Pay Voucher (2)Pay Voucher
Owner: City of Shorewood
5755 Country Club Road
Shorewood, MN 55331 -8926
For Period: 8/31/2016 to 10111/2016
Contractor: GMH Asphalt Corporation
9180 Laketown Road
Chaska, MN 55318
Pay Voucher
SHOR - 2016 Mill and Overlay Improvement Project
Client Contract No.:
Project No.: 02925 -09
Client Project No.:
Page 1 of 3
Date: 10/1112016
Request No.: 2 & FINAL
Project Summary
1
Original Contract Amount
$217,971.50
2
Contract Changes - Addition
$0.00
3
Contract Changes - Deduction
$0,00
4
Revised Contract Amount
$217,971.50
5
Value Completed to Date
$204,593.68
6
Material on Hand
$0.00
7
Amount Earned
$204,593.68
8
Less Retainage
$0.00
9
Subtotal
$204,593.68
10
Less Amount Paid Previously
$194,364.00
11
Liquidated Damages
$0.00
12
JAMOUNT DUE THIS PAY VOUCHER NO. 2 & FINAL
$10,229.68
I HEREBY CERTIFY THAT A FINAL EXAMINATION HAS BEEN MADE OF THE ABOVE NOTED CONTRACT, THAT THE
CONTRACT HAS BEEN COMPLETED, THAT THE ENTIRE AMOUNT OF WORK SHOWN IN THE FINAL VOUCHER HAS BEEN
PERFORMED AND THE TOTAL VALUE OF THE WORK PERFORMED IN ACCORDANCE WITH, AND PURSUANT TO, THE
TERMS OF THE CONTRACT IS AS SHOWN IN THIS FINAL VOUCHER.
Recommended for Approval by:
WSB & Associates, Inc.
Fe
G
Specified Contract Completion Date:
8/15/2016
Comment:
Construction Observer:
Date:
http: / /wsb 10/RtAEC /Reports/ rpt__PayRequest.asp ?WorkOrderld =11474 10/11/2016
Pay Voucher
Project Material Status
Page 2 of 3
Item
No.
Item
�
Description
I
Units
Unit Price
Contract
Quantity
Quantity
to Date
Current
Quantity
Amount to
Date
SCHEDULE
A. - SURFACE IMPROVEMENTS
1
2021.501
MOBILIZATION
LS
$6,100.00
1
1
0
$6,100.00
2
2104,501
REMOVE BITUMINOUS CURB
L F
$1.50
120
118
0
$177.00
3
2104.505
REMOVE CONCRETE DRIVEWAY PAVEMENT
S Y
$12.00
10
0
0
$0.00
4
2104.505
REMOVE BITUMINOUS DRIVEWAY PAVEMENT
S Y
$4.00
80
147.1
0
$588.40
5
2104.505
REMOVE BITUMINOUS PAVEMENT
S Y
$4.00
70
116.6
0
$466.40
6
2104.509
REMOVE CASTING
EACH
$200.00
2
0
0
$0.00
7
2104.511
SAWING CONCRETE PAVEMENT (FULL DEPTH)
L F
$5.00
20
0
0
$0.0
8
2104.513
SAWING BITUMINOUS PAVEMENT (FULL DEPTH)
L F
$2.50
200
1527
0
$3,817.50
9
2104.601
REMOVE & REPLACE CONCRETE CURB & GUTTER
L F
$28.45
910
1005
0
$28,592.25
10
2104.602
SALVAGE AND REINSTALL MAIL BOX
EACH
$120.00
10
0
0
$0.00
11
2105.523
COMMON BORROW (LV)
C Y
$20.00
10
20.
0
$400.00
12
2105.603
MINOR GRADING
S Y
$3.00
70
0
0
$0.00
13
2123.610
STREET SWEEPER (WITH PICKUP BROOM)
HOUR
$1.00
10
11
0
$11.00
14
2231.501
BITUMINOUS PATCHING MIXTURE
TON
$100.00
10
55.84
0
$5,584.00
15
2232.501
MILL BITUMINOUS SURFACE
S Y
$1.10
9000
7909
0
$8,699.90
16
2331.501
JOINT ADHESIVE -MASTIC
L F
$0.60
9100
31401
0
$1,884.00
17
2357.502
BITUMINOUS MATERIAL FOR TACK COAT
GAL
$2.80
1310
850
0
$2,380.00
18
2360.501
TYPE SP 9.5 WEARING COURSE MIX (2,B)
TON
$61.05
2030
1742.79
0
$106,397.33
19
2360.503
TYPE SP 9.5 WEARING COURSE MIX (2,B) 3.0" THICK
S Y
$35.00
80
147.1
0
$5,148.50
20
2360.601
BITUMINOUS SPILLWAY
EACH
$250.00
1
3
0
$750.00
21
2503.602
CHIMNEY SEALS (EXTERNAL)
EACH
$165.00
24
301
0
$4,950.00
22
2504.602
ADJUST GATE VALVE
EACH
$270.00
5
6
0
$1,620.00
23
2506.516
CASTING ASSEMBLY
EACH
$700.00
2
0
0
$0.00
24
2506.522
ADJUST FRAME & RING CASTING
EACH
$500.00
12
18
0
$9,000.00
25
2506.522
ADJUST FRAME & RING CASTING (STORM)
EACH
$315.00
8
8
0
$2,520.0
26
2506.602
ADJUST FRAME & RING CASTING (SPECIAL)
EACH
$475.00
121
6
0
$2,850.00
27
2511.501
RANDOM RIPRAP CLASS 11
C Y
$180.00
0.5
1.4
0
$252.00
28
2531.501
CONCRETE CURB & GUTTER DESIGN B618
L F
$19.95
140
154
0
$3,072.30
29
2531.507
6" CONCRETE DRIVEWAY PAVEMENT
S Y
$75.95
10
0
0
$0.00
30
2535.501
BITUMINOUS CURB
L F
$6.50
120
151
0
$981.50
31
2557.602
REPAIR DOG FENCE
EACH
$90.00
5
8
0
$720.00
32
2563.601
TRAFFIC CONTROL
LS
$2,500.00
1
1
0
$2,500.00
33
2573.530
STORM DRAIN INLET PROTECTION
EACH
$150.00
9
9
0
$1,350.00
34
2575.505
SODDING TYPE LAWN
S Y
$11.60
500
326
0
$3,781.60
Totals For SCHEDULE A. - SURFACE
IMPROVEMENTS:
$204,593.68
i Project Totals:
$204,593.681
http://wsb I O/RtAEC/Reports/rpt-PayRequest.asp?WorkOrdei-ld= 11474 10/11/2016
Pay Voucher
Project Payment Status
Owner: City of Shorewood
Client Project No.:
Client Contract No.:
Project No.: 02925 -09
Contractor: GMH Asphalt Corporation
Contract Changes
Page 3 of 3
No. Type Date Description
Amount
Change Order Totals:
$0.00
Payment Summary
No.
From
To Date
Payment
Total
Retainage Per
Total
Total Payment
Work Certified
Total Work
Date
Payment
Payment
Retainage
+ Retainage
Per Payment
Certified
1
4/25/2016
8/30/2016
$194,364.00
$194,364.00
$10,229.68
$10,229.68
$204,593.68
$204,593.68
$204,593.68
2&
FINAL
8/31/2016
10/11/2016
$10,229.68
$204,593.68
($10,229.68)
$0.00
$204,593.68
$0.00
$204,593.68
Payment Totals:
$204,593.68
$0.00
$204,593.68
$204,593.68
Proiect Summary
Material On Hand:
Total Payment to Date:
Total Retainage:
Total Amount Earned:
$0.00
$204,593.68 Original Contract:
$0.00 Contract Changes:
$204,593.68 Revised Contract:
$217,971.50
$0.00
$217,971.50
http: / /wsh10/RtAEC/Reports /rpt PayRequest .asp ?WorkOrderld =11474 10/11/2016
Page 1 of 1
Contractor Affidavit Submitted
Thank you, your Contractor Affidavit has been approved
Confirmation Summary
Confirmation Number:
0 -340 -136 -256
Submitted Date and Time:
31- Oct -2016 10:07:43 AM
Legal Name:
G M H ASPHALT CORP
Federal Employer ID:
41- 1662485
User Who Submitted:
gmhasphalt
Type of Request Submitted:
Contractor Affidavit
unfrommkm=j
Affidavit Number:
Minnesota ID:
Project Owner:
Project Number:
Project Begin Date
Project End Date:
Project Location:
Project Amount:
1848066048
2857091
CITY OF SHOREWOOD
02925 -09
01- Aug -2016
31- Aug -2016
SHOREWOOD
$204,593.68
Name ID Affidavit Number
MID STATE RECLAMATION INC 1719563 1288421376
GROUNDSCAPE ENTERPRISES LLC 3364293 1742282752
FRENCH LAKE CURB CO 3825384 427737088
PARAGON COMPANY INC 8418947 1498660864
Important Messages
A copy of this page must be provided to the contractor or government agency that hired you.
Contact Us
If you need further assistance, contact our Withholding Tax Division at 651- 282 -9999, (toll -free) 800 - 657 -3594, or (email)
withholding.tax@state.mn.us. Business hours are 8:00 a.m. - 4:30 p.m. Monday - Friday.
Please print this page for your records using the print or save functionality built into your browser.
https:llwww. ndor. state. mn. usl tpl eservicesl_ lRetrievel0 /c- /7bYEpDdirnp47rpC77n8aA ... 1013112016
10/12/2Oa Phnt2
M1,NNEso"rA- REVENUE
Thank you, your Contractor Affidavit has been approved,
Confirmation Summary
Confirmation Number:
Submitted Date and Time:
Legal Name:
Fvdano| Employer ID:
User Who Submitted:
Type of Request Submitted:
Affidavit Number:
Minnesota ID:
Project Owner:
Project Number:
Project Begin Date:
Project End Date:
Project Location:
Project Amount:
1-182-880-582
12-Oct-2010 11:32:54 AM
MID STATE RECLAMATION INC
38-172752O
brondopotsoh
Contractor Affidavit
1288421376
1719563
CITY OfGM0REYYOOO
O2925-09
21-Ju|-2010
21-Ju|-2016
GHOREWOOD
$5.088.40
No Subcontractors
Important Messages
A copy of this page must be provided to the contractor or government agency that hired you.
Contact Us
If you need further assistance, contact our Withholding Tax Division amO51-202-9S88.(tol|-freo)8OO-6S7-35g4.nr(wmoi|)
w0nho|ding1ox@state.mn.ux. Business hours are 8:0Oo.m.-4:3Op.m. Monday - Fhdox
Please print this page for your records using the print or save functionality built into your browser.
hupsJhvww.mndm,suatemuuoxpAesmv BsU6j4ljw_7F|LE—=Pnm2 1/1
UV
Contractor Affidavit Submitted
Thank you, your Contractor Affidavit has been approved.
dma��ffl
1.904-990-784
30-Oct-2016 6:08:30 PM
GROUNDSGAPE ENTERPRISES LLC
46-1888734
rob69M
Contractor Affidavit
1742282762
3364293
CITY OF SHOREWVVOD
1612
22-Aug-20I6
22-Aug-2016
SHOREWOOD
$1,876.15
No Subcontractors
Important Nfteages
A copy of this plia, Must be pMvided to the contractor or govemrnent agency that hired you.
Contact Lis
If you need further assistance, contact our Wthholding Tax Division at 651-282-9999, 004 -free} 800-657-3594, or (email)
withhoIdIng.tax@stat@.Mn.u& Business hours are fl.oa am. - 4:30 p.m, Monday - Friday.
Please VI&IWA ae for your records using the Print OF save functionality built into year brower.
6 abed LLL96L17E9L XOJ dH WdOOZL 9 Z W TKO
Page 1 of 1
MINNESOTA- REVENUE
Contractor ffi vit Completed
Thank you, your Contractor Affidavit has been approved.
Confirmation Summary
Confirmation Number:
Submitted Date and Time:
Legal Name:
Federal Employer ID:
User Who Submitted:
Type of Request Submitted:
J
Affidavit Number:
Minnesota ID:
Project Owner:
Project Number:
Project Begin Date:
Project End Date:
Project Location:
Project Amount:
Subcontractors:
1- 830 -501 -952
26- Oct -2016 11:12:16 AM
FRENCH LAKE CURB CO
41- 1913224
djohns
Contractor Affidavit
427737088
3825384
CITY OF SHOREWOOD
02925 -09
08- Jun -2016
03- Oct -2016
CITY OF SHOREWOOD
$21,482.00
No Subcontractors
Important Messages
A copy of this page must be provided to the contractor or government agency that hired you.
Contact Us
If you need further assistance, contact our Withholding Tax Division at 651 -282 -9999, (toll -free) 800 -657 -3594, or (email)
withholding.tax @state.mn.us. Business hours are 8:00 a.m. - 4:30 p.m. Monday - Friday.
Please print this p e for your records using the print or save functionality built into your browser.
https: / /www.mndor. state. mn. us /tp /eservices /_ /Retrieve /0 /c -/t 1 kZ6kYDM2syZbZFsHbZZ... 10/26/2016
10/31/2016 https:/AvwwmrKlor.state,mn.us/tpleservices/ /Retrieve/Otc-/g7wieEXRJqko65bLqT IuA_?F ILE_= Pri rW2
MINKIESOT'A- REVENUE
Contractor Affidavit Submitted
Thank you, your Contractor Affidavit has been approved.
� = A
Affidavit Number:
Minnesota ID:
Project Owner:
Project Number:
Project Begin Date:
Project End Date:
Project Location:
Project Amount:
Subcontractors:
1-618-993-472
31-Oct-2016 9:39:20 AM
PARAGON COMPANY INC
20-5004675
paragoncompany
Contractor Affidavit
1498660864
8418947
CITY OF SHOREWOOD, MN
16305
03-Aug-2016
03-Aug-2016
SHOREWOOD, MN
$2,091.69
No Subcontractors
Important Messages
A copy of this page must be provided to the contractor or government agency that hired you.
Contact Us
If you need further assistance, contact our Withholding Tax Division at 651-282-9999, (toll-free) 800-657-3594, or (email)
withholding.tax@state.mn.us. Business hours are 8:00 a.m. - 4:30 p.m. Monday - Friday.
Please gbisi y for your records using the print or save functionality built into your browser.
tgps:IANww.mndor.staW.mn.usApteservicesl–lRetrievet0tc-ig7wicEXRJqko65t)t_qTI uA—?FILE—=Prird2 111
emp
DATED: October
The undersigned hereby acknowledges receipt of the sum of $ 5,099.*0
from G&qH ASPHALT C0PORATOM.
CHECK ONLY ONE
1.) as partial payment for labor, skill and material furnished
Z> as payment for labor, skill and material furnished ortobefurnished
(Except the sum of $ - uonetaina8enrholdback)
3.) XX as full and final payment for all labor, skill and material furnished.
To the following real property (legal description, street address or project name:
CITY PROJECT NUMER: 02925-09
and for value received hereby waives all rights acquired bv the undersigned N file nrrecord
mechanic's liens against said property for labor, skill nr material furnished to said real]
property (only for the amount paid if box 1 is checked and except for retainage shown if box 2 is
The undersigned affirms that all material furnished bv the undersigned hasbeenpaNfnr,andaU
subcontractors employed by the undersigned have been paid in full.
WA
mgnature
Federal iD.#:
NOTE: If this instrument is executed bya corporation, b must be signed byan officer, and if
executed by a partnership it must be signed by a partner.
Oct 31 2016 12:OOPM HP Fax 7634796777 page 2
RIGHTS RECEIPT AND WAIVER OF MECHANIC'S LIEN
24 XX as Payment for labor, skill and material furnished or to be furnished
(Except the surn of $ 93.9:1 asretainageorholdback)
+ and Payment
Y'
To the following real property (legal description, street arml. 't' I
C17Y OF SHOREWOOD
L. i #, R `4
ClTy PROJECT
and for value received hereby waives all rights acquired i
mechanic's liens against k property folabor, skill or material furnished
t said
property (only f t paid if box
Y, 3
{. {
1 .,
111! 17il
DATED: October 5, 2016
The undersigned hereby acknowledges receipt of the sum of $ 21,482.50
CHECK ONLY ONE
1.) as partial payment for labor, skill and material furnished
I) XX as payment for labor, skill and material furnished ortobefurnished
(Except the sum nf $ 1,074.13 asretainageorholdback)
3.) as full and final payment for all labor, skill and material furnished.
To the following real property (legal description, street address orproject name:
CITY OF SHOREWOOD
and for value received hereby waives all rights acquired bv the undersigned to file orrecord
mechanic's liens against said property for labor, skill or material furnished to said real]
property (only for the amount paid if box 1ischecked and except for retainage shown if box 2is
The undersigned affirms that all material furnished by the undersigned has been paid for, and all
subcontractors employed by the undersigned have been paid in full.
�Q���
RECEIPT AND WAIVER OF MECHANIC'S LIEN RIGHTS
J'ATED: October 5, 2016 --
payment for labor, skill and material furnished • 'rte furnished
(Except the sum of $ 104.58 as retainage or holdback)
3.) __as full and final payment for all labor, skill and material furnished.
To the followi,
aTy OF SHOREWOOD
CITYPROJECT NUMER: 02925-09
and for value received hereby waives all rights acquired by the undersigned to file or record
mechanic's liens against said a•, erty for labor, skill or material furnished to said real]
property (only for the amount,;# aid if box I is
checked).
The undersigned affirmt thnt Al
310
NOTE: If this instrument is executed by a corporation, it must be signed by an officer, and if
zxecuted by a partnership it must be signed by a partner.
CONSENT OF SURETY
TO FINAL PAYMENT
ALA Document G707
Bond No. 929633582
TO 0VNER;-
(Name turd addaxes)
City of Shorewood
5755 Country Club Road
Shorewood, MN 55331
PROJECT,
(Mone and aekbvzQ
OWNER
❑
AR(JUTECT
D
CONTRACTOR
0
SURM
❑
OTHER
ARCHITECT'S PROJECT NO.:
CONTRACT FOR. Mill and Overlay
CON TRACT DATED: April 26, 2016
2016 Mill and Overlay Improvement Project and Appurtenant Work, City of Shorewood Project No. 16-03, WSB
Project No. 2925-09
In accordance with The provisions of the Contract bemeen the Owner and the Contractor as indicatect above, the
()twl nanrea)W a0dmn crsrrr y}
Western Surety Company
333 South Wabash Ave. 41- South
Chicago, IL 60604
, SURFTY,
on bond of
fJmien name aitd addrnss q
.fConimciar)
GMH Asphalt Corporation
9180 Laketown Road
Chaska, MN 55318
CONTRACTOR,
hereby approves of the final payment to the Contractor, and agrees that final payment to the Contractor shall not relieve the Surety of
any of its obligations to
(la awrt nwyla and a4wmoz qfoqwer)
City of Shorewood
5755 Country Club Road
Shorewood, MN 55331
as set fortis in said Surety's bond.
IN WITNESS WHEREOF, the Surety has hereunto set its hand on this date-, November 1, 2016
Western Surety Company
BYE`
Barbara L. Raecleke Attorney -in -Fact
ehfnl d name andlitk)
, OWNHI�
=� F2
POWER OF ATTORNEY APPOINTING INDIVIDUAL ATTORNEY -IN -FACT
Know All Men By These Presents, That WES'T'ERN SURETY COMPANY, a South Dakota corporation, is a duly organized and existing corporation
having its principal office in the City of Sioux Falls, and State of South Dakota, and that it does by virtue of the signature and seal herein affixed hereby
make, constitute and appoint
Barbara L. + Individually
of St Louis Park, MN its true and lawful Attomey -in -Fact with full power and authority hereby conferred to sign, seal and execute for and on its
behalf bonds, undertakings and other obligatory instruments of similar nature
- In Unlimited Amounts -
Surety Bond No: 929633582
Principal: GMH Asphalt Corporation
obligee: City of Shorewood
and to bind it thereby as fully and to the same extent as if such instruments were signed by a duly authorized officer of the corporation and all the acts of said
Attorney, pursuant to the authority hereby given, are hereby ratified and confirmed.
This Power of Attorney is made and executed pursuant to and by authority of the By -Law printed on the reverse hereof, duly adopted, as indicated, by
the shareholders of the corporation.
In Witness whereof, WESTERN SURETY COMPANY has caused these presents to be signed by its Vice President and its corporate seal to be
hereto affixed on this I st day of December, 2015.
"uuErr� WESTERN SURETY COMPANY
cW.40 T�.pi
z�
aul T. Bruflat, Vice President
State of South Dakota
ss
County of Minnehaha
On this I st day of December, 2015, before me personally carne Paul T. Bruflat, to me known, who, being by me duly sworn, did depose and say: that
he resides in the City of Sioux Falls, State of South Dakota; that he is the Vice President of WESTERN SURETY COMPANY described in and which
executed the above instrument; that he knows the seal of said corporation; that the seal affixed to the said instrument is such corporate seal; that it was so
affixed pursuant to authority given by the Board of Directors of said corporation and that he signed his name thereto pursuant to Iike authority, and
acknowledges same to be the act and deed of said corporation.
My commission expires
J. MOHR
kDrARYPUBM.
June 23, 2021 SOUTH DAKOTA '
3. Mohr, Notary Public
CERTIFICATE
I, L. Nelson, Assistant Secretary of WESTERN SURETY COMPANY do hereby certify that the Power of Attorney hereinabove set forth is still in
force, and further certify that the By -Law of the corporation printed on the reverse hereof is stilt in force. In testimony whereof I have hereunto subscribed
my name and affixed the seal of the said corporation this 1 St day of November, 2016.
ra'`y WESTERN SURETY COMPANY
_2L. Nelson, Assistant Secretary
Form 1-4280 -7 -2012
Authorizing By -Law
ADOPTED BY THE SHAREHOLDERS OF WESTERN SURETY COMPANY
This Power of Attorney is made and executed pursuant to and by authority of the following By -Law duly adopted by the shareholders
of the Company.
Section 7. All bonds, policies, undertakings, Powers of Attorney, or other obligations of the corporation shall be executed in the
corporate name of the Company by the President, Secretary, and Assistant Secretary, Treasurer, or any Vice President, or by such other
officers as the Board of Directors may authorize. The President, any Vice President, Secretary, any Assistant Secretary, or the Treasurer
may appoint Attorneys in Fact or agents who shall have authority to issue bonds, policies, or undertakings in the name of the Company.
The corporate seal is not necessary for the validity of any bonds, policies, undertakings, Powers of Attorney or other obligations of the
corporation. The signature of any such officer and the corporate seal may be printed by facsimile.
MKOINAMAR-3y 10 a a IMA
Bond No. 929633582 - M2
GMH Asphalt Corporation
That
9180 Laketown Romer! Chaska. MU 55318
as Principal, hereinafter called Contractor, and Western Surety Company
333 South Wabash Ave 41- Sotith Chicago. IL 60L04, as Surety, hereinafter called Surety, are held
and firmly bound unto City of Shorewood
5755 Country Club Road Shorewood, MN 55331 as Obligee, hereinafter
called Owner, in the penal sum of ' One Hundred Ninety Four Thousand Three Hundred Sixty Four
Dollars and 00/100 Dollars for payment whereof Contractor
and Surety bind themselves, their heirs, executors, administrators, successors, and assigns,
jointly and severally, firmly by these presents.
WHEREAS, Contractor has constructed various public improvements:
2016 Mill and Overlay improvement Project and Appurtenant Work, City of Shorewood Project No,
16-03, WSB Project No. 2925-09 - Two Year Maintenance Term - Effective 11/14/2016
in accordance with the General Conditions, the Drawings and Specifications, which Plans are by
reference incorporated herein, and made a part hereof, and is referred to as the Plans.
NOW, THEREFORE, the condition of this obligation is such that, if Contractor shall remedy any
defects due to faulty materials or workmanship, and pay for any damage to other work resulting
therefrom, which shall appear within a period of 2 years from the date of substantial
completion of the work provided for in the Plans, then this obligation to be void; otherwise to
remain in full force and effect.
PROVIDED, HOWEVER, that Owner shall give Contractor and Surety notice of observed
defects with reasonable promptness.
In the presence of;
November 2016
GMF-1 Asphalt Corporation
Princi al lj
By:
Brandon E. Butorac Vice— side I nt - 'Title
Western Surety Company
Surety
7h,q)), L(
By:' / )' ' ' "_-
I 4b
ar ara L. Raedeke Attorney -in -Fact
STATE OF MINNESOTA
COUNTY OF CARVER
On this 1st day of November, 2016 before me personally appeared Brandon E. Butorac
to me known, who being by me duly sworn, did say that he is the Vice President of the
GMH ASPHALT CORPORATION, the corporation described in and which executed the
foregoing instrument; that he knows the seal of said corporation; that the seal affixed to
said instrument is such corporate seal- that it was so affixed by order of the Board of
Directors of said corporation; and that he signed his name thereto by like order.
JHE S ERICA LYNN JOHNSON
Notary Public,
NOTARY PUBLIC
&
MINNESOTA (NN ry Seal)
My Commission Expires Jan. 31, 2]020
STATE OF MINNESOTA
COUNTY OF HENNEPIN
On this 1 st day of November, 2016 before me personally appeared Barbara L. Raedeke
to me known, who being by me duly sworn, did say that (s)he is the aforesaid Attorney-
in-Fact of the WESTERN SURETY COMPANY, a corporation- that the seal affixed to
the foregoing instrument is the corporate seal of said corporation, and that said
instrument was signed and sealed on behalf of said corporation by the aforesaid officer,
by authority of its Board of directors- and the aforesaid officer acknowledged said
instrument to be the free act and deed of said corporation.
Notary Public, Vn
(Notary Se6/
ANGELA MARIE NYAMBURI
NOTARY PUBLIC • MINNESOTA
MY COMMISSION EXPIRES 01/31/20
Western Surety Compan\A
POWER OF ATTORNEY APPOINTING INDIVIDUAL ATTORNEY -IN -FACT
Know All Men By These Presents, That WESTERN SURETY COMPANY, a South Dakota corporation, is a duly organized and existing corporation
having its principal office in the City of Sioux Falls, and State of South Dakota, and that it does by virtue of the signature and seal herein affixed hereby
make, constitute and appoint
Barbara L. Raedeke , Individually
of St Louis Park, MN its true and lawful Attorney -in -Fact with full power and authority hereby conferred to sign, seal and execute for and on its
behalf bonds, undertakings and other obligatory instruments of similar nature
- In Unlimited Amounts -
Surety Bond No: 929633582 - M2
Principal: GMH Asphalt Corporation
Obligee: City of Shorewood
and to bind it thereby as fully and to the same extent as if such instruments were signed by a duly authorized officer of the corporation and all the acts of said
Attorney, pursuant to the authority hereby given, are hereby ratified and confirmed.
This Power of Attorney is made and executed pursuant to and by authority of the By -Law printed on the reverse hereof, duly adopted, as indicated, by
the shareholders of the corporation.
In Witness Whereof, WES'T'ERN SURETY COMPANY has caused these presents to be signed by its Vice President and its corporate seal to be
hereto affixed on this Ist day of December, 2015.
State of South Dakota
ss
County of Minnehaha
On this 1st day of December, 2015, before me personally came Paul T. Bnrflat, to me known, who, being by me duly sworn, did depose and say: that
he resides in the City of Sioux Falls, State of South Dakota; that he is the Vice President of WESTERN SURETY COMPANY described in and which
executed the above instrument; that he knows the seal of said corporation; that the seal affixed to the said instrument is such corporate seal; that it was so
affixed pursuant to authority given by the Board of Directors of said corporation and that he signed his name thereto pursuant to like authority, and
acknowledges same to be the act and deed of said corporation.
My commission expires
J. MtlHR
SWTH MOTA
June 23, 2021 FQ�s_ -M+-' ar h w
J. Mohr, Notary Public
CERTIFICATE
1, L. Nelson, Assistant Secretary of WESTERN SURETY COMPANY do hereby certify that the Power of Attorney hereinabove set forth is still in
force, and further certify that the By -Law of the corporation printed on the reverse hereof is still in force. In testimony whereof I have hereunto subscribed
my name and affixed the seal of the said corporation this 1 st clay of November, 2016-
WESTERN SURETY COMPANY
N'giQ °¢Eiji °y�.
2 sacs . Zs
L. NelSOn, Assistant Secretary
Form F4280 -7 -2012
WESTERN SURETY COMPANY
w; 'cpgp �A'q�M n
3w; tx�
r."'QCA
aul T. Bruflat, Vice President
State of South Dakota
ss
County of Minnehaha
On this 1st day of December, 2015, before me personally came Paul T. Bnrflat, to me known, who, being by me duly sworn, did depose and say: that
he resides in the City of Sioux Falls, State of South Dakota; that he is the Vice President of WESTERN SURETY COMPANY described in and which
executed the above instrument; that he knows the seal of said corporation; that the seal affixed to the said instrument is such corporate seal; that it was so
affixed pursuant to authority given by the Board of Directors of said corporation and that he signed his name thereto pursuant to like authority, and
acknowledges same to be the act and deed of said corporation.
My commission expires
J. MtlHR
SWTH MOTA
June 23, 2021 FQ�s_ -M+-' ar h w
J. Mohr, Notary Public
CERTIFICATE
1, L. Nelson, Assistant Secretary of WESTERN SURETY COMPANY do hereby certify that the Power of Attorney hereinabove set forth is still in
force, and further certify that the By -Law of the corporation printed on the reverse hereof is still in force. In testimony whereof I have hereunto subscribed
my name and affixed the seal of the said corporation this 1 st clay of November, 2016-
WESTERN SURETY COMPANY
N'giQ °¢Eiji °y�.
2 sacs . Zs
L. NelSOn, Assistant Secretary
Form F4280 -7 -2012
Authorizing By -Law
ADOPTED BY THE SHAREHOLDERS OF WESTERN SURETY COMPANY
This Power of Attorney is made and executed pursuant to and by authority of the following By -Law duly adopted by the shareholders
of the Company.
Section 7. All bonds, policies, undertakings, Powers of Attorney, or other obligations of the corporation shall be executed in the
corporate name of the Company by the President, Secretary, and Assistant Secretary, Treasurer, or any Vice President, or by such other
officers as the Board of Directors may authorize. The President, any Vice President, Secretary, any Assistant Secretary, or the Treasurer
may appoint Attorneys in Fact or agents who shall have authority to issue bonds, policies, or undertakings in the name of the Company.
The corporate seal is not necessary for the validity of any bonds, policies, undertakings, Powers of Attorney or other obligations of the
corporation. The signature of any such officer and the corporate seal may be printed by facsimile.