HomeMy WebLinkAboutOpening of Bids - 2017 Curb and Sidewalk Construction Proj No. 117-008- Ziolkowski Construction, Inc.LAP
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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. Please See Attached
2. Attach a listing of public works projects currently in process of construction by your
organization. Please See Attached
3. Attach information regarding any failure to complete any work awarded to you and the
location thereof. Please See Attached
4. Attach references from private firms for which you have performed work.
Please See Attached
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.) As directed by the Architect/Construction Manager
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.
If Subcontractors will be used we will submit this information 24 hours after notification.
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.
If Subcontractors will be used we will submit this information 24 hours after notification.
4. Attach a listing of equipment you have available to use for the proposed project.
Whatever is required to complete the project properly and on time.
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. Yes
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.
Version 10/17/2016 Contractor's Bid for Public Works - 3 Project 117-008 — Addendum #1
When theprospective Contractor is unable to Certify to any of the statentents below, it shall affach an explanation to this Affi(lavit.
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 COUNTY ) SS:
The undersigned Contractor, being duly sworn upon Iris/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 fi•om 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.
Version 10/17/2016 Contractor's Bid for Public Works - 4 Project 117-008 -- Addendum #1
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
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 terns 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 persons 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.
1, 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 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
Version 10/17/2016 Contractor's Bid for Public Works - 5 Project 117-008 —Addendum #1
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BIDIPROPOSAL
CITY OF SOUTH BEND
Project Name 2017 Curb and Sidewalk Construction
Project No. 117-008
For Bids Due May 9t", 2017
Division A
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Item
No.
Description
Quantity
Unit
Unit Price
Total Amount
1
CONCRETE SIDEWALK, REMOVE
269
SY
7
1,883
2
CONCRETE; SIDEWALK, 4-IN
269
SY
43
11,567
3
CONCRETE CURB, REMOVE
1194
LF
6
7164
4
CONCRETE CURB, MODIFIED
1194
LF
26
31,044
5
CONCRETE APPROACH, REMOVE
85
SY
7
595
6
CURB RAMP, REMOVE
63
SY
7
441
7
ONE-WAY PERPENDICULAR CURB
RAMP
20
SY
70
1,400
8
DEPRESSED CORNER CURB RAMP
43
SY
75
3,225
9
TOPSOIL AND SEEDING
176
SY
20
3,520
16
BRICK PAVEMENT PATCH
1350
LF
47
63,450
Bidder (Firm):
Zioikowski Construction. Inc.
DIVISION A TOTAL 124.289
Version 10117/2016 Contractor's Bid for Public Works - 7 Project 117-008 — Addendum #1
Division B
Item
No.
Description
Quantity
Unit
Unit Price
Total Amount
1
CONCRETE SIDEWALK, REMOVE
728
SY
7
5,096
2
CONCRETE SIDEWALK, 4-IN
728
SY
43
31,304
3
CONCRETE CURB, REMOVE
75
LF
8
600
4
CONCRETE CURB, MODIFIED
70
LF
26
1,826
5
CONCRETE APPROACH, REMOVE
31
SY
7
217
6
PCCP FOR APPROACHES, 6-IN
31
SY
70
2,170
7
CURB RAMP, REMOVE
66
SY
7
462
8
ONE-WAY PERPENDICULAR CURB
RAMP
42
SY
70
2,940
PAIRED PERPENDICULAR CURB
RAMP
24
SY
70
1,680
10
TREE, REMOVE, 18-IN
7
EA
350
2,450
11
TREE, REMOVE, 30-IN
6
EA
1100
6 600
12
TREE, REMOVE, 48-IN
2
EA
1500
3,000
13
TREE, REMOVE, 60-IN
1
EA
1800
1,800
14
STUMP, REMOVE
1
EA
150
150
15
PLANT, DECIDUOUS TREE, SINGLE
STEM, 2-IN TO 2,5-IN
17
EA
330
5,610
16
TOPSOIL AND SEEDING
28
SY
50
1,400
DIVISION B TOTAL. 67,305
Division C
Item
No.
Description
Quantity
Unit
Unit Price
Total Amount
1
CONCRETE SIDEWALK, REMOVE
262
SY
7
1,834
2
CONCRETE SIDEWALK, 4-IN
262
SY
43
11,266
3
CONCRETE APPROACH, REMOVE
62
SY
7
434
4
PCCP FOR APPROACHES, 6-IN
62
SY
70
4,340
5
TREE, REMOVE, 18-IN
1
EA
400
400
6
TREE, REMOVE, 30-IN
1
EA
1200
1,200
7
TREE, REMOVE, 48-IN
2
EA
1500
3,000
8
TREE, REMOVE, 60-IN
2
EA
1900
3,800
9
STUMP, REMOVE
1
EA
150
150
10
PLANT, DECIDUOUS TREE, SINGLE
STEM, 2-IN TO 2.5-IN
7
EA
330
2,310
DIVISION C TOTAL. 28,734
Bider (Firm): Ziolkowski Construction, Inc.
Version 10/1712016 Contractor's Bid for Public Works - 8 Project 117-008 — Addendum #1
Division D
Item
No.
Description
Quantity
Unit
Unit Price
Total Amount
1
CONCRETE SIDEWALK, REMOVE
522
SY
7
3,654
2
CONCRETE SIDEWALK, 4-IN
522
SY
43
22,446
3
CONCRETE CURB, REMOVE
1628
LF
6
9,768
4
CONCRETE CURB, MODIFIED
1628
LF
26
42 328
5
CONCRETE APPROACH, REMOVE
31
SY
7
217
6
PCCP FOR APPROACHES, 6-IN
31
SY
70
2,170
7
CURB RAMP, REMOVE
61
SY
7
427
8
PAIRED PERPENDICULAR CURB
RAMP
61
SY
70
4,270
9
TREE, REMOVE, 18-IN
4
EA
400
1,600
10
TREE, REMOVE, 30-IN
3
EA
1100
3,300
11
TREE, REMOVE, 48-IN
1
EA
1500
1,500
12
STUMP, REMOVE
1
EA
150
150
13
PLANT, DECIDUOUS TREE, SINGLE
STEM, 2-IN TO 2.5-IN
9
EA
330
2,970
14
TOPSOIL AND SEEDING
667
SY
14
9,338
DIVISION D TOTAL 104,138
Division E
Item
No.
Description
Quantity
Unit
Unit Price
Total Amount
1
CONCRETE SIDEWALK, REMOVE
211
SY
7
1,477
2
CONCRETE SIDEWALK, 4-IN
211
SY
43
9,073
3
CONCRETE CURB, REMOVE
300
LF
6
1,800
4
CONCRETE CURB, MODIFIED
300
LF
26
7,800
5
CONCRETE APPROACH, REMOVE
23
SY
7
161
6
PCCP FOR APPROACHES, 6-IN
23
SY
70
1,610
7
CURB RAMP, REMOVE
33
SY
7
231
8
DEPRESSED CORNER CURB RAMP
45
SY
75
3,375
9
TOPSOIL AND SEEDING
53
SY
42
2,226
DIVISION E TOTAL 27,753
Bidder (Firm): Ziolkowski Construction, Inc.
Version 10/17/2016 Contractor's Bid for Public Works - 9 Project 117-008 —Addendum ##1
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CITY OF SOUTH BEND
MINORITY AND WOMEN BUSINESS ENTERPRISE DIVERSITY 1'� / , �xA.,
DEVELOPMENT PROGRAM f �;
FORM MWBE-2.0�_:
EVIDENCE OF GOOD FAITH EFFORTS
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 MBEIWBE 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: 117-008
Project Name: 2017 Curb and Sidewalk Construction
Bidder: Ziolkowski Construction. Inc.
Date: May 9. 2017.
Contact Person: Gary Paston Telephone: 574-287-1811
Address: 4050 Ralph Jones Drive
City: South Bend state: Indiana zip: 46628
Email: gpaston@zhuild.com
To determine whether a bidder has demonstrated good faith efforts to reach the MBEIWBE 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
Enterprise Diversity Development Program, which uses the IDOA approved list of Minority and Women
Owned Business as found on their website (http://www.in.gov/idoa).
ACTION (ADVERTISEICONTACT): 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.
2. Advertise in general circulation and/or trade association publications concerning 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.
4. 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 MBEIWBE firms.
**Bidder must circle or otherwise notate which of the two (2) required actions were performed.
ee
GOOD FAITH NEGOTIATIONS: The bidder negotiated in good faith with interested MBE/WBEs,
ached
including providing such MBEIWBE's with adequate information about the plans, specifications and other
aper Ad
requirements of the subcontract and did not reject MBE/WBEs as unqualified without sound business
reasons based on a thorough investigation of their capabilities.
SMALL CONTRACT(S): The bidder selected specific portions of the work to be performed by
MBE/WBEs in order to increase the likelihood of meeting the MBE/WBE goals (including breaking down
contracts into smaller units to facilitate MBEIWBE participation)
CONTRACT RECORDS: The bidder has maintained the following records for each MBE/WBE that has
bid on the subcontracting opportunity:
1. Name, address, and telephone number;
2. A description 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.
"Proper demonstration of Good Faith 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 10/17/2016 Contractor's Bid for Public Works - 12 Project 117-008 —Addendum #1
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THIS POWER.OF ATTORNEY IS NOT VALID UNLESS IT IS PRINTED ON RED BACKGROUND..
This Power of Attorney limits the acts of those named herein, and they have no authority to bind the Company except in the manner and to the extent herein stated.
Certificate No. 773
4996.
Liberty Mutual Insurance. Company
The Ohio Casualty Insurance Company West American.l.rtsurance Company.
POWER OF ATTORNEY
KNOWN ALL PERSONS BY THESE PRESENTS: That The Ohio Casualty Insurance Company is a corporation duly organized under the laws of the State of New Hampshire, that
Liberty Mutual insurance Company is a corporation duly organized.under the laws of the State of Massachusetts,. and. West American -Insurance Company. is a icurporatlon duly'
organized under the laws of the State of Indiana (herein collectively called the,. 'Companies'), pursuant to and,by authority herein set forth, does hereby name, constitute and appoint, .`
Adrienne C. Stevenson; Amy B Wlckatt' C. R. Hernandez,. abriei Jac u.ez John K. Johnson; Katherine.J. Foreit• Triniy Garcia
all of the city of CHICAGO state of AL each individually if there be -more than one named, Its true.a. nd lawful. altorney-in4act to make, execute, seal, acknowledge
and deriver, for and on its behalf as surety and a8 its act:and:deed, any:and all undertakings, bonds :recognizances and other surety obligations; in pursuance of these presents and shall
be as binding upon.lhe Companies as if they have been duly signed by the president and attested by secretary of the Companies in their own. proper persons,
IN WITNESS WHEREOF, this Power ofAltorney::has been subscribed. by an authorized officer or official of the Companies and the corporate seals.of.tie Companies have been affixed
thereto this 18rh day of Aril 2017
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Nse, ^ y� C xcrtrk The Ohio Casualty Insurance Company.. `N
F 1 Liberty Mutual Insurance. Company
q -}9i4-1991
a WestAmerican Insurance Company
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David M. CareY, Assistant cretxry �!
STATE OF PENNSYLVANIA ss
COUNTY OF MONTGOMERY �I
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On this 18th day of April 2017 , before me personally appeared David M. Carey, who acknowledged himself to be the Assistant Secretary of Liberty Mutual insurance u
v ( Company, The Ohio Casualty Company, and West American insurance Company, and that he, as such, being authorized so to ilo, execute.the foregoing instrument for The purposes y,to
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therein contained by signing on behalf of the corporations byhimself as a duly authorized officer.
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m >. IN WITNESS WHEREOF, I have hereunto subscribed my name and affixed my notarial seal at King of Prussia, Pennsylvania, oil the day and year first above written. 0
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�p 1'RSy COMMONWEALTH OF PENNSYLVANfA Q M
Notarial5eal
t[ Teresa t'asle[!a, Notary Rr6IIC _ 0 _-�
pOF - _I Uppar_h9erionTwp., Montgomery Counly Teresa Pastal.la Notary.Aubhc
.` a� holy Commis sirin Expires Mardi 28, 2021
d CYO PeV� A9eml3�r, Yenlisy{v�nia ASSVCf3lEOfi of Notar�cs�
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! This Power of Attorney is made and executed pursuant to and by authority of the following By-laws and Authorizations of The Ohio Casualty insurance Company Liberty Mutual O O
(D Insurance Company, and West American Insurance Company which resolutions are flow in full force and effect reading as. follows: ?
m cn ` ARTICLE IV- OFFICERS- Section:l2. Power of Attorney. Any officer or other official of the Corporation authorized for that purpose in writing by tine Chairman or the President, and subject. O
4-to. such limitation as the Chairman or the. President may prescribe, shall appoint. such attorneys -in -fact, as may be necessary to act in behalf of the Corporation to make, execute, seal, 4.
O , acknowledge and deliver as surety any and ail undertakings, bonds, recognizances and other surety obligations. Such attorneys -In -fact, subject to the limilations set forth in their.respective ^5
E. 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.:
p j 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 ?
Sthe provisions of this article may be revoked at any tlme.by the Board, the Chairman, the President or by the officer or officers granting such power or authority. et
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0 c ARTICLE XIII -:Execution of Contracts -SECTION 5. Surety Bonds and Undertakings. Anyofficer of the Company authorized for that purpose. in writing by the chairman or lhe.president, ` E. 0?
( and subject to such limitations as the chairman or.the president may prescribe, shall appoint such:attorneys-in-fact, as may be necessary to act in behalf.of the .Company to make; execute;
q seal, acknowledge and deliver as surety any and all undertakings, bonds, recognizances and oilier. surely obligations.. Such attorneys -in -fact subject to the limitations set forth in their
Z respective powers of attorney, shall have full power to bind the Company by their signature and execution of any such instruments and to attach thereto the seal of the .Company. When so 00
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executed such. instruments shall be aa.binding as if signed by the president and attested by the secretary, la
Certificate of Designation - The President of the Company, acting pursuant:to the Bylaws. of the Company, authorizes David M. Carey, Assistant Secretary to appoint such attorneys -in-:
fact as may be. necessary to. act on behalf of the Company to make; execute, seal, acknowledge and deliver as. surety airy and all undertakings, bonds, recognizances and other surety
obligations.
Authorization By unanimous consent of the Company's Board of Directors, the Company consents that facsimile or mechanically reproduced signature of any assistant secretary of the
Company, wherever appearing upon a certified copy of any power.cif altorney 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.
1, Renee C. Llewellyn, the undersigned, Assistant. Secretary, The Ohio. -Casualty. InsuranGe...Company, Liberty. Mutual Insurance Company, and: West American Insurance Company do
hereby certify that the. original power of attorney ot:which the foregoing is a full, true and correct copy of the Power of Attorney executed by said .Companies, is in full force and effect and
has not been revoked.
IN TESTIMONY WHEREOF, I have hereunto set my hand and affixed the seals of said Companies this A t. h � day of M a 17 20. 12
�S`! IN)fJp l lY Un,� ;ti5Ur7,r -a.r
IJN3 ; t c 991 By.*"`
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Renee C. Llewe ssistant Secretary
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PART 11
(For projects of$100,000 or more— IC 36-1-12-4)
Governmental Unit: South Bend Community School Corp
Bidder (Firm) Ziolkowski Construction Inc.
Date (month, day, year): May 3; 2010,�
These statements to be submitted under oath by each bidder with and as a part of his bid.
Attach additional pages for each section as needed.
SECTION I EXPERIENCE QUESTIONNAIRE
1. What public works projects has your organization completed for the period of one (1 ) year prior to the
date of the current hid?
Contract Amount
Class of Work
Completion
Date
Name and Andress of Owner
$16,473,549
General
01/2012
IUSB Cancer Research Center
$12,274,292
General
01/2016
Lake Central High School
$16,920,600
General
1 08/2011
Kankakee Valley New Middle School
$7,663,700
General 1
02/2013
Mishawaka River Center Aparhnents
2. What public works projects are now in process of construction by your organization?
3.
Contract Amount
Class of Work
Expected
Completion
Date
Name and Address of Owner
$27,366,910
General
05/2016
Purdue University North Central
$21,355,975
General
06/2015
Armed Forces Reserve Center
$4,824,179
General
08/2015
Mishawaka Central Park
$9,020,000
General
10/2016
South Bend Airport- New Arrivals Termi
Have you ever failed to complete any work awarded to you? No
4. List references from private firms for which you have performed work.
al
If so, where and why?
University of Notre Dame, Tony Polotto, LEED, AP, 200 Facilities Bldg., Notre Dame, IN 46556 574-631-4200
City of Mishawaka, Ken .Prince, 600 East Third Street, Mishawaka, IN 574-258-1625
Fetters Construction Inc., Steven A. Fetters, 5417 County Rd 427, Auburn, Indiana 46706 260-927-8516
Memorial Hospital & Health System, Larry Lies, 615 N Michigan St., South Bend, IN 46601 574-647-1000
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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 Ziotkowski 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 11
FUNCTIONS TO BE PERFORMED
A. RESPONSIBILITIES OF SSA
1. SSA agrees to provide the Employer with available information that allows the Employer to
confirm the accuracy of Social Security Numbers provided by all employees verified under this
MOU and the employment authorization of U.S. citizens.
2. SSA agrees to provide to the Employer appropriate assistance with operational problems that
may arise during the Employer's participation in the E-Verify program. SSA agrees to provide
the Employer with names, titles, addresses, and telephone numbers of SSA representatives to
be contacted during the E-Verify process.
3. SSA agrees to safeguard the information provided by the Employer through the E-Verify
program procedures, and to limit access to such information, as is appropriate by law, to
individuals responsible for the verification of Social Security Numbers and for evaluation of the
E-Verify program or such other persons or entities who may be authorized by SSA as governed
Page 1 of 13 1 E-Verify MOU for Employer I Revision Date 09101/09 www.dhs.gov/E-Verify
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Company ID Number: 486671
To be accepted as a participant in E-Verify, you should only sign the Employer's Section
of the signature page. If you have any questions, contact E-Verify at 888-464-4218.
Employer Ziolkowsld Construction, Inc.
Bill Favors
Name (Please Type or Print)
Electronically Signed
Title
01/10/2012
Signature
Date
Department of Homeland Security -- Verification Division
SCIS Verification Division
Name (Please Type or Print)
Electronically Signed
Title
01110/2012
Signature
Date
Information Required for the E-Verify Program
Information relating to your Company:
Company Name:
Ziolkowski Construction, Inc.
Company Facility Address:
4050 Ralph Jones Dr.
South Bend, 1N 46628
Company Alternate
Address:
County or Parish:
STJOSEPH
Employer Identification
Number:
351445992
Page 12 of 13 1 E-Verify MOU for Employer I Revision Date 09/01/09 www.dhs.gov/E-Verify
E-Veri
Company ID Number: 486671
V.ti SFC`G"
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North American Industry
Classification Systems
Code:
236
Administrator:
Number of Employees:..._
100 to 499
Number of Sites Verified
fo r:
1
Are you verifying for more than 1 site? If yes, please provide the number of sites verified for
in each State:
• INDIANA 1 site(s)
Information relating to the Program Administrator(s) for your Company on policy
questions or operational problems:
Name: James Keldsen
Telephone Number: (574) 287 -1811 ext. 368 Fax Number: (574) 344 - 5533
E-mail Address: jheldsen@zbuild.com
Page 13 of 13 1 E-Verify MOU for Employer I Revision Date 00101109 www.dhs.gov/E-Verify
i. E-Verify - Employer Wizard - Company Information Page I of 1
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Company Name:
Ziolkowski Construction, Inc.
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Company ID Number:
486671
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State:
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ZIP Code:
46628
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ST JOSEPH
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Employer Identification Number: 351445992
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Total Number of Employees:
100 to 499
Shareldeas
Parent Organization:
Contact Us
Administrator:
Organization Designation:
Employer Category: None of these categories apply
NAICS Code:
Total Hiring Sites:
236 - CONSTRUCTION OF BUILDINGS
k
Total Points of Contact: 1
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