HomeMy WebLinkAboutMike Sippo - Bond for McDonalds ADAGallagherInsuranceRiskManagementConsultingDecemberIi,2020viaUPSMcDonald’sCorporationAttn:JodySundquist2811TucsonDriveJoliet,IL60432Re:TypeofBond:BondNumber:Obligee:Description:BondAmount:PremiumDue:ExcessWeightandOtherHighwayandStreetPermits404242321CityofRentonMcDonald’sADA,SiteImprovements,3209NE4th$23,068.65$115.00Wearepleasedtoenclosethebondyourequested.Thebondissuedwasbasedupontheinformationyouprovided.Wesuggestyoucheckallthedocumentsenclosed,includingthePowerofAttorney,signatures,dates,amounts,description,andanyotherattachments.Pleaseverifythatthebondformattachedistheformrequited,andbesuretoexecutethebondwiththepropersignatureandseal.ChristinaMayorgaoftheWalnutCreekFieldOfficerequestedthebond.SheasksthebondbesenttoCurtHobbs,addressontheenclosedrequestform.Thankyouandpleasecallmeshouldyouhaveanyquestions.Sincerely,,‘QJ_W,KathleenWeaverSeniorClientServiceManagerWilliamT.KrummProducer2850GolfRoadRollingMeadows,IL60008-4050USA630.773.3800www.ajg.comEnclosures
MCDONALD’SCORPORATIONBONDREQUESTWORKSHEEETBONDTYPE:PERFORMANCEPAYMENTXLICENSEWAGE/WELFAREOTHERSUBDIVISIONUTILITYPAYMENT(PLEASEPRINLORTYPE)Dn1sTHEREASPECIALBONDFORM?YESXNO_IFSO,ATTACHORIGINALFORMATTACHCOPYOFCONTRACTFORPERFORMANCE&PAYMENTBONDSLOCATIONCODE:46-0524MAILCODE:_____________TERRITORYADDRESS:2999OakRoad,Ste900,WalnutCreekCA94597OBLIGEE:CityofRentonADDRESS:1055SouthGradyWay6thFloor,RentonWA98057EFFECTIVEDATE:ASAPDATEBONDNEEDED:BY12/28/2020BONDAMOUNT:23,068.65_CONTRACTVALUE$____BOND/PROJECTDESCRIPTION:ImprovementsforStreet,drainageandstormwaterLOCATIONOFWORK:3209NE4thRentonWA98056cCONTRACTSCHEDULEDSTART:06/14/21COMPLETION:08/02/21‘ADDITIONALINFORMATION:____________________________________REQUESTEDBY:ChristinaMayorgaDATE:12/11/2020REQPH#650-922-8901RETURNTO:CurtHobbs•McDonaldsUSA500EImWay#21,EdmondsWA98020TERRITORY:EmailtocurrentcontactwithArthurJ.Gallagher(Kathy_Weaver@AJG.com)
1Select the current project status/phase from the following options:
For Approval -Preliminary Data Enclosed,pending approval from the City;
For Construction -Estimated Data Enclosed,Plans have been approved for contwction by the City;
Project Closeout -Final Costs and Quantities Enclosed for Project Close-out Submittal
Page 1 of 1
Ref B-H Bond Quantity Worksheet
Unit Prices Updated:06/14/2016
Version:04/26/2017
Printed 3/11/2020
SITE IMPROVEMENT BOND QUANTITY WORKSHEET
PROJECT INFORMATION
Planning Division 11055 South Grady Way —6th Floor /Renton,WA 98057(425)430-7200
CITY OF—‘Renton
0
Community &Economic
Development
Date Prepared:13/11/2020 I Project Phase’IFOR APPROVAL
Prepared by:—Engineer Stamp Requited
Name:Chris Jensen have original wet stamp and signature)
PE Registration No:47671
Firm Name:Barghausen Consulting Engineers
Firm Address:18215 72nd Avenue South
Phone No.425-251-6222
Email Address:cjensen@barghausen.com 03/11/2020
Project Location and Description Project Owner Information
Project Name:McDonald’s ADA Project Owner:CURT HOBBS
CEO Plan #fLUA):#-######Phone:4253050266
CEO Permit #(U):########Address:2999 OAK ROAD STE 900
Site Address:3209 NE 4TH RENTON WA,98056 WALNUT CREEK,CA,94567
Street Intersection:Monroe Ave NE AdUtI Project Owner:Additional Project Owner
Parcel #(s):162305-9111 Phone:Phone
Abbreviated Legal LOT 4 OF Cliv OF RENTON SHORT PLAT NO 373-79 RECORDING NO Address Address7910049001SOFIATOAF-N 330 Ft OF NE 1/4 OF NE 1/4 OF NW 1/4Description:LESS CO ROS SUBJ TO TRANS IN ESMTh LESS C/M RGTS City,State,Zip
Clearing and Grading —Utility Providers
Clearing and grading greater than or equal to 5,000 board feet of timber?
Yes/No:INO I Water Service Provided by:CITY OF RENTON
If Yes,Provide Forest Practice Permit #:IN/A I Sewer Service Provided by:CITY OF RENTON
SECTION I PROJECT INFORMATION
CITYOANDECONOMICDEVELOPMENT---“RentonPERMITBONDBondNumber:404242321ProjectName:McDonald’sADAKNOWALLMENBYTHESEPRESENT;thatweMcDonald’sCorporationof110N.CarpenterStreet,Chicago,IL60607asPrincipal,andLibertyMutualInsuranceCompanaCorporation,asSurety,areheldandfirmlybounduntotheCityofRenton,amunicipalcorporationoftheStateofWashington,inthesumof$23,068.65lawfulmoneyoftheUnitedStatesofAmerica,forthepaymentofwhich,willandtrulytobemade,wefirmlybindourselves,andeachofourheirs,executors,administratorsandassigns,jointlyandseverallybythesepresent.THECONDITIONOFTHEFOREGOINGOBLIGATIONSISSUCH,thatWHEREAS,theabovenamedPrincipalhasappliedforapermit,pursuanttotheprovisionsofOrdinanceNo.3205,todocertainworkonaCityofRentonroadway,street,alley,avenue,orotherpublicplace,duringaperiodending_______________________________NOWTHEREFORE,iftheabovenamedPrincipalshallindemnifyandsaveharmlesstheCityofRenton,fromallclaims,actionsordamagesofeverykindanddescription,whichmayaccrueasaresultofopeningand/orworkinguponaroadway,street,alley,avenue,publiceasement,orotherpublicplace,byhimorthoseinhisemploy,ininstallingormakingconnectionswithanypublicorprivatesewerorwatersystem,oranyotherpurposeorobjectwhatever,andthathewillreplaceandrestoresuchroadway,street,avenue,alleyorotherpublicplacetoasgoodastateorconditionasatthetimeofthecommencementofsaidwork,andmaintainthesameingoodordertothedecidedsatisfactionoftheCityofRenton,andthathewillcomplywithallprovisionsofhisortheirfranchiseofourpermitandallresolutionsorinstrumentsrelatingthereto,thisobligationtobevoid;otherwisetoremaininfullforceandeffect.TheliabilityunderthisbondisforaperiodofoneyearfromDecember11,2020toDecember10,2021andmaybeextendedbythesuretyissuingaContinuationCertificate.Sealedwitoursealsdatedthis11thdayofDecember,2020BY:___________BY:___________gnatureofBongAgentBond110N.CarpenterStreetIncludecontactinformation.Applicant’sAddressSharonA.Foulk,Attorney-in-Fact—.‘‘—rL—Chicago,1L60607City,State,Zipip$‘H:\CED\Data\Forms-Templates\SeIf-HeIpHandouts\DevelopmentEngineering\PERMITBOND.docxRev:02/2018
ACKNOWLEDGMENTOFCORPORATIONSTATEOFILLINOIS))COUNTYOFWILL)Theforegoinginstrumentwasacknowledgedbeforeme,JodyA.Sundquist,thisjthdayofDecember,2020,byDavidBartlett,CorporateVicePresidentofMcDonald’sCorporation,aDelawarecorporation,onbehalfofthecorporation.(Jody*Sunaquis1”yPublicOFFICIALSEALE’‘JODYA.SUNDQUSTkNOTARYPUBUC,SWFOFILLINOISMyCommissionExpiresjUfl€12,2023PrintedName:JodyA.SundquistCommissionNumber:896418MyCommissionExpires:June12,2023
jStateofIllinois10JSS:CountyofCookOnthisI1thdayofDecemberintheyeartwothousandtwenty,beforeme,KathleenMoesleWeaver,aNotaryPublicinandforsaidCountyandState,residingtherein,dulycommissionedandsworn,personallyappearedSharonA.FoulkknowntometobethedulyauthorizedzAttorney-in-factoftheLibertyMutualInsuranceCompanyandthesamepersonwhosenameissubscribedtothewithininstrumentastheAttorney-in-factofsaidCompanyandthesaidSharonA.FoulkdulyacknowledgedtomethatshesubscribedthenameoftheLibertyMutual0InsuranceCompanyandtheretoasSuretyandherownnameasAttorney-in-fact.INWITNESSWHEREOF,IhavehereuntosetmyhandandaffixedmyofficialsealthedayandyearinthisCertificatefirstabovewritten.MyCommissionExpires_____________________________________1/7/2024NotaryPublicinandforKathleenMoesle-WeaverCity,StateofRollingMeadows,IllinoisIIIii
ThisPowerofAttorneylimitstheactsofthosenamedherein,andtheyhavenoauthoritytobindtheCompanyexceptinthemannerandtotheextenthereinstated.LibertyLibertyMutualInsuranceCompanyJ,IufijalTheOhioCasualtyInsuranceCompanyCertificateNo:8201926-285005WestAmericanInsuranceCompanySURETYPOWEROFATTORNEYKNOWNALLPERSONSBYTHESEPRESENTS:ThatTheOhioCasualtyInsuranceCompanyisacorporationdulyorganizedunderthelawsoftheStateofNewHampshire,thatLibertyMutualInsuranceCompanyisacorporationdulyorganizedunderthelawsoftheStateofMassachusetts,andWestAmericanInsuranceCompanyisacorporationdulyorganizedunderthelawsoftheStateofIndiana(hereincollectivelycalledtheCompanies’),pursuanttoandbyauthorityhereinsetforth,doesherebyname,constituteandappoint,SharonA.Foulk;PatrickGallagher,ThomasGill;KathyHill;WilliamT.Krumm;ChristinaLaurendi;DavidL.Marcus;LiviaOliveira;CynthiaPreston;MurielSaen2;JonA.Schroeder;JodieSellers;KarenE.SochaCassandraL.Stone;KathleenWeaverallofthecityofRollingMeadowsstateofILeachindwlduallyiftherebemorethanonenamed,itstrueandlawfiulattorney-in-facttomake,execute,seal,acknowledgeanddeliver,forandonitsbehalfassuretyandasitsactanddeed,anyandallundertakings,bonds,recognizancesandothersuretyobligations,inpursuanceofthesepresentsandshallbeasbindingupontheCompaniesasiftheyhavebeendulysignedbythepresidentandattestedbythesecretaryoftheCompaniesintheirownproperpersons.INWITNESSWHEREOF,thisPowerofAttorneyhasbeensubscribedbyanauthorizedofficerorofficialoftheCompaniesandthecorporatesealsoftheCompanieshavebeenaffixedtheretothis16thdayofAugust,2019LibertyMutualInsuranceCompany—TheOhioCasualtyInsuranceCompanyWestAmericanInsuranceCompanyBy:4ZDavidM.Carey,AssistantSecretary.jState0tPENNSYCVAN1AVCountyofMONTGOMERYccici)Onthis16thdayofAugust,2019beforemepersonallyappearedDavidM.Carey,whoacknowledgedhimselftobetheAssistantSecretaryoflibertyMutualInsurance°‘S.Company,TheOhioCasualtyCompany,andWestAmericanInsuranceCompany,andthathe,assuch,beingauthorizedsotodo,executetheforegoinginstrumentforthepurposes=>thereincontainedbysigningonbehalfofthecorporationsbyhimselfasadulyauthorizedofficer.iii>‘EINWITNESSWHEREOF,IhavehereuntosubscribedmynameandaffixedmynotanalsealatKingofPwssia,Pennsylvania,onthedayandyearfirstabovewritten.IDCOMMONWEALThOFPENNSYLVANIANotanalSealólNII“—ID0TeresaPastella,NotaryPublic1’o)UpperMerionTwp,,MontgomeryCountyBy:/IDMyCommissionExpiresMarch28,2021TeresaPastella,NotaryPubliccii.
‘Member.PenosylvaniaAssocrabonofNotariesThisPowerofAttomeyismadeandexecutedpursuanttoandbyauthorityofthefollowingBy-lawsandAuthorizationsofTheOhioCasualtyInsuranceCompany,LibertyMutualo.InsuranceCompany,andWestAmericanInsuranceCompanywhichresolutionsarenowinfullforceandeffectreadingasfollows:‘SARTICLEIV—OFFICERS:Section12.PowerofAttorney.AnyofficerorotherofficialoftheCorporationauthorizedforthatpurposeinwritingbytheChairmanorthePresident,andsubjecttosuchlimitationastheChairmanorthePresidentmayprescribe,shallappointsuchattorneys-in-fact,asmaybenecessarytoactinbehalfoftheCorporationtomake,execute,seal,acknowledgeanddeliverassurety>ocanyandallundertakings,bonds,recognizancesandothersuretyobligations.Suchattorneys-in-fact,subjecttothelimitationssetforthintheirrespectivepowersofattorney,shallhavefullpowertobindtheCorporationbytheirsignatureandexecutionofanysuchinstrumentsandtoattachtheretothesealoftheCorporation.Whensoexecuted,such—0?instrumentsshallbeasbindingasifsignedbythePresidentandattestedtobytheSecretary.Anypowerorauthoritygrantedtoanyrepresentativeorattorney-in-factundertheprovisionsofthisarticlemayberevokedatanytimebytheBoard,theChairman,thePresidentorbytheofficerorofficersgrantingsuchpowerorauthority.ARTICLEXIII—ExecutionofContracts:Section5.SuretyBondsandUndertakings.AnyofficeroftheCompanyauthorizedforthatpurposeinwritingbythechairmanorthepresident,andsubjecttosuchlimitationsasthechairmanorthepresidentmayprescribe,t—-shallappointsuchattorneys-in-fact,asmaybenecessarytoactinbehalfoftheCompanytomake,execute,seal,acknowledgeanddeliverassuretyanyandallundertakings,—bonds,recognizancesandothersuretyobligations.Suchattorneys-in-factsubjecttothelimitationssetforthintheirrespectivepowersofattorney,shallhavefullpowertobindtheCompanybytheirsignatureandexecutionofanysuchinstrumentsandtoattachtheretothesealoftheCompany.Whensoexecutedsuchinstrumentsshallbeasbindingasifsignedbythepresidentandattestedbythesecretary.CertificateofDesignation—ThePresidentoftheCompany,actingpursuanttotheBylawsoftheCompany,authorizesDavidM.Carey,AssistantSecretarytoappointsuchattorneys-in-factasmaybenecessarytoactonbehalfoftheCompanytomake,execute,seal,acknowledgeanddeliverassuretyanyandallundertakings,bonds,recognizancesandothersuretyobligations.Authorization—ByunanimousconsentoftheCompany’sBoardofDirectors,theCompanyconsentsthatfacsimileormechanicallyreproducedsignatureofanyassistantsecretaryoftheCompany,whereverappearinguponacertifiedcopyofanypowerofattorneyissuedbytheCompanyinconnectionwithsuretybonds,shallbevalidandbindingupontheCompanywiththesameforceandeffectasthoughmanuallyaffixed.I,ReneeC.lieweflyn,theundersigned,AssistantSecretary,TheOhioCasualtyInsuranceCompany,LibertyMutualInsuranceCompany,andWestAmericanInsuranceCompanydoherebycertifythattheoriginalpowerofattorneyofwhichtheforegoingisafull,hueandcorrectcopyofthePowerofAttorneyexecutedbysaidCompanies,isinfullforceandeffectandhasnotbeenrevoked.By:___ReneeC.Lleweilyn,AssistantSecretaryINTESTIMONYWHEREOF,IhavehereuntosetmyhandandaffixedthesealsofsotdCompaniesthis11thdayofDecember,2020LMS-12873LMICOCICWAICMultiCo_062018