HomeMy WebLinkAboutOpening of Bids - Jefferson & Twyckenham Signal Improvements Proj No 116-027 - TGB Unlimited dba ST BancroftProject Name Jefferson and Twyckenharn Signal Improvements
Project No. 116-027
For Bids Due July-W-,-2W December 19,2017 at gam
P'ART I
(Must be completed for all bids. Please type or print)
Date: 12-19-201Z. . Bidder (Firm): TGB Unlimited (dba) SIT Bancroft Electric
Address: 25020 State Road 2
City/State/Zip: South Bend, IN 46619 Telephone Number: ( 574 ).....968-2040
Agent of Bidder (if Applicable): N/A
Pursuant to notices given, the undersigned offers to furnish labor and/or material necessary to complete the
public works project of:
Jefferson & Twckenham Signal Improvements
the City of South Bend, Indiana, in accordance with plans and specifications prepared by:
V, I
CA&A Oq
and dated fl-?)o n for the sum of (enter the
Two Hundered Twelve Thousand Three Hundired Seventy Six 20/100
(Erit6
.61 r:
Bid as shown on the Proposal)
212,376.20
(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 addendurns attached will be specifically referenced at the applicable page.
If additional units of material included in the contract are needed, the cost of units must be the same as that
shown in the original contract if accepted by the City of South Bend. If the bid Is to be awarded on a unit
basis, the itemization of the units shall be shown on a separate attachment,
.3
Ty Bancroft
(Printed Name of Person Signing)
ACCEPTANCE
The above bid is accepted this 19th --- day of
Subject to the following conditions: None
Gary A. Gilot, President
Elizabeth A. Maradik, Member
James A. Mueller, Member
December
Suzanna M. Fritzberg, Member
Therese J. Dorau, Member
Attest: Linda M. Martin, Clerk
20 17
Version 110/1712017 Contractor's Bid for Public Works - 2 Addendum #1
BIDIPROPOSAL
CITY OF SOUTH BEND
Project Name Jefferson and Twyckenham Signal Improvements
Project No. 116-027
For Blds Due July 26'", 2017
BIDDER TGB Unlimited (dba) SIT Bancroft El
nASE BID
R=4tir�
Description
Quantity
Unit
Unit Price
Total Amount
1
Mobilization & Demobilization
1
LS
6,000.00
6,000.00
2
Maintenance of Traffic
1
LS
6,000.00
6,000.00
3
Traffic Signal Equipment, Remove & Salvage
1
LS
3,600.00
3,600.00
4
5
Signal Cantilever Structure, Drilled Shaft
Foundation, T e A
Signal Cantilever Structure, Single Arm 25 k
4
1
EA
EA
2,800.00
9,500.00
11,200.00
9,500.00
6
Signal Cantilever Structure, Single Arm 30 ft.
3
EA
10,000.00
30,000.00
7
8
Traffic Signal Head, 3-Section, LED
Traffic Signal Head, 6-Section, LED
6
2
EA
EA
650.00
1,080.00
3,900.00
2,160.00
9
10
Handhole, Signal, Type 1
Pedestrian Push Button w1 R10-3e sign
4
8
EA
EA
800.00
945.00
3,200.00
7,560.00
11
Pedestrian Signal Head with Countdown, 18-
inch
g
EA
725.00
5,800.00
12
Conduit, HDPE, 2-inch, Schedule 80
600
LF
17.00
8,500.00
13
Conduit, HDPE, 3-inch, Schedule 80
50
LF
25.00
1,250.00
14
Signal Cable, Control, Copper 704GA
415
LF
1.00
415.00
16
Si nal Cable Control, Co er 5cI14GA
1574
LF
1.00
1,574.00
17
Si nal Cable, Service, Co er 3c18
25
LF
25
625.00
18
Vehicle Video Detection System
4
EA
9,500.00
38,000.00
19
Traffic Signal Controller and Cabinet P-1
1
EA
26,000.00
26,000.00
20
Controller Cabinet Foundation, P-1
1
EA
900.00
900,00
21
TESCO Cabinet and Foundation
1
EA
6,000.00
6,000.00
22
Sodding
70
SYS
15.00
1,050.00
2$
Sidewalk
106
SYS
76.00
8,056.00
24
Special Concrete Curb
150
LF
55.00
8,250.00
25
HMA Pavement Patch
35
SYS
165.00
5,775.00
26
Sidewalk Curb Ram
36,
SYS
300.0
10,800.00
Version 10/17/2017 Contractors Bid for Public Works - 7
Description
Quantity
Unit
Unit Price
Total Amount
27
Si n, Sheet, with Legend 0.100 IN
26
SIFT
40,00-.---
1,040.00
28
Line Removal
390
LF
100
1,170.00
29
24" White Thermoplastic Stop Line
110
LF
6.00
660.00
30
66" Solid White Thermoplastic Line
420
LF
3.0�0
1,260.00
31
4" Solid Yellow Thermoplastic Line
226
LF
2.20
497,20
3 3 2
4" Solid White Thermoplastic Line
470
LF
2 .20
—
1034,00
33
Pavement Message Marking, Left Turn Arrow
2
EA
300-00T:600.00
212,376.20
Bidder (Firm): TGB Unlimited (dba),S/T Bancroft Electric
Address:
25020 SIR 2
City/State/lip: South Bend, IN 46619 Telephone Number: _t_574_)- 968-2040
BY
Ty Bancroft, President
(Printed IName of Person Signing)
Version 10/1712017 Contractor's Bid for Pub�lic Works - 8
-0-0�
yWESTBEND
A MUTUAL INSURANCE COMPANY'
Bond Number 2373179
N. V I -, 0=1 q I
KNOW ALL BY THESE PRESENTS, That We, TGB Unlimited Inc dba SIT Bancroft Electric as Principal,
and WEST BEND MUTUAL INSURANCE COMPANY, a corporation, organized under, the laws of the State of Wisconsin
and having its principal office in Middleton, Wisconsin, in said State, as Surety, are Iheld and firmly bound unto
City of South Bend Board of Public Works as Owner, in the full and just sum of
Five Percent 5 %) of amount bid for the payment
whereof said Principal binds its heirs, administrators, and executors and said Surety binds itself, its successors
and assigns firmly by these presents
WHEREAS, said Principal has submitted to said Owner a bid or proposal for
Signals at Jefferson and Twyckenham
NOW THEREFORE, THE CONDITION OF THIS OBLIGATION IS SUCH that if within Sixty days hereof and in
accordance with said proposal a contract shall be awarded to sand Principal and the said Principal shall enter into a
contract for said work and shall furnish bond with surety as required for its faithful performance then this obligation
shall be void, otherwise remain in full force and virtue.
Signed and Sealed this 19 day of December 20 17
Witness:
Principal:
(SEAL)
-,Ndme Typed: Ty G Bancroft, President
Title
Surety:
West 11,4nd Mutual Insurr ce CImpany
By: (SEAL)
Name Typed:' Tara M Patterson , Attorney- I in- Fact
Title
CAN BERRY INSURANCE AGENCY INC
SOUTH BEND, IN 46635
Phone Number: {574) 255-6222
MICHIGAN ONIILY. This policy is exempt from the filing requirements of Section 2236 of the lnsurance Code of 1956,
1956 PA 218 and MCL 500.223&
NIB 0192 11 17 Page 1 of 1
PO Box 620976 1 Middleton, WI 53562 1 Phone: (608) 410-3410 1 Fax: (877) 674-2663 1 www.thesilverlining.com
WESTBEND
A MUTUAL. INSURANCE COMPANY'
POWER OF ATTORNEY
Tf-iE SILVER LINING"
Bond No. 2373179
Know all men by these Presents, That West Bend Mutual Insurance Company, a corporation having its principal office in the City of West
Bend, Wisconsin does make, constitute and appoint:
Tara M Patterson
lawful Attorneys) -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,
undertakings and contracts of suretyship, provided that no bond or undertaking or contract of suretyship executed under this authority
shall exceed in amount the sum of: Seven Million Five Hundred Thousand Dollars ($7,500,000)
This Power of Attorney is granted and is signed and sealed by facsimile under and by the authority of the following Resolution adopted
by the Board of Directors of West Bend Mutual Insurance Company at a meeting duly called and held on the 21st day of December,
1999.
Appointment of Attorney -In -Fact. The president or any vice president, or any other officer of West Bend Mutual Insurance
Company may appoint by written certificate Attorneys -In -Fact to act on behalfof the company in the execution ofand attesting of
bonds and undertakings and other written obligatory instruments of like nature. The signature of any officer authorized hereby
and the corporate seal may be affixed by facsimile to any such power of attorney or to any certificate relating therefore and any
such power of attorney or certificate bearing such facsimile signatures or facsimile seal shall be valid and binding upon the
company, and any such power so executed and certified by facsimile signatures and facsimile seal shall be valid and binding upon
the company in the future with respect to any bond or undertaking or other writing obligatory in nature to which it is attached.
Any such appointment may be revoked, for cause, or withoutcause, by anysaid officer atany time.
In witness whereof, the West Bend Mutual Insurance Company has caused these presents to be signed by its president undersigned
and its corporate seal to{be hereto duly attested by its secretary this 22nd day of SeeDttember, 2017.
Attest
GORPORAi�•i``
Christopher C. Z Bart $''. Kevin A. Steiner
Secretary '" � AL�p !-' Chief Executive Officer/President
State of Wisconsin
County of Washington
On the 22nd day of September, 2017, before me personally came Kevin A, Steiner, to me known being by duly sworn, did depose and
say that he resides in the County of Washington, State of Wisconsin; that he is the President of West Bend Mutual Insurance Company,
the corporation described in and which executed the above instrument; that he knows the seal of the said corporation; that the seal
affixed to said instrument is such corporate seal; that is was so affixed by order of the board of directors of said corporation and that he
signed his name thereto by like order. 44
]uli A nedum
Nam.• !'QQ0G ;!�;= Senior orporate Attorney
Notary Public, Washington Co., WI
My Commission is Permanent
The undersigned, duly elected to the office stated below, now the incumbent in West Bend Mutual Insurance Company, a Wisconsin
corporation authorized to make this certificate, Do Hereby Certify that the foregoing attached Power of Attorney remains in full force
effect and has not been revoked and that the Resolution of the Board of Directors, set forth in the Power of Attorney is now in force.
Signed and sealed at West Bend, Wisconsin this 19th day of December 2017
P.& r�uu......
-'!E SEAL `f'
-I � Heather Dunn
`o . Vice President — Chief Financial Officer
Notice: Any questions concerning this Power of Attorney maybe directed to the Bond Manager at NSI, a division of West Bend
Mutual Insurance Company.
1900 S. 1811, Ave, West Bead, WI 53095 1 ph (262) 334-6430 1 1-800-236-5004 1 fax (262) 338-5058 1 www.thesilverlining.com
1316 COUN'ry-Cuy BuiLDI NO
227 W. JEFFERSON BOULLVARD
Scum BEND, INDIANA 46601-1830
Date:
To:
From
Subject
Project Name:
Project No.:
December 14,2017
All Planhold,ers
Linda M. Martin, Clerk, Board of Public Works
Addendum Number: 1
PHON11 574/235-9251
FAX 574/ 235-9171
TDD 574/ 235-5567
Jefferson and Twyekenham Signal Improvements
116-027
Date Received: 12-15-2017
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.
Notes:
The attached documents are hereby added to the Specifications and Contract
Documents and become a part of herein.
Company: TGB Unfimited (dba) SfT Bancroft Electric
Authorized Signature:
Date: 12 -1 5-2017
• 0 11 . I I I I
0-1 Tie
MOS 1 MV J."A ILI
CHECKLIST FOR BIDDERS
Project Name Jefferson and Twyckenham Signal Improvements
Project No. 116-027
For Bids Due JWy4W",-2WDecember l9,2017atgam
From time to time the South Bend Board of Public Works finds lit 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 its 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-Diebarment Affidavit, Certification Regarding Investments
with Iran, Employment Eligibility'Verification, Non -Discrimination Commitment, and
Certification of use of United States Steel Products or Foundry Products.
Proof of MBEIWBE Participation Goal Form [MWBE-1,O]. If minimum participation goal is not
met, also provide Evidence of Good Faith Efforts Form [MWBE-2.0], and MBEANBE Contacted
Form [MWBE-2. I],
V 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,
V 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: TGIB Unlimited (dba) S/T Bancroft Electric Date:
By Authorized Representative:
Signature:
FM M, i ! F. ri 11, M.
12-19-2017
Version 10/17/2017 Contractor's Bid for Public Works - I Addendum #1
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 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 Bend can make a proper determination of the bidder's
capability for completing the project if awarded.
Version 1011712017 Contractor's Bid for Public Works - 3 Addendum #1
When the prospective Contractor is unable to certify to any of the statements Belo;p, it sir all attach an explanallon to this Affidapil.
CONTRACTOR'S NON -COLLUSION AND NON -DEBARMENT AFFIDAVIT, CERTI 'ICA.TION
REGARDING INVESTMENT WITH U AN, EMPLOYMENT ELIGIBILITY VERIFICATION, NON
DISCRIMINATION COMMITMENT AND CERTIFICATION OF USE OF UNITED STATICS STEEL
PRODUCTS OR FOUNDRY PRODUCTS
(Must be completed for all quotes and bids. Please type or print)
STATE OF Indiana )
) SS:
St. Joseph COUNTY )
The undersigned Contractor, being duly sworn upon his/her/its oath, affirms under the penalties of perjury
that:
1. Contractor has not, nor has any other member, representative, or agent of the firm, company,
corporation or partnership represented by him, entered into any combination, collusion or agreement with
any person relative to the price to be bid by anyone at such letting nor to prevent any person from bidding
nor to induce anyone to rofrain from bidding, and that this bid is made without reference to any other bid and
without any agreement, understanding or combination with any other person in reference to such bidding.
Contractor further says that no person or persons, firms, or corporation has, have or will receive directly or
indirectly, any rebate, fee, gift, commission or thing of value on account of such sale; and
2. Contractor certifies by submission of this proposal that neither contractor nor any of its principals
are presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from
participation in this transaction by any Federal department or agency; and
3. Contractor has not, nor has any successor to, nor an affiliate of, Contractor, engaged in
investment activities in Iran.
a. For purposes of this Certification, "Iran" means the government of Iran and any agency
or instrumentality of Iran, or as otherwise defined at Ind, Code § 5-22-16.5-5, as
amended from time -to -time.
b. As provided by Ind. Code § 5-22.16.5-5, 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 titnc 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
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/shcht 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/het/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 tine Contractor fails to cure a breach of this provision
no later than thirty (30) days after being notified by the City.
6. Persons, partnerships, corporations, associations, or joint venturers awarded a contract by the City
of South Bend through its agencies, boards, or commissions shall not discriminate against any employee or
applicant for employment in the performance of a City contract with respect to hire, tenure, terms, conditions,
or privileges of employment, or any matter directly or indirectly related to employment because of race, sex,
religion, color, national origin, ancestry, age, gender expression, gender identity, sexual orientation or
disability that does not affect that person's ability to perform the work.
In awarding contracts for the purchase of work, labor, services, supplies, equipment, materials, or any
combination of the foregoing including, but not limited to, public works contracts awarded under public
bidding laws or other contracts in which public bids are not required by law, the City, its agencies, boards,
or commissions may consider the Contractor's good faith efforts to obtain participation by those Contractors
certified by the State of Indiana as a Minority Business ("MBE") or as a Women's Business Enterprise
("WBE") as a factor in determining the lowest, responsible, responsive bidder.
In no event shall persons or entities seeking the award of a City contract be required to award a subcontract
to an MBEIWBE; however, it may not unlawfully discriminate against said WBE/MBE. A finding of a
discriminatory practice by the City's MBEME 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 (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 10/17/2017 Contractor's Bid for Public Works - 5 Addendum #1
may result in forfeiture of contractual payments.
I hereby affirm under the penalties of perjury that the facts and information contained in the foregoing bid
for public works are true and correct,.
December
Dated this 1 9th day of_, 20 17
Subscribed and sworn to before me this 1(4th
My Commission Expires June 18, 2023
County of Residence
TGB Unfimited (dba) SIT Bancroft Electric
Contractor/Bidder (Firm)
Signature of Contractoifflidder or Its Agent
Ty Bancroft, President
Printed Name and Title
SART I
notary vubq% state 01 tndien
LOPOrtO County
CO.MISSIOn Expires
Version 10/1712017 Contractor's Bid! for Public Works - 6 AddendUM #1
l r CONTRA{CTOR'S BI�DIsed FOR PUBLIC WORK - FORM 96
State Form 52414 2013)
Prescribed by State Board of Accounts
r ,e
PART
(To be completed for all bids. Please type or print)
Date (month, day, year): December 19, 2017
1. Governmental Unit (Owner): City of South Bend, Board of Public Works
2. County: St. Joseph
3. Bidder (Firm): TGB Unlimited (dba) SIT Bancroft Electric
Address: 25020 SR 2
City/State/ZlPcode: South Bend, IN 46619
4. Telephone Number: 574-968-2040
5. Agent of Bidder (if applicable): NIA
Pursuant to notices given, the undersigned offers to furnish labor and/or material necessary to complete
the public works project of Jefferson & Twyckenham Signal Improvement
(Governmental Unit) in accordance with plans and specifications prepared by South Bend Engineering
and dated 11-30-2017 for the sum of
Two Hundred Twelve Thousand Three Hundred Seventy Six 20-100 $ 212,376.20
The undersigned further agrees to furnish a bond or certified check with this bid for an amount specified in the
notice of the letting. If alternative bids apply, the undersigned submits a proposal for each in accordance with the
notice. Any addendums attached will be specifically referenced at the applicable page.
If additional units of material included in the contract are needed, the cost of units must be the same as
that shown in the original contract if accepted by the governmental unit. If the bid is to be awarded on a unit
basis, the itemization of the units shall be shown on a separate attachment.
The contractor and his subcontractors, if any, shall not discriminate against or intimidate any employee,
or applicant for employment, to be employed in the performance of this contract, with respect to any matter
directly or indirectly related to employment because of race, religion, color, sex, national origin or ancestry.
Breach of this covenant may be regarded as a material breach of the contract.
CERTIFICATION OF USE OF UNITED STATES STEEL PRODUCTS
(If applicable)
I, the undersigned bidder or agent as a contractor on a public works project, understand my statutory
obligation to use steel products made in the United States (I.C. 5-16-8-2). 1 hereby certify that I and all
subcontractors employed by me for this project will use U.S. steel products on this project if awarded. I
understand that violations hereunder may result in forfeiture of contractual payments.
ACCEPTANCE
The above bid is accepted this 19th day of December 2017 , subject to the
following conditions: NIA
Contracting Authority Members:
PART 11
(For projects of $150,000 or more — IC 35-1-12-4)
Governmental Unit: City of South Send Public Works Department
Bidder (Firm) TGB Unlimited (dba) SIT Bancroft Electric
Date (month, day, year):
12-19-2017
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.
SECTION I EXPERIENCE QUESTIONNAIRE
What public works projects has your organization completed for the period of one (1) year prior to the
date of the current bid?
Contract Amount
Class of Work
Completion
Date
Name and Address of Owner
93,894.00
Lighting/Conduit
8-2017
Goshen Community Schools
55,000.00
Signal Modernization
11-2017
City of Elkhart 1201 S Nappanee ST. Elkhart
43,500.00
Electrical/Lighting
6-2016
City of Portage 6301 S. Founders Square Portage, IN
385, 986.00
Street Lighting
7-2016
City of South Bend 227 W. Jefferson Blvd. South Bend
2. What public works projects are now in process of construction by your organization?
Contract Amount
Class of Work
Expected
Completion
Date
Name and Address of Owner
562,750.00
Street Lighting/Signals
2017
Elkhart County, Elkhart Indiana
47,990.00
Foundation/Conduit
2017
City of South Bend
499,964.00
Street Lighting/Signal
2017
City of South Bend
150,000.00
Conduit/Foundations
2017
Watermark Company
Have you ever failed to complete any work awarded to you? No If so, where and why?
4. List references from private firms for which you have performed work.
American Renolit Corporation, Tim Jones, 219-324-6886
Gurley Leep, Pat Kelly, 574-272-2043
G.E. Marshall, Clint Marshall, 219-462-3415
Walsh & Kelly, Kevin Kelly, 574-288-4811
C & E Excavating, Bryan Slott, 574-262-4346
SECTION 11 PLAN AND EQUIPMENT QUESTIONNAIRE
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.)
Per Plans and Specifications
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.
NIA
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.
NIA
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.
Ford F700 Dump Truck, T190 Bobcat, 763 Bobcat, XP185 Ingersoll Rand Compressor,
275 Ring O Matic Vacuum/Excavator, Ford 8000, Kodiak Digger Derrik
Vermeer 24 x 40 Directional Boring Machine, Vermeer 18 x 22 Directional Boring Machine,
Vermeer RTX450 combination Trencher/Backhoe, Vermeer MX240 Mixing System
John Deer 401 C
5. 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.
Yes
SECTION III CONTRACTOR'S FINANCIAL STATEMENT
Attachment of bidder's financial statement is mandatory. Any bid submitted without said financial
statement as required by statute shall thereby be rendered invalid. The financial statement provided hereunder to
the governing body awarding the contract must be specific enough in detail so that said governing body can make
a proper determination of the bidder's capability for completing the project if awarded.
SECTION IV CONTRACTOR'S NON — COLLUSION AFFIDAVIT
The undersigned bidder or agent, being duly sworn on oath, says that he has not, nor has any other
member, representative, or agent of the firm, company, corporation or partnership represented by him, entered
into any combination, collusion or agreement with any person relative to the price to be bid by anyone at such
letting nor to prevent any person from bidding nor to 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.
SECTIONV 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 South Bend this 19th day of December 2017
TGB 'Unlimited (dba) SJT Bancroft Electric
(Name of organization)
President
(Title of Person Signing)
ACKNOWLEDGEMENT
STATE OF Indiana
COUNTY OF St. Joseph ) ss
Before me, a Notary Public, personally appeared the above -named Ty Bancroft and
swore that the statements contained In the foregoing document are true and correct.
Subscribed and sworn to before me this 19th
day ofDe ta..er 2017
..., ,. _.. „ Notary
Public
M Commission Expires: June 18, 2023.
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Public, SWO Of indiana
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CITY OF SOUTH BEND 7- a� . �,. „
MINORITY AND WOMEN BUSINESS ENTERPRISE DIVERSITY
DEVELOPMENT PROGRAM
FORM MwBE-2.0
EVIDENCE OF GOOD FAITH EFFORTSa;�r`_any
This completed form should be included as part of the Bids documents related to City of South Bend Public
Works Projects requiring Good Faith Efforts to obtain MBEIWBE participation. It Is the bidder's sole
responsibility to verify whether any listed minority or woman business meets the qualifications of a Minority
or Women's owned business as defined by the Indiana Department of Administration ("IDOA").
Project Number: 116-027
Project Name: Jefferson and Twyckenham Signal Improvements
Bidder: TGB Unlimited (dba) SIT Bancroft Electric
Contact Person:
Address:
City:
Email:
Ty Bancroft
25020 State Road 2
South Bend State: IN
Date: 12-19-2017
Telephone: 574-968-2040
zip: ___46619
To determine whether a bidder has demonstrated good faith efforts to reach the MBE/WBE utilization goals set
forth in the City of South Bend Public Works Project Specifications, the City and its agencies, boards, or
commissions, REQUIRE ALL of the following Good Faith Efforts as listed in the table below*:
EVIDENCE OF GOOD FAITH EFFORTS
MBEIWBE LIST(S): The bidder reviewed the City of South Bend's Minority and Women Business
Enterprise Diversity Development Program, which uses the IDOA approved list of Minority and Women
Owned Business as found on their website (hftp://www,in.gov/ldoa).
ACTION (ADVERTISEICONTACT): In order for your bid to be deemed responsive, the City of South
Bend requires that all perspective bidders complete no less than 2 of the following:
1. Attend all pre -bid meetings scheduled by the City to inform MBEAA/BEs of contracting and
subcontracting opportunities.
2. Advertise in general circulation and/or trade association publications concerning subcontracting
opportunities, and allow MBE/WBEs reasonable time to respond.
3. Perform any and all necessary steps to provide written notice in a manner reasonably calculated
to inform MBEANBEs of subcontracting opportunities and allowed sufficient time for them to
participate effectively.
4. Utilize pre-existing services of available community organizations, small and/or disadvantaged
business assistance offices and other organizations that provided assistance in the recruitment
and placement of MBEIWBE firms.
**Bidder must circle or otherwise notate which of the two (2) required actions were performed.
GOOD FAITH NEGOTIATIONS: The bidder negotiated in good faith with Interested MSE/WBEs,
including providing such MBEIWBE'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.
SMALL CONTRACT(S): The bidder selected specific portions of the work to be performed by
MBE/WBEs in order to increase the likelihood of meeting the MBE IWBE goals (including breaking down
contracts into smaller units to facilitate MBEIWBE participation)
CONTRACT RECORDS: The bidder has maintained the following records for each MBE IWBE that has
bid on the subcontracting opportunity:
1, Name, address, and telephone number;
2. A description of information provided by the bidder or subcontractor; and
3. A statement of whether an agreement was reached, and if not, why not, including any reasons for
concluding that the 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 10/1712017 Contractor's Bid for Public Works - 10 Addendum 41
I ° rY.pj"
CITY OF SOUTH BEND
MINORITY AND WOMEN BUSINESS ENTERPRISE DIVERSITY
DEVELOPMENT PROGRAM
:
VIA
Me
FORM MWBE-2.1
S
MBEfWBE CONTACTED
This completed form should be supplied with Bids that pertain to City of South Bond Public Works Projects
requiring contacted MBEIWBE to obtain Good Faith Efforts. IIt 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.
PAGE___L_OF
Project Number: 116-027 MBEIWBE Participation Goal
Project Name: Jefferson and Twyckenharn Signal Improvements
Bidder: TGB Unlimited (dba) S/T Bancroft Electric
By:PresideIt 12-19-2017
m (Signature) (Title) (Date)
MBE/WBE Firm —Traffic Control Specialists
Owner or Contact at M B EANBE Firm Tracey Triska
Telephone: 574-772-7001
Fax: 574-772-7002
TYPE OF WORK SOLICITED FOR THIS PROJECT:
Pavement Marking and removal (items 28-33)
RESULTS OF CONTACT WITH THE MBEIWBE FIRM:
received quote
MBE/WBE Firm Premium Concrete
Owner or Contact at MBEA1VBE Firm Rob Becker
Telephone: 574-264-0196 Fax:
TYPE OF WORK SOLICITED FOR THIS PROJECT.
Concrete Curb/Sidewalk
RESULTS OF CONTACT WITH THE MBEIWBE FIRM:
Received Quote
Email: tcsinc@tcspecialists.net
Email: rbecker@premilumconcreteonfine.com
Version 10M7/2017 Contractors Bid! for Public Works - 11 Addendum #1