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HomeMy WebLinkAboutInt.Sign & Design #1r' SECTION 00410 BID FORM THIS BID IS SUBMITTED T0: City of Sunny Isles Beach 17070 Collins Avenue, Suite 9250 Sunny Isles Beach, Florida 33160 MAY 15 2003 11 1. The undersigned BIDDER proposes and agrees, if this Bid is accepted, to enter into an agreement with The City of Sunny Isles Beach in the form included in the Contract Documents to perform and famish all Work as specified or indicated in the Contract Documents for the Contract Price and within the Contract Time indicated in this Bid and in accordance with the other terms and conditions of the Contract Documents. 2. BIDDER accepts all of the terms and conditions of the Advertisement or Invitation to Bid and Instructions to BIDDER'S, including without limitation those dealing with the disposition ofBid Security. This Bid will remain subject to acceptance for 90 days after the day of Bid opening. BIDDER agrees to sign and submit the Agreement with the Bonds and other documents required by the Bidding Requirements within ten days after the date of City's Notice of Award. 3. In submitting this Bid, BIDDER represents, as more fully set forth in the Agreement, that: (a) BIDDER has examined copies of all the Bidding Documents and of the following Addenda (receipt of all which is hereby acknowledged.) Addendum No. Dated: Addendum No. Dated: Addendum No. Dated: Addendum No. Dated: (b) BIDDER has familiarized themselves with the nature and extent of the Contract Documents, Work, site, locality, and all local conditions and Law and Regulations that in any manner may affect cost, progress, performance or furnishing of the Work. (c) BIDDER has studied carefully all reports and drawings of subsurface conditions and drawings of physical conditions. (d) BIDDER has obtained and carefully studied (or assumes responsibility for obtaining and carefully 00410-1 studying) all such examinations, investigations, explorations, tests and studies (in addition to or to supplement those referred to in (c) above) which pertain to the subsurface or physical conditions at the site or otherwise may affect the cost, progress, performance, or furnishing of the Work at the Contract Price, within the Contract Time and in accordance with the other terms and conditions of the Contract Documents, and no additional examinations, investigations, explorations, tests, reports or similar information or data are or will be required by BIDDER for such purposes. (e) BIDDER has reviewed and checked all information and data shown or indicated on the Contract Documents with respect to existing Underground Facilities at or contiguous to the site and assumes responsibility for the accurate location of said Underground Facilities. No additional examinations, investigations, explorations, tests, reports or similar information or data in respect of said Underground Facilities are or will be required by BIDDER in order to perform and furnish the Work at the Contract Price, within the Contract Time and in accordance with the other terms and conditions of the Contract Documents. (f) BIDDER has correlated the results of all such observations, examinations, investigations, explorations, tests, reports and studies with the terms and conditions of the Contract Documents. (g) BIDDER has given Consultant written notice of all conflicts, errors, discrepancies that it has discovered in the Contract Documents and the written resolution thereof by Consultant is acceptable to BIDDER. (h) This Bid is genuine and not made in the interest of or on behalf of any undisclosed person, firm or corporation and is not submitted in conformity with any agreement or rules of any group, association, organization, or corporation; BIDDER has not directly or indirectly induced or solicited any other BIDDER to submit a false or sham Bid; BIDDER has not solicited or induced any person, firm or corporation to refrain from bidding; and BIDDER has not sought by collusion to obtain for itself any advantage over any other BIDDER or over the City. 4. BIDDER understands and agrees that the Contract Price is lump sum to furnish and install all of the Work complete in place. The Schedule of Values is provided for the purpose of Bid Evaluation and when initiated by the City, the pricing of change orders. Contractor's price will not be adjusted to reflect any deviation from the Schedule Of Values, except to the extent that the City changes the scope of Project after the Contract Date. As such the Contractor shall furnish all labor, materials, equipment, tools superintendence and services necessary to provide a complete in place Project for the Bid Price of 00410-2 A h BASE BID: SEVENTY SEVEN THOUSAND, FIFTY THREE dollars and ZERO cents LUMP SUM (Written Total Base Bid Price - From Schedule Of Values, Page 00410 -4) BIDDER agrees that the work will be complete in full within 150 calendar days from the date stipulated in the Notice to Proceed. Communications concerning this Bid shall be addressed to: BIDDER INTERNATIONAL SIGN & DESIGN CORPORATION Address: Telephone Facsimile Number 10831 CANAL STREET LARGO, FLORIDA 33777 727 -541 -5573 727 - 544 -7745 Attention: THOMAS J. KITCHELL The terms used in this Bid which are defined in the general Conditions of the Construction Contract included as part of the Contract documents have the meanings assigned to them in the General Conditions. SUBMITTED THIS DA)MAY 14 20 03 00410-3 SCHEDULE OF VALUES FOR LUMP SUM CONTRACT BASE BID CITY OF SUNNY ISLES BEACH ENTRANCE SIGNAGE SIGNAGE References Section Description Unit Unit Price 02841 Sign Type I (Installed) LS s42,663 02841 Sign Type II (Installed) LS $14,399 02841 Sign Type III (Installed) LS $19,991 TOTAL OF BASE BID $ 77,053 00410-4 A CORPORATION By: INTERNATIONAL SIGN & DESIGN CORPORATION (Corporation Name) FLORIDA 0 Attest: WILLIAM H. GRIFFIN PRESIDENT (Title) (Corporate Seal) (S (Name of Person Authorized to Sign) (President) Business address: 10831 CANAL STREET LARGO, FLORIDA 33777 Phone No: 727 -541 -5573 Facsimile No: 727- 544 -7745 00410-7 CERTIFICATE OF AUTHORITY (IF CORPORATION STATE OF FLORIDA ) SS: COUNTY OF PINELLAS ) I HEREBY CERTIFY that a meeting of the Board of Directors of the INTERNATIONAL SIGN & DESIGN CORPORATION a corporation existing under the laws of the State of FLORIDA 20 0 3 , the following resolution was duly passed and adopted: , held on MAY 14 , "RESOLVED, that as President of the Corporation, be and is hereby authorized to execute the Bid dated, MAY 15 , 20 03 , to the City of Sunny Isles Beach and this corporation and that their execution thereof, attested by the Secretary of the Corporation, and with the Corporate Seal affixed, shall be the official act and deed of this Corporation." I further certify that said resolution is now in full force and effect. IN WITNESS WHERE F, I have hereunto set my hand and affixed the official seal of the corporation this , day of , 200 . Secretary: (SEAL) LINDA M. LABONTE Notary Public, State of Florida My comm. exp. Aug. 24, 2004 Comm. No. CC 955383 00410-9 SECTION 00456 PUBLIC ENTITY CRIlVIES Pursuant to the provisions of paragraph (2) (a) of Section 287.133, Florida State Statutes - A person or affiliate who has been placed on the convicted vendor list following a conviction for a public entity crime may not submit a Bid on a Contract to provide any goods or services to a public entity, may not submit a Bid on a Contract with a public entity for the construction or repair of a public building or public Work, may not submit bids on leases of real property to a public entity, may not be awarded to perform Work as a Contractor, supplier, Subcontractor, or Consultant under a Contract with any public entity, and may not transact business with any public entity in excess of the threshold amount Category Two of Sec. 287.017, FS for thirty six months from the date of being placed on the convicted vendor list ". CONFLICTS OF INTEREST The award of any contract hereunder is subject to the provisions of Chapter 112, Florida State Statutes. BIDDER's must disclose with their Bids, the name of any officer, director, partner, associate or agent who is also an officer or employee of the City of Sunny Isles Beach or it's agencies. 00456-1 SWORN STATEMENT PURSUANT TO SECTION 287.133(3)(a) FLORIDA STATUTES, ON PUBLIC ENTITY CRIMES THIS FORM MUST BE SIGNED AND SWORN TO IN THE PRESENCE OF A NOTARY PUBLIC OR OTHER OFFICIAL AUTHORIZED TO ADMINISTER OATHS. This swom statement is submitted toCITY OF SUNNY ISLES BEACHby WILLIAM H. GRIFFIN for INTERNATIORAL SIGN & DE= CORP. whose business address is L STREET, LARGO, 33777 _ and (if applicable) its Federal Employer Identification Number (FEIN) is (IF the entity had no FEIN, include the Social Security Number of the individual signing this sworn statement: FEIN #59-1683519 I understand that a "public entity crime" as defined in Paragraph 287.133(1)(g), Florida Statutes, means a violation of any state or federal law by a person with respect to and directly related to the transaction of business with any public entity or with an agency or political subdivision of any other state or with the United States, including, but not limited to, any Bid or Contract for goods or services to be provided to any public entity or an agency or political subdivision of any other state of the United States and involving antitrust, fraud, theft, bribery, collusion, racketeering, conspiracy, or material misrepresentation. 3. I understand that "convicted" or "conviction" as defined in Para. 287.133(1)(b), Florida Statutes, means a finding of guilt or a conviction of a public entity crime, with or without an adjudication of guilt, in any federal or state trail court of record relating to charges brought by indictment or information after July 1, 1989, as a result of a jury verdict, non jury trial, or entry of a plea of guilty or nolo contendere. 4. I understand that an "affiliate" as defined in Para. 287.133(I)(a), Florida Statutes, means: A predecessor or successor of a person convicted of a public entity crime; or 1 Any entity under the control of any natural person who is active in the management of the entity and who has been convicted of a public entity crime. The term "affiliate" includes those officers, directors, executors, partners, shareholders, employees, members, and agents who are active in the management of an affiliate. The ownership by one person of shares constituting a controlling interest in another person, or a pooling of equipment or income among persons when not for fair market value under an arm's length agreement, shall be a prime facie case that one person controls another person. A person who knowingly enters into a joint venture with a person who has been convicted of a public entity crime in Florida during the preceding 36 months shall be considered an affiliate. I understand that a "person" as defined in Para. 287.133(1)(e), Florida Statutes, means any natural person or entity organized under the laws of any state or of the United States with the legal power to enter into a binding Contract and which Bids or applies to Bid on Contracts for the provision of goods or services let by a public entity, or which otherwise transacts or applies to transact business with a public entity. The term "persons" includes those officers, directors, executives, partners, shareholders, employees, members, and agents who are active in management of any entity. 6. Based on information and belief, the statement which I have marked below is true in relation to the entity submitting this sworn statement. (Indicate which statement applies.) X Neither the entity submitting this sworn statement, nor any of it's officers, directors, executives, partners, shareholders, employees, members, or agents who are active in the management of the entity, nor any affiliate of the entity has been charged with and convicted of a public entity crime subsequent to July 1, 1989. 00456-2 The entity submitting this sworn statement, or one or more of its officers, directors, executives, partners, shareholders, employees, members, or agents who are active in the management of the entity, or an affiliate of the entity has been charged with and convicted of a public entity crime subsequent to July 1, 1989. The entity submitting this sworn statement, or one or more of its officers, directors, executives, partners, shareholders, employees, members, or agents who are active in the management of the entity, or an affiliate of the entity has been charged with and convicted of a public entity crime subsequent to July 1, 1989. However, there has been a subsequent proceeding before a Hearing Officer of the State of Florida, Division of Administrative Hearings and the Final Order entered by the Hearing Officer of the State of Florida, Division of Administrative Hearings and the Final Order entered by the Hearing Officer determined that it was not in the public interest to place the entity submitting this sworn statement on the convicted vendor list. (Attach a copy of the final order.) I UNDERSTAND THAT THE SUBMISSION OF THIS FORM TO THE CONTRACTING OFFICER FOR THE PUBLIC ENTITY IDENTIFIED IN PARAGRAPH 1 (ONE) ABOVE IS FOR THAT PUBLIC ENTITY ONLY AND, THAT THIS FORM IS VALID THROUGH DECEMBER 31 OF THE CALENDAR YEAR IN WHICH IT IS FILED. I ALSO UNDERSTAND THAT I AM REQUIRED TO INFORM THE PUBLIC ENTITY PRIOR TO ENTERING INTO A CONTRACT IN EXCESS OF THE THRESHOLD AMOUNT PROVIDED IN SECTION 287.017, FLORID A STATUTES, FOR CATEGORY TWO OF ANY, CHANGE IN THE INFORMATION CONTAINED IN THIS FORM. 00456-3 By: WILLIAM H. FFIN (Printed Name) PRESIDENT (Title) Sworn to and subscribed fore me this �5 day of 120 Personally known Or Produced Identification Notary Public - State of My Commission Expires (Type of Identification) (Printed, typed, or stamped commissioned name of notary public) LINDA M. LABONTE Notary Public, State of Florida END OF SECTION My comm. exp. Aug. 24, 2004 Comm. No. CC 955383 00456-4 ACORD, CERTIFICATE OF LIABILITY INSURANCE OP ID Kl DATE(MM /DD/YYYY) INTE -17 05/13/03 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION TYPE OF INSURANCE ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Brown & Brown, Inc. HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR P. 0. Box 1229 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Tampa FL 33601 -1229 GENERAL LIABILITY Phone: 813- 226 -1300 Fax: 813- 226 -1313 INSURERS AFFORDING COVERAGE NAIC # INSURED INSURER A: AUTO OWNERS INSURANCE 18988 Intez7national Sig4 & Design Corp Sign X-Press Wm H Gr if fin ATIMA INSURER B: AUTO OWNERS INSURANCE 18988 INSURER C: ZENITH INSURANCE CO PREMISES(Ea occurence) 10831 Canal Street Largo FL 33777 -1696 INSURER D: $5,000 INSURER E: s500,000 COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTR NSR I TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE MM /DD/YY POLICY EXPIRATION DATE (MMIDDIYYI LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 500 , 000 A X COMMERCIAL GENERAL LIABILITY CLAIMS MADE OCCUR 20545600 04/15/03 04/15/04 PREMISES(Ea occurence) $50,000 MED EXP (Any one person) $5,000 PERSONAL BADV INJURY s500,000 GENERAL AGGREGATE $500,000 GENT AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP /OP AGG $ 500 , 000 POLICY X PRO- JECT LOC B AUTOMOBILE LIABILITY ANY AUTO 9669517500 04/15/03 04/15/04 COMBINED SINGLE LIMIT (Ea CO accident) $ 1 000 000 r r X ALL OWNED AUTOS SCHEDULED AUTOS BODILY INJURY (Per person) $ HIRED AUTOS NON -OWNED AUTOS BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ ANY AUTO H OTHER THAN EA ACC $ $ AUTO ONLY: AGG EXCESS /UMBRELLA LIABILITY EACH OCCURRENCE $ 5,000,000 B X OCCUR E-1 CLAIMS MADE 9669517501 04/15/03 04/15/04 AGGREGATE $ 5,000,OOO DEDUCTIBLE $ X RETENTION $10,000 $ C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER /EXECUTIVE Z830005715 09/15/02 09/15/03 X TORY LIMITS ER E.L. EACH ACCIDENT $500 OOO r OFFICER /MEMBER EXCLUDED? If yes, describe under E.L. DISEASE - EA EMPLOYEE s500,000 E.L. DISEASE - POLICY LIMIT 1 $500,000 SPECIAL PROVISIONS below OTHER A Installation 20545600 04/15/03 04/15/04 Inst Fltr $50,000 Floater I All Risk DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION CITYOFS SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATIO DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 010 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL City of Sunny Isles Beach IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR 17070 Collins Avenue #250 REPRP NTATIVES. Sunny Isles Beach FL 33160 A THORI DREPRESE rA ACORD 25 (2001/08) © ACORD CORPORATION 198 r THE AMERICAN INSTITUTE OF ARCHITECTS ENNUI,' AIA Document A310 Bid Bond KNOW ALL MEN BY THESE PRESENTS, that we (Here insert full name and address or legal title of Contractor) INTERNATIONAL SIGN & DESIGN CORPORATION 10831 CANAL ST. LARGO, FL 33777 as Principal, hereinafter called the Principal, and (Here insert full name and address or legal title of Surety) WESTERN SURETY COMPANY PO BOX 946640 MAITLAND, FL 32794 -6640 a corporation duly organized under the laws of the State of SOUTH DAKOTA as Surety, hereinafter called the Surety, are held and firmly bound unto (Here insert full name and address or legal title of Owner) CITY OF SUNNY ISLES BEACH, FLORIDA 17070 COLLINS AVE., SUITE 250 SUNNY ISLES BEACH, FL 33160 as Obligee, hereinafter called the Obligee, in the sum of FIVE PERCENT OF THE AMOUNT BID -------------------------------------------------------- Dollars, ($ ------ 5 % ------ ) for the payment of which sum well and truly to be made, the said Principal and the said Surety, bind ourselves, our heirs, executors, administrators, successors and assigns, jointly and severally, firmly by these presents. WHEREAS, the Principal has submitted a bid for (Here insert full name, address and descrint;on of projoct, Entryway Signage Bid No. 03 -04 -01 BID DATE: May 15, 2003 NOW, THEREFORE, if the Obligee shall accept the bid of the Principal and the Principal shall enter into a Contract with tine Obligee in accordance with the terms of such bid, and give such bond or bonds as may be specified in the bidding or Cor ac:: Documents with good and sufficient surety for the faithful performance of such Contract and for the prompt payment of labor and materials furnished in the prosecution thereof, or in the event of the failure of the Principal to enter such Contract and give such bond or bonds, if the Principal shall pay to the Obligee the difference not to exceed the penalty hereof between the amount specified in said bid and such larger amount for which the Obligee may in good faith contract with another party to perform the Work covered by said bid, then this obligation shall be null and void, otherwise to remain in full force and effect. Signed and sealed this 13th (Witness) day of May 20 03. INTERNATIONAL SIGAI & ADE.%TGN CORPORATION / R ea WESTERN SURETY COMPANY / ure y ea (Witness) \ /to Amt sep W. LoPresti, (Title) Attorney -ir. -Fact. and Florida Resident Agent INQUIRIES: 8131226 -1312 AIA DOCUMENT A310 • BID BOND • AIA 11 • FEBRUARY 1970 ED. • THE AMERICAN INSTITUTE OF ARCHITECTS, 1735 N.Y. AVE., N.W., WASHINGTON, D.C. 20006 r NOTICE In accordance with the Terrorism Risk Insurance Act of 2002, we are providing this disclosure notice for bonds and certain insurance policies on which one or more of the Writing Companies identified below is the surety or insurer. To principals on bonds and insureds on certain insurance policies written by any one or more of the following companies (collectively the "Writing Companies ") as surety or insurer: Western Surety Company, Universal Surety of America, Surety Bonding Company of America, Continental Casualty Company, National Fire Insurance Company of Hartford, American Casualty Company of Reading, PA, The Firemen's Insurance Company of Newark, NJ, and The Continental Insurance Company. DISCLOSURE OF PREMIUM The premium attributable to coverage for terrorist acts certified under the Act was Zero Dollars ($0.00). DISCLOSURE OF FEDERAL PARTICIPATION IN PAYMENT OF TERRORISM LOSSES The United States will pay ninety percent (90 %) of covered terrorism losses exceeding the applicable surety /insurer deductible. Form F7310 Western Surety Company 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 Joseph W LoPresti, C Roy Bridges, Russell Ayers, Rita M Lucas, Peter N Lagos, Individually of Tampa, FL, its true and lawful Attomey(s) -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 - 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 Attomey is made and executed pursuant to and by authority of th , 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 Executive Vice President and its corporate seal to be hereto affixed on this 26th day of September, 2001. State of South Dakota ss County of Minnehaha On this 26th day of September, 2001, before me personally came Stephen T. Pate, to me known, who, being by me duly swom, did depose and say: that he resides in the City of Sioux Falls, State of South Dakota; that he is the Executive 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 •"`"""""""""""""M'M'~" "`'+ { J. MOHR { _ r October 22, 2005 J SEAL NOTARY PUBLIC SEAL { {SOUTH DAKOTAd Commission Expires t0- :2'2005 L 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 ill force, and further certify that the By -Law of the corporation printed on the reverse hereof is still in force. In testimony whereof l have hereunto subscribed my name and affixed the seal of the said corporation this 13th day of May 2003 Form F12SO -04 -01 5 ' °c N WESTERN SURETY COMPANY o a:4 �iD :2 '1PA ��N DAKO L. Nelson, Assistant Secretary WESTERN SURETY COMPANY r "�aer �'•_.._.. •01pa. )NppK Stephen T. Pate, Executive Vice President State of South Dakota ss County of Minnehaha On this 26th day of September, 2001, before me personally came Stephen T. Pate, to me known, who, being by me duly swom, did depose and say: that he resides in the City of Sioux Falls, State of South Dakota; that he is the Executive 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 •"`"""""""""""""M'M'~" "`'+ { J. MOHR { _ r October 22, 2005 J SEAL NOTARY PUBLIC SEAL { {SOUTH DAKOTAd Commission Expires t0- :2'2005 L 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 ill force, and further certify that the By -Law of the corporation printed on the reverse hereof is still in force. In testimony whereof l have hereunto subscribed my name and affixed the seal of the said corporation this 13th day of May 2003 Form F12SO -04 -01 5 ' °c N WESTERN SURETY COMPANY o a:4 �iD :2 '1PA ��N DAKO L. Nelson, Assistant Secretary