HomeMy WebLinkAboutOpening of Quotations - 2017 Crack Sealing Proj No 117-102 - Asphalt Restoration Services LLCCITY OF SOUTH BEND, INDIANA
(;ONTRACTOR'S QUOTE FOR PUBLIC WORK Y
PROJECT NAME:
PROJECT NO.
QUOTES DUE
Date:
Address:
City/State/Zip:
2017 Crack Sealing
117-102
December 19. 2017 at 9:00 am EST
(Must be cornpleted for all quotes. Please type or print)
Agent of Bidder (if Applicable):
Pursuant to notices given, the
public works project of:
ma, . .... ...........
Telephone Number: (A�) aA 2 — 0 9�
offers to furnish labor and/or material necessary to complete the
- Pro'
the City of South Bend, Indiana, in actZrdance with plans and specifications prepared by:
The City of South Bend, Department of Public Works
and dated W il'k a n n j for the sum of (enter the Total Quote as shown on the Proposal)
cr
nter Sum of Total Quote shown on Proposal) (Numerical)
If alternative quotes 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 City of South Bend. If the quote is to be awarded on a unit basis, the
itemization of the units shall be shown on a separate attachment.
By (41'ew�
(Si nature)
(Printed Name of Person Signing)
ACCEPTANCE
The above quote is accepted this day of
Subject to the following conditions:
BOARD OF PUBLIC WORKS
Gary A. Gllot, President
Elizabeth A. Maradik, Member
,lames A. Mueller, Member
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20
Suzanna M. Fritzberg, Member
Therese J. Dorau, Member
Attest: Linda M. Martin, Clerk
Page - 7 Public Works Quote
QUOTE/PROPOSAL
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CITY OF SOUTH BEN®
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PROJECT NAME 2017 Crack Sealing
PROJECT NO. 117-102
QUOTES DUE December 19, 2017 at 9:00 am EST
Item
No.
Description
Quantity
Unit
Unit Price
Total Amount
1
Cracks in Asphalt Pavement, Rout and
5
TON
Seal
2
Cracks in Asphalt Pavement, Fill
10
TON
aJn �IijA i
Total Amount of Quote
$
Firm:
k .
Address: P
City/State/Zip: �A� Telephone Number:
Fax Number: { ) f 1
By �w....
(Signature)
h>r n W Yi
(Printed dme of Person Signing)
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When the prospective Contractor is unable to certlft to racy oj'the statements below, it shall attach an explanation to this Affrdaroit.
CONTRACTOR'S NON -COLLUSION AND NON -DEBARMENT AFFIDAVIT,
CERTIFICATION REGARDING INVESTMENT WITH IRAN, EMPLOYMENT ELIGIBILITY
VERIFICATION, NON-DISCRIMINATION COMMITMENT AND CERTIFICATION OF USE
OF UNITED STATES STEEL PRODUCTS OR FOUNDRY PRODUCTS
(Must be completed for all quotes and bids. Please type or print)
STATE OF }
} SS:
COUNTY }
The undersigned Contractor, being duly sworn upon his/leer/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 anyperson relative to the price to be bid by anyone at such letting nor to prevent
any person from bidding nor to induce anyone to refrain from bidding, and that this bid is made
without reference to any other bid and without any agreement, understanding or combination with
any other person in reference to such bidding. Contractor 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 hid. Code § 5-22-16.5-5, as amended from
tune -to -time.
b. As provided by Ind. Code § 5-22-I6.5-8, 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 Snore in credit to another person for forty-five (45)
days or more, if that person will (i) use the credit to provides goods and services in
the energy sector in Iran; and (ii) at the time the financial institution extends credit, is
a person identified on list published by the Indiana Department of Administration.
4. Contractor does not knowingly employ or contract with an unauthorized alien, nor retain
any employee or contract with a person that the Contractor subsequently learns is an unauthorized
alien. Contractor agrees that he/she/it shall enroll in and verify the work eligibility status of all of
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Contractor's newly hired employees through the E-Verify Program as defined by I.C. 22-5-1.7-3.
Contractor's documentation of enrollment and participation in the E-Verify Program is included
and attached as part of this bid/quote; and
5. Contractor shall require his/her/its subcontractors performing work under this public
contract to certify that the subcontractors do not knowingly employ or contract with an
unauthorized alien, nor retain any employee or contract with a person that the subcontractor
subsequently learns is an unauthorized alien, and that the subcontractor has enrolled in and is
participating in the E-Verify Program. The Contractor agrees to maintain this certification
throughout the term of the contract with the City of South Bend, and understands that the City
may terminate the contract for default if the Contractor fails to cure a breach of this provision no
later than thirty (30) days after being notified by the City.
fi. 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 MBE/WBE; however, it may not unlawfully discriminate against said
WBE/MBE. A finding of a discriminatory practice by the City's MBE/WBE Utilization Board
shall prohibit that person or entity from being awarded a City contract for a period of one (1) year
from the date of such determination, and such determination may also be grounds for terminating
the contact for which the discriminatory practice or noncompliance pertains.
7. The undersigned contractor agrees that the following nondiscrimination commitment shall
be made a part of any contract which it may henceforth enter into with the City of ,South Bend,
Indiana or any of its agencies, boards or commissions.
Contractor agrees not to. discriminate against or intimidate any employee or applicant for
employment in the performance of this contract with privileges of employment, or any matter
directly or indirectly related to employment, because of race, religion, color, sex, gender
expression, gender identity, sexual orientation, handicap, national origin or ancestry. Breach of
this provision may be regarded as material breach of contract.
1, the undersigned bidder or agent as contractor on a public works project, understand my statutory
obligations to the use of steel products or foundry products made in the United States (LC, 5-16-
8-1). 1 hereby certify that I and all subcontractors employed by me for this project will use steel
products or foundry products made in the United States on this project if awarded. I understand I
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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. able. I understand that violations hereunder may result in
forfeiture of contractual payments.
I hereby of under the penalties of periury that the facts and information contained in the foregoing bid for public
works are true and correct.
Dated this day of = 20_L_7
or/Bidder (Firm)
Signature of Contractor/Bidder or Its Agent
Printed Name and Title
Subscribed and sworn to before ine this day of 20
My Commission Expires
f Notary je'��7
County of Residence _5
[Y: IRIPYAN P. SOUSLEY
M N: 0 Public
Notary Public - State of Indiana
SEAL
C MIS'Sic
Commission Number 682764
M C; mmis: sio
y Commission Expires April 9, 2024
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