HomeMy WebLinkAboutOpening of Quotations - 12th Floor Remodel 116-125 - Ziolkowski Construction, Inc.! po gE
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CITY OF SOUTH BEND, INDIANA W;
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CONTRACTOR'S QUOTE FOR PUBLIC WORK
�1865 ;r
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PROJECT NAME: 12t^ Floor Remodel
PROJECT NO. 116-125
QUOTES DUE November 22, 2016. 9:30 a.m. Local Time
(Must be completed for all quotes. Please type or print)
Date: November 22, 2016 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): n/a
Pursuant to notices given, the undersigned offers to furnish labor and/or material necessary to complete the
public works project of:
121n Floor Remodel
the City of South Bend, Indiana, in accordance with plans and specifications prepared by:
The City of South Bend, Department of Public Works
and dated 11/7116 j for the sum of (enter the Total Quote as shown on the Proposal)
F 4:4,v S i Y Thou.� r l'Lxy (g 5 1P, O a 5 >
(Enter Sum of Total Quote plus Alternates shown on Proposal) (Numerical)
If alternative quotes 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 quote is to be awarded on a unit basis, the
itemization of the units shall be shown on a separate attachment.
The above quote is accepted this
Subject to the following conditions:
BOARD OF PUBLIC WORKS
Gary A. Gilot, President
Elizabeth A. Maradik, Member
James A. Mueller. Member
i
By
(Signature)
Bill Favors, President
(Printed Name of Person Signing)
ACCEPTANCE
day of
Suzanne M. Fritzberg, Member
Therese J. Dorau, Member
Attest: Linda M. Martin, Clerk
20
Version 10/18/2016 Page - 7 Public Works Quote
When the prospective Contractor is unable to certify to any of the statements below, it shall attach an explanation to this Affidavit
CONTRACTOR'S NON -COLLUSION AND NON -DEBARMENT AFFIDAVIT,
CERTIFICATION REGARDING INVESTMENT WITH MAN, 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
) SS:
St Joseph COUNTY )
The undersigned Contractor, being duly sworn upon his/her/its oath, affirms 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 -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
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 he/she/it shall enroll in and verify the work eligibility status of all of
Version 10/18/2016 Page - 8 Public Works Quote
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 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 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
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 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.
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 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
Version 10/18/2016 Page - 9 Public Works Quote
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 under the penalties of perjury that the facts and information contained in the foregoing bid for public
works are true and correct.
Dated this 22"d day of November 2016
•""' I Ziolkowski Construction Inc
°c,-.-• T9,,• Contractor/Bidder(Finn)
o-C��oA•'GO•
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J : SEAL --I = Signature of Contractor/Bidder or Its Agent
o:• ; o=
%:�:
Bill Favors. President
%,�•-• •• •+S',, Printed Name and Title
VDi.A +
Subscribed and sworn to before me this 22' day of November 2016
My Commission Expires March 1, 2020
Shannon Reidenbach - Notary Public
County of Residence St Joseph
E
HANNONHEIDENBACHNotary Public- SealState of Indianamission Expires Mar 1, 2020
Version 10/18/2016 Page - 10 Public Works Quote
yo'u ra eE
QUOTE/PROPOSAL °
CITY OF SOUTH BEND
1865
PROJECT NAME 12t4 Floor Remodel
PROJECT NO. 116-125
QUOTES DUE November 22, 2016. 9:30 a.m. Local Time
Item
No.
Description
Quantity
Unit
Unit Price
Total Amount
1
Base Bid Remodel
1
LSUM
a" t q00
$ c 4 r q0o
Total Amount of Base Quote
$ a 1i t q 00
r��A�N N►I•p���:1
Item
No.
Description
Quantity
Unit
Unit Price
Total Amount
2
Alternate A
1
LSUM
Total Amount of Alternate A
$
r1s 111►r_vw:1
Item
No.
Description
Quantity
Unit
Unit Price
Total Amount
3
Alternate B
1
LSUM
q ppp
$ 9,000
Total Amount of Alternate B
$ ct , D O O
AL1EKiNA1bU
Item
No.
Description
Quantity
Unit
Unit Price
Total Amount
4
Alternate C
1
LSUM
Lo,Ci'SO
$ Co,9 Sb
Total Amount of Alternate C
$
Firm: Ziolkowski Construction, Inc.
Address: 4050 Ralph Jones Drive
City/State/Zip: South Bend, IN 46628 Telephone Number: 574-287-1811
Fax Number: 574-234-0151
By �L 4 Aav-1�
(Signature)
Bill Favors, President
(Printed Name of Person Signing)
Version 10/18/2016 Page - 11 Public Works Quote
E-Veri
I
Company ID Number: 486671
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-Veri J .
Company ID Number: 486671
To be accepted as a participant in E-Verify, you should only sign the Employer's Section
of the signature page. If you have any questions, contact E-Verify at 888-464-4218,
Employer Ziolkowski Construction, Inc.
ill Favors
Name (Please Type or Print)
Electronically Signed
itle
�1/1012012
ignature
ate
Department of Homeland Security — Verification Division
SCIS Verification Division
Name (Please Type or Print)
Electronically Signed —71/10/2012
itle
ignature
Date
Information Required for the E-Verify Program
Information relating to your Company:
Comp ny Name:
iolkowski Construction, Inc.
Company Facility Address:
050 Ralph Jones Dr.
South Bend, IN 46628
Company Alternate
Address:
County or Parish:
3TJOSEPH
Employer Identification
Number:
351445992
Page 12 of 13 1 E-Verify MOU for Employer I Revision Date 09/01/09 www.dhs.gov/E-Verify
E-Veri
Company ID Number: 486671
North American Industry
Classification Systems
Code:
236
Administrator:
Number of Employees:
100 to 499
Number of Sites Verified
for:
1
Are you verifying for more than 1 site? If yes, please provide the number of sites verified for
in each State:
INDIANA 1 site(s)
Information relating to the Program Administrator(s) for your Company on policy
questions or operational problems:
Name: James Keldsen
Telephone Number: (574) 287 -1811 ext. 368 Fax Number: (574) 344 .5533
E-mail Address: jkeldsen?azbuild.com
Page 13 of 13 1 E-Verify MOU for Employer I Revision Date 09/01/09 www.dhs.gov/E-Verify
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NAICS Code: 236 - CONSTRUCTION OF BUILDINGS
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