HomeMy WebLinkAboutOpening of Bids - Jefferson & Twyckenham Signal Improvements Proj No 116-027 - Hawk Enterprises, Incs uxh
BIDIPROPOSAL
P
CITY of sourH BEND
F
Project Name Jefferson and Twyckenham Signal Improvements
Project No. 116-027
For Blds Due iuIy2601r2W December 19, 2017 at gam
BIDDER Hawk Enterprises, Inc.
BASE BID
_.1
Description
Quantity
Unit
Unit Price
Total Amount
Mobilization & Demobilization
1
LS
$9,200.00
$9,200.00
2
Maintenance of Traffic
1
LS
$9,100.00
$9,100.00
3
Traffic Signal Equipment, Remove & Salvage
1
LS
$2,870.00
$2,870.00
4
Signal Cantilever Structure, Drilled Shaft
Foundation, T A
4
EA
$3,400.00�
$13,600.00
5
Signal Cantilever Structure Single Arm 25 ft.
g
1
EA
$7,600.00�
^$7,60 ...,_
$7600.00
6
Signal Cantilever Structure, Single Arm 30 ft.
3
EA
$8,000.00
$24,000.00
7
8
Traffic Signal Head, 3-Section, LED
6
2
EA
$755.00
$4,530.00
Traffic Signal Heats, 5-Section, LEI)
EA
$1,120.00
$2,240.00
9
Handhole, Signal, Type 1
4
EA
$1,200.00
$4,800.00
10
Pedestrian Push Button wl R10-3e sign
8
8.__.
EA
EA
$840.00
$675.00
$6,720.00
11
Pedestrian Signal Head with Countdown, 18-
Inch
$5,400.00
12
Conduit, HDPE, 2-inch, Schedule 80
500
LF
$13.00
$6,500.00
13
Conduit, HDPE, 3-Inch, Schedule 80
50
LF
$15.00
$750.00
14
Signal Cable, Control, Copper 7c/14GA
415
LF
$2.25
$933.75
$3,148 00
16
....... ...... ..
Signal Cable, Control, Copper 5c/14GA
1574
Lr
$2.00
17
Si na! Cable, ServlceLCapper 3c/8
_:_ _ .
Vehicle Video Detection System
-- —_
25
LF
$3.00
$75.00
18
4
EA
$9,100.00
$36,400.00
19
Traftic,Signal Controller and Cabinet, P-1
1
EA
_._..._.....__.._................ ._
$23,120,00
_._..... —_ _...
$23,120.00
20
Controller Cabinet Foundation, P-1
1
1
EA
EA
$870.00
$6,120.00
$870.00
$6,120.00
21
TESCO Cabinet and Foundation
22
Soddin
70
SYS
$21.00
$1,470.00.mm��
23
Sidewalk
106
150
SYS
LF
$75.00
$55.00
_ ._....._ ... .
$7,950.00
24
Special Concrete Curb
$8,250.00
25
26
HMA Pavement Patch
36
SYS
SYS
$175.00
$6,125.00
Sidewalk Curb Ramp
$250.00
$9,000.00
Version 10/17/2017 Contraotor's Bid for Public Works - 7 Addendum #1
_........ ..... -
Description
Quantity
Unit
Unit Price
Total Amount
_ 27
Sign, Sheet, with Legend 0,100 IN
26
SIFT
$16.00
$416,00...__...
28
Line Removal
390
LF
$2.00
$780.00
29
__.
24" White Thermoplastic Stop Line
...
6" Solid White Thermoplastic Line
110
LF
$5,00
$550,00
30
420
LI=
. $2.10
$882.00
31
4" Solid Yellow Thermoplastic Line
226
LF
$1.00
$226,00
32
4" Sotld White Thermoplastic Line
470
LF
$1.00
$470.00
33
Pavement Message Markinq, Left Turn Arrow
2
EA
$150.00
$300.00
BASE BID TOTAL $204,395.75
Bidder (Firm): Hawk Enterprises, Inc.
Address: 1850 E. North Street
City/State/Zip: Crown Point, IN 46307 Telephone Number: ( 219 ) _662-809
B
(Signature)
Johanna Plank, President
(Printed name of Person Signing)
Version 10/17/2017 Contractor's Bid for Public Works - 8 Addendum #1
CITY OF SOUTH BEND, INDIANA
CONTRACTOR'S BID FOR PUBLIC WORK
Project Name Jefferson and Twyckenham Signal Improvements
7' Project No. 116-02_.
For Bids Due 151hr2W December 19, 2017 at gam
PART 1
(Must be completed for all bids. Please type or print)
Date: 12/19/17 Bidder (Firm): Hawk Enterprises, Inc.
Address: 1850 E. North Street -...._ .
City/State/Zip: Crown Point, IN 46307 Tefephone Number: � 2�„ � l _ j 662-8090
Agent of Bidder (if Applicable):
Pursuant to notices given, the undersigned offers to furnish labor and/or material necessary to complete the
public works project of:
Jefferson & Twyckenham Signal Improvements - Project No. 116-027
the City of South Bend, Indiana, in accordance with plans and specifications prepared by:
Department of Public Works - Division of Engineering - South Bend, Indiana
and dated 12/19/17 for the sum of {enter the Total Bid as shown on the Proposao
Two hundred four thousand three hundred ninety-five and 75/100 204,395.75
,.., v.
a.W6 (Numerical)
The undersigned further agrees to furnish a bond or certified check with this bid for an amount specified In
the notice of the letting. If alternative bids apply, the undersigned submits a proposal for each in accordance
with the notice. Any addendums attached will be specifically referenced at the applicable page.
If additional units of material included In the contract are needed, the cost o ust be the same as that
shown In the original contract if accepted by the Cit f South Bend, I� a bid 1 to be rded n a unit
basis, the Itemization of the units shall be sho
B n a pa to atta rn in
Y� �........._
(Signature)
........... .
Johanna Plank, resident
(Printed Name of Person Signing)
ACCEPTANCE
The above bid is accepted this 19th day of December 20 17
Subject to the following conditions: Al/fj
BOARD OF PUBLIC WORKS, /
Gary A. Gifot, Presfdent
Ellzabeth A, Maradik, Member— __.
Suzanna M. Fritzberg, Member -
Therese J. Donau, Member
__.._._........ _ ..__-...... -
James A. Mueller, Member Attest: Linda M. Martin, Clerk
Version 10117/2017 Contractor's Bid for Public Works - 2 Addendum #1
CONTRACTOR (Name, lap] status and address): SURETY (Name, [opt status and principal place of business);
Hawk EnLergr es In Fidglily gnd Deposit Company of MapLiand
1850 E.-North Street 600 Red Brook Blvd, Sulte,600
gLM,PoIpJ. IN 46207
OWNER (Name, legal status and address):
CItyofSouth Bend,,indlana, Board of Public Works
1316UIy-.Coun!I Building
South Bend, IN 46601
Owings Mills, MI) 21117
Bond Amount: 5% Five Percent of the Base B,ld Plus Any Alternate
PROJECT: (Name, location or address, and Project number, if any):
Jefferson and IackenhaMIiLnal Improvements, Pro' ect No. 116-027
The Contractor and Surety are bound to the Owner in the amount set forth above, for the payment of which the Contractor and Surety
bind themselves, their heirs, executors, administrators, successors and assigns, jointly and severally,, as provided herein.' The conditions
of this Bond are such that if the Owner accepts the bid of the Contractor within the time specified in the bid documents, or within such
time period as may be agreed to by the Owner and Contractor, and the Contractor either (1) enters in to a contract with the Owner in
wcordarice with the terms of such bid, and gives such bond or bonds as may be specified in the bidding or Contract Documents, with a
surety admitted in the jurisdiction of the Project and otherwise acceptable to the Owner, for the faithful performance of such Contract and
for the prompt payment of labor and material furnished in the prosecution thereof, or (2) pays to the Owner the difference, not to exceed
the amount of this Bond, between the amount specified in said bid and such larger amount for which the Owner may in good faith
contract with another party to perform the work covered by said bid, then this obligation shall be null and void, otherwise to remain in
full force and effect, The Surety hereby waives any notice of an agreement between the Owner and Contractor to extend the time in
which the Owner may accept the bid. Waiver of notice by the Surety shall not apply to any extension exceeding sixty (60) days in the
aggregate beyond the time for acceptance of bids specified in the bid documents, and the Owner and Contractor shall obtain the Surety's
consent for an extension beyond sixty (60) days.
If this Bond is issued in connection with a subcontractor's bid to a Contractor, the term Contractor in this Bond shall be deemed to be
Subcontractor and the term Owner shall be deemed by the Contractor.
When this Bond bus been Rimished to comply with astatutory or other legal requirement in the location of the Project; any p
this Bond conflicting with said statutory or legal requirement shall be deemed deleted herefrom and provi I s conforml
statutory or other legal requirement shall be deemed incorporated herein. When so flimished, the in t Is
construed as a statutory bond and not as a common law bond.
Signed sealed this 19thL—day of December 2017 Hatry 7er Ises, C
ff rl /Orr
(Seal] (P ' tpa"IN
V
(Title)
Orr 01P:0- DEP
Terry R. IHurst
41
Language conforms to AIA Document A3 10 Bid Bond
DID7000IM31117
and
M. Wahistrom
islon, in
to such
luq4tl�
131 lost
%-I eo
KON
Attorney -in -Fact
Bond Number Hid Bond
Obligee: Ciro of South BaA Indiana, noW of Public woTb
ZURICH AMERICAN INSURANCE COMPANY
COLONIAL AMERICAN CASUALTY AND SURETY COMPANY
FIDELITY AND DEPOSIT COMPANY OF MARVI AND
POWER OF ATTORNEY
KNOW ALL MEN BY THESE PRESENTS: That the ZURICH AMERICAN INSURANCE COMPANY. a corporation of the State of New
York, the COLONIAL AMERICAN CASUALTY AND SURETY COMPANY, a corporation of the State of Maryland, and the FIDELITY
AND DEPOSIT COMPANY OF MARYLAND a corporation of the State of Maryland (herein collectively called the "Companies"I by
Michael P. Bond, Vice President, in pursuance of authority granted by Article V, Section 8, of the By -Laws of said Companies, which are
set forth on the reverse side hereof and are hereby certified to be in fiill force and effect on the date hereof, do hereby nominate, constitute,
and appoint Eric M. Wahlstrorla its true and lawful agent and Attorney -in -Fact, to
make, execute, seal and deliver, for, and on its behalf as surety, and as its act and deed: any and all bonds and undertakings, and the
execution of such bonds or undertakings in pursuance of these presents, shall be as binding upon said Companies, as fully and amply, to all
intents and purposes, as if they, had been duly executed and acknowledged by the regularly elected officers of the ZURICH AMERICAN
INSURANCE COMPANY at its office in New York, New York., the regularly elected officers of the COLONIAL AMERICAN
CASUALTY AND SURETY COMPANY at its office in Owings Mills, Maryland., and the regularly elected officers of the FIDELITY AND
DEPOSIT COMPANY OF MARYLAND at its office in Owings Mills, Maryland, in their own proper persons.
The said Vice President does hereby certify that the extract set forth on the reverse side hereof is a true copy of Article V, Section 8, of
the By -Laws of said Companies, and is now in force.
IN WITNESS WHEREOF. the said Vice -President has hereunto subscribed his/her names and affixed the Corporate Seals of the said
ZURICH AMERICAN INSURANCE COMPANY, COLONIAL AMERICAN CASUALTY AND SURETY COMPANY, and
FIDELITY AND DEPOSIT COMPANY OF NIARYLAND, this 22'd day of July. A.D. 2015.
By: Michael A Bond
Vice Presldent
Joe.
b'
By: Eric D. Bames
Secretary
State of Maryland
County of Baltimore
ATTEST:
ZURICH AMERICAN INSURANCE COMPANY
COLONIAL AMERICAN CASUALTY AND SURETY COMPANY
FIDEI.FPY AND DEPOSIT COMPANY OF MARYLAND
ION *11110
S AL.
On this 22nd day of hly, A.D. 2015, before the subscriber, a Notary Public of the State of Maryland, duly commissioned and qualified, Michael P.
Bond, Vice President and Eric D. Barnes, Secretary of the Companics. to me personally known to W the individuals and offcera described in and who
executed the preceding instrument, and acknowledged the execution of soma; and being by vto duly sworn, deposeth and saith, that he/she is rho said officer of
the Company aforesaid, end that the seals affixed to the preceding instrument are the Corporate Seals of said Companies, and that the said Corporate Seals and
the signature as such officer were duly affixed and subscribed to the said instrument by the authority and direction of the said Corporations.
IN TBSTIMONY WHEREOF. I have bereanto set my hand and affixed my Official Seal the day and year first above wrinca.
�ruutr II
Constance A. Dunn, Notary Public,
�,•
�,,`�r+u►+r"��•
My Commission Expirer July 9, 2019
EXTRACT FROM BY-LAWS OF THE COMPANIES
"Article V, Section 8, A3to=s-1nFact. The Chief Executive Officer, the President, or any Executive Vice President or Vice President
may, by written instrument under the attested corporate seal, appoint attorneys -in -fact with authority to execute bonds, policies,
recognizences, stipulations, undertakings, or other like instruments on behalf of the Company, and may authorize any officer or any such
attorney -in -fact to affix the corporate seal thereto; and may with or without cause modify of revoke any such appointment or authority at any
time."
CERTIFICATE
1, the undersigned, Vice President of the ZURICH AMERICAN INSURANCE COMPANY, the COLONIAL AMERICAN
CASUALTY AND SURETY COMPANY, and the FIDELITY AND DEPOSIT COMPANY OF MARYLAND, do hereby certify that the
foregoing Power of Attorney is still in full force and effect on the date of this certificate; and I do further certify that Article V, Section 8, of
the By -Laws of the Companies is still in force.
This Power of Attorney and Certificate may be signed by facsimile under and by authority of the following resolution of the Board of
Directors of the ZURICH AMERICAN INSURANCE COMPANY at a meeting duly called and held on the 15th day of December 1998.
RESOLVED: "That the signature ofthe President or a Vice President and the attesting signaW re of a Secretary or an Assistant Secretary
and the Seal of the Company may be affixed by facsimile on any Power of Attorney -Any such Power or any certificate thereof bearing such
facsimile signature and sea] shall be valid and binding on the Company."
This Power of Attorney and Certificate may be signed by facsimile under and by authority of the following resolution of the Board of
Directors of the COLONIAL AMERICAN CASUALTY AND SURETY COMPANY at a meeting duly called and hold on the Sth day of
May, 1994, and the following resolution of the Board of Directors of the FIDELITY AND DEPOSIT COMPANY OF MARYLAND at a
meeting duly called and held on the 10th day of May,1990.
RESOLVED; "'That the facsimile or mechanically reproduced sea] of the company and facsimile or mechanically reproduced signature
of any Vice -President, Secretary, or Assistant Secretary of the Company, whether made heretofore or hereafter, wherever appearing upon a
certified copy of any power of attorney issued by the Company, shall be valid and binding upon the Company with the same force and effect
as though manually affixed.
IN TESTIMONY WHEREOF, I have hereunto subscribed my name and affixed the corporate seals of the said Companies,
this 19th day of December 2017
SBAL
w
X.� "7''•
Gerald F. Haley, Vice President
TO REPORT A CLAIM WITH REGARD TO A SURETY BOND, PLEASE SUBMIT ALL REQUIRED
INFORMATION TO:
Zurich American Insurance Co.
Attn. Surety Claims
1299 Zurich Way
Schaumburg, IL 60196-1056
PART 1
(For projects of $100,000 or more w 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
I. 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 11 PLAN AND EQUIPMENT QUESTIONNAIRE
I. 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 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.
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 Rend can make a proper determination of the bidder's
capability for completing the project if awarded.
Version 10//1712017 Contractor's Bid for Public Works - 3 Addendum #1
PART 11
Section I
1. Projects completed for the period of one year prior to date of current bid
Contract Amount
Class of Work
Completion date
Owner
$293,828.93
Signals / Lighting
November 2016
INDOT
$1,294,388.00
Signals / Lighting
December 2016
INDOT
$580,482.00
Signals / Lighting
December 2016
INDOT
$562,869.00
Signals / Lighting
November 2016
INDOT
2. Public Works projects currently in process of construction
Contract Amount
Class of Work
Completion Date
Owner
$301,371.00
Lighting
March 2018
City of Hammond, IN
$418,855.00
Lighting
March 2018
City of Hammond, IN
$99,362.00
Lighting
September 2018
City of East Chicago, IN
$44,275.00
Fiber Optic
September 2018
City of East Chicago, IN
3. Information regarding failure to complete any work— NONE
4. List of references from private firms for which we have performed work:
• Walsh & Kelly, 1700 E. Main St. Griffith, IN 46319
• Rieth-Riley Construction, 7500 W. 5th Ave Gary, IN 46406
• Woodruff & Sons, P.O. Box 450 Michigan City, IN 46361
• Gatlin Plumbing & Heating, 1111 E. Main St. Griffith, IN 46319
• Grimmer Construction, 2619 Main St. Highland, IN 46322
SECTION II
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
government unit to consider your bid.)
a. Utility Locates
b. Layout
c. Foundations
d. Underground Conduit
e. Concrete, Sidewalk, & Curb
f. Set Signal Poles & Signal Controller
g. Hang & Wire Signal Heads & Cameras
h. Cleanup & Seeding / Sodding
i. Pavement Markings
i. Final Job
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.
i. N/A
3. If you intend to sublet any portion of 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 government unit in the event that you subsequently
determine that you will use a subcontractor on the proposed project.
a. NO.
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.
a. Gradall's
b. Dump Truck
c. Boring Unit & Truck
d. Spool Trailer
e. Utility Truck
f. Bucket Truck
g. Crane
S. 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.
a. YES.
When the prospective Contractor is unable to certyyto any of fire state uenis below, It shall aftach an explanation to this Aff7dapit,
CONTRACTOR'S NON -COLLUSION AND NON -DEBARMENT AFFIDAVIT, CERTWI ICATION
REGARDING INVESTMENT WYM HL4N, EMFLOYMBNT ELIGIBILITY VERIFICATION, NON-
DISCRIMINATION COMMITMENT AND CERTIFICATION OF USE OF UNITED STATE STEEL
PRODUCTS OR FOUNDRY PRODUCTS
(Must be completed for all quotes and bids. Please type or print)
STATE OF Indiana )
) SS:
Lake COUNTY )
The undersigned Contractor, being duly sworn upon his/her/its oath, affirms under the penalties of perjury
that;
1. Contractor has not, nor has any other member, representative, or agent of the firm, company,
corporation or partnership represented by him, entered into any combination, collusion or agreement with
any person relative to the price to be bid by anyone at such letting nor to prevent any person from bidding
nor to induce anyone to refrain fiona bidding, and that this bid is made without reference to any other bid and
without any agreement, understanding or combination with any other person in reference to such bidding.
Contractor further says that no person or persons, fimrs, or corporation has, have or will receive directly or
indirectly, any rebate, fee, gift, commission or thing of value on account of such sale; and
2. Contractor certifies by submission of this proposal that neither contractor nor any of its principals
are presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from
participation in this transaction by any Federal department or agency; and
3. Contractor has not, nor has any successor to, nor an affiliate of, Contractor, engaged in
investment activities in Iran.
a. For purposes of this Certification, "Iran" means the government of Iran and any agency
or instrumentality of Iran, or as otherwise defined at Ind. Code § 5-22-16.5-5, as
amended from time -to -time.
b. As provided by Ind. Code § 5-22-16.5-8, as amended from time -to -time, a Contractor
is engaged in investment activities in Iran if either.
i. Contractor, its successor or its affiliate, provides goods or services of twenty
million dollars ($20,000,000) or more in value in the energy sector of Iran;
or
ii. Contractor, its successor or its affiliate, is a financial institution that extends
twenty million dollars ($20,000,000) or more in credit to another person for
forty-five (45) days or more, if that person will (i) use the credit to provides
goods and services in the energy sector in Iran; and (ii) at the time the
financial institution extends credit, is a person identified on list published by
the Indiana Department of Administration.
Version 10/17/2017 Contractor's Bid for Public Works - 4 Addendum #1
A. 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 LC. 22-5-1.7-3. Contractor's
documentation of enrollment and participation in the E-Verify Program is included and attached as pant of
this bidlquote; 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 City contract with respect to hire, tenure, terms, conditions,
or privileges of employment, or any matter directly or indirectly related to employment because of race, sox,
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 lawns 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
("WBW) as a factor in determining the lowest, responsible, responsive bidder.
In no event shall persons or entities seeking the award ofa City contract be required to award a subcontract
to an MBE/WBE; however, it may not unlawfully discriminate against said WBENBB. A finding of a
discriminatory practice by the City's MHEIWBE 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 conunitment 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 foundryproducts made in the United States (1.C. 5-16-8-1). I hereby
certify that I and all subcontractors employed by me for this project will use steel products or foundry
products made in the United States on this project if awarded. I understand I 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. 1 understand that violations hereunder
Version 10117/Z017 Contractor's Bid for Public Works - 6 Addendum #1
may result in forfeiture of contractual payments.
I hereby affirm under the penalties of peijury that the facts and information contained in the foregoing bid
for public works are true and correct.
Dated this 19th day ofDecembe} 2Q17
Subscribed and sworn to before me this
My Commission Expires 10/14/23
Hawk Enterprises, Inc.
Co r/B idder
yk
of Contra t /Bidder or Its Agent
Johanna Plank, President
Printed Name and Title
19th day of December 20 17
Notary Public
County of Residence
LaPorte
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CITY OF SOUTH SEND
MINORITY AND WOMEN BUSiNESS ENTERPRISE DIVERSITY
DEVELOPMENT PROGRAM
FORM MWBE-2,0
EVIDENCE OF GOOD FAITH EFFORTS r
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 MSMSE 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. 116-027 pate. 12/19/17
Project Name: Jefferson and Tw ►yckenham Signal Improvements
Bidder: Hawk Enterprises, Inc.
Contact Person: Ries Plank
Address: 1850 E. North Street
City:
Crown Point
Telephone: 219-662-8090
State: Indiana Zip. 46307
Email: ries@hawk-inc.com
To determine whether a bidder has demonstrated good Faith efforts to reach the MBENVBE utilization goals set
forth in the City of South Bend Public Works Project Specifications, the City and its agencies, boards, or
comtnlsslons, 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://www.In.gov/ldoa).
ACTION (ADVERTISE/CONTACT): 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 pro -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 MBE/WBF-s reasonable time to respond.
3. Perform any and all necessary steps to provide written notice in a manner reasonably calculated
to inform MBEIWBEs 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 MBENVBE firms.
*"Bidder must circle or otherwise notate which of the two (2) required actions were performed,
GOOD FAITH NEGOTIATIONS. The bidder negotiated in good faith with interested MBE/WBEs,
including providing such MBENUBE's with adequate Information about the plans, specifications and 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.
- -
__- d by
SMALL CONTRACT(S): The bidder selected specific portions of the work to be performed
MBENVBEs In order to increase the likelihood of meeting the MBENVBE goals (including breaking down
contracts into smaller units to facilitate MBENVBE participation)
CONTRACT RECORDS: The bidder has maintained the following records for each MBENVBE 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 fnr
concluding that the MBENVBE 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 1011712017 Contractor's Bid for Public Works -10 Addendum #1
o, 17.
CITY OF SOUTH BENDA
MINORITY AND WOMEN BUSINESS ENTERPRISE DIVERSITY '"� ' •
DEVEL.OPmENT PROGRAM
FORM MWBE-2.1A
MSEIWBE CONTACTED ? '
This completed form should be supplied with Bids that pertain to City of South Bend Public Works Projects
requiring contacted MBEIWBE to obtain Good Faith Efforts. It is the bidder's sole responsibility to verify
whether any listed minority or woman business meats the qualifications of a Minority or Women's owned
business.
PAGE f OF �
Project Number. 116-027 MBEMBE Participation Goal
Project Name: Jeff,evckephharn Signal In
Bidder: Hawk terp ' s, Inc.
By; President
(Sig tur) (Title)
MBEIWBE Firm Premium Concrete Services, Inc.
12/19/17
Owner or Contact at MBEIWBE Firm Becky Yeakey
Telephone: 574-264-0196 Fax: 574-266-5392 Email: becky@premiumconcreteonline.com
TYPE OF WORK SOLICITED FOR THIS PROJECT:
Concrete
RESULTS OF CONTACT WITH THE MjE/WBE FIRM:
E-mailed RFQ, responded with quote, not using due to higher price
MBEIWBE Firm State Barricading, Inc.
..
Owner or Contact at MBE/Wf3E Firm Esther Michalski
Telephone: 574-287-2078 Fax: 574-287-1744 Email: statebarricade1 @aol.com
TYPE OF WORK SOLICITED FOR THIS PROJECT:
Maintaining Traffic
RESULTS OF CONTACT WITH THE MBFJWBE FIRM:
E-mailed and RFQ, responded with quote, not using due to higher price than competitive DBE
company, traffic control specialists, Inc.
Version 10/17/2017 Contractor's Bid for Public Works - 11 Addendum #1
■
From: STATEBARRICADE1@aol.com
Sent: Monday, December 18,2017 12:39 PM
To: Ries Plank
Subject: Re: Jefferson & Twyckenham Signal Improvements
Attachments: Jefferson & Twykenham Signal Improvements.pdf
am
Here you go. If you need anything else please let me know. Thank you!
Regards,
James R Michalski
Vice President Of Operations/ Road Striping
State Barricading Inc.
24963 US 20 W South Bend In, 46628
Phone: 574-287-2078
Fax: 574-287-1744
Cell:574-3010-7721
"The Road To Success Is Always Under Construction,"
In a message dated 12/18/2017 1:29:38 P.M, US Eastern Standard Time, ries@hawk-!nc.com writes:
James,
Yes we need a price for Maintaining Traffic including but not limited to:
Temporary Road Construction Ahead Sign Type A — 4 IEA
Daily costs for: Barrels, Arrow Boards, temp lane closure signs.
I hope this is enough to base your quote off of.
Thank you!
J� f7 Q K7 S
I
Ries Plank
Hawk Enterprises, Inc.
FLWK�- - I �16 I
F: (219) 662-8093
This e-mail and any attachments thereto, are intended only for use by the addressee(s) named herein and may
contain legally privileged and/or confidential information. If you are not the intended recipient of this e-mail (or the
person responsible for delivering this document to the intended recipient), you are hereby notified that any
dissemination, distribution, printing or copying of this e-mail, and any attachment thereto, is strictly prohibited. If
you have received this e-mail in error, please respond to the individual sending the message, and permanently
delete the original and any copy of any e-miail and printout thereof.
From: STATEBARRICADE1@aol.com [m aiilto, STATEBARRI CADE 1 @aol.com]
Sent: Monday, December 18, 2017 12:04 PM'
To: Ries Plank <ries@hawk-inc.com>
Subject: Re'. Jefferson & Twyckenham Signal Improvements
Do you need a price on the Maintaining Traffic? If so, what all do you anticipate needing for traffic control?
Unfortunately, I can't price out the Thermoplastic pavement markings as I don't have the equipment to do that.
Thanks!
Regards,
James R Michalski
Vice President Of Operations/Road Striping
State Barricading Inc.
24963 US 20 W South, Bend In,, 46628
Phone: 574-287-2078
Fax: 574-287-1744
Cell:574-300-7721
"The Road To Success I's Always Under Construction"
In a message dated 12/18/2017 11:47:45 A.M. US Eastern Standard Time, ries@hawk-inc.com writes:
Hello James,
My apologies for the late notice (we just found out about this job today) but have you heard of Project
No, 116-027 — Jefferson & Twyckenham Signal Improvements? Could you provide us with a quote if
possible? II have attached the items and specs.
Thank you!
Ries Plank
Hawk Enterprises, Inc.
F: (219) 662-8093
This e-mail and any attachments thereto, are intended only for use by the addressee(s) named herein
and may contain legally privileged and/or confidential information. If you are not the intended recipient of
this e-mail (or the person responsible for delivering this document to the intended recipient), you are
hereby notified that any dissemination, distribution, printing or copying of this e-mail:, and any
attachment thereto, is strictly prohibited. If you have received this e-mail in error, please respond to the
individual sending the message, and permanently delete the original and any copy of any e-mail and
printout thereof.
Ries Plank
From:
Ries Plank
Sent:
Monday, December 18,2017 12:12 PM
To:
'Rob Becker'
Subject:
RE: Jefferson & Twyckenh,am Signal Improvements RFQ
Thank you, Rob!
Ries Plank
Hawk Enterprises, Inc.
WIM a 1. �V* I �44
a 0 0 . 0 6
This e-mail and any attachments thereto, are intended only for use by the addressee(s) named herein and may contain legally
privileged and/or confidential information. If you are not the intended recipient of this e-mail (or the person responsible for
delivering this document to the intended) recipient), you are hereby notified that any dissemination, distribution, printing or copying
of this e-mail, and any attachment thereto, is strictly prohibited. If you have received this e-mail in error, please respond to the
individual sending the message, and permanently delete the original and any copy of any e-mail and printout thereof.
From: Rob Becker [ma ifto: rbecker@ pre rn iu mconcreteo n I i ne.comi]
Sent: Monday, December 18, 2017 12:04 PM
To: Ries Plank <ries@hawk-inc.com>
Cc: Max Yeakey <max@premiumconcreteonline.com>; Kevin, Crouch <kevin@premiumconcreteoniiine.com>
Subject: RE: Jefferson & Twyckenhalim Signal Improvements RFQ
Good: Afternoon Reis,
Please see attached proposal. Let me know if you have any questions or concerns.
Thank you,
Rob Becker Estirnator/Project Manager
Premium Concrete Services, linc.
712 Richmond St
Elkhart, Indiana 4651.6
Ph: (574), 26441,96 Exth 13
Fax: (574) 266-5392
Cell: (574) 612-3709
From: Kevin Crouch
Sent Monday, December 18,2017 11:54 AM
To: Ries Plank
Cc: Rob Becker
Subject: RE: Jefferson &TxwyokenhomnSignal Improvements RFC\
Ries,
Rob is putting it together, I will pass along to him
From: Ries PlIank
Sent: Monday, December 18, 2017 11:510/\M
To: Kevin Crouch <
Subject: Jefferson & Twyckenharn Signal Improvements RFQ
Hello Kevin,
Sorry for the Uatenotice but have you heard anything about'ectno, 11G-Q27Jefferson 0&Tu«yokenhanmsignal
improvements? There are a few concrete items. Please let me know if you can provide me with aquote. |have
attached the item list and specs.
Thank you!
Ries Plank
Hawk Enterprises, Inc.
This e-mail and any attachments thereto, are intended only for use by the addressee(s) named herein and may contain legally
privileged and/or confidential information. |fyou are not the intended recipient mfthis e-ma|U(or the person responsible for
delivering this document to the intended recipient), you are hereby notified that any dissemination, distribution, printing or copying
ofth|ue'mmi|,umdanyettachmentthepeto,isstrActUypnohi61ted.Ufyouhavemeooivedthime'rmai[inenur, please respond tuthe
individual sending the message, and permanently delete the original and any copy of any e-mail and printout thereof.
1316 COUNTY -CITY BUII.n1NC3
227 W, ]ErFERSON 13OULE-VARD
SOUTH BEND, INDIANA 46601-1830
PROM 574/235-9251
rax 574/235-9171
TDD 574/ 235-5567
CITY OF SOUTH BEND PETE BUTTIGIEG, MAYOR
BOARD OF PU13LIC WORKS
Date: December 14,_2017
To: All Planholders
From Lm-da_M. Marina, Clerk, Board of Public Works
Subject Addendum Number:I _
ProjectName: Jefferson and Twyekenham Signal Improvements
Project No.: 116-027
ACKNOWLEDGEMENT OF RECEIPT OF ADDENDUM
Date Received: December 14, 2017
This addendum is being forwarded to you for the above referenced project,
Please sign below and acknowledge receipt of this Addendum by
faxing this sheet to the Board of Public Works at (574) 235-9171
within 48 hours of receipt. A copy MUST also be included with your
bid package upon submittal.
THIS ADDENDUM MAY AFFECT YOUR BID.
Notes:
The attached documents are hereby added to the Specifications and Contract
Documents and become a part of herein.
Company. -
Authorized Sip
Bate: December 10, /-U i r
1316 COUNTY -CITY BUILDING
227 W.1rrFFRSON BOULEVARD
SOUTH BEND, INDIANA 46601-1830
CITY OF SOUTI
PHONE 574/235-9251
FAX 574/235-9171
TDD 5741235-5567
- _ MCIEG, MAYOR
BOARD Or PUBLIC WORKS
Jefferson and Twyekenham Traffic Signal Improvements
1116-027
Addendum No. 1
Date: December 14, 2017
To: All Planholders
From: Roger T. Nawrot, PE & PLS, Assistant City Engineer
The following information is to be changed/added to the contract documents:
1. Special Provisions
1. Change To, Section XXVI.B.4
4. The Contractor is to have the existing utility .marred and layout the locations of
the Signal Cantilever Structures in the field prior to submitting the shop drawings for
review and approval to verify the arm lengths. The Contractor is advised to order new
signal equipment as soon as possible due to project schedule.
11. Bid/Proposal
REPLACE entire Contractor's Bid for Public Works because of revised bid date to
December 19, 2017 at gam.
Attachments:
Revised Contractor's Bid for Public Works (11 pages)
-This addendum consists of a total 13 pages inclusive of "Acknowledgement of Receipt of
Addendum" sheet -
End of Addendum #1
.4� IY CERTIFICATE OF LIABILITY INSURANCE
11DATE(M I DIYYYY)
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 pollcy(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 endorsements .
PRODUCER
Arthur J. Gallagher Risk Management Services, Inc.
650 E. Carmel Drive, Suite 400
Carmel IN 46032
: oni Linhart
NAAMEJ
PHONE 317-587-1330 FAX 317-810-4930
E-MAILADDRESS-jon! linhart@ajg.com
INSURERS AFFORDING COVERAGE
NAIC #
INSURERA;PhoenIX Insurance Company
25623
INSURED
INSURER B:Charter Oak Fire Insurance Company
25615
Hawk Enterprises, Inc.
1850 East North Street
307
Crown Point, IN 46307-8566
INSURER c :Travelers Indemnity Company
25658
INSURER D : Travelers Property CasualtyCo of A
25674
INSURER E :
INSURER F ;
CnVFRAr,FS r.r-RTIFIreTP milimR1=u• 14977479R7 Or-Wi CICtu MI IR1R11�0.
THIS 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
LTR
TYPE OF INSURANCE
INSD
WVD
POLICY NUMBER
POLICY EFF
MM1DD YY)
POLICY EXP
(MMIDDIYYYYJ
LIMITS
A
X
COMMERCIAL GENERAL LIABILITY
CLAIMS -MADE IX-1OCCUR
DT-CO.9H818638-PHX-17
2/1/2017
2/1/2018
EACH OCCURRENCE
$1,000,000
DAMAGE TO RENTED
PREMISES Ea occurrence
$300,000
MED EXP (Any one person)
$5,000
GEN'L
PERSONAL& ADV INJURY
$1,000,000
AGGREGATE LIMIT APPLIES PER:
� [)�] LOC
POLICY JEC
OTHER:
GENERAL AGGREGATE
$2,000,000
PRODUCTS - COMP/OP AGG
$2,000,000
$
B
AUTOMOBILE
X
LIABILITY
A1NY AUTO
OWNED SCHEDULED
AUTOS ONLY AUTOS
HIRED NON -OWNED
AUTOS ONLY AUTOS ONLY
DT-810-OJ382147-COF-17
2/1/2017
2/1/2018
Ea aCOMBINEDSINGLE LIMIT
!
$1,000,000
BODILY INJURY (Per person)
$
Bdent) ODILY INJURY (Per acci
$
PROPERTY DAMAGE
Per accident
$
C
UMBRELLA LIAR
EXCESS LIAR
I X
OCCUR
CLAIMS -MADE
CUP-OJ675073-17-26
2/1/2017
2/1/2018
EACH OCCURRENCE
$9.000,000
X
rl
AGGREGATE
$9.000,000
DEO X RETENTION $10,000
$
D
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY Y I N
ANY PROPRIETORIPARTNERIEXECUTIVE
OFFICER/MEMBER EXCLUDED4 [
(Mandatory in NH)
it yes, describe under
DESCRIPTION OF OPERATIONS below
N f A
UB-OJ675602-17-26-G
2/1/2017
2/1/2018
X STATUTE 'ER'-
E.L. EACH ACCIDENT
$1,OOD,000
E.L. DISEASE - EA EMPLOYE
$1,000,000
E.L. DISEASE - POUCY LIMIT
$1,000,000
DESCRIPTION OF OPERATIONS f LOCATIONS ! VEHICLES iACORD 101, Additional Remarks Schedule, may be attached If more space Is required)
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
St Joseph County/City of South Bend Building THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
& Permit Department ACCORDANCE WITH THE POLICY PROVISIONS.
125 S Lafayette Blvd, Ste 100
South Bend IN 46601
USA AUTHORIZED REPRESENTATIVE
4D1988-2015 ACORD CORPORATION. All rights reserved.
ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD
�n:sF
Company 10 Number: 799651
THE E-VERIFY
MEMORANDUM OF UNDERSTANDING
FOR EMPLOYERS
ARTICLE I
PURPOSE AND AUTHORITY
The parties to this agreement are the Department of Homeland Security (DHS) and the
Hawk Enterprises, Inc. (Employer). The purpose of this agreement is to set forth terms and
conditions which the Employer will follow while participating in E-Verify.
E-Verify is a program that electronically confirms an employee's eligibility to work in the United States
after completion of Form 1-9, Employment Eligibility Verification (Form 1-9). This Memorandum of
Understanding (MOU) explains certain features of the E-Verify program and describes specific
responsibilities of the Employer, the Social Security Administration (SSA), and DHS.
Authority for the E-Verify program is found in Title IV, Subtitle A, of the Illegal Immigration Reform and
Immigrant Responsibility Act of 1996 (IIRIRA), Pub. L. 104-208, 110 Stat. 3009, as amended (8 U.S.C.
§ 1324a note). The Federal Acquisition Regulation (FAR) Subpart 22.18, "Employment Eligibility
Verification" and Executive Order 12989, as amended, provide authority for Federal contractors and
subcontractors (Federal contractor) to use E-Verify to verify the employment eligibility of certain
employees working on Federal contracts.
ARTICLE II
RESPONSIBILITIES
A. RESPONSIBILITIES OF THE EMPLOYER
1. The Employer agrees to display the following notices supplied by DHS in a prominent place that is
clearly visible to prospective employees and all employees who are to be verified through the system:
a. Notice of E-Verify Participation
b. Notice of Right to Work
2. The Employer agrees to provide to the SSA and DHS the names, titles, addresses, and telephone
numbers of the Employer representatives to be contacted about E-Verify. The Employer also agrees to
keep such information current by providing updated information to SSA and DHS whenever the
representatives' contact information changes.
3. The Employer agrees to grant E-Verify access only to current employees who need E-Verify access.
Employers must promptly terminate an employee's E-Verify access if the employer is separated from
the company or no longer needs access to E-Verify.
Page 1 of 17 E-Verify MOU for Employers I Revisions Date 06/01/13
Company ID Number: 799651
4. The Employer agrees to become familiar with and comply with the most recent version of the
E-Verify User Manual.
5. The Employer agrees that any Employer Representative who will create E-Verify cases will
complete the E-Verify Tutorial before that individual creates any cases.
a. The Employer agrees that all Employer representatives will take the refresher tutorials when
prompted by E-Verify in order to continue using E-Verify. Failure to complete a refresher tutorial
will prevent the Employer Representative from continued use of E-Verify.
6. The Employer agrees to comply with current Form 1-9 procedures, with two exceptions:
a. If an employee presents a "List B" identity document, the Employer agrees to only accept "List
B" documents that contain a photo. (List B documents identified in 8 C.F.R. § 274a.2(b)(1)(B)) can
be presented during the Form 1-9 process to establish identity.) If an employee objects to the photo
requirement for religious reasons, the Employer should contact E-Verify at
888-464-4218.
b. If an employee presents a DHS Form 1-651 (Permanent Resident Card), Form 1-766
(Employment Authorization Document), or U.S. Passport or Passport Card to complete Form 1-9,
the Employer agrees to make a photocopy of the document and to retain the photocopy with the
employee's Form 1-9. The Employer will use the photocopy to verify the photo and to assist DHS
with its review of photo mismatches that employees contest. DHS may in the future designate
other documents that activate the photo screening tool.
Note: Subject only to the exceptions noted previously in this paragraph, employees still retain the right
to present any List A, or List B and List C, document(s) to complete the Form 1-9.
7. The Employer agrees to record the case verification number on the employee's Form 1-9 or to print
the screen containing the case verification number and attach it to the employee's Form 1-9.
8. The Employer agrees that, although it,participates in E-Verify, the Employer has a responsibility to
complete, retain, and make available for inspection Forms 1-9 that relate to its employees, or from other
requirements of applicable regulations or laws, including the obligation to comply with the
antidiscrimination requirements of section 274E of the INA with respect to Form 179 procedures.
a. The following modified requirements are the only exceptions to an Employer's obligation to not
employ unauthorized workers and comply with the anti -discrimination provision of the INA: (1) List B
identity documents must have photos, as described in paragraph 6 above; (2) When an Employer
confirms the identity.and employment eligibility of newly hired employee using E-Verify procedures,
the Employer establishes a rebuttable presumption that it has not violated section 274A(a)(1)(A) of
the Immigration and Nationality Act (INA) with respect to the hiring of that employee; (3) If the
Employer receives a final nonconfirmation for an employee, but continues to employ that person,
the Employer must notify DHS and the Employer is subject to a civil money penalty between $550
and $1,100 for each failure to notify DHS of continued employment following a final
nonconfirmation; (4) If the Employer continues to employ an employee after receiving a final
nonconfirmation, then the Employer is subject to a rebuttable presumption that it has knowingly
Page 2 of 17 E-Verify MOU for Employers I Revision pate 06/01/13
�Itl1 ^�. trrN
Company ID Number: 799651
employed an unauthorized alien in violation of section 274A(a)(1)(A); and (5) no E-Verify participant
is civilly or criminally liable under any law for any action taken in good faith based on information
provided through the E-Verify.
b. DHS reserves the right to conduct Form 1-9 compliance inspections, as well as any other
enforcement or compliance activity authorized by law, including site visits, to ensure proper use of
E-Verify.
9. The Employer is strictly prohibited from creating an E-Verify case before the employee has been
hired, meaning that a firm offer of employment was extended and accepted and Form 1-9 was
completed. The Employer agrees to create an E-Verify case for new employees within three Employer
business days after each employee has been hired (after both Sections 1 and 2 of Form 1-9 have been
completed), and to complete as many steps of the E-Verify process as are necessary according to the
E-Verify User Manual. If E-Verify is temporarily unavailable, the three-day time period will be extended
until it is again operational in order to accommodate the Employer's attempting, in good faith, to make
inquiries during the period of unavailability.
1-0. The Employer agrees not to use E-Verify for pre -employment screening of job applicants, in
support of any unlawful employment practice, or for any other use that this MOU or the E-Verify User
Manual does not authorize.
11. The Employer must use E-Verify for all new employees. The Employer will not verify selectively
and will not verify employees hired before the effective date of this MOU. Employers who are Federal
contractors may qualify for exceptions to this requirement as described in Article 11.13 of this MOU.
12. The Employer agrees to follow appropriate procedures (see Article III below) regarding tentative
nonconfirmations. The Employer must promptly notify employees in private of the finding and provide
them with the notice and letter containing information specific to the employee's E-Verify case. The
Employer agrees to provide both the English and the translated notice and letter for employees with
limited English proficiency to employees. The Employer agrees to provide written referral instructions
to employees and instruct affected employees to bring the English copy of the letter to the SSA. The
Employer must allow employees to contest the finding, and not take adverse action against employees
if they choose to contest the finding, while their case is still pending. Further, when employees contest
a tentative nonconfirmation based upon a photo mismatch, the Employer must take additional steps
(see Article III.B. below) to contact DHS with information necessary to resolve the challenge.
13. The Employer agrees not to take any adverse action against an employee based upon the
employee's perceived employment eligibility status while SSA or DHS is processing the verification
request unless the Employer obtains knowledge (as defined in 8 C.F.R. § 274a.1(1)) that the employee
is not work authorized. The Employer understands that an initial inability of the SSA or DHS automated
verification system to verify work authorization, a tentative nonconfirmation, a case in continuance
(indicating the need for additional time for the government to resolve a case), or the finding of a photo
mismatch, does not establish, and should not be interpreted as, evidence that the employee is not work
authorized. In any of such cases, the employee must be provided a full and fair opportunity to contest
the finding, and if he or she does so, the employee may not be terminated or suffer any adverse
employment consequences based upon the employee's perceived employment eligibility status
Page 3 of 17 E-Verify MOU for Employers I Revision Date 00/01/13
fcr,
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Company ID Number: 799651
(including denying, reducing, or extending work hours, delaying or preventing training, requiring an
employee to work in poorer conditions, withholding pay, refusing to assign the employee to a Federal
contract or other assignment, or otherwise assuming that he or she is unauthorized to work) until and
unless secondary verification by SSA or DHS has been completed and a final nonconfirmation has
been issued. If the employee does not choose to contest a tentative nonconfirmation or a photo
mismatch or if a secondary verification is completed and a final nonconfirmation is issued, then the
Employer can find the employee is not work authorized and terminate the employee's employment.
Employers or employees with questions about a final nonconfirmation may call E-Verify at 1-888-464-
4218 (customer service) or 1-888-897-7781 (worker hotline).
14, The Employer agrees to comply with Title Vll of the Civil Rights Act of 1964 and section 274B of
the INA as applicable by not discriminating unlawfully against any individual in hiring, firing,
employment eligibility verification, or recruitment or referral practices because of his or her national
origin or citizenship status, or by committing discriminatory documentary practices. The Employer
understands that such illegal practices can include selective verification or use of E-Verify except as
provided in part D below, or discharging or refusing to hire employees because they appear or sound
"foreign" or have received tentative non confirmations. The Employer further understands that any
violation of the immigration -related unfair employment practices provisions in section 274B of the INA
could subject the Employer to civil penalties, back pay awards, and other sanctions, and violations of
Title VII could subject the Employer to back pay awards, compensatory and punitive damages.
Violations of either section 274B of the INA or Title VII may also lead to the termination of its
participation in E-Verify. If the Employer has any questions relating to the anti -discrimination provision,
it should contact OSC at 1-800-255-8155 or 1-800-237-2515 (TDD).
15. The Employer agrees that it will use the information it receives from E-Verify only to confirm the
employment eligibility of employees as authorized by this MOU. The Employer agrees that it will
safeguard this information, and means of access to it (such as PINS and passwords), to ensure that it
is not used for any other purpose and as necessary to protect its confidentiality, including ensuring that
it is not disseminated to any person other than employees of the Employer who are authorized to
perform the Employer's responsibilities under this MOU, except for such dissemination as may be
authorized in advance by SSA or DHS for legitimate purposes.
16. The Employer agrees to notify DHS immediately in the event of a breach of personal information.
Breaches are defined as loss of control or unauthorized access to E-Verify personal data. All
suspected or confirmed breaches should be reported by calling 1-888-464-4218 or via email at
sending (a db,h s.gov. Please use "Privacy Incident — Password" in the subject line of your email when
each report to E-Verify.
17. The Employer acknowledges that the information it receives from SSA is governed by the Privacy
Act (5 U.S.C. § 552a(i)(1) and (3)) and the Social Security Act (42 U.S.C. 1306(a)). Any person who
obtains this information under false pretenses or uses it for any purpose other than as provided for in
this MOU may be subject to criminal penalties.
18. The Employer agrees to cooperate with DHS and SSA in their compliance monitoring and
evaluation of E-Verify, which includes permitting DHS, SSA, their contractors and other agents, upon
Page 4 of 17 E-Verify MOU for Employers J Revision Date 06/01/13
Company ID Number: 799651
reasonable notice, to review Forms 1-9 and other employment records and to interview it and its
employees regarding the Employer's use of E-Verify, and to respond in a prompt and accurate manner
to DHS requests for information relating to their participation in E-Verify.
19. The Employer shall not make any false or unauthorized claims or references about its participation
in E-Verify on its website, in advertising materials, or other media. The Employer shall not describe its
services as federally -approved, federally -certified, or federally -recognized, or use language with a
similar intent on its website or other materials provided to the public. Entering into this MOU does not
mean that E-Verify endorses or authorizes your E-Verify services and any claim to that effect is false.
20. The Employer shall not state in its website or other public documents that any language used
therein has been provided or approved by DHS, USCIS or the Verification Division, without first
obtaining the prior written consent of DHS.
21. The Employer agrees that E-Verify trademarks and logos may be used only under license by
DHS/USCIS (see M-795 (Web)) and, other than pursuant to the specific terms of such license, may not
be used in any manner that might imply that the Employer's services, products, websites, or
publications are sponsored by, endorsed by, licensed by, or affiliated with DHS, USCIS, or E-Verify.
22. The Employer understands that if it uses E-Verify procedures for any purpose other than as
authorized by this MOU, the Employer may be subject to appropriate legal action and termination of its
participation in E-Verify according to this MOU.
B. RESPONSIBILITIES OF FEDERAL CONTRACTORS
1. If the Employer is a Federal contractor with the FAR E-Verify clause subject to the employment
verification terms in Subpart 22.18 of the FAR, it will become familiar with and comply with the most
current version of the E-Verify User Manual for Federal Contractors as well as the E-Verify
Supplemental Guide for Federal Contractors.
2. In addition to the responsibilities of every employer outlined in this MOU, the Employer understands
that if it is a Federal contractor subject to the employment verification terms in Subpart 22.18 of the
FAR it must verify the employment eligibility of any "employee assigned to the contract" (as defined in
FAR 22.1801). Once an employee has been verified through E-Verify by the Employer, the Employer
may not create a second case for the employee through E-Verify.
a. An Employer that is not enrolled in E-Verify as a Federal contractor at the time of a contract
award must enroll as a Federal contractor in the E-Verify program within 30 calendar days of
contract award and, within 90 days of enrollment, begin to verify employment eligibility of new hires
using E-Verify. The Employer must verify those employees who are working in the United States,
whether or not they are assigned to the contract. Once the Employer begins verifying new hires,
such verification of new hires must be initiated within three business days after the hire date. Once
enrolled in E-Verify as a Federal contractor, the Employer must begin verification of employees
assigned to the contract within 90 calendar days after the date of enrollment or within 30 days of an
employee's assignment to the contract, whichever date is later.
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Company ID Number: 799651
b. Employers enrolled rin E-Verify as a Federal contractor for 90 days or more at the time of a
contract award must use E-Verify to begin verification of employment eligibility for new hires of the
Employer who are working in the United States, whether or not assigned to the contract, within
three business days after the date of hire. If the Employer is enrolled in E-Verify as a Federal
contractor for 90 calendar days or less at the time of contract award, the Employer must, within 90
days of enrollment, begin to use E-Verify to initiate verification of new hires of the contractor who
are working in the United States, whether or not assigned to the contract. Such verification of new
hires must be initiated within three business days after the date of hire. An Employer enrolled as a
Federal contractor in E-Verify must begin verification of each employee assigned to the contract
within 90 calendar days after date of contract award or within 30 days after assignment to the
contract, whichever is later.
C. Federal contractors that are institutions of higher education (as defined at 20 U.S.C. 1001(a)),
state or local governments, governments of Federally recognized Indian tribes, or sureties
performing under a takeover agreement entered into with a Federal agency under a performance
bond may choose to only verify new and existing employees assigned to the Federal contract. Such
Federal contractors may, however, elect to verify all new hires, and/or all existing employees hired
after November 6, 1986. Employers in this category must begin verification of employees assigned
to the contract within 90 calendar days after the date of enrollment or within 30 days of an
employee's assignment to the contract, whichever date is later.
d. Upon enrollment, Employers who are Federal contractors may elect to verify employment
eligibility of all existing employees working in the United States who were hired after November 6,
1986, instead of verifying only those employees assigned to a covered Federal contract. After
enrollment, Employers must elect to verify existing staff following DHS procedures and begin
E-Verify verification of all existing employees within 180 days after the election.
e. The Employer may use a previously completed Form 1-9 as the basis for creating an E-Verify
case for an employee assigned to a contract as long as:
i. That Form 1-9 is complete (including the SSN) and complies with Article II.A.6,
ii. The employee's work authorization has not expired, and
iii. The Employer has reviewed the Form 1-9 information either in person or in
communications with the employee to ensure that the employee's Section 1, Form 1-9
attestation has not changed (including, but not limited to, a lawful permanent resident alien
having become a naturalized U.S. citizen).
f. The Employer shall complete a new Form 1-9 consistent with Article II.A.6 or update the
previous Form 1-9 to provide the necessary information if:
i. The Employer cannot determine that Form 1-9 complies with Article II.A.6,
ii. The employee's basis for work authorization as attested in Section 1 has expired or
changed, or
iii. The Form 1-9 contains no SSN or is otherwise incomplete.
Note: If Section 1 of Form 1-9 is otherwise valid and up-to-date and the form otherwise complies with
Page 6 of 17 E Verity MOU for Employers I Revision Date 06/01/13
Company ID Number: 799651
Article II.C.5, but reflects documentation (such as a U.S. passport or Form 1-551) that expired after
completing Form 1-9, the Employer shall not require the production of additional documentation, or use
the photo screening tool described in Article II.A.5, subject to any additional or superseding instructions
that may be provided on this subject in the E-Verify User Manual.
g. The Employer agrees not to require a second verification using E-Verify of any assigned
employee who has previously been verified as a newly hired employee under this MOU or to
authorize verification of any existing employee by any Employer that is not a Federal contractor
based on this Article.
3. The Employer understands that if it is a Federal contractor, its compliance with this MOU is a
performance requirement under the terms of the Federal contract or subcontract, and the Employer
consents to the release of information relating to compliance with its verification responsibilities under
this MOU to contracting officers or other officials authorized to review the Employer's compliance with
Federal contracting requirements.
C. RESPONSIBILITIES OF SSA
1. SSA agrees to allow DHS to compare data provided by the Employer against SSA's database. SSA
sends DHS confirmation that the data sent either matches or does not match the information in SSA's
database.
2. SSA agrees to safeguard the information the Employer provides through E-Verify procedures. SSA
also agrees to limit access to such information, as is appropriate by law, to individuals responsible for
the verification of Social Security numbers or responsible for evaluation of E-Verify or such other
persons or entities who may be authorized by SSA as governed by the Privacy Act (5 U.S.C. § 552a),
the Social Security Act (42 U.S.C. 1306(a)), and SSA regulations (20 CFR Part 401).
3. SSA agrees to provide case results from its database within three Federal Government work days of
the initial inquiry. E-Verify provides the information to the Employer.
4. SSA agrees to update SSA records as necessary if the employee who contests the SSA tentative
nonconfirmation visits an SSA field office and provides the required evidence. If the employee visits an
SSA field office within the eight Federal Government work days from the date of referral to SSA, SSA
agrees to update SSA records, if appropriate, within the eight -day period unless SSA determines that
more than eight days may be necessary. In such cases, SSA will provide additional instructions to the
employee. If the employee. does not visit SSA in the time allowed, E-Verify may provide a final
nonconfirmation to the employer.
Note; If an Employer experiences technical problems, or has a policy question, the employer should
contact E-Verify at 1-888-464-4218.
D. RESPONSIBILITIES OF DHS
1. DHS agrees to provide the Employer with selected data from DHS databases to enable the
Employer to conduct, to the extent authorized by this MOU;
a. Automated verification checks on alien employees by electronic means, and
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Company ID Number: 799651
b. Photo verification checks (when available) on employees.
2. DHS agrees to assist the Employer with operational problems associated with the Employer's
participation in E-Verify. DHS agrees to provide the Employer names, titles, addresses, and telephone
numbers of DHS representatives to be contacted during the E-Verify process.
3. DHS agrees to provide to the Employer with access to E-Verify training materials as well as an
E-Verify User Manual that contain instructions on E-Verify policies, procedures, and requirements for
both SSA and DHS, including restrictions on the use of E-Verify.
4. DHS agrees to train Employers on all important changes made to E-Verify through the use of
mandatory refresher tutorials and updates to the E-Verify User Manual. Even without changes to
E-Verify, DHS reserves the right to require employers to take mandatory refresher tutorials.
5. DHS agrees to provide to the Employer a notice, which indicates the Employer's participation in
E-Verify. DHS also agrees to provide to the Employer anti -discrimination notices issued by the Office of
Special Counsel for Immigration -Related Unfair Employment Practices (OSC), Civil Rights Division,
U.S. Department of Justice.
B. DHS agrees to issue each of the Employer's E-Verify users a unique user identification number and
Password that permits them to log in to E-Verify.
7. DHS agrees to safeguard the information the Employer provides, and to limit access to such
information to individuals responsible for the verification process, for evaluation of E-Verify, or to such
other persons or entities as may be authorized by applicable law. Information will be used only to verify
the accuracy of Social Security numbers and employment eligibility, to enforce the INA and Federal
criminal laws, and to administer Federal contracting requirements.
8. DHS agrees to provide a means of automated verification that provides (in conjunction with SSA
verification procedures) confirmation or tentative nonconfirmation of employees' employment eligibility
within three Federal Government work days of the initial inquiry.
9. DHS agrees to provide a means of secondary verification (including updating DHS records) for
employees who contest DHS tentative nonconfirmations and photo mismatch tentative
nonconfirmations. This provides final confirmation or nonconfirmation of the employees' employment
eligibility within 10 Federal Government work days of the date of referral to DHS, unless DHS
determines that more than 10 days may be necessary. In such cases, DHS will provide additional
verification instructions.
ARTICLE III
REFERRAL OF INDIVIDUALS TO SSA AND DHS
A. REFERRAL TO SSA
1. If the Employer receives a tentative nonconfirmation issued by SSA, the Employer must print the
notice as directed by E-Verify. The Employer must promptly notify employees in private of the finding
and provide them with the notice and letter containing information specific to the employee's E-Verify
Page 8 of 17 E-Verify MOU for Employers I Revision Date 06/01/13
Company ID Number. 799651
case. The Employer also agrees to provide both the English and the translated notice and letter for
employees with limited English proficiency to employees. The Employer agrees to provide written
referral instructions to employees and instruct affected employees to bring the English copy of the letter
to the SSA. The Employer must allow employees to contest the finding, and not take adverse action
against employees if they choose to contest the finding, while their case is still pending.
2. The Employer agrees to obtain the employee's response about whether he or she will contest the
tentative nonconfirmation as soon as possible after the Employer receives the tentative
nonconfirmation. Only the employee may determine whether he or she will contest the tentative
nonconfirmation.
3. After a tentative nonconfirmation, the Employer will refer employees to SSA field offices only as
directed by E-Verify. The Employer must record the case verification number, review the employee
information submitted to E-Verify to identify any errors, and find out whether the employee contests the
tentative nonconfirmation. The Employer will transmit the Social Security number, or any other
corrected employee information that SSA requests, to SSA for verification again if this review indicates
a need to do so.
4. The Employer will instruct the employee to visit an SSA office within eight Federal Government work
days. SSA will electronically transmit the result of the referral to the Employer within 10 Federal
Government work days of the referral unless it determines that more than 10 days is necessary.
5. While waiting for case results, the Employer agrees to check the E-Verify system regularly for case
updates.
6. The Employer agrees not to ask the employee to obtain a printout from the Social Security
Administration number database (the Numident) or other written verification of the SSN from the SSA.
B. REFERRAL TO DHS
1. If the Employer receives a tentative nonconfirmation issued by DHS, the Employer must promptly
notify employees in private of the finding and provide them with the notice and letter containing
information specific to the employee's E-Verify case. The Employer also agrees to provide both the
English and the translated notice and letter for employees with limited English proficiency to
employees. The Employer must allow employees to contest the finding, and not take adverse action
against employees if they choose to contest the finding, while their case is still pending.
2. The Employer agrees to obtain the employee's response about whether he or she will contest the
tentative nonconfirmation as soon as possible after the Employer receives the tentative
nonconfirmation. Only the employee may determine whether he or she will contest the tentative
nonconfirmation.
3. The Employer agrees to refer individuals to DHS only when the employee chooses to contest a
tentative nonconfirmation.
4. If the employee contests a tentative nonconfirmation issued by DHS, the Employer will instruct the
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Company Ib dumber: 799651
employee to contact DHS through its toll -free hotline (as found on the referral letter) within eight
Federal Government work days.
5. If the Employer finds a photo mismatch, the Employer must provide the photo mismatch tentative
nonconfirmation notice and follow the instructions outlined in paragraph 1 of this section for tentative
non confirmations, generally.
6. The Employer agrees that if an employee contests a tentative nonconfirmation based upon a photo
mismatch, the Employer will send a copy of the employee's Form 1-551, Form 1-766, U.S. Passport, or
passport card to DHS for review by:
a. Scanning and uploading the document, or
b. Sending a photocopy of the document by express mail (furnished and paid for by the employer).
7. The Employer understands that if it cannot determine whether there is a photo match/mismatch, the
Employer must forward the employee's documentation to DHS as described in the preceding
paragraph. The Employer agrees to resolve the case as specifled by the DHS representative who will
determine the photo match or mismatch.
8. DHS will electronically transmit the result of the referral to the Employer within 10 Federal
Government work days of the referral unless it determines that more than 10 days is necessary.
9. While waiting for case results, the Employer agrees to check the E-Verify system regularly for case
updates.
ARTICLE IV
SERVICE PROVISIONS
A. NO SERVICE FEES
1. SSA and DHS will not charge the Employer for verification services performed under this MOU. The
Employer is responsible for providing equipment needed to make inquiries. To access E-Verify, an
Employer will need a personal computer with Internet access.
ARTICLE V
MODIFICATION AND TERMINATION
A. MODIFICATION
1. This MOU is effective upon the signature of all parties and shall continue in effect for as long as the
SSA and DHS operates the E-Verify program unless modified in writing by the mutual consent of all
parties.
2. Any and all E-Verify system enhancements by DHS or SSA, including but not limited to E-Verify
checking against additional data sources 'and instituting new verification policies or procedures, will be
covered under this MOU and will not cause the need for a supplemental MOU that outlines these
changes.
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Company ID Number: 799651
B. TERMINATION
1. The Employer may terminate this MOU and its participation in E-Verify at any time upon 30 days
prior written notice to the other parties.
2. Notwithstanding Article V, part A of this MOU, DHS may terminate this MOU, and thereby the
Employer's participation in E-Verify, with or without notice at any time if deemed necessary because of
the requirements of law or policy, or upon a determination by SSA or DHS that there has been a breach
of system integrity or security by the Employer, or a failure on the part of the Employer to comply with
established E-Verify procedures and/or legal requirements. The Employer understands that if it is a
Federal contractor, termination of this MOU by any party for any reason may negatively affect the
performance of its contractual responsibilities. Similarly, the Employer understands that if it is in a state
where E-Verify is mandatory, termination of this by any party MOU may negatively affect the
Employer's business.
3. An Employer that is a Federal contractor may terminate this MOU when the Federal contract that
requires its participation in E-Verify is terminated or completed. In such cases, the Federal contractor
must provide written notice to DHS. If an Employer that is a Federal contractor fails to provide such
notice, then that Employer will remain an E-Verify participant, will remain bound by the terms of this
MOU that apply to non -Federal contractor participants, and will be required to use the E-Verify
procedures to verify the employment eligibility of all newly hired employees.
4. The Employer agrees that E-Verify is not liable for any losses, financial or otherwise, if the Employer
is terminated from E-Verify.
ARTICLE VI
PARTIES
A. Some or all SSA and DHS responsibilities under this MOU may be performed by contractor(s), and
SSA and DHS may adjust verification responsibilities between each other as necessary. By separate
agreement with DHS, SSA has agreed to perform its responsibilities as described in this MOU.
B. Nothing in this MOU is intended, or should be construed, to create any right or benefit, substantive
or procedural, enforceable at law by any third party against the United States, its agencies, officers, or
employees, or against the Employer, its agents, officers, or employees.
C. The Employer may not assign, directly or indirectly, whether by operation of law, change of control or
merger, all or any part of its rights or obligations under this MOU without the prior written consent of
DHS, which consent shall not be unreasonably withheld or delayed. Any attempt to sublicense, assign,
or transfer any of the rights, duties, or obligations herein is void.
D. Each party shall be solely responsible for defending any claim or action against it arising out of or
related to E-Verify or this MOU, whether civil or criminal, and for any liability wherefrom, including (but
not limited to) any dispute between the Employer and any other person or entity regarding the
applicability of Section 403(d) of IIRIRA to any action taken or allegedly taken by the Employer.
E. The Employer understands that its participation in E-Verify is not confidential information and may be
disclosed as authorized or required by law and DHS or SSA policy, including but not limited to,
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Nei £R�
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Company ID Number: 799651
Congressional oversight, E-Verify publicity and media inquiries, determinations of compliance with
Federal contractual requirements, and responses to inquiries under the Freedom of Information Act
(FOIA).
F. The individuals whose signatures appear below represent that they are authorized to enter into this
MOU on behalf of the Employer and DHS respectively. The Employer understands that any inaccurate
statement, representation, data or other information provided to DHS may subject the Employer, its
subcontractors, its employees, or its representatives to: (1) prosecution for false statements pursuant to
18 U.S.C. 1001 and/or; (2) immediate termination of its MOU and/or; (3) possible debarment or
suspension.
G. The foregoing constitutes the full agreement on this subject between DHS and the Employer.
To be accepted as an E-Verify participant, you should only sign the Employer's Section of the
signature page. If you have any questions, contact E-Verify at 1-888-464.4218.
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Company ID Number: 799651
Approved by:
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Company ID Number: 799651
Are you verifying for more than 1 site? If yes, please provide the number of sites verified for in
each State:
INDIANA 1 site(s)
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..E-Verify.,
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Company fg Number: 799651
Information relating to the Program Administrator(s) for your Company on policy questions or
operational problems:
Name
Mary Mastrantonio
Phone Number
(219) 662 - 8090
Fax Number
(219) 662 - 8093
Email Address
mary@hawk-inc.com
Name
Johanna Plank
Phone Number
(219) 662 - 8090
Fax Number
(219) 662 - 8093
Email Address
gregp@hawk-inc,com
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S
Company ID Number: 799651
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CHECKLIST r. BIDDERS
Project Name Jefferson and Twyckenham Signal Improvements
Project No. 116-027
For Bids Due jUFy-26'h December 19, 2017 at gam
From time to time the South Bend Board of Public Works finds it necessary to reject a bid because
it does not comply with statutory requirements. In preparing your bid, please use the following
checklist in order to make sure that your bid is done in the proper manner.
Proper bid security included. The bidder has the option of providing either a Certified Check
or Bid Bond.
Bid prepared on the City of South Bend Contractor's Bid for Public Work Form, completely
executed.
Contractor's Non -Collusion and Non -Debarment Affidavit, Certification Regarding Investments
with Iran, Employment Eligibility Verification, Nan -Discrimination Commitment, and
Certification of use of united States Steel Products or Foundry Products.
Proof of MBEMBE Partiolpatiop Goal Form [MWBE-1.01. If minimum participation goal is not
met, also provide Evidence of Good Faith Efforts Form [MWBE-2,0) and MBE/WBE Contacted
Form [MWBE-2,1].
Acknowledge Receipt of 1 Addendum(s) included with the bid.
All required additional information is included with the bid.
Proposal statements and other affidavits all signed by the proper party with name either
printed or typed underneath signature.
This checklist submitted with the Bid.
This checklist Is provided for bidder's use in assuring compliance with required
documentation; however, it does not Include all specifications requirements and does not
relieve the bidder of the need to read and comply with the specifications,
Bidder; Hawk Enterprises, Inc.
By Authorized
Signature:
Print Name & Title:
President
12/19/17
Version 10117/2017 Contractor's Bid for Public Works -1 Addendum #/1