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Drilling Technologyl~~rlL~S e~ hno%9u~ 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 it 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). BID FORM TO THE TOWN BOARD, TOWN OF WAPPINGER, NEW YORK Pursuant to and in ompli ce with your invitation to id contained in the Notice to Contractors dated Olr ~ rr~ _, ~ t ~ , (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 stipulated and as shown on this bid form. Name of Bidder: ~ - ~ -'-'~ (Individual, Part rship Corporation r LLC)* * Circle applica a wor 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. TOWN OF WAPPINGER UNITED WAPPINGER WATER DISTRICT ROUTE 9 WATER MAIN LOOP CONTRACT NO. 13-010 Receipt of the following addenda is hereby acknowledged: DATE SIGNATURE ADDENDUM NO. 1 ~ f ~~~~r~ ~~~ ADDENDUM NO. 2 -:~:- . . ADDENDUM NO. 3 ADDENDUM N0.4 200 01 e \documents\t wappinger\a w21J081w20ti02 united wapp water1w20802.12 meadow_rte9 loops filtration\specsVoute 9 loop\general\div 200.doc J J ilw ~•• 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 defaultef as 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. i`" 200 02 e:\dowments\t wappinger\a w2008\w20802 united wapp water\w20802.12 meadow rte9 loops filtrationlspecslroute 9 loop\general\div 200.doc J (h) Each and every provision of any law and clause required by law to be inserted in 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: ~r / ~ o,v~, rra~ i ivn/ ~~ /~i1nlo~ru~ S~v ~ 2~ ~~t 7~~J~a~~/eNa~ fi~iv~~ (Words) ran/ ~~~~~• (Figures) W ~~~~~~~ W MAR 31 2014 1 TOWN OF WAPPINGER ~' 200 03 TOWN CLERK e:\documentslt wappinger\a v/1006\w20802 united wapp water\w20802.12 meadow rte9 loops filtration\specsVoute 91oop\generalldiv 200.doc l ~• Also made a part of this bid is the attached documentation per Division 100, Article C.3. Sign Bid Here ,,, AU HORIZED SIGNATURE Print Name M ~Cha~,1 f~QTT~~/~ Title V, f-'" Official Company Name ~rl ~ ~ ~ ~ ~~C~" 11~/ O P.,~P ~~ (individual, Partn hip, orporation, LC)'~ " Circle applicable wo Company 1 Mailing Address STREET ~ orK % ~q~ ,,, CITY STATE ZIP CODE Federal Employer D ~ , ~~, / ~ Q l Identification No. `t . `~ rw Telephone No. l ~ 1 ~ .~j o ~p " ~ `-'~~p lnjCCG'[~~M[D `' MAR 31 2014 :TOWN OF WAppINGER TOWN CLERK I. ... 200 4 e:klocuments\t wappinger\a w2008\w20802 united wapp water\w20802.12 meadow_rte9 loops fittrationlspecs\route 9 looplgeneralkiiv 200.doc i (If bidder is a corporation, fill in the following blanks.) w Or anized under the laws of the State of: 1~- e~W 1 0 I' t~ 9 Name and redress of President: Name and Address of Secretary: rl Name and Address of Treasurer: ~ l n/~~/ Y~-k ia~9~ ++hew~ ,/ew ark la 195 ~+h~.ws (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:\documents\t wappingeRa w2o06\w20t302 united vrapp wateRw20H02.12 meads Reg loops filtration\specs\route 9 Iooplgenerel\div 2o0.doc STATE OF NEW YORK ) ss: COUNTY OF ~e~~S~ air ) On the ~! day of I `+\~~~ ~ ,v~a!~ beforeme,the undersigned, a Notary Public in and for said State, personally appeared ~ +C~'~ ~ -f-f ~¢,ws 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. ALYSIA D. MILLER Notary Public, State of NY No. 01M16217955 nComfmission Expi es 2!221- NOTARY PUBLIC s 200 06 e:kJocuments\t wappinger\a w2006\w20802 united wapp water\w20802. t2 meadow_rte9 loops filtretion\specsVoute 9 loop\generel\div 200.doc o ~W s ~ ~ ~ o Jb /` ~ 9 g ~ ~ ~, @ ~ ~ ~ ~ ~ ~ Q Q ~' ~ ~ ~ ysT~ `~ \ ~ ~ ~ ` ~ ~ ~ -` ~ l ~ V V V ~ 'v t ~ '\. ~ ~ ~ ~. ~ u' ~ ~ ~ _ ~ ~ ~ e ~, ~ e e ~ g ~~ ~ ~ g ~~ '~ g `~_ ~ o z o S ~1 ~. ~ ~.. ~ O~ ~ ~ ~ Q ~ ~ ~ ~ O ~ ~ ~ ~ ~ te ~ ~ e. ~- W ~ ~ ~ ~ ~ +~ ~ ~ ~ ~ o- ;~ ~ + ~ 6 U Z ~ ~ h ~ ~ ~ `~ ? ~ ~ ~ ~ ~ ~ ~ ~ Q ~ ~ ~ ,, ~ ~ ~ ~ ~ ~ ~ ~~ ~ ~ ~ a ~ ~ r i ~ l~ 3 i ~+ ~S ~ ~ ~ ~ ~ ~ Z ~''- . f- Z ~ ~ ~ ~ ~ ~ ~ > ~ > ~ > ~ > ~ > ~ ~ ~ ~ W W W w W W W W W W W W W W W w W f" ~? to a (A a cn a cA a (n a fn a fA a. (n a (n a Cn s LL . l i t i_ I i t i_ L L L. t i d > J > J _ J ~ J ~ J ~ J > J > J > J > J Z Z Z Z Z Z Z Z J J J J J J J ...! F- ~- ~~ Q Z Q Z Q Z Q Z Q Z Q Z Q Z Q Z Q Z Q Z l1) N ~ N f~ M t0 ~' M M O r M fM O 0 Z O rn ~ O C O o O C ~ L C ~ L ~ ~ ` ~ N ~ d U O ~ ° U ~ U ~ c ~ aoi ~ ~ ~ - ~ ~ - m ~ ~ °' o U -a ~ w p ~ ~ o U o U ~ o o 0 o m 0 ° a~Y 0 0 c 3 o ~ o ~ o ~ o ~ o U ~ 3 m w O O ~ O c w Q ~ w o ~' ~~ ~ ca ~ o N _ °~ W m~ W~ F- c ~ O c ' O~ _c Q Y C O H U ~ Y Z .N N ~ t6 ~ y= ~ O O O ~ ~ ~ O N Q U_ •~ >+..... N O ~ O O N ~ O ~ Q = 0 p~ = O L ~ ~ ~ ~ (p O ~ Y N L ~ • ~ C CO C C cO C W l_ ~ ~ Q m (n ~ ~ ~ d cn ~ F'tn ~ ~~ U ~ ~ ~H .. ° .. ° °d0 ° ao 00 Q r m r ci r o ~- u.i ~- ii r c~ r _ r r -; r Q oo N cv N o N ui N ii N ~ N _ A U lY! I1 O a L ~N (~, ~_ `"' Ln ~AX~~ N f6 m V ~ y la O ~T T Q 0 0 J m 0 Q 0 y Q 0 Q° J o~ o ~~ CV o m a~ N ~ Q ~ 8 ~ ~ ~ g ~ ~ ~ (~. ~ ~ O `n ~` ~` ~` ~ ~` 1 ' '` ~ ~, V V ~ O ` W a~ c g ~ ~ ~ ~ ~_ 8 ~ ~ ~ ~ s 8, ~ o Z --= - - ~- cc~ `~ ~ `~ ~ ~ ~ W ~ . ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~~~ ~ U a z ~ ~ ~ w '~ G , ~ ~g 1n "`C ~ ~ ~ ~ _ ' O Z tL ~ ~ 1- ~~ ~i ~ o ~ o O ~ o ~,;, O W ~ 2 2 = 2 ~ lWi ~ IWL = ~ tiJ ~ IWi ~ Cn ~ ~ ~ ~ ~ 2 Q= U W U W U W U W J Z J Z U W J Z J W d j d j m j U W a J J J J J J U J ~ ~ W C~ O O `_ r `- OO N ~ N ~ N ~ ~ ~ T- O O (!1 _I (!1 J C'7 ~ Cn J ~ Z ~ U ~ ~ ~ N m ~ c a o~ ~ 4. ~ a~ m ~ rn ~ ~ a a ~ m a o {,C U W ~' ~ N > ~ X om rn ,~ ~ rn .~ d ~ ° cn x cm 0 _c _a c_ _a w ~ ~ ~ ~ ; m ~ N ~° > c~ W O ~ (0 ~ ~ ~ C ,, ~ W Q ~ ~ L ~ ~ ~' Q ~ Q ~ Q ~ ~ ~ ~ ~ Q ~ ~ ~ ~ Q ~ Q Q ~ V / ~ ~ .~ ~ O ~ L 0 O 0 `r Z w O //~~~ V ~ ~T T Q N ~ Q. ~ ~ O Q ~ ~ ~ ~ 0 ~ ~ Q C O N U Q ~ O 0 O ~ U ~ L~ /O~ ~ U ~ ~ +r ~ Q ~ (Q I..I~ V ~ ~~ '~ ~ Q L r ~ /~~ l9 ~~ / VJ U \ ~ Q \ 11 ~ J ~ ~ / ~ ~ V/ U ~ ~ ~ ~ ~ O ~ ~ ~ m W M m ¢ ~Q m U ~ ~ ~ ti ~ rn o 0 U ~~~ O d d ~. t ;O 4 m ~y. W O Vi m_ N m cfl 0 0 0 N w L ... ~o O M ~ U t0 F.. C o $~LU = Q No ' Q IY~ m J C W 'cv N ~ m N cu o~ N 0 V Ylr Qm ~ ~ ~ ~ °o ~w o ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~, ~ ttj ~` ~'-' Kl `~ W y w ~ g ~ g mo , m w ~ ~ ~ ~ U d Z ~ ~ ~ p ,rte ~ (~ ~ ~ ~ 7 ~ ~ ~ • `~ 'V/ H ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ W H , ~ ~ ~ } CA Ol ~j ~ ~ ~ U m U m U m U m ~ `~-- ~ U U U U ~ ~~ r~ ~ u~ ~ cV ~ r. ~ ~ ~ ~ W C~ c ~~ Z p ~ ~ ~` ~ - ~ ~ U W a~i ~ u"i c ~~ i a ~> " p ~a~°i c ~~:~ D ~ ~ ~ ~~ ~ ~ ~~ ~ Z Z i ~ ,~ f6 ~ (3 C U (' ~ U ~ Q V' W ~ ~ ~ o QU 00 QU om Q o o~ Q~ tvn ~ ~~ ©~ Q Q m U D cv d ~{ J U m~ a' '~. a r- m d N lC m O O O N N O C7D O N 0 N d rn 'a a m c a~ E U O II7 L w ~ 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. t 200 07 e:\documentslt wappingerla w200t3\w20802 united wapp water\w20ti02.12 meadow_rte9 loops filtration\specslroute 9 loop\general\div 200.doc i KNOW ALL MEN BY THESE PRESENTS: that as Principal; and E *'` as Surety, are hereby BID BOND 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 severalty, 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 certain bid, 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:\documentsu wappingerla w20081w20802 united wapp water1w20802.12 meads rte9 loops fittrationlspecslroule 9 Iooplgeneralldiv 200.doc rr w. Signed, sealed and delivered in the presence of (Corporate seal of Contractor ~ if a corporation) .. Contractor By By (Title of Officer) (Corporate seal of Surety) Attest (Title of Officer) 200 09 e:ldocumentslt wappingerla w20061w20802 united wapp water\w20802.12 meadow rte9 loops fittrationlspecslroute 9 looplgeneralldiv 200.doc 1` it ~" STATE OF NEW YORK ) ss: a COUNTY OF ~e+~sS~,la~r---) ~ On the O~ 7 ~ day of I '' \GZ r(i~ ,O7~j`t before me, the undersigned, a Notary Public in and for said State, personally appeared iCh (L ~ ~~~,wS x. . 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 it 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. ALYSIA 0. MILLER Notary Public, State of NY No. 01 M16217955 ./\ Qualified in Rensselaer Coun l~ Commission Expires 2/221 NOTARY PUBLIC ~: rrr ... 20010 e:ldocuments\t wappinger\a w2008\w20802 united wapp water\w20802.12 meadow rte9 loops filtration\specs\route 9 loop\generalkiiv 200.doc W CERTIFICATION OF NON-COLLUSION BY BIDDER No bid will be con s 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. (Z) Unless otherwise required bylaw the 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) (Z) 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) (Z) 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 ~" 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 irr certificate as to non-collusion as the act and deed of the corporation. I affirm these statements under penalty of perj ry. / ,,(~ BIDDER'S SIGNATURE: V.1?DATE: 3~ao ~r ~ ~11 r ~ 12C r+/o l09 ~~P,,s, z~NC . 9 Zoo„ e:\documents\t wappinger\a w2008\w20802 united wapp water\w20802.12 meadow_rte9 loops filtration\specs\route 9 ~ loop\generalkJiv 200.doc . B1D B©ND KNOW ALL MEN BY THESE PRESENTS: that * Drilling Technologies, Inc. as Principal; and ** International Fidelity Insurance Company as Surety, are hereby held and firmly bound unto the Town Board, Town of 1Nappinger, New York in the amount of: Five Percent of Bid Dollars ~ 5x of Bid 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 28th day of march 2014 WHEREAS, the condition of the above obligation is such that, whereas the Principal has submitted to the Town Board acertain-bid, 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. 13-01 a. NOW THEREFORE, {a} if said Bid shall be rejected, or in the alternate {b} If said Bid shah 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 shah 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) 'Insert Bidder's Name **lnsert Surety's Name By PRINCIPAL Zaa as e:tdocvmentatt waPP~t'taiertn w''O09tw20dD2 talitCd w2pp wafeiiw2pgp2f 2 ttte3f7t)w flt39 mops filtrationlspecsVpttg 81oop~generall~v 20U.tbc Signed, sealed and delivered in the presence of (Corporate seal of Contractor if a corporation} Drilling Technologies, Inc. By Contractor International Fidelity Insurance Company By Gail D Valentino, Attorney-In-Fact (Title of Officer) (Corporate seal of Surety} Attest (Title of Officer) 200 09 e:Woa.xn•nTSit weppinperla w20061wZQ802 united wapp wateriw2t)902.12 meadav_tte9loops fihntion\specsYoute 91oop18enetaRdiv 2ft0.doc STATE OF NEW YORK ) ss: COUNTY OF 12~~JsS+~.IGd~t'' ) On the ~ day of oj~,(before me, the ~ N~U Y"G undersigned, a Notary Public in and for said State, personally appeared /~ i!'~^~~ ~ /~(a~-ff~~,~/.~ 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. AIYSIA,D. MILLER Notary Public. State of NY No. 01 M16217955 Q amm ss on Expo es 21221 .,, zoo ~a R~ NOTARY PUBLiC e:ldocumertts~t'wappingeria w20081w20802 united wapp watertw2p802.12 meadow rte9 {cops filtrationlspecslroute 8 looplgenera-ktiv 2QO.doc ~,., . STATE OF NEW YORK ) ss: GOUNTY OF SCHENECTADY ) On the 28th day of March , 2014 before me, the undersigned, a Notary Public in and for said State, personally appeared Gail n. valentine 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. KIMBERLY S. SYLV,ESTER Notary Public, State of New York No. 01 SY6089309 Qualified in Schenectady County Commission Expires March 24, 20 .a, 200 70 e:\documentslt wappingerla w2DO81w20802 united wapp watertw20802.12 meadow rte9 loops filtrationlspecslraute 9 loop\generalldiv 200.doc ;. _ n T,~ . t],.., c~V _ ~ -Tel (s73~ 62a-7200 f ~~ ~~ i~ l ~ r~G i (NTERNATIC?NAL, ~'IIZELITY INSURANCE CpMPANY ALLEGFIENY CASUALTY COMP,4NY ONE NEWARK CENTER, 20TH FLOOR NEWARK, NEW JERSEY 07102-5207 KNOW ALL MEN BY THESE PRESENTS: That INTEI2NA1'IONAL FIDELITY WSURANCE .COMPANY , a corporation organized and existing under the laws of the State of New Jersey, and: ALLEGHENY CASUALTY. COMPANY a corporation organized and existing under thelaws of the State of Pennsylvania, having .their prihapal office in the City of Newark; New Jersey, do hereby constitute and appoint _ _ _ CATHERINE T. BAZYCKI, GAIL D.'VALENTINO, J. CARLOS VIANA, JEANNE M. MALOY Glenville, NY. their true and lawful attomey(s}-in-fact to execute, seal and deliver for and on its behalf as surety, any and all bonds and undertakings; contracts of indemnity. and other writings obligatory in the nature thereof, which are or may be allowed, required or permitted by law, statute rule, reggulation, contract or otherwise and the execution of such instrument(s) in ursuance of these presents, shaFl be as binding upon the said INTERNATIONAL FIDELITY INSURANCC` COMPANY and ALLEGHENY CASUALTY COMPANY, as fully and amply, to all .intents and purposes; as if the same had been duly executed and acknowledged by their regularly elected officers at their principal offices.. This Power of Attorney is executed, and may be revoked, pursuant. to and byy authority of the B -Laws of INTERNATIONAL FIDELITY .INSURANCE. COMPANY and ALLEGHENY CASUALTY COMPANY and is granted under and by authon of the foAowing resolution adopted by the Board of Directors of INTERNATIONAL FIDELITY INSURANCE COMPANY at a meeting duly held on the 20th dayofJuly; 2010 and by the Board of Directors of ALLEGHENY CASUALTY COMPANY at a meeting duly held on the 15th day of August, 2000: "RESOLVED, that (1 }the President, Vice President Executive Vice President or Secretary of the Corporation shall have the power to appoint, and to revoke the appointments of, Attorneys-in-Fact or agents with power and authority as defined or limited in their respective powers of a omey, an • to execute on behalf of the Corporation and affix the Corporation's seal thereto, bonds, undertakings, recognizances, :.contracts. of indemnittyy and other wntten obligatforts in the nature thereof or related thereto• and (2) any such Officers of the Corporation may appoint and revoke the appointments of Joint-control custodians, aggents for acceptance of process, and Attorneys-in-fact with authority to execute waivers and consents' on behalf of the Corporation;. and (3) the signature of any such Officer of the Corporation and the Corporation's seal may 6e affixed by facsimile to any power of attorney yr ce ification groen or the executiop of any bond, undertaking; recogn¢ance, contract of indemnity or other wntten obli atlon rn the nature thereof or related thereto; such signature and seals when so used whether. heretofore or hereafter, being hereby adopted by the corporation as the original .signature of such officer and the original seal of the :Corporation, to be valid and .binding upon the Corporation with the same force and effect as though. manually affixed." IN WITNESS WHEREOF, INTERNATIONAt FIDELITY .INSURANCE COMPANY and ALLEGHENY_CASUALTY COMPANY have each executed and attested these presents on this 12th day of March, 2012. ~~~~~ ~ STATE OF NEW JERSEY .ti ~aSU~~Py. G~ ~~~~~ County of Essex ~~~ `~~' ~'-o ~, ~~ai ~ ~'" ~ ' 193 ~ ~` f~ ROBERT W: MINSTER ~~~ ~, ~~ Executive Vice President~Chief 0 crating Clfficer 'bYLUpt'~ti~ (International Fidelity Insurance Gompanyj and President (Allegheny Casualty Company) On this 12th day of March 2012, before me came the individual who executed the preceding instrument, to me personallyknown, and, being by me duly sworn, said he is the therein described and authorized officerof 1NTERNATIONAC 'FIDELITY° INSURANCE COMPANY and ALLEGHENY CASUALTY. COMPANY ; that the seals .affixed to said instrument are the Corporate Seals of said Companies; that the said Corporate Seals. and his signature were duly affixed by order of the Boards of Directors of said Companies. IN TESTIMONY WHEREOF; I have hereunto set m hand affixed my Official Seal, at the City of Newark, New Jersey the day and year first above written, MARQ ~ NOTARY ~ ~ ~ '~ PUBLIG ' '* 'k A NOTARY PUBLIC OF NEW JERSEY ~ ~-L My Commission: Expires Nov. 21, 2015 ~JEas CERTIFICATION I, the undersigned officer of INTERNATIONAL FIDELITY INSURANCE COMPANY and ALLEGHENY CASUALTY COMPANY do hereby certify thatl have compared the foregoing copy of the Power of Attorney and affidavit; and the copy of the Sections of the By-Laws of said Companies as set forth in said Power of Attorney; with the originals on file In the home office of said companies, and that the same. are correct transcripts thereof, and of the whole of the said originals, and that: the said Power of Attorney has not been revoked and is now in fuh force and effect. IN TESTIMONY WHEREOF, I have hereunto sei my hand this 28th. day of March, 2©14 ~~`or~L-~'_ ' MARIA BFtANGO, Assist2int S~etetary _. ,. , INTERNATIONAL FIDELITY INSURANCE COMPANY ONE NEWARK CENTER, 20Tri FLOOR, NEWARK, NEW JERSEY 07102-5207 STATEMENT OF ASSETS, LIABILITIES, SURPLUS AND OTHER FUNDS AT DECEMBER 31, 2013 ASSETS Bonds (Amortized Value) ..................................... $31,509,516 Preferred Stocks (Market Value) ................................ 50Q000 Common Stocks (Market Value) ................................ 72,911,462 Mortgage Loans on Real Estate ................................. 1,647,030 Cash, Bank Deposits & Short Term Invesmnents ..................... 93,684,839 Other Invested Assets ....................................... 315,354 Unpaid Premiums S: Assumed Balances .......................... 11,732,240 Reinsurance Recoverable from Reinsurers ......................... 2,478,315 Electronic Data Processing Equipment ............................ 219,074 lnvestment Income Due and Accrued ............................ 319,691 Net Deferred Tax Assets ..................................... 5,399,057 Health Care and Other Amounts Receivable ...................... 26,890 Receivables h•om Parent, Subsidiaries d: Affiliates ................... 387,293 Other Assets .............................................. 12,158,440 TOTAL ASSETS ................................... $233,292,201 LIABILITIES, SURPLUS S OTHER FUNDS Losses (Reported Losses Net as to Reinsurance Ceded and hncurred But Not Reported Losses) .............................. $5,552,28"1 Reirnsur~-nrue Payable on Paicl Losses and Loss Adjustrnent Expenses ...... 4,143,085 Loss Adjustment Expenses .................................... 4,346,188 Commissions Payable, Contingent Commissions & Other Similar Charges .. 5,653,297 Other Expenses (Excluding Taxes, Licenses and Fees) ................. 5,787,847 Taxes, Licenses S Fees (Excludung Federal Income Tax) ............... 473,850 Current Federal and Foreign lncomc Taxes ........................ 417,364 Unearned Premiums ........................................ 35,500,215 Dividends Declared & Unpaid: Policyholders ....................... 922,379 Ceded Reinsurance Premiums Payable ........................... 4,167,182 Funds I]eld b}~ Company under Reinsurance Treaties ................. 1,037 Amounts Withheld by Company for Account of Others ............... 59,435,171 Provision Ior Reinsurance ..................................... 2,667 Payable to Parent, Subsidiaries and Affiliates ....................... 104,335 Other Liabilities ........................................... 4,975 TOTAL LIABILITIES ............................ $126.511.867 Common Capital Stock ....................................... $1,500,000 Gross Paid-in d; Contributed Surplus ............................. 374,600 Surplus Notes ........................................... 16,000,000 Unassigned Funds (Surplus) ................................... 92,680,339 Less: Treasury Stock at cost (83,880 shares conunon) (value incl. $45.) ..... 3,774,600 Surplus as Regards Policyholders ................... $106,780,339 TOTAL LIABILITIES, SURPLUS & OTHER FUNDS ...... $233?92.200 I, Francis L. Mitterhoff, President of INTERNATIONAL FIDELITY INSURANCE COMPANY, certify that the foregoing is a fair statement of Assets, LiabIlities, Surplus and Other Funds of this Company, at the close of business, December 31, 2013, as reflected by its books and records and as reported in its statement on file with the Insurance Deparhnent of the State of Ne~~ Jersey. ~~p6tlTY ~NSG IN TESTIMONY 1NHEREOF, I have set my hand and affixed the o ~'~ SEA~~ m seal of tlne Compare}~, this 25t~~ da}~ of February, 2014. r y 1904, ~ INTERNATIONAL FIDELITY INSURANCE COMPANY ~d''fNl *E ~~~ /f ~i~.~' '' y ,:.