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Opening of Bids - Fire Station No. 9 Demolitions Proj No 117-088 - Green Demolition Contractors
4*1 1 �4. k, A a pi .1 xay..,'ry� r _ YY.. 5' G� � '- '..,� �,�:,.., $ .-_y¢ .. � i. :. � � 5l,. s3 ;a•i 3. e� i6 k yr, P' d-#.v �:. . 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. 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.) 2. Attach a listing of the names and addresses of all subcontractors (i.e. persons or firms outside (� your own firm who have performed park 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. U 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. 4. Attach a listing of equipment you have available to use for the proposed project. 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. 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 bidder's capability for completing the project if awarded. Version 10/17/2016 Contractor's Bid for Public Works - 3 �( 1� 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 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 o f 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).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 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 Version 10/17/2016 Contractor's Bid for Public Works - 5 f ti ;;a of"Mm A ��; �..,� _ ,ti _ �- _ , � ` ��' ' t ,,� arao a ,- _._�e,c_:�.m. �� EE��-: af= c;� .: �a �se.a-�€'; tGp _;�3&r., .. —.='L .5 Y�.�_ Lai � 3,�t�+ .n! _-�^SE r � �'. ��:"c X,II-FAp:,xl.x-*7Z4YM rl - W? M-41 ZZ", to;_; 7F Ml� - MA L 4141 V H, ,e _el Pik Y AMMIROLL-. .�.. � _..: � ass.. _ - � � - � _- — �� — � — — - I i - laf R nil t L MINI - C. 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'fTIIIN,• 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 —1C 36-1-12-4) Governmental Unit: City of South Bend Indiana Department of Public Works Bidder (Firm) Green Demolition Contractors Incorporated LLC Date (month, day, year): November 28, 2017 These statements to be submitted under oath by each bidder with and as a part of his bid. Attach additional pages for each section as needed. 1 2. 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? Completion Contract Amount Class of Work Date Name and Address of Owner See attached What public works projects are now in process of construction by your organization? Expected Contract Amount Class of Work Completion Name and Address of Owner Date See Attached { � 5 523 Northbrook Drive Michigan City, IN 46360 Office: 312-409-4771 Fax: 773-477-7149 Incorporated in the State of Indiana Union Shop PROJECT EXPERIENCE GOVERNMENT City of South Bend Indiana 1316 County -City Bldg. Rm. 1316 South Bend, Indiana 46601 Mr. Toy Villa 574-235-5920 Demolition of 103 Abandoned Properties Scope of Work: Wreck and Remove Complete with Grading and Seeding of 120 Properties Cook County Land Bank Authority 69 W. Washington Suite 2938 Chicago, IL 60602 Mr. Mustafaa Saleh 312-603-8015 Scope of Work: 2015/16 $ 1,878,922.00 2015/16/17 $ 925,000.00 Open Ended Contract ongoing through the depletion of Grants/Funds Demolition of Abandoned / Vacant Homes throughout Chicago and Cook County. Brown & Momen, Inc. 823 E. Drexel Square Chicago, IL 60615 Mr. David Clark 312-788-0770 Marshall Field Garden Apartments Building 5 Chicago, IL Scope of Work: Interior selective removals of all finishes multi story level HUD Building 2016 $744,000.00 "Recycling Today For A Greener Tomorrow" 523 Northbrook Drive Michigan City, IN 46360 Office. 312-409-4771 Fax; 773-477-7149 City of Chicago/Wight Co. 2500 North Frontage Road Darien, IL 60561 Dennis Podzimek 630-918-9428 City Hall Space Consolidation Scope of Work: Multiple Interior Floor Selective Removals of Finishes and Furnishings. Working in strict adherence with Municipal Building — Security Procedures IHC Companies 1500 Executive Dr. Elgin, II, 60123 Toro Carrano 847-841-7713 Niles North HS 2014Summer Renovation Skokie, Il Scope of Work: Selective and gut removals of Locker Rooms - Kitchen Cafeteria- Entrances and other various areas Lee & Ryan Construction 1707 Melody Ln. Greenfield, IN 46140 Ryan Keane 317-467-6577 Edward Hines VA Hines, 11 Scope of Work: 2014 $498,800.00 2015 $524,000.00 2014 $190,000.00 Main Hospital North Entrance removal of Front Structural Fagade, floors and roof with all adjoining finishes. Barton Malow Company 150 N Upper Wacker Dr 41650 Chicago, IL 60606 Brian Courtney 312-281-0821 523 Northbrook Drive Michigan City, IN 46360 Office: 3,12-409-4771 Fax: 773-477-7149 January 2015 Argonne National Laboratory $212,000.00 Argonne National Lab -- Materials Engineering Building 370 Building 360 Expansion Scope of Work: Green Demolition performed wreck removals within Building 370 adjacent to an ongoing Phosphorous Experiment working in direct conjunction with electric, communications systems, sprinkler systems, natural gas and steam while performing lead and asbestos abatement. Green Demolition performed a Building Wreck within 10 feet of a Linear Accelerator without service interruptions to the electric, water, sewer, natural gas, steam and communications systems. 523 Northbrook Drive Michigan City, IN 46360 Office: 312-409-4771 Fax: 773-477-7149 Current Projects City of East Chicago Indiana Redevelopment Mr. James Portalatin 4525 Indianapolis Blv. East Chicago, Indiana 46312 4027 Main and 509-11 Emlyn Complete Building Wrecks $45,000.00 Cook County Land Bank Authority Mr. Mustafaa Saleh 69 West Washington Suite 2938 Chicago, Illinois 60606 Various Complete Building Wrecks $925,000.00 to date Open Ended Contract on going through depletion of Grants/Funds Gilbane Co. Mr. Christopher Urban 8550 West Bryn Mawr Chicago, Illinois 60631 Grass Lake School District 36 Addition and Renovations to Grass Lake School Release Wreck and Remove 1 Story School Building Vision Construction Mr, Matt Brokenshire 1733 North 33rd Ave Stone Park, Illinois 60165 Interior and Exterior Removals Two Schools Wight Co. Mr. Scott Richards 2500 Frontage Road Darien, Illinois 60156 Interior Renovations Administration Building "Recycling "today For A Greener Tomorrow" Have you ever failed to complete any work awarded to you? No 4. List references from private firms for which you have performed work. See attached SECTION 11 PLAN AND EQUIPMENT QUESTIONNAIRE If so, where and why? Explain 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 governmental unit to consider your bid.) See Attached 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 523 Northbrook Drive Michigan City, IN 46360 Office: 312-409-4771 Fax: 773-477-7149 References Private CR Realty Advisors 325 West Huron Chicago, I160654 Cell: 847.721.7906 Office: 312.332.7100 Brown & Momen, Inc. 823 Gast Drexel Square Chicago, IL 60615 Mr. David Clark 312-788-0770 Rockford Construction Grand Rapids, MI 49508 Brock Burgess 616-437-4226 LaPorte, In Meijer Cook County Land Bank Authority 69 W. Washington Suite 2938 Chicago, IL 60602 Mr. Mustafaa Saleh 312-603-8015 "Recycling Today For A Greener Tomorrow" 523 Northbrook Drive Michigan City, Indiana 46360 Office: 312-409-4771 Fax: 773-477-7149 Section II Plan and Equipment Questionnaire 1. Green Demolition Contractors Incorporated will mobilize at the site and perform inspections. We will confirm utilities are disconnected, abatement is complete (if applicable), and the building is free of pedestrians. Then, we will demolish the structure. We will salvage and recycle materials to meet qualifications and load out debris. Concrete and brick will be demolished and loaded out. We will backfill and compact site and deliver and spread black dirt. This will be repeated at each property. After all properties are complete, we will confirm the seeding at each property. 2. Waste Management Disposal 2221 W. Mt. Pleasant Muncie, Indiana Air Management Techniques Abatement if applicable 2650 Kilgore Muncie, Indiana 3. Not Applicable 4. (2) Two CAT 320 Excavators (2) Two T-300 Skid Steer (1) One Mack Semi 65 yard Roll Off (1) One Mack 6 Wheeler 40 yard Roll Off (1) One Mack Semi Low Boy 5. Yes 523 Northbrook Drive Michigan City, IN 46360 Office: 3'12-409-477 ,! Fax: 773-477-7149 Section II Plan Subcontractors Interstate Environmental Services, Inc. 337 W 806 N Valparaiso, IN 46385 Republic Service 3300 Charlotte Avenue Elkhart, IN 46517 MerkPak, Inc. 6655 N. Avondale Avenue Chicago, 1160631 Abatement Disposal / Hauling Universal Waste Removal/Disposal �•; i �e .,n ,r; �� -�: is 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. See attached 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. See attached Have you entered into contracts or received offers for all materials which substantiate the prices used in preparing your proposal? If not, please explain the rationale used which would corroborate the prices listed. See attachedd 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. a' 1 i' t-1_101.11�Y �►1' 523 Northbrook Drive Michigan City, Indiana 46360 Office: 312-409-4771 Fax: 773-477-7149 Field Men 1 Equipment Outline City of South Bend Indiana Department of Public Works Re: 622 Fire Station Number 9 Demolitions South Bend, Indiana Green Demolition Contractors Incorporated proposes to complete their work utilizing the following Number of Men and Equipment: One (1) Union Operating Engineer One (1) Union Laborer One (1) Foreman One (1) Caterpillar 320 Excavator with Grapple One (1) S300 Bobcat with Grapple Respectfully submitted, Michael Brough, President Green Demolition Contractors, Inc. Qty Description 2 2 1 1 1 2 2 l 8 2 8 6 1 1 1 1 1 1 1 2 1 4 2 2 4 2 1 5 1 14 EQUIPMENT LIST 330 Excavators Caterpillar 320 Excavators Caterpillar 331 Excavator 432 Excavator 2011 Galbreath Semi Roll Off Trailer 65 Yard Roll Off Boxes Excavator Hammers Excavator Grapple Overseas Containers Converted for Roll Off Truck 40 Yard Roll Off Boxes 30 Yard Roll Off Boxes 20 Yard Roll Off Boxes Flat Deck for Roll Off w/ Built In Wench 20 Ton Flat Deck Trailer 10 Ton Flat Deck Trailer Bobcat Tag Trailer Tilt Deck Trailer Flat Deck Single Axel 963 Bobcat 863 Bobcats S-185 Bobcat S-250 Bobcats S-300 Bobcats S-70 Bobcats 463 Bobcats 553 Bobcat 763 Bobcat T300 Bobcat 853 Bobcat Ingersoll Rand Mason Lull Lull Conversion Brackets 320 excavator Wrecking Pole Wrecking Poles 80" Root Grapple Bucket Grapple Buckets 523 Northbrook Drive Michigan City, IN 46360 Office: 312-409-4771 Fax: 773-477-7149 & 523 Northbrook Drive Michigan City, IN 46360 Office: 312-409-4771 Fax: 773-477-7-149 2 2015 Ford One Ton Dually Dump Trucks 1 2005 Mack Tractor 1 2006 Mack Six Wheeler Roll Off Truck 1 Semi Roll Off Trailer 4 Bobcat Hammers 15 Misc. Buckets for Bobcat 2 Terminators 1 Atlas Capco 185 Air Compressor I Ingersoll Rand 185 Air Compressor I Ingersoll Rand 250 Air Compressor 10 Cargo Trailers 1 Water Trailer I Lowboy Trailer Misc. Inventory Steel I Beams Misc. Inventory Lumber Misc Hand Tools, Boxes, Equip i.e. Saw, Air Hammers, etc. Any and all equipment and tools listed above are free of encumbrances, none of the above listed items are ]eased, all equipment is owned by Michael Brough, President Green Demolition Contractors, Incorporated LLC Michael Brough, President 523 Northbrook Drive Michigan City, IN 46360 Office: 312-409-4771 Fax: 773-477-7149 Demolition Plan City of South Bend Indiana Board of Public 227 Jefferson Blvd City County Building Room 1316 South Bend, Indiana 46601 Re: Fire Station Number 9 Demolitions Sealed Bid November 28, 2017 Green Demolition Contractors Incorporated will Mobilize upon Contract Award and Notice to Proceed. We will immediately begin verification of completion of abatement if applicable, owners salvage if any is completed and verify that the disconnects etc., have been completed. Green Demolition Contractors Incorporated will then subsequently begin the wreck and removal process of properties that have been previously abated. All work is to be performed within the durations noted in the contract documents as follows: 2104 E. Mishawaka 3 Days 2108 E. Mishawaka 2 Day 2112 E. Mishawaka 3 Days 914 S. 21 st Street 2 Days 918 S. 21 st Street 3 Days Respectfully submitted, Michael Brough, President Green Demolition Contractors, Inc. 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 include 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 PUBLIC WORKS ARE TRUE AND CORRECT. Dated at ivILAIdei Druuyil, rie5uient (Title of Person Signing) ACKNOWLEDGEMENT STATE OF IN ) COUNTY OF ) ss_LaPorte ) Before me, a Notary Public, personally appeared the above -named Michael Brough and swore that the statements contained in the foregoing document are true and correct. Subscribed and sworn to before me this 28th day of November 2017 My Commission Expires: do y�l-'c•. County of Residence: LaPorte '6.& \A � Notary Public IiPUY ANN LAND NOTARY PUBLIC — OFFICIAL SEAL State of Iadlana, LaPorte County my Commission E res: October 28, 202 I All OR O LL U) F-- U W O rY cL Y 0 U_ M� W Cl- 1 O co C M C m .0 0 U) 0 N LL Incorporated in the State of Indiana Union Shop PROJECT EXPERIENCE Tonn & Blank Construction LLC 1623 Greenwood Ave. Michigan City, IN 46360 Joel Gonzales 219 877-8174 Uptown Artist Lofts Michigan City, IN Scope of Work: 523 Northbrook Drive Michigan City, IN 46360 Office: 312-409-4771 Fax: 773-477-7149 February 2016 $611,086.00 Interior Selective Finish / Abatement and Structural Removals of Multi Level Facility Rockford Construction July 2014 Grand Rapids, MI 49508 Brock Burgess 616-437-4226 LaPorte, In Meijer $787,000.00 Scope of Work: Complete 100% gut re -habilitation project with Bobcat machines of an existing Big Box facility consisting of ceilings, drywall partition walls, storefronts, facades, floorings, concrete removals, M.E.P. and portion of structure removals. TUC Companies 1500 Executive Dr. Elgin, IL 60123 Tom Carrano 847-841-7713 Niles North CIS 2014Summer Renovation Skokie, II Scope of Work: Selective and gut removals of Locker Rooms - Kitchen Cafeteria- Entrances and other various areas July 2015 $524,000.00 BOWA Group 7050 S. Stony Island Ave. Chicago, IL. 60649-1906 Nose Ehi 773-577-3845 University of Chicago Neuroscience Chicago, IL Scope of Work: Interior finishes removals of current Laboratory Spaces. Barton Malow Company 150 N Upper Wacker Dr #16.50 Chicago, IL 60606 Brian Courtney 312-281-0821 Argonne National Laboratory Argonne National Lab — Materials Engineering Building 370 Building 360 Expansion Scope of Work: �PEPF -, x 1 `Tip' V f i 523 Northbrook Drive Michigan City, IN 46360 Office: 312-409-4771 Fax: 773-477-7149 December 2014 $521,000.00 January 2015 $212,000.00 Green Demolition performed wreck removals within Building 370 adjacent to an ongoing Phosphorous Experiment working in direct conjunction with electric, communications systems, sprinkler systems, natural gas and steam while performing lead and asbestos abatement. Green Demolition performed a Building Wreck within 10 feet of a Linear Accelerator without service interruptions to the electric, water, sewer, natural gas, steam and communications systems. 3 � R Wreck Experience City of South Bend Indiana Mr. Toy Villa 1316 County -City Bldg. Rm. 1316 South Bend, Indiana 46601 574-235-5920 Demolition of 103 Abandoned Properties Scope of Work: Wreck and Remove Complete with Grading and Seeding 121 Properties Cook County Land Bank Authority Mr. Mustafaa Saleh 69 W. Washington Suite 2938 Chicago, IL 60602 312-603-8015 Scope of Work: 523 Northbrook Drive Michigan City, IN 46360 Office: 312-409-4771 Fax: 773-477-7149 2015 / 2016 $ 1,609,090.00 $925,000.00 to date Open Ended Contract ongoing through the depletion of Grants/Funds Demolition of Abandoned / Vacant Homes throughout Chicago and Cook County. Frank Novotny & Associates, Inc. James Cainkar 825 Midway Drive Willowbrook, IL 60527 630-887-8640 Village of Lemont Four Complete Wreck and Removal Scope of Work: 12890 Main St, 10970, 10980, and 10990 Archer Ave. Wreck removals of Four Structures September 2015 $ 167,000.00 523 Northbrook Drive Michigan City, IN 46360 Office: 312-409-4771 Fax: 773-477-7149 Deconstruction Experience Cook County Land Bank Authority Mr. Mustafaa Saleh 69 W. Washington Suite 2938 Chicago, IL 60602 312-603-801 S Scope of Work: Open Ended Contract ongoing through the depletion of Grants/Funds Demolition and or Deconstruction of Abandoned / Vacant Homes throughout Chicago and Cook County. Deconstruction 11718 S. Prairie Chicago, II Deconstruct Existing One and One Half Building in its entirety. Demolish all associated footings, foundations and slabs. Demolish all associated fencing, landscaping, etc All debris to be hauled off site and disposed of at a legal landfill. Backfill site with clean recycled CA6 Stone in twelve inch lifts. Deconstruct Old Growth Lumber. Deconstruct miscellaneous interior finishes, doors, flooring, casework, etc. Deconstruct porch columns. 144 West 1181h Ch icowy.o,_Il Deconstruct Existing Building in its entirety. Demolish all associated footings, foundations and slabs. Demolish Side Driveway in its entirety. Deconstruct existing Two and One Half Car Wood Frame Garage in its entirety. Demolish all associated fencing, landscaping, etc All debris to be hauled off site and disposed of at a legal landfill. Backfill site with clean recycled CA6 Stone in twelve inch lifts. Deconstruct Old Growth Lumber. Deconstruct miscellaneous interior finishes, doors, flooring, casework, etc. Deconstruct radiators and selective mechanicals. Deconstruct porch columns. 523 Northbrook Drive Michigan City, rN 46360 Office: 312-409-4771 Fax: 773-4 77-7149 7823 Mar rreffe Chica o Il Deconstruct Existing One and One Half Story Building in its entirety. Demolish all associated footings, foundations and slabs. Demolish all associated fencing, landscaping, etc All debris to be hauled off site and disposed of at a legal landfill. Backfill site with clean recycled CA6 Stone in twelve inch lifts. Deconstruct Old Growth Lumber. Deconstruct miscellaneous interior finishes, doors, flooring, casework, etc. Deconstruct porch columns. Attached please see the Deconstructed Material Inventory Statements ,.:.: .�- i APPROVED AND FILED CONNME LAWSON INDIANA SECRETARY OF STATE 04/06/2017 07:54 AM BUSYNESS ENTITY REI'0I2T NAME ANY) PRYNGYPAY, QFTCE.ADDRE$S BUSINESS ID 2015061100177 BUSINESS TYPE Domestic Limited Liability Company BUSINESS NAME GREEN DEMOLITION CONTRACTORS INCORPORATED PRINCIPAI, OFFICE, ADDRESS 523 NORTHBROOK DRIVE, MICHIGAN CITY, IN, 46360, USA YEARS FIL YEARS REGISTEREI),OFF CE AND AbDItESS 2017/2018 NAME MICHAEL BROUGH ADDRESS 523 NORTHBROOK DRIVE, MICHIGAN CITY, IN, 46360, USA TITLE President NAME ADDRESS SIGI�IA'I'LIR� ;. Michael Brough 523 Northbrook Drive, Mich City, IN, 46360, USA IN WITNESS WHEREOF, THE UNDERSIGNED HEREBY VERIFIES, SUBJECT TO THE PENALTIES OF PERJURY, THAT THE STATEMENTS CONTAINED HEREIN ARE, TRUE, THIS DAY April 6, 2017. SIGNATURE TITLE. Michael 3 Brough Registered Agcnt Business ID: 2015061 100177 Filing; No.: 7567738 - Page I of I - 523 Northbrook Drive Michigan City, IN 46360 Office: 312-409-4771 Fax: 773-477-7149 MISSION STATEMENT Green Demolition Contractors Incorporated LLC is a fully licensed, bonded, and insured demolition company servicing the Midwest. Our management team possess over 50 years of field experience. We are a proud signatory contractor with the International Laborer's Union of North America and the International Union of Operating Engineers, as well as a member of the National Association Demolition Contractors. We are LEED experienced and a lead -safe certified firm. Green Demolition specializes in a variety of services including: • Selective Demolition • Total Building Demolition • Mechanical Demolition • Structural Demolition • Selective Excavation • Concrete Crushing • Scrap Recovery • Fire and Disaster Relief Work • Waste Hauling • 24-Hour Emergency Service We service Industrial, Manufacturing, Commercial, Schools, Hospitals, Public, Municipal and Government Sectors. Our mission is to provide every client with safe, innovative, cost-effective and environmentally sound solutions while promoting a standard of excellence with our trained Union Field personnel. Green Demolition Contractors Incorporated LLC strives to reuse and repurpose our demolition material by utilizing sustainable deconstruction practices minimizing waste and recycling all material possible in order to ensure a positive impact on the environment. 523 Not Drive Michigan City, IN 46360 Office: 312-409-4771 Fax: 773-477-7149 EMPLOYEE DRUG POLICY The past success and future growth of the Company are a direct result of our most important asset: Our people. Consequently, the Company is concerned about the use of alcohol, illegal drugs or controlled substances as it affects the workplace. Use of these substances, whether on or off the job, can adversely affect an employee's work performance, efficiency, safety and health, and may therefore seriously impair his or her value to the Company. In addition, the use or possession of these substances on the job constitutes a potential danger to the welfare and safety of other employees and exposes the Company to risks of property loss or damage, or injury to other persons. The Company has a vital interest in maintaining safe and efficient working conditions for its employees and ensuring that all the Company vehicles are properly maintained and operated in a safe manner. Furthermore, the use of prescription drugs and/or over-the-counter drugs may affect an employee's job performance and seriously impair the employee's value to the Company. Any employee who is using prescription and/or over-the-counter drugs that may impair the employee's ability to safely perform the job, or affect the safety or well-being of others, should not report for work during the time the employee is using the medication. You may be required to provide a doctor's note validating your need for time off due to the use of medication which interferes with your ability to safely perform your duties. The employee should use any accrued vacation or sick leave during this time period. If the employee does not have accrued leave, the employee should discuss their need for time off with their supervisor or Human Resources to determine if an accommodation may be made. Proper use of prescription drugs directly prescribed to the employee is exempt from these restrictions so long as the employee is complying with physician orders and does not create a safety hazard for the employee or his/her co-workers. Contact Green Demolition Contractors Human. Resources when an employee has been prescribed drugs from a complying physician. The following rules and standards of conduct apply to all employees either on the Company property (owned or leased or off premises job site) or during the workday (including meals and rest periods). The following are strictly prohibited by the Company; however this section does not apply to the legal use of prescription drugs. 1 Possession or use of alcohol, or being under the influence of alcohol while on the .lob. 2. Driving a company vehicle while under the influence of alcohol or a controlled substance, 3. Distribution, sale or purchase of an illegal or controlled substance. 4. Possession or use of an illegal or controlled substance or being under the influence of an illegal or controlled substance while on the job. 523 Northbrook Drive Michigan City, 1N 46360 Office: 312, 409-4771 Fax; 773-477-7149 Violation of the above rules and standards of conduct will not be tolerated. The Company may also bring the matter to the attention of appropriate law enforcement authorities. Drug Testing Each employee, as a condition of employment, may be required to participate in pre- employment, reasonable suspicion, and follow-up testing upon selection or request of management. Any employee who refuses to submit to drug or alcohol testing requested by management will be subject to disciplinary action, up to and including immediate termination. Altered samples, substituted samples and negative dilutes constitute employee failure to cooperate with a management investigation in violation of The Company business conduct policy. Any employee submitting such a sample will be subject to disciplinary action, up to and including immediate termination. Drug or alcohol testing required or requested by the Company will be conducted at the Company expense. Testing for the presence of alcohol will be conducted by analysis of breath. Testing for the presence of the metabolites of drugs will be conducted by the analysis of urine. To ensure the accuracy and fairness of our testing program, all testing will be conducted according to DHHS/SAMHSA guidelines where applicable and will include a screening test; a confirmation test; the opportunity for a split sample; review by a Medical Review Officer, including the opportunity for employees who test positive to provide a legitimate medical explanation, such as a physician's prescription, for the positive result; and a documented chain of custody. Testing Based on Reasonable Suspicion Employees may be referred by a supervisor to a company -approved physician or medical group for evaluation when a supervisor has reason to believe that the employee is intoxicated or using controlled substances or other illegal drugs during work hours or at a time which may affect job performance or safety. Evidence of such behavior may include, but is not limited to: slurred speech, uneven gait, mood swings, violent temper, or excessive absenteeism and/or tardiness. Employee Consent to Release Chemical Analysis When the Company requires an employee to submit body fluids for chemical analysis, the employee must sign an Employee Consent Form authorizing the results to be forwarded to Green Demolition Contractors HR Representative. An employee who refuses to submit body fluid samples upon request of the Company or who refuses to execute the Employee Consent Form has failed to cooperate with a management investigation in violation of the Company business conduct policy. Such conduct will subject the employee to disciplinary action, up to and including immediate termination of employment. r 523 Northbrook Drive Michigan City, IN 46360 Office: 312-409-4771 Fax: 773-477-7149 4. Confidentiality of Test Results Test results of the chemical analysis of body fluids for substance abuse will be kept confidential in the same manner that all other confidential personnel records and confidential medical records are kept. Upon written request, the employee will be furnished with a copy of his or her substance abuse test results. 5, Analysis of Test Results Being under the influence of drugs or alcohol on the job or during work hours will be presumed by the Company to pose a serious safety and health risk. Additionally, any use of alcohol or drugs during non -work time which results in a positive test of the employee during work hours may result in a similar presumption that the use of the drugs or alcohol poses serious safety and health risks. 6. Positive Test The Company reserves the right to impose discipline, up to and including immediate termination of employment, upon any employee who tests positive, The Company reserves the right to require, as a condition of reinstatement and continued employment, completion of an approved rehabilitation program, at employee expense, which shall include but not be limited to: A period of inpatient care A return to work test, prior to reinstatement Follow-up testing Any employee testing positive during or subsequent to a rehabilitation program will be subject to immediate termination. Employee Signature Date Supervisor / Witness Signature Date 523 Northbrook Drive Michigan City, IN 46360 Office: 312-409-4771 Fax: 773-477-7149 EEO STATEMENT It is the policy of Green Demolition Contractors Incorporated LLC to provide equal employment opportunity (EEO) to all persons regardless of age, color, national origin, citizenship status, physical or mental disability, race, religion, creed, gender, sex, sexual orientation, gender identity and/or expression, genetic information, marital status, status with regard to public assistance, veteran status or any other characteristic that is protected by Federal, State or Local Law. In addition, Green Demolition Contractors Incorporated will provide reasonable accommodations for qualified individuals with disabilities. Green Demolition Contractors Incorporated LLC goal is to increase representation of women, people of color, veterans and individuals with disabilities. Our programs and training are designed to apply to all applicable federal, state and local laws, ordinances and regulations and cover all human resource actions including employment, compensation, benefits, training, education, tuition aid, transfers, promotions and social/recreational programs. Green Demolition Contractors Incorporated LLC CEO and senior leadership along with Local Branches of International Operating Engineers Union and International Brotherhood of Laborer's Union regularly receive and review affirmative action reports and monitor progress, reinforce policies and hold the organization accountable to meet objectives. Michael Brough, President and Norman Bennett, Business Manager are responsible for leading Green Demolition Contractors Incorporated LLC affirmative action efforts and ensuring that the principle of equal employment opportunity is understood and followed. Tile Human Resource head, is responsible for local efforts. All members and management must be familiar with this policy, must fully support it and are responsible for applying these principals in good faith. All employees are responsible for conduct consistent to demonstrate respect for all co-workers. All statements are posted in the Corporate Office and in the HR Office and may be reviewed by applicants and employees on weekdays during normal working hours. Michael J. Brough President and Chief Executive Officer S 523 Northbrook Drive Michigan City, IN 46360 Office: 312-409-4771 Fax: 773-477-7149 EEO STATEMENT It is the policy of Green Demolition Contractors Incorporated LLC to provide equal employment opportunity (EEO) to all persons regardless of age, color, national origin, citizenship status, physical or mental disability, race, religion, creed, gender, sex, sexual orientation, gender identity and/or expression, genetic information, marital status, status with regard to public assistance, veteran status or any other characteristic that is protected by Federal, State or Local Law. In addition, Green Demolition Contractors Incorporated will provide reasonable accommodations for qualified individuals with disabilities. Green Demolition Contractors Incorporated LLC goal is to increase representation of women, people of color, veterans and individuals with disabilities. Our programs and training are designed to apply to all applicable federal, state and local laws, ordinances and regulations and cover all human resource actions including employment, compensation, benefits, training, education, tuition aid, transfers, promotions and social/recreational programs. Green Demolition Contractors Incorporated LLC CEO and senior leadership along with Local Branches of International Operating Engineers Union and International Brotherhood of Laborer's Union regularly receive and review affirmative action reports and monitor progress, reinforce policies and hold the organization accountable to meet objectives. Michael Brough, President and Norman Bennett, Business Manager are responsible for leading Green Demolition Contractors Incorporated LLC affirmative action efforts and ensuring that the principle of equal employment opportunity is understood and followed. The Human Resource head, is responsible for local efforts. All members and management must be familiar with this policy, must fully support it and are responsible for applying these principals in good faith. All employees are responsible for conduct consistent to demonstrate respect for all co-workers. All statements are posted in the Corporate Office and in the HR Office and may be reviewed by applicants and employees on weekdays during normal working hours. Michael J. Brough President and Chief Executive Officer 523 Northbrook Drive Michigan City, IN 46360 Office: 312-409-4771 Fax: 773-4 77-7149 Purchasing Policy Statement of Purpose Phis shall be known as the Green Demolition Contractors Incorporated LLC, Purchasing Policy. Its purpose is to rnsure that Green Demolition Contractors Inc., purchases recycled and other environmentally preferable products whenever they meet cost and performance requirements. Definitions "1--�Mvlronmentally Preferable Products" means products that have a lesser impact on human health and the environment when compared with competing products. This comparison may consider raw materials acquisition, production, manufacturing, packaging, distribution, reuse, operation, maintenance, or disposal of the product. "Recycled Products" are products manufactured with waste material that has been recovered or diverted from solid waste. "Practicable" means sufficient in performance and available at a reasonable cost. "Cost" means the total expense of the product including the initial price, lifecycle costs, and disposal costs. "Price" means the initial expense to acquire the product. Statement of Policy (;reen Demolition Contractors Incorporated LLC, shall purchase recycled and other environmentally preferable products whenever practicable. ( ;recn Demolition Contractors Incorporated LLC, shall require contractors and consultants to use recycled and ()ther environmentally preferable products whenever practicable. Statement of Procedure (;recn Demolition Contractors Incorporated LLC, shall be responsible for coordinating implementation of this policy as follows: I . Assign appropriate personnel to fulfill the requirements of this policy. 2. Research opportunities for procurement of recycled and other environmentally preferable products and communicate these to purchasing decision makers for evaluation and purchase. 3. Collaborate with specifying agencies to prepare or revise bid documents and contract language where necessary to implement this chapter. 4. Collect data on purchases by Green Demolition Contractors Incorporated LLC, of recycled and other environmentally preferable products. 523 Northbrook Drive Michigan City, IN 46360 Office: 312-409-4771 Fax: 773-477-7149 5. Prepare and submit an annual report to Green Demolition Contractors Incorporated LLC, by Jan 30th of each year, describing the progress of Green Demolition Contractors Incorporated LLC, in implementation of the policy, including the following elements: a. Quantities, costs, and types of recycled and other environmentally preferable products purchased; b. A summary of savings achieved through the purchase of recycled and other environmentally preferable products; c. A suminaty of program promotional efforts; d. Recommendations for changes in procurement policy. 0. Promote the use of recycled and other environmentally preferable products by publicizing its environmental purchasing policy and its implementation. Educating staff about the policy and listening to staff comments and suggestions. Exemptions Nothing in this policy shall be construed as requiring the purchase of products that do not perform adequately or ;ire not available at a reasonable cost. Implementation '['his policy shall be effective immediately from the date of signature. l )ated the day of 2015 Signature 523 Northbrook Drive Michigan City, IN 46360 Office; 312-409-4771 Fax: 773-477-7149 Project: Recycling Scope: Green Demolition will and is currently pursuing a recycling at Green Demolition is using it owns dumpsters to recycle all metals which may include any all of the, following, desks, file cabinets, pipe, conduit, tee grid from the ceilings, and wiring. Green Demolition is also using it owns dumpsters to recycle all concrete, brick and block, etc that we will be removing and disposing of. a contracted waste hauler will also be segregating materials at a transfer site that were hauled from . Materials that will salvage for reuse are paper, cardboard, wood, plastics, metals, brick, block, and concrete. End of month reports will be generated showing percentages of recycled materials to waste disposed of in an approved land fill. A final report will be generated at the end of the project showing a combined report for the demolition debris at Respectfully, Green Demolition, Inc. Laura Hayes Mi " 0 At 523 Northbrook Drive Michigan City, IN 46360 Office: 312-409-4771 Fax: 773-477-7149 November 28, 2017 City of South Bend Indiana Department of Public Works Re: Fire Station Number 9 Demoitions Green Demolition Contractors, Inc. is committed to exceeding the Goal from a Section 3 firm. Green Demolition Contractors, Inc. currently has a relationship with Unique Casework 3936 W. 16th Street, Chicago, Illinois 60623 (773-522-7771) Pat Davis, Owner. Unique Casework is MBE, WBE, and Section 3 Certified. It is the intent of Green Demolition Contractors, Inc. to utilize Unique Casework for disposition and if applicable, recycle / reuse of any materials being deemed as such. Thank you, Michael Brough, President Green Demolition Contactors, Inc. [ia= 1310= Eli;r .a FAAAMM AmTrust Surety ,n AmTrust Financial Company July 31, 2017 Re: Green Demolition Contractors Incorporated To whom it may concern: Developers Surety and Indemnity Company, a division of AmTrust Financial Group is the current surety for Green Demolition Contractors, Inc.We have maintained a bonding relationship with this contractor since 2010. Developers Surety and Indemnity Company holds an A (Excellent) XIII Financial Rating by AM Best and has a United States Department of Treasury listing in excess of $7,446,000. Based on our underwriting review and this contractor's past history, we hold this firm in high regards and we are confident in their ability to complete their work. We currently have in place a bond line of $1,500,000 single over a bonded aggregate program of $4,000,000. Please note that a line is established for convenience purposes only and is not indicative as to how high we may consider. We have approved, on a case by case basis up to $2,200,000. If, Green Demolition Contractors, Inc. should be awarded a project with The City of Chicago, Developers Surety and Indemnity Company would be willing to write the performance and payment bonds subject to an acceptable contract. Sincerely, Ronald B. Gengler Director of underwriting AmTruSt Surety 1038 Oak Street Sugar Grove, IL 60554 630.466.4860 office ron� al"enaler _,amtrustgroup,com www.amtrustsurety.com 17771 Cowan, Suite 100• Irvine, CA 92614 (p) 800.782.1546• (f 800.261.1955-www.AmTrustSurety,com nab �Ell 0 4 ta ��'� `i_i L1/14/�'1014 08:21 17AX 1 `L yp , 9 =I Ujuj. vi APPROVED AND FILED CONNIE LAWSON INDIANA SECRETARY OF STATE 04/06/2017 07:54 AM BUSINESS ID 2015061100177 BUSINESS TYPE Domestic Limited Liability Company BUSINESS NAME GREEN DEMOLITION CONTRACTORS INCORPORATED PRINCIPAL OFFICE ADDRESS 523 NORTHBROOK DRIVE, MICHIGAN CITY, IN, 46360, USA na EARS FILED YEARS 2017/201 R AtQT$TERED bI'FICE AND ADIME, SS — — NAME MICHAEL BROUGH ADDRESS 523 NORTHBROOK DRIVE, MICHIGAN CITY, IN, 46360, USA PRINCIPALS)ww TITLE President NAME ADDRESS Michael Brough 523 Northbrook Drive, Mich City, IN, 46360, USA IN WITNESS WHEREOF, THE UNDERSIGNED HEREBY VERIFIES, SUBJECT TO THE PENALTIES OF PERJURY, THAT THE STATEMENTS CONTAINED HEREIN ARE TRUE, THIS DAY April 6, 2017. SIGNATURE TITLE . . Michael J Brough Registered Agent Business ID: 2015061 100177 Filing No.: 7567739 -Page 1 of 1 - ACORO® CERTIFICATE OF LIABILITY INSURANCE DATE (MMlDDIYYYY) 1 llk.� 11/20/2017 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 have ADDITIONAL INSURED provisions or 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 David S. Parriill NAME: €'arrllll, David PHONE (312) 621-5182 nAic No : {312) 621-2288 AIC Nn Ext: E-MAIL dparrilil@rockWOodoo.Com ADDRESS: The Rockwood Company p y INSURER(S) AFFORDING COVERAGE NAIL p 20 N Wacker Drive, Suite 960 INSURER A : Navigators specialty ins Co. 36056 Chicago IL 60606 INSURED V •�^^ INSURER B : S1afSione National insurance Co. 25496 Green Demolition Contractors, Inc INSURER C INSURER D 4840 S St Louis Ave Ste 100 INSURER E : INSURER F : Chicago IL 60632 COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: fHIS 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. INSR I.TR TYPE OF INSURANCE ADOL INSD SURN WVD POLICY NUMBER O ICY EFF JMMIDDIYYYYI POLICY EXP MMIDDNYYY LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS•MADE OCCUR ❑ T RE ❑ PREMISES Ea eccurfenoe _._... 50,000 $ MED EXP (Any one person) $ 5,000 PERSONAL & ADV INJURY $ 1,000,000 A X X CE17GGL1326961C 05/16/2017 05/16/2018 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE g 2,000,000 POLICY [g PRO- E] LOC PRODUCTS-GMPfOPAGG O. 2,000,000 $ _. $ OTHER _ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident g 1,000,000 BODILY INJURY (Per person) $ ANY AUTO A — OWNED SCHEDULED AUTOS ONLY AUTOS HIRED NON -OWNED AUTOS ONLY AUTOS ONLY X X CE17CGL1326961C 05/16/2017 05/16/2018 - BODILY INJURY (Per accdant) $ PROPERTY DAMAGE Par accident) $ $ UMBRELLA LIAR OCCUR EACH OCCURRENCE $ 10,000,000 AGGREGATE $ 10,000,000 B EXCESS LIAR CLAIMS -MADE 590958175ALI 05/16/2017 -05/16/2018 LOX RETENTION $ 10,000 $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN STATUTE 11 ERH_ ANY PROPRIETOWPARTNERlEXECUTIVE E.L. EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? ❑ NIA (Mandatory In NHI E.L. DISEASE - EA EMPLOYEE $ E.L. DISEASE - POLICY LIMIT $ If yes, describe under DESCRIPTION OF OPERATIONS below nESCR€PTION OF OPERATIONS! LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space Is required) ^ SEE ADDITIONAL REMARKS (ACORD 101) r'.FPTtFIr.GTF Hoi nFR CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN LG Construction Group, LLC ACCORDANCE WITH THE POLICY PROVISIONS. 2234 W North Ave AUTHORIZED REPRESENTATIVE Chicago IL 60647 @ 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD POLICY NUMBER: CEI7CGI.132696IC COMMERCIAL GENERAL LIABILITY CG20101001 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS -- SCHEDULED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name of Person or Organization: Any Person or organization for whom you are performing operations during the policy period have agreed in writing in a contract or agreement that such person or organization be added as an additional insured on your policy, (If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement.) A. Section If — Who Is An Insured is amended to (1) All work, including materials, parts or include as an insured the person or organization equipment furnished in connection with shown in the Schedule, but only with respect to such work, on the project (other than liability arising out of your ongoing operations service, maintenance or repairs) to be performed for that insured. performed by or on behalf of the addi- B. With respect to the insurance afforded to these tional insured(s) at the site of the cov- additional insureds, the following exclusion is ered operations has been completed; added, or 2. Exclusions (2) That portion of "your work" out of which ! to "bodily �n- the injury or damage arises has been This insurance does not apply y y put to its intended use by any person or jury" or "property damage" occurring after: organization other than another con- tractor or subcontractor engaged in performing operations for a principal as a part of the same project. CG 20 10 10 01 0 ISO Properties, Inc., 2000 Page 1 of 1 POLICY NUMBER: CEI7CGI,1326961C COMMERCIAL GENERAL LIABILITY CG 24 04 05 09 WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE Name Of Person Or Organization, Any Person or organization for whom you are performing operations during the policy period have agreed in writing in a contract or agreement that such person or organization be added as an additional insured on your policy. [ Information_ requiredto complete this Schedule, if not shown above, will be shown in the Declarations. 1 The following is added to Paragraph 8, 'transfer Of Rights Of Recovery Against Others To Us of Section IV — Conditions: We waive any right of recovery we may have against the person or organization shown in the Schedule above because of payments we make for injury or damage arising out of your ongoing operations or "your work" done under a contract with that person or organization and included in the "products - completed operations hazard". This waiver applies only to the person or organization shown in the Schedule above. CG 24 04 05 09 © Insurance Services Office, Inc., 2008 Page 1 of 1 13 A C"R O L AGENCY CUSTOMER ID: LOC #: ADDITIONAL REMARKS SCHEDULE Page 2 of 2 ACENCY NAMEDINSURED Parrilli, David Green Demolition Contractors, Inc POLICY NUMBER See Prior Page CARRIER NAIL CDDE See Prior Page EFFECTIVE DATE: ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: Certificate of Liability Insurance Re: Taureaux Tavern - 155 W. Van Buren St - Chicago, IL 60605 Additional insureds when required by written contract on a primary & non-contributory basis with respect to General Liability, Aired & Non Owned Auto Liability (Umbrella follows form) for work performed by Green Demolition Contractors, Inc. per ISO Forms CG 2010 10/01 and CG 2037 10/01 (attached); A Waiver of Subrogation in favor of Additional Insureds with regard to General Liability, Hired & Non Owned Auto Liability (Umbrella follows form) is included when required by written contract per ISO Form CG 2404 (05/09) (attached): -I.G Construction Group, LLC (General Contractor) •Taureaux Tavern, LLC (Owner) -.7onatahan Splitt Architects Ltd (Architect of Record) And LG Construction's peripheral parties, including: LG Development Group LLC, Goldberg Development Group LLC, ML Development Group LLC, and Cuda Development LLC." ACORD 101 (2008/01) a 2008 ACORD CORPORATION. All rights reserved. INS101 {200e01) The ACORD name and logo are registered marks of ACORD POLICY NUMBER: CEI7CGL132696IC COMMERCIAL GENERAL LIABILITY CG 20 37 10 01 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - COMPLETED OPERATIONS This endorsement modifies insurance provided under the following: (COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name of Person or Organization: Any Person or organization for whom you are performing operations during the policy period have agreed in writing in a contract or agreement that such person or organization be added as an additional insured on your policy. Location And Description of Completed Operations: Additional Premium: (If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement.) Section If -- Who Is An Insured is amended to include as an insured the person or organization shown in the Schedule, but only with respect to liability arising out of "your work" at the location designated and described in the schedule of this endorsement performed for that insured and included in the "products -completed operations haz- ard". CG 20 37 10 01 O ISO Properties, Inc., 2000 Page 1 of 1 —� DATE (MMf2017 YY) 111212017 AC"I?" `..� CERTIFICATE OF LIABILITY INSURANCE ACOW:2494065 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: It 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 �r Lockton Companies, LLC 2100 Ross Ave, Suite 1400 40MHONE AX AlC No,F.xt : 214-771-4411 A,C, No): -MAIL Dallas, TX 75201 %DDRESS: wcOresourcin ed e.com INSURER(S) AFFORDING COVERAGE NAIC '.. NSURER•A: Indemn€iy Insurance Co. of North America 43576 INSURED NSURER•B: NSURER-C: Resourc€ng Edge I, LLC 1309 Ridge Rd, Suite 200 Rockwall, TX 75067 NSURER-D: NSURER-E: "See Below NSURER-F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD in,DICATED. 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, INSR ADDL PUBR POLICY EFF POLICY EXP LTR OF INSURANCE INSR WVD POLICY NUMBER MMIDDIYYYY MM1DDlYY_YY LIMITS _ _TYPE COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ DAMAGE TO RENTED CLAIMS_- MADE OCCUR PREMISES Ea occurrence _ VIED EXP (Any oneperson) PERSONAL & ADV INJURY GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE PRO _ POLICY JECT LOG PRODUCTS — COMPIOP AGO $ OTHER: AUTOMOBILE LIABILITY Ea COMBINED LIMIT $ BODILY INJURY Per Person $ ANY AUTO BODILY INJURY (Per accident) $ ALL OWNED SCHEDULED AUTOS AUTOS PROPERTY DAMAGE Per accidenl� $ NON -OWNED AIRED AUTOS AUTOS OCCUR EACH OCCURRENCE $ AGGREGATE $ -IIMBRELLALIAB XCESS LIAB CLAIMS MADE DED RETENTION $ r.. _ CRXVRSCOMPENSATION PER OTH- �— A ND EMPLOYERS' LIABILITY ANY PROPRIFTORIPARTNERlEXEGUTIVE YIN N I A X STATUTE ER E.L. EACH ACCIDENT $ 1,000,000 FFICERIMEMSER EXCLUDED? X C64BG2884 10101/2017 10/01/2018 - MANDATORY IN NH) I yes, doscdbo under E.L. DISEASE — EA EMPLOYEE $ 1,000,000 DESCRIPTION OF OPERATIONS below E.L. DISEASE —POLICY LIMIT - $ 1,000;0oo DESCRIPTION OF OPERATIONS (LOCATIONS I VEHICLES (Acord 101, Additional Remarks Schadute, may he attached If more space is required) Green Demolition Contractors Inc. (2496y Is Included as a named Insured through endorsement. Coverage provided toy all teased employees but not subcontractors of: Green Demolition Contractors Inc. Wxlver of Subrogation In favor of LG Construction Group, LLC (General Contractor), Taureaux Tavern, LLC (owner), donalshan Architects Ltd (Archkecl of Record), and LG Construcllen's peripheral parties, Includ€ng: LG ilevelapmanl Grout' LLC, Goldberg Development Group LLC, ML Developmenl Group LLC and Curia Development LLC when required by written contract ac: Taureaux Tavern, 155 W. Van Buren St., Chleago, IL 60605 [t��R111i-ild[+aillI:4:IQ 11111:1 N_i11144:4rt4-1t♦I[a]► --- ---� 2494066 LG Construction Group, LLC 2234g W. North Ave. Chicago, IL 60647 SHOULD ANY OF THE. A13OVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS AUTHORIZED REPRES(E�NTATIIVE 01988-2014 ACORD CORPORATION. All Rights Reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD ' Workers' Compensation and Employers' Liability Policy Named Insured Endorsement Number Resourcing Edge 1, LLC Green Demolition Contractors Inc. Policy Number Symbol: W L R Number: C64802884 Policy Period Effective Date of Endorsement 10/01 /2017 TO 10/o1 /2o 18 11 /21 /2017 Issued By (Name of Insurance Company) Indemnity Insurance Co. of North America Inserl the policy number. The remainder of the information is to be completed only when this endorsement is issued subsequent to the preparation of the policy. WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce our right against the person or organization named in the Schedule. This agreement applies only to the extent that you perform work under a written contract that requires you to obtain this agreement from us. This agreement shall not operate directly or indirectly to benefit any one not named in the Schedule. Schedule LG Construction Group, LLC (General Contractor), Taureaux Tavern, LLC (Owner), Jonatahan 5plitt Architects Ltd (Architect of Record), and LG Construction's peripheral parties, including: LG Development Group LLC, Goldberg Development Group LLC, ML Development Group LLC and Cuda Development LLC 2234g W. North Ave. Chicago, IL 60647 Re: Taureaux Tavern, 155 W. Van Buren 5t., Chicago, IL 60605 For the states of CA, UT, TX, refer to state specific endorsements. This endorsement is not applicable in KY, NH, and NJ. The endorsement does not apply to policies in Missouri where the employer is in the construction group of code classifications. According to Section 287.150(6) of the Missouri statutes, a contractual provision purporting to waive subrogation rights against public policy and void where one party to the contract is an employer in the construction group of code classifications. For Kansas, use of this endorsement is limited by the Kansas Fairness in Private Construction Contract Act(K.S.A.. 16-1801 through 16-1807 and any amendments thereto) and the Kansas Fairness in Public Construction Contract Act(K.S.A 16-1901 through 16-1908 and any amendments thereto). According to the Acts a provision in a contract for private or public construction purporting to waive subrogation rights for losses or claims covered or paid by liability or workers compensation insurance shall be against public policy and shall be void and unenforceable except that, subject to the Acts, a contract may require waiver of subrogation for losses or claims paid by a consolidated or wrap-up insurance program. IY�l dlae �°� Authorized Representative WC 0003 13 01/OS) Ptd. U.S.A. Copyright 1982-83, National Council on Compensation ---1 � DATE {MMlD61YYYY! ,4c©rry CERTIFICATE OF LIABILITY INSURANCE PRODUCER THIS CERTIFICATE IS ISSUED AS MATTER OF INFORMATION Mark Mackey Ins Agcy ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 3338 W Foster HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR Chicago, IL 60625 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. 5 INSURERS AFFORDING COVERAGE NAIC # INSURED INSURERA:State Farm Mutual Auto Insurance Company 2.5178 GREEN DEMOLITION CONTRACTORS INC - - - - - 4890 South St. Louis Avenue INSURER B: Suite 100 INSURERC; Chicago, T1 60632 INSURER D: INSURER E: 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, AGGREGATE LIMITS SHOW_ N_ MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR AOIm - � POLICY EFFECTIVE POLICY EXPIRATItlN LTR INSRD TYPE OF INSURANCE POLICY NUMBER DATE MMlDDNY) DATE IMMlDDIYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY DAMAGE 0 PREMISES Ea Occurrence $ MED EXP (Anyone pem*n $ CLAIMS MADE OCCUR PERSONAL & ADV INJURY $ GENERALAGGREGATE _ $ GE..NL AGGREGATE LMITAPP€IF..S PER PRODUCTS -COMPYOP AEG $ PRO, POLICY JECT LOG A X AUTOMOBILE X LIABILITY ANYAUTO C16 1981-A16-13A JUL-16-17 JUL-16-18 COMBINED SINGLE LIMIT (Ea accident) 3 1,000,000 BODILY INJURY {Per person} S X ALL OWNED AUTO$ SCHEDULED AUTOS BODILY INJURY (Per accident) $ X X HIRED AUTOS NON -OWNER AUTOS PROPERTY DAMAGE (Per accident) $ GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ OTHER THAN EA ACC $ ANY AUTO AUTO ONLY: AGC $ EXCESSIUMBRELLA LIABILITY EACH OCCURRENCE $ AGGREGATE $ OCCUR OCLAIMSMADE 5 $ DEDUCTIBLE $ RETENTION _ S WORKERS COMPENSATION AND EMPLOYERS' LIABILITY -- WC STATU, OTH• TORY LIMITS ER E.L EACH ACCIDENT $ ANY PROPRIETORIPARTNER/EXECUTIVE OFFICERIMEMBER EXCLUDED? es, describe under JFCIAL PROVISIONS below - E.L. DISEASE - EA EMPLOYEE $ E.L. DISEASE - POLICY LIMIT $ OTHER DESCRIPTION OF OPERATIONS I LOCATIONS T VEHICLES f EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS Project: Taureaux Tavern 155 W. Van Buren St. Chicago, IL 60605 Additi.ona.l, TnSUrPd: Jonathan Splitt Architects Ltd, as the Architect of Record, Taureaux Tavern, LLC, and All Parties as the Owner, LG Construction Group LLC as the General Contractor, and LG Construction's periphe'ral'parties, including: LG Development Group LLC, Goldberg Development Group LLC, ML Development Group LLC, and Cuda Development LLC GERTIFICATE HOLDER CANCELLATION LG Construction Group, LLC SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION 2234 W. North Ave, DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL _,�O DAYS WRITTEN Chicago, IL 60647 NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE MARK MACKEY AGOR13 25 (200 e regls ra Ion notices indicate owners Ip of e mats by tHeir respeC IVe owners o 132849 03-13.2007 All rights reserved