20040520Bid Tabulations.pdf

STATE OF IDAHO
DEPARTMENT OF
ENVIRONMENTAL QUALITY
ECEIVED
II ;::-r"'o'" \...,.
l2'J
2nuil f::1AY 20 PH 12: Sf.)
'_._......."._........_----_
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c_- -. LiLit.,1410 North Hilton. Boise, Idaho 83706-1255 . [phone] U T IL i TiE S cot'1 rill I 55 iON Dirk Kempthorne, Governor
C. Stephen Allred, Director
May 20, 2004
5~ LU 5 - LA-) - "45 -
Mr. Robert Smith
Idaho Public Utilities Commission
4 72 Washington
Boise, ID 83720
Dear Bob:
Attached is a copy of the bid tabulations for the Stoneridge project. In as much as the
low bidder has stated that the bid prices are only good through May 24, 2004 we are
considering giving at least a conditional approval for award of the bid by that date. It is
likely that if we had Stoneridge reject all bids the re-bid would only result in higher costs.
We would appreciate your advice on how best to approach this with the Commission.
Sincerely,
Bill J errel
Loan Program Manager
Newport
600 4th Street West
Newport, Washington 99156
[phone]
[phone]
[phone] Fax
JAMES A. SEWELL & ASSOCIATES
Consulting Engineers & Land Surveyors
Spokane
Hutton Building
9 South Washington, Suite 708
Spokane, \Vashington 99201
[phone]
[phone] Fax
- *CiviIE gh~eering *ElectricaiEngin ~ring *LandSu~~eying *Building ijeio
Sandpoint
Pend Oreille Professional Center
30336 Highway 200, Suite C
Ponderay, Idaho 83852
[phone]
Fax [phone]
State of Idaho
Division of Environmental Quality
2110 Ironwood Parkway
Coeur d' Alene , Idaho 83814
f()fC3) \V1
~~
lr"
MAY 1 9 2DO~
Department ot EnWionmental
State Water QuaU QualIty
rograms
. .. - ..
May 17, 2004
Attn:Roger Tinkey P .
RE:Stoneridge Utilities and Happy Valley Ranchos Water Systen1s
Bid Award
Dear Roger
The Stoneridge Utilities - Happy Valley Ranchos Water Interconnection project bid opening was
. last Friday May 14, 2004 at 1 :30 pn1. The bid docun1ents were originally n1ailed to the
prospective bidders on April 30, 2004 and a prebid n1eeting was held on I\1ay 6 , 2004. Four
contractors submitted bids on the work. The lowest respon~iye responsible bidder for both
schedules was David BellOlny Excavation and Pipeline Specialists. Enclosed is a copy of
Stoneridge Utilities tentative award to BellOlny. A copy of the certified tabulation received isenclosed.
A copy of Bellomy s bid is enclosed. There were no addenda issued. The bid package includes:
The Bid signed by the contractor;
List of subcontractors;
Bid Bond;
Certification of Conlpliance with Anti-Lobbying Act;
Minority, Women, and Small Business to be Utilized;
Statement of Compliance \vith Minority, Women, and Small Business Utilization
requirements;
Contractor s Compliance Statement;
Certification of Nonsegregated Facilities;
Affidavit of Payment or Securement of all Taxes;
Contractor for Public Works to Payor Secure Taxes folm.
The budget for construction including the allowance for contingency was $167 550. The bid
amount by Bellomy for both schedules is $182 990.
Licensed in Washington, Idaho, & Montana
RE: Stoneridge Utilities and Happy Valley Ranchos Water Systen1s
Bid Award
May 17, 2004
Page 2 of 2 Pages
Last Thursday the Easement and Quit Clailn Deed for access to Ronald Bacon s property was
filed with Bonner County. This provides for the necessary Right of Ways to construct and
operate the project.
The inspectorrepr~senting theengineeron the project \vill be Jack Anderson. His reSUlne is
attached.
The Contractor has indicated that his suppliers prices are only good for ten days after the bid
date, so anything you can due to help speed along the concurrence by DEQ would be appreciated.
Sincerely,
JAMES A. SEWELL AND ASSOCIATES
Consulting Engineers
Joe M. Ohnstead P., Partner
Bill Jerrel SRF Manager; 1410 N Hilton Street; Boise, Idaho 83706; 208-373-0502
Stoneridge Utilities \vl copy
Newport Office wlo copy
File wi copy
licensed in Washington, Idaho, & Montana
MaY,17. 2004 1:43Pf~
SENT, BY:
~~~
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650 579 1320
.. , 'NO. ~UJb
MAY. 17 - 04
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. I ~GE 2/2
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~ONE RtoGE
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May 16. 2004
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STONCIII,COWIga-o 1'".0""
j~:r~n.P o
of QtIa1ity
2110 1Nc1~
C()aII' d'AAeoe. ID 83814
R F. : Happy V a1 \ey Conncc;tion Bi d.,
()Qr J nhrI ,
BeUosny Excav1dio~ on the b1d $ubmjua\s rec.eNc:d on Friday Mtty 14. 2004. was
the t~'t responsive ~b\e \nddes- fUT" the proj~ to COftIICd the HV1l water sy~
10 the SmncflidF Utility S)'~. Afb' ofthc with SeweU ~1"':'100.
;'.g..
StvIcR Utitity is confident \n ~ng Bet 10m Y , s b'd for the and
request!i DEQ
~~~
me;r b1d ~ submiltad
W c 1IIUC advised at the time of bid i WI!that pric.cs are only ,good for 1 0 days due t
cscallltiDg macaial oom. The on it ~UrriDg with othec OOfClh \JCticm
projects we bgv e prugI (.Ss -
A~l)' r 1U a result of this low bid wmiOl in 8% higher Ulan our pIO~CQSI,
will be a ~d:1aJ need to increase the loan amouat for this
, '
Dam "I lara
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A
M
JACK D. ANDERSON
James A. Sewell and Associates
Education:
Spokane Community College, AAS Civil Engineering Technology
Certifications:
Washington Alliance for Quality Transportation Construction (WQA TC), Certification #21221
First Aid & Industrial First Aid
Radiation Safety and Use of Nuclear Gauges
Washington State Traffic Control/Flagger, Certification # 1 0 1951
Level I Autocad
Employment History:
2001 - Pres. James A. Sewell & Associates, Soils Technician, Construction Inspector
Related Experience:
Lead lab technician for James A. Sewell & Associates, overseeing and performing the following activities for
various projects throughout Northeastern \Vashington and North Idaho:
ASTl\1 0-598, Cement Treated Bases
Soil Screen Analysis
Soil Wash Analysis
33 Screen Analysis
Proctor Soil Test, Modified & Standard Procedure
Soil Compaction Testing
Atterburg Limits
Concrete Compressive Strength
Concrete Slump Test
Concrete Air Content
Related Projects:
Stoiteridge Golf Club, Blanchard
Id.
Spirit Lake Wastewater
Treatment Plant, Spirit Lake, Id.
James A. Sewell and Associates
Pend Oreine County Public
\Vorks, Pend Oreine County, Wa.
2003 , Lagoon inspection. Soil compaction testing. HOPE liner
inspection.
2003 , Wastewater Treatment Plant Upgrade. Soil compaction testing.
Concrete inspection and testing. HOPE liner inspection.
2003, Testing laboratory manager.
2001 , Completed soil testing on reclaimed base material for Pend Oreille
County projects.
James A. Sewell & Associates
Stoneridge Utilities - Stoneridge Happy VaHey Ranchos
BID
BID
Proposal of David Bellomy Excavation & Pipeline Specialist g:hereinafter
called "BIDDER") organized and existing under the laws of the State of Idaho
doing business as (a Corporation), (a Partnership), (an Individual).
To Stoneride:e Utilities (herein after called "OWNER"
In compliance with the Advertisement for Bids, BIDDER hereby proposed to perform all WORK
far the construction of the WATER SYSTEM CONNECTION STONERIDGE / HAPPY VALLEY
RANCHOS in strict accordance with the CONTRACT DOCUMENTS, within the time frame set forth
therein, and at the prices stated below.
By submission of the BID, BIDDER Certifies, and in the case of a joint BID each Party thereto
certifies as to his own organization, that this BID has been arriv~d at independently, withaut consultation
. communication, or agreement as to' any matter related to this BID with any other BIDDER orwith any
competitor. BIDDER proposes and agrees, if this bid is accepted, to enter into an AGREEMENT with
the OWNER in the form included in the CONTRACT DOCUMENTS to perform the WORK as specified
or indicated therein.
BID will remain open for the period stated in the INFORMATION FOR BIDDERS. BIDDER
certifies that he has familiarized himselfwith the nature of the WORKto be performed, legal
requirements, and the canditions affecting cost, progress or performance afthe WORK, and has made
such independent investiga~ions as BIDDER deems necessary. BIDDER certifies that he is qualified by
reason of satisfactory experience to perform WORK of this type, nature and scope.
BIDDER hereby agrees to commence WORK under this contract on or before a date to be
specified in the NOTICE TO PROCEED and to fully complete Schedule 1 within 90 consecutive ca1endar
days thereafter. All work, including the work in Schedule 2, shall be campleted within 150 calendar days
after the NOTICE TO PROCEED. BIDDER further agrees to pay as liquidated damages, the sum af
$100 for each consecutive calendar day after completion date.
BIDDER acknowledges receipt of the following ADDENDA:
Number Date
Note:Failure to ac~owledge Addenda will render the BID non-responsive and be cause for rejection.
Bid Fonn 00-
Stonerldge Utilities - Stoneridge iHappy Valley Ranchos
. '
BID
BIDDER agrees to perform all of the work described in the CONTRACT DOCUMENTS for the
following unit or lump sum prices:Bid Sched ole
No., Item Quan
..
Unittit)( Written Amount
Schedule,l~Bid:Items.
:, ',-,
::C-"
::'-"':""::"=""~~;'"..... --...." "..." ..".. . ..
. c"
" -' --
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.. .... ". --
- : 1.MobiliiationandDemobilization -
: .
2. 8" Water line Installation
3. Control Wire
4. Main Line Tap
5. 6" Gate Valves
6. , 8" Gate Valves
NOTES:
10.
Check Valve Vault and Valves
Fire Hydrants
Air Release Valve
Blow Off
New Booster Station Construction
HVR Tank Addition
Project Sign
Utility Primary Trenching
3490
3400
500
EA.
EA.
EA.
EA.
EA.
EA.
EA.
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f"1 FT'c' '- E
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n.wIJs ",,"\oJ I() or H- rt,.i: ~
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f'+J~NO c ~fVr 5
'\wc ""~O"S~tJD FcIJR.
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~/)(
HVNj)A~(j S;;.VEI'VT1frlll& .j)()1-~~/l..s. ANO tJO c E'N1"5
FIFTY 7kJIJ 7Hc/JSAND ;E:tcrH7H/,/II#~() DOu.AP-S v- NO E-NT!,
Tw c. t..U E.. 7HcPSN.)() FOIJR,.
/11)NlJ~e..t:J OOL"'A~~ ~IV" c. ~NT'S
Fo~n. \--\"NDQ..F-~ Fu::T'/
'Pd'"~~s ~ NO G~1VI5
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r~ F"1'"Y t::- c.NTS
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1=1c,..Hi ~"""/)AE.O OO~SC:~ s
ONe: ~&)'V',O~~ $Ev6-AlTI(
-rH'C "'SA NO TWO HuN6tt.~o
NJf\I!T)lOoI.-"'\A1t..S MJO JU CENT ~
~;:\lE:W 1-l!JNOfl.E-OCo~Mt.S ANt) ~D ~NTS
FouCt. T~CIISAt.JD FIVE.~,,"'P~e:.C O(;LL.AI2-S p..tJ/)Nt'J c. II".. "J~
()~H:: -rTtOl1SANO i'wE.
rWNO(Lt!p Do~~Arl. ~ ~ NO CENr5
Number
, ',.,- -, .... ..
Lf,KOO.
1?, / IS", 00
'$'$0.
el,&, 00.
qs;o.
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1. OOO.
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/-HlNl)teo f)cL-UttftS /tWO tJc c.EWT~ Idol ?O(),
BIDS shall'include sales tax and all other applicable taxes and fees.
Specification Section 01010 Bid Item Description and Requirements contains
expandecf.description of each Bid Item.
Lump Sum bid amounts are to include an costs nec~ssary to provide a complete
and operable system.
Bid Fonn
12.
Electrical.
SCHEDULE 1 BID TOTAL
Schedule 2 Bid Items
21.
22.
23.
Mobilization and Demobilization
Clean and Paint Existing Steel Tanks
Additional Cost if Interior Coating is
Classified as Hazardous
SCHEDULE 2 BID TOTAL
1. .
00-
Stoneridge Utilities - Stoneridge Happy VaHey Ranchos
BID
SUBMITIED:
David Bellomy Excavation Pipeline Specialists
Business
, .. ... .. '
Ownei
. . ,
P . o. Box 592
Address
Sandpoint , rd. 83864
Gity, State; Zip
- .- --
U' -
...
Title
May 12, 2004
Date
12389-
License Number
Seal (If a Corporation)
OWNER intends to award each schedule of this contract separately on the basis of the
mathematical sum of Bid Items for Schedule 1 and the mathematical sum of bid items for Schedule 2.
Bid Award may occur, up to 90 days fol1owing Bid Opening.
. .
Bid Fonn 00-
....
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Water System Connection - Stoneridge Happy Yaney Ranchos
BID
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REQUIRED SUBCONTRACTOR LISTING
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(fIYA~~~luIIlJ)i?~;~4El~ctrical subcohtractorsus~d in prepari~g Bi~) :-
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ITEM #DESCRIPTION SUBCONTRACTOR
PLUMBING CONSTRUCTION Sandpoint Pump &Power
ELECTRICAL CONSTRUCTION Sandpoint P urn p Power
BOOSTER STATION CONCRETE Reader Concret~ Construction
HYDRO-SEED Northwest Tree & Reclamation-'U
BOOSTER STATION BUILDING Baker Construction & Develop.
, .
Idaho Contractor License Numbers for Subcontractors
Sandpoint Pump & Power 1 527 2-C- 4 ( 1 4, 33, 47)
Reader Concrete Construction 13157-4 (9)
Northwest Tree & Reclamation 13288-4 (7 25,47)
Baker Construction & Development 1 4380-4 (43,47)
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Bid Fonn
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I .. BIDDER
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13:42 BELLOMY EXC PAGE ~:L2082650153
PENAL SUM FORM
BID BOND
Bellomy Excavation & Pipeline
PO Box 1592
Sandppint , Idaho 83864
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OWNER Name and Address:
Stone
364 Stone R.iBlaR€hard ID 83804
BID-
-.!.
BID DUE DATE: 2004
PROJECT (Brief Description Including Description):
Water system connection between Stone Ridge and Happy Valley Ranchb ' s
subdi vision. "Bid Schedule " attached-
BOND:
BOND NUMBER: N/ A
DATE: (Not later than Bid Due Date): 5 11
PENAL SUM:Five r ent of t e total of the ba e bid and all additi al bid items.
IN WITNESS WHEREOF, Surety and Bidder, intending to be legally bound hereby, subject
to .the terms printed on the ,reverse side hereof, do each cause this Bid Bond to be dulyexecuted on its behalf by its authorized officer ,agent, or representative.
BIDDER SURETY
Bellomy Exca va tion &Pi ~line (SEAL)
BIdder me and Corporate Seal
--i
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By:
Signature and Title
Da vid Bellomy, Owner
Travelers Casualty & Surety (SEAL)
Surety s Name and Corporate Seal
BY;TruJLmc:
Signature a d. itle
(Attach Power of Attorney). Harjorie Trulock , Attorney in Fact
Attest:
Signature an~ Title
Attest:
Signature and Title
Note: (1) Above addresses are to be used for giving required notice.
(2) Any singular reference to Bidder, Surety, Owner or other party shall be
considered plural where applicable.
00-
EJCDCNO. 1910-2So.C (1996 Edition)
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~~0511112004 ' 13: 42 2082650153 BE;LLOMV EXC PAGE 03~. i ::? . "
PENAL SUM FORM
Bidder s~d"Surety, jointly 8"d severally, bind themselves, their heirs, executors, '
/ administrators, successors and assigns to paY,to Owner upon default of Bidder the penal sum set forth on the
face of this Bond.
Oefeult of Bidder shall occur upon the failure of Bidder to deliver within the time
required by the Bidding Documents (or any extension thereof agreed to In writing by OWNER) the executed
Agreement required by the Bidding Documents and any performance and payment bonds re~ulred by the BiddingDocuments.
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This obligation shall be' nun end void if:
: 3. 1-.. OWf\J~R accepts Bidder' s Bid and Bidder del1vers within the time required by.
- -, ,
:~,th$Biddlng lJocument8 (or any extensiQnthereof agreed to in writing by OWN~Rl ~f:1~_~xecllted "
- ' ,
Agreement required by the BiddIng Documents and any performance and payment Bond!trequiredby theBidding DocumentSi or '
All Bids are rejected by OWNER, or
OWNER fails to issue a Notice of Award to Bidder within the time specified
in the Bidding Documents (or any extension thereof agreed to in writIng by
Bidder and. if applicable, consented to by Surety when required by paragraph
5 hereof).
Payment under this Bond wl1l be due and payable upon default by BIdder end within 30 calendar days
after receipt by Bidder and Surety of written notice of default 1romOWNER, which notice will be given
with reasonable promptness, identifying this Bond and the Project 8nd including 8 statement of the amount due.
Surety waives notice of and any and all defenses based on or arising out of any time extensIon to
issue Notice of Award agreed to in writing by OWNER and Bidder, provided that the total time for
issuing Notice of Award Including extensions shan not In the aggregate exceed 120 days from BId due
dete without Surety's written consent.
No suit or action shan be commenced under this Bond prior to 30 calendar days after the notice of
default required in paragraph 4 above is received by Bidder an~ Surety and In no case later than oneyeer after Bid due date.
Any suit or action under this Bond shan be cbmmenced only in a court of competent jurisdiction
located 10 the state in which the Project is located.
. .
Notices required hereunder shan be in writing and sent to. Bidder and Surety at their respective
addresses shown on the face of the Bond. Such notices may be sent by personal delivery, commercial
courier or by United States Registered or Cenlfled Malt, return receipt requested, postage pre-paid, and
shall be deemed to be effective upon receipt by the party concerned.
Surety shall cause to be attached to this Bond a current and eff$ctlve Power or Attorney evidencing
the euthority of the officer, agent or representative who executed this Bond on behstf of Surety to
execute, seal and deliver such Bond and bind the Surety thereby.
O. This Bond is Intended to conform to all applicable statutory requirements. Any eppncabl~ requirement
of any applicable statute that has been omitted from this Bond shall be deemed to be included herein
as If set forth at length. If any provision of thia Bond conflicts with any applicable statue, tl1e" the
provision of said statute shall govern and the remainder of this Bond that Is not in confliCt therewith
shall continue in fun force and effect.
, 1. The term -Bid" 85 used herein includes 8 Bid, offer or proposel 8S applicable.
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EJCDC NO. 1910-2S.C (1996 Edition)
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IN WITNESS WHEREOF, TRAVELERS CASUALTY AND SURETY COMPANY OF AMERICA, TRAVELERS
CASUALTY AND SURETY COMPANY and FARMINGTON CASUALTY COMPANY have caused this instrument to be
signed by their Senior Vice President and their corporate seals to be hereto affixed this 6th day of October, 2003.
STATE OF CONNECTICUT
) SS. Hartford
TRAVELERS CASUALTY AND SURETY COMPANY OF AMERICA
TRAVELERS CASUALTY AND SURETY COMPANY
, FARMINGTON CASUALTY COMPANY
COUNTY OF HARTFORD
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George W. Thompson
Senior Vice President
On this 6th day of October, 2003 before me personally came GEORGE W. THOMPSON to me known, who, being by me duly
sworn, did depose and say: that he/she is Senior Vice President of TRAVELERS CASUALTY AND SURETY COMPANY OF
AMERICA, TRAVELERS CASUALTY AND SURETY COMPANY and FARMINGTON CASUALTY COMPANY, the
corporations described in and which executed the above instrument; that he/she knows the seals of said corporations; that the seals
affixed to the said instrument are such corporate seals; and that he/she executed the said instrument on behalf of the corporations by
authority of his /her office under the Standing Resolutions thereof.
c..
My commission expires June 30. 2006 Notary Public
Marie C. Tetreault
. .
CERTIFICATE
, the undersigned, Assistant Secretary of TRAVELERS CASUALTY AND SURETY COMPANY OF AMERICA
TRAVELERS CASUALTY AND SURETY COMPANY and FARMINGTON CASUALTY COMPANY, stock corporations of
the State of CO1mecticut, DO HEREBY CERTIFY that the foregoing and attached Power of Attorney and Certificate of Authority
remains in full force and has not been revoked; and furthennore, that the Standing Resolutions of the Boards of Directors, as set forth
in the Certificate of Authority, are now in force.
Signed and Sealed at the Home Office of the Company, in the City of Hartford, State of Connecticut. Dated thisMay , 20 04. 11th day of
r--.pl.By .
Kori M. Johanson
Assistant Secretary, Bond
TRAVELERS CASUALTY AND SURETY COMPANY OF AMERICA
TRAVELERS CASUALTY AND SURETY COMPANY
FARMINGTON CASUALTY COMPANY
Hartford, Connecticut 06183-9062
PO\VER OF ATTORNEY AND CERTIFICATE OF AUTHORITY OF ATTORNEY(S)-IN-FACT
KNO\V ALL PERSONS BY THESE PRESENTS, THAT TRAVELERS CASUALTY AND SURETY COMPANY OF
Al\'IERICA, TRAVELERS CASUALTY AND SURETY CO1YIPANY and FARMINGTON CASUALTY COMPANY
corporations duly 0 rganized under the laws of the State of Connecticut, and having their principal offices in the City of Hartford
County of Hartford, State of Connecticut, (hereinafter the "Companies ) hath made, constituted and appointed, and do by these
presents make, constitute and appoint: Marjorie Trulock, Michael Mahoney, Christy C. Prill, of Sandpoint, Idaho, their true and
lawful Attorney(s)-in-Fact, with full power and authority hereby conferred to sign, execute and acknowledge, at any place within the
United States, the following instrument(s): by his/her sole signature and act, any and all bonds, recognizances, contracts of indemnity,
and other writings obligatory in the nature of a bond, recognizance, or conditional undertaking and any and all consents incident
thereto and to bind the Companies, thereby as fully and to the same extent as if the same were signed by the duly authorized officers of
the Companies, and all the acts of said Attorney(s)-in-Fact, pursuant to the authority herein given, are hereby ratified and confinned.
This appointment is made under and by authority of the following Standing Resolutions of said Companies, which Resolutions are now
in full force and effect:
VOTED: That the Chairman, the President, any Vice Chairman, any Executive Vice President, any Senior Vice President, any Vice President, any
Second Vice President, the Treasurer, any Assistant Treasurer, the Corporate Secretary or any Assistant Secretary may appoint Attorneys-in-Fact and
Agents to act for and on behalf of the company and may give such appointee such authority as his or her certificate.of authority may prescribe to sign
with the Company s name and seal with the Company s seal bonds, recognizances, contracts of indemnity, and other Writings obligatory in the nature
of a bond, recognizance, or conditional undertaking, and any of said officers or the Board of Directors at any time may remove any such appointee
and revoke the power given him or her.
VOTED: That the Chainnan, the President, any Vice Chairman, any Executive Vice President, any Senior Vice President or any Vice President may
delegate all or any part of the foregoing authority to one or more officers or employees of this Company, provided that each such delegation is in
\\'fltil1g and a copy thereof is filed in the office of the Secretary.
VOTED: That any bond, recognizance, contract of indemnity, or writing obligatory in the nature of a bond, recognizance, or conditional undertaking
shall be \"alid and binding upon the Company when (a) signed by the President, any Vice Chairman, any Executive Vice President, any Senior Vice
President or any Vice President, any Second Vice President, the Treasurer, any Assistant Treasurer, the Corporate Secretary or any Assistant
Sccrctaryand duly attested and sealed with the Company's seal by a Secretary or Assistant Secretary, or (b) duly executed (under seal , ifrequired) by
one or more Attorneys-in-Fact and Agents pursuant to the po\ver prescribed in his or her certificate or their certificates of authority or by one or more
Company officers pursuant to a \vritten delegation of authority.
This Power of Attorney and Certificate of Authority is signed and scaled by facsimile (mechanical or printed) under and by
authority of the following Standing Resolution voted by the ,Boards of Directors of TRAVELERS CASUALTY AND SURETY
COi\lPANY OF MIERICA, TRAVELERS CASUALTY AI"D SURETY COMPANY and FARMINGTON CASUALTY
COMPAl'iY, which Resolution is now in full force and effect:
VOTED: That the signature of each of the following officers: President, any Executive Vice President , any Senior Vice 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 Resident Vice Presidents, Resident 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 a nd facsimile seal shall be valid and binding upon the Company in the future with respect to any bond or
undertaking to \vhich it is attached.
- (11-00 Standard)
Certification of Compliance With
Anti-Lobbying Act
The undersigned certifies, to the best of his /her knowledge and belief that:
(1) No federally appropriated funds have been paid or will be paid, by or on behalf of the undersigned
to any person for influencing or attempting to influence an officer or employee of any agency, a
Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress
in connection with the awarding of any federal contract, the making of any federally funded grant
the making of any federally funded loan, the entering into of any cooperative agreement, and the
extension, continuation, renewal, amendment, or modification of any federally funded contract
grant, loan or cooperative agreement.
(2) If any funds other than federally appropriated funds have been paid or will be paid to any person for
influencing or attempting to influence an officer or employee of any agency, a Member of Congress
an officer or employee of Congress, or an employee of a Member of Congress in connection with
this federally funded contract, grant, loan or cooperative agreement, the undersigned shall complete
and submit Standard Form-LLL
, "
Disclosure Form to Report Lobbying , in accordance with its
instructions.
(3) The undersigned shall require that the language of this certification be included in the award
documents for all subawards at all tiers (including subcontracts, subgrants, and contracts under
grants, loans and cooperative agreements) and that all subrecipients shall certify and disclose
accordingly.
This certification is a material representation of fact upon which reliance was placed when this
transaction was made or entered into. Submission of this certification is a prerequisite for making or
entering into this transaction imposed by Section 1352, Title 31 , U. S. Code. Any person who falls
to file the required certification shall be subject to a civil penalty of not less than $10 000 and not
more than $100 000 for each such failure.
Signature Date May 12, 2004
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ATTACHMENT A
MINORITY, WOMEN AND SMALL BUSINESSES TO BE UTILIZED
stoneridge utili ties - Stoneridqe/tlappy Valley RanchosProject:
Name of Bidder:David Bellomy
........... ........... ......... .......... ....... ...... ........... .......
Name of Firm:
Address:
Phone #:
MBE
WBE
SBRA
Joint Venture
Other
Subcontractor
Supplier
Manufacturer
Description of Work Element or Supplies:
Amount to be contracted $
Name of Firm:
Address:
Phone #:
MBE
WBE
SBRA
Joint Venture
Other
Subcontractor
Supplier
Manufacturer
Description of Work Element or Supplies:
Amount to be contracted $
Name of Firm:
Address:
Phone #:
MBE
WBE
SBRA
Joint Venture
Other
Subcontractor
Supplier
Manu facturer
Description of Work Element or Supplies:
Amount to be contracted $
Name of Firm:
Address:
Phone #:
MBE
WBE
SBRA
Joint Venture
Other
Subcontractor
Supplier
Manufacturer
Description of Work Element or Supplies:
Amount to be contracted $
................................................. *................. .**..
Contractor David Bellomy
Signatu
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Use additional pages if necessary
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ATTACHMENT B
SWORN STATEMENT OF COMPLIANCE WITH MINORITY. WOMEN
AND SMALL BUSINESS UTILIZATION REQUIREMENTS
Each bidder must execute, and submit, as part of their proposal, and together with their bid, the following certification relating to
MBE/WBE/SBRA participation. The certification below shall be deemed a part of the resulting contract.
The bidder has taken the following affinnative steps in awarding subcontracts:
(1 )Include qualified small, minority and women businesses on solicitation lists;
(2)Insure that small, minority and women businesses are solicited whenever they are potential sources;
(3 )Divide total requirements, when economically feasible, into smaller tasks or quantities to pem1it ma:ximum participation of small. minority
and women businesses;
(4 )Establish delivery schedules, where requirements of the work pennit, which will encourage participation of small, minority and women
businesses;
(5)Use the services and assistance of the Idaho Transportation Department, Small "Business Administration and the Office of Minority
Business Enterprise of the U.S. Department of Commerce as appropriate.~~~L:
ignature Date May 1 2 ,2004
David Bellomy Owner
Name and Title of Signer (please type)
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IT ACHMENT C
CONTRACTOR'S COMPLIANCE STATEMENT
(EXECUTIVE ORDER # 11246)
Date May 1 2 2004
This statement relates to a proposed contract with
stoneridge utili ties
(Name of Owner)
who expects to finance the contract with assistance from the Department of Environmental Quality. I am the undersigned bidder orprospectivc
contractor. I represent that:
I have -2L- I have not participated in a previous contract or subcontract subject to Executive Order 11246 of September 24, 1965
(regarding equal employment opportunity) or a preceding similar Executive Order. 1 agree to comply with all the provisions of this
Executive Order and the rules, regulations and relevant orders of the Secretary of Labor. (41 CFR 60-1.4(b)(4)):R~~
Signature
Ma y 2 ,
Date
2004
David Bellomy Owner
Name and Title of signcr(please type)
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ATIAcHMENT D
CERTIFICATION OF NONSEGREGATED FACILITIES
(Applicable to federally assisted construction contracts and related subcontracts exceeding $10,000 which are not exempt from the Equal
Opportunity clause.
The federally assisted construction contractor certifies that he does not maintain or provide for his employees any segregated facilities at any of
his establishments, and that he does not permit his employees to perform their services at any location, under his control, where segregated
facilities are maintained. The federally assisted construction contractor certified further that he will not maintain or provide for his employees
any segregated facilities at any of his establishments, and that he will not permit his employees to perform their services at any location, under
his control, where segregated facilities are maintained. The federally assisted constrllction contractor agrees that a breach of this certification is a
violation of the Equal Opportunity clause of this contract.
As used in this certification, the term "segregated facilities" means any waiting rooms, work area, rest rooms and wash rooms. restaurants and
other eating areas, time clocks, locker rooms and other storage or dressing areas, parking lots, drinking fountains, recreation or entertainment
areas, transportation, and housing facilities provided for employees which are segregated by explicit directive or are, in fact, segregated on the
basis of race, creed, color, or national origin, because of habit, local custom, or otherwise. The federally assisted construction contractor agrees
that (except where he has obtained identical certifications from proposed subcontractors for specific time periods) he will obtain identical
certifications from proposed subcontractors prior to the award of subcontracts exceeding $10 000 which are not exempt from the provisions of
the Equal Opportunity clause, and that he will retain such certification in his files.
ignature
May 12,2004
Date
David Bellomy
Name and title of signer (please type)
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AFFIDA VlT OF PAYMENT OR SECUREMENT
OF ALL TAXES
STATE OF Jd--cV//.i;
) ss:
County o j~~b1-1j;/
David Bellomy
Idaho Code 63-1502; that he is authorized to do business in the State of Idaho and that he can furnish satisfactory evidence that he has paid or
being first duly sworn on oath deposes and says that he is in confonnance with
secured to the satisfaction of the respective taxing units all taxes for which he or his property is liable, now due or delinquent. including
assessments, excises and license fees levied by the State of Idaho or any taxing unit within the State of Idaho,
DA TED this /)7/day of l'/fM'1 , 20
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SU~SCRIBED AND SWOfN to before me this tJ.:ri.dayof
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Residing at /17i.
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Commission ExpIres 4-- -JU - dO6
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CONTRACTOR FOR PUBLIC WORKS TO PAY OR SECURE TAXES
(Idaho Code 63-1503)
The Contractor, in consideration of securing the business of erecting or constructing public works in this State, recognizing that the business in which heis engaged is of a transitory character, and that in the pursuit thereof, his property used therein may be without the State when taxes, excises, or licensesfees to which he is liable become payable agrees:
I. To pay promptly when due all taxes (other than on real property) excises and license fees due to the State, its subdivisions, and municipal andquasi-municipal corporations therein, accrued or accruing during the tenn of this contract, whether or not the same shall be payable at the end of suchterm;
2. That if the said ta.-xes, excises and I icense fees are not payable at the end of said term, but I iabil ity for the payment thereof exists, even though thesame constitute liens upon his property, to secure the same to the satisfaction of the respective officers charged with the collection thereof;
3. That, in the event of his default in the payment or securing of such taxes, excises and license fees, to consent that the Department., Officer. Board orTaxing Unit entering into this contract may withhold from any payment due him hereunder the estimated amount of such accrued and accruing taxing
units to which said contractor is liable.
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By ~~.u"",,
Name David Bellomy
Address P.O. Box 1592Sandpoint, Id.83864
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