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QUOTE/PROPOSALw
CITY OF SOUTH BEND
1865
PROJECT NAME Human Right Commission Office Remodel
PROJECT NO. 18.018
QUOTES DUE April 9, 2019, 9:30 am Local Time (EST)
Item Quantit
No. Description y Unit Unit Price Total Amount
1 Office Update to Human Rights
Commission Offices Lump Sum $
Total Amount of Quote $
Firm:!'YL
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Address:
City/State/Zip: cam'• Telephone Number:
Fax Number:
By
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Version 10/18/2016 Page - 2 Public Works Quote
Date:
Address:
CITY OF SOUTH BEND, INDIANA
CONTRACTOI!'S UOTE FOR I UBLIC Oi I
PROJECT NAME: Human Right Commission Office Remodel
PROJECT NO. 18.018
QUOTES DUE April 9, 2019, 9:30 am Local Time EST
(Must be completed for all quotes. Please type or print)
Firm: r0?,A9rW l e f
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City/State/Zip: fTelephone Num
Agent of Bidder (if Applicable): N I U,%
Pursuant
nt to notices t ogiven, the undersigned offers to furnish la,
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and'/or material necessary to complete the
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the City of South Bend, Indiana, in accordance with plans and specifications prepared by:
The Ci of South Bendp!artment of Public Works
It
_. ( e Total Quote as shown on the Proposal
and crated for the sum of enter th
r/
(E 'er Sum ofi dotal Cuote p us Alternates shown on Proposal) (Numerical)
If alternative quotes 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 quot is to be awarded on a unit basis,
the itemization of the units shall be shown on a separate 94acfXnent.
The above quote is accepted this
Subject to the following conditions:
BOARD OF PUBLIC WORKS
Gary A. Gilot, President
Elizabeth A. Maradik, Member
James A. Mueller, Member
B
y
ACCEPTANCE
day of
13
Person
Suzanna M. Fritzberg, Member
Therese J. Dorau, Member
Attest: Linda M. Martin, Clerk
20
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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
SS:
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
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unauthorized alien. Contractor agrees that he/she/it shall enroll in and verify the work eligibility
status of all of Contractor's newly hired employees through the E-Verify Program as defined by
I.C. 22-5-1.7-3. Contractor's documentation of enrollment and participation in the E-Verify
Program is included and attached as part of this bid/quote; and
5. Contractor shall require his/her/its subcontractors performing work under this public
contract to certify that the subcontractors do not knowingly employ or contract with an
unauthorized alien, nor retain any employee or contract with a person that the subcontractor
subsequently learns is an unauthorized alien, and that the subcontractor has enrolled in and is
participating in the E-Verify Program. The Contractor agrees to maintain this certification
throughout the term of the contract with the City of South Bend, and understands that the City
may terminate the contract for default if the Contractor fails to cure a breach of this provision no
later than thirty (30) days after being notified by the City.
6. Persons, partnerships, corporations, associations, or joint venturers awarded a contract by
the City of South Bend through its agencies, boards, or commissions shall not discriminate
against any employee or applicant for employment in the performance of a City contract with
respect to hire, tenure, terms, conditions, or privileges of employment, or any matter directly or
indirectly related to employment because of race, sex, religion, color, national origin, ancestry,
age, gender expression, gender identity, sexual orientation or disability that does not affect that
person's ability to perform theyyprk,
In awarding contrgctsf6r the, purchase of work:, labor, services, supplies, equipment, materials,
or any combination uf—the b l&-egoing 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
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(I.C. 5-16-8-1). I hereby certify that I and all subcontractors employed by me for this project will
use steel products or foundry products made in the United States on this project if awarded. I
understand I have an affirmative duty to notify the City in my bid that my proposal does not
include the use of steel products or foundry products made in the United States. I understand it is
my sole obligation and responsibility to provide a justification to the City, subject to review and
approval, why the cost of United States made steel or foundry products is unreasonable. Prior to
award and upon submission of bid which does not use steel products or foundry products made
in the United States, the City, through its director of public works, shall make a determination if
the price of United States made steel or foundry is unreasonable. I understand that violations
hereunder may result in forfeiture of contractual payments.
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 day of , 20
Contractor/Bidder (Fig
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lei S. co" IN,
Printed Name and Title
Subscribed and sworn to before me this VIN day of , 20 JA
My Commission Expires
Notary Public
County of Residence CY
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