HomeMy WebLinkAboutOpening of Bids - Great Lakes Capital Spec Building Project No 118-058 - Niblock Excavating IncCITY OF SOUTH BEND, INDIANA
CONTRACTOR'S BID FOR PUBLIC WORK 1865
11 8-0}58
September 26, 2018
PART I
(Must be completed for all bids. Please type or print)
Date: '9-25-18
Bidder (Firm): Niblock Excavating Inc.
Address: PO Box 211
City/State/Zip: Bristol. In 465QL Telephone Number: ( 574 848-4437
Agent of Bidder (if Applicable): nZa
Pursuant to notices given, the undersigned offers to furnish labor and/or material necessary to complete the
public works project of:
Great Lakes .Capital Spec Building, 5545 Chet Waggoner Court Paving
the City of South Bend, Indiana, in accordance with plans and specifications prepared by:
Abonmarche Consultants,, Inc.
and dated Sent 2018 for the sum of (enter the Total Bid as shown on the Proposal)
Five luiked six bmdLp-d fifty one Llars arri wantv c�: ($ w,figil -2,o
- (Enter --sum of Total Basp Rid shown on Pr000saq I (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 addenclums attached wiilli 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 shoVn on a separate attachment.
By
(Siginature)
Gary NXock. President
(Printed Name of Person Signing)
The above bid is accepted this
Subject to the following conditions:
Gary A. Gilot, President
Elizabeth A. Maradik, Member
day of
Suzanna M. Fritzberg, Member
Therese J. Dorau, Member
James A. Mueller, Member Attest: Linda M. Martin, Clerk
II' E
Version 7/20/2018 Contractor's Bid for Public Works - 2
Contractor's Bid for Public Work - City of South Bend September 2018
Project No. 118-058
race
E31D/PROPOSAL
CITY OF SOUTH BEND
Project Name: Great Lanes Capital SpeG Building, 5645 Chet Waggoner Court Paving
Prolect Number: 118-058
For Bids Due: September 26, 2018
Contractor Name: Niblock, Excavating Inc.
.11
Item
No.
Description
Quantity
Unit
'Unit PrIce
Total Amount
1.
Construction Engineering
1
LS
50W.CO
50W.(:X)
2.
Mobilization/Demobilization
1
LS
am.00
M.00
1
Fine Grading
15,110
SYD
0.85
12843.50
4,
B Borrow (Undistributed)
100
CYD
10.00
low. 00
5.
Compacted Aggregate, No. 53
5,286
TON
20.,W
105711. CO
6,
7.
HMA Surface, 9.5mm, Type 8 * VolUntaq AlterMLe
HMA Intermediate, 19.5mm, Type B
1,310
450
TON
TON
1()9. W
75.25
14-2790,00
33862.50
S.
HMA Base, 25.Omm, Type B
2,420
TON
70.W
169400.W
9.
10.
Concrete Curb, 6"
Adjust Casting to Grade
578
1
LFT
EA
24 - 5)
175.00
14.161.00
175100'
11,
12,
4" Solid White Line, Patnt
4" Solid, Blue Line, Paint
1,690
222
LFT
LFT
o.35
0.35
591.50
77.20
13.
ADA Symbol of Accessibility, Paint
2
LFT
25.00
50.00
14.
Material Testing
1
LS
6 .11)
60MOD
"r o repla--e Item 6 with a. -Stard,3xd.e,,B Srface rad-L-rllm Ig SB
Total Amount of Base Bid (ItemsI trough 14) SPE]CME�d h1`1IXWL, 1 $T% 651.20
Noluntary Alternate: DFRU $25.00 ps� ton X 1310 = $32�750.00 ions
Bidder (Firm): Niblock Excavatina Inc.
Address: PO Box 211
City/State/bp: .,Bri tol 1D 46 07 Telephone Number: (574) 848-4437
By
(Signature)
Gar y Niblock, President
(Printed Name of Person Submitting)
Version 7/2012018 Contractor's Bid For Public Works-7
When the prospective Contractor is unable to certify to ai{v 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, 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 Indiana )
) SS:
Elkhart; 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 § 5-22-16.5-5, as amended from time -to -tithe, 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.
Version 7/20/2018 Contractor's Sid for Public Works - 4
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 lie/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. Contractor's
documentation of enrollment and participation in the E-Verify Program is included and attached as part of
this bid/quote; and
5. Contractor shall require his/her/its subcontractors performing work under this public contract to
certify that the subcontractors do not knowingly employ or contract with an unauthorized alien, nor retain
any employee or contract with a person that the subcontractor subsequently learns is an unauthorized alien,
and that the subcontractor has enrolled in and is participating in the E-Verify Program. The Contractor agrees
to maintain this certification throughout the term of the contract with the City of South Bend, and understands
that the City may terminate the contract for default if the Contractor fails to cure a breach of this provision
no later than thirty (30) days after being notified by the City.
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 MBE/WBE; however, it may not unlawfully discriminate against said WBE/MBE. A finding of a
discriminatory practice by the City's MBE/WBE Utilization Board shall prohibit that person or entity from
being awarded a City contract for a period of one (1) year from the date of such determination, and such
determination may also be grounds for terminating the contact for which the discriminatory practice or
noncompliance pertains.
7. The undersigned contractor agrees that the following nondiscrimination commitment shall be made
a part of any contract which it may henceforth enter into with the City of South Bend, Indiana or any of its
agencies, boards or commissions.
Contractor agrees not to discriminate against or intimidate any employee or applicant for employment in the
performance of this contract with privileges of employment, or any matter directly or indirectly related to
employment, because of race, religion, color, sex, gender expression, gender identity, sexual orientation,
handicap, national origin or ancestry. Breach of this provision may be regarded as material breach of
contract.
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). I 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
Version 7/20/2018 Contractor's Bid for Public Works - 5
may result in forfeiture of contractual payments.
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 25th day of. Sept , 2018
Niblock Excavatin.2 Inc.
Contractor/Bidder (Firm)
tu,,,Z,�Az� t-�
Signature ontractor/Bidder or Its Agent
Gary Niblock, President
Printed Name and Title
Subscribed and sworn to before me this 2 St-h day of Se-Dtember, 2018
My Commission Expires 9-30-18
Public Juli
County of Residence
Version 7/20/2018 Contractor's Bid for Public Works - 6
Bid on
CONTRACTOR:
(Name, legal slatus and address)
Niblock Excavating Inc,
PO Box 211
Bristol IN
OWNER:
(Name. legal slaws andad*ays)
City of South Bend
227 W. Jefferson Blvd'.
South Bend IN
Document A31OTM - 2010
Conforms with Thee American Institute of Architects AIA Document 310
SURETY:
(Name, legalsialas andpHliciValplace aflifuhicxv)
Liberty Mutual Insurance Company
175 Berkeley Street
Boston MA 02116
46507 Mailing Address for Notices
Five Percent of Amount Bid
This document has Important
legal consequences, Consultation
with an attorney is encouraged
with respect to Its completion or
modillcation,
Any singular reference to
Contractor, Surety, Owner or
other party shall be considered
plural where applicable.
PROJECT:
(,Vanta, locallon or address. and Project number, Ifany)
Great Lake Capital Spec Building, 5545 Chet Waggoner Court Paving - Project No. 118-058
The Contractor and. Surety are bound to flicOwner in the amount set forth above, for the payment of which llic Contractor and Surety bind
thenisoh,os, their licirs, executors, administrators,, successors and assigns. jointly severally, as provided licrein.The conditionsofillis
Bond are such that if llic Owner accepts the bid of the Contractor %vilifln, tile time specified in the bid documents, or widiin such time period
as may be agreed to by the Owner and Contractor, and the Contractor either (1) entors inlo, a contract with lite Owner in accordance with
the terms of such bid, and gives such bond or bonds as may be specified in the bidding or Contract Documents, with a surety admitted in
the Jurisdiction of the Project and olbeoviso acceptable to the Qwiior, for the faithful performance of such Contract and for the prompt
payment of labor and material Aimislied in (lie prosecution thereat; or (2) pays to the Owner the ditTerence, not to exceed the amount of
this Bond, between, the aniount specified in said bid and such larger amount for which Ilic Owner may ill good faith contract with another
party to pertlinn the ivorL, covered by raid bid, tilen this ohligutjon shall be 111111 and void, ollicirwiso (4) re lain in 111111 Im"Ce Ulld 011CUL The
Surety hereby waives any notice oaf an agreement between the Owner and, Contractor to extend [lie (itne in which the Owirer may accept (lie
bid, Nkluivorol'ilotice by the Surety shall nol apply to any extension exceeding sixty (60) days in tile aggregate beyond the litne 0ir
ucceplance ol'bids specilied in lilt: bid documents.. and the Owner and Contractor shall obtain the Surety's consent kir all extension beyond
sixty (60) days,
If this Bond is issued in connection wills a subcontractor's bid to a Contractor, the tortil. Contractor in this Bond shall be docilled to be
Subcontractor and the term Owner shall be deemed to be Contractor.
When this Bond lias been famished to coniply with a statutory orollier legal requirement in the location ol'(he Project, any provisioo in
this flood contlicting %villisaid statutory or legal requirement shall he deemed deleted herWroni and provision,, coil 1110niiing, to such
statutory or other legal requirement sliall be deemed' incorporated herein. When so furnished, (lie intent is that lhi% Dond shall be construed
as a slatuton, bond and not to; a common law bond,
Signed and scaled this 25th day of September, 2018,
Niblock Excavating Inc.
(Principal) (Seal)
13y: zx� 1!�--
(F1,10) Gar 'Ni stack, President
y
Liberty Mutual Insurance Company
(, val)
By��
(��)'Jainice Stickles Attorney--F-Fkt
S-00541AS 8110
THIS POWER OF ATTORNEY IS NOT VALID UNLESS IT IS PRINTED ON RED BACKGROUND,
This Power of Attorney breads the acts of those named have Miry authority to bind the Company except in il rinanneranal to the extent lierern stated.
c(3roijoqjEI B+) 7851,155
Liberty MLIILIaI III Company
The Ohio, Casually Insl Company WeAil:Amerieari, 41SUraricfi, Compony
MIUMAR10-II&INIM111m,
KI ALL PER8ONS BY THFSI PRFS-EMT",, II The Olno Casually 111sulancp Company is to coillooiation duly organized im(ler the Ovis of the SIMP of New Haolpsinne, that
Libody Muhial losurarico Company is 1 e"orpefation duly ore armed under the im of tho Slitir" of Massm"Ibusetts, all(J vVest American Insurance Company is a corporatior duly
organized (oldw I lam of Itie "tale of Indiana (herein ("OlifeGlively vallsd Ilie, "Companies), pursuant to and by aillhonify heiRin Set '0111, does hereby Wire, (;OaSNUta and appoint,
Janilce Sticklosi Ki I.. Hg..rri L Kidq-0, y far!
all of the cityof-Caledonia, __51aleof I each Individually if there be more that) one liarned ts troo And lawful altorney-in-fact to inalke, ii seal, aGknowledge,
and deliver, for and on its befialf as sijra,.ty and as its acir And deed, any and aII till Jet lakinqs' Imodo, recognizances and other Su'oy dalalifgaalioras in pursilance of lhe'9e presents and shall)
he as their o
bindirc.1 6 osfod by the ociulnry ol lie Conipardej in, wri proper persons, upon LM Conipanios n� it they have bean duly sIgnell by [lie Or sid0nita rid all
IN WI1 NE88 MINCOF, this Power of Attorney har been Subscribed by art authorized officpir or nfridat of die, cofnpailip_q and 1110 corponite seals of tire CornpanioI beau affixed
thereto INS 31SI day of --J-L-)-1y-' 20 17
7,
The ONO Casualty InWrillWe Company
Liberty Multual Insurance Compary
'I
PIN]
Insurance Coml
By:
STAFF OF PENNSYLVANIA
COUNTY OF NION I"GOMERY
On IlliS 3 1 st day,o' July_ before me pemmally appeared David M, Carey, who acknowledged himself to lee the, Ass:stanl Secretary of Libeily Minual Insorance
compairq, The Ohio C,)qlolty Company and Walt Amnficm Insurance Company, and that hart, iits sect), being authoii so to do, qmmile the forngoing instrument for ilia porpD.SsS
lh,wioj conlaiaoirf by signing on behalf of lhe mipuralions by himself as a dully authorized officpr.
IN VJf'NES.�r WHE'REOF I havp hoieuilfo subscribed my name and ',iffixad my notarial seal at King of Flrmsa Pennsylvania on the day and year lir"A above Written.
COMMONWEALTH OF PENNSYLVANIA
f
By.
Teresa Pastalla, Nojjry Prjhji(;
1'0 .1
I hiis Pm,4ei of Al is made, and exockiled piusuii�f 1 -0- and by authmily of trip follmloo Hy -laws and Aijilonrizations of Tho Ohio Camalty Inmitance Company I.Ilbery ld(jloai
losurannp. Cowpary, rand *P.sl American losMAWc Company villich toclulions are now in full fame, anti a4fool reading as follovi's:
ARTICLE IV - OFFICERS Soctiwn Q Power oaf Allorney. thpiChwirriian orlhe President, andsubil%Ii
to such tilintalion i's the Charlatan or Ille, pre.gidpril may pAescdbp, shall 3I)PO4A 3LICb attornoys411-fact, as may be rrecesaty to act in behalf olfflee Corliftlaball to alike, exemle, seal,
ackirmviodge And deliver a,"' "urely Any and ali rmdertakingS, b0idS, rnC0goi7,,1rXeq and other surely oblioalioinb. SUCh '.Albjw,'t to Uie limitations sotfinlh in tiieirIespectrve
ji of avorney, Ili4 have full povvLir to I Hie, CIirporaliari by their signature and execution of any such insifurnenis Awl to attach thereto the seal of the Colporallion, When so
eXeCkiled, sLICII inStlLifflOrl", Shalf he as binding As if signed by tire, President and afesled to by Ifie Secretary. Any power orauthority granted toany ropromilative or aftorney-m fact ondar
the provistons of this ii-We may be revoked At any lime by the Board, the CKatonan, the PrPsAcrit or by Ifle officer or officers granting such power Or raufhanty.
ARTICLE XIII - Execilion of ",onlracts - SECTION 5. SLIFOly 30MIS and JlidoNtakjnqs. Any officer of tire Conipany authorized for that purpose in miling by I chairman or the prosiderA,
and Subject to Such liiolltaliolls as the cha,rnlifl or fire president nmy pmcrilhQ, shall IppohA �sucti as may be necessary io act In bejIalf of the conqually to Ini4e, execute,
seal, ackno,,,;Ipdq� oird delimr as surety any and all underlakim s: beards rem nizir.)nc6s and olhor surufy otirgairons SLICh alloinqs ri-fact subjefA to Ore li6fations sol fool) in their
respective powers of attorney, simil have full, power to bind iho Company by their signalure Lind execution of arty such instruments And to al Iferelothe seal of the Company. Men so
Merited such instruments shall be as I as it signed by the president and atloMed by the secretary.
Certificate, of Dpsignatioil - The President cif the Company. Acting Pursuant to itre Bylaws of Illu cclni authorizes David M, Carey, Assistant Secretary 1) appoint such altornoys-in-
fact as may he necessary to aci oil behalf of the Company to make execute, seat, acknooliedge and deliver' As surely any and M undertakings, Lords, re(m9nizalices and other surety
obligations
Authorization -- By unammous r4onseni, oI file colopally"q Baird oll Diiii fhp Conill causcrils that facsimile or reechanivally feirroduced sk goalure of any a,,,sislonl s crcfary of Ihe
ominjuarly, viberever appealing (Iftion, a certified copy of ally power of altiorney ismied by the Company in connection willb ,mi bonds, shall tie valid And binding upon the Company w%Nth
the saiiiia (I and r4lact as, Ihough rnani affixed
I Renee C J, lewetlyn, tiro ondersigned. Assistant 5ucrel Trip Ohio Casually Inslivarim Company, Liberty NILItlial Insurance ("nminany, and West American Insurnm* Company (In
homeby certify heat the ork inal power of allorney of whidi the lafegoinq is a I ("m and roved copy of ffie Power ofAUo rap 'y oxocrited by sakl Companies, is in for lorce and affect and
has mot been revoked.
ay of
IN rcSTIMONY WHEREOF, ' frave herptlril[D set ray hand 'and affixed the spals of sdid Comfoarlies this COO ,, . . . . ....... 20_./
... . ..... . . . . .... . .
�V
Ry:
,mve C Lkh, ('Creluty R
153 of 250
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CHECKLIST FOR BIDDERS
Project Name Great Lakes Capital Spec Building, 6545 Chet Waggoner Court Paving
Project No. 1118-058
For Bids Due September 25, 2018
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 iincluded. The bidder has the option of providing either a Certified Check
it/ or Bid Bond.
Bid prepared on the City of South Bend Contractor's Bid! for Public Work Form, completely
executed,
Contractor's Non -Collusion and Non -Debarment Affidavit, Certification Regarding Investments
with Iran, Employment Eligibility Verification, Non -Discrimination Commitment, and
Certification of use of United States Steel Products or Foundry Products.
Proof of MBE/WBE Participation Goall Form [MWBE-1.0]. If minimum participation goal is not
met, also provide Evidence of Good Faith Efforts Form [MWBE-2.0] and MBEMBE Contacted
Form [MWBE-2.1].
.11 Acknowledge Receipt of '0 Addendum(s) included with the bid,
W, All requiired additional information is included with the bid.
Proposal statements and other affidavits WI signed by the proper party with name either
printed or typed underneath signature.
W, 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: Niblock Excavating Inc. Date: 9-25-18
By Authorized' Representative:
Signature: A LZ2
Print Name & Title: Gary Niblogk, President
Version 7/2 0/2018 Contractor's Bid for Public Works - 1
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.
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 II 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,
etc. and any other information which you believe would enable the City of South Bend to
consider your bid.)
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.
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.
4. Attach a listing of equipment you have available to use for the proposed project.
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.
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 7/20/2018 Contractor's Bid for Public Works - 3
CITY OF SOUTH BEND Ilk "o
MINORITY AND WOMEN BUSINESS ENTERPRISE DIVERSITY 'IL,
DEVELOPMENT PROGRAM k ,
FORM MWBE-1.0
MBE/YVBE PARTICIPATION
This completed form should be supplied with Bids that pertain to City of South Bend Public Works Projects involving MIBE/MBE participation.
It Is the bidder's sole responsibility to verify whether any listed minority orwoman business meets the qualifications of a Minority orWomen's
owned business.
Project Number:
Bidder:
1118-068
Project Name: Great Lakes Capital Spec Building, 6545 Chet Waggoner Court Paving
ib1-ock---ExQaSMting_Inc Total Bid Amount:
MBEMBE Goal:
Pageof
Name & Address of MBENVBE
Primary Contact Person
INameffelephone)
Scope of Work to be Performed
(Attach scope/schedute if you need additional space)
Dollar Amount of
MBEMBE Component
Percentage
of Total
BidJPro22 at
To be deter r
dned
Submitted by: President W, Gary Niblock, Pr September 25, 2018
Print Name Signature Date
Version 7/20/2018 Contractor's Bid for Publ'c Works - 8
001 F I
CITY OF SOUTH BEND
MINORITY AND WOMEN BUSINESS ENTERPRISE DIVERSITY I 1�I'
MUN
DEVELOPMENT PROGRAM
FORM MWBE-2.0
EVIDENCE OF GOOD FAITH EFFORTS Per
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 MBEIWBE 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: 118-058 Date: Sept 25, 901k
Project Name; Great Lakes Capital Spec Building, 5545 Chet Waggoner Court Paving
Bidder: Niblock Excavating Im .. . ................ ..........
Contact Person: Chad Niblock, General Manager Telephone: 574-848-4437
Address: PO Box 211
City: Bristol State: Indi-ana Zip
Email: — cniblockOniblockexc.com
To determine whether a bidder has demonstrated good faith efforts to reach the MBENVBE utilization goals set
forth in the City of South Bend Public Works Project Specifications, the City and its agencies, boards, or
commissions, REQUIRE AILL of the following Good Faith Efforts as listed in, the table below*:
EVIDENCE OF GOOD FAITH EFFORTS
MBEIWBE LIST(S): The bidder reviewed the City of South Bend's Minority and Women Business
Enterprise Diversity Development Program, which uses the IIDOA approved list of Minority and Women
Owned Business as found on their website (hftp:Hwww,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 pre -bid meetings scheduled by the City to inform MBENVBEs of contracting and
subcontracting opportunities.
2. Advertise in general circulation and/or trade association publications concerning subcontracting
opportunities, and allow MBENVBEs reasonable time to respond,.
3. Perform any and all necessary steps to provide written notice in a manner reasonably calculated
to inform MBENVBEs 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 MBENVBE 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 MBENVBEs,
including providing such MBENVBE's with adequate information about the plans, specifications and other
requirements of the subcontract and did' not reject MBENVBEs as unqualified without sound business
reasons based on a thorough investigation of their capabilities.
SMALL CONTRACT(S): The bidder selected specific portions of the work to be performed by
MBENVBEs in order to increase the likelihood of meeting the MBENVBE goals (including breaking down
contracts into smaller units to facilitate MBE/WBE participation)
CONTRACT RECORDS: The bidder has maintained the following records for each MBEANBE 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 MBEIWBE 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. The City of
South Bend reserves the right to request additional information.
Version 7/20/2018 Contractor's Bid for Public Works - 9
CITY OF SOUTH BEND
MINORITY AND WOMEN BUSINESS ENTERPRISE DIVERSITY
01 IN 11
I W71
DEVELOPMENT PROGRAM
FORM MWBE-2.11
MBEIWBE CONTACTED 1865
Thiscompleted form should be supplied with Bids that pertain to City of South Bend Public Works Project's
requiring contacted MBEIWBE to obtain Good Faith Efforts. 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.
PAGE 1 OF A 2
Project Number: 118-068 MBE/WBE Participation, Goal
Project Name: Great Lakes Capital Spec Building, 5545 Chet Waggoner Court Paving
Bidder: N block ExcavatinsZ Inc-,
By: A Gary Niblock, President 9-25-18 �.
(Signature ,)oe- // " ' (Title) (Date)
MBE/WBE Firm V & R Truckin
Owner or Contact at MBEANBE Firm Veda Godette
Telephone: 574-234-1268 Fax: 574-234-0748 Email rfightingirish@aol.com
TYPE OF WORK SOLICITED FOR THIS PROJECT:
Trucking
RESULTS OF CONTACT WITH THE MBE/WBE FIRM:
fax sent with no reply
MBE/WBE Firm Traffic Control Specialists
Owner or Contact at MBEMBE Firm —Tracey Triska/Jon
Telephone: 574-772-7001 Fax: Email: Jon@tcsspeciali,sts.net
TYPE OF WORK SOLfCITED FOR THIS PROJECT:
striping
RESULTS OF CONTACT WITH THE MBEMBE FIRM:
email with no reply
Version 7/20/2018 Contractor's Bid for Public Works - 10
CITY OF SOUTH BEND
MINORITY AND WOMEN BUSINESS ENTERPRISE DIVERSITY ti
DEVELOPMENT PROGRAM
FORM MWBE-2.1 z..;.
MBEIWBE CONTACTED ryes
This completed form should be supplied with Bids that pertain to City of South Bend Public Works Projects
requiring contacted MBEIWBE to obtain Good Faith Efforts. 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.
PAGES OFF_
Project Number:
118-058
MBEIWBE Participation Goal
Project Name: Great Lakes Capital Spec Building, 6545 Chet Waggoner Court Paving
Bidder: Ni_hl_nck Excavating Inc:.
By: Gary Niblock President 9-25-18
{Signature (Title) (Date)
MBEIWBE Firm Journev Truckin
Owner or Contact at MBEIWBE Firm Lisa Shively/Trent Shivel
Telephone: 260-755-5825 Fax: Email:
TYPE OF WORK SOLICITED FOR THIS PROJECT:
trucking
RESULTS OF CONTACT WITH THE MBEIWBE FIRM:
MBE/WBE Firm
Owner or Contact at MBEANBE Firm
Telephone: Fax Email:
TYPE OF WORK SOLICITED FOR THIS PROJECT:
RESULTS OF CONTACT WITH THE MBEIWBE FIRM:
Version 7/20/2018 Contractor's Bid for Public Works -10
CITY OF SOUTH BEND, INDIANA
CONTRACTOR'S BID FOR PUBLIC WORK
RESPONSIBLE BIDDER CHECKLIST
Project Name Great Lakes Capital Spec Building, 5545 Chet Waggoner Court Paving
Project No. 118-068
For Bids Due September 26, 2018
Contractor Name: Ni hl ack Excavating Inc,
The City seeks to enhance its ability to identify responsive and responsible bidders on all City public works
projects by institution of comprehensive submission requirements in compliance with State law. Quality
workmanship, efficient operation, safety, and timely completion of projects requires that all bidders meet
certain minimum requirements to be responsive and responsible bidders.
THIS FORM MUST BE SUBMITTED WITH YOUR BID.
INSTRUCTIONS:
If you are a pre -qualified bidder, complete Section I only.
If you are not a pre -qualified bidder, complete Section 11 only.
Section II acts as an application for pre -qualification. Submission of Section 11 will allow the bidder to be
considered for pre -qualification for bids with the City of South Bend Department of Public Works. Pre -
qualified bidders will then be exempt from a portion of the submission requirements outlined in Section 6-
63 of The Responsible Bidding Ordinance No. 10694-18 (hereinafter, "Responsible Bidding Ordinance")
for a period of twelve (12) months.
Thereafter, contractors who are pre -qualified must submit a complete application for continuation of "pre -
qualified" standing, on a form provided by the City ("Responsible Bidder Checklist (1) Pre -Qualified
Bidders") by December 3111 for the upcoming calendar year, or within twelve (12) months of obtaining pre -
qualified standing. If the status of any item changes within the twelve (12) months, it is the responsibility of
the contractor to notify the City. Failure by any pre -qualified contractor to submit its complete application
for continuation of "pre -qualified" standing within the time prescribed above shall result in automatic removal
of the designation, effective January 1 of the following year, or immediately following the twelve (12) months
of pre -qualified standing.
However, the "removed" contractor or subcontractor shall still be permitted to bid on City public works
projects, though the contractor must submit all required documents under 6-63 until "pre -qualified" status
is re-established.
Please Note: The City reserves the right to request supplemental information from the bidder,
additional verification of any information provided by the bidder, and may also conduct random
inquiries of the bidder's current and previous customers regardless of pre -qualified standing.
It is the sole responsibility of the potential bidder to comply with all submission requirements applicable to
the bidder in Section 6-63 of the Responsible Bidding Ordinance no later than the date of the public bid
opening.
Version 7/20/2018 General Conditions - 6
POST BID SUBMISSIONS:
Post -bid submissions must be submitted in accordance with Section 6-64 of the Responsible Bidding
Ordinance. The post -bid submission requirements are as follows:
1. All bidders shall collect, maintain, and provide upon request, a current written list that discloses the
name, address, licensing status, and type of work for any subcontractor from whom the bidder has
accepted a bid and/or intends to hire on any part of the public work project, including individuals
performing work as independent contractors.
2. Each subcontractor, whose portion of the project is estimated to be at least one -hundred fifty
thousand dollars ($150,000.00), shall be required to adhere to the requirements of Section I of the
Responsible Bidder Ordinance as though it were bidding directly to the City, except that the
subcontractor shall submit the required information (including the name, address, and type of work)
to the successful bidder prior to the commencement of work.
3. Failure of a subcontractor to submit the required information shall not disqualify the successful
bidder from performing work on the project and shall not constitute a contractual default and/or
breach by the successful bidder. However, the City may withhold all payment otherwise due for
work performed by a subcontractor, until the subcontractor submits the required information and
the City approves such information.
4. The disclosure of a subcontractor list ("Disclosed Subcontractor(s)") to the City by a bidder shall
not create any rights in the Disclosed Subcontractor(s). Thus, a bidder may substitute another
subcontractor for a Disclosed Subcontractor by giving the City, upon request, written notice of the
name, address, licensing status, and type of work of the substitute subcontractor.
5. The successful bidder and all subcontractors on a public works project are required to submit
certified payroll utilizing the federal form known as WH-347 or a similar form on a bi-weekly basis,
submitted within 10 days after the end of each bi-weekly payroll period. Certified payrolls shall
identify the job title and craft for each employee. Certified payrolls shall be submitted
electronically.
Please Note: Submissions deemed inadequate, incomplete, or untimely by the City may result in
the automatic disqualification of the bid.
The City, after review of complete and timely submissions, shall, in its sole discretion, after taking into
account all information in the submission requirements, determine whether a bidder is responsive and
responsible, and provide a Pre -Qualification Verification Letter. The City specifically reserves the right to
utilize all information provided in the contractor's submission and any information obtained by the City
through its own independent verification of the information provided by the contractor.
Version 7/20/2018 General Conditions - 7
PRE -QUALIFIED BIDDER CHECKLIST
(a) Acknowledgements:
(i) ✓ By checking this box, I hereby acknowledge that I am a pre -qualified bidder with
the City of South Bend and that I have met the pre -qualification requirements within
the last twelve (12) months. A copy of my Pre -Qualification verification letter
is attached.
(ii) ✓ By checking this box, I hereby acknowledge that the City reserves the right to
request supplemental information, additional verification of any information
provided by me, and may also conduct random inquiries of my current and prior
customers.
(b) Attachments:
(i) ✓ Indiana Secretary of State's on-line records (ie. Business verification) dated within
sixty (60) days of the submission of said document showing that business is in
existence, current with the Indiana Secretary of State's Business Entity Report,
and eligible for a certificate of good standing. (Not applicable to individuals, sole
proprietors or partnerships).
(ii) Statement on staffing capabilities, including labor sources. This statement
indicates and ensures I have sufficient employees on staff to complete the work. It
outlines how I intend to meet the staffing needs of the work.
(iii) Evidence that I am utilizing a surety company which is on the United States
Department of Treasury's Listing of Approved Sureties as required in the bid
specifications or contract.
(Iv) ✓ List of projects of similar size and scope of work performed in all areas, including
the State of Indiana, within the last three (3) years.
Version 7/20/2018 General Conditions - 8
II. PRE -QUALIFICATION CHECKLIST (FOR BIDDERS THAT ARE NOT PRE -QUALIFIED)
(a) Acknowledgements:
0) ✓ By checking this box, I hereby acknowledge that I am not a pre -qualified bidder
with the City of South Bend.
(ii) ✓ By checking this box, I hereby acknowledge that the City reserves the right to
request supplemental information, additional verification of any information
provided, and may also conduct random inquiries of my current and prior
customers. The City reserved the right to utilize all information provided in this
submission and all information obtained in inquiries or requests to determine if a
bidder is responsive and responsible. Additionally, I acknowledge that all
information provided to the City shall be regarded as public records.
(iii) N.A. By checking this box, I hereby acknowledge that copies of all Applicable
apprenticeship certificates or standards for training programs applicable to the
work performed on the project may be requested at any time and shall be furnished
upon request.
(iv) By checking this box, I hereby acknowledge and ensure that I and all sub-
contractors, from whom I have accepted a bid and/or intend to hire to perform work
on the public work project, are properly licensed. Furthermore, I acknowledge my
understanding that it is my responsibility to ensure that all sub -contractors have
the necessary licenses to undertake the work called for in this bid. If a sub-
contractor loses their license at any point, it is the responsibility of that sub-
contractor to notify the City.
(b) Attachments:
(i) ✓
Indiana Secretary of State's on-line records (ie. Business verification) dated within
sixty (60) days of the submission of said document showing that business is in
existence, current with the Indiana Secretary of State's Business Entity Report,
and eligible for a certificate of good standing. (Not applicable to individuals, sole
proprietors or partnerships).
(ii) ILA
List identifying all former business names.
(iii).
Any determinations by a court or governmental agency any violations of federal
state, or local laws including, but not limited to, violations of contracting or antitrust
laws, tax or licensing laws, environmental laws, Occupational Safety and Health
Act (OSHA), or federal Davis -Bacon and related Acts, within the preceding five (5)
years.
(iv) I.A.
Statement about staffing capabilities, including labor sources. This statement
indicates and ensures I have sufficient employees on staff to complete the work I
am bidding on OR outlines how I intend to meet the staffing needs of the work.
(v) I
Statement that individuals who will perform work on the public work project on my
behalf will be properly classified as an employee or as an independent contractor
under all applicable state and federal laws and local ordinances.
(vi)
Evidence of participation in apprenticeship and training programs, applicable to the
work to be performed on the project, which are approved by and registered with
the United States Department of Labor's Office of Apprenticeship, or its successor
organization.
(vii) ✓
Copy of a written plan for employee drug testing that covers all of my employees
who will perform work on the public work project and meets or exceeds the
requirements set forth in IC 4-13-18-5 or IC 4-13-18-6.
(viii) /
Evidence that I am utilizing a surety company which is on the Bureau of Fiscal
Service "Department of Treasury's Listing of Approved Sureties" as required in the
bid specifications or contract.
Version 7/20/2018 General Conditions - 9
(ix) ALA, Written statement of any federal, state or local tax liens or tax delinquencies owed
to any federal, state or local taxing body in the preceding three years.
(i) List of projects of similar size and scope of work performed in all areas, including
the State of Indiana, within three (3) years prior to the date on which the bid is due.
94 pop-" 14TTACA&P
Date: Sent
(Sign Here)
Gary Niblock, President
(Print Name Here)
Niblock Excavating Inc.
(Name of Company)
PO Box 211
(Address of Company)
Bristol
(City)
Indiana
(State)
574-848-4437
(Telephone Number)
Version 7/20/2018 General Conditions -10
E-Verify Affldavit
_Niblock Excavating Inc. , to comply with the requirements of Indiana Code 22-5-1.7-11, affirms under
(Contractor)
the penalties of perjury that it does not knowingly employ an unauthorized alien.
The Contractor shall enroll in and verify the work eligibility status of all its newly hired employees through the Verify
program as defined in IC 22-5-1.7-3. The Contractor is not required to participate should the E-Verify program cease to
exist. Additionally, the Contractor is not required to participate if the Contractor is self-employed and does not employ any
employees.
The Contractor shall not knowingly employ or contract with an unauthorized alien. The Contractor shall not retain an
employee or contract with a person that the Contractor subsequently learns is an unauthorized alien.
The Contractor shall require its subconsultants, who perform work under this Contract, to certify to the Contractor that the
subconsultant does not knowingly employ or contract with an unauthorized alien and that the subconsultant has enrolled
and is participating in the E-Verify program. The Contractor agrees to maintain this certification throughout the duration of
the term of a contract with a sub -consultant.
Dated: September 25, 2018
STATE OF _ Indiana
COUNTY OF Elkhart
)SS:
}
Signature:
Printed Name: ock
- . MI
Company: —Ni block Excavating Inc.
Address: O Box 211 Bristol Indiana 46507
Before me, a Notary Public in and for said County and State, personally appeared
Gary Niblock as
(Name)
President
(Title)
of Niblock Excavating Inc.
(Company)
who acknowledged the execution of the foregoing instrument, and who, having been duly sworn, stated that any
representations therein contained are true.
WITNESS my hand and Notarial Seal thW5th day ofSQt_._ 2018
My Commission Expires: Signature;
Sept 30. 2025 Printed: �Li`le Crawford
County of Residence; TARY PUBLIC
Iranian Government Affidavit
Niblock Excavating Inc. , to comply with the requirements of Indiana Code 5-22-16.5, affirms under
(Contractor)
the penalties of perjury that it does not deal with the Government of Iran.
The Contractor shall require its sub -contractors, who perform work under this Contract, to certify to the Contractor that the
sub -contractor does not knowingly deal with the Government of Iran. The Contractor agrees to maintain this certification
throughout the duration of the term of a contract with a sub -consultant.
Dated; 25., 2018
STATE OF Indiana
COUNTY OF Elkhart
}
)SS:
Signature:_
Printed Name; ock
Title: President
Company; NjU0cl Excavating Inc.,..
Address: _ PO Box 211. Bristol, Indiana 46507
Before me, a Notary Public in and for said County and State, personally appeared
Gary Niblock as
(Name)
President
(Title)
of Niblock Excavating Inc.
(Company)
who acknowledged the execution of the foregoing instrument, and who, having been duly sworn, stated that any
representations therein contained are true.
WITNESS my hand and Notarial Seal this 25t1dK of Sept 20 18
My Commission Expires: Signature; I AA
Sept 30, 2025 Printed: Julie rawford
County of Residence: NO ARY PUBLIC
Elkhart
Part of State Form 52414 (R2 / 2-13)1 Form 96 (Revised 2013)
BID OF
Nibtock Excavating Inc.
(Confraclor)
PO Box 211
(Address)
Bristol Indiana 46507
FOR
PUBLIC WORKS PROJECTS
OF
City of South Bend, Board of Public Works
Great Lake Capital Spec Building
5545 Chet Waggoner Court Paving -Project No. 118-058
Filed September 25 2018
Action taken
Are�.
CONTRACTOR'S BID FOR PUBLIC WORK - FORM 96
I; State Form 52414 (R212-13)1 Form 96 (Revised 2013)
Prescribed by State Board of Accounts
PART I
(To be completed for all bids. Please type or print)
Date (month, day, year): September 25, 2018
1. Governmental Unit (Owner): City of South Bend, Board of Public Works
2. County: St Joseph
3. Bidder (Firm): Niblock Excavating Inc.
Address: PO Box 211
City/State/ZlPcode: Bristol Indiana 46507
4. Telephone Number: 574.848.4437
5. 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 Great Lake Capital Spec Building 5545 Chet Waggoner Court Paving Project No. 118-058`
(Governmental Unit) in accordance with plans and specifications prepared by
Abonmarche Consultants Inc.
and dated September 2018 for the sum of
see attached itemized proposal $ see attached itemized proposal
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 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 governmental unit. If the bid is to be awarded on a unit
basis, the itemization of the units shall be shown on a separate attachment.
The contractor and his subcontractors, if any, shall not discriminate against or intimidate any employee,
or applicant for employment, to be employed in the performance of this contract, with respect to any matter
directly or indirectly related to employment because of race, religion, color, sex, national origin or ancestry.
Breach of this covenant may be regarded as a material breach of the contract.
CERTIFICATION OF USE OF UNITED STATES STEEL PRODUCTS
(If applicable)
I, the undersigned bidder or agent as a contractor on a public works project, understand my statutory
obligation to use steel products made in the United States (I.C. 5-16-8-2). I hereby certify that 1 and all
subcontractors employed by me for this project will use U.S. steel products on this project if awarded.
understand that violations hereunder may result in forfeiture of contractual payments.
ACCEPTANCE
The above bid is accepted this day of subject to the
following conditions:
Contracting Authority Members:
PART II
(For projects of $150,000 or more —1C 36-1-12-4)
Governmental Unit: City of South Bend, Board of Public Works
Bidder (Firm) Niblock Excavating Inc.
Date (month, day, year): September 25, 2018
These statements to be submitted under oath by each bidder with and as a part of his bid.
Attach additional pages for each section as needed.
SECTION I EXPERIENCE QUESTIONNAIRE
What public works projects has your organization completed for the period of one (1) year prior to the
date of the current bid?
Contract Amount
Class of Work
Completion
Date
Name and Address of Owner
269,58925
Intersection Improvements
2017
City of Goshen -Dickerson Landing Goshen Indiana
647,285.00
Sewer
2017
Elkhart Co Regional Sewer District Middlebury Indiana
308,350.00
Force Main
2017
Waterloo Redevelopment Com-Waterloo Indiana
2,490,000.00
Resurfacing
2017
Elkhart Co Hwy -Elkhart Indiana
2.. What public works projects are now in process of construction by your organization?
Contract Amount
Class of Work
Expected
Completion
Date
Name and Address of Owner
2,039,505.00
Road Construction
2019
Town of Bristol, Bristol Indiana
2,238,870.00
Whitley Consolidatedschools
2019
Whitley schools, Columbia city Indiana
419,588.00
Road Reconstruction
2018
City of Goshen, Goshen Indiana
9,598,749.00
Sewer
2019
LaGrange Co Regional Sewer District, LaGrange Indiana
3. Have you ever failed to complete any work awarded to you? no If so, where and why?
4. List references from private firms for which you have performed work.
Almac-Sotabeer Construction John Sotebeer
Majority Builders Rick Slagle
Wagner Construction Mark Elliott
Northern Indiana Construction David Walorski
SECTION II PLAN AND EQUIPMENT QUESTIONNAIRE
Explain 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, etc. and any other information which you
believe would enable the governmental unit to consider your bid.)
We agree to use our efforts to complete the project in an expeditious and economical manner.
2. Please list 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.
see attached schedule
PO Box 211
Bristol Indiana 46507
Phone 574.848..4437
Fax 574.848,4575
Section II Plan & Equipment Questionnaire
2. Please list 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.
Slusser's Green Thumb — PO Box 33, Logansport Indiana 46947 — Landscaping
State Barricading — 24963 US 20 W South Bend Indiana 46628 — Traffic Control
Premium Concrete — 1737 Crabtree Lane Elkhart Indiana 46514 — Concrete
National Striping Inc. — PO Box 432 Lakeville Indiana 46536 --- Asphalt Markings
Primco Inc. — PO Box 9782 Ft Wayne Indiana 46899 — Bridge Work
Javelina Construction Inc. —13476 Britton Pk Rd Fishers Indiana 4603 8 — Milling
The Airmarking Company --- PO Box 526 Rochester Indiana 46975 — Asphalt Marking
Specialty Company LLC — 7212 N Shadeland Ave #209 Indianapolis, Indiana - Misc Metals
J L Milling ---- 15262 Industrial Dr. Schoolcraft Michigan 49087 — Milling
DeWind Dewatering — 9150 961h Street Zeeland Michigan 49464 — Dewatering
Michiana Contracting ---- PO Box 929 Plymouth Indiana 46563 - Signalization
If you intend to sublet any portion of the work, state 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 governmental unit in the event that you subsequently determine that you will use a
subcontractor on the proposed project.
to be determined at a later date
4. What equipment do you have available to use for the proposed project? Any equipment to be used by
subcontractors may also be required to be listed by the governmental unit.
All equipment necessary to complete the project in a safe, timely, and professional manner.
5. Have you entered into contracts or received offers for all materials which substantiate the prices used in
preparing your proposal? If not, please explain 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 governing body awarding the contract must be specific enough in detail so that said governing body can make
a proper determination of the bidder's capability for completing the project if awarded.
SECTION IV CONTRACTOR'S NON — COLLUSION AFFIDAVIT
The undersigned bidder or agent, being duly sworn on oath, says that he 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 include 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.
He 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.
SECTION V OATH AND AFFIRMATION
I HEREBY AFFIRM UNDER THE PENALTIES FOR PERJURY THAT THE FACTS AND INFORMATION
CONTAINED IN THE FOREGOING BID FOR PUBLIC WORKS ARE TRUE AND CORRECT.
Dated at Bristol this 25th
Niblock Excavating Inc.
By.
day of September 2018
(!Name of Organization)
Gary Nibloc<President
(Title of Person Signing)
ACKNOWLEDGEMENT
STATE OF Indiana )
ss
COUNTY OF Elkhart )
Before me, a Notary Public, personally appeared the above -named Gary Niblock, President and
swore that the statements contained in the foregoing document are true and correct.
Subscribed and sworn to before me this 25th
My Commission Expires: Sept 30, 2025
County of Residence: Elkhart
day of September 2018
JSSUED BY
Jtoima 39eparhmd- of QIrmsirMation
INoIANmPOU3.IN August 7,2018
TO
NIBLOCK EXCAVATING INC
omSTpL, IN
who has filed with the Department a Contractor's Statement of Experience and Financial Condition as
required under lndiana Code 8-23-10, is hereby qual!ified to bid at any Department of Transportation
letting in Classes of Work and within the amount and other limitation of each classification as listed
below, for such period as the uncompleted work on hand from A sources does not exceed the Aggregate
amount. Uassification references by narne or symbol are in accordance with the definitions in the
Contractor's Statement of Experience and Financial Condition. Thils certificate supersedes any certificate
previousIly issued, but is subject to revision or revocation according to the law, if and when changes
in the financial condition of the contracting firm or other facts justify such revision or revocation.
AoonE{aoa .......... ....... _......... ....... ... —_....... .................. ... —......... .......... ---_'---......... $az,4n4mm
8112 TRINCBLESS PIPE IN3TAIATx}N........ ...................... --- ....... ............. ........... ..... ................. »30,000,0"
B(A) ASPHALT rvMrvwImn0,CERTIFIED omxAPLANT ............ ..... .... .... ........ —................................ $6/,494,00
C(A) HEAVY GRADONG_-......... .............. ............ ... -----........ ............................. ........... —....... —.... $62,494,00
E(E) SMALL STRUCTURES AND DRAINAGE ITEMo-.... ..... _--............ ... .... ................................. $30,000,00
E(F) SURFACE MASONRY AND umSCCONCRETE .............. ---............ ........................ ........ ... ..... ' $30\00,00
PREQUALIFICATION ENGINEER
CERTIFICATE OF EXISTENCE
To Whom These Presents Come, Greeting;
I, CONNIE LAWSON, Secretary of State of Indiana, do hereby certify that I am, by virtue of the laws of
the State of Indiana, the custodian of the corporate records and the proper official to execute this
certificate.
I further certify that records of this office disclose that
NIBL®CK EXCAVATING INC
duly filed the requisite documents to commence business activities under the laws of the State of
Indiana on May 03, 1971, and was in existence or authorized to transact business in the State of
Indiana on September 24, 2018.
I further certifiy this Domestic For -Profit Corporation has filed its most recent report required by
Indiana law with the Secretary of State, or is not yet required to file such report, and that no notice of
withdrawal, dissolution, or expiration has been filed or taken place. All fees, taxes, interest, and
penalties owed to Indiana by the domestic or foreign entity and collected by the Secretary of State
have been paid.
In Witness Whereof, I have caused to be affixed my
signature and the seal of the State of Indiana, at the City
of Indianapolis, September 24, 2018
CONNIE LAWSON
SECRETARY OF STATE
197105-015 / 2018739074
All certificates should be validated here: https://bsd.sos.in.gov/ValidateCertificate
Expires on October 24, 2018.
MP
Client#: 33579 N113LEXC
CERTIFICATE ®F LIABILITY INSURANCE
D91E(MMDDI YYYY]
ID DATE (MMDf., 18
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(les) must be endorsed. If SUBROGATION IS WAIVED, subject to
the terms and conditlons of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the
certificate holder in Ileu of such endorsement(s).
PRODUCER
ONl Risk Partners
600 E 96th St Suite 400
CO
NA TACT E: Robin Stinger
L N E , 317-706-9861 Arc Nor.
EMAIL ADDREss: robin.stinger@onirisks.com
Indianapolis, IN 46240
INSURER(S) AFFORDING COVERAGE
NAIC p
_
INSURER A:ZudchAmarlo ntnsumnceCompa
16635
INSURED Niblack Excavating, Inc.
906 Maple Street
P.O. Box 211
INSURER B : Tmvefem Properly Casualty Co
25674
INSURER C :
INSURER D :
Bristol, IN 46507
INSURER E:
INSURER F
COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
LTR
TYPE OP INSURANCE
A SDL
y yB�
POLICY NUMBER
MMfaDY�YEYYY
POLICY EXP
LIMITS
A
X
COMMERCIAL GENERAL LIABILITY
CLAIMS -MADE � OCCUR
Primary & NonContrib
X
X
GLO101091403
10/01/2017
101011201E
AAq
$1 000 000
ppECMMHgqGGOCCrrUR��NTErRRENCE
PR 6&1 EaEnce
000,030
X
MED EXP (Any one person)
$5 000
PERSONAL & ADV INJURY
$1,000,000
GEN'L AGGREGATE LIMIT APPLIES PER:
POLICY PE 0 LOC
OTHER:
GENERAL AGGREGATE
S2,DDO,O00
PRODUCTS - COMPIOP AGG
s2,000,000
S
A
AUTOMOBILE LIABILITY
X ANY AUTO
ALL OAMED SCHEDULED
AUTOSAUFOS Ix
NOWOWNED
X HIRED AUTOS
X
X
BAP101091303
0/01/2017
101011201
Es acBI�IVdeDSINGLE LIMIT
$1,000,000
BODILY INJURY (Per person)
$
BODILY INJURY (Per accident)
S
PROPERTY GAM47E
Par accident
$
$
B
X
UMBRELLA LfAO
EXCESS LIAB
X OCCUR
CLAIMS -MADE
X
X
ZUP41 M3247317NF
10/01/2017
10/01/201t
EACH OCCURRENCE
$5 000 000
AGGREGATE
$5 000 000
DEO I X RETENTION $1D 000
$
A
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY
ANY PRSIATUTE.
rRIETOR/PARTNERIEXECUTfVEYrN
OFFICE MEMBER EXCLUDED?
(Mandatary In NH)
Ues, describe under
DESCRIPTION OF OPERATIONS below
N! A
X
_
WG101091203
10/01/2017
10/01/201
X PER OTH-
ER
E.L.EACH ACCIDENT
$1 OOOOOO
E.L. DISEASE - EA EMPLOYEEI
$1 00O 000
E.L. DISEASE - POLICY LIMIT
$1 00O 000
A
Leased & Rented
Equipment
CPP011740102
10/01/2017
101011201E
$800,000 Limit
$5,000 Deductible
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more apace is required)
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVE
O 1988-2014 ACORD CORPORATION. All rights reserved.
ACORD 25 (2014101) 1 of 1 The ACORD name and logo are registered marks of ACORD
#S16839411M1621955 TCROW
Niblock Excavating Inc.
PO Box 211
Bristol Indiana 46507
Pbone 574.848..4437
Fax 574.848.4575
September 25, 2018
City of South Bend
Board of Public Works
Re: Great Lake Capital Spec Building
Project No. 118-058
Statement (b) Attachments (ii)
This is to be Niblock Excavating Inc. official statement in regards to "staffing capabilities,
including labor sources". Niblock Excavating Inc. has a total of 102 employees ready and able to
complete this project as per plans and specification.
Niblock Excavating Inc.
PO Box 211
Bristol Indiana 46507
Phone 574.848..4437
Fax 574.848.4575
January 2, 2018
:employee Drug Testing Policy
It is the policy of Niblock Excavating, Inc. to maintain a drug -free workplace and conduct testing
required by Indiana law (IC 4-13-18) to discourage the use of prohibited substances by our
employees. The revised drug testing policy consist of the following steps:
(1) All field employees will be subject to random drug testing at least one (1) time each year.
(2) A master employee list will be kept by the certified drug testing facility. This list will be
used for the drug testing "pool". The certified facility is responsible for the selection of
subjects for the random testing.
(3) At least two percent (2%) of the subject employees will be randomly selected for testing
each month.
(4) Once an employee has been notified of his/her selection for testing, they will be taken or
directed to the certified facility to provide a specimen.
(5) Specimens will be tested for amphetamines, cocaine, opiates (2000ng/ml), PCP, and
THC.
(6) All test results will be reviewed by a Medical Review Officer (MRO) from the certified
lab. The MRO shall be a licensed doctor of medicine or osteopathy.
(7) The concentration thresholds established under 49 CFR Part 40.87 will determine
whether a drug test is positive or negative.
(8) If the MRO notifies Niblock Excavating, Inc. that an employee has tested positive, the
following disciplinary progression will be followed, unless Niblock Excavating, Inc.
determines that it is in the company's best interest to terminate the employee:
(A) After the first positive test, an employee must be:
(i) suspended from work for thirty (30) days.
(ii) Directed to a program of treatment or rehabilitation; and
(iii) Subject to unannounced drug testing for one (1) year.
(B)After a second positive test, an employee must be:
(i) Suspended from work for ninety (90) days.
(ii) Directed to a program of treatment or rehabilitation; and
(iii) Subject to unannounced drug testing for one (1) year.
(9) All subcontractors for work to be performed on state public works contracts will include
a provision requiring the subcontractor to have a drug testing policy that complies with
IC 4-13-18 and to provide information regarding implementation of its drug testing
program upon request of the owner agency.
A C R I S U R E
September 25, 2018
City of South Bend
County -City Bldg., Room 1316
227 W. Jefferson Blvd.
South Bend, IN 46601
Rl-,: Niblock Excavating, Inc.
PROJECT: Great Lake Capital Spec Building, 5545 Chet Waggoner Court
Paving Project No. 118-058
To Whom It May Concern:
Liberty Mutual Insurance: Company has provided surety credit to Niblock Excavating, Inc. for
many years. This letter is written to confirm that we consider Niblock Excavating, Inc. to be
capably managed, properly financed and we Would consider supporting a bond request that
would fall within their standard line of work.
Liberty Mutual Insurance Company is on the U.S. Treasury Department's Listing of Approved
Sureties (Department Circular 570) and is rated "A" (Excellent) with a Financial Size Category
of XV by A.M. Best Rating Services.
If you have any questions, please feel free to call.
Sincerely,
Lori Kin g Cl de
Attorney- 1 n-Fac t
Liberty Mutual Insurance Company
6307 84°h St., SE, Caledonia, M11 49316
p (800) $47-0351 — f (800) $47-3129
www.ac:risur,e.coni
THIS POWER OF ATTORNEY IS NOT VALID 'UNLESS IT IS PRINTED ON RED BACKGROUND,
This Power of Attorney limits the acts of those named herehi,and they have no aotbority, to bind tire Company except in the manner and to the extent herein stated,
Crartiricrewte No, 7851471
Liberty Mutual tnsurance Company
The Ohio Casually Insurance Company West Arriericanr Insurance Comparily
KNOWN ALL PERSONS BY THESE PRESENTS, The( The Ohio Casualty insurance Company is a �,O(p(jrahoh rimy orgaiiized under the laws of the Slate of New Harripshue, lhal
Liberty Mutual Insurance Company is a Porporaholl duly organized tinder the laws of [lie State at and WastAnnorrcan Insmance, Company is ! corporation duly
organtzed under the Raves of are State of Indiana ilierein collenhvefy called the 'Companies'), Pursuant to and by antrortly herein set forth. does hereby name, conslihoie and appol;0,
Janice Sfickles. Kustre L. Harris L r I<i(jgL a (�oi or- Tamara Malin
..._. _.1_.1_._1_1_.._.--------
all of tfic city of Caledonia _._ state of -MI '__' each individuallyo if there he rinure than ne named, its Injeand lawtnl allorney-inmake, to ako, eXCIseed
, aAnuMedgin.
and (if' fliver, for and an its bet,,allas surety and as its act and deed, any and all im(fada"kings, bonds, recognizancps and olllvr surety olollyahons. !in pirisuance, of those; prese'rils, and shall
be as hindiii-I upon fits, Companies as it they have been duly si( jned by the presidiimt and aflesired by [lie sacrMary of the Coinfpaaiias in their own peoper parsons,
IN WITNESS WHEREOF, this Power of Attorney 111S been subscriber) by of) aurilmized officer or 011156af of III(, Corripiruesand the corporAr" sraais of the comp'll-lias have been affixed
thereto this. 3 18t day of _J( ------ . ... . .. .... _ 2017
-Lly— 1.
9
N,
z
STATE OF FENNSYLVAMA ss
COUNTY OF moNTGomERY
The Ohio Casualty Insurance Company
Liberty M1.1b,121 lill-30ranFiR Company
West4ijilarican Insuratice Company
By:
I)avr6 M Carey�Assistant Secretary
On this 31 at day ofjulv 2017 , before me personally appeared David 14 Camy, who acknowledged himself to be tho AssiMan: Socroary of Liberty Moluil 4usihanco
Company, The Onto Casualty Company. and West American Instmanco Company, and that he, as such, being authorized so to do, execute be forepoing instrument for the pwposos
thprpin corilained by signing on behalf of the corporations by hansielf as a duly authorized officer.
IN WITNESS WHEREOF, I have heieurlo subscribed my naine and iffixed my nuartal seat at King of Prussia. Pennsylvania, on the day and: year first above oirillpii,
GONIMONWA-LTH OF PENNSYLVAMA
TWO, F`anto!lj, Nolmy ruhlic Bye Teresa Pastelizi, Notary Public
My (ogry I i""Mon r NlnI r"s Niarcl, 2")a I
%1.1mi,cl
011011's .1 ffic (),,in C �orjncu Gortipany, ll r/atua�
This Power ijfAtfornoy is made and execuled per$ ffl 10 and by aui of the, following l3y-llaws and AulliodzCasually in,
ln,qiiance Company, and West American Insurance Company vilrich resolutions are ri in full force and effect reading as follows:
ARTICLE IV— OFFICERS — Section 12 Power of Attorney. Any olticer or other official Of the Cirrp0farfOn dLlth(ffiZPrJ for that purpose i vorifing by the Cramium or the President, and subject
to such hintAflon as the Chairman or the President may prescribe, stiall appoint such as may beirecossary to act in behalfofthe Curpoiation to make, execute, seal,
acknowled9p anti deliver as surely any and all uridertaktrrgs, hands, wcognizances and rither surety obl:rgbNMS, SUCII attorneys -in -fact, suli to the, limitations set forth in their respective
powers of attorney, shall have full Power to bind the Corporauerl by their signaturn and oxei;uliov of any such instruments and to aliqch thereto the seal oftho Corporation. Whon so
0XCUlted, such ruasira.uaaonls sh uBl be os binding a,; it signed by the prerldent and attested to by the Socrotary. Any power or authodly 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 greenling such power or authority,
ARTICLE XIII Execution of Coolrods — SECTION 5, Surety Bonds and Undertakings Any officer of the Coonpany authorized for that purpose in wriling by the chiinnan or the president,
and Ribyi@Ct to Such frariMlions as the chairman or the president may Proscribe. shall ippoirl such attorneys in -tact, as may be necessary to actin behalf of the Company to make, execute,
seal, acknowledge and deliver as Surety any and air undertakings, boards, riecagritzances and other Surety ObligaliMIS, Such atorripys-in-fact subject to the hivitalrons set forth in tirtnr
respective powers of attorney, shill have full power to bind the Company by their signature and executen of any such instruments and to allach thereto, the seal of the Company, Wren so
exacured such shall be as buo(fing as if signed by [lie president and attested by the sacxelahy,
Certificate of Designation The President of the Corntl acting ouciamol to the Bylaws of thee ('0111may, authorizes David M Carey, Assistant Secretary to appoint stion atiorneys-in-
fact as may be n(rcessivy to act kit) behalf of [tie Company 10 make, execute, seal', acknoi, e and delivef as surely any and all undertakings, fronds, remgnizances and other stjrety
obligations.
Authorization —Nay unanavoris consent of (ho Coamany's i of Directors. lire Company consents that fauslinile or muuiraniCaaNly reproduced signalureofany assistant secretary orlho
Company, vdierever afrippading upDri a certified copy of any power of attorney issued by the Company hi connection with surety bonds, shall be valid and binding upon the Company wifln
IhL same force and affect as though manually affixed
I, Renee C Lkiwellyn, the Assistant Screirelity, the Ohio Casually InsuiarePe Corivany, Literly Mutual Insumoce Conniri and "lost Awhi Insurance Cordi
hereby coiffy flial the orshoal power of allorhey of vvkOi The foregoing Is I full, low and Correct copy of Irle Povm ofAtIolmoy execirled by said Corriparrillos, is in full force and effect and
has it(,,( berm revoked
IN TESTIMONY WHEREOF. I have herewito sot my hand and affixed the soars of said Companies this -:2,.5 (Jay of 20ZIE .... .. . ...
A x' 11 IV" r
:9iq 912 By,
yr
Secretary
-2—
169o[250
I %IS 'Pi/3 022017
V,
Drivitig; /tidlatia's omic Growfli
ME
1,00 Senae Avvwe Pi- X4,,E: (317) 233-2412 Eric Holcomb, Governor
Roorn N760 Joe McGuinness, Commissionor
rfndara,4C2014
February 8, 2018
Chad Niblock
General Manager
Niblock Excavating inc
Re: 2018 OJT Training Prograrn Agreement
Nil)lock Excavating:
Enclosed you will find a copy of the approved 2018 OJT Program and Partnership Agreement. The primary objective of the
program is to provide training and advancement opportunities to minorities and women toward journey level positions in all
phases of the highway construction industry. Thank you in advance for your participation in the Program and I look forward
to working with YOU this year.
Please feel free to contact rile at 317-233-2412 or kdaniels2@indot,iti.gov if you have any questions.
Respepffully, if j
... ... . ...
Katie Daniels
Contract Compliance Specialist
Indiana Department of Transportation - Economic Opportunity Division
Enclosure
An Eqgewl Oppeftni'm,0awyon,
L�.16.Ainnual Training Goal 'olcula tion and, Partnership Agreement
Step I.- Determine the total number of hours worked in the highway construction trades on INDOT
federal -aid contracts (either as a prince contractor or subcontractor) duriflgilie, past three years.
Do not include hours worked on state -funded and private work.
14OURS WORKED DURING
201 5 HOURS
1 2016 110�11�S�20�V
HOURS
TOTAL
L 91,000
=F, vs-9, 5
Step 2: Add the total number of hours front each year and divide by three (3).
+ �3=
2016 2017 Average I-Imms
Step 3: MLIltiply the "Average Hours" by five percent (5%)�; .. ....... . ..
J'
913j x -051 1 415
Average Hours 2019 Training
Goals,
I hereby agree to all of the terms and conditions contained herein and affirm under penalty and perjury
that the i n Form ation stated above is true and accurate,
FOR CONTRACTOR USE,
r
D"�g n a ra
12-
:d Nand Title
P4 arrm o evfq (5-11,
hom NtaOer li Emmfl Address
FOR INDOT USE
V T
Ptea,ve delaeb Seefivit 1.16 andreturn to IND07'r-lo Kafle Danifels at Maniels L2@�h�jdoi. im �qy
6