HomeMy WebLinkAbout25-138.02 Leone & Keeble Inc. - Princinct Remodelsp"'iikane
jUalley
Public Works Department
Engineering Division
10210 E Sprague Ave ♦ Spokane Valley WA 99206
509.720.5075 ♦ Fax: 509.720.5075 ♦ cityhatt@spokanevalley.org
Change Order Memorandum
Date: 118126
To: Gloria Mantz, City Services Administrator
From: tY Glenn Ritter, Senior Engineer/Project Manager
Re: Change Order #2 for Leone & Keeble, Inc on Precinct Remodel Project
Budget Account No. PS594210-562002
Contract No. 25-138.02
This change order will pay to repair the existing plumbing leak found above the ceiling in SVIU,
to reconfigure and relocate the light switching for Traffic/Patrol/Admin, to add carpet tiles in the
Administration area, and to reconfigure the ceiling grid in the demolished office area of Traffic to
match existing in the remaining Traffic area. This change order will be funded by the available
project contingency for a total cost (excluding sales tax) of $7,807.00.
Original Contract Amount (without sales tax): $ 511,005.00
Previous Change Order Cost: $ 63,530.00
Change Order #2 Cost (without sales tax): $ 7,807.00
Project Cost including Change Order #2: $ 582,342.00
City Manager's Contract authority (15% of contract) $ 76,650.75
Change Order Cost to date: $71,337.00
Remaining City Manager's Contract Authority after CO #2 $ 5,313.75
cc: Finance Department
Clerk's office
Spokane
,;,wOVal ley
ENGINEERING DIVISION
CHANGE ORDER NO: 2
CONSTRUCTION CONTRACT NO: 25-138.02
PROJECT: Precinct Remodel CONTRACT DATE:
8/14/2025
PRIME CONTRACTOR: Leone & Keeble, Inc. CIP NO:
n/a
DESCRIPTIONOF
Additional work to repair a plumbing leak above the SVIU ceiling, add decals to Division doors, reconfigure
and
relocate light switching for Patrol/Traffic/Admin areas, add carpet in Admin area and reconfigure the ceiling grid in
Traffic to match existing.
Item No. Description Unit Quantih Unit Price
Total
CO #2.1 Repair plumbing leak above ceiling in SVIU 1 LS $ 2,716.00 $
2,716.00
CO#2.2 Reconfigure/Relocate light switching 1 LS $ 1,385.00
1,385.00
CO #2.3 Add carpet tiles in Admin area 1 LS $ 2,420.00
2,420.00
CO #2.4 Reconfigure ceiling grid in Traffic to match existing 1 LS $ 1,286.00
1,286.00
Total Amount of this Change Order (w/o tax): $
7,807.00
9% Sales Tax S
702.63
APPROVALVERBAL JUSTIFICATION
Independent Justification on File Y.es. .........................................................
Verbal Approval Yes Verbal Approval by
Glenn Ritter
PHYSICAL COMPLETION
Original Contract Working Days: 75 Revision By This Change Order:
10
Revisions by Prior Change Orders: 0 Total Revised Contract Working Days:
85
CONTRACT•
THESE CHANGES RESULT IN THE FOLLOWING ADJUSTMENTS OF TOTAL CONTRACT AMOUNT:
ORIGINAL TOTAL CONTRACT AMOUNT $
..........
511,005.00
TOTAL PRIOR CONTRACT CHANGE ORDER AMOUNT (through C0#1) $
63,530,00
TOTAL CONTRACT AMOUNT PRIOR TO THIS CHANGE ORDER $
................
574,535.00
NET THIS CHANGE ORDER $
7,807.00
_
TOTAL CONTRACT AMOUNT INCLUDINiIS CH Ti E ORDER (w/o tax) .................................... $
582,342.00
CONTRACTOR ACCEPTANCE: DATE: 01/07/26
The contractor hereby accepts this adjustment u der the terms of Section 1-04.4 of the original contract.
RECOMMENDED BY: y DATE: 1 /7/26
Project anager V.
APPROVED BY: DATE:
C4 SServices Administra or
APPROVED BY:�DATE:
City Manager
ATTACHMENTS: L&K's COP #19, 24, 25 & 26
Distribution: ORIGINAL TO: City of Spokane Valley Clerk's Office
COPIES TO: Contractor, PW Project File, Owner's Representative, Finance Department
COSY Form 9/5/2014
I' LEONE & KEEBLE
'W/ COP General Contractor Breakdown Summary
Project Name: SVPD Precinct Remodel
COP No.
19
Project No. 25-1284 Source Documents:
Emails Date:
11/13/2025
Contractor: Leone & Keeble, Inc
Contractor Ref. No.
Description: Pricing to fix water leak in existing piping in SVIU
area.
1. CRAFT LABOR COSTS
Itemize all costs on attached COP Cost Breakdown form.
Direct Labor Costs:
a. crew (apprentices, journeymen, & laborers)
$
b. direct supervision (NTE 15% of 1a)
$
-
c. safety (NTE 2% of lines 1 a, b, & c)
$
-
1. CRAFT LABOR COSTS
$
-
2. MATERIAL COSTS
a. material costs
$
b. freight costs
$
2. MATERIAL COSTS
$
3. EQUIPMENT COSTS
a. owned or rented equipment
$
3. EQUIPMENT COSTS
$
4. SMALL TOOLS
small tools (NTE 3% of is & b)
$
-
4. SMALL TOOLS
$
SUBTOTAL 1 thru 4
$
5. OVERHEAD & PROFIT
Enter % 15.00%
$
5. OVERHEAD & PROFIT
$
-
6.SUBCONTRACTORS
a. KC Charles
$
2,446.00
b.
$
C.
$
d.
$
6. SUBCONTRACTORS
$
2,446.00
7. OVERHEAD & PROFIT ON SUBCONTRACTORS
Enter % 8.00%
$
195.68
7.
OVERHEAD & PROFIT ON SUBCONTRACTORS
$
196.00
8. INSURANCE
1.00 %of1-7
$
26.42 8.INSURANCE
$
27.00
9. BOND
1.25 % of 1-7
$
33.03 9. BOND
$
34.00
10. B&O Tax
0.471 % of 1-7
$
12.44 10. B&O Tax
$
13.00
TOTAL COST
$
2,716.00
SVPD COP 19 Page of Issued 11/13/2025
ii,ry K.C. Charles, Inc.
--plumbing & piping since 1989—
November 13, 2025
Leone & Keeble, Inc.
P O Box 2747
Spokane, WA. 99220
Attention: Jesse
Re: SVPD
Subject: RFCO
5685 Jergens Road
Nine Mile Falls, WA 99026
509.276.1228 1 Fax: 509.276.1270
St. Cont. Lic. #KCCHAI*0880T
We will supply necessary labor and material to install the following.
BASE
1. Demo domestic cold -water main as needed to make repairs.
2. New 2" copper fitting as needed to make repairs.
3. Lift rental as needed to access location.
4. Prevailing wages as applicable.
BID PRICE OF
$2,446.00
EXCLUSIONS: No electrical, No HVAC, No concrete pour back, No back framing, No
access doors, No commissioning, No bond, No seismic bracing, No seismic engineering,
No engineering.
If you have any questions, please contact the undersigned.
Sincerely,
Cameron S. Berger
I' LEONE 6 KEEBLE
MAW COP General Contractor Breakdown Summary
Project Name: SVPD Precinct Remodel COP No. 24
Project No. 25-1284 Source Documents: RFI 19 Date: 11/18/2025
Contractor: Leone & Keeble, Inc Contractor Ref. No.
Description: Pricing to add new switches to accommodate the new work spaces per the response to RFI 19.
1. CRAFT LABOR COSTS
Direct Labor Costs:
a. crew (apprentices, journeymen, & laborers)
b. direct supervision (NTE 15% of 1a)
c. safety (NTE 2% of lines 1a, b, & c)
2. MATERIAL COSTS
a. material costs
b. freight costs
3. EQUIPMENT COSTS
a. owned or rented equipment
4. SMALL TOOLS
small tools (NTE 3% of I & b)
5. OVERHEAD & PROFIT
Enter % 15.00%
6.SUBCONTRACTORS
a. Electric City
b.
C.
d.
7. OVERHEAD & PROFIT ON SUBCONTRACTORS
Enter % 8.00%
8. INSURANCE
Itemize all costs on attached COP Cost Breakdown form.
1. CRAFT LABOR COSTS $
2. MATERIAL COSTS $
3. EQUIPMENT COSTS
$ -
4. SMALL TOOLS
$ -
SUBTOTAL 1 thru 4
$ -
5. OVERHEAD & PROFIT
$ -
$
1,247.00
6. SUBCONTRACTORS
$ 1,247.00
$
99.76
7. OVERHEAD & PROFIT ON SUBCONTRACTORS
$ 100.00
1.00 %of1-7 $ 13.47 8.INSURANCE $ 14.00
9. BOND
1.25 % of 1-7 $ 16.84 9. BOND $ 17.00
10. B&O Tax
0.471 % of 1-7 $ 6.34 10. B&O Tax $ 7.00
TOTAL COST $ 1,385.00
SVPD COP 24 Page of Issued 11/18/2025
CHANGE REQUEST #10
ELECTRIC CITY, INC.
16019 E Lacrosse Ln
Phone (509) 536-6292 Fax (509) 536-1709
PROPOSAL SUBMITTED TO Leone & Keeble
PHONE 509-327-4451
DATE 11/18/2025
STREET
JOB NAME SVPD Precict Remodel
CITY, STATE AND ZIP CODE
JOB LOCATION 12710 E Sprauge Ave.
We hereby submit specifications and estimates for:
Add new switch locations.
Traffic area switch
Labor - 1 man x 2 hrs -
Material -
$ 196.00
$ 117.00
Hall switch / demo existing switches
Labor - 1 man x 1 .5 hrs -
Material -
$ 147.00
$ 5.00
Stafff area switch
Labor- 1 man x 1.5 hrs -
Material -
$ 147.00
$ 80.00
Sean's office / work area -
Labor - 1 man x 1.5 his -
Material -
$ 147.00
$ 99.00
prep time - 2 men x 1 hr
$ 196.00
10% mark up -
$ 113.00
Sub Total -
$ 1,247.00
We Propose hereby to furnish material and labor -complete in accordance with above specifications, for the sum of:
One thousand two hundred forty seven dollars $1,247.00
Payment to be made as follows:
All material is guaranteed to be as specified. All work to be completed in a workmanlike
manner according to standard practices. Any alteration or deviation from above specifications Authorized
involving extra costs will be executed only upon written orders, and will become an extra charge Signature
over and above the estimate. All agreements contingent upon strikes, accidents or delays
beyond our control. Owner to carry fire, tornado and other necessary insurance. Our workers Note: This proposal may be
are fully covered by Workman's compensation Insurance. withdrawn by us if not accepted within N/A days
Acceptance of Proposal - The above prices, specifications and conditions are
satisfactory and are hereby accepted. You are authorized to do the work as
specified. Payment will be made as outlined above. Signature
II• LEONE 6 KEEBLE
'WWr
COP General Contractor Breakdown Summary
Project Name: SVPD Precinct Remodel
COP No.
25
Project No. 25-1284 Source
Documents:
Email Date:
11/20/2025
Contractor: Leone & Keeble, Inc
Contractor Ref. No.
Description: Pricing to add carpet in Admin area per owner request.
1. CRAFT LABOR COSTS
Itemize all costs on attached COP Cost Breakdown form.
Direct Labor Costs:
a. crew (apprentices, journeymen, & laborers)
$
b. direct supervision (NTE 15% of 1 a)
$
c. safety (NTE 2% of lines 1a, b, & c)
$
1. CRAFT LABOR COSTS
$
2. MATERIAL COSTS
a. material costs
$
b. freight costs
$
2. MATERIAL COSTS
$
3. EQUIPMENT COSTS
a. owned or rented equipment
$
3. EQUIPMENT COSTS
$
4. SMALL TOOLS
small tools (NTE 3% of 1a & b)
$
4. SMALL TOOLS
$ -
SUBTOTAL 1 thru 4
$
5. OVERHEAD & PROFIT
Enter % 15.00%
$
-
5. OVERHEAD & PROFIT
$
6.SUBCONTRACTORS
a. Ibex
$
2,180.00
b.
$
C.
$
d.
$
-
6. SUBCONTRACTORS
$ 2,180.00
7. OVERHEAD & PROFIT ON SUBCONTRACTORS
Enter % 8.00%
$
174.40
7. OVERHEAD & PROFIT ON SUBCONTRACTORS
$
174.00
& INSURANCE
1.00 % of 1-7 $
23.54 & INSURANCE
$
24.00
9. BOND
1.25 %of 1-7 $
29.43 9. BOND
$
30.00
10. B&O Tax
0.471 % of 1-7 $
11.09 10. B&O Tax
$
12.00
TOTAL COST
$
2,420.00
SVPD COP 25 Page of Issued 11/21/2025
Sam Stoner
From: Ethan Myers <ethanm@ibexflooring.com>
Sent: Thursday, November 20, 2025 1:39 PM
To: Sam Stoner
Cc: Jesse Hunt
Subject: Re: Precinct Remodel
Sam,
For carpet tile, rubber base, transitions and necessary prep- looking at $2,180 for an ADD in the
highlighted area next to the LT Office.
Let me know if you need it broken down any more or have any questions!
Ethan Myers
Project Manager
ibex
Commercial Flooring
2925 N. Martin Spokane, WA 99207
C: (509) 638-9863 0: (509) 327-3331 ext #106 F: (509) 327-4033
Sam Stoner
From: Glenn Ritter <gritter@spokanevalleywa.gov>
Sent: Tuesday, November 18, 2025 7:11 AM
To: Sam Stoner
Cc: C.J. Balcom; Jesse Hunt; Jerry Burk; smwalter@spokanesheriff.gov
Subject: Precinct Remodel
Good morning Sam,
We are requesting a few more COPs. Please see below and submit individually for review/approval as follows:
• Add carpet to Admin area as shown below:
Add carpet in
Admin area �.
-12" CLR
LT 0 F FI+C E
14
CPT .vs
P R9
74A M
rx
�C G
�' 70A F,
. SEE SHEET A4.10 FOR ALTERNATE 2
13-02
' TRAFFIC I
I
'= LEC�NE KEEBLE COP General Contractor Breakdown Summary
Project Name: SVPD Precinct Remodel
COP No.
26
Project No. 25-1284 Source Documents:
Emails & Meetings
Date:
12/2/2025
Contractor: Leone & Keeble, Inc
Contractor Ref. No.
Description: Pricing to re -orient the ceiling grid in Traffic to match the rest of the area as discussed in weekly meetings.
1. CRAFT LABOR COSTS
Itemize all costs on attached COP Cost Breakdown form.
Direct Labor Costs:
a. crew (apprentices, journeymen, & laborers)
$
310.55
b. direct supervision (NTE 15% of 1a)
$
46.58
c. safety (NTE 2% of lines la, b, & c)
$
6.21
1. CRAFT LABOR COSTS
$
363.00
2. MATERIAL COSTS
a. material costs
$
-
b. freight costs
$
-
2. MATERIAL COSTS
$
3. EQUIPMENT COSTS
a. owned or rented equipment
$
-
3. EQUIPMENT COSTS
$
-
4. SMALL TOOLS
small tools (NTE 3% of 1 a & b)
$
9.32
4. SMALL TOOLS
$
9.00
SUBTOTAL 1 thru 4
$
372.00
5. OVERHEAD & PROFIT
Enter % 15.00%
$
55.80
5. OVERHEAD & PROFIT
$
56.00
& SUBCONTRACTORS
a. Spokane Acoustics
$
762.00
b.
$
C.
$
-
d.
$
-
6. SUBCONTRACTORS
$
762.00
7. OVERHEAD & PROFIT ON SUBCONTRACTORS
Enter % 8.00%
$
60.96
7. OVERHEAD & PROFIT ON SUBCONTRACTORS
$
61.00
8. INSURANCE
1.00 % of 1-7
$
12.51
& INSURANCE
$
13.00
9. BOND
1.25 % of 1-7
$
15.64
9. BOND
$
16.00
10. B&O Tax
0.471 % of 1-7
$
5.89
10. B&O Tax
$
6.00
TOTAL COST
$
1,286.00
SVPD COP 26 Page of Issued 12/2/2025
COP Cost Breakdown
Project Name: SVPD Precinct Remodel
Project No. 25-1284
Contractor: Leone & Keeble, Inc.
COP No. 26
Date: 12/2/2025
Contractor Ref. No. 0
Description
Quantity
Unit
Type
Labor
Material
Equipment
Total
Cost
Unit $
Cost
Unit $
Cost
Unit $
Cost
Demo Grid
4
mh
$62.11
$ 248.44
$
$
$ 248.44
Daily Clean
1
mh
$62.11
$ 62.11
$
$
$ 62.11
Travel and Per
diem calculator
# of workdays per week
5
days
Labor Subtotal
$ 311
Hourly Rate
56.41
OFM Standard Per Diem
0
days
$55.00
$
$
OFM Standard Lodging
0
days
$110.00
$
$
Extended Overhead
# of days added to contract time
0
days
$
$
$
$
Extended Overhead
0
days
$500.00
$
$243.50
$
$23.33
$
$
Total Cost of Work
$ 310.55
$ -
$ -
$ 310.55
SVPD COP 26
Page of Issued 12/2/2025
From:
Joseph McCoury <joem@spokaneacoustics.com>
Sent:
Tuesday, December 2, 2025 9:19 AM
To:
Sam Stoner
Cc:
Jon Gotfredson
Subject:
Added room
Hello,
Per your conversation with Jon, here is the additional cost to add grid in that room.
$762.00
Thank You!
Joe McCoury
Spokane Acoustics
509-862-8141
From: Sam Stoner
Sent: Thursday, November 20, 2025 3:50 PM
To: Jon Gotfredson (jon@spokaneacoustics.com) <jon@spokaneacoustics.com>; Sammie Reed
(sammie@spokaneacoustics.com) <sammie@spokaneacoustics.com>
Cc: C.J. Balcom <CBalcom@leone-keeble.com>; Jesse Hunt <jhunt@leone-keeble.com>
Subject: SVPD Change Order
Hey Jon, can you provide your cost to add new grid in part of the Traffic area so it matches the rest of the
area? See attached photo and drawing markup below.
ALTERNATE 2: REFLECTED CEILING PLAN
1 /A" = V-W
76
ACOR" CERTIFICATE OF LIABILITY INSURANCE
16.� 9/30/2026
DATE(MM/DD/VVYv)
F9/25/2025
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed.
If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on
this certificate does not confer rights to the certificate holder in lieu of such endorsement(s).
PRODUCER Lockton Companies, LLC
CONTACT
NAME:
PHONE FAX
A/C No):
DBA Lockton Insurance Brokers, LLC in CA
CA license #OF ] 5767
8110 E Union Ave., Ste. 100
E-MAIL
ADDRESS:
Denver CO 80237
INSURER(S) AFFORDING COVERAGE
NAIC #
INSURER A :Liberty Insurance Corporation
42404
denver-certs@lockton.com
INSURED Leone & Keeble, Inc.
1544568 108 W Boone Ave
INSURER B:Liberty Mutual Fire Insurance Company
23035
INSURER C :
INSURER D:
Spokane, WA 99201
INSURER E:
INSURER F :
COVERAGES CERTIFICATE NUMBER: 2229f1Rh7 REVISION NUMBER: XXXXXXX
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR
LTR
TYPE OF INSURANCE
ADDL
SUBR
POLICY NUMBER
/DD/YPOLICY EFF
MM
POLICY EXP
MM/ D/Y Y
LIMITS
g
X
COMMERCIAL GENERAL LIABILITY
CLAIMS -MADE � OCCUR
$5,000 PD Deductible
Y
N
TB2-Z91-480936-035
9/30/2025
9/30/2026
EACH OCCURRENCE
$ 1000 000
AGE TO RENTED
PREDAMMISES Ea occurrence
$ 100,000
X
MED EXP (Any one person)
$ 10,000
PERSONAL & ADV INJURY
$ 1,000,000
GEN'L AGGREGATE LIMIT APPLIES PER:
POLICY NIJECTPRO- LOC
OTHER:
GENERAL AGGREGATE
$ 2,000,000
PRODUCTS - COMP/OP AGG
$ 2 000 000
$
B
AUTOMOBILE
LIABILITY
ANY AUTO
OWNED SCHEDULED
AUTOS ONLY AUTOS
HIRED NON -OWNED
AUTOS ONLY AUTOS ONLY
y
j�j
AS2-Z91-480936-025
9/30/2025
9/30/2026
COMBINED SINGLE LIMIT
Ea accident
$ 1,000,000
X
BODILY INJURY (Per person)
$ XXXXXXX
BODILY INJURY (Per accident)
$ XXXXXXX
PROPERTY DAMAGE
Per accident
$ XXXXXXX
$XXXXXXX
A
X
UMBRELLA LIAB
EXCESS LIAB
X
OCCUR
CLAIMS -MADE
Y
N
TH7-Z91-480936-065
9/30/2025
9/30/2026
EACH OCCURRENCE
$ 10,000,000
AGGREGATE
$ 10.000.000
DED I X I RETENTION $ $0
$ XXXXXXX
B
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY Y / N
ANY PROPRIETOR/PARTNER/EXECUTIVE
OFFICER/MEMBER EXCLUDED? N
(Mandatory In NH)
If yes, describe under
DESCRIPTION OF OPERATIONS below
N / A
N
EL2-Z91-480936-015
9/30/2025
9/30/2026
PER OTH-
STATUTE X ER
E.L. EACH ACCIDENT
$ 1,000,000
E.L. DISEASE - EA EMPLOYEE
$ 1,000,000
E.L. DISEASE - POLICY LIMIT
$ 1,000,000
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
Re: Precinct Remodel Project
City of Spokane Valley and its officers, elected officials, employees, agents, and volunteers and Spokane Valley Police Department c/o Spokane County Sheriff and its officers,
elected officials, employees, agents, and volunteers are included as Additional Insured on a primary and non-contributory basis.
GtH I IFIGA I t HOLUEH GANGELLA I IUN Jee Attachments
22290867
City of Spokane Valley
10210 E Sprague Avenue
Spokane, WA 99206 USA
ACORD 25 (2016/03)
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVE�-•
(c) 1
The ACORD name and logo are registered marks of ACORD
TION- All riehts reserved
J
INCREASE PENALTY RIDER
BOND AMOUNT $625,668.62 BOND NO. GM250602
To be attached and form a part of Bond No. GM250602 dated the 14th Day of
August, 2025, executed by Great Midwest Insurance Company as surety, on behalf
of Leone & Keeble, Inc. as current principal of record, and in favor of City of
Spokane Valley, Washington, as Obligee for Precinct Remodel , and in the amount of
Six Hundred Twenty Five Thousand Six Hundred Sixty Eight Dollars and 62/100
($625,668.62).
In consideration of the agreed premium charged for this bond, it is understood and
agreed that Great Midwest Insurance Company hereby consents that effective from
the 14th Day of August, 2025, said bond shall be amended as follows:
THE BOND PENALTY SHALL BE INCREASED:
FROM: Six Hundred Twenty Five Thousand Six Hundred Sixty Eight Dollars and
62/100 ($625,668.62)
TO: Six Hundred Thirty Four Thousand Seven Hundred Fifty Two Dollars and 78/100
($634,752.78)
The INCREASE of said bond penalty shall be effective as of the 14th Day of August,
2025, and does hereby agree that the continuity of protection under said bond
subject to changes in penalty shall not be impaired hereby, provided that the
aggregate liability of the above mentioned bond shall not exceed the amount of
liability assumed by it at the time the act and/or acts of default were committed
and in no event shall such liability be cumulative.
Signed, sealed and dated this 8th Day of January, 2026
Leone & Keeble, Inc.
PRINCIPAL
BY
Great Midwest Insur nce Company
SURETY
BY S&zn �Vn,��fVJL
Susan J. Lat arulo, ATTORNEY -IN -FACT
z
POWER OF ATTORNEY
Great Midwest Insurance Company
KNOW ALL MEN BY THESE PRESENTS, that GREAT MIDWEST INSURANCE COMPANY, a Texas Corporation, with its principal
Houston, TX, does hereby constitute and appoint:
omas F. McCoy Jr., Kelli E Housworth, Susan J. Lattarulo, Travis J. Robles, Andrea T. Windish
true and lawful Attorney(s)-In-Fact to make, execute, seal and deliver for, and on its behalf as surety, any and all bonds, undertakings or
tings obligatory in nature of a bond.
This authority is made under and by the authority of a resolution which was passed by the Board of Directors of GREAT M
INSURANCE COMPANY, on the 15t day of October, 2018 as follows:
Resolved, that the President, or any officer, be and hereby is, authorized to appoint and empower any representative of the Company or
person or persons as Attorney -In -Fact to execute on behalf of the Company any bonds, undertakings, policies, contracts of indemnity or other
igs obligatory in nature of a bond not to exceed Twenty -Five Million dollars ($25,000,000.00), which the Company might execute through its
elected officers, and affix the seal of the Company thereto. Any said execution of such documents by an Attorney -In -Fact shall be as binding
the Company as if they had been duly executed and acknowledged by the regularly elected officers of the Company. Any Attorney -In -Fact, so
inted, may be removed in the Company's sole discretion and the authority so granted may be revoked as specified in the Power of Attorney.
Resolved, that the signature of the President and the seal of the Company may be affixed by facsimile on any power of attorney granted,
the signature of the Secretary, and the seal of the Company may be affixed by facsimile to any certificate of any such power and any such
ar or certificate bearing such facsimile signature and seal shall be valid and binding on the Company. Any such power so executed and sealed
certificate so executed and sealed shall, with respect to any bond of undertaking to which it is attached, continue to be valid and binding on the
IN WITNESS THEREOF, GREAT MIDWEST INSURANCE COMPANY, has caused this instrument to be signed by its President, and
Seal to be affixed this 11 th day of February, 2021.
ACKNOWLEDGEMENT
GREAT MIDWEST INSURANCE COMPANY
BY
Mark W. Haushill
President
On this 11th day of February, 2021, before me, personally came Mark W. Haushill to me known, who being duly sworn, did depose and
iy that he is the President of GREAT MIDWEST INSURANCE COMPANY, the corporation described in and which executed the above instrument;
at he executed said instrument on behalf of the corporation by authority of his office under the By-laws of said corporation.
i��4,� CHRISTINA pP
}i CA
Notary Public, Stets of Texas BY
' ;! s Comm, Expires 04•14-20215 Christina Bishop
'a �Notary !D t31090488 Notary Public
CERTIFICATE
I, the undersigned, Secretary of GREAT MIDWEST INSURANCE COMPANY, A Texas Insurance Company, DO HEREBY CERTIFY that
e original Power of Attorney of which the foregoing is a true and correct copy, is in full force and effect and has not been revoked and the resolutions
set forth are now in force.
and Sealed at Houston, TX this 8th Day of January 2026
BY
Leslie K. Shaunty
Secretary
,NING: Any person who knowingly and with intent to defraud any insurance company or other person, files and application for insurance of claim
ining any materially false information, or conceals for the purpose of misleading, information concerning any fact material thereto, commits a
ilent insurance act, which is a crime and subjects such person to criminal and civil penalties.