Okaloosa County BOCC — December 31, 2012 — APAC Final Payment

EXHIBIT H CONTRACT CLOSE-OUT CHECKLIST (To Be Prepared by the Contracts & Leases Coordinator) DATE: nlele TO: Contracts & Grants Manager, Finance Department Contracts & Grants Division SUBJECT: Contract No. C/2-/4%9-AW MANAGING DEPARTMENT: _/Ud/t. bdo ks CONTRACTOR'S NAME: ALAC Mid-South , Ine. PROJECTTITLE: = Sy/vania Heiphts AO3372 The attached has met the final payment contract requirement in subject contract. Yes No 1. Final Invoice ay O 2. Completed Contract/Lease Payment Approval Form a oO 3, Close-Out Documents Yes No N/A a. Signed Release of Lien ap O O b. Proof of Completion Advertisement ea oO O c. Certificate of Insurance ag O O d. Consent of Surety to Final Payment “Pg im O e. Proof of Performance/Payment Bond ia O O Continuation 12 Months Following Final Payment Yes No a 4. Agenda Request 5: Remarks LAL f- wal Contracts and Lease Coordinator DATE EXHIBIT I CONTRACT/LEASE PAYMENT APPROVAL FORM COMPLETE AND FORWARD TO THE NEXT APPROVING DEPARTMENT COMPLETED BY DEPARTMENT DATE: 11/5/2012 VENDOR NAME: APAC Mid-South Inc. VENDOR #: COUNTY AGREEMENT # (Contact Contract/Lease Coordinator, if unknown) PW 33-12 Sylvania Heights TASK COUNTY/FEMA VENDOR ORDER # PROJECT # BUDGET INVOICE # (if applicable) (if applicable) DEPARTMENT # ACCOUNT # AMOUNT 002 $28,774.22, TOTAL $28,774.22 APPROVED FOR PAYMENT (please initial, as applicable and date): ENGINEER/ARCHITECT/PROJECT MANAGER caer a DATE: 5-Nov-12 COUNTY PROJECT a DATE: _ Wtofzore 1G, DEPARTMENT HEAD: DATE: “ADA FINAL PAYMENT: YES = O CONTRACTS & GRANTS DATE: CONTRACTS & GRANTS MANAGER: DATE: COUNTY ADMINISTRATOR APPROVAL : (Only Payments $25,001 - $50,000) FINAL PAYMENT APPROVAL (if needed): PURCHASING DIRECTOR: (Only Contracts < = $25,000) COUNTY ADMINISTRATOR : (Only Contracts between $25,001 to $50,000) Contracts Over $50,000 — BCC Approved COMPLETED BY FINANCE - ACCOUNTS PAYABLE ONLY FISCAL YR: DATE RECEIVED: Form revised 1-20-2011 APPLICATION FOR PAYMENT PERIODIC ESTIMATE NO.: an PROJECT NO.: PW. 33-12, WORK PERIOD BEGIN DATE: Det. |, 261 enn vate: _Oet. 10, 212 ROAD NAME: Sy Vania. Heights ORIGINAL CONTRACT SUM $_315, 152.% NET CHANGE BY CHANGE ORDERS $_Z£ 14, 08 |. 90> CONTRACT SUM TO DATE $_24], bb. 10 ANALYSIS OF WORK PERFORMED 1. Value of original contract work performed previously: $ atl 4f SOD, 93 2. Work performed this month: $ ) 1 BLY LT 3y Total value of work performed to date: $ T6./0 4. Less: Amount retained at five (5%) percent: $ oO. 66 5. Net amount earned on contract work to date: $ b./0 6. Less: Amount of previous payment: $ aA ie, g qs. 88 7, AMOUNT DUE THIS PAYMENT $ AS Z Zt. ey) a CERTIFICATION OF CONTRACTOR According to the best of my knowledge and belief, I certify that all items and amounts shown on the face of the Periodic Estimate are correct; that all work has been performed and/or materials su PA? full accordance with the terms and conditions of the contract between Okaloosa County and yi CG , and that the items for which payment is requested have been paid and that there are no vendors-mechanics, or other liens or conditional sales contracts which should be satisfied or ‘discharged before such payment is made. APAG Mid-Smucbh, Tne, By: watt x as Hobe. (Firm Name) (Name ‘of Authorized Officer & Title) CERTIFICATION OF ENGINEER I certify that I have verified this Periodic Estimate and that to the best of my knowledge and belief, it is a true and correct statement of work performed and materials supplied by the Contractor; and that the Contractor's ede we xs account and the amount due him is correct. —Grne Chal be Lease” Date: November E MMs Project Manager UY C C7 ° Sylvania Heights Resurfacing App. For Payment MI ee vLL'sz $ qunowy ad10Au] So’S0z‘ LL $ aBeurejay eseajoy ZV69S‘ZL $ PeWOpeg YOM LL69S°ZL $ [YUOIN Sy} PeULOLEd YOM 00'rre'2 $ 00°21 $ dt Z8L ISL SUUM ve ‘PIS ‘ONSe|doueYL 00°90'S| $ 00°r$ AS 6SZE ooge pos‘pn] soueuopeg : $ 00°e$ AS 008 HN] soueUOpeg * $ 00'S Les va s ysnipy xoq eajen 2 $ 00'SLe$ Wa Se ysnipy ajoyueyy (00'0z6'e) $ | 00'0z¢"e$- $7 L L SUO} 000z JO %RE JOIORY Aeg aysoduioD (€9°0) $ 00'es$ NL L0‘0- OZ0¢ yeudsy eaegiedns 00°000'2 $ 00'0r$ AO os ost uoneaeoxy Jejnboy * $ | 00°000'¢$ $1 L Buiqqnidy pue buiuseala z $ os'e$ 41 000g JoLueg yUuaWIpas - $ 00'8$ AS 002 [O1U0D UOISOI pajjo1/SbulaA0D [elOWY 00°08 $ | 00°008'E$ $1 (xe) L oes] JO souBUalUIEL] 00°0Ee'L $ | 00°00E'21$ ial xe) L 1SO09 GSQNSLxX3 | 390ldd LINN | LINN | SLVIWILSS | ALLLNVNO SIHL XVIAl Buleynsay syy6ioy eiuealAs CONTRACTOR'S RELEASE OF LIENS STATE OF: _t lorida COUNTY OF: _FScamloia Before me, the undersigned Notary Public in and for the said County and State personally appeared Lysa_ S. Habec , representing the Contractor, . PAC Mid-Seith Tne. who being duly sworn according to law deposes and says that all labor, materials, and outstanding claims and indebtedness of whatever nature arising out of the performance of the Contract with OKALOOSA COUNTY BOARD OF COUNTY COMMISSIONERS the Owner, for Sy\anic. Ye aris , Contract No. , have been paid in full and that for the final payme in the amount of DU L(A1DAd , the Contractor releases and discharges the Owner and- his authorized ‘representatives from any liens or claims of any nature because of or arising from this contract and/or its performance, which it has had, has or May have in the future. oy, Mica SS. Heabren MINDY &. SMALLWOOD Sworn to and subscribed before me this Ic hy %, NOTARY PUBL STATE OF FLORIDA ad day of November, 2012 & HAGE Commit EEO17848 Mandy & Sonodttueod See Expires 8/16/2014 (Notary Public) My Commission Expires: LAle -AdIY Sylvania Heights Resurfacing Release of Liens Ol Page 4 of 1 10/16/2012 10:48:39 Ad Number : 34530734 Ad Key : Order Number: 34228561 Salesperson : 25 - Maureen Wiltse PO Number : Publication . Northwest Florida Daily News Customer : 33857108 APAC Mid-South Sectlon : Classified 2006 Contact y Mindy Smallwood Sub Soctlon 4 Classified 2006 Address1 : 4375 McCoy Drive Category : 4100 Legal Advertising Address2 ; Dates Run : 10/18/2012-1 1/08/2012 Clty St Zip ; Pensacola FL 32503 Days : 4 Phone 5 (850) 462-1337 Size : 1x 3.60, 34 lines Fax : (850) 434-8971 Words : 83 Credit Card : Sarseaeteseng {91 Ad Rate : Legals Rate Printed By : Maureen Wiltse Ad Price : 221.24 Entered By 3 Maureen Wiltse Amount Pald =: 221.24 AmountDue —: -0.00 Keywords 3 3239 Sylvania Heights Notes F Advertisement of Completion Zones F Legal 3239 AOVERTISEMENT OF COMPLETION APAC Mid-South, Inc. 4375 McCoy Drive, Pensacola, FL 32503 gives notice of compte thon of Syivania Heights Resurfacing Improve- ments and sets Novom- bor 6, 2012 as tho dato of final seltement All persons and = firms should file all claims for payment ta the below address prior to the setiiement dale: Okaloosa County (Owner) ATTN: Contracts and Leases Coordinator 602-C North Peart Street Crestview FL 32536 By: Lisa S. Haber Project Manager Legal 3239 Oct. 18, 25, Nov. 4, 8, 2012 MinSOUTH A SEMING. — 4375 wcCoy Drive Pensacola, FL 325034 (850) 433-3001 November 9, 2012 Mr. James R. VanSteenburg, P.E. Senior Project Engineer HDR Construction Control Corporation 4673 Highway 20 East Niceville, Florida 32578 RE: County: Okaloosa Project Description: Sylvania Heights Resurfacing Improvements Letter Description: Letter of Acceptance Dear Mr. VanSteenburg, Please find attached a copy of the current certificate of insurance for the above referenced project. APAC Mid-South, Inc. agrees to maintain said certificate of insurance for a period of two years from the date of acceptance which is October 9, 2012. Sincerely, Ya 2 Lisa S. Haber Project Manager APAC Mid-South, Inc. o Oldcastle’ Materials Certificate of Insurance THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON YOU THE CERTIFICATE HOLDER. THIS CERTIFICATE IS NOT AN INSURANCE POLICY AND DOES NOT AMEND, EXTEND, OR ALTER THE COVERAGE AFFORDED BY THE POLICIES LISTED BELOW. POLICY LIMITS ARE NO LESS THAN THOSE LISTED, ALTHOUGH POLICIES MAY INCLUDE ADDITIONAL SUBLIMIT/LIMITS NOT LISTED BELOW. This is to Certify that APAC Mid South Inc 500 Riverhills Park Suite 590 e Birmingham AL 35242 ADDRESS. Liberty Mutual. OF INSURED INSURANCE is, at the issue date of this certificate, insured by the Company under the policy(ies) listed below. The insurance afforded by the listed policy(ies) is subject to all their terms, exclusions and Conditions and is not altered by any requirement, term or condition of any contract or other document with respect to which this certificate may be issued. EXP DATE CONTINUOUS TYPE OF POLICY Oo : POLICY NUMBER LIMIT OF LIABILITY EXTENDED [1 pouicy term WORKERS 9/1/2013 WAT-C8D-004095-022 Bae OCLOWING States, | EMPLOYERS LIABILITY ALL STATES EXCLUDING COMFENSSTION WG7-C81-004095-012 | MONOPOLISTICS STATES AND [Polly Hur by boric NY Each Accident! wi Bodily Injury By Disease $1,000,000 poticy tim! Bodily Injury By Disease $1,000,000 Fach Person COMMERCIAL General Aggregate GENERAL LIABILITY 9/1/2013 TB2-C81-004095-112 $2,000,000 MW occurrence Products / Completed Operations Aggregate $2,000,000 O1 crams Mabe Each Occurrence $2,000,000 RETRO DATE Personal & Advertising Injury $2,000,000 Per Person / Organization (Other Other FIRE DAMAGE $100,000 PER PROJECT AGGREGATE Medical Exp-$5.0! AUTOMOBILE Each ee Limit LIABILITY 9/1/2013 AS2-C81-004095-122 $2,000,000 B1. And P.D. Combined aw Each Person OWNED M1 noy-ownep Each Accident or Occurrence M1 rireo Each Accident or Occurrence OTHER Auto: Comp Ded $10,000/Coll Ded $10,000 EVIDENCE OF COVERAGE ADDITIONAL COMMENTS Okaloosa County, its respective agents, consultants, servants and employees of each and all other interests are listed as acoltona! ineured. Coverage is primary and non- “contributory. Includes a waiver of subrogation in favor of the additional insure * If the certificate expiration date is continuous or extended term, you will be notified if coverage is terminated or reduced before the certificate expiration date. NOTICE OF CANCELLATION: (NOT APPLICABLE UNLESS A NUMBER OF DAYS IS ENTERED BELOW.) — BEFORE THE STATED EXPIRATION DATE THE COMPANY WILL NOT CANCEL OR REDUCE THE Liberty Mutual INSURANCE AFFORDED UNDER THE ABOVE POLICIES UNTIL ATLEAST 30 DAYS NOTICE Insurance Group OF SUCH CANCELLATION HAS BEEN MAILED TO: [ Okaloosa County ~] Yi Walyentis’ 602-C North Pearl Street Judith Balazentis bs Crestview FL 32536 Pittsburgh / 0387 AUTHORIZED REPRESENTATIVE Es 12 Federal Street, Ste. 310 2 Pittsburgh PA 15212-5706 412-231-1331 11/27/2012 OFFICE PHONE DATE ISSUED This certificate is executed by LIBERTY MUTUAL INSURANCE GROUP as respects such insurance as is afforded by those Companies NM 772 07-10 CERT NO.: 14780374 CLIENT CODE: LM 44 Christopher Herring - NE 11/27/2012 7:45:02 AM Page 1 of 1 BOND NO. 8229-91-83 Rule 14-24, FAC. STATE OF FLORIDA DEPARTMENT OF TRANSPORTATION 700-050-241 CONTRACTOR'S AFFIDAVIT AND SURETY CONSENT adnan (FORM 21-A) STATE OF FLORIDA countyor —fSCambia Before me, the undersigned Notary Public, personally appeared Tun sto\\ QB. Pe WN TV. to me well known er-who-has-produced KRY“ LLY LY. as identification, (Type of Identification) who being first duly sworn, deposes and says that he/she is: Nice Pres ident (Title of duly authorized person) of _ APAC MID-SOUTH, INC. a CORPORATION i (Contracting entity) (Type of entity) the Contractor on Financial Project |.D. * NIA , Road No. N/A in OKALOOSA County, Florida under Contract No. REB# PW 33-12 ; OLAS Count ; Dot with the State-of Florida- Department of Transportation-dated the i —_ day of duly . BOA; and that the Affiant based on his/her personal knowledge says that: 1, Said contract has been complied with in every particular by the Contractor and that all parts of the work have been approved by the District Director of Operations of the State of Florida Department of Transportation. 2. The Contractor has not offered or made any gift or gratuity to, or made any financial transaction of any nature with, any employee of the Department in connection with obtaining or performing said contract. 3. All amounts payable for labor, materials, or otherwise, in connection with said contract and work have been paid excep for normal sub-contract retainages, which will be satisfied within 30 days after payment and/or release of retainage withheld under said contract. 4. There are no claims or suits pending against said Contractor or anyone in connection with the work done, materials furnished or otherwise, under said contract except as listed below. As to any such exception listed below, the Contractor has stated the name of the entity making the claim, the name of the entity against whom the claim is being made, and demonstrated below good cause as required by Section 337.11(10)(b), Florida Statutes. Claiming Entity Claim Agent Nature of claim Good cause explanation None State of Florida A false statement or omission made in connection with this County of E SCO o 1a qh rh affidavit is sufficient cause for suspension, revocation, or ; . denial of qualification to bid, and a determination of Sworn to and subscribed before me this day non-responsibility, and may subject the person and/or entity making the false statement to any and all civil and criminal of Novembk dev Dod by “Tur \stall ion Porry TV penalties available pursuant to applicable Federal and State Mund, S 9 (Print name of person signing an Law. YY £. SMALLWOOD - iN ain ’ ama Public _ - CCe aC Z : APAC MID-SOUTH, INC. t AG TE P Ante Ab! 1 BAN? Commit 017848 Oe EE. MLESPIE EAS” Expires 8/16/2014 = = Personally Known j~~ OR Produced Identification Punstall B. Berry WIA Vice President a Title Type of Identification Produced Rule 14-24, FAC. 700-050-21 CONSTRUCTION 08/04 We, the FEDERAL INSURANCE COMPANY _, duly authorized to do business under the laws of Florida, having (Type or printname of surety) heretofore executed a performance and payment bond for the Contractor covering the contract described above, hereby consent to the State of Florida Department of Transportation making full payment of the final estimate, including the retained percentage, to the Contractor. It is fully understood that consenting to the State of Florida Department of Transporation making payment of the final estimate to the Contractor and/or its assignee, shall not relieve this surety company of any of its obligations under its bond. IN WITNESS WHEREOF, the FEDERAL INSURANCE COMPANY has caused this (Type or print name of surety) instrument to be executed by its President, Chief Executive Officer or duly authorized Attorney-In-Fact and it's corporate seal to be hereto affixed, all on this 8TH day of NOVEMBER ' 2012 FEDERAL INSURANCE COMPANY (AFFIX SEAL) BY: : {J Its President or chift Executive Officer LISA HALL [Xi Its Attorney-In-Fact FL LICENSE NO. W043413 {J Florida Licensed Insurance Agent STATE OF UTAH (Attach Power of Attorney) COUNTY OF SALT LAKE to me well known or who Before me, the undersigned Notary Public, personally appeared LISA HALL has produced DRIVERS LICENSE as identification as the person described in and who executed the forgoing (Type of Identification) FEDERAL INSURANCE COMPANY surety, as its and LISA HALL ATTORNEY-IN-FACT instrument in the name of ATTORNEY-IN-FACT acknowledged that he/she executed said instrument in the name of said surety as its arate purposes therein expressed and that he/she has due and legal authority to execute the same on behalf of said surety. Sworn to and subscribed before me this 8TH day of NOVEMBER _ | 2012 My commission expires JULY 26, 2015 Notary Public, State of UTAH Notary Public JESSICA ARNOLD Commission Number 612061 My Commission Expires July 26, 2015 State of Utah =o S07 69 6S OS GO sy BG YO Fn SS On Om OW 80 BP POWER Federal Insurance Company Attn: Surety Department Chubb OF Vigilant Insurance Company 15 Mountain View Road GHUBB Surety ATTORNEY Pacific Indemnity Company Warren, NJ 07059 Know All by These Presents, That FEDERAL INSURANCE COMPANY, an Indiana corporation, VIGILANT INSURANCE COMPANY, a New York corporation, and PACIFIC INDEMNITY COMPANY, a Wisconsin corporation, do each hereby constitute and appoint Tina Davis, Lindsey Gates and Lisa Hall of Salt Lake City, Utah and Melanie Walker of Tulsa, Oklahoma -=----=-:-s0++-022=0= each as their true and lawful Attorney- in- Fact to execute under such designation in their names and to affix their corporate seals to and deliver for and on their behalf as surety thereon or otherwise, bonds on behalf of contractors in connaction with bids, proposals or contracts to or with the Department of Transportation, and any and all consents required by the Department of Transportation of Florida incident to the release of retained percentages and or final estimates on engineering and construction contracts. In Witness Whereof, said FEDERAL INSURANCE COMPANY, VIGILANT INSURANCE COMPANY, and PACIFIC INDEMNITY COMPANY have each executed and attested these presents and affixed their corporate seals on this 5th day of July, 2011, 2 eS poe Nontis, Jr., Vice all STATE OF NEW JERSEY County of Somerset 8s. On this Sth day of July, 2011 before me, a Notary Public of New Jersey, personally came Kenneth C. Wendel, to me known to be Assistant Secretary of FEDERAL INSURANCE COMPANY, VIGILANT INSURANCE COMPANY, and PACIFIC INDEMNITY COMPANY, the companies which executed the foregoing Power of Attorney, and the said Kenneth C. Wendel, being by me duly sworn, did depose and say that he is Assistant Secretary of FEDERAL INSURANCE COMPANY, VIGILANT INSURANCE COMPANY, and PACIFIC INDEMNITY COMPANY and knows the corporate seals thereof, that the seals affixed to the foregoing Power of Attorney are such corporate seals and were thereto affixed by authority of the By- Laws of said Companies; and that he signed said Power of Attorney as Assistant Secretary of said Companies by like authority; and that he is acquainted with David B. Norris, Jr., and knows him to be Vice President of said Companies; and that the signature of David B. Norris, Jr., subscribed to said Power of Attorney is in the genuine handwrjina of David B, Norris, Jr., and was thereto subscribed by authority of said By- Laws and in deponent's presence. ERINE J, ADELAAR Notarial Seal NOTARY PUBLIC OF NEW JERSEY __No, 2316685 Commission Expires July 14, 2014 VE he © Notary Public CERTIFICATION VY Extract from the By- Laws of FEDERAL INSURANCE COMPANY, VIGILANT INSURANCE COMPANY, and PACIFIC INDEMNITY COMPANY: “All powers of attorney for and on behalf of the Company may and shall be executed in the name and on behalf of the Company, either by the Chairman or the President or a Vice President or an Assistant Vice President, jointly with the Secretary or an Assistant Secretary, under their respective designations. The signature of such officers may be engraved, printed or lithographed. The signature of each of the following officers: Chairman, President, any Vice President, any Assistant Vice President, any Secretary, any Assistant Secretary and the seal of the Company may be affixed by facsimile to any power of attomey or to any certificate relating thereto appointing Assistant Secretaries or Attorneys- in- Fact for purposes only of executing and attesting bonds and undertakings and other writings obligatory in the nature thereof, and any such power of attorney or certificate bearing such facsimile signature or facsimile seal shall be valid and binding upon the Company and any such power so executed and certified by such facsimile signature and facsimile seal shall be valid and binding upon the Company with respect to any bond or undertaking to which it is attached.” |, Kenneth C. Wendel, Assistant Secretary of FEDERAL INSURANCE COMPANY, VIGILANT INSURANCE COMPANY, and PACIFIC INDEMNITY COMPANY (the “Companies”) do hereby certify that {i) the foregoing extract of the By- Laws of the Companies is true and correct, (ii) the Companies are duly licensed and authorized to transact surety business in all 50 of the United States of America and the District of Columbia and are authorized by the U.S, Treasury Department; further, Federal and Vigilant are licensed in Puerto Rico and the U.S. Virgin Islands, and Federal is licensed in American Samoa, Guam, and each of the Provinces of Canada except Prince Edward Island; and (ili) the foregoing Power of Attorney is true, correct and in full force and effect. Given under my hand and seals of said Companies at Warren, NJ this 8TH dayof NOVEMBER, 2012 Kenneth C. el, Secretary IN THE EVENT YOU WISH TO NOTIFY US OF A CLAIM, VERIFY THE AUTHENTICITY OF THIS BOND OR NOTIFY US OF ANY OTHER MATTER, PLEASE CONTACT US AT ADDRESS LISTED ABOVE, OR BY Telephone (908) 903- 3493 Fax (908) 903- 3656 e-mail: surety@chubb.com Form 15-10- 0153B-U (Rev. 5-03) FLA DOT MAINTENANCE BOND Bond Number: 8229-91-83 KNOW ALL MEN BY THESE PRESENTS, thatwe APAC MID-SOUTH, INC. as Principal, (the “Principal”), and Federal Insurance Company, a corporation organized under the laws of the State of Indiana, as Surety, (the “Surety’), are held and firmly bound unto OKALOOSA COUNTY BOARD OF COMMISSIONERS as Obligee (the “Obligee’), in the penal sum of TWO HUNDRED FORTY ONE THOUSAND SIX HUNDRED SEVENTY AND 10/100 Dollars ($241,670.10), for the payment of which sum well and truly to be made, the Principal and the Surety, bind ourselves, our heirs, executors, administrators, successors and assigns, jointly and severally, firmly by these presents. th WHEREAS, the Principal has by written agreement dated Dal ,ZO\2Z_. entered into a contract (the “Contract”) with the Obligee for RFB #PW 33-12 SYLVANIA HEIGHTS RESURFACING PROJECT which contract is by reference made a part hereof. NOW, THEREFORE, the condition of this obligation is such that if the Principal shall remedy without cost to the Obligee any defect which may develop during a period of ONE (1) year(s) from the date of completion and acceptance of the work performed under the Contract provided such defects are caused by defective or inferior materials or workmanship, then this obligation shall be null and void; otherwise it shall be and remain in full force and effect. DATED as of this 18TH day of OCTOBER, 2012. APAC MID-SOUTH, INC. (Seal) Principal ‘ WITNESS/ATTEST: ; 2 Dndy & Smobliccart MEE as Name: Title: Tunstall B. Perry Vice President FEDER INSURANCE COMPANY (Seal) ISA HALL, ‘aot Fact SURETY ACKNOWLEDGMENT STATE OF UTAH } COUNTY OF SALT LAKE } SS On this 18TH day of OCTOBER, 2012, before me personally came LISA HALL to me known, who, being by me duly sworn, did depose and say that she is an Attorney-In-Fact of FEDERAL INSURANCE COMPANY the corporation described in and which executed the within instrument; that she knows the corporate seal of said corporation, that the seal affixed to the within instrument is such corporate seal, and that she signed the said instrument and affixed the said seal as Attorney-In-Fact of the Board of Directors of said corporation and by authority of this office under the Standing Resolutions thereof. Shona _ Notary Public Notary Public JESSICA ARNOLD Commission Number 612061 My Commission Expires July 26, 2015 State of Utah poeoeesesee eeecesescon! [ Chubb POWER Federal Insurance Company = Attn: Surety Department u OF Vigilant Insurance Company 15 Mountain View Road Surety ATTORNEY Pacific Indemnity Company Warren, NJ 07059 CHUBB Know All by These Presents, That FEDERAL INSURANCE COMPANY, an Indiana corporation, VIGILANT INSURANCE COMPANY, a New York corporation, and PACIFIC INDEMNITY COMPANY, a Wisconsin corporation, do each hereby constitute and appoint Tina Davis, Lindsey Gates and Lisa Hall of Salt Lake City, Utah and Melanie Walker of Tulsa, Oklahoma ----+--=-=~ each as their true and lawful Attorney- in- Fact to execute under such designation in their names and to affix their corporate seals to and deliver for and on their behalf as surety thereon or otherwise, bonds and undertakings and other writings obligatory in the nature thereof (other than bail bonds) given or executed in the course of business, and any instruments amending or altering the same, and consents to the modification or alteration of any instrument referred to in said bonds or obligations. In Witness Whereof, said FEDERAL INSURANCE COMPANY, VIGILANT INSURANCE COMPANY, and PACIFIC INDEMNITY COMPANY have each executed and attested these presents and affixed their corporate seals on this 5th day of July, 2011. G ” wm rae Gc Kenneth rendel, Assistant Secretary David forris, Jr., Vice Preside STATE OF NEW JERSEY SS. County of Somerset Onthis 5th day of July, 2011 before me, a Notary Public of New Jersey, personally came Kenneth C. Wendel, tome known to be Assistant Secretary of FEDERAL INSURANCE COMPANY, VIGILANT INSURANCE COMPANY, and PACIFIC INDEMNITY COMPANY, the companies which executed the foregoing Power of Attorney, and the sald Kenneth C. Wendel, being by me duly sworn, did depose and say that he is Assistant Secretary of FEDERAL INSURANCE COMPANY, VIGILANT INSURANCE COMPANY, and PACIFIC INDEMNITY COMPANY and knows the corporate seals thereof, that the seals affixed to the foregoing Power of Attorney are such corporate seals and were thereto affixed by authority of the By- Laws of said Companies; and that he signed said Power of Attorney as Assistant Secretary of said Companies by like authority; and that he is acquainted with David B. Norris, Jr., and knows him to be Vice President of said Companies; and that the signature of David B. Norris, Jr., subscribed to said Power of Attorney is in the genuine handwriting of David B. Norris, Jr., and was thereto subscribed by authority of said By- Laws and In deponent's presence. KATHERINE J. ADELAAR NOTARY PUBLIC OF NEW JERSFY Milli No, 2316685 Commission Expires July 14,2074 Notary Public Notarial Seal CERTIFICATION Extract from the By- Laws of FEDERAL INSURANCE COMPANY, VIGILANT INSURANCE COMPANY, and PACIFIC INDEMNITY COMPANY: “All powers of attorney for and on behalf of the Company may and shall be executed in the name and on behalf of the Company, either by the Chairman or the President or a Vice President or an Assistant Vice President, jointly with the Secretary or an Assistant Secretary, under their respective designations. The signature of such officers may be engraved, printed or lithographed. The signature of each of the following officers: Chairman, President, any Vice President, any Assistant Vice President, any Secretary, any Assistant Secretary and the seal of the Company may be affixed by facsimile to any power of attorney or to any certificate relating thereto appointing Assistant Secretaries or Attorneys- in- Fact for purposes only of executing and attesting bonds and undertakings and other writings obligatory in the nature thereof, and any such power of attorney or certificate bearing such facsimile signature or facsimile seal shall be valid and binding upon the Company and any such power so executed and certified by such facsimile signature and facsimile seal shall be valid and binding upon the Company with respect to any bond or undertaking to which it is attached.” |, Kenneth C. Wendel, Assistant Secretary of FEDERAL INSURANCE COMPANY, VIGILANT INSURANCE COMPANY, and PACIFIC INDEMNITY COMPANY (the “Companies*) do hereby certify that (i) _ the foregoing extract of the By- Laws of the Companies is true and correct, (ii) the Companies are duly licensed and authorized to transact surety business in all 50 of the United States of America and the District of Columbia and are authorized by the U.S, Treasury Department; further, Federal and Vigilant are licensed in Puerto Rico and the U.S. Virgin Islands, and Federal is licensed in American Samoa, Guam, and each of the Provinces of Canada except Prince Edward Island; and (ili) the foregoing Power of Attorney is true, correct and in full force and effect. Given under my hand and seals of said Companies at Warren, NJ this 18TH day of OCTOBER, 2012 enneth C. Wendel, Assistant Secretary IN THE EVENT YOU WISH TO NOTIFY US OF A CLAIM, VERIFY THE AUTHENTICITY OF THIS BOND OR NOTIFY US OF ANY OTHER MATTER, PLEASE CONTACT US AT ADDRESS LISTED ABOVE, OR BY Telephone (908) 903- 3493 Fax (908) 903- 3656 e-mail: surety@chubb.com Form 15-10- 0225B-U (Ed. 5-03) CONSENT