The Hickman County Finance Office will be accepting bids for "School Paving Services for 2021-2022."
Specifications may be found at www.hickmank12.org/request-for-proposal, or contact the Building
Maintenance Office at 931-729-3391 Ext. 3.
All bidders will be required to submit a conflict of interest disclosure form that can also be obtained at
www.hickmank12.org/request-for-proposl.
All bidders must meet TCA 49-5-406 regarding compliance to all Local, State, and Federal guidelines for
working on school properties. All bidders must have a TN business license, carry a 1 million dollar
liability insurance and workers compensation insurance and must attach copies of certificates to bid.
Sealed bids must be mailed or hand delivered to the Hickman County Finance Office, 114 North Central
Ave. Suite 203, Centerville, TN 37033 and clearly marked on the outside of the envelope "School Paving
Services". Bids will be opened on Wednesday, June 2, 2021 at 10:30 a.m. in the Finance Office.
Hickman County Board of Education reserves the right to accept, or reject any and all bids or parts of
bids and to waive any informalities that may prevent the acceptance of a better bid.
Present CardiCan Penny Mayberry
Bids Rec'd
Sessions Paving
Please see attached bids
Four Star Paving
Sessions Paving Company
The Hickman County Finance Office will be accepting bids for "School Paving Services for 2021-2022."
Specifications may be found at www.hickmank12.org/request-for-proposal, or contact the Building
Maintenance Office at 931-729-3391 Ext. 3.
All bidders will be required to submit a conflict of interest disclosure form that can also be obtained at
www.hickmank12.org/request-for-proposal.
All bidders must meet TCA 49-5-406 regarding compliance to all Local, State, and Federal guidelines for
working on school properties. All bidders must have a TN business license, carry a 1 million dollar
liability insurance and workers compensation insurance and must attach copies of certificates to bid.
Sealed bids must be mailed or hand delivered to the Hickman County Finance Office, 114 North Central
Ave. Suite 203, Centerville, TN 37033 and clearly marked on the outside of the envelope "School Paving
Services". Bids will be opened on Wednesday, June 2, 2021 at 10:30 a.m. in the Finance Office.
Hickman County Board of Education reserves the right to accept, or reject any and all bids or parts of
bids and to waive any informalities that may prevent the acceptance of a better bid.
Contractor's License
SESSIONS PAVING COMPANY
ID No. 6962
Phone(615) 356-0600
P.O. BOX 90266
NASHVILLE, TN 37209
Mail - Robert N. Hutcheson
Paving, surfacing, grading, bridges, structures and work
rnhutcheson@sessions paving.com
incidental thereto, airports, site grading and excavation.
Expiration Date: 1/31/2022
Limit: AGLM Unlimited
Class: BC; CE-A; CE-B; HC-D; HRA; MU
Part B
Sessions Paving Company
Paving Specifications
Please bid using the following bid form:
Scope: This bid is for the July 1 2021 thru June 30, 2022, school year and pricing shall be good for the remaining school
year.
All paving costs below to include cleaning, milling, key joints and tie ins, removal of any vegetation, cleaning of loose
sand and millings and applying the required tack coats per standard DOT specifications and laying of top coat as
specified in separate line items below. Any low drains, of utility covers, risers are to be included, unless the paving is
milled down to make them smooth and level to travel and to not impose any trip hazard. This bid may be applied to any
location as needed.
Overlay:
Price per square yard of 2 inch overlay rolled to 1.5 inch minimum thickness $ 1420 per square yard of paving.
Paving:
Price per square yard of 2 inch CW grade(220# per sq. yd.) / binder, with 1.5 inch (165# per sq. yd.) top coat finish paving
overlay $ 2600 per square yard of paving.
Milling:
Sawing/Demo/milling existing pavement by the square yard removed down to 4 inches, to include sawing and hauling
off/disposal of the excess debris. $ 3300
per square yard of demo.
Patch paving:
To saw cut, remove all loose or broken materials, to include binder, or wet earth, insuring solid dry compacted layer is
exposed, adding back 4inches of pug or rock material compacted 2 inches of commercial grade CW binder, and 2 inches
topcoat rolled to 1.5 inches and level. All patches to be level and smooth to finish grade. Per Sq. Yard.
$ 8000
Earth removal:
Digging/ Undercutting of earth and removal and disposal of excess dirt $ 8600 per yard.
Crack sealing/ resealing of lots:
Cost to remove any vegetation from cracks, blow out and sweep clean pavement, hot tar slurry crack fill all cracks and
then mop finish cracks level. $ 2.30 per LF.
Cost to seal spray two coats of parking lot sealer. $ 1.80 per yard
Painting/Striping of lots:
Re-striping of parking lots/drives for the following locations pricing each location at the existing striping layout as
needed/ if change is requested later, additional payment adjustments may apply:
CES $375000 EHHS $6,775°C HCHS $6,2500 HCMS $4,25000
CIS $2,250 EHIS $2,150 EHMS $2,7500 EHES $3,475 Central Office $2,27500
BOE reserves the right to allow other bidders that are not pavers to bid "striping only" in this bid, and to
award any said bidder the striping portion of the bid.
Sessions Paving Company
lay Robert Antiheron President
Hickman County Government
Conflict of Interest Disclosure Form
The County Financial Management System of 1981 contains the most stringent conflict of
interest provisions. TCA $5-21-121 provides:
(a) The director, purchasing agent, members of the committee, members of the county
legislative body or other officials, employees, or members of the board of education
or highway commission shall not be financially interested or have any personal
beneficial interest, either directly or indirectly, in the purchase of any supplies,
materials, equipment or contractual services for the county.
(b) No firm, corporation, partnership, association or individual furnishing any such
supplies, materials, equipment or contractual services, shall give or offer, nor shall
the director or purchasing agent or any assistant or employee accept or receive
directly or indirectly from any person, firm, corporation, partnership or association to
whom any contract may be awarded, by rebate, gift or other otherwise, any money
or other things of value whatsoever, or any promise, obligation or contract for future
reward or compensation.
Date: Juner, 2021 Name: Sessions Paving Company
Please describe below any relationships, transactions, positions you hold (volunteer or
otherwise), or circumstances that you believe could contribute to a conflict of interest:
I have no conflict of interest to report.
I have the following conflict of interest to report (please specify any boards or
committees you (and/or your spouse) sit on, the name of your employer and any businesses
you or your spouse may own.
I hereby certify that the information set forth above is true and complete to the best of my
knowledge.
Date: June 2, 2021
Signature:
President
THE
STATED
OF
AGRICULTURE
7706
Hickman County
Business Tax Standard License
July 20, 2020
Letter ID:
L0119324416
SESSIONS PAVING COMPANY
Expiration Date:
15-Aug-2021
PO BOX 90266
NASHVILLE TN 37209-0266
Return Due By:
15-Jul-2021
The business tax license printed below certifies the receipt and approval of your business tax
license application or the renewal of a license for your existing business. The license is valid until
the expiration date noted above. Your license number is 1000380328 and your classification is 4.
The certificate must be displayed publicly at the location for which it is issued.
All business tax returns are required to be filed and the payment remitted electronically. Your
return is due on July 15, 2021. Please visit www.tn.gov/revenue for additional information.
Note: This license does not permit operation unless properly zoned and/or in compliance
with all other applicable state, county, or city laws, rules and regulations. Also, as required
by Tenn. Code Ann. § 39-17-1801 et seq., businesses must comply with all provisions of the
Tennessee Non-Smoker Protection Act.
DETACH LICENSE BELOW AND DISPLAY IN PUBLIC AREA
Hickman County
Business Tax Standard License
This certificate must be publicly displayed.
OF
SESSIONS PAVING COMPANY
STATE
Date Issued:
20-Jul-2020
6535 ROBERTSON AVE
Classification:
4
NASHVILLE TN 37209-1682
AGRICULTURE
Letter ID:
L0119324416
License Number:
1000380328
Expiration Date:
15-Aug-2021
Client#: 614030
22SESSIPAV
ACORD™
DATE (MM/DD/YYYY)
CERTIFICATE OF LIABILITY INSURANCE
03/30/2021
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 any rights to the certificate holder in lieu of such endorsement(s).
PRODUCER
CONTACT
NAME:
Wendy Nowlin
McGriff Insurance Services
PHONE
615-346-0323
FAX
(A/C, No, Ext):
(A/C, No):
8777677417
3322 West End Ave., Suite 300
E-MAIL
ADDRESS:
wmnowlin@mcgriff.com
Nashville, TN 37203
INSURER(S) AFFORDING COVERAGE
NAIC #
INSURER A: Phoenix Insurance Company
25623
INSURED
INSURER B : Travelers Property Casualty Co of Amer
25674
Sessions Paving Company
INSURER C : MidSouth Mutual Insurance Company
12839
6535 Robertson Avenue
INSURER D : Travelers Indemnity Co of CT
25682
P. O. Box 90266
INSURER E :
Nashville, TN 37209
INSURER F:
COVERAGES
CERTIFICATE NUMBER:
REVISION NUMBER:
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
ADDL SUBR
POLICY EFF
POLICY EXP
LTR
TYPE OF INSURANCE
INSR
WVD
POLICY NUMBER
(MM/DD/YYYY)
(MM/DD/YYYY)
LIMITS
A
COMMERCIAL GENERAL LIABILITY
DTCO7890P35PHX21
04/01/2021
04/01/2022
EACH OCCURRENCE
$1,000,000
CLAIMS-MADE
DAMAGE TO RENTED
OCCUR
PREMISES (Ea occurrence)
$300,000
PD Ded:500
MED EXP (Any one person)
$5,000
PERSONAL & ADV INJURY
$1,000,000
GEN'L AGGREGATE LIMIT APPLIES PER:
GENERAL AGGREGATE
$2,000,000
PRO-
POLICY
JECT
LOC
PRODUCTS COMP/OP AGG
$2,000,000
OTHER:
$
D
AUTOMOBILE LIABILITY
8108M9623792126G
04/01/2021
04/01/2022
COMBINED SINGLE LIMIT
(Ea accident)
$1,000,000
ANY AUTO
BODILY INJURY (Per person)
$
OWNED
SCHEDULED
AUTOS ONLY
AUTOS
BODILY INJURY (Per accident)
$
HIRED
NON-OWNED
PROPERTY DAMAGE
AUTOS ONLY
$
AUTOS ONLY
(Per accident)
$
B
UMBRELLA LIAB
OCCUR
CUP2J5568542126
04/01/2021
04/01/2022
EACH OCCURRENCE
$5,000,000
EXCESS LIAB
CLAIMS-MADE
AGGREGATE
$5,000,000
DED
RETENTION $10000
$
C
WORKERS COMPENSATION
WC052562021
01/01/2021
01/01/2022
PER
OTH-
AND EMPLOYERS' LIABILITY
STATUTE
ER
Y/N
ANY PROPRIETOR/PARTNER/EXECUTIVE
E.L. EACH ACCIDENT
$1,000,000
OFFICER/MEMBER EXCLUDED?
Y
N/A
(Mandatory In NH)
E.L. DISEASE - EA EMPLOYEE
$1,000,000
If yes, describe under
DESCRIPTION OF OPERATIONS below
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)
** Workers Comp Information Officers/Members Excluded: Scott Price, Officer**
Re: Proof of Coverage
CERTIFICATE HOLDER
CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
Sessions Paving Company
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
6535 Robertson Avenue
ACCORDANCE WITH THE POLICY PROVISIONS.
P.O. Box 90266
Nashville, TN 37209
AUTHORIZED REPRESENTATIVE
Mitael A. Wode
© 1988-2015 ACORD CORPORATION. All rights reserved.
ACORD 25 (2016/03)
1 of 1 The ACORD name and logo are registered marks of ACORD
#S27640148/M27640042
WMN
CONTRACTOR DRUG-FREE WORKPLACE AFFIDAVIT
STATE OF TENNESSEE
COUNTY OF DAVIDSON
1.
Now comes the Affiant, who being duly sworn, deposes and says:
2.
He/she is the principal officer for
SESSIONS PAVING COMPANY
(Name and Address of Bidding Entity
P.O. Box 90266 (6535 Robertson Avenue)
Nashville, TN 37209
3.
That the bidding entity
has submitted a bid to Hickman (Owner) County Board of Education
for the construction of School Paving Services (Name of Project) for 2021-2022
4.
That the bidding entity employs no less than five (5) employees.
5.
That the Affiant certifies that the bidding entity has in effect, at the time of submission of its bid to
perform the construction referred to above, a drug-free workplace program that complies with
§ 50-9-113, Tennessee Code Annotated.
6.
That this affidavit is made on personal knowledge.
Further Affiant saith not.
Robert Л. Hutsheron
AFFIANT
President
STATE OF TENNESSEE
COUNTY OF DAVIDSON
Before me personally appeared
Robert N. Hutcheson
, with whom I am personally
acquainted (or proved to me on the basis of satisfactory evidence), and who acknowledges that such
person executed the foregoing affidavit for the purposes therein contained.
Witness my hand and seal at office this
2nd
day of
June
, , 20 21 . 21.
Jean m. Starkey
March 03, 2025
My commission expires
JEAN M. STATE
Notary STARKEY Public
OF
TENNESSEE
COUNTY NOTARY PUBLIC OF DAVIDON
FOUR STAR PAVING, LLC
06/01/2021
CONT LIC NO: 00050045
LIC STATUS: ACTIVE
ESP STAR PAVING
EXPIRATION DATE: 1/31/2023
FOUR
Part B
HRA-B; HRA-E.3; MU-D:
1441 Elm Hill Pike
UNLIMITED
Nashville, TN 37210
Paving Specifications
Please bid using the following bid form:
Scope: This bid is for the July 1 2021 thru June 30, 2022, school year and pricing shall be good for the remaining school
year.
All paving costs below to include cleaning, milling, key joints and tie ins, removal of any vegetation, cleaning of loose
sand and millings and applying the required tack coats per standard DOT specifications and laying of top coat as
specified in separate line items below. Any low drains, of utility covers, risers are to be included, unless the paving is
milled down to make them smooth and level to travel and to not impose any trip hazard. This bid may be applied to any
location as needed.
Overlay:
Price per square yard of 2 inch overlay rolled to 1.5 inch minimum thickness $ 14,25 per square yard of paving.
Paving:
Price per square yard of 2 inch CW grade(220# per sq. yd.) / binder, with 1.5 inch (165# per sq. yd.) top coat finish paving
overlay $ 28.50 per square yard of paving.
Milling:
Sawing/Demo/milling existing pavement by the square yard removed down to 4 inches, to include sawing and hauling
off/disposal of the excess debris. $ 15.00 per square yard of demo.
Patch paving:
To saw cut, remove all loose or broken materials, to include binder, or wet earth, insuring solid dry compacted layer is
exposed, adding back 4inches of pug or rock material compacted 2 inches of commercial grade CW binder, and 2 inches
topcoat rolled to 1.5 inches and level. All patches to be level and smooth to finish grade. Per Sq. Yard.
$ 110.00
Earth removal:
Digging/ Undercutting of earth and removal and disposal of excess dirt $ 50.00 per yard.
Crack sealing/ resealing of lots:
Cost to remove any vegetation from cracks, blow out and sweep clean pavement, hot tar slurry crack fill all cracks and
then mop finish cracks level. 1.05 per LF.
Cost to seal spray two coats of parking lot sealer. $ 1.25 per yard
Painting/Striping of lots:
Re-striping of parking lots/drives for the following locations pricing each location at the existing striping layout as
needed/ if change is requested later, additional payment adjustments may apply:
CES
EHHS
HCHS
HCMS
CIS
EHIS
EHMS
EHES
Central Office
BOE reserves the right to allow other bidders that are not pavers to bid "striping only" in this bid, and to
award any said bidder the striping portion of the bid.
by: David M. Varghn
DAVID m. VAUGHN
STATE OF TENNESSEE
DEPARTMENT OF
COMMERCE AND INSURANCE
FOUR STAR PAVING, LLC
371859
ID NUMBER: 50045
LIC STATUS: ACTIVE
REC'D JAN 11 2021
EXPIRATION DATE: January 31, 2023
BOARD FOR LICENSING CONTRACTORS
CONTRACTOR
THIS IS TO CERTIFY THAT ALL REQUIREMENTS
OF THE STATE OF TENNESSEE HAVE BEEN MET
ATTN:MICHAEL MAYNARD
FOUR STAR PAVING, LLC
1441 ELM HILL PIKE
NASHVILLE, TN 37210
State of Tennessee
373859
12438512
BOARD FOR LICENSING CONTRACTORS
CONTRACTOR
FOUR STAR PAVING, LLC
This is to certify that all requirements of the State of Tennessee have been met.
THE
ID NUMBER: 50045
LIC.STATUS: ACTIVE
OF
AGRICULTURE
EXPIRATION DATE: January 31, 2023
UNLIMITED; HRA-B; HRA-E.3; MU-D
1796
IN-1313
DEPARTMENT OF
COMMERCE AND INSURANCE
DRUG-FREE WORKPLACE AFFIDAVIT
STATE OF TENNESSEE
COUNTY OF DAVIDSON
The undersigned, principal officer of FOUR STAR PAVING LLC , an employer of
five(5) or i employees contracting with Hickman County government to provide
construction services states under oath as follows:
1.
The undersigned is a principal officer
of
FOUR STAR PAVING LLC
(hereinafter referred to as the
"Company"), and is duly authorized to execute this Affidavit on behalf of the Company.
2.
The Company submits this Affidavit pursuant to T.C.A. § 50-9-113, which requires each
employer with no less than five (5) employees receiving pay who contracts with the state or any
local government to provide constructiomi services to submit an affidavit stating that such
employer has a drug-free workplace program that complies with Title 50, Chapter 9, of the
Tennessee Code Annotated.
3.
The Company is in compliance with T.C.A.- 50-9-113. Further affiant saith not.
Principal Officer
STATE OF
TENNESSEE
COUNTY OF
DAVIDSON
Before me personally appeared Robert Loudermilk with whom I am personally acquainted (or
proved to me on the basis of satisfactory evidence), and who acknowledged that such person executed the
foregoing affidavit for the purposes therein contained.
Witness my hand and seal at office this day of may 2021
may Jahnson Notary Public
MINIMARY STATE JOHNSON
OF
My commission expires:
5/2
TENNESSEE
NOTARY
Hickman County Government
Conflict of Interest Disclosure Form
The County Financial Management System of 1981 contains the most stringent conflict of
interest provisions. TCA $5-21-121 provides:
(a) The director, purchasing agent, members of the committee, members of the county
legislative body or other officials, employees, or members of the board of education
or highway commission shall not be financially interested or have any personal
beneficial interest, either directly or indirectly, in the purchase of any supplies,
materials, equipment or contractual services for the county.
(b) No firm, corporation, partnership, association or individual furnishing any such
supplies, materials, equipment or contractual services, shall give or offer, nor shall
the director or purchasing agent or any assistant or employee accept or receive
directly or indirectly from any person, firm, corporation, partnership or association to
whom any contract may be awarded, by rebate, gift or other otherwise, any money
or other things of value whatsoever, or any promise, obligation or contract for future
reward or compensation.
Date: 5/24/21
Name: MG maynal
Please describe below any relationships, transactions, positions you hold (volunteer or
otherwise), or circumstances that you believe could contribute to a conflict of interest:
I have no conflict of interest to report.
I have the following conflict of interest to report (please specify any boards or
committees you (and/or your spouse) sit on, the name of your employer and any businesses
you or your spouse may own.
I hereby certify that the information set forth above is true and complete to the best of my
knowledge.
Date:
5/24/21
Signature: mamager
AIA Document 310 - 2010 Bid Bond
CONTRACTOR (Name, legal status and address):
SURETY (Name, legal status and principal place of business):
Four Star Paving LLC
Fidelity and Deposit Company of Maryland
1441 Elm Hill Pike
1299 Zurich Way
Nashville, TN 37210
Schaumburg, IL 60196
OWNER (Name, legal status and address):
Hickman County Finance Office
114 North Central Ave., Suite 203
Centerville, TN 37033
Bond Amount: Five Percent (5%) of Amount of Attached Bid
PROJECT : (Name, location or address, and Project number, if any):
School Paving Services for 2021-2022, Hickman County, Tennessee
The Contractor and Surety are bound to the Owner in the amount set forth above, for the payment of which the Contractor and Surety
bind themselves, their heirs, executors, administrators, successors and assigns, jointly and severally, as provided herein. The conditions
of this Bond are such that if the Owner accepts the bid of the Contractor within the time specified in the bid documents, or within such
time period as may be agreed to by the Owner and Contractor, and the Contractor either (1) enters in to a contract with the Owner in
accordance with the terms of such bid, and gives such bond or bonds as may be specified in the bidding or Contract Documents, with a
surety admitted in the jurisdiction of the Project and otherwise acceptable to the Owner, for the faithful performance of such Contract and
for the prompt payment of labor and material furnished in the prosecution thereof; or (2) pays to the Owner the difference, not to exceed
the amount of this Bond, between the amount specified in said bid and such larger amount for which the Owner may in good faith
contract with another party to perform the work covered by said bid, then this obligation shall be null and void, otherwise 10 remain in
full force and effect. The-Surety hereby waives any notice of an agreement between the Owner and Contractor to extend the time in
which the Owner may accept the bid. Waiver of notice by the Surety shall not apply to any extension exceeding sixty (60) days in the
aggregate beyond the time for acceptance of bids specified in the bid documents, and the Owner and Contractor shall obtain the Surety's
consent for an extension beyond sixty (60) days.
If this Bond is issued in connection with a subcontractor's bid to a Contractor, the term Contractor in this Bond shall be deemed to be
Subcontractor and the term Owner shall be deemed by the Contractor.
When this Bond has been furnished to comply with a statutory or other legal requirement in the location of the Project, any provision in
this Bond conflicting with said statutory or legal requirement shall be deemed deleted herefrom and provisions conforming to such
statutory or other legal requirement shall be deemed incorporated herein. When so furnished, the intent is that this Bond shall be
construed as a statutory bond and not as a common law bond.
Signed and scaled this 2ndday of June
, 2021
mary (Witness) phano
Four Star)Paving
(Seal)
(Pringipal)
(Seal)
VD
(Witness) Jem Bein
(Title)
Fidelity and Deposit Company of Maryland
(Seal)
(Surety)
(Title) Mark Neal
Attorney-in-Fact
Language conforms to AIA Document A310 BidBond
BID70001ZZ0311f
ZURICH AMERICAN INSURANCE COMPANY
COLONIAL AMERICAN CASUALTY AND SURETY COMPANY
FIDELITY AND DEPOSIT COMPANY OF MARYLAND
POWER OF ATTORNEY
KNOW ALL MEN BY THESE PRESENTS: That the ZURICH AMERICAN INSURANCE COMPANY, a corporation of the State of New
York, the COLONIAL AMERICAN CASUALTY AND SURETY COMPANY, a corporation of the State of Illinois, and the FIDELITY
AND DEPOSIT COMPANY OF MARYLAND a corporation of the State of Illinois (herein collectively called the "Companies"), by
Robert D. Murray, Vice President, in pursuance of authority granted by Article V, Section 8, of the By-Laws of said Companies, which are
set forth on the reverse side hereof and are hereby certified to be in full force and effect on the date hereof, do hereby nominate, constitute,
and appoint Frank E. NEAL, III, Mark NEAL, Brent W. NEAL, Michael B. MATTOX, and Jerri BAIN of Nashville, Tennessee
EACH, its true and lawful agent and Attorney-in-Fact, to make, execute, seal and deliver, for, and on its behalf as surety, and as its act and
deed: any and all bonds and undertakings, and the execution of such bonds or undertakings in pursuance of these presents, shall be as
binding upon said Companies, as fully and amply, to all intents and purposes, as if they had been duly executed and acknowledged by the
regularly elected officers of the ZURICH AMERICAN INSURANCE COMPANY at its office in New York, New York., the regularly
elected officers of the COLONIAL AMERICAN CASUALTY AND SURETY COMPANY at its office in Owings Mills, Maryland., and the
regularly elected officers of the FIDELITY AND DEPOSIT COMPANY OF MARYLAND at its office in Owings Mills, Maryland., in their
own proper persons.
The said Vice President does hereby certify that the extract set forth on the reverse side hereof is a true copy of Article V, Section 8, of
the By-Laws of said Companies, and is now in force.
IN WITNESS WHEREOF, the said Vice-President has hereunto subscribed his/her names and affixed the Corporate Seals of the said
ZURICH AMERICAN INSURANCE COMPANY, COLONIAL AMERICAN CASUALTY AND SURETY COMPANY, and
FIDELITY AND DEPOSIT COMPANY OF MARYLAND, this 17th day of November, A.D. 2020.
STATE
IT
ELOREATE AND IIM DEPOSIT COMPARY
seal
ATTEST:
ZURICH AMERICAN INSURANCE COMPANY
COLONIAL AMERICAN CASUALTY AND SURETY COMPANY
FIDELITY AND DEPOSIT COMPANY OF MARYLAND
B
By: Robert D. Murray
Vice President
Dawn E Brown
By: Dawn E. Brown
Secretary
State of Maryland
County of Baltimore
On this 11th day of November, A.D. 2020, before the subscriber, a Notary Public of the State of Maryland, duly commissioned and qualified, Robert D.
Murray, Vice President and Dawn E. Brown, Secretary of the Companies, to me personally known to be the individuals and officers described in and who
executed the preceding instrument, and acknowledged the execution of same, and being by me duly sworn, deposeth and saith, that he/she is the said officer of
the Company aforesaid, and that the seals affixed to the preceding instrument are the Corporate Seals of said Companies, and that the said Corporate Seals and
the signature as such officer were duly affixed and subscribed to the said instrument by the authority and direction of the said Corporations,
IN TESTIMONY WHEREOF, I have hereunto set my hand and affixed my Official Seal the day and year first above written.
BOTARY PUBLIC THE 1
Constance a. Dumn Dumn
Constance A. Dunn, Notary Public
My Commission Expires: July 9, 2023
Authenticity of this bond can be confirmed at bondvalidator.zurichna.com or 410-559-8790
ACORD®
CERTIFICATE OF LIABILITY INSURANCE
DATE (MM/DD/YYYY)
05/26/2021
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
CONTACT
NAME:
Frank E. Neal & Co., Inc.
PHONE
(A/C, No, Ext):
(615) 383-8874
(A/C, FAX No): (615) 383-8939
P.O. Box 40507
E-MAIL
ADDRESS:
LTomberlain@feneal.com
193-B Polk Avenue (37210)
INSURER(S) AFFORDING COVERAGE
NAIC #
Nashville
TN 37204
INSURER A : Phoenix Insurance CO
25623
INSURED
INSURER B : Travelers Indemnity Co
25658
Four Star Paving LLC
INSURER C : Travelers Prop Cas Co America
25674
1441 Elm Hill Pike
INSURER D : Midwest Emloyers Casualty Company
23612
INSURER E: Charter Oak Fire Ins Co
25615
Nashville
TN 37210
INSURER F :
COVERAGES
CERTIFICATE NUMBER: 12/21/2020-21
REVISION NUMBER:
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
ADDL
SUBR
POLICY EFF
POLICY EXP
LTR
TYPE OF INSURANCE
INSD
WVD
POLICY NUMBER
(MM/DD/YYYY)
(MM/DD/YYYY)
LIMITS
COMMERCIAL GENERAL LIABILITY
EACH OCCURRENCE
$ 1,000,000
CLAIMS-MADE
DAMAGE TO RENTED
OCCUR
PREMISES (Ea occurrence)
$ 300,000
MED EXP (Any one person)
$ 5,000
A
CO4P451936
12/21/2020
12/21/2021
PERSONAL & ADV INJURY
1,000,000
GEN'L AGGREGATE LIMIT APPLIES PER:
GENERAL AGGREGATE
$ 2,000,000
PRO-
POLICY
JECT
LOC
PRODUCTS- COMP/OP AGG
$ 2,000,000
OTHER:
$
AUTOMOBILE LIABILITY
COMBINED SINGLE LIMIT
(Ea accident)
$ 1,000,000
ANY AUTO
BODILY INJURY (Per person)
$
B
OWNED
SCHEDULED
BA4P335199
12/21/2020
12/21/2021
AUTOS ONLY
AUTOS
BODILY INJURY (Per accident)
$
HIRED
NON-OWNED
PROPERTY DAMAGE
AUTOS ONLY
AUTOS ONLY
$
(Per accident)
$
UMBRELLA LIAB
OCCUR
EACH OCCURRENCE
$ 5,000,000
C
EXCESS LIAB
CLAIMS-MADE
CUP4P480004
12/21/2020
12/21/2021
AGGREGATE
$ 5,000,000
DED
RETENTION 10,000
$
WORKERS COMPENSATION
PER
OTH-
AND EMPLOYERS' LIABILITY
STATUTE
ER
Y/N
D
ANY PROPRIETOR/PARTNER/EXECUTIVE
OFFICER/MEMBER EXCLUDED?
N/A
MEWC336601
12/21/2020
12/21/2021
E.L. EACH ACCIDENT
$ 1,000,000
(Mandatory in NH)
E.L. DISEASE - EA EMPLOYEE
$ 1,000,000
If yes, describe under
DESCRIPTION OF OPERATIONS below
E.L. DISEASE- POLICY LIMIT
$ 1,000,000
CONTRACTORS EQUIPMENT
E
LEASED/RENTED COVERAGE
QT6604P033947COF19
12/21/2020
12/21/2021
LEASED/RENTED LIMIT
500,000
DEDUCTIBLE
2,500
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
RE: BID FOR SCHOOL PAVING SERVICES FOR 2021-2022, HICKMAN COUNTY, TENNESSEE
CERTIFICATE HOLDER
CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
HICKMAN COUNTY FINANCE OFFICE
ACCORDANCE WITH THE POLICY PROVISIONS.
114 NORTH CENTRAL AVE.
AUTHORIZED REPRESENTATIVE
SUITE 203
CENTERVILLE
TN 37033
mare Meal
© 1988-2015 ACORD CORPORATION. All rights reserved.
ACORD 25 (2016/03)
The ACORD name and logo are registered marks of ACORD

## Table 1

| CES $375000 | EHHS $6,775°C | HCHS $6,2500 HCMS $4,25000 |
| --- | --- | --- |
| CIS $2,250 | EHIS $2,150 | EHMS $2,7500 EHES $3,475 |

## Table 2

| Letter ID: | L0119324416 |
| --- | --- |
| Expiration Date: | 15-Aug-2021 |
| Return Due By: | 15-Jul-2021 |

## Table 3

| Date Issued: | 20-Jul-2020 |
| --- | --- |
| Classification: | 4 |
| Letter ID: | L0119324416 |
| License Number: | 1000380328 |
| Expiration Date: | 15-Aug-2021 |

## Table 4

| CONTACT NAME: Wendy Nowlin |  |
| --- | --- |
| PHONE (A/C, No, Ext): 615-346-0323 | FAX (A/C, No): 8777677417 |
| E-MAIL ADDRESS: wmnowlin@mcgriff.com |  |

## Table 5

|  | INSURER(S) AFFORDING COVERAGE | NAIC # |
| --- | --- | --- |
| INSURER A: | Phoenix Insurance Company | 25623 |
| INSURER B : | Travelers Property Casualty Co of Amer | 25674 |
| INSURER C : | MidSouth Mutual Insurance Company | 12839 |
| INSURER D : | Travelers Indemnity Co of CT | 25682 |
| INSURER E : |  |  |
| INSURER F: |  |  |

## Table 6

| LIMITS |  |
| --- | --- |
| EACH OCCURRENCE | $1,000,000 |
| DAMAGE TO RENTED PREMISES (Ea occurrence) | $300,000 |
| MED EXP (Any one person) | $5,000 |
| PERSONAL & ADV INJURY | $1,000,000 |
| GENERAL AGGREGATE | $2,000,000 |
| PRODUCTS COMP/OP AGG | $2,000,000 |
|  | $ |
| COMBINED SINGLE LIMIT (Ea accident) | $1,000,000 |
| BODILY INJURY (Per person) | $ |
| BODILY INJURY (Per accident) | $ |
| PROPERTY DAMAGE (Per accident) | $ |
|  | $ |
| EACH OCCURRENCE | $5,000,000 |
| AGGREGATE | $5,000,000 |
|  | $ |
| [X] PER OTH- STATUTE ER |  |
| E.L. EACH ACCIDENT | $1,000,000 |
| E.L. DISEASE - EA EMPLOYEE | $1,000,000 |
| E.L. DISEASE - POLICY LIMIT | $1,000,000 |
|  |  |

## Table 7

| INSR LTR | TYPE OF INSURANCE | INSR | ADDL SUBR WVD | POLICY NUMBER | POLICY EFF (MM/DD/YYYY) | POLICY EXP (MM/DD/YYYY) |
| --- | --- | --- | --- | --- | --- | --- |
| A | [X] [X] [X] [X] COMMERCIAL GENERAL LIABILITY CLAIMS-MADE OCCUR PD Ded:500 GEN'L AGGREGATE LIMIT APPLIES PER: PRO- POLICY JECT LOC OTHER: |  |  | DTCO7890P35PHX21 | 04/01/2021 | 04/01/2022 |
| D | [X] [X] [X] AUTOMOBILE LIABILITY ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS HIRED NON-OWNED AUTOS ONLY AUTOS ONLY |  |  | 8108M9623792126G | 04/01/2021 | 04/01/2022 |
| B | [X] [X] [X] UMBRELLA LIAB OCCUR EXCESS LIAB CLAIMS-MADE DED RETENTION $10000 |  |  | CUP2J5568542126 | 04/01/2021 | 04/01/2022 |
| C | WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y/N ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? Y (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS below | N/A |  | WC052562021 | 01/01/2021 | 01/01/2022 |
|  |  |  |  |  |  |  |

## Table 8

| Principal Officer |  |
| --- | --- |
| STATE OF | TENNESSEE |
| COUNTY OF | DAVIDSON |

## Table 9

| CONTRACTOR (Name, legal status and address): | SURETY (Name, legal status and principal place of business): |
| --- | --- |
| Four Star Paving LLC | Fidelity and Deposit Company of Maryland |
| 1441 Elm Hill Pike | 1299 Zurich Way |
| Nashville, TN 37210 | Schaumburg, IL 60196 |

## Table 10

| By: Robert D. Murray Vice President |  |
| --- | --- |
| Dawn E Brown |  |
| By: Dawn E. Brown Secretary |  |
| State of Maryland County of Baltimore |  |

## Table 11

| CONTACT NAME: |  |
| --- | --- |
| PHONE (A/C, No, Ext): (615) 383-8874 | (A/C, FAX No): (615) 383-8939 |
| E-MAIL ADDRESS: LTomberlain@feneal.com |  |

## Table 12

|  | INSURER(S) AFFORDING COVERAGE | NAIC # |
| --- | --- | --- |
| INSURER A : | Phoenix Insurance CO | 25623 |
| INSURER B : | Travelers Indemnity Co | 25658 |
| INSURER C : | Travelers Prop Cas Co America | 25674 |
| INSURER D : | Midwest Emloyers Casualty Company | 23612 |
| INSURER E: | Charter Oak Fire Ins Co | 25615 |
| INSURER F : |  |  |

## Table 13

| INSR LTR | TYPE OF INSURANCE | ADDL INSD | SUBR WVD | POLICY NUMBER | POLICY EFF (MM/DD/YYYY) | POLICY EXP (MM/DD/YYYY) |
| --- | --- | --- | --- | --- | --- | --- |
| A | [X] [X] [X] COMMERCIAL GENERAL LIABILITY CLAIMS-MADE OCCUR GEN'L AGGREGATE LIMIT APPLIES PER: PRO- POLICY JECT LOC OTHER: |  |  | CO4P451936 | 12/21/2020 | 12/21/2021 |
| B | [X] [X] [X] AUTOMOBILE LIABILITY ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS HIRED NON-OWNED AUTOS ONLY AUTOS ONLY |  |  | BA4P335199 | 12/21/2020 | 12/21/2021 |
| C | [X] [X] [X] UMBRELLA LIAB OCCUR EXCESS LIAB CLAIMS-MADE DED RETENTION 10,000 |  |  | CUP4P480004 | 12/21/2020 | 12/21/2021 |
| D | WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y/N ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below | N/A |  | MEWC336601 | 12/21/2020 | 12/21/2021 |
| E | CONTRACTORS EQUIPMENT LEASED/RENTED COVERAGE |  |  | QT6604P033947COF19 | 12/21/2020 | 12/21/2021 |

## Table 14

| LIMITS |  |
| --- | --- |
| EACH OCCURRENCE | $ 1,000,000 |
| DAMAGE TO RENTED PREMISES (Ea occurrence) | $ 300,000 |
| MED EXP (Any one person) | $ 5,000 |
| PERSONAL & ADV INJURY | 1,000,000 |
| GENERAL AGGREGATE | $ 2,000,000 |
| PRODUCTS- COMP/OP AGG | $ 2,000,000 |
|  | $ |
| COMBINED SINGLE LIMIT (Ea accident) | $ 1,000,000 |
| BODILY INJURY (Per person) | $ |
| BODILY INJURY (Per accident) | $ |
| PROPERTY DAMAGE (Per accident) | $ |
|  | $ |
| EACH OCCURRENCE | $ 5,000,000 |
| AGGREGATE | $ 5,000,000 |
|  | $ |
| [X] PER OTH- STATUTE ER |  |
| E.L. EACH ACCIDENT | $ 1,000,000 |
| E.L. DISEASE - EA EMPLOYEE | $ 1,000,000 |
| E.L. DISEASE- POLICY LIMIT | $ 1,000,000 |
| LEASED/RENTED LIMIT | 500,000 |
| DEDUCTIBLE | 2,500 |