HomeMy Public PortalAboutr 22-043An- olu#Yon of #4e 3.axong4 of (garttrd,
#22 -43 February 10, 2022
Date of Adoption
APPROVING FINAGPAYMENT NO. 10
& CLOSEOUT CHANGE ORDER
CARTERET WATERFRONT MARINA — PHASE III
WHEREAS, the Governing Body of the Borough of Carteret has previously awarded a contract to Black
Rock Enterprises, LLC in the adjusted contract amount of $2,896,540.95 for the Carteret Waterfront
Marina — Phase III Project; and
WHEREAS, the Borough's Consulting Engineer for the project, CME Associates, has advised the
Governing Body that a modification of the contract is reasonable and necessary and has recommended that
the aforesaid contract be modified in accordance with Final Payment 410 & Closeout Change Order (see
attached); and
WHEREAS, Final Payment No. 10 & the Closeout Change Order include a change in the description of
work and/or to decrease quantities to reflect as -built conditions, and to provide for certain supplementary
items; and
WHEREAS, the Closeout Change Order provides for a net increase in the contract price in the amount of
$24,021,97, resulting in a revised contract price of $2,920,562.92 including all previously approved change
orders; and
WHEREAS, the Borough's Consulting Engineer, CMG Associates has advised that the above described
changes and/or modifications to the project were unforeseen at the time of the award of the original
contract. Acct.# G 04 -21- 103 -201
NOW, THEREFORE, BE IT RESOLVED by the Mayor and Council of the Borough of Carteret as
follows:
1. That Final Payment No. 10 & the Closeout Change Order attached hereto and
made a part hereof, resulting in a net increase of $24,021.97 and resulting in a
revised contract price of $2,920,562.92 is hereby approved.
2. That the appropriate Borough Officials are hereby authorized to execute Final
Payment No. 10 & the Closeout Change Order, and issue payment thereon,
based upon the recommendation of the Borough Engineer and subject to
attorneys review of the maintenance bond.
3. A copy of this resolution and a fully executed copy of Final Payment No. 10 &
the Closeout Change Order be forwarded to the Borough's Purchasing
Department and CME Associates for distribution to Black Rock Enterprises,
LLC.
Adopted this 10 day of February, 2022
and certified as a true copy of the
original on February 11, 2022.
CARMELA POGORLELSKI, RMC
Municipal Clerk
RE, CORD Or COUNCIL VOTE
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COUNCILMAN
YES
NO
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X- Indicate Vote AB- Absent NV -Not Voting XOR- Indicates Vote to Overrule Veto
Adopted at a meeting of the Municipal Council
February 10, ' 022
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BOROUGH OF CARTERET DaniclU. Rd" Oil
CARMBLA POGORZELSIQ, t.M.C. (732) S41-3800
MUNICIPAL CLERIC
Date; February A 2022
To:
Patrick DeBlaslo
Donsurer
Borough of Carteret
RBOUMT FOR CERTIFICATION OF AVAILABLE FUNDS
For: APPROVING FINAL PAYMENT NO 10 & CLOSEOUT CHANOE ORDj?R CARTERE-T WATERFRONT
MARINA— PHASE_III
Resolution at 1122- 0
Nantc of Aceoaot: BLACK ROCK ENTBRPRISPS I LC
AMOUNT TO BE
Acting Municipal Clerk
CERTIFICATION OF AVAILABILITY OF FUNDS
1, Treasurer of t110 Borough of Cafterel, do hereby certify that there are sufficient hands available in the current
budget to onablo the Municipal Counoil to aulhorlm the entering into a Contract between the Borough of Carteret
and; /
13lacA-gXCA- E.1 Uti ?ors LC.e
The £rinds available fer ([its contract are iu the Budget, in the account o@
In tho amount of -f
By this certification, t have hereby encumbered the above named account for the amount of (ho contract pending
Council action. VVJJ{nn{���
PntteStasi o
Treasurer
Data: J-� 8 0) -�L
MetnorlalMtn-ricipalkli lding 0 QCoolee.Awnne • Carteret, New Jerseg07008
T6732-54.1-3800 a Pax; '732 - 541.8925 14 ci rkofti�eC�carteret net
Wwzgarteret net
AFFIDAVIT OF PUBLICATION
The following is a true copy of an Ordinance or Resolution of
(be Borough of Carteret that has appeared in the Home News
Tribune, a newspaper which is printed in Freehold, New
Jersey and published in Neptune, in said County and State and
of general circulation in said county. One 1 time(s), once in
each issue as follows:
February 16, 2022
I
Notary Public of New Jersey
OANAARCHEVAL
NOTARY PUBLIC OF NEW JERSEY
My Commission Expires Jan. 12, 2027
Sworn and subscribed before
me this day of Puar ICJ'=
Municipal Clerk
BOROUGH OF CARTERET
NOTICE OF AWARD OF CHANGE ORDER
revised contract price of $2,920,562.92
The Change Order specifically was for Black Rock Enterprises, LLC
with regard to the Carteret Waterfront Marina - .Phase 111::
The Borough's Engineer has certified that the changes were
necessary and not anticipated at the beginning of the project.
Copies of Resolution 022 -43 and supporting documents are on file
at
MUNICIPAL CLERK'S OFFICE
.MEMORAL MUNICIPAL BUILDING
61 COOKE AVENUE
CARTERET, NEW JERSEY 07008
CARMELA POGORZELSKI, RMC
Municipal Clerk
($22.36)
Via Electronic (pogorzelskic(a)carteret.net) and Regular Mail
Mayor Daniel J. Reiman and Borough Council
Borough of Carteret
Municipal Building
61 Cooke Avenue
Carteret, NJ 07008
Attn: Carmela Pogorzelski, Municipal Clerk
Re: Carteret Waterfront Marina — Phase Ill
Final Payment Estimate No. 10 and Closeout Change Order
Black Rock Enterprises, LLC
Borough of Carteret, Middlesex County, NJ
CME File: HCA00501.16
Dear Mayor and Borough Council:
Transmitted herewith please find the Final Payment Estimate for the above - referenced project in
the amount of $85,015.28 as approved by this office for your review, approval and further
handling. The project is complete at this time, including all punch list items.
The change order reflects increases and decreases in original contract quantities required to
complete the project. The increases in quantities could not, in our opinion, have reasonably
been effectuated by a separately bid contract without unduly disrupting work and imposing
adverse consequences on the Borough and will provide an improved level of service to
residents.
The Closeout Change Order results in an increase in the project cost from the adjusted contract
amount of $2,896,540.95 to a final total of $2,920,562.92 for an increase of 24,021.97.
Also enclosed is the two (2) year Maintenance Bond in the amount of $584,112.58, twenty
percent (20 %) of the final Contract Amount. By copy of the bond to the Borough Attorney, we
request that same is reviewed and approved.
Our office is in the process of completing and submitting closeout documents to the NJDEP's
Office of Natural Resource Restoration (ONRR) to complete the disbursement of the grant
received for this work. To date, vouchers totaling $5,929,204.50 of the $6,588,055.00 grant
have been processed for disbursement to the Borough.
8: \Ca1ere1 \HCA00501.16 - Marine Phase ilhCorrespondencW2 -01 -24 - Final Pay Estimate No. 70 LV.doc
CONSULTINGAND MUNICIPAL ENGINEERS
1460 ROUTE 9 SOUTH . HOWELL, NEW JERSEY 07731 . (732) 462 -7400. FAX: (732) 409 -0756
JOHN H. ALLGAIR, PE, PP, LS (190 3-2001)
DAVID J. SAMUEL, PE, PP, CME
JOHN J. STEFAN], PE, LS, PP, CME
JAY B. CORNELL, PE, PP, CME
'rr
MICHAEL J. McCLELLAND, PE, PP, CME
GREGORY R. VALESI, PE, PP, CME
TIMOTHY, PE, PP, CME
BRUCE E M. . KOCH KOCH, PE, PP, CME
LOUIS J. PLOSKONKA, PE, CME
ASSOCIATES
TREVOR J. TAYLOR, PE, PP, CME
BEHRAM TURAN, PE, LSRP
LAURA J. NEUMANN, PE, PP
January 24, 2022
DOUGLAS ROHMEYER, PE, CFM, CME
ROBERT J. RUSSO, PE, PP, CME
Via Electronic (pogorzelskic(a)carteret.net) and Regular Mail
Mayor Daniel J. Reiman and Borough Council
Borough of Carteret
Municipal Building
61 Cooke Avenue
Carteret, NJ 07008
Attn: Carmela Pogorzelski, Municipal Clerk
Re: Carteret Waterfront Marina — Phase Ill
Final Payment Estimate No. 10 and Closeout Change Order
Black Rock Enterprises, LLC
Borough of Carteret, Middlesex County, NJ
CME File: HCA00501.16
Dear Mayor and Borough Council:
Transmitted herewith please find the Final Payment Estimate for the above - referenced project in
the amount of $85,015.28 as approved by this office for your review, approval and further
handling. The project is complete at this time, including all punch list items.
The change order reflects increases and decreases in original contract quantities required to
complete the project. The increases in quantities could not, in our opinion, have reasonably
been effectuated by a separately bid contract without unduly disrupting work and imposing
adverse consequences on the Borough and will provide an improved level of service to
residents.
The Closeout Change Order results in an increase in the project cost from the adjusted contract
amount of $2,896,540.95 to a final total of $2,920,562.92 for an increase of 24,021.97.
Also enclosed is the two (2) year Maintenance Bond in the amount of $584,112.58, twenty
percent (20 %) of the final Contract Amount. By copy of the bond to the Borough Attorney, we
request that same is reviewed and approved.
Our office is in the process of completing and submitting closeout documents to the NJDEP's
Office of Natural Resource Restoration (ONRR) to complete the disbursement of the grant
received for this work. To date, vouchers totaling $5,929,204.50 of the $6,588,055.00 grant
have been processed for disbursement to the Borough.
8: \Ca1ere1 \HCA00501.16 - Marine Phase ilhCorrespondencW2 -01 -24 - Final Pay Estimate No. 70 LV.doc
CONSULTINGAND MUNICIPAL ENGINEERS
1460 ROUTE 9 SOUTH . HOWELL, NEW JERSEY 07731 . (732) 462 -7400. FAX: (732) 409 -0756
ASSOCIATES
Mayor and Borough Council
Re: Final Payment No, 10 and Closeout Change Order
Waterfront Marina — Phase III
January 24, 2022
Our File No. HCA00501.10
Page 2
We trust this is the information you require to process payment; however, if there are any
questions or comments, please do not hesitate to contact this office.
TT1MZ
Enclosures
cc: John DuPont, PE, CME (via email)
Robert Bergen, Borough Attorney (via email)
Patrick DeBlasio, CFO (via email)
Matt Mauro, LSRP — Excel Environmental (via email)
Manny DaRocha — Black Rock Enterprises, LLC (via email)
S9Ca0erehHCA00501.16 - Manna Phase III\Correspoodence\22 -01 -24 -Final Pay Estimate No. 10 Ltr.doc
'E, PP, CME
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c Bond No. CA- 3187227M
GREAIAMENCAN
INSURANCE GROUP
MAINTENANCE BOND
KNOW ALL MEN BY TI-IBSE PRESENTS, That
Black Rock Enterprises, LLC
as Principal,
and the GREAT AMERICAN INSURANCE COMPANY, a corporation organized under the laws of the State of
Ohio and duty authorized to transact business in the State of New JerSBy
as Siuety, tuehcfil and firmly hound unto
Borough of Carteret its 'Obligee; in lire sum of
Five hundred eighty four thousand one hundred twelve and 50/100 - -- DOLLARS,
for the payment whereof well and truly to be made, and Principal and the said Surety, bind themselves, their heirs,
executors, admfuish'alors, successors and assigns, jomlly and severally, firmly by these presents.
SIGNFD, sodlod and dated this 17th day of January ,2022
WHEREAS dw Principal and tare Obligee have entered into a written agreomeni dated the 22nd
day of July , 2019 , for
WATERFRONT MARINA — PHASE III
the terms of which agreementweie completed and accented the 19th day or April 2021
and
WHEREAS the Principal has given a Two year maintenance guarantee under said agreement
or otherwise against defective materitds and workmansbip.
NOW, THEREFORE, the condition ol'lhis obligation is such that if the Principal Shalt wetland truly comply
with such guarantee, then this obligation to be void;' otherwise it shall reimin in full force:
PROVIDED that no tight of action shall accrue on this bond to or for the use of-any Person or Corporation
other than the Ob]iggo named herein; and
PROVIDED FURTHER that the Surety Shall have no liability under this bond unless the Obligec shall give
written notice of claim of thePtincipal`s failure to comply with such guiaranteed to the Surety at its Administrative=
Office it E. Fourth Strut, Cincinnati, Ohio 45202 such notice to be given wihsin the Two year
year mainteunnce poriod.
Black Rock Enterprises, LLC %
PrInelpal
GREAT AalIERICAN Si - V, .OMPANY
By:
Allorncv -rn- act
DONALD GOETZ, Attorney-In-Fact
F.9607(511 i)
Reset.
CONSENT OF SURETY
TO FINAL PAYMENT
A&I lDOUmenl G707
(Imuilethms un ravemumao
TO OWN IM:
(Nam"I""t,40"m'
Borough of Carteret
61 Cooke Avenue
Carteret, NJ 07008
m(IJECIt
I Alm n- ml,vlJmN
Bond #CA- 3187227
OWNER
.E3
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ARCHl7$C1" S I!ROJWt' NO::
CONTRACI'ros:
CONTRACT DATED;.
WATERFRONT MARINA — PHASE III (REBID)
7/22/2019
In imijAmm wilt th4 (lnil?51uns,ttrdtc.Ctidtmtl hl'lWCp1 the Qtvnl9 :Intl rlu:.Glfnntturts intllraldd UITIM dIa
lO Jn++mVl4�(.mli4 /r /na+(rY��'{P!
Great American Insurance Company
301 E 4th Street
Cincinnati, OH 45202
sufu:w.
nn tx?>xl eJ
1( rdQ '�lIIiO(6((NtG >ltinYVffima4iJUry '
Black Rock Enterprises,LLC
1316 Englishtown Road
Old Bridge, NJ 08857
. coNrRncroR,
111 r hp nlaxoms orlhC anal ltym-will To 111V Cunlmoor, tnul offmi lllw rival t*yIIIU111 UI I 11 6XII' 1orshdll and w1low•�; the 8ulutp nr
any n?ls ohUpItoms nt.
;hmr waemuG,td4*,Vc)wnw
Bo ough of Carteret
61 Cooke Avenue
Carteret, NJ 07008 owhlt.
;anwi ronh insnldsur�r.gIxod.
iY Wm hR,SWHRnIX;F' thr&m.tl No l+twumu Hal Us lwntl n111hHttu "0 1 -17 -2022
lhtdYtLnrdllrµ b,• rnwNG,IN(!rtnr{A,t (ly!n ri,vtnMJrmGlnwi�•!
,Great American Insurance Company
BM-
C_.____
lFr6anlmmnvnlAlNel-
1 t GAUTIONI You should Sign an original AIA document that has this oautlon printed In red, Art
odglnol AssufOS that changes will not be obsourod As troy occur when documents are raproducad,
Sao Instruotion Sheet for Limited License for Reproduction of this documerlL
A"
i11711 ItKnimltlUKAVENI N AWMIT-
MOM nc 11410-110 • ATIRM uroatnew pnow.pytro vialew U,a: w+r- G 707- -1984
tlWrt.Favro arta.M4WU41taI M9NMtlatintegypmei •,upaq
GREAT AMERICAN INSURANCE COMPANY®
Administrative Office: 301 E 4TH STREET • CINCINNATI, OHIO 45202 • 513- 369 -5000 • FAX 513 - 723 -2740
The number of persons authorized by
this power of attorney is not more than SIX
No,o 20526
POWER OFATTORNEY
KNOWALLMEN BY THESE PRESENTS: That the GREATAMERICAN INSURANCE COMPANY, a corporation organized and existing under
and by virtue of the laws of the State of Ohio, does hereby nominate, constitute and appoint the person or persons named below, each individually if more than
one is Rained, its true and lawful attorney -in -Pact, for it and in its name, place and stead to execute on behalf of the said Company, as surety, any and all bonds,
undertakings and contracts of suretyship, or other written obligations in the nature thereof; provided that the liability of the said Company oil any such bond,
undertaking or contract of suretyship executed under this authority shall not exceed the limit stated below.
Name Address Limit of Power
DONALD GOETZ ALL OF ALL
ROBERT CULNEN MENDHAM, NEW JERSEY $100,000,000
MARK CULNEN
LISA NOSAL
LOUIS VLAHAKES
QUINTIN PETTY
This Power ofAttoruey revokes all previous powers issued on behalf of the attorney(s) -in -fact named above.
IN WITNESS WHEREOF the GREATAMERICAN INSURANCE COMPANY has caused these presents to be signed and attested by its appropriate
officers and its corporate seal hereunto affixed this 16TH day of DECEMBER 2020
Attest GREATAMERICAN INSU " NCE COMPAN
Assistant SeovtaQ, Ditdsiotml Senior t9ce PresiAenl
STATE OF OHIO, COUNTY OF HAMILTON - ss: MARK vicARio te77-377-24051
On this 16TH day of DECEMBER 2020 ,before are personally appeared MARK VICARIO, to meknown,
being duly sworn, deposes and says that Ire resides in Cincinnati, Ohio, that he is a Divisional Senior Vice President of the Bond Division of Great American
Insurance Company, the Company described in and which executed the above instrument; that lie knows the seal of the said Company; that the seal affixed to the
said instrument is such corporate seal; that it was so affixed by authority of his office under the By -Laws of said Company, and that Ire signed his name thereto
by like authority.
SUSAN A KOHORST
•' n °a Notary Public
i : •; State of Ohio
'+ My Comm. Expires
May 18, 2025
- -)a,I a,/ -v
This Power ofAttomey is granted by authority of the following resolutions adopted by the Board of Directors ofGreatAnrerican Insurance Company
by unanimous written consent dated June 9, 2008.
RESOLVED: That the Divisional President, the several Divisional Senior Nce Presidents, Divisional Fite Presidents and Divisonal Assistant Vice
Presidents, or any one offbeat, be and hereby is authorized, fivin line to time, to appoint one or more Attorneys-in-Fact to execute on behalf of the ConnpanJ;
as suet}; any and all bonds, undertakings and contracts ofsureh�ship, or other written obligations in the nature!hereof to prescribe their respective duties and
the respective limits of their authority; and to revoke any such appointment at any lime.
RESOLVED FURTHER: That the Company seal and the signature of any of the afa'esaid officers and any Secretary or Assistant Secretary of the
Company may he affixed by facsimile to any power of attorney or ceri ficate of either givenfa• the ecectntio n of any band, undertaking, contract a suretyship,
a- other written obligation in the nature thereof, such signature and seal when so used being hereby adopted by the Company as the original signature of such
officer and the original seal ofthe Counpoopi to be valid and binding upon the Company wilh the sameforce and effect as though manually gf%ixed
CERTIFICATION
I, STEPHEN C. BERAHA, Assistant Secretary of Great American Insurance Company, do hereby certify that the foregoing power of Attorney and
the Resolutions of the Board of Directors of June 9, 2008 have not been revoked and are now in full force and effect.
Signed and sealed this i~}-T� dayofb�.J'rzpc -, _i , ? — (): -,�/
S1029AH (03120)
f.�,ixA n. Jj ..uw l
.tirvv x- .veews
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GiREATAA' ERICAN,
INSURANCE GROUP
301 East 4th Street
Clnclnnatl, OH 45202
GAIG.cum
GREAT AMERICAN INSURANCE COMPANY
STATEMENT OF ASSETS, LIABILITIES AND CAPITAL & SURPLUS
AS OF DECEMBER 31, 2020
ADMITTED ASSETS
LIABILITIES, CAPITAL AND SURPLUS
Sonds ...........:........::...... :.................,,., .,,..:,.::..a................., $ 4,386,347,507
Unpaid losses and loss oxpensaa.. ....................
I ... .. ... ,..,.,...
$ 4,495,001,334
Stocks..;,;, ,..:,:,:, ;.,.
1,201,860,403
Reserve for underwriting expenses
,.....
314,467,440
Mortgage loans on real estate ..................................... ....
400,472,365
Federal income taxes =.................. ............
._.::...:..::.....
2,100,834
Real estate (not of encumbrances) ...... . ...............................
37,066,932
Reserve far unearned premiums.........:, ...............,,........,...
1,503,390,002
Cash and short4erm Investments-- ......................... ........
1,049,550,643
Ceded reinsurance premiums payable ... ,, .............
............. 1
178,446,021
Other Invested assets......:, .......... ..........
926,866,836
Funds held under reinsurance trashes
..................
571,592,513
Receivable for securities .......................... ........,...
5,090,812
Retroactive reinsurance ceded.........,.. .,............,:....,::...,.,,.
(107,661,805)
Investment Income due and accrued .... ...............................
36,502,562
Other liabilities ............................. ....... : ,..,..,......................
q,
228,081,621
Agents' and premium balances ............. ...............................
728,740,997
Total liabilities.. ... .. ........................ ,. .....,,,,,.,.h,,...,,.,...,..,.
7,266,385,960
Reinsurance recoverable on loss payments ........................
126,954,023
Net deferred tax easel...... ....:..................... _ ... ...... ............. .
149,581,575
Receivable from affiliates ...................... ...............................
13,340,599
Receivable from Federal Crop Insurance Corporation_--
398,733,306
Company owned life Insurance ............................................
101,104,977
Capital Block.......... ............................... $
15,440,600
Funds held as collateral,. ............. — ....................................
0,356,261
Paid in surplus....... ........................ ......
080,010,977
Funded deducllbles ..:...,:. ....,::... ........ .,....
30,751,380
Special surplus funds .........................
83,566,748
Other admitted aerials........ ................... ........ .......... .............
45,245,180
Unassigned funds ........ ,, ........... I. ......... I
1,576892183
Pollcyholders' surplus ........................ ...............................
2,555,910,608
Total.... ...; .... —.- ............. ...... $ 8,8)2,290,468
Total ....... I ....... ................................... ....:..: ................. $ 9,822,296,468.
Securities have been valued on the basis prescribed by the National Association of Insurance Commissioners.
STATE OF OHIO
COUNTY OF HAMILTON
Robert J. Schwartz, Vice President and Controller, and Stephen Oemhe, Assistant Vice President and Assistant Secretary, being duly sworn,
each for himself deposes and says that they are the above described officers of the Great American Insurance Company of Cincinnati, Ohio;
that said Company Is a corporation duly organized, existing and engaged In business as a Surety by virtue of the laws of the State of Ohio
and has duly complied with all the requirements of the laws of said stets applicable to said Company and is duly qualified to not as Surety
under such laws; that said Company has also complied with and is duly qualified to act as Surety under Public Law 07 -256 enacted
September 13, 1002 (96 Stat. 1047 as emended: 31 U.S.C. 03049300); that to the bast of their knowledge and belief the above statement la
a full, true and correct Statement of the Assets, Liabilities and Capital & Surplus of the said Company as of December 31, 2020.
Subscribed and sworn to before me
this 2nd day of March, 2021,
Publlo Nolary
Notary Public, S to of Ohio
My Commission Expires April 28, 2025
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DEPARTMENT OF BANKING AND INSURANCE
CERTIFICATE OF AUTHORITY
Date: May 01, 2021
NAIC Company Code: 16691
THIS IS TO CERTIFY THAT THE GREAT AMERICAN INSURANCE COMPANY,
HAVING COMPLIED WITH THE LAWS OF THE STATE OF NEW JERSEY, AND ANY
SUPPLEMENTS OR AMENDMENTS THERETO WITH RESPECT TO THE
TRANSACTION OF THE BUSINESS OF INSURANCE,.IS LICENSED TO TRANSACT
IN THIS STATE UNTIL THE 1st DAY OF MAY, 2022, THE LINES OF INSURANCE
SPECIFICALLY DESIGNATED BELOW:
01 Fire and Allied Lines
10 - Aircraft Physical Damage
11 - Other Liability
12 - Boiler and Machinery
13 - Fidelity and Surety
14 - Credit
15 - Burglary and Theft
16 - Glass
17 - Sprinkler Leakage and Water Damage
18 - Livestock
02 - Earthquake
20 - Physical Loss to Buildings
21 - Radioactive Comtamination
22 - Mechanical Breakdown /Power Failure
23- Other (P /C)
26 - Accident and Health
03 - Growing Crops
04 - Ocean Marine
06 - Inland Marine
06 - Workers Compensation and Employers Liability
07 - Automobile Liability Bodily Injury
08 - Automobile Liability Property Damage
09 - Automobile Physical Damage
MARLENE CARIDE
COMMISSIONER OF
BANKING AND INSURANCE
SURETY DISCLOSURE STATEMENT AND CERTIFICATION
pursuant to N.L.S.A. 2A:44 -143
(for use when surety(ies) have a certificate from U.S, Secretary of the Treasury in accordance with 31 U.S.C. 9305)
(name of surety(in) GREAT AMERICAN INSURANCE COMPANY
surety(ies) on the attached bond, hereby ecnlifies(y) the following:
(1) The surety(ies) meets (meet) the applicable capital and surplus requirements of R.S. 17:17 -6 or R.S. 17:17 -7 as of
the surety's most current annual filing with the New Jersey Department of Insurance
(2) The capital and surplus, as determined in accordance with the applicable laws of this State, of the surety(ies)
participating in the issuance of the attached bond is (are) in the following amounts as of the calendar year ended
December 31, 2020, (=most recent calendar year which capital and surplus amounts are available), which amounts have
been certified on a Consolidated Certification by Ernst & Young LLP, 250 E. 5th Street, Cincinnati, Ohio 45202 and
are included in the Annual Statement on file with the New Jersey Department of Insurance, 20 West State Street CN-
325, Trenton, New Jersey 08625 -0325,
SURETY COMPANIES(Y) CAPITAL AND SURPLUS
Great American Insurance Company $2,555,910,508
(3) With respect to each surety participating in the issuance of the attached bond that has received from the United
States Secretary of lire Treasury a certificate of authority pursuant to 31 U.S.C. 9305, the underwriting limitation
established therein on July 1, 2021 (must recent calendar year available) is as follows:
SURETY COMPANIES(VI LIMITATION
Great American Insurance Company $250,981,000
(4) The amount of the bond to which the statement and certification is attached is $ 2,920,562.92
(fill in bond amount)
(5) If, by virtue of one or more contracts of reinsurance, the amount of the bond indicated under item (4) above exceeds
the total underwriting limitation of all sureties on the bond as set forth in item (3) above, then for each such contract of
reinsurance:
(a) The name and address of each such reinsurer under that contract and the amount of the reinsurer's
participation in the contract is as follows:
REINSURER ADDRESS AMOUNT
and;
(b) Each surety that is party to any such contract of reinsurance certifies that each reinsurer listed under item
(5)(a) satisfies the credit for reinsurance requirement established under P.L. 1993, c.243(C. 17:5 1 B -1 et seq.) acrd any
applicable regulations in effect as of the date on which the bond to which this statement and certification is attached
shall have been filed with the appropriate public agency.
CERTIFICATE
(to be completed by an authorized certifying
agent for each surety on the bond)
1, Jamie Neuspiekle, as Divisional Vice President - Bond Division for Great American Insurance Company, a
corporation domiciled in Ohio, DO HEREBY CERTIFY that, to the best of my knowledge, the foregoing statements
made by me are true, and ACKNOWLEDGE that, if any of those statements made by me are false, this bond is
VOIDABLE.
(' a=ura ofcetti' ing agent/officeri
Jamie Neuspiekle
(Printed name of certifying agent/officer)
Divisional Asst. Vice President
Dated: 1 -17 -2022 (Title of certifying agend/officer)
.
(fill in month, day, year)