HomeMy WebLinkAboutOpening of Quotations - Century Center Skylight Beams Painting - Project No. 114-004 - Gibson-Lewis LLCWhen 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 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 trade
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 trillion
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 ]earns 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.
hi 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
WBENBE. 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 1011812016 Page - 9 Public Works Quote
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POWER OF ATTORNEY APPOINi'ING INDIVIDUAL ATTORNEY -IN -FACT
Know All Men 13y 'These Presents, That The Continental Insurance Company, a Pennsylvania insurance company, is a duly organized and existing
insurance company having its principal office in the City of Chicago, and Stale of Illinois, and that it does by virtue of the signature and seal herein
affixed hereby ntnke, constitute and appoint
Kathy L. DelGreco , Individually
of Southfield, MI , its true and lawful Attorncy(s)-in-Fact with full power and authority hereby conferred to sign, seal
and execute t'or and on its behalfbonds, undertakings and other obligatory instruments of similar nature
— In Unlimited Amounts —
Surety Bond Number: 0399217-CNA-110
Principal: Gibson -Lewis, LLC
Obligee: City of South Bend Board of Public Works
and to bind them thereby as fully and to the same extent as if such instruments were signed by a duly authorized officer of the insurance company and all
the acts of said Attorney, pursuant to the authority hereby given is hereby ratified and confinned.
This Power of Attorney is made and executed pursuant to and by authority of the By -Law and Resolutions, printed on the reverse hereof, duly
adopted, as indicated, by the Board of Directors of -the insurance company.
In Witness Whereof, The Continental Insurance Company has caused these presents to be signed by its Vice President and its corporate seal to be
hereto afiixcd on this 3rd day of'Junc, 2015.
INS The Continental Insurance Company
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State of South Dakota, County of Minnelraha, ss:
Ott this 3rd day of June, 2015, before me personally came Paul T, Bruflat to me known, who, being by me duly sworn, did depose and say: that he
resides in the City of Sioux Falls, State of South Dakota; that lie is a Vice President of The Continental Insurance Company, a Pennsylvania insurance
company, described in and which executed the above instrument; that he knows the seal of said insurance company; that the seal affixed to the said
instrument is such corporate seal; that it was so affixed pursuant to authority given by the Board of Directors of said insurance company and that he
signed his name thereto pursuant to like authority, and acknowledges same to be the act and deed of said insurance company.
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S. Eich Notary Public
CERTIFICATE
1, D. Bult, Assistant Secretary of The Continental Insurance Company, a Pennsylvania insurance company, do hereby certify that the Power of
Attorney herein above set forth is stilt in force, and further certify that the Lay -Law and Resolution of the Board of Directors of the insurance company
printed on the reverse hereof is still in force. In testimony whereof I have hereunto subscribed my name and affixed the seal of the said insurance
company this 19th day of October , 2017 .
•h�"tlj�.""++ The Continental Insurance Company
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