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Opening of Bids - 2018 Demolitions Project No 118-307 - Indiana Earth Inc
B!D/PROPOSAL��� CITY OF SOUTH BEND 4, Project Name: 2018Demolitions Project Number: 118-307 For Bids Due: November 13, 2018, 9:30 AM Local Time DIVISION A: Asbestos Item Description Abatement Demolition Total Amount No. LSUM LSUM- A-01 Demolition of 721 S Lake St. House, Garage, and Fence $ $ %`.4-V, $ Demolition of 2614 Fisher St. A-02 House **Duct $ I dGt�_ - $ �Lf.uco $ /5 i �loU. Tape . Demolition of 805 S Phillipa St. A-03 House and Garage g $ I, yy D - $ p,. $ o� U) 4`lv. 00 ct Wra , - tA-04 olition of 228 E Donald St. tHouse,Garage, Fences $ 93C7. - $ %,wcq - $ 7, urnace Ta a Onlolition A-05 of 225 Chestnut St. House, Garage, Fence $ $ 1 S, vim, _ $ A-06 Demolition of 314 Maple St. House $ $ j q, dvo-_ $ % Q, a00, o C rA-O8 Demolition of 933 S 33rd St. House and Garage $ $ ��+voo _ $ IS-, vJJ , G Environmental Allowance - - $ 10,000 DIVISION A TOTAL $ /� C�v© **Denotes Homes with Asbestos Material. Verify with inspections & reports for proper disposal, Bidder (Firm) Name: P, �, - 7''t DIVISION B: Asbestos Item Description Abatement Demolition Total Amount No. LSUM LSUM Demolition of 1418 W. Washington St. B-01 House $ ?00_ .- $ I �i� '76� _ $ %, SDU,oa Duct Wrap Demolition of 126 N Walnut St. B-02 House, Garage, and Fences ** $ �� _ $ III- $ `3) %Sa• ov Duct rap and Duct Tape B-03 Demolition of 319 N Johnson St. House, Garage, and Shed $ �� $ �, (7u�, $ l 7, %70 . pc) B-04 Demolition of 122 N Carlisie St. House and Fence $ $ ��,Sea . $ to, SW, oC) Demolition of 2022 Linden Ave. B-05 House, Garage, and Fence $ .3,s0,,.-. $ ds $ Demolition of 517 Walnut St. B-06 House "Black $ /)lVO.'" $'�' ?vC $ r �� CU Mastic Floors Version 7/20/2018 Contractor's Bid for Public Works - 7 BIDBID/PROPOSAL ---CITY OF SOUTH, Pr c1 Na' me: 2018 Demolitions Project Nurnber: 119-3 - For"BidsDue: a.ove��� �_�-�� 9:30 AM Local Time B 07 Demolition of 1123 Cedar St House and Fence $ 5 bo. _ $ Demolition of 706- 'BrlentSt. B-08 House Garage, and Fence **Duct Wrap and Rear Floor Covering $ ex_ — $ and Mastic Demolition of 723 Harrison Ave. B-09 House and Fence **Duct Wrap, Duct Tape, and Black $ //� _ $ /Y, -zoo $ S'j b-Oo Mastic with Floor Tile Sample B-10 Environmental Allowance - $ 10,000 DIVISION B TOTAL [!—,-�Y **Denotes Homes with Asbestos Material. Verify with inspections & reports for proper disposal. DIVISION C: Bidder (Firm) Name: .ZQ ,,,. T" Asbestos Item Description Abatement Demolition Total Amount No. LSUM LSUM C-01 Demolition of 2521 Hollywood Place House and Garage $ $ i �,ac��,, $ l4) aua. e0 Demolition of 1726 O'Brien St. C-02 House **Duct $ �� $ ! T �' _ $ , �l �� d� Wra and Duct Ta e C-03 Demolition of 1637 Elmer St. $ $! $ House , ���. l3, vw, v,3 Demolition of 2611 Humboldt St. C-04 House, Garage, and Fence $ �� r $ l0-�wo $ a, io00 Mastic with Floor Tile Sample O C-05 Demolition of 1137 N. Olive St. [House $ $ /6 $ �G, Wo .off Demolition of 810 Cleveland Ave. C-06 House and Fence $ Pipe Wrap Demolition of 1121 N. Elmer St. C-07 House ** $ �� ' ' $ , �'- - $�► Duct Wra Ta e, and D Wall C-08 Environmental Allowance - - $ 10,000 DIVISION C TOTAL $ .Sbo, Lb **Denotes Homes with Asbestos Material. Verify with inspections & reports for proper disposal'. Bidder (Firm) Name:o� Version 7/20/2018 Contractor's Bid for Public Works - 8 BID/PROPOSAL CITYOF Sid FB - f", F1' ilDcName: 2018 Demolitions flroju",RNYnFna:r: 118-307 rv..a. i a^fi: Due: Noeember13 2/t �@�6po ASBESTOS AB (required for Item No. Unit Pricing if Required Unit Add Per Unit Price Removal, Management, and Disposal of Linear Feet Duct Tape Material Containin Asbestos p II. Removal, Management, and Disposal of Square Feet $ Duct WrapMaterial Containin Asbestos c�®i •d� Removal, Management, and Disposal of III. Floor Tile and Mastic Material Containing Square Feet $ Asbestos IV Removal, Management, and Disposal of Square Feet $ Plaster Material ContainingAsbestos 7,go Removal, Management, and Disposal of V. Corrugated Sheet Material Containing Square Feet $ io Asbestos _off Removal, Management, and Disposal of w VI. Attic Insulation Material Containing Square Feet $ 7- Asbestos Bp Removal, Management, and Disposal of VII. Transite Siding Material Containing Square Feet $ �p 7. Asbestos Bidder (Firm): ? r, 4, u-,z k L-Q . Z, Address: /c � ,.� . 41 . City/State/Zip:�,,�� Telephone Number: By wM (Printed Name of Person Sighing) Y vr Version 7/20/2018 Contractor's Bid for Public Works - 9 9..-ug, ' G A CITY F SOUTHy UTH BEN® INDIANA krn " ,� 4, a ;a CONTRACTOR'S TR'S BID FOR PUBLIC WORK, Project Name 2018 Demolitions Project No. 118-307 For Bids Due November 13, 2018, 9:30 AM Local Time PART I _�..._.... _... (Must be completed for all bids. Please type or print) Date: Bidder (Firm): " Address: City/State/Zip: Yce-dq i Telephone Number: 5 7 7 Agent of Bidder (if Applicable): Pursuant to notices given, the public works project of: undersigned offers to furnish labor and/or material necessary to complete the 'Ins the City of South Bend, Indiana, in accordance with plans and specifications prepared by: and dated ., R for the sum of (enter the Total Bid as shown on the Proposal) F-o ` r Ay (En er sum of D ision R4TC) 40, " a. r �� (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 addendums attached will be specifically referenced at the applicable page. If additional units of material included in the contract are needed, a cost of units must be the same as that shown in the original contract if accepted by the City of Sout end. If the bi s to be awarded on a unit basis, the itemization of the units shall be shown on a se0a a attachment. The above bid is accepted this Subject to the following conditions: BOARD OF PUBLIC WORKS Gary A. Gilot, President Elizabeth A. Maradik, Member By r gnature) (, r rued t�a¢x�e of l�erson� Signin ) ACCEPTANCE day of 20 Suzanna M. Fritzberg, Member Therese J. Dorau, Member James A. Mueller, Member Attest: Linda M. Martin, Clerk Version 7/20/2018 Contractor's Bid for Public Works - 2 4w.y z 3 PARTAI (For•prgjpcts'cf $100,000 or rnom -- H."' i63-1-12-4) These statements to be submitted under oath by each bidderwith,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 contrast 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 Wh eir /heprarspeetliv +Con rac of is Unable air f of tilc "boo w, is shall affisch ,anr cxpla naarims, ray; rl'ar�,N ,=,JffJm,1�°. CONTRACTOR'S NON -COLLUSION ANDNON-DEBARMENT AFFIDAV19 , C"la.+,°I IFJCAT GN 'GI) G I ;STMENT' I'r � EM I,oY'MENT EI_,IGI I.1;I Y ,'�^ ERII, .1C'ATl(J 44,:1 k � A IISCRIVINATICN COMMIT ENTAND CERTIFICATION OF USE OFUNITED S'oI ATE & TEEL. PRODUCTS COIL FOUNDRY PRODUCTS (Must be completed for all quotes and bids. Please type or print) STATE OF .77KL ) SS: cS �. s"_ COUNTY ) The undersigned Contractor, being duly sworn upon his/her/its oath, affmrms 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: 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 aNcri,,nor retain ar ) chro with a'-�pe�•so�h t'�� at the Contractor.:u l�:�e���e�i�i��.� 9�,��°�����is -an-� ,Jnautliori�zed ����a,��.` Contractor agrees that he/she/it shall enroll in and verify the work JOjgibility status or all Of Contractor's a,pewly hired employees through the ]E;-Verify, Program as deti.neO by, I C. � .5,®g o7:,,3. Contractor's t�tropurr.»enta ion ofenji-011mera;t and pau-ticipgt on imthe Z-Verifyl)lrogra t is: included and attached as part n.f 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 Contractors Bid for Public Works - 5 + may result in forfeiture ofaontractual payments. I hereby affirm under the penalties of perjury that the facts and information contained n,the,foregoing bid for public works are true and correct. Dated this day of _ �c 201F r � m ���g pJ Contractor�I iclder ;»1� I SEAL Sig ire of Contr ctor/bidder or Its Agent NN 1'rtn ecl Name and Title Subscribed and sworn to before me this 3 day of 1, 20 My Commission Expires -7� No ary Public County of Residence Version 7/20/2018 Contractors Bid for Public Works - 6 1316 COUNTY -CITY BUILDING 227 W.JEFFERSON BOULEVARD SOUTH BEND. INDIANA 46601-1830 CITY OF SOUTH BEND PETE BUTTIGIEG, MAYOR BOARD OF PUBLIC WORDS October 2, 2018 Mr. Keith Stevens Indiana Earth, Inc. 10343 McKinley Hwy. Osceola, IN 46561 RE: Pre -Qualification Verification Dear Mr. Stevens: PHONE 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 M. Martin, Clerk GARY A. GILOT DAVID P. RELOS ELIZABETH A. MARADIK 3AMES A. MUELLER THERESE J. DORAU AIA CONTRACTOR: SURETY: (Name, legal status and address) (Name, legal status and principal place Indiana Earth, Inc. of business) North American Specialty Insurance Compa 10343 McKinley Highway 650 Elm Street his document has important legal Osceola, IN 46561 consequences. Consultation with OWNER: Manchester, NH 03101 an attorney is encouraged with (Vame, legal status and address) respect to its completion or City of South Bend modification. 227 West Jefferson Boulevard Any singular reference to South Bend, IN 46601 Contractor, Surety, Owner or BOND AMOUNT: ***FIVE PERCENT OF AMOUNT BID*** other party shall be considered plural where applicable. PROJECT: (Name, location or address, and Project number, if any) 2018 Demolitions 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 cof �l�itlg to hpch statutory or other legal requirement shall be deemed incorporated herein. When so furnished„ a intent is 0 l this Bond shall be construed as a statutory bond and a common law bond. Signe and sealed lhi., 13th day of November 211 India h , c (Sea d rtrae. ; l) M (Title) d, North ur AmericanSpecialty Insurance Com dtt r Hai ittlaa"Thomas O. Chambers. Attornev-In-Fr act In it. AIA Document A3101 — 2010. Copyright C 1963, 1970 and 2010 by The American Institute of Architects. All rights reserved. WARNING: This AIAe Document is protected by U.S. Copyright Law and International Treaties. Unauthorized reproduction or distribution of this AIAe Document; or any portion of it, may result In severe civil and criminal penalties, and will be prosecuted to the maximum extent possible under the law. t Purchasers are permitted to reproduce ten (10) copies of this document when completed, To report copyright violations of A Contract Documents, e-mail The American Institute of Architects' legal counsel, copyright@aia.org 05110 SWISS RE CORPORATE SOLUTIONS NORTH AMERICAN SPECIALTY INSURANCE COMPANY WASHINGTON INTERNATIONAL INSURANCE COMPANY GENERAL POWER OF ATTORNEY KNOW ALL MEN BY'l HESE PRESENT8 714A'T North American Specialty Insurance Company, a corporation duly organized and existing under laws of the States of New l'lampshiro, and having its principal office in the City of Overland Park, Kansas, and Washington International Insurance Company, a corporation organized and existing under the laws of the State of New Hampshire and having its principal office in the City of Overland Park, Kansas, each does hereby make, constitute and appoint: THOMAS 0. CHAMBERS, TODD SCHAAP and KIMBERLY S. RASCH JOINTLY OR SEVERALLY Its true and lawful Attorney(s)-in-Fact, to make, execute, seal and deliver, for and on its behalf and as its act and deed, bonds or other writings obligatory in the nature of a bond on behalf of each of said Companies, as surety, on contracts of suretyship as are or may be required or permitted by law, regulation, contract or otherwise, provided that no bond or undertaking or contract or suretyship executed under this authority shall exceed the amount of FIFTY MILLION ($50,000,000.00) DOLLARS This Power of Attorney is granted and is signed by facsimile under and by the authority of the following Resolutions adopted by the Boards of Directors of both North American Specialty Insurance Company and Washington International Insurance Company at meetings duly called and held on the 9 h of May, 2012: "RESOLVED, that any two of rice Presidents, any Managing Director„ any Senior Vice President, any Vice President„ any Amistant Vice President, the Secretary or any Assistant Secretary be, and cacti or any of them hereby is authorized to execute aPower of„Attorney qualil}rmg lite attorney named in the given Power of Attorney to execute oil behalf of the Company bonds„ undertakings and all contfacts of surcty„ and that each or any of them hereby isattthoraxed to attest to the execration of any such Power of Attorney and to attach therein Ilse .seal of the Company;, and it 'is PURTIlER RESOLVED, that the Signature ofsuch officers and the seal of the Company may be affixed to any such Power ofAttomey or to any certificate relating thereto by facsimile, and any such Power of Attorney or certificate hearing such fsacasirnile signatures or faesianale seal shall be binding upon the Company when so al"fixcd and in the future avids regard to any bond, undertaking or contract of surety to which it is attached." Mltrrva vsvatt,ahur°x; troatnr �, SEAL �ro BY g Company ao'� Ig' 1973 Steven P„ AWei son, Senior Vivo Preatdraa of %Voataln 'ton Inlornolaatnol Insurance Cam an 5s�� &Seoior Viet, President or Norlh American SPlaawtty Insurance Company r } ���Ylj�yk �tgtlta��" By _ h? Michael A. llo, Ic""nd Fw'lIC¢xri pEmi' n�u as ng ern mrp ruiswFoma esurnana�p tiarrpady ,V. & Senior Vice I'mideal or North American Specialty InsuranceCompany IN WITNESS WHEREOF, North American Specialty Insurance Company and Washington International Insurance Company have caused their official seals to be hereunto affixed, and these presents to be signed by their authorized officers this I Ith day of tpril 20IS . North American Specialty Insurance Company Washington International Insurance Company State of Illinois County of Cook SS: On this I Ith day of _ April 2018 before me, a Notary Public personally appeared ,.__ 5t yen P, Andersggw Senior Vice President of Washington International Insurance Company and Senior Vice President of North American Specialty Insurance Company and Idichael A. Ito Senior Vice President of Washington Intemational Insurance Company and Senior Vice President of North American Specialty Insurance Company, personally known to me, who being by me duly sworn, acknowledged that they signed the above Power of Attorney as officers of and acknowledged said instrument to be the voluntary act and deed of their respective companies. rJrMMI. wtAt Mg gMF.NNV '^ n'oM�a�ryP PuNdto • State ut hl8iau My Commit than rap4l M. Kenny, Notary Public � 11M1+FP"21 , I, ,l, rev C,oldb the duly elected a t Sccretaa of"North American Specialty Insurance Company and Washington International Insurance Company, do hereby certify that the above and foregoing is a true and correct copy of a Power of Attorney given by said North American Specialty Insurance Company and Washington International Insurance Company, which is still in full force and effect. IN WITNESS WHEREOF, I have set my hand and affixed the seals of the Companies this 13th day of November , 2018 Jeffroy Gotdheott, Vice. Nooldenl & Assistant Sam toay of W uhington too mitaaml. Insu=Co Company & North Anwokan Specially Im,munce Company STATE OF WISCONSIN ) COUNTY OF Racine ) ON THIS 13th day of November � 2018 before me, a notary public, within and for said County and State, personally appeared Thomas O. Chambers to me personally known, who being duly sworn, upon oath did say that he is the Attorney -in -Fact of and for the North American SpecialtySp2clalty Insurance Company a corporation of New Hampshire , created, organized and existing under and by virtue of the laws of the State of New Hampshire ; that the corporate seal affixed to the foregoing within instrument is the seal of the said Company; that the seal was affixed and the said instrument was executed by authority of its Board of Directors; and the said Thomas O. Chambers did acknowledge that he/she executed the said instrument as the free act and deed of said Company. - n�)-Il J'f "Addd), jac le Sheldon Notary Public, Racine County, Wisconsin My Commission Expires 4/13/2019 CITY OF SOUTH BEND, INDIANA Z;A :. CONTRACTORS BID FOR, PUBLIC. WORK r CHECKLIST FOR BIDDERS Project Name Project No. For Bids Due 2018 Demolitions 118-307 November 13, 2018, 9:30 AM Local Time 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. _Z Proper bid security included. The bidder has the option of providing either a Certified Check 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 Goal Form [MWBE-1.0]. If minimum participation goal is not met, also provide Evidence of Good Faith Efforts Form [MWBE-2.0] and MBE/WBE Contacted Form [MWBE-2.1 ]. Acknowledge Receipt of Q Addendum(s) included with the bid. All required additional information is included with the bid. Proposal statements and other affidavits all signed by the proper party with name either printed or typed underneath signature. f 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: .T,11 4.1a,"I'Ll�44 C �r Date: By Authorized Representative: Signature: Print Name & Title: Version 7/20/2018 Contractor's Bid for Public Works - 1 CITY OF SOUTH BEND Al d7%i�I.av4�� vY,l ?ina.l..1,ia;"r d.nw,.1q r4 i e:" • is a hIa`r��..§ R;er.�r?:.,_�•.�.�.; �`"», r�,N's+ � "�`".��P�" ,. ��" EVIDEMaSV .�� a„+"'�. ; :.Ru,t r.^��,,,µ°.,Pa g ye a r �'�a"� i, J;: t. .rr. ;1� qW " .�i... Tr e3e —. ar . �,ar as �o Crty.of South 13enr ".•.�"a.�Dlo;ai;"6C �'�lTm should be included as p�C� �e d�P6?• �eb�+� C;g, .� � �x �'« � ' h Works Projects requiring Good Faith `Efforts to obtain li���l..; y�iw e�s�rllc`spation® It is the bid er'4&:" aaie e: responsibility to verify whether any listed minority or woman bu iner-dimeets the qualifications of aAffnadt k, or Women's owned business as defined by the Indiana Departmdht,of•Administratiun ("IDOA" ). Project Number:-118-307 Date: Project Name: 2018 Demolitions Bidder: Contact Person:Telephone: G Address:+ t t 1 avant. City: I State: Zip: ;rG Email: C? /rD 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 ALL of the following Good Faith Efforts as listed in the table below*: EVIDENCE OF GOOD FAITH EFFORTS MBE/WBE LIST(S): The bidder reviewed the City of South Bend's Minority and Women Business 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 Ben1. equires that all perspective bidders complete no less than 2 of the following: 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 �L opportunities, and allow MBE/WBEs reasonable time to respond. D� 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. Utilize pre-existing services of available community organizations, small and/or disadvantaged business assistance offices and other organizations that provided assistance in the recruitment and placement of MBE/WBE firms. **Bidder must circle or otherwise notate which of the two (2) required actions were performed. GOOD FAITH NEGOTIATIONS: The bidder negotiated in good faith with interested MBE/WBEs, I / including providing such MBENVBE's with adequate information about the plans, specifications and other tf� requirements of the subcontract and did not reject MBE/WBEs as unqualified without sound business reasons based on a thorough Investigation of their capabilities. ff SMALL CONTRACT(S): The bidder selected specific portions of the work to be performed by b— MBE/WBEs in order to increase the likelihood of meeting the MBE/WBE goals (including breaking down contracts into smaller units to facilitate MBE/WBE participation) CONTRACT RECORDS: The bidder has maintained the following records for each MBE/WBE that has bid on the subcontracting opportunity: 1. Name, address, and telephone number; 2. A description of information provided by the bidder or subcontractor; and 3. A statement of whether an agreement was reached, and if not, why nc', including any reasons for concluding that the MBE/WBE was unqualified to perform the job. *Proper demonstration of Good Faith Effort requires your initials next to all of the above boxes. Any omissions shall be considered grounds for rejection of the bid by the Board of Public Works. The City of South Bend reserves the right to request additional information. Version 7/20/2018 Contractor's Bid for Public Works - 11 �N. Q.' w G w _N rR w0. � O C9 0 w MOOO�a �CCO)— my OOZZ NmwLL �a Omp -m } O F- W w V X. W w O � Z rQ O _z 5 N }; = c o Q d :2 in m co N F- � O C 0 n o QW `m m om �..: V Di c� n N m c v o v of ea m � a O m c o0 oa) 0 L o� U fA CL n W J i O� �p 12 m �= (D c X 0� 15 cCL m N i C N -� r 00 tiY t 2 E .� W -�( O w a m Z j c M C c,, - ,. ✓ c k (0 0 v a) E U) m W, co 0 N 0 N c 0 SOU a m IIrt1''I!d"A �„ y CITY r" IV�iii i�`,NI�� urIIRITY A ICI lBttIIII-S iEu w u .':� " : ;• ` , i Wf Ul,.�li yy �""�M, y E�i5� i� I,IRC GRAM. .. ri a ^ •µ 's � , .., FOR INIWBE-2.1 w r 1 r E r i ; J3E1WI3E CONTACTED This comglet d form should be�suppHtd.1,aith Bids -that pertain to City a !,k,�)'arts.s.�•li--n.61 i"''cfbtrc requirintV contacted MB&WBE._td,*bbt n, Good i Faith Efforts. It is:t coy,biidlerzzlt;0l'6�'roe 6nai.bi€i' .t`o!Verify , whether any listed minority or -woman business meets the qualifications iaf`a -Minority or, Womerft' owned business. o, PAGE --OF Project Number: 118-307 MBE/WBE Participation Goal Project Name: 2018 Demolitions Bidder: �� r ( i0n (rtle) (Date) atur'& MBE/WBE Firm �jd. "Truce M Owner or Contact at MBEM/BE Firm L1 0 Telephone: 57y_ a aC f_ �� 6 Fax: Email: TYPE OF WORK SOLICITED FOR THIS PROJECT: —PE RESULTS OF CONTACT WITH THE MBE/WBE FIRM: MBE/WBE Firm k� Owner or Contact at MBE/WBE Firm J, Telephone: J_ 7y . _ q„ 7 dj_ Fax: Email: TYPE OF WORK SOLICITED FOR THIS PROJECT: aim RESULTS OF CONTACT WITH THE MBEM/BE FIRM: Version 7/20/2018 Contractor's Bid for Public Works - 12 INDIANA EARTH, INC. 10343 MCKINLEY HWY OSCEOLA, IN 46561 Section 1 Public Projects completed: 1) Excavation & Utility —St Marys College, South Bend, IN $900,000 Fall 2017 2) Northwood High School Phase B — Nappanee, IN $168,900 Fall 2017 3) Excavation & Utility CR 38 —City of Goshen, IN $2,491,277 Spring 2018 4) Utility— Nappanee WWTP, Nappanee, IN $519,020 Summer 2017 Public Works in Process: 1) Northwood High School Athletic Center, Nappanee, IN $1,233,500 Fall 2018 2) Excavation and Utility — Laporte Intermediate School $1,531,400 Fall 2017 3) Excavation and Utility — Concord High School $451,100 Summer 2018 4) Excavation and Utility — Warsaw High School $612,400 Summer 2018 5) Excavation and Utility — Penn High School $219,400 Summer 2018 Completed all work awarded to our firm. References of Private Firms 1) Rieth Riley Construction 574-288-8321 2) Gibson Lewis LLC 574-259-8581 3) Larson Danielson 219-362-2127 4) Holladay Group 574-234-2073 5) Robert Henry Const. 574-232-2091 Section 2 Plan of proposed work 1) Pre -construction meeting 2) Mobilization 3) Removals and backfill basements 4) Place topsoil 5) Install seeing Subcontractors Utilized on Past Projects 1) Hydroseed — Osceola, IN, Hydro seeding 2) HydroTek — Nappanee, IN, Hydro seeding 3) Weaver Boos —South Bend, IN, Compaction Testing 4) Bob's Landscaping — Granger, IN, Sodding 5) JPR—South Bend, IN, Surveying 6) Rieth Riley —Goshen, IN, Paving Subcontractors to Utilize on this Project — Possible subs listed, will determine prior to contract approval 1) Hydro -seed List of our Equipment Owned: 1) 13 Excavators 2) 4 Dozers 3) 3 Dump Trucks 4) 2 Semi Trucks with dump trailers 5) 2 Rollers 6) 5 Loaders 7) 2 Skidsteers We have received pricing for services and materials by potential subcontractors. CITY OF SOUTH BEND, INDIANA CONTRACTOR'S BID FOR PUBLIC WGIRK IIII JI SIII° ON II nll „I W; IIII III1G;X)I I 1 1EG11K.1, ,IS,,, } Project Name 2018 Il ernolliit,liioins Project No. 118-307 For Bids Due November 13, 2018 Contractor Name: 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 II only. Section II acts as an application for pre -qualification. Submission of Section II 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 31 sl 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 5t S4 of the Pes1ronsible.M3iding, 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:.frorn whormthe 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 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 I. PRE -QUALIFIED BIDDER CHECKLIST' (a) Acknowled eats: (i) By checking this box, I hereby acknowledge that am a pre quelufii d b'idder with the City of South lWSend'and that I have met the ll�re,,.quaViflcatuon,r �,uHreiri eiit " nff in" the lasttiwelv&(12) months. A copy of my !pre... uualiii-fiucatioiii,jVeiirlf'I' tlon I' Item ff;e is attached.' 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; W (iv) M 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). Statement on staffing capabilities, including labor sources. This statement indicates and ensures I have sufficient employees or. staff to complete the work. It outlines how I intend to meet the staffing needs of the work. 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. 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 Zia PRE -QUALIFICATION CHECKLIST (F I E THAT AF ; N O �,P E�Q. LI.FIE ),,-t (a) Acknowledgements: (<i) By checking this box, I hereby acknowled,ge;1hat l am not a .prenqualified bidder With the City of South Bend, 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 aub-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). List identifying all former business names. 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 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 Written -staterneh't--of ahy, federal, state or localtax liens or tax delinquencies.dwed�,.' � to any federal, state or local taxing body in the preceding three years.,. _ -." List of projects of similar size and scope of work performed imall areas,,, including the State -of lndiana; within three-(3) years prior to the too hich;ithe-,Ibid.),,Is,.,,due. Date: (Sign Here) 7- (n6L qt- re (Print Name Here) 44 _7n C (Name of Company) //41-A (Address of Company) e"' let (City) .:rr (State) ® Y— 6 ?Lo, (Telephone Number) Version 7/20/2018 General Conditions - 10 X) . x • Indiana Earth has the crew and staff to complete this project. • Those that work on this project will be employees of Indiana Earth or of a hired subcontractor which are under all applicable state and federal laws and local ordinances. • Apprentice programs are managed through operator and labor unions that we are signatory with. • Drug testing is accomplished through the unions of operators, laborers and teamsters, for our employees. • Indiana Earths surety company is approved. • Projects similar to this one. o Indiana Department of Corrections o County Road 38 o Nappanee Waste Water Treatment Plant o St Mary's College o Northwood High School o Warsaw High School o Laporte Intermediate School o Concord High school o Penn High School o Portage, IN Police Station o Discount Tire of Warsaw o Pierston School o Bell Tire of South Bend o Bell Tire of Mishawaka o B and B manufacturing o Central Park in Mishawaka 10343 McKinley Hwy. ® Osceola, IN 46561 • (574) 674-6488 m FAX (574) 674-6480 Business Name: INDIANA EARTH, INC. Entity 1�pe: Domestic For -Profit Corporation Creation Date: 03/22/1990 Principal Office Address: 10343 MCI NLEY HWY., OSCEOLA, IN, 46561- 9756, USA Jurisdiction of Formation: Indiana BUSINESS INFORMATION CONNIE LAWSON INDIANA SECRETARY OF STATE 09/20/2018 07:33 AM Business ID: 1990031137 Business Status: Active Inactive Date: Expiration Date: Perpetual Business Entity Report Due Date: 03/31/2020 Years Due: Title Name Address President MARK L OSLER 10343 McKinley Hwy., Osceola, IN, 46561, USA Type: Individual Name: MARK OSLER Address: 10343 MCKINLEY HWY., OSCEOLA, IN, 46561- 9756, USA