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Pay Voucher No. 2 Owner: City of Shorewood Date: 12/21/2016 5755 Country Club Road Shorewood, IAN 55331-8926 For Period: 10/6/2016 to 12/21/2016 Request No.: 2 &FINAL. WSB Contractor: Pearson Bros., Inc. 11079 Lamont Avenue NE Hanover, MN 55341-4063 RM ii 'Ih Pay Voucher SHOR-2016 Crack Fill &Seal Coat Project Client Contract No.: Project No.: 02925-08 Client Project No.: Project Summary 1 Original Contract Amount $182,020.00 2 Contract Changes-Addition $13,860.00 3 Contract Changes- Deduction ($2,126.00) 4 Revised Contract Amount $193,754.00 5 Value Completed to Date $213,256.30 6 Material on Hand $0.00 7 Amount Earned $213,256.30 8 Less Retainage $0.00 9 Subtotal $213,256.30 10 Less Amount Paid Previously $129,689.25 11 Liquidated Damages $0.00 12 AMOUNT DUE THIS PAY VOUCHER NO. 2 & FINAL $83,567.05 1 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: Construction Observer: WSB&Associates, Inc. Approved by Contractor: Approved by Own Pearson Bros., Inc. Citv of Shorewood Specified Contract Completion Date: Date: Comment: CITY OF SHOREWOOD 5755 Country Club Road Shorewood, MN 55331-8926 Project No. 02925-08 Final Pay Voucher No. 2 02925-08 Payment Summary No. From Date To Date Work Certified Amount Retained Amount Paid Per Pay Voucher Per Pay Voucher Per Pay Voucher 1 05/09/2016 10/05/2016 $136,515.00 $6,825.75 $129,689.25 2 10/06/2016 12/21/2016 $76,741.30 ($6,825.75) $83,567.05 Totals: $213,256.30 $0.00 $213,256.30 02925-08 Funding Category Report Funding Work Less Less Amount Paid Total Category Certified Amount Previous This Amount Paid No. To Date Retained Payments Pay Voucher To Date UNF 213,256.30 0.00 129,689.25 83,567.05 213,256.30 Totals: $213,256.30 $0.00 $129,689.25 $83,567.05 $213,256.30 02925-08 Funding Source Report Accounting Funding Amount Paid Revised Funds Paid To No. Source This Contract Encumbered Contractor Pay Voucher Amount To Date To Date UNF Unfunded 83,567.05 193,754.00 182,020.00 213,256.30 Totals: $83,567.05 $193,754.00 $182,020.00 $213,256.30 f CITY OF SHOREWOOD 5755 Country Club Road Shorewood, MN 55331-8926 Project No. 02925-08 Final Pay Voucher No. 2 02925-08 Project Material Status Quantity Amount Line Item Description Units Unit Price Contract This This Quantity Amount Quantity Pay Pay To Date To Date Voucher Voucher SCHEDULE A-CITY OF SHOREWOOD 1 2021.501 MOBILIZATION LS $5,000.00 1 0 $0.00 0.75 $3,750.00 BITUMINOUS 2 2356.505 MATERIAL FOR GAL $2.60 36100 15216 $39,561.60 42291 $109,956.60 SEAL COAT (CRS- 2P) SEAL COAT 3 2356.604 AGGREGATE FA-2 S Y $0.60 138600 -103950 ($62,370.00) 0 $0.00 CLASS A (GRANITE) Totals For Section SCHEDULE A-CITY OF SHOREWOOD: I ($22,808.40) J $113,706.60 SCHEDULE B -CITY OF VICTORIA 4 2021.501 MOBILIZATION LS $0.00 1 0 $0.00 0 $0.00 BITUMINOUS 5 2355.502 MATERIAL FOR FOG GAL $0.00 50 0 $0.00 0 $0.00 SEAL BITUMINOUS 6 2356.505 MATERIAL FOR GAL $0.00 13800 0 $0.00 0 $0.00 SEAL COAT (CRS- 2P) SEAL COAT 7 2356.604 AGGREGATE S Y $0.00 53100 0 $0.00 0 $0.00 CLASS A(TRAP ROCK) Totals For Section SCHEDULE B -CITY OF VICTORIA: $0.00 $0.00 SCHEDULE C -CITY OF MINNETRISTA ROADWAYS 8 2021.501 MOBILIZATION LS $0.00 1 0 $0.00 0 $0.00 BITUMINOUS 9 2356.505 MATERIAL FOR GAL $0.00 6700 0 $0.00 0 $0.00 SEAL COAT(CRS- 2P) SEAL COAT 10 2356.604 AGGREGATE FA-2 S Y $0.00 25700 0 $0.00 0 $0.00 CLASS A(GRANITE) ROUT AND SEAL 11 2331.619 BITUMINOUS RD $0.00 86 0 $0.00 0 $0.00 PAVEMENT STA CRACKS Totals For Section SCHEDULE C-CITY OF MINNETRISTA $0.00 $0.00 ROADWAYS: SCHEDULE D-CITY OF MINNETRISTA TRAILS 12 2021.501 MOBILIZATION LS $0.00 1 0 $0.00 0 $0.00 BITUMINOUS 13 2355.502 MATERIAL FOR FOG GAL $0.00 2100 0 $0.00 0 $0.00 SEAL CITY OF SHOREWOOD 5755 Country Club Road Shorewood, MN 55331-8926 Project No. 02925-08 Final Pay Voucher No. 2 02925-08 Project Material Status Quantity Amount Line Item Description Units Unit Price Contract This This Quantity Amount Quantity Pay Pay To Date To Date Voucher Voucher ROUT AND SEAL 14 2331.619 BITUMINOUS LF $0.00 2500 0 $0.00 0 $0.00 PAVEMENT CRACKS Totals For Section SCHEDULE D -CITY OF MINNETRISTA TRAILS: $0.001 1 $0.00 Change Order 1 -Seal Coat Aggregate Revised SEAL COAT 15 2356.604 AGGREGATE FA-2 SQ CLASS A(TRAP YD $0.70 138600 145251 $101,675.70 145251 $101,675.70 ROCK) SEAL COAT SQ 16 2356.604 AGGREGATE FA-2 YD ($0.60) 138600 0 $0.00 0 $0.00 CLASS A(GRANITE) Totals For Change Order 1 -Seal Coat Aggregate Revised 1 $101,675.701 $101,675.70 Supplemental Agreement 1 -DESIGN SERVICES 17 12011.601 1 DESIGN SERVICES I LS ($2,126.00) 1 1 ($2,126.00) 1 ($2,126.00) Totals For Supplemental Agreement 1 - DESIGN SERVICES: ($2,126.00) ($2,126.00) Project Totals: $761741.30 $213,256.30 02925-08 Contract Changes Estimated Amount No. Type Date Explanation Amount Paid To Date CO1 Change Order 7/14/2016 SEAL COAT AGGREGATE REVISED $13,860.00 $101,675.70 WHEREAS: ADDITIONAL TIME WAS SPENT BY ENGINEER ON DESIGN SERVICES FOR SA1 Supplemental 12/21/2016 RECONFIGURATION OF LINES NOW, THEREFORE, IT $2,126.00 Agreement IS HEREBY MUTUALLY AGREED AND UNDERSTOOD ( ) ($2,126.00) THAT: ENGINEERING DESIGN TIME WILL BE DEDUCTED FROM CONTRACT Contract Change Totals: $11,734.00 $99,549.70 l 4 I DEPARTMENT OF REVENUE Contractor Affidavit Submitted Thank you,your Contractor Affidavit has been approved. Confirmation Summary Confirmation Number: 1-455-216-960 Submitted Date and Time: 2-Jan-2017 1:45:58 PM Legal Name: PEARSON BROS INC Federal Employer ID: 41-1751395 User Who Submitted: mhallich Type of Request Submitted: Contractor Affidavit Affidavit Summary Affidavit Number: 1498423296 Minnesota ID: 1232027 Project Owner: CITY OF SHOREWOOD Project Number: 3986 Project Begin Date: 15-Sep-2016 Project End Date: 15-Sep-2016 Project Location: CITY OF SHOREWOOD Project Amount: $213,256.30 Subcontractors: No Subcontractors Important Messages A copy of this page must be provided to the contractor or government agency that hired you. Contact Us r If you need further assistance, contact our Withholding Tax Division at 651-282-9999, (toll-free)800-657-3594, or(email) withhold ing.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. ,� TM E Document 707 - 1994 Consent Of Surety to Final Payment Bond No. MNC67282 PROJECT:(Name and address) ARCHITECT'S PROJECT NUMBER, OWNER: 2016 Crack Fill and Seal Coat Project- Seal Coat Various Roads,Shorewood, CONTRACT FOR: Construction ARCHITECT: MN(Schedule A) CONTRACTOR: SURETY: TO OWNER:(Name and address) CONTRACT DATED: 6/3/2016 OTHER: City of Shorewood 5755 Country Club Road Shorewood, MN 55331 hi accordance with the provisions of the Contract between the Owner and the Contractor as indicated above,the (Insert narne and address of Surety) Merchants Bonding Company(Mutual) P.O. Box 14498 Des Moines, IA 50306-3498 SURETY, on bond of (Insert name and address of Contract a) Pearson Bros., Inc. 11079 Lamont Avenue N.E. Hanover, MN 55341 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 (Insert name and address ofOivnet) City of Shorewood 5755 Country Club Road Shorewood, MN 55331 OWNER, as set forth in said Surety's bond. IN WTINESS WHEREOF,the Surety has hereunto set its hand on this date: January 5,2017 (Insert in writing the monthfollowed by the nunwrie date anti!year.) Merchants Bondina Company(Mutual) (Surety) r (Signature of authorized representative) Attest ;° - Kurt C.Lundblad,Attorney-in-Fact C '' � _ (Seal): (Printed name and title) 3f i AIA Document G707"m—1994.Copyright©1982 and 1994 by The American Institute of Architects.All rights reserved.WARNING:This AIA04 Document is protected by U.S:Copyright Law and International Treaties.Unauthorized reproduction or distribution,of this Ale Document,or any portion of it, 1 may result In severe civil a nd criminal penalties,and will be prosecuted to the maximum extent possible under the law. I i (\1 I MERCHANT BONDING COMPANY,,, POWER OF ATTORNEY Know All Persons By These Presents,that MERCHANTS BONDING COMPANY(MUTUAL)and MERCHANTS NATIONAL BONDING, INC.,both being corporations duly organized under the laws of the State of Iowa(herein collectively called the"Companies"), and that the Companies do hereby make,constitute and appoint,individually, Brian J Oestreich; Craig Remick; D R Dougherty;Jack Cedarleaf II;Jerome T Ouimet;John E Tauer;Joshua R Loftis; Kurt C Lundblad; R C Bowman; R Scott Egginton; R W Frank; Ted Jorgensen of Minneapolis and State of Minnesota their true and lawful Attorney-in-Fact,with full power and authority hereby conferred in their name, place and stead,to sign, execute, acknowledge and deliver in their behalf as surety any and all bonds, undertakings, recognizances or other written obligations in the nature thereof, subject to the limitation that any such instrument shall not exceed the amount of: FIFTEEN MILLION($15,000,000.00)DOLLARS and to bind the Companies thereby as fully and to the same extent as if such bond or undertaking was signed by the duly authorized officers of the Companies,and all the acts of said Attorney-in-Fact, pursuant to the authority herein given,are hereby ratified and confirmed. This Power-of-Attorney is made and executed pursuant to and by authority of the following By-Laws adopted by the Board of Directors of the Merchants Bonding Company(Mutual)on April 23,2011 and adopted by the Board of Directors of Merchants National Bonding,Inc.,on October 24,2011. "The President,Secretary,Treasurer,or any Assistant Treasurer or any Assistant Secretary or any Vice President shall have power and authority to appoint Attorneys-in-Fact,and to authorize them to execute on behalf of the Company,and attach the seal of the Company thereto, bonds and undertakings,recognizances,contracts of indemnity and other writings obligatory in the nature thereof. The signature of any authorized officer and the seal of the Company may be affixed by facsimile or electronic transmission to any Power of Attorney or Certification thereof authorizing the execution and delivery of any bond, undertaking, recognizance, or other suretyship obligations of the Company, and such signature and seal when so used shall have the same force and effect as though manually fixed." In Witness Whereof,the Companies have caused this instrument to be signed and sealed this 29th day of April , 2015. r.• rrrpra. �-1 10 14,4,( �O Cp . 't ,O'= `O 'Q1N 1P09A9° MERCHANTS BONDING COMPANY(MUTUAL) 61-. MERCHANTS NATIONAL BONDING,INC. 1933 c• ° J l: BY STATE OF IOWA w %, �t 17,�4`� •••�j •••°• COUNTY OF POLK ss. "rrrr'•"" °'•' President On this 29th day of April 2015,before me appeared Larry Taylor,to me personally known,who being by me duly sworn did say that he is President of the MERCHANTS BONDING COMPANY(MUTUAL)and MERCHANTS NATIONAL BONDING,INC.;and that the seals affixed to the foregoing instrument is the Corporate Seals of the Companies;and that the said instrument was signed and sealed in behalf of the Companies by authority of their respective Boards of Directors. In Testimony Whereof, I have hereunto set my hand and affixed my Official Seal at the City of Des Moines, Iowa,the day and year first above written. A,!?, <S WE N D Y WOODY z •o•. Commission Number 784654 My Commission Expires • %wP June 20 2017 Notary Public,Polk County,Iowa STATE OF IOWA COUNTY OF POLK ss. I, William Warner,Jr.,Secretary of the MERCHANTS BONDING COMPANY(MUTUAL)and MERCHANTS NATIONAL BONDING,INC., 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 and effect and has not been amended or revoked. In Witness Whereof, I have hereunto set my hand and affixed the seal of the Companies on this 5th day of January 2017 �pruHlrry,r�h .•�.oe�.•• 4• ° �i i r �.• r s 1933 Secretary - � , x003 , .� ��.:•. .��. POA 0014 (7114) ''.�.r'�; • .. ..•:r���,.'� �'��':�Gy ... .• �1� +•r''•�rrrr'rfirifrllrrt+'```` • '•°:••••, E MAINTENANCE BOND Bond Number: MNC67282 KNOW ALL MEN BY THESE PRESENTS, That we Pearson Bros.,Inc. as Principal, and Merchants Bonding Company(Mutual) as Surety, are held and firmly bound unto, City of Shorewood,MN as Obligee, in the penal SUM Of Two Hundred Thirteen Thousand Two Hundred Fifty-six And 30/100THS ( $213,256.30 ) to which payment well and truly to be made we do bind ourselves, our and each of our heirs, executors, administrators, successors and assigns jointly and severally, firmly by these presents. WHEREAS,the said Principal Pearson Bros., Inc, has entered an agreement with City of Shorewood.MN for_ 2016 Crack Fill and Seal Coat Project-Seal Coat Various Roads,Shorewood,MN(Schedule A) WHEREAS, the Principal will furnish a bond conditioned to guarantee for the period of Two year(s) against all defects in workmanship and materials which may become apparent during said period. NOW, THEREFORE, THE CONDITION OF THIS OBLIGATION IS SUCH that, if the Principal shall indemnify the Obligee for all loss that the Obligee may sustain by reason of any defective materials or workmanship which become apparent during the period of Twoyear(s) from the date of acceptance. The aggregate liability of the Surety shall not exceed the penal sum of this bond irrespective of the number of years it is in effect and irrespective of the number of claims instituted by the Obligee. SIGNED,SEALED AND DATED January 5th 2017 Pearson Bros., Inc. �1 Principal Jack E. Pearson, President Merchants Bonding Company.(Mutual) SLirety By: Kurt C. Lundblad, Attorney-in-Fact CORPORATE ACKNOWLEDGMENT State of Minnesota ) )Ss County of ) On this day of , before me appeared Jack E. Pearson to me personally known, who, being by me duly sworn, did say that he/she is the President of Pearson Bros., Inc. , a corporation, and that said instrument was executed in behalf of said corporation by authority of its Board of Directors, and that said Jack E. Pearson acknowledged said instrument to be the free act and deed of said corporation. T , �7 MELISSA CATHERINE HALLICH Notary Public jQ,1A.1 County(�(!&WeSO NOTARY PUBLIC-MINNESOTA gt- f� a My Commission Expires Jan.31,2018 My commission expires 8 ( �d/p 5, 1 SURETY ACKNOWLEDGMENT State of Minnesota ) )ss County of Hennepin ) On this 5th day of January 2017 , before me appeared Kurt C. Lundblad to me personally know, who being by me duly sworn, did say that(s)he is the Attorney-in-Fact of Merchants Bonding Company(Mutual) , a corporation,that the seal affixed to the foregoing instrument is the corporate seal of said corporation and that said instrument was executed in behalf of said corporation by authority of its Board of Directors; and that said Kurt C. Lundblad acknowledged said instrument to be the free act and deed of said corporation. f / r pNil Notary Public Washington County,Minnesbta n��,} i,,• �,a� i I ,�i, My commission expires 1/31/2018 F, i 4 { S MERCHANTS BONDING COMPANY7M POWER OF ATTORNEY Know All Persons By These Presents,that MERCHANTS BONDING COMPANY(MUTUAL)and MERCHANTS NATIONAL BONDING, INC.,both being corporations duly organized under the laws of the State of Iowa(herein collectively called the"Companies"), and that the Companies do hereby make,constitute and appoint,individually, Brian J Oestreich; Craig Remick; D R Dougherty;Jack Cedarleaf II;Jerome T Ouimet;John E Tauer;Joshua R Loftis; Kurt C Lundblad; R C Bowman; R Scott Egginton; R W Frank;Ted Jorgensen of Minneapolis and State of Minnesota their true and lawful Attorney-In-Fact,with full power and authority hereby conferred in their name, place and stead,to sign, execute, acknowledge and deliver in their behalf as surety any and all bonds, undertakings, recognizances or other written obligations in the nature thereof, subject to the limitation that any such instrument shall not exceed the amount of: FIFTEEN MILLION($15,000,000.00)DOLLARS and to bind the Companies thereby as fully and to the same extent as if such bond or undertaking was signed by the duly authorized officers of the Companies,and all the acts of said Attorney-in-Fact, pursuant to the authority herein given,are hereby ratified and confirmed. This Power-of-Attorney is made and executed pursuant to and by authority of the following By-Laws adopted by the Board of Directors of the Merchants Bonding Company(Mutual)on April 23,2011 and adopted by the Board of Directors of Merchants National Bonding,Inc.,on October 24,2011. "The President,Secretary,Treasurer,or any Assistant Treasurer or any Assistant Secretary or any Vice President shall have power and authority to appoint Attorneys-in-Fact,and to authorize them to execute on behalf of the Company,and attach the seal of the Company thereto, bonds and undertakings,recognizances,contracts of indemnity and other writings obligatory in the nature thereof. The signature of any authorized officer and the seal of the Company may be affixed by facsimile or electronic transmission to any Power of Attorney or Certification thereof authorizing the execution and delivery of any bond, undertaking, recognizance, or other suretyship obligations of the Company, and such signature and seal when so used shall have the same force and effect as though manually fixed." In Witness Whereof,the Companies have caused this instrument to be signed and sealed this 29th day of April , 2015. �•``�`' 10 JrAt. ••#OIXG'COM,6•. MERCHANTS BONDING COMPANY(MUTUAL) "s�•; �aRq���d;• �•�O�OQIPOg4�9y�• MERCHANTS NATIONAL BONDING,INC. S- 1933 c. 2003 .ti' '\ R` vd �. By STATE OF IOWA ••yr �*` •'• `°` • COUNTY OF POLK ss. ,JI""'��""" •••'••• President On this 29th day of April 2015,before me appeared Larry Taylor,to me personally known,who being by me duly sworn did say that he is President of the MERCHANTS BONDING COMPANY(MUTUAL)and MERCHANTS NATIONAL BONDING,INC.;and that the seals affixed to the foregoing instrument is the Corporate Seals of the Companies;and that the said instrument was signed and sealed in behalf of the Companies by authority of their respective Boards of Directors. In Testimony Whereof, I have hereunto set my hand and affixed my Official Seal at the City of Des Moines, Iowa,the day and year first above written. �PRtA<S WENDY WOODY Z � Commission Number 784654 My Commission Expires %wP June 20 2017 Notary Public,Polk County, Iowa STATE OF IOWA COUNTY OF POLK ss. I, William Warner,Jr.,Secretary of the MERCHANTS BONDING COMPANY(MUTUAL)and MERCHANTS NATIONAL BONDING,INC., 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 and effect and has not been amended or revoked. In Witness Whereof, I have hereunto set my hand and affixed the seal of the Companies on this 5th day of January 2017 0. Wit• ;_ '''� 1933 '° Secretary POA 0014 (7/14) �a'�y' • ••'����,•�'�, •to';>W" � �to•••