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HomeMy WebLinkAbout6A(1) Bid PacketG A c (> • r a n • u m ryOUTH 8F Community & Economic Development 1200 County -City Building, 227 West Jefferson, South Bend, Indiana 46601 -1830 Phone 574/235 -9371 Fax 574/235 -9021 To: Redevelopment Commission From: Bill Schalliol, Economic Development Planner Subject: Bid Opening — Prairie Avenue Disposition Parcel Date: November 16, 2010 Attached to this memorandum is a copy of the "Receipt of Bid Packet" form and a copy of the Bid Packet for the Prairie Avenue Disposition Parcel (1313 Prairie Avenue). To submit a conforming bid, a bidder must offer the bid price and submit a project that meets the requirements of the bid specifications. The bid price is $189,000 and a copy of the bid specifications is listed on page 10 of the Bid Packet. Staff has worked with one party that is interested in the property but it is assumed that they will not be submitting a conforming bid. I do not anticipate any other bidders, conforming or non - conforming, for this property. What We Do Today Makes A Difference! Proposal Documents and Forms for Land Disposition City of South Bend Redevelopment Commission Prairie Avenue Disposition Parcel 1313 Prairie Avenue Airport Economic Development Area City of South Bend Stephen Luecke Mayor Jeff Gibney Director Community & Economic Development Donald Inks Director Department of Redevelopment Charles Leone Legal Counsel Redevelopment Commission Marcia Jones President David Varner Vice - President Nancy King Secretary Greg Downes Member Don Alford Member Bidding Expires on November 19, 2010 Index of Documents Proposal Documents 1. Instructions to Applicants 2 2. Offering Sheet 7 3. Plat of Survey and Legal Description 8 4. Disposition Property Map 9 5. Bid Specifications & Design Considerations 10 6. Legal Notice 11 7. Resolution Regarding Prevailing Wage Rates 12 Proposal Forms 1. Proposal 1 2. Statement of Qualifications and Financial Responsibility 3 3. Statement for Public Disclosure 7 4. Affidavit of Non - Collusion 1 9 Instructions to Applicants The South Bend Redevelopment Commission ( "Commission ") invites proposals for the purchase and development of certain real property described as the Prairie Avenue Disposition Parcel located at 1313 Prairie Avenue, within the Airport Economic Development Area, South Bend, Indiana. The Proposal Documents provide Applicants with essential information regarding the Disposition process and the Project Site. Each Applicant should read this information thoroughly before submitting a proposal to the Commission. The Proposal Forms are required as part of any proposal submitted for the purchase of Redevelopment owned land. All Forms must be complete. The Commission may reject any proposal submitted with incomplete or missing information. Evaluation Criteria The Commission may use the following criteria to guide its review and acceptance or denial of a proposal: The degree to which the Applicant's proposal meets the objectives of the Development Plan for the Development Area prepared by the Department of Redevelopment and approved by the Commission, the Area Plan Commission, and the Common Council. The size and character of the improvements proposed to be made by the Applicant on the real property; the Applicant's plans and ability to improve the real estate with reasonable promptness; whether the real property, when improved, will be sold or rented; the Applicant's proposed sale or rental prices; and any factors which will assure the Commission that the sale or lease, if made, will further the execution of the Airport Economic Development Plan and will best serve the interest of the community, from the standpoint of both human and economic welfare. The financial responsibility, qualifications, experience and ability of the Applicant to finance and complete the development. The proposal which will provide the Commission with the best possible development, based upon the price offered for the property and consistent with the preceding objectives. Any conflict among these criteria will be reconciled to the best interest of the Development Area and the City of South Bend, as determined by the Commission. 2 Disposition Process Bidding All bids for the purchase and development of certain property in the Airport Economic Development Area must be delivered to the Department of Redevelopment ( "Department "), located at: 1200 County -City Building 227 West Jefferson Boulevard South Bend, Indiana 46601 on or before 10:00 a.m. (EDT) on the 19th of November 2010. Immediately thereafter, all proposals will be opened and made public at a public meeting of the South Bend Redevelopment Commission, at 1308 County -City Building, 227 West Jefferson Boulevard, South Bend, Indiana 46601. Proposals with completed forms and without any missing information will be reviewed by the Commission according to the Evaluation Criteria as stated above. The Commission reserves the right to reject any bid and may make awards to the highest and best bidder. Notice of acceptance or rejection will be mailed to each of the bidders via US Mail to the address stated on the Proposal Forms. All offers are subject to the requirements of the Contract for Sale of Land. After the Bidding Period Once the bidding period has expired, proposals may be made to the Commission for the remaining property available, if any. All Applicants should familiarize him /herself with the Proposal Forms and any proposal submitted after the bidding period has expired shall be completed utilizing the Proposal Forms. Proposals after the termination of the bidding period are to be submitted to the Department for review and consideration. The Commission will review proposals based upon the Evaluation Criteria as stated above. The Commission reserves the right to reject any proposal. Notice of acceptance or rejection will be mailed to each of the Applicants via US Mail to the address as stated on the Proposal Forms. Proposals All proposals must be complete and include the information and documentation requested in the Proposal Forms. Proposals that are submitted with incomplete or missing information will not be accepted. Applicant must use the Proposal Forms as provided by the Department. 3 Proposal Forms The Proposal Forms must be complete before the Commission will review the proposal. The first and second pages of the Proposal Forms describe the Applicant's offer for the real property. Applicants shall fill in all applicable spaces and sign accordingly. Each Applicant shall submit the following as part of the Applicant's proposed offer: Narrative Description (Proposal Forms, page 1) A Narrative Description of the Applicant's proposed development project for the real property must be submitted as part of the proposal. The Narrative Description should note the exact nature, character and use of the proposed improvements. Maps, plans and drawings shall be included to clearly indicate the location, size, materials, style of structures, parking lots, and other improvements. All proposed improvements and uses must conform to the Bid Specifications and Design Considerations and the Airport Economic Development Area Development Plan. The maps, plans and drawings as submitted will be examined by the Commission to determine whether, in the Commission's sole opinion, the Applicant's proposal conforms to the Bid Specifications and the Airport Economic Development Plan. The Commission may reject any offer which does not conform to said Specifications, Guidelines and /or Plan. Proposed Site Reuse Plan (Proposal Forms, page 1) All Applicants must submit a site reuse plan for the real property on which the Applicant has made an offer. This site reuse plan should be included as Exhibit "A" of the proposal. If the Applicant's proposal is accepted, the Applicant will be required to formalize the site reuse plan with Commission Staff as part of the final documentation. Faithful Performance Guaranty (Proposal Forms, page 2) All proposals must be submitted with a Faithful Performance Guaranty in an amount not less than 10% of the total purchase price offered for the property. The Faithful Performance Guaranty will secure the execution of the Contract and the development of the proposed improvements. The Faithful Performance Guaranty may be in the form of a certified or cashier's check or other security as approved by the Department. No offer will be considered unless it is accompanied by the required guaranty. All checks should be made payable to the City of South Bend, Department of Community & Economic Development. el Statement of Qualifications and Financial Responsibility (Proposal Forms, pages 3 -6) The Commission shall have the right to make such investigations as it deems necessary to determine the ability of the Applicant to perform the obligations of his /her proposed offer. The Commission reserves the right to reject any proposed offer where the evidence or information does not satisfy the Commission that the Applicant is qualified to properly carry out the obligations of his /her /its proposed offer, or where the Applicant refuses to cooperate or assist the Commission in making such investigation. Statement for Public Disclosure (Proposal Forms, pages 7 -8) The Commission shall have the right to make such investigations as it deems necessary to determine the completeness of the Applicant's disclosure. The Commission reserves the right to reject any proposed offer where the available evidence or information does not satisfy the Commission that the Applicant has made a full disclosure, or where the Applicant refuses to cooperate and assist the Commission in making such investigation, or the Commission otherwise determines said Statement to be unsatisfactory. Affidavit of Non - Collusion (Proposal Forms, page 9) The form of Affidavit of Non - Collusion is included in Proposal Forms and Applicant must use the form provided. The Affidavit is to the effect that the Applicant has not colluded, conspired, connived, or agreed with any other Applicant or person, firm or corporation in regard to any offer submitted to the Commission. The failure of any Applicant to submit the Affidavit of Non - Collusion shall be cause for rejection of his /her /its offer. Except as otherwise herein noted, the Faithful Performance Guaranty of all unsuccessful Applicants will be returned as soon as practicable after notice of rejection. The Faithful Performance Guaranty will be refunded to the successful Applicant at such time that the Commission deems that Applicant has completed all improvements to the real property, as proposed, and the Commission has issued a Certificate of Completion evidencing same. Corrections Erasures or other changes to the Proposal Forms must be explained or noted over the signature of the Applicant. Withdrawal of Proposals Proposals submitted prior to the scheduled public opening of the bids may be withdrawn upon written request of the Applicant if such request is received by the Department not less than twenty -four (24) hours prior to said public opening. Unopened bids will be returned promptly. 1.7 Commission's Rights The Commission reserves the right to accept or reject any or all proposals and to waive informalities in any proposal. Execution of Contract Upon award of the bid by the Commission, the successful Applicant shall enter into a Contract for Sale of Land with the Commission for the purchase and development of said property within 30 days of notice of acceptance. The Contract for Sale of Land will provide for the conveyance of the property therein purchased by quit -claim deed, together with title insurance policy showing good and merchantable title, upon payment of the full purchase price. Additional Information For further information as to the disposition program of the South Bend Redevelopment Commission, interested parties should contact the following staff member: Bill Schalliol Economic Development Planner Division of Economic Development 1200 County -City Building 227 West Jefferson Boulevard South Bend, Indiana 46601 (574) 235 -5842 (Office Phone) (574) 235 -9021 (Office Fax) bschalIi south bend in.gov 0 Offering Sheet Parcel Size Minimum Offering proposed Re -Use ±6,432 SF Use or Commercial- Price Prairie Avenue Building $ 189,000.00 Light or General Industrial Disposition Parcel ±6,432 SF Use or Commercial- Industrial Use in accordance with the °Gl 1313 Prairie Avenue Site General Industrial District 18- 8021 - 0847.01 240'x 370' zoning designation. 18- 8021 - 0847.08 2.04 Acres Strong emphasis will be placed during the review process on compatibility with the goals and objectives of Ignition Park. 7 Plat of Survey and Legal Descriptions BOUNDARY LEGAL DESCRIPTION PRAIRIE AVENUE DISPOSITION PARCEL 1313 PRAIRIE AVENUE LEGAL DESCRIPTION PARCEL I: Part of the Northeast Quarter and also part of the Northwest Quarter of Section 14, Township 37 North, Range 2 East of the 2nd P.M., in the City of South Bend, in St. Joseph County, more particularly described as follows: Commencing at a point in the West line of Prairie Avenue 45.00 feet South by rectangular measurement from the South line of Garst Street in said City; thence South 28 114'42" West along the Westerly line of said Prairie Avenue a distance of 1035.84 feet to the point of beginning; thence continuing South 28 °14'42" West along the Westerly line of Prairie Avenue 120.00 feet; thence Northwesterly at right angles to the last described course 370.00 feet; thence North 28 014'42" East, parallel with the Westerly line of Prairie Avenue 120.00 feet; thence Southeasterly at right angles to the last described course 370.00 feet to the point of beginning. PARCEL II: Part of the Northeast Quarter and also part of the Northwest Quarter of Section 14, Township 37 North, Range 2 East of the 2nd P.M., in the City of South Bend, in St. Joseph County, more particularly described as follows: Commencing at a point in the West line of Prairie Avenue 45.00 feet South by rectangular measurement from the South line of Garst Street in said City; thence South 28 014'42" West along the Westerly line of said Prairie Avenue a distance of 1155.84 feet to the point of beginning; thence continuing South 23 014'42" West along the Westerly line of Prairie Avenue 120:00 feet; thence Northwesterly at right angles to the last described course 370.00 feet; thence North 28 014'42" East, parallel with the Westerly line of Prairie Avenue 120.00 feet; thence Southeasterly at right angles to the last described course 370.00 feet to the point of beginning. Disposition Property Map 1313 Prairie Avenue C , 7r' P \F, r % COTTER ST ti _ 4 I W J m W E �I ED LD o Bid Specifications & Design Considerations Sale of Redevelopment Owned Property Prairie Avenue Disposition Parcel 1313 Prairie Avenue Airport Economic Development Area All of the provisions of I.C. 36- 7 -14 -22 will apply to the bidding process. 2. All offers must meet the minimum price of $189,000.00. 3. The site purchase must include the entire ± 2.04 Acre parcel being bid and must include the adaptive reuse of the building. 4. The building and property are being offered in an "As Is" condition. 5. The required use for the Parcel is for Light or General Industrial Use or Commercial - Industrial Use in accordance with the "GI" General Industrial District zoning designation. Strong emphasis will be placed during the review process on compatibility with the goals and objectives of Ignition Park. 6. All proposals for the reuse of the disposition parcel must include a basic reuse plan for the existing building and site and a project timeline detailing aspects of the site redevelopment or site improvements. All proposals for the disposition parcel must conform to the existing zoning provisions set forth for "GI" General Industrail District as described in the South Bend Zoning Ordinance Title 21 of the City of South Bend Municipal Code. 7. Bidders are required to present their proposals at the November 19, 2010, Regular Meeting of the Redevelopment Commission. 8. All other provisions of the Airport Economic Development Area Development Plan must be met. 10 Legal Notice AIRPORT ECONOMIC DEVELOPMENT AREA Prairie Avenue Disposition Parcel 1313 Prairie Avenue South Bend, Indiana Notice is hereby given that the Redevelopment Commission of the City of South Bend, Indiana, will receive sealed offers for the purchase of certain property situated in the Airport Economic Development Area until 10:00 a.m. (EDT) on the 19th day of November 2010 in the Office of the Department of Redevelopment, 1200 County -City Building, 227 West Jefferson Boulevard, South Bend, Indiana, 46601. All offers will be publicly opened and read aloud at 10:00 a.m. on the 19th day of November 2010 at the Regular Meeting of the Redevelopment Commission to be held that date and time in Room 1308 County -City Building, 227 West Jefferson Boulevard, South Bend, IN 46601. Bid proposals for the purchase of the property offered will be considered. The property being offered is located 1313 Prairie Avenue in the Airport Economic Development Area, in South Bend, Indiana. Any proposal submitted must be for the entire parcel being offered. The required use for the Parcel is for Light or General Industrial Use or Commercial - Industrial Use in accordance with the "GI" General Industrial District zoning designation. Strong emphasis will be placed during the review process on compatibility with the goals and objectives of Ignition Park. A packet containing bid forms, the offering sheet and other pertinent information may be picked up at the Department of Community and Economic Development, 1200 County -City Building, 227 West Jefferson Boulevard, South Bend, IN 46601. The Commission reserves the right to reject any and all bids, and to make the award to the highest and best bidder. In determining the best bid, the Commission will take into consideration the following: 1. The size and character of the improvements proposed to be made by each bidder on the property 2. Each bidder's ability to improve the property with reasonable promptness 3. Each bidder's proposed purchase price 4. Any factors which will assure the Commission that the sale, if made, will further the carrying out of the Development Plan for the Airport Economic Development Area and will best serve the interest of the community from the standpoint of human and economic welfare 5. The ability of each bidder to finance the proposed improvements to the property with reasonable promptness The Commission further reserves the right to waive any formalities in bidding which are not mandatory requirements. To secure the execution of the disposition agreement, the purchase of the property and the redevelopment thereof in accordance with the agreement, the bidder must submit with the proposal a faithful performance guaranty, in the sum of ten percent (10 %) of the amount offered for the purchase of the property. The guaranty sum may be in the form of a certified check, a cashier's check, or surety bond, letter of credit from a bank or trust company as approved by the Redevelopment Commission, or by other sufficient security, but the form, substance and terms of the performance guaranty must be approved as satisfactory by the Redevelopment Commission. The performance guaranty, if by certified check, shall be deposited in any account of the Department of Redevelopment, City of South Bend, in a bank or trust company selected by the Redevelopment Commission. CITY OF SOUTH BEND, INDIANA DEPARTMENT OF REDEVELOPMENT Donald Inks, Director Publish Dates: October 22nd and October 29"', 2010 11 Resolution Regarding Prevailing Wage Rates R�UTIOM !M}, 65Z RESCL[TTIDN AEGMrNG PREMLIW, WP4E pATtS MUM. the South Bond AW @VQ i 0PM*n t Caiarr s s t On ( -Ca�s ss ien') s.+s established redevelcitwt ar"s within the City Of South Send and bas W4#rtaken aCt ritit>e within Uri# drtias: and ioiEXAB. an integral part Of Met 4Ctirity iwolves the Rate of and for private development: and WMEME. , the CanOission desires that push sale Of IAM and private deY'"Ment 3hOuld have t-40 MMI' uft positivr impact Possible on the reai- dents of the Souk bend COMMni:y. and W"ERUS , the Cafe• i s s I NIn has determined that the South (lend COMMOwi ty will bOnufit from naviag local Contractors constrtttting the private prtkj- Octs and W"9 paid in aecardantt with the pr slung wage ratol of St. .iasapis Cou"tY. MOW. THEURORf, dE V RESOLVED. that the Camission enmurogts a:! purcaastrs of land ac,4uired, cleared and sold by the Gpanission in re- d"1160"- t arts to "1 1601 COntreCtors and :OCal Manpower and pay vrevAiiing wage rates Adopted at the Rcgu:ar meeting Cf the South $tad PMdtvelcPi}etnt Commis- Sion. held on the 23rd day of Apra', . 1981, in the off jr of the kederetCO. rent C ee"Si0A, 400m 1 200. CCunty -City Building. 221 west .ierfvmon soulerard. South Band. tndla+li 46601. C'TY OF SWTH SEND. iMC1ANA DEPAR NEV' or REXV5L0P4ENT F. y Mt ,pen: A. Peter titian. ecretary ter, .r l��ur•{' � .r i z. - ��r_ :M . 12 Proposal Forms To: South Bend Redevelopment Commission 1200 County -City Building 227 West Jefferson Boulevard South Bend, Indiana 46601 Commissioners: The Undersigned having familiarized itself with the present conditions of the Project Site as hereinafter designated and legally described and with the Proposal Documents and Forms; and certifying its desire to participate in the development of the said property pursuant to Federal, State and Local ordinances and regulations, and the Development Plan as approved by the Redevelopment Commission; hereby offers and proposes to purchase or lease all or part of the Disposition Parcel identified in Exhibit "A" made part of this proposal. The Applicant's offer is described as follows: Project Area Disposition Parcel Number Total Acres Offer is for: ❑ Entire Parcel ❑ Part of Parcel Form of Contract: ❑ Purchase ❑ Lease Term Dollars $ Purchase Price Dollars $ Annual Lease Payment A Narrative Description of the proposed development on the Disposition Parcel identified in Exhibit "A ", describing the exact nature and character of the improvements proposed and their use; together with maps and plans sufficiently complete to indicate the general improvements to be made is attached and is to be considered a part of this proposal. (Maps and plans must be of sufficient scale to indicate clearly the location of the structures and other proposed improvements and should provide information on building elevations and materials.) The Proposal Forms as provided by the Department of Community & Economic Development/Division of Economic Development (Department) have been completed and are considered a part of this proposal. The Proposal Forms include: (1) a Statement of the Qualifications and Financial Responsibility; (2) a Statement for Public Disclosure, and; (3) a sworn Affidavit of Non - Collusion. It is the understanding of the Applicant that the Statement of the Qualifications and Financial Responsibility is confidential and to be used solely by the South Bend Redevelopment Commission and the Department. A Faithful Performance Guaranty in the sum of Dollars ($ ), an amount equal to at least 10% of the total amount offered for the real property described in Exhibit "A ", it being understood by the Applicant that the Faithful Performance Guaranty shall guarantee the Applicant's execution of and performance of the purchase or lease agreement. The Faithful Performance Guaranty will be refunded to the successful Applicant at such time the Commission deems that the improvements to the land, as proposed, have been completed and the Commission as evidenced by a Certificate of Completion issued by the Commission. The Faithful Performance Guaranty will be refunded in the event this offer is rejected. Acceptance or rejection of Applicant's proposal shall be made by depositing such notification in the US Mail addressed to the undersigned (Applicant) at the address set forth below. In submitting this offer to purchase or lease, it is understood that the right to reject such offer is reserved by the Commission. The undersigned further agrees to execute a contract for the purchase or lease of land for development in the form prepared by the Department within thirty (30) days after notification of acceptance of this offer and to develop and use the above identified parcel(s) of land in conformity with the Federal, State and Local ordinances and regulations; applicable Development Plan, and the Narrative Description and maps and plans as submitted herein, with amendments, if any, as approved by the Commission. Dated Respectfully submitted. ATTEST- (BY SECRETARY OF A Corporation) Address: Signature Name (type) Title Address: 0) Name of Individual or Corporation Signature Name (type) Title Statement of Qualifications and Financial Responsibility Applicant: Address: 1. Is the Applicant a subsidiary of or affiliated with any other corporation or corporations or any other firm or firms? ❑ Yes ❑ No If yes, list each corporation or firm by name and address, specify its relationship to the Applicant, and identify the officers and directors or trustees common to the Applicant and such other corporation or firm: 2. The financial condition of the Applicant, as of , is as reflected in the attached financial statement. Name and address of auditor or public accountant who performed the audit on which said financial statement is based: (NOTE: Attach to this statement a certif ed financial statement showing the assets and the liabilities, fully itemized in accordance with accepted accounting standards and based on a proper audit. If the date of the certified financial statement precedes the date of this submission by more than six months, also attach an interim balance sheet not more than 60 days old.) 3. If funds for development of the land are to be obtained from sources other than the Applicant's own funds, a statement of the Applicant's plan for financing the acquisition and development of the land: 4. Sources and amount of cash available to Applicant to meet equity requirements of the 3 proposed undertaking: a. In banks: Name and Address of Bank Amount b. By loans from affiliated or associated corporations or firms: Name and Address of Bank Amount C. By sale of readily salable assets: Description Market Value Mortgages or Liens Names and addresses of bank references: 6. Has the Applicant or (if any), the parent corporation, or any subsidiary or affiliated corporation of the Applicant or said parent corporation, or any of the Applicant's officers or principal members, shareholders or investors, or other interested parties (as listed in items 5, 6, and 7 of the Statement for Public Disclosure and referred to herein as principals of the Applicant) been adjudged bankrupt, either voluntary or involuntary, within the past 10 years? ❑ Yes ❑ No If yes, give date, place and under what name: 7. Has the Applicant or anyone referred to above as principals of the Applicant been indicted for or convicted of any felony within the past 10 years? ❑ Yes ❑ No If yes, give for each case (1) date, (2) charge, (3) place, (4) Court, (5) action taken. Attach any explanation deemed necessary. 8. Undertakings, comparable to the proposed development, which have been completed by the Applicant or any of the principals of the Applicant, including a brief description of each project and date of completion: 9. If the Applicant, or any principals of the Applicant, has ever been an employee, in a rd 10 supervisory capacity, for a construction contractor or builder on undertakings comparable to the proposed development, the name of such employee, name and address of employer, title, and brief description of work: If the Applicant or a parent corporation, a subsidiary, an affiliate, or a principal of the Applicant is to participate in the development of the land as a construction contractor or builder: a. Name and address of such contractor or builder: Has such contractor or builder within the last 10 years ever failed to qualify as a responsible bidder, refused to enter into a contract after an award has been made, or failed to complete a construction or development contract? ❑ Yes ❑ No If yes, explain: C. Total amount of construction or development work performed by such contractor or builder during the last three years: $ General description of such work: d. Construction contracts or developments now being performed by such contractor or builder: Identification of Date to be Contract or Development Location Amount Completed 11. Brief statement regarding equipment, experience, financial capacity, and other resources available to such contractor or builder for the performance of the work involved in the development of the land, specifying particularly the qualifications of the personnel, the nature of the equipment and the general experience of the contractor: 12. Does any member of the South Bend Redevelopment Commission or any officer or employee of the City of South Bend Department of Redevelopment have any direct or 5 indirect personal interest in the Applicant or the development of the land as proposed? ❑ Yes ❑ No If yes, explain: 13. Does any member of the governing body of the City of South Bend or any public official or employee of the City of South Bend have any direct or indirect personal interest in the applicant or the development of the land as proposed? If yes, explain: 14. Statements and other evidence of the Applicant's qualifications and financial responsibilities (other than the financial statement referred to above) are attached hereto and hereby made a part hereof as follows: Certification I (We), Certify that this Statement of Qualifications and Financial Responsibility and the attached evidence of the Applicant's qualifications and financial responsibility, including financial statements, are true and correct to the best of my (our) knowledge and belief. Name Signature Title Date Name Signature Title Date (If the Applicant is an individual, this statement should be signed by such individual; if a partnership, by one of the partners; if a corporation or other entity, by one of its chief officers having knowledge of the facts required by this statement.) on Statement for Public Disclosure Applicant: Address: Taxpayer ID#: Applicant proposes to enter into contract for the purchase or lease of land from the South Bend Redevelopment Commission. Said land is more accurately described in Exhibit «A» 2. Organizational Status of Applicant: ❑ An individual ❑ A corporation ❑ A not - for - profit corporation or charitable institution ❑ A partnership known as: ❑ A business association or a joint venture known as: ❑ A Federal, State or Local government or instrument thereof ❑ Other (explain): 3. Organized and operating under the laws of 4. Date of Organization: Names, addresses, and title of principal officers, investors, members or shareholders of Applicant, as follows: (attach additional sheets if necessary) a. CORPORATION: the officers, directors or trustees, and each stockholder owning more than 10% of any class stock b. NOT - FOR - PROFIT: the members who constitute the board of trustees or board of directors or similar governing body PARTNERSHIP: each partner, whether a general or limited partner, and the nature and percent of interest d. BUSINESS ASSOCIATION OR JOINT VENTURE: each participant and the nature and percent of interest 7 e. OTHER ENTITY: the officers, the members of the governing body, and each person having an interest of more than 10% Name & Address Title and nature and percent of interest 6. Names, addresses, and the nature and percent of interest of each person or entity (not named in Item 5) who has a beneficial interest in any of the shareholders or investors named in Item 5 which gives such person or entity more than a computed 10% interest in the Applicant (for example, more than 20% of the stock in a corporation which holds 50% of the stock of the Applicant; or more than 50% of the stock in a corporation which holds 20% of the stock of the Applicant). Name & Address Title and nature and percent of interest 7. Names of officers and directors, or trustees of any corporation or firm listed under Item 5 or Item 6 above. Name & Address Title and nature and percent of interest Certification I (We), Certify that this Statement for Public Disclosure is true and correct to the best of my (our) knowledge and belief. Name Signature Title Date Name Signature Title Date (If the Applicant is an individual, this statement should be signed by such individual; if a partnership, it should be signed by one of the partners; if a corporation or other entity, it should be signed by one of its chief officers having knowledge of the facts required by this statement.) Affidavit of Non - Collusion State of Indiana SS: County of St. Joseph The undersigned, being first fully sworn, deposes and says that: He /she is:❑ owner, ❑ partner, ❑ officer, ❑ representative, ❑ agent, of (applicant); 2. He /she is fully informed respecting the preparation and contents of the attached offer and of all pertinent circumstances respecting such offer; Such offer is genuine and not a collusive or sham offer; 4. Neither said Applicant nor any of its officers, partners, owner's agents, representatives, employees, or parties in interest, including this affiant, has in any way colluded, conspired, connived, or agreed directly or indirectly, with any other Applicant, firm or person to submit a collusive or sham offer in connection with the Contract for which the attached offer has been submitted or to refrain from making an offer in connection with such Contract, or has in any manner, directly or indirectly, sought by agreement or collusion or communication or conference with any other Applicant, firm or person to fix the price or prices in the attached offer, or .of any other Applicant, or to fix any overhead, profit, or cost element of the offering price of any other Applicant, or to secure through any collusion, conspiracy, connivance or unlawful agreement any advantage against the City of South Bend and /or its Department of Redevelopment and /or the South Bend Redevelopment Commission person interested in the proposed Contact; and The price or prices quoted in the attached offer are fair and proper and are not tainted by any collusion, conspiracy, connivance, or unlawful agreement on the part of the Applicant or any of its agents, representatives, owners, employees or parties in interest, including this affiant. Before me, the undersigned., a Notary Public, Non - Collusion on this (Seal) A resident of day of County, 0 Affiant Signature Title subscribed and swore to this Affidavit of Notary Public