HomeMy WebLinkAboutOpening of Bids - Vietnam Veterans Memorial Relocation Proj No 117-047A - Ziolkowski ConstructionBID/PROPOSAL
CITY OF SOUTH BEND
Project Name VIETNAM VETERANS MEMORIAL RELOCATION
Project No. 117-047-A
For Bids Due May 22, 2018 9:30 a.m. EST
RARF RID
Item
No.
Description,
Quantity
Unit
Unit Price
Totall Amount
Furnish all labor, services,
materials, insurance and
1
equipment for the removal and
1
Lump Sum
$ 281,000-00
relocation of the existing Vietnam
Veterans Memorial,
Total Amount of Quote
281,0,00.
ALTERNATE#11
Item
No.
Description
Quantity
Unit
Unit Price
Total Amount
Delete removal of existing
I
Lump Sum
$ <10,000.00>
concrete substrate.
Total Amount of Quote
$ < I opo.00>
UNIT PRICING
Item
No.
Unit Pricing
Unit
Add Price Per Unit
A
Granite Pavers -to match existing
SF
$ 225.00
B
Granite 1-1/2 Polished Veneer
SF
$ MOM
Slab -to match existing
C
Granite Curb-t'o match existing
SF
$ 275.00
Firm: Ziolkowski Construction, Inc.
Address: 4050 Ralph Jones Drive
City/State/Zip: South Bend, IN 46628 Telephone Number: (.574 ) 287-1811
Fax Number: ( 574 ) 234-0151
By
(Signature)
Bill Favors, President
Version 10/17/2017 Contractor's Bid for Public Works - 7
11 7-047-A Vietnam Veteran's Memorial Relocation
CITY OF SOUTH BEND, INDIANA
CONTRACTOR'S BID FOR PUBLIC WORK
Project Name VIETNAM VETERANS MEMORIAL RELOCATION
Project No. 117-047-A
For Bids Due May 22, 20118 9:30 a.m. EST
PART I
(Must be completed for all bids. Please type or print)
Date: M, !y 22,2018 Bidder (Firm): Ziolkowski ConstrUction, Inc.
Address: 4050 Ralph,jones Drive
City/State/Zip: South Bend, IN 46628 Telephone Number: �287-1811
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:
VIE,rNAm VETERANS MEMORIAL RELOCATION
the City of South Bend, Indiana, in accordance with plans and specifications prepared by:
ALLIANCE Architects
and dated 5/4/18 for the sum of (enter the Total Bid as shown on the Proposal)
Two Hundred Seve itv One Thousand Dollars ($ 271,000.00
(Enter .sum of Total Base Bidplus Alternates shown on, Proposal) (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.
By
(Signature)
Bill Favors, President
(Printed Name of Person Siigning)
The above bid is accepted this
Subject to the following conditions:
BOARD OF' PLIBLIC WORKS
Gary A. Gilot, President
Elizabeth A. Maradlik, Member
James A. Mueller, Member
ACCEPTANCE
day of
Suzanna M. Fritzberg, Member
Therese J. Dorau, Member
Attest: Linda M. Martin, Clerk
9#1
Version 10/17/2017 Contractor's Bid for Public Works - 2
11 7-047-A Vietnam Veteran's Memorial Relocation
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/her/its bid.
Attach additional pages for each section as needed.
Please see attached 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 Il 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, eto. and any other
information which you believe would enable the City of South Bend to consider your bid.)
As directed by the Architect/Construction Manager
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.
If Subcontractors will be used we will submit this information 24 hours after notification.
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.
If Subcontractors will be used we will submit this information 24 hours after notification.
4. Attach a listing of equipment you have available to use for the proposed project.
Whatever is required to complete the project properly and on time.
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. 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 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 10/1712017 Contractor's Bid for Public Works - 3
117-047-A Vietnam Veteran's Memorial Relocation
When the prospective Contractor is unable to certify to any of the statements below, it shall attach an explanation
to this Affidavit.
CONTRACTOR'S NON -COLLUSION AND NON -DEBARMENT AFFIDAVIT, CERTIFICATION
REGARDING INVESTMENT WITH IRAN, EMPLOYMENT ELIGIBILITY VERIFICATION, NOW
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 Indiana )
St ose ) SS:
h
T P COUNTY )
The undersigned Contractor, being duly sworn upon his/her/Its oath, affirms under the penalties of perjury
that:
1. Contractor has not, nor has any other member, representative, or agent of the firm,
company, corporation or partnership represented by him, entered into any combination, collusion
or agreement with any person relative to the price to be bid by anyone at such letting nor to prevent
any person from bidding nor to induce anyone to refrain 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 § 5-22-16.5-8, as amended from time -to -time, a Contractor
is engaged in investment activities in Iran if either:
i. Contractor, its successor or its affiliate, provides goods or services of twenty
million dollars ($20,000,000) or more in value in the energy sector of Iran; or
ii. Contractor, its successor or its affiliate, is a financial institution that extends
twenty million dollars ($20,000,000) or more in credit to another person for
forty-five (45) days or more, if that person will (i) use the credit to provides
goods and services in the energy sector in Iran; and (ii) at the time the
financial institution extends credit, is a person identified on list published by
the Indiana Department of Administration.
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
Contractor's newly hired employees through the E-Verify Program as defined by I.C. 22-5-1.7-3.
Version 10/17/2017 Contractor's Bid for Public Works - 4
117-047-A Vietnam Veteran's Memorial Relocation
Contractor's documentation of enrollment and participation in the E-Verify Program is included and
attached as part of this bidlquote; and
5. Contractor shall require his/her/its subcontractors performing work under this public
contract to certify that the subcontractors do not knowingly employ or contract with an unauthorized
alien, nor retain any employee or contract with a person that the subcontractor subsequently learns
is an unauthorized alien, and that the subcontractor has enrolled in and is participating in the E-
Verify Program. The Contractor agrees to maintain this certification throughout the term of the
contract with the City of South Bend, and understands that the City may terminate the contract for
default if the Contractor fails to cure a breach of this provision no later than thirty (30) days after
being notified by the City.
6. Persons, partnerships, corporations, associations, or joint venturers awarded a contract by
the City of South Bend through its agencies, boards, or commissions shall not discriminate against
any employee or applicant for employment in the performance of 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 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.
I, 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 (I.C. 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
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. I understand that violations hereunder may result in
forfeiture of contractual payments.
Version 10/17/2017 Contractor's Bid for Public Works - 5
117-047-A Vietnam Veteran's Memorial Relocation
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
Dated this 22nd day of May 2018
0
rm 100 0
—4
0.. SEAL a
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,PA/
IA
Subscribed and sworn to before me this
My Commission Expires March 1, 2020
Ziolkowski Construction, Iric.
Contractor/Bidder (Firm)
_e , - -All $ 1 C 4 le
S!gAatuire of Contractor/Bidder or Its Agent
Bill Favors, Presiderit
Printed Name and Title
22nd day of May —120 18
Notary Public 'Shannon Reidenbach
County of Residence St Joseph Co., Indiana
SHANNON REIDENBACH
Notary Niblic- Seal
State of Indiana
MY Commission Fxpires Mar 1, 2020
Version 10/17/2017 Contractors Bid for Public Works - 6
11 7-047,-A Vietnam Veteran's Memorial Relocation
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CITY OF SOUTH BEND
MINORITY AND WOMEN BUSINESS ENTERPRISE DIVERSITY
DEVELOPMENT PROGRAM
FORM MWBE-2.0
EVIDENCE OF GOOD FAITH EFFORTS
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 MBE/WBE 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:
Project Name:
Bidder:
117-047-A
VIETNAM VETERANS MEMORIAL RELOCATION
Ziolkowski Construction, Inc.
Date, May 22, 2018
Contact Person: -.GaEy Paston Telephone: 574-287-1811
Address: 1(150 Ralph,lones Drive
City: South Bend State: Indiana Zip: 46628
Email: gl:)aston@zbtiild.com
To determine whether a bidder has demonstrated good faith efforts to reach the MBE/WBE utilization
goals set forth in the Clty 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
MBE/WBE LIST(S): The bidder reviewed the City of South Bend's Minority and Women
X
Business Enterprise Diversity Development Program, which uses the IDOA approved Ilst of
Minority and Women Owned Business as found on their website (http://www.in.gov/idoa).
ACTION (ADVERTISE/CONTACT): In order for your bid to be deemed responsive, the City of
South Bend requires that all' perspective bidders complete no less than 2 of the following:
1. Attend all ii meetings scheduled by the City to inform MBE/WBEs 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 MBEAIVBEs 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 MBE/WBE 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
X
MBEIWBEs, including providing such MBE/WBE's with adequate information about the plans,
specifications and other requirements of the subcontract and did not reject MBE/WBEs as
itschard
unqualified without sound business reasons based on a thorough investigation of their
Bros.
capabilities,.
SMALL CONTRACT(S): The bidder selected specific porti:ons of the work to be performed by
MBE/WBEs in order to increase the likelihood of meeting the MBE/WBE goals (including
breaking down contracts into smaller units to facilitate MBE/WBE participation)
CONTRACT RECORDS: The bidder has maintained the following records for each MBE/WBE
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 MBE/WBE 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.
Version 10/17/2017 Contractor's Bid for Public Works - 9
11 7-047-A Vietnam Veteran's Memorla I Relocation
n
CITY OF SOUTHI BEND, INDIANA
CONTRACTOR'S BID FOR PUBLIC WORK
CHECKLIST FOR BIDDERS
Project Name, VIETNAM VETERANS MEMORIAL RELOCATION
Project No. 117-047-A
For Bids due May 22,201189:30a.m.EST
From time to time the South Bend Board of Public Works finds it necessary to reject a bid because
it does not comply with statutory requirements. in preparing your bid, please use the following
checklist in order to make sure, that your bid is done in the proper manner.
Proper bid security included. The bidder has the option of providing either a Certified Check
X or Bid Bond.
Bid prepared on the City of South Bend Contractor's Bid for Public Work Form, completely
X executed.
Contractor's Non -Collusion and Non -Debarment Affidavit, Certification Regarding Investments
with Iran,, Employment Eligibility Verification, Non -Discrimination, Commitment, and
X Certification of use of United States Steel Products or Foundry Products.
Proof of MBE/WBE Participation Goal Form [MWBE-1.0], if minimum participation goal is not
met, also provide Evidence of Good Faith Efforts Form [MWBE-2.0] and MBE/WBE Contacted
X Form [MWBE-2.1 ].
Acknowledge Receipt of I Addendum(s) included with the bid,
X 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,
x 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: Ziolkowski Construction, Inc Date: May 22, 2018
By Authorized Representative:
Signature:
Print Name & Title:
Version 10/17/2017
Bill Favors, President
Contractor's Bid for Public Works - 1
11 7-0,47-A Vietnam Veteran's Memorial Relocation
May- 18. 2018 9:54AM
Na, 2355 P. i
1316 Cot mry-CrrY SUILDINO
227 W. YEFFEP SON 13oULE VAM
Soum ft m, INDLkNA 46601-1830
PHONE 574/ 235-9251
PAX 574/ 235-9171
TDD 574/ 235-5561
CITY OF SOUTH BEND PETS BUTT101E4, MAYOR
]BOARD OF PUBLIC WORKS
Hate: Ma 18, 2018
To: All Planholders
From Linda M. Martin, Clerk, Board of Public Works
Subject Addendum Number: 1
Project Na1ne: Vletnam Veteran's Memorial Relocation
Project Number- 117-047-A
ACKNOWLEDGEMENT OF RIECEXPT OF ADDENDUM
Date Received: 5 -1 7 - I g
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 capon submittal,
THIS ADDENDUM MAY AFFECT YOUR BID,
Notes:
The attached documents are hereby added to the Specifications and Contract
Documents and become a part of herein.
Company.
'Zt`e t Ie-0 o s i'..,, cak-.-L,� -
Authorized Signature: �c�. fZ i acC ,
Date: 5 I� s I I
Version 4/2/2015
AIA Document A31 OTM -2010
CONTRACTOR:
(yVaine, legal status and adclress)
Ziolkowski Construction, Inc.
4050 Ralph Jones Drive,
South Bend, Indiana 46628
OWNER:
(Xame, legal status and address
)
City of South Bend, Board of Public Works
227 West Jefferson Boulevard
South Bend, Indiana 46601
BOND AMOUNT:
SURETY:
(A'anie, legal status and principal place
ofbitsiness)
Liberty Mutual Insurance Company
175 Berkeley Street
Boston, MA 02116
Five Percent of Accompanying IBrod (5% of Accompanying Bid)
PROJECT:
(Alame, location or address, and Project number, ij'ony)
Vietnam Veterans Memorial Relocation
Project INo, 1 17-047-A
This document has important legal
consequences. Consultation with
an attorney is encouraged with
respect to its completion or
modification.
Any singular reference to
Contractor, Surety, Owner or
other party shall be considered
plural where applicable,.
The Contractor and Surety are bound to the Owner in the aniourit set forth above, for the payment of which the
Contractor and Surety bind themselves, their heirs, executors, administrators, successors and assigns, jointly and
severally, as provided herein. The conditions of this Bond are such that if the Owneraccepts the bid of the Contractor
within the time specified in the bid documents, or within such time period as may be agreed to by the Owner and
Contractor, and the Contractor either (1) enters into a contract with the Owner in accordance with the terms of SLICII
bid, and gives such bond or bonds is may be specified in the bidding or Contract Documents, with a surety admitted
in the jurisdiction of the Project and otherwise acceptable to the Owner, for the faithful performance of such Contract
and for the prompt payment of labor and material furnished in the prosecution thereof, or (2) pays to the Owner the
differeence, not to exceed the amount of this Bond, between the amount specified in said bid and such larger amount
for which the Owner may in good faith contract with another party to peirforin die work covered by said bid, then this
obligation shall be D1111 and void, otherwise to remain in full force and effect, The Surety hereby waives any notice of
an agreement between the Owner and Contractor to extend the time in which the Owner may accept the bid. Waiver of
notice by the Surely shall not apply to any extension exceeding sixty (60) days in the aggregate beyond the time for
acceptance of bids specified in the bid documents, and the Owner and Contractor shall obtain the Surety's consent for
an extension beyond sixty (60) days.
If this Bond is issued in connection with a subcontractor's bid to a Contractor, the term Contractor in this Bond shall
be deemed to be Subcontractor and the term Owner shall be deemed to be Contractor.
When flus Bond has been furnished to comply with a statutory or other legal requirement in the location of the Project,
any provision in this Bond conflicting with said statutory or legal requirement shall be deemed deleted herefroin and
provisions conforming to such statutory or other legal requirement shall be deemed incorporated herein. When so
furnished, the intent is that this Bond shall be construed as a suitutory bond and not as a common law bond.
Signed and seated this 22nd day of May, 2018
.2,- , Rs- ji ra <,,L
(I'Vitness) Shannon Reidenbach
(iltitaess) John K./Jollus'on
Zio4kowski Construction, Inc.
(7 , NO Bill Favors, President
Libedy..Mutual Insurance Compar.1v
(V . . . . ...... —) (Seal)
Adrienne C. Stevenson, Attorney -in -Fact
State of IL
County of DDuPa¢de ss:
On May 22, 2018 , before me, a Notary Public in and for said County and State, residing
therein, duly commissioned and sworn, personally appeared
Adrienne C. Stevenson
known to me to be .attorney -in -Fact of Liberty Mutual Insurance Company
the corporation described in and that executed the within and foregoing instrument, and known to me to be the person who executed.
the said instrument in behalf of the said corporation, and he duly acknowledged to me that such corporation executed the same.
IN WITNESS WHEREOF, I have hereunto set my hand and affixed my official seal, the day and year stated in this certificate above.
My Commission Expires 61812020
C -Hernandez NotaryFublic
p C fi HERN'ANDCZ
Official IS
�Notary P,Wic - Slate of Illinois
My Coinrnisslon Expires Jura 8, 2020
This Power of Attorney limits the acts of those named herein, and they have no authority to bind the Company except in the manner and to the extent herein stated. Not
valid for mortgage, note, loan, letter of credit, bank deposit, currency rate, interest rate or residual value guarantees. To confirm the validity of this Power of Attorney call
610.832.8240 between 9:00 am and 4:30 pm EST on any business day.
Liberty Mutual Insurance Company
The Ohio Casualty Insurance Company
West American Insurance Company
POWER OF ATTORNEY
KNOWN ALL PERSONS BY THESE PRESENTS: That The Ohio Casualty Insurance Company is a corporation duly organized under the laws of the State of New Hampshire, that
Liberty Mutual Insurance Company is a corporation duly organized under the laws of the State of Massachusetts, and West American Insurance Company is a corporation duly
organized under the laws of the State of Indiana (herein collectively called the "Companies"), pursuant 10 and by authority herein set forth, does hereby name, constitute and appoint,
Adrienne C. Stevensoo
of the city of Chicago„ , state of Illinois its true and lawful attorney -in -fact, with full power and authority hereby conferred to sign, execute and
acknowledge the following surely bond:
Principal Name: Ziolkowski Construction Inc.
Obliges Name: City of South Bend Board of Public Works
Surety Bond Number: 001
IN WITNESS WHEREOF, this Power of Attorney has been subscribed by an aulhorized officer or official of the Companies and the corporate seals of the Companies have been affixed
thereto this 2711, day of February. 2017.
JP� trySU9q l i INSI) ANINSURR The Ohio Casualty Insurance Company
�LO{iPQ/�rF'r�,c` Liberty Mutual Insurance Company �
o C o o We�merican Insurance Company
x 1912 1919 1991 v
yi �'955 5 ra o1"2�yHAN1p`'���wF By: �.� ��/.✓r.
J AtHu o h'DInK David VCarey, Assistant Secretary
STATE OF PENNSYLVANIA ss
COUNTY OF MONTGOMERY
On this 271° day of February. 2017 before me personally appeared David M. Carey, who acknowledged himself to be the Assistant Secretary of , Liberty Mutual Insurance Company,
The Ohio Casualty Company, and West American Insurance Company, and that he, as such, being aulhorized so to do, execute the foregoing inslmment for the purposes therein
contained by signing on behalf of the corporations by himself as a duly authorized officer.
IN WITNESS WHEREOF, I have hereunto subscribed my name and affixed my notarial sear at King of Prussia, Pennsylvania, on the day and year first above written.
COMMONWEALTH OF PENNSYLVANIA
` Notarial Seal
s Teresa Pastella, Notary Public By.
s 3 Upper Marian iwp„ Montgomery County Teresa Pastella, otary Public
+ My Commission Expires March 28.2021
Member, Pennsylvania Association of Notaries
This Power of Attorney is made and executed pursuant to and by autharty of the fallowing By-laws and Authorizations of, The Ohio Casually Insurance Company, Liberty Mutual
Insurance Company, and West American insurance Company which resolutions are now in full force and effect reading as follows:
ARTICLE IV - OFFICERS - Section 12. Power of Attorney. Any officer or other official of the Corporation authorized for that purpose in writing by the Chairman or the President, and
subject 10 such limitation as the Chairman or the President may prescribe, shall appoint such aftomeys-in-fact, as may be necessary to act in behalf of the Corporation to make, execute,
seal, acknowledge and deliver as surety any and all undertakings, bonds, recognizances and other surely obligations. Such allamays-in-fact, subject to the limitations set forth in their
respective powers of attorney, shall have full power to bind the Corporation by their signature and execution of any such instruments and to attach thereto the seal of the Corporation.
When so executed, such instruments shad be as binding as if signed by the President and attested to by the Secretary. Any power or authority granted to any representative or attorney -
in -fact under the provisions of this article may be revoked at any time by the Board, the Chairman, the President or by the officer or officers granting such power or authority.
ARTICLE XIII - Execution of Contracts - SECTION 5. Surety Bonds and Undertakings. Any officer of the Company aulhorized for that purpose in wiling by the chairman or the
president, and subject to such limitations as the chairman or the president may prescribe, shall appoint such aftomeys-in-fact, as may be necessary 10 act in behalf of the Company to
make, execute, seal, acknowledge and deliver as surely any and all undertakings, bonds, recognizances and other surely obligations. Such attomeys-in•fact subject to (he limitations set
forth in their respective powers of allomey, shall have full power to bind the Company by their signature and execution of any such instruments and to attach (hereto the seal of the
Company. When so executed such instruments shall be as binding as if signed by the president and attested by the secretary.
Certificate of Designation - The President of the Company, acting pursuant to the Bylaws of the Company, aulhorizes David M. Carey, Assistant Secretary to appoint such attorneys -
in -fact as may be necessary to act on behalf of the Company to make, execute, seal, acknowledge and deliver as surety any and all undertakings, bonds, recognizances and other
surety obligations.
Authorization -- By unanimous consent of the Company's Board of Directors, the Company consents that facsimile or mechanically reproduced signature of any assistant secretary of
the Company, wherever appearing upon a certified copy of any power of attorney issued by the Company in connection with surety bonds, shall be valid and binding upon the Company
with the same force and effect as though manually affixed.
I, Renee C. Ltewellyn, the undersigned, Assistant Secretary, of The Ohio Casualty Insurance Company, Liberty Mutual Insurance Company, and West American Insurance Company
do hereby certify that the original power of attorney of which the foregoing is a full, true and correct copy of the Power of Attorney executed by said Companies, is in full force and effect
and has not been revoked.
IN TESTIMONY WHEREOF, I have hereunto set my hand and affixed the seals of said Companies this 22nd day of May 2018
JP�iNS0,9 JP�11INSUR,y �NSNSi/gtH
� ,onporl�y, ��5`�conaarrgf��nr �W�`�GOVPor�for�,o
1912 ° 1919 1991 By:
y ��9SSACHu5�2 W�ryykAtnvS�P��=' rNOInNP t� Renee C. Llewellyn, Assistant Secretary
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DIY 141ACIE
r PHONk 574/ 235-9251
13 16 COUNTY -CITY BUILDING
227 W, h,"FFERSON 130MINARD FAX 574/ 235-9171
TDD 574/ 235-5567
Soun i MND, I NDIANA 46601-1930 1865
Crry oi-,, Souri i BEND PETE Bul-TIGIEG, MAYOR
BOARD OFPUBLIC WORKS
Date: May 18,2018
To: All Planholders
From Linda M. Martin, Clerk, Board of Public Works
Subject Addendum Number: I
Project Name: Vietnam Veteran's Memorial Relocation
Project Number: 11 7-047-A
Date Received: 5' — 1 7 1 1 1?
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.
RM 111011311MIN
Notes:
The attached documents are hereby added to the Specifications and Contract
Documents and become a part of herein.
Company:
Authorized Signature: 2-�, -f-I
,5- � I ,-
Date: e) I I
Versioji 4/2/2015
0
SEA 1 ON I EXPERIENCE QUESTION NAIRE
1. What public works projects has your orgarizatlon completed for the period of one (`I) year prior to the
date of the current bid?
Contract Amount
Class of Work
Completion
Date
Name and Address of Owner
$16,473,549
General
01/2012,
IUSB Cancer Research Center
$12,274,292
General
01/2016
Lake Central High School
$16,920,600
General
08/2011
1 Kankakee Valley New Muddle School
$7,663,700
General
0212013
1 Mishawaka River Center Apartments
. What public works projects are now in process of construction by your organization?
GontractAmount
Glass of Work
Expected
Completion
Date
Name and Address of Owner
$27,366,910
General
05/2016
Purdue University North Central
$21,355,975
General
0612015
Armed Forces Reserve, Center
$4,824,179
General
08/2015
Mishawaka Central Park
$9,020,000
General
10/2016
outh Bend Airport New Arrivals Te
al
1 Have you ever failed to complete any work awarded to you? No If so, where and why?
4. I,fst -references from private firms for which you have performed work_
University of Notre Dame, Tony Polotto, LEED, AP, 200 Facilities Bldg., Noire Dame, IN 46556 574-631-4200
City of Mishawaka, Ken Prince, 600 East Third Street, Mishawaka, IN 574-258-1625
Fetters Construction Inc., Steven A. Fetters, 5417 County Rd 427, Auburn, Indiana 46706 260-927-8516
Memorial Hospital & Health System, Larry Lies, 615 N Michigan St., South Bend, IN 46601 574-647-1000
raa
a
Company ID Number: 486671
THE E-VERIFY PROGRAM FOR EMPLOYMENT VERIFICATION
MEMORANDUM OF UNDERSTANDING
ARTICLE 1
PURPOSE AND AUTHORITY
This Memorandum of Understanding (MOU) sets forth the points of agreement between the
Department of Homeland Security (DNS) and Zioikowski Construction Inc. (Employer)
regarding the Employer's participation in the Employment Eligibility Verification Program (E-
Verify). This MOU explains certain features of the E-Verify program and enumerates specific
responsibilities of DHS, the Social Security Administration (SSA), and the Employer. E-Verify is
a program that electronically confirms an employee's eligibility to work in the United States after
completion of the Employment Eligibility Verification Form (Form 1-9). For covered government
contractors, E-Verify is used to verify the employment eligibility of all newly hired employees and
all existing employees assigned to Federal contracts or to verify the entire workforce if the
contractor so chooses.
Authority for the E-Verify program is found in Title IV, Subtitle A, of the Illegal Immigration
Reform and Immigrant Responsibility Act of 1996 (IIRIRA), Pub. L. 104-208, 110 Stat. 3009, as
amended (8 U.S.C. § 1324a note). Authority for use of the E-Verify program by Federal
contractors and subcontractors covered by the terms of Subpart 22.18, "Employment Eligibility
Verification", of the Federal Acquisition Regulation (FAR) (hereinafter referred to in this MOU as
a "Federal contractor with the FAR E-Verify clause") to verify the employment eligibility of
certain employees working on Federal contracts is also found in Subpart 22.18 and in Executive
Order 12989, as amended.
ARTICLE II
FUNCTIONS TO DE PERFORMED
A. RESPONSIBILITIES OF SSA
1. SSA agrees to provide the Employer with available information that allows the Employer to
confirm the accuracy of Social Security Numbers provided by all employees verified under this
MOU and the employment authorization of U.S. citizens.
2. SSA agrees to provide to the Employer appropriate assistance with operational problems that
may arise during the Employer's participation in the E-Verify program. SSA agrees to provide
the Employer with names, titles, addresses, and telephone numbers of SSA representatives to
be contacted during the E-Verify process.
3. SSA agrees to safeguard the information provided by the Employer through the E-Verify
program procedures, and to limit access to such information, as is appropriate by law, to
individuals responsible for the verification of Social Security Numbers and for evaluation of the
E-Verify program or such other persons or entities who may be authorized by SSA as governed
Page 1 of 13 I E-Verify MOU for Employer I RexAsion Date 09/01/09 w mv.dhs.gcv1E—Verity
N
Company ID Number: 486671
i by .may. SECG
CY d�
S
V A y
To be accepted as a participant in E-Verify, you should only Sign theEmployer's Section
of the Signature page. if you have any questions, contact E-Verify at 888-464-4218.
Employer Ziolkowski Construction, Inc.
Bill Favors
Name (Please Type or Print)
Electronically Signed
Title
01/10/2012
Signature
Date
Department of Homeland Security -^ Verification Division
CIS Verification Division
Name (Please Type or Print)
Electronically Signed
itle
0111012012
Signature
Date
Information Required for the E-Verify Program
Information relating to your Company:
Company Name:
Zlolkowski Construction, Inc.
Company Facility Address:
4050 Ralph Jones Dr.
South Send, IN 46628
Company Alternate
Address:
County or Parish:
T JOSEPH
Employer Identification
Number:
351445992
Page 12 of 13 1 E-Verify MOU for Employer 1 Revision Date 09101/09 ww.d hs.gov1E-Verify
:.E-VerO1OfV llii�
Company ID Number: 486671
North American Industry
Classification Systems
Code:
236
Administrator:
Number of Employees:
100 to 499
Number of Sites Verified
far:
1
Are you verifying for more than 1 site? If yes, Tease provide the number of sites verified for
in each State:
a RgDL4,NA r site(s)
Information relating to the Program Administrator(s) for your Company on policy
questions or operational problems:
Name: .lames Keldsen
Telephone Number: (574) 287 -1811 ext. 368 Fax Number: (574) 344 - 5533
E-mail Address: jkeldsen(a zbuild.com
Page 13 0€13 l E-Verify NOU for Employer I Revision Date 09/01/09 Init!dw.dhs.gov1E-Ver1fy
6/12/2017
Welcome
James Keldsen
Company Information
Company Name
Ziolkowski Construction, Inc.
Company ID Number
486671
Doing Business As (l)BA) Name
DUNS Number
Physical location
Address t
4050 Ralph Jones Dr.
Address 2
-
city
South Bend
state
IN
Zip Code
46628
County
STJOSEPH
Mailing Address
j Address 7
? Address2
City
$fate
Zip Code
r Additional Information
Emptayer Identification Number
351445992
Total Number of Employees
100 to 499
ParentOrganizatlon
F j Administrator
Organization Designation
Employer Category
None of these categories apply
View / Edit
i NAICSCode
236 - CONSTRUCTION OF BUILDINGS
View ! Edit
Total Hiring Sites
htfps://F,-verify.uscis.gov/wehEmployerWizard.aspx
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