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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 11 Ms I ,.V 3 02210 11' •a-m toNJ go] ZA all U] I Ilya 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