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1i Accept Trail ProjectCITYOF CHAN EN 7700 Market Boulevard PO Box 147 Ohanhassen Mil 55317 Adminislralion Phone: 9522271100 Fax~ 952 2271110 Building Inspections Engineering Finance P~one: 952227.1140 Fax 952 227.1110 Park & Recreation Phooe: 9522271120 Fax: 9522271110 Recreation Center 2310 Coulter Boulevard Phone 952 2271400 Fax: 952 2271404 Planning & Natural Resources Fax: 952227 1110 Public Works 1591 Park Road Phone: 952227 1300 Fax 952 227 1310 Senior Center Phone: 952 227 1125 Fax: 9522271110 Web Site wwwci chanhassen mo us MEMORANDUM TO: Todd Gerhardt, City Manager ,..,~/ FROM: Todd Hoffman, Park & Recreation Director · /' DATE: September 2, 2003 SUB J: Project Acceptance, 2002 Trail Connectors Attached please find a project acceptance form for the 2002 Trail Connectors Project. Barber Construction has completed all punch list items and a final inspection has been conducted. The final construction cost for the three trails was $351,968. This is 4.5% under the project budget of $368,706. Mr. Phil Gravel of Bonestroo Rosene Anderlik and Associates was the Project Manager. Mr. Mark Statz of the same firm was the Project Inspector. The fact that the city received a quality product under budget, is a credit to these two gentlemen. Timely completion of these trail connectors was critical to bringing the two new trail underpasses on Highway 5 "on-line" and connecting downtown Chanhassen to Bandimere Community Park and the South Light Rail Transit pedestrian trail. RECOMMENDATION It is recommended that the City Council authorize execution of the project acceptance form for the 2002 Trail Connector Project. C: Teresa Burgess, City Engineer Bruce DeJong, Finance Director Phil Gravel, BRAA The City of Chanhassen · A growing comr'nunity with clean lakes, quality schools a charming do'c,,'nlow/~ thrivin!l !)us~qesses wmdinq trai!s, and beautiful parks A great ~)Jace to, ii,,e wc,k and [:la,, PROJECT ACCEPTANCE FORM FOR 2002 TRAIL CONNECTOR PROJECT CITY OF CHANHASSEN FILE NO. 393-01-123 CITY FILE RA-630 RECOMMENDATION FOR ACCEPTANCE This project included the construction of segments of recreational bituminous trail along T.H. 101 and at two underpasses on T.H. 5. This project was tested and inspected in accordance with standard city policy and procedure. The work is complete and complies with the specifications. Therefore this project is recommended for acceptance by the City Council for perpetual maintenance. Parks and Recreation Director: Date: City Administrator: Date: Project Inspector: City Council Acceptance Date: Bonestroo Rosene Anderlik & Associates Engineers & Architects Bonestroo. Rosene, Anderlik and Associates, Inc. is an Affirmative Action/Equal Opportunity Employer and Employee Owned Principals: Otto G. Bonestroo, RE · Marvin L Sorvala, RE · Glenn R Cook. RE. · Robert G Schunicht, F~E, · Jerry A Bourdon, RE · Mark A Hanson, PE Senior Consultants: Robert V(/. Rosene, RE · Joseph · Anderlik, RE. · Richard E. Turner, I~E, · Susan M. Eberlin, CRA Associate Principals: Keith A Gordon, RE · Robert R. Pfefferle, RE · Richard W Foster, P.E. · David O. Loskota, RE · Michael T Rautmann, P.E · Ted K Field, RE. · Kenneth P Anderson, RE · Mark R Rolls, RE · David A. Bonestroo, M.B.A. · Sidney R Williamson, I~E., LS. · Agnes M Ring, MB.A. · Allan Rick Schmidt, RE · Thomas W. Peterson, PE · James R Maland, RE, · Miles B. Jensen, RE. · L. Phillip Gravel IlL F~E · Daniel J Edgerton, DE. · Ismael Martinez. PE - thomas A Syfko, RE. · Sheldon J Johnson - Dale A. Grove, P.E · Thomas A Roushar, F~E - Robert J. Devery, RE Offices: St Paul, St Cloud. Rochester and Willmar, MN · Milwaukee, V~'I · Chicago, IL ~/ebsite: www.bonestroo com August 5, 2003 Mr. Todd Hoffman City of Chanhassen 7700 Market Blvd. Chanhassen, MN 55317 Re: 2002 Trail Connector Project Contractor's Request for Payment #4 and Final Our File 393-0:[-123 City File RA-630 Dear Todd: Attached for your approval is the final Contractor's Request for payment from Barber Construction Company for the retainage on the 2002 Trail Connector Project. We recommend that you pay the requested amount of $5,000. The final construction costs for this project total $351,968. This is 4.5% under the Bid Amount plus Change Order No. I of $368,706. All punch list work has been completed and the job is ready for final approval. We have enclosed the Contractor's ]'C-134 forms along with the Project Completion Form. Feel free to contact Phil Gravel or me if you have any questions. Sincerely, BONESTROO ROSENE ANDERL][K AND ASSOCIATES ][NC Mark Statz cc: .lerry Barber - Barber Construction Company, Inc. Phil Gravel - BRAA file encl. 2335 West Highway 36. St. Paul, MN 55113- 651-636-4600. Fax: 651-636-1311 Form IC-134 Rev. 11/90 Company name BARBER CONSTRUCTION CO., iNC. P.O. BOX 5324 HOPKIN~0 MN r~3~3,2r~, 4 Minnesota Department of Revenue Withholding Affidavit for Contractors This affidavit must be approved by the Minnesota Department of Revenue before the State of Minnesota or any of its subdivisions can make final pa)L~_e_n_t to contracto[_s..~ Minnesota ID number Month/year work began State Zip Code Please type or print clearly above. This will be your mailing label for returning the completed form, Telephone number Did you have employees work on this project? ~'/'~---~ -~ If none, explain who did the work: Month/year work ended ,ota, con,,actamo. ] 3 Amount still due: '- Project owne[~ ~/~ ~/~ _~~~ Check the box that describes your involvement in the project and fill in all information requested in that category: [] Sole contractor [] Subcontractor If you are a subcontractor, fill in the name and address of the contractor that hired you: Prime Contractor If you subcontracted out any work on this project, all of your subcontractors must file their own IC-134 affidavits and have them certified by the Department of Revenue before you can file your affidavit. For each subcontractor you had, fill in the business information below, and attach a copy of each subcontractor's certified IC-134. (If you need more space, attach a separate sheet.) Address Business name Owner/Officer I declare that all information I have filled in on this form is true and complete to the best of my knowledge and belief. I authorize the Department of Revenue to disclose pertinent information relating to this project, including sending copies of this form, t~he~orime contractor if I am a subcontractor, and to any subcontractors it I am aprime contractor, and to the contracting a~ency=__. racto~%'*/'- ~ ~-~! ....... --I/~'' ~ ~'~ .......... .......... Title ~% ~ ..................... //- /''~-i:~ '~ Date ~ For certification, mail original and one copy to: /e / Minnesota Department of Revenue, Business Trust Tax Section L // Mail Station 6610, St. Paul, MN 55146~6610 Certificate of Compliance with Minnesota Income Tax Withholding Law Based on records of the Minnesota Department of Revenue, I certify that the contractor who has signed this certificate has fulfilled ail the requirements of Minnesota Statutes 290.92 and 290.97 concerning the withholding of Minnesota income tax from wages paid to employees relating to contract services with the state of Minnesota and/or its subdivisions. Signature of a~thorized Department of Revenue official - Date ~.-I,:,~. :.-, .. .:-.~ ,' : :X.~-,~,e,:~~ : Stock No. 5000134 14:18 ~52~4727~ Withholding Affidavit for Contractors ,c.,~i · ~lS a~do~t mus~ ~ a~ by ~e ~lnneso~ ~po,men~ of Revenue ~e ~e ~te of ~nne~ m any of ~ ~u~i~tl~s ~n mo~e ~nal ~en~ ~ ~-- F.F. JEDLICKI. INC. ) ~''' ~''"~'~'~-- [~. ,4203 w. ,2,,~ s,.- ,, ~/-va ¢ / Sk)~e Z~p cede Subcoflll, tCl~ [] Priml ¢Ol~fl,~el~e'--If ~u lu~onfracled o~1 a~y w~r~ on ~11 project all d you~ ~ubcom,ac~r~ musl l~le the~, own lC-134 o~id~lts ~u~mc~r need more ~e. ankh o ~ro~ Based on records of ~e Mlnnelola Depodmenl of Revenue. I ce~Fy thai ~he co.l~ador who hm signed this ce~Ficat, I~as fulfilled all the fequfremenls of Mlnnesola. SfWv~es 290.92 and 290.97 com:emlng fhe wl~holdlng o.F Mlnnesola Income ~cN~ v~c~ges pold 1o emplo),~el r~aflng k~ conffacf lervlce, with the .lole of Mlnnemlo ond/m I~ lulxlh'lBionJ. -. 41N'NE.SOTA Department of Revenue This affidavit must be approved by the Minnesota Department of Revenue before the state of Minnesota or any of its subdivisions can make final payment to contractors. type or p n. clearly. This will be your mailing label for returning the completed form. /~Company ne,'ne "~ Daytime phone Address ............. I Tolal contract amount P.0. Box 756 City State I¢- 134 Minnesc, ta withholding tax ID number ...... 45_920Z9 ..... Month/~year work began I ~__~mt~,qS,~ Zip Code IAmou kill due - [ Month,/year work e~eZ 'r' Project number Project IocOn ~ ~ Mn/DOT Transportation Bldg. St. '~. i Did you have employees work on this project? ~ [] No If no, who did the work? 0 $;mle Z,p code Paul, MN 55155 Check the box lhat describes your involvement in the project and fill in all information requested. [] Sole contractor Name of contractor who hired you ~ Prime contractor--If you subconlracled out any work on tints project, all of your subcontractors must fiie their own IC-134 affidavits and have them certified by the Department of Revenue before you can file your affidavit. For each subcontractor you had, fill in the information below and attach a copy of each subcontractor's certified IC-134. If you need more space, attach a separate sheet. Business name Address Owner/Officer i declare that all information I hove fi/lea' in on this farm .is true and complc'te to thc' best of my knowledge anJ belief. I c,~rncn'ze 1,% Deco, tment or Revenue to disclose pertinent information relating to this project, including sending copies a[ this form, to fl:e prime contractor if I am a subcontractor, ~nd to any subcontractors ill am a prime contractor, and to the contracting agency. ...... 3~ ~~_ _Admin-istra~i~e Asst. N ~~C~Z~, Vall to: MN De~t. of Revenue ~ithhalding Division ,M:;~~ Station 6610 St Paul MN 55~46-6610 ~ Ez:s~d on records of the Minnesota Deparirnent of Revenue, I cer ~fy that the contractor who has signed this certificate has ~u.nuecl ail the requirements of Minnesoia Slatutes 290.92 and 290.97 concerning the wirhhoJding oF Minnesota income tax wages paid to employees rebling to contract services wilh the state o~ Minnesota and/or ils subdivisions. Derarrment of Revenue approval ,. Date MINNESOTA Department of Revenue Withholding Affidavit for Contractors This affidavit must be approved by the Minnesota Department of Revenue before the state of Minnesota or any of its subdivisions can make final payment to contraclors. IC-134 Please type or print clearly. This will be your mailing label for returning the completed form. ~ .~Company nan~e. "~ Daytime phone Minnesota tax ID number I~. I A~d~e'ss''~"~ I Totalcontrad amount Month/year work began ~ ICily ~tale Zip Code I Amount sliJl due Month/year work ended Projecl number Project location Did you have employes work on this projecl? ~Yes ~No I~ no, who did Ihe work? Stale Zip code Check the box that describes your involvement in the project and fill in afl information requested. [] Sole c~ntracter /~ Subcontractor Name of conJ,r~clor who hired you Address [] Prime contractor--If you subcontracted out any work on this project, all of your subcontractors must file their own IC-134 affidavits and have them certified by the Department of Revenue before you can file your affidavit. For each subcontractor you had, fill in the information below and attach a copy of each subcontractor's certified tC-134. If you need more space, attach a separate sheet. Business name Address Owner/Officer I declare thc~oll information I have filed in on this form is true and complete to the best of my knowledge and belief. I authorize the Department of  Revenue to~i}~clase pertinent information relating to this project, including sending copies orthis form, to the prime contractor if I am a subqontroctor, ~,- and to an)~ ~bcontrectc~ if[em a p~me contractor, and to the contracting agency. . ~ I~ Conlroctar s~i~r~ J I II 1~ '~ ~ .title [ Dote/ Mini to ~ston Mod Sial ul MN 551466610 · : p. , · ~,~d,.--0'~iv' , ' ' ,-- , [ / Certificate of Compliance Based on records of the Minnesota Department of Revenue, I certify that the contractor who has signed this certificate has fulfilled all the requirements of Minnesota Stalutes 290.92 and 290.97 concerning the withholding of Minnesota income tax ~om wages paid to employees relating to contract services with the state of Minnesota and/or its subdivisions. L~tl?e~l of Revenue ~o~rovgl ._ Date Sto~ No. 5000134 (lev. t 1/99) Prinled on recycled pape~ with t 0% po~l-eon~.umer wo~le u~in9 ~oy-based ink. vi!NN'ESOTA Department of Revenue 'Withholding Affidavit for Contractors ?.~ This affidavit must be approved by the Minnesota Department of Revenue before lhe 5tare Minnesota or any of its subdivisions can make final payment to contractors. Please lype or print clearly. This will be your mailing label for returning the completed form. ~ompany name Lino Lakes Landscaping, Inc. Address 18400 Lex±ngLon Avenue f . Stat~ i~yoming MlnnesoEa ~i~6~2 lC- 134 Daytime phone Mi,,nesoia withholding tax iD number ~51 p464-6026 9475971 Total contract amount Mo.~ti~/ye~)r ~ork began I $43,957.50 - Amount still due Momh/yeor work enaed $43,957.50 11-02 Project number f Proiect location RA-630 .~__B_l_u_.f__f__Creek Crossing Trail Proiect owner Add, ,~ Cily City of Chanhassen Chanhassen Did you have empbyees work on this project? [] Yes ~ No If no, who did the work? State Zip code Hinnesota Check the box that describes your involvement in the project and fill in all information requested. [] Sole contractor ~3 Subcontractor Name of contractor who hired you Barber Construction Co., Inc. Address .... PO Box 5324 Hopkins, MN 55343 Prime contractor--If you subcontracted out any work on this project, oil of your subcontractors must file their own IC-134 affidavits and have them certified by the Department of Revenue before you can file your affidavit. For each subcontractor you had, fill in the information below and attach a copy of each subcontractor's certified lC-134. If you need more space, attach a separate sheet. Business name Address ............. ~O_w_.n_er/Officer ................... I declare that all information I have filled in on this form is true and complete to the best of my knowledge and belief. I authorize the Department of Revenue Io disclose pertinent information relating to lhis project, including sending copies of this form, to the prime contractor if I am a subcontractor, and to any subcontractors if I am a prime contractor and to the contracting agency. Contract ssignature /,~ ~ ~~' Title Date ,tra~~.~~ Clerk 11-18-02 Mail to: MN Dept. of Revenue, Withholding Division, Mail Station 6610, St. Paul, MN 55146.6610 Certificate of Compliance Based on records of the Minnesota Department of Revenue, I certify that the corttractor who has signed this certificaie has fulfilled all the requirements of Minnesota Statutes 290.92 and 290.97 concerning the withholding of Minnesota income tax front wages paid to employees relating to contract services with the state of Minnesota and/or its subdivisions. D~p~rl~m~nt of Reven~ %opr~v~l ., Date No 5000134 1/95) Prmled on recycled paper wilh 10% pos~.consumer wasle uMrlcl sov.{~osed ink Form IC-134 Minnesota Department of Revenue Rev. 9/89 0 Withholding Affidavit for Contractors . ,- ..... /71 ~ ?l~-'t' This affidavit must be approved by the Minnesota Department of Revenue before the ~. ! ~ i'~ State of Minnesota or any of its subdivisions can make final payment to contractors. Company name ............ I ' Min~s0ta ID number Curb Masters, Inc 2207114 Address Momh~year wo~k began 500 W Poplar Street October 2002 City Slate Zip Code Month/year work ended Stil lwater, MN 55082 October 2002 (651 ) 351-9200 Did you have employees work on this project? · II none, explain who did the work: yes _P__rpJ_eCtowneF Ci_t.y o~ Cllall_hasscn Address Check the box that describes your Involvement in the project and fill in all information requested in that category: [] Sole contractor ~ Subcontractor If you are a subcontractor, fill in the name and address of the contractor that hired you: Barber Construction Co., Inc P 0 Box 5324 hopkins, MN 55343 [] Prime Contractor If you subcontracted out any work on this project, all of your subcontractors must file their own IC-134 affidavits and have them certified by the Department of Revenue before you can file your affidavit. For each subcontractor you had, fill in the business information below, and attach a copy of each subcontractor's certified IC-134. (If you need more space, attach a separate sheet.) Business name I declare that all information I have filled in on this form is Irue and complete to the best of my kn(~wledge and belief. I authorize the Department of Revenue to disclose pertinent information relating to this project, including sending copies of this form, to Ihe prime contractor if I am a subcontractor,~.n_~ tp_apy_~s_u~bc_o_n?_a_qt~L~.i_f_!..~[n_~..pri~m_~ c_o_nj~__ac_!_o~ and to t~h~._~9~n_t[_a~ct!_ncj age~_cy._ . For certification, mail to: Minnesota Department of Revenue, Business Trust Tax Section Mail Station 6610, St. Paul, MN 55146-6610 Certificate of Compliance with Minnesota Income Tax Withholding Law Based on records of the Minnesota Department of Revenue, I certify that the contractor who has signed this certificate has fulfilled all the requirements of Minnesota Statutes 290.92 and 290.97 concerning the withholding of Minnesota income tax from wages paid to employees relating to contract services with the state of Minnesota and/or its subdivisions. s~=~,,~.~ .~,~i.o~. o,,~, ._ - ........................................ 0~,; ............ lC-134 Minnesota Department of Revenue Withholding Affidavit for Contractors 03 . · / ~,. ;. ~. Tnl~ affidavit taus! be appn3vecl by th~ Minnesota Department el Revenue before the ~. ~..,.[ o ~.--~' '- $~te of Minnesota or any el its subcllvisions can ma~e final paymenl to contractors. yx ,j Ple~e ~ or pdnt deafly ~ve, ~is will be your mstllng I~el lot ta~ming ~ ~pl~t~ ti no~e. expl~n w~ did ~ work: P'rojact owner: ABdre~s Check the box that de~cribes your Involvement in the p~oJeCt and fill In all Information requested In that Category: ._~ Sole contractor Subcontractor If you are a subcontractor, fill in the name and address of the contractor that hired you: .... Po. ~ Prime Contractor If you subcontracted out any wonv, on this projnct, all ol your subcontractors must file lheir own IC-134 affidaviLs and have them certified by the Department of Revenue belore you can file your afflda, vit. For each subcontractor you had fill in the business information below, and attach a copy of each subcontractods certified IC-134. (If you need more ,~pace, attach a separate sheet.) Business name .Actdres$ Owner/Officer ~]001 I de~;lere thai NI Inlorm&~on I have filled i~ on mm ~ ~ i~ a~ ~mplem IO ~e ~ of my kn~l~ge and ~llef. I sutho~ze .... ....... F~t ~iti~lio., ~1 orlglnnl ~nd on~ c~y 1~: M.il $~on ~610, ~t. P~ul, MN 5514G-6610 Based on recess of the Mlnneso~ Dep~enl ot Revenue; I cagily that the contractor who has signed this cenificam has ~ulf~l~ed all the requlmmen~ et Minnesota S~tut~ ~0,92 and 290.97 ~eming the withl~olding o1 Minnesota ~ncome tax hum wages paiO to emp~yees rel~ng to ~n~ct se~es with the state of Minnesota an~or its Subdivisions. Form IC-134 ' Rev. 9/89 ~r~an¥ nam~ ~ State Minnesota Department of Revenue Withholding Affidavit for Contractors This affidavit must be approved by the Minnesota Department of Revenue before the State of Minnesota or any of its subdivisions can make final payment to contractors. z~ Cod. 55u0-8 Telephone number Did you have employees work on this project? If none, explain who did the work: Minnesota ID numbe~ Month/year work began Month/year work ~ Amount still due: Prelect number: ,5 Proioct location: '2~ Project owner: ff/ Address 77~ - ~/~'~ CheCk the box that describes your involvement in the projeCt and fill in all information requested In that category: Subcontractor [] Prime Contractor Business name Sole contractor If you are a subcontractor, fill in the name and address of the contractor that hired you: If you subcontracted out any work on this project, all of your subcontractors must file their own IC-134 affidavits and have them certified by the Department of Revenue before you can file your affidavit. For each subcontractor you had, fill in the business information below, and attach a copy of each subcontractor's certified IC-134. (If you need more space, attach a separate sheet.) Address Owner/Officer I declare that all information I have filled in on this form is true and complete to the best of my knowledge and belief. I authorize  the Department of R 9ve'~ue to disclose pertinent information relating to this project, including sending copies of this form, · to the prime contr~,~tor if am a subcontractor, and to any subcontractors if I am a prime contractor, and to the contracting agency. Contractor's si~ln~ tLZd~ ~' - ' ' J ' // Title D~e For cedification, mail to: , Minnesota Depadment of Revenue, Business Trust Tax Section Mail Station 6610, St. Paul, MN 55146-6610 Cedificate of Compliance with Minnesota Income Tax Withholding Law Based on records of the Minnesota Depadment of Revenue, I cedify that the contractor who has signed this cedificate has fulfilled all the requirements of Minnesota Statutes 290.92 and 290.97 concerning the withholding of Minnesota income tax from wages paid to employees relating to contract se~ipes with the state of Minnesota and/or its subdivisions. Sig~BorizedDep~ol.e~. tAR 1 3 2003 'CONSENT OF SURETY TO FINAL PAYMENT MA Document G707 (Instructions on reverse side) Bond No. TO OWNER: (Nalne and addrex~) City of Chanhassen 7700 Market Boulevard Chanhassen, MN. 55317 PROJECT: (Name and address) 2002 Trail Connectors Project Chanhassen, MN. 55317 MNC 5776 OWNER ARCHITECT CONTRACTOR SURETY OTHER ARCHITECT'S PROJECT NO.: CONTRACT FOR: City Project No. RA - 630 CONTRACT DATED: July 22nd, 2002 In accordance ~vith the provisions of the Contract between the Owner and the Contractor as indicated above, thc (Insert name and address pf SureO,) Merchants Bonding Company (Mutual) 2100 Fleur Drive Des Moines, Iowa 50321-1158 , SURETY, on bond of (Insert name and address (?/'Contractor) Barber Construction Co., Inc. 5400 Rowland Road Minnetonka, MN. 55343 , CONTRACTOR, hereby approves of the final payment to the Contractor, anti agrees that final payment to thc Contractor shall not relieve the Surety of any of its obligations to (Insert name and address City of Chanhassen 7700 Market Boulevard Chanhassen, MN. 55317 , OWNER, as set forth in said Surety's bond. 1N WITNESS WHEI~7OF, the Surety has hereunto set its hand on this date: (Ir sert ir cr'tin,~ tbe lnontb fi)llou,ed by the mtmeric date a~ld l,ear) November 12th 2002 Attest: (Seal): Meant s Bond},~ompany (Mumal) O,,'e~'~ / I I M. A. Jones Attorney-In-Fact (PFl'tlled Il(lille (111(] ll'l/e) O~UTION: You should sifln an oriflinal Al~ document that has lhis caution printed in red. ori~inal assures that chanties will not be obscured as may occur when documents are roproduced. S~ Instruction Sheet tot Limited Liconse lot ~oproduction ol this documenl. AIA DOCUMENT G707 · CONSENT OF SURE*IT TO FINAl, PAYMENT · 1994 EI)ITION ° 'AIA ~) 1994 ° TIlE ,&MERICAN INSTITt!TE OF ARCHITECTS, 17.55 NEW YORK AVF. NI',E, NW, xXASH INGTON, I).C 20006-5292 · WARNING: Unlicensed photocopying violates U.S. copy- right laws and will subject the violator to legal prosecution. G707--1994 Merchants Bonding Company (Mutual) POWER OF ATTORNEY Know All Persons By These Presents, that the MERCHANTS BONDING COMPANY (MUTUAL), a corporation duly organ/zed under the laws of the State of Iowa, and haying its principal office in the City of Des Moines, County of Polk, State of Iowa, hath made, constituted and appointed, and does by those presents make. conslitute and appoint Litton E. $. Field, Jr., M. A. Jones, F. E. Lannstein, Knthleen $orenson of SL Paul and State of 1Vlinnc~ota its tree and lawful Attomey4n-Fact. with full power and authoffiy hereby conferred in its name, place and stead, to sign, execute, acknowledge and deliver in its behalf as surety any and all bonds, undertakings, recognizances or other written obligalions in the nature th~eof, subject lo the limitation that any such instrument shall not exceed the amount of:. FIVE MILlION ($5,0ee,0e0.ffi)) DOLLARS and to bind the MERCHANTS BONDING COMPANY (MUTUAL) thereby as fully and to the same extent as if such bond or undertaking was signed by the duly authorized of Tm~rs of the MERCHANTS BONDING COMPANY (MUTUAL), and aR the acts of said Altomey4mFac~. pursuant to the authority herein given, are hereby marled and confirmed. This Power-of-Attorney is made and executed pursuant to and by authority of the fo#owing Amended Substituted and Restated By- Laws adopted by the Board of Directors of the MERCHANTS BONDING COMPANY (MUTUAL) on October 3. 1992. ARTICLE 11, SECTION 8 - The Chairman of the Board mr President or any V'me President or Secmtmy shall have power and authority to appr)int Attomey~ln-Fact, and to authorize them to execute on behalf of the Company, and ~ the Seal of the Company thereto, bonds and undertakings, recognizances, contracts of Indemnity and other wrffings obiig~tory in the nature thereof. ARTICLE 11, SECTION 9 - The signature of any authorized officer and the Seal of the Company may be affixed by facsimile to any Powe~ of Attorney or Certirmatiea thereof authorizing the execulion and del'wery of any bond, undertaking, recognizance, or other suretyship ebligalions of lhe Company, and such signature and seal when so used shall have the same force and effect as though manually fixed. In Witness Whereof, MERCHANTS BONDING COMPANY (MUTUAL) has caused these presents to be signed by its President and its corporate seal to be hemto affixed, this 8th dayof No¥Cmb~ , 200] . ." ~?' ~' ' ~':~".~x--.-- p- -.:,-, MERCHANTS BONDING CO~iPANY (MUTUAl) ; ~..:.. -- ..-'.~,,~ By STATE OF IOWA COUNTY OF POLK ss. On this 8th day of Novcmb~' , 2001 . before me appeared Lam/Taylor, to me personally known, who beiag by me duly sworn did say that he is President of the MERCHANTS BONDING COMPANY (MUTUAL), the corporatio~ described in the foregoing instrtlment, and that the Seal affixed to the said instrument is the Coq)orate Seal of the said Coq,oration and that the said instrument was signed and sealed in behalf of said Corporation by authority of its Board of Directors. In Testimony Whereof, I have hereunto set my hand and affixed my Official Seal at the City of Des Moines, Iowa, the day and year above written. :°' °%. g ." : [ IOWA } : No~e'~,~r~,'~,o~co~ty, ~ '.. ~IA~ ~ ." STATE OF IOVVA eeeeseeeeee COUNIY OF POLK SS. 1, William Wamer, Jr., Secretary of tho MERCHANTS BONDING COMPANY (MUTUAL). do hereby certify that the above and foregoing is a Iron and correct copy of the PO1/VER-OE-ATI'ORNEY executed by said MERCHANTS BONDING COMPANY (MUTUAl.), which is still in force and effect. In W'~ness Whereof, I haw hamunb se~ my hand and affixed the seal of the Company on this 12th dayof November .2002,,:~\.~.H.C..O4f?· ..... . ~ .~:a: o re. · · ~.: 1933 ,- ~-. '.~'~'; ........ · .;~ ~ ..' Secretary Form IC-134 Rev. 9/89 Minnesota Department of Revenue Withholding Affidavit for Contractors This affidavit must be approved by the Minnesota Department of Revenue before the State of Minnesota or any of its subdivisions can make final payment to contractors. Minnesota lO numbe~ Total con,,~acl amount: Amount still due: Project number: Te~ohone number Did you have employees work on this project? ~] ~" S, If none, explain who did the work: Check the box that describes your involvement in the project and fill in all information requested in that category: [] Sole contractor Subcontractor Prime Contractor Business name If you are a subcontractor, fill in the name and address of the contractor that hired you: If you subcontracted out any work on this project, all of your subcontractors must fife their own IC-134 affidavits and have them certified by the Department of Revenue before you can file your affidavit. For each subcontractor you had, fill in the business information below, and attach a copy of each subcontractor's certified IC-134. (If you need more space, attach a separate sheet.) Address Owner/Officer I declare that all information I have filled in on this form is true and complete to the best of my knowledge and belief. I authorize "~t the Department of Reve'3ue to disclose pertinent information relating to this project, including sending copies of this form, o the prime contr~,~tor if am a subcontractor, and to any subcontractors if I am a prime contractor, and to the contracting agency. ContractoFs Silm t~'~, ~ ~ ' JJ Title D~e ~ ~ u For ce~ification, mail to: [ Minnesota Depa~ment of Revenue, Business Trust Tax Section Mail Station 6610, St. Paul, MN 55146-6610 Certificate of Compliance with Minnesota Income Tax Withholding Law Based on records of the Minnesota Department of Revenue, I certify that the contractor who has signed this certificate has fulfilled all the requirements of Minnesota Statutes 290.92 and 290.97 concerning the withholding of Minnesota income tax from wages paid to employees relating to contract services with the state of Minnesota and/or its subdivisions.