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HomeMy WebLinkAboutCarl Bowers & Sons 23-11BID BOND No.442166 CITY OF OSHKOSH Contract City Contract 23-11 Date Bond Executed (Date of Contract or Later) .tune 2, 2023 PRINCIPAL/CONTRACTOR (Legal Name and Business Address) Type of Organization Cad Bowers & Sons Construction Co., Inc. N1844 Maloney Road Individual Partnership Kaukauna WI 64130 p X Corporation State of Incorporation Wisconsin SURETY(IES) (Legal Name(s) and Business Address(es)) Penal Sum of Bond Merchants Bonding Company (Mutual) Dollars ($ 5%) PO Box 14498 Des Moines IA 50306-3498 Ip OWNER (Legal Name and Business Address) JON CITY OF OSHKOSH DLpT, Cf tjpiJi( 215 Church Avenue OSto,Sii, :�s PO Box 1130 CONSIN Oshkosh, Wisconsin 54903-1130 10y9[e1.yt[ilzi The Contractor and Surety, jointly and severally, bind themselves, their heirs, executors, administrators, successors, and assigns to the Owner for the amount of the penal sum identified above if the Owner accepts the bid of this Contractor within the time specified in the Bid documents or within such time period as may be agreed upon between the Owner and the Contractor, and the Contractor shall fail to execute the Contract within five (5) business days of written notice to the Contractor and Surety of Owner's intent to make a claim upon this Bond. The Surety hereby waives any notice of an agreement between the Owner and Contractor to extend the time in which the Owner may accept the Bid. If the Contractor either enters into a contract with Owner in accordance with the terms of the Bid and gives such bond(s) that may be specified in the Bidding documents for the faithful performance of the Contract and for the prompt payment of labor, materials, and supplies furnished for the purpose thereof; or pays to the Owner the difference between the amount specified in the Bid and such larger amount for which the Owner may in good faith contract with another party to perform the work covered in such Bid, then the Surety and the Contractor shall have no obligation under tlus Bond. Page 1 of 2 Notice to the Contractor or Surety shall be deemed to have been given: (i) upon delivery to an officer or person entitled to such notice, if hand delivered; or (ii) two (2) business days following deposit in the Urdted States mail, postage prepaid; (iii) gpon delivery by a commercial carrier that will certify the date and time of delivery; or (iv) upon transmission if by facsimile, e-mail, or other form of electronic transmission. Notices shall be provided to the Owner, Surety, and/or Contractor at their address as specified on this Bond or to a facsimile, e-mail or other electronic address that has been provided in writing to the other party to be used for this purpose. The laws of the State of Wisconsin shall govern the interpretation and construction of this Bond.. Winnebago County shall be the venue for all disputes arising under this Bond. Any provision in this Bond that may conflict with statutory or other legal requirement shall be deemed deleted herefrom and provisions conforming to the statutory or other legal. requirement shall be deemed incorporated herein. Ca.r j s ¢cJw (44-61L Name of Principal/Contractor Title 1,•r ; Merchants Bonding Company (Mutual) Name of Surety Page 2 of 2 Bond ##: 442166 MERCH.ANTS BONDING COMPANY. POWER OF ATTORNEY Know All Persons By These Presents, that MERCHANTS BONDING COMPANY (MUTUAL) and MERCHANTS NATIONAL BONDING, INC., both being corporations of the State of Iowa, dlbla Merchants National Indemnity Company (In California only) (herein collectively called the "Companies") do hereby make, constitute and appoint, individually, Michael L Tiedt their true and lawful Attorney(s)-in-Fact, to sign its name as surety(ies) and to execute, seal and acknowledge any and all bonds, undertakings, contracts and other written Instruments in the nature thereof, on behalf of the Companies in their business of guaranteeing the fidelity of persons, guaranteeing the performance of contracts and executing or guaranteeing bonds and undertakings required or permitted in any actions or proceedings allowed by law. This Power -of -Attorney is granted and is signed and sealed by facsimile under and by authority of the following By -Laws adopted by the Board of Directors of Merchants Bonding Company (Mutual) on April 23, 2011 and amended August 14, 2015 and adopted by the Board of Directors of Merchants National Bonding, Inc., on October 16, 2015. "The President, Secretary, Treasurer, or any Assistant Treasurer or any Assistant Secretary or any Vice President shall have power and authority to appoint Attomeys-in-Fact, and to authorize them to execute on behalf of the Company, and attach the seal of the Company thereto, bonds and undertakings, recognizances, contracts of indemnity and other writings obligatory in the nature thereof." "The signature of any authorized officer and the seal of the Company may be affixed by facsimile or electronic transmission to any Power of Attorney or Certification thereof authorizing the execution and delivery of any bond, undertaking, recognizance, or other suretyship obligations of the Company, and such signature and seal when so used shall have the same force and effect as though manually fixed," In connection with obligations in favor of the Florida Department of Transportation only, it is agreed that the power and aut hority hereby given to the Attorney -in -Fact includes any and all consents for the release of retained percentages and/or final estimates on engineering and construction contracts required by the State of Florida Department of Transportation. It is fully understood that consenting to the State of Florida Department of Transportation making payment of the final estimate to the Contractor and/or its assignee, shall not relieve this surety company of any of Its obligations under its bond. In connection with obligations in favor of the Kentucky Department of Highways only, it is agreed that the power and authority hereby given to the Attorney -in -Fact cannot be modified or revoked unless prior written personal notice of such Intent has been given to the Commissioner - Department of Highways of the Commonwealth of Kentucky at least thirty (30) days prior to the modification or revocation. In Witness Whereof, the Companies have caused this instrument to be signed and sealed this 2nd day of June 2023 *.nl�ne .•`P�1aNq�'+ ••�� MERCHANTS BONDING COMPANY (MUTUAL) .•'� •..��t%ty.• MERCHANTS NATIONAL BONDING, INC, po : pRRgf. C3'g �O..pRP09q ;9y d/b/a MERCHANTS NATIONAL INDEMNITY COMPANY 2003 ;�� : y 1933By c, STATE OF IOWA +++`""" • • •' • President COUNTY OF DALLAS ss. On this 2nd day of June 2023 , before me appeared Larry Taylor, to me personally known, who being by me duly sworn did say that he is President of MERCHANTS BONDING COMPANY (MUTUAL) and MERCHANTS NATIONAL BONDING, INC.; and that the seals affixed to the foregoing instrument are the Corporate Seals of the Companies; and that the said instrument was signed and sealed in behalf of the Companies by authority of their respective Boards of Directors. twl, lam tAm CommisspnNumberpates CP14y CAmmiss on Expires A�n1 14, 202A §Notary Public (Expiration of notary's commission does not invalidate this instrument) I, William Warner, Jr., Secretary of MERCHANTS BONDING COMPANY (MUTUAL) and MERCHANTS NATIONAL BONDING, INC., do hereby certify that the above and foregoing is a true and correct copy of the POWER -OF -ATTORNEY executed by said Companies, which Is still in full force and effect and has not been amended or revoked. In Witness Whereof, I have hereunto set my hand and affixed the seal of the Companies on this 2nd day of �.1+111111+� •....... • .�a011 cap•.. s�-yta aRp flR Al 2003 ,q �O's �O 4R P O,qq ;°9y Secreta June 12023 THE AMERICAN INSTITUTE OF ARCHITECTS ii - AIA Document A370 ,Bid Bond. Bond No.: 442166 KNOW ALL MEN BY THESE PRESENTS, that we Carl Bowers & Sons Construction Co., Inc. N1844 Maloney Road,`Kaukauna, WI 54130 as Principal, hereinafter call the Principal, and Merchants Bonding Company (Mutual) P.O. Box 14498, Des Moines, Iowa 50306-3498 a corporation duly organized under the laws of the State of Iowa as Surety 5eina er called the Surety, are held and firmly bound unto City of.Osbkosh, 215 Church Ave., Oshfcosh as Obligee, hereinafter called the Obligee, in the sum of Five Percent ofBid Amount Dollars ($ 5 % ), for the -payment of which sum well and truly to be made, the said Principal and the said Surety, bind ourselves, our heirs, executors, administrators, successors and assigns, jointly and severally, firmly by these presents. WHEREAS, the Principal has submitted a bid for City Contract 23-11 NOW THEREFORE, if the Obligee shall accept the bid of the Principal and the Principal shall enter into a Contract with the Obligee in accordance with the terms of such bid, and give such bond or bonds as may be specified in the bidding or Contract Documents with good and sufficient surety for the faithful performance of such Contract and for the prompt payment of labor and materials furnished in the prosecution thereof, or in the event of the failure of the Principal to enter such Contract and give such bond or bonds, if the Principal shall pay to the Obligee the difference not to exc@ed the penalty hereof between the amount specified in said bid and such larger amount for which the Obligee may in good faith , contractwith another party to perform the Work covered by said bid, then this obligation shall be null and void ,,otherwise to remain in full force and effect Signed and sealed this 2nd day of June 2023x Carl Bowers & Construction Co., Inc. A;A DOCUMENT A310•BID BOND -AIA'VO FEBRUARY 1970 ED.,P THE AMERICAN INSTITUTE OF ARCHITECTS, 1735 N.Y. AVE., N.W„ WASHINGTON D.C. 20006 l ERCHANT'S Bond #: 442166 BONDING COMPANY,. POWER OF ATTORNEY Know All Persons By These Presents, that MERCHANTS BONDING COMPANY (MUTUAL) and MERCHANTS NATIONAL BONDING, INC., both being corporations of the State of Iowa, d/b/a Merchants National Indemnity Company (in California only) (herein collectively called the "Companies") do hereby make, constitute and appoint, individually, Michael L Tiedt their true and lawful Attomey(s)-in-Fact, to sign its name as surety(ies) and to execute, seal and acknowledge any and all bonds, undertakings, contracts and other written instruments in the nature thereof, on behalf of the Companies in their business of guaranteeing the fidelity of persons, guaranteeing the performance of contracts and executing or guaranteeing bonds and undertakings required or permitted in any actions or proceedings allowed by law. This Power -of -Attorney is granted and is signed and sealed by facsimile under and by authority of the following By -Laws adopted by the Board of Directors of Merchants Bonding Company (Mutual) on April 23, 2011 and amended August 14, 2015 and adopted by the Board of Directors of Merchants National Bonding, Inc., on October 16, 2015. "The President, Secretary, Treasurer, or any Assistant Treasurer or any Assistant Secretary or any Vice President shall have power and authority to appoint Attorneys -In -Fact, and to authorize them to execute on behalf of the Company, and attach the seal of the Company thereto, bonds and undertakings, recognizances, contracts of Indemnity and other writings obligatory in the nature thereof," "The signature of any authorized officer and the seal of the Company may be affixed by facsimile or electronic transmission to any Power of Attorney or Certification thereof authorizing the execution apd delivery of any bond, undertaking, recognizance, or other suretyship obligations of the Company, and such signature and seal when so used shall have the same force and effect as though manually fixed." In connection with obligations In favor of the Florida Department of Transportation only, it is agreed that the power and aut hority hereby given to the Attorney -In -Fact Includes any and all consents for the release of retained percentages and/or final estimates on engineering and construction contracts required by the State of Florida Department of Transportation. It is fully understood that consenting to the State of Florida Department of Transportation making payment of the final estimate to the Contractor and/or its assignee, shall not relieve this surety company of any of its obligations under its bond, In connection with obligations in favor of the Kentucky Department of Highways only, it is agreed that the power and authority hereby given to the Attorney -in -Fact cannot be modified or revoked unless prior written personal notice of such intent has been given to the Commissioner - Department of Highways of the Commonwealth of Kentucky at least thirty (30) days prior to the modification or revocation. In Witness Whereof, the Companies have caused this instrument to be signed and sealed this 2nd day of June 2023 ' y0 • MERCHANTS BONDING COMPANY (MUTUAL) +�14.••()••. �y+' ��, .,!f%+a MERCHANTS NATIONAL BONDING, INC. ��� RPJ :Oyt q0. ONI'Oltt�•,4 d/bla MERCHANTS NATIONAL INDEMNITY COMPANY eo cam;^ 2003 1933 c: �', 6y•� C : c�+' By C STATE OFIOWA `•�Nr,■aaa+'a sa�+'a+tea President COUNTY OF DALLAS ss. On this 2nd day of June 2023 before me appeared Larry Taylor, to me personally known, who being by me duly sworn did say that he is President of MERCHANTS BONDING COMPANY (MUTUAL) and MERCHANTS NATIONAL BONDING, INC.; and that the seals affixed to the foregoing instrument are the Corporate Seals of the Companies; and that the said instrument was signed and sealed in behalf of the Companies by authority of their respective Boards of Directors. W, Kim Lee ti s� CSNly Coaanission puns 7 `- fitlyt�mmissionF_xpires Apk619, 2t724 Notary Public (Expiration of notary's commission does not invalidate this Instrument) 1, William Warner, Jr., Secretary of MERCHANTS BONDING COMPANY (MUTUAL) and MERCHANTS NATIONAL BONDING, INC., do hereby certify that the above and foregoing is a true and correct copy of the POWER -OF -ATTORNEY executed by said Companies, which is still in full force and effect and has not been amended or revoked_ In Witness Whereof, I have hereunto set my hand and affixed the seal of the Companies on this 2nd day of June 2023 +++At0Nq�'+�,�� O : •ate ' q '�q y : . 0 +':� 2003 ; ��� 1933 secretary i AR v® CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDDIYYYY) 6/2/2023 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s), PRODUCER Spectrum insurance Group GB 303 Packerland Dr., Ste G Green Bay WI 54303 CONTACT Gina Keller PHONE ): g20-593-2801 mm AIC No : 920-884 2851 E-MAIL -- ADDRESS: glna.keller@specVu!minsgroup.com _ INSURER(S) AFFORDING COVERAGE NAIC# _ _ INSURER A: Selective Insurance Company 12572 INSURED-CARLB-2 Carl Bowers & Sons Construction Co Inc iNsuRERB: Selective Insurance Company of South Carolina 19259 N1844 Maloney Rd Kaukauna Wl 54130 INSURERC: INSURERD: INSURER E : ' INSURER F: COVERAGES CERTIFICATE NUMBER: 1143563827 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR �m TYPE OF INSURANCE ADDLSUSR S POLICY NUMBER POLICYEFF MMlDD POLICYEXP MM1DD LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS MADE FRI OCCUR S 2553019 41/2023 4/1/2024 EACH OCCURRENCE S1,0o0,000 DAMAGETO RENTED PREMISES (Eo occurrence_ �5500,060 _ MED EXP (Any one person) $15,000 PERSONAL & ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY PEA ffl LOC OTHER: GENERAL AGGREGATE .S 2,000,000`T PRODUCTS -COMP/OPAGG $2,000,000.� $ A AUTOMOBILE X X LIABILITY ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS HIRED X NON -OWNED AUTOS ONLY AUTOS ONLY S 2553019 4/1/2023 4/1/2024 COMBINED SINGLE LIMIT Ea accidentl $1,000,000 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (per ace identt $ $ ' . A X - UMBRELLALIAB EXCESS LIAB X OCCUR CLAIMS -MADE S 2553019 I 4/1/2023 4/1/2024 EACH OCCURRENCE $5,000,000 _ AGGREGATE $ DED X RETENTION $ ri _5,000,000 $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANYPROPRIETOR/PARTNER/EXECUTIVE OFFICER1MEMBEREXCLUDED7FN (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS below A NIA WC 9135809 4/1/2023 4/112024 X PER O7H- STATUTE ER Increased Limits _ E.L. EACH ACCIDENT $ 600,000 E.L. DISEASE -EAEMPLOYEE -- $ 500,000 E.L. DISEASE -POLICY LIMIT ,$500,000 A A BarrowedlLeasedlRentedEquipment Installation Floater S 2553019 S 2653019 4/1/2023 4/1/2023 4/1/2024 4/1/2024 Limit Umil $300,000 $2,000,000 DESCRIPTION OF OPERATIONS/ LOCATIONS 1 VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached if more space Is required) Bid - City Contract 23-11 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. City of Oshkosh 215 Church Ave AUTHORIZED REPRESENTATIVE Oshkosh WI 54903 l�.J ©1988.2015 ACORD CORPORATION, All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD TO: ALL CONTRACTORS FROM: ENGINEERING DIVISION OF CITY OF OSHKOSH DEPARTMENT OF PUBLIC WORKS SUBJECT: DISCLOSURE OF OWNERSHIP FORM JUN - 202,,E 4qscCi`lvsl l Please review the attached Department of Workforce Development Disclosure of Ownership form. I£ Item 3 on this Disclosure of Ownership form applies to your company, you must complete the Disclosure of Ownership form and upload in the appropriate location on Quest V-Bid. If Item 3 on the Disclosure of Ownership form does NOT apply to your company, you must complete the information below and upload this page in the appropriate location on Quest V-Bid. CERTIFICATION I certify by my signature below that Item 3 of the attached Disclosure of Ownership form does NOT apply to my firm, or a shareholder, officer, or partner of my firm. Name t t" Printed Name Title - 0—ar � �At6n2s, 4 /,", /-) P � -T-,,- ( Company Name (P r Date l:\Engineering\Tracy Taylor\ Public WorksContrach%Miscellaneous\Disclosure of OwnershipForm-2.1- page 1 of 1 ]7.docx City Hall, 215 Church Avenue P.O. Box 1130 Oshkosh, WI 54903-1130 http://www.cl.oshkosh.wi.us State of Wisconsin Department of Workforce Development Equal Rights Division Disclosure of Ownership The statutory authority for the use of this form is prescribed in Sections 66,0903(12)(d), 66,0904(10)(d) and 103.49(7)(d), Wisconsin Statutes. The use of this form is mandatory. The penalty for failing to complete this form is prescribed in Section 103,005(12), Wisconsin Statutes. Personal information you provide may be used for secondary purposes [Privacy Law, s. 15.04(1) (m), Wisconsin Statutes]. (1) On the date a contractor submits a bid to or completes negotiations with a state agency, local governmental unit, or developer, investor or owner on a project subject to Section 66.0903, 66.0904 or 103.49, Wisconsin Statutes, the contractor shall disclose to such state agency, local governmental unit, or developer, investor or owner, the name of any "other construction business," which the contractor, or a shareholder, officer or partner of the contractor, owns or has owned within the preceding three (3) years. (2) The term "other construction business" means any business engaged in the erection, construction, remodeling, repairing, demolition, altering or painting and decorating of buildings, structures or facilities. It also means any business engaged in supplying mineral aggregate, or hauling excavated material or spoil as provided by Sections 66.0903(3), 66.0904(2), 103.49(2) and 103.50(2), Wisconsin Statutes. (3) This form must ONLY be filed, with the state agency project owner, local governmental unit project owner, or developer, investor or owner of a publicly funded private construction project that will be awarding the contract, if both (A) and (B) are met. (A) The contractor, or a shareholder, officer or partner of the contractor: (1) Owns at least a 25% interest in the "other construction business," indicated below, on the date the contractor submits a bid or completes negotiations; or (2) Has owned at least a 25% interest in the "other construction business" at any time within the preceding three (3) years. (B) The Wisconsin Department of Workforce Development (DWD) has determined that the "other construction business" has failed to pay the prevailing wage rate or time and one-half the required hourly basic rate of pay, for hours worked in excess of the prevailing hours of labor, to any employee at any time within the preceding three (3) years. Other Construction Business Business Name tt ( � Street Address or P O Box City State Zip Code Business Name Street Address or P O Box City State Zip Code Business Name Street Address or P O Box City State Zip Code Business Name Street Address or P O Box City State Zip Code 1 hereby state under penalty of perjury that the information, contained in this document, is true and accurate according to my knowledge and belief. Print the Name of Authorized Officer Fr T r �v S Authorized Officer Signat Date Signed hip or Sole Proprietorship Name Corpor on, Par7=6 car 4 S, A �xa, Street Address or P O Box City State Zip Code If you have any questions call (608) 266-6861 ERD-7777 (R. 01/2011) I r1,A,6 cito fw, Oshkosh TO: ALL CONTRACTORS FROM: ENGINEERING DIVISION OF ',PTA CITY OF OSHKOSH DEPARTMENT OF PUBLIC WORKS 0,SW0'3P 1j_1(1 xs SUBJECT: LANDFILL GAS MITIGATION PLAN Al CERTIFICATION I certify by my signature below that our firm has read the Landfill Gas Mitigation Plan included in the Specifications and will comply with the requirements of the Plan. Name V-, c ;ors Printed Name Title / Company Name ^kAr Alo 2-3 _ Date IA Engineering\ 2021 - 2030 Contracts\2023 CONTRACTS\23•I1 San MH Rehab\Project Information\Contract Info\Contract Book\23.1i Landfill Gas Mitigation Plan Certification_5-15-23. do« Page 1 of 1 City Half, 215 Church Avenue P.O. Box 1130 Oshkosh, WI 54903-1130 http://www.ci.oshkosh.wi,us city offv Oshkosh TO: ALL CONTRACTORS JIJIVe 202 FROM: ENGINEERING DIVISION OF St OS1q tV- CITY OF OSHKOSH DEPARTMENT OF PUBLIC WORKS 3 C014;�5 SUBJECT: AMENDED SOIL AND GROUND WATER MANAGEMENT PLAN CERTIFICATION I certify by my signature below that our firm has read the Amended Soil and Ground Water Management Plan included in the Specifications and will comply with the requirements of the Plan. ;9�2 Name Printed Name �/J�/d ✓( v�� Title Company Name Date I:Angineering\2021- 2030 Contracts\2023 CONTRAM V3.11 San MH Rehab\PmlectInfotmatfon\Contract Info\ Contract Hook\23-11 Amended Soil & Groundwater Management Plan Certification S-15-23.dorx Page i of 1 City Hall, 215 Church Avenue P.O. Box 1130 Oshkosh, WI 54903-1130 http://www.ci.oshkosh.wi.us ilr JUIV CONTRACT 23-11 PROPOSAL II'?PToF I'u rc oSo8; r Rs The undersigned will begin work as specified after award of the Contract and complete as s 8fied. I hereby certify that all statements are made ui behalf of (Name of Corporation, Partnership, or Person Submitting Bid) a corporation organized and existing under the laws of the State of C -07.r(-7 a Partnership consisting of • or an individual trading as the City of State of of That I have examined and carefully prepared this Proposal from the Plans and Specifications and have checked the same in detail before submitting this Proposal; that I have full authority to make such statements and submit this Proposal in (its) (their) behalf; and that said statements are true and correct. Signature itle, if any) Subscribed and sworn to before me this day of ` .:l v+4 , 2C e-? . Notary Public, or other authorized to administer ADAM CARL BOWERS Notary Public State of Wisconsin (Bidder should not add any conditions or qualifying statements to this Proposal as otherwise the Proposal may be declared irregular as not being responsive to the Advertisement.) Accompanying this Proposal is a Bid Bond in the amount of % of the total amount of the Bid, as called for in the Official Notice to Contractors. Page 10 of 10 CONTRACT 23-11 Lr ATTACHMENT A LIST OF SUBCONTRACTORS ,opptla r� 08 a T - ORKS Pursuant to Section 66.29(7), Wisconsin Statutes, the Bidder, as part of this Proposal, su�bjQW# Mull and complete list of all the Subcontractors and the class of work to be performed by each. The CONTRACTOR will be permitted to sublet a portion of the Contract, but shall perform with their organization work amounting to at least thirty percent (30%) of the original Contract amount. Work performed by the CONTRACTOR for any Bid Item that had been subcontracted will not be included towards the thirty percent (30%) calculation. If the CONTRACTOR shall sublet any part of this Contract, the CONTRACTOR shall be as fully responsible to the CITY for the acts and omissions of their Subcontractor and of the persons either directly or indirectly employed by their Subcontractor as they are by acts or omissions of persons directly employed by themselves. All Subcontractors, if any, shall be listed in the spaces provided on the Proposal Form and said list shall not be added to or altered without the written consent of the CITY. Signed, final waivers of lien will need to be provided to the CITY prior to the release of the final retainage to the CONTRACTOR. When a Subcontractor and the class of work to be performed are not listed, it shall be considered that the Bidder will perform the work themselves. NAME OF SUBCONTRACTOR 41 4 X �cz;t CLASS OR ITEMS OF WORK PERCENT OF CONTRACT AMOUNT � C1/' I hereby certify that the use of the name(s) of the above Subcontractor(s) was with the knowledge and consent of the said Subcontractor(s). Signature dBidder Page 7 of 10 :�0 Contract Number 23-11 Date Bond Executed (Date of Contract or Later) 6/5/2024 PRINCIPAL/CONTRACTOR (Legal Name and Business Address) De Groot, Inc. 4201 Champion Road Green Bay, WI 54311 SURETY(IES) (Legal Name(s) and Business Address(es)) Employers Mutual Casualty Company 1815 S. Meyer Road 0 Oakbrook Terrace, IL 60181 OWNER (Legal Name and Business Address) 4� s I)SPT OV Vi e 9 CITY OF OSHKOSHiCc�> 215 Church Avenue PO Box 1130 Oshkosh, Wisconsin 54903-1130 OBLIGATION CITY OF OSHKOSH Type of Organization hulividttnl — Parhtersltip Corporation State of Incorporation Wisconsin Penal Stun of Bond 5% of Bid The Contractor and Surety, jointly and severally, bind themselves, their heirs, executors, administrators, successors, and assigns to the Owner for the amount of the penal sum identified above if the Owner accepts the bid of this Contractor within the time specified in the Bid documents or within such time period as may be agreed upon between the Owner and the Contractor, and the Contractor shall fail to execute the Contract within five (5) business days of written notice to the Contractor and Surety of Owner's intent to make a claim upon this Bond. The Surety hereby waives any notice of an agreement between the Owner and Contractor to extend the time in which the Owner may accept the Bid. If the Contractor either enters into a contract with Owner in accordance with the terms of the Bid and gives such bond(s) that may be specified in the Bidding documents for the faithful performance of the Contract and for the prompt payment of labor, materials, and supplies furnished for the purpose thereof, or pays to the Owner the difference between the amount specified in the Bid and such larger amount for which the Owner may in good faith contract with another party to perform the work covered in such Bid, then the Surety and the Contractor shall have no obligation under this Bond. Page 1 of 2 Notice to the Contractor or Surety shall be deemed to have been given: (i) upon delivery to an officer or person entitled to such notice, if hand delivered; or (ii) two (2) business days following deposit in the United States mail, postage prepaid; (iii) upon delivery by a commercial carrier that will certify the date and time of delivery; or (iv) upon transmission if by facsimile, e-mail, or other form of electronic transmission. Notices shall be provided to the Owner, Surety, and/or Contractor at their address as specified on this Bond or to a facsimile, e-mail or other electronic address that has been provided in writing to the other party to be used for this purpose. The laws of the State of Wisconsin shall govern the interpretation and construction of this Bond. Wirmebago County shall be the venue for all disputes arising under this Bond, Any provision in this Bond that may conflict with statutory or other legal requirement shall be deemed deleted herefrom and provisions conforming to the statutory or other legal requirement shall be deemed incorporated herein. De Groot, Inc. Name of Principal/Contractor Title Employers Mutual Casualty Company Name of Surety Title Atto y-In-Fact Page 2 of 2 ArEMC P.O. Box 712 • Des Moines, Iowa 50306-0712 INSURANCE POWER OF ATTORNEY APPOINTING INDIVIDUAL ATTORNEY -IN -FACT KNOW ALL MEN BY THESE PRESENTS, that: 1. Employers Mutual Casualty Company, an Iowa Corporation 2. EMCASCO Insurance Company, an Iowa Corporation 3, Union Insurance Company of Providence, an Iowa corporation 4, Illinois EMCASCO Insurance Company, an Iowa Corporation 5. Dakota Fire Insurance Company, a North Dakota Corporation 6. EMC Property & Casualty Company, an Iowa Corporation hereinafter referred to severally as "Company" and collectively as "Companies", each does, by these presents, make, constitute and appoint: Sherry L Hendricks its true and lawful attorney -in -fact, with full power and authority conferred to sign, seal, and execute the Bid Bond Any and All Bonds and to bind each Company thereby as fully and to the same extent as if such instruments were signed by the duly authorized officers of each such Company, and all of the acts of said attorney pursuant to the authority hereby given are hereby ratified and confirmed. AUTHORITY FOR POWER OF ATTORNEY This Power -of -Attorney is made and executed pursuant to and by the authority of the following resolution of the Boards of Directors of each of the Companies at the first regularly scheduled meeting of each company duly called and held in 1999: RESOLVED; The President and Chief Executive Officer, any Vice President, the Treasurer and the Secretary of Employers Mutual Casualty Company shall have power and authority to (1) appoint attorneys -in -fact and authorize them to execute on behalf of each Company and attach the seal of the Company thereto, bonds and undertakings, recognizances, contracts of indemnity and other writings obligatory in the nature thereof; and (2) to remove any such attorney -in -fact at any time and revoke the power and authority given to him or her. Attorneys -in -fact shall have power and authority, subject to the terms and limitations of the power -of -attorney issued to them, to execute and deliver on behalf of the Company, and to attach the seal of the Company thereto, bonds and undertakings, recognizances, contracts of indernnity and other writings obligatory in the nature thereof, and any such instrument executed by any such attorney -in -fact shall be fully and in all respects binding upon the Company. Certification as to the validity of any power -of -attorney authorized herein made by an officer of Employers Mutual Casualty Company shall be fully and in all respects binding upon this Company. The facsimile or mechanically reproduced signature of such officer, whether made heretofore or hereafter, wherever appearing upon a certified copy of any power -of -attorney of the Company, shall be valid and binding upon the Company with the same force and effect as though manually affixed. IN WITNESS THEREOF, the Companies have caused these presents to be 22nd day of September , 2022 Seals ;NS M SEAL1953 IMA 000, `�\NsueaNO I" :,`,���Tual ' iZ f = SEAL `<= = SEAL =y= - SEAL 0, OR)p �DAKOS� KATHYLOVEAIDGE rCommtsebn NufrlbeEr�76{0�769 ocC t 1tobei�r t�'0,'tols for each by their officers as shown, and the Corporate seals to be hereto affixed this $Jott R. Jean, P dent & CEO of Company 1; rrman, President & CEO of Comp ies 2, 3, 4, 5 & 6 Todd Strother, Executive Vice President Chief Legal Officer & Secretary of Companies 1, 2, 3, 4, 5 & 6 On this 22nd day of September 2022 before me a Notary Public in and for the State of Iowa, personally appeared Scott R, Jean and Todd Strother, who, being by me duly sworn, did say that they are, and are known to me to be the CEO, Chairman, President, Executive Vice President, Chief Legal Officer and/or Secretary, respectively, of each of the Companies above; that the seals affixed to this instrument are the seals of said corporations; that said instrument was signed and sealed on behalf of each of the Companies by authority of their respective Boards of Directors; and that the said Scott R. Jean and Todd Strother, as such officers, acknowledged the execution of said instrument to be their voluntary act and deed, and the voluntary act and deed of each of the Companies. My Commission Expires October 10, 2025. lMe 1� NotaryUbli and fte o owa CERTIFICATE I, Ryan J. Springer, Vice President of the Companies, do hereby certify that the foregoing resolution of the Boards of Directors by each of the Companies, and this Power of Attorney issued pursuant thereto on 22nd day of September , 2022 , are true and correct and are still in full force and effect. In Testimony Whereof I have subscribed my name and affixed the facsimile seal of each Company this _ 1st day of ____ May_ _ , 2023_ Vice President 7854 (9-22) 8021884-NA D8452 957 A 000000 "For verification of the authenticity of the Power of Attorney you may call (515) 345-7548." TO: FROM: SUBJECT: City o� Oshkosh ALL CONTRACTORS ENGINEERING DIVISION OF CITY OF OSHKOSH DEPARTMENT OF PUBLIC WORKS E EEIVP0 J - 202 DEFT OF PUBLIC WORKS 0SffK SH, MSCONSIN AMENDED SOIL AND GROUND WATER MANAGEMENT PLAN CERTIFICATION I certify by my signature below that our firm has read the Amended Soil and Ground Water Management Plan included in the Specifications and will comply with the requirements of the Plan. Mark De Groot Printed Name President Title De Groot, Inc. Company Name 6/5/2023 Date 1:\Engineering\2021 - 2030 Contracts\2023 CONT12ACrS\23-11 San MH IEehab\Project_ln(ornmtion\Contract Into\Contract Book\23-11 Amended Soil & Groundwater Management Plan Certification_5-15-23Am Page 1 of 1 City Hall, 215 Church Avenue P.O. Box 1130 Oshkosh, WI 54903-1 130 hitp://www.cl.oshkosh.wi.us if t x sue"-4v City of Oshkosh TO: ALL CONTRACTORS FROM: ENGINEERING DIVISION OF CITY OF OSHKOSH DEPARTMENT OF PUBLIC WORKS SUBJECT: DISCLOSURE OF OWNERSHIP FORM DE PT OF PUBLIC WOPKS Please review the attached Department of Workforce Development Disclosure of Oznership form. If Item 3 on this Disclosure of Ownership form applies to your company, you must complete the Disclosure of Ownership form and upload in the appropriate location on Quest V-Bid. If Item 3 on the Disclosure of Ownership form does NOT apply to your company, you must complete the information below and upload this page in the appropriate location on Quest V-Bid. CERTIFICATION I certify by my signature below that Item 3 of the attached Disclosure of Oznership form does NOT apply to my firm, or a shareholder, officer, or partner of my firm. Mark De Groot Printed Name President Title De Groot, Inc. Company Name 6/5/2023 Date 1AEngineering\Tracy Taylor\Public Works Contracts\Miscellaneous\Disclosure of Ownership Forno-1- Page 1 of 1 17.doca City Nall, 215 Church Avenue P.O. Box 1 130 Oshkosh, WI 54903-1 130 http://www.cl,oshkosh.wl.us State of Wisconsin Department of Workforce Development Equal Rights Division Disclosure of Ownership The statutory authority for the use of this form is prescribed in Sections 66.0903(12)(d), 66.0904(10)(d) and 103.49(7)(d), Wisconsin Statutes. The use of this form is mandatory. The penalty for failing to complete this form is prescribed in Section 103.005(12), Wisconsin Statutes. Personal information you provide may be used for secondary purposes [Privacy Law, s. 15.04(1) (m), Wisconsin Statutes]. (1) On the date a contractor submits a bid to or completes negotiations with a state agency, local governmental unit, or developer, investor or owner on a project subject to Section 66.0903, 66,0904 or 103.49, Wisconsin Statutes, the contractor shall disclose to such state agency, local governmental unit, or developer, investor or owner, the name of any "other construction business," which the contractor, or a shareholder, officer or partner of the contractor, owns or has owned within the preceding three (3) years. (2) The term "other construction business" means any business engaged in the erection, construction, remodeling, repairing, demolition, altering or painting and decorating of buildings, structures or facilities. It also means any business engaged in supplying mineral aggregate, or hauling excavated material or spoil as provided by Sections 66.0903(3), 66.0904(2), 103.49(2) and 103.50(2), Wisconsin Statutes. (3) This form must ONLY be filed, with the state agency project owner, local governmental unit project owner, or developer, investor or owner of a publicly funded private construction project that will be awarding the contract, if both (A) and (B) are met. (A) The contractor, or a shareholder, officer or partner of the contractor: (1) Owns at least a 25% interest in the "other construction business," indicated below, on the date the contractor submits a bid or completes negotiations; or (2) Has owned at least a 25% interest in the 'other construction business" at any time within the preceding three (3) years. (B) The Wisconsin Department of Workforce Development (DWD) has determined that the "other construction business" has failed to pay the prevailing wage rate or time and one-half the required hourly basic rate of pay, for hours worked in excess of the prevailing hours of labor, to any employee at any time within the preceding three (3) years. Other Construction Business Business Name N/A Street Address or P O Box City State Zip Code Business Name N/A Street Address or P O Box City State Zip Code Business Name N/A Street Address or P O Box City State Zip Code Business Name N/A Street Address or P O Box City State Zip Code I hereby state under penalty of perjury that the information, contained in this document, is true and accurate according to my knowledge and belief. Print the Name of Authorized Officer Mark De Groot Authorize i nat Date Signed 6/5/2023 Corporation, Partners ip or Sole Proprietorship Name De Groot, Inc. Street Address or P O Box City State Zip Code 4201 Champion Rd. Green Bay IWI 54311 If you have any questions call (608) 266-6861 ERD-7777 (R. 01/2011) r,A & Citof Oshkosh 1UN= TO: ALL CONTRACTORS 18HKOSH CoNgm FROM: ENGINEERING DIVISION OF CITY OF OSHKOSH DEPARTMENT OF PUBLIC WORKS SUBJECT: LANDFILL GAS MITIGATION PLAN CERTIFICATION I certify by my signature below that our firm has read the Landfill Gas Mitigation Plan included in the Specifications and will comply with the requirements of the Plan. Mark De Groot Printed Name President Title De Groot, Inc. Company Name 6/5/2023 Date I:\Engineering\2021 -2030 Cartracts\2023 CONTRACM23-11 San MH Page 1 of 1 Rehab\ Project_lnformation\Contract Info\Contract Book\23-11 Landfill Gas Mitigation Plan Certification 5-15-23.dnca City Hall, 215 Church Avenue P.O. Box 1 130 Oshkosh, WI 54903-1 130 http://www.ci.oshkosh.wi.us E CONTRACT 23-11 ATTACHMENT A JUN LIST OF SUBCONTRACTORS E)EPT OF PUBLIC WORU 0SUKOSH, WISCONSIN Pursuant to Section 66.29(7), Wisconsin Statutes, the Bidder, as part of this Proposal, submits this full and complete list of all the Subcontractors and the class of work to be performed by each. The CONTRACTOR will be permitted to sublet a portion of the Contract, but shall perform with their organization work amounting to at least thirty percent (30%) of the original Contract amount. Work performed by the CONTRACTOR for any Bid Item that had been subcontracted will not be included towards the thirty percent (30%) calculation. If the CONTRACTOR shall sublet any part of this Contract, the CONTRACTOR shall be as fully responsible to the CITY for the acts and omissions of their Subcontractor and of the persons either directly or indirectly employed by their Subcontractor as they are by acts or omissions of persons directly employed by themselves. All Subcontractors, if any, shall be listed in the spaces provided on the Proposal Form and said list shall not be added to or altered without the written consent of the CITY. Signed, filial waivers of lien will need to be provided to the CITY prior to the release of the final retainage to the CONTRACTOR. When a Subcontractor and the class of work to be performed are not listed, it shall be considered that the Bidder will perform the work themselves. NAME OF SUBCONTRACTOR V rlg La s CLASS OR ITEMS OF WORK P&'A.�' f,-Gr l - PERCENT OF CONTRACT AMOUNT MW I hereby certify that the use of the name(s) of the above Subcontractor(s) was with the knowledge and consent of the said Subcontractor(s). Ili e12 4-� �— - Signature of Bidder Page 7 of 10 ON M CONTRACT 23-11 PROPOSAL -"0PP BL[C o RXS s ,w The undersigned will begin work as specified after award of the Contract and complete as, specified. I hereby certify that all statements are made in behalf of De Groot, Inc. (Name of Corporation, Partnership, or Person Submitting Bid) a corporation organized and existing under the laws of the State of Wisconsin a Partnership consisting of an individual trading as the City of ;State of or of That I have examined and carefully prepared this Proposal from the Plans and Specifications and have checked the same in detail before submitting this Proposal; that I have full authority to make such statements and submit this Proposal in (its) (their) behalf, and that said st nts are true and correct. Signature President (Title, if any) Subscribed and sworn to before me this 5 day of June 2023 N tary Public, or of r authorized to Wdminister f' (Bidder should not add any conditions or gt Zil gfi i� �eY%ents to this Proposal as otherwise the Proposal may be declared irregular as not being responsive to the Advertisement.) Accompanying this Proposal is a Bid Bond in the amount of 5 % of the total amount of the Bid, as called for in the Official Notice to Contractors. 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