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HomeMy WebLinkAboutOpening of Bids - Janitorial-Cleaning Supplies 2017 Spec S - Sanco Distributing, Inc.CITY OF SOUTH BEND INDIANA SELLER'S BID FOR SALE OR LEASE OF MATERIALS AND NON -COLLUSION AND NON DEBARMENT AFFIDAVIT AND NON-DISCRIMINATION COMMITMENT FOR SELLERS BID NAME Spec S — Janitorial -Cleaning Supplies 2017 FOR BIDS DUE June 27, 2017, 9:30 a.m., local time 06-26-17 Late: Bidder SANCO DISTRIBUTING INC. (Firm): Address: 919 N. OLIVE ST. City/State/Zip: south 8a99 IN 46�A§phone Number: ._( 574282-251 0 Agent of Bidder (if Applicable): When the prospective Contractor is unable to certify to any of'the statements below, it shall altaeh 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 ST • INDIANA } ST. JOSEPH } 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 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 fi•om 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. 4 I hereby affirm under the penalties of perjury ury that the facts and information contained in the foregoing bid for public works are true and correct. Dated this 0 6— 2 6 day of 26 2017 SANCO DISTRIBUTING INC. Coi i ctor/Si cr (P'ir� RACHELLOVE Notary Public State of Indiana Si at ee of Contr etor i er or Its Agent My Commission Expires JOHN SANDERS May 16, 2025 Printed Name and Title 26TH Subscribed and sworn to before me this JUNE JUNE ej1 My Commission Expires O 0 102 County of Residence c} 0 b s q c V Cc 11 o U di tio p a) O U � � U U U V V G U V U a. U U U U U U U U U o�. 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V 3 X O Q O u aq App 33 O O y�y..�� N "� o .D '1J u y�j •any .v� c o 'a'o N ki q��+ PL ' o N N u Q n n m� D s D o o 'o,� N N c(Vtl N N N :.C4 o >' O •� O O D w u. �l w � � '°� a � D O o o a O �`` � s'' r•'' s1 � 7 � a 'a A a �q �C.� � v O ai A v O a� 6 ..� b D O o D bN N rl N A ❑ a N V v�p C Lit r� Ci7 p p`q C4 a:1 I cq c0 c4 i� C7 t7 C7 � � �` 5 � � a, c. a. a. w � V , o00000 O d� h u M n M rn M M M n M M m M d `Y hl M �n �O h o0 O� O .-. N m 7 4's �D t� 06 a O CI •i �Y 'mil �O h C 12 13 SANCO DISTRIBUTING INC. Bidder (Firm): Address: 919 N . OLIVE ST . City/State/Zip: SOUTH BEND IN 46628 Telephone Number: 574-282-281 0 BOARD OF PUBLIC WORKS Gary A. Gilot, President Suzanna M. Fritzberg, Member James A. Mueller, Member Fax Number: NIA By. JO' N SANDER'? ature) 14 PRESIDENT (Printed Name) (Title) Elizabeth A. Maradik, Member Therese J. Dorau, Member Attest: Linda M. Martin, Clerk (To be completed only by CoutractorsBidders clahning to be a "locallurliana business"pursuant to I.C. 36-1-12-22) INDIANA LOCAL BUSINESS PREFERENCE CLAIM A "local Indiana business" refers to any o/'the following: (1) A business whose principal place of business is located in an affected county, (2) A business that pays a majority cif its payroll (in dollar volume) to residents of affected counties. (3) A business that employs residents of affected counties as a tnajorio, of its employees. (4) A business that makes significant capital hwestrnents in the affected counties as defined in rules adopted by the political subdivision. (5) A business that has a substantial positive econotnic impact on the affected counties as defined by criteria in rules adopted by the political subdivision. An "af fecled county " refers to St. Joseph County, Indiana, or the follrnving counties located adjacent to St. Joseph County: Elkhart Corm> ,, Marshall County, Starke County and LaPorte Counq There are the following price preferences_ for supplies purchased, from a local Indiana business: • 5%,for a purchase expected by the purchasing agency to be less than $50,000 • 3% for a purchase expected by the purchasing agency to be (it least $50,000 Ind less than $100,000, • 1 % or a purchase e, ected b , the pm•chasitt a enc , to be at least $100, 000. Date: 06-26-17 Pursuant to I.C. 36-1-12-22, preference for Project South Bend, St. Joseph County, Indiana. claims a local Indiana business (Project # ) located within the City of 919 N. OLIVE ST. © The location of the principal place of business is (Address) © St. Joseph County, Indiana ❑ The following county located adjacent to St. Joseph County, Indiana: The majority of the business's payroll for the 12 months prior to the date of this Bid is to residents of St. Joseph County, Indiana or the adjacent county noted above. ® The majority of the business's employees for the 12 months prior to the date of this Bid are residents of St. Joseph County, Indiana, or the adjacent county noted above. If the business is deemed to be the apparent lowest, responsible, responsive bidder, then it shall provide supporting docurnentation for the 12 month period prior to the date of the Bid of (i) the total payroll arnount paid to all employees of the business, and (ii) the total payroll amount paid to employees who are residents of St. Joseph County and the adjacent county noted above. WHENSUPPLYING SUPPORTING PAYROLL RECORDS, BIDDER SHALL REDACT ALL SOCIAL SECURITY NUMBERS. Dated this day of 120 Contractor/Bidder (Firm) Signature of Contractor/Bidder or Its Agent Printed Name and Title M.