HomeMy WebLinkAboutPleasant St & Ridgemont Ave ROW Permit 12/1�/2UU5 12:18 FAX 6512989113 ECI � 002/006
�DEC-1�—Z0�5 09�4a CITY OF PRIp� LAKE MRINT p.p�ip4
Post-it• �ax Nota T671 pa �L��'��.'�S� p�es� ��
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PERMIT
PERMIT TO WORK WITHIN CI7Y pROPERTY RIGHT-O�-WAY/EASEMEN�S �
. AND . ,
APPUCATION FOR 1NSTALLATION OF UTil1'fICS
1. Location � N E�'O�'Z �' �Zc� �,EA-Sa�v 7 c?r � ,2 � oc.�N+.O ^�t� A-V� .
T
2. NatuteofWork„�P��2 oF E�c�Snn+� Sf..��.r� L�,.,� , ,_.
3. ixulicatc below iterx�c tq ht affectcd and include s sketch or plan, of wock ta be done.
Curb & Gutter ,�, Strecl
7'r.�i1/Sidewaik �Trees:
PondlWcd3n�is (P�blicslly own�tl
'I'ra�ic Co�►tro� Aevices/Si�s Or Privately owned _)
Araina�e Utili�ics
St�uctureBuildings Ottur
4. Mcth�d of Jnstallstion or Construction '�+�' ��'�r+wc.r�,,,�uG caoz.� � B�Kr�-�'�u
5. Work r� stact on nr a fter: Z Ja�.s oc— and shall be eornpleted by: _ 3� m�y a� unless �n
exter�ion granted to: by:
DATE STAIT/DATE
, 6. Will dctouring of tra�c be aecessaty? Y�S If nccessary ee detour tz�a�c, de.ccr�be auggeated
zoute: Dv�u r7+ A+�S . To �c.ostwrraa ST. ro Z� o�s M eN r f�dE
7, Providc with this appliaatlon a c+opy af the conuactors Public Liability�surancc•
D�I'OURS: Tl�e Directnr of Public Works ak�a11 be norAfied in writing a te�nst '72 ho»YS in advmn�x of a�►
dccour tyeia� cstablishcd, changcd ar cliscontinued.
NAMEOFAP��,ICAN'T 5�+�►-�= �M�F�.a�� PXIONF Cvs�— �" 9 l► 1
r�ens� rR�N
nDDRESS �go Sav��. L�.E�� �1 Sr r�.�c, mN 5� o�
STREET CI7Y ,STATG ZlP
NA11� O� PARTY OF� ORGAN'IZATION P�RFORM?NG WORK �G�
CONTn,CT PkRSON: i�Y � EMERGLNCY (2� I�t.) rk�ON�#: �.3?�v�� e�3¢
ADDRESS: �'o p�r��. �NNaL_ IZ/1 Sr� �'ia,.�-�r?� DAY PHQNE 4iZ -S�o - 4�1
STREET CITY STATE Z1P S'STcY�
The un�lcrsigned htrewidi :ticacnt.e the cern7s and e,�+ndition� of thia permit by the City af Prior L�kc �s hcrcrt+ oont+imed aod agree ta
fulty oc�mply th io of ihe Ci�y of Pr;ar Lakc.
Sig ..3'iUe: �S� �✓� __,_, Date: ,,.� a S
12/15/2(aG5 12:19 FA� 651�989113 ECI � 003/006
� �DEC-��-2005 �9�45 CITI OF PRIOR �RK� t1AINT P.�2i�4
EXHIBIT "C"
. TO
PRIQR LAKE PUBLJC WORKS DESIGN MANUAL
PERMIT TO WpRK WI�'HIN CITY PRO�ERTY RIGNT•OF-YVAY/EASEMEN7S
ANb
APPI.ICATION FOR INSTA�I.ATION OF UtiL{71ES
P�►C�E 2
�'OR CITY US@ ONI_Y AUTHORIZ/�TiON OF PERMIT
FINANCIAL SECURITY: AMOUNT: TYPE:
(Cash, Bon�l,
LOC, Etc.)
Fee: 5 �J'��• � Rec�ipt No. � Permit No, � "
LIA[3lILI7Y INSURt1NCE PROVIDED: ���yL'� e�+ . �n�
In con;;dcration of agreemerit to comply in all res�,ect� with the regulations of ihe Criy of Prbr Lake couering such o�eratwns,
and pursuar�t �� autho�ization duly given by said City ot Prior l.ake; permis5ion �q heraby g�a�ted for the work to be done as
descrlbad in the above applicaUnn. �ajd work lo be done in ac,cordance with special Drovisions as hereby staled:
��� ��� m I�+ 41`+G � i"tJ� APPROV D BY: DEPT, OF PUBLIC W�RKS
� 1n rI �+ G&.! c.. ey: i� /�
w � h �v' ' 0 '�, /DATE
�oL �..L +�� _ �D� �.r�r.� .
�kLL LEGAL RE�UIREMENTS SHOWN ON PAGE OIVE (1) MNC� ON AI.L "SPECII�I PROYISION�' SHAU. eE COMPLIED
W17H. THE DATE WHEN W�ORK 15 COMPLETEQ MUST BE REPORTEQ 70 THE GITY OF PRIOR LAKE CITY CNGINE�R.
�` �o� 4. j �i�y /rbr 'b � �.5�'ru Cf"Q.-,
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12/15/2005 12:19 FAX 6512989113 ECI � 004/006
DEC-12-�005 09-45 CiT'� OF PRIOR LAKE MAINT P.03%04
EXHIBIT "G"
TO
�..., �
PRIOR LAKE PUBUC WORKS DEStGN MANUA�
REGU{.AT10NS PERTAINING TO TH� INSTALLATION OR
REPAIR OF UNDERGROLJNf� UTII.(71E� lN CITY S7REE'CS
OR IN Cl'T`Y' RICyHT-OF WAY/EASEMENTS
T1ie following regulalians and cor�ditions cor►stitute a part of tha applicatiott made by any installer or cont►actor for
the instaliation ot uliliGcs in any City street right-of-way or Ciiy utillty easement and the applicant, in making his
app�ication io do such work, shall agree io abide by these regutations and conditions:
1. The individua) obtaining the permil shall, hefo�e camrnencing such work, not�fy the City Engineer when the
work at Qach bcat4on is to commence; and, when requested by the Engineer, shall submil pl�ns and
specifications.
2. Up�n comp�et'�n of tl�F nroieci,,,,t� inciividual shall nromatly notifv the Ciiv En4ineerin_ Deoartmeni tor final
insnectfon
3. The public is to be protected by the individual, at all time�, from lhe cor�mencemertt of the w�k until the
campteGon and acce{�tance by lhe �ity. Tha installe� c7r contractor shall so conduct his operal'bns as to
cause the minimum inconvenienco io lhe publie. The installer or eontractor shall iurnish, erect, and
mai�tain, in accardance wifh the legally accepted standards, all necessary warning and traific coMro! signs,
barricades, traffic cvnes, and flashing li�hts to direct and control the movement of traitic through the project
in all direcfions and at all times.
The foregoing provisions shell not in any way rAfieve the installer or contractor of any of his tegal
respo�sibilitiES or liabi{it(es far the safely of the public.
4. All openings in bituminous surtaces shail be cut in a straignt line with sides smooth and vertical. No r�gged
edges witl be permitted. Cutting shafl be do�e wilh a concrete saw, cutting wheel, jack hamrner, spades or
simil�r approved tools.
Backt�u material shall be suitable far highw�y embankment const�uction. Na peat, froz�en lumps, broken
asphatt, sod, roots, or other undesirabfe materia! shali be permitted as backfill. Rocks la�ger than six
inches (6") in diameter shall not be used in backfilling of tranches.
7he Dackfill material shall be placr�d ;n layers not to exceed ons toot (1') and mechaniCally compacted ta
not less than J5 percent of modified Proctor density.
Th� uppe� six inches (6") af the backfill shall meet Minnesota Highway Department Spec�caGons fot Class
5 mater'�al and shall De compacted to not less than 95 percenl of moditied Proctor density.
As soon as possible efter backfill ope�ations are oompleted, the cut bituminous edg�s o�f lhe french Shall be
painted with an asphalt emulsion such as SS-1, Immediately tliereafter, the patching material shall be
placed and mechanically compacted to not tess than 95 percent of modiiied Prxtor density. The asphaltic
mater7al used in patching shali be of the same type as removed frorra the roadway, except, that in no case,
win � plant mixed asphalt of less quality than Minnrsot9 Highway Department SpecificaCw�s 2331 be used.
The flnished surface of the patet� shall cenferm to the surlaae of the undistu�bed roadway.
No permanerit asphalt pakhes shatl be o� any base whose temperature is 32 deg�ees Fahrenheit ot less.
Cold weather patching shall be of temporary nature, using coid mixed asphalt, well graded c.rushed �ock or
similar �ppraved materials. 7'emporary patches shatl be true to line and grade. Temporairy patches shall
c;vEan�n�suww w;r�ow v�xuits.e�
12f15/2U05 12:19 FAK 651�989113 ECI � 005/006
DEC-12-7_pp5 ����5 CIT'� OF PR1nR LAKE MAINT p.pqr0a
be replaoed by permanent patches when weather conditions permit and notification shall be requi�ed as
sWted in 2.
5. Other areas may be required to be� compacted at lhe direcli�n of the City Engineer.
6. Such permitlee lo be r�e�por�sible tor maintenance and repai� of all trenches tor a period of one (1) year and
i� settlement ocaurs or excava'tlon cav�s in, the sarn� shdlt be promptly indicatsd by adequate waming
signs and shall be restored to p�oper condition in accardance with specifications above provided as soon
as cond'+tions per'mit.
7. All culverts and ditches shall be replaced in their �riginal posiGon and cond�tion existin9 prior to
construction and na change shall �e made in drainage v+rithout approva! of the Ciiy Engineer.
8. Permittee shall save the Cily harmless ftom all thit'd party claims fo� injury or damage which may occur
between the t�me the wo�k commencas and the time it is finally accepted by the City.
9. The permiltee may he required to ja�k or bore under nertain streets, as determined by the City Engineer.
10, The appli�.�nl shall furnish evidenee of �ublic liability lnsurance of not less than �100,0001300,�00 and
prop�ty damage of not less than $Z5,000 i59ued by an insyrance company dulhoriud to do busi�ess in
the State of Mitlnesota ori whicll the City is n�med as an ad�tiunal insured party.
11, Except f�r the negligent acts of the City, its age�nts and !ts ecnployecs, the permittee shall assume all
liability tor, and save tf�e City, its agents and its employAes, harmless and defend same �t its s�le oost and
cxpense from any and all cfaims for damage�s, actions or causcs of ac#ion arising out of the work to be
done hc:rein and the contlnuing uses by tMe permittEe, including but not lim�ted to the placing, constructing,
and reconstructing, maintaining, protecti�g and use ot said facility under this application and permit tor
construction.
't2. Exisiing Facilities - The utility facility and installations sh�ll not intarfere with any existtng ulility facility on
the City's right-of-way or easements. It is the responsibility of the applicant to call for necessary locations
of existing utili6es. (Go{�her One)
13. Private Praperty -- The work permit or p¢�mit for construction as issued do¢� not in any way fmply that the
approprlate easemenc exists to allow the applicant io work on private property.
14, Cutting Trees - The pc�rmission herein granled does n�t cnnfer upan Ihe permiKee the right to cut, femeve
ar destroy trees or shrubbery within the tega! limlts of the right-of-wsy. Easements that are not specifically
identifieQ on the plan attached tfl this pertnit or �e�ieve pemnittee from obtaini�g any con4ent olhene►ise
required from the owner of the property adjacent thereta
15. ClearrUp - Street, uailways and affeGted rlght-of•way shall be scraped cle�n at the end oF sach wo�k day
and swepl clean a(ter constructior► is completed� and left in a neat and presentable condit�ort.
16. Replacemerrt of Svd - Whereva� top-soil and sod 8f@ dlSfUl'bEEd they shall be replaced in kind ond
maintained satisfactorily unttl the turt is establ'rshed.
The undersigned h►�reby declares he/she has read and will comply with alt thc PERTINFNl' REGULA710NS as
stated abov� and refevarrl City Ordinanc�s.
DATE: IZ-l/4I c��" SIGNED:
o:+raRMrrsveaw v,nr,�aowrexe+iTS.e�
TpTR� P.04
12/16f2005 09:�6 FAX 6512989113 ECI � 002/009
Prior Lake 7120 Improvements
� Metr,gpo�itan C nsi�
Euildiir,g communlNta tha! work �� po. 37SB104583996
DOCUM�NT 00613
PERFORtVrANCE BOND
Date Bond Executed: October 19, 2005
(Must be same or later than Contract Date)
Metropolitan Council Division: Environmental Services
Metropolitan Councll Project Name: Prior Lake 7120 Irnprovements
Metropolitan Council Project Number: 809011
Metropolitan Council Contract Number; 04P087
PRINCIPAL: Fuil Legal Name: Engineerin� & Construction Innovat�ona, Inc.
Complete Business Address: 780 Barge Cl�annel RoAd
St. �au), MN 55107
Telephone Number: (651) 298 - 91Z�
Fax Number: (65�) 298 - 9113
Organization Type: Individual Partnership Joint Venture X Corporation
State of Incorporation: Miinnesota
SURETY: Full Legal Name: Trt+velers Casualty a�nd �arety Compaay of Amer
Complete Business Address One Tower Square
Hartford, CT 06183-6014
Telephone Number: (657.) 3X0 - 3�50
Fax Number: (651) 310 - 3Z14
PENAL SUM OF BOND: $ 270,250.00
04PO87 Performance Bond
� 8o9o�,z Oa613-�
12/16/2005 09:06 FAX 6512989113 ECI � 003/009
Prlor Lake 7120 Improvements
� tro l�tan Co cil
B�dlA/ng canm�cnit/ee ehar teark
OBLIGATION
We, the Princlpal and Surety, are firmly bound to the Metropolitan Council (hereinafter called
the Obligee) in the above penal sum. For payment of the penal sum, we bind ourselves, our
heirs, executo�s, administrators, and successQrs, jointly and severally.
CONDITIONS
The Principal has entered Into the Contract identifled above,
THEREFORE
The above obligation is void if the Principal: (1) Performs and fulfills all the undertakings,
covenanCs, terms, cond(tions, and agreements of the Cvnfiract during the o�iginal term
of the Contract and any extensions thereof that are granted by the Obligee, with or
without notice to the Surety, and during the life of any corredlon period under the
Contract; and (2) performs and fulfills all the undertakings, covenants, terms, conditions,
and agreements of any and all duly authorized modifications of the Contract that
hereafter are made, � Notice o� those modifications to the Surety is waived.
WITNESS
The Principal and Surety executed this Performance Bond and affixed their seals on the
above date.
Fngineering �c ovations, Tnc, Travelcrs Casualty and Surety Company o[Amcrica
L (1�o sea' SU TY ea,
�Y� $y _
(Signature) (Signaht�e
Robb Johnson, Vice president Y{urt C. Lundblad
(Type Name) (Type Name)
Attorney-In-Fact
(Type T�tle) (Type Title)
(NOTE: COMPLETE ACNOWLEDGEMENT FORM AND
ATTACH APPROPRIATE POWER OF ATTORNEY)
04P087 ptrtorma�e 6�d
809011 006�3-2
12/16/2Q05 09:06 FAX 6512989113 ECI � 004/009
Prlor Lake 712U Improvements
� �etropol�tan Council
Buliding wmmunlfles thaf mork ,
ACKNOWL,EDGMENT OF PRINCIPAL
' (For Partnership)
STATE OF
ss.
COUNTY OF
The foregoing bond was acknowledged befiore me this day of , 20 ,
b —
(Name), partner on behalf oF,
(Name of Partnership) d pdPtllership.
(seai)
Notary Public
ACKNOWLEDGMENT OF PRINCIPAL
(For Corporationl
STATE OF Minncsota
ss.
COUNTY OF �tamsey •
The foregoing bond was acknowledged before me this �9th day of October , 20 05 , by
Robb �ohnson (Name Vice �resident �i e
o Engincering & Construction Innovationa, Inc. (Full Coivoration Name)
a Minnesota S� te corporation, on behalf of the corporation.
{-� "X ��.e+s".."•�Yn.:c.��'r-"'.,.;.�:'•L�y'�."Eaa�S"
( \ ..q.•..� f, 1 ��[',�y��I '
:� ai�.'l, �. � �.'�.�'�:��„'� � . \'�.1''.� ..�
:��.'`"'�'(rr �:i';'�i�5'c,ii�':1r�•t�i��1 Notary Pub c
_ � . : ,; ..
�.li K�s^ ;�;�•. 1', f : d^ar:;.. ..� . . _� . � � � . i
�,� s.�.
��°�"'��� � ACKNOWL�DGMENT OF SURETY
STATE OF MinneSOta
ss.
COUNTY OF Ramsey �
The foregoing bond was acknowledged before me this 19th day of October , 20 05 , by
Kurc C. Lundblad Nam ), attorney-in-fact of
Travclers Casualty and S�rety Company of Amc�-ica (Full Sweiv �Tame)
a Connecticut S tc corp ration on e alf of fihe corporation,
f'�,�;;= :.';�'r;� �� r:�'�'-.;���^.�:::� .
�Y ��a°°� r�;;:���,�.:� ��. c�;��::�.�;r� (N ary Public)
i, e,.r� ' r '?�,: ",•.,•9 � r :..i� � Li�ie;V�'i��Tn
�; `rc��'::`'� '�'r�����'��'•�������t��+�lal ��TE ACKNOWI.EpGMENT FROM AND
`�=`'�'e ROPRIATE P01NER OF ATTORNL`1(�
04P067 Performarue eond
809011 00613-3
12/16/2005 09;06 FAX 6512989113 ECI � 005/009
Prior Lake 7120 Improvements
� Metro olitan oun il � ,aoNn 1�, 37SBx04583996
BNc7ding tcmninnitrts thaf wc�k
DOCUMENT 00614
PAYMENT BONb
Date Bond Executed: October X9, 2005
(Must be same or later than Contract Date)
Metropolitan Council Divislon: Environmental Services
Metropolitan Council Project Name: Prior Lake 712� Improvements
Metropolitan Council Project Number: 809011
Metropolitan Councif Contract Number: 04P087 `
PRINCIPAL; Full Legal Name: En�ineering & Construcfiion Innovationa, Inc.
Complete Business Address 780 Barge Channe! �oad
St. �aul, NIN 55107
Telephone Number. (ggX� 298 _ 9�X�
Fax Number: (651) 298 - 9XX3
Organization Type; Individual Partnership Joint Venture � Corporation
State of Incorporation: Minnesota
SURETY: Full Lega! Name: TrAVCIcr� Casu�tty aad Surety Company o�A�nerica
Complete Business Address One Tower Square
�Iartford, CT 06],83-6014
Telephone Number: (65X) 310 - 3150
Fax Number: (651) 310 - 3z14
PENAL SUM OF BOND: $ 270,250.00
04P087
8090�1 �ymerrt Bond
� 00614-1
12/16/2003 U9:06 FAX 6512989113 ECI � 006/009
Prior Lake 7120 Improvements
� Metxopolxtan Cowncil
Burld(ng commanitiea lhat uark
OBUGATION
We, the Principal and Surety, are Frmly bound to the Metropolitan Councii (hereinafter called
the Obligee) in the above penal sum. For payment of the penal sum, we bind ourselves, our
hei�s, executors, administrators, and successors, jointly and severally.
CONDITtONS
The Principal has entered into the Corrtract ldentified ahove.
THEREFORE
The above obligation is vold if the Princlpal prompHy makes payment to all persons having a
direct relationshlp with the Principal or a subcontractor of the Principal for fumishing labor,
material, or both In the prosecution of the Work provided for in the Contrad identified above,
and any authorized modifications of the Contrack that subsequently are made. Notice of those
modifications to the Surety Is waived.
wiTNESs
The Principal and Surety executed this Payment Bond and affixed their seals on the above
date.
Eng�necring ec In�ovatioas, Inc. Travelers Casualty and Surety Company of America
PAL o s���) SURETY (Se
BY � $Y� __.E`'Tr��'" � �
ignature) (Signaturc)
Robb Johneon Kurt C. LundblRd
ypo Name (Type Nat�c)
V �r eaidcnt . Attorncy-Zn-Fact
(Type Title) ('Z`ype Ti e
(NOTE: COMPLETE ACNOWLEDGEMENT FORM AND
ATTACH APPROPRIATE POWER OF ATTORNEY)
.
�� PaymenC Bond
809011
00614-2
12f16/2005 09:06 FAX 6512989113 ECI � 00�/009
Prlor Lake 7120 Improvements
� �¢tTO� �10 • tdri COL1nCi�
Bullding cnrnn�unlHns thof work
ACKNOWLEDGMENT OF PRINCIPAL
' (For Partnership)
STATE OF
couiv oF �'
The foregoing bond was acknowledged before me this day of , z0
by _�
(Name), partner on behalf of,
(Name of Partnership) a partnership.
(seal)
Notary Public
ACKNOWLEDGMENT OF PRINCIPAL
(For Corporation)
STATE OF Minncsota
ss.
� COUNTY OF �tamsey ,
The foregoing bond was acknowledged before me this i�th day of Octobe� , 20 OS , by
�obb Jo6nson ( ame , Vice President 't e
of Engincoring & Coustruction ��naovations, Xnc. (i'u11 Corporation Na�m�)
a Minnesota (st corporation, on behalf of the corporation.
��+r��!.��t,�r-�� .
�� ,.�"�
���� �� t�.•^, ri�i� �', CJR�,�ld ublic
� �~x�}y�-�:,., + Notary P
;�; • � ,� �Fil 'O
��+�F�i n�y Gnr•+n��,:iG� Gxpi,ea 5i, 2f!10
h '� t �� r �'�"� WLEDGMENT OF SURETY
5TATE OF 1V�innesota
ss.
COUNTY OF Ramsey
The foregoing bond was acknowledged before me this 19t6 day of Octobcr , 20 OS , by
Kurt C. Lundblad ( ame�, attorney-in-fact of
Travelers as�talty and Surety Company of America fFull Sureiv Na,�ngl
a Con�accticut St cor oration on e alf of the corpora�on.
'r�,�j�, .�.,;�<xtrsl -
"�"'"�' (No ary Public)
,
>�� .; '`•= � `�, h': .:��,•:°.: i .. ��l.:h�,�thi��
� � '` a�'/ ;r~ L+ ���, �,-: '.iy F:{���� If f . �;1,��1lar 1�; , �
C '
' y � �' R' (�T��C MPLETE ACKNOWLEDGMENT FROM AND
'� ` !,; �ii i C�,r,t,:u:�: •7+: ��rii
t '�'��`� r '�� APPROPRIATE POWEIt OF ATTORNL��
04P087
Payment eond
809011
00614-3
12/16/2��5 09:06 FAX 6512989113 ECI � 008/p09
� .�
'�R�1'VLI.ERS CASU2IL'�X AND SURETX COMI',A1�7( OF A1YXL�RICA
x6tAVBLERS CASUALTY AIVD SURE'�'Y COMPANX
FARMINGTOI�I CASUAL' TY COMpr1Ny
I3artYord,.Conneeticut 06183-9062
�OWER OF ATTORNEY AND CERTIFXCAT� OF AIITSAR�'�Y OF AT�'ORNEY(S)-xAi-FACT
KNOW Ax.T, PER50NS BY 'I'BES� FRT�S�NTS, TgAT x'RAVEL�,S CASUA�.TY AND 3URST7l COIV�ANY O�'
'`'���C`� x����5 CA�SUAI-x`X' AND S�RETX COMPANY and FAgt1�1GTON CASIIALx'X CO1Vl�ANY,
corporntions duly organized undcz the laws o# thc State of Connccticu� and having theii pri�cipal offices in the City of Hartfotd�
County of Haziford, State ot' Connccticut, (hereina�tr the ��omp�eb,') �th made, constituted and appointed, and do by thesc
Presents �t&ke, constitute and 2ppoinL C.A. Hauah, C6ristinc 1VY. $aneen, b.�. Dongherty, Lr. Lange, Jack Cedairllesf T[, Kurt
C. Lundhl�d, o� St Paul, Minne9ota� their Grue and lawful A a e
ttozncy(s)-in-Fact, with fiil,l power and authority lucr�by coaber�ced to
sign, c.rc.ccute and aclrnawladge, at any plaae within the Unital States, the fo�owing instrum�nt(�): by his/her solc signaturo aad a�ct,
any and all bonds, recogniza,nces� contracts o;f inrlcmaity� and other woitings obugatory in tt�e na�r� of a bo�d� recognizancc, or
conditional undcttalring and a�y and all coneents inaident thercto a�d to bind the Companies� thercby as fully and to the same extcnt
as if the same were signed lry the dnly authorized offiacrs of the Companies, and all the acts oF said Attornty(s)-in Fact, p�asuant to
the authoritY hexein givcn, aze hexebq tatified and cotrH[med.
This appointment is made under and by authority o,� thc �fnl�owins Standing Rcsoludona of said Compaaies, which Rusolutioas ate
now in full forcc and c�'ect:
r
VOTBll: lhat the Ghairmen, the I'tesident, a�y Viee ChamnAa, any Pacecufiivc Vice PresiJcm, arry Senior Vice I'reaident. any Yce Psrsidarrt, aaY
. Second Vice Preeident, the Tra�surer, n�ty Assistant Trei+aurrer, ihe Cozporeta gooretary ar nny Assistartt Scacetary may appni=tt A
and Asenb to act far and an behalf o�' the cam and ma ��Ys-m-Fact
�►Y Y�nive auch np�intee snch authority as hia or her oertifieate of auth�ity maY prescri�be
to si�t with the Compsny's name a�td seal with thc Canpari,ys aeal bonds. re�og�izar►c�a, conisacts of inde,mtiity, and other writings obligata�y in
U�c nature of a b�;d, reco�iaanco, or conditional undertekang� end a� of eaid of�ioeca ex the Hoard of Dirxto� at eaY timc ma�'remove �ny sueh
appointee and revoke tht pow+er given 1rim oa' har.
VO�D: That the Chairme=►. the presidcnt, any Vice Citiaiimea, eay �xecutivc Vice Presidcnt, any Scnior Vice Pregideat as a�y Vice President
may dele�te ell ar aay part of tlle fotegoing autharity to one ot marc officer�+ or empleyees nf this ComD�Y. P�vided that each anch delegetiosi is
in writing aad e copy thercof is filtd in the oSuae of the Se�y.
VO�?D: T�at any bond, rer canh�act of in�lernrkity, or writing obligatary in the nature of a bond, recognizancq or umditional
vndcrtnki�� ahall be valid and binding upon the Compaay whea (a) ai�ncd by the Preaidcet, any Vicc Chaim�an, aay Exr.cutive Vice Prosiden� an.y
Sauor Vice President or any Vico pneiden� �y ��d Vice Preaident, the Tzeasurcr, any q�i$� �'��� � Cocparate 3e�
Asaistant 3ecretary and duly attested and sealed with thc Com 's aeal c�Y ot pay
re uired P�Y bY a�r�Y ar Aasist�trt SecretarY. or (b) dulY txccuted (unda seal� if
9 ) bY one or more Attorneys-in-Fact nnd Ag+errts p�utsuant to t6e power pccsaribed in his or tuec ecrtiGcate ar tttcir ccrtificah;s of autharity ar
by one or more Compa�y ot�icers puc�uaut !o a wIitten dele,gation of authoril,y.
Thi� �►ower of Attarney and Certx�'icate o� ,A.uthnraty u�iigued and seaYcd by facaimile (mechanical or p�iated) antle�r aad by
uuthority of thc folpowing Standing Resolution �mted by the Boards of D'uectors of TRAV'E�,��S CASUAX,�"f�' AND SURETy
C4MQANY OF A1V��LICA, �'�AV�,]� �U�,x-x, pNA SURETy COMpANY and 1�'AR1V�A�TGTON CASIIALTY
CO1ViPA1VX, wbich �olntioo is nrnv iu full farc� aa��t effect:
VOTED: 7hat the sigaaturc o�' eACh of the �llov�ring o�cen: Pnaidcnt� as�y Lxocutive Vice President, aqy $eniot Vioe President, u�y Vice
1'ttsidcnt, �lV Assistani Via Presideat, any Secretaty, any Assiataat 9ocre4sry, snd thc se�ai of the C an
paa�er of attomey or m eny certi�cate relaiin thereto n °mP Y�Y be affixed by facsimile to any
g �poiating Residw! Viae Aresidents, Resiident Aeristent Secretaries or Attornrys-i�Fatt for
P�uposes aaily of exautiag nnd attesting bonds m�d uadcrtakings and other wtitings abligatory im the nahtt+e thereoP, end azty sueh potiver of attomey
or certificacc beating snch fnc�imile sig�aitue or fecsimile ual �11 be valid and binding npon the Com�y and eay snd4 povver so e�ceouted and
cczti�ed by such facsimile �ip�ature aad facsimile seal ahall bc valid ard bindiag upon the Compaay in the fu�c�c t�vith resper.t to eny bomd or
undcstaldng M whieh it is attscMecl.
(o2-oa) th+tiRUt«l
12/16/2005 09:07 FAX 6512989113 ECI � 009/009
� srPau�.
TRAVE�ER5
IMPOF2TANT DISCLQSURE NOTICE �F TERRORISM
INSURANCE COVERAGE
On Nov. 26, 2002, President 8ush 5igned into law the Terrorism �
Risk Insurance Act of 2002 (the "Act"). The A�t establishes a
short-term program underwhich the federal govemmentwiil shane �
in the payrrtient of cover�ed losses �aused by certain acts of
intemational terrorism. We� are providing you with this notice to
inform you of the key features of the� Act, and to let you know what
effect, if any, the Act will have on your premium.
Under the Act, insurers are required to provide carrerage for �
certain losses caused by international acts of terrorism as defined
in the Act. The Ac# further provides that the federal govemment
will pay a share of such losses. Specifically, the federal
govemment will pay 90 percent of the amount of covered losses
caused by certain acts of temorism, which is in excess of an
insurers statutority established deductible far that year. The Act
also caps the amount af terrorism-r�elated losses for which the
federel govemment or an insurer can be respansible af �.
$100 billion, provided fhat the insurer has met its dcductible.
Please note that passage of the Act does not result in any change
in coverage under the attached policy or tmnd (or the policy or
bond being quoted). Please also note that no separate additional
premium change has been made for the terrorism coverage �
required by the Act. The premium charge that is allocable to such
coverage is inseparable from and irnbedded in your ovierall
, pr�emium, and is no more than one percent of your premium.
ILT• 1018 (9/(I�1)
12/16/2005 09:07 FAk 6512989113 ECI � 001/001
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OP ID °AT� INN�r)
ACORD CERTIFICATE O� LIABILl7Y tNSURANCE ENGI2dEE �.z ia os
OAODUOER TMIS CERTIFICATE 13 ISSUED AS A MATTER OF lNFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE �
Piaroe Agancy , Inn • HOIDER. TH13 CERTIFICATE DOES NOT AMEND, EXTEND Oli
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
p,o. Box d18
Litchfiald MN 55355 NAIC M
Phoz�e Faut:320-693��3452 INSURERSAFFORDINGCOVERNGE
WSURFD INS URERA. i ie�tazn Natxonal Mubual
E,nginaerinq t Construction u+sur�ae:
Inc�►ovatione, Inc iN�uREpc
PO Box 7095 '
780 Barqe Channel RoAd iNSU�o�
st paul 1� 5510� iNSuAEaE:.
COVEW►GES �
TME Po�iGE9 OF aSUiiANCE L�ST@0 BELOW N�VE BEEN 15�UE0 TO THE INSUREO N�ED AEOVE FOR TH� POLIC� PERIOD INDICA�'E0� NOTINITHICTANDING
ANV REQUIIiEMENT, TFRWION COND�TION OF ANY CONTAl�7 OR OTF1�lt DOCUM�1 �N Rl�I`EGT TO WNICM TMIS C�7fPICATE ►wY 6E ISSVEO OR
F
MAT pE1lT1UN, TME �N3UPN1C61�'FpR060 8'�Ti iE POLIGIES DE8CR18E0 HERCIN IS SU��BC� TO ALl TME TER�� ��S��g � ��mON3 OP SUC
v0�1t1lf. ACAREGIITE lq+rt's SNOWN MAY HnVE BEEN pE�ED B7 PA�O CWMS�
pO1,IGYNUNBER OA M � M ���
LM � N � T� ����N� MCtt OGCWtAlNCE 1 1. OO�
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cwMS r� X� OCfUR MED EXP (M�Y � V�1 ' S 000
A X CP300a06543 01/31/05 01/31/06 reneo►�d����v s1 000,000'
�FNEHALAGOPF.GATE E Z OOO OOO
vnoouc�•coMrror.r►o +2 000 000
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AUTOMOaLY UAaLfTY COMBWED SINGLE IW�T t], � OOO � OOO
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ANY MlTO OTMEP 7F1AN EA nGC s
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Fucc�s,uwenF�u une�urw =
A X xcua a cwusr� GU300002469 Ol/31/05 O1/31/06 nc,c,�EC,�rE
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D�R}p}qM pp pp�µTlpNS � LOCAT10NS f VEMIClEB I DICLUdIONS ADOE� � FNDOASENENT 18PEGAL Ptt0�1ElONS
The city of Prior Lako ia named as an addstional insured.
CER7IFICATE MOLDER CANCELUITION
PRIORI.�► �UI.Q ANY OF THEAlC9►E DE6�NDl0 Mt�ICIL�S 1E ���D eEF011�TH6 iY�►Tr
DATE1ME11EOR. TII! 198WNG IN9YRERNALL ENOBAVORTO �L i0 oA`IS WIIITT�
NOTOE 70 TNe CER17C1CA1'i M0��11 N/1ME0 TO THfi L4fT. BUT F10.tIR! TG DO 6O s�
�MppfE NO OBL16+1'ROl10R L �� �� A ��
Clty Of PY3.OT Lako REPRESENTAm�.
AUTFIORtiEO MJRESl�A� �
P=10� ��CO �
Sto hen R. p=o �� ) A C D POP
ACORD 26.�2001J08)