HomeMy WebLinkAboutOpening of Bids - Calvert St. Lift Station Replacement - Proj No. 116-053 - Haskins Underground, Inc.CITY OF SOUTH BEND, INDIANA
CONTRACTOR'S BID FOR PUBLIC WORK
CHECKLIST FOR BIDDERS
Project Name Calvert Street Lift Station Replacement
Project No.
For Bids Due
116-053
November 22, 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
!/ or Bid Bond.
S Bid prepared on the City of South Bend Contractor's Bid for Public Work Form, completely
V executed.
Contractor's Non -Collusion and Non -Debarment Affidavit, Certification Regarding Investments
With Iran, Employment Eligibility Verification, Non -Discrimination Commitment, and
Certification of use of United States Steel Products or Foundry Products.
Proof of MBE/WBE 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
Form [MWBE-2.1].
v Acknowledge Receipt of 2 Addendum(s) included with the bid.
All required additional information is included with the bid.
Proposal statements and other affidavits all signed by the proper party with name either
printed or typed underneath signature.
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: Ask", Uq� �� </� Date: 4),12ho/d
By Authorized Representative:
Signature: ,
Print Name & Title: �qr f�llS%f'ihS �reS�Je�f
Version 10/18/2016 Contractor's Bid for Public Works - 1
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CITY OF SOUTH BEND, INDIANA
CONTRACTOR'S BID FOR PUBLIC WORK
axes
Project Name Calvert Street Lift Station Replacement
Project No. 116-053
For Bids Due November 22, 2016
PART
(Must be completed for all bids. Please type or /p/ri�n/t)
Date: L941,Lb/6 Bidder (Firm): Wa4y&r t�'�I erall2 � l o
Address: </// 9B i6d
City/State/Zip: X'*O.A _ .tN Telephone Number: { 6 7y) 93 V -6 k 5—k
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:
the City of South Bend, Indiana, in accordance with plans and specifications prepared by:
and dated tLou `1F 4011b for the sum of (enter the Total Bid as shown on the Proposal)
e' ". Aweif � /a .✓ e -%�l.�arorlr/ ($ 4 /73,So0. — )
(Enter sum of Total Base -Bid on Prop al)(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 shalt be shown separate attachment.
By —/7/�ly/ "
A// �" (Signature)
(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
Suzanna M. Fritzberg, Member
Therese J. Dorau, Member
James A. Mueller, Member Attest: Linda M. Martin,
Version 10/18/2016 Contractors Bid for Public Works - 2
ie
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.
2. Attach a listing of public works projects currently in process of construction by your
organization.
3. Attach information regarding any failure to complete any work awarded to you and the
location thereof.
4. Attach references from private firms for which you have performed work.
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.)
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.
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.
4. Attach a listing of equipment you have available to use for the proposed project.
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.
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. �4eloS fj
Version 10/18/2016 Contractor's Bid for Public Works - 3
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 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)
r M A
KaWne S. Whey
STATE OF 9113I )JA ) Notary Pabno, Ebb 01Indim
SS: f esmont of Marshall Co., IN ,
J&2A$L COUNTY ) My wmmhlsIN egIM
Odebw 20, 2023
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.
Version 10/1812016 Contractor's Bid for Public Works - 4
Contractor agrees that he/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 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 ventures 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. 5-16-5-1). 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. Iunderstand 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 obligationand 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.
Version 10/18/2016 Contractor's Bid for Public Works - 5
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 day of A&AA, 2016
Contractor/Bidder (Firm
Signature of Contractor/Bidder or Its Agent
Printed Name and Title
Subscribed and sworn to before me this day ofQ'Cewbt�' , 201Q
My Commission Expires 0(:-h)bel?- 2D, Q 3
otary Public
County of Residence // /H 1lzaA Z.
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Esrnr: - - - - - VO W Seal"- ,
i KamMM E. Whey r
° 1181011Y Public, >t ba of Indlans
f Resident of ilgraMll Co., w ;
My canuals" expires r
2023
Version 10/18/2016 Contractor's Bid for Public Works - 6
BID/PROPOSAL
CITY OF SOUTH BEND
�. 1N65
Project Name Calvert Street Lift Station
Project No. 116-053
For Bids Due November 22, 2016
BASE BID
Item
No.
Description
Quantity
Unit
Unit Price
Total Amount
1
Mobilization and Demobilization
1
LS
50 OQ7,—
SO 000.
2
Maintaining Traffic
1
LS
$ /OUD _
/ 0d0. —
3
Clearing Right of Way
1
LS
tad ply
1/29,OW —
4
Construction Engineering
1
LS
/$000,
/S�OLW-
5
Temporary Erosion and Sediment
Control
1
LS
S J 0t7�
f 001J
6
Maintaining Flow
1
LS
/S b00.�
} /$ 000,E
7
Dewatering
1
LS
/(,�� X4
8
Curb and Gutter, Type 'B'
20
LFT
,j S, —
5b0, —
9
Compacted Aggregate, No. 53, Base
120
TON
3 S, ~
yRoo,
10
Concrete Pavement Patching
80
SYS
I y d00. —
11
PCCP for Drive, 9"
280
SYS
so • �
key 000.
12
Chain Link Fence, PVC Coated, 6' Ht
296
LFT
yp �—
13
Chain Link Swing Gate, 16' Opening,
Double Leaf
1
LS
(1G1�•
�� Old9•
14
Top Soil
320
CYS
%,
15
Mulch Seeding
2800
SYS
'Y
d` �Q J i
16
Doghouse Manhole, 6' Dia.
2
EA
,01000 '
10, 000.
17
Manhole, Drop Type, 6' Dia.
1
EA
000,—
,`'000.
18
Manhole, 6' Dia.
1
EA
/J! aJ,
SiY7�, —
19
Force Main, 8" Dia.
114
LFT
%s
7 p
20
Sanitary Sewer, 24" Dia,
108
LFT
21
Sanitary Sewer, 30" Dia.
92
LFT
FIT
SQ
UOb,
22
Lift Station
1
"
23
Lift Station Electrical
1
LS
24
Lift Station Abandonment
1
LS
5.00,
/Z Soa, —
BASE BID TOTA 5 s'O,
Bidder (Firm):
Version 10/18/2016 Contractor's Bid for Public Works - 7
Address: all/ YD /S Lw
City/State/Zip: )Q66U?% I/V Telephone Number: (Vy) 130 ^ to f( S 8
ByL✓
(Signature)
%"!lank Hasx�r
(Printed Name of Person Signing)
Version 10/18/2016 Contractor's Bid for Public Works - 8
HASKINS
UNDERGROUND, INC.
UTILITIES • SITE WORK • EROSION CONTROL
8111 9B Road
Plymouth, IN 46563
RE: Form 96
Section I
1. Project that Haskins Underground, Inc. has completed are as follows:
Tel- 574.935.3151
Description
Amount
Owner
Lake Pleasant Sanitary
Sewer
1.1 mil
Steuben County Regional
Waste District
SR 19 Water Main
$288,050.00
City of Nappanee
East Lake Shore Storm
Sewer
1.03 mil
Town of Culver
2. Public Works Projects that Haskins Underground Currently have contracts for are
Description
Amount
Owner
Stony Run Bank Stabilization
$99,000.00
City of Ft. Wayne
Water Main Extension
$515,000.00
City of Plymouth
3. Haskins Underground, Inc. has completed all contracts that have been awarded
4. Private References are as follows
Michiana Contracting P.O. Box 929, Plymouth, IN 46563
Banner Electric, 1515 W. Jefferson St., Plymouth, IN 46563
Section II
Start date would be February of 2017 weather permitting and after all shop drawings are submitted
and approved. Work would begin by installation of erosion control measures and clearing and
grubbing of site. Then dewatering would progress with the excavation of the bottom of the new wet
well to follow. While excavating steel would be tied. The majority of the tank would be poured
within 6 weeks. Piping would follow after. Then building of the interior of pump station, along with
electrical and controls. Once new station is active it would be tested per specifications before old
iron is taken out of service.
2. Contractors that we have used are as follows
Michiana Contracting P.O. Box 929, Plymouth, IN 46563 used for Electrical
Banner Electric, 1515 W. Jefferson St., Plymouth, IN 46563 used for Electrical
Rensberger Construction, 8530 6B Road, Plymouth, IN 46563 used for carpenters
Haskins Inc, 2520 Oak Road, Plymouth, IN 46563 used for additional labor and operators
Jeff Gustafson Farms, 18871 W. 4B Road Walkerton, IN 46574 used for trucking
3. Concrete / Rebar, Electrical, Coatings, along with shoring and possible dewater/bypass pumping will
be sublet.
3. Haskins Underground has various equipment to compete the project including excavators and loaders.
pumps trench boxes
4. Material price quotes have been received for this project.
Mark Haskins Jr.
President
Haskins Underground, Inc.
CITY OF SOUTH BEND tiyot rx RFC
MINORITY AND WOMEN BUSINESS ENTERPRISE DIVERSITYLL rx
DEVELOPMENT PROGRAM nj
Z Y
FORM MWBE-2.0
EVIDENCE OF GOOD FAITH EFFORTS 1865
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: 116-053 Date:
Project Name: Calvert Street Lift Station Replacement
Bidder: yAia; �i,,� oL,2gv / zi-
Contact Person: /i/ptK Telephone: 51`/ ?o -6$S'y
Address: gz/z l'B Aaff l
City A60;� State: TN zip:
Email: m4r -a hQs/(!os b//derarnc Q1 40fi
To determine whether a bidder has demonstrated good faith efforts to reach the MBE/WBE 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
/
MBEIWBE LIST(S): The bidder reviewed the City of South Bend's Minority and Women Business
J
Enterprise Diversity Development Program, which uses the IDOA approved list of Minority and Women
Owned Business as found on their website (http:/Jwww.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.
Advertise in general circulation and/or trade association publications concerning
J
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 MBE/WBEs of subcontracting opportunities and allowed sufficient time for
them to participate effectively.
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 MBE/WBE firms.
"Bidder must circle or otherwisenotate which of the two (2) required actions were performed.
GOOD FAITH NEGOTIATIONS: The bidder negotiated in good faith with interested MBE/WBEs,
including providing such MBE/WBE'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 investigation of their capabilities.
The bidder selected specific portions of the work to be performed by
s in order to increase the likelihood of meeting the MBEIWBE goals (including breaking down
into smaller units to facilitate MBE/WBE participation)
F�WON7RACT(S):
T RECORDS: The bidder has maintained the following records for each MBE/UVBE that has
subcontracting opportunity:
ddress, and telephone number;iption
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.
..aper ucdwusueuon or Good Farm 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 10/18/2016 Contractor's Bid for Public Works - 10
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CITY OF SOUTH BEND C4 YOl Tk OAt
MINORITY AND WOMEN BUSINESS ENTERPRISE DIVERSITY 4 It y
DEVELOPMENT PROGRAM -
FORM MWBE-2.1
MBEIWBE CONTACTED 105
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: 116-053 MBEIWBE Participation Goal
Proji
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0
MBE/WBE Firm S74fe
Owner or Contact at MBE/WBE Firm
Telephone: V (-a 0 % -20 )f Fax: Email: &C,-k rricadV -0 01 CO M
TYPE OF WORK SOLICITED FOR THIS PROJECT: 9J
i rit f-oa CO h fro
RESULTS OF CONTACT WITH THE MBEANBE FIRM:
ICC/wiLeJ Q.a1e
MBEIWBE Firm G q, r- e� Sit./yey0i5
Owner or Contact at MBEIWBE Firm Rtt 3A� n c on
Telephone: I(,0- QC10 -83P7 Fax:
TYPE OF WORK SOLICITED FOR THIS PROJECT:
y Ov.r
RESULTS OF CONTACT WITH THE MBE/WBE FIRM:
Ot ckc Re�-P(,U"
Email: f0 W,0,) @ 3q rC1'agSk i vetipt's , C0^1
Version 10/18/2016 Contractor's Bid for Public Works - 11
Liberty
MUtUdIo The Ohio Casualty Insurance Company
SURETY BID OR PROPOSAL BOND
KNOW ALL MEN BY THESE PRESENTS, That we, Haskins Underground, Inc.
of 8111 9B Road. Plymouth IN 46563
(hereinafter called the Principal) as Principal, and The Ohio Casualty Insurance Company , with its principal
office in the City of Keene , New Hampshire (hereinafter called the Surety), as Surety, are held and
firmly bound unto City of South Bend, Department of Public Works
of 227 West Jefferson St., Room 1316, South Bend, IN 46601
(hereinafter called the Obligee) in the penal sum of 5%
Dollars 5% lawful money of the United States, for the payment of which sum well and truly to be made,
we bind ourselves, our heirs, executors, administrators, successors, and assigns.
THE CONDITION OF THIS OBLIGATION IS SUCH, that whereas, the Principal has submitted the accompanying
bid dated December 8, 2016 for Calvert Street Lift Station Replacement Project; Project No. 116-053
NOW, THEREFORE, if the Obligee shall make any award according to the terms of said bid and the Principal shall
enter into a contract with said Obligee in accordance with the terms of said bid and give bond for the faithful performance
thereof within the time specified; or if no time is specified within thirty days after the date of said award; or if the Principal
shall, in the case of failure so to do, indemnify the Obligee against any loss the Obligee may suffer directly arising by reason
of such failure, not exceeding the penalty of this bond, then this obligation shall be null and void: otherwise to remain in full
force and virtue.
Signed, sealed and dated: December 5, 2016
Haskins Underground,lnc.
(Principal)
By: //�/ j/
Mark Haskins, Jr.
The Ohio Casualty Insurance Company
By:hx0t..& kge�:2
Gregory S. NIler ' (Attorney -in -Fact)
S-137-Rev.
POWER OF ATTORNEY
The Ohio Casualty Insurance Company Bond Number:
Principal: Haskins Underground,Inc.
Agency Name: RICHARD S. MILLER & SONS INC.
Obligee: CitV of South Bend, Department of Public Works Agent Code: 133847
Know All Men by These Presents: That The Ohio Casualty Insurance Company, pursuant to the authority granted by Article IV, Section 12 of the Code of Regulations and
By -Laws of The Ohio Casualty Insurance Company, do hereby nominate, constitute and appoint: Gregory S. Miller, Christian L. Barnes of BREMEN, Indiana its true and lawful
agent(s) and attorney(ies)-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, UNDERTAKINGS, and
RECOGNIZANCES, excluding, however, any bond(s) or undertaking(s) guaranteeing the payment of notes and interest thereon.
And the execution of such bonds or undertakings in pursuance of these presents, shall be as binding upon said Company, as fully and amply, to all intents and purposes, as if
they had been duly executed and acknowledged by the regularly elected officers of said Company at their administrative offices in Keene, New Hampshire, in their own proper
persons. The authority granted hereunder supersedes any previous authority heretofore granted the above named attorney(im)-in-fact.
In WITNESS WHEREOF, the undersigned officer of the said The Ohio Casualty Insurance Company has hereunto subscribed his name and affixed the Corporate Seal of
said Company this 26th day of September, 2016.
VtY INS[,qq
i ?p0.POggjYy�
0�1919Wp __ 4�Z17' �-
��y1 A*Pe ddaa David M. Carey, Assistant Secretary
STATE OF PENNSYLVANIA
COUNTY OF MONTGOMERY
On this 26th day of September, 2016 before the subscriber, a Notary Public of the State of Pennsylvania, in and for the County of Montgomery, duly commissioned and qualified,
came David M. Carey, Assistant Secretary of The Ohio Casualty Insurance Company, to me personally known to be the individual and officer described in, and who executed the
preceding instrument, and he acknowledged the execution of the same, and being by me duly sworn deposes and says that he is the officer of the Company aforesaid, and that the
seal affixed to the preceding instrument is the Corporate Seal of said Company, and the said Corporate Seal and his signature as officer were duly affixed and subscribed to the said
instrument by the authority and direction of the said Corporation.
IN TESTIMONY WHEREOF, I have hereunto set my hand and affixed my Official Seal at the City of King of Prussia, State of Pennsylvania, the day and year first above
written.
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COMMONWEALTH OF PENNSYLVANIA
seal
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Teresa la,, Notary Public
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IlpDer Merlon aTwpwIefl Twp., Montgomery County
My Commission Expires March 28,2017
Notary Public in and for County of Montgomery, State of Pennsylvania
Member. Peon
My Commission expires March 28, 2017
This power of attorney is granted under and by authority of Article IV, Section 12 of the By -Laws of The Ohio Casualty Insurance Company, extracts from which read:
ARTICLE IV - Officers: Section 12. Power of Attorney.
Any officer or other official of the Corporation authorized for that purpose in writing by the Chairman or the President, and subject to such limitation as the Chairman or President
may prescribe, shall appoint such attorneys -in -fact, as may be necessary to act in behalf of the Corporation to make, execute, seal, acknowledge and deliver as surety any and all
undertakings, bond, recognizances and other surety obligations. Such attorneys -in -fact, subject to the limitations set forth in their respective 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 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 power or authority.
This certificate and the above power of attorney may be signed by facsimile or mechanically reproduced signatures under and by authority of the following vote of the board of
directors of The Ohio Casualty Insurance Company effective on the 15th day of February, 2011:
VOTED that the 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.
CERTIFICATE
I , the undersigned Assistant Secretary of The Ohio Casualty Insurance Company, do hereby certify that the foregoing power of attorney, the referenced By -Laws of the Company
and the above resolution of their Board of Directors are true and Correa copies and are in full force and effect on this date.
IN WITNESS WHEREOF, I have hereunto set my hand and the seal of the Company this Sth
day of December 1 2016
VTY INSUp
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Renee C. Llewellyn, Assistant Secretary
1316COUNTY-CITY BUILDING
227 W JEFFERSON BOULEVARD
SOUTH BEND, IND} NA 46601- 1830
Date:
To:
From
Subject
Project Name:
Project No.:
PHONE 574235-9251
FLK 574 235-9171
TDD 57,t' 235-5567
CITY OF SOUTH BLND PETL BUTTIGIEG, MAYOR
BOARD OF PUBLIC WORKS
November 16, 2016
All Planholders
LindaM. Martin, Clerk, Board ofPublic Works
Addendum Number: 1
Calvert Street Lift Station Replacement
116-053
ACKNOWLEDGEMENT OF RECEIPT OF ADDENDUM
Date Received:
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
within 48 hours of receipt. A copy MUST also be included with your
bid package upon submittal.
THIS ADDENDUM MAY AFFECT YOUR BID.
Notes:
The attached documents are hereby added to the Specifications and Contract
Documents and become apart of herein.
Company:
Authorized Signature: 7-pz7ez
Date: /2/ y
13160'pUNTY-CITY BUILDING PHONE.
227 W. JEFFERSON BOHLEVARD U� \ %< C FAX
SOUTH BEND, INDIANA46601-1830 TDD
CITY OF SOUTH BEND FETE BUTTIGIEG, MAYOR
BOARD OF PUBLIC WORKS
Date:
To:
From
Subject
Project Name:
Project No.:
November 30, 2016
All Planholders
Linda M. Martin, Clerk, Board of Public Works
Addendum Number:2
574/235 -9251
574, 235-9171
574/235-5567
Cahert Street Lift Station Replacement
116-053 --
ACKNOWLEDGEMENT OF RECEIPT OF ADDENDUM
Date Received:
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
within 48 hours of receipt. A copy MUST also be included with your
bid package upon submittal.
THIS ADDENDUM MAY AFFECT YOUR BID.
Notes:
The attached documents are hereby added to the Specifications and Contract
Documents and become a part of herein.
Company:
Authorized Signature:
Date:
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