HomeMy WebLinkAboutAgreements/Contracts - Public Works (003)K 19-054
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 Revised Code of Washington,
as amended, hereinafter called the County, and til rW) S�cxr to&I QLn,� 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 Centerline and Shoulder Rumble Strips, CRP 18-07, located in Grant
County, Washington, as proposed in a bid opened 1:30 P.M., Tuesday, March 26, 2019 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 the 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.
S. It is further provided that no liability shall attach to the County by reason of entering into
this contract, except as expressly provided herein.
mble 5trips CRP 18-07Contract —
APR 'I 2015
RANT COUNTY COI ,41ISSIONERS
IN WITNESS WHEREOF, the said Contractor has executed this instrument, and the said
Board of County Commissioners of Grant County has caused this instrument to be executed by
and in the name of said Board by its Members, duly attested by its Clerk, the day and year below
written, and the seal of said Board to be hereunto affixed on said date.
7rk
ST:
of he Board
APPROVED AS TO FORM:
L�day of A, 2019
Deputy Prosecuting Attorney
� day of r 2019
v v Signature
Print Name
Firm lame
Address
City State Zip
Phone
BOARD OF COUNTY COMMISSIONERS
OF GRANT COUNTY, WASHINGTON
Done this day of '2019
Cha r
Member
Member
ne and Shoulder Rumble Strips CRP 18-07Contract —
CONTRACT BOND
KNOW ALL MEN BY THESE PRESENTS:
BOND No. 107058274
That we, the undersigned, North Star Enterprises, Inc. as
principal, and Travelers Casualty and Surety Company of America a
corporation organized and existing under the laws of the State of CT 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
Five Hundred Eighteen Thousand Eight Hundred Thirty and 56/100 Dollars _
($ 518,830.56 ) 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 Liberty Lake . Washington, this 8th day of April , 2019.
The conditions of the above obligation are such that:
WHEREAS, on March 26, 2019, 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 Centerline and Shoulder Rumble Strips, CRP 18-07, 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:
Travelers Casualty and Surety Company of America
Licensed Agent/5urety Co.
501 N. Riverpoint Blvd., Suite 403
Spokane, WA 99202
509 1 755-9338
Frtm, Street Address JNo P.0 Box), Phone of Local Office of Agent
North Star Enterprises, Inc.
Principal
Thomas V A DAMS Attortfey-fn-fact, Surety
Centerline and Shoulder Rumble Strips CRP 18-07Contract — Page 3
Approved as to form:
-
puty Prose ng Attorney
"DePuty Prose 1ft Attorney
Travelers Casualty and Surely Company of America
.A► Travelers Casualty and Surety Company
TRAVELERS J SL Paul Rre and Marine insurance Company
POWER OF ATTORNEY
KNOW ALL MEN BY THESE PRESENTS: That Travelers Casualty and Surety Company of America, Travelers Casualty and Surety Company, and St
Paul Fire and Marine Insurance Company are corporations duly organized under the laws of the State of Connecticut (herein collectively called the
"Companies"), and that the Companies do hereby make, constitute and appoint Thomas V A Davis, of Spokane, Washington, their true and lawful
Attomey-in-Fact to sign, execute, seal and admrnMedge any and all bonds, recognizences, conditional undertakings and other writings obligatory in
the nature thereof on behalf of the Companies in their business of guaranteeing the fidelity of parsons, guaranteeing the performance of contrails
and executing or guaranteeing bonds and undertakings required or permitted in any actions or proceedings allowed by law.
IN WITNESS WHEREOF, the Companies have caused this instrument to be signed, and their corporate seals to be hereto affixed, this 3rd day of February,
2017.
! s � � aos�orrte
• ht � *M+ �b
State of Connecticut
By:
City of Hartford ss. Robert L. Raney, Se r Vice President
On this the 3rd day of February, 2017, before me personally appeared Robert L. Raney, who acknowledged himself to be the Senior Vice President of
Travelers Casualty and Surety Company of America, Travelers Casualty and Surety Company, and St Paul Fire and Marine Insurance Company, and
that he, as such, being authorized so to do, executed the foregoing Instrument for the purposes therein Contained by signing on behalf of the corporations
by himself as a duty authorized officer.
M Witness Whereof, I hereunto set my hand and official seal.
a �-� .l
My Commission expires the 30th day of June, 2021 mt�ALA. UutR+R�k1
•
Marre C. Tetreauk, Notary Public
This Power of Attorney is granted under and by the authority of the following resolutions adopted by the Hoards of Directors of Travelers Casualty and
Surety Company of America, Travelers Casualty and Surety Company, and St. Paul Fire and Marine Insurance Company, which resolutions are now in
full force and effect, reading as follows:
RESOLVED, that the Chairman, the President, any Vice Chairman, any Executive Vice President, any Senior Vice President, any Vice President, any
Second Vice President, the Treasurer, any Assistant Treasurer, the Corporate Secretary or any Assistant Secretary may appoint Attorneys -In -Fact and
Agents to act for and on behalf of the Company and may give such appointee such authority as his or her certificate of authority may prescribe to sign with
the Company's name and seal with the Company's seal bonds, recognlzences, contracts of Indemnity, and other writings obligatory in the nature of a
bond, recognizance, or conditional undertaking, and any of said officers or the Board of Directors at any time may remove any such appointee and revoke
the power given him or her, and it is
FURTHER RESOLVED, that the Chairman, the President, any Vice Chairman, any Executive Vice President, any Senior Vice President or any Vice
President may delegate all or any part of the foregoing authority to one or more officers or employees of this Company, Provided that each such delegation
Is in writing and a copy thereof is tiled In the office of the Secretary; and it is
FURTHER RESOLVED, that any bond, recognizance, contract of indemnity, or writing obligatory in the nature of a bond, recognizance, or conditional
undertaking shall be valid and binding upon the Company when (a) signed by the President, any Vice Chairman, any Executive Vice President, any Senior
Vice President or any Vice President, any Second Vice President, the Treasurer, any Assistant Treasurer, the Corporate Secretary or any Assistant
Secretary and duly attested and sealed with the Company's seal by a Secretary or Assistant Secretary; or (b) duly executed (under seal, If required) by
one or more Attomeys-in-Fact and Agents pursuant to the power prescribed in his or her certificate or their certificates of authority or by one or more
Company officers pursuant to a written delegation of authority; and it Is
FURTHER RESOLVED, that the signature of each of the following officers: President, any Executive Vice President, any Senior Vice President, any Vioe
President, any Assistant Vice President, any Secretary, any Assistant Secretary, and the seal of the Company may be affixed by facsimile to any Power
of Attorney or to any certificate relating thereto appointing Resident Vice Presidents, Resident Assistant Secretaries or Attomeys-in-Fact for purposes only
of executing and attesting bonds and undertakings and other writings obligatory in the nature thereof, and any such Power of Attorney or certificate bearing
such facsimile signature or facsimile seal shall be valid and binding upon the Company and any such power so executed and certified by such facsimile
signature and facsimile seal shall be valid and binding on the Company In the future with respect to any bond or understanding to which it is attached.
I, Kevin E. Hughes, the undersigned, Assistant Secretary of Travelers Casualty and Surety Company of America, Travelers Casualty and Surety
Company, and St Paul Fire and Marine Insurance Company, do hereby certify that the above and foregoing is a true and correct copy of the Power of
Attorney executed by said Companies, which remains in full force and effect.
Dated this sin day of Aprn , 2019
� E A
9 Kevin E. Hughes, Assistant Secretary
To rarity the andrenhVfy ofbkhr Power ofAEtbrney, pdfaese m# tm at 1 -OW 421 388&
PAsese n0isr to Ere abrin -named Aft ornmer in-Factand die aWWk of 0e bond to whidi ftse power Is aMm*d.
PROPOSAL
To: Board of County Commissioners Date: 3 al � 2019
Grant County, Washington
This certifies that the undersigned has examined the location of Centerline and Shoulder Rumble
Strips, CRP 18-07, in Grant County, Washington, and that the plans, specifications and contract
governing the work embraced in the improvement, and the method by which payment will be
made for said work is understood. The undersigned hereby proposes to undertake and complete
the work embraced in this improvement, or as much thereof as can be completed with the money
available in accordance with said plans, specifications and contract and at the following schedule
of rates and prices.
Centerline and Shoulder Rumble Strips
Note: Unit prices for all items, all extensions, and total amount must be shown. Please type or
use ink. Please initial all changes.
Item
Plan
Item Description
Price per Unit*
Total Amount
No.
Quantity
Dollars. Cents
I Dollars. Cents
PREPARATION
1
1
Mobilization
At
Lump Sum
/////////•/////
asi 000.00
Per Lump Sum
2
1
Notification
At
Lump Sum
/////////•/////
15o -00
Per Lump Sum
TRAFFIC
3
108.83
Centerline Rumble Strip
At
Mile
_715 -DV
%5j4,;1-55
Per Mile
4
217.66
Shoulder Rumble Strip
At
Mile
TS .ao
no, u93- Io
Per Mile
5
554,881
Paint Line
At
L.F.
. 11
Ula 03U . of 1
Per Linear Foot
6
1
Project Temporary Traffic Control
At
Lump Sum
/////////•/////
1l a7, Off' 00
PerLump Sum
Item
Plan
Item Description
Price per Unit*
Total Amount
No.
Quantity
Countermeasure (SPCC) Plan/
Dollars. Cents
I Dollars. Cents
OTHER ITEMS
7
1
Spill Prevention, Control, and
At
Lump Sum
Countermeasure (SPCC) Plan/
j///// j j, j/// j
-150 , vp
Per Lump Sum
8
Calculated
Minor Changes
At
-$1.00
Calculated
Contract Total
Certification of Compliance with Wage Payment Statutes
The bidder hereby certifies that, within the three-year period immediately preceding the
bid solicitation date (2/25/2019), the bidder is not a "willful" violator, as defined in RCW
49.48.082, of any provision of chapters 49.46, 49.48, or 49.52 RCW, as determined by a
final and binding citation and notice of assessment issued by the Department of labor
and Industries or through a civil judgment entered by a court of limited or general
jurisdiction.
I certify under penalty of perjury under the laws of the State of Washington that the
foregoing is true and correct.
Nown 5kc►.r
Bidder's Business Name
n of Alithorized Official*
at'p 4g �� �T �iin5
Printe Name
fc 1
Me
Date City State
Check One:
Sale Proprietorship ❑ Partnership ❑ Joint Venture ❑ Corporations
State of Incorporation, or if not a corporation, State where business entity was
formed:
yV t
If a co -partnership, give firm name under which business is transacted:
* if a corporation, proposal must be executed in the corporate name by the president or
vice-president (or any other corporate officer accompanied by evidence of authority to
sign). if a ca partnership, proposal must be executed by a partner.
r Failure to return this Declaration as part of the bid proposal package
will make the bid nonresponsive and ineligible for award.
NON -COLLUSION DECLARATION
I, by signing the proposal, hereby declare, under penalty of perjury under the laws of the
United States that the following statements are true and correct:
1. That the undersigned person(s), firm, association, or corporation has (have) not,
either directly or indirectly, entered into any agreement, participated in any
collusion, or otherwise taken any action in restraint of free competitive bidding in
connection with the project for which this proposal is submitted.
2. That by signing the signature page of this proposal, I am deemed to have signed
and to have agreed to the provisions of this declaration.
To report rigging activities call:
Notice to All Bidders
1-800-424-9071
The U.S. Department of Transportation (USDOT) operates the above toll-free "hotline" Monday
through Friday, 8:00 a.m. to 5:00 p.m., Eastern Time. Anyone with knowledge of possible bid
rigging, bidder collusion, or other fraudulent activities should use the "hotline" to report such
activities.
The "hotline" is part of USDOT's continuing effort to identify and investigate highway
construction contract fraud and abuse and is operated under the direction of the USDOT
Inspector General. All information will be treated confidentially and caller anonymity will be
respected.
a
roposai —
Proposal —`Signature Page
The'bidder,is hereby advised that by signature of this proposal he/she is deemed to have
acknowledged all requirements and signed all certificates Ontaine0erein.
A proposal guaranty in an amount of five percent (5%) of the total bid, _based upon the
approximate estimate of quantities at the above;prices and in the form as indicated.beiow, is
attached hereto:
Cash 0 In the Amount of
CashIdet Check ❑ Dollars
Certified Check 0 ($ } Payableto_the Grant County Treasurer
Proposal Bond X In the Amount of 5% of the'Bid
Receipt is hereby acknowledged of addendum(s) No.(s) I SL &
Signature of Authorized Officials)
Proposal Must Be Signed
ckylkg-
Please Print Name of Authorizecial
Firm Name�h
Address V LtLO
,A f V1—P I %A,
_ a
State of Washington Contractor's License No. N_O 014 D 5 -
Federal ID No.
Note:
(i) This proposal form is not transferable and airy alteration entered hereon without prior, permission from the county
Engineer will be. cause The considering the proposal irregular and subsequent rejection of bid.
(2) Please rtafe to section 1-02.6 of_the standard specifications, re:"Preparadon of Proposer or "Article 4" of the
instructlons to bidders for buildingcgristnrction Jobs.
(3) Should it be necessary to mod*, this proposal either in writing or electronic means,
ng by please make reference to the
following proposal number in your communication:
Rkied 8/95
Statement of Contractor Qualifications
To: Board of County Commissioners Date: 0 2019
Grant County,'Washington
RE: Centerline and Shoulder Rumble Strips, CRP 18-07
I hereby maintain that I am a responsible bidder as contemplated by the policies of the State of
Washington and Chapter 36.77 of the Revised Code of Washington. ,
1. My permanent business name and address is 0 _
which I have maintained for IL years. My phone is ( Oq) 21"11 - OIA Fax (5D9 qaa "333 a
2. 1 have adequate plant equipment to expeditiously and properly perform the work contemplated
for Grant County, Washington. Description of work: This contract provides for the installation of
centerline and shoulder rumble strips, County Wide, on two lane county roads in Grant County,
WA, and includes project temporary traffic control and other work, all in accordance with the
attached Contract Plans, these Contract Provisions and the Standard Specifications. (Please list
equipment to be used on this pr Attach list if necessary.) l _
3. 1 have adequate funds to promptly meet obligations
4.
bank, contact
nhone.) a) ��\ . AAOCA i N b)
txi-t- yo51-\1KOX - c)(50S -5 A A
I have adequate experience in this class of work and I am thoroughly familiar with the
specifications used in this project. I have constructed the following similar improvements:
(Provide project name, contact & phone.) ftPV\ '�-i1�ft{1�50°17 Say",aa5r�
at bye., S -W\
b) a 1 - -29M c)
Mnn1: r,.\ 1r,,Vffi IV, .���nn - �Mti�� �Pr\\.o.r\("Sna►7 ��L1-1 oaSd`
S. I have submitted and maintain annuallya''Standard Questionnaire and Financial Statement" to
the Washington State Department of Transportation (WSDOT): Yes K No O Region:
WSDOT has determined: a) J amrequalified to &ry - 4.,��MEAS-
Q0
S -
Q0 t1� c o \ in the amount of \A. 0 r
b) I have failed to be prequalified for the following reasons:
The Contracting Agency may determine a prospective Bidder who is not prequalified to perform
certain types of work within the financial and experience constraints determined by WSDOT to
be not responsible and refuse to award a contract.
The Board of County Commissioners shall proceed to award the contract to the lowest and best
bidder but may reject any or all bids if in its opinion good cause exists therefor. (RCW 36.77.040)
1 hereby certify that the above statements are true and accurate.
By:
(Print Name)
Company Name:
Address:
City, State, Zip:
Washington State Contractor's License No.:
Revised 4/02
W.,
Bid Bond
KNOW ALL MEN BY THESE PRESENTS:
That we, North Star Enterprises, Inc. , as
Principal, and Travelers Casualty and Surety Company of America , as
Surety, are held and firmly bound unto Grant County, Washington, as Obligee, in the penal sum
of 5 percent of the total amount of the bid proposal Dollars
($ 5% ) for the payment of which the Principal and Surety bind themselves,
their heirs, executors, administrators, successors and assigns, jointly and severally, by these
presents.
The condition of the obligation is such that if the Obligee shall make any award to the
Principal for Centerline and Shoulder Rumble Strips, CRP 18-07, located in Grant County,
Washington, according to the terms of the proposal or bid made by the Principal therefor, and
the Principal shall duly make and enter into a contract with the Obligee in accordance with the
terms of said proposal or bid and award and shall give bond for the faithful performance
thereof, with the Surety or Sureties approved by the Obligee; or if the principal shall, in case of
failure so to do, pay and forfeit to the Obligee the penal amount of the deposit specified in the
call for bids, then this obligation shall be null and void; otherwise it shall be and remain in full
force and effect and the Surety shall forthwith pay and forfeit to the Obligee, as penalty and
liquidated damages, the amount of this bond.
SIGNED, SEALED AND DATED THIS 114 _h_ DAY OF March , 2019
Principals
-T_
Surety AN
Attorney -in -Pact Thomas V.A. Davis
Travelers Casualty and Surety Company of America
A Travelers Casualty and Surety Company
TRAVELERS J St. Paul Fire and Marine insurance Company
POWER OF ATTORNEY
KNOW ALL MEN BY THESE PRESENTS: That Travelers Casualty and Surety Company of America, Travelers Casualty and Surety Company, and St
Paul Fire and Marine Insurance Company are corporations duly organized under the laws of the State of Connecticut (herein collectively called the
"Companies"), and that the Companies do hereby make, constitute and appoint Thomas V A Davis, of Spokane. Washington, their true and lawful
Attorney -In -Fact to sign, execute, seal and acknowledge any and all bonds, recogniz aces, conditional undertakings and other writings obligatory in
the nature thereof on behalf of the Companies in thele business of guaranteeing the fidefity 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
IN WITNESS WHEREOF, the Companies have caused this instrument to be signed, and their corporate seals to be hereto affixed, this 3rd day of February,
2017.
��l �tt• y�
o .
s
State of Connecticut
By. •
City of Hartford ss. Robert L. Raney, Se or Vice President
On this the 3rd day of February, 2017, before me personally appeared Robert L. Raney, who acknowledged himself to be the Senior Vice President of
Travelers Casualty and Surety Company of America, Travelers Casualty and Surety Company, and St. Paul Fire and Marine Insurance Company, and
that he, as such, being authorized so to do, executed the foregoing instnrnent for the purposes therein contained by signing on behalf of the corporations
by himself as a duly authorized officer.
In Witness Whereof, I hereunto set my hand and official seal,
My Commission expires the 30th day of June, 2021 �`(iQJkJt . JnRDu1 AJk
• t t Marie C. Tetreault, Notary Pubic
This Power of Attorney Is granted under and by the authority of the.foilowing resolutions adopted by the Boards of Directors of Travelers Casualty and
Surety Company of America, Travelers Casualty and Surety Company, and St. Paul Fire and Marine Insurance Company, which resolutions are now in
full force and effect, reading as kftws:
RESOLVED, that the Chairman, the President, any Vice Chairman, any Executive Vice President, any Senior Vice President, any Vice President, any
Second Vice President, the Treasurer, any Assistant Treasurer. the Corporate Secretary or any Assistant Secretary may appoint Attorneys -in -Fact and
Agents to act for and on behalf of the Company and may give such appointee such authority as his or her certificate of authority may prescribe to sign with
the Company's name and seal with the Comparrys seal bonds, recognizances, contracts of Indemnity, and other writings obligatory in the nature of a
bard, recognizance, or conditional undertaking, and any of said officers or the Board of Directors at any time may remove any such appointee and revoke
the power given him or her, and it is
FURTHER RESOLVED, that the Chairman, the President, any Vice Chairman, any Executive Vice President, any Senior Vice President or any Vice
President may delegate all or any part of the foregoing authority to one or more officers or employees of this Company, provided that each such delegation
Is in writing and a copy thereof is filed In the office of the Secretary; and It is
FURTHER RESOLVED, that any bond, recognizance, contract of indemnity, or writing obligatory in the nature of a bond, recognizance, or conditional
undertaking shall be valid and binding upon the Company when (a) signed by the President, any Vice Chairman, any Executive Vice President, any Senior
Vice President or any Vice President, any Second Vice President, the Treasurer, any Assistant Treasurer, the Corporate Secretary or any Assistant
Secretary and duly attested and sealed with the Company's seal by a Secretary or Assistant Secretary, or (b) duly executed (under seal, if required) by
one or more Attorneys -in -Fact and Agents pursuant to the power prescribed in his or her certificate or their certificates of authority or by one or more
Company officers pursuant to a written delegation of authority; and It Is
FURTHER RESOLVED, that the signature of each of the following officers: President, any Executive Vice President, any Senior Vice President, any Vice
President, any Assistant Vice President, any Secretary, any Assistant Secretary, and the seal of the Company may be affixed by facsimile to any Power
of Attorney or to any curtificate relating thereto appointing Resident Vice Presidents, Resident Assistant Secretaries or Attomeys-in-Fad for purposes only
of execu ft and attesting bonds and undertakings and other writings obligatory in the nature thereof, and any such Power of Attorney or certificate bearing
such facsimile signature or facsimile seal shall be valid and binding upon the Company and any such power so executed and certified by such facsimile
signature and facsimile seal shall be valid and binding on the Company, in the future with respect to any bond or understanding to which it Is attached.
I, Kevin E. Hughes, the undersigned, Assistant Secretary of Travelers Casualty and Surety Company of America, Travelers Casualty and Surety
Company. and St. Paul Fire and Marine Insurance Company, do hereby certify that the above and foregoing Is a true end coned copy of the Power of
Attorney executed by said Companies, which remains In full force and effect.
Dated this 14th day of mach ch , 2019
�� j Jin •«.4 00
v
K�evkn E. Hughes, Assistant Secretary
To vwW dee audrent/dty of this Pkmw ofAtt mey, please caul us at I -BOR -421 38M
Please f efer to the above named Attorney -In -fact and the details of dw bond to which die power is aetrdied
Adak
ft
wv. of �nanaolls.�
Underutilized Disadvantaged Business
Enterprise Utilization Certification
To be eligible for Award of this Contract the Bidder shall fill out and submit, as a supplement to its sealed Bid Proposal, an
Underutilized Disadvantaged Business Enterprise (UDBE) Utilization Certification. The Contracting Agency shall consider
as non-responsive and shall reject any Bid Proposal that does not contain a UDBE Utilization Certification which properly
demonstrates that the Bidder will meet the UDBE participation requirements in one of the manners provided for in the
proposed Contract. Refer to the instructions on Page 2 when filling out this form or the Bid may be rejected. An
example form has been provided on Page 3. The successful Bidder's UDBE Utilization Certification shall be deemed a
part of the resulting Contract.
Box 1: North Star Enterprises{Inc. certifies that the UDBE firms listed below have been contacted
regarding participation on this project. If this Bidder is successful on this project and is awarded the Contract, it shall
assure that subcontracts or supply agreements are executed with named UDBEs. (If necessary, use additional sheets.)
Box 2: Centerline & Shoulder Rumble Strips
Column 1
Name of UDBE
(See instructions)
Column 2
Project Role
(See instructions)
Column 3
Description of Work
(See instructions)
Column 4
Dollar Amount
Subcontracted
to UDBE
(See Insltuctions)
Column 5
Dollar Amount
to be Applied
Towards Goal
(See Instructions)
Awlrew Michael Cortins
DBA Andrew Michael
Subcontractor
Dump Trucking
$31,500.00
S31,500.00
Underutilized Disadvantaged Business 6% Total UDBE Commitment Dollar Amount 31.500.00
Enterprise Condition of Award Contract Goal Box 3 Box 4
5 EBy checking Box 5 the Bidder is stating that their attempts to solicit sufficient UDBE participation to meet
the OA Contract goal has been unsuccessful and good faith effort will be submitted in accordance with
Section 1-02.9 of the Contract
DOT Form 272 -MU
Revised 0212018
ffir"Depail,tilnent
�Washington State Underutilized Disadvantaged Business
of Transportation Enterprise (UDBE) Written
Confirmation Document
See Contract Provisions: UDBE Document Submittal Requirements
Dicadrantaged Business Enterprise Participation
THIS FORM SHALL ONLY BE SUBMITTED TO A UDBE THAT IS LISTED ON THE CONTRACTOR'S
UNDERUTILIZED DISADVANTAGED BUSINESS ENTERPRISE UTILIZATION CERTIFICATION.
THE CONTRACTOR SHALL COMPLETE PART A PRIOR TO SENDING TO THE UDBE.
PART A: 'J'o be completed by the bidder
The entries below shall be consistent with what is shown on the Bidder's Underutilized Disadvantaged Business
Enterprise Utilization Certification. Failure to do so will result in Bid rejection,
Contract Title: Centerline & Shoulder Rumble Strips
Bidder's Business Name: North Star Enterprisesl Inc.
UDBE's Business Name: Andrew Michael Cortinas. DBA Andrew Micheal Cortinas
Description of UDBE's Work: Dump Trucking
Dollar Amount to be Applied Towards UDBE Goal: 31,500.00
Dollar Amount to be Subcontracted to UDBE*:
'Optional Field
PART B: To bs_comoleted by the Underutilized Disadvantaged Business F„te[ rise
As an authorized representative of the Underutilized Disadvantaged Business Enterprise, I confirm that we
have been contacted by the Bidder with regard to the referenced project for the purpose of performing the Work
described above. If the Bidder is awarded the Contract, we will enter into an agreement with the Bidder to
participate in the project consistent with the information provided in Part A of this form.
Name (printed):
Signature:
Title -
Address:
DOT Form 422-031 U
Revised 02/2018
Owner
2304 N 7th St
Coeur d alene. Id 83814
Date: March 25, 2019