HomeMy WebLinkAboutAgreement - Northeast Neighborhood Revitalization Organization, Inc. - Agreement for Programs & ServicesAGREEMENT FOR PROGRAMS AND SERVICES WITH
NORTHEAST NEIGHBORHOOD
REVITALIZATION ORGANIZATION, INC.
(PROGRAMS AND SERVICES)
THIS AGREEMENT (the or this "Agreement") is made effective the ' day
ofgu PXYI l 2016, by and between the CITY OF SOUTH BEND,
INDIANA, a municipal corporation organized and operating under the laws of the State of
Indiana, acting by and through its Board of Public Works (collectively the "City") and
NORTHEAST NEIGHBORHOOD REVITALIZATION ORGANIZATION, INC.
(the "Organization").
RECITALS
WHEREAS, the City is empowered under the authority of Ordinance No. 10197-
12 adopted by the South Bend Common Council, the legislative body of the City, pursuant
to Indiana Code § 36-1-3-6(b)(1) to enter into this Agreement; and
WHEREAS, the City finds that the area commonly described as the Northeast
Neighborhood and depicted at Appendix I (the "Neighborhood") is a neighborhood
consisting of a significant number of low and moderate income individuals and families
and is at risk of developing the conditions set forth at Indiana Code § 36-7-1-3 without
additional services being provided in the Neighborhood; and
WHEREAS, the Organization is an Indiana non-profit corporation, with the
purpose of the social, physical and economic revitalization of the Northeast Neighborhood
in South Bend, Indiana; and
WHEREAS, the Organization has represented that it is a duly existing non-profit
corporation under Indiana law and exempt from federal income taxation under Section
501(c)(3) of the Internal Revenue Code, as evidenced by the copy of the Indiana Secretary
of State's Certificate of Existence for the Organization and the copy of its Tax -exemption
Letter issued by the Internal Revenue Service, respectively attached as Appendix II and
Appendix III; and
WHEREAS, the City desires to provide for certain services and programs to be
provided to the residents of the City, including residents of the Neighborhood, which
services and programs are more particularly described at Exhibit A (collectively, the
"Program"); and
WHEREAS, the Organization is duly qualified to provide for, oversee and
administer the Program; and
WHEREAS, the City has appropriated funds for the Program in the amount of
Seventy Five Thousand and 00/100 Dollars ($75,000.00) (the "Contract Amount") as
required by Indiana Code § 5-22-17-3 and the Contract Amount does not exceed such
appropriation; and
WHEREAS, the City believes that the actions contemplated by this Agreement are
in the best interests of the health, safety and welfare of the City and its residents and that
such actions comply with the public purposes and applicable provisions of state and local
law.
NOW THEREFORE, for and in consideration of the mutual covenants and
promises contained herein, the City and the Organization hereby agree as follows:
1. ContractAmount and Term. The Organization shall provide the programs
and services set forth at Exhibit A (the "Program") on behalf of the City, for the Contract
Amount for the period commencing January 1, 2017 and ending December 31, 2017. The
approved schedule for the Program is set forth at Exhibit B. The Organization shall submit
quarterly reports to the Contract Administrator on March 31, June 30, September 30 and
December 31 showing the progress of the Program.
2. Program Budget and Budget Modification. The approved Program Budget
is set forth at Exhibit C hereto (the `Budget'), which exhibit is hereby incorporated herein
by reference. The Organization shall not seek from the City more than the Contract
Amount for any expenses related to the Project or otherwise. The Organization shall only
use the Contract Amount to implement the Project or provide the services in conformance
with the Budget and for no other purpose.
3. Compensation Lor Program. All payments shall be made quarterly (on or
approximately near March 31, June 30, September 30 and December 31) for expenses
incurred during that quarter provided that the Organization provides an invoice and
sufficient evidence to the Contract Administrator (as defined herein) for such expenses
(including amounts allocated to staff time and expenses) including, but not limited to, a
budget expenditure report summarizing disbursements and expenditures of the Contract
Amount by the line items set forth in the Program Budget. The quarterly payments shall
be paid in equal amounts unless the Contract Administrator determines that the
Organization is materially failing to complete the Program in accordance with the Program
Schedule, in which case the City shall only be obligated to pay the applicable portion of
the Contract Amount substantiated by reliable evidence submitted by the Organization.
With any invoice for services required for payment hereunder, the Organization shall
submit a report to the Contract Administrator showing the progress of the Program. The
report shall provide an overview of the work of the Organization in progress and/or
completed in the Neighborhood including, but not limited to, the Program as outlined in
Exhibit A during the Program Schedule (Exhibit B).
2
4. Design and Implementation of Program. To the extent not set forth in
Exhibit A, Exhibit B and Exhibit C, the Organization shall be solely responsible for the
design and implementation of the Program, unless specifically directed otherwise by the
City, the City's Internal Auditor (as defined herein), or the Director of Neighborhood
Engagement or any person appointed by said Director or the City to administer this
Agreement (the "Contract Administrator"). The Program and this Agreement must be
performed and administered in accordance with all applicable federal, state and local laws.
The Organization shall use the Contract Amount only for activities related to the Program.
The Organization shall further enter into a written agreement documenting the
disbursement of funds attributable to the Contract Amount.
S. Termination of Agreement, If the City Controller makes a written
determination that funds are not appropriated or are otherwise unavailable to support the
continuation of this Agreement, it shall be cancelled. A determination by the City
Controller that funds are not appropriated or are otherwise unavailable to support the
continuation of performance shall be final and conclusive. Effective thirty (30) days after
delivery of a written termination notice, the City may terminate this Agreement, in whole
or in part, for any reason, if the City determines that such termination is in the best interest
of the City., The Organization shall be compensated for completion of the Program
properly done prior to the effective date of termination. The City will not be liable for
work on the Program performed after the effective date of termination. In no case shall
total payment made to the Organization exceed the original Contract Amount.
6. Remedies for Breach of Contract. Failure to complete the Program in
accordance with this Agreement may be considered a material breach, and shall entitle the
City to impose sanctions against the Organization including, but not limited to, suspension
of all payments, and/or suspension of the Organization's involvement in the Program, on
behalf of the City. The Organization shall repay any portion of the Contract Amount
expended for matters not within the scope of the Program or the Budget.
7. Maintenance of Records Access to Records. The Organization shall keep
a written record, in a form acceptable to the City, related to the use and expenditure of the
Contract Amount. Within thirty (30) days of the expiration or termination of this
Agreement, the Organization shall provide the City with a final accounting of the use and
disposition of the Contract Amount by the Organization. Unless otherwise authorized by
the City or required by law, such records shall be maintained by the Organization for a
period of four (4) years of the date of this Agreement. The Organization understands and
agrees to comply with the legal requirements of Indiana Code § 5-14-3-1 et seq.
(commonly known as Indiana's Access to Public Records Act), if applicable, with respect
to all documentation related to the Contract Amount.
8. Audit Requirements. The Organization agrees to make all information
available to the Indiana State Board of Accounts, the City's Internal Auditor, and the
Contract Administrator as requested to comply with any audit requested related to the
receipt and use of the Contract Amount and the Organization's performance in delivering
the Program in accordance with the provisions of this Agreement. If requested by the City
91
or the Contract Administrator, the Organization shall provide the City a progress report on
the Program. If requested by the City or the City's Internal Auditor, the Organization shall
arrange for a financial and compliance audit of the Contract Amount to be conducted by
an independent public or certified public accountant (or as applicable, the Indiana State
Board of Accounts) and in accordance with applicable Indiana State Board of Accounts
standards. The City's Internal Auditor shall mean the City Controller or Acting City
Controller appointed pursuant to Indiana Code § 36-4-9-6 (the "City Controller") or any
person appointed or retained by the City Controller or the City for the purpose of auditing
the Organization for this Agreement or other agreements of the City.
9. Conflicts of Interest. The Organization hereby certifies and agrees that no
member, officer, or employee of the City, or its designees or agents, and no member of the
governing body of the City of South Bend or the Organization (and no one with whom
there is a family or business tie) who exercises any functions or responsibilities with respect
to the receipt. and use of city funds during his or her tenure or for one year thereafter, shall
have any financial benefit, direct or indirect, in any contract or subcontract, or the proceeds
thereof, for work to be performed in connection with the Program. To the extent the
Program involves the awarding of a contract or grant, the Organization shall not award the
same to a person or entity that creates a conflict of interest described in Indiana Code § 5-
16-11-5.5.
10. Relationship. The Organization shall at all times be an independent
contractor for the performance of the Program rather than an employee of the City, and no
act, action or omission to act by the Organization shall in any way bind or obligate the City.
This Agreement is strictly for the benefit of the parties and not for any third -party or person.
This Agreement was negotiated by the parties at arm's length and each of the parties hereto
has reviewed the Agreement after the opportunity to consult with independent legal
counsel. Neither party shall maintain that the language in the Agreement shall be construed
against any signatory hereto. The City and the Organization hereby renounce the existence
of any form of agency relationship, joint venture or partnership between the Organization
and the City and agree that nothing contained herein or in any document executed in
connection herewith shall be construed as creating any such relationship between the City
and the Organization.
11. Notices. Any notice required or permitted to be delivered hereunder shall
be deemed to be delivered, whether or not actually received, when deposited in the United
States Postal Service, postage prepaid, registered or certified mail, return receipt requested,
addressed to the City or the Organization, as the case may be, at the address set forth below.
Organization: City:
Northeast Neighborhood Pamela C. Meyer
Revitalization Organization, Inc. Department of Community Investment
c/o South Bend Heritage Foundation City of South Bend, Indiana
803 Lincolnway West 227 W. Jefferson Boulevard, Suite 1400S
South Bend, IN 46616 South Bend, IN 46601
Attention: Marco Mariani
4
12. Equal Opportunity. The Organization shall comply with federal, state and
local laws in its hiring and employment practices and policies for any activity covered by
this Agreement.
13. Entire Agreement and Amendment. This Agreement sets forth the entire
agreement and understanding between the parties as to the subject matter hereof, and
merges and supersedes all prior discussions, agreements, and understanding of any and
every nature between them. This Agreement may be amended only by separate writing,
approved by both the Organization and the City.
14. Additional Representations. The undersigned persons executing and
delivering this Agreement on behalf of the Organization represent and certify that they are
the duly authorized officers of the Organization and have been fully empowered to execute
and deliver this Agreement and that all necessary corporate action has been taken and done.
15. Non -Collusion and Acceptance. The Organization hereby represents and
certifies that it may enter into this agreement under Indiana Code § 35-44-1 and, to the
extent applicable, has executed and filed with the City a "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", the form of which is attached hereto and incorporated herein
as Appendix IV prior to the City's approval of this Agreement.
(remainder ofpage intentionally left blank)
G
IN WITNESS WHEREOF, the Parties hereto have caused this Agreement to be
executed as of the day and year first above written.
CITY OF SOUTH BEND, INDIANA
BOARD OF PUBLIC WORKS
Date: / -,)- / 2 -2- 2016
Gary A. Gilotv
Suzanna M. Fritzberg
Elizabeth A. Maradik
Therese J. DoWu
14 7-"�
J es A. Mueller
ATTEST:
ll i�� r,.��GLA-�c-r�-
i da M. Martin
NORTHEAST NEIGHBORHOOD
REVITALIZATION ORGANIZATION,
INC.
EXHIBIT A
Program Description
The Organization shall preserve and revitalize the northeast neighborhood by
providing the following services and programs:
1. Develop and execute an annual development plan for encouraging private
sector investment.
Evaluate existing infrastructure in the neighborhood with neighborhood input
and provide a recommendation to the City for requested infrastructure
improvements, including improvements to Eddy St. (between Campeau and
Colfax).
Design, develop and implement the following activities or programs provided
that the Organization implements such activities in a manner that is acceptable
to the Contract Administrator.
General Operations
Eddy Street Commons Partnership
Triangle Residential Development
St. Joseph High School area planning
University coordination and partnerships
Support of market -rate housing development
Support of low -moderate income housing development
4. Upon the written request of the City, participate in miscellaneous City
initiated revitalization projects or programs, including acting as an acquisition
agent to secure options for the City for properties in or near the Neighborhood
in accordance with any guidelines provided by the City.
5. Update the neighborhood plan as needed and implement efforts as requested
by the City.
6. Provide semi-annual reports to the Department of Community Investment
regarding any upcoming Neighborhood initiatives or events and
recommendations on how the Department could coordinate its efforts with the
upcoming initiatives or events.
7. Promote activities within Northeast Neighborhood sponsored or encouraged
by the City, including but not limited to the Northeast Neighborhood Council
efforts, through the best medium, whether print, electronic media, signage or
otherwise.
EXHIBIT B
Program Schedule
The Organization shall preserve and revitalize the northeast neighborhood by providing the
Program as described in Exhibit A during the period of January 1, 2017 — December 31, 2017.
EXHIBIT C
Program Budget
Total Cost for Programs and Services $75,000.00
APPENDIXI
Depiction of Northeast Neighborhood
NorCheaot Neighborhood Development Area
Legend
NNDATIF District
— NNDA Streets
ajor Streets
Przpu[A 0Y
J ....
N nnn[�x
cneiu rt [t
Chy N0e.t ft9e'j.wnl.Ill
F[lru,ry122008.
APPENDIX II
Certificate of Existence
(issued within last 60 days evidencing that the Organization is in good standing)
State of Indiana
Office of the Secretary of State
CERTIFICATE OF EXISTENCE
To Whom These Presents Come, Greeting:
I, CONNIE LAWSON, Secretary of State of Indiana, do hereby certify that I am, by virtue of the laws of
the State of Indiana, the custodian of the corporate records and the proper official to execute this
certificate.
I further certify that records of this office disclose that
NORTHEAST NEIGHBORHOOD REVITALIZATION ORGANIZATION, INC.
duly filed the requisite documents to commence business activities under the laws of the State of
Indiana on August 24, 2000, and was in existence or authorized to transact business in the State of
Indiana on November 28, 2016.
I further certifiy this Domestic Nonprofit Corporation has filed its most recent report required by
Indiana law with the Secretary of State, or is not yet required to file such report, and that no notice of
withdrawal, dissolution, or expiration has been filed or taken place.
In Witness Whereof, I have caused to be affixed my
signature and the seal of the State of Indiana, at the City
of Indianapolis, November 28, 2016
CONNIE LAWSON
SECRETARY OF STATE
2000091100259 / 2016158989
Verify this certificate:https://bsd.sos.in.gov/ValidateCertificate
APPENDIX III
P, 0'.. BOX 2508
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PO BOX 300 2-10 6 IffCMaga SPT
SOUTH: PbWP; tO 4it04"
Dear
'R,mpk Ayer TdeotlficaUQ4 Nuuib=;
X7053011=LX031
adlitaA teroont
C! - altAat
677i azq=jr soo
jkccoantlug Periqd
Advakic* Ruling period 13 e6r�j*,,.
WgUat 24', 2006 ,
AdVenqg RnJ4ng Paxlca Ea,.,
)3asod on Anfo#uktiqn you 6nipplied, ana assuming your operations will be aq
Eitate'd In pout gj�plicdti6a for recognition :bf qxOp'piti6n, 'we, have -63tek-.Pd yon
k�
ATO from. f��'aera'inUdMe ta
x uxkgor -A6ction 501 (a) of the zrjto4i,Rvenns
code as an orgahizaUon deGcV0f;4 An reatioa 501(c)(3).
npoaiifje YQAaxa A newly created 9xqanizabion, we axa. not now making afii final detaxmation of your. T6unaaBoxi ao:atp . u. unc.Iqr aedt;iqia 50. Cja
we have, datdjadiidd that You can xaai4&nably expect to 'bm 't pubjiqly
anppo;ofed orgah-ia4tion *�,ftacxihed in sec4ovo 5L9(a) Mi and ild N
Ai,quxa3ng7.y, auking an advance ruling
p,-xIb4 you will be txeatiad ;ag qL
puPic.1y Nuppoxted owyanUataon, and not as a pw..vake' =a advance
raling perlod beaiaa afid endson tba.datiasi -ahloim �.ahovd,
Wth'An 90 days, qLft:0k the 6XUd of y6ut advance ruling period, ybi. ygIst
send no -IMe information beaded -to det:e=i ne whether you 44yo tpqt 'the
'nif yp�
:that� ts -0� 6�you
"0, clsaai4
section
5 continue
1� r
11' au�vlrt ra iao it y,,� as 1 PIC, asaify
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your beginning
date x
49rantO3?d ana-.a6ntrjhUbOra may rely on onr d OteXpinablon, that you are not :d.
Your advance raing pq#icsai
privatefmp�&Uon until.90 days sfidr I;h 9 P.
Xf yk7u Head Us thd rdqbii�ed info;. !on within tlie bo days, dxAnt6ia ap4
469tKibUPI�ra may. q0nbioVe to .rely On tb:'Ei ad,),Akc6 Avt6imixlatica:( until wbE make
UBC Arr. U45 (Wlqqi
11
-2-
NORTHEAST IMIGRHORHOOD
a final deter pi3nation'of your foundation status
If spa .publish a noE!Qe iu the Igteknal Revenue Hu3letifx at •ting that we
W.41.W6 longer Crdat you as :a publiciy supported crgaxijgaat�.ba, grautoxa aneY
contributoPa stay not rely orn this :detexminatloh .ik�ter tee .date fire pub`.kieh tba
notice. Ta additlob, "ir you lope your iYdtup as a paucly suiiporked organi
nation, and a grantbr'ar conCiHhutor was xenpona3ble'for, or was aware of, the
act or failure to act, that .resulbad in your loss of auch status, that pesos.
may not rely on this determivatiari from the data of the act or Eailliwe to apt:
Also, if a grantor or "gpntxlbutpr lea as that we had"giiren notdk'ce that you
would be reipoVdd.from elaAaification as 4 publicly supported 'oxgaiU zgtion, them
that person may not rely on this dcteimination as of the date he or'9he
acqui=4ouch knowledge:
Xf you change your adu*ms of Support., your ,purposes, character, or m p a
of operatio4i, pleas@ let us know ao we can oonbider the ef$egt of the change .on
ybW auer.V.O statue an51 foundation status, If yv.G "aisand your ozgariizatioiral
document or byiaws, please send us a copy of "the ,amended" dooumecit or laylavra.
Alk let us icriocy all. oli uigea -in your mame. or a}d004 '
Am: pf'0anuaXg 1, 1984, you are }$.able £or eooial. Security "taxes under
the "Y'edzral Tnsurafice. Conks bi€biona Act on amouatm of $loo or"ruore you pay to
each of your etlipl.oyeea during a calendar year. You are Pot liable ;far the tax
imposed under the Federal tiriemp36ymeat Tax. Act ():.tA).
O.xij'aaizations that: are not private foundations are not subject to the pxi-
vate rounaation exeise. taxes under ah#pter 42 of the Xtexaal RSVenup Code.
However, you are not auko*gigally e4gvt; from other federal exnfse baxea, If
You have 'any giieati,one about .excise, employment, a'r." other fedora]; taxee, p]:eaae
let us know.
Donors may deduct'contriButions to you as..provided in Section l70 of the
Internal Revenue lode. 9equepte, legacies; devises, tranafera,'or gifts to you
er"tor your use are deduakillle for Federal estate and gift t43i puriroaes if they
meet the apPlidable provisions of sections 20SE, 2106, aiici zF'z2 of the gam;
Donora inay de"dddE pofttributiona to you only to the extent tbat their
'gpritributa.bns are ui ta, w.i.6h no consitleiwaca. iatglv'egz •'iigket pU„x°ch$ses, as(d
similar payment`s is amijunctior} with fundraising evenpS may not ;deoeaanrlly
Cif , . y as deiiuctible ijohtxihutions, depeuding on the cirqumSt,3;ioes. Revenue
Ruling 67-246, published in dumulatiVe Hialetiu 1967-2, otl.page 164, gi'kes
guideliues regarding Wiaes. m payers may deduct paymants,for admission to, or
other participa't"ion is, fondr`aia3ng activities £dr charitty.
'You are not xequir"ed to file "Form 49f7, Aetura of Oxganizatian k?cemph.From
2peaiab Tax, if your_yroaS ecel�ta each year are nbratally $25;Ooll or .lees,. 2f
you. receive a Norm 9A0, package in the mail., dimply aheaeli the label.".pkovided,
check .tbe lioX is Liza.heading to indicate that your auaU. gr-o..a.msseilita are
zioxmally $25,00,0 or lase, and aien'tlye"return_ #ooauea you will lie, treated as
a public charity,ios .return filing pnxposea during yourntC eire,aQvanae xuiing
period, you shopld"me Form 990 £oz each year iii::ypur advance ruling period
Letter- I,U45 (IHS om
El
-3-
NORTMW.2' mfoi BowaooD
that: you. exceed -the $25, 000 filing tbreshgld even if..your soureegt of support
do not ea6isf'y Y;ha p%a.support test specified in.tbe heading of this 7etfev,
z>c a return is required, it must be filed by the 16th day of 'tbe fifth
month after t)e and. of your annual aocoilating. period.. A p"eii:alty og $20 a Bay
is gharged irhma a return is lileii hate, auiiess tlxaYe is zflaeonab2O ca-20 da
hhe delay tidy ever-S th'e maximuor
m .penalty charged canquh.exceed $1a O* c
5 ercent 'Of gi1T r
p y gross receipts X6ic the year, whichever is Tess. Vos
ozgani!kAmons with gross rerzeilits exceeding $1, 000, 006 xn any yea:c, t$e penalty
is $1011 der day per.retux1r, unless there is r�aponahie cause #6-v :the delay -
Via igaxitnum.p enalty Pax an organizatid». w4tkh. grow Yege3,gte 'exaeedincr7 .
$1.;000;ndb sPiall not excegio 04)'PaU. This penalty fiat also be dha ,ii, if a
return is not complete, 9a, please be sure your .return is abmplete'beEaxe yot2
file it.
you are not zegiiixed to file £edowal i.neome. tax returns uxiiepn, you, are.
glah)6de to the tax on unrelated busifiegs income unz7er section 57.3 of the Cade.
ifyou aXe, subject to thin tail, you must file an income tax.: eOt oil idrni
'990IT., Nxempt Oryanizagian 4vOness Ynoome Tax Returia, In this letter -we are
not detezbifiing whethox any of your prespxit or.pro-voeed- aetivibiea are unre"
iate4 gads or'business as denied in section 513 of the Code;
Xon.. axe required to make your axiiiixal information return, Form 990 or
Norm qDb-R'Z" available fbr'publio inspection. far three 'pears after -ilia l4bet
Of the due, data .bf"the i kurn or the date the return is 'filed. You and also,
=x¢aii.yed to rake available.for-public inspection gazer sxemptign ap-p'licaeion,
.any anppprting do-Cumenta; aid''=your exemptiott l:. 'Copies <i£ bhene
docuweata are algo'rgqui.sed to be provided 6O any individual upon wtitten or in
pexsou Hquge t withadt 'charge othtoi than reasonable fees fo - ciipying and
pgstage. 'yqu may fulfill this requirement by placing these dtiaumenta "oxi the
iatertat. .penalkies may he imposed for >ai3nre to comply with Cli®se
rbgyizeu'ente. tdditional information is available.;in pablication 557,
Tax=hxempt .Status for Tolir Organization, or you may call our tall .free
alum Ix "shown shover
'you need an erriployer ide#tUieation number eveix if you Wage ng empl.oyama,
T£ an .smp5byer 15leritii.t%gai;,ion number was Act enaerad Qn ycux ap1�licatiian, pie
will aauigd a numbex to you and adviee yqu of it, 'Please usa t}iat an
all.. ratruras yaa his and 1xi all cozreepon`dence wifih. eke Iiit$rnal Revenue
service. ,
7.'h3s determination ie.baaed on,� evidence that your funds are dedicated to
the puipOaea 1_isted, ifi section S97-iCOdl ) �9) of the e; To .asa=a your abgtU41ed
exkeuptimci you Aouid keep vedorda to ghofd that Euu3d are spent only fi"ou tHase
purponea. if youh digtribube f it to :other or9anizatio411, )!odr recordsshould
show y)hether they axe exempt .und'ex seetion.501.fo)(3). In' eases whets the
recipient oxganizatIon.In not ekWVt under &ectl n ED7,(ej(3), you mast have
evidence tliae the funds will remain dm&cates to tfie requ3"red pusposea anii that
the recipient Will usp the .funds for, thooe purposed.
tf we saidba t4,A heading of this letter that an.addbndu+d 6ppi,ies, the
Letter 1945 06/OG)
-4-
NORTJMST Xzl,UnOIHOOD
aildendwci enclosed is i,tegrAj paxt of thAqs getter.
otitua and koun<?a.Ejioh otixtud, tould heap I's xesolve any (Plm�qt.ionm abutYOur exempt
alkould keep it .in Your perm;54411t racoxila, -
We haveS-At a CqPy of thin letfiEM to your raprOHontative aO ludJ04ted
in Yonr tower at attornG*Y,
If YPU have any question, please. contact the pornon Whose name and
telephone nnwbej7 are bhow* in th'e heckling .6f this letter,
Steven T. Miller
Ll
3.645 .(WICO)
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)
STATE OF '0 )
SS:
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.
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.
Non -Collusion Non -Debarment Affidavit Non Van Form 2016
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 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
S. 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
Non -Collusion Non -Debarment Affidavit Non Iran Form 2016
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). 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 under the penalties of perjury that the facts and information contained in the foregoing bid for
public works are true and correct.
Dated this 4Z day of -W* , 20 1('
Contractor/Bidde (Firm N WrIPA4L
Signature of C n ractor/Bidder or Its Agent
,Dkt7f�0�D �
Printed Name and Title
Subscribed and sworn to before me this— day of
My Commission Expires) ja 20 2-01'3
County of Residence
2b(4
Jessica K. Kitchens
Notary Public
SEAL
Elkhart County, State of Indiana
My Commission Expires November 20, 2023
Nan -Collusion Non -Debarment Affidavit Non Iran Form 2016 Commission No 673938
Date
Name
BOARD OF PUBLIC WORKS
AGENDA ITEM REVIEW REQUEST FORM
12/15/16
Lory Timmer
Department DC]
BPW Date 12/27/16 Phone Extension 5841
Re uirad Prior to Submittal fio Board
Legal ® Attorney Name Michael Schmidt
Controller ® Controller review is required for all Contracts $5,000.00 or more and
greater than one year in length per the City Purchasing Policy
Purchasing
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Agreement
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Contract ❑ Proposal ❑ Addendum
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Professional Services
Bid Opening
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Resolution
Bid Award ❑ Req. to Advertise ❑ Title Sheet
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Quote Opening
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Quote Award
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Change Order No.
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C/O & PCA No. ❑ PCA
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Ease/Encroach.
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Traffic Control
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Other: Amendment
Company or Vendor Name Northeast Neighborhood Kevitalization Vrganization, mc.
New Vendor ❑ Yes ® No ❑ If Yes, Approved by Purchasing
MBE/WBE Contractor ❑ MBE ❑ WBE
MBE/WBE Contractor Requested ® No ❑ Yes Name of Company
Project Name Agreement for Programs and Services
Project Number
Funding Source EDIT
Account No. 408.1001.460.39.30
Amount $75,000
Terms of Contract 1/01/17 — 12/31/17
Purpose/Description Support the NNRO's revitalization efforts in South Bend's Northeast
Neighborhood
® Required Contractor's Certification Form Attached (Non -
Collusion. Non -Discrimination, Non -Debarment, E-Verify, Iran, etc.)
Amount of ❑ Increase 4i
❑ Decrease $
Previous Amount $
Current Percent of Change: %
New Amount $
Total Percent of Change: %
Copy
Original
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Love