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Steiny and Company, IncI 1 1 I 1 SECTION 1 - BID SCHEDULE 1 1 1 1 1 1 1 1 1 BIDDER: STMNYANDC0MPANY,1NC• BID SCHEDULE SCHEDULE OF PRICES FOR RUSH AND ANGELUS TRAFFIC SAFELY IMPROVEMENTS PROJECT PROJECT No. P82329 EST. UNIT ITEM NO. ITEM DESCRIPTION UNIT QTY. PRICE COST 1 Perform Clearing & Grubbing per LS 1 plans and specifications. See i i h i l Q prov s ons. tec n ca 2 Disposal of Waste Materials. LS 1 /,po, C)o 3 Construct 4-inch thick PCC SF 2,200 GY> ~ sidewalk. , 13 zo,00 4 Construct PCC Curb Ramp per EA 4 r APWA Std. Plan 111-4. ~~Q,pO 5 Construct PCC variable height LF 200 retaining curb (6" - 12") per APWA 1 IF A dfl . Std. Plan 120- !(j, 340 6 Construct PCC Driveway approach Plan 110-2 APWA Std LF 300 Q / 6 '37 . per . 6 t 7 Install Traffic Striping, Pavement LS 1 Markers, Signs including Post per Plans and Specifications l t C omp e e. , 8 Install In-Road Warning Light LS 1 System from Spot Devices or approved equal per Plans and Specifications Complete. 9 Install Solar School Zone Safety System Complete from Radarsign EA 2 6 or approved equal per plans and specifications. TOTAL BASE BID PRICE (SCHEDULE BID PRICE): $ JOQ. 96D-dD .~/I A ® P1/2"ow 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. CBF-1 BIDDER: STMNY AND COMPANY, INC, The undersigned agrees that these Contract Bid Forms constitute a firm offer to the Owner which cannot be withdrawn for the number of Working Days indicated in the Notice Inviting Bids from and after the bid opening date, or until a Contract forthe Work is fully executed by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. 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. Attached hereto is a certified check, a cashier's check or bid bo in the amount of Dollars (yi feaid amount being not less than ten percent (10%) of the Total Bid Price. 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 Ownerfor execution, within five (5) Calendar Days following the Letter of Award for the Contract, and will deliverto 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 contractor's 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 and subject to the terms and conditions described in the Contract Form and the Contract 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. ' 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 1 CBF-2 ' BIDDER: STEM AND COMPANY.INC, necessary bonds and accept the Total Bid Price as compensation in full for all Work under the contract. 12907 East Garvey Avenue P.O. Box 8100 By: / Baldwin Park, CA 91706-0993 Signature Business Street Address Richard Tesoriero Type or Print Name City, State and Zip Code Vice President 626438.9923 Title Telephone Number Bidder's/Contractor's State of Incorporation: 1 A)tkn i Partners or Joint Venturers: State License No. 161273 Bidder's License Number(s): Class A, B. C-7 & C-10 NOTES: ' 1) By its signature on this Bid, the Bidder certifies under penalty of perjury the accuracy of the representations made on the Contract Bid Forms. ' 2) If Bidder is a corporation, enter State of Incorporation in addition to Business Address 3) 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. 1 I CBF-3 STEINY AND COMPANY. INC. Certification by Secretary of Corporate Resolution At the meeting of the Directors of Steiny and Company, Inc., a corporation organized and existing under the laws of the State of California, duly called and held in accordance with the articles of incorporation and bylaws of the corporation at its office on May 28, 2009 at which a quorum of the directors were present the following resolution was adopted to wit: Resolved, that: Chairman of the Board President and Treasurer Chief Financial Officer Vice President Vice President Vice President Secretary J.O. Steiny Susan Steiny Vincent P. Mauch Willie B. Hadley Walter E. Johansen III Richard Tesoriero Gayle C. Kappelman Are hereby authorized to sign contracts/agreements in the name of and on behalf of Steiny and Company, Inc. I Gayle C. Kappelman, Secretary of Steiny and Company, Inc., do hereby certify that I am the Secretary of Said corporation and that the above is a full, true, and correct copy of a resolution of the Board of Directors of said corporation, duly adopted at the meeting held on May 28, 2009 and that said resolution has not been revoked or rescinded. In witness whereof, I have hereunto subscribed my name and affixed the seal of said corporation. Gay C. Kapp.°A n, Secretary-^- I BIDDER: STEM AND CC)NVANY- 'NC' 1 11 I 1 SECTION 2 ' BID DATA FORMS I I I I I I I 1 I I CBF-4 I BIDDER: S7EINYANDCO1vMANY, INC, ' 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 Contractors total bid or ten thousand dollars ($10,000), ' whichever is greater, and shall further set forth 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. ' Pursuant to Public Contract Code Section 4104, the Owner has determined that it will 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 (greater than 0.5%) of the 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 ' Contractors 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. I I CBF-6 1 1 1 BIDDER: rrFtwyAwnrnmPAwv C_ 2.B LIST OF PROPOSED SUBCONTRACTORS (continued) i"Duplicate Ne)d 2 Pages if needed for listing additional subcontractors.'I Name and Location Description of Work of Subcontractor to be Subcontracted Name: Name and Location of Subcontractor Name: Address ?6-o!57 / /i. - i~ ~awhc, i~& •P/713 Description of Work to be Subcontracted / Axt, PGe 4&,44.t,0,0%4,(, 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 Name and Location of Subcontractor Name: Address: CBF-7 Description of Work to be Subcontracted BIDDER: STEM AND COMPANY. INC. 2.C REFERENCES 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: ' 1. ~5 ~L A~ ach td- e and Address of Owner t Name and telephone number of person familiar with project e of Work t T Date Completed yp Contract amoun 2 Name and Address of Owner ' Name and telephone number of person familiar with project ' Contract amount Type of Work Date Completed 3. ' Name and Address of Owner ' Name and telephone number of person familiar with project Contract amount Type of Work Date Completed 4 . Name and Address of Owner Name and telephone number of person familiar with project ' Contract amount Type of Work Date Completed S ' CBF-8 STEINY AND COMPANY, INC. ELeatY6GGIL GOwtv'pc'tDYs awd C-ne),vweeYs CURRENT, PREVIOUS. AND MAJOR PROJECTS 4822 OCTA SR22 4695 Fair Oaks Corridor Transportation Improvements Owner: Orange County Transportation Authority (OCTA Owner: City of Pasadena General: Granite-Myers-Rados General: Stein & Company Value: $22,140,890.00 Value: $1,814,489 Contact: David Smith (GMR) (714) 712-1600 Contact: Dave Ortega (626) 744-4312 Completion: 7/112008 Completion: 10/18!1005 4895 FY2005 Street & Park Lighting 4853 TSMODIO151 Traffic Signal Mod. Artesia BI. ETAL Owner: City of Santa Monica Owner: County of Los Angeles General: Stein & Company General: Stein & Company Value: $2,045,021.04 Value: $914,000.00 Contact: Gene Higginbotham (310) 458-8721 Contact: Issa Adawi a (626) 458-5100 Completion: 2282008 Completion: 04117108 4811 LACO - Pacific 4819 RD00013015, Eastern Ave/Garfield Av Traffic Sync. Owner: County of Los Angeles Owner: County of Los Angeles General: Stein & Company General: Stein & Company, Inc. Value: $1,229,488.16 Value: $1,020,690.66, Contact: Cliff Craig (626) 458-5100 Contact: Cliff Craig 626) 458-5100 Completion: 02/28108 Completion: 0520108 4769 Phase III Res. Street Lighting Improvements 4506 L.A. -ATSAC (S.D. F . Corridor) Owner: City of Bever! Hills Owner: County of Los Angeles General: Balfour Beat Infrastructure, Inc. General: Stein & Company, Inc. Value: $7,050,023.89 Value: $12,130,768.40 Contact: Chris Theisen (310) 285-2504 Contact: Manoochehr Adhami (213) 847-5102 Completion: 1015/2006 Completion: 07/31/05 4926 University Park 4908 Mission Viejo - Crown Valle Parkway Widening Owner: Palm Desert Funding Co., LP Owner: City of Mission Viejo General: Granite Construction Co. General: All American Asphalt Value: 1,387,745.29 Value: $1,037,218 Contact: Joe Richardson (760) 775-7500 Contact: Jerry LeBouef (951) 739-4671 Completion: 12/3012007 Completion: open 4998 1683-Bed Bath & Beyond 4997 Anaheim - Garden Walk Owner: ABAH LLC/KDMM LLC Owner: Anaheim GW, LLC General: VCC - West Coast General: Bayley Construction Value: $795,428.10 Value: $876,255.00 Contact: George Erskine (949) 851-8474 Contact: Chuck Hi'azi 714) 540-8863 Completion: 121162007 Completion: Dec-08 4935 Rosecrans Ave./Aviation BI. Intersection Project PH11 4124 08-Riv.,SBd-10,91,215-Var., Contract 08 OK5004 Owner: City of Hawthorne Owner: State of CA Dept. of Transportation General: Griffith Company General: Stein & Company, Inc. Value: $1,373,079.95 Value: $2,992,124.00 Contact: Jason Spear (562) 929-1128 Contact: John C. McMillan (916) 227-6300 Completion: 11111/2007 Completion: Aug-09 4912 Agoura Hills - Kanan Rd. 4107 RD00015060 - As Needed Traffic Signals Owner: City of Agoura Hills Owner: County of Los Angeles General: Security Paving Company, Inc. General: Stein & Company, Inc. Value: $984,975.00 Value: $1,949,905.00 Contact: Chris Wenzel (818) 767-8418 Contact: Robert Eisenhamer (626) 458-3155 Completion: 12/162007 Completion: open 4960 Tustin - Offsite Backbone Infrastructure 4030 Caltrans RT 710 Project Owner: Vestar/Kimco Tustin, L.P., Bayley Slater Tustin Venture Owner: Caltrans General: Sema Construction General: Atkinson Construction Value: $931,920.00 Value: $9,178,065.00 Contact: Eric Westman (949) 470-0500 Contact: Felipe Oliver (949) 855-9755 Com letion: 11/92008 Completion: open Offices in Vallejo, Los Angeles, EI Cajon and Baldwin Park Page 1 of 2 Current Div. 4 STEINY AND COMPANY, INC. ELectrCeaL CDvbtractors avid C-v i n.ders CURRENT, PREVIOUS. AND MAJOR PROJECTS 4105 5 Traffic Signal Synch. Sys., Project SV 07-24 4012 Si nalization Improvements - Audie Murphy Ranch Owner: City of Simi Valle Owner: Audie Murphy Ranch,LLC General: Stein & Company, Inc. General: Woodside Homes of CA, Inc. Value: $978,666.30 Value: $1,026,516.00 Contact: David Medina (805) 583-6810 Contact: Pat Celella (951) 710-1900 Completion: open Completion: open 4055 2nd & 4th St. Pod. Streetsca a Project - Contract 8814 4996 San Clemente - Marblehead Coasta TTM 8817) Owner: City of Santa Monica Owner: City of San Clemente General: Griffith Company General: Suncal Companies Value: $2,480,568.08 Value: $1,588,740.00 Contact: Jason Spear (562) 929-1128 Contact: Cynthia Kendall 949) 241-8437 Completion: open Completion: open 4114 Crystal Cove State Park - Laguna Beach 4957 Rancho Cucamonga - 5 Signals Owner: State of California - Department of Parks & Recreation Owner: The City of Rancho Cucamonga General: L.A. Engineering, Inc. General: Stein & Company, Inc. Value: $899,221.00 Value: $1,087,302.00 Contact: John Risch (626) 454-5222 Contact: Jim Harris (909) 477-2740 Completion: open Completion: 12101/07 4982 Jefferson Blvd. Widening, Contract 2006-3001 4945 Port Incident M mt. System Project HDS2232 Owner: Playa Capital Company, LLC Owner: Port of Lon Beach General: Excel Pavin Company General: Peterson Chase General Engineering Value: $1,047,782.89 Value: $1,058,579.50 Contact: David Cook (562) 599-5841 Contact: Dick Vo els (949) 252-0441 Completion: 10/07/08 Completion: 728!1009 4963 SANBAG - Various 4661 L.A.- Wilshire Center Owner: San Bernardino Associated Governments Owner: City of Los Angeles General: Stein & Company, Inc. General: Stein & Company, Inc. Value: $1,537,866.00 Value: $2,314,512.00 Contact: David Nelson TES (909) 291-2424 Contact: Greg Tworek 213) 978-0262 Completion: open Completion: 51182008 4040 Chino Hills - Paton Drive 4038 Fred Waring Widening Project #655-01 Owner: City of Chino Hills Owner: City of Palm Desert General: Herman Weissker, Inc. General: Granite Construction Co. Value: $634,543.00 Value: $782,885.00 Contact: Jimmy Lee (951) 826-8800 Contact: Joe Richardson (760 775-7500 Completion: 1 1/3 02 0 0 8 Completion: 7242008 4216 SCRRA - Various 4218 Corona - AIMS Phase2 Owner: SCRRA - Metrolink Commuter Rail System Owner: City of Corona General: Herzog Contracting Corp. General: Stein &Com an ,Inc. Value: $5,116,124.00 Value: $1,697,687.40 Contact: Deron Ha tonstall (714) 938-0977 Contact: Clint Herrera (951) 739-4888 Completion: open Completion: open 4213 07-LA-10.50.2153.4 4198 LA CO - West Coast Basin Owner: State of California Owner: County of Los Angeles General: Flan Construction Corporation tiro General: Stein & Company, Inc. Value: $2, 834,429.00 Value: $2,623,506.00 Contact: Sean Tarp (760) 535-8175 Contact: Jose Pou (626) 458-4951 Completion: l o pen Completion: open Offices in Vallejo, Los Angeles, El Cajon and Baldwin Park Page 2 of 2 Current Div. 4 ' BIDDER: STMNY AND COMPANY, ENC. 1 1 ' SECTION 3 ' NON-COLLUSION AFFIDAVIT 1 1 1 1 1 11 1 1 I CBF-9 I J I BIDDER: STENYANDCOMPANY,NC- 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, orthe 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. Signature Richard Tescriem Typed or Printed Name Vice President Title STEINY AND COMPANY. NC- Bidder Subscribed and sworn before me Thisy3&~-dayof Mj>j-LmbW 20bq (obli r~ kddu 'Notary Public in and for V the State of California My Commission Expires: aS01) (Seal) SHAWN R. BRADFIE LD Commisslon # 1738049 Notary Public - California Riverside County MyCOnm. Fxdres May 9, 2011 I CBF-10 BIDDER:gteiny and Company. Inc. 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 SID BOND KNOW ALL MEN BY THESE.PRESENTS: THAT Stein, Principal, and as as Surety, are held firmly bound unto the CITY OF ROSEMEAD (hereinafter called the OWNER) in the sum of Ten percent of the total bid Price I.VLLAM0 ($_107 of total bid 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, jointlyand severally, firmly by these presents. WHEREAS, said Principal has submitted a bid to the OWNER to perform all Work required for the Rush and Angelus Traffic Safety Improvements Project as set forth in the Notice Inviting Bids and accompanying Bid Documents, dated December 2 2009 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 fined by the court. SIGNED AND SEALED, this 24th day of November , 2012_. Safeco Insurance Company Stein and Com an nc. (SEAL) of America -(SEAL) Principal Surety By; By: Signature Sig ture Rhonda-C. Abel_ hiichard Tesoriero, Vice President Attorney-in-Fact CBF-5 CALIP'ORIN LA CER'I'It IUA State of California l County of Los Angeles j ss. On November 30, 2009 before me, Shawn R. Bradfield, Notary Public D. Name and rule of ORcn bug. "Jane Doc, Now n, Public") personally appeared Richard Tesoriero N-ce) of S.,nao) who proved to me on the basis of satisfactory evidence to be the person(s) whose name(s) is/are subscribed to the within instrument and acknowledged to me that he/she/they executed the same in his/her#heif authorized capacity(ies), and that by his,/hen4h° f signature(s) on the instrument the person(s), or the entity upon behalf of which the person(s) acted, executed the instrument. I 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. fLI~Y~ si\@a1(IC~s1) SignPtum SHAWN R. BRADFIELD Commission # 1738049 -u Notary Public - California _ Riverside County My Comm. Expires May9, 2011 OPTIONAL Though the information below is mn required bylaw, it may prove valuable to persons relying on The document and cou/dprevenf fraudulent removal and reattachment-al his form to another document. Description of Attached Document: Title or Type of Document: Bid Bond Document Date: November 24, 2009 Number of Pages: Signer(s) Other Than Named Above: Rhonda C. Abel, Safeco Insurance Co. of America Capacity(ies) Claimed by Signer Signer's Name: Richard Tesoriero ❑ Individual Q Corporate Officer - Title(s): ❑ Partner(s) - ❑ Limited ❑ Anomey-in-Fact ❑ Trustee ❑ Guardian or Conservator ❑ Other: Vice President ❑ General Signer is Representing: STEINY AND COMPANY, INC. M:\SHAWN\Nolary\Copy of 2008 Notary Forms 1 12/1/2009 CALIFORNIA ALL-PURPOSE CERTIFICATE OF ACKNOWLEDGMENT State of California County of Orange On 11 NOV 2 4 2009 before me, K. Luu, Notary Public (Here insert name and title of the officer) personally appeared Rhonda C. Abel who proved to me on the basis of satisfactory evidence to be the person(R) whose name(a) is/pw subscribed to the within instrument and acknowledged to me that hatshehbuq executed the same in his/her/theia authorized capacity( , and that by bxa/her/tbaiy signature(s) on the instrument the person(s), or the entity upon behalf of which the person(s) acted, executed the instrument. I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph is true and correct. K. w i commission # 1778641 --m Notary Public - California WITNESS no d and official seal. a orange County My Comm. Expires Nov 6.2011 Signature of Notary Public (Notary Seal) ADDITIONAL OPTIONAL INFORMATION DESCRIPTION OF THE ATTACHED DOCUMENT (Title or description of attached document) (Title or description of attached document continued) Number of Pages _ Document Date (Additional information) CAPACITY CLAIMED BY THE SIGNER ❑ Individual (s) ❑ Corporate Officer ❑ Partner(s) I& Attorney-in-Fact ❑ Trustee(s) ❑ Other INSTRUCTIONS FOR COMPLETING THIS FORM Any acknowledgment completed in California must contain verbiage exactly as appears above in the notary section or a separate acknowledgment form mutt be property completed and attached to that document The only exception is if a document is to be retarded outride of California. In such instances, any alternative acknowledgment verbiage as my be printed on such a document so long as the verbiage does not require the notary to do something that is illegal for a notary in California (is. certifying the authorized capacity of the signer). Please check the document carefullyfor proper notarial wording and attach this form ifrequired. • State and County information must be the State and County where the document signin(s) personalty appeared before the notary public for acknowledgment. • Date of notarization must be the date that the signer(s) personally appeared which must also be the same dale the acknowledgment is completed. • The notary public must print his or her time as it appears within his or her commission followed by a comma and then your title (notary public). • Print the name(s) of document signer(s) who personally appear at the time of notarization. • Indicate the correct singular or plural forms by crossing off incorrect forms (i.e. hatahdthey, is /ere) or circling the correct forms. Failure to correctly indicate this information may lead to rejection of document recording. • The notary seal impression must be clear and photographically reproducible. Impression must not cover text or lines. If seal impression smudges, re-scat if a sufficient area permits, otherwise complete a different acknowledgment form. • Signature of the notary public must match the signature on file with the office of the county clerk. Additional information is not required but could help to ensure this acknowledgment is not misused or attached to a different documenL Indicate title or type of attached document, number of pages and date. Indicate the capacity claimed by the signer. If the claimed capacity is a corporate officer, indicate the title (i.e. CEO, CFO, Secretary). • Securely attach this document to the signed document Liberty POWER MUtUc11. OF ATTORNEY KNOW ALL BY THESE PRESENTS: Safeco Insurance Company of Amenca General Insurance Company of America 1001 4th Avenue Suite 1700 Seattle, WA 98154 No. 9675 That SAFECO INSURANCE COMPANY OF AMERICA and GENERAL INSURANCE COMPANY OF AMERICA, each a Washington corporation, does each hereby appoint **RHONDA C. ABEL; JERI APODACA; LISA K. CRAIL; LINDA ENRIGHT; JANE KEPNER; NANETTE MARIELLA-MYERS; MIKE PARIZINO; RACHELLE RHEAULT; JAMES A. SCHALLER; Irvine, California*****"*»*»'**""""**»*****'******"»» its true and lawful attomey(s}in-fact, with full authority to execute on its behalf fidelity and surety bonds or undertakings and other documents of a similar character issued in the course of its business, and to bind the respective company thereby. IN WITNESS WHEREOF, SAFECO INSURANCE COMPANY OF AMERICA and GENERAL INSURANCE COMPANY OF AMERICA have each executed and attested these presents this 21 st March 2009 day of - j~x~r a. yU1~ ~ u Dexter R. Long Secretary Timothy A. Mikolalewskl Vice President CERTIFICATE Extract from the By-Laws of SAFECO INSURANCE COMPANY OF AMERICA and of GENERAL INSURANCE COMPANY OF AMERICA: "Article V, Section 13. - FIDELITY AND SURETY BONDS... the President, any Vice President, the Secretary, and any Assistant Vice President appointed for that purpose by the officer in charge of surety operations, shall each have authority to appoint individuals as attomeys-in-fact or under other appropriate titles with authority to execute on behalf of the company fidelity and surety bonds and other documents of similar character issued by the company in the course of its business... On any instrument making or evidencing such appointment, the signatures may be affixed by facsimile. On any instrument conferring such authority or on any bond or undertaking of the company, the seal, or a facsimile thereof, may be impressed or affixed or in any other manner reproduced; provided, however, that the seal shall not be necessary to the validity of any such instrument or undertaking." Extract from a Resolution of the Board of Directors of SAFECO INSURANCE COMPANY OF AMERICA and of GENERAL INSURANCE COMPANY OF AMERICA adopted July 28, 1970. "On any certificate executed by the Secretary or an assistant secretary of the Company setting out, (I) The provisions of Article V, Section 13 of the By-Laws, and (ii) A copy of the power-of-attorney appointment, executed pursuant thereto, and (iii) Certifying that said power-of-attomey appointment is in full force and effect, the signature of the certifying officer may be by facsimile, and the seal of the Company may be a facsimile thereof." I, Dexter R. Legg Secretary of SAFECO INSURANCE COMPANY OF AMERICA and of GENERAL INSURANCE COMPANY OF AMERICA, do hereby certify that the foregoing extracts of the By-Laws and of a Resolution of the Board of Directors of these corporations, and of a Power of Attorney issued pursuant thereto, are true and correct, and that both the By-Laws, the Resolution and the Power of Attorney are still in full force and effect. IN WITNESS WHEREOF, 1 have hereunto set my hand and affixed the facsimile seal of said corporation NOV 2 4 2009 this day of CORPMATE a 1953.~wt raze ~~IRSM"'lof~ S-09741DS 3109- SEAL ~ W SEAL ~X* R.kjj Dexter R. Legg, Secretary WEB PDF