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ELQ
ECC~I PROPOSAL FOR TOWN OF WAPPINGER UNITED WAPPINGER WATER DISTRICT ROUTE 9 WATER MAIN LOOP CONTRACT NO. 13-010. DIVISION 200 BID FORM PREPARED BY: MORRIS ASSOCIATES ENGINEERING CONSULTANTS, PLLC 9 ELKS LANE POUGHKEEPSIE, NEW YORK 12601 DECEMBER 2013 REVISED FEBRUARY 2014 MA#: W21215.122 ~" TOWN OF WAPPINGER UNITED WAPPINGER WATER DISTRICT ROUTE 9 WATER MAIN LOOP CONTRACT NO. 13-010 BID FORM THE TOWN RESERVES THE RIGHT TO REJECT ANY OR ALL BIDS. EACH BID FORM SHALL BE ACCOMPANIED BY BID SECURITY (AS DESCRIBED IN THE INSTRUCTION ~,,, TO BIDDERS). TO THE TOWN BOARD, TOWN OF WAPPINGER, NEW YORK Pursuant to and in c mpliance with our invitation t bid contained in the Notice to Contractors dated ~ _ ~ , ~. (month) (day) (year the undersigned hereby proposes to furnish all labor, machinery, equipment, facilities, tools, transportation, supplies, materials, insurances, permits, certificates, tests, guarantees, protection of equipment and property and life during construction; as well as competent and qualified supervision for all phases of the work, and other facilities and things necessary or proper for or incidental to, Town of Wappinger Route 9 Water Main Loop, Town of Wappinger, as required by and in strict accordance with the plans, specifications and all other documents relating to Contract No. 13-010, for the prices X11' stipulated and as shown on this bid form. Name of Bidder: (Individual, Partnership,( orpora io or LLC)* * Circle applicable word The undersigned declares that the bidding and contract documents have been carefully examined and that all things necessary for the completion of the work shall be provided. ` Receipt of the following addenda is hereby acknowledged: DATE SIGNATURE ADDENDUM NO. 1 3 al 1 ~.~.-~n.J V~.^~ ADDENDUM NO. 2 ADDENDUM NO. 3 ADDENDUM NO.4 ~. 200 01 e-ldocuments\t wappingerla w20D61w20802 united wapp water1w20602.12 meads rte9 loops filtretion\specslroute 9 loop\general\div 200.doc €: In consideration of, and to induce the award of this contract to him/her, the bidder represents and warrants that: (a) If this bid is accepted by the Town Board, Town of Wappinger, as evidenced by issuance of a Notice of Award by the Owner, and mailed by registered mail with return receipt requested to the address of the bidder as indicated on his/her bid, the bidder will execute a contract on the form of agreement herein provided and will comply with all provisions of said Notice of Award. (b) This bid is made without any understanding, agreement or connection with any other person, firm or corporation making a bid for the same work, and that it is in all respect fair and without collusion or fraud. (c) The bidder has carefully examined and fully understands all of the parts of the contract documents, and that the bidder will execute the contract and will completely perform it in strict accordance with the provisions thereof for the sum set forth on the bid. Unit Prices have been computed in accordance with the Contract Documents. Bidder acknowledges that estimated quantities are not guaranteed, and are solely for the purpose of comparison of Bids, and final payment for all Unit Price Bid items will be based on actual quantities, determined as provided in the Contract Documents. (d) No officer or employee of the Town Board, Town of Wappinger, or any person whose salary is payable in whole or in part by the Town Board is, shall be, or shall become interested directly or indirectly as a contracting party, partner, stockholder, surety or otherwise in this bid or in the performance of the contract or in the supplies, materials or equipment, or to work or labor to which it relates, or in any portion of the profits thereof. (e) The bidder is not in arrears to the Town Board upon debt or contract and is not a defaultefas surety, contractor, or otherwise upon any obligation to the Town Board, Town of Wappinger. (f) All work shall be completed within the time allotted, from the date specified in the Notice to Proceed or set by the contract documents, mailed to the undersigned by registered mail with return receipt requested to the legal address of the bidder as indicated on his/her bid. (g) If the bid documents contain any unlawful provision not an essential part of the bid and which shall not appear to have been a controlling or material inducement to the making thereof, the same shall be deemed of no effect and will upon notice by either the Owner or the bidder be deemed stricken from the bid documents without affecting the binding force of the remainder. a ~. 200 02 e:ldowments\t wappingetla w2008\w20602 united wapp water1w20802.12 meadow_rte9 loops fikration\specsVOUte 9 loop\generalldiv 200.doc "" (h) Each and every provision of any law and clause required by law to be inserted m the bid documents shall be deemed to be inserted herein and the bid documents shall be read and enforced as though it were included herein; ""' and if through mistake or otherwise any such provision is not inserted or is not correctly inserted, then upon the application of either party, the bid documents shall forthwith be physically amended to make such insertion. (i) The bidder is financially solvent and sufficiently experienced and competent to perform the work. (j) The work can be performed as called for by the proposal and that the plans and specifications are in all respects suitable and adequate for the work. (k) The facts stated in his/her bid and the information given by him/her are true and correct in all respects. (I) The bidder is fully informed regarding all the conditions affecting the work to be done and labor and materials to be furnished for the completion of this contract, and that his/her information was secured by personal investigation and research. (m) In the event of a lawsuit, the bidder agrees that said suit shall be filed in the same county as the location of the project. BID FOR CONTRACT WORK: Base Bid Install water distribution improvements and related items in accordance with the Contract Documents. The signatory to this bid, for all work proposed, items furnished and strict compliance with all provisions of each and every Contract Document relating to Contract 13-010, agrees to accept (unless modified pursuant to the terms of the General Conditions) a total, final and fixed contract price not to exceed: ~. ~~£ ~uNO~ ~u6~!( .. _ .~ t+, 3~ q, ~5. oV r', vE ~f~ (Figures) ~~- MAR 81 2014 TOWN OF WAppINGER _m._.~_ TOUI~N CLERK _ .___ _~~ 200 03 ~ai.C,Q25 e:\dowments\t wappingerla w2006\w20802 united wapp water\w20802.12 meadow rte9 loops filtrationlspecs\route 9 loop\generalldiv 200.doc r. ~""' Also made a part of this bid is the attached documentation per Division 100, Article C.3. Sign Bid Here '~`~ `~ ~~~ +r AUTHORIZED SIGNATURE Print Name ~ObQ ~' ~Q Title T `~I~~ Official Company Name ~L ~ ~n~} (f~~l ~C (Individual, Partnership, Corporation, LLC)* '` Circle applicable word Company ~"' Mailing Address U ~~ ~ ~11~ ~ STREET ~~ ~ ~ ~Q N ~/ ~ r~~r~~ CITY STATE ZIP CODE Federal Employer Identification No. ~3~ ~~y ~~1~'. ~. Telephone No. C~I~(~ ~~"I~~ ~~~~Od~~ MAR 31 2014 SOWN OF WAPPINGER T0~1`~N CLERK. d 200 4 ~, e:\documentslt wappinger\a w2008\w20802 united wapp water\w20802.12 meadow rte9 loops filtration\specslroute 9 loop\general\div 200.doc 1 (If bidder is a corporation, fill in the following blanks.) Organized under the laws of the State of: ~~~ Name and Address of President: Name and Address of Secretary: ~Q,r('. ~"{'~ - {~ m~ ~ ~~~ Name and Address of Treasurer:~~,~ r~, ~Y;Q ~- ~~1~, (~~ (If bidder is a Limited Liability Company, fill in the following blanks.) Organized under the laws of the State of: Name of Manager or Managing Member: Agent for Service of Process: Address for Service of Process: 200 05 e:kJocumentsU wappingerle w20081w20802 united wapp wateAw20802.12 meadow_rte9 loops fittration\speakoute 9 loop\generalldiv 200.doc ~. STATE OF NEW YORK ) ss: COUNTY OF ~,~~~~~,r ) 2 s+ On the ,> ~ day of _ ~a~~~r~ , oC01 before me, the undersigned, a Notary Public in and for said State, personally appeared b~r~- personally known to me or proved to me on the basis of satisfactory evidence to be the individual whose name is subscribed to the within instrument and acknowledged to me that he executed the same in his capacity, and that by his signature on the instrument, the individual, or the person upon behalf of which the individual acted, executed the instrument. ~. NOTARY PUBLIC ANDREA ESPINAL Notary Public, State of New York No.01ES6245627 Qualified in Westchester County Commission Expires August 8, 2015 200 06 e:\documentslt wappingerW w20081w20802 united wapp water\w20802.12 meadow Reg loops filtretionlspecslroute 9 loop\general\div 200.doc ~ . .,~~ `~ ~I ~I ~' ~ I ~ ~ I ~~ Q w ~ a ~ 3 ~~ al o 3~ ~ a! ~~ ~~ ~~ e~ O ~ ~ 0 o ~ ~ ~ ~l ~ ~ a ~ ~ ~ d ~ J ~ ~ a ~ ~ ~ ~ ~ o° ~ o ,~° . $ ~° $ 3 °~. ~ o~ ~I ~I Z o f o $ ~ ~ "~ (~ ~ ~ b.. ~ ~~„ '°D O o o ~ c~ .,fl ~ M ~~ ~ ~ ~ ~ In m •- w U ~ > d Z ~ ^ A y n ~ ~ ~' ~ v , ~' ~ 1 Z w ~ 8 ~ ~' ~ ~ 1~ ~ ` , ~ ~ 4 ~ ~ ~ , ~ ~ ~ Xi ~ ~ \ ~ ~ 2 ~ X /C ~ 2 "M ~ ~y,~ ~ ~ ~ u~ ~ W ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ O ~~ , ~~ ~ ~ ~ ~ ~ ~ ~ o S H ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ W W W W W W W W Z ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ W W W W W W W W W ~ (A (n fn fn (A !A (n (A fn to lL LL LL LL LL tL LL LL ~ Z a, a a, d 4. d Q. a a d J J J J J J J J ~ a ? ~ ? ~ ~ ~ ? > > ? z z z z z z z z _ _ J J J ._! 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LL 2 LL lL ~ fn ~ 2 ~~ U U U U J J U J ~ d a U W W W W W W W W W ~ ~ ~p ~ W a z_ z_ z z ~ J ~ J J J J U ~ ~ ~ O ~ N ~ ~ ~ ~ ~ fn (n M (A ~ W~ N N r- J J ~ J O ~ Z U ca ~ N ~ ca c O Q m a ui cOa a > > a~i o ~_ O~ I I Q N I i o 'a Q "r [r U N fn X rn ~ rn •~ ~ a~ ~ X rn o rn ~ ~ Q E m ~ > m ~ U ~ ~ ~ c Q- ~ rn ~> fl- °-'a o ~ rn > n a i~ ~ ~ a~i o O o Z O ~ (p c o o o> c a L a o ~ 0 rn ° ~ ~ C ` (0 ~ - U ~ T - Ua~ U~ UQ °~a~ U~ Uc`~a ~ ~ ~ •` ~ -° W ~ QO = ~ ~ O " a ~ ~ a C ~ c ~ O ~ - ~ r = ~ ~ N (0 O ~ fII O Q ~ tAC.) Q ~ (AU Q Q H ~ U m W Q m Q Q m U ~ ~ ~ o ~ ~ ti ~ rn U O N L a m m fU f6 m O f`') m a 0 0 J m a~ 0 d a c 0 N a m J O o O ~ ~ ;I N o II l6 d N ,~. ~ ~~ ~ Jm i S3 $ i ~ ~ O p ~? ~ ~ 0 ~ ~ ~ ~ ~' ~ ~ W 1~ ~ ~~ /~ 7`l J tl . V 1 W Q ' J p Z 0 m ~ W U ~ Z 'v ~"' ~ i Z i ' ~ ~ ~ J ~ O ~ ~ ~ ~ ~ W F- ~ ~ ~- ~- ~- CA ~z U U U U n- Q~ m m m m ' a U U U U ~ ~ ti ~ J W (~ N ~ Z O I 1 ' d I.L ~_ LL ~, V- Q~ Il. ~ ~ U U to V U (' Q ~ N (n ~ N (n ~ ~ > ~ N ~ ~ fA -p C O W V U~ -a U~ ui U~ cL U (' ~= C Y ~ Q W ~ ~~ ~ o ~ m ~ N W ~ ~ Q V Q V Q o Q~ ~ J Q Q to U ~ N U O a m m L ~_ CO N N f0 m O_ N f6 d c a~ a 0 0 J N 0 U N Q C O (6 LL N Q U~ o~ °o ~~ N o m m N N O O m a a m a~ .~ N O W O >N } O O N a~ rn c 'a a w m E U O v J 1 J BID BOND "" If a bond is used, the form bound in this manual should be used. No other form may be used except with prior approval by the Owner after review by the Town Attorney which approval may be granted or withheld, in the Owner's discretion. • 200 07 e:\dowments\t wappingerla w2006\w20802 united wapp wateAw20802.12 meads rte9 loops Tittration\specsVoute 9 loop\general\div 200.doc wi BID BOND KNOW ALL MEN BY THESE PRESENTS: that as Principal; and ** as Surety, are hereby held and firmly bound unto the Town Board, Town of Wappinger, New York in the amount of: Dollars $ for the payment whereof Principal and Surety bind ourselves, our heirs, executors, administrators, successors and assigns, jointly and severally, firmly by these presents. Signed this day of 20 WHEREAS, the condition of the above obligation is such that, whereas the Principal has submitted to the Town Board a certainbid, attached hereto and hereby made a part hereof, ~,. to enter into a contract in writing for the Water Main Extension to Route 9 Water Main Loop for the Town of Wappinger, New York, as shown and specified in Contract No. 13-010. NOW THEREFORE, (a) If said Bid shall be rejected, or in the alternate (b) If said Bid shall be accepted and the Principal shall execute and deliver a contract in the Form of an Agreement attached hereto (properly completed in accordance with said Bid) and shall in all respects perform the agreement created by the acceptance of said Bid, then this obligation shall be void. Otherwise, the same shall remain in force and effect, it being expressly understood and agreed that the liability of the Surety for any and all claims hereunder shall, in no event, exceed the amount of this obligation as herein stated. The Surety, for value received, hereby stipulates and agrees that the obligations of said Surety and its bond shall in no way be impaired or affected by any extension of the time within which the Principal may accept such bid; and said Surety does hereby waive notice of any such extension. IN WITNESS WHEREOF, the Principal and the Surety have hereunto set their hands and seals, and such of them as are Corporations have caused their Corporate seals to be hereto affixed and these presents to be signed by their proper officers, the day and year first set forth above. (SEAL) PRINCIPAL *Insert Bidder's Name **Insert Surety's Name By 200 08 e:Wocumentslt wappingerla w200t3\w20802 united wapp water\w20802.12 meadow rte9 loops filtration\specsUoute 9 loop\generelldiv 200.doc J fw Signed, sealed and delivered in the presence of (Corporate seal of Contractor if a corporation) Contractor gy By (Title of Officer) (Corporate seal of Surety) Attest ..(Title of Officer) r 200 09 e:\documents\t wappinger\a w2006\w20802 united wapp water\w201302.12 meadow_rte9 loops filtration\specsVOUte 9 looplgenerat\div 200.doc t ~~ ~" STATE OF NEW YORK ) ss: COUNTY OF ) On the day of before me, the undersigned, a Notary Public in and for said State, personally appeared personally known to me or proved to me on the basis of satisfactory evidence to be the individual whose name is subscribed to the within instrument and acknowledged to me that he executed the same in his capacity, and that by his signature on the instrument, the individual, or the person upon behalf of which the individual acted, executed the instrument. NOTARY PUBLIC iAf 20010 i.. e:\documents\t wappinger\a w2008\w20802 united wapp water\w20802.12 meadow rte9 loops filtrationlspecs\route 9 loop\generalkliv 200.doc `' CERTIFICATION OF NON-COLLUSION BY BIDDER No bid will be considered unless this Certification remains attached to and is submitted with the Bid By submission of this bid, each bidder and each person signing on behalf of any bidder certifies, and ,. in the case of a joint bid each party thereto certifies as to its own organization, under penalty of perjury, that to the best of his knowledge and belief: (1) The prices in this bid have been arrived at independently, without collusion, consultation, communication, or agreement for the purpose of restricting competition as to any matter relating to such prices, with any other bidder or with any competitor. (2) Unless otherwise required bylawthe prices which have been quoted in this bid have not knowingly been disclosed by the bidder and will not knowingly be disclosed by the bidder, directly or indirectly, to any other bidder or to any competitor, before the time of the bid opening. (3) No attempt has been made or will be made by the bidder to induce any other person, partnership or corporation to submit or not to submit a bid for the purpose of restricting competition. A bid shall not be considered for award nor shall any award be made where (1) (2) and (3) above have not been complied with; provided however, that if in any case the bidder cannot make the foregoing certification, the bidder shall so state and shall furnish with the bid a signed statement which sets forth in detail the reasons therefore. Where (1) (2) and (3) above have not been complied with, the bid shall not be considered for award nor shall any award be made unless the head of the purchasing unit of the State, public department or agency to which the bid is made, or his designee, determines that such disclosure was not made for the purpose of restricting competition. (4) The fact that a bidder (a) has published price lists, rates, or tariffs, covering items being procured, (b) has informed prospective customers of proposed or pending publication of new or revised price lists for such items, or (c) has sold the same items to other customers at the same prices being bid, does not constitute, without more, a disclosure within the meaning of subparagraph (1). (5) Any bid hereafter made to any public authority or to any official of any public authority created by the State or any political subdivision, by a corporate bidder for work of services performed or to be performed or goods sold or to be sold where competitive bidding is required by statute, rule, regulation, or local law, and where such bid contains rrr the certification referred to in the lead paragraph of this section, shall be deemed to have been authorized by the board of directors of the bidder and such authorization shall be deemed to include the signing and submission of the bid and the inclusion therein of the certificate as to non-collusion as the act and deed of the corporation. I affirm these statements under penalty of perjury. BIDDER'S SIGNATURE: ~~~ ~ DATE: _ ~ ~ 20011 e:\documents\t wappingerla w2008\w20802 united wapp water\w20$02.12 meadow_rte9 loops filtration\specs\route 9 loop\general\div 200.doc . BID BONA KNOW ALL MEN BY THESE PRESENTS: that #~~n% * ELQ Industries, Inc. ** Fidelity and Deposit Company of Maryland aS PnnClpal; and held and firmly bound unto the Town Boar as Surety, are hereby of: ..5°i° of the Bid Amount d, Town of Wappinger, New York in the amount for the payment whereof Principal and oSure ~ bin ~~ administrators, successors and assigns, joint) an tY d ourselves, our heirs, executors, Y d severalty, firmly by these presents. Signed this 31st ` day pf March 20 14 WHEREAS, the condition~of the above obligation is suc submitted to the Town Board a certain bid, attached here o and h hereas the Principal has to enter into a contract in writing for the Water Main Extension t ereby made a part hereof, for the Town of Wappinger, New York, as shown ands ecifi ° Route 9 Water Main Loop p ed m Contract No. 13-010. NOW THEREFORE, (a) If said Bid shall be rejected, or in the alternate (b) If said Bid shall be accepted and the Principal shall ' contract in the Form of an Agreement attached hereto a ~eocute and deliver a accordance with said ( erl B p created b Id) and shall in all respects perforprn the agpeement y the acceptance of said Bid, then this obligation shall be Otherwise, the same shall remain in force and effect, it bein a void. ~' understood and agreed that the liabili hereunder shall, in no event, exceed theof the Surety for any and aA claims stated. amount of this obligation as herein The Surety, for value received, hereby stipulates and agrees that the Surety and its bond shall in no way be impaired or affe within which tfie Principal may accept such bid• cted by any extens9onlof the timd of any such extension. ~ ~ and said Sure e ty does hereby waive notice IN WITNESS WHEREOF, the Principal and the Sure h .seals, and such of them as are Corporations have caused their Co or hereto affixed and these presents to be ~ ave hereunto set their hands and first set forth above. signed by their proper officers the day andtoeae (SEAL) ELQ Industries, Inc. Y ~~;~~ "Insert Bidder's Name PRINCIPAL 0.o1os,-~~ t~ ~~~ ~,~ **Insert Surety's Name g Y Fidelity and Deposit Company of Maryland Emdund J. Bergassi, A orney-In-Fact .:e~sv 200 08 ~' ~PPlnperla W10081~/10802 wiled wapp walarlW20HD2.12 meadow ne9 loops filtretlonlspees4oule 9 I°°P~eralldly z00.doc ~.:: ~~ Signed, sealed and d+ in the presence of (Corporate seal of Contractor if a corporation) t L~ '~nc~oa~n..~.e, Z~` ~~~ Contractor By ey (Title of Officer) (Corporate seal of ~/~ ~ ~ ~~ Surety) Attest (/ _(Title of icer) 200 09 e:Wownwnklt wappinperla w20081W20802 united wapp walerW/10802.12 meadow rte9 loops flluation~speaYoute 9 iooplperxratldiv 200.doc STATE OF NEW YORK ) ss: ;OUNTY OF ~~~TC~ff EJr~ft. ~ On the 3isr day of MArzcN 2oi~ befoneme,the ndersigned, a Notary Public in and for said State, personally appeared ' Rof3ERr" Errt..~ ersonally known to me or proved to me on the basis of satisfactory evidence to be the dividual whose name is subscribed to the within instrument and acknowledged to me that executed the same in his capacity, and that by his signature on the instrument, the dividual, or the person upon behalf of which the individual acted, executed the ~trument. . ~ NOTARY PUBLIC DEBRA A. TORINO Notary Public State of New Yak No. O1~f06035062 Qualified in Putnam Cou~r~tyy Commission Expires December 20, 2t?l~ .~. 200 70 e:ldocumentslt wappingerla w20081u20802 united wapp water1w20802.12 meadow rte9 loops filtrationlspecs~route 9 looplgeneralldiv 200.doc ~-. .. Consent of Surety The Fidelity & Deposit Company Of Maryland a corporation organized and existing under the laws of the State of MD, hereby guarantees the proposal of ELQ INDUSTRIES, INC., 567 Fifth Avenue, New Rochelle. NY 10801 (hereinafter called the bidder), To Town Of Wappinger, NY For Route 9 Water Main Loop. Contract No. 13-010 And further guarantees that if the contract is so awarded to the said ELQ INDUSTRIES, INC., that the said Fidelitv 8~ Deposit Company Of Maryland, will execute said contract within the period of time required after its delivery for that purpose; and further guarantees that if the contract is so awarded to the said ELQ INDUSTRIES, INC., that Fidelity & Deposit Company Of Maryland will become surety on bond guaranteeing the faithful performance of said contract. Provided and subject to the condition precedent: The surety reserves the right to require evidence of financing, and, to review and approve contract documents and bond forms, prior to issuing any performance and payment bonds on the above captioned project. *THIS OFFER WILL EXPIRE (60) DAYS FROM THE DATE OF EXECUTION* In Witness Whereof, the said Fidelity & Deposit Company Of Maryland has caused this agreement to be signed by proper officers and its corporate seal to be here unto affixed this 31 st day of March , 2014. Fidelitv & Deposit Company Of Maryland r Edmund J. Ber assi, Attorney-in-Fact ACKNOWLEDGEMENT OF PRINCIPAL, IF A CORPORATION STATE OF ~ ~ W ~°~" ) ss: COUNTY OF ~,(~eTcN E:St~ On the 3~ g day of Ni~el~ in the year'~l `~ ,before me personally came Ro13EiZ1" EtiK.~ to me known, who, being by me duly sworn, did depose and say that the resides at N1~M^Rar4Ec;k , ~y that he/she is the {~sipEr~Cf of ELQ INDUSTRIES, INC. ,the corporation described in and which executed the above instrument; and that he/she signed her/his name thereto by order of the Board of Directors of said corporation. DEBRA A. TUFtiNO lt,Q~-~-Gt.~-~[t-Kew"-~ Notary Public, State vi NewYO~k Notary Public No. O1T06~)35062 Qualified in Putr7am Commission Expires DecembK2 .2017 ACKNOWLEDGEMENT OF PRINCIPAL, IF A PARTNERSHIP STATE OF ) ss: COUNTY OF On the day of in the year ,before me personally came to me known and known to me to be a member of the firm , described in and who executed the foregoing instrument, and he/she duly acknowledged to me that he/she executed the same for and in behalf of said firm for the uses and purpose mentioned therein. Notary Public ACKNOWLEDGEMENT OF PRINCIPAL, IF AN INDIVIDUAL STATE OF ) ss: COUNTY OF On the day of in the year ,before me personally came to me known and known to me to be the person described in and who executed the foregoing instrument, and he/she duly acknowledged to me that he/she executed the same. Notary Public ~~ ACKNOWLEDGEMENT OF SURETY STATE OF NEW YORK COUNTY OF WESTCHESTER) ss; On the 31st day of March in the year 2014 ,before me personally came Edmund J. Bergassi to me known, who, being by me duly sworn, did depose and say that he/she resides at New Rochelle , NY ,that he/she is the Attorney-in-Fact of Fidelity & Deposit Company Of Maryland ,the corporation described in and which executed the above instrument; and that he/she signed her/his name thereto by order of the Board of Directors of said corporation. ~~ Notary Public __.___.,,.,..e.ww a ~ t„ ~ l L: k ~f ~s'6~ { :~, ~ r Z,a~;~53°~ ~e FIDELITY AND DEPOSIT COMPANY OF MARYLAND 600 Red Brook Blvd., Suite 600, Owings Mills, MD 21117 Statement of Financial Condition As Of December 3l, 2013 ASSETS Bonds ............................................................................................................................................... $ 139,272,722 Stocks .............................................................................................................................................. 22,258,887 Cash and Short Term Investments ................................................................................................... 6,595,113 Reinsurance Recoverable ................................................................................................................ 17,970,134 Other Accounts Receivable ............................................................................................................. 33,409,916 ToTALADMIITI;DAssL'•TS .........................................................................................................$ 219,506,772 ~~ LIABILITIES, SURPLUS AND OTHER FUNDS Reserve for Taxes and Expenses ................................................................. ......... $ 1,787,480 ........................... Ceded Reinsurance Premiums Payable ............................................................................................ 42,]46,005 Securities Lending Collateral Liabi]ity ............................................................................................ 6,613,750 TOTAL LIABII.I'fIES .................................................................................................................... $ 50,547,235 Capital Stock, Paid Up ......................................................................................... $ 5,000,000 Sutplus ................................................................................................................. 163,959,537 Surplus as regards Policyholders ..................................................................................................... 168,959,537 TOTAL ........................................................................................................................................ $ 219,506,772 Securities carried at $58,378,690 in the above statement are deposited with various states as t~equired bylaw. Securities carried on the basis prescribed by the National Association of Insurance Commissioners. On the basis of market quotations for all bonds and stocks owned, the Company's total admitted assets at December 31, 2013 would be $223,222,696 and surplus as regards policyholders $172,675,461. 1, DENNIS F. KERRIGAN, Corporate Secretary of the FiDEL1TY AND DEPOSIT COMPANY of MARYLAND, do hereby certify that the foregoing statement is a con~ct exhibit o e assets and IiabiIities of the said Company on the 31st day of December, 2013. Secretary State of Illinois City of Schaumburg SS: Subscribed quid s~vom to, before me, a Notary Public ofthe State of Illinois, in die City of Schaumburg, this i Sth day of March, 2014. ((~ u U Notary Public V oF~tciAt. st:At. DARRYL JOINER Notary Public • State of Illinois My Commission Expires May 3, 2014 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 GEOFFREY DELISIO, 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 Edmund J. BERGASSI, Wendy COSTANTINO and Margaret BERGASSI, all of New Rochelle, New York, 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 7th day of May, A.D. 2013. ATTEST: ZURICH AMERICAN INSURANCE COMPANY COLONIAL AMERICAN CASUALTY AND SURETY COMPANY FIDELTIY AND DEPOSIT COMPANY OF MARYLAND ,a '4 c+~Myy Ewa ova+~~ ; ~~~ ~G~ is w. tb ti ~ a , vi ? c°'~r°ryp •tiPCa's ~~: SEAL ~ ~ `~`~-~-° ... ~ teM =u ;'O5 ~' ~ 6 \~ 100! .+: ~~ ~ 4 one 9r ~ ••~»...%~~~ Assistant Secretary Eric D. Barnes Vice President Geoffrey Delisio State of Maryland City of Baltimore On this 7th day of May, A.D. 2013, before the subscriber, a Notary Public of the State of Maryland, duly commissioned and qualified, GEOFFREY DELISIO, 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 helshe 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 ``~~~nurrq~?i ttt.1,~,?,, ~<~ ~ c i €" ~~i.a ~ f . icy+., ~ Maria D. Adamski, Notary Public My Commission Expires: July 8, 2015 POA-F 093-76906 EXTRACT FROM BY-LAWS OF THE COMPANIES "Article V, Section 8, Attornevs-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 TESTIMONY WHEREOF, I have hereunto subscribed my name and affixed the corporate seals of the said Companies, this ~~ay of March , 20~.• y-~+w 'wo ocroj~~ ;~'~ ~~~'~i W~4y! ~ bi ~ W i • ~t+4 ,~ _ ~, ;~~ SEAL ~,~• tie ~~~~~,~ '"' ttP ~/CG ~~%~ Thomas O. McClellan, Vice President