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HomeMy WebLinkAboutChestnut Streetscape Improvements W estern Sure Company POWER OF ATTORNEY APPOINTING INDIVIDUAL ATTORNEY -IN -FACT Know All Men By These Presents, That WESTERN SURETY COMPANY, a South Dakota corporation, is a duly organized and existing corporation having its principal office in the City of Sioux Falls, and State of South Dakota, and that it does by virtue of the signature and seal herein affixed hereby make, constitute and appoint Pamela S. Canter , Individually of Louisville, KY its true and lawful Attorneys) -in -Fact with full power and authority hereby conferred to sign, seal and execute for and on its behalf bonds, undertakings and other obligatory instruments of similar nature - In Unlimited Amounts - Surety Bond No.: 58 704 009 Principal: Pace Contracting, LLC. Obligee: City of Jeffersonville and to bind it thereby as fully and to the same extent as if such instruments were signed by a duly authorized officer of the corporation and all the acts of said Attorney, pursuant to the authority hereby given, are hereby ratified and confirmed. This Power of Attorney is made and executed pursuant to and by authority of the By -Law printed on the reverse hereof, duly adopted, as indicated, by the shareholders of the corporation. In Witness Whereof, WESTERN SURETY COMPANY has caused these presents to be signed by its Vice President and its corporate seal to be hereto affixed on this 10th day of August, 2012. SuaEr WESTERN SURETY COMPANY 'mac '1\ocAvAii Alle aul T. Bruflat, Vice President State of South Dakota ss County of Minnehaha On this loth day of August, 2012, before me personally came Paul T. Bruflat, to me known, who, being by me duly sworn, did depose and say: that he resides in the City of Sioux Falls, State of South Dakota; that he is the Vice President of WESTERN SURETY COMPANY described in and which executed the above instrument; that he knows the seal of said corporation; that the seal affixed to the said instrument is such corporate seal; that it was so affixed pursuant to authority given by the Board of Directors of said corporation and that he signed his name thereto pursuant to like authority, and acknowledges same to be the act and deed of said corporation. My commission expires J. MOHR NOTARY PUBLIC June 23, 2015 - SOUTH DAKOTA -717) Ca l - J. Mohr, Notary Public CERTIFICATE I, L. Nelson, Assistant Secretary of WESTERN SURETY COMPANY do hereby certify that the Power of Attorney hereinabove set forth is still in force, and further certify that the By -Law of the corporation printed on the reverse hereof is still in force. In testimony whereof I have hereunto subscribed my name and affixed the seal of the said corporation this day of rr WESTERN SURETY COMPANY W 1 4 ' 4 21°112-17'L'°/ L. Nelson, Assistant Secretary Form F4280 -7 -2012 Authorizing By -Law ADOPTED BY THE SHAREHOLDERS OF WESTERN SURETY COMPANY This Power of Attorney is made and executed pursuant to and by authority of the following By -Law duly adopted by the shareholders of the Company. Section 7. All bonds, policies, undertakings, Powers of Attorney, or other obligations of the corporation shall be executed in the corporate name of the Company by the President, Secretary, and Assistant Secretary, Treasurer, or any Vice President, or by such other officers as the Board of Directors may authorize. The President, any Vice President, Secretary, any Assistant Secretary, or the Treasurer may appoint Attorneys in Fact or agents who shall have authority to issue bonds, policies, or undertakings in the name of the Company. The corporate seal is not necessary for the validity of any bonds, policies, undertakings, Powers of Attorney or other obligations of the corporation. The signature of any such officer and the corporate seal may be printed by facsimile. - LOUIPAV -01 AYOERG '4. CC) CERTIFICATE OF LIABILITY INSURANCE DATE 6//12/212 /2013 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 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 CONTACT NAME: ' Neace Lukens - Louisville/ Assured NL Insurance Agency Inc PHONE 502 ! FAX (502) 894 - 8602 2305 River Road (A/C, No, Ext): ( ) 894 - 2100 , (A/C, No): ) Louisville, KY 40206 ADDRESS: A DOF INSURER(S) AFFORDING COVERAGE NAIC # _ INSURER A : Charter Oak Fire Insurance Co 25615 INSURED INSURER e : Travelers Property Casualty Co of America 25674 Pace Contracting LLC INSURER C : Kentucky Associated General Contractors 200 Willinger INSURER D : Great American Insurance Co of NY 22136 Jeffersonville, IN 47130 INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER: 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 1 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 i ADDL SUBR POLICY EFF POLICY EXP — 1 LTR TYPE OF INSURANCE INSR WVD POLICY NUMBER AMM /DD/YYYY) JMM /DD/YYYYL LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DA TO A X COMMERCIAL GENERAL LIABILITY X DTCOOD55919A 4/1/2013 4/1/2014 PREMISES (Ea occur rence) $ 300,000 CLAIMS -MADE X OCCUR MED EXP (Any one person) $ 10,000 PERSONAL & ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP /OP AGG $ 2,000,000 POLICY PRO- JECT LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 1000000 (Ea accident) $ > > A H ANY AUTO DT8100D55919A 4/1/2013 4/1/2014 BODILY INJURY (Per person) $ ALL OWNED SCHEDULED BODILY INJURY (Per accident) $ AUTOS AUTOS , ( ) PROPERTY DAMAGE X HIRED AUTOS X AOS NED JPER ACCIDENT) $ UT $ X UMBRELLA LIAB X OCCUR EACH OCCURRENCE _ $ 1,000,000 B EXCESS LIAB CLAIMS -MADE DTSMCUPOD55919A 4/1 /2013 4/1/2014 AGGREGATE $ 1,000,000 DED RETENTION $ $ WORKERS COMPENSATION X WC STATU- I °E- AND EMPLOYERS' LIABILITY Y / N TORY LIMITS ER C ANY PROPRIETOR/PARTNER /EXECUTIVE 18803 1/1/2013 12/31/2013 E.L. EACH ACCIDENT $ 4,000,000 OFFICER/MEMBER EXCLUDED? N / A (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE $ 4,000,000 If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 4,000,000 ■ A Equipment Floater QT6609C484030 4/1/2013 4/1/2014 Per Item 1,250,000 D Excess Liability SBE020310802 4/1/2013 4/1/2014 Per Occ 9,000,000 I DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) Chestnut Street Streetscape Improvements City of Jeffersonville, Indiana R City of Jeffersonville is added as an additional insured to the Named Insured's General Liability policy as respects to operations performed by the Named Insured under contract with the Certificate Holder. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Jeffersonville THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 500 Quartermaster Court, Ste. 250 Jeffersonville, IN 47130 AUTHORIZED REPRESENTATIVE -—---- © 1988 -2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD _____.....4p LOUIPAV -01 AYOERG '4 . ,.- --- CERTIFICATE OF LIABILITY INSURANCE r D D/YYYY) 1 _ — 6//12/212 /2013 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 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 CONTACT NAME: Neace Lukens - Louisville/ Assured NL Insurance Agency Inc PHONE (502) 894 - 2100 , FAX 502 894 - 8602 2305 River Road (A/C, No, Ext): j (A/c No): ( ) Louisville, KY 40206 E-MAIL ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC # INSURER A : Charter Oak Fire Insurance Co _ 25615 INSURED INSURER B : Travelers Property Casualty Co of America 25674 Pace Contracting LLC INSURER C : Kentucky Associated General Contractors 1 200 Willinger INSURER D : Great American Insurance Co of NY 22136 Jeffersonville, IN 47130 INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: I THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD I 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 ADDL SUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSR WVD POLICY NUMBER (MM/DD/YYYY) (MM /DD/YYYY) LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A X COMMERCIAL GENERAL LIABILITY X DTCOOD55919A 4/1/2013 4/1/2014 DAMAGE TO RENTED PREMISES (Ea occurrence) $ 300,000 CLAIMS -MADE X OCCUR MED EXP (Any one person) $ 10,000 PERSONAL & ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP /OP AGG $ 2,000,000 7 POLICY I I PRO- LOC $ JECT AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 1,000 00 0 (Ea accident) _ $ A X ANY AUTO DT8100D55919A 4/1/2013 4/1/2014 BODILY INJURY (Per person) $ ALL OWNED SCHEDULED BODILY INJURY (Per accident) $ AUTOS AUTOS ( ) NON OWNED PROPERTY DAMAGE X HIRED AUTOS X AUTO JPER ACCIDENT) $ $ X UMBRELLA LIAB X OCCUR EACH OCCURRENCE _ $ 1,000,000 B EXCESS LIAB CLAIMS -MADE DTSMCUPOD55919A 4/1/2013 4/1/2014 AGGREGATE _ $ 1,000,000 DED RETENTION $ I $ WORKERS COMPENSATION X WC STATU- OTH- AND EMPLOYERS' LIABILITY y / N TORY LIMITS ER C ANY PROPRIETOR/PARTNER/EXECUTIVE 18803 1/1/2013 12/31/2013 E.L. EACH ACCIDENT $ 4,000,000 OFFICER/MEMBER EXCLUDED? N / A (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE $ 4,000,000 If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 4,000,000 A Equipment Floater QT6609C484030 4/1/2013 4/1/2014 Per Item 1,250,000 D Excess Liability SBE020310802 4/1/2013 4/1/2014 Per Occ 9,000,000 1 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) Chestnut Street Streetscape Improvements City of Jeffersonville, Indiana R City of Jeffersonville is added as an additional insured to the Named Insured's General Liability policy as respects to operations performed by the Named Insured under contract with the Certificate Holder. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Jeffersonville THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 500 Quartermaster Court, Ste. 250 Jeffersonville, IN 47130 AUTHORIZED REPRESENTATIVE --..------- i I © 1988 -2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD ____.—.45 LOUIPAV-01 AYOERG ACRD CERTIFICATE OF LIABILITY INSURANCE DATE(MWDD/YYYY) j 6/12/2013 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 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 CONTACT NAME: Neace Lukens - Louisville/ Assured NL Insurance Agency Inc PHONE (502) I FAX 2305 River Road (A/C, No, Ext): ) 894 - 2100 1 (A/C, No): (502) 894 - 8602 Louisville, KY 40206 A ADDDRDR ESS: INSURER(S) AFFORDING COVERAGE NAIC # INSURER A : Charter Oak Fire Insurance Co 25615 INSURED INSURER B : Travelers Property Casualty Co of America 25674 Pace Contracting LLC INSURER c : Kentucky Associated General Contractors 200 Willinger INSURER D : Great American Insurance Co of NY 22136 Jeffersonville, IN 47130 INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER: 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 1 ADDL SUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSR WVD POLICY NUMBER (MM/DD/YYYY) (MM /DD/YYYY) LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A I X COMMERCIAL GENERAL LIABILITY X DTCOOD55919A 4/1/2013 4/1/2014 DAMAGE TO RENTED PREMISES (Ea occurrence) $ 300,000 CLAIMS -MADE X OCCUR MED EXP (Any one person) $ 10,000 PERSONAL & ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 . GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP /OP AGG $ 2,000,000 POLICY PRO- — — JECT LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea accident) $ 1,000,000 A X ANY AUTO DT8100D55919A 4/1/2013 4/1/2014 BODILY INJURY (Per person) $ ALL OWNED SCHEDULED BODILY INJURY (Per accident) $ AUTOS AUTOS ( ) X HIRED AUTOS X NON -OWNED PROPERTY DAMAGE AUTOS JPER ACCIDENT) $ $ X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 1,000,000 B EXCESS LIAB CLAIMS -MADE DTSMCUPOD55919A 4/1/2013 4/1/2014 AGGREGATE $ 1,000,000 j DED RETENTION $ _ $ WORKERS COMPENSATION WC STATU- OTH- AND EMPLOYERS' LIABILITY Y / N X TORY LIMITS ER C ANY PROPRIETOR/PARTNER/EXECUTIVE 18803 1/1/2013 12/31/2013 i E.L. EACH ACCIDENT $ 4,000,000 OFFICER/MEMBER EXCLUDED? N / A (Mandatory in NH) If yes, describe under E.L. DISEASE - EA EMPLOYEE $ 4,000,000 DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT _ $ 4,000,000 A Equipment Floater QT6609C484030 4/1/2013 4/1/2014 Per Item 1,250,000 O Excess Liability SBE020310802 4/1/2013 4/1/2014 Per Occ 9,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) Chestnut Street Streetscape Improvements City of Jeffersonville, Indiana R City of Jeffersonville is added as an additional insured to the Named Insured's General Liability policy as respects to operations performed by the Named Insured under contract with the Certificate Holder. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Jeffersonville THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 500 Quartermaster Court, Ste. 250 ACCORDANCE WITH THE POLICY PROVISIONS. Jeffersonville, IN 47130 AUTHORIZED REPRESENTATIVE © 1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD