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HomeMy WebLinkAboutOpening of Bids - 100 Wayne Street Plaza and Streetscape Project No 116-047R - Ziolkowski Construction IncR..�_��..�. -� T s. - . James A. Mueller, Member Attest; Linda M. Martin, Clerk PART II (For projects of $100,000 or more -- IC 36-1-12-4) 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, Please See Attached SECTION I EXPERIENCE QUESTIONNAIRE 1. Attach information regarding projects your organization has completed for the period of one (1) year prior to the date of the current bid. 2. Attach a listing of public works projects currently in process of construction by your organization. 3. Attach information regarding any failure to complete any work awarded to you and the location thereof. 4. Attach references from private firms for which you have performed work. SECTION II PLAN AND EQUIPMENT QUESTIONNAIRE 1. Attach an explanation of your plan or layout for performing proposed work. (Examples could include a narrative of when you could begin work, complete the project, number of workers, etc. and any other information which you believe would enable the City of South Bend to consider your bid.) As directed by the Architect/Construction Manager 2. Attach a listing of 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. If Subcontractors will be used we will submit this information 24 hours after notification. 3. If you intend to sublet any portion of the work, attach 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 City of South Bend in the event that you subsequently determine that you will use a subcontractor on the proposed project. If Subcontractors will be used we will submit this information 24 hours after notification. 4. Attach a listing of equipment you have available to use for the proposed project. Whatever is required to complete the project properly and on time. 5. Have you entered into contracts or received offers for all materials which substantiate the prices used in preparing your proposal? If not, attach an explanation for the rationale used which would corroborate the prices listed. Yes 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 City of South Bend awarding the contract must be specific enough in detail so that said City of South Bend can make a proper determination of the Version 10/17/2016 Contractor's Bid for Public Works - 3 bidder's capability for completing the project if awarded. Version 10/17/2016 Contractor's Bid for Public Works - 4 Wien the prospective Contractor is unable to Certify to any of file stateinents below, It shall attaeli 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 fain, 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 fiulher 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 fi•om tune -to -time. b. As provided by Ind. Code § 5-22-16.5-8, as amended from tinge -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. Version 10/17/2016 Contractor's Bid for Public Works - 5 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 hi 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 tenninate 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, terns, 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 requited 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 WBEIMBE. A finding of a discriminatory practice by the City's MBEAVBE 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). 1 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 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 hi 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 Version 10/17/2016 Contractor's Bid for Public Works - 6 11 8 wzq a� s �a> r a f, s a 71 i:,�w �_V. 7x I spa , a�_¢, = �a � e > �,u 4 Odmitalmu �. ET '. 5 @ BED 8 = 23 Tree Removal 4 24 Trees, Canopy 4 25 Tree Grates and R-Frame 4 26 Ornamental Light Poles 4 27 Light Pole Foundation 4 28 Light Pole Conduit / Wiring 112 29 Perennials 84 30 Mulch 5 31 Topsoil 13 32 33 34 35 36 37 38 39 40 41 Alt. #3 - All Work in the West Planting Red Zone Brick Paver Removal 39 Concrete Sidewalk, 4" 5 Top Soil, 12" Depth 12 Mulch 4 Perennials 88 Alt. #4 - All Work in the Parking Landscape Zone Mulch 12 Trees 4 Shrubs 18 Perennials 62 Liriope / Bulbs 642 LSum 650 2,600 Ea. 700 2,800 Ea, 3,550 14,200 Ea. 7,000 28,000 Ea. 850 3,400 LF 30 3,360 Each 20 1,680 CYS 75 375 CYS 110 1,43Q ALTERNATE #3 TOTAL 119,671 SYS 45 1,755 SYS 45 255 CYS 200 2,400 cvs 75 300 Ea. 20 1 760 ALTERNATE #4 TOTAL 6,470 CYS 75 900 Ea. 320 1,280 Ea. 60 1,080 Ea. 20 1,240 Ea. 4 2,568 ALTERNATE #5 TOTAL 7,068 Other 42 Alt. #5 - Monument Lighting 3 Ea• 2,030 6 090 43 Alt. #6 - Monument Signage 1 LSum 7 730 7,730 44 Alt. #7 - Decorative Benches 2 Ea. 1,600 3,200 45 Alt. #8 - New Plaza Planters 3 Ea. 1,030 3,090 ALTERNATES TOTAL 207.379 Version 10/17/2016 Contractor's Bid for Public Works - 9 I At Newsy CITY OF SOUTH BEN© MINORITY AND WOMEN BUSINESS ENTERPRISE DIVERSITY t { DEVELOPMENT PROGRAM m x" FORM MWBE-2.0 EVIDENCE OF GOOD FAITH EFFORTS 'sbs This completed form should be included as part of the Bids documents related to City of South Bend Public Works Projects requiring Good Faith Efforts to obtain MBEIWBE participation, 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 as defined by the Indiana Department of Administration ("IDOA"). Project Number: 116-047R Project Name: Bidder: Contact Person Address: City: 100 Wayne Street Plaza and Streetscape Ziolkowski Construction, Inc. Gary Paston 4050 Ralph Jones Drive South Bend State: Indiana Late: November 14, 2017 Telephone: 574-287-1811 Zip: 46628 Email: gpaston zbuild.com To determine whether a bidder has demonstrated good faith efforts to reach the MBE/WBE utilization goals set forth in the City of South Bend Public Works Project Specifications, the City and its agencies, boards, or commissions, REQUIRE ALL of the following Good Faith Efforts as listed in the table below*: EVIDENCE OF GOOD FAITH EFFORTS MBEIWBE LIST(S): The bidder reviewed the City of South Bend's Minority and Women Business Enterprise Diversity Development Program, which uses the IDOA approved list of Minority and Women Owned Business as found on their website (http:/Iwww.in.gov/ldoa). ACTION (ADVERTISEICONTACT): In order for your bid to be deemed responsive, the City of South Bend requires that all perspective bidders complete no less than 2 of the following: 1. Attend all pre -bid meetings scheduled by the City to inform MBENVBEs of contracting and subcontracting opportunities. 2. Advertise in general circulation and/or trade association publications concerning subcontracting opportunities, and allow MBENVBEs reasonable time to respond. 3. Perform any and all necessary steps to provide written notice in a manner reasonably calculated to inform MBENVBEs of subcontracting opportunities and allowed sufficient time for them to participate effectively. 4. Utilize pre-existing services of available community organizations, small and/or disadvantaged business assistance offices and other organizations that provided assistance in the recruitment and placement of MBEIWBE firms. **Bidder must circle or otherwise notate which of the two (2) required actions were performed. See GOOD FAITH NEGOTIATIONS: The bidder negotiated in good faith with interested MBENVBEs, ached including providing such MBENVBE's with adequate information about the plans, specifications and apex Ad other requirements of the subcontract and did not reject MBE/WBEs as unqualified without sound business reasons based on a thorough investigation of their capabilities. SMALL CONTRACT(S): The bidder selected specific portions of the work to be performed by MBE/WBEs in order to increase the likelihood of meeting the MBENVBE goals (including breaking down contracts into smaller units to facilitate MBEIWBE participation) CONTRACT RECORDS: The bidder has maintained the following records for each MBEA/VBE that has bid on the subcontracting opportunity: 1. Name, address, and telephone number; 2. A description of information provided by the bidder or subcontractor; and 3. A statement of whether an agreement was reached, and if not, why not, including any reasons for concluding that the MBE/WBE was unqualified to perform the job. *Proper demonstration of Good Faith Effort requires your initials next to all of the above boxes. Any omissions shall be considered grounds for rejection of the bid by the Board of Public Works. The City of South Bend reserves the right to request additional information. Version 10/17/2016 Contractor's Bid for Public Works - 12 A KLM45, "M on. � �t�r' ��a,,i ._ < �°� � ��.ia� �� i THIS:POWER.OF ATTORNEY IS NOT:VALID.UNLESS IT IS PRINTED ON RED BACKGROUND. This Power of Attorney limits the acts of those named herein, and they have no authority to bind the Company except in. the. manner and to the extent herein stated.. Certificate No. 7862545 Liberty Mutual Insurance Company. The.Ohio.Casualty Insurance Company. West American insurance Company POWER OF ATTORNEY KNOWN ALL PERSONS BY THESE PRESENTS; That The Ohio.Casualty Insurance Company is..a corporation duly organized under the laws of the. Stale of New Hampshire, that Liberty Mutual Insurance Company is a corporation duty organized.; under the taws of the State of Massachusetts, and West.American Insurance Company.is a corporation duly organized under. the laws of the State of Indiana (herein collectively called the j'Companies'), pursuant to avid by authority herein set forth, does hereby name, constitute and appoint, Adrienne C: Stevenson• Amy B Wicketty C. R. Hernandez;• :Gabriel Jac uez; John K. Johnson' Katherine J. Foreit� Triniy Garcia art of the city of CHICAGO state of IL each. individually if there be more than one named, its true and lawful attorney -in -fact to make, execute, seal, acknowledge and deliver, for and on its behalf as surety and as.its act aiid deed, any and. all undertakings, bonds,. recognizances and other. surety obligations; in pursuance of these presents and shall be as binding upon the Companies as if they have boen duly signed by the president and attested by the secrelaryof the Companies in their own proper persons. IN WITNESS WHEREOF, this Power of. Attorney. has been subscribed by an authorized officer or official of the Companies .and the corporate seals of the Companies have been affixed thereto this 14th day of August 2017 t1y The Ohio Casualty Insurance Company. U ... Liberty Mutual Insurance. Company as 0 1919 a 1912 ° 1991 ti y A West American.. Insurance Company STATE OF PENNSYLVANIA as David M. Carey Assistant Secrotary C 4 L COUNTY OF MONT60MERY t — o On this 14th day of August 20t7 , before me personally appeared David M.:Carey, who acknowledged himself to be the Assistant Secretary of Liberty Mutual Insurance v v .ar Company, The Ohio Casualty Company, and West American Insurance Company, and.that he, as such, being authorized so to do, execute the foregoing instrument. for the. purposes >,0 p 2 therein contained by signing on behalf of the corporations by himself as a duty authorized officer. l3 E w > IN WITNESS WHEREOF, I have hereunto subscribed my name and affixed my notarial seat at King of Prussia, Pennsylvania, on the day and year first above wrillen. O CL p PASp COMMONWEALTH OF PENNSYLVANIA Q M Notarial Seal .N !w 4° . Toreso PaMella, Notary Pubilc BY' of Upper Mr:rion Twp.; Montrgomery County Teresa Pastella, Notary Public `y .0 L ° My Commission Expires March 28, 2021 fC. Q. ydTq ty Member, Pannsylvani a Assucialian or Wilries :a-.E - - _ (1Y 1 This Power of Attorney is made and executed pursuant to and by authority of the following By-laws and Authorizations of The Ohio Casualty. Insurance Company, Liberty Mutual.. to c r Insurance Company, and West American Insurance Company which resolutions are now in full force and effect reading as. follows: m L 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 O. c +; to such limitation as the Chairman or the President may prescribe, shall appoint such attorneys -in -fact, as may be necessary to act in behalf of the Corporation to make, execute seal, + O . acknowledge and deliver as surety any and. all undertakings, bonds, recognizances and othersurety obligations. Such attorneys -in -fact, subject.to the ]imitations set forth in theirrespective: E powers of attorney, 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 '@ p executed, such instrumants .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: 7 CD the provisions.. this article maybe revoked at any time by the Board, the Chairman, the President orbg.ttle officer or officers granting such power or authority. et. �.. N R ARTICLE XIII - Execution of Contracts — SECTION 5. Surety Bonds. and Undertakings. Anyofficer of the Company authorized for that purpose in writing by the chairman or the. president, o? and subject to.such.limitations as the chairman or the president may prescribe, shall appoint such attorneys -in -fact as may be necessary to act in behalf of the Company to make, execute, � M O seal, acknowledge and deliver as surety any and all undertakings, bonds, recognizances and other surety obligations. Such attorneys -in -fact subject to the limitations set forth in their C o? Z.0 respective powers of attorney, shaft have full power to bind the Company by their signature and execution of any such instruments and to attach thereto the seal of the Company. When so O o executed such Instruments shall be as binding as if signed by the: president and attested by .the secretary. Certificate of Designation -'The President of the Company,.acting pursuant to the Bylaws of the Company, authorizes David M Carey, Assistant Secretary to appoint such attorneys -in- ~ r fact as maybe necessary to act on behaff of the Companylo make,:execu€e, seal, acknowledge and detfyer as. surety any: and all undertakings;bands, recognizances and other surely. obligations. Authorization By unanimous consent of the Company's Board of Directors, the Company consent0hat facsimile or mechanically ireproduced signature of any assistant secretary of the Company, .wherever appearing upon.a certified copy of any power of:attorney issued by the.Company in conriactiorr with surety bonds, shad be valid and binding upon the Company with the same force and effect as though manually affixed. €, Renee. C. Llewellyn, the .undersigned, Assistant Secretary, The Ohio. Casualty. Insurance. Company, ILlberty Mutual Insurance Company, and West American Insurance Company do hereby certify that the originat power of attorney of:which the foregoing.is: a full, true and correct copy of the Rowevof Attorney executed. by said_Companfes, is in full force and effect and. has not been revoked. IN TESTIMONY WHEREOF, l have hereunto set my hand.and affixed the seals of said Companies this 14 day of N O V e mb % 20 17 `0 IN 414S 0 1919 0 _ 1912 r 1991 By: Renee C. Llew , ssistant Secretary HeE.ro>+`X� J her F rrrni.,ttr �. 129 of 250 :LMS-12873 022047. - 'AD. �A �w I � � ll� t � kT k-k� M-2 � I i W &;,� I � M I'l 0 .E 0 SECTION I EXPERIENCE QUES` IOi�NAI E 1. What public works projects has your organization completed for the period of one (1) year prior to the state of the current bid? Contract Amount Class of Work Completion Date Name and Address of Owner $16,473,549 General 01/2012, IUSB Cancer Research Center $12,274,292 General 01/2016 Lake Central High School $16,920,600 General 08/2011 Kankakee Valley New Middle School $7,663,700 General 02/2013 Mishawaka River Center Apartments 2. What public works projects are now in process of construction by your organization? Contract Amunt Class of Work Expected Completion Date Marne and Address of Owner $27,366,910 General 05/2016 Purdue University North Central $21,355,975 General 06/2015 Armed Forces Reserve Center $4,824,179 General 0812015 Mishawaka Central Park $9,020,000 General 10/2016 South Bend Airport- New Arrivals Terinfil 31 S. Have you ever failed to complete any work awarded to you? No If so, where and why's 4, Ust -references from private firms for which you have performed work. University of Notre Dame, Tony Polotto, LEER, AP, 200 Facilities Bldg., Noire Dame, IN 46556 574-631-4200 City of Mishawaka, Ken Prince, 600 East Tbird Street, Mishawaka, IN 574-258-1625 Fetters Construction Ine., Steven A. Fetters, 5417 County Rd 427, Auburn, Indiana 46706 260-927-8516 Memorial Hospital & Health System, Larry Lies, 615 N Michigan St., South Bend, IN 46601 574-647-1000 M d 0 e,w «+ | v y.: ] »\\, 0 ° \ \ J \ ■ « > E Company ID Number: 486671 g4 e �r1111I�,� THE E-VERIFY PROGRAM FOR EMPLOYMENT VERIFICATION MEMORANDUM OF UNDERSTANDING ARTICLE PURPOSE AND AUTHORITY This Memorandum of Understanding (MOU) sets forth the points of agreement between the Department of Homeland Security (DHS) and Ziolkowski Construction, Inc. (Employer) regarding the Employer's participation in the Employment Eligibility Verification Program (E- Verify). This MOU explains certain features of the E-Verify program and enumerates specific responsibilities of DHS, the Social Security Administration (SSA), and the Employer. E-Verify is a program that electronically confirms an employee's eligibility to work in the United States after completion of the Employment Eligibility Verification Form (Form 1-9). For covered government contractors, E-Verify is used to verify the employment eligibility of all newly hired employees and all existing employees assigned to Federal contracts or to verify the entire workforce if the contractor so chooses. Authority for the E-Verify program is found in Title IV, Subtitle A, of the Illegal Immigration Reform and Immigrant Responsibility Act of 1996 (11RIRA), Pub. L. 104-208, 110 Stat. 3009, as amended (8 U.S.C. § 1324a note). Authority for use of the E-Verify program by Federal contractors and subcontractors covered by the terms of Subpart 22.18, "Employment Eligibility Verification", of the Federal Acquisition Regulation (FAR) (hereinafter referred to in this MOU as a "Federal contractor with the FAR E-Verify clause") to verify the employment eligibility of certain employees working on Federal contracts is also found in Subpart 22.18 and in Executive Order 12989, as amended. ARTICLE it FUNCTIONS TO 13E PERFORMED A. RESPONSIBILITIES OF SSA 1. SSA agrees to provide the Employer with available information that allows the Employer to confirm the accuracy of Social Security Numbers provided by all employees verified under this MOU and the employment authorization of U.S. citizens. 2. SSA agrees to provide to the Employer appropriate assistance with operational problems that may arise during the Employer's participation in the E-Verify program. SSA agrees to provide the Employer with names, titles, addresses, and telephone numbers of SSA representatives to be contacted during the E-Verify process. 3. SSA agrees to safeguard the information provided by the Employer through the E-Verify program procedures, and to limit access to such information, as is appropriate by law, to individuals responsible for the verification of Social Security Numbers and for evaluation of the E-Verify program or such other persons or entities who may be authorized by SSA as governed Page 1 of 13 1 E-Verify MOU for Employer I Revision Date 09/01/09 vjww.dhs.gov1E--VeN y Company I® Number: 486671 To be accepted as a participant in E-Verify, you should only sign the Employer's Section of the signature page. If you have any questions, contact E-Verify at 888-464-4218. Employer Ziolkowskit Construction, Inc. Bill Favors Name (Please Type or Print) Electronically �igned Tile 01/10/2012 Signature Rate Department of Homeland Security m Verification Divisioli CIS Veriiiication Division Name (Please Type or Print) Electronically Signed Ale 01/1012012 Signature t]ate Information Required for the E-Verify Program Information relating to your Company: Company Name: Ziolkowski Construction, Inc. Company Facility Address: 050 Ralph Jones Dr. Bend, IN 46620 -South Company Alternate Address: County or Parish: �ST JOSEPH Employer Identification Number: 351445992 Page 12 of 13 1 E-Verify MOU for Employer I Revision ©ate 09/01/09 mww.dhs.gov1E-Verify �,�n�..F� 1 SEcL r� -Verl ��[�I111�To Company I® Number: 4006671 North American Industry Classification Systems Code: 236 Administrator: Number of Employees: 100 to 499 Number of Sites Verified for: I Are you verifying for more than f site? If yes, please provide the number of sites verified for in each Mate: a INDIANA. I site(s) Information relating to the Program Administrator(s) for your Company on policy questions or operational problems: Name: Tames Keidsen Telephone Number: (974) 287 -1811 ext. 368 Fax Number: (574) 344 - 5533 E-mail Address: jkeldsen@,zbuild.eom Page 13 of 13 1 E-Verify NOU for Employer I Revision Date 09/01/09 wv,Ritr«dhs.go,vIE-Ver 16Ly 61=t2I2017 Welcome James Keldsen Company Information Company Name Ziolkowski Construction, Inc Company 1D Number 486671 Doing Business As (DBA) Name DUNS Number Physical Location Address 1 4050 Ralph Jones Dr. Address 2 city South Bend State IN Zip Cade 46628 County STJOSEPH Mailing Address Address 1 Address 2 City state Zip Code Additional Information Employer Idenlilication Number 351445992 Total Number of Employees 100 to 499 Parent Organization ; Administrator E Verify: Employer Wizard - Company Information MENU Organization Designation Employer Category None of these categories apply view I Edit NAILS Code 236 -CONSTRUCTION OF BUILDINGS View ! Edit Total Hiring Sites https:l/e verifyuscis.govlwehlErnployerWizard.aspx 119