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Home My WebLink AboutOpening of Bids - 2016 Parking Garage Improvements - Ziolkowski Construction,u7rr er. CITY OF SOUTH BEND, INDIANA CONTRACTOR'S BID FOR PUBLIC WORK ,X CHECKLIST FOR BIDDERS Project Name 2016 Parking Garage Improvements Project No. 115-143 For Bids Due 9:30am November 6, 2016 From time to time the South Bend Board of Public Works finds it necessary to reject a bid because it does not comply with statutory requirements. In preparing your bid, please use the following checklist in order to make sure that your bid is done in the proper manner. Proper bid security included. The bidder has the option of providing either a Certified Check X or Bid Bond. Bid prepared on the City of South Bend Contractor's Bid for Public Work Form, completely X executed. Contractors Non -Collusion and Non -Debarment Affidavit, Certification Regarding Investments with Iran, Employment Eligibility Verification, Non -Discrimination Commitment, and X Certification of use of United States Steel Products or Foundry Products. Proof of MBEMIBE Participation Goal Form [MWBE-1.0]. If minimum participation goal is not met, also provide Evidence of Good Faith Efforts Form [MWBE-2.0] and MBE/WBE Contacted X Form [MWBE-2.1]. X Acknowledge Receipt of 1 Addendum(s) included with the bid. X All required additional information is included with the bid. Proposal statements and other affidavits all signed by the proper party with name either X printed or typed underneath signature. X This checklist submitted with the Bid. This checklist is provided for bidder's use in assuring compliance with required documentation; however, it does not include all specifications requirements and does not relieve the bidder of the need to read and comply with the specifications. Bidder: Ziollcowski Construction, Inc. Date: November 8, 2016 By Authorized Representative: Signature: Print Name & Title: _ Bill Favors, President Version 7,131/2015 Contractor's Bid for Public Works -1 you re pF.. 1Y _tJ J � r CITY OF SOUTH BEND, INDIANA CONTRACTOR'S BID FOR PUBLIC WORK ,X65 Project Name 2016 Parking Garage Improvements Project No. 115-143 For Bids Due 9:30am November 8, 2016 PART (Must be completed for all bids. Please type or print) Date: November 8, 2016 Bidder (Firm): Ziolkowski Construction, Inc. Address: 4050 Ralph Jones Drive City/State/Zip: South Bend, IN 46628 Telephone Number: _�574 ) 287-1811 Agent of Bidder (if Applicable): Pursuant to notices given, the undersigned offers to furnish labor and/or material necessary to complete the public works project of: 2016 Parking Garage Improvements the City of South Bend, Indiana, in accordance with plans and specifications prepared by: Byce & Associates Inc. and dated 3/9/16 for the sum of (enterthe Total Bid as shown on the Proposal) 011-& V)I 11 i a v�-Tt,�o N 'o-MArif _(g 1, 6001 a00 ) (Enter sum of Total Base Bid plus Alternates shown on Proposal) (Numerical) The undersigned further agrees to furnish a bond or certified check with this bid for an amount specified in the notice of the letting. If alternative bids apply, the undersigned submits a proposal for each in accordance with the notice. Any addendums attached will be specifically referenced at the applicable page. If additional units of material included in the contract are needed, the cost of units must be the same as that shown in the original contract if accepted by the City of South Bend. If the bid is to be awarded on a unit basis, the itemization of the units shall be shown on a separate attachment. By 4 (signature) Bill Favors, President (Printed Name of Person Signing) ACCEPTANCE The above bid is accepted this day of Subject to the following conditions: BOARD OF PUBLIC WORKS Gary A. Gilot, President Elizabeth A. Maradik, Member David P. Relos, Member Therese J. Dorau, Member James A. Mueller, Member Attest: Linda M. Martin, Clerk Version 713112015 Contractor's Bid for Public Works - 2 20 PART II (For projects of $100,000 or more — IC 36-1-12-4) These statements to be submitted under oath by each bidder with and as part of his bid. Attach additional pages for each section as needed. SECTION I EXPERIENCE QUESTIONNAIRE 1. Attach information regarding projects your organization has completed for the period of one (1) year prior to the date of the current bid. See Attached 2. Attach a listing of public works projects currently in process of construction by your organization. See Attached 3. Attach information regarding any failure to complete any work awarded to you and the location thereof. See Attached 4. Attach references from private firms for which you have performed work. See Attached SECTION II PLAN AND EQUIPMENT QUESTIONNAIRE 1. Attach an explanation of your plan or layout for performing proposed work. (Examples could include a narrative of when you could begin work, complete the project, number of workers, etc. and any other information which you believe would enable the City of South Bend to consider your bid.) As directed by the Architect/Construction Manager 2. Attach a listing of the names and addresses of all subcontractors (i.e. persons or firms outside your own firm who have performed part of the work) that you have used on public works projects during the past five (5) years along with a brief description of the work done by each subcontractor_ If Subcontractors will be used we will submit this information 24 hours after notification. 3. If you intend to sublet any portion of the work, attach the name and address of each subcontractor, equipment to be used by the subcontractor, and whether you will require a bond. However, if you are unable to currently provide a listing, please understand a listing must be provided prior to contract approval. Until the completion of the proposed project, you are under a continuing obligation to immediately notify the City of South Bend in the event that you subsequently determine that you will use a subcontractor on the proposed project. If Subcontractors will be used we will submit this information 24 hours after notification. 4. Attach a listing of equipment you have available to use for the proposed project. Whatever is required to complete the project properly and on time. 5. Have you entered into contracts or received offers for all materials which substantiate the prices used in preparing your proposal? If not, attach an explanation for the rationale used which would corroborate the prices listed. yes SECTION III CONTRACTOR'S FINANCIAL STATEMENT Attachment of bidder's financial statement is mandatory. Any bid submitted without said financial statement as required by statute shall thereby be rendered invalid. The financial statement provided hereunder to the City of South Bend awarding the contract must be specific enough in detail so that said City of South Bend can make a proper determination of the bidder's capability for completing the project if awarded. Version 7/31/2015 Contractor's Bid for Public Works -3 Wien rheprospeclive Contractor is unable to cert fjr to nap of1he slalenrenls below, it shall attach an arplanatior to dzisAfdavi/. CONTRACTOR'S NON -COLLUSION AND NON -DEBARMENT AFFIDAVIT, CERTIFICATION REGARDING INVESTMENT WITH IRAN, EMPLOYMENT ELIGIBILITY VERIFICATION, NON-DISCRIMINATION COMMITMENT AND CERTIFICATION OF USE OF UNITED STATES STEEL PRODUCTS OR FOUNDRY PRODUCTS (Must be completed for all quotes and bids. Please type or print) STATE OF Indiana ) St Joseph COUNTY ) SS: ) The undersigned Contractor, being duly sworn upon his/her/its oath, affnns under the penalties of perjury that: 1. Contractor has not, nor has any other member, representative, or agent of the firm, company, corporation or partnership represented by him, entered into any combination, collusion or agreement with any person relative to the price to be bid by anyone at such letting nor to prevent any person from bidding nor to induce anyone to refrain from bidding, and that this bid is made without reference to any other bid and without any agreement, understanding or combination with any other person in reference to such bidding. Contractor further says that no person or persons, firms, or corporation has, have or will receive directly or indirectly, any rebate, fee, gift, commission or thing of value on account of such sale; and 2. Contractor certifies by submission of this proposal that neither contractor nor any of its principals are presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from participation in this transaction by any Federal department or agency; and 3. Contractor has not, nor has any successor to, nor an affiliate of, Contractor, engaged in investment activities in Iran. a. For purposes of this Certification, "Iran" means the government of Iran and any agency or instrumentality of Iran, or as otherwise defined at Ind. Code § 5-22-16.5-5, as amended from time -to -thee. b. As provided by Ind. Code § 5-22-16.5-8, as amended from time -to -time, a Contractor is engaged in investment activities in Iran if either: i. Contractor, its successor or its affiliate, provides goods or services of twenty million dollars ($20,000,000) or more in value in the energy sector of Iran; or ii. Contractor, its successor or its affiliate, is a financial institution that extends twenty million dollars ($20,000,000) or more in credit to another person for forty-five (45) days or more, if that person will (i) use the credit to provides goods and services in Non -Collusion Non-nobarment Affidavit Non rran Form 2016 the energy sector in Iran; and (ii) at the time the financial institution extends credit, is a person identified on list published by the Indiana Department of Administration. 4. Contractor does not knowingly employ or contract with an unauthorized alien, nor retain any employee or contract with a person that the Contractor subsequently learns is an unauthorized alien. Contractor agrees that be/she/it shall enroll in and verify the work eligibility status of all of Contractor's newly hired employees through the E-Verify Program as defined by I.C. 22-5-1.7-3. Contractor's documentation of enrollment and participation hm the E-Verify Program is included and attached as part of this bid/quote; and 5. Contractor shall require his/her/its subcontractors performing work wider this public contract to certify that the subcontractors do not knowingly employ or contract with' an unauthorized alien, nor retain any employee or contract with a person that the subcontractor subsequently learns is an unauthorized alien, and that the subcontractor has enrolled in and is participating in the E-Verify Program, The Contractor agrees to maintain this certification throughout the term of the contract with the City of South Bend, and understands that the City may terminate the contract for default if the Contractor fails to cure a breach of this provision no later than thirty (30) days after being notified by the City. 6. Persons, partnerships, corporations, associations, or joint venturers awarded a contract by the City of South Bend through its agencies,, boards, or commissions shall not discriminate against any employee or applicant for employment in the perfonuance of a City contract with respect to lure, tenure, terns, conditions, or privileges of employment, or any matter directly or indirectly related to employment because of race, sex, religion, color, national origin, ancestry, age, gender expression, gender identity, sexual orientation or disability that does not affect that person's ability to perform the work. In awarding contracts for the purchase of work, labor, services, supplies, equipment, materials, or any combination of the foregoing including, but not limited to, public works contracts awarded under public bidding laws or other contracts in which public bids are not required by law, the City, its agencies, boards, or commissions may consider the Contractor's good faith efforts to obtain participation by those Contractors certified by the State of Indiana as a Minority Business ("MBE") or as a Women's Business Enterprise ("WBE") as a factor in determining time lowest, responsible, responsive bidder - In no event shall persons or entities seeking the award of a City contract be required to award a subcontract to an MBE/WBE, however, it may not unlawfully discriminate against said WBE/MBE. A finding of a discriminatory practice by the City's MBE/WBE Utilization Board shall prohibit that person or entity from being awarded a City contract for a period of one (1) year from the date of such determination, and such determination may also be grounds for terminating the contact for which the discriminatory practice or noncompliance pertains. 7. The undersigned contractor agrees that the following nondiscrimination commitment shall be made a part of any contract which it may henceforth enter into with the City of South Bend, Indiana or any of its agencies, boards or commissions. Non -Collusion Non-Debanncnt Arfidasdt Non Iran Form 2016 Contractor agrees not to discriminate against or intimidate any employee or applicant for employment in the performance of this contract with privileges of employment, or any matter directly or indirectly related to employment, because of race, religion, color, sex, gender expression, gender identity, sexual orientation, handicap, national origin or ancestry. Breach of this provision maybe regarded as material breach of contract. I, the undersigned bidder or agent as contractor on a public works project, understand my statutory obligations to the use of steel products or foundry products made in the United States (I.C. 5-16-8-1). I hereby certify that I and all subcontractors employed by me for this project will use steel products or foundry products made in the United States on this project if awarded. I understand I have an affirmative duty to notify the City in my bid that my proposal does not include the use of steel products or foundry products made in the United States. I understand it is my sole obligation and responsibility to provide a justification to the City, subject to review and approval, why the cost of United States made steel or foundry products is unreasonable. Prior to award and upon submission of bid which does not use steel products or foundry products made in the United States, the City, through its director of public works, shall make a determination if the price of United States made steel or foundry is unreasonable. I understand that violations hereunder may result in forfeiture of contractual payments. �*>x I hereby affirm under the penalties of perjury that the facts and information contained in the foregoing bid for public works are true and correct. Dated this 8th day of Novemb90 2016 COA" 5 ..... ` o SEAL �`.zNDIANP• Ziolkowski Construction, Inc. Contractor/Bidder (Firm) Signature of Contractor/Bidder or Its Agent Bill Favors, President Printed Name and Til1e Subscribed and sworn to before me this 8th day of November 2016 My Commission Expires March 1, 2020\Q Notary Public ShannonReidenbach County of Residence Non -Collision Non -Debarment Affidavit Non Iran Fonu 2016 St Joseph (IN) SHAN=HEIDENBACHHNotSMy Commis, 2020 tiV Tit BIDIPROPOSAL CITY OF SOUTH BEND IN16 Project Name 2016 Parking Garage Improvements Project No. 115-143 For Bids Due 9:30am November 8, 2016 BASE BID DIVISION A: Wayne Street: Northwest Tower Improvements Item No. Description p Quantity Unit Unit PriceRIO 1 EElevatorquipment 1 LS oZ01 Utz2 al 1 LS Co3 Electrical 1 LS 3 04 General Trades 1 LS5 General Conditions LS (7 VDO BASE BID TOTAL a R 0 rq 0 L7 BASE BID DIVISION B: Leighton Plaza' Stair 1 Tnwpr ImnrnvAmonf< Item No Description p Quantity Unit Unit Price Total Amount 6 Elevator Equipment 1 LS g5I "Co ac1 D0 7 Mechanical 1 LS 3 090 3, q00 8 Electrical 1 LS O� ® 0 Zj 9 General Trades 1 LS 1 30 b 10 General Conditions 1 LS OW 0 0 �r 0400 BASE BID TOTAL $ ( O BASE BID DIVISION C: Wayne Street: Southeast tower Imnrovementc Item No, Description p Quantity Unit Unit Price Total Amount 11 Elevator Equipment 1 LS of 7,'ad 5t37 r 1 b 12 Mechanical 1 LS ® O 0 13 Electrical 1 LS 31 q bb go D 14 General Trades 1 LS a VO q DO 15 1 General Conditions 1 LS ,08 dD r op'7 BASE BID TOTAL r 6 BASE BID DIVISION D: Leighton Plaza: Stair Tower 2 Improvements Item No, Description p Quantity Unit Unit Price Total Amount 16 Elevator Equipment 1 LS 17 Mechanical 1 LS _3,14 Version 7/3112015 Contractor's Bid for Public Works - 7 18 Electrical j)0 0 E2O General Trades Hijiguo, Q O d General Conditions 00 D BASE BID TOTAL a3 Sr W U ALTERNATE #1: DIVISION B ADDITIONAL ItemrRemove�& Description No. Quantity Unit Unit Price Total Amount replaceroof of Leighton21 tair Tower 1 as necessary to 1 LS "r 7rD�elevator machine. t ALTERNATE #1 TOTAL 7 f fD b D ALTERNATE #2: DIVISION D ADDITIONAL E scri tionPQuantity Unit Unit Price Total Amount move &replace roof df Leightona Stair Tower 2 as necessary to 1 LS,DD% 7 0Qblace elevator machine. t r ALTERNATE #2 TOTAL �t Q Q O ALTERNATE #3: DIVISION A nFnur.T Item No. Description P Quantity Unit Unit Price Total Amount 23 NEMA 1 elevator and electrical fixtures in Wayne Street Northwest Tower 1 LS �� of ALTERNATE #4- nlVlsinN n nFnl WIT ALTERNATE #3 TOTAL <t{ 2, DDO� Item No. Description P Quantity Unit Unit Price Total Artm�onu�lt L24 NEMA1 elevator and electrical fixtures In Leighton Plaza Stair Tower 1 1 LS /�� pn, yo <d I� i t/W ALTERNATE #4 TOTALy ALTERNATE #5: DIVISION C DEDUCT [n-NEMA1 Description P Unit Unit Price Total Amount elevator and electrical fixtures in Wa Wayne Street Southeast Tower MQuanfity LSr�� i t7O ALTERNATE #5 TOTAL. ALTERNATE #6: DIVISION n nFni IrT MiNTEMA Description Unit Unit Price Total Amount evator and electrical fixtures 7ntity Plaza Stair Tower 2 LS Tnn tl I i') I)t\ ALTERNATE #6 TOTAL Version 7/31/2015 Contractor's Bid for Public Works - a Bidder (Firm): Ziolkowski Construction, Inc. Address: 4050 Ralph Jones Drive City/State/Zip: South Bend IN 46628 Telephone Number: (574 ) 287-1811 �•��•C 7rr By J_e�l �ls Colo Ot'�4p ,Y (Signature) e• Bill Favors, President J; _ Q : SEAL A L (Printed Name of Person Signing) Version 7/31/2015 Contractor's Bid for Public Works - 9 ul ❑ ul 0) Ir ag �Q WZ� co WO tz r�ii a. Dzz U)FnW LL52 0a70 rrww Upw O Q } t- 0 z AMOKU, m 0 O LLl m LD J O N 0 N O %o s See A Newsp CITY OF SOUTH BEND MINORITY AND WOMEN BUSINESS ENTERPRISE DIVERSITY, DEVELOPMENT PROGRAM ; y FORM MWBE-2.0 EVIDENCE OF GOOD FAITH EFFORTS '"" This completed form should be included as part of the Bids documents related to City of South Bend Public Works Projects requiring Good Faith Efforts to obtain MBEANBE participation. It is the bidder's sole responsibility to verify whether any listed minority or woman business meets the qualifications of a Minority or Women's owned business as defined by the Indiana Department of Administration ("IDOA"), Project Number: 115-143 Date: November 8, 2016 Project Name: Bidder: Contact Person: Address: City: Email: _2016 Parking Garage Improvements Ziolkowski Construction, Inc. Gary Paston Telephone: 574-287-1811 4050 Ralnh Jones Drive South Bend State: IN gPaston(ilzbuild.com To determine whether a bidder has demonstrated good faith efforts to reach the MBE/W BE utilization goals set forth in the City of South Bend Public Works Project Specifications, the City and its agencies, boards, or commissions, REQUIRE ALL of the following Good Faith Efforts as listed in the table below*: Zip: 46628 EVIDENCE OF GOOD FAITH EFFORTS MBEANBE LIST(S): The bidder reviewed the City of South Bend's Minority and Women Business Enterprise Diversity Development Program, which uses the IDOA approved list of Minority and Women Owned Business as found on their website (http://www.in.govTdoa). ACTION (ADVERTISEICONTACT): In order for your bid to be deemed responsive, the City of South Bend requires that all perspective bidders complete no less than 2 of the following: 1. Attend all pre -bid meetings scheduled by the City to inform MBEANBEs of contracting and subcontracting opportunities. 2. Advertise in general circulation and/or trade association publications concerning subcontracting opportunities, and allow MBElWBEs reasonable time to respond. 3. Perform any and all necessary steps to providewritten notice in a manner reasonably calculated to inform MBEIINBEs of subcontracting opportunities and allowed sufficient time for them to participate effectively. 4. Utilize pre-existing services of available community organizations, small and/or disadvantaged business assistance offices and other organizations that provided assistance in the recruitment and placement of MBEM/BE firms. "Bidder must circle or otherwise notate which of the two (2) required actions were performed. ached GOOD FAITH NEGOTIATIONS: The bidder negotiated in goad faith with interested MBE/WBEs, p er Ad inproviding such MBE/W BE's with adequate information about the plans, specifications and other requirements of the subcontract and did not reject MBEANBEs as unqualified without sound business reasons based on a thorough ifof their capabilities. SMALL CONTRACT(S): The bidder selected specific portions of the work to be performed by MBE/WBEs m order to increase the likelihood of meeting the MBE/WBE goals (including breaking down contracts into smaller units to facilitate MBENVBE participation) CONTRACT RECORDS: The bidder has maintained the following records for each MBEINBE that has bid on the subcontracting opportunity: 1. Name, address, and telephone number, 2. A description of information provided by the bidder or subcontractor; and 3. A statement of whether an agreement was reached, and if not, why not, including any reasons for concluding that the MBEIWBE was unqualified to perform thejob. 11-P.1 tit uuuu raft" muort requires your initials next to an of the above boxes, Any omissions shall be considered grounds for rejection of the bid by the Board of Public Works. The City of South Bend reserves the right to request additional information. Version 7/31/2015 Contractors Bid for Public Works - 11 CITY OF SOUTH BEND ` � . MINORITY AND WOMEN BUSINESS ENTERPRISE DIVERSITY � 1�-:a DEVELOPMENT PROGRAM FORM MWBE-2.1 MBEfWBE CONTACTED 1965 This completed form should be supplied with Bids that pertain to City of South Bend Public Works Projects requiring contacted MBE/WBE to obtain Good Faith Efforts. It is the bidder's sole responsibility to verify whether any listed minority or woman business meets the qualifications of a Minority or Women's owned business. PAGE OF Project Number: 115-143 MBEANBE Participation Goal Project Name: 2016 Parking Garage Improvements Bidder: Ziolkowski Construction, Inc. BY: � President November 8 2016 1 (Signature) (Title) (Date) MBE/WBE Finn Owner or Contact at MBE/WBE Firm Telephone: Fax: Email: TYPE OF WORK SOLICITED FOR THIS PROJECT: RESULTS OF CONTACT WITH THE MBE/WBE FIRM: MBE/BE Firm Owner or Contact at MBENVBE Firm Telephone: Fax: Email: TYPE OF WORK SOLICITED FOR THIS PROJECT: RESULTS OF CONTACT WITH THE MBE/WBE FIRM: Version 7/31/2015 Contractor's Bid for Public Works - 12 pll fry Bp CITY OF SOUTH BEND, INDIANA � CONTRACTOR'S BID FOR PUBLIC WORK CHECKLIST FOR BIDDERS Project Name 2016 Parking Garage Improvements Project No. 115-143 For Bids Due 9:30am November 8, 2016 From time to time the South Bend Board of Public Works finds it necessary to reject a bid because it does not comply with statutory requirements. In preparing your bid, please use the following checklist in order to make sure that your bid is done in the proper manner. Proper bid security included. The bidder has the option of providing either a Certified Check X or Bid Bond. Bid prepared on the City of South Bend Contractor's Bid for Public Work Form, completely X executed. Contractor's Non -Collusion and Non -Debarment Affidavit, Certification Regarding Investments with Iran, Employment Eligibility Verification, Non -Discrimination Commitment, and X Certification of use of United States Steel Products or Foundry Products. Proof of MBENVBE Participation Goal Form [MWBE-1.0]. If minimum participation goal is not met, also provide Evidence of Good Faith Efforts Form [MWBE-2.0] and MBE/WBE Contacted X Form [MWBE-2.1]. X Acknowledge Receipt of I Addendum(s) included with the bid. X All required additional information is included with the bid, Proposal statements and other affidavits all signed by the proper party with name either X printed or typed underneath signature. X This checklist submitted with the Bid. This checklist is provided for bidder's use in assuring compliance with required documentation; however, it does not include all specifications requirements and does not relieve the bidder of the need to read and comply with the specifications. Bidder Ziolkowski Construction, Inc. _ Date: November 8, 2016 By Authorized Representative: Signature: Print Name & Title: Bill Favors, President Version 7/31/2015 Contractor's Bid for Public Works - 1 CITY OF SOUTH BEND, INDIANA CONTRACTOR'S BID FOR PUBLIC WORK Project Name 2016 Parking Garage Improvements Project No. For Bids Due 115-143 9:30am November 8, 2016 PART I (Must be completed for all bids. Please type or print) Date: November 8, 2016 Bidder (Firm): Ziolkowski Construction, Inc. Address: 4050 Ralph Jones Drive City/State/Zip: South Bend,1N 46628 Telephone Number: ( 574 ) 287-1811 Agent of Bidder (if Applicable): Pursuant to notices given, the undersigned offers to furnish labor and/or material necessary to complete the public works project of: 2016 Parking Garage Improvements the City of South Bend, Indiana, in accordance with plans and specifications prepared by: Byce & Associates, Inc. and dated 3/9/16 sum plus for the sum of (enter the Total Bid as shown on the Proposal) ILA-tidye-d ($ I One) I Ron tes shown on Proposal) (Numerical) The undersigned further agrees to furnish a bond or certified check with this bid for an amount specified in the notice of the letting. If alternative bids apply, the undersigned submits a proposal for each in accordance with the notice. Any addendums attached will be specifically referenced at the applicable page. If additional units of material included in the contract are needed, the cost of units must be the same as that shown in the original contract if accepted by the City of South Bend. If the bid is to be awarded on a unit basis, the itemization of the units shall be shown on a separate attachment. By �� n / a� ' (Signature) Bill Favors, President (Printed Name of Person Signing) ACCEPTANCE The above bid is accepted this day of Subject to the following conditions: BOARD OF PUBLIC WORKS Gary A. Gilot, President Elizabeth A. Maradik, Member David P. Relos, Member Therese J. Dorau, Member James A. Mueller, Member Attest: Linda M. Martin, Clerk Version 7/31/2015 Contractor's Bid for Public Works - 2 99 PART 11 (For projects of $100,000 or more — IC 36-1-12A) These statements to be submitted under oath by each bidder with and as part of his bid. Attach additional pages for each section as needed. SECTION 1 EXPERIENCE QUESTIONNAIRE 1. Attach information regarding projects your organization has completed for the period of one (1) year prior to the date of the current bid. See Attached 2. Attach a listing of public works projects currently in process of construction by your organization. See Attached 3. Attach information regarding any failure to complete any work awarded to you and the location thereof. See Attached 4. Attach references from private firms for which you have performed work. See Attached SECTION If PLAN AND EQUIPMENT QUESTIONNAIRE 1. Attach an explanation of your plan or layout for performing proposed work. (Examples could include a narrative of when you could begin work, complete the project, number of workers, etc. and any other information which you believe would enable the City of South Bend to consider your bid.) As directed by the Architect/Construction Manager 2. Attach a listing of the names and addresses of all subcontractors (i.e. persons or firms outside your own firm who have performed part of the work) that you have used on public works projects during the past five (5) years along with a brief description of the work done by each subcontractor. If Subcontractors will be used we will submit this information 24 hours after notification. 3. If you intend to sublet any portion of the work, attach the name and address of each subcontractor, equipment to be used by the subcontractor, and whether you will require a bond. However, if you are unable to currently provide a listing, please understand a listing must be provided prior to contract approval. Until the completion of the proposed project, you are under a continuing obligation to immediately notify the City of South Bend in the event that you subsequently determine that you will use a subcontractor on the proposed project. If Subcontractors will be used we will submit this information 24 hours after notification. 4. Attach a listing of equipment you have available to use for the proposed project. Whatever is required to complete the project properly and on time. 5. Have you entered into contracts or received offers for all materials which substantiate the prices used in preparing your proposal? If not, attach an explanation for the rationale used which would corroborate the prices listed. yes SECTION III CONTRACTOR'S FINANCIAL STATEMENT Attachment of bidder's financial statement is mandatory. Any bid submitted without said financial statement as required by statute shall thereby be rendered invalid. The financial statement provided hereunder to the City of South Bend awarding the contract must be specific enough in detail so that said City of South Bend can make a proper determination of the bidder's capability for completing the project if awarded. Version 7/31/2015 Contractor's Bid for Public Works - 3 When theprospecline Contractor is unable to terrify to any of the stalemenls below, it shall anach an ewplanrnion to this Affidavit CONTRACTOR'S NON -COLLUSION AND NON -DEBARMENT AFFIDAVIT, CERTIFICATION REGARDING INVESTMENT WITH IRAN, EMPLOYMENT ELIGIBILITY VERIFICATION, NON-DISCRIMINATION COMMITMENT AND CERTIFICATION OF USE OF UNITED STATES STEEL PRODUCTS OR FOUNDRY PRODUCTS (Mast be completed for all quotes and bids. Please type or print) STATE OF Indiana ) ) SS: St Joseph COUNTY ) The undersigned Contractor, being duly sworn uponhisiher/its oath, affirms under the penalties ofpedury that: 1. Contractor has not, nor has any other member, representative, or agent of the firm, company, corporation or partnership represented by him, entered into any combination, collusion or agreement with any person relative to the price to be bid by anyone at such letting nor to prevent any person fi-om bidding nor to induce anyone to refrain from bidding, and that this bid is made without reference to any other bid and without any agreement, understanding or combination with any other person in reference to such bidding. Contractor further says that no person or persons, firms, or corporation has, have or will receive directly or indirectly, any rebate, fee, gift, commission or thing of value on account of such sale; and 2. Contractor certifies by submission of this proposal that neither contractor nor any of its principals are presently debarred, suspended, proposed for debannent, declared ineligible, or voluntarily excluded from participation in this transaction by any Federal department or agency; and 3. Contractor has not, nor has any successor to, nor an affiliate of, Contractor, engaged in investment activities in Iran. a. For purposes of this Certification, "Iran" means the government of Iran and any agency or instrumentality of Iran, or as otherwise defined at Ind. Code § 5-22-16.5-5, as amended from time -to -time. b. As provided by Ind. Code § 5-22-16.5-8, as amended from time -to -time, a Contractor is engaged in investment activities in Iran if either: i. Contractor, its successor or its affiliate, provides goods or services of twenty million dollars ($20,000,000) or more in value in the energy sector of Iran; or ii. Contractor, its successor or its affiliate, is a financial institution that extends twenty million dollars ($20,000,000) or more in credit to another person for forty-five (45) days or more, if that person will (i) use the credit to provides goods and services in Non -Collusion Non -Debarment Affidavit Non bran Fnnn 2016 the energy sector in Iran; and (ii) at the time the financial institution extends credit, is a person identified on list published by the Indiana Department of Administration. 4. Contractor does not knowingly employ or contract with an unauthorized alien, nor retain any employee or contract with a person that the Contractor subsequently learns is an unauthorized alien. Contractor agrees that lie/she/it shall enroll in and verify the work eligibility status of all of Contractor's newly hired employees through the E-Verify Program as defined by I.C. 22-5-1.7-3. Contractor's documentation of enrollment and participation in the E-Verify Program is included and attached as part of this bid/quote, and 5. Contractor shall require his/her/its subcontractors performing work under this public contract to certify that the subcontractors do not knowingly employ or contract with an unauthorized alien, nor retain any employee or contract with a person that the subcontractor subsequently learns is an unauthorized alien, and that the subcontractor has enrolled in and is participating in the E-Verify Program. The Contractor agrees to maintain this certification throughout the teen of the contract with the City of South Bend, and understands that the City may terminate the contract for default if the Contractor fails to cure a breach of this provision no later than thirty (30) days after being notified by the City. 6. Persons, partnerships, corporations, associations, or joint venturers awarded a contract by the City of South Bend through its agencies, boards, or commissions shall not discriminate against any employee or applicant for employment in the performance of a City contract with respect to hire, tenure, terms, conditions, or privileges of employment, or any matter directly or indirectly related to employment because of race, sex, religion, color, national origin, ancestry, age, gender expression, gender identity, sexual orientation or disability that does not affect that person's ability to perform the work. In awarding contracts for the purchase of work, labor, services, supplies, equipment, materials, or any combination of the foregoing including, but not limited to, public works contracts awarded ruder public bidding laws or other contracts in which public bids are not required by law, the City, its agencies, boards, or commissions may consider the Contractor's good faith efforts to obtain participation by those Contractors certified by the State of Indiana as a Minority Business ("MBE") or as a Women's Business Enterprise ("WBE") as a factor in determining the lowest, responsible, responsive bidder. In no event shall persons or entities seeking the award of a City contract be required to award a subcontract to an MBE/WBE; however, it may not unlawfully discriminate against said WBE/MBE. A finding of a discriminatory practice by the City's MBE/WBE Utilization Board shall prohibit that person or entity from being awarded a City contract for a period of one (1) year from the date of such determination, and such determination may also be grounds for terminating the contact for which the discriminatory practice or noncompliance pertains. 7. The undersigned contractor agrees that the following nondiscrimination commitment shall be made a part of any contract which it may henceforth enter into with the City of South Bend, Indiana or any of its agencies, boards or commissions. Non -Collusion Non -Debi neat Affildivit Nam Iran Perm 2016 Contractor agrees not to discriminate against or intimidate any employee or applicant for employment in the performance of this contract with privileges of employment, or any matter directly or indirectly related to employment, because of race, religion, color, sex, gender expression, gender identity, sexual orientation, handicap, national origin or ancestry. Breach of this provision may be regarded as material breach of contract. I, the umdersigned bidder or agent as contractor on a public works project, understand illy statutory obligations to the use of steel products or foundry products made in tire United States (I.C. 5-16-8-1). 1 hereby certify that I and all subcontractors employed by me for this project will .use steel products or foundry products made in the United States on this project if awarded. I understand I have an affirmative duty to notify the City in my bid that my proposal does not include the use of steel products or foundry products made in the United States. I understand it is my sole obligation and responsibility to provide a justification to the City, subject to review and approval, why the cost of United States made steel or foundry products is unreasonable. Prior to award and upon submission of bid which does not use steel products or foundry products made in the United States, the City, through its director of public works, shall make a determination if the price of United States made steel or foundry is unreasonable. I understand that violations hereunder may result in forfeiture of contractual payments. I hereby affirm wider the penalties of penury that the facts and information contained in die foregoing bid for public works are true and correct. Dated this 8th day of Novembgo 2016 0" C C O' GpRI'O� • `' Y: ;n o SEAL o !/DlAtAt Subscribed and sworn to before Inc this 8th My Commission Expires March 1, 2020 Cotwty of Residence Non -Collusion Non-Debanncot Affidavit Non Iran Fonu 2016 Ziolkowski Construction, Inc. Contractor/Bidder (Firm) Signature of Contractor/Bidder or Its Agent Bill Favors, President Printed Name and Title day oof� November Q2016 Notary Public Shannon Reidenbach St Joseph (IN) SHANNON REIDEN8ACH Notary Public- Seal State of Indiana My Commission Expires Mar t, 2020 Project Name Project No. For Bids Due ovrn nF Of ~ tL BID/PROPOSAL c y CITY OF SOUTH BEND ' rxns 2016 Parking Garage Improvements 115-143 9:30am November 8, 2016 BASE BID DIVISION A: Wavne Straat Nnrthwact Tnwar Imnrn�mmnatc Item No. Description Quantity Unit Unit Price Total Amount 1 Elevator Equipment 1 LS 2 Mechanical 1 LS 1 3 Electrical 1 LS 3 QO p dD 4 General Trades 1 LS a 152 1ab0 C2lgDo 5 General Conditions 1 LS Q O D b00 i 111000 BASE BID TOTAL _,XQ t) qt)O BASE BID DIVISION B: Leiahton Plaza: Stair 1 Tnwar Imnrnvamantc Item No, Description P Quantity Unit Unit Price Total Amount 6 Elevator Equipment 1 LS aJrt qVo 6 y00 7 Mechanical 1 LS 3 Y 00 3 0®• °' 8 Electrical 1 LS 000 y a0 0 9 General Trades 1 LS 130a ` 3 0 10 General Conditions 1 LS O(D 06)0 BASE BID DIVISION C: Wavne Street: Snuthaast tnwar Imnrnvamantc Item No. Description P Quantity Unit FUnit Price Total Amount 11 Elevator Equipment 1 LS 37I00 a -7 12 Mechanical 1 LS aD l i t 000 13 Electrical 1 LS 406 2 qD® 14 General Trades 1 LS a Dd 00 15 General Conditions 1 LS gn l R o ao O BASE BID TOTAL d 9'6, 9 00 BASE BID DIVISION D: Leiahton Plaza: Stair Tnwer 2 irnnrnvemantc Item No. Description Quantity Unit Unit Price Total Amount 16 Elevator Equipment 1 LS A51 I LV 17 Mechanical 1 LS 3. qQD 0® Version 7/31/2015 Contractor's Bid for Public Works - 7 18 Electrical 1 LS 000 0 0 19 General Trades 1 LS l 00 0 "7 r7 0 20 General Conditions 1 LS Z, 06 v a0 t 00 0 BASE BID TOTAL @3 J 1 q00 ALTERNATE #1: DIVISION B ADDITIONAL Item 0_ Description P Quantity Unit Unit Price Total Amount Remove & replace roof of Leighton 21 Plaza Stair Tower 1 as necessary to 1 LS `% 0 0 O 7,000 replace elevator machine. r ALTERNATE#1 TOTAL , 000 ALTERNATE #2: DIVISION D ADDITIONAL Item Description No. P Quantity Unit Unit Price Total Amount Remove & replace roof of Leighton 22 Plaza Stair Tower 2 as necessary to 1 LS �] 7 1 000 1 ®0 c replace elevator machine. t ALTERNATE #2 TOTAL ALTERNATE #3: DIVISION A DFnucT Item No. Descri lion P Quantity Unit Unit Price 1 elevator and electrical fixtures�dt®in Wa ne Street Northwest Tower 1 LS =Amount23NEMA ALTERNATE #3 TOTAL 000 ALTERNATE #4: DIVISION B DEDUCT Item No Description P Quantity Unit Unit Price Total Amount 24 NEMA 1 elevator and electrical fixtures n Leighton Plaza Stair Tower 1 LS '49,p00 /I D0Q 1 1At ALTERNATE #4 TOTAL a 000 ALTERNATE #5: DIVISION C DEDUCT P Descri tion Quantity Unit Unit Price Total Amount T25 NEMA 1 elevator and electrical fixtures in Wa Street Southeast 1 LS �� 31 ®®t7 ne Tower 1 B ALTERNATE #5 TOTAL ALTERNATE #6: DIVISION D DFnttCT No. Item[NEMA Description P Quantity Unit Unit Price Total Amount 26 1 elevator and electrical fixtures Lei Leighton Plaza Stair Tower 1r�® g 2 ALTERNATE #6 TOTAL Version 7/31/2015 Contractor's Bid for Public Works - 8 Bidder (Firm): Ziolkowski Construction, Inc. Address: 4050 Ralph Jones Drive City/State/Zip: South Bend, W 46628 Telephone Number: (574 ) 287-1811 ,�`O...,.,,IO�Un..... KqI 2�/ 0 CD O; .•Gp1tP012f,? (Signature) �Bill Favors, President Q " SEAL (Printed Name of Person Signing) Version 7/31 /2015 Contractor's Bid for Public Works - 9 w w U ag 0 W Q C7 m w O Q Z)La zz o U) w U- ODQ H_wuuj U0W 0 Z Q O z ZE UJ m co O w = cm 0 C � O U w O m O Q � O Lr L C *' � N � m O' N v E y N w V1 U N N _C O y D o o � U 3 Q � O O D � 7 T a Z a a O c c Q m a L n m U 0 F O oc m y 0 UL o° �r c � t! w 0 'c U N Q > N � w � a_ .o co N L C C 3 N a w N y no0 Q to m � N O d m w D a � aD � D N o y c L 3 W N O E. N 0 - c o_ O o E 0 ci o m c �t ❑0 O m a n 0 o.:7- m O w >CLl ul m L Ed m E m Z N 0 See A Newsp CITY OF SOUTH BEND MINORITY AND WOMEN BUSINESS ENTERPRISE DIVERSITY DEVELOPMENT PROGRAM FORM MWBE-2.0 `. EVIDENCE OF GOOD FAITH EFFORTS 1965 This completed form should be included as part of the Bids documents related to City of South Bend Public Works Projects requiring Good Faith Efforts to obtain MBE/WBE participation. It Is the bidder's sole responsibility to verify whether any listed minority or woman business meets the qualifications of a Minority or Women's owned business as defined by the Indiana Department of Administration (` IDOA"). Project Number: 115-143 Date November 8, 2016 Project Name: 2016 Parking Garage Improvements Bidder: Ziolkowski Construction, Inc. Contact Person: GaryPaston Telephone: 574-287-1811 Address: 4050 Ralph Jones Drive City: South Bend State: IN zip: 46628 Email: gpaston(a)zbuild.com To determine whether a bidder has demonstrated good faith efforts to reach the MBENVBE utilization goals set forth in the City of South Bend Public Works Project Specifications, the City and its agencies, boards, or commissions, REQUIRE ALL of the following Good Faith Efforts as listed in the table below*: EVIDENCE OF GOOD FAITH EFFORTS MBENVBE LIST(S): The bidder reviewed the City of South Bend's Minority and Women Business Enterprise Diversity Development Program, which uses the IDOA approved list of Minority and Women Owned Business as found on their website (http://www.in.gov/idoa)- ACTION (ADVERTISE/CONTACT): In order for your bid to be deemed responsive, the City of South Bend requires that all perspective bidders complete no less than 2 of the following: 1. Attend all pre -bid meetings scheduled by the City to inform MBE/WBEs of contracting and subcontracting opportunities. 2. Advertise in general circulation and/or trade association publications concerning subcontracting opportunities, and allow MBE/WBEs reasonable time to respond. 3. Perform any and all necessary steps to provide written notice in a manner reasonably calculated to inform MBENVBEs of subcontracting opportunities and allowed sufficient time for them to participate effectively. 4. Utilize pre-existing services of available community organizations, small and/or disadvantaged business assistance offices and other organizations that provided assistance in the recruitment and placement of MBENVBE firms. **Bidder must circle or otherwise notate which of the two (2) required actions were performed. ached GOOD FAITH NEGOTIATIONS: The bidder negotiated in good faith with interested MBE/WBEs, per Ad including providing such MBE/WBE's with adequate information about the plans, specifications and other requirements of the subcontract and did not reject MBE/WBEs as unqualified without sound business reasons based on a thorough investigation of their capabilities. SMALL CONTRACT(S): The bidder selected specific portions of the work to be performed by MBENVBEs in order to increase the likelihood of meeting the MBENVBE goals (including breaking down contracts into smaller units to facilitate MBENVBE participation) CONTRACT RECORDS: The bidder has maintained the following records for each MBENVBE that has bid on the subcontracting opportunity: 1. Name, address, and telephone number, 2. A description of information provided by the bidder or subcontractor; and 3. A statement of whether an agreement was reached, and if not, why not, including any reasons for concluding that the MBE/WBE was unqualified to perform the job. per demonstration of Good Faith Effort requires your Initials next to all of the above boxes. Any omissions shall be considered grounds for rejection of the bid by the Board of Public Works. The City of South Bend reserves the right to request additional information. Version 7/31/2015 Contractors Bid for Public Works - 11 CITY OF SOUTH BEND ` tiuurx MINORITY AND WOMEN BUSINESS ENTERPRISE DIVERSITY :F DEVELOPMENT PROGRAM FORM MWBE-2.1 MBE/WBE CONTACTED 180 This completed form should be supplied with Bids that pertain to City of South Bend Public Works Projects requiring contacted MBEIWBE to obtain Good Faith Efforts. It is the bidder's sole responsibility to verify whether any listed minority or woman business meets the qualifications of a Minority or Women's owned business. PAGE OF Project Number: 115-143 MBE/WBE Participation Goal Project Name: 2016 Parking Garage Improvements Bidder: Ziolkowski Construction, Inc. By: �ol � President November 8 2016 (Signature) (Title) (Date) MBE/WBE Finn Owner or Contact at MBENVBE Firm Telephone: Fax: Email: TYPE OF WORK SOLICITED FOR THIS PROJECT: RESULTS OF CONTACT WITH THE MBEMBE FIRM: MBENJBE Firm Owner or Contact at MBENVBE Firm Telephone: Fax: Email: TYPE OF WORK SOLICITED FOR THIS PROJECT: RESULTS OF CONTACT WITH THE MBENVBE FIRM: Version 7/31/2015 Contractor's Bid for Public Works - 12 IA Document A310TM - 2010 CONTRACTOR: SURETY: (Nance, legal staters and address) (Mance, legal staters and principal place Ziolkowski Construction, Inc. ofbu.siness) 4050 Ralph Jones Drive Liberty Mutual Insurance Company South Bend, Indiana 46628 175 Berkeley Street This document has important legal Boston, MA 02116 consequences. consultation with OWNER: an attorney is encouraged with (Nance, legal status and address) respect to its completion or City of South Bend modification. 227 West Jefferson Blvd, Room 1316 Any singular reference to South Bend, Indiana 46601 Contractor, Surety, Owner or BOND AMOUNT: other party shall be considered Five Percent of Accompanying Bid (5% of Accompanying Bid) plural where applicable. PROJECT: (Xanre, location or address, and Project n unib er, if any) 2016 Parking Garage Improvements Project No. 115-143 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 into 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 to 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 tern Owner shall be deemed to be 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 sealed this t 6th day of November, 2016 R.\O�JL-Ja� Ziolkowski Construction, Inc. (GI'itness) Shannon Reidenbach (Principal A (Seal) (Title gill Favors, President Liberty Mutual Insurance Company [ (Seal) (lI'tnessJ nniy Garcia o � (Title) Adrienne C. Stevenson, Attorney -In -Fact STATE OF ILLINOIS COUNTY OF COOK h Katherine J. Foreit , a Notary Public in and for said County, do hereby certify that Adrienne C. Stevenson as Attorney -in -Fact, who is personally known to me to be the same person whose name is subscribed to the foregoing instrument, appeared before me this day in person, and acknowledged that they signed, sealed, and delivered said instrument for and on behalf of LIBERTY MUTUAL INSURANCE COMPANY for the uses and purposed therein set forth. Given under my hand and notarial seal at my office in the City of Chicago in said County, this 8ih day of November A.D. 2016 C HEHINE J FONFiTOINsi11 Seatpblic • Stete Ot 1111 1ion Expifes Apo 10, 2017 THIS'POWER OF ATTORNEY IS NOT VALID UNLESS IT IS PRINTED ON RED BACKGROUND. This Power of Attorney limits the acts of those named herein, and they have no authority to bind the Company except in the manner and to the extent herein stated. Certificate No. 7505741 Liberty Mutual Insurance Company The Ohio Casualty Insurance Company WestAmerican Insurance Company POWER OF ATTORNEY KNOWN ALL PERSONS BY THESE PRESENTS: That The Ohio Casualty Insurance Company is a corporation duly organized under the laws of the State of New Hampshire, that Liberty Mutual Insurance Company is a corporation duly organized under the laws of the State of Massachusetts, and West American Insurance Company is a corporation duly organized under the laws of the State of Indiana (herein collectively called the 'Companies ), pursuant to and by authority herein set forth, does hereby name, constitute and appoint, Adrienne C. Stevenson; Amy B. Wicked; C. R. Hernandez; Gabriel Jacquez; John K. Johnson; Katherine J. Foreit Rebecca Hobbs' Triniy Garcia all of the city of CHICAGO state of IL each individually if there be more than one named, its true and lawful attorney-in-factto make, execute, seal, acknowledge and deliver, for and on its behalf as surety and as its act and deed, any and all undertakings, bonds, recognizances and other surety obligations, in pursuance of these presents and shall be as binding upon the Companies as if they have been duly signed by the president and attested by the secretary of the Companies in their own proper persons. IN WITNESS WHEREOF, this Power of Attorney has been subscribed by an authorized officeror official of the Companies and the corporate seals of the Companies have been affixed theretothis 11th dayof October 2016 - JµtY INSLgt Jp�fNSUggZ `re,lliVAgry T a y^ �, t. P [. t. � F n � 5 0 o t9t9 0 7912 a 1991 r (3,t, b,4 �1,D Ry�i%'�� [wC SC' � •[AYN� Y 1 ♦ F ♦ ♦ STATE OF PENNSYLVANIA ss COUNTY OF MONTGOMERY The Ohio Casualty Insurance Company Liberty Mutual Insurance Company q, West merican Insurance Company V]-54 , David M. Care , Assistant Secretary On this 11th day of October 1 2016 , before me personally appeared David M. Carey, who acknowledged himself to be the Assistant Secretary of Liberty Mutual Insurance Company, The Ohio Casualty Company, and West American Insurance Company, and that he, as such, being authorized so to do, execute the foregoing instrument for the purposes therein contained by signing on behalf of the corporations by himself as a duly authorized officer. IN WITNESS WHEREOF, I have hereunto subscribed my name and affixed my notarial seal at King of Prussia, Pennsylvania, on the day and year first above written. O 9P pgSp COMMONWEALTH OF PENNSYLVANIA P�wEgr Fly Notarial Sea. 44� r' Q F v Teresa Pastella, Notary Public 1 ` ��I.000LJ 4& O n s �s of "">�ttar Upper Merlon Twp., Montgomery County My Commission Expires March 28, 2017 By; Teresa Pastella. Notary Public y 3 q Memher, Pennsylvania Assoaetlon of Notanes ev O a This Power of Attorney is made and executed pursuant to and by authority of the following By-laws and Authorizations of The Ohio Casualty Insurance Company, Liberty Mutual In Insurance Company, and West American Insurance Company which resolutions are now in full force and effect reading as follows: Y ARTICLE niOFFICERS—Section 12. Power of Attorney. Any officeror otherofficial of the Corporation authorized for that purpose in writing by the Chairman orthe President, and subject O to such limitation as the Chairman or the President may prescribe, shall appoint such attorneys -in -fact, as may be necessary to act in behalf of the Corporation to make, execute, seal, Z, acknowledge and deliver as surety any and all undertakings, bonds, recognizances and other surety obligations. Such attorneys -in -fact, subject to the limitations set forth in their respectivep powers of attorney, shall have full power to bind the Corporation by their signature and execution of any such instruments and to attach thereto the seal of the Corporation. When so is executed, such instruments shall be as binding as if signed by the President and attested to by the Secretary. Any power or authority granted to any representative or attorney -in -fact under > the provisions of this article may be revoked at any time by the Board, the Chairman, the President or by the officer or officers granting such poweror authority. N t ARTICLE XIII — Execution of Contracts— SECTION 5. Surely Bonds and Undertakings. Any officer of the Company authorized for that purpose in writing by the chairman or the president, .. and subject to such limitations as the chairman or the president may prescribe, shall appoint such attorneys -in -fact, as may be necessary to act in behalf of the Company to make, execute, seal, acknowledge and deliver as surety any and all undertakings, bonds, recognizances and other surety obligations. Such attorneys -in -tact subject to the limitations set forth in their respective powers of attorney, shall have full power l0 bind the Company by their signature and execution of any such instruments and to attach thereto the seal of the Company. When so O' executed such instruments shall be as binding as if signed by the president and attested by: the secretary. : - C i Certificate of Designation — The President of the Company, acting pursuant to the Bylaws of the Company; authorizes David M. Carey Assistant Secretary to appoint such attomeys-in- ~ fact as may be necessary to act on behalf of the Company to make, execute, seal, acknowledge. and deliver as surety any and all undertakings, bonds, recognizances and other surety obligations. Authorization — By unanimous consent of the Company's Board of Directors, the Company consents that facsimile or mechanically reproduced signature of any assistant secretary of the Company, wherever appearing upon a certified copy of any power of attorney issued by the Company in connection with surety bonds, shall be valid and binding upon the Company with the same force and effect as though manually affixed. I, Renee C. Llewellyn, the undersigned, Assistant Secretary, The Ohio Casualty Insurance Company, Liberty Mutual Insurance Company, and West American Insurance Company do hereby certify that the original power of affomey of: which the foregoing is a. full, true and correct copy of the Power of Attorney executed by. said Companies, is in full force and effect and has not been revoked - .. IN TESTIMONY WHEREOF, I have hereunto set my hand and affixed the seals of said Companies this 8 day of No v e r r , 20 16 h epe tNSVggM1 C p d'P'4r C (0(0(0 � � 7997 x BY: ,Tz3 ARenee C. Uew lty ssistant Secretary r 5a of 250 LMS_12873_082016 4 SpU TH g� 1316COUNTY-CITY BUILDING PHONE 5741235-9251 227 W. JEFFERSON BOULEVARD FAX 574/235-9171 SOUTH BEND, INDIANA 46601-1830 = "�'^� - TDD 574/ 235-5567 i 1 a7 18G5 CITY OF SOUTH BEND PETE BUTTIGIEG, MAYOR BOARD OF PUBLIC WORKS Date: To: From Subject 2016 Richard Estes, Engineer, City of South Bend Addendum Number: 1 Project Name: 2016 Parking Garage Improvements Project Number: 115-143 ACKNOWLEDGEMENT OF RECEIPT OF ADDENDUM Date Received: I t — 3 — I Lc This addendum is being forwarded to you for the above referenced project. Please sign below and acknowledge receipt of this Addendum by faxing this sheet to the Board of Public Works at (574) 235-9171. A copy MUST also be included with your bid package upon submittal. THIS ADDENDUM MAY AFFECT YOUR BID. Note: The attached documents are hereby added to the Specifications and Contract Documents and become a part of herein. Company: Authorized Signature: C Date: 0 — 0 • PART 11 (For projects of $100, 000 or more — IC 36-1-12-4) Governmental Unit: City of South Bend Bidder (Firm) Ziolkowski Construction, Inc. Date (month, day, year): November 8, 2016 These statements to be submitted under oath by each bidder with and as a part of his bid. Attach additional pages for each section as needed. SECTION I EXPERIENCE QUESTIONNAIRE 1. What public works projects has your organization completed for the period of one (1) year prior to the date of the current bid? 2. 3. Contract Amount Class of Work Completion Date Name and Address of Owner $16,473,549 General 01/2012 IUSB Cancer Research Center $12,274,292 General 01/2016 Lake Central High School $16,920,600 General 08/2011 Kankakee Valley New Middle School $7,663,700 General 02/2013 Mishawaka River Center Apartments What public works projects are now in process of construction by your organization? Contract Amount Class of Work Expected Completion Date Name and Address of Owner $27,366,9 00 General 05/2016 Purdue University North Central $21,355,975 General 06/2015 Armed Forces Reserve Center $4,824,179 General 08/2015 Mishawaka Central Park $9,020,000 General 10/2016 South Bend Airport- New Arrivals Termi Have you ever failed to complete any work awarded to you? No If so, where and why? 4. List references from private firms for which you have perforned work - University of Notre Dame, Tony Polotto, LEED, AP, 200 Facilities Bldg., Notre Dame, IN 46556 574-631-4200 City of Mishawaka, Ken Prince, 600 East Third Street, Mishawaka, IN 574-258-1625 Fetters Construction Inc., Steven A. Fetters, 5417 County Rd 427, Auburn, Indiana 46706 260-927-8516 Memorial Hospital & Health System, Larry Lies, 615 N Michigan St., South Bend, IN 46601 574-647-1000 Date: Account #: Company Name: INC. Contact: Address: City: State: Telephone: Ad ID: Run Dates: Ad Class: Columns wide: Total # of Lines: Total Cost: Account Rep: Phone # Email: Payments: Method Carol Type South Bend TRIBUNE The voice that connects us. -Receipt- 10/25/16 135334 ZIOLKOWSKI CONSTRUCTION 4050 RALPH JONES DRIVE SOUTH BEND IN (999)287-1811 146925 10/31/16 to 10/31/16 Other Legals 1 16 $26.88 Susan Mahoney (574)235-6216 legals@sbtinfo.com Last 4 Digits Check Publications: South Bend Tribune SB Online Gross: $26.88 Paid Amount: $0.00 Amount Due: $26.88 Amount Your ad Actively seeking bids from cer- tified Ni businesses in several construction trades to participate in the construction of the 2016 Parking Garage Improvements project located in South Bend, IN. Bid date is November 10, 2016. Plans are available in our planroom web - site (www.zplanroom.com). If questions arise, please con- tact Shannon at ZIOLKOWSKI CONSTRUCTION, INC. at 574- 287-1811 ext. 271 or in person at 4050 Ralph Jones Drive, S.B. Hspaxlp It 10:31 P.-es:,ibed by State Board of Accounts Governmental Unit General Form No. 99P (Rev. 2009A) To.................................................................................... Dr. IDEM South Bend Tribune 225 West Colfax Ave ............................................County, Indiana South Bend, Indiana 46628 Tax ID# 35-13-1571 PUBLISHER'S CLAIM LINE COUNT Ad #: 146925 Display Master (Must not exceed two actual lines, neither of which shall total more than four solid lines of type in which the body of the advertisement is set) -- number of equivalent ................................... Head --Number of lines Body -- Number of lines Body -- Number of lines Total number of lines in notice 16 COMPUTATION OF CHARGES 16 lines, 1 columns wide equals 16 equivalent lines at 1.68 cents per line Additional charges for notices containing rule or tabular work (50 per cent of above amount) Charge for extra proofs of publication ($1.00 for each proof in excess of two) TOTAL AMOUNT OF CLAIM $26.88 DATA FOR COMPUTING COST Width of single column in picas 9.4ems Size of 8 point Number of Insertions $0.00 ................................... Pursuant to the provisions and penalties of IC 5-11-10-1, 1 hereby certify that the foregoing account is just and correct, that the amount claimed is legally due, after allowing all just credits, and that no part of the same has been paid. I also certify that the printed matter attached hereto is a true copy, of the same column width and type size, which was duly published in said paper 1 time(s). The dates of publication being as follows: South Bend Tribune: 10/31 /16. 3 n ral Manager South Bend Tribune 225 W. Colfax Ave. South Bend, IN 46628 ON ACCT OF APPROPRIATION FOR $26.88 Appropriation No. Tax ID# 35-138-1571 ALLOWED IN THE SUM OF $26.88 YYI.e� Cheryl J tae Morey, Notary Public Resident of St. Joseph County My Commission expires December 21, 2016 That it is duly authenticated as required by law. That it is based upon statutory authority. That it is apparently correct incorrect I certify that the within claim is true and correct; that the services there in itemized and for which charge is made were ordered by me and were necessary to the public business Attest Ad #: 146925 Actively seeking bids from cer- tified MBE/WBE businesses in several construction trades to participate in the construction of the 2016 Parking Garage Improvements project located in South Bend, IN. Bid date is November 10, 2016. Plans are available in our planroom web - site (www.zplanroom.com). If questions arise, please con- tact Shannon at ZIOLKOWSKI CONSTRUCTION, INC. at 574- 287-1811 ext. 271 or in person at 4050 Ralph Jones Drive, S.B. Hspaxlp it 10:31 E-Veri Company ID Number: 486671 ( ` � IIIIIII =�a 1 THE E-VERIFY PROGRAM FOR EMPLOYMENT VERIFICATION MEMORANDUM OF UNDERSTANDING ARTICLE I PURPOSE AND AUTHORITY This Memorandum of Understanding (MOU) sets forth the points of agreement between the Department of Homeland Security (DHS) and Ziolkowski Construction. Inc (Employer) regarding the Employer's participation in the Employment Eligibility Verification Program (E- Verify). This MOU explains certain features of the E-Verify program and enumerates specific responsibilities of DHS, the Social Security Administration (SSA), and the Employer. E-Verify is a program that electronically confirms an employee's eligibility to work in the United States after completion of the Employment Eligibility Verification Form (Form 1-9). For covered government contractors, E-Verify is used to verify the employment eligibility of all newly hired employees and all existing employees assigned to Federal contracts or to verify the entire workforce if the contractor so chooses. Authority for the E-Verify program is found in Title IV, Subtitle A, of the Illegal Immigration Reform and Immigrant Responsibility Act of 1996 (IIRIRA), Pub. L. 104-208, 110 Stat. 3009, as amended (8 U.S.C. § 1324a note). Authority for use of the E-Verify program by Federal contractors and subcontractors covered by the terms of Subpart 22.18, "Employment Eligibility Verification", of the Federal Acquisition Regulation (FAR) (hereinafter referred to in this MOU as a "Federal contractor with the FAR E-Verify clause") to verify the employment eligibility of certain employees working on Federal contracts is also found in Subpart 22.18 and in Executive Order 12989, as amended. ARTICLE II FUNCTIONS TO BE PERFORMED A. RESPONSIBILITIES OF SSA 1. SSA agrees to provide the Employer with available information that allows the Employer to confirm the accuracy of Social Security Numbers provided by all employees verified under this MOU and the employment authorization of U.S. citizens. 2. SSA agrees to provide to the Employer appropriate assistance with operational problems that may arise during the Employer's participation in the E-Verify program. SSA agrees to provide the Employer with names, titles, addresses, and telephone numbers of SSA representatives to be contacted during the E-Verify process. 3. SSA agrees to safeguard the information provided by the Employer through the E-Verify program procedures, and to limit access to such information, as is appropriate by law, to individuals responsible for the verification of Social Security Numbers and for evaluation of the E-Verify program or such other persons or entities who may be authorized by SSA as governed Page 1 of 13 1 E-Verify MOU for Employer I Revision Date 09/01/09 www.dhs.gov/E-Verify E-Verify - Employer Wizard - Company Information Page 1 of 1 E-Verify, Employment Eligibility Verification Click any Q for help 4 11 A� Well User ID Us' James Keldsen I� 12:34 PM - 06/20/2016 Log Out Home Company Information My oases New Case Company Name: Ziolkowski Construction, Inc. View Cases Search Cases My Profile Company ID Number: 486671 Doing Business As (DBA) Edit Profle Name: Change Password DUNS Number: Change Security questions My Company Physical Location: Edit Company Profile Address 1: 405D Ralph Jones Dr. Add New User Address 2: View Existing Users City: South Bend Close Company Account State: IN My Reports Zip Code: 46628 View Reports County: STJOSEPH My Resources View Essential Resources Additional Information: Take Tutorial Employer Identification Number: 351445992 View User Manual Total Number of Employees: 100 to 499 Share Ideas Parent Organization: Contact Us Administrator' Organization Designation: Employer Category: None of these categories apply Mailing Address Address 1: Address 2: City: State: Zip Code: NAICS Code: 236-CONSTRUCTION OF BUILDINGS Total Hiring Sites: 1 Total Points of Contact: 1 View MOU U.S. Department of Homeland Security -vmvechs,ev U.S. criosrahip and lmmiaration Services-www.Usdrr.gov View/ Edit View/ Etlit View/ Edit View /Edit Enable Permanent Tooltips Accessibility Download Viewers hftps://e-verify.uscis.gov/emp/EmployerWizard.aspx 6/20/2016