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Home My WebLink AboutOpening of Quotes - Charles Black Monument Sign - Burkhart Sign SystemsC oVT11 iJgip A, 01 U CITY OF SOUTH BEND, INDIANA CONTRACTOR'S QUOTE FOR PUBLIC WORK 1 1865 PROJECT NAME: Charles Black MqnMMppt Sign PROJECT NO. 1072-2018 (Must be completed for all quotes. Please type or print) Date: Zo Firm: Address: City/State/Zip: Telephone Number: Agent of Bidder (if Applicable): Pursuant to notices given, the undersigned offers to furnish iabor and/or material necessary to complete the public works project of: the City of South: Bond, Indiana, in accordance with plans and specifications prepared by: The I -ity of South Bend, Department of Public Works ,I Quote as shown on the Proposal) (s ly, �z;o J- I '(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 attac' ent. By ignalu re (Printed'Nam6 of Person Signing) The above quote is accepted this _ day of Subject to the following conditjops: BOARD OF PUBLIC WORKS Gary A. Gilot, President Elizabeth A. Maradik, Member James A. Mueller, Member Version 10/31/2017 20 Suizanna M. Fritzberg, Member Therese J. Dorau, Member Attest: Linda M. Martin, Clerk Page - 7 Public Works Quote 4# Is65 PROJECT NAME Charles Black Monument Sign PROJECT NO. 1072-2018 tr 0 a Item No. Description Total Amount 1 Fabrication and Installation of Monument Sign Per the specifications $ Firm Address: City/State/Zip: 1,7 Telephone Number: Fax Number: By (Signature) (Printed Name of Person Signing Version 10/31/2017 Page - 11 Public Works Quote 114ien the prospective Contradoi- is unable to cerlify to an), of the statements below, it shall attach an explanation to tHV Affidavit. 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 flor all quotes and bids. Please type or print) STATE OF //Z) SS: COUNTY The undersigned Contractor,, being duly sworn LIP011 his/her/its oath, affirins under the penalties of perjury that: I 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, COHLISion 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 pet -son in reference to such bidding. Contractor ftn'ther 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 ofsuch sale; and 2. Contractor certifies by snbrriission of this proposal that neither contractor nor any of its principals are presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded frorn participation in this transaction by any Federal department or agency; and 3. Contractor has not, nor has any SLICCeSsor to, not, 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-tinie, a Contractor is engaged in investment activities in Iran if either: i. Contractor, its successor or its affiliate, provides goods or set -vices of twenty million dollars ($20,000.000) or wore in value in the energy sector of Iran; or ii. Contractor, its successor 01' its affiliate, is a F1118116al itlStiftnjOrl 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 tirne 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 Nan unauthorized alien. Contractor agrees that he/she/it shall enroll in and verify the work eligibility statLIS of all of Versaon 10/31/2017 Page - 8 Pubtic Works Quote 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, not, 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, gentler 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 liaxrited to, priblic 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 WBEINIBE. A finding of a discriminatory practice by the City's MBEIWBE 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 (I.C. 5-16- 8-1). I hereby certify that I and all subcontractors employed by me for this project will use steel products or foundry products trade in the United States on this project if awarded. I understand I Version 10/31/2017 Page - 9 Public Works Quote have an affirmative duty to notify the City in my bid that my proposal does not include the use of steel products or foundry proCILICtS made in the United States. I understand it is my sole obligation and responsibility to provide as justification to the City., subject to review and approval, why the cost of United States made steel or fOLIndry 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 ifthe price of United States made steel Or foundry is Unreasonable. I Understand that violations hereunder may result in forfeiture of contractual payments. I hereby affil-111 under the penalties of pc�gtjry that the facts and information contained in the foregoi jig bid for public ic works are true and correct. I)ated this day of 201& Contractor/Bidder irm) Signature of ontractor/Bidder or its Agent P, in ed Name and Title rip �Iq sworn to bel'ore me this 2"4 day of a4l 20--�f M, '6111111ission Ex'[A rrLsem-- Notary Public� COUnLy of Residence Version 10/31/2017 Page - 10 Public Works Quote