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Home My WebLink AboutQuote Opening - 2016 Bus Shelters - Ziolkowski Construction, Inc.s soara eF o tia CITY OF SOUTH BEND, INDIANA CONTRACTOR'S QUOTE FOR PUBLIC WORK 1865 PROJECT NAME: 2016 Bus Shelters PROJECT NO. 116-046 QUOTES DUE December 13, 2016 by 9:30 am local time (Must be completed for all quotes. Please type or print) Date: December 13, 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: 2016 Bus Shelters 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 6/30/15 1 for the sum of (enter the Total Quote as shown on the Proposal) shown on ($ 188 000 00 ) (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. By JC / � (Signature) Bill Favors President (Printed Name of Person Signing) ACCEPTANCE The above quote is accepted this day of Subject to the following conditions: BOARD OF PUBLIC WORKS Gary A. Gilot, President Elizabeth A. Maradik, Member James A. Mueller, Member Suzanna M. Fritzberg, Member Therese J. Dorau, Member Attest: Linda M. Martin, Clerk 20 Version 10/18/2016 Page - 8 Public Works Quote When the prospective Contractor is unable to certify to any of the statements belon,, 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) STATE OF Indiana ) St Joseph ) SS: COUNTY } The undersigned Contractor, being duly sworn upon his/her/its oath, affinns 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 - 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 13th day ofDecembero 2016 Subscribed and sworn to before me this 13th My Commission Expires March 1, 2020 County of Residence Ziolkowski Construction, Inc. Contractor/Bidder (Firm) J� Signature of Contractor/Bidder or Its Agent Bill Favors, President Printed Name and Title - day of December 2Q16 p Notary Public Shannon Reidenbach St Joseph SHANNON REIDENBACH Notary Public- Seal State of Indiana My Commission Expires Mar 1, 2020 Version 10/18/2016 Page - 11 Public Works Quote O450l TH Bury QUOTE/PROPOSAL W , CITY OF SOUTH BEND 1865 PROJECT NAME 2016 Bus Shelters PROJECT NO. 116-046 QUOTES DUE December 13, 2016 by 9:30 am local time Base Quote 1 ........ Mobilization and Demobilization WUMILny 1 unit LS Unit Price 6,000.00 $ Total Amount 6,000.00 2 Maintenance of Traffic Allowance 2,000 DOL $1.00 $ 2,000.00 3 Excavation Allowance 4,000 DOL $1.00 $ 4,000.00 2 Bus Shelter Furnishing and Installation g EACH 14,400.00 $ 129,600.00 3 Concrete Pad, 4-inch 180 SYS 152.78 $ 27,500.00 Total Amount Quote $ 169,100.00 Alternate A •�• uescnption Quantity it Unit Price Total Amount 1 Mobilization and Demobilization 1 LS $ 1,100.00 1,100.00 2 Bus Shelter Furnishing and Installation 1 EACH 14400. $ 14,400.00 3 Concrete Pad, 4-inch 20 SYS 170.00 $ 3,400.00 Total Amount of Alternate A $ 18,900.00 *Proposal fakes exception o completig date of 120 days due to the lead time for the bus shelters of 10 12 weeks a er approved shop drawings Firm: Ziolkowski Construction, Inc. Address: 4050 Ralph Jones Drive City/State/Zip: South Bend, IN 46628 Telephone Number: ( 574) 287-1811 Fax Number: ( 574) 287-1811 ByLG� (Signature) Bill Favors, President (Printed Name of Person Signing) Version 10/18/2016 Page - 12 Public Works Quote E-Veri 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 i 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 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 833-464-4218. Employer Ziolkowski Construction, Inc. ill Favors Name (Please Type or Print) Electronically Signed itle 101/10/2012 Signature Date Department of Homeland Security — Verification Division SCI5 Verification Division Name (Please Type or Print) Electronically Signed itle 111012012 Signature Date Information Required for the E-Verify Program Information relating to your Company: Company Name: iolkowski Construction, Inc. Company Facili Address: 050 Ralph Jones Dr. South Bend, IN 46628 Company Alternate Address: County or Parish: 3TJOSEPH Employer Identification Number: 1351445992 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 far: 1 Are you verifying for more than 1 site? If yes, please provide the number of sites verified for in each State: INDUNA 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@zbuild.com Page 13 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 - erify Employment Eligibility Verification Click any i() for help Home My Cases New Case View Cases Search Cases My Profile Edit Profile Change Password Change Security Questions My Company Edit Company Profile Add New User View Existing Users Close Company Account My Reports View Reports My Resources View Essential Resources Take Tutorial View User Manual Share Ideas Contact Us Welcome DserlD LasLLogln James K.Idsen 1234 PM- 06/20/2016 Log Out Company Information Company Name: Ziolkowski Construction, Inc Company ID Number: 486671 Doing Business As (DBA) Name: DUNS Number: Physical Location: Address 1: 4050 Ralph Jones Dr Address 2: City: South Bend State: IN Zip Code: 46628 County: STJOSEPH Additional Information: Employer Identification Number: 351445992 Total Number of Employees: 100 to 499 Parent Organization: Administrator: Organization Designation: Employer Category: None of these categories apply Mailing Address Address 1: Address 2: City: State: Zip Code: View /Edit NAICS Corte: 236 - CONSTRUCTION OF BUILDINGS View/ Edit Total Hiring Sites: 1 View /Edit Total Points of Contact•. 1 View/ Edit View MOU U.S.Dapartment of Homeland Security -weW, chs.gov LLS. 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