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Home My WebLink AboutOpening of Bids - 2019 Curb & Sidewalk Construction Project No 119-004 - Indiana Earth IncProject Name: Project Number: For Bids Due: Contractor Name: M1110inki A4 BID/PROPOSAL CITY OF SOUTH BEND 2019 Curb and Sidewalk Construction 119-004 May 14,2019 at9:30am Local Time Item No. Description Quantity Unit . ........ . ..... Unit Price Total Amount ... ........... 1 CONCRETE SIDEWALK, REMOVE . ........... . . . ........ _CONCRETE 364 SYS__ c)0 � 3, 0 _2 .... � SIDEWALK, 4-1—N 364 ...... t6 .. SYS_ITITIT 3CONCRETE CURB, REMOVE 0 3 LFT /0"o C � /O,V/o 4 CONCRETE CURB, MODIFIED 603 LFT 5 CONCRETE APPROACH, REMOVE 50 Sys 6 PCCP FOR APPROACHES, 6-IN Sys () '4 0 6, 7 TOPSOIL AND SEEDING . ............ .. 454 SYS 010-7-0 ' 1, %317, RQ_ 11 TREE, REMOVE, 30 IN 2 EA . ....... 1#1 1 00 ........ ...... STUMP, REMOVE 1 EA A_iD -7 D _&P !u ... ..... 14 PLANT, DECIDUOUS TREE, SINGLE STEM, 2-IN TO 2.5 IN 3 EA 6 '70 - 0_2 15 CURB RAMP, REMOVE 40 SYS 00 , 0 16 ONE-WAY PERPEN LAR CURB RAMP G ONE-WAY - - .. . . . . . . ..................................... 8 SYS -3 Lb 17 PAIRED PERPENDICULAR CURB RAMP 16.0 SYS 70, 0J 8 -DEPRESSED CORNER., CURB ..,RAMP,.. ---- - ------- .. ....... ........ ...... 16.0 SYS 43.13 L J 0*. u DIVISION BI Item No. Description 1 CONCRETE SIDEWALK, REMOVE 2 CONCRETE SIDEWALK, 4-IN 3 CONCRETE CURB, REMOVE 4 dd'K'dR_tJT_ECURB, MODIFIED 5 CONCRETE APPROACH, REMOVE 6 PCCP FOR APPROACHES, 6-IN 7 TOPSOIL J ----------- —i-t—i"""", "_ AND SEEDING DIVISION C1 Item No. Description ................................... CONCRETE SIDEWALK, REMOVE 2CONCRETE SIDEWALK, 4-"1' 3 CONCRETE CURB, REMOVE 4 CONCRETE CURB, MODIFIED 5 CONCRETE APPROACH, REMOVE PCCP...FOR APPROACHES, 6-IN TOPSOIL AND SEEDING 11 -TREE, REMOVE, 30 IN . .................. -STUMP, 13 REMOVE PLANT, DECIDUOUS TREE, SINGLE 14 STEM, 2-IN TO 2.5 IN 15 _ 60R6RAMP, REMO_V PAiRED PERPENDICULAR CURB RAMP DIVISION Al TOTAL)' J . �('?, As — Quantity � Unit I Unit Price N Total Amount 179 179 §Y 242 LF 50/, a 242 LF 2 3) 90 20 I _JD 3c?2,0 20 242 .. ........... SY LTsnv_) W.. U DIVISION BI TOTAL YN, 20 Quantity Unit Unit Price Total Amount 320 SYS .. ...... /0 qg;?, (_to 320 SYS 631 LFT I e4, 6o . . . . . ....... .. n. 631 LFT gi-t, Y, Tor, -1,), 162 SYS 162 Sys 631 . SYS ........... 16, dw /0 _.J_ a- 1 ---- --- ....... A1,111Q1120— 1 EA 5W OD 2 EA 32 JSYS DIVISION C1 TOTAL 'fAJ._J.,_1"'" Version 10/17/2017 Contractors Bid for Public Works -1 BID/PROPOSAL CITY OF SOUTH BEND Project ectName: 2019 Curb and Sidewalk Construction Project Number: 119-004 For Bids Due: May 14, 2019 at 9:30am Local Time Contractor Name: DIVISION C2 ... .............. Item Description No. 1 CONCRETE SIDEWALK, REMOVE 2 CONCRETE SIDEWALK, 4-IN 3 CONCRETE CURB, REMOVE 4.. CONCRETE CURB, . _.......I...__u_w ____....... MODIFED 5 CONCRETE APPROACH, REMOVE 6 PCCP FOR APPROACHES, 6-IN 7 TOPSOIL AND SEEDING 11 TREE, REMOVE, 30 IN PLANT, DECIDUOUS TREE, SINGLE STEM, 14 2-IN TO 2.5 IN 15 _ CURB RAMP, REMOVE 16 ONE-WAY PERPENDICULAR CURB RAMP 17 PAIRED PERPENDICULAR CURB RAMP DIVISION D1 .... Item No. ion Description 1 _ CONCRETE SIDEWALK, REMOVE- ................ 2 CONCRETE SIDEWALK, 4-IN 3 CONCRETE CURB, REMOVE 4 CONCRETE CURB, MODIFIED 7_.. TOPS. __. OIL AND SEEDING_ _11 TREE, REMOVE, 30 IN PLANT, DECIDUOUS TREE, SINGLE 14 STEM, 2-IN TO 2.5 IN _ 15 CURB RAMP, REMOVE ONE-WAY PERPENDICULAR CURB 16 RAMP 17 PAIRED PERPENDICULAR CURB RAMP DIVISION D2 Item Description 1 CONCRETE SIDEWALK, REMOVE 2 CONCRETE SIDEWALK, 4-IN 3 CONCRETE CURB, REMOVE 4 CONCRETE CURB, MODIFIED -_..... _....... 5 CONCRETE APPROACH, REMOVE 6 PCCP FOR APPROACHES, 6-IN 7 TOPSOIL AND SEEDING 15 CURB RAMP, REMOVE 17 PAIRED PERPENDICULAR CURB RAMP Quantity I Unit h Unit Price 190 SYS "3,Lgm, mmm 190 SYS R , 357 _ LFT.. .... 357 LFTIT _79, -7 [ 40 SYS / 7. �U 40 SYS 9, yU 357 SYS J 2 ._... _ EA W A- Total Amount l4, , 606, . n-a ay 2 EA S-to 24 SYS _ ' .. o, 8 SYS a (4J. vJ 1 _a!?.... 16 SYS 1 78. �AJ DIVISION C2 TOTAL 14 Quantity I Unit 1I Unit Price I Total Amount 391 SYS a (a, — 9,P 391 SYS r'7_ ui 4, 017. v.o �370 LFT.. ... LFT 7a 7�a _._370 370--- SYS .. __1— —2 _ EA owl 4 ojo. .'). 2 EA Ste. 56 SYS 1 vim. yo Co (� 9�', ti 24 SYS 110.1-1 32 SYS 14,0".v .a % DIVISION 01 TOTAL i a u, (,oS, y � Quantity h Unit j Unit Price 1' Total Amount 188 SYS 188 SYS 1, S / 9 168 LFT S— LA . (D 168 _ LFT l r`' Ax). q 20............ SYS Jw.... 20 _..... SYS 130 SYS 3S. LO 16 SYS 16. SYS ...... _.......: (ocq. DIVISION D2 TOTAL Version 10/17/2017 Contractors Bid for Public Works - 2 BID/PROPOSAL ,,,tux-,,, 1'4 CITY OF SOUTH BEND, .. Project Name: 2019 Curb and Sidewalk Construction ... p Project Number: 1m19-004 For Bids Due: May 14, 2019 at 9:30am Lo cal Time .........m ..... " .' Contractor Name: ALTERNATE 1 Item Description Quantity No. Unit Unit Price Total Amount 1 wwwww mITCONCRETE SIDEWALK, REMOVE 101 SYS � � I 2...__ CONCRETE SIDEWALK, 4-IN 101 ITIT _ IT SYS'9, l U ci' 9`t..f..s..... 3..._ CONCRETE CURB, REMOVE LFT ... CONCRETE C,7 IFIED ..................172 vk ....... TOPSOIL ANDURBSEEDING I SYS 4 s rtf'y 8 J TREE, REMOVE, 6 IN 1 EA I ldOm.mmu�ITITIT',� a �_.......�' 10 TREE, REMOVE, 18 IN�� 1 EA ksb. Lu esp, o 11 TREE, REMOVE, 30 IN 2 ..............................uu......._ EAmmmmm _...... ,aa, . �{ ), 13 STUMP, REMOVE 1 mm _..�......._. EA �a ) PLANT, DECIDUOUS TREE, SINGLE STEM, 2-IN 14 TO 2.5 IN 5 ......................... EA y cJ u(�) 3 SW, <Q 7 a ALTERNATE 1 TOTAL 7) Coo 3, YZ) ALTERNATE 2 ....... -...... -----------........... Item Description Quanti No. p ty .. -- Unit _.,_.. Unit Price Total Amount 1 CONCRETE SIDEWALK, REMOVEITm 80 SYS *3 3. 75 _ 2 CONCRETE SIDEWALK, 4-IN 80 SYS .... —ITm IT mmmmmm-7—,--&2 , u, _ 3 CONCRETE CURB, REMOVE 13003a. a-1 4 CONCRETE CURB, MODIFIED ED 130 LFT /„U3 7 TOPSOIL AND SEEDING 130 .--_ ... SYSw0, 11 TREE, REMOVE, 30 IN 2 PLANT, DECIDUOUS TREE, SINGLE STEM, 2-IN �� 14 TO 2.5 IN 2 EA ��mm 0 ALTERNATE 2 TOTAL 3 t Bc��IT O Bidder (Firm):al .......... Address: �� mm _ � ' .. guy-.. . �� .1 _.__M........ City/State/ ip:Q��, /,.-./: ",,�_._1 Telephone Number: ..,. ` ..... By ti. (Printed Name of Person Version 10/17/2017 Contractor's Bid for Public Works - 3 61 CITY OF SOUTH BEND, INDIANA CONTRACTOR'S BID FOR PUBLIC WORK'' Project Name 2019 Curb and Sidewalk Construction Project No. 119-004 For Bids Due May 14, 2019 at 9:30am Local Time PART I (Must be completed for all bids. Please type or print) Date: 6-" 1 3 — % Bidder (Firm):�� ✓� , , Address: y ai i�%,% _k r City/State/Zip:,,wK.� Telephone Number: Si'/ Agent of Bidder (if Applicable): Pursuant to notices given, the undersigned moffers to µfurnish labor and/or material necessary to complete the public works project of: the City of South Bend, Indiana in accordance with plans and specifications prepared by: ... _ �_ �"_.. �.....�.... .:�- � ��.. ✓ o d own on the Proposal) and dated � � or e sum o enter the Total Bid as shown l � �A (Enter S P► ,...., sum of Total Ba a Bid plus Alternates shown on Proposal) / (Numerical) Gel S k X� S e-, en w ✓� C •� Tf J h �c c G-'YJ 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 n shown in the original contract if accepted by the City of t basis, the itemization of the units shall be shown on a set By The above bid is accepted this Subject to the following conditions: Gary A. Gilot, President Elizabeth A. Maradik, Member Laura L. O'Sullivan, Member ACCEPTANCE day of i, the cost of units must be the same as that Bend. If the bid is to be awarded on a unit Of c Genevieve E. Miller, Member Therese J. Dorau, Member ................ Attest: Linda M. Martin, Clerk Version 1/17/2019 Contractor's Bid for Public Works -2 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 ofthis Certification, "Iran" means the government of Iran and any agency or instrumentality of Iran, or as otherwise defined at Intl, Code § 5-22-I6.5-5, as atnended frorn tintc-to-timc. 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 inillion dollars ( 2tl,000,dld ) 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 ($2II,000,000) or more in credit to another person for forty -live (5) clays or more, if that person will (t) use the credit to provides goods and services in the energy sector in Iran; and (ii) at the time the financial institution extends credit,, is a person identified on list published by the Indiana Department of Administration. Version 1/17/2019 Contractor"s Bid for Public Work - 4. Contractor does not knowingly employ or contract with an unauthorized alien, nor retain any employee or contract with a person that the Contractor subsequently learns is an unauthorized alien. Contractor agrees that he/she/it shall enroll in and verify the work eligibility status of all of Contractor's newly hired employees through the E-Verify Program as defined by I.C. 22-5-1.7-3. Contractor's documentation of enrollment and participation in the E-Verify Program is included and attached as part of this bid/quote; and 5. Contractor shall require his/her/its subcontractors performing work under this public contract to certify that the subcontractors do not knowingly employ or contract with an unauthorized alien, not 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 cmploymcnt, 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. 1„ the undersigned bidder or agent as contractor on a public, works project, understand nay statutory obligations to the use of"steel products or fouaadryproducts made in the United States (l.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 ntade in the United States on this project if awarded. I understand 1 have an affirmative duty to notify tire City in my bid than my proposal does not include tlae use of steel products or liraunda-y 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 cast of United States rnaade steel or foundry products is unreasonable. Prior to award and upon submission of bid which does not use steel products or foundry products made in the United States, the City, through its director of public works, shall make a determination if the price of United States made steel or foundry is unreasonable. I understand that violations hereunder Version U17/2019 Contractors Bid for Public Works - 5 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_L..l Contractor/Bidder (Fi in) ' I 'Sig4natuii of Contonl4actorl Bidder or Its Agent J44 6--a Printed Name and "Title Subscribed and sworn to Wore me this clay of... ' c,,q 20_1_1 My Commission Expires It-10-7-5 L Notary Public County of Residence S I . ....... wJ°Zse,f k Brandon McGuire, Notary Public Delaware County, State of Indiana My Commission Expires December 10, 2025 Version 1117/2019 Contractor's Bid for Public Works - 6 r / %I pN8 r. .r 1316 COUNTY -CITY BUILDING PHONE 574/ 235-9251 227 W. JEFFERSON BOULEVARD " , r , Fnx 574/ 235-9171 SOUTH BEND, 1NDIANA 46601-1830 66 TDD 574/ 235-5567 CITY OF S1'.1UT14 BEND D A 1'. TE BU TIGirio', MAYOR BOARD OF PUBLIC WORKS Date: May 2019 To: All Planholders _. ._. ....... ........... _ . From Linda M. Martin, Clerk, Board of Public Works Subject Addendum Number: 1 Project Name: 2019 Curb and Sidewalk Construction Project Number: 119-004 ACKNOWLEDGEMENT OF RECEIPT OF ADDENDUM Date Received: S— 1 3-- 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 1e Specifications and Contract. Documents and hecotrle a part of herein. Company: � t c: a a, r � 4 IT0,4, 1 �. Authorized Signature-, Date: V '�— °— / -- / Version 4/2/2015 11_0',,�AIA Document A310T"" - 2010 01 0 CONTRACTOR: SURETY: (Name, legal status and address) (Name, legal status and principal place Indiana Earth, Inc. of business) North American Specialty Insurance ComparThis document 10343 McKinley Highway 650 Elm Street le has important al P legal Osceola, IN 46561 NH 03101 consequences. Consultation with OWNER,.Manchester, an attorney is encouraged with (Name, legal status and address) respect to its completion or City of South Bend modification. 227 West Jefferson Boulevard Any singular reference to South Bend, IN 46601 Contractor, Surety, Owner or BOND AMOUNT: ***FIVE PERCENT OF AMOUNT BID*** other party shall be considered plural where applicable. PROJECT: (Name, location or address, (,,`and Project number, if any) 2019 Remove Curti & Sidewalk Construction 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 boUd and not as t tLomrnon law bond. Signed and sealed this 14th day of May India .nm. (1'a arra rl (Witness) (Title) North Ar ~�. II (Strrety) (lf'irr �S.S) (Title)...... Todd Schaap, Attornev-in-Fact AIA Document A310TM — 2010. Copyright ®1963, 1970 and 2010 by The American Institute of Architects. All rights reserved. WARNING: This AIA" Init. Document is protected by U.S. Copyright Law and International Treaties. Unauthorized reproduction or distribution of this AIA® Document, or any portion of it, may result in severe civil and criminal penalties, and will be prosecuted to the maximum extent possible under the law. t Purchasers are permitted to reproduce ten (10) copies of this document when completed. To report copyright violations of AIA Contract Documents, e-mail The American Institute of Architects' legal counsel, copyright@1aia.org. 051110 SWISS RE CORPORATE SOLUTIONS NORTH AMERICAN SPECIALTY INSURANCE COMPANY WASHINGTON INTERNATIONAL INSURANCE COMPANY GENERAL POWER OF ATTORNEY KNOW ALL MEN BY THESE PRESENTS, THAT North American Specialty Insurance Company, a corporation duly organized and existing under laws of the State of New Hampshire, and having its principal office in the City of Overland Park, Kansas, and Washington Intemational Insurance Company, a corporation organized and existing under the laws of the State of New Hampshire and having its principal office in the City of Overland Park, Kansas, each does hereby make, constitute and appoint: THOMAS 0. CHAMBERS, TODD SCHAAP and KIMBERLY S. RASCH JOINTLY OR SEVERALLY Its true and lawful Attorneys) -in -Fact, to make, execute, seal and deliver, for and on its behalf and as its act and deed, bonds or other writings obligatory in the nature of a bond on behalf of each of said Companies, as surety, on contracts of suretyship as are or may be required or permitted by law, regulation, contract or otherwise, provided that no bond or undertaking or contract or suretyship executed under this authority shall exceed the amount of: FIFTY MILLION ($50,000,000.00) DOLLARS This Power of Attorney is granted and is signed by facsimile under and by the authority of the following Resolutions adopted by the Boards of Directors of both North American Specialty Insurance Company and Washington International Insurance Company at meetings duly called and held on the 9's of May, 2012: "RESOLVED, that any two of the Presidents, any Managing Director, any Senior Vice President, any Vice President, any Assistant Vice President, the Secretary or any Assistant Secretary be, and each or any of them hereby is authorized to execute a Power of Attorney qualifying the attorney named in the given Power of Attorney to execute on behalf of the Company bonds, undertakings and all contracts of surety, and that each or any of them hereby is authorized to attest to the execution of any such Power of Attorney and to attach therein the seal of the Company; and it is FURTHER RESOLVED, that the signature of such officers and the seal of the Company may be affixed to any such Power of Attorney or to any certificate relating thereto by facsimile, and any such Power of Attorney or certificate bearing such facsimile signatures or facsimile seal shall be binding upon the Company when so affixed and in the future with regard to any bond, undertaking or contract of surety to which it is attached." arur jy 1l0 y J42— SBieven P.Anderson, Senior Vice President of wosldoron lo9rrnadoaaJJnraranao Conaps:ny SEAL & Senior Vice President or North American Speclally Insurance Company i t AlrArAyl'1111444'"� 0y ,.. Michael A. no,r Vttoo 'i""o-w:.s't'ircut ontpsny g.: & Senior Vice President or Norlh American Specialty lusurance Company IN WITNESS WHEREOF, North American Specialty Insurance Company and Washington International Insurance Company have caused their official seals to be hereunto affixed, and these presents to be signed by their authorized officers this 1 lth day of April , 2018 . North American Specialty Insurance Company Washington International Insurance Company State of Illinois County of Cook ss: On this l lth day of April 2018 before me, a Notary Public personally appeared Steve�sdersMa,..., Senior Vice President of Washington International Insurance Company and Senior Vice President of North American Specialty Insurance Company and 1�1ichI A. Ito . Senior Vice President of Washington International Insurance Company and Senior Vice President of North American Specialty Insurance Company, personally known to me, who being by me duly sworn, acknowledged that they signed the above Power of Attorney as officers of and acknowledged said instrument to be the voluntary act and deed of their respective companies. OFFlCtitt SEAL n. xcNNv -.,w NaalaryPkobWc•�atruJPlomaia M. At�yCorm hlFonri0o Kenny, Notary Public , 7pPtl�'Y I leffrev taoldbcrg the duly elected Assistant NegrellryNorth American Specialty Insurance Company and Washington Intemational Insurance Company, do hereby certify that the above and foregoing is a true and correct copy of a Power of Attorney given by said North American Specialty Insurance Company and Washington International Insurance Company, which is still in full force and effect. IN WITNESS WHEREOF, I have set my hand and affixed the seals of the Companies this 14th day of May , 2019 Jenny Goldberg, Vice President & Assislunl Secretuyur Washington International Insurance Company & North American Specially Insurance Company STATE OF WISCONSM ) COUNTY OF Kenosha ) ON THIS 14th day of May 12019 b before me, a notary public, within and for said County and State, personally appeared Todd Schaap to me personally known, who being duly sworn, upon oath did say that he is the Attorney -in -Fact of and for the North American Specialty Insurance Company , a corporation of New Hampshire created, organized and existing under and by virtue of the laws of the State of New Hampshire ; that the corporate seal affixed to the foregoing within instrument is the seal of the said Company; that the seal was affixed and the said instrument was executed by authority of its Board of Directors; and the said Todd Schaap did acknowledge that he/she executed the said instrument as the free act and deed of said Company. Kimbe la asc: tit i Notary Public, Kenosha , iscon, My Commission Expire 022 � tlY �; 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. 2. Attach a listing of public works projects currently in process of construction by your organization. 3. Attach information regarding any failure to complete any work awarded to you and the location thereof. 4. Attach references from private firms for which you have performed work. SECTION II PLAN AND EQUIPMENT QUESTIONNAIRE 1. Attach an explanation of your plan or layout for performing proposed work. (Examples could include a narrative of when you could begin work, complete the project, number of workers, etc. and any other information which you believe would enable the City of South Bend to consider your bid.) 2. Attach a listing of the names and addresses of all subcontractors (i.e. persons or firms outside your own firm who have performed part of the work) that you have used on public works projects during the past five (5) years along with a brief description of the work done by each subcontractor. 3. If you intend to sublet any portion of the work, attach the name and address of each subcontractor, equipment to be used by the subcontractor, and whether you will require a bond. However, if you are unable to currently provide a listing, please understand a listing must be provided prior to 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. 4. Attach a listing of equipment you have available to use for the proposed project. 5. Have you entered into contracts or received offers for all materials which substantiate the prices used in preparing your proposal? If not, attach an explanation for the rationale used which would corroborate the prices listed. SECTION III CONTRACTOR'S FINANCIAL STATEMENT Attachment of bidder's financial statement is mandatory. Any bid submitted without said financial statement as required by statute shall thereby be rendered) invalid. The financial statement provided hereunder to the City of South, Bend awarding the contract must be specific enough in detail so that said City of South Bend can make a proper determination of the bidders capability for completing the project if awarded. Version 1/17/2019 Contractor's Bid for Public Works - 3 y41L9 i'4A CITY OF SOUTH BEND MINORITY AND WOMEN BUSINESS ENTERPRISE DIVERSITY - DEVELOPMENT PROGRAM FORM MWBE-2.0 p EVIDENCE OF GOOD FAITH EFFORTS rr�i ,.86i This completed form should be included as part of the Bids documents related to City of South Bend Public Works Projects requiring Good Faith Efforts to obtain MBE/WBE participation. It is the bidder's sole responsibility to verify whether any listed minority or woman business meets the qualifications of a Minority or Women's owned business as defined by the Indiana Department of Administration ("IDOA"). Project Number: 119-004 Date: S," %--! Project Name: 2019 Curb and Sidewalk Construction Bidder: 1,�, ci _................... Contact Person: 4 ........ __- .... .. .___ Telephone: Address: S 3 Y..........�t %� icy City: 3 State: /1 Zip: �� SZ p _... l' Email: Jkct icl e +.!'� 40 Y_...� _...,_.,..�i�e�A Co - ._............... To determine whether a bidder has demonstrated good faith efforts to reach the MBE/WBE utilization goals set forth in the City of South Bend Public Works Project Specifications, the City and its agencies, boards, or commissions, REQUIRE ALL of the following Good Faith Efforts as listed in the table below*: EVIDENCE OF GOOD FAITH EFFORTS ..................:..._....: ...___ .... .......... MBE/WBE LIST(S): The bidder reviewed the City of South Bend's Minority and Women Business Enterprise Diversity Development Program, which uses the IDOA approved list of Minority and Women Owned Business as found on their website (http://www.in.gov/idoa). ACTION (ADVERTISE/CONTACT): In order for your bid to be deemed responsive, the City of South Ben3dequires 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. 2. Advertise 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 MBE/WBE firms. **Bidder must circle or otherwise notate which of the two (2) required actions were performed. GOOD FAITH NEGOTIATIONS: The bidder negotiated in good faith with interested MBE/WBEs, Tk including providing such MBE/WBE's with adequate information about the plans, specifications and other requirements of the subcontract and did not reject MBEM/BEs 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 uk_ MBE/WBEs in order to increase the likelihood of meeting the MBEANBE goals (including breaking down contracts into smaller units to facilitate MBE/WBE participation) CONTRACT RECORDS: The bidder has maintained the following records for each MBE/WBE that has bid on the subcontracting opportunity: V k- 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 MBE/WBE was unqualified to perform the job. *Proper demonstration of Good Faith Effort requires your initials next to all of the above arares. Any omissions shall be considered grounds for rejection of the bid by the Board of Public Works. The City of South Bend reserves the right to request additional information. Version 10/17/2017 Contractor's Bid for Public Works - 5 CITY OF SOUTH BEND )A1r"°r MINORITY AND WOMEN BUSINESS ENTERPRISE DIVERSITY "10 1' DEVELOPMENT PROGRAM,; 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: 119-004 Project Name 01 Curb and Sldie atk Construction Bidder: Total Bid Amount. ,2, 5- MBEIWBE Goal. 0 Page�—of� .......................... ............ --.... _, ...................... ..... _-------- .... Primary Contact Person Scope of Work to be Performed Dollar Amount of Percentage Name 8 Address of MBENVBE (Name/Telephone)of Total p y pace) MBFaIN.. Component Bid/Proposal ---- _ �.„........ Hach scope/schedule a schedule i you need additional s LL"` v _ _ _ 18,4S 6- �I..,cr�st s 7,�- �3y-ia�� r�.t,�A-- J Iq-,- J . Zn r�L�1 d Submitted by: _ s r, (+ 4e N.7 -- ------ Print Name SIg,nat Date Version 10/17/2017 Contractors Bid for Public Works - 4 CITY OF SOUTH BEND`"��'�'�, MINORITY AND WOMEN BUSINESS ENTERPRISE DIVERSITYr DEVELOPMENT PROGRAM FORM MWBE-2.1 M MBE/WBE CONTACTED This completed form should be supplied with Bids that pertain to City of South Bend Public Works Projects requiring contacted MBE/WBE to obtain Good Faith Efforts. It is the bidder's sole responsibility to verify whether any listed minority or woman business meets the qualifications of a Minority or Women's owned business. PAGE ol- OF_ �__ Project Number:-119-004 MBE/WBE Participation Goal Project Name/ 2019 Curb and Sidewalk Construction Bidder: �p a ..° � . �� E6, : (Title) " / (Date) MBENVBE Firm V ' ,� 0 -7-.- Owner or Contact at MBENVBE Firm V Telephone: 5-74i Fax: Email: TYPE OF WORK SOLICITED FOR THIS PROJECT: RESULTS OF CONTACT WITH THE MBENVBE FIRM; MBENVBE Firm Owner or Contact at MBENVBE Firm () , Telephone: S` 7 - 9 p -7 j Fax: Email: TYPE OF WORK SOLICITED FOR THIS PROJECT: ....._........................_.... l .l.........C.. vu............... _._. ._ __......_uuu.___..uu__.._._.................. RESULTS OF CONTACT WITH THE MBE/WBE FIRM: Version 10/1712017 Contractors Bid for Public Works - 6 INDIANA EARTH, INC. 10343 MCKINLEY HWY OSCEOLA, IN 46561 Section 1 Public Projects completed: 1) Northwood High School Phase B — Nappanee, IN $168,900 Spring 2018 2) Excavation & Utility CR 38 — City of Goshen, IN $2,491,277 Spring 2018 3) Utility — Nappanee WWTP, Nappanee, IN $519,020 Summer 2018 4) Northwood High School Athletic Center, Nappanee, IN $1,233,500 Fall 2018 5) Excavation and Utility — Penn High School $219,400 Summer 2018 Public Works in Process: 1) Excavation and Utility — Laporte Intermediate School $1,531,400 Spring 2019 2) Excavation and Utility — Concord High School $451,100 Summer 2019 3) Excavation and Utility — Warsaw High School $612,400 Summer 2019 4) Excavation and Utility — Howard Park $1,923,700 Summer 2020 5) Excavation and Utility — 320 at the Cascade $189,000 Summer 2019 Completed all work awarded to our firm. References of Private Firms 1) Rieth Riley Construction 574-288-8321 2) Gibson Lewis LLC 574-259-8581 3) Larson Danielson 219-362-2127 4) Holladay Group 574-234-2073 5) Robert Henry Const. 574-232-2091 Section 2 Plan of proposed work 1) Pre -construction meeting 2) Mobilization 3) Removals 4) Strip topsoil 5) Establish subgrades 6) Install concrete curb, sidewalks, approaches 7) Install tree's 8) Place topsoil and seed Subcontractors Utilized on Past Projects 1) Hydroseed —Osceola, IN, Hydro seeding 2) HydroTek— Nappanee, IN, Hydro seeding 3) Weaver Boos —South Bend, IN, Compaction Testing 4) Bob's Landscaping —Granger, IN, Sodding 5) New Frontiers Landscaping — I USB West Parking Lot 6) JPR —South Bend, IN, Surveying 7) Rieth Riley —Goshen, IN, Paving S) Martell Electric— IUSB West Parking Lot Subcontractors to Utilize on this Project — Possible subs listed, will determine prior to contract approval 1) Rieth Riley 2) Acorn Landscaping List of our Equipment Owned: 1) 13 Excavators 2) 4 Dozers 3) 3 Dump Trucks 4) 2 Semi Trucks with dump trailers 5) 2 Rollers 6) 5 Loaders 7) 2 Skidsteers We have received pricing for services and materials by potential subcontractors. CITY OF SOUTH BEND, INDIANA CONTRACTOR'S BID FOR PUBLIC 'PORK RESPONSIBLE BIDDER CHECKLIST Project Name 2019 Curb and Sidewalk Construction Project No. 119-004 For Bids Due May 14, 2019 at 9:30am Local Time . I ...._. Contractor Name The City seeks to enhance its ability to identify responsive and responsible bidders on all City public works projects by institution of comprehensive submission requirements in compliance with State law. Quality workmanship, efficient operation, safety, and timely completion of projects requires that all bidders meet certain minimum requirements to be responsive and responsible bidders. THIS FORM MUST BE SUBMITTED WITH YOUR BID. INSTRUCTIONS: If you are a pre -qualified bidder, complete Section I only. If you are not a pre -qualified bidder, complete Section II only. Section II acts as an application for pre -qualification. Submission of Section II will allow the bidder to be considered for pre -qualification for bids with the City of South Bend Department of Public Works. Pre - qualified bidders will then be exempt from a portion of the submission requirements outlined in Section 6- 63 of The Responsible Bidding Ordinance No. 10594-18 (hereinafter, "Responsible Bidding Ordinance") for a period of twelve (12) months. Thereafter, contractors who are pre -qualified must submit a complete application for continuation of "pre - qualified" standing, on a form provided by the City ("Responsible Bidder Checklist (1) Pre -Qualified Bidders") by December 31st 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 PRE -QUALIFIED BIDDER CHECKLIST (a) Acknowledgements: (i) _ By checking this box, I hereby acknowledge that I am a pre -qualified bidder with the City of South Bend and that I have met the pre -qualification requirements within the last twelve (12) months. A copy of my Pre -Qualification verification letter is attached. _ By checking this box, I hereby acknowledge that the City reserves the right to request supplemental information, additional verification of any information provided by me, and may also conduct random inquiries of my current and prior customers. (b) Attachments: (i) _ Indiana Secretary of State's on-line records (ie. Business verification) dated within sixty (60) days of the submission of said document showing that business is in existence, current with the Indiana Secretary of State's Business Entity Report, and eligible for a certificate of good standing. (Not applicable to individuals, sole proprietors or partnerships). Statement on staffing capabilities, including labor sources. This statement indicates and ensures I have sufficient employees on staff to complete the work. It outlines how I intend to meet the staffing needs of the work. Evidence that I am utilizing a surety company which is on the United States Department of Treasury's Listing of Approved Sureties as required in the bid specifications or contract. (iv) List of projects of similar size and scope of work performed in all areas, including the State of Indiana, within the last three (3) years. (v) For every project, submit 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. Version 7/20/2018 General Conditions - 8 PRE -QUALIFICATION CHECKLIST (FOR BIDDERS THAT ARE NOT PRE -QUALIFIED) (a) Acknowledgements: (i) By checking this box, I hereby acknowledge that I am not a pre -qualified bidder with the City of South Bend. By checking this box, I hereby acknowledge that the City reserves the right to request supplemental information, additional verification of any information provided, and may also conduct random inquiries of my current and prior customers. The City reserved the right to utilize all information provided in this submission and all information obtained in inquiries or requests to determine if a bidder is responsive and responsible. Additionally, I acknowledge that all information provided to the City shall be regarded as public records. 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 anytime and shall be furnished upon request. (iv) By checking this box, I hereby acknowledge and ensure that I and all sub- contractors, from whom I have accepted a bid and/or intend to hire to perform work on the public work project, are properly licensed. Furthermore, I acknowledge my understanding that it is my responsibility to ensure that all 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) 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 or partnerships). List ```proprietors identifying all former business names. Any determinations by a court or governmental agency any violations of federal state, or local laws including, but not limited to, violations of contracting or antitrust laws, tax or licensing laws, environmental laws, Occupational Safety and Health Act (OSHA), or federal Davis -Bacon and related Acts, within the preceding five (5) (iv)" " years. Statement about staffing capabilities, including labor sources. This statement indicates and ensures I have sufficient employees on staff to complete the work I am bidding on OR outlines how I intend to meet the staffing needs of the work. (v) Statement that individuals who will perform work on the public work project on my behalf will be properly classified as an employee or as an independent contractor under all applicable state and federal laws and local ordinances. (vi) For every project, submit evidence of participation in apprenticeship and training programs, applicable to the work to be performed on the project, which are approved by and registered with the United States Department of Labor's Office of Apprenticeship, or its successor organization. (vii) Copy of a written plan for employee drug testing that covers all of my employees who will perform work on the public work project and meets or exceeds the requirements set forth in IC 4-13-18-5 or IC 4-13-18-6. (viii) AZ 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) 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) !.. 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. (Print Name Here) BALL .�.°"•®1 (Name of Company) (Address of Company) (City) (State) 5—_ -P (Telephone Number) Version 7/20/2018 General Conditions -10 Building Pre -qualification checklist items: • Indiana Earth has the crew and staff to complete this project. • Those that work on this project will be employees of Indiana Earth or of a hired subcontractor which are under alll applicable state and federal laws and local ordinances. • Apprentice programs are managed through operator and labor unions that we are signatory with. • Drug testing is accomplished through the unions of operators, laborers and teamsters, for our employees. • Indiana Earths surety company is approved. • Projects similar to this one. o Indiana Department of Corrections o County Road 38 o Nappanee Waste Water Treatment Plant o St Marys College o Northwood High School o Warsaw High School o Laporte Intermediate School o Concord High school o Penn High School o Portage, IN Police Station o Discount Tire of Warsaw o Pierston School o Bell Tire of South Bend o Bell Tire of 'Mishawaka o B and B manufacturing o Central Park in Mishawaka 10343 McKinley Hwy. • Osceola, IN 46561 • (574) 674-6488 • FAX (574) 674-6480 'BUSIMS INF, ORANIATION' COWSON� Business Name: MJANAEARTH, INC. Business ID: 1990011137 Entity L'ype: Domestic For -Profit Corporation Business Status: Active Creation Date: 03/22/1990 Inactive Date: Principal Office Address: 10343 MCWLEY HWY., OSCEOLA, IN, 46561 - 9756, USA Expiration Date: Perpetual Anisdiction of Formation: Indiana Business Entity Report Due 03/31/2020 Date: Yew Due: Tide Name Address President MARK L OSLER 10343 McKinley Hwy., Osceola, IN, 46561, USA Type: Individual Name: MARK OSLER Address: 10343 MCKINLEY HWY., OSCEOLA, IN, 46561 - 9756, USA CITY OF SOUTH BEND, INDIANA CONTRACTOR'S BID FOR PUBLIC WORK CHECKLIST FOR BIDDERS Project Name 2019 Curb and Sidewalk Construction Project No. 119-004 For Bids Due May 14, 20.19 at 9:30am Local Time From time to time the South Bend Board of Public Works finds it necessary to reject a bid because it does not comply with statutory requirements. In preparing your bid, please use the following checklist in order to make sure that your bid is done in the proper manner. Proper bid security included. The bidder has the option of providing either a Certified Check A or Bid Bond. Bid prepared on the City of South Bend Contractor's Bid for Public Work Form, completely w,✓ executed. Contractor's Non -Collusion and Non -Debarment Affidavit, Certification Regarding Investments with Iran, Employment Eligibility Verification, Non -Discrimination Commitment, and ✓ Certification of use of United States Steel Products or Foundry Products. Proof of MBENVBE Participation Goal Form [MWBE-1.0]. If minimum participation goal is not met, also provide Evidence of Good Faith Efforts Form [MWBE-2.0] and MBE/WBE Contacted Form [MWBE-2.1]. Acknowledge Receipt of ) Addendum(s) included with the bid.. All required additional information is included with the bid. Proposal statements and other affidavits all signed by the proper party with name either „✓ printed or typed underneath signature. 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 Date: By Authorized Representative: Signature: Print Name & Title: k",-e rrl i5 e--� & , vim , VLk Version 1l17l2019 Contractor's Bid for Public Works -1