HomeMy WebLinkAboutOpening of Quotations - York Road Sewer Repairs Project No 115-139 - Walsh & Kelly, Inc.WAFM
When the prospective Contractor is unable to certify to any of the statements belmv, it shall attach 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 Indiana )
) SS:
St. Joseph 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 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; 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
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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
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 10/18/2016 Page -12 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 I Oth day of Qctober, 2017
�`re �OItPORA;r' e
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Sign ure of Contractor/Bidder or Its Agent
ustin Hilary, South Bend Area Manaaer
Printed Name and Title
Subscribed and sworn to before me this 1 Oth day of October 20 17
My Commission Expires 6/5/22
Notary Pu c I Alisha Krueger
County of Residence St. Joseph
ALISHA KRUEGER
`� APY PU
o; �s Notary Public, State of lndlana
' Y"SEAL'"= St. Joseph County
My Commission Explras
JuneO5,2022
Version 10118/2016 Page -13 Public Works Quote
Part of State Form52414 (R2 ! 2-13) Form 96 (Revised 2013)
BID OF
Walsh & Kelly, Inc.
(Contractor)
24358 SR 23
(Address)
South Bend IN 46614
FOR
PUBLIC WORKS PROJECTS
OF
City of South Bend, Indiana
York Road Sewer ^Repairs
Project No. 115-139
Filed October 101h, 2017
Action taken
State Form 52414 (R 19-10)
Prescribed by State Board of Accounts Form No. 96 (Revised 2013)
CONTRACTOR'S BID FOR PUBLIC WORK — FORM 96
PART 1
(To be completed for all bids. Please type or print)
Date (month, day, year): October 10, 2017
1. Governmental Unit (Owner): City of South Bend, Indiana
2. County: St. Joseph
3. Bidder (Firm):
Address:
City/State:
4. Telephone Number
5. Agent of Bidder (If applicable):
Walsh & Kelly, Inc.
24358 SR 23
South Bend, IN 46614
574-288-4811
Pursuant to notices given, the undersigned offers to furnish labor and/or material necessary to complete the
public works project of City of South Bend, Indiana — Board of Public Works & Safety (Governmental Unit) in
accordance with plans and specifications prepared by City of South Bend, Indiana — Engineering Dept. dated August 30,
2017 for the sum of See Attached $ See Attached
The undersigned further agrees to furnish a bond or certified check with this bid for an amount specified in the notice of
the letting. If alternative bids apply, the undersigned submits a proposal for each in accordance with the notice. Any
addendums attached will be specifically referenced at the applicable page.
If additional units of material included in the contract are needed, the cost of units must be the same as that
shown in the original contract if accepted by the Governmental Unit. If the bid is to be awarded on a unit basis, the
itemization of the units shall be shown on a separate attachment.
The Contractor and his subcontractors, if any, shall not discriminate against or intimidate any employee, or
applicant for employment, to be employed in the performance of this contract, with respect to any matter directly or
indirectly related to employment because of race, religion, color, sex, national origin or ancestry. Breach of this covenant
may be regarded as a material breach of the contract.
CERTIFICATION OF USE OF UNITED STATES STEEL PRODUCTS
(If applicable)
I, the undersigned bidder or agent as a contractor on a public works project, understand my statutory obligation
to use steel products made in the United States. I.C. 5-16-8-2. 1 hereby certify I and all subcontractors employed by me
for this project will use U.S. steel products on this project if awarded. I understand that violations hereunder may result in
forfeiture of contractual payments.
ACCEPTANCE
The above bid is accepted this day of - subject to the following conditions:
Contracting Authority Members:
PART 11
(For projects of $150,000 or more — IC 36-1-12-4)
Governmental Unit: City of South Bend, Indiana
Bidder (Firm): Walsh & Kelly, Inc.
Date(month, day, year): October 10, 2017
These statements to be submitted under oath by each bidder with and as part of his bid. Attach additional pages
for each section as needed.
SECTION I EXPERIENCE QUESTIONNAIRE
What public works projects has your organization completed for the period of one (1) year prior to the date of
the current bid?
Contract Amount
Class of Work
When Completed
Name and Address of Owner
$6,030,341
Resurface
December 2015
Lake County Hwy Dept.
$5,758,069
Resurface
November 2015
Town of St. John
$4,461,632
Reconstruction
December 2015
INDOT
$3,571,923
Reconstruction
July 2015
INDOT
2. What public works projects are now in process of construction by your organization?
Contract Amount
Class of Work
When to be Completed
Name and Address of Owner
$5,080,808
Reconstruction
November 2017
City of South Bend, IN
$5,938,220
Resurface
October 2017
INDOT
$5,775,000
Reconstruction
November 2016
Town of Merrillville, IN
$3,102,502
Reconstruction
October 2016
INDOT
3. Have you ever failed to complete any work awarded to you? Na If so, where and why?
4. List references from private firms for which you have performed work.
Gatlin Plumbing & Heating, Inc. l I I I E. Main St., Griffith, IN Ms. Clara Muiphy
Gou h Ina 2200 E. 88"' Dr., Merrillville IN 46410 Mr. Ra and Gough
Dyer Construction Co., 1716 Sheffield Avenue, Dyer, IN Janet Furman
Grimmer Construction Co. Inc. 2619 Main Street Highland, IN Mr. Greg Grimmer
SECTION 11 PLAN AND EQUIPMENT QUESTIONNAIRE
1. Explain your plan or layout for performing proposed work. (Examples could include a narrative of when you could
begin work, completed the project, number of workers, etc. and any other information which you believe would
enable the governmental unit consider your bid.)
As required by owner
2. Please list the names and addresses of all subcontractors (i.e. persons or firms outside your own firm who have
performed part of the work) that you have used on public works projects during the past five (5) years along with a
brief description of the work done by each subcontractor.
See Attached List
3. If you intend to sublet any portion of the work, state the name and address of each subcontractor, equipment to be
used by the subcontractor, and whether you will require a bond. However, if you are unable to currently provide a
listing, please understand a listing must be provided prior to contract approval. Until the completion of the proposed
project, you are under a continuing obligation to immediately notify the governmental unit in the event that you
subsequently determine that you will use a subcontractor on the proposed project.
Will supply upon award of contract
4. What equipment do you have available to use for the proposed project? Any equipment to be used by subcontractors
may also be required to be listed by the governmental unit.
QUANTITY
ITEM
DESCRIPTION,
SIZE, CAPACITY,
ETC.
CONDITION
YEARS
OF
SERVICE
PRESENT LOCATION
5
Asphalt Plants
Various
Good
Griffith, South Bend,
Valparaiso, Lowell, LaPorte,
18
Asphalt Pavers
Various
Good
Griffith, South Bend
4
Slipform Cone. Paver
Comm H
Good
Griffith, South Bend
3
Road Widener
Various
Good
Griffith, South Bend
5
Motor Graders
CAT/J.D.
Good
Griffith, South Bend
48
Rollers
Various
Good
Griffith, South Bend
31
Rubber Tire Loaders
Various
Good
Griffith, South Bend
15
Excavators
Various
Good
Griffith, South Bend
8
Bulldozers
Various
Good
Griffith, South Bend
6
LowBoy Tractors
Various
Good
Griffith, South Bend
7
Flatbed Dumps
Various
Good
Griffith, South Bend
39
'/2 and 34 ton Pickups
Various
Good
Griffith, South Bend
59
1 Ton Crew Trucks
Various
Good
Griffith, South Bend
3
Cold Planers
Wirtgen 1900
DC
Good
Griffith, South Bend
3
Tri-Axle Dump
Mack
Good
South Bend
5. Have you entered into contracts or received offers for all materials which substantiate the prices used in preparing
your proposal? Otherwise, please explain the rationale used which would corroborate the prices listed.
Yes, we received quotes from potential subcontractors and suppliers
SECTION III CONTRACTOR'S FINANCIAL STATEMENT
Attachment of bidder's financial statement is mandatory. Any bid submitted without said financial statement as required
by statute shall thereby be rendered invalid. The financial statement provided hereunder to the governing body awarding
the contract must be specific enough in detail so that said governing body can make a proper determination of the bidder's
capability for completing the project if awarded.
SECTION IV CONTRACTOR'S NON -COLLUSION AFFIDAVIT
The undersigned bidder or agent, being duly sworn on oath, says that he 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.
He 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
SECTION V OATH AND AFFIRMATION
I HEREBY AFFIRM UNDER THE PENALTIES FOR PERJURY THAT THE FACTS AND INFORMATION
CONTAINED IN THE FOREGOING BID FOR PRBLIC WORKS ARE TRUE AXEMORRECT.
Dated at South Bend this
of
2017.
(Title of Person Signing)
STATE OF Indiana
} ss
COUNTY OF St. Josenh )
Before me, a Notary Public, personally appeared the above -named Dustin Hilary and
swore that the statements contained in the foregoing document are true and correct.
Subscribed and sworn to before me this 10111 day of October, 2017.
L
Ali Krueger, LNotary Public
My Commission Expires: June 5 2022
� �p+n,;
,,
ALISHA KRU£GER
County of Residence: St. Joseph �A� ' ���y°� NUtorY Pu�Iic. State of 4ndians
St. Joseph county
MY commission Expires
Jun®Q a, 2022
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