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HomeMy WebLinkAboutOpening of Quotations - Bowen Street Drainage Improvements Project No. 116-082A - HRP Construction Inc.'I'll 9 Avi* III A 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 AFFIDAVIT, NON -DEBARMENT AFFIDAVIT, EMPLOYMENT ELIGIBILITY VERIFICATION, NON-DISCRIMINATION COMMITMENT FOR CONTRACTORS 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 histher/its oath, affirms under the penalties of perjury that: 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; Version 7/28/2016 Contractors Bid for Public Works - 15 and (ii) at the time the financial institution extends credit, is a person identified on list published by the Indiana Department of Administration. 4. Contractor does not knowingly employ or contract with an unauthorized alien, nor retain any employee or contract with a person that the Contractor subsequently learns is an unauthorized alien. Contractor agrees that he/she/it shall enroll in and verify the work eligibility status of all of 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 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 MBENVBE; however, it may not unlawfully discriminate against said WBE/MBE. A finding of a discriminatory practice by the City's MBENVBE 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. Version 7/28/2016 Contractor's Bid for Public Works - 16 ins M. W ��� w•i �' spa w IM mllov YMI W. n E~=L r[ri QUOTEIPROPOSAL. , « CITY OF SOUTH BEND u PROJECT NAME Bowen Street Drainage Improvements PROJECT NO. QUOTES DUE 116-083A Auaust 22. 2017 -- 9:30 AM EST Responding Firm Name: Item No. Description Quantity Unit Unit Price Total Amount I Construction Engineering LS 1 $ �, ��a • v o $ a,� ao. c�v 2 Mobilization and Demobilization LS 1 $ $ o,'fCJO.oc7 a,Yoo. vD 3 Clearing Right of Way LS 1 $ $ 1, 000- 00 1r t700. od 4 Pavement, Remove SYS 224 $ $ 1a. op a, c��8. oa 5 Curb, Concrete, Remove LI-7 20 $ $ 1S,Qo 300.00 6 Excavation, Common 1,S 1 $ a, 000. ao $ a, onv . no 7 Structure Backfill LS 1 $ $ 1. co, oo 8 Compacted Aggregate, No. 53 Base TON 50 $ $ asap 1, a so. 00 9 HMA, Surface, Typc B, 9.5 mm TON 25 $ $ 13c�.vo 3 d5d•cao ' 10 I-IMA, Base, Type B, 19.0 mm TON 74 $ go.�o $ s,4a�.nU I I Curb, Concrete LFT 20 $ ,<aspa $ a, sa�.na 12 Geotextiles SYS 300 $ $ 13 1500 Gal. Drywell Structure EACH 4 $ $ sue,. oa ale,ap0- as 14 Casting, Furnish and Adjust to Grade, EACH 4 $ �{ `Y. .t7U $ �, �dp• DO Drywell 15 Pipe, Circular, 8 IN LFT 40 $ 3 y. oa $ 1, 3lon • o0 16 Vowel, Pole Support DAY 6 $ $ 17 Maintenance of Traffic LS 1 $ 475.no $ $7S.ao Total Amount of Quote $ S(p, yy9 t7O HRP CONSTRUCTION INC. Version 7/28/2016 Contractor's Bid for Public Works - 18 n � h V? �a MINORITY AND WOMEN BUSINESS ENTERPRISE DIVERSITY DEVELOPMENT PROGRAM The City of South Bend, Indiana has shown its commitment to addressing Minority Business ("MBE") and Women's Business Enterprise ("WBE") participation in public contracting through the adoption of the City of South Bend Ordinance No. 10081-11. Persons, partnerships, corporations, associations, or joint ventures 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 or disability that does not affect that person's ability to perform work. The goal for MBENVBE participation for the purchase of work, labor, services, supplies, equipment, materials, or any combination in this project is 7.1% of the total bid amount, whether it be base bid or base bid plus alternate(s). Minority and Women's Businesses are described on the Indiana Department of Administration website: http://www.in.gov/idoa/ . 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. Documentation shall be provided with the bid that states the MBENVBE that will be contracted, the dollar amount of the work that will be performed on the project and the percentage of the dollar amount as it relates to the total bid amount by using Form MWBE-1.0, Proof of MBENVBE Participation Goal Form. In the event the bidder cannot meet the MBENVBE participation goal set for this project, the award of the contract under public bidding laws or other contracts in which public bids are not required by law, the City, its agencies, boards, or commissions requires the Contractor's good faith efforts to obtain participation by those Contractors classified as a Minority Business ("MBE") or as a Women's Business Enterprise ("WBE"). Failure to either meet the MBENVBE participation goal set forth in this project or provide ALL the required evidence of good faith efforts with the bid will be grounds for rejecting a bid as non -responsive. The requirements that bidders shall supply as good faith efforts to have active participation from MBEs and/or WBEs on this Project is written documentation evidencing the efforts by using Form MWBE-2.0, Evidence of Good Faith Efforts and Form MWBE-2,1, MBENVBE Contacted. Such documentation shall include but is not limited to the following items: a. A listing of all MBENWBEs contacted including: (1) the name and address of the MBENVBE; (2) the date of contact; (3) the type of contact (i.e. phone call, written solicitation, etc.); (4) the nature or type services or goods requested; and (5) the result of the contact. b. Written evidence of outreach and copies of email exchanges inviting and receiving quotes or other responses from MBENVBE businesses or other documentations of efforts to encourage and secure competitive quotes from MBENVBE and local businesses to be included in the benefits of building this Project. c. Written documentation of letters of introduction, invitations to forging majority/minority strategic alliances for capacity building including but not limited to mentoring, extensions of assistance on payroll, insurance, bonding, line of credit, technical skills or business skills. All bidders are actively encouraged to reach out to the MBENVBE businesses in St. Joseph County, Indiana and other local Indiana counties to utilize a good faith effort to forge constructive and lasting business partnerships. Notwithstanding the foregoing, the award and performance of all City contracts shall comply with applicable federal, state, and local laws. Version 7/2812016 Contractor's Bid for Public Works - 20 I k+ S y w Bowen Street Drainage Improvement, South Bend, IN BIDDER: HRP CONSTRUCTION INC Contractor List from IDOA's MWWBE Certified Businesses MBEIWBE CONTACTED - Attachment to Form MWBE-2.1 Company Name and Address Owner or Contact Phone Fax Email Address Type of Work Solicited Results of Contact Global Land Surveying, LLC, 413 Hesham Construction No quote W. Coolspring, Michigan City, IN Khalil, PLS 219 872 4444 219 879-9920 Engineering received Highway Safety Service, Inc., P.O. mike. madrid hs Traffic No quote Box 4697 Lafayette, IN Mike Madrid 765 474-1000 s-mmco.com Maintenance received ,Indiana Sign & Barricade, 5240 E. Kirby kfaulkner(abindia Traffic No quote j 25th Street Indianapolis IN Faulkner 317 377-8000 317-377-8008 naSB.com Maintenance received ` statebarricbarrio adel Traffic Quote State Barricading, Inc., 24963 US Mary m receivedQaoLco- �20 West, South Bend, IN Michalski 574-287 2078 574 287-1744 Maintenance used in bid 1 ITraffic Control Specialists, Inc., 305 tcs tcspecialist Traffic No quote tW. Hamilton Dr., Knox, IN Barry Triska 574-772-7001 574-772-7002 s.net Maintenance received i N&R Trucking, 1845 N. Elmer, Veda No quote `South Bend, IN Goddette 574-234-1268 574-234-0748 Trucking received D M W B B B E E E Bowen Street Drainage RFQ TRACKING COMPANY PHONE FAX Abonmarche Consultants, Inc, Farmer Tank Ferguson Waterworks Global Land Surveying, LLC HD Supply Waterworks Highway Safety Service, Inc. I Indiana Sign & Barricade JPR Jones Petrie Rafinski Corp. Klink Trucking, Inc. Rieth-Riley Construction I I 'State Barricading, Inc. I I Traffic Control Specialists, Inc. I I V & R Trucking, Inc. Walsh & Kelly, Inc. 574-232-8700 574-251-4440 574-264-4625 574-264-6287 574-282-2323 574-287-9523 219-872-4444 219-879-9920 574-231-8739 574-231-8794 765-474-1000 317-377-8000 317-377-8008 574-232-4388 574-232-4333 574-287-9000 574-287-2300 574-288-8321 574-233-3464 574-287-2078 574-287-1744 574-772-7001 574-772-7002 574-234-1268 574-234-0748 574-288-4811 574-289-7174 8/17/2017 Email mrozycki(a.abonmarche.com gdfarmer@frontler.com iohn.waller@fecguson.com danntraeaer(oOdsupply.com mike. madridAhss-mmco.com kfaulkner(@IndianaSB.com kbowmariftprl source.com NShanahan@kllnktrucking.com imccorm ick@ rieth-ri ley.com statebarricadel aol.com barry(a)tcspecialists. net: tcs(5)tcspecialists.net dustinh@waishkelly.com Page 1 of 1 Julie Jackson From: Microsoft Outlook To: 'statebarricade1@aol.com`; `jmccormick@rieth-riley.com; `nshanahan@klinktrucking.com; 'dustinh@walshkelly.com'; 'tcs@tcspecialists.net' (tcs@tcspecialists.net); 'barry@tcspecialists.net' (barry@tcspecialists.net); 'kbowman@jpr1source.com; John.walter@ferguson.com;'gdfarmer@frontier.com'; Michael Rozycki (mrozycki@abonmarche.com); 'kfaulkner@indianaSB.com'; Highway Safety Service, Inc.; 'dan.traeger@hdsupply.com' Sent: Thursday, August 17, 2017 2:41 PM Subject: Relayed: Bowen Street Drainage Improvements, South Bend, IN - Request for Quote Delivery to these recipients or groups is complete, but no delivery notification was sent by the destination server: 'statebarricadel@aol.com' (statebarricadei@aol.com) Jmccormick@rieth-riley. com' (Imccormick@rieth-riley.com) 'nshanahan@klinktrucking.com' (nshanahan@klinktrucking.com) 'dustinh(aa)waishkelly.com' (dustinh(dwalshkelly.com) 'tcs tcspecialists.net' (tcs( tcspecialists.net) (tcs(c tcspecia lists. net) 'barryCa1tcspecialists. net' (barty( tcspecialists.net) (barry(a)tcspecialists. net) 'kbowman@jprlsource.com' (kbowman@jprlsource.com) John.walter@ferguson.com' (iohn.walter@ferguson.com) ' dfarmer frontier.com' Cqdfarmer@fro.ntier.com Michael Roz cki mroz cki abonmarche.com) C.mrQzycki@abonmarche.com 'kfaulkner indianaSB.com' (kfaulkner@indiana.SB..com Highway Safety Service Inc. mike.madrid hss-mmco.com 'dan.traeger@hdsupply.com' (dan.traeger@hdsupply.com) Subject: Bowen Street Drainage Improvements, South Bend, IN - Request for Quote I Bowen Street Drainage Impro... Julie Jackson From; Scan@HRPConstruction.com Sent: Thursday, August 17, 2017 2:52 PM To: Julie Jackson Subject: TASKalfa 3551ci Job end report mail Attachments: 060338.pdf Job No.: 060338 Result: OK End Time: Thu 17 Aug 2017 14:51:57 File Name: Bowen St. Drainage -Request for Quote.pdf Category: Sending Jobs Result Job Type Address OK FAX Global Land Surveying OK FAX V & R Trucking .C& HRP CONSTRUCTION EXCAVATING•SEWERS•WATERMAINS rr' v�`o7hin9 Jo .LSE of cS'wiaz" REQUEST FOR QUOTE FROM: Joe Saggars PHONE: 574-271-7800 EMAIL: joes@hrpconstruction.com FAX: 574-271-0524 Please quote any work in your field associated with the following m ect. PROJECT: Bowen Street Drainage Improvements TYPE OF PROJECT: Draina a and street improvements. South Bend, Indiana David McCormick, PE, McCormick Engineering LLC, 574-232--6800 Monday, August 21, 2017 by 2:00 PM August 22, 2017 LOCATION: ENGJARCH: QUOTES DUE: BIDS: Plans and Specs are available via Dropbox (free to sign up). Click HERE or email us for download information. This bid has the following DBE goals, please do your part to meet these goals. 7.1 % MIWBE % DBE None Notes/Comments: IF YOU ARE RECEIVING THIS RFQ VIA FAX AND WOULD PREFER EMAIL, PLEASE INDICATE YOUR EMAIL ADDRESS BELOW PLEASE COMPLETE INFORMATION BELOW AND FAX OR EMAIL BACK ASAP. COMPANY: PHONE: CONTACT: FAX: EMAIL: ❑ We plan on bidding the following on this project: Please provide a scope sheet as soon as possible. ❑ We will NOT be bidding on this project. We are a state qualified ❑ MBE ❑ WBE ❑ DBE Shipping: 5777 Cleveland Road South Bend, IN 46628-9418 Phone 574-271-7800 Mailing: P.O. Box 266 South Bend, IN 46624-0266 FAX 574-271-0524 State Barricading Inc "The Road To Success Is Always Under Construction" 24963 US 20 West South Bend, Indiana, 46628 Phone: 574 287-2078 Fax: 574 287-1744 Quote Date: 8121 /2017 Job Bowen Street Drainage Improvements, Project No, 116-082A rr.>•.v>tx:t:ra� Qty Item # Description Unit Price Discount Maintenance Of Traffic - Consists Of 2 Construction Signs, A For Duration Of Project (30 Calendar Days), 1 LS 17 Type lit Barricades, Road $875.00 Lump Sum Closure Sign Assemblies & Labor For Set-Up/Pick Up Of Road Closure On Bowen St (Approximately 6 Calendar Days) Drums, if Needed. (Not Shown On Plan) $0.60 Per Day, Each Llne Total $875.00 WBE/DBE*Equal Opportunity Employers *Indiana L aborars *A TSSA Certified* ISN Certified Subtotal $875.00 Thl'u?k Vol.,P for I Uo p m I t! I o qoods na �T I 'td 'im b I d lj�.;! i i Dol"1; 0." m r." E4md �Gllr p,, koi nu pi I t i : 3 t I llll" Qt-'Wml h0lro i 00' wo0`Lz0°z nn • ngin`Q0Q 67 uraged to respond to this n tifi ton. A e-Bid Conference will e held n August 22, 201 at 11:00 - .m Local Time the County- ity Building oom 1316, . 22 West Jeffers n Blvd, South Be d, Indian 46601.. Any questi s. abo bidding' conditions M st b addressed to Corbitt Kerr t kerr@south bendin.gov in sting no late than 5:00 p.m n Septem be 1, 2017. The Board r erve the right to reject any o all bids to accept a full or p tial awar f the bid or bids hlch, in its j dgment, will be o the best int ests of the C' of South Ben.If the Boar elects to award th base bid' plus an alternates), the B rd will look at the totali of t e cost when determining he :Tribune is HRP Construction Inc., an' EE} :Employer, is :seeking proposals from qualified MBE/WBE/DBE businesses for the City of South 3/4 El Bend, IN; Bowen Street Drain- up to, age Improvements, Project No. ing, 116-082A, which has a 7.1 % (260)! goal of MBE/WBE use. This ; project bids on Tuesday, August 22, 2017 at 9:30 ;a.rnAil pro- posals must be received prior to noon on August 21,'2017 and must be per the contract docu- 7 ments. Anyone interested in bid.- Shepl -ding on any part of this project tan a\ should contact Joe Saggars by both phone at 574-271-7800 or by fax Dam - at 574-271-0524. Project docu- line. ments are available for review at heart .our office at 5777 Cleveland Rd, (812) South Bend, IN 46628 or e-mail Joe at estimating@hrpconstruc- tion.com. Hspaxlp 1t 8:18 t !1 # Fi:.:."L..�aoa�. .,�, "i'S. k`.; `-. ••:- ZURICH AMERICAN INSURANCE COMPANY COLONIAL AMERICAN CASUALTY AND SURETY COMPANY FIDELITY AND DEPOSIT COMPANY OF MARYLAND POWER OF ATTORNEY KNOW ALL MEN BY THESE PRESENTS: That the ZURICH AMERICAN INSURANCE COMPANY, a corporation of the State of New York, the COLONIAL AMERICAN CASUALTY AND SURETY COMPANY, a corporation of the State of Maryland, and the FIDELITY AND DEPOSIT COMPANY OF MARYLAND a corporation of the State of Maryland (herein collectively called the "Companies"), by MICHAEL BOND, Vice President, in pursuance of authority granted by Article V, Section 8, of the By -Laws of said Companies, which are set forth on the reverse side hereof and are hereby certified to be in full force and effect on the date hereof, do hereby nominate, constitute, and appoint Barbara E. PE ARSON, Nicole L. BICKNELL, Marla E. WOBBE, Debra K. HULL, Jennifer L. KASZNIA, William J. CERNEY,111, Theresa M. BURNS and Megan E. RIESENBERG, all of South Bend, Indiana, EACH its true and lawful agent and Attorney -in -Fact, to make, execute, seal and deliver, for, and on its behalf as surety, and as its act and deed: any and all bonds and undertakings, and the execution of such bonds or undertakings in pursuance of these presents, shall be as binding upon said Companies, as fully and amply, to all intents and purposes, as if they had been duly executed and acknowledged by the regularly elected officers of the ZURICH AMERICAN INSURANCE COMPANY at its office in New York, New York., the regularly elected officers of the COLONIAL AMERICAN CASUALTY AND SURETY COMPANY at its office in Owings Mills, Maryland., and the regularly elected officers of the FIDELITY AND DEPOSIT COMPANY OF MARYLAND at its office in Owings Mills, Maryland., in their own proper persons. The said Vice President does hereby certify that the extract set forth on the reverse side hereof is a true copy of Article V, Section 8, of the By -Laws of said Companies, and is now in force. IN WITNESS WHEREOF, the said Vice -President has hereunto subscribed his/her names and affixed the Corporate Seals of the said ZURICH AMERICAN INSURANCE COMPANY, COLONIAL AMERICAN CASUALTY AND SURETY COMPANY, and FIDELITY AND DEPOSIT COMPANY OF MARYLAND, this ] 4th day of April, A.D. 2016. ATTEST: ZURICH AMERICAN INSURANCE COMPANY COLONIAL AMERICAN CASUALTY AND SURETY COMPANY FIDELITY AND DEPOSIT COMPANY OF MARYLAND SAL llatl� 4M,e. 4y71•�. ..s��,s BY cto i Secretary Vice President Michael McKibben Michael Bone! State of Maryland County of Baltimore On this 14th day of April, A.D. 2016, before the subscriber, a Notary Public of the State of Maryland, duly commissioned and qualified, MICHAEL BOND, Vice President, and MICHAEL MCKIBBEN, Secretary, of the Companies, to me personally known to be the individuals and officers described in and who executed the preceding instrument, and acknowledged the execution of same, and being by me duly sworn, deposeth and saith, that he/she is the said officer of the Company aforesaid, and that the seals affixed to the preceding instrument are the Corporate Seals of said Companies, and that the said Corporate Seals and the signature as such officer were duly affixed and subscribed to the said instrument by the authority and direction of the said Corporations. IN TESTIMONY WHEREOF, 1 have hereunto set my hand and affixed my Official Seal the day and year first above written tt�)tf.�• i'pp��f ti l p{ t 5 f�hf 11N55 Maria D. Adatnski, Notary Public My Commission Expires: July 8, 2019 POA-F 044-4495 AC40 �® CERTIFICATE OF LIABILITY INSURANCE ATE Da/�7/zo17YI THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE. CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTANAME: Stacy Christlieb Gibson Insurance Agency, Inc. 130 S Main St, Ste 400 PHONE HONN E,ep. (800) 814-2122 l FAX NoF: (800)836-2122 E-MAIL s.schristlieb@gibsonins.comADDRES PO Box 11177 INSURERS) AFFORDING COVERAGE NAIL p INSURERAAmerisure Mut Ins Co 23396 South Bend IN 46601-0177 INSURED INSURER B : INSURERC: HRP Construction Inc. iNSURERD:- 5777 Cleveland Rd INSURER o- -- ---._ PO Box 266 INSURERF: South Send IN 46624-0266 COVERAGES CERTIFICATE NUMBER:9-1-16/17 RFVISICIN NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR '_......................... _.__,,,_�_�_ TYPE OF INSURANCE A D 5 $�0_R _____,_-✓____W_-- POLICY NUMBER POLICY EFF MMIDDlYYYY POLICY EXP MMIDDIYYYY LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A = CLAIMS -MADE X OCCUR DAMAGE FO RENTEP PREMISES (Ea occurrence § 1,000,000 * MED EXP (Any one person) _ $ 10,000 XCU CPP20316441202 9/1/2016 9/1/2017 X Contractual_Liabil4y PERSONAL $ 1,000,000 _&ADVINJURY GENERAL AGGREGATE S 2,000,000 Gl- NTAGGREGATELIMITAPPLIESPER: POLICY X JECT LOC. PRODUCTS-COMPIOPAGG $ 2,000,000 OTHER' AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident],,,_„�, S 1r � 000 000 _ BODILY INJURY (Per person) $ `A X ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS I.,..... rn70316451202 9/1/2016 9/1/2017 BODILY INJURY (Per accident) $ X WIRED AUTOS X NON -OWNED AUTOS PROPERtY DAMAGE Per accident $ X UMBRELLA LIAB X OCCUR EACH OCCURRENCE .. $ 10 000 000 _1........_.._..c. AGGREGATE $ 10,000,000 EXCESSLIAB I CLAIMS -MADE $ �DED X I RETENTIONS 0 CU20316431102 9/1/2016 9/1/2017 WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN X STATUTE ORTH E.L. EACH ACCIDENTENT $ 1 000 000 A. ANY PROPRIETORlPARTNERIEXECUTIVE OFFIC£RIMEMBER £XCLUO£0? (Mandatory In NHI NIA WC203164211 9/1/2016 I € 9/1/2017 -D'-'''� EL DISEASE - EA EMPLOYE ---'-'-"""'--- $ 1,00() 000 L" —..'-- It yas, descohe undar DESCRIPTION OE OPERATIONS below I States of IN t: MI E,L- DISEASE - POLICY LIMIT 1 $ 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space Is required) Project: Bowen Street Drainage Improvements, 116-082A. Certificate holder is additional insured with respect to general liability coverages regarding work performed by the insured. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE The City of South Bend THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 1316 County -City Building ACCORDANCE WITH THE POLICY PROVISIONS. 227 W. Jefferson Blvd. AUTHORIZED REPRESENTATIVE South Bend, IN 46601 r G SnS Agency/STACYC ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD INS025 001401)