HomeMy WebLinkAboutCalumet Asphalt/Engr Dept. • ,-k,resc..4 -0706.05. 01--i
Engineering Department
Project 04-06
Ditch Road from 141"to 146th
Appropriation:2004 Road Bond;P.0.#13806
Not to Exceed: $1,557,112. 71 AGREEMENT /1PFRDVEDASTOFORM
City of Carmel, Indiana EEEE��//////
THIS AGREEMENT is made and entered into by and between the City of Carmel, Indiana,
acting by and through its Board of Public Works and Safety("City of Carmel") and Calumet Asphalt Paving
Cn
r c ("CONTRACTOR"), concerning the project "Ditch Road from 141s' Street to
146111 Street" described more particularly in Appendix A which is attached hereto and
incorporated herein by reference.
•
•
RECITALS:
•
A. The OWNER has heretofore caused to be prepared certain plans, specifications and other,
documents (collectively,the "Contract Documents") as hereinafter listed pertaining to the
• Project, and the CONTRACTOR has filed a bid proposal ("Proposal") to furnish labor,
tools, material, equipment and/or services, and to perform the work ("Work") called for
• in the Contract Documents pertaining to the Project, upon the terms and for the price(s)
therein fully stated and set forth; and
B. The said Contract Documents accurately arid fully describe the terms and conditions upon
which the CONTRACTOR is willing to furnish the labor, tools, material, equipment,
services, and perform the Work called for by the Contract Documents and in the manner
and time and for the price(s) set forth therein.
THE OWNER AND CONTRACTOR AGREE AS FOLLOWS:
1.0. Contract Documents
•
1.1 This Agreement consists of the following Contract Documents all of which are as fully a
part of this Agreement as if set out verbatim herein or attached hereto and the same do in
all particulars become the Agreement between the parties hereto in all matters and things
set forth herein and described:
a. This Agreement, including any attachments hereto; •
•
b. All Addenda issued prior to receipt of bid proposals, whether or not receipt
thereof has been acknowledged by CONTRACTOR in its Proposal;
c. The Specifications; •
d. The Additional Requirements;
e. Notice to Bidders;
Instructions to Bidders;
g, Plans and Drawings; •
Engineering Department
Project 04-06
g �rgDitch Road from 141 S1 to 14gq6t°gg
tggrlExceea2i4, 5/°1289T.d;P:0.#13806
h. Performance, Payment and Maintenance Bonds;
i. CONTRACTOR'S Itemized Proposal and Declarations; and
j. All other documents defined as Contract Documents in any of the above listed
documents.
•
1.2 In•resolving conflicts, errors, discrepancies and disputes concerning the nature, character,
scope and/or extent of Work to be performed or furnished by the CONTRACTOR
hereunder, or.other rights and obligations of the OWNER and/or CONTRACTOR, the•
provision of a Contract Document expressing the greater quantity, quality or scope of the
Work, or imposing a greater obligation upon the CONTRACTOR, or affording a greater
right or remedy to OWNER, shall govern, without regard to the party who drifted such
provision; otherwise, the Documents shall be given precedence in the order as listed in
paragraph 1.1 herein above.
2.0 Contract Price
2:1 The CONTRACTOR shall, in strict conformity with the Contract Documents, furnish-all
necessary labor, tools, materials, equipment, services, assume and fulfill all obligations
and perform all Work required to construct, complete, and make ready for use by the
OWNER at the Unit Prices as quoted in the Proposal for a total contract price not to
exceed $ 1,557',112.71 Base Bid, subject to any additions or deletions
based on actual approved quantities 'of the respective unit price items, which price the
CONTRACTOR agrees to accept as full payment for all such Work actually performed
and accepted as described in the "Contract Items and Unit Prices specification" and other
• Contract Documents (the "Contract Price"). The CONTRACTOR agrees that each unit
'price shall be deemed full and complete compensation for all direct and indirect costs for
the each respective item of Work, including, without limitation, all materials, labor,
supervision, equipment, transportation, warranties, repairs, replacement, overhead and
profit for the item, complete and in place.
2.2 The above stated Contract Price will be paid to the CONTRACTOR in the manner and at
such times as set forth in the Contract Documents.
3.0 Contract Time
•
3.1 It is hereby understood and mutually agreed, by and between the CONTRACTOR and
OWNER, that the date of commencement and the time for completion of the Work as
specified in the Contract Documents are essential conditions of this Agreement.
3.2 The CONTRACTOR agrees that the Work shall be commenced no later than the date
indicated in the Notice to Proceed to be provided by OWNER to CONTRACTOR and
that the Work shall be performed regularly, diligently and without interruption at such a
rate of progress as will insure "Substantial Completion" of the Project, including
completion of performance testing and such remedial work as may be required-by the
OWNER, by the dates specified in the Contract Documents.
A-21r'004v043300 ditch roadvspecificationsvFront end specs L04doe.doc
Engineering Department
Project 04-06
Ditch Road from 141'to 146'1'
Approriation: 2004 Road Bond;P.0.#13806
Not to Exceed: $1,557,112.71
3.3 The CONTRACTOR.and OWNER acknowledge and agree that the time allotted by this
Agreement for the performance and completion of the Work is:reasonable and takes into
account any and all risks and adverse conditions which may befall the CONTRACTOR
hereunder. •
4. Effective Date
This Agreement shall be deemed effective as of the date and year on which the last of the
parties hereto, or their representative, executes same.
5. Miscellaneous Provisions
5.1 OWNER's Property
Any and all documentation (other than original tracings and original calculations)
generated by CONTRACTOR pursuant to this Agreement shall be considered OWNER's
exclusive property and shall be disclosed only to OWNER and to no other person without
OWNER's prior express written consent. CONTRACTOR shall keep confidential all
working and deliberative material pursuant to IC 5-14-3-4.
5.2 Termination
Except as expressly stated to the contrary herein, this Agreement may be suspended
and/or terminated upon such terms as are set forth in Article 14 of the City of Carmel,
Standard General Conditions for Construction Contracts 9003 (the "General
Conditions"), as incorporated herein by this reference.
In the event any amount allegedly due hereunder is disputed and such dispute is not
resolved to OWNER's satisfaction within ten (10) business days after notice of such
dispute is given to CONTRACTOR, OWNER shall pay such amount as is in dispute,
under protest, into the City Court of Carmel, which Court shall hold such money until
notified of a resolution signed by both parties hereto or until a final judgment is entered
thereon.
5.3 Binding Effect
OWNER and CONTRACTOR and their respective officers, officials, partners,
successors, executors, administrators, assigns and legal representatives are bound by
this Agreement to the other party hereto and to the officers, officials, partners,
successors, executors, administrators, assigns and legal representatives of such other
party in all respects as to all covenants, agreements and obligations contained and/or
incorporated herein.
5.4 No Third Party Beneficiaries
Nothing contained herein shall be construed to give any rights or benefits
hereunder to anyone other than OWNER or CONTRACTOR.
• A-31:A2004V043300 ditch roadAsneciticntinnAfmni rod cnrn 19ndd�r.d��
•
Engineering Department
Project 04-06 •
Ditch Road from 141"to 146`h •
Appropriation: 2004 Road Bond;P.0.#13806
Not to Exceed: $1,557, 112.71
5.5 Relationship
The.relationship of the parties hereto shall be as provided for in this Agreement, and
CONTRACTOR, as well as its agents, employees, contractors, subcontractors, outside
sources and other persons shall in no fashion be deemed to be an employee of
OWNER. Furthermore, CONTRACTOR shall be solely responsible for payment to or
for its agents, employees, contractors, subcontractors, outside sources and other persons
all statutory, contractual and other compensation, benefits and obligations due thereto, •
and OWNER shall not be responsible for same. Rather, the Contract Price to be paid
hereunder by OWNER to CONTRACTOR shall, subject to the terms and conditions
• hereof, be the full and maximum compensation and monies required of OWNER to be
paid to CONTRACTOR pursuant to this Agreement.
5.6 Insurance •
• CONTRACTOR shall maintain such bonds and insurance as are set forth in
Article 5 of the General Conditions.
•
5.7 Indemnification •
CONTRACTOR shall indemnify and hold harmless OWNER, its officers, officials,
employees, agents and legal representatives, from all losses, liabilities, claims,
judgments and liens, including, but not limited to, all costs, expenses and attorney
• fees, arising out of any intentional or negligent act or omission of CONTRACTOR
and/or any of its agents, employees, contractors, subcontractors, outside sources
and/or other persons in the performance of this Agreement. The failure to do so shall
constitute a material breach of this Agreement. This indemnification obligation shall
survive the termination of this Agreement. •
•
5.8 Setoff
In addition to any right of setoff provided by law, all amounts due CONTRACTOR
shall be considered net of indebtedness of CONTRACTOR to OWNER, and
OWNER may deduct any amounts due or to be come due from CONTRACTOR to
OWNER from any sums due or to become due from OWNER to CONTRACTOR
hereunder.
•
5.9 Government Compliance
CONTRACTOR agrees to comply with all present and future federal, state and local
laws, executive orders, rules, regulations, codes and ordinances which may be
applicable to CONTRACTORS performance of its obligations under this Agreement,
and all relevant provisions thereof are incorporated herein by this reference.
CONTRACTOR agrees to indemnify and hold harmless OWNER from any loss,
damage or liability resulting from any violation of such laws, orders, rules,
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Engineering Department
Project 04-06
Ditch Road from 141'to146'n4 g
ongr xceeai a y9055!°1I2li9njd;P.0.#13806
regulations, codes and/or ordinances. This indemnification obligation shall survive
the termination of this Agreement. •
5.10 Severability.
If any provision of this Agreement is held to be invalid, illegal or unenforceable by a
court of Competent jurisdiction, that provision shall be stricken, and all other
provisions of this Agreement which can operate independently of such stricken
provision shall continue in full force and effect.
5.11 Notice.
Any notice, invoice, order or other correspondence required or permitted to be sent
under or pursuant to this Agreement shall be in writing and either hand-delivered or
sent by postage prepaid, U.S. Certified mail, return receipt requested, addressed to
the parties at the following address:
OWNER: CONTRACTOR:
City of Carmel Calumet Aspha] t Paving Co. , Inc.
Board ofPublic Works and Safety 526�ast96rh S r t`
One Civic Square Tnd;nnnpolis, TN 46240
Carmel, IN 46032
Attention: Mr.Mike McBride,PE, City Engineer •
(with a copy to City Attorney,
Department of Law, same address)
•
Notwithstanding the above, a Notice To Cease All Work issued under or pursuit to
• Paragraph 5.2 hereinabove may be orally given, as long as such notice is thereafter
followed by written notice as provided in this Paragraph 5.11 within five (5) business
days of the date of such oral notice.
5.12 Governing Law
This Agreement shall be governed by and construed in accordance with the laws of
•
the State of Indiana, except for its conflict of laws provisions, as well as with all
•
municipal ordinances and codes of the City of Carmel. The parties further agree that,
in the event a lawsuit is filed hereunder, they waive any rights to a jury trial they may
have, agree to file any such lawsuit in an appropriate court in Hamilton County,
Indiana only, and agree that such court is the appropriate venue for and has
jurisdiction over same.
5.13 Waiver •
•
Any delay or partial inaction on the part of OWNER in exercising or pursuing any
right and/or remedy provided hereunder or by law shall not operate to waive any such
rights or remedies.
5.14 Exhibits
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Engineering Department
Project 04-06 •
Ditch Road from 14 I'"to q' g �7
NggrggrE.Xceeeu: ,j5, ,iI2B9yd;P.o.#13806
All exhibits and/or appendices referenced herein, whether marked "Exhibit",
"Appendix", or by some other title, shall be considered a part of this Agreement.
5.15 Prior Agreements
This Agreement contains all of the agreements of the parties hereto with respect to
the subject matter hereof, and supersedes all prior negotiations, representations,
and/or contracts, either oral or written, respective thereto.
5.16 Representation and Warranties
Each party hereto represents and warrants that it is authorized to enter into this
Agreement and that such party, in executing this Agreement, has the.authority to
bind such party or the party which it represents, as the case may be.
5.17 Headings
All headings and sections of this Agreement are inserted for convenience only and do
notforn a part of this Agreement nor limit, expand or otherwise alter the meaning of
any provisions hereof.
.5.18 Advice of Counsel •
The parties warrant that they have read this Agreement and understand it, are fully
aware of their respective rights, have had the opportunity for the advice and
assistance of an attorney throughout the negotiation of this Agreement, and enter into•
this Agreement freely, voluntarily and without any duress, undue influence, coercion
or promise of benefit, except as expressly set forth herein.
5.19 Entire Agreement •
This Agreement, together with any attachments hereto or referenced herein, constitutes
the entire agreement between Vendor and City with respect to the subject matter hereof,
and supersedes all prior oral or written representations and agreements regarding same:
Notwithstanding any other term or condition set forth herein, but subject to paragraph
5.10 hereof, to the extent any term or condition contained in any exhibit attached to this •
Agreement conflicts with any term or condition contained in this Agreement, the term
or condition contained in this Agreement shall govern and prevail, unless the parties
hereto, or their successors in interest, expressly and in writing agree otherwise. This
Agreement may only be modified by written amendment executed by both parties
hereto, or their successors in interest.
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Engineering Department .
Project 04-06
Ditch Road from 141"to 146th
IN WITNESS WHEREOF, the parties hereto set their hand on the dates below written :
OWNER: CONTRACTOR:
CITY OF CARMEL, INDIANA
by and through its Board of Public Works and
Safety
BY: 1,�P1 �4_ BY: JAfi
James Brainard, Presiding Officer
Date: .a.„. .I Ili.?° e<5 . -
Printed Name: Steven P. Milbourne .
)2) Title: Vice-President ,
MaryyAA n Burke, Member 6/21/05
Date:
7 I _ , •.l,
Date:
Air
Lori Watson, •(-mber .
• Date: 7/&A) S
ATTEST: Sandra M.Johnson,
�� Depu Clerk for •
//
u" e I Date: 7 le br
4ordiay, 1erk-T(surer /
. _ , . A-7I:\2004\043300 ditch roadlst;ecifications`front end specs 1204dne.doc {
•
PERFORMANCE BOND BOND NO. 7572431
City of Carmel
•
• Instructions:
•
Successful Bidder must use this form or other form containing the same material conditions and
provisions as approved in advance by OWNER.
Date of Bond must not be prior to date of Contract. If CONTRACTOR is a Partnership, all partners
• should execute bond.
Surety company executing this bond shall appear on the most current list of "Surety Companies
Acceptable on Federal Bonds," as specified in the U.S. Treasury Department Circular 570, as amended,
and be authorized to transact business in the State of Indiana. •
KNOW ALL MEN BY THESE PRESENTS: that
•
"CONTRACTOR": •
CALUMET ASPHALT PAVING CO., INC.
•
and
"Surety": [Name] FIDELITY AND DEPOS ITTCOMPANY OF MARYLAND
[Address] P.O. BOX 1227
BALTIMORE, MD 21203-1227
a corporation chartered and existing under the laws of the State of
MARYLAND , and authorized to do business in the State of
Indiana,
are held and firmly bound unto the City of Carmel, Indiana hereinafter called OWNER, in the penal sum
of ** Dollars, ($ 1 ,557,112.71 ) in lawful money of the
United States, for the payment of which sum well and truly to be made, together with interest at the
maximum legal rate from date of demand and any attorney fees and court costs incurred by Obligee to
enforce this instrument, we bind ourselves,successors, and assigns,jointly and severally, firmly by these
presents. • ** ONE MILLION FIVE HUNDRED FIFTY SEVEN THOUSAND
ONE HUNDRED TWELVE AND 71/100
WHEREAS,the CONTRACTOR has entered into a certain Agreement with the OWNER, dated as of the •
21st day of June ,2005 ,by which CONTRACTOR has agreed to perform and
furnish certain Work for or in furtherance of construction of public improvements described generally as
Ditch Road from 141"Street to 146°'Street
04-06
A boulevard style roadway with curb and gutter beginning just south of 141s`Street and
continuing to 146"'Street intersection, including enclosed storm sewers, multi-use path, a
roundabout located at 141"Street, and incidental work such as lighting,striping and signage.
which Agreement, and the"Contract Documents"as referred to therein,are hereby incorporated herein
by reference;
PFB-I 1:\2004\043300 ditch road'specifcationsUiont and specs 1204doc.dac
•
NOW, THEREFORE, the conditions of this obligation are such that if the CONTRACTOR shall well,
truly and faithfully perform his duties, all the undertakings, covenants, terms and conditions of said
Agreement whether during the original term thereof, and any extensions thereof which may be granted by
the OWNER, with or without notice to the Surety and during any period of guaranty or warranty
provided therein or arising thereunder, and if CONTRACTOR shall satisfy all claims and demands
incurred under such Contract, and shall fully indemnify and save harmless the OWNER from all costs
and damages which.he may suffer by reason of failure to do so, and shall reimburse and repay the
OWNER all outlay and expense which the OWNER may incur in making good any default, then this
obligation shall be void; otherwise to remain in full force and effect.
PROVIDED, FURTHER, that the said Surety, for value received, hereby stipulates and agrees:
I. that no defect or irregularity in the Contract or in the proceedings preliminary to the letting of the
Contract will operate to release or discharge Surety;
2. that no change, omission, extension of time, alteration or addition to the terms of the Agreement,
Contract Documents or to any Work to be furnished thereunder, and no delay by the OWNER in
enforcement of the Agreement or this bond shall in any way affect its obligation on this bond,
and it does hereby waive notice of any such change, extension of time, alteration or addition to
the terms of the Agreement, Contract Documents or to the Work;
3. that no final settlement between the OWNER and the CONTRACTOR shall abridge any right of
the OWNER hereunder as to any claim that may remain unsatisfied; and
that this Performance Bond and Surety shall not be released until one(1) year after the OWNER's fmal
settlement with the CONTRACTOR.
IN WITNESS WHEREOF, this instrument is executed in 1 (number) counterparts, each one of
which shall be deemed an original, this the?1st day of June , 20 05
CONTRACTO�/:[[name] CALUMET ASPHALT PAVING CO., INC.
By: gtPven P Milhourne
[signature] [printed name]
ATT ST:
Secretary
[ ' afore]
[name] FIDELITY AND DEPOSIT COMPANY OF MARYLAND
Attorney-in-fact
[signal re
TIMOTHY J. TA LOR P.O. BOX 1227
[printed nanie].Z_../.,, ' [address]
•
BALTIMORE, MD 21203-1227
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0
ZURICH
THIS IMPORTANT DISCLOSURE NOTICE IS PART OF YOUR BOND
Fidelity and Deposit Company of Maryland, Colonial American Casualty and Surety Company, Zurich American
Insurance Company, and American Guarantee and Liability Insurance Company are making the following
informational disclosures to compliance with The Terrorism Risk Insurance Act of 2002.No action is required on your
part.
Disclosure of Terrorism Premium
The premium charge for risk of loss resulting from acts of terrorism (as defined in the Act) under this bond is
$ waived . This amount is reflected in the total premium for this bond.
Disclosure of Availability of Coverage for Terrorism Losses
As required by the Terrorism Risk Insurance Act of 2002, we have made available to you coverage for losses resulting
from acts of terrorism (as defined in the Act) with terms, amounts and limitations that did not differ materially as those
for losses arising from events other than acts of terrorism.
Disclosure of Federal Share of Insurance Company's Terrorism Losses
The Terrorism Risk Insurance Act of 2002 establishes a mechanism by which the United States government will share
in insurance company losses resulting from acts of terrorism (as defined in the Act) after a insurance company has paid
losses in excess of an annual aggregate deductible. For 2002, the insurance company deductible is 1% of direct earned
premium in for the prior year; for 2003, 7%of direct earned premium in the prior year; for 2004, 10%of direct earned
premium in the prior year; and for 2005, 15% of direct earned premium in the prior year. The federal share of an
insurance company's losses above its deductible is 90%. In the event the United States government participates in
losses, the United States government may direct insurance companies to collect a terrorism surcharge from
policyholders. The Act does not currently provide for insurance industry or United States government participation in
terrorism losses that exceed $100 billion in any one calendar year.
Definition of Act of Terrorism
The Terrorism Risk Insurance Act defines "act of terrorism" as any act that is certified by the Secretary of the Treasury,
in concurrence with the Secretary of State and the Attorney General of the United States.
I. to be an act of terrorism;
2. to be a violent act or an act that is dangerous to human life, property or infrastructure;
3. to have resulted in damage within the United States, or outside of the United States in the case of an air carrier
(as defined in section 40102 of title 49, United 17 States Code) or a United States flag vessel (or a vessel based
principally in the United States, on which United States income tax is paid and whose insurance coverage is
subject to regulation in the United States), or a United States mission; and
4. to have been committed by an individual or individuals acting on behalf of any foreign person or foreign
interest as part of an effort to coerce the civilian population of the United States or to influence the policy or
affect the conduct to the United States Government by coercion.
But, no act shall be certified by the Secretary as an act of terrorism if the act is committed as part of the course of a war
declared by Congress (except for workers' compensation) or property and casualty insurance losses resulting from the
act, in the aggregate, do not exceed $5,000,000.
These disclosures are informational only and do not modify your bond or affect your rights under the bond.
Copyright Zurich American Insurance Company 2003
-0050749.doc
Power of Attorney
FIDELITY AND DEPOSIT COMPANY OF MARYLAND
KNOW ALL MEN BY THESE PRESENTS:That the FIDELITY AND DEPOSIT COMPANY OF MARYLAND, a
corporation of the Slate of Maryland, by WILLIAM J. MILLS. Vice President, and ERIC D. BARNES, Assistant Secretary,
in pursuance of authority granted by Article VI. Section 2, of the By-Laws of said Company, are set forth on the
reverse side hereof and arc hereby certified to be in full force and effect on the date hEyre tk s by,nominate,constitute
and appoint Nick J. RUTIGLIANO,Timothy J.TAYLOR and Robert t 111 f,V NOS all:} ndianapolis,Indiana,
EACH its true and lawful agent and Attorney-in-Fact, to maky o s cjivrer ffk i {1 5 behalf as surety. and
as its act and deed: any and all bonds and undertake g a ci c. ecu �a}�1•. b gnu?S or undertakings in pursuance of
these presents, shall he as binding upon sai con slivl�ty 8nd ? .aII--talents and purposes. as if they had been
duly executed and acknowlled e r idly elect i t e man at its office in Baltimore, Md., in their
`r tr Vatttt .y \tl1'24„ 1e roY P Y
own proper persons 1"' er >rny r�Gs J ed�on behalf of Nick J. Rutigliano,Timothy J.Taylor, Robert
M. Rutigliano,date 1 u•rY 2,�2�3Pt�2 tt l3-
The said Assistant tp, estTtere y certify that the extract set forth on the reverse side hereof is a true copy of Article VI,
Section 2.of the By-L&sys•said Company,and is now in force.
IN WITNESS WHEREOF, the said Vice-President and Assistant Secretary have hereunto subscribed their names and
affixed the Corporate Seal of the said FIDELITY AND DEPOSIT COMPANY OF MARYLAND, this 27th day of March,
A.D. 2003.
ATTEST: FIDELITY AND DEPOSIT COMPANY OF MARYLAND
tp Was
_ p o
.w. E
O to - i..
By:
Eric D. Barnes Assistant Secretary William J. Mills Vice President
State of Maryland ssl
City of Baltimore
On this 27th day of March, A.D. 2003, before the subscriber, a Notary Public of the State of Maryland, duly
commissioned and qualified, came WILLIAM J. MILLS. Vice President, and ERIC D. BARNES, Assistant Secretary of the
FIDELITY AND DEPOSIT COMPANY OF MARYLAND. to me personally known to he the individuals and officers
described in and who executed the preceding instrument, and they each acknowledged the execution of the same, and being
by me duly sworn, severally and each for himself deposeth and saith, that they are the said officers of the Company aforesaid,
and that the seal affixed to the preceding instrument is the Corporate Seal of said Company, and that the said Corporate Seal
and their signatures as such officers were duly affixed and subscribed to the said instrument by the authority and direction of
the said Corporation. '
IN TESTIMONY WHEREOF, I have hereunto set my hand and affixed my Official Seal the day and year first above
written.
v
I41n.'•
�I,u M1O`•
Constance A. Dunn Notary Public
My Commission Expires: July 14, 2007
POA-F 044-0465
•
PAYMENT BOND
City of Cannel
Instructions:
Successful Bidder must use this form or other form containing the same material conditions and
provisions as approved in advance by OWNER.
Date of Bond must not be prior to date of Contract. If CONTRACTOR is a Partnership, all partners
should execute bond.
Surety company executing this bond shall appear on the most current list of "Surety Companies
Acceptable on Federal Bonds," as specified in the U.S. Treasury Department Circular 570, as amended,
and be authorized to transact business in the State of Indiana.
KNOW ALL MEN BY THESE PRESENTS: that
"CONTRACTOR":
CALUMET ASPHALT PAVING CO., INC. •
and
"Surety": [Name] FIDELITY AND DEPOSIT COMPANY OF MARYLAND
[Address] P.O. BOX 1227 • t
BALTIMORE, MD 21203-1227
a corporation chartered and existing under the laws of the State of
MARYLAND , and authorized to do business in the State of
Indiana,
are held and firmly bound unto the City of Cannel, Indiana hereinafter called OWNER, in the penal sum
of ** Dollars, ($ 1,557,112.71 ) in lawful money of the
United States, for the payment of which sum well and truly to be made, plus interest at the maximum
legal rate from date of demand and any attorney fees and court costs incurred by Obligee to enforce this
instrument, we bind ourselves,successors and assigns,jointly and severally, firmly by these presents.
** ONE MILLION FIVE HUNDRED FIFTY SEVEN THOUSAND
ONE HUNDRED TWELVE AND 71/100
WHEREAS, the CONTRACTOR has entered into a certain Agreement with the OWNER, dated as of the
21 s t day of June , 20 05 , by which CONTRACTOR has agreed to perform and
furnish certain Work for or in furtherance of construction of public improvements described generally as
Ditch Road from 141"Street to 146th Street
04-06
A boulevard style roadway with curb and gutter beginning just south of 141"Street and
continuing to 146th Street intersection, including enclosed storm sewers, multi-use path, a
roundabout located at 141"Street, and incidental work such as lighting,striping and sign age.
which Agreement, and the "Contract Documents" as referred to therein, are hereby incorporated herein
by reference;
• PMB-11:12004t043300 ditch road\specifications\front end specs 1204doc.doc
NOW, THEREFORE, the conditions of this obligation are such that if the CONTRACTOR shall
promptly make payments of all amounts due to all Claimants, then this obligation shall be void;
otherwise to remain in fill] force and effect. "Claimant"shall mean any Subcontractor, material supplier
or other person, firm, or corporation furnishing materials or equipment for or performing labor or
services, in the prosecution of the Work provided for in such Agreement, including lubricants, oil,
gasoline, coal and coke, repairs on machinery, and tools, whether consumed or used in connection with
the construction of such work, and all insurance premiums on said work, and for all labor, performed in
such work. •
PROVIDED, FURTHER,that the said Surety, for value received, hereby stipulates and agrees:
1. that no defect or irregularity in the contract or in the proceedings preliminary to the letting of the
Agreement will operate to release or discharge Surety;
2. that no change,omission, extension of time, alteration or addition to the terms of the Agreement,
Contract Documents or to any Work to be furnished thereunder,and no delay by the OWNER in
enforcement of the Agreement or this bond shall in any way affect its obligation on this bond,
and it does hereby waive notice of any such change, extension of time, alteration or addition to
the terms of the Agreement, Contract Documents or to the Work;
3. that no final settlement between the OWNER and the CONTRACTOR shall abridge any right of
the OWNER hereunder as to any claim that may remain unsatisfied; and
4. that this Payment Bond and Surety shall not be released until one (1) year after the OWNER's
final settlement with the CONTRACTOR.
IN WITNESS WHEREOF, this instrument is executed in 1 (number) counterparts, each one of
which shall be deemed an original, this the 21 s t day of June ,2005
CONTRACT : [name]
CALUM ASPHALT PAVING CO., INC.
By: �_�tf7_"_'Y Steven P. Milbourne
[signature] [printed name]
ATT T:
Secretary
gnature
S [name] FIDELITY AND DEPOSIT COMPANY OF MARYLAND
Attomey-in-fact
[sign e] •
TI THY. J. .T yLOR P.O. BOX 1227
[printed name]"! [address]
BALTIMORE, MD 21203-1227
•
1/4
• PMB-21:12004\043300 ditch macnspecifications\Ciont end specs 12042oc.doc
9
ZURICH
THIS IMPORTANT DISCLOSURE NOTICE IS PART OF YOUR BOND
Fidelity and Deposit Company of Maryland, Colonial American Casualty and Surety Company. Zurich American
Insurance Company, and American Guarantee and Liability Insurance Company are making the following
informational disclosures to compliance with The Terrorism Risk Insurance Act of 2002. No action is required on your
part.
Disclosure of Terrorism Premium
The premium charge for risk of loss resulting from acts of terrorism (as defined in the Act) under this bond is
$_waived_. This amount is reflected in the total premium for this bond.
Disclosure of Availability of Coverage for Terrorism Losses
As required by the Terrorism Risk Insurance Act of 2002, we have made available to you coverage for losses resulting
from acts of terrorism (as defined in the Act) with terms, amounts and limitations that did not differ materially as those
for losses arising from events other than acts of terrorism.
Disclosure of Federal Share of Insurance Company's Terrorism Losses
The Terrorism Risk Insurance Act of 2002 establishes a mechanism by which the United States government will share
in insurance company losses resulting from acts of terrorism (as defined in the Act) after a insurance company has paid
losses in excess of an annual aggregate deductible. For 2002, the insurance company deductible is I%of direct earned
premium in for the prior year; for 2003, 7%of direct earned premium in the prior year; for 2004, 10% of direct earned
premium in the prior year; and for 2005, 15%of direct earned premium in the prior year. The federal share of an
insurance company's losses above its deductible is 90%. In the event the United States government participates in
losses, the United States government may direct insurance companies to collect a terrorism surcharge from
policyholders. The Act does not currently provide for insurance industry or United States government participation in
terrorism losses that exceed $100 billion in any one calendar year.
Definition of Act of Terrorism
The Terrorism Risk Insurance Act defines "act of terrorism"as any act that is certified by the Secretary of the Treasury,
in concurrence with the Secretary of State and the Attorney General of the United States.
1. to be an act of terrorism;
2. to be a violent act or an act that is dangerous to human life, property or infrastructure;
3. to have resulted in damage within the United States, or outside of the United States in the case of an air carrier
(as defined in section 40102 of title 49, United 17 States Code) or a United States flag vessel (or a vessel based
principally in the United States, on which United States income tax is paid and whose insurance coverage is
subject to regulation in the United States). or a United States mission; and
4. to have been committed by an individual or individuals acting on behalf of any foreign person or foreign
interest as part of an effort to coerce the civilian population of the United States or to influence the policy or
affect the conduct to the United States Government by coercion.
But, no act shall be certified by the Secretary as an act of terrorism if the act is committed as part of the course of a war
declared by Congress (except for workers' compensation) or property and casualty insurance losses resulting from the
act, in the aggregate, do not exceed $5,000,000.
These disclosures are informational only and do not modify your bond or affect your rights under the bond.
Copyright Zurich American Insurance Company 2003
-0050749.doc
Power of Attorney
FIDELITY AND DEPOSIT COMPANY OF MARYLAND
KNOW ALL MEN BY THESE PRESENTS:That the FIDELITY AND DEPOSIT COMPANY OF MARYLAND, a
corporation of the State of Maryland, by WILLIAM J. MILLS,Vice President,and ERIC D.•BARNES,Assistant Secretary,
in pursuance of authority granted by Article VI, Section 2, of fhe By-Laws of said Company, ire set forth on the
reverse side hereof and are hereby certified to he in full force and effect on the date here s ei by nominate,constitute
and appoint Nick J. RUTIGLIANO,Timothy J. TAYLOR and RobertJVl;�(fis� O,allcof ndianapolis,Indiana,
EACH its true and lawful agent and Attorney-in-Fact, to mall ''c'tcs I A c cl'v�>rfif rd ¢ behalf as surety, and
caik as its act and deed: any and all bonds and undertakt s, rC execntittrt6i'kc or undertakings in pursuance of
these presents,shall be as binding upon sal qui\�i#O #nl� andafnii��s*\l�m7�ents and purposes as if they had been
duly executed and acknowledie.0pl, tFjttt jtaily ele�.t�,cd"'(T ktr fv Vie Company at its office in Baltimore.Md.,in their
own proper persons M�ttnn-{{sr`d�htt6Tsty " s�kf4.il S�iee6 on behalf of Nick J. Rutigliano,Timothy J.Taylor, Robert
M. Rutigliano,dateccahuzf' e2,42F �1=lis
The said Assistant 491 a ‘sizle�liy certify that the extract set forth. on the reverse side hereof is a true copy of Article VI.
Section 2,of the By-Lkws said Company,and is now in force.
IN WITNESS WHEREOF, the said Vice-President and Assistant Secretary have hereunto subscribed their names and
affixed the Corporate Seal of the said FIDELITY AND DEPOSIT COMPANY OF MARYLAND, this 27th day of March.
A.D. 2003.
ATTEST: FIDELITY AND DEPOSIT COMPANY OF MARYLAND
r.` ues,
ine
By:
Eric D. Barnes Assistant Secretary William J. Mills Vice President
State of Maryland
}SS: •
City of Baltimore
On this 27th day of March, A.D. 2001 before the subscriber, a Notary Public of the State of Maryland, duly
commissioned and qualified, came WILLIAM J. MILLS, Vice President, and ERIC D. BARNES, Assistant Secretary of the
FIDELITY AND DEPOSIT COMPANY OF MARYLAND. to me personally known to he the individuals and officers
described in and who executed the preceding instrument, and they each acknowledged the execution of the same, and being
by me duly sworn, severally and each for himself deposeth and saith,that they are the said officers of the Company aforesaid,
and that the seal affixed to the preceding instrument is the Corporate Seal of said Company, andthat the said Corporate Seal
and their signatures as such officers were duly affixed and subscribed to the said instrument by the authority and direction of
the said Corporation.
IN TESTIMONY WHEREOF. I have hereunto set my hand and affixed my Official Seal the day and year first above
written.
uun,,
y v
r�
pnu
Constance A. Dunn Notary Public
My Commission Expires: July 14, 2007
POA-F 044-0465
•
•
MAINTENANCE BOND BOND NO. 7572431
City of Carmel •
Instructions:
Successful Bidder must use this form or other form containing the same material conditions and
provisions as approved in advance by OWNER.
Date of Bond must not be prior to date of Contract. If CONTRACTOR is a Partnership, all partners
should execute bond.
Surety company executing this bond shall appear on the most current list of "Surety Companies
Acceptable on Federal Bonds," as specified in the U.S. Treasury Department Circular 570, as amended,
and be authorized to transact business in the State of Indiana.
KNOW ALL MEN BY THESE PRESENTS: that
"CONTRACTOR":
CALUMET ASPHALT PAVING CO., INC.
and
"Surety":a [Name] FIDELITY AND DEPOSIT COMPANY OF MARYLAND
[Address] P.O. BOX 1227
BALT IMORE, MD 21203-1227
a corporation chartered and existing under the laws of the State of
MARYLAND , and authorized to do business in the State of
Indiana,
are held and firmly bound unto the City of Carmel,Indiana hereinafter called OWNER, in the penal sum
of ** Dollars, ($ 155,711 .27 ) in lawful money of the
United States, for the payment of which sum well and truly to be made, together with interest at the
maximum legal rate from date of demand and any attorney fees and court costs incurred by Obligee to
enforce this instrument,we bind ourselves,successors, and assigns,jointly and severally, firmly by these
presents. ** ONE HUNDRED FIFTY FIVE THOUSAND SEVEN HUNDRED
ELEVEN AND 27/100
WHEREAS,the CONTRACTOR has entered into a certain Agreement with the OWNER,dated as of the
21 s t day of Tune ,20 05 ,by which CONTRACTOR has agreed to perform and .
furnish certain Work for or in furtherance of construction of public improvements described generally as
Ditch Road from 141"Street to 146m Street
04-06
A boulevard style roadway with curb and gutter beginning just south of 141'"Street and
continuing to 146`h Street intersection, including enclosed storm sewers, multi-use path, a
roundabout located at 1415e Street, and incidental work such as lighting,striping and signage.
•
which Agreement, and the "Contract Documents" as referred to therein, are hereby incorporated herein
by reference;
•
WHEREAS, CONTRACTOR has installed and completed and met all improvements, installations and
requirements applicable to the above described Work, but said improvements and installations have not
yet been accepted for public maintenance; and
WHEREAS, the OWNER requires a guarantee from the CONTRACTOR against defective materials and
workmanship in connection with such maintenance.
NOW, THEREFORE, CONTRACTOR warrants the workmanship and all materials used in the
construction, installation and completion of said Work, including all improvements and installations
thereof, to be of good quality and constructed and completed in a workmanlike manner in accordance
with the Agreement and Contract Documents and all local, state and federal laws, ordinances, rules,
standards and regulations applicable to said Work;
FURTHERMORE, the conditions of the Surety's obligation hereunder are such that if CONTRACTOR
at his own expense, for a period of three (3) years after said Work, improvements and installations are
accepted for public maintenance by the OWNER, shall make all repairs or replacements thereto which
may become necessary by reason of improper or defective workmanship or materials, or any failure
thereof to conform to the provisions of the Agreement or Contract Documents,then Surety's obligation is
to be null and void; otherwise such obligation shall remain in full force and effect. Any repairs or
replacements made under this bond shall in like manner be subject to the terms and conditions hereof.
CONTRACTOR and Surety covenant that all action required by law to be taken by them to authorize the
execution and delivery of this bond have been previously taken,that the officers whose signatures appear
below have been fully empowered to execute and deliver this instrument and that once executed and
delivered, it shall represent the lawful and binding obligation of the parties.
IN WITNESS WHEREOF, this instrument is executed in 1 (number) counterparts, each one of
which shall be deemed an original,this the 21stday of June ,20 05
CONTRACTO : [name] CALU ET ASPHALT PAVING CO., INC.
By: / ! Steven P. Milbourne
[signature] [printed name]
ATT T:
Secretary
[s' ture
SURE ame] FIDELITY AND DEPOSIT COMPANY OF MARYLAND
Attorney-in-fact
[signat
TIMOT .J. TAYLO P.O. BOX 1227
[printed name]' [address]
BALTIMORE, MD 21203fl227
•
AIn _,._
0
•
ZURICH
THIS IMPORTANT DISCLOSURE NOTICE IS PART OF YOUR BOND
Fidelity and Deposit Company of Maryland, Colonial American Casualty and Surety Company, Zurich American
Insurance Company, and American Guarantee and Liability Insurance Company are making the following
informational disclosures to compliance with The Terrorism Risk Insurance Act of 2002. No action is required on your
part.
Disclosure of Terrorism Premium
The premium charge for risk of loss resulting from acts of terrorism (as defined in the Act) under this bond is
$ waived . This amount is reflected in the total premium for this bond.
Disclosure of Availability of Coverage for Terrorism Losses
As required by the Terrorism Risk Insurance Act of 2002, we have made available to you coverage for losses resulting
from acts of terrorism (as defined in the Act) with terms, amounts and limitations that did not differ materially as those
for losses arising from events other than acts of terrorism.
Disclosure of Federal Share of Insurance Company's Terrorism Losses
The Terrorism Risk Insurance Act of 2002 establishes a mechanism by which the United States government will share
in insurance company losses resulting from acts of terrorism (as defined in the Act) after a insurance company has paid
losses in excess of an annual aggregate deductible. For 2002, the insurance company deductible is I%of direct earned
premium in for the prior year; for 2003, 7% of direct earned premium in the prior year; for 2004, 10% of direct earned
premium in the prior year; and for 2005, 15% of direct earned premium in the prior year. The federal share of an
insurance company's losses above its deductible is 90%. In the event the United States government participates in
losses, the United States government may direct insurance companies to collect a terrorism surcharge from
policyholders. The Act does not currently provide for insurance industry or United States government participation in
terrorism losses that exceed $100 billion in any one calendar year.
Definition of Act of Terrorism
The Terrorism Risk Insurance Act defines "act of terrorism" as any act that is certified by the Secretary of the Treasury,
in concurrence with the Secretary of State and the Attorney General of the United States.
1. to be an act of terrorism;
2. to be a violent act or an act that is dangerous to human life, property or infrastructure;
3. to have resulted in damage within the United States, or outside of the United States in the case of an air carrier
1 (as defined in section 40102 of title 49, United 17 States Code) or a United States flag vessel (or a vessel based
principally in the United States, on which United States income tax is paid and whose insurance coverage is
subject to regulation in the United States), or a United States mission; and
4. to have been committed by an individual or individuals acting on behalf of any foreign person or foreign
interest as part of an effort to coerce the civilian population of the United States or to influence the policy or
affect the conduct to the United States Government by coercion.
But, no act shall be certified by the Secretary as an act of terrorism if the act is committed as part of the course of a war
declared by Congress (except for workers' compensation) or property and casualty insurance losses resulting from the
act, in the aggregate, do not exceed $5,000,000.
These disclosures are informational only and do not modify your bond or affect your rights under the bond.
Copyright Zurich American Insurance Company 2003
-0050749.doc
•
Power of Attorney
FIDELITY AND DEPOSIT COMPANY OF MARYLAND
KNOW ALL MEN BY THESE PRESENTS: That the FIDELITY AND DEPOSIT COMPANY OF MARYLAND. a
corporation or the State of Maryland. by WILLIAM J. MILLS, Vice President, and ERIC D. BARNES. Assistant Secretary,
in pursuance of authority granted by Article VI. Section 2,of the By-Laws of said Company, vtyare set forth on the
reverse side hereof and are hereby certified to be in.full force and effect on the date here p ,E s:bertby nominate,constitute
and appoint NickJ. RUTIGLIANO,Timothy J.TAYLOR and Robert N `r L/A O,allaf(ndianapolis,Indiana,
EACH its true and lawful agent and Attorney-in-Fact, tomak>< �u t seliver'f' re s i1y behalf as surety, and
as its act and deed: any and all bonds and nndert p' ,/a thh"e�ee ecu on use' ,or undertakings in pursuance of
these presents, shall he as binding upon sai nS s �Tall 3ndca('1(i yam!_ I�rftents and purposes.as if they had been
duly executed and acknowledgeexi h� Whh+'ly`"electoiNfteri f�ite'Company at its office in Baltimore.Md., in their
own proper ersons„ a cr Wat xn t s, t
p p� p ..� (^, y� � .���;�khtcd on behalf of Nick J. Rutigliano,Timothy J.Taylor,Robert
M. Rutigliano,dateaj `/ r`y 22..24 fti\`>a . .=
The said Assistant yt1aA n, `esteby certify that the extract set forth on the reverse side hereof is a true copy of Article VI,
Section 2,of the By-Laws t aid Company,and is now in three.
IN WITNESS WHEREOF, the said Vice-President and Assistant Secretary have hereunto subscribed their names and
affixed the Corporate Seal of the said FIDELITY AND DEPOSIT COMPANY OF MARYLAND, this 27th day of March,
A.D. 2003.
ATTEST: FIDELITY AND DEPOSIT COMPANY OF MARYLAND
'•0 DIP ps`
'p�eo io
-q , Y, , ,, .U, /.1-'a-'-r�2--_. ✓/, ,may,
nm.
By:
Eric D. Barnes Assistant Secretary William J. Mills Vice President
State of Maryland ss[
City of Baltimore
On this 27th day of March, A.D. 2003, before the subscriber, a Notary Public of the State of Maryland, duly
commissioned and qualified, came WILLIAM J. MILLS, Vice President, and ERIC D. BARNES, Assistant Secretary of the
FIDELITY AND DEPOSIT COMPANY OF MARYLAND. to me personally.known to be_the individuals and officers
described in and who executed thepreceding instrument, and they each acknowledged the execution of the same, and being
by me duly sworn,severally and each for himself deposeth and saith, that they are the said officers of the Company aforesaid,
and that the seal affixed to the preceding instrument is the Corporate Seal of said Company, and:that the said Corporate Seal
and their signatures as such officers were duly affixed and subscribed to the said instrument by the authority and direction of
the said Corporation.
IN TESTIMONY WHEREOF, I have hereunto set my hand and affixed my Official Seal the day and year first above
written.
nw„u;,,
i
12143....`:
Constance A. Dunn Notary Public
My Commission Expires: July 14,2007
POA-F 044-0465 •
/From:Robin Reeder At:Tobias Insurance Group.Inc. FaxID: To:MICHELLE CAIN • Date:6/172005 07:10 AM Page:2 of 2 }'-
a
ACORD CERTIFICATE OF LIABILITY INSURANCE OP ID R3 DATE IMM/DOM'YYI
CALUM-4 06/17/05
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
Tobias Insurance Group, Inc. - HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR
• 9247 N. Meridian St. Ste. 300 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Indianapolis IN 46260
Phone: 317-844-7759 Fax:317-844-9910 INSURERS AFFORDING COVERAGE NAIC
INSURED INSURER A' y
Acui! A[Satual Inauiance Co.
INSURER B.
Calumet Asphalt Paving Co, Inc INSURER C:
5265 East 96th Street INSURER D.
Indianapolis IN 46240-1452
- INSURER E'.
COVERAGES
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE P0_ICY PERIOD INDICATED.NOTWITHSTANDING
ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR 01HER DOCUMENT-WITH RESPECTTO WHICH THIS CERTIFICATE MAT BE ISSUED CR
MAY PERTAIN.THE.INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS 0=SUCH
POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
TNSI< UU L PULILY EHEQ I IVE POCRRERPIRATIOIU
LTR NSRD TYPE OF INSURANCE POLICY NUMEER DATE(MM/DDNY) DATE I WIDOW) LIMITS
GENERAL LIABILITY EACH OCCURRENCE - $ 1,000,000
A X X COMMERCIAL-GENERAL LIABILITY K424.66 (05) 04/01/05 04/01/06 PRcwss7e nlwrence) $ 100,000
CLAMS MADE fX OCCUR MED EYE(Any one person) $5,000 •
PERSONAL BADV INJURY $ 1,000,000
GENERAL AGGREGATE $2,000,000 •
GENT AGGREGATE LIMIT APPLIES PER. PRODUCTS-COMP/OP AGG $2,000,000
POLICY X 'JECi Los
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT
A X X ANY AUTO K42466 (05) 04/01/05 04/01/06 1Eceocicent) $1,000,000
ALL OWNED AUTOS BODILY INJURY
SCHEDULED AUTOS (Per person)
X HIRED AUTOS BODILY INJURY
X NON-OWNED AUTOS (Per accident)
PROPERTY DAMAGE $
(Per eccidert)
GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $
ANY AVID OTHER THAN
EA ACC $
AUTO ONLY AGG $
EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $5,000,000
A X • OCCUR CLAIMS MADE K92466 (05) 04/01/05 04/01/06 AGGREGATE $5,000,000•
$
DEDUCTIBLE _
X RETENTION $0 - $
WORKERS COMPENSATION AND X WORTLIMCSIMIITS UIH-
TER
EMPLOYERS'LIABILITY
A ANY PROPRIETOR/PARTNER/EXECUTIVE K42966 (05) 04/01/05 04/01/06 EL.EACH ACCIDENT $500000
OTFICERIMEMBEP EXCLUDED? E.L.DISEASE-EAEMPLOYEE $ 500000
cribe under
SPECIAL�PROVISIONS below E.L.DISEASE-POLICY LIMIT $500000
OTHER
DESCRIPTOR OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS
ADDITIONAL INSURED(S) [GENERAL AND AUTOMOBILE LIABILITY] : CITY OF CARMEL AND
ANY CONTRACTUALL REQUIRED ENTITIES. RE: DITCH ROAD FROM 141ST STREET TO
146TH STREET. -
•
CERTIFICATE HOLDER CANCELLATION
CARME-2 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRREN
CITY OF CARMEL NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL
BOARD OF PUBLIC WORKS & SAFETY IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR
ONE CIVIC SQUARE
('aRFThL IN 46032 REPRESENTATIVES.
AUTH ED REPRESENTATIVE
ACORD 25(2001108) y, 72)41.41 CORD
CORPORATION 1988