HomeMy WebLinkAboutOpening of Bids - 2017 Demolitions, Phase I Project No. 117-065 - Ritschard Bros., Inc.CITY OF SOUTH BEND, INDIANA
CONTRACTOR'S BID FOR PUBLIC WORK
CHECKLIST FOR BIDDERS
Project Name 2017 Demolitions
Project No. 117-065
For Bids Due June 27, 2017
From time to time the South Bend Board of Public Works finds it necessary to reject a bid because
it does not comply with statutory requirements. In preparing your bid, please use the following
checklist in order to make sure that your bid is done in the proper manner.
Proper bid security included. The bidder has the option of providing either a Certified Check
X or Bid Bond.
Bid prepared on the City of South Bend Contractor's Bid for Public Work Form, completely
X executed.
Contractor's Non -Collusion and Non -Debarment Affidavit, Certification Regarding Investments
with Iran, Employment Eligibility Verification, Non -Discrimination Commitment, and
X Certification of use of United States Steel Products or Foundry Products.
Proof of MBEIWBE Participation Goal Form [MWBE-1.0]. If minimum participation goal is not
met, also provide Evidence of Good Faith Efforts Form [MWBE-2.0] and MBEIWBE Contacted
X Form [MWBE-2.1].
X Acknowledge Receipt of 2 Addendum(s) included with the bid.
X All required additional information is included with the bid.
Proposal statements and other affidavits all signed by the proper party with name either
X printed or typed underneath signature.
X This checklist submitted with the Bid.
This checklist is provided for bidder's use in assuring compliance with required
documentation; however, it does not include all specifications requirements and does not
relieve the bidder of the need to read and comply with the specifications.
Bidder: Ritschard Bros.. Inc
By Authorized
Signature:
Print Name & Title: Rachelle L. DoIni.ak, President
Version 10/17/2016 Contractor's Bid for Public Works - 1
Date: June 27. 201
CITY OF SOUTH BEND, INDIANA f�
CONTRACTOR'S BID FOR PUBLIC WORK s * '1866
Project Name 2017 Demolitions, Phase I
Project No. 117-066
For Bids Due June 27, 2017
PART I
(Must be completed for all bids. Please type or print)
Date: June 27, 2017 Bidder (Firm):
Address: 1204 W. Sample Street
Ritschard Bros., Inc.
City/State/Zip: South Bend, IN 46619 Telephone Number: (574 ) 288-4777
Agent of Bidder (if Applicable):
Pursuant to notices given, the undersigned offers to furnish labor and/or material necessary to complete the
public works project of: 2017 Demolitions, Phase I
the City of South Bend, Indiana, in accordance with plans and specifications prepared by City of South Bend
and dated May 2017 for the sum of (enter the Total Bid as shown on the Proposal)
Thirty—two Thousand Seven Hundred Forty—four Dollars ($ 32,744.00 )
(Enter sum of Division A shown on Proposal) (Numerical)
Seventy—three Thousand Nine Hundred Eighty—six Dollars ($73,986.00 )
(Enter sum of Division B shown on Proposal) (Numerical)
Sixty—nine Thousand Three Hundred Fifteen Dollars ($69,315.00 )
(Enter sum of Division C shown on Proposal) (Numerical)
The undersigned further agrees to furnish a bond or certified check with this bid for an amount specified in
the notice of the letting. If alternative bids apply, the undersigned submits a proposal for each in accordance
with the notice. Any addendums attached will be specifically referenced at the applicable page.
If additional units of material included in the contract are needed, the cost of units must be the same as that
shown in the original contract if accepted IMthe City of South Bend. If the bid is to be awarded on a unit
basis, the itemization of the units shall be spqwn on a separate attac Tt.
By
(Signature)
Rachelle L. Dolniak, President
(Printed Name of Person Signing)
ACCEPTANCE
The above bid is accepted this z "7 day of cf _ 20 7
Subject to the following conditions:
B R�OF UBI_1C WOR '
Gary A. Gilot, President Suzanna M. Fritzberg, Member
Elizabeth A. Maradik, Member T e se J. Dorafi, Member
James . Mueller, Member f1 test: Linda M. Martin, CI rk
Version 10/17/2016 Contractor's Bid for Public Works - 2
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 1 EXPERIENCE QUESTIONNAIRE
1. Attach information regarding projects your organization has completed for the period of one
(1) year prior to the date of the current bid.
2. Attach a listing of public works projects currently in process of construction by your
organization.
3. Attach information regarding any failure to complete any work awarded to you and the
location thereof.
4. Attach references from private firms for which you have performed work.
SECTION II PLAN AND EQUIPMENT QUESTIONNAIRE
Attach an explanation of your plan or layout for performing proposed work. (Examples could
include a narrative of when you could begin work, complete the project, number of workers,
etc. and any other information which you believe would enable the City of South Bend to
consider your bid.)
2. Attach a listing of the names and addresses of all subcontractors (i.e. persons or firms outside
your own firm who have performed part of the work) that you have used on public works
projects during the past five (5) years along with a brief description of the work done by each
subcontractor.
3. If you intend to sublet any portion of the work, attach the name and address of each
subcontractor, equipment to be used by the subcontractor, and whether you will require a
bond. However, if you are unable to currently provide a listing, please understand a listing
must be provided prior to contract approval. Until the completion of the proposed project, you
are under a continuing obligation to immediately notify the City of South Bend in the event that
you subsequently determine that you will use a subcontractor on the proposed project.
4. Attach a listing of equipment you have available to use for the proposed project.
5. Have you entered into contracts or received offers for all materials which substantiate the
prices used in preparing your proposal? If not, attach an explanation for the rationale used
which would corroborate the prices listed.
SECTION III CONTRACTOR'S FINANCIAL STATEMENT
Attachment of bidder's financial statement is mandatory. Any bid submitted without said
financial statement as required by statute shall thereby be rendered invalid. The financial
statement provided hereunder to the City of South Bend awarding the contract must be specific
enough in detail so that said City of South Bend can make a proper determination of the bidder's
capability for completing the project if awarded.
Version 10/17/2016 Contractor's Bid for Public Works - 3
When the prospective Contractor is unable to certify to any of the statements below, it shall attach an explanation to this Affidavit.
CONTRACTOR'S NON -COLLUSION AND NON -DEBARMENT AFFIDAVIT, CERTIFICATION
REGARDING INVESTMENT WITH IRAN, EMPLOYMENT ELIGIBILITY VERIFICATION, NON-
DISCRIMINATION COMMITMENT AND CERTIFICATION OF USE OF UNITED STATES STEEL
PRODUCTS OR FOUNDRY PRODUCTS
(Must be completed for all quotes and bids. Please type or print)
STATE OF Indiana )
) SS:
St. Joseph 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 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
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 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 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
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 27 th day of'3une , 2017
Ritschard Bros., Inc.
ntractor/Bidder (I~ i
Signature of Contractor/Bidder or Its Agent
Rachelle L. Dolniak, President
Printed Name and Title
Subscribed and sworn to before me this 2 7 th day of une , 20
I
My Commission Expires 9/$'_Y111111�/i,
�'%, N t y ublic
ort9dP�deie St. Joseph
.�O�' IND�P��..
1110 1111W\`\
Version 10/17/2016 Contractor's Bid for Public Works - 6
,R —
II
Removal, Management, and Disposal of Duct Wrap
Square Feet
$ 30.00
Material Containing Asbestos
Itl
Removal, Management, and Disposal of Floor Tile and
Square Feet
$ 7.00
Mastic Material Containing Asbestos
IV.
Removal, Management, and Disposal of Plaster Material
Square Feet
$ 30, 00
Containin Asbestos
V.
Removal, Management, and Disposal of Corrugated
Square Feet
$ 25.00
Sheet Material Containing Asbestos
VI.
Removal, Management, and Disposal of Attic Insulation
Square Feet
$ 25.00
Material Containing Asbestos
VII
Removal, Management, and Disposal of Transite Siding
Square Feet
$ 9.00
Material Containing Asbestos
Bidder (Firm): Ritschard Bros., Inc.
Address: 1204 W. Samole Street
City/State/Zip: South Bend, IN 46619Telephone N ber: (574 ) 288-5438
BY -
(Signature)
Rachelle L. Dolniak, President
(Printed Name of Person Signing)
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CITY OF SOUTH BEND
MINORITY AND WOMEN BUSINESS ENTERPRISE DIVERSITY ry ,fi ryn
DEVELOPMENT PROGRAM��
FORM MWBE-2A
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: 117-065
Project Name: 2017 Demolitions, Phase I
Bidder:
Contact Person:
Address:
City:
Email:
State:
Date:
Telephone:
Zip:
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
MBE/WBE 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 MBENVBEs 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 MBENVBEs 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 MBE/WBE firms.
"*Bidder must circle or otherwise notate which of the two (2) required actions were performed.
GOOD FAITH NEGOTIATIONS: The bidder negotiated in good faith with interested MBENVBEs,
including providing such MBENVBE's with adequate information about the plans, specifications and other
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
MBENVBEs in order to increase the likelihood of meeting the MBEIWBE goals (including breaking down
contracts into smaller units to facilitate MBENVBE participation)
CONTRACT RECORDS: The bidder has maintained the following records for each MBENVBE 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 MBEIWBE 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 -10
CITY OF SOUTH BEND
MINORITY AND WOMEN BUSINESS ENTERPRISE DIVERSITYh
DEVELOPMENT PROGRAM'"
FORM MWBE-2.1� a
MBEIWBE CONTACTED�a"ds3
This completed form should be supplied with Bids that pertain to City of South Bend Public Works Projects
requiring contacted MBElWBE to obtain Good Faith Efforts. It is the bidder's sole responsibility to verify
whether any listed minority or woman business meets the qualifications of a Minority or Women's owned
business.
PAGE OF
Project Number: 117-065
Project Name: 2017 Demolitions, Phase I
Bidder:
By:
(Signature) (Title) (Date)
MBENVBE Firm
Owner or Contact at MBENVBE Firm
Telephone: Fax: Email:
TYPE OF WORK SOLICITED FOR THIS PROJECT:
I*YIJ f.TQ dJTjkTJ19.ONa'IQ>>l 3;4►riT1:3:191 iiTii
MBENVBE Firm
Owner or Contact at MBENVBE Firm
Telephone: Fax: Email:
TYPE OF WORK SOLICITED FOR THIS PROJECT:
RESULTS OF CONTACT WITH THE MBENVBE FIRM:
Version 10/17/2016 Contractor's Bid for Public Works - 11
RITSCHARD
BROS., INC.
EXCAVATING AND DEMOLITION
FORM 96 (Revised 2005)
SECTION H Plan and Equipment Questionnaire
ITEM 3 — LIST OF OWNED EQUIPMENT
3 — Vibratory Compactors
I — D3C Caterpillar Bulldozer
2 -- 650J John Deere Bulldozers
2 — 750C John Deere Bulldozers
I -- D7G Caterpillar Bulldozer
-1— 450E John Deere Bulldozer Wide Track
1— 450G John Deere Bulldozer Long Track
1— 450H John Deere Long Track Dozer
1— 416C Caterpillar Loader/Backhoe Combinations
1-- 420D Caterpillar Loader/Backhoe Combination
2 — TS14 Terex Earthmovers
1-120G Caterpillar Grader
1— 30B Bucyrus Erie Crawler Crane —1 yd
2 --- L70 Volvo Loaders - 2 % yd
4 — L90 Volvo Loaders - 3 ;/4 yd
2 — L120 Volvo Loaders - 3 %2 yd
2 — Gehl Skid Steer Track Loaders
I — 595D John Deere Excavator
1— Gehl GE383Z Mini Excavator
1 - Takeuchi TB 180FR Excavator
1— ZX160LC-5 Hitachi Excavator
1— ZX350LC-5 Hitachi Excavator
1-- EX330LC-5 Hitachi Excavator
1-- EC210BLC Volvo Excavator
I -- EC240CLC Volvo Excavator
3 — Tri Axle Dump Trucks
204 West Sample Street - South Bend, Indiana 46619 - PHONE (574) 288.4777 - FAX (574) 288.5438 - E-MAIL: ritl204@datacruz.com
1316 COUNTY -CITY BUILDING SOUTH BEND PETS BUTTIGIEG, . PHONE 574/235-9251
227 W.JEFFERSON BOULEVARD FAX 574/235-9171
SOUTH BEND, INDIANA 46601-1830 OARD OF PUBLIC WORK TDD 574/ 235-5567
Date: June 19, 2017
To: All Bidders
From Linda M. Martin, CIerk, Board of Public Works
Subject Addendum Number: 1
Project Name: 2017 Demolitions, Phase 1
Project
Number: 117-065
ACKNOWLEDGEMENT OF RECEIPT OF ADDENDUM
Date Received: June 20, 2017
This addendum is being forwarded to you for the above referenced project.
Please sign below and acknowledge receipt of this Addendum
by faxing this sheet to the Board of Public Works at (574) 235-9171.
A copy MUST also be included with your bid package upon
submittal.
THIS ADDENDUM MAY AFFECT YOUR BID.
Note:
The attached documents are hereby added to the Specifications and Contract
Documents and become a part of herein.
Company: Rito4hard Bros., Inc.
Authorized Signature:
Date: June- 22. 2017
1316 COUNTY -CITY BUILDING CITY OF SOUTH BEND PETE BUTTIGIEG, MAYOR PHONE 574/235-9251
227 W. JEFFERSON BOULEVARD FAX 574/ 235-9171
SOUTH BEND, INDIANA 46601-1830 BOARD OF PUBLIC WORKS TDD 574/ 235-5567
Date: June 20, 2017
To: All Bidders
From Linda M. Martin, Clerk, Board of Public Works
Subject Addendum Number: 2
Project Name: 2017 Demolitions, Phase I
Project
Number: 117-065 -
ACKNOWLEDGEMENT OF RECEIPT OF ADDENDUM
Date Received: 6 2p t
This addendum is being forwarded to you for the above referenced project.
Please sign below and acknowledge receipt of this Addendum
by faxing this sheet to the Board of Public Works at (574) 235-9171.
A copy MUST also be included with your bid package upon
submittal.
THIS ADDENDUM MAY AFFECT YOUR BID,
Note:
The attached documents are hereby added to the Specifications and Contract
Documents and become a part of herein.
Company: Rit�'}chard Bros., Inc
Authorized Signature:
Date: June 22, 2017
1:35& 0g
CONTRACTOR:
(Name, legal status and address)
Ritschard Bros., Inc.
1204 W. Sample Street
South Bend, IN 46619
CNASURETY
Bond No.
SURETY: Western Surety Company: South Dakota Corporation
(Name, legal status and principal place
of business)
333 S. Wabash Avenue
41st Floor
Chicago, IL 60604
OWNER:
(Name, legal status and address)
City of South Bend, Indiana
Board of Public Works
County -City Building, Room 1316
227 West Jefferson Blvd.
South Bend, IN 46601
BOND AMOUNT: Five percent (5%) of accompanying bid
PROJECT:
(Name, location or address, and Project number, if any)
2017 Demolitions, Phase 1
Project No. 117-065
This document has important legal
consequences. Consultation with
an attorney is encouraged with
respect to its completion or
modification.
Any singular reference to
Contractor, Surety, Owner or
other party shall be considered
plural where applicable.
The Contractor and Surety are bound to the Owner in the amount set forth above, for the payment of which the
Contractor and Surety bind themselves, their heirs, executors, administrators, successors and assigns, jointly and
severally, as provided herein. The conditions of this Bond are such that if the Owner accepts the bid of the Contractor
within the time specified in the bid documents, or within such time period as may be agreed to by the Owner and
Contractor, and the Contractor either (1) enters into a contract with the Owner in accordance with the terms of such
bid, and gives such bond or bonds as may be specified in the bidding or Contract Documents, with a surety admitted
in the jurisdiction of the Project and otherwise acceptable to the Owner, for the faithful performance of such Contract
and for the prompt payment of labor and material furnished in the prosecution thereof, or (2) pays to the Owner the
difference, not to exceed the amount of this Bond, between the amount specified in said bid and such larger amount
for which the Owner may in good faith contract with another party to perform the work covered by said bid, then this
obligation shall be null and void, otherwise to remain in full force and effect, The Surety hereby waives any notice of
an agreement between the Owner and Contractor to extend the time in which the Owner may accept the bid. Waiver of
notice by the Surety shall not apply to any extension exceeding sixty (60) days in the aggregate beyond the time for
acceptance of bids specified in the bid documents, and the Owner and Contractor shall obtain the Surety's consent for
an extension beyond sixty (60) days.
If this Bond is issued in connection with a subcontractor's bid to a Contractor, the term Contractor in this Bond shall
be deemed to be Subcontractor and the term Owner shall be deemed to be Contractor.
When this Bond has been furnished to comply with a statutory or other legal requirement in the location of the Project,
any provision in this Bond conflicting with said statutory or legal requirement shall be deemed deleted herefrom and
%rovisions conforming to uch statutory or other legal requirement shall be deemed incorporated herein. When so
-nished, the intent is Vit this Bond shall construed as a statutory bond and not as a common law bond.
(Witness)
day/f _ ._. June 2017 .
i)schard Bros., Inc.
Princi al) (Seal)
( Atle) Rachelle L. Dolniak, President
Western Surety Company
(Surety) / c (Sea1)
(Title) d Ke n ughes, Attorney-' -Fact:
Printed in cooperation with the American Institute of Architects (AIA).
The language in this document conforms to the language used in AIA Document A310 - Bid Bond - 2010 Edition.
Western Surety Company
POWER OF ATTORNEY APPOINTING INDIVIDUAL ATTORNEY -IN -FACT
Know All Men By These Presents, That WESTERN SURETY COMPANY, a South Dakota corporation, is a duly organized and existing corporation
having its principal office in the City of Sioux Falls, and State of South Dakota, and that it does by virtue of the signature and seal herein affixed hereby
make, constitute and appoint
Thomas J Mc Govern, Harold E Everett, Elaine K Miller, J Kevin Hughes, Thomas
J Van Dyck;, Melody S Hoerl, Jada M Karst, Melinda S Jagger, Tracie M Mc Bride, Connie
J Messer, Individually
of Fort Wayne, IN, its true and lawful Attorney(s)-in-Fact with full power and authority hereby conferred to sign, seal and execute for and on its behalf
bonds, undertakings and other obligatory instruments of similar nature
- In Unlimited Amounts -
and to bind it thereby as fully and to the satne extent as if such instruments were signed by a duly authorized officer of the corporation and all the acts of said
Attorney, pursuant to the authority hereby given, are hereby ratified and confirmed.
This Power of Attorney is made and executed pursuant to and by authority of the By -Law printed on the reverse hereof, duly adopted, as indicated, by
the shareholders of the corporation.
In Witness Whereof, WESTERN SURETY COMPANY has caused these presents to be signed by its Vice President and its corporate seal to be
hereto affixed on this 16th day of February, 2017.
5uaEr':%, WESTERN ,SURETY COMPANY
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aul T. Bruflat, Vice President
State of South Dakota
SS
County of Minnehaha
On this 16th day of February, 2017, before me personally came Paul T. Bruflat, to me known, who, being by the duly sworn, did depose and say: that
he resides in the City of Sioux Falls, State of South Dakota; that he is the Vice President of WESTERN SURETY COMPANY described in and which
executed the above instrument; that he knows the seal of said corporation; that the seal affixed to the said instrument is such corporate seal; that it was so
affixed pursuant to authority given by the Board of Directors of said corporation and that he signed his name thereto pursuant to like authority, and
acknowledges same to be the act and deed of said corporation.
My commission expires
J. MOHR
June 23, 2021 KoTMxallauc
�SOUM DMOTA 5
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J. Mohr, Notary Public
CERTIFICATE
1, L. Nelson, Assistant Secretary of WESTERN SURETY COMPANY do hereby certify that the Power of Attorney hereinabove set forth is still in
force, and further certify that the By -Law of the corporation printed on the reverse hereof is still in force. In testimony whereof I have hereunto subscribed
my name and affixed the seal of the said corporation this 2 7 th day of unp ? 017
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V,RIM,hy xErtrC" WES'TER,N 'SURETY COMPANY
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L. Nelson, Assistant Secretary
Form F4280-7-2012
� � DEPARTMENT OF ADMINISTRATION
-•�`� STATEMinority and Women's Business Enterprises Division
.eK Michael R. Fence., Governor Indiana Government Center South
402 West Washington Street, Room W478
Indianapolis, IN' 46204
(317) 232 - 3061
April 27, 2015
Rachelle Dolniak
Ristchard Bros., Inc.
1204 W. Sample St.
Sought Bend, ihr 46619
Subject: Application for WBE certification
Dear Rachelle Dolnialw,
Congrauadado,%T! The Indiana Department of Administration., Minority and Women's Business Enterprises
Division is pleased to inform you that Fistchard Bros., Inc. is hereby certified as a Women Business Enterprise
(%rBE). -- --
Your company provides a commercially useful function in the areas listed below. Only wort: performed in these
areas will be counted towards Women-s Business Enterprise participation:
UI\SPSC CODR(S)
Code?escri
tiaxr
72103000
Site Preparation Services
72103001
Land Clearing Services
72103002
Land Leveling Services
72103003
Demolition Services
72103004
17iggging Services
931015Q0
Water and Sewer Utilities
On September 13, 2010, the Governor's Commission on Minority and Women's Business Enterprises approved the
department's effort to streamline its recertification process. Instead of conducting an onsite visit to each company
seeking recertification, the department now has the discretion to waive the visit after a thorough review of the
company's file and recertification documents. We have approved your recertification and it is valid througb
Mat+ 31, 201 S. Please note that IDOA continues to reserve the right to conduct a site visit or phone interview at any
tirne io certified companies.
Although your certification is valid for a three-year period, you are required to submit an annual Affidavir of
Continues' Eliglbf of (ACE) form, located at http://mww.in.gov/idoatfiestACE_Form-pdf. Please remember you
must notify us immediately if any changes occur. Failure to notify us of changes or to provide an ACE form
annually ,will result iu r6vocation of your certification. Changes include, but are not limited to, changes in location,
contact information, ownership and control.
We encourage you to visit IDOA-s procurement website, hq:llwwvv.in.gov/jdoa/2463.btm, and update your
Business Registration Profile. It is important that you review and update your profile regularly, because state
purchasing agents and prime contractors may use this information to contact you for business opportunities. For
questions regarding your registration profile, you may contact our office at 317-232-3061.
Reference: Ristchard Bros., Inc..
While this letter serves as notification of certification, it does not serve to prove continued eligibility. Please visit
http./I%vww.iia.govlidoa./tainority/Certifications.-ds to verify certification status, please contact our office at ("a 17)
232-3061 if you have any other questions.
We ask than you please contact Luther Tayior, Deputy Director of Certification and Operations, at
(317) 234-3424 or ltaylor@idoa.in.gov if you have any questions or concerns about your letter,
Sincerely, R
Terrie F. Daniel, Deputy Commissioner
Indiana Department of Administration
Minority and Women's Business Enterprises Division
TFD:LT
Bidder Registration Number: 0000023294