HomeMy WebLinkAboutQuote Opening - Emergency Sewer Lining Notre Dame Avenue Project No. 116-139 - Insituform Technologies USA, LLCCITY OF SOUTH BEND, INDIANA
CONTRACTOR'S QUOTE FOR PUBLIC WORK
PROJECT NAME:
PROJECT NO.
QUOTES DUE
(Must be completed for all quotes. Please type or print)
Date: December 13, 2016 Firm: Insituform Technologies USA, LLC
Address: 17988 Edison Avenue
City/State/Zip: Chesterfield, MO 63005 Telephone Number: ( 636 ) 530-8000
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:
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 1 Z i?-16 I for the sum of (enter the Total Quote as shown on the Proposal)
' Ti ftuf 7{W94-&M 7A964F /%eJ0.eE0 7-04 a ��.'S ($ P--54 ,.jO )
(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.
By
(Signature)
Jana Lause, Contracting &Attesting Officer
(Printed Name of Person Signing)
ACCEPTANCE
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
day of
Suzanna M. Fritzberg, Member
Therese J. Dorau, Member
Attest: Linda M. Martin, Clerk
20
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Page -15
Public Works Quote
Mien the prospective Contractor is unable to certify to any of the statements below, it shall attack 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 MISSOURI )
) SS:
ST. LOUIS 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 fiom 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
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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
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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 13 day of December 20 16
Insituform Technologies USA, LLC
ContxactorBidd, r�
Si , ature of Contractor/Bidder or Its Agent
Jana Lause, Contracting & Attesting Officer
Printed Name and Title
Subscribed and sworn to before me this 13 day of December 20 16
My Commission Expires NOV l %, U1 P
Notary` Public
County of Residence
'. 'S,LlJJ.
K, Jasrr-r�
Notary Fublic - fdatecy Sea!
STAT[ GF P.9lSSGURI
St. Charles Cot!nty
fvj 1y Commission Etpires:i7, 2010
CumrNs;ian 8 7 ^Sf95na
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QUOTE/PROPOSAL
CITY OF SOUTH BEND
"ou Tile
of to ;
aL: ,
1865
PROJECT NAME
Emergency Sewer Lining — Notre Dame Avenue
PROJECT NO.
116-139
QUOTES DUE
December 13, 2016 at 9:30 am local time
Item
No.
Description
Quantity
Unit
Unit Price
Total Amount
CURE -IN -PLACE (CIPP) 15 inch
1
SEWER LINING 1100 Block of
1
Lump
$ 2s; 3/o.3D
Notre Dame Avenue -Complete
Sum
up
i
Total Amount of Quote
$ Z� 310.1 D
Firm: Insituform Technologies USA, LLC
Address: 17988 Edison Avenue
City/State/Zip:
Chesterfield, MO 63005 Telephone Number: 636) 530-8000
Fax Number: ( 636) 530-8701
BY
(Signature)
Jana Lause, Contracting & Attesting Officer
(Printed Name of Person Signing)
Version 10/18/2016 Page - 19 Public Works Quote
INSITUFORM TECHNOLOGIES USA, LLC
Assistant Secretary's Certificate
The undersigned, being the Assistant Secretary of Insituform Technologies USA, LLC, a
Delaware limited liability company (the "Company"), hereby certifies that:
1. The following individuals have been appointed by the Board of Managers to serve in the
office of the Company set opposite their respective names:
Name
H. Douglas Thomas
Debra Jasper
Jana Lause
Whittney Schulte
Office
Vice President
Assistant Secretary
Assistant Secretary
Assistant Secretary
2. The following is a true and correct excerpt from the Limited Liability Company Agreement
of the Company:
Appointment by the President. The president of the Company may from time to time
appoint officers of the Company's operating divisions, and such contracting and
attesting officers of the Company as the President may deem proper, who shall have
such authority, subject to the control of the Board of Managers, as the President may
from time to time prescribe.
The President of the Company has, pursuant to the above authority, duly appointed Debra
Jasper, Jana Lause, Ursula Youngblood, Diane Partridge, Laura M. Andreski and Wlrittney
Schulte as Contracting and Attesting Officers of the Company. Each of the foregoing have
been fully authorized and empowered by the President of the Company (i) to certify and to
attest the signature of any officer of the Company, (ii) to enter into and to bind the Company
to perform pipeline rehabilitation activities of the Company and all matters related thereto,
including the maintenance of one or more offices and facilities of the Company, (iii) to
execute and to deliver documents on behalf of the Company, and (iv) to take such other
action as is or may be necessary and appropriate to carry out the project, activities and work
of the Company.
IN WITNESS WHEREOF, I have hereunto affixed my name as Assistant Secretary this 23rd day
of October, 2015.
INSITUUFQORM TECHNOLOGIES USA, LLC
�
ByI � i"-V�
Daniel P. Schoenekase
Assistant Secretary
State of Indiana
Office of the Secretary of State
APPLICATION FOR AMENDED CERTIFICATE OF AUTHORITY
of
INSITUFORM TECHNOLOGIES USA, INC.
1, CHARLES P. WHITE, Secretary of State of Indiana, hereby certify that Application for
Amended Certificate of Authority of the above Delaware Foreign Limited Liability Company
(LLC) has been presented to me at my office, accompanied by the fees prescribed by law and
that the documentation presented conforms to law as prescribed by the provisions of the
Indiana Business Flexibility Act.
The name following said transaction will be:
INSITUFORM TECHNOLOGIES USA, LLC
NOW, THEREFORE, with this document I certify that said transaction will become effective
Wednesday, January 25, 2012.
In Witness Whereof, I have caused to be
affixed my signature and the seal of the
State of Indiana, at the City of Indianapolis,
January 25, 2012.
CHARLES P. WHITE,
SECRETARY OF STATE
1998081113l2012012769077
APPLICATION FOR AMENDED CERTIFICATE OF AUTHORITY
State Fonn 39034 (R9 / 2.11) Copaleie Fonn tb. 115
Approved by the State Board of Accounle, 2007
NOTE An Original CadiBcate of Erlstence dulyauthenticated by the Amps, authority from the corporation's
domicltiary state within the last sixty (60) days must be submitted with this application.
INSTRUCTIONS: 1. Use 8 TJ2'x 11'whHe paparfor attachments.
2. Present orrprial and one copy to address In uppernght comerof this form.
3. Please TYPEorPRINT.
4. Please Visit our office on the web at w..sas.tn.00y.
=W�4*q�hS�,
S P. WHRE
Y OF STATE
RVICES OMSION
n Soaet, Room E013Indiana 462M317) 232• 8576
Indiana Code 23-1.49-4, 23-17-264
Filing Fee: $ 30.00
Make check or money order
payable to Secretary of Sfato
APPLICATIN F
AMENDED CERTIFICATE AUTHORITY
OF
F,4r
INSITUFORM TECHNOLOGIES USA, INC.
Name dCnryoralion � :
�c �J
Xpss—
A FOREIGN CORPORATION ADMITTED TO ='iA S
TRANSACT BUSINESS IN INDIANA iND, SeGRM
c_
The undersigned officers oflnsduPoml Technologies USA, Inc.
(hereinafterrerened to as the "COrporation7, which exists pursuant to the provisions of the laws of Delawareas
amended, desire to obtain an Amended Certificate of Authority. _... tc• ``
1. The above Corporation received a Certificate of Authority to transact business in the State of Indiana on the 78th
day of August 20 199B
` 2. The Corporation desires to change its corporate name in Indiana as follows:
Insitufomt Technologies USA, LLC
3. The Corporation has changed the period of Its duration from
to
4. The Corporation has changed the state or country of Its incorporation from
to
5. The Corporation has converted the enfity type to a Limited Liability Company
In Witness Whereof, the undersigned, being the Senior Vice President of said
rua
Corporation executes this Application for Amended Certificate of Authority and verifies, subject to penaltles of perjury, that the
statements contained herein are true, this �i day Of January 20 12 i
Signature
Printed name
David F, Moms
Delaware
Ire First State
PAGE 1
I, JEFFREY W. BULLOCK, SECRETARY OF STATE OF THE STATE OF
DELAWARE DO HEREBY CERTIFY THAT THE CERTIFICATE OF CONVERSION OF
A DELAWARE CORPORATION "INSITUFORM TECHNOLOGIES USA, INC." TO A
DELAWARE LIMITED LIABILITY COMPANY OF "INSITUFORM TECHNOLOGIES
USA, LLC", WAS FILED IN THIS OFFICE ON THE THIRTIETH DAY OF
DECEMBER, A.D. 2011, AT 11:35 O'CLOCK A.M.
AND I DO HEREBY FURTHER CERTIFY THAT THE EFFECTIVE DATE OF
THE AFORESAID CERTIFICATE OF CONVERSION IS THE THIRTY-FIRST DAY
OF DECEMBER, A.D. 2011, AT I1:58 O'CLOCK P.M.
2024080 8317
120074038
You may verify this certificate online
at Corp. delavare.gov/autkver.sb m2
1G!SQ�
Jeffrey W. Bullock, Secretary of State
AUTHEN TION: 9313330
DATE: 01-23-12
Delaware
the First State
PAGE 1
I, JEFF,REY W. BULLOCK, SECRETARY OF STATE OF THE STATE OF
DELAWARE, DO HEREBY CERTIFY "INSITUFORM TECHNOLOGIES USA, LLC"
IS DULY FORMED UNDER THE LAWS OF THE STATE OF DELAWARE AND IS IN
GOOD STANDING AND HAS A LEGAL EXISTENCE SO FAR AS THE RECORDS OF
THIS OFFICE SHOW, AS OF THE EIGHTEENTH DAY OF JANUARY, A-D.
2012.
AND I DO HEREBY FURTHER CERTIFY THAT THE SAID "INSITUFORM
TECHNOLOGIES USA, LLC" WAS FORMED ON THE TWENTY-SECOND DAY OF
DECEMBER, A.D. 1983.
AND I DO HEREBY FURTHER CERTIFY THAT THE ANNUAL TAXES HAVE
BEEN PAID TO DATE.
J,
2024080 8300
120059761
You may verify this certificate online
at corp.delaware. gov/authvsr. ahtml
Jeffrey W Bullock, Secretary of State
AUTHEN' C TION: 9304231
DATE: 01-18-12