HomeMy WebLinkAbout090820_ca13Department of Public Works
O Consent Agenda
Page 1 of 1
Jefferson County
Board of Commissioners
Agenda Request
To: Board of Commissioners
Philip Morley, County Administrator
From: Monte Reinders, P.E., Public Works Director/County Engineer
Agenda Date: September 8, 2020
Subject: Execution of Contract with Rognlins Inc., Upper Hoh Road MP 7.9
to MP 8.0 Repair, Project No. 18020381, County Road No. 914207,
Federal Aid No. ER-WA-20-03
Statement of Issue: Execution of contract with Rognlins Inc. for the Upper Hoh Road
MP 7.9 to MP 8.0 Repair, County Project No. 18020381.
Analysis/Strategic Goals/Pro's Et Con's: During February 2020, emergency bank
stabilization was constructed at Upper Hoh Road MP 7.9-8.0 following high flow events
in the Hoh River that caused a road washout. Additional repairs that still need to be
performed include re -paving, re -striping, and guardrail installation. This contract is
for performing those repairs. This project has 100% funding from the Federal Highway
Administration Emergency Relief program.
Fiscal Impact/Cost Benefit Analysis: The bid amount is $109,898.25. Construction
will be funded at 100% by the Federal Highway Administration.
Recommendation: Public Works recommends that the Board execute all three (3)
originals of the Contract with Rognlins Inc. and return two (2) originals to Public
Works for further processing.
Department Contact: Mark Thurston, P.E., Project Manager, 385-9160.
Date
CONTRACT
JEFFERSON COUNTY, WASHINGTON
THIS AGREEMENT, made and entered into this day of , 20 , between
the COUNTY OF JEFFERSON, acting through the Jefferson County Commissioners and the Director of
Public Works under and by virtue of Title 36, R.C.W, as amended and
Rognlins Inc. of Aberdeen, Washington
hereinafter called the Contractor.
WITNESSETH:
That in consideration of the terms and conditions contained herein and attached and made a part of this
agreement, the parties hereto covenant and agree as follows:
1. The Contractor agrees to furnish all labor and equipment and do certain work, to -wit: That the
Contractor herein will undertake and complete the following described work:
This Contract provides for the repair of Upper Hoh Road at MP 8.0 in west Jefferson County near
Forks, Washington. The work includes repaving a 300 foot section of road following a washout
repair, restriping the road, installing new guardrail, temporary traffic control, and other work
for the total sum of One hundred nine thousand, eight hundred ninety eight dollars ($ 109,898.25 )
in accordance with and as described in the attached plans and specifications and the Standard
Specifications of the Washington Department of Transportation which are by this reference
incorporated herein and made a part hereof. The Contractor shall perform any alteration in or addition
to the work provided in this contract and every part thereof.
The Contractor shall complete the described work as follows:
Contract time shall begin on the first working day following the Notice to Proceed Date. Beginning
with the first working day, the project shall be physically complete within 15 working days.
The Contractor shall provide and bear the expense of all equipment, work and labor of any sort
whatsoever that may be required for the transfer of materials and for constructing and completing
the work provided for in this contract and every part thereof.
2. The County of Jefferson hereby promises and agrees with the Contractor to employ, and does employ
the Contractor to furnish the goods and equipment described and to furnish the same according to the
attached specifications and the terms and conditions herein contained, and hereby contracts to pay for
the same according to the attached specifications and the schedule of unit or itemized prices hereto
attached, at the time and in the manner and upon the condition provided for in this contract. The
County further agrees to employ the Contractor to perform any alterations in or additions to the work
provided for in this contract that may be ordered and to pay for the same under the terms of this
contract and the attached specifications at the time and in the manner and upon the conditions
provided for in this contract.
3. The Contractor for himself, and for his heirs, executor, administrators, successors, and assigns, does
hereby agree to the full performance of all the covenants herein contained upon the part of the
Contractor.
Construction Contract Contract G Version 1 Risk Legal Review Date 06/17/2020 Page l of 10
4. Prior to commencing work, the Contractor shall obtain at its own cost and expense the following
insurance from companies licensed in the State with a Best's rating of no less than A: VII. The
Contractor shall provide to the County Risk Manager certificates of insurance with original
endorsements affecting insurance required by this clause prior to the commencement of work to be
performed.
The insurance policies required shall provide that thirty (30) days prior to cancellation, suspension,
reduction or material change in the policy, notice of same shall be given to the County Risk Manager
by registered mail, return receipt requested, for all of the following stated insurance policies.
If any of the insurance requirements are not complied with at the renewal date of the insurance policy,
payments to the Contractor shall be withheld until all such requirements have been met, or at the
option of the County, the County may pay the renewal premium and withhold such payments from
the moneys due the Contractor.
All notices shall name the Contractor and identify the agreement by contract number or some other
form of identification necessary to inform the County of the particular contract affected.
A. Workers Compensation and Employers Liability Insurance. The Contractor shall procure and
maintain for the life of the contract, Workers Compensation Insurance, including Employers
Liability Coverage, in accordance with the laws of the State of Washington.
B. General Liability (1) - with a minimum limit per occurrence of one million dollars ($1,000,000)
and an aggregate of not less than two million dollars ($2,000,000) for bodily injury, death and
property damage unless otherwise specified in the contract specifications. This insurance
coverage shall contain no limitations on the scope of the protection provided and indicate on the
certificate of insurance the following coverage:
1. Broad Form Property Damage with no employee exclusion;
2. Personal Injury Liability, including extended bodily injury;
3. Broad Form Contractual/Commercial Liability including completed operations (contractors
only);
4. Premises - Operations Liability (M&C);
5. Independent Contractors and Subcontractors; and
6. Blanket Contractual Liability.
(1) Note: The County shall be named as an additional insured party under this policy.
C. Automobile (2) - with a minimum limit per occurrence of $1,000,000 for bodily injury, death and
property damage unless otherwise specified in the contract specifications. This insurance shall
indicate on the certificate of insurance the following coverage:
1. Owned automobiles;
2. Hired automobiles; and,
3. Non -owned automobiles.
(2) Note: The County shall be named as an additional insured party under this policy.
Any deductibles or self -insured retention shall be declared to and approved by the County prior to
the approval of the contract by the County. At the option of the County, the insurer shall reduce
or eliminate deductibles or self -insured retention or the Contractor shall procure a bond
guaranteeing payment of losses and related investigations, claim administration and defense
expenses.
The Contractor shall include all subcontractors as insured under its insurance policies or shall
furnish separate certificates and endorsements for each subcontractor. All insurance provisions
for subcontractors shall be subject to all of the requirements stated herein.
Construction Contract Contract G Version I Risk Legal Review Date 06/17/2020 Page 2 of 10
Failure of the Contractor to take out and/or maintain any required insurance shall not relieve the
Contractor from any liability under the Agreement, nor shall the insurance requirements be
construed to conflict with or otherwise limit the obligations concerning indemnification.
It is agreed by the parties that insurers shall have no right of recovery or subrogation against the
County (including its employees and other agents and agencies), it being the intention of the
parties that the insurance policies so affected shall protect both parties and be primary coverage
for any and all losses covered by the above described insurance. It is further agreed by the parties
that insurance companies issuing the policy or policies shall have no recourse against the County
(including its employees and other agents and agencies) for payment of any premiums or for
assessments under any form of policy. It is further agreed by the parties that any and all
deductibles in the above described insurance policies shall be assumed by and be at the sole risk
of the Contractor.
It is agreed by the parties that judgments for which the County may be liable, in excess of insured
amounts provided herein, or any portion thereof, may be withheld from payment due, or to
become due, to the Contractor until such time as the Contractor shall furnish additional security
covering such judgment as may be determined by the County.
The County reserves the right to request additional insurance on an individual basis for extra
hazardous contracts and specific service agreements.
Any coverage for third party liability claims provided to the County by a "Risk Pool" created
pursuant to Ch. 48.62 RCW shall be non-contributory with respect to any policy of insurance the
Contractor must provide in order to comply with this Agreement.
If the proof of insurance or certificate of coverage indicating the County is an "additional insured"
to a policy obtained by the Contractor refers to an endorsement (by number or name) but does not
provide the full text of that endorsement, then it shall be the obligation of the Contractor to obtain
the full text of that endorsement and forward that full text to the County within 30 days of the
execution of this Agreement.
The County may, upon the Contractor's failure to comply with all provisions of this contract
relating to insurance, withhold payment or compensation that would otherwise be due to the
Contractor.
5. The Contractor shall comply with all Federal, State, and local laws and ordinances applicable to the
work to be done under this Agreement. This Agreement shall be interpreted and construed in accord
with the laws of the State of Washington and venue shall be in Jefferson County, WA.
The Contractor shall defend, indemnify and hold the County, its officers, officials, employees, agents
and volunteers (and their marital communities) harmless from any and all claims, injuries, damages,
losses or suits including attorney fees, arising out of or resulting from the acts, errors or omissions of
the Contractor in performance of this Agreement, except for injuries and damages caused by the sole
negligence of the County. Should a court of competent jurisdiction determine that this Agreement is
subject to RCW 4.24.115, then, in the event of liability for damages arising out of bodily injury to
persons or damages to property caused by or resulting from the concurrent negligence of the
Contractor and the County, its officers, officials, employees, agents and volunteers (and their marital
communities) the Contractor's liability, including the duty and cost to defend, hereunder shall be only
to the extent of the Contractor's negligence.
Claims against the County shall include, but not be limited to assertions that the use and transfer of
any software, book, document, report, film, tape, or sound reproduction of material of any kind,
delivered hereunder, constitutes an infringement of any copyright, patent, trademark, trade name, or
otherwise results in an unfair trade practice or an unlawful restraint of competition.
Construction Contract Contract G Version 1 Risk Legal Review Date 06/17/2020 Page 3 of 10
The Contractor specifically assumes potential liability for actions brought against the County by the
Contractor's employees, including all other persons engaged in the performance of any work or
service required of the Contractor under this Agreement and, solely for the purpose of this
indemnification and defense, the Contractor specifically waives any immunity under the state
industrial insurance law, Title 51 R.C.W. The Contractor recognizes that this waiver was specifically
entered into pursuant to provisions of R.C.W. 4.24.115 and was subject of mutual negotiation.
The provisions of this section shall survive the expiration or termination of this Agreement
The Contractor's relation to the County shall be at all times as an independent Contractor, and
nothing herein contained shall be construed to create a relationship of employer -employee or master -
servant, and any and all employees of the Contractor or other persons engaged in the performance of
any work or service required of the Contractor under this Agreement shall be considered employees
of the Contractor only and any claims that may arise on behalf of or against said employees shall be
the sole obligation and responsibility of the Contractor.
7. The Contractor shall not sublet or assign any of the services covered by this contract without the
express written consent of the County or its authorized representative. Assignment does not include
printing or other customary reimbursable expenses that may be provided in an agreement.
8. Nothing in the foregoing clause shall prevent the County, at its option, from additionally requesting
that the Contractor deliver to the County an executed bond as security for the faithful performance of
this contract and for payment of all obligations of the Contractor.
For contracts of $150,000 or less, the County and the Contractor may agree that in -lieu of the
Contract Bond; the County will withhold 10% of the Contract amount in accordance with R.C.W
39.08.010. If applicable, the Contractor will indicate this option on Exhibit D.
9. The Contractor will declare a management option of the statutory retained percentage on Exhibit E.
❑ Limited Small Works Project per RCW 39.04.155(3): Performance Bond and Retainage Waived
INDEX OF EXHIBITS
Exhibit A:
Certification Regarding Debarment, Suspension, Ineligibility, and Voluntary
Exclusion
Exhibit
B:
Certification of Compliance with Wage Payment Statues
Exhibit C:
Contract
Bond, Jefferson County, Washington
Exhibit D:
Contractor's Declaration of Option for Contracts for Less Than $150,000
❑
Exhibit E:
Contractor's
Declaration of Option for Management of Statutory Retained Percentage
Construction
Contract
Contract G Version 1 Risk Legal Review Date 06/17/2020 Page 4 of 10
IN WITNESS WHEREOF, the Contractor has executed this instrument on the day and year first below
written, and the Board of County Commissioners has caused this instrument to be executed by and in the
name of said County of Jefferson the day and year first above written.
Executed by the Contractor , 20
Contractor:
Rognlins Inc.
(Please print)
By: Oat e. sno '1 rnS`a'y lam-` )MIde ,
(Please print)
gCbW L-*!"342LP
State of Washington, Contractor Registration Number
COUNTY OF JEFFERSON
BOARD OF COMMISSIONERS
Kate Dean, District 1
David Sullivan, District 2
Greg Brotherton, District 3
Approved as to form only:
PRE-,AppRGK ED GOntTRAGT
Philip C. Hunsucker Date
Chief C' e y_Pr,00secutor
1�1'1 11XZ-"6
s, P.E. bate
Public Works Director/County Engineer
Construction Contract Contract G Version 1 Risk Legal Review Date 06/17/2020 Page 5 of 10
EXHIBIT A
CERTIFICATION REGARDING
DEBARMENT, SUSPENSION, INELIGIBILITY, AND VOLUNTARY EXCLUSION
The Contractor certifies to the best of its knowledge and belief, that it and its principals:
(1) Are not presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily
excluded from covered transactions by any Federal department or agency;
(2) Have not within a 3-year period preceding this proposal been convicted of or had a civil judgment
rendered against them for commission of fraud or a criminal offense in connection with obtaining,
attempting to obtain, or performing a public (Federal, State, or local) transaction or contract under a
public transaction; violation of Federal or State antitrust statutes or commission of embezzlement,
theft, forgery, bribery, falsification or destruction of records, making false statements, or receiving
stolen property;
(3) Are not presently indicted for or otherwise criminally or civilly charged by a governmental entity
(Federal, State, or local) with commission of any of the offenses enumerated in paragraph (2) of this
certification; and
(4) Have not within a 3-year period preceding this contract had one or more public transactions (Federal,
State, or local) terminated for cause or default.
Where the Contractor is unable to certify to any of the statements in this certification, such Contractor
shall attach an explanation.
Rognlins Inc.
Name of Contractor (Please print)
6a--n t 3 tiO 6 S3 V i l e 'Pilk:s1 ap n t-
Name and Title of Authorized Representative (Please print)
Authorize Representative
❑ I am unable to certify to the above statement. An explanation is attached.
Construction Contract Contract G Version 1 Risk Legal Review Date 06/17/2020 Page 6 of 10
EXHIBIT B
CERTIFICATION OF COMPLIANCE WITH WAGE PAYMENT STATUTES
I declare under penalty of perjury under the laws of the State of Washington that the foregoing is true and
correct.
The undersigned bidder hereby certifies that, within the three-year period immediately preceding the bid
solicitation date July 21, 2020 , the bidder is not a "willful" violator, as defined in RCW 49.48.082,
or any of the provisions of chapters 49.46, 49.48, or 49.52 RCW as determined by a final and binding
citation and notice of assessment issued by the Department of Labor and Industries or through a civil
judgment entered by a court of limited or general jurisdiction.
Rognlins Inc.
Bidder's Business Name
qSigN�Jure of �Authirizcdfficial*
&A —A t s noacarq"�-S
Printed Name
Title
F�iaJzczo A 17trc WR,r1 WY4
Da e City State
Check One:
Sole Proprietorship Partnership ® Joint Venture® Corporation
State of Incorporation, or if not a corporation, State where business entity was formed:
&Sn11AWDn
If a co -partnership, give firm name under which business is transacted:
* If a corporation, proposal must be executed in the corporate name by the president or vice-
president (or any other corporate officer accompanied by evidence of authority to sign). If a co-
partnership, proposal must be executed by a partner.
Construction Contract Contract G Version 1 Risk Legal Review Date 06/17/2020 Page 7 of 10
EXHIBIT C
CONTRACT BOND
JEFFERSON COUNTY, WASHINGTON
KNOW ALL MEN BY THESE PRESENTS: Bond No. 023215154
That Rognlins Inc. , of Aberdeen, Washington , as
Principal, and Liberty Mutual Insurance Company, as Surety, are jointly and severally held and bound unto
the COUNTY OF JEFFERSON, the penal sum of
Dollars ($109.898.25 * ), for the payment of which we jointly and severally bind ourselves, or
heirs, executors, administrators, and assigns, and successors and assigns, firmly by these presents.
*One Hundred Nine Thousand Eight Hundred Ninety Eight and 251100THS
The condition of this bond is such that WHEREAS, on the day of , A.D., 20^, the said
Rognlins Inc. , Principal herein, executed a certain contract with the County of
Jefferson, by the terms, conditions and provisions of which contract the said Rognlins Inc.
, Principal herewith, agrees to furnish all materials and do certain work, to -wit: That the said Principal herein
will undertake and complete the following described work:
This Contract provides for the repair of Upper Hoh Road at MP 8.0 in west Jefferson County near Forks,
Washington. The work includes repaving a 300 foot section of road following a washout repair,
restriping the road, installing new guardrail, temporary traffic control, and other work
in Jefferson County, Washington, as per maps, plans and specifications made a part of said contract, which
contract as so executed, is hereunto attached, and is now referred to and by this reference is incorporated
herein and made a part hereof as full for all purposes as if here set forth at length.
NOW THEREFORE, if the Principal herein shall faithfully and truly observe and comply with the terms,
conditions and provisions of said contract, in all respects and shall well and truly and fully do and perform all
matters and things by the said Principal undertaken to be performed under said contract, upon the terms
proposed therein, and within the time prescribed therein, and until the same is accepted, and shall pay all
` iiilil)Ift�is, mechanics, subcontractors and materialmen, and all persons who shall supply such contractor or
�pp`,�'"'ctor with provisions and supplies for the carrying on of such work, and shall in all respects
�RPf%Qileiform said contract according to law, then this obligation to be void, otherwise to remain in full
SL, i�tcca��u t�j1Gl 1.
9 Aj, AWNESS our hands this 26th day of August
Rognlins Inc.
//d GAw
PAL
By:
Kat Sno grass, Vice Presi ent
ltdSU,,�
/ '"ogP o
J
1912
Y��? SgC14%3
Seal No. 5fi49
2020
Liberty Mutual Insurance C, ompany
SURETY COMPANY
By:
By: Heather L. Allen
Attorney -in -fact
Address of local office and agent of surety company:
prnp� PI In.guranrp
PO Box 2940
Tacoma, WA 98401
Construction Contract Contract G Version I Risk Legal Review Date 06/17/2020 Page 8 of 10
EXHIBIT D
CONTRACTOR'S DECLARATION OF OPTION FOR
CONTRACTS FOR LESS THAN $150,000
A. A Contract Bond will be provided as required.
Date 115 1202.0 Signed*)!eZa���
B. In lieu of providing a Contract Bond, the County will withhold 10% of the Contract amount.
Date
Signed
Construction Contract Contract G Version 1 Risk Legal Review Date 06/17/2020 Page 9 of 10
01 LibertX
Mutual®
SURETY
This Power of Attorney limits the acts of those named herein, and they have no authority to
bind the Company except in the manner and to the extent herein stated.
Liberty Mutual Insurance Company
The Ohio Casualty Insurance Company
West American Insurance Company
POWER OF ATTORNEY
Certificate No: 8203181-023049
KNOWN ALL PERSONS BY THESE PRESENTS: That The Ohio Casualty Insurance Company is a corporation duly organized under the laws of the State of New Hampshire, that
Liberty Mutual Insurance Company is a corporation duly organized under the laws of the State of Massachusetts, and West American Insurance Company is a corporation duly organized
under the laws of the State of Indiana (herein collectively called the "Companies"), pursuant to and by authority herein set forth, does hereby name, constitute and appoint, Holli
Albers; Heather L. Allen; James B. Binder; Amelia G. Burrill; Brandon K. Bush; Carley Espiritu; Jacob T. Haddock; Diane M. Harding; Brent E. Heilesen• Kyle Joseph
Howat; Cynthia L. Jay; Aliceon A. Keltner; Christopher Kinyon; Alyssa J. Lopez; Jamie L. Marques; Erica E. Mosley Annelics M. Richie• Katharine J. Snider Eric A
all of the city of Tacoma state of WA each individually if there be more than one named, its true and lawful attorney -in -fact to make,
execute, seal, acknowledge and deliver, for and on its behalf as surety and as its act and deed, any and all undertakings, bonds, recognizances and other surety obligations, in pursuance
of these presents and shall be as binding upon the Companies as if they have been duly signed by the president and attested by the secretary of the Companies in their own proper
persons.
IN WITNESS WHEREOF, this Power of Attorney has been subscribed by an authorized officer or official of the Companies and the corporate seals of the Companies have been affixed
thereto this 25th day of February , 2020 .
rn
c
co
c`o State of PENNSYLVANIA
:,3, County of MONTGOMERY ss
Liberty Mutual Insurance Company
P� iNSt/R� P�jY INgUpNX 1Nop, The Ohio Casualty Insurance Company
ooaPO�r ti� yJ o°R°ORar `9y �GP °oaPORvr yn West American Insurance Company
r Fo v 3 Fo m Fo m
Y;1912y o 0 1919 0 2 1991
� 3 y a �4V s o l_
~dJl9 `QgCMUS�.aa 0 ryM MPS as `Ps �NDIANP `da `
�i2 * 1 dye * By:
David M. Carey, Assistant Secretary
� 0 On this 25th day of February , 2020 before me personally appeared David M. Carey, who acknowledged himself to be the Assistant Secretary of Liberty Mutual Insurance
io Company, The Ohio Casualty Company, and West American Insurance Company, and that he, as such, being authorized so to do, execute the foregoing instrument for the purposes
therein contained by signing on behalf of the corporations by himself as a duly authorized officer.
IN WITNESS WHEREOF, I have hereunto subscribed my name and affixed my notarial seal at King of Prussia, Pennsylvania, on the day and year first above written.
c •�
0 pqs
L poNw Ail COMMONWEALTH OF PENNSYLVANIA
0 0 {y Notarial Seal
O � OF Teresa Pastella, Notary Public
C Upper MerionTwp., Montgomery County By:
My Commission Expires March 28, 2021
ryo eresa Pastella, U, Member, Pennsylvania Association of Notaries Notary Public
10
0 45 This Power of Attorney is made and executed pursuant to and by authority of the following By-laws and Authorizations of The Ohio Casualty Insurance Company, Liberty Mutual
0 •� Insurance Company, and West American Insurance Company which resolutions are now in full force and effect reading as follows:
? ARTICLE IV — OFFICERS: Section 12. Power of Attorney.
Any officer or other official of the Corporation authorized for that purpose in writing by the Chairman or the President, and subject to such limitation as the Chairman or the
President may prescribe, shall appoint such attorneys -in -fact, as may be necessary to act in behalf of the Corporation to make, execute, seal, acknowledge and deliver as surety
any and all undertakings, bonds, recognizances and other surety obligations. Such attomeys-in-fact, subject to the limitations set forth in their respective powers of attorney, shall
have full power to bind the Corporation by their signature and execution of any such instruments and to attach thereto the seal of the Corporation. When so executed, such
instruments shall be as binding as if signed by the President and attested to by the Secretary. Any power or authority granted to any representative or attorney -in -fact under the
provisions of this article may be revoked at any time by the Board, the Chairman, the President or by the officer or officers granting such power or authority.
ARTICLE XIII — Execution of Contracts: Section 5. Surety Bonds and Undertakings.
Any officer of the Company authorized for that purpose in writing by the chairman or the president, and subject to such limitations as the chairman or the president may prescribe,
shall appoint such attorneys -in -fact, as may be necessary to act in behalf of the Company to make, execute, seal, acknowledge and deliver as surety any and all undertakings,
bonds, recognizances and other surety obligations. Such attorneys -in -fact subject to the limitations set forth in their respective powers of attorney, shall have full power to bind the
Company by their signature and execution of any such instruments and to attach thereto the seal of the Company. When so executed such instruments shall be as binding as if
signed by the president and attested by the secretary.
Certificate of Designation — The President of the Company, acting pursuant to the Bylaws of the Company, authorizes David M. Carey, Assistant Secretary to appoint such attorneys -in -
fact as may be necessary to act on behalf of the Company to make, execute, seal, acknowledge and deliver as surety any and all undertakings, bonds, recognizances and other surety
obligations.
Authorization — By unanimous consent of the Company's Board of Directors, the Company consents that facsimile or mechanically reproduced signature of any assistant secretary of the
Company, wherever appearing upon a certified copy of any power of attorney issued by the Company in connection with surety bonds, shall be valid and binding upon the Company with
the same force and effect as though manually affixed.
I, Renee C. Llewellyn, the undersigned, Assistant Secretary, The Ohio Casualty Insurance Company, Liberty Mutual Insurance Company, and West American Insurance Company do
hereby certify that the original power of attorney of which the foregoing is a full, true and correct copy of the Power of Attorney executed by said Companies, is in full force and effect and
has not been revoked.
IN TESTIMONY WHEREOF, I have hereunto set my hand and affixed the seals of said Companies this 26th day of August , 2020
L tNSU V" INS& %NSUR
j P°ovtpor�rRoyc'cn �Jr°owaoggy \GP`oavOk, 4
�= o m ? o to
1912 0 U w
1919 1991 0" r~
4, !9 pACHU`��C'�aS SOy -4
Renee By
d Renee C. Llewellyn, Assistant Secretary
LMS-12873 LMIC OCIC WAIC Multi Cc 12/19
— I—
cmi W
aE
m n
c
L O
O co
Q �
O�
ca
N ca
0 Co
a- O
� O
om
�0
>O
v
00
E CV
C OO
00
U �
o C°
jp' aRPo�Toy�
� F
1912 0
CO 0
gCHus````�,aa$
Seal No. 5649