 50ND 3�RE AS FOLl04YS: ��p,9ce is provided below for addktional signatures of added�arties,od}er than those appearing on the cover pa�e.i CONTR.ACTOR AS PRtNCIPP.� SEJRETY i��zr��i;�y: (Corporate Seal) Compar.y: tCofpo�a�e Sc-al) See Attached Signature Page Si�r�ature: Signature: "a:-rne and Title: Name anJ Title: Attor�Eey-i�t-Fact P,��;dress: Ad�?rets: ,nl,�.G()CUh1ENT A372; PERF02M:4NCF 90ND ANU PAYMENT!�OND�DECEN4HER 1984 ED.;.�IAS 11iF AMZr21CAN INSTlTUTE OF ARCHITEC�S, 1735 NE�N YCRK AVF., N.1N.,W.A5H1:�'GTON, D.C. 20GD6 A312-?984 3 (iiIRD PRI�t�INC;s MAKCt; 19<i _', _ ____ .-- ----- -_ - - -------- _--- ATTA�H�fENT TO B(3'iD �ti0. 0��o63�G0!9Q962i7 StiRETIES Surety A Liberty Mutual fnsurance Company 8044 Montgomer� Road Cincinnati, OH 45236 Surety Phone No. State of Incorporation: M� By: - Limit of Liability: 50% Aiz �o , or -In-�ast Surety B Fidelity and Deposit Company of Marylar�d 1400 American Lane Schau.mburg, IL 60196 Surety Phone No. State of Incorporation: M� By: Limit of Liability: 50% Aiza z , A arney- -Fact Surety C Surety Phone No. State of Incorporation: By. Limit of Liability: , Attorney-ln-Fact . --,-- -___� ---- --- --------------- --_ _:. _ . - —--------_ __ T�� Ar�E��::;��i� ��4�T��: �'^ ��t.::�-�i�:-'��`�� lA Docurnent A392 �'ayment Sond Bt3nt� �l0.014063500! 9096217 Any singuiar reference to Contracior, Surefy,Owner or other party shail be considered plural where applicable. �Ol�TRACTOR (Name and Address): SURETY {Name and Principal Place of Business}: Apex Paving Company Liberty Mutual Insurance Company/ Fidelity and Deposit Company of Maryland P.G. Box 6?7 Cape Girardeau, MO 637Q2-0637 01NNFR {Name and Address): Ciiy of Cape Girardeau PO Box 617 C;ape Girardeau, MO 63702 CONSTRUCTION CONTRACT Date: August 21, 2012 Amount: {$316,070.92 ) Three Hurdred Sixteen Thousand Seventy Doilars and 92/100 Descriptior� (Name and Location?: 2012 Asphaft Overlay Program Street Overlays QCND Date: tNot earlier than Construction Contract Date?: August 21, 2012 Amour�t: (� 316,070.92 } TF�ree Hundred Sixteen 7housand Seventy Do{lars and 92;100 A�lodifications;o ihis Bor�d: ❑ Nc�ne � See Page 6 CCNTR?,CTOR AS PRfNCIPAL SURETY C�mpany_ (C<,rporate Sealj Company: iCoFpo�a�e Sea�) .�pex Paving Company See Attached Signature Page �ignature: Signature: Name anrj Ti�le: Glen Graham, PreSldent Name and TitEe: Attomey-in-Fact ;Any additio�lal signatu�es appear on page 6) f;OR hVE C,Rhfi.(fO.N OiJIY-Narre,Addre•s and Telephore; ��GEI�:T or ERC�KER: O�vNERS REPRESENTAT!`✓E(Arch+teci, Engineer or VVillis �f New York, Inc. o�her;,ar�•,�): Une VVorfd Financial Center, 20Q Liberty Strcet f�Jew York, NY 10281 , 212-915-8888 ,.;A DOCUMENt A312�?EP,FORMAtirF SGND.�N�i F;i.'i'n�F`;T r(:�r�!U s`vECE.n�5ER 199�2 E�-:P.IA<,--- -- THE ,4MEkICAti iNSTITUTE OF P.RC:HITE�TS, 17s5 tvE��`Yi��K�,�"r., tJ.\N.,1h'A�FliP.�GI OFd, J.C.Z�C�+::�5 A312-1484 4 i i-ifP,rJ PRII�TITJG S MARCH 1987 _. - ---------- ------ --- ---- --- - � --__ __-- ------- --- ; -,._ Co;�tracti;r ;=n;i th� Sureiy, ;�ini!y ard se��e�:;�),,, bi�r� �,revio:,� �vri;t��; notice furnished �-, ;�:;: ;^Crt?�civE•5, tF��ir }�PilS, �xBCutGrS, ?E�millisir�tU;S, <L:CCC.55prS c!;�c� �palitaCior. � �<si�ns tn tt;e Owner 10 pay ior labor, maEerialt and ec;uipi��ent 5 If a notice requirec; by F'aragraph 4 ic ��ve+� E�y the Owner t�� ifEe ;�_:r��i�,k��d for use in ti�e perfon�iance of the Const;uaion Contr�ct, Contractor or to the Suren�, that is sufficfent compliance. �,.ri�_h i��ncorporatec9 herein by reference. 6 1h'hen the�iain-�ant has sausfied the conc3itions of Paragrapll a, the 2 `.�%.h respect to the Owner, t!-�is obligation shall be nuil and vo�d it' Surety shall pramptly and at the Surety's expense take the following ii:e C'.c�niraCtOr: aCtions: 2.1 Prornptfy makes payment, directly or indirectfy, for a!I 6.1 Send an ancwer io the Claimant, with a topy !o il�e sums due Claimants, ar�d Owner, wirhin 45 days arter rEceipt of the dai�r, stating tF,e amounts that are undisputed and the basis (or challengine 2.2 Defends, inilemnifies and holds harmless the Owner any amounts that are disputed. from cfaims, den�ands, fiens or suits by any person or entity �vhose claim, demand, €ien or suit is ior the payment for 6.2 Pay or arrange for payment of any undisputed amounts. labor, materials or eyuipnient furnished for use in [he perEormance of-the Corutruction Contract, nrovided the 7 The Surety's total oblig�tions shall not erceed the amount o( the Owner has promptly noti#ied the Contractor and the Surery Bond, and the amount of this Bond shall be credited for any payments (1t the address desaibed in Paragraph 12> of any claims, made in good faith by the Surery. demands, liens o�suits and tendered defense of sUch claims, c�emands, liens or suits to the Contractor and the Sure►y,and & Arnounts awed by the 04vner ro the Contractor uncier the provided there is no 9wner Defauli. Construciion Contra�[ shali be usecl for �he perfarmance ot the Construction Cantract and to satisfy cfaims, if any, under any 3 b4'ith res�mct to Claimants, �his obligation shali be nu4{ and void if Construction Perfarmance Bonc�. By ihe Contractor furnishing and tre tiie :;on:racror promptty makes �,ayment, directly or in�irectiy, fur ail Owner accepting this Bond, they �gree that all tunds earned by the surn�du�.. Contractor in the peiiorn�anCe of the Construction Contract are dedicated io satisfy ob(igations oi tne Contractor and the Surety under � Ihe Surety shall have no obligation to Qaimants under this L'ond this Bond, subject to the Ow��er's priorty tu use the funds tor the ,,ntil: compfet�on of the work. 4.1 Ciaimants �vho are employed by nr nave a direct 9 The Surery shali rot be (i:�ble to theOwner, Claimants or others for contract with the Contractor have given notice to the Surety obligations of the Contractor that are unrelated to the Construction iat the address descrihed in Para�raph 12) and sent a copy, ContracL The Owner shall not t-�e 1iable for payment of any costs or or notice rhereof, to the Owner,stating that a dairn is bei��g expenses ofi any Elaimant under this S�nd, and shzll have uncler this make under this Bond and, 4vitV� subsiantial accuracy, the 6�nd no obligations t_n make payments to, give i�otices on behalf of, amount of the claim. or otherwise have obligations to Claimants�nder this Bond. a.2 Claimants who do noi have a direci contract witt� the 70 The Surety herehy waives nouce of any change, including c.hanges Contratior. of time, to the Constr;,c��on Contr�ct or to relatea si�bcontrac�s, pirrchase orders anc!other obligations. .1 hiave fumishec� writFer. notiCe to the Contractor and sent a copy, ar notice 1i No suit or action sha{f be comme��ced by a C�aimd«t :inder thi5 thereof, to the O�mer, �vitl�in 9d days 8ond other than in a Ccurt of Compefent jurisCliCtion in Ehe ioc3ticn in after having last performed fabor or last tivhich the wor� of part of ih2 work �s loca[ed or after the expiration of furnished materials or equipn,ent one year from the date (1) on which ihe Claimant gave the nci�ce included in the c!aim stating, witn required by Subpar.:graph 4.1 or Clause 4.2.3,or i2)on which the last substantial accuracy, che amount of the labor or service v.�as E�erforrned by a«yone or the last materials or claim and the naiTie of the party to equipment were furnished by anyone under the Constructio� �ti•hom the materials were furn�ched or Contract, whichever of (i) or (Z) first occurs. If the provisions ��f the supplied or for whom the labor was Yaragraph Rre void or prohibited by law, the minimum ��eriocl of c}one or performed; and limitation available to suret+es as a defense in the jurisdiction uf t}ie suit shal! be applicable. .2 Ftave either received a rejection in whole or in part fro�n the Contract�r, nr 12 Notir_e to the Su�ety, the C>wner or tl�e Co��tractor shall f�e mailed r,ot received within 30 oays c�f or delivered �o the address shown on the signature page. Ac�ual fvrnishing the akx;ve notice any receip[ uf notice by Surety, the Owner or the Contractur, hov.-ever ca»mur.ication from th2 Contra�tor by accomplisheci,shail f>e sufficient compliai�ce as of the daie receiv2d at �vhich the Contractor has fndicated the the address shown on tne signat�re page. daim will t� paid direcdy or indirectly; and 13 VVhen this Eond has txen iurnisiied to comply with a statutor� or other legal requirement i,i the locaeion w�here the cor7struciion Gvas io .3 Not having oeen paid �Nithin tne abuve be performed, any pr�v�s;on in this Bond con�licting •,n�ith s��id 30 days, have sent a writcen notice to staturory or legal requiremenl sha!f be deemed dcleted herefrom and t1�e Surety tat the address destrsbed in provisions confonning :o such statutory or other legal requirer�ient Paragrapn 12) and sent a copy, ur shal! 1;e dee:ned incorporated i�erein. lhe intent is that ti,is 6ond nosice thereof, ro the Oti+ner, siating sha!i be construed as a staiuiury bo�}d actd not as a carrxrion lan�tx.nd. ,hat a ckaim is being ^.ade �rder tV�e Bend arx� enciosino a copL o{ the - - - _---- AfA i�OrUt.�tNT P st?�i'ERFUR��hAhJCE BONrJ AND P.�YMF_r1 i£ONU c t�ECEysBER 39fi4 ED.�•S!its. i hif,��.Eii�rl�tJ �NST?i UTF CF f�.RC1�ITEC75, 1735 NE�h'`'O�K AVt., I�.�N.,1'.'?SHiNG i ON, D.C, '000h .`�312-;984 5 �.��• c":� . c �r{;, :� � n,��;�Nc s r„r'1k Ft ,.f,7 . l f 14 Upon request by any person or entity appearing to be a potential engineering services required for performance of the work of beneficiary of this Bond, the Contractor shall promptly furnish a copy the Contractor and [he Contractor's subcontractors, and all , of this Bond or shall permit a copy to be made. other items for which a mechanic's lien may be asserted in the jurisdiction where the labor, materials or equipment 15 DEFINfTIQIVS were furnished. 15.1 Claimant: An individual or entity having a direct 15.2 Construction Contrad: The agreement beEween the contract with the Contractor or with a subcontrac[or of the Owner and the Contractor identified on the signature page, Contractor.to furnish-labor, materials or equipment for use including all Contract Documents and changes thereto. in the performance of the Contract. The intent of this Bond shali be to include without limitations in the terms "labor, 15.3 Owner DeFault: Failure of the �wner, which has materials or equipment"that part of water,gas, power, light, neither been remedied nor waived, to pay the Contractor as heat, oil, gasoline, telephone service or rental equipment required by the Construction Contract or to perform and used in [he Construction Contract, architecturai and complete or comply with the other terms thereo(. MODIFICATIONS TO THIS SOND ARE AS FOLLOWS: Paragraph 6 is deleted in its entirety and the following is substituted in its place: Dispute, such claim. Rather, the Claimant's sole remedy shall be the immediate right,without further notice,to bring suit against the 6. When the Claimant has satisfied the conditions�f Paragraph Surety to enforce any remedy available to it under this.Bond. 4, and has submitted proof of claim swom to by Claimant with adequate supporting documentation proving the amount claimed Paragraph 12 shall be amended to add the following paragraphs: is due and payable, the Surety shall, within 90 days, notify the Claimant of the amounts that are undisputed and the basis for CLAIM NOTICE for the LIBERTY MiTTUAL INSUR.ANCE challenging any amounts that are disputed, including, but not COMPANY must be sent to the following address: Liberty Mutual limited to,the lack of substantiating documentation to support the Insurance Company, Interchange Corporate Center, 450 Plymouth claim as to entiflement or amount, and the Surety shall, within a Road,Suite 400,Plymouth Meeting,PA 19462-1644. reasonable period of time,pay or make arrangements for payment of any undisputed amount,provided,however,that the failure of CLAIM NOTICE for the FIDELITY AND DEPOSIT COMPANY the Surety to timely discharge its obligations under this OF MARYLAND, ZURICH AMERICAN INSURANCE paragraph or to dispute or indentify any specific defense to all or COMPANY, COLONIAL AMERICAN CASUALTY AND any part of a claim shall not be deemed to be an admission of INSURANCE COMPANY and/or AMERICAN GUAR.ANTEE liability by the Surety as to such claim or otherwise constitute a AND LIABILIT'Y INSUR.ANCE COMPANY must be sent to the waiver of the Contractor's or Surety's defenses to,or right to following address: Zurich Surety Claims, 1400 American Lane, Schaumburg,IL 60196,Attention: Surety Department. (Space is provided belo�a for additional signatures of added parties, other than those appearing on the cover page.) CONTRACTOR AS PRINCIPAL - SURETY COmpdny: (Corporate Seal) Company: (Corporate Seai) See Attached Signature Page Signature: Signature: Name and Ti[le: Name and Title: Attome}r-in-Fact Address: Address: AIA DOCUMEI�T A312�PERFORMANCE BOND AND PAYMENT BOND�DECEMBER 1984 ED.S AIAS THE?J��ERICAN INSTfTUTE OF ARCHITEC75, 1735 NEW YORK AVE., N.W.,WASHIrlGTON, D.C. 20006 A312-1984 0 IHIRD PRINTIhJGSMARCH 1987 . __ - -------- ----- _ __..--- _ _- --__ ----_ _ -- ---------- � _ � . ----- ---__ - --- -- — __ - ----- - A�'T'ACHh�fENT' z C) B�3?�"I} NO. 014G635U�/ 9C�6?'i 7 SUt�,TIE S Surety A Liberty Mutuai Insurance Company &044 Montgomery Road Cincinnati, OH 45236 Surety Phone No. Sta.te of Incorparation: MA By � _ Limit of Liability: 50% Ai ez Attor y-In-Fact Surety B Fidelity and Deposit Company cf Maryland 1400 Arnerican Lane Schaumburg, IL 60196 Surety Phone No. �� State of Incorparatron: MD By: Limit of Liability: 50% Aiza Lc�e� , Attor y-In-Fact Si�ret}�C Surety Phone No. State of Incorporation: By: Limit of Liabifity: , Atton�;,y-In-Fact ' , THI$ POWER OF ATTORNEY IS NOT VALID UNLESS IT IS PRINTED ON RED BACKGROUND. 5387941 This Power of Attomey limits the acts of those named herein,and they have no authorily to bind the Company except in the manner and to the extent herein stated. Certificate No. American Fire and Casualty Company Liberty Mutual Insurance Company The Ohio Casualty Insurance Company Peerless Insurance Company West American Insurance Company POWER OF ATTORNEY KNOWN ALL PERSONS BY THESE PRESENTS: ThatAmerican Fire&Casualty Company and The Ohio Casualty Insurance Company are corporations duty organized under the laws of the State of Ohio,that Liberty Mutual Insurance Company is a corporation duly organized under the laws of the State of Massachusetts,that Peerless Insurance Company is a corporation duly organized under the laws of the State of New Hampshire,and West American Insurance Company is a corporation duly organized under the laws of the State of Indiana(herein collectively called the"Companies"),pursuant to and by authority herein set forth,dces hereby name,constitute and appoint, JEANNETTE PORRINI,STACY RNERA,DANIELLE M.BECHARD, ELANAV.SANCHEZ,AVA LOPEZ................................................................................................................................................................................................................................................................... .............................................................................................................................................................................................................................................................................................................................. all of the city of HARTFORD ,state of CONNECTICUT each individually if there be more than one named,its true and lawful attomey-in-fact to make,execute,seal,acknowledge and deliver,for and on its behalf as surety and as its ad and deed,any and all undertakings,bonds,recognizances and other surety obligations,in pursuance of these presents and shall be as binding upon the Companies as if they have been duly signed by the president and attested by the secretary of the Companies in their own proper persons. IN WITNESS WHEREOF,this Power ofAttorney has been subscribed by an authorized officeror official of the Companies and the corporate seais of the Companies have been affixed thereto this 18th day of MAY � 2012, _ ,�A��f� ��,�€�� ;�sU#� �� g��f American Fire and Casualty Company � N �w�""'`e�� ,�� , ,�.��`'"�'��'��. ��`�' `\�c�� The Ohio Casualty Insurance Company H o '�• �°�"'��-�`t,° �,Q -°"�"°��r�`4� ��, 1�� r �,� ��FF LibertyMutuallnsuranceCompany d a i .�...... . � n � Hc��*wv�� . 19�}1 �z. i d �,t�;��, ,, �. v�;;:�� a j� �` c�f�� > Peerless Insurance Company � Yy ��'�� '� ��,�� °�;.�� 'c�,��°� WestAmericanlnsuranceCompany � � m v �aa�� fi�x�,� �c�c � d ,�Q C By: G _� STATE OF WASHINGTON ss Gregory W.Davenport,Assistant Secretary = 'a � COUNTY OF KING — O v y On this iatn day of MAY , 2o�z before me personally appeared Gregory W.Davenport,who acknowledged himself to be theAssistant Secretary ofAmerican Fire and �W p 3 Casualty Company,Liberty Mutual Insurance Company,The Ohio Casualty Company,Peerless Insurance Company and WestAmerican Insurance Company,and that he,as such,being d � � authorized so to do,execute the foregoing instrument for the purposes therein contained by signing on behalf of the corporations by himself as a duly authorized officer. � Q m� IN WITNESS WHEREOF,I have hereunto subscribed my name and affixed my notarial seal at Seattle,Washington,on the day and year first above written. Q�o �� ,��:�x.°,3''fi'''.. ��, O� ��_ T ' � L - '��RO7Ati'� `�. BY: C� f. — � � ' ��`� � = KD Riley,No Public 3 �t d p 1'.y ,�o:'_�; � � :;,.��.,� � �+ � `-,'�' ,y°.«`';;,;<;<S O�, ,,,�.::..,�;;,,,, d <p _ � This Power ofAttomey is made and executed pursuant to and by authority of the following By-taws and A`u�fiorizations ofAmencan Fire and Casualty Company,The Ohio Casualty Insurance s o �N Company,Liberty Mutual Insurance Company,WestAmerican Insurance Company and Peedess Insurance Company,which resolutions are now in full force and effect reading as follows: ++� w �d ARTICLE IV–OFFICERS–Section 12.Power of Attomey.Any officer or other official of the Corporation authorized for that purpose in writing by the Chairman or the President,and subject �,� p c to such limitation as the Chairman or the President may prescribe,shall appoint such attomeys-in-fact,as may be necessary to act in behalf of the Corporation to make,execute,seal, .a � � acknowledge and deliver as surety any and all undertakings,bonds,recognizances and other surety obligations. Such attomeys-in-fact,subject to the limitations set forth in their respective ' � �+� powers of attomey,shall have full power to bind the Corporation by their signature and execution of any such instruments and to attach thereto the seal of the Corporation. When so >� � L executed,such instruments shall be as binding as if signed by the President and attested to by the Secretary.Any power or authority granted to any representative or attomey-in-fact under a>� .a � the provisions of this article may be revoked at any time by the Board,the Chairman,the President or by the officer or officers granting such power or authority. �� ea C � , � � ARTICLE XIII–Execution of Contracts–SECTION 5.Surety Bonds and Undertakings.Any officer of the Company authorized for that purpose in wri6ng by the chairman or the president, ;�eN � � and subject to such limitations as the chairman or the president may prescribe,shall appoint such attorneys-in-fact,as may be necessary to act in behalf of the Company to make,execute, O o Z � seal,acknowledge and deliver as surety any and all undertakings,bonds,recognizances and other surety obligations. Such attomeys-in-fact subject to the limitations set forth in their v� respective powers of attomey,shall have full power to bind the Company by their signature and execution of any such instruments and to attach thereto the seal of the Company. When so �T executed such instruments shall be as binding as if signed by the president and attested by the secretary. Certificate of Designation–The President of the Company,acting pursuant to the Bylaws of the Company,authorizes Gregory W.Davenpo�,Assistant Secretary to appoint such attomey-in-fact as may be necessary to act on behalf of the Company to make,execute,seal,acknowledge and deliver as surety any and all undertakings,bonds,recognizances and other surety obligations. Authorization–By unanimous consent of the Company's Board of Directors,the Company consents that facsimile or mechanically reproduced signature of any assistant secretary of the Company,wherever appearing upon a certified copy of any power of attomey issued by the Company in connection with surety bonds,shall be valid and biding upon the Company with the same force and effect as though manually affixed. I, David M.Carey,the undersigned,Assistant Secretary,of American Fire and Casualty Company,The Ohio Casualty Insurance Company,Liberty Mutual Insurance Company,West American Insurance Company and Peerless Insurance Company do hereby ceRify that the original power of attomey of which the foregoing is a full,true and correct copy of the Power of Attomey executed by said Companies,is in full force and effect and has not been revoked. IN TESTIMONY WHEREOF,I have hereunto set my hand and affixed the seals of said Companies this�day of �� ,20.L,�. ��Z�P�y��+ �p,yqY kN3(j,g� �a��a�WL� ��d5llR'A^�1y.C,�� A�EF�t�9 � I .,� ��' r`� uta'� '^..,\ � Q��AtiV4T�� q''�'I G�Ri'CJ£��$.�� I��n.��F � � ��§ � ,g t�� G�RPOP�'�" ; � 7MG�RP?2RIeTC�C+` i .._. �� C2 m 194i i� '�; E��'� 3 2* t � B�l: �'� `��-:��-�� -�,��'<F��• <� "'�� t�` �� x4 ��==��,,�� DavidM.Carey,AssistantSecretary '�'�.�''��-" �'�.,�axas��at °��rh`�.,,_��` `'`�,.V.-l� `��g�,._.�'�+�� '��r'v cc�� '�r` � �v�.;��,�F� �`��,�� c�� POA-AFCC,LMIC,OCIC,PIC 8 WAIC LMS 12873 041012 . , � � _ _ _ .__-___ _. _ _ _— - _ . _--- __ . - - --- — __ -- y --- ----- , , "�> ' -a �,�EKTYr,nL?":iUA;�Il�SURA:IC�C:0;•�1PAi��Y � ��1��'��`� =� �r �V�L��.-L.t�l,�., FL�TAnTCIAL S"TATk;'�IEIv'"I'—AECEA�iBER 31;2011 SURETY Assets �iabiIities Cash�r�d Bank Deposits........._.......-----..__..........$ 696,606,339 Unearried Premiu.�ns...........................-_---...............$3,762,485,9li *Aonds—U.S Government................................. .... 9 i0,151,865 Reserve for Clauns and Claims Expense..............._ 15,817,904,502 Funds Held Under Reinsurance Treaties................. 1,249,980,610 *Other Bonds....................._..----..._..---........._..._..._. 11,794,;92,561 • Reserve for Dividends to Policyholders.................. 4,656,284 *Stocks........._...-..............--.--.....................--------- 8,216,137,875 Additional Stah:tory Reserve..._....._..._.__..........._. 77,791,575 Real Esta.e......__.._.........__..............._............._._. 268,420,606 Reserve ior Commissions,Taxes and �gents'Balances or Uncollected Piemiums...._...... 3,191,269,641 Other Liabilities.......__._..............__....__...__.. 2,885,589,205 Acerued Interest and Rents............................_.._._.. 151,164,670 T'ota 1--------�-----------------.....--------------------$23,798,408,089 Special Surplus Funds.................$1,036,917,657 Other Admitted Assets........................__.._._..._.... 12.166.299.092 Capital Stock....._......._...__......... 10,000,000 Paid in Surplus----.--_._................ 7,732,061,653 Unassigned Surplus.....................4,817,45�,750 Total Admitted Assets._...._.__._._...___..._.__.._...�37}Q4.R4i.14.4 Surplus to Policyholders........................____..I3�96,435,060 Tofal Liabilities and Surplus____._.__.._._.__.._.__.�37.�94, 43 144 y ivsu q i`�RP�qSt � $'- r o✓*` * Bonds are stated at amortized or investment value;Stocks at Association D4arket Values. ' �9�2 o The foregoing financial inionnation is�ken from Liberiy Mutual Tnsurance Comp�ny's financial &�°'>o„ µ�}r' statemeni filed with the state of Mnssachusetts Depar[ment of Insurance. I,TIM MIKOLAJEWSKI,Assistant Secretary of I,iberty Mutual Insurance Company,do hereby certify that tYie forego:ng is a tr.�e, and correct statement of the Assets and Liabilities of said Corporation,as of December 31,201 l,to the best of my knowledge ar,d belief. IIvT VJTTNESS WT-�EREGr, I hzve herei:nto set my hand and afFixed the seal of said Corporation at Sea«le,Washinb on,this Sth day of April,ZOi2. � ' � Assistant Secretary s-2F2�Mi�.:i,-,:nz , .- �« . EXTRACT FROM BY-LAWS OF THE COMPANIES "Article V,Section 8,Attorneys-in-Fact. The Chief Executive Officer,[he President,or any Executive Vice President or Vice Presiden[ may, by written instrument under the attested corporate seal, appoint attorneys-in-fact with authority to execute bonds, policies, recognizances, stipulations, undertakings, or other like instruments on behalf of the Company, and may authorize any officer or any such attorney-in-fact to affix the corporate seal thereto;and may with or without cause modify of revoke any such appointment or authority at any time." CERTIFICATE I, the undersigned, Vice President of the ZURICH AMERICAN INSURANCE COMPANY, the COLONIAL AMERICAN CASUALTY AND SURETY COMPANY, and 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 Article V,Section 8,of the By-Laws of the Companies is still in force. This Power of Attorney and Certificate may be signed by facsimile under and by aothority of the following resolution of the Board of Directors of the ZURICH AMERICAN INSURANCE COMPANY at a meeting duly called and held on the 15th day of December 1998. RESOLVED: "That the signature of the President or a Vice President and the attesting signature of a Secretary or an Assistant Secretary and the Seal of the Company may be affixed by facsimile on any Power of At[orney...Any such Power or any certi�cate thereof bearing such facsimile signature and seal shall be valid and binding on the Company." This Power of Attomey and CeRificate may be signed by facsimile under and by authority of the following resolution of[he Board of Directors of the COLONIAL AMERICAN CASUALTY AND SURETY COMPANY at a meeting duly called and held on the Sth day of May, 1994, and 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 lOth 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 TEST'IMONY HEREO ,I have hereunto subscribed my name and affixed the corporate seals of the said Companies, this�L day of >20�. �,„„�.....,w. ''a ocius�. Qs�►!��„_"~- ': ��► o � = �A�'�'�s ��4.'��MON�I:c�=i 4r s � i =u; ' ,'o: BBAL � , o ` t��,,.�°,.i�a�3� «'��Q ..n, • ? 1�J' `�,,,,,..*w»�° uh . � Geoffrey Delisio,Vice President -. , M r' ZURICH AMERICAN INSURANCE COMPANY COLONIAL AMERICAN CASUALTY AND SURETY COMPANY FIDELITY AND DEPOSIT COMPANY OF MARYLAND POWER OF ATTORNEY KNOW ALL MEN BY THESE PRESENTS:That the ZURICH AMERICAN INSURANCE COMPANY,a corporation of the State of New York,the COLONIAL AMERICAN CASUALTY AND SURETY COMPANY,a corporation of the State of Maryland,and the FIDELITY AND DEPOSIT COMPANY OF MARYLAND a corporation of the State of Maryland (herein collectively called the "Companies"), by THOMAS O. MCCLELLEN, Vice President, in pursuance of authority granted by Article V, Section 8, of the By-Laws of said Companies,which are set foRh on the reverse side hereof and are hereby ceRified to be in full force and effect on the date hereof,do hereby nomina[e,constitu[e,and appoint Jeannette PORRINI,Stacy RIVERA and Aiza LOPEZ,all of Hartford,Connecticut, EACH its true and lawful agent and Attorney-in-Fact,to make,execute,seal and deliver,for,and on its behalf as surety,and as its act and deed:any and all bonds and undertakings, and the execution of such bonds or undertakings in pursuance of these presents, shall be as binding upon said Companies, as fully and amply, to all intents and purposes, as if they had been duly executed and acknowledged by the regularly elected officers of the ZURICH AMERICAN INSURANCE COMPANY at its office in New York,New York.,the regularly elected officers of the COLONIAL AMERICAN CASUALTY AND SURETY COMPANY at its office in Owings Mills, Maryland., and the regularly elected officers of the FIDELITY AND DEPOSIT COMPANY OF MARYLAND at its office in Owings Mills, Maryland., in their own proper persons. The said Vice President does hereby certify that the extract set foRh on the reverse side hereof is a true copy of ARide V,Section 8,of' the By-Laws of said Companies,and is now in force. IN WITNESS WHEREOF, the said Vice-President has hereunto subscribed his/her names and affixed[he Corporate Seals of the said ZURICH AMERICAN INSURANCE COMPANY, COLONIAL AMERICAN CASUALTY AND SURETY COMPANY, and FIDELITY AND DEPOSIT COMPANY OF MARYLAND,this 15th day of May,A.D.2012. ATTEST: ZURICH AMERICAN INSURANCE COMPANY COLONIAL AMERICAN CASUALTY AND SURETY COMPANY ' FIDELITY AND DEPOSIT COMPANY OF MARYLAND �N ��ti �.�yly�4 � ,�O pw�Ip� GµitNS!/ 6 �"" r O '��w•,o =�b�'$o°��'y.�io? BBAL � ~ ` `�= � �' � ' — i o. : ; «�� % � : �u��e f�� utt 'y..... %,1 •��'p�aa "�nw«...o•'• �//'/ � ��) �r/`� .��:+fJ��'f r f/�, fj�VI'� ,7, i� , N� �/�i� ��'�i.�. ,�{.. /�� 7� ..✓S.^' p� L%��...� U �r; .'7• ( Assistant Secretary Vice President Eric D.Barnes Thomas O.McClellen State of Maryland City of Baltimore On this 15th day of May,A.D.2012,before the subscriber,a Notary Public of the State of Maryland,duly commissioned and qualified,THOMAS O. MCCLELLEN,Vice President,and ERIC D.BARNES,Assistant Secretary,of the Companies,to me personally known to be the individuals and officers described in and who executed the preceding instrument, aod ackoowledged the execution of same, and being by me duly sworn, deposeth and saith, that he/she is the said officer of the Company aforesaid,and that the seals affixed to the preceding instrument are the Corporate Seals of said Companies,and that the said Corporate Seals and the signature as such officer were duly affixed and subscribed to the said instrument by the authority and direction of the said Corporations. IN TESTIMONY WHEREOF,1 have hereunto set my hand and affixed my Official Seal the day and year first above written. .'��!�"��'j:�ts�'' �.I�UfiV�'<• `�.�� .�s. nn/ /�/ r�;�' �� j��, `/� W-�'��.�Sfi� �`�f'•��'7 IG :�C,�: / '�"-'".Lc.� ,�4i�rti;(;in��`�``+'. ��iU��1�� Maria D.Adamski,Notary Public My Commission Expires:July 8,2015 POA-F 142-0587E �+ - •* , � FIDELITY AND DEPOSIT COMP.ANY OF MARYLAND 600 Red Brook Blvd.,Suite 600,Owvigs Mills,1VID 2I 127 Stafement of Financiat Condifion As Of December 31,2411 ASSETS Bonds............................................................................................................................................... $ 167,477,539 Stocks............................................................................................................................................... 23,576,974 Cash and Short Term Investments................................................................................................... 235,580 Reinsurance Recoverable................................................................................................................. 12,886,175 Other Accounts Receivable.............................................................................................................. 39,980,988 To1'al.Ar�M11'T�nAssE'rs........................................................................................................ $ 244,157,256 - LIABiLTTIES,SURPLUS AND OTH�R FUNllS Reserve for Taxes and Expenses......................................................................................................$ 127,987 Ceded Keinsurance Pz•emiums.Payable............................................................................................ 48,215,682 Securities Lending Collateral Liability............................................................................................ 1,022,500 `I'OTt1LLTABII,ITIES....................................................................................................................$ 49,366,169 CapitaI Stock,Paid Up........................................................................................ $ S,OOQ,Q00 Surplus................................................................................................................ 189,791,087 Smplus as regards Policyholders...................................................................................................... 194,791,087 ToT,�........................................................................................................................................$ 244,157,256 Securiries can•ied at$59,049,993 in the above statemenE are depos�ted as required by law. Securities ca�ried on the basis prescriUed by the National Association of lnsurance Con�missioners. On the basis of December 31,2U 12 rnarket quotations for ali bonds and stocks owned,the Company's total admitted assets would be $253,778,028 and surplus as regards poiicyho2ders$2Q4,41 I,SS9. I,DENNIS F.KERRIGAN,Corporate Secretary of the FIDELITYAND DEPos1T CoMPANY oF MARYLAND,do hereby certify that the foregoing statement is a correct e�chibit of the assets and liabilities of the said Company an tha 31st day of December,2011. orporaie Secrelary Stata of Illinois � City of Schaumburg S5: Subscribed and s�vorn to,befnre nre,a Notary Pubtic of the State of tllinois,in the Cily of Schaumburg,this 15th day of March,2012. 4 „ ,+�j � OFfIClAL SEAi � U�� 4 NotaryPublic DARRYL JOiNER Notary Public • State of IUinais My Commission Expues A�ay 3,2014 �,�.,�s�yyJr...C....'., �n"'[n�aY^". � � . Certificate of Insurance THIS CERTIFICATE IS ISSUED AS A MATfER OF INFORMATION ONLY AND CONFERS NO RIGH'I'S UPON YOU TE�CERTIFICATE HOLDER.THIS CERTIFICATE IS NOT AN INSURANCE POLICY AND DOES NOT AMEND,EXTEND,OR ALTER THE COVERAGE AFFORDED BY THE POLICIES LISTED BELOW. POLICY LIMITS ARE NO LESS THAN'C[IOSE LISTED ALTHOUGH POLICIES MAY INCLUDE ADDITIONAL SUBLIMIT/LIMIT'S NOT LISTED BELOW. This is to Certify that City of Cape Girardeau � � NAME AND .-. Libe P. O. Box 617 ADDRESS " �� OF INSURED Mutual� Cape Girardeau MO 63702 � is,at the issue date of this certificate,insured by the Company under the policy(ies)listed below. The insurance afforded by the listed policy(ies)is subject to all their terms,exclusions and Conditions and is not altered by any requirement,term or condihon of any conhact or other dceument with respect ro which this cenificate may be issued. EXP DATE TYPE OF POLICY �coNrirr�rous pOLICY NUMBER LIMIT OF LIABILITY ❑EXTENDED �POLICY TERM WORKERS COVERAGE AFFORDED UNDER WC EMPLOYERS LIABILITY LAW OF THE FOLLOWING ST'ATES: COMPENSATION Bodily Injury by Accident Each Accident Bodily Injury By Disease Bodily Injury By Disease GENERAL LIABILITY BODILY INJURY PROPERTY DAMAGE � ComprehensiveForm 9/19/2013 TF2-631-510040-452 $ ��h g Each � Schedule Occurrence Occurrence � Products/Completed Opera[ions $ A e ate $ A re ate � independent Contracrors/ Combined Single Limit Contracrors protective Bodily Injury and Property Damage � Contractual Liability �Owners'&Contracrors' $ 2,62�,000 �ch Occu�rence protective liability policy $ 2�62�,�� Aggrega[e �Raiiroad Protective AjTTOMOBILE Each Accident—Single Limit LIABILITY B.I.And P.D.Combined ❑OWNED Each Person ❑NON-OWNED Each Acciden[or Occucrence ❑HIRED Each Accident or Occurrence ADDITIONAL INSURED: See Addendum Attached. Lacallon(s)ot Operations&Job#(if applicable) Descrip[ion of Operations: City Streets in the City of Cape Girardeau 2012 Asphalt Overlay-TTF-IV •If[he certificate expiration date is continuous or ex[ended term,you will be no[ified if wverage is termina[ed or reduced before the certificate expira[ion date. Liberty Mutual NOTICE OF CANCELLATION:(NOT APPLICABLE UNLESS A NUMBER OF DAYS IS ENTERED BELOW.) Insurance Group BEFORE THE STATED EXPIRATION DATE THE COMPANY WILL NOT CANCEL OR REDUCE TIIE INSURANCE AFFORDED UNDER THE ABOVE POLICIES UNTIL AT LEAST 30 DAYS. City of Cape Girardeau �,�cc�,�v`R, �UY� Adrienne Kisonas WBStOf1/0102 AUTHORIZED REPRESENTATIVE Y S Riverside Office Park,9 Riverside Road � P. O. Box 617 Weston MA 02493-2298 781-891-8900 9/20/2012 �pe Girardeau M� 63702 � OFF[CE PHONE DATEISSUED This certificate is executed by LIBERTY MUTUAL INSURANCE GROUP as respects such insurance as is afforded by Those Companies NM 772A R6 07-10 LDI COI 268895 02 11 NAMED INSURED CERTIFICATE HOLDER 9/20/2012 City of Cape Girardeau City of Cape Girardeau P. O. Box 617 P. O. Box 617 Cape Girardeau MO 63702 Cape Girardeau MO 63702 Designated Contractor: Apex Paving Company, P. O. Box 637, Cape Girardeau, MO 63702 Policy Term: 9/19/2012 to 9/19/2013 � x., �. , is'I�,�,a �.,�i�t� „rr�.-- ,a- ,;��" � �` ?:�ti `hN° _�"�'""�.� E " �'�� '�.��a ""' ;..�..k-#�� .�'�` '��, ,, s `�k*'�.'�,�t'��-�c., � 'C t�' TM �'� � �t� �`�� .�t� �r.%'�a z��'�A`��,��p'Z� ; w _. . � ��"Eed��»..� ' '�� . . W�° � ��;�.r � ,. � �� , ��,�� € '�"'a� s.�.w�,� r �; �n �a�k, a �'. . , '" , . - ^"�-�k.".�,m� �i� ;'�.� ��".�s�^Ym- '� "�-�';x; ^� ,aco� CERTIFICATE OF LIABILITY INSURANCE DAiE(MMIDO/YYYI� �- ��o,�,z THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and 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). PRODUCER CONTACT MARSH USA,INC. NAME: 445 SOUTH STREET PHONE A/C No: MORRISTOWN,NJ 07960-6454 E-MAIL AtN:Morristown.certrequest@Marsh.caNFax:212-948-0979 ADORESS: INSURER S AFFORDING COVERAGE NAIC# 10W65-ALL.-UM&12-13 SMITH DELTA �NsuRER A:�is Insurance Company 37273 INSURED INSURER B;N/A WA APEX PAVING COMPANY P.O.BOX 637 �NSURER C: CAPE GIRARDEAU,MO 63702-0637 INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: NYG006469046-01 REVISION NUMBER:2 THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTIMTHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOVIM MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR 7ypE OF INSURANCE ADDL SUBR POIICY EFF POLICY EXP IIMITS LTR POLICYNUMBER MMIDDMlYY MMIDDM'YY GENERAL LIABILITY EACH OCCURRENCE $ COMMERCWL GENERAL LIABILITY PR MISES Ea oaurrence $ CWMS-MADE �OCCUR MEOEXP(Anyoneperson) $ PERSONAL&ADVINJURY $ GENERALAGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG E POLICY PR� LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE L1MIT Ea accidert S ANY AUTO BODILY INJURY(Per perwn) $ ALL OWNED SCHEDULEO BODILY INJURY(Per accident) $ AUTOS NON�WNED PROPERTYDAMAGE $ HIRED AUTOS AUTOS Peracddent a UMBRELLA LIAB X p�CUR EACH OCCURRFNCE a 1,000,000 A X EXCESS LIAB CLAIMS-MADE MNU 731833101/2012 0410112012 04/O112013 qGGREGATE $ 1,000,000 DED RETENTION$ $ WORKERS COMPENSATION VvC STATU- OTH- AND EMPLOYERS'LIABILITY Y/N ANYPROPRIETOR/PARTNER/EXECUTIVE� N�A E.L.EACHACCIDENT $ OFFICER/MEMBER EXCLUDED7 (Mandatory in NH) E.L.DISEASE-EA EMPLOYE $ If Yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT S I DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) CITY OF CAPE GIRARDEAU IS INCLUDED AS ADDITIONAL INSURED WHERE RE�UIRED BY WRITTEN CONTRACT AND ALLO WED BY LAW. CERTIFICATE HOLDER CANCELLATION CITY OF CAPE GIRARDEAU SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE PO BOX 637 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN CAPE GIRARDEAU,MO 63702 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE of Marsh USA Inc. Edward J.Smith �+.�� d• .e�--�+(. O 1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD v Certificate of Insurance THIS CERTIFICATE IS ISSUED AS A MATi'ER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON YOU THE CERTIFICATE HOLDER.THIS CER'I]FICATE IS NOT AN INSURANCE POLICY AND DOES NOT AMEND,EXTEND,OR ALTER THE COVERAGE AFFORDED BY THE POLICIES LISTED BELOW.POUCY LIMITS ARE NO LESS THAN THOSE LISTED ALTHOUGH POLIC[ES MAY INCLUDE ADDITIONAL SUBLIMIT/LIMITS NOT LISTED BELOW. This is to Certify that Delta Companies Inc. Delta Asphalt Inc., Heartland � � Asphalt Materials inc., Delta Asphalt of Arkansas NAME AND .-. Llber Inc., APEX paving Co., Southern Illinois Asphalt ADDRESS "' � Co., Inc. /114 South Silver Springs Road OF INSURED Mutual Cape Girardeau MO 63702 � � is,a[the issue date of this certifica[e,insured by the Company under the policy(ies)lis[ed below. 'Che insurance afforded by the listed policy(ies)is subject[o all[heir[ertns,exclusions and Conditions and is not altered by any requiremeot,term or condition of any contract or other document with respect to which this certificate may be issued. EXP DATE TYPE OF POLICY �corrrnvvous pOLICY NUMBER LIMIT OF LIABILITY ❑EXTENDED �POLICY TERM WORKERS �NC7-631-004090-592 COVERAGE AFFORDED UNDER WC EMPLOYERS L[ABILITY 4/1/2013 LAW OF THE FOLLO W ING STATES: COMPENSATION AR,IL,MO,TX Bodily ldury by Accident 2��Q��Q Each Accidenc Bodily Injury By Disease �2��0�� Bodily Injury By Disease 2��QQ� a COMMERCIAL 4/1/2013 T62-631-004090-602 General Aggregate GENERAL LIABILITY 3 000 000 �OCCURRENCE Products/Completed Operations Aggregate ❑CLAIMS MADE 3 OOO OOO Each Occurrence 2�0�� RETRO DATE Personal&Advertising Injury $2 00��00 Per Person/Organizatio❑ Other [her Includes Per Job Aggregate& Damages to Premises:$100,0 AUTOMOBILE 4/1/2013 AS2-631-004090-612 Each Accident—Single Limit LIABILITY $2,00�,000 B.1.And P.D.Combined �O WNED Each Person �NON-OWNED Each Accident or Occurrence IJ HIRED Each Accident ur Occurtence OTHER ADDITIONAL COMMENTS Project: 2012 Asphalt Overlay Program-TTF-IV. City of Cape Girardeau is additional insured with regards to general liability and auto liability as their interest may appear where required by written contract. 'If the certificate expiration date is continuous or extended term,you will be no[ified if coverage is terminated or reduced before the certificate expiration date. Liberty Mutual NOTICE OF CANCELLATION:(NOT APPUCABLE UNLESS A NUMBER OF DAYS IS ENTERED BELOW J Insurance Group BEFORE THE STATED EXPIRATION DATE THE COMPANY WILL NOT CANCEL OR REDUCE THE INSURANCE AFEORDED UNDER THE ABOVE POUC[ES LJNTIL AT LEAST 3O DAYS NOTICE OF SUCH CANCELLATION HAS BEEN MAILED TO: �ity of Cape Girardeau � ��u�,��,�, �uJU�� Adrienne Kisonas WEStOfI/O1 O2 AUTHORIZED RFPRESENTATNE " Riverside Office Park,9 Riverside Road � PO Box 637 Weston MA 02493-2298 781-891-8900 9/6/2012 �ape Girardeau MO 63702 � OFFICE �HONe DATE ISSUED This certificate is executed by LIBERTY MUTUAL INSURANCE GROUP as respects such insurancc as is afforded by those Companies NM 772 07-10 LDI COI 268896 02 11 . Certificate of Insurance THIS CERTIFICATE IS ISS[JED AS A MA'[TER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON YOU THE CERTIF[CATE HOLDER.TFIIS CER'[IFICATE IS NOT AN INSURANCE POLICY AND pOES NOT AMEND,EXIEND,OR ALTER Tf�COVERAGE AFFORDED BY Tf�POLICIES LISTED BELOW.POLICY LIMITS ARE NO LESS THAN THOSE LISTED ALTHOUGB POLICIES MAY INCLUDE ADDITIONAL SUBLIMIT/LIMITS NOT LISTED BELOW. This is to Certify that ' Apex Paving � • PO Box 637 NAME AND '' Llbe ADDRESS " �� Cape Girardeau MO 63702 OF INSURED Mutual� � � is,at the issue date of this cectificate,insured by the Company under the policy(ies)listed below. The insurence afforded by the listed policy(ies)is subject to all the'v terms,exclusions and Conditions and is not altered by any requ'vement,term or condition of any conaact or other document with respect to which this certificate may be issued. EXP DATE TYPE OF POLICY �corrraauous pOLICY NUMBER LIMIT OF LIABILITY ❑EXTENDED �POLICY'CERM WORKERS WC7-631-004090-592 COVERAGE AFFORDED UNDER WC EMPLOYERS LIABILITY 4/1/2013 LAW OF Tf�FOLLO WING STATES: COMPENSATION AR,IL,MO,TX Bodilyln'urybyAccident 2 0��Each Accident Bodily Injury By Disease 2�� Bodily Injury By Disease 2�� a COMMERCIAL 4/1/2013 T62-631-004090-602 General Aggregate GENERAL LIABILITY 2 000 000 �OCCURRENCE Products/Completed Opecations Aggregate ❑CLntMS MnDE 2 OOO OOO Each Occutrence 2��0�� RETRO DAT'E Personal&AdveRising Injury $2 QQQ QQ� Per Person/Organization �Includes Per Job Aggregate 8� �Damages to Premises:$100,0 AUTOMOBILE 4/1/2013 AS2-631-004090-612 Eech pccident—sinete Limit LIASILITY $Z,��D,OOO B.I.And P.D.Combiced �OWNED Each Pecson �NON-OWNED Each Accident or Occucrence �HIRED Each Acciden[or Occumence OTHER ADDITIONAL COMMENTS RE:2012 Asphalt Overlay Program-TTF-IV.City of Cape Girardeau is named as"Additional"Insured with respect to the General Liability Policy. �[f the ceRificate expiration date is continuous or ex[ended term,you will be notified if coverage is tertninated or reduced before the certificate expiration date Liberty Mutual NOTICE OF CANCELLATION:(NOT APPLICABLE UNLESS A NiJMBER OF DAYS IS ENTERED BEIAW.) Insurance Group BEFORE TE� STATED EXPIRATION DATE 'I'f�COMPANY WILL NO'f CANCEL OR REDUCE THE INSURANCE AFFORDED UNDER iHE ABOVE POLIC[ES UNTIL AT LEAST 3O DAYS NOTICE OF SUCH CANCELLA"CION HAS BEEN MAILED TO: �City of Cape Girardeau � C6�c� Rudy Milfort .. PO Box 617 New York/0202 AUTHORIZED REPRESENTATIVE r x Cape Girardeau,MO 63702 114 West 47th St. $�21 f�2 v" New Yoric NY 10036 212-391-7500 _ � � OFFICE PHONE This certificate is executed by LIBERTY MLITUAL INSURANCE GROUP as respects such insurance as is afforded by those Companies N ) LDI COI 268896 02 11 CITY OF CAPE GIRARDEAU 2012 ASPHALT OVERLAY PROGRAM STANDARD FORM OF AGREEMENT BETWEEN OWNER AND CONTRACTOR ON THE BASIS OF A STIPULATED PRICE THIS AGREEMENT is dated as of the day of in the year 2012 by and between the City of Cape Girardeau, Missouri (hereinafter called OWNER) and Apex Paving Company (hereinafter called CONTRACTOR). OWNER and CONTRACTOR, in consideration of the mutual covenants hereinafter set forth, agree as follows: Article 1. WORK. CONTRACTOR shall complete all Work as specified or indicated in the Contract Documents. The Work is generally described as follows: The locations for the work to be performed under these Contract Documents are William Street from Sprigg Street to Park Street and from Louisiana to Kingshighway; Bernice Street from Lakeshore Drive to Fremont Street; Old Highway 61 from Delta Drive to South Sprigg Street; Koch Street from Good Hope to Brink Street. The improvements consist of resurfacing the existing pavement on the above mentioned City streets; the removal and replacement of portions of curb, gutter, alleys, and driveways; adjustments to existing manholes and utility castings as well as re -striping for streets that have existing striping as noted for each location, all as described in the contract documents. The streets are located in various areas within the City of Cape Girardeau, Missouri. The existing surface of William Street will be overlaid by placing and compacting a 314 inch thin lift of new hot mix asphalt. The existing surfaces of Bernice St., Old Highway 61, and Koch Street will be removed by milling approximately 2 inches off the existing pavement and a new surface will be added by placing and compacting 2 inches of new hot mix asphalt. Article 2. ENGINEER. The City Engineer or his designee is to act as OWNER'S representative, assume all duties and responsibilities and have the rights and authority assigned to ENGINEER in the Contract Documents in connection with completion of the Work in accordance with the Contract Documents. I'AW Article 3. CONTRACT TIMES. 3.1 The work will be substantially completed within Sixty (60) calendar days after the date when the Contract Times commence to run as provided in paragraph 2.3 of the General Conditions, and completed and ready for final payment in accordance with paragraph 14.13 of the General Conditions within Ninety (90) days after the date when the Contract Times commence to run. 3.2 Liquidated Damages. OWNER and CONTRACTOR recognize that time is of the essence of this Agreement and that OWNER will suffer financial loss if the Work is not completed within the times specified in paragraph 3.1 above, plus any extensions thereof allowed in accordance with Article 12 of the General Conditions. They also recognize the delays, expense and difficulties involved in proving the actual loss suffered by OWNER if the Work is not competed on time. Accordingly, instead of requiring any such proof, OWNER and CONTRACTOR agree that as liquidated damages for delay (but not as a penalty) CONTRACTOR shall pay OWNER Seven hundred fifty dollars $750.00 for each day that expires after the time specified in paragraph 3.1 for Substantial Completion until the Work is substantially complete. After Substantial Completion, if CONTRACTOR shall neglect, refuse or fail to complete the remaining Work within the time specified in paragraph 3.1 for completion and readiness for final payment or any proper extension thereof granted by OWNER, CONTRACTOR shall pay OWNER One thousand dollars 1000.00 for each day that expires after the time specified in paragraph 3.1 for completion and readiness for final payment. Article 4. CONTRACT PRICE. OWNER shall pay CONTRACTOR for completion of the Work in accordance with the Contract Documents an amount in current funds equal to the sum of the amounts determined pursuant to paragraphs 4.1 and 4.2 below: 4.2 For all Unit Price Work, an amount equal to the sum of the established unit price for each separately identified item of Unit Price Work times the estimated quantity of that item as indicated in the bidding documents. TOTAL OF ALL UNIT PRICES: Three Hundred Sixteen Thousand Seventy Dollars and Ninety-two Cents ($ 316,070.92) As provided in paragraph 11.9 of the General Conditions estimated quantities are not guaranteed, and determinations of actual quantities and classification are to be made by ENGINEER as provided in paragraph 9.10 of the General Conditions. Unit prices have been computed as provided in paragraph 11.9.2 of the General Conditions. A-2 'Cl Article 5. PAYMENT PROCEDURES. CONTRACTOR shall submit Applications for Payment in accordance with Article 14 of the General Conditions. Applications for Payment will be processed by ENGINEER as provided in the General Conditions. 5.1 Progress payments, Retainage. OWNER shall make progress payments on account of the Contract Price on the basis of CONTRACTOR'S Application for Payment as recommended by ENGINEER, on or about the 10th day of each month during construction as provided in paragraphs 5. 1.1 and 5.1.2 below. All such payments will be measured by the schedule of values established in paragraph 2.9 of the General Conditions (and in the case of Unit Price Work based on the number of units completed) or, in the event there is no schedule of values, as provided in the General Requirements. 5.1.1 Prior to Substantial Completion, progress payments will be made in an amount equal to the percentage indicated below, but, in each case, less the aggregate of payments previously made and less such amounts as ENGINEER shall determine, or OWNER may withhold, in accordance with paragraph 14.7 of the General Conditions. 90% of Work completed (with the balance being retainage). If Work has been 50% completed as determined by ENGINEER, and if the character and progress of the Work have been satisfactory to OWNER and ENGINEER, OWNER, on recommendation of ENGINEER, may determine that as long as the character and progress of the Work remain satisfactory to them, there will be no additional retainage on account of Work completed, in which case, the remaining progress payments prior to Substantial Completion will be an amount equal to 100% of the Work completed. 90% (with the balance being retainage) of materials and equipment not incorporated in the Work (but delivered, suitably stored and accompanied by documentations satisfactory to OWNER as provided in paragraph 14.2 of the General Conditions). 5.1.2 Upon Substantial Completion, in an amount sufficient to increase total payments to CONTRACTOR to 95% of the Contract Price (with the balance being retainage), less such amounts as ENGINEER shall determine, or OWNER may withhold, in accordance with paragraph 14.7 of the General Conditions. 5.2 Final Payment. Upon final completion and acceptance of the Work in accordance with paragraph 14.13 of the General Conditions, OWNER shall pay the remainder of the Contract Price as recommended by ENGINEER as provided in said paragraph 14.13. Article 6. INTEREST. All moneys not paid when due as provided in Article 14 of the General Conditions shall bear interest at the maximum rate allowed by law at the place of the Project. Anr Article 7. CONTRACTOR'S REPRESENTATIONS. In order to induce OWNER to enter into the Agreement, CONTRACTOR makes the following representations: 7.1 CONTRACTOR has examined and carefully studied the Contract Documents (including the Addenda listed in paragraph 8) and the other related data identified in the Bidding Documents, including "technical data". 7.2 CONTRACTOR has visited the site and become familiar with and is satisfied as to the general, local and site conditions that may affect cost, progress, performance and furnishing of the Work. 7.3 CONTRACTOR is familiar with and is satisfied as to all federal, state and local laws and Regulations that may affect cost, progress, performance and furnishing of the Work. 7.4 CONTRACTOR has carefully studied all reports of explorations and tests of subsurface conditions at or contiguous to the site and all drawings of physical conditions in or relating to existing surface or subsurface structures at or contiguous to the site (except Underground Facilities) which have been identified. CONTRACTOR acknowledges that such reports and drawings are not Contract Documents and may not be complete for CONTRACTOR'S purposes. CONTRACTOR acknowledges that OWNER and ENGINEER do not assume responsibility for the accuracy or completeness of information and data shown or indicated in the Contract Documents with respect to Underground Facilities at or contiguous to the site. CONTRACTOR has obtained and carefully studied (or assumes responsibility for having done so) all such additional supplementary examinations, investigations, explorations, tests, studies and data concerning conditions (surface, subsurface and Underground Facilities) at or contiguous to the site or otherwise which may affect cost, progress, performance or furnishing of the Work or which relate to any aspect of the means, methods, techniques, sequences and procedures of construction to be employed by CONTRACTOR and safety precautions and programs incident thereto. CONTRACTOR does not consider that any additional examinations, investigations, explorations, tests, studies or data are necessary for the performance and furnishing of the Work at the Contract Price, within the Contract Times and in accordance with the other terms and conditions of the Contract Documents. 7.5 CONTRACTOR is aware of the general nature of work to be performed by OWNER and others at the site that relates to the Work as indicated in the Contract Documents. 7.6 CONTRACTOR has correlated the information known to CONTRACTOR, information and observation obtained from visits to the site, reports and drawings identified in the Contract documents and all additional examinations, investigations, explorations, tests, studies and data with the Contract Documents. 7.7 CONTRACTOR has given ENGINEER written notice of all conflicts, errors, ambiguities or discrepancies that CONTRACTOR has discovered in the Contract Documents and the written resolution thereof by ENGINEER is acceptable to CONTRACTOR, and the Contract Documents are generally sufficient to indicate and convey understanding of all terms and conditions for performance and furnishing of the Work. Article 8. CONTRACT DOCUMENTS. The Contract Documents which comprise the entire agreement between OWNER and CONTRACTOR concerning the Work consist of the following: 8.1 This Agreement (pages 1 to 7 inclusive). 8.2 Exhibits to this Agreement (pages BF- to BF- , inclusive). 8.3 Performance, Payment, and other Bonds, identified as exhibits and consisting of pages. 8.4 Notice to Proceed. 8.5 General Conditions (pages 1 to 55 , inclusive). (EJCDC No. 1910-8 1990 Edition) 8.6 Supplementary Conditions (pages SC -1 to SC -5 , inclusive). 8.7 Specifications bearing the title 2012 Asphalt Overlay Program . 8.8 Drawings. 8.9 Addenda numbers 1 to 1 , inclusive. 8.10 CONTRACTOR'S Bid (pages BF- 1 to BF- 8 , inclusive) marked exhibit "A" . 8.11 Pursuant to 285.530 R.S. Mo, the contractor must affirm its enrollment and participation in a federal work authorization program with respect to the employees proposed to work in connection with the services requested herein by 1) submitting a completed, notarized copy of AFFIDAVIT OF WORK AUTHORIZATION and 2) providing documentation affirming the bidder's enrollment and participation in a federal work authorization program with respect to the employees proposed to work in connection with the services requested herein. 8.12 Documentation submitted by CONTRACTOR prior to Notice of Award (pages to _, inclusive). 8.13 The following which may be delivered or issued after the Effective Date of the Agreement and are not attached hereto: All Written Amendments and other documents A-5 amending, modifying or supplementing the Contract Documents pursuant to paragraphs 3.5 and 3.6 of the General Conditions. The documents listed in paragraphs 8.2 et seq. above are attached to this Agreement (except as expressly noted otherwise above). There are no Contract Documents other than those listed above in the Article 8. The Contract Documents may only be amended, modified or supplemented as provided in paragraphs 3.5 and 3.6 of the General Conditions. Article 9. MISCELLANEOUS. 9.1 Terms used in this Agreement which are defined in Article 1 of the General Conditions will have the meanings indicated in the General Conditions. 9.2 No assignment by a party hereto of any rights under or interests in the Contract Documents will be binding on another party hereto without the written consent of the party sought to be bound; and, specifically but without limitation, moneys that may become due and moneys that are due may not be assigned without such consent (except to the extent that the effect of this restriction may be limited by law), and unless specifically stated to the contrary in any written consent to an assignment no assignment will release or discharge the assignor from any duty or responsibility under the Contract Documents. 9.3 OWNER and CONTRACTOR each binds itself, its partners, successors, assigns and legal representatives to the other party hereto, its partners, successors, assigns and legal representatives in respect to all covenants, agreements and obligations contained in the Contract Documents. 9.4 Any provision or part of the Contract Documents held to be void or unenforceable under any Law or Regulation shall be deemed stricken, and all remaining provisions shall continue to be valid and binding upon OWNER and CONTRACTOR, who agree that the Contract Documents shall be reformed to replace such stricken provision or part thereof with a valid and enforceable provision that comes as close as possible to expressing the intention of the stricken provision. 9.5 Pursuant to 292.675, R.S. Mo, the contractor is informed that all contractors or subcontractors doing work on this project to provide, and require its on-site employees to complete, a ten (10) hour course in construction safety and health approved by the Occupational Safety and Health Administration ("OSHA") or similar program approved by the Missouri Department of Labor and Industrial Relations which is at least as stringent as an approved OSHA program. The training must be completed within sixty (60) days of the date work on the project commences. On-site employees found on the worksite without documentation of the required training shall have twenty (20) days to produce such documentation. 9.6 The General Contractor shall provide to the City of Cape Girardeau City Engineer's Office weekly certified payrolls from the General Contractor and all Subcontractors during the course of the project. These must be provided on a weekly basis; if no work was done, then a payroll stating "No Work Done" must be submitted. IN WITNESS WHEREOF, OWNER and CONTRACTOR have signed the Agreement in multiple copies, One counterpart each has been delivered to CONTRACTOR and ENGINEER and two counterparts to the OWNER. All portions of the Contract Documents have been signed, initialed or identified by OWNER and CONTRACTOR or identified by ENGINEER on their behalf. This Agreement will be effective on Effective Date of the Agreement). OWNER City of Cape Girardeau Scott Meyer, City Manager Attest [CORPORATE SEAL] Gayle L. Conrad, City Clerk Address for giving notices 40.1 Independence Street Cape Girardeau, MO 63703 (If OWNER is a public body, attach evidence of authority to sign and resolution or other documents authorizing execution of Agreement. 2012 (which is the CONTRACTOR Apex Paving Company [CORPORATE SEAL] Attest Address for giving notices License No. A-7 Agent for service of process: (If CONTRACTOR is corporation, attach evidence of authority to sign.) EXHIBIT "A" CITY OF CAPE GIRARDEAU 2092 ASPHALT OVERLAY PROGRAM BID FORM (EJCDC 1910-18) (1990) PROJECT IDENTIFICATION: The improvement consists of resurfacing the existing pavement on portions of William Street, Bernice Street, Old Highway 61 and Koch Street; the removal and replacement of portions of curb, gutter, alleys, and driveways; adjustments to existing manholes and utility castings as well as re -striping for streets that have existing striping as noted for each location, all as described in the contract documents. The streets are located in various areas.within the City of Cape Girardeau, Missouri. The existing surface of William Street will be overlaid by placing and compacting a 3/4 inch thin lift of new f-iof mix asphalt. TFie exisf�ng surfaces of -Bernice Sf ; OI- F�igfiway 6y; antl--Koch Street will be removed by milling approximately 2 inches off the existing pavement and a new surface will be added by placing and compacting 2 inches of new hot mix -asphalt. THIS BID IS SUBMITTED TO CITY OF CAPE GIRARDEAU, MO 401 INDEPENDENCE STREET CAPE GIRARDEAU, MO 63703 1. The undersigned BIDDER proposes and agrees, if the Bid is accepted, to enter into an agreement with OWNER in the form included in the Contract Documents to perform and furnish all Work as specified or indicated in the Contract Documents for the Bid, Price and within the Bid Times indicated in -this Bid and in accordance with the other terms and conditions of the Contract Documents. 2. BIDDER accepts all of the terms and conditions of the Advertisement or Invitation to Bid and Instructions to Bidders, including without limitation, those dealing with the disposition of Bid security. This Bid will remain subject to acceptance for sixty days after the day of Bid opening. BIDDER will sign. and deliver the required number of counterparts of the Agreement with the Bonds and other documents required by the Bidding Requirements within fifteen days after the date of OWNER'S notice of Award. - 3. In submitting this Bid, BIDDER represents, as more fully set forth in the Agreement, that: (a) BIDDER has examined and carefully studied the Bidding Documents and the following: Addenda, receipt of all which is hereby acknowledged: (List Addenda by Addendum Number and Date) BF -1 A m e-nlurn I �- oilst a (b) BIDDER. has visited the site and become familiar with and is satisfied as to the general, local and site conditions that may affect cost, progress, performance and furnishing of the Work, (c) BIDDER is familiar with and is satisfied as to all federal, state and local Laws and Regulations that may affect cost, progress, performance and furnishing of the Work. . (d) BIDDER has carefully studied all reports of explorations and tests of subsurface conditions at or contiguous to the site and all drawings of physical conditions in or relating to existing surface or subsurface structures at or contiguous to the site (except Underground Facilities) which have been identified. BIDDER acknowledges that such reports and drawings are not Contract Documents and may not be complete for BIDDER'S purposes. BIDDER acknowledges that OWNER and Engineer do not assume responsibility for accuracy or completeness of information and data shown or indicated in the Bidding Documents With respect to Underground Facilities.at or contiguous to the site. BIDDER has obtained and carefully studied (or assumes responsibility for having done so) all such additional or supplerrientary examinations, investigations,., explorations, tests, studies and data concerning: conditions (surface, subsurface and Underground Facilities) at or contiguous to the site or otherwise which may affect cost progress, performance or furnishing of the Work or which relate, to any aspect of the means, methods, techniques, sequences and procedures of construction .to. be employed by BIDDER and safety precautions and programs incident thereto. BIDDER'does not consider that any additional examinations, investigations, explorations, tests, studies or data are necessary for the determination of this Bid.for.performance and furnishing of the Work in accordance with the times, price. and other.terms and.conditions of the Contract Documents. (e) BIDDER is .aware of the general nature of Work -to be performed: by Owner. and others at the site that relates to Work for which this Bid is submitted as indicated. in the Contract Documents. (f) BIDDER has correlated_ the* information known. to BIDDER, information and observations obtained from visits to the site, reports and drawings identified in the Contract Documents and all additional examinations, investigations, explorations, tests, studies and data with the Contract Documents. (g) BIDDER has given Engineer written notice of all conflicts, errors, ambiguities or discrepancies that BIDDER has discovered in the Contract Documents and the written resolution thereof by ENGINEER is acceptable to BIDDER, and the Contract Documents are generally sufficient to indicate and convey understanding of all terms and conditions for performing and furnishing the Work for which this Bid is submitted. BF -2 Any questions, comments, or concerns regarding the design of this project should be addressed to Jake Garrard, E. I., City of Cape Girardeau at 573-339-6327. (h) This Bid is genuine and not made in the interest of or on behalf of any undisclosed person, firm or corporation and is not submitted in conformity with any agreement or rules of any group association, organization or corporation; BIDDER has not directly or indirectly induced or solicited any other Bidder to submit a false or sham Bid; BIDDER has not solicited or induced any person, firm or corporation to refrain from bidding; and BIDDER has not sought by collusion to obtain for itself any advantage over any other Bidder or over OWNER. (i) Pursuant to 285.530 RSMo, the bidder must affirm its enrollment and participation in a federal work authorization program with respect to the employees proposed to work in connection with the servicesrequested herein by • submitting a completed, notarized copy of AFFIDAVIT OF WORK AUTHORIZATION and • providing documentation affirming the bidder's enrollment and participation in a federal work authorization program with respect to the employees proposed to work in connection with the services requested herein. • http://vvwvi.uscis-gov/portal/site/uscis Q) Bidders are informed that the Project is subject to the requirements of Section 292.675, R.S. Mo, which requires all contractors or subcontractors doing work on the Project to provide, and require its on-site employees to complete, a ten (10) hour course in construction safety and, health approved by the Occupational Safety and Health Administration ("OSHA") or similar program approved by the Missouri Department of Labor and- Industrial Relations which is at least as stringent as an approved OSHA program. The training must be completed within sixty (60) days of the date work on the Project commences. On-site employees found on the worksite without documentation of the ..__-.r_equired._training shall. have twenty ..(20)--days..to- produce :such -documentation: B1=-3 4. BIDDER will complete the Work in accordance with the Contract Documents for the following price(s): UNIT PRICE BID No. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 UNIT PRICE TOTAL EST. EST. ITEM UNIT s --D-, 05 $ QTY. Hot Mix Asphaltic Concrete Ton 1568 (3/4" Thin Lift) $ 1 $s Hot Mix Asphaltic Concrete Ton 1434 (MoDOT BP -2) $ Liquid Asphalt Tack Coat Gal 5103 Milling SY 7515 Replace Concrete Curb LF 10 and Gutter s a $a5.t�b Replace Concrete Alleys SY 16 and Driveways $ �Zl , �� Single Curb Ramp with Each 12 Truncated Domes $ Ob $ 3,1N, Double Curb Ramp with Each 24 Truncated Domes Concrete Patch SY 89 Adjust Manhole Each 31 Adjust Valve Box Each 35 Striping - Double Yellow LF 6890 Line Striping - Dashed Yellow. LF 2805 Line Striping - Dashed White LF 13140 Line Striping - Solid White Line LF 534 Turn Arrows Each 16 Temporary Traffic Control LS 4 Temporary Erosion Control LS 1 Base 5 Aggregate Ton 276 Butt Joint and Spot Milling SY 798 Asphalt Patch SY 80 TOTAL BID FOR ALL UNIT PRICES UNIT PRICE TOTAL EST. $ -Jb rrPRICE $ �V � �•C7U s --D-, 05 $ $ � � $ a � !bD $ 3. l4 $ 431 40 $ 21 $ 1 $s $ ,_ Li—� �D $ $j5 r66 $ $ 0,4L $ 10 $ 0.42 $5, cbI $ o. 2 s a $a5.t�b $ -401.2 $ $ �Zl , �� $ 2-, $ C) `C -b $ Lb $ 00 $ Ob $ 3,1N, b. �a T'hf-u h u d :) 4a,3 -Aout)m rt1 jUf U1 ftob U t1+� (Written figure) ADDENDUM One BF -4 Bid Form (Total bid amount is to be shown in both words and figures. In case of discrepancy, the amount shown in words will govern. In case of error in extension, the unit and lump sum prices under each Pay Item will be considered correct, and these sums when properly extended, shall constitute the Bid.) Unit Prices have been computed in accordance with paragraph 11.9.2 of the General Conditions. BIDDER acknowfedges that quantities are not guaranteed and final paymentwill be based: on actual quantities determined as provided in the Contract Documents. calendar 5. BIDDER agrees that the Work will bel MM 00- - ° a days after the date when the Contract Times commences to run as provided in paragraph 2.3 of the General Conditions, and completed and ready for final payment m accordance with paragraph 14.13 of the General Conditions within Ninety (90) calendar days after the date when the Contract Times commences to run. BIDDER accepts the provisions of the Agreement as to liquidated damages in the event of failure to complete the Work within the times specified in the Agreement. 6. The following documents are attached to and made a condition of this Bid: (a) RequiredBid` Security in the form of bid bond or cashiers check. (b) Acknowledgement of any addenda issued. (c) Exhibit Affidavit of Work Authorization (d) Exhibit Affidavit* of Excessive Unemployment (if applicable) (e) The E -Verify. Program . for Unemployment Verification Memorandum of Understanding http://www.uscis.gov/files/nativedocuments/MOU.pdf (f) Exhibit Affidavit of OSHA Training (g) Certification Regarding Debarment, Suspension and Other Responsibility Matters 7. Bidder agrees to submit the following documents within three (3) business days after the opening of Bids if requested: (a) BIDDER'S Qualification Statement with supporting data. 8. Communications concerning this Bid shall be addressed to: Name L`� tiril J CIA u 11rk-Mk BF -5 Address t�() rvoxt� (a) Performance and Payment Bonding Company r , Name 111-5, G C C Address J,(,.!O 6`� l� iCag AgentlPower of Attorney Name (if used) Address 9. Terms used in the Bid which are defined in the General conditions or Instructions will have the meaning/sy indicated. in the General Conditions or Instructions. SUBMITTED on 201A State Contractor License No. IF BIDDER is: An Individual By (SEAL) (Individual's Name) doing business as .'Business address: (HrM Name) (General Partner) Business address: Phone No.: BFr6 (SEAL) A Corporation By (Corporlation Name) RL1Lc� (State of Incorporation) (Name of P son A the �A aim (Title). (Corporate Seal) Attest (Seer ----- - usrness a ress: - L) to Sign) r Y 51 Phone No.: Is JO{ - , Date of Qualification to do business isdig A Joint Venture By (Name) (SEAL) (Address) - - By (SEAL): (Name) (Address) Phone Number and Address for receipt of official communications: (Each joint venturer must sign. The manner of signing for each individual, partnership and corporation that is a party to the joint venture should be in the manner indicated above.) 5 -WA I r BREAKDOWN OF WORK FORCE (Required): The Contractor shall be registered with the Missouri Secretary of State in order to work on this project. BIDDER hereby states that he will perform the following items of work directly without employment of subcontractors: It anticipated that the following subcontractors will be employed for work on this project: *SUBCONTRACTORS: '(Name of Company.) (Type of Work) All subcontractors shalf be registered with the.Missouri Secretary of State in order to work .on this project: TIE AMERICAN INSTITUTE OF ARCHITECTS AIA Document A310 Bid Bond NOW ALL MEN BY THESE PRESENTS, THAT WE Apex Paving Company �.O. Box 880. Cane Girardeau. MO 63702 Principal, hereinafter called the Principal, and Liberty Mutual Insurance Company ;044 Montgomery Road Cincinnati OH 45236 corporation duly organized under the laws of the State of Massachusetts ;Surety, hereinafter called the Surety, are held and firmly bound unto : City of Cape Girardeau, 401 Independence, Cape Girardeau, Missouri Obligee, hereinafter called the Obligee, in the sum of Five Percent of Total Bid Dollars ($5% of Total Aid )+ the payment of which sum well and truly to be made, the said Principal and the said Surety, bind ourselves, our heirs, ecutors, administrators, successors and assigns, jointly and severally, firmly by these presents. AEREAS, the Principal has submitted a bid for 2012 Asphalt Overlay Program )W, THEREFORE, if the Obligee shall accept the bid of the Principal and the Principal shall enter into a Contract with : Obligee in accordance with the terms of such bid, and give such bond or bonds as may be specified in the bidding or ntract Documents with good and sufficient surety for the faithful performance of such Contract and for the prompt yment of labor and materials furnished in the prosecution thereof, or in the event of the failure of the Principal to enter ,h Contract and give such bond or bonds, if the Principal shall pay to the Obligee the difference not to exceed the nalty hereof between the amount specified in said bid and such larger amount for which the Obligee ma:y,-.f6 good faith Ttract with another party to perform the Work covered by said bid, then this obligation shall be null and�oP'-' �erwise -emain in full force and effect. fined and sealed this 14th day of August Apex P Aving Company Mgr apa/) I iu fir i_rginia Smith, Asst. Secretary B s��; 1 z' Glen Graham, President`' r a, Liberty Mutual Insurance UrnanY (eYine (Witness)' AIA DOCUMENT A310 0 BID BOND • PIA • INSTITUTE OF ARCHITECT'S, 1735 r?yt , . v .l, AI2Y 1970 D.�D.C. N.W., WASH G :. -r, o subsG3zts�ell [ny pah7g arta aftoted Ti. r�nia of deaf dt Pty�n�lh IU�aeting t3tansyJvarasa, rt #hg day�nd yep , � �rp�adars�a� - 71+s3PneL� {Jatepf _� Pyritatttlr FAap MorgBomdq Eo ..: ` artd the ahoy+# p6Wer of atfomey may be sigr Q ti i'bf the board ofd¢ectorsof Liberty ttron - to Mual liTsurance C tuorrlpz 170TEb:fhat copy ofanypoweihe:facstm�le orinect}anicalfy reproddced .r of attoM.ey issued:by the`compan same force and Mect as though manually affixed ss rESTINIONY HEAt& I have hereunto subsgri �r nib Company do hereby eelbiy#hat the iia�natpow? ot$ rrJey of4r(hieh #tee%regoin�:t this cdrGaie anii i do [irriFidrcer#ii-at lbE afico� or C�}fiaaf wtio Executed tl�e std Cttieidjafmarvov, a prpstdent t6ap oint attomeys�h fact as prbvjded in 7�ttrcle Xtli, acsEnule pr medJanicaly_faprodueed S rtgtylh�s unde7 and by a�titoniy bf iff fot101ing at amee.0g du[yc-WIW and held op fhb f ih day of hl[arch 191J� rtu[e of<�nyas i isecre6ry o7 maL. wFiereanng upon cet6freil i suF> bonds shali:trs valid and 4,ndiiig upon-tlie company -w -:6e arid' afixe� coprate -sedl of .the' said company, this day. of.:.. Ws ' °n �.i = Gregory W. Davenl LIBERTY MUTUAL INSURANCE C OWANY FINANCIAL STATEMENT—BEC1iAOYR31, 2410 Assets Cash and Sank }7eposits . .. _..... $ 795,278,733 *Bonds-- U.S Government ._ _ _.._ . .. 928,976,332 12,269,586,768 8,410,330,089 Real Esta e...._.... ....._._ ... : _ .. _..__ 280,897,975 .Agents' Balances or Uncollected Premiums........... 2,971,477,549 Accrued interest andiZeuts .__ _. _..._. 156,129,412 Other Admitted .Assets..........__ _.. 10,888871.535 Total Admitted Assets.—____ T16 701,-AR.343 Vabiliiies Unearned Premiums .. _.. __ $3,502,531,059 RIC=ve for Claims and Claims ] xpease... _ __.15,450,806,243 Funds Held Under ReirstrobceTreaties___..__-__ 1,764,193,716 Reserve forDividauds to Poiicyboldsx ___.__._.. 4,776,435 Additional Statutory Reserve,_ . _ S9,441,297 Reserve for Commissions, Taxes and OthcrLiabilities __... r .__.._._..... 2.126.508.564 Total.._..»..... - ....._ _.;-.»»- __$22,938,257,314 Special Surplus Funds ....... .._-.._$1,218,426,655 Capital Stock.. _ ............ 10,000,000 Paid in SurpIus.T ___ ... 7,731,965,815 Unassigned Su1plus___..-.-_........4,802,898,559 Surplus to Policyholders.- - ....................13,763.291.029 Total IaabRities and Surplus - ___�ft6t7fti.Skft 343 ll3S(/ Bonds are stated utamortized or investment value; Stocks atAssoeiatiou Market Value,- ZP �,q��4 Cn The foregoing financial information is taken from Liberty Mutual lnsuranoo Company's financial r 1912 n statement filed with the state of Massachusetts Department of Insurance. 0 ON -t Co �Ja y � I, TIM MIKOLmEWSKI, Assistant Secretary of Liberty Mutual Insurance Company, do hereby certify that the foregoing is afire, and corrcct statement of the Assets and Liabilities of said Corporation, as of December 31, 2010, to the best ofmy knowledge and belief M WITNESS WMREOF, I have hereunto set ray hand and affixed the seal of said Corporation at Seattlq Washington, this 29th day of March, 2011. Assistant Secretary S-1282L"Icfa Nt 1 1w _ ! Z } O 12 P L 7 U) M X TIMON CITY Of CAPE GIRARDEAU 2012 Asphalt Overlay Program DEER C ERG BOUT L RIO qN F O Y O c K cF N s �p1��RRi AU N WADE ,p R RIER Lu T UN�c C) } D Lu Z LL O Lp NGTON ; O z QS A VO O/ SCFnue� N_ �, I,/ Z :—s, n J J /— Z } O 12 P L 7 U) M X TIMON CITY OF CAPE GIRARDEAU 2012 ASPHALT OVERLAY PROGRAM STANDARD FORM OF AGREEMENT BETWEEN OWNER AND CONTRACTOR ON THE BASIS OF A STIPULATED PRICE THIS AGREEMENT is dated as of the day of C'1,1` in the year 2012 by and between the City of Cape Girardeau, Missouri ereinafter called OWNER) and Apex Paving Company_ (hereinafter called CONTRACTOR). OWNER and CONTRACTOR, in consideration of the mutual covenants hereinafter set forth, agree as follows: Article 1. WORK. CONTRACTOR shall complete all Work as specified or indicated in the Contract Documents. The Work is generally described as follows: The locations for the work to be performed under these Contract Documents are William Street from Sprigg Street to Park Street and from Louisiana to Kingshighway; Bernice Street from Lakeshore Drive to Fremont Street; Old Highway 61 from Delta Drive to South Sprigg Street; Koch Street from Good Hope to Brink Street. The improvements consist of resurfacing the existing pavement on the above mentioned City streets; the removal and replacement of portions of curb, gutter, alleys, and driveways; adjustments to existing manholes and utility castings as well as re -striping for streets that have existing striping as noted for each location, all as described in the contract documents. The streets are located in various areas within the City of Cape Girardeau, Missouri. The existing surface of William Street will be overlaid by placing and compacting a 3/4 inch thin lift of new hot mix asphalt. The existing surfaces of Bernice St., Old Highway 61, and Koch Street will be removed by milling approximately 2 inches off the existing pavement and a new surface will be added by placing and compacting 2 inches of new hot mix asphalt. Article 2. ENGINEER. The City Engineer or his designee is to act as OWNER'S representative, assume all duties and responsibilities and have the rights and authority assigned to ENGINEER in the Contract Documents in connection with completion of the Work in accordance with the Contract Documents. A-1 Article 3. CONTRACT TIMES. 3.1 The work will be substantially completed within Sixty (60) calendar days after the date when the Contract Times commence to run as provided in paragraph 2.3 of the General Conditions, and completed and ready for final payment in accordance with paragraph 14.13 of the General Conditions within Ninety (90) days after the date when the Contract Times commence to run. 3.2 Liquidated Damages. OWNER and CONTRACTOR recognize that time is of the essence of this Agreement and that OWNER will suffer financial loss if the Work is not completed within the times specified in paragraph 3.1 above, plus any extensions thereof allowed in accordance with Article 12 of the General Conditions. They also recognize the delays, expense and difficulties involved in proving the actual loss suffered by OWNER if the Work is not competed on time. Accordingly, instead of requiring any such proof, OWNER and CONTRACTOR agree that as liquidated damages for delay (but not as a penalty) CONTRACTOR shall pay OWNER Seven hundred fifty dollars $750.00 for each day that expires after the time specified in paragraph 3.1 for Substantial Completion until the Work is substantially complete. After Substantial Completion, if CONTRACTOR shall neglect, refuse or fail to complete the remaining Work within the time specified in paragraph 3.1 for completion and readiness for final payment or any proper extension thereof granted by OWNER, CONTRACTOR shall pay OWNER One thousand dollars 1000.00 for each day that expires after the time specified in paragraph 3.1 for completion and readiness for final payment. Article 4. CONTRACT PRICE. OWNER shall pay CONTRACTOR for completion of the Work in accordance with the Contract Documents an amount in current funds equal to the sum of the amounts determined pursuant to paragraphs 4.1 and 4.2 below: 4.2 For all Unit Price Work, an amount equal to the sum of the established unit price for each separately identified item of Unit Price Work times the estimated quantity of that item as indicated in the bidding documents. TOTAL OF ALL UNIT PRICES: Three Hundred Sixteen Thousand Seventy Dollars and Ninety-two Cents ($ 316,070.92) As provided in paragraph 11.9 of the General Conditions estimated quantities are not guaranteed, and determinations of actual quantities and classification are to be made by ENGINEER as provided in paragraph 9.10 of the General Conditions. Unit prices have been computed as provided in paragraph 11.9.2 of the General Conditions. A-2 Article 5. PAYMENT PROCEDURES. CONTRACTOR shall submit Applications for Payment in accordance with Article 14 of the General Conditions. Applications for Payment will be processed by ENGINEER as provided in the General Conditions. 5.1 Progress payments; Retainage. OWNER shall make progress payments on account of the Contract Price on the basis of CONTRACTOR'S Application for Payment as recommended by ENGINEER, on or about the 10th day of each month during construction as provided in paragraphs 5.1.1 and 5.1.2 below. All such payments will be measured by the schedule of values established in paragraph 2.9 of the General Conditions (and in the case of Unit Price Work based on the number of units completed) or, in the event there is no schedule of values, as provided in the General Requirements. 5.1.1 Prior to Substantial Completion, progress payments will be made in an amount equal to the percentage indicated below, but, in each case, less the aggregate of payments previously made and less such amounts as ENGINEER shall determine, or OWNER may withhold, in accordance with paragraph 14.7 of the General Conditions. 90% of Work completed (with the balance being retainage). If Work has been 50% completed as determined by ENGINEER, and if the character and progress of the Work have been satisfactory to OWNER and ENGINEER, OWNER, on recommendation of ENGINEER, may determine that as long as the character and progress of the Work remain satisfactory to them, there will be no additional retainage on account of Work completed, in which case, the remaining progress payments prior to Substantial Completion will be an amount equal to 100% of the Work completed. 90% (with the balance being retainage) of materials and equipment not incorporated in the Work (but delivered, suitably stored and accompanied by documentations satisfactory to OWNER as provided in paragraph 14.2 of the General Conditions). 5.1.2 Upon Substantial Completion, in an amount sufficient to increase total payments to CONTRACTOR to 95% of the Contract Price (with the balance being retainage), less such amounts as ENGINEER shall determine, or OWNER may withhold, in accordance with paragraph 14.7 of the General Conditions. 5.2 Final Payment. Upon final completion and acceptance of the Work in accordance with paragraph 14.13 of the General Conditions, OWNER shall pay the remainder of the Contract Price as recommended by ENGINEER as provided in said paragraph 14.13. Article 6. INTEREST. All moneys not paid when due as provided in Article 14 of the General Conditions shall bear interest at the maximum rate allowed by law at the place of the Project. M Article 7. CONTRACTOR'S REPRESENTATIONS. In order to induce OWNER to enter into the Agreement, CONTRACTOR makes the following representations: 7.1 CONTRACTOR has examined and carefully studied the Contract Documents (including the Addenda listed in paragraph 8) and the other related data identified in the Bidding Documents, including "technical data". 7.2 CONTRACTOR has visited the site and become familiar with and is satisfied as to the general, local and site conditions that may affect cost, progress, performance and furnishing of the Work. 7.3 CONTRACTOR is familiar with and is satisfied as to all federal, state and local Laws and Regulations that may affect cost, progress, performance and furnishing of the Work. 7.4 CONTRACTOR has carefully studied all reports of explorations and tests of subsurface conditions at or contiguous to the site and all drawings of physical conditions in or relating to existing surface or subsurface structures at or contiguous to the site (except Underground Facilities) which have been identified. CONTRACTOR acknowledges that such reports and drawings are not Contract Documents and may not be complete for CONTRACTOR'S purposes. CONTRACTOR acknowledges that OWNER and ENGINEER do not assume responsibility for the accuracy or completeness of information and data shown or indicated in the Contract Documents with respect to Underground Facilities at or contiguous to the site. CONTRACTOR has obtained and carefully studied (or assumes responsibility for having done so) all such additional supplementary examinations, investigations, explorations, tests, studies and data concerning conditions (surface, subsurface and Underground Facilities) at or contiguous to the site or otherwise which may affect cost, progress, performance or furnishing of the Work or which relate to any aspect of the means, methods, techniques, sequences and procedures of construction to be employed by CONTRACTOR and safety precautions and programs incident thereto. CONTRACTOR does not consider that any additional examinations, investigations, explorations, tests, studies or data are necessary for the performance and furnishing of the Work at the Contract Price, within the Contract Times and in accordance with the other terms and conditions of the Contract Documents. 7.5 CONTRACTOR is aware of the general nature of work to be performed by OWNER and others at the site that relates to the Work as indicated in the Contract Documents. 7.6 CONTRACTOR has correlated the information known to CONTRACTOR, information and observation obtained from visits to the site, reports and drawings identified in the Contract documents and all additional examinations, investigations, explorations, tests, studies and data with the Contract Documents. 7.7 CONTRACTOR has given ENGINEER written notice of all conflicts, errors, ambiguities or discrepancies that CONTRACTOR has discovered in the Contract Documents and the written resolution thereof by ENGINEER is acceptable to CONTRACTOR, and the Contract Documents are generally sufficient to indicate and convey understanding of all terms and conditions for performance and furnishing of the Work. Article 8. CONTRACT DOCUMENTS. The Contract Documents which comprise the entire agreement between OWNER and CONTRACTOR concerning the Work consist of the following: 8.1 This Agreement (pages 1 to 7 inclusive). 8.2 Exhibits to this Agreement (pages BF- to BF- , inclusive). 8.3 Performance, Payment, and other Bonds, identified as exhibits and consisting of pages. 8.4 Notice to Proceed. 8.5 General Conditions (pages 1 to 55 , inclusive). (EJCDC No. 1910-8 1990 Edition) 8.6 Supplementary Conditions (pages SC -1 to SC -5 , inclusive). 8.7 Specifications bearing the title 2012 Asphalt Overlay Program am . 8.8 Drawings. 8.9 Addenda numbers 1 to 1-, inclusive. 8.10 CONTRACTOR'S Bid (pages BF- 1 to BF- 8, inclusive) marked exhibit "A" 8.11 Pursuant to 285.530 R.S. Mo, the contractor must affirm its enrollment and participation in a federal work authorization program with respect to the employees proposed to work in connection with the services requested herein by 1) submitting a completed, notarized copy of AFFIDAVIT OF WORK AUTHORIZATION and 2) providing documentation affirming the bidder's enrollment and participation in a federal work authorization program with respect to the employees proposed to work in connection with the services requested herein. 8.12 Documentation submitted by CONTRACTOR prior to Notice of Award (pages _to inclusive). 8.13 The following which may be delivered or issued after the Effective Date of the Agreement and are not attached hereto: All Written Amendments and other documents A-5 amending, modifying or supplementing the Contract Documents pursuant to paragraphs 3.5 and 3.6 of the General Conditions. The documents listed in paragraphs 8.2 et seq. above are attached to this Agreement (except as expressly noted otherwise above). There are no Contract Documents other than those listed above in the Article 8. The Contract Documents may only be amended, modified or supplemented as provided in paragraphs 3.5 and 3.6 of the General Conditions. Article 9. MISCELLANEOUS. 9.1 Terms used in this Agreement which are defined in Article 1 of the General Conditions will have the meanings indicated in the General Conditions. 9.2 No assignment by a party hereto of any rights under or interests in the Contract Documents will be binding on another party hereto without the written consent of the party sought to be bound; and, specifically but without limitation, moneys that may become due and moneys that are due may not be assigned without such consent (except to the extent that the effect of this restriction may be limited by law), and unless specifically stated to the contrary in any written consent to an assignment no assignment will release or discharge the assignor from any duty or responsibility under the Contract Documents. 9.3 OWNER and CONTRACTOR each binds itself, its partners, successors, assigns and legal representatives to the other party hereto, its partners, successors, assigns and legal representatives in respect to all covenants, agreements and obligations contained in the Contract Documents. 9.4 Any provision or part of the Contract Documents held to be void or unenforceable under any Law or Regulation shall be deemed stricken, and all remaining provisions shall continue to be valid and binding upon OWNER and CONTRACTOR, who agree that the Contract Documents shall be reformed to replace such stricken provision or part thereof with a valid and enforceable provision that comes as close as possible to expressing the intention of the stricken provision. 9.5 Pursuant to 292.675, R.S. Mo, the contractor is informed that all contractors or subcontractors doing work on this project to provide, and require its on-site employees to complete, a ten (10) hour course in construction safety and health approved by the Occupational Safety and Health Administration ("OSHA") or similar program approved by the Missouri Department of Labor and Industrial Relations which is at least as stringent as an approved OSHA program. The training must be completed within sixty (60) days of the date work on the project commences. On-site employees found on the worksite without documentation of the required training shall have twenty (20) days to produce such documentation. 9.6 The General Contractor shall provide to the City of Cape Girardeau City Engineer's W. Office weekly certified payrolls from the General Contractor and all Subcontractors during the course of the project. These must be provided on a weekly basis; if no work was done, then a payroll stating "No Work Done" must be submitted. IN WITNESS WHEREOF, OWNER and CONTRACTOR have signed the Agreement in multiple copies, One counterpart each has been delivered to CONTRACTOR and ENGINEER and two counterparts to the OWNER. All portions of the Contract Documents have been signed, initialed or identified by OWNER and CONTRACTOR or identified by ENGINEER on their behalf. This Agreement will be effective on L j�`.�-} 2012 (which is the Effective Date of the Agreement). OWNER Citv Scott MuLf B 5 [CORP Attest Gavle V EAL nrad, City Clerk Address for giving notices 401 Independence Street Cape Girardeau, MO 63703 (If OWNER is a public body, attach evidence of authority to sign and resolution or other documents authorizirxscution of Agreement. CONTRACTOR Apex Paving Company Glen Graham, President By: _ 9LI—,-- [CORPORATE SEAL] Attest K Kel Scha er, Secretary Address for giving notices PO Box 637 Cape Girardeau, MO 63702 0637 License No. A-7 Agent for service of process: (If CONTRACTOR is corporation, attach evidence of authority to sign.) EXHIBIT "A" CITY OF CAPE GIRARDEAU 2012 ASPHALT OVERLAYPROGRAM BID FORM (EJCDC 1910-18) (1990) PROJECT IDENTIFICATION: The improvement consists of resurfacing the existing pavement on portions of William Street, Bernice Street, Old Highway 61 and Koch Street; the removal and replacement of portions of curb, gutter, alleys, and driveways; adjustments to existing manholes and utility castings as well as re -striping for streets that have existing striping as noted for each location, all as described in the contract documents. The streets are located in various areas within the City of Cape Girardeau, Missouri. The existing surface of William Street will be overlaid by placing and compacting a 3/4 inch thin lift of new hof mix asphalt. The_existing surfaces of Bernice St.,- Old Hig hway 61-, and -Koch Street will be removed by milling approximately 2 inches off the existing pavement and a new surface will be added by placing and compacting 2 inches of new hot mix asphalt. THIS BID IS SUBMITTED TO CITY OF CAPE GIRARDEAU, MO 401 INDEPENDENCE STREET CAPE GIRARDEAU, MO 63703 1. The undersigned BIDDER proposes and agrees, if the Bid is accepted, to eater into an agreement with OWNER in the form included in the Contract Documents to perform and furnish all Work as specified or indicated in the Contract Documents for the Bid Price and within the Bid Times indicated in this Bid and in accordance with the other terms and conditions of the Contract Documents. 2. BIDDER accepts all of the terms and conditions of the Advertisement or Invitation to Bid and Instructions to Bidders, including without limitation_ those dealing with the disposition of Bid security. This Bid will remain subject to acceptance for sixty days after the day of Bid opening. BIDDER will sign and deliver the required number of counterparts of the Agreement with the Bonds and other documents required by the Bidding Requirements within fifteen days after the date of OWNER'S notice of Award. 3. In submitting this Bid, BIDDER represents, as more fully set forth in the Agreement, that: (a) BIDDER has examined and carefully studied the Bidding Documents and the following: Addenda, receipt of all which is hereby acknowledged: (List Addenda by Addendum Number and Date) BF -1 (b) BIDDER has visited the site and become familiar with and is satisfied as to the general, local and site conditions that may affect cost, progress, performance and furnishing of the Work-, (c) BIDDER is familiar with and is satisfied as to all federal, state and local Laws and Regulations that may affect cost, progress, performance and furnishing of the Work. (d) BIDDER has carefully studied all reports of explorations and tests of subsurface conditions at or contiguous to the site and all drawings of physical conditions in or relating to existing surface or subsurface structures at or contiguous to the site (except Underground Facilities) which have been identified. BIDDER acknowledges that such reports and drawings are not Contract Documents and may not be complete for BIDDER'S purposes. BIDDER acknowledges that OWNER and Engineer do not assume responsibility for accuracy or completeness of information and data shown or indicated in the Bidding Documents with respect to Underground Facilities at or contiguous to the site. BIDDER has obtained and carefully studied (or assumes responsibility for having done so) all such additional or supplementary examinations, investigations, explorations, tests, studies and data concerning conditions (surface, subsurface and Underground Facilities) at or contiguous to the site or otherwise which may affect cost progress, performance or furnishing of the Work or which relate to any aspect of the means, methods, techniques, sequences and procedures of construction to be employed by BIDDER and safety precautions and programs incident thereto. BIDDER does not consider that any additional examinations, investigations, explorations, tests, studies or data are necessary for the determination of this Bid.for performance and furnishing of the Work in accordance with the times, price. and other terms and.conditions of the Contract Documents. (e) BIDDER is aware of the general nature of Work to be performed by Owner and others at the site that relates to Work for which this Bid is submitted as indicated in the Contract Documents. (f) BIDDER has correlated the information known to BIDDER, information and observations obtained from visits to the site, reports and drawings identified in the Contract Documents and all additional examinations, investigations, explorations, tests, studies and data with the Contract Documents. (g) BIDDER has given Engineer written notice of all conflicts, errors, ambiguities or discrepancies that BIDDER has. discovered in the Contract Documents and the written resolution thereof by ENGINEER is acceptable to BIDDER, and the Contract Documents are generally sufficient to indicate and convey understanding of all terms and conditions for performing. and furnishing the Work for which this Bid is submitted. BF -2 Any questions; comments, or concerns regarding the design of this project should be addressed to Jake Garrard E.I. City of Cape Girardeau at 573-339-6327. (h) This Bid is genuine and not made in the interest of or on behalf of any undisclosed person, firm or corporation and is not submitted in conformity with any agreement or rules of any group association, organization or corporation; BIDDER has not directly or indirectly induced or solicited any other Bidder to submit a false or sham Bid; BIDDER has not solicited or induced any person, firm or corporation to refrain from bidding; and BIDDER has not sought by collusion to obtain for itself any advantage over any other Bidder or over OWNER. (i) Pursuant to 285.530 RSMo, the bidder must affirm its enrollment and participation in a federal work authorization program with respect to the employees proposed to work in connection with the services requested herein by • submitting a completed, notarized copy of AFFIDAVIT OF WORK AUTHORIZATION and • providing documentation affirming the 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. • http://www.uscis.gov/portal/site/uscis (j) Bidders are informed that the Project is subject to the requirements of Section 292.675, R.S. Mo, which requires all contractors or subcontractors doing work on the Project to provide, and require its on-site employees to complete, a ten (10) hour course in construction safety and health approved by the Occupational Safety and Health Administration ("OSHA") or similar program approved by the Missouri Department of Labor and Industrial Relations which is at least as stringent as an approved OSHA program. The training must be completed within sixty (60) days of the date work on the Project commences. On-site employees found on the worksite without documentation of the required. -training shall have twenty (20) days toproducesuch documentation. BF -3 4. BIDDER will complete the Work in accordance with the Contract Documents for the following price(s): UNIT PRICE BID No. ITEM UNIT EST' UNIT PRICE TOTAL EST. QTY. 1 Hot Mix Asphaltic Concrete Ton 1568 $ b ((rPRICE $ (3/4" Thin Lift) 2 Hot Mix Asphaltic Concrete Ton 1434 $ V $ �1 y �� 6b (MoDOT BP -2) 3 Liquid Asphalt Tack Coat Gal 5103 $ $ �q JJ . I� 4 Milling SY 7515 $-� $ c% -, D 5 Replace Concrete Curb LF 10 $ A5. $ 4J . 4(:) and Gutter 6 Replace Concrete Alleys SY 16 $ 21 $Q`� and Driveways 7 Single Curb Ramp with Each 12 $ $ l 4 Truncated Domes 8 Double Curb Ramp with Each 24 $ $� (� 66 9 Truncated Domes Concrete Patch SY 89 $-W q $ 5 �� 10 Adjust Manhole Each 31 $rr11_b . $ 11 Adjust Valve Box Each 35 $ c7i LP • W $ 12 Striping - Double Yellow LF 6890 A $ �. �i� Q� $ l� Line 13 Striping - Dashed Yellow LF 2805 $ 0. 4L $ C Line 14 Striping - Dashed White LF 13140 $ 0.42- ' Line► 15 Striping - Solid White Line LF 534 Z� 16 Turn Arrows Each 16 $ �5 : roc` $ 4V 1 . 17 Temporary Traffic Control LS 4 $ �_ $ 18 Temporary Erosion Control LS 1 '•r�� t ��r ` $ OCA 19 Base 5 Aggregate Ton 276 $ bo $ 2 20 Butt Joint and Spot SY 798 $ ( $ Milling 21 Asphalt Patch SY 80 $ Lko $ "l allD G� TOTAL BID FOR ALL UNIT PRICES $ 3,1b I CO D. qa 1hw hunctu d fix+ -u iq Acu5and --) Pam fu d'L1Ia"I a 1 F,U�Gl f Ut)b � P tqf �:)(Written figure) ADDENDUM One BF -4 Bid Form (Total bid amount is to be shown in both words and figures- In case of discrepancy, the amount shown in words will govern. In case of error in extension, the unit and lump sum prices under each Pay Item will be considered correct, and these sums when properly extended, shall constitute the Bid.) Unit Prices have been computed in accordance with paragraph 11.9.2 of the General Conditions. BIDDER acknowledges that quantities are not guaranteed and final payment will be based on actual quantities determined as provided in the Contract Documents. 5. BIDDER agrees that the Work will be 7b�sft t 71 co p tevvi 11calendar days after the date when the Contract Times commences to run as provided in paragraph 2.3 of the Gen e ral Donditions, and completed and ready for fiffi a-1 payment in accordance with paragraph 14.13 of the General Conditions within Ninety (90) calendar days after the date when the Contract Times commences to run. BIDDER accepts the provisions of the Agreement as to liquidated damages in the event of failure to complete the Work within the times specified in the Agreement. 6. The following documents are attached to and made a condition of this Bid: (a) Required Bid Security in the form of bid bond or cashiers check. (b) Acknowledgement of any addenda issued. (c) Exhibit Affidavit of Work Authorization (d) Exhibit Affidavit of Excessive Unemployment (if applicable) (e) The E -Verify Program for Unemployment Verification Memorandum of Understanding http://www.uscis.gov/files/nativedocuments/MOU.pdf (f) Exhibit Affidavit of OSHA Training (g) Certification Regarding Debarment, Suspension and Other Responsibility Matters 7. Bidder agrees to submit the following documents within three (3) business days after the opening of Bids if requested - (a) BIDDER'S Qualification Statement with supporting data. 8. Communications concerning this Bid shall be addressed to: : l i Name �;1� r�arir, BF -5 1 Address J( l ��; �' (a) Performance and Payment Bonding Company Name l , Address ,C't-ttQ11k, 1 6,o 1 'v , �C Agent\Power of Attorney Name (if used) Address 9. Terms used in the Bid which are defined in the General conditions or Instructions will have the meanings indicated in the General Conditions or Instructions. SUBMITTED on d_, 201 State Contractor License No. IF BIDDER is: An Individual By doing business as Business address: Phone No.: A Partnershi By Business address: Phone No.: (Individual's Name) (Firm Name) (General Partner) B F-6 (SEAL) (SEAL) A Corporation By 101 (Corporbtion Name) Lh t � (State of Incorporation) l' (Name of P son A thoriz (Title) (Corporate Seal) Attest �s (Secreta�A1i Business address: .. _ c/) �/;, V & (SEAL) Phone No.: Date of Qualification to do business is —*— -1 A Joint Venture By (SEAL) (Name) (Address) By (SEAL) (Name) (Address) Phone Number and Address for receipt of official communications: (Each joint venturer must sign. The manner of signing for each individual, partnership and corporation that is a party to the joint venture should be in the manner indicated above.) BF -7 BREAKDOWN OF WORK FORCE (R0C1Uired): The Contractor shall be registered with the Missouri Secretary of State in order to work on this project. BIDDER hereby states that he will perform the following items of work directly without employment of subcontractors: It anticipated that the following subcontractors will be employed for work on this project: *SUBCONTRACTORS: (Name of Company) (Type of Work) * All subcontractors shall be registered with the Missouri Secretary of State in order to work on this project, ME THE AMERICAN INSTITUTE OF ARCHITECTS AIA Document A310 Bid Bond NOW ALL MEN BY THESE PRESENTS, THAT WE Apex Paving Company ?.O. Box 880, Cape Girardeau MO 63702 ; Principal, hereinafter called the Principal, and Liberty Mutual Insurance Company ;044 Montgomery Road , Cincinnati OH 45236 corporation duly organized under the laws of the State of Massachusetts Surety, hereinafter called the Surety, are held and firmly bound unto City of Cape Girardeau, 401 Independence, Cape Girardeau, Missouri Obligee, hereinafter called the Obligee, in the sum of Five Percent of Total Bid Dollars ($ 5% of Total Bid ), the payment of which sum well and truly to be made, the said Principal and the said Surety, bind ourselves, our heirs, ecutors, administrators, successors and assigns, jointly and severally, firmly by these presents. -IEREAS, the Principal has submitted a bid for 2012 Asphalt Overlay Program )W, THEREFORE, if the Obligee shall accept the bid of the Principal and the Principal shall enter into a Contract with Obligee in accordance with the terms of such bid, and give such bond or bonds as may be specified in the bidding or ntract Documents with good and sufficient surety for the faithful performance of such Contract and for the prompt yment of labor and materials furnished in the prosecution thereof, or in the event of the failure of the Principal to enter :h Contract and give such bond or bonds, if the Principal shall pay to the Obligee the difference not to exceed the salty hereof between the amount specified in said bid and such larger amount for which the Obligee may: in good faith itract with another party to perform the Work covered by said bid, then this obligation shall be null and -void .; ,otherwise -emain in full force and effect. coed and sealed this 14th day of irginia Smith, Asst. Secretary ine davidson (Witness) August A ex P ving Company cipal) a` (Se,6i y. By: Glen Graham, President` !`Y `. (Tit(e) Libertv Mutual In AIA DOCUMENT A310 0 BID BOND e AIA 0 FEB AR1' INSTITUTE OF ARCHITECTS, 1735 N.W., W Co • THE AMERIC TON, D.C. 20006 4,59, aF ATTORNEY IS NOT VA,LfD:UNLESS;IT iS PRINTED ON,RED BACKGROUND. is Power of Attorney limits the -acts of those'namee iierem ;and they have no authority to bind the Company except in the manner and to the tent herein stated. LIBERTY MUTUAL INSURANCE -COMPANY BOSTON,MASSAGHUSETTS POWER OF ATTORNEY IOW ALL PERSONS BY THESE PRESENTS That Liberty Mutual InsuranceCompany (the "Company"), a Massachusetts stock insurance company, •suant to and by authority of-tfle $y,law and Authorization her_eliiafteretorth does tjeretiy name, constitute and appoint JEANNETTE-PORRIKIy ACY RIVERA, DANIELLE M _BEC ARD, ALL OF, "EzClM'P� "�j TFOR� TATE OFC ECTICUT .: _ .. acif individually if there be riidre_than one itamea .0,U€.and`IawTul attomey In fact to:make e5cec`ufe,=seal acknowledge and deliver, for and�n tts jalf as surety and as its aet_a Ld deed anyalEu itertakings b o" %s Y cogilizprIpe and other surety-obligaUo�s m the penal not exceeding .- my ion of suchundertakirSgs b if"theyhad been duly signed bj at this power is made and exec Any officer of the Y chairman -or,the pre execute, seal, ackn.i 1n:fact subject t0"th, on --p . any d signo�#)�-e presk the following inslaimenttfi1 Ruu�uaat%14fftcie� ""` "`�*«"`" ••"" `�"��"�"DOL lA3S ($ t00 000,000 oQ �J „«` «' �� ;:) each -and the - recognlz�nces a�i3 other surety of liga jons uT�ursuance of these presents sbail be as binding vpgn the Company president ar�datested by the secreta%j�of I CS�mpany m theie own per persons. ;pursuant o and�y authority of the following-Sy)aw and Authorization`. Confracts Sectwn 5 Surety Bonds_and Underakings: 1trttitit�zed for khat purpose�n venting byiijeirtnan or the president and Scbfeet tcj suctf lira�tatioris �s;tje lay pee -scribe shall appointsucfi aitomeys in-fact��s inlay be necessary t6,acUn be?�aif gf the CoSnpany,to make. and deliver as surety any and all undertakmgs�6ondS,�ecogrnancgad otf�erSOTet�+oliljgattons.1SuchIt b�s -, Sits set forth 1n,their respective powefs of attomey, shall havefiwlt RoweFto bind$ne Gompaax byrslgtt�re3ad menuand to attach th4e6,�the s"F-6f�0Company. Whenso_ exec5ted such �nsiiamentsshalf�beas b��tggas : �wi dttested iiylie secretary.- n or the pre _'dint has authorized the officer or other official named.therein to appolnt attorneys to act �r faalyynsurance Company hasbeefiffixed lhereto�n PIYlnouth lvlee?prx, PenpsylvamaihiS daof-�.y'r'1'' IBERf-44WU,� L ISt�RJ11dCE CaMPAI Y f bavld M:afey, A sls`taaf�cretary AM3NWE4LT1j+OF PENN NIA ss 1�1T1'`!DR�UI�iCff�OMEf�Y_� � this 20th ; tla�(`f may 2o1i before me a Notary Puplic person`alJy came David M Careytne KKR above Power of Attorney and affixed the corporate seal cf"Liberty Mutual Insurance Company thereto with the authority and at th :dlrectiDl) o sal .eon. ?oration. TESTIMONY WHER Oj�j to subscribed my name and affixed my notarial seal "at Plymouth Meeting, Pennsylvania on the day and year.; �, C' 73Hft�CO -above written. tiA l e !{f pB. <`p3aat . `,M Seal 6 Ct' fernsaPasaiy No2�ty�upl�c ,� QF Piymo.rthF.wp }4orifpomecyC'on4y �,t, _ H'Q'1:,' t�1y Comri � oa rjr ea - 9 t e8 2C 1V BYE O O tellaMerrisr oryHP, V 2TIFICATE c�°��aYLN 0� F r e undersigned, Assi , erty;Mutual Insurance Company, do hereby certify that the original power of attorney of which the foregoing is 11, true and correctGopy, 1 ce and effect on the date of this certificate; and I do further certify that the officer or official who exec -the said ier of attomey 1s an Assistant Secretary specially authorized by the chairman or the president to _appoint attorneysdn-fact as provided in Article X111, " tion 5 of the By-laws of Liberty Mutual Insurance 'Company- certificate and the above power of attorney may be signed by facsimile or mechanically reproduced signatures under and by authority of the following a of the board of directors of Liberty Mutual Insurance Company at a meeting duly called and held on the 12th day of March, 1980. VOTED that the facsimile or mechanically reproduced signature:of anyassistant secretary of the company, wherever appearing upon a certified copy of any power of attorney issued by the company -in connection With'urety bonds, shall be valid and binding upon the company with the same. force and effect as though manually affixed r'( _ .fESTIMONY {HEREOF, I have hereunto subscribed my ,name and affiixec Lthe, corporate seal of the said company, this day of i 4 *� Gregory W. Davenport, Assistant Secretary Assets LIBERTY MUTUAL INSURANCE C01yTANY b�T NCIAL STATEMENT— DECEMBER31, 2010 Cash and Bank Deposits.........- .............................. $ 795,278,733 *Bonds —U.S Government .............. -..................... 928,976,332 *Other Bonds .... -.................... .......................... ...- 12,269,586,768 *Stocks ........... ........................ ............................... 8,410,3 30,089 Real Estate ...... »..................... .....................-......... 280,897,925 Agents' Balances or Uncollected Premiums ........... 2,9771,477,549 Accrued Interest and Rents ... .......................... ....... 156,129,412 Other Admitted Assets .......... _................................ 10.888.871.535 Total Admitted Assets Liabilities Unearned Premiums_.. ............ ...._....................... $3,502,531,059 Reserve for Claims and Claims Expense ................. 15,450,806,243 Funds Held Under Reinsurance Treaties_. ............ 1,764,193,716 Reserve for Dividends to Policyholders ................ 4,776,435 Additional Statutory Reserve .................................. 89,441,297 Reserve for Commissions, Taxes and Other Liabilities .. ................._......._..._............. 2,126.508.564 Total_+.._._—...».................»......._..........$22,438,257,314 Special Surplus Funds.................$1,218,426,655 Capital Stock.---......- .................. 10,000,000 Paid in Surplus ............ ............ . 7,731,965,815 Unassigned Surplus ...... _............ 4,802,898,559 Surplus to Poiicyba[ders .. » »».»».13.763.291,029 Total Liabilities and Surplus * Bonds are stated at amortized or investment value; Stocks at Association Market Values. The foregoing financial infomation is taken from Liberty Mutual Insurance Company's financial statement filed with the state of Massachusetts Department of Insurance. I, TIM MIKOLAJEWSKI, Assistant Secretary of Liberty Mutual Insurance Company, do hereby certify that the foregoing is a true, and correct statement of the Assets and Liabilities of said Corporation, as of December 3I, 2010, to the best of my knowledge and belief IN WITNESS WHEREOF, I have hereunto set my hand and affixed the seal of said Corporation at Seattle, Washington, this 29th day of March, 2011. Assistant Secretary S-1262Lh11C1a 2(11 Company ID Number: 188332 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 Apex (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 II 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 131E-Ver71r MOM for EmioyerlRevis on Date 10,29/08 Company ID Number: 188332 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 Page 2 of 131E-Ve0j MDU for EmpfoyerlRevoon Date 10129I08 ♦ y l\ _�E-Verpry_ i. Company ID Number: 188332 nonconfirmation of employees' employment eligibility within 3 Federal Government work days of the initial inquiry. 8. DHS agrees to provide a means of secondary verification (including updating DHS records as may be necessary) for employees who contest DHS tentative non confirmations 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. Page 3 of 131E-`Jerin/ f.1CU for E ?OoyerlRevision Date 10!29/08 MA EA USA W ormy, .os;�.�;:--.�a�;.,�:.Y-;.cxa+�•.�_-...:.... �.<.<,,.s.i,.�y.:..:.<;E,;r.wc,.,.,.ur..<;�.r✓.tea �,-.. Company ID Number: 188332 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 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 Page 4 of 131E-Venfy MOU for Employer'Re.islon Date 10129/u8 — _�,E-V s .. ..:t-f•`^`.+�Y�-^-dek e� 9• K'•�..++.c�i cy„-.Spwvx::2t«^'risaf s, �.+-^.'_a% 1.Ytifm:�4e. .f+cf. Company ID Number: 188332 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. 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 274B of the INA could subject the Employer to civil penalties, back pay awards, and other sanctions, and violations of Title VII could subject the Employer to back pay awards, compensatory and punitive damages. 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 Page 5 of 13JE-Verify MOU for Employe lReosion Date 10129108 sem. 't,+i'�.'.aw6 - :�5-:�aer. �..-r-.!.•G:x:.,.w'v.?nsn - rify.-M.- Company ID Number: 188332 authorized by this MOU. The Employer agrees that it will safeguard this information, and means of access to it (such as PINS and passwords) to ensure that it is not used for any other purpose and as necessary to protect its confidentiality, including ensuring that it is not disseminated to any person other than employees of the Employer who are authorized to perform the Employer's responsibilities under this MOU, except for such dissemination as may be authorized in advance by SSA or DHS for legitimate purposes. 14. The Employer acknowledges that the information which it receives from SSA is governed by the Privacy Act (5 U.S.C. § 552a(i)(1) and (3)) and the Social Security Act (42 U.S.C. 1306(a)), and that any person who obtains this information under false pretenses or uses it for any purpose other than as provided for in this MOU may be subject to criminal penalties. 15. The Employer agrees to cooperate with DHS and SSA in their compliance monitoring and evaluation of E -Verify, including by permitting DHS and SSA, upon reasonable notice, to review Forms 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 Page 6 of 13IE-`detiiy MOU for EmpioyerlRevision Date 1012M8 .-Veff S w Company ID Number: 188332 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(x)), State or local governments, governments of Federally recognized Indian tribes, or sureties 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 ILD, 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 1-9 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. Page 7 of 13JE-Verify MOU for EmployerlRevision Date 10l29iO8 -EVenry- Company ID Number: 188332 ARTICLE Ili REFERRAL OF INDIVIDUALS TO SSA AND DHS A. REFERRAL TO SSA 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 Page 8 of 13IE-`Je0i MOU for EmpioyerlRevis on Date 10/29/o8 y, +,_ '7^r w ..iE,' ti Company ID Number: 188332 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 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, • Sending a photocopy of the document for by DHS). or by an express mail account (furnished and paid 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 Page 9 of 131E -Verify MOU for EmployerlRevison Date 10%29(08 Company ID Number: 188332 ,cal c Ill�i�l 4V - 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 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. Page 10 of 131E -Verify MOU for EmployerlRevision Date 10/29/08 ^ , m -Verl �V% y ,°°." .,^=== °° Company |ONumber: 188332 To beaccepted as o participant in E -Verify, you should only sign the Employer's Section ofthe signature page. /fyou have any questions, contact E'Yerifvmt88G-4G4'421O. Employer Apex Debbi Robinson Name (Please i5-rF,,F) Electronically S4ql7ed Signature Department of Homeland Security - Verification Division USCIS Verification Division Narne (Please Type or Print) Electronically Signed Signaiure Page nm131c-Venf� Mouxxsmpior 4newoonoae1no9/n 020G/2003 Date 0208C2O0S Date L See, o, i Of l� III(III Company ID Number: 188332 Information Required for the E -Verify Program Information relating to your Company: Company Name: Apex Company f=acility Address: 114 S. Silver Springs Rd ------------ Cape Girardeau, MO 63701 Company Alternate Address: county or Parish: CAPE GiRARDEAU Emptoyer identification Number: 43117450 Nctrth;Amefican Industry -ta s>ftcation systera13-1 Code: 237 Parent Company: Detla Companies Inc Number of Employees: 20. to 99 Number of Sites Verified for: 26 Are you verifying for more than 1 site? If yes, please provide the number of sites verified for in each State: MISSOURI 26 site(s) Page 12 of 131E-Ver.fy NIOU for EmpioyerlRevision Date 10(29/08 •a _ cca ._� �_f fUs�i �: rz Company ID Number: 188332 Information relating to the Program Administrator(s) for your Company on policy questions or operational problems: Name: Debbi Robinson Telephone Number: (573) 334 - 5261 ext. 345 Fax Number: (573) 332 - 0931 E-mail Address: drobinson@deltacos.com Page 13 of 131E -Verify MOU for EmployerlRevision Date 10;29?08 i EXHIBIT AFFIDAVIT OF OSHA. TRAINING COMES NOW (Name) C as (Office Held) I�QSe of (Company Name/Contractor) /_1 J and first being duly sworn, on my oath, affirm in connection with the contracted services related to reQ J 0 h 11ft P10 I d,, (Project Name) for the duration of the contract, as follows: 1. Contractor shall provide a ten (10) hour Occupational Safety and Health Administration (OSHA) construction safety program for all employees who will be on-site at the Proiect. The construction safety program shall include a course in construction safety and health that is approved by OSHA or a similar program approved by the Missouri Department of Labor and Industrial Relations which is at least as stringent as an approved OSHA program as required by Section 292.675, RSMo. 2. Contractor shall require its on-site employees to complete a construction safety program within sixty (60) days after the date work on the Project commences, as required by Section 292.675, RSMo. 3. Contractor acknowledges and agrees that any of Contractor's employees found on the Project site without documentation of the successful completion of a construction safety program shall be required to produce such documentation within twenty (20) days, or will be subject to removal from the Project. 4. Contractor shall require all of its Subcontractors to comply with the requirements of Section 292.675, RSMo. 5. Contractor acknowledges that pursuant to Section 292.675, RSMo., Contractor shall forfeit to City as a penalty two thousand five hundred dollars ($2,500.000), plus one hundred dollars (4100.00) for each on-site employee employed by Contractor or its Subcontractor, for each calendar day, or portion thereof, such on-site employee is employed without the construction safety training required in Section 292.675, RSMo. 6. Contractor acknowledges that violations of Section 292.675, RSMo, and imposition of the penalties described therein shall be investigated and determined by the Missouri Department of Labor and Industrial Relations. 7. Contractor acknowledges that in the event that the Missouri Department of Labor and Industrial Relations has determined that a violation of Section 292.675, RSMo., has occurred and that a penalty shall be assessed, the City shall withhold and retain all sums and amounts due and owing when malting payments to Contractor under this Contract. FURTHER AFFIANT SAITH NOT. IN AFFIRMATION THEREOF, the facts stated above are true and correct (the undersigned understands that false statements made in this filing are subject to the penalties provided in Section.575.040, RSMo.) By: ATTF�S: i : Secre a� 'efier) r CORPC7IZATION) AVs 7 e -P 7 STATE OF MISSOURIss- ) APE GIRARDEAU ©n this day of. , 20Lr before me appeare > to me rsona4 known, who, be g by me duly sworn, did say that he/she is the Of a Missouri Corporation, and that the seal affixed to the foregoin� instrument is e seal of said Corporation, and that the, said instrument was signed and sealed in behalf of said Corporation by authority of its Board of Directors, and acknowledged said instrument to be the free act and deed of said Corporation. IN TESTIMONY WHEREOF, I have hereunto set my hand and affixed my official seal, at my office in Cape Girardeau, Missouri, the day an year first above written. wa.swrx i NOMW �� s� �OF WSOMR rarcoao,,s�s�cwo�'am�s�� Nota Public coa�nss� ►axe �4or�saB My Commission Expires: l EXHIBIT VIT OF WORK AUTHORIZA' COMES NOW (Name)6(e do 4A /J]( (Wk, as (Office Held) 6� /tC OC J. (J of (Company Name/Contractor) L)1 -1C4 L) and first being duly sworn, on my oath, affirm as follows: f 1. (Company Name/Contractor) is enrolled and will continue to participate in a federal work authorization program in respect to employees that will work in connection with die contracted services related to (Project Name) / m W�'di for the duration of the contract in accordance with RSMo 7-t.- - Chapter 285.530(2). 2. I also affirm that (Company Name/Contractor) does not and will not knowingly- employ a person who is an unauthorized alien in connection with the contract services related to (Project Name) ( 77 � )Oh�Q r! Y a-ol for the duration of the contract. 3. Attached hereto _ is documentation affirming Contractor's enrollment. and participation in a federal work authorization program with respect to the employees working in connection with -the contracted=services. FURTHER AFFIANT SAITH NOT. IN AFFIRMATION THEREOF, the facts stated above are true and correct (the undersigned understands that false statements made in this filing are subject to the penalties provided in Section 575.040, RSMo.) (name o oratio B y -- (name of officer lof corporation and title) CSV t t�'7�t 0./✓h-, �J`�-2-,� (. �:�.-�j ATTEST: Secr ary (or dher officer) (SEAL OF CORPORATION) STATE OF MISSOURI , / ►1 75 ktvIW ) ss. COUNTY OF CAPE GIRARDEAU ) On this.a of c5li, 20efore me appearedt% y_ to in person y known, mho, bein by me duly sworn, did say that he/she is the of (Sj a Missouri Corporation, and that the seal affixed to the foregoing instrument s the—seal of said,.Corporation, and that the said instrument was signed and sealed in behalf of said Corporation by authority of its Board of Directors, and acknowledged said instrument to.be.the free act and deed of said Corporation. IN TESTIMONY WHEREOF, I have hereunto set my hand and affixed my official seal, at my office in Cape Girardeau, Missouri-,--the; day and year fust above written. Nota�Pblic srAmor- M Commission Expires- ° � J c�,ar�ss�^rt �u�rarct �ior7szs 6164 Project Number w Certification Regarding Debarment, Suspension and Other Responsibility Matters The contractor hereby certifies to the best of its knowledge and belief and that it and its principals and its subcontractors and their principals: (a) Are not presently debarred, suspended, proposed for debarment, declared ineligible or voluntarily excluded from covered transactions by any Federal or State department or -agency; -- (b) Have not within a three (3) year period preceding this proposal been convicted of or had a civil judgment rendered against them for commission of fraud or a criminal offense in connection with obtaining, attempting to obtain or performing a public (Federal, State or Local) transaction or contract under a public transaction; violation of Federal or State antitrust statutes or commission of embezzlement, theft, forgery, bribery, falsification or destruction of records, making false statements or receiving stolen property; (c) Are not presently indicted for or otherwise criminally or civilly charged by a government entity (Federal, State or Local) with commission of any of the offenses enumerated in paragraph (1)(b) of this certification; and (d) Have not within a three-year period preceding this subcontract had one or more public transactions (Federal, State or Local) terminated for cause or default. I understand that a false statement on this certification may be grounds for rejection of this contractor or termination of the contract. In addition, under IS USC Sec. 1001, a false statement may result in a fine of up to S 10,000 or imprisonment for up to five (5) years or both. LTypJNCamq*Title of Authorized Representative Signature of Authorized Representative ate ❑ I am unable to certify to the above statement- My explanation is attached. THE AMERICA IN"S.,JITUTEE OF ARCHITEC'jS AIA Document A312 Performance Sond Bond No. 014063500/9096217 Any singular reference to Contractor, Surety, Owner or other party shall be considered plural where applicable. CONTRACTOR (Name and Address): Apex Paving Company P.O. Box 637 Cape Girardeau, MO 63702-0637 OWNER (Name and Address): SURETY (Name and Principal Place of Business): Liberty Mutual Insurance Company / Fidelity and Deposit Company of Maryland City of Cape Girardeau PO Box 617 Cape Girardeau, MO 63702 CONSTRUCTION CONTRACT Date: August 21, 2012 Amount: (S 316,070.92 ) Three Hundred Sixteen Thousand Seventy Dollars and 92/100 Description (Name and Location): 2012 Asphalt Overlay Program Street Overlays BOND Date (Not earlier than Construction Contract Date): August 21, 2012 Amount: (S 316,070.92 ) Three Hundred Sixteen Thousand Seventy Dollars and 92/100 Modifications to this Bond: CONTRACTOR AS PRINCIPAL Company: (Corporate Seal) Apex Paving Company Signature: 9 1 "�' Name and Title: Glen Graham, President :Any additional signatures appear on page 3) K] None See Page 3 SURETY Company: (Corporate Seal) See Attached Signature Page Signature: Name and Title: Address: (FOR;NFORN1ATION ONLY -Name, Address and Telephone) AGENT or BROKER: OWNERS REPRESENTATIVE (Architect, Engineer or Willis of New York, Inc. other party): One World Financial Center, 200 Liberty Street New York, NY 10281 212-915-8888 Aliomey-in-Fact AiA DOCUMENT A312 5 PERFORMANCE BOND AND PAYMENT BOND i DECEMBER 1984 E.D - AIA_ IDiE AMERICAN INSTITUTE OF ARCHITECTS, 1735 NEW YORK AVE., N.W., WASHINGTON, D.C. 20006 A312-1984 1 THIRD PRINTING t MARCH 1987 x The Contractor 2^d the Surety, jointly andseverally, bird j;iE:mselves, their heirs, executors, administrators, successors and assigns to the Owner for the performance of the Construction i;ontiact, which is incorporated herein by reference. 2 If the Contractor performs the Construction Contract, the Surety and ,he Contractor shall have no obligation under this Bond, except to participate in conferences as provided in Subparagraph 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 that 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 time 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 formally terminated the Contractor's right to complete the contract. Such Contractor Default shall not be declared earlier than twenty days after the Contractor and the Surety have received notice as provided in Subparagraph 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 shall promptly and at the Surety's expense take one of the following actions: 4.1 Arrange for the Contractor, with the consent of the Owner, to perform and complete the Construction Contract; or 4.2 Undertake to perform and complete the Construction Contact itself, through its agents or through independent contractors; or 4.3 Obtain bids or negotiated proposals from qualified contractors acceptable to the Owner for a contract for performance 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 the 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: After investigation, determine the amol:nt for which it may be liable to the Owner and, as soon as practicable after the amount is determined, tender payment 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 Contractors right to complete the Construction Contract, and if the Surety elects to act under Subparagraph 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 grater 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 of the 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 liable to the Owner or others for obligations 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 subcontracts, purchase orders and other obligations. 9 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 the Paragraph are void or prohibited by law, the minimum period of iitnitation available to sureties as a AIA DrDCU.^GENT A312 i PERFORMANCE BOND AND PAYMENT BOND k DECEAfiRER 1984 FD i ALAS TME AMERICAN INSTITUTE OF ARCHITECTS, 1735 NEW YORK AVE., N.W., LVASHiNGTON, D.C. 20006 A312-1984 2 T HiRD PRINTING � MARCH 1587 r z cS ,>casc in the jurisdiction of the suit shall be applicable. 10 ?Notice to the Surety, the Owner or the Contractor shalt be mailed cr 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 the Bond conflicting with said statutory or legal requirement shall be deemed deleted herefrom and provisions conforming to such statutory or other legal requirements 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 MODIFICATIONS TO THIS BOND ARE AS FOLLOWS: l y the Owner in settlement of insurance or ocher claims for dare,ages Io which ;he 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 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 Seal) Company: Signature: Name and Title: Address: See Attached Signature Page Signature: Name and Title: Address: AIA. DOCUMENT A312 ; PERFORMANCE BOND AND PAYMENT BOND 5 DECEMBER 1984 ED. x AIAS -1 HE AMERICAN INSTITUTE OF ARCHITECTS, 1735 NEW YORK AVE., N.W., WASHINGTON, D.C. 20006 THIRD PRINTING S MARCH 1987 (Corporate Seal) Attorney -in -Fact A312-1984 3 ATTACHMENT TO BO -N F) NO. 014063500 ! 90962 17 SURETIES Surety A Liberty Mutual Insurance Company 8044 Montgomery Road Cincinnati, OH 45236 Surety Phone No. State of Incorporation: MA Limit of Liability: 50% Surety B Fidelity and Deposit Company of Maryland 1400 American Lane Schaumburg, IL 60196 Surety Phone No. State of Incorporation: MD Limit of Liability: 50% Surety- C Surety Phone No. State of Incorporation: Limit of Liability: By: Aizz , Attorney -In -Fact t y.,..r. � x.�. jr� a . E A3`Ju Ef IC.tkt 1 1* N"- _ °; � a-�. -..�.r F A T ''�S# T L -V .y'S A 1 Document A312 Payment Bond Band No.014063500 / 9096217 Any singular reference to Contractor, Surety, Owner or other party shall be considered plural where applicable. CONTRACTOR (Name and Address): Apex Paving Company P.G. Box 637 Cape Girardeau, MO 63702-0637 OWNER (Name and Address): City of Cape Girardeau PO Box 617 Cape Girardeau, MO 63702 CONSTRUCTION CONTRACT Date: August 21, 2012 Amount: (S 316,070.92 ) SURETY (Name and Principal Place of Business): Liberty Mutual Insurance Company / Fidelity and Deposit Company of Maryland Three Hundred Sixteen Thousand Seventy Dollars and 92/100 Description (Name and Location): 2012 Asphalt Overlay Program Street Overlays BOND Date: (Not earlier than Construction Contract Date): August 21, 2012 Amount: ($ 316,070.92 ) Three Hundred Sixteen Thousand Seventy Dollars and 92/100 Modifications to this Bond: CONTRACTOR AS PRINCIPAL Company: (Corporate Seal) Apex Paving Company Signature: Name and Title: Glen raham, President (Any additional signatures appear on page 6) El Nene Q See Page 6 SURETY Company: (Corporate Seal) See Attached Signature Page Signature: Name and Title: (FOR INFORMATION ONLY -Name, Address and Tedeohone3 AGENT or BROKER: OWNERS REPRESENTATIVE (Architect, Engineer or Willis of New York, Inc. other party): One World Financial Center, 200 Liberty Street New York, NY 10281 212-915-8888 Attorney -in -Fact AIA DOCUMENT A312 Z PERFORMANCE BOND AND PAYMEN''T BOND S DECEMBER 1984 ED S AIA --e THE AMERICAN INSTITUTE OF ARCHITECTS, 1735 NEW YORK AVE-,,N.W., WASHINGTON, D.C. 20Cv6 A312-1984 4 T HIRD PRINTING S MARCH 1987 .f_ Contractor and ike Surety, Jointly and severally, �inci previa::s written notice furnished to th ves, their hefts, executors, administrators, successors and Contractor. assig .s to the Owner to pay for labor, materials and equipment 5 If a notice required by Paragraph 4 is given by the Owner to the furnished for use in the performance of the Construction Contract, Contractor or to the Surety, that is sufficient compliance. 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 the. 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, and 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 indirectly, 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 make under this Bond arid, with substantial accuracy, the amount of the claim. 4.2 Claimants who do not have a direct contract with the Contractor: A 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 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 the Bond and enclosing a caps of the 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 obligations shall not exceed the amount of the Bond, and the amount of this Bond shall be credited for any payments made in good faith by the Surety.. & Amounts owed by the Owner to the Contractor under the Construction Contract shall be used for the performance of the Construction Contract and to satisfy claims, if any, under any Construction 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 payment 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 subcontracts, purchase orders and other obligations. 11 No suit or action shalt be commenced by a Claimant under this Bond other than in a court of competent jurisdiction in the location in which the work of part of the work is located or after the expiration of one year from the date (1) on which the Claimant 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 o; equipment were furnished by anyone under the Construction Contract, whichever of (1) or (2) first occurs. If the provisions of the 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 cornrrbnJ;wWnd. AIA DOCUMENT A312 7 PERFORMANCE BOND AND PAYMENT FOND k DECEMBER 1984 ED. C AIA<— THE AMERICAN !NST!TUTE OF ARCHITECTS, 1735 NEW YORK AVE., N.W., WASHINGTON, D.C. -0006 A312-1984 THIRD PRINT tNG S MARCH 1987 14 Upon request by any person or entity appearing to be a potential beneficiary of this Bond, the Contractor shall promptly furnish a copy of r`is Bond or shall permit a copy to be made. 15 DEFINITIONS 15.1 Claimant: An individual or entity having a direct contract with the Contractor or with a subcontractor of the Contractor. to furnish.labor, materials or equipment for use in the performance of the Contract. The intent of this Bond shall be to include without limitations 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 MODIFICATIONS TO THIS BOND ARE AS FOLLOWS: Paragraph 6 is deleted in its entirety and the following is substituted in its place: 6. When the Claimant has satisfied the conditions of Paragraph 4, and has submitted proof of claim sworn to by Claimant with adequate supporting documentation proving the amount claimed is due and payable, the Surety shall, within 90 days, 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, within a reasonable period of time, 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 indentify 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 engineering services 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. 15.2 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. 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 paragraphs: CLAIM NOTICE for the LIBERTY MUTUAL INSURANCE COMPANY must be sent to the following address: Liberty Mutual Insurance Company, Interchange Corporate Center, 450 Plymouth Road, Suite 400, Plymouth Meeting, PA 19462-1644. 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, 1400 American Lane, Schaumburg, IL 60196, Attention: Surety Department. (Space is provided below for additional signatures of added parties, other than those appearing on the cover page.) CONTRACTOR AS PRINCIPAL Company: (Corporate Seal) Signature: Name and Title: Address: SURETY Company: (Corporate Seal) See Attached Signature Page Signature: Name and Title: Address: Attomey-in-Fact AIA DOCUMENT A312 ; PERFORMANCE BOND AND PAYMENT BOND E DECEMBER 1984 ED. S AIAS THE AMERICAN INSTITUTE OF ARCHITECTS, 1735 NEW YORK AVE., N.W., WASHINGTON, D.C. 20006 A312-1984 5 THIRD PRINT1NG5MARCH 1987 ATTAC MI ENU TO BOND NO. 01406-D500/90962'17 SURETIES Surety A Liberty Mutual Insurance Company 8044 Montgomery Road Cincinnati, OH 45236 Surety Phone No. State of Incorporation: MA Limit of Liability: 50% Surety B Fidelity and Deposit Company of Maryland 1400 American Lane Schaumburg, IL 60196 Surety Phone No. State of Incorporation: MD Limit of Liability: 50% Surety C Surety Phone No. State of Incorporation: Limit of Liability: By Ail By: Aiza o ' , Atto -In-Fact , Attorney -In -Fact THIS POWER OF ATTORNEY IS NOT VALID UNLESS IT IS PRINTED ON RED BACKGROUND. 5387943 This ower of Attorney limits the acts of those named herein, and they have no authority to bind the Company except in the manner and to the extent herein stated. Certificate No. American Fire and Casualty Company Liberty Mutual Insurance Company The Ohio Casualty Insurance Company Peerless Insurance Company West American Insurance Company POWER OF ATTORNEY KNOWN ALL PERSONS BY THESE PRESENTS: That American Fire & Casualty Company and The Ohio Casualty Insurance Company are corporations duly organized under the laws of the State of Ohio, that Liberty Mutual Insurance Company is a corporation duly organized under the laws of the State of Massachusetts, that Peerless Insurance Company is a corporation duly organized under the laws of the State of New Hampshire, and West American Insurance Company is a corporation duly organized under the laws of the State of Indiana (herein collectively called the "Companies"), pursuant to and by authority herein set forth, does hereby name, constitute and appoint, JEANNETTE PORRINI, STACY RIVERA, DANIELLE M. BECHARD, ELANAV. SANCHEZ, AIZA LOPEZ, ....................................................................................... .............................................................. --------------- all of the city of HARTFORD state of CONNECTICUT each individually if there be more than one named, its true and lawful attorney-in-fact to make, execute, seal, acknowledge and deliver, for and on its behalf as surety and as its act and deed, any and all undertakings, bonds, recognizances and other surety obligations, in pursuance of these presents and shall be as binding upon the Companies as if they have been duly signed by the president and attested by the secretary of the Companies in their own proper persons. IN WITNESS WHEREOF, this PowerofAttorney has been subscribed by an authorized officer or official ofthe Companies and the corporate seals ofthe Companies have been affixed thereto this 18th day of MAY 2012. American Fire and CasualtyCompany w¢`oara �ep� 11 INS�y� H _O_ +, > The Ohio Casualty Insurance Company O Liberty Mutual Insurance Company tNo d a) SEAL SE -XL 1 ¢ S.i AI Company ® / '$�' � Peerless Insurance Com an � �ouo yloxr� �as �•�'� o�Q� West American Insurance Company L sraasn�E'NE, • SCE C ea •) > c By: STATE OF WASHINGTON ss Gregory W. Davenport, Assistant Secretary = COUNTY OF KING — O v a) On this 18th day of MAY 2012 , before me personally appeared Gregory W. Davenport, who acknowledged himself to be the Assistant Secretary of American Fire and > N p Casualty Company, Liberty Mutual Insurance Company, The Ohio Casualty Company, Peerless Insurance Company and West American Insurance Company, and that he, as such, being >%U) W > authorized so to do, execute the foregoing instrument for the purposes therein contained by signing on behalf of the corporations by himself as a duly authorized officer. C E cl mIN WITNESS WHEREOF, I have hereunto subscribed my name and affixed my notarial seal at Seattle, Washington, on the day and year first above written. Q M toy 'cfi a.% O 'a O L - NOTARYBY: d C i%s= u = KD Riley, Nota Public ai O = ",., ?t £ CL M = L This Power ofAttorney is made and executed pursuant to and by authority of the following By-laws and Autfiorizations of American Fire and Casualty Company, The Ohio Casualty Insurance 4 c N Company, Liberty Mutual Insurance Company, WestAmerican Insurance Company and Peerless Insurance Company, which resolutions are now in full force and effect reading as follows: E o c a) ARTICLE IV- OFFICERS -Section 12. Power of Attomey. Any officer or other official of the Corporation authorized for that purpose in writing by the Chairman or the President, and subject >% W O = m to such limitation as the Chairman or the President may prescribe, shall appoint such attorneys -in -fact, as may be necessary to act in behalf of the Corporation to make, execute, seal, � 3 E acknowledge and deliver as surety any and all undertakings, bonds, recognizances and other surety obligations. Such attorneys -in -fact, subject to the limitations set forth in their respective '— a JL powers of attorney, shall have full power to bind the Corporation by their signature and execution of any such instruments and to attach thereto the seal of the Corporation. When so > executed, such instruments shall be as binding as if signed by the President and attested to by the Secretary. Any power or authority granted to any representative or attomey-in-fact under tv the provisions of this article may be revoked at any time by the Board, the Chairman, the President or by the officer or officers granting such power or authority. N E 00 r ARTICLE XIII - Execution of Contracts - SECTION 5. Surety Bonds and Undertakings. Any officer of the Company authorized for that purpose in writing by the chairman or the president, M 0 andsubjectto such limitations as the chairman or the president may prescribe, shall appoint such attorneys -in -fact, as may be necessary to actin behalf of the Company to make, execute, 00 seal, acknowledge and deliver as surety any and all undertakings, bonds, recognizances and other surety obligations. Such attorneys -in -fact subject to the limitations set forth in their v r respective powers of attorney, shall have full power to bind the Company by their signature and execution of any such instruments and to attach thereto the seal of the Company. When so o executed such instruments shall be as binding as if signed by the president and attested by the secretary. Certificate of Designation - The President of the Company, acting pursuant to the Bylaws of the Company, authorizes Gregory W. Davenport, Assistant Secretary to appoint such attorney-in-fact as may be necessary to act on behalf of the Company to make, execute, seal, acknowledge and deliver as surety any and all undertakings, bonds, recognizances and other surety obligations. Authorization - By unanimous consent of the Company's Board of Directors, the Company consents that facsimile or mechanically reproduced signature of any assistant secretary of the Company, wherever appearing upon a certified copy of any power of attorney issued by the Company in connection with surety bonds, shall be valid and biding upon the Company with the same force and effect as though manually affixed. 1, David M. Carey, the undersigned, Assistant Secretary, of American Fire and Casualty Company, The Ohio Casualty Insurance Company, Liberty Mutual Insurance Company, West American Insurance Company and Peerless Insurance Company do hereby certify that the original power of attorney of which the foregoing is a full, true and correct copy of the Power of Attorney executed by said Companies, is in full force and effect and has not been revoked. IN TESTIMONY WHEREOF, I have hereunto set my hand and affixed the seals of said Companies this 9_ day of C'V , 20,�2 . C,;0 FJ -9Y t� F{3s.;,:tvEUa„�` yi3Rfi1'I { — >f - -- e� j €acs of l e I 1$Q1 a By: "77 r ' fit- S= fit.. J David M. Carey, Assistant Secretary POA-AFCC, LMIC, OCIC, PIC & WAIC LMS_12873_041012 _ Liberty i tu,-1 . SURETY LIBERTY MUTUAL INSURANCE COMPANY FINANCIAL STATEMENT —DECEMBER 31, 2011 Assets Cash and Bank Deposits ----------------------------------------- $ 696,606,839 *Bonds —U.S Government------------------------------------- 910,151,865 *Other Bonds ................................... •........................ 11,794,792,561 *Stocks ------------------------------------ •--------•----------- .......... 81216,137,875 Real Estate ----- ---------_-------- •-•--------- •--------- ............ 268,420,606 Agents' Balances or Uncollected Premiums........... 3,191,269,641 Accrued Interest and Rents------------------------------------- 151,164,670 Other Admitted Assets ------------------------------------------- - 12.166.299.092 Total Admitted Assets._................_------_-----...�37 394 R43 149 Liabilities Unearned Premiums ............................................ _ $3,762,485,913 Reserve for Claims and Claims Expense ................. 15,817,904,502 Funds Held Under Reinsurance Treaties ................. 1,249,980,610 Reserve for Dividends to Policyholders .................. 4,656,284 Additional Statutory Reserve .................................. 77,791,575 Reserve for Commissions, Taxes and Other Liabilities ................................................ 2.885.589.205 Total .............................................................. $23,798,408,089 Special Surplus Funds ................. $1,036,917,657 Capital Stock ............................... 10,000,000 Paid in Surplus ............................ 7,732,061,653 Unassigned Surplus ..................... 4,817,455,750 Surplus to Policyholders ...............................13,596;435,060 Total Liabilities and Surplus ..........................._... 394.843.149 JpV Wsu, /. (aPO R '1' Bonds are stated at amortized or investment value; Stocks at Association Market Values. 1912 The foregoing financial information is taken from Liberty Mutual Insurance Company's financial statement filed with the state of Massachusetts Department of Insurance. I, TIM MMOLAJEWSKI, Assistant Secretary of Liberty Mutual Insurance Company, do hereby certify that the foregoing is a true, and correct statement of the Assets and Liabilities of said Corporation, as of December 31, 2011, to the best of my knowledge and belief. IN WITNESS WHEREOF, I have hereunto set my hand and affixed the seal of said Corporation at Seattle, Washington, this 5th day of April, 2012. Assistant Secretary S-1262LMIC/a 4112 EXTRACT FROM BY-LAWS OF THE COMPANIES "Article V, Section 8, Attorneys -in -Fact. The Chief Executive Officer, the President, or any Executive Vice President or Vice President may, by written instrument under the attested corporate seal, appoint attorneys -in -fact with authority to execute bonds, policies, recognizances, stipulations, undertakings, or other like instruments on behalf of the Company, and may authorize any officer or any such attorney-in-fact to affix the corporate seal thereto; and may with or without cause modify of revoke any such appointment or authority at any time." CERTIFICATE I, the undersigned, Vice President of the ZURICH AMERICAN INSURANCE COMPANY, the COLONIAL AMERICAN CASUALTY AND SURETY COMPANY, and 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 Article V, Section 8, of the By -Laws of the Companies is still in force. 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 ZURICH AMERICAN INSURANCE COMPANY at a meeting duly called and held on the 15th day of December 1998. RESOLVED: "That the signature of the President or a Vice President and the attesting signature of a Secretary or an Assistant Secretary and the Seal of the Company may be affixed by facsimile on any Power of Attorney ... Any such Power or any certificate thereof bearing such facsimile signature and seal shall be valid and binding on the Company." 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 COLONIAL AMERICAN CASUALTY AND SURETY COMPANY at a meeting duly called and held on the 5th day of May, 1994, and 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 TESTIMONWHEREOF, I have hereunto subscribed my name and affixed the corporate seals of the said Companies. this o2j day of 201a_ ti ,p��Q1� o :��P,.'`Q11ror�r••; /gym' "wr-vY•( Y' f3 Oe1 O s SEAL i b., 1068 �7 Geoffrey Delisio, Vice President i ZURICH AMERICAN INSURANCE COMPANY . COLONIAL AMERICAN CASUALTY AND SURETY COMPANY FIDELITY AND DEPOSIT COMPANY OF MARYLAND POWER OF ATTORNEY KNOW ALL MEN BY THESE PRESENTS: That the ZURICH AMERICAN INSURANCE COMPANY, a corporation of the State of New York, the COLONIAL AMERICAN CASUALTY AND SURETY COMPANY, a corporation of the State of Maryland, and the FIDELITY AND DEPOSIT COMPANY OF MARYLAND a corporation of the State of Maryland (herein collectively called the "Companies"), by THOMAS O. MCCLELLEN, Vice President, in pursuance of authority granted by Article V, Section 8, of the By -Laws of said Companies, which are set forth on the reverse side hereof and are hereby certified to be in full force and effect on the date hereof, do hereby nominate, constitute, and appoint Jeannette PORRINI, Stacy RIVERA and Aiza LOPEZ, all of Hartford, Connecticut, EACH its true and lawful agent and Attorney -in -Fact, to make, execute, seal and deliver, for, and on its behalf as surety, and as its act and deed: any and all bonds and undertakings, and the execution of such bonds or undertakings in pursuance of these presents, shall be as binding upon said Companies, as fully and amply, to all intents and purposes, as if they had been duly executed and acknowledged by the regularly elected officers of the ZURICH AMERICAN INSURANCE COMPANY at its office in New York, New York., the regularly elected officers of the COLONIAL AMERICAN CASUALTY AND SURETY COMPANY at its office in Owings Mills, Maryland., and the regularly elected officers of the FIDELITY AND DEPOSIT COMPANY OF MARYLAND at its office in Owings Mills, Maryland., in their own proper persons. The said Vice President does hereby certify that the extract set forth on the reverse side hereof is a true copy of Article V, Section 8, of the By -Laws of said Companies, and is now in force. IN WITNESS WHEREOF, the said Vice -President has hereunto subscribed his/her names and affixed the Corporate Seals of the said ZURICH AMERICAN INSURANCE COMPANY, COLONIAL AMERICAN CASUALTY AND SURETY COMPANY, and FIDELITY AND DEPOSIT COMPANY OF MARYLAND, this 15th day of May, A.D. 2012. ATTEST: �&,_ Z�, 15_11� ZURICH AMERICAN INSURANCE COMPANY COLONIAL AMERICAN CASUALTY AND SURETY COMPANY FIDELITY AND DEPOSIT COMPANY OF MARYLAND ..,vL,. '�ppO�tlpf� �.•G�I INSI�p'q�b ` SEAL 0 o Assistant Secretary Vice President Eric D. Barnes Thomas O. McClellen State of Maryland City of Baltimore On this 15th day of May, A.D. 2012, before the subscriber, a Notary Public of the State of Maryland, duly commissioned and qualified, THOMAS O. MCCLELLEN, Vice President, and ERIC D. BARNES, Assistant Secretary, of the Companies, to me personally known to be the individuals and officers described in and who executed the preceding instrument, and acknowledged the execution of same, and being by me duly sworn, deposeth and saith, that he/she is the said officer of the Company aforesaid, and that the seals affixed to the preceding instrument are the Corporate Seals of said Companies, and that the said Corporate Seals and the signature as such officer were duly affixed and subscribed to the said instrument by the authority and direction of the said Corporations. IN TESTIMONY WHEREOF, I have hereunto set my hand and affixed my Official Seal the day and year first above written. r Maria D. Adamski, Notary Public My Commission Expires: July 8, 2015 POA -F 142-0587E FIDELITY AND DEPOSIT COMPANY OF MARYLAND 600 Red Brook Blvd., Suite 600, Owings Mills, MD 21117 Statement of Financial Condition As Of December 31, 2011 ASSETS Bonds........................................................................................................ ......... $ 167,477,539 .............................. Stocks............................................................................................................................................... 23,576,974 Cash and Short Term Investments................................................................................................... 235,580 Reinsurance Recoverable................................................................................................................. 12,886,175 Other Accounts Receivable.............................................................................................................. 39,980,988 TOTALADMITTEDASSETs........................................................................................................ $ 244,157,256 LIABILITIES, SURPLUS AND OTHER FUNDS Reserve for Taxes and Expenses...................................................................................................... $ 127,987 Ceded Reinsurance Premiums Payable............................................................................................ 48,215,682 Securities Lending Collateral Liability ......................................... ...... 1,022,500 ............................................. TOTALLIA>3n.1TIEs.................................................................................................................... $ 49,366,169 Capital Stock, Paid Up........................................................................................ $ 5,000,000 Surplus................................................................................................................ 189,791,087 Surplus as regards Policyholders...................................................................................................... 194,791,087 . TOTAL....................................................................................................................................... $ 244,157,256 Securities carried at $59,049,993 in the above statement are deposited as required by law. Securities carried on the basis prescribed by the National Association of Insurance Commissioners. On the basis of December 31, 2011 market quotations for all bonds and stocks owned, the Company's total admitted assets would be $253,778,028 and surplus as regards policyholders $204,411,859. I, DENNIS F. KERRIGAN, Corporate Secretary of the FIDELITY AND DEPOSIT COMPANY OF MARYLAND, do hereby certify that the foregoing statement is a correct exhibit of the assets and liabilities of the said Company on the 31st day of December, 2011. State of Illinois i City of Schaumburg J} SS: Subscribed and sworn to, before me, a Notary Public of the State of Illinois, in the City of Schaumburg, this 15th day of March, 2012. Notary Public OFFICIAL SEAL OARRYL JOINER Notary Public . State of Illinois My Commission Expues May 3, 2014 Certificate of Insurance THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON YOU THE CERTIFICATE HOLDER. THIS CERTIFICATE IS NOT AN INSURANCE POLICY AND DOES NOT AMEND, EXTEND, OR ALTER THE COVERAGE AFFORDED BY THE POLICIES LISTED BELOW. POLICY LIMITS ARE NO LESS THAN THOSE LISTED, ALTHOUGH POLICIES MAY INCLUDE ADDITIONAL SUBLIMIT/LIMITS NOT LISTED BELOW. This is to Certify that City of Cape Girardeau P. O. Box 617 NAME AND �� Liber tX ADDRESS Cape Girardeau MO 63702 OF INSURED Mutual. is, at the issue date of this certificate, insured by the Company under the policy(ies) listed below. The insurance afforded by the listed policy(ies) is subject to all their terms, exclusions and Conditions and is not altered by any requirement, term or condition of any contract or other document with respect to which this certificate may be issued. • If the certificate expiration date is continuous or extended term, you will be notified if coverage is terminated or reduced before the certificate expiration date. NOTICE OF CANCELLATION: (NOT APPLICABLE UNLESS A NUMBER OF DAYS IS ENTERED BELOW.) BEFORE THE STATED EXPIRATION DATE THE COMPANY WILL NOT CANCEL OR REDUCE THE INSURANCE AFFORDED UNDER THE ABOVE POLICIES UNTIL AT LEAST 30 DAYS. Liberty Mutual Insurance Group City of Cape Girardeau �`tLs,1v`2U Adrienne Kisonas Weston / 0102 AUTHORIZED REPRESENTATIVE Riverside Office Park, 9 Riverside Road m P. O. Box 617 Weston MA 02493-2298 781-891-8900 9/20/2012 Cape Girardeau MO 63702 I OFFICE PHONE DATE ISSUED This certificate is executed by LIBERTY MUTUAL INSURANCE GROUP as respects such insurance as is afforded by Those Companies NM 772A R6 07-10 LDI COI 268895 02 11 EXP DATE ❑ CONTINUOUS TYPE OF POLICY ❑ EXTENDED POLICY NUMBER LIMIT OF LIABILITY m POLICY TERM WORKERS COVERAGE AFFORDED UNDER WC EMPLOYERS LIABILITY LAW OF THE FOLLOWING STATES: COMPENSATION Bodily Injury by Accident Each Accident Bodily Injury By Disease Poli" Linnit Bodily Injury By Disease Each Person GENERAL LIABILITY BODILY INJURY PROPERTY DAMAGE Comprehensive Form 9/19/2013 TF2-631-510040-452 $ Each $ Each Schedule Occurrence Occurrence Products/Completed Operations $ Aggregate $ Aggregate Combined Single Limit Independent Contractors / Contractors protective Bodily Injury and Property Damage ❑ Contractual Liability Owners' & Contractors' $ 2,620,000 Each Occurrence protective liability policy $ 2,620,000 Aggregate Railroad Protective AUTOMOBILE Each Accident—Single Limit LIABILITY B.I. And P.D. Combined ❑ OWNED Each Person Each Accident or Occurrence ❑ NON -OWNED ❑ HIRED Each Accident or Occurrence ADDITIONAL INSURED: See Addendum Attached. Location(s) of Operations & Job # (if applicable) Description of Operations: City Streets in the City of Cape Girardeau 2012 Asphalt Overlay-TTF-IV • If the certificate expiration date is continuous or extended term, you will be notified if coverage is terminated or reduced before the certificate expiration date. NOTICE OF CANCELLATION: (NOT APPLICABLE UNLESS A NUMBER OF DAYS IS ENTERED BELOW.) BEFORE THE STATED EXPIRATION DATE THE COMPANY WILL NOT CANCEL OR REDUCE THE INSURANCE AFFORDED UNDER THE ABOVE POLICIES UNTIL AT LEAST 30 DAYS. Liberty Mutual Insurance Group City of Cape Girardeau �`tLs,1v`2U Adrienne Kisonas Weston / 0102 AUTHORIZED REPRESENTATIVE Riverside Office Park, 9 Riverside Road m P. O. Box 617 Weston MA 02493-2298 781-891-8900 9/20/2012 Cape Girardeau MO 63702 I OFFICE PHONE DATE ISSUED This certificate is executed by LIBERTY MUTUAL INSURANCE GROUP as respects such insurance as is afforded by Those Companies NM 772A R6 07-10 LDI COI 268895 02 11 11 -44��T .° NAMED INSURED CERTIFICATE HOLDER 9/20/2012 City of Cape Girardeau City of Cape Girardeau P. O. Box 617 P. O. Box 617 Cape Girardeau MO 63702 Cape Girardeau MO 63702 Designated Contractor: Apex Paving Company, P. O. Box 637, Cape Girardeau, MO 63702 Policy Term: 9/19/2012 to 9/19/2013 Created at www.eCertsONLINE.com IV-AD2 (2002) ACORO® CERTIFICATE OF LIABILITY INSURANCE DATE /2012 /YYYY) os/zo/zo1 z THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(les) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER MARSH USA, INC. 445 SOUTH STREET CONTACT NAME: PHONE FAX AIC No Ext): A/C No ADDRESS: MORRISTOWN, NJ 07960-6454 Attn: Morristown.certrequest@Marsh.com/Fax: 212-948-0979 -- INSURER(S) AFFORDING COVERAGE NAIC # INSURER A : Axis Insurance Company 37273 100065-ALL.-UMB-12-13 SMITH DELTA INSURED APEX PAVING COMPANY INSURER B: N/A N/A - INSURER C: P.O. BOX 637 INSURER 0: CAPE GIRARDEAU, MO 63702-0637 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: NYC -006469046-01 REVISION NUMBER:2 THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE ADDL SUER POLICY NUMBER POLICY EFF MM/DD/YYYY POLICY EXP MM/DD/YYYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY DAMAGE T RENTED PREMISES Ea occurrence) $ CLAIMS -MADE OCCUR MED EXP (Any one person) $ PERSONAL &ADV INJURY $ GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ POLICY PRO LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE OMIT Ea accidert $ BODILY INJURY (Per person) $ ANY AUTO I ALL OWNED n SCHEDULED _ AUTOS ` AUTOS - BODILY INJURY (Per accident) $ PROPERTY DAMAGE Per ac..leyq $ I NON -OWNED HIRED AUTOS ! AUTOS $ UMBRELLA LIAB X ! OCCUR EACH OCCURRENCE_ 1,000,000 A X __I EXCESS LIAB CLAIMS -MADE MNU 731833/01/2012 04/01/2012 04/01/2013 --- _A AGGREGATE $ 1,000,000 DED RETENTION$ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y/ NF H- WCSTATU- OTIR ORY LIMITS E ANY PROPRIETOR/PARTNER/EXECUTIVE --1i OFFICER/MEMBER EXCLUDED? N / A E.L. EACH ACCIDENT $ -- (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE $ If yes, describe under'-- DESCRIPTION OF OPERATIONS below - --- - ----- -_--- E.L. DISEASE -POLICY LIMIT $ I I I DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) CITY OF CAPE GIRARDEAU IS INCLUDED AS ADDITIONAL INSURED WHERE REQUIRED BY WRITTEN CONTRACT AND ALLO WED BY LAW. KlInQ CA In aL•-111INo FL•JA.JaC 9L\C01 a9 W -11I CITY OF CAPE GIRARDEAU PO BOX 637 CAPE GIRARDEAU, MO 63702 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE of Marsh USA Inc. Edward J. Smith .. P W.-ae.-AC. © 1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD Certificate of Insurance THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON YOU THE CERTIFICATE HOLDER. THIS CERTIFICATE IS NOT AN INSURANCE POLICY AND DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES LISTED BELOW. POLICY LIMITS ARE NO LESS THAN THOSE LISTED, ALTHOUGH POLICIES MAY INCLUDE ADDITIONAL SUBLIMIT/LIMITS NOT LISTED BELOW This is to Certify that Delta Companies Inc. Delta Asphalt Inc., Heartland F Asphalt Materials Inc., Delta Asphalt of Arkansas NAME AND ,•. Liberty Inc., APEX paving Co., Southern Illinois Asphalt ADDRESS Co., Inc. / 114 South Silver Springs Road OF INSURED Mutualo Cape Girardeau MO 63702 is, at the issue date of this certificate, insured by the Company under the policy(ies) listed below. The insurance afforded by the listed policy(ies) is subject to all their terms, exclusions and Conditions and is not altered by any requirement, term or condition of anv contract or other document with resnect to which this certificate maw }w i—ri TYPE OF POLICY EXP DATE ❑ CONTINUOUS ❑ EXTENDED POLICY NUMBER LIMIT OF LIABILITY El POLICY TERM WORKERS COMPENSATION 4/1/2013 WC7-631-004090-592 COVERAGE AFFORDED UNDER WC LAW OF THE FOLLOWING STATES: AR,IL,MO, TX EMPLOYERS LIABILITY Bodily ln'ury by Accident 2 y OOO Each Accident Bodily Injury By Disease $2,000,000 Bodily Injury By Disease $2,000,000 EachPerson COMMERCIAL GENERAL LIABILITY ❑ OCCURRENCE 4/1/2013 TB2-631-004090-602 General Aggregate $3,000,000 Products / Completed Operations Aggregate ❑ CLAIMS MADE 3 000 000 Each Occurrence $2,000,000 RETRO DATE Personal & Advertising Injury $2000,000 Per Person /Organization Inc includes Per Job Aggregate & hh ee t ar mages to Premises: $100,0 AUTOMOBILE LIABILITY 4/1/2013 AS2-631-004090-612 Each Accident—Single Limit $2,000,000 B.I. And P.D. Combined Each Person IJ OWNED mNON -OWNED HIRED Each Accident or Occurrence Each Accident or Occurrence OTHER ADDITIONAL COMMENTS Project.- 2012 Asphalt Overlay Program-TTF-IV. City of Cape Girardeau is additional insured with regards to general liability and auto liability as their interest may appear where required by written contract. 11 the certificate expiration date is continuous or extended term, you will be notified if coverage is terminated or reduced before the certificate expiration date. NOTICE OF CANCELLATION: (NOT APPLICABLE UNLESS A NUMBER OF DAYS IS ENTERED BELOW.) BEFORE THE STATED EXPIRATION DATE THE COMPANY WILL NOT CANCEL OR REDUCE THE INSURANCE AFFORDED UNDER THE ABOVE POLICIES UNTIL AT LEAST 30 DAYS NOTICE OF SUCH CANCELLATION HAS BEEN MAILED TO: Liberty Mutual Insurance Group F -city of Cape Girardeau, Adrienne Kisonas – Weston / 0102 AUTHORIZED REPRESENTATIVE Riverside Office Park, 9 Riverside Road PO Box 637 Weston MA 02493-2298 781-891-8900 9/6/2012 Cape Girardeau MO 63702 OFFICE PHONE DATE ISSUED This certificate is executed by LIBERTY MUTUAL INSURANCE GROUP as respects such insurance as is afforded by those Companies NM 772 07-10 LDI COI 268896 02 11 Certificate of Insurance THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON YOU THE CERTIFICATE HOLDER. THIS CERTIFICATE IS NOT AN INSURANCE POLICY AND DOES NOT AMEND, EXTEND, OR ALTER THE COVERAGE AFFORDED BY THE POLICIES LISTED BELOW. POLICY LIMITS ARE NO LESS THAN THOSE LISTED, ALTHOUGH POLICIES MAY INCLUDE ADDITIONAL SUBLIMIT/LIMITS NOT LISTED BELOW This is to Certify that F_ Apex Paving � N PO Box 637 NAME AND '"Libe ADDRESS l ty L I I Cape Girardeau MO 63702 OF INSURED Mutual.� is, at the issue date of this certificate, insured by the Company under the policy(ies) listed below. The insurance afforded by the listed policy(ies) is subject to all their terms, exclusions and Conditions and is not altered by any requirement, term or condition of any contract or other document with respect to which this certificate may be issued. TYPE OF POLICY EXP DATE ❑ CONTINUOUS ❑ EXTENDED POLICY NUMBER LIMIT OF LIABILITY Insurance Group ® POLICY TERM INSURANCE AFFORDED UNDER THE ABOVE POLICIES UNTIL AT LEAST 30 WORKERS COMPENSATION 4/1 /2013 WC7-631-004090-592 COVERAGE AFFORDED UNDER WC LAW OF THE FOLLOWING STATES: AR,IL,MO,TX EMPLOYERS LIABILITY Bodily ln y%nAccident 2 OV� 0�0 Each Accident Bodily Injury By Disease of Girardeau Rudy Milfort PO Box 617 New York / 0202 AUTHORIZED REPRESENTATIVE r o Cape Girardeau, MO 63702 $2,000,000 Bodily Injury By Disease 3 New York NY 10036 212-391-7500 LI OFFICE PHONE $2,000,000 a n COMMERCIAL GENERAL LIABILITY 4/112013 TB2-631-004090-602 General Aggregate $2,000,000 ❑ OCCURRENCE Products/ Completed Operations Aggregate ❑ CLAIMS MADE2 000 000 Each Occurrence $2,000,000 RETRO DATE Personal & Advertising Injury $2,000,000 Per Person /organization O her Sncludes Per Job Aggregate & ther Damages to Premises: $100,0 AUTOMOBILE LIABILITY 411 /2013 AS2-631-004090-612 Each Accident—Single Limit $2,000,000 B.I. And P.D. Combined Each Person OWNED ❑ NON -OWNED Each Accident or Occurrence HIRED Each Accident or Occurrence OTHER ADDITIONAL COMMENTS RE: 2012 Asphalt Overlay Program-TTF-IV. City of Cape Girardeau is named as "Additional" Insured with respect to the General Liability Policy. ' If the certificate expiration date is continuous or extended term, you will be notified if coverage is terminated or reduced before the certificate expiration date. This certificate is executed by LIBERTY MUTUAL INSURANCE GROUP as respects such insurance as is afforded by those Companies N LDI COI 268896 02 11 Liberty Mutual NOTICE OF CANCELLATION: (NOT APPLICABLE UNLESS A NUMBER OF DAYS IS ENTERED BELOW.) Insurance Group BEFORE THE STATED EXPIRATION DATE THE COMPANY WILL NOT CANCEL OR REDUCE THE INSURANCE AFFORDED UNDER THE ABOVE POLICIES UNTIL AT LEAST 30 DAYS NOTICE OF SUCH CANCELLATION HAS BEEN MAILED TO: City Cape 7 of Girardeau Rudy Milfort PO Box 617 New York / 0202 AUTHORIZED REPRESENTATIVE r o Cape Girardeau, MO 63702 114 West 47th St. 8/21/12 3 New York NY 10036 212-391-7500 LI OFFICE PHONE This certificate is executed by LIBERTY MUTUAL INSURANCE GROUP as respects such insurance as is afforded by those Companies N LDI COI 268896 02 11 CHANGE ORDER # 1 PROJECT TITLE: 2012 ASPHALT OVERLAY CONTRACT DATE: August 21, 2012 CONTRACTOR: Apex Paving Co. The following changes are hereby made to the Contract Documents: Part 1. Items Quantity Reduced: ITEM NO DESCRIPTION QTY UNIT UNIT PRICE TOTAL 2 Hol Mix Asphaltic Concrete (MoDOT BP -2) (812.68) Ton $ 65.00 $ (52,824.20) Subtotal Reductions $ (52,824.20) Part 2. Additional Items: ITEM NO I DESCRIPTION QTY UNIT UNIT PRICE TOTAL 22 Hol Mix Asphaltic Concrete (SP -125) 812.68 Ton $ 68.50 $ 55,668.58 23 Hot Mix Asphaltic Concrete (3/4" Thin Lift) (Side Streets) 37.90 Ton $ 240.00 $ 9,096.00 Subtotal Additional Items $ 64,764.58 Total Change in Change Order # 1 $ 11,940.38 JUSTIFICATION: Part 1. Items Quantity Reduced: IThe City directed Apex to install a stronger hot mix asphalt (SP -125) along Old Highway 61 due to the amount of heavy truck traffic. The 812.68 I Item 2 tons of BP -2 was no longer needed to overlay Old Highway 61. Part 2. Additional Items: CONTRACT PRICE: Original contract price $316,070.92 Current contract price due to previous change orders: $316,070.92 Current contract price due to this change order will be increased by: $11,940.38 The new contract price due to this change order will be: $328,011.30 Change Order # 1 2012 Asphalt Overlay Page 1 of 2 The City directed Apex to install a stronger hot mix asphalt (SP -125) along Old Highway 61 due to the amount of heavy truck traffic The SP -125 Item 22 will last longer and provide a better finished product for the City, The City directed Apex to pave into some of the side streets along William to smooth the transition. The side streets included Sheridan, Koch, and Item 23 Albert. CONTRACT PRICE: Original contract price $316,070.92 Current contract price due to previous change orders: $316,070.92 Current contract price due to this change order will be increased by: $11,940.38 The new contract price due to this change order will be: $328,011.30 Change Order # 1 2012 Asphalt Overlay Page 1 of 2 CONTRACT TIME: Original contract time Substantial Completion December 14, 2012 Final Completion : January 13, 2013 Contract time due to previous change orders: Substantial Completion None Final Completion None Contract time due to this change order will be increased by: Substantial Completion : None Final Completion None The new contract time due to this change order will be: Substantial Completion : None Final Completion : None APPROVALS REQUIRED: To be effective, this Change Order must be approved by the owner if it changes the scope or objective of the project or may otherwise be required under the terms of the Supplementary General Conditions of the Contract. Recommended by �� 't Date Alt P—(7— Casey —(2Casey Brunke, City Engineer Approved by Approved by Accepted by Change Order # 1 2012 Asphalt Overlay Date � \ % Zs�I I Z Date % Date ' 12 Page 2 of 2 9`%©% s+° RE c E i 4 20111_ RECEIVED - 2 /Of, a � RECEIVED 0 2012 CHANGE ORDER # 2 PROJECT TITLE: 2012 ASPHALT OVERLAY CONTRACT DATE: August 21, 2012 CONTRACTOR: Apex Paving Co. The following changes are hereby made to the Contract Documents: Part 1. Items Quantity Reduced: ITEM NO DESCRIPTION QTY UNIT UNIT PRICE UNIT PRICE 1 TOTAL 3 Liquid Asphalt Tack Coat (1,851.00) Gal $ 0.05 $ (92.55) 12 Striping - Double Yellow Line (1,980.00) LF $ 0.42 $ (831.60) 13 Striping - Dashed Yellow Line (1,155.00) LF $ 0.42 $ (485.10) 14 Striping - Dashed White Line (10,130.00) LF $ 0.42 $ (4,254.60) 19 Base 5 Aggregate (178.98) Ton $ 27.00 $ (4,832.46) 20 Butt Joint and Spot Milling (57.10) SY $ 9.00 $ (513.90) Subtotal Reductions $ (11,010.21) Part 2. Additional Quantities: ITEM NO DESCRIPTION QTY UNIT UNIT PRICE TOTAL 1 Hot Mix Asphalt (3/4" Thin Lift) 851.05 Ton $ 70.00 $59,573.50 2 Hot Mix Asphalt (MoDOT BP -2) 12.79 Ton $ 65.00 $831.35 4 Milling 165.30 SY $ 1.70 $281.01 15 Striping - Solid White Line 2,430.00 LF $ 0.42 $1,020.60 16 Tum Arrows 6.00 Ea $ 25.08 $150.48 Subtotal Additions $61,856.94 Total Change in Change Order # 2 $ 50,846.73 JUSTIFICATION: Part 1. Items Quantity Reduced: Item 3 Field conditions did not merit the use of the entire plan quantity. Item 12 Due to conditions in the field, the quantity of double yellow line placed was less than what was shown in the project plans. Item 13 The spaces between the dashed yellow line were not subtracted from the total street length. Item 14 The spaces between the dashed white line were not subtracted from the total street length. Item 19 Due to conditions in the field, the quantity of base 5 aggregate placed was less than what was shown in the project plans. Item 20 The quantity of butt joint and spot milling was decreased due to field deviations that werent shown on the plans. Change Order # 2 2012 Asphalt Overlay Page 1 of 3 Part 2. Additional Quantities: Item 1 William Street was not milled before the overlay so even though the edges of the paver held at 3/4" more asphalt was being used to fill in potholes and ruts, this had not been accounted for in the original quantities. Item 2 The quantity of hot mix asphalt was increased due to field deviations that werent shown on the plans. Item 4 The quantity ofmilling was increased due to field deviations that werent shown on the plans. Item 15 This item is increased to account for actual useage in the field. Item 16 This item was increased because more was actually used in the field. CONTRACT PRICE: Original contract price: $316,070.92 Current contract price due to previous change orders: $328,011.30 Current contract price due to this change order will be increased by: $50,846.73 The new contract price due to this change order will be: $378,858.03 CONTRACT TIME: Original contract time ❑ Substantial Completion ❑ Final Completion Contract time due to previous change orders: ❑ Substantial Completion ❑ Final Completion Contract time due to this change order will be increased by: ❑ Substantial Completion Final Completion The new contract time due to this change order will be: Substantial Completion Final Completion December 14, 2012 January 13, 2013 None None None None None None Change Order # 2 2012 Asphalt Overlay Page 2 of 3 APPROVALS REQUIRED: To be effective, this Change Order must be approved by the owner if it changes the scope or objective of the project or may otherwise be required under the terms of the Supplementary General Conditions of the Contract. i Recommended by ' :i Date asey Bru e, ity Engineer Approved by Kelly�G4-�e"sistant City Manager Approved by cott Meyer ity Ma ager Accepted by F Apex Fyaving Co. Change Order # 2 2012 Asphalt Overlay Date \ /c1 I -Z-�— Date 1 I(-'�� Date ) r 10 —1 ?:> Page 3 of 3 N CHANGE ORDER # 3 and FINAL PROJECT TITLE: 2012 ASPHALT OVERLAY CONTRACT DATE: August 21, 2012 CONTRACTOR: Apex Paving Co. The following changes are hereby made to the Contract Documents: Part 1. Items Quantity Reduced: ITEM NO DESCRIPTION QTY UNIT UNIT PRICE TOTAL TOTAL 6 Replace Concrete Alleys and Driveways (16.00) SY $ 63.21 $ (1,011.36) 8 Double Curb Ramp with Truncated Domes (24.00) Each $ 757.50 $ (18,420.00) 10 Adjust Manholes (18.00) Each $ 205.00 $ (3,690.00) 11 Adjust Valve Box (6.00) Each $ 26.00 $ (156.00) 21 Asphalt Patch (80.00) SY $ 60.00 $ (4,800.00) Subtotal Reductions $ (28,077.36) Part 2. Additional Quantities: ITEM NO DESCRIPTION QTY UNIT UNIT PRICE TOTAL 5 Replace Concrete Curb and Gutter 11.00 LF $ 43.14 $474.54 7 Single Curb Ramp with Truncated Domes 27.00 Each $ 561.83 $15,169.41 9 Concrete Patch 239.30 SY $ 64.61 $15,461.17 Subtotal Additions $31,105.12 Total Change in Change Order # 3 $ 3,027.76 JUSTIFICATION: Part 1. Items Quanti Reduced: Item 6 Field conditions did not merit the use of the entire plan quantity. Item 8 Field conditions did not merit the use of the entire plan quantity. Item 10 Due to conditions in the field, the quantity of manhole adjustments needed was less than what was shown in the project plans. Item 11 Due to conditions in the field, the quantity of valve box adjustments needed was less than what was shown in the project plans. Item 21 The contractor, with City's approval, elected to use Item 9 (Concrete Patch) for the patches. Part 2. Additional Quantities: Item 5 Due to conditions in the field, the quantity of concrete curb and gutter was more than what was shown in the project plans. Item 7 Due to conditions in the field, the quantity of single curb ramps with truncated domes was more than what was shown in the project plans. Item 9 Due to conditions in the field, the quantity of concrete patch was more than what was shown in the project plans. Change Order # 3 and Final 2012 Asphalt Overlay Page 1 of 2 I CONTRACT PRICE: Original contract price: $316,070.92 Current contract price due to previous change orders: $378,858.03 Current contract price due to this change order will be increased by: $3,027.76 The new contract price due to this change order will be: $381,885.79 CONTRACT TIME: Original contract time: ❑ Substantial Completion : December 14, 2012 ❑ Final Completion : January 13, 2013 Contract time due to previous change orders: ❑ Substantial Completion : None ❑ Final Completion : None Contract time due to this change order will be increased by: ❑ Substantial Completion : None ❑ Final Completion : Five (5) Calendar Days The new contract time due to this change order will be: ❑ Substantial Completion : None ❑ Final Completion : January 18, 2013 APPROVALS REQUIRED: To be effective, this Change Order must be approved by the owner if it changes the scope or objective of the project or may otherwise be required under the terms of the Supplementary General Conditions of the Contract. Recommended by �,C Date _lJ " .� < (� Casey Bru ke, ity Engineer Approved by Approved by Accepted by Change Order # 3 and Final 2012 Asphalt Overlay Date Date Z "Z,b '%3 Date 2 �%— Page 2 of 2 � . No K7o7 RECEIVED � LLQ 3