HomeMy WebLinkAboutOpening of Quotations - Alley Drywall Install (Near St Vincent and Notre Dame Ave) Proj No 117-101 - John Boettcher Sewer & ExcavatingrM �717 717 7.171,
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James A. Mueller, Member
Attest: Linda M. Martin, Clerk
Version 10118/2016 Page - 7 Public Works Quote
When the prospective Contractor is tellable to certify to any of the slatements below, it shall attach #n explanation to thisAfflrlavit.
CONTRACTOR'S NON -COLLUSION AND NON -DEBARMENT AFFIDAVIT,
CERTIFICATION REGARDING INVESTMENT WITH IRAN, EMPLOYMENT ELIGIBILITY
VERIFICATION, NONDISCRIMINATION 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 OFT Qi )
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# Tos�1n COUNTY }
The undersigned Contractor, being duly sworn upon his/her/its oath, arms under the penalties of perjury that:
1. Contractor has not, nor has any other member, representative, or agent of the filar,
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.S-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.
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 10118/2016 Paige - 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/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
fiom 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-I). 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 10118/2016 Page - 9 Public Works Quote
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 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 OLP m day of�.,,., 20-7
C tra tor/Bidder (Firm)
Siva tor,
a ContractorBi der or Its Agent
rimed Name and Title
Subscribed and sworn to before me this dtP' day of f"em , 2D E7
My Commission Expires y'
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Notary Public
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Version 10/18/2016 Page -10 Public Works Quote
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Liberty
MUtUa � The Ohio Casualty Insurance Company
suaETY BID OR PROPOSAL BOND
KNOW ALL MEN BY THESE PRESENTS, That we, John Boettcher Sewer & Excavating Contractor LTD
of 3305 N. Home St., Mishawaka, IN 46545
(hereinafter called the Principal) as Principal, and The Ohio Casualty Insurance Company _, with its principal
office in the City of Keene , New Hampshire (hereinafter called the Surety), as Surety, are held and
firmly bound unto City of South Bend, Department of Public Works
of 227 W. Jefferson St., South Bend, IN 46601
(hereinafter called the Obligee) in the penal sum of 5%
Dollars 5% lawful money of the United States, for the payment of which sum well and truly to be made,
we bind ourselves, our heirs, executors, administrators, successors, and assigns.
THE CONDITION OF THIS OBLIGATION IS SUCH, that whereas, the Principal has submitted the accompanying
bid dated September 26, 2017 for Alley Drywell Install near St. Vincent & Notre Dame Ave)
Project No. 117-101
NOW, THEREFORE, if the Obligee shall make any award according to the terms of said bid and the Principal shall
enter into a contract with said Obligee in accordance with the terms of said bid and give bond for the faithful performance
thereof within the time specified; or if no time is specified within thirty days after the date of said award; or if the Principal
shall, in the case of failure so to do, indemnify the Obligee against any loss the Obligee may suffer directly arising by reason
of such failure, not exceeding the penalty of this bond, then this obligation shall be null and void: otherwise to remain in full
force and virtue.
Signed, sealed and dated: September 25, 2017 _
By:
By:
John Boettcher Sewer & Excavating Contractor, LTD
(Principal)
S-] 37-Rev.
POWER OF ATTORNEY
The Ohio Casualty Insurance Company Bond Number:
Prindpal:John Boettcher Sewer & Excavating Contractor, LTD
Agency Name: RICHARD S. MILLER & SONS INC
Obligee: CitV of South Bend Department of Public Works Agent Code:133847
Know All Men by These Presents: That The Ohio Casualty Insurance Company, pursuant to the authority granted by Article IV, Section 12 of the Code of Regulations and
By -Laws of The Ohio Casualty Insurance Company, do hereby nominate, constitute and appoint: Christian L. Barnes; Gregory S. Miller of BREMEN, Indiana its true and lawful
agent(s) and attorney(ies)-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, UNDERTAKINGS, and
RECOGNIZANCES, excluding, however, any bond(s) or undertaking(s) guaranteeing the payment of notes and interest thereon.
And the execution of such bonds or undertakings in pursuance of these presents, shall be as binding upon said Company, as fully and amply, to all intents and purposes, as if
they had been duly executed and acknowledged by the regularly elected officers of said Company at their administrative offices in Keene, New Hampshire, in their own proper
persons. The authority granted hereunder supersedes any previous authority heretofore granted the above named attorney(ies)-in-fact.
Ili WITNESS WHEREOF, the undersigned officer of the said The Ohio Casualty Insurance Company has hereunto subscribed his name and affixed the Corporate Seal of
said Company this 26th day of September, 2016.
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tAa David M. Carey, Assistant Secretary
STATE OF PENNSYLVANIA
COUNTY OF MONTGOMERY
On this 26th day of September, 2016 before the subscriber, a Notary Public of the State of Pennsylvania, in and for the County of Montgomery, duly commissioned and qualified,
came David M. Carey, Assistant Secretary of The Ohio Casualty Insurance Company, to me personally known to be the individual and officer described in, and who executed the
preceding instrument, and he acknowledged the execution of the same, and being by me duly sworn deposes and says that he is the officer of the Company aforesaid, and that the
seal affixed to the preceding instrument is the Corporate Seal of said Company, and the said Corporate Seal and his signature as officer were duly affixed and subscribed to the said
instrument by the authority and direction of the said Corporation.
IN TESTIMONY WHEREOF, I have hereunto set my hand and affixed my Official Seal at the City of King of Prussia, State of Pennsylvania, the day and year first above
written.
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Q� �poHW �f COMMONWEALTH OF PFNNSYLVANIANut
astanal Seal /
OF Teresa Pastella, Notary PnhEiC
Lipper Mefion Twp., Montgomery County
NSY1r,si JU My Commission Expifes Marcie 28, 2021 y y y t Notary Public in and for Count of Montgomery,State of Pennsylvania
�Ry Pig Member, PennsyWanleAssociation oiNoiades My Commission expires March 28, 2021
This power of attorney is granted under and by authority of Article IV, Section 12 of the By -Laws of The Ohio Casualty Insurance Company, extracts from which read:
ARTICLE IV - Officers: Section 12. Power of Attorney.
Any officer or other official of the Corporation authorized for that purpose in writing by the Chairman or the President, and subject to such limitation as the Chairman or President
may prescribe, shall appoint such attorneys -in -fact, as may be necessary to act in behalf of the Corporation to make, execute, seal, acknowledge and deliver as surety any and all
undertakings, bond, mcognizances and other surety obligations. Such attorneys -in -fact, subject to the limitations set forth in their respective powers of a€torney, shall have full
power to bind the Corporation by their signature and execution of any such instruments and to attach thereto the seal of the Corporation. When so executed, such instruments shall
be as binding as if signed by the President and attested to by the Secretary.
Any power or authority granted to any representative or attorney -in -fact under the provisions of this article may be revoked at any time by the Board, the Chairman, the President
or by the officer or officers granting such power or authority.
This certificate and the above power of attorney may be signed by facsimile or mechanically reproduced signatures under and by authority of the following vote of the board of
directors of The Ohio Casualty Insurance Company effective on the 15th day of February, 2011:
VOTED that the facsimile or mechanically reproduced signature of any assistant secretary of the company, wherever appearing upon a certified copy of any power of attorney
issued by the company in connection with surety bonds, shall be valid and binding upon the company with the same force and effect as though manually affixed.
CERTIFICATE
I , the undersigned Assistant Secretary of The Ohio Casualty Insurance Company, do hereby certify that the foregoing power of attorney, the referenced By -Laws of the Company
and the above resolution of their Board of Directors are true and correct copies and are in full force and effect on this date.
1N WITNESS WHEREOF, I have hereunto set my hand and the seal of the Company this 251h
day of September 2017
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Renee C. Llewellyn, Assistant Secretary