HomeMy WebLinkAbout6.8 Motion to accept bid for Fire Station 12 and Booster Pumping Station 16 Parking Lot Improvements in an amount not to exceed $82,500.t�.f)AAI1C 1�d'+rn�iect
Subject Motion to accept bid for Fire Station 12 and
Booster • gStation•Parking •
Improvementsi• toexceed
$821,500.
Meeting
Fiscal Impact
Dollar Amount
Budget Source
Category
Type
Information
July 6, 2021 - REGULAR MEETING OF THE MOUNT PROSPECT
VILLAGE BOARD -
true
Community Investment Program Fund
CONSENT AGENDA
Consent
Maintaining the paved lots that service the Village's buildings and facilities is important to
the efficient operations of the Village. This year the parking lots at Fire Station 12 and
Booster Pumping Station 16 are in need of repair. The site improvements include
resurfacing of the paved areas, utility structure adjustments and restriping of the lots.
F.111-111IRTMr!m
A Notice to Bidders was posted on the Demandstar website.
The bid opening for the Fire Station 12 and Well 16 Parking Lot Improvements was held on
June 21, 2021 at 1:00 PM. Four (4) contractors submitted bids for this project. The bids
ranged from a low of $75,000.00 by Chicagoland Paving Contractors, Inc. to a high of
$95,564.00 by A Lamp Concrete Contractors, Inc. Below is a summary of the bids:
1
Bidders
Total Bid
Chicagoland Paving Contractors, Inc. $75,000.00
J & R 1st in Asphalt, Inc. $84,535.06
J A Johnson Paving Co. $88,337.00
A Lamp Concrete Contractors, Inc. $95,564.00
Engineer's
Estimate
$71,644.00
All bidders submitted a bid bond in the amount of 10% of the total bid as required in the
bid proposal packet. All bids were checked for their accuracy and no mistakes were found.
All bidders correctly signed their bids and bid bonds.
The low bidder, Chicagoland Paving Contractors, Inc. meets the requirements of the
contract documents and is qualified to complete the work involved with this project. They
having successfully completed numerous parking lot projects in neighboring communities
and also successfully completed the Village of Mount Prospect Busse / Lonnquist Pedestrian
Crossing Project.
Staff recommends including a 10% contingency in the project award to allow for quantity
variances and unanticipated construction conflicts which would result in a total
recommended award of $82,500.00 ($75,000.00 + 7,500.00 = $82,500.00)
Alternatives
1. Accept the lowest -cost, responsive bid for the Fire Station 12 and Booster
Pumping Station 16 Parking Lot Improvements.
2. Action at the discretion of the Village Board.
2
Staff recommends that the lowest cost, responsive bidder, Chicagoland Paving Contractors,
Inc. of Lake Zurich, Illinois be awarded the contract for the Fire Station 12 and Booster
Pumping Station 16 Parking Lot Improvements in the amount not to exceed $82,500.
ATTACHMENTS:
00 - Plans-Final.pdf
Chicago Paving Bid.pdf
Project Location Maps.pdf
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ac--- 360
BID DATE:
BID TIME: 1: C`0
COMPLETE DATE/DAYS
TO
Bid Request
For
2021 Fire Station 12 and Well 16 Parking Lot Improvements
BID OPENING:
June 21, 2021 — 1:00 P.M. Local Time
50 S. Emerson Street, Mount Prospect, Illinois 60056
Mount Prospect Public Works Department
1700 W. Central Road, Mount Prospect, Illinois 60056-2229
12
2021 Fire Station 12 and Well 16
Bid Form Page 1
BID FORM
2021 Fire Station 12 and Well 16 Parking Lot Improvements,
Village of Mount Prospect
Department of Public Works
Chicagoland Paving Contractors Inc.
FROM: 225 Telser Road
Lake Zurich, IL 60047
(hereinafter called "Bidder")
TO: Office of the Village Manager, 3rd Floor
50 South Emerson Street
Mount Prospect, Illinois 60056
(hereinafter called "Village" or "Village of Mount Prospect")
Bid For: "2021 Fire Station 12 and Well 16 Parking Lot Improvements"
The bidders have familiarized themselves with the work and probable work conditions
required under this Bid affecting the cost of the work and with the Bid Documents which
include:
• Notice to Bidders
• Table of Contents
• Instructions for Bidders
• General Conditions and Special Provisions
• Specifications
• Bid Form
• Affidavit — Bid Certification Form
• Bid Security
• Bid Sheet — 2021 Fire Station 12 and Well 16 Parking Lot Improvements
• Contract Document
• Labor and Materials Payment bond form
• Performance Bond Form
• Supporting Documents
Therefore, the Bidder hereby proposes to furnish all supervision, technical personnel,
labor, materials, tools appurtenances, equipment, and services (including all utility and
transportation services) required to construct and complete the Work, all in accordance
with the above listed documents.
Bidder agrees to perform all of the Work and provide the equipment and materials
described in the Bid Documents, as follows:
Bidder has bid on all items and has provided a price for all items.
K81
13
2021 Fire Station 12 and Well 16
Bid Form Page 2
The Bidder acknowledges that it is responsible for verification of all pipe sizes and
depths prior to the ordering of materials.
The Bidder will complete and provide all labor, equipment, materials and mobilization (if
applicable) to perform the Work as incidental to the fixed item price for each item
proposed.
In submitting this bid, the Bidder understands that the Village of Mount Prospect
reserves the right to add to or subtract from the estimated quantities.
The Village of Mount Prospect intends to award one (1) contract (if at all) for the items
bid. If written notice of award of this bid is mailed, emailed or otherwise delivered to the
Bidder at any time before this bid is withdrawn, the Bidder agrees to execute and deliver
the contract in the prescribed form and furnish payment and performance bonds, or
letter of credit, and the insurance certificates required by the Bid Documents to the
Village within ten (10) days after receipt.
The Bidder, and as successful bidder/Contractor upon award of the Contract
understands and agrees to the following:
1) The Contractor agrees to provide all Work and items and material to the Village as
noted in the Bid Documents and comply with the requirements of the Bid
Documents.
2) The Contractor agrees to comply with all applicable state and federal laws, rules
and regulations, and county and municipal ordinances, as described in the General
Conditions.
All Addenda pertaining to this project shall be acknowledged by the Bidder in the
spaces provided below:
Addendum Addendum Acknowledgement by Bidder or _ Date
No. Date
_,......ww__._ _..............._ Aut_h..o.......r....ize....d _Renresentative Acknowledged — . . w
Failure to acknowledge receipt, as provided above, may be considered sufficient
grounds for disqualification of the bidder and rejection of his/her bid submittal. A record
of all Addenda and copies of same will be available to all qualified bidders from the
Village of Mount Prospect Public Works Department, 1700 West Central Road, Mount
Prospect, Illinois two (2) days prior to the letting. It shall be the bidder's responsibility to
become fully advised of all Addenda prior to submitting its bid.
14
2021 Fire Station 12 and Well 16
Bid Form Page 3
Upon award the contract the Village will send Notice of Award to the successful bidder,
the bidder must then execute the contract and provide the required bonds or letter of
credit and certificate of insurance to the Village within ten (10) days. The Village will
then issue a written Notice to Proceed, which starts the performance period. The
Contractor shall reach substantial completion within nine 90 consecutive calendar
days after the Notice to Proceed with final completion fourteen(14),days thereafter.
Failure to complete the work in the designated time frame may result in the Director of
Public Works withholding compensation due the Contractor for failure to complete the
said work in the designated time frame, calling the bonds, or taking such other action as
may be available.
Secprity in the sum of ten (10%) percent of the amount bid in form of (check one):
Bid Bond Certified Check Bank Cashier's Check
is attached hereto in accordance with the "Instructions for Bidders".
This Bid Submittal contains the following:
1) Bid Form
2) Affidavit - Bid Certification Form
3) Bid Security
4) Bid Sheet(s) - 2021 Fire Station 12 and Well 16 Parking Lot Improvements
Respectfully submitted:
Name of Firm/Bidder:_
By: �--
Title: V f -
Date: 6 at abk
Contact Information;
Official Address: al.. P -d
L.oJc e Zv-t �cF• �,,. 6c�oy'�—.
Telephone: ` 4"1 o 9 &ZI
Email: �u�R Coil,
ONE (1) SIGNED COPY OF THIS BID FORM AND BID SHEET(S) ALONG WITH THE AFFIDAVIT —
BID CERTIFCATION FORM, AND BID SECURITY SHALL BE SUBMITTED IN A SEALED MARKED
ENVELOPE.
41
15
2021 Fire Station 12 and Well 16
VILLAGE OF MOUNT PROSPECT
AFFIDAVIT — BID CERTIFICATION FORM
Bidder:
Chicagoland Paving Contractors Inc.
Company/Firm Name: 225 Telser Road
Lake Zurich, IL 60047
Address:
As a condition of entering into a contract with the Village of Mount Prospect, and under
oath and penalty of perjury and possible termination of contract rights and debarment,
the undersigned, .1 wP , being first duly sworn on oath,
deposes and states that he or she is
(sole owner, partner, joint ventured, President, Secretary, etc.) of
_.._,_ . \kL_ and has the authority to make all
(Nang f Company)
certifications required by this affidavit.
Section I Non Collusion
The undersigned certifies that this bid is genuine and not collusive or a sham, that said
bidder has not colluded, conspired, connived or agreed, directly or indirectly, with any
bidder or person, to put in a sham bid or to refrain from bidding, and has not in any
manner, directly or indirectly, sought by agreement or collusion, or communication or
conference with any person, to fix the bid price element of this bid, or of that of any
other bidder, or to secure any advantage against any other bidder or any person
interested in the proposed contract.
Section II Bid Rigging and Rotatin
The undersigned further states that C.k- ca. ?G��f`
(Name of Company)
is not barred from bidding or contracting as a result of a conviction for violations of state
laws prohibiting bid rigging or bid rotating or any similar offense of any state of the
United States, as provided in Sections 33E-3 and 33E-4 of the Illinois Criminal Code,
720 ILCS 5/33E-3, 33E-4.
Section III Drug Free Workplace
The undersigned further states that c5�CL r\
e of Company)
provides a drug free workplace pursuant to the Drug Free Workplace Act, 30 ILCS
580/1, et seq., and has, to the extent not covered by a collective bargaining that deals
with the subject of the Substance Abuse Prevention in Public Works Projects Act, 820
ILCS 265/1 et seq., a substance abuse prevention program that meets or exceeds
these requirements of that Act.
42
16
2021 Fire Station 12 and Well 16
AFFIDAVIT — BID CERTIFICATION FORM — Page 2
Section IV Tax Pavment
The undersigned further states that C_. ,\ CS S, � �.„ is
(ftme of Compafly)
not delinquent in payment of any taxes to the Illinois Department of Revenue, in
accordance with Illinois Compiled Statues, 65 ILCS 5/11-42.1. The undersigned
understands that making a false statement regarding delinquency in taxes is a Class A
Misdemeanor and, in addition voids the contract and allows the municipality to recover
all amounts paid to the individual or entity under the contract in civil action.
Section V
Pursuant to Section 2-105(A) of the Illinois Human Rights Act, 775 ILCS 5/2-105 (A), every party to a
public contract must:
"Have written sexual harassment policies that shall include, at a mini -mum, the following information: (1)
the illegality of sexual harassment; (II) the definition of sexual harassment under State law; (III) a
description of sexual harassment, utilizing examples; (IV) the vendor's internal complaint process
including penalties; (V) the legal recourse, investigative and complaint process available through the
Department (of Human Rights) and the Commission (Human Rights Commission); (VI) directions on how
to contact the Department and Commission; and (VII) protection against retaliation as provided by
Section 6-101 of the Act. (Illinois Human Rights Act)."
A "public contract" includes: ... every contract to which the State, any of its political subdivisions or any
municipal corporation is a party." 775 ILCS 5/1-103 (M) (2002),
The undersigned further states that, has
(Name of Comgray)
a written sexual harassment policy in place in full compliance with 775 ILCS 5/2-105 (A)
(4).
It is expressly understood the foregoing statements and representations and promises
are made as a condition to the right of the bidder to receive payment under any award
made under the terms and provisions of this bid.
The undersigned certifies that all information contained in this Affidavit is true and
correct.
Signed by: Title: V•! "
Signatu
Name Printed:
Signed and sworn to before me this day of d 2 .
My commission expires:
�~ OFFICIAL SEAL
ary Public JULIE C HEIDERMAN
NOTARY PUBLIC - STATE OF ILLINOIS
MY COMMISSION EXPNW
43
17
2021 Fire Station 12 and Well 16
BID SHEET
SCHEDULE OF PRICES
2021 Fire Station 12 and Well 16 Parking Lot Improvements
(TO BE FILLED OUT BY THE CONTRACTOR/BIDDER)
The Bidder
will complete pricing for all items (No. 1 through 10)
to provide
all labor, equipment,
materials
and mobilization
(if applicable) to perform this work. The fixed item
price
given is to be
all inolUsive.
ITEM
NO.
DESCRIPTION
UNIT
QUANTITY
UNIT PRICE
TOTAL
1
SPECIAL EXCAVATION
CU YD
51
d'.0
10 A 0
2
HMA ASPHALT SURFACE REMOVAL, 3"
SQ YD
2900
3 7S
j 0, 17 5
3
AGGR. BASE COURSE, TYPE B, 9"
SQ YD
290
S
1 WSO
4
HMA SURFACE COURSE, MIX "D", N50,1.5"
TON
250
100—
aSj 00 0
5
LEVELING BINDER (MACHINE METHOD), N50,15'
TON
250
100
aS 000
6
STRUCTURE TO BE ADJUSTED
EACH
2
360-
Toa
7
THERMOPLASTIC PAVEMENT MKGS — 4"
FOOT
586y
0
8
THERMOPLASTIC PAVEMENT MKG, LET & SYM
....................
_..LSUM
SQ FT
50
ay. so
� zdS
9
TRAFFIC CONTROL & PROTECTION
1
10
Y
STEEL PLATE BEAM GUARDRAIL, TYPE A, 6 FOOT
POSTS
EACH
2�
,
_....
._............ �—
— w_ . _
w._www
f ........................... ............
.......
TOTAL
FOR ITEMS
(1 through 10)
t
45
18
Chicagoland Paving Contractors, Inc.
225 Telser Road Lake Zurich, IL 60047
Phone: 847-550-96_81 Fax: 847-550-9684
Credit ReferencesReference & Insurance & Bank Referen ._.....wvww.vw.wv.........ww..........._..
Agency
Peter Baker & Son Company
1349 Rockland Road
Lake Bluff, IL 60044
Phone: 847-362-3663
Fax: 847-362-0707
art( aetcrhakerxom
Arrow Road Construction
3401 S. Busse Road
Mount Prospect, IL 60056
Phone: 847-437-0700
Fax: 847-437-0779
ki °ars ei),arrowroad.cont
Leach Enterprises, Inc.
4304 Route 176
Crystal Lake, IL 60014
Phone: 815-459-6917
Fax: 815-459-9430
Napa Auto Supply — Lake Zurich
191 S. Rand Road
Lake Zurich, IL 60047
Phone: 847-438-7880
Fax: 847-438-9667
Bank Reference:
5/3 rd Bank
6111 N. River Road 4th Floor
Rosemont IL 60018
847-517-8804
Fax: 847-776-6163
James. Charek 53.com
Casper True Value Hardware
100 S. Old Rand Road
Lake Zurich, IL 60047
Phone: 847-438-6751
Fax: 847-438-6792
John Casper
Vulcan Materials
1520-1700 Midway Ct.
Elk Grove Village, IL 60007
Lori Jermyn
630-816-6700
crm Rn1LW*memail.com
Insurance Agency:
Corkill Insurance
25 Northwest Point Bldv.
Ste. 625
Elk Grove Village, IL 60007
Paul Praxamer
847-758-1000
19
Village of Forest Park
CTA Blue Line Parking Lot Improvements
ContractAmount: $485,000.00
Jamies Amelic,
Christopher B. Burke Engineering
847-652-1343
Westmoreland Country Club
Parking Lot Expansion (Wilmette)
Contract Amount: $285,000.00
Mark Constantinou
Westmoreland Country Club
847-853-4700
Parking Lot
City of Rolling Meadows
Parking Lot Pavement Patching
Contract Amount: $ 75,000.00
Bull Suchecki
City of Rolling Meadows
847-917-9338
Village of Northbrook
Crestwood Parking Lot
Contract Amount: $94,000.00
Nailah Walters
Village of Northbrook
847-272-4711
20
Bond Number: 2493707
225 Telser Rd
Lake Zurich, IL 60047-1582
OWNER:
(Name, legal status and address)
Village of Mount Prospect
50 S Emerson St
Mount Prospect, IL 60056-3218
West Bend Mutual Insurance Company
PO Box 620976
Middleton, WI 53562
BOND AMOUNT: $ Ten Percent of the Amount Bid
PROJECT:
(Name, location or address, and Project number, if any)
2021 Fire Station 12 and Well 16 Parking Lot Improvements
The Contractor and Surety are bound to the Owner in the amount set forth above, for the
payment of which the Contractor and Surety bind themselves, their heirs, executors,
administrators, successors and assigns, jointly and severally, as provided herein. The
conditions of this Bond are such that if the Owner accepts the bid of the Contractor within
the time specified in the bid documents, or within such time period as may be agreed to by
the Owner and Contractor, and the Contractor either (1) enters into a contract with the
Owner in accordance with the terms of such bid, and gives such bond or bonds as may be
specified in the bidding or Contract Documents, with a surety admitted in the jurisdiction
of the Project and otherwise acceptable to the Owner, for the faithful performance of such
Contract and for the prompt payment of labor and material furnished in the prosecution
thereof; or (2) pays to the Owner the difference, not to exceed the amount of this Bond,
between the amount specified in said bid and such larger amount for which the Owner may
in good faith contract with another party to perform the work covered by said bid, then this
obligation shall be null and void, otherwise to remain in full force and effect. The Surety
hereby waives any notice of an agreement between the Owner and Contractor to extend the
time in which the Owner may accept the bid. Waiver of notice by the Surety shall not apply
to any extension exceeding sixty (60) days in the aggregate beyond the time for
acceptance of bids specified in the bid documents, and the Owner and Contractor shall
obtain the Surety's consent for an extension beyond sixty (60) days.
If this Bond is issued in connection with a subcontractor's bid to a Contractor, the term
Contractor in this Bond shall be deemed to be Subcontractor and the term Owner shall be
deemed to be Contractor.
When this Bond has been furnished to comply with a statutory or other legal requirement in
the location of the Project, any provision in this Bond conflicting with said statutory or
legal requirement shall be deemed deleted herefrom and provisions conforming to such
statutory or other legal requirement shall be deemed incorporated herein. When so
furnished, the intent is that this Bond shall be construed as a statutory bond and not as a
common law bond.
ADDITIONS AND DELETIONS:
The author of this document has
added information needed for its
completion. The author may also
have revised the text of the original
AIA standard form. An Additions and
Deletions Report that notes added
information as well as revisions to the
standard form text is available from
the author and should be reviewed. A
vertical line in the left margin of this
document indicates where the author
has added necessary information
and where the author has added to or
deleted from the original AIA text.
This document has important legal
consequences. Consultation with an
attorney is encouraged with respect
to its completion or modification.
Any singular reference to Contractor,
Surety, Owner or other party shall be
considered plural where applicable.
Init. AIA Document A310TM — 2010. Copyright 1963, 1970 and 2010 by The American Institute of Architects. All rights reserved. WARNING: This AIA°' Document
is protected by U.S. Copyright Law and Inteirnational TreaVes. Unauthorized reproduction ordistributllon of this Alk' Document, or any portion of it, may
result in severe civil and criminal penalties, and vAll be prosecuted to the maximum extent possible under the law. This document was produced by AIA
i software at 06:24:00 ET on 02/17/2021 under Order No. 7609530746 mvhich expires on 02/20/2022, and is not for resale.
User Notes: (1496601206)
21
Signed and sealed this 21 day of June , 2021
Chicagoland Paving Contractors Inc
(Contractor as l'°itcr (Seal)
(Title)
W st Y) .._ .. I is n urancew...t�ori,,r .,id,i
(Suret
11)
(Witness) "7iII � LUKE �= ''
F' I I' P t�� rw1oy--In-Pact
Init„ AIA Document A3101' —2010. Copyright @ 1963, 1970 and 2010 by The American Institute of Architects. All rights reserved. WARNING: This AIA°"' Document
Is protected by U.S. Copyright haw and Ilinternationel Treaties. Unauthorized reproduction or diistdbutiion of this AIAtr° Docurnent, or any portion of It, nnay
result In severe civil and criminal penalties,, and will be prosecuted to the maAr num extent possible under the law. This document was produced by AIA
t software at 06:24:00 ET on 02/17/2021 under order No, 7609530746 which expires on 02/20/2022, and is not for resale,
User Notes: (1496601206)
22
EST BEND
A MUTUAL INSURANCE COMPANY'
POWER OF ATTORNEY
THE SILVER LINING®
Bond No. 2493707
Know all men by these Presents, That West Bend Mutual Insurance Company, a corporation having its principal office in the City of West
Bend, Wisconsin does make, constitute and appoint:
LUKE F PRAXMARER
lawful 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 bonds,
undertakings and contracts of suretyship, provided that no bond or undertaking or contract of suretyship executed under this authority
shall exceed in amount the sum of: Ten Minion Dollars ($10,000,000)
This Power of Attorney is granted and is signed and sealed by facsimile under and by the authority of the following Resolution adopted
by the Board of Directors of West Bend Mutual Insurance Company at a meeting duly called and held on the 21 st day of December,
1999,
Appointment of Attorney -In -Fact. The president or any vice president, or any other officer of West Bend Mutual Insurance
Company may appoint by written certificate Attorneys -In -Fact to oct on behalf of the company in the execution of and attesting of
bonds and undertakings and other written obligatory instruments o/"like nature. The signature of any officer authorized hereby
and the corporate seal may be affixed by facsimile to any such power of attorney or to any certificate relating therefore and any
such power of attorney or certificate hearing such fac intile signatures be valid and binding upon the
comthe any, and n the utupre with resect to any cert or undertaking or 'matures and seal shall be valid and binding upon
such lc cl la acsimila�, sic
company f p y other writing obligatory in nature to which it is attached.
Any such appointment may be revoked, for cause, or without cause, by any said officer at any time.
In witness whereof, the West Bend Mutual Insurance Company has caused these presents to be signed by its president undersigned
and its corporate seal to be hereto duly attested by its secretary this 22nd day of September, 2017.
Attest-
.......... __.....-.. _
Christopher C. Z gart Kevin evin A
. Steiner
Secretary" S1 , Chief Executive Officer/President
a
X*(P
State of Wisconsin
County of Washington
On the 22nd day of September, 2017, before me personally came Kevin A. Steiner, to me known being by duly sworn, did depose and
say that he resides in the County of Washington, State of Wisconsin; that he is the President of West Bend Mutual Insurance Company,
the corporation described in and which executed the above instrument; that he knows the seal of the said corporation; that the seal
affixed to said instrument is such corporate seal; that is was so affixed by order of the board of directors of said corporation and that he
signed his name thereto by like order. y.,M
air rrr °°
PU[UO S *. Senio orpora.te Attorl'.wy
Notary Public,'Washington Co., Wel:
My Commission is Permanent
The undersigned, duly elected to the office stated below, now the incumbent in West Bend Mutual Insurance Company, a Wisconsin
corporation authorized to make this certificate, Do Hereby Certify that the foregoing attached Power of Attorney remains in full force
effect and has not been revoked and that the Resolution of the Board of Directors, set forth in the Power of Attorney is now in force.
g 21st da y e 202
Signed and sealed at West Bend, Wisconsin this of ...._ June.... 1 _m _ .._.. .�_
rAPOI Ar�
L..... .. ...... _w .w ... __w ww... __....w.._._.._-....
Heather Dunn
Vice President — Chief Financial Officer
Notice: Any questions concerning this Power of Attorney may ..,�.,...
bac directed to the Bond Manager at NSI, a division of West Bend
Mutual Insurance Company.
1900 S. 1811, Ave. West Bend, W1 53095 1 ph (262) 334-6430 1 1-800-236-5004 1 fax (262) 338-5058 1 www.thesilverlining.com
23
INSURANCE COMPANY o TIME TESTED SINE 1844
19W SOUTH 18TH AVENUE e WEST BEND, WI 53095
ACKNOWLEDGMENT OF CORPORATE SURETY
STATE OF Illinois............... _...__...... _...._..... ....... )
ss
County of Will ........... ......-..ww__ww_wwww_.wwww___— )
......... _....J 2
On this � st .._.. day of June , 20 21 before me appeared
Luke F. Praxmarer to me personally known, who being by me duly sworn,
did say that he/she is the aforesaid officer or attorney in fact of the WEST BEND MUTUAL INSURANCE COM-
PANY, a corporation; that the seal affixed to the foregoing instrument is the corporate seal of said cor oration, and
that said instrument was signed and sealed on behalf of said corW-ro
by the a *es id o er ( ttorney-in-
Y Yedged said in-
strument
b authority of its Board of Directors; and the aforesaid offAtt me t c t kn
strument to be the free act and deed of said corooratiorr.
PHAMOD HAM VENKATES
OFFICIAL SEAL
My Commission Expires Notary Public, state of. a
My Commission Expir ;
October 28, 2023
Notary Public
October 28 M _...__. 20 23 County of Will , State of Illinois
MICHIGAN ONLY: This policy is exempt from the filing requirements of Section 2236 of the Insurance Code
of 1956, 1956 PA 218 and MCL 500.2236.
NB 0017 10 03
Page 1 of 1
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Project Location a s
Fire Station 12
Well 16
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