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HomeMy WebLinkAboutOpening of Quotations - Alley Drywall Install (Near St Vincent and Notre Dame Ave) Proj No 117-101 - HRP Construction Inc.8;& t r- j 00 V s " .! .' James A. Mueller, Member Attest: Linda M, Martin, Clerk Version 10118/2016 Page - 7 Public Works Quote ll'hell the prospective Contractor is unable io cedify to airy of the statements below, it shall attach an expin►urilon to thisAf davit. 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: I. 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 fiom 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 tinre-to-tune, 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. 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 Version 10/1812016 Page - 8 Public Works Quote 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/lier/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 fiom 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 Version 10/1812016 Page - 9 Public Works Quote MO . . . . . . . ..... n 4w m ri � P. �l P, - =7 acoR®® CERTIFICATE OF LIABILITY INSURANCE DATE[MMIDDfYYYY) 8/28/2017 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 CONTACT Ellie Lloyd NAME: Y Gibson Insurance Agency, Inc. [AlCDNN ,EKt• (800)814-2122 FAX arc No:(aOo)836-212z„ ... ... 130 S Main St, Ste 400 £-MAILADDRESS;elloyd@gibsonins.com PO Box 11177 -.. __--...., ._.. _.... INSURER(S) AFFORDING COVERAGE NAIC # South Bend IN 46601-0177 INSURFRAAmerisure Mut Ins Co 23396 INSURED INSURER B HRP Construction Inc. INSURERC: 5777 Cleveland Rd _ INSURER D : PO Box 266 INSU_RERE: _ South Bend IN 46624-0266 1 INSURER F: -- -- _— rnVFRAnFS r.FRTIFIr:ATFNiIMRFR,9-1-17/18 Liabilitv RFVISIr1NNIIMRI=R- 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. ILTR ADS L $-fTDD .....� PODGY Ni1MBER��.__ ,..-_-.....,-._......_... TYPE OF INSURANCE OLICY EFF POLICY EXP LIMITS MIDDIYYYY MMIDDIYYYY X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A _ CLAIMS -MADE lil OCCUR DAMAGE TO RENTED PREMISES occurrence $ �1 000 D00 • MED EXP (Any one person) $ 10 , 000 XCG CPP20316441202 9/1/2017 9/1/2018 PERSONAL& ADV INJURY $ 1,000,000 X Contractual Liability AGGREGATE €.IM)T APPLIES PER: GENERAL AGGREGATE $ 2,000,000 GEN'L PRO- POLICY X JECT LOC I PRODUCTS - COMPIOPAGG ....._.`- $ 2,000,000 _- -- 5 OTHER, I AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea apgden! $ 1,000,000 BODILY INJURY (Per person) $ A X ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS CA20316451202 9/1/2017 9/1/2018 BODILY INJURY (Per accident) $ X NON -OWNED HIRED AUTOS X AUTOS PROPERTY DAMAGE ,[i'er_accidenli_ $ $ X UMBRELLA LIg6 X OCCUR EACH OCCURRENCE $ 10000 000 $ 10 Opp 000 A EXCESS LIAB CLAIMS -MADE DED I X I RETENTION 0 _AGGREGATE $ CU20316431102 9/1/2017 9/1/2018 WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN I X PER pTH- STATUTE ER E.L. EACH ACCIDENT .--.,.,_._,_.,..._.,__......-..__.._.,.____ E.L. DISEASE - EA EMPLOYE __.._.._ $ 1,000,000 _..� $ 1 000, 000 A ANY PROPRIETORIPARTNERIEXECUTlVE OFFICERIMEMBER EXCLUDED? n {Mandatory in NHI NIA WC20316421102 I 9/1/2017 9/1/2018 If yes, deswba under DESCRIPTION OF OPERATIONS below States of IN E MI E.L. DISEASE - POLICY LIMIT $ 1 000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached it more space is required) Certificate holder is additional insured with respect to general liability coverages regarding work performed by the insured. CFRTIFICATF Hrll_DFR CANCFI I ATinm (574)235-9171 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City Of South Bend THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Board of Public Works ACCORDANCE WITH THE POLICY PROVISIONS. 1316 County --City Building AUTHORIZED REPRESENTATIVE 227 West Jefferson South Bend, IN 46601 G Ins Agency/ELLIE ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD INS025 19014011 1316 COUNTY-Crry 13UILDING 227 W.JGFURSON Boom. VARD SoUi'H 13r;ND, INDIANA 46601-1830 niom 574/235-9251 PAX 574/235-9171 TDD 574/235-5567 CITY OF SOUTH BEND PETE BUTTIGIEG, MAYOR BOARD OF PUBLIC WORKS Date: _September 21, 2017 To: All Planholders From Linda M. Martin, Cleric, Board of Public Works Subject Addendum Number: 1 Project Name: Alley Drywell Install (Near St. Vincent and Notre Dame Ave.) Project Number: I1.7-10I ACKNOWLEDGEMENT OF RECEIPT OF ADDENDUM Date Received: qa]l 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 within 4$ hours of receipt. A copy MUST also be included with your bid package upon submittal. THIS ADDENDUM MAY AFFECT YOUR BID. Notes: The attached documents are hereby added to the Specifications and Contract Documents and become a part of herein. Company: (I 'L t c Authorized Signature: Date: Q�cA ! Ve,rsimi 4/2/2015