HomeMy WebLinkAboutOpening of Bids - 2018 Demolitions Project No 118-307 - R&R Excavating Incyllati q'1' 7
BID/PROPOSAL '
CITY OF SOUTH BEND
Project Name: 2018 Demolitions
Project No: 118-307
For Bids Due: November 13, 2018, 9:30 AM Local Time
DIVISION A:
Item No.
Description
Asbestos
Abatement
Demolition
Total Amount
LSUM
(LSUM)
A-01
Demolition of 721 S Lake St.
$ 510.00
$ 21,000.00
$ 21,510.00
House, Garage, and Fence
Demolition of 2614 Fisher St.
A-02
House
$ 1,300.00
$ 29,000.00
$ 30,300.00
**Duct Ta e
Demolition of 805 S Phillipa St.
A-03
House and Garage
$ 1,540.00
$ 35,000.00
$ 36,540.00
**Duct Wrap
Demolition of 228 E Donald St.
A-04
House, Garage, Fences
$ 1,030.00
$ 28,000.00
$ 29,030.00
**Furance Tape Only
A-05
Demolition of 225 Chestnut St.
N/A
$ 22,000.00
$ 22,000.00
House, Garage, Fence
A-06
Demolition of 314 Maple St.
N/A
$ 28,000.00
$ 28,000.00
House
A-07
Demolition of 933 S 33rd St.
N/A
$ 28,000.00
$ 28,000.00
House and garage
=A-08Environmental
Allowance
$ 10,000
DIVISION A TOTAL $ 205,380.00
"Denotes Homes with Asbestos Material. Verify with inspections & reports for proper disposal.
Bidder (Firm) Name: R&R Excavating, Inc.
DIVISION B:
Item No.
Description
Asbestos
Abatement
Demolition
Total Amount
(LSUM)
Demolition of 1418 W Washington St.
B-01
House
$
900.00
$
34,000.00
$
34,900.00
**Duct Wrap
Demolition of 126 N Walnut St.
B-02
House, Garage, and Fences
$
1,050.00
$
29,000.00
$
30,050.00
**Duct Wrap and Duct Tape
B-03
Demolition of 319 N Johnson St.
$
800.00
$
35,000.00
$
35,800.00
House, Garage, and Shed
B 04
Demolition of 122 N Carlisle St.
N/A
$
28,000.00
$
28,000.00
House and Fence
B-05
Demolition of 2022 Linden Ave.
$
450.00
$
35,000.00
$
35,450.00
House, Garage, and Fence
Demolition of 517 Walnut St.
B-06
House
$
1,200.00
$
29,000.00
$
30,200.00
**Black Mastic (Floors)
Version 7/20/2018 Contractor's Bid for Public Works Forms - 7
pr,V'AW b
BID/PROPOSAL Am's .
Project Name: 2018 Demolitions
Project No: 118-307
For Bids Due: November 13, 2018, 9:30 AM Local Time
B-07 Demolition of 1123 Cedar St.
House and Fence $ 600.00 $ 30,000.00 $ 30,600.00
Demolition oO'Brien St.
13-08 House, Garage, and Fence $ 900.00 $ 29,000.00 $ 29,900.00
**Duct Wrap and Rear Floor Covering
B 09 House and Fence I $ 1,200.00 $ 35,000.00 $ 36,200.00
**Duct Wrap, Duct Tape, and Black
13-10 1 Environmental Allowance I$ 10,000.00
DIVISION B TOTAL $ 301,100.00
"Denotes Homes with Asbestos Material. Verify with inspections & reports for proper disposal.
Bidder (Firm) Name: R&R Excavating, Inc.
DIVISION C:
Item No.
Description
Asbestos
Abatement
Demolition
Total Amount
LSUM
(LSUM)
C-01
Demolition of 2521 Hollywood Place
N/A
$ 25,000.00
$
25,000.00
House and Garage
Demolition of 1726 O'Brien St.
C-02
House
$ 850.00
$ 30,000.00
$
30,850.00
**Dust Wra and Duct Tape
C-03
Demolition of 1637 Elmer St.
N/A
$ 28,000.00
$
28,000.00
House
Demolition of 2611 Humboldt St.
C-04
House, Garage, Fence
$ 700.00
$ 30,000.00
$
30,700.00
**Mastic with Floor Tile Sample
C-05
Demolition of 1137 N. Olive St.
N/A
$ 35,000.00
$
35,000.00
House
Demolition of 810 Cleveland Ave.
C-06
House and Fence
$ 600.00
$ 35,000.00
$
35,600.00
**Pi a Wra
Demolition of 1121 N. Elmer St.
C-07
House
$ 2,750.00
$ 35,000.00
$
37,750.00
**Duct Wra Tape, and Dry Wall
C-08
Environmental Allowance
$
10,000
DIVISION
C TOTAL
$
232,900.00
"Denotes Homes with Asbestos Material. Verify with inspections &
reports for proper
disposal.
Bidder (Firm) Name:
R&R Excavatin ,
Inc.
Version 7/20/2018 Contractor's Bid for Public Works Forms - 1$
BID/PROPOSAL
CITY OF SOUTH BEND
Pro ect Name: 2018 Demolitions
Project No: 118-307
For Bids Due: November 13 2018 8:0 AM Local Time
ASBESTOS ABATEMENT UNIT PRICING (required for all bids):
Item No..
Unit Pricing if Required
Unit
Add Per Unit Price
I
Removal, Management and Disposal of Duct
Linear Feet
$30.00
Tape Material Containing Asbestos
II.
Removal, Management and Disposal of Duct
Square Feet
$30.00
Wrap Material Containing Asbestos
Ill.
Removal, Management and Disposal of Floor
Square Feet
$10.00
Tile and Mastic Material Containing Asbestos
IV„
Removal, Management and Disposal of
Square Feet
$20.00
Plaster Material Containing Asbestos
Removal, Management and Disposal of
V.
Corrugated Sheet Material Containing
Square Feet
$10.00
Asbestos
VI,
Removal, Management and Disposal of Attic
Square Feet
$20.00
Insulation Material Containing Asbestos
VII
Removal, Management and Disposal of
Square Feet
$10.00
Transite Siding Material Containing Asbestos
Bidder (Firm): R & R Excavating, Inc.
_.............—.
Address: 2010 Went Avenue
City/State/Zip: Mishawaka, Indiana 46545 Telephone Number: 574-256-2467
BY _ w_
(Signature)
William H. Loudin President
(Printed Name of Person Submitting)
Version 7/20/2018 Contractor's Bid for Public Works Forms - 9
CITY OF SOUTH BEND, INDIANA
CONTRACTOR'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: 11 / 13 / 2018 Bidder (Firm): R&R Excavating, Inc.
Address: 2010 Went Avenue
City/State/Zip: Mishawaka, IN 46545 Telephone Number: (574 ) 256-2467
0%1 r01 4
:0865
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:
2018 Demolitions; Project No. 118-307
the City of South Bend, Indiana, in accordance with plans and specifications prepared by:
City of South Bend, Indiana
and dated October 2018 for the sum of (enter the Total Bid as shown on the Proposal)
See attached Itemized Pro osal & Below* ( See attached**
(Enter sum of Division A-C) (Numerical)
*Seven Hundred Thirty-nine Thousand Three Hundred Eighty Dollars $739,380.00**
The undersigned further agrees to furnish a bond or certified check with this bid for an amount specified in
the notice of the letting. If alternative bids apply, the undersigned submits a proposal for each in accordance
with the notice. Any addendums attached will be specifically referenced at the applicable page.
If additional units of material included in the contract are needed, the cost of units must be the same as that
shown in the original contract if accepted by the 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.
Byu�
('Signature)
William Loudin, President
(Printed Name of Person Signing)
ACCEPTANCE
The above bid is accepted this
Subject to the following conditions:
BOARD OF PUBLIC WORKS
Gary A. Gilot, President
Elizabeth A. Maradik, Member
James A. Mueller, Member
day of
Suzanna M. Fritzberg, Member
Therese J. Dorau, Member
Attest: Linda M. Martin, Clerk
Version 7/20/2018 Contractor's Bid for Public Works - 2
20
When the prospective Contractor is unable to certify to any of the statements below, it shall attach an explanation to this Affidavit.
CONTRACTOR'S NON -COLLUSION AND NON -DEBARMENT AFFIDAVIT, CERTIFICATION
REGARDING INVESTMENT WITH IRAN, EMPLOYMENT ELIGIBILITY VERIFICATION, NON-
DISCRIMINATION COMMITMENT AND CERTIFICATION OF USE OF UNITED STATES STEEL
PRODUCTS OR FOUNDRY PRODUCTS
(Must be completed for all quotes and bids. Please type or print)
STATE OF Indianamm- )
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 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).1 hereby
certify that I and all subcontractors employed by me for this project will use steel products or foundry
products made in the United States on this project if awarded. I understand I have an affirmative duty to
notify the City in my bid that my proposal does not include the use of steel products or foundry products
made in the United States. I understand it is my sole obligation and responsibility to provide a justification
to the City, subject to review and approval, why the cost of United States made steel or foundry products is
unreasonable. Prior to award and upon submission of bid which does not use steel products or foundry
products made in the United States, the City, through its director of public works, shall make a determination
if the price of United States made steel or foundry is unreasonable. I understand that violations hereunder
Version 7/20/2018 Contractor's Bid for Public Works - 5
may result in forfeiture of contractual payments.
EM
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 13 th day of Nov ' 2018
R&R Excavating, Inc.
Contractor/Bidder (Firm)
Signature of Contractor/Bidder or Its Agent
William Loudin, President
Printed Name and Title
Subscribed and swornto before me this 13th day of November 2018
My Commission Expires 9 / 28 / 2024 UAL
Notary Public Rebecca S. Black ston
County of Residence S t . Jose h
r REBECCA S. BLACKSTON'
;.`k
„ -``, Notary Public, State of Indiana
SEL„�'� St. Joseph County
My Commission Expires
Sepwmber M, 2024
Version 7/20/2018 Contractor's Bid for Public Works - 6
0,1111FAIA
Document A31 - 2011,
Bid Bond
CONTRACTOR:
(Name, legal status and address)
R & R Excavating, Inc.
2010 Went Avenue
SURETY:
(Name, legal status and principal place
of business)
Merchants Bonding Company (Mutual)
Mishawaka, IN 46545 West Des Moines, IA
OWNER:
(Name, legal status and address)
City of South Bend Board of Public Works
County -City Building Room 1316, 227 West Jefferson Blvd
South Bend, IN 46601
BOND AMOUNT:
Five Percent of the Total Bid ( 5% of Total Bid
PROJECT:
('Name, location or address, and Project number, if any)
2017 Demolitions; Project No. 118/307
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.
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 'bits 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 Owncr and Contractor to extend the titne 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 tern Contractor in this Bond shall
be deemed to be Subcontractor and the tern 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 shall be construed as a statutory bond and not as a common law bond.
Signed and sealed this 9th day of
November 2018
_....... ................ & R Excavating, Inc.
(Princie... (Seal)
.._...
" al
(Title) Williax�t Loud'tx, Presi ent
Merchants Bonlmg Company 4utual)
(Surety) (Seal)
(Title` t nlfr L. tea rtlia, A.tto in Fact _......._
CAUlI11�iOIIY. You shoulld sign an orIgimnal AJIA Contract IGrocumnneunt, on icllx tln'ls text aplP7tears Ginn RED. I�. Ainoirlgluxal assuuir°es that
charmges wlHII not The olb scured.
ocument A310111— 010, Copyrwght 1963, 1970 . by The Asv edcan Institute of Architects, AU rights reserved. R . „L
Init. ArA ty end 010 p served. yrd'Aftttgflan rinGs AntA"
urorectdrl by U.S. r"opor,auanreerll s P mca ht Law and Infeunatronall 't'yeatres. Unauthorized reproductIoun oar afhs rIbuuftrw of trrlfs MAC' IDoc�uu�eirnt, or
�yrUg
any rrorttoun of It, May .» uurt lion severe cIIAt and crllr nrunall peunallhles„ and wUP be prosecuted to the maallunnuuru esteunt possihie umnder tine mane.
T Purchasers are permitted to reproduce ten (10) copies of this document when completed. To report copyright violations of AIA Contract Documents, e-mail
The American Institute of Architects' legal counsel, copyright@aia.org. 061110
MERCHANTS
BONDING COMPANY
POWER OF ATTORNEY
Know All Persons By These Presents, that MERCHANTS BONDING COMPANY (MUTUAL) and MERCHANTS NATIONAL BONDING, INC.,
both being corporations of the State of Iowa (herein collectively called the "Companies") do hereby make, constitute and appoint, individually,
Barbara E Pearson; Cheryl E Alkire; Jennifer L Kasznia; Jordan M Scheiber; Mark E Wobbe; Megan E Riesenberg; Nicole L Bicknell; Sandra L
Junk; Theresa M Burns; Wesley L Mantooth; William J Cerney III
their true and lawful Attomey(s)-in-Fact, to sign its name as surety(ies) and to execute, seal and acknowledge any and all bonds, undertakings,
contracts and other written instruments in the nature thereof, on behalf of the Companies in their business of guaranteeing the fidelity
of persons, guaranteeing the performance of contracts and executing or guaranteeing bonds and undertakings required or permitted in any
actions or proceedings allowed by law.
This Power -of -Attorney is granted and is signed and sealed by facsimile under and by authority of the following By -Laws adopted by the Board
of Directors of Merchants Bonding Company (Mutual) on April 23, 2011 and amended August 14, 2015 and adopted by the Board of Directors
of Merchants National Bonding, Inc., on October 16, 2015.
"The President, Secretary, Treasurer, or any Assistant Treasurer or any Assistant Secretary or any Vice President shall have power and authority
to appoint Attorneys -in -Fact, and to authorize them to execute on behalf of the Company, and attach the seal of the Company thereto, bonds and
undertakings, recognizances, contracts of indemnity and other writings obligatory in the nature thereof."
"The signature of any authorized officer and the seal of the Company may be affixed by facsimile or electronic transmission to any Power of Attorney
or Certification thereof authorizing the execution and delivery of any bond, undertaking, recognizance, or other suretyship obligations of the
Company, and such signature and seal when so used shall have the same force and effect as though manually fixed."
In connection with obligations in favor of the Florida Department of Transportation only, it is agreed that the power and aut hority hereby given to the
Attorney -in -Fact includes any and all consents for the release of retained percentages and/or final estimates on engineering and construction
contracts required by the State of Florida Department of Transportation. It is fully understood that consenting to the State of Florida Department
of Transportation making payment of the final estimate to the Contractor and/or its assignee, shall not relieve this surety company of any of
its obligations under its bond.
In connection with obligations in favor of the Kentucky Department of Highways only, it is agreed that the power and authority hereby given
to the Attorney -in -Fact cannot be modified or revoked unless prior written personal notice of such intent has been given to the Commissioner -
Department of Highways of the Commonwealth of Kentucky at least thirty (30) days prior to the modification or revocation.
In Witness Whereof, the Companies have caused this instrument to be signed and sealed this 20th day of June 2018
«.wnM rrer�,
" ' «« gP0# ky* +`q' ",
Ate» cj `""• : �,�
MERCHANTS BONDING COMPANY (MUTUAL)
MERCHANT ' NATIONAL BONDING, INC.
, w
" 2003 11933 ' �
By
President
STATE OF IOWA
COUNTY OF DALLAS ss.
On this this 20th day of June 2018 before me appeared Lary Taylor, to me personally known, who being by me duly sworn
did say that he is President of MERCHANTS BONDING COMPANY (MUTUAL) and MERCHANTS NATIONAL BONDING, INC.; and that the
seals affixed to the foregoing instrument are the Corporate Seals of the Companies;
and that the said instrument was signed and sealed in behalf
of the Companies by authority of their respective Boards of Directors.
"�+�IA4 0 AUCIA K. GRAM
o Commission Number767430
?" My Commission Expires
" April 1, 2020
Notary Public
(Expiration of notary's commission
does not invalidate this instrument)
I, William Warner, Jr., Secretary of MERCHANTS BONDING COMPANY (MUTUAL) and MERCHANTS NATIONAL BONDING, INC., do hereby
certify that the above and foregoing is a true and correct copy of the POWER -OF -ATTORNEY executed by said Companies, which is still in full
force and effect and has riot been amended or revoked.
In Witness Whereof, I have hereunto set my hand and affixed the seal of the Companies on this i day of f
0.
« tv
1933Secretary
2003 .
POA 0018 (3/17)
CITY OF SOUTH BEND, INDIANA "
CONTRACTOR'S BID FOR PUBLIC WORK
CHECKLIST FOR BIDDERS
Project Name 2018 Demolitions
Project No. 118-307
For Bids Due 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.
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 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
X Form [MWBE-2.1].
X__ Acknowledge Receipt of 0 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: R&R Excavating, Inc.
By Authorized Representative
Signature:
Print Name & Title: William Loudin, President
Date: 11 / 13 /`2018
Version 7/20/2018 Contractor's Bid for Public Works - 1
PART II
(For projects of $100,000 or more — IC 36-1-12-4)
These statements to be submitted under oath by each bidder with and as part of his/her/its bid.
Attach additional pages for each section as needed.
SECTION I EXPERIENCE QUESTIONNAIRE
1. Attach information regarding projects your organization has completed for the period of one
(1) year prior to the date of the current bid. See attached.
2. Attach a listing of public works projects currently in process of construction by your
organization. See attached.
3. Attach information regarding any failure to complete any work awarded to you and the
location thereof. Not applicable.
4. Attach references from private firms for which you have performed work.
See attached.
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.) Per plans & specifications as directed by Owner.
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. See attached.
3. If you intend to sublet any portion of the work, attach the name and address of each
subcontractor, equipment to be used by the subcontractor, and whether you will require a
bond. However, if you are unable to currently provide a listing, please understand a listing
must be provided prior to contract approval. Until the completion of the proposed project, you
are under a continuing obligation to immediately notify the City of South Bend in the event that
you subsequently determine that you will use a subcontractor on the proposed project.
To be provided before Notice to Proceed.
4. Attach a listing of equipment you have available to use for the proposed project.
See attached.
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.
See attached.
Version 7/20/2018 Contractor's Bid for Public Works - 3
N
C
Q
3
CD
a
Q
`G
m
0
H
(D Z
c-i a)n 3
m m
D
(D a
r y
O
o_
td
L�7 co
m
m
m
In
r-
-----------------
rt z 3
w 3�
CD 0 rt
o m d
11)
0
H' O CD
O
O
a
• D
0
� y
0
a 'a
a 0CD
r
D0
O S.
rt m o
QQ l< �
m 0 0
rt c 0-
0 m
C m
�C a
a
oa
b w
o y
m 0
cn
n
....... mmwm . _....w
Goho
ri m o
m
O
rt 0 0
w 3c
n 0
rt 0 0
o
CD
?gym
0 0
0 o d
m m
0
v
0o
a
D
3
0
I-d
rn
N
0
w
v
CD
0
0
U!
o
S
y (n
am0
Ua3
5 am CD m
y (n a (nM -
tl)h
2.
M y
m �.
0 O
M_
m a
y. Q
Q m
y
q�
m G.
S
C W
3 (U
1 �
S
7 a1
_m
CD
30
o
o�
o co
'O
3 S
0 W
C 0
CL
C
CD
L4 n
0 0
CD
f! y
=r
S�
M.
c �
m �
=h
^' O
O �
N
oto
3 m
7 3
O m
O w
n
O
0 O
V! �
ic
Z
0
X
Z
Cv
C
<3n
mm-1
r, z
mNcn
qmc
XCA -Mi
cnx
0mW
�mo
�M
O)
m
v
m
7a
N
CITY OF SOUTH BEND
MINORITY AND WOMEN BUSINESS ENTERPRISE DIVERSITY
DEVELOPMENT PROGRAM
FORM MWBE-2.0
EVIDENCE OF GOOD FAITH EFFORTS ,86
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 MBE/WBE participation. It is the bidder's sole
responsibility to verify whether any listed minority or woman business meets the qualifications of a Minority
or Women's owned business as defined by the Indiana Department of Administration ("IDOA").
Project Number: 118-307 Date: 11 / 13 / 2018
Project Name: 2018 Demolitions
Bidder: R&R Excavating, Inc.
Contact Person: _Becky Blatkston Telephone: 574-256-2467
Address: 705 S. Beige Street
City: MishawakaState: — Indiana Zip: 46544
Email: beckyb@rrexcavating.com
To determine whether a bidder has demonstrated good faith efforts to reach the MBENVBE utilization goals set
forth in the City of South Bend Public Works Project Specifications, the City and its agencies, boards, or
commissions, REQUIRE ALL of the following Good Faith Efforts as listed in the table below":
EVIDENCE OF GOOD FAITH EFFORTS
�m mmMBE/WBE LISTS : The bidder reviewed the City of South O y 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).
mACTION (ADVERTISE/CONTACT): In order for your bid to be deemed responsive, the City of South
Beequires that all perspective bidders complete no less than 2 of the following:
Cl,)Attend all pre -bid meetings scheduled by the City to inform MBENVBEs of contracting and
subcontracting opportunities.
{Z Advertise in general circulation and/or trade association publications concerning subcontracting
fJ opportunities, and allow MBE/W'BEs reasonable time to respond.
3. Perform any and all necessary steps to provide written notice in a manner reasonably calculated
to inform MBENVBEs of subcontracting opportunities and allowed sufficient time for them to
participate effectively,
Utilize pre-existing services of available community organizations, small and/or disadvantaged
business assistance offices and other organizations that provided assistance in the recruitment
and placement of MBENVBE firms.
""Bidder must circle or otherwise notate which of the two (2) required actions were performed.
GOOD FAITH NEGOTIATIONS: The bidder negotiated in good faith with interested MBENVBEs,
2 including providing such MBE/WBE's with adequate information about the plans, specifications and other
7 requirements of the subcontract and did not reject MBENVBEs as unqualified without sound business
reasons based on a thorough investigation of their capabilities.
SMALL CONTRACTS : The bidder selected specific portions of the work to be y
O p p performed b
MBENVBEs in order to increase the likelihood of meetingthe MBENVBE goals (including breakingdown
contracts into smaller units to facilitate MBENVBE participation)
.............................................. __.........._. uu........—_.
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 not, including any reasons for
concluding that the MBENVBE 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
CITY OF SOUTH BEND�'"��"�'°�
MINORITY AND WOMEN BUSINESS ENTERPRISE DIVERSITY
DEVELOPMENT PROGRAM
FORM MWBE-2.1
MBE/WBE CONTACTED65
This completed form should be supplied with Bids that pertain to City of South Bend Public Works Projects
requiring contacted MBE/WBE 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: 118-307
Project Name: 2018 Demolitions
Bidd R&R Excavating, Inc.
By:W_Ir�� Secreta
inatur (Title)
AL:t:F1kri97MUM
Owner or Contact at MBE/WBE Firm
Telephone:
Fax:
TYPE OF WORK SOLICITED FOR THIS PROJECT. -
PAGE 1 OF 1
MBE/WBE Participation Goal
Email:
11/13/2018
Asbestos removal and Landscaping We did not have any response from
WBE/MBE contractors.
RESULTS OF CONTACT WITH THE MBE/WBE FIRM:
�d 3��►��l'3*dT%i1
Owner or Contact at MBE/WBE Firm
Telephone:
Fax:
TYPE OF WORK SOLICITED FOR THIS PROJECT:
RESULTS OF CONTACT WITH THE MBE/WBE FIRM:
Email:
Version 7/20/2018 Contractor's Bid for Public Works - 12
COMPLETED PROJECTS 2017-2018
OWNER
UNIVERSITY OF NOTRE DAME
CITY OF SOUTH BEND
PANZICA CONSTRUCTION
MCSHANE CONSTRUCTION
UNIVERSITY OF NOTRE DAME
CITY OF MISHAWAKA, INDIANA
UNIVERSITY OF NOTRE DAME
CITY OF MISHAWAKA, INDIANA
UNIVERSITY OF NOTRE DAME
CITY OF MISHAWAKA, INDIANA
CITY OF MISHAWAKA, INDIANA
PROJECT NAME
CAMPUS CROSSROADS BID PACKAGE 3
DEMOLITION OF 84 ABANDONED HOUSES
BEACON HEALTH & FITNESS CENTER
VA OUTPATIENT CLINIC
DEMOLITION OF FORMER ST JOE HIGH SCHOOL
TRINITY PLACE WATERMAIN
VARIOUS PROJECTS FOR CAMPUS CROSSROAD
DEMO OF STRUCTURE AT 1516 N MAIN STREET
WARREN GOLF COURSE REHAB
UNION STREET DEMOLITIONS
TRINITY PLACE PHASE IV
NOVEMBER 2018
CURRENT PUBLIC WORKS PROJECTS
OWNER PROJECT NAME
INDIANA DEPARTMENT OF TRANSPORTATION CLEVELAND ROAD BRIDGE REHAB: R-40170
INDIANA DEPARTMENT OF TRANSPORTATION 12TH STREET, MISHAWAKA REHAB: R-37503
REFERENCES FROM PREVIOUS PROJECTS
FIRM
CONTACT
UNIVERSITY OF NOTRE DAME
MR. DOUG MARSH
ADAMS ROAD DEVELOPMENT
MR. DAVID ECKRICH
RANS BUILDERS
MR. RYAN RANS
STERLING CONSTRUCTION
MR. LANCE SWANK
CITY OF SOUTH BEND
MR. TOY VILLA
MORTENSON-TONN & BLANK
MR. BOB LOPEZ
CITY OF MISHAWAKA
MR. GARY WEST
DLZ OF INDIANA
MR. BRAD DAILY
ABONMARCHE CONSULTANTS
DARYL KNIP
RIETH RILEY CONSTRUCTION CO., INC.
MR. GENE YARKIE
SUBCONTRACTORS FROM PREVIOUS PROJECTS
NAME
RIETH-RILEY CONSTRUCTION
P O BOX 1775
SOUTH BEND, INDIANA 46628
CLEAN AIR ENVIRONMENTAL
P O BOX 314
NORTH LIBERTY, INDIANA 46554
ACORN LANDSCAPING
3680 W. SAMPLE STREET
SOUTH BEND, INDIANA 46619
HYDROSEED, INC.
1320 THIRD STREET
OSCEOLA, INDIANA 46561
BERTSCH FRANK & ASSOCIATES
4630 W. JEFFERSON STREET
FT. WAYNE, INDIANA 46804
STATE BARRICADING, INC.
24963 U. S. 20
SOUTH BEND, INDIANA 46628
WORK PERFORMED
ASPHALT -CONCRETE PAVEMENT
ASBESTOS REMOVAL
LANDSCAPING, SEEDING
EROSION CONTROL
LANDSCAPING, SEEDING
EROSION CONTROL
CONSTRUCTION ENGINEERING
TRAFFIC CONTROL &
SIGNS
MISHAWAKA CONCRETE ASPHALT RECYCLE CONSTRUCTION MATERIALS
806 S. BEIGER STREET
MISHAWAKA, INDIANA 46544
WARNER & SONS LANDFILL
COUNTY ROAD 45
ELKHAT, INDIANA 46514
DLZ OF INDIANA
2211 E. JEFFERSON BLVD.
SOUTH BEND, INDIANA 46615
CONSTRUCTION DEBRIS DISPOSAL
CONSTRUCTION ENGINEERING
EQUIP #T 2016 PARTIAL EQUIPMENT LIST
1 LABOR
36 '99 Kom WA600 Whl Loader A52048
37 '95 Komatsu WA600 Loader A50038
38 '99 Kom WA600 Whl Loader A52055
39 1996 Komatsu PC 200 A71046
43 Bobcat Roller/Compactor
44 Case 1840 BobcatJAF0186639
45 2001 Case 1840 Bobcat #3651
65 D5K2 DOZER EKYY01042
6812004 Stlg Quad Dump Truck 53636
72 PC400LC-6 Excavator - 1999 A83060
78 '97 Komatsu WA600 Loader
wwwwW
92 Komatsu WA 500 Loader #A20931
99 2003 Bandit 3680 S/N 1421
101 Komatsu WA380 Loader A50468
102 938K Cat Loader SWL02533
1051Komatsu PC300 Excavator 83226
112 Kom D65EX 12 Crawler Dozer
113 Komatsu PC400 LC6 Exc A84023
114 Komatsu PC400 Excavator A80204
115 Komatsu PC-650 Excavator 20093
116 Moxy Truck MDL MT "Leah"
117 Moxy Truck MT40 "Lynne"
119 1992 Ingersoll SD70D Roller 5439
120 1997 Ingersoll Roller/Comp SD100152576
123 '99 Moxy MT40B "Kaye"
124 '99 Moxy MT40B "Harriet II"
125 Komatsu PC 138 Excavator 2247
126 D-8 CAT Dozer 7XM03672
127 Skid Steer - Ross' 70 XT JAF0371885
133 D5K2 DOZER CKYY01043
135 Moxy MT40B (#513139) "Jennifer"
136 Moxy MT40B (#513138) "Mary"
137 Komatsu PC 400 LC7 Excavator A86291
139 D5G LGP Serial #RKG1856 513104
144 Large Grinder "The Beast" 3680
145 WA600-3 Serial #A52031
149 D5K2 DOZER HKYY01041
wwwww...
227 T300 Bobcat Compact Track Loader
230 322 Cat Excavator (Old Warner)00750
231 Cat 420E IT Backhoe 01226
233 Kom PC400 HD-6 A84008
235 PC750LC-7 Excavator 20020
240 CAT 815 Compactor 9180516
244 Moxy Brittany
245 Moxy Courtney
246 I/R Roller SD199D
248 06 Komatsu PC228 #32319
249 Cat938G Loader 01582
254,07 Kom PC400 LC8 a88040
255 07 Kom PC400 LC8 87370
256112 D6K LGP Dozer ODHA02065
257 03 Kom PC228 USLC-3NO
......
258,1 Cat 740E Articulated Truck #1334
EQUIP # 2016 PARTIAL EQUIPMENT LIST
260 06 PC220LC-8 Exc w/10' arm/thumb
263 Komatsu WA500-6 Loader A92328
264 WA450-6 Loader 66022
301 1987 Ford Tandem Dump Truck
310 08 KW T800 Semi Tractor
510 Komatsu WA500 Loader A60025
515 2002 Moxy MT40B #513107 "Bogue"
516 2004 Case 40XT S#JAF400654
517 420 IT GP W/ ATTACHMENTS
wwW
526 PC210LC-6 Excavator K34439
539 Cat 304CCR Mini -Excavator SN OFPK03224
549 3680 Beast Recycler (Brock) 1252
551 850G LGP Dozer(Brock)JJG0253963
554 Kom WA450 Whl Ldr 2005
564 06 Cat D6R LGP Dozer WRG00333
574 D6K LGP Dozer DHA00504
583 04 Sterling Dump Truck 53641
588 04 Sterling Dump Truck 53637
594 Cat 740E Articulated Truck #1335
6101 Cat 950G II Whl Ldr s/n AXX01696
637 98 CAT GENERATOR SR4
639 KOMATSU WA 500-6 LOADER
641 PC88 Excavator
643 10 PC200 LC-8 Excavator was 259
www.Gibsonlns.com
t (800) 814-2122
I (800) 836-2122
9
South Bend, IN
Plymouth, IN
Indianapolis, IN
Fort Wayne, IN
Elkhart, IN
Kalamazoo, MI
November 9, 2018
City of South Bend Board of Public Works
County -City Building Room 1316
227 West Jefferson Blvd
South Bend, IN 46601
RE: R & R Excavating, Inc.
To Whom It May Concern:
It is our understanding that you have requested a surety reference letter from R & R
Excavating, Inc. First, we would like to provide you background information about us.
Merchants Bonding Company (Mutual)'s rating provided by A. M. Best is a Financial
Strength Rating of A and a Financial Size Category of Class VII.
We have been providing surety bonds for R & R Excavating, Inc. since 2016. We have
approved bonds for them covering jobs up to $30,000,000 and potential work programs
of $50,000,000.
Additionally, in compliance with the United States Department of Treasury's Listing of
Certified Companies, this letter will serve to confirm that at this time the surety
company Merchants Bonding Company (Mutual) is listed with the United States
Department of Treasury's Listing of Approved Sureties according to Department
Circular 570.
We continue to be confident in R & R Excavating, Inc.'s ability to perform and we
recommend them for your favorable consideration.
This letter is not to be construed as an agreement to provide surety,bonds for are
particular project, but is offered as an indication of our past experience and confidence
in this firm. Any specific request for bonds will be underwritten on its own merits.
Sincerely,
MERCHANTS BONDING COMPANY (MUTUAL)
Jennifer L. Kasznia
Attorney in Fact
jlk
ERC... N S
BONDING COMPANY,.
POWER OF ATTORNEY
Know All Persons By These Presents, that MERCHANTS BONDING COMPANY (MUTUAL) and MERCHANTS NATIONAL BONDING, INC.,
both being corporations of the State of Iowa (herein collectively called the "Companies") do hereby make, constitute and appoint, individually,
Barbara E Pearson; Cheryl E Alkire; Jennifer L Kasznia; Jordan M Scheiber; Mark E Wobbe; Megan E Riesenberg; Nicole L Bicknell; Sandra L
Junk; Theresa M Burns; Wesley L Mantooth; William J Cerney III
their true and lawful Attomey(s}in-Fact, to sign its name as surety(ies) and to execute, seal and acknowledge any and all bonds, undertakings,
contracts and other written instruments in the nature thereof, on behalf of the Companies in their business of guaranteeing the fidelity
of persons, guaranteeing the performance of contracts and executing or guaranteeing bonds and undertakings required or permitted in any
actions or proceedings allowed by law.
This Power -of -Attorney is granted and is signed and sealed by facsimile under and by authority of the following By -Laws adopted by the Board
of Directors of Merchants Bonding Company (Mutual) on April 23, 2011 and amended August 14, 2015 and adopted by the Board of Directors
of Merchants National Bonding, Inc., on October 16, 2015.
"The President, Secretary, Treasurer, or any Assistant Treasurer or any Assistant Secretary or any Vice President shall have power and authority
to appoint Attorneys -in -Fact, and to authorize them to execute on behalf of the Company, and attach the seal of the Company thereto, bonds and
undertakings, recognizances, contracts of indemnity and other writings obligatory in the nature thereof."
"The signature of any authorized officer and the seal of the Company may be affixed by facsimile or electronic transmission to any Power of Attorney
or Certification thereof authorizing the execution and delivery of any bond, undertaking, recognizance, or other suretyship obligations of the
Company, and such signature and seal when so used shall have the same force and effect as though manually fixed."
In connection with obligations in favor of the Florida Department of Transportation only, it is agreed that the power and aut hority hereby given to the
Attorney -in -Fact includes any and all consents for the release of retained percentages and/or final estimates on engineering and construction
contracts required by the State of Florida Department of Transportation. It is fully understood that consenting to the State of Florida Department
of Transportation making payment of the final estimate to the Contractor and/or its assignee, shall not relieve this surety company of any of
its obligations under its bond.
In connection with obligations in favor of the Kentucky Department of Highways only, it is agreed that the power and authority hereby given
to the Attorney -in -Fact cannot be modified or revoked unless prior written personal notice of such intent has been given to the Commissioner -
Department of Highways of the Commonwealth of Kentucky at least thirty (30) days prior to the modification or revocation.
In Witness Whereof, the Companies have caused this instrument to be signed and sealed this 20th day of June 2018
p 0 0
"� +�` ' "
�«` ' �w *�
« '
MERCHANTS BONDING COMPANY (MUTUAL)
MERCHANTNATIONAL BONDING, INC.
«"
,•
-o-oe
=r 2003 �
1933 w � '
By Ir
President
.,�,,l •.
STATE OF IOWA **"..,rrc1 0a+*"wa` r ,
COUNTY OF DALLAS ss.
On this this 20th day of June 2018 , before me appeared Larry Taylor, to me personally known, who being by me duly sworn
did say that he is President of MERCHANTS BONDING COMPANY (MUTUAL) and MERCHANTS NATIONAL BONDING, INC.; and that the
seals affixed to the foregoing instrument are the Corporate Seals of the Companies; and that the said instrument was signed and sealed in behalf
of the Companies by authority of their respective Boards of Directors.
A,y AUCIA K. GRAM
o Commission Number 767430
" My Commission Expires
r April 1, 2020 "
Notary Public
(Expiration of notary's commission
does not invalidate this instrument)
I, William Warner, Jr., Secretary of MERCHANTS BONDING COMPANY (MUTUAL) and MERCHANTS NATIONAL BONDING, INC., do hereby
certify that the above and foregoing is a true and correct copy of the POWER -OF -ATTORNEY executed by said Companies, which is still in full
force and effect and has not been amended or revoked.
In Witness Whereof, I have hereunto set my hand and affixed the seal of the Companies this �� day of��N� „�wlie6 � 2
M y�MI1®u,� M i t,, f
7yP M#/t l r1++ AMA ,Z
_0-
S yn 1933 :' Secretary
2003a
POA0018 (3/17)*".�.��F*,. .�„�.«.•«
R & R EXCAVATING, INC.
2010 WENT AVENUE
MISHAWAKA, INDIANA 46545
PHONE: 574-256-2467
FAX: 574-256-2473
EMAIL becky]�,(j, w t:?,
November 13, 2018
ATTACHMENTS TO CITY OF SOUTH BEND, INDIANA
CONTRACTOR'S PRE -QUALIFICATION CHECKLIST
(i) See attached
(ii) R&R Excavating, Inc. has never been known by any other business name.
(iii) R&R Excavating, Inc. has never been charged in a court of law for any
State, Federal or Local violations.
(iv) R&R Excavating, Inc. has a well established, dependable and experienced
employee pool.
(v) All employees are paid weekly in accordance with Federal and State tax
laws, paid by both the employee and employer. If any subcontractors are
needed for this project, they will be properly vetted and set up in our
accounts payable system, backed up by references and documentation.
(vi) At this time, R&R Excavating does not employ any apprentices.
(vii) See attached
(viii) See attached
(ix) There are no Federal, State or Local tax liens against R&R Excavating, Inc.
(x) See attached
CITY OF SOUTH BEND, INDIANA
CONTRACTOR'S BID FOR PUBLIC WORK
RESPONSIBLE BIDDER CHECKLIST
Project Name 2018 Demolitions
Project No. 118-307
For Bids Due November 13, 2018
Contractor Name: R&R Excavat in$ . Inc.
The City seeks to enhance its ability to identify responsive and responsible bidders on all City public works
projects by institution of comprehensive submission requirements in compliance with State law. Quality
workmanship, efficient operation, safety, and timely completion of projects requires that all bidders meet
certain minimum requirements to be responsive and responsible bidders.
THIS FORM MUST BE SUBMITTED WITH YOUR BID.
INSTRUCTIONS:
If you are a pre -qualified bidder, complete Section I only.
If you are not a pre -qualified bidder, complete Section 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 st for the upcoming calendar year, or within twelve (12) months of obtaining pre -
qualified standing. If the status of any item changes within the twelve (12) months, it is the responsibility of
the contractor to notify the City. Failure by any pre -qualified contractor to submit its complete application
for continuation of "pre -qualified" standing within the time prescribed above shall result in automatic removal
of the designation, effective January 1 of the following year, or immediately following the twelve (12) months
of pre -qualified standing.
However, the "removed" contractor or subcontractor shall still be permitted to bid on City public works
projects, though the contractor must submit all required documents under 6-63 until "pre -qualified" status
is re-established.
Please Note: The City reserves the right to request supplemental information from the bidder,
additional verification of any information provided by the bidder, and may also conduct random
inquiries of the bidder's current and previous customers regardless of pre -qualified standing.
It is the sole responsibility of the potential bidder to comply with all submission requirements applicable to
the bidder in Section 6-63 of the Responsible Bidding Ordinance no later than the date of the public bid
opening.
Version 7/20/2018 General Conditions - 6
POST BID SUBMISSIONS:
Post -bid submissions must be submitted in accordance with Section 6-64 of the Responsible Bidding
Ordinance. The post -bid submission requirements are as follows:
1. All bidders shall collect, maintain, and provide upon request, a current written list that discloses the
name, address, licensing status, and type of work for any subcontractor from whom the bidder has
accepted a bid and/or intends to hire on any part of the public work project, including individuals
performing work as independent contractors.
2. Each subcontractor, whose portion of the project is estimated to be at least one -hundred fifty
thousand dollars ($150,000.00), shall be required to adhere to the requirements of Section I of the
Responsible Bidder Ordinance as though it were bidding directly to the City, except that the
subcontractor shall submit the required information (including the name, address, and type of work)
to the successful bidder prior to the commencement of work.
3. Failure of a subcontractor to submit the required information shall not disqualify the successful
bidder from performing work on the project and shall not constitute a contractual default and/or
breach by the successful bidder. However, the City may withhold all payment otherwise due for
work performed by a subcontractor, until the subcontractor submits the required information and
the City approves such information.
4. The disclosure of a subcontractor list ("Disclosed Subcontractor(s)") to the City by a bidder shall
not create any rights in the Disclosed Subcontractor(s). Thus, a bidder may substitute another
subcontractor for a Disclosed Subcontractor by giving the City, upon request, written notice of the
name, address, licensing status, and type of work of the substitute subcontractor.
5. The successful bidder and all subcontractors on a public works project are required to submit
certified payroll utilizing the federal form known as WH-347 or a similar form on a bi-weekly basis,
submitted within 10 days after the end of each bi-weekly payroll period. Certified payrolls shall
identify the job title and craft for each employee. Certified payrolls shall be submitted
electronically.
Please Note: Submissions deemed inadequate, incomplete, or untimely by the City may result in
the automatic disqualification of the bid.
The City, after review of complete and timely submissions, shall, in its sole discretion, after taking into
account all information in the submission requirements, determine whether a bidder is responsive and
responsible, and provide a Pre -Qualification Verification Letter. The City specifically reserves the right to
utilize all information provided in the contractor's submission and any information obtained by the City
through its own independent verification of the information provided by the contractor.
Version 7/20/2018 General Conditions - 7
I. PRE -QUALIFIED BIDDER CHECKLIST
(a) Acknowledgements:
(i) _ By checking this box, I hereby acknowledge that I am a pre -qualified bidder with
the City of South Bend and that I have met the pre -qualification requirements within
the last twelve (12) months. A copy of my Pre -Qualification verification letter
is attached.
_ By checking this box, I hereby acknowledge that the City reserves the right to
request supplemental information, additional verification of any information
provided by me, and may also conduct random inquiries of my current and prior
customers.
(b) Attachments:
(i) _ Indiana Secretary of State's on-line records (ie. Business verification) dated within
sixty (60) days of the submission of said document showing that business is in
existence, current with the Indiana Secretary of State's Business Entity Report,
and eligible for a certificate of good standing. (Not applicable to individuals, sole
proprietors or partnerships).
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.
Evidence that I am utilizing a surety company which is on the United States
Department of Treasury's Listing of Approved Sureties as required in the bid
specifications or contract.
(iv) List of projects of similar size and scope of work performed in all areas, including
the State of Indiana, within the last three (3) years.
Version 7/20/2018 General Conditions - 8
II. PRE -QUALIFICATION CHECKLIST (FOR BIDDERS THAT ARE NOT PRE -QUALIFIED)
(a) Acknowledgements:
(i) x By checking this box, I hereby acknowledge that I am not a pre -qualified bidder
with the City of South Bend.
(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, 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) x 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) x 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) x
Indiana Secretary of State's on-line records (ie. Business verification) dated within
sixty (60) days of the submission of said document showing that business is in
existence, current with the Indiana Secretary of State's Business Entity Report,
and eligible for a certificate of good standing. (Not applicable to individuals, sole
proprietors or partnerships).
(ii) x
List identifying all former business names.
(iii) X
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) x
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) x
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) X
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) X
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) x
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) x 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) x 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: 1-1/13/2018
(Sign Here)
William,Loudin, President
(Print Name Here)
R&R Excavating, Inc.
(Name of Company)
2010 Went Avenue
(Address of Company)
Mishawaka
(City)
Indiana 46545
(State)
574-256-2467
(Telephone Number)
Version 7/20/2018 General Conditions - 10
APPROVED AND FILED
CONNIE LAWSON
INDIANA SECRETARY OF STATE
04/19/2018 01:02 PM
BUSINESS ID 1992060273
BUSINESS TYPE Foreign For -Profit Corporation
BUSINESS NAME R & R EXCAVATING, INC.
ENTITY CREATION DATE 06/03/1992
JURISDICTION OF FORMATION Michigan
PRINCIPAL OFFICE ADDRESS 2010 WENT AVENUE, Mishawaka, IN, 46545, USA
YEARS 2018/2019
EFFECTIVE DATE 04/19/2018
EFFECTIVE TIME 1:02 PM
REGISTERED AGENT TYPE Individual
NAME Robert P. Loudin
ADDRESS 2010 Went Ave., MISHAWAKA, IN, 46545 - 0000, USA
SERVICE OF PROCESS EMAIL juliec@rrexcavating.com
I acknowledge that the Service of Process email provided above is the email address at which electronic service of process may be accepted and
is publicly viewable.
- Page 1 of 2 -
APPROVED AND FILED
CONNIE LAWSON
INDIANA SECRETARY OF STATE
04/19/2018 01:02 PM
TITLE Vice President
NAME Robert P Loudin SR.
ADDRESS 15833 Ashville Lane, GRANGER, IN, 46530, USA
TITLE President
NAME William H Loudin
ADDRESS 2430 Autumn Trails Drive, Mishawaka, IN, 46544, USA
TITLE Secretary
NAME William Loudin
ADDRESS 2430 Autumn Trails Drive, Mishawaka, IN, 46544, USA
TITLE
NAME
ADDRESS
Treasurer
William H. Loudin
2430 Autumn Trails Drive, Mishawaka, IN, 46544, USA
r
M�M M M), I , IM M� M I Ml �� M" r
111
THE SIGNATOR(S) REPRESENTS THAT THE REGISTERED AGENT NAMED IN THE APPLICATION HAS CONSENTED TO THE
APPOINTMENT OF REGISTERED AGENT.
IN WITNESS WHEREOF, THE UNDERSIGNED HEREBY VERIFIES, SUBJECT TO THE PENALTIES OF PERJURY, THAT THE
STATEMENTS CONTAINED HEREIN ARE TRUE, THIS DAY AprI119, 2018.
SIGNATURE
TITLE
ROBERT P. LOUDIN
Vice President
Business ID: 1992060273
Filing No.: 7890556
- Page 2 of 2 -
11/12/2018
(http://www.IN Biz.IN.gov)
INBiz: Your one -stop source for your business.
Business Details
Business Name: R & R EXCAVATING, INC.
Entity Type:
Foreign For -Profit
Corporation
Creation Date:
06/03/1992
Principal Office
2010 WENT AVENUE,
Address:
Mishawaka, IN, 46545,
USA
Jurisdiction of Michigan
Formation:
Original 09/20/1990
Formation Date:
Principal Information
Title
Name
Vice President
Robert P Loudin SR.
President
William H Loudin
Secretary
William Loudin
Treasurer
William H. Loudin
Page 1 of 1, records 1 to 4 of 4
Business ID: 1992060273
Business Status: Active
Inactive Date:
Expiration Date: Perpetual
Business Entity
Report Due 06/30/2020
Date:
Years Due:
Registered Agent Information
Type: Individual
Name: Robert P. Loudin
Address: 2010 Went Ave., MISHAWAKA, IN, 46545 - 0000, USA
Print Entity Details
Filing History Name History Assumed Name History
Back Return to Search
Certified Copies Request
hftps:llbsd.sos.in.gov/PublicBusinessSearch/Businesslnformation?businessld=284307&businessType=Foreign%2OFor-Profit%2OCorporation&isSerie... 1 /1
n D m -gym z �m 0 -1 0Z00 0
Oiv r0 0c"0c O
0�pOm Z� Ov r vri�7 Z�
;a Co n ��C�zzz D� O�0'0m y�
pL -i m m m� �n n m 'm-4-qm z 30
m� Z " 00r- n 0-0 o n �°�� mm
�0 O -�I� nO z 0 �r ^
z z 0 j z z 0 "
m c
O
D � z m dam-
m an < D z o m -a 0 x a
z o NCA) � z m ;a z- m m N CD -u r
Cnz 0 o in zD DOc �� o -� m v
.gym m V o fir- o CO) ° 0� 1 N o m O m<
x 0 0 m aw 0 cn m o N � m Z Z R1
Kr � cnD 0 m -1 � m
Q°y m *m
zm 0 _z m= m 0
D
�m M m 0 �0 O X"
m D O �
D z 7C z D n
m( �D u z
z
M0 0 = xm zCO
cz
0
m z Kv 0
zm z
o 0� D
0 o - � Dx
A m
O D -N � z0 w �
.Z cn W W D C O cn N
y ? �m
D v W
m D
m n 2 CL - �` >
T
F C—
o O m y m r-
-� 9 O
a -n
;GUI z
D iD C
0 X a) a r
CD D o �i
�m m
m o � o O
C—
D D o 3
m m
� D n `!
m
D
(� c
C N
m O
0 n
cn m
-i
D � 1
� o N
0 O
0
z m
cn 0
0 r
z
c`
z
m
N
O
W
ov r- p-0
;a 0n m�m z2 z D; 0 F- D0C) �
O r m m 3O m(1) n _t t m Z-0
M� O m � � m�- ;u0 a m�OZZZ z M
-ter0, z '"� m .fir o m � m
M0 z z X n
m O f/1 n Z O
D Z D fm Z m nDm�0 V
-� m .r m -i N O D 0 W m m
O M m Z o _ M> CO)
m D Z n m
G m D o Z
Z : Z p MM
D 7�
A O �7 IV
O Z o ^
m � Z D Z V "
-i TTC
Z p D N
C
C K cn f
v cn /V
X X mpp w 6 D �
m w Cl)Z
w
N Co
O O p X V
1- O ;F v
fn D : a) 0)
a p m
m
m w Z N L
z a
O D � O
90 �' a s
C co�
a
oja
p
K a
p m to
r-
O
3 D,
o m
-Zz
n
m m
-n m
0 0 CD
N
m m C)
z m a
D �
2 O
V
C-
C
Z
m
N
O
Ov r-DO�O n 0.� Z
0 m
mo>>mitnz zz D; nm° o vnm � Z 0;v *0m-+ -+m z gp -o n ���+ am
� 0 m �� m� y m 0z zz n�
0 - 0 nr m p; 1 m -gym m 30
�' z o -4 m z° � i" m`
z � � n
n
D _' �~-
Cl' O� D _0n 00 " O
1 -I to O
D
Z w �� �0 Z C ts� O Z
Z m �� �Z G) O Ofn O n
o s m m c PQ -,
Om N N �D �m DNS o �m =1 r
�0m w ZZ �-ri OK -n 0 : W 1 D- n rnJ
m� _� � � p °D O m 0 C —1
"' zz m Z " m m
cD n m D
co
O
2 Cn m D 0
G) Z = n X IQO
O D
7 p G) O Z
X m 0 -0 _
< O C
m D 2 N
0o D N m T
D O m � /V
c) m co m c„ m
T N O
W
0 M, V � �N N
X CA
Ocri Z O O
n
a z CL
00 X 3L
21F -
O
coo
r- D
c m m Ccx
:
a
D _D K T
Cl) O
Z 0
O C.
D ^m
D
Z
D
D D
-< Z
Z D
0
< ►V
m O m
m
Cl)
m X
m
cn O
C-
c
z
m
N
O
a
m
n
r
D
G co
D
D
0
A
M
c
0
c
m
c
0
m
3
O
r
--1
O
Z
O
20
D
Z
D
m
m
D
m
D
Z
0m o
M z
C
M
M,
w
0,
o
Z>
--i
v
v
o
c r
m
CO)
m
0r
I M
w
rb
w
cn
1p
CA
4
A
m
I-110
p O
0
a v
r
zm
--q
v M
4
JQO
C
X
X
m
z
D
C.
O
X
V
T
N
O
L
^m
J
VJ
IV
0
Ta
V J
1
N
C-
c
z
m
N
0
w
rn
D m0U00
00r-
O m
z
>
m
o
O
Z z
O
O M
� m
y
90
D m
Z
D
C
m
m
m
D
D
2
O
X
D
D
m
90
0
m
m
O
m
O
c
z
D
0
z
20
m
m
z
z
�z
z
z xm
nD m�
mm
$
V
mZ
zm0
N
G) m
rr-
D Cil
m j
D 4.
m o
X 1 o
C)
O
con
Or
I m
m
m
M m
0
7�
0
TT
N
X
m
C.
TO
X
TV
N
L
m
0
V J
N
C)
0)
1
N
C)
c
z
m
N
O
O
EXCAVATING, INC
MISHAWAKA CONCRETE/ASPHALT RECYCLE, INC.
2010 WENT AVE.
MISHAWAKA, INDIANA 46545
219-259-0076 - OFFICE
219-259-8091 - TRAILER
DRUG 40 ALCWOL TEGTING POLICY
INTRODUCTION
The following Policy lips been developed in order to comply with
the new mandates set forth by the Department of Transportation
reaardinq drug and alcohol testinu. Beginninq January 1. 1995 all
companies emplovinq•50 or. fewer commercial motor vehicle drivers
(vehicles more than 26.0DO lbs GVV1I11) are to begin alcohol testing
in addition to the already required druq testinq. Companies with
50 or more employees were required to begin on January 1. 1995.
Gmployee's havinq questions reaardinq this Policy shall refer
their questions to the Iluman Resources Director (Julie Culo).
Statement of Philosophy
R & R Excavatinca. Inc.. has compiled the following druq and
alcohol abuse nolicv in order to comply with the Department of
Transoortation's rules set forth for motor carriers. It is
managements feeling that these rules are beneficial as they aim to
reduce accidents and inJuries that could result from driver's of
commercial vehicles being imoaired by the ill effects of drugs or
alcohol. We expect that .a11 covered employees will comply fully
with the policy.
This policy should not be interpreted in any way as an
employment contract. Emplovees should be aware that all employment
is at will. This at will relationship can be terminated at any
time by either the employee or the employer with or without reason.
scooe
Employees covered by this policy include all drivers of
commercial vehicles over 26.000 lbs. GVVIR as defined by the'. D.O.T.
AND ALL EMPLOYEES, REGARDLESS OF
THERE POSITION ARE IN A RANDOM POOL
This policy prohibits the Drpsence of alcohol and controlled
substances in the body while ooeratina a commercial vehicle, and
any safety sensitive positions or Ileavy Eauioment operators.
Controlled substances include amnhetamines, marijuana, cocaine, and
PCP. Testing for the L)resence of alcohol will begin January 1.
1�9G. ��
Prohibited Conduct
Alcohol
1 ) No driver or emolovee shall report for duty or remain on duty
to drive while havinq an alcohol concentration of 0.04 or
greater.
2) No driver or employee shall use alcohol during the 4 hours
before reportiiiq for duty to drive.
x
I
3) No driver or employee shall use alcohol while on duty.
4) No driver or employee shall operate a commercial vehicle
while the driver is in DOSsession of alcohol.
5) No driver or employee shall use alcohol during the 8 hours
following an accident, or until heJshe undergoes a post -
accident test.
6) No d r i ver or emo I ovee sha I I refuse to take a reau i red a I coho I
test. This shall be considered the same as a positive
result.
A driver or employee found to have an alcohol concentration between
.02 and .04 shall not be oermitted to drive for a period of at
least 24 hours.
RHMMMM
11 No driver or employee shall report for duty when he/she is
using any controlled substance. except when the use is
pursuant to the instructions of a Physician who has advised
the driver that the substance does not adversely affect the
driver's ability to safely operate a commercial vehicle.
21 No driver or employee shall test positive for drugs; and
3) No driver or eMDIOVee shall refuse to take a required drua
test.
Testing and Circumstances
Drug and alcohol testing will occur under the following
circumstances.
Pre -Employment or Pre -Duty Testinq - all employees and emolovees
hired to drive commercial vehicles or heavy eauipment must pass a
ore -employment drug and alcohol screen before they will A allowed
to drive, New emolovees who do not pass the drug screen will be
terminated. Current, employees being transferred into driving
oasitions who were not previously subject to the drug and alcohol
testing policy must also submit to a drug and alcohol test before
they will be allowed to drive. Employees who fail will not be
considered for employment.
Post -Accident Testing - employees must submit drug and alcohol
tests after an accident resulting in the following conditions:
1) The accident involves a fatality.
2) The driver is issued a citation under state or local law
for a movinq violation resulting from the accident.
Post Accident testing for alcohol shall be done within 2 hours
following the accident. Drivers subject to post -accident testjncr
shal I remain available and shal I refrain from drinking for 8 hours
or until the alcohol test has been taken, whichever comes f irst.
Failure to do so will constitute a refusal to submit.
Post-Acc i dent test! nq for control I ed substances shal I be done as
soon as practical, testinq must be done within 32 hours following
the accident.
A positive result from zu) alcohol or drug test followings an
accident Could result in termination. The same shall hold true for
a refusal to consent.
11, andorn T e s t i nq -- In acco rda nce with D. 0 - 1'. rea u I at i or) s, random d r U a
testing shall be conducted at a rate of 60% annually. Likewise
random testing for alcohol shall be conducted at a rate of 20.
annually. When an emnlovee has been selected for random test inq
he/she shall report immediately fcal lowinq notification to the
selected testing site. Random selection is to be performed by an
outside source in order to guarantee non -biased results.
Reasonable Gusoicion - Emnlovees covered by this policy will be
subject to drug and alcohol testina. Any employee- who °s work
Derformance has decreased dramatically for no explained reason may
be asked to submit to a alcohol or drug test. Employee's asked to
submit a reasonable suspicion test will be escorted to the test
site by their supervisor or another comoany supervisor. Employees
will be immediately removed from safeti sensitive Positions until
test results have been received.
Return -to -Duty Testinci any time an emolovee has tested positive
for either drugs or alcohol concentration of greater than .04, that
employee must pass a return -to -duty test before being placed back
in service. This only applies to random and reasonable suspicion
testing. This is because a positive test result for alcohol or
dl-uqS under all other -types of testing could result in termination.
A return to duty test will be the responsibility of the employee
both functionally and financially. Results will then be given
directly to the employee and the employee must be responsible for
presenting the results to the employer in order to be reinstated.
In order to be reinstated, the employee must have a negative result
for drugs and a concentration of less than .02 for alcohol.
Follow-up Testing - After an employee has been reinstated following
a positive test result for drugs or alcohol, that employee must
undergo a series of follow up tests. In addition to this, any
employee 1010 tests positive for drugs or alcohol shall be evaluated
by a substance abuse professional who shall determine what
M
assistance if any, the emnlovee needs in resolving problems,-;
associated with alcohol misuse and drun use. The nLnnber and
frequency of follow-uo tests shall be determined by the substance
abuse Professional and be no less than six (5) in the first twelve
(12) months followinn the driver's return to dutv.
The employee may be directed to undergo both return_ to -duty and
fallow --up testing for both alcohol and drugs if the substance abuse
Professional determines that they are both necessary for that
oarticular driver or emolovee. Follow-uo testing shall not exceed
60 months from the date of the driver's return to duty. T h e
substance abuse Professional may terminate the requirement for
follow-uo testing at any time after the first six (5) tests have
been administered, if the substance abuse orofeasional determines
that such testing is no lonqer necessary. The employee shall be
responsible for the cost of any rehabilitation.
Alcohol Testing Methodology
All technicians used, (Memorial Health System's Center for
Occupational Health and Med Points) the alcohol test site Provider
for R & R Excavating, Inc.. are to be certified BAT's in accordance
with D.O.T. regulations,
Evidential Breath Testing Device (EFT) - his reouired by the
D.O.T. (Memorial Health System's Center for Occupational Health and
Med-Points) uses testing devices aoDroved by the National Highway
Traffic Safety Administration (NHTGA). All EBT's shall be subject
to quality assurance Plan which will insure that the device is
Pronerly calibrated. If the device fails the calibration test it
shall be taken out of service until it has been repaired.
Alcohol Testing Procedures
When the driver or eMDlovee arrives at the test site he/she
shall be required to show Positive identification. The employee
may also reauest the BAT to show positive identification. The BAT
shall then explain the testing procedure to the driver or employee.
1 ) The driver or emolovee shall sign the necessary consent form,
Refusal to sign the form shall be regarded as a refusal to
take the test.
2) An individually sealed mouthpiece shall be opened in view of
the driver or employee and attached to the EBT.
3) If the test results are less than .02 the BAT and the
employee shall sign and date the form in the necessary places
and no further testing is authorized. The BAT shall then
transmit the results to the employer in a confidential
manner.
I
4) If the result is e04 or qreater, a second, confirmation test.
must be performed. The confirmation test must be conducted
within 30 minutes but no sooner than 15 minutes after the
initial screening test. If the results of the confirmation
test are different than that of the initial screening test,
the confirmation test results will be deemed to be the final
result uoon which any action under operating administration
rules shall be based.
In the event that
a driver or
employee is not able to
provide an
adequate amount of
breath, -the
driver or employee shall
be directed
to obtain as soon
as practical
after the attempted provision
of
breath, an evaluation
from a
licensed physician who is
acceptable
to the emr) I over conce
rn i n q the
emD I ovees fined i cal ab i I i ty
to D I-OV i de
an adequate amount
of breath.
1) If the physician determines that a medical condition has or
could have precluded the driver or employee from providing an
adequate amount o f breath . the emp I oyee's f a i 1 u re to D rov i de
an adequate amount of breath shall not be deemed a refusal tu
take a test. The Dhysician shall provide the employer a
written statement of the basis for his or her conclusion.
2 ) If the, physician is unable to make the determination that the
emo I oyee's inability to provide an adequate amount of breath
was due to a medical condition. the driver's failure to
provide an adequate amount of breath shall be regarded as a
refusal to take the Lest. The physician shall provide a
written statement of the basis for his or her conclusion.
A breath alcohol test shall be considered invalid for any one of
the following reasons.
I ) The EBT fails the next cal ibra Lion following any breath test.
2 ) The BAT does not observe the minimum 15 minute waiting Perind
prior to the confirmation test.
3) The BAT does not per corm an air blank of the EFT before a
confirmation test, or an air blank does not result in a
reading of 0.00 prior to the administration of the test.
4) The BAT does not sign the form in the necessary spots.
51) The BAT has f ai led to note on the remarks section of the form
that the driver or employee has failed or refused to sign the
form following the recording or printing on or attachment to
the form of the test result.
6) An EBB fails to Drint a confirmation test result: or
0
7) On a confirmation test and. where apolicable, on a screening
test, the sequential test number, or alcohol concentration
displayed on the EDT is not the same as the sequential test
number or alcohol concentration on the printed result.
R & F? Excavating, Inc. requires that when an employee is
notified that he or she needs to submit to a drug screening test.
that employee must Proceed immediately to the location identified
by the employees supervisor.
The following is a description of the minimum precautions to be
taken to ensure that unadulterated specimens are obtained and
correctly identified.
1) Toilet blueing agents added to toilet water and where
possible sources of water contamination is eliminated.
2) Driver or employee positively identified by photo I.D.
3) If the test subject fails to arrive at the designated time,
the employer shall be notified.
4.) The test subject shall be required to remove all unnecessary
outer garments (i.e. coat or jacket) and all personal
belongings shall be secured (individual may retain his or her
wallet).
5) The test subject shall be instructed to wash their hands
prior to providing specimen.
6) After washing their hands, the individual shall remain in the
presence of the collection site personnel, no access shall be
provided to any agents which could be to adulterate the
specimen.
7) The test subject is then allowed to provide his or her
specimen in the orivacv of a stall.
13) The collection site personnel shall note any Unusual behavior
or appearance on the collection site form.
9) A sufficient amount of urine shall be collected in order to
perform a split sample according to Sec. 40.25 of the D;O.T.
regulations.
10) After providing the specimen, the test subject shall be
allowed to wash his or her hands.
7
11) Within four (4) minutes after obtaining the specimen,
collection site oe r son ne I sh a I I test measure; the temperature
of the specimen, the acceotable temperature range is 90 -100
degrees F.
12) Immediately after the specimen is collected, the collection
site personnel shall inspect the specimen for color and look
for any sign of contamination or tampering.
13) If the collection site oersonnel believes tampering has
occurred, a second Specimen shall be collected immediately
under the direct observation of a same gender collection
site person.
14) Both the individual being tested and the collection site
personnel shall keen the soecimen in view at all times DOOF
to being sealed and labeled,
15) The collection site personnel shall place an identification
label securelv on the bottle containing the date, the
individual snecimen number and any other identifying
information required by the employer. The bottle shall have
a tamper proof tyre seal and shall be initialed by the
collection site person and the test subject.
16) The collection site personnel shall enter all information
identifying the specimen on the custody and control form
certifying collection was accomplished in accordance with
the instructions r)rovided.
17 ) The test subject shall sign the form indicating the sDecimen,
collected was his or hers and may also be required to sign
a consent or release form.
113) The collection site personnel shall complete the chain of
custody portion of the custody and control form certifying
proper Completion of the collection.
19) If the specimen is not immediately shipped to the
laboratory, it shall be secured during temporary storage.
201) The urine specimen and custody document must be under the
control of the collection site person while the chain of
custody procedures are being performed.
The collection site personnel shall then arrange to ship the
collected specimen to the drug testing laboratory in a contailier
with a signed tamper proof seal. The collection site personnel
shall ensure that the chain of custody forms are sealed inside of
the shipping package.
3
As per D.O.T. regulations Memorial Health system's Center for
Occupational Health and rued- Points (the testing site eMDlowed b,,/ Ifs
& R Excavat i Ing, Inc ® ) i s a Ideal th and human Se ry ices ce rt i f i ed 11 ab .
Every urine specimen collection is required to undergo an
initial screen followed by confirmation of all positive screen
results® Listed below are the cutoff levels for both the initial
-test and the confirmation test.
initial Test
Marijuana metabolites
Cocaine metabolites
Opiate metabolites
Phencyclidine (PCP)
Amphetamines
Marijuana metabolites
Cocaine metabolites
ODiates
Morphine
Cade ine
Phencvclidine
Amphetamine
Methamphetamine
0
All substances identified on the initial test must be
confirmed by gas chromatography/mass spectometry at the cut off
levels shown above.
D.O.T. regulations require that the lab report the test results
directly to the employer's Medical Review officer (MRO) ' ) within an
average of five (15) working days. The MRO works for the test site
provider (Memorial Health system's Center for Occupational Health
and hied -Points)® It is the primary duty of the MRO to review and
interpret positive results obtained from the lab. The MRO must
assess and determine whether alternate medical explanations could
account for the positive test result. If an employee tests
positive for any of the five (5) scheduled drugs, the MRO must
first discuss this with the emDloYeG before contacting the
emoloyer. At this time the Mko will by way of an interview and
review of medical history, determine if there is an alternate
medical explanation as to the positive result. When the final
decision is made, the MRO shall then report to the employer.
The MRO shall notify each employee who has a confirmed
positive test that the employee has seventy-two ( 7 2 ) hours in which
to request a test of the Split saMDle. If the spl it sample is
unable to confirm the presence of the drugs found in the primary
sample, or if the split samole is unavailable, the MRO shall cancel
the test and report cancellation and the reasons for it, to the DOT.
the employer, and the employee. If there is an additional cost
associated with the testing of the split sample, it shall be raid
by the employee.
If the MF.10 is unable to contact the employee directly, the MRO
shall contact a designated management official of the employer to
arrange for the employee to contact the MRO prior to going or) duty.
The MPO may verify positive results with the employer official
without having communicated ON the employee under the followinq
circumstances:
1 ) The employee expressly declines the opportunity to discuss
the results, or
2) Within five (5) days after a documented contact by a
designated management official of the employer instructing
the employee to contact the MRO, the employee has not done
so.
Y V T regulations recuire that. the MRO provide Ej signed
written notification within three (3) business days of completion
of the review. The MRO must reoort the following information to
the employer:
1) That the controlled substances test being reported was in
accordance with oart 40 of the D.O.T. regulations;
2) The name of the individual for whom the test results are
being reported:
3) The tyre of test indicated on the custody and conti-01 form:
41 The date and location of the test collection;
5) The identities of the entities performing the collections,
analysis of the Specimen and the MRO for the specific test;
G) The verified results of controlled substances test, either
positive or negative and if positive, the identity of the
controlled substances for which the test was verified
positive.
No
The purpose of this section is to inform the employee of the
assistance available to them in the event they test positive for
drugs or alcohol. Any cluestions regarding this policy or where to
go for assistance should be directed to the Supervisor.
Any employee testing positive for drugs or alcohol (not
subject to immediate termination) shall be referred to the
substance abuse professional. The substance abuse professional
shall determine what type of follow up treatment is necessary. The
employee shall proceed to the substance abuse professional as soon
as practical after testing positive, it is not necessary to wait
for the negative result to come back from the return to duty test.
Referral to the substance abuse professional shall be done by the
employee®s supervisor.
If the substance abuse Drofessional prescribes a recommended
treatment, the employee must follow the recommended treatment in
order to continue his or her employment with the company.
Discipline
This section refers to the actions that will be taken by the
Company in the event of a Dos i ti ve test result under all of the
different types of testing performed in accordance with LhCnT.
regulations.
Pre -employment - Candidates for employment who test positive for
drugs or alcohol will not be considered for employment. They will
be able to reapply after six (6) weeks have passed from the initial
drug screen. At that time if thev wish to reapply they must again
submit a pre -employment drug and alcohol screen. Personnel who are
seeking transfer into a driving position and were already employed
by the company will not be permitted to drive for six (6) weeks and
at that time must also pass the ore -employment drug and alcohol
screen. If at this time they again fail the drug or alcohol screen
their employment could be terminated.
Reasonable cause - Employees testing positive for drugs or 0.04 or
higher for alcohol under this portion could be� immediately
suspended from work without pay. Employees testing between 0.02
and 0.04 for alcohol could be temporarily suspended for 24 hours
and then reinstated to duty. The employee must then report to a
substance abuse professional. The substance abuse orofessional
will determine what -type of, if any, rehabilitation will be
necessary. The substance abuse prof ess i onal wi 1 1 also determine
the number and freauency of follow up tests to be conducted. There
shall be at least six (6) follow up test in the first twelve (12)
months. After the first six (6) tests, the substance abuse
professional may cease further testing as he or she sees fit.
Follow up testing shall go no longer than sixty (00) months, it
HM
will be the responsibility (functionally and financially) of the
employee to provide a negative return to duty test in order to be
reinstated to duty. Not until a negative test result for drugs or
a 0.02 or lower for alcohol is received by the employer, shall the
employee be allowed to return to work.
Post -Accident - Employees testing positive for drugs or testing
0.04 or higher for alcohol could be immediately terminated from
employment in a post accident situation.
Random- Employees testing nositive for drugs or 0.04 or higher for
alcohol will follow the same procedures as a Under Reasonable Cause
testing (see above).
Return to Work - After testing positive under 'the random or
reasonable suspicion testing for drugs or testing 0.04 or higher
for alcohol , employee must undergo a return to work test. This
test will be the responsibility of the employee and results will be
communicated directly from the KIRO to the eMplOYSe whether they are
negative or positive. Because the cost of the return to work test
is the responsibility of the employee. it is 01 the employee's best
interest not to take the return to duty test until he or she is
sure to pass the test. Also because of the fact that the employee
is the only one communicating with the MRO or test facility, the
employer will not know the results until the employee passes.
Insubordination - Any employee who knowingly attempts to
adulterate a drug specimen or alcohol test in order to produce
a false negative or refuses to take a drug or alcohol test could W�
terminated immediately.
Recordkeeping
Five (5) year Retention Period
Alcohol tests resulting in 0.02 or greater
Verified positive drug tests
Refusals to submit to reauired drug or alcohol tests
Reauired calibration of evidential breath testing devices
Substance abuse professional's evaluations and referrals
Annual calendar year summary
Two (2) Year Retention Period
- Records related to the collection process and training
12
1 Year Retention Period
Negative and canceled drug test results
Alcohol test results indicating breath alcohol
concentration of less than 0.02
CMPLOYCC ACKNOWLEDGEMCNT
DRUG AND ALCOHOL TESTING POLICY
I acknowledge that I have received a copy of the Drug and
Alcohol Testing Policy. I also acknowledge that the provisions of
the Policy are part of the terms and conditions of my employment
and that I agree to abide by them.
Date:
Signature:
Print Name:
Social Security #:
-...�...... � � gn ._
R & R EXCAVATING, INC. o Representative's � ature Date
-AND-
MISHAWAKA CONCRETE/ASPHALT RECYCLE, INC.
a