HomeMy WebLinkAboutOpening of Bids - VPA 2018 Chemical Supply - Harrell's LLCBID NAME
FOR BIDS DUE,
Date:
Address:
CITY OF SOU'TH BEND,,--INDIANA
SELLER'S BID FOR SALE OR LEASE OF MATERIALS
Venues Parks & Arts 2018 Chemical Su
December 2111, 2017 @ 9:30am
Uty/State/Dp: 'LaZE(ad4.
Agent of Bidder (if Applicable):
Bidder I I
(Firm): dacc
elephone tlunibier: )6,97-e
0
When the prospective Contractor is unable to certify to any of the statenients belmil, it shall attach an explanation to this Afflulavit
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 -EkCL6A(
) SS:
COUNTY
The undersigned Contractor, being duly sworn upon his/her/its oath, affirms under the penalties of perjury
that:
I . Contractor has not, nor has any other member, representative, of 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 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.
For purposes of this Certification, "Iran" rneans 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.
Ver. 13'— 6101115
I hereby affirm under the penalties of peKjuiy that the facts and information contained in the foregoing bid
for public works are trine and correct.
Dated this day of '. , 20
a
t"
MARY E EISN�ER
MY COMMISSION #FF099586 S gna ure of Contractor/Bidder or Its Agent
EXPIRES March 9, 2018 ,r
�aoa) 3sa.o153� NoridallotarySerWcexom r
Printed Name and Title S*&Ufk, AAArkgftw, j
Subscribed and sworn to before me this day of 20 17
My Commission Expires
Notary Pri' lic
County of Residence
Ver. 13 — 0101115
(To be completed only by Contractors/Bidders claiming to be a "local Indiana business" pursuant to I.C. 36-1-12-22)
INDIANA LOCAL BUSINESS PREFERENCE CLAIM
A "local Indiana business" refers to, any of the following:
(1) A business whose principal place of business is located in an affected county.
(2) A business that pays a majority of its payroll (in dollar volume) to residents of affected counties.
(3) A business that employs residents of affected counties as a majority of its employees.
(4) A business that makes significant capital investments in the affected counties as defined in rules adopted by the
political subdivision.
(5) A business that has a substantial positive economic impact on the affected counties as defined by criteria in rules
adopted by the political subdivision.
An "affected county" refers to St. Joseph County, Indiana, or the following counties located adjacent to St. Joseph
County., Elkhart County, Marshall County, Starke County and LaPorte County
There are the following price preferences for supplies purchased from a local Indiana business:
* 5% for a purchase expected by the purchasing agency to be less than $50,000
• 3% for a purchase expected by the purchasing agency to beat least $50,000 but less than $100,000.
• 1% for a purchase.expected by the purchasing agency to beat least $100,000.
Date:
Pursuant to I.C. 36-1-12-22,
preference for Project
South Bend, St. Joseph County, Indiana.
0 The location of the principal place of business is
claims a local Indiana business
(Project # _) located within the City of
(Address)
St. Joseph County, Indiana
The following county located adjacent to St. Joseph County, Indiana:
The, majority of the business's payroll for the 12 months prior to the date of this Bid is to residents of St.
Joseph County, Indiana or the adjacent county noted above.
The majority of the business's employees for the 12 months prior to the date of this Bid are residents of St.
Joseph County, Indiana, or the adjacent county noted above.
If the business is deemed to be the apparent lowest,, responsible, responsive bidder, then it shall provide
supporting documentation, for the 12 month period prior to the date of the Bid of (i) the total payroll amount
paid to all employees of the business, and (ii) the total payroll amount paid to employees who are residents
of St. Joseph County and the adjacent county noted above.
WHEN SUPPLYING SUPPORTING PAYROLL RECORDS,
BIDDER SHALL REDACT ALL SOCIALSECURITYNUMBERS,
Dated this day of 1 20.
Contractor/Bidder (Firm)
Signature of Contractor/Bidder or Its Agent
Printed Name and Title
Ver. 13 -- 6101115
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Bidder (Firm): 0-6tra L
Address:
s)o,<-- IlUe-ij
City/State/Zip,: Lake-ladd Fl- S3'81,S-
Telephone Number:. - Fax Number: -3 - aQ_q = L,'j: �Q �
BOARD OF PUBLIC WORKS
Gary A. Giilot, President
§wzanna M. Fritzberg, Member
James A. Mueller, Member
By
ak."' Hacc ell la:
(Printed Name)
(Title)
Therese J. Dorau, Member
Elizabeth A. Maraclik, Member
Attest: Linda M. Martin, Clerk
Vei,. 13 — 0101115
HARLLCI OP ID: PG
RATE (MMIODIY
CERTIFICATE OF LIABILITY INSURANCE 12r15r2017
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
CE
RTIFICATE
CERTIFICATE CATEFOF INSIURANCE DOES NOTCONSTITUTEY AMEND, EXTEND TBETWEENR ALTER THE OVERAGE AFFORDED BY �
CONSTITUTE A CONTRACT TH I SUING NSURER(S),
HE POLICIES
BELOWAUTHORIZED
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER,
IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to
the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the
r.artifirate holder in lieu of such endorsements .
PRODUCER
Sale Insurance Agency, Inc.
P.O. Drawer 426
Lakeland, FL 33802-0426
Robert H. Sale
INSURED Harrell's LLC
Harreli's,inc.
5105 New Tampa Highway
Lakeland, FL 33815
CONTACT Robert H. gale
NAME:
rlaoN� 863-682-0363 Atc Nn : 863-682-0086
ieinsurance.com
it
INSURERA:AIG Specialty ins Co
ENSURER 9 : Ins Co of the State of PA
INSURER 0:Commerce & Industry Ins. Co.
INSURER D: Natl Union Fire Ins Co of Pit
INSURER E : Lloyd's of Landon
COVERAGES CERTIFICATE :
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURE
INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER I
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBE[
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES, LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
a
ILTRSD POLICY EFF POLICY FXP
TYPE OF INSURANCE O R POLICY NUMBER MMlDD dMIDWYYYY
A x COMMERCIAL GENERAL LIABILITY
CLAIMS -MADE � OCCUR EG17937836 01/0112017 01/0112018
X Contractual,ind C
x Pollution
GEN'L AGGREGATE LIMIT APPLIES PER:
POLICY T PRO-
JECT LOC
AUTOMOBILE LIABILITY
D I ANY AUTOAALL UTOS NED H
AUTOSSCHEDULED
NON-O W NEO
HIRED AUTOS AUTOS
j( UMBRELLA LIA6 1& OCCUR
A EXCESS LIAR CLAIMS -MADE
10.000
AND EMPLOYERS' LIABILITY
�ANYPROPRIFI
FFICERlMEMi
C (Mandaloryin
If V", describe
821
5146
NtA
:CI2662635 (AOS)
C12862536(CA)
011D112017 1 01f0112018
011011201710110112018
0110112017 01101/2018
01101/2017 10110112018
utbl,Ktr IIull Vr Vrr_s.n„v,.v rv,-• 01/01/2017 011011201s
Professional Liab PGIARLC0347"3
DESCRIPTION OF OPERATIONS! LOCATIONS f VEHICLES (ACCRO 110i, Additional Romarka Sehsdule, may be astaohad it more space is requi
aid Name: Venues Parks & Arts 2018 Chemical Supply
w1/Ih rf\\I \FF ,ILMM ,
'D NAMED ABOVE FOR THE POLICY PERIOD
]OCUMENT WITH RESPECT TO WHICH THIS
HEREIN IS SUBJECT TO ALL THE TERMS.
L€Mrrs
EACH OCCURRENCE
$ 1,ti00,000
A E TO RE T
1,000,000
PREMISES Ee aecurrence
MFD EXP (Any one person)
S 10,00 DO
PERSONAL S ADV INJURY
5 1,000,00
GENERAL AGGREGATE
$ 2,000,00
PRODUCTS-COMPIOP AGG
S 2,000,00
S
COMBINED SINGLE LIMIT
S 1,000,00
Ee accldenl
BODILY INJURY (Per parson)
S
BODILY INJURY (Per acaddenl)
S
PROPERTY DAMAGE
S
Per acclden
PIP (FL) (FL)
s 10,00
EACH OCCURRENCE
$ 10,000,00
AGGREGATE
S 10,000,000
F1F
S
PER OTH-
STA UTE X ER
51- EACH ACCIOI=NT
$ 1,000,00
SE - Fri EMPLOYEE
S 'I,000,0�}0
ESE - POLICY LRUT
5 1 �000,000
Limit ea
1,000,00
Ded
10,00
ad)
CITYlNC3
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
The City of South Bend ACCORDANCE WITH THE POLICY PROVISIONS.
Clerk of the Board of Public
Works,1316 County -City Bldg AUTHORIZED REPRESENTATIVE
227 West Jefferson Blvd
South Bend, IN 46601 7��4 AC=S__
(D1988-2014 ACORN CORPORATION, All rights reserved.
ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD
BID BOND Travelers Casualty and Surety Company of America
One Tower Square 3PB, Hartford, CT 06183
Bond No. 1066875,88
KNOW ALL MEN BY THESE PRESENTS,
That we, Harrell's, LLC . as Principal, hereinafter called the Principal, and
Travelers Casualty and Surely Company of America, of One Tower Square 3PI3. Hartford, CT 06183, a corporation duly
organized under the laws of the State of Connecticut, as Surety, hereinafter called the Surety, are held and firmly bound unto
City of South (Bend , as Obligee, hereinafter called the Obligee, in, the sum of
Dollars ($ Ten Percent for the payment of which sum well and truly to be, made, the said Principal and the said Surety, bind
ourselves, our heirs, executors, administrators, successors and assigns, jointly and severally, firmly by these presents.
** Ten Percent of Amount Bid
WHEREAS, the Principal has submitted a bid for Venues Parks & Arts 2018 Chemical Supply
NOW, THEREFORE, if the Obligee shall accept the bid of the Principal and the Principal shall enter into a Contract with the Obligee in
accordance with the terms of such bid, and give such bond or bonds as may be specified in the bidding or Contract Documents with
good and sufficient surety for the faithful performance of such Contract and for the prompt payment of labor and material furnished in
the prosecution thereof, or in the event of the failure of the Principal to enter such Contract and give such bond or bonds, if the Principal
shall pay to the Obligee the difference not to exceed the penalty hereof between the amount specified in said bid and such larger
amount for which the Obligee 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.
Signed and sealed this 21st- day of December =.
HarreWs, LL
(Seal)
By: (seal)
Witness Principal
lers Casualtytand Uiety Com
By:
Witness Bryce R./Guignarcl
Attorney in Fact & IN Licensed Non -Resident Agent
Inquiries: (407) 834-,0022
Printed in cooperation with the American Institute of Architects (AIA) by Travelers Casualty and Surety Company of America
this document conforms exactly to the language used in ABA Document A310, February 1970 edition.
(Seal)
Attorney-in-Fact
I The language in
S-1 869-G (10-00)
W;k NiNd:"
A01h, POWER OF ATTORNEY
TRAVELERSJ Farmington Casualty Company
Fidelity and Guaranty Insurance Company
Fidelity and Guaranty Insurance Underwriters, Inc.
St. Paul Fire and Marine Insurance Conitian.),
St. Paul Guardian insurance Company
Attorney -In Fact No. 232734
St. Pan] Mercury Insurance Company
'fi-avelers Casualty :in([ Surety Company
Travcicrs Casualty and Surety Company ofAmerica
United States Fidelity and Guaranty Company
Certificate No. 007422833
KNOW ALL MEN BY THESE PRESENTS: That Farmington Casualty Company, St. Paul Fire and Marine Insurance Company, St. Paul Guardian Insurance
Company, St. Paul Mercury Insurance Company, Travelers Casualty and Surely Company, Travelers Casualty and Surely Company ol'Atocrica, and United States
Fidelity and Guaranty Company are corporations (July organized under the laws of the Skate of Connecticut, that Fidelity and Guaranty insurance Company N a
corporation duty organized under the laws of the State of Iowa, and that Fidelity and Guaranty Insurance Underwriters, Inc„ is a corporation duly organized under the
laws of the State of Wisconsin (herein collectively called the "Companies"), and that the Companies (to hereby make, constitute and appoint
Bryce R. Guignard, April L. Lively, Patti J. Ciambriello, Jennifer L. Hindley, Margie L. Morris, Deborah Anti Murray, Eileen C. Heard,
and Christine Morton
of the City of State of Florida
---Longwood I - , their true and lawful Attorney(s)-in-Fact,
each in their separate capacity if more than one is named above, to sign, execute, seal and acknowledge any and all bonds, recognizances, conditional undertakings and
other writings obligatory in the nature thereof on behalf of the Companies in their business of guaranteeing the fidelity of persons, guaranteeing the performance of
contracts and executing or guaranteeing bond,; and undertakings required or permitted in any actions or proceedings allowed by law.
IN WITNESS WIIEREOF, the Companies have caused this instrument to be signed and their corporate seals to be hereto affixed, this 26th
day of October ----2017 .
State of Connecticut
City of Hartford ss.
Farmington Casualty Company
Fidelity and Guaranty Insurance Company
Fidelity and Guaranty Insurance Underwriters, Ine
St, Paul Fire and Marine Insurance Company
St. Paul Guardian Insurance Company
St. Paul Mercury Insurance Company
Travelers Casualty and Surety Company
Travelers Casualty and Surely Company of America
United States Fidelity and Guaranty Company
f �000RAP,: a 110
K. 'A !k
W
L, a L -i
............ ..
By:
Robert L. Riney, Scnior Vice President
On this the 26th dav of October 2017
m
' -'— — - I — before e personally appeared Robert L. Raney, who acknowledged himself to
be the Senior Vice President of FaralingtotiCasuilty Company, Fidelity and Guaranty Insurance Company, Fidelity and Guaranty Insurance Underwriters, tile,, St. Paul
Fire and Marine Insurance Company, St. Paul Guardian Insurance Company, St. Paul Mercury Insurance Corrip,,uty,Fravelers Casualty and Surely Company, Travelers
Casualty and Surely Company of America, and United States Fidelity and Guaranty Company, and that he, as such, being authorized so to do, executed the foregoing
instrument for the purposes therein contained by signing on behalf of the corporations by himself as a duly authorized officer.
In Witness Whereof, I hereunto set my hand and official seal.
My Commission expires the 301h (lay of June, 2021 .Teo-eault, Notary f1uhlic
Cr
m
58440-5-16 Printed in U.S.A.
WARNING: THIS POWER OF ATTORNEY IS INVALID WITHOUT THE RED BORDER