HomeMy WebLinkAboutOpening of Quotations - Bowen Street Drainage Improvements Project No. 116-082A - Selge Construction Co., Inc.l4ta-
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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 U00MA
MICHICAN
BERRIEN COUNTY
The undersigned Contractor, being duly sworn upon his/her/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
& 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:
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;
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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
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
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 MBEIVVBE 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 Contractors Bid for Public Works -16
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Firm:
Address:
City/State/Zip:
Selge Construction Co., Inc.
2833 S. 11th Street
Niles, MI 49120 Telephone Number: ( 269) 684-0842
Fax Number: ( 269 ) 684--0846
By��--.
(Signature)
Robert Kuhns, Project Engineer
(Printed Name of Person Signing)
Version 7/28/2016 Contractors Bid for Public Works - 19
This completed form should be supplied with Bids that pertain to City of South Bend Public Works Projects
requiring contacted MBEIWBE 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 1 OF 1
Project Number: 116-082A MBEIVVBE Participation Goal 7.1%
Project Name: Bowen Street Drainage Improvements
Bidder: Selge Cmstruction Co, Inc-
By7 1 �f - Robert Kuhns Project; Engineer 8/22/17
(Signature) (Title) (Date)
MBE/WBE Firm State Barricading, Inc.
Owner or Contact at MBEAMBE Firm Mary
Telephone: 574-287-2078 Fax: 574-287-1744 Email: statebarricad1@aol.corn
TYPE OF WORK SOLICITED FOR THIS PROJECT:
Accepted Bid
RESULTS OF CONTACT WITH THE MBE/WBE FIRM:
MBEIWBE Firm
Owner or Contact at MBE/WBE Firm
Telephone: Fax: Email:
TYPE OF WORK SOLICITED FOR THIS PROJECT:
RESULTS OF CONTACT WITH THE MBE/WBE FIRM:
Version 7/28/2016 Contractor's Bid For Public Works - 23
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MERCHANi7s_7�k
BONDING COMPANY,.
POWER OF ATTORNEY
Know All Persons By These Presents, that MERCHANTS BONDING COMPANY (MUTUAL) and MERCHANTS NATIONAL BONDING, INC.,
both being corporations of the State of Iowa (herein collectively called the "Companies") do hereby make, constitute and appoint, individually,
Connie J Messer; Dawn M Pequignot; Elaine K Miller; Harold E Everett; J Kevin Hughes; Jada M Karst; Jessica K Callahan; Marie E Comparet;,
Melinda Jagger; Thomas J VanDyck; Tom McGovern
their true and lawful Altorney(s)-in-Fact, to sign Its name as surety(ies) and to execute, seal and acknowledge any and all bonds, undertakings,
contracts and other written instruments In the nature thereof, on behalf of the Companies in their business of guaranteeing the fidelity
of persons, guaranteeing the performance of contracts and executing or guaranteeing bonds and undertakings required or permitted in any
actions or proceedings allowed by law.
This Power -of -Attorney is granted and is signed and seated by facsimile under and by authority of the following By -Laws adopted by the Board
of Directors of Merchants Bonding Company (Mutual) on April 23, 2011 and amended August 14, 2015 and adopted by the Board of Directors
of Merchants National Bonding, Inc., on October 16, 2015.
"The President, Secretary, Treasurer, or any Assistant Treasurer or any Assistant Secretary or any Vice President shall have power and authority
to appoint Attorneys -in -Fact, and to authorize them to execute on behalf of the Company, and attach the seal of the Company thereto, bonds and
undertakings, recognizances, contracts of indemnity and other writings obligatory in the nature thereof."
"The signature of any authorized officer and the seal of the Company may be affixed by facsimile or electronic transmission to any Power of Attorney
or Certification thereof authorizing the execution and delivery of any bond, undertaking, recognizance, or other suretyship obligations of the
Company, and such signature and seal when so used shall have the same force and effect as though manually fixed."
In connection with obligations in favor of the Florida Department of Transportation oniy, it is agreed that the power and aut hority hereby given to the
Attorney -in -Fact includes any and all consents for the release of retained percentages and/or final estimates on engineering and construction
contracts required by the State of Florida Department of Transportation. It is fully understood that consenti ng to the State of Florida Department
of Transportation making payment of the final estimate to the Contractor and/or Its assignee, shall not relieve this surety company of any of
its obligations under its bond.
In connection with obligations in favor of the Kentucky Department of Highways only, it is agreed that the power and authority hereby given
to the Attorney-tn-Fact cannot be modified or revoked unless prior written personal notice of such intent has been given to the Commissioner -
Department of Highways of the Commonwealth of Kentucky at least thirty (30) days prior to the modification or revocation.
In Witness Whereof, the Companies have caused this instrument to be signed and sealed this 14th day of July 2017
`, APOR �O t '•O�� [PO/�p9• MERCHANTS BONDING COMPANY (MUTUAL)
C.� 9� •�4 • MERCHANT NATIONAL BONDING, INC.
2003 ; �� : y 1933 By
';d�••. .� N,•'" •.may e •;,ace:' 6�
.�r.'�'�I•'••�j`..•'.h`•�•r •r+i•• •\`r• President
STATE OFIOWA ••'lrrrr[.x•' •�•rrr••
COUNTY OF DALLAS ss.
On this this 14th day of July 2017 before me appeared Larry Taylor, to me personally known, who being by me duly sworn
did say that he is President of MERCHANTS BONDING COMPANY (MUTUAL) and MERCHANTS NATIONAL. BONDING, INC.; and that the
seals affixed to the foregoing instrument are the Corporate Seals of the Companies; and that the said instrument was signed and sealed in behalf
of the Companies by authority of their respective Boards of Directors, _
�R At s ALIC[A EGRAMCommission N7430'[° c My Commisres April
Notary Public
(Expiration of notary's commission
does not invalidate this instrument)
I, William Warner, Jr., Secretary of MERCHANTS BONDING COMPANY (MUTUAL) and MERCHANTS NATIONAL BONDING, INC., do hereby
certify that the above and foregoing is a true and correct copy of the POWER -OF -ATTORNEY executed by said Companies, which is still in full
force and effect and has not been amended or revoked.
In Witness Whereof, I have hereunto set my hand and affixed the seal of the Companies on this 22nd day of August 2017
�..+P�10 Nq� •.,�� •, • ��tyG Cph•.
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2003 1933� Secretary
POA0018(3/17) ••''''■,[•"'x` •••rr••••