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/26 AY20 (A L0166
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CTY OF RENION SUBMITTAL FORMS:SUBMITTED WITH BID
This form must be submitted with the Bid Proposal
PROPOSAL&COMBINED AFFIDAVIT
AND CERTIFICATE FORM
CITY OF RENTON
PRV STATION 1 REHABILITATION PROJECT
CAG-26-096
WTR-27-4321
TO THE CITY OF RENTON
RENTON,WASHINGTON
To whom it may concern:
The undersigned hereby certify that the bidder has examined the site of the proposed work and has
read and thoroughly understand the plans,specifications and contract governing the work
embraced in this improvement, and the method by which payment will be made for said work, and
hereby propose to undertake and complete the work embraced in this improvement, or as much
thereof as can be completed with the money available, in accordance with the said plans,
specifications and contract and the schedule of prices.
(Note: Unit prices for all items, all extensions, and
total
amount of bid should be shown. Show unit prices
both in writing and in figures.)
The undersigned further certifies and agrees to the following provisions:
NON-COLLUSION AFFIDAVIT
Being duty sworn, deposes and says,that he is the identical person who submitted the foregoing
proposal or bid, and that such bid is genuine and not sham or collusive or made in the interest or on
behalf of any person not therein named, and further,that the deponent has not directly induced or
solicited any other Bidder on the foregoing work or equipment to put in a sham bid, or any other
person or corporation to refrain from bidding, and that deponent has not in any manner sought by
collusion to secure to himself or to any other person any advantage over other Bidder or Bidders.
AND
CERTIFICATION RE:ASSIGNMENT OF ANTI-TRUST CLAIMS TO PURCHASER
Vendor and purchaser recognize that in actual economic practice overcharges resulting from anti-
trust violations are in fact usually borne by the purchaser.Therefore,vendor hereby assigns to
purchaser any and all claims for such over-charges as to goods and materials purchased in
connection with this order or contract,except as to overcharges resulting from anti-trust violations
commencing after the date of the bid, quotation, or other event establishing the price under this
order or contract. In addition,vendor warrants and represents that such of his suppliers and
7 PROPOSAL AND COMBINED AFFIDAVIT&CERT.FORM:NON-COLLUSION,ANTI-TRUST CLAIMS,MINIMUM WAGE
1 PRV STATION 1
APRIL 2026 REHABILITATION PROJECT
Provided to Builders Exchange of WA, Inc. For usage Conditions Agreement see www.bxwa.com - Always Verify Scal
CITY OF RENTON SUBMITTAL FORMS:SUBMITTED WITH BID
subcontractors shall assign any and all such claims to purchaser, subject to the aforementioned
exception.
AND
MINIMUM WAGE AFFIDAVIT FORM
I,the undersigned, having been duly sworn,deposed, say and certify that in connection with the
performance of the work of this project, I will pay each classification of laborer, workman, or
mechanic employed in the performance of such work; not less than the prevailing rate of wage or
not less than the minimum rate of wages as specified in the principal contract.
I have read the above and foregoing statements and certificate, know the contents thereof and the
substance as set forth therein is true to my knowledge and belief.
FOR: PROPOSAL, NON-COLLUSION AFFIDAVIT,ASSIGNMENT OF ANTI-TRUST CLAIMS TO
PURCHASER AND MINIMUM WAGE AFFIDAVIT
CR Construction LLC
Name of Bidder's Firm
Signature of Authorized Representative of Bidder*:
Printed Name: Sara Slatten Title: P e ide t/ anaging Member
Address: 45127 SE 140th St, North Bend, WA 9 045
Contact Name (please print): Dan Roesler
Phone: 206-947-3206 Email: droesler@crconstructionlIc.com
*The above signature must be notarized using the applicable notary language found on pages
3 and 4.
If business is a CORPORATION,please complete this section:
Name of President of Corporation
Name of Secretary of Corporation
Corporation Organized under the laws of
With Main Office in State of Washington at
If business is a PARTNERSHIP or LIMITED LIABILITY COMPANY, please complete this
section:
Name: Title(Partner, Member, Manager):
Sara Slatten President/Managing Member
7 PROPOSAL AND COMBINED AFFIDAVIT&CERT.FORM:NON-COLLUSION,ANTI-TRUST CLAIMS,MINIMUM WAGE
2 PRV STATION 1
APRIL 2026 REHABILITATION PROJECT
Provided to Builders Exchange of WA, Inc. For usage Conditions Agreement see www.bxwa.com - Always Verify Scal
CITY OF RENTON SUBMITTAL FORMS:SUBMITTED WITH BID
INDIVIDUAL FORM
STATE OF WASHINGTON
):ss
County of
On this day of , 2026, before me personally appeared
to me known to be the individuals)described in and who executed the foregoing instrument, and
acknowledged under oath that they signed and sealed the same as their free and voluntary act and
deed,for the uses and purposes therein mentioned.
GIVEN under my hand and official seal the day and year last above written.
(SEAL)
Dated:
(Signature)
(Print Name)
Notary Public in and for the State of
Commission Expires:
CORPORATION FORM
STATE OF WASHINGTON
):ss
County of
On this day of , 2026, before me personally appeared
to me known to be the (President,Secretary,Treasurer)of the
corporation that executed the foregoing instrument, and acknowledged said instrument to be the
free and voluntary act and deed of said corporation,for the uses and purposes therein mentioned,
and on oath stated that they are authorized to execute said instrument.
GIVEN under my hand and official seal the day and year last above written.
(SEAL)
Dated:
(Signature)
(Print Name)
Notary Public in and for the State of
Commission Expires:
7 PROPOSAL AND COMBINED AFFIDAVIT&CERT.FORM:NON-COLLUSION,ANTI-TRUST CLAIMS,MINIMUM WAGE
3 PRV STATION 1
APRIL 2026 REHABILITATION PROJECT
Provided to Builders Exchange of WA, Inc. For usage Conditions Agreement see www.bxwa.com - Always Verify Scal
CITY OF RENTON SUBMITTAL FORMS:SUBMITTED WITH BID
PARTNERSHIP FORM
STATE OF WASHINGTON
):ss
County of
On this day of , 2026, before me personally appeared
to me known to be a General Partner of the partnership known as that
executed the foregoing instrument, and acknowledged said instrument to be the free and voluntary
act and deed of said partnership,for the uses and purposes therein mentioned, and on oath stated
that they are authorized to execute said instrument.
GIVEN under my hand and official seal the day and year last above written.
(SEAL)
Dated:
(Signature)
(Print Name)
Notary Public in and for the State of
Commission Expires:
LIMITED LIABILITY COMPANY(LLC) FORM
STATE OF WASHINGTON
King ):ss
County of
On this 20th day of May , 2026 , before me personally appeared Sara Slatten
to me known to be a Managing Member of the Limited Liability Company known as
CR Construction LLC ,and that they executed the foregoing instrument,and
acknowledged said instrument to be the free and voluntary act and deed of said Limited Liability
Company,for the uses and purposes therein mentioned,and on oath stated that they are
authorized to execute said instrument.
GIVEN under my hand and official seal the day and year last above written.
(SEAL)
�`�q�'"zv 1.0144' Dated: 5 0/2026
4i' SOUR
`►•r • (Signature)
Ausoc Ben Gutenberg
•• �,, • (Print Name)
••• *lam•'� Notary Public in and for the State of WA
CAP 'mot" 4/16/2028
Commission Expires:
7 PROPOSAL AND COMBINED AFFIDAVIT&CERT.FORM:NON-COLLUSION,ANTI-TRUST CLAIMS,MINIMUM WAGE
4 PRV STATION 1
APRIL 2026 REHABILITATION PROJECT
Provided to Builders Exchange of WA, Inc. For usage Conditions Agreement see www.bxwa.com - Always Verify Scal
CITY OF RENTON SUBMITTAL FORMS:SUBMITTED WITH BID
Show price per unit in figures only. Figures written to the right of the decimal in the price per unit
column shall be interpreted as cents.
See Section 1-09.14 of the Special Provisions for information on Bid Items.
ITEM # ITEM DESCRIPTION UNIT (STY UNIT TOTAL
PRICE
Mobilization and Demobilization
1 (Maximum bid 100/0 of Total Bid) LS 1 3,S'AJ�, �' •v
2 Construction Surveying, Staking, &As LS 1 675v 5-7�c d�
Built Drawings
3 Clearing and Grubbing LS 1 !01!,cj$c0 (00 S,O.
4 Removal and Replacement of TON 10 l t(, 311./0 00
Unsuitable Foundation Material
5 Remove and Replace Concrete Curb LF 20 ZO47.4?() y1201 Gb
and Gutter
6 Remove and Replace Concrete SY 11 t r< OD
Sidewalk two�vD y��
7 Abandon Existing Water Main LS 1 13Z4,0 a 00 1 ozeto, (.70
8 Decommission and Abandon Existing LS 1 0-6PRV 1 Station g7�i00 g7�
9 Concrete for Thrust Blocking and Dead CY 10 too c r'b
Man Anchors (�� (v000
10 Quarry Spalls for Extension of Ditch TON 20 15 3 r 0t7 706,0,CO
Line
11 Connect to Existing Water Main EA 5 Z/78.°fl /t/i3Vr °
12"x10"Tapping Tee and Valve
12 Assembly EA 1 (orgt17,o, (q897 Ob
13 Fire Hydrant Complete Assembly EA 1 15-8101 00 IS?1010t)
14 Pressure Reducing Valve (PRV 1) LS 1 0511/Lb foo 105q/y,co
Station 8"x 3"
DI Pipe for Water Main, 8-In. Diam.
15 Class 52, Restrained Joint Fittings with LF 80 238r Ol] lqO 10t •
Potywrap
DI Pipe for Water Main, 10-In. Diam.
16 Class 52, Restrained Joint-Fittings with LF 110 Taos?) Zei?7c;
Po lywra p
17 8"Gate Valve Assembly EA 3 31 VtOv 911,000°
18 10" Gate Valve Assembly EA 2 j7q ,5O L{RC(( C)
19 Extra DI Fittings LBS 1,000 10 r O 1 tc cbrOrV
20 Crushed Surfacing Top Course TON 31 Zq(oc Da 94/7(p1co
21 Gravel Borrow for Trench Backfill TON 72 Z$tO Z.01(oc op
HMA CL 1/2-Inch PG 58H-22 for Final
22 Trench Patch TON 60 Z'75 00 1(05'(aD
23 HMA CL 1/2-Inch PG 58H-22 for TON 62 27$ cb 1- 06.0
Overlay
10 SCHEDULE OF PRICES
1 PRV STATION 1
APRIL 2026 REHABILITATION PROJECT
Provided to Builders Exchange of WA, Inc. For usage Conditions Agreement see www.bxwa.com - Always Verify Scal
CITY OF RENTON SUBMITTAL FORMS:SUBMITTED WITH BID
ITEM # ITEM DESCRIPTION UNIT 1 QTY UNIT TOTAL
PRICE
24 Erosion and Sedimentation Control LS I 1 7469,00 Z&40100
25 Traffic Control LS 1 58 ZP2coc 2pt,ob
26 Trench Safety Systems LS 1 5Oc,c20 SpOO,cap
27 Site Specific Utility Potholing EA 5 fbg7,oD 5235,to
28 Pavement Marking Restoration LS 1 '771)c OD 770,6i7
29 General Restoration&Cleanup LS 1 NeVt00 , 8644010b
30 ( Minor Changes FA 1 $25,000 $25,000
SUBTOTAL L1e5 01Q7 tpc.
WASHINGTON SALES TAX: 10.5% Sb'i3Zt 03
TOTAL BID 5,5-99y, 03
10 SCHEDULE OF PRICES
PROPOSAL&AFFIDAVIT CERTIFICATE 2 PRV STATION 1
APRIL 2026 REHABILITATION PROJECT
Provided to Builders Exchange of WA, Inc. For usage Conditions Agreement see www.bxwa.com - Always Verify Scal
CITY OF RENTON SUBMITTAL FORMS:SUBMITTED WITH BID
This form must be submitted with the Bid Proposal
ACKNOWLEDGEMENT OF RECEIPT OF ADDENDA
PRV STATION 1 REHABILITATION PROJECT
CAG-26-096
WTR-27-4321
ACKNOWLEDGEMENT OF RECEIPT OF ADDENDA
NO. DATE:
NO. DATE:
NO. DATE:
NO. DATE:
NO. DATE:
SIGNED: Sara Slatten
TITLE: Preside an Ing Member
NAME OF COMPANY: CR Construction LLC
ADDRESS: 45127 SE 140th St
CITY/STATE/ZIP: North Bend, WA 98045
TELEPHONE: 425-888-0590
11 ACKNOWLEDGEMENT OF RECEIPT OF ADDENDA
PROPOSAL&AFFIDAVIT CERTIFICATE 1 PRV STATION 1
APRIL 2026 REHABILITATION PROJECT
Provided to Builders Exchange of WA, Inc. For usage Conditions Agreement see www.bxwa.com - Always Verify Scal
CITY OF RENTON
A'S V O.c
+ +
This form must be submitted with the Bid Proposal k'n►To�
CERTIFICATION OF COMPLIANCE WITH
WAGE PAYMENT STATUTES FORM
This form must be submitted with the Bid Proposal.
The bidder hereby certifies that,within the three-year period immediately preceding the bid
solicitation date,the bidder is not a "willful"violator, as defined in RCW 49.48.082, of any provision
of Chapters 49.46,49.48,or 49.52 RCW, as determined by a final and binding citation and notice of
assessment issued by the Department of Labor and Industries or through a civil judgment entered
by a court of limited or general jurisdiction.
I certify under penalty of perjury under the laws of the State of Washington that the foregoing is true
and correct.
CR Construction L C�
Bidder's - s N
Signature f thori ed Official*
Sara Slatt
Printed Name
President/Managing Member
Title
5/20/2026 North Bend WA
Date City State
Check One:
Sole Proprietorship [ Partnership I I Joint Venture Corporation (LLC)
State of Incorporation, or if not a corporation, State where business entity was formed:
WA
If a co-partnership,give firm name under which business is transacted:
*If a corporation,proposal must be executed in the corporate name by the president or vice-president(or any
other corporate officer accompanied by evidence of authority to sign). If a co-partnership,proposal must be
executed bya partner.
12 CERTIFICATION OF COMPLIANCE WITH WAGE PAYMENT STATUTES TEMPLATE UPDATED 2-12-19
1 PRV STATION 1
APRIL 2026 REHABILITATION PROJECT
Provided to Builders Exchange of WA, Inc. For usage Conditions Agreement see www.bxwa.com - Always Verify Scal
CITY Or RENTON SUBMITTAL FORMS:SUBMITTED WITH BID
This form must be submitted with the Bid Proposal
SUBCONTRACTOR LIST
PRV Station 1 Rehabilitation Project
CAG-26-096
WTR-27-4321
In accordance with RCW 39.30-060 as amended:
For all public works contracts exceeding$1,000,000 the bidder shall submit with the bid the names
of the licensed subcontractors and proof of license by providing subcontractors license number
with whom the bidder, if awarded the contract,will subcontract for the following work or to name
itself for the work, if it is licensed to perform the work for which it has named itself.:
• All structural steel installation, rebar installation, heating,ventilation and air conditioning,
and plumbing work as described in chapter 18.106 RCW,and electrical work as described
in chapter 19.28 RCW(this also includes the control system integrator subcontractor as
well as other electrical subcontractors)shall be submitted as part of the bid.
If the work does not apply to this contract,check the box"Not Applicable". If the work will be self-
performed by the bidder, check the box"Self-Performed".
If the subcontractors' names are not submitted with the bid OR if two or more subcontractors
are named to perform the same work,the bid shall be considered nonresponsive and,
therefore,void.
If subcontractors vary with bid alternates, please complete a separate form indicating which
subcontractors will be used for which bid alternate.
Complete the following:
If awarded the contract} CR Construction LLC will contract with the
following subcontractors for the performance of heating,ventilation and air conditioning,
plumbing,electrical(including automatic controls)work, structural steel installation, and
rebar installation:
The following list of subcontracts is due with the bid. Errors identified by the contracting agency
in the proof of license information must be corrected by the bidder within 48 hours of bid
submission.
13 SUBCONTRACTORS LIST APPROVED CLB 4-2-26
1 PRV STATION 1
APRIL 2026 REHABILITATION PROJECT
Provided to Builders Exchange of WA, Inc. For usage Conditions Agreement see www.bxwa.com - Always Verify Scal
SUBCONTRACTOR LIST
To Be Submitted with the Bid Proposal
In accordance with RCW 39.30-060 as amended:
For all public works contracts exceeding$1,000,000 the bidder shall submit with the bid the names of the
licensed subcontractors and proof of license by providing subcontractors license number with whom the
bidder, if awarded the contract,will subcontract for the following work or to name itself for the work, if it is
licensed to perform the work for which it has named itself.
• All structural steel installation, rebar installation, heating, ventilation and air conditioning, and
plumbing work as described in chapter 18.106 RCW,and electrical work as described in chapter 19.28
RCW (this also includes the control system integrator subcontractor as well as other electrical
subcontractors)shall be submitted as part of the bid.
If the work does not apply to this contract, check the box "Not Applicable". If the work will be self-
performed by the bidder, check the box"Self-Performed".
If the subcontractors' names are not submitted with the bid OR if two or more subcontractors are
named to perform the same work,the bid shalt be considered nonresponsive and,therefore, void.
If subcontractors vary with bid alternates, please complete a separate form indicating which
subcontractors will be used for which bid alternate.
Complete the following:
If awarded the contract, CR Construction LLC will contract with the following
subcontractors for the performance of heating,ventilation and air conditioning, plumbing,
electrical(including automatic controls)work,structural steel installation,and rebar installation:
The following list of subcontracts is due with the bid. Errors identified by the contracting agency in the
proof of license information must be corrected by the bidder within 48 hours of bid submission.
Category of Work Heating,Ventilation&Air Conditioning(HVAC) Not Applicable V
Subcontractors Name Self-Performed ❑
Address
Subcontractor's WA License
Phone No. No.
Bid Item Numbers
Description of Work
Approved CLB 4-2-26
Provided to Builders Exchange of WA, Inc. For usage Conditions Agreement see www.bxwa.com - Always Verify Scal
SUBCONTRACTOR LIST
To Be Submitted with the Bid Proposal
Category of Work Plumbing(per RCW 18.106) Not Applicable
Subcontractors Name Self-Performed ❑
Address
Phone No. Subcontractor's WA License
No.
Bid Item Numbers
Description of Work
Category of Work Electrical(per RCW 19.28) Not Applicable LV"
Subcontractors Name Self-Performed E
Address
Phone No. Subcontractor's WA License
No.
Bid Item Numbers
Description of Work
Category of Work Structural Steel Not Applicable
Subcontractors Name Self-Performed 0
Address
Subcontractor's WA License
Phone No. No.
Bid Item Numbers _
Description of Work
Category of Work Rebar Installation Not Applicable
Subcontractors Name Self-Performed ❑
Address
Subcontractor's WA License
Phone No. No.
Bid Item Numbers
Description of Work
2 Approved CLB 4-2-26
Provided to Builders Exchange of WA, Inc. For usage Conditions Agreement see www.bxwa.com - Always Verify Scal
,, CITY OF RENTON SUBMITTAL FORMS:SUBMITTED WITH BID
r
This form must be submitted with the Bid Proposal
PROPOSAL BID BOND
KNOW ALL MEN BY THESE PRESENTS,That we, [Contractor] CR Construction LLC
of[address] 45127 SE 140th Street, North Bend, WA 98045 as Principal,
and [Surety] Atlantic Specialty Insurance Company
a corporation duly organized under the laws of the State of New York ,
and authorized to do business in the State of Washington,as Surety, are held and firmly bound
unto the City of Renton in the sum of five (5)percent of the total amount of the bid proposal of said
Principal for the work hereinafter described,for the payment of which,well and truly to be made,
we bind ourselves, our heirs,executors, administrators and assigns, and successors and assigns,
jointly and severally,firmly by these presents.
The condition of this bond is such,that whereas the Principal herein is herewith submitting his/her
or its sealed proposal for the following project,to wit:
PRV STATION 1 REHABILITATION PROJECT, CAG-26-096
said bid and proposal, by reference thereto, being made a part hereof.
NOW,THEREFORE, if the said proposal bid by said Principal be accepted, and the contract be
awarded to said Principal, and if said Principal shall duly make and enter into and execute said
contract and shall furnish performance bond as required by the City of Renton within a period of
ten (10)days from and after said award, exclusive of the day of such award,then this obligation
shall be null and void, otherwise it shall remain and be in full force and effect.
IN THE EVENT the Principal,following award,fails to execute an Agreement with the City of Renton
in accordance with the terms of the Proposal and furnish a performance bond with Surety or
Sureties approved by the City of Renton within ten (10) days from and after said award,then
Principal shall forfeit the Bid Bond/Bid Proposal Deposit or Surety shall immediately pay and forfeit
to the City of Renton the amount of the Proposal Bid Bond,as set forth in RCW 35A.40.200 and
RCW 35.23.352.
IN TESTIMONY WHEREOF,the Principal and Surety have caused these presents to be signed and
sealed this 15th day of May , 2026.
r,`..t+ He 9;
,•W
CR Construct'in C Atlantic Specialty Insurance Company �,,,,,vs
—14- SEAL" m:
[Princila [Surety] 1986 �J
i i V 14- /--
[Sig tre if:u hor ze• o 'dal] Lure of auth ized o cial] U
[Title] * Q `_By: Liliana Castrejon Perez
[Attorney-in-Fact]
Marsh McLennan Agency
rAddress
501 N. iverpoint Blvd., Suite 403
Spokane, WA 99202
(509)838-3501
[Telephone Number]
7 PROPOSAL AND COMBINED AFFIDAVIT&CERT.FORM:NON-COLLUSION,ANTI-TRUST CLAIMS,MINIMUM WAGE
1 PRV STATION 1
APRIL 2026 REHABILITATION PROJECT
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Intact
INSURANCE Power of Attorney Principal: CR Construction LLC
Surety Bond No: Bid Bond Obligee: City of Renton
KNOW ALL MEN BY THESE PRESENTS,that ATLANTIC SPECIALTY INSURANCE COMPANY,a New York corporation with its principal office in Plymouth,
Minnesota,does hereby constitute and appoint: Liliana Castrejon Perez each individually if there be more than one named,its true and lawful Attorney-in-
Fact,to make,execute,seal and deliver,for and on its behalf as surety,any and all bonds,recognizances,contracts of indemnity,and all other writings obligatory in the nature
thereof;provided that no bond or undertaking executed under this authority shall exceed in amount the sum of:unlimited and the execution of such bonds.recognizances,
contracts of indemnity,and all other writings obligatory in the nature thereof in pursuance of these presents,shall be as binding upon said Company as if they had been fully
signed by an authorized officer of the Company and sealed with the Company seal. This Power of Attorney is made and executed by authority of the following resolutions
adopted by the Board of Directors of ATLANTIC SPECIALTY INSURANCE COMPANY on the twenty-fifth day of September,2012:
Resolved: That the President,any Senior Vice President or Vice-President(each an"Authorized Officer")may execute for and in behalf of the Company any and
all bonds,recognizances,contracts of indemnity,and all other writings obligatory in the nature thereof,and affix the seal of the Company thereto;and that the
Authorized Officer may appoint and authorize an Attorney-in-Fact to execute on behalf of the Company any and all such instruments and to affix the Company
seal thereto;and that the Authorized Officer may at any time remove any such Attorney-in-Fact and revoke all power and authority given to any such Attorney-in-
Fact.
Resolved: That the Attorney-in-Fact may be given full power and authority to execute for and in the name and on behalf of the Company any and all bonds,
recognizances,contracts of indemnity,and all other writings obligatory in the nature thereof,and any such instrument executed by any such Attorney-in-Fact shall
be as binding upon the Company as if signed and sealed by an Authorized Officer and,further,the Attorney-in-Fact is hereby authorized to verify any affidavit
required to be attached to bonds,recognizances,contracts of indemnity,and all other writings obligatory in the nature thereof.
This power of attorney is signed and sealed by facsimile under the authority of the following Resolution adopted by the Board of Directors of ATLANTIC SPECIALTY
INSURANCE COMPANY on the twenty-fifth day of September.2012:
Resolved: That the signature of an Authorized Officer,the signature of the Secretary or the Assistant Secretary,and the Company seal may be affixed by
facsimile to any power of attorney or to any certificate relating thereto appointing an Attorney-in-Fact for purposes only of executing and sealing any bond.
undertaking,recognizance or other written obligation in the nature thereof,and any such signature and seal where so used,being hereby adopted by the Company
as the original signature of such officer and the original seal of the Company,to be valid and binding upon the Company with the same force and effect as though
manually affixed.
IN WITNESS WHEREOF,ATLANTIC SPECIALTY INSURANCE COMPANY has caused these presents to be signed by an Authorized Officer and the seal of the Company
to be affixed this first day of January,2023.
ofV s1"' P i
Ito pRPOR.1t �2
. SEAL in
t 2 1986 0' By
U
STATE OF MINNESOTA r`1.41i,~F Yoe. Sarah A.Kolar,Vice President and General Counsel
HENNEPIN COUNTY "`••"•
On this first day of January,2023,before me personally came Sarah A.Kolar,Vice President and General Counsel of ATLANTIC SPECIALTY INSURANCE COMPANY,to
me personally known to be the individual and officer described in and who executed the pieceding instrument,and she acknowledged the execution of the same,and being by me
duly sworn,that she is the said officer of the Company aforesaid,and that the seal affixed to the preceding instrument is the seal of said Company and that the said seal and the
signature as such officer was duly affixed and subscribed to the said instrument by the authority and at the direction of the Company.
` ALISON D. NASH-TROUT I
f + =' NOTARY PUBLIC-MINNESOTAle
' My Commission Expires
January 31,2030 I Notary Public
I.the undersigned.Secretary of ATLANTIC SPECIALTY INSURANCE COMPANY,a New York Corporation,do hereby certify that the foregoing power of attorney is in cull
force and has not been revoked,and the resolutions set forth above arc now in force.
Signed and sealed. Dated 15th day of May , 2026 ,
94
ft . 0RPOR.1r1..1
oi
jy. SEAL ^':
I:1. 1986 o I a�.
ti
This Power of Attorney expires iry` tifw roi" ,a
January 31,2030 '.; tr �:r Kara L.B.Barrow,Secretary
Please direct bond verifications to_xu1ctkjintactin urauce corn
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CITY OF RENTON SUBMITTAL FORMS:SUBMITTED WITH BID
This form must be submitted with the Bid Proposal
CERTIFICATE OF REGISTRATION
DEPARTMENT OF LABOR & INDUSTRIES
INFORMATION FORM
PRV STATION 1 REHABILITATION PROJECT
CAG-26-096
WTR-27-4321
Name on Registration: CR Construction LLC
Registration Number: 231,644-01 CRCONCL881 DG
Expiration Date: 4/6/2028
Note:A copy of the certificate will be requested as part of contract execution when
project is awarded.
7 PROPOSAL AND COMBINED AFFIDAVIT&CERT.FORM:NON-COLLUSION,ANTI-TRUST CLAIMS,MINIMUM WAGE
1 PRV STATION 1
APRIL 2026 REHABILITATION PROJECT
Provided to Builders Exchange of WA, Inc. For usage Conditions Agreement see www.bxwa.com - Always Verify Scal