HomeMy WebLinkAboutOpening of Bids - Lafayette Bldg Exterior Renovation - Project No 117-100R - Ziolkowski Construction IncProject Name Lafayette Building Exterior Renovation
Project No. 117-10OR
For Bids Due October 9, 2018
PART I
(Must be completed for all bids. Please type or print)
Date: October 9, 2018
Bidder (Firm): Ziolkowski Construction, Inc.
Address: 4050 Ralph Jones Drive
City/State/Zip: South Bend, IN 46628 Telephone Number: ( 574 ) 287-1811
Agent of Bidder (if Applicable): n/a
Pursuant to notices given, the undersigned offers to furnish labor and/or material necessary to complete the
public works project of:
Lafayette Building Exterior Renovation
the City of South Bend, Indiana, in accordance with plans and specifications prepared by:
KIL Architecture and Plann
and dated Septernber2018 for the sum of (enter the Total Bid as shown on the Proposal)
($
(Enter sum of Total Base Bid plus Aiterdstep shoArroin Propqsa,!), (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 addendlums attached wi:ll be specifically referenced at the applicable page.
If additional units of material included in the contract are needed, the cost of units must be the same as that
shown in the original contract if accepted by the City of South Bend. If the bid is to be awarded on a unit
basis, the itemization of the units shall be shown on a separate attachment.
By el"
—!A 0
(Signature)
Bill Favors, President
(Printed Name of Person Signing)
ACCEPTANCE
The above bid is accepted this day of
Subject to the following conditions:
BOARD OF PUBLIC WORKS
Gary A. Gilot, President
Elizabeth A. Maradik, Member
James A. Mueller, Member
Suzanna M. Fritzberg, Member
Therese J. Dorau, Member
Attest: Linda M. Martin, Clerk
0
Version 7/20/2018 Contractor's Bid for Public Works- 2
A 1-10 TiTrFrg M601
BID/PROPOSAL
CITY OF SOUTH BEND
t•
October 9, 2018
(Name Here) Ziolkowski Construction, Inc.
Item
No.
Description
Quantity
Unit
Unit Price
Total Amount
1
Removal and replacement of existing
LS
No Bid
skylight at the upper level roof
i
2
Allowance for skylight curb
I
LS
$25,000.00
$25,000.00
reinforcement and repair
DIVISION A BASE BID TOTAL Ni Bid
r1l;•il I i i "I 1� J;J--�
Item
No.
Description
Quantity
Unit
Unit Price
Total Amount
Limestone and brick masonry
rehabilitation on north, east, south and
1
west facades of building, includes crack
LS
189,5211
189,521.00
repair, tuck -point, masonry replacement
and rebuilding, soft control joint
installation, and limestone patching
2
Configency allowance for Division B
1
LS
$15,000.00
$15,000.100
masonry package
iii "k , 1 .1
Item
No.
Description
Quantity
Unit
Unit Price
Total Amount
1
Masonry Cleaning of East Fagade and
5880
LS
2.35
$13,8 1 & 00
North and South Returns
DIVISION B ALTERNATE #1 TOTAL $13,818.00
If 11" 11111111
ffr - "IT
Description
Unit Price
Total Amount
Masonry Cleaning of North, Wnt, and
190 -, ft-=�
2.75
South Facades
DIVISION B ALTERNATE #2 TOTAL $41,489.25
Item
No.
Description
Quantity
I
Unit
Unit Price
Total Amount
Water Repellent on East Fagade and
5880
LS
1.25
$7,350.00
returns at North and South Walls
DIVISION B ALTERNATE #3 TOTAL $7,350.00
Version 7/20/2018 Contractor's Bid for Public Works - 7
1; M01 mrarlomil
BID/PROPOSAL
CITY OF SOUTH BEND
Lafayette Building Exterior Renovation
October 9, 2018
(Name Here) Ziolkowski Construction, Inc.
5719WOG F--- "Tiff 51, �M- �F
a
Item
No'.
Description
Quantity
Unit
Unit Price
Total Amount
Water Repellent on North, West and
15,087
LS
1.70
$25,647.90
South Facades
r0TMMrGT.qr:TTT1FFff.q7.--Vr=
Item
No.
Description
Quantity
Unit
Unit Price
Total Amount
Restore painted "Lafayette Building" sign
1
on brick masonry at east end of
2
LS
9,140
$18,280
parapets on north and south walls,
DIVISION B ALTERNATE#6 TOTAL $18,280.0O
0 •1 jy
Item,
No.
Description
DEDUCT/SF
ADD/SF
1
Masonry Brick Tuck -pointing per SF
14.75
15.20
2
Masonry Limestone repointing per SF
5.08
5.50
3
Masonry Brick Re-bu i Idi ng/Re placement
per SF
80.00
82.00
4
Brick and Limestone Cleaning (East
Fa2ade and N/S Returns) per SF
2.20
2.35
5
Brick and Limestone Cleaning (West,
South and North Fagade) per SF
2.60
2.75
6
Water Repellent on East Fagade per SF
1.15
1.25
7
Water Repellent on North, West and
1.55
1.70
South Facades per SF
-R$T$M- MI'd "11
Ziolkowski Construction, Inc.
Address: 4050 Ralph Jones Drive
City/Statep: South Bend, IN 466 8 Telephone Number: ( 574 ) 287-1811
By -&ek-Ln
(Signature)
Bill Favors, President
(Printed Name of Person Signing)
Version 7/2012018 Contractor's Bid for Public Works - 8
When the prospective Contractor is unable to certify to any of the statentents 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:
St Joseph COUNTY )
The undersigned Contractor, being duly sworn upon his/her/its oath, affirms under the penalties of perjury
that:
1. Contractor has not, nor has any other member, representative, or agent of the firm, company,
corporation or partnership represented by him, entered into any combination, collusion or agreement with
any person relative to the price to be bid by anyone at such letting nor to prevent any person from bidding
nor to induce anyone to refrain from bidding, and that this bid is made without reference to any other bid and
without any agreement, understanding or combination with any other person in reference to such bidding.
Contractor further says that no person or persons, firms, or corporation has, have or will receive directly or
indirectly, any rebate, fee, gift, commission or thing of value on account of such sale; and
2. Contractor certifies by submission of this proposal that neither contractor nor any of its principals
are presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from
participation in this transaction by any Federal department or agency; and
3. Contractor has not, nor has any successor to, nor an affiliate of, Contractor, engaged in
investment activities in Iran.
a. For purposes of this Certification, "Iran" means the government of Iran and any agency
or instrumentality of Iran, or as otherwise defined at Ind. Code § 5-22-16.5-5, as
amended from time -to -time.
b. As provided by Ind. Code § 5-22-16.5-8, as amended from time -to -time, a Contractor
is engaged in investment activities in Iran if either:
i. Contractor, its successor or its affiliate, provides goods or services of twenty
million dollars ($20,000,000) or more in value in the energy sector of Iran;
or
ii. Contractor, its successor or its affiliate, is a financial institution that extends
twenty million dollars ($20,000,000) or more in credit to another person for
forty-five (45) days or more, if that person will (i) use the credit to provides
goods and services in the energy sector in Iran; and (ii) at the time the
financial institution extends credit, is a person identified on list published by
the Indiana Department of Administration.
Version 7/20/2018 Contractor's Bid 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 he/she/it shall enroll in and verify the work eligibility status of all of Contractor's
newly hired employees through the E-Verify Program as defined by I.C. 22-5-1.7-3. 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 contact 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 contact by the City
of South Bend through its agencies, boards, or commissions shall not discriminate against any employee or
applicant for employment in the performance of a City contract with respect to hire, tenure, terms, conditions,
or privileges of employment, or any matter directly or indirectly related to employment because of race, sex,
religion, color, national origin, ancestry, age, gender expression, gender identity, sexual orientation or
disability that does not affect that person's ability to perform the work.
In awarding contracts for the purchase of work, labor, services, supplies, equipment, materials, or any
combination of the foregoing including, but not limited to, public works contracts awarded under public
bidding laws or other contracts in which public bids are not required by law, the City, its agencies, boards,
or commissions may consider the Contractor's good faith efforts to obtain participation by those Contractors
certified by the State of Indiana as a Minority Business ("MBE") or as a Women's Business Enterprise
("WBE") as a factor in determining the lowest, responsible, responsive bidder.
In no event shall persons or entities seeking the award of a City contract be required to award a subcontract
to an MBEIWBE; however, it may not unlawfully discriminate against said WBE/MBE. A finding of a
discriminatory practice by the City's MBE/WBE Utilization Board shall prohibit that person or entity from
being awarded a City contract for a period of one (1) year from the date of such determination, and such
determination may also be grounds for terminating the contact for which the discriminatory practice or
noncompliance pertains.
7. The undersigned contractor agrees that the following nondiscrimination commitment shall be made
a part of any contract which it may henceforth enter into with the City of South Bend, Indiana or any of its
agencies, boards or commissions.
Contractor agrees not to discriminate against or intimidate any employee or applicant for employment in the
performance of this contract with privileges of employment, or any matter directly or indirectly related to
employment, because of race, religion, color, sex, gender expression, gender identity, sexual orientation,
handicap, national origin or ancestry. Breach of this provision may be regarded as material breach of
contract.
1, the undersigned bidder or agent as contactor 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
may result in forfeiture of contractual payments.
Version 7/20/2018 Contractor's Bid for Public Works - 5
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 9th day of 0ct0ber2018
GOA
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IN D I WA
Subscribed and sworn to before me this 9th
My Commission Expires
March 1, 2020
County of Residence
Ziolkowski Construction, Inc.
Contractor/Bidder (Firm)
Si nature of Contractor/Bidder or Its Agent
Bill Favors, President
Printed Name and Title
day of October _, 20 1 8
Notary Public Shannon Reidenbach
St Joseph
SHANNON REIDENBACH
Seal
t u 9 S'
ENotary Public- Seal
State of Indiana
'r Mar
1
My commission Expires Mar 1. 2JO20)
Version 7/20/2018 Contractor's Bid for Public Works - 0
Document At 1 OTM - 201
Conforms with The American Institute of Architects AIA Document 310
CONTRACTOR:
(Narne, legal status and address)
Ziolkowski Construction, Inc.
4050 Ralph Jones Drive
South Bend, IN 46628
OWNER:
(Nance„ legal status .and address)
City of South Bend Board of Public Works
227'West Jefferson Boulevard
South Bend, IN 46601
SURETY:
(Nance, legal status and principal place of business)
Liberty Mutual Insurance Company
175 Berkeley Street
Boston, MA 02116
State of Inc: Massachusetts
BOND AMOUNT: Five Percent of Amount Bid (5%)
PROJECT:
This document has important legal
consequences. Consultation with
an attorney is encouraged with
respect to Its completion or
modification.
Any singular reference to
Contractor, Surety, Owner or
other party shall be considered
plural where applicable.
(Name, location or address, and Project number, if any)
Lafayette Building Skylight &Masonry Repairs, Division B: Exterior Brick and Limestone Masonry Rehabilitation, Project No. 117-100R,
The Contractor and Surety are bound to the Owner in the amount set forth above, for the payment of which the
Contractor and Surety bind themselves, their heirs, executors, administrators, successors and assigns, jointly and
severally, as provided herein. The conditions of this Bond are such that if the Owner accepts the bid of the Contractor
within the time specified in the bid documents, or within such time period as may be agreed to by the Owner and
Contractor, and the Contractor either (1) enters into a contract with the Owner in accordance with the terms of 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 otherwise acceptable to the Owner, for the faithful performance of such Contract and for
the prompt payment of labor and material furnished in the prosecution thereof, or (2) pays to the Owner the difference„
not to exceed the amount of this Bond, between the amount specified in said bid and such larger amount for which the
Owner may in good faith contract with another party to perform the work covered by said bid, then this obligation shall
be null and void, otherwise to remain in full force and effect. The Surety hereby waives any notice of an agreement
between the Owner and Contractor to extend the time in which the Owner may accept the bid. Waiver of notice by the
Surety shall not apply to any extension exceeding sixty (60) days in the aggregate beyond the time for acceptance of bids
specified in the bid documents, and the Owner and Contractor shall obtain the Surety's consent for an extension beyond
sixty (60) days,
If this Bond is issued in connection with a subcontractor's bid to a Contractor, the term Contractor in this Bond shall be
deemed to be Subcontractor and the term Owner shall be deemed to be Contractor.
When this Bond has been furnished to comply with a statutory or other legal requirement in the location of the project,
any provision in this Bond conflicting with said statutory or legal requirement shall be deemed deleted herefrom and.
provisions conforming to such statutory or other legal requirement shall be deemed incorporated herein. When so
furnished, the intent is that this Bond sball be construed as a statutory bond .and not as a common law bond.
Signed and sealed this 9th day of October , 2018
2sk'A" �, �,..,, �4
to u
(Witness) Shannon ReIU-e-nb-a-cTi
( Itness) John .Johnson
Ziolkowski Construction, Inc.
(Principal) _ (Seal)
(Title)Bi1l Favors, president
Libertv Mutual Insurance Company
(Seal)
( itle) Adrienne C. Stevenson, Attorney -in -Fact
State of IL
County of DuPege ss:
On October 09, 2018 , before me, a Notary Public in and for said County and State, residing
therein, duly commissioned and sworn, personally appeared.
Adrienne C. Stevenson
known to me to be Attorney -in -Fact of Liberty Mutual Insurance Company
the corporation described in and that executed the within and foregoing instrument, and known to me to be the person who executed
the said instrument in behalf of the said corporation, and he duly acknowledged to me that such corporation executed the same.
IN Wl'INESS WHEREOF, I have hereunto set my hand and affixed my official seal, the day and year stated in this certificate above..
I'k+Iy Commission. Expires 6f8d2020
C. R. hlern Jez Notary Public
C R HERNANDEZ
Oftkiat Seal
Notary Pubiia ut7tk3 rat lilic01S;
My Corninission I�"Ypir ^�; ,drtn i9� 2020
p l
This Power of Attorney limits the acts of those named herein, and they have no authority to bind the Company except in the manner and to the extent herein stated. Not
valid for mortgage, note, loan, letter of credit, bank deposit, currency rate, interest rate or residual value guarantees, To confirm the validity of this Power of Attorney call
610.832.8240 between 9:00 am and 4:30 pm EST on any business day.
Liberty Mutual Insurance Company
The Ohio Casualty Insurance Company
West American Insurance Company
POWER OF ATTORNEY
KNOWN ALL PERSONS BY THESE PRESENTS: That The Ohio Casualty Insurance Company is a corporation duty organized under (he laws of the State of New Hampshire, that
Liberty Mutual Insurance Company is a corporation duly organized under the laws of the State of Massachusetts, and West American Insurance Company is a corporation duly
organized under the laws of the State of Indiana (herein collectively called the "Companies"), pursuant to and by authority herein set forth, does hereby name, constitute and appoint,
u
of the city of Chicago state of fllinois its true and lawful attorney -in -fact, with full power and authority hereby conferred to sign, execute and
acknowledge the following surety band:
Principal Name: Ziolkovvski Construe ion Inc.
Obligee Name: __qjU of South Bend Board of Public Works
Surety Bond Number:
001
IN WITNESS WHEREOF, this Power of Attorney has been subscribed by an authorized officer or official of the Companies and the corporate seals of the Companies have been affixed
thereto this 27�1 day of February, 2017,
INNSI),? Y C IN (/ �MSUg4 The Ohio Casualty Insurance Company
era �� `�fF c LORPoq�t rF Liberty Mutual Insurance Company
o ° QF Fo o Wes merican Insurance Company
1912 i 1919 1991 1,7
By.
David V. Carey, Assistant Secretary
STATE OF PENNSYLVANIA
COUNTY OF MONTGOMERY
On this 27th day of February. 2017. before me personally appeared David M. Carey, who acknowledged himself to be the Assistant Secretary of , Liberty Mutual Insurance Company,
The Ohio Casualty Company, and West American Insurance Company, and that he, as such, being authorized so to do, execute the foregoing instrument for the purposes therein
contained by signing on behalf of the corporations by himself as a duly authorized officer.
IN WITNESS WHEREOF, I have hereunto subscribed my name and affixed my notarial seal at King of Prussia, Pennsylvania, an the day and year first above written,
COMMONWEALTH OF PENNSYLVANIA
t i+; Notarial Seal
„ Teresa Pastella, Notary Public By:
a Upper Mefion Twp., Montgomery County P/,,
My Commission Expires March 28, 202t Teresa Pastelfa, Notary Public
Member, Pennsylvania Association of Notaries
This Power of Attorney is made and executed pursuant to and by authority of the following By-laws and Authorizations of, The Ohio Casualty Insurance Company, Liberty Mutual
Insurance Company, and West American Insurance Company which resolutions are now in full force and effect reading as follows:
ARTICLE IV — OFFICERS -- Section 12. Power of Attorney. Any officer or other official of the Corporation authorized for that purpose in writing by the Chairman or the President, and
subject to such limitation as the Chairman or the President may prescribe, shall appoint such attomeys-in-fact, as may be necessary to act in behalf of the Corporation 10 make, execute,
seal, acknowledge and deliver as surety any and all undertakings, bonds, recognizances and other surety obligations. Such attorneys -in -fact, subject to the limitations set forth in their
respective powers of attorney, shall have full power to bind the Corporation by their signature and execution of any such instruments and to attach thereto the seal of the Corporation.
When so executed, such instruments shall be as binding as if signed by the President and afiested to by the Secretary. Any power or authority granted to any representative or attorney -
in -fact under the provisions of this article may be revoked at any time by the Board, the Chairman, the President or by the officer or officers granting such power or authority.
ARTICLE }(III -- Execution of Contracts -- SECTiON 5. Surety Bonds and Undertakings. Any officer of the Company authorized for that purpose in writing by the chairman or the
president, and subject to such limitations as the chairman or the president may prescribe, shall appoint such attomeys-in-fact, as may be necessary to act in behalf of the Company to
make, execute, seal, acknowledge and deliver as surety any and all undertakings, bonds, recognizances and other surety obligations. Such attorneys -in -fact subject to the limitations set
forth in (heir respective powers of attorney, shall have full power to bind the Company by their signature and execution of any such instruments and to attach thereto the seal of the
Company. When so executed such instruments shall be as binding as if signed by the president and attested by the secretary.
Certificate of Designation —The President of the Company, acting pursuant to the Bylaws of the Company, authorizes David M. Carey, Assistant Secretary to appoint such attorneys -
in -fact as may be necessary to act on behalf of the Company to make, execute, seal, acknowledge and deliver as surety any and a1 undertakings, bonds, recognizances and other
surety obligations,
Authorization — By unanimous consent of the Company's Board of Directors, the Company consents that facsimile or mechanically reproduced signature of any assistant secretary of
the Company, wherever appearing upon a certified copy of any power of attorney issued by the Company in connection with surety bonds, shall be valid and binding upon the Company
with the same force and effect as though manually affixed.
I, Renee C. Llewellyn, the undersigned, Assistant Secretary, of The Ohio Casualty insurance Company, Liberty Mutual Insurance Company, and West American Insurance Company
do hereby certify that the original power of attorney of which the foregoing is a full, true and correct copy of the Power of Attorney executed by said Companies, is in full force and effect
and has not been revoked.
iN TESTIMONY WHEREOF, I have hereunto set my hand and affixed the seals of said Companies this
INSU.? I,( INSU `AiAMSuR
gi. \�GOHPOq,�l'I'�m `�y \�LaRPOggfo'L�,� �Q� �Lp4lFOq,9rFCF.
r t972 0 ° 1919 1991 0
9SSArwoS r= ti� NAnnvS`�
Sth day of October 2018
By:
Renee C. Llewellyn, Assislan(Secrelary
13116 COUNTY Cr ry Buiu)m
2227 W. JEFFERSON BCAH,FIVARD
SIOU111 BEND, IN[MANIA4660 I.- 1 830
Date:
To:
From
Subject
Project Name:
Project No.:
III iow 57'4/ 235-9251
FAX 5741235-9171
'I DD 5'14J 235 6567
CITY OF SOUTH 1.3E,,ND fliz rr, B (rrnoa,"G, MA'S OI�
BOARD OF PUBLIC'WORKS
October 5, 2018
All Planholders
Linda M. Martin, Clerk, Board of Public Works
Addendum Number: I
Lafayette Building Sly fight and Masonry Repairs
117-10OR
.......... 1111,111
Date Received:
This addendum is being forwarded to you for the above referenced project.
Please sign below and acknowledge receipt of this Addendum by
faxing this sheet to the Board of Public Works at (574) 235-9171
within 48 hours of receipt. A copy MUST also be included with your
bid package upon submittal.
Notes:
The attached documents are hereby added to the Specifications and Contract
Documents and become a part of herein.
Company: Z �` e::) I kv t".3 -1E,)
Authorized Signature: .
Date:
�Mq h IL 0
CHECKLIST FOR BIDDERS
Project Name Lafayette Building Exterior Renovation
ProjectNo., 117-10OR
For Bids Due October 9, 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 included. The bidder has the option of providing either a Certified Check
X or Bid Bond.
Bid prepared on the City of South Bend Contractor's Bid for Public Work Form, completely
X executed.
Contractor's Non Collusion and Non -Debarment Affidavit, Certification Regarding Investments
with Iran, Employment Eligibility Verification, Non -Discrimination Commitment, and
X Certification of use of United States Steel Products or Foundry Products.
Proof of MBEIWBE Participation Goal Form [MWBE-1.0], If minimum participation goal is not
met, also provide Evidence of Good Faith Efforts Form [MWBE-2.0],anid MBEANBE Contacted
X Form [MWBE-2,1],
X Acknowledge Receipt of 1 Addendum(s) included with the bid.
X All required additional information is included! with the bid,
Proposal statements and other affidavits all signed by the proper party with name either
X printed or typed underneath signature.
X This checklist submitted with the Bid.
This checklist is provided for bidder's use in assuring compliance with required
documentation; however, it does not include all specifications requirements and does not
relieve the bidder of the need to read and comply with the specifications.
Bidder: Ziolkowski Construction, Inc. Date: October 920,.18_, .
By Authorized Representative:
Signature:
Print Name & Title: Bill Favors, President
Version 7/2012018 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 hislherfits bid.
Attach additional pages for each section as needed.
Please see Attached SECTION I EXPERIENCE QUESTIONNAIRE
1. Attach information regarding projects your organization has completed for the period of one
(1) year prior to the date of the current bid.
2. Attach a listing of public works projects currently in process of construction by your
organization.
3. Attach information regarding any failure to complete any work awarded to you and the
location thereof.
4. Attach references from private firms for which you have performed work.
SECTION 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.)
As directed by the Arch itect/Construction Manager
2. Attach a listing of the names and addresses of all subcontractors (i.e. persons or firms outside
your own firm who have performed part of the work) that you have used on public works
projects during the past five (5) years along with a brief description of the work done by each
subcontractor.
If Subcontractors will be used we will submit this information 24 hours after notification.
3, if you intend to sublet any portion of the work, attach the name and address of each
subcontractor, equipment to be used by the subcontractor, and whether you will require a
bond. However, if you are unable to currently provide a listing, please understand a listing
must be provided prior to contract approval. Until the completion of the proposed project, you
are under a continuingobligationto immediately notify the City of South Bend in the event that
If Suucon ra� orsl wdil beuse�weywill submit.1hisbimormavonn24�iou►saer�n� cation.
4. Attach a listing of equipment you have available to use for the proposed project.
Whatever is required to complete the project properly and on time.
5. Have you entered into contracts or received offers for all materials which substantiate the
prices used in preparing your proposal? If not, attach an explanation for the rationale used
which would corroborate the prices listed. Yes
SECTION III CONTRACTOR'S FINANCIAL STATEMENT
Attachment of bidder's financial statement is mandatory. Any bid submitted without said
financial statement as required by statute shall thereby be rendered invalid. The financial
statement provided hereunder to the City of South Bend awarding the contract must be specific
enough in detail so that said City of South Bend can make a proper determination of the bidder's
capability for completing the project if awarded.
Version 7/20/2018 Contractor's Bid for Public Works - 3
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CITY OF SOUTH BEND
UTH'4F
MINORITY AND WOMEN BUSINESS ENTERPRISE DIVERSITY
y �.
DEVELOPMENT PROGRAM
ra
FORM MWBE-2.0
EVIDENCE OF GOOD FAITH EFFORTS
iss...
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: 117-10OR
Project Name: Lafayette Building Exterior Renovation
Bidder: Ziolkowski Construction. Inc.
Contact Person: Brad Dennis
Address: 4050 Ralph Jones Drive
City:
Email:
South Bend state: Indiana
bdennis@zbuild.com
Date: October 9, 2018
Telephone:
574-287-1811
zip: 46628
To determine whether a bidder has demonstrated good faith efforts to reach the MBEIWBE utilization goals set
forth in the City of South Bend Public Works Project Specifications, the City and its agencies, boards, or
commissions, REQUIRE ALL of the following Good Faith Efforts as listed in the table below':
EVIDENCE OF GOOD FAITH EFFORTS
MBEIWBE LIST(S): The bidder reviewed the City of South Bend's Minority and Women Business
X
Enterprise Diversity Development Program, which uses the IDOA approved list of Minority and Women
Owned Business as found on their website (http://www.in.gov/idoa).
ACTION (ADVERTISE/CONTACT): In order for your bid to be deemed responsive, the City of South
Bend requires that all perspective bidders complete no less than 2 of the following:
1. Attend all pre -bid meetings scheduled by the City to inform MBE/WBEs of contracting and
subcontracting opportunities.
2. Advertise in general circulation and/or trade association publications concerning subcontracting
opportunities, and allow MBE/WBEs reasonable time to respond.
3. Perform any and all necessary steps to provide written notice in a manner reasonably calculated
to inform MBEIWBEs of subcontracting opportunities and allowed sufficient time for them to
participate effectively.
4. Utilize pre-existing services of available community organizations, small andlor disadvantaged
business assistance offices and other organizations that provided assistance in the recruitment
and placement of MBEIWBE 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 MBE/WBEs,
including providing such MBE/WBE's with adequate information about the plans, specifications and other
requirements of the subcontract and did not reject MBE/WBEs as 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
MBE/WBEs in order to increase the likelihood of meeting the MBEIWBE goals (including breaking down
contracts into smaller units to facilitate MBEIWBE participation)
CONTRACT RECORDS: The bidder has maintained the following records for each MBEIWBE 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 - 10
CITY OF SOUTH BEND
MINORITY AND WOMEN BUSINESS ENTERPRISE DIVERSITY
DEVELOPMENT PROGRAM
FORM MWBE-2.1
MBENVBE CONTACTED
This completed form should be supplied with Bids that pertain to City of South Bond 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.
Project Number:
Project Name;
Bid'd,
M
MBE/WBE Firm
117-10OR
PAGE OF
IMBEANBE Participation Goal
Lafayette Bu�ilding Exterior Renovation
Owner or Contact at MBE/WBE Firm
Telephone: Fax:
TYPE OF WORK SOLICITED FOR THIS PROJECT:
01MIN
RESULTS OF CONTACT WITH THE MBE/WBE FIRM:
MBEfWBE Firm
Owner or Contact at MBEIWBE 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 - 11
CITY OF SOUTH BEND, INDIANA
CONTRACTOR'S BID FOR PUBLIC WORK
RESPONSIBLE BIDDER CHECKLIST
Project Name Lafayette Building Exterior Renovation
Project No. 117-100R
For Bids Due October 9, 2018
Contractor Name: Ziolkowski Construction, Inc.
The City seeks to enhance its ability to identify responsive and responsible bidders on aii 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. 10594-18 (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 3151 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 Subcontractors)") 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 shalt 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:
0) X 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. See Attached
(ii) X 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:
0) _.X_ Indiana Secretary of State's on-line records (i.e. 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) X 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) X 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) X 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
Il. PRE -QUALIFICATION CHECKLIST (FOR BIDDERS THAT ARE NOT PRE -QUALIFIED)
(a) Acknowledgements:
(i) ____ 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) 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 (i.e. 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) _ 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) 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) 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 1C 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) 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.
Date: October 9, 20,18
dn Here)
MMWM��=
(Print Name Here)
Ziolkowski Construction, Inc.
(Name of Company)
(Address of Company)
South Bend
(City)
Indiana, 46628
(State)
M&WYAMOU
(Telephone Number)
Version 7120/2018 General Conditions - 10
1316 Coum Y-Cjj,y BUILDIN(i
227 W. JEFFERSON BOULEVARD
SOUTH BEND. INDIANA 46601-1830
CITY OF SOUTH BEND PETE Bvi-nOtEG, MAY
130ARD OF PUBLIC WORKS I
September 5, 2018
Mr. Bill Favors
Ziolkowski Construction, Inc.
4050 Ralph Jones Drive
South Bend, IN 46628
RE: Pre -Qualification Verification
Dear Mr. Favors:
Pj foNri 574/ 235-9251
FAX 574/ 235-9171
This letter serves as verification of Pre -Qualification status of your company for bidding with the City of South
Bend. This Pre -Qualification status is effective for twelve (12) months from the date of this letter. Thereafter you
are required to re -submit a complete application for continuation of pre -qualification status prior to December 31
for the upcoming calendar year.
A copy of this Verification Letter must be included with every bid exceeding $150,000 submitted to the City of
South Bend Board of Public Works, along with your Pre -Qualified Bidder Checklist and attachments.
If you have any further questions regarding this matter, please call this office at (574) 235-9251 .
Sincerely,
Linda A Martin, Clerk
GAR), A. GjLOT DAvID P. RELOS Ei,IZABL'm A. MARADIK JAWS A. MUELLER Ti iERESE, J. DORAIJ
ZIOLKOWSKI
INN", 11"',
Construction, Nnc.
General construction & Design/Build
BtAilding StrMig ROW11011,011JU Since 1,974
October 9, 2018
City of South Bend
Subject: Operations Letter
Lafayette Building Skylight & Masonry Repairs
Dear Sirs:
Ziolkowski Construction, Inc. has been in business since 1974 and operated during that
period of time under that name only.
Ziolkowski Construction has not violated any federal, state or local laws, including
violations of contracting or antitrust laws, tax or licensing laws, environmental laws,
Occupational Safety and Health Act (OSHA) laws, federal Davis -Bacon Act laws, within
the past five years.
Ziolkowski Construction, Inc. is proud to employ the industry's top skilled craftsmen. We
have a core group of union craftsmen working on our projects and supplement that group
with trained skilled workers from the local union halls. We currently have sufficient
workers to perform the work that we are bidding for the above project.
All individuals performing work for Ziolkowski Construction, Inc. will be property
classified as employees under the federal Fair Labor Standards Act and in line with all
Indiana State and local ordinances.
Ziolkowski Construction, Inc, had no federal, state or local tax liens or tax delinquencies
in any of the preceding three tax years.
Respectfully,
ZIOLKOWSKI CONSTRUCTION, INC.
Bill Favors
President & CFO
Committed to professionalism and excellence for the benefit of our clients, employees, and shareholders.
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STATE OF I DIANA
OFFICE OF THE SECRETARY OF STATE
CERTIFICATE OF EXISTENCE
To Whom These Presents Come, Greetings:
I, Connie Lawson., Secretary of State of Indiana, do hereby certify that I mu, by virtue of the laws of the State of Indiana, the
custodian of the corporate records, and proper official to execute this certificate.
I further certify that records of this office disclose that
ZIOEKOWSKI CONSTRUCTION, INC.
duty filed the requisite documents to commence business activities under the laws of State of Indiana on December 11, 1978,
and was in existence or authorized to transact business in the State of Indiana on December 02, 2015,
I further certify this For -Profit Domestic 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.
In Witness Whereof, I have hereunto set my hand
and affixed the seal of the State of Indiana, at the
city of Indianapolis, this Second Day of December, 2015.
Connie Lawson, Secretary of State
197812-318 12015120203232
Busiress Brtii"tyReportBiling
I s:l/sec re.i .gov/sos/bus ser�ricelanline corps/carp reporycota
Business Entity Report Filing
1Vame Searched On.
Zioli owski (Legal)
Current information
Ent& Legal !Rama.
ZXOL KOWSKI CONSTRUCTION, INC.
Entity Address.,
4050 RALPH TONES DU, SOUT" REND, IN 46628
General Entity Znformatlan:
Control Nurnber= 197812-318
Status: Active
Entity Type, For-Pe®fit Domestic Corporation
Entity Creation mate: 12111/1978
En�i gate to Bx ire:
Enti lGactive Gate:
other flames fcstdais Entity;
Date Name (Type)
12/11/1978 POWELL AND ASSOCIATES
(Assumed ST JOSEPH County)
(J
This entity is current with Business Entity Reports}. No filing is du® at this time,
If you encounter technical difficulties while using these services, please contact the IN,gov Webmaster
if you are unable to find the -information you need through the resources provided on this web site, pl
contact Secretary of State Connie Lawson's Business services Division at 317-232--6576.
<� Back to the SOS Web site
INDIANA BUSINESS ENTITY REPORT 7ndiana5errataryOfstate
10128/2014. .-27:70 AM
Filer Name Filer Title
BILL FAVORS PRESIDENT
Years Filed
20/412015
Entity name and current principal office address
ZIOLKOWSKI CONSTRUCTION, INC.
4050 RALPH JONE.S DR
SOUTH BEND, IN 46628
Entity Creation Cate bcrnicile State
121111197E . ] N'! l IANA
Entity Type
FOR -PROFIT DOMESTIC CORPORAT ]ON
Current- registered agent ,and registered address
BILL FAVORS
4050 RALPH JONIES DR
SOUTH BEND, IN 46620-1000
Current principal(s),and address(es)
PRESIDENT
BILL FAVORS
4050 RALPH JONES DR.
SOUTH BEND, IN 46628
VICE PRESIDENT
CHUCK LEWIS
4050 RALPH JONES DR.
SOUTH BEND, IN 46628
Page: l oE 1 Packet: 197812-318 DCH: 0141028{M1,[6
Business Name: ZIOLKOWSKI CONSTRUCTION, INC.
Entity Type: Domestic For -Profit Corporation
Creation Date: 12/11/1978
Principal Office Address: 4050 RALPH JONES DR, SOUTH BEND,
IN, 46628, USA
Jurisdiction of Formation: Indiana
BUSINESS INFORMATION
CONNIE LAWSON
INDIANA SECRETARY OF STATE
03/06/2018 01:33 PM
Business ID: 197812-318
Business Status: Active
Inactive Date:
Expiration Date: Perpetual
Business Entity Report Due 12/31/2018
Date:
Years Due:
Title
Name
Address
Vice President
Chuck Lewis
4050 Ralph Jones Dr., South Bend, IN, 46628, USA
President
Bill Favors
4050 Ralph Jones Dr., SOUTH BEND, IN, 46628, USA
President
Bill Favors
4050 RALPH TONES DR, South Bend, IN, 46628, USA
Type: Individual
Name; BILL FAVORS
Address: 4050 RALPH JONES DR, SOUTH BEND, IN, 46628 -1000, USA
APPROVED AND FILED
CONNIE LAWSON
INDIANA SECRETARY OF STATE
12/27/2016 04:07 PM
f
BUSINESS ID 197812-318
BUSINESS TYPE Domestic For -Profit Corporation
BUSINESS NAME ZIOLKOWSKI CONSTRUCTION, INC.
PRINCIPAL OTFICE ADDRESS 4050 RALPH JONES DR, SOUTH BEND, IN, 46628, USA
YEARS 201612017
NAME BILL FAVORS
ADDRESS 4050 RALPH JONES DR, SOUTH BEND, IN, 46628 -1000, USA
TITLE
Vice President
NAME
Chuck Lewis
ADDRESS
4050 Ralph Tones Dr., South Bend, IN, 46628, USA
TITLE
President
NAME
Bill Favors
ADDRESS
4050 Ralph Jones Dr., SOUTH BEND, IN, 46628, USA
TITLE
NAME
ADDRESS
President
Bill Favors
4050 RALPH ,TONES DR, South Bend, IN, 46628, USA
-I>-7 F`f-
APPROVED AND FILED
CONNIE LAWSON
INDIANA SECRETARY OF STATE
12/27/2016 04:07 PM
IN WITNESS WHEREOF, THE UNDERSIGNED HEREBY VERIFIES, SUBJECT TO THE PENALTIES OF PERJURY, THAT THE
STATEMENTS CONTAINED HEREIN ARE TRUE, THIS DAY December 27, 20I6
SIGNATURE Bill Favors
TITLE
President
Business ID., 197812-318
Filing No.: 7464509
-P.-7of? -
form SSC p! +
STAVE OF INDIANA
OFFICE OF THE SECRETARY OF STATE
CERTIFICATE OF INCORPORATION
OF z
ZIOLKOVSKI CONSTRUCTION, INC
I, EDWIP J SIMCOX Secretary of State of the State of Indiana, hereby eevliffr that
Artieles of taeorporatrort of the above Corporation, in lhefor- n prescribed b1I nryoffice, prepared and signcd ill
duplicate by the incorporator(s}, and acknowledged and verified by the saute before' et .Votury Public. Itu ve in,,r
presented to meat my office aceornpan ied bythefees 1wescribedby tart, that Ihavefound sueh et rtirtvs con fc>rrrt to
law that 1have endorsed my approval upon the duplicate eopieti of such Articles; that all fees here bec-n pct id at,
-�-egtcir'etd by 1mv; that one copy of such A rlicles has been filed in my office; and that the remain ing ropy C,i such
Articles bearing the endorsement of my approval and filinghas been returned by »veto the inrorporator(L) orhi
(their)•r•epresentatives; all n&presrribedbythe pmvisiensofthe .I6914WODISRAL, CORPORATION, ACT— ..
. ............. .... , cts amended.
NOW. THERE FORE, I hereby issue to sash Corporation this Certificate of Incorporation, card frcrtlr:-rc�'r trfrf
that its Corporate existence has begun.
/it K'itrtess 711hereof, I have herewav srt my hat;d apd affixed
the seal of the State of Indiana, at the City of Indiampolis,
this ---- ........ ..........T1th---- .... ., —.- .. ... ..........day of
.pec'emher--_..___ .., tg..76.
Secretor}- of State ,
S
�.
Dorf =E
I
r
NOTE: This form .may now also be used for incorpor Corporate Form No, 101 (Jan. 19n)—page one
'rating pursuant to the Medical Professional Corpora. ARTICLES OF INCORPORATION
tion Act, the Dental Professional Corporation Act, and
the Professional Corporation Act of 1965, as well se harry A. Conrad, Secretary of Stale of Indiana
the General Corporation Act, if the corporation is to
be formed pursuant to the authority of one of these Use white Paper—Site8'!r x 1l-1"or Inserts
statutes other than the General Corporation Act, so
Indicate In the preamble below by striking the refer. Filing Requirements -•-Present 2 originally signed and
encestothe threeInappropriate statutes. Professional fully exeeuted copies to Secretary of State. Room
Accounting Corporations are considered to he formed 155, State House, Indianapolis 46M
pursuant to the authority of the Indiana Genera! Recording Requirements ---Recording of Articles of
Corporation Act, but subject to the provisions of 10
Incorporation in the office of the Count Ftttorder
23.1-13.6, and appropriate statutory referent* should fM Y
he made in the preamble or Article N below. is no longer required by the Indiana General
Carporation Art.
ARTICLES OF INCORPORATION ' e .D
OF .
ZIOLKOWSKI CONSTRUCTION, INC',
•..rr. .rr•.......r ............................... .......................... ............. ............................... ... ...... •.-ii 1f=.. .,. <.
. •ice'~' • �-� .• L:: .: ! `a.,
The undersigned incorporator or irycorporators, desiring to form a corporation (hereinafter referrtc) to as the
"Corpora(ion") pursuant to the provisions of the Indiana General Corporation Act (Medical f'rofessivnal Corporation Act/
Dental Professional Corporation Ac(/Professional Corporation Act of 1965), as amended (hereinafter referred to as the "Act").
execute the following Articles of incorporation,
ARTICLE I
Lazne
ZIOLKOWSKI CONSTRUCTION, INC.
Tire name of the Corporation is......................................................................................... ------------
ARTICLE 11
Purposes
The purposes for which the Corporation is formed are:
The transaction of all lawful business.
f (corporate Form No. IOI--Wage Two
•Prescribed by Larry A. Conrad, Secretary of State
(Jan. 1977)
ARTICLE III
Period of Existence
Th% period (litriq whieli tli4 corporation Shalt continue is ........ pCCpt?tu�I�.....................................
ARTICLE IV
Resident Agent and Principal Office
Section I . Resident Agent. The natttc and a dress of the Corporation's Resident Agent for service of proc:ev,
e... is llC4�u ki................. ...1005 S.L.afa et.te Street
is......... . .... ...... ..
{\�mel {humrrr and Strret o.--#tu�tJ:�t1
South Bend Indiana
....... ............. .......................... ................... .... ._..,............4.6624 - ...
(C11yt (sim) (Lp cc.fti•.,..
Section 2. Principal Office. The post office address of the principal office of the Corporation is,...
1005 S, Lafayette Street South Bend Indiana 46624
....-•............................................................
G%'. Cf snd Sifm or Doi]dWO (Cityt (SMC) temp cc,1r)
ARTICLE V
Authorized Shames
Section 1, Number of Shares:
The total number of shares which the Corporation is to have authority to issue is a, 000
lit L P.f �1ia �ri7i�� lip tornn� Finn rf_ a -ates as haviDg nary VAlle is
B. The number of authorized shares which the corporation designates as without par value is 1, 000
Section 2. TeTms of Shares (if any):
Norte
f ' Corporate Form No. I03---)'age Three
Prescribed by Larry A. Conrad, Secretary of Stale
(.fan. 1977)
ARTICLE V1_
Requirements Prior To Doitiff Bushiess
The Corporal ioti will not commence. business until consideration of the Value cif at least S I'(){]() (one thou"and
dollars) has been received for the issklance of shares.
ARTICLE V11
Director (s)
§ection I. Number of Directors. The initial Board of Directors is composed of_....._.�.....,.... member(s).
The ttt}l0cr of directors rmly be [iron) tints to time fixed by the By -Laws of the Corporation at any nunibcr,
ja the nhcnnco of rMY-Law fixi., tho numbeg of diRaGWFS,
Section 2. Names and Post Office Addresses of the Director(s): The name(s) :end post office addresses)
of the initial Board of Director(s) of the Corporation is (are) ;
Name Number and Street or building City
Ben Zialkowski 1005 S. Lafayette Street South Bend
Roberta Ziolkowski 1005 S. Lafayette Street South Bend
Section 3. Qualifications of Directors (if any):
Norse
State Zip Code
Indiana 46624
Indiana 46624
•
T Corporate Farm No. 101—Page Four
Prescribed by Larry A. Conrad, 5ecretuy of Statr
Gi a". 19771
ARTICLE VIII
Incorporator(s)
The name(s) and post office addresses) of the incorporator(s) of the Corporation is (art):
Name Number and Street or Building City State Zip Code
Ben Zioikowski 1005 S. Lafayette Street South Bend Indiana 46624
ARTICLE IX
Provisions for Regulation of Business
and Conduct of Affairs of Corporation
("Powers" of the Corporation, its directors or Shareholders)
Section 1, ` All shares of this corporation Issued prior to June 30, 1979, shall he
"Section 1244" stock, and shall be issued by the corporation pursuant to a certain plats
adopted by it for the purpose of so qualifying!. On or after Tune 30, 1979, the shares of
this corporation may be issued for such consideration and upon such terms as the Directors
may from time to time determine. -
IF
Corporate Form No. 101—Page Five
Prescribed by Larry A. Conrad, Secretary of State
(Jan. 1977)
IN WITNESS WHEREOF, the undersigned, being all of the incorporator(s) designated in Article '111,
execute(s) these Arts a of Incorporation and certify to the truth of the facts hereirt stated, this
day of , 19 78 .
(walten srgnalurc} {LLMIM Sljrnziuret
Ben Ziolkowski
............................ _......... .........................
(t'rintrd Signature) (Printed Sijnatutn)
...._.................................._._..........._...,,.,......•..
Wrwrn $rfniture)
.._................. ...............................
41'nntrd Srgnttulri
STATR OF INDIANA
ss:
COUNTY OF...St....TPseF h........
I, the undersigned, a Notary Public duly commissioned to take acknoveiedgenients and athninister oaths
in the State of Indian,i, certify that_.. ........... 13er1 Ziolkowski txin,
.................................................of the incorporator(s) referred to in Article Ville of the forccoing
Articles of Incorporation, personally appeared before u)e; acknowledged the execution thereof; and swore io the
truth of the facts therein stated.
`] Lam` /f}
Witness my band and Notarial Seal this ............ ....-----
...-------- clay of_........
r� ..��t,f1�,f.--....,
{LYrtrtra 5arttatwr3 -� .� ,
Georgia A. Liridorf
.............................................. .......... ....--•
iPeirtteJ Sig"sturrl
residing in St, Joseph County, Indiana
My Cont"ssion Expires: Notary Public
2-18--80
This instrument was prepared by ................ non G, Blackrnond —, Attorney at Law,
126 S, Scott Street South Bend Indiana 46625
......... .........................I".......................... ... ....... .................. ....
._........._.... Cafe= -
(
Number (humber ROd Strcrt nr $! (City)
Adrienne C. Stevenson
Vice President
Marsh USA Inc.
540 West Madison Street
Chicago, IL 60661-3530
adr1enne.c.stevenson@marsh,corn
+1 312 627 6772
www,marsh.com
October 9, 2018
Ptoject: Lafayette Building Skylight & Masonry Repairs
To Whom It May Concern:
Liberty Mutual Insurance Company (Liberty) is the surety for Ziolkowski Construction, Inc.
and Marsh USA, Inc. is their surety agent,
Liberty Mutual Insurance Company is listed on the Department of Treasury's Listing of
Certified Companies,
9=1
Liberty Mutual Insurance Company
Adrienne C. Stevenson
Attorney -in -Fact
hAARSH & McLEN NAN
a.EAID C01IMPA110ES
I., C.R. Hernandez -, a Notary Public in and for said County, do hereby
certify that Adrienne C. Stevenson as Attorney -in -Fact, who is personally
known to me to be the same person whose —name -ifs—subscribed to the foregoing instrument,
appeared before one this day in person, and acknowledged that they signed, sealed, and
delivered said instrument for and on behalf of
for the uses and purposed therein set forth.
Given under m hand and notarial sea] at my office in the City of _Chicago in said County,
this 22"V ffi— day of AMgust AD, 2018
otary
G R HERNANDEZ
Official Seal
Notary Public , State of Illinois
My Commission 10'res Jun 8, 2020
. . . .. ....
THIS -POWER OF ATTORNEY IS NOT VALID UNLESS IT IS PRINTED ON RED BACKGROUND.
This Power of Attorney limits the acts of those named hereln, and they have no authority to bind the Company except in the manner and to the extent herein stated.
Certiffcate No. 60555U0
Liberty Mutual Insurance Company
The Ohio Casualty Insurance Company West American Insurance Company
ROWER OF ATTORNEY
f(NCWN ALL PERSONS BY THESE PRESENTS. That The Ohio Casuatly Insurance Company is a corporation duty organized under the laws of the State of New Hampshire, that
Liberty Mutual Insurance Company Is a corporation duly organized under the laws of the State of Massachusetts, and West American Insurance Company is a corporation duly .
organized under the laws of the Stale of Indiana (herein collectively called lhe'Companles'), pursuant to and by authority herein set forth, does hereby name, constitute and appoint,
John K. Johnson; Adrienne C. Stevenson; Triniv Garcia; C. R. Hernandez; Gabriel Jacguex
ali of the city of CHICAGO state of IL each Individually If there be more than one named, its true and lawful attorney-in•fact to make, execute, seal, acknowledge
and deliver for and on its behalf as surely and as its act and deed, any and all undertakings, bonds, recognizances and other surely obligations, to pursuance of these presents and shall
be as binding upon the Companies as if they have been duly signed by the president and attested by the secretary of the Companies in their own proper persons,
IN WITNESS WHEREOF, this Power of Attorney has been subscribed by an authorized officer or officim.o€ the Companies and the corporate seals of the Companies have been affixed
thereto this 5th day of April 2018,
The Ohio Casually Insurance Company �
` Liberty Mutual Insurance Company �1
U ` 191J a� t�i2 tool Wesf mefiiGEIInn Insurance Company
STATE OF PENNSYLVANIA ss David M. Care , Assistant Secretary
€ 4J COUNTY OF MONTGOMERY
j On this 5th day of April 018, before me personally appeared David M. Carey, who acknowledged himself to be the Assistant. Secretary of Liberty Mutual insuranco cap-
[( O .(D Company, The Ohio Casually Company, and West American Insurance Company, and that he, as such, being authorized so to do, execute the foregoing instrument for the purposes y40)
€ therein contained by signing on behalf of 1he.corporations by himself as a duly authorized officer. LLA
asLC > :IN WITNESS WHEREOF, l have hereunto subscribed my name and affixed my notarial seal at King of Prussia, Pennsylvania, on the day and year first above written q CL
p PAST COMMONWEALTH OF PE_NNSYLVANIA
�� o��aelw� �t� Notarial Seat
'�} Toresa Pastelist, Notary Public By:
- of Lipper McrionTwp, Montgomery Counly _ Teresa Paslelia, Notary Public -
My Commission Expires March 28, 2021 - � _ - fit
MasnlsaL Pcnnsylvamo ASswaifnn at NuLrulas - � � � � � � 0 E
I W This Power of Attorney is made and executed pursuant to and by authority of the following By-laws and Authorizations of The Ohio Casualty Insurance Company, Liberty Mutual. ,U_t 0
insurance Company, and West American Insurance Company which resolutions are nowise full force and effect reading as follows:.
ARTICLE W—OFFICERS -- Section 12. Power of Attorney Any officer or other olfrcial of the Corporation authorized for that purpose in writing by the Chairmani or the President, and subject 0 r'
to such limitation} as the Chairman or the President may prescribe, shall appoint such attorneys•in-fact, as may be necessary to act in behalf of the Corporation to make, execute, seal,'
CE acknowledge and deliver as surety any and all undertakings, bonds, recognizances and other surety obligations. Such attorneys -in -fact, subject to the limitations set forth in their respective
E powers of attorney, shall have full power to bind the Corporation by their signature and execution of any such instruments and to attach thereto the seal of the Corporation. When so w
o m executed, such instruments shall be as binding as it signed by the President and attested to by the Secretary. Any power or authority granted to any representative or attomey-in-fact under >'0
'4- '- the provisions of [his article may be revoked at any lime by the Board, the Chairman, the President or by the officer or officers granting such power or authority. 0
cv
ARTICLE X111 Execution of Contracts - SECTION 5. Surely Bonds and Undertakings, Any officer of the Company authorized for that purpose in willing by:lhe chairman or the president, OP
E .and subject to such limitations as the chairman or the president may prescribe, shall appowl such altomeys-in-fact, as may be necessary to act in behalf of the Company to make, execute, I
o � seat, acknowledge and deliver.as surely any and all undertakings, bonds, recognizances and other surely obligations. Such attorneys -in -fact subject to the limitations set forth in their E o?
Z 0 respective powers of attorney, shall have full power to bind the Company by their signature and execution of any such instruments and to attach thereto the seal of the Company. When so v 0
executed such instruments shall be as binding as if signed by the president and attested by the secretary, 0 to
Certificate of Designation — The President of the Company, acting pursuant to the Bylaws of the Company, authorizes David M. Carey, Assistant Secretary to appoint such atlomsys-in-
fact as may be necessary to act on behalf of the Company to make, execute, seal, acknowledge and deliver as surely any and all undertakings, bonds, recognizances and other surety
obligations.
Authorization — By unanimous consent of the Company's Board of Directors, the Company consents that facsimile or mechanically reproduced signature of any assistant secretary of the
Company, wherever appearing upon a certified copy of any power of attorney issued by the Company in connection with surely bonds, shall be valid and binding upon the Company with
the same force and effect as though manually affixed,
1, Renee C. Llewellyn, the undersigned, Assistant Secretary, The Ohio Casualty Insurance Company, Liberty Mutual Insurance Company, and West American Insurance Company do
hereby codify that the original power of attomey of which the foregoing is a full, true and correct copy of the Power of Attorney executed by said Companies, is in full force and effect and
.:has not Won revoked.
IN TESTIMONY WHEREOF, I have hereunto set my hand and affixed the seals of said Companies Ihis2.2nd day of A20J8____—
s iesy o 1<atz b tti�i 4 By. Renee C,Lle ssislantSecfetary
83 of 250
LMS_12873_022017
El
SECTION I EXPERIENCE QUESTIONNAIRE
1. What public works projects hass your organization completed for the period of one (1) year prior to the
date of the current bird?
Contract Amount
Class of Work
Completion
Date
Name and Address of Owner
$27,366,910
General
05/2016
Purdue University North Central
$21,355,975
General
06/2015
Armed Forces Reserve Center
$9,020,000
General
10/2016
South Bend Airport- New Arrivals Term
$15,964,580
General
12/2016
Renaissance District - Phase I
2. What public works projects are now in process of construction by your organization?
Contract Amount
Class of Work
Expected
Completion
Bate
Name and Address of Owner
$6,528,402
General
6/2018
UND Walsh Hall Selective Renovations
$5,139,150
General
8/2018
Laporte High School - Performing Arts C
$13,208,000
General
8/2019
aporte Intermediate on the Kesling Cam
$3,472,000
General
8/2018
PHM Schools - Football Stadium Irnprov
al
nter
is
ments
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.
University of Notre Dame, Tony Polotto, LEER, AP, 200 Facilities Bldg., Notre Dame, IN 46556 574-631-4200
City of Mishawaka, Ken Prince, 600 East Third Street, Mishawaka, IN 574-258-1625
Fetters Construction Inc., Steven A. Fetters, 5417 County Rd 427, Auburn, Indiana 46706 260-927-8516
Memorial Hospital & Health System, Larry Lies, 615 N Michigan St., South Bend, IN 46601 574-647-1000
ry. Ya s++s
Verl
2ren �s a.rn�,r ere a.v s:a
Company ID Number: 486671
THE E-VERIFY PROGRAM FOR EMPLOYMENT VERIFICATION
MEMORANDUM OF UNDERSTANDING
ARTICLE
PURPOSE AND AUTHORITY
This Memorandum of Understanding (MOU) sets forth the points of agreement between the
Department of Homeland Security (DHS) and Ziolkowski Constrnction, Inc. (Employer)
regarding the Employer's participation in the Employment Eligibility Verification Program (E-
Verify). This MOU explains certain features of the E-Verify program and enumerates specific
responsibilities of DHS, the Social Security Administration (SSA), and the Employer. E-Verify is
a program that electronically confirms an employee's eligibility to work in the United States after
completion of the Employment Eligibility Verification Form (Form 1-9). For covered government
contractors, E-Verify is used to verify the employment eligibility of all newly hired employees and
all existing employees assigned to Federal contracts or to verify the entire workforce if the
contractor so chooses.
Authority for the E-Verify program is found in Title IV, Subtitle A, of the Illegal Immigration
Reform and Immigrant Responsibility Act of 1996 (IIRIRA), Pub. L. 104-208, 110 Stat. 3009, as
amended (8 U.S.C. § 1324a note). Authority for use of the E-Verify program by Federal
contractors and subcontractors covered by the terms of Subpart 22.18, "Employment Eligibility
Verification", of the Federal Acquisition Regulation (FAR) (hereinafter referred to in this MOU as
a "Federal contractor with the FAR E-Verify clause") to verify the employment eligibility of
certain employees working on Federal contracts is also found in Subpart 22.18 and in Executive
Order 12989, as amended.
ARTICLE II
FUNCTIONS TO BE PERFORMED
A. RESPONSIBILITIES OF SSA
1. SSA agrees to provide the Employer with available information that allows the Employer to
confirm the accuracy of Social Security Numbers provided by all employees verified under this
MOU and the employment authorization of U.S. citizens.
2, SSA agrees to provide to the Employer appropriate assistance with operational problems that
may arise during the Employer's participation in the E-Verify program. SSA agrees to provide
the Employer with names, titles, addresses, and telephone numbers of SSA representatives to
be contacted during the E-Verify process.
3_ SSA agrees to safeguard the information provided by the Employer through the E-Verify
program procedures, and to lirnit access to such information, as is appropriate by law, to
individuals responsible for the verification of Social Security Numbers and for evaluation of the
E-Verify program or such other persons or entities who may be authorized by SSA as governed
Page I of 131 E-Verify MOLT for Employer I Rex islon Date 09/01/09 1Luww.dhs.rgov1E—Verify
va ,y5e[-4
b��lll�llr�
E' Hvm.ry is Aamunaratu ua aca
Company l® Number: 486671
To be accepted as a participant in E-Verify, you should only sign the Employer's Section
of the signature page. If you have any questions, contact E-Verify at. 888m464-4218.
Employer Ziolkowski Construction, Inc.
Bill Favors
Name (Please Type or Print)
Electronicall Sinned
tle
�111012012
Signature
Date
Department of Homeland Security — Verification Division
SCIS Verification Division
Name (Please Type or Print)
Signed
T011110/2012
oElectronicall
Signature
date
Information Required for the E-Verify Program
Information relating to your Company:
Company Name:
iolkowski Construction, Inc.
Company Facility Address:
4050 Ralph Jones Dr.
kouth Bend, IM 46628
Company Alternate
Address:
County or Parish:
STJOSEPH
Employer Identification
Number:
P61445992
Page 12 of 13 1 E-Verify NOU for Employer I Revision Date 09/01109 wvuw.dhs.gov/E-Verify
5Ft
� C�i1:RTR a5(11�� n! nRt s1x tLy
Company I® Number: 486671
North American Industry
Classification Systems
Code:
236
Administrator:
Number of Employees:
100 to 499
Number of Sites Verified
for:
1
Are you verifying for more than I. site? If yes, please provide the number of sites verified for
in each Stage:
0 INAIANA 1 site(s)
--information relating to the Program Administrator(s) for your Company on policy
questions or operational problems:
Name: .lames Keldsen
Telephone Number: (574) 287 -1811 ext. 368 Fax Number: (574) 344 - 5533
E-mail Address: jkeldsen(a)zbuild.com
Page 13 of 131 E-Verify MOU for Empfoyer I Revision Bate 09/01/09 Ennpm.dhs.gov/E-Verify
6fJ212017 E Verify: Employer Wizard -Company Information
E-Verify
Welcome
James Keldsen
Company information
Company Name
Ziolkowski Construction, Inc.
i Company iD Number
486671
Doing Business As (DBA} Name
4 UUNSNumber
+ Physical Location
Address 1
4050 Ralph Jones Car.
Address 2
Cdy
South Bend
State
IN
Zip Code
46628
County
i STJOSEPH
Mailing Address
Address 1
Address 2
City
state
Zip Code
Additional Information
Employer identification Number
351445992
Total Number of Employees
10010499
Parent Organization
Administrator
Organization Designation
Employer Category
None of these categories apply
View! Edit
NAICSCode
236 - CONSTRUCTION OF BUILDINGS
View 1 Edit
Total Hiring Sites
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