HomeMy WebLinkAboutAgreements/Contracts - Public WorksK22-252
THIS AGREEMENT, between the Board of County Commissioners of Grant County, State
of Washington, acting under and by virtue of Chapter 36.77 of the Rev' ed Code of Washington,
as amended, hereinafter called the County, and for itself, its
heirs, executors, administrators, successors and assigns, hereinafter called the Contractor.
WITNESSETH:
That in consideration of the payments, covenants, and agreements, hereinafter
mentioned, and attached and made a part of this agreement, to be made and performed by the
parties hereto, and the parties hereto covenant and agree as follows:
DESCRIPTION OF WORK:
1. The Contractor shall do all work and furnish all tools, materials, and equipment
necessary to improve and complete 3 -NE ROAD PHASE % CRP 21-03, located in Grant County,
Washington, as proposed in a bid opened 1:00 P.M., Tuesday, October 18,, 2022 in accordance
with and as described in the herein attached plans and standard specifications, and in full
compliance with the terms, conditions, and stipulations herein set forth and attached, now
referred to any by such reference incorporated herein and made part hereof as fully for all
purposes as if here set forth at length, and shall perform any alterations in or additions to the
work covered by this contract and every part thereof and any force account work may be
ordered as provided in this contract and every part thereof.
2. The Contractor shall provide and be at t * he expense of all materials, labor, carriage,
tools, implements and conveniences and things of every description that may be requisite for
the transfer of materials and for constructing and completing the work provided for in this
contract and every part thereof.
3. The County hereby promises and agrees with the Contractor to employ, and does
employ the Contractor to provide the materials and to do and cause to be done the above
described work and to complete and finish the same according to the attached plans and
specifications and the terms and conditions herein contained, and hereby contracts to pay for
the same according to the attached specifications and the schedule of unit or itemized prices
hereto attached, at the time and in the manner and upon the conditions provided for in this
contract and every part thereof. The County further agrees to employ the Contractor to
perform any alterations in or additions to the work covered by this contract and every part
thereof and any force account work that may be ordered and pay for same under the terms of
this contract and the attached plans and specifications.
4. The Contractor for himself, and for his heirs, executors, administrators and assigns, and
successors and assigns, does hereby agree to the full performance of all the covenants herein
contained upon the part of the Contractor.
5. It is further provided that no liability shall attach to the County by reason of entering
into this contract, except as expressly provided herein.
3 -NE Rd. Phase 3, CRP 21-03 Contract --Page 1
_v12-252
XN�Z�
CONTRACT
THIS AGREEMENT, between the Board of County Commissioners of Grant County, State
of Washington, acting under and by virtue of Chapter 36.77 of the Rev" sed Code of Washington,
as amended, hereinafter called the County, and for itself, its
heirs, executors, administrators, successors and assigns, hereinafter called the Contractor.
WITNESSETH:
That in consideration of the payments, covenants, and agreements, hereinafter
mentioned, and attached and made a part of this agreement, to be made and performed by the
parties hereto, and the parties hereto covenant and agree as follows:
DESCRIPTION OF WORK:
1. The Contractor shall do all work and furnish all tools, materials, and equipment
necessary to improve and complete 3 -NE ROAD PHASE 3, CRP 21-03, located in Grant County.,
Washington, as proposed in a bid opened 1:00 P.M.,, Tuesday, October 18, 2022 in accordance
with and as described in the herein attached plans and standard specifications, and in full
compliance with the terms, conditions, and stipulations herein set forth and attached, now
referred to any by such reference incorporated herein and made part hereof as fully for all
purposes as if here set forth at length, and shall perform any alterations in or additions to the
work covered by this contract and every part thereof and any force account work may be
ordered as provided in this contract and every part thereof.
2. The Contractor shall provide and be at t * he expense of all materials, labor, carriage,
tools, implements and conveniences and things of every description that may be requisite for
the transfer of materials and for constructing and completing the work provided for in this
contract and every part thereof.
3. The County hereby promises and agrees with the Contractor to employ, and does
employ the Contractor to provide the materials and to do and cause to be done the above
described work and to complete and finish the same according to the attached plans and
specifications and the terms and conditions herein contained, and hereby contracts to pay for
the same according to the attached specifications and the schedule of unit or itemized prices
hereto attached, at the time and in the manner and upon the conditions provided for in this
contract and every part thereof. The County further agrees to employ the Contractor to
perform any alterations in or additions to the work covered by this contract and every part
thereof and any force account work that may be ordered and pay for same under the terms of
this contract and the attached plans and specifications.
4. The Contractor for himself, and for his heirs, executors, administrators and assigns, and
successors and assigns, does hereby agree to the full performance of all the covenants herein
contained upon the part of the Contractor.
5. It is further provided that no liability shall attach to the County by reason of entering
into this contract, except as expressly provided herein.
3 -NE Rd. Phase 3, CRP 21-03 Contract —Page 1
CONTRACT BOND Bond No. 2334544
KNOW ALL MEN BY THESE PRESENTS:
That we, the undersigned, Wheeler Excavation, LLC as
principal, and Swiss Re Corporate Solutions America InquEance Corporation a
corporation organized and existing under the laws of the State of Missouri as
surety corporation, and qualified under the laws of the State of Washington to become surety
upon bonds of contractors with municipal corporations, as surety, are jointly and severally held
and firmly bound to Grant County, Washington, in the penal sum of & 45/100
One Million Two Hundred Seventy- Five Thou &al]d TM Hundred Eifty EiVe
$1,275,255.45 ) for the payment of which sum on demand we bind ourselves and our
successors, heirs, administrators or personal representatives, as the case may be.
This obligation is entered into in pursuance of the statutes of the State of Washington,
the Ordinances of Grant County, Washington.
Dated at ge 4 , Washington, this day of _GLee� bw, 2022.
The conditions of thabove obligation are such that:
WHEREAS., on October 18, 2022, the Board of County Commissioners of said Grant
County has let or is about to let to the Principal, a certain contract, the said contract providing
for the improvement of 3 -NE ROAD PHASE 3, CRP 21-03, located in Grant County, Washington,
(which contract is referred to herein and is made a part hereof as though attached hereto), and
WHEREAS, the said Principal has accepted, or is about to accept, the said contract, and
undertake to perform the work therein provided for in the manner and within the time set
forth;
NOW, THEREFORE, if the said Principal shall faithfully perform all of the provisions of
said contract in the manner and within the time therein set forth or within such extensions of
time as may be granted under said contract, and shall pay all laborers, mechanics,
subcontractors and material men, and all persons who shall supply said Principal or
subcontractors with provisions and supplies for the carrying on of said work, and shall hold said
Grant County harmless from any loss or damage occasioned to any person or property by
reason of any carelessness or negligence on the part of said Principal, or any subcontractor in
the performance of said work and shall indemnify and hold Grant County harmless from any
damage or expense by reason of failure of performance as specified in said contract or from
defects appearing or developing in the material or workmanship provided or performed under
said contract, and until the same is accepted, then and in that event this obligation shall be void
but otherwise it shall be and remain in full force and effect.
Countersigned: N/A
Swiss Re Corporate Solutions America Insurance Corporation
Licensed Agent/Surety Co.
Hentschell & Associates (agents
1436S. Union Ave. Tacoma, WA 98405
(253 ) 272-1151
Firm, Street Address (No P.O. Box), Phone of Local Office of Agent
3 -NE Rd. Phase 3, CRP 21-03
Wheeler Exca
by:
Principal
q(jo, ne Reinkensmeyer Attorney-in-fact, Surety
Approved as to Form:
2022
4reputy Prosecuting Attorney
Contract --Page 3
SWISS RE CORPORATE SOLUTIONS
SWISS RE CORPORATE SOLUTIONS AMERICA INSURANCE CORPORATION ("SRCSAIC")
SWISS RE CORPORATE SOLUTIONS PREMIER INSURANCE CORPORATION ("SRCSPIC")
WESTPORT INSURANCE CORPORATION ("WIC")
GENERAL POWER OF ATTORNEY
KNOW ALL MEN BY THESE PRESENTS, THAT SRCSAIC, a corporation duly organized and existing under laws of the State of Missouri, and
having its principal office in the City of Kansas City, Missouri, and SRCSPIC, a corporation organized and existing under the laws of the State of
Missouri and having its principal office in the City of Kansas City, Missouri, and WIC, organized under the laws of the State of Missouri, and having its
principal office in the City of Kansas City, Missouri, each does hereby make, constitute and appoint:
THOMAS P. HENTSCHELL, BRADLEY A. ROBERTS, JULIE A. CRAKER, AND JOANNE REINKENSMEYER
JOINTLY OR SEVERALLY
Its true and lawful Attorneys) -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 surety, on contracts of suretyship as are or may be required or permitted by
law, regulation, contract or otherwise, provided that no bond or undertaking or contract 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 SRCSAIC and SRCSPIC at meetings duly called and held on the 18th of November 2021 and WIC by written consent of its
Executive Committee dated July 18, 2011.
"RESOLVED, that any two of the President, any Managing Director, any Senior Vice President, any 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 Corporation 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 Corporation; and it is
FURTHER RESOLVED, that the signature of such officers and the seal of the Corporation 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 Corporation when so affixed and in the future with retard to anv bond, undertaking or contract of surety to which it is attached."
O*��7�Y11 Y ipt' F�yII,I,�M��y/,IMI r,�� N�g1��1 � R I�IgY�,Mj'1
,y�ot*
..re°ri+JwMr.�#8h*Ir�r�Mt/�»_..w��F+•:._:+a,r
•
CT'`" : = Prik Janssens Senior Vice President of SRCSAIC & Senior Vice President 'Cj Byti
A
M, «S E �.Z of SRCSPIC & Senior Vice President of WIC �
EA. y �.
rN
0
tri rr. 1973
�r4/ y; moi" Cd V��r rr
""►"% �! _'{/1lp�l � y.4'� rr *.� +°'11 i"R Ai" rr ryqy.y��M1s�, ■° ��ti"r' i ��# � 0�E
fr.� '°wT rr.} ,�i,A°r� M�\4 1�� '" •l,fl S 0•y }l7. ,`rli, * •"
*11
+C1 wti�1�M '09;
Ll �".rtr�.��yw► By ON
♦��'�rA�a�, A�s�k�+`` ; '09 *�"` Gerald Jagrowski, Vice President of SRCSAIC & Vice President of SRCSPIC
& Vice President of WIC
IN WITNESS WHEREOF, SRCSAIC, SRCSPIC, and WIC have caused their official seals to be hereunto affixed, and these presents to be signed by their
authorized officers
this10 day of NOVEMBER 20 22
Swiss Re Corporate Solutions America Insurance Corporation
State of IllinoisSwiss Re Corporate Solutions Premier Insurance Corporation
County of Cook ss Westport Insurance Corporation
On this 10 day of NOVEMBER � 20 22 , before me, a Notary Public personally appeared Erik Janssens , Senior Vice President of SRCSAIC
and Senior Vice President of SRCSPIC and Senior Vice President of WIC and Gerald JaQrowski , Vice President of SRCSAIC and Vice President of
SPCSPIC and Vice President of WIC, 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.
omotAL SM.
Plow
I, Jeffrey Goldberg, the duly elected Senior Vice President and Assistant Secretary of SRCSAIC and SRCSPIC and WIC, do hereby certify that the above and
foregoing is a true and correct copy of a Power of Attorney given by said SRCSAIC and SRCSPIC and WIC, whic is still in f ll force and effect.
IN WITNESS WHEREOF, I have set my hand and affixed the seals of the Companies this�day of s.20
22
Jeffrey Goldberg, Senior Vice President &
Assistant Secretary of SRCSAIC and
SRCSPIC and WIC
j .
T(?: Board of County ComrnissiQners Date: 2022
Qrant C-Qvnty, Wa�hin&tQn
TN.* wtiflo thot th@ 9.0944DO ha AiWnO the locotIon qf S-rN.E RP 41-!
V ROAD PHA59 3,
Q3,, in Grant County, washln#�Qn' 4, lid that th
Q plqns,, spq�ific
Ooms ond �Q�itr-act governing
work embraced in the impmvement and therinethod �y which paymerlt wi
HI be mad�p for spid,
work is vnderstQQd, T e t e
h. jnd rsIg;ied hpre4%j pmpq5e.� tp underta4 od. cpmp-10. the wi?rk
qm�raccd in this improvement, or as mt-4gh thereof o. can �q �ornple.tqd with tho
money
awila�lp In a�cp rd *th
a, nGip wi M plans, �PeccatiQn4 4nd contract and at the fqllo'wing
sOodule of ratcs and Prim.
S-PNE ROAP
Noftw L_Jn4t- i Qn o
I , prIfq§ for oil itom
oil PXtipns' total A
nd, rn.,-Vnt rnu5t Oe, Opm., Pleia�e type
W§0 ink. Rloajo initl4l oll cho
--- IN ga.- . , - -7 ='
1 te m- Pion Itom D04gipt
PrIcq por Unit" To* AMPOM
N9, Quantity
001 l cents P011m. Cents
CZ
AL a
PRE ATI
9 VA 2 7 $W-7-- V .M N.� 1`4
Mpbllli�oflpn 1, A t
Lump Stim
Per ^svmp 5"rji
HT1 an t
A,
L14MP 5,,UM
Per Lwmp 5 -urn
-:
77-.r-
74
........ .
, T
304750 R09milling 5itPa -n@p t At
fi
S.Y.
ro
�. ~ . r Per $q,uarq YArd-
--rl
7-7- 7 `=7
atip,
•
". I 'd
4 Y
c Y.
Haji
Per Cubic YmrO___•,
9- Z Fmbon�'ry)ent CQ'qipo
I At
Old 6*0
4 /.3, 69
r•. -:t- q: '•'a W c Yard
RAINAGE
va
Th
n P A
too
P!pr Liriepr P-Ipqt
.7 la -
4.,,ys.��urc�tacxs�.,,�w.a:,w.:f.ua��wc� :r a.>. -t �. .e �.�m. � - �. ,. _.- _ .._ .. - _. _ -. � "-•`--�I •-.e<^-.'�.... - �,�. - _, _s._� �.: �_ia:,:7� _._: :yam. _. -._ - - __ :�,�,...,_;:..:r .... _ .3...g,x..:,.�aesscse.�s+re'... _ _
Item Plea Item Pewiption Price per Unit*.. Total Arnount
No. Quantity Do t Dollars Cents
tr�"r•'n ��S'�. ;.-;��,mZ'�"e_`�'^ "<`+ ys••:: s; s'�q%-.""`:4p?'" �^'.-#"`ate"'.^._ .... 's"'+d_:: s .:-�: t,:-_t"r••^.�x:r.^--7'•"C�'•w"r,,�y".�s.•^ry..�.g..•.mr*a-.s.-r-•3'•".e :.: '"""�""oe.'m:�:r:+w,..r.e:����tidaud.�ars,..-r
'•^'y ':rpt` -sem; �..�- r^^sr^;.r
'18
, 7_.'
<.,_•" „ _ ._ .-- "`.. �'
$pCC Plan£ At
a k
Per
cl
L - .
+ny�a.-raw-a-..a-.. .4 -;:,. �.: : �^-"-r-.. -r, .; vgc.,•::>r r^--.� ..,._..�"r'..E,a.,-•• •{;,'" ,.+-ry i< ..... �,:' ... -...t .. _. _ �:.. _,a s -.^r_
`%.' •:t`^,.y-yy, .;,,>&'S. r-..= - .-:,.i. ^t,F 4`.:^ ;. ..,,;�. :-T-S-:pn+�:¢�r..y. ..t., d. '.'.'i �" 9 �.�. �f .. - ik - �;4- t.�-. ¢.a�+.
,
-- 1 Monument At
1476
x,�_. .r, p,;,,•..: . :..:::.y,;,r.. �. r.., .. ,.. .. � .r a:�...i;�^+- .r,.,,•-••.-..,..�.,...`•,.jr r _ .J -:.1.-- `""'_ , _ �� __ 3.. - •+,-;v-
_t '-.ar:mx.'�r: ^i'rr '-':� -i, _ c:x--•e re•�rm^-•g•-rr'•�-s-'�•'a :'�?"-r. ,�'-=.�-r.n'ry-'.. r -'„yr... ",..� x . � - _ ,--a _ < .�.. a-. y .. .':.",=t,�,,.Q"„y,.y.. -_.....N._....-., ;rr. �.,.--r y.a.'1'1'..,• '^4 .""".s:."^'^....�y„s".u^'.�,r• y�-'--'•.•., ••+-:•-•-.r,
.ti .
T'-
Trimmino andCle.'pnup At
W ��1 .
., _.. -..: �..•. .. .�: ;:.....,.y :_tu3. sir: tr :.5t4..^.:y'iT'°' r"'.•-.a.<•,...,,�--" r�+!.-x. -..,y �..,. ...._.,dri.:.z .,q ., ^e ,.�. 1 k' „-�_-•»^..:r. r-•-^'..•.r�•.,
.W.�,,+es,-�+.�.--'�'±.;w"Ks'^.',..�.n,..1j._ _ 0$8{�V7�'
fo,
y
qi6 4•.�' t, a -o- c�?' . �::' .. �� �'�^*S^.q,.^^��.�"^.c'i`^..+_'^row r -.l_ �.Y':yw..:r *.... uy'p.Fy- sp.. ,y ;ql. �.... .�. .�:_ w w'Y
See rtil'o 1 and k in .. At
5 y -. _
r
Akre With Roadside MixJV L9z) If
ION
Acre
-='777-7,"W raT-"-•rr:-r-r•'--^var-,-•i`. Y^z�-'•--•w - V - ... �TM---se•*v+-,sr�-.r- .aa,w•^i.- ..�.�.c•-,,�-"..r�•-
-�''h^g6�i4•...,� .s".:s:---���777 r„;�,:.� x ......-is +-xa:-�y^-ar.. ^••^-n 'R•^-e••�•r,_ .. *^'S,"""_...».,t..�......-� ,.,,V,:y ., Y'•*: _ t _ ""r.;;x �,.z a. •...._�. .. ... '�..f-....�...�....
$1100 Minpr Chanoe At
Est�f
• a
' '.: y'a'4'�w9z .'"CSr.':R7:�"""i_. x,q._..-,•�:wL ...y,. x,,......W....: ,.. .-r s• _, �'^e` , ..' '�" 'i., u..,...,A- -..., ' ..... "!C' •t c -... .r a �..,....., �. •,: •-.,.` s' .« . _ . .
r ,,.. -.w ��+-'-+-++-..,...ri•r-.",�r._.r �.9-��-,.: P: r�,... -:e'r _; µx.:-r-"t..r,_ r.;:". � ..7 ''.- : •-ey-r.,.•-_:'"kyr••':"-zn,'�r:nR•.:'•�-�-"•.s-¢'.:.a�=iF' : sw:':y"t,-.:'.:`�•t:-aa •�.^-lr. �''r'__� a+eai,�.3�:;aG�.t�2' :r�_;^r�v?35.'7;'T •s�--="".'p+: r'oa•;, _. �r,TM.ti-+a-" :.. -
The �idder he- reby certif i�s that, within the OreeyQar ppriod immediately pr@ceOins the
bid 5pliv-00oln 04 (JQ/10/70�2)j the. bi,dder i5 not 0 iwillfo @5 d§-flngd, in KW
Wviqlawr.
•
of any p_rp,,v14*1p-n of chaptus 4q,.46, 49-.48, or 49,5z RC s d
W, a e m- ined by a
finol and �jndlng qlt4tion 4nd notj�p of. asse4sment Issqed by the Qep�rtment Q
f La�pr anO
Indostries,qrthrot-ighociyiijud-omentqnter-ed�yacoqrtoflimitctdor e r i di i n.
I O@r cortify un pry vnder �ho 14 pqpolty of pqrji ws of the Stote Qf 'hid g0n that
-s tr u.9 ood qprregt.
v
Blddnr-s Bw6inpo, Norp@
pt,9 zefa
Printed N, a
1 0 , rn e
-11�
q,-he)c,,k One:
S, -ole PrQprleAorPor
oh1p tne
j r�hjp I )pInt. V@ntqq Co-rporotign
$tate of JnC--Qr-ppr4t-jUn., prWrpQr-oflonj yelp whore iniitw
4s
formedo
..n....». t ..tet. ` �•'�'.�;a!::"1•l:��r`'1"°,'�'/`..:�w�-.?�.:.v`�-rt•.r•r..,:r',--���r•;a-s�..�
If a qq!-pprtnerhipi - nom under whi�h b t. a A# d
l v- firm 11
'Ile
o corparvion, pra-pQwa! mim# bo gxo;vtv0 in Ov, (arpgroov 119,mg. by t4a proidmot qr
VjCCrprQ#d#n1 (Qr (.10 1f9r QCCQM 10# 4 .100
Y Oth@f 9.9 1 - to
-;QrPOF (C Qff P91) Y @V tt(;!p
sign
a vorport-pership, pmpolulmW, Ae oxw4ad by p pqrtngr-,
rrgpo4 4.
3' N,
Statement of Contractor Qualifications
TO: Board of County Ommi54ioners _/O
Grant CQtjnty,, VVoshington
RE 1 -NE ROAD PHASE 3, CRP
I herqby maintain that I an a r-q$pon5jole bldOr as cQnbmplated
�y the pili ciq$
qf the tf� 0
WAWngton and Chaptpr30,77 qf t Rveiq
h
e of W*ip&
. 0 9
My parmanipt n
Owo 4nO podrew§,W A.
7'
ph' nq
which I hove m�lrmkiO fpr. yqar�! my 9,-
2 1 havq ad ate plant g
qgipment tq q.gip@qltiqqsly and pr-gperiy tile w gontgrnp
9rqperly pq
rfprm k lateq
. .1 _ , _ ,
for (irant County, W, aihinton, P ndpfign of wo. rhv, TW ntrut prQyid @5 fpr the co tr tion
Qf 1"99 Millin of Rgad fQm MP 4.9; q two. lane qgqnty r-9 ponty.,
to M_ P go in Orant C
WA., and indwdv§ rq.p0w@y axqav4,tjq_n, qui an h.m §L I
qnt �-qrnpi�ctjgn, gv5he ,gtopir g ha5e cot
j r5a,
m0ed sprfacing kow up,, HMA, �p OOWRy o
_�#dffing anO
painteo edp Ono
centerline and 9the_r �qgr
all in oroonqe W.It�� the attuhO, �pntra�t Pja thsq Qontrcj�t
Pro_vWQn, and 0@ 5-t#pdard 5pg
§qd non this project �, (P 'Aop I* equipment to �e U
Mov. Ist if rlf-uugr
y
IeO
010'
-awl,
_1 _ 7 7qPjL -Tz---
3, have ao@q �q prom et Qbli�Oons in0dem� to this work. 1prc) NO,
u ptl Vid
r,,Q,ntagt phorv,
400
4. 1 have yOqqyatg �xp@rlfengie, in thli 004 -Of wgrk and, I am- thgroqghly fgroilia
vyith th
5pecJfK@V9ns used in this, pro Aha vq p .- -up.
,n�,trtqO the fpllc2w'ng�imilarimprovemerits,
(Provide
project narno, �onta�t
47—
-I XA_
Z. JNor
have to
50 d and, main -ain a-pnow -4 1$tanOprd Quo
�tIgnnqire and Finonjql Statem
ent"
the Mshington 5tat Department of Trop,5po, rtation MSDOT); Yes Q No V ion:
WSDOT has determinf4d, a) I �M proquAliflo d tQ
Q
in the ampqnt of
b) I ho
_vV fail tQ e qprU plif dr
q ligWing reqsons ,
jo foth@ tQ
. . . . . . . . . .
Th@ Contractino Aoengy may, dgWrip-ine a PrciweOfve Wddt�r whg nt)t prqqy@jjftd
to
%
q e Ftrk wilhin the floonvI4 _pd IVF ppsia_jns det@rpj1jjqd
ajn typ@5 pf WO iqL trt
�y W�QOT tp
Thi -4, 9@0 of OuntyCornn*09.n*r§ 01M
0! prPoed tp, owand ft gqntract tq th@ w g apo st
Wddur Ipwt rngy r.ejqc,-t any pr oil WdIf In it! QP'rj!!Pn vqO gtiju,5e Wst§ therp
Or. W"W �Or77404,
ti
I hereby w-tify that t, h@ a6vwp stp.tm�nti arq t rum and A
c grate.
Ve,ry truly yqwry,
cltyF tate zip; Lzea2A MAO" —
W45hington Ste je
SWISS RE CORPORATE SOLUTIONS
SWISS RE CORPORATE SOLUTIONS AMERICA INSURANCE CORPORATION F/K1A NORTH AMERICAN SPECIALTY INSURANCE. COMPANY ("SRCSAIC")
SWISS RE CORPORATE SOLUTIONS PREMIER INSURANCE CORPORATION F/KJA WASHINGTON MTERNATIONAL INSURANCE COMPANY ("SRCSPIC")
WEST ORT INSURANCE CORPORATION ("WIC")
GENERAL POWER OF ATTORNEY
KNOW ALL MEN BY THESE PRESENTS, THAT SRCSAIC, a corporation duly organized and existing undcr laws of the State of Missouri, and
having its principal office in the City of Kansas City, Missouri, and SRCSPIC, a corporation organized and existing under the laws of the State of
Missouri and having its principal office in the City of Kansas City, Missouri, and WIC, organized under the laws of the State of Missouri, and having its
principal office in the City of Kansas City, Missouri, each does hereby make, constitute and appoint:
THOMAS P. HENTSCHELL, BRADLEY, A. ROBERTS, JULIE A. CRAKER, and JOANNE REII' KENSMEYER
JOINTLY or SEVERALLY
Its true and lawful Attorneys}-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 surety, on contracts of suretyship as are or may be required or permitted by
law, regulation, contract or otherwise, provided that no bond or undertaking or contract or suretyship executed under this authority shall exceed the
amount of:
FIFTY MILLION ($50,000,000.00) DOLLARS
This Power of Attorney is granted and is signed by facsimile under and by the authority of the following Resolutions adopted by the Boards of
Directors of both SRCSAIC and SRCSPIC at meetings duly called and held on the I Sth of November 2021 and WIC by written consent of its
Executive Committee dated July 18, 2411.
"'RESOLVED, that any two of the President, any Managing Director, any Senior Vice President, any Vice President, the Secretary or any Assistant
Secretary be, and each or any of them hereby is, authorized to execute a Power of Attorney qualifying the attorney named in the given Power of
Attorney to execute on behalf of the Corporation bonds, undertakings and all contracts of surety, and that each or any of them hereby is authorized to
attest to the execution of any such Power of Attorney and to attach therein the seal of the Corporation; and it is
FURTHER RESOLVED, that the signature of such officers and the seal of the Corporation may be affixed to any such Power of Attorney or to
any certificate relating thereto by facsimile, and any such Power of Attorney or certificate bearing such facsimile signatures or facsirtuile seal shall be
binding upon the Corporation when so affixed and in the future with regard to any bond, undertaking or contract of surety to which it is attached."
SNOI1r"Mfprl%Q `Cj `�111l116�
CSC
ell
C�; •. �+ s ,, Era Janma , S"1W visa Proddtat of SRCSAIC do Seniw vte Prearideat
z t i ,•' gf$RCSPXC & Se br We FnWdent of WIC
out ESLcc :
E A L :_
• "• •
3
+��,�r*� WA4,.
�ld :�:5 �..����3�'� Gea, w&K vl* Pr Wd=t cfSRCSAIC & Via Preddent of SRCSPIC
044* � tit vke P'reddeot Of WIC
IN WITNESS WHEREOF, SRCSAIC, SRCSPIC, and WIC have caused their official seals to be hereunto affixed, and these presents too be signed by their
authorized officers
this 29TH day of APRIL 2022.
Swiss Re Corporate Solutions America Insurance Corporation
State of Illinois Swiss Re Corporate Solutions Premier Insurance Corporation
County of Cook Westport Insurance Corporation
On this 29TH day of APRIL , 24 22 before=, a Notary Public personally appeared Erik Janssens , Senior nice President of SRCSAIC
and Senior Vice President of SRCSPIC and Senior nice President of WIC and Gerald Lazgwski , Vice President of SRCSAIC and Vice President of
SPCSPIC and Vice President of WIC, 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 vee L1nta act and deed of ibei respective companies.
VO4MIN k PAM
0 FFICI AL UAL
NN&V how. Woo wool
ar+G•lr�tae+e� s �ei
Yasmin A. Patel, Notary
I, Jae ' rey. Goldberg, the duly elected Senior Vine President and Assistant Secretary of SRCSAIC and SRCSPIC and WIC, do hereby certify that the above and
foregoing is a true and correct copy of a Power of Attorney given by said SRCSAIC and SRCSPIC and WIC, which is still in full force and effect.
IN Wn NESS WHEREOF, I have set my hand and affixed the seals of the Companies this 111th day ofQctober , 2o22.'
Jeffrey Goldberg, Senior Vice President &
Assistant Secretary of SRCSAIC and
SRCSPIC and WIC
Washington State Disadvantaged Business Enterprise
qF` Department of Transportation (DBE) Bid Item Breakdown Form
1, Contract Number 2, Contract Name
iflz Lez _&/V
3. Prime Co tractur
4. Pri T e Contractor Repre entative Name
5. Prime Contractor Representative Phone Number 6. Prime Contractor Representative Email
Col
Column umn 8
7
Column I Column 2 Column 3 Column 4 Column 5 Column 6 Doll r Arnou
M _. a I "t
Total Unit
NarneofUDBE Bid Item # Full/Pirtial Quantity Description unit Price C� to, be Applied
ost
(See Instmcdo6s) hi�n'i) ($4 ei instmck6s) (S"fnsbucW* OvAe 1mtmctkm) 1owards G0111
nsuuc*m
(Soo Insbucu")
%Ali
*-
T_
Subtotal: $0.00 $0.00
Name of UDBE
Old Item
Full/Partial Quantity
Description
Total Unit Dollar Amount
,, to be Applied
Unit Pricecos t
T6viircls Goal
9i ^l
�zl"e-x 2S ->p ;z
_S__5
Vo
Subtotal. $0.00 $0.00
Name of UDBE
Bid Item #
FulMirtial
Quantity
Description
Total Uhl Dollotr Amount
Unit
---Unit Price 61 V� be'Appiled
ostTbivirds
Goal
aim
k
ISO
hr-, 4A -CIIJ4, -4H D
1
1*110 LS
M0
_q 0qtM, UA�
Subtotal: $ 0.00 $ 0.00
Name ofUDSE
Bid Kom #
FUJI/Paklal
Quantity
Description
Unit Price Total Unit Dollar Amount
to W AO Al
'Cost p ed
Towards Goal
It% 0
11 IXA
1� — I
Subtotal: $0.00 $0.00
m
TOTAL UDBE Dollar A ount $ TOO"
DOT Form 272-054
Revised 09/2020
OMMn
-ftdvantaged Business Ente e (DBE)
Itate rprM
S,
mt of Transportation
Written Confirmation Document
Sc -),e- (7ontract Pt�OVL"Sions '- DBE Docionent Subinitial Reqtdreinents
Di'vadvantaged Buvineats EnterpriseParticil7aion
THIS .FORM SHA -LL ONLY BE SUBMITTED TO A DBE Tli.. ` IS LISTED ON THE CONTRA-CTOWS
DISADVANTAGED BUEWES S ENTERPRISE UTILIZ.ATION CERTIFICATION.
THE CONTRACTOR SHALL COMPLETE PART A PRIOR TO SENDING TO THE DBE,
PART -1ohg—cqmTJetsd b the bl*d ir
The entries below shall be consistent what 'is shown on the Bidder's Disadvantaged Business Enterprise
Utilization Certification, Failure to do so will result in Bid rejecti-on.
Contract Title:
Bidder's Busl'ness Name:
DBE's Business Name,:
Description of DBE's Work:
Dollar Amount to be Applied Tr DB1!',G-Yoa1-.
Dollar Amount to be Subccvntraded to DB E*
*Optional Field
ed�P ess EntgM. ri
As an authon"zed representative of the. Disadvantaged Business Enterprise., I confirm that we hays been
contacted by the Bidder with regard to the referenced for the purpose of perfon-ning the Work described
above.. If the Bidder is awarded the Contract, we will enter ftito an agreement with the Bidder to participate in
the project consistent with th-e, nformafion provided in Part A of this form.
Name (printed).,'
Signature:
'1e. -
Address:
14e. -
Address:
�lLi'� ll AV 4. 4,`� �6'bz
DOT Form 422-031
Revised 0712016
I M- I 0ZA7ffNV1 M,
Name/Title (please print)
Cer tfification, Nu mber '?)"o via
Phone Fax Signature
1501.3 ZI Leo
Address 1.0 . *op
u vI certify that the above information is oomph e ani accurate.
Email 0Date
10 Ia
DOT Form 272-05$
Revised 0912020
Disadvantaged Business Ento r*
rp ise
111'arg. on" Sul*
Depa 4*%ent of lVanspo"st ion
C! t
(0,,BE)T khIg, Cred *t Form.
PART A: TO BE COMPLETEDBY THE BIDDER,
This form is in support of the trucking commitment identified on the DBE Utilization Certification Form submitted with the proposal.
Please note that OSE s must be cerfified prior to time of submittal.
Federal Aid # Contract #
Project Name
2 04
if li$rting items by hours, or by lump suni amounts, please providecalctilations to substantiate the quantities listed.
I 'd
Use additional sheets as necessary.
Bidder
NameMitle (please print)
eAc
Phone Fax
Signature
L
Address 4r
;r3 Z6
1, certify that the above information i's complete an4 accurate.
Email
Date
PART 0, TO BE COMPLETED BY THE DBE TRUCKING FIRM
Note.- DOE t mcking firm parti'cllip abon may only be loredited as DSS ponidi ipation for the value of the hauling. services,not, for the
materials being hauled unless the truddnq firm, is also recognized as a supplier of the materials used on the project an approved
for this pr %t as a regular dealer.
I - Type of MaterW expected to be
hauled'?
i I M,
J.-
Tractor/trailers:
2. Number of fully operational trucks
Dump trucks:
expected to be used on this project?
AOn
3. Number of trucks and trailers owned by
Tractor/trailers: Dump trucks:
the DBE that will be used onthis
project'?
4. Number of trucks and trailers leased by
Tractor traders. Dump trucks:
the DBE that will be used on this
Name/Title (please print)
Cer tfification, Nu mber '?)"o via
Phone Fax Signature
1501.3 ZI Leo
Address 1.0 . *op
u vI certify that the above information is oomph e ani accurate.
Email 0Date
10 Ia
DOT Form 272-05$
Revised 0912020
shington State Disadvantaged Business Enterpnse (DBE)
Department of Transportation Written Confirmation Document
See Contract 1,181,011S., ME Docl'wnew Sithinittol
M, CIL�ecl Business Enicipt-'w Par
TI --II S FO R NVI SSI: 1- L.. () NN I -.Y B1. S LJUNJ I "I "YE, D 1`0 A D B E J- I- I M' I S 1- 1 S'1- E D () N 'F I i I C' N ' I R A ( 1 R
DISA DVANTA(i FD BU11SINESS FNITRPRISF, tiTILIZATION (T-`RTIFICA-1-1 (r -)N.
CONTRAC-FOR SHALL CON -1 M.- 1-14"' PA.R1-'A PRIOR 1-0 SEINDIN(J 11) T111`1 Mil".
RA RT A -6 TO b e c o leted 4,y
j1je bidder
'I'lic entries below shall be consistent with �N.,-,hai is shwvn on the ad
Disvantaged BuSli-icss Enterpr-
Litt I I lz(,Atl()Il Certification. Fallure to dog so NSUtt In Bid re,le%cstroll.
o n t ra ct Title. AIL
5 . ...... -------
Bidder's BU.Siness'Nanie:- "eet,
DBE's Business Name: _ZY,
Description of DBE's NA)"ork: .12
Dollar AniOL111t to be Applied Tc vvards DBF- Goal: -3
D.011ar Aniount to beSUhcontracted to DBUl"', #4102 11 1 !� ?-.
'Optional Field
PART B.- TO be co!pjjttjg, 4
_djly_the Disaclyantp I nterp IS(!
- gg.d..Bus"ness E -r—
As an authorized representative of the Disadvantaged Business Enterprise,, Iconfirm that we has ,-e been
contacted by the Bidder with regard to the referenced project or the PL11-POS e of perfoniiing the Work descr-lbed
above, If the Bidder is aixarded the Contract, we %vill enter into an agreement with the Bidder to participiate in
the project consistent kvith the information provided in Part A of this fora'.
Name (printed)- Stephame.-Simpkins
Signature.,
'Fitle.
Address:
DOT Forrr 422-031
Revised 0712016
President
PO Box 607
Liberty Lake WA, 99019
Date: 10/18/22