HomeMy WebLinkAboutBid
Prescribed by the Slate Booard of Accounts
Form No. 96 (Revised 2000)
1
o
CONTRACTORS BID FOR PUBLIC WORKS
PART I
(To be completed for all bids)
(Please type or print)
Ken Ellis Senior Center .
Date: l:j 11 R IOn
1. Governmental Unit (Owner): City of Jeffersonville
2. I County:
I
3. . Bidder (Firm):
Clark
J{pvr'o i'on~t l"11r't: ; on. Lr.i'
Address:
P.O. Box 3243.
City/State:
Louisville. KY40201-3243
(502)635-1641
4. Telephorie Number:
5. Agent of Bidder (if applicable):
{'\
Pursuant to notices given. the undersigned offers to furnish labor and/or material necessary to
complete the public works project of
J{pn ~11i9 5~n~nr Cpnrp~ ~PG #JFFF022
. ,
(Governmental Unit) in accordance with plans and specifications' prepared byThe Estopinal Group,
903 Sp~inq Street,Jeff.,IN
. il
and dated
Mav 18,2006
for the sum of
$
The undersigned further agrees to furnish a bond or certified check with this bid for anamount'specified in the notice
of the letting. If alternative bids apply. the undersigned submits a proposal for each in accordance with the notice.
Any addendums attached will be specifically referenced at the applicable page.
If additional units of material included in the contract are needed, the cost of the units must be the same
as that shovtn in the original contract if accepted by the Government Unit. Ifthe bid is to be awarded on a unit basis,
the itemization of the units shall be shown on a separate attachment.
The Contractor and his subcontractors, if any. shall not discriminate against or intimidate any employee.
or applicant for employment, to be employed in the performance of this contract, with respect to any matter directly
or indirectly related to employment because of race, religion, color, sex, national origin or ancestry. Bteach of this
covenant may be regarded as a material breach of the contract. J
CERTIFICATION OF USE OF UNITED STATES STEEL PRODUCTS
(If applicable)
I, the undersigned bidder or agent as a contractor on a public works project. understand my statutory
obligationto use steel products made in the United States. I.e. 5-16-8-2. I hereby certify that I and all subcontrac-
tors employed by me for this project will use U.S. steel products on this project if awarded. I understand that
violations hereunder may result in forfeiture of contractual payments.
>p
NON-COLLUSION AFFIDAVIT
r
The undersigned bidder or agent, being duly sworn on oath, says that he has not, nor has any other memo
ber. representative, or agent of the firm. company, corporation or partnership represented by him, entered into any
combination, collusion or agreement with any person relative to the price to be bid by anyone at suqh letting nor to
prevent any, person from bidding nor to induce anyone to refrain from bidding; and that this bid is made without
reference t~ any other bid and without .any agreement, understanding or combination with any other person in
reference to such bidding.
He further says that no person or persons, firms, or corpor,atiion has, have or will receive directly or indi-
rectly, any rebate, fee, gift, commission or thing of value on account of such contract.
OATH AND AFFIRMATION " 1
( affirm under penalties of perjury that the foregoing facts and information are true and correct
to the best of my knowledge and belief.
Dated at T.nl1 i ~vi , 1 Po _ R'V
.
this 18th
day of Me y
~evco Constt''\lction,LLC
By L~mz+~
Vice-President
, '(Title. of Person SIgning)
(',
I
STATE OF Kentucky
ACKNOWLEDGMENT
'COUNTY OF JeffQt'C!("'ln
)
) SS:
)
Kev; n Rostock, Jr. being duly sworn, deposes and sals that heis
vi ("'p 'Prr;;~i npnt-. of the above Kevco Construction.1 LLC and
. ' (Title) , (Name,of Organlzailon)
that the statements contained in the foregoing bid, certification and affidavit are true and correct.
Subscribed and sworn to before me this
18th
day of May , 2006'
~~~~
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My Commission Expires: ::JU/Y\.,~ _ /JD, :J6ll7
I
County of Residence: ~jbu. Ilrlt-
'''''I
ACCEPTANCE
r\i
The above bid is accepted this
conditions:
day of
. subject to the following
Contracting. Authority Members:
PARr II
(Complete sections I. II. III and IV for all state and local public works projects as required
b1statutes if project is one hundred thousanddollars ($100.000) or more. (IC 36-1-12-4)j
Governmental Unit: Ken Ell i s Senior Center
"Bidder (Firm):
T{pvC'n ~m'lRt.rllC't.; on. T.T.~
Date:
May 18, 2006
These statements to be submitted under oath by each bidder with and as a part of his bid Attachadditional
pages for each section as needed.
r,
SECTION I EXPERIENCE QUESTIONNAIRE
1. What public works projects has your organization completed for the period of one (.1) year prior to the date
of the current bid?
Cont act
Amount
Class of Work When. Completed
Name and Address of Owner
3
d
School
2. What p.ublicworks projects are now in process of construction by your organization?
0i
Contract Class of Work When to be Name and Address of Owner
Amount Completed
.
\
',...-....
3. Have you ever failed to complete any work awarded to you?
No
If 50, whe$ and why?
4. List references from private firms for which you have performed work.
Hllmana, Il1C' !=:r.~vp Fonnr.rlin E:)()() W. 'Mrlin !=:t.T.Oll.. Ky (502)"580-1380
~i~~~~~'H~~r{h~:~: ~~i~lo~~:r~~~o ~f)~~~ ~~~::~~ ~~8~~5~~6~~~~8
SECTION II PLAN AND EQUIPMENT QUESTONNAIRE
1. Explain your plan or layout for performing proposed work. (Examples could include a narrative of when you
could begin work, complete the project, number of workers, etc. and any other information which ybu
believe would enable the governmental unit to consider your bid.)
Per flans and Specs - Union Contractor
~.
2. If you intend to subject any portion of the work. state the name and address of each sUbcontractor,
equipmEfnt to be used by the subcontractor, and whether you expect to reqUire a bond. However. if you are
unable fto currently provide a listing, please understand, a listing must be provided prior to contract
approval.
See Bid Form
3. What equipment do you' have available to use for the proposed project? Any equipment to be used by
subcontractors may also be required to be listed by the govermental unit.
(Own or have access to all equipment needed.
(Truqks, skid Steer,Loader, Handtools, e~c.)
. '
1
4. Have you entered into contracts or received offers ,for all materials which substantiate the prices used in
preparing your proposal? Otherwise, please explain the rationale used which would corroborate the prices
listed.
NOI
,~,I
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SECTION III CONTRACTOR'S FINAN~IALSTATEMENT
Attachment of bidder's financial statement is mandatory. Any bid submitted without said financial state-
ment as required by statute shall thereby be rendered invalid. The financial statement provided hereunder to
the governing body awarding the contract must be specific enough in detail so thatsaid governing body can
make a proper determination of the bidder's capability for completing the project if awarded.
SECTION IV OATH AND AFFIRMATION
I hereby affirm under the penalties of perjury that the facts and information contained in the foregoing bid
for public works are true and. correct to the bestof my knowledge and belief.
Dated at Lou i sv; 1 le ..
this 18th dayof May
By
Kevrn ('nn~trilction. LLC
~ (Nam.e of organizatio. n)
.~~~;Z
Vice-President
(Title of Person Signing)
ACKNOWLEDGEMENT
STATE OF Kentucky
)
) SS:
)
COUNTY01 Jefferson
Kevin Bostock, Jr. being duly sworn, deposes and says that he is
Vice President of the above Kev("n ('oni=:+.rllr+.; on. LT.('
(Title) ( Name of Organization)
and that the answers. to the questions in the foregoing Questiohnaire and all statements therein contCj.ined
are true and !correct. .. . .
Subscribed and sworn to before me this 18th
d~ . . 200.6
cI~~.
Notary P lie
My Commission Expires: .::rt lM~ ~) ::x::vr;
County of Residence: '6r.."- Uttl-
APR-10-200f 13:01
STROTHMAN ~ coMPANY PSC "
5132 585 1601.
P.04/07 '
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aalance sheet.
KT'icaOanstrucuan;lLC.. ':'"
.D~embet 31; ~005 , ",
I J?MFfI
Assats '
C1!~::"~/;;;,/,. ,'<,:">
. .' . Co~ts and Ei$tlmated earnlngs'ln Qxclm ~1 bltllngs '. .
on uncompleted contracts
. loan to related employee .'
, Prepaid expenses and,othEir
. .' ;,
. . Totai Current Assais ..
.$ 863,407
f 1;842,304
1'97,1'38
. 39.144
9,770'
$,651,823
E~UiPm~nt ' ' .
Construction eq'ulpmerit' , .
Truck$ , ". ':..,.
. Offico. furniture and eqUipment,' .. '
......
"';-"
79,855
'172,~:3a
17,954
270,241
'(103i781) .
. .
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. .
iLess ac~~muliliecf d~pre?iatiori '. .
. '
Net' Eq'ulpmEint
166,4$6
Other ASSGts
Goodwill '
. ,
,*,eso
. '
. . LiI~*,i1it'Q$ and ~em~r"s Equity
$ 3,752,919.
Current LIabilities '. .... . .
AccQunts payable.... ,.... ' .' ';
Ai::oruecf expenses:, '
Loan payable to leWIs'Falr' .' . .
.: EilJing$ in ~GSS 0.1 costs and estimated earnings on uncompleted co'ntfacts
. Current portion of' iotlg~ierrr'l debt.. .' ...
t .
$ 1,6SB,946
:112,918
! 26,000..'
339,$52
24,730
I
. Long..i,~rm ~Gbt. I~~ c;u~ent pOrtion
. MamIHr'. Equity :.' ,,: ::
. ' ,
total'Currant Liabilities' 2,183,046
. t 23~~1
1,545,932 .
$ .3',752,919'
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see Aceountanfs' Revteyi'RElpert .
and No~~ to Financial Statem~nts' '. . '
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APR-10-2006 13=e2'
'SiRcm-IMAN . & cQMpF!NY F.sc,
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Statement of InC;ome 'and Me.mpe~~.~qu~. .; :.:." ;'.:-: .
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. K~vi;o. Construcitio~, l.i6..... '. .
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, . Year Ended. December 31,; '2005' .
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.contra~~~V$nu~~'../.;. .::,: .:......:.~....':::.......:..;.;C.:::.:.~.:.: ;.
Co;n~ct. Co'$t8 ' '. .)"
. Labor .
SUbcontractors
I. Mater1al$ .' . : .
. Union flinge bsnefits" . ;
Workmen's doinpen~tlon Insurance
Contract labor. .
. FayroJl t~es '.
Truck expensa '. '.
Depreclation . . .'. .' , , '.
Tools a~d equIpment ren~ :..... '.
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( ":.
~
. .
. Dumpster"expense'.'
Other Job costs
.'. To~l.Contraqt Costs'
. . .".
. Gross Profit
General and Admini*atiw ~pen:s~.~ .
Office salaries .., . '.
payrbirtaXeS and ben$flt$. ' .'
R~nt expeil:sa' .. .' :. . .: ".:.'. .
General Insurance- .
. I 'O:epreci~on
T etephona . .: ..' .
. Utiliti~':. .; .
. OffiCe expense' . ....., '.' .
. ProfeSsion'aJ fees' .... .:
Tilxe$'and licenses'. '.:
. '..
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O~es and s~~sCrlptJoi1s .: .:'. ..
Travel ':'. ":. '. . .'
custorn~r 'relatIons "
. BuIlding repairs
Advertising
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Cohtlnueci
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50a 585 1601
p.es/a?
4/1U/2.000
./URAFil
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$9,142,489, 100.0 %'
1,210,216 13.2
2,856,2.12 31.3
.:3,029.9~9 33.1
. 227,899 2.5
21,591 0.2
14 329 ' 0.2
,
0.1
36~648 0.4
39.660 0~4
88;2~9 1.0 .
16,760 0.2
. 11,440 :0.1
7,552,993 82.7
1 ,~S9A96 17.3
'.
. , . 1 'l.7. '
243,444 '
59,58a ,,0.7
18,000, . '0.2
. 8.e99 '0.1
- 0.0
16,836 .0.2
4,485 . 0.0
. 8,789 , 0.1
38,058' 0.4
64.761 0.1
.,1,~.1 0.0
.' 790 0.0
~,o~n 0.0.
'151 0.0
.' 7,2.73 p.1
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APR-10-2006. . 13: 02.
STROTI-lMAN 8. COMPANY PSC
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statame~ of I'ri.;om~"anctM~~bGr'S Equ1ty~ontin~~ .
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'KavcoCo'ri$t~ct~on.;'LLC '. . '. .' ....'.. .: ;'.'
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Year ~d~ ~eQember 31, 20Q5
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.Contrn:,)Ution~": ~;::."...,: ;'.:.':.. :....~....:........::.:..:::.
Ml'ials)md entertaInment :. . . ...... .' .:.: ".:
'Bad.de~ ..:.:....:.:,. .:", '. .
. Miscellaneous ".: ;':.. .... .: . .
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Total Gen~~1. and Administratiw E;cpensss
':,; 9p.~r~ting In~oma .
. ,~her.lncC;;ma'(Ex'pen$G) .'. .'
. Interest rricQrne. . .' ,':. ..'
. Gain on sala and disposal of ~ .
rnterest ~p~mse .. .
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Member's Equity ~~gi~nJ~'g of Year .
Distributions fQrYs~r.: .' .' :
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. .' Net Incom,
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and ~otas to Frnanchal statements .
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502 585 1601 fi .06/07
. 4/10(2006
I DRAFT I
~.a67 0.0
. -8~O72' 0.1.
:3,735 . 0.0
_ ,..8,814 0.1
497.610 f 5.4
1,091.886,' 11.9
4.793 0.1
10,000' 0.1
!7,252) (O.i)
7.541 0.1
'.1,099,427 .. 12.0. %'
916,039
. (469,S34)
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$ '1.545,932 .
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'Year Ended Oe:cember"31, 2005':' :, , :' ',: ',,"r, ':.:. ':,:'
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op$ratt~9~~ies .,::'.: '..:'::. ..':'" ::, ':,:. ('; '.
Net Jnceme' ',,'. ".,. . .' :
Adjustments ,
Oeprec~tlon . " .' "
Gain on sala and dispo$$l of ~ '. . ,.; , "
. Changes 'fn oerta,n C':lITerrt a$$et$ and liabiiitiGS ,~ '.
Contracts receiVable" , .
qosts and 'estimated earnings fn excesS of billings
, on uncompleted co!rtracW , .
Prepaid' oxPell$e$ and pther . '. . .,'. ,
. ',Accounts payable, ::;:' '.
Accrued e~en$es.. .'" .".::.
BilJrngs rn excess of cqsts 1Jnd ~m~ted ~mlngs
Qn uncOmpIetec:J'c:.o~cf$ '. . " .
Net Cash. Pr:ovided I$Y Oper~ting ~ivitiGS
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APR-10-'-200S 13=1::12
STR(Jl"fli1AH & COMP~ r$C .
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, lnve$tln9 Activitie:s . '. ...
Proceeds 'from safe of aiset '
Purchase of trucks and ~qi.Jij:tniei1t.
. .
I Net Cash Used In Jnw:slJrig ActMiie~ .... ' .
FrMnciog Actlvlties .' . .
Payments'on loan to L-ewIs FaIr . '
Payments on long-term debt' .:
, Proc!3eds from 'o~m 10 related empf.Oyee
. DlstrlbutJons paid to member.. : ' ,.
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NGt Cash Use~ In FIr:ta~.QIng ActMtie$:
, 5~2 585 1601
f
.P.07/07
4/ fU/~VVO
IDRAFT I
"
C4sh J;ndofYear
$ 1 ;099,421
39,el;lO
(10.000). .
(1,079,034)
(430,249)
'12;491.
1.250,.954
98,80;3
j-
201,943
1,178,SQ5.
10,00Q
(33,O47)
I (23,047)
-(24~OOO)
(33,258)
856
(469,534)
(525,936) .
630,Q12 .
233,455
$.f 863,467
, $' 14,296
~!
$, 7,252
'. Cash BeginnIng ~fYeai-"
:'.' ; ': : '. Net Increase in Cuh
Supplem.e~1 D~oio$unJ of Cash Flow Inrortriati~n
Cash.Paid During f,h~Ye;ador.:' .'
LOQS'Jn~me~;: :". .
fnterest .
See Accountants' ij~vfew Report .'
and Notes to Flnanoial statements
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City of Jeffersonville
Ken Ellis Senior Center
r SECTION 00310. BIDDERS CHECKLIST
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The following is a list of required documents which each General Contractor is required to provide:
Complete Section 00300 - Bid Form
Acknowledge Receipt of All Addenda
Complete Bid Bond - AlA Document A-31 0
(Circular 570 as amended)
Include Bid Security (5% of total bid including all add alternates)
Complete Form 96
Complete Contractor's Qualification Statement - AlA Document A305
END OF SECTION 00310
BIDDERS CHECKLIST
JEFF.022
April 2006
00310 - 1
City of Jeffersonville
Ken Ellis Senior Center
JEFF.022
April 2006
(' SECTION 00410 - BID SECURITY FORM
PART 1 - GENERAL
1.1 PROJECT MANUAL
A. All requirements of the Project Manual shall apply to this Section.
1.2 SCOPE
A. Contractors Bid Security shall be a Certified Check, Cashier's Check or Bid Bond in amount of five (5)
percent of the total bid including all add alternatives.
B. The Bid Bond, if used, shall be AlA DocumentA310, February, 1970 Edition entitled "Bid Bond."
1. Bond shall be executed by an acceptable Surety Company licensed to do business in the State of
Indiana.
2. A copy of this form is bound herewith.
C. Bid Security shall be executed in an amount equal to five (5) percent of the total lump sum bid plus five
(5) percent of all add alternatives.
1. Security shall be executed in favor of the Owner.
2. Should the successful Bidder fail to enter into a contract or furnish the required Bonds within ten
(10) days from date of notice of award, the Owner may declare the Bidder's Bid Security forfeited
and the Security amount retained by the Owner as liquidated damages.
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1.3
SURETY REQUIREMENT
!
A. Surety companies executing bonds must appear on the Treasury Department's most current list
(Circular 570 as amended) and be authorized to transact business in the State of Indiana.
END OF SECTION 00410
f'
BID SECURITY FORM
00410-1
City of Jeffersonville
Ken Ellis Senior Center
JEFF.022
April 2006
~.
SECTION 00450- NON-COLLUSION AFFIDAVIT
PART 1 . GENERAL
1.1 REQUIREMENTS
A. Each bidder is required to submit this properly executed Affidavit with their Bid Form.
Complete the following:
Non-Collusion Affidavit
The bidder, by its officers and agents, representatives present at the time of filing this bid, being duly sworn,
on their oaths say that neither they nor any of them have in any way, directly or indirectly, entered into an
agreement or agreements with any other bidder, or with any public official. Whereby such affiant or affiants
or either of them, has paid or is to pay to such bidder to public official, any sum of money, or has given or is
to give such other bidder or public official anything of value whatsoever, or such affiant or affiants or either
of them has not directly or indirectly entered into any agreement or agreements or arrangements with
another bidder or bidders which tends to or does lessen or destroy free competition in the letting or the
contract sought for by the attached bids; that no inducement of any form or character other than that which
appears upon the face of the bids will be suggested, offered, paid or delivered to any person whomsoever
to influence the acceptance of said bid or awarding of the contract; nor has this bidder any agreement or
understanding of any kind whatsoever, with any other person whomsoever to pay, deliver to , or share with
any other person in any way or manner, any of the proceeds or the contract sought by this bid.
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(Corporate Seal)
Kevrn r.nnRr. rllC""r. inn. r.r.r.
L .... (Bidder)
~~~~
Vice-President
(Title)
Subscribed and sworn to before me by
this .1..at.lGayof
May
, 20 D..6.....:.-.
9~4~
'. (Not. Public)
(Notary Seal)
My Commission Expires .::si..l/Yt.Q
In and For ..::r~n
/)0 I (;)CD '7
I
CountY.
END OF SECTION 00450
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NON-COLLUSION AFFIDAVIT
I 00450-1
,'\
BID BOND
The American Institute of Architects.
AlA Document No. A310 (February, 1970 Edition)
KNOW ALL MEN BY THESE PRESENTS, that we KEVCO CONSTRUCTION, LLC
LOUISVILLf' KY 40201
As Principal, hereinafter called Principal, and The Ohio Casualty Insurance Company , a corporation duly organized
under the laws of the State of Ohio , as Surety, hereinafter called Surety, are held and firmly bound unto
As Obligee, hereinafter called Obligee, in the sum of 5% OF THE AMOUNT OF THE BOND
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 .
A NEW ONE STORY STRUCTURE TO BE KNOWN AS KEN ELLIS SENIOR CENTER, 1425 PENNSYLVANIA
A VENUE, JEFFERSONVILLE, IN
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 payment of labor
and material furnished in the prosecution thereof, or in the event of the failure of the Principal to enter into such contract and
r', give such bond or bonds, if the Principal shall pay to the Obligee the difference not exceed the penalty hereof between the
amount specified in such bid and such larger amount for which the Obligee may in good faith contract with another party to
perform the wprk covered by said bid, then this obligation shall be null and void, otherwise to remain in full force and effect.
l
Signed and sealed this
15TH
day of MAY
2006
~~/c;j~,
I (Witne,,)
KEVCO CONSTRUCTION, LLC
(Principal)
4.1?~~
(/,p
(Title)
The Ohio Casualty Insurance Company
(Attorney-in-Fact)
Revised to February, 1970
SB 5714b Printed in U.S.A.
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CERTIFIED COPY OF POWER OF ATTORNEY
THE OHIO CASUALTY INSURANCE COMPANY
WEST AMERICAN INSURANCE COMPANY
No. 39-236
Know All Men byThese Presents: That THE oHio CASUALTY INSURANCE COMPANY, an Ohio Corporation, and WEST AMERICAN
INSURANCE COMPANY, an Indiana Corporation, pursuant to the authority granted by Article ill, Section 9 of the Code of Regulations and By-Laws of The Ohio
f" Casualty Insurance Company and West American Insurance Company, do hereby nominate, constitute and appoint: Brent L. Smith, Mary R. Hupp, Michelle M.
, Bridwell, Jean A. Humphrey, Alma Jean White or Gloria Ray of Louisville, Kentucky its true and lawful agent (s) and attorney (s)-in-fact, to make, execute, seal
and deliver for and on its behalf as surety, and as its act and deed any and all BONOS, UNDERTAKINGS, and RECOGNIZANCES, not exceeding in any single
instance ONE MILLION FIVE HUNDRED THOUSAND ($1,500,000.00) DOLLARS, excluding, however, any bond(s) or undertaking(s) guaranteeing the
payment of notes and interest thereon
And the execution of such bonds or undertakings in pursuance of these presents, shall be as binding upon said Companies, as fully and amply, to all intents and
purposes, as if they had been duly executed and acknowledged by the regularly elected officers of the Companies at their administrative offices in Fairfield, Ohio, in
their own proper persons.
The authority granted hereunder supersedes any previous authority heretofore granted the above named attorney(s)-in-fact.
A~4~
Sam Lawrence, Assistant Secretary
STATE OF OIDO, I:
COUNTY OF BUTLER"
On this 21st day of March, 2006 before the subscriber, a Notary Public of the State of Ohio, in and for the County of Butler, duly commissioned and qualified, came
Sam Lawrence, Assistant Secretary of THE OHIO CASUALTY INSURANCE COMPANY and WEST AMERICAN INSURANCE COMPANY, to me personally
known to be the individual and officer described in, and who executed the preceding instrument, and he acknowledged the execution of the same, and being by me
duly sworn deposes and says that he is the officer of the Companies aforesaid, and that the seals affixed to the preceding instrument are the Corporate Seals of said
Companies, and the said Corporate Seals and his signature as officer were duly affixed and subscribed to the said instrument by the authority and direction of the said
Corporations.
IN TEStIMONY WHEREOF, I havo ho_to oct my hMd Md"''''''' my om"" Sod "tho Cityf:::j. S1. 04~" fiM ,b"o writren.
Notary Public in and for County of Butler, State of Ohio
My Commission expires August 6, 2007.
This power of attorney is granted under and by authority of Article ill, Section 9 of the Code of Regulations imd By-Laws of The Ohio Casualty Insurance Company
and West American Insurance Company, extracts from which read:
Article ill, Section 9. Appointment of Attorneys-in-Fact. The Chairman of the Board, the President, any Vice-President, the Secretary or any Assistant
Secretary of the corporation shall be and is hereby vested with full power and authority to appoint attorneys-in-fact for the purpose of signing the name of the
corporation as surety to, and to execute, attach the seal of the corporation to, acknowledge and deliver any and all bonds, recognizances, stipulations, undertakings or
other instruments of suretyship and policies of insurance to be given in favor of any individual, firm, corporation, partnership, limited liability company or other entity,
or the official representative thereof, or to any county or state, or any official board or boards of any county or state, or the United States of America or any agency
thereof, or to any other political subdivision thereof
This instrument is signed and. sealed as authorized by the following resolution adopted by the Boards of Directors of the Companies on October 21,.2004:
RESOLVED, That the signature of any officer of the Company authorized under Article III, Section 9 of its Code of Regulations and By-laws and the
Company seal may be affixed by facsimile to any power of attorney or copy thereof issued ort behalf of the Company to make, execute, seal and deliver for and on its
behalf as surety any and ~Il bonds, undertakings or other written obligations in the nature thereof; to prescribe their respective duties. and the respective limits of their
authority; and to revoke any such appointment. Such signatures and seal are hereby adopted by the Company as original signatures and seal and shall, with respect to
any bond, undertaking or other written obligations in the nature thereof to which it is attached, be valid and binding upon the Company with the same force and effect
as though manually affixed.
CERTIFICATE
I, the undersigned Assistant Secretary of The Ohio Casualty Insurance Company and West American Insurance Company, do hereby certifY that the foregoing power of
attorney, the referenced By-Laws of the Companies and the above resolution of their Boards of Directors are true and correct copies and are in full force and effect on
this date.
IN WITNESS WHEREOF, I have hereunto set my hand and the seals of the Companies this day of
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Assistant Secretary
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