Addendum No. 2.pdf

751.13243.JBB Addendum #2.docx Page 1 of 2

ADDENDUM NO. 2

DATE: June 1, 2020

PROJECT: Baraga to Arnheim Rail Trail – Phase 3 Trestle Deck Repair over the Little Carp River

OWNER: State of Michigan

FILE NO.: 751/13243.JBB

INDEX NO.: 51110

BID DATE: Wednesday, May 13, 2020 at 2:00 p.m. Wednesday, July 8, 2020 at 2:00 p.m.

Eastern Time (1:00 p.m. Central Time)

The following shall be incorporated into the Contract Documents dated 31 MAR 2020.

GENERAL

This addendum is being issued to update bid dates and provide language needed to comply with COVID 19 Safety following all federal and state requirements and guidelines.

SPECIFICATIONS

PROJECT ADVERTISEMENT:

An updated Project Advertisement is attached.

BID SUMMARY

An updated Bid Summary is attached.

DC SPEC

Division 00, Section 00010, Paragraph 8, Revise to:

All requests or inquiries concerning the Bidding Documents or the Work must be addressed to: Michael Markham, PE, OHM Advisors at (906)482-0535. Questions will be accepted until 12:00 p.m. Eastern Time on June 29th, 2020.

Division 00, Section 00100, Paragraph 23, Revise to:

CONTRACT TIME; LIQUIDATED DAMAGES: Work of all trades as specified in the Contract Documents must be substantially completed by July 30, 2021, with final completion to be August 20, 2021 based on Notice-to-Proceed except for minor replacement, correction, or adjustment items which do not interfere with the complete operation and utilization of all parts of the Contract Work. This Contract Time is of the essence and liquidated damages for each Calendar Day that expires after this Substantial Completion of the entire Work must be in the amount of $150 per day. Liquidated damages will be in the amount of $100 per day for each day after final completion. Liquidated damages are not a penalty, are cumulative and represent a reasonable estimate of the Owner’s extra costs and damages, which are difficult to estimate with accuracy in advance.

Division 00, Section 00800, Add Paragraph 2 to Section:

2. The Contractor will be required to create a project specific COVID19 Safety/Operations Plan complying with all federal & state requirements and guidelines, including but not limited to, the most recent Executive Orders, OSHA, MiOSHA, and the CDC.

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DRAWINGS

No Changes

End of Addendum No. 2

DTMB-0415 (R 11/19)

PROJECT ADVERTISEMENT

DEPARTMENT OF TECHNOLOGY, MANAGEMENT AND BUDGET

STATE FACILITIES ADMINISTRATION

DESIGN & CONSTRUCTION DIVISION

This form is required for the advertisement of all construction projects. (1984 PA 431)

TO:

DESIGN & CONSTRUCTION DIVISION

DATE

June 1, 2020

FROM:

DTMB/DNR

PROJECT MANAGER

Jeff Barsch

DTMB FILE NUMBER

751/13243.JBB

ACCOUNTING TEMPLATE

ADVERTISEMENT DATE

March 31, 2020

ELECTRONIC BID DUE DATE

Wednesday, July 8, 2020 at 2:00 p.m. Eastern Time (1:00 p.m. Central Time)

PROJECT NAME AND LOCATION (INCLUDE STREET ADDRESS)

Baraga to Arnheim Rail Trail – Phase 3 Trestle Deck Repair Over Little Carp River

PHONE CONFERENCE DATE, TIME, AND LOCATION

A mandatory prebid phone conference will be held on Tuesday, June 9, 2020 at 3:00 p.m. EDT (2:00 p.m. CDT). Please call

(312) 584-2401 ext. 208750 to join the conference call. The contractor is highly encouraged to visit the projects site before submitting their bid. Any contractor participating in the conference call needs to e-mail the company name, name of person attending and contact number to Deana Wuori at deana.wuori@ohm-advisors.com one day prior to the conference call.

Mandatory Yes No

DESCRIPTION OF WORK:

Project consists of removal of the existing railroad ties and installation of a new steel frame bridge deck system with an oak wearing surface on the approximate 221-foot-long railroad trestle over the Little Carp River in Baraga Township. Work also includes the installation of steel railings and wood approach safety railings, concrete patching on the north abutment, riprap installation, clearing, permanent sheet piling installation, trail surfacing, restoration and associated SESC measures.

Please NOTE:

• Any contractors who perform a site visit prior to the bid submittal will need to comply with all federal and state COVID19 requirements and guidelines, including, but not limited to, the most recent State of Michigan Executive Order, OSHA, MiOSHA and CDC guidelines.

• All Bid Attachments MUST be uploaded to SIGMA VSS.

• Please remember that individual attachments can be no larger than 6 mb

• If you experience issues or have questions regarding your electronic submission, bidders must contact the SIGMA Help Desk for assistance.

Bidders can contact the Help Desk by calling 888-734-9749 or emailing sigma-procurement-helpdesk@michigan.gov or sigma-vendor@michigan.gov

• Bidders are reminded to keep our office apprised of SIGMA VSS issues and to include your SIGMA ticket number when communicating with our office. Emailed submissions will need prior DCD approval and will be handled on a case by case basis. Approved emailed submissions MUST be received prior to the 2:00 p.m. deadline to be considered.

5% Bid Security:

Required

Not Required

NIGP CODES: 91200, 91313, 91479

ACCEPTING QUESTIONS UNTIL: 12:00 p.m. Eastern on Monday, June 29, 2020

Documents may be obtained from:

https://sigma.michigan.gov/webapp/PRDVSS2X1/AltSelfService

PSC/Agency: OHM Advisors

Address: 424 Hancock Street, Hancock, MI 49930

Phone: (906) 482-0534

Email: deana.wuori@ohm-advisors.com

Fax: (906) 482-6453

Approved by:

Bidding and Contract Document (R 11/19) Baraga to Arnheim Phase 3 File No. 751/13243.JBB Trestle Deck Repair Over Little Carp River

DTMB-0401D (R 05/19)

BID SUMMARY

DEPARTMENT OF TECHNOLOGY, MANAGEMENT AND BUDGET

STATE FACILITIES ADMINISTRATION

DESIGN AND CONSTRUCTION DIVISION

3111 W. St. Joseph Street Lansing, Michigan 48917

Bids must be submitted electronically through the SIGMA VSS website at https://sigma.michigan.gov/webapp/PRDVSS2X1/AltSelfService

FILE NUMBER

751/13243.JBB

INDEX NUMBER

51110

DEPARTMENT/AGENCY

DTMB/DNR

CONTRACT TIME(S)

Substantial Completion: July 30, Final Completion: August 20, PROJECT NAME

Baraga to Arnheim Rail Trail Phase 3

LOCATION

Baraga, MI

BID OPENING DATE

Wednesday, July 8, 2021 at 2:00 pm Eastern Time

FOR AN EXAMINATION OF THE SITE CONTACT:

Recommended to visit site prior to prebid meeting

SEE SECTION 00100 INSTRUCTIONS TO BIDDERS AND SECTION 00700 GENERAL CONDITIONS PROVIDED WITH THE BIDDING DOCUMENTS.

BID: WE PROPOSE TO FURNISH, PERFORM AND COMPLETE THE ENTIRE WORK IN ACCORDANCE WITH THE CONTRACT DOCUMENTS IN

CONSIDERATION OF THE BID PRICE (S) STATED BELOW.

FIRM NAME AND COMPLETE ADDRESS TELEPHONE NUMBER and E-MAIL ADDRESS

□ Qualified Disabled Veteran

FEDERAL I.D. NUMBER (LAST 4 ONLY)

(protected information required for processing payments)

BIDDER'S SIGNATURE AND TITLE DATE

WITNESS' SIGNATURE DATE

By signing this bid above, bidder certifies their enclosed Qualified Disabled Veteran and Michigan-Based Business Certifications.

BASE BID FROM BID SCHEDULE (Include specified Allowances):

____________________________________________________________________________Dollars $____________________ (use words) (in figures)

Alternate1: (Add) ______________________________________________________ Dollars $ ____________________ (use words) (in figures)

Builder’s Risk Insurance is NOT provided by the State of Michigan.

A PERFORMANCE BOND AND A PAYMENT BOND ARE REQUIRED FOR ALL BIDS OVER $50,000.00. EACH BID MUST BE

ACCOMPANIED BY A FIVE (5) PERCENT BID GUARANTEE.

BIDDERS ARE ALSO CAUTIONED TO FAMILIARIZE THEMSELVES WITH ALL OF THE OTHER CONDITIONS OF THE CONTRACT.

Project Scope of Work:

Project consists of removal of the existing railroad ties and installation of a new steel frame bridge deck system with an oak wearing surface on the approximate 221-foot-long railroad trestle over the Little Carp River in Baraga Township. Work also includes the installation of steel railings and wood approach safety railings, concrete patching on the north abutment, riprap installation, clearing, permanent sheet piling installation, trail surfacing, restoration and associated SESC measures.

The Bidder must figure its Base Bid on the specified, or Addendum-approved, materials and equipment only. No “or equal” or substitution proposals will be permitted after Bid opening, except as provided in the General Conditions.

Addenda: Bidder acknowledges receipt of Addenda: No. ___ dated: ________, No. ___ dated: ________ No. ___ dated: ________

Bidding and Contract Document (R 11/19) Baraga to Arnheim Phase 3 File No. 751/13243.JBB

FIRM NAME TELEPHONE NUMBER and E-MAIL ADDRESS

BID SCHEDULE

Base Bid Schedule - The Bidder will complete the Work and accept as full payment, for the Work items listed, the following Unit Prices and/or Item Bid Prices, as applicable:

Base Bid Item No.

Bid Quantity

Description (Bidder to write price in Words)

Unit Price

Item Bid Price

1 1 Project Work

ALLOWANCE AMOUNT $5.000 $5,000

TOTAL (This amount should equal the Base Bid amount on the Bid Summary Form) $

Base Bid (Sum of Item Bid Prices for all Base Bid Items):

__________________________________________________________________ Dollars $__________________________ (use words) (in figures)

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Schedule of Alternates - The Bidder will complete (or deduct from the Contract) the parts of the Work designated by the Alternates that follow and accept in full payment (or allow in full credit) for those parts of the Work the following Item Bid Prices:

Alternate Item No.

Bid Quantity

Description (Bidder to write price in Words)

Unit Price

Item Bid Price

1 1 LSUM ADD ALTERNATE: SHEET PILE AND

RIPRAP

The Bidder further acknowledges and agrees that the separate prices bid on this “Schedule of Alternates,” where they are applicable and deemed acceptable by the Owner, will be used if incorporated into the Contract when the Owner issues the Notice of Award.

Schedule of Unit Prices or Contingent Change Order Prices - The Bidder shall use this “Schedule” to quote unit prices identified in the bid documents or propose other contingent Change Order prices. The proposed Unit Prices or contingent Change Order prices set forth in this schedule, at the sole discretion of the Owner, may, or may not be incorporated into the Contract Documents. The Owner reserves the right to negotiate Unit Prices or contingent Change Order prices set forth herein prior to their possible incorporation into the Contract Documents.

Item No.

Units or Quantity

Description

(Bidder to write price in Words)

Bidder’s Bid

Price

Price Proposed

By The Owner

Bidding and Contract Document (R 11/19) Baraga to Arnheim Phase 3 File No. 751/13243.JBB

DEPARTMENT OF TECHNOLOGY, MANAGEMENT AND BUDGET

State Facilities Administration

Design & Construction Division

Qualified Disabled Veteran (QDV) Business Representation

‘Qualified Disabled Veteran,’ means a business entity that is 51% or more owned by one or more veterans with a service-connected disability.

‘Qualified Disabled,’ means a business entity that is 51% or more owned by one or more with a service-connected disability.

The vendor represents that it IS _____, a qualified disabled veteran.

The contractor represents and warrants that the company meets the above (when checked) and has attached supporting documentation per the following:

Each bid requesting the Qualified Disabled Veterans (QDV) preference, in accordance with Public Act 22 of 2010, MCL 18.1241.3 shall include a DD214 Proof of Service and Discharge, a Veterans Administration rating decision letter, proof of disability (if the disability is not indicated on the DD214), and appropriate legal documents setting forth the 51% natural persons QDV ownership.

Fraudulent Certification as a Qualified Disabled Veteran may result in debarment under MCL 18.264.

Certification of a Michigan Based Business

(Information Required Prior to Contract Award for Application of State Reciprocity Provisions)

To qualify as a Michigan Based Business:

Vendor must have, during the 12 months immediately preceding this bid deadline:

or If the business is newly established, for the period the business has been in existence, it has:

(check all that apply):

Filed a Michigan single business tax return showing a portion or all of the income tax base allocated or apportioned to the State of Michigan pursuant to the Michigan Single Business Tax Act, 1975 PA 228, MCL

208.1 – 208.145; or

Filed a Michigan income tax return showing income generated in or attributed to the State of Michigan; or

Withheld Michigan income tax from compensation paid to the bidder’s owners and remitted the tax to the Department of Treasury; or

I certify that I have personal knowledge of such filing or withholding, that it was more than a nominal filing for the purpose of gaining the status of a Michigan business, and that it indicates a significant business presence in the state, considering the size of the business and the nature of its activities.

I authorize the Michigan Department of Treasury to verify that the business has or has not met the criteria for a Michigan business indicated above and to disclose the verifying information to the procuring agency.

Bidder shall also indicate one of the following:

Bidder qualifies as a Michigan business (provide zip code: ________________)

Bidder does not qualify as a Michigan business (provide name of State: _____________).

Principal place of business is outside the State of Michigan, however service/commodity provided by a location within the State of Michigan (provide zip code: (___________).

Fraudulent Certification as a Michigan business is prohibited by MCL 18.1268 § 268. A BUSINESS THAT PURPOSELY OR WILLFULLY SUBMITS A FALSE CERTIFICATION THAT IT IS A MICHIGAN BUSINESS OR FALSELY INDICATES THE STATE IN WHICH IT HAS ITS PRINCIPAL PLACE OF BUSINESS IS GUILTY OF A FELONY, PUNISHABLE BY A FINE OF NOT LESS THAN $25,000 and subject to debarment under MCL 18.264.

Bidding and Contract Document (R 11/19) Baraga to Arnheim Phase 3 File No. 751/13243.JBB

BID BOND

BID SUBMITTED ON the _______ day of ________________, 20____.

Bid Security is in the form of: a Bid Bond _______ Bid Bond form has been duly executed _______; or

A Bank Certified or Cashier's check ___ or Money Order ___ is attached to this page ____ (If Bid Security is by Check or Money Order, the original check or money order must be delivered to the issuing office before Bid Due Time. ALL other SIGMA bid submittals are also still to be made).

If the Bidder is an Individual:

Name of Individual: _________________________________________________________

Name & Title of Person Authorized to sign: ___________________________________________

Signature: _________________________________________________________ (If not the Individual, Attach Power of Attorney) Date

Doing Business as: _________________________________________________________

Business Address: _________________________________________________________

County of registration _________________________

Telephone: _________________________ FAX: ______________________

If the Bidder is a Partnership:

By: _________________________________________________________ (True Name of the Partnership)

Partner Authorized to Sign Date

Signature: _________________________________________________________ (Attach evidence of Authority to sign) Date

Business Address: _________________________________________________________

County of registration _________________________

Telephone: _________________________ FAX _______________________

If the Bidder is a Corporation:

By: _________________________________________________________ (Legal Corporation Name)

Name & Title of Authorized Officer: __________________________________________________

Signature: _________________________________________________________ (Attach evidence of Authority to sign) Date

Name & Title of Officer Attesting: __________________________________________________

Signature: _________________________________________________________ Date

Business Address: _________________________________________________________

Telephone: _________________________ FAX _______________________

(State of Incorporation): _________________________________________________________

If The Bidder is A Joint Venture: JOINT VENTURE SIGNATURES MUST BE AS PROVIDED IN INSTRUCTIONS TO BIDDERS.

EACH JOINT VENTURER SIGNING THE BID MUST SIGN IN THE MANNER INDICATED FOR AN INDIVIDUAL, A PARTNERSHIP OR A CORPORATION. IF MORE THAN TWO JOINT VENTURERS OF THE SAME TYPE ARE INCLUDED, USE ADDITIONAL PAGES. JOINT VENTURE STATE OF INCORPORATION ___________________ OR COUNTY OF REGISTRATION

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POST-BID SUBMITTALS

The PSC will request this submittal after bid opening. Complete and submit these items within two business days after the request.

BIDDER’S EXPERIENCE MODIFICATION RATING (EMR) ____________

Attach letter of explanation if the Bidder does not have an EMR.

PROPOSED PROJECT SUPERINTENDENT _______________________________

Attach brief resume or list of similar successful projects.

LIST OF SIMILAR PROJECTS COMPLETED BY THE BIDDER

Please list at least three completed projects of similar size and complexity to the project being bid, with reference contact information

REFERENCE #___

Owner: _____________________________________________________________________________________

Project/Contract Name: ________________________________________________________________________

Location of Project/Contract: ____________________________________________________________________

Contract Price: _______________________ Project/Contract Started: ____________ Completed: ____________

Owner's Representative (Name and Telephone): _____________________________________________________

Scope of Project/Contract: ______________________________________________________________________

REFERENCE #___

Owner: _____________________________________________________________________________________

Project/Contract Name: ________________________________________________________________________

Location of Project/Contract: ____________________________________________________________________

Contract Price: _______________________ Project/Contract Started: ____________ Completed: ____________

Owner's Representative (Name and Telephone): _____________________________________________________

Scope of Project/Contract: ______________________________________________________________________

REFERENCE #___

Owner: _____________________________________________________________________________________

Project/Contract Name: ________________________________________________________________________

Location of Project/Contract: ____________________________________________________________________

Contract Price: _______________________ Project/Contract Started: ____________ Completed: ____________

Owner's Representative (Name and Telephone): _____________________________________________________

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Scope of Project/Contract: ______________________________________________________________________

POST BID SUBMITTALS: LIST OF SUBCONTRACTORS

The Apparent Low Bidder shall nominate for each Division of Specification and/or trade category, the Subcontractor to be awarded Sub-agreements, including the apparent Low Bidder if work is to be self-performed. Nominated subcontractors shall not be removed, replaced or added to except by written request for good reason, subject to Owner acceptance.

Division, Specification Section Nominated Amount of Subcontract Minority, Woman, and/or Trade Subcontractor(s) Handicapped?

1.________________________ _________________________ __________________ ______________

2.________________________ _________________________ __________________ ______________

3.________________________ _________________________ __________________ ______________

4.________________________ _________________________ __________________ ______________

5.________________________ _________________________ __________________ ______________

6.________________________ _________________________ __________________ ______________

7.________________________ _________________________ __________________ ______________

8.________________________ _________________________ __________________ ______________

9.________________________ _________________________ __________________ ______________

10._______________________ _________________________ __________________ ______________

11._______________________ _________________________ __________________ ______________

12._______________________ _________________________ __________________ ______________

13._______________________ _________________________ __________________ ______________

14._______________________ _________________________ __________________ ______________

The undersigned Apparent Low Bidder _____________________________________________________________ certifies that all the information and data furnished in this List of Subcontractors are current, accurate and complete as of the date stated below.

Signed by:____________________________Name_______________________________ Title ________________________ on this __________ day of ____________________, 20_______.

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PERFORMANCE BOND

SURETY COMPANY REFERENCE No. __________________________________

That "the Contractor," ___________________________________________________, a corporation ___, individual ___, partnership ___, joint venture ___ of the State of __________________, qualified to do business in the State of Michigan, as Principal, and "the Surety," ____________________________________________________________________, of the State of _________________, as surety, are held and bound unto the State of Michigan, "the Owner," as Obligee, in the amount of __________________________________________________________________________ Dollars ($_________________), for the payment of which the Contractor and Surety bind themselves, their respective heirs, successors, legal representatives and assigns, jointly and severally, in compliance with 1963 PA 213, as amended, MCL 129.201 et seq.

The Contractor has entered into "the Contract" with the Owner for _______________________________________________ _______________, "the Work," covered by the Contract Documents, which are incorporated into this Performance Bond by this reference;

If the Contractor faithfully performs and fulfills all the undertakings, covenants, terms, conditions, warranties, indemnifications and agreements of the Contract Documents within the Contract Time (including any authorized changes, with or without notice to the Surety) and during the Correction Period, and if the Contractor also performs and fulfills all the undertakings, covenants, terms, conditions, warranties, indemnifications and agreements of any and all duly authorized modifications of the Contract Documents, then THIS

OBLIGATION IS VOID, OTHERWISE TO REMAIN IN FULL

FORCE AND EFFECT.

A. No change in Contract Price or Contract Time, "or equal" or substitution or modification of the Contract Documents (including addition, deletion or other revision) releases the Surety of its obligations under this Section 00610 Performance Bond. The Surety expressly waives notice of any such change in Contract Price or Contract Time, "or equal" or substitution or modification of the Contract Documents (including addition, deletion or other revision).

B. This Performance Bond must be solely for the protection of the Owner and its successors, legal representatives or assigns.

C. It is the intention of the Contractor and Surety that they must be bound by all terms and conditions of the Contract Documents (including, but not limited to General Conditions and this Performance Bond). However, this Performance Bond is executed pursuant to 1963 PA 213, as amended, MCL 129.201 et seq., and if any provision(s) of this Performance Bond is/are illegal, invalid or unenforceable, all other provisions of this Performance Bond must nevertheless remain in full force and effect, and the Owner must be protected to the full extent provided by 1963 PA 213, as amended, MCL 129.201 et seq.

IMPORTANT: The Surety must be authorized to do business in the State of Michigan by the Department of Licensing and Regulatory Affairs − Insurance Bureau, must be listed on the current U.S. Department of the Treasury Circular 570, and, unless otherwise authorized by the Owner in writing, must have at least an A− Best's rating and a Class VII or better financial size category per current A. M. Best Company ratings.

Name, Address and Telephone of the Surety:

Address and Telephone of Agent, who is either a resident of, or whose principal office is maintained in, the State of Michigan

Signed and sealed this __________ day of _______________________, 20_____.

THE CONTRACTOR: (Print Full Name and Sign) By:___________________________________________________________

WITNESS ______________________________ Name & Title: __________________________________________________

Telephone No. _________________________________________________

THE SURETY: (Print Full Name and Sign) Agent: ________________________________________________________

WITNESS ______________________________ Attorney-in-Fact: ________________________________________________

Telephone No. _______________________________________________

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PAYMENT BOND

SURETY COMPANY REFERENCE No.___________________________________

"the Contractor," ___________________________________________________, a corporation ___, individual ___, partnership ___, joint venture ___ of the State of __________________, qualified to do business in the State of Michigan, as Principal, and "the Surety," ____________________________________________________________________, of the State of _________________, as surety, are held and bound unto the State of Michigan, "the Owner," as Obligee, in the amount of __________________________________________________________________________ Dollars ($_________________), for the payment of which the Contractor and Surety bind themselves, their respective heirs, successors, legal representatives and assigns, jointly and severally, in compliance with 1963 PA 213, as amended, MCL 129.201 et seq.

The Contractor has entered into "the Contract" with the Owner for _____________________________________________ __________________, "the Work," covered by the Contract Documents, which are incorporated into this Payment Bond by this reference;

If the Contractor promptly pays all claimants supplying labor or materials to the Contractor or to the Contractor's Subcontractors in the prosecution of the Work, then THIS

OBLIGATION IS VOID, OTHERWISE TO REMAIN IN FULL

FORCE AND EFFECT.

A. All rights and remedies on this Payment Bond are solely for the protection of all claimants supplying labor and materials to the Contractor or the Contractor's Subcontractors in the prosecution of the Work, and must be determined in accordance with Michigan Law.

B. No change in Contract Price or Contract Time, "or equal" or substitution or modification of the Contract Documents (including addition, deletion or other revision) must release the Surety of its obligations under this Payment Bond. The Surety hereby expressly waives notice of any such change in Contract Price or Contract Time, "or equal" or substitution or modification of the Contract Documents (including addition, deletion or other revision).

C. It is the intention of the Contractor and Surety that they must be bound by all terms and conditions of the Contract Documents (including, but not limited to this Payment Bond). However, this Payment Bond is executed pursuant to 1963 PA 213, as amended, MCL 129.201 et seq., and if any provision(s) of this Payment Bond is/are illegal, invalid or unenforceable, all other provisions of this Payment Bond must nevertheless remain in full force and effect, and the Owner must be protected to the full extent provided by 1963 PA 213, as amended, MCL 129.201 et seq.

IMPORTANT: The Surety must be authorized to do business in the State of Michigan by the Department of Licensing and Regulatory Affairs − Insurance Bureau, must be listed on the current U.S. Department of the Treasury Circular 570, and, unless otherwise authorized by the Owner in writing, must have at least an A− Best's rating and a Class VII or better financial size category per current A. M. Best Company ratings.

Name, Address and Telephone of the Surety:

Address and Telephone of Agent, who is either a resident of, or whose principal office is maintained in, the State of Michigan

Signed and sealed this __________ day of _______________________, 20_____.

THE CONTRACTOR: (Print Full Name and Sign) By:___________________________________________________________

WITNESS ______________________________ Name & Title: __________________________________________________

Telephone No. _________________________________________________

THE SURETY: (Print Full Name and Sign) Agent: ________________________________________________________

WITNESS ______________________________ Attorney-in-Fact: ________________________________________________

Telephone No. ____________________________________________________