HomeMy WebLinkAboutContract 1858
Address:
({)u.a }Jy J?eJtdf'a.IOf) SevtrJl:.~f; Inc,
30 t 6 S fi r lAC e SfreeT
,
Contractor's Business Name:
. L/ f-I-I ~ ('4;1et j"" /11 tV S- 5"1 f7
,
Phone No:
Fax No:
(p 51-2.2 '1- Z. Ii '2 Y
657- ;J.').i.{- ;2;2;20
II
BID FORM
II
PROJECT IDENTIFICATION:
CITY PROJECT NO. 0500
2005 MISCELLANEOUS.
CONCRETE REPAIRS
AND INSTALLATIONS
BIDS TO BE OPENED:
10:00 A~M. - TUESDAY, MAY 3,2.005
This bid is submitted to:
CITY OF COLUMBIA HEIGHTS
63738TH AVENUENE'
COLUMBIAHEIGHTS, MN 55421
, . .
. . ,
-' "-' - . . - ,
1. The undersigned BIDDER proposes and agrees, if this Bid is accepted, to enter into an
a.gr~ement with O'YNERCln the forminclllcied in the Contract Documents toperfoTIh
and furnish all Work as specified or iIldicatedin the ContractDocuments for tl~e Contract
. Price and within the Contracttime indicated in this bid and in accordance with the other
'. terms and conditions of the ContractDocuinent.
: , . , , -
2. IUDDER accepts all of the terms and conditions of the Advertisement or lnvItation to
Bid and Instructioh~o Bidders. ThisBidwill remain subjecttoacceptanceJorsixty (60)
days afterthedayofBid opening. BIDDER will sign and submit theAgreem~nt:with
the Bonds and other documents required by the Bidding Requirements within fifteen (15)
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:
9
(a) BIDDER has examined copies of all the Bidding Documents and of the
following Addenda (receipt of all of which is hereby acknowledged):
Date
Number
(b)
BIDDER has familiarized itself with the nature and extent of the Contract
Documents, Work, site, locality, and all local conditions and laws and regulations
that in any manner may affect cost, progress, performance or furnishing of Work.
(c)
BIDDER has studied carefully all reports and drawings of subsurface conditions
and drawings of physical conditions which are identified in the Supplementary
Conditions as provided in Paragraph 4.02 & 4.03 ofthe General Conditions, and
acc~pts the determination set forth in Paragraph S.C. 4.02 & 4.03 of the
Supplementary Conditions of the, extent of the technical data contained in such
reports and drawings upon which BIDDE,R is entitled to rely.
" "
, "
(d)
BIDDER has obtained and carefully studie~ (or assumes responsibility for
obtaining and carefully studying} aU such examinations, "investigations,
, e:X:pl()rations, tests and studies {in addition t6 orto supplement those referred to in
(c}above) which pertain tothe subsurface orphysical conditiohsatthe site or
, otherwise may affectthe cost, progress, performance orfurnishingofthework as
BID D Jij:ij. consider~ necessaryJor the p~rformance of furnishing the work at the
Contract Price, within the Contract Tirne and in accordance with the other terms
aIldco:nditions of the Contract Documents, including specifically: the provisions,
of paragraph 4.02& 4.03 of the General Conditions; and noadditicmal
examinations, investigations, exploratlOhs,tests, reports or siInilar information or
data,a.reorwill be required by BI])DERfor such purposes.
(e)
, ,- -.,
- -, .
. - , .~., .
. ' . . . .
\ . - ' .
, ' '
BID])E, R has reviewed and checked all information and data shown or indicated
. on th"e, Con, tr,ac,t, Documents Wl,'th" r, esp,ec,t,to,', ex, is,.,ting,,U, Il,',dergrou,n", ,dF,' ,a" ,c, ilities a, tor,'
contiguous to the, site arid assumes responsibility for the accurate location of sai,d
Underground Facilities.' ,No additional examinations, investigations,
explorations, tests, reports or similar information or data in. respect of said
Underground Facilities are orwill be requiredby BIDDER inorder to perform
and,fumish the Work at the Contract Price, within the Contract Time and in
accordance with the other terms ,and conditions of the Contract Docurtlents,
including specifically' the provisions of Paragraph 4.04 of the General
Con.ditions.
.10
(f) BIDDER has correlated the results of all such observations, examinations,
investigations, explorations, tests, reports and studies with the terms and conditions of
the Contract Documents.
(g) BID D ER has given EN GINEER written notice of all conflicts, errors, discrepancies that
it has discovered in the Contract Documents and the written resolution thereof by
ENGINEER is acceptable to BIDDER.
(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) Any other representation as required by Laws and Regulations.
4. BIDDER WILL 'COMPLETE THE WORK FOR THE FOLLOWING UNIT PRICES:
(See attached Page'12)
Qmintities are indicated for the convenience ,of the Bidder. Although no driveway or step
quantities are anticipated at this time, a line item is provided to obtain a uirit price for Phase 2;
Final payment will be based on actual quailtities.
11
CITY OF COLUMBIA HEIGHTS
"2005 MISCELLANEOUS CONCRETE REPAIRS AND INSTALLATIONS"
UNIT
NO. ITEM UNIT QUAN. PRICE AMOUNT
1. Remove curb and gutter L.F. 320 $ S. 0 () $ /6PtJO.OO
2. Construct concrete curb and gutter L.F. 320 $ /7,()O $ 5"L{lfO,oo
3. Remove street/alley
4. . Construct 8" concrete street/alley
S.F. 1,324 $ J 1).5
S.F. 1,324 $ 3.76
$ 16,55,00
$ Lf'1&5,aO
5. Remove driveway/apron S.F. 100 $ I. ;( 5' $ /2S',OO
6. Construct 6" concrete driveway/apron S.F. 100 $ 3.2.5 $ 3:l S.O 0
7. Remove sidewalk S.F. . 594 $ J, 00 $ S<9 I{. (10
8. Construct 4" concrete sidewalk S.F. 594 $ 3.00 $ I 78;J..()O
9; Remove step
10.. Constructconcrete step
S.F... 10 . $ S.OO.
S.P. 10 $ 30.()O
CO,dO
TOTAL BID
$ It, 8St;.OO
.
....;..,....~..../V...41'.() ..
$;~ fee~Th()US4I1J /E'Jh fllWtJrerl Tk'vf; Six ~-L~ v
TotalBid Written In Words. ... . . . .
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5. BIDDER agrees that the Work will be completed as follows:
@ 2005 M!SCELLi~..NEOUS CONCRETE :REPAIRS & INSTALLATIONS
CITY PROJECT 0500
. All work listed in the Supplemental Information (phase I) must be completed by
June 10,2005.
. The. Contractor shall anticipate a second list of removals and concrete repairs or
inst~llations at various locations by September 9, 2005. These qUarltities are in
addition to those listed in the Proposal.
. Final inspection by October 21, 2005, in accordance with Paragraph 14.06 of the
General Conditions.
. BIDDER accepts the provisions of the Agreement as to liquidated damag~s in the
event offailure to complete the work on time.
6. The following documents are attached to andmade a condition of the BID.
(a) A tabulation of Subcontractors, ~uppliers,and other persons' and organizations
required to be identified in this Bid,
(b) The contractor will complete the. Work sequence in accordance with DivisionJ,
Section 4, General Requirements.
. .
(c) . Affidavit of Non-Collusion.
., , ,
7. COIll~unicationsconcerningthis BID shall be addressed t<; the address of BIDDER
. indicatedbelow,
8. The terms used in this BID, which are defmed in the General Conditions of the
Construction Contract included aspart of the Contract Documents, have the meanings
assigned to them in the General.Conditions. .
SUBMITTED ON:
/vJC{ v J('cl
,
, 2005.
13
If BIDDER is:
AN INDIVIDUAL
By
(Individual's Name)
Doing Business As
Address:
Telephone No:
A P ARTNERSIDP
By
(Firm N~me)
(General Partner)
. Telephone No.:
(Continued on next page.)
. .
14
(SEAL)
. (SEAL)
; 'I!;; 1,','
',.j(:r \ "
". 1',-'
, '
By ~Ut:l/. 7'1 J<f'sto r~1f,.tJJ1 SeJv/ces, Lt;.
. , I
(Corporation Name)
\ ~,
,I ,i ',")
1 ..1' 'J
, '\, (SlJ:At)/
, , 'I
I
A CORPORATION
By
M//1 nesdfa
(State of Incorporation)
.J;""OJ:b,rn ~~
, (Name of Per so A thorized to Sign)
,I'. . ;
",,: I:;
) 'II I] 'II! )1
pres/c(eh f
(Title)
ATTEST: DOLl) Ydzer~{)LJ 9~
(Secretary) ~. . ~ .~.
Business Address: ~ 3 tJ '6 fp rl.tU Sfve.et- ~
.
L/fj./e~ lieu/d., /Vllv' 5'SI/7
~ I
A JOINT VENTURE
By
~ame)
. (Address)
By
'. (Name)
(Address)
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.
15
STATE OF JV//f1Y1€$~ft::l
COUNTY OF 1?t:J.Yl1Sev
/
AFFIDAVIT OF NON-COLLUSION:
(1) That I am the BIDDER (if the bidder is an individual), a partner in the BIDDER
(if the bidder is a partnership) of an officer or employee of the BIDDER
corporation having authority to sign on its behalf (if the BIDDER is a
corporation;
(2) That the attached bid or bids have been arrived at by the BIDDER individually
and have been submitted without collusion with, and without any agreement,
understanding or planned common course of action with any vendor of materials,
supplies, equipment or services described in the invitation to bid designed to limit
individual bidding or competition;
(3) That the contents of the bid or bids have not been communicated by the
BIDDER, or its employees or agents, to any person not anyemployeeor agent of
the BIDDER, or its surety, on any bond furnished with the bid or bids, andwi11
not be communicated to any person, prior to any official opening ofthe bids, or
bids. and. ..
- , . ,
" I '
. .' . , ! ' , I ~
(4) . Thatlhavefully informedmyselfregarding the accuracy of the statements made
" in this affidavit.. .
Jo.y OS,)! r n.
BIIJQER'
" .
. "
(;)ua /,.1'1 '1( esf~rtt f'~4I1,..'Serl//ce~ ."In c.' "
F1RMMAKING BIDS '
. ' .
Subs~r~fd and sworntohefore\me
.~his 3 .,dayofl11~X,' "
, (}:f6(:?nL
, NAME
J(esburc-e. /'1~u1a.Jer , ~ A/olttryP4. /'/,;"C.
OFFICIAL TITLE
, 2005.
," '
~~Ap~bl~M~:'~ I
My CommIaBIon ExpIrN Jan 31, 20101 16
EJCDC
STANDARD FORM OF AGREEMENT
BETWEEN OWNER AND CONTKACTOR
ON THE BASIS OF STIPULATED PRICE
THIS AGREEMENT.
(OWNER) and
(CONTRACTOR).
OWNER and CONTRACTOR, in consideration of the mutual covenants set forth herein,
agree as follows:
ARTICLE 1 - WORK
1.01 CONTRACTOR shall complete all Work as specified or indicated in the Contract
Documents. The Work is generally described as follows:
Concrete curb and gutter, sidewalk, steps or flatwork removals and repairs or
installations at spot locations throughout the City.
ARTICLE 2 - THE PROJECT
2.01 The Project for which the Work under the Contract Documents may be the whole or only a
part is generally described as follows:
+ 2005 MISCELLANEOUS CONCRETE REPAIRS AND INSTALLATIONS
CITY PROJECT NO. 0500
ARTICLE 3 - ENGINEER
3.01 The Project has been designed by the CITY OF COLUMBIA HEIGHTS' ENGINEERING
DEPARTMENT (ENGINEER), who 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 the completion of the Work in accordance with the Contract
Documents.
17
ARTICLE 4 - CONTRACT TIMES
4.01 Time of the Essence
A. All time limits for Milestones, if any, Substantial Completion, and completion and
readiness for final payment as stated in the Contract Documents are of the essence of the
Contract.
4.02 Dates for Substantial Completion and Final Payment
A. The Work will be substantially completed on or before October 1,2005, and completed
and ready for final payment in accordance with Paragraph 14.07 of the General Conditions
on or before October 21,2005.
4.03 Liquidated Damages
A. CONTRACTOR and OWNER 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 4.02 above, plus any extensions thereof allowed in accordance with
Article 12 of the General Conditions. The parties also recognize the delays, expense, and
difficulties involved in proving in a legal or arbitration proceeding the actual loss suffered by
OWNER if the Work is not completed 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 $250.00 for each day that expires after the time
specified in Paragraph 4.02 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 Contract Time or any proper extension thereof
granted by OWNER, CONTRACTOR shall pay OWNER $250.00 for each day that expires
after the time specified in Paragraph 4.02 for completion and readiness for final payment
until the Work is completed and ready for final payment.
ARTICLE 5 - CONTRACT PRICE
5.01 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 below:
For all Work, at the prices stated in CONTRACTOR's Bid, attached hereto as Exhibit A.
As provided in Paragraph 11.03 of the General Conditions, estimated quantities are not
guaranteed, and determinations of actual quantities and classifications are to be made by
ENGINEER as provided in Paragraph 9.07 of the General Conditions. Unit prices have been
computed as provided in Paragraph 11.03 of the General Conditions.
18
ARTICLE 6 - PAYMENT PROCEDURES
6.01 Submittal and Processing of Payments
A. 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.
6.02 Progress Payments; Retainage
A. OWNER shall make progress payments on account of the Contract Price on the basis of
CONTRACTOR's Applications for Payment on or about the fifteenth day of each month
during performance of the Work as provided in Paragraphs 6.02.A.1 and 6.02.A.2 below. All
such payments will be measured by the schedule of values established as provided in
Paragraph2.07.A 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:
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 may determine or
OWNER may withhold, including but not limited to liquidated damages, in accordance
with Paragraph 14.02 of the General Conditions:
a. 95% of Work completed (with the balance being retainage). Ifthe 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; and
b. 95% of cost of materials and equipment not incorporated in the Work (with
the balance being retainage).
2. Upon Substantial Completion, OWNER shall pay an amount sufficient to
increase total payments to CONTRACTOR to 98% of the Work completed, less such
amounts as ENGINEER shall determine in accordance with Paragraph 14.02.B.5 of the
General Conditions and less 5% of ENGINEER's estimate of the value of Work to be
completed or corrected as shown on the tentative list of items to be completed or
corrected attached to the certificate of Substantial Completion.
6.03 Final Payment
A. Upon final completion and acceptance ofthe Work in accordance with Paragraph 14.07
of the General Conditions, OWNER shall pay the remainder of the Contract Price as
recommended by ENGINEER as provided in said Paragraph 14.07.
19
ARTICLE 7 - INTEREST
7.01 All moneys not paid when due as provided in Article 14 of the General Conditions shall bear
interest at the rate of 6% per annum.
ARTICLE 8 - CONTRACTOR'S REPRESENTATIONS
8.01 In order to induce OWNER to enter this Agreement CONTRACTOR makes the following
representations:
A. CONTRACTOR has examined and carefully studied the Contract Documents and the
other related data identified in the Bidding Documents.
B. 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, and performance of the
Work.
C. CONTRACTOR is familiar with and is satisfied as to all federal, state, and local Laws
and Regulations that may affect cost, progress, and performance of the Work.
D. CONTRACTOR has carefully studied all: (1) 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 in the Supplementary Conditions as
provided in Paragraph 4.02 of the General Conditions and (2) reports and drawings of a
Hazardous Environmental Condition, if any, at the Site which has been identified in the
Supplementary Conditions as provided in Paragraph 4.06 of the General Conditions.
E. CONTRACTOR has obtained and carefully studied (or assumes responsibility for
doing so) all additional or supplementary examinations, investigations, explorations, tests,
studies, and data concerning conditions (surface, subsurface, and Underground Facilities) at
or contiguous to the Site which may affect cost, progress, or performance of the Work or
which relate to any aspect of the means, methods, techniques, sequences, and procedures of
construction to be employed by CONTRACTOR, including any specific means, methods,
techniques, sequences, and procedures of construction expressly required by the Bidding
Documents, and safety precautions and programs incident thereto.
F. CONTRACTOR does not consider that any further examinations, investigations,
explorations, tests, studies, or data are necessary for the performance of the Work at the
Contract Price, within the Contract Times, and in accordance with the other terms and
conditions of the Contract Documents.
G. CONTRACTOR is aware ofthe 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.
20
H. CONTRACTOR has correlated the information known to CONTRACTOR,
information and observations obtained from visits to the Site, reports and drawings identified
in the Contract Docu...-rnents, and all additional examinations, investigations, explorations,
tests, studies, and data with the Contract Documents.
1. 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.
J. The Contract Documents are generally sufficient to indicate and convey
understanding of all terms and conditions for performance and furnishing of the Work.
ARTICLE 9 CONTRACT DOCUMENTS
9.01 Contents
A. The Contract Documents consist of the following:
1. This Agreement (pages _ to _, inclusive).
2. Performance Bond (pages _ to _, inclusive).
3. Payment Bond (pages _ to _, inclusive).
4. Other Bonds (pages _ to _, inclusive).
5. General Conditions (pages _ to _, inclusive).
6. Supplementary Conditions (pages _ to _, inclusive).
7. Specifications as listed in the table of contents ofthe Project Manual.
8. Drawings consisting of none.
9. Addenda (numbers _ to _, inclusive).
10. Exhibits to this Agreement (enumerated as follows):
a. CONTRACTOR's Bid (pages _ to _, inclusive).
b. Documentation submitted by CONTRACTOR prior to Notice
of Award (pages to _, inclusive).
c.
21
11. The following which may be delivered or issued on or after the Effective
Date of the Agreement and are not attached hereto:
a. Notice to Proceed (pages _ to _, inclusive).
b. Work Change Directives.
c. Change Order(s).
B. The documents listed in Paragraph 9.0 I.A are attached to this Agreement (except as
expressly noted otherwise above).
C. There are no Contract Documents other than those listed above in this Article 9.
D. The Contract Documents may only be amended, modified, or supplemented as
provided in Paragraph 3.04 of the General Conditions.
ARTICLE 10 - MISCELLANEOUS
10.01 Terms
A. Terms used in this Agreement will have the meanings stated in the General Conditions
and the Supplementary Conditions.
10.02 Assignment of Contract
A. No assignment by a party hereto of any rights under or interests in the Contract 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.
10.03 Successors and Assigns
A. 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.
10.04 Severability
A. 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
22
a valid and enforceable provision that comes as close as possible to expressing the intention
of the stricken provision.
10.05 Other Provisions (if applicable).
23
IN WITNESS WHEREOF, OWNER and CONTRACTOR have signed this Agreement in duplicate.
One counterpart each has been delivered to OWNER and CONTRACTOR. All portions of the Contract
Documents have been signed or identified by)::;>WNER and CONTRACTOR or on their behalf.
This Aweement will be effective on ;:}"11 9 , 2005 (which is the Effective Date of the
Agreement).
OWNER:
d~
Attest:
Title:
[CORPORATE SEAL]
Address for giving notices:
(If OWNER is a corporation, attach evidence
of authority to sign. If OWNER is a public
body, attach evidence of authority to sign and
resolution or other documents authorizing
execution of OWNER-CONTRACTOR
Agreement).
Phone:
Facsimile:
CONTRACTOR:
w~
By: J~,y OSh"Jrh
Title: Pres/de".-f
[CORPORATE SEAL]
Attest: M'IF~Wl JV/t:<trk~i tJ-r. /YbL
Title: f(t'flJi.ly(e MaM~e.~
Address for giving notices:
;] {J Ie (;' S.1/~/;fC IE' Sfr-e el
.
LIHle L~(J/f4dtt . 1V1A./ S-S"1/7
,
License No.
(Where applicable)
Agent for service of process:
(If CONTRACTOR is a corporation or a
partnership, attach evidence of authority to sign.)
Designated Representative:
Name: PC<."t! /t:r' IASCJ,~ k
Title: Mc...t1.ti. t:;<~'
"
Address: 3(/6' S/t)Y"t-tc-e Slvee f
L/ffJe (#I h Gt cia , IVI N 6"S-117
/
Phone: t I Z ~ 3~; q,. "I r; t if
Facsimile:_trl.::._:?-~Y - l-_?::_~Q____
24
ACORDTM CERTIFICATE OF LIABILITY INSURANCE I DATE (MM/DDIYYVY)
06/09/05
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
MN-FG/HG ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
COBB STRECKER DUNPHY & ZIMMERMANN HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
150 S FIFTH ST STE 2800
MINNEAPOLIS, MN 55402 INSURERS AFFORDING COVERAGE NAIC#
INSURED INSURER A: ZURICH AMERICAN INSURANCE COMPA NY
QUALITY RESTORATION SERViCES INC INSURERS: !NS CO OF THE STATE OF PA
QUALITY UNDERGROUND SERVICES INC INSURER c: AMERICAN ZURICH INSURANCE COMPA \IV
UTILITY RESOURCES INC INSURER D:
3066 SPRUCE ST, ST PAUL, MN 55117 INSURER E:
Client#: 2998
QUALRESI
COVERAGES
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING
ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR
MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH
POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR ~~~~ TYPE OF INSURANCE POLICY NUMBER PJlAI{~~J~i~8m\E p~~~J {~X:'Wb'~N LIMITS
LTR
A GENERAL LIABILITY GL0370315801 04/01/05 04/01/06 EACH OCCURRENCE $1 000 000
- DAMAGE r9..RE~TED
X COMMERCIAL GENERAL LIABILITY ., $300 000
I CLAIMS MADE [K] OCCUR INCLUDES: MED EXP (Anyone person) $10,000
lL XCU OPERATIONS OF PERSONAL & ADV INJURY $1 000 000
lL BROAD FORM PD SUBS-CONTINGENT GENERAL AGGREGATE $2,000,000
GEN'L AGGREGATE LIMIT APPLIES PER: CONTRACTUAL L1AB PRODUCTS - COMP/OP AGG $2 000 000
I POLICY rxl j~gT !Xl LOC
A ~TOMOBILE LIABILITY BAP370315701 04/01105 04/01/06 COMBINED SINGLE LIMIT
lL ANY AUTO (Ea accident) $1,000,000
ALL OWNED AUTOS BODILY INJURY
- (Per person) $
- SCHEDULED AUTOS
X HIRED AUTOS BODILY INJURY
- $
lL NON-OWNED AUTOS (Per accident)
- PROPERTY DAMAGE $
(Per accident)
GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $
=1 ANY AUTO OTHER THAN EA ACC $
AUTO ONLY: AGG $
B ~ESS/UMBRELLA LIABILITY 46056401 04/01/05 04/01/06 EACH OCCURRENCE $5,000,000
'OCCUR 0 CLAIMS MADE AGGREGATE $5 000 000
$
~ DEDUCTIBLE $
X RETENTION $0 $
C WORKERS COMPENSATION AND WC370.3'j 59(J'I 04/01 i05 04iOii06 X I ;~~J;ri~Tri;, I IOJ~-
EMPLOYERS' LIABILITY $1,000,000
ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT
OFFICER/MEMBER EXCLUDED? E.L. DISEASE - EA EMPLOYEE $1,000,000
If yes, describe under E.L. DISEASE - POLICY LIMIT $1,000,000
SPECIAL PROVISIONS below
OTHER
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS
2005 MISCELLANEOUS CONCRETE
ADDITIONAL INSURED W/RESPECT TO GENERAL LIABILITY:
CITY OF COLUMBIA HEIGHTS
CERTIFICATE HOLDER
CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
CITY OF COLUMBIA HEIGHTS DATE THEREOF, THE ISSUING INSURER WILLX~lUtX~MAIL -3lL DAYS WRITTEN
KATHYJEAN KYOUNG NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,1IlnRM~)(
637 38TH AVE NE ~IOtK~Jl~KDUOKX~~X)OOlOUJI!)o{Kri{_~n>>Jli~XX
MINNEAPOLIS, MN 55421 XJm8e6K~X.X
Arr;rIZO:~~NTATIVE
ACORD 25 (2001/08) 1 of 2
#S189058/M178646
DLL
@ ACORD CORPORATION 1988
IMPORTANT
If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A statement
on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s).
If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may
require an endorsement. A statement on this certificate does not confer rights to the certificate
holder in lieu of such endorsement(s).
DISCLAIMER
The Certificate of Insurance on the reverse side of this form does not constitute a contract between
the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it
affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon.
ACORD 25-5 (2001/08) 2 of 2
#S189058/M178646
Bond No. F17100
PAYMENT BOND
Any singular reference to Contractor, Surety, Owner, or other party shall be considered plural where applicable.
CONTP~ACTOR (Name and .A.ddress):
Quality Restoration Services, me.
'llfj Spruce Street, Little Canada, MN 55117
OWNER (Name and Address):
City of CollllIlbia Heights
637 38th Avenue N.E., Columbia Heights, MN 55421
CONTRACT
Date: 5/10/05
Amount: $16,836.00 sixteen thousand eight hundred thirty-six & 00/100
Description (Name and Location): 2005 Miscellaneous concrete repairs and installations - City of Columbia Heights
SURETY (Name and Address of Principal Place of Business):
ACSI'AR Insurance Canpany
233 M:rin Street, NEW Britain, cr 0:051
BOND
Bond Number: F17100
Date (Not earlier than Contract Date): 7/19/05
Amount: $16,836.00 sixteen thousand eight hundred thirty-six & 00/100
Modifications to this Bond Form: None
Surety and Contractor, intending to be legally bound hereby, subject to the terms printed on the reverse side hereof, do each cause this
Payment Bond to be dilly executed on its behalf by its authorized officer, agent, or representative.
Signature:
Name and Title:
SURETY
CONTRACTOR AS
Company:
ices, Inc.
, . (Seal)
ACSI'AR Insurance Ccmoanv (Seal)
Surety's Name and Corporate Seal
By: ~
Signaturfl'1 d. . e Henry W. Nozko, Jr., President
(Attach Power of Attorney)
00 i.(J e lz.e V"
Se<. I Ti'"e.r:i.5'VI'er
(Space is. provided below for signatures of additional
parties, if required.)
Attest: KU11. ~ 7J e ~ J) ,
Signature and Title Diane L. Plante Bond Administrator
CONTFACTORASPillNC~AL
Company:
SURETY
Signature:
Name and Title:
(Seal)
(Seal)
Surety's Name and Corporate Seal
By:
Signature and Title
(Attach Power of Attorney)
Attest:
Signature and Title:
EJCDC No. C-615 (2002 Edition)
Originally prepared through the joint efforts of the Surety Association of America, Engineers Joint Contract. Documents Committee, the Associated General
Contractors of America, the American Institute of Architects, the American Subcontractors Association, and the Associated Specialty Contractors.
I. Contractor and Surety, jointly and severally, bind themselves, their heirs,
executors, administrators, successors, and assigns to Owner to pay for labor,
materials, and equipment furnished by Claimants for use in the performance of
the Contract, which is incorporated herein by reference.
2. With respect to Owner, this obligation shall be null and void if Contractor:
2.1. Promptly makes payment, directly or indirectly, for all _sums due
Claimants, and
2.2. Defends, indemnifies, and holds harmless Owner from all claims,
demands, liens, or suits alleging non-payment by Contractor by any
person or entity who furnished labor, materials, or equipment for use in
the performance of the Contract, provided Owner has promptly notified
Contractor and Surety (at the addresses described in Paragraph 12) of
any claims, demands, liens, or suits and tendered defense of such
claims, demands, liens, or suits to Contractor and Surety, and provided
there is no Owner Default.
3. With respect to Claimants, this obligation shall be null and void if Contractor
promptly makes payment, directly or indirectly, for all sums due.
4. Surety shall have no obligation to Claimants under this Bond until:
4.1. Claimants who are employed by or have a direct contract with
Contractor have given notice to Surety (at the addresses described in
Paragraph 12) and sent a copy, or notice thereof, to Owner, stating that
a claim is being made under this Bond and, with substantial accuracy,
the amount of the claim.
4.2. Claimants who do not have a direct contract with Contractor:
I. Have furnished written notice to Contractor and sent a copy, or
notice thereof, to 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 or equipment 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 Contractor,
or not received within 30 days of furnishing the above notice any
communication from Contractor by which Contractor had 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 Surety and sent a copy, or notice thereof, to Owner, stating
that a claim is being made under this Bond and enclosing a copy of
the previous written notice furnished to Contractor.
5. If a notice by a Claimant required by Paragraph 4 is provided by Owner to
Contractor or to Surety, that is sufficient compliance.
6. When a Claimant has satisfied the conditions of Paragraph 4, the Surety shall
promptly and at Surety's expense take the following actions:
6.1. Send an answer to that Claimant, with a copy to 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. Payor arrange for payment of any undisputed amounts.
7. Surety's total obligation shall not exceed the amount of this Bond, and the
amount of this Bond shall be credited for any payments made in good faith by
Surety.
Bond No. 1'17100
8. Amounts owed by Owner to Contractor under the Contract shall be used for
the performance of the Contract and to satisfy claims, if any, under any
performance bond. By Contractor furnishing and Owner accepting this Bond,
they agree that all funds earned by Contractor in the performance of the Contract
are dedicated to satisfy obligations of Contractor and Surety under this Bond,
subject to Owner's priority to use the funds for the completion of the Work.
9. Surety shall not be liable to Owner, Claimants, or others for obligations of
Contractor that are unrelated to the Contract. 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. Surety hereby waives notice of any change, including changes of time, to the
Contract or to related Subcontracts, purchase orders and other obligations.
II. No suit or action shall be commenced by a Claimant under this Bond other
than in a court of competent jurisdiction in the location in which the Work or
part of the Work is located or after the expiration of one year from the date (I)
on which the Claimant gave the notice required by Paragraph 4.1 or Paragraph
4.2.3, or (2) on which the last labor or service was performed by anyone or the
last materials or equipment were furnished by anyone under the Construction
Contract, whichever of (I) or (2) first occurs. If the provisions of this paragraph
are void or prohibited by law, the minimum period of limitation available to
sureties as a defense in the jurisdiction of the suit shall be applicable.
12. Notice to Surety, Owner, or Contractor shall be mailed or delivered to the
addresses shown on the signature page. Actual receipt of notice by Surety,
Owner, or 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 requirement
in the location where the Contract was to be performed, any provision in this
Bond conflicting with said statutory requirement shall be deemed deleted
herefrom and provisions conforming to such statutory requirement shall be
deemed incorporated herein. The intent is that this Bond shall be construed as a
statutory Bond and not as a common law bond.
14. Upon request of any person or entity appearing to be a potential beneficiary
of this Bond, Contractor shall promptly furnish a copy of this Bond or shall
permit a copy to be made.
IS. DEFINITIONS
15.1. Claimant: An individual or entity having a direct contract with
Contractor, or with a first-tier subcontractor of 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 limitation
in the terms "labor, materials or equipment" that part of water, gas,
power, light, heat, oil, gasoline, telephone service, or rental equipment
used in the Contract, architectural and engineering services required for
performance of the Work of Contractor and 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. Contract: The agreement between Owner and Contractor identified on
the signature page, including all Contract Documents and changes
thereto.
15.3. Owner Default: Failure of Owner, which has neither been remedied nor
waived, to pay Contractor as required by the Contract or to perform and
complete or comply with the other terms thereof.
FOR INFORMATION ONLY -Name, Address and Telephone
Surety Agency or Broker:
Owner's Representative (engineer or other party):
Pond No. F17100
PERFORMANCE BOND
Any singular reference to Contractor, Surety, Owner, or other party shall be considered plural where applicable.
SUP.ETY (Name and Address ofPri~'1cipal Place of Business):
AcsrAR Insurance Canpany
233 l'1lln Street, NEW Britain, cr CX:051
CONTP~A.CTOR (Name and Address):
Quality Restoration Services, Inc.
3CXj6 Spruce Street, Little Canada, MN 55117
OWNER (Name and Address):
City of Columbia Heights
637 38th Avenue N.E.
Columbia Heights, MN 55421
CONTRACT
Date: 5/10/05
Amou.nt:. $16,836.00 sixtee:n thousand eight hundred thirty-six & 00/100
Descnption (Name and Location): 2005 Miscellaneous concrete repairs and installations - City of Columbia Heights
BOND
Bond Number: Fl7100
Date (Not earlier than Contract Date): 7/19/05
Amount: $16,836.00 _sixteen thousand eight hundred thirty-six & 00/100
Modifications to this Bond Form: None
Surety and Contractor, intending to be legally bound hereby, subject to the terms printed on the reverse side hereof, do each cause this
Performance Bond to be duly executed on its behalf by its authorized officer, agent, or representative.
(Space is provided below for signatures of additional
paIties, if required.)
CONTRACTORASPRlNC~AL
Company:
Signature:
Name and Title:
(Seal)
SURETY
ACSTAR Insurance Canpany (Seal)
Surety's Name and Corporate Seal
~r.'na~ w. Nazko, Jr.. President
(Attach Power of Attorney)
Attest: /JAf~ -,7ft. ~Ul /tX-P ,
Signature and Title Diane L. Plante Bond Administrator
SURETY
(Seal)
Surety's Name and Corporate Seal
By:
Signature and Title
(Attach Power of Attorney)
Attest:
Signature and Title:
EJCDC No. C-610 (2002 Edition) .
Originally prepared through the joint efforts of the Surety Association of America, Engineers Joint Contract Documents Committee, the Associated General
Contractors of America, and the American Institute of Architects.
1. Contractor and Surety, jointly and severally, bind themselves, their heirs,
executors, administrators, successors, and assigns to Owner for the performance of the
Contract, which is incorporated herein by reference.
2. If Contractor performs the Contract, Surety and Contractor have no obligation
under this Bond, except to participate in conferences as provided in Paragraph 3.1.
3. If there is no Owner Default, Surety's obligation under this Bond shall arise after;
3.1.
Owner has notified Contractor and Surety, at the addresses described in
Paragraph 10 below, that Owner is considering declaring a Contractor
Default and has requested and attempted to arrange a conference with
Contractor and Surety to be held not later than 15 days after receipt of
such notice to discuss methods of performing the Contract. If Owner,
Contractor and Surety agree, Contractor shall be allowed a reasonable
time to perform the Contract, but such an agreement shall not waive
Owner's right, if any, subsequently to declare a Contractor Default; and
3.2.
Owner has declared a Contractor Default and formally terminated
Contractor's right to complete the Contract. Such Contractor Default shall
not be declared earlier than 20 days after Contractor and Surety have
received notice as provided in Paragraph 3.1; and
3.3.
Owner has agreed to pay the Balance of the Contract Price to;
I. Surety in accordance with the terms of the Contract;
2. Another contractor selected pursuant to Paragraph 4.3 to perform the
Contract.
4. When Owner has satisfied the conditions of Paragraph 3, Surety shall promptly and
at Surety's expense take one oft.l]e following actions;
4. I. Arrange for Contractor, with consent of Owner, to perform and complete
the Contract; or
4.2.
Undertake to perform and complete the Contract itself, through its agents
or through independent contractors; or
4.3.
Obtain bids or negotiated proposals from qualified contractors acceptable
to Owner for a contract for performance and completion of the Contract,
arrange for a contract to be prepared for execution by Owner and
Contractor selected with Owner's concurrence, to be secured. with
performance and payment bonds executed by a qualified surety equivalent
to the bonds issued on the Contract, and pay to Owner the amount of
damages .as described in Paragraph 6 in excess of the Balance of the
Contract Price incurred by Owner resulting from Contractor 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:
I. After investigation, determine the amount for which it may be liable to
Owner and, as soon as practicable after the amount is determined,
tender payment therefor to Owner; or
2. Deny liability in whole or in part and notifY Owner citing reasons
therefor.
5. If Surety does not proceed as provided in Paragraph 4 with reasonable promptness,
Surety shall be deemed to be in default on this Bond 15 days after receipt of an
additional written notice from Owner to Surety demanding that Surety perform its
obligations under this Bond, and Owner shall be entitled to enforce any remedy
available to Owner. If Surety proceeds as provided in Paragraph 4.4, and Owner
refuses the payment tendered or Surety has denied liability, in whole or in
part, without further notice Owner shall be entitled to enforce any remedy available to
Owner.
fund No. F171m
6. After Owner has terminated Contractor's right to complete the Contract, and if
Surety elects to act under Paragraph 4.1, 4.2, or 4.3 above, then the responsibilities of
Surety to Owner shall not be greater than those of Contractor under the Contract, and
the responsibilities of Owner to Surety shall not be greater than those of Owner under
the Contract. To a limit of the amount of this Bond, but subject to commitment by
Owner of the Balance of the Contract Price to mitigation of costs and damages on the
Contract, Surety is obligated without duplication for:
6.1.
The responsibilities of Contractor for correction of defective Vv"ork and
completion of the Contract;
6.2.
Additional legal, design professional, and delay costs resulting from
Contractor's Default, and resulting from the actions or failure to act of
Surety under Paragraph 4; and
6.3.
Liquidated damages, or if no liquidated damages are specified in the
Contract, actual damages caused by delayed performance or non-
performance of Contractor.
7. Surety shall not be liable to Owner or others for obligations of Contractor that are
unrelated to the 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 Owner or its heirs, executors,
administrators, or successors.
8. Surety hereby waives notice of any change, including changes of time, to 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 Contractor ceased working or within two years after Surety refuses or fails
to perform its obligations under this Bond, whichever occurs first. If the provisions of
this paragraph are void or prohibited by law, the minimum period of limitation
available to sureties as a defense in the jurisdiction of the suit shall be applicable.
10. Notice to Surety, Owner, or Contractor shall be mailed or delivered to the address
shown on the signature page.
II. When this Bond has been furnished to comply with a statutory requirement in the
location where the Contract was to be performed, any provision in this Bond
conflicting with said statutory requirement shall be deemed deleted here from and
provisions conforming to such statutory requirement shall be deemed incorporated
herein. The intent is that this Bond shall be construed as a statutory bond and not as a
common law bond.
12. Definitions.
12.1
Balance of the Contract Price: The total amount payable by Owner to
Contractor under the Contract after all proper adjustments have been
made, including allowance to Contractor of any amounts received or to be
received by Owner in settlement of insurance or other Claims for damages
to which Contractor is entitled, reduced by all valid and proper payments
made to or on behalf of Contractor under the Contract.
12.2. Contract: The agreement between Owner and Contractor identified on the
signature page, including all Contract Documents and changes thereto.
12.3. Contractor Default: Failure of Contractor, which has neither been
remedied nor waived, to perform or otherwise to comply with the terms of
the Contract.
12.4. Owner Default: Failure of Owner, which has neither been remedied nor
waived, to pay Contractor as required by the Contract or to perform and
complete or comply with the other terms thereof.
FOR INFORMATION ONLY - Name, Address and Telephone
Surety Agency or Broker
Owner's Respresentative (engineer or other party)
--LlrCT lIR
~ T"I"'~'" "
INSURANCE COMPANY
233 MAIN STREET' P.O. BOX 2350' NEW BRITAIN, CT 06050-2350' (860) 224.2000
BOND NO. f= \ '1 \ 0'1
RIDER CONTAINING DISCLOSURE NOTICE OF TERRORISM
COVERAGE
This disclosure notice is required by the Terrorism Risk Insurance Act of 2002 (the
"Act"). No action is required on your part. This Disclosure Notice is incorporated in
and a part of the attached bond, and is effective the date of the bond.
You should know that, effective November 26, 2002, any losses covered by the
attached bond that are caused by certified acts of terrorism would be partially
reimbursed by the United States under a formula established by the Act. Under this
formula, the United States reimburses 90% of covered terrorism losses exceeding
the statutory established deductible paid by the insurance company providing the
coverage.
Under the Act, there is a cap on our liability to pay for covered terrorism losses if the
aggregate amount of insured losses under the Act exceeds $100,000,000,000.
during the applicable period for all insured's and all insurers combined. In that case,
we will not be liable for the payment of any amounts, which exceeds that aggregate
amount of $100,000,000,000.
The portion of your premium that is attributed to coverage for acts of terrorism is
~O.OO.
IMPORTANT NOTE: THE COST OF TERRORISM COVERAGE IS SUBJECT TO
CHANGE ON ANY BONDS THAT PREMIUM IS CHARGED ANNUALLY.
EXCLUSION OF LIABILITY FOR MOLD, MYCOTOXINS, AND FUNGI
The Bond to which this Rider is attached does not provide coverage for, and the
surety thereon shall not be liable for, molds, living or dead fungi, bacteria, allergens,
histamines, spores, hyphae, or mycotoxins, or their related products or parts, nor the
remediation thereof, nor the consequences of their occurrence, existence, or
appearance.
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233 MAIN STREET. P.O. BOX 2350
NEW BRITAIN, CT 06050-2350
(860) 224-2000
POWER OF ATTORNEY
N~ 19999
This Power of Attorney must have original corporate seal, and red and blue ACSTAR logo to be valid.
Know all men by these presents: That ACSTAR Insurance Company, a corporation of the State of Illinois, having its
principal office in the City of New Britain, Connecticut, pursuant to the following Resolution, which was adopted by the Board of Directors of the said
Company on June 26, 2003, to wit:
RESOLVED, That the following Rules shall govern the execution for the Company of bonds, undertakings, recognizances, contracts and other writings in the nature
thereof:
(1) That the Chairman, the President, any Vice President and General Counsel, or any Attorney-in-fact, may execute for and on behalf of the Company any and all bonds, under-
takings, recognizances, contracts and other writings in the nature thereof, the same to be attested when necessary by the Corporate Secretary, or any Assistant Corporate
Secretary, and the seal of the Company affixed thereto; and that the Chairman or President may appoint and authorize any other Officer (elected or appointed) of the Company,
and Attorneys-in-Fact to so execute or attest to the execution of all such writings on behalf of the Company and to affix the seai of the Company thereto.
(2) Any such writing executed in accordance with these Rules shall be as binding upon the Company in any case as though signed by the President and attested to by the
Corporate Secretary.
(3) The signature of the Chairman, the President, or a Vice President of the Company may be affixed by facsimile on any power of attorney granted pursuant to this Resolution,
and the signature of a facsimile to any certificate of any such power, and any such power or certificate bearing such facsimile signature and seal shall be valid and binding
on the Company.
(4) Such other Officers of the Company, and Attorneys-in-Fact shall have authority to certify or verify copies of this Resoiution, the By-Laws of the Company, and any affidavit or
record of the Company necessary to the discharge of their duties.
does hereby nominate, constitute and appoint
HENRY W. NOZKO, JR., ROBERT H. FRAZER, DAVID A. PRICE, MICHAEL P. CIFONE, JOAN C. FORTIER, HENRY W. NOZKO III each
individually, its true and lawful Attorney-in-fact, to make, execute, seal and deliver on its behalf, and as its act and deed any and all bonds, under-
takings, recognizances, contracts and other writings in the nature thereof in penalties not exceeding TEN MILLION DOLLARS ($10,000,000.00) each,
and the execution of such writings in pursuance of these presents, shall be as binding upon said Company, as fully and amply, as if they had been
duly executed and acknowledged by the regularly elected officers of the Company at its principal office.
IN WITNESS WHEREOF, Henry W. Nozko, Jr., President, has hereunto subscribed his name and affixed the corporate seal of ACSTAR
Insurance Company this 1 st day of July 2003.
ACSTAR Insurance Company
by
STATE OF CONNECTICUT )
) ss. NEW BRITAIN
COUNTY OF HARTFORD )
On this 1 st day of July 2003, before me, a Notary Public of the State of Connecticut came, Henry W. Nozko, Jr., President of ACSTAR
Insurance Company, to me personally known to be the individual and officer who executed the preceding instrument, and he
acknowledged that he executed the same, and the seal affixed to the preceding instrument is the corporate seal of said Company; that the said
corporate seal and his signatures were duly affixed by the authority and direction of the said corporation, and the Resolution adopted by the Board
of Directors of said Company, referred to in the preceding instrument, is now in force.
IN TESTIMONY WHEREOF, I have hereunto set my hand and affixed my official seal at the City of New Britain the day and year first above
written.
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I, the undersigned, Secretary or Assistant Secretary of ACSTAR Insurance Company, do hereby certify that the original POWER
OF ATTORNEY of which the foregoing is a full, true and correct copy, is in full force and effect.
In witness whereof, I have hereunto subscribed my name as Secretary or Assistant Secretary, and affixed the corporate seal of the
Corporal;on, th;s \ C\ +h day 01 ,".j\ ~ 2005 /t-
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