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HomeMy WebLinkAboutPW Point San Pedro Asphalt Sidewalk; First AmendmentFIRST AMENDMENT TO THE PUBLIC WORKS CONTRACT WITH GHILOTTI
BROS., INC. FOR THE POINT SAN PEDRO ASPHALT SIDEWALK PROJECT
THIS FIRST AMENDMENT to the "Public Works Contract for Projects up to
$175,000" by and between the CITY OF SAN RAFAEL (hereinafter "CITY"), and
GHILOTTI BROS. INC. (hereinafter "CONTRACTOR"), is made and entered into as of the
day of 202
RECITALS
WHEREAS, the CITY and CONTRACTOR entered into a "Public Works Contract for
Projects up to $175.000" dated January 5, 2022 for CONTRACTOR to perform construction
services in connection with CITY'S Point San Pedro Asphalt Sidewalk project, for an amount
not to exceed $103,615 (the "Contract"); and
WHEREAS, a change in project specifications by CITY requires an adjustment of the
compensation payable to CONTRACTOR under the Contract;
AMENDMENT TO CONTRACT
NOW, THEREFORE, the parties hereby agree to amend the Contract as follows:
1. Section I of the Contract, entitled "Scope of Work" is hereby amended to reflect
the Change Order Request dated 01/12/22 attached to this First Amendment as
Exhibit A and incorporated herein by reference.
2. Section 3 of the Contract, entitled "Contract Price" is hereby amended to increase
the compensation payable to CONTRACTOR for the revised Scope of Services
described in Exhibit A to this First Amendment to a not -to -exceed total of
$135,000.
3. CONTRACTOR shall provide CITY with revised payment and performance
bonds reflecting the amended contract amount as set forth herein.
4. Except as specifically amended herein, all of the other provisions, terms and
obligations of the Contract between the parties shall remain valid and shall be in
frill force.
IN WITNESS WHEREOF, the parties have executed this First Amendment on the clay,
month, and year first above written.
CITY OF SAN RAFAFL
S T Cit Manager
11
ATTEST:
A/ , , &tL,4
LINDSAY LARA, City Clerk
APPROVED AS TO FORM:
61r'� R08ERT F. EPS`i'EIN, City Attorney
2
CONTRACTOR
By-
Name:
Y:
Name: Michael M. Ghilotti
Title: President
[If Contractor is a corporation, add signature
of second corporate officer]
Fav:
Name: Daniel Y. Chin
Title: Chief Financial Officer
11 (� General Engineering Contractors — Excavating, Paving, Grading
pp n 525 JACOBY STREET n SAN RAFAEL, CA 94901 a TELEPHONE (415) 454-7011
0gEk 100 YEAPS FAX (415) 454-5376 STATE CONTRACTORS LICENSE #132128
lr( CHANGE ORDER REQUEST
Date: 01/12/22 GBI Job Number:
21429
To: City on San Rafael Public Works IProled:
111 Morphew St, San Rafael, CA 94901
CORM
PI San Pedro
ODI
OCO P
Attention: April Miller GBI EW ii:
Total
Fax or e-mail M
Explanation:
Concrete sidewalk fn fieu of asphalt 8168%valk.
Cost: Liohtlno Chances
EWN Unit Descriptions
Un Pr ce Amount
601-001-01 LS ACPathwayDeletion- Contract
$ (103,615.00) $ (103,615.00)
601-001-01 LS Concrete Sidewalk
$ 135,000.00 $ 135,000,00
Total
$ 31,386.00
Total This COR
By reason of this extra work, contract time will be extended:
Note: GBI does not perform extra work without written authorization.
Submitted by: Dennis Huelte Dale:
Accepted by:
Date:
01/12/22
31,3$5.afl
Exhibit A
P'ty RAF,4 `
Ie
��:
a
0
f•�rk WITH P�`
CONTRACT ROUTING FORM
INSTRUCTIONS: Use this cover sheet to circulate all contracts for review and approval in the order shown below.
TO BE COMPLETED BY INITIATING DEPARTMENT PROJECT MANAGER:
Contracting Department: Public Works
Project Manager: Ashley Dohrmann (for Alysia)
Contractor Name: Ghilotti Bros, Inc.
Contractor's Contact: Dennis Huette
❑ FPPC: Check if Contractor/Consultant must file Form 700
Extension: 3352
Contact's Email: dennish@gbi1914.com
Step
RESPONSIBLE
DESCRIPTION
COMPLETED
REVIEWER
DEPARTMENT
DATE
Check/Initial
1
Project Manager
a. Email PINS Introductory Notice to Contractor
Click here to
❑
enter a date.
b. Email contract (in Word) and attachments to City
1/20/2022
Attorney c/o Laraine.Gittens@cityofsanrafael.org
MAD
2
City Attorney
a. Review, revise, and comment on draft agreement
1/21/2022
❑x LG
and return to Project Manager
1/21/2022
® LG
b. Confirm insurance requirements, create Job on
PINS, send PINS insurance notice to contractor
3
Department Director
Approval of final agreement form to send to
1/26/2022
© BG
contractor
4
Project Manager
Forward three (3) originals of final agreement to
1/28/2022
contractor for their signature
5
Project Manager
When necessary, contractor -signed agreement
© N/A
agendized for City Council approval *
*City Council approval required for Professional Services
Agreements and purchases of goods and services that exceed
Or
$75,000; and for Public Works Contracts that exceed $175,000
Click here to
Date of City Council approval
enter a date.
PRINT
CONTINUE ROUTING PROCESS WITH HARD COPY
6
Project Manager
Forward signed original agreements to City
3/7/2022
AD
Attorney with printed copy of this routing form
31g, 2pZ„
7
City Attorney
Review and approve hard copy of signed
agreement
Review and approve insurance in PINS, and bonds
8
City Attorney
(for Public Works Contracts)
d
9
Agreement executed by City Council authorized
City Manager/ Mayor
official�-
10
City Clerk
Attest signatures, retains original agreement and
forwards
copies to Project Manager
CL Q -Y
1i1r
Rider Executed in Triplicate HARTF0r11a
RIDER
Attached to and forming part of Bond # 57BCSIR3889
on behalf of Ghilotti Bros., Inc.
of San Rafael, CA
in favor of City of San Rafael
and in the amount of One Hundred Three Thousand Six Hundred Fifteen & 00/100 --- ($103,615.00)
1t is understood and agreed that effective March 18th, 2022
The Bond Amount has Increased
from One Hundred Three Thousand Six Hundred Fifteen & 00/100 --- ($103,615.00)
to One Hundred Thirty Five Thousand & 00/100 --- ($135,000.00)
**This Bond Amount Increase has Generated an Additional Premium Due of $223.00**
All other conditions and terms remain as originally written.
Signed, Sealed, and Dated March 18th 2022
By: ` Ce 1--=
Kelly Hol mann Attorney -in -Fact
Forth GENCNG-A (Rev. 03/22/10)
CALIFORNIA LLL -PURPOSE ACKNOWLEDGMENT
CIVIL CODE § 1189
waia�;osti-''w�e?hav r:�ie ricair-aKa:�s'�ia��;xayt�.hs?�;�T��?�a,�.t%s.'a o.•�.H9?v:d.:io d.d.i:d.+�?olt c:c .tee cadre'tPve?v:r:a�+?i�+:fia�'v'�►'t�iC+L
A notary public or other officer completing this certificate verifies only the identity of the individual who signed the
document to which this certificate is attached, and not the truthfulness, accuracy, or validity of that document.
State of California
County of Marin
On l'LlCI�ZC�by l7. 7/�'Z Lbefore me,
Date
personally appeared
J. DeLuca, Notary Public
Here Insert Name and Title of the Officer
Kelly Holtemann
Name(s) of Signer(s)
who proved to me on the basis of satisfactory evidence to be the person(s) whose name(s) isfare-
subscribed to the within instrument and acknowledged to me that He/she/they executed the same in
his/her/their authorized capacity(ies), and that by Ftis/her/their signature(s) on the instrument the person($),
or the entity upon behalf of which the person(s) acted, executed the instrument.
c _r_ J. DELUCA
iNotary Public • California
Marin County Y
i Commission # 2338744
My Comm. Expires Nov 27, 2024
K
Place Notary Seal Above
I certify under PENALTY OF PERJURY under the laws
of the State of California that the foregoing paragraph
is true and correct.
WITNESS my hand and official seal.
7
Signature
Signature of Notary Public
OPTIONAL
Though this section is optional, completing this information can deter alteration of the document or
fraudulent reattachment of this form to an unintended document.
Description of Attached Document
Title or Type of Document: Document
Number of Pages: Signer(s) Other Than Named Above:
Capacity(ies) Claimed by Signer(s)
Signer's Name: -
El Corporate Officer — Title(s):
❑ Partner — ❑ Limited ❑ General
❑ Individual ❑ Attorne ac
❑ Trustee ❑ an or Conservator
❑ Other: _
Signer i presenting:
;3igner's Name:
❑ Corporate Officer — Title(s):
❑ Partner — ❑ Limited ❑ General
❑ Individual ❑ Attorney in Fact
❑ Trustee ❑ Guardian or Conservator
❑ Other:
Signer Is Representing:
• _ �esarx4crcc:.��:�xxx;u�.�cxc. �crc:tc> �. ��sc.^u;�vs
02014 National Notary Association • www.NationaiNotary.org • 1 -800 -US NOTARY (1-800-876-6827) Item #5907
KNOW ALL PERSONS BY THESE PRESENTS THAT: Agency Name: WOODRUFF SAWYER & COMPANY
A enc Code: 57-554795
0 Hartford Fire Insurance Company, a corporation duly organized under the laws ofthe State of Connecticut
0 Hartford Casualty Insurance Company, a corporation duly organized under the laws ofthe State of Indiana
Hartford Accident and Indemnity Company, a corporation duly organized under the laws ofthe State of Connecticut
0 Hartford Underwriters Insurance Company, a corporation duly organized under the laws ofthe State of Connecticut
Twin City Fire Insurance Company, a corporation duly organized under the laws ofthe State of Indiana
Hartford Insurance Company of Illinois, a corporation duly organized under the laws ofthe State of Illinois
Hartford Insurance Company of the Midwest, a corporation duly organized under the laws ofthe State of Indiana
Hartford Insurance Company of the Southeast, a corporation duly organized under the laws ofthe State of Florida
having their home office in Hartford, Connecticut, (hereinafter collectively referred to as the "Companies") do hereby make, constitute and appoint,
up to the amount of Unlimited :
Nerissa S. Bartolome, Christina Burton, Alicia Dass, Joan DeLuca, Patrick R Diebel,
Valerie Garcia, Kelly Holtemann, Thomas E. Hughes, Mark M. Munekawa, Zachary V.
Overbay, Sara Ridge, Yvonne Roncagliolo, Charles R. Shoemaker, Peter Tam of SAN
FRANCISCO, California
their true and lawful Attorney(s)-in-Fact, each in their separate capacity if more than one is named above, to sign its name as surety(ies) only as
delineated above by ®, and to execute, seal and acknowledge any and all bonds, undertakings, contracts and other written instruments in the
nature thereof, on behalf of the Companies in their business of guaranteeing the fidelity of persons, guaranteeing the performance of contracts and
executing or guaranteeing bonds and undertakings required or permitted in any actions or proceedings allowed by law.
In Witness Whereof, and as authorized by a Resolution of the Board of Directors of the Companies on May 23, 2016 the Companies
have caused these presents to be signed by its Assistant Vice President and its corporate seals to be hereto affixed, duly attested by its Assistant
Secretary. Further, pursuant to Resolution of the Board of Directors of the Companies, the Companies hereby unambiguously affirm that they are
and will be bound by any mechanically applied signatures applied to this Power of Attorney.
1 ` �r►pYr ,.ss..�.ue: � ► �i 8 t _ .. � .�'u°wg4 _ ; :St.�7j. _ ,>ra
r 4ard P6�N Risr+n�ati+� = tfl79rl�F r�: F3 I979 41'
Cr� ✓V CJ� 7C V � " ' VJJ JA
LJ
Shelby Wiggins, Assistant Secretary Joelle L LaPierre- Assistant Vice President
STATE OF FLORIDA
ss. Lake Mary
COUNTY OF SEMINOLE
On this 20th day of May, 2021, before me personally came Joelle LaPierre, to me known, who being by me duly sworn, did depose and say: that
(s)he resides in Seminole County, State of Florida; that (s)he is the Assistant Vice President of the Companies, the corporations described in and which
executed the above instrument; that (s)he knows the seals of the said corporations; that the seals affixed to the said instrument are such corporate seals;
that they were so affixed by authority of the Boards of Directors of said corporations and that (s)he signed his/her name thereto by like authority.
Jessica Ciccone
- My Commission HH 122280
Expires June 20, 2025
I, the undersigned, Assistant Vice President of the Companies, DO HEREBY CERTIFY that the above and foregoing is a true and correct
copy of the Power of Attorney executed by said Companies, which is still in full force effective as of March 18th, 2022
Signed and sealed in Lake Mary, Florida.
�SY I / � 4,1i ` �.i=ly' �` �+� CF t•y Wu�
�.ye�,� w `4• y 6
I' r -� � '.�can•ne:,i a {0 i! T `� �wey sla�""'�'_;, a�� �
W-71
-9 7y
Keith D, Dozois, Assistant Vice President
Direct Inquiries/Claims to:
THE HARTFORD
POWER
OF
ATTORNEY
BONDectic
One Hartford Plaza
Hartford, Connecticut 06155
Bond.Clainjs@thefiarffard.com
call: 888-266-3488 or fax: 860-757-5835
KNOW ALL PERSONS BY THESE PRESENTS THAT: Agency Name: WOODRUFF SAWYER & COMPANY
A enc Code: 57-554795
0 Hartford Fire Insurance Company, a corporation duly organized under the laws ofthe State of Connecticut
0 Hartford Casualty Insurance Company, a corporation duly organized under the laws ofthe State of Indiana
Hartford Accident and Indemnity Company, a corporation duly organized under the laws ofthe State of Connecticut
0 Hartford Underwriters Insurance Company, a corporation duly organized under the laws ofthe State of Connecticut
Twin City Fire Insurance Company, a corporation duly organized under the laws ofthe State of Indiana
Hartford Insurance Company of Illinois, a corporation duly organized under the laws ofthe State of Illinois
Hartford Insurance Company of the Midwest, a corporation duly organized under the laws ofthe State of Indiana
Hartford Insurance Company of the Southeast, a corporation duly organized under the laws ofthe State of Florida
having their home office in Hartford, Connecticut, (hereinafter collectively referred to as the "Companies") do hereby make, constitute and appoint,
up to the amount of Unlimited :
Nerissa S. Bartolome, Christina Burton, Alicia Dass, Joan DeLuca, Patrick R Diebel,
Valerie Garcia, Kelly Holtemann, Thomas E. Hughes, Mark M. Munekawa, Zachary V.
Overbay, Sara Ridge, Yvonne Roncagliolo, Charles R. Shoemaker, Peter Tam of SAN
FRANCISCO, California
their true and lawful Attorney(s)-in-Fact, each in their separate capacity if more than one is named above, to sign its name as surety(ies) only as
delineated above by ®, and to execute, seal and acknowledge any and all bonds, undertakings, contracts and other written instruments in the
nature thereof, on behalf of the Companies in their business of guaranteeing the fidelity of persons, guaranteeing the performance of contracts and
executing or guaranteeing bonds and undertakings required or permitted in any actions or proceedings allowed by law.
In Witness Whereof, and as authorized by a Resolution of the Board of Directors of the Companies on May 23, 2016 the Companies
have caused these presents to be signed by its Assistant Vice President and its corporate seals to be hereto affixed, duly attested by its Assistant
Secretary. Further, pursuant to Resolution of the Board of Directors of the Companies, the Companies hereby unambiguously affirm that they are
and will be bound by any mechanically applied signatures applied to this Power of Attorney.
1 ` �r►pYr ,.ss..�.ue: � ► �i 8 t _ .. � .�'u°wg4 _ ; :St.�7j. _ ,>ra
r 4ard P6�N Risr+n�ati+� = tfl79rl�F r�: F3 I979 41'
Cr� ✓V CJ� 7C V � " ' VJJ JA
LJ
Shelby Wiggins, Assistant Secretary Joelle L LaPierre- Assistant Vice President
STATE OF FLORIDA
ss. Lake Mary
COUNTY OF SEMINOLE
On this 20th day of May, 2021, before me personally came Joelle LaPierre, to me known, who being by me duly sworn, did depose and say: that
(s)he resides in Seminole County, State of Florida; that (s)he is the Assistant Vice President of the Companies, the corporations described in and which
executed the above instrument; that (s)he knows the seals of the said corporations; that the seals affixed to the said instrument are such corporate seals;
that they were so affixed by authority of the Boards of Directors of said corporations and that (s)he signed his/her name thereto by like authority.
Jessica Ciccone
- My Commission HH 122280
Expires June 20, 2025
I, the undersigned, Assistant Vice President of the Companies, DO HEREBY CERTIFY that the above and foregoing is a true and correct
copy of the Power of Attorney executed by said Companies, which is still in full force effective as of March 18th, 2022
Signed and sealed in Lake Mary, Florida.
�SY I / � 4,1i ` �.i=ly' �` �+� CF t•y Wu�
�.ye�,� w `4• y 6
I' r -� � '.�can•ne:,i a {0 i! T `� �wey sla�""'�'_;, a�� �
W-71
-9 7y
Keith D, Dozois, Assistant Vice President
rl III
Rider Executed in Triplicate Fol 11)
RIDER
Attached to and forming part of Bond # 57BCSIR3889
on behalf of Ghilotti Bros., Inc.
of San Rafael, CA
in favor of City of San Rafael
and in the amount of One Hundred Three Thousand Six Hundred Fifteen & 00/100 --- ($103,615.00)
It is understood and agreed that effective March 18th, 2022
The Bond Amount has Increased
from One Hundred Three Thousand Six Hundred Fifteen & 00/100 --- ($103,615.00)
to One Hundred Thirty Five Thousand & 00/100 --- ($135,000.00)
"This Bond Amount Increase has Generated an Additional Premium Due of $223.00**
All other conditions and terms remain as originally written.
Signed, Sealed, and Dated March 18th - 2022
By: -
Kelly Holkemann Attorney -in -Fact
Form GENCNG-A (Rev. 03/22/10)
CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT CIVIL CODE § 1189
�e,�cs��r.�r:�r�e.r�rs,�r�rrx•,z�c,�,�xr.ries,acccc,cc;�,�r�r�r���xi
A notary public or other officer completing this certificate verifies only the identity of the individual who signed the
document to which this certificate is attached, and not the truthfulness, accuracy, or validity of that document.
State of California
County of Marin
On _t)Al, 0 V )-Z before me,
Date
personally appeared
J. DeLuca, Notary Public
Here Insert Name and Title of the Officer
Kelly Holtemann
Name(s) of Signer(s)
who proved to me on the basis of satisfactory evidence to be the person(s) whose name(s) isAve-
subscribed to the within instrument and acknowledged to me that He/she/t" executed the same in
hWher/their authorized capacity(ies), and that by his/her/their signature(s) on the instrument the person($),
or the entity upon behalf of which the persons) acted, executed the instrument.
' "'•: J. DELUCA
Notary Public - California
x - Marin County
_ Commission # 2338744
My Comm. Expires Nov 27, 2024
I certify under PENALTY OF PERJURY under the laws
of the State of California that the foregoing paragraph
is true and correct.
WITNESS my hand and official seal.
Signature.
Signature of Notary Public
Place Notary Seal Above
OPTIONAL
Though this section is optional, completing this information can deter alteration of the document or
fraudulent reattachment of this form to an unintended document.
Description of Attached Document
Title or Type of Document: Document
Number of Pages: Signer(s) Other Than Named Above:
Capacity(les) Claimed by Signer(s)
Signer's Name: _ _
EJCorporate Officer — Title(s):
❑ Partner — ❑ Limited ❑ General
❑ Individual ❑ Attorne - act
El Trustee ❑ ,an
or Conservator
❑ Other:
Signer I presenting:
ner's Name:
_ ❑ Corporate Officer — Title(s):
❑ Partner — ❑ Limited ❑ General
❑ Individual ❑ Attorney in Fact
❑ Trustee ❑ Guardian or Conservator
❑ Other:
Signer Is Representing:
�'(7�%.'�'JSeC"xZJ4�.Y-�{:±JC7�:{�'rC7(.fJL'�?i<+.%S+R.'�✓7�:4Se.G`SXJS:G•`h�,`Ce�Y%CJc%(.ti::'.�c%GY.:i7[;4`�e�'SSG`t>{.oi`�'4Y:.[ri'G¢a4'_z:{.sri.{aS{aCe(tciC^C4riTc':c�.<JeiG:v%4'is�i'�
02014 National Notary Association • www.NationalNotary.org - 1 -800 -US NOTARY (1-800-876-6827) Item #5907
KNOW ALL PERSONS BY THESE PRESENTS THAT: Agency Name: WOODRUFF SAWYER & COMPANY
A enc Code: 57-554795
Hartford Fire Insurance Company, a corporation duly organized under the laws ofthe State of Connecticut
0 Hartford Casualty Insurance Company, a corporation duly organized under the laws ofthe State of Indiana
1 " J Hartford Accident and Indemnity Company, a corporation duly organized under the laws ofthe State of Connecticut
Hartford Underwriters Insurance Company, a corporation duly organized under the laws ofthe State of Connecticut
Twin City Fire Insurance Company, a corporation duly organized under the laws ofthe State of Indiana
Hartford Insurance Company of Illinois, a corporation duly organized under the laws ofthe State of Illinois
0 Hartford Insurance Company of the Midwest, a corporation duly organized under the laws ofthe State of lndiana
0 Hartford Insurance Company of the Southeast, a corporation duly organized under the laws ofthe State of Florida
having their home office in Hartford, Connecticut, (hereinafter collectively referred to as the "Companies") do hereby make, constitute and appoint,
up to the amount of Unlimited :
Nerissa S. Bartolome, Christina Burton, Alicia Dass, Joan DeLuca, Patrick R Diebel,
Valerie Garcia, Kelly Holtemann, Thomas E. Hughes, Mark M. Munekawa, Zachary V.
Overbay, Sara Ridge, Yvonne Roncagliolo, Charles R. Shoemaker, Peter Tam of SAN
FRANCISCO, California
their true and lawful Attorney(s)-in-Fact, each in their separate capacity if more than one is named above, to sign its name as surety(ies) only as
delineated above by ®, and to execute, seal and acknowledge any and all bonds, undertakings, contracts and other written instruments in the
nature thereof, on behalf of the Companies in their business of guaranteeing the fidelity of persons, guaranteeing the performance of contracts and
executing or guaranteeing bonds and undertakings required or permitted in any actions or proceedings allowed by law.
In Witness Whereof, and as authorized by a Resolution of the Board of Directors of the Companies on May 23, 2016 the Companies
have caused these presents to be signed by its Assistant Vice President and its corporate seals to be hereto affixed, duly attested by its Assistant
Secretary. Further, pursuant to Resolution of the Board of Directors of the Companies, the Companies hereby unambiguously affirm that they are
and will be bound by any mechanically applied signatures applied to this Power of Attorney.
��� � eiss�r�rs.•. �+aia%> -:i
9ID
,� \'✓t�..f� 147
��� - � �+iy '. r�+lam` � • } ,�'ti huvv'� rv�n+' � y � •
Shelby Wiggins, Assistant Secretary Joelle L. LaPierre, Assistant Vice President
STATE OF FLORIDA
ss. Lake Mary
COUNTY OF SEMINOLE
On this 20th day of May, 2021, before me personally came Joelle LaPierre, to me known, who being by me duly sworn, did depose and say: that
(s)he resides in Seminole County, State of Florida; that (s)he is the Assistant Vice President of the Companies, the corporations described in and which
executed the above instrument; that (s)he knows the seals of the said corporations; that the seals affixed to the said instrument are such corporate seals;
that they were so affixed by authority of the Boards of Directors of said corporations and that (s)he signed his/her name thereto by like authority.
Jessica Ciccone
T • . My Commission HH 122280
Expires June 20. 2025
I, the undersigned, Assistant Vice President of the Companies, DO HEREBY CERTIFY that the above and foregoing is a true and correct
copy of the Power of Attorney executed by said Companies, which is still in full force effective as of March 18th, 2022
Signed and sealed in Lake Mary, Florida.
�r ,r�,��r�s++•� +sia%► � ` S1iT4 °; sa7o r^• ..; ]944
Keith D. Dozois, Assistant Vice President
Direct Inquiries/Claims to:
THE HARTFORD
POWER
OF
ATTORNEY
BONnectic
One Hartford Plaza
Hartford, Connecticut 06155
Bond.0 laims(Mthehartford.com
call: 888-266-3488 or fax: 860-757-5835
KNOW ALL PERSONS BY THESE PRESENTS THAT: Agency Name: WOODRUFF SAWYER & COMPANY
A enc Code: 57-554795
Hartford Fire Insurance Company, a corporation duly organized under the laws ofthe State of Connecticut
0 Hartford Casualty Insurance Company, a corporation duly organized under the laws ofthe State of Indiana
1 " J Hartford Accident and Indemnity Company, a corporation duly organized under the laws ofthe State of Connecticut
Hartford Underwriters Insurance Company, a corporation duly organized under the laws ofthe State of Connecticut
Twin City Fire Insurance Company, a corporation duly organized under the laws ofthe State of Indiana
Hartford Insurance Company of Illinois, a corporation duly organized under the laws ofthe State of Illinois
0 Hartford Insurance Company of the Midwest, a corporation duly organized under the laws ofthe State of lndiana
0 Hartford Insurance Company of the Southeast, a corporation duly organized under the laws ofthe State of Florida
having their home office in Hartford, Connecticut, (hereinafter collectively referred to as the "Companies") do hereby make, constitute and appoint,
up to the amount of Unlimited :
Nerissa S. Bartolome, Christina Burton, Alicia Dass, Joan DeLuca, Patrick R Diebel,
Valerie Garcia, Kelly Holtemann, Thomas E. Hughes, Mark M. Munekawa, Zachary V.
Overbay, Sara Ridge, Yvonne Roncagliolo, Charles R. Shoemaker, Peter Tam of SAN
FRANCISCO, California
their true and lawful Attorney(s)-in-Fact, each in their separate capacity if more than one is named above, to sign its name as surety(ies) only as
delineated above by ®, and to execute, seal and acknowledge any and all bonds, undertakings, contracts and other written instruments in the
nature thereof, on behalf of the Companies in their business of guaranteeing the fidelity of persons, guaranteeing the performance of contracts and
executing or guaranteeing bonds and undertakings required or permitted in any actions or proceedings allowed by law.
In Witness Whereof, and as authorized by a Resolution of the Board of Directors of the Companies on May 23, 2016 the Companies
have caused these presents to be signed by its Assistant Vice President and its corporate seals to be hereto affixed, duly attested by its Assistant
Secretary. Further, pursuant to Resolution of the Board of Directors of the Companies, the Companies hereby unambiguously affirm that they are
and will be bound by any mechanically applied signatures applied to this Power of Attorney.
��� � eiss�r�rs.•. �+aia%> -:i
9ID
,� \'✓t�..f� 147
��� - � �+iy '. r�+lam` � • } ,�'ti huvv'� rv�n+' � y � •
Shelby Wiggins, Assistant Secretary Joelle L. LaPierre, Assistant Vice President
STATE OF FLORIDA
ss. Lake Mary
COUNTY OF SEMINOLE
On this 20th day of May, 2021, before me personally came Joelle LaPierre, to me known, who being by me duly sworn, did depose and say: that
(s)he resides in Seminole County, State of Florida; that (s)he is the Assistant Vice President of the Companies, the corporations described in and which
executed the above instrument; that (s)he knows the seals of the said corporations; that the seals affixed to the said instrument are such corporate seals;
that they were so affixed by authority of the Boards of Directors of said corporations and that (s)he signed his/her name thereto by like authority.
Jessica Ciccone
T • . My Commission HH 122280
Expires June 20. 2025
I, the undersigned, Assistant Vice President of the Companies, DO HEREBY CERTIFY that the above and foregoing is a true and correct
copy of the Power of Attorney executed by said Companies, which is still in full force effective as of March 18th, 2022
Signed and sealed in Lake Mary, Florida.
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Keith D. Dozois, Assistant Vice President