Casale Construction Services Inc.
+t _ __,
TOWN OF WAPPINGER
UNITED'VYAppINGER WATER DIS RICT SAN ~ ~ Zv'3 !
WATER MAIN EXTENSION TO NY pip
CONTRACT NO. 12-007 r~~'~'~ ~~ '.r~. ~:;
~ ~~' ` 1
.. _ fj.4.
BID FORM
THE TOWN RESERVES THE RIGHT TO REJECTANY 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 compliance with your invitation to bid contained in the Natice to
Contractors dated ~~~ ~_ ~o-~_
(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 fife during construction; as well as
competent and qualified supervision for all phases of the work, and other facilities and
things necessary or proper far or incidental to, Town of Wappinger Water Main Extension
to NYCDEP Project, Town of Wappinger, as required by and in strict accordance with the
plans, specifications and all other documents refacing to Contract No. T2-007, for the prices
stipulated and as shown on this bid form.
Name of Bidder:
-~f'~lC~d1 J~r'VI C.f',5 , .~,,~ .
(Individual, Partnership, Corporation or LLC}~
* Circle applicable word
The undersigned declares that the bidding and contract documents have been carefully
examined and that alf things necessary for the completion of the work shall be provided.
Receipt of the following addenda is hereby acknowledged:
DATE
ADDENDUM NO. 1 ~ ~ i3
ADDENDUM NO.2 - I ~
ADDENDUM NO, 3
ADDENDUM N0.4
200 02
~ _ ._ r
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 accepfed 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 ail respect fair and without collusion or fraud.
(c) He/She has carefully examined and fully understands all of the parts of the
contract documents, and that he/she will execute the contract and will
completely pertorrn it in strict accordance with the provisions thereof far 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 contractor in the supplies, materials or equipment, or to
work or labor to which it relates, or in any portion of the profits thereof.
(e) He/She is not in arrears to the Town Board upon debt or contract and is not
a defaulter as surety, contractor, or otherwise upon any obligation to the
Town Board, Town of Wappinger.
(f) AI[ 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.
200 03
(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) That he/she is financially solvent and sufficiently experienced and competent
to perform the work.
Q) The work can be performed as called for by the proposal and that the plans
and specifications are in al( respects suitable and adequate for the work.
{k) That the facts stated in his/her bid and the information given by him/her are
true and correct in ail respects.
(I} That he/she 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 shalt be filed in the
same federal district or 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, not including Bid Alternates No. 1, Na .2 and No. 3. 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 12-007, agrees to accept (unless modified
pursuant to the terms of the General Conditions) a total, final and fixed con#ract price not to
exceed:
(Words) ~-}'11'~e `'1 G~~'~C~ -~
~ s~~~e~a dvllu~,~
(Figures)
200 04
I
. ~
~ r
Alternate Bid
Install wafer distribution improvements and related items in accordance with the Contract
Documents, including Bid Alternates No. 1, No. 2 and No. 3. The signatory to this bid, for
alt work proposed, items furnished and strict compliance with all provisions of each and
every Contract Document relating to Contract 12-007, agrees to accept (unless modified
pursuant to the terms of the General Conditions) a total, final and fixed contract price not to
exceed:
you ~c._. M ~ I I ~ ~ ~ h u ~ ~ re cl S~ v-e ~ ~ve.. ~-h c~u~ c~ h ~
~ ~ d re ~ v~. ~~,
(W r )
~ 5 ~ ~ . D~
,(Figures}
~ '
i' -
Also made a part of this bjd'is the , efed cu ntati per Division 100, Article C.3.
~. Sign Bid H e `~
TH ZED SIGNATURE --
Print a ~ h~s!QS t,a5~l,~(
Title U Y f ~. ~~~,i~~
Official Company Name ~U~ rued' ~, ~c
(Individual, Partnership, orporation, LC}~
" Circle applicable wor
Company
Mailing Address .5S/ ,' ,~~
STREET
CITY ST TE ZfP CODE
Federal Employer
Identification No. j ~ - / 7~ ~ f~~.,j
Telephone No. ~/~~~~~- 0~~~
I
a r ,
(!f bidder is a corporation, fill in the following blanks.)
Organized under the laws of the State of:
Name and Address of President:~~en ~ !S~-/ and .n ~, ,, ~~,~~
Name and Address ofSecretary:~~„ (14t~~~~ ~ ~~.,~ ~~„,~~~
Name and Address of Treasurer:~,~, , ~, ~s~,(, S ~ ~ M„ „ ~
(ff 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 6
.,
~ r ~ ,
STATE OF NEW YORK )
COUNTY QF .R ,, , ss:
On the ,~~~ day of ~~.~,,~ ~,~i ~ ,before me, the
undersigned, a Notary Public in and for said State, personalty appeared
C.bcrl~~~~1 e
personally known to me or proved to me an the basis of satisfactory evidence to be the
individual whose name is subscribed to the within instrument and acknawtedged 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.
KRISTINA iN. GROSS
~Mry Nob01 GR61382 N8 w York
1"Ped in Rensselaer County J
~41~mission Expires December 18, 20.,L,,,
200 7
ITEM NO./DESCRIPTION
1A. Mobilization
1 B. Bonds
1C. Insurance
1 D. Permits
1 E. Photographic Documents
1 F. Submittals
1 G. Temporary Construction
Services
1 H. Survey and Construction
Layout
1 L Close Out Documentation
1J. Demobilization
2A. 12" Main Town Road
2B. 12" Main Off Road
2C. 12° Main Off Road
County R.O.W.
2D. 12" Main K-Crete with
Insulation
2E. 8" DI Main Town Road
2F. 8" DI Main Off Road
2G. 14" HDPE Bored Water
Main
BASE BID SHEET
NYCDEP Water Main. Extension -Contract 12-007
EST. PAYMENT UNfT PRICE BID
(.2TY• UNIT _ WRITTEN AMOUNT fN FIGURES
N/A LUMP SUM
N/A LUMP SUM X1'1 i vL
N/A LUMP SUM
N/A
LUMP SUM r
lva-tno~~~nq ~uC.
N/A
LUMP SUM r
twPn v~e
N/A
LUMP SUM V
SQ/:e~ ~'1~~.~lir,q'
G/ -i
N/A LUMP SUM fP~ ~h ot~s a»o/
rs
N/A LUMP SUM fiw-en~,J ~~~
NIA LUMP SUM ~i~e ~hou3and
N/A LUMP SUM ~~~~ -t-l'70U,~and
3,950
LINEAL FEET r
OnP hunCYP
l qYS
8,310 LINEAL FEET vhf, n n
~r~C/
`
4,540 ~~ y1GlhCJ~P(~'
LINEAL FEET Q1~~V1 G~0 /~q `~
230 LI ~~ Ui'lCIY~~
~ 7D, ~~
TOTAL
PR[CE BlD
~~~
D~C~- OZ~
~gz,~ov, o0
~`3 l ~OC~ < ~d
77l ~oG, a0
NEAL FEET ~ ~D .~~/~~, aQ
Gib q rl 7
70 LINEAL FEET ~'!,{,Yj h 1~ ~ 2 /~Ob~, ~ a
100 LINEAL FEET P huh IMP ~ / /
o ur~ClF'~ ! I IDO,bC.~
1400 LINEAL FEET
. ,
E:ldocumentslT Wa 200 07A
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ITEM NO./DESCRIPTION.
2H. 14n HDPE Bored Water
Main Through Rock
21. 14" HDPE Water Main
CHG&E Areas
3A. 12" Ga#e Valves
3B. 8" Gate Valves
4A. Hydrants
4B. Sampling Stations
5A. 3/." Corporation Stops,
Curb Stops, Valve Boxes
and Couplings
5B. '/" Copper Piping -
Paved Areas
5C. 3/" Copper Piping -
Unpaved Areas
5D 1"Corporation Stops,
Curb Stops, Valve Boxes
and Couplings
5E. 1" Copper Piping -
Paved Areas
5F. 1" Capper Piping -
Unpaved Areas
5G 2" Corporation Stops,
Curb Stops, Valve Boxes
and Couplings
5H. 2" Copper Piping -
Unpaved Areas
BASE B{D SHEET
NYC DEP Water Main Extension -Contract 12-007
EST. PAYMENT UNIT PRICE BfD
QTY• UNIT WRITTEN AMOUNT IN FIGURES
540 LINEAL FEET ~~Q, h ~n ri°C
~7D
Ob
~~
,
650 LINEAL FEET h~ ~d y~q
~r.~j--~ db11Q~ i~ 7~ bC
61 EACH ~ 7UV5 0~~~
v
OU
9 EACH ~
h1~r un r~~ (o ~ oQ
49 EACH dur o~J~G
. n Y ~~ ~d
1 EACH
71 I EACH
390 ~ LINEAL FEET
585
34
~r°~ d~~ ~re~, a boo, o
Vr l'i Lt n~i~~CJ
F~-~i~~cly~~~-~ ~~5~ OU
/~r~~~~I~i1q~S
J 7, n0
LINEAL FEET ~l>I,l ~~ b ~ (,a ~ ~~ Q~
EACH ~~(~~' I~.U/1~~~C1 ~~r~ a~
U ~~ ~
240 LINEAL FEET ~l~j~J y~G~l ~Y,~ gU ~ ri~
250 L{NEAL FEET I~V~ ~U~ ~ qv~
~w~-t~o>)s ~~~
1 EACH 1 ~ h {~~I~t°~
15 LINEAL FEET ~ ~O,I ~`,~
~ , ~Q
TOTAL
PRICE BID
~07~'oC, ~
J~~~, ~
~~2.5-c~S~ ,
~yd, bQ
~3o3bd, 00
~~ O~
~~ ~D~ DD
a~ ~~, o~
~ ~o~ ~d,
i 9a oo, ~b
~~~,b0
~c~v,a~ ~~,~v
U`v~Uo ~oJVV
E:ldocuments\T Wappingerla W20121W21215 NYCDEP ExtensionlSpecslGeneraflbaseOd~sh~eet~ ddenduml.doc
~• ~ ~ ~~r- water Mam Extensl
ITEM NO./DESCRIPTION QTY. PAYMENT
UNIT WRIT
6 Testing Services L.S. LUMP SUM ~ e ~
7 Road, Drainage and
Miscellaneous Improve. L.S. LUMP SUM d~
8 Rock Removal 1400 CUBIC YARD ~
SA. Removal of Trees 12" up
to 24" in diameter 40 EACH 1,1
9B. Removal of Trees 24"
and above in diameter 40 EACH ~/,~
9C. Protection of Trees 160 EACH
10 Clearing of Trees and ~ ~~
Brush in Off-Road Areas L-S~ LUMP SUM ~.
11. Exp{oratory Excavations 10 EACH
ALLOWANCES
1A Allowance: Select Fill -
Crusher Run 17Q0 CUBIC YARD
1 B Allowance: Select Fifl -
'
Controlled Density Fi[I ! 00 CUBIC YARD
1 C Allowance: Select Fill -
Run of Bank Gravel 800 CUBIC YARD ' - "`'
1 D AAowance: Select Fill -
Select Graded Gravel 800 CUBIC YARD
2 Misc. Additional Work L.S. LUMP SUM
u ~
i.. tli'
,
c P'
2
~ ii iP~;. 4~' .
~
14.
e :~
~ -
. ... .. .. ..._. r
.. ,
~ :~~ r.. ~
~}
e ~
,
Tl=A1 ennn~ ~r.~r .
gall U ~
!~
/C
r~
u
~r
,-,
J 200 07C
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BASE BiD SHEET
..
.~
ALTERNATE BID SHEET
NYCDEP Water Main Extension -Contract 12-007
EST. PAYMENT UNIT PRICE BID
ITEM NO./DESCRIPTION QTY. UNIT WRITTEN AMOUNT IN F IGURES TOTAL
1A.
Mobilization
N/A
LUMP SUM
I ~U,lC{~ PRICE BfD
1 B. Bonds N/A LUMP SUM ~'VJ l ~~~ ~ ' ~
1C. Insurance
NIA
LUMP SUM ~
~ L~~h ~
1 D. Permits NIA LUMP SUM O th ZJ.~ Gh
" ` ~ ~~ ` L
1E.
Photographic Documents
N/A
LUMP SUM r y
n
v ~-~
1F. Submittals
N/A
LUMP SUM ~ ~`~
~Yf ~ ~U .1qh ' ~ U.
1 G.
Temporary Construction
Services
NIA
LUMP SUM
~
Y1~dU~1~(~` O
'
(~
1H. Survey and Construction /~~~ ~~ ~ D
Layout
1 I
Cl
O NIA LUMP SUM ~I~S q l ~'~ ~~ ~/~~J ~~
J C~ b~
.
ose
ut Documentation NIA LUMP SUM ye U ~~
1 J. Demobilization
"
N/A
LUMP SUM
V-~ U?A-S'G 1~ ~
~- ~r~` ~ ~5~
2A. 12
Main Town Road 4,030 LINEAL FEET hC ~~ ~ D
ny~
2B. 12" Main Off Road
2
"
8,050
LINEAL FEET
DY1e ~~~ C/ ~ o
~ f
$~C~
C. 12
Main Off Road 4,540 d ~ Yl U, hC~l'eC~
County R.O.W.
" LINEAL FEET ~`~1~.Q ~ ~O''~,~~ / ~/'~` Q `l ~~/ ~~~/
(J (J
2D. 12
Main K-Crete with
Insulation 410 LINEAL FEET ~~~ h ~~.
H' j~ /h~ //ll ) n ~~~ ` ~O
~ ~/ ~" fJV ~/
2E. 8" DI Main Town Road 70 LINEAL FEET
2F. 8" DI Main Off Road g0 LINEAL FEET Yl d Y~ " p
2G. 14" HDPE Bored Water / U~ v ~ lC~~q~i ~~'
Main 1400 LINEAL FEET J/C ~a~~qv ~ ~O/ ~/~
v ~01'`l GD(J, G~
E:ldocumentslT Wappinger\a W2012\W21215 NYCDEP Extension\Specs\General\altbidash~ee4t Addenduml.doc
k
ITEM NO./DESCRIPTION
2H. 14" HDPE Bored Water
Main Through Rock
2i. 14n HDPE Water Main
CHG&E Areas
3A. 12" Gate Valves
3B. 8" Gate Valves
4A. Hydrants
4B. Sampling Stations
5A. ~/" Corporation Stops,
Curb Stops, Valve Boxes
and Couplings
5B. 3/" Copper Piping -
Paved Areas
5C. 3/" Capper Piping -
Unpaved Areas
5D 1" Corporation Stops,
Curb Stops, Valve Boxes
and Couplings
5E. 1"Copper Piping -
Paved Areas
5F. 1"Copper Piping -
Unpaved Areas
5G 2" Corporation Stops,
Curb Stops, Valve Boxes
and Couplings
5H. 2" Copper Piping -
Unpaved Areas
ALTERNATE BID SHEET
NYCDEP Water Main Extension -Contract 12-007
EST. PAYMENT UNIT PRICE Blb
QTY UNIT WRITTEN AMOUNT IN FIGURES
540 LINEAL FEET n) /-e h u ~tC~r~e
620
59
8
49
1
71
310
585
36
240
250
1
15
LINEAL FEET ~ ~ r?cyr~
-e ~ l~ , ~b
EACH f -tht;llsa~~
EACH ~ h~ n ~ re 9'
EACH Fvur D Yep r~~~
EACH -_ t5~DU5.an~/ ~ _. - - -
EACH ~ ~Y Ytd r ~%
I~Q (GQ~
~ ~a~a -
y~~, ~~
LINEAL FEET S~ V.~ ~~~ ~IQI ~q~ I ~ G~
LINEAL FEET TUU1~ CIO) ~ Q r~
;~O
EACH ~~~" hu~~lr~~/"
~°olCa~'J
~~'~C'
LINEAL FEET ~ ~~/l qy,~ ~ ~ , nD
LINEAL FEET V,P ~~l'~~S ,~- ~/!
~ V
~~IOtJ~sG~~
TOTAL
PRICE BID
9 7310, t~~
~~~i~~
a~3a3(~, ter
c~s,0 v
~~ y0, od
~~~ ~ O
l9z G~~' O~
~03~, ~ ~
EACH ~ ~ U ~~ ~ ~ O O?~~ OO ~ ~~
LINEAL FEET ~ ~v/~ qyS ~~ ' oi-1 /ACV ~ DO
E:\documentslT Wappingerla W20121W29215 NYCDEP ExtensionlSpecslGenerailaltbi 00 0 A dendumi.doc
ITEM NO./DESCRIPTION
51. 1" HDPE Piping -
Unpaved Areas
6 Testing Services
7 Road, Drainage and
Miscellaneous Improve.
8 Rock Removal
9A. Removal of Trees 12" up
to 24" in diameter
9B. Removal of Trees 24"
and above in diameter
9C. Protection of frees
10 Clearing of Trees and
Brush in Off-Road Areas
11. Exploratory Excavations
ALLOWANCES
1A Allowance: Select Fill -
Crusher Run
1 B Allowance: Select Fill -
Controlled Density Fill
1 C Allowance: Select Filf -
Run of Bank Gravel
1 D Allowance: Select Fill -
Select Graded Gravel
2 Misc. Additional Work
ALTERNATE BID SHEET
NYCDEP Water Main Extension -Contract 12-007
EST. PAYMENT UNIT PRICE BfD
QTY. UNIT WRITTEN AMOUNT IN FIGURES
200 LINEAL FEET !'~ !Y~ h~
~v
L.S. LUMP SUMLUMP SUM
~ ~ ~ ~
~ , vn
L.S. LUMP SUM ~ ~~/ l ~ ~~ ~ 1 ~U
1400 CUBIC YARD ht,C
~
~
~
40 EACH ~~-~ Y7 ~ j'C~/ L /
"~~
~~
~
40 EACH ~/ FLU l? C1 Y~~
160
EACH QT'S
h }') ClY~ ~/
L.S.
LUMP SUM v
~ u~ d ~
//11
~Z ~OV ~ o~
10 EACH ~~ h u>7 cfY-~d . ., ,->, ,.
--- ___
1700 CUBIC YARD V~C
jj~~ Y
100 CUBIC YARD "~'t~ ~~ ~~
800 I CUBIC YARD C~~ f1 liC„
800 CUBIC YARD 1Z~Y7. ~~j 1i-e
~~
L.S. LUMP SUM
ToTA~
PRICE BID
. D C~
. Q~
'7 100 , ~
~DOO~, t~~
l3~ DDU - DQ
~~, p ~~ ~(~, ~~
I ~U~ E~~
~~, C~0 ~0~ ~ bo
--- $150, 000
TOTAL ALT.
Bio: ~0~75 q~7, ~
•
E:klocuments\T Wappingerla W20121W21215 NYCDEP Extension~ecslGeneratlaltti OshOeeOt q dendumi.doc
.
~.~
~ --- r
C 1 ~=: 111 1
,,~~ r~
t _... F `°
BID BOND ~ -~~~~~ ~~~
_ .3 `
KNOW ALL MEN BY THESE PRESENTS: that
551 Main Avenue
* Casale Construction Services, Inc. Wynantskill, NY 12198 as Principal; and
e ey ee
** Liberty Mutual Insurance Company Boston, MA 02116
as Surety, are hereby
held and firmly bound unto the Town Board, Town of Wappinger, New York in the amount
of: Five Percent of Arrgunt Bid Dollars $ ----5%----
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 22nd day of _ January 2013
WHEREAS, the condition of the above obiigation 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 NYCDEP for the Town of
Wappinger, New York, as shown and specified in Contract No. 12-007.
NOW THEREFORE,
(a) If said Bid sha(I 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 pertorm the agreement
created by the acceptance of said Bid, then this obligation shall be void.
Othenrvise, 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 aff[xed and these presents to be si d by eir proper offrcers, the day and year
first set forth above.
(SEAL) Ca e Cori ucti on Series _ r r,~
*Insert Bidder`s Name
**Insert Surety's Name ( /,EKar~fes Casale, ~i~e~PrEesident
200 09
Signed, sealed and d
in the presence of
NoMry pubnN eM. QROSS
ste of New York
1138218
'Se~ae- Cou
~Cember f 9,~~
(Corporate seal of Contractor ~-, ~ //-~
if a corporation) ~ 1.~k5~:}~'U1~~-~viC@.~,~
~,r
,.t ~ ,
l 4.~L~~ ~. ~1C7,t.~..wL
By ~~ ~c~.
Dawn J. Riley,
of Officer)
(Corporate seal of
Surety) Attest ~ Fower of Attorney
(Title of Officer}
2D0 09 0
Liberty Mutual Insurance Ca'rpany '
1 ~~ ~ ~
STATE OF NEW YORK -)
ss: -
COUNTY OF Rensselaer 1
On the 22nd day of January , 2013 ,before me, the
undersigned, a Notary Public in and for said State, personally appeared Charles Casale
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.
2x01 ~
Notary Publ!c, State of New York
Qualified in ensselaer County
Commission Expires December 19, 20.
~ .~~ ~
Surety Acknowledgement
State of New York
County of Albany
On this ~~ day of January
Dawn J. Riley
sworn, did depose and. say that he resides in
Albany, New York
that he
is the Attorney-in-Fact of the Liberty Mutual Insurance Comoanv ,the corporation described
in and which executed the foregoing instrument; that he knows the Seal of said corporation; that one of
the Seals affixed to the foregoing instrument is such Seal; that it was so affixed by order of the Board of
Directors of said corporation; and that he signed his name thereto by Like order.
DONNA L. 8HARPE
Notary Public, State of New York
~uatitied in Schenectady County
No. 4850071
Commissbn Expires Jsnwry 19, ~ l
,~ ~ 5~~~~
Notary Public
2t)13 ,before me personally came
to me known, who being by me duly
My commission expires
~ A Ji r ,
.,:~
l ~ ~ ~a
Assets
LIBERTY MUTUAL INSURANCE COMPANY
FINANCIAL STATEMENT -DECEMBER 31, 2011
Cash and Bank Deposits ......................................... $ 696,606,839
*Bonds - U. S Government ..................................... 910,151, 865
*Other Bonds ............................................................ 11,794,792,561
*Stocks ..................................................................... 8,216,137,875
Real Estate .............................................................. 268,420,606
Agents' Balances or Uncollected Premiums........... 3,191,269,641
Accrued Interest and Rents ..................................... 151,164,670
Other Admitted Assets ............................................ 12,166.299 092
Total Admitted Assets ..................................... $37.394 R43,149
Liabilities
Unearned Premiums .............................................. .. $3,762,485,913
Reserve for Claims and Claims Expense .............. .. 15,817,904,502
Funds Held Under Reinsurance Treaties ............... .. 1,249,980,610
Reserve for Dividends to Policyholders
.................
Additional Statutory Reserve . 4,656,284
.................................
Reserve for Commissions, Taxes and . 77,791,575
Other Liabilities ............................................... . 2 885,589 205
Total ............................................................
Special Sur
lus Fu
d . $23,798,408,089
p
n
s ................. $1,036,917,657
Capital Stock ............................... 10,000,000
Paid in Surplus ............................ 7,732,061,653
Unassigned Surplus ..................... 4,817,455,750
Surplus to Policyholders ............................... 13,596,435,060
Total Liabilities and Surplus ................................ ~ 7.i94 R43,149
P~' iNS(~~
J~GORQ Uk4 ~yn
~ ~`' 18"i2 FQ n *Bonds are stated at amortized or investment value; Stocks at Association Market Values.
a~~~s ~~ ti~y~~b The foregoing financial information is taken from Liberty Mutual Insurance Company's financial
>> ~,~ statement filed with the state of Massachusetts Department of Insurance.
I, T[M MIKOLAJEWSKI, Assistant Secretary of Liberty Mutual Insurance Company, do hereby certify that the foregoing is a true, and
correct statement of the Assets and Liabilities of said Corporation, as of December 31, 2011, to the best of my knowledge and belief.
IN WITNESS WHEREOF, 1 have hereunto set my hand and affixed the seal of said Corporation at Seattle, Washington, this 5th day of
April, 2012.
Assistant Secretary
5-1262LMIC/a 4/12
THt~ POWER dF~A~`f~R~lE1r: IS NOT•VALID UNLESS IT IS PRINTED ON RED BACKGROUND. 1 0 ((~~
This Power of Attorney limits the acts of those named herein, and they have no authority to bind the Company except in the ma S I ~ 8 ~ the
extent herein stated.
LIBERTY MUTUAL INSURANCE COMPANY
BOSTON, MASSACHUSETTS
POWER OF ATTORNEY
KNOW ALL PERSONS BY THESE PRESENTS: That Liberty Mutual Insurance Company (the "Company"), a Massachusetts stock insurance company,
pursuant to and by authority of the By-law and Authorization hereinafter set forth, does hereby name, constitute and appoint GUY ALONGE, III,
RICHARD W. MAHLSTEDT, DONNA L. SHARPE, CHRISTOPHER J. KNAUF, DAWN J. RILEY, ALL OF THE CITY OF ALBANY, STATE OF NEW YORK .......................
.......
...........................................................................................................................................................................................................
each individually if there be more than one named, its true and lawful attorney-in-fact to make, execute, seal, acknowledge and deliver, for and on its
behalf as surety and as its act and deed, any and all undertakings, bonds, recognizances and other surety obligations in the penal sum not exceeding
THIRTY MILLION AND 00/100:..»+,..:.«« .....................:.........:.....»......,,..:....,............
execution of such undertakings, bonds, recognizances and other surety obligations, in puDrsuanAe of these p esents,*shall»be as binding•upon the Company
as if they had been duly signed by the president and attested by the secretary of the Company in their own proper persons.
That this power is made and executed pursuant to and by authority of the following 8y-law and Authorization:
ARTICLE XIII -Execution of Contracts: Section 5. Surety Bonds and Undertakings.
Any officer of the Company authorized for that purpose in writing by the chairman or the president, and subject to such limitations as the 'OC
chairman or the president may prescribe, shall appoint such attorneys-in-fact, as may be necessary to act in behalf of the Company to make, N
execute, seal, acknowledge and deliver as surety any and all undertakings, bonds, recognizances and other surety obligations. Such attorneys- d
in-fact, subject to the limitations set forth in their respective powers of attorney, shall have full power to bind the Company by their signature and =
execution of any such instruments and to attach thereto the seal of the Company. When so executed such instruments shall be as binding as if
signed by the president and attested by the secretary. rn
3
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By the following instrument the chairman or the president has authorized the officer or other official named therein to appoint attorneys-in-fact: ~
C
Pursuant to Article XIII, Section 5 of the By-Laws, David M. Carey, Assistant Secretary of Liberty Mutual Insurance Company, is hereby authorize
to appoint such attorneys-in-fact as may be necessary to act in behalf of the Company to make, execute, seal, acknowledge and deliver as curet
any and all undertakings, bonds, recognizances and other surety obligations.
That the By-law and the Authorization set forth above are true copies thereof and are now in full force and effect.
IN WITNESS WHEREOF, this Power ofAttorney has been subscribed by an authorized officer or official of the Company and the corporate seal of Liberty
Mutual Insurance Company has been affixed thereto in Plymouth Meeting, Pennsylvania this day of 31st day of January
2ot2
LIBERTY MUTUAL INSURANCE COMPANY
By
COMMONWEALTH OF PENNSYLVANIA ss David M. Carey, sistant Secretary
COUNTY OF MONTGOMERY
On this 3tst day of January 2ot2 ,before me, a Nota Public, y __'
acknowledged that he is an Assistant Secretary of Liberty Mutual Insurance Company; that he knows the sea of sDaid orporat on Vand that he executed
the above Power of Attorney and affixed the corporate seal of Liberty Mutual Insurance Company thereto with the authority and at the direction of said
corporation.
IN TESTIMONY WHEREOF,-I -have hereunto subscribed my name and affixed my notarial seal at Plymouth Meeting, Pennsylvania, on the day and year
first above written.
l _. B ~ /G Q% L~ct a/
Y
CERTIFICATE Teresa Pastella, Notary Public
I, the undersigned, Assistant Secretarsr of Liberty Mutual Insurance Company, do hereby certify that the original power of attorney of which the foregoing is
a full, true and correct copy, is in~fuit force and effect on the date of this certificate; and I do further certifythat the officer or official who executed the said
power of attorney is an Assistant Secretary specially authorized by the chairman or the president to appoint attorneys-in-fact as provided in Article XIII,
Section 5 of the By-laws of Liberty Mutual Insurance Company.
This certificate and the above power of attorney may be signed by facsimile or mechanically reproduced signatures under and by authority of the following
vote of the board of directors of Liberty Mutual Insurance Company at a meeting duly called and held on the 12th day of March, 1980.
VOTED that the facsimile or mechanically reproduced signature of any assistant secretary of the company, wherever appearing upon a certified
copy of any power of attorney issued by the company in connection with surety bonds, shall be valid and binding upon tha company with the
same force and effect as though manually affixed.
IN TESTIMONY WHEREOF, I have hereunto subscribed my name and affixed the corporate seal of the said company, this 22nd day of
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Gregory W. Davenport, Assistant Secretary
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CERTIFICATION OF NON-COLLUSIO BY BID[3 '~ ~ 2013
,~"' No bid will be considered unless this Certification remains attache iQ~ut~1~~d ~ e~id
TC~1~~~~~ ~.'I...~~t~
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 bylaw the prices which have been quoted in this bid have not
,-w.~- 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
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 sig ~ g and submission of the bid and the inclusion therein of the
certificate as to -col sion as a act and deed of the corporation.
affirm these stateme sand e lty of p jury.
,,,,,,, BIDDER'S SIGNAT RE: ~n"^ ~, DATE: 1 02.1 /
% eS C~ Q~
200 12