Marjani BuildersCITY OF ROSEMEAD
ROSEMEAD COMMUNITY RECREATION CENTER INTERIOR
RENOVATION PROJECT
PROJECT No. 31004
BIDDER: 1 M 1 kfAA11 6U/L,0 P
CONTRACT BID FORMS
TABLE OF CONTENTS
SECTION 1 BID SCHEDULE ............... ...............................
SECTION 2 BID DATA FORMS ............ ...............................
2.A BID BOND ......................... ...............................
2.13 LIST OF PROPOSED SUBCONTRACTORS..
SECTION 3 NON - COLLUSION AFFIDAVIT........
1
...........................5
...........................6
...........................7
10
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SECTION 1- BID
SCHEDULE
_l
BIDDER:
BID SCHEDULE
SCHEDULE OF PRICES FOR
ROSEMEAD COMMUNITY RECREATION CENTER
INTERIOR RENOVATION PROJECT
PROJECT No. 31004
BASE BID SCHEDULE
NO.
ITEM DESCRIPTION
UNIT OF
MEASU
RE
EST.
QTY.
UNIT
PRICE
ITEM
COST
1
General Conditions
LS
1
43= 60
2
Disposal of Waste Materials
LS
1
k!jjCW , dd
3
Restroom Removal & Replacement
LS
1
Lnmo , w
4
Flooring
LS
1
12, 000.00
5
Painting
LS
1
A116W . 00
6
HVAC Work
LS
1
304 cm. 00
7
Electrical work
LS
1
3 - 75 r 000. 00
8
Sitework
LS
1
'Cj 000.00
9
Acoustical Panels
LS
1
t 3').000.00
TOTAL BASE BID PRICE (SCHEDULE BID PRICE):$ -0 OOO _ W
Dollar amount in written form
ALTERNATE BID ITEM 1
NO.
ITEM DESCRIPTION
UNIT.OF
MEASURE
EST.
QTY.
UNIT
PRICE
ITEM
COST
10
Removal of flooring & base and
LS
1
replacement with Linoleum
flooring & 6" rubber base for
dD
Multi- purpose Room 1 (Room
I^^O
W
107). Repaint all wall surfaces,
soffit, doors and ceiling surfaces,
etc.
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TOTAL ALTERNATE BID ITEM #1 PRICE
BIDDER: �A�fAAI! 81-11
Dollar amount fn written form
ALTERNATE BID ITEM 2
NO.
ITEM DESCRIPTION
UNIT OF
MEASURE
EST.
QTY.
UNIT
PRICE
ITEM
COST
11
Removal of flooring & base and
LS
1
replacement with Linoleum
flooring & 6" rubber base for
Multi- purpose Room 2 (Room
102). Repaint all wall surfaces,
soffit, doors and ceiling surfaces
TOTAL ALTERNATE BID ITEM #2 PRICE
$ 2 OW. 00
0
form
TOTAL BASE BID PRICE INCLUDING ALTERNATE BID ITEM #1 & #2 $ (07h400 o 00
Dollar amount in written form
Note: The City of Rosemead reserves the right to reduce or increase the quantities of any items in
the schedule of bid items above, within the limits define in Section 3 -2.2.1 of the Standard
Specifications, to stay within the budgeted amount of this project.
If the Bid Documents specify alternate bid items, the following Alternate Bid amounts shall
be added to or deducted from the Total Bid Price entered above. The owner can choose to
include one or more of the alternates in the Total Bid Price of the Project. If any of the
Alternate Bids are utilized by the Owner, the resulting amount shall be considered the Total
Bid Price for the Project.
The undersigned agrees that these Contract Bid Forms constitute a firm offer to the Owner which
cannot be withdrawn for the number of Working Days indicated in the Notice Inviting Bids from and
after the bid opening date, or until a Contract for the Work is fully executed by the Owner and a third
party, whichever is earlier. The undersigned also agrees that if there is a discrepancy between the
written amount of the Bid Price and the numerical amount of the Bid Price, the written amount shall
govern.
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BIDDER: 11 *tf�N 1 Cj211"
Attached hereto is a certified check, a cashier's check or a bid bond in the amount of
Io Z Dollars ($ said amount being not less than ten percent (10 %) of the Total
Bid Pri e. The undersigned agrees that said amount shall be retained by the Owner if, upon award,
we fail or refuse to execute the Contract and furnish the required bonds, certificates and
endorsements of insurance and other certifications within the time provided.
If awarded a Contract, the undersigned agrees to execute the formal Contract, which will be
prepared by the Owner for execution, within five (5) Calendar Days following the Letter of Award for
the Contract, and will deliver to the Owner within that same period the necessary original Certificates
of Insurance, Endorsements of Insurance, Performance Bond, Payment Bond and all other
documentation and certification required by the Contract.
The undersigned offers and agrees that if this bid is accepted, it will assign to the purchasing body
all rights, title, and interest in and to all causes of action it may have under Section 4 of the Clayton
Act (15 U.S.C. Section 15) or under the Cartwright Act (Chapter 2 of Part 2 of Division 7 of the
Business and Professional Code), arising from purchases of goods, materials or services by the
Bidder for sale to the purchasing body pursuant to the bid.. Such assignment shall be made and
become effective at the time the purchasing body tenders final payment to he Contractor.
Bidder understands and agrees that,.when requested by Owner, he shall provide: (1) evidence
satisfactory to the Owner of Bidder's California contractors license(s) in good standing; (2) evidence
that the person signing this Bid is authorized to bind Bidder to this Bid and to a contract resulting
therefrom; and (3) any other information and documentation, financial or otherwise, needed by
Owner to award a Contract to the lowest responsible and responsive bidder.
Bidder understands and agrees that liquidated damages shall apply to this Contract in the amounts
of five hundred dollars ($500.00) if project is not completed in one hundred twenty (120) calendar
Documents.
Bidder acknowledges that data submitted with its Contract Bid Forms which it requires to be
incorporated into a Contract arising out of this Submittal has been so identified by Bidder. Bidder
further acknowledges that the Owner may, at its discretion, incorporate any of the remaining data
submitted herewith into a contract arising out of this Bid.
The undersigned acknowledges receipt, understanding and full consideration of the following
addenda to the Contract Documents.
Addenda Nos. Nn f (l� l *p"(j doACd gpVjj 1
The Bidder understands and agrees that the Total Bid Price is inclusive of all labor, materials, and
equipment or supplies necessary to complete the Work as described in the Bid Documents. If this
bid is accepted, the undersigned Bidder agrees to enter into and execute the Contract with the
necessary bonds and accept the Total Bid Price as compensation in full for all Work under the
contract.
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BIDDER: &TRN/ Aulz6foox
By: -
Signature
AL6,xgNDGR A. MAK ANI
Type or Print Name
Title
Bidder's /Contractor's State of Incorporation:
Partners or Joint Venturers:
2 -4 41 Rd , - VCA<) A- 1 4A.g
Business Street Address
M4.rlon aej 44 9269
City, State and Zao Code
949.305. o993
Telephone Number
Bidder's License Number(s):
NOTES:
1)
2)
3)
96712-8
By its signature on this Bid, the Bidder certifies under penalty of perjury the accuracy of the
representations made on the Contract Bid Forms.
If Bidder is a corporation, enter State of Incorporation in addition to Business Address
If Bidder is a partnership or joint venture, give full names of all partners or joint
venturers.
As further discussed in the Instructions to Bidders, Bidder will be
required to provide evidence that the person signing on behalf of the
corporation, partnership or joint venture has the authority to do so.
CBF -4
BIDDER: /'Y,#R A1-11LGl
SECTION 2
BID DATA FORMS
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BIDDER: /V '6L1l1-o �
Bidder shall submit its Bid data in accordance with the format shown on each of the following Bid
Data Forms. Bidders shall prepare and use as many sheets as are necessary to adequately
provide the information required. Bidder shall ensure that every page of its Bid Data Forms are
properly identified with the Bidder's name and page number.
2.A BID BOND
KNOW ALL MEN BY THESE PRESENTS:
THAT
Principal, and
as
, as Surety, are held firmly bound unto the
CITY OF ROSEMEAD (hereinafter called the OWNER) in the sum of
DOLLARS
($ ), being not less than ten percent (10 %) of the Total
Bid Price; for the payment of which sum will and truly to be made, we bind
ourselves, our heirs, executors, administrators, successors, and assigns, jointly and
severally, firmly by these presents.
WHEREAS, said Principal has submitted a bid to the OWNER to perform all Work
required for the Rosemead Community Recreation Center Interior Renovation
Project as set forth in the Notice Inviting Bids and accompanying Bid Documents,
dated
NOW, THEREFORE, if said Principal is awarded a Contract for the Work by the
OWNER and, within the time and in the manner required by the above- referenced
Bid Documents, enters into the written form of Contract bound with said Bid
Documents, furnishes the required bonds (one to guarantee faithful performance
and the other to guarantee payment for labor and materials) furnishes the required
insurance certificates and endorsements, and furnishes any other certifications as
may be required by the Contract, then this obligation shall be null and void;
otherwise it shall remain in full force and effect. In the event suit is brought upon
this bond by the OWNER and judgment is recovered, said Surety shall pay all costs
incurred by the OWNER in such suit, including reasonable attorneys' fees to be fixed
by the court.
SIGNED AND SEALED, this day of , 20
Principal
By:
Signature
0
Surety
Signature
CBF -6
BIDDER: MARVIAll 6L11L.0Lr
2.13 LIST OF PROPOSED SUBCONTRACTORS
In compliance with the "Subletting and Subcontracting Fair Practices Act,' Sections 4100
through 4114 of the California Public Contract Code, and any amendments thereto, each
Bidder shall provide the information requested below for each subcontractor who will
perform work, labor or render service to Bidder in or about the construction of the Work in
an amount in excess of one -half of one percent (greater than 0.5 %) of the Bidder's Total
Bid Price, or, in the case of bids or offers for the construction of streets or highways,
including bridges, in excess of one -half of 1 percent of the Contractor's total bid or ten
thousand dollars ($10,000), whichever is greater, and shall further setforth the portion of the
Work which will be done by each subcontractor. Bidder shall list only one subcontractor for
any one portion of the Work.
Pursuantto Public Contract Code Section 4104, the Owner has determined that itwill allow
Bidders twenty -four (24) additional hours after the deadline for submission of bids to submit
the information requested by the Owner about each subcontractor, other than the name and
location of each subcontractor.
If the Bidder fails to specify a subcontractor for any portion of the Work to be performed
under the Contract, it shall be deemed to have agreed to perform such portion itself, and
shall not be permitted to subcontract that portion of the Work except under the conditions
hereinafter set forth below.
Subletting or subcontracting of any portion of the Work in excess of one half of one percent
1 (greaterthan 0.5 %) of the Total Bid Price or, in the case of bids or offers forthe construction
_.� of streets or highways, including bridges, in excess of one -half of 1 percent of the
Contractor's total bid or ten thousand dollars ($10,000), whichever is greater, for which no
subcontractor was designated in the original bid shall only be permitted in cases of public
emergency or necessity, and then only after Owner approval.
CBF -7
BIDDER: /`M red . 11 &aZL<6 - "
2.13 LIST OF PROPOSED SUBCONTRACTORS (continued)
["Duplicate Next 2 Pages if needed for listing additional subcontractors." ]
Name and Location Description of Work
of Subcontractor t Subcontracted
Name: UCA I��WQ`I I
So W I U '�
Address: C C � nn 1n�, and roofirw�
(\�L.11Y 10� I CW
Name and Location
of Subcontractor
Name and Location
of Subcontractor
Name: L pP F-6
_ Address OffrINts .0
Description of Work
to be Subcontracted
W \0�
Description of Work
to be Subcontracted
MOYI � fir
0\1AU
(fir & onin9
Name and Location
of Subcontractor
Name:
Name and Location
of Subcontractor
Name:
Address:
Description of Work
to be Subcontracted
Description of Work
to be Subcontracted
CBF -8
BIDDER: vi7,C Ti$e(// c/�UlL
J 2.B LIST OF PROPOSED SUBCONTRACTORS (continued)
.._- ["Duplicate Next 2 Pages if needed for lisfing additional submntracbr *
Name and Location Description of Work
of Subcontractor to be Subcontracted
Name:
Address:
Name and Location Description of Work
of Subcontractor to be Subcontracted
Name:
Address:
Name and Location
of Subcontractor
Name:
Address:
1
Name and Location
of Subcontractor
Name:
Address:
Name and Location
of Subcontractor
Name:
Address:
Description of Work
to be Subcontracted
Description of Work
to be Subcontracted
Description of Work
to be Subcontracted
CBF -8
BIDDER: M/A/L.TAiI// ll/LL906
2.
2.0
The following are the names, addresses and telephone numbers for three public agencies for which BIDDER
has performed similar work within the past two (2) years:
t. 4 .
Name and Address of Owner
Name and telephone number of person familiar with project
Contract amount Type of Work Date Completed
and Address of Owner
Name and telephone number of person familiar with project
Contract amount
Type of Work Date Completed
l � 3.
/ Name and Address of Owner
Name and telephone number of person familiar with project
Contract amount
4.
Name and Address of Owner
Type of Work Date Completed
Name and telephone number of person familiar with project
Contract amount
Type of Work Date Completed
CBF -9
BIDDER: -Yi�2fd�i(// QL/lG
SECTION 3
NON - COLLUSION AFFIDAVIT
CBF -10
BIDDER: 1')1?1��MNI 201,
NON - COLLUSION AFFIDAVIT
In accordance with Public Contract Code Section 7106, the undersigned, being first duly
sworn, deposes and says that he or she holds the position listed below with the bidder, the
party making the foregoing bid, that the bid is not made in the interest of, or on behalf of,
any undisclosed person, partnership, company, association, organization, or corporation;
that the bid is genuine and not collusive or sham; that the bidder has not directly or indirectly
induced or solicited any other bidder to put in a false or sham bid, and has not directly or
indirectly colluded, conspired, connived, or agreed with any bidder or anyone else to put in a
sham bid, or that anyone shall refrain from bidding; that the bidder has not in any manner,
directly or indirectly, sought by agreement, communication, or conference with anyone to fix
the bid price of the bidder or any other bidder, or to fix any overhead, profit, or cost element
of the bid price, or of that of any other bidder, or to secure any advantage against the public
body awarding the contract of anyone interested in the proposed contract; that all
statements contained in the bid are true; and, further, that the bidder has not, directly or
indirectly, submitted his or her bid price or any breakdown thereof, or the contents thereof,
or divulged information or data relative thereto, or paid, and will not pay, any fee to any
corporation, partnership, company association, organization, bid depository, or to any
member or agent thereof to effectuate a collusive or sham bid.
t Signe 0ER A. M41Z1.4N1
} Typed or Printed Name
Title
P1 4 (JA ii I 6U t (D 's
Bidder
Subscribed sworn before me
This day of 20
(Seal)
See Attached Document
Notary Public in and for
the State of California
My Commission Expires:
CBF -11
Jurat
State of California
County of afa", �c
Subscribed and sworn to (or affirmed) before me on this
20,/3 by r 1(e2cancXC�
day of fir
proved to me on the basis of satisfactory evidence to be the person( who appeared before me.
Signature (qma y seal)
JUAN PEREZ
Commission # 1983651
- -r Notary Public - Calitornia z
Z Orange County
M Comm. Ea Ives Jul 25, 2016
OPTIONAL INFORMATION
DESCRIPTION OF THE ATTACHED DOCUMENT
koA- c /r A(1110 i"l
(Titlem description of attached document)
(Title m description of attached document continued)
Number of Pages Document Date
(Additional information)
INSTRUCTIONS FOR COMPLETING THIS FORM
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document must be signed AFITR the oath or affirmation. If the document was
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• State and Comity information must be the State and County where the
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Indicate title or type of attached document, number of pages and date.
• Securely attach this document to the signed document
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MARJANI BUILDERS
Lie. #967128
26091 Ravenna Road • Mission Viejo • CA 92692 • Tel: 949.305.0393 • Fax: 949.305.0394
Completed Proiects durine the last three vears:
Project Name:
City of Rialto
Improvements at Fitness Center - New Addition
Contract Amount:
$420,000
Contact:
Eddie Chan
City of Rialto
Public Works Department
335 W. Rialto Avenue
Rialto, CA 92376
Architect:
T. 909.820.2651
Architect:
Miller Architecture Interiors Planning
1177 Idaho Street, Suite 200
Redlands, CA 92374
Project Name:
City of Moreno Valley
Emergency Operations Center
Contract Amount:
$650,000
Contact:
Dale Brose
City of Moreno Valley
14177 Frederick Street
Moreno Valley, CA 92552
T. 951.413.3355
Architect:
WWC -OT (Widom Wein Cohen O'Leary Terasawa)
4280 Latham Street
Riverside, CA 92501
Eric DeMott, RA - Senior Associate
Project Name:
County of Los Angeles ,
Ladera Heights Community and Senior Center
Contract Amount:
$452,000
Contact:
Alicia R. Ramos
Capital Projects Management Associate
Project Management Division II
Count of Los Angeles
Department of Public works
900.South Fremont Avenue, 5` Floor
Alhambra, CA 91803
T. 626.300.3210
MARJAM BUILDERS
Lic. #967126
26091 Ravenna Road • Mission Viejo • CA 92692 • Tel: 949.305.0393 • Fax: 949.305.0394
Project Name: Los Angeles Valley College
Theatre Arts and Movie Production Buildings
Contract Amount: $580,000
Contact: Robert Rincon
Senior Project Manager - Prop A & AA Bond Program
Los Angeles Community College District - URS Corporation
5800 Fulton Avenue
Valley Glen, CA 91401
T. 818.756.0952
Project Name: County of Orange - John Wayne Airport
Renovation At Gate 4 and 11 Restrooms
Contract Amount: $460,000
Contact: Rick Cathey
Project Manager
3160 Airway Avenue
Costa Mesa, CA 92626
T. 949.252.5129
MARJAM BUILDERS
Lie. #967128
26091 Ravenna Road • Mission Viejo • CA 92692 • Tel: 949.305.0393 • Fax: 949.305.0394
Projects in Progress:
Project Name:
City of Arcadia
Cay Mortenson Auditorium Remodel
Contract Amount:
$122,000
Contact:
Dave McVey
Public Work Services Department
11800 Goldring Road
Arcadia, CA 91066
T. 626.256.6664
Architect:
TKE Planning
2305 Chicago Ave.
Riverside, CA 92506
Completed:
35
Completion Date:
May 31 2013
�L
BIDDER: MARJANI BUILDERS
Bidder shall submit its Bid data in accordance with the format shown on each of the following Bid
Data Forms. Bidders shall prepare and use as many sheets as are necessary to adequately
provide the information required. Bidder shall ensure that every page of its Bid Data Forms are
properly Identified with the Bidder's name and page number.
2.A BID BOND
KNOW ALL MEN BY THESE PRESENTS:
THAT MARJANI BUILDERS as
Principal, and NORTH AMERICAN SPECIALTY INSURANCE COMPANY
, as Surety, are held firmly bound unto the
CITY OF ROSEMEAD (hereinafter called the OWNER) in the sum of
TEN PERCENT OF GREATER AMOUNT BID --- - - - - --
($ 10% ), being not less than ten percent (10 %) of the Total
Bid Price; for the payment of which sum will and truly to be made, we bind
ourselves, our heirs, executors, administrators, successors, and assigns,joWly and
severally, firmly by these presents.
WHEREAS, said Principal has submitted a bid to the OWNER to perform all Work
required for the Rosemead Community Recreation Center Interior Renovation
Project as set forth In the Notice Inviting Bids and accompanying Bid Documents,
dated APRIL 17,2013 -
NOW, THEREFORE, if said Principal is awarded a Contract for the Work by the
OWNER and, within the time and in the manner required by the above- referenced
Bid Documents, enters Into the written form of Contract bound with said Bid
Documents, furnishes the required bonds (one to guarantee faithful performance
and the other to guarantee payment for labor and materials) furnishes the required
Insurance certificates and endorsements, and furnishes any other certifications as
may be required by the Contract, then this obligation shall be null and vold;
otherwise N shall remain in full force and effect. In the event suit is brought upon
this bond bythe OWNER and judgment Is recovered, said Surety shall pay all costs
incurred by the OWNER in such suit, including reasonable attomeys' fees to be fixed
by the court.
SIGNED AND SEALED, this 11TH day of
MARJANI BUILDERS (SEAL)
Principal
B
Sig ature
APRIL 2013 T .
NORTH AMERICAN SPECIALTY
INSURANCE COMPANY (SE)
Surety //_
IJW
Signature
GLENDA J. GAR ER, ATTORNEY -IN -FACT
CBF -0
CALIFORNIA ALL - PURPOSE ACKNOWLEDGMENT
STATE OF CALIFORNIA
County of SAN DIEGO
On 4/11/2013 before me, MICHELLE M BASUIL NOTARY PUBLIC
Data Here Insert Name and Title at the Officer
personally appeared GLENDA J. GARDNER
Name(s) of Signer(s)
MICHELLE M. BASUIL
COMM #1
NOTARY PUO -CAUFO
LIC- CALIFORNIA N
SAN DIEGO COUNTY
e My Comm. Exp AUO 24, 2013
Place Notary Seal Above
who proved to me on the basis of satisfactory evidence to
be the person(r� whose name(&) is /are subscribed to the
within instrument and acknowledged to me thatiie'shekH�
executed the same in 4aia /her /tFie4 authorized capacity(ies),
and that by- kisiherfiheii: signature(E) on the instrument the
person( &), or the entity upon behalf of which the person(*
acted, executed the instrument.
certify under PENALTY OF PERJURY under the laws of
the State of California that the foregoing paragraph is true
and correct.
Witness my hand and official seal.
Signature X044 p
Signature of Notary Public
OPTIONAL
Though the information below is not required by law, it may prove valuable to persons relying on the document
and could prevent fraudulent removal and reattachment of this form to another document.
Description of Attached Document
Title or Type of Document: BID BOND
Document Date:
Signer(s) Other Than Named Above:
Capacity(ies) Claimed by Signer(s)
Signer's Name: GLENDA J. GARD NER
❑ Individual
❑ Corporate Officer — Title(s):_
❑ Partner— ❑ Limited ❑ General
V Attorney in Fact
❑ Trustee
❑ Guardian or Conservator
❑ Other:
Signer Is Representing:
Number of
Signer's Name:
❑ Individual
❑ Corporate Officer— Title(s)
❑ Partner — ❑Limited ❑General
❑ Attorney in Fact
❑ Trustee
❑ Guardian or Conservator
❑ Other:
Signer Is Representing:
0 20D7 National Notary Association • 9350 Do Soto Ave., P.O. Box 2402 • Chalmorth, CA 91313 -2402 • w .NalionalNotary.org Item #590] Reorder: Call Tall -Free 1- 800 -876 -6027
NAS SURETY GROUP
NORTH AMERICAN SPECIALTY INSURANCE COMPANY
WASHINGTON INTERNATIONAL INSURANCE COMPANY
GENERAL POWER OF ATTORNEY
KNOW ALL MEN BY THESE PRESENTS, THAT North American Specialty Insurance Company, a corporation duly organized and existing under
laws of the State of New Hampshire, and having its principal office in the City of Manchester, New Hampshire, and Washington International
Insurance Company, a corporation organized and existing under the laws of the State of New Hampshire and having its principal office in the City of
Schaumburg, Illinois, each does hereby make, constitute and appoint
JOHN G. MALONEY. HELEN MALONEY, MICHELLE M, BASUIL,
GLENDA J. GARDNER, MARK D. IATAROLA and DEBORAH D. DAVIS
JOINTLY OR SEVERALLY
Its true and lawful Attomey(s) -in -Fact, to make, execute, seal and deliver, for and on its behalf and as its act and deed, bonds or other writings
obligatory in the nature of a bond on behalf of each of said Companies, as suety, on contracts of suretyship as are or may be required or peimitled by
law, regulation, contract or otherwise, provided that no bond or undertaking or contact or suretyship executed under this authority shall exceed the
amount of: FIFTY MILLION ($50,000,000.00) DOLLARS
This Power of Attorney is granted and is signed by facsimile under and by the authority of the following Resolutions adopted by the Boards of
Directors of both North American Specialty Insurance Company and Washington Intemational Insurance Company at meetings duly called and held
on the 91h of May, 2012.
"RESOLVED, that any two of the Presidents, any Managing Director, any Senior Vice President, any Vice President, any Assistant Vice President,
the Secretary or any Assistant Secretary be, and each or any of them hereby is authorized to execute a Power of Attorney qualifying the attorney named
in the given Power of Attorney to execute on behalf of the Company bonds, undertakings and all contracts of surety, and that each or any of them
hereby is authorized to attest to the execution of any such Power of Attorney and to attach therein the seal of the Company; and it is
FURTHER RESOLVED, that the signature of such officers and the seal of the Company may be affixed to any such Power of Attorney or to any
certificate relating thereto by facsimile, and any such Power of Attorney or certificate bearing such facsimile signatures or facsimile seal shall be
binding upon the Company when so affixed and in the future with regard to any bond, undertaking or contact of surety to which it is attached."
111111041
\ psQ hh pllTPj .iG
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By
,,�1 \IONA
19
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SEAL inE
Steven P. Anderme, Senior Vim President of Wasbinglon lnlernullonnl Insurance Company
�2' SIAL
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4 1 Wa �Wy:O`
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&Senior Viec President of NOrlM1 Americans uV In+aranec Q,m
Pea Y pant'
�1 (na �
a#1111[111115
�$O
BY
David Af. racmm, Vice President of Was" hingfan International lnmeann Cumpony
& Vice President ofNorlh American Specially reentrance Company
IN WITNESS WHEREOF, North American Specialty Insurance Company and Washington International Insurance Company have caused their
official seals Lobe hereunto allured, and these presents to be signed by their authorized officers thisl 0th day of Decenhbei , 2012 .
North American Specialty Insurance Company
Washington International Insurance Company
State of Illinois
County of Cook as:
On anis 101 th day of December , 20 , before me, a Notary Public personally appeared Steven P, Anderson , Senior Vice President of
Washington International Insurance Company and Senior Vice President of North American Specialty Insurance Company and David M. Layman ,
Vice President of Washington Intemational Insurance Company and Vice President of North American Specialty Insurance Company,
personally known to me, who being by me duly sworn, acknowledged that they signed the above Power of Attorney as officers of and
acknowledged said instrument to be the voluntary act and deed of their respective companies.
"OPPICLtLSEAL" k.ot>la �O p Bk J _
DONNA D. SKLENS "�' " ' U
Notary Public, State or Illinois Dolma D. Sklens, Notary Public
My Commission P.xpkas 1010612015
I, Jeffrey Goldberg , the duly elected Assistant Secretary of North American Specialty Insurance Company and Washington
International Insurance Company, do hereby certify that the above and foregoing is a true and correct copy of a Power of Attorney given by said North
American Specialty Insurance Company and Washington International Insurance Company, which is still in full force and effect.
IN WITNESS WHEREOF, I have set my hand and affixed the seals of the Companies this l lth day of APRIL , 20 13 .
Jeff e Go1d1vo,, Vice Praidad & Assislanl 1ecm1a1 of
Woshiuglou Ina mxaomd Immane Company & North American Specially Immerm Comlauy