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Home My WebLink AboutOpening of Bids - Fat Daddy's Building Demolition Proj No 118-066 - R&R Excavating IncCITY OF SOUTH BEND, INDIANA CONTRACTOR'S BID FOR PUBLIC WORK Project Name Fat Daddy's Building Demolition Project No. 118-066 For Bids Due November 27, 2018 ............... --------- PART I (Must be completed for all bids. Please type or print) Date: 11 / 2 7 / 2018 Bidder (Firm): R&R Excavating, Inc. Address: 2010 Went Avenue City/State/Zip: Mishawaka, IN 46545 Telephone Number: (574 ) 256-2467 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: Fat Daddy's Building Demo the City of South Bend, Indiana, in accordance with plans and specifications prepared by: DLZ of Indiana and dated October 2018 for the sum of (enter the Total Bid as shown on the Proposal) Six Hundred Fifteen Thousand and No Cents _( 615,000.00 ( P p ) (Numerical) Enter sum of Total Base Bid plus Alternates shown on Pro osal 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 sepajate attachment. 110 By William Loudin, Presidef - aturent (Printed Name of Person Signing) ACCEPTANCE The above bid is accepted this day of Subject to the following conditions: BOARD OF PUBLIC WORKS Gary A. Gilot, President Elizabeth A. Maradik, Member James A. Mueller, Member Suzanna M. Fritzberg, Member Therese J. Dorau, Member Attest: Linda M. Martin, Clerk 20 Version 7/20/2018 Contractor's Bid for Public Works - 2 (Revised, Addendum No. 1) BID/PROPOSAL_ REVISED CITY OF SOUTH BEND Project Name: Fat Daddy's Building Demolition Project Number: 118-066 For Bids Due: November 27, 2018 Contractor Name: R&R Excavating, Inc. BASE BID Item No. Description Quantity Unit ................ Unit Price Total Amount 0 1 MOBILIZATION/DEMOLITION �.WWW 1 LSUM $24,000.00 24, 000.00 2 ASBESTOS ABATEMENT ....._... 1 LSUM .__ ...... 85,000.00 ....... 85,000.00 3 MAINTENANCE OF TRAFFIC 1 LSUM 20,000.00 20,000.00 4 BELOW -GRADE DEMOLITION 1 ....... LSUM 35,000.00 35,000.00 5 BUILDING MATERIAL REMOVAL AND 1 DISPOSAL LSUM 150,000.00 150,000.00 6 BACKFILL AND COMPACTION 1 LSUM 85 , 000.00 85,000.00 7 SITE RESTORATION 1 LSUM 65 , 000.00 65,000.00 8 FLOWABLE FILL 60 CYS 100.00 6,000.00 9 ENVIRONMENTAL ALLOWANCE 1 ALL $30,000.00 $30,000.00 BASE BID TOTAL 500.000.00 ENVIRONMENTAL ALLOWANCE UNIT PRICES Item No. Description Unit Unit Price �. .................. CONTAMINATED SOIL REMOVAL 1 AND DISPOSAL TON $ 100.00 ASBESTSOS CONTAINING THERMAL 2 SYSTEM PIPE INSULATION LFT $ 30.00 REMOVAL AND DIPOSAL ALTERNATE #1 Item Description Quantity Unit Unit Price Total Amount No. 1 TEMS EXTERIOR MED LL OM SALVAGE 1 SUM 1p�� 1 . 00 _�a , 00010 ,000.00 ALTERNATE NO. 1 TOTAL 10 000.00 DESCRIBE EQUIPMENT MATERIALS AND LABOR PLANNED TO COMPLETE ALTERNATE #1: Nanlift, saws and shipping hammers Version 7/20/2018 Contractor's Bid for Public Works - 7 (Revised, Addendum No. 1) BID/PROPOSAL—REVISED��.� CITY OF SOUTH BEND Project Name: Fat Daddy's Building Demolition Project Number: 118-066;F For Bids Due: November 27, 2018 ' Contractor Name: R&R Excavating, Inc. ALTERNATE #2 _.. Item Description —............ No. p Quantity Unit Unit Price Total Amount ..... _.........._ .............. 505 SOUTH MICHIGAN STREET BUILDINFG - MONROE STREET LSUM 10 , 1 DECORATIVE FLOOR FRAME 000.0 10, 000.00 1 SALVAGE ITEMS (MANDATORY) _ _ ALTERNATE NO.2 TOTAL $ 10,000.00 Man . i.... EQUIPMENT and chipping MATERIALS ND LABOR PLANNED COMPLETE ALT _..... _. DESCI�I �F EQUIPMENT MATERIALS �N ERNATE #2: comers. ALTERNATE #3 Item _. _w No. Description Quantity Unit Unit Price Total Amount EXTERIOR FAQADE SALVAGE ITEMS 1 —YELLOW HIGHLIGHTED ITEMS 1 LSUM 30 , 000.00 30, 000.00 MANDATORY ALTERNATE NO. 3 TOTAL 13300,000.00 DESCRIBE EQUIPMENT MATERIALS AND LABOR PLANNED TO COMPLETE ALTERNATE #3: Manlift, saws and chipping hammers. ALTERNATE #4 Item No. Description Quantity Unit Unit Price Total Amount EXTERIOR FACADE SALVAGE ITEMS 1 — GREEN HIGHLIGHTED ITEMS 1 LSUM 65,000.00 65,000.00 MANDATORY ALTERNATE NO.4 TOTAL $ 65000.00 DESCRIBE EQUIPMENT MATERIALS AND LABOR PLANNED TO COMPLETE ALTERNATE #4: Manlift saws and chipping hammers. Version 7/20/2018 Contractor's Bid for Public Works - 8 (Revised, Addendum No. 1) Project Name: Project Number: For Bids Due: Contractor Name: BID/PROPOSAL—REVISED CITY OF SOUTH BEND Fat Daddy's Building Demolition 118-066 November 27, 2018 R&R Excavatinc. Inc. Bidder (Firm): R&R Excavating, Inc. Address: 2010 Went Avenue City/State/Zip: Mishawaka., IN .46545 Telephone Number: 574 256-2467 By (Signature) William Loudin, President (Printed Name of Person Signing) Version 7/20/2018 Contractor's Bid for Public Works - 9 (Revised, Addendum No. 1) 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 Indiana ) )SS, St. Jose h 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. 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 Version 7/20/2018 Contractor's Bid for Public Works - 4 (Revised, Addendum No. 1) 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 Version 7/20/2018 Contractor's Bid for Public Works - 5 (Revised, Addendum No. 1) made steel or foundry is unreasonable. I understand that violations hereunder may result in forfeiture of contractual payments. I hereby affirm under the penalties of perjury that the facts and information contained in the foregoing bid for public works are true and correct. Dated this 2 7 th day of Nov. , 20 18 R&R Excavating, Inc. Contractor/Bidder (Firm) igna ure of Contractor/Bidder or Its gent William Loudin, PYesident Printed Name and Title Subscribed and sworn to before me this 27th day of November 20 18 My Commission Expires 9/28/2024 Notary Publuc FRebecca S. Blackston County of Residence St. Joseph REBECCA S. BLACKSTON Notary Public, State of Indiana St. Joseph County ,SEAL:' say My Commission Expires tix, popiernber 28, 2024 Version 7/20/2018 Contractor's Bid for Public Works - 6 (Revised, Addendum No. 1) 1411 a rom 21 M 101103 ra I'M MUTAIIJ 0 PHONE 574/235-9251 FAX 574/ 235-9171 TDD 574/ 235-5567 CITY OF SOUTH BEND PETL BUTTIGIEG, MAYOR BOARD OF PUBLIC WORIIKS Date: November 21, 2018 To: All Planholders From Linda M. Martin, Clerk, Board of Public Works Subject Addendum Number: I Project Name: Fat Daddy's Building Demolition Project Number: 118-066 ACKNOWLEDGEMENT OF RECEIPT OF ADDENDUM Date Received: /I —Rf-18 This addendum is being forwarded to you for the above referenced project. Please sign below and acknowledge receipt of this Addendum by faxing this sheet to the Board of Public Works at (574) 235-9171 within 48 hours of receipt. A copy MUST also be included with your bid package upon submittal. THIS ADDENDUM MAY AFFECT YOUR BID. Notes: The attached documents are hereby added to the Specifications and Contract Documents and become a part of herein. Company: Authorized Signature: Date: - D 61 a-, 0- 2 C-3 -L-,7 U Version 4/2/2015 M *AIA Doicument A31 OTM -2011 Bid Bond CONTRACTOR: (Name, legal status and address) R & R Excavating, Inc. 2010 Went Avenue Mishawaka, IN 46545 SURETY: (Name, legal status and principal place of business) Merchants Bonding Company (Mutual) 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 PROJECT: (Name, location or address, and Project number, if any) Fat Daddy's Building Demolition; Project No. 118-066 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 5% of Total Bid 1 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 bid and such larger amount for which the Owner may in good faith contract with another party to perform the work covered by said bid, then this obligation shall be null and void, otherwise to remain in full force and effect. The Surety hereby waives any notice of an agreement between the Owner and Contractor to extend the time in which the Owner may accept the bid. Waiver of notice by the Surety shall not apply to any extension exceeding sixty (60) days in the aggregate beyond the time for acceptance of bids specified in the bid documents, and the Owner and Contractor shall obtain the Surety's consent for an extension beyond sixty (60) days. If this Bond is issued in connection with a subcontractor's bid to a Contractor, the term Contractor in this Bond shall be deemed to be Subcontractor and the term Owner shall be deemed to be Contractor. When this Bond has been furnished to comply with a statutory or other legal requirement in the location of the Project, any provision in this Bond conflicting with said statutory or legal requirement shall be deemed deleted herefrom and provisions conforming to such statutory or other legal requirement shall be deemed incorporated herein. When so furnished, the intent is that this Bond shall be construed as a statutory bond and not as a common law bond. Signed and sealed this 21st day of November 2018 m�..e._ R & R Excavating, ... .....� (Pr, �....w ( (Seal .... (Title) William Loudin, President Merchants Bonding Company (Mutual) (' ty) (Seal) re ennat �.'�� ( tll ¢r 1 4SxnIa, orncy in Fact CAUIfltitlNm You should sigin"In aain w° id giffialll MA aC oiru!t,ir w.t DocumentTy" h1ch this test appears in R IX An ar�vigiinal assures that willll iriuot bewslb.�cuwawt. Init. AIA Document A310TM — 2010. Copyright © 1963, 1970 and 2010 by The American Institute of Architects. All rights reserved. ARI llll� . "II" Ilmlls AVA`a4 Docuonneunt Its protected by U.S. Colpyrilght Law and Ilrnterrnatioruall "II"reatles, Li nautlhorlized reproductUoru or dllstrlllbutl of'this MAs IDocurnent, or any poof It, may resullt in severe cllvill and crl homed pseiruaVQlles, and wVVV Ise prosecuted to the rinaxhinumrn extentp;po.ssll0alle under the law. / Purchasersapermitted to reproduce ten (10) copies of this document when completed. To report copyright violations of All Contract Documents, a -mall e American Institute of Architects' legal counsel, copyrlght@aia.org. 061110 .M RC Nis _"_q�k 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 Attorney(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 w** sto, www+'y,'�i1�IV 'P() � *,, MERCHANTS BONDING COMPANY (MUTUAL) MERCHANT NATIONAL BONDING, INC. 4 . v STATE OF IOWA *on f�*+,w..+,•' Pre sident one 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. ._ 1 -,qsk AUCIA K. GRAM Commission Number 767430 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 not been amended or revoked. In Witness Whereof, I have hereunto set my hand and affixed the seal of the Companies on this day of �• �� wwwwwwrrwmaa.ar wwrr "wr / (ierwir' 0 * " 9 " _ o- �dR 1 93 Secretary . « POA 00 18 (3/17) '"*w.rawwwaww" •+..«.• CITY OF SOUTH BEND, INDI'ANA CONTRACTOR'S S BID FOR PUBLIC "CORK CHECKLIST FOR BIDDERS Project Name Fat Daddy's Building Demolition Project No. 118-066 For Bids Due November 27, 2018 From time to time the South Bend Board of Public Works finds it necessary to reject a bid because it does not comply with statutory requirements. In preparing your bid, please use the following checklist in order to make sure that your bid is done in the proper manner. Proper bid security included. The bidder has the option of providing either a Certified Check x or Bid Bond. Bid prepared on the City of South Bend Contractor's Bid for Public Work Form, completely x executed. Contractor's Non -Collusion and Non -Debarment Affidavit, Certification Regarding Investments with Iran, Employment Eligibility Verification, Non -Discrimination Commitment, and x Certification of use of United States Steel Products or Foundry Products. Proof of 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 1 Addendum(s) included with the bid. x All required additional information is included with the bid. Proposal statements and other affidavits all signed by the proper party with name either x printed or typed underneath signature. x This checklist submitted with the Bid. This checklist is provided for bidder's use in assuring compliance with required documentation; however, it does not include all specifications requirements and does not relieve the bidder of the need to read and comply with the specifications. Bidder: R&R Excavating, Inc. Date: 11/27/2018 By Authorized Representative: Signature: Print Name & Title: Becky Packston, Assistant Version 7/20/2018 Contractor's Bid for Public Works -1 (Revised, Addendum No. 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 a� l4able. 4. Attach references from private firms for whichru ave 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 (Revised, Addendum No. 1) CITY OF SOUTH BENDarraa�,� MINORITY AND WOMEN BUSINESS ENTERPRISE DIVERSITY DEVELOPMENT PROGRAM W; FORM MWBE-1.0 MBE/WBE PARTICIPATION" This completed form should be supplied with Bids that pertain to City of South Bend Public Works Projects involving MBE/MBE 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. Project Number: 118-066wwwwwwww ........ Project Name: Fat Dadoy's BWntrlitlon &R Excavating,Inc. Total Bid Amount: See Itemized Bi �. E ...�E WW Bidder: R . d MBNVBGoal: Page r of�_ Primary Contact Person Scope of Work to be Performed Dollar Amount of Percentage Name &Address of MBENVBE Name/Tele hone of Total ...............................µpal y .pace) MBEMIBE Component Bid/Proposal p (Attach scope/schedule scheduled you need additional s � �. State Barridading Jim Traffic Control $5892.00 Machalski Submitted by: Becky Blackston �� h.!�8 Print Name S ature Date Version 7/20/2018 Contractor's Bid for Public Works - 10 (Revised, Addendum No. 1) CITY OF SOUTH BEND MINORITY AND WOMEN BUSINESS ENTERPRISE DIVERSITY DEVELOPMENT PROGRAM FORM MWBE-2.0 - M EVIDENCE OF GOOD FAITH EFFORTS " 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 MBEfWBE 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: 118-066 Date: 11 / 27 / 2018 Project Name: Fat Daddy's Buildin,q Demolition Bidder: R&R Excavating, Inc, Contact Person: -Becky Blackston Telephone: _5_74 —24h7 Address: 705 S. Beiger Street City: Mishawaka State: Indiana Zip: 46544 Email: beckyb@rrexcavatina.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 MBE/WBE LIST(S): The bidder reviewed the City of South Bend's Minority and Women Business bf) 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 Send quires that all perspective bidders complete no less than 2 of the following: 1 Attend all pre -bid meetings scheduled by the City to inform MBENVBEs of contracting and subcontracting opportunities. CAdvertise in general circulation and/or trade association publications concerning subcontracting opportunities, and allow MBE/WBEs reasonable time to respond. 3. Perform any and all necessary steps to provide written notice in a manner reasonably calculated to inform MBE/WBEs of subcontracting opportunities and allowed sufficient time for them to participate effectively. 4. Utilize pre-existing services of available community organizations, small and/or disadvantaged business assistance offices and other organizations that provided assistance in the recruitment and placement of MBENVBE firms. **Bidder must circle or otherwise notate which of the two (2) required actions were performed. GOOD FAITH NEGOTIATIONS The bidder negotiated in good faith with interested MBENVBEs, including providing such MBENVBE's with adequate information about the plans, specifications and other requirements of the subcontract and did not reject MBENVBEs as unqualified without sound business reasons based on a thorough investigation of their capabilities. SMALL CONTRACT(S): The bidder selected specific portions of the work to be performed by Pj 1�) MBENVBEs in order to increase the likelihood of meeting the MBENVBE goals (including breaking down contracts into smaller units to facilitate MBENVBE participation) CONTRACT RECORDS: The bidder has maintained the following records for each MBENVBE that has n bid on the subcontracting opportunity: 1� 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 span oe consiaerea grounds for rejection or 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 (Revised, Addendum No. 1) CITY OF SOUTH BEND,'''"�""� MINORITY AND WOMEN BUSINESS ENTERPRISE DIVERSITY DEVELOPMENT PROGRAM �i 9 FORM MWBE-2.1 MBEIWBE CONTACTED This completed form should be supplied with Bids that pertain to City of South Bend Public Works Projects requiring contacted MBEIWBE to obtain Good Faith Efforts. It is the bidder's sole responsibility to verify whether any listed minority or woman business meets the qualifications of a Minority or Women's owned business. PAGE 1 OF 1 Project Number: 118-066 MBEIWBE Participation Goal Project Name: Fat Daddy's Buildina Demolition R&R Excavating, Inc. By: _ ` Assistant `dnau° Becky Blackston (Title) MBE/WBE Firm State Barricading, Inc. Owner or Contact at MBE/WBE Firm Jim Michalski Telephone: 574-287-2078 Fax:574-287-1 744 TYPE OF WORK SOLICITED FOR THIS PROJECT: Traffic Control RESULTS OF CONTACT WITH THE MBE/WBE FIRM: 11,/27/2018 (Date) Email: statebarricadel@aol.com Received a quote; Agreement could be si ned. MBENVBE Firm o otb,er MBE/BE Owner or Contact at MBE/WBE Firm Telephone: Fax: Email: TYPE OF WORK SOLICITED FOR THIS PROJECT: Asbestos removal seeding, est control�aving, masoay RESULTS OF CONTACT WITH THE MBEANBE FIRM: Version 7/20/2018 Contractor's Bid for Public Works - 12 (Revised, Addendum No. 1) 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 UNIVERSITY OF NOTRE DAME ADAMS ROAD DEVELOPMENT RAMS BUILDERS STERLING CONSTRUCTION CITY OF SOUTH BEND MORTENSON-TONN & BLANK CITY OF MISHAWAKA DLZ OF INDIANA ABONMARCHE CONSULTANTS CONTACT MR. DOUG MARSH MR. DAVID ECKRICH MR. RYAN RANS MR. LANCE SWANK MR. TOY VILLA MR. BOB LOPEZ MR. GARY WEST MR. BRAD DAILY 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 # 2016 PARTIAL EQUIPMENT LIST 1 LABOR 36 . .. ....... '99 Kom WA600 Whl LoaderA52048 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 92'Komatsu WA 500 Loader #A20931 99 2003 Bandit 3680 S/N 1421 101 Komatsu WA380 Loader A50468 102 938K Cat Loader SWL02533 105 Komatsu 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 SD100 152576 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 iMoxy 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 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 1/11 Roller SD199D 248 06 Komatsu PC228 #32319 249 Cat 938G Loader 01582 254 07 Kom PC400 LC8 a88040 .. ....... 255,07 Kom PC400 LC8 87370 256 ____ 12 D6K LGP Dozer ODHA02065 25703 Kom PC228 USLC-3NO 258 ICat 740B Articulated Truck #1334 ....... _ ..... EQUIP # 2016 PARTIAL EQUIPMENT LIST 260 06 PC220LC-8 Ex_c 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 526 PC21OLC-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 WRGO0333 574 D6K LGP Dozer DHAO0504 583 04 Sterling Dump Truck 53641 588 04 Sterling Dump Truck 53637 594 Cat 740B Articulated Truck #1335 610 Cat 950G II Whl Ldr s/n AXX01696 637 98 CAT GENERATOR SR4 .�.�........639 KOMATSU WA 500-6 LOADER .m�........�....__._.W.e..-�,....�.......�.........a_- 641 PC88 Excavator 643 1 10 PC200 LC-8 Excavator was 259 CITY OF SOUTH BEND, INDIANA CONTRACTOR'S BID FOR PUBLIC WORK RESPONSIBLE BIDDER CHECKLIST Project Name Fat Daddy's Building Demolition Project No. 118-066 For Bids Due November 27, 2018 Contractor Name: R&R Excavating, Inc. The City seeks to enhance its ability to identify responsive and responsible bidders on all City public works projects by institution of comprehensive submission requirements in compliance with State law. Quality workmanship, efficient operation, safety, and timely completion of projects requires that all bidders meet certain minimum requirements to be responsive and responsible bidders. THIS FORM MUST BE SUBMITTED WITH YOUR BID. INSTRUCTIONS: If you are a pre -qualified bidder, complete Section I only. If you are not a pre -qualified bidder, complete Section 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 sc 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. (ii) _ By checking this box, I hereby acknowledge that the City reserves the right to request supplemental information, additional verification of any information provided by me, and may also conduct random inquiries of my current and prior customers. (b) Attachments: (i) _ Indiana Secretary of State's on-line records (ie. Business verification) dated within sixty (60) days of the submission of said document showing that business is in existence, current with the Indiana Secretary of State's Business Entity Report, and eligible for a certificate of good standing. (Not applicable to individuals, sole proprietors or partnerships). 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. x O �_ 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: 11/27/2018 (Sign Hre) 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 APPR('):VED AND FILED CONNIELAWSON INDLANA SH(RE:TARY OF STAI 04119/2018 01.02 PM BUSINESS ID 1992060273 BUSINESS TYPE Foreign For -Profit Corporation BUSINESS NAME R & R EXCAVATING, INC, ENTITY CREATION DATE 0610311992 JURISDICTION OF FORMATION Michigan PRINCIPAL OFFICE ADDRESS 2010 WENT AVENUE, Mishawaka, IN, 46545, USA 7r777 . .. ....... ITflflfl 77E L`17091 I REGISTERED AGENT TYPE Individual NAME Robert P. Loudin ADDRESS 2010 Went Ave., NL%1AWAKA, IN, 46545 - 0000, USA SERVICE OF PROCESS EMAIL juliec@rrexcavafing,com 7W as 7- r7 " 4=6 -to m I rs publicly viewable. APPROVED AND FILED CONNIE LAWSON INDIANA SECRETARY OF ST 04/1912018 01:02 PM 0 TITLE Vice President NAME Robert P Loudin SR. ADDRESS 15833 Ashville Lane, GRANGER, IN, 46530,'USA MLE President NAME William R Loudin ADDRESS 2430 Autumn Tmils Drive, Mishawaka, IN, 46544, USA TITLE Secretary NAME William Loudin ADDRESS 2430 Autumn Trails Drive, Mishawaka, IN, 46544, USA TITLE Treasurer NAME William H. Loudin ADDRESS 2430 Autumn Trails Drive, Mishawaka, IN, 46544, USA ............... -4, . . . . . . . I "'i 1EM14FA—M MM11TIEV IWUM A MACATMA t1W UWASEATED APPOINTMENT OF REGISTERED AGENT. IN WMIMSS WBEREOF, THE UNDERSIGNED BEREBY VERIFIES, SUBJECT TO TBE PENALTIES OF PERJURY, THAT THE SI'MEMENTS CONTAINED HEREIN ARE TRUE, TIM DAY April 19,2018. 01110 M13MTP. LOUDIN Vice President solIBM 11 /12/2018 (http://www.INBiz.IN.gov) 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 INBiz: Your one -stop source for your business. 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 Back Return to Search Print Entity Details Filing History Name History Assumed Name History Certified Copies Request https://bsd.sos.in.gov/PublicBusinessSearch/Businessinformation?businessld=284307&businessType=Foreign%20For-Profit%2oCorporation&isSerie... 1 /1 www.Gibsonlns.com (( )� t (000) 814-2122 1 (800) 836-2122 mm South Bend, IN Plymouth, IN Indianapolis, IN Fort Wayne, IN Elkhart, IN Kalamaino, 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 anw agreement to Drovide surety bonds_ for any 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 MERCHANTS BONDING• POWER • 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 Aikire; 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 Attorney(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 Attomey-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 " MERCHANTS BONDING COMPANY (MUTUAL) MERCHAN*rS NATIONAL BONDING,, INC. ^t " - to ^,^ : °� � � p..,, • o w 'k» 200 � � :r, 1 33 •' By `.V 0` 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 mspecliye Boards of Directors. ALICIA K. GRAM Commission Number767430 My Commission Expires r rf A, n11, 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 on this 9 � day of /V�7zt j �eC_-Cl 4 W` 2011 Secretary POA 0018 (3/17) A4,,yGiBS0N November 21, 2018 RE: R & R Excavating, Inc. To Whom It May Concern: 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. MERCHANTS BONDING COMPANY (MUTUAL) Jennifer L. Kasznia Attorney in Fact jlk/ www.GibsonIns.com i t (800) 814-2122 1 (800) 836-2122 9 South Bend, IN Plymouth, IN Indianapolis, IN Fort Wayne, IN Elkhart, IN Kalamazoo, MI MFRCHANI�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 Carney III their true and iaWul Attorneys) -in -Fact, to sign its name as surety(les) 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, recGgnizances, 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 seat 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 andlor Its assignee, shall not relieve this surety company of any of I is 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 Aftomey-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 tile modification or revocation. In Witness Whereof, the Companies have caused this instrument to be signed and sealed this 20th day of June 2018 10 ......... \G CO3 P0 MERCHANTS BONDING COMPANY (MUTUAL) q$.■ MERCHANT NATIONAL BONDING, INC. -0- 0 2003 1933 4 .- By 6� : Pmsident STATE OF IOWA 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 duty 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. 7 , IA4 �,VA , AUCIA K. GRAM 0 43 Commission Number 767430 My Commission Expires April l,2020 Notary Public (Expiration of notary's commission does not invalidate this instrument) 1, 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 -Or -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 on this ,?IS' ay of W�y�� ,)0/ 01441012".r 0 * a . - . all d 0N4 #'-&, * 0 \VkG Co ........... ........ 4. vi� P 0 094 to 201933 Secretary 03 N !r .0 .0 '01 ic POA 00 18 (3/17) R & R EXCAVATING, INC. 2010 WENT AVENUE MISHAWAKA, INDIANA 46545 PHONE: 574-256-2467 FAX: 574-256-2473 EMAIL becky ')L LL� �!yatJ �). November 27, 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 60 nM .r. 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MISHAWAKA, INDIANA 46545 219-259-0076 - OFFICE 219-259-8091 - TRAILER DRUG AND ALCOHOL TESTING POLICY INTRODUCTION The followinq Policy has been developed in order to comply with the new mandates set forth by the Department of Transportation reqardinq drug and alcohol testing. Oeginninq January 1. 199B all companies emolovinq 50 or. fewer commercial motor vehicle drivers (vehicles more than 26.000 lbs GVW(1) are to begin alcohol testinq in addition to the already required drug testinq. Companies with 50 or more employees were required to begin on January 1. 1995. Employee's havinq auestions reqardinq this policy shall refer their questions to the human Resources Director (Julie Culp). Statement of Philosophv R & R Excavating. Inc, has compiled the following druq and alcohol abuse policv in order to comply with the Department of Transportation's rules set forth for motor carriers. It is managements feelinq that these rules are beneficial as they aim to reduce accidents and iniuries that could result from driver's of commercial vehicles beiiq impaired by the ill effects of drugs or alcohol. We expect that all covered emoloyees will comply fully with the Policy. This policy should not be interpreted in any way as an employment contract. Emolovees should be aware that all employment is at will. This at will relationship can be terminated at any time by either the emDlovee or the employer with or without reason. Scope Employees covered by this Policy include all drivers of commercial vehicles over 26.000 lbs. GVWR as defined by the-D.O.T. This policy prohibits the presence of alcohol and controlled substances in the body while ooeratinq a commercial vehicle, and any safety sensitive positions or heavy Eauinment operators. Controlled substances include amphetamines, marijuana, cocaine, and PCP. Testing for the presence of alcohol will begin January 1. 1990. Prohibited Conduct Alcohol 1) No driver or employee 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 reporting for duty to drive. x 2 No driver or allinlovee shall use alcohol while of dutv. 4) No driver, or employee shall operate a commercial vehicle while the driver is ill possession of alcohol® 5) No driver or emplovee shall use alcohol durina the a hours following an accident. or until her/She undergoes a post - accident test. 6) No driver or emplovee shall refuse to take a required alcohol test. This shall be considered the ;x,jrpje as a positive result. A drivt,,,r or emplovee found to )iavn an alcoil(,,0 concentration between .02 arld .04 shall not be Dertnit,,ted to drive for a oeriod of at least 24 hours. Druas 11 No driver or emplovee shall report for deity when he/she is using any controlled Substance. except when the use is pursuant to the instructions of a ohysician who has advised the driver that the substance does not adversely affect the driver's ability to safely oinerate a commercial vehicle, 2) No driver or emplovee shall 'test positive for drugs; and 3) No driver or employee shall refuse to take a required drug test, Testinq and Circumstances Drug and alcohol testing will occur under the following circumstances. F're A7mrj I oy$jjsnr t or OlAl',f I est I n<1 - all crrrpra loyees and emo I ovep—I., hIrAd to 11riVA COMMi4l'Cial viFIhick,,,s ar heavy eqUiPMent Must pass a orn-emt)loymallt drug ajjcj a -0 a W sc�r(,ien berol threY Will IN 0 t 10 Od to ("Ir i,rep Now eFTlr)lOYCIeIG Who do not DaSS the drug screen wi I I be terminated. Current cpprpslswrres being transferred into d r l v I l) P vositions who were not nrevilousliv -,ulblect to the drug arld al c o l"i, 0 1 test inq oolic'y must, also skAMIL tci a, druq and alcohol test h8l'Ol-e they will ho allowed to drive. Elljoloypes who fai 1: wi I I not Wa considered for employment. Pbst--Accident Testing - employees must submit druQ and alcohol tests after an accident resulting in the following conditions: 2) The driver is issued a citation under state or local law for a moving violation resulting from the accident. Post Accident t(4stinq for' shall, be done within 2 hours following the at".cidont, to post-accjtjel,it testinq shall remabi available and stroll refrain from drii%inq for B hours or until tjjf.aalcahal towt, has be LAam whoicineyer cytes first. Failure to do so will constitute a refusal to submit. Post -Accident 'testing for controlled substances shall be done as soon as practical, testing must be done within 32 hours following the accident. A positive i-emot from an alcohol or drug test following an accident Could result in termiratiori. The same shall hold true for a refusal to consents IM"dom Testina - In nowwWwe wi", CO. 1'. reaqulations, random dl-Uca testing shall be FM a rate of 50% 1, i k ow i S ("r rwWom testAnq for mKohol shill be comhwLed at a "Me of 25% Wirmal on When an emOo Yee has been aolectqd 'Vor random tostinq lie/she shall remwt immdiatelv followino noUrNation to the S lectod teqtinq site. f�� a 1r1(jogj is to be net formed Ixe an, outsido soi,jrce in i',)rder tr) ousArantee non binsed-t mults, ReaswAable susialwon Ltnplovees covered hY this oolicy Will be suWsct to drug and alcohol testing. Any emDlQVOO Who's w40E* ne"omatice fins derreased ¢dr~aaxauotw4ral l s four do oxplairind reason mov bo asked to aubmit to as 01001101 or drug test- Embloy"'S asked to submit as roatsonable sugpician test, wi I I k.)o v.,,�scortod to the to-st, * I to by thel r sunery i sm, or arrothor CCATIOany supery i sor. ii-m 0 10, V a 0 s * I I I be I rnmod"j a to I v r,emoved ( rorn aafaaty' qons r t,j ve pas i t i ons unt i I test results have been received. lewtAnq am time an eomlovee Flas tested W)sitiy4l for either drugs or, n 1m aaNeez1 ccnceot rat ion of greater, than .04, that efooloyen onust p,,ass a motiarii G.ra olrjt.v tost bc,,�rore beij,aq placed back iii servive. This only avalies to I'Otsdom and reasonable susuicoon testing. This is bwm"se ai hositive test result for alcohol or dnxts umfer aVl other tvp(,'rs of tfastinla could result in termination. A return 1�o duty —test will be the rospollsibiloty of the emf':')loyee both functionally and fhlancially� nestAji,-,s will then be 91voh dUnctly to the emaloyee and the emQuyse namt be r-osconsible for, oresentiriq the resWts to Lhe ew)loyor in order to be rs%skatwl. In uWar to be reinstated. the njuAt have a negative Vesult for dmqa and a concentration of loss than .07 for alcohol. ro 1 1 ow- up To 4�'4 t i ng - Aft or an emnl OYO. a hA8 be 01-1 t-0 I ris t ato d following a Pus i t i V e test res u l 1. fear d 1, va s or- a I Coho I , that emt") d OVO e must underao ei series of -"allow Up tosts, In addition to tr0s, any emoloyee who emts nstt"For dme or aloO�ol shal I be evaluated bv a substancto abuseorive e n whci s�jall determllie what assistance if any, the emolovee needs In resolving problems associated with alcohol misuse and drug use. The number, and frequency of follaw-uD 'tests shall be determined by the substance abuse orafessional and be no less than six (6) in the first twelve (121 manths fallowhia t,,1144 drivel"s returo to duty, 1he employee may he directad to mWerao both Mid follow-up testing for both alcohol +-,krid drugs if the substance abuse professional determines Uyat Mmy are —both necessary for that nw*ic*0nr driver or emnwves. roAlOWLM testing shall not exceed 60 munlOw from the date of the 5,0er's return to duty. I he subsl,ant,o abku,e Droff- .s r, i r) lI al naav t;iie ro ou i rem fot follow uo testit" aL m,�v ��jje z.,IfLer the fIrst, six W, Lasts have, been ff the suuzLajnre abuse ororessk3nal dr-tormirles L�j,�,jt si,jcti testbw in w; lore er necessary. The employee --,hall be responsible for the cost of any rehabilitation. Alcohol Testing Methodology All technicians used. (Memorial lWaIMI SysteWs Center for Occupatit)ual Health and Medpo,jvjts) the T,11cabof teaj� site nrovider for R & R Excevoong. Ow.. are to be certified BAT in scomManne with D-O.T. regulations. l_',eidential Rrenth resMnq Device (EM As woul red by the (Monlorial tlealth Systam"s Center for Ocim,jaulonal Haalth and Mad F%Ws) uses taw"nq devises aor�roved by the Natlorial jlrrlhwtly Traffic Safety Administration IMITGA). All IDT's shall be sulject. to crva"lity assurance alan which will insure that the device Is properly calibrateck If thn device fails the calibratJon testa it, shall be taken out of servic-e until it, has bOle0l r-eriaired. Alcohol Testing Procedures When the driver or emulhovea arrives at the test site he/she shall be raawhmd to Owm oasutive The employee may also remest the UAT to sl-roar positive identification. The BAT shall then exclain the LesOna onmedt,ire to the Oriver or. employee. 11 The driver or employee shall sign the uw-,3cesaary consent form. refusal to sign the form shall be reqnrdad an 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 result.,,:, are lese,, than .02 the DAl` and the employee shall sign and daLe the form in Lhe necossai-Y Places and no further teelvilmg I- autharized. The BAT shall then transmit the lesults Lo ljie employer in at confidential manner. 41 If the result is .04 or great.er. a socond, confil"Plation Lee,- =mt be uerfomw& M9 test IrIust be con(IIIAGLed aqjtjjjIn 3() minutes, but, rip SOCPne'" that' 15 minutes after the &J"al s"aminina teM" if the results of the Cunfimamon test-. FAre difforent than, thrt cj"the initial screening test, the confi I—Mationtest resu It's W I III b o deemed to tie the r I r to I resu"; mon which anACt'QIn onder ooeratip'tq administrntion rules shall be based. In the ovent that a dII or eiw,Io1oyc-.ie is not able, to Provide an adaotjats arnoi,int of breatin the drkver Or emPlOve;-) nhall tie directed to Obtain as soon as rIractrc;al after the atteinf)tr4d Of breath, an evaluatlmi fram a "cmmed oh"10an who in accentable to the employer concerni no the elIRs 1710MC01 ab 111 ty to Orovide an adeouato amount of breath. 1) If the phqaiciav detenOnes threat m0d"Wal cwAVWon has or could have precluded the dwiver or emoloyoo, from pAuvidina In r,.idec,Iuatn amount of breath. tire epr3loyee's failure tu PrOvIde a,, adequate amount of breath shawl I not be domed a re"mal Lo take as tosm the ol'lvsicj�'In Shall Provide, the amoloyer a wrttj",en st.ateaient of the basis for his or her conclusion. 21 if the physicion is unable to mW% two deter0nation that the emalovee, s inabi I itm to Drov ide ran adeuUate amount of hreatt" was due to ','r mnrlicll r'OVKJItion. the, driver's failure to provide an adeutgate aniount of breath shall ire regarded as a reNsY to tle Me tOW" the Wpsiciwi shall ;xmvide n iooritten stats,-_rjent of the baNg for hVs or hor inoriclusion. A breath alcohol test shall be considered invalid for any one of the following reasons. il The EST fai 1 s the next ca I i bration fol lowi ng any breath test. 2) The BAT does not observe the minimum 15 minute waiting period prior to the confirmation test. 3) The BAT does not oerform an air blank of the EST 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 ®AI" has failed to note an the remarks section of the form that the driver Or emr)loyee has failed or refused to sign the form followinv Me reumdag or printing on Or attachment to the form of the test result. 6) An EST fails to print a confirmation test result; or 6 71 on a confirmation test and, where applicable, on a screening test, the sequential test number, or alcohol concentration displayed on the EBT is not the same as the sequential test number or alcohol concentration on the printed result. Drug Testing Specimen Collection Procedures R & R Excavating, Inc. reouires 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 supervisors Thefollowing is a desQriotion of the minimuni� precatitions to be taken to ensure that u�'K11dL1lteP-,1ted specimens are �(")btained and correctly identified. 11 Toilet blueinq agents added to toilet water and where possible sources of water contamination is eliminated. 2) Driver or employee positively identified by photo I.D. 31 If the test subject fails to arrive at the designated time, the emplover shall be notified. 41 The test saibject shall be required to remove all unnecessary 4�;qjt,er qarments ( i f,cq�jat, or .jacket ) and al I personal belonginos sha tl he geckjred (individual tlay r-etan his or her wallet). 51 The test subject shall be instructed to wash their hands prior- to providing specimen. 6.1 After wnshing theeir hands. the indivIdual shall remain in the presence of U"le collottion site personnel, no access shall be provided to anY a9WILS 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. B) The collection site personnel shall note any unusual behavior or appearance on the collection site form. 91 A sufficient amount of urine shall be collected in order to perform a split samole ;According to Sec. 40.25 of the D-,O.T. regulations. 101 After providing the specimen, the test subject shall be allowed to wash his or her hands. 11) Within four (4) minutes after obtaining the specimen, co I I ecl, I on site Dersonne I shall test maAsura the temperature of the specimen, tile �iccr,+Dtable temPorature 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. 131 If the collection site personnel believes tampering has occurred, a second specimen shall be collected immediately under the direct observation of a same aender collection site person. 14) Both the individual being tested and the collection site personnel shall keep the snecimen in view at all times prior to being sealed and labeled. 15) The collection site personnel shall place an identification label securely on the bottle containing the date, the individual specimens number- and any othor identifying -information re(juire(I bY the employer, The bottle shall have a tamper prc4of tvrlaz so,491 and shall be initialed by the collection site person and the test subject. 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 provided. 17) The test subject shall sign the form indicating the specimen collected was his or hers and may also be reouired to sign a consent or release form. 18) 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. 20) The urine specimen and custody document must be under tile 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 container 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. Drug Testing Methodology As oar 1).0.1, Fegkj Ig tions, Memori a I He a It h Systejr), s ceriter for occuontional Hoalth aped t4sicj- po lilts (the t.c-sting Site employed by R R Emcavating, Inc. 11 is a health and Human Ser-viCOS CeFtififld lab. F-very urine sPecinle" C011ectiQ" is required to under go an initial screen followed by cc,)tjfjrmfttion of all POGItiv"0- ' screen results_ Uste(J below are the cUtf)ff levels for both the initial test and the confirmation test, Initial Test Substance Marijuana metabolites Cocaine metabolites Opiate metabolites Phencyclidine (-PCP) Amphetamines Confirmatory Test Substance Marijuana metabolites Cocaine metabolites Opiates Morphine Codeine Phencyclidine Amphetamine Methamphetamine Test Level (ng/ml) 50 300 300 25 1000 Test Level (ng/ml) IB 150 200 300 25 500 500 All substances identified on the initial test must be confirmed by gas chromatography/mass sDectometry at the cut off levels shown above. 0,0.r, rwwlations requl— '611a,t, aie iala resort the test resuits directly to the employer's ndz�view OFficer (MRO) within 4an avarage of five (5d working (Jays. 1he HRO wear for tile t0flt P"" Drovider (J�emnorial llenith Systnni's Center for Occwpationnl 14'94310'k and Meal-Paints1i. It is the orimary duty Or 1-tie MHO Lo leviesq and IrIts;.prat oositiye r,A,)tnlo°md from the lab. The MR0 must assess and deterlillne whut .1�ey medical exalarlAtIOns COU10 occoutit for the u0sitive Lest P'esult. if an employee terits Positive for any of trio (Tive (51 scl-ioduled, drugs, the 141ZQ MU%t: first discuss this with thfeiigooyee beFore contacting the =Wlo"r. At th i s t i n'Prij tl W 14R() UV Wa v 'f an '"t(-) 'v review A medical history. determirite , if there is an meMcal exWenstion as tm the OusItive—result. Wheri the final decision is made, than (11130 Shf,"I'll their reoort to the employer. The MRO shall notify SaW, empWyee who ham a cmWi"Od positive test that the emulmee has SevMUM-10WO ( 721 twurs in whicll'r to requaWy a test of the S10it SMMIO, If the split samT.00 is unable to confirm tMe aresencs; of Ko drag" found in am arimarY sampl e, or If the an I i L OamU I e is un"a "Abl e - the MRQ sha 1 1 cance. I the test and romrt uwwr�11,atitm mind tjje reasons for jj, to the DOT. Uv4 omployer, and the emt)lovt!P. If tliare is an additional GOSt assc)clated with the t0st,ijpt; c.)r the �q ,plit sample, It shall he paid by the stmolovee, if the M130 is unable to contact the mmloyee direpot lY, the MRO shall cw)Lact a desigaKed mmmmement official of the employer to arrange for the wmalmee to cmItmt Ile MnO orWr to qoing on duty. The MRO, maw verifY nositive rt,+sults with the employer- official withoul; having communicated $41th the employee tinder too f&Wwing circumstances: 1) The employee expressly declines the opportunity to discuss the results, or 2) Within five (,5) tJav^,t Fter o dommwned co=als by a designated management offlcal of the mMloyer i"tmcMng the employee to CWQKc the MPO, the employee has not done So. D.O.T regulations reauire that the MRO provide a signed written notificaticin within three (3) business days of completion of the review. The MRO must report the following information to the employer: 1) That the controlled substances test being reported was in accordance with Dart 40 of the D.O.T. regulations', 2) The name of the individual for whom the test results are being reported: 3) The type of test indicated on the custody and control form,. 4) 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; 6) The vwAfiad results of cwU.rolled substances test, either positive or nnqAtKe and if positive, the identity of the cmtrQ19d substances for which the test was verified positive. 10 Employee Assistance Program 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 Questions regarding this policy or where to go for assistance should be directed to the Supervisor. Any OMPIC)Yee testing positive For drugs or alcohol (not subject to immediatQ termination) shall be referred to the substance abuse proFessional. H,,aO substance at)kjse profossional shall determine what tyoc,r cj fol low uo trentrPent is necessary, The employee shall proceed to the SLPbGr',AnCO atm.use vrofosslonal as soon as practical after teatin9 it -h.5 not necesenry to wait for the negative result to come back from the return to duty test. Referral to the substance abuso orofossional shkill be done by the employee's supervisor. If the substance abuse W-Of(ISSI(MRI firpscribes a recommended treatment, the emolovee must f011ow the recommerhd8d treatArent, in order to continue his or her r4runloympilt With the oornrrany. Discipline This section refers to the actions that will be taken by the coniDanv in the event of a positive test result under all of the different types of testing performed in accordance with D.O.T. regulations. Pre evirrloyment for orpriloy"If.-Int who test, positive for drugs or alcohol will not be cOnsidored for- employment. 010 Y W i I I be able to re�jpply after six (61 weeks $)Fuve passed from the initial drug screen, At "that time if tsj(.jv w1goi to reapply they must await) submit, a vre-orrlployrrient. (jrijq 4,,,rjc9 alcoh(>1 rcl-eqn. 1jersannel Who are seeking transfer lntt) a dri'vinci u0sitiori and were already Ornployo'd by the company will riot be 1-uernOtted to drive for six r6,1 weeks and at that time must RISO rlaSs then ore employment drug and alcohol screen. If at this time they again fail the drug or alcohol screen their employment could be terminated. Reasonable Cause - Employees testing positive for drugs or 0.04 or higher for alcohol under this portion could be• immediately suspended from work without pay. Employees testing between 0.02 and 0.04 for alcohol could be temporarily suspended for 24 hours 1;hGn r,einstated to dul,,y, 19rar employee anus" then rarwort to a substance abuse Professlot-1. nutistance abuse arofO8,qi0M1l wl"ll determine what tynelia b ) 1 1 t a V, 10 F1 w i I I b (-I necessary. I'lie si,sbstance abusn orofessional will MsO d0termine the, number and freauency of follow on test,; to be conducted. there shall be at least six 101 f0ljow, t;o Lost in the first twelve ( 12i months, AfLer the first six h0) tastrs, the substance abuse, professional way cease further testing as he or she sees fit. Follow up testing shall go no lontier than sixty (001 monrtllr— it wi I I be the I' 0�500n$ Ib i I i LO" ( I'un(',Oot I a I I y and f irl a nci a I I y) k,4 the employee to provide a rjogil.1ve return Lo duty taut 11" carder t0be reinstated to duty. NOL; WA,11 a test result fir drugs or a 0.02 or lower for alcohol 03 received by the employer, shall the employee be allowed to return to work. Post -Accident - Emplovees 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 positive for drugs or 0.04 or higher for alcohol will follow the same Procedures as a Under Reasonable Cause testing (see shovel. return to work , After. testing, 0OSItAV0 "O(JOr rr'le ranfl('-)m or reasonable qusPiclOn t"tO19 for - drugs testing 0.04 or higher for alcohol, emr)jOyL.9 rapjst, uj)(jer-qo a return to work test. This oast w J'j I be the resnons I b I I I ty of ti-je employee and resul is W1 11 be communicated directly from MR O to the emWoYee whether U19Y 81" T,legative or posy itivtl, l3ecauge, glte cost , of the return to work, t0sl, is tj-)q r-esponsibility of the employee, It is il-) tl-N9 eMPIOY06's not to tnke the rstuj-j,a Lo duty 'test until lie or she is sure 1,0 bass the test_ Also beckluse of the fac,,,t that; I:fse employee is the only one with the MRO or, test facll Ity, the employer will not know Lhe results until the employee passes insubordination - Any employee who knowl0gly attempts to adulterate a dri,ig wing imen tjr alcohol test in order to Produce a false negAl'.Jve or refuses to take a drug or alcobal test could be terminated iryvinediately. Five (5) year Retention Period - Alcohol tests resulting in 0.02 or greater, 111111W� - Refusals to submit to required drug or alcohol tests - Required calibration of evidential breath testing devices - Substance abuse nrofessional's evaluations and referrals - Annual calendar year summary Two (2) Year Retention Period - Records related to the collection Process and training 12 i Year Retention Period - Negative and canceled drug test results - Alcohol test results indicating breath alcohol concentration of less than 0.02 EMPLOYEE ACKNOWLEDGEMENT 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 #: R 6 R EXCAVATING, INC. Representative's Signature Date -AND- MISHAWAKA CONCRETE/ASPHALT RECYCLE, INC. 13 EMPLOYEE ACKNOWLEDGEMENT MUD 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 ablde bv them. Signature, Print Name:, Gocial Gecvrity 0: & R Excavating, Inc. Signature Date