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HomeMy WebLinkAboutSewer Insurance Program Approved Contractors - Grove Excavating and Bob Frame Plumbing Services IncCITY OF SOUTH BEND PETE BUTTIGIEG, MAYOR DEPARTMENT OF PUBLIC WORKS Eric Horvath, Director The Sewer Insurance program is requesting the board of public works approve these two contractors for the Sewer Insurance program. 1. Grove Excavating Per -Qualification Category Excavation — Yes 2. Bob Frame Plumbing Services, Inc Per -Qualification Category Excavation — Yes Second Opinion —Yes Special — Yes Liner and patch repairs Thank you, Manager, Sewer Division Sean Ward 441 a. mu i rare _,Name of Com a� ny: ��! r� — Pre -Qualification Category Second Opinion Excavation Special ❑ Attach copies of the following documents. 1. License Number 2. Bond letter stating limits for single project and aggregate program 3. (Corp. or LLC Only) Corporate authority and/or proof of registry with the Secretary of State to do business in Indiana Principal Pzinci aI Place of Business: ........... �p _ 0 c A � �� � Mailin "°g...A_.- _�.......-._ ddress. � . _� ........ I�r� p T �� Im �`7;a I 1� .� Fa � �._ ..... ..... E-Mat Ownership Information (Identify all owners iflhe Company, ifapplicable) _._.... Nature of Company's BusinessDA ,_ .. ........... .. __,........................ ........... �/tt C (OXYt "S C.C.S (Briefly describe the flee of servicesyoea-conopanyprovider) pUs, j r lL1L_� X (Provide references as needed to validate erperience forspecffic p)e-gaalifcafioa) o mpetent Person Certification. � _ ........... _ .... nn ---- (Naineofholder, expiration date) 11C CV 13 w °1'ri1ril' APPLICATION PRE -QUALIFICATION FOR THE CITY OF SOUTH BEND, INDIANA SEWER INSURANCE PROGRAM 12 OSHA Confined Space Training Certification P"ND-0,--o-A CJ�t `v, ��`�S (Nameofholder, expiration date) L ......_. __..... License Information (Name of l+older, license type, rnanber) PC��'lC� $mid By signing and submitting this application, Uwe agree to follow all City of South Bend Prevailing Specifications and Special Provisions (enclosed in the Sewer Insurance Program Policy as Exhibit G) By signing and submitting this application for pre -qualification, Uwe understand that as a Contractor under the City Sewer Insurance Program, Uwe shall be directly and solely liable to a Homeowner for any damage to any Homeowner's person or property caused by the Contractor's acts, conduct or omissions arising from or within the scope of this Program. Uwe shall release and fully indemnify the City from any claim or cause of action of any kind which Homeowner may make against the City for any act, conduct or omission by the Contractor under this Program. Indemnification includes but is not limited to Contractor's payment of any legal feesr , lspej)se incurred by the City in defending such Homeowner claim. r5 gnatare , - Signature Signature Title Title Titter Date Date Dare 14 ExhibitE SEWER INSURANCE CONTRACTOR RATE SCHEDULE November 8, 2016 Pre -qualification categoiy., Second opinion CablL Augerhig . ...... $20-0.09 'no—ur--- Pre-qualification category: Excavation Notes: 1. Total crew size shall be a maximum of two persons unless otherwise approved by the Sewer Insurance Administrator or representative thereof. 2. Equipment costs shall include WeratM for salneµ 3. Contractor shall invoice all other inaterial used on an itemized basis. 4. No rate adjustments shall be made For overtiniv hours nor fees associated with travel time. 5. There will, be no fces associated with 1.1sc ofpick-up trucks and trailers. Trip Charge for Excavator Excavator Trip Charge for Other Equipment Rubber tire backhoe Mini Excavator Air Compressor Combination cleaner Truck Compactor (hand) Dump Truck (20 A F350 Dump Truck or Similar Trailer Laborer Saw Cutting Trench box, 6' x 6 Trench box, 8' x 6' Trench box, 10' x 16' *When needed, steel sheeting included in cost of trench box. Pre -qualification category: Special Job H am S_125,70O Job ___�U7%QL Hour ,..$L20,.,kQ,_ Hour jQQ j9 Job �$Inox' Hour L%00 - Job _$9Q.AOL "our _$7QO(t__ Hour ___$00.00 Ho-ur M_-00 j9b Job OO.Qp,,,_ Job __j4QQ.90 Job Special conditions shall be address by the Sewer Insurance Administrator through City of South Bend emergency coRtractilig Procedures. 15 Exhibit F SEWER INSURANCE REPORTABLE JOB CATEGORIES BY PRE -QUALIFICATION CATEGORY Pre -qualification category: Second opinion Cable ..... Repair of a Private Sewer through cieanout of the line b.. ....mac y cable machine. Clean o 'Install of a clean -out by the Sewer Insurance Program as determined by the Sewer Insurance Administrator Pre -qualification category: Excavation r Leve.. D' 1 Definition .. _ ____ Slab home foundation (four to five feet deep) 1 • Repair work performed mainly by hand or backhoe at depths up to five feet _------... � _. Home..has a basement with floor drain 2 • Repair work performed mainly by backhoe at depth from five to eight feet ........___...__.. • may Trench box be re wire d _. .m.. ,._�..........._...._ ............. .........� _. • Home has a basement with floor drain • Repair work may require sidewalk removal and replacement 3 • Repair work requires working around water lines • Repair work performed mainly by backhoe at depth from six to eight feet • Trench box nceurred „ • Home has a basement with floor drain; basement wall may be between sidewalk and curb line • Repair work may require sidewalk removal and replacement 4 • Repair work requires working around water lines, tree removal required • Repair work performed mainly by backhoe at depth from seven to ten feet __ ..... Trench boe 9rabreth. ..... -...__ ...._.W...__._ �... _ ._..... Pre -qualification category: Special Level Definition_ • Horne has a basement with floor drain; basement wall may be w' between sidewalk and curb line; repair work involves work Lander the street pavement • Repair work may require sidewalk and curb removal and replacement 5 • Repair work requires working around large diameter water lines (24" diameter), large gas mains (six-inch diameter), tree removal required • Repair work performed mainly by backhoe at depth from nine to 15 feet • Trench box required �.....Re lacin long sections of Private Sewer with �..... 6 p g th new pipe or using liner to nix sections of tnioc. 16 Exhibit G SEWER INSURANCE PROGRAM SPECIAL PROVISIONS The City of South Bend's PREVAILINGSPECIFICATIONS, most recent version, and DESIGN & C'ONSTRUCTION ',STANDARDS, most recent version, and the INDOT Standard Specifications, -current edition with all Supplemental Specifications to date, are to be used in this program. E,,Icll contractor is specifically insirticted to becorne completely hmllili3r With the PREVAILING SPECII"ICATIONS and the 0ESIGN & CONS]'RUCYION STANDARI)S prior to subinitting a pre -qualification application. These SPECIAL PROVISIONS will list only "Additions" or "Deletions" to the PREVAILING SPECIFICATIONS and are to be used only in conjunction with the PREVAILING SPECIFICATIONS. In the evellt of conflict 1),etwcon the SPECIAL VROVISIONS and the PRE, VAILING SPECIFICXVIONS, the SPECIAL PROVISIONS will govern. II.31, Jim A. Prevailing Specifications/INDOT Standard Specifications Section: None B. Additions: 1. Where the term "or cqtial" is use(] in these S 0 specifications, the contractor deviating ftolil SpL-cified item shall file With his/her bid a letter fully exPl3illingarid iustif,} ing his/her proposed article or equal with the Sewer Insurance Administrator. The Sewer Insurance Administrator shall be the sole jedge in determining if the "or equal" offered meets the specification. A. Prevailing Specifications/MOT Standard Specifications Section: None B. Additions: 1. M'aterials and pyopertics purchased under contract, with the ()wner that becomes a periqu,tilent part of the struchire or facilities constrocted are not subjcct to the Indiana0ross Rctail Tax (Stiles Tax). IV. C0N1KQLQL!&M A. Prevailing SpecificationsANDOT Standard Specifications Section: 105 B. Additions: 1. The complete responsibility for this project lies with the Director of Public Works of the City of South Bend, Indiana through his authorized representatives. 17 2. Construction Engineering - The Contractor shall provide all the necessary, qualified personnel, equipment and supplies to perform all work required under this item. There will be no direct payment for this item. A. Prevailing Speeifications/INDOT Standard Specifications Section: 107 B. Additions: 1. The Owner, where mentioned in these documents, is the City of South Bend. The Engineer, where mentioned in these documents, is the South Bend Department of Public Works, acting through its Bureau of Construction. 2. The Contractor shall apply for and obtain any and all required permits for the work from local, state, and federal agencies and shall comply with pen -nit requirements, including the St. Joseph County / City of South Bend Building Department. 3. If the Contractor awarded this contract is not a resident of Indiana, within thirty days, the Contractor shall provide the Engineer with proof that the Contractor is duly licensed, qualified and registered with the Secretary of State of Indiana to engage in business within the State of Indiana. VI. ' SLe) , A. Prevailing Specifications/INDOT Standard Specifications Section: 108 B. Additions: 1. In the event that excessive inclement weather causes a delay in work, the Contractor may apply in writing for an extension of work schedule. The Director of Public Works through his authorized representative will establish all time extensions. 2. Liquidated damages will be assessed at the cost of the day's work on the given day that the work is not completed as assigned or agreed upon. 3. All work will be done between 7:00 ami. and 6:00 p.m. unless authorized otherwise by the Sewer Insurance Administration. The contractor shall not be paid for travel time and shall not bill for overtime hours. 4. The Contractor shall plat. his work and provide signs, barricades, personal notifications, watchmen or any other necessary means to prevent damage to work site by vandals and passers-by. This effort is considered incidental to the work. No direct payment will be made. MEMPAI►� A. Prevailing Specifications/INDOT Standard Specifications Section: 103 B. Additions: 1. All Contractors and subcontractors doing business with the City of South Bend shall present a Certificate of Insurance showing coverage in the following minimum amount: a. General Liability: Premises -Completed Operations or Products, Bodily Injury and Property Damage Combined Single Limit - $1,000,000 or $50,000 per person. b. There shall be no exclusion for explosion, collapse or underground hazard. 18 c. Workmen's Compensation: Statutory State of Indiana Employer's Liability - $ 100,000. d. Auto Liability: Bodily Injury and Property Damage Combined Single limit - $1,000,000. e. City of South Bend shall be named as additional insured on the Certificate. VIIII. A ISUA4 1 3, = A. Prevailing Specifications/MOT Standard Specifications Section: None B. Additions: 1, The (,ollfractor shall be responsible for providing all materials necessary Bor the dewatering and protections of existing structures to porforin the work included on this prqject. 2. The Contractor shall submit a Dewatering and Protection of Existing Structures Plan to the Owner and Frigincer for review Prior to beginning any work affected by the control of ground Water arldprotection of existing structures, The playa shall hictude drawings, calcutations and descriptions, as necessary, to clearly describe tile nature: of tile methods to be used by the Contractor, The Phui must be preparcd, signed and sealed by a Professional Vngincer registered in the State of jildialla, wilo is experienced iv dewatering (cchniclues and support of structures and hydraulic loadijjgs. '111c plan must be submitted, reviewed 011d COITUMMS addressed adequately before the start of conslructioa� 'File responsible Professional Engineer shall supervise and inordtor the installation and operation of the dewatering/protection of existing structures elerlients. The Contractor shall have full responsibility for tile adcotLlacy of the dewatering melho& of the diversiOn/fete"ti011 systems used, and Por Protection of all existing, structures. 3. Foundations and all other parts of tile construction site shall be dewatered and kept free of standing water and muddy conditions, as necessary, for the proper execution of tile work. The Contractor shall install, maintain, and operate all cofferdams, sumps, and other temporary diversion and protective works needed to coltitrol ground water and surface water at the site. Since the work will be perfornied in a resideritial/collinercial arc,:, all continuously operating equipment such as pumps and generators must be irtuffied and enclosed in noise dampening structures so as not to cause a nuisance to nearby residences and commercial establishments. 4, Control of surface and groundwater shall be continuous during the period of construction so that olarriage to the work shall not occur. Removal of water from the construction site shall be performed so that erosioll and the transporting of sediment and other pollutartts are ininiinized. Wheal tel-RIVIlAry works used fior dewatering are no longer needed, the Contractor shall remove them and return tile area to a coliditiOn similar to t1lat which existed prior to construction. IX. aLVV Ab V LAI A. Prevailing Specifioations/INI)OT Standartl Specifications Section: 2001, 2100, 715 and City Standard Drawings WW-2, WW-3, WW-6, NVW-7 and WW-8. B. Additions: i. "This work shall entail the removal of conflicting portions of existing sanitary laterals and tile reinstatement of said laterals encountered in tile progress Zild prosecution of the work and tile installation of new sanitary sewer pipe and, laterals and connection to tile exi-sting systern. 19 Where proposed work conflicts with existing private building sewer laterals, a segment of the existing sewer lateral, in conflict, shall be removed and replaced/reinstated. Removal of existing sanitary laterals shall be limited to the first joint upstream and downstream of the portion of work in conflict with the proposed improvements, or as required to tie into existing lateral locations. This work will be measured on a per instance basis for conflicting laterals encountered during the course of the Work and shall include all labor, equipment and materials (including pipe, fittings and couplings). 3. Replacement work materials shall be PVC SDR 35 per ASTM D3034. New sanitary laterals and fittings shall be 6-inch diameter PVC SDR 35 per ASTM D3034 unless otherwise directed by the Owner. The pipe and fittings for the 12-inch and 8-inch Sanitary Sewer shall be PVC SDR 35 per ASTM D3034. 4. The work performed with this Pay Item shall conform to the current City Standards and IDEM's requirements 5. Watertight joints shall be provided at all connections. 6. Installation of the sanitary sewer pipe shall be in accordance with the pipe manufacturer's recoimmndations, ASTM D2321, the City of South Bend's requirements and IDEM's requirements. Pipe installations shall be backfilled as shown on the Plans or as directed, 7. The termination point of each sanitary sewer lateral shall be marked with a steel reinforcing bar and with a wood stake. The reinforcing bar shall be size A, installed flush with proposed grade and shall extend to the center of the sewer lateral pipe. The reinforcing bar shall be offset from the end of the lateral pipe such that it does not touch the pipe. The wood stake shall be pressure treated and shall be 2"x2"x24" long. The top of the stake shall protrude Vabove finish grade. The sanitary sewer lateral markers are incidental to the respective pay item. 8. Leakage tests of the sanitary sewer shall be conducted by the Contractor for infiltration or cAltration using a hydrostatic test. The hydrostatic test shall be performed with a minimum positive head of 2-feet. The rate of infiltration or exfiltration shall not exceed 100 gallons per inch diameter per nine per day for any section of the system. In lieu of the hydrostatic test, all sanitary sewer piping shall be subject to a low pressure air test per ASTM F1417. The City and Engineer shall be advised 48-hours prior to conducting all tests. 9. A five percent (5%) Mandrel Deflection Test shall be performed on all PVC sanitary sewer pipe. 10. These pipes shall be mandrelled with a rigid device sized to pass five percent (50/0) or less deflection (or deformation) of the base inside diameter of the pipe. The Mandrel Test shall be conducted no earlier than thirty (30) calendar days after reaching final trench backfill grade. Each pipe material/type required to be Mandrel tested shall be tested with a Mandrel approved by the pipe manufacturer and meeting the requirements of this section. The test shall not be performed with the aid of a mechanical pulling device. 11. The mandrel shall be pulled by hand through all sewer lines in a manner acceptable to the City and any section of sewer not passing the mandrel shall be uncovered, replaced or repaired to the City's satisfaction and retested. 20 12, The Contractor shall provide PIVvilig rings to clieck the mandrel, Drawings ofinalidrels with complete dimensions shall be rumished by the Contraetol, to the City upon request for each diameter and specification of pipe. 13, Bypass pumping required to complete the work shall be discharged to the itearest existing sanitary sewer or as directed by the Owner. 'tile sariitaiy sewer bypass plunping work item shall include all labor, eqviipment all(I materials as required to maintafit colifintious service of the existing sanitary sewer system. The bypass puniping system shall operate such that surcharging and backups of the existing system does not occur. 21 ExhibitH When the prospective Co»ti•actoi- is unable to certify to any ol'the statements below, it shall attack 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 ) SS: Mx. COUNTY ) The undersigned Contractor, being duly sworn upon his/herlits 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 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/qnote; and 22 5. Contractor shall require his/her/its subcontractors perforating 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 alter 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 Contactors 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. Contactor 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 on this project if awarded. 1 understand that violations hereunder may result in forfeiture of contractual payments. 23 I hereby affirm under the penalties of perjury that the facts and information contained in the foregoing bid for public works are tme and correct. Dated this .� I _ day of 20 l M 11 JOAN L. FRAME $ , Joseph ou ty i* my Coninlisdon EXplfos ,'''anasary 2fru 202t� Contaactorlll'idde -Firm bagnat re of Contractor/Bidder or Its Agent Printed Name and Title Subscribed and sworn to before me this ril .. day of �+!")J_ . ;, 20 My Commission Expires /�....!'.. Notary Public County of Residence 24 1/12/2018 Details Next/ Se arcfa, Lttf .mien oocaanao ai ltat� ,,t"ertificaaflqu Plat nbina Coa'flnL14 on fdIndiana a i li aemLicensing License No: 999108 3 License Plumbing Type: Corporation License No: F8LZ 02�d1_ License Plumbing Type: Apprentice License No: '080ify License Plumbing Type: Apprentice License No: ?A998d28 License Plumbing Type: Apprentice Person Inforaa'tation Per,w ., DAVID P FRAME Address Informatioa� LAKEVILLE IN 46536 License Information License No: Profession: License Type: Obtained By Method: issue Date: Expiration Date: License Status: pj-evjojjs Action No Data Available violations No Data Available Related I icenses Bob Flume Plumbing Name: Services, Inc status: Active Claeys-Smith, Nance: Adam C Status: Expired Frame, Tyler Name: M. status: Expired Palmer, Steve Name; A Status: Expired PC88700840 Plumbing Commission Plumber Contractor Examination 512611987 12/31 /2019 Active Relationship: Manager Relationship: Employer/Employee Relationship: EmployerlEmployee Relationship: Employer/Employee https://myliconse.in.gov/EVerification/Detalls.eispx?agency_id=1 &license—id=1185598& 111 111 2/2018 Details - t 2442 Jaclyn Court South Bend IN 46614-3700 License Information License No: Profession: License Type: Obtained By Method. Issue Date: Expiration Date: License Status: Previous Actimi ............... No Data Available violations No Data Available Related Licenses License No: Rg887008 0_ Name: FRAME, DAVID P License Type: Plumber Contractor Status: Active C081053737 Plumbing Commission Plumbing Corporation Application 12131/2019 Active Relationship: Manager https://mylicense.in.gov/EVerification/Details.aspx?agencyjd=l Micense—ld=118479% 1/1 BOB FRAME PLUMBING SERVICES, Business Name: INC. Entity Type: Domestic For -Profit Corporatimt Creation Date: 05/16/1975 2442 JACL'YN CT, SOUTH BEND, IN, Principal Office Address: 46614 - 3700, USA Jurisdiction of Formation: Indiana BUSINESS INFORMATION CONNIE LAWSON 1NDIANA SECRETARY OF STATE 01/12/2018 07:16 AM Business ID: 197505-304 Business Status: Active Inactive Date: Expiration Date: Perpetual Business Entity Report Due 05/31/2019 Date: Years Due: DIMS NO. J218-LIQ am ()CCtjpAjTm-%L S.AFE7Y AND HOALTH ADMINIST&ATION 16141 ojjTV.FACH TRATNUING FROGP-W -RBFORT CO-NSTAUC!TION. Reid ilks(rucliousbefoke C0111I)IOU9 VIIS 101111- sj'jt�,cvrll TrAwrXCoutse exg.�40&i city louffiDend State UNI Zip 46628 10-hour 9, 30-bf Youth (kw- I e OT less) OSTM.kjjjajjeO OV F8dV1Cr&hiP (6Pe64')-- other rlZg a Simef address W-27RSIP1110110tour, , WeS f+l union -Stan End End Start -filne- ()8.00 AM Thilie. 05,00P)d Tithe! 05:00 PM Tbile; 0:00 -111.W Time 05:00 PM 'little: 08:00 PM Thue: 05:00 P*.%4 Tuna: 08'-00 PubI 1 1011513-016 CotmeDale-Z 10/1912016 Cavuw Date'101U,0-016 —1 —4- —V 13 onsorbig Oygafitzaltowk jEmployel,Assoviation ..Safety &- pealth Employer NVA y other (specify? 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Aal�dReams - 0,9RA Pooch I'otuw•71a'za s - n ate tits total liauto ap nt ontlaclitte " to itoa 10tt, awtdt ioualiJc Cfoc tiwtc breakdown aawtae1t late is ?tirt i q_d FolI 1lrOle ction Struck BY _ Carw�,ltt ir�bottwesttw 1 11ez rpstl tot lit'a Equrypwn( ..-..'�•�'�11ea1tttHazsrcJs iw> Consttuatian Cntyo, Delrirks, Tioists,>zlevatrns, an<1 Colt3)ora �W� P�anNaltolhs r fi lalraiafs 1dRu1R0lixtq„ Stagg% Use and Disposal Staitrti'�w}'a �dLaddei ,r"cols puld N)d RAVer 1�OTA µ i.. - tI 1dolit TOPICS (11adweate tho aniountOf time spent ors eaala toplt in'G1a class. Hours ° 2 hrs )wtlrodoc nowt to+11S11 rt OSRA oaua k�wn 1la.raIdsM ltola t0wr tantal Nitttos1�we11fi on t0wu111wc , 0 to 1110lcil, two indta ala 14, tdltta WCobdoml ola owl, iune taelOV" •a e �61 . S las a1;rota t k t; d ` 21krs Y4T.Y�i�M.R,@t YpY,�§ �'UO(�'Fpi'eSS% ,�'et'a�1111w"Q1"*""71M4°4* 'Health 1-laesards in r: nnrtwwrtrlion C�a" wtoisa, hazard 1a eoannrounia+Utio hand silica hen S{alwjv iw and i.addets u :161ticuaaltlw 5aiaty and health ELLCTWE t 1us > tra Protection and Prevention `t stirs I :rwlelel^ia.0s IlandOnrb. Siotvge+Use andT)Isposa 1 hex �Tcoln - Hwuwd and Potter l' Itr� ti e0dwal and culling 110 sr" folatc 1 lart . ,«...,,.. ,. t�inslas, l onlc s,11ni5 $t 1110valon, aidunw�wrycws uquipment old aYlne�)0YLraliom: rTctot'" elMtalea,ll', "fJlhii.n1'd"ei1 Overhead Protections, awlal llollover 1)^atcvliva sl"10tulvs stud siprlats Arid Banvicades 1'1t t li-wo 'attiolm 1 hri *coacreteandMasonryCotwstiOCtion 71t1a fit eJ I;a"e403 I. llrs safely and Healtll P08Y"s'w M ..111% CunlittadSpacelirlity. 'l Iwas Potwtratal ladush€al Vehicles OPTIONAL i. ,2i� Iacab lv9 �ou1�1o�s A e . 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W2619 J _ Camrpzwty .Plumbers & PipeC. rs Loca117"_ Address 41 alo-101-1Court City Svudt Bend 5taie.lA Phalle No. >:rna11 uaw3louss 12e[kgwtiall sera .._.,., .:.. .. �.....�...�..�..�. � � 9«r'�trltther•atlilaTattwllA^r m, ,.CourseGouBucred t Cvausek:aul>Waasts(efporta.nllt]rataPPt)) w r 10.hrnwr r • suarrrslr +I'animse olhew 2Ii Wa or J]l�.orrislr (slaeol s 9 a ;w 30•hs Yvu111(W 18 at' less) -` OSHs1 it lliaueo ocPa[iStetsitip (aPecify): ' Olhex(specifi}; _' �10 iaalwrlrrBrrWtedtrass state IN C shyU city South $cud am n]todstates Strant address 417'-Ralph Jones Court 1 l � Type of Trahrlrrt rltte >cP •School {+ 6rAP10}e rAaoarairon o er (aPeol ): Oiwc UntO i2 {"rgurselllnadoaw w.� .M. _..,..� ..�.�,�...�.._.......,.,_ ...�.. �,,........�._,..._.. ) End Slant End Start End Stall ud e: 08:s0 PMStart e Trnre: 05:30 Phi Trrr_e: 0S 70 PM Time: 05:30 P%1 'Fiore: 08:30 PM Tirtte: 08:00 Abf Tina. (noo mI � i ime- 05:30 PVf Tim f Date: CouluDate 04161,201E Course Date: 04a21a 9 CourseDa1e:05f071�:0'16 Goau�e ..,.,...� ""` ,,..,�.....�...�._.. ];d. lrt1'lsoailr� Cgrarlaatl�lr ..»� •.�� , �����.�.. �� mm��� ..� .w Employer Aisociahiwk i Sa£atylviTeaktlt :Employer v.Laboi:fUvion 1 Y f r:: EduaaUon �w Camwnuniha NM Otlter ("Ce )) 14 Stfrtcwrtarwwtali Cer tiW]cwwtPoTu Jcarl t=¢7roarF!lravecoif4wflrt"J145OrtrrEcukll mlrrfrt Frr+{rruwrPrrasiraaccordancetelflecvrdOSH,I0 ra toaa�dr9of rrhtr'orlcw rriucario(: or€fs EJr ti-)w rc+1'r rarrrJ,lr Wxatd tFac awra",", «r�ra oraFs rrs sfewtEd Fit lJae ElrrU°rrrrffrars 6wae1 i ]a„IJi akowFzNa rhes rknot 1d [F t J uFFJ J e swat acr ra irwawaaorJdcrru rFsrtiisxcrl, frearrt t as OSIGi wards rfalw 7 rrwir a !'ro +aaa�ao J or rl aF Ja't CTS c r 00 (VO C110 )7(g) Of fhe arrlrol° a'wespaear !'rwrrdrrnsraar J , wrrareaas�arwa"CiaaraFdr°ra's^idttr� rrFsrtr"Grkaaatraraifo2'Elrwrrr�y+srabfacranada+rfwJ�a�uaci'arJlwrfrwulpr�w[rJrioanirowdarErara n �; CJra:w aatFErrrwJ.Srrefrryrraw lrrtaJrJr sfa�PGs,C,dddlbrwJrSa;laprot�dasoxlrtfPlsrrB�earwzlCJasfaaa°awrikFt3grls�r�lsftarrwaarJsal'repreaeruarionatramtydracafraaarrl,�dtr�,PrrrsrcrfDrrrorLar °ab„r'rrotaosf FFtur faBF,luw"ooFdare!'ls ra°rrrcrrJrri asrrr'dG'{. Date: Trahter Slgtratwtre: �IfsilbNllrlF)1�'alars' ow71a 'CJEC.trOlwfCJkCAf1-1 bf%CJfeckngs,i6bG,1'i4rJ1L'FPifFOYA�f1.Y11r�5!$/7b3i{fvratrestilllJt(rFF•17�UrwwationprotFdEd(riuInto dwissrrbnitssiorlowrrlaccroE'afE. 1rt°@a^ac)° sift Slatataielrt arsrl k"rwPar rt°orda iCetlwactloror a1a°T StatrrarenaT Tha lyrrt ae + art oC1 7+1 ars warrtarrded ( "f J. S,C .1S2o) rr atiow1+201 of 11t1s311 to the US Cock, null 200 R S Sleieai�4 orEtlletiort ofih% tfxrnrMR; is not mlandatorp ho�tever, Ilais of this iwilorrrrati trot is lotetaanrirrr�ralrellror tlra -reinter rs atrtira r'izeal orrt rn ltoTlter rho tra¢rwiwa tins J y l „ irwSarur atiaxrl is rrr uirud to airlrolin 081i4 siw aiolt4 course rraflagrUotla a arrwrd `.: idltivatal alasalo�sur,� tl°d illft at lit OMB wAl ,al nuraalaen Pu tic reprsrtro bual fro? for IMP t Aolof'l TlS rto wa'somssnl�al tlir+sdtoxasiloaroeftouCcrtfaol'aonafwrowCorrrorocrkioarrorrfesssetio9tevleawtwrawa ,i �ww riq collertrurr o� inlarwxuuRworr w; ostaruaroteal Tar avera?So 1 lrtiuulss fit'„rusgloaie ivafardllr, tirlre fol'tar^iarwirllf^ to thisl llea08, tloll is resrdlArae1wvirtng u" 0$11 thwant rrellmerwcom dodo r tlrry aloroa areeded, awTd utpwralaloTlwro� alyd 1°aar"1e.ti+rin llwe cadieetiouat infoiattat�au.3"1roo 01li atioar to resplaaira� t this � 1s ass staicai irr f3S1d1t,"s t?uSraar:la'1"zotoisw r�? �'arar lteyarurerlroorrta and lrrar:eahaw°es: etwrt oorar+ �m%�1Prasllr aswall k tewalRl�dro�rr"ssisu,liol4 lr etor°oTof afFlioruirnr wsrht 4wtr� tfarclasrtx 2C t1a srWritRisblvr ilttr o1+'r",i10 taa a18,11faalr�ga icsuU7 uraleiurrthe t>,'r 113 C?trarlstrf�'rorrrwhur SSat s Plea a ale rral rztwst ilao eauartp9etr wl Caallrl Fornr 4.50..1 to tnis address. Cj1ffi No. I? t S•0262 +"�^ ; ° OC;Ct,'P3TIO3eALSAFFTILIA DBFALTHADlNIL"ISMATION F.apiration:lf3170 OUTRZACH TR,41NI\' 1'ROO"I REPi�Ri "I CONsT'RUGT10 3 Read Ill stroMalt s b66L% CoraPIMing Oils ]'onn. *�GtItt eltt�tatnai3' , c �li I otuir tlntlaao t _t i'v'tttwatsma�t�eYeglkatt"�� �lndloato the t�rnrtiat+at haute alaont aatt aaelr t6 iC lia tha class a a - � . m�� .�, 1 pg .t �ka� . rt n� t.ln� j°w avuit9a 1u. Qu RED > 1 t ka F, (%O �... a«. Hours .„ ..—.... ..11 krtrtBaroar l6 t15Ii ..�... CASzAF isaCuls 7�olaa 1lar.rrd+t - soot% t)ta. to�lial little xpant 6tt kl1e� �i'ita6 � � to Ihe'14, 01"d datdaaato the tnw brrrikalown On emit litsa tretoty, d. , 'Foil prolaetion s � alW101 u Streak By ataght hViietweert Sat�rsrrss�u4preteotire 1?quipmeatt � f � 7. E"sta'��w �-�w- �.-—"","..""� j k�ie6ltl�ro iiazrl� in (:anSUUction � S. ly�,b�l'l�,ydt� t i ra ui f Hoists, ] la\ ata>Y, and Cm\\EELECTWE yols 9. l ttit � m tittermutalHandfing, Storage, Use aatdDialtassl i, kaiyelds o- G „""—' 'Slain\�my,tgdLoddrax r " "Toa7s —nand ond;Povo'r i q... � �.:.� W,�° Stt 1"totlt• "I"ogtlts *Indtcala the sunounl Of tatlo spout oil ea6ll tolal6 as Mh lass „w mm n a 'Roull V " fiY6 li tta°6d iieCiaatt to 0514A k 0814 1%aorasltoaia liacxalt%s wltola ttte total twallo&"An gait ihaslhle ro m to the lslft, anti indicate th6lime bt'elkkdotwat oral c Aelt Hoe below. wxm s ]>Ftt'a 2'9u's pensaaatptojte.ldvt,mid i.r`'lauovlisgFgil'ilipilem 1t tilllueAsilu ranttursCtt6ir-a,g,,laaiae,4aa�«a� v 2h>x Cauppactaitioati6rtoltdtaliah _ i z1sr�AStaic°staylrmid Ladders ita I—'sisoaa?'jng Safety and IIen1_ih I ._.,._............. '&LECTIt,'E i l lao Fist" proteelian and prevention 3 I'm metey$aall Haudibig, storage, [use MaDIS S01 i uts Taeh-Ilmtdand-po\ver } hr Nvejl piaeg and Gutting 1 m }} �ars�3Caffnlds t9tut tataes,C�ert[rks,kloista;?z4mIidots„itod onvetyolS 9 M� acwttw a eAtie9 , Njgehalstd red Yquipinentt 8114 M01411e gaezraticstis, i nlweFprateeti eStw�aotttret%runt eeritpad proledioaltaA4 I itv� sitw, Sigaraia.enst I3owaiuw.ad9� , Ilir�a ;I1wil alimlit W t d irt� . Conra�te dttd'Masnnuy Gottslauatian I Fin sleellSraatiou t i?ra .� Ot'y and Health Progil(ne ..�. � i>rs """..tn"oaaiCtied'Spgce )3ntu}l , oMONAL u��l tlu^a m poneredlnda3triol Veltielns 6 . l icrr3 ;l�u'c�oi�nmios , I- 7 tlldtl21tt w ... _,.. °A Cealbod Pupirce PVQOGG$ Assioclaticin Oest Type certification Programs UAOSHA 0412 12016 No rxpirallon OHR C01,11floate of Qualifications n,,O, ADAM 0 CLAEYS-SMITH 0:002076164 Local:172 Training records available upon requesi. /).x-- e) AN, -caoorat �10614mst United AssmilatIOVI TYLER M FRAME ID.'001680565 Laottl 72- TraIlling recofdsaVallablO upon request, iAPI,14, G t Celt Typo catifled Expires Piroad6s UAOSHA oel-MM0,16 No 8)(PI(OtlOtl IOHR 1/1212018 UA Members Only:: Smart Functions Certification Card Unified Association Certification Programs Celtificate of Qualifications BRANDON P GALVAN ID:002076169 i_ocal:172 Training records available upon request. General Pt;esi►lent Cert Type Certified FRMAN 12/19/2016 UAOSHA 04125/2016 "yam UAOSHA 0511912016 Expires Process 1211912020 UAMCAA FOREMAN No Expiation 10HR No Expiration 301IR 1/1 https:/Iuanet.org/badge_nonweld.asp United , cs"toOkA fOl't certification Programs Cergftcaie of Quaimeations DAVID ROSS iD.001103083 t_ucaH72 Training words available upon request. , � -- p toner"t rh^eMotut, Ced TYPe Certified Expires Process uAWHA 0112912o0% No Expiration 101-111 The person stated onthis card has attended the United Rentals Excavation Safety For Competent Person Training class. Only their employer can designate them the Competent Person, A Competent Person is one who is capable of Identifying existing and predictable haxards In the surroundings or working conditlong which are unsanitary, hazardous, or dangerous to employees and who has the authorization to i take prompt corrective measures to eliminate them. Excavation Safety for Competent Person Training United* D"o Moss has accened hours of training .� . .��.�.,.. _. d...r.._ _._. In Trench andExcl�l11d 9.,1n�4slcy, 2127/15 The person stated on this card has attendedtheUnited Rentals s Excavation Safety for Competent person Training class, Only their employer can designate them the Competent Person. A Competent I'rerson is one whcr" is capable of identifying ; existing and predictable hwe..Irds In the surroundings or working conditions which are unsanitary, hazardous, or dangerous to employees and who has the authorization to take prompt corrective measures to eliminate them. Continuation Certificate IN CONSIDERATION of the payment of a premium of $ 100.00 Federated Mutual Insurance Company hereby continues in force to its bond No. 0942863 effective 12I31/2015 FIVE THOUSAND AND NO/100-- BOB FRAME PLUMBING SERVICES INC represented b if applicable) CITY OF SOUTH BEND BOARD OF PUBLIC WORKS ..- ...-- .._.._.m.w 12-31-2018 Dollars ($ 5,000.00 Obligee subject to all its terms, conditions and limitations as set forth and expressed in said bond. in the sum of on behalf of Principal, in favor of This certificate is executed upon the express condition that the Company's liability under said bond and this and all continuation certificates issued in connection therewith shall not be cumulative, and shall not in any event exceed the amount set forth in said bond, or said amount as it may have been increased or decreased by any rider(s) or endorsement(s) properly Issued by the Company. Dated this 27TH day of NOVEMBER 2017 Federated Mutual Insurance Company BY MICHELLE KRAAY Attorney -in -Fact ;,If RenewalLL Not Desired, Please Return Atom Of Original Continuation Certificate With Power .. .- Attorney Davs For Cancellation. Within 30 t7 ._ INSURANCE'7w PO Box 328 Owatonna, MN 55060 Equipment List - Updated 01-15-18 m Naaae of _.-Gr e c xc cxya i � h Pre Qualification Category Second Qpiinion Excavation Sp al Attach copies of the followm ' g do cuments I. License Number 2. Bond letter stating limits for single project and aggregate program 3. (Corp. or LLC Only) Corporate authority and/or proof of registry with the Secretary of State to do business in Indiana Principal Place of Business: 30416 _ (o CvnA-y Roo, ,... 24 ©5Ge_010.1 W + 5(91 Mailing Address: A 304 q 5 _ & Co\i M-Y toga Zf ' O sr ec� la ( /A/ 4loslo Te➢ laoa Cell Fax: I c ()wncrsbip Information 11- j /7 Company, l i(applicable) bl)e Pn e 1 Cm none Co an , : a livable c Nature of Company's . .. Business &rrVe EXr,, <xA- a &Y\ eY (A1\1A -" Tas:6r (Briefly describe the type of ` servicesyourcompanyprovides) �1 f rry (Provide references as needed to validate experiencefor specific q �' pre -qualification) t 1tMa a f' 11a I� 4ak,%r..a6*'t) OSHA Competent Person Certification P a7Trp1f� (Name of holder, expiration date) r� 05VA 40 *14s?tFl 7J 1 9 13 OSHA Confined Space Training Certification t (Name of holder, expiration date) r Jz^ 2 1 License Information (Name of holder, license type, number) Equipment On Hand (Pvideproofofownershipand � Ivor i Q��� xcA'qJ'a'�- list of equipment owned by companyfor use in determination � ofpre-qualification) i�l I1 q r T l p l b —rML-� nMc- By signing and submitting this application, Uwe agree to follow all City of South Bend Prevailing Specifications and Special Provisions (enclosed in the Sewer Insurance Program Policy as Exhibit G) By signing and submitting this application for pre -qualification, Uwe understand that as a Contractor under the City Sewer Insurance Program, I/we shall be directly and solely liable to a Homeowner for any damage to any Homeowner's person or property caused by the Contractor's acts, conduct or omissions arising from or within the scope of this Program. Uwe shall release and fully indemnify the City from any claim or cause of action of any kind which Homeowner may make against the City for any act, conduct or omission by the Contractor under this Program. Indemnification includes but is not limited to Contractor's payment of any legal fees for legal expensd' irred by the City in defending such Homeowner claim. ....... S�gnrrtar Signature Signature Title Title T711e bate Date Date 14 %-^M A--ff DA -M (MMfDDNYYY) k.1-1, CERTIFICATE OF LIABILITY INSURANCE 10/15.COIS THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, E)ffEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT,, If the certificate holder is an ADDITIONAL INSURED, the policy(ios) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain polides may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorse mants ). PRODUCER CONTACT NAME: Matt Dodd Pilot Insurance Agency A/C No East : (574) 855-4937 822 W. 8th St. -A C, No INSURER(S) AFFORDING COVERAGE NAIC 0 Mishawaka IN 46544 INSURER A; Indiana Fanners Mutual Insurance Company INSURED INSURERS; Grove Excavating INSURER C 30495-6 County Road 24 INSURER D.- JINSURER Osceola IN 46561 INSURER F: Ci;VERAGES CERTIFICATE NUMBER: _ REVISION NUMBER: THIS IS TO 3M-nFY THAT THE POLICIES OF INSURANCE LISTED SEEM HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. MW WOM SURR F TYPE 01: INSURANCE LTR INSD WVO POLICY NUMBER -MaLly mum 1001100 LIMITS _f X'COMMERVAL GENERAL LIABILITY --::ICLAIMS-MADE Fx-]OCCUR EACH OCCURRENCE $ J7)J3Q0V6 "RMTMU 11000,000 PRtMEES !MCrE—) 100,000 M!EO EXP (AAY one VIII—) $ 5,000 A I CGLI008928 06/08/2018 06/08/2019 prRSONAL & ADV INJURY $ 110001000 GENT AGGREGATE LIMIT APPLIES PER: X POLICY OPRO' JECT LOC F-] -- CEN&RAL AGGREGATE S 2,000,000 PRODUCTS - COMPIOP AGG $ 2,000,000 OTHER: —Ty .AUTOMOBILE T FA a i u - — - ........ — ............ T ANYALITO (Ea atd�� 1,000,000 — BOOLY INJURY (Per person) $ OWNED OWNED SCHEDULED A S6HCD'JLCO U' rOS ONLY X AUTOS — AUTOS ONLY X AUTOS CAPI009680 05/23/2018 05/23/2019 BODILY INJURY (Pot accicenl) $ HIRED NON -OWNED HE "ON -OWNED ONLY AUtCG ONLY AUTOS ONLY S AUTOS ONLY VM­aRi­UA'UUA8- OCCUR CUR U r rAcI-f OCCURRENCE I$ 'SS U EXCESS; LIAB CLAIMS -MADE CLAIMS MADE . .... ... . . AGGREGATE $ DED RETENTION !i ORX Ratolel.Ebl' T"W XERS COMPENSATION kNO EMPLOYERS' LIABILMY YIN WY PROPRIETORMARTNER(EXECU71VE )FFICF-FUMEMBE'R EXCL6DED"? N/A . EL. EACH ACCIDENT $ ......... Mantlailory in NH) I describe under E.L. DISEASE. - EA EMPLOYEE $ rs,r .S RIPTION OF OPERATIONS below ' . . ....... . .. EL. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached IF more space Is required) I'r-RTIr1(*.ATI: Wfil n=0 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POUCY PROVISIONS. AUTHOKRIUD REPRESENTATIVE @ 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD